Simulating Counterfeit Personal Protective Equipment (PPE) Supply Chains During Covid-19

Increased demand for medical supplies, and specifically respirators and face masks, during the Covid-19 pandemic along with the inability of legitimate suppliers to meet these needs created a window of opportunity for counterfeiters to capitalize on the supply chain disruptions caused by a global health crisis. Both legitimate and illicit businesses began shifting their scope from sectors such as textiles to producing and distributing personal protective equipment (PPE), many of which were counterfeit or unauthentic products and thus unable to properly protect users. To study cost-effective disruption strategies, this study proposes a simulation-optimization framework. The framework is used to model counterfeiters' behavior and analyze the effectiveness of different disruption strategies for counterfeit PPE supply chains during the Covid-19 pandemic. © 2022 IEEE.

Incidence of Acute Myocardial Infarction and Hurricane Katrina: Sixteen Years after the Storm

Background We aimed to evaluate the incidence of acute myocardial infarction (AMI) in New Orleans in the sixteen years after Hurricane Katrina. Methods This was a single-center, retrospective study performed at Tulane University Health Sciences Center of patients admitted for AMI during two years prior to Hurricane Katrina and sixteen years after Hurricane Katrina. The pre-Katrina and post-Katrina cohorts were compared according to pre-specified demographic and clinical data. Results In the sixteen-year post-Katrina period, there were 3696 admissions for AMI out of a total census of 128,276 (2.9%) compared to 150 admissions out of a census of 21,079 (0.7%) in the pre-Katrina group (p<0.0001). The post-Katrina group had a higher prevalence of known coronary artery disease (CAD) (43.8% vs. 30.7%, p<0.0001), diabetes mellitus (40.7% vs. 28.7%, p<0.002), hypertension (80.1% vs. 74.0%, p<0.05), hyperlipidemia (54.2% vs. 44.7%, p<0.0001), smoking (54.2% vs. 39.3%, p<0.0002), drug abuse (18.7% vs. 6.7%, p<0.0002), and psychiatric disease (15.3% vs. 6.7%, p<0.0004). The post-Katrina group was more often prescribed aspirin (49.6% vs. 31.3%, p<0.0001), beta-blocker (46.9% vs. 34.0%, p<0.004), ACE inhibitor or ARB (51.9% vs. 36.0%, p<0.0004), and statin (52.6% vs. 28.0%, p<0.0001) but with higher medication non-adherence (15.8% vs. 7.3%, p<0.0001). The post-Katrina patients were also more likely to be unemployed (75.6% vs 22.7%, p<0.0001) and non-married (56.3% vs. 52.7%, p<0.0001). Rates of STEMI were lower in the post-Katrina group (29.1% vs 42.0%, p<0.002). There was no significant difference in terms of sex, being uninsured, or prior coronary artery bypass grafting. Four patients were COVID positive in the post-Katrina cohort. Conclusion There was a 4-fold increase in the incidence of AMI sixteen years after Hurricane Katrina. Psychosocial, behavioral, and traditional CAD risk factors were significantly higher among the post-Katrina group. These findings add to the growth of literature demonstrating the adverse cardiovascular outcomes that occur after a natural disaster. Further research is needed to explain the underlying mechanisms to help diminish future cardiac morbidity.Copyright © 2023 American College of Cardiology Foundation

