The effect of co-location on human communication networks

The ability to rewire ties in communication networks is vital for large-scale human cooperation and the spread of new ideas. We show that lack of researcher co-location during the COVID-19 lockdown caused the loss of more than 4,800 weak ties—ties between distant parts of the social system that enable the flow of novel information—over 18 months in the email network of a large North American university. Furthermore, we find that the reintroduction of partial co-location through a hybrid work mode led to a partial regeneration of weak ties. We quantify the effect of co-location in forming ties through a model based on physical proximity, which is able to reproduce all empirical observations. Results indicate that employees who are not co-located are less likely to form ties, weakening the spread of information in the workplace. Such findings could contribute to a better understanding of the spatiotemporal dynamics of human communication networks and help organizations that are moving towards the implementation of hybrid work policies to evaluate the minimum amount of in-person interaction necessary for a productive work environment. © 2022, The Author(s), under exclusive licence to Springer Nature America, Inc.

Development, Implementation, and Delivery of a Remote Burnout Prevention Elective Course in an Accelerated Doctor of Pharmacy Program During COVID-19

Purpose: There is limited evidence describing burnout among graduate health professions students, including pharmacy students, and there is a need for educational institutions to mitigate burnout and promote future healthcare provider wellness. Methods: A burnout prevention elective course was developed within an accelerated Doctor of Pharmacy program. Course faculty transitioned from live to fully remote instruction in April 2020. The modified course format combined discussion-based lectures, burnout self-assessments, reflective writing assignments, and applications-based presentations. Results: Twentyone second-year pharmacy students completed the elective, and 13 completed post-course evaluations (61.9% response rate). Evaluations indicated substantial student support, with 92.3% "strongly agree" and 7.7% "agree" responses for all questions. Students suggested incorporating this course into the core didactic curriculum rather than offering it as an elective. Conclusion: Pharmacy programs considering piloting similar courses may effectively implement them even under the modified learning conditions imposed by COVID-19.

Portable Ultraviolet-C Chambers for Inactivation of SARS-CoV-2

The goal of this project was to create and optimize the performance of portable chambers for reliable ultraviolet (UV) disinfection of personal protective equipment (PPE) and enable its safe reuse. During unforeseen times of high demand for PPE, such as during the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), single-use PPE supply can be quickly depleted. UV radiation has been shown to disinfect materials with high efficacy. This paper reports the design and construction of two 280 nm ultraviolet-C (UV-C) disinfection chambers in the form of portable chambers with 46 cm x 46 cm x 46 cm interior dimensions, one using light-emitting diodes and the other using mercury vapor lamps. This paper summarizes and presents a review of SARS-CoV-2 UV deactivation research during 2020 to 2021. Additionally, this paper discusses efforts to increase the uniformity and overall intensity of the UV-C radiation within the chambers through the installation of a UV-reflective, porous polytetrafluoroethylene (PTFE) material. A calculator prototype was additionally designed to calculate the reduction of SARS-CoV-2 as a result of UV-C disinfection, and the prototype code is presented. The paper describes the selection of UV-C radiation sources for the chambers and the chambers' mechanical and electrical design, PTFE installation, testing, and safety considerations.

Legal Extension Strategies to Increase Awareness of Drinking Water Contaminant Regulatory Framework

It is important for stakeholders, scientists, industry, lawyers, and decision-makers to understand the varying approaches to regulating drinking water contaminants. To increase awareness and understanding among stakeholder audiences of the legal framework for drinking water protection, the National Sea Grant Law Center (NSGLC) at the University of Mississippi School of Law has developed and implemented research and extension projects for lead, nitrates, and per-and polyfluorinated substances (PFAS). The NSGLC's mission is to encourage a well-informed constituency by providing legal information and analysis to the Sea Grant community, policy makers, and the general public through a variety of products and services. For each contaminant, the NSGLC conducted legal research to identify relevant laws, regulations, policies, and court decisions to gain an in-depth understanding of the existing legal framework. The NSGLC then translated its information on the current legal framework, identified gaps, and potential solutions into a variety of outreach programming. For each of the relevant drinking water contaminants, the NSGLC has taken different outreach approaches. For lead, the NSGLC has worked with an interdisciplinary academic team to conduct community-based research and outreach directly to families. With nitrates, the NSGLC has focused more on professional development for attorneys, natural resource managers, and other policy makers. With PFAS, the NSGLC is proposing a hybrid approach, drawing on lessons learned from its previous projects and the COVID-19 pandemic, to disseminate information to both professionals and communities. This case study will synthesize key findings on the legal overview, potential legal issues, and outreach efforts for lead, nitrates, and PFAS.

Allelic variation in class I HLA determines CD8(+) T cell repertoire shape and cross-reactive memory responses to SARS-CoV-2

[Figure: see text].

