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Background: The COVID-19 pandemic adversely disrupted global health service delivery. We aimed to assess impact of the pandemic on same-day HIV diagnosis/ART initiation, six-months non-retention and initial virologic non-suppression (VnS) among individuals starting antiretroviral therapy (ART) in Kenya. Methods: Individual-level longitudinal service delivery data were analysed. Random sampling of individuals aged >15 years starting ART between April 2018 - March 2021 was done. Date of ART initiation was stratified into pre-COVID-19 (April 2018 - March 2019 and April 2019 - March 2020) and COVID-19 (April 2020 - March 2021) periods. Mixed effects generalised linear, survival and logistic regression models were used to determine the effect of COVID-19 pandemic on same-day HIV diagnosis/ART initiation, six-months non-retention and VnS, respectively. Results: Of 7,046 individuals sampled, 35.5%, 36.0% and 28.4% started ART during April 2018 - March 2019, April 2019 - March 2020 and April 2020 - March 2021, respectively. Compared to the pre-COVID-19 period, the COVID-19 period had higher same-day HIV diagnosis/ART initiation (adjusted risk ratio [95% CI]: 1.09 [1.04-1.13], p<0.001) and lower six-months non-retention (adjusted hazard ratio [95% CI]: 0.66 [0.58-0.74], p<0.001). Of those sampled, 3,296 (46.8%) had a viral load test done at a median 6.2 (IQR, 5.3-7.3) months after ART initiation. Compared to the pre-COVID-19 period, there was no significant difference in VnS during the COVID-19 period (adjusted odds ratio [95% CI]: 0.79 [95% CI: 0.52-1.20], p=0.264). Conclusions: In the short term, the COVID-19 pandemic did not have an adverse impact on HIV care and treatment outcomes in Kenya. Timely, strategic and sustained COVID-19 response may have played a critical role in mitigating adverse effects of the pandemic and point towards maturity, versatility and resilience of the HIV program in Kenya. Continued monitoring to assess long-term impact of the COVID-19 pandemic on HIV care and treatment program in Kenya is warranted.
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INTRODUCTION AND OBJECTIVE: Infection control practices and public policy in response to the COVID-19 pandemic shifted healthcare practices towards a telemedicine format. Even two years after peak onset of the pandemic, many clinics, including our own institution, maintain a working telehealth option for patient visits, with some patients even preferring this modality of care delivery. Our objective was to evaluate patient utilization of telehealth visits versus inperson visits at our institution and whether this was impacted by demographics, medical history, and socioeconomic factors. METHOD(S): Medical Record Numbers for all patients with bladder cancer were pulled via accessible billing-level data from the period 7/1/2019-2/28/2022. Chart review was conducted to pull clinical data on patients including telehealth versus in person visits, demographic data, clinical stage, comorbidities (diabetes, smoking status, BMI), rural/urban status by zip code (>50,000, <50,000 individuals) and income levels by zip code (25K-49.9K, 50K-99.9K, <100K), payor status, patient distance, and gas savings/carbon footprint. RESULT(S): 430 patients completed in person visits while 268 completed telehealth visits. There was no statistically significant difference for in person visits vs. telehealth visits regarding patients' race (p=0.541), ethnicity (p=0.394) age (p=0.862), urban/rural status (p=0.507), payor status (p=0.127), mean zip code income (p=0.175), and comorbidities (p=0.626 for diabetes, p=0.706 for smoking, p=0.459 for BMI), and clinical stage (p=0.07). There was a statistically significant difference in mean distance (14.85 miles versus 26.86 miles, p<0.01). CONCLUSION(S): Post-pandemic, telehealth usage and acceptability among patients with bladder cancer remains high. Patients' with bladder cancer receive care from their urologist via in person visits versus telehealth at similar rates irrespective of their urban/rural status, demographics, payor status, relevant comorbidities, or relative income. Patients are more likely to engage in care with their urologist via telehealth if they live farther from a large urban academic center, which produces an economical and environmental impact via gas/time savings and reduced carbon footprint.
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The COVID-19 pandemic has indirectly accelerated the lifestyle transition to a cashless society and the application of digital payment transactions. However, compared to existing digital payment channels, the acceptance of e-wallets among consumers in Malaysia is still minimal. Therefore, this study aims to identify factors affecting the consumers' intention to use e-wallets during the post-COVID-19 pandemic in Malaysia. The study integrates the Unified Theory of Acceptance and Use of Technology (UTAUT) and Mental Accounting Theory (MAT) models by considering additional factors of perceived benefit, perceived security, and trust. It uses the purposive sampling technique and collected 303 responses through a survey. Based on the PLS-SEM analysis, the findings indicate that perceived benefits, perceived security, trust, and social influence positively impact the intention to use e-wallets. Meanwhile, the effects of performance expectation and effort expectation are not significant. This study provides knowledge to the industry to understand consumer behaviour during post-pandemic to develop business strategies and digital payment applications such as by enhancing e-wallet design, content, system and features. © 2022 Authors. All rights reserved.
