Pulmonary complications and mortality among COVID-19 patients undergoing a surgery: a multicenter cohort study (preprint)

Background Managing COVID-19-positive patients requiring surgery is complex due to perceived heightened perioperative risks. However, Canadian data in this context remains scarce. To address this gap, we conducted a multicenter cohort study in the province of Québec, the Canadian province most affected during the initial waves of the pandemic, to comprehensively assess the impact of COVID-19 symptoms, and recovery time, on postoperative outcomes in surgical patients. Methods We included adult surgical patients with either active COVID-19 at time of surgery or those who had recovered from the disease, from March 13, 2020, to April 30, 2021. We evaluated the association between symptoms or recovery time and postoperative pulmonary complications and hospital mortality using multivariable logistic regression and Cox models. Results We included 105 patients with an active infection (47 were symptomatic and 58 were asymptomatic) and 206 who had healed from COVID-19 in seven hospitals. Among patients with an active infection, those who were symptomatic had a higher risk of pulmonary complications (odds ratio = 3.19; 95% CI, from 1.12 to 9.68; p = 0.03) and hospital mortality (hazard ratio = 3.67; 95% CI, from 1.19 to 11.32; p = 0.02). We did not observe any significant effect of the duration of recovery prior to surgery on patients who had healed from their infection. Their postoperative outcomes were also similar to those observed in asymptomatic patients. Interpretation Symptomatic status should be considered in the decision to proceed with surgery in COVID-19-positive patients. Our results may help optimize surgical care in this patient population. Trial registration: ClinicalTrials.gov Identifier: NCT04458337, Registration Date: July 7, 2020.

The Presence of Non-pharmaceutical Interventions Correlates with Decreased Rates of Asthma Exacerbations and RSV infections in Arkansas

Rationale: To reduce transmission of SARS-CoV-2, non-pharmaceutical interventions (NPIs), including school closures, hand hygiene, mask mandates, and social distancing, were enforced in Arkansas from 3/2020-2/2021. We hypothesized that the presence of NPIs would correlate with a decrease in asthma exacerbations and viral infections. Methods: Demographic information was collected on subjects with asthma exacerbations or viral infections from 3/2018-5/2022, including age, race, ethnicity, and sex. To evaluate the effects of NPIs, three periods were considered: pre- (03/2018-02/2020), during (03/2020-02/2021), and post- (03/2021-05/2022) NPIs. ANOVA analysis and generalized linear models were performed to determine statistical significance. The stringency of NPIs was evaluated using publicly available data (Oxford Covid-19 Government Response Tracker), which allows for direct comparison of Arkansas NPI status to exacerbation data during the same time periods. Results: 5055 asthma exacerbations (3322 unique subjects) occurred between 3/2018-5/2022. Asthma exacerbations decreased from 3/2020-3/2021 and returned to pre-pandemic numbers by summer 2021 (p<0.0001). Similar downward trends occurred for respiratory syncytial virus (RSV) with out-of-season return in summer 2021 (p<0.0001). Rhinovirus was present throughout NPIs. The mean age of exacerbations decreased by 0.9 years when comparing the during NPIs and after NPIs periods (p = 0.0002). An increase in the proportion of exacerbations was noted for non-black and other/unknown ethnicity subjects during and after NPIs. Conclusions: Fewer asthma exacerbations occurred during the most significant NPI employment period (03/2020-02/2021), and an increase in exacerbations was seen as mitigation strategies were relaxed, which correlated with timing of increasing RSV infections.

Ferrets as a model for tuberculosis transmission.

Even with the COVID-19 pandemic, tuberculosis remains a leading cause of human death due to a single infectious agent. Until successfully treated, infected individuals may continue to transmit Mycobacterium tuberculosis bacilli to contacts. As with other respiratory pathogens, such as SARS-CoV-2, modeling the process of person-to-person transmission will inform efforts to develop vaccines and therapies that specifically impede disease transmission. The ferret (Mustela furo), a relatively inexpensive, small animal has been successfully employed to model transmissibility, pathogenicity, and tropism of influenza and other respiratory disease agents. Ferrets can become naturally infected with Mycobacterium bovis and are closely related to badgers, well known in Great Britain and elsewhere as a natural transmission vehicle for bovine tuberculosis. Herein, we report results of a study demonstrating that within 7 weeks of intratracheal infection with a high dose (>5 x 103 CFU) of M. tuberculosis bacilli, ferrets develop clinical signs and pathological features similar to acute disease reported in larger animals, and ferrets infected with very-high doses (>5 x 104 CFU) develop severe signs within two to four weeks, with loss of body weight as high as 30%. Natural transmission of this pathogen was also examined. Acutely-infected ferrets transmitted M. tuberculosis bacilli to co-housed naïve sentinels; most of the sentinels tested positive for M. tuberculosis in nasal washes, while several developed variable disease symptomologies similar to those reported for humans exposed to an active tuberculosis patient in a closed setting. Transmission was more efficient when the transmitting animal had a well-established acute infection. The findings support further assessment of this model system for tuberculosis transmission including the testing of prevention measures and vaccine efficacy.

