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Objectives: The COVID pandemic has imposed significant direct medical cost and resource use burden on healthcare systems. This study described the patient demographic and clinical characteristics, healthcare resource utilization and costs associated with acute COVID in adults in England. Method(s): This population-based retrospective study used linked primary care (Clinical Practice Research Datalink, CPRD, Aurum) and secondary care (Hospital Episode Statistics) data to identify: 1) hospitalized (admitted within 12 weeks of a positive COVID-19 PCR test between August 2020 and March 2021) and 2) non-hospitalized patients (positive test between August 2020 and January 2022 and managed in the community). Hospitalization and primary care costs, 12 weeks after COVID diagnosis, were calculated using 2021 UK healthcare reference costs. Result(s): We identified 1,706,368 adult COVID cases. For hospitalized (n=13,105) and non-hospitalized (n=1,693,263) cohorts, 84% and 41% considered high risk for severe COVID using PANORAMIC criteria and 41% and 13% using the UKHSA's Green Book for prioritized immunization groups, respectively. Among hospitalized cases, median (IQR) length of stay was 5 (2-7), 6 (4-10), 8 (5-14) days for 18-49 years, 50-64 years and >= 65 years, respectively;6% required mechanical ventilation support, and median (IQR) healthcare costs (critical care cost excluded) per-finished consultant episode due to COVID increased with age (18-49 years: 4364 (1362-4471), 50-64 years: 4379 (4364-5800), 65-74 years: 4395 (4364-5800), 75-84 years: 4473 (4364-5800) and 85+ years: 5800 (4370-5807). Among non-hospitalized cases, older adults were more likely to seek GP consultations (13% of persons age 85+, 9% age 75-84, 7% age 65-74, 5% age 50-64, 3% age 18-49). Of those with at least 1 GP visit, the median primary care consultation total cost in the non-hospitalized cohort was 16 (IQR 16-31). Conclusion(s): Our results quantify the substantial economic burden required to manage adult patients in the acute phase of COVID in England.Copyright © 2023
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Objectives: Clinical Practice Research Datalink (CPRD) Aurum contains primary care electronic health records, including vaccinations and nearly complete capture of SARS-CoV-2 PCR test results between August 2020-March 2022. Our objective was to build code lists to define a cohort of persons diagnosed with COVID in England using routinely collected health data. Method(s): Persons aged 1 year or older were indexed on first COVID diagnosis from August 1, 2020 - January 31, 2022. We developed SNOMED code lists to define high risk of severe disease: 1) National Health Service's (NHS) list of highest risk conditions;2) PANORAMIC trial inclusion criteria;3) UK Health Security Agency (UKHSA) clinical risk groups. COVID vaccinations were defined as of December 1, 2021 using medical and product codes. Code lists were developed using wildcard search terms which were reviewed by multiple independent reviewers, and inclusion/exclusion was determined by consensus. All lists for diagnoses were reviewed by a UK physician. Result(s): We identified 2,257,907 people diagnosed in primary care with COVID;46% were male and mean age was 34 years, comparable to governmental data for the same period reporting 47% of cases in England were male and mean age was 34 years. We identified 12% at high risk of severe disease using the NHS definition, 31% using the PANORAMIC trial criteria, and 10% using the UKHSA clinical risk groups. Among adults, 86.1% had >=1 and 80.2% had >=2 COVID vaccine doses (2% and 0.2% lower than official reports, respectively). Conclusion(s): This cohort represented the age and sex distribution of COVID cases, and the COVID vaccination coverage, in England through January 2022. Definitions were built using reproducible methods that can be leveraged for future work. The high capture of COVID vaccinations supports the use of this cohort to examine clinical and societal benefits of COVID vaccination in England.Copyright © 2023
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Objectives: Clinical Practice Research Datalink (CPRD) Aurum captures primary care electronic healthcare records for ~28% of the population in England. From August 2020-;March 2022, all SARS-CoV-2 polymerase chain reaction (PCR) tests performed were reported back to the patient's general practitioner (GP), making the CPRD a closed system uniquely positioned to answer COVID research questions. Method(s): We defined persons with COVID as those recorded in primary care with a positive PCR test from August 1, 2020-March 31, 2021. We required continuous registration with their GP practice for >=365 days prior to diagnosis to establish comorbid conditions, and eligibility for linkage to Hospital Episode Statistics (HES) Admitted Patient Care data. Hospitalizations for COVID were defined as persons admitted with a primary diagnosis of COVID (ICD-10-CM U07.1) within 12 weeks of the initial primary care diagnosis record. Result(s): Our cohort included 535,453 persons diagnosed in primary care with COVID, with 2% later hospitalized. The hospitalized group was 57% male, 42% current/former smokers, 35% obese46% with a Charlson Comorbidity Index >1 and 98% had never received any COVID vaccine. Hospitalizations increased with age;<0.1% of patients aged 1-17, 1% aged 18-49, 4% aged 50-64, 9% aged 65-74, 13% aged 74-84, and 11% of COVID cases aged >=85 were hospitalized. Persons living in socially disadvantaged areas were overrepresented in the hospitalized cohort (25% in the Index of Multiple Deprivation's most deprived quintile). Conclusion(s): Consistent with other studies, hospitalized COVID patients were disproportionately those with male sex, smoking history, high body mass index, comorbidity and unvaccinated status. Hospitalizations were more common with age, and for individuals living in socially and economically deprived communities. Understanding the demographic and clinical characteristics of this cohort can help contextualize future work describing healthcare resource utilization and costs, as well as the impact of vaccines, associated with COVID in England.Copyright © 2023