Food delivery app continuance: a dual model and segmentation approach

Purpose: The outbreak of the COVID-19 pandemic has led to the pervasiveness of food delivery apps (FDAs) and the increased scholars' attention for the topic of FDA continuance usage intention. However, the limited understanding about possible segments of FDA users has hindered food retailers from providing FDAs with a personalized manner, which impairs the effectiveness of marketing strategies. Thus, this study aims to first explore key antecedents of users' continuance intention toward FDAs and then segment and profile Taiwanese users based on the identified antecedents of FDA continuance intention and demographics. Design/methodology/approach: An online survey was implemented to collect responses from FDA users in Taiwan. With a response rate of 82.4%, the final sample of 326 respondents (average age = 28.3;female = 54.9%) was analyzed by using two techniques of structural equation modeling (SEM) and cluster analysis. Findings: The results indicate six antecedents of users' continuance usage intention towards FDAs, including information quality, system quality, information quality, perceived usefulness, perceived enjoyment and satisfaction. Additionally, three distinct clusters of FDA users are successfully identified, labeled as "value sensitive users”, "time-sensitive users” and "security sensitive users”. Originality/value: This study is one of the pioneers that explores the possible segments in FDA market, which helps FDA providers and food retailers develop more focused and appropriate strategies to encourage users to continue using FDAs. Our findings contribute to building an optimized version of "FDA Tech” that becomes an omni-channel solution to serve the increased home-delivery needs in the new normal era. © 2023, Emerald Publishing Limited.

Incidence of acute myocardial infarction and Hurricane Katrina: Sixteen years after the storm

Purpose of Study:We aimed to evaluate the incidence of acute myocardial infarction (AMI) in New Orleans in the sixteen years after Hurricane Katrina. Methods Used: This was a single-center, retrospective study performed at Tulane University Health Sciences Center of patients admitted for AMI during two years prior to Hurricane Katrina and sixteen years after Hurricane Katrina. The pre-Katrina and post-Katrina cohorts were compared according to pre-specified demographic and clinical data. Summary of Results: In the sixteen-year post-Katrina period, there were 3696 admissions for AMI out of a total census of 128 276 (2.9%) compared to 150 admissions out of a census of 21 079 (0.7%) in the pre-Katrina group (p < 0.0001). The post-Katrina group had a higher prevalence of known coronary artery disease (CAD) (43.8% vs. 30.7%, p < 0.0001), diabetes mellitus (40.7% vs. 28.7%, p < 0.002), hypertension (80.1% vs. 74.0%, p < 0.05), hyperlipidemia (54.2% vs. 44.7%, p < 0.0001), smoking (54.2% vs. 39.3%, p < 0.0002), drug abuse (18.7% vs. 6.7%, p < 0.0002), and psychiatric disease (15.3% vs. 6.7%, p < 0.0004). The post-Katrina group was more often prescribed aspirin (49.6% vs. 31.3%, p < 0.0001), betablocker (46.9% vs. 34.0%, p < 0.004), ACE inhibitor or ARB (51.9% vs. 36.0%, p < 0.0004), and statin (52.6% vs. 28.0%, p < 0.0001) but with higher medication nonadherence (15.8% vs. 7.3%, p < 0.0001). The post- Katrina patients were also more likely to be unemployed (75.6% vs 22.7%, p < 0.0001) and non-married (56.3% vs. 52.7%, p < 0.0001). Rates of STEMI were lower in the post-Katrina group (29.1% vs 42.0%, p < 0.002). There was no significant difference in terms of sex, being uninsured, or prior coronary artery bypass grafting. Four patients were COVID positive in the post-Katrina cohort. Conclusion(s): There was a fourfold increase in the incidence of AMI sixteen years after Hurricane Katrina. Prevalent psychosocial, behavioral, and traditional CAD risk factors were significantly higher among the post- Katrina group. These findings will continue to add to the growing body of literature demonstrating the adverse cardiovascular outcomes that occur after a natural disaster. Despite this, further research is required to explain the underlying mechanisms to help mitigate future cardiac morbidity. This study will help enable cardiovascular clinicians to further understand the needs and dynamic changes that can occur following natural disasters. Copyright © 2023 Southern Society for Clinical Investigation.

