Producing Official Statistics During the COVID-19 Pandemic

This chapter provides some international case studies of responding to COVID-19 to mitigate risks to business surveys and economic statistics. The case studies include impacts on the statistical business register, maintaining response rates, the classification and statistical implementation of COVID-19 Government policies, seasonal adjustment, and trend estimation. © 2023 John Wiley and Sons, Inc. All rights reserved.

COVID-19 in Ultramarathon Runners: Findings of The Ultrarunner Longitudinal TRAcking Study

Purpose: Ultramarathon runners are a unique patient population who have been shown to be free of nearly all severe chronic medical conditions. The effect that COVID-19 infection has on this population and their running behavior is unknown. Method(s): The Ultrarunner Longitudinal TRACking Study (ULTRA Study) is the largest known longitudinal study of ultramarathon runners. Questions on general health status, running behavior, performance, and COVID-19 infection were included. Result(s): Six hundred sixty-two ultramarathon runners participated in the study. This group exercised an average of 10.0 hours per week, including running an average of 26.8 miles per week;52.1% of ultramarathon runners reported ever being symptomatic from a COVID-19 infection with 6.3% testing positive multiple times. Severe infection occurred in 0.3% (2 patients) requiring a total of 3 days of hospitalization. Of those who were infected, 84% were fully vaccinated at the time of their infection;67% of infections effected running for a mean of 33.1 days. The most common other symptoms included fever (73.3%), fatigue (68.7%), sore throat (67.5%), runny nose (67.0%), and cough (66.7%). Cardiovascular symptoms, which are of particular interest in the running population, included shortness of breath (46.4%), increased heart rate (45.2%), chest pain (34.2%), and wheezing (32.5%). Of 662, 48 (7.3%) of ultrarunners reported Long COVID (symptoms lasting more than 12 weeks). Conclusion(s): Severe COVID-19 infection is rare in ultramarathon runners, although symptomatic infection that affects running is common. These rates, along with Long COVID, are lower than is reported in the literature for the population on average. Significance: Ultrarunners are at very low risk of COVID- 19 symptoms requiring hospital care but significant risk of infection that effects running. Cardiovascular symptoms are common, and the long-term significance of these symptoms in runners is unknown.

Advances in Business Statistics, Methods and Data Collection

Advances in Business Statistics, Methods and Data Collection delivers insights into the latest state of play in producing establishment statistics, obtained from businesses, farms and institutions. Presenting materials and reflecting discussions from the 6th International Conference on Establishment Statistics (ICES-VI), this edited volume provides a broad overview of methodology underlying current establishment statistics from every aspect of the production life cycle while spotlighting innovative and impactful advancements in the development, conduct, and evaluation of modern establishment statistics programs. Highlights include: •Practical discussions on agile, timely, and accurate measurement of rapidly evolving economic phenomena such as globalization, new computer technologies, and the informal sector. •Comprehensive explorations of administrative and new data sources and technologies, covering big (organic) data sources and methods for data integration, linking, machine learning and visualization. •Detailed compilations of statistical programs responses to wide-ranging data collection and production challenges, among others caused by the Covid-19 pandemic. In-depth examinations of business survey questionnaire design, computerization, pretesting methods, experimentation, and paradata. •Methodical presentations of conventional and emerging procedures in survey statistics techniques for establishment statistics, encompassing probability sampling designs and sample coordination, non-probability sampling, missing data treatments, small area estimation and Bayesian methods. Providing a broad overview of most up-to-date science, this book challenges the status quo and prepares researchers for current and future challenges in establishment statistics and methods. Perfect for survey researchers, government statisticians, National Bank employees, economists, and undergraduate and graduate students in survey research and economics, Advances in Business Statistics, Methods and Data Collection will also earn a place in the toolkit of researchers working with data in industries across a variety of fields. © 2023 John Wiley and Sons, Inc. All rights reserved.

A Coaching Co-Design: Fostering Change, Innovation, and Collaboration

A model of coaching co-design for executive teams (ETC) based on a four-year program using diagnostic and dialogic organization development tools focused on fostering change, innovation, and collaboration. The study engaged a leadership team of 34 participants from a fast-paced global software and hardware gaming company. Using extensive proprietary data, the model offers practitioners and academics a guide for co-creating a team coaching design. Co-creating a cooperative learning process uses a framework of interventions for intentionally planning and aligning behaviors and practices to support dynamic capabilities to boost firm success, adaptability, and organizational performance. This model exemplifies conditions that can unleash shared personal and organizational power for practitioners and academics. The research was undertaken in an industry where innovation and execution were necessary skills for survival and growth. This duality of skills is referred to as ambidexterity.

