The role of race and scientific trust on support for COVID-19 social distancing measures in the United States

Pundits and academics across disciplines note that the human toll brought forth by the novel coronavirus (COVID-19) pandemic in the United States (U.S.) is fundamentally unequal for communities of color. Standing literature on public health posits that one of the chief predictors of racial disparity in health outcomes is a lack of institutional trust among minority communities. Furthermore, in our own county-level analysis from the U.S., we find that counties with higher percentages of Black and Hispanic residents have had vastly higher cumulative deaths from COVID-19. In light of this standing literature and our own analysis, it is critical to better understand how to mitigate or prevent these unequal outcomes for any future pandemic or public health emergency. Therefore, we assess the claim that raising institutional trust, primarily scientific trust, is key to mitigating these racial inequities. Leveraging a new, pre-pandemic measure of scientific trust, we find that trust in science, unlike trust in politicians or the media, significantly raises support for COVID-19 social distancing policies across racial lines. Our findings suggest that increasing scientific trust is essential to garnering support for public health policies that lessen the severity of the current, and potentially a future, pandemic.

Managing SARS-CoV-2 Testing in Schools with an Artificial Intelligence Model and Application Developed by Simulation Data

Research on SARS-CoV-2 and its social implications have become a major focus to interdisciplinary teams worldwide. As interest in more direct solutions, such as mass testing and vaccination grows, several studies appear to be dedicated to the operationalization of those solutions, leveraging both traditional and new methodologies, and, increasingly, the combination of both. This research examines the challenges anticipated for preventative testing of SARS-CoV-2 in schools and proposes an artificial intelligence (AI)-powered agent-based model crafted specifically for school scenarios. This research shows that in the absence of real data, simulation-based data can be used to develop an artificial intelligence model for the application of rapid assessment of school testing policies.

The dilemma of treating the infected versus the wounded: Gaza's healthcare system is choked

Gaza has been facing persistent disturbance since the last 14 years. Even before the pandemic, Gaza faced a dire healthcare consequence with prevalent instability, lack of adequate medical resources, and limited health-related infrastructure. Gaza continued to struggle while responding to the pandemic as the other nearby countries. However, the challenges were compounded with the onset of the conflict that affected Gaza's infrastructure and displaced tens of thousands to make-shift shelters. The testing capacity of Gaza is alarmingly low that makes any outbreak difficult to document. Additionally, all medical centres have been affected by the ongoing conflict. These centres, if not directly impacted, are severely overwhelmed with those injured during the conflict, shifting focus and resources away from coronavirus. Vaccinations in Gaza cover only 1.9% of the population and a great number of unvaccinated people now may act as vectors of transmission in overcrowded shelters. Furthermore, non-availability of clean water to maintain hygienic conditions has heightened the risk of an explosive surge in cases. Hence, beyond the ceasefire, further steps need to be taken to strengthen Gazan response to COVID-19 pandemic.

Applications of Machine Learning and High-Performance Computing in the Era of COVID-19

During the ongoing pandemic of the novel coronavirus disease 2019 (COVID-19), latest technologies such as artificial intelligence (AI), blockchain, learning paradigms (machine, deep, smart, few short, extreme learning, etc.), high-performance computing (HPC), Internet of Medical Things (IoMT), and Industry 4.0 have played a vital role. These technologies helped to contain the disease’s spread by predicting contaminated people/places, as well as forecasting future trends. In this article, we provide insights into the applications of machine learning (ML) and high-performance computing (HPC) in the era of COVID-19. We discuss the person-specific data that are being collected to lower the COVID-19 spread and highlight the remarkable opportunities it provides for knowledge extraction leveraging low-cost ML and HPC techniques. We demonstrate the role of ML and HPC in the context of the COVID-19 era with the successful implementation or proposition in three contexts: (i) ML and HPC use in the data life cycle, (ii) ML and HPC use in analytics on COVID-19 data, and (iii) the general-purpose applications of both techniques in COVID-19’s arena. In addition, we discuss the privacy and security issues and architecture of the prototype system to demonstrate the proposed research. Finally, we discuss the challenges of the available data and highlight the issues that hinder the applicability of ML and HPC solutions on it.

Free Market Availability of Rapid Diagnostics Will Empower Communities To Control Malaria in India

Globally, malaria incidence has declined but further reductions in malaria are not evident in many countries. In addition to the public health approaches for tackling malaria, involvement of the private sector is vital because the private sector plays a central role in healthcare delivery to the masses. In India, malaria management is primarily provided through government programs, nonetheless, significant numbers of fever patients continue to seek healthcare in the private sector. The private sector in India is comprised of formal healthcare (qualified and approved), informal healthcare (unqualified, untrained), including traditional healers. Commercial channels for the procurement of quality-assured malaria diagnostics like rapid diagnostic tests via pharmacies or other approved outlets would empower Indian populations to self-detect malaria without delay. Easier access would minimize the diagnostic time gap, reduce costs to the patient, prevent inappropriate malaria treatment, and foster timely treatment of both malaria and non-malaria infections. Commercially available rapid diagnostic tests in the hands of the people could be an important tool in our fight against malaria.

Investigating the resilience of refugee camps to COVID-19: A case of Rohingya settlements in Bangladesh

Bangladesh Rohingya camps have hosted 65,000 refugees fled from Myanmar only since 2017. Their compromised living environment and limited physical and socioeconomic facilities make them highly sensitive to COVID-19. The Government of Bangladesh and international aid agencies have applied WHO's IPC (Infection, Prevention, and Control) guidelines to mitigate the transmission of COVID-19 outbreaks and enhance their resilience. However, Rohingyas often disregard these guidelines or become reluctant to follow them. Building on 10 in-depth interviews, 66 questionnaires, and observation, the study investigates the limitations and challenges of implementing these guidelines toward building community resilience. It assesses their resilience, focusingon Kutupalong camp, Cox's Bazar-one of the world's largest refugee camps. Findings reveal that Rohingya's past experience associated with their psychological trauma largely influences their current actions and demotivates them fromfollowing the health guidelines. Their deep mistrust of and disrespect to healthcare providers and aid agencies discourage them to follow the IPC. Also, insufficient built infrastructure and unhygienic living conditions, including improper WASH management, increase their risk to COVID-19. The study highlights a need for understanding their socio-psychological values and cultural narratives and recommends a set of guidelines for policymakers and aid agencies to build community resilience to COVID -19.