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This study is carried out to find novel active drug candidates which can effectively bind to key residues of main protease (Mpro) of SARS-CoV-2. We performed molecular docking of fifty-seven (57) ligands from two classes: vanillylacetone and its derivatives and beta-hydroxy ketone derivatives against Mpro of SARS-CoV-2. We also docked three antiviral drugs as reference/benchmark drugs including remdesivir (RDV), chloroquine (CQ), and hydroxychloroquine (HCQ) against Mpro for comparison of inhibition tendencies of selected ligands. Binding energies of our reference drugs are as: CQ = -5.1 kcal mol-1 (with predicted inhibition constant (Ki pred) = 177 mu mol), HCQ = -5.7 kcal mol-1 (Ki pred = 64.07 mu mol) and RDV -6.3 kcal mol-1 (Ki pred = 13.95 mu mol). We got remarkable results for our docked ligands as 79% of total ligands indicated binding energies better than CQ, 39 % better than both HCQ and CQ, and 19 % better than all reference drugs. More interestingly interaction analysis of eight best-docked ligands showed that they interacted with desired key residues of Mpro. We further selected the four best-docked ligands L1 = -6.6 kcal mol-1 (Ki pred=13.95 mu mol), L6 = -7.0 kcal mol-1 (Ki pred = 7.08 mu mol), L34 = -6.0 kcal mol-1 (Ki pred = 38.54 mu mol), and L50 = -6.6 kcal mol-1 (Ki pred=13.95 mu mol) for further analysis by quantum chemical study, molecular dynamic (MD) simulations and ADMET analysis. We have also carried out MD-simulations of six more docked ligand L2, L14, L20, L36, L46 and L48 some of which were showing weak binding affinities and some average binding affinities to check their simulation behavior. Their RMSD, RMSF and binding free energy results were also quite satisfying. We believe the current investigation will evoke the scientific community and highlights the potential of selected compounds for potential use as antiviral compounds against Mpro of SARS-CoV-2.
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Background Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopmental conditions in children, and with the coronavirus pandemic, ADHD children now pose obvious challenges. This retrospective prospective cohort study was conducted on 150 ADHD children and adolescents that had previously attended the child unit of the Psychiatry Department, Zagazig University Hospitals, Sharkia, Egypt, and diagnosed as ADHD patients using the research diagnostic criteria of DSM-5 which administrated by experienced psychiatrists and evaluated by The Arabic version of Conner's Parent Rating Scale Revised-short version (CPRS-48) before the onset of COVID-19 pandemic. We collected the other data of the study by applying an Arabic language questionnaire which included the data related to the COVID -19 pandemic and the Arabic version of CPRS-48 by which we reevaluated the behavioral symptoms of the subjects who participated in the study during COVID-19 pandemic. This research aimed to evaluate the behavioral symptoms among ADHD children and adolescents and detect the change in these symptoms during the COVID-19 pandemic by comparing them before and during the pandemic. Results One hundred fifty ADHD children were included in the study with a mean age of 10 years old. The male gender was predominant and represented 76.7% of the sample. Ninety percent were living in urban areas with more low social class (50%), 84.7% of parents were married, 60% of the family member of our subjects had COVID-19 while 12% lost one or more of their relative by the pandemic (64.7%). The fathers continued working as normal, while 40.7% of the mothers stopped working because of COVID-19. 62.7% of the parents were verbally and physically abusive to their children. Unfortunately, 100% of the subjects stopped attending their behavioral therapy center, 96.0% stopped their Follow up with a psychiatrist, and 55% stopped complying with their medications. As we presumed, we found a statistically significant change in the behavioral and psychological symptoms measured by Conner's Parent Rating Scale Revised-short version (CPRS-48) during the COVID-19 pandemic compared to the period before. The worsening of the symptoms was associated with age, sex, residency, social class, father and mother present working and couple status, having positive cases or losses of COVID-19 among family members, and patient maltreatment. Conclusions To conclude, this study suggests that the lockdown caused by the COVID-19 pandemic has worsened symptoms in a significant number of children and adolescents with ADHD, which needs clinical attention. Moreover, the patients' psychiatric follow-up and compliance with their medications were markedly affected. Additionally, the lockdown has also led to an increase in the abusive behavior of the parents towards their children.
