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BackgroundInflammatory rheumatic and musculoskeletal diseases (iRMDs), including rheumatoid arthritis (RA) and juveneille inflammatory arthritsi (JIA), are common and cause a high disease burden globally. Early diagnosis of iRMDs and subsequent timely access to disease modifying therapies is associated with improved health and socio-economic outcomes. However, the COVID-19 pandemic meant that the way healthcare was delivered changed abruptly as all consultations were ‘remote by default' was widely implemented, replacing traditional ‘face-to-face' healthcare.ObjectivesTo describe the impact of the COVID-19 pandemic upon referral patterns and incident diagnosis of iRMDs.MethodsData from the Clinical Practice Research Datalink Aurum were analysed from 01/04/17 to 01/10/2021 to describe episodes of care for patients with musculoskeletal (MSK) conditions, in a primary care setting, for pre-COVID-19 (01/04/2017–31/03/2020), early-COVID-19 (01/04/2020–31/07/2021), and late-COVID-19 pandemic (01/08/2020–31/10/2021) periods. Prevalent and incident MSK consultations were determined. Referrals were matched to these consultations. Trends in referrals to MSK services and further incident diagnoses of iRMDs were described using Joinpoint regression and comparisons made between time-periods. Negative binomial regression was used to compare incident rates between time-periods: first MSK consultation to RA/JIA/iRMD diagnosis;first MSK consultation to first referral;first referral to RA/JIA/iRMD diagnosis. The number of consultations between first MSK consultation and referral/diagnosis were described. Results were adjusted for age and sex and further stratified by geographical region and deprivation.ResultsThe incidence of RA and JIA reduced by -13.3% (from 32.0 to 17.2 per 100,000) and -17.4% (from 1.8 to 0.97 per 1,000,000) per month respectively between January 2020 and April 2020, and then increased by 1.9% (from 17.2 to 25.2 per 100,000) and 3.7% (from 0.97 to 1.3 per 1,000,000) per month respectively between April 2020 and October 2021. The incidence of all diagnosed iRMDs was stable until October 2021. Referral incidence decreased between February 2020 and May 2020 by -16.8% (from 4.8 to 2.4 per 100) per month in patients presenting with a MSK condition. After May 2020, referrals increased significantly (16.8% per month from 2.4 to 4.5 per 100) to July 2020. Time from first MSK consultation to RA diagnosis, and referral to RA diagnosis increased in the early-pandemic period (rate ratio (RR) 1.11, 95% confidence interval (CI) 1.07-1.15;RR 1.23, 95%CI 1.17-1.30) and remained consistently higher in the late-pandemic (RR 1.13, 95%CI 1.11-1.16;RR 1.27, 95%CI 1.23-1.32) periods respectively, compared to the pre-COVID-19 period.ConclusionPatients with underlying RA/JIA that developed during the pandemic may be yet to present, or in the process of being referred and/or diagnosed. Primary care clinicians should remain alert to this possibility and consider the use of fast-track referral pathways where indicated. It is apparent that patients developing incident episodes of inflammatory arthropathies may display a prodrome of other MSK symptoms and conditions, which alone may not warrant referral but in combination require further investigation. Commissioners should be alert to these findings to allow for the appropriate planning and commissioning of services.References[1]Jordan KP, Kadam UT, Hayward R, et al. Annual consultation prevalence of regional musculoskeletal problems in primary care: an observational study. BMC Musculoskeletal Disorders 2010;11:144.[2]NHS England and NHS Improvement. Important and urgent - Next steps on NHS response to COVID-19 2020. Available at: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0098-total-triage-blueprint-september-2020-v3.pdf Accessed Oct 2, 2021.AcknowledgementsWe wish to acknowledge: members of our PPIE group who helped to formulate the research question and provide insight into the implications of our results;and to Prof Edward Roddy, Prof Sa antha Hider and Dr Lorna Clarson for their insights as consultant rheumatologists and commissioners of healthcare services.Disclosure of InterestsNone Declared.
