Epidemiological modeling of SARS-CoV-2 in white-tailed deer (Odocoileus virginianus) reveals conditions for introduction and widespread transmission (preprint)

Emerging infectious diseases with zoonotic potential often have complex socioecological dynamics and limited ecological data, requiring integration of epidemiological modeling with surveillance. Although our understanding of SARS-CoV-2 has advanced considerably since its detection in late 2019, the factors influencing its introduction and transmission in wildlife hosts, particularly white-tailed deer (Odocoileus virginianus), remain poorly understood. We use a Susceptible-Infected-Recovered-Susceptible epidemiological model to investigate the spillover risk and transmission dynamics of SARS-CoV-2 in wild and captive white-tailed deer populations across various simulated scenarios. We found that captive scenarios pose a higher risk of SARS-CoV-2 introduction from humans into deer herds and subsequent transmission among deer, compared to wild herds. However, even in wild herds, the transmission risk is often substantial enough to sustain infections. Furthermore, we demonstrate that the strength of introduction from humans influences outbreak characteristics only to a certain extent. Transmission among deer was frequently sufficient for widespread outbreaks in deer populations, regardless of the initial level of introduction. We also explore the potential for fence line interactions between captive and wild deer to elevate outbreak metrics in wild herds that have the lowest risk of introduction and sustained transmission. Our results indicate that SARS-CoV-2 could be introduced and maintained in deer herds across a range of circumstances based on testing a range of introduction and transmission risks in various captive and wild scenarios. Our approach and findings will aid One Health strategies that mitigate persistent SARS-CoV-2 outbreaks in white-tailed deer populations and potential spillback to humans.

Evaluation of sleep medicine fellowship program websites.

STUDY OBJECTIVES: Sleep fellowship program websites likely serve as a preliminary source of information for prospective fellows. Arguably, applicants have likely become even more reliant on program websites during the COVID-19 pandemic due to travel restrictions and social-distancing measures limiting in-person interviews. In this study, we evaluated the content and comprehensiveness of sleep medicine fellowship websites to identify areas of improvement. METHODS: A list of sleep medicine fellowship programs in the United States participating in the 2021 match cycle was compiled using the Electronic Residency Application Service (ERAS) and Fellowship and Residency Electronic Interactive database (FREIDA) websites. Twenty-two prespecified content criteria related to education, recruitment, and compensation were used to evaluate each program website. Sleep programs' website comprehensiveness were compared based on US location, type, matching status, core specialty, and size of programs. RESULTS: Seventy-eight US sleep fellowship program websites were evaluated. Most program websites had a working hyperlink on ERAS or FREIDA. There was considerable variability in content reported across program websites, with a mean of 56.8% of content items reported per program. There was a greater educational website content comprehensiveness for internal medicine compared with other specialty-based sleep programs. There was no difference in sleep programs' website comprehensiveness based on US location, type, matching status, or size of programs. CONCLUSIONS: Website content comprehensiveness among sleep fellowship programs is variable. There is opportunity for all sleep fellowship programs to improve their websites to better inform prospective trainees. CITATION: Shenoy S, Akberzie W, Landeo-Gutierrez JS, Leon Guerrero CR, Karroum EG. Evaluation of sleep medicine fellowship program websites. J Clin Sleep Med. 2023;19(6):1083-1088.

Management leadership in clinics in the health sector as of Covid-19

The pandemic caused by Covid-19 spread rapidly throughout the world, bringing as a consequence that, in various economic sectors of many countries, such as Mexico, a variety of practices associated with work where the strategic role of managers is fundamental, will be reconsidered. since through leadership subordinates must be guided to achieve objectives through a positive attitude of protection and care. The objective of this work was to analyze the leadership of managers in medium-sized companies in the health sector, in the context of Covid-19. The approach was quantitative and the Multifactor leadership questionnaire developed by Bass and Avolio (2004) was used, and it was applied to 32 managers. The main results show that younger leaders prefer the transformational and transactional leadership style, highlighting the participation of female managers as they are more likely to establish recurring communication with their subordinates. It is concluded that managers show an optimistic and enthusiastic attitude that allows them to infect their workers and manage to form authentic collaborative work teams. © 2022, Universidad del Zulia. All rights reserved.

