"A Switch Went off in my Whole Body": Lived Experiences of Fatigue and Post-Exertional Malaise in Long Covid

The growing HCI agenda on health has focused on different chronic conditions but less so on Long Covid, despite its severe impact on the quality of life. We report findings from 2 workshops with 13 people living with Long Covid, indicating the challenges of making sense of their physical, cognitive, and emotional symptoms, and of monitoring the triggers of post-exertional malaise. While most participants engage in pacing activities for the self-management of fatigue, only a few are aware of the importance of planning all their daily activities and routines in order to avoid post-exertional malaise. We conclude with design implications to support lightweight tracking and sensemaking of fatigue symptoms, novel data analytics for monitoring the triggers of post-exertional malaise and the worsening of symptoms, and support for self-management in order to prevent post-exertional malaise. © 2023 Owner/Author.

Consumer demand for food at home and food away from home: Understanding economic linkages during the pandemic

Household food expenditure has shifted away from Food at Home (FAH) and towards Food Away from Home (FAFH). Prior to the COVID-19 pandemic, FAFH's share of food expenditure surpassed that of FAH, reaching 55% in 2019. Yet economic research on FAFH and the interaction of FAFH and FAH has been limited. Combining scanner data for meat sales in grocery stores with data for FAFH expenditure, we estimate a model of demand for at-home meat, incorporating FAFH expenditure as a demand shifter. We quantify substitution between FAFH expenditure and FAH meat and quantify the impact of the COVID-19 disruptions to the food service sector on retail prices of FAH meat. © 2023 The Authors. Applied Economic Perspectives and Policy published by Wiley Periodicals LLC on behalf of Agricultural & Applied Economics Association.

Dipeptidyl Peptidase-1 Inhibition in Patients Hospitalized with COVID-19: a Multicentre Randomized Double-Blind Placebo Controlled Trial

Background: Neutrophil serine proteases (NSPs) are involved in the pathogenesis of COVID19 and are increased in severe and fatal infection. We investigated whether treatment with Brensocatib, an inhibitor of dipeptidyl peptidase-1, an enzyme responsible for the activation of NSPs, would improve outcomes in hospitalized patients with COVID19. Method(s): In a randomized, double-blind, placebo-controlled trial, 406 hospitalized patients with COVID19 with at least one risk factor for severe disease were randomized 1:1 to once-daily Brensocatib 25mg (n=192) or placebo (n=214) for 28 days. Primary outcome was the 7-point World Health Organisation Clinical Status scale at day 29. Secondary outcomes included time to clinical improvement, national early warning score, new oxygen and ventilation use, neutrophil elastase activity in blood and mortality. Finding(s): Brensocatib treatment was associated with worse clinical status at day 29 (adjusted odds ratio 0 72, 95%CI 0 57-0 92) compared to placebo. The adjusted hazard ratio (aHR) for time to clinical improvement was 0 87 (95%CI 0 76-1 00) and time to hospital discharge was 0 98 (95%CI 0 84-1 13). During the 28-day follow-up period, 23 (11%) and 29 (15%) patients died in the placebo and Brensocatib treated groups respectively). Oxygen and new ventilation use were greater in the Brensocatib treated patients. Neutrophil elastase activity in blood was significantly reduced in the Brensocatib group from baseline to day 29. Prespecified subgroup analyses of the primary outcome supported the primary results.

Filtration performance of three models of N95 filtering facepiece respirators following clinical usage and vaporized hydrogen peroxide decontamination.

BACKGROUND: N95 filtering facepiece respirators (FFRs) are essential personal protective equipment (PPE) for protecting healthcare workers from airborne pathogens. AIM: To perform the first large-scale evaluation of particulate filtration efficiency (PFE) of three models of N95 FFRs following clinical usage and vaporized hydrogen peroxide (VHP) decontamination. METHODS: Three variables were assessed for effect on PFE following VHP decontamination: VHP sterilizer model, N95 respirator model, and prior N95 clinical usage. FINDINGS: The VHP sterilizer model and N95 FFR model impacted PFE performance. Worn N95 FFRs had a 91% lower odds of exhibiting ≥95% PFE compared with the control. CONCLUSION: This work highlights the importance of validating any N95 FFR decontamination programme in its entirety, including prior clinical usage.

