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Purpose: The purpose of this paper is to discuss the evolving interpretations of the Covid crisis and its impact on hospitality and tourism. Design/methodology/approach: Scenario planning paper following Framework Foresight about the Covid pandemic and its impact on hospitality and tourism. Research input was gathered from research reports in different disciplines and discussions with an expert panel. Findings: The paper argues that hypothesized recovery scenarios were founded on hope and inaccurate extrapolations, and that hospitality and tourism may head for permanently lower volumes. Research limitations/implications: The paper contributes to the debate on tourism resilience and hopeful visions of a sustainable restart. Practical implications: Instead of just focusing on direct pandemic impact and that of governmental measures, a third variable of consumer confidence will be decisive, and more important than expected by many initially, in future scenarios for hospitality and tourism. Originality/value: The proposed scenarios that were designed with executive level industry input have so far proven more realistic than prevalent views of a swift recovery.
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Introduction: The SARS-CoV-2 pandemic accelerated health disparities in chronic kidney disease (CKD). Here, we describe risk factors and access to care surrogates (area deprivation index-ADI) for clinical outcomes among SARS-CoV-2-tested patients in the Center for Kidney Disease Research, Education, and Hope (CURE-CKD) Registry. Method(s): We formed a COVID-19 Sub-Registry within CURE-CKD (1/1-6/30/2021;N=171,988) of patients with CKD, diabetes (DM)/pre-DM, or hypertension (HTN) with SARS-CoV-2 testing at UCLA Health (UCLA;N=17,884) and Providence St. Joseph Health (PSJH;N=154,104). Statistical analyses and fitted multivariable logistic regression models were adjusted for age and sex. The UCLA cohort included analyses for acute kidney injury (AKI), area deprivation index (ADI, for poor housing, education, income), Charlson Comorbidity Index (CCI), and severe COVID-19 disease. Result(s): We determined the odds ratios and 95% confidence interval (OR[95%CI[) of COVID-19 positivity for the combined UCLA + PSJH population, as well as OR of having severe COVID-19 disease in the UCLA cohort (Table 1) only. OR[95%CI] for AKI was higher for ages >=80 years (1.77[1.14-2.46]), ADI by state (1.12[1.06-1.18]), CKD (12.20[8.46-17.58]) and pre-existing DM (3.65[2.62-5.08]), p<0.001. In the UCLA CURE-CKD population, AKI was associated with severe COVID-19 (r=0.26) and ICU admissions (r=0.29). Mortality was associated with severe COVID-19 disease (r=0.5). [Formula presented] Conclusion(s): Non-White and/or LatinX race/ethnicity, ADI, CKD, DM, and older age were associated with higher risks of COVID-19 positivity, disease severity, and mortality in CURE-CKD. Efforts on viral screening, timely COVID-19 diagnosis, and optimal care delivery for patients with or at-risk of CKD are needed. Conflict of interest Potential conflict of interest: SBN is supported by NIH research grants R01MD014712, RF00250-2022-0038, U2CDK129496 and P50MD017366, and CDC project number 75D301-21-P-12254 receives research support from Bayer AG for the submitted work, Goldfinch Bio, Travere and Terasaki Institute of Biomedical Innovation, and personal fees and other support from AstraZeneca, Bayer AG, Gilead, NovoNordisk and Boehringer Ingelheim/Lilly. KBD is supported by an NIH research grant R01MD014712 and CDC project number 75D301-21-P-12254 and reports other support from Bayer AG for the submitted work, and Goldfinch Bio and Travere outside the submitted work. CRJ is supported by an NIH research grant R01MD014712 and CDC project number 75D301-21-P-12254 and reports other support from Bayer AG for the submitted work, and Goldfinch Bio and Travere outside the submitted work. KCN is supported in part by NIH research grants UL1TR001881, P30AG021684, U2CDK129496 and P50MD017366. KRT is supported by NIH research grants R01MD014712, U2CDK114886, UL1TR002319, U54DK083912, U01DK100846, OT2HL161847, UM1AI109568 and CDC project number 75D301-21-P-12254 and reports other support from Eli Lilly personal fees and other support from Boehringer Ingelheim personal fees and other support from AstraZeneca grants, personal fees and other support from Bayer AG grants, personal fees and other support from Novo Nordisk grants and other support from Goldfinch Bio other support from Gilead and grants from Travere outside the submitted work.Copyright © 2023
