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Seafood is the food group with the highest share traded, and the U.S. is the world's largest seafood importer, importing 79% of the seafood consumed. Hence, a study examining the impacts of the measures to contain COVID-19 on U.S. seafood imports will not only show how U.S. seafood availability has been affected, but will also give strong indications of how resiliently the global seafood markets have worked through the pandemic. We find that U.S. imports of seafood actually increased in 2020 and 2021, suggesting supply chains were able to adapt to potential disruptions. Moreover, for the 14 largest product forms imported to the U.S., there are no strong price movements. Given that there is a global market for most species groups, this adaption also suggests that the markets have worked quite well beyond the U.S. Hence, while there have undoubtedly been market shocks associated with the COVID-19 measures such as the reduction in demand from the restaurant sector and the increased sales in the retail sector, opportunities seem to balance out challenges, and the supply chains for seafood to the U.S. have been highly resilient.
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Purpose: The purpose of this paper is to develop a framework to evaluate and assess the performance of the COVID-19 vaccine distribution process that is sensitive to the unique supply-side and demand-side constraints exhibited in the US vaccine rollout. Design/methodology/approach: A queuing framework that operates under two distinct regimes is formulated to analyze service rates that represent system capacity to vaccinate (under the first regime) and hesitancy-induced throughput (under the second regime). These supply- and hesitancy-constrained regimes form the focus of the present paper, as the former reflects the inherent ability of the nation in its various jurisdictions to mobilize, whereas the latter reflects a critical area for public policy to protect the population's overall health and safety. Findings: The two-regime framework analysis provides insights into the capacity to vaccinate and hesitancy-constrained demand, which is found to vary across the country primarily by politics and region. The framework also allows analysis of the end-to-end supply chain, where it is found that the ability to vaccinate was likely constrained by last-mile administration issues, rather than the capacity of the manufacturing and transportation steps of the supply chain. Originality/value: This study presents a new framework to consider end-to-end supply chains as dynamic systems that exhibit different regimes because of unique supply- and demand-side characteristics and estimate rollout capacity and underlying determinants at the national, state and county levels. © 2023, Sharika J. Hegde, Hani Mahmassani and Karen Smilowitz.
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Seafood is the food group with the highest share traded, and the U.S. is the world's largest seafood importer, importing 79% of the seafood consumed. Hence, a study examining the impacts of the measures to contain COVID-19 on U.S. seafood imports will not only show how U.S. seafood availability has been affected, but will also give strong indications of how resiliently the global seafood markets have worked through the pandemic. We find that U.S. imports of seafood actually increased in 2020 and 2021, suggesting supply chains were able to adapt to potential disruptions. Moreover, for the 14 largest product forms imported to the U.S., there are no strong price movements. Given that there is a global market for most species groups, this adaption also suggests that the markets have worked quite well beyond the U.S. Hence, while there have undoubtedly been market shocks associated with the COVID-19 measures such as the reduction in demand from the restaurant sector and the increased sales in the retail sector, opportunities seem to balance out challenges, and the supply chains for seafood to the U.S. have been highly resilient. © 2022 Walter de Gruyter GmbH, Berlin/Boston 2022.
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SESSION TITLE: Infections In and Around the Heart Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Myocarditis is inflammation of the heart muscle, and its onset is usually followed by an inciting event such as a viral infection. Here, we report a case of myocarditis in an adolescent male with no significant medical history who presented with chest pain after his second dose of the covid vaccine. CASE PRESENTATION: An 18-year old male presented with no significant past medical/surgical history presented with chest pain. His only triggering event was receiving the second dose of his covid vaccine. A physical examination, chest x-ray, electrocardiogram, and echocardiogram revealed no significant findings. His laboratory findings were positive for myocardial damage with elevated troponin. All other laboratories for autoimmune and inflammation were negative. He was transferred to another facility for cardiac MRI, which subsequently had findings consistent with myocarditis. He remained asymptomatic, and laboratories were normalized. He was discharged and, on follow-up, remained asymptomatic. DISCUSSION: Covid vaccine-induced myocarditis has become a prominent