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Introduction: COVID pneumonia can lead to pneumomediastinum or pneumothorax during non-invasive or invasive mechanical ventilation. This affects the prognosis. Methodology: During the study period, 121 patients with SARS-CoV-2 infections and invasive or non-invasive ventilation therapy were recorded in our hospital. All patients with a pneumothorax or pneumomediastinum were analyzed in more detail. Result(s): Pneumothorax and pneumomediastinum occurred in 12 patients and resulted in 7 deaths. Discussion(s): The incidence of pneumothorax with COVID infection ranges from 0.56 to 1%, reaching 3.5% in our own studies and 4.2% under invasive mechanical ventilation. The incidence of pneumomediastinum was 10% and 9.2% in our own patients. Overall mortality was 58.3% and similar to that reported in the literature, up to 60%.Copyright © 2023 Dustri-Verlag Dr. K. Feistle.
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The COVID-19 crisis is disrupting and changing the lives of consumers in dramatic ways. Research and businesses face the challenge of responding to an unprecedented situation. Drawing on a three-step empirical study design, this study identifies how consumers in Germany and Switzerland reacted to financial and non-financial constraints imposed by the COVID-19 crisis. Building on these findings, we typologize consumer reactions to the COVID-19 crisis. Based on this in-depth analysis of consumer reactions, this study provides guidance to researchers and businesses during volatile times of the COVID-19 crisis. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.
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In extraordinary situations, like the Covid-19 pandemic, irregular demand fluctuations can hardly be predicted by traditional forecasting approaches. Even the current extent of decline of demand is typically unknown since tourism statistics are only available with a time delay. This study presents an approach to benefit from user generated content (UGC) in form of online reviews from TripAdvisor as input to estimate current tourism demand in near real-time. The approach builds on an additive time series component model and linear regression to estimate tourist arrivals. Results indicate that the proposed approach outperforms a traditional seasonal naïve forecasting approach when applied to a period of extraordinary demand fluctuations caused by a crisis, like Covid-19. The approach further enables a real-time monitoring of tourism demand and the benchmarking of tourism business in times of extraordinary demand fluctuations. © 2023, The Author(s).
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Background: Concerns about safety and treatment interference are known barriers to COVID-19 vaccination in cancer patients. Data on safety and tolerability in this population remain scarce. One of the objectives of this study is to describe COVID-19 vaccination safety in cancer patients. Methods: Patients diagnosed with a malignancy requiring systemic treatment in the last 12 months and undergoing COVID-19 vaccination were prospectively enrolled in this single-center study. Validated questionnaires to assess vaccine-related adverse events (VRAEs) were collected;chart review identified baseline characteristics and treatments received. Descriptive statistics and logistic regressions were performed. Results: 253 questionnaires were collected from 171 patients, enrolled between May and September 2021. 130 patients were survey-eligible after the 1st dose (D1) and 185 after 2nd dose (D2). 91 questionnaires were collected after D1 (Questionnaire 1: Q1) and 162 after D2 (Questionnaire 2: Q2). Surveys couldn't be collected due to interval > 1 month between D1 / enrollment, patients' unavailability, withdrawal of study or death. Median age was 55 (24-87) and 62.8% were female. 58.5% had solid tumors, treated with chemotherapy (49%) or checkpoint inhibitors only (9.5%);19.4% malignancies were treated with targeted therapies and 22.1% had hematological malignancies. Most frequent solid tumors were breast (31.3%), lung (15.9%) and gastro-intestinal (GI) (14.3%). Patients received 45.6% Pfizer/BioNTech, 52.8% Moderna and 1.6% Oxford/AstraZeneca. A combination of 2 different vaccines was administered to 11.9%. Interval between D1 and D2 was ≤30 days in 53.1%, 31-90 days in 42.6%, and 91-180 days in 4.3%. Among all patients, 84.1% developed VRAEs after a median of 2 days post-vaccine for a median of 4 days. 74.5% had local symptoms (Sx) (pain, sensitivity and/or redness at injection site and/or arm) and 65.8% had systemic Sx. Most frequent systemic Sx were fatigue, chills or myalgia (39.4%), GI (6.3%) and fever (2.9%). Most patients (90.7%) described their Sx as having no / minimal impact (Gr 1), 7.8% reported seeking medical consultation (Gr 2), and 1.5% lead to hospitalization (Gr 3) (1 cardiovascular event, 1 infection;causality with concurrent systemic treatment not excluded and 1 due to malignancy). Gr 2, but not Gr 3, VRAEs were more common after D2 (11.4% vs 2.5%, p = 0.03). 41.7% considered their Sx as a new health problem. On multivariate analysis, younger age and female sex were significantly associated with the development of any Sx (OR 1.08, p = 0.01;OR 2.92, p = 0.02, respectively) and local Sx (OR 1.04, p = 0.04;OR 2.19, p = 0.04), but not systemic Sx or new health problem. Conclusions: Patients experienced mostly minor and transient symptoms post-vaccination;few perceived these as a new health problem. COVID-19 vaccination is overall safe and well-tolerated among cancer patients.