Overcoming adversity: Insights into an acute hospital service of supported viewing for families bereaved during the Covid-19 pandemic

The number of people bereaved due to the Covid-19 pandemic is a major health and social care concern. At a time of unprecedented demand on acute and critical care services, restricted family presence to reduce transmission of the disease had a profound impact on the way bereavement support could be provided in the hospital setting. In response, relatively rapid adaptions to practices were required. This paper provides inspiration and guidance on an acute hospital initiative designed to address the emotional needs of the immediately bereaved. The core features of a supported viewing service are presented through the lens of key employees who played a central role in its development and delivery, and with reference to the prevailing literature. Formal evaluation of the service through qualitative inquiry is recommended, complementary to anecdotal evidence of appreciative uptake of the service during the pandemic. © 2022, Cruse Bereavement Care. All rights reserved.

The "problem” of teacher quality: exploring challenges and opportunities in developing teacher quality during the Covid-19 global pandemic in England

Teachers and teacher education are often presented as "problems” to be solved, with policy solutions that focus on ways to make teachers "better” and improve teacher "quality” by introducing prescriptive strategies. We investigate the ways Covid-19-related changes to university and school-based facets of Initial Teacher Education (ITE) in England influence teacher quality in relation to both student teachers and early career teachers, working in secondary schools. Drawing on 34 interviews with school leaders, school mentors and ITE tutors, we critically explore the ways in which teacher quality was developed through key aspects of teachers' pedagogy and practice during the pandemic crisis when schools were closed and teaching moved online. Our findings show that the pandemic crisis has highlighted the different facets of teacher quality which arguably disrupt narrow and prescriptive understandings of what constitutes "quality” in policy terms. Although there were many instances of challenge in the development of new and student teachers, our data also shows how ITE tutors, school mentors and leaders responded creatively to the crisis. Participants highlighted the opportunities afforded by the pandemic to develop diverse and innovative pedagogies and practice, enhance students' subject knowledge, as well as overcome some of the challenges in other areas of pedagogy and practice. Furthermore, the study shows that teacher quality was not substantially reduced despite the challenges arising from the pandemic and concerns that pre-service teachers would not be ready and prepared for a career in the classroom. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Low-Density Lipoprotein Cholesterol Testing Following Myocardial Infarction Hospitalization among Medicare Beneficiaries

Background Low-density lipoprotein cholesterol (LDL-C) is used to guide lipid-lowering treatment following hospitalization for myocardial infarction (MI). Lack of LDL-C testing may represent a missed opportunity to prevent recurrent events. Methods We conducted a retrospective cohort study to estimate the cumulative incidence of Medicare beneficiaries, 66 years or older in the Optum Medicare Advantage (MA) or Medicare fee-for-service (FFS) population, who had LDL-C measured post-MI hospital discharge between January 1, 2016, and December 31, 2020. Results LDL-C testing at 30-, 90-, and 365-days post MI was 9.7%, 27.4%, and 66.7%, respectively, among MA patients (n=228,104), and 10.7%, 29.9%, and 65.7%, respectively, among FFS patients (n=532,767). LDL-C testing varied by state (Figure). Among those with MA and FFS, the 90-day LDL-C testing was 34.2% and 33.9% respectively among Hispanic patients, 32.7% and 32.5% respectively among Asian patients, 26.4% and 30.0% respectively among White patients, and 26.4% and 26.1% respectively among Black patients. There was no difference in LDL-C testing from before to after the start of the COVID pandemic. Conclusion LDL-C testing was low following hospital discharge for MI among Medicare beneficiaries with substantial geographic and race disparities. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Patient Outcomes on Remdesivir According to Baseline 4c Mortality Score

