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Background: With the introduction of new cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy (elexacaftor/tezacaftor/ ivacaftor), peoplewith CF experiencing severe lung disease can experience significant improvements in clinical symptoms. Method(s): This single-center institutional review board-approved retrospective chart review identified patients with advanced lung disease who met criteria for a compassionate use or expanded access program because of high risk of death or transplant need within 2 years. Clinical data collection for all patients began at baseline, 2 to 4 weeks after therapy initiation, and continued every 3 months for 2 years. Datawere collected on demographic characteristics, clinic progress notes, clinical labs, forced expiratory volume in 1 minute (FEV1),weight, body mass index, respiratory colonization, and hospitalizations after drug initiation. Patients also completed sinus and chest computed tomography (CT) to track clinical changes. Result(s): Eighteen people with CF (aged 15-49, 56% male) from a large midwestern CF center who initiated drug therapy between July and September 2019 in an inpatient hospital or clinic setting were identified. Clinical markers (Table 1) indicated that modulator therapy was well tolerated and not discontinued by any participant;safety lab values did not indicate medical concern or discontinuation. There were 90 admissions for the group in the 2 years before therapy and 17 admissions during the 2 years after, although seven of the posttherapy admissions were for nonrespiratory indications. Monitoring results indicated the safety of modulator therapy because there were no adverse clinical occurrences or laboratory events, and all patients presented with universal stabilization. There have been no deaths and no transplants. Unlike lumacaftor/ivacaftor, therewere no problems with chest tightness or any difficulty with troublesome increases in expectoration burden or choking during initiation of therapy. Most had significant reduction in or loss of spontaneous cough and sputum production. The impact on microbial colonization is unclear, because even in this severe group, inability to produce sputum on command led to considerable missing data in follow-up, leaving colonization status at follow-up unclear. Conclusion(s): This study focused on people with CF who qualified for modulator therapy based on advanced lung disease. Initiation of modulator therapy was deemed safe and resulted in objective positive changes in nutrition;cough;FEV1);and subjective reports of clinical status, level of activity, and reduction in burden of treatment. No evidence was found of difficulty managing the increased expectoration during initial therapy. Limitations were noted in missing data during the COVID-19 pandemic, small sample size, and delayed follow-up for drug monitoring.(Table Presented) Clinical indicators before and after modulator therapy *Completed post-drug initiation (earlier than 12 months), **24 months before and after therapy initiationCopyright © 2022, European Cystic Fibrosis Society. All rights reserved
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To date, the selection of a project portfolio that maximises the decision-making outcome remains essential. However, existing research on project synergy has mainly focused on two projects, while there are multiple projects in some cases. Two kinds of synergies among multiple projects are proposed. First, multiple projects must be selected together, in order to produce synergy. Second, some projects depend on synergy with other projects, leading to a synergetic increase in performance. Furthermore, we present strategic synergy, with benefits, resources, and technology, which is quantified for a procurement project concerning a COVID-19 pandemic recovery plan. A design structure matrix is used to describe the technology diffusion among the projects. Then, strategic alignment is utilised to measure the strategic contribution of projects. Next, a portfolio selection model considering uncertainty is established, based on the strategic utility. Finally, our results indicate that selecting projects considering multi-project synergy is more advantageous. © 2023, Journal of Industrial and Management Optimization. All Rights Reserved.