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This is the first study to use discrete choice experiment in exploring the stated choice preference of blended learning preference among the university students in the context of Bangladesh. As a prerequisite in developing student engagement learning strategies, we investigate the choice preference of university students towards different types of blended learning to explore relevant concerns and challenges in order to plan for successful implementation of this option. Around 306 responses from the students belonging to Bangladesh University of Professionals (BUP) and North South University (NSU) are considered representing both public and private universities in Bangladesh. Conditional logit model is used to explore the choice preference of the respondents based on the attributes. We find that university students explicitly dislike recorded videos as the primary mode of instruction as there is minimum human interaction using this method. Students with mobile internet also prefer offline classes to online classes, whereas students with broadband internet prefer the opposite choices. The policy implications of these findings hold global relevance in devising student engagement strategies towards blended learning such as for other developing economies in South Asia which were forced to transition to online learning as an adaptation response to the COVID-19 pandemic. Practitioner Notes 1. This is the first study to use discrete choice experiment in exploring the stated choice preference of blended learning preference of the university students in the context of Bangladesh. 2. We apply Conditional logit model is used to explore the choice preference of the respondents based on the attributes. 3. Our sample includes 306 responses belonging to Bangladesh University of Professionals (BUP) and North South University (NSU). 4. We find that university students explicitly dislike recorded videos as the primary mode of instruction as there is minimum human interaction using this method. 5. Students with mobile internet also prefer offline classes to online classes, whereas students with broadband internet prefer the opposite choices.
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Objective: N/A Background: COVID-19 infection has been shown to be associated with a number of neurologic sequelae in the post-infection period. There have been rare cases of autoimmune neurologic disease associated with COVID-19 infection. Here we present a case of myelin oligodendrocyte glycoprotein (MOG)-associated encephalomyelitis two months after COVID-19 infection. Design/Methods: N/A Results: A 44-year old female presented to the hospital with progressive decline in mentation and fevers for 1 week. Three months prior, she tested positive for COVID-19 by nasopharyngeal PCR testing, had mild symptoms and recovered at home. On presentation, neurologic examination showed sensory level at T8, lower extremity hyperreflexia. and gait instability. MRI of the neuroaxis showed bilateral white matter lesions in the brain and longitudinal cord lesions at multiple cervical and thoracic spinal levels. CSF showed lymphocyte-predominant pleocytosis. Patient was diagnosed with encephalomyelitis and started on plasma exchange and high dose steroids on alternating days with improvement in her symptoms. Patient was positive for serum MOG antibody. She was discharged on a prolonged prednisone taper. Conclusions: This case highlights the importance of testing for MOG antibody disease in patients presenting with findings of brain and spinal cord lesions after COVID-19 infection. The course of MOG-associated antibody disease in post-COVID patients is unknown and warrants further investigation.
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Background: Unexpected postponement or delay in various treatment protocols during peak time of COVID-19 cause serious psychological trauma and obstacle to orthodontists and orthodontic patients as well. Objective: To evaluate depression and anxiety level of orthodontic patients during this chaos regarding their treatment even when the treatment was resumed. Study Design: Questionnaire-based cross-sectional study. Place and Duration of Study: Department of Orthodontics, Bacha Khan College of Dentistry, Mardan from 1st July 2021 to 31st December 2021. Methods: One hundred and sixty-six orthodontic patients were enrolled after taking informed consent from the patients. Data were taken in hard form and then later verbally translated into native language of this area. Numerical rating scale was used for psychological assessment and for the determination of anxiety level where 0 refers to no anxiety and 10 interprets extreme anxiety. Results: Ninety-three females and seventy-three males were present in this study. Conclusion: Severe anxiety level was reported and patients were greatly concerned about their health.
