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Liver enzyme abnormalities occur frequently in patients diagnosed with Coronavirus disease 2019 (COVID-19). It has been suggested that patients with severe acute liver injury are more likely to be admitted to intensive care, require intubation or renal replacement therapy and their mortality rate is higher than patients without severe acute liver injury. This review article explores the possible aetiologies of liver dysfunction seen in patients with COVID-19 and also the effect of COVID-19 on patients with pre-existing liver disease. Finally, we suggest clinical approaches to treating a patient with liver enzyme disturbance and COVID-19 and also caring for patients who require liver transplantation in the COVID-19 era.Copyright © 2022 Bentham Science Publishers.
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Factors associated with continued driving during shelter in place orders have been examined in a community sample of typically developing teen drivers, but not in teens diagnosed with Attention/Deficit-Hyperactivity Disorder (ADHD). Our objective was to examine psychosocial factors that predicted risky driving during shelter in place orders in teens with ADHD, which is important since teens with ADHD are at particular risk for poor driving outcomes. The present study is also novel in that it uses naturalistic data of risky driving rather than self-report of continued driving. Naturalistic in-car data from 56 ADHD participants (M age = 16.875 years, SD = 0.955;55.400 % were male) enrolled in an on-going study were used in the present study. Teens had an average of 26.915 months (SD = 14.343) of driving experience. Risky driving was defined as experiencing an event exceeding 0.600 g-force during the first month of COVID-19 pandemic shelter in place ordinances in Ohio, Kentucky, and Indiana, USA. A hierarchical logistic regression with a post-COVID driving event as the dependent variable was conducted. Baseline ratings of ADHD and oppositional defiant disorder/conduct disorder (ODD/CD) severity were entered in the first step of the model, while anxiety severity and parent behaviors regarding teen driving safety (monitoring and limit setting) were entered in the second step of the model. The first step of the model reached statistical significance (χ2(2, 54) = 7.577, p =.023), with only greater symptoms of ODD/CD significantly predicting a post-COVID driving event (B = 0.144, p =.020). With each point increase in ODD/CD symptoms, there was a 15.5 % increase in the probability of experiencing a high g-force event during COVID-19 restrictions. The model was no longer significant at step 2 when anxiety severity and parent behaviors were added to the model (χ2(3, 55) = 10.97p =.052). We conclude that ODD/CD symptom severity was the strongest predictor of risky driving during COVID-19 restrictions within a sample of teen drivers with ADHD. Study implications may be beneficial for clinicians who work with families of teens with ADHD;suggestions for strategies mitigating this risk are discussed. These findings also have implications for which teens with ADHD may be less positively impacted by other government mitigation strategies such as Graduated Drivers Licensing (GDL) regulations. © 2022
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IntroductionThere is much debate regarding the impact of COVID-induced lockdown on the standard of assessments, mainly since students were assessed at home via an online assessment platform. Regular orthodox lectures and assessments were carried out during the first term, while the strictly enforced South African COVID lockdown warranted that 2nd term lectures and assessments were based online. This created the fortunate control conditions to statistically compare orthodox face-to-face with online-home-based assessments. MethodsWe compared the assessments of a cohort of second-year students studying physiology and anatomy during 2019 and 2020: Orthodox face-to-face teaching and assessments (2019) were compared to online teaching and their analogous online assessments (2020) during the COVID-19-induced lockdown. ResultsAlthough class pass rates and marks for online assessments (2020) were significantly higher than for traditional assessments (2019), an essential finding of the study was that the Gaussian distribution of the marks across the class for both modes of assessment was statistically identical. This indicated that although students performed better with home-based online assessments, poor-performing students populated the lower spread of marks, modal students occupied the central distribution, while good students occupied the higher mark distribution of the curve. DiscussionThe students were found to be resilient in adapting to things and learning, online presentations, and computer-based assessments. No gender-based difference or advantage to adjusting to newly introduced blended learning and concomitant changes in learning assessment strategies was found. The online-home-based assessments proved to incentivize prior learning and preparation for assessments by implementing strict time limits or assessments and randomizing the selections of questions and respective (MCQ) answer choices. We conclude that although home-based online assessments significantly improve the overall mark distribution, there was no distinction in the spread of the distribution of marks, which was indicative that the home-based online assessment process was able to provide an identical measure of course proficiency as in the orthodox sit-down assessment. Therefore, our statistical analysis of the performance of students under student assessment performances indicates that there is no rationale for thinking that the home-based online mode of assessment is equivalent to or better than the orthodox modes of assessment.
