COVID-19 as a Catalyst for Same Day Discharge After Minimally Invasive Hysterectomy

Objective: This study quantified the COVID-19 pandemic's impact on same-day discharges for minimally invasive hysterectomy and evaluated the effect on postoperative morbidity and health care use.Materials and Methods: This retrospective cohort study, from March 2018 to October 2021 at a single institution, included women older than age 18 who had laparoscopic, vaginal, or robotic-assisted hysterectomy by any gynecologic surgeon. Primary outcome was rate of same-day hospital discharge. Secondary measures were length of stay and rates of 30-day postoperative morbidity and health care use. Univariate and multivariable logistic regression analyses were conducted to evaluate associations between patients' characteristics and likelihood of same-day discharge.Results: There were 1608 women included, 896 in a prepandemic cohort and 712 in a postpandemic cohort. Surgeon subspecialty rates were similar between groups, but surgical approaches differed, with more laparoscopic procedures in the postpandemic cohort (p = 0.007). Case order and lengths, and concurrent procedures were not different between groups. Postpandemic patients were more likely to be discharged on the same day even after controlling for confounders in a multivariable regression (32% versus 54%, respectively;odds ratio: 2.78;p < 0.001). Rates of 30-day postoperative complications, transfusions, emergency department visits, readmissions, reoperations, and mortality were not significantly different.Conclusions: The COVID-19 pandemic was associated with increased same-day discharges without increases in 30-day postoperative complications. The data confirmed that same-day discharge following minimally invasive hysterectomy was safe for managing hospital constraints caused by the COVID-19 pandemic. (J GYNECOL SURG 20XX:000)

Uncertainty management in electricity demand forecasting with machine learning and ensemble learning: Case studies of COVID-19 in the US metropolitans

Improving load forecasting is becoming increasingly crucial for power system management and operational research. Disruptive influences can seriously impact both the supply and demand sides of power. This work examines the impact of the coronavirus on power usage in two US states from January 2020 to December 2020. A wide range of machine learning (ML) algorithms and ensemble learning are employed to conduct the analysis. The findings showed a surprising increase in monthly power use changes in Florida and Texas during the COVID-19 pandemic, in contrast to New York, where usage decreased over the same period. In Texas, the quantity of power usage rises from 2% to 6% practically every month, except for September, when it decreased by around 1%. For Florida, except for May, which showed a fall of roughly 2.5%, the growth varied from 2.5% to 7.5%. This indicates the need for more extensive research into such systems and the applicability of adopting groups of algorithms in learning the trends of electric power demand during uncertain events. Such learning will be helpful in forecasting future power demand changes due to especially public health-related scenarios. © 2023 Elsevier Ltd

National Guard service members decedent recovery and processing operations during the COVID-19 pandemic in New York City

In Spring 2020, the New York Army and Air National Guard (NYNG) rapidly deployed to New York City (NYC) to assist in the recovery, processing, and transport of COVID-19 decedents. This study reports on a survey conducted by NYNG service members three to six months post-mission (n = 177). Data showed that there was a dose–response relationship between mission stress exposure and decremented mental health, but certain activities were associated with better mental health outcomes. The paper also reviews resources provided by behavioral health personnel to support service members during the mission and lessons learned to inform future decedent recovery missions. © 2023 Division 19 (Society for Military Psychology) of the American Psychological Association.