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Background: A thorough understanding of the inflammatory reaction to SARS-CoV-2 variants, specifically the Delta and Alpha variants, can provide crucial insight into future treatment of individuals infected with these strains. Mice are an effective model for predicting the pathologic processes of these viruses in humans. Design: K18-hACE2 transgenic mice were raised either under normal conditions (control) or infected with either the Alpha (strain B.1.1.7) or Delta (B.1.617.2) variant of SARS-CoV-2, via intranasal challenge with 1000 PFU virus. Mice were then euthanized at days 2 and 6 post-challenge. Lung sections were used for pathological evaluation of H&E stained slides scanned using the Dynamyx software. Blood vessel cross sections were examined and the average number of marginating inflammatory cells per millimeter of vessel were quantified. Additionally, the percentage of total tissue area that was inflamed was calculated. Results: Our data indicates that the Delta variant elicits a strong lymphocytic immune response in the lungs. At two days postchallenge, Inflammation and margination of inflammatory cells could be appreciated in Delta infected mice, but not in Alpha infected mice. The inflammatory infiltrate was composed predominantly of lymphocytes and occasional histiocytes at 2 days. By day 6, marked perivascular inflammation and margination was appreciated, more prominently in Delta (36 lymphocytes per mm. of endothelium) than Alpha infected mice (22 lymphocytes per mm. endothelium) (p=0.022). At this time point, Alpha infected mice showed 4% involvement of pulmonary area by inflammation, compared to 20% for Delta infected mice (p=0.014). Conclusions: This study quantifies the lymphocytic immune response in the lungs to the Alpha and Delta variants of SARS-CoV-2 in mouse models. Both variants showed a lymphocyte predominant inflammatory response. However, the response was much more robust and severe in Delta infected mice compared to Alpha. The results support why the Delta variant is more virulent and fatal compared to Alpha. Ongoing longer term studies and effects in other organs are ongoing and will help to provide further insight into pathogenesis of long COVID-19.
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How best to apply vaccines to a population is an open problem. It is trivial to derive intuitive strategies, but until tested, their efficacy i s n ot k nown. T his p roblem i s particularly challenging when considering the dynamics of social contact networks and their changes over time. A system for automatically discovering tested vaccination strategies with evolutionary computation has been improved upon to include additional graph metrics and to generate vaccination strategies for dynamic graphs, something that is expected of real social networks within communities. The system’s ability to generate effective strategies was demonstrated along with a comparison of the strategies developed when fit t o a s tatic g raph v ersus a d ynamic g raph. I t w as observed that the additional computational resources required to generate strategies on a dynamic graph may not be necessary as strategies developed for static graphs performed similarly well;however, the authors are careful to acknowledge that results may differ significantly w hen a djusting t he s ystems m any parameters. © IEEE 2021.
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INTRODUCTION: As the surge of COVID-19 continues, low resource settings such as Pakistan have encountered an acute shortage of ICU facilities and trained intensivists. The dearth of resources is apparent in the remote region of Northern Pakistan. Therefore, we established a tele-ICU consultation service model to address these concerns and leverage critical care capacity in these remote settings. METHODOLOGY: This study was conducted in Gilgit and Chitral secondary care hospital in Northern Pakistan. Gilgit is a 46-bedded hospital with 6 ventilators, and Chitral is a 25-bedded hospital with 3 ventilators in their ICU. The study duration is 1 year from July 2020 till June 2021. This is a centralised and decentralised hub-and-spoke tele-ICU model. The main hub is located in Aga Khan University Hospital (AKUH) in the metropolitan city Karachi. The distance from the main hub to the remote facilities is approximately 1800km. The tele-ICU followed a 24/7 Scheduled Care Model (periodic consultations on a predetermined time) and Responsive Care Model (unscheduled teleconsultations prompted by an alert) to provide care. The mode of communication is teleconference calls, video calls, and text messaging. This service is provided by 24/7 AKUH trained intensivists. Patient information such as demographics, clinical course, teleconsultation interventions, and management were obtained from these remote ICUs. RESULTS: A total of 157 patients presented to the tele-ICU from Pakistan's remote regions of Gilgit and Chitral. Of these, 60% were male (n=95). 86% (n=135) patients presented with COVID-19. 64% (n=97) patients had comorbidities with hypertension (47%, n=46) being the most common. Invasive mechanical ventilation was provided to 12% (n=18) of the tele-ICU patients, while 62% patients (n=98) received noninvasive mechanical ventilation interventions. Average length of stay of patients in the tele-ICU was 9 days with a range of 1-41 days. 72% (n=113) patients were discharged home from the hospital. Tele-ICU mortality was 29% (n=44). CONCLUSION: We utilized a peer-to-peer tele-consult model to support critical care services in Northern Pakistan. The survival rate achieved by this model is comparable to national and international hospital published data. This was possible through use of multimodal information technology in Pakistan.
