Impacts of Covid-19 on children and adolescent well-being

The COVID-19 pandemic imposed significant and abrupt lifestyle changes on the pediatric population. Major lifestyle changes that occur during children's and adolescents' vital developmental years have the potential to introduce stressors, which have both immediate and long-term effects on physical and mental health. The aspects of the COVID-19 pandemic that impacted pediatric mental health included school closures, quarantine, increases in screen time, changes to Labor & Delivery unit COVID-19 policies, and changes to the delivery of clinical mental health care, including telehealth. In addition, pediatric mental health was deeply impacted by the ongoing challenges to health equity associated with health disparities and racism as a health crisis. Pediatric mental health declined since the start of the pandemic, school closures and quarantine affected rates of food insecurity and physical activity levels, and the COVID-19 pandemic exacerbated pre-existing health disparities and mental health conditions among the pediatric population. Recommendations for building more resilient public health systems are explored. © 2023 The authors.

Prolonged respiratory viral infection associated with presence of coinfections in an urban birth cohort

Background. Prolonged infection by respiratory viruses has been reported, especially in hospitalized or immunocompromised children. However, little is known of factors contributing to prolonged respiratory viral infection, particularly in asymptomatic and less severe infections. We examined characteristics associated with prolonged viral infection in a community-based birth cohort. Methods. The PREVAIL cohort is a CDC-sponsored two-year birth cohort in Cincinnati, Ohio conducted during 4/2017 to 8/2020. Mid-turbinate nasal swabs were collected weekly from children and tested using the Luminex Respiratory Pathogen Panel. The primary outcome was prolonged viral infection, which was defined as a viral nucleic acid detection lasting 4 or more weeks. Proportions of prolonged viral infections were compared using Fisher's exact test with Holms corrections. Adjusted odds ratios (aOR) and 95% confidence intervals were calculated using a mixed effects logistic regression model while controlling for within-subject clustering, viral species, child age, child sex, symptom status, and coinfection. This analysis was limited to subjects who provided at least 70% of weekly samples. Results. Among 101 children, providing 7871 child-weeks of follow-up, we identified 780 viral infections. The median duration of infection across all respiratory viruses was 1 week, except for bocavirus and coronavirus NL63, each with 2 weeks;40% of bocavirus and >10% of adenovirus, coronavirus NL63, RSV A, human metapneumovirus, and parainfluenza 1 infections were associated with prolonged infection (>4 weeks). No prolonged infections were detected for influenza A or B, coronavirus 229E or HKU1, or parainfluenza 2 or 4 infections. Viral coinfection (aOR=3.1, 95% CI 1.9, 5.0) and female sex (aOR 1.8, 95%CI 1.1, 2.9) were significantly associated with prolonged infection, while symptom status and child age were not. Conclusion. In the PREVAIL cohort, detection of respiratory viruses lasting 4 weeks or longer was common for certain respiratory pathogens and was especially prolonged for bocavirus. Biological factors such as the presence of additional viral infections or child sex may affect the likelihood of prolonged infection. (Figure Presented).

Impact of the Coronavirus 2019 Pandemic on Pediatric Out of Hospital Cardiac Arrest Outcomes During 2020

Purpose: The Coronavirus 2019 (COVID-19) pandemic impacted adult out-of-hospital arrest (OHCA) outcomes in the United States. The impact of the pandemic on pediatric OHCA is unknown. Materials and methods: An analysis of the Cardiac Arrest Registry to Enhance Survival for non-traumatic pediatric OHCAs (≤18 years) was conducted. Outcomes during 3 pandemic surge periods in 2020 (March 16 to May 15, July 1 to August 15, and October 16 to December 31) were compared to the same time periods pre-pandemic in 2019. The primary outcomes were overall survival and neurologically favorable survival, defined as a cerebral performance score of 1 or 2 at the time of hospital discharge. Age groups included infants (<1 year), children (1 to 11 years), and adolescents (≥12 years). Results: A total of 1381 pandemic surge period arrests were compared to 1274 pre-pandemic arrests. There was an increase in OHCAs in adolescents (pandemic 26.6% [368/1381], pre-pandemic 22.4% [286/1274], p = 0.01). Therewere no differences in OHCAs by sex, race/ethnicity, witness status, location, initial rhythm, bystander CPR rates or bystander AED use. There were no differences in overall survival during the pandemic surge periods in 2020 (10.6% [147/ 1381]), as compared to the same months in 2019 (9.7% [123/1274], p = 0.40) or in neurologically favorable survival (2020: 8.9% [123/1381] vs. 2019: 7.3% [93/1274], p = 0.13). Conclusions: During the COVID-19 pandemic surge periods in 2020, pediatric OHCA survival rates in the United Stateswere similar to the rates of pediatric OHCA pre-pandemic. Further study is warranted to determine if pediatric survival for OHCA was affected during the delta and omicron COVID-19 surges in 2021.

