Exploring the Usefulness of Downscaling Free Forecasts from the Warn-on-Forecast System

The National Severe Storms Lab (NSSL) Warn-on-Forecast System (WoFS) is an experimental real-time rapidly-updating convection-allowing ensemble that provides probabilistic short-term thunderstorm forecasts. This study evaluates the impacts of reducing the forecast model horizontal grid spacing Δx from 3 km to 1.5 km on the WoFS deterministic and probabilistic forecast skill, using eleven case days selected from the 2020 NOAA Hazardous Weather Testbed (HWT) Spring Forecasting Experiment (SFE). Verification methods include (i) subjective forecaster impressions; (ii) a deterministic object-based technique that identifies forecast reflectivity and rotation track storm objects as contiguous local maxima in the composite reflectivity and updraft helicity fields, respectively, and matches them to observed storm objects; and (iii) a recently developed algorithm that matches observed mesocyclones to mesocyclone probability swath objects constructed from the full ensemble of rotation track objects. Reducing Δx fails to systematically improve deterministic skill in forecasting reflectivity object occurrence, as measured by critical success index (CSIDET), a metric that incorporates both probability of detection (PODDET) and false alarm ratio (FARDET). However, compared to the Δx = 3 km configuration, the Δx = 1.5 km WoFS shows improved mid-level mesocyclone detection, as evidenced by its statistically significant (i) higher CSIDET for deterministic mid-level rotation track objects and (ii) higher normalized area under the performance diagram curve (NAUPDC) score for probability swath objects. Comparison between Δx = 3 km and Δx = 1.5 km reflectivity object properties reveals that the latter have 30% stronger mean updraft speeds, 17% stronger median 80-m winds, 67% larger median hail diameter, and 28% higher median near-storm-maximum 0-3 km storm-relative helicity.

Clinical Characteristics, Diagnosis, Treatment, and Mortality Rate of TB/COVID-19 Coinfectetd Patients: A Systematic Review

Introduction: Novel coronavirus (COVID-19) and tuberculosis (TB) are the newest and one of the oldest global threats, respectively. In the COVID-19 era, due to the health system's focus on the COVID-19 epidemic, the national TB control program received less attention, leading to a worsening of the global TB epidemic. In this study, we will review the characteristics of TB patients coinfected with COVID-19.Material and Methods: Using Scopus, PubMed/Medline, Embase, and Web of Science databases, a systematic search was performed. Case reports and case series on TB/COVID-19 coinfection published from January 1, 2019 to February 24, 2021 were collected. There were no limitations regarding publication language.Results: Eleven case series and 20 case reports were identified from 18 countries, with the majority them being from India (N = 6) and China (N = 4). Overall, 146 patients (114 men and 32 women) coinfected with TB and COVID-19 enrolled. Smoking (15.1%), diabetes (14.4%), and hypertension (8.9%) were the most frequent comorbidities among these patients. The COVID-19 patients with TB mainly suffered fever (78.8%), cough (63.7%), and respiratory distress (22.6%). Hydroxychloroquine (64.0%) and lopinavir/ritonavir (39.5%) were the most common treatments for them. The mortality rate was 13.0% and the rate of discharged patients was 87.0%.Conclusion: Global prevalence of COVID-19-related deaths is 6.6%. Our results showed that 13.0% of patients with TB/COVID-19 died. Thus, this study indicated that coinfection of TB and COVID-19 can increase the mortality. The respiratory symptoms of TB and COVID-19 are very similar, and this causes them to be misdiagnosed. In addition, TB is sometimes diagnosed later than COVID-19 and the severity of the disease worsens, especially in patients with underlying conditions. Therefore, patients with TB should be screened regularly in the COVID-19 era to prevent the spread of the TB/COVID-19 coinfection.

Integrating Corporate Social Responsibility into Corporate Strategy: The Role of Formal Tools

This paper contributes to the literature debate on the role that formal tools used in the management of CSR activities can play in the integration of CSR into corporate strategy. In particular, the purpose of this research is two-fold: firstly, to investigate if a high degree of formalisation of CSR activities is needed to reach a high degree of integration of CSR into corporate strategy; secondly, to understand what roles CSR formal tools play in this integration process. In order to answer these research questions, eleven case studies of large multinational companies operating in Italy were developed. The results of the empirical analysis show that a high degree of integration is often coupled with intensive use of formalization, with some interesting exceptions. This result can be explained by the active role that almost all CSR formalisation elements play in the integration process of CSR in the overall corporate strategy.