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As the transition point between middle and high school, ninth grade can either set a student up for long-term success or diminish a student's likelihood of graduating high school altogether. The Ninth Grade Success Initiative is a dropout prevention program, piloted in five Washington State high schools in 2019–2020. We evaluated the effects on student outcomes and found that the program led to improvements in course grades, behavioral outcomes, more effective targeting of services to higher-need students, and better preparation for the COVID-19 transition to virtual learning. © 2023 Kappa Delta Pi.
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Covid-19 has put social security systems under immense pressure. Governments saw demand for social security rise dramatically whilst attempting to support those whose employment had temporarily stopped once severe economic restrictions were put in place. Drawing on a range of evidence (including original interviews), this chapter focuses on the experience of larger families (households with three or more children) during the pandemic as a way of illuminating how these pandemic-induced policy responses often failed to reach those groups who have been subject to austerity measures over the previous decade. We explore this in three ways. First, we unpack how the government's response to Covid-19 left larger families in a precarious position. Secondly, we situate the experience of larger families in the context of a wider set of reforms to social security-such as the benefit cap, the two-child limit, and the benefits freeze-which have already pushed even more larger families into poverty over the last decade. The final section of the chapter draws out how these policy decisions exacerbate inequalities between groups, while alluding to implications for protected characteristics as enshrined in the Equality Act 2010. This analysis not only illuminates how the pandemic has increased gender and ethnic inequalities but also suggests that the degree to which the pandemic was inequality-generating is rooted in policy decisions made before the pandemic even began. Avoiding exponential inequalities in response to future crises requires that policies-and the discourses which surround them-are sensitive to the potential for other kinds of societal shock. © The several contributors 2022. All rights reserved.
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During the period of the Covid-19 pandemic, the traditional education structure as we know it has been largely transformed due to lockdowns and social distancing. This study is a detailed description of how a normally face-to-face undergraduate course in digital design with laboratory sessions at the University of Iceland was transformed into a fully online based course. We show the essentialities required to transform the lectures and laboratory sessions from local to online. Furthermore, we compare the students' performance during the online teaching with that of previous students who participated in local teaching. © 2022 IEEE.
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The ability to offer courses over the Internet between remote teacher(s) and students enhances curricula and can improve quality in university work regarding both teaching and research. This is particularly true for small universities that struggle to offer comprehensive curricula due to lack of professors and students. In the spring semester of 2021, the University of Iceland offered a course on the Internet of Things taught by a professor emeritus in Atlanta, Georgia, assisted by a local professor. The lectures were given on Zoom and all assignments and exams were given over the Internet. In this paper, this course's framework will be described, how it was implemented and what was accomplished. The authors will also share their thoughts on the future of this kind of university work that has to some extent developed due to the Covid situation. © 2022 IEEE.
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A laboratory experiment in an undergraduate course on electronics was conducted remotely during the COVID-19 pandemic. The lab assignment was to construct and analyze a single-transistor NPN amplifier. In the conventional on-site lab experiment the students would construct the amplifier on a breadboard, carry out measurements of DC and small signal characteristics, and compare with both SPICE simulations and manual calculations. The pandemic prevented the attendance of students in the lab, and thus the experiment was redesigned and carried out online, using remotely controlled instruments through the internet. It was found that to some extent a remotely conducted experiment can substitute the on-site work, and there are some unique advantages of this approach. On the other hand, some aspects of the on-site laboratory experiment cannot be substituted by the remote experience, and this is discussed in the paper. © 2022 IEEE.
