Indoor Chemical Exposures in Secondary Schools post-COVID-19 Pandemic: A Cohort Study of New Work-Based Learning Teachers

We obtained cross-sectional repeated measures self-report survey data on workplace safety and health and wellness from newer, early-to-mid-career New Jersey (NJ) secondary or high school (HS) teachers supervising work-based learning on- and off-campus in specific career clusters within career-technical-vocational education. This cohort study in the 2021-2024 school years (SYs) is a unique opportunity. It immediately proceeded the 2019-2021 SYs. Due to COVID-19, most 2020 2nd semester (3/18-6/30/2020) and 2020-2021 SY in-person classes went online;extracurricular activities were cancelled or substantially altered for online/virtual substitutes;and, no-to-little in-person HS teaching and off- or on-campus activities. Upon return 8-9/2021, classrooms, labs, shops, etc. were cleaned. Data suggested risks of human exposure to chemical agents from cleaning, disinfecting and sanitation consumer products use, given concerns about viral (and bacterial) loads collecting and potentially remaining on frequently contacted surfaces. We present study design, recruitment data, and selected survey content responses from ongoing research 2021-2024. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.

Multisystemic Inflammatory Syndrome in Children and Kawasaki Disease: Parallels in Pathogenesis and Treatment.

PURPOSE OF REVIEW: Since it first appeared, multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) has been compared to Kawasaki disease (KD). Although there were early parallels between MIS-C and KD, key differences emerged over time. Here, we aim to compare the pathogenesis, clinical presentation, treatment, and outcomes of MIS-C and KD. RECENT FINDINGS: In this article, we review and compare MIS-C and KD, highlighting differentiating features. We discuss the epidemiological and immunological factors along with clinical and laboratory features which discern MIS-C from KD. We also compare treatment and our understanding of long-term outcomes. Though parallels exist between MIS-C and KD, distinguishing the two is important for clinical management of patients, counseling about natural history, and determining long-term monitoring. While both MIS-C and KD are characterized by profound inflammation and inflammatory vasculopathy, further study is needed to determine whether they are distinct immunopathogenic disorders.

Critical Environmental Justice and Pandemic Events: Florida Farm Work during COVID-19

Extant research has well established that exposure to infectious disease can be a significant problem for vulnerable populations that have been deemed "essential" during widespread health crises. We contribute to this growing body of literature by delineating the utility of the critical environmental justice (CEJ) framework for investigating infectious disease in the context of at-risk groups such as farmworker communities. Specifically, we highlight how the four pillars of CEJ are applicable to potential or real exposure to pathogens in farmworkers' living and working spaces, and how responses and support for these essential workers can be shaped by intersectional factors, the "expendability" of farmworkers, and broader state and corporate structural influences. We draw from a case study of Florida farmworker outreach professionals to center the perceptions and experiences of individuals working directly with farmworker communities during the COVID-19 pandemic. We conclude with a discussion of how our research contributes to the broader understanding of CEJ in the context of widespread health threats, as well as an overview of lessons learned for regulatory and health agencies.

Examination of Adverse Reactions After COVID-19 Vaccination Among Patients With a History of Multisystem Inflammatory Syndrome in Children.