Uncertainty Analysis of Business Interruption Losses in the Philippines Due to the COVID-19 Pandemic

In this study, we utilize an input–output (I–O) model to perform an ex-post analysis of the COVID-19 pandemic workforce disruptions in the Philippines. Unlike most disasters that debilitate physical infrastructure systems, the impact of disease pandemics like COVID-19 is mostly concentrated on the workforce. Workforce availability was adversely affected by lockdowns as well as by actual illness. The approach in this paper is to use Philippine I–O data for multiple years and generate Dirichlet probability distributions for the Leontief requirements matrix (i.e., the normalized sectoral transactions matrix) to address uncertainties in the parameters. Then, we estimated the workforce dependency ratio based on a literature survey and then computed the resilience index in each economic sector. For example, sectors that depend heavily on the physical presence of their workforce (e.g., construction, agriculture, manufacturing) incur more opportunity losses compared to sectors where workforce can telework (e.g., online retail, education, business process outsourcing). Our study estimated the 50th percentile economic losses in the range of PhP 3.3 trillion (with telework) to PhP 4.8 trillion (without telework), which is consistent with independently published reports. The study provides insights into the direct and indirect economic impacts of workforce disruptions in emerging economies and will contribute to the general domain of disaster risk management.

Student stress in focus: Short-term fixes and long-term pedagogical change in business school curriculum

This paper explores course design and curriculum decisions made to acknowledge the contextual and personal stressors experienced by business school students. Business school professors have an opportunity to promote an active orientation to stress management, teach stress management skills, and link these practices to students’ lives beyond academia. We use a lens of intersectionality to understand the human experience of stress and coping, connecting research from the management, psychology, biology, and sociology literatures to reveal a more complicated picture of stress for students in the 2020–2021 academic year. We then examine recent pedagogical changes in two business courses, Personal and Professional Development I for first-year students and Organizational Behaviour for second year students, as we discuss how many stressors can be addressed at the course-design level (through principles of simplicity, predictability, and consistency) as well as through module design (by creating community and connections to services, societies, and supports). Rather than viewing pandemic-induced course modifications as a temporary “fix” for the current situation, professors can use this time to re-imagine the importance of student stress in the learning process. We offer recommendations for long-term change to business school curriculum to accomplish this goal.

Scientific literacy, librarians and information literacy in the post-truth era

Purpose: The purpose of this paper is to challenge librarians to reconceptualize their professional self-image and practice so that it more closely aligns with the information science discipline that is part of the Masters of Library and Information Science degree. Design/methodology/approach: This column is primarily theoretical and philosophical but also draws on the author’s observations of trends and patterns in both librarianship and changes in information needs in recent years. Findings: Urgent, high-cost information needs created by COVID-19 and climate change coexist in a reality where technological change has made traditional librarian roles and functions less critical. By developing their information science skills and strengthening their professional identity as information scientists, librarians have the opportunity to address the urgent information needs of the day while remaining highly relevant professionals. Practical implications: Librarians will need to strengthen their science-related skills and knowledge and begin to promote themselves as information scientists. Social implications: Librarians are in a position to make a meaningful contribution to two of the most pressing challenges of the day, climate change and dealing with the COVID-19 pandemic. Originality/value: This paper is relevant to all librarians at any stage of their career. It will help them to reflect on both their skillset and career path and to make any needed adjustments so that they can remain relevant in a volatile and demanding information environment. © 2021, Emerald Publishing Limited.

Research interrupted: Applying the CONSERVE 2021 Statement to a randomized trial of rehabilitation during critical illness affected by the COVID-19 pandemic (preprint)