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Background. Limited availability of multiplex molecular tests in the near-patient setting can impact the rapid diagnosis and treatment of patients experiencing symptoms of respiratory tract infections, including pharyngitis. The BioFire Respiratory/ Sore Throat (R/ST) Panel (bioMerieux, Salt Lake City, UT), designed for use with the BioFire SpotFire System, is a PCR-based sample-to-answer diagnostic test that identifies four bacteria and 10 viruses (including SARS-CoV-2) from nasopharyngeal swab (NPS) or throat swab (TS) specimens in about 16 minutes. This study evaluated the performance of an Investigational Use Only (IUO) version of the BioFire R/ST Panel in the near patient setting. Methods. NPS and TS specimens were prospectively enrolled from symptomatic consented/assented volunteers of all ages, or obtained as residual leftover specimens. Enrollment was conducted between December 2020 and September 2021 at five study sites in the US and UK (adult and pediatric emergency departments or urgent care clinics) with testing performed by personnel representative of the intended users (non-laboratory professionals). Several analytes that were not circulating during the COVID-19 pandemic were supplemented with archived specimens of known analyte composition. Performance was determined for both sample types by comparison to FDA cleared multiplex PCR tests or culture and PCR followed by sequencing of isolates (Streptococcus from throat swabs). Results. A total of 1131 NPS and 452 TS prospectively collected specimens and 542 NPS and 128 TS archived specimens were tested with the BioFire R/ST Panel. For NPS specimens (prospective and archived) overall positive percent agreement (PPA) was 98.7% and negative percent agreement (NPA) was 99.1%, and for TS specimens (prospective and archived) overall PPA was 95.9% and NPA was 99.2%. Conclusion. The BioFire R/ST Panel is a sensitive, specific, and robust test for rapid detection of a wide range of organisms in NPS and TS specimens in the nearpatient setting. This test is expected to aid in the timely diagnosis and appropriate management of pharyngitis and other respiratory infections.
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Learning Objectives: Covering the domains of knowledge, skills and attitudes, residents were expected to analyze structural violence and health gaps, demonstrate inclusive and trauma-informed care, recognize implicit bias, use strategies to reduce it, and critically assess the EM health equity literature. Introduction/Background: Since the 2003 Unequal Treatment report showed that health gaps are not due to access or income, racial injustice and COVID-19 have laid bare worse inequities. In 2021, the ACGME EM Milestones addressed recognition of health gaps and personal bias, however there is no guidance on how to do this. ED patients require an unbiased evaluation to ensure rapid and accurate diagnosis and treatment, but implicit bias reigns with high cognitive load. Thus, we describe a deliberate and formal diversity, inclusion and racial equity (DIRE) curriculum. Educational Objectives: Residents were expected to analyze structural violence and health gaps, demonstrate inclusive and trauma-informed care, recognize implicit bias, use strategies to reduce it, and critically assess the EM health equity literature. Curricular Design: An ED survey confirmed the need for this curriculum. Since July 2020, the course has been available to all ED staff but is mandatory for residents. The free online platform, Canvas, was chosen for ease of access and use, and for resource sharing, discussion facilitation, and quiz scoring. Biweekly articles, online videos, a journal club and quarterly book clubs led to health equity discourse. Residents took part in simulated cases involving diverse patients. A workshop reviewed strategies to reduce implicit bias. Residents were assessed with quizzes, reflective writing and direct observation. Based on feedback, sessions are now held monthly with more media resources, live seminars, and diverse content. Impact/Effectiveness: As of July 2021, residents have had positive feedback, 100% completion rates, and high knowledge retention. Structural violence must be included in resident didactics. Simulated cases provide an avenue to assess interpersonal communication skills for residents to develop tools to partner with patients. This model may serve as a blueprint for those seeking to improve DIRE knowledge, skills and attitudes.
