The Impact of a Virtual Radiology Medical Student Rotation: Maintaining Engagement During COVID-19 Mitigation.

INTRODUCTION: The purpose of this study is to introduce a virtual radiology rotation curriculum that is being used to safely maintain medical student and intern education and engagement with the Department of Radiology at Walter Reed National Military Medical Center during coronavirus disease 2019 (COVID-19) mitigation. MATERIALS AND METHODS: The curriculum is designed as a 4-week block with each week representing one of the four highest yield radiology subspecialties for medical students; neuroradiology, thoracic radiology, body radiology, and musculoskeletal radiology. A subspecialist radiologist from each section was identified as a primary mentor and tasked with designing a daily schedule for medical students and interns. The first 2 months of virtual rotators were surveyed to assess the effectiveness of the course. RESULTS: Thirty-five of 41 rotators responded to the survey, a response rate of 85%. Thirty-one of 35 (89%) of the rotators gave this virtual elective rotation a positive rating, with 16 trainees scoring the course as 4 out of 5 and 15 trainees selecting 5 out of 5. Four respondents selected 3 out of 5. Five out of 5 respondents who had experienced an in-person radiology elective rotation before this virtual rotation rated the virtual elective as more educational than the in-person rotation. We found the 4-week subspecialist mentor-based structure to be highly versatile, allowing us to simultaneously accommodate multiple groups of full or partial block rotators throughout COVID-19 mitigation. CONCLUSION: A virtual rotation curriculum is a viable method of maintaining medical student and intern education and engagement with the department of radiology during COVID-19 mitigation.

Enhanced self-harm presentation reporting using additional ICD-10 codes and free text in NSW emergency departments.

OBJECTIVES: Understanding and responding to emergency department (ED) presentations for suicide and self-harm is a major health system priority. Reporting using routinely collected ED diagnoses or presenting problem codes leads to significant underestimation of rates. We aimed to implement an enhanced method for reporting ED self-harm presentations in New South Wales (NSW), Australia. METHODS: An enhanced method was developed based on a literature review and clinical consultation. For NSW ED data collection records from 2005-2020, presenting problem codes were mapped to International Classification of Diseases version 10 (ICD-10). Self-harm codes (ICD-10 X60-84, Y87.0) were combined with additional codes for poisoning with medications commonly used in overdose and automated keyword searching of presenting problem text. Enhanced ED diagnoses were validated against hospital diagnoses for presentations resulting in hospital admission. RESULTS & DISCUSSION: Core ICD-10 self-harm codes identified 21 797 suicide and self-harm-related presentations per year to NSW EDs, of which 79% were for suicide-related ideation (R45.81). The enhanced method increased estimated annual presentations to 51 822 and increased sensitivity for suicide-related behaviours from 12.2% to 73.9%, while retaining high specificity (99.4%). Results matched known demographics of ED self-harm, and revised estimates were consistent with population rates reported by other jurisdictions. Service feedback and data sharing during the coronavirus disease 2019 (COVID-19) pandemic suggest that estimates from the enhanced method are plausible and sensitive to change. CONCLUSIONS: In NSW ED data, standard presenting problem codes recorded by clinicians detect less than half of presentations for self-harm or suicidal ideas. An enhanced method using additional codes and free text searching is computationally simple and increases sensitivity for monitoring trends and service performance. The method will continue to be refined as new data items become available.

The Interplay of COVID-19 and Hereditary Angioedema: Preventing an Acute Attack

Hereditary angioedema (HAE) is a rare inherited disease that is caused by the inactivation of the C1 esterase inhibitor. In this case report, we present a 51-year-old female previously diagnosed with HAE who tested positive for SARS-Cov-2 (COVID-19). The patient was treated symptomatically. Dexamethasone was used to treat COVID-19 pneumonia. Broad-spectrum antibiotics (vancomycin and meropenem) were utilized to prevent future infection. Although the patient did not experience an acute angioedema attack during her hospital stay, the patient expired due to the exacerbation of COVID-19 pneumonia.

The Interplay of COVID-19 and Hereditary Angioedema: Preventing an Acute Attack.