Health Preparedness and Narrative Rationality: A Call for Narrative Preparedness

This conceptual paper argues the need for narrative preparedness, understood as the ability to engage and empathize with peoples' stories and the values they encode, assess them based on the universe in which people live, and acknowledge the narrative rationality of each story – even when it conflicts with the rationality of science. Expanding ‘health preparedness' to encompass ‘narrative preparedness' complements the ideals of patient centeredness, which are sometimes betrayed when implemented into concrete decisions because the rationality of science that underpins medical practice fails to make sense of patients' stories. We outline the central tenets of narrative preparedness and demonstrate its relevance by discussing various responses to mainstream discourses on COVID-19 as a case in point. We discuss and further develop Fisher's narrative paradigm, which provides a model that complements traditional, scientific rationality with attention to narrative rationality and a radical democratic ground for health political critique. Applying the narrative paradigm to authentic examples of vaccine hesitancy and anti-vaccination demonstrates how closer attention to the way narratives are assessed by different constituencies might help us mitigate some of the sources of resistance and misunderstanding that continue to plague public communication about important medical issues such as pandemics. Health authorities must acknowledge and engage with the stories people believe in and their reasons for doing so. The crucial question for the success of health policy interventions is not only ‘what are the facts' but ‘how do these facts make sense to people, and why.' To be prepared for the next pandemic, health professionals must learn to engage with people's stories and the processes by which they come to be understood and assessed differently by various constituencies. © 2023 The Author(s);Published by Kerman University of Medical Sciences.

CLUSTER Trial An 82 U.S. Hospital Cluster Randomized Trial (CRT) to Assess the Impact of an Automated Statistical Outbreak Detection Tool and Response Protocol to Limit Hospital Transmission

Background. The CLUSTER trial assessed the impact of prospective identification of clusters coupled with a response protocol on the containment of hospital clusters. Methods. This 82-hospital CRT in 16 states compared clusters of bacterial and fungal healthcare pathogens using a statistical outbreak detection tool (WHONET-SaTScan) coupled with a standardized response protocol (automated cluster detection arm) compared to routine surveillance with the response protocol (control arm). Trial periods: 24 mo Baseline (2/17-1/19);5 mo Phase-in (2/19-6/ 19);30 mo Intervention (7/19-1/22). The primary outcome was the number of additional cases occurring after initial cluster detection. Analyses used generalized linear mixed models to assess differences in additional cases between the intervention vs baseline periods across arms, clustering by hospital. Results were assessed overall and, to account for the effect of COVID-19 on hospital operations, stratified into pre-COVID-19 (7/19-6/20) and during COVID-19 (7/20-1/22) intervention periods. We also assessed the probability that a patient was in a cluster. Results. In the baseline period, the automated cluster detection and control arms had 0.09 and 0.07 additional cluster cases/1000 admissions, respectively. The automated cluster detection arm had a 22% greater relative reduction in additional cluster cases in the intervention vs baseline period compared to control (P=0.5). Within the intervention period, the automated cluster detection arm had a significant 64% relative reduction pre-COVID-19 (P< 0.05) and a non-significant 6% relative reduction during COVID-19 (P=0.9) compared to control (Figure). When evaluating patient risk of being part of a cluster across the entire intervention period, the automated cluster detection arm had a significant 35% relative reduction vs control (P< 0.01). Conclusion. A statistical automated tool coupled with a response protocol improved cluster containment by 64% pre-COVID-19 but not during COVID-19;there were no significant differences between the arms when using the entire intervention period. Automated cluster detection may substantially improve outbreak containment in non-pandemic periods when infection prevention programs are able to optimize containment protocols. (Figure Presented).

From surviving to co-creating: the effects of the reshaped physical and social servicescape on customer citizenship behavior

The pandemic has reshaped customer perceptions of the new normal with both the physical and social service environments. Surprisingly, however, how reshaped servicescape design affects customers, especially their value co-creation behaviors, has not been studied. Drawing on value co-creation and signaling theory, this research aims to examine the comprehensive effects of the physical servicescape (signages, partitions, and spatial density) and the social servicescape (other customer misbehavior) on customer citizenship behavior and revisit intention via the mediating roles of perceived competence, perceived ethicality, and other customer trust. This study conducts two between-subjects experimental design studies with both written and pictorial manipulations in restaurant and retail store contexts to increase generalizability for services marketing. Signages and other customer misbehavior promote customer citizenship behavior through perceived competence and ethicality while partition shows the mixed results on customer perceptions. This paper contributes to servicescape and customer citizenship literature by identifying how the servicescape affects customer citizenship behavior via customers' perception. The findings of this current study also offer practical guidance as to how firms can be more strategic in design choices.

