The 2019 newfound Coronavirus (COVID-19) still remains as a threatening disease of which new cases are being reported daily from all over the world. The present study aimed at estimating the related rates of morbidity, growth, and mortality for COVID-19 over a three-month period starting from Feb, 19, 2020 to May 18, 2020 in Iran. In addition, it revealed the effect of the mean age, changes in weather temperature and country’s executive policies including social distancing, restrictions on travel, closing public places, shops and educational centers. We have developed a combined neural network to estimate basic reproduction number, growth, and mortality rates of COVID-19. Required data was obtained from daily reports of World Health Organization (WHO), Iran Meteorological Organization (IRIMO) and the Statistics Center of Iran. The technique used in the study encompassed the use of Artificial Neural Network (ANN) combined with Swarm Optimization (PSO) and Bus Transportation Algorithms (BTA). The results of the present study showed that the related mortality rate of COVID-19 is in the range of [0.1], and the point 0.275 as the mortality rate provided the best results in terms of the total training and test squared errors of the network. Furthermore, the value of basic reproduction number for ANN-BTA and ANN-PSO was 1.045 and 1.065, respectively. In the present study, regarding the closest number to the regression line (0.275), the number of patients was equal to 2566200 cases (with and without clinical symptoms) and the growth rate based on arithmetic means was estimated to be 1.0411 and 1.06911, respectively. Reviewing the growth and mortality rates over the course of 90 days, after 45 days of first case detection, the highest increase in mortality rate was reported 158 cases. Also, the highest growth rate was related to the eighth and the eighteenth days after the first case report (2.33). In the present study, the weather variant in relationship to the basic reproduction number and mortality rate was estimated ineffective. In addition, the role of quarantine policies implemented by the Iranian government was estimated to be insignificant concerning the mortality rate. However, the age range was an ifluential factor in mortality rate. Finally, the method proposed in the present study cofirmed the role of the mean age of the country in the mortality rate related to COVID-19 patients at the time of research conduction. The results indicated that if sever quarantine restrictions are not applied and Iranian government does not impose effective interventions, about 60% to 70% of the population (it means around 49 to 58 million people) would be afflicted by COVID-19 during June to September 2021.

Aim: Within the context of increasing mental distress noted since the beginning of the COVID19 pandemic, the study aims at analysing the relationship between mental health, vaccine distrust and vaccine hesitancy in South Africa. Subject and methods: The study uses nationally representative panel data of 3241 individuals interviewed prior to and during the COVID19 pandemic. The study uses a range of regression techniques including logit, mediation and gradient-boosted causal mediation models to identify the causal relationship while accounting for selection bias. Results: The results of multivariate logit regression reveal that vaccine distrust is the most important predictor of vaccine hesitancy [Coeff: 3.420, CI 3.122, 3.717]. Mental distress is not found to be a significant driver in a fully specified logit model, pointing to the need to analyse the pathways through which mental distress impacts vaccine hesitancy. The mediation regression undertaken for this purpose finds that the mental distress has a positive and significant association with vaccine distrust [Coeff: 0.027, CI: 0.0029, 0.052]. The increased vaccine distrust in turn results in increased vaccine hesitancy [Coeff: 0.661, CI: 0.611, 0.711]. The results of mediation regression therefore indicate strong and significant mediation effects, whereby mental health effects vaccine hesitancy through the mediating variable of vaccine distrust. These results are robust to the gradient boosted causal mediation model which establishes strong and significant indirect effects [Coeff: 0.015, CI: 0.01, 0.019], whereby mental health effects vaccine hesitancy through the mediating variable of vaccine distrust. Conclusion: The study concludes that mental health impacts on vaccine intention through the mediating role of vaccine distrust. The findings indicate that individuals at high risk of depression are more concerned regarding the safety of vaccines, which in turn feeds into vaccine hesitancy. Therefore, depressive symptoms impact on vaccine hesitancy through the mediating factor of vaccine distrust.