Importance: Data are limited regarding adverse reactions after COVID-19 vaccination in patients with a history of multisystem inflammatory syndrome in children (MIS-C). The lack of vaccine safety data in this unique population may cause hesitancy and concern for many families and health care professionals. Objective: To describe adverse reactions following COVID-19 vaccination in patients with a history of MIS-C. Design, Setting, and Participants: In this multicenter cross-sectional study including 22 North American centers participating in a National Heart, Lung, and Blood Institute, National Institutes of Health-sponsored study, Long-Term Outcomes After the Multisystem Inflammatory Syndrome in Children (MUSIC), patients with a prior diagnosis of MIS-C who were eligible for COVID-19 vaccination (age ≥5 years; ≥90 days after MIS-C diagnosis) were surveyed between December 13, 2021, and February 18, 2022, regarding COVID-19 vaccination status and adverse reactions. Exposures: COVID-19 vaccination after MIS-C diagnosis. Main Outcomes and Measures: The main outcome was adverse reactions following COVID-19 vaccination. Comparisons were made using the Wilcoxon rank sum test for continuous variables and the χ2 or Fisher exact test for categorical variables. Results: Of 385 vaccine-eligible patients who were surveyed, 185 (48.1%) received at least 1 vaccine dose; 136 of the vaccinated patients (73.5%) were male, and the median age was 12.2 years (IQR, 9.5-14.7 years). Among vaccinated patients, 1 (0.5%) identified as American Indian/Alaska Native, non-Hispanic; 9 (4.9%) as Asian, non-Hispanic; 45 (24.3%) as Black, non-Hispanic; 59 (31.9%) as Hispanic or Latino; 53 (28.6%) as White, non-Hispanic; 2 (1.1%) as multiracial, non-Hispanic; and 2 (1.1%) as other, non-Hispanic; 14 (7.6%) had unknown or undeclared race and ethnicity. The median time from MIS-C diagnosis to first vaccine dose was 9.0 months (IQR, 5.1-11.9 months); 31 patients (16.8%) received 1 dose, 142 (76.8%) received 2 doses, and 12 (6.5%) received 3 doses. Almost all patients received the BNT162b2 vaccine (347 of 351 vaccine doses [98.9%]). Minor adverse reactions were observed in 90 patients (48.6%) and were most often arm soreness (62 patients [33.5%]) and/or fatigue (32 [17.3%]). In 32 patients (17.3%), adverse reactions were treated with medications, most commonly acetaminophen (21 patients [11.4%]) or ibuprofen (11 [5.9%]). Four patients (2.2%) sought medical evaluation, but none required testing or hospitalization. There were no patients with any serious adverse events, including myocarditis or recurrence of MIS-C. Conclusions and Relevance: In this cross-sectional study of patients with a history of MIS-C, no serious adverse events were reported after COVID-19 vaccination. These findings suggest that the safety profile of COVID-19 vaccination administered at least 90 days following MIS-C diagnosis appears to be similar to that in the general population.

Impact of the COVID-19 Pandemic on Healthcare-Associated Infections (HAI) by Race and Ethnicity in a Large Network of Community Hospitals: A Call to Action

Background. Inequities in healthcare among racial and ethnic minorities are globally recognized. The focus has centered on access to healthcare, equitable treatment, and optimizing outcomes. However, there has been relatively little investigation into potential racial and ethnic disparities in HAI. Methods. We performed a retrospective cohort analysis of select HAI prospectively-collected by a network of community hospitals in the southeastern US, including central line-associated bloodstream infection (CLABSI), catheterassociated urinary tract infection (CAUTI), and laboratory-identified Clostridioides difficile infection (CDI). Outcomes were stratified by race/ethnicity as captured in the electronic medical record. We defined the pre-pandemic period from 1/1/2019 to 2/29/2020 and the pandemic period from 3/1/2020 to 6/30/2021. Outcomes were reported by race/ethnicity as a proportion of the total events. Relative rates were compared using Poisson regression. Results. Overall, relatively few facilities consistently collect race/ethnicity information in surveillance databases within this hospital network (< 40%). Among 21 reporting hospitals, a greater proportion of CLABSI occurred in Black patients relative toWhite patients in both study periods (pre-pandemic, 49% vs 38%;during pandemic, 47% vs 31%;respectively, Figure 1a), while a higher proportion of CAUTI and CDI occurred in White patients (Figures 1b-c). Black patients had a 30% higher likelihood of CLABSI than White patients in the pre-COVID period (RR, 1.30;95% CI, 0.83-2.05), which was not statistically significant (Table 1). However, this risk significantly increased to 51% after the start of the pandemic (RR, 1.51;95% CI, 1.02-2.24). Similar trends were not observed in other HAI (Tables 2-3). Conclusion. We found differences in HAI rates by race/ethnicity in a network of community hospitals. Black patients had higher likelihood of CLABSI, and this likelihood increased during the pandemic. Patient safety events, including HAI, may differ across racial and ethnic groups and negatively impact health outcomes. (Figure Presented).

