American Association of Geographers' Response to the COVID-19 Crisis

This chapter discusses how the American Association of Geographers (AAG) responded to the emerging COVID-19 pandemic during the spring of 2020. Events described include the decision to cancel the physical meeting, how the pandemic has affected AAG operations and finances and how we have used AAG resources to assist our membership. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Screening for Hepatocellular Carcinoma and Overall Survival in a Cohort of Veterans with Cirrhosis: A Snapshot of the Post-Daa Era

Background: Screening for hepatocellular carcinoma (HCC) is associated with earlier stage at diagnosis and longer HCC-specific survival after diagnosis, but recent studies in Veterans Affairs (VA) cohorts have reached contrasting conclusions regarding this association. Few studies have evaluated screening and overall survival. Direct-acting antivirals (DAAs) for HCV have altered the natural history of HCV cirrhosis. We evaluated screening and overall survival in the post-DAA and pre-COVID era in a national cohort of veterans with cirrhosis largely due to alcohol and HCV. Method(s): All adults in VA care with CTP A or B cirrhosis for at least 1 year prior to January 1, 2015 were followed for incident HCC and all-cause mortality through December 31, 2019. Patients were censored at development of CTP C cirrhosis or maximum follow-up. Percent of time up to date with screening (PTUDS) for eligible follow up was calculated using relevant cross-sectional imaging. Time-updating age, MELD, and comorbidity score were identified for 180-day windows. We used Cox proportional hazards regression to compare survival time after HCC diagnosis by PTUDS and logistic regression to assess 3-year all-cause mortality after HCC diagnosis. Result(s): A total of 21,441 veterans were included, of whom 4.2% developed CTP C cirrhosis, 34.3% died, and 61.6% were censored at maximum follow-up. In all, 30.3% had cirrhosis from alcohol, 24.6% from HCV, 23.4% from alcohol/HCV, and 17.7% from NAFLD. There were 2,021 incident HCCs. Adjusting for time-updating age, MELD, and comorbidities, as well as etiology of cirrhosis, race, tobacco, BMI, CTP class, and GI and PCP visit density per year of follow-up, PTUDS was associated with decreased mortality in veterans diagnosed with HCC (HR for 10% increase in PTUDS 0.90, 95% CI 0.88-0.92). Restricting to those with HCV cirrhosis, PTUDS was associated with decreased mortality in those who cleared HCV (HR=0.88, 95% CI 0.85-0.91) but not in persistently HCV positive patients (HR=0.98, 95% CI 0.95-1.02). Among veterans diagnosed with HCC by December 31, 2016, PTUDS was associated with decreased 3-year overall mortality adjusting for age, MELD, and comorbidities at time of HCC diagnosis (OR for 10% increase in PTUDS 0.76, 95% CI 0.68-0.86). Restricting to those affected by HCV, the association was stronger in those who cleared HCV (OR=0.72, 95% CI 0.62-0.84) than those persistently HCV positive (OR=0.84, 95% CI 0.71-0.99). Conclusion(s): Screening is associated with both longer survival and greater 3-year overall survival in veterans with CTP A and B cirrhosis diagnosed with HCC, in particular among those who have cleared HCV.