AURICULAR TRANSCUTANEOUS HI-FREQUENCY E-MMUNOTHERAPY SEQUENCES (ATHENS) for the TREATMENT of RHEUMATOID ARTHRITIS: 1-YEAR CHANGES in SYNOVITIS, OSTEITIS, and BONE EROSION

Background: Current pharmacological treatments remain inadequate for a signifcant proportion of patients with rheumatoid arthritis (RA), and thus alternative treatment approaches are needed. Prior results from the frst 12 weeks of a proof-of-concept (POC) study showed that ATHENS, a non-invasive high-frequency vagus nerve therapy, was well-tolerated with meaningful reductions in RA disease severity as measured by the American College of Rheumatology response criteria (ACR) and the Disease Activity Score using 28 joints (DAS28)[1]. Objectives: The current analysis assessed long-term changes (52 weeks total follow-up) in disease activity as measured by ACR, DAS28, and the following MRI-assessed changes: synovitis, osteitis, bone erosion, and cartilage loss. Methods: Following the completion of the 12-week POC study, patients achieving a reduction in DAS28-CRP of ≥1.2 were given the option to enroll in the 9-month open-label extension (OLE) study. During the extension phase, patients were to use the wearable device for 15 minutes per day. Adjustment of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biologic disease-modifying antirheumatic drugs (bDMARDs) were allowed during the OLE. Changes from baseline were assessed at 12 weeks (end of initial POC) and 52 weeks (end of the OLE). Structural damage and disease progression were evaluated by standardized MRI of the wrist and hand, with and without intravenous gadolinium-based contrast. MRIs were evaluated by two independent, central readers, blinded to clinical information and visit-order of the images, and were scored for synovitis, osteitis and bone erosion using the OMERACT-RAM-RIS method. Cartilage loss was also determined using the 9-point cartilage loss scale (CARLOS). Results: Twenty-seven of 30 patients completed the initial 12-week study, of whom 19 consented and entered the OLE. Of those 19 patients, 4 (21%) discontinued due to lack of efficacy, while the remaining 15 completed the 9-month extension. Due to the COVID-19 pandemic, 7 patients were unable to complete a 52-week MRI scan;MRI evaluations at baseline, 12 weeks, and 52 weeks were available for 8 patients. DAS28-CRP mean (standard deviation [SD]) change from baseline was-1.78 (1.01) at 12 weeks (n=19;p<0.0001) and-2.30 (1.22) at 52 weeks (n=15;p<0.0001). ACR20, ACR50, and ACR70 response rates were 68%, 42%, and 21% at 52 weeks (n=19;discontinued participants were deemed non-responders). MRI analysis of synovitis, osteitis, bone erosion, and cartilage loss showed no evidence of disease progression through 52 weeks compared with baseline (Table 1). During the 9-month extension study, two new adverse events were reported (cornea transplant and right hand dysesthesia) in 2 (11%) patients;neither was treatment-related and both resolved without intervention. No serious adverse events were reported. Conclusion: In patients with an initial treatment response to the Nēsos ATHENS therapy in the 12-week POC study, reductions in DAS28-CRP were sustained through 52 weeks. Although results should be interpreted cautiously given the small sample size and lack of control arm, MRI evaluation of synovitis, osteitis, bone erosion, and cartilage loss suggested no disease progression.

