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Case report: Dupilumab is a novel anti-interleukin- 4 (IL-4) receptor-alpha monoclonal antibody that targets the signaling pathways of IL-4 and IL-13, which are key type 2 cytokines. Current evidence suggests that patients on dupilumab are not at significantly increased risk of SARS-CoV- 2 related hospitalization and mortality and clinicians should avoid preventive cessation of therapy in patients with moderate-to- severe disease necessitating systemic treatment with dupilumab. However, there has been limited data about adequate and durable humoral immune response after vaccination to SARS-CoV- 2 in these patients, with some recent evidence by Runnstrom et al. suggesting that patients with severe asthma or atopic dermatitis on biologic therapies have lower antibody levels after SARS-CoV- 2 mRNA vaccination compared to healthy adults. We previously reported the case of a 71-year- old man with IgG4 related-disease (IgG4-RD) that we successfully treated with dupilumab. This patient was followed over the past three-years while his IgG4-RD remained well controlled on dupilumab which he remained on during the pandemic. Based on the vaccination guidelines and availability, he received two SARS-CoV- 2 mRNA vaccinations on March 24, 2021 and June 18, 2021. On July 24, 2021 (36 days after his last vaccination), during his routine follow up assessment, he was found to have no antibodies against SARS-CoV2. In response to this, we facilitated for him to receive his third booster vaccination on November 10, 2021. In preparation for this, his dupilumab was held for 1 month prior to this date and was continued two weeks after the injection. On December 3, 2021 (23 days after), his SARS-CoV2 Spike Total AB was repeated and found to be elevated at 2282 while his SARS-CoV2 NPROT Total AB was negative, implying immune response through vaccination and not natural exposure. To our knowledge, this is the first case report on a patient with IgG4-RD controlled on dupilumab who was found to have adequate vaccine titres after his dupilumab was held for 1 month after failing to mount a response to the first two vaccination doses while on therapy. As there is evidence that lower vaccine-specific titers afford less protection against COVID-19, acknowledging that holding dupilumab may not be feasible in all cases, this report highlights this approach as one possible strategy to protecting these individuals who may unknowingly remain at high risk for severe disease.
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Critical cross-border issues have emerged during the COVID-19 pandemic, especially pertaining to security, supply chain, and education, which has led to several new challenges for management. The balance between potential risks and economic benefits has attracted the attention of both industry and academia. Hence, we invited three panelists to participate in the 2021 Association for Information Systems (AIS) Special Interest Group (SIG) on Information Systems in Asia Pacific (ISAP) workshop. The suggested solutions include the right Internet approach, multi-national cooperation to develop flexible global operations, and people's education (especially refugees) to mitigate risks. These solutions encompass three levels, i.e., technology, management, and society. © 2023 Xi'an Jiaotong University
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Pregnant people seeking abortion may require access to cash-pay services, and little is known about cash-pay availability for abortion services among US abortion clinics. We examined differences in cash-pay options between hospital-affiliated clinics and non-hospital-affiliated clinics (independent or Planned Parenthood clinics). We analyzed data from the second phase of a longitudinal nationwide survey of abortion providers conducted by the Society of Family Planning (collected May–July 2020). We compared cash-pay options for medication abortion, first-trimester surgical/procedural abortion, and dilation and evacuation offered by hospital-affiliated and non-hospital-affiliated clinics. Sixty-two clinics completed the survey (31 hospital-affiliated and 31 non-hospital-affiliated). We found that 85% of all clinics offered a cash-pay option for medication abortion, 86% for first-trimester abortion, and 78% for dilation and evacuation. We found that hospital-affiliated clinics were significantly less likely to report serving out-of-state patients (p<0.01), first-trimester surgical/procedural abortion (75% vs. 97%, p=0.02), and dilation and evacuation (62% vs. 100%, p<0.01). Though a majority of all clinics surveyed offered cash-pay options for abortion, hospital-affiliated clinics were less likely to offer cash-pay options for abortion procedures. Given concerns regarding future abortion access, it will be important to expand availability of cash-pay options for abortion in all settings. From our data, hospital-affiliated clinics have the most room to improve on this front. [ FROM AUTHOR]
