Patient and provider perspectives to utilization of telemedicine in surgery.

Objectives: Determine patient and provider perspectives on widespread rapid telemedicine implementation, understand the key components of a surgical telemedicine visit and identify factors that affect future telemedicine use. Summary of background data: Compared to other specialties, the field of surgery heretofore has had limited adoption of telemedicine. During the COVID-19 pandemic Healthcare, including the surgical specialties, saw new widespread use of telemedicine. Methods: We conducted a prospective cohort study during the COVID-19 California stay-at-home and physical distancing executive orders. Utilization data were collected from clinics and compared to usage data during the same time 1 year later. All patients and providers who participated in a telemedicine visit during the study period were asked to complete a survey after each encounter and the surveys were analyzed for trends in opinions on future use by stakeholders. Results: Over the 10-week period, the median percentage of telemedicine visits per clinic was 33% (17%-51%) which peaked 3 weeks into implementation. One hundred and ninety-one patients (48% women) with a median age of 64 years (IQR 53-73) completed the patient survey. Patients were first-time participants in telemedicine in 41% (n = 79) of visits. Fifty-seven percent (n = 45) of first-time users preferred that future visits be in-person versus 31% of prior users (p = 0.007). The median travel time from home to the clinic was 40 min (IQR = 20-90). Patients with longer travel times were not more likely to use telemedicine in the future (61% with longer travel vs. 53% shorter, p = 0.11). From the 148 provider responses, 90% of the visits providers were able to create a definitive plan with the telemedicine visit. A physical exam was determined not to be needed in 45% of the visits. An attempt at any physical exam was not performed in 84% of routine follow-up or new-patient visits, compared to 53% of post-op visits (p = 0.001). Conclusion: Telemedicine is a viable ambulatory visit option for surgical specialists and their patients. During rapid telemedicine deployment, travel distance did not correlate with increased use of telemedicine, and in-person visits are still preferred. However, nearly half of all visits did not need a physical exam, which favors telemedicine use.

Synergies Between COVID-19 and Climate Change Impacts and Responses

The COVID-19 pandemic and anthropogenic climate change are global crises. We show how strongly these crises are connected, including the underlying societal inequities and problems of poverty, substandard housing, and infrastructure including clean water supplies. The origins of all these crises are related to modern consumptive industrialisation, including burning of fossil fuels, increasing human population density, and replacement of natural with human dominated ecosystems. Because business as usual is unsustainable on all three fronts, transformative responses are needed. We review the literature on risk management interventions, implications for COVID-19, for climate change risk and for equity associated with biodiversity, water and WaSH, health systems, food systems, urbanization and governance. This paper details the considerable evidence base of observed synergies between actions to reduce pandemic and climate change risks while enhancing social justice and biodiversity conservation. It also highlights constraints imposed by governance that can impede deployment of synergistic solutions. In contrast to the response to the COVID-19 pandemic, governance systems have procrastinated on addressing climate change and biodiversity loss as these are interconnected chronic crises. It is now time to address all three to avoid a multiplication of future crises across health, food, water, nature, and climate systems.

Knowledge, attitude, and practice toward COVID-19 among healthy population in the Philippines

COVID-19 pandemic has become a severe health threat to the Philippines and around the world. At the early onset of the pandemic, it is imperative to measure the knowledge, attitude, and practice (KAP) among healthy individuals to better understand the causes, transmission, and preventive measures. Purpose: This study aimed to identify the knowledge, attitude, and practice towards COVID-19 in a healthy Filipino population during the early onset of the pandemic outbreak. Methods: This cross-sectional rapid online and web-based survey was conducted among healthy Filipino population. A total of 1634 subjects participated via the Google survey link. Descriptive statistics were used to describe the respondents' profile characteristics and KAP scores. The One-Way ANOVA or independent sample t-test was used to measure KAP scores' differences when grouped according to respondents' profile characteristics. Pearson correlation was used to measure the relationship among the KAP scores. The data were all analyzed using the SPSS version 26.0. Results: The overall knowledge scores revealed 67.7%. Filipinos believed COVID-19 would finally be successfully controlled and confident that the Philippines can win the battle against the virus through preventive practices. KAP scores showed significant differences with age, sex (p<0.000), and place of residence (p<0.000), occupation (p<0.000), and marital status (p<0.000). A significant positive low correlation between knowledge and practice (r=0.076, p<0.01), attitude and practice (r=0.100, p<0.01).Conclusion: Albeit a low knowledge of COVID-19, healthy Filipino populations had a positive attitude and compliant with the preventive measures. This study hopes to contribute to the growing corpus of literature on COVID-19 to provide evidence-based information towards health promotion, illness prevention, and control of possible virus' spread.