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Background: Significant evidence suggests that SARS-CoV-2 can be transmitted via respiratory aerosols, which are known to vary as a function of respiratory activity. Most animal models examine disease presentation following inhalation of small-particle aerosols similar to those generated during quiet breathing or speaking. However, despite evidence that particle size can influence dose-infectivity relationships and disease presentation for other microorganisms, no studies have examined the infectivity of SARS-CoV-2 contained in larger particle aerosols similar to those produced during coughing, singing, or talking. Therefore, the aim of the present study was to assess the influence of aerodynamic diameter on the infectivity and virulence of aerosols containing SARS-CoV-2 in a hamster model of inhalational COVID-19. Methods: Dose-response relationships were assessed for two different aerosol particle size distributions, with mass median aerodynamic diameters (MMADs) of 1.3 and 5.2 µm in groups of Syrian hamsters exposed to aerosols containing SARS-CoV-2. Results: Disease was characterized by viral shedding in oropharyngeal swabs, increased respiratory rate, decreased activity, and decreased weight gain. Aerosol particle size significantly influenced the median doses to induce seroconversion and viral shedding, with both increasing â¼30-fold when the MMAD was increased. In addition, disease presentation was dose-dependent, with seroconversion and viral shedding occurring at lower doses than symptomatic disease characterized by increased respiratory rate and decreased activity. Conclusions: These results suggest that aerosol particle size may be an important factor influencing the risk of COVID-19 transmission and needs to be considered when developing animal models of disease. This result agrees with numerous previous studies with other microorganisms and animal species, suggesting that it would be generally translatable across different species. However, it should be noted that the absolute magnitude of the observed shifts in the median doses obtained with the specific particle sizes utilized herein may not be directly applicable to other species.
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Background/Aims The COVID-19 pandemic abruptly changed healthcare delivery. This study describes the impact the pandemic had on time to referral and diagnosis of inflammatory arthropathies (IA), including rheumatoid arthritis (RA) and juvenile inflammatory arthritis (JIA), in patients presenting in primary care with musculoskeletal problems. Methods Data from the Clinical Practice Research Datalink (CPRD) Aurum were analysed from 01/04/17 to 01/10/2021 to describe episodes of care for patients with musculoskeletal conditions for pre-COVID-19 (01/04/ 2017-31/03/2020), peri-COVID-19 (01/04/2020-31/07/2021), and post- COVID-19 lockdown (01/08/2020-31/10/2021) periods. Prevalent and incident musculoskeletal consultations were determined. Referrals were matched to these consultations. Trends in referrals to musculoskeletal services and further incident diagnoses of IA were described using Joinpoint Regression and comparisons made between timeperiods. Negative binomial regression was used to compare incident rates between time-periods of: RA/JIA/IA diagnosis and referral from first musculoskeletal consultation;and RA/JIA/IA diagnosis from first referral. The number of consultations between first musculoskeletal consultation and referral/diagnosis were described. Results were adjusted for age and sex and further stratified by geographical region and deprivation. Results The incidence rate of RA and JIA reduced by average -13.32% (from 31.98 per 1,000,000 to 17.15 per 1,000,000) and -17.43% (from 1.77 per 1,000,000 to 0.97 per 1,000,000) per month respectively between January 2020 and April 2020, then increased by 1.9% (from 17.15 per 1,000,000 to 25.22 per 1,000,000) and 3.7% (from 0.97 per 1,000,000 to 1.28 per 1,000,000) per month respectively between April 2020 and October 2021. Referral incidence decreased between February 2020 and May 2020 by -16.8% per month in patients presenting with a musculoskeletal condition. After May 2020, referrals increased significantly (16.8% per month) July 2020. Time from first musculoskeletal consultation to RA diagnosis, and referral to RA diagnosis increased in the peri-COVID-19 period (IRR 1.11, 95%CI 1.07-1.15;IRR 1.23, 95%CI 1.17-1.30) and remained consistent in the post- COVID-19 (IRR 1.13, 95%CI 1.11-1.16;IRR 1.27, 95%CI 1.23-1.32) periods respectively, compared to the pre-COVID-19 period. Similarly, number of consultations between first musculoskeletal consultation and referral/RA diagnosis reduced significantly in the peri-COVID-19 (IRR 0.92, 95%CI 0.88-0.96) and post-COVID-19 (IRR 0.92, 95%CI 0.90-0.95) periods. No change was observed between first musculoskeletal consultation and first referral. Similar results were observed for IA but not for JIA. Conclusion Patients with RA/JIA onset during the pandemic may be yet to present or are currently transitioning through referral and diagnosis. Primary care clinicians should remain alert to possible IA diagnosis and consider fast-track referral pathways where indicated. Patients developing incident episodes of IA may display a prodrome of other musculoskeletal symptoms and conditions, which alone may not warrant referral but in combination require further investigation. Commissioners should be alert to these findings to allow for the appropriate planning and commissioning of services.