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Background. Ageing population is a major health care problem all over the world. In Singapore, as of 2020, senior citizen (65 years and above) consists of 15.2 % of total population. By 2030, one in five Singaporeans will be more than 65 years old. Thus, nursing home (NH) is an important pillar of a health care system. Nursing home staff are in the front line to manage common infections. However, the inexperience and the lack of guidance have led to inappropriate transfer to acute hospitals. Infectious Diseases Community Program (IDCP) is the project to enhance partnerships with NHs. We work with NHs to develop, adapt, and implement appropriate processes related to infection control, prevention, and management. One of our objectives is the enhancement of assessment and appropriate evaluation of fever. The aim is to reduce the inappropriate admissions to acute hospitals. Methods. Fever and desaturation pathway (figure 1) was developed by IDCP team. Six participating NHs adopted the pathway and trained their staff. The study was approved by NHG domain specific review board (DSRB). Hospital records were reviewed. We compared the rate of inappropriate admission from 2015-2017 which serve as a baseline and 2019-2020. The wash-out period was 2018 when NHs were implementing the pathway. Inappropriate admission is defined as < ! 1. Admission is against advanced care planning / preferred plan of care or 2. Criteria in the pathway are not met on admission, 48 hours later and no other medical reason for admission. Figure 1 Results. Total number of fever transfers was 950 in 2015-2017 and 688 in 2019-2020. Number of inappropriate admissions was 115 in 2015-2017 and 50 in 2019-2020. Inappropriate admission was 12.11% in 2015-2017 and 7.27 % in 2019-2020 (table 1). Figure 2 shows the rate of inappropriate admissions of six participating NHs from 2015-2020. There is a decreasing trend after the pathway has been implemented in 2018. Conclusion. Adopting fever and desaturation pathway has reduced the rate of inappropriate admission in six participating NHs in Singapore. However, there is an increasing trend in inappropriate admission in 2020. This could be due to the lack of isolation facility in the NHs during the COVID-19 pandemic. We are continuing the implementation of the pathway to the rest of the NHs in the western region of Singapore.
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Waiting in queues in service systems is an inevitable part of the customer's everyday routine. Waiting time is an important indicator of a service system's performance. This paper studies the efficiency of service operations in a college campus dining setting. The authors implemented a discrete event simulation (DES) model in Simio to study how class scheduling may affect the overall customer waiting time and satisfaction at the college campus dining location. The results provide recommendations on how classes could be scheduled to optimize students' satisfaction with their lunchtimes and the quality of service. The results also provide valuable insights for operating during the COVID-19 pandemic, as campus dining locations have a decreased maximum capacity, which may lead to more bottlenecks than usual and increase waiting times. © 2021 The Authors.