ESTABLISHING THE SAFETY OF OUTPATIENT RETROPERITONEAL SACROSPINOUS LIGAMENT FIXATION - A RETROSPECTIVE REVIEWAT A LARGE ACADEMIC HEALTHCARE CENTER

Introduction: With the strain placed on the medical system by the ongoing surges of the Covid-19 pandemic, inpatient surgery is often suspended, and same day discharge rates are increasing. Sacrospinous ligament fixation (SSLF) is an apical suspension procedure performed retroperitoneally;retroperitoneal hemorrhage and nerve injury are potential severe complications. Given these risks, providers vary in their preference for same day discharge vs. routine overnight admission after this procedure. Objective: To establish the safety of outpatient SSLF and evaluate the frequency of complications identified during the hospital stay. Methods: This is a retrospective cohort study of women who underwent SSLF by Urogynecologists at our large, academic institution between March 2018 and October 2021. Patients were identified from the Gynecologic Enhanced Recovery Surgical database, which includes all surgical patients in the department of OBGYN. The data was collected from the electronic medical record (EMR) to track compliance and outcomes in real time for quality improvement purposes during implementation of our enhanced recovery protocol. Institutional IRB approval was obtained. Descriptive statistics were performed. Student's t-test and two-sample tests-of-proportions were used, with a p-value <0.05 denoting statistical significance. Results: A total of 165 patients underwent SSLF;23 were outpatient, and 142 were admitted for at least one night. Over 90% of patients in both groups identified as white, non-Hispanic, and English-speaking. The mean BMI for both groups was 28.8 kg/m2. The outpatient group was younger (57.9 years compared to 64.7 years;P = 0.0051);outpatients were more likely to have commercial insurance (P = 0.0143) and inpatients to have Medicare (P = 0.0282). Almost double the proportion of those in the inpatient group had anxiety and depression, but this did not achieve statistical significance. Outpatients were more likely to be never smokers (P = 0.0175) and use narcotics preoperatively (P = 0.0385). They had a lower mean ASA score (P = 0.0067), Charleston Comorbidity Index score (P = 0.0452), total length of surgery (P < 0.001), total length of anesthesia (P < 0.001), and estimated blood loss (P = 0.0142). Those who went home the same day were more likely to have been the first case (P = 0.0123), and same-day discharge rates increased significantly after the onset of the Covid-19 pandemic (P = 0.0039). Both complications that required operative intervention were identified in the post-anesthesia care unit on the day of surgery. Notably, 30-day post-operative complications were proportionally lower in the outpatient group, but this did not achieve significance. Most of the complications were urinary tract infections, including the sole complication identified in the outpatient group. Conclusions: With the ongoing Covid-19 pandemic and rapidly evolving practice patterns, it is important to establish the safety of outpatient surgery. Our study demonstrates that outpatient SSLF is safe for appropriately selected patients after routine post-operative monitoring including serial vital signs and assessment of neuropathic pain. Severe complications requiring reoperation can often be identified immediately after surgery. Thirty-day post-operative complication rates did not significantly differ between patients undergoing outpatient versus inpatient SSLF.