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Purpose: This study aims to show how a massive open online course (MOOC) can be used as an educational tool to diffuse specialised corporate sustainability research globally to a broad range of learners. Design/methodology/approach: This study is based on insights from the design and implementation of a sustainable fashion MOOC. The MOOC was launched in late 2019 on a global learning platform and has recently passed 40,000 enrolments (February 2022). The presentation of the MOOC draws on quantitative and qualitative data available to instructors on the global learning platform. Findings: Based on the data about the learners and their use of the MOOC, this study demonstrates how MOOC can be a powerful tool to diffuse sustainability research to new groups of learners, who differ significantly from the typical students at business schools and universities in the West. Moreover, the findings also demonstrate how the COVID-19 pandemic had a significant impact on the MOOC’s popularity. Originality/value: This study provides new empirical evidence on how sustainability research can be translated into online education material of relevance for a broad range of learners from around the world. Moreover, the study also points to the number of practical and structural challenges linked to the future mainstreaming of MOOCs and other types of online education material. © 2022, Emerald Publishing Limited.
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This chapter examines public belief formation in Sweden during the first six months of the COVID-19 pandemic. Based on theories of sociotropic belief formation, we analyze how citizens’ ideology, personal experience, interpersonal talk and media use influence their beliefs about how the coronavirus affects the Swedish society. The findings from analyses of three waves of panel survey data suggest that (1) citizens continuously update their corona beliefs over time, (2) ideological belief gaps emerge in the initial phase of the crisis but remain relatively constant over time, (3) corona beliefs primarily depend on ideology and news media use and (4) these two factors also influence the likelihood that citizens hold on to beliefs formed at an early stage of the pandemic. Furthermore, while news media use was more clearly related to perceptions about the magnitude of the coronavirus as a societal problem, ideology played a larger role for perceptions about how Sweden had managed the virus. © 2022 selection and editorial matter, Peter Van Aelst and Jay G. Blumler.
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Background: It is not clear how to best control for comorbidities when examining short-term mortality among individuals with COVID-19. The Charlson and Elixhauser Comorbidity Index were developed to predict 1-year and in-hospital mortality, respectively, and both indices can be operationalized using individual comorbidities or a weighted summary score. We compared the predictive accuracy for these comorbidity scores in predicting in-hospital death among adults hospitalized with COVID-19 from 5 hospitals comprising a health care system in the Mid-Atlantic United States. Methods: We used electronic health record data from adults hospitalized for COVID-19 from March 4-November 6, 2020. We ascertained comorbidities using all available lookback data from January 1, 2018 through COVID-19 hospital admission.We operationalized both comorbidity scores using individual comorbidities - 17 for Charlson and 29 for Elixhauser. We calculated weighted Charlson scores four ways, separately, using weights proposed by Deyo (1992), Schneeweiss (2003), Quan (2011) and Mehta (2016).We calculated the Elixhauser comorbidity score using weights proposed by van Walraven (2009) and Thompson (2015). We used logistic regression to compare the performance of different comorbidity scores in predicting in-hospital death. Nine models were constructed (1 baseline model that included age and sex, 1 for Charlson individual comorbidities, 4 for weighted Charlson scores, 1 for Elixhauser individual comorbidities and 2 for weighted Elixhauser scores). All models included age and sex as covariates.We evaluated the performance of each model using the c-statistic, and compared cstatistics using chi-square statistics, with a p-value < 0.05 considered significant model fit improvement. Secondarily, we compared model fit using Akaike Information Criteria (AIC), where lower values indicate better model fit.We used PROC LOGISTIC in SAS version 9.4. Results: Of 2,815 COVID-19 hospitalized patients, 12% (n=349) died in the hospital. Each comorbidity score performed significantly better (p < 0.001) than age and sex alone (c-statistic 0.775) at predicting COVID-19 related death. Overall, the ranking of the top 4 comorbidity scores were as follows: individual Elixhauser comorbidities (c-statistic 0.822) > Elixhauser-Thompson (c-statistic 0.803) > Elixhauser-van Walraven (c-statistic 0.796) = individual Charlson comorbidities (c-statistic 0.796).Weighted Elixhauser comorbidity scores (c-statistics ranging from 0.796 to 0.803) had significantly better performance than weighted Charlson comorbidity scores (c-statistics ranging from 0.786 to 0.790). Conclusions were similar when using AIC values to assess model fit. Conclusion: The individual comorbidities in the Elixhauser were the most accurate in predicting in-hospital death. If the weighted score needs to be used due to sample size limitations, we found that the Elixhauser-Thompson score was the most accurate in this training set. While statistically significant, the magnitude of predictive accuracy gained by adding covariates to the model for in-hospital mortality were small. Future research should investigate the utility of a customized COVID-19-specific comorbidity score in predicting mortality among adults hospitalized with COVID-19.