Impact of COVID-19 Pandemic on Urological Service: Experience at a Taiwanese Tertiary Center

Purpose: The Taiwan Central Epidemic Command Center raised the coronavirus disease 2019 (COVID-19) pandemic alert to level 3 throughout the nation since May 19, 2021, and asked hospitals to reduce patient intake. Surgical departments were the worst affected. The aim of this study is to share experiences of urological practice adjustment in a tertiary medical center during the pandemic and to evaluate the impact of the COVID-19 pandemic on the urological service in Taiwan under a level 3 epidemic alert. Materials and Methods: This observational study was conducted from June 1, 2021, to June 31, 2021, when a level 3 pandemic alert was declared. Data of patients visiting the urology department at the Taipei Veterans General Hospital were recorded and compared with data 1 year before the COVID-19 outbreak in Taiwan (June 1, 2020, to June 31, 2020). Data included outpatient visits, elective surgeries, emergent surgeries, functional urological examinations, and diagnostic procedures in outpatient settings. Results: There was no significant decrease in all types of uro-oncological surgeries, except bladder urothelial carcinoma (UCB)-related procedures. The total number of UCB-related procedures showed 66.67% reduction. Stone-related surgeries were reduced by 45.7%. Only 12% of all transurethral prostate resections were performed in the pandemic. There was a significant decrease in all types of functional urology and andrology procedures. More than 30% reduction was noted in the number of patients visiting the urology department in June 2021 compared to that in June 2020. Conclusion: Our data provide a reference of how the urological service was affected during the level 3 pandemic alert in Taiwan. We postponed most elective surgeries and outpatient visits or diagnostic outpatient examinations procedures according to prioritization guidelines. Uro-oncology-related service was less affected because oncology patients have a stronger motivation for treatment. Benign urological condition-related procedures were significantly influenced. After the epidemic slowdown, the backlog should be gradually managed based on priority.

Providing Anticipatory Guidance for Children with Gastrostomy Tubes: Feasibility and Impact of an Online Curriculum for Residents

Background and Objective(s): Adults with Cerebral Palsy (CP) experience ongoing health issues from childhood in addition to the issues related to ageing. A recent systematic review highlighted adults used a wide range of medical and rehabilitation services but also experienced challenges in accessing appropriate health services in adulthood. A quantitative study from Ireland on health service use reported that adults with CP used a range of health services, but required more services to adequately meet their needs. In order to inform planning and delivery of health and care services for adults with CP in Ireland it is necessary to understand their lived experience of adult healthcare. Therefore, this study aimed to explore the experiences of health service use among adults with CP from the perspectives of adults with CP, their support person, and service providers, in Ireland. Study Design: A qualitative study design was employed to gather data on experiences of health service use. Study Participants & Setting: Twenty-one adults with CP (mean age 38.4 years, age range 22-58 years, GMFCS I-V);seven support people (primary carer[s], family carer[s], spouse or partners, other relative or friend of the adults with CP);and fifteen service providers participated in the study. Participants were recruited from different geographic regions, with the support of the study Public and Patient Involvement advisory group. Materials/Methods: In-depth semi-structured interviews were carried out remotely from March 2021 to August 2021. Thematic analysis was used to analyze the data. Result(s): Seven themes were identified from the data. (1) Access challenges in adult services: I cannot go to my GP at all because there is problems with the doors;(2) insufficient care provision to meet adults' needs: I don't actually have any service at the minute;(3) knowledge and information needs in adult services: Professionals tell you that CP is non-progressive. They don't really understand how CP worsens it's kind of frustrating. You know;(4) communication and interaction in adult services: I feel like now they just don't listen as not as enough compared to like when I was in my teens or when I was like in my childhood;(5) health system challenges in adult services: I feel like funding experience is a huge issue even before Covid;(6) taking control of own needs: I go by myself, mostly I can speak up for myself;and (7) support people's role and care burden: Because it can be such a lonely and upsetting and hard journey. Conclusions/Significance: Adults with CP in Ireland face multiple challenges accessing the health services they need. Services were reported to be both insufficient and inadequate, with poor communication and lack of knowledgeable staff, resulting in an increased care burden for support people, and adults with CP self-advocating for healthcare. Participants highlighted that system-level interventions in relation to funding and resources are required.