Doctor-patient communication and trust in doctors during COVID 19 times-A cross sectional study in Chennai, India

BACKGROUND

The COVID 19 pandemic created a global public health crisis. Physical distancing, masks, personal protective equipment worn by the doctors created difficulties in effective doctor-patient communication.

OBJECTIVES

This study was conducted to assess the difficulties faced by patients in communicating with their doctors due to the COVID 19 preventive measures, and its impact on the trust on their doctors.

METHODS

A cross sectional study of 359 persons attending a tertiary care center in Chennai, sampled in a non-probabilistic manner selected from the outpatient department, wards, and isolation facilities, was conducted using a questionnaire containing items covering three dimensions namely difficulties faced in accessing the health facility, difficulties in doctor-patient communication and trust in the doctors. The data were collected using Google Forms and analyzed using GNU PSPP open-source statistical software version 1.4.0.

RESULTS

More than 60% of the participants complained of difficulty in accessing the health facility. More than 60% had difficulties in communicating with the doctors. There was a high level of trust in doctors among more than 80% of the participants. Comparison of the mean scores revealed that accessibility was a problem across ages, sexes, education and occupation groups. Communication barriers decreased with age and increased with education, but trust increased with age, but reduced with increasing education. Multivariable linear regression analysis revealed that difficulties in communication had a negative impact on trust (β = -0.63, p<0.001) and increasing education had a negative impact on trust (β = -0.42, p = 0.034).

CONCLUSIONS

The COVID 19 pandemic and the preventive strategies such as lock-down, physical distancing, face mask and personal protective equipment created barriers to effective doctor patient communication and led to some compromise in trust in doctors during this time.

Predictors of mental health during the COVID-19 pandemic in older adults: the role of socio-demographic variables and COVID-19 anxiety

The objective of this study was to evaluate factors related to the mental health of Peruvian older adults during the COVID-19 pandemic. The study had a cross-sectional and observational design. A total of 274 older adults in Lima, Peru (M_age = 67.86) filled out a sociodemographic survey, the Coronavirus Anxiety Scale, Mental Health Inventory-5, Patient Health Questionnaire-2 item, and Generalized Anxiety Disorder Scale. A Structural Equation Model (SEM) was estimated to test an a priori model that relates the sociodemographic variables, COVID-19 Anxiety, psychological well-being, anxiety and depression. The model fit indices indicated a good fit to the data. The socio-demographic variables explained 23.8% of the variance of the COVID-19 Anxiety (R² = .238). Socio-demographic variables explained 50.5% of psychological well-being variance, 52% of anxiety and 46.9% of depression. Also, sex, work; being diagnosed with COVID-19; family member with COVID-19 diagnosis; and time of exposure to COVID-19 information had statistically significant effects psychological well-being, anxiety and depression. In conclusion, some sociodemographic characteristics and COVID-19 anxiety affect the psychological well-being, anxiety and depression. The findings may allow for a better understanding of the mental health of older adults during the COVID-19 pandemic and guide government responses to detect, anticipate and minimize its impact on the mental health of this population.

Remaining Human in COVID-19: Dialogues on Psychogeography

Post-COVID-19 environments have challenged our embodied identities with these challenges coming from a variety of domains, that is, microbiological, semiotic, and digital. We are embedded in a new complex set of relations, with other species, with cultural signs, and with technology and venturing further into an era that pushes back on our anthropocentrism to create a post-human dystopia. This does not imply that we are less human or forfeit ethics in this state of flux, but can lead to considering new ways of being alive and humanists. The aim of this project was to explore walking through our associated psychogeographies as captured in photographs and text from individual walks, as the means by which to characterize responses to the distress of the pandemic and to assess resistance to non-being. The psychogeographies were the starting points for our dialogic enquiry between authors who each represent living theory, representing their own emergent knowledge, inseparable from personal commitments and history. Walking and the associated images and reflections, provided a way to regulate our affect, reconnecting with our bodies, leading to understand and adapt to new meanings of context and ways of coping and healing in this new becoming. The interdisciplinarity of philosophy, social psychology, botany, and clinical psychology is nonetheless rejected in favour of multi-vocality; each author representing their own emergent, living theory, inseparable from personal commitments, and history.

A Study of Leisure Constraints and Job Satisfaction of Middle-Aged and Elderly Health Care Workers in COVID-19 Environment

The purpose of the study was to examine the leisure constraints and job satisfaction of middle-aged and elderly health care workers. The study employed a mixed research method, utilizing SPSS 22.0 and AMOS 23.0 statistical software to analyze 260 questionnaires using basic statistical tests, t-tests, ANOVA tests, and structural equation models, and then interviewed medical and public health workers and experts in the field, and the results were analyzed using multivariate verification analysis. The results showed that there was a significant low correlation between leisure constraints and job satisfaction among middle-aged and elderly health care workers (p < 0.01); interpersonal constraints and external job satisfaction factors were the main influencing factors; improving promotion opportunities and receiving appreciation increased job satisfaction; poor working environment and facilities, as well as the lack of achievement, were the main factors that reduced satisfaction; health factors, a lack of family support, no exercise partner, and a lack of extra budget are the key to leisure constraints. If the organization can provide nearby sports facilities for middle and high-age medical workers, improve welfare, and increase willingness to participate in leisure activities, physical and mental health can be improved. Finally, interpersonal interaction in leisure obstacles is the main reason for improving job satisfaction.

Nanomedicine: A Diagnostic and Therapeutic Approach to COVID-19

The SARS-CoV-2 virus is causing devastating morbidity and mortality worldwide. Nanomedicine approaches have a high potential to enhance conventional diagnostics, drugs and vaccines. In fact, lipid nanoparticle/mRNA vaccines are already widely used to protect from COVID-19. In this review, we present an overview of the taxonomy, structure, variants of concern, epidemiology, pathophysiology and detection methods of SARS-CoV-2. The efforts of repurposing, tailoring, and adapting pre-existing medications to battle COVID-19 and the state of vaccine developments are presented. Next, we discuss the broad concepts and limitations of how nanomedicine could address the COVID-19 threat. Nanomaterials are particles in the nanometer scale (10-100 nm) which possess unique properties related to their size, polarity, structural and chemical composition. Nanoparticles can be composed of precious metals (copper, silver, gold), inorganic materials (graphene, silicon), proteins, carbohydrates, lipids, RNA/DNA, or conjugates, combinations and polymers of all of the aforementioned. The advanced biochemical features of these nanoscale particles allow them to directly interact with virions and irreversibly disrupt their structure, which can render a virus incapable of replicating within the host. Virus-neutralizing coats and surfaces impregnated with nanomaterials can enhance personal protective equipment, hand sanitizers and air filter systems. Nanoparticles can enhance drug-based therapies by optimizing uptake, stability, target cell-specific delivery, and magnetic properties. In fact, recent studies have highlighted the potential of nanoparticles in different aspects of the fight against SARS-CoV-2, such as enhancing biosensors and diagnostic tests, drug therapies, designing new delivery mechanisms, and optimizing vaccines. This article summarizes the ongoing research on diagnostic strategies, treatments, and vaccines for COVID-19, while emphasizing the potential of nanoparticle-based pharmaceuticals and vaccines.