Comparison of Trends in Hospital-Onset Bloodstream Infections (HOBSIs) and Central Line Associated Bloodstream Infections (CLABSIs) across a Three-Hospital Health System in the COVID Era

Background. Hospital-onset bloodstream infection (HOBSI) incidence has been proposed as a complementary quality metric to central line-associated bloodstream infection (CLABSI) surveillance. Several recent studies have detailed increases in median HOBSI and CLABSI rates during the COVID-19 pandemic. We sought to understand trends in HOBSI and CLABSI rates at a single health system in the context of COVID-19. Methods. We conducted a retrospective analysis of HOBSIs and CLABSIs at a three-hospital health system from 2017 to 2021 (Figure 1). We compared counts, denominators, and demographic data for HOBSIs and CLABSIs between the prepandemic (1/1/2017-3/30/2020) and pandemic period (4/1/2020-12/31/2021) (Table 1). We applied Poisson or negative binomial regression models to estimate the monthly change in incidence of HO-BSI and CLABSI rates over the study period. Figure 1: Definitions applied for hospital-onset bloodstream infections (HO-BSIs) and central line-associated bloodstream infections (CLABSIs). Potentially contaminated blood cultures were identified by microbiology laboratory technicians as any set of blood culture in which a single bottle was positive for organisms typically considered as skin contaminants. Uncertain cases undergo secondary review by senior lab technicians. Table 1: Count, denominator, and device utilization ratio data for hospital-onset bloodstream infections (HO-BSIs) and central line-associated bloodstream infections (CLABSIs) Note that central line utilization increased upon regression analysis (p<0.001). Results. The median monthly HOBSI rate per 1,000 patient days increased from 1.0 in the pre-pandemic to 1.3 (p< 0.01) in the pandemic period, whereas the median monthly CLABSI rate per central line days was stable (1.01 to 0.88;p=0.1;Table 2). Our regression analysis found that monthly rates of HO-BSIs increased throughout the study, but the increase was not associated with the onset of the COVID-19 pandemic based on comparisons of model fit (Figure 2;Table 3). Despite an increase in central line utilization, regression modelling found no changes in monthly CLABSIs rates with respect to time and the COVID-19 pandemic. Incidence of HOBSIs and CLABSIs by common nosocomial organisms generally increased over this time period, though time to infection onset remained unchanged in our studied population (Table 2). Conclusion. HOBSIs rates did not correlate with CLABSI incidence across a three-hospital health system from 2017 and 2021, as rates of HOBSI increased but CLABSI rates remained flat. Our observed increase in HOBSI rates did not correlate with the onset of the COVID-19 pandemic, and caution should be used in modeling the effects of COVID-19 without time-trended analysis. Further evaluation is needed to understand the etiology, epidemiology, and preventability of HO-BSI.

The Role of Residencies in Promoting Student Engagement in Online Pedagogy

The COVID-19 pandemic has fractured social connections across all industries, including higher education. Some social work departments were forced to shift from traditional on-ground learning to adopt virtual delivery methods, while others voluntarily made this shift to join the emerging online education trends. When the pandemic restrictions abate, online programs may seek to promote social connections through targeted activities such as adopting a grounded residency. Online programs in social work and other fields have varied application in using residencies to bridge the online and on-ground modalities for learning. Students often report asynchronous online platforms foster a reduced sense of engagement in learning and low levels of connected engagement with faculty and peers. In social work programs, these residencies build on explicit and implicit curricular aims and have an argued externality of building engagement. This paper explores data collected from students (n=131) in a master's in social work program before the initiation of pandemic social distancing protocols and their perceptions of engagement related to their grounded residency experience in one online social work program in the southeastern United States. Results of survey data (quantitative and qualitative) are presented and analyzed with a discussion of the relative impact residency efforts may have on students' reported levels of engagement and opportunities to increase social connection in a post-pandemic environment. © 2022 Authors,.