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Journal of the International Network for Korean Language and Culture 19-2, 259-280. This article aims to examine the state of Korean ww .e tic e et language education in Guatemala's public elementary schools and suggest future directions for its stable settlement and continuous development in Guatemala's public education. In March 2020, four public elementary schools in Guatemala adopted Korean as a regular foreign language subject for the first time. As of February 2022, ten elementary schools are offering regular Korean language courses. In Guatemalan public schools, Korean language education has grown quantitatively over the past two years despite COVID-19. However, some tasks need to be solved for the Korean language to have a stable footing in Guatemala's public education, ensure internal stability, and promote qualitative growth together. First, the most urgent task is to secure Korean language teachers. For the stable production of professional Korean teachers, it is essential to establish a training course for Korean language teachers and offer a major in Korean studies as a degree program within universities. Additionally, developing customized Korean textbooks considering the age, level, and culture of elementary school students in Guatemala is essential. Moreover, it is necessary to develop a Korean language curriculum so that the Korean language can establish its status as an official foreign language of Guatemala. Lastly, to expand the base of Korean language education in Guatemala, an institution in charge of spreading the Korean language and culture should be rapidly established.(Sogang University, Yonsei University, Myongji University)
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Background and Aims: The COVID-19 pandemic profoundly impacted clinical services globally, including colorectal cancer (CRC) testing such as fecal immunochemical test (FIT) screening and colonoscopy. We investigated the impact of the pandemic on FIT and colonoscopy utilization, and colorectal neoplasia detection in a large community-based population in the United States. Methods: We performed a retrospective cohort study of patients ages 18-89 years undergoing FIT screening or colonoscopy in 2019 and 2020 within Kaiser Permanente Northern California (KPNC), a large integrated healthcare organization. We calculated percentage changes in FIT kits mailed, FITs completed, positive FITs, colonoscopies performed overall and by indication, and colorectal neoplasia detection (advanced adenoma and CRC) in 2020 compared to 2019. Results: FIT kit mailings ceased in mid- March through April 2020 but rebounded thereafter leading to an 8.7% increase in total FIT kits mailed in 2020 compared to 2019. However, with the later mailing of FIT kits, there were 9.0% fewer FITs completed and 10.1% fewer positive tests in 2020 compared to 2019. Colonoscopy volumes nadired in April 2020, with a 79.4% reduction compared with April 2019, but recovered to near pre-pandemic monthly volumes in September through December 2020. However, overall, there was a 26.9% decline in colonoscopies performed in 2020 compared to 2019. Declines of 41.5%, 38,3%, 19.9%, and 20.0% were seen for screening, surveillance, diagnostic, and FIT positive colonoscopies, respectively, in 2020 compared to 2019. With the gradual recovery of colonoscopy volumes after the initial pandemic lockdown, by November and December 2020 the numbers of patients with advanced adenomas or CRC detected by colonoscopy were comparable to those same months in 2019. However, the total number of patients with advanced adenomas or CRC detected by colonoscopy declined by 26.9% and 8.7%, respectively, in 2020 compared to 2019. Conclusions: The COVID-19 pandemic led to fewer FIT screenings and colonoscopies performed in 2020 compared with 2019. However, after the lifting of regional lockdowns, FIT screenings exceeded, and colonoscopy volumes nearly reached numbers from those same months in 2019. Overall, the pandemic led to 27% and 9% reductions in advanced adenoma and CRC detection, respectively, in 2020 compared to 2019, validating concerns about the potential for stage progression for cancers that went undetected due to the pandemic. Strategies to identify high-risk patients for expedited colonoscopy procedure scheduling and resolve remaining colonoscopy procedure backlogs are needed to mitigate this risk.(Figure Presented)Figure 1. Number of FIT kits mailed, completed, and positive in 2019 and 2020(Figure Presented)Figure 2. Number of colonoscopies and advanced adenomas and colorectal cancers detected by colonoscopy in 2019 and 2020