DEPRESSION, SOCIAL RELATIONS, AND COGNITIVE HEALTH DURING THE COVID-19 PANDEMIC

This study examines cognitive abilities, number of people in a social network, and presence of depressive symptoms among the "youngest old”, "middle old”, and "oldest old”, by ethnicity. A sample of 600 people;200 Blacks, 200 Whites, and 200 non-white Arabs were recruited for the survey. Those with missing data were omitted from analysis, which left 435. Data were collected via a computer assisted telephone survey. Data were analyzed using two-way ANOVAs. We found significant effects on cognition by ethnicity f(2,430)=2.71, p<0.05 and age group f(2,430)=11.24, p<0.001. There was a significant effect of the number of people in social networks on cognition across all groups f(2,430)=10.4, p<0.01. The presence of depressive symptoms was not a mediator. There was no significant interaction between ethnicity and age group, or ethnicity and social network structure.

COVID-19 disease is associated with a hypofibrinolytic state driven by elevated plasminogen activator inhibitor-1 and its cofactor vitronectin

Background: COVID-19 disease arises from infection with severe acute respiratory cornonavirus-2 (SARS-CoV- 2). Severe disease is associated with a coagulopathy characterised by elevated D-dimer levels, fibrin deposition in the lung, and a thrombotic incidence of approximately 30%, indicating catastrophic derailment of the haemostatic system. Aim(s): To investigate whether SARS-CoV- 2- induced coagulopathy arises due to an imbalance in the fibrinolysis. Method(s): Citrated plasma was collected from 139 patients presenting with symptomatic COVID-19, 24 patients with non-COVID- 19 respiratory infection and 30 healthy controls in a dual-centre study. Fibrinolytic biomarkers were evaluated including plasminogen activator inhibitor 1 (PAI-1), tissue plasminogen activator (tPA), plasminogen, vitronectin and thrombin activatable fibrinolysis inhibitor (TAFI). Furthermore, diagnostic biomarkers including, fibrinogen, C-reactive protein (CRP), D-dimer and inflammatory cytokines were quantified. Clot lysis was evaluated using turbidity assays, plasma clot structure visualised by confocal microscopy and plasmin generation quantified by chromogenic substrate. Result(s): PAI-1 antigen, activity, and the cofactor for this serpin, vitronectin, were significantly elevated in patients with COVID-19 compared to healthy controls and non-COVID- 19 respiratory infection. Patients with COVID-19 exhibit attenuated plasmin generation compared to healthy volunteers despite significant elevation in tPA. PAI-1 correlated with inflammatory cytokines (IL-1beta, IL-8 and TNF-alpha). In line with this acute phase proteins, fibrinogen and CRP were high in patients with COVID-19 but only CRP was increased compared to non-COVID- 19 respiratory infections. Levels of PAI-1 and vitronectin were associated with escalating oxygen support and a corresponding decrease in plasminogen. Importantly, patients with COVID-19 disease exhibit resistance to fibrinolytic degradation by Actilyse, however, this could be overcome by the PAI-1 resistant form of tPA, Metalyse. Conclusion(s): We reveal that COVID-19 disease promotes a hypofibrinolytic state due to elevated PAI-1 and its stabilizing cofactor vitronectin. PAI-1 correlates with inflammatory cytokines and disease severity thereby highlighting its potential prognostic power in the development of severe COVID-19 disease.

Conducting remote materials education and outreach with in-person communities: implementation and reflections

The COVID-19 pandemic has greatly impacted educators all over the world and a major area of disruption has been the ability for higher education institutions to provide meaningful STEM education activities to the broader community. In this work, methods to adapt materials science outreach activities to meet the needs of students, teachers, and the community at large during the pandemic are explored and outcomes and recommendations are provided. This is accomplished through a focus on three efforts: fully-virtual classroom visits, remote visitation for in-person classrooms, and an innovative hybrid museum tour that showcases materials science in art for general community outreach. Results show that methods developed with restrictions on in-person interaction in place can have benefits in terms of the ability to reach broader audiences while also fostering more consistent interaction between those broader audiences and those conducting outreach. These methods also have the potential to remain effective even following a return to "normal" conditions and thus supplement and positively augment pre-pandemic methods. © American Society for Engineering Education, 2022.