Introduction: Coronavirus 2019 (COVID-19) is known to affect the central nervous system. Neurologic morbidity associated with COVID-19 is commonly attributed to sequelae of some combination of thrombotic and inflammatory processes. The aim of this retrospective observational study was to evaluate neuroimaging findings in hospitalized COVID-19 patients with neurological manifestations in cancer versus non-cancer patients, and in patients with versus without ventilatory support (with ventilatory support defined as including patients with intubation and noninvasive ventilation). Cancer patients are frequently in an immunocompromised or prothrombotic state with side effects from chemotherapy and radiation that may cause neurological issues and increase vulnerability to systemic illness. We wanted to determine whether neurological and/or neuroimaging findings differed between patients with and without cancer. Methods: Eighty adults (44 male, 36 female, 64.5 ±14 years) hospitalized in the Mount Sinai Health System in New York City between March 2020 and April 2021 with reverse-transcriptase polymerase chain reaction-confirmed COVID-19 underwent magnetic resonance imaging (MRI) during their admissions. The cohort consisted of four equal subgroups based on cancer and ventilatory support status. Clinical and imaging data were acquired and analyzed. Results: Neuroimaging findings included non-ischemic parenchymal T2/FLAIR signal hyperintensities (36.3%), acute/subacute infarcts (26.3%), chronic infarcts (25.0%), microhemorrhages (23.8%), chronic macrohemorrhages (10.0%), acute macrohemorrhages (7.5%), and encephalitis-like findings (7.5%). There were no significant differences in neuroimaging findings between cancer and non-cancer subgroups. Clinical neurological manifestations varied. The most common was encephalopathy (77.5%), followed by impaired responsiveness/coma (38.8%) and stroke (26.3%). There were significant differences between patients with versus without ventilatory support. Encephalopathy and impaired responsiveness/coma were more prevalent in patients with ventilatory support (p = 0.02). Focal weakness was more frequently seen in patients without ventilatory support (p = 0.01). Discussion: This study suggests COVID-19 is associated with neurological manifestations that may be visible with brain imaging techniques such as MRI. In our COVID-19 cohort, there was no association between cancer status and neuroimaging findings. Future studies might include more prospectively enrolled systematically characterized patients, allowing for more rigorous statistical analysis.

Nigeria has the second largest share of undiagnosed TB cases in the world and a large private health sector estimated to be the point of initial care-seeking for 67% of TB patients. There is evidence that COVID-19 restrictions disrupted private healthcare provision, but insufficient data on how private healthcare provision changed as a result of the pandemic. We conducted qualitative interviews and a survey to assess the impact of the pandemic, and government response on private healthcare provision, and the disruptions providers experienced, particularly for TB services. Using mixed methods, we targeted policymakers, and a network of clinical facilities, laboratories, community pharmacies, and medicine vendors in Kano and Lagos, Nigeria. We interviewed 11 policymakers, surveyed participants in 2,412 private facilities. Most (n = 1,676, 70%) facilities remained open during the initial lockdown period, and most (n = 1,667, 69%) offered TB screening. TB notifications dipped during the lockdown periods but quickly recovered. Clinical facilities reported disruptions in availability of medical supplies, staff, required renovations, patient volume and income. Few private providers (n = 119, 11% in Kano; n = 323, 25% in Lagos) offered any COVID-19 screening up to the time of the survey, as these were only available in designated facilities. These findings aligned with the interviews as policymakers reported a gradual return to pre-COVID services after initial disruptions and diversion of resources to the pandemic response. Our results show that COVID-19 and control measures had a temporary impact on private sector TB care. Although some facilities saw decreases in TB notifications, private facilities continued to provide care for individuals with TB who otherwise might have been unable to seek care in the public sector. Our findings highlight resilience in the private sector as they recovered fairly quickly from pandemic-related disruptions, and the important role private providers can play in supporting TB control efforts.

The presence of potentially toxic metal(loid)s (As, Pb, Cd, Cr, Mn, Fe, Zn, Cu, Ni, Mo and Co) in 120 white (polished) rice grains (Oryza sativa; 2017 or earlier crop) purchased from farmers in the five most agriculturally active townships near Yangon in the eastern edge on Ayeyarwady Delta was determined by triple quadrupole inductively coupled plasma mass spectrometry (ICP-QQQ). Their total-As and Ni concentrations (0.16 mg/kg, 0.39 mg/kg) were around the worldwide average literature values from a heavy metal non-contaminated area of intermediate to acidic (non-mafic) composition. Their Pb, Cd, and Cr mean concentrations (0.010, 0.0056, and 0.056 mg/kg, respectively) were lower than the maximum allowable levels by over one magnitude, reaching the concentration ranges comparable to the lowest level in the literature values. This study’s natural background levels were explained by a negligible influence of human, mining and industrial activities in this area, and probably genotype effect, which remains to be examined by the associated paddy soil analysis. Health risks associated with rice consumption (ca. 0.5 kg/day) by the inhabitants were estimated, assuming that inorganic arsenic was 30% of the total. Arsenic was the main contributor (30%) to the total value of the non-cancer risk (HI) of each element, which was 4.5 times the reference value (< 1), followed by Mn, Zn, Cu, Mo, Co and Ni (15–7%) and Pb, Cd, Cr and Fe (below 4%). The total cancer risk (TCR) for each element was around 17 times higher than the upper limit of cancer risk for an environmental carcinogen (< 0.0001): Nickel accounts for two-thirds of the contribution (66%), followed by Cd (16%) and As (13%). This study suggests that consumers of Yangon rice from paddy fields without groundwater irrigation may need to be concerned about the potential risk of Ni intake besides arsenic.