Evaluation of Sleep Medicine Fellowship Program Websites

Introduction Fellowship program websites often serve as the initial resource applicants use to learn about programs. Websites have likely become even more important due to social distancing mandates related to the on-going Covid-19 pandemic. In this study, we evaluated the websites of sleep medicine fellowship programs and analyzed the comprehensiveness of their content. Methods Sleep medicine fellowship programs in the United States (US) for the 2021 match cycle were identified using the Electronic Residency Application Service (ERAS) directory and the Fellowship and Residency Electronic Interactive database (FREIDA). Twenty-two prespecified website content criteria related to education, recruitment, and compensation were evaluated. Programs’ website comprehensiveness was compared based on geographic location (Northeast/Midwest/South/West);type of programs (Community/University);programs matching status (Complete/Partial or No matching status);core specialty (Internal medicine/Other specialties);and program size (based on number of sleep fellows). Results A total of 78 US sleep fellowship program’ websites were evaluated. Most (80.8%) had a direct functional link to ERAS or FREIDA websites. The percentage of sleep medicine fellowship program’ websites reporting each of the twenty-two-criterion was highly variable (range: 2.6%-98.7%). The percentage of overall website comprehensiveness among sleep medicine fellowship programs was 56.8%±16.5% (range:13.6%-90.9%). There was a significantly higher educational website content comprehensiveness for the Internal medicine compared to other specialties-based sleep programs (p = 0.002). There were no significant association between the overall, educational, recruitment, and compensation website content comprehensiveness of sleep programs and their US region location, type of affiliation, matching status, or program size. Conclusion Website content comprehensiveness amongst sleep fellowship programs in the US is variable with a lower educational content on website pages of non-internal medicine-based sleep programs. Improvement in website content of sleep medicine programs is a potentially easy way for programs to improve fellow recruitment, and more importantly, allow prospective sleep fellow applicants to make a more informed decision with regards to program selection. Support (If Any) This study was not funded.

Considerations in imaging interpretations for colitis in critically ill patients during the COVID-19 era.

OBJECTIVE: The study aims to demonstrate risk factors for colitis in intensive care unit patients with and without coronavirus disease 2019 (COVID-19). METHODS: Retrospective review was performed to identify intensive care unit (ICU) patients with the diagnosis of COVID-19 with computed tomography (CT) between March 20 and December 31, 2020. ICU patients without COVID-19 diagnosis with CT between March 20 and May 10, 2020 were also identified. CT image findings of colitis or terminal ileitis as well as supportive treatment including ventilator, vasopressors, or extracorporeal membrane oxygenation (ECMO) were recorded. Statistical analysis was performed to determine if clinical factors differed in patients with and without positive CT finding. RESULTS: Total 61 ICU patients were selected, including 32 (52%) COVID-19-positive patients and 29 (48%) non-COVID-19 patients. CT findings of colitis or terminal ileitis were identified in 27 patients (44%). Seventy-four percent of the patients with positive CT findings (20/27) received supportive therapies prior to CT, while 56% of the patients without abnormal CT findings (19/34) received supportive therapies. Vasopressor treatment was significantly associated with development of colitis and/or terminal ileitis (p = 0.04) and COVID-19 status was not significantly different between these groups (p = 0.07). CONCLUSIONS: In our study, there was significant correlation between prior vasopressor therapy and imaging findings of colitis or terminal ileitis in ICU patients, independent of COVID-19 status. Our observation raises a possibility that the reported COVID-19-related severe gastrointestinal complications and potential poor outcome could have been confounded by underlying severe critically ill status, and warrants a caution in diagnosis of gastrointestinal complication.

COVID-19 in Kidney Transplantation

Increased mortality of COVID-19 has been reported in older patients with diabetes, high blood pressure, lung disease and immunocompromised people such as kidney transplant recipients. Both the behavior of the viral infection and the treatments proposed so far interact with the state of immunosuppression and immunosuppressants. Herein, we report two cases of kidney transplant recipients with COVID-19 infection. The first patient presented with gastrointestinal symptoms and progressively advanced to multilobar pneumonia. The second case presented with fever accompanied by gastrointestinal and urinary symptoms and dry cough. Both patients responded appropriately to treatment.