LAB-ON-PCB TECHNOLOGY FOR HANDHELD, SAMPLE-IN-ANSWER-OUT SARS-CoV-2 DIAGNOSTIC

Since the early reports of SARS-CoV-2 in Wuhan, China in the winter of 2019, the virus spread has resulted in the most socially-crippling pandemic of the last century. Here, we report the development of a rapid, molecular COVID-19 test utilizing for the first time a loop-mediated isothermal amplification (LAMP) assay on Lab-on-Printed Circuit Board (Lab-on-PCB) to exploit the established integration and up-scaling advantages the latter offers. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.

RESIDENT PERCEPTIONS OF VIRTUAL, IN-PERSON, AND SIMULCAST TEACHING SETTINGS

BACKGROUND: In response to the COVID-19 pandemic, our internal medicine (IM) residency program transitioned between in-person, virtual, and “simulcast” educational sessions to balance social interaction with exposure risk. In simulcast sessions, small groups of learners meet in-person in separate rooms and connect to the large-group session via videoconferencing. METHODS: This qualitative study describes IM residents' perceptions regarding advantages and disadvantages of learning in virtual, in-person, and simulcast settings during the pandemic. Categorical IM residents at Penn State Health during the academic year 2020 to 2021 were invited to participate in one 30-minute virtual, semi-structured focus group. We used inductive thematic coding to analyze resident responses. RESULTS: Forty-eight percent (n=29/60) of invited residents participated in focus groups. Overall, the in-person setting was preferred when possible due to increased social connection. While virtual sessions were perceived as convenient and more welcoming to quieter learners, the ability to multi-task was a potential distraction. In the simulcast setting, participants felt accountability to participate in their small groups, but had varied educational experiences based upon the room's facilitator. Respondents identified educator enthusiasm and presentation quality as key to engagement regardless of setting. CONCLUSIONS: Residents had variable perceptions of educational settings based upon their comfort with participation by group size and desire for social engagement. As the need for educational adaptability continues, it is reassuring that learners perceive that engagement can be achieved in a variety of settings through the use of interactive teaching techniques.

Prolonged N-95 Mask Use Did Not Result in Carbon Dioxide Retention or Clinically Significant pH Changes in One Cohort of Health Care Workers

Study Objective: Concerns over emerging infectious diseases spread via airborne or respiratory droplet transmission have highlighted the importance of respiratory protection for health care workers. During the current COVID-19 pandemic, widespread use of N95 masks by health care workers helped to prevent transmission and contraction of SARS-CoV2. It is not clear if prolonged continuous use of an N-95 during clinical duties results in any detrimental physiological effects and clinical features from increased carbon dioxide. The primary objective of the study was to evaluate for carbon dioxide retention and/or clinically significant changes in pH with prolonged use of N-95 masks. Secondary objective assessed for changes in vital signs and any unexpected subjective symptoms experienced by the study participants. Methods: 10 healthy emergency medicine residents between the ages of 27 and 31 years old provided written consent. All subjects denied history of structural lung disease (asthma, COPD, interstitial lung disease) and had been previously fit-tested for the correct size of N-95 mask. Each participant was provided a new N-95 mask and instructed to don as if they were about to enter a clinical scenario that would require this degree of respiratory protection. All subjects remained in a seated position and asked to refrain from speaking in order maximize fit of the mask. Venous blood gas samples were obtained prior to donning their mask followed by three additional intervals at, 20, 40, and 60 minutes. In addition, vital signs (heart rate, pulse oximetry, blood pressure and respiratory rate) were recorded at each of those four intervals and subjects were ask to self-record any symptoms they experienced prior to each blood draw. Each sample collected consisted of acquiring 2 ml of venous blood, which were analyzed within 30 minutes at the University of Nebraska Medical Center’s core lab. PCO2 and pH was assessed at each of the time intervals and fit with a linear mixed effect model to determine if statistically significant change over time for these measurements. Mean and standard deviations were used to describe the values at each time point. Pairwise comparisons between time points were adjusted using Tukey’s method. All analysis was done using SAS, Version 9.4 and a p-value < 0.05 was considered statistically significant. Results: The mean carbon dioxide levels at time 0 and 60 minutes were 48.9 (CI, 49.0-56.0) and 48.5 (CI 39.0- 57.0) and there was no statistically significant change across any of the time intervals (p=0.20). There was a small significant increase in the mean pH between the 20-minute assessment and baseline [(7.367, CI 7.350- 7.400) vs (7.381, CI 7.350-7.410) p=0.019], which was not clinically significant. In addition, there were no significant changes in vital signs or report of unexpected clinical symptoms by any the subjects. Conclusion: In this small cohort of subjects, there was no evidence of carbon dioxide retention or clinically significant changes in pH with prolonged use of N-95 masks. [Formula presented]