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Supply chains are usually perceived as a stable environment where only local or regionalised disruptions may happen, thus this paper focuses on the unpreceded situation where cumulative impact of Brexit, Covid-19, and Suez Canal blockage on supply chains. Each event has been analysed from different angles to provide a wider view and depiction of complexity of modern supply chains as well as their vulnerability when it comes to cumulative impacts of major disruptions. © 2021 IEEE.
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The COVID-19 pandemic highlights the pursuit of business continuity efforts in a variety of companies that adapt their theoretical plans to the ever-changing environment of today's society. Business continuity generally increases the resilience of businesses to disruptions, interruptions, or loss of ability to meet their key objectives. Business continuity is therefore important in fulfilling the agreed tasks and outlined strategies. Theoretically, most railway companies have a business continuity plan, however, get hardly ever implemented. The main reason behind that is the fact the railway participation in the transport system, has a very specific role in providing transport services. The continuity of railway activities fulfils a specific task, providing transport services, which is one of the basic functions of the state.The application of participatory continuity can also be used in air transport. © 2021 IEEE.
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In perhaps unparalleled fashion, the ongoing pandemic has showcased the complex entanglements between science and other fields of society, such as politics and the media. This intricate and often conflictive relationship becomes particularly manifest in the controversies surrounding scientific experts, who have been transformed from science communicators into iconic figures since the outbreak of COVID-19. Accordingly, this article examines two of these "pandemIcons," the American immunologist Anthony Fauci and the German virologist Christian Drosten, which have functioned as sites of ideological struggle. As this article shows, the cultural negotiation of these iconic figures demonstrates not only how the media have been engaging with images of scientists in Western countries during the COVID-19 pandemic but also how repertoires of (often stereotypical and hegemonic) images and rhetorical strategies employed in the formation and transformation of these figures circulate across both media and national borders.
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As of the start of the COVID-19-pandemic, basis undergraduate, postgraduate as well as continuous medical education had often been switched to e-learning. This is a chance and a challenge at the same time. In this work, we describe the e-learning experiences of the competence center for postgraduate medical education in Baden-Württemberg. We aim to support broad implementation of e-learning by the exchange of educational as well as organizational approaches. In March 2020, we planned synchronic (live) webinars with asynchronic preparation and postprocessing (flipped classroom). We focused on elements to improve interaction. All the process was managed with respect to the program curriculum in a multicentered team. In 2020, n = 263 postgraduate trainees in family medicine (FM trainees) participated in n = 12 online single seminar days of the KWBW Verbundweiterbildungplus. Due to multiple participation, they induced n = 379 participations. N = 353 evaluations could be included (93,1 % response rate). 77 % (n = 182/236) assessed the use of the software Zoom® with satisfying or very satisfying, 75 % (n = 122/163) the use of the software Heiconf® with satisfying or very satisfying. 59 % (n = 208) wanted to continue with seminar days during workdays, whereas 26 % (n = 91) wished for trainings on Saturdays. A technical check was rated as very helpful. From the organizational point of view, an additional lecturer (= moderator) was necessary. Some lecturers needed extra support in advance of the e-learning. We provide didactic elements that can help to improve the interaction between participants which have to be planned ahead. We present a successful approach to face the educational and organizational challenges of e-learning. E-learning was broadly accepted which supports permanent implementation. However, social and collegial interaction is both, most challenging and most important for postgraduate training in family medicine. Therefore, approaches supporting the interaction in e-learning should be developed and implemented. © 2021, Deutscher Arzte-Verlag GmbH. All rights reserved.