Clinical profiles of neonates born to mothers with COVID-19

Background The risk of congenital infections in neonates born to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected mothers and those breastfed by infected mothers remains largely unknown. Objective To describe the outcomes and clinical features of neonates born to mothers infected with SARS-CoV-2 during pregnancy, to follow up neonates who were positive for SARS-CoV-2 at the time of delivery for a period of 1 month, and to identify potential risk factors associated with disease transmission. Methods This prospective observational study on neonates born to SARS-CoV-2-infected mothers between June 2020 and January 2021 was carried out after getting written informed consent in a tertiary care government hospital (Government Medical college Kannur, North Kerala, India). The clinical and demographic characteristics of infected mothers were reviewed. Neonates were tested for SARS-CoV-2 infection within 24 hours of birth, with repeat testing on day 5 for those who were negative at birth. The demographic and clinical characteristics as well as potential risk factors for disease transmission in these neonates were evaluated. Results A total of 342 neonates (95.3%) were tested for SARS-CoV-2 infection at birth. Rooming-in and breastfeeding was practiced in 75% of at-risk neonates. Fifty neonates tested positive for SARS-CoV-2 infection at birth (14.3%);293 neonates who tested negative at birth remained so on day 5, except one baby isolated with a caretaker who also tested positive, indicating postnatal infection. There was no statistically significant increased risk of infection in neonates born to SARS-CoV-2-positive mothers compared to those born to mothers who had already become negative at delivery. Mild symptoms were present in 8% of positive neonates. On one-month follow up, all neonates were well and gaining weight. Conclusion Vertical transmission, in particular trans-placental, may be possible in SARS-CoV-2-infected mothers. Maternal infection at the time of delivery is not a predictor for increased vertical transmission compared to mothers whose infections had resolved prior to delivery. Breastfeeding with appropriate hygiene measures is not a risk factor for horizontal transmission.

P.79 A care bundle to improve perioperative care of women having caesarean section under general anaesthesia using appreciative methodology

Introduction: Two failed intubations at our Trust highlighted the need to examine current practice for obstetric general anaesthesia. The aim of this medical student project was to examine the entire care pathway of women undergoing a general anaesthetic for caesarean section (CS) and introduce interventions to improve care. The first element included optimising rates of first-time intubation;the second involved optimisation of post-op analgesia;the third investigated follow-up for women who had difficult/failed intubations perinatally. Methods: A blended methodology was used: traditional ’PDSA’ quality improvement methods were employed with appreciative inquiry (AI). AI is an approach to organisational improvement that focuses on strengths and assets, rather than the traditional approach of focussing only on adverse incidents or failures. On account of COVID, planned face-to- face interviews and direct observation of practice could not proceed. Questions where therefore emailed to all staff. Questions were appreciative and thus focussed the responder on situations where care had gone well, as well as identifying areas for improvement. Stakeholders were actively encouraged to be creative and submit their ideas for improvement as part of the co-development of the service. Results: Regarding improving rates of successful intubation, 23 anaesthetists and ODP’s responded. The most important factors in successful intubation were thought to be: systematic approach, patient positioning;equipment preparation and a calm environment. Interestingly, ’leadership’ and ’procedural skill’ were mentioned least frequently. Suggestions for enhancing safety included clearly communicated plans for difficult/failed intubations. Sixty-five percent of respondents requested further teaching on obstetric difficult airway management;with suggestions such as 30 second simulation drills, revision of OAA/DAS and changing attitudes towards obstetric anaesthesia so that trainees are less fearful. The post-operative questionnaire gained 31 responses. The current post-CS advice and leaflet was felt to be inadequate (58%). The need for improved advice on pain management and activity was highlighted. Common practice following difficult intubation included face-to-face discussions with the patient and logging on the Difficult Airway Society database. Some wrote to the GP. Discussion: Based on the findings, a number of action plans have been implemented: 1) Regular 30 second MDT simulated intubation drills 2) new easy-read, obstetric intubation prompt (to be used in conjunction with OAA/DAS flowchart) to be visible in maternity theatres 3) Generation of rapid pre- intubation checklist 4) Publication of a new leaflet to address pain control and activity post LSCS, to include helpful quotes from past patients. 5) Production of a checklist to ensure standardisation of process for women who have had difficult/failed intubation.