Comparative Analysis of Psychology Responding to COVID-19 Pandemic in Brics Nations

The BRICS Forum, an independent international organization encouraging commercial, political, and cultural cooperation between Brazil, Russia, India, China, and South Africa, was formed in 2011, and these countries have a significant influence on their regional affairs. These nations were hit by COVID-19 at different times, and all adopted home quarantine to reduce the spread of the virus. We present a comparative analysis of actions of psychology and potential outcomes during the COVID-19 pandemic in BRICS nations regarding five aspects: psychology in health policies, social roles of psychology, socioeconomic context, actions for the general population, and health professionals during stage 1 of the pandemic, and possible actions in stage 2. Various types of actions were taken by psychologists in BRICS, with different levels of coordinated cooperation with respective governmental and non-governmental organizations, multiple and parallel efforts from different scientific societies, and professional regulatory agencies. Scientific societies have had an important role in coordinating some of these efforts, especially because they congregate the psychologists from different parts of these countries, improving communication and access to key information. The aim of these actions varies from improving situational skills and competences to increase the accessibility of psychological services and provide psychoeducation and telepsychology. We will consider the social importance of these actions within these countries as a global opportunity for psychology to stage in a complex context involving human health. The way psychology in BRICS will face this challenging situation is likely to produce important regional influence, stimulate scientific contribution, and increase the accessibility of psychology.

A mathematical programming approach for equitable COVID-19 vaccine distribution in developing countries

Developing countries scramble to contain and mitigate the spread of coronavirus disease 2019 (COVID-19), and world leaders demand equitable distribution of vaccines to trigger economic recovery. Although numerous strategies, including education, quarantine, and immunization, have been used to control COVID-19, the best method to curb this disease is vaccination. Due to the high demand for COVID 19 vaccine, developing countries must carefully identify and prioritize vulnerable populations and rationalize the vaccine allocation process. This study presents a mixed-integer linear programming model for equitable COVID-19 vaccine distribution in developing countries. Vaccines are grouped into cold, very cold, and ultra-cold categories where specific refrigeration is required for their storage and distribution. The possibility of storage for future periods, facing a shortage, budgetary considerations, manufacturer selection, order allocation, time-dependent capacities, and grouping of the heterogeneous population are among the practical assumptions in the proposed approach. Real-world data is used to demonstrate the efficiency and effectiveness of the mathematical programming approach proposed in this study.

Ethical Responses to the COVID-19 Pandemic-Lessons from Sri Lanka

The COVID-19 pandemic has undoubtedly become an era-defining challenge for the entire world. It has implications not only in the public health sector but also in the global economy and political landscape. The prevention strategy that has been followed in Sri Lanka is unique. Early action taken by the government and the ministry of health, being one of pre-emptive quarantining and isolation of suspected contacts even before they developed symptoms, was vital to contain the spread of the disease. During the early phase, a nationwide lockdown in the form of a curfew was imposed which helped mitigate the spread of the virus. However, due to several lapses, there was a threat of community transmission; this was swiftly brought under control through ongoing government interventions. Thus, strict social/physical distancing measures enforced by the government, together with an increase in testing capacity, prevented widespread community transmission. Strictly containing the outbreaks as and when they were identified made it easier to bring the spread under control through contact tracing. In this article, we give an account of the strategy taken by Sri Lanka to mitigate the pandemic and comment on the lessons learned concerning the ethical responses to the COVID-19 crisis.

Hazardous infectious waste collection and government aid distribution during COVID-19: A robust mathematical leader-follower model approach

The outbreak of COVID-19 has posed significant challenges to governments across the world. The increase in hazardous infectious waste (HIW) caused by the pandemic is associated with the risk of transmitting the virus. In this study, hazardous waste includes infectious waste generated both by individuals and by hospitals during the COVID-19 pandemic. To control the outbreak by maintaining social distance and home quarantine protocols, daily necessities and health supplies must be provided to the people affected. Governments play an essential role in the management of the crisis, creating an elaborate plan for collecting HIW and providing necessities and health supplies. This paper proposes a leader-follower approach for hazardous infectious waste collection and government aid distribution to control COVID-19. At the top level of the model, government policies are designed to support people by distributing daily necessities and health supplies, and to support contractors by waste collection. The lower level of the model is related to the operational decisions of contractors with limited capacities. Due to the potential risk of virus transmission via contaminated waste, the proposed model considers the complications imposed on contractors at the lower level. Applying a stochastic programming approach, four possible scenarios are examined, dependent of the severity of the outbreak. As a solution approach, the Benders decomposition method is combined with Karush-Kuhn-Tucker conditions. The results show that government support, in addition to much better management of citizen demand, can control the spread of the virus by implementing quarantine decisions.

Analysis of Key Factors of a SARS-CoV-2 Vaccination Program: A Mathematical Modeling Approach

The administration of vaccines against the coronavirus disease 2019 (COVID-19) started in early December of 2020. Currently, there are only a few approved vaccines, each with different efficacies and mechanisms of action. Moreover, vaccination programs in different regions may vary due to differences in implementation, for instance, simply the availability of the vaccine. In this article, we study the impact of the pace of vaccination and the intrinsic efficacy of the vaccine on prevalence, hospitalizations, and deaths related to the SARS-CoV-2 virus. Then we study different potential scenarios regarding the burden of the COVID-19 pandemic in the near future. We construct a compartmental mathematical model and use computational methodologies to study these different scenarios. Thus, we are able to identify some key factors to reach the aims of the vaccination programs. We use some metrics related to the outcomes of the COVID-19 pandemic in order to assess the impact of the efficacy of the vaccine and the pace of the vaccine inoculation. We found that both factors have a high impact on the outcomes. However, the rate of vaccine administration has a higher impact in reducing the burden of the COVID-19 pandemic. This result shows that health institutions need to focus on increasing the vaccine inoculation pace and create awareness in the population about the importance of COVID-19 vaccines.

