How Videoconferencing and its Affordances Transformed Teaching in Schools During COVID-19 Pandemic

The COVID-19 pandemic has brought about major changes in digitization in many areas of life and professions. New areas were digitized almost overnight, the school system in Germany was no exception leading to a demand for videoconferencing tools and communication platforms. These technologies have many different functionalities that need to be discovered, explored, and exploited by the user. Given the disruptive events that the COVID pandemic brought to us, this paper aims to shed light on how the dynamics of discovery, exploration, and exploitation unfolds. We use a functional affordance theory perspective to analyze and understand how user learn to use new technologies. To do this, we conducted an exploratory case-study-based research design including interviews with teachers from various schools to analyze how they appropriate new technologies to develop an explanatory theoretical model. © 2023 IEEE Computer Society. All rights reserved.

Risk Prediction for AKI in Patients Hospitalized With COVID-19: Withstanding Variants Over Time

Background: Acute kidney injury (AKI) is common in patients hospitalized with COVID-19, predictive models for AKI are lacking. We aimed to develop the best predictive model for AKI and assess performance over time. Method(s): Patients with positive SARS CoV-2 PCR hospitalized between 3/1/2020 to 1/14/2022 at 19 Texas hospitals were included. Those with AKI present on admission were excluded. Comorbidities, demographics, baseline laboratory data, and inflammatory biomarkers were obtained from the EHR and used to build nested models for AKI in an inception cohort. Models were validated in four out-of-time cohorts. Model discrimination and calibration measures were compared to assess performance. Result(s): Of 13,468 patients, 5,676 were in the Inception Cohort and 7,792 in subsequent validation cohorts grouped based on predominance of COVID variants, with cohorts 1 and 3 containing a mix of variants, cohort 2 corresponding to Delta predominance, and cohort 4 to Omicron. Prevalence of AKI was 13.7% in inception and 12.6%, 12.4%, 13.3%, and 14.4% in the validation cohorts. Proportion of AKI stages 2 or 3 vs. 1 was lower in the Omicron-dominant cohort 4 compared to the inception cohort (28/139 vs. 257/776, P=0.008), but was no different for cohorts 1-3. The final model containing demographics, comorbidities and baseline WBC, hemoglobin, hsCRP, ferritin, and D-dimer, had an AUC=0.781 (95% CI, 0.763, 0.799). Compared to the inception cohort, discrimination by AUC (validation 1: 0.785 [0.760, 0.810], P=0.14, validation 2: 0.754 [0.716, 0.795], P=0.14, validation 3: 0.778 [0.751, 0.806], P=0.14, and validation 4: 0.743 [0.695, 0.789], P=0.14) and calibration by ECI (validation 1: 0.116 [0.041, 0.281], P=1.0, validation 2: 0.081 [0.045, 0.295], P=0.64, validation 3: 0.055 [0.030, 0.162], P=1.0, and validation 4: 0.120 [0.043, 0.472], P=0.50) showed stable performance over time. Conclusion(s): Using demographics, comorbidities, admission laboratory values, and inflammatory biomarkers, we developed and externally validated a model to accurately predict AKI in hospitalized patients with COVID-19. A lower proportion of patients hospitalized during the Omicron-dominant period of the pandemic experienced severe AKI, but our predictive model withstood changes in practice patterns and virus variants.

Leadership, creativity, and recovery from crisis in rural tourism

Leadership and crisis are closely intertwined, yet studies of leadership during crisis remain scarce. The 2020 Covid-19 outbreak offers an ideal context to examine leaders' roles during severe crises. Grounded in the theoretical framework of transformative leadership and based on a study of four cases in rural Ningbo, Zhejiang Province, the study examines rural tourism enterprises' post-pandemic recovery to identify how leadership navigated organizations through the recovery process. The study demonstrates that each case displays components of transformational leadership that facilitated businesses' recovery. Creativity appears especially important in promoting effective leadership amid crisis and uncertainty. Theoretical and practical implications are discussed.