Rationale: The COVID-19 pandemic disrupted non-COVID critical care trials globally as intensive care units (ICUs) prioritized patient care and COVID-specific research. The international randomized controlled trial CYCLE (Critical Care Cycling to Improve Lower Extremity Strength) was forced to halt recruitment at all sites in March 2020, creating immediate challenges. We applied the CONSERVE (CONSORT and SPIRIT Extension for RCTs Revised in Extenuating Circumstance) guidance to report the impact of the pandemic on CYCLE and describe our mitigation approaches.Methods On March 23, 2020, the CYCLE Methods Centre distributed a standardized email to determine the number of patients still in-hospital and those requiring imminent 90-day endpoint assessments. We assessed protocol fidelity by documenting attempts to provide the in-hospital randomized intervention (cycling or routine physiotherapy), collect the primary outcome (physical function 3-days post-ICU discharge), and 90-day outcomes. We advised sites to prioritize data for the study’s primary outcome. We sought feedback on pandemic barriers related to trial procedures.Results As of March 17, 2020, 197 patients (of 360 planned) had been randomized; 26 (13.2%) remained in hospital or were pending 90-day assessments. From 15 active sites (12 Canada, 2 US, 1 Australia), we identified 5 patients still receiving the study intervention in ICUs, 6 requiring primary outcomes, and 17 requiring 90-day assessments. All ICU interventions (5/5, 100%), 5/6 (83%) of primary outcomes, and all (17/17, 100%) 90-day assessments were attempted. Out of the 6 primary outcomes, one site was unable to attempt due to a temporary institutional ban on direct patient contact for non-COVID research, 2 were attempted but not completed due to reasons unrelated to the pandemic, and 3 were completed. Our main mitigation strategies included identifying patients at risk for protocol deviations, communicating early and frequently with sites, monitoring patient progress, data entry, and validation, and providing guidance for conducting some research activities remotely.Conclusions We retained all enrolled patients with minimal missing data using several time-sensitive strategies. Although CONSERVE recommends reporting only major modifications incurred by extenuating circumstances, we suggest that there are other benefits to reporting mitigation strategies with the goal of improving research transparency and trial management.Trial Registration: NCT03471247

Will preprint servers disrupt scientific publishing, reference work and information science?

Purpose: The purpose of this paper is to discuss whether preprint servers are a disruptive technology for science, librarians or information seeking among the general population. Design/methodology/approach: This column explores what preprint servers are, how they are used in the world of science, how their usage changed in response to the deluge of COVID-19 related research papers and how they might impact the work of librarians and society in general. Findings: Preprint servers are not a highly disruptive technology, but they do challenge both scientists and librarians to understand them better, use the information they find on them with care and educate society in general on topics such as peer review and the importance of using well-vetted, good quality science in making important decisions. Originality/value: Up until the past year and a half, only a small segment of the librarian profession needed to be concerned with preprint servers. With the increasing presence of references to non-peer-reviewed articles from preprint servers in popular media reports, most librarians now need to know something about this technology. It is also useful to consider how the technology might benefit and create challenges for their work. © 2021, Emerald Publishing Limited.

Postoperative Outcomes in Surgical COVID-19 Patients: A Multicenter Cohort Study (preprint)

Background: Data on postoperative outcomes of the COVID-19 patient population is limited. We described COVID-19 patients who undergone a surgery and the pandemic impact on surgical activities. Methods: We conducted a multicenter cohort study between March 13 and June 19 2020. We included COVID-19 patients who underwent surgery in nine centres of the Province of Québec, the Canadian province most afflicted by the pandemic. We also included suspected COVID-19 (subsequently confirmed not to have COVID-19) patients and patients who had recovered from it. We collected data on baseline characteristics, postoperative complications and overall surgical activities performed in participating centres. Our primary outcome was 30-day mortality. Results: We included 44 COVID-19 patients, 18 suspected patients, and 18 patients who had recovered from COVID-19 at time of surgery. Among the 44 COVID-19 patients, 31 surgeries (71%) were urgent and 16 (36%) were major. In these patients, pulmonary complications were frequent (25%) and 30-day mortality was 15.9%. This mortality was higher in patients with symptoms (23.1%) compared to those without symptoms (5.6%), although not statistically significant (p = 0.118). Of the total 22 616 cases performed among participating centres during the study period, only 0.19% had COVID-19 at the time of surgery. Fewer procedures were performed during the study period compared to the same period in 2019 (44 486 cases). Conclusion: In this study, postoperative 30-day mortality in COVID-19 patients undergoing surgery was 15.9%. Although few surgeries were performed on COVID-19 patients, the pandemic impact on surgical activity volume was important. Trial registration ClinicalTrials.gov Identifier: NCT04458337

Researching Crime After a Disaster: What We Can Learn From a Large Survey in New Orleans After Hurricane Katrina

In this article, I describe a large (N = 7,000) survey we conducted in greater New Orleans after Hurricane Katrina. We encountered many challenges in conducting the survey and used a number of creative means of collecting the data. Our survey, which included detailed questions about collective resources and can be aggregated to the census tract level, has great utility in investigating not only crime but also such questions as repopulation, blight reduction, resident stress, heart health, Airbnbs or short-term rentals, and foreclosures. The main difficulty was the time it took to conduct the survey because many interviews had to be done door-to-door and face-to-face to produce a representative sample. While we clearly outlined these limitations in papers we wrote, the survey duration raised questions of causal direction, and we had to conduct detailed tests of endogeneity to provide convincing evidence that our analyses were sound. I also briefly describe some of the other data we utilized, other surveys we conducted, and ethnographic and organizational work we did that not only assisted disaster recovery but also gave us insights into the social processes we investigated with our quantitative data.