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INTRODUCTION: At the onset of the COVID-19 pandemic, providers were encouraged to counsel patients interested in longacting reversible contraception (LARC) about immediate postpartum placement to decrease in-person postpartum visits. We assessed the impact of this COVID-related hospital policy on postpartum LARC uptake. METHODS: In this retrospective cohort study, we compared patients who delivered a live born infant(s) during two periods, one immediately prior to the COVID pandemic (“pre-COVID cohort” (December 16, 2019 to March 1, 2020)), and one at the onset of the pandemic (“COVID cohort” (March 16-May 31, 2020)). We collected electronic medical record data, including sociodemographic characteristics and contraception choices, in the antenatal and postpartum periods for 649 patients. Odds ratios were adjusted for age and race. RESULTS: We found an increase in immediate postpartum LARC use during COVID (13% vs. 9%, P=.12, aOR 1.44, CI 0.87-2.39). The etonogestrel implant was the most placed form of immediate postpartum LARC in both cohorts (67% and 71% in pre- and during COVID cohorts, respectively). In general, contraceptive choices at discharge differed between the cohorts (P=.01), with fewer patients desiring LARC placement at the postpartum visit during COVID (13% vs. 6% in pre- and during COVID cohorts). There was no difference between the average number of postpartum visits attended in each cohort (OR 0.93, CI 0.68-1.28). CONCLUSION: Changes in contraceptive counseling during COVID were accompanied by differences in postpartum contraceptive choices at discharge. Targeted contraceptive counseling can influence patient choices in the setting of expected barriers to routine postpartum care.
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Introduction: The Asia Pacific Fragility Fracture Alliance (APFFA) is a federation committed to reducing the burden of low trauma fracture throughout the region. Education on fracture prevention to those at the forefront of patient care is an important part of this effort. Methods: APFFA has curated educational materials developed by others (https://apfracturealliance.org/education-directory/) and developed a Primary Care Physician (PCP) Education Toolkit (https://apfracturealliance.org/education-toolkit/). Here we describe the toolkit and report its introduction during the COVID-19 pandemic. Results: The PCP Education Toolkit is designed as a half-day educational program together with supporting resources to highlight the role of primary care providers in this effort. The educational program includes a lecture focused on the burden of fracture, a lecture focused on clinical assessment of fracture risk, a discussion kit, and materials to assist with meeting planning. The discussion kit is designed to be adaptable to local practices and constraints. The supporting material features a patient handbook that gives practical advice on nutrition, home safety, and issues to be raised during medical encounters. COVID-19 hampered rollout of these materials. In addition, APFFA has relied on its constituent organizations to provide educational content to promote best practices in acute fracture management, rehabilitation, and secondary fracture prevention through the development of an education directory. The directory includes synopses and links to high quality materials from around the world. Conclusion: The PCP Education Toolkit was designed with the expectation that the program would be presented as live meetings. The pandemic made this infeasible. Despite the restrictions, the PCP Education Toolkit materials have been enthusiastically received in New Zealand and disseminated by Osteoporosis NZ. As the world emerges from the pandemic, we are looking to present this material in more venues in 2022 and beyond. The toolkit is available free of charge at the above address.