Hereditary angioedema (HAE) is a rare inherited disease that is caused by the inactivation of the C1 esterase inhibitor. In this case report, we present a 51-year-old female previously diagnosed with HAE who tested positive for SARS-Cov-2 (COVID-19). The patient was treated symptomatically. Dexamethasone was used to treat COVID-19 pneumonia. Broad-spectrum antibiotics (vancomycin and meropenem) were utilized to prevent future infection. Although the patient did not experience an acute angioedema attack during her hospital stay, the patient expired due to the exacerbation of COVID-19 pneumonia.

The Association Between Sleep Quality and Anxiety in Postsecondary Students: A Systematic Review of the Literature

Introduction:Mental health conditions such as anxiety represent a growing health concern for students in institutions of higher education. Postsecondary students are a vulnerable population that is increasingly recognized to be at risk for both mental health problems and significant sleep problems. While it has been hypothesized that poor sleep quality may be a risk factor for developing anxiety, little is known about the frequency and severity of sleep problems and their association with anxiety within the postsecondary student population. The aim of this systematic review was to synthesize the best evidence on the association between sleep quality and anxiety in postsecondary students. Materials and Methods: An experienced librarian developed systematic search strategies in four databases: MEDLINE, Embase, APA PsycInfo (through Ovid Technologies Inc.) and CINAHL, Cumulative Index to Nursing and Allied Health Literature (through EBSCOhost). Databases were searched from inception to September 2020. Random pairs of independent reviewers screened titles and s for eligibility and critically appraised all eligible studies. We assessed the quality of studies using the Scottish Intercollegiate Guidelines Network (SIGN) criteria for cohort studies, and the Hoy tool for cross-sectional studies. One author extracted and synthesized the results from all of the low and moderate risk of bias studies. We synthesized our results by study design and population. Results: Once duplicates were removed, a total of 3203 unique citations were screened. Fifty-one articles were eligible and critically appraised. Studies with low and moderate risk of bias were included in our final synthesis of which 24 were cross-sectional studies and four were cohort studies. With the exception of one study, all cross-sectional studies reported a statistically significant association between poor sleep quality and anxiety. All four of the cohort studies found that students who reported poor sleep quality were more likely to develop future anxiety and students with anxiety were more likely to develop future poor sleep quality. Conclusions: Poor sleep quality is associated with anxiety in postsecondary students. Due to the cross-sectional nature of most studies, we cannot determine the direction of this association. Future studies should focus on developing high-quality prospective cohort or longitudinal studies to help understand the impact and direction that this association has in postsecondary populations. This research has the potential to inform the development and design of mental health policies and programs that are created by postsecondary institutions to address the increasing rates of student mental health issues. Acknowledgements: Canadian Institutes of Health Research (CIHR) Operating Grant: Knowledge synthesis: COVID-19 in Mental Health & Substance Use;University of Ontario Institute of Technology;Institute of Disability and Rehabilitation Research.

Remdesivir-Associated Sinus Arrest in COVID-19: A Potential Indication for Close Cardiac Monitoring.

Remdesivir is an antiviral, nucleoside analog used extensively during the coronavirus-disease 2019 (COVID-19) pandemic with proven efficacy against COVID-19-induced acute respiratory distress syndrome (ARDS). Our case report details the clinical course of a 50-year-old, COVID-19-positive patient who developed sinus arrest after being treated with remdesivir. Within 24 hours of discontinuing remdesivir therapy, the patient's sinus arrest resolved to a normal sinus rhythm. The findings from our case report add to a growing body of evidence on the cardiotoxic profile of remdesivir. Remdesivir's ability to cause bradyarrhythmias, and specifically sinus arrest, should be acknowledged when considering the use of this drug in at-risk patients.

