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Background: People presenting with early-stage LPCa have several treatment options. There is therapeutic equipoise with lack of randomised evidence for superiority of radiotherapy or surgery. PACE-A aimed to determine if there is improved quality of life (QoL) following SBRT compared to surgery. Method(s): PACE (NCT01584258) is a phase 3 open-label multiple-cohort RCT. In PACE-A, people with LPCa, T1-T2, Gleason<=3+4, PSA<=20ng/mL & suitable for surgery were randomised (1:1) to SBRT or surgery. SBRT dose was 36.25Gy/5 fractions in 1-2 weeks;surgery was laparoscopic or robotically assisted prostatectomy. Androgen deprivation was not permitted. Co-primary endpoints were patient reported outcomes (PROs) of Expanded Prostate Index Composite (EPIC-26) questionnaire number of absorbent pads per day & EPIC bowel subdomain score at 2 years. Target sample size was 234 participants (pts) to detect 9% difference in urinary incontinence (80% power, 5% 2-sided alpha) & 5-point difference in mean bowel subdomain score (90% power, 5% 2-sided alpha) with higher EPIC score (range 0-100) indicating better QoL. Secondary endpoints included clinician reported toxicity and additional PROs (1% significance level). Analysis is by treatment received. Result(s): From Aug 2012 to Feb 2022, 123 men from 10 UK centres were randomised. The IDMC advised stopping recruitment after a 2-year gap in during COVID. Pts had median age 66years (IQR: 61, 69), median PSA 8ng/ml (6, 11) with 52% tumours >=T2b and 79% Gleason 3+4;93% pts were of white race. 58/63 pts received SBRT as allocated (2 received surgery, 2 unknown, 1 withdrawn);48/60 received surgery as allocated (1 received SBRT, 3 received CRT, 2 unknown, 6 withdrawn). 8 laparoscopic and 42 robotic assisted operations were performed. Median follow-up is 50 months (IQR 41, 74). At 2 years, fewer SBRT pts reported use of urinary pads: 2/43 (4.5%) vs 15/32 (46.9%), p<0.001. SBRT pts had significantly worse bowel subdomain score (mean (SD) 88.4 (12.7) vs 97.3 (5.5), p<0.001). 7/45 (15.6%) SBRT and 0/31 (0%) surgery pts reported moderate/big problem with bowel symptoms (p=0.04). SBRT pts reported less EPIC sexual subdomain score (58.0 (31.9) vs 29.3 (20.5), p<0.001);there was no evidence of a difference in urinary subdomain score (85.5 (19.8) vs 80.5 (20.8), p=0.29). At 2 years, CTCAE genitourinary grade 2 or higher(G2+) toxicity was seen in 5/54 (9.3%) SBRT vs 4/42 (9.5%) surgery pts (p=0.97);there was no G2+ gastrointestinal (GI) events seen in either group. Conclusion(s): PACE-A contributes the first randomised data to the comparison of SBRT with surgery in LPCa providing PRO data relevant to informed decision making. Compared to surgery, pts receiving SBRT had better urinary continence & sexual bother score;clinician reported GI toxicity was low but SBRT pts reported more bowel bother at 2 years.
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Background. Prior to the COVID-19 pandemic, the incidence of infection related ventilator associated complications plus possible ventilator associated pneumonias (IVAC+) was decreasing;however, as the number of COVID-19 hospitalizations increased, so did the number of IVAC+. Our goal was to investigate if there was a relationship between these two occurrences. Methods. This was a retrospective study at the Audie Murphy VA Hospital (ALMVA) from October 2017 to December 2021. ALMVA is a level 1A facility with 232 beds and an active bone marrow transplant program in San Antonio, Texas. This study included acute care COVID-19 hospitalizations per 10,000 bed days of care and IVAC+ per 1000 ventilator days. Monthly acute and intensive care COVID-19 hospitalization rates were correlated with IVAC+ rates using Pearson correlation for the overall study period and in the subgroup of COVID pandemic months (Mar 2020-December 2021). Results. During the overall study period, COVID-19 hospitalization rates were significantly associated with IVAC+ rates: acute care correlation 0.86 (p< 0.01) and intensive care correlation 0.33 (p=0.04). During the COVID-19 pandemic months, acute care COVID-19 hospitalizations but not intensive care COVID-19 hospitalizations, were correlated with IVAC+ (correlation 0.90, p< 0.01 and correlation 0.21, p=0.53, respectively). There were 0 IVAC+ before the pandemic months and this rose to 14 during (0 per 1000 ventilator days and 3.05 per 1000 ventilator days, respectively). All but 2 cases of IVAC+ had COVID-19. COVID-19 Hospitalizations and IVAC Plus, October 2017 to December 2021 A sharp increase in COVID-19 hospitalizations correlated with a rise in patients meeting criteria for IVAC Plus. Conclusion. The natural history of COVID-19 disease has presented challenges for IVAC+ monitoring. COVID-19 can cause persistent fevers and worsening oxygenation, and antibiotic use is common during periods of clinical deterioration. These factors can fulfill criteria for IVAC+. In this study, each IVAC+ case was traced for safety bundle compliance. These bundles were followed, along with conservative fluid management, low tidal volume ventilation, and sedation breaks. Patients met NHSN criteria for IVAC+ despite these measures and most had COVID-19. Given the common occurrence of IVAC+ in COVID-19 patients, futures studies are needed to define if IVAC+ are preventable in this population and whether IVAC+ surveillance has any value among COVID-19 patients. (Figure Presented).