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Objective: The Asia Pacific Fragility Fracture Alliance (APFFA) is a federation committed to reducing the burden of low trauma fracture throughout the region. Education on fracture prevention to those at the forefront of patient care is an important part of this effort Methods: APFFA has curated educational materials developed by others (https://apfracturealliance.org/education-directory/) and developed a Primary Care Physician (PCP) Education Toolkit (https:// apfracturealliance.org/education-toolkit/). Here we describe the toolkit and report its introduction during the COVID-19 pandemic Results: The PCP Education Toolkit is designed as a half-day educational program together with supporting resources to highlight the role of primary care providers in this effort. The educational program includes a lecture focused on the burden of fracture, a lecture focused on clinical assessment of fracture risk, a discussion kit, and materials to assist with meeting planning. The discussion kit is designed to be adaptable to local practices and constraints. The supporting material features a patient handbook that gives practical advice on nutrition, home safety, and issues to be raised during medical encounters. COVID-19 hampered rollout of these materials. In addition, APFFA has relied on its constituent organizations to provide educational content to promote best practices in acute fracture management, rehabilitation, and secondary fracture prevention through the development of an education directory. The directory includes synopses and links to high quality materials from around the world Conclusion: The PCP Education Toolkit was designed with the expectation that the program would be presented as live meetings. The pandemic made this infeasible. Despite the restrictions, the PCP Education Toolkitmaterials have been enthusiastically received in New Zealand and disseminated by Osteoporosis NZ. As the world emerges from the pandemic we are looking to present this material inmore venues in 2022 and beyond. The toolkit is available free of charge at the above address Acknowledgements: Development of the PCP Education Toolkit and Education Directory was funded via an unrestricted grant from Amgen Asia to APFFA and its content was developed independently by APFFA.
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Background. The COVID-19 pandemic has brought to light the importance of contact tracing in outbreak management. Digital technologies have been leveraged to enhance contact tracing in community settings. However, within complex hospital environments, where patient and staff movement and interpersonal interactions are central to care delivery, tools for contact tracing and cluster detection remain limited. We aimed to develop a system to promptly, identify contacts in infectious disease exposures and detect infectious disease clusters. Methods. We prototyped a 3D mapping tool 3-Dimensional Disease Outbreak Surveillance System (3D-DOSS), to have a spatial representation of patients in the hospital inpatient locations. Based on the AutoCAD drawings, the hospital physical spaces are built within a game-development software to obtain accurate digital replicas. This concept borrows from the way gamers interact with the virtual world/space, to mimic the interactions in physical space, like the SIMS franchise. Clinical, laboratory and patient movement data is then integrated into the virtual map to develop syndromic and disease surveillance systems. Risk assignment to individuals exposed is through mathematical modeling based on distance coordinates, room type and ventilation parameters and whether the disease is transmitted via contact, droplet or airborne route. Results. We have mapped acute respiratory illness (ARI) data for the period September to December 2018. We identified an influenza cluster of 10 patients in November 2018. In a COVID-19 exposure involving a healthcare worker (HCW), we identified 44 primary and 162 secondary contacts who were then managed as per our standard exposure management protocols. MDRO outbreaks could also be mapped. Conclusion. Through early identification of at-risk contacts and detection of infectious disease clusters, the system can potentially facilitate interventions to prevent onward transmission. The system can also support security, environmental cleaning, bed assignment and other operational processes. Simulations of novel diseases outbreaks can enhance preparedness planning as health systems that had been better prepared have been more resilient in this current pandemic.