Neurosurgery Operating Room Efficiency During the COVID-19 Era: JCOM

Background: The COVID-19 pandemic has had broad effects on surgical care, including operating room (OR) staffing, personal protective equipment (PPE) utilization, and newly implemented anti-infective measures. Our aim was to assess neurosurgery OR efficiency before the COVID-19 pandemic, during peak COVID-19, and during current times. Methods: Institutional perioperative databases at a single, highvolume neurosurgical center were queried for operations performed from December 2019 until October 2021. March 12, 2020, the day that the state of Tennessee declared a state of emergency, was chosen as the onset of the COVID-19 pandemic. The 90-day periods before and after this day were used to define the pre-COVID-19, peak-COVID-19, and post-peak restrictions time periods for comparative analysis. Outcomes included delay in first-start and OR turnover time between neurosurgical cases. Preset threshold times were used in analyses to adjust for normal leniency in OR scheduling (15 minutes for first start and 90 minutes for turnover). Univariate analysis used Wilcoxon rank-sum test for continuous outcomes, while chi-square test and Fisher's exact test were used for categorical comparisons. Significance was defined as P<.05. Results: First-start time was analyzed in 426 pre-COVID-19, 357 peak-restrictions, and 2304 post-peak-restrictions cases. The unadjusted mean delay length was found to be significantly different between the time periods, but the magnitude of increase in minutes was immaterial (mean [SD] minutes, 6 [18] vs 10 [21] vs 8 [20], respectively;P=.004). The adjusted average delay length and proportion of cases delayed beyond the 15-minute threshold were not significantly different. The proportion of cases that started early, as well as significantly early past a 15-minute threshold, have not been impacted. There was no significant change in turnover time during peak restrictions relative to the pre-COVID-19 period (88 [100] minutes vs 85 [95] minutes), and turnover time has since remained unchanged (83 [87] minutes). Conclusion: Our center was able to maintain OR efficiency before, during, and after peak restrictions even while instituting advanced infection-control strategies. While there were significant changes, delays were relatively small in magnitude.

Outcomes at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination in adolescents and young adults in the USA: a follow-up surveillance study.

BACKGROUND: Data on medium-term outcomes in indivduals with myocarditis after mRNA COVID-19 vaccination are scarce. We aimed to assess clinical outcomes and quality of life at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination in adolescents and young adults. METHODS: In this follow-up surveillance study, we conducted surveys in US individuals aged 12-29 years with myocarditis after mRNA COVID-19 vaccination, for whom a report had been filed to the Vaccine Adverse Event Reporting System between Jan 12 and Nov 5, 2021. A two-component survey was administered, one component to patients (or parents or guardians) and one component to health-care providers, to assess patient outcomes at least 90 days since myocarditis onset. Data collected were recovery status, cardiac testing, and functional status, and EuroQol health-related quality-of-life measures (dichotomised as no problems or any problems), and a weighted quality-of-life measure, ranging from 0 to 1 (full health). The EuroQol results were compared with published results in US populations (aged 18-24 years) from before and early on in the COVID-19 pandemic. FINDINGS: Between Aug 24, 2021, and Jan 12, 2022, we collected data for 519 (62%) of 836 eligible patients who were at least 90 days post-myocarditis onset: 126 patients via patient survey only, 162 patients via health-care provider survey only, and 231 patients via both surveys. Median patient age was 17 years (IQR 15-22); 457 (88%) patients were male and 61 (12%) were female. 320 (81%) of 393 patients with a health-care provider assessment were considered recovered from myocarditis by their health-care provider, although at the last health-care provider follow-up, 104 (26%) of 393 patients were prescribed daily medication related to myocarditis. Of 249 individuals who completed the quality-of-life portion of the patient survey, four (2%) reported problems with self-care, 13 (5%) with mobility, 49 (20%) with performing usual activities, 74 (30%) with pain, and 114 (46%) with depression. Mean weighted quality-of-life measure (0·91 [SD 0·13]) was similar to a pre-pandemic US population value (0·92 [0·13]) and significantly higher than an early pandemic US population value (0·75 [0·28]; p<0·0001). Most patients had improvements in cardiac diagnostic marker and testing data at follow-up, including normal or back-to-baseline troponin concentrations (181 [91%] of 200 patients with available data), echocardiograms (262 [94%] of 279 patients), electrocardiograms (240 [77%] of 311 patients), exercise stress testing (94 [90%] of 104 patients), and ambulatory rhythm monitoring (86 [90%] of 96 patients). An abnormality was noted among 81 (54%) of 151 patients with follow-up cardiac MRI; however, evidence of myocarditis suggested by the presence of both late gadolinium enhancement and oedema on cardiac MRI was uncommon (20 [13%] of 151 patients). At follow-up, most patients were cleared for all physical activity (268 [68%] of 393 patients). INTERPRETATION: After at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination, most individuals in our cohort were considered recovered by health-care providers, and quality of life measures were comparable to those in pre-pandemic and early pandemic populations of a similar age. These findings might not be generalisable given the small sample size and further follow-up is needed for the subset of patients with atypical test results or not considered recovered. FUNDING: US Centers for Disease Control and Prevention.