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TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: COVID-19 is thought to cause a prothrombotic state with a relatively high rate of associated thromboembolic disease. Priapism has previously been described in a single case report as a potential thrombotic complication of severe COVID-19.1 Priapism, the persistence of an erection not associated with sexual desire, mostly commonly results from ischemic (low-flow or veno-occlusive) causes. Medications and blood dyscrasias are among the most common etiologies of ischemic priapism. Here we report a case of priapism in a patient admitted to the medical ICU for ARDS caused by severe COVID-19. CASE PRESENTATION: A 68-year-old man with a past medical history of chronic kidney disease, benign prostatic hyperplasia, and diabetes mellitus presented to the emergency department for worsening dyspnea, nausea and fatigue. He had been diagnosed with COVID-19 eight days prior. On arrival, the patient was profoundly hypoxemic despite being placed on high-flow nasal cannula. He was then intubated and placed on mechanical ventilation. A chest x-ray showed bilateral patchy infiltrates consistent with COVID-19 pneumonia. The patient became hypotensive and was started on vasopressors. His platelet count was normal and he was maintained on heparin subcutaneously three times per day for DVT prophylaxis. On the morning of hospital day seven, it was noted that the patient had a persistent erection for > 4 hours. He had not received any alpha adrenergic antagonist, antipsychotic, or antidepressant medications.Urology was consulted who subsequently performed a corporal aspiration and irrigation. Approximately 75 cc of dark blood were evacuated, which led to flaccidity of the penis. A corporal blood gas was found to be consistent with ischemia with a pH<6.8, pCO2=86, and a paO2=19. Over the next three days, the patient required three additional aspiration and irrigation procedures due to recurrent priapism, and each time dark blood was drained. A combination of intracavernosal injection of phenylephrine and aspiration on hospital day 10 led to resolution of his priapism. Despite maximal medical management, the patient developed multiorgan failure and expired after a prolonged hospital course. DISCUSSION: This case is the second reported case of priapism in a patient admitted to a medical ICU for severe COVID-19. The patient's priapism was thought to be as a result of a prothrombotic state related to COVID-19. At the time of the diagnosis, the patient had not received any medications associated with priapism and was not on a propofol infusion. Per the patient's partner, he had no known prior episodes of priapism. CONCLUSIONS: Priapism may be a rare thromboembolic complication of severe COVID-19. Prompt recognition of this condition is important as a delay in diagnosis can lead to irreversible penile damage and erectile dysfunction. REFERENCE #1: Lamamri M, Chebbi A, Mamane J et al. Priapism in a patient with coronavirus disease 2019 (COVID-19). Am J Emerg Med. 2021. 39: 251. e5-251 DISCLOSURES: No relevant relationships by Karl Andersen, source=Web Response No relevant relationships by Brandon Childs, source=Web Response No relevant relationships by James Dargin, source=Web Response
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Utopia and dystopia can be seen to exist within each other. What is a desirable future for one might put someone else in an uncomfortable or conflicted position. Speculative design serves as a tool to let people experience situations through different perspectives of criticality. This paper argues to use speculative methodologies to design for Ustopia. We consider different perspectives from Margaret Atwood's novels "The Handmaid's Tale"and "The Testaments", and use these to define different critical perspectives that speculative design and speculative designers could take to pave the way to Ustopia. We present pastiche scenarios to illustrate how the perspectives could be applied to a transition that impacts all of us: the introduction of the COVID-19 vaccines. We use these pastiche scenarios and related work from the field of speculative design as examples to illustrate how the different perspectives might be integrated into one speculative experience. We propose that Ustopia can be used to harness and encompass such complexity. © 2021 Owner/Author.