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Background. Coronavirus disease-19 (COVID-19) has been associated with an increase in healthcare-associated infections (HAI). This increase is likely multifactorial (i.e. higher hospitalization rates, COVID-19 and post-COVID-19 complications, lower staffing, delayed care among others). The objective of this study was to determine the association between COVID-19 hospitalization rates and central line- associated blood stream infections (CLABSI). Methods. We conducted a retrospective study in acute care unit hospitalizations in a Veterans Affairs (VA) hospital in San Antonio, Texas from October 2017 to December 2021. Individuals over 18 years of age admitted with a new diagnosis of COVID-19, determined by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) polymerase chain reaction (PCR) were included in the study. CLABSIs were defined by the National Healthcare Safety Network (NHSN) criteria for laboratory confirmed bloodstream infections. Pearson correlation was used to determine correlation of CLABSI and COVID-19 disease hospitalization rates. CLABSI rates were also compared pre-COVID-19 (Oct 2017-Feb 2020) to COVID-19 (Mar 2020-Dec 2021) periods using the chi-square test. Results. During the study period, a total of 0.69 CLABSIs per 1,000 central line days occurred in the pre-COVID-19 period compared to 1.98 per 1,000 in the COVID-19 period (p=0.004). There was a significant correlation between CLABSI and ICU COVID-19 hospitalization rates (R=0.459;p=0.001) as well as CLABSI and acute care COVID-19 hospitalization rates (R=0.341;p=0.014). During the COVID-19 period only, there continued to be a significant correlation between CLABSI and COVID-19 ICU hospitalization rates (R=0.426;p=0.048). Conclusion. CLABSI rates significantly increased during the COVID-19 period compared to the pre-COVID-19 period and CLABSI rates were significantly correlated with COVID-19 ICU and acute care hospitalizations. Accounting for this variable allows us to factor in impact of post-COVID-19 related complications and association with CLABSI rate. We urge for careful implementation of HAI prevention strategies during the pandemic. Awareness of anticipated increase is important in allocating resources essential for prevention of HAIs.
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Background. Covid-19 infection is associated with a lack of immune resilience that may be magnified using immunomodulators to suppress the cytokine storm, facilitating the emergence of opportunistic infections. We describe five cases of cryptococcal infection complications among Covid-19 hospitalized patients. Methods. This was a retrospective cohort study based on chart review performed at the Audie Murphy Veteran Affairs Hospital from 8/2020 to 8/2021;a level 1A facility with 232 beds and an active bone marrow transplantation program. We included patients aged >= 18 with a diagnosis of Covid-19 and subsequent Cryptococcal infection based on cultures or antigen testing. Results. Our patients were all male with ages ranging between 64 to 80 years. Three had underlying type II diabetes, hypertension, and two had end-stage renal disease. Only one had underlying immunosuppression with hydroxychloroquine for rheumatoid arthritis and one had underlying cirrhosis. Four patients had disseminated disease/fungemia while one had localized pulmonary disease. All the cases had low CD4 counts (158-300) and low CD8 counts (92-290). Two of the fungemia cases were diagnosed by blood culture and the other two by serum cryptococcus antigen test. All the patients had received corticosteroids with or without remdesivir, while one received additional tocilizumab, one baricitinib and one convalescent plasma infusion. Four cases of fungemia received liposomal amphotericin B and three of them received additional flucytosine. The patient with cryptococcal pulmonary disease received only fluconazole. Four patients expired at 28 days after diagnosis, only one recovered and is still alive at 1-year follow up. Table 1. Case details. ESRD: end stage renal disease;DM-2: diabetes mellitus type ;HTN: hypertension;A-fib: Atrial Fibrillation;HFpEF: heart failure with preserved ejection fraction;PVD: peripheral vascular disease;RA: rheumatoid arthritis;PTSD: post traumatic stress disorder;BPH: benign prostatic hyperplasia;CAD: coronary artery disease;HLD: hyperlipidemia;CVA: cerebrovascular accident. Conclusion. Cryptococcus infection has been described among patients with Covid-19 during the pandemic. This may be due to immunosuppression caused by the Covid-19 infection and its related-treatments. Most of our patients presented with disseminated cryptococcus infection complicating covid-19 with resulting high mortality rates. Low CD4/CD8 counts and corticosteroid use were documented in all cases. Further studies are needed to better characterize at-risk patients for cryptococcal infection that may benefit from cryptococcal prophylaxis.
