272 research outputs found
Особенности подготовки специалистов пограничного контроля
No full textMakarevich A. A.; Skvortsov D. A.; Protsenko L. N. Features of the training of border control specialist
Replacement renal therapy in the treatment of patients with a severe course of the new coronavirus infection
No full textObjective: to study the use of RRT methods and their influence on the results of treatment of patients with severe COVID-19. Subjects and methods. We retrospectively analyzed the data of 283 patients with COVID-19 in the intensive care units of Moscow City Hospital no. 40 in 2020 who had received RRT as one of the treatment methods. Results. Frequency of RRT in COVID-19 patients in ICU of Moscow City Hospital no. 40 for 2020 made 5.7% (504 out of 8.711 patients treated in ICU received RRT). In 86% of cases, RRT was performed for renal indications. At the time of initiation of RRT, the studied groups did not differ according to SOFA score. The frequency of using dialysis units with high and low cut-off point in the groups of survived and deceased patients differed significantly. The surgery itself started at relatively the same time from the onset and statistically significantly earlier in the group of survivors from the beginning of tracheal intubation (4.9 ± 0.5 vs 6.8 ± 0.3 days, p = 0.0013). Against the background of ongoing therapy, overall severity of the state progressed in the group of deceased patients to 9.9 ± 0.2 SOFA scores, while in the group of survivors there was an improvement to 6.1 ± 0.4 scores
In-hospital clinical outcomes after upper gastrointestinal surgery: Data from an international observational study
No full textAIMS:
Previous research suggests that patients undergoing upper gastrointestinal surgery are at high risk of poor postoperative outcomes. The aim of our study was to describe patient outcomes after elective upper gastrointestinal surgery at a global level.
METHODS:
Prospective analysis of data collected during an international seven-day cohort study of 474 hospitals in 27 countries. Patients undergoing elective upper gastrointestinal surgery were recruited. Outcome measures were in-hospital complications and mortality at 30-days. Results are presented as n(%) and odds ratios with 95% confidence intervals.
RESULTS:
2139 patients were included, of whom 498 (23.2%) developed one or more postoperative complications, with 30 deaths (1.4%). Patients with complications had longer median hospital stay 11 (6-18) days vs. 5 (2-10) days. Infectious complications were most frequent, affecting 368 (17.2%) patients. 328 (15.3%) patients were admitted to critical care postoperatively, of whom 161 (49.1%) developed a complication with 14 deaths (4.3%). In a multivariable logistic regression model we identified age (OR 1.02 [1.01-1.03]), American Society of Anesthesiologists physical status III (OR 2.12 [1.44-3.16]) and IV (OR 3.23 [1.72-6.09]), surgery for cancer (OR 1.63 [1.27-2.11]), open procedure (OR 1.40 [1.10-1.78]), intermediate surgery (OR 1.75 [1.12-2.81]) and major surgery (OR 2.65 [1.72-4.23]) as independent risk factors for postoperative complications. Patients undergoing major surgery for upper gastrointestinal cancer experienced twice the rate of complications compared to those undergoing other procedures (224/578 patients [38.8%] versus 274/1561 patients [17.6%]).