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Newly born babies are very sensitive to rough environments, especially in Pakistan. The dust and temperature issues here can be life threatening. Due to these issues, a baby incubator is made that can provide the same temperature and environmental conditions as a mother's womb does, as well as it monitors the baby's medical conditions such as heart beat, skin temperature, internal temperature, etc. Due to COVID-19 pandemic, healthcare has become a major concern for everyone. Being physically present with the patients has become a huge problem for doctors. In such cases, implementing IoT with hospital equipment such as a Baby Incubator, has become one of the main goals for us. Providing an app that can track the baby's condition remotely will prove to be very fruitful. Our main goal is to make a smart baby incubator that can detect baby's condition and in case anything goes wrong, the system can trip itself so that the conditions can return to a normal state. We will integrate it with IoT and a mobile app so that doctors can check the baby's condition remotely. It can be easy to think of an incubator as just a bed for a sick baby, but it's so much more than a place for sleeping. An incubator is designed with such techniques and care that it can provide a safe and sound atmosphere for a newborn baby to rest until its vital organs are still in a development stage. When we compare our incubator to a simple hospital bed, an incubator will provide a completely controlled environment as well as the required amount of oxygen levels, perfect light exposure and humidity matches with the mother's womb. In addition to climate control, an incubator offers protection from other harmful factors that can damage a baby such as allergens, loud noises, bacteria and viruses, etc. An incubator's ability to control humidity also allows it to protect a baby's skin from losing too much water and becoming brittle or cracking. An incubator can include equipment to track a range of things including a baby's temperature and heart rate. This monitoring allows nurses and doctors to constantly track a baby's health status. © 2021 IEEE.
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INTRODUCTION: Telemedicine has the potential to improve access to care; however, its utility in the field of sexual medicine remains in question. AIM: To examine the importance of video visits for the treatment of male sexual medicine at our academic center during the period of peak telemedicine use in April 2020. METHODS: We collected and compared deidentified data from all nonprocedure, adult outpatient encounters conducted as either office visits in April 2019 (n = 1,949) or video visits in April 2020 (n = 608). The primary International Classification of Diseases codes (ICD-10) labeled as diagnoses from all encounters were collected, with most encounters linked to several disease codes (n = 4,584). Demographic data were also collected. We performed comparative analyses on Stata (College Station, TX, USA) with significance set at α = .05. MAIN OUTCOME MEASURES: Disease codes were categorized based on their use and classification in urological care and the proportion that each category made up within the outpatient practice was calculated. RESULTS: In comparison to the office visits, which took place in April 2019, male sexual medicine visits in April 2020, during the peak of telemedicine use, made up a significantly larger overall share of our practice (P = .012), defined by relative rises in encounters pertaining to male hypogonadism, infertility, penile abnormalities, and testicular abnormalities. Outpatients seen over video visits were also younger than outpatients seen during the previous year over office visits (58.9 vs 60.8, P = .008). Further, race and ethnicity characteristics in the outpatient population were unaffected during the period of telemedicine use. CONCLUSIONS: During the period of historically high telemedicine use following the SARS-CoV-2 outbreak, encounters associated with male sexual medicine made up a significantly larger portion of our outpatient practice. Although the full influence of the COVID-19 pandemic cannot be delineated, our findings suggest telemedicine use is compatible with the field of sexual medicine. Rabinowitz MJ, Kohn TP, Ellimoottil C, et al. The Impact of Telemedicine on Sexual Medicine at a Major Academic Center During the COVID-19 Pandemic. Sex Med 2021;9:100366.
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Introduction: The @Gijournal (#GIJC) is the first Gastroenterology and Hepatology focused online journal club on Twitter. Since its inception 18 months ago, it has garnered an international following.We aimed to assess its effectiveness as an educational platform by using Kirkpatrick's evaluation model. Methods: A 12-item survey was posted online via the Twitter account of @Gijournal (#gijc). Kirkpatrick's four-level evaluation model (reaction, learning, behavior, and results) was applied to analyze impact and effectiveness. Results: Out of the 189 responders, most were aged from 31-40 years (60.8%). There was a broad geographical distribution with most of the respondents from North America and Europe (70.9%). [1302] Table 1. 