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Factors associated with continued driving during shelter in place orders have been examined in a community sample of typically developing teen drivers, but not in teens diagnosed with Attention/Deficit-Hyperactivity Disorder (ADHD). Our objective was to examine psychosocial factors that predicted risky drivingduring shelter in place orders in teens with ADHD, which is important since teens with ADHD are at particular risk for poor driving outcomes. The present study is also novel in that it uses naturalistic data of risky driving rather than self-report of continued driving. Naturalistic in-car data from 56 ADHD participants (M age =16.875 years,SD= 0.955;55.400% were male) enrolled in an on-going study were used in the present study. Teens had an average of 26.915 months (SD = 14.343) of driving experience. Risky driving was defined as experiencing an event exceeding 0.600 g-force during the first month of COVID-19 pandemic shelter in place ordinances in Ohio, Kentucky, and Indiana, USA. A hierarchical logistic regression with a post-COVID driving event as the dependent variable was conducted. Baseline ratings of ADHD and oppositional defiant disorder/conduct disorder (ODD/CD) severity were entered in the first step of the model, while anxiety severity and parent behaviors regarding teen driving safety (monitoring and limit setting) were entered in the second step of the model. The first step of the model reached statistical significance (χ2(2, 54) =7.577, p = .023), with only greater symptoms of ODD/CD significantly predicting a post-COVID driving event (B = .144, p = .020). With each point increase in ODD/CD symptoms, there was a 15.5% increase in the probability of experiencing a high g-force event during COVID-19 restrictions. The model was no longer significant at step 2 when anxiety severity and parent behaviors were added to the model (χ2(3, 55) =10.97 p = .052).We conclude that ODD/CD symptom severity was the strongest predictor of risky driving during COVID-19 restrictions within a sample of teen drivers with ADHD. Study implications may be beneficial for clinicians who work with families of teenswith ADHD;suggestions for strategies mitigating this risk are discussed. These findings also have implications for which teens with ADHD may be less positively impacted by other government mitigation strategies such as Graduated Drivers Licensing (GDL) regulations.
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The Resistance as a movement really began on that chilly day in January when millions of people— 85% of whom were women— joined together to raise their voices to protest the new president and the divisive campaign. Protest events have taken place around the United States, focusing on a variety of issues, including racial justice, climate change, immigration, and the Trump administration’s perceived stance on science. In early 2020, there was clear evidence that the Resistance was gearing up to channel the energy and outrage of American progressives into efforts around the 2020 election. However, as federal, state, and local governments respond to the spread of the coronavirus, many questions emerge about how the practice of social distancing will affect activism and efforts to register voters and get them out to participate in the 2020 election. © 2021 Taylor & Francis.
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This paper adds to our understanding of how people's climate change concern and norms influence their leisure air travel. It does so by examining the roles of Norwegians' beliefs about climate change and emissions from air travel, their felt responsibility to limit emissions (personal norm), and expectations and behaviors of friends and family (social norms) in such travel. A representative sample of Norwegians was surveyed in 2019 and 2020 (N = 2842), based on a framework combining institutional and social-psychological perspectives. Structural equation modeling of the data reveals that leisure air travel is habituated and part of a lifestyle, supported by social norms, self-enhancement values and urban residency. Personal norms for reducing greenhouse gas emissions from flying are beginning to emerge in Norway, but their effect on leisure air travel is small and only indirect. Our findings suggest the need for interventions to complement and potentially amplify the emerging moralization process and support an evolution of new habits and travel lifestyle to limit the emissions from leisure air travel substantially. The disruption of travel habits by the COVID-19 pandemic might ease such a process.
