Don't just look at the surface: When mucosa tells more than the skin

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Resilience of mobility network to dynamic population response across COVID-19 interventions: Evidences from Chile

The COVID-19 pandemic highlighted the importance of non-traditional data sources, such as mobile phone data, to inform effective public health interventions and monitor adherence to such measures. Previous studies showed how socioeconomic characteristics shaped population response during restrictions and how repeated interventions eroded adherence over time. Less is known about how different population strata changed their response to repeated interventions and how this impacted the resulting mobility network. We study population response during the first and second infection waves of the COVID-19 pandemic in Chile and Spain. Via spatial lag and regression models, we investigate the adherence to mobility interventions at the municipality level in Chile, highlighting the significant role of wealth, labor structure, COVID-19 incidence, and network metrics characterizing business-as-usual municipality connectivity in shaping mobility changes during the two waves. We assess network structural similarities in the two periods by defining mobility hotspots and traveling probabilities in the two countries. As a proof of concept, we simulate and compare outcomes of an epidemic diffusion occurring in the two waves. While differences exist between factors associated with mobility reduction across waves in Chile, underscoring the dynamic nature of population response, our analysis reveals the resilience of the mobility network across the two waves. We test the robustness of our findings recovering similar results for Spain. Finally, epidemic modeling suggests that historical mobility data from past waves can be leveraged to inform future disease spatial invasion models in repeated interventions. This study highlights the value of historical mobile phone data for building pandemic preparedness and lessens the need for real-time data streams for risk assessment and outbreak response. Our work provides valuable insights into the complex interplay of factors driving mobility across repeated interventions, aiding in developing targeted mitigation strategies

How Covid-19 changed the epidemiology of febrile urinary tract infections in children in the emergency department during the first outbreak

Background: The first Covid-19 pandemic affected the epidemiology of several diseases. A general reduction in the emergency department (ED) accesses was observed during this period, both in adult and pediatric contexts. Methods: This retrospective study was conducted on the behalf of the Italian Society of Pediatric Nephrology (SINePe) in 17 Italian pediatric EDs in March and April 2020, comparing them with data from the same periods in 2018 and 2019. The total number of pediatric (age 0–18 years) ED visits, the number of febrile urinary tract infection (UTI) diagnoses, and clinical and laboratory parameters were retrospectively collected. Results: The total number of febrile UTI diagnoses was 339 (73 in 2020, 140 in 2019, and 126 in 2018). During the first Covid-19 pandemic, the total number of ED visits decreased by 75.1%, the total number of febrile UTI diagnoses by 45.1%, with an increase in the UTI diagnosis rate (+ 121.7%). The data collected revealed an increased rate of patients with two or more days of fever before admission (p = 0.02), a significant increase in hospitalization rate (+ 17.5%, p = 0.008) and also in values of C reactive protein (CRP) (p = 0.006). In 2020, intravenous antibiotics use was significantly higher than in 2018 and 2019 (+ 15%, p = 0.025). Urine cultures showed higher Pseudomonas aeruginosa and Enterococcus faecalis percentages and lower rates of Escherichia coli (p = 0.02). Conclusions: The first wave of the Covid-19 pandemic had an essential impact on managing febrile UTIs in the ED, causing an absolute reduction of cases referring to the ED but with higher clinical severity. Children with febrile UTI were more severely ill than the previous two years, probably due to delayed access caused by the fear of potential hospital-acquired Sars-Cov-2 infection. The possible increase in consequent kidney scarring in this population should be considered

Nationwide survey on the management of pediatric pharyngitis in Italian emergency units

Background: Acute pharyngitis is a frequent reason for primary care or emergency unit visits in children. Most available data on pharyngitis management come from primary care studies that demonstrate an underuse of microbiological tests, a tendency to over-prescribe antibiotics and a risk of antimicrobial resistance increase. However, a comprehensive understanding of acute pharyngitis management in emergency units is lacking. This study aimed to investigate the frequency of rapid antigen test use to diagnose acute pharyngitis, as well as other diagnostic approaches, the therapeutic attitude, and follow-up of children with this condition in the emergency units. Methods: A multicentric national study was conducted in Italian emergency departments between April and June 2022. Results: A total of 107 out of 131 invited units (response rate 82%), participated in the survey. The results showed that half of the units use a scoring system to diagnose pharyngitis, with the McIsaac score being the most commonly used. Most emergency units (56%) were not provided with a rapid antigen diagnostic test by their hospital, but the test was more frequently available in units visiting more than 10,000 children yearly (57% vs 33%, respectively, p = 0.02). Almost half (47%) of the units prescribe antibiotics in children with pharyngitis despite the lack of microbiologically confirmed cases of Group A β-hemolytic streptococcus. Finally, about 25% of units prescribe amoxicillin-clavulanic acid to treat Group A β-hemolytic streptococcus pharyngitis. Conclusions: The study sheds light on the approach to pharyngitis in emergency units, providing valuable information to improve the appropriate management of acute pharyngitis in this setting. The routinary provision of rapid antigen tests in the hospitals could enhance the diagnostic and therapeutic approach to pharyngitis

A robust and energy-conserving model of freezing variably-saturated soil

Phenomena involving frozen soil or rock are important in many natural systems and, as a consequence, there is a great interest in the modeling of their behavior. Few models exist that describe this process for both saturated and unsaturated soil and in conditions of freezing and thawing, as the energy equation shows strongly non-linear characteristics and is often difficult to handle with normal methods of iterative integration. Therefore in this paper we propose a method for solving the energy equation in freezing soil. The solver is linked with the solution of Richards equation, and is able to approximate water movement in unsaturated soils and near the liquid-solid phase transition. A globally-convergent Newton method has been implemented to achieve robust convergence of this scheme. The method is tested by comparison with an analytical solution to the Stefan problem and by comparison with experimental data derived from the literature

GEOtop 2.0: simulating the combined energy and water balance at and below the land surface accounting for soil freezing, snow cover and terrain effects

Abstract. GEOtop is a small-scale grid-based simulator that represents the heat and water budgets at and below the soil surface. It represents the energy exchange with the atmosphere, considering the radiative and turbulent fluxes, and describes the three-dimensional subsurface water flow. Furthermore, it reproduces the highly non-linear interaction of the water and energy balance during soil freezing and thawing, and describes the temporal evolution of water and energy budgets in the snow cover and their effect on soil temperature. Here, we describe the core components of GEOtop 2.0 and demonstrate its functioning. Based on a synthetic simulation, we show that the interaction of processes represented in GEOtop 2.0 can result in phenomena that are significant and relevant for applications involving permafrost and seasonally-frozen soils, both in high altitude and latitude regions. </jats:p

GEOtop 2.0: simulating the combined energy and water balance at and below the land surface accounting for soil freezing, snow cover and terrain effects

GEOtop is a fine-scale grid-based simulator that represents the heat and water budgets at and below the soil surface. It describes the three-dimensional water flow in the soil and the energy exchange with the atmosphere, considering the radiative and turbulent fluxes. Furthermore, it reproduces the highly non-linear interactions between the water and energy balance during soil freezing and thawing, and simulates the temporal evolution of the water and energy budgets in the snow cover and their effect on soil temperature. Here, we present the core components of GEOtop 2.0 and demonstrate its functioning. Based on a synthetic simulation, we show that the interaction of processes represented in GEOtop 2.0 can result in phenomena that are significant and relevant for applications involving permafrost and seasonally frozen soils, both in high altitude and latitude regions