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SESSION TITLE: Challenges in Lung Tumors SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION: Patients can have a variety of post Coronovirus induced disease (COVID) associated interstitial lung diseases (ILD) ranging from cystic lung disease to fibrinous organizing pneumonia. However, very little is known about malignancies that have been overshadowed by post COVID associated pulmonary changes. We present one such case of insidious invasive mucinous adenocarcinoma of the lung that was masked by post COVID related changes. CASE PRESENTATION: A 70 year old female with COPD, systolic heart failure and significant tobacco use disorder presented with progressively worsening hypoxemic respiratory failure. She has had 4 hospitalizations in past year all for acute on chronic hypoxemic respiratory failure following COVID. She has been on Supplemental Oxygen 3L/min since her infection with SARS-COV2. Patient was found to have worsening bibasilar ground glass opacities (GGO) on CT of chest over the past 1 year since having COVID. She was treated with several rounds of steroids without any relief. Patient had a PET scan that showed a very avid left upper lobe consolidation. Given these worsening abnormalities and symptoms, she underwent bronchoscopy with transbronchial biopsy guided by the positive PET scan and fluoroscopy. However, during bronchoscopy she had copious secretions which were therapeutically cleared helping relieve some of patient's hypoxemia. All her cultures and Fungitell assay on bronchoalveolar lavage were negative. However, post biopsy pathology came back positive for Invasive Mucinous Adenocarcinoma. Patient was treated with chemo and radiation therapy with good response against her malignancy and significant relief in her hypoxemia. DISCUSSION: COVID associated pneumonia is well known to cause chronic hypoxemic respiratory failure. Post COVID related pulmonary changes range from organizing pneumonia to fungal pneumonia. However, patients should start to recover with time as inflammatory changes resolve on CT scan with adequate steroids or anti-fungals. If patients continue to deteriorate then a prompt work-up that rules out other infections and even malignancies is warranted as seen in our patient. This case brings forth an important consideration for aggressively pursuing an adequate work-up in the face of worsening GGO on the CT and patient's continual deterioration due to her hypoxemic respiratory failure. Our patient was able to be adequately diagnosed with malignancy and was then started on chemotherapy that allowed for adequate control of her hypoxemic respiratory failure and helped improve her quality of life. CONCLUSIONS: Post COVID related pulmonary changes can be from a variety of ILD and infections. However, clinician should be vigilant in considering malignancy as a possible etiology of post COVID related changes and initiate an adequate work-up to help evaluate for cancer that can be masked amongst post COVID related ILD. Reference #1: Beck KS, Sung YE, Lee KY, Han DH. Invasive mucinous adenocarcinoma of the lung: Serial CT findings, clinical features, and treatment and survival outcomes. Thorac Cancer. 2020 Dec;11(12):3463-3472. doi: 10.1111/1759-7714.13674. Epub 2020 Oct 5. Reference #2: Matsui T, Sakakura N, Koyama S, Nakanishi K, Sasaki E, Kato S, Hosoda W, Murakami Y, Kuroda H, Yatabe Y. Comparison of Surgical Outcomes Between Invasive Mucinous and Non-Mucinous Lung Adenocarcinoma. Ann Thorac Surg. 2020 Nov 24:S0003-4975(20)32001-4. doi: 10.1016/j.athoracsur.2020.09.042. Epub ahead of print. Reference #3: Lee MA, Kang J, Lee HY, Kim W, Shon I, Hwang NY, Kim HK, Choi YS, Kim J, Zo JI, Shim YM. Spread through air spaces (STAS) in invasive mucinous adenocarcinoma of the lung: Incidence, prognostic impact, and prediction based on clinicoradiologic factors. Thorac Cancer. 2020 Nov;11(11):3145-3154. doi: 10.1111/1759-7714.13632. Epub 2020 Sep 25. DISCLOSURES: No relevant relationships by Danya Ahmed No relevant relationships by David Chambers No rele ant relationships by Jalal Damani No relevant relationships by Deon Ford No relevant relationships by Rachaita Lakra
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Rationale: Burnout and distress amongst ICU staff are prevalent and have been exacerbated during the COVID-19 pandemic. In this context, recent data have revealed an increased incidence of adverse mental health events (AMHE) amongst healthcare workers (HCW). However, identifying HCWs at risk for AMHE and offering timely support services remains a challenge. Our aim is to develop a telehealth-based platform to provide mental health screening and tailored interventions to ICU HCW at an academic medical center. Methods: A multidisciplinary team comprised of clinical and behavioral psychologists, resiliency coordinators, pulmonary critical care fellows, and faculty iteratively developed a screening questionnaire using validated tools directed at various domains of mental health including