Botanical boom: A new opportunity to promote the public appreciation of botany

Societal Impact Statement: Plants are indispensable to life on Earth. Securing our future requires protecting plant biodiversity and the development of climate-resilient crops. Activities fostering public appreciation of plant science, and promoting plant-related professions, are therefore critical. These efforts can be hindered by plant awareness disparity, manifesting as difficulty in recognizing the presence and importance of plants. However, interest in plants as a hobby and as lifestyle elements has rapidly increased in younger demographics over the last decade. We suggest these topics should be exploited urgently by researchers and educators to increase further the reach of science communication, thereby enhancing societal awareness of botany and stimulating interest in plant-related degrees and career pathways. Summary: Plants are the basis of life on Earth as we know it and the study of plants is essential to protect our future. Yet botany and plant science are in crisis and suffer a low uptake at the level of undergraduate degrees. Increasing science communication about exciting advances in our knowledge of plants and their importance to society may be a strategy to counteract this. Here, we comment on the recent trends in the public perception of plants and explore them using infoveillance tools. Our observations highlight that paradoxically over the last decade public interest in plant-related topics has increased considerably, with the advent of a new type of social media influencer—‘plantfluencers’. Additionally, recent studies demonstrate that the COVID-19 pandemic has boosted awareness of the therapeutic value of interacting with plants and their positive effect on human well-being. We suggest that this offers a window of opportunity to develop an appreciation of plant science among the wider public, who are reconnecting with plants in new ways. Plant-focused communities and online groups on social media platforms can facilitate engagement with new audiences. In particular, trends relating to houseplants, plant-based diets and the benefits of interacting with plants on mental health and well-being together provide an attractive springboard for science outreach and botany-focused conversations. Here, we discuss these trends and make recommendations for researchers and educators. © 2022 The Authors. Plants, People, Planet published by John Wiley & Sons Ltd on behalf of New Phytologist Foundation.

The relationship between HRM and TQM practices among egyptian employees - Work outcomes effect

Employee engagement in work outcomes is becoming a critical phase in organizational life, as more and more businesses are recovering from the menace of the recent global recession caused by the ongoing COVID-19 pandemic. This chapter investigated the relationships between HRM/TQM practices and their effects on organizational outcomes such as employees' satisfaction and intention to leave. Using Bosille and van der Wiele (2002) instrument, first used in the Netherlands, to collect data from 690 Egyptian employees. Our findings showed that salary, leadership, cooperation within business units, and cooperation between business units had statistically significant relationships with employees' satisfaction and their intention to leave. Results were consistent with prior findings, in that the instrument appears scalable, thus, can be extended or generalized to a developing country like Egypt, with different cultural and social values. Overall, by discussing caveats and implications, the chapter laid foundations for artifacts that can guide future thoughtful research toward increasing employee commitment and helping organizations to attain high-level organizational performance, employee retension, and productivity. © 2021 Nova Science Publishers, Inc.

The Association of Altered Mental Status in the Emergency Department With In-Hospital Mortality in COVID-19 Patients

Study Objectives: Altered mental status (AMS) is frequently associated with poor outcomes across a wide spectrum of conditions including infections. This study aims to identify whether AMS in emergency department (ED) patients with COVID-19 is independently associated with in-hospital mortality. Methods: This was a retrospective multicenter cohort study. We included all patients with a positive SARS-CoV-2 PCR within 2 weeks of presentation, who were admitted from the ED of three hospitals in the greater Boston area between March and August 2020. The primary covariate of interest was ED AMS at ED arrival and the primary outcome was in-hospital mortality. The ED charts were abstracted for demographics, comorbid conditions, symptoms, laboratory testing, and radiology testing along with in-hospital outcomes. AMS was defined by documentation of changes in mental status from baseline. We used logistic regression modeling with backwards elimination to determine an adjusted estimate for the independent association of AMS with mortality. Results: We included 824 visits with 51% male, a mean age was 67.1 (SD 17.0) and 153 (18.6%) had AMS. There were 132 deaths for an overall mortality rate of 16.1%. Patients with AMS had in-hospital mortality of 38.2% (95% CI 30.4%-46.4%), compared to 11.1% (8.8%-13.7%) for patients without AMS (p<0.0001). After adjusting for potential confounders, visits by patients with AMS during their stay at the ED had 3.1 (95% CI, 2.1-5.9) times the odds of death compared to those without AMS. Conclusion: Among patients with COVID-19, AMS in the ED was associated with three-fold increase in mortality compared to patients without AMS.