CONCLUSIONS:
Complications and death are common after upper gastrointestinal surgery. Patients undergoing major surgery for cancer are at greatest risk
Vakavasti psyykkisesti sairaiden vanhempien jälkeläisten kardiometabolinen riski ja tautikuolleisuus
No full textAbstractParental severe mental illness (SMI) may affect offspring physical health outcomes in multiple ways. Offspring of parents with SMI are at higher risk of developing mental illness. The impact of parental SMI on offspring’s cardiometabolic health and mortality by diseases and medical conditions is still poorly understood.This study aimed to examine cardiometabolic morbidity in middle-aged offspring of parents with SMI. The following cardiometabolic disorders were used as outcome measures: diabetes mellitus, hypertension, hyperlipidaemia, coronary artery disease, obesity and cerebrovascular disorders. The study also examined cardiometabolic risk factors including glucose levels, lipid levels, insulin levels and insulin resistance. Another aim of the study was to investigate mortality by diseases and medical conditions in offspring of parents with SMI. The follow-up time was 49 years. The study determined if the risk of mortality by diseases and medical conditions increased among offspring of individuals with SMI compared to a comparison group. The hypothesis was that offspring of people with severe mental disorders have increased cardiometabolic morbidity risk and mortality risk by diseases and medical conditions. The study was prospective with data from both clinical examination and registers. Participants were from unselected population-based birth cohort: The Northern Finland Birth Cohort 1966 (n=12,231).Offspring of parents with SMI had increased cardiometabolic morbidity risk. Male offspring had elevated risk of coronary artery disease, hyperlipidaemia, obesity and hypertension. Offspring of parents with SMI had increased risk for obesity, especially offspring of mothers with SMI. Female offspring of parents with SMI had partly increased risk for disturbances in cardiometabolic risk factors. They had increased risk for higher glucose level and waist circumference. Offspring of parents with SMI had no increased risk for mortality by diseases and medical conditions. In fact, the risk for dying in the group of offspring of fathers with SMI was lower than in the comparison group. The study concludes that parental SMI has a noteworthy effect on offspring physical health. However, the impact of parental SMI on offspring physical health is complex issue.Original papersOriginal papers are not included in the electronic version of the dissertation.Protsenko, M., Kerkelä, M., Miettunen, J., Auvinen, J., Järvelin, M.-R., Jones, P. B., Gissler, M., & Veijola, J. (2022). Cardiometabolic disorders in the offspring of parents with severe mental illness. Psychosomatic Medicine, 84(1), 2–9. https://doi.org/10.1097/PSY.0000000000001022Self-archived versionProtsenko, M., Kerkelä, M., Miettunen, J., Auvinen, J., Järvelin, M.-R., Jones, P. B., Gissler, M., & Veijola, J. (2022). Body mass index in the middle-aged offspring of parents with severe mental illness. Psychological Medicine. Advance online publication. https://doi.org/10.1017/S0033291722000253Self-archived versionProtsenko, M., Kerkelä, M., Miettunen, J., Auvinen, J., Järvelin, M.-R., Jones, P. B., Gissler, M., & Veijola, J. (2023). Insulin resistance and lipid levels in the middle-aged offspring of parents with severe mental illness. Schizophrenia Research, 252, 271–278. https://doi.org/10.1016/j.schres.2023.01.013Self-archived versionProtsenko, M., Kerkelä, M., Miettunen, J., Auvinen, J., Järvelin, M.