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BACKGROUND: The COVID-19 pandemic magnified the digital health divide among marginalized populations when health systems scaled back inperson visits as a public health precaution. We conducted this qualitative study during the pandemic to solicit patient and provider perceptions of use of digital health programs (patient portals, telemedicine, remote hypertension/diabetes monitoring) and to inform strategies to surmount barriers to accessing remote care. METHODS: We conducted semi-structured interviews with 40 patients and 29 primary care providers (PCPs) from northern and southeastern Louisiana who were recruited within an integrated delivery health system and an FQHC between May and July 2021. We used constant comparative method of grounded theory to identify themes. Commonalities/differences in perspectives between patients and PCPs were analyzed. RESULTS:Most patients recruited to the study self-identified as Black (68%), female (73%), mean age 51, lived in an urban area (77%), and had Medicaid (58%). Most PCPs were White (79%), male (52%), mean age 39, and reported Medicaid as the predominant insurer (59%). Most patients reported using smartphones for accessing the internet for health and non-health activities. Some participants used apps to track their health but noted internet/data/storage limits. PCPs noted increased uptake of misinformation on the internet prompting them to proactively recommend websites and apps. Most patients had used a patient portal and reported convenience of messaging their PCP, getting refills, scheduling appointments, and reviewing test results. PCPs noted a concurrent increase in their in-basket workload with a particular concern for frequent messaging like cellphone texting. Most patients had telemedicine video visits using their smartphones - some of which converted to audio when technology problems arose. Patients and PCPs noted telemedicine is appropriate for routine follow-up but preferred in-person visits. PCPs noted additional workflow disruption when moving from in-person to video visits in the same clinic session. Few patients were enrolled in a digital health program for remote monitoring;however, patients and PCPs agreed these programs provide valuable adjuncts to chronic care. PCPs reported patient limitations in accessing such programs due to the need for smartphones/internet/WiFi and select insurance coverage which can lead to further disparities in access to care. CONCLUSIONS: Health policies that support broadband/internet/ smartphone service as a standard utility and insurance coverage for digital health programming are paramount for surmounting major patient barriers. Clinical practice procedures which optimize technical support for patients and providers are also needed. RESULTS: Of the 236 women in the study, there was a mean age of 66.5 years ± 7.1;67 self-identified as Black, 93 as White, 49 as Hispanic and 16 as Other. Median CA anxiety score was 3 while DM anxiety score was 2.5 (p<0.001). For the anxiety groups, 67 (28%) were in the high CA/high DM group, 52 (22%) in the high CA/low DM group, 15 (6%) in the low CA/high DM group, and 94 (39%) in the low CA/low DM group. Participants in the high CA/low DMand low CA/low DMgroups were more likely to adhere to a healthy diet (73% and 71% compared with 51% for high CA/high DM and 53% for low CA/high DM, p= 0.02). They also had an increased likelihood of consuming at least 5 servings of fruits and veggies daily (69% and 57% vs. 45% for high CA/high DM and 40% for low CA/high DM, p= 0.03) and adhering to oral DM medications (62% and 75% vs. 52% for high CA/high DM and 20% for low CA/high DM, p= 0.05). CONCLUSIONS: Older breast cancer survivors with DM have different levels of anxiety about CA versus DM and those with high DM anxiety are less likely to adhere to DMSMBs. Our findings suggest that increased anxiety might hinder one's ability to achieve disease control, making anxiety management vital to supporting patient adherence and health.
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We sought to determine parameters of the acute phase response, a feature of innate immunity activated by infectious noxae and cancer, deranged by Covid-19 and establish oncological indices' prognostic potential for patients with concomitant cancer and Covid-19. Between 27/02 and 23/06/2020, OnCovid retrospectively accrued 1,318 consecutive referrals of patients with cancer and Covid-19 aged 18 from the U.K., Spain, Italy, Belgium, and Germany. Patients with myeloma, leukemia, or insufficient data were excluded. The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), prognostic nutritional index (PNI), modified Glasgow prognostic score (mGPS), and prognostic index (PI) were evaluated for their prognostic potential, with the NLR, PLR, and PNI risk stratifications dichotomized around median values and the pre-established risk categorizations from literature utilized for the mGPS and PI. 1,071 eligible patients were randomly assorted into a training set (TS, n=529) and validation set (VS, n=542) matched for age (67.9±13.3 TS, 68.5±13.5 VS), presence of 