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Domestic wastewater, when collected and evaluated appropriately, can provide valuable health-related information for a community. As a relatively unbiased and non-invasive approach, wastewater surveillance may complement current practices towards mitigating risks and protecting population health. Spurred by the COVID-19 pandemic, wastewater programs are now widely implemented to monitor viral infection trends in sewersheds and inform public health decision-making. This review summarizes recent developments in wastewater-based epidemiology for detecting and monitoring communicable infectious diseases, dissemination of antimicrobial resistance, and illicit drug consumption. Wastewater surveillance, a quickly advancing Frontier in environmental science, is becoming a new tool to enhance public health, improve disease prevention, and respond to future epidemics and pandemics.
ABSTRACT
OBJECTIVE: To assess rates of COVID-19 positivity in a fertility treatment population who continued to seek care throughout the pandemic. MATERIALS AND METHODS: A retrospective chart review of all patients actively pursuing fertility treatment and had a positive COVID-19 test between March 2020 and February 2021 at a University-affiliated IVF center was performed. Testing was performed on medication start date, and regularly throughout the treatment cycles, approximately once a week. Social distancing, mask use, and temperature and symptomatic screening was implemented early in the process. Rates of infection were calculated by dividing COVID-19 positive patients (whether symptomatic or asymptomatic) by total number of patients in care. This was then multiplied by 100,000, in order to compare our rates to the rate of cases in the state. Information on the general population's COVID-19 positivity rate was obtained from the State Department of Health. RESULTS: Rates of infection in our treatment population varied from 55 in August of 2020 to a high of 2333 per 100,000 in April of 2020. Rates of infection in the general population ranged from 167 per 100,000 to a high of 1367 in Nov of 2020. Our rates of infection did see a trend that was consistent with the curve of infections seen in the general population in the state (Table 1). CONCLUSIONS: Rates of infection were consistently at or below the state's rate per month for much of the 12-month period of study. The exceptions to this included April 2020, where we suspect that patients undergoing treatment were more likely than the general population to receive testing due to the center's testing policies compared to the lack of tests for the general population. Indeed, throughout the studied period, the patients receiving fertility treatment were much more likely than the general population to receive a test, as they were undergoing testing while asymptomatic. Additionally, the rate in February of 2021 was higher than that of the general population. IMPACT STATEMENT: The Covid-19 pandemic was unprecedented in the history of gynecologic endocrinology and infertility, and impacted the ability of patients to access fertility care worldwide. Our findings reveal that with proper mitigation techniques, infertility treatment can be safely delivered even in the face of a pandemic without radically increasing the risk of infection. (Table Presented).
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OBJECTIVE: To assess if COVID-19 infection differentially impacts first trimester outcomes in patients seeking infertility care at one large fertility practice. MATERIALS AND METHODS: A retrospective chart review of all female patients actively pursuing fertility care in a single fertility center with positive COVID-19 test results from March 2020 to February of 2021 was performed. Positive COVID-19 test results included PCR tests performed in our clinic and symptomatic patients who informed us of their outside positive test results by phone during their treatment with our clinic. This was compared to a control group of all comers in our clinic in 2020. Information was gathered on infertility treatment type, and pregnancy outcomes. Chemical pregnancy rate (CPR) is documented as a positive pregnancy test and ongoing pregnancy was documented as a positive fetal heart beat between 7-8 weeks of gestation and discharge to routine OBGYN care. Fishers exact test was used to calculate p value, statistically significant associations were considered to exist when the p value ≤0.05. RESULTS: A total of 178 cases of COVID-19 were documented in patients between April 2020 and February 2021. After COVID-19 infection (Covid+) sixty-two pregnancies were documented, with sustained implantation in fifty-three (85%) patients. In the subgroup of Covid+ patients that underwent subsequent fertility treatment the CPR was 30.1% with IUI, and 70.1% with IVF and single frozen embryo transfer. This is in comparison to our control population CPR of 14.1 % with IUI (p=0.002) and 68% (p=0.78) with IVF with single embryo transfer (Table 1). Clinical pregnancy loss rate was recorded and shown in Table 1. CONCLUSIONS: In an infertile population, a recent history of COVID-19 diagnosis did not negatively impact pregnancy outcome as measured against a control population. One of the limitations of this study was the relatively small sample size, which may have conflated our data on COVID-19 patients who underwent IUI, whose higher rate of pregnancy is unlikely to be clinically significant. IMPACT STATEMENT: Patients who have had COVID-19 and then proceeded with infertility treatment were no more likely than our control population to have first trimester complications in one fertility clinic. The findings from this study should provide reassurance that attempts at pregnancy do not need to be delayed after recovery from a COVID-19 diagnosis.
