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COVID-19 has been a crisis unexpected in scale and nature. It has changed many assumptions that we have about life and work. It has also forced drastic behavioural changes. Dispute lawyers everywhere are not spared. To a large extent, technology and the internet avoided a complete collapse in the administration of justice. To what extent has the practice of dispute resolution changed during the pandemic, and what lies in store after the pandemic? This paper examines this question, particularly from the perspective of an arbitrator.
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Background. Universities are interactive communities where frequent contacts between individuals occur, increasing the risk of outbreaks of COVID-19. We embarked upon a real-time wastewater (WW) monitoring program across the University of Calgary (UofC) campus measuring WW SARS-CoV-2 burden relative to levels of disease in the broader surrounding community. Figure 1 The colour scheme shows 6 sewer sub-catchments at the University of Calgary. Auto samplers were deployed at 4 sampling nodes within sub-catchments CR and YA (both residence halls), and UCE and UCS (catchments that include several campus buildings). Figure 2 Log10-transformed abundance (i.e., copies per mL) of nucleocapsid gene (i.e., N1) for SARS-CoV-2 for each sampling location during October 2021 - April 2022. Locations denoted by the same letters (A, B, or C) show no statistical difference (p > 0.05) according to the Wilcoxon rank-sum test. The WWTP sample corresponds to a catchment area covering most of Calgary including the university campus, for which sampling locations CR, UCE, UCS, and UCW are defined in Fig. 1. Methods. From October 2021 - April 2022, WW was collected thrice weekly across UofC campus through 4 individual sewer sampling nodes (Fig. 1) using autosamplers (C.E.C. Analytics, CA). Results from these 4 nodes were compared with community monitoring at Calgary's largest WW treatment plant (WWTP), which received WW from surrounding neighborhoods, and also from UofC. Nucleic acid was extracted from WW for RTqPCR quantification of the N1 nucleocapside gene from SARS-CoV-2 genomic RNA. Qualitative (positive samples defined if cycle threshold < 40) and quantitative statistical analyses were performed using R. Results. Levels of SARS-CoV-2 in WW were significantly lower at all campus monitoring sites relative to the WWTP (Wilcoxon rank-sum test p < 0.05;Fig. 2). The proportion of WW samples that were positive for SARS-CoV-2 was significantly higher for WWTP than at least two campus locations (p < 0.05 for Crowsnest Hall and UCE - University way and campus drive) according to Fischer's exact 2-sided test. The proportion of WW samples with positive WW signals were still higher for WWTP than the other two locations, but statistically not significant (p = 0.216). Among campus locations, the buildings in UCE catchment showed much lower N1 signals than other catchments, likely owing to buildings in this catchment primarily being administration and classroom environments, with lower human-to-human contact and less defecation compared to the other 3 catchments, which include residence hall, a dining area, and/or laboratory spaces. Conclusion. Our results show that SARS-CoV-2 RNA shedding in WW at the U of C is significantly lower than the city-wide signal associated with surrounding neighborhoods. Furthermore, we demonstrate that WW testing at well-defined nodes is a sampling strategy for potentially locating specific places where high transmission of infectious disease occurs.