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In response to disruption to education during the COVID-19 pandemic, mobile phone-based messaging has emerged in some instances as an accessible, low-connectivity way of promoting interactivity. However, no recent reviews have been undertaken in relation to how social media and messaging apps can be used to effectively support education in low- and middle-income countries. In this scoping review, 43 documents were identified for inclusion, and three main thematic areas emerged: supporting student learning (including interacting with peers and other students, peer tutoring and collaborative learning;and interacting with teachers, through content delivery, teaching and assessment);teacher professional development (including structured support and prompts, and informal communities of practice);and supporting refugee education. The discussion and findings are both of practical use, to inform responses to the current pandemic and designing initiatives in the future, and will also be useful for advancing research in this expanding field. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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Enrollments in computer science courses and majors are at or exceeding capacity at the college level. This context drives local innovations that may benefit individuals across the SIGCSE community. The panelists will share how, in the context of booming enrollments and COVID, they strive to protect faculty time, engage students in larger classes, take advantage of scale, improve student-TA interactions, motivate faculty to teach larger classes, and better monitor students in large classes. During the panel Q&A, attendees will be invited to share additional strategies live on Course.Care, which will then be disseminated through CSTeachingTips.org.
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INTRODUCTION: Telehealth service provision has accelerated during the Coronavirus disease 2019 (COVID-19) pandemic. As the pandemic continues, clinical practices have discovered ways to resume operations. Opportunities exist to understand patient preferences for telehealth clinical services and to tailor offerings to different demographic groups. METHODS: We conducted a survey of patients receiving telehealth services through our outpatient practice to understand the types of healthcare services for which patients report preferences for telehealth. RESULTS: We received 551 survey responses (response rate = 20.8%; 551/2650). More than half of patients indicated being 'very likely' to use telehealth services to refill medication(s) (67.3%), prepare for an upcoming visit (66.1%), review test results (60.3%), or receive education (54.2%). Males had lower odds of preferring telehealth services for reviewing test results (odds ratio (OR) = 0.57; 95% confidence interval (CI): 0.34-0.94) or mental health issues (OR = 0.54; 95% CI: 0.38-0.77). Respondents who received a video visit were significantly more likely than those who received a telephone visit to report preferences for using telehealth for education, care plan discussions, long-term health issues, and mental health. DISCUSSION: Patient preferences for telehealth services vary by services provided and respondent demographics. Experience with telehealth increases the likelihood for future use of these services.
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Purpose: The purpose of this case study is to describe a simulation-based assessment designed to assure student readiness for a first full-time clinical experience in an entry-level Doctor of Physical Therapy program that transitioned to mixed-mode instruction during the COVID-19 pandemic. Design/methodology/approach: A cohort of 40 second-year physical therapy students whose content delivery mode, assessment methods and curricular sequence deviated from the curricular plan participated in a new assessment using standardized patients. The assessment was developed to preferentially address the knowledge, skills, abilities and professional behaviors (KSAs) that were typically assessed with other methods before the pandemic. Findings: The assessment was useful in identifying students who required additional learning experiences to meet expected levels of competence before transition to a first full-time clinical experience. It also identified KSAs that needed to be strengthened within the entire cohort of students. Research limitations/implications: This case study provides an example of feasible implementation of an assessment of student readiness for clinical education that may guide future development of standardized assessments in health profession education (HPE) programs that have or plan to transition to mixed-mode content delivery. Originality/value: This case study highlights the need and process for developing and implementing additional assessments in HPE programs when planned changes or unexpected variations in curriculum delivery occur. This evidence-based assessment preferentially addresses the affective domain of learning and includes competency standards that have recently been developed for physical therapy education in the USA. © 2022, Emerald Publishing Limited.
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As clinicians are faced with a deluge of clinical data, data science can play an important role in highlighting key features driving patient outcomes, aiding in the development of new clinical hypotheses. Insight derived from machine learning can serve as a clinical support tool by connecting care providers with reliable results from big data analysis that identify previously undetected clinical patterns. In this work, we show an example of collaboration between clinicians and data scientists during the COVID-19 pandemic, identifying sub-groups of COVID-19 patients with unanticipated outcomes or who are high-risk for severe disease or death. We apply a random forest classifier model to predict adverse patient outcomes early in the disease course, and we connect our classification results to unsupervised clustering of patient features that may underpin patient risk. The paradigm for using data science for hypothesis generation and clinical decision support, as well as our triaged classification approach and unsupervised clustering methods to determine patient cohorts, are applicable to driving rapid hypothesis generation and iteration in a variety of clinical challenges, including future public health crises.
