How TikTok served as a platform for young people to share and cope with lived COVID-19 experiences

The short-video app TikTok saw a large increase in usage during the COVID-19 lockdown because it provided entertainment, distraction, and social interaction based on video content engagement. We present results from an interview study with 28 U.S. TikTok users on how they shared and engaged with lived pandemic experiences on TikTok to cope with and socialize after the U.S. imposed its first lockdown. Participants had already established TikTok as a peer community platform on which sharing lived experiences felt appropriate. Due to COVID-19 restrictions, participants started to look for TikTok videos of shared lived pandemic experiences to interact with others when physical interaction was made impossible. We find that TikTok videos facilitated communication and parasocial interaction based on known audiovisual styles. Participants were able to communicate through video creation based on shared ways of presenting short-video content during COVID-19 physical distancing. © 2023 The authors.

Four cases of acute comitant esotropia associated with diffuse intrinsic pontine glioma in children.

BACKGROUND: Acute acquired concomitant esotropia (AACE) is usually a benign form of strabismus that infrequently is associated with intracranial pathology. Clinicians have noted an increase in its incidence and theorize that it may be related to public health "lockdown" measures taken in response to the COVID-19 pandemic. With an increased incidence of AACE clinicians must firstly differentiate AACE from common accommodative esotropia and secondly recognize AACE as a possible sign of serious neuropathology.Diffuse Intrinsic Pontine Glioma (DIPG) is a devastating diagnosis for affected families. Children typically present at age 6-7 years with cranial nerve palsies, long tract signs, and/or cerebellar signs. Diagnosis is made from characteristic findings on magnetic resonance brain imaging (MRI brain) and treatment includes radiotherapy and palliative care. Two years from diagnosis, 90% of affected children will have died from their disease. CASE SERIES: We present four cases that attended our pediatric ophthalmology clinic with AACE either as a presenting sign of DIPG or as a clinical finding following a DIPG diagnosis. Patient A (age 5 years) presented to the emergency eye clinic with sudden onset diplopia and intermittent esotropia. Suppression later developed, they had 0.00 logMAR visual acuity either eye, and bilateral physiological hypermetropia. MRI brain imaging requested as a result of the unusual presentation led to the DIPG diagnosis. The other 3 cases (ages 11, 5 & 5 years) were assessed post DIPG diagnosis and found to have an esotropia measuring bigger on 1/3-meter fixation than 6-meter fixation, full ocular motility, physiological hypermetropia or emmetropia, and visual acuity normal for age. Other than patient B (age 11 years), who had papilledema and gaze evoked nystagmus when they were assessed 2 weeks prior to death, no patient had any other clinical eye findings. CONCLUSIONS: This small series of 4 patients attending our clinic within a 12-month period supports the notion that children presenting with AACE should routinely be offered brain MRI. Not all children with DIPG-associated AACE have significant ophthalmic findings indicative of intracranial pathology. With the potential for increased incidence of AACE related to lockdowns, clinicians should be reminded of the infrequent possibility their patient has a more serious condition.

Happily Distant or Bitter Medicine? The Impact of Social Distancing Preferences, Behavior, and Emotional Costs on Subjective Wellbeing During the Epidemic.

To inhibit the spread of COVID-19 Public health officials stress, and governments often require, restrictions on social interaction ("social distancing"). While the medical benefits are clear, important questions remain about these measures' downsides: How bitter is this medicine? Ten large non-probability internet-based surveys between April and November 2020, weighted statistically to reflect the US population in age, education, and religious background and excluding respondents who even occasionally role-played rather than giving their own true views; N = 6,223. Pre-epidemic data from 2017-2019, N = 4,032. Reliable multiple-item scales including subjective wellbeing (2 European Quality of Life Survey items, Cronbach's alpha = .85); distancing attitudes (5 items, alpha = .87); distancing behavior e.g., standing 6' apart in public (5 items, alpha = .80); emotional cost of distancing and restrictions on social interaction (8-12 items, alpha = .94); and an extensive suite of controls (19 variables). Descriptive statistics, OLS regression, structural equation models. Subjective wellbeing is greater for those who approve of distancing, for those who practice distancing, and particularly for those whose distancing attitudes and behavior are congruent, either both in favor or both opposed (multiplicative interaction). The emotional cost of distancing is strongly tied to wellbeing and is heterogeneous, with some disliking distancing much more than others. An SEM model suggests causality: that emotional costs strongly reduce wellbeing but not vice-versa. During the epidemic, COVID issues constitute two of the top 5 influences on wellbeing, behind only subjective health and religious belief and tied with income. All this is net of family background, religious origins, age, ethnicity, race, gender, rural residence, education, occupational status, marriage, unemployment, income, health, religion, and political party. Supplementary Information: The online version contains supplementary material available at 10.1007/s11482-023-10149-0.