INTRODUCTION: Remdesivir was the first antiviral to show clinical benefit in patients with COVID-19. Trials have demonstrated faster recovery in hospitalized patients treated with remdesivir vs placebo. Guidelines recommend treatment with remdesivir based on hospitalization status, oxygen requirements, and time from symptom onset. However, other factors may be evaluated to determine disease severity and risk for progression to critical illness. The 4C mortality score is a validated tool that may be used to categorize patients by mortality risk at the time of hospital admission for COVID-19. The objective of this study was to determine if the 4C mortality score may be used to predict which patients will benefit from remdesivir at the time of hospital admission. METHOD(S): This was a single-center retrospective cohort study comparing time to recovery among hospitalized patients with moderate-to-severe COVID-19 who were treated with remdesivir compared to those treated with standard of care (SOC). The primary outcome was time to recovery, defined as discharge from the hospital or no longer requiring supplemental oxygen, stratified by the 4C mortality score risk group. Secondary outcomes included in-hospital mortality, hospital length of stay, and time to recovery in patients who were started on remdesivir within 7 days vs after 7 days from symptom onset. A survival analysis was used to analyze time to recovery outcomes. RESULT(S): Data was collected and analyzed for a total of 300 patients, of which 200 received remdesivir and 100 received SOC. Patients in the remdesivir group had a longer time to recovery compared to patients in the standard of care group (6 days vs 4 days). This finding was driven by patients who were categorized to the intermediate risk and high risk mortality groups. Additionally, patients who received remdesivir had a longer length of hospital stay compared to those who received standard of care (12 days vs 9 days). Remdesivir was not associated with an increased rate of adverse events. CONCLUSION(S): This study found that patients who were treated with remdesivir had a longer time to recovery and a longer length of stay compared to those who received SOC. These findings add to the body of evidence questioning the benefit of remdesivir therapy among patients hospitalized with COVID-19.

Modelling Ozone Disinfection to Prevent Covid-19 Transmission

A modelling approach is proposed to study ozone distribution and destruction in indoor spaces. The level of ozone gas concentration in the air, confined within an indoor space during an ozone-based disinfection process, was modelled. The emission and removal of ozone from the air volume were carried out using a generator located in the middle of the room. The computational fluid dynamics (CFD) model proposed accounts for ozone generation and decay kinetics, and buoyancy variations in the airflow. This framework was validated against experimental measurements at different locations in the room during the disinfection cycle. The model was then applied to a more challenging environment and demonstrated the suitability of ozone circulation as a disinfection process. The study also highlights the need for a well-controlled ozone removal process. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Time Between Viral Loads for People With HIV During the COVID-19 Pandemic

Background: During the COVID-19 pandemic, patients experienced significant care disruptions, including lab monitoring. We investigated changes in the time between viral load (VL) checks for people with HIV associated with the pandemic. Methods: This was an observational analysis of VLs of people with HIV in routine care at a large subspecialty clinic. At pandemic onset, the clinic temporarily closed its onsite laboratory. The exposure was time period (time-varying): pre-pandemic (January 1st 2019-March 15th, 2020);pandemic lab-closed (March 16th-July 12th, 2020);and pandemic lab-open (July 13th-December 31st, 2020). We estimated time from an index VL to a subsequent VL, stratified by whether the index VL was suppressed (<= 200 copies/mL). We also calculated cumulative incidence of a non-suppressed VL following a suppressed index VL, and of re-suppression following a loss of viral suppression. Results: Compared to pre-pandemic, hazard ratios for next VL check were: 0.34 (95% CI: 0.30, 0.37, lab-closed) and 0.73 (CI: 0.68, 0.78, lab-open) for suppressed patients;0.56 (CI: 0.42, 0.79, lab-closed) and 0.92 (95% CI: 0.76, 1.10, lab-open) for non-suppressed patients. The 12-month cumulative incidence of loss of suppression was the same in the pandemic lab-open (4%) and pre-pandemic period (4%). The hazard of re-suppression following loss of suppression was lower during the pandemic lab-open versus the pre-pandemic period (hazard ratio: 0.68, 95% CI: 0.50, 0.92). Conclusions: Early pandemic restrictions and lab closure significantly delayed VL monitoring. Once the lab re-opened, non-suppressed patients resumed normal monitoring. Suppressed patients still had a delay, but no significant loss of suppression.

Occupational meaning, well-being and coping: A study of culturally and linguistically diverse hotel workers during COVID-19

Given COVID-19's disproportionate adverse impact on hospitality employees, we explore the proposition that COVID-19-related career challenges prompt CALD hospitality workers to rethink the meaning and purpose of work to explore ways to cope and restore occupational well-being, thus triggering occupational change. Thematic analysis of qualitative data from interviews with 25 CALD hotel workers reveal different sub-groups of CALD hotel workers differentially cognitively frame pandemic-induced employment changes to cope and restore occupational well-being: 1. as an opportunity for behavioral (occupational) change by CALD workers in refugee jobs;2. as a temporary phenomenon, with CALD workers who were temporary migrants foreseeing positive career outcomes;and 3. as an opportunity for behavioral (occupational) advancement in hotels by CALD workers who were permanent residents with hospitality qualifications. We contribute to literature at the intersection of coping and occupational well-being research in hospitality, providing a fine-grained understanding of how CALD hotel workers coped and restored occupational well-being, by differentially reconstruing the meaning of work and undertaking occupational change, be it cognitive or behavioral.