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COVID-19 , Humans , COVID-19/epidemiology , Pandemics , Machine Learning , Patients , Big DataABSTRACT
During the COVID-19 pandemic, governments at every level in the United States made various policies to reduce the spread of the disease and to mitigate pandemic-related economic impacts. Such policies included stay-at-home orders that shuttered "non-essential" businesses and economic stimulus programs that provided financial assistance. Using Israel Kirzner's insights from "The Perils of Regulation," we argue that local, state, and federal COVID-19 policies have had and will continue to have long-run spillover effects and other negative unintended consequences. Pandemic policies have stifled entrepreneurial discovery and created opportunities for superfluous discovery, thus directing entrepreneurial efforts in directions that would not have existed otherwise. The normative implications of this analysis are that policymakers should better account for the wide variety of seen and unseen costs of policies that are likely to have many negative unintended consequences, regardless of the intentions behind such policies. One of the most effective ways to limit the perils of regulation is polycentric governance systems. With multiple, overlapping decision-making centers, polycentric systems allow for policymakers to experiment with different policy approaches and learn from other jurisdictions. Polycentric systems also limit the spillover effects of negative unintended consequences onto other jurisdictions.
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Background: As the COVID-19 pandemic has progressed, numerous variants of SARS-CoV-2 have arisen, with several displaying increased transmissibility. Methods: The present study compared dose-response relationships and disease presentation in nonhuman primates infected with aerosols containing an isolate of the Gamma variant of SARS-CoV-2 to the results of our previous study with the earlier WA-1 isolate of SARS-CoV-2. Results: Disease in Gamma-infected animals was mild, characterized by dose-dependent fever and oronasal shedding of virus. Differences were observed in shedding in the upper respiratory tract between Gamma- and WA-1-infected animals that have the potential to influence disease transmission. Specifically, the estimated median doses for shedding of viral RNA or infectious virus in nasal swabs were approximately 10-fold lower for the Gamma variant than the WA-1 isolate. Given that the median doses for fever were similar, this suggests that there is a greater difference between the median doses for viral shedding and fever for Gamma than for WA-1 and potentially an increased range of doses for Gamma over which asymptomatic shedding and disease transmission are possible. Conclusions: These results complement those of previous studies, which suggested that differences in exposure dose may help to explain the range of clinical disease presentations observed in individuals with COVID-19, highlighting the importance of public health measures designed to limit exposure dose, such as masking and social distancing. The dose-response data provided by this study are important to inform disease transmission and hazard modeling, as well as to inform dose selection in future studies examining the efficacy of therapeutics and vaccines in animal models of inhalational COVID-19.
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Commercial and social entrepreneurs are likely to help communities combat public health crises. Research on responses to pandemics has underappreciated the critical role of entrepreneurs. In the context of post-disaster response and recovery, entrepreneurs provide needed goods and services, repair and rebuild disrupted social networks, and can act as focal points for disaster survivors as they develop their plans to rebuild. During a pandemic, entrepreneurs perform similarly important economic and social functions. This article highlights these functions, including (1) providing the goods needed to survive and combat the pandemic, (2) performing the services needed so that people can stay productive and connected during the pandemic, and (3) acting as a source of community support and leadership. It also discusses how entrepreneurs are able to perform these roles despite operating in an environment that constricts the range and nature of entrepreneurial activity. Finally, this article describes a legal regime that will promote entrepreneurship during a pandemic.
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Purpose: The purpose of this case study is to describe a simulation-based assessment designed to assure student readiness for a first full-time clinical experience in an entry-level Doctor of Physical Therapy program that transitioned to mixed-mode instruction during the COVID-19 pandemic. Design/methodology/approach: A cohort of 40 second-year physical therapy students whose content delivery mode, assessment methods and curricular sequence deviated from the curricular plan participated in a new assessment using standardized patients. The assessment was developed to preferentially address the knowledge, skills, abilities and professional behaviors (KSAs) that were typically assessed with other methods before the pandemic. Findings: The assessment was useful in identifying students who required additional learning experiences to meet expected levels of competence before transition to a first full-time clinical experience. It also identified KSAs that needed to be strengthened within the entire cohort of students. Research limitations/implications: This case study provides an example of feasible implementation of an assessment of student readiness for clinical education that may guide future development of standardized assessments in health profession education (HPE) programs that have or plan to transition to mixed-mode content delivery. Originality/value: This case study highlights the need and process for developing and implementing additional assessments in HPE programs when planned changes or unexpected variations in curriculum delivery occur. This evidence-based assessment preferentially addresses the affective domain of learning and includes competency standards that have recently been developed for physical therapy education in the USA. © 2022, Emerald Publishing Limited.