-R., Gissler, M., & Veijola, J. (2020). Mortality by diseases and medical conditions in the offspring of parents with severe mental illness. Social Psychiatry and Psychiatric Epidemiology, 55(12), 1649–1657. https://doi.org/10.1007/s00127-019-01781-zSelf-archived versionTiivistelmäVanhempien vakava mielenterveyden häiriö (SMI) voi vaikuttaa jälkeläisten fyysiseen terveyteen monin eri tavoin. Vakavaa mielenterveydenhäiriötä sairastavien vanhempien jälkeläisillä on suurempi riski sairastua psykiatrisiin sairauksiin. Vanhempien vakavan mielenterveyden häiriön vaikutus jälkeläisten kardiometaboliseen terveyteen ja tautikuolleisuuteen on kuitenkin heikosti ymmärretty.Tämän tutkimuksen tavoitteena oli tutkia vakavaa mielenterveyden häiriötä sairastavien vanhempien keski-ikäisten jälkeläisten kardiometabolista sairastavuutta. Seuraavia kardiometabolisia häiriöitä käytettiin tulosmuuttujina: diabetes mellitus, verenpainesairaudet, rasva-aineenvaihdunnan häiriöt, iskeemiset sydänsairaudet, lihavuus ja aivoverenkierron sairaudet. Tutkimuksessa tarkasteltiin myös kardiometabolisia riskitekijöitä, mukaan lukien glukoositaso, lipiditaso, insuliinitaso ja insuliiniresistenssi. Tutkimuksen tavoitteena oli selvittää myös vakavaa mielenterveyden häiriötä sairastavien vanhempien jälkeläisten tautikuolleisuutta. Seuranta-aika oli 49 vuotta. Hypoteesina oli, että vakavaa mielenterveydenhäiriötä sairastavien vanhempien jälkeläisillä on suurentunut kardiometabolisten sairauksien riski ja suurentunut kuolleisuusriski. Tutkimus oli prospektiivinen kliinisistä tutkimuksista ja rekistereistä saatuun dataan perustuva. Osallistujat olivat valikoimattomasta väestöpohjaisesta syntymäkohortista: Pohjois-Suomen syntymäkohortti 1966:sta (n=12,231).Vakavaa mielenterveyden häiriötä sairastavien vanhempien jälkeläisillä oli suurentunut riski kardiometabolisiin sairauksiin. Vakavaa mielenterveydenhäiriötä sairastavien vanhempien miespuoleisilla jälkeläisillä oli suurentunut iskeemisen sydänsairauden, hyperlipidemian, lihavuuden ja verenpainetaudin riski. Lihavuuden riski oli kohonnut vaikeaa mielenterveyden häiriötä sairastavien vanhempien jälkeläisillä, erityisesti äitien. Vakavaa mielenterveydenhäiriötä sairastavien vanhempien naispuoleisilla jälkeläisillä oli osittain lisääntynyt riski häiriöihin kardiometabolisissa riskitekijöissä. Heillä oli lisääntynyt riski korkeampaan glukoositasoon ja suurentuneeseen vyötärönympärykseen. Tautikuolleisuus ei ollut suurentunut vakavaa mielenterveydenhäiriötä sairastavien vanhempien jälkeläisillä. Itse asiassa tautikuolleisuusriski oli pienentynyt vakavaa mielenterveydenhäiriötä sairastavien isien jälkeläisillä. Tutkimuksessa todetaan, että vanhemman vaikealla mielenterveydenhäiriöllä on huomattava vaikutus jälkeläisten fyysiseen terveyteen. Vanhemman vaikean mielenterveyden häiriön vaikutus jälkeläisten fyysiseen terveyteen on kuitenkin monimutkainen kysymys.OsajulkaisutOsajulkaisut eivät sisälly väitöskirjan elektroniseen versioon.Protsenko, M., Kerkelä, M., Miettunen, J., Auvinen, J., Järvelin, M.-R., Jones, P. B., Gissler, M., & Veijola, J. (2022). Cardiometabolic disorders in the offspring of parents with severe mental illness. Psychosomatic Medicine, 84(1), 2–9. https://doi.org/10.1097/PSY.0000000000001022Rinnakkaistallennettu versioProtsenko, M., Kerkelä, M., Miettunen, J., Auvinen, J., Järvelin, M.-R., Jones, P. B., Gissler, M., & Veijola, J. (2022). Body mass index in the middle-aged offspring of parents with severe mental illness. Psychological Medicine. Advance online publication. https://doi.org/10.1017/S0033291722000253Rinnakkaistallennettu versioProtsenko, M., Kerkelä, M., Miettunen, J., Auvinen, J., Järvelin, M.-R., Jones, P. B., Gissler, M., & Veijola, J. (2023). Insulin resistance and lipid levels in the middle-aged offspring of parents with severe mental illness. Schizophrenia Research, 252, 271–278. https://doi.org/10.1016/j.schres.2023.01.013Rinnakkaistallennettu versioProtsenko, M., Kerkelä, M., Miettunen, J., Auvinen, J., Järvelin, M.-R., Gissler, M., & Veijola, J. (2020). Mortality by diseases and medical conditions in the offspring of parents with severe mental illness. Social Psychiatry and Psychiatric Epidemiology, 55(12), 1649–1657. https://doi.org/10.1007/s00127-019-01781-zRinnakkaistallennettu versioAcademic dissertation to be presented with the assent of the Doctoral Programme Committee of Health and Biosciences of the University of Oulu for public defence in Auditorium 1, Building PT1 of the Department of Psychiatry (Peltolantie 17), on 15 September 2023, at 12 noonAbstract
Parental severe mental illness (SMI) may affect offspring physical health outcomes in multiple ways. Offspring of parents with SMI are at higher risk of developing mental illness. The impact of parental SMI on offspring’s cardiometabolic health and mortality by diseases and medical conditions is still poorly understood.