1 comorbidity (52.1% TS, 49.8% VS), development of 1 Covid-19 complication (27% TS, 25.9% VS), and active malignancy at Covid-19 diagnosis (66.7% TS, 61.6% VS). Among all 1,071 patients, deceased patients tended to categorize into poor risk groups for the NLR, PNI, mGPS, and PI (P<0.0001) with a return to pre-Covid-19 diagnosis NLR, PNI, and mGPS categorizations following recovery (P<0.01). In the TS, higher mortality rates were associated with NLR>6 (44.6% vs 28%, P<0.0001), PNI<40 (46.6% vs 20.9%, P<0.0001), mGPS (50.6% for mGPS2 vs 30.4% and 11.4% for mGPS1 and 0, P<0.0001), and PI (50% for PI2 vs 40% for PI1 and 9.1% for PI0, P<0.0001). Findings were confirmed in the VS (P<0.001 for all comparisons). Patients in poor risk categories had shorter median overall survival [OS], (NLR>6 30 days 95%CI 1-63, PNI<40 23 days 95%CI 10-35, mGPS2 20 days 95%CI 8-32, PI2 23 days 95%CI 1-56) compared to patients in good risk categories, for whom median OS was not reached (P<0.001 for all comparisons). The PLR was not associated with survival. Analyses of survival in the VS confirmed the NLR (P<0.0001), PNI (P<0.0001), PI (P<0.01), and mGPS (P<0.001) as predictors of survival. In a multivariable Cox regression model including all inflammatory indices and pre-established prognostic factors for severe Covid-19 including sex, age, comorbid burden, malignancy status, and receipt of anti-cancer therapy at Covid-19 diagnosis, the PNI was the only factor to emerge with a significant hazard ratio [HR] in both TS and VS analysis (TS HR 1.97, 95%CI 1.19-3.26, P=0.008;VS HR 2.48, 95%CI 1.47- 4.20, P=0.001). We conclude that systemic inflammation drives mortality from Covid-19 through hypoalbuminemia and lymphocytopenia as measured by the PNI and propose the PNI as the OnCovid Inflammatory Score (OIS) in this context.
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The Internet has never been more important to our society, and understanding the behavior of the Internet is essential. The Center for Applied Internet Data Analysis (CAIDA) Telescope observes a continuous stream of packets from an unsolicited darkspace representing 1/256 of the Internet. During 2019 and 2020 over 40,000,000,000,000 unique packets were collected representing the largest ever assembled public corpus of Internet traffic. Using the combined resources of the Supercomputing Centers at UC San Diego, Lawrence Berkeley National Laboratory, and MIT, the spatial temporal structure of anonymized source-destination pairs from the CAIDA Telescope data has been analyzed with GraphBLAS hierarchical hypersparse matrices. These analyses provide unique insight on this unsolicited Internet darkspace traffic with the discovery of many previously unseen scaling relations. The data show a significant sustained increase in unsolicited traffic corresponding to the start of the COVID19 pandemic, but relatively little change in the underlying scaling relations associated with unique sources, source fan-outs, unique links, destination fan-ins, and unique destinations. This work provides a demonstration of the practical feasibility and benefit of the safe collection and analysis of significant quantities of anonymized Internet traffic.
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Purpose of Study The objective of this study was to identify generational differences in COVID-19 vaccine hesitancy among college students. Methods Used An online survey was conducted between September and October 2021 to the student body at Louisiana State University Shreveport to compare COVID-19 vaccine hesitancy among the following generations: Baby Boomers (1955-1964), Generation X (1965-1980), Millennials (1981- 1996), and Generation Z (1997-2000). Summary of Results Among the 339 participants, 66.8% were female, 28.5% male, 2.4% non-binary, and 2.4% other. Regarding their race, 64% were White, 16% African American, 9.8% selected two or more races or other, 6% Middle Eastern or North African, 5% Hispanic/Latinx, 2.7% Asian, and 1.2% Native American or Alaska Native. Among the generations who participated in the study, 43.2% were from Generation Z (GZ), 31.8% Millennials (M), 21.9% Generation X (GX), and 3% Baby Boomer (BB). Of the participants who selected that they had not received the COVID-19 vaccine, Generation Z (53.8%) reported the highest number, followed by Millennials (26.1%). In addition, when asked if participants planned to receive the COVID-19 vaccine, over half of Generation Z reported that they did not plan to get the vaccine compared to 19.7% of Generation X and 1.7% of Baby Boomers. Interestingly, when asked if FDA approval made them feel more confident in the vaccine's safety, the data suggests no statistical significance between groups. The leading causes for vaccine hesitancy among Generation Z were not trusting the COVID-19 vaccine (56.7%), and concerns about unknown long-term side effects of the vaccine (68.3%). Conclusions Of the generational groups, Generation Z college students report low rates of COVID-19 vaccination and intention of receiving the vaccine. This fact may have implications for herd immunity for college campuses across the nation.