sleep disturbance, depression, anxiety, PTSD, resiliency, alcohol misuse, and burnout. Using Research Electronic Data Capture (REDCap) with an integrated Twilio platform, we developed a text-based, interactive tool designed to 1) screen HCWs for AMHE, 2) communicate results to respondents in real-time, and 3) provide risk-stratified referrals to support services such as a mental health practitioner or self-help mobile applications. We performed cognitive pretesting on the amalgamated survey instrument with 6 ICU HCW stakeholders including three ICU RNs, one RT, and two physicians. We sought feedback on survey length, concerns about confidentiality, likelihood to accept mental health referrals, and pertinence of the questions to ICU HCWs. Feedback was obtained via a 4-question survey and through qualitative field notes. Results: The mean duration required to complete the survey during beta-testing was 6.97 mins +/-2.46 mins (SD). 100% of participants reported that the questionnaire was ”not overly burdensome” (5/6) or “minimally burdensome” (1/6). Participants were also “very confident” (4/6) or “confident” (2/6) their confidentiality would be maintained with this intervention. 83% (5/6) of participants stated that they were either “extremely likely” (3/6) or “likely” (2/6) to accept real-time feedback including a mental health referral if their responses suggest possible mental health distress. Only 17% (1/6) reported that they are unlikely to accept a mental health referral. All participants rated the pertinence of the questions to the healthcare workers to be high with 33% (2/6) characterizing the pertinence as excellent and 67% (4/6) as very good. Illustrative comments from the qualitative assessment are included in the Table. Conclusion: A telehealth-based platform for a mental health screening with real-time feedback and support service referral is feasible and was well-received by ICU HCW during cognitive pretesting.
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The COVID-19 pandemic has shaken the world to its core and has provoked an overnight exodus of developers who normally worked in an office setting to working from home. The magnitude of this shift and the factors that have accompanied this new unplanned work setting go beyond what the software engineering community has previously understood to be remote work. To find out how developers and their productivity were affected, we distributed two surveys (with a combined total of 3,634 responses that answered all required questions) weeks apart to understand the presence and prevalence of the benefits, challenges, and opportunities to improve this special circumstance of remote work. From our thematic qualitative analysis and statistical quantitative analysis, we find that there is a dichotomy of developer experiences influenced by many different factors (that for some are a benefit, while for others a challenge). For example, a benefit for some was being close to family members but for others having family members share their working space and interrupting their focus, was a challenge. Our surveys led to powerful narratives from respondents and revealed the scale at which these experiences exist to provide insights as to how the future of (pandemic) remote work can evolve.
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Background: Health care providers (HCPs) have always been a common target of stigmatization during widespread infections and COVID-19 is not an exception. Aim: This study aims to investigate the prevalence of stigmatization during the COVID-19 pandemic among HCPs in seven different countries using the Stigma COVID-19 Healthcare Providers tool (S19-HCPs). Design: Cross-sectional. Methods: The S19-HCPs is a self-administered online survey (16-item) developed and validated by the research team. The participants were invited to complete an online survey. Data collection started from June-July 2020 using a convenience sample of HCPs from Iraq, Jordan, Egypt, Saudi Arabia, Indonesia, Philippines, and Kuwait. Results: A total number of 1726 participants were included in the final analysis. The majority of the study participants were Jordanians (22%), followed by Kuwaitis (19%), Filipinos (18%) and the lowest participants were Indonesians (6%). Other nationalities were Iraqis, Saudis, and Egyptians with 15%, 11% and 9% respectively. Among the respondents, 57% have worked either in a COVID-19 designated facility or in a quarantine center and 78% claimed that they had received training for COVID-19. Statistical significance between COVID-19 stigma and demographic variables were found in all aspect of the S19-HCPs. Conclusion: The findings of this study demonstrated high levels of stigmatization against HCPs in all the included seven countries. On the other hand, they are still perceived positively by their communities and in their utmost, highly motivated to care for COVID-19 patients. Educational and awareness programs could have a crucial role in the solution of stigmatization problems over the world.