Development of a self-management workbook and virtual programme for patients in the fife pain management service during the COVID-19 pandemic

Keywords: Virtual;Pain;Covid-19 Purpose: Due to the Covid-19 crisis, face-to-face groups were cancelled in the fife pain management service (FPMS) for an indefinite period. This resulted in a group of patients, waiting to attend a face-to-face physiotherapy led education and exercise group, requiring an alternative format. Therefore, the need for a virtual alternative was established. The primary aim of the project was to develop and evaluate a patient self-learning resource that may be used on an individual basis, with virtual clinician support, or as part of a virtual group. The secondary aim was to develop and implement the use of this learning resource with patients on the physiotherapy led education and exercise group waiting list in a virtual environment. The tertiary aim of this project was to determine whether this virtual alternative would be an effective means of delivering pain management education during the covid-19 pandemic and beyond. Methods: A working group developed a patient self-management workbook based on the FPMS ‘Self-Management Jigsaw’ tool. An operational procedure was developed and implemented on how the workbook could be used during the pandemic and subsequent restrictions. Patients on the pre-pandemic group waiting list were invited to participate in the programme. The patients had a choice of (1) a telephone supported programme or (2) a video group programme. Due to the limitations of the service at the time, the telephone programme commenced first. The working group implemented the telephone programme operational procedure and collected patient and staff quantitative and qualitative feedback to determine the effectiveness of the intervention. Once feedback was analysed, the group made minor changes to the workbook and developed an operational procedure for a virtual video group programme. This programme was piloted and qualitative and quantitative data was collected, analysed and compared to the telephone pilot group. Results: This project demonstrated the usefulness of a workbook to support pain education virtually. The workbook was better received in the video group (9.75/10) to the telephone cohort (7.5/10). Due to limitations within this pilot project, we are unable to ascertain the reason for this. The telephone support was equally effective and valuable in both pilot groups from both quantitative and qualitative data. Both groups reported high satisfaction rates with an average of 9.5/10, with multiple positive qualitative feedback. This data suggest the user led video approach supported engagement within the group based on the comparison of retention rates. Conclusion(s): The project demonstrates that these programmes have the potential to be an effective means of delivering pain education and have a place within the service post Covid-19. However, they are very much in their infancy and further virtual programmes within the FPMS are required to determine longer term effectiveness and efficiency. Impact: Further research is required to determine whether the delivery of virtual physiotherapy led pain education and exercise groups are effective and offer comparable results to face-to-face groups. Additionally, research is required to establish which factors enable service users to engage effectively with virtual physiotherapy led pain education and exercise programmes. Funding acknowledgements: This work was not funded.

The Development and Evaluation of the Leeds Clinical and Health Psychology Department COVID-19 Staff Support Service

During the Coronavirus disease (COVID-19) pandemic, supporting the emotional wellbeing of healthcare staff is essential to help prevent burnout and promote self-care, given the emotional demands and increased workload. An overview of the development of a staff support service in a large teaching hospital is provided. The Leeds Clinical and Health Psychology department set up a face to face, drop-in service, and telephone support service for all staff. A comprehensive evaluation database and attendance log wasdeveloped. This ensured that data were recorded from each staff support session. A short anonymous electronic survey was sent to staff who had accessed the service. Over an 18-week period, a total of 458 sessions were offered to support staff;318 were face to face, 134 were telephone sessions, and six were email enquiries. Three hundred and ninety-four unique individuals accessed the service over this period. In response to the data collected, adjustments were made to when the service was available. Work-related stress was the most consistent reason for staff accessing support. Of the 458 staff contacts, 243 contacts specifically named COVID-19 related issues. Psychological first aid and coping strategy development were the most widely used interventions offered. The data collected highlights the benefit of offering a staff support service during COVID-19, and the benefit of evaluating a service, ensuring that the service is responsive to staff need © 2021 American Psychological Association

Lung epithelial and endothelial damage, loss of tissue repair, inhibition of fibrinolysis, and cellular senescence in fatal COVID-19.