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Background: Immune checkpoint inhibitors targeting PD-1 and PD-L1 have significantly impacted treatment of Non-Small Cell Lung Cancer (NSCLC). KEYNOTE-189 demonstrated first-line pembrolizumab plus pemetrexed-platinum improves progressionfree survival (PFS) and overall survival (OS) in metastatic nonsquamous NSCLC, regardless of tumour PD-L1 expression [1]. Translating evidence from trials to real-world patient populations can be challenging as a significant proportion of patients in daily practice are often under-represented in randomised control trials due to strict inclusion and exclusion criteria. We aimed to compare real-world data with outcomes from KEYNOTE-189. Methods: We performed a retrospective analysis of 56 patients with metastatic nonsquamous NSCLC without targetable mutations, treated with first line pembrolizumab, pemetrexed and platinum. Data were collected from electronic records between October 2018 and January 2021 in 2 London cancer centres. Results: Our cohort comprised 56 patients with median age 61 years, 75% with smoking history, 59% male and 41% female. PD-L1 expression was <1% in 57% of patients. Median follow-up was 8.7 months. All patients received at least one cycle and 53% completed 4 cycles of chemoimmunotherapy. Treatment was stopped early or pemetrexed maintenance treatment was omitted due to COVID-19 in 4 patients (7%). Median PFS was 7.1 months (range 1.8 to 26.3) and median OS was 8.7 months (range 1.8 to 26.3). OS at 12 months was reached by 21 patients (38%). Adverse events were observed in 30 patients (54%), including grade 3-5 adverse events in 15 patients (27%). Conclusions: Median PFS was similar in our cohort compared to KEYNOTE-189, but not as substantial as that reported in their updated analysis. OS was lower in our cohort, however a significant proportion of our patients recently commenced treatment and had shorter duration follow-up. Safety outcomes were superior in our cohort compared to KEYNOTE-189. Disclosure: No significant relationships.
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PURPOSE OF THE PROGRAM: This article provides guidance on optimizing the management of pediatric patients with end-stage kidney disease (ESKD) who will be or are being treated with any form of home or in-center dialysis during the COVID-19 pandemic. The goals are to provide the best possible care for pediatric patients with ESKD during the pandemic and ensure the health care team's safety. SOURCES OF INFORMATION: The core of these rapid guidelines is derived from the Canadian Society of Nephrology (CSN) consensus recommendations for adult patients recently published in the Canadian Journal of Kidney Health and Disease (CJKHD). We also consulted specific documents from other national and international agencies focused on pediatric kidney health. Additional information was obtained by formal review of the published academic literature relevant to pediatric home or in-center hemodialysis. METHODS: The Leadership of the Canadian Association of Paediatric Nephrologists (CAPN), which is affiliated with the CSN, solicited a team of clinicians and researchers with expertise in pediatric home and in-center dialysis. The goal was to adapt the guidelines recently adopted for Canadian adult dialysis patients for pediatric-specific settings. These included specific COVID-19-related themes that apply to dialysis in a Canadian environment, as determined by a group of senior renal leaders. Expert clinicians and nurses with deep expertise in pediatric home and in-center dialysis reviewed the revised pediatric guidelines. KEY FINDINGS: We identified 7 broad areas of home dialysis practice management that may be affected by the COVID-19 pandemic: (1) peritoneal dialysis catheter placement, (2) home dialysis training, (3) home dialysis management, (4) personal protective equipment, (5) product delivery, (6) minimizing direct health care providers and patient contact, and (7) caregivers support in the community. In addition, we identified 8 broad areas of in-center dialysis practice management that may be affected by the COVID-19 pandemic: (1) identification of patients with COVID-19, (2) hemodialysis of patients with confirmed COVID-19, (3) hemodialysis of patients not yet known to have COVID-19, (4) management of visitors to the dialysis unit, (5) handling COVID-19 testing of patients and staff, (6) safe practices during resuscitation procedures in a pandemic, (7) routine hemodialysis care, and (8) hemodialysis care under fixed dialysis resources. We make specific suggestions and recommendations for each of these areas. LIMITATIONS: At the time when we started this work, we knew that evidence on the topic of pediatric dialysis and COVID-19 would be severely limited, and our resources were also limited. We did not, therefore, do formal systematic review or meta-analysis. We did not evaluate our specific suggestions in the clinical environment. Thus, this article's advice and recommendations are primarily expert opinions and subject to the biases associated with this level of evidence. To expedite the publication of this work, we created a parallel review process that may not be as robust as standard arms' length peer-review processes. IMPLICATIONS: We intend these recommendations to help provide the best care possible for pediatric patients prescribed in-center or home dialysis during the COVID-19 pandemic, a time of altered priorities and reduced resources.