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Background. Clostridioides difficile infection (CDI) continues to be a major global public health concern, particularly during the ongoing SARS-CoV-2 coronavirus disease 2019 (COVID-19) pandemic. Despite new social distancing guidelines and enhanced infection control procedures (e.g., masking, hand hygiene) being implemented since the beginning of COVID-19, little evidence indicates whether these changes have influenced the prevalence of CDI hospitalizations. This study aims to measure CDI prevalence before and during the COVID-19 pandemic in a local cohort of U.S. Veterans. Methods. This was a cross-sectional study of all Veterans presenting to the South Texas Veterans Health Care System in San Antonio, Texas from Jan 1, 2019 to Apr 30, 2021. Monthly laboratory confirmed CDI events were collected overall and categorized as the following: hospital-onset, healthcare facility-associated (HO-HCFACDI), community-onset, healthcare facility-associated CDI (CO-HCFA-CDI), and community-associated CDI (CA-CDI). Monthly confirmed COVID-19 cases were also collected. CDI prevalence was calculated as CDI events per 10,000 bed days of care (BDOC) and was compared between pre-pandemic (Jan 2019-Feb 2020) and pandemic (Mar 2020-Apr 2021) periods. Results. A total of 285 CDI events, 920 COVID-19 cases, and 104,220 BDOC were included in this study. The overall CDI rate increased from 20.33 per 10,000 BDOC pre-pandemic to 34.51 per 10,000 during the pandemic (p< 0.0001). This was driven primarily by a rise in CO-HCFA-CDI rates (0.95 vs 2.52 per 10,000 BDOC;p< 0.0001) during the pandemic, followed by increases in CA-CDI (15.58 vs. 18.61 per 10,000 BDOC;p< 0.0001) and HO-HCFA-CDI (2.66 vs. 5.43 per 10,000 BDOC;p< 0.0001). Lastly, CDI rates have tripled since the start of the pandemic (March-Apr 2020) compared to the current year (March-Apr 2021) (14.69 vs. 43.76 per 10,000 BDOC). Conclusion. Overall, CDI prevalence increased during the COVID-19 pandemic, driven mostly by an increase in CO-HCFA-CDI. As COVID-19 rates increased, CDI rates also increased, likely due to greater healthcare exposures and antibiotic use. Continued surveillance of COVID-19 and CDI is warranted to further decrease infection rates.
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Introduction Under federal and provincial legislations, employers across Canada have a responsibility to reasonably protect the health and safety of their workforce. The COVID-19 pandemic has created many challenges for employers to meet these responsibilities. Employers have been particularly hindered in their efforts to protect their workers due to changing understandings of COVID-19 risks over time. Knowledge of effective public health measures is continuously evolving, with new evidence emerging almost daily. Workplace-led strategies have been designed and implemented to specifically protect workers from exposure to the COVID-19 virus. What we don't know is the unintended long-term consequences these workplace protection measures may be having on workers' health and ability to work safely during the pandemic. Objectives To examine the influences of geographical region, sex and gender, industry, occupation, and perceptions of worker autonomy on the relationship between workplace-led strategies to protect workers from exposure to COVID-19 on measures of worker health safety and productivity. Methods Using a longitudinal survey with a purposive sampling of Newfoundland and Labrador workers at regular intervals over a 12-month period, data were collected across six domains: participant demographics, pandemic-specific workplace policies and practices, working environment (including remote and on-campus work), psychosocial working conditions, physical health and mental health. Results Findings from the baseline, 3 month and 6-month follow-up surveys will be presented. Preliminary results from this work highlight the challenges faced by workers under remote and standard work arrangements and the relationship among these working conditions and impacts on worker health, safety and productivity during the changing nature of work throughout the COVID-19 pandemic. Conclusion The outcomes from our research will provide new knowledge through the collection of stakeholder perspectives about how current workplace strategies to prevent the spread of COVID-19 may be having unintentional consequences on worker health and safety.
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The COVID-19 study (clinicaltrials.gov:NCT04354519) is a prospective observational cohort launched on 17 March 2020 as part of the UKMSR. As of 24 April, out of 3910 participants, 237 (6.1% (95% CI 5.3% to 6.8%)) reported self-diagnosed COVID-19 among whom 54 (22.8% (17.5% to 28.2%)) also had a diagnosis by a healthcare professional based on symptoms and 37 (15.6% (11.2% to 20.6%)) a confirmed diagnosis by testing. Three participants reported hospitalisation due to COVID-19. No deaths were reported. Among 1283 siblings without MS, 79 (6.2%) had a reported diagnosis of COVID-19. Adjusting for age and gender, the likelihood of contracting COVID-19 in pwMS was similar to siblings (OR 1.180 (0.888 to 1.569)). Seven hundred and fifty-nine of 3812 participants reported that they were self-isolating and that they had been self-isolating for at least 2 weeks before symptom onset if they had COVID-19. Of these, 2 (0.3% (0% to 0.7%)) had self-diagnosed COVID-19 whereas 137 of 3053 participants not self-isolating (4.5% (3.8% to 5.2%)) had the disease. Participants on DMTs were less likely to have self-diagnosed COVID-19 (OR 0.640 (CI 0.428 to 0.957)), which remained significant after removing self-isolating participants (OR 0.633 (0.402 to 0.998)). High-efficacy DMTs reduced the likelihood of self-diagnosed COVID-19 compared with no DMTs (OR 0.540 (0.311 to 0.938)) but not compared with moderate-efficacy DMTs. Including webEDSS (n=2808) and physical MSIS-29v2 (n=3192) as additional predictors in the analysis showed no significant association with the likelihood of contracting COVID-19. The gender distribution was similar between participants with and without COVID-19. More participants with self-diagnosed COVID-19 reported themselves as having any ethnicity other than white compared with those without the disease (6.9% (3.9% to 10.1%) vs 3.8% (3.2% to 4.4%), p=0.019). Gender and ethnicity did not affect the likelihood of having COVID-19.