Rapid Expansion of VV-ECMO Support during the COVID-19 Pandemic: Experiences from a Community Hospital

Purpose: We report the clinical outcomes of an Adult Respiratory ECMO (VV-ECMO) program that was rapidly established in a community hospital within a 4-week period. The program was launched in response to increasing patients presenting with acute respiratory failure due to COVID-19. Method(s): Our institution supported urgent preparedness to add VVECMO therapy to our established, nurse-run Adult VA-ECMO program. ICU nurses were trained to run VV-ECMO through interdisciplinary collaboration with neonatal-pediatric ECMO nurses, cardiac perfusionists, providers (NP, PA), respiratory therapists, and physicians. Retrospective data of VV-ECMO therapy was collected between November 2020 and June 2022. Result(s): 29 patients with ARDS due to COVID-19 received VV-ECMO. Of the 29 patients were 23 males and 6 females, of median age 48 (31-59) years and median body mass index (BMI) 31.4 kg/m2 (20.5-49.2). The mean duration of VV-ECMO was 970 hours (44.1 days) and the longest run time was 2752 hours (114.6 days). Patient survival rate to VV-ECMO explant was 66%. Patient survival to discharge with a return to pre-ECMO functional capacity was 55%, defined as supplemental oxygen requirements less than 3L nasal cannula and rehabilitating to activities of daily living. Conclusion(s): In the setting of the COVID-19 pandemic, an Adult VV-ECMO program was rapidly developed and executed in an advanced community hospital system. Our VV-ECMO program results are comparable to programs at major academic centers, with survival rates on par with statistics reported by the ELSO registry. Additionally, our outcomes demonstrate that a nurse-run VV-ECMO program can be both feasible and successful.

COVID-19 training for healthcare workers

This article concentrates on the most important COVID-19 data that are relevant to doctors, nurses, and other healthcare professionals who provide clinical care. The "Infodemic," or flood of false information being spread mostly through social media platforms and unofficial social networks, has hindered the use of vaccines, public health prevention measures, and patient care procedures. Healthcare professionals have a crucial role in both caring for their patients and teaching their communities. They are regarded as reliable sources of up-to-date knowledge. Unfortunately, it can be difficult for healthcare professionals to locate easily available, reliable sources of information. The collaboration between AFREHealth and Stanford University seeks to close this gap by offering training resources from reliable sources that will aid medical professionals in their fight against the widespread misinformation present in their communities. AfreHealth and Stanford University are collaborating to spread a free course that teaches medical professionals how to recognize and treat COVID-19 patients. Evidence to date shows that prompt diagnosis and top-notch treatment can significantly lower mortality rates and stop the spread of infections. In order to effectively care for their patients and be important information sources for their communities, healthcare staff must enhance what they already know with trustworthy information.

Overcoming adversity: Insights into an acute hospital service of supported viewing for families bereaved during the Covid-19 pandemic

The number of people bereaved due to the Covid-19 pandemic is a major health and social care concern. At a time of unprecedented demand on acute and critical care services, restricted family presence to reduce transmission of the disease had a profound impact on the way bereavement support could be provided in the hospital setting. In response, relatively rapid adaptions to practices were required. This paper provides inspiration and guidance on an acute hospital initiative designed to address the emotional needs of the immediately bereaved. The core features of a supported viewing service are presented through the lens of key employees who played a central role in its development and delivery, and with reference to the prevailing literature. Formal evaluation of the service through qualitative inquiry is recommended, complementary to anecdotal evidence of appreciative uptake of the service during the pandemic.