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Background: The SARS-CoV-2 pandemic accelerated health disparities in chronic kidney disease (CKD). Here, we describe risk factors and access to care surrogates (area deprivation index-ADI) for clinical outcomes among SARS-CoV-2-tested patients in the CURE-CKD Registry. Methods: We formed a COVID-19 Sub-Registry within CURE-CKD (1/1-6/30/2021;N=171,988) of patients with CKD, diabetes (DM)/pre-DM, or hypertension (HTN) with SARS-CoV-2 testing at UCLA Health (UCLA;N=17,884) and Providence St. Joseph Health (PSJH;N=154,104). Statistical analyses and fitted multivariable logistic regression models were adjusted for age and sex. The UCLA cohort included analyses for acute kidney injury (AKI), ADI (for poor housing, education, income), Charlson Comorbidity Index (CCI), and severe COVID-19 disease. Results: Odds ratios (OR) of COVID-19 positivity for the combined UCLA + PSJH population, as well as OR of having severe COVID-19 disease in the UCLA cohort are presented (Table). OR[95%CI] for AKI were higher for ages ≥80 years (1.77[1.14-2.46]), ADI by state (1.12[1.06-1.18]), CKD (12.20[8.46-17.58]) and pre-existing DM (3.65[2.62-5.08]), p<0.001. In the UCLA CURE-CKD population, AKI was associated with severe COVID-19 (r=0.26) and ICU admissions (r=0.29). Mortality was associated with severe COVID-19 disease (r=0.5). Conclusions: Non-White and/or LatinX race/ethnicity, ADI, CKD, DM, and older age were associated with higher risks of COVID-19 positivity, disease severity, and mortality in CURE-CKD. Efforts on viral screening, timely COVID-19 diagnosis, and optimal care delivery for patients with or at-risk for CKD are needed.
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Background: Early reports from registry studies demonstrated high vulnerability of cancer patients from COVID-19, with case-fatality rates (CFR) >30% at the onset of the pandemic. With advances in disease management and increased testing capacity, the lethality of COVID-19 in cancer patients may have improved over time. Methods: The OnCovid registry lists European cancer patients consecutively diagnosed with COVID-19 in 35 centres from Jan 2020 to Feb 2021. We analysed clinical characteristics and outcomes stratified in 5 trimesters (Jan-Mar, Apr-Jun, Jul-Sep, Oct-Dec 2020 and Jan-Feb 2021) and studied predictors of mortality across 2 semesters (Jan-Jun 2020 and Jul 2020-Feb 2021). Results: At data cut-off, the 2634 eligible patients demonstrated significant time-dependant improvement in 14-days CFR with trimestral estimates of 29.8%, 20.3%, 12.5%, 17.2% and 14.5% (p<0.0001). Compared to the 2nd semester, patients diagnosed in the Jan-Jun 2020 time period were ≥65 (60.3% vs 56.1%, p=0.031) had ≥2 comorbidities (48.8% vs 42.4%, p=0.001) and non-advanced tumours (46.4% vs 56.1%, p<0.001). COVID-19 was more likely to be complicated in Jan-Jun 2020 (45.4% vs 33.9%, p<0.001), requiring hospitalization (59.8% vs 42.1%, p<0.001) and anti-COVID-19 therapy (61.7% vs 49.7%, p<0.001). The 14-days CFR for the 1st and 2nd semester was 25.6% vs 16.2% (p<0.0001), respectively. After adjusting for gender, age, comorbidities, tumour features, COVID-19 and anti-cancer therapy and COVID-19 complications, patients diagnosed in the 1st semester had an increased risk of death at 14 days (HR 1.68 [95%CI: 1.35-2.09]), but not at 3 months (HR 1.10 [95%CI: 0.94-1.29]) compared to those from the 2nd semester. Conclusions: We report a time-dependent improvement in the mortality from COVID-19 in European cancer patients. This may be explained by expanding testing capacity, improved healthcare resources and dynamic changes in community transmission over time. These findings are informative for clinical practice and policy making in the context of an unresolved pandemic. Clinical trial identification: NCT04393974. Legal entity responsible for the study: Imperial College London. Funding: Has not received any funding. Disclosure: D.J. Pinato: Financial Interests, Personal, Speaker’s Bureau: ViiV Healthcare;Financial Interests, Personal, Speaker’s Bureau: Bayer;Financial Interests, Personal, Advisory Board: EISAI;Financial Interests, Personal, Advisory Board: Roche;Financial Interests, Personal, Advisory Board: AstraZeneca. All other authors have declared no conflicts of interest.