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Background: Rapidly worsening symptoms in multiple sclerosis (MS) can be associated with relapses or temporary changes due to systemic disturbances such as an increase in temperature eg Uthoff's phenomena. COVID-19 infections can exacerbate MS symptoms (Garjani, 2021), notably this worsening seems to be ameliorated by disease modifying therapies (DMT). Vaccinations have a long history of issues for people with MS (pwMS) as they have been associated with MS worsening. COVID-19 vaccines were developed rapidly and have been associated with vaccine related side effects that we are continuing to establish Objective: To determine the range of side effects from the AstraZeneca (AZ) and Pfizer (PF) vaccines in pwMS and factors associated with their occurrence Methods: A vaccine survey was deployed to all pwMS on the UK MS Register, which remains accessible to all participants. First dose vaccine type and effects were collected and linked with demographics and prior COVID-19 studies. Control data was derived from a UK-wide observational study focusing on particular matched questions (Menni et al, 2021). Results: As of 23-Mar-21, 388/1154 (34.5%) had vaccine effects with the PF vaccine and significantly more 822 /1408 (58.4%) had vaccine effects from the AZ vaccine (p<0.0001). There was no difference in the rate of severe side effects between the two vaccines (2.4% AZ,1.03% PF). Particular symptoms: fatigue, headaches and fever could be matched with control data. Fatigue: AZ-MS 59.3% v 21.1% controls;PF-MS 47.4% vs 8.4% controls Headaches: AZ-MS 58.3% v 22.8% controls;PF-MS 43.0% vs 7.8% controls Fever: AZ-MS 26.5% v 8.2% controls;PF-MS 11.1% vs 1.5% controls Sensory loss: AZ-MS 7.5%;PF-MS 3.4%. No control comparison. Logistic regression for the presence of vaccine effects (vs none) was associated with younger age (0.97 [0.96, 0.98], (<0.0001): odds ratio [95%CI], p), female gender (0.56 [0.45, 0.70], (<0.0001), prior COVID-19 infection (1.98 [1.24, 3.21], 0.0049) and the AZ vaccine (2.93 [2.45, 3.51], < 0.0001). Notably being on a DMT, higher disability and progressive MS were not significant. No factors were associated with severe reactions. Conclusion: In MS, as in other studies vaccine effects are more prominent in the AZ group compared to PF but there is no difference in severe vaccine effects. Systemic symptoms fever, headaches and fatigue are more common in MS than in a control population with associated increases in sensory symptoms.
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This document describes the survey instruments from our paper "How Was Your Weekend?" Software Development Teams Working From Home During COVID-19 as well as how to access them.
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TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: COVID Pneumonia is associated with high morbidity and mortality accounting for 3 million deaths worldwide. This aim of this study is to identify risk factors related to mortality in patients admitted to the hospital with COVID Pneumonia and to compare baseline characteristics and outcomes of different racial groups. METHODS: This is a retrospective observational study of patients 18 years and older who were admitted to an academic medical center between March to May of 2020. Categorical variables were reported as counts and percentages, using Chi Square or Exact Fischer test. Continuous variables were reported in means and standard deviation using Student T test. Logistic regression was performed to identify factors associated with mortality. RESULTS: 190 patients were included in the study, 157 (82.63%) were African American (AA). AA patients had significantly higher weight, BMI and creatinine on admission. Prevalence of chronic kidney disease (CKD) was significantly higher in AA patients while the prevalence of atrial fibrillation was higher in non-AA patients. There was no difference in all-cause mortality between non-AA and AA groups (27.27% VS 20.38%, p=0.38). Factors that were associated with all-cause mortality included underlying CVA (OR=2.84, p<0.01, CI (1.3, 6.22)), thrombocytopenia (OR=0.99, p<0.01, CI (0.98, 0.99)), acute kidney injury (OR=2.95, p<0.01, CI (1.45, 6)), elevated alkaline phosphatase (OR=1.006, p=0.035, CI (1.0004, 1.01)), elevated D dimer (OR=1.0003, p<0.01, CI (1.00008, 1.0006)), elevated CRP (OR=1.1, p<0.01, CI (1.04, 1.16)), acute respiratory distress syndrome (ARDS) (OR=11.17, p<0.01, CI (4.9, 25.46)), intubation (OR=22.56, p<0.01, CI (9.49, 53.66)), vasopressor requirement (OR=14.77, p<0.01, CI (6.36, 34.3)) and use of hydroxychloroquine (OR=25.37, p<0.01, CI (2.96, 217.55)). Multi-variable logistic regression was used to control for confounding and race was not associated with mortality (OR=0.25, p=0.21, CI (0.03,2.19)). CONCLUSIONS: In patients with COVID pneumonia, organ dysfunction and the use of Hydroxychloroquine were factors associated with increased mortality. Despite significant differences in baseline weight, BMI, prevalence of AF and CKD among AA and non-AA patients, there was no significant difference in mortality between the 2 groups. CLINICAL IMPLICATIONS: Clinicians should consider early close monitoring of patients with COVID19 pneumonia and evidence of end organ dysfunction since there seems to be an association with increased mortality. Based on our retrospective study the use of hydroxychloroquine should be avoided in this patient population. DISCLOSURES: No relevant relationships by Adekola Adedeji, source=Web Response No relevant relationships by Prangthip Charoenpong, source=Web Response No relevant relationships by Nour Daoud, source=Web Response No relevant relationships by Deon Ford, source=Web Response No relevant relationships by Nasim Motayar, source=Web Response No relevant relationships by Diana Song, source=Web Response