AKI in inpatients with COVID-19: Risk factors and mortality

Background: AKI in hospitalized patients with COVID-19 is a common adverse complication. Our aim was to investigate risk factors associated with AKI and whether AKI in this setting is independently associated with in-hospital mortality at 30 days. Methods: All adult patients admitted with a positive SARS-CoV-2 PCR between 3 /2021 to 1/2021 to nineteen hospitals who had a COVID-associated billing diagnosis and no history of ESKD or kidney transplant were included. AKI was defined according to the Kidney Disease Improving Global Outcomes guidelines. Risk factors associated with AKI were evaluated with univariable and multivariable logistic regression, and mortality was evaluated using Kaplan-Meier and Cox Proportional Hazards models. Results: The study cohort included 9,681 patients, of which 3,666 (38%) met criteria for AKI. Compared with patients without AKI, patients with AKI were older [mean (SD) age 67 (16) vs. 60 (18) years], more likely to be male (58% vs. 47%), and more likely to be black (21% vs. 15%). Patients with AKI were also more likely to have diabetes mellitus (52% vs. 32%), hypertension (78% vs. 57%), CKD (55% vs. 17%), and coronary artery disease (20% vs. 11%). Patients with AKI were also more likely to be on ACEi/ ARB on admission (51% vs. 37%), require mechanical ventilation (21% vs. 3.2%) or have higher WBC, hs-CRP, ferritin, D-dimer, and cardiac troponin). P-values were <0.001 for all of the aforementioned comparisons. Risk factors significantly associated with AKI in the multivariable model included age, sex, race, hypertension, CKD, diabetes, ACEi or ARB on admission, mechanical ventilation, WBC on admission, hs-CRP, ferritin, d dimer and troponin. Death occurred more frequently in patients with AKI (22.1%;n=811) than in those without (3%;n=178). Patient with AKI had higher mortality risk as compared to those without AKI, hazard ratio (HR) 3.08 (95% CI 2.56-3.71), that remained significant even after controlling for all variables associated with AKI, such as age, sex, race, comorbidities, inflammatory biomarkers, elevated troponin, and COVID-related treatments, HR 1.64 (95% CI 1.34-2.01). Conclusions: Patients with COVID-19 who develop AKI have a higher mortality. We found risk factors associated with AKI in the setting of COVID, and that the increased mortality risk associated with AKI in COVID-19 is independent of these factors.

AKI prediction and recovery in hospitalized patients with COVID-19

Background: AKI is a complication in patients hospitalized with COVID-19 and is associated with poor outcomes. We aimed to develop predictive models for AKI development and recovery in patients hospitalized with COVID-19. Methods: Patients with a positive SARS-CoV2 PCR admitted to 19 Texas hospitals from 3/13/2020-1/1/2021 were included. AKI presence and stages were determined using KDIGO guidelines. Individuals with AKI present on admission (POA) were excluded for predictive models. Patients were followed for 90 days to evaluate for renal recovery (serum creatinine ≤1.1 times baseline). Nested models for AKI were built using logistic regression: Model 1 included age, sex, race, smoking status, presence of hypertension (HTN), diabetes (DM), chronic kidney disease (CKD), coronary artery disease (CAD), and chronic heart failure (CHF), and use of ACEI/ARB;Model 2, added admission WBC, hs-CRP, and hemoglobin;Model 3, added ferritin and D-Dimer to Model 2 to assess for accuracy improvements. 10-fold stratified cross validation was done to evaluate model performance. Results: Of 8392 patients, 2702 (32%) had AKI, of which 2281 (84%) recovered by 90 days: 92% of stage 1, 75% of stage 2, and 40% of stage 3 AKI, p for trend <0.001. After excluding AKI present on admission, 776 of 5671 developed AKI during the hospitalization. Percentages of AKI stages 1, 2 and 3 were 67%, 8%, and 25%. Overall, 152 (20%) of 776 required RRT. Patients with AKI were older, more likely to be male, black, and have hypertension, diabetes, coronary artery disease, congestive heart failure, and CKD. The interval improvement of each AKI predictive model was statistically significant, with last model AUC of 78.1 (95% CI 76.3%-79.9%) and all p<0.001. The final model had improvement in all metrics when compared to Models 1 and 2, with a sensitivity of 69%, specificity 76%, positive predictive value 32%, negative predictive value 94%, positive likelihood ratio 3.02, and negative likelihood ratio 0.40. Conclusions: AKI is common among patients hospitalized with COVID-19, but a large proportion recover renal function by 90 days. Recovery rate is lower based on stepwise higher stages of AKI. Addition of inflammatory biomarkers to demographics and medical comorbidities can improve prediction of AKI in this patient population.

Nursing management at a Chinese fever clinic during the COVID-19 pandemic.

BACKGROUND: The rampant spread of the novel coronavirus disease (COVID-19) has assumed pandemic proportions across the world. Attempts to contain its spread have entailed varying early screening and triage strategies implemented in different countries and regions. AIM: To share the experience of scientific and standardized management of fever clinics in China, which provide the first effective checkpoint for the prevention and control of COVID-19. INTRODUCTION: A fever clinic was established at our hospital in Tianjin, China, for initially identifying suspected cases of COVID-19 and controlling the spread of the disease. METHODS: The management system covered the following aspects: spatial layout; partitioning of functional zones; a work management system and associated processes; management of personnel, materials and equipment; and patient education. RESULTS: Within two months of introducing these measures, there was a comprehensive reduction in the number of new COVID-19 cases in Tianjin, and zero infections occurred among medical staff at the fever clinic. DISCUSSION: The fever clinic plays an important role in the early detection, isolation and referral of patients presenting with fevers of unknown origin. Broad screening criteria, an adequate warning mechanism, manpower reserves and staff training at the clinic are essential for the early management of epidemics. CONCLUSION: The spread of COVID-19 has been effectively curbed through the establishment of the fever clinic, which merits widespread promotion and application. IMPLICATIONS FOR NURSING AND HEALTH POLICIES: Health managers should be made aware of the important role of fever clinics in the early detection, isolation and referral of patients, and in the treatment of infectious diseases to prevent and control their spread. In the early stage of an epidemic, fever clinics should be established in key areas with concentrated clusters of cases. Simultaneously, the health and safety of health professionals require attention.