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Introduction: Occupational noise exposure can lead to noise-induced hearing loss (NHL) with serious health and economic consequences for workers. The Center for Disease Control and Prevention and the National Institute for Occupational Safety and Health (NIOSH) have published a recommended exposure limit of 85-decibels (dB) for workplace exposure to prevent NHL. Despite these recommendations for workplace noise exposure, little is known about the noise levels generated during gastrointestinal (GI) endoscopy. We aimed to investigate the noise generated by suction during GI endoscopy. Methods: Sound levels were measured using the “NIOSH Sound Level Meter” smart phone application. The noise generated from an adult colonoscope (Olympus HQ190) at various levels of suction were measured using Neptune 3 (Stryker, Kalamazoo, MI) mobile surgical suction device (SSD) that allows a wide range of suction pressure levels versus “traditional” wall suction (WS). Measurements were obtained as average levels over a 30-second interval in a quiet, outpatient ambulatory endoscopy room. Noise measurements were obtained at various positions within the room (endoscopist, nurse/ technician) as well as next to the endoscope suction button. The measurements were obtained with the endoscopist applying no suction, partial suction and complete suction. Results: With the SSD, sound levels increased as suction pressure increased. The highest sound levels were generated when no endoscopic suction was applied. None of the measurements exceeded recommended exposure limits set by the NIOSH (Table 1). With pressure levels set at 200 mmHg (traditional wall suction maximums) sound levels at the endoscopist for SSD and WS were 54.3 dB and 47.1 dB, respectively, e.g. more than 7 times louder. Conclusion: Little is known about the occupational safety of noise levels in endoscopy nor the contribution suction contributes. In this study, noise levels did not exceed the recommended exposure limit set by the NIOSH. However, SSD generates significantly more noise than WS at the same pressure levels. While these levels may not constitute an occupational hazard, they make communication more difficult especially in the COVID era of enhanced PPE (e.g. face shield, N95). The techniques developed during the study offer a simple process that can be implemented in any GI endoscopy suite to assess the contributions of suction to workplace noise..
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Background: In 2020, Med Learning Group (MLG) launched an interactive, multi-faceted educational initiative focusing on COVID-19. The innovative education & tools developed for FRONTLINE are publicly available for the entire healthcare community to use. Learners range from a variety of specialties, including infectious disease specialists, pulmonary medicine specialists, emergency room practitioners, advanced practitioners, nurses, & other healthcare professionals to help support them in their effort to optimize care of patients with COVID-19. MLG partnered with Health Resources & Services Administration, Project ECHO, Public Health Foundation & community, VA & academic centers to create a collaborative network with shared goals for education. Methods: This initiative seeks to reach over 25,000 learners with innovative educational programs & tools to enhance the learning experience, facilitate continuous learning & support the translation of education into practice, & encourage HCPpatient dialogue: • COVID Community of Care Website/Application • COVID Frontline Update Podcast Series • Virtual/Live ECHO Series with 3D animations of pathophysiology • Enduring ECHO Module with Case Discussions • Quality Improvement Personalized Posters Results: By September 2020, we will have the results from pre/posttests, intra-activity Q&A, evaluations, & 60- to 90-day follow-on assessments. We will evaluate learners' changes in knowledge & competence, & reported practice changes. In addition, MLG will have feedback collected via surveys & interviews on the various point-ofcare tools. Based off previous MLG educational initiatives, it is expected that learners will find value in the various tools available in this programming. Conclusion: Advanced tools like virtual live learning platforms, mobile websites/ apps, 3D animations & podcasts will prove to be an asset to the continuing education of HCPs treating patients with COVID-19. The outcomes are expected to demonstrate the extent to which HCPs have enhanced their ability to identify clinical predictors of disease severity of COVID-19 & apply current treatment guidelines, clinical trial data, & patient-specific factors to the management of patients with COVID-19. These results will be available in time to share via a poster at IDWeek 2020.