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Background. WW surveillance enables real time monitoring of SARS-CoV-2 burden in defined sewer catchment areas. Here, we assessed the occurrence of total, Delta and Omicron SARS-CoV-2 RNA in sewage from three tertiary-care hospitals in Calgary, Canada. Methods. Nucleic acid was extracted from hospital (H) WW using the 4S-silica column method. H-1 and H-2 were assessed via a single autosampler whereas H-3 required three separate monitoring devices (a-c). SARS-CoV-2 RNA was quantified using two RT-qPCR approaches targeting the nucleocapsid gene;N1 and N200 assays, and the R203K/G204R and R203M mutations. Assays were positive if Cq< 40. Cross-correlation function analyses (CCF) was performed to determine the timelagged relationships betweenWWsignal and clinical cases. SARS-CoV-2 RNA abundance was compared to total hospitalized cases, nosocomial-acquired cases, and outbreaks. Statistical analyses were conducted using R. Results. Ninety-six percent (188/196) of WW samples collected between Aug/ 21-Jan/22 were positive for SARS-CoV-2. Omicron rapidly supplanted Delta by mid-December and this correlated with lack of Delta-associated H-transmissions during a period of frequent outbreaks. The CCF analysis showed a positive autocorrelation between the RNA concentration and total cases, where the most dominant cross correlations occurred between -3 and 0 lags (weeks) (Cross-correlation values: 0.75, 0.579, 0.608, 0.528 and 0.746 for H-1, H-2, H-3a, H-3b and H-3c;respectively). VOC-specific assessments showed this positive association only to hold true for Omicron across all hospitals (cross-correlation occurred at lags -2 and 0, CFF value range between 0.648 -0.984). We observed a significant difference in median copies/ ml SARS-CoV-2 N-1 between outbreak-free periods vs outbreaks for H-1 (46 [IQR: 11-150] vs 742 [IQR: 162-1176], P< 0.0001), H-2 (24 [IQR: 6-167] vs 214 [IQR: 57-560], P=0.009) and H-3c (2.32 [IQR: 0-19] vs 129 [IQR: 14-274], P=0.001). Conclusion. WWsurveillance is a powerful tool for early detection andmonitoring of circulating SARS-CoV-2VOCs.Total SARS-CoV-2 andVOC-specificWWsignal correlated with hospitalized prevalent cases of COVID-19 and outbreak occurrence.
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Introduction: Burnout in academia is an issue of growing concern. The COVID-19 pandemic has increased the risk of burnout;however, the data are limited for pharmacy faculty and the associating factors have not been identified. Research Question or Hypothesis: To evaluate the factors contributing to burnout among pharmacy faculty during the COVID-19 pandemic. Study Design: Quantitative survey study Methods: Pharmacy faculty in the U.S. and Canada were invited to take part in a web-based survey. The survey collected demographic information, responses from the standardized Maslach Burnout Inventory Educators Survey (MBI-ES) and questions assessing how the pandemic has affected the respondent's personal and professional life. MBI-ES specifically measured emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Responses to each of the three MBI-ES subcategories were converted to a sum score. Factors contributing to burnout were identified by comparing the mean sum scores of the MBI-ES versus demographics, primary responsibilities, academic ranks, and other variables. Single-factor analysis of variance and the post-hoc Tukey HSD-Kramer test were used to determine statistical significance between groups. Result(s): We received 128 responses during a 10-week period. The mean sum scores for EE, DP, and PA for the entire cohort were 25.9, 6.1, and 33.6 respectively. These scores are higher than those from studies conducted before the pandemic, suggesting higher burnout in general. Junior faculty experienced higher burnout. Faculty with primarily research responsibilities experienced the greatest EE;those with primarily patient-care responsibilities experienced the most DP;and those with primarily didactic teaching responsibilities experienced the lowest PA. Factors having the most impact on burnout included increased workhours, having school-age children, and not having a consistent work location. Conclusion(s): Pharmacy faculty experienced a heightened level of burnout during the pandemic. Interventions should be targeted towards junior faculty, those with significant research responsibilities, and those with school-age children.
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Background: Biomarkers TNFR1, TNFR2, and KIM1 are associated with progression of kidney disease. These biomarkers have not been evaluated in patients who have recovered from COVID-19. Method(s): Patients who had COVID-19 and recovered were followed longitudinally at an outpatient clinic with labs and surveys as part of the Mount Sinai Post-COVID clinic. Blood was sent for creatinine at baseline and 6 month follow up visit. We measured plasma TNFR1, TNFR2, and KIM-1 from the first post-COVID visit via Renalytix' proprietary multiplex assay. eGFR was calculated using the 2021 CKD-EPI formula. Result(s): 450 COVID survivors had serum creatinine values measured at baseline (222+/-89 days post-COVID) and 6 month (419+/-97 days post-COVID) follow up. The average age of patients was 50+/-14 years, 62% were female, 60% were white, and 17% were Black. 23% were hospitalized, 4% required ICU admission, and 2% of patients reported AKI. eGFR at the baseline visit was 94+/-21 and at 6-months was 96+/-22 ml/ min/1.73m2. At the baseline visit, KIM-1, TNFR-1, and TNFR-2 levels were highest in patients who were hospitalized and had AKI (Figure 1a) and concentrations of all three were associated with lower eGFR 6 months later (Figure 1b). Conclusion(s): Severity of illness during COVID is associated with higher levels of plasma TNFR1, TNFR2, and KIM1 several months after recovery. The degree of biomarker elevation post-COVID was associated with lower kidney function more than 1 year post-COVID.
