Current Smoking and Risk of Coronavirus Infection and Illness in a Highly Controlled Challenge Study: A Re-analysis of the British Cold Study.

INTRODUCTION: Meta-analyses have shown an association between smoking and the risk of Coronavirus Disease 2019 (COVID-19) disease severity, but the risk of smoking and coronavirus infection is less clear. AIMS AND METHODS: We re-analyzed data from the British Cold Study, a 1986-1989 challenge study that exposed 399 healthy adults to 1 of 5 "common cold" viruses (including n = 55 for coronavirus 229E). Participants with cotinine levels below 15 ng/mL (noncurrent smokers) were compared with participants with higher cotinine levels or self-reported smoking (current smokers). We calculated overall and coronavirus-specific unadjusted and adjusted relative risks (RRs) for current smoking and each outcome (infection and illness), and tested whether each association was modified by the type of respiratory virus. RESULTS: Current smokers had a higher adjusted risk than noncurrent smokers for infection (adjusted RR [aRR] = 1.12, 95% CI: 1.01, 1.25) and illness (aRR = 1.48, 95% CI: 1.11, 1.96). Neither association was modified by an interaction term for smoking and type of virus (infection: p = .44, illness: p = .70). The adjusted RR estimates specific to coronavirus 229E for infection (aRR = 1.22, 95% CI: .91, 1.63) and illness (RR = 1.14, 95% CI: .62, 2.08) were not statistically significant. CONCLUSIONS: These RRs provide estimates of the strength of associations between current smoking and infection and illness that can be used to guide tobacco control decisions. IMPLICATIONS: Systematic reviews and meta-analyses have found an association between smoking and COVID-19 disease severity, but fewer studies have examined infection and illness. The British Cold Study, a high-quality challenge study that exposed healthy volunteers to respiratory viruses including a coronavirus, provides an opportunity to estimate the RR for current smoking and infection and illness from coronaviruses and other viruses to guide tobacco control decisions. Compared with noncurrent smokers, current smokers had a 12% increased risk of having a laboratory-confirmed infection and a 48% increased risk of a diagnosed illness, which was not modified by the type of respiratory virus including a coronavirus.

EVALUATION OF A NON-VISUAL AUDITORY CHOROPLETH AND TRAVEL MAP VIEWER.

The auditory virtual reality interface of Audiom, a web-based map viewer, was evaluated by thirteen blind participants. In Audiom, the user is an avatar that navigates, using the arrow keys, through geographic data, as if they are playing a first-person, egocentric game. The research questions were: What will make blind users want to use Audiom maps? And Can participants demonstrate basic acquisition of spatial knowledge after viewing an auditory map? A dynamic choropleth map of state-level US COVID-19 data, and a detailed OpenStreetMap powered travel map, were evaluated. All participants agreed they wanted more maps of all kinds, in particular county-level COVID data, and they would use Audiom once some bugs were fixed and their few recommended features were added. Everyone wanted to see Audiom embedded in their existing travel and mapping applications. All participants were able to answer a question evaluating spatial knowledge. Participants also agreed this spatial information was not available in existing applications.

Surgical Simulation-Does it improve the undergraduate surgical experience?

Aims: Many final year undergraduate students rotating through Surgery in our DGH have had their clinical experience adversely affected by COVID due to missed or cancelled patient contact, absence, or cancelled placements earlier in The curriculum. We sought to improve The experience by designing a new simulation programme of acute surgical presentations to become embedded in The teaching schedule and to audit The feedback from this and make improvements. Method(s):Weheldasmall focus group with FYs and medical students to identify surgical presentations that they would benefit from practice on. We wrote a package of simulated cases including "unwell pancreatitis", "wound dehiscence" and "post op pyrexia". All scenarios had The aim of encouraging A-E assessment by The student pitched at incoming-FY1 level, and available equipment in The SIM lab includes SIM man, realtime obs, and General ward equipment. Scenarios were written to include multidisciplinary input from nursing, anaesthetic and surgical colleagues and include flexible options depending on student performance. The hospital resus of ficer helped to run The scenarios. Result(s): The scenarios were run with 4 consecutive blocks of students. All feedback was positive with all students grading feedback as "very good" or "excellent". Other feedback included "more scenarios" and "helps prepare for FY1". Small improvements were made to The written documentation through PDSA cycles over The 4 blocks and are now embedded in The curriculum. Conclusion(s): Availability of surgical simulation helped students to become more confident in A-E assessment of unwell surgical patients despite loss of patient interactions due to COVID.

What happens to hernias if we don't operate? A Covid-19 waiting list study

Aims: Many patients with symptomatic abdominal hernias have suffered delays and cancellations due to The reduction of elective operating lists. This waiting list study looks to examine what has happened to patients who were On The waiting list On The day of The first lockdown in March 2020, and whether there were any adverse outcomes. Method(s):We used coding data, TrakCare IT information and op notes to identify The outcomes of those patients between March 2020 and December 2021. We looked at whether elective surgery had been done, waiting times, if The patient had presented as an emergency, and if they had been removed from The list. We included any symptomatic abdominal hernia ie inguinal, incisional, paraumbilical, ventral. Result(s): There were 78 patients included. 33 had elective repair, min waiting time 6 months, max 18 months. There were 5 emergency presentations for operative repair (6.4%) including 1 death (3 inguinal, 2 incisional). A further 3 required expedited repair at 5, 8 and 9 months. 4 patients removed themselves due to improvement in symptoms and 27 patients remained On The list (min 19 months, max 27 months). Conclusion(s): Waiting lists for benign surgery have been adversely affected by The pandemic and this difficulty is seen clearly in our small district general. Patients who have been waiting a long time are at risk of emergency presentations and ongoing symptoms. Those with The fewest symptoms are waiting over two years and are at risk of continued waits due to ongoing service pressures.

