Blurred Boundaries: What It Means To Be an Early Career Faculty Member During a Pandemic

Early career faculty are undergoing a stressful transition period and actively negotiating their professional identity. The COVID-19 pandemic has changed the daily activities in early career faculty's personal and professional lives and thus complicated the negotiation process. This study explores how engineering faculty members redefine and reconceptualize what it means to be in their early career during the COVID-19 pandemic. Through an emergent qualitative coding technique, we identified two themes: 1) the blurring of personal and professional boundaries, and 2) the renegotiation of different identities. The findings offer insights into how to better support early career faculty and allow them to balance these different dimensions of their academic identities. © 2022 IEEE.

Modeling SARS-CoV-2 RNA degradation in small and large sewersheds