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Rationale: The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has killed millions via the acute respiratory distress syndrome (ARDS). The early immune suppression of SARS-CoV-2 then subsequent inflammation suggests an unusual ability to cause immune dysregulation. Host transforming growth factor beta (TGF-β) is an immunesuppressing and profibrotic cytokine frequently “hijacked” by microbes to evade immune detection. We discovered a KRFK domain (a potent activating motif for latent TGF-β) in the SARS-CoV-2 nonstructural 15 (NSP15) protein. We hypothesized that this NSP15 protein causes immune dysregulation by activation of latent TGF-β and subsequent activation of immunosuppressive Tregulatory (Treg) cells, and that substantial TGF-β is present in the lungs of COVID-19 ARDS patients. Methods: We evaluated TGF-β1 concentrations in endotracheal aspirates (ETA) of 27 COVID-19 ARDS patients by ELISA. We produced recombinant SARS-CoV-2 NSP15 protein in E. coli and tested its ability to activate latent TGF-β1 using in vitro assays. TGF-β inhibitors were assessed for their ability to block effects. We obtained blood mononuclear cells from healthy subjects and isolated Tregs to assess their activation state via intracellular smad-2 phosphorylation (pSMAD2) using flow cytometry. Results: The KRFK domain was present in all SARS-CoV-2 variants. High concentrations of both active and total TGF-β1 were detected in ETA of COVID-19 ARDS patients (150 +/- 34 pg/ml active;1,819 +/- 304 pg/ml total) in a range previously shown to affect T cell function. NSP15 at 2.4 nM increased activation of latent TGF-β 12-fold (P < .001 vs. vehicle), compared to an 11% activation with the positive control thrombospondin-1 (TSP1;10 nM) (Figure). TGF-β receptor inhibitors blocked NSP15 effects on latent TGF-β activation and intracellular TGF-β1 signaling in a bioassay by over 95% (p<.01). At tested concentrations (25, 50, 100 nM) NSP15 increased Treg pSMAD2 levels via activation of latent TGF-β1, exceeding levels seen in Tregs stimulated with 400 pM of active TGF-β1 (+ control) (pSMAD2 + cells: vehicle 1.1%, active TGF-β1 43%, NSP15/latent TGF-β1 49-56%). Conclusions: High concentrations of active and total TGF-β1 are present in the lungs of COVID-19 ARDS patients, suggesting SARS-CoV-2 uses host TGF-β hijacking as a mechanism for immune evasion. The NSP15 protein of SARSCoV- 2 potently activates latent TGF-β, leading to Treg activation. TGF-β inhibitors are potent inhibitors of these NSP15 effects. A strategy to block NSP15-mediated effects with TGF-β inhibitors is an innovative therapy worthy of testing in animal models of COVID-19.
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Numerous studies have demonstrated that SARS-CoV-2 can be inactivated by ultraviolet (UV) radiation. However, there are few data available on the relative efficacy of different wavelengths of UV radiation and visible light, which complicates assessments of UV decontamination interventions. The present study evaluated the effects of monochromatic radiation at 16 wavelengths from 222 nm through 488 nm on SARS-CoV-2 in liquid aliquots and dried droplets of water and simulated saliva. The data were used to generate a set of action spectra which quantify the susceptibility of SARS-CoV-2 to genome damage and inactivation across the tested wavelengths. UVC wavelengths (≤280 nm) were most effective for inactivating SARS-CoV-2, although inactivation rates were dependent on sample type. Results from this study suggest that UV radiation can effectively inactivate SARS-CoV-2 in liquids and dried droplets, and provide a foundation for understanding the factors which affect the efficacy of different wavelengths in real-world settings.