issue. As of March 2022, there are 2323 preliminary reports of myocarditis/pericarditis following either mRNA vaccine, with most cases being young male adolescents. Prior vaccination, such as the smallpox vaccine, has a well-documented history of causing myocarditis, initially thought to be a rare occurrence, it had a prevalence as high as 10% when reviewed. A similar pattern may be observed with the covid vaccine;thus, this complication can be significantly underestimated, and physicians must be vigilant. Thus, cardiac MRI should be pursued if clinically suspected. It has been shown to provide reliable clinical information even in the early phases of inflammation as well as the extent of the inflammatory process, and it avoids invasive procedures1 It can also be used prognostically to monitor disease status. Myocarditis may be immune-related. Key observations include increased systemic reactogenicity and immunogenicity in younger study participants in Pfizer-biotech clinical trials. However, another report showed no difference in spike antibody between patients with myocarditis and those without myocarditis post-covid mRNA vaccine, arguing against a hyperimmune response2. Another plausible mechanism is molecular mimicry between the spike protein and self-antigens, showing cross-reactivity between human peptides in the body, including alpha-myosin3, which may explain why only mRNA covid vaccine causes this complication. Currently, there is no causal relationship, but numerous hypotheses are being examined. CONCLUSIONS: Myocarditis must be recognized as a complication of the covid vaccine and a possible differential of chest pain,specifically in young men in the current pandemic.Early referral of cardiac MRI, if unavailable at centers, is essential for diagnosis and prognostication,given the unknown sequela of this disease. Reference #1: M. Giulia Gagliardi and Bruno Polletta Paolo Di Renzi, Gagliardi, M. G., M. Giulia Gagliardi Department of Cardiology and Cardiac Surgery, Polletta, B., Bruno Polletta Department of Cardiology and Cardiac Surgery, Renzi, P. D., & Paolo Di Renzi Department of Radiology Fatebenefratelli-Isola Tiberina Hospital. (1999, January 26). MRI for the diagnosis and follow-up of Myocarditis. Circulation. Retrieved April 13, 2022, from https://www.ahajournals.org/doi/full/10.1161/circ.99.3.457/a Reference #2: Muthukumar, A., Alagarraju Muthukumar Department of Pathology (A.M., Narasimhan, M., Madhusudhanan Narasimhan Department of Pathology (A.M., Li, Q.-Z., Quan-Zhen Li Department of Immunology (Q.-Z.L.), Mahimainathan, L., Lenin Mahimainathan Department of Pathology (A.M., Hitto, I., Imran Hitto https://orcid.org/0000-0002-9928-4175 Department of Pathology (A.M., Fuda, F., Franklin Fuda Department of Pathology (A.M., Batra, K., Kiran Batra Department of Radiology (K.B.), Jiang, X., Xuan Jiang Department of Internal Medicine (Q.-Z.L., Zhu, C., Chengsong Zhu Department of Internal Medicine (Q.-Z.L., Schoggins, J., … Al., E. (2021, June 16). In-depth evaluation of a case of presumed myocarditis after the second dose of COVID-19 mrna vaccine. Circulation. Retrieved March 31, 2022, from https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056038 Reference #3: Vojdani, A., & Kharrazian, D. (2020, August). Potential antigenic cross-reactivity between SARS-COV-2 and human tissue with a possible link to an increase in autoimmune diseases. Clinical immunology (Orlando, Fla.). Retrieved March 31, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246018/ DISCLOSURES: No relevant relationships by Aaron Douen No relevant relationships by Sudhanva Hegde No relevant relationships by Marc Sukhoo-Pertab
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SESSION TITLE: Cardiovascular Complications in Patients with COVID-19 SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: COVID-19 is associated with a hypercoagulable state and has been linked with Disseminated Intravascular Coagulation (DIC) [1]. DIC causes systemic thrombosis in micro- and macro- vasculature and in rare instances can involve coronary arteries [2]. In this case report, we present a patient who presented as an ST-segment elevation myocardial infarction (STEMI) and DIC in the setting of severe COVID-19 disease. CASE PRESENTATION: A 46-year-old lady with a history of hypertension presented with acute onset of typical chest pain. She tested positive for COVID-19 infection. Emergency room EKG showed anterior STEMI, and the patient underwent cardiac catheterization via a femoral approach which revealed a 99% stenosis in the proximal LAD, with filling defects consistent with a thrombus. Thrombectomy was performed and three drug-eluting stents were placed in the left anterior descending artery. Following stent placement, the patient went into ventricular fibrillation cardiac arrest followed by PEA. ROSC was attained after 3 rounds of CPR. Labs showed an acute drop in hemoglobin from 14 gm/dL to 5 gm/dL with CT evidence of extensive retroperitoneal bleed, extraperitoneal bleed, and large abdominal aorta thrombus proximal to the bifurcation. Labs were significant for prolonged INR (2.1), PT (23.4 seconds), PTT (106.7 seconds), elevated D-dimer (>4.0), decreased platelets (101K/μl), and increased fibrin split products (80uG/mL) consistent with DIC. The acute aortoiliac occlusive thrombus resulted