Happily Distant or Bitter Medicine? The Impact of Social Distancing Preferences, Behavior, and Emotional Costs on Subjective Wellbeing During the Epidemic

To inhibit the spread of COVID-19 Public health officials stress, and governments often require, restrictions on social interaction ("social distancing"). While the medical benefits are clear, important questions remain about these measures' downsides: How bitter is this medicine? Ten large non-probability internet-based surveys between April and November 2020, weighted statistically to reflect the US population in age, education, and religious background and excluding respondents who even occasionally role-played rather than giving their own true views;N = 6,223. Pre-epidemic data from 2017–2019, N = 4,032. Reliable multiple-item scales including subjective wellbeing (2 European Quality of Life Survey items, Cronbach's alpha = .85);distancing attitudes (5 items, alpha = .87);distancing behavior e.g., standing 6' apart in public (5 items, alpha = .80);emotional cost of distancing and restrictions on social interaction (8–12 items, alpha = .94);and an extensive suite of controls (19 variables). Descriptive statistics, OLS regression, structural equation models. Subjective wellbeing is greater for those who approve of distancing, for those who practice distancing, and particularly for those whose distancing attitudes and behavior are congruent, either both in favor or both opposed (multiplicative interaction). The emotional cost of distancing is strongly tied to wellbeing and is heterogeneous, with some disliking distancing much more than others. An SEM model suggests causality: that emotional costs strongly reduce wellbeing but not vice-versa. During the epidemic, COVID issues constitute two of the top 5 influences on wellbeing, behind only subjective health and religious belief and tied with income. All this is net of family background, religious origins, age, ethnicity, race, gender, rural residence, education, occupational status, marriage, unemployment, income, health, religion, and political party. Supplementary Information The online version contains supplementary material available at 10.1007/s11482-023-10149-0.

Comparing impacts of the COVID-19 pandemic on training of public health Specialty Registrars starting before or after its onset.

Objectives: To capture and compare the differences in experiences of public health Specialty Registrars who commenced training prior to the COVID-19 pandemic (pre-pandemic Registrars) and those who commenced training during the pandemic (post-pandemic Registrars). Study design: This is a mixed methods study comprising a cross-sectional survey and participatory action research. Methods: A questionnaire of 10 open and 5 closed questions exploring participants experience of training during the pandemic was sent to East Midlands Specialty Registrars. Thematic analysis and double coding were undertaken, coded based on pre- or post-pandemic Registrar status. Participatory action research was then undertaken in 2 rounds with 2 groups, based on pre/post-pandemic status to consolidate themes. Results: The survey was completed by 17 Registrars (8 pre-pandemic, and 9 post-pandemic) and 19 Registrars took part in participatory action research. The findings showed pre-pandemic Registrars noted the importance of negative impacts on their mental health whilst post-pandemic Registrars were more positive and felt well supported in their training. Conclusions: There is a stark difference in the impact of the pandemic for Registrars who started training before compared to during the pandemic. The training programme was not resilient to the impact of the pandemic. Robustness could be increased by encouraging early leadership experience and providing wellbeing support, particularly for post pandemic Registrars now and in future.