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Background. COVID-19 infection is usually mild in children. Progression to severe disease with multiple organ systems compromise described as Multi Inflammatory Syndrome in Children (MIS-C) is a rare occurrence believed to be immunologically mediated. Previous reports describe a possible link between children of Latino origin and high incidence of MIS-C in the US. 40% of the total population in Western Massachusetts is of Latino origin. Methods. Retrospective chart review of 30 children admitted to Baystate Medical Center in Springfield, Massachusetts from April 2020-June 2021 meeting Centers for Disease Control and Prevention (CDC) criteria for MIS-C. Demographics, laboratory data, and clinical outcomes including progression to Macrophage Activation Syndrome (MAS) were analyzed. Results. 60% of children were Hispanic. Mean age (9.1 yrs). Range (3m-20 yrs). COVID PCR positive (78%) and COVID Antibody positive (68%). The most common symptom was fever (96.8%) followed by gastrointestinal symptoms (84%). Respiratory symptoms (29%), dermatological manifestations (39%). Most common comorbidity, asthma (19%) followed by obesity (17%). Leukocytosis (47%), lymphopenia (45%), Anemia (55%), thrombocytopenia (20%), high CRP (90%), ferritinemia (57%), acute kidney injury (20%), elevated liver enzymes (53%), 52% children had electrocardiogram (EKG) abnormalities, 34% had abnormal echocardiograms, none displayed coronary artery dilation. Progression to MAS (20%). All patients were treated with intravenous immunoglobulin G, steroids, aspirin, and anakinra (IL1 receptor antagonist) if progression to MAS. All patients survived. Conclusion. In our population, gastrointestinal symptoms were predominant despite a high prevalence of asthma and obesity, previous reports of children with MIS-C describe predominance of respiratory manifestations. We did not encounter any coronary aneurysms during admission. Most children had positive PCR or Antibodies for COVID 19 and showed important abnormalities in multiple cell lines and inflammatory markers. More research is needed to fully understand ethnical risk factors associated with disease severity especially the risk of progression to MAS from MIS-C in children of Latino origin diagnosed with COVID 19 infection.
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Background: Outcomes in RAS-mutant metastatic colorectal cancer (mCRC) remain poor and patients have limited therapeutic options. Adavosertib is the first small molecule inhibitor of WEE1 kinase. We hypothesised that aberrations in DNA replication seen in mCRC with both RAS and TP53 mutations would sensitise tumours to WEE1 inhibition. Methods: Patients with newly diagnosed mCRC were registered into FOCUS4 and tested for TP53 and RAS mutations. Those with both mutations who were stable or responding after 16 weeks of chemotherapy were randomised 2:1 between Adavosertib or active monitoring (AM). The primary outcome was progression-free-survival (PFS). Results: Between Jul 2017 and Mar 2020 718 patients were registered into FOCUS4;247 (34%) were RAS/TP53-mutant. 69 patients were randomised from 25 UK hospitals (44 to Adavosertib;25 to AM) and recruitment terminated early due to COVID-19 and following DMEC review of efficacy data. Adavosertib was associated with a PFS improvement over AM (median 3.61 vs 1.87 months;HR=0.35[95% CI 0.18-0.68], p=0.0022). In pre-specified subgroup analysis, Adavosertib activity was greater in left-sided tumours HR=0.24 [95% CI 0.11–0.51], versus right-sided HR=1.02 [95% CI 0.41–2.56] (interaction p=0.043). Adavosertib activity was limited to tumours with KRAS12/13 mutations, rather than mutations in extended KRAS or NRAS (interaction p=0.01). Overall survival (OS) was not improved with Adavosertib vs AM (median 14.0 vs 12.8 months;HR=0.92[95%CI 0.44-1.94], p=0.93);however in left-sided tumours, median OS was 14.1 vs 11.3 months (HR=0.37 [95%CI 0.15-0.87]) and 6.5 vs 15.5 months in right-sided (HR=2.15 [95%CI 0.72-6.43], interaction p=0.0047). Adavosertib was well tolerated;grade 3 toxicities were diarrhoea (9%), nausea (5%) and neutropenia (7%). Conclusions: In this phase II randomised trial, Adavosertib improved PFS compared with AM and demonstrates potential as a well-tolerated therapy for RAS/TP53-mutant mCRC. Activity was greater in patients with left-sided tumours, with potential impact on OS. Further testing is required in this sizable population of unmet need. Clinical trial identification: ISRCTN90061546. Legal entity responsible for the study: The authors. Funding: MRC/NIHR, CRUK, AstraZeneca. Disclosure: J. Seligmann: Financial Interests, Personal, Invited Speaker: Pierre Fabre;Financial Interests, Personal, Invited Speaker: Merck Serono;Financial Interests, Personal, Advisory Board: Pierre Fabre;Financial Interests, Personal, Expert Testimony: Roche Diagnostics;Financial Interests, Personal, Invited Speaker: Servier. T. Maughan: Financial Interests, Personal, Advisory Board: AstraZeneca;Financial Interests, Personal, Advisory Board: Pierre Fabre;Financial Interests, Personal, Advisory Board: Pfizer;Financial Interests, Institutional, Funding: AstraZeneca;Financial Interests, Institutional, Funding: Psioxus;Financial Interests, Institutional, Funding: Merck KGAA. All other authors have declared no conflicts of interest.