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Communication is essential for the success of student and professional software engineering (SE) team development projects. The projects delivered by SE courses provide valuable learning experiences for students because they teach industry-required skills such as teamwork, communication, and scheduling. Professional SE teams have adopted communication software such as Slack, Miro, Microsoft Teams, and GitHub Discussions to share files and convey information between team members. Likewise, they have distributed software development tools such as Visual Studio CodeSpaces and Jira to support productivity. In contrast, within academia, students have focused on having face-to-face meetings for team communication and communication tools for file sharing. Due to the COVID-19 pandemic, universities have been forced to switch to an online or hybrid modality abruptly, thus compelling SE students to quickly adopt communication software. This paper proposes a study on the use of communication software in industry to prepare students for remote software development positions after graduation. © 2021 IEEE.
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The mass shift to working at home during the COVID-19 pandemic radically changed the way many software development teams collaborate and communicate. To investigate how team culture and team productivity may also have been affected, we conducted two surveys at a large software company. The first, an exploratory survey during the early months of the pandemic with 2,265 developer responses, revealed that many developers faced challenges reaching milestones and that their team productivity had changed. We also found through qualitative analysis that important team culture factors such as communication and social connection had been affected. For example, the simple phrase "How was your weekend?" had become a subtle way to show peer support. In our second survey, we conducted a quantitative analysis of the team cultural factors that emerged from our first survey to understand the prevalence of the reported changes. From 608 developer responses, we found that 74% of these respondents missed social interactions with colleagues and 51% reported a decrease in their communication ease with colleagues. We used data from the second survey to build a regression model to identify important team culture factors for modeling team productivity. We found that the ability to brainstorm with colleagues, difficulty communicating with colleagues, and satisfaction with interactions from social activities are important factors that are associated with how developers report their software development team's productivity. Our findings inform how managers and leaders in large software companies can support sustained team productivity during times of crisis and beyond.
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The COVID-19 pandemic has impacted the way that software development teams onboard new hires. Previously, most software developers worked in physical offices and new hires onboarded to their teams in the physical office, following a standard onboarding process. However, when companies transitioned employees to work from home due to the pandemic, there was little to no time to develop new onboarding procedures. In this paper, we present a survey of 267 new hires at Microsoft that onboarded to software development teams during the pandemic. We explored their remote onboarding process, including the challenges that the new hires encountered and their social connectedness with their teams. We found that most developers onboarded remotely and never had an opportunity to meet their teammates in person. This leads to one of the biggest challenges faced by these new hires, building a strong social connection with their team. We use these results to provide recommendations for onboarding remote hires.
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Introduction: The COVID-19 pandemic has required urgent scientific response to investigate the disease, its prevention and treatment and interactions with cardiovascular conditions. Consequently, a centralized workflow was needed to effectively recruit, screen and connect volunteers to COVID-19 research opportunities. Objective: To create a centralized registry to match eligible and interested volunteers ≥18 years with COVID-19 outpatient research studies at an academic health system. Methods: Key stakeholders, including researchers and participant advocates, collaborated to build the Hopkins Opportunity for Participant Engagement (HOPE) Registry in English and Spanish. REDCap, a secure web-based application, served as the Registry platform. Study teams recruiting for outpatient studies were invited to present their studies through the Registry. Study volunteers were recruited using multiple methods, including patient portal messages, email, social media, and online advertisement. The Registry included COVID testing results and participant survey of demographic and COVID-19 related questions. Branching logic was used to pre-screen and present participating studies for which the person was eligible. The individual then selected which studies, ifany, they were interested in. Study teams received an automatic notification and reached out directlyto individuals expressing interest in their study ( Figure ). Results: The HOPE Registry includes 7 studies and has enrolled 4186 people. Over half (55%)were >55 years and the majority were female (64%). Racial/ethnic groups represented were Whites(80%), Black s (9%), Asians (4.7%), Hispanics (5%), and American Indian (0.3%). Participants were interested in: 29%, treatment study;37%, vaccine study;and 66%, donating plasma. Within 10weeks, 585 persons were matched with an actively recruiting study. Conclusions: The ongoing HOPE registry has shown promise in engaging individuals with COVID-19 research and improving research recruitment workflow.