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BACKGROUND AND AIM: Colorectal cancer (CRC) screening reduces CRC mortality by early detection and CRC incidence by polypectomy. Kaiser Permanente Northern California (KPNC) initiated organized CRC screening in 2006 using annual mailed fecal immunochemi-cal test (FIT) screening and opportunistic colonoscopy, with high screening rates. Public health guidance related to the COVID-19 pandemic led to elective colonoscopies and mailed FIT outreach being paused in March 2020. This study evaluated the impact of the pandemic on CRC screening at KPNC. METHODS: For January-December 2019 and January-October 2020, we evaluated: the KPNC screening-eligible population aged 50-75;those up to date with screening due to colonoscopy;eligible for a FIT;mailed a FIT kit;completed a FIT;completed a follow-up colonoscopy after a positive FIT;completed a colonoscopy unrelated to a positive FIT;and up to date with screening by end of follow-up (i.e., 2019 and end of October 2020, respectively). RESULTS: There were 913,873 and 941,763 eligible members in 2019 and 2020;151,252 (16.6%) and 150,407 (16.0%) were up to date with screening due to prior colonoscopy, leaving 762,621 and 791,356 eligible for FIT, respectively. Compared to 2019, when FIT kits were mailed to 627,260 of 762,621 (82.3%) FIT-eligible members, FIT kits were mailed to 521,239 of 791,356 (65.9%) eligible members by the end of October 2020, with mailings ongoing. Declines in FIT mailings occurred in March-May 2020 but rebounded quickly thereafter (Fig 1a). FIT kits were returned by 504,152 of 762,621 (66.1%) members in 2019, and 365,972 of 791,356 (46.2%) members through October 2020, with lower returns in March-June 2020 (Fig 1b). In 2019, 11,119 of 15,402 (72.2%) FIT-positive patients received a follow-up colonoscopy by year end, and through October 2020, 6,856 of 10,922 (62.8%) received a follow-up colonoscopy after a positive FIT (Fig 1c). Another 14,420 of 762,621 (1.9%) and 9,902 of 791,356 (1.3%) members completed a colonoscopy during 2019 and 2020, respectively (Fig 2). By the end of 2019, 665,541 of 913,873 (72.8%) were up to date with screening, and through October 2020, 522,215 of 941,763 (55.5%) were up to date with screening (Fig 2). CONCLUSION: The COVID-19 pandemic resulted in temporary delays in the mailing and return of FITs;and a reduction in colonoscopies performed, due, in part, to patient reluctance to respond to FIT outreach or complete follow-up colonoscopy during the pandemic. Also, fewer individuals were up to date with screening, although outreach continues through December 2020. The organized mailed FIT program allowed for the rapid resumption of outreach;however, follow-up is needed to assess the impact of screening delays on CRC outcomes and to identify ways to improve adherence with FIT screening, including colonoscopy follow-up after a positive FIT.(Figure presented) (Figure presented) (Figure presented) (Figure presented)
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The coronavirus disease 2019 pandemic has been continuously spreading throughout the world. As of July 15, 2021, there have been more than 188 million confirmed cases and more than 4.06 million deaths. Although the incidence of severe infections is relatively low in children and adolescents compared to adults, a complication called multisystem inflammatory syndrome in children (MIS-C) may occur in some cases at approximately 2–6 weeks after severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. MIS-C can be seen in patients of various ages, from young infants to adolescents, and may present with diverse clinical manifestations. While fever present in a great majority of patients, symptoms suggesting the involvement of the digestive or nervous system and the skin and mucous membranes (Kawasaki disease-like symptoms) also appear in many cases. Cardiac involvement may also be observed, including left ventricular dysfunction, myocarditis, coronary artery dilatation, and coronary aneurysm. In some cases, hypotension or shock can occur, and mechanical ventilation or treatment in the intensive care unit may be necessary. Fortunately, recovery is generally reported after appropriate treatment. MIS-C is a rare but important complication of SARS-CoV-2 infection in children and adolescents. As such, it is important to recognize the clinical symptoms and provide appropriate treatment at an early stage. In this review, the epidemiology, clinical symptoms, suggested pathophysiology, diagnostic approach, and treatment of MIS-C will be discussed. © 2021 The Korean Society of Pediatric Infectious Diseases.