1N = 794 responses for this question.2N = 795 responses for this question.3”Other” included: GI psychologist (1), Hereditary Cancers (1), Internal Medicine (1), Pancreatology (2), Functional GI (2), Fellowship notated with no specific specialty indicated (3), Esophageal Diseases (3), Nutrition (3), and Pediatric GI (5).4N = 757 for this question.5N = 690 for this question.6N 5 348 for this question.7N = 373 for this question.8N = 414 for this question.9N = 788 responses for this question.10N = 795 responses for this question.11US 5 United States.12Responses were received from: Bangladesh (4), Middle East region (9), Mexico (3), Canada (9), South America (7), Pakistan (4), Western Europe (6), Eastern Europe (3), India (9), Southeast Asia (4), Dominican Republic (2), and Jamaica (2).13N = 794 responses for this question.14”Other” included self-employed (16) or retired (4).15N = 790 responses for this question.16N = 792 responses for this question.17N=795 responses for this question.18Participants were exited from the survey if they answered “no, I do not want a child and/or children” to this question.19N 5 794 responses for this question.20N = 792 responses for this question.21N = 108 “yes” responses for this question.22Free-text comments included: “pay disparity for female providers”, “lack of family planning education”, and “impact of volume/RVU forgiveness and impact on parental leave”.23N = 601 responses for this question.24A chi square analysis (n = 599) was performed to determine if there was a difference in the decision to delay and/or defer by sex, revealing there is no significant association (p =0.252;54.0% male and 58.7% of female respondents chose to defer/delay).25N = 340 individuals that answered, with N = 192/340 providing multiple reasons for delay and/or deferring having a child.26Total number of responses received 5 789.27Percents were calculated using the number of individuals for each reason provided, thus the total for this cell will be larger than 100% (as there were a large number of multiple responses).28”Other” responses included: “COVID-19 delayed fertility treatments”, “Females in GI are judged very differently, I was asked at my Fellowship interview if I planned on becoming pregnant”, “I had a child before Fellowship, it was very difficult and restrained career choices”.29N = 672 responses for this question.30N = 135 individuals that answered, with 97/ 135 indicating they used more than one type of assistive medicine.31Percents were calculated using the total number of individuals for each type of assistive medicine, thus the total for this cell will be higher than 100%.32Total number of responses received 5 242.33N = 684 responses for this question.34N = 635 responses for this question.35N=536 responses for this question.36N 5 527 responses for this question.37”Other” responses included: prior to Medical school (3), Not working (1), Military (3), Veterans Affairs' (1), and Clinical NIH Associate (1).38N = 536 responses for this question.39A chi square analysis (n=534) was performed to determine if there was a difference in the length of leave (0-6 weeks, 7-12 weeks, 121 weeks, or “other”) and sex, revealing there is a significant association (p<0.001. 68.3% male and 34.4% female respondents indicating they took 6 o less weeks of parental leave. 9.1% male and 51.1% female respondents indicating they took 7-12 weeks of parental leave) between sex and length of parental leave taken.40The majority of “other” responses indicated that no leave was taken (47) and use of vacation time instead of parental leave (5).41N = 516 responses for this question.42N 5 486 for this question.43The majority of “other” responses indicated that vacation and/or PTO was used instead of parental leave (16), selected other comments included: “Because our child was adopted, this was not covered by the institutional leave policy”, and “I was in Fellowship and risked losing my spot in the program if I took leave”.44N = 397 responses for this question.45For partial pay, the mean reported percentage was 54.5% of salary benefits (SD 5 17.1), with a range of 20-85%.46N = 320 responses for this question.47N = 218 responses for this question.48N 5 420 responses for this question.49The majority of the “other” responses indicated that no unpaid leave was taken (46), selected other comments included: “I was afraid to take any extra leave”, and “I did not want to take unpaid leave because I would have had to “make up” or delay my training/graduation (3)”.50N = 296 responses for this question.51N = 513 responses for this question.52N = 475 responses for this question.53N = 320 individuals answered, with 227/320 indicating they incurred more than one consequence as a result of taking parental leave.54Percents were calculated using the total number of individuals for each consequence reported, thus the total for this cell will be higher than 100%.55Total number of responses received 5 690.56Selected “other” comments include: “I was threatened in my Fellowship that I would not be allowed to graduate if I took leave”, and “I didn't receive training in fluoroscopy because I took leave”.57N = 519 responses for this question.58N=279 responses for this question.59A chi square analysis was performed to determine if there was an association between fluoroscopy exposure and subsequent pregnancy complication, revealing there is no significant association between fluoroscopy exposure and subsequent pregnancy complication(s) (p 5 0.383. 76.4% of women exposed to fluoroscopy experienced a complication vs. 65.9% of women not exposed/opted out).60N = 260 responses for this question.61N = 177 individuals answered, with 118/177 indicating they experienced more than one pregnancy complication.62Percents were calculated using the total number of individuals for each pregnancy complication reported, thus the total for this cell will be higher than 100%.63Total number of responses received 5 438.64”Other” responses included: Carpal tunnel (2), Pulmonary Emboli (2), Oligohydraminos (2), Hypotension (1), Retrovaginal fistula (1), Pubic symphysis dysfunction (1), Fetomaternal hemorrhage (1), Recurrent vaginal bleeding (1), Post-partum anxiety (1), Placental abruption (1), Premature rupture of membranes (1), Intra-abdominal abscess (1), Intrauterine Fetal Demise (1), Norovirus from occupational exposure (1), Micro-preemie (1), Gestational hypertension (1), Fetal Cystic lesions (1), COVID-19 (1).65N = 258 responses for this question.66N = 134 individuals answered, with 73/134 indicating they had difficulty with more than one accommodation during or after pregnancy.67Percents were calculated using the total number of individuals that reported experiencing difficulty with accommodations during or after pregnancy, thus the total for this cell will be higher than 100%.68Total number of responses received 5 281.69Selected other comments include: “Would breastfeed in closets”, and “no time off for infant or post-partum appointments”.70N = 226 responses for this question.7186.8% of women (N = 231/266) reported that they breastfed.72N = 218 responses for this question..