Assessment of Humoral and Cellular Immune Responses to Sars Cov- 2 Vaccination in Immunocompromised Renal Allograft Recipients

Purpose: SARS CoV-2 vaccination elicits both robust humoral and T-cell immune responses in healthy individuals. However, a comprehensive assessment of immune responses to SARS-CoV-2 vaccination in renal allograft recipients is variable and dependent primarily on Spike IgG levels. Here, we analyzed the humoral and T-cell responses in vaccinated transplant recipients. Method(s): 61Tx patients maintained either on Tacrolimus (TAC, 32) or Belatacept (BELA, 29) who were greater than one month post 2nd dose of the Pfizer BNT162b2, and 41 healthy individuals were enrolled. Fresh whole blood was incubated with SARS CoV-2 Spike peptides pool and the activated CD4+ (IL-2/TNF-alpha)+ and CD8+ (TNF-alpha/IFN-gamma)+ T cells were enumerated by flow cytometry and defined as CoV-2-specific T cells. Plasma was analyzed for Spike Receptor Binding Domain (RBD)-specific IgG by ELISA. The Spike RBD-specific IgG levels and Spikespecific CD4+/CD8+ T-cell immune responses were analyzed in TAC- and Bela- Tx patients along with healthy controls. Result(s): Our data demonstrated poor Spike IgG and T cell immune responses in Tx patients1M post-2nd dose of vaccine (21% v. 93% in positive Spike IgG and 37% v. 88% in positive T cell responses, Tx v. controls, respectively). However, 34% of Spike IgG (-) patients demonstrated positive CD4+ and/or CD8+ T-cell immune responses. No significant difference in T cell immunity was found between TAC and BELA treated patients. Conclusion(s): Immunocompromised Tx patients demonstrated significant defects in humoral and T cell immune response after vaccination. Patients maintained on TAC v. BELA demonstrated similar depressions in immune responses post-vaccination. 34% of vaccinated Tx patients, demonstrated Spike-specific T cell immunity despite being Spike IgG negative. This is suggestive of a divergent immune response with dominant cellular immunity. These observations are important since activation of T-cell immunity early after exposure to SARS-CoV2, while not preventing infection will likely modify severity of disease. (Table Presented).

Integrated Arts and Culture Education Model for Public Schools in Indonesia: The Case Study of 'Made in Cirebon' as a Cooperation Project with an Artist Community

There is an urgency to improve arts and culture education in public schools in Indonesia. Currently, the sector faces various challenges, such as insufficient course hours, limited topics, as well as inadequate number and expertise of teachers. With the Covid-19 pandemic, the situation has become even more precarious. To solve these problems, ARCOLABS organized an alternative arts and culture education program for local public-school students in 2020 as part of the Official Development Assistance (ODA) for Arts and Culture Education. Entitled `Made in Cirebon', this pilot project served as preliminary research to look for the most appropriate models to encourage innovations and sustainability in arts and culture education in local public schools in Cirebon through cooperation with local artists. This project-based study utilized several research methodologies, including seminars and discussions to develop learning contents, implementation of an online/on-site learning model, a mini showcase of learning outcomes by students, along with participant interviews, surveys, and evaluation by all stakeholders to prepare for a successive project in 2021. Through the inclusive, innovative and productive outcomes of the project, this research has drawn several positive conclusions: (1) various genres and disciplines can be integrated into an interdisciplinary subject that could overcome the limited course hours and topics within the school curriculum;(2) local artists can be important artistic and educational assets that could fill the gaps in formal education;and (3) a creative approach to local issues is a significant catalyst for the sustainability of the implemented model.