The Future of Energy and the Case of the Arctic Offshore: The Role of Strategic Management

As risk and uncertainty factors have become more prominent in the already volatile energy market because of the COVID-19 pandemic, the development of Arctic hydrocarbon resources has become a debatable issue. At any rate, oil and gas companies need to improve their strategic management systems (along with the development of technologies) for the successful implementation of such complex projects. The purpose of this study was to propose the conceptual basis for transforming strategic management and planning systems of oil and gas companies so that they can successfully face global challenges when implementing offshore oil and gas projects in the Arctic as well as provide more sustainable energy sources. The article discusses the current situation with Arctic initiatives and the results of an analysis of price instability in the energy sector, along with an analysis of several megatrends affecting oil and gas companies. All this allows for presenting a conceptual vision of how a strategic management system should be transformed in order to become able to meet the requirements for implementing Arctic projects, with the emphasis being placed on sustainability, management requirements, and the key principles. The research is based on the fundamentals of strategic management and strategic planning and relies on methods such as desk study, content analysis, event analysis, comparative analysis, and factor analysis.

Quantifying the decrease in emergency department imaging utilization during the COVID-19 pandemic at a multicenter healthcare system in Ohio.

PURPOSE: To illustrate the change in emergency department (ED) imaging utilization at a multicenter health system in the state of Ohio during the COVID-19 pandemic. METHODS: A retrospective observational study was conducted assessing ED imaging volumes between March 1, 2020, and May 11, 2020, during the COVID-19 crisis. A rolling 7-day total value was used for volume tracking and comparison. Total imaging utilization in the ED was compared with new COVID-19 cases in our region. Utilization was first categorized by modality and then by plain films and computed tomography (CT) scans grouped by body part. CT imaging of the chest was specifically investigated by assessing both CT chest only exams and CT chest, abdomen, and pelvis (C/A/P) exams. Ultimately, matching pair-wise statistical analysis of exam volumes was performed to assess significance of volume change. RESULTS: Our multicenter health system experienced a 46% drop in imaging utilization (p < 0.0001) during the pandemic. Matching pair-wise analysis showed a statistically significant volume decrease by each modality and body part. The exceptions were non-contrast chest CT, which increased (p = 0.0053), and non-trauma C/A/P CT, which did not show a statistically significant volume change (p = 0.0633). CONCLUSION: ED imaging utilization trends revealed through actual health system data will help inform evidence-based decisions for more accurate volume predictions and therefore institutional preparedness for current and future pandemics.

Anesthetic management in the pediatric patient with COVID-19

Infection with SARS-CoV-2 virus has a different behavior in pediatric patients, so the anesthetic approach may differ from that performed in adults. The present work touches on some generalities of anesthetic management of the pediatric patient that should be considered.

COVID-19 Pandemic Impact on Decreased Imaging Utilization: A Single Institutional Experience.

RATIONALE AND OBJECTIVES: Predictive models and anecdotal articles suggest radiology practices were losing 50%-70% of their normal imaging volume during the COVID-19 pandemic. Using actual institutional data, we investigated the change in imaging utilization and revenue during this public health crisis. MATERIALS AND METHODS: Imaging performed within the 8-week span between March 8 and April 30, 2020 was categorized into the COVID-19 healthcare crisis timeframe. The first week of this date range and the 10 weeks prior were used to derive the normal practice expected volume. A rolling 7-day total value was used for volume tracking and comparison. Total imaging utilization was derived and organized by patient setting (outpatient, inpatient, emergency) and imaging modality (X-ray, CT, Mammography, MRI, Nuclear Medicine/PET, US). The three highest volume hospitals were analyzed. Revenue information was collected from the hospital billing system. RESULTS: System-wide imaging volume decreased by 55% between April 7 and 13, 2020. Outpatient exams decreased by 68% relative to normal practice. Emergency exams decreased by 48% and inpatient exams declined by 31%. Mammograms and nuclear medicine scans were the most affected modalities, decreasing by 93% and 61%, respectively. The main campus hospital experienced less relative imaging volume loss compared to the other smaller and outpatient-driven hospitals. At its lowest point, the technical component revenue from main campus imaging services demonstrated a 49% negative variance from normal practice. CONCLUSION: The trends and magnitude of the actual imaging utilization data presented will help inform evidence-based decisions for more accurate volume predictions, policy changes, and institutional preparedness for current and future pandemics.