This paper contributes to the literature on how diversity impacts groups by exploring how communication mediates the ability of diverse individuals to work together. To do so we incorporate a communication channel into a representative model of problem-solving by teams of diverse agents that provides the foundations for one of the most widely cited analytical results in the literature on diversity and team performance: the “Diversity Trumps Ability Theorem”. We extend the model to account for the fact that communication between agents is a necessary feature of team problem-solving, and we introduce the possibility that this communication occurs with error, and that this error might sometimes be correlated with how different agents are from one another. Accounting for communication does not give us reason to reject the claim associated with the theorem, that functionally diverse teams tend to outperform more homogeneous teams (even when the homogeneous teams are comprised of individuals with more task relevant expertise). However, incorporating communication into our model clarifies the role that four factors play in moderating the extent to which teams capture the benefits of functional diversity: i) the complexity of the problem, ii) the number of available approaches to solving the problem, iii) the ways of encoding or conceptualizing a problem, and iv) institutional characteristics, such as how teams work together. Specifically, we find that whether (and to what extent) teams capture the benefits of functional diversity depends on how these four factors interact with one another. Particularly important is the role institutional dynamics (like search methods) play in moderating or amplifying interpersonal frictions (like miscommunication), and notably we find that institutions that work in one setting can be counterproductive in other settings.

Background: Currently, there is a growing concern about the disease burden of child asthma particularly due to high body mass index (BMI). The prevalence and disease burden of asthma differ between developing and developed countries, with implications on disease intervention. Therefore, we provide a comparative analysis of childhood asthma between China and the United States of America (USA). Methods: Using the Global Burden of Disease (GBD) 2019 data, we estimated and compared the age-standardized prevalence, disability-adjusted life years (DALYs), years of life lost (YLLs), years of lost due to disability (YLDs), DALYs due to high BMI of asthma in children aged 1–14 years in China and the USA. Joinpoint regression analysis was applied to assess changes in temporal trends. Results: DALYs due to high BMI and the ratio of DALYs to DALYs due to high BMI in children with asthma showed a significant upward trend in both countries and were higher in males than in females. Almost all epidemiological indicators of asthma showed a hump of curve from 2014 to 2019, and peaked in 2017. There was a decreasing trend of YLLs for asthma in children both countries, while China has a saliently greater decreasing trend. Conclusion: The disease burden caused by high BMI of childhood asthma was on the rise in children with asthma in both China and the USA. High BMI needs to be taken more into account in the development of future policies for the prevention, control, and treatment of childhood asthma. However, the increasing trend of this disease burden in American children was significantly lower than that in Chinese children. We recommend learning from the American government to impose a high-calorie tax, increase physical exercise facilities, and provide better health care policies.

Background: Adhesive capsulitis or contracted shoulder, known as frozen shoulder, is a persistent painful condition that may last for more than three months. It is a common disease-causing morbidity that causes pain and loss of shoulder range of motion. Physical therapy is advocated for the restoration of a pain-free state and normal use of the upper extremity, along with other interventions. Purpose: This study aimed to explore the level of current clinical practice for managing chronic contracted frozen shoulder (CCFS) among physiotherapy professionals in the United Arab Emirates (UAE) compared to well–established evidence-based practices, and to identify the most common therapy practiced in UAE to manage CCFS. Method: This study was based on a cross-sectional quantitative analysis using an adapted questionnaire. The main themes of questions were the presence of a special interest in CCFS, management options, symptoms, diagnosis, referral, and best physiotherapy intervention recommendations. The results were analyzed using simple descriptive analyses, such as frequency, mean, and percentage of total responses; additionally, thematic and content analyses were performed for open-ended questions. Results: Overall, 101 physiotherapy professionals participated in the survey: 62% female and 38% male; 59% were bachelors- and 36% masters-degree holders, respectively. In the closed ended question regarding the interest in CCFS, male physiotherapists (PTs) were more interested than females (82% vs. 68%). For the most common indication of CCFS, 76% of the participants selected “Limitation of movement" as the main indication. However, only 42% confirmed the presence of clinical protocols in their employment setting. In their opinion, the most effective therapies were patient education, superficial heat or cold, manual joint mobilization, and sustained stretching exercises. Conclusion: A well-established professional competence exists among physiotherapists in the UAE to manage and treat patients with CCFS. The findings showed sufficient standard, theoretical, and practical knowledge among the study groups.