Exploring the pandemic's potential effects on workers' collectivist values, prosocial behaviors, and attitudes toward mistreatment

The global COVID-19 pandemic has fundamentally changed the way we live and work in the short-term, but history suggests that the crisis may also exert deeper, longer-lasting effects. With the aim of providing preliminary insight into this possibility, we theoretically construct and empirically test hypotheses for how exposure to COVID-19 stimuli (e.g., reading or watching media coverage, observing relief efforts) relates to the deep-seated values that guide workers' attitudes and behaviors. Specifically, we build from prior work to posit that exposure to COVID-19 stimuli is positively associated with workers' self-transcendent prosocial values, which motivate prosocial behaviors directed toward society as a whole (i.e., charitable donations) and coworkers (i.e., helping). Extend the extant literature, we further argue that exposure to COVID-19 stimuli will be positively associated with conservation values emphasizing self-restraint, submission, protection of order, and harmony in relations, which in turn influences workers' willingness to tolerate mistreatment by authorities (i.e., abusive supervision, authoritarian leadership, exploitation). Evidence from 2,929 full-time Chinese employees tracked for nearly 2 months and a diverse sample of 310 workers in the United States generally support our arguments, but also provide insight into potential cultural nuances. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

COVID-19 pandemic related improvement in hospital utilization and outcomes for children on home mechanical ventilation

Introduction: The COVID-19 pandemic has disrupted healthcare systems worldwide. In addition to the direct impact of the virus on patient morbidity and mortality, the effect of lockdown strategies on health and healthcare utilization have become apparent. The effect of the pandemic on children on home mechanical ventilation is unknown. We examined the impact of the pandemic on pediatric healthcare utilization in children on home mechanical ventilation. Methods: Between March 11 and December 1, 2020, we conducted a single center, retrospective analysis of 81 children, younger than 18 years old, on home mechanical ventilation who are followed at the UT Physicians High Risk Children's Clinic. Using the same cohort of patients, we compared healthcare utilization during the pandemic in 2020 to the same period in 2019. Results: We observed a massive decline in pediatric healthcare utilization during the pandemic year compared with the previous year. Emergency department total visits decreased by 70% (33 vs 10) (p<0.01). Total number of hospital admissions declined by 38% (52 vs 32) (p=0.03). The mean length of stay (LOS) in hospital admission was 6.7 days in 2019 and 5.3 days in 2020 (p=0.3). Similarly, pediatric intensive care unit (PICU) admissions reduced by 57% (30 vs 13) (P=0.04), and the mean PICU LOS was 7.5 days in 2019 and 6.0 days in 2020 (p=0.5). Mortality did not change during 2020 period (1 vs 0). Conclusions: Our data illustrate a significant improvement in pediatric hospital utilization and outcomes for children on home mechanical ventilation during the COVID-19 pandemic. We speculate that fewer medical office visits, increase in telehealth follow ups, school closures, social distancing, massive mask utilization, and increased hand washing during the pandemic year were protective factors that contributed to a lower hospitalization rate. However, we cannot fully exclude the possibilities of natural history of disease fluctuation, or regression to the mean phenomenon. More studies are needed to confirm the etiology of these findings.

Sars-cov-2 surveillance in 14 health facilities in malawi

Background: As of October 26, 2020, Malawi reported 5,894 confirmed COVID-19 cases with 183 deaths. A state of disaster was declared in March;however, a strict lockdown order was never issued. Malawi has implemented a testing strategy involving screening and testing only symptomatic persons due to limited availability of tests. Sentinel surveillance was conducted with the primary purpose of estimating the prevalence of symptomatic and asymptomatic SARS-CoV-2 infection among children >5 years and adults in Malawi health facilities (HF). Methods: SARS-CoV-2 surveillance was conducted at 14 purposively selected HFs across 8 districts in all 3 regions of Malawi from August 27 to October 14, 2020. Persons entering HFs were screened for COVID-19 symptoms;all those with symptoms suggestive of COVID-19 per Malawi guidelines and a systematic sample of asymptomatic individuals were invited to participate. Questionnaire data and nasopharyngeal swabs were collected from consenting persons. Infection was confirmed by SARS-CoV-2 RT-PCR assay (Abbott m2000). This preliminary analysis was restricted to those with test results. We performed chisquare tests to assess bivariate associations between demographic or behavioral characteristics and SARS-CoV-2 status stratified by symptom status. Results: A total of 8,169 (1,350 symptomatic, 6,819 asymptomatic) individuals were enrolled. Results are currently available for 1,300 (96%) symptomatic and 6,648 (97%) asymptomatic participants. A total of 30 (2%) symptomatic and 37 (0.6%) asymptomatic participants tested SARS-CoV-2 positive (Table). Most (67%) positive symptomatic participants were aged 15-49 years, followed by 50+ years (30%);a similar trend was seen for asymptomatic cases. A higher percentage of symptomatic cases reported being in contact with a confirmed or suspected COVID-19 case than symptomatic non-cases (p=.03). Among positive symptomatic individuals, the most common symptom was cough (70%);fever and loss of smell or taste were reported in 13% and 10% of individuals, respectively. Most COVID-19 cases in both symptom groups reported not adhering to social distancing guidelines. Conclusion: Based on preliminary data, asymptomatic SARS-CoV-2 infection in Malawians visiting HFs was relatively rare. This suggests a need for continued surveillance to ensure a better understanding of exposures as well as further monitoring of SARs-CoV-2 transmission in Malawi.