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This study acknowledges the necessity to make changes in the domestic education service market given the coronavirus (COVID-19) pandemic outbreak in the fourth industrial revolution era. Considering the change from traditional classroom education service to online education service, we measure the online education service quality and investigate its effects on its acceptance intention among college students. We employ the SERVQUAL measurement model, a universal method with the longest history. In measuring acceptance intention, we use the unified theory of acceptance and use of technology (UTAUT), an accurate measurement method for the effect on acceptance intention of introducing new technology. So, this study mainly focuses on SERVQUAL and UTAUT as these tools relate to online education. The research results show that all five sub-factors of the online education service quality have positive correlations with acceptance intention. The higher the empathy with the online education service quality and the higher the performance expectancy and social influence in the UTAUT model, the higher the college students' intention to accept the online education service. Given that the significance of online education service will likely further increase in the future, this study can serve as a reference for preparing a practical framework.
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The pandemic has been afflicting the planet for over a year and from the occupational point of view, healthcare workers have recorded a substantial increase in working hours. The use of personal protective equipment (PPE), necessary to keep safe from COVID-19 increases the chances of overheating, especially during the summer seasons which, due to climate change, are becoming increasingly warm and prolonged. A web survey was carried out in Italy within the WORKLIMATE project during the summer and early autumn 2020. Analysis of variance (ANOVA) was used to evaluate differences between groups. 191 questionnaires were collected (hospital doctor 38.2%, nurses 33.5%, other healthcare professionals 28.3%). The impact of PPE on the thermal stress perception declared by the interviewees was very high on the body areas directly covered by these devices (78% of workers). Workers who used masks for more than 4 h per day perceived PPE as more uncomfortable (p < 0.001) compared to the others and reported a greater productivity loss (p < 0.001). Furthermore, the study highlighted a high perception of thermal stress among healthcare workers that worn COVID-19-PPE and this enhances the need for appropriate heat health warning systems and response measures addressed to the occupational sector.
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BACKGROUND: Complete contact tracing of COVID-19 patients in Korea allows a unique opportunity to investigate cluster characteristics. This study aimed to investigate all the reported COVID-19 clusters in Seoul Metropolitan area from January 23 to September 24, 2020. METHODS: Publicly available COVID-19 data was collected from the Seoul Metropolitan city and Gyeonggi Province. Community clusters with >= 5 cases were characterized by size and duration and then categorized using K-means clustering, and the correlation between the types of clusters and the level of social distancing was investigated. RESULTS: A total of 134 clusters including 4,033 cases were identified. The clusters were categorized into small (Type I, II), medium (type III), and large (type IV) clusters. With the same number of daily confirmed cases, cases were composed of different types of clusters by different periods of time. Raising social distancing was related with shifting types of clusters from large to small sized clusters. CONCLUSIONS: Classification of clusters may provide opportunities to better portray the pattern of COVID-19 outbreaks and implement more effective strategies. Social distancing administered by the government may be effective in suppressing large clusters but may not be effective in controlling small and sporadic clusters.
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The current understanding of ambient temperature and its link to the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear. The objective of this study was to explore the environmental and climatic risk factors for SARS-CoV-2. For this study, we analyzed the data at the beginning of the outbreak (from 20 January to 31 March 2020) to avoid the influence of preventive or control measures. We obtained the number of cases and deaths due to SARS-CoV-2, international tourism, population age, universal health coverage, regional factors, the SARS-CoV-2 testing rate, and population density of a country. A total of 154 countries were included in this study. There were high incidence rates and mortality risks in the countries that had an average ambient temperature between 0 and 10 degreeC. The adjusted incidence rate for temperatures between 0 and 10 degreeC was 2.91 (95% CI 2.87-2.95). We randomly divided the data into a training set (80% of data) for model derivation and a test set (20% of data) for validation. Using a random forest statistical model, the model had high accuracy for predicting the high epidemic status of a country (ROC = 95.5%, 95% CI 87.9-100.0%) in the test set. Population age, temperature, and international tourism were the most important factors affecting the risk of SARS-CoV-2 in a country. An understanding the determinants of the SARS-CoV-2 outbreak can help to design better strategies for disease control. This study highlights the need to consider thermal effect in the prevention of emerging infectious diseases.