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Cities face an uncertain future. While the COVID-19 pandemic is unlikely to end the process of urbanization that has been increasing in scale since the beginning of the Industrial Revolution, the reality of urban living has taken a turn for the worst. Design interventions cannot only facilitate a healthy return to urban living, they can increase systemic health by reducing the likelihood of zoonoses, the transfer of disease from animals to humans. © 2022 selection and editorial matter, Keely Menezes, Pamela de Oliveira Smith, and A. Vernon Woodworth.
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Purpose : Despite an increasing incidence of skin cancer over the last decade, studies have reported a decline in the diagnosis and treatment of skin cancer during the COVID19 pandemic. We performed a retrospective cohort study using a large population-based cohort from the Veterans Health Administration (VHA) to determine how the pandemic has affected tumor size and morbidity in veterans with periocular non-melanoma skin cancer. Methods : Electronic health records from all VHA sites were accessed through the VA Informatics and Computing Infrastructure (VINCI). Data were stored in the Observational Medical Outcomes Partnership (OMOP) model and queried via SQL Server. ICD-10 and current procedural terminology codes were used to identify patients who received Mohs surgery for periocular basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) between 08/01/2018 and 09/10/2021. A combination of structured algorithms and manual review were used to extract patient demographics, lesion characteristics, and surgical outcome at three time points, ie. pre-COVID, early, and late COVID. Unpaired t-tests were used to assess statistical significance. Results : Patient characteristics were similar between pre- and post-COVID cohorts in terms of gender, age, race, and tumor type. The average number of Mohs periocular surgeries performed per week were 23.1% (7.31 vs 5.62) and 13.1% (7.49 vs 6.51) lower in the early and later pandemic, respectively, compared to similar pre-COVID timeframes by month (Figure 1). Mean lesion size (maximum diameter) was 1.35 cm larger post-COVID compared to pre-COVID (95% CI 0.19 2.51, P=0.022);however, the defect size remained similar (Figure 2). Stratifying by tumor type, the same trends were noted in BCC, particularly early in the pandemic. However, mean SCC lesion and defect sizes did not vary over time. Conclusions : Periocular Mohs surgery rates declined in the COVID pandemic across VHA. Lesions were larger particularly in the earlier phase of the pandemic for BCC. Future analyses using this cohort will attempt to determine if telehealth and travel time were associated with distinct outcomes.
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Aim: Outbreaks of infectious diseases, namely dengue, rabies, leptospirosis, influenza, and chickenpox, have sparked the need to educate people on the diseases. For this purpose, infectious disease-based socioscientific instruction (IDSSI) was developed, and the effects of IDSSI in enhancing knowledge of diseases and nurturing character and values were measured. Subject and methods: A total of 85 11-year-old fifth-year students from a primary school were randomly assigned to treatment (N = 44) and comparison groups (N = 41) in this quasi-experimental study. Results: The quantitative ANCOVA analysis and qualitative interview findings revealed that fifth-year students’ knowledge of infectious diseases improved with IDSSI, and IDSSI also helped to cultivate the students’ character and values. Conclusion: The findings suggest that IDSSI is a practical approach that can be incorporated within the primary science curriculum to educate students on the diseases beginning at an early stage.