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Background: Cystic fibrosis (CF) is a life-limiting disease with chronic, debilitating pulmonary, endocrine, gastrointestinal, and other symptoms. Patients with CF have higher rates of anxiety and depression than the general population (Quittner 2014). Elexacaftor-tezacaftor-ivacaftor (ETI) has resulted in significant improvement of physical CF symptoms by targeting defects in in the CF transmembrane regulator proteins transcribed by the deltaF508 mutation (Middleton 2019). This data is part of a 5 year study monitoring medical and psychiatric symptoms, especially anxiety and depression, in patients taking ETI. Method(s): This is a single center, Nationwide Children's Hospital IRB approved, longitudinal observational study evaluating the effects of ETI treatment on mood and anxiety. Eligible participants were recruited during routine CF clinic visits. Subjects are administered standardized validated measures for anxiety and depression at baseline, 1, 3, 6, 9, 12, 18, 24, 36, 48, and 60 months. Measures include the PHQ-9, GAD-7, adult and pediatric PROMIS Depression and Anxiety Scales. Result(s): 184 subjects (93 males, 91 females), completed all anxiety and depression measures at the 6 month mark. Thirty-two of 184 received pediatric measures. Linear mixed-effects model was used to evaluate changes of primary outcomes, PHQ-9, GAD-7, and PROMIS over the study visits. All statistical analyses are performed in R version 4.0 (R Core Team, Vienna, Austria). Normal range score rates at baseline then 6 months were: PHQ-9, 67%/78%;GAD-7, 71%/79%;adult PROMIS Depression, 87%/91%;pediatric PROMIS Depression, 91%/85%;adult PROMIS Anxiety, 83%/87%;pediatric PROMIS Anxiety, 91%/95%. Overall trends were toward stability to slight improvement on all measures, with only 5 respondents reporting shifts from "normal" to "severe" symptoms. No study participants required emergency or inpatient psychiatric care during this 6 month period. Discussion(s): A significant majority of 184 patients with CF demonstrated normal scores on measures of depression and anxiety during their first 6 months on ETI. These results indicate trends toward improvement in mental health upon initiation of ETI in this sample. While this does not reflect each individual case, it indicates that patients with CF collectively may have decreased anxiety and depression during this time period. While improvements in anxiety and depression as CF symptoms improve with ETI treatment make intuitive sense, the first 6 months of this study occurred during the COVID-19 pandemic. Hence, anxiety and depression may also have been affected by social isolation, changes in routine, and fear of contracting COVID-19. Conclusion/Implications: Continued follow-up is required to evaluate the relationships of CF medical symptoms, depression, anxiety, and ETI treatment over time. References: Middleton PG, et al. (2019). Elexacaftor-Tezacaftor-Ivacaftor for cystic fibrosis with a single Phe508del allele. NEJM, 381(19):1809-19. Quittner AL, et al. (2014). Prevalence of depression and anxiety in patients with cystic fibrosis and parent caregivers. Thorax, 69:1090-97. Copyright © 2022
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Objective: To compare features of hospitalized pediatric patients with seizures and respiratory viruses. Background: Neurological symptoms are reported in children with COVID-19, caused by SARS-CoV2. Limited data is available on neurological symptoms in other respiratory viruses, including influenza and other coronaviruses. Design/Methods: Retrospective data was extracted from EPIC on all children between 0-21 years old admitted to Children's Hospital of Atlanta from January 1, 2014 to June 1, 2021 for seizures and had positive PCR for SARS-CoV-2, other coronaviruses (Coronavirus NL63 and Coronavirus OC34) and influenza (A and B). Patient characteristics including age, race, sex, ethnicity, hospital length of stay, intensive care unit admission, intubation, chest x ray, MRI, and disposition were included. Comparison of patient characteristics between children with COVID-19 and the two other groups were conducted respectively. Results: A total of 487 pediatric patients were included: 68 COVID-19, 232 influenza, and 187 with other coronaviruses (OC), with median age of 6.2 (interquartile range (IQR): [3.1,11.2]). COVID-19 patients had higher ICU admission rates (50% versus 31%, p = 0.008) but lower intubation rates than OC (19% versus 35%, p = 0.021). Stroke rates were higher in COVID-19 versus OC (6% versus 0.5%, p= 0.019). Initial white blood cell counts were lower in the COVID-19 (median 7.32[6.05, 11.07]) than OC (median 10.66[ 7.61, 14.26];p = 0.001). The rate of abnormal MRI was lower among COVID-19 patients, compared to OC patients (57% versus 82%) with a medium to large effect size (standard mean difference) of 0.55. However, no differences were observed between COVID-19 and influenza cohorts. Conclusions: Differences in patients with COVID-19 versus other coronaviruses were observed, whereas no differences were observed in COVID-19 versus influenza patients. Vigilance should be undertaken in treatment of children presenting with all respiratory illnesses.
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In the version of this article initially published, the first name of Chuansheng Zheng was misspelled as Chuangsheng. The error has been corrected in the HTML and PDF versions of the article. © The Author(s) 2022.
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This study investigated the effects of tangible rewards on student learning performance, knowledge construction of online discussions, and perception in fully online gamified learning during the COVID-19 pandemic. We conducted a quasi-experiment study involving two classes: (a) A control group (N = 26) utilized gamification points as main intangible rewards, and (b) A treatment group (N = 26) utilized gamification points as main intangible rewards and high-quality assignment samples from a previous cohort as tangible rewards. Results suggest that the presence of tangible rewards had no impact on learning performance. However, tangible rewards motivated students to create more posts and replied more often to a peer's post in online discussions. According to the survey responses, students liked the learning experience where both tangible rewards and game elements as intangible rewards were used all together in a gamified class. Students also preferred the provision of course content closely related to learning material as rewards and suggested offering multiple types of rewards at regular intervals. Most students in the tangible rewards group often checked their peers' posts for gaining new knowledge and reflecting on their own work by comparison, which also showed students' active participation in knowledge construction of online discussions. © 2021 IEEE.