Pool Testing as a Strategy for Prevention of SARS-CoV-2 Outbreaks in Schools: Protocol for a Feasibility Study

BACKGROUND

School closures are a widely implemented strategy for limiting infection spread in the current COVID-19 pandemic. The negative impact of school closures on children and young people is increasingly apparent, however.

OBJECTIVE

We aim to evaluate the feasibility of an infection monitoring program in schools to enable targeted quarantining to replace school closures. The program is currently being implemented in two model schools in Magdeburg, Germany, within the framework of the Study of Coronavirus Outbreak Prevention in Magdeburg Schools (Studie zur Ausbruchsvermeidung von Corona an Magdeburger Schulen [STACAMA]).

METHODS

Five pupils per class are pseudorandomly selected twice a week and asked to provide a gargle sample over a 16-week evaluation period. RNA is extracted from each sample individually in a laboratory and pooled according to school class for real-time reverse transcription polymerase chain reaction (rRT-PCR) analysis. Immediate individual sample testing will be carried out in the case of a positive pool test. Individual RNA extraction prior to pooling and application of rRT-PCR result in high test sensitivity. Testing will be performed in strict adherence to data protection standards. All participating pupils will receive a 16-digit study code, which they will be able to use to access their test.

RESULTS

When the study commenced on December 2, 2020, 520 (52%) pupils and their families or guardians had consented to study participation. The study was suspended after four test rounds due to renewed school closures resulting from rising regional infection incidence. Testing resumed when schools reopened on March 8, 2021, at which time consent to participation was provided for 54% of pupils. We will quantitatively and qualitatively evaluate the logistics and acceptability of the program.

CONCLUSIONS

The findings from this study should inform the design of infection surveillance programs in schools based on gargle samples and a PCR-based pool testing procedure, enabling the identification of aspects that may require adaptation before large-scale implementation. Our focus on each step of the logistics and on the experiences of families should enable a robust assessment of the feasibility of such an approach.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/28673.

Advocacy, Hesitancy, and Equity: Exploring U.S. Race-Related Discussions of the COVID-19 Vaccine on Twitter

BACKGROUND

Our study aimed to describe themes of tweets related to COVID-19 vaccines, race, and ethnicity to explore the context of the intersection of these topics on Twitter.

METHODS

We utilized Twitter's Streaming Application Programming Interface (API) to collect a random 1% sample of publicly available tweets from October 2020 to January 2021. The study team conducted a qualitative content analysis from the full data set of 1110 tweets.

RESULTS

The tweets revealed vaccine support through vaccine affirmation, advocacy through reproach, a need for a vaccine, COVID-19 and racism, vaccine development and efficacy, racist vaccine humor, and news updates. Vaccine opposition was demonstrated through direct opposition, vaccine hesitancy, and adverse reactions. Conspiracy and misinformation included scientific misinformation, political misinformation, beliefs about immunity and protective behaviors, and race extermination conspiracy. Equity and access focused on overcoming history of medical racism, pointing out health disparities, and facilitators to vaccine access. Representation touted pride in development and role models, and politics discussed the role of politics in vaccines and international politics.

CONCLUSION

Our analysis demonstrates that Twitter can provide nuances about multiple viewpoints on the vaccine related to race and ethnicity and can be beneficial in contributing to insights for public health messaging.

On the relationship between COVID-19 reported fatalities early in the pandemic and national socio-economic status predating the pandemic

This study investigates the relationship between socio-economic determinants pre-dating the pandemic and the reported number of cases, deaths, and the ratio of deaths/cases in 199 countries/regions during the first months of the COVID-19 pandemic. The analysis is performed by means of machine learning methods. It involves a portfolio/ensemble of 32 interpretable models and considers the case in which the outcome variables (number of cases, deaths, and their ratio) are independent and the case in which their dependence is weighted based on geographical proximity. We build two measures of variable importance, the Absolute Importance Index (AII) and the Signed Importance Index (SII) whose roles are to identify the most contributing socio-economic factors to the variability of the COVID-19 pandemic. Our results suggest that, together with the established influence on cases and deaths of the level of mobility, the specific features of the health care system (smart/poor allocation of resources), the economy of a country (equity/non-equity), and the society (religious/not religious or community-based vs not) might contribute to the number of COVID-19 cases and deaths heterogeneously across countries.

Anti-IgE monoclonal antibodies as potential treatment in COVID-19

Coronavirus disease 2019 (COVID-19) is associated with irreversible effects on vital organs, especially the respiratory and cardiac systems. While the immune system plays a key role in the survival of patients to viral infections, in COVID-19, there is a hyperinflammatory immune response evoked by all the immune cells, such as neutrophils, monocytes, and includes release of various cytokines, resulting in an exaggerated immune response, named cytokine storm. This severe, dysregulated immune response causes multi-organ damage, which eventually leads to high mortality. One of the most important components of hypersensitivity is immunoglobulin E (IgE), which plays a major role in susceptibility to respiratory infections and can lead to the activation of mast cells. There is also a negative association between IgE and IFN-α, which can reduce Toll-like receptor (TLR) nine receptor expression and TLR-7 signaling to disrupt IFN production. Moreover, anti-IgE drugs such as omalizumab reduces the severity and duration of COVID-19. In addition to its anti-IgE effect, omalizumab inhibits inflammatory cells such as neutrophils. Hence, blockade of IgE may have clinical utility as an immunotherapy for COVID-19.

COVID-19 Pandemic and Equal Access to Vaccines

The COVID-19 pandemic has evidenced the chronic inequality that exists between populations and communities as regards global healthcare. Vaccination, an appropriate tool for the prevention of infection, should be guaranteed by means of proportionate interventions to defeat such inequality in populations and communities affected by a higher risk of infection. Equitable criteria of justice should be identified and applied with respect to access to vaccination and to the order in which it should be administered. This article analyzes, as regards the worldwide distribution of anti-COVID-19 vaccines, the various ways the principle of equity has been construed and applied or even overlooked. The main obstacle to equal access to vaccines is vaccine nationalism. The perception of equity varies with the differing reference values adopted. Adequate response to needs appears to be the principal rule for achieving the criterion of equity in line with distributive justice. Priorities must be set equitably based on rational parameters in accordance with current needs. The entire process must be governed by transparency, from parameter identification to implementation. The issue of equal access to vaccination affects the entire world population, necessitating specific protective interventions. In light of this, the World Health Organization (WHO) has devised the COVAX plan to ensure that even the poorest nations of the world receive the vaccine; certain initiatives are also supported by the European Union (EU). This pandemic has brought to the fore the need to build a culture of equitable relationships both in each country’s own domain and with the rest of the world.