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Background: Appropriate human resources interventions to address healthcare workers’ concerns are key to maintaining confidence and morale of staff to combat a pandemic in any healthcare system. The objectives of this study are to analyze concerns of healthcare workers in public hospitals during the initial 3 months, throughout which the Hong Kong Hospital Authority implemented multiple measures to address staff needs. Methods: A retrospective study analyzing the immediate and longitudinal concerns of healthcare workers during the coronavirus disease 2019 (COVID-19) pandemic. All enquiries by unsolicited phone calls and WhatsApp messages raised over a 12-week period from 29/1/2020 to 22/4/2020 were reviewed and categorized. Thematic analysis of the enquiries was conducted, together with timing and frequency of enquiry categories. Results: A total of 1,868 enquiries were raised over the 12-week period. These enquiries comprised 740 (40%) in “recognition and staff wellbeing”, 573 (31%) in “infection control”, 357 (19%) in “duty arrangement” and the remaining 196 (10%) “others”. Conclusions: Spikes spread over the 12 weeks of data capture demonstrated major concern areas for a healthcare system in maintaining the morale and confidence of staff. Financial incentives introduced during the pandemic may have drawbacks around equity, defining thresholds for payments and setting precedence. A Human Resources App and e-bulletins were effective in rapidly communicating information to staff and allaying their fears, especially during the initial phase of the crisis. Further study of financial incentives to help decision-makers understand the impact and consequences of such approaches should be undertaken. © Journal of Hospital Management and Health Policy. All rights reserved.
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Background: Within seconds of antigen-encounter, B-cell receptor (BCR) signaling induces dramatic changes of cell membrane lipid composition, including >40-fold increases of local PIP3-concentrations within lipid rafts. While several structural elements, including pleckstrin homology (PH) domains have been identified as PIP3-binding proteins, the underlying mechanisms that amplify BCR-signaling to assemble large signaling complexes within lipid rafts within 15 to 30 seconds, remained elusive. To understand the mechanistic and biophysical requirements for PIP3 accumulation during normal B-cell activation and acute oncogenic transformation, we identified PIP3-interacting proteins by cell-surface proteomic analyses. Results: In addition to proteins known to bind PIP3 with their PH-domains, we identified the short 133 aa protein IFITM3 (interferon-inducible transmembrane protein 3) as a top-ranking PIP3 scaffold. This was unexpected because IFITM3 was previously identified as endosomal protein that blocks viral infection by stiffening endosomal membranes to firmly contain viral cargo. Previous studies revealed that polymorphisms that lead to the expression of truncated IFITM3 are associated with increased susceptibility to viral infections, including SARS-CoV2. Among known cell membrane lipids, PIP3 has the highest negative charge. Instead of a PH-domain, IFITM3 laterally sequestered PIP3 through electrostatic interactions with two basic lysine residues (K83 and K104) located at the membrane-solution interface. Together with three other basic lysine and arginine residues K83 and K104 form a conserved intracellular loop (CIL), which enable IFITM3 to efficiently capture two PIP3 molecules. Bivalent PIP3-binding of the IFITM3-CIL enables a crosslinking mechanism that results in dramatic amplification of B-cell activation signals and clustering of large signaling complexes within lipid rafts. In normal resting B-cells, Ifitm3 was minimally expressed and mainly localized in endosomes. However, B-cell activation and oncogenic kinases induced phosphorylation at IFITM3-Y20, resulting in translocation of IFITM3 from endosomes and massive accumulation at the cell surface. Ifitm3ˉ /ˉ naïve B-cells developed at normal numbers, however, activation by antigen encounter was compromised. In Ifitm3ˉ /ˉ B-cells, lipid rafts were depleted of PIP3, resulting in defective expression of >60 lipid raft-associated surface receptors and impaired PI3K-signaling. Ifitm3ˉ /ˉ B-cells were unable to undergo affinity maturation and di not contribute to germinal