Anti-Asian American Discrimination and COVID-19: Living with Fear

Previous research has demonstrated the deleterious effects of discrimination on health and well-being, as well as how these incidents maintain and/or increase inequalities and disparities for marginalized groups. The COVID-19 pandemic and media scapegoating of Asian Americans have been linked to increases in hate crimes and other discriminatory incidents. As such, it is important to uncover the lived experiences of Asian Americans, in the context of a global crisis, to inform recommendations related to the United Nations Sustainable Development Goals (SDGs) 3 and 10 prioritizing health and equality (United Nations, 2015). The current study advances existing research by investigating the qualitative impact of postpandemic discrimination experienced by Asian American young adults from immigrant households. Analysis revealed several main themes expressed by participants such as a distinct difference in the lived experience of hostility, xenophobia, racism, and discrimination pre-COVID-19 and post-COVID-19 and the mental and physical health effects of discrimination-related stress, anxiety, and hypervigilance. Analysis also highlighted recommendations from participants for community support and resources. These findings align with emerging evidence demonstrating an increase in quantity and severity of discriminatory experiences among Asian Americans since the pandemic, as well as document the impact of these experiences on a sample of Asian Americans living through this unprecedented international event. Findings may inform interventions, programs, and policies to better serve Asian Americans, as well as directly and indirectly contribute to UN SDG 3 and SDG 10. © 2022 Hogrefe Publishing.

School Connectedness and e-cigarette Susceptibility and Use in a Diverse Urban Adolescent Sample

Purpose: Adolescent school connectedness, particularly positive relationships with teachers, generally protects from health risk behaviors such as tobacco use, yet how this relates to adolescent e-cigarette use has not yet been described. This study examines the relationship between school connectedness and e-cigarette susceptibility and use in a diverse adolescent longitudinal sample. Methods: This is a secondary analysis of a school-based intervention including ten public schools in one urban school district. We surveyed 661 middle (66.6% eighth grade) and high school (33.4% eleventh grade) student participants at three time points between spring 2019 and spring 2020. The 2020 surveys were completed early in the COVID-19 pandemic, prior to the transition to remote learning. Respondents had a mean age of 14.1 years, were 53% female, and 28% identified as non-Hispanic white,15.6% as Hispanic, 23.8% as Black, 29.8% as Asian, and 2.9% as American Indian/Alaska Native. Ordinal logistic regression models examined unadjusted and adjusted associations between school connectedness (both baseline and concurrent) and an ordinal measure of e-cigarette susceptibility (any vs. none) and use (any vs. no past 30-day use) at all three time points. Covariates in the adjusted models included grade, intervention condition, English language learner status, gender, race/ethnicity, baseline use of any tobacco, and baseline weighted grade point average. Results: Levels of any tobacco use were low in the spring of 2019 (3.8%), e-cigarettes represented the predominant form of tobacco use (2.4%), and most respondents reported no e-cigarette susceptibility (69%). E-cigarette susceptibility and use remained relatively stable during the follow-up period. Higher levels of baseline school connectedness were consistently associated with lower odds of e-cigarette susceptibility/use in spring 2019 (OR: 0.37, 95% CI: 0.26, 0.53), fall 2019 (OR: 0.51, 95% CI: 0.35, 0.74), and spring 2020 (OR: 0.47, 95% CI: 0.30, 0.73). Higher levels of concurrent school connectedness were also associated with lower odds of e-cigarette susceptibility/use over time: spring 2019 (OR: 0.36, 95% CI: 0.25, 0.51), fall 2019 (OR: 0.48, 95% CI: 0.34, 0.66), and spring 2020 (OR: 0.65, 95% CI: 0.42, 0.99). Findings were similar for eighth and eleventh graders and did not differ significantly both before and after adjusting for other covariates. Conclusions: Both adolescents’ baseline levels of connection to their schools and their connectedness over time appear to serve as protective factors for e-cigarette susceptibility and use. These findings highlight the importance of promoting positive school experiences and strong teacher-student relationships as a mechanism of reducing adolescent risk behaviors such as e-cigarette use among diverse adolescent populations. Sources of Support: This project was funded by a grant from the National Institute of Minority Health and Health Disparities (NIMHD) grant number R01MD010586 (PI: Allen).