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is characterized by respiratory distress, multiorgan dysfunction, and, in some cases, death. The pathological mechanisms underlying COVID-19 respiratory distress and the interplay with aggravating risk factors have not been fully defined. Lung autopsy samples from 18 patients with fatal COVID-19, with symptom onset-to-death times ranging from 3 to 47 days, and antemortem plasma samples from 6 of these cases were evaluated using deep sequencing of SARS-CoV-2 RNA, multiplex plasma protein measurements, and pulmonary gene expression and imaging analyses. Prominent histopathological features in this case series included progressive diffuse alveolar damage with excessive thrombosis and late-onset pulmonary tissue and vascular remodeling. Acute damage at the alveolar-capillary barrier was characterized by the loss of surfactant protein expression with injury to alveolar epithelial cells, endothelial cells, respiratory epithelial basal cells, and defective tissue repair processes. Other key findings included impaired clot fibrinolysis with increased concentrations of plasma and lung plasminogen activator inhibitor-1 and modulation of cellular senescence markers, including p21 and sirtuin-1, in both lung epithelial and endothelial cells. Together, these findings further define the molecular pathological features underlying the pulmonary response to SARS-CoV-2 infection and provide important insights into signaling pathways that may be amenable to therapeutic intervention.

Practical geospatial and sociodemographic predictors of human mobility.

Understanding seasonal human mobility at subnational scales has important implications across sciences, from urban planning efforts to disease modelling and control. Assessing how, when, and where populations move over the course of the year, however, requires spatially and temporally resolved datasets spanning large periods of time, which can be rare, contain sensitive information, or may be proprietary. Here, we aim to explore how a set of broadly available covariates can describe typical seasonal subnational mobility in Kenya pre-COVID-19, therefore enabling better modelling of seasonal mobility across low- and middle-income country (LMIC) settings in non-pandemic settings. To do this, we used the Google Aggregated Mobility Research Dataset, containing anonymized mobility flows aggregated over users who have turned on the Location History setting, which is off by default. We combined this with socioeconomic and geospatial covariates from 2018 to 2019 to quantify seasonal changes in domestic and international mobility patterns across years. We undertook a spatiotemporal analysis within a Bayesian framework to identify relevant geospatial and socioeconomic covariates explaining human movement patterns, while accounting for spatial and temporal autocorrelations. Typical pre-pandemic mobility patterns in Kenya mostly consisted of shorter, within-county trips, followed by longer domestic travel between counties and international travel, which is important in establishing how mobility patterns changed post-pandemic. Mobility peaked in August and December, closely corresponding to school holiday seasons, which was found to be an important predictor in our model. We further found that socioeconomic variables including urbanicity, poverty, and female education strongly explained mobility patterns, in addition to geospatial covariates such as accessibility to major population centres and temperature. These findings derived from novel data sources elucidate broad spatiotemporal patterns of how populations move within and beyond Kenya, and can be easily generalized to other LMIC settings before the COVID-19 pandemic. Understanding such pre-pandemic mobility patterns provides a crucial baseline to interpret both how these patterns have changed as a result of the pandemic, as well as whether human mobility patterns have been permanently altered once the pandemic subsides. Our findings outline key correlates of mobility using broadly available covariates, alleviating the data bottlenecks of highly sensitive and proprietary mobile phone datasets, which many researchers do not have access to. These results further provide novel insight on monitoring mobility proxies in the context of disease surveillance and control efforts through LMIC settings.

Assessing the risks posed by SARS-CoV-2 in and via North American bats - decision framing and rapid risk assessment