THE IMPACT OF CENTRAL COORDINATION ON ENDOSCOPY EFFICIENCY

Background: The impacts of the COVID-19 pandemic have been far reaching and have necessitated many changes to healthcare delivery. At the QEII Health Sciences Center physical space limitations for patient check-in and recovery have restricted outpatient endoscopy to 3 of 4 available endoscopy suites. On June 1, 2020 a new system of central endoscopy triage and coordination for the Division of Digestive Care and Endoscopy (DC&E) was implemented in an effort to increase efficiency and maintain patient access to endoscopy. The components of the RESET (Re-introduce Endoscopy Safely and EfficienTly) Plan included a) a new endoscopy coordinator role to manage a common endoscopy waitlist, endoscopist schedules, and booking clerks, b) a modified triage system to improve waitlist consistency, c) a common endoscopy waitlist with patients booked in the next available appointment regardless of endoscopist, d) discontinuation of fixed endoscopy slots for endoscopists, and e) appointment scheduling no sooner than 4-weeks in advance to minimize no-shows and last-minute cancellations. Aims: The aim of this study is to evaluate the impact of the RESET Plan on the efficiency of DC&E endoscopy. Methods: A retrospective pre- and post-implementation study evaluating the volume and efficiency of outpatient endoscopy before and after implementation of the RESET Plan. The Pre-RESET period included all procedures performed from June 1, 2019 to October 31, 2019. The Post-RESET period included all procedures performed from June 1, 2020 to October 31, 2020. A separate endoscopy suite and triage system is used for endoscopic retrograde cholangiopancreatography (ERCP) and these cases were excluded. Early effectiveness outcomes were reported including a comparison of the number of endoscopic procedures per week and per list, pre- and post- implementation. Data analysis was primarily descriptive with data expressed as frequencies, means (SD), and proportions (%). Exploratory group comparisons were performed using independent-samples T-Test. Results: During the 5-month Pre-RESET period, 2203 endoscopic procedures were performed. During the Post-RESET period a total of 1920 procedures were performed. Due to pandemic restrictions, there was a 29% decrease in available endoscopy lists from 2019 to 2020. There was a 24% increase in the number procedures performed per endoscopy list, from 6.4 to 8.0 (p=0.004, 95% CI 0.52- 2.53), pre- and post-RESET. Conclusions: While the COVID-19 pandemic has disrupted healthcare delivery, it has also provided an opportunity to implement health system structure and process changes. The RESET Plan resulted in significant gains in efficiency which largely offset losses in endoscopy throughput imposed by COVID-19 pandemic restrictions. Future research will determine what patient and health system factors most significantly impact system efficiency as well as the cost-effectiveness of the RESET Plan.

LINKING PRIMARY AND SPECIALTY CARE FOR THE MANAGEMENT OF DIGESTIVE HEALTH CONDITIONS: AN EVALUATION OF GUT LINK IMPLEMENTATION

Background: Severe restrictions on in-person encounters and endoscopic procedures for digestive care have occurred as a result of the COVID-19 pandemic. This has exacerbated pre-existing barriers in access to gastroenterology (GI) care across Nova Scotia (NS) for patients and primary healthcare providers (PHCPs). In response, a provincial PHCP-GI consultative service (GUT LINK) was implemented at a single tertiary care center with the goal of supporting PHCPs in the management of non-urgent GI referral conditions. Aims: To implement and evaluate the acceptability, feasibility, appropriateness, and early effectiveness of the GUT LINK PHCP-GI consultation service. Methods: This is an ongoing prospective observational cohort study. All referrals received through the EMR-based referral and triage management system between May and November 2020 that were deemed to be amenable to management within primary care with specialist support were returned to the PHCP with the suggestion to arrange a GUT LINK telephone consultation. GUT LINK appointments were scheduled through an administrative support telephone line with the PHCP and a GI specialist. A post-consultation e-questionnaire was distributed to PHCPs who consented to participate. Feasibility (number of and indication for referrals, PHCP participation rates), acceptability and appropriateness (satisfaction, future use, likelihood to recommend) metrics and outcomes (case resolution, re-referrals, proportion requiring endoscopic investigations) were recorded. Patient charts were reviewed to determine whether the patient ultimately required GI speciality care. Analyses were descriptive and expressed as frequencies, means (+/-SD), medians (+/-SE), and proportions (%). Results: A total of 45 GUT LINK consultations were completed between May and November 2020. Of these, 20% required GI specialist care and 80% have remained within primary care, with a median follow-up of 101 (+/-9.1) days. The indications for GUT LINK consultation included lower GI symptoms (64%), abnormal imaging or investigations (17%), and upper GI symptoms (19%). been completed. All PHCPs reported that GUT LINK consultation was easy to access, while 90% found the advice helpful and 80% reported that that it resolved the issue. Following the GUT LINK appointment, 80% felt they would not need to refer their patient to GI. Conclusions: The implementation of GUT LINK was acceptable, feasible, and improved access to specialist support for management of undifferentiated GI symptoms. Future research will focus on comprehensive stakeholder engagement in order to design, implement, and evaluate GUT LINK PHCP care pathways.