center formation upon immunization. Analyses of gene expression and clinical outcome data from patients in six clinical cohorts for pediatric and adult B-ALL, mantle cell lymphoma, CLL and DLBCL, we consistently identified IFITM3 as a top-ranking predictor of poor clinical outcome. Inducible activation of BCR-ABL1 and NRAS G12D rapidly induced development of B-ALL but failed to transform and initiate B-ALL from Ifitm3ˉ /ˉ B-cell precursors. Conversely, the phospho-mimetic IFITM3-Y20E mutation, mimicking phosphorylation of the IFITM3 N-terminus at Y20 induced constitutive membrane localization of IFITM3, spontaneous aggregation of large oncogenic signaling complexes and readily initiated transformation in a genetic model of pre-malignant B-cells. Conclusions: We conclude that phosphorylation of IFITM3 upon B-cell activation induces a dynamic switch from antiviral effector functions in endosomes to oncogenic signal-amplification at the cell-surface. IFITM3-dependent amplification of PI3K-signaling is critical to enable rapid expansion of activated B-cells. In addition, multiple oncogenes depend on IFITM3 to assemble PIP3-dependent signaling complexes and amplify PI3K-signaling for malignant transformation and initiation of B-lymphoid leukemia and lymphoma. [Formula presented] Disclosures: Weinstock: SecuraBio: Consultancy;ASELL: Consultancy;Bantam: Consultancy;Abcuro: Research Funding;Verastem: Research Funding;Daiichi Sankyo: Consultancy, Research Funding;AstraZeneca: Consultanc ;Travera: Other: Founder/Equity;Ajax: Other: Founder/Equity.
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Introduction: Severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) has resulted in a pandemic which has infected more than 128 million people and led to over 2.8 million deaths worldwide. Although the introduction of efficacious vaccines has led to overall declines in the incidence of SARS-CoV-2 infection, there has been a recent increase in infections once more due to the appearance of mutant strains with higher virulence. It therefore remains vital to identify predictors of poor outcomes in this patient population. Purpose: The objective of our study was to identify predictors of prolonged hospitalization, intensive care unit (ICU) admission, intubation, and death in patients infected with SARS-CoV-2. Methods: We conducted a retrospective analysis of all patients hospitalized with SARS-CoV-2 at our health system that includes one tertiary care center and two community hospitals located in the Chicago metropolitan area. The main outcome was a composite endpoint of hospitalization >28 days, ICU admission, intubation, and death. Explanatory variables associated with the primary outcome in the bivariate analysis (p<0.05) were included in the multivariable logistic regression model. Statistical analysis was performed using IBM SPSS 25.0. Results: Between March 1, 2020 and May 31, 2020, 1029 patients hospitalized with SARS-CoV-2 were included in our analysis. Of these patients, 379 met the composite endpoint. Baseline demographics are described in Table 1. Of note, our cohort consisted of a predominantly minority patient population including 47% Hispanic, 17% African American, 16% Caucasian, and 16% other. In bivariate analysis, age, hypertension, tobacco and alcohol abuse, obesity, coronary artery disease, arrhythmias, valvular heart disease, dyslipidemia, hypertension, stroke, diabetes, documented thrombosis, troponin, CRP, ESR, ferritin, LDH, BNP, D-dimer >5x the upper limit of normal, lactate, and right ventricular outflow tract velocity time integral <9.5 were significant. After multivariable adjustment, explanatory variables associated with the composite endpoint included troponin (OR 2.36;95% CI 1.08-5.17, p 0.03), D-dimer (OR 1.5;95% CI 1.23-1.98, p<0.01, lactate (OR 1.58;95% CI 1.28-1.95, p<0.01), and documented thrombosis (OR 3.56;95% CI 1.30-8.70, p<.05). Race was not a predictor of poor outcomes in the bivariate or multivariate analysis (Table 2). Conclusions: In a large urban cohort with a predominantly minority population, we identified several clinical predictors of poor outcomes. Of note, race was not a predictor of the primary endpoint in this study. While recent literature has demonstrated worse outcomes among racial minorities infected with SARS-CoV-2, our data suggests these variations are related to social determinants of health rather than biologic causes. (Figure Presented).