EARLY ONSET COLORECTAL CANCER: RACIAL DISPARITIES & PRESENTATION TO HEALTH SYSTEM

Purpose/Background: Early onset CRC (EO CRC), patients <50yo, is increasing in incidence. Diagnosis is driven by symptoms as the patients are ineligible for screening. Where patients access the health system is unclear. Hypothesis/Aim: We hypothesize that non-white patients with EO CRC present at disproportionate rates to the Emergency Department (ED). Methods/Interventions: Our institutional tumor board registry was reviewed for patients who were presented from August 2020-August 2021. Clinical chart review for race, sex, age, hospital presentation, site of malignancy, and access to health system: primary care, emergency department, outside referral, were extracted. Access to the health system was determined by who ordered the diagnostic colonoscopy or imaging study. Results/Outcome(s): One-hundred ninety-seven patients with colon and rectal adenocarcinoma were discussed at tumor board between August 2020-August 2021 (Table 1). Fifty-seven were EO and 140/197 were age >50. The sex distribution was approximately equal across ages. Of those <50 the median age was 45, and non-white patients were disproportionally represented with 47% Hispanic, 17.5% Black, 10.5% Asian patients. Non-white EO patients were more likely to present through the ED (16/34) relative to white EO patients (1/13). Of all EO patients 17 presented through the Emergency Department, 24 through primary care providers, 11 were referred in from an outside facility, and 2 diagnosed internationally (Figure). Limitations: This is an exploratory, retrospective single institution review of patients discussed at multidisciplinary tumor board over a single year. The population includes a safety-net institution and may not reflect presentation patterns at other hospitals. The cohort size is underpowered for meaningful statistical comparison. The cohort was generated during the COVID-19 pandemic. Conclusions/Discussion: Patients with early onset colorectal cancer are referred for colonoscopic or imaging diagnostics through their primary care doctors, followed by the Emergency Department. Non-white patients, compared to other groups, access the healthcare system through the ED. However, whether this observation is due to the absence of a PCP access, due to restricted screening/diagnostic guidelines, or due to colonoscopic provider availability is unclear. Hispanic patients are disproportionately represented in our early onset cohort relative to the demographics of the hospital referral base. While the study is underpowered, it is provocative for requiring further investigation. Resources to heighten the suspicion for malignancy in patients presenting to our emergency departments and primary care offices, especially in young, non-white populations, may expedite access to diagnosis and definitive therapy for these patients. (Figure Presented).

SARS-CoV-2 Environmental Surface Contamination of Healthcare Staff Common Areas

Background. There are limited data regarding SARS-CoV-2 (SC2) environmental contamination in staff areas of healthcare settings. We performed environmental sampling of staff areas in wards where coronavirus disease 19 (COVID-19) patients received care and compared findings to surfaces within COVID-19 patient rooms. Methods. The study was conducted at the Hospital of the University of Pennsylvania (Philadelphia, PA) from 9/15/20-1/26/21. Sampling of 20cm2 surfaces in staff common areas (breakroom high-touch surfaces comprising tables and microwave/refrigerator handles;bathroom surfaces comprising toilet, sink, and doorknob;and floors), nurse workstations (computer mice and floors), and COVID-19 patient rooms (high-touch surfaces comprising bedrail, computer mice/ keyboards, and doorknobs;bathroom surfaces;and floors) was performed using flocked swabs one or more times per week. Specimens underwent RNA extraction and quantitative real-time polymerase chain reaction to detect the SC2 N1 region. Median comparisons were performed using Wilcoxon rank sum test. Trends in odds were evaluated using Score test. Results. Proportions of surface specimens with detectable SC2 RNA are summarized in Table 1. Median copy numbers were lower among staff toilets compared to COVID-19 patient toilets (135.6 vs. 503.8 copies/specimen, p=0.02), lower among staff breakroom compared to patient room high-touch surfaces (104.3 vs. 220.3 copies/ specimen, p=0.007), and similar between staff and patient room samples from sinks and floors. At nurse workstations, SC2 RNA was detected among 22/177 (12.4%) computer mouse and 147/178 (82.6%) floor samples. Odds of SC2 detection increased by study week among common area (p< 0.001) and nurse workstation samples (p< 0.001) (Figures 1 and 2). Conclusion. A low prevalence of detectable SC2 RNA was observed among staff area high-touch surfaces;however, the likelihood of detection increased over time. Environmental SC2 RNA detection may reflect primary contamination from infected healthcare workers or secondary contamination from contact with infected patients, though a direct relationship between surface SC2 RNA viral detection and transmission risk has not been established.

