Social Justice and Exponential Functions: Using Pandemic Data to Increase Student Understanding

This paper describes a class activity based on real data about COVID-19 death rates in California. The activity helps students learn about exponential func-tions while providing an opportunity to integrate social justice concerns into the mathematics classroom.

Measles, Mumps, and Rubella Booster Immunization Practices

Reported cases of mumps infection in the United States (U.S.) have dropped since the introduction of the single-component mumps vaccine in 1967. After introduction of the multi-component measles, mumps, rubella (MMR) vaccine, cases in the U.S. and worldwide fell to the point where the International Task Force for Disease Eradication identified mumps for eventual global eradication. By 1991, all military recruits received an MMR vaccine. By 2010, the Department of Defense (DoD) had adopted a policy of immunizing recruits with MMR vaccine only if their antibody titers to measles or rubella had dropped below threshold levels established by the commercial testing laboratories as indicative of immunity. As part of a 2010 Defense Health Board (DHB) review of MMR immunization practices by the Department of the Navy, the DHB recommended that the Navy continue the practice of MMR immunization based on serosurveillance, but that universal MMR vaccination be re-instituted in the event of an increased risk of a mumps outbreak.

Epicardial adipose tissue thickness as a mortality risk marker in covid-19

Intro: Cardiac involvement in COVID-19 infection is common. Epicardial adipose tissue functions as an inflammatory depot, and a thickness (EAT-T) >5mm is associated with increased cardiovascular risk. The present study assessed the significance of increased EAT-T in patients with COVID-19. Methods: A retrospective cohort study of 149 consecutive patients diagnosed with COVID-19 between March 2020 to January 2021 was performed. Inclusion criteria were lab-confirmed COVID19 infection and having a Chest CT scan without contrast during hospitalization. EAT-T was measure in right ventricle free wall (Figure 1). Characteristic of patients and comparisons were analyzed by T-Test and Chi-square. Log-linear analysis and cumulative logistic regression was carried out to predict effect between EAT-T and mortality Results: The mean age was 67 ± 15 years, 65% were male, and time from onset of symptoms was 7 ± 5 days. Forty-seven (31.5%) patients required mechanical ventilation, and 34 (22.8%) required vasopressors. Medical therapy included convalescent plasma (36%), Remdesivir (28%), Tocilizumab (46%), Enoxaparin (64%), and Dexamethasone (39%). There were 36 (24.2%) inhospital deaths, with a greater incidence amongst patients with an EAT-T > 5 mm versus ≤ 5 mm (95 vs 5%, p=.001). Notably, age was not significantly different on patients with in-hospital mortality (69 vs 66 years, p=0.5), and higher EAT-T by 2.17 mm on patient with acute respiratory distress syndrome (p=.001) and 10.9 mm in myocardial infarction (p=.02). In multivariable analysis an EAT-T >5mm was associated with an increased risk of mortality (OR 12.3, 95% CI 3-55, p=.001). In the presence of EAT-T > 5 mm, no effect was observed by chronic kidney disease, hypertension, coronary artery disease, dyslipidemia, or body mass index (p >0.5). Conclusions: In patients with COVID-19, an EAT-T > 5 mm is associated with increased risk of inhospital mortality and may provide important risk stratification.

KBART Phase III: Unresolved questions

During the “NISO update” session at the NISO Plus 2021 conference, which took place online due to the COVID-19 pandemic, members of the KBART (Knowledge Base and Related Tools) Standing Committee presented their plans and work toward KBART Phase III, a revision of the KBART Recommended Practice. In an interactive breakout session, they sought input from attendees on how KBART is being used and what new content types it should support. Presenters from the KBART Standing Committee were Noah Levin (Independent Professional), Stephanie Doellinger (OCLC, Inc.), Robert Heaton (Utah State University), and Andrée Rathemacher (University of Rhode Island). Assisting them in preparing the presentation were Jason Friedman (Canadian Research Knowledge Network), Sheri Meares (EBSCO Information Services), Benjamin Johnson (ProQuest), Elif Eryilmaz-Sigwarth (Springer Nature), and Nettie Lagace (NISO). © 2021 - The authors. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC 4.0).