Risk communication and community engagement strategies for COVID-19 in 13 African countries

Background: Coronavirus disease 2019 (COVID-19) outbreak is a major threat facing health systems globally and African countries are not an exception. Stakeholders, governments, and national authorities have mounted responses to contain the pandemic. This study aimed to catalogue the risk communication and community engagement (RCCE) strategies as well as the challenges facing RCCE in 13 African countries.

Methods: We conducted a narrative review of evidence to answer the aim of the study. The search was conducted in March 2021 and evidence published between December 2019 and February 2021 were included. Data reported in this article were obtained from reports, literature in peer-reviewed journals, grey literature and other data sources in 13 African countries. The 13 countries include Ethiopia, Ghana, Kenya, Algeria, Angola, Cote d’Ivoire, the Democratic Republic of the Congo, Mauritius, Nigeria, South Africa, Tanzania, Uganda, and Zambia. The authors also snowball further data to gather information for this review.

Results: Most of the priority African countries have RCCE strategies to contain the transmission and spread of the coronavirus. Our findings revealed RCCE strategies in the 13 African countries focused on training and capacity building, risk communication systems, internal and partners’ coordination, community engagement, public communication, contending uncertainty, addressing misperceptions and managing misinformation. However, the RCCE response activities were not without challenges, which included distrust in government, cultural, social, and religious resistance, and inertia among others.

Conclusion: With the similar RCCE approaches and interventions seen across the countries, it is clear that countries are learning from each other and from global health organizations to develop COVID-19 RCCE programs. It is important for African countries to address the challenges facing RCCE in order to effectively contain the pandemic and to prepare for future public health emergencies.

Food Insecurity: A Constant Factor in the Lives of Low-Income Families in Scotland and England

During the school summer holidays, pressures on the already tight budgets of low-income families are compounded, particularly when the safety net of free school meals is removed. The main aim of the current study was to investigate how low-income parents and carers feed their families during term time when children receive free school meals and if, and how, strategies differ during the school summer holidays. A secondary aim was to investigate the role of holiday activity and food programmes in supporting parents and carers to feed their children during the school summer holidays. We used purposive sampling to recruit a total of 21 parents (N = 20 Female, N = 1 Male) whose children attended free summer holiday clubs in Scotland and England during summer 2017. Participants were asked about their food and shopping habits during the school term and if, and how they differed during the school summer holidays when free school meals were not available. The findings suggest that food insecurity is a constant factor in the lives of low-income parents in England and Scotland, and that the stages of food insecurity and the strategies employed to mitigate its effects appear to be cyclical, aligning with the Food and Agriculture Organisation's (FAO) food insecurity continuum and the school academic year. During term time, parents and carers worried about food, suggesting they were experiencing mild food insecurity, despite their children being in receipt of free school meals. As the school holidays approached, moderate food insecurity was experienced as parents reported that they began "provisioning," storing food and reducing household expenditure. During the summer holidays, food did not last, and parental food acquisition habits became more intense. Parents downgraded food brands and bought reduced price items of food. Ultimately, parents self-sacrificed their own nutritional intake by only buying food their children would eat and parents often skipped meals or only ate their children's leftovers. However, children's attendance at holiday club helped make the food at home last longer and once school resumed, parents returned to their less intense, but constantly coping approach to food shopping. The findings of this study suggest that food insecurity is a constant factor in the lives of low-income families who simply do not have enough household income to prevent them from experiencing food insecurity, even when initiatives such as free school meals and access to holiday club provision with food and activities are in place.

COVID-19: breaking down a global health crisis

Coronavirus disease 2019 (COVID-19) is the second pandemic of the twenty-first century, with over one-hundred million infections and over two million deaths to date. It is a novel strain from the Coronaviridae family, named Severe Acute Respiratory Distress Syndrome Coronavirus-2 (SARS-CoV-2); the 7th known member of the coronavirus family to cause disease in humans, notably following the Middle East Respiratory syndrome (MERS), and Severe Acute Respiratory Distress Syndrome (SARS). The most characteristic feature of this single-stranded RNA molecule includes the spike glycoprotein on its surface. Most patients with COVID-19, of which the elderly and immunocompromised are most at risk, complain of flu-like symptoms, including dry cough and headache. The most common complications include pneumonia, acute respiratory distress syndrome, septic shock, and cardiovascular manifestations. Transmission of SARS-CoV-2 is mainly via respiratory droplets, either directly from the air when an infected patient coughs or sneezes, or in the form of fomites on surfaces. Maintaining hand-hygiene, social distancing, and personal protective equipment (i.e., masks) remain the most effective precautions. Patient management includes supportive care and anticoagulative measures, with a focus on maintaining respiratory function. Therapy with dexamethasone, remdesivir, and tocilizumab appear to be most promising to date, with hydroxychloroquine, lopinavir, ritonavir, and interferons falling out of favour. Additionally, accelerated vaccination efforts have taken place internationally, with several promising vaccinations being mass deployed. In response to the COVID-19 pandemic, countries and stakeholders have taken varying precautions to combat and contain the spread of the virus and dampen its collateral economic damage. This review paper aims to synthesize the impact of the virus on a global, micro to macro scale.

Vietnam's success story against COVID-19

Vietnam's close proximity to China where the COVID-19 outbreak started made it one of the countries expected to have widespread transmission of the virus. However, the country opposed this expectation and attained low spread of COVID-19 infection due to its proactive approaches in containing the disease. As of March 11, 2021, Vietnam has a total of 2529 confirmed cases, equivalent to 26 cases per one million population-compared to the global rate of 15,223 cases. The low-cost model approach used by Vietnam in dealing with previous public health issues, tackle the importance of a strategic public health system, good governance, and citizen cooperation in the fight against COVID 19 pandemic. This paper aims to analyze Vietnam's achievement in its early and continued success in combating COVID-19 by taking into account various aspects of its health system and experience on outbreaks that have previously occurred and how these can be applied to current COVID-19 responses.