The novel beta-coronavirus, SARS-CoV-2, may pose a threat to North American bat populations if bats are exposed to the virus through interaction with humans, if the virus can subsequently infect bats and be transmitted among them, and if the virus causes morbidity or mortality in bats. Further, if SARS-CoV-2 became established in bat populations, it could possibly serve as a source for new infection in humans, domesticated animals, or other wild animals. Wildlife management agencies in the United States are concerned about these potential risks and have begun to issue guidance regarding work that brings humans into contact with bats, but decision making is difficult because of the high degree of uncertainty about many of the relevant processes that could lead to virus transmission and establishment. The risk assessment described in this report was undertaken to provide management agencies with an understanding of the likelihood that the various steps in the causal pathways would lead to SARS-CoV-2 infection of North American bats from people. This assessment focused on the active season for bats in the temperate zone of North America (April 15 through November 15), and used Myotis lucifugus (little brown bats) as a surrogate species. At the time of this work (April 2020), no empirical data about the effects of SARS-CoV-2 on North American bats were available, so a formal process of expert judgment was used to elicit estimates of the underlying parameters. Twelve experts in bat ecology, epidemiology, virology, and wildlife disease from the United States, United Kingdom, and Australia participated in the elicitation. A Monte Carlo simulation model was used to integrate the parameter estimates elicited from the experts and to predict the likelihood of exposure and infection in bats through a series of transmission pathways, with particular attention to capturing uncertainty in the predictions. Given the current state of knowledge as expressed by the expert panel, the results of this assessment indicate that there is a non-negligible risk of transmission of SARS-CoV-2 from humans to bats. For example, if a research scientist were shedding SARS-CoV-2 virus while handling bats under the field protocols used in North America prior to the COVID-19 pandemic, the risk model indicates that 50 percent (uncertainty, 15-84 percent) of those bats could be exposed to virus, and 17 percent (uncertainty, 3-51 percent) could become infected. Use of personal protective equipment, especially a respirator, is expected to reduce the exposure risk. The expert panel estimated that exposure risk from research scientists could be reduced 94-96 percent (uncertainty, 86-99 percent) through proper use of appropriate N95 respirators (a type of mechanical filter worn over the nose and mouth), dedicated clothing (such as Tyvek coveralls), and gloves. Should any North American bats become infected with SARS-CoV-2, the expert panel estimated that there is an approximately 33-percent chance the virus could spread within a bat population. This study, conducted by the U.S. Geological Survey in cooperation with the U.S. Fish and Wildlife Service, identified several critical uncertainties that could affect the estimate of risks associated with SARS-CoV-2 entering bat populations- notably, the underlying probability that a human would be shedding virus while working with bats, the likelihood of the virus replicating in bat tissue, and the likelihood of transmission of the virus within bat populations. Ongoing empirical work during May-October 2020 may shed light on these issues. Follow-up work is needed to better understand the probability of transmission of SARS-CoV-2 to bats from the general public;the manner in which the probabilities of exposure, infection, and transmission would differ during hibernation compared to the breeding season;and the likelihood of important effects, like morbidity and mortality in bats, the possibility of zoonosis from a North American bat reservoir, and effects of and on other wildlife.

News Coverage of Child Care during COVID-19: Where Are Women and Gender?

Research has long observed the absence of gender in child care policy, media, and elections. However, the COVID-19 pandemic has invoked critical questions about child care and its importance to states' economic recoveries around the world. In this research note, we analyze news coverage of child care in major Canadian daily newspapers to explore whether and how news narratives regarding child care are shifting in light of the COVID-19 pandemic. In particular, are we seeing a focus on women and gender in child care coverage amid the compounding pressures that women face in the current social and economic climate? The results of our analysis suggest that the pandemic has not shifted the conversation on child care and that current coverage principally reflects long-standing trends in child care framing. We find that gender remains systematically written out of coverage of child care, occluded by a larger focus on health-, economic-, and accessibility-related concerns about child care services.

Comparative analysis of immune-associated genes in COVID-19, cardiomyopathy and venous thromboembolism (preprint)

As of 28 August 2020, there have been 5.88 million Coronavirus Disease 2019 (COVID-19) cases and 181,000 COVID-19 related deaths in the United States alone. Given the lack of an effective pharmaceutical treatment for COVID-19, the high contagiousness of the disease and its varied clinical outcomes, identifying patients at risk of progressing to severe disease is crucial for the allocation of valuable healthcare resources during this pandemic. Current research has shown that there is a higher prevalence of cardiovascular comorbidities amongst patients with severe COVID-19 or COVID-19-related deaths, but the link between cardiovascular disease and poorer prognosis is poorly understood. We believe that pre-existing immune dysregulation that accompanies cardiovascular disease predisposes patients to a harmful inflammatory immune response, leading to their higher risk of severe disease. Thus, in this project, we aim to characterize immune dysregulation in patients with cardiomyopathy, venous thromboembolism and COVID-19 patients by looking at immune-associated gene dysregulation, immune infiltration and dysregulated immunological pathways and gene signatures.