The deadly air we breathe: How infectious illness built the modern city

For many historians of disease and medicine, the first months of the coronavirus pandemic were disorienting and sobering. The question “What can history teach us about COVID-19?” seemed omnipresent in print and digital media. Yet historical perspectives on the crisis not only came with the standard caveats—that each epidemic and historical era is distinct and should not be generalized—but also quickly made clear that even protocols based on lessons learned from the influenza pandemic in 1918/19 or SARS in 2003 had limited value. Nonetheless, what history does offer is a trajectory to understanding a modern approach to epidemics which was shaped by events centuries ago. During the late sixteenth and seventeenth centuries, pandemic cities in Europe responded by introducing quarantines anticipating the steps taken during COVID-19. This essay argues that the histories of infectious diseases and modern cities have been intertwined, not only because cities foster the spread of disease but also because accounts of urban events have framed our understanding of epidemics and epidemics effected enormous changes in the cities. © 2022 selection and editorial matter, Irene Gammel and Jason Wang;individual chapters, the contributors.

Development of a Low-Cost, Compact, and Portable Experimental Kit for Online Engineering Statics Course

Online education is expanding rapidly. The ongoing COVID-19 pandemic has forced many universities to move from conventional, face-to-face instruction to hybrid or entirely online instruction. To overcome this unprecedented situation, instructors have modified course content and laboratories to be available virtually while trying to make them as interactive as possible. Virtual laboratories are either mostly pre-recorded experiments or involve controlling physical/virtual equipment through an online interface. None of these methods provide an adequate hands-on learning experience, which is essential for understanding fundamental engineering concepts. For online and distance learning programs, hands-on activities in a laboratory classroom setting are not always feasible, generating a strong push to develop low-cost, compact, and portable experimental toolboxes and kits that individual students can obtain. A group of faculty, students, and staff at the University of Indianapolis has developed an experimental toolbox that allows students to visualize engineering statics fundamentals. The experimental kit and a list of experiments complete with instructions will be made available to the students at the beginning of the course to perform the laboratory-style experiments at home. Students will be able to collect an experimental kit from campus with an appropriate deposit (each kit costs approximately $180 to $200 US). The university can also ship kits to students' addresses upon request with an additional delivery cost. Students can return the experimental kit at the end of the course and have their deposits returned. Performing laboratory style experiments at home using these kits will provide a valuable hands-on learning experience. © American Society for Engineering Education, 2021

Effect of the COVID-19 pandemic on ICU ischemic and hemorrhagic stroke outcomes

Objective: Evaluate impact of COVID-19 pandemic on mortality and care limitations in critically-ill stroke patients. Background: COVID-19 pandemic overwhelmed medical systems leading to resource shortages in many regions, which may impact care limitations and mortality in non-COVID patients. This is of particular concern in severe stroke population where perceived poor prognosis can lead to early care limitations and the self-fulfilling prophecy of worse outcomes. Design/Methods: During first 3 months of COVID-19 pandemic (03/28/30-06/28/20) we prospectively enrolled consecutive adults with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) meeting pre-pandemic criterial for intensive care unit (ICU) admission at single comprehensive stroke center, systematically recorded COVID-19 status, pre-existing code status, disease severity, transition to do-notresuscitate (DNR), do-not-intubate (DNI), and comfort measures (CMO) code status and inhospital mortality. Results were compared with a 3-months retrospective cohort from prior to global COVID-19 pandemic (10/1/19-12/31/19). Results: Pandemic cohort (N=196, mean age 63, 48% female, 60% AIS, 26% ICH, 14% SAH, 22% COVID-19 person-under-investigation) and pre-pandemic cohort (N=199, mean age 63, 46% female, 58% AIS, 26% ICH, 16% SAH) were similar. Our hospital did not experience resource shortages during peak pandemic. Compared with the pandemic cohort, pre-pandemic cohort had similar stroke severity scores but more pre-existing care limitations at admission (90% vs. 98% full code, p=0.005), more frequent transition to DNR (13% vs. 5%, p=0.0025), DNI (10% vs. 3%, p=0.0078), and higher in-hospital mortality (21% vs. 9%, p=0.0012). Conclusions: COVID-19 pandemic was associated with lower incidence of care limitations and in-hospital mortality in severe stroke patients at a stroke center that did not experience resource shortages. Further studies are needed to determine whether these results are due to in-person family visit restrictions during the pandemic. Multicenter studies are needed to determine whether these observations hold true in centers impacted by resource shortages.