Dental practice closure during the first wave of COVID-19 and associated professional, practice and structural determinants: a multi-country survey

BACKGROUND

The coronavirus outbreak (COVID-19) in China has influenced every aspect of life worldwide. Given the unique characteristics of the dental setting, the risk of cross-infection between dental practitioners and patients is high in the absence of adequate protective measures, and dentists may develop severe anxiety in relation to the current pandemic. The limited provision of services and widespread closure of dental practices have raised concerns among dental professionals about the financial impact. The present study assessed the frequency of dental practice closure during the pandemic's first wave in several countries and whether closures and their associated factors differ between the private and non-private sectors.

METHODS

An electronic cross-sectional survey questionnaire was sent to dentists in several countries, from April to May 2020. The survey assessed professional, practice related and country-level structural factors elucidating the reason for practice closure. Multilevel logistic regression was used to assess the association between practice closure and these factors, and differences were evaluated by sector type.

RESULTS

Dentists from 29 countries (n = 3243) participated in this study. Most of the participants (75.9%) reported practice closure with significantly higher percentage in the private sector than the non-private sector. Greater pandemic-related fears were associated with a significantly higher likelihood of practice closure in the private (odds ratio [OR] = 1.54, 95% confidence interval [CI] 1.24, 1.92) and non-private (OR = 1.38, 95% CI 1.04, 1.82) sectors. Dentists in non-private rural areas (OR = 0.58, 95% CI 0.42, 0.81), and those in hospitals (overall OR = 0.60, 95% CI 0.36, 0.99) reported a low likelihood of closure. A high likelihood of closure was reported by dentists in the academia (OR = 2.13, 95% CI 1.23, 3.71). More hospital beds at the country-level were associated with a lower likelihood of closure in the non-private sector (OR = 0.65, 95% CI 0.46, 0.91). Private- sector dentists in high- income countries (HICs) reported fewer closures than those in non-HICs (OR = 0.55, 95% CI 0.15, 1.93).

CONCLUSIONS

Most dentists reported practice closure because of COVID-19, and greater impacts were reported in the private sector than in the non-private sector. Closure was associated with professional, practice, and country-levels factors.

An assessment of socioeconomic impact of COVID-19 pandemic in India

Coronavirus (COVID-19) pandemic has created an unprecedented loss and disruptions over all across the world. From developed to developing, no country has been spared from its brunt. In this paper, we have analyzed the implications of COVID-19 on the economy and society of India so far. An impact assessment on the basis of available lietrature is made on all the three sectors-primary, secondary and service sector along with the impact on migrants, health, poverty, job losses, informal sector, environment, and so forth. The all sectors of the economy has been disproportionately affected and even within a sector, there is a disproportionate loss. The societal impacts are dire too with job losses, mental illness, increased domestic violence, and so forth. Some positive effects can be seen in terms of improved air quality, water quality, wildlife but the sustainability of such impact is conditional upon post-COVID and people's habits and future policies related to the environment.

Anemia and Vitamin B-12 and Folate Status in Women of Reproductive Age in Southern India: Estimating Population-Based Risk of Neural Tube Defects

BACKGROUND

Women of reproductive age (WRA) are a high-risk population for anemia and micronutrient deficiencies. However, there are few representative population-level data from India, which could help inform evidence-based recommendations and policy.

OBJECTIVE

To conduct a population-based biomarker survey of anemia and vitamin B-12 and folate status in WRA as part of a periconceptional surveillance program in southern India.

METHODS

Participants were WRA (15-40 y) who were not pregnant or lactating. Whole blood (n = 979) was analyzed for hemoglobin via a Coulter counter (Coulter HMX). Plasma, serum, and RBCs were processed and stored at -80°C or less until batch analysis. Vitamin B-12 concentrations were measured via chemiluminescence; RBC and serum folate concentrations were evaluated via microbiological assay. Anemia and severe anemia were defined as hemoglobin <12.0 g/dL and <8.0 g/dL, respectively. Vitamin B-12 deficiency and insufficiency were defined as total vitamin B-12 <148 pmol/L and <221 pmol/L, respectively. Folate deficiency and insufficiency were defined as RBC folate <305 nmol/L and <748 nmol/L. A previously developed Bayesian model was used to predict neural tube defect (NTD) prevalence per 10,000 births.

RESULTS

A total of 41.5% of WRA had anemia and 3.0% had severe anemia. A total of 48.3% of WRA had vitamin B-12 deficiency and 74.3% had vitamin B-12 insufficiency. The prevalence of RBC folate deficiency was 7.6%, and 79.3% of WRA had RBC folate <748 nmol/L, the threshold for optimal NTD prevention. Predicted NTD prevalence per 10,000 births based on RBC folate concentrations was 20.6 (95% uncertainty interval: 16.5-25.5).

CONCLUSIONS

The substantial burden of anemia, vitamin B-12 deficiency, and RBC folate insufficiency in WRA in this setting suggests an opportunity for anemia and birth defects prevention. Findings will directly inform the development of a randomized trial for anemia and birth defects prevention in southern India.This study was registered at clinicaltrials.gov as NCT04048330.

Research on International Cooperative Governance of the COVID-19

Since the first case of the novel coronavirus (SARS-CoV-2) was reported in Wuhan, China, in December 2019, the coronavirus disease (COVID-19) has quickly spread to all the corners of the world. Amid the global public health threats posed by the COVID-19 pandemic, active cooperative governance has gradually emerged as the most powerful weapon against its spread. To facilitate international cooperation for pandemic governance, this paper applied the evolutionary game theory to analyze the factors influencing active cooperative governance and, based on the results, proposed a series of recommendations for promoting international cooperation. (1) leveraging the role of international organizations to reduce the cost of realizing the strategy of active cooperative governance, (2) promoting the international exchange of related experiences to lower the cost of active pandemic governance, (3) sustaining productive and daily activities during the pandemic in a classified and hierarchical manner to reduce the economic loss incurred by active pandemic governance, and (4) optimizing the incentive measures of international organizations to facilitate the selection of active cooperative governance. Finally, from the four aspects of resource management of pandemic treatment, supply management of living materials, population flow cooperation management, and governance fund cooperation management, this paper gives the path of international pandemic cooperative governance.

