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Abstract The paper focuses on crisis responses and resilience within hospitals. The study is based on structured expert interviews with medical directors in selected hospital departments in two of the five regions of Denmark and primary care physicians in the same regions. We investigate stage 3 (Shock impact and management) and stage 4 (Recovery and learning) within hospital organizations using Denmark as case country, and we pay particular attention to issues of “organisational learning”, “purchasing flexibility and reallocation of funding”, “distribution of human and physical resources” and “motivated and well-supported workforce”. Particular attention is paid to care for patients with chronic care needs and lessons for the long-term resilience building in the health system. The study highlights strategic choices and lessons for the long-term resilience within hospitals. It demonstrates, how the initial strategy of organizing specific COVID-19 response units was abandoned relatively early, as it appeared more efficient to integrate COVID-19 patients in the regular specialized department structure. Emergency wards experienced increasing pressure during the pandemic as primary care clinics were referring (too) many patients suspected of COVID-19. This raises questions about capacity and relations between primary and specialized care in crisis situations. Management of human resources is crucial. While the initial phases of the pandemic response were characterized by flexibility and “team-spirit”, there has been a negative long-term impact particularly among the nursing staff, where burnouts and attrition are major issues. Pandemic crises place significant strain on health systems and personnel. This raises issues about communication of strategies and principles for organizing efforts. The Danish health system managed the crisis adequately, but there are also lessons that should be learned regarding long-term implications and preparedness for future crises.

In this paper, we propose an approach to automatically classify COVID-19 and non-COVID-19 cough samples based on the combination of both feature engineering and deep learning models. In the feature engineering approach, we develop a support vector machine classifier over high dimensional (6373D) space of acoustic features. In the deep learning-based approach, on the other hand, we apply a convolutional neural network trained on the log-mel spectrograms. These two methodologically diverse models are then combined by fusing the probability scores of the models. The proposed system, which ranked 9th on the 2021 Diagnosing COVID-19 using Acoustics (Di- COVA) challenge leaderboard, obtained an area under the receiver operating characteristic curve (AUC) of 0:81 on the blind test data set, which is a 10:9% absolute improvement compared to the baseline. Moreover, we analyze the explainability of the deep learning-based model when detecting COVID-19 from cough signals. Copyright © 2021 ISCA.

We introduce the novel concept of a Sparse Layered Graph (SLG) for s-t graph cut segmentation of image data. The concept is based on the widely used Ishikawa layered technique for multi-object segmentation, which allows explicit object interactions, such as containment and exclusion with margins. However, the spatial complexity of the Ishikawa technique limits its use for many segmentation problems. To solve this issue, we formulate a general method for adding containment and exclusion interaction constraints to layered graphs. Given some prior knowledge, we can create a SLG, which is often orders of magnitude smaller than traditional Ishikawa graphs, with identical segmentation results. This allows us to solve many problems that could previously not be solved using general graph cut algorithms. We then propose three algorithms for further reducing the spatial complexity of SLGs, by using ordered multi-column graphs. In our experiments, we show that SLGs, and in particular ordered multi-column SLGs, can produce high-quality segmentation results using extremely simple data terms. We also show the scalability of ordered multi-column SLGs, by segmenting a high-resolution volume with several hundred interacting objects.

Background Therapeutic cancer vaccines represent an intriguing approach to cancer immunotherapy and they have been widely explored for the last decade. As opposed to standard modalities, such as surgery and chemotherapy, an effective vaccine-based immune response may provide protection against metastatic disease. Peptide based vaccines can elicit a highly targeted immune response and include a simple, fast and cost-effective production due to recent developments in solid phase peptide synthesis. Recent development within the field of COVID-19 vaccines has highlighted the use of lipid nanoparticles as an effective drug delivery system for vaccination. Incorporation of peptide antigens into engineered micro- and nanoparticles enables induction of a potent T cell response, partly attributed to prolonged and improved antigen presentation by dendritic cells after particle internalization. Peptide-based vaccines are often based on delivery of high-affinity T cell model epitopes. However, the therapeutic relevance of vaccination with low-affinity epitopes is gaining increasing support following the observation that high-affinity epitopes can promote T cell exhaustion resulting from excessive T cell receptor stimulation. Here, we characterize and evaluate a novel lipid nanoparticle (LNP) vaccine platform that is suited for delivery of both high- and low-affinity epitopes in the setting of therapeutic cancer vaccination.Methods LNPs were formulated to carry high- or low-affinity peptide epitopes from Ovalbumin (OVA) in conjunction with the TLR7 agonist 1V270. The peptides were anchored to the surface of the LNPs via a reducible DSPE-PEG2000 linker system. The therapeutic vaccine platform was evaluated in vivo both as a monotherapy and in combination with adoptive transfer of OT-I T cells in the syngeneic B16-OVA murine melanoma model.Results The LNP vaccine promotes efficient antigen-release and ensures high, continuous antigen-presentation by antigen-presenting cells. While the LNPs can be administered via multiple routes, intratumoral vaccination favors enhanced particle uptake in dendritic cells in the tumor. Formulated with either high- or low-affinity epitopes, intratumorally delivered vaccine particles promote superior tumor-infiltration of adoptively transferred T cells, which translates into potent anti-tumor efficacy in vivo. Finally, we show that vaccination with both CD8+ and CD4+ epitopes can delay tumor growth and prolong survival in an antigen-dependent manner.Conclusions This study presents a versatile and multi-purpose LNP vaccine platform that ensures effective delivery of high- and low-affinity epitopes. Intratumoral administration promotes vaccine particle uptake by intratumoral dendritic cells, which is followed by T cell infiltration and anti-tumor efficacy in vivo.