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Purpose The purpose of this paper is to identify the drivers of customer satisfaction (CS) and sales performance at wineries in the Finger Lakes region of New York State in the context of changes winery tasting rooms implemented due to the COVID-19 pandemic. Design/methodology/approach A survey was administered to tasting room visitors at two wineries in October 2020 in the Finger Lakes region of New York State resulting in 215 usable survey responses measuring customer satisfaction. A factor analysis was used to identify primary factors influencing overall CS. The authors then modeled how these primary factors, along with various demographic factors, influence sales metrics. The results are then compared with previous estimates of such drivers in pre-COVID tasting rooms. Findings The authors identified four main CS factors: Staff Interactions, Wine Tasting, COVID-19 Precautions and Ambience that play a significant role in overall CS. Of these, Wine Tasting was shown to have a positive influence on total amount spent and the number of bottles purchased, whereas COVID-19 Precautions positively impacted the number of bottles purchased. Overall, CS is also shown to positively impact total amount spent and number of bottles purchased. Customers are shown to prefer some changes to the tasting room due to COVID-19, such as having table service and reservations. Originality/value This is the first study researching the influence of certain tasting room changes implemented due to the COVID-19 pandemic has had on CS and wine-purchasing decisions in tasting rooms.
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INTRODUCTION To examine the impact of COVID-19 pandemic on the presentation, management and outcome of testicular torsion at our institution. MATERIALS AND METHODS: A retrospective review of a prospectively maintained testicular torsion database was performed. Patients <= 18 years of age evaluated in our emergency room between 3/11/2020 to 10/1/2020 (during-COVID-19) and the same period in 2018 and 2019 (pre-COVID-19) with US diagnosed and OR confirmed testicular torsion were included. Basic demographics, timing of presentation, referral rate, time to OR and orchiectomy rate were extracted and compared. P < 0.05 was considered statistically significant. RESULTS: A total of 82 torsions were included in the study;55 pre-COVID-19 and 27 during-COVID-19. The incidence of testicular torsion remained the same;3.93 cases/month pre-COVID-19 versus 3.86 cases/month during-COVID-19 (p = 0.791). However, there were significantly fewer delayed (> 24 hours) presentations (11.1% versus 45.5% , p = 0.003), shorter time from onset of symptoms to presentation (median 15.5 hours versus 8 hours, p = 0.001), and a lower but not statistically significant overall orchiectomy rate (33.3% versus 50.9% p = 0.1608) during-COVID-19. Among those presenting acutely with torsion (< 24 hours from onset), no statistical differences were found in the median time from US diagnosis to OR, from ED to OR, referral rate, or orchiectomy rate between the two groups. Lastly, SARS-CoV2 testing did not delay median time from ED to OR. CONCLUSIONS: There was a notably less delayed presentation of testicular torsion and shorter ischemia time on presentation during-COVID, however, no significant change of time to OR or orchiectomy rate in those with acute testicular torsion were observed.
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Personal protective equipment (PPE) is crucially important to the safety of both patients and medical personnel, particularly in the event of an infectious pandemic. As the incidence of Coronavirus Disease 2019 (COVID-19) increases exponentially in the United States and many parts of the world, healthcare provider demand for these necessities is currently outpacing supply. In the midst of the current pandemic, there has been a concerted effort to identify viable ways to conserve PPE, including decontamination after use. In this study, we outline a procedure by which PPE may be decontaminated using ultraviolet (UV) radiation in biosafety cabinets (BSCs), a common element of many academic, public health, and hospital laboratories. According to the literature, effective decontamination of N95 respirator masks or surgical masks requires UV-C doses of greater than 1 Jcm-2, which was achieved after 4.3 hours per side when placing the N95 at the bottom of the BSCs tested in this study. We then demonstrated complete inactivation of the human coronavirus NL63 on N95 mask material after 15 minutes of UV-C exposure at 61 cm (232 µWcm-2). Our results provide support to healthcare organizations looking for methods to extend their reserves of PPE.