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We study the problem of targeted, district-level COVID testing of local residents and incoming migrants in order to contain the growth of infection rates in the district. We present a generic optimization problem to solve the optimal testing strategy that set differentiated testing rates on local and migrant populations based on their travel history, relative severity of the epidemic in their origin regions, and whether or not they have COVID-related symptoms. Our optimization problem minimizes the total number of tests that are needed to contain the virus spread assuming a Susceptible-Infected-Qarantined-Recovered (SIQR) transmission dynamics. We provide a complete characterization of the set of optimal testing strategies, and propose a simple greedy algorithm for computing an optimal strategy. We also study the comparative statics of the optimal strategy with respect to several key parameters related to the social distancing policy and epidemic transmission. Finally, we calibrate our model and compute the optimal testing strategies at district level for an Eastern India state Odisha based on the acquired data on migrants' travel logs and active COVID cases.
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Background: Since February 2020, there have been 825,519 confirmed COVID-19 cases and 17,957 fatalities across Pakistan. The number of ICU beds in Pakistan is approximately 2166, a ratio of 0.7 beds per 100,000 population. Critical care resources are concentrated in metropolitan cities with limited availability in rural areas. These gross shortages have escalated during the COVID-19 pandemic, leaving large parts of the country without access to skilled personnel or ICU beds. The Aga Khan University established a free 24/7 teleICU consultation service to rapidly increase access to trained personnel during the COVID-19 pandemic. Methods: The tele-ICU service adheres to a Scheduled and Responsive Care Model delivered through a centralized and decentralized structure. Using two-way audio-visual technology, the tele-ICU leverages critical care expertise and connects to clinical teams in rural and remote hospital settings. Endto- end encrypted Zoom and WhatsApp applications or telephone calls are utilized. Initially, only COVID-19 patients were consulted;however, coverage was broadened to include surgical and medical patients requiring intensive care. Results: Between June 2020 and April 2021, 1709 teleconsultations have been conducted on 404 patients. These include 339 COVID-19 patients, 231 of which were severe and critically ill. An estimated 20,394 minutes of consultative services have been provided covering 26 hospitals across 4 provinces. The mean call duration of each teleconsultation was 13.29 (1-60) minutes. The major mode of communication was Zoom (45.58%) followed by Telephone (43.30%) and WhatsApp (11.12%). The overall hospital discharge outcome for the teleICU is 58.27% with a mortality rate of 29.13%. The remaining patients (12.60%) were transferred or left against medical advice. Conclusion: To combat the insufficient critical care capacity, Aga Khan University implemented a novel tele-ICU service to provide an innovative solution for coordination of care and increase availability of intensivists in remote settings across Pakistan.
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PURPOSE: Oncofertility counseling regarding the reproductive risks associated with cancer therapy is essential for quality cancer care. We aimed to increase the rate of oncofertility counseling for patients of reproductive age (18-40 years) with cancer who were initiating systemic therapy at the Johns Hopkins Cancer Center from a baseline rate of 37% (25 of 68, June 2019-January 2020) to 70% by February 2021. METHODS: We formed an interprofessional, multidisciplinary team as part of the ASCO Quality Training Program. We obtained data from the electronic medical record and verified data with patients by phone. We surveyed patients, oncologists, and fertility specialists to identify barriers. After considering a prioritization matrix, we implemented Plan-Do-Study-Act (PDSA) cycles. RESULTS: We identified the following improvement opportunities: (1) oncologist self-reported lack of knowledge about counseling and local fertility preservation options and (2) lack of a standardized referral mechanism to fertility services. During the first PDSA cycle (February 2020-August 2020, disrupted by COVID-19), we introduced the initiative to increase oncofertility counseling at faculty meetings. From September 2020 to November 2020, we implemented a second PDSA cycle: (1) educating and presenting the initiative at Oncology Grand Rounds, (2) distributing informative pamphlets to oncologists and patients, and (3) implementing an electronic medical record order set. In the third PDSA cycle (December 2020-February 2021), we redesigned the order set to add information (eg, contact information for fertility coordinator) to the patient after-visit summary. Postimplementation (September 2020-February 2021), counseling rates increased from 37% to 81% (38 of 47). CONCLUSION: We demonstrate how a trainee-led, patient-centered initiative improved oncofertility care. Ongoing work focuses on ensuring sustainability and assessing the quality of counseling.