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Introduction: While the global dissemination of vaccines targeting the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a decline in the incidence of infections, the case fatality rates have remained relative stable. A major objective of managing hospitalized patients with documented or suspected COVID-19 infection is the rapid identification of features associated with severe illness using readily available laboratory tests and clinical tools. The sequential organ failure assessment (SOFA) score is a validated tool to facilitate the identification of patients at risk of dying from sepsis. Purpose: The aim of this study was to assess the discriminatory accuracy of the SOFA score in predicting clinical decompensation in patients hospitalized with COVID-19 infection. Methods:We conducted a retrospective analysis at a three-hospital health system, comprised of one tertiary and two community hospitals, located in the Chicago metropolitan area. All patients had positive SARS-CoV-2 testing and were hospitalized for COVID-19 infection. The primary outcome was clinical decompensation, defined as the composite endpoint of death, ICU admission, or need for intubation. We utilized the most abnormal laboratory values observed during the admission to calculate the SOFA score. Receiver Operating Curves (ROC) were then constructed to determine the sensitivity and specificity of SOFA scores. Results: Between March 1st and May 31st 2020, 1029 patients were included in our analysis with 367 patients meeting the study endpoint. The median SOFA score was 2.0 IQR (Q1, Q3 1,4) for the entire cohort. Patients who had in-hospital mortality had a median SOFA score of 4.0 (Q1,Q3 3,7). In patients that met the primary composite endpoint, the median SOFA score was 3.0, IQR (Q1, Q3 2,6). The ROC was 0.776 (95% CI 0.746-0.806, p<0.01). Conclusion: The SOFA score demonstrates strong discriminatory accuracy for prediction of clinical decompensation in patients presenting with COVID-19 at our urban hospital system. (Figure Presented).
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Background: We sought to assess changes in well-being of nephrology fellows over the first year of the COVID-19 pandemic in the U.S. Methods: The Resident Well-Being Index (RWBI), a validated tool assessing physician distress, was distributed as part of ASN's annual nephrology fellow survey to 920 current adult, pediatric, and adult/pediatric fellows. An RWBI ≥5 (range 0-7) indicated distress. Demographic and fellowship factors associated with meeting the distress threshold were evaluated in univariable and multivariable logistic regression. Results: A total of 511 fellows participated (56% response), of whom 463 completed the RWBI instrument. After 1 year of the COVID-19 pandemic, there were a higher proportion of nephrology fellows meeting the RWBI distress threshold-22% in 2021 versus 15% in 2020. Female nephrology fellows had higher RWBI scores (median 3 [IQR 5]) than their male colleagues (median 1 [IQR 3]). Higher proportions of 1st-year fellows (50% vs 42% for 2nd years, OR 0.61 for 2nd years [95% CI 037-0.99], p=0.046) and women (27% vs 18% of men, OR 1.71 [95%CI 1.06-2.76], p=0.028) met the distress threshold (Figure 1). There were no significant differences by race, ethnicity, medical school location, or adult vs pediatric fellowship. Despite the higher proportion of distress overall, 88% of respondents would recommend nephrology to medical students and residents. Conclusions: Our follow-up assessment of nephrology fellows' well-being after the first year of the COVID-19 pandemic indicate the continued need for supportive measures to ensure the health of the future nephrology workforce, especially among 1st year and women trainees. (Figure Presented).