This study aimed to examine cardiometabolic morbidity in middle-aged offspring of parents with SMI. The following cardiometabolic disorders were used as outcome measures: diabetes mellitus, hypertension, hyperlipidaemia, coronary artery disease, obesity and cerebrovascular disorders. The study also examined cardiometabolic risk factors including glucose levels, lipid levels, insulin levels and insulin resistance. Another aim of the study was to investigate mortality by diseases and medical conditions in offspring of parents with SMI. The follow-up time was 49 years. The study determined if the risk of mortality by diseases and medical conditions increased among offspring of individuals with SMI compared to a comparison group. The hypothesis was that offspring of people with severe mental disorders have increased cardiometabolic morbidity risk and mortality risk by diseases and medical conditions. The study was prospective with data from both clinical examination and registers. Participants were from unselected population-based birth cohort: The Northern Finland Birth Cohort 1966 (n=12,231).
Offspring of parents with SMI had increased cardiometabolic morbidity risk. Male offspring had elevated risk of coronary artery disease, hyperlipidaemia, obesity and hypertension. Offspring of parents with SMI had increased risk for obesity, especially offspring of mothers with SMI. Female offspring of parents with SMI had partly increased risk for disturbances in cardiometabolic risk factors. They had increased risk for higher glucose level and waist circumference. Offspring of parents with SMI had no increased risk for mortality by diseases and medical conditions. In fact, the risk for dying in the group of offspring of fathers with SMI was lower than in the comparison group. The study concludes that parental SMI has a noteworthy effect on offspring physical health. However, the impact of parental SMI on offspring physical health is complex issue.Tiivistelmä
Vanhempien vakava mielenterveyden häiriö (SMI) voi vaikuttaa jälkeläisten fyysiseen terveyteen monin eri tavoin. Vakavaa mielenterveydenhäiriötä sairastavien vanhempien jälkeläisillä on suurempi riski sairastua psykiatrisiin sairauksiin. Vanhempien vakavan mielenterveyden häiriön vaikutus jälkeläisten kardiometaboliseen terveyteen ja tautikuolleisuuteen on kuitenkin heikosti ymmärretty.
Tämän tutkimuksen tavoitteena oli tutkia vakavaa mielenterveyden häiriötä sairastavien vanhempien keski-ikäisten jälkeläisten kardiometabolista sairastavuutta. Seuraavia kardiometabolisia häiriöitä käytettiin tulosmuuttujina: diabetes mellitus, verenpainesairaudet, rasva-aineenvaihdunnan häiriöt, iskeemiset sydänsairaudet, lihavuus ja aivoverenkierron sairaudet. Tutkimuksessa tarkasteltiin myös kardiometabolisia riskitekijöitä, mukaan lukien glukoositaso, lipiditaso, insuliinitaso ja insuliiniresistenssi. Tutkimuksen tavoitteena oli selvittää myös vakavaa mielenterveyden häiriötä sairastavien vanhempien jälkeläisten tautikuolleisuutta. Seuranta-aika oli 49 vuotta. Hypoteesina oli, että vakavaa mielenterveydenhäiriötä sairastavien vanhempien jälkeläisillä on suurentunut kardiometabolisten sairauksien riski ja suurentunut kuolleisuusriski. Tutkimus oli prospektiivinen kliinisistä tutkimuksista ja rekistereistä saatuun dataan perustuva. Osallistujat olivat valikoimattomasta väestöpohjaisesta syntymäkohortista: Pohjois-Suomen syntymäkohortti 1966:sta (n=12,231).