Purpose: To examine the association between the presence and severity of migraine and development of primary open-angle glaucoma (POAG) using a nationwide population-based longitudinal cohort data. Methods: Data were retrieved from the Korean National Health Insurance Service for 2,716,562 individuals aged ≥ 40 years and assessed for the development of POAG from 2009 through 2018. Subjects were classified into the following 3 groups: healthy control subjects, subjects with mild migraine, and those with severe migraine. Hazard ratios (HR) of glaucoma development were calculated for each group. Subgroup analyses of subjects stratified by age, sex, lifestyle factors (smoking, drinking, and body mass index (BMI)), and comorbidities (diabetes, hypertension, and dyslipidemia). Results: During the 9-year follow-up period, the incidence rate of POAG per 1000 person-years was 2.41 and 3.25 in subjects without and with migraine, respectively. Among the migraine group, the incidence rate was 3.14 and 3.89 in mild and severe subgroups, respectively. The HR was 1.355 (95% CI, 1.300–1.412) and 1.188 (95% CI, 1.140–1.239) before and after adjusting for potential confounding factors in the migraine group per se. Regarding the severity of migraine, the adjusted HRs were 1.169 (95% CI, 1.117–1.224) in the mild migraine group, and 1.285 (95% CI, 1.166–1.415) in the severe migraine group compared to the control group. The results were consistent in subgroup analyses after stratifying by age, sex, lifestyle factors, and comorbidities. Conclusions: Migraine is associated with increased risk of POAG development. Furthermore, chronic and severe migraine is associated with greater risk of POAG development.

Thermodynamic stability is a crucial fitness constraint in protein evolution and is a central factor in shaping the sequence landscapes of proteins. The correlation between stability and molecular fitness depends on the mechanism that relates the biophysical property with biological function. In the simplest case, stability and fitness are related by the amount of folded protein. However, when proteins are toxic in the unfolded state, the fitness function shifts, resulting in higher stability under mutation-selection balance. Likewise, a higher population size results in a similar change in protein stability, as it magnifies the effect of the selection pressure in evolutionary dynamics. This study investigates how such factors affect the evolution of protein stability, site-specific mutation rates, and residue-residue covariation. To simulate evolutionary trajectories with realistic modeling of protein energetics, we develop an all-atom simulator of protein evolution, RosettaEvolve. By evolving proteins under different fitness functions, we can study how the fitness function affects the distribution of proposed and accepted mutations, site-specific rates, and the prevalence of correlated amino acid substitutions. We demonstrate that fitness pressure affects the proposal distribution of mutational effects, that changes in stability can largely explain variations in site-specific substitution rates in evolutionary trajectories, and that increased fitness pressure results in a stronger covariation signal. Our results give mechanistic insight into the evolutionary consequences of variation in protein stability and provide a basis to rationalize the strong covariation signal observed in natural sequence alignments. Author summary: Modern-day proteins are the result of the process of evolution. The fate of random substitutions at the nucleotide level is dependent on the fitness of the new gene variant. One of the strongest fitness pressures shaping the sequences of protein is thermodynamic stability; proteins must typically be stable to carry out its function and misfolded proteins can be toxic. To understand the importance of thermodynamic stability in protein evolution and to what extent it can explain natural sequence variation we have developed a method for simulating protein evolution using a three-dimensional structure and structure-based stability calculations. In the simulations, the strength of selection can be varied, and complete phylogenetic trees of a protein family can be generated. Using these simulations, we demonstrate how mutation rates at individual sites in a protein are coupled to the overall stability of the protein, and how the spectrum of accepted mutations is shaped by stability, and how strong interactions between residues in a protein can result in sequence covariation.