FLASH GLUCOSE MONITORING WITH THE FREESTYLE LIBRE 2: RESULTS FROM THE FLASH-UK RANDOMISED CONTROLLED TRIAL (ON BEHALF OF THE STUDY GROUP)

Objectives To evaluate whether intermittently scanned continuous glucose monitoring (isCGM) with optional alarms (FreeStyle Libre 2) improves glycaemia as measured by HbA1c and sensor-based gluco-metrics, patient reported outcome measures (PROMS) and cost-effectiveness compared with selfmonitoring of blood glucose (SMBG). Design Flash UK is a multicenter, open-label, two arm, parallel, randomised controlled trial delivered in 7 specialist hospital diabetes clinics and 1 primary care centre. Participants 156 people with Type 1 diabetes, age 16 years and over treated with either multiple daily insulin injections or insulin pump therapy with HbA1c 7.5%-11% were randomised. Interventions Participants were randomised (1:1) to the FreeStyle Libre 2 (n = 72) or standard care with SMBG (n = 69). Participants were reviewed at 4, 12 and 24 weeks post-randomisation. Education and treatment optimisation was provided to both groups at randomisation, 4 and 12 weeks. Participants in the SMBG arm wore blinded glucose sensor (Freestyle Libre Pro) during the last 2 weeks of the study;all participants wore a 2-week blinded sensor prior to randomisation. All study visits were conducted either inperson or virtually owing to the COVID-19 pandemic. Main outcome measures The primary outcome was HbA1c at 24 weeks, analysed by intention to treat. Secondary outcomes included glucose time in range (3.9 to 10mmol/l), time below and above range and glucose variability. PROMS included EQ-5DL-5L, Type 1 Diabetes Distress Scale, Diabetes fear of injecting and self-testing, Diabetes Eating Problem Survey, Diabetes Treatment Satisfaction, Patient Health Questionnaire and The Glucose Monitoring Satisfaction Survey. Economic evaluation included healthcare resource use, insulin usage and Freestyle Libre 2 utilisation. Results & Conclusion Results and conclusions will be presented during the 15th International Conference on Advanced Technologies & Treatments for Diabetes, April 27 to 30th Barcelona, Spain and Online.

Oncology clinical trial disruption during the COVID-19 pandemic: a COVID-19 and cancer outcomes study.

BACKGROUND: COVID-19 disproportionately impacted patients with cancer as a result of direct infection, and delays in diagnosis and therapy. Oncological clinical trials are resource-intensive endeavors that could be particularly susceptible to disruption by the pandemic, but few studies have evaluated the impact of the pandemic on clinical trial conduct. PATIENTS AND METHODS: This prospective, multicenter study assesses the impact of the pandemic on therapeutic clinical trials at two large academic centers in the Northeastern United States between December 2019 and June 2021. The primary objective was to assess the enrollment on, accrual to, and activation of oncology therapeutic clinical trials during the pandemic using an institution-wide cohort of (i) new patient accruals to oncological trials, (ii) a manually curated cohort of patients with cancer, and (ii) a dataset of new trial activations. RESULTS: The institution-wide cohort included 4756 new patients enrolled to clinical trials from December 2019 to June 2021. A major decrease in the numbers of new patient accruals (-46%) was seen early in the pandemic, followed by a progressive recovery and return to higher-than-normal levels (+2.6%). A similar pattern (from -23.6% to +30.4%) was observed among 467 newly activated trials from June 2019 to June 2021. A more pronounced decline in new accruals was seen among academically sponsored trials (versus industry sponsored trials) (P < 0.05). In the manually curated cohort, which included 2361 patients with cancer, non-white patients tended to be more likely taken off trial in the early pandemic period (adjusted odds ratio: 2.60; 95% confidence interval 1.00-6.63), and substantial pandemic-related deviations were recorded. CONCLUSIONS: Substantial disruptions in clinical trial activities were observed early during the pandemic, with a gradual recovery during ensuing time periods, both from an enrollment and an activation standpoint. The observed decline was more prominent among academically sponsored trials, and racial disparities were seen among people taken off trial.