Efficacy and safety of ivermectin for the treatment of COVID-19: a systematic review and meta-analysis.

BACKGROUND: Ivermectin became a popular choice for COVID-19 treatment among clinicians and the public following encouraging results from pre-print trials and in vitro studies. Early reviews recommended the use of ivermectin based largely on non-peer-reviewed evidence, which may not be robust. This systematic review and meta-analysis assessed the efficacy and safety of ivermectin for treating COVID-19 based on peer-reviewed randomized controlled trials (RCTs) and observational studies (OSs). METHODS: MEDLINE, EMBASE and PubMed were searched from 1 January 2020 to 1 September 2021 for relevant studies. Outcomes included time to viral clearance, duration of hospitalization, mortality, incidence of mechanical ventilation and incidence of adverse events. RoB2 and ROBINS-I were used to assess risk of bias. Random-effects meta-analyses were conducted. GRADE was used to evaluate quality of evidence. RESULTS: Three OSs and 14 RCTs were included in the review. Most RCTs were rated as having some concerns in regards to risk of bias, while OSs were mainly rated as having a moderate risk of bias. Based on meta-analysis of RCTs, the use of ivermectin was not associated with reduction in time to viral clearance, duration of hospitalization, incidence of mortality and incidence of mechanical ventilation. Ivermectin did not significantly increase incidence of adverse events. Meta-analysis of OSs agrees with findings from RCT studies. CONCLUSIONS: Based on very low to moderate quality of evidence, ivermectin was not efficacious at managing COVID-19. Its safety profile permits its use in trial settings to further clarify its role in COVID-19 treatment. PROTOCOL REGISTRATION: The review was prospectively registered in PROSPERO (CRD42021275302).

Update on the NCI-NCTN clinical trial: Natural history ofCOVID-19 in cancer patients

Objectives: In order to observe the biologic effects of COVID-19 as a rising co-morbidity in cancer patients, the NCIinitiated a natural history clinical trial (NCI-COVID) via its National Clinical Trial Network and its National CommunityOncology Research Program. Clinical data, bio specimens, CT, MRI and PET/CT imaging performed as part ofclinical care within the initial 6 months after COVID-19 diagnosis are being collected to assess the impact of COVID-19 on cancer lesions, such as flare or accelerated progression, and to determine the potential diagnostic difficultiesin evaluating cancer burden due to residual abnormalities from COVID-19. Methods: Images collected pre-COVID infection are being used as reference. COVID-19 management-relatedimaging which document organ involvement and complications is being collected via the NCI Imaging and RadiationOncology Core. Radiological findings prevalent among the first 300 patients will be used to develop the analysisplan. Radiological findings on patient subgroups will investigate the relationship of cancers and COVID-19. Whileless than 2% of COVID-19 infections occur in pediatrics, we will attempt to collect from pediatric patients. Results: At the end of the calendar year 2020, 760 patients were enrolled in the trial, of which 262 had submittedimaging data. Of this imaging data, 63 were PET/CT studies, 51 performed prior to COVID-19 infection, 3 duringactive infection, and 9 post-infection. At that time, five patients had repeated imaging, 1 of which was a scanperformed during infection 3 months after the reference, pre-infection scan, the other 4 of which were post-infection,within 3-6 months of the pre-infection imaging. The most recent information shareable will be presented just in timeat SNMMI 2021, along with the reporting of any challenges or learning points from the organization of such a study.At that timepoint, information will also be provided on how limited imaging data may be made available and timelinesof the NCI The Cancer Imaging Archive. Conclusions: This update provides current status of experience, organization and assessment plans of the NCI-NCTN Clinical Trial: Natural History of COVID-19 in Cancer Patients.