A Comprehensive Strategy for an Emergency Action Plan to Support Patient Transfusion Needs During Extreme Blood Shortage

Background/Case Studies: A national blood shortage resulted in the stringent allocation of blood resources below standard operating levels, beginning October 2021. A robust emergency action plan (EAP) was necessary to manage operations and support patient care. The comprehensive approach and final plan are reported here. Study Design/Methods: The transfusion committee, hospital CMOs, transfusion directors, ethics officer, and legal counsel developed a comprehensive emergency action plan (EAP) for the 3 hospital health system. Critical elements were identified for a tiered EAP based the percent of product in inventory compared to optimal non-shortage levels. Input from clinical divisions coupled with a communication plan were needed as operational capabilities could change unpredictably. The High Blood Utilization Plan (HBUP) using an in-house critical care physician team was created to rapidly assess ongoing heavy blood use such as transplant or MTP patient trajectory and ongoing blood need. A triage team for scarce resources, developed for COVID pandemic care allocation, was briefed on the potential for triaging blood in a manner as defined by NC state law. Information technology (IT) developed an inventory level dashboard using a visual analytics platform as well as reports to quickly identify patients with competing transfusion needs, defined as active RBC transfusion orders and ECMO patients. Provisions for sharing blood resources among the 3 hospitals were included. Perioperative planning reviewed the real time inventory dashboard daily to streamline OR scheduling and provide standardized decision support for case delays or cancellations. The dashboard also allow patient transfers to be informed of current operating status. Results/Findings: From 12/2021 to 2/2022 the EAP functioned in the critical tier with the exception of 1 day at panic tier. The HBUP was used on 2 occasions, however no triage decisions for competing blood needs occurred. Conclusion(s): The creation of an EAP coordinated across a 3 hospital health system was created to operationalize tiered care during an extreme blood shortage. The success of this plan was dependent on IT resources with strong communication to execute the required decisions. This plan remains available for future emergency use.

Impact of the COVID-19 Pandemic on Perceived Stress and Eating Behaviors of Undergraduate and Postgraduate Students of UWI, Cave Hill Campus, Barbados

Objective: The impact of the COVID-19 pandemic on perceived stress, anxiety, depression, and eating behaviors of university students in Barbados was investigated. Design and Methods: Students completed an online survey between June and July 2021 including the Patient Health Questionnaire (PHQ-4), SCOFF Questionnaire, and Salzburg Stress Eating Scale. We used bivariate and multivariable logistic regression to assess factors associated with eating behaviour and eating disorders. Result(s): Of 506 respondents (mean age 26 years, 81.4% female, 85.2% undergraduates), 7.23% were underweight, 52.34% normal weight, 20.85% overweight, and 19.57% obese. PHQ-4 screening suggested anxiety prevalence of 46% (95% CI 42% to 51%) with 22% (95% CI 17% to 25%) severe anxiety, and 43% (95% CI 39% to 47%) depression prevalence. 22.5 % of students screened positive for eating disorders on the SCOFF;positive screen for eating disorder was more likely positive in obese (36%) vs underweight (15%) students (p Conclusion(s): The screening instruments indicated concerning levels of anxiety, depression, and eating disorders associated with the COVID-19 pandemic among university students in Barbados. These conditions may remain undetected unless students seek help or are referred. Proactive health services and educational outreach are needed. Prevalence estimates should be viewed with caution until cut-off scores are empirically established for students in Barbados.