Subject(s)
COVID-19 , SARS-CoV-2 , Disinfection/methods , Humans , Light , Ultraviolet Rays , Virus Inactivation/radiation effectsABSTRACT
Background/Aims The substantial personal and socioeconomic costs associated with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (SpA) make understanding their epidemiology crucial. The Clinical Practice Research Datalink (Aurum) is an electronic healthcare record (EHR) database, containing primary care records from ≥20% of English practices (>13 million patients currently registered). To determine RA/PsA/axial SpA epidemiology using EHR data, validated methods need to be applied to ascertain patients with these diagnoses. To address this, we updated and applied approaches validated in other primary care EHR databases in Aurum and described the annual incidence/point-prevalence of RA/PsA/axial SpA alongside patient characteristics (providing indirect evidence of coding accuracy). Methods Diagnosis and synthetic disease-modifying anti-rheumatic drug (DMARD) prescription code lists were constructed, and pre-defined approaches for ascertaining patients with RA/axial SpA/PsA applied. The annual incidence and point-prevalence of RA/PsA/axial SpA were calculated from 2004-2020. Samples were stratified by age/gender, and mean age and gender/ethnic-group relative frequencies described. The study was approved by the CPRD Independent Scientific Advisory Committee (reference 20-000244). Results From 2004-2019 the point-prevalence of RA/PsA increased annually, peaking in 2019 (RA 7.79/1,000;PsA 2.87/1,000) then falling slightly. From 2004-2020 the point-prevalence of axial SpA increased annually (except in 2018/2019), peaking in 2020 (1.13/1,000). Annual RA incidence was higher between 2013-2019 (when included in the Quality Outcomes Framework, ranging 0.491 to 0.521/1,000 personyears) than 2004-2012 (ranging 0.345 to 0.400/1,000 person-years). The annual incidence of PsA and axial SpA increased from 2006 (0.108 to a peak of 0.172/1,000 person-years) and 2010 (0.025 to a peak of 0.045/1,000 person-years), respectively. These years were when new disease classification criteria were introduced. Marked falls in the annual incidence of RA, PsA and axial SpA between 2019 and 2020 were seen, reducing by 40.1%, 67.4% and 38.1%, respectively, reflecting the impact of the COVID-19 pandemic on arthritis diagnoses. Stratifying incidence/prevalence by age/gender broadly showed expected patterns (although the incidence of axial SpA/PsA in women increased over time), and the mean age and gender proportions followed those previously reported. Conclusion The approaches we used to determine patients with RA, PsA, and axial SpA in Aurum led to incidence/prevalence estimates broadly consistent with published studies, and patient characteristics as would be expected. These data support the potential of the Aurum-updated ascertainment approaches for use in further studies of RA, PsA and axial SpA.
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Introdução: A pandemia trouxe inúmeros desafios aos serviços de saúde e isso não foi diferente nos serviços de hemoterapia. O novo cenário exigiu constantes modificações nas rotinas de trabalho de acordo com o que se descobria a respeito da doença e seus impactos na transfusão de sangue. Novas estratégias de captação de doadores, manejo ainda mais criterioso dos estoques de hemocomponentes e adequação da infraestrutura às medidas sanitárias são alguns exemplos das adaptações que ocorreram. Concomitantemente ocorreu uma importante alteração do perfil de pacientes atendidos nos hospitais em geral com redução significativa de pacientes cirúrgicos e elevação do número de atendimentos clínicos, em especial em ambientes de terapia intensiva. Objetivo: Avaliar o volume de transfusões por tipo de hemocomponente antes e depois do início do cenário de pandemia de COVID-19 em uma instituição privada da região sul da cidade de São Paulo. Métodos: Foi realizado estudo descritivo e comparativo através de análise de dados obtidos no sistema informatizado de gerenciamento da agência transfusional. Foram incluídos os dados referentes às transfusões que ocorreram no período abril/2019 a março/2021 classificando-as de acordo com o tipo de hemocomponente diferenciando-se entre componentes eritrocitários, componentes plaquetários e componentes plasmáticos (plasma e crioprecipitado). Resultados: Nos 12 meses que antecederam o início da pandemia foram realizadas 5.613 transfusões, sendo 2.553 concentrados de hemácias (45%), 1.407 concentrados de plaquetas (25%), 1.453 plasmas frescos congelados (26%) e 200 crioprecipitados (4%). Já no período de abril/2020 a março/2021, foram realizadas 6.091 transfusões, sendo 2.599 concentrados de hemácias (43%), 2.614 concentrados de plaquetas (43%), 598 plasmas frescos congelados (10%) e 280 crioprecipitado (4%). Observou-se que no período houve um crescimento do número total de transfusões de 8% em relação ao período pré pandemia, além de uma alteração do perfil de consumo dos hemocomponentes, com expressivo crescimento absoluto e relativo do número de transfusões de componentes plaquetários (25% versus 43%). Conclusões: A pandemia alterou significativamente o perfil de paciente atendido nos hospitais de todo o mundo e isso não foi diferente no hospital estudado. Os pacientes com quadros graves de COVID-19 apresentavam frequentemente quadros de insuficiência respiratória hipoxêmica com necessidade de circulação extracorpórea com membrana de oxigenação (ECMO) além distúrbios de coagulação o que resultou no aumento do consumo de concentrados de plaquetas.