Family absence at the bedside during the COVID-19 pandemic

BACKGROUND: Child and family-centered care, a partnership approach to health care decision-making, is central to paediatric practice. To reduce transmission of SARS-CoV-2, healthcare institutions implemented policies to protect staff, patients and families. Family presence at the bedside was reduced to one caregiver, except in special circumstances requiring pre-approval by hospital leadership. OBJECTIVES: We explored the impact of the COVID-19 pandemic on paediatric healthcare delivery, focusing on family presence. We describe the clinician's experience of restricted family presence during the COVID-19 pandemic in a paediatric hospital. DESIGN/METHODS: Physicians, trainees, and nurses at The Hospital for Sick Children completed surveys between March-August 2020 to identify patients they perceived to have experienced a suboptimal quality of care or health-outcome related to changes that had occurred as a result of the pandemic and describe the impact. Data were analyzed via case report and thematic analysis. As part of a larger study, here we report on cases related to family presence in the hospital. RESULTS: A total of 212 clinicians reported 116 cases;eighteen cases specified an impact on child and family-centered care. Nine cases related to patient experiences and nine to family experiences of the restricted family presence policy. Clinicians reported a perceived distress in patients due to family members not being present. 6267 family restriction exemption requests were received. Cases described families who opted for a different location for end-of-life care so that extended family could be present. Further cases highlighted how important conversations such as disclosure of diagnosis involved one parent present and the other joining remotely. Siblings were also reported to be impacted by visitor restrictions and closure of the sibling play area. Exclusions were also reported to be challenging for children with complex medical needs and technology dependency whereby two-caregivers were often required. Clinicians reported experiencing stress and moral distress as part of being required to support family restriction policies, impairing their ability to provide care. CONCLUSION: Family presence policies are a critical component of child and family-centered care and have been impacted by the pandemic as described both by family and clinician stress. Recommendations based on these findings would include: facilitating two-caregiver presence to support shared decision making, regular remote meetings to communicate information with families in cases where they cannot be physically present;using remote technology or implementing allotted visitation time for siblings, reviewing exceptions to caregiver restrictions, and mental health supports for clinicians such as peer-support groups, or wellness workshops.

The unintended consequences and impact of the COVID-19 pandemic on patients, families and clinicians in a children's hospital

BACKGROUND: The coronavirus (COVID-19) pandemic has broad implications for children and families. Healthcare experience and delivery has changed significantly, and changes will likely continue for some time. Particular attention has been paid to delays in accessing timely pediatric care leading to unintended morbidity. OBJECTIVES: This study aimed (1) to describe the broader spectrum of unintended negative consequences by describing the courses of care altered by the COVID-19 pandemic from the clinician's perspectives and (2) to identify thematic similarities to inform clinical practice change. DESIGN/METHODS: All full-time doctors, dentists, and nurse practitioners working at a tertiary care children's hospital in Canada were surveyed every two weeks throughout the initial phase of the COVID-19 pandemic. We asked them to identify and describe clinical cases in which they perceived a negative outcome associated with hospital or societal changes due to the COVID-19 pandemic. Analysis followed a qualitative case series methodology using a narrative synthesis approach to determine similarities and associated themes. RESULTS: Two-hundred and twelve clinicians reported 116 cases. Several broad themes emerged, including (1) timeliness of care, (2) disruption of child and family-centred care, (3) new pressures in the provision of safe and efficient care and (4) inequity in the experience of the COVID-19 pandemic. Within each of these themes, subthemes emerged, highlighting its impact on (1) patients, (2) their families and (3) healthcare providers. Table 1 provides examples of cases within each theme. CONCLUSION: The broad consequences of the COVID-19 pandemic impact patients, families, healthcare providers and the healthcare system. Understanding this breadth is necessary as we strive to deliver safe, high quality, family-centred pediatric care in this new era. As the pandemic continues, we need to consider carefully how to provide elective and ambulatory care, including surgery, in this era of social distancing. Particular attention is needed to understand particular aspects, including vulnerable children and the clinician experience of the COVID-19 pandemic.