EFFECTIVENESS OF COVID-19 VIRAL VECTOR JANSSEN AD.26.COV2.S VACCINE AND COMPARISON WITH MRNA VACCINES IN CIRRHOSIS

commonly worldwide but their effectiveness in participants with cirrhosis is unknown. We explored the effectiveness of vaccination with the Janssen Ad.26.COV2.S compared to the mRNA Pfizer BNT162b2 or Moderna 1273-mRNA vaccine in participants with cirrhosis. Method: This was a test-negative case control study among participants with cirrhosis. This study design is widely used in evaluations of vaccine effectiveness and has the advantage of minimizing biases associated with access to vaccination or health care. Cases were those who were SARS CoV2 PCR positive, controls were those who tested negative during the study period between March 15, 2021 and October 3, 2021. Participants who did not undergo SARS CoV2 PCR testing, who had COVID-19 before the study period, or received a liver transplant, were excluded. COVID-19 was classified based on individual chart review using the National Institute of Health (NIH) COVID-19 severity scale as asymptomatic, mild, moderate, severe or critical illness. Propensity score matching was used to match test positive cases and test negative controls. The propensity score of having COVID-19 were derived from a logistic regression that adjusted for the participant's sex, age, date of testing, race/ethnicity, location, alcohol as the etiology of liver disease, body mass index (BMI), diabetes mellitus, current tobacco use, current alcohol use, co-morbidities, and the Child Turcotte Pugh score. Multinomial logistic regression models were fit for COVID-19, to assess the adjusted effect from vaccination with either the Ad.26.COV2.S or the mRNA-1273 or BNT162b2 vaccines. Results: A total of 955 cases and 955 matched controls were included in the study population. The two groups were well matched to all baseline characteristics. The Ad.26.COV2.S vaccine had an effectiveness of 64% against COVID-19 (adjusted Odds Ratio [aOR] 0.36, 95% CI 0.20-0.62, p=0.005). Effectiveness was lowest with asymptomatic illness (aOR 0.42, 0.18-0.73, p=0.03), and higher against mild (aOR 0.36, 0.15-0.63, p= 0.006), moderate (aOR 0.33, 0.14-0.49, p=0.002) and severe/critical (aOR 0.24, 0.08-0.83, p=0.04) COVID-19. In the same period, mRNA vaccines had a 73% effectiveness against overall COVID-19 (aOR 0.27, 0.19-0.37, p<0.0001), progressively higher from asymptomatic (aOR 0.38, 0.23-0.59, p=0.0004) to mild (aOR 0.29, 0.18-0.42, p<0.0001), moderate (aOR 0.27, 0.18-0.36, p<0.0001), and severe or critical illness (aOR 0.17, 0.06-0.32, p<0.0001). There were no statistically significant differences between the viral vector and mRNA vaccines. Conclusion: In participants with cirrhosis, the Ad.26.COV2.S demonstrated a 64% effectiveness against COVID-19, and a 74% effectiveness against severe or critical COVID-19, similar to that associated with mRNA vaccines. (Figure Presented)

COMPARISON OF INFECTION-INDUCED AND VACCINE-INDUCED IMMUNITY AGAINST CORONAVIRUS 2019 IN PATIENTS WITH CIRRHOSIS

Background and Aims: Immunity to Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be either infection-induced or vaccine-induced. The duration of protective immunity following SARS-CoV-2 infection and how this compares with that from vaccination is presently unclear. Cirrhosis is associated with vaccine hyporesponsiveness to several vaccines include COVID-19 mRNA vaccines. The objective of our study was to compare infection-induced and vaccine-induced immunity against COVID-19 among patients with cirrhosis. Methods: This was a retrospective cohort study among patients with cirrhosis. Vaccine-induced immunity group was defined as participants with cirrhosis who were fully vaccinated with an mRNA vaccine and received the first dose of the mRNA vaccine between 12/18/2020 and 4/1/2021. Infection-induced immunity was defined as participants who had their first positive SARS-CoV-2 PCR in the same study period. The outcome was a positive SARS-CoV-2 PCR more than 60 days after previous infection or vaccination. Patients were followed until the outcome, death or the end of the study period (11/16/21). COVID-19 cases were classified based on individual chart review using the National Institute of Health (NIH) COVID-19 severity scale as asymptomatic, mild, moderate, severe or critical illness. The two groups were matched 1:3 using propensity score (PS) matching, with PS scores calculated based on variables associated with COVID-19 severity, including for the date of infection or first dose of vaccnation, and location, to account for variants. Cox proportional hazards models were fit from the immunity generating event to outcome (SARS-CoV-2PCR). Logistic regression models were also fit for the outcome (positive SARS-CoV-2 PCR) after the immunity generating event. Results: There were 443 participants in the infection-induced group, that were PS matched with 1,329 participants in the vaccine-induced group. The two groups were well matched after PS matching. On multivariable Cox hazard model, vaccine-induced immunity was associated with a 75% reduction in COVID-19 compared to infection-induced immunity (adjusted Hazard Ratio 0.25, 95% CI 0.15-0.43, p<0.0001). On multinomial logistic regression analysis, vaccine-induced immunity was associated with a 80% reduction in asymptomatic (adjusted Odds Ratio [aOR] 0.20, 95% CI 0.09-0.47, p-0.0002), 64% reduction in mild (aOR 0.36, 95% CI 0.13-0.97, p=0.048), and 79% reduction in severe or critical COVID-19 (aOR 0.21,95% CI 0.06-0.74, p=0.02) compared to infection-induced immunity. There were no observed differences between the two groups for moderate COVID-19 (aOR 0.31, 95% CI 0.06-1.56, p=0.16). Conclusions: In participants with cirrhosis, vaccine-induced immunity is associated with a significantly greater protection against COVID-19 compared to infection-induced immunity.[Figure Presented]