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Background: Acute infections and fever under chemotherapy are an important cause for morbidity and mortality in hematologic malignancies such as Hodgkin lymphoma (HL). Prophylactic anti-infective concomitant medication is prescribed frequently. Another protective measure could be self-protection via social distancing and wearing facemasks. However, evidence on the effect of self-protection on infections during chemotherapy is currently not available. Aims: We asked if the frequency of acute infections during chemotherapy for advanced-stage HL decreased when Corona Virus Disease 2019 (COVID-19) protection measures were in effect. Methods: We analyzed the occurrence of infections during all documented eBEACOPP cycles that started between 01 March and 30 June of 2017-2020 among patients treated within the GHSG HD21 study in Germany. We compared cycles starting between March and June 2020 with cycles starting between March and June of 2017-2019 regarding infection rates and infection characteristics by logistic regression models and means of descriptive statistics. Results: We analyzed 911 cycles of 313 adult patients treated with 4 to 6 cycles of eBEACOPP. We found a significant decrease in the frequency of infections during chemotherapy for HL during COVID-19 lockdown from131 (19.6%) of 670 cycles in the years 2017-2019 to 30 (12.6%) of 239 cycles during COVID-19 lockdown (OR 0.574 (95% CI 0.354- 0.930), P = 0.024). Correspondingly, 20 (24.1%) of 83 patients had an infection during the COVID-19 lockdown versus 99 (43.2%) of 229 patients in the years 2017-2019 (P = 0.0023). The strongest effect was observed for unspecified infections (unknown type of etiologic agent), occurring in 39 cycles (5.8%) during 2017-2019 in comparison to 5 cycles (2.1%) during COVID-19 lockdown. There was also a strong trend towards fewer minor infections: during the COVID-19 lockdown period there were 8 cycles (3.3%) with a minor infection compared to 66 cycles (9.9%) with an infection during the reference period. Summary/Conclusion: The significant and relevant decrease observed in acute infections while receiving chemotherapy for HL during the COVID-19 lockdown demonstrates the potential of protective measures to shield patients from transmissible pathogens. We conclude that these measures may be recommended for cancer patients at risk for infections during chemotherapy.
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Background & Aim: In allogeneic hematopoietic cell transplantation (HCT), NMDP guidelines are for stem cell product (SCP) infusion within 48 hrs or as soon as feasible after collection. However, given the possibility of long transit times, staffing limitations, and travel disruptions from natural disasters or pandemics, delays occur in the timing of infusions. We performed a pilot study to evaluate the safety of delayed SCP infusions. Methods, Results & Conclusion: We prospectively determined total transit time (time from end of collection to end of HCT infusion, TTT), viability, and product characteristics of SCP infused <48 or ≥48 hrs after collection. Differences in post-HCT outcomes were determined using Kaplan-Meier analysis and two-tailed t tests. We also retrospectively analyzed an independent cohort of SCP that required mandatory cryopreservation during the COVID- 19 pandemic. [Figure presented] In the <48 hr cohort (n=36), median TTT was 34.9 hrs. Median viability on arrival and at time of HCT were each 100%, with median infused CD34 dose of 5.58E6/kg. In the ≥48 hr cohort (n=23) median TTT was 58.1 hrs. Median product viability on arrival and at time of HCT were 100% and 99%, and median infused CD34 dose was 5.91E6/kg. Median time to neutrophil engraftment was longer for <48 hr cohort (p=0.048). Grade III/IV infusion reactions were 2.8% for <48 hr cohort, and primary graft failure was 2.8%;neither event occurred in >48 hrs cohort. Acute GVHD was 50% and 56.5%, and death from any cause was 39.9% versus 39.1%, in the <48 vs. ≥48 hr cohort groups. Death from any cause was seen in 39.9% versus 39.1% subjects, with median follow-up of 21 vs 13 months. 44 patients with SCPs (PBSC 86.4%, BM 13.6%) cryopreserved prior to HCT due to the COVID-19 pandemic response were also reviewed. Median infused CD34/kg was 5.5E6, with a median of 16 and 25 days for neutrophil and platelet engraftment. Grade III/IV infusion reactions and secondary graft failure were seen in 1 patient each (2.3%). Death from any cause was seen in 20.5% with a median follow-up of 5 months. Infusion of SCP products?>48 hrs was associated with no adverse outcomes post-HCT, compared to published parameters. In comparison, cryopreserved products during COVID-19 pandemic showed a delayed time to engraftment. While more definitive randomized studies are necessary, our preliminary results suggest that holding products for >48 hrs may be an acceptable alternative to cryopreservation in times of possible transit delay. [Table presented]