Subject(s)
COVID-19/therapy , Dysgeusia/therapy , Olfaction Disorders/therapy , SARS-CoV-2/isolation & purification , Aged , COVID-19/diagnosis , Dysgeusia/virology , Female , Humans , Immunization, Passive , Olfaction Disorders/virology , Pandemics , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2/genetics , Smell , Taste , Treatment Outcome , COVID-19 SerotherapyABSTRACT
Objective: In these times of COVID, social isolation is a problem especially affecting older adults. Outdoor social gathering, with appropriate physical distancing, is often recommended. Group outdoor health walks (GOHW) are nature-based interventions that promote physical activity, positive emotions, and mental wellbeing. However, results of quantitative social health scales often do not match qualitative reports of enhanced social wellbeing. In this qualitative study, we explore older adults' experiences of a GOHW to learn how the walks might mitigate social isolation and promote social wellbeing. Methods: Eight individual or paired interviews were recorded among nine walkers six months after a 12-week GOHW. Analysis was conducted by a multi-disciplinary team. The coding frame included both a priori and emergent codes. An iterative process identified key themes. Results: Three themes illustrated the social dimensions of GOHW. First, individuals' social relatedness changed loneliness, social confidence and the quality of friendships, through mixing during and after the walks. Second, social support was experienced through emerging group cohesion and the supportive environment for inexperienced or physically challenged individuals. Tensions were also identified. Third, the social component of GOHW was related to walker wellbeing, by providing an opportunity to safely exercise outdoors, while the socializing helped them overcome their physical ailments and offered something to look forward to each week. Together these themes provide insight into the social elements of nature-based interventions, the mediating effects of group cohesion and social support, and the contribution to wellbeing. Conclusion: GOHWs mitigate social isolation by providing a low-risk social activity that develops and strengthens relationships among members of the walking group. Socializing, group cohesion and social support contribute to both physical and social wellbeing. With attention to physical distancing, GOHW may be beneficial in COVID times. Findings also can inform selection and development of social health measures for use in studies of nature-based interventions.
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BACKGROUND: Preprint manuscripts, rapid publications and opinion pieces have been essential in permitting the lay press and public health authorities to preview data relating to coronavirus disease 2019 (COVID-19), including the range of clinical manifestations and the basic epidemiology early on in the pandemic. However, the rapid dissemination of information has highlighted some issues with communication of scientific results and opinions in this time of heightened sensitivity and global concern. MAIN TEXT: Rapid publication of COVID-19 literature through expedited review, preprint publications and opinion pieces are important resources for the medical scientific community. Yet the risks of unverified information loom large in times when the healthcare community is desperate for information. Information that has not been properly vetted, or opinion pieces without solid evidence, may be used to influence public health policy decisions. We discuss three examples of unverified information and the consequences in this time of high anxiety surrounding COVID-19. CONCLUSIONS: In an era when information can be widely and swiftly disseminated, it is important to ensure that the scientific community is not an inadvertent source of misinformation. This will require a multimodal approach, with buy-in from editors, publishers, preprint servers, authors and journalists. The landscape of medical publications has changed, and a collaborative approach is required to maintain a high standard of scientific communications.