Trends in Child Abuse Reporting

The United States relies on the Child Protective Service (CPS) system to protect children from abuse and neglect. The foundation of this system is reporting—reporting is supposed to bring maltreated children to the attention of CPS and CPS is supposed to appropriately respond to the report. This chapter examines trends in CPS reporting, the evidence that maltreated children are reported and receive CPS attention, and current issues affecting this system. Beginning with the history and current status of mandatory reporting laws, it describes the challenges involved in studying mandatory reporting and the limitations of the existing evidence. Subsequent sections summarize research on reports CPS receives and how CPS responds;on the maltreated children mandated reporters encounter, whether these children receive CPS investigation, and why they may not;and on the mandated reporters—who doesn’t report and why. The chapter then considers current issues and trends, including the impacts of the COVID-19 pandemic and of racial inequities on reporting and the use of data-driven approaches to understand reporting patterns and manage screening of referrals and responses to reports. The conclusion discusses the failures of mandated reporting and recent system reform efforts that may dramatically alter reporting trends in the future. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

[COVID-19 related mortality in Swedish patients with renal replacement therapy]

Data from the Swedish Renal Registry (SRR) show that during the period March 16, 2020 to March 15, 2021 0.4% of all renal transplant recipients and 3% of all dialysis patients died due to COVID-19 in Sweden. Of all registered deaths, 20% were attributed to COVID-19. In the age group 50-59 years the risk ratio for COVID-19 related mortality was 16 (95% CI 6.5-38) among transplant recipients and 22 (95% CI 7.1-69) among dialysis patients, compared to the background population in the same age group. Excess mortality, compared to the five years preceding the pandemic, was 30% for transplant recipients and 8.7% for dialysis patients, compared to 7.7% for the entire Swedish population. Detailed reports were sent to SRR for 864 patients with confirmed COVID-19 infection representing 5.0% of all transplant recipients and 13% of all dialysis patients. The case fatality rate was 7.0% and 21% respectively.

Disruption to care of patients with thoracic malignancies: A COVID-19 and cancer outcomes study

Introduction: Patients with thoracic malignancies are susceptible to severe outcomes from coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the disruption to care of patients with thoracic malignancies during the COVID-19 pandemic. Methods: The COVID-19 and Cancer Outcomes Study (CCOS) is a multicenter prospective cohort study comprised of adult patients with a current or past history of hematological malignancy or invasive solid tumor who had an outpatient medical oncology visit on the index week between March 2 and March 6, 2020 at the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai in New York, NY (MSSM) or the Dana-Farber Cancer Institute in Boston, MA (DFCI). An electronic data capture platform was used to collect patient-, cancer-, and treatment-related variables during the three months prior to the index week (the baseline period) and the following three months (the pandemic period). Two-by-three contingency tables with Fisher's exact tests were computed. All tests were two-tailed and considered statistically significant for p<0.05. All analyses were done in the R statistical environment (v3.6.1). Results: The overall cohort included 2365 patients, of which 313 had thoracic malignancies, 1578 had other solid tumors, and 474 had hematological malignancies. At a median follow-up of 84 days (95% confidence interval, 82-84), 13 patients with thoracic malignancies (4.1%) had developed COVID-19 (vs. other solid: 63 [4.0%] and hematological: 52 [11.0%];p<0.001). When comparing data from the pandemic period to the baseline period, patients with thoracic malignancies had a decrease in the number of in-person outpatient visits (thoracic: 209 [66.8%] vs. other solid: 749 [47.5%] vs. hematological: 260 [54.9%];p<0.001) and an increase in the number of telehealth visits (thoracic: 126 [40.3%] vs. other solid: 465 [29.5%] vs. hematological: 168 [35.4%];p<0.001). During the pandemic period, 33 (10.5%) patients with thoracic malignancies experienced treatment delays due to the pandemic (vs. other solid: 127 [8.0%] and hematological: 79 [16.7%];p<0.001), and 26 (8.3%) patients with thoracic malignancies experienced delays in cancer imaging or diagnostic procedures (vs. other solid: 63 [4.0%] and hematological: 26 [5.5%];p=0.003). Discussion: In this prospective cohort study, patients with thoracic malignancies were not at increased risk of developing COVID-19 compared to patients with other cancers, but experienced significant cancer care disruption during the COVID-19 pandemic with a higher likelihood of decreased in-person visits and increased telehealth visits compared to patients with other malignancies. Focused efforts to ensure continuity of care for this vulnerable patient population are warranted.