in acute limb ischemia, rhabdomyolysis causing renal failure, and compartment syndrome requiring bedside fasciotomy. She was treated with triple therapy and demonstrated gradual clinical improvement. DISCUSSION: DIC was a possible precipitant of STEMI in this patient with evidence of thrombotic occlusion of LAD. DIC is a life-threatening coagulopathy characterized by mixed hypo- and hypercoagulation. This often leads to a systemic distribution of clots, evidenced by thrombi present in the coronary and aortoiliac arteries. Historically, bacterial sepsis was more strongly linked with DIC than viral causes;however, there has been an increasing amount of evidence linking COVID-19 with DIC, likely due to the severity of the illness. In this patient with recent stent placement, large aortic thrombus, and extensive retroperitoneal bleed, management was complicated by need for dual antiplatelet therapy for drug-eluting stents as well as anticoagulation for acute limb ischemia. Another diagnosis to keep in the differential includes heparin-induced thrombocytopenia, characterized by similar findings to DIC, but is associated with antibodies against platelet factor 4, which was not found in our patient. CONCLUSIONS: In this case, a young female patient without traditional cardiac risk factors was found to have an anterior STEMI, likely precipitated by DIC as a complication of COVID-19 infection. Reference #1: Asakura, Hidesaku, and Haruhiko Ogawa. "COVID-19-associated coagulopathy and disseminated intravascular coagulation.” International journal of hematology vol. 113,1 (2021): 45-57. doi:10.1007/s12185-020-03029-y Reference #2: M. Sugiura, K. Hiraoka, and S. Ohkawa, "A clinicopathological study on cardiac lesions in 64 cases of disseminated intravascular coagulation,” Japanese Heart Journal, vol. 18, no. 1, pp. 57–69, 1977. DISCLOSURES: No relevant relationships by radhika deshpande No relevant relationships by Shruti Hegde No relevant relationships by Robert Kropp No relevant relationships by Prashanth Singanallur
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We present a blended approach to integrate qualitative human factors and quantitative operations research modeling to understand how Clemson University adapted to the challenges of the COVID-19 pandemic. We focus primarily on the strategic deployment of hand sanitizer stations to reduce transmission of the virus. We identify key adaptations and effective coordination amongst various departments during the crisis. We describe how the qualitative data influenced our development of a discrete facility location covering model and use the model to select optimal locations for dispenser stations. Future plans include further model development, providing model-informed redeployment recommendations in preparation for the Fall 2021 semester, and tactical planning. The blended approach can be broadly applied to understand and improve resiliency decisions in other contexts.
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Tic disorders are one of the most prevalent neurodevelopmental disorders and if unattended, can have other psychological impact. It can present as poor academic performance, poor concentration, low confidence, anxiety, depression and many others. This case series is about seven children diagnosed with tic disorder, as per Diagnostic and Statistical Manual (DSM) 5 criteria. These children underwent standard behavioural training module comprising of behavioural rewards, Habit Reversal Training (HRT), relaxation training, identification and management of emotions and social skills training;which was planned following case conceptualisation. Yale Global Tic Severity Scale (YGTSS) was used before starting therapy and while completing the therapy. Considering the severity of symptoms and distress caused by them, three children were started on medicine (clonidine) along with therapy. Same therapy module was provided online for those children (three) who were not able to come for direct training due to geographic distance and Coronavirus disease-2019 (COVID-2019) pandemic restrictions. All the seven children showed favourable improvement in terms of severity and improvement in the co-morbid conditions. All of them responded to the individualised treatment protocol and showed difference in pre (mean=38) and post (mean=12) total tic severity score suggesting response to treatment. Among them, two children scored zero. This case series demonstrates the application of behavioural therapy including varied strategies as per the individual case conceptualisation.
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The present year saw the emergence of a pandemic Corona Virus Disease of 2019 (COVID 19). The unpreparedness for the pandemic and lack of drugs/vaccine against this virus has led to a high mortality rate across the world. In the process, a number of drugs have been tried against the corona virus including antivirals like remdesivir, lopinavir-ritonavir, and favipiravir, monoclonal antibodies like tocilizumab and sarilumab and antimalarial drugs like chloroquine and hydroxychloroquine. At the present time, none of these drugs have reported efficacy against the virus. Here we present a review of all these drugs, their proposed mechanism of action against the corona virus and their status in clinical trials.