Self-Reported Post-Vaccination Adverse Events of COVID-19 Vaccines among Bangladeshi Medical Students

Objective: To investigate self-reported post-vaccination adverse events for COVID-19 vaccines among medical students in Bangladesh. Design and Methods: A cross-sectional study was conducted using an online questionnaire for Bangladeshi medical students (n = 3,545). Students who received at least one dose of COVID-19 vaccine were included. The study was carried out from October 2021 to January 2022 in 75 public and private medical colleges. Result(s): The majority of respondents were female (60.6%) and third-year (26.5%) students. >11% had tested positive for COVID-19 infection, and 97.6% of respondents (n = 3,461) received both first and second doses of COVID-19 vaccination. Most students (79.1%) received Sinopharm and 11.2% got AstraZeneca. More than two-thirds (67.9%) indicated that COVID-19 vaccines are safe in the long term. 54.8% of respondents (n = 1,842) reported one or more adverse events. Pain at injection site (78.2%), fever (49.3%), tiredness and fatigue (46.8%), headache (41.1%), generalized body ache (21.4%), over sleepiness/laziness (18.4%) and myalgia (17.5%) were the most commonly reported adverse events. 47.4% of respondents characterised adverse events as "mild". Majorities experienced symptoms within 12 hours of vaccination (68%) and for 1-3 days (56.8%). More than two-thirds (66.2%) of respondents had rest at home, and almost one-third (31.8%) took painkillers. Thirty-nine respondents visited physicians, mainly due to high fever, severe body ache, and severe headache, but there was no need for hospitalization. Conclusion(s): The majority of students reported adverse events, but symptoms were mild and of short duration. Further multi-centre studies with larger cohorts are required to monitor vaccine safety and strengthen public confidence in vaccines.

Medical student satisfaction in online modified clinical clerkship curriculum during the COVID-19 pandemic

Objective: The COVID-19 pandemic has caused significant disruption to medical education and clinical training. This not only affected delivery of the clinical curriculum but also resulted in stressors which may impede learning. This study aimed to assess the impact of a modified on-line curriculum in selected clinical clerkships in the Faculty of Medical Sciences, UWI, Cave Hill Campus, during the COVID-19 pandemic. Design and Methods: Fourth and Fifth year medical students completed an online survey in January 2021 covering the following areas: student satisfaction, self-efficacy (Online Learning Self-Efficacy Scale) and perceived effectiveness of online versus face-to-face learning. Students who agreed/strongly agreed to the statement "Overall, I was highly satisfied with the clerkship placement" were classified as satisfied. Result(s): 88 of 131 students completed the survey (response rate = 67 %). More than half of students (51%) were satisfied with online clerkship delivery. Fewer than half of students (46%) believed online learning effectively increased their knowledge, compared to 56% for face-to-face learning. Perception of effectiveness of online learning and face-to-face teaching of clinical skills was 18% and 89%, respectively (p < 0.0001). Fewer students perceived online teaching to be effective for developing social competencies (27%) compared to face-to-face instruction (67%) (p < 0.001). Students satisfied with online learning were more likely to be female (OR = 2.6) and older respondents. Mean self-efficacy scores were higher for persons who perceived online teaching to be effective for increasing knowledge, improving clinical skills, and social competencies. Students' perception of online learning was strongly associated with online selfefficacy. Conclusion(s): Students perceived online learning to be least effective for enhancing clinical skills. Students' perception of effectiveness of online learning was strongly associated with online self-efficacy. Further research to examine how the perception of online delivery impacts student performance in online learning is recommended. Educators have been challenged to design online programmes that facilitate development of clinical and social skills. Understanding medical students' experiences and identifying unmet needs will help improve clerkship curriculum and support medical students during and after the COVID-19 pandemic.