Encephalopathy and life-threatening gastrointestinal hemorrhage in a child with mis-c

INTRODUCTION: Multisystem Inflammatory Syndrome in Children (MIS-C) is a recently described phenomenon associated with Coronavirus Disease 2019 (COVID-19). Children typically present with fever and laboratory evidence of systemic inflammation. Additional signs and symptoms can vary widely, leading to diagnostic and management challenges. Given the range of clinical manifestations in children with MIS-C, it is important to report unique cases that represent uncommon but life-threatening complications associated with the disease and its management. DESCRIPTION: A previously healthy 11 year old male was admitted to the pediatric ICU and diagnosed with MIS-C based on clinical appearance, laboratory pattern, and SARS-CoV-2 antibody profile. The patient presented with shock and neurologic symptoms including encephalopathy and dysarthria. The shock was relatively mild and consistent with the hemodynamic profile commonly seen with MIS-C. Brain MRI, obtained to rule out thromboembolic injury, demonstrated cytotoxic edema of the corpus callosum, an imaging finding similar in nature to several previous reports of MRI abnormalities in children with MIS-C. Following administration of intravenous immunoglobulin and pulse dose steroids, the patient convalesced and was discharged home. Medications prescribed at discharge included a steroid taper, aspirin, and proton pump inhibitor. Four days later, he was readmitted with shock and life threatening gastrointestinal hemorrhage. The patient required large scale resuscitation with vasoactive agents and over twice his own circulatory volume in blood products delivered by a rapid infusion system. After extensive evaluation of potential bleeding sources, angiography revealed active bleeding from two arterial vessels supplying the duodenum. The patient demonstrated no further bleeding following successful coil embolization of the two arteries. DISCUSSION: We hypothesize that the vasculitic nature of MIS-C combined with anti-inflammatory and anti-thrombotic therapy placed the patient at risk of hemorrhage. This case highlights unique radiologic features of MIS-C as well as potential complications of treatment and the disease process itself. To our knowledge, this is the first report of a child with life-threatening GI hemorrhage in the setting of MIS-C.

Primary care practitioners have a high level of satisfaction with the current breast referral pathway but the majority would support a change to patient self-referral

Aim: Currently, patients must consult with a primary care practitioner (PCP) prior to being referred to secondary care breast services. A change to patient self-referral would arguably reduce primary care workload, improve access for patients, and allow breast units to allocate resources more appropriately;no data currently supports this. This study aims to explore PCP's views on breast referral, evaluate the community breast workload, and to investigate the impact of COVID-19 on referral rates. Method: An electronic survey was designed on SurveyMonkey.com which aimed to collect both quantitative and qualitative data. The weblink to the survey was sent out via two electronic newsletters. Participants were asked: their role and gender, their level of confidence surrounding breast care, details surrounding their breast workload, how they felt COVID-19 had affected their referral rates, their level of satisfaction with the current pathway, and their opinions on a potential change to patient self-referral. Results: 79 responses were received. PCPs estimated that 7.0% (median) of their total consultations were regarding a breast-related issue and that COVID-19 had not had a significant impact on the rate of referral to breast units (P=0.75). 84.8% of PCPs were satisfied with the current referral pathway. Whilst 74.5% felt a change to patient self-referral would benefit patients and primary care services, their free text comments highlighted some of their reservations. Conclusions: PCPs have a high level of satisfaction with the current breast referral pathway, but the majority would be open to a change to patient self-referral to specialist breast units.

