Race to the Summit: Impact of a Social Media-based Exercise Competition on Physician Physical, Psychological, and Emotional Well-being

Background In the wake of the COVID-19 pandemic and with increasing non-clinical demands on physician time and effort, the health care community is experiencing disproportionate rates of burnout. Oncologists, specifically, frequently endure challenging situations of caring for terminally ill patients who require emotional support along with intricate medical care. In response, various well-being initiatives for physicians have emerged, predominantly focusing on education or wellness opportunities. However, most these programs are institution-based and not accessible to the physician community as a whole. The effect of physical exercise, particularly team-based activity, on physician well-being and burnout has been postulated but not rigorously studied. We therefore seek to formally investigate whether team-based exercise programs can facilitate collective well-being by enabling physicians to address burnout collectively rather than individually. Methods This prospective study will involve the two-month voluntary team-based multi-sport competition, ACRO Race to the Summit, which will track total exercise minutes logged across various forms of physical activities during the racing period of January 1st, 2023- February 28th, 2023. A pre/post survey design will be used to investigate the potential impact of such collective activity on radiation oncology physician well-being. Included in both surveys, a set of 25 multiple-choice questions based on the validated Stanford Medicine well-being survey and the IPAQ (International Physical Activity Questionnaire) will focus on physical activity level and psychological and emotional well-being in the work place. The post-race survey will include additional questions meant to evaluate participants' perceived impact of the competition on these categories. Results Primary endpoints will assess change in pre- and post-survey metrics related to level of physical activity, and psychological and emotional well-being at work. Secondary endpoints will examine perceived value of team-based exercise in cultivating well-being. Discussion We anticipate that the results from this survey may inform commentary on the role of collective, inclusive exercise as a tool to combat physician burnout. Moreover, the study may provide insight into existing trends in physical activity, and psychological and emotional well-being in the radiation oncology community. Formation of and investment in non-institution, non-work related teams may prove to be a unique means of addressing burnout by strengthening a sense of community within the field as a whole.

Evaluating the Utility of Webinars Discussing the Radiation Oncology Residency Application Process in the COVID-19 Era

Background Since the start of the COVID-19 pandemic, the number of digital resources available for medical students (MS) interested in radiation oncology (RO) has increased. Here, we evaluated the utility of webinars focused on educating MS about the RO residency application process. Methods The American College of Radiation Oncology hosted webinars in 2021 and 2022 prior to the Electronic Residency Application Service (ERAS) application deadline. For each webinar, program directors gave short presentations about the ERAS application, interviews, and program ranking, and concluded with question and answer session. Participant demographics were collected using live poll questions and understanding was assessed using a Likert scale (range 1 [no, not at all] to 4 [yes, definitely]). Recordings were available online for asynchronous viewing. Differences between groups were assessed using Chi-square statistics. Results Between both webinars, there were a total of 69 participants and 170 asynchronous views. A total of 86% and 71% of participants answered the demographics and understanding questions, respectively. The majority attended medical school within the US (75%), were in their third/fourth year (70%), graduating with an M.D. degree (88%), and planned to apply to RO residency (78%). In terms of baseline knowledge of the application process, 49% believed they knew "a lot," while 51% believed they knew "a little" or "nothing." The majority of participants noted the webinar improved their understanding of the general application process (mean 3.80), the ERAS application (mean 3.65), and the interview process (mean 3.90). For a subset of participants (n=39), survey results were stratified by baseline understanding of the application process ("a little" versus "a lot"). Compared to participants who knew "a lot" about the application process, those that knew "a little" about the process reported higher scores in general understanding (mean 3.80 versus 3.60), ERAS application (mean 3.72 versus 3.50), and interview process (mean 3.93 versus 3.8). However, these differences were not statistically significant. Discussion As the number of digital resources in RO increases, we must examine whether they meet the needs of their target audience. Webinars can improve MS understanding of the RO residency application process. These webinars were an ideal format to educate MS about this process because they utilized both attending and resident physicians - two sources of information considered highly trustworthy by MS. Given the recent decline in applications to RO, engaging with MS through dedicated webinars warrants continued exploration.

Online medical education: A student survey.

BACKGROUND: During COVID-19, medical schools transitioned to online learning as an emergency response to deliver their education programmes. This multi-country study compared the methods by which medical schools worldwide restructured the delivery of medical education during the pandemic. METHODS: This multi-country, cross-sectional study was performed using an internet-based survey distributed to medical students in multiple languages in November 2020. RESULTS: A total of 1,746 responses were received from 79 countries. Most respondents reported that their institution stopped in-person lectures, ranging from 74% in low-income countries (LICs) to 93% in upper-middle-income countries. While only 36% of respondents reported that their medical school used online learning before the pandemic, 93% reported using online learning after the pandemic started. Of students enrolled in clinical rotations, 89% reported that their rotations were paused during the pandemic. Online learning replaced in-person clinical rotations for 32% of respondents from LICs versus 55% from high-income countries (HICs). Forty-three per cent of students from LICs reported that their internet connection was insufficient for online learning, compared to 11% in HICs. CONCLUSIONS: The transition to online learning due to COVID-19 impacted medical education worldwide. However, this impact varied among countries of different income levels, with students from LICs and lower middle income countries facing greater challenges in accessing online medical education opportunities while in-person learning was halted. Specific policies and resources are needed to ensure equitable access to online learning for medical students in all countries, regardless of socioeconomic status.

Viral Dynamics and Factors Favouring the Duration of Covid-19 Positivity in Cameroon

Background: Evolution evidence of Coronavirus disease 2019 (COVID-19) and viral clearance time remains limited in tropical settings. Understanding this is crucial for public health control measures at community-level. We evaluated the viral dynamics of SARS-CoV-2 infection and factors associated with positivity duration in COVID-19 cases in Cameroon. Method(s): We conducted a prospective cohort-study of SARS-CoV-2 positive cases from the first to third wave (March 2020-October 2021) in Yaounde- Cameroon. RT-PCR was performed on nasopharyngeal swabs. SARS-CoV-2 positivity duration was evaluated from the first to last positive test before a negative result. Epi-info V.7.0 was used for data analyses with p< 0.05 considered statistically significant Results: A total of 282 participants were enrolled. The mean age was 41+/-14 years, with male predominant (62.1%). We had 15.6% symptomatic cases and cough most common (59.09%). The overall median positivity duration was 15[IQR: 9-23] days with 15[ IQR: 13-16] in the first, 17[ IQR: 11-26] in the second and 8[ IQR: 4-12] in the third wave (p= 0.007). Positivity duration was significantly higher in males (16 versus 14 days, p=0.03) and people aged >40 years (15 versus 14 days, p=0.02). Positivity duration was not affected by presence or absence of symptoms (p=0.80). No significant correlation was found with viral load (r=0.03;p=0.61). Considering baseline (24.7+/-7.2Ct) and last viral load (29.3+/-5.9 Ct), the DELTACt (4.6+/-1.3) and positivity duration (15 days) revealed a kinetic in viral decay of 0.3+/-0.087 Ct/day. Conclusion(s): A median positivity duration of 15 days is in accordance with viral clearance around 2 weeks for optimal confinement at community-level. Men and/or the elderly stand at higher risk of prolonged infection. Given the viral decay (0.3 Ct daily), we suggest personalized confinement periods. The variability of positivity duration according to phases could be function of strains which could be a factor of positivity duration.

Impact of COVID-19 on cardiac autonomic function in healthy young adults: potential role of symptomatology and time since diagnosis.

Emerging evidence suggests that COVID-19 may affect cardiac autonomic function; however, the limited findings in young adults with COVID-19 have been equivocal. Notably, symptomology and time since diagnosis appear to influence vascular health following COVID-19, but this has not been explored in the context of cardiac autonomic regulation. Therefore, we hypothesized that young adults who had persistent symptoms following COVID-19 would have lower heart rate variability (HRV) and cardiac baroreflex sensitivity (BRS) compared with those who had COVID-19 but were asymptomatic at testing and controls who never had COVID-19. Furthermore, we hypothesized that there would be relationships between cardiac autonomic function measures and time since diagnosis. We studied 27 adults who had COVID-19 and were either asymptomatic (ASYM; n = 15, 6 females); 21 ± 4 yr; 8.4 ± 4.0 wk from diagnosis) or symptomatic (SYM; n = 12, 9 females); 24 ± 3 yr; 12.3 ± 6.2 wk from diagnosis) at testing, and 20 adults who reported never having COVID-19 (24 ± 4 yr, 11 females). Heart rate and beat-to-beat blood pressure were continuously recorded during 5 min of rest to assess HRV and cardiac BRS. HRV [root mean square of successive differences between normal heartbeats (RMSSD); control, 73 ± 50 ms; ASYM, 71 ± 47 ms; and SYM, 84 ± 45 ms; P = 0.774] and cardiac BRS (overall gain; control, 22.3 ± 10.1 ms/mmHg; ASYM, 22.7 ± 12.2 ms/mmHg; and SYM, 24.3 ± 10.8 ms/mmHg; P = 0.871) were not different between groups. However, we found correlations with time since diagnosis for HRV (e.g., RMSSD, r = 0.460, P = 0.016) and cardiac BRS (overall gain, r = 0.470, P = 0.014). These data suggest a transient impact of COVID-19 on cardiac autonomic function that appears mild and unrelated to persistent symptoms in young adults.NEW & NOTEWORTHY The potential role of persistent COVID-19 symptoms on cardiac autonomic function in young adults was investigated. We observed no differences in heart rate variability or cardiac baroreflex sensitivity between controls who never had COVID-19 and those who had COVID-19, regardless of symptomology. However, there were significant relationships between measures of cardiac autonomic function and time since diagnosis, suggesting that COVID-19-related changes in cardiac autonomic function are transient in young, otherwise healthy adults.

Power of pedaling: Physician well-being as a collaborative effort in social media-based cycling

The impact of the COVID-19 pandemic on the lives of radiation oncologists, from the attending to trainee level, has been multifactorial. One such notable shift has been the limitation of colleague interactions to Zoom-type calls for over two years. Moreover, work-related stress has significantly risen largely due to additional and increasingly complex patient management secondary to COVID-related precautions. As part of the run-up to the ACRO 2022 Annual Meeting, we initiated a friendly competition utilizing a social media-based cycling platform to promote physician well-being as part of #TOURdeACRO. The goal was to support both formation of new connections and strengthening of existing ones between colleagues. Team members were solicited via email, social media, the ACRO websites, and word of mouth. #TOURdeACRO occurred between 1/1/2022 and 2/28/2022. Team members competed based on the number of miles they completed using a social media-based cycling platform. Participants were asked to post their rides on social media platforms so that other Team Members could view the rides and offer positive encouragement. Interval updates were given to encourage friendly competition and reinforce continued investment of teammates in one another's progress. At the Annual meeting, all Team Members were given an official ACRO Racing Jersey to strengthen the unified team culture. A total of 7 female and 5 male team members participated, including3 resident physicians and 9 attending physicians. Female riders were significantly more productive than male riders, as evident by total combined mileage. The overall winner was determined on the last day of the #TOURdeACRO. The top three productive team members produced 1066 miles, 834 miles, and 787 miles over the two months. Eight riders reported significant increases in weekly and monthly mileage over their baseline in preceding months. A social media-based cycling platform was useful and effective in creating and fostering a team culture for a demographically diverse group of radiation oncology physicians. Moving forward, additional riders will be recruited and other social media-based platforms that involve exercise (other than cycling) will be explored to further strengthen this inclusive team environment to enhance physician well-being. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

A Validation Study on a Sputum Home Collection Method with Immediate Freezing and Delayed Processing: Impact on Proteomic, Mucin and RNA/DNA Endpoints

Introduction: Due to Covid-19 restrictions on collecting and processing sputum samples in real time in clinic, we designed a novel sputum home collection method with immediate freezing and delayed processing (“home”). A validation study was carried out to compare key sputum endpoints using the “home” vs “real time (RT)” collection and processing methods. Sputum soluble phase proteomics, mucins and RNA/DNA endpoints were measured and compared between the 2 methods to assess the validity of the “home” method. Methods: Spontaneous sputum samples were collected from N=10 healthy adult volunteers. Each sample was split evenly by weight and processed, half by the “home” method and half by the RT method. Home method samples were first aliquoted into 3 collection tubes (T) as follows: T1: 100-250mg for mucin analysis (refractive index, gel chromatography, and CsCl gradients);T2 and T3: equal weights each, T2 for proteomic analysis (MesoScale Discovery) and T3 for RNA/DNA analysis (Isohelix collection kit). Each was immediately frozen at -20 deg C (24-48hr), then at -80 deg C (2-4 weeks) without any processing. Thawed home T1 and T2 samples were processed by treating with 8M Urea (1:1) to deactivate SARS-CoV-2 if present. T1 was then stored at 2-4 deg C, and T2 was processed with 7x DPBS, centrifuged and recovered supernatants stored at -80 deg C. In contrast, the RT sputum was first treated with 8M Urea (1:1) soon after collection, and then processed for mucins and proteomics per the “home” method above. The remaining cell pellet from the RT processed sample was stored in Zymo research RNA/DNA shield (0.5ml) and, along with home T3 samples, extracted and analyzed for qualitative and quantitative yield, as well as for genes of interest. Paired T-Test analysis compared all sputum endpoints between the home and RT method. Results: There were no statistically significant differences (p<0.05) between the home and RT method for any mucin (MUC5B, MUC5AC, MUC5AC:MUC5B ratio, total mucin) or proteomic endpoint (IL-1a, IL-6, IL-8, TNFalpha, TIMP1, TIMP2, MMP-9, CRP, MPO). In addition, except for CRP and MUC5AC, correlation between sample pairings was strong (correlation coefficient R, range = 0.5-0.9) and statistically significant (p<0.05) for all sputum endpoints. RNA/DNA results are still pending. Conclusion: The sputum “home collection method with immediate freezing and delayed processing” does not result in significantly different proteomic and mucin measurements when compared to the same samples being processed in real time in an identical manner.

Impact of breakthrough COVID-19 cases during the omicron wave on vascular health and cardiac autonomic function in young adults.

We and others have previously shown that COVID-19 results in vascular and autonomic impairments in young adults. However, the newest variant of COVID-19 (Omicron) appears to have less severe complications. Therefore, we investigated whether recent breakthrough infection with COVID-19 during the Omicron wave impacts cardiovascular health in young adults. We hypothesized that measures of vascular health and indices of cardiac autonomic function would be impaired in those who had the Omicron variant of COVID-19 when compared with controls who never had COVID-19. We studied 23 vaccinated adults who had COVID-19 after December 25, 2021 (Omicron; age, 23 ± 3 yr; 14 females) within 6 wk of diagnosis compared with 13 vaccinated adults who never had COVID-19 (age, 26 ± 4 yr; 7 females). Macro- and microvascular function were assessed using flow-mediated dilation (FMD) and reactive hyperemia, respectively. Arterial stiffness was determined as carotid-femoral pulse wave velocity (cfPWV) and augmentation index (AIx). Heart rate (HR) variability and cardiac baroreflex sensitivity (BRS) were assessed as indices of cardiac autonomic function. FMD was not different between control (5.9 ± 2.8%) and Omicron (6.1 ± 2.3%; P = 0.544). Similarly, reactive hyperemia (P = 0.884) and arterial stiffness were not different between groups (e.g., cfPWV; control, 5.9 ± 0.6 m/s and Omicron, 5.7 ± 0.8 m/s; P = 0.367). Finally, measures of HR variability and cardiac BRS were not different between groups (all, P > 0.05). Collectively, these data suggest preserved vascular health and cardiac autonomic function in young, otherwise healthy adults who had breakthrough cases of COVID-19 during the Omicron wave.NEW & NOTEWORTHY We show for the first time that breakthrough cases of COVID-19 during the Omicron wave does not impact vascular health and cardiac autonomic function in young adults. These are promising results considering earlier research showing impaired vascular and autonomic function following previous variants of COVID-19. Collectively, these data demonstrate that the recent Omicron variant is not detrimental to cardiovascular health in young, otherwise healthy, vaccinated adults.

Coordination of SARS-CoV-2 wastewater and clinical testing of university students demonstrates the importance of sampling duration and collection time.

Wastewater surveillance has been a useful tool complementing clinical testing during the COVID-19 pandemic. However, transitioning surveillance approaches to small populations, such as dormitories and assisted living facilities poses challenges including difficulties with sample collection and processing. Recently, the need for reliable and timely data has coincided with the need for precise local forecasting of the trajectory of COVID-19. This study compared wastewater and clinical data from the University of Delaware (Fall 2020 and Spring 2021 semesters), and evaluated wastewater collection practices for enhanced virus detection sensitivity. Fecal shedding of SARS-CoV-2 is known to occur in infected individuals. However, shedding concentrations and duration has been shown to vary. Therefore, three shedding periods (14, 21, and 30 days) were presumed and included for analysis of wastewater data. SARS-CoV-2 levels detected in wastewater correlated with clinical virus detection when a positive clinical test result was preceded by fecal shedding of 21 days (p< 0.05) and 30 days (p < 0.05), but not with new cases (p = 0.09) or 14 days of shedding (p = 0.17). Discretely collected wastewater samples were compared with 24-hour composite samples collected at the same site. The discrete samples (n = 99) were composited examining the influence of sampling duration and time of day on SARS-CoV-2 detection. SARS-CoV-2 detection varied among dormitory complexes and sampling durations of 3-hour, 12-hour, and 24-hour (controls). Collection times frequently showing high detection values were between the hours of 03:00 to 05:00 and 23:00 to 08:00. In each of these times of day 33% of samples (3/9) were significantly higher (p < 0.05) than the control sample. The remainder (6/9) of the collection times (3-hour and 12-hour) were not different (p > 0.05) from the control. This study provides additional framework for continued methodology development for microbiological wastewater surveillance as the COVID-19 pandemic progresses and in preparation for future epidemiological efforts.

Association between government policy and delays in emergent and elective surgical care during the COVID-19 pandemic in Brazil: a modeling study.

BACKGROUND: The impact of public health policy to reduce the spread of COVID-19 on access to surgical care is poorly defined. We aim to quantify the surgical backlog during the COVID-19 pandemic in the Brazilian public health system and determine the relationship between state-level policy response and the degree of state-level delays in public surgical care. METHODS: Monthly estimates of surgical procedures performed per state from January 2016 to December 2020 were obtained from Brazil's Unified Health System Informatics Department. Forecasting models using historical surgical volume data before March 2020 (first reported COVID-19 case) were constructed to predict expected monthly operations from March through December 2020. Total, emergency, and elective surgical monthly backlogs were calculated by comparing reported volume to forecasted volume. Linear mixed effects models were used to model the relationship between public surgical delivery and two measures of health policy response: the COVID-19 Stringency Index (SI) and the Containment & Health Index (CHI) by state. FINDINGS: Between March and December 2020, the total surgical backlog included 1,119,433 (95% Confidence Interval 762,663-1,523,995) total operations, 161,321 (95%CI 37,468-395,478) emergent operations, and 928,758 (95%CI 675,202-1,208,769) elective operations. Increased SI and CHI scores were associated with reductions in emergent surgical delays but increases in elective surgical backlogs. The maximum government stringency (score = 100) reduced emergency delays to nearly zero but tripled the elective surgical backlog. INTERPRETATION: Strong health policy efforts to contain COVID-19 ensure minimal reductions in delivery of emergent surgery, but dramatically increase elective backlogs. Additional coordinated government efforts will be necessary to specifically address the increased elective backlogs that accompany stringent responses.

Recovery of SARS-CoV-2 from Wastewater Using Centrifugal Ultrafiltration.

The COVID-19 pandemic is a global crisis and continues to impact communities as the disease spreads. Clinical testing alone provides a snapshot of infected individuals but is costly and difficult to perform logistically across whole populations. The virus which causes COVID-19, SARS-CoV-2, is shed in human feces and urine and can be detected in human waste. SARS-CoV-2 can be shed in high concentrations (>107 genomic copies/mL) due to its ability to replicate in the gastrointestinal tract of humans through attachment to the angiotensin-converting enzyme 2 (ACE-2) receptors there. Monitoring wastewater for SARS-CoV-2, alongside clinical testing, can more accurately represent the spread of disease within a community. This protocol describes a reliable and efficacious method to recover SARS-CoV-2 in wastewater, quantify genomic RNA levels, and evaluate concentration fluctuations over time. Using this protocol, viral levels as low as 10 genomic copies/mL were successfully detected from 30 mL of wastewater in more than seven-hundred samples collected between August 2020 and March 2021. Through the adaptation of traditional enteric virus methods used in food safety research, targets have been reliably detected with no inhibition of detection (RT-qPCR) observed in any sample processed. This protocol is currently used for surveillance of wastewater systems across New Castle County, Delaware.

Erratum to "Impact of COVID-19 on Future Ischemic Stroke Incidence" [eNeurologicalSci, 22C (2021) 100325].

[This corrects the article DOI: 10.1016/j.ensci.2021.100325.].

Failure of Anticoagulation to Prevent Stroke in Context of Lupus-Associated Anti-Phospholipid Syndrome and Mild COVID-19.

Hypercoagulability and virally-mediated vascular inflammation have become well-recognized features of the SARS-CoV-2 virus infection, COVID-19. Of growing concern is the apparent ineffectiveness of therapeutic anticoagulation in preventing thromboembolic events among some at-risk patient subtypes with COVID-19. We present a 43-year-old female with a history of seropositive-antiphospholipid syndrome and systemic lupus erythematosus who developed an acute ischemic stroke in the setting of mild COVID-19 infection despite adherence to chronic systemic anticoagulation. The clinical significance of SARS-CoV-2-mediated endothelial cell dysfunction and its potential to cause macrovascular events in spite of full anticoagulation warrants further investigation and likely represents another disease-defining pathology of COVID-19.

Impact of COVID-19 on Future Ischemic Stroke Incidence.

With the ever-expanding population of patients infected with SARS-CoV-2, we are learning more about the immediate and long-term clinical manifestations of coronavirus disease 2019 (COVID-19). Ischemic stroke (IS) is now one of the well-documented additional clinical manifestations of COVID-19. Most COVID-19 related IS cases have been categorized as cryptogenic or embolic stroke of undetermined source (ESUS), which are most often suspected to have an undiagnosed cardioembolic source. COVID-19 is known to also cause cardiac dysfunction, heart failure, and atrial arrhythmias (AA), but the long-term impact of this cardiac dysfunction on stroke incidence is unknown. With millions afflicted with COVID-19 and the ever-rising infection rate, it is important to consider the potential long-term impact of COVID-19 on future IS incidence. Accomplishing these goals will require novel strategies that allow for diagnosis, data capture, and prediction of future IS risk using tools that are adaptable to the evolving clinical challenges in patient care delivery and research.

Preserving stroke care during the COVID-19 pandemic: Potential issues and solutions.

The coronavirus 2019 (COVID-19) pandemic requires drastic changes in allocation of resources, which can affect the delivery of stroke care, and many providers are seeking guidance. As caregivers, we are guided by 3 distinct principles that will occasionally conflict during the pandemic: (1) we must ensure the best care for those stricken with COVID-19, (2) we must provide excellent care and advocacy for patients with cerebrovascular disease and their families, and (3) we must advocate for the safety of health care personnel managing patients with stroke, with particular attention to those most vulnerable, including trainees. This descriptive review by a diverse group of experts in stroke care aims to provide advice by specifically addressing the potential impact of this pandemic on (1) the quality of the stroke care delivered, (2) ethical considerations in stroke care, (3) safety and logistic issues for providers of patients with stroke, and (4) stroke research. Our recommendations on these issues represent our best opinions given the available information, but are subject to revision as the situation related to the COVID-19 pandemic continues to evolve. We expect that ongoing emergent research will offer additional insights that will provide evidence that could prompt the modification or removal of some of these recommendations.