Vakavaa mielenterveyden häiriötä sairastavien vanhempien jälkeläisillä oli suurentunut riski kardiometabolisiin sairauksiin. Vakavaa mielenterveydenhäiriötä sairastavien vanhempien miespuoleisilla jälkeläisillä oli suurentunut iskeemisen sydänsairauden, hyperlipidemian, lihavuuden ja verenpainetaudin riski. Lihavuuden riski oli kohonnut vaikeaa mielenterveyden häiriötä sairastavien vanhempien jälkeläisillä, erityisesti äitien. Vakavaa mielenterveydenhäiriötä sairastavien vanhempien naispuoleisilla jälkeläisillä oli osittain lisääntynyt riski häiriöihin kardiometabolisissa riskitekijöissä. Heillä oli lisääntynyt riski korkeampaan glukoositasoon ja suurentuneeseen vyötärönympärykseen. Tautikuolleisuus ei ollut suurentunut vakavaa mielenterveydenhäiriötä sairastavien vanhempien jälkeläisillä. Itse asiassa tautikuolleisuusriski oli pienentynyt vakavaa mielenterveydenhäiriötä sairastavien isien jälkeläisillä. Tutkimuksessa todetaan, että vanhemman vaikealla mielenterveydenhäiriöllä on huomattava vaikutus jälkeläisten fyysiseen terveyteen. Vanhemman vaikean mielenterveyden häiriön vaikutus jälkeläisten fyysiseen terveyteen on kuitenkin monimutkainen kysymys
LIMITATIONS AND DEFICIENCIES OF PHARMACO-ECONOMIC STUDIES IN THE RUSSIAN FEDERATION COMMENTS TO THE ARTICLE OF S. L. PLAVINSKIY ET AL. «PHARMACOECONOMIC ANALYSIS OF THE IMPACT ON THE BUDGET COSTS OF ADDING DEXMEDETOMIDINE (DEXDOR) INTO THE LIST OF VITAL AND ESSENTIAL DRUGS»
No full textN-terminal Pro-B-Type Natriuretic Peptide is a Myocardial Biomarker in Pulmonary Sepsis and Septic Shock
No full textThe objective: to study changes and prognostic significance of the blood NT-proBNP in the patients with pulmonary sepsis.Subjects and Methods. The study included 34 patients aged 54.5 ± 2.9 years with pulmonary sepsis or septic shock. Lethality in the intensive care unit (ICU) was 47.1%. NT-proBNP, procalcitonin (PCT) levels, blood lactate and hemodynamic parameters were registered on the 1st day (stage 1) and on the 4th-5th day of the ICU stay (stage 2). Hemodynamics was assessed through transpulmonary thermodilution. The differences were considered statistically significant at p < 0.05.Results: At stage 1, NT-proBNP level was 5,220 [1,380‒17,850] pg/ml, did not decrease (p = 0.726) at stage 2 and amounted to 1,760 [631‒847] pg/ml. At stage 1, NT-proBNP correlated with extravascular lung water index (rho = 0.445; p = 0.038) and systolic pulmonary artery pressure (rho = 0.414; p = 0.023). At stage 2, NT-proBNP correlated with PCT (rho = 0.569; p = 0.003), blood lactate (rho = 0.525; p = 0.001), and mean arterial pressure to norepinephrine dosage ratio (rho = -0.422; p = 0.035). At stage 1, NT-proBNP was no predictor of lethality in the ICU: OR 1.0000; 95% CI 1.0000-1.0001. At stage 2, NT-proBNP > 4,260 pg/ml (sensitivity 87.5%, specificity 94.4%) was a predictor of lethality: OR 1.0004, 95% CI 1.0000-1.0008, p = 0.046 (AUC 0.893, 95% CI 0.732-0.974). Any increase of NT-proBNP level (> 0 pg/ml) between stages 2 and 1 was a predictor of lethality (sensitivity 87.5%, specificity 94.4%): OR 119.0, 95% CI 9.7432‒1,453.4241, p = 0.0002 (AUC 0.903, 95% CI 0.751-0.977).Conclusion: Patients with pulmonary sepsis are characterized by a significant increase of blood NT-proBNP. At stage 1, the biomarker correlated with pulmonary hypertension and moderate pulmonary edema and was no predictor of lethality. At stage 2, NT-proBNP correlated with the indices of infection and sepsis severity (procalcitonin, blood lactate, and mean arterial blood pressure/norepinephrine dosage ratio). At this stage, NT-proBNP levels greater than 4,000 pg/mL and/or any degree of increase in blood levels of the biomarker were both sensitive and specific predictors of a lethal outcome. Specific features of etiopathogenesis of BNP hyperproduction in pulmonary sepsis make it difficult to interpret the elevation of NT-proBNP as an indicator of septic cardiomyopathy but does not reduce its value as a sensitive and specific predictor of lethality
Levosimendan Hemodynamic Effects Depending on the Outcome of Sepsis