The Simple Things: Using Simulation Models to Improve Junior and Undergraduate Surgical Teaching in a DGH

Aims: Many clinical activities remain cancelled or uncertain in The CoVID world. We established a Surgical Skills Club in our DGH, where students and juniors are rotated far from their home institution. We also aimed to improve our undergraduate teaching by incorporating new surgical Sim sessions. Method(s): We established a weekly Surgical Skills Club by trainees, and promoted this through MedEd to all juniors, students and ANps. We used a combination of higher-fidelity models owned by The hospital and low fidelity models designed by ourselves such as lap-appendix and hernia. We utilised social media to share ideas. We recorded attendance and sought written feedback. We also set up dedicated simulation sessions as part of ongoing undergraduate teaching. Result(s): Anonymous feedback was documented weekly via app/online. For skills club, 100% of attendees documented experience as "great" or "good" (options great, good, average, fair, poor). Attendance varied from 2-15 each week. The best attendance was a formalised session with consultant input. For undergraduate Sim, 100% of attendees rated experience as "great" or "good". All attendees agreed Sim teaching improved their experience of surgery. 20% stated it made them consider a career in surgery. Conclusion(s): Surgical simulation is an excellent tool for improving experience of general surgery especially in a CoVID environment, and can widen access to surgical training by allowing juniors to explore their skills in a controlled, informal environment. Lap Skills gave students real-world confidence. A combination of low fidelity models provided The best experience showing that The barrier of cost can be broken.

The simple things: Using surgical simulation to improve junior and undergraduate surgical teaching in a rural DGH

Aim: Many clinical activities remain cancelled or uncertain in the COVID world. We established a Surgical Skills Club in our rural DGH, where students and juniors are rotated far from their home institution. We also aimed to improve our undergraduate teaching by incorporating new surgical Sim sessions. Method: We established a weekly Surgical Skills Club by trainees, and promoted this through MedEd to all juniors, students and ANPs. We used a combination of higher-fidelity models owned by the hospital and low fidelity models designed by ourselves such as lap-appendix and hernia. We utilised social media to share ideas. We recorded attendance and sought written feedback. We also set up dedicated simulation sessions as part of ongoing undergraduate teaching. Results: Anonymous feedback was documented weekly via app/online. For skills club, 100% of attendees documented experience as 'great' or 'good' (options great, good, average, fair, poor). Attendance varied from 2-15 each week. The best attendance was a formalised session with consultant input. For undergraduate Sim, 100% of attendees rated experience 'great' or 'good'. All attendees agreed Sim teaching improved their experience of surgery. 20% stated itmade them consider a career in surgery. Conclusions: Surgical simulation is an excellent tool for improving experience of general surgery especially in a COVID environment and can widen access to surgical training by allowing juniors to explore their skills in a controlled, informal environment. Lap Skills gave students real-world confidence. A combination of low fidelity models provided the best experience showing that the barrier of cost can be broken.

Positive outcomes from integrating telehealth into routine clinical practice for eating disorders during COVID-19.

BACKGROUND: The coronavirus pandemic (COVID-19) has required telehealth to be integrated into the delivery of evidence-based treatments for eating disorders in many services, but the impact of this on patient outcomes is unknown. OBJECTIVE: The present study examined the impact of the first wave of COVID-19 and rapid transition to telehealth on eating disorder symptoms in a routine clinical setting. METHOD: Participants were 25 patients with a confirmed eating disorder diagnosis who had commenced face-to-face treatment and rapidly switched to telehealth during the first wave of COVID-19 in Western Australia. Eating disorder symptoms, clinical impairment and mood were measured prospectively before and during lockdowns imposed due to COVID-19. HYPOTHESES: We predicted that patients would experience poorer treatment outcomes during COVID-19 and would perceive poorer therapeutic alliance and poorer quality of treatment compared to face-to-face therapy. RESULTS: Our hypotheses were not supported. On average, patients achieved large improvements in eating disorder symptoms and mood, and the magnitude of improvement in eating disorder symptoms was comparable to historical benchmarks at the same clinic. Patients rated the quality of treatment and therapeutic alliance highly. DISCUSSION: Providing evidence-based treatment for eating disorders via telehealth during COVID-19 lockdown is acceptable to patients and associated with positive treatment outcomes.

Does the High Prevalence of Vitamin D Deficiency in African Americans Contribute to Health Disparities?

African Americans have higher incidence of, and mortality from, many health-related problems than European Americans. They also have a 15 to 20-fold higher prevalence of severe vitamin D deficiency. Here we summarize evidence that: (i) this health disparity is partly due to insufficient vitamin D production, caused by melanin in the skin blocking the UVB solar radiation necessary for its synthesis; (ii) the vitamin D insufficiency is exacerbated at high latitudes because of the combination of dark skin color with lower UVB radiation levels; and (iii) the health of individuals with dark skin can be markedly improved by correcting deficiency and achieving an optimal vitamin D status, as could be obtained by supplementation and/or fortification. Moderate-to-strong evidence exists that high 25-hydroxyvitamin D levels and/or vitamin D supplementation reduces risk for many adverse health outcomes including all-cause mortality rate, adverse pregnancy and birth outcomes, cancer, diabetes mellitus, Alzheimer's disease and dementia, multiple sclerosis, acute respiratory tract infections, COVID-19, asthma exacerbations, rickets, and osteomalacia. We suggest that people with low vitamin D status, which would include most people with dark skin living at high latitudes, along with their health care provider, consider taking vitamin D3 supplements to raise serum 25-hydroxyvitamin D levels to 30 ng/mL (75 nmol/L) or possibly higher.