A strategic framework managing challenges of integrating lean construction and integrated project delivery on construction megaprojects, towards global integrated delivery transformative initiatives in multinational organisations

Purpose Built environment encounters substantial risks and challenges in its evolution towards sustainable development. International businesses and multinational engineering organisations face global connectivity challenges between business units, especially during the outbreak of the novel coronavirus pandemic (COVID-19), which has profoundly disrupted the construction industry throughout the world. That raises the need to manage global connectivity as a main strategic goal of multinational architecture, engineering and construction (AEC) organisations. This study aims to develop a strategic framework managing challenges of integrating lean construction (LC) and integrated project delivery (IPD) on construction megaprojects (CMPs) towards global integrated delivery (GID) transformative initiatives in multinational AEC organisations. Design/methodology/approach "Mixed research methods" involving a two-stage quantitative and qualitative research approach is adopted. The qualitative research methodology consists of a literature review to assess challenges to integrate LeanIPD&GID on CMPs. There is an assessment of conceptualisation of LeanIPD&GID and GID strategy placements, development of LeanIPD&GID integration framework and future of work (FOW) global initiatives with multiple validations. The analysis involved semi-structured interviews and focus group techniques. Stage 2 consisted of an empirical questionnaire survey that shaped the foundation of analysis and findings of 190 respondents from 23 countries with an extensive cosmopolitan experience of megaprojects in construction. The survey examined a set of 20 challenges to integrate LeanIPD&GID on CMPs resulting from a detailed analysis of extant literature after validation. Descriptive and inferential statistical tests were exploited for data analysis and percentage score analysis. Findings The research conceptualised LeanIPD&GID principles, proposed GID strategy placements, a framework for managing challenges of LeanIPD&GID transformative initiatives, FOW global initiatives and key performance indicators (KPIs). It concluded that the most significant challenges to integrate of LeanIPD&GID on CMPs are "lack of governmental incentives, policies, regulations or legal frameworks", "lack of client's awareness and IPD experience amongst key stakeholders", "lack of organisation's senior-management and client's commitment to IPD approaches", "resistance of industry to change from traditional procurement to IPD" and "lack of integrated synergies between LC, IPD working towards LeanIPD&GID". Awareness of building information modelling (BIM) in the Middle East and North Africa (MENA) region is higher than LC, and LC awareness is higher than IPD knowledge. While BIM adoption in the MENA region is higher than LC, LC is still taking its first steps, and IPD has little implementation. LeanBIM is slightly integrated, while LeanIPD integration is almost not present. Originality/value The research findings, conclusions and recommendations provide a proposed framework for implementation, KPIs and GID strategy placements for LeanIPD&GID transformative initiatives to integrate LeanIPD&GID on CMPs and FOW global initiatives. This will allow project key stakeholders to place emphasis on managing LeanIPD&GID challenges identified in this research and commence GID strategies. The study has provided effective practical strategies for enhancing integration of LeanIPD&GID transformative initiatives on CMPs.

Impact of COVID-19 Restrictions on Atmospheric Concentrations of O3 and NO2 Across the Globe

We use a machine learning algorithm combining information from the NASA GEOS composition forecast (GEOS-CF) model and surface observations of nitrogen dioxide (NO2) and ozone (O3) at more than 5,000 observation sites to assess the impact of COVID-19 restrictions on surface air quality in 46 countries. Our methodology removes the compounding impacts of meteorology, seasonality and atmospheric chemistry on air pollution, thus allowing for a quantitative estimate of the change in surface air quality following COVID-19 containment measures. Compared to GEOS-CF model predictions that do not include emission reductions related to COVID-19 restrictions, surface observations show a drop in surface NO2 of up to 60% after the implementation of lockdowns. Average NO2 concentrations between February 2020 to June 2020 were 18% lower than business as usual. The earliest and strongest declines are observed over China, followed by Europe and the US. While NO2 concentrations over China recovered within 2 months, the recovery has been slower over Europe and the US. The impact of COVID-19 restrictions on O3 is complicated by non-linear atmospheric chemistry. Locally, O3 can show a short-term increase of up to 50% as a result of the decrease in NO2, which leads to a reduction in night time titration. However, this effect is offset by a decrease in photochemical production during the day. Our results indicate that these two competing processes resulted in a net zero change in average surface ozone during the first 5 months of the pandemic. The results also indicate that the reduced photochemical production becomes increasingly important over time. Our analysis is based on surface observations and model simulations available in near real-time, and we will present an up-to-date view of the short and medium-term impacts of COVID-19 restrictions on air quality around the world.