SAME DAY DISCHARGE AFTER MINIMALLY INVASIVE HYSTERECTOMY IN THE COVID-19 PANDEMIC

Introduction: While same day discharge after minimally invasive hysterectomy (MIH) has demonstrated efficacy, patient's and provider's comfort and safety concerns have limited the universal transition to outpatient MIH. Beginning in March 2020, the COVID-19 pandemic led to an increased demand for hospital beds and limited the capacity for overnight admissions. Additionally, concerns over infection exposure increased patient and provider interest in limiting patient time in the hospital system. Together, these factors increased pressure for same day discharge in MIH cases. Objective: To quantify the impact of COVID-19 pandemic on same day discharges for MIH and evaluate the effect on postoperative outcomes and health care utilization. Methods: This was a retrospective cohort study of women who underwent MIH at a single institution between March 2018 and October 2021. Women over age 18 who underwent laparoscopic, vaginal, or robotic assisted hysterectomy by any gynecologic surgeon were included. Cases that converted to laparotomy or where a gynecologic surgeon was not listed as the primary surgeon were excluded. The primary objective measure was rate of same day hospital discharge. Secondary measures included length of stay and 30-day postoperative complications, readmissions, reoperations, and mortality. Continuous variables were summarized using medians (quantiles) and assessed with Wilcoxon rank tests;Categorical variables were presented using frequencies (percentages) and assessed with χ2 tests. All analyses were conducted using R version 4.1. Results: A total of 1608 women were included: 896 in the pre-pandemic cohort and 712 in the post pandemic cohort. Demographics are summarized in Table 1. The pre-pandemic cohort was more likely to have an ASA class III or IV (P < 0.01) and more likely to have a diagnosis of diabetes (P < 0.01). Surgical characteristics are described in Table 1 and Figure 1. Breakdown of surgeon subspecialty was similar between groups, endoscopic procedures were more frequent in the post-pandemic cohort (p < 0.01), and the timing in the day of cases was not different between groups. Intraoperative complications were more frequent in the pre-pandemic cohort (2.8% vs. 1.0%, P < 0.01). The post-pandemic cohort was significantly more likely to discharge on postoperative day 0 (32% vs. 54%, P < 0.01). Rates of 30-day postoperative complications were not significantly different (16.4% vs. 15.4%, P = 0.60), and there were not significant differences in postoperative transfusion (0.6% vs 1.0%, P = 0.78), readmissions (3.5% vs. 2.5%, P = 0.28), reoperations (0.8% vs. 0.8%, P = 0.89), or mortality (1 vs. 0, P = 0.37). Thirty-day postoperative emergency department visits were more frequent in the post-pandemic cohort (0.1% vs. 1.3%, P < 0.01). Conclusions: The COVID-19 pandemic was associated with an increase in same day discharge without increase in 30-day postoperative complications, although there was a significant increase in postoperative emergency room visits. Our data suggests increased utilization of same day discharge is a safe strategy for management of capacity and hospital bed constraints caused by the COVID19 pandemic (Table Presented).

Public Sentiment Analysis and Topic Modeling Regarding COVID-19's Three Waves of Total Lockdown: A Case Study on Movement Control Order in Malaysia

The COVID-19 pandemic has affected many aspects of human life. The pandemic not only caused millions of fatalities and problems but also changed public sentiment and behavior. Owing to the magnitude of this pandemic, governments worldwide adopted full lockdown measures that attracted much discussion on social media platforms. To investigate the effects of these lockdown measures, this study performed sentiment analysis and latent Dirichlet allocation topic modeling on textual data from Twitter published during the three lockdown waves in Malaysia between 2020 and 2021. Three lockdown measures were identified, the related data for the first two weeks of each lockdown were collected and analysed to understand the public sentiment. The changes between these lockdowns were identified, and the latent topics were highlighted. Most of the public sentiment focused on the first lockdown as reflected in the large number of latent topics generated during this period. The overall sentiment for each lockdown was mostly positive, followed by neutral and then negative. Topic modelling results identified staying at home, quarantine and lockdown as the main aspects of discussion for the first lockdown, whilst importance of health measures and government efforts were the main aspects for the second and third lockdowns. Governments may utilise these findings to understand public sentiment and to formulate precautionary measures that can assure the safety of their citizens and tend to their most pressing problems. These results also highlight the importance of positive messaging during difficult times, establishing digital interventions and formulating new policies to improve the reaction of the public to emergency situations.

Correlation between ABO blood group and coronavirus disease in 2019 (COVID-19) vulnerability

COVID-19 is rapidly spreading over the world, resulting in a global health crisis. SARS-COV-2 is the pathogen of COVID-19, and prior research has suggested a link between the ABO blood group and coronavirus. The goal of this study is to look at the link between the ABO blood group and COVID-19 infection, severity, and death. Through detection of detect the association between blood group and (age and Gender) in COVID-19 infected. The 375 samples from many Hospital and Health center in Iraq- Wasit, Erbil, Kirkuk, and Sulaimani applied to determine the results of the present study included: Descriptive statistical data analysis:(Frequency, Percentage, Mean, and Mode and stander deviation) and inferential data analysis: Chi-square test and one-way ANOVA (F-Test). A result of this study shows that, there was a statistically significant association between Blood groups in age (p=0.01). Nevertheless, there was no statistically significant association between A, B, AB, and O) Blood Groups in related gender (p=0.19) which was more than the stander alpha of 0.05. © 2022 Author(s).

