Effects of the Pandemic on Observing the Global Ocean

The years since 2000 have been a golden age in in situ ocean observing with the proliferation and organization of autonomous platforms such as surface drogued buoys and subsurface Argo profiling floats augmenting ship-based observations. Global time series of mean sea surface temperature and ocean heat content are routinely calculated based on data from these platforms, enhancing our understanding of the ocean's role in Earth's climate system. Individual measurements of meteorological, sea surface, and subsurface variables directly improve our understanding of the Earth system, weather forecasting, and climate projections. They also provide the data necessary for validating and calibrating satellite observations. Maintaining this ocean observing system has been a technological, logistical, and funding challenge. The global COVID-19 pandemic, which took hold in 2020, added strain to the maintenance of the observing system. A survey of the contributing components of the observing system illustrates the impacts of the pandemic from January 2020 through December 2021. The pandemic did not reduce the short-term geographic coverage (days to months) capabilities mainly due to the continuation of autonomous platform observations. In contrast, the pandemic caused critical loss to longer-term (years to decades) observations, greatly impairing the monitoring of such crucial variables as ocean carbon and the state of the deep ocean. So, while the observing system has held under the stress of the pandemic, work must be done to restore the interrupted replenishment of the autonomous components and plan for more resilient methods to support components of the system that rely on cruise-based measurements. © 2023 American Meteorological Society.

Parenting during the second year of COVID-19: Positive and negative parental experiences in the U.S.A

Objective: In this study, we examine the impact of the COVID-19 pandemic on parenting during the second year of the pandemic. Background: Many families experienced abrupt and prolonged changes in their daily routines. Due to the influence of long-term stress on parenting quality and parenting behaviors, the current study focused on understanding the potential impact of the ongoing pandemic on parents. Method: Twenty parents (Mage = 38.25, SD = 7.77), living in the United States, with at least one child (newborn to 18 years of age) participated in an online interview. The majority of participants identified as White/European (80%), married (95%), and female (80%), with an undergraduate degree or higher (95%). All participants were fluent in English. Thematic analysis was used to identify themes based on parents' answers to questions about their parenting and family routines during the pandemic. Results: Four themes and three subthemes were produced from the data: experiences as a parent (subthemes included negative experiences, positive experiences, and sources of social support), stressors impacting parenting, concerns for child(ren), and changes in child(ren)'s daily lives. Conclusion: Parents reported experiencing some of the same stressors that were identified at the beginning of the pandemic. The majority had positive and negative experiences parenting, and a few participants reported similarities in their parenting. Many parents utilized their social supports, but some lost social relationships. Finally, potential patterns emerged based on parent gender, household size, and household income. Implications: Supporting healthy child development during stressful periods may involve providing support for parents and assistance managing parental stress. © 2023 National Council on Family Relations.

Outcomes of Covid-19 Patients Who Underwent Tracheostomies

INTRODUCTION: Tracheostomy is the most frequent surgical procedure performed in critically ill patients, mostly in patients requiring prolonged mechanical ventilation. We aimed to describe the outcomes associated with tracheostomies in critically ill COVID-19 patients admitted to our ICU. METHOD(S): We studied a cohort of adult patients admitted with the diagnosis of COVID-19 to a mixed ICU between 03/2020 and 06/2021. We collected patients' demographics, severity of illness, ICU resource utilization, and outcomes. Descriptive statistics were reported. RESULT(S): A total of 275 patients with confirmed COVID-19 were admitted to our ICU during the study period. Among them, 26 patients (9.45%) underwent tracheostomy. There were 10 females (38.4%) with an average age of 60 years (range 53-67). Median body mass index was 31 (range 26-41). Patients identified themselves as African American (39%), Caucasian (27%), and the remaining as other or declined to answer. Median Sequential Organ Failure Assessment (SOFA) score on admission was 10 (range 8-12) and max SOFA score was 13 (range 11-17). Mean mechanical ventilation-days was 19 days (range 12-23). Median ICU length of stay (LOS) was 41 days (range 31-48) and hospital LOS was 46 days (range 32-60). The ICU and hospital mortality rates were 23% and 27% respectively. There were no procedural causes of death. CONCLUSION(S): Although the mortality of the patients that underwent tracheostomies was relatively high, these patients were less than 3% of the total cohort of COVID-19 patients admitted to the ICU and had lower mortality than expected adjusted for their severity of illness based on the SOFA score.

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.

A COVID-19 Clinical Management Committee to Standardize Care in a 2-Hospital System

Objective: The COVID-19 pandemic has been a challenge for hospital medical staffs worldwide due to high volumes of patients acutely ill with novel syndromes and prevailing uncertainty regarding optimum supportive and therapeutic interventions. Additionally, the response to this crisis was driven by a plethora of nontraditional information sources, such as email chains, websites, non-peer-reviewed preprints, and press releases. Care patterns became idiosyncratic and often incorporated unproven interventions driven by these nontraditional information sources. This report evaluates the efforts of a health system to create and empower a multidisciplinary committee to develop, implement, and monitor evidence-based, standardized protocols for patients with COVID-19. Method(s): This report describes the composition of the committee, its scope, and its important interactions with the health system pharmacy and therapeutics committee, research teams, and other work groups planning other aspects of COVID-19 management. It illustrates how the committee was used to demonstrate for trainees the process and value of critically examining evidence, even in a chaotic environment. Result(s): Data show successful interventions in reducing excessive ordering of certain laboratory tests, reduction of nonrecommended therapies, and rapid uptake of evidence-based or guidelines-supported interventions. Conclusion(s): A multidisciplinary committee dedicated solely to planning, implementing, and monitoring standard approaches that eventually became evidence-based decision-making led to an improved focus on treatment options and outcomes for COVID-19 patients. Data presented illustrate the attainable success of a committee that is both adaptable and suitable for similar emergencies in the future. Copyright © 2022 Turner White Communications Inc.. All rights reserved.

Genomic evidence of SARS-CoV-2 reinfection in Ireland

Presentation A 40-year-old healthcare worker (HCW) presented with cough, headache, sore throat, fatigue and myalgia seven months after primary infection with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Symptoms were milder and recovery was faster on the second episode. Diagnosis Reinfection with phylogenetically distinct SARS-CoV-2 was confirmed by whole-genome sequencing (WGS). Treatment Management involved symptomatic treatment and self-isolation. Discussion The incidence of SARS-CoV-2 reinfection is not well characterised. Infection control precautions may still be required in healthcare facilities, even in previously infected and possibly in vaccinated individuals while SARS-CoV-2 remains in circulation. Further research on the nature and duration of immunity is required to inform public health and infection control policy.