Neurologic manifestations associated with COVID-19 in hospitalized patients

Objective: To identify major phenotypes of neurologic manifestations and their prevalence in hospitalized patients infected with severe acute respiratory syndrome corona virus disease 2019 (COVID-19). Background: Emerging evidence suggests COVID-19 presentation is not limited to the respiratory system but may have multi-organ involvement including dysfunctions of the nervous system. However, little is known about the major phenotypes, prevalence, and impact of nervous system involvement on patient outcomes. Design/Methods: We are the coordinating center and part of the GCS-Neuro COVID consortium tier 1 pragmatic study. We prospectively screened 127 consecutive patients admitted to a large academic hospital from 03/22/2020 to 09/05/2020. Adults age ≥ 18 years old admitted to the hospital with suspected or confirmed COVID19 infection were included. Eight patients met exclusion criteria of severe pre-existing baseline neurologic dysfunction such as coma or vegetative state that limit detection of new or worsening neurologic symptoms. Results: Of the total cohort of 119 patients (mean age 63.4 years, 48% women), 73 (61.3%) exhibited new/worsening neurologic symptoms. The most common phenotype was acute encephalopathy (44%), followed by headache (40%), abnormal smell/taste (23%), and new movement abnormalities (21%). Other neurologic manifestations included clinical or electrographic seizures (10%), coma (4%), and intracerebral hemorrhage (3%). Neurologic symptoms began an average of 6.2 days after respiratory symptoms (range 0 to 48), although 2 patients developed neurologic symptoms before respiratory symptoms. COVID-19 patients with neurologic symptoms were less likely to have a favorable outcome at discharge (24.6%) with mRS (0-1) compared to those without neurological symptoms (61.9%). Conclusions: Neurologic manifestations in patients infected with COVID-19 are prevalent and have significant impact on patient outcomes at acute hospital discharge in this single-center study. Further studies are underway to better characterize neurologic symptoms as well as follow-up to determine the long-term impact of COVID-19 on patient outcome and recovery.

Acute hospital outcomes COVID-19 associated neurological dysfunction

Objective: Determine outcomes of hospitalized adult patients with severe acute respiratory syndrome coronavirus disease-2019 (COVID-19) and neurological dysfunction. Background: Emerging data suggest a wide range of neurological symptoms associated with COVID-19. Outcomes of patients with neurological dysfunctions and COVID-19 is unknown. Design/Methods: A prospective cohort of 127 consecutive adult (age≥18) patients admitted with suspected or confirmed COVID-19 infection to single academic hospital from 30/22/2020-09/05/2020 were included. We are part of the GCS-NeuroCOVID consortium. Eight patients met exclusion criteria of severe pre-existing baseline neurologic dysfunction that limit detection of new or worsening symptoms. Neurological dysfunctions were systematically recorded. Global outcome is measured by modified Rankin Score (mRS) at hospital discharge. Between-group differences were compared using parametric or non-parametric test based on data distribution. Results: The final cohort consisted of 119 COVID-19 subjects where 73 (61%) had new neurological dysfunction. Patients with neurological dysfunctions had similar mean age (63.4 vs. 59.3 years) and gender distribution (52% vs. 50% male) compared to those without neurological dysfunction. Presence of neurological dysfunction is associated with need for mechanical ventilation (39.7% vs. 10.9%, p=.0007), longer median ICU (4 vs. 0 days, p=.0004) and hospital lengths of stay (12.5 vs. 6 days, p=.0007), worse functional outcome at discharge (mRS 3 vs. 1, p=.002) and non-home discharge destination (43% vs. 70%, p=.002). Neurological symptoms may be associated with higher incidence of do-not-resuscitate code status (27% vs. 13%, p=0.058) but did not impact in-hospital mortality (17.8% vs. 8.7%, p=0.19). Conclusions: COVID-19 patients with new or worsened neurological dysfunction are more likely to require mechanical ventilation, had longer ICU and hospital length of stay, and worse global functional outcome at discharge. Relatively low mortality rate makes this study underpowered to detect a between-group mortality difference. Future studies are needed to determine long-term outcome impacts of neurological dysfunction associated with COVID-19.

Bias in Medicine: Lessons Learned and Mitigation Strategies.

Cognitive bias consists of systematic errors in thinking due to human processing limitations or inappropriate mental models. Cognitive bias occurs when intuitive thinking is used to reach conclusions about information rather than analytic (mindful) thinking. Scientific progress is delayed when bias influences the dissemination of new scientific knowledge, as it has with the role of human leucocyte antigen antibodies and antibody-mediated rejection in cardiac transplantation. Mitigating strategies can be successful but involve concerted action by investigators, peer reviewers, and editors to consider how we think as well as what we think.