Objectives: We sought to evaluate the association between age and presentation of SARS-COV2 infection Methods: Clinical presentation and radiological data of all consecutive COVID19 patients admitted to our Hospital between 01-03-2020 and 30-04-2020 were analyzed SARS-CoV-2 positive patients were diagnosed by either swab test or bronchoalveolar lavage Patients without proved SARS-CoV-2 infection or without HRCT scan were excluded All HRCT were reviewed and classified according to RSNA Classification of SARS-CoV-2 pneumonia(l) Results: Over the study period, 179 patients met the inclusion criteria Mean age was 67 years (SD 15 1, range 19-96);55 8% (N= 100) were male Of them, 22 patients (12%) had atypical clinical presentation The more frequent atypical presentations were cardiovascular, including syncope (N= 5, 22%) and heart failure (N= 5, 22%) HRCT was Typical in 151 (84 4%) patients, Indeterminate in 14 (7 8%), Atypical in 12 (6 7%), and Negative in 2 (0 01%) Among elderly patients (>70 years old) accounting for 44% of the total population (N=80), HRTC was more frequently Atypical (11/80 patients, 13 75%) compared to younger patients (<70 year of age, 1/99 patients, 1%) (p-value= 0 001) Similarly, the clinical presentation was more frequently atypical in the elderly (19/80, 23%) compared to the younger (3/99, 3 0%) (p-value <0 0001) Conclusions: Our study demonstrated that SARS-CoV-2 infections in elderly can results in atypical clinical and radiological presentation, potentially leading to misdiagnosis and unrecognized cases (1)Simpson S, et al Radiology 2020 doi: 10 1148/ryct 2020200152

1. Background and GoalsA major challenge for public palliative care is to support all people who want to die at home. Last Aid Courses (LAC) have been started in 2015 to educate citizens and to empower them to participate in end-of-life care. The main goals of the International Last Aid project were to establish an International Last Aid working group and to provide and evaluate public palliative care education for citizens. 2. MethodsBetween 2017 and 2019 an International Last Aid working group with representatives from different countries and national organisations from e.g. palliative care, health-services, and the church as cooperation partners has been established. The curriculum and contents of the International Last Aid course are revised every other year by the International Last Aid working group. Scientific evaluation of LAC is coordinated by the international Last Aid Research Group Europe (LARGE) that was founded in September 2019. The experiences from he implementation process and the findings from the scientific evaluation will be summarised and presented during the Zoominar. 3. Results and ConclusionWork on LAC has been started in 17 countries as Denmark, Germany, Slovenia, Lithuania, Scotland, Ireland, Australia, Brasil, etc. The overall results show that the LAC is feasible and very well accepted in many different countries, cultures and groups. It has been used for adults, children and groups as hospital employees and policemen. LAC are even possible as online course format that was tested during the COVID-19 pandemic. Scientific work on cultural issues and the effects of Last aid Courses are ongoing in a number of countries. In conclusion Last Aid Courses are feasible and well accepted by citizens in different countries. The courses can contribute to a public debate on death, dying and palliative care and may contribute to empower citizens to provide end-of-life care. Keywords: Palliative care, public palliative care education, end-of-life care, home death, compassionate communities, Last Aid Course Biography: Dr. med. Georg Bollig, PhD, MAS, DEAA is a physician and researcher. He is a specialist in anaesthesiology, emergency medicine and palliative medicine with scientific work in various fields. He works as consultant in palliative medicine at the Medical Center Sønderjylland in Sønderborg, South Jutland Hospital, Denmark. Georg is a clinical associate professor in palliative care at the University of Southern Denmark. He invented Last Aid Courses and is the leader of Last Aid International and the international Last Aid working group. At present he is working on research projects about ethics, telemedicine and the effects of Last Aid Courses. The presented research has been performed without external funding.Presenting author details that will be used for Certificates and Id cardsDr. Georg Bollig, PhD, MAS, DEAA; Clin. Assoc. Prof. in Palliative Care Palliative Care Team, Medical Department Sønderborg/Tønder, South Jutland Hospital, Sønderborg, Denmark b Palliative Care research group, Medical Research Unit, Institute of Regional Health Research, University of Southern Denmarkc Last Aid International, Schleswig, GermanyEmail 1(Work): georg.bollig@rsyd.dkEmail 2(Personal): bollig.georg@gmx.deMobile: +49-17634747059Office Tel: +45-20168303ORCID iD: https://orcid.org/0000-0002-0367-5295

The reliability of power distribution networks can be threatened due to the health of repair crews. Covid-19 is a nowadays challenge that affects the health and the availability of repair crews. Monte Carlo simulation is implemented in this paper to evaluate the reliability of power distribution networks considering Covid-19. This paper alerts the power distribution companies to consider some strategies to prevent the growth of expected energy not served (EENS) during the pandemics era such as Covid-19.