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With the onset of the COVID-19 pandemic, outdoor spaces remained one of the few places for youth recreation. Outdoor recreation and sport have been associated with positive youth development (PYD) prior to the pandemic, so we sought to test these relationships during the pandemic, accounting for self-efficacy and demographic factors that may be associated with participation. To achieve this aim, we conducted an online survey of United States youth (N=116) aged 12-17. Higher levels of PYD during the pandemic were associated with higher levels of school-based sport prior to the pandemic, community-based sport during the pandemic, and outdoor time prior to and during the pandemic. Self-efficacy, but not demographics, was associated with outdoor time. Outdoor recreation should be promoted for youth as it is positively associated with PYD, especially when other forms of recreation are restricted. Recreation professionals should foster self-efficacy and ensure that opportunities for outdoor recreation are equitably accessible.
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Due to the high popular concentration of large-scale events, once an emergency (like a stampede) occurs, it will often cause severe casualties. Moreover, since the widespread of the COVID-19, the prevention of the novel coronavirus should also be considered during mass gatherings. How to reduce the probability and potential consequence of emergencies is of great significance. This research designs an emergency management framework using ArcGIS-based geographic information technology for large-scale events. To verify the effectiveness of our framework, we take the Winter Olympic torch relay in university as an example. The paper is mainly divided into two parts, emergency resource allocation and the emergency prevention model. The former part focuses on the site selection of emergency sentries and emergency hospitals during the torch relay. In the latter part, an emergency prevention model is designed for two significant emergencies: stampede and epidemic. © 2021 Information Systems for Crisis Response and Management, ISCRAM. All rights reserved.
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Artificial intelligence provides a promising solution for streamlining COVID-19 diagnoses;however, concerns surrounding security and trustworthiness impede the collection of large-scale representative medical data, posing a considerable challenge for training a well-generalized model in clinical practices. To address this, we launch the Unified CT-COVID AI Diagnostic Initiative (UCADI), where the artificial intelligence (AI) model can be distributedly trained and independently executed at each host institution under a federated learning framework without data sharing. Here we show that our federated learning framework model considerably outperformed all of the local models (with a test sensitivity/specificity of 0.973/0.951 in China and 0.730/0.942 in the United Kingdom), achieving comparable performance with a panel of professional radiologists. We further evaluated the model on the hold-out (collected from another two hospitals without the federated learning framework) and heterogeneous (acquired with contrast materials) data, provided visual explanations for decisions made by the model, and analysed the trade-offs between the model performance and the communication costs in the federated training process. Our study is based on 9,573 chest computed tomography scans from 3,336 patients collected from 23 hospitals located in China and the United Kingdom. Collectively, our work advanced the prospects of utilizing federated learning for privacy-preserving AI in digital health. The COVID-19 pandemic sparked the need for international collaboration in using clinical data for rapid development of diagnosis and treatment methods. But the sensitive nature of medical data requires special care and ideally potentially sensitive data would not leave the organization which collected it. Xiang Bai and colleagues present a privacy-preserving AI framework for CT-based COVID-19 diagnosis and demonstrate it on data from 23 hospitals in China and the United Kingdom.
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To date, the selection of a project portfolio that maximises the decision-making outcome remains essential. However, existing research on project synergy has mainly focused on two projects, while there are multiple projects in some cases. Two kinds of synergies among multiple projects are proposed. First, multiple projects must be selected together, in order to produce synergy. Second, some projects depend on synergy with other projects, leading to a synergetic increase in performance. Furthermore, we present strategic synergy, with benefits, resources, and technology, which is quantified for a procurement project concerning a COVID-19 pandemic recovery plan. A design structure matrix is used to describe the technology diffusion among the projects. Then, strategic alignment is utilised to measure the strategic contribution of projects. Next, a portfolio selection model considering uncertainty is established, based on the strategic utility. Finally, our results indicate that selecting projects considering multi-project synergy is more advantageous.