Clinical Characteristics And Outcomes of 16 Cases With COVID19 and Mucormycosis: Experience From A Tertiary Care Center In India and Review of Literature

Background-The sharp uptick in the cases of mucormycosis in the background of the COVID19 pandemic is a cause of concern and the reasons and it’s impact remains to be seen. We studied the clinical characteristics in patients with mucormycosis and COVID19 co-infection and performed a literature review.Methods-This retrospective study was conducted at tertiary centre in India. All patients admitted with COVID19 and mucormycosis were included, clinical details were obtained from hospital records. We did review of literatures using the terms “SARS-CoV2” OR “COVID19” AND “Mucormycosis” AND “co-infection” on Pubmed published before February 20, 2021.Results-Sixteen cases (M:F–13:3), mean age 46·5 years (24-75years), were included. Fourteen had known risk factors for mucormycosis, the most common being diabetes mellitus. Most patients (n=14) were symptomatic with mucormycosis before diagnosis of COVID19. There was delay in surgery by 22.5 days (IQR–>17.75–29.5), pending SARS-CoV-2 RT-PCR negativity. There were six deaths in this cohort, unrelated to the COVID19 severity. The literature review revealed eleven case reports on co-infection. Patients who had developed mucormycosis were found to have history of mechanical ventilation.Conclusion-The apparent increase in the incidence of mucormycosis may be due to decompensation of underlying comorbidities (decreased access to healthcare), and increased use of immunosuppressants in COVID19. Patients with co-infection were noted to have poorer outcomes.

Pathological Nipple discharge: a comparison between breast ultrasound and mammography

Background:Nipple discharge is a relatively common complaint of females in reproductive age and after menopause. Objectives: The aim of this stud was to compare the radiological findings of mammography and ultrasound in women with pathological nipple discharge of different pathology. Methods: mammography and ultrasound was done for a total of 50 patients attending the National center of Early detection of Breast cancer with pathological nipple discharge. Ultrasound guided FNA was performed for all cases, and histopathology was available for eleven case. Results: ultrasound was able to provide clue of possible underlying cause for all pathological nipple discharge whereas mammography was negative in 54%. Ultrasound was more sensitive in diagnosing malignant breast lesions associated with pathological nipple discharge (85.7%) but less specific (88.3%) as compared with mammography which had (71.4%) sensitivity and (90.6%) specificity. Negative predictive value of ultrasound was 97.4% , mammography was 95.1% and of non-bloody nipple discharge was 94%. Conclusion: Ultrasound is essential to complete pathological nipple discharge workup, particularly when mammography is normal, to rule out the possibility of neoplastic changes and to provide clues for nonneoplastic etiology that may guide the management.

The Role of Leakage and Warning Behaviors

This chapter considers ways to detect mass shootings before they occur. It focuses on the role of leakage in prevention, whereby the communication of an intention to do harm can be used to assess the nature and viability of a mass shooting occurring. Eleven case studies of mass shootings are used to assess leakage and other warning signs displayed prior to these attacks. Documented are possible types of leakages, audiences for leakages, ways leakages were communicated, and other types of warning behaviors. Findings from interviews with threat assessment experts are also discussed in relation to the role leakage plays. It is hoped this chapter will go some way to informing risk and threat assessment procedures, which will be discussed in more detail in the subsequent chapters.

Synthesis: Conception, Approaches and Strategies for Transformative Change

This chapter synthesises major findings from the eleven case studies from different countries across the world (i.e. Kenya and Madagascar from Africa; Chinese Taipei, India, Nepal and the Philippines from Asia; Italy, Spain and UK from Europe; Antigua and Barbuda and Colombia from Latin America) concerning SEPLS management in relation to transformative change. It distils key messages in regard to how to understand, assess and take action on transformative change. Implications for science, policy and practice, as well as interfaces between them, are drawn out to address the following questions: (1) what is transformative change? (2) how do we know if we are moving towards a sustainable society? and (3) what are challenges, opportunities and “seeds of change” in the SEPLS context to bring about transformative change? The chapter concludes with five common principles identified across the case studies, while revising the notion of transformative change to reconceptualise it as a radical change that is built on niche innovations of local initiatives and can be fostered through adaptive co-management in the SEPLS context.

Ethics

The practice of medicine is an intrinsically ethical endeavor because its fundamental goal is health, a good necessary for and integral to human flourishing. This goal also helps define and identify what counts as ethical behavior in the practice of medicine. Fundamentally, actions that promote the possibility of health are generally to be accounted as ethically good actions. Conversely, those that tend to frustrate or destroy the possibility of health are to be accounted as ethically bad. In addition to having an identity-defining goal, clinical medicine also has a nature or structure proper to it. That structure is relational. The authentic and effective practice of medicine requires a relationship of deep mutual trust between the physician and the physician’s patient and the patient’s family. Therefore, a commitment to and an ability to create and sustain such a relationship is a legitimate moral expectation of a physician and is the source of many of the physician’s ethical responsibilities. In the eleven case studies that follow, common ethical challenges that pediatricians might reasonably expect to encounter in their practice are explored. In each case, it is recommended that the pediatrician adopt the course of action that is most consistent with the nature and goal of medicine understood as a healing profession rooted in and requiring a relationship of mutual trust.