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Introduction: Following hospitalisation with SARS-Cov2 infection a large proportion of individuals report fatigue as a persisting symptom. Here, we performed a detailed study of the muscle for insight into underlying mechanisms. Method(s): Adults were recruited at 5-7 months following hospital discharge for severe SARS-Cov2 infection (n=21), along with control volunteers (n=10) of a similar age, gender, ethnicity and body mass. Perceived fatigue was estimated using the fatigue severity scale. The short physical performance battery test determined habitual functionality, alongside isometric quadriceps strength normalised for appendicular mass and isokinetic force loss during 20 knee extensions (Cybex Norm dynamometer). Leg muscle volume, and phosphocreatine (PCr) resynthesis during recovery from ischemic plantar flexion exercise (an index of muscle metabolic resilience) were quantified using MRI and 31P MRS. Student t-test was used to detect differences between groups and all data are mean (SD). Result(s): Patients (P) reported greater perception of fatigue and demonstrated worse habitual functionality compared to controls (C). However, leg volume [P: 2,578 (303) cm3/m2 vs C: 2,384 (289) cm3/m2, p=0.1], strength [P: 21.8 (4.1) Nm/kg vs C: 21.1 (4.5) Nm/kg, p=0.7], force loss [P: 25% (6) vs C: 21% (10), p=0.1] and PCr recovery kinetics (Qmax) [P: 25.8 (11.3) vs C: 22.8 (8.7), p=0.5] were not different. Conclusion(s): Despite greater perception of fatigue and lower habitual functionality, patients recovering from severe COVID-19 infection did not have altered muscle volume, strength, fatiguability or metabolic resilience compared to controls.
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Falls, considered a serious health-related concern for the elderly people, are associated with multiple diverse and dynamic needs for the elderly people themselves, their caregivers, their family members, and healthcare professionals. The modern-day Internet of Everything lifestyle is characterized by people using the internet for a multitude of reasons which also includes seeking and sharing information related to such needs. Such activity on the internet results in the generation of tremendous amounts of web behavior-based Big Data which can be studied and analyzed to investigate the trends in the underlining needs and the associated web search interests. The COVID-19 pandemic that the world is facing right now has impacted the elderly population to a significant extent. In fact, the elderly population is considered a demographic group that is most likely to get infected by this virus and develop serious symptoms, which could lead to hospitalizations and death. There hasn't been any study conducted in the field of aging research thus far that investigates how the COVID-19 pandemic may or may not have impacted the needs related to fall detection in the elderly. This work aims to address this research challenge. A dedicated methodology based on Google Trends is proposed in this paper that studies the web behavior-based Big Data related to fall detection from different countries both before and after the pandemic. The preliminary results presented from the analysis of the web behavior-based Big Data from 14 countries - USA, India, Germany, United Kingdom, Spain, Australia, Indonesia, Malaysia, Thailand, South Africa, Canada, Philippines, Sweden, and Ireland, which are amongst the countries worst hit by COVID-19, shows evidence that the pandemic had an impact towards increasing the web search interests related to fall detection in multiple countries. © 2022 ACM.
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P226 Figure 1ConclusionPatients recovering from severe Covid-19 have worse insulin sensitivity compared to controls, but similar metabolic flexibility. Physical inactivity and liver adiposity may play a role in these observations.FundingNIHR Nottingham BRC (NoRCoRP), PHOSP UKRI, Nottingham Hospitals Charity, University of Nottingham alumni donation.
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Aims Improving access to Hackney Integrated Learning Disability Service (ILDS) using quality improvement (QI) methodology by reducing the time taken to complete eligibility assessment by 50% by April 2021, while improving service user and staff experience. Background Referrals to ILDS require assessment of eligibility. It was noted that there was significant waiting time between referral and eligibility assessment, exacerbated by the COVID-19 pandemic. Quality Network for Community Learning Disability Services guidelines suggest waiting times for those accessing adult learning disability (LD) community services be locally agreed, although there is limited literature on this topic. Methods All staff members across the multidisciplinary team were invited to participate in the QI project. We defined outcome measures as days from referral to allocation of eligibility assessment to staff member and to completion of eligibility assessment, comparing referrals received before and after start of the project. The key change ideas tested using Plan-Do-Study-Act cycles were: (1) eligibility screening checklist, (2) eligibility assessments drop-in sessions for staff, (3) formal training for ILDS staff, (4) eligibility screening allocation system, (5) template letters for eligibility decisions, (6) new ILDS referral form, (7) workshops for local general practitioners. Results Time taken to eligibility assessment allocation decreased from median of 184 (mean=183.5 +/- 109.8) to 13 days (mean=19.9 +/- 26.4) (93% reduction). Time to completion of eligibility assessment decreased from a median of 271 (mean=296.0 +/- 133.8) to 63 days (mean=75.7 +/- 34.8) (77% reduction). We received positive feedback from staff and service users regarding the new eligibility process. Conclusions We report waiting times for accessing our community adult LD services and effective strategies for reducing this. We recommend similar services use a QI methodology to reduce waiting times and improve the experience of staff and service users.