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Objective: To determine the prevalence of depression and anxiety in patients with corona virus disease and without corona virus disease. Study Design: Cross-sectional/observational Place and Duration: Psychiatry department of KMC Teaching Hospital Khairpur Mirs for four months duration from 1st July, 2020 to 30th October, 2020. Methods: Two hundred and twenty patients of both genders were presented in this study. Patients detailed demographics were recorded after taking written consent. Patients were ages between 20-70 years. Among all the patients, 110 patients (group I) with covid-19 disease taken as cases and 110 non-covid 19 patients (group II) were taken as control. Prevalence of depression and anxiety were measured by DASS-21. Complete data was analyzed by SPSS 27.0 version. Results: Mean age of the patients in group I and II was 42.38 ±12.44 years and 41.22±12.85 years. Mean BMI in group I was 23.46±1.52 kg/m2 and in group II it was 24.33±1.58 kg/m2. 76 (69.10%) and 70 (63.64%) patients were males while 34 (30.91%) and 40 (36.36%) were females in cases and control. Frequency of depression and anxiety was significantly among patients with covid-19 disease as compared to without covid-19 disease patients (p-value <0.05). Conclusion: Anxiety and depression was significantly associated with COVID-19 disease. Medically ill patients should develop techniques for rapid diagnosis and treatment of depression and anxiety.
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A decision support system that performs a comprehensive analysis on risks of the COVID-19 pandemic and its subsequent medium- and long-term impacts is highly desirable, especially in view of the still ongoing pandemic in the world. This paper focuses on the modeling process of such a decision support system. The modeling process includes the following steps: generating appropriate strategies that suit the specific situation concerned, where each strategy is composed of measures and each measure consists of a static (textual) part relating to the contexts abstracted from existing literature via techniques inspired by natural language processing and a dynamic part adapted by using scenario planning method and agent-based simulation;generating utility-based recommender based on soft systems methodology and recommending the Top-N strategies to the group of stakeholders based on the scores of the strategies using multiple-criteria decision analysis method. The proposed model is highly flexible in that it recommends appropriate strategies in respect of the various scenarios concerned and may thus be applied to various types of risk management. © 2021, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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The epidemiological history and clinical characteristics of 7 cases of COVID-19 and 1 case of close contact in the first family aggregation epidemic of COVID-19 in Gansu Province were analyzed. The first patient A developed on January 22, 2020, with a history of residence in Wuhan, and confirmed severe cases of NCP on January 24, 2020; patient B, on January 23, 2020, diagnosed on January 31, severe cases; patient C, asymptomatic, diagnosed on January 27; patient D, asymptomatic, diagnosed on January 27; patient E, on January 24, diagnosed on January 28; patient F, asymptomatic, diagnosed on January 31; Patient G was asymptomatic and was diagnosed on January 31. In close contact, H was asymptomatic, PCR test was negative and asymptomatic, and he was discharged early. Among the 7 patients, 1 case died of (B) aggravation, and the other patients' condition was effectively controlled after active treatment. Except for the discharged cases, 5 cases were positive for COVID-19 specific IgM antibody and 1 case was negative. In this clustering outbreak, 4 patients remained asymptomatic, but PCR and IgM antibodies were positive, indicating that asymptomatic patients may be the key point to control the epidemic. Specific IgM antibody screening for patients whose pharyngeal swab nucleic acid test is negative but with ground glass-like lung lesions is very important for early detection and early isolation.
Subject(s)
Asymptomatic Infections , Coronavirus Infections/diagnosis , Family Health , Pneumonia, Viral/diagnosis , Antibodies, Viral/blood , Betacoronavirus , COVID-19 , China , Humans , Immunoglobulin M/blood , Male , Pandemics , SARS-CoV-2ABSTRACT
The epidemiological history and clinical characteristics of 7 cases of COVID-19 and 1 case of close contact in the first family aggregation epidemic of COVID-19 in Gansu Province were analyzed. The first patient A developed on January 22, 2020, with a history of residence in Wuhan, and confirmed severe cases of NCP on January 24, 2020; patient B, on January 23, 2020, diagnosed on January 31, severe cases; patient C, asymptomatic, diagnosed on January 27; patient D, asymptomatic, diagnosed on January 27; patient E, on January 24, diagnosed on January 28; patient F, asymptomatic, diagnosed on January 31; Patient G was asymptomatic and was diagnosed on January 31. In close contact, H was asymptomatic, PCR test was negative and asymptomatic, and he was discharged early. Among the 7 patients, 1 case died of (B) aggravation, and the other patients' condition was effectively controlled after active treatment. Except for the discharged cases, 5 cases were positive for COVID-19 specific IgM antibody and 1 case was negative. In this clustering outbreak, 4 patients remained asymptomatic, but PCR and IgM antibodies were positive, indicating that asymptomatic patients may be the key point to control the epidemic. Specific IgM antibody screening for patients whose pharyngeal swab nucleic acid test is negative but with ground glass-like lung lesions is very important for early detection and early isolation.