Implementing Pool-Based Surveillance Testing for SARS-CoV-2 at the Army Public Health Center Laboratory and across the Army Public Health Laboratory Enterprise

With limited clinical resources, burgeoning testing requests from Army and other Service units to clinical laboratories, and the continued spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) throughout the military population, the Army Public Health Laboratory (APHL) Enterprise was tasked to establish surveillance testing capabilities for active duty military populations in an expedient manner. Following a proof-of-concept study conducted by Public Health Command-Pacific, Public Health Command-Europe was the first public health laboratory to offer the capability to assess for SARS-CoV-2 in pooled samples, followed closely by the Army Public Health Center (APHC) at Aberdeen Proving Grounds, MD, paralleling the spread of the SARS-CoV-2 virus from China to Europe to the continental US. The APHLs have selected pool sizes of up to 10 samples per pool based on the best evidence available at the time of method development and validation. Real-Time quantitative Reverse Transcriptase-Polymerase Chain Reaction (qRT-PCR) assays using RNA extracts from pooled nasopharyngeal swabs preserved in viral transport media were selected to assess the presence of SARS-CoV-2. The rapid development of initial surveillance testing capabilities depended on existing equipment in each laboratory, with a plan to implement full operational capability using additional staff and common high-throughput platforms. APHL Enterprise has successfully used existing resources to begin to address the changing and complex needs for COVID-19 testing within the Army population. Successful implementation of pooled surveillance testing at the APHC Laboratory has enabled more than 8,600 Soldiers to avoid clinical testing to date. The APHC Laboratory alone has tested over 10,000 samples and prevented approximately 8,600 soldiers from seeking testing with clinical diagnostic assays.

First case report of a successfully managed severe COVID-19 infection in Malawi

The coronavirus disease 2019 (COVID-19) pandemic is now established on the African continent, with cases rapidly increasing in Malawi (1742 confirmed cases and 19 deaths as of 5 July 20201). Clinicians require guidelines, deliverable in the Malawi context, to effectively and safely treat patients for the best possible outcome. In Malawi, key public messages around social distancing, hand washing and shielding for at-risk individuals have been widely distributed by the Ministry of Health. However, it has not been possible to implement strict lockdown measures in Malawi due to the risk of widespread economic disruption, hunger, worsened food insecurity, risk of violence and mass political rallies. Testing rates are low such that the number of confirmed cases in Malawi is likely to significantly under-represent the actual number of cases. As the epidemic unfolds, it is vital that doctors implement standardised case management guidelines to improve survival for patients who require hospital admission. The majority of patients hospitalised with COVID-19 require medical-ward level care, including provision of adequate oxygen3. Increased oxygen provision has been a major focus of COVID-19 preparedness activities in Malawi.

284EMF Thromboelastography to Assess Coagulopathy and Glycocalyx Degradation in Sepsis

Study Objectives: Sepsis is a common and deadly clinical syndrome that affects many patients presenting to the emergency department (ED). Sepsis-induced inflammation leads to abnormal coagulation. Additionally, one potential mechanism for abnormal coagulation and organ dysfunction in sepsis is injury to the endothelial glycocalyx;the glycocalyx contains heparans which are released during degradation and may cause mild coagulopathy. We hypothesize that coagulation abnormalities detected by bedside viscoelastic monitoring (VEM), such as thromboelastography, are associated with organ dysfunction and death (suggesting abnormal coagulation as a mediator). We further hypothesize that heparinase R-time, a VEM measurement that may detect glycocalyx degradation, will be associated with organ dysfunction. Methods: Patients >18 years old with a diagnosis of sepsis were recruited from an urban ED (∼55,000 visits per year) as part of an ongoing observational study of a convenience sample of patients. After informed consent was obtained, blood samples are to measure VEM. VEM measurements include the R time, K time, alpha angle, maximum amplitude (MA), lysis percent at 30 minutes (LY30), and change in R time with the addition of heparinase (ΔR). We also collect demographic information, comorbidities, sepsis severity, the information necessary to determine the Sequential Organ Failure Assessment (SOFA) score, and mortality data. We calculated descriptive statistics for VEM measurements, and Pearson correlations between VEM measurements and SOFA score on enrollment and on days 1-3. Results: We have enrolled 79 subjects thus far (study is ongoing). The baseline VEM parameters, expressed as median (IQR), are as follows: R, 5.3 minutes (4.2-6.4);K, 1.2 minutes (0.9-1.8);alpha angle, 72.0 degrees (65.7-75.8);MA, 68.3 millimeters (63.2-73.5);and LY30, 0.1 percent of maximum amplitude (0-1). The baseline ΔR is 0.4 minutes (IQR, 0.1-55). For patients enrolled to date, ΔR was correlated with day 1 SOFA score (r = -0.21, p < 0.03). Additionally, K was correlated with SOFA score on day 1 (0.22, p < 0.02) and day 2 (0.26, p < 0.03). Further results, delayed due to the impact of coronavirus on this project, will be available at the time of the Research Forum. Conclusion: It is feasible to obtain VEM measurements in patients with sepsis. Our ongoing work will recruit additional patients, measure syndecan-1 levels (a marker of glycocalyx degradation), determine illness severity scores (using Sequential Organ Failure Assessment scores) on days 0-3 and mortality outcomes, and determine whether syndecan-1 levels, VEM measurements, and patient outcome measurements are associated.