Global health (security), immigration governance and Covid-19 in South(ern) Africa: An evolving research agenda

The Covid-19 pandemic provides a stark reminder of the political tensions associated with the field of immigration and health, highlighting the central role that nationalism, racism and xenophobia play in determining responses to communicable diseases. The blurring of global health, immigration governance, and the global health security agendas has long been recognised. However, an improved understanding of the politics influencing these entanglements, specifically within the context of the Covid-19 response in low- and middle-income country contexts, is urgently needed. This includes - but is not limited to - the immediate concerns surrounding inclusive social, political and medical responses to Covid-19; vaccine nationalism - at both global and national levels; and calls for 'vaccine passports'. To this end, we draw on the Southern African Development Community (SADC) context - one associated with high levels of diverse population movements and a large burden of communicable diseases - to explore responses to Covid-19. We unpack tensions surrounding the management of migration and the ways in which sovereignty impacts attempts at building regional, coordinated responses to migration and health, and consider how this affects progress towards global health targets. With an initial focus on South Africa, we build on previous work exploring the blurring of global health, immigration governance, and the global health security agendas in SADC, and draw from ongoing research on the governance of migration and health within the region. This includes current and evolving research exploring migration and Covid-19, initiated in March 2020 when the first cases of Covid-19 were identified in Southern Africa. The aim is for these findings to catalyse a new and evolving researh agenda to inform the development and implementation of appropriate pandemic responses in a region associated with some of the highest levels of inequality globally. To this end, an evolving research agenda should be responsive to current needs. We suggest that, in SADC, priority research should focus on improving our understanding of (1) the political factors influencing the (dis)connections between migration and health governance structures in the context of Covid-19, and how to overcome these in the context of a pandemic; and (2) the motivations for and implications of a 'vaccine passport' system on movement within and beyond the SADC region. This requires a reactive, cross-disciplinary, regional research network. In a context where funding for research is increasingly inaccessible, this requires innovative, informal, collaborative engagement.

A critical narrative of Ecuador's preparedness and response to the COVID-19 pandemic

Ecuador’s National Health System has been severely overwhelmed by the COVID-19 pandemic despite public health efforts. This was primarily due to limited health emergency planning responses. Ecuador’s COVID-19 mortality rate was 8.5% in early June 2020. The capital city (Quito) and Pichincha province, Guayaquil city and Guayas province, as well as Manabi, Azuay, the El Oro and Tungurahua provinces were the most severely impacted locations by the COVID-19 pandemic, resulting in thousands of positive cases. Using the World Health Organization (WHO) Operational Planning Guidelines to Support Country Strategic Preparedness and Response Plan for COVID-19 as a reference point, we highlight the urgent need to implement a proactive preparedness and response plan to address the COVID-19 pandemic, with the aim of improving Ecuador’s public health system. The mitigation of COVID-19 transmission and hazard reduction is crucial in protecting the most vulnerable at-risk populations in this nation.

The capacity of primary health care facilities in Saudi Arabia: infrastructure, services, drug availability, and human resources

BACKGROUND

Primary healthcare (PHC) is an essential component of an effective healthcare system. The Kingdom of Saudi Arabia's (KSA) health reforms prioritize tackling the increasing noncommunicable disease burden by prioritizing PHC, centering it as the core of the newly proposed Model of Care. To identify challenges and opportunities to scale up PHC capacity, understanding the current capacity of primary health care centers (PHCC) is critical. A limited number of publications review PHC capacity in KSA, focusing on specific regions/sectors; this paper is a first to examine PHC capacity on a national level.

METHODS

The study uses a countrywide Facility Survey that collected data in 2018 from 2319 PHCCs, generating information on their characteristics, number of health workers, services provided, and capacity elements captured through the Service Availability and Drug Availability constructed indices. Descriptive analysis was performed by rural-urban classification. Ordinary Least Squares (OLS) regressions were used to understand correlates to health workers and equipment availability. Finally, a logistic regression was fitted for selected services. Regressions controlled for various measures to determine correlates with facilities' capacity.

RESULTS

On a national level, there are 0.74 PHCCs per 10,000 population in KSA. There are variations in the distribution of PHCCs across regions and within regions across rural and urban areas. PHCCs in urban areas have more examination rooms but lower examination room densities. Offering 24 × 7 services in PHCCs is infrequent and dependency on paper-based medical recording remains common. More urban regions are more likely to offer general services but less likely to offer burn management and emergency services. PHCCs are mostly staffed with general medicine, family medicine, and obstetrics & gynecology physicians, whose numbers are more concentrated in urban areas; however, their densities are higher in rural areas. Finally, psychiatrists and nutritionists are rare to find in PHCCs.

CONCLUSIONS

Decision-makers need to consider several factors when designing PHC policies. For instance, PHC accreditation needs to be prioritized given its positive correlation with service provision and health workers availability. PHC 24 × 7 operation also needs considerations in rural areas due to the high dependency on PHCCs. Finally, there is a substantial need for improvements in e-health.

From imperialism to inpatient care: Work differences of Filipino and White registered nurses in the United States and implications for COVID-19 through an intersectional lens

In the United States, nursing is the largest healthcare profession, with over 3.2 million registered nurses (RNs) nationwide and comprised of mostly women. Foreign‐trained RNs make up 15 percent of the RN workforce. For over half a century, the U.S. healthcare industry has recruited these RNs in response to nurse shortages in hospitals and nursing homes. Philippines‐trained RNs make up 1 out of 20 RNs in this country and continue to be the largest group of foreign‐trained nurses today. Recently, the news media has publicized the many deaths of Filipino RNs as a result of the COVID‐19 pandemic in the United States. Given the imperial historical ties between these two countries in the context of the nursing profession and the enduring labor inequities that persist, this nationally representative study is one of the few to our knowledge to not only quantitatively examine the current work differences in characteristics and experiences of Philippines‐trained RNs and U.S.‐trained white RNs practicing in the United States today, but to also do so from an intersectionality lens. The overall aim of this paper is to illuminate how these differences may serve as potential factors contributing to the disproportionate number of Filipino nurses' COVID‐19 related vulnerability and deaths in the workplace.