No full textThe objective: to study hemodynamic and clinical effects of levosimendan depending on the clinical outcome in patients with sepsis and impaired cardiac pumping function.Subjects and Methods. the retrospective study involved 31 patients of 52.7 ± 2.8 years old with sepsis or septic shock which were treated with levosimendan at the dose of 0.16 [0.15‒0.17] mg/kg (0.11 [0.1‒0.12] μg × kg-1 × min-1) on days 1–4 of ICU stay. The patients were divided into the following groups: Group 1 ‒ survivors (n = 19) and Group 2 – non-survivors (n = 12). Central hemodynamics was assessed through transpulmonary thermodilution. The differences were considered statistically significant at p < 0.05.Results. Most of the hemodynamic parameters and vasopressors and inotropes doses had no differences between the groups before levosimendan administration. There were no differences in the cardiac index (3.8 ± 0.3 vs 3.5 ± 0.3 L/min/m2; p = 0.479) between the groups following levosimendan administration, however, Group 1 demonstrated the following parameters to be lower versus Group 2: central venous pressure (7 ± 0.7 vs 11 ± 1 mm Hg; p = 0.005), blood lactate (1 [0.9‒1.8] vs 2.4 [2.2‒3.3] mmol/L; p = 0.04), norepinephrine dosages (0.2 [0.15‒0.35] and 0.5 [0.4‒0.6] ng/kg/min; p = 0.023 ), global end-diastolic volume index (693 [688‒28] vs 870 [779‒961] mL/m2; p =0,0009) and the level of NT-proBNP (1,590 [1,080‒3,160] vs 35,000 [21,400‒35,000] pg/mL; p = 0,0001). Global heart ejection fraction (23 [21‒27] vs 15 [12‒20]%; p = 0.015) and heart function index (6 [5‒8] vs 3 [ 3-4] min-1; p = 0.003) ) were higher in Group 1 versus Group 2. APACHE II >19 (AUC 0.906; p < 0.0001), SOFA > 9 (AUC 0.805; p = 0.0002); heart rate > 114 min-1 (AUC 0.755; p = 0.0095), and index of total peripheral vascular resistance < 1,700 dyn × s × cm-5 × m2 (AUC 0.806; p = 0.001) before levosimendan administration were the independent predictors of death in patients treated with levosimendan.Conclusion: non-survivors patients with sepsis had significantly higher APACHE II and SOFA scores, higher heart rate and lower index of total peripheral vascular resistance before levosimendan infusion. In survivors levosimendan infusion at a standard dose led to a significant improvement in the heart pumping function accompanying by global heart ejection fraction and heart function index increasing and NT-proBNP decreasing. In non-survivors such favorable central hemodynamics changes did not occur, although the cardiac index increased after inodilator administration. Further studies of levosimendan efficacy in patients with sepsis of varying severity are advisable. It is necessary to specify the indications and contraindications for levosimendan administration to patients with sepsis
ОГРАНИЧЕНИЯ И НЕДОСТАТКИ ФАРМАКОЭКОНОМИЧЕСКИХ ИССЛЕДОВАНИЙ В РОССИЙСКОЙ ФЕДЕРАЦИИ. КОММЕНТАРИЙ К СТАТЬЕ С. Л. ПЛАВИНСКОГО И ДР. «ФАРМАКОЭКОНОМИЧЕСКИЙ АНАЛИЗ ВЛИЯНИЯ НА БЮДЖЕТНЫЕ РАСХОДЫ ВКЛЮЧЕНИЯ ДЕКСМЕДЕТОМИДИНА (ДЕКСДОР) В СПИСОК ЖИЗНЕННО НЕОБХОДИМЫХ И ВАЖНЕЙШИХ ЛЕКАРСТВЕННЫХ ПРЕПАРАТОВ»
No full textIsolation and phylogenetic analysis of SARS-CoV-2 variants collected in Russia during the COVID-19 outbreak
No full textObjectives: The outbreak of coronavirus disease 2019 (COVID-19) started in December 2019 in China and then spread worldwide over the following months, involving 188 countries. The objective of this study was to determine the molecular epidemiology of the COVID-19 outbreak in Russia. Methods: In this study, two severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains were isolated and genetically characterized. A phylogenetic analysis of all available Russian sequences was then performed and these were compared to the epidemiological data on COVID-19 incidence to evaluate the molecular epidemiology and pattern of virus spread in the territory of Russia. Results and conclusions: Whole genome analysis of the isolates obtained in this study and 216 others isolated in Russia revealed a set of seven common mutations when compared to the original Wuhan virus, including amino acid substitutions in spike protein S and nucleoprotein N, possibly affecting their properties. Phylogenetic analysis of all Russian sequences and 8717 sequences from other countries showed multiple importations of the virus into Russia, local circulation, and several patterns of virus spread. © 2020 The Author(s
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