Community-Engaged Regenerative Mapping in an Age of Displacement and COVID-19

Displacement is detrimental not only to displaced individuals and families but also to the communities left behind and their ability to collectively resist and mobilize against global processes that negatively affect their ability to engage in practices of resilience and regeneration that support well-rooted communities. Critical approaches to the study of displacement should not only focus on mapping vulnerability factors and analyzing dominant power structures driving racial, social, and environmental injustice but should also include the collective resilience, everyday vitality, and community knowledge that characterize rooted urban neighborhoods and build immunity to serial forced displacement. Building on theoretical and methodological foundations in critical, Black, Latinx, and Indigenous geographies;Black feminist theory;and environmental justice, we argue that for mapping to have a positive change outside the already academic understanding of displacement and inequity, we need a methodology to (1) identify intersectional oppressions and name them as such, (2) center community knowledge and strengths enabling resilience, and (3) advance community activism. This methodology requires trust and community engagement but is vulnerable to systems that interrupt the embeddedness of researchers. The response to the COVID-19 pandemic is one such system;not only has the pandemic exacerbated displacement crises, making the need for engaged, critical, and cocreative partnerships even greater, it has abruptly halted opportunities for these community partnerships and regenerative work to happen. Drawing on our experiences attempting these approaches during the COVID-19 pandemic, we discuss challenges that arise when researchers are displaced from field sites, best practices, and implications for future research.

Allyship as activism: advancing social change in global sport through transformational allyship. (Special Issue: Sport, Race and Ethnicity at a time of multiple global crises.)

As the world is racing to find a cure to save lives and economies amidst a global pandemic, COVID-19 has inadvertently caused a shift of focus towards the inequities and injustices plaguing society economically, politically, and socially. In response, athletes, coaches, managers, and other change agents with institutional power in sport organisations across the globe have begun to utilise their platforms to champion social justice generally, and racial justice in particular, in solidarity. Historically, in concert with trends in neoliberal and neocolonial hegemonic societies, sport has reproduced various oppressive ideologies, discourses, and systems grounded in racism, sexism, heterosexism, ableism, homophobia, xenophobia and related systemically oppressive forces. Given the visibility of sport in the global marketplace, racialized groups have used sport as a site of resistance and activism for social justice. Since the athlete activist has re-emerged as an important change agent in the public consciousness, an increasing number of supporters holding privileged identities, within and beyond sport, have backed social justice movements through their allyship. However, scholarship has focussed largely on the allyship of athletes. Perhaps more problematically, the ambiguity of allyship has resulted in instances of decentring the core targets or victims of oppressive systems, who are best positioned to lead social movements. In an effort to cultivate a deeper understanding of allyship and how allies can optimise social movements, the purpose of this conceptual paper is to call for more intentional, critically reflexive, and culturally conscious allyship that is reflective of a transformation of allyship from reactive advocacy to proactive activism for long-term substantive gains. The authors posit that transformational allyship is allyship as activism on both individual and institutional levels. Allyship as activism should consist of intentionality to centre the core targets and victims of oppression, critical reflexivity of the relationship between ally and core activist, the presence of a clear opposition, a challenge or disruption to hegemonic systems, and a connection to a broader social movement. Implications for coaches, administrators, sport managers, and athletes are discussed.