Resilience of HIV activities during COVID-19 pandemic at health facilities in africa

Background: The COVID-19 pandemic has impacted healthcare access due to travel restrictions, fear of exposure at health facilities (HF), changes in national policies and redirection of resources. We aimed to examine the impact that COVID-19 had on specific HIV activities including HIV testing, antiretroviral therapy (ART) initiation and viral load (VL) testing and suppression (VLS) at President's Emergency Plan for AIDS Relief (PEPFAR)-supported HF in 11 African countries. Methods: Retrospective routine data collected quarterly (Q) [Q1:October- December 2019;Q2:January-March 2020;Q3:April-June 2020;Q4:July- September 2020] from 1059 ICAP-supported HF in Angola (HF=17), Burundi (HF=88), Cameroon (HF=73), Cote d'Ivoire (HF=145), the Democratic Republic of Congo (HF=199), Eswatini (HF=42), Ethiopia (HF=31), Kenya (HF=1), Mozambique (HF=59), South Sudan (HF=20) and Zambia (HF=384) were analyzed to determine quarterly trends along the HIV testing and treatment cascade. Results: Overall, there was a 3.3% decrease in the number HIV tested from Q2 (572,845) to Q3 (553,780) (Figure 1). This change varied by country ranging from a 57% decrease in Kenya (5,460 to 2,364) to a 104% increase in Cameroon (45,940 to 93,735). The number testing HIV-positive in all countries declined by 5.0% from Q2 (22,662) to Q3 (21,553) with little change in yield (4.0% vs. 3.9%). In Q4 the number HIV tested increased by 10.6% (to 612,646) from Q3, and the number testing HIV+ increased by 9.0% (23,457) with little change in yield (3.8%). New ART initiations declined by 9.8% from Q2 to Q3 but increased again by 9.8% in Q4 (Q2:24,918;Q3:22,469;Q4:24,665). In every quarter, the number of patients currently on ART increased-Q1:419,028;Q2:435,852;Q3:454,208 and Q4:476,010. The number receiving a VL test also increased (Q1:255,290;Q2:276,001;Q3:297,876;Q4:312,869) with slight increases in the percentage with VLS (Q1:87.5%;Q2:88.6%;Q3:89.7%;Q4:90.1%). Conclusion: In this large study, with the of COVID-19 pandemic acceleration from Q2 to Q3, the number HIV tested decreased along with declines in number of HIV+ persons identified and new ART initiations. However, rebound was brisk as the pandemic progressed (Q4), demonstrating remarkable HIV program resilience. The number on ART, VL testing and VLS continued to increase throughout the period. This may have been, in part, due to recent expansions of non-HF-based differentiated service delivery models that include more diverse groups.

Smartphone based symbol digit modalities test reliably measures cognitive function in multiple sclerosis patients

Background: Neurological examination is a powerful tool for diagnosing and measuring progression of neurodegenerative diseases. However, examinations are resource intensive and thus not practical for comprehensive measurement of neurological disability in chronic diseases. A remote digital solution may be more practical and particularly relevant now due to the ongoing COVID-19 pandemic. Objectives: To clinically validate a digital adaptation of the Symbol Digit Modalities Test (SDMT) developed as part of a smartphone test suite replicating aspects of a neurological exam. Methods: Participants consisted of healthy volunteers (HV;n=39) and multiple sclerosis (MS;n=154) patients, with a longitudinal subcohort that performed tests at home (n=15). During clinic visits, the smartphone test suite was administered alongside a full neurological exam. The smartphone SDMT featured randomization of symbol-digit code and testing sequence. The subjects also underwent written SDMT and brain MRI. Results: Performance differed significantly between HV and MS cohorts (p<.0001). Performance on smartphone and written SDMT had strong evidence of association (R2=0.71, concordance coefficient CCC=0.69, p<.0001). Smartphone SDMT had higher criterion validity than written SDMT measured by correlation with T2 lesion load and brain atrophy. Correlations with NeurEx subdomains identified neurological functions involved in performance of each of the 3 functional cognitive tests. Correcting for these contributing non-cognitive disabilities generated linear regression models strongly predicting the amount of MS-related brain injury measured by volumetric MRI (R2 = 0.75, p < 0.0001 vs R2 = 0.62, p < 0.0001). Of the longitudinal cohort, 87% of patients demonstrated practice effects measured by non-linear regression. Averaging multiple sequential post-learning results significantly decreased threshold for identifying true test deteriorations on a patient level. Conclusions: Smartphone SDMT allows for less resource intensive remote administration. The clinometric properties of smartphone SDMT compare to or outperform written SDMT. This study expands the validation of multiple neurological tests administered via smartphone and bring us closer to a patient-autonomous neurological examination.