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Francisella tularensis is a virulent bacterium which hijacks the host's immune response, turning cells usually tasked with killing foreign organisms as nutrient-rich receptacles for rapid multiplication. It is designated a Tier 1 Select Agent by the US CDC due to its potential to cause widespread mortality upon deliberate release. In this study, the key biological mechanisms of host infection are modelled as a continuous-time Markov chain (CTMC) and solved via discrete event simulation (DES). The efficacy of various medication strategies at the behest of public health authorities are investigated. Without treatment, the median lethal dose - not previously considered in humans - is estimated at approximately 1,000 organisms. Results suggest that fatality can be averted if antibiotics are administered for at least 7 days, no later than 10 days post exposure. In a mass casualty setting, this can reduce symptomatic cases by 18% from the baseline involving no medication. Reductions of 59% are possible if medication can be disseminated no later than 5 days post exposure, mitigating otherwise severe pressure on healthcare services. Novel use of CTMC and DES highlight the potential for OR in the field of immunology, where further opportunities may present in a post COVID-19 world.
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Background: On March 13, 2020 a national emergency was declared and protective measures were implemented in response to the COVID-19 pandemic. PrEP prescriptions had increased in the United States since 2014, but shutdown because of COVID-19 resulted in decreased use of health services. The objective of this study was to evaluate the impact of the COVID-19 on PrEP prescriptions in the United States. Methods: We analyzed data from the IQVIA Real World Data-Longitudinal Prescriptions Database from 2017 to the end of June 2020. Using a validated algorithm, we identified PrEP prescriptions and new PrEP users. We used a Bayesian structural time series model to predict the trajectory in PrEP prescriptions for the period of March 15-June 27, 2020 in the absence of the pandemic. The prediction was computed based on the pre-COVID-19 weekly PrEP data from January 1, 2017 to March 14, 2020 in the IQVIA database and adjusted for decreased PrEP prescriptions during holidays. The impact of COVID-19 was inferred by the differences between predicted and observed time series. We stratified the effect of COVID-19 on PrEP prescriptions by age group, insurance type, and among 10 states with most PrEP prescriptions prior to the national emergency declaration. Results: In the absence of the pandemic, our time series model predicted that there would have been 264,281 PrEP prescriptions during March 15-June 27, 2020 and we observed 222,589 PrEP prescriptions in the IQVIA database, a 15.8% reduction after the emergency declaration (Figure). The model predicted 43,636 new PrEP users during the same time period and we observed 29,971 new PrEP users, a 31.3% reduction after the emergency declaration. The impact of the pandemic on PrEP prescriptions was greater for those who paid for PrEP with cash (34.3% reduction in PrEP prescriptions;44.3% reduction in new PrEP users). The COVID-19 impact varied among the 10 states with the most PrEP prescriptions prior to the pandemic, ranging from 6.8% to 25.1% reductions in PrEP prescriptions and 19.8% to 48.1% reductions in new PrEP users. The number of new PrEP users began to increase towards the end of June 2020. Conclusion: Closures during the initial phase of the COVID-19 pandemic resulted in decreases in PrEP prescriptions and even more in new PrEP users. Ongoing monitoring is warranted to assess whether the impact has abated since June 2020. The reasons for decreased PrEP prescriptions could be lack of access to care or decreased risk behavior during the pandemic.
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BACKGROUND: COVID-19 care home outbreaks represent a significant proportion of COVID-19 morbidity and mortality in the UK. National testing initially focused on symptomatic care home residents, before extending to asymptomatic cohorts. AIM: The aim was to describe the epidemiology and transmission of COVID-19 in outbreak free care homes. METHODS: A two-point prevalence survey of COVID-19, in 34 Liverpool care homes, was performed in April and May 2020. Changes in prevalence were analysed. Associations between care home characteristics, reported infection, prevention and control interventions, and COVID-19 status were described and analysed. FINDINGS: No resident developed COVID-19 symptoms during the study. There was no significant difference between: the number of care homes containing at least one test positive resident between the first (17.6%, 95% confidence interval (CI) 6.8-34.5) and second round (14.7%, 95% CI 5.0-31.1) of testing (p>0.99); and the number of residents testing positive between the first (2.1%, 95% CI 1.2-3.4) and second round (1.0%, 95% CI 0.5-2.1) of testing (P=0.11). Care homes providing nursing care (risk ratio (RR) 7.99, 95% CI 1.1-57.3) and employing agency staff (RR 8.4, 95% CI 1.2-60.8) were more likely to contain test positive residents. Closing residents shared space was not associated with residents testing positive (RR 2.63, 95% CI 0.4-18.5). CONCLUSIONS: Asymptomatic COVID-19 care homes showed no evidence of disease transmission or development of outbreaks; suggesting that current infection prevention and control measures are effective in preventing transmission. Repeat testing at two to three weeks had limited or no public health benefits over regular daily monitoring of staff and residents for symptoms. These results should inform policies calling for regular testing of asymptomatic residents.