Unusual presentation of paraneoplastic myopathy and non-bacterial thrombotic endocarditis due to metastatic gastrointestinal malignancy

Introduction: Gastrointestinal (GI) malignancies are associated with paraneoplastic sequelae such as non-bacterial thrombotic endocarditis (NBTE) and inflammatory myopathy. We describe a unique case in which a metastatic gastric malignancy presented without typical GI symptoms and instead was discovered after pursuing a unifying diagnosis for a constellation of cardiac, neurologic, and musculoskeletal manifestations. Case Description/Methods: A 61-year-old woman presented to a tertiary medical center with shoulder and thigh soreness and weakness with functional decline in the 3 months prior to presentation. Her medical history included morbid obesity, atrial fibrillation (AF), diabetes mellitus, and resolved COVID-19 pneumonia. Her physical exam was notable for proximal muscle weakness and tenderness, bilateral ptosis, vertical gaze deficit, and 4/6 diastolic murmur. Laboratory values included CRP 3.2 mg/dL (normal range <0.8 mg/dL), ESR 51 mm/hour (, 30 mm/hour), creatine kinase 822 IU/L (25-185 IU/L), and aldolase 24.3 U/L (<8.1 U/L). A muscle biopsy was performed revealing an equivocal inflammatory myopathy process. The gaze deficit prompted an MRI of the brain, revealing multiple thromboembolic strokes. COVID related hypercoagulability and AF were considered, however given the murmur on exam, a transesophageal echocardiogram was performed which showed large mobile echodensities on the aortic valve. She was empirically treated for infectious endocarditis, though with concern for NBTE and occult malignancy. CT scan of the abdomen and pelvis with IV contrast was then performed, demonstrating metastatic liver lesions and enlarged gastrohepatic and cardiophrenic lymph nodes. In discussion with radiology, it was suggestive of a gastric primary malignancy. Carcinoembryonic antigen and carbohydrate antigen 19-9 returned at 4965 ng/mL (<3 ng/mL) and 1878 U/mL (<35 U/mL), respectively. The patient ultimately decided to pursue hospice care. Discussion: In this unusual case, a gastric malignancy presented with paraneoplastic phenomena in multiple systems, but without GI symptoms. Physical exam findings led to critical diagnostic steps. NBTE is associated with malignancy, commonly carcinomas of the stomach, biliary system, pancreas, ovaries, or lung. Inflammatory myopathy can also share strong associations with cancer. Our report highlights a unique diagnostic journey and should alert physicians to include GI malignancy on the differential when presented with NBTE and myopathy..

Assessing complement activation in COVID-19 predicts hypoxemia and mortality

Background: Infection with SARS-CoV-2 triggers a thromboinflammatory response with widespread endothelial damage and micro-and macro-vascular thrombosis that is associated with impaired function of multiple organs. Mechanisms underlying the hyperacute innate response that drives coagulation and inflammation are incompletely understood. Several lines of evidence support a role for overactivation of complement. Aims: To better understand the involvement of complement in COVID-19. Methods: We prospectively studied 25 COVID-19 ICU-hospitalized patients for up to 21 days. Commercial ELISAs were used to quantify complement pathway proteins and activation markers in serum of the patients and 25 healthy controls. Correlative and regression analyses were performed to determine the predictive value of biomarkers, in terms of respiratory function and mortality. Results: On admission, all COVID-19 patients exhibited significantly increased serum levels of terminal products of complement activation, C5a and sC5b-9. C4d levels, reflecting activation via the classical/ lectin pathways, were variably increased. All patients had excess activation of the alternative pathway (AP) with significantly elevated levels of factor B activation fragments, Ba and Bb. This was associated with a significant reduction (∼25%) in FH, a negative regulator of the AP. Ba levels correlated strongly with serum creatinine, the latter being a strong predictor of in-hospital mortality in COVID-19. C5a, Ba, Bb and factor D (FD) were significantly associated with hypoxemia. C5a, Ba, and FD, but not D-dimer, were significant independent predictors of mortality. Notably, levels of all complement activation markers were sustained throughout the patients' ICU stays, a finding in contrast to serum levels of IL-6, C-reactive protein and ferritin, which were more variable. Conclusions: All severely ill COVID-19 patients have increased and persistent activation of complement, minimally mediated via the AP. Complement activation biomarkers may be valuable predictors of hypoxemia and mortality. Large-scale studies will reveal the relevance of these findings to thrombo-inflammation in acute and postacute COVID-19.