Doing family while poor: agentic hopelessness as lived knowledge

What does ‘doing family while poor’ teach us about agency, resilience and care under COVID-19? Set against a dual backdrop of increasing economic hardships and expanding inequalities, and in light of a shifting perspective in poverty and family studies, we employ David Morgan’s family practices approach to study the lived realities of family life through the perspective of everyday relationships. Our research, led by a team comprised of academics and activists who themselves endure poverty, is set to allow people experiencing poverty to document their everyday lives. In their journals we identify a form of social awareness to the politics of poverty, which consist of negative emotions emanating from one’s daily struggles against the harsh reality of inequality, yet do not lead to paralysis and inaction. We dub this state agentic hopelessness. © Policy Press 2022.

Systemic Challenges in Internship Training for Health-Service Psychology: A Call to Action From Trainee Stakeholders.

The challenges observed in health service psychology (HSP) training during COVID-19 revealed systemic and philosophical issues that preexisted the pandemic, but became more visible during the global health crisis. In a position paper written by 23 trainees across different sites and training specializations, the authors use lessons learned from COVID-19 as a touchstone for a call to action in HSP training. Historically, trainee voices have been conspicuously absent from literature about clinical training. We describe longstanding dilemmas in HSP training that were exacerbated by the pandemic and will continue to require resolution after the pandemic has subsided. The authors make recommendations for systems-level changes that would advance equity and sustainability in HSP training. This article advances the conversation about HSP training by including the perspective of trainees as essential stakeholders.

The Pandemic-Resilient Office Tower

This paper examines architectural design strategies to create a “Pandemic-Resilient Office Tower.” In addition to incorporating a suite of measures to impede the spread of disease, the design’s defining feature is its ability to flex between normal and health-crisis modes. The building’s operation is optimized for both of these conditions, and will seek to anticipate unknown stressors. A proposed Class-A office building in Manhattan’s Hudson Yards that features this approach is analyzed, including qualitative and quantitative considerations. Building entrance sequence, lobby layout, vertical circulation, core design, wellness, and productivity aspects are considered, lessons learned and insights for further research are shared, and larger questions relating to a resilient design ethos and its lessons for both health and climate crises are explored. © 2020, Council on Tall Buildings and Urban Habitat. All rights reserved.