Complicated Grief during COVID-19: An International Perspective

Cultures across the globe have evolved time-tested rituals to honor those who die and offer solace and support to survivors with the goal of helping them to accept the reality of the death, cope with the feelings of loss, adjust to life without the deceased, and find ways to maintain a connection to the memory of the deceased. The COVID-19 pandemic has disrupted these rituals and brought significant changes to the way we mourn. Specifically, public health responses to COVID-19 such as social distancing or isolation, delays or cancellations of traditional religious and cultural rituals, and shifts from in-person to online ceremonies have disrupted rituals and thus made it more difficult to access support and complete the psychological tasks typically associated with bereavement. This paper conceptualizes the common bereavement tasks including emotion-focused coping, maintaining a connection to the deceased, disengagement and reframing death and loss, and problemfocused coping. It provides examples of how the COVID-19 pandemic has altered mourning rituals across several cultures and religions and contributed to prolonged grief disorder as defined by the ICD-11 that includes depressive symptoms and post-traumatic stress. Early evidence suggested that the suddenness of loss, the social isolation, and the lack of social support often associated with COVID-19-related death are salient risk factors for complicated grief. As a consequence, psychological assessments, grief counseling, and mental health support are needed by families of patients who died from COVID-19. These services must be essential components of any comprehensive public health response to the pandemic. © 2022 Hogrefe Publishing.

COVID-19 Associated Hypercalcemia, A Rare Yet Interesting Case

Introduction: Hypercalcemia is a common clinical diagnosis. Hyperparathyroidism is one of the most common etiologies. Rarely hypercalcemia is associated with intense inflammation secondary to IL-6 production. Herein we present an interesting case of hypercalcemia associated with COVID-19. Case Description: 36-year-old woman with history of Cirrhosis secondary to hepatitis C and alcohol abuse initially admitted for COVID/ARDS and cryptococcemia without CNS involvement. She was initially treated with amphotericin B and continued on fluconazole. Patient was re-admitted after 2 weeks with abdominal pain, constipation and hypercalcemia (Ca 14.2 mg/dl (normal range 8.7-10.1mg/dl). Her ionized calcium was 1.78 mmol/L (normal range 1.12-1.32 mmol/L). Serum phosphorus was 2.5 mg/dl (normal range 2.5-4.5mg/dl). Intact PTH level was 6.7 pg/ml (normal range 6-48pg/ml). Vitamin D 25-OH level was 26.8 ng/ml (sufficient range 32-100 ng/ml);Vitamin D 1,25-OH level was 7.4 pg/ml (normal 19.9-79.3pg/ml). PTH-rp was unmeasurable (< 2pmol/l). CRP was elevated at 31.7mg/L (normal range 0.2-8 mg/L). She was not on calcium, Vitamin D supplementation or thiazide diuretics. Her renal functions were normal. She was given Intravenous fluids & Intravenous pamidronate. Steroids were not used due to an ongoing fungal infection. It was proposed that the patient had Interleukin-induced hypercalcemia secondary to COVID-19 infection. Her serum calcium normalized with improvement in clinical status Discussion: Recent literature suggests COVID-19 is associated with inflammatory response with cytokines & interleukins production. IL-6 production is significantly upregulated especially in severe cases of COVID-19 known as “Cytokine storm”. IL-6 is produced by bronchial epithelial cells. High levels of IL-6 are associated with worse outcomes and much more severe disease. IL-6 in turn causes osteoclast activation, bone resorption & hypercalcemia. In our patient other potential causes of hypercalcemia were ruled out. The proposed mechanism of her hypercalcemia is an intense inflammatory response associated with COVID-19 infection. Conclusion: We present a rare sequelae of COVID-19 infection which presents a teaching point for clinicians to consider while managing such novel disease