Is the virtual interview platform as reliable as in-person interviews for colorectal surgery fellowship?

Purpose/Background: The ACGME suggested residency/fellowship programs conduct interviews virtually in 2021 application cycle due to the health concerns and travel restrictions imposed by the COVID pandemic. Although virtual interview platform made the process more accessible and affordable for both applicants and programs, it also triggered concerns that programs might not be able to reliably identify optimal applicants. Virtual interviews are perceived to be less personal than in-person interviews raising concerns that the assessment process will yield divergent results between interviewers, leading to a greater degree of inter-observer variability. The purpose of this study was to assess the degree of agreement among raters between inter-person and virtual interviews. Methods/Interventions: Interview evaluations from 2019, 2020 and 2021 Colorectal Surgery fellowship cycles were extracted and de-identified. Intraclass Correlation Coefficient (ICC) was used to assess the reliability of the interview evaluations by a pool of faculty members. The ICC for the in-person interview evaluations were compared with those for the virtual interview cycle. Least squares regression model was used to calculate the effect of gender on faculty ratings. Results/Outcome(s): Out of 81 applicants, 64% (52/81) were evaluated through in-person interviews and 36% (29/81) through virtual interviews. The level of inter-rater agreement was similar across three years. In 2019 application cycle, 24 applicants were interviewed in-person and graded by a total of 6 faculty members resulting in a total of 120 interviews with an ICC = 0.60. In 2020 cycle, 28 applicants were interviewed in-person and graded by a total of 7 faculty members producing a total of 177 interviews with an ICC=0.58. In 2021 cycle, 29 applicants were interviewed and graded via a virtual platform by a total of 7 faculty members producing a total of 175 interviews and resulting in an ICC=0.60. The differences in ICC were not statistically significant when virtual interviews were compared to 2019 (p=1.0) and 2020 (p=0.77) in-person interview cycles. Overall, applicant gender had a lager effect on ratings than faculty gender (1.26>0.15, p= 0.06). Applicant gender had a larger effect on ratings using in-person (2.12>0.04, p=0.008) than using virtual interviews (0.24>0.07, p=0.57-0.85). Conclusions/Discussion: Virtual interviews did not diminish the agreement among faculty interviewers and successfully retained the degree of reliability noted for in-person interviews. Furthermore, virtual interiviews appear to blunt the effect of gender on applicant ratings. We found only a moderate degree of inter-observer agreement in the Colorectal Surgery fellowship interview process at our institution;a finding underscoring the subjective nature of the interview process. Our study, while demonstrating reliability of the virtual interview process, is not able to determine the validity of the process.

Physiologic and biochemical rationale for treating COVID-19 patients with hyperbaric oxygen

The SARS-Cov-2 (COVID-19) pandemic remains a major worldwide public health issue. Initially, improved supportive and anti-inflammatory intervention, often employing known drugs or technologies, provided measurable improvement in management. We have recently seen advances in specific therapeutic interventions and in vaccines. Nevertheless, it will be months before most of the world's population can be vaccinated to achieve herd immunity. In the interim, hyperbaric oxygen (HBO2) treatment offers several potentially beneficial therapeutic effects. Three small published series, one with a propensity-score-matched control group, have demonstrated safety and initial efficacy. Additional anecdotal reports are consistent with these publications. HBO2 delivers oxygen in extreme conditions of hypoxemia and tissue hypoxia, even in the presence of lung pathology. It provides anti-inflammatory and anti-pro inflammatory effects likely to ameliorate the overexuberant immune response common to COVID-19. Unlike steroids, it exerts these effects without immune suppression. One study suggests HBO(2 )may reduce the hypercoagulability seen in COVID patients. Also, hyperbaric oxygen offers a likely successful intervention to address the oxygen debt expected to arise from a prolonged period of hypoxemia and tissue hypoxia. To date, 11 studies designed to investigate the impact of HBO2 on patients infected with SARS-Cov-2 have been posted on clinicaltrials.gov . This paper describes the promising physiologic and biochemical effects of hyperbaric oxygen in COVID-19 and potentially in other disorders with similar pathologic mechanisms.