An innovative, blended, and supplementary clerkship to minimize clinical training gaps identified during the COVID-19 pandemic

Objective: 1. To identify training gaps in junior clerkship rotations during the COVID-19 pandemic. 2. To develop a Clinical Transition Selective Clerkship (CTSC) during Year 4. 3. To seek student feedback on organization and management of the CTSC. Design and Methods: An online cross-sectional survey of medical students was conducted during June-September 2021 to identify training gaps. In response to identified gaps, the 4-week CTSC was developed to provide further opportunities to develop core competencies. Result(s): Just under half of students reported the opportunity to observe (45.7%) and perform (44.5%) core skills >3 times during the medicine junior clerkship. For the surgical clerkship, 48.3% observed and 44.2% performed core skills 1-3 times. For child health, 39.6% observed and 34.8% performed skills 1-3 times. More than half of respondents (55.3%) expressed concern that they missed the usual clinical clerkship training experiences during online rotations. Three-quarters (74.5%) expressed the need to acquire additional clinical experience. The majority of students rated the following aspects of the CTSC as 'Good' or better: clarity of goals and objectives (58.3%);educational value/amount learned (56.2%);professionalism of faculty (66.7%) and other clinical staff (75%);usefulness of feedback (75%);workload challenge/level of material appropriate (70.8%);overall rating/quality of CTS (60.4%). However, the following aspects were rated as 'Poor' or "Fair": organization and coherency (77.1%);commitment of coordinators (64.6%);CTS achieved stated goals (62.5%). Conclusion(s): Our study identified training gaps in junior clerkship rotations during the COVID-19 pandemic. The CTSC provided opportunities to develop clinical competencies disrupted by the pandemic.

Resilient Coping is More Important than Previous Experience with Virtual Learning: Predicting Stress Experienced by Pharmacy Students in Trinidad and Tobago During the COVID-19 Pandemic

Objective: To summarize pharmacy students' previous experience and current confidence with online learning and explore the association of prior experience with online learning and resilient coping with perceived stress at the beginning of the COVID-19 pandemic. Method(s): Students completed an online cross-sectional survey during April-June, 2020. Measures included Likert items for experience and current comfort levels with online learning;the Brief Resilient Coping Scale (BRCS);and the Perceived Stress Scale-10 Item Version (PSS-10). We summarized experience and comfort with online learning;reported scores and internal consistency for the BRCS and PSS-10;and estimated a regression model of perceived stress as a function of prior experience with online education, gender, and resilient coping. Result(s): Of 113 respondents (response rate 41%, 78% female, mean age 22.3 years) >50% had only occasional prior experience with online learning, coursework, and examinations, but 63% expressed confidence with online learning. Mean PSS-10 and BRCS scores were 23.8 and 13.3 respectively, and both scales demonstrated good internal consistency (a > .80). BRCS score was the single predictor of PSS-10 score (r2 = 0.18, p < 0.001). Gender was not a significant predictor of perceived stress (p = 0.11). A simultaneous regression model explained a moderate amount of variation in perceived stress (adjusted R2 = 0.19). Conclusion(s): Most students had limited previous online learning, coursework, and examination experience. Responses indicated moderate levels of stress and coping skills after introducing online teaching. Lower resiliency scores, but not lack of virtual learning experience, predicted higher perceived stress. Results underscore the importance of efforts to enhance coping and resilience of students.

Double Jeopardy: COVID-19 and Me

The author describes her personal experience having COVID-19 and an acute case of pneumonia, and how COVID-19 has exposed long-known racial disparities in healthcare. © 2022 American Society on Aging.