LIVER TRANSPLANTATION EVALUATION BY TELEMEDICINE IS ASSOCIATED WITH EXPEDITED EVALUATION AND LISTING

Background and Aims: The recent COVID-19 pandemic has upended health care delivery in the United States and the world, resulting in a rapid switch from in-person patient interactions to telemedicine. While telemedicine evaluation offers many advantages including convenience, patient satisfaction and improved access, it is unclear if it is an adequate substitute for in-person evaluation for complex interventions such as liver transplantation. There is a dearth of multi-center data on transplant evaluation using telemedicine and its impact on liver transplant outcomes. Methods: We performed a retrospective analysis of 1,118 non-local patients who underwent non-urgent evaluation for liver transplantation within the Veterans Affairs Health care system, which had implemented liver transplant evaluation by telemedicine predating COVID-19. During the study period, 176 patients underwent initial evaluation by telemedicine and 942, by an in-person evaluation. We studied the association of evaluation by telemedicine on pre-transplant mortality, as well as with time to evaluation, listing and transplantation. Results: After its initial introduction, the proportion of patients who underwent transplant evaluation by telemedicine, increased from 1.6% in 2013 to 20.2% in 2017. The percentage of telemedicine adoption varied across centers, from 0.5% to 44.2% of all evaluations. Patients in the telemedicine group had a shorter unadjusted time from referral to evaluation (20.0 vs. 27.0 days, p<0.0001), and listing (65.0 vs. 99.0 days, p<0.0001). There were no differences in time from referral to transplantation (220.5 vs. 265.5 days, p=0.25). These differences were maintained on an adjusted analysis, with transplant evaluation by telemedicine associated with a shorter adjusted time from referral to evaluation (19.4 vs. 28.9 days, p<0.001), and listing (97.4 vs. 118.7 days, p=0.0003), but not to transplantation (253.3 vs. 311.2 days, p=0.06). Telemedicine offered the highest benefit in patients with MELD below 20. Conclusion: In a national multi-center study within the VA system, Liver transplant evaluation by telemedicine is associated with a shorter time to evaluation and listing, and a trend towards shorter time to transplantation. (Table presented.) Time from referral to evaluation, listing and transplantation, by telemedicne or in-person evaluation (Generalized linear regression) by MELD-Na

Forecasting air travel demand for selected destinations using machine learning methods

Over the past decades, air transportation has expanded and big data for transportation era has emerged. Accurate travel demand information is an important issue for the transportation systems, especially for airline industry. So, “optimal seat capacity problem between origin and destination pairs” which is related to the load factor must be solved. In this study, a method for determining optimal seat capacity that can supply the highest load factor for the flight operation between any two countries has been introduced. The machine learning methods of Artificial Neural Network (ANN), Linear Regression (LR), Gradient Boosting (GB), and Random Forest (RF) have been applied and a software has been developed to solve the problem. The data set generated from The World Bank Database, which consists of thousands of features for all countries, has been used and a case study has been done for the period of 2014-2019 with Turkish Airlines. To the best of our knowledge, this is the first time that 1983 features have been used to forecast air travel demand in the literature within a model that covers all countries while previous studies cover only a few countries using far fewer features. Another valuable point of this study is the usage of the last regular data about the air transportation before COVID-19 pandemic. In other words, since many airline companies have experienced a decline in the air travel operation in 2020 due to COVID-19 pandemic, this study covers the most recent period (2014-2019) when flight operation performed on a regular basis. As a result, it has been observed that the developed model has forecasted the passenger load factor by an average error rate of 6.741% with GB, 6.763% with RF, 8.161% with ANN, and 9.619 % with LR. © 2021, IICM. All rights reserved.

LESSONS FROM THE COVID-19 PANDEMIC: KNOWLEDGE AND PREVENTIVE ACTIONS AMONG A MEXICAN POPULATION SAMPLE

Objective: to evaluate the knowledge of the general population about the COVID-19 pandemic, including the disease and the preventive measures to reduce spreading of the virus undertaken by participants. Materials and methods: a cross-sectional study on a Mexican population sample was conducted during the period of March 20th to March 27th in Mexico, via a computer-based survey. General knowledge about COVID-19 and the adherence to recommendations were evaluated. Results: a total of 2,577 participants completed the survey. The results revealed an overall proper knowledge about the disease, with 76.2% having the proper knowledge about the disease, which was significantly correlated with age (r=0.15, p<0.001), socioeconomic status (r=0.06, p<0.003) and maximum academic level achieved by the study subjects (r=0.12, p<0.001). Conclusions: overall, people have good knowledge of COVID-19 and know about the specific public health recommendations, but a large proportion of people do not strictly follow these recommendations.