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Background: Studies have reported both hypo and hypernatremia in patients hospitalized with COVID-19. We sought to examine the prevalence and association of dysnatremia with clinical outcomes among hospitalized COVID-19 patients at the Mount Sinai Health System. Methods: We included 5,712 patients with COVID-19 who were ≥18 years old and hospitalized for ≥24 hours in the Mount Sinai Health System. Patients with ESKD, who received dialysis within the first 24 hours were excluded. We evaluated the association between serum sodium on admission (first level within 24 hours from admission) and the lowest serum sodium during hospitalization with AKI, IMV requirement, and in-hospital mortality using multivariable logistic regression models. Results: The median age of patients was 67 (55-78) years, 57% were male, and median serum creatinine was 1.0 (IQR, 0.7-1.4) mg/dL. On hospital admission, 6% had moderate/severe hyponatremia (<130 mEq/L), 18% had mild hyponatremia (130-134 mEq/L), and 8% had hypernatremia (>145 mEq/L). After adjustment for demographics, comorbidities, and admission lab values, the adjusted OR for moderate/ severe hyponatremia, mild hyponatremia, and hypernatremia on admission, compared to normal serum sodium, for in-hospital mortality were 1.59 (1.16-2.19), 1.42 (1.14-1.76) and 2.91 (2.16-3.93), respectively (Figure 1A). Dysnatremias during hospitalization were also associated with all three outcomes, except IMV requirement was not significantly associated with hypernatremia. (Figure 1B). Conclusions: Both hypo-and hypernatremia on hospital admission and during hospitalization for COVID-19 were independently associated with AKI, IMV requirement, and in-hospital mortality. It is highly likely that dysnatremias are a marker for severity of illness and not causal for the adverse outcomes in COVID-19.
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Background: Patients hospitalized with COVID-19 are at risk for major adverse kidney events (MAKE). Predicting which patients will experience progression of disease and poor outcomes remains elusive. We sought to develop a biomarker-based risk model for predicting MAKE in patients hospitalized with COVID-19. Methods: We applied least absolute shrinkage and regression methodology (LASSO) to a prospectively enrolled cohort of 432 patients admitted with COVID-19 who had blood specimens collected (median 2 days [IQR 2-4 days] from admission) from March 2020-January 2021, at three large academic medical centers. Clinical variables and 26 plasma biomarkers were used as candidate features in the prediction models for the outcome of MAKE, defined as KDIGO stage 3 AKI, dialysis-requiring AKI, or in hospital mortality. Cross-validation was used for optimal shrinkage parameter selection and model AUCs were optimism-corrected using bootstrapping. Results: MAKE occurred in 85 (20%) patients within 60 days of admission. Application of LASSO to the 26 biomarkers selected IL-12, IL-13, IL-6, Tie2, FLT1, NGAL, MCP1, YKL40, Ang1, Ang2, and TNFR1, which yielded an AUC of 0.88 (95% CI 0.85-0.91). Plasma TNFR-1 alone had an AUC of 0.88 (0.84,0.91). When LASSO was applied on the clinical variables and TNFR1, 4 clinical variables (age, black race, obesity, WHO COVID severity score) and TNFR1 were selected with an AUC was 0.88 (95% CI 0.87-0.89). Random Forest models of biomarkers and clinical variables had similar prediction performance. A cutoff of TNFR1 at 3005 pg/ml had a sensitivity of 69%, specificity of 89%, PPV of 60% and NPV of 92% for occurrence of MAKE over 60 days. Conclusions: In this multi-center cohort study, plasma TNFR1 by itself produced a robust prediction for MAKE in patients hospitalized with COVID-19 that did not improve when combined with multiple clinical variables and was equivalent to combined inputs of 10 other plasma biomarkers.
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Background: We sought to identify how educational tools utilized in nephrology training had evolved in the past 5 years and through the COVID-19 pandemic. Methods: Questions about educational tools were distributed as part of ASN's annual nephrology fellow survey to 920 current adult/pediatric fellows. Results: 511 fellows participated in 2021 (56% response rate), compared with 377 fellows in 2016 (31% response rate). Fellows indicated that UpToDate was still the most used (82%) and most effective educational tool (66% rated it Very Effective);however, ASN KSAP increased in popularity (27% in 2016, 58% 2021) and was also highly rated (65% Very Effective). Use of online resource and social media increased, including both new opportunities and prior available ones such as NephJC (7% to 32%, with 46% rated Very Effective) (Figure 1). A majority of fellows (84%) rated their education as good or excellent in 2021, a percentage similar to 2016 (81%). Conclusions: Our follow-up assessment of nephrology fellows' educational tools found an increase in the adoption of online resources with similar effectiveness ratings as traditional resources. (Figure Presented).