Evaluation of outcomes after receipt of intravenous iron at a tertiary academic medical center

Introduction: Iron administrations replenish iron stores and enhance hemoglobin synthesis across many indications. Parenteral iron is utilized when patients cannot tolerate oral iron or if a shorter treatment course is desired. Given the different dosing schedules of available agents, combined with a drug shortage, a drug utilization review was performed. Research Question or Hypothesis: Is one iron product more effective in achieving a hemoglobin increase of >1 g/dL? Study Design: An IRB-approved, retrospective, single-center chart review. Methods: Adult patients who received at least one dose of parenteral iron at Lahey Hospital & Medical Center's (LHMC) between 01/2018-05/2019 were included. The primary outcome was achievement of hemoglobin increase by >1 g/dL. Data collected from the electronic medical records included indication for use, baseline and post-infusion iron and red blood cell indices, and renal function. Descriptive statistics were used to analyze results. Results: Of the 496 patients reviewed, 201 received a full course of parenteral iron and were included in the analysis. The median age was 58, 72.6% were female (N = 146), and iron deficiency (56.2%) and chronic blood loss (17.9%) were the most common indications for use. Of those receiving a full course, 67.2% (N = 135) demonstrated a change in hemoglobin of >1 g/dL, with 23.8% (N = 48) receiving iron sucrose;8.4% (N = 17) receiving iron dextran;and 51.9% (N = 70) receiving ferumoxytol. The mean hemoglobin change was 1.81 (iron sucrose, SD 1.48);1.75 (iron dextran, SD 1.42);and 1.81 (ferumoxytol, SD 1.46). Conclusion: There is no difference between iron sucrose, iron dextran, and ferumoxytol in achieving a hemoglobin increase of >1 g/dL. Iron sucrose may be effective even when patients do not receive the full course. Due to the COVID-19 pandemic limiting office visits, iron dextran, ferumoxytol or an incomplete iron sucrose course may be preferred.

Developing Strategies for Primary Healthcare in Times of Epidemic of COVID-19

Primary healthcare settings are the control and prevention network basis of COVID-19 epidemic.So improving COVID-19 control and prevention,service delivery and response levels of these institutions is crucial to the national epidemic control and prevention.Based on the analysis of related field survey results as well as information from national and local official websites,we summed up the important role of primary healthcare in dealing with the epidemic.Moreover,we proposed the following priorities for primary healthcare settings in combating the complex epidemic and delivering daily healthcare services:strengthening community-based control and prevention of COVID-19,providing assistance for other institutions in combating COVID-19,implementing daily healthcare and essential public health services,ensuring medical safety and strengthening the control and prevention of nosocomial infections,and adequately playing the role in county-based healthcare network.Furthermore,developing strategies targeting the weaknesses in combating the epidemic and inadequacies in delivering daily healthcare services of primary healthcare were also put forward:strengthening the development of general practitioner system and hierarchical medical system;improving early warning sensitivity,awareness of timely report of major epidemic,and emergency response level in primary healthcare workers;enhancing the informatization construction and application in primary care using artificial intelligence and cutting-edge technologies;promoting the development of regional medical consortiums and local healthcare networks,and exploring patterns for efficiently integrating medical and prevention services;vigorously carrying out patriotic public health campaigns,strengthening the mechanism of group-based control and prevention of communicable diseases,and facilitating the construction of healthy communities and villages. Copyright © 2020 by the Chinese General Practice.