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A myriad of acute clinicopathological effects of novel SARS Coronavirus 2 (SARS-Cov-2) infection are being described. Here, we present a case report which illustrates a biopsy proven distinct chronic complication of Covid-19 disease which afflicts some survivors: Post Covid-19 Organizing Pneumonia (PCOP). A 30 year old African-American female with known Human Immunodeficiency Virus (HIV) infection on anti-retroviral therapy (ART) and recently diagnosed nodular marginal zone lymphoma, on chemotherapy, became infected with SARS-Cov-2 in early August, 2020. She presented with fever, increased cough, and shortness of breath worsening over two weeks. In the emergency room, she had temperature 102o F, heart rate of 110 with oxygen saturation 88% on room air. Lab work was significant for Leukocytosis of 17.62 k/uL and recent absolute CD4 of 590/mm3. SARSCoV-2 Polymerase Chain Reaction (PCR) test was positive. Admission Chest Roentgenogram (X-ray) revealed bilateral basal opacities consistent with Covid-19 Pneumonia. Our patient was admitted and received Dexamethasone and a course of empiric antibiotics for community acquired pneumonia. She was discharged on brief oral prednisone taper with home oxygen 2L/min;However, she would be readmitted to hospital twice more over the next eight weeks with similar complaints of cough, recurrent fever, and dyspnea with new focal opacities on serial chest imaging (Figure 1). Her symptoms persisted despite broadened empiric antibiotics including antifungal therapy. Extensive lab work-up for secondary infection and autoimmune disease was unrevealing. Bronchoscopy was finally done with Transbronchial Cryobiopsy (TBC) revealing acute and chronic inflammation with interstitial fibrosis. Bronchoalveolar lavage (BAL) cultures were negative. As evidenced by serial imaging (Figure 1), our patient consistently improved with empiric steroids for organizing pneumonia. Her clinical findings recurred with attempts to taper steroids even at five months post initial positive SARS-CoV-2 PCR. This case illustrates Post Covid-19 Organizing Pneumonia (PCOP). It is a Clinicopathologic syndrome characterized by rapid resolution with corticosteroids, but frequent relapses when treatment is tapered or stopped.1 It also illustrates several salient issues in caring for patients who survive acute SARS-CoV-2 infection: i) Delayed viral clearance related to chronic immunosuppression,2 ii) Delayed Bronchoscopy in an effort to mitigate infection risk to care providers, iii) The impact of ongoing therapy on consequent delayed pathology findings,3 iv) Increased morbidity associated with both late disease recognition and our attempts to taper chronic steroid therapy in the setting of an Organizing Pneumonia4 and v) The possibility that earlier biopsy, diagnosis and uninterrupted therapy may prevent pulmonary fibrosis.
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Background: The UK MS Register captures longitudinal data directly from people with MS (pwMS) as patient reported outcome measures but also from NHS Trusts via electronic Case Return Form (eCRF). As part of our response to the COVID19 pandemic we designed an anonymised clinical capture instrument to allow clinicians from non affiliated NHS hospitals capture important clinical data on incident cases. Here we outline our current clinicians reported findings from these collected data. Objectives: Report on patients with Multiple Sclerosis and COVID as reported by UK National Health Service MS clinicians to the UK MS Register Methods: Data were captured using the RedCap platform to design forms and were stored on secured databases at Swansea University Medical School. The URL for data capture was shared on social media and via clinician groups to encourage as many clinicians as possible to report hospitalised pwMS and confirmed COVID. Variables included: Age, Gender, MS Type, Expanded Disability Status Score (EDSS), Disease Modifying Therapy (DMT) Details, COVID clinical treatment and outcomes. Results: Between 27/03/2020 and 14/07/2020, 93 patients with COVID were reported. Their mean Age was 53.38 (±14.2) and median EDSS 6.0. Of these 11 patients died with mean Age 63.7(±10.9). Median EDSS 8.0. Multivariate regression showed increased EDSS score to be the most significant factor for mortality (P <0.01) with the other variables (age, gender, disease type, DMT,) not influencing mortality. All the patients that died had progressive MS and only one was on a DMT. Conclusions: Here we present the UK PwMS, with laboratory confirmed COVID19 as reported by hospital clinicians. We found increased disability rather than age or MS type to be the only predictor of mortality. These results are strikingly different from the patients reported UK MS register COVID study (separate abstract) that had a much milder COVID illness that led to hospitalisation in only 3% of the cases.