Investigation of the urbanization contribution to the COVID-19 outbreak in Iran and the MECA countries

The main objective of this research was to disclose the correlative contribution of urban-associated factors affecting the COVID-19 outbreak in the macro-scale of MECA countries and the downscaled micro-scale of the provincial divisions in Iran. For this purpose, the correlation coefficients between the variables and clustering analysis were used to expose the possible effects. Results revealed the comparatively strong relationships between some independent variables (e.g., total greenhouse gas emissions, CO2 emissions, nitrous oxide emissions, and urban population) and confirmed cases (R from 0.619 to 0.695), demonstrating the possible effective role of urbanization and its induced GHG emissions on the COVID-19 outbreak in the country level of the MECA region. Therefore, the results significantly confirmed the strong relationships between some independent variables (e.g., total population, urban population, fuel consumption, NO2-CO2 emissions, energy use, and total intra-changed travels) and confirmed cases (R from 0.724 to 0.945), explaining an explicit relationship between urbanization processes and the COVID-19 outbreak in Iran. Besides, the HCA results revealed the substantial role of the urban population and urban-induced energy use and gas emission in clustering locations regarding the COVID-19 outbreak in both the MECA region and Iran. The main implication of this research is to give a practical correlation between Coronavirus infection and urban constitution, aiming to increase the health of urban societies by creating effective planning in the future.

'COVID-19 and palliative medicine: faith-based hospitals in India'

OBJECTIVES

Faith-based organisations (FBOs) in India provide health services particularly to marginalised communities. We studied their preparedness and delivery of palliative care during COVID-19 as part of a mixed-method study. We present the results of an online questionnaire.

METHODS

All FBOs providing palliative care in India were invited to complete an online questionnaire. Descriptive analysis was undertaken.

RESULTS

Response rate was 46/64 (72%); 44 provided palliative care; 30/44 (68%) were in rural or semiurban areas with 10-2700 beds. Fifty-two per cent (23/44) had dedicated palliative care teams and 30/44 (68%) provided it as part of general services; 17/44 (39%) provided both. 29/44 (66%) provided palliative care for cancer patients; 17/44 (34%) reported that this was more than half their workload.The pandemic led to reduced clinical work: hospital 36/44 (82%) and community 40/44 (91%); with reduction in hospital income for 41/44 (93%). 18/44 (44%) were designated government COVID-19 centres; 11/40 (32%) had admitted between 1 and 2230 COVID-19 patients.COVID-19 brought challenges: 14/44 (32%) lacked personal protective equipment; 21/44 (48%) had reduced hospital supplies and 19/44 (43%) lacked key medications including morphine. 29/44 (66%) reported reduction in palliative care work; 7/44 (16%) had stopped altogether. Twenty-three per cent (10/44) reported redeployment of palliative care teams to other work. For those providing, palliative care 32/37 (86%) was principally for non-COVID patients; 13/37 (35%) cared for COVID-19 patients. Service adaptations included: teleconsultation, triaged home visits, medication delivery at home and food supply.

CONCLUSIONS

FBOs in India providing palliative care had continued to do so despite multiple challenges. Services were adapted to enable ongoing patient care. Further research is exploring the effects of COVID-19 in greater depth.

Ebola Outbreak amid COVID-19 in the Republic of Guinea: Priorities for Achieving Control

In February 2021, a new Ebola outbreak occurred amid the coronavirus disease 2019 (COVID-19) pandemic in the Republic of Guinea. Technical committees and Ebola mitigation mechanisms used during the 2014–2016 Ebola epidemics, have been redeployed by the public health organizations and African health organizations. As the burden on the local healthcare system is rising, fears of socioeconomic disruption are growing as well. Strategies used during the previous epidemic need to be reactivated, and new measures taken during the challenges of COVID-19 are being considered. This perspective discusses the available evidence regarding the epidemic of Ebola in Guinea amid the COVID-19 pandemic, highlights the challenges to be prioritized, and provides evidence-based recommendations.

Knowledge, attitudes and practices associated with the COVID-19 among slum dwellers resided in Dhaka City: a Bangladeshi interview-based survey

BACKGROUND

The emergent COVID-19 has impacted unprecedentedly to all classes of people. Slum-dwellers' knowledge, attitudes and practices (KAP) toward COVID-19 are currently poorly understood. The present study aimed to investigate the KAP toward COVID-19 among slum dwellers resided in Dhaka City, Bangladesh.

METHODS

A cross-sectional offline survey was carried out enrolling 406 slum dwellers (53.2% male; mean age = 44.9 years [SD = 12.1]; age range = 18-85 years) between August and September, 2020. The face to face interview was conducted to collect data from six selected slum areas in Dhaka City using convenience sampling. The questionnaire consisted of informed consent along with questions concerning observational checklists, socio-demographics and KAP.

RESULTS

A sizeable minority were observed without wearing face masks during the survey periods (18.2%) and a vast portion (97.5%) without any hand protection. The mean scores of KAP were 6.1 ± 2.6 (out of 17), 12.3 ± 1.7 (out of 14) and 9.8 ± 1.6 (out of 12), respectively. Moreover, the KAP were strongly and positively correlated with each other.

CONCLUSIONS

The findings revealed that the majority of slum dwellers in Bangladesh have limited knowledge of COVID-19. Poor practices (i.e. face mask and hand protection) were directly observed during the survey. The findings suggest the immediate implementation of health education programs and adequate interventions.

An Architecture for Reliable Transportation of Delicate Goods

Adequate conditions are critical to avoiding damage or degradation of products during transportation, especially in the case of delicate goods like food products, live animals, precision machinery or art items, among others. The damages are not always readily identified: sometimes they are only detected several days or weeks after the merchandise has been delivered. Moreover, it may be hard to assess if the problems resulted from the transport conditions, and it may be even harder to prove it, making it difficult to determine and assign responsibilities. Also, transport is a global business, typically involving different companies and means (truck, train, plane, ship, …). Usually, customers hire the service to a single commercial entity, but the service is performed by several companies, like transporters, stockists and dispatchers. To know whether the transport requirements are fulfilled or not is thus essential to assessing responsibilities and encouraging compliance by all the players in the process. In this paper, the authors propose an architecture that allows certifying, in an exempt manner, the conditions under which the transport of sensitive goods are carried out. In case of compliance, it protects the entities of the transport chain and ensures the customer that the merchandise has not been subject to conditions that may have affected its integrity or quality. If problems are detected, it allows to identify the non-compliant players and to assign responsibilities. The solution is based on ultra-low-power, low-cost devices (equipped with several sensors, a real-time clock, and Bluetooth Low Energy services), a mobile application and several cloud services (including a Coordinated Universal Time service).