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Enrollments in computer science courses and majors are at or exceeding capacity at the college level. This context drives local innovations that may benefit individuals across the SIGCSE community. The panelists will share how, in the context of booming enrollments and COVID, they strive to protect faculty time, engage students in larger classes, take advantage of scale, improve student-TA interactions, motivate faculty to teach larger classes, and better monitor students in large classes. During the panel Q&A, attendees will be invited to share additional strategies live on Course.Care, which will then be disseminated through CSTeachingTips.org. © 2022 Owner/Author.
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In this paper, we argue that digital platforms play an important role within higher education, not least of all when Covid-19 has made remote working the norm. An increasingly rich field of theoretical and empirical work has helped us understand platforms as socio-technical infrastructures which shape the activity of their users. Their insertion into higher education raises urgent institutional questions which necessitate dispensing with the individualised mode of analysis and instrumentalised conception of technology which often accompany these topics. We outline an alternative approach through a case study of social media in the 2014 Research Excellence Framework, exploring the incorporation of platforms into research evaluation. Our findings suggest social media is invoked differently across disciplinary groupings, as well as platform metrics being cited in a naive and problematic matter. We offer a neo-institutionalist analysis which identifies a tendency towards isomorphism, with perceived ‘best practice’ being seized upon in response to uncertainty. We suggest such an approach is urgently needed given the role which digital platforms will play in building the post-Pandemic university. © 2021, The Author(s).
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Travel aggregator websites empower vacation planners to efficiently match their travel-specific needs with tourism suppliers. Prominent in communication studies, limited aggregator website research has been conducted in examining vacation planners' usage behavior with travel aggregators. Particularly relevant during the travel and tourism restrictions midst COVID-19, this study extends the Information Needs Model by recognizing the broadened role travel aggregator websites play in the decision-making process of vacation planning. This research explores how leisure planners utilized travel aggregators when travel restrictions and mandates were employed and then rescinded the following year. Travel aggregation websites' functionality was analyzed via vacation planners who use these websites. The online survey addressed: website functionality, demographics, perceived needs of leisure travelers, motivation for travel information sharing, and security concerns during COVID-19. Items addressed were personalization, needs, and satisfaction per demographics. This research provides recommendations to help travel aggregation websites, marketers, and tourism organizations adapt travel aggregation websites' search functionality and customize content post-pandemic to create a more consumer-focused approach.
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While evidence exists supporting the potential for aerosol transmission of SARS-CoV-2, the infectious dose by inhalation remains unknown. In the present study, the probability of infection following inhalation of SARS-CoV-2 was dose-dependent in a nonhuman primate model of inhalational COVID-19. The median infectious dose, assessed by seroconversion, was 52 TCID50 (95% CI: 23-363 TCID50), and was significantly lower than the median dose for fever (256 TCID50, 95% CI: 102-603 TCID50), resulting in a group of animals that developed an immune response post-exposure but did not develop fever or other clinical signs of infection. In a subset of these animals, virus was detected in nasopharyngeal and/or oropharyngeal swabs, suggesting that infected animals without signs of disease are able to shed virus and may be infectious, which is consistent with reports of asymptomatic spread in human cases of COVID-19. These results suggest that differences in exposure dose may be a factor influencing disease presentation in humans, and reinforce the importance of public health measures that limit exposure dose, such as social distancing, masking, and increased ventilation. The dose-response data provided by this study are important to inform disease transmission and hazard modeling, and, ultimately, mitigation strategies. Additionally, these data will be useful to inform dose selection in future studies examining the efficacy of therapeutics and vaccines against inhalational COVID-19, and as a baseline in healthy, young adult animals for assessment of the importance of other factors, such as age, comorbidities, and viral variant, on the infectious dose and disease presentation.