Bromodomain Inhibition Blocks Inflammation-Induced Cardiac Dysfunction and SARS-CoV2 Infection (preprint)

Cardiac injury and dysfunction occur in COVID-19 patients and increase the risk of mortality. Causes are ill defined, but could be direct cardiac infection and/or ‘cytokine-storm’ induced dysfunction. To identify mechanisms and discover cardio-protective drugs, we use a state-of-the-art pipeline combining human cardiac organoids with high throughput phosphoproteomics and single nuclei RNA sequencing. We identify that ‘cytokine-storm’ induced diastolic dysfunction can be caused by a cocktail of interferon gamma, interleukin 1β and poly(I:C) and also human COVID-19 serum. Bromodomain protein 4 (BRD4) is activated along with pathology driving fibrotic and induced nitric oxide synthase genes. BRD inhibitors fully recover function in hCO and totally prevent death in a cytokine-storm mouse model. BRD inhibition decreases transcription of multiple genes, including fibrotic, induced nitric oxide synthase and ACE2, and prevention of cardiac infection with SARS-CoV2. Thus, BRD inhibitors are promising candidates to prevent COVID-19 mediated cardiac damage.Funding: We acknowledge grant and fellowship support from the National Health and Medical Research Council of Australia (J.E.H., M.J.S., C.R.E., T.B.), Heart Foundation of Australia (J.E.H.), QIMR Berghofer Medical Research Institute (J.E.H.), The Stafford Fox Foundation (E.R.P.), the Royal Children’s Hospital Foundation (E.R.P.), Australian Research Council Strategic Initiative in Stem Cell Science (Stem Cells Australia) (E.R.P. and J.E.H.) and the Medical Research Future Fund (MRFF9200008) (J.E.H., T.B., M.J.S., K.P.A.MD., C.R.E., E.R.P.). M.J.S. is supported by Health and Medical Research Council of Australia Program (APP1132519) and Investigator (APP1173958) grants. A.S. is also supported by Investigator grant (APP1173880). The Murdoch Children’s Research Institute is supported by the Victorian Government’s Operational Infrastructure Support Program. This project received support from Dynomics Inc. J.E.H. is supported by a Snow Medical Fellowship. Conflict of Interest: R.J.M., J.E.H., G.A.Q.-R., D.M.T. and E.R.P. are listed as co-inventors on pending patents held by The University of Queensland and QIMR Berghofer Medical Research Institute that relate to cardiac organoid maturation and putative cardiac regeneration therapeutics. J.E.H. is a coinventor on licensed patents held by the University of Goettingen. R.J.M, E.R.P., D.M.T., B.G. and J.E.H. are co-founders, scientific advisors and stockholders in Dynomics Inc. D.M.T. and B.G. are employees of Dynomics Inc. /Dynomics Pty Ltd. QIMR Berghofer Medical Research Institute has filed a patent on the use of BRD inhibitors. Ethical Approval: Animal work was approved by the QIMR Berghofer Medical Research Institute Animal Ethics Committee. Ethical approval for the use of human embryonic stem cells (hESCs) was obtained from QIMR Berghofer’s Ethics Committee and was carried out in accordance with the National Health and Medical Research Council of Australia (NHMRC) regulations. Procedures complied with standards set under Australian guidelines for animal welfare and experiments were subject to Monash University animal welfare ethics review (Approval #MARP/2019/13606).