Technology as Treatment: Use of Virtual Complementary and Integrative Therapies by Patients in Neurology

Objective: Given the reductions in in-person visits and the increases in teleneurology visits, we sought to determine whether patients increased their use of virtual complementary and integrative therapies. Background: Patients with neurological disorders may seek treatment options in addition to those recommended by their providers. Prior to the COVID-19 pandemic, about half of patients from populations that sought care in neurology tried complementary and integrative therapies (CITs). Design/Methods: By examining two separate datasets that included cohorts of patients with neurological disorders, we assessed patients' use of virtual (and non-virtual) CITs and determined whether there were clinical characteristics that predicted their use. The two studies that comprised this report included one that examined patient and provider experiences with teleneurology visits, and another that assessed patients with a history of COVID-19 infection who presented for neurologic evaluation. Results: Patients who postponed medical treatment for non-COVID-19-related problems during the pandemic were more likely to seek CITs. Virtual exercise, virtual psychotherapy and relaxation/meditation smartphone applications were the most frequent types of virtual CITs chosen by patients. In both studies, age was a key demographic factor associated with mobile/virtual CIT usage. Conclusions: Data from our investigations demonstrated that, in addition to its other roles in teleneurology, CIT-related technologies may be utilized in the treatment of neurologic conditions.

Analyzing the Current State of Sleep Apps in the App Marketplace and in Literature: A Systematic Review

Objective: To analyze the characteristics of commercially available sleep-exclusive apps using the Mobile Health Index and Navigation (MIND) apps database published by the Division of Digital Psychiatry at BIDMC for app review. Background: Over 70 million Americans endure a chronic sleep disorder during their lifetime. Due to the COVID-19 pandemic, mobile app benefits have been postulated as a means of expanding patient access to scientifically-based interventions in aiding their sleep disorders. With the increasing adoption of mobile health apps, it is critical that information regarding these mobile apps are sufficiently analyzed. Design/Methods: Using pre-specified criteria, we identified 106 sleep related mobile apps in the iOS and Google Playstores, and rated them using a 105 question review that is part of the MIND database. Questions focused on: Accessibility, Privacy & Security, Clinical Foundation, Engagement Style, and Interoperability. The features of the 106 apps were compared to a control group of non-sleep apps to evaluate the features and limitations sleep apps bear relative to the remainder of the marketplace. Results: The most common features of sleep apps were mindfulness (68.9%), deep breathing (54.7%), and psychoeducation (30.2%). Regarding functionality, 39.6% of apps have accessibility features and 49.1% can be used offline. However, sleep apps lack sleep trackers (22.6%), exportability features (21.7%), and opportunities to collaborate with one's provider (7.6%). Only 10.4% of sleep apps have an efficacy study. Conclusions: Sleep apps in the marketplace are primarily used to help the user fall and stay asleep. In its current state, sleep apps can assist only the user as a self-help tool. The lack of sleep tracking, support, exportability, the inability to collaborate with one's provider and efficacy studies limit the potential of implementing sleep apps for clinical use.

Features, Functionalities, and the Future of Commercial Pain Applications

Objective: We aimed to assess the characteristics of the pain application (app) marketplace and determine improvements to mobile health (m Health) that could assist patients with pain disorders in obtaining more accessible care. Background: During the COVID-19 pandemic, complementary and integrative therapies delivered via mHealth technologies have become more popular due to their accessibility. As more users are downloading apps to address health concerns, it is important to analyze the ever growing marketplace's features and limitations. Design/Methods: After searching the iOS and Google Play Stores for commercially available pain apps that met pre-specified search criteria, trained app raters entered 47 apps into the Mobile-Health Index and Navigation Database (MIND) published by the Division of Digital Psychiatry at BIDMC. Through a 105-question objective rating framework, each app was evaluated for its accessibility, privacy, cost, functionalities, features, and clinical foundations. The data was compared with a control group of non-pain apps-matched for platform and cost -to examine the traits of pain apps in contrast with the rest of the marketplace. Results: The top features were 44.7% (21/47) offered symptom tracking, 34.0% (16/47) offered medication tracking, and 42.6% (20/47) offered physical health exercises. Just 2.13% (1/47) of apps offered HIPAA privacy protections or had a crisis management feature. Additionally, only 10.64% (5/47) of pain apps were supported by efficacy studies. Conclusions: Commercially available pain apps are typically used to record pain episodes or document medications. However, the lack of privacy, crisis management, and efficacy studies may be preventing their clinical implementation.