Subject(s)
COVID-19 , Fertility Preservation , Neoplasms , Adolescent , Adult , Counseling , Humans , Neoplasms/complications , Neoplasms/therapy , Quality Improvement , SARS-CoV-2 , Young AdultABSTRACT
This paper examines the impact of COVID-19 on the integration and dynamic linkages of the cryptocurrencies (Bitcoin, Ethereum, Litecoin, XRP and Stellar). ARDL bound test approach and Granger causality tests are used in this study for the period from 17 April 2019 to 15 September 2020. We found evidence of no cointegration among the cryptocurrencies in both pre- and during COVID-19. Thus, the cryptocurrencies market offers an ample opportunity for the potential benefits from portfolio diversification and hedging strategies even during the COVID-19 pandemic. In addition, Granger causality tests show that Bitcoin is the most influential cryptocurrency in the short-run. The findings of this study may have implications for crypto-investors, international investors and fund managers who want to diversify their investments in cryptocurrencies. © 2022, Institute of Technology PETRONAS Sdn Bhd.
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The world of the twenty-first century has not experienced such a lockdown situation before, which leads to a complete shutdown of economy not until the novel coronavirus disease 2019 (COVID-19) came caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It becomes an unacceptable global threat to human lives. The COVID-19 has been known only worldwide in the last few months, but it is spreading in a speed of light from Wuhan, China, to the rest of the world. About 2 crore of people have been infected and more than 7 lakh of people have died worldwide till now due to the deadly SARS-CoV-2 infection. There are still no drugs exclusively available in the market for the treatment of SARS-CoV-2 infection, though supportive treatment of hydroxychloroquine, ribavirin, favipiravir, and remdesivir have shown clinical evidences to treat COVID-19. Therefore, it is utmost importance for the medicinal chemists to design and discover novel drugs urgently to rescue or to protect the humanity worldwide from this deadly virus. However, lack of experimental evidences and understanding the behavior of the SARS-CoV-2 within this short period may hinder the process of drug discovery. Still a ray of hope resides in the structural features of SARS-CoV-2 and related coronaviruses (SARS-CoV and MERS-CoV) as these are homologous. Therefore, depending on the established viral target proteins (spike protein, ACE-2, 3CLpro, PLpro, RdRp, helicase, as well as other viral proteins), novel chemical entities may be designed. In this context, several computational modeling approaches (generally structure-based modeling techniques) may be utilized which are cost-effective and less time-consuming. Different structure-based modeling techniques, namely, homology modeling, robust molecular docking, molecular dynamics simulation, and structure-based pharmacophore mapping followed by in silico virtual screening, may be effective and fruitful approaches to design compounds against SARS-CoV-2. In this chapter, various structure-based drug design and discovery strategies from target identification that could be optimized against SARS-CoV-2 have been discussed in detail. Additionally, ongoing and previously reported computational modeling techniques performed by different groups of researchers on various SARS-CoV-2 target proteins have been highlighted elaborately. In addition to the identification techniques of drugs, this chapter also discloses their binding mode of action along with the pharmacokinetics and toxicity criteria computed by modeling techniques. This chapter, therefore, may be a stepping-stone for the researchers to open up a new horizon in the discovery of novel anti-coronavirus drugs in the future.
ABSTRACT
This paper aims to explore the outcome of a telephone triage system used by different team members to run an Urgent Dental Care Hub (UDCH) during the first wave of the COVID-19 pandemic. It will also look at the adjustments made to the system because of the challenges faced. Data were collected from the telephone triage proforma and clinical notes of patients that were triaged from 2nd April to 10th June 2020. With 65% of telephone triaged and accepted patients receiving definitive treatment that alleviated the presenting complaint, the value of telephone triage is highlighted in streamlining an urgent dental care service during a viral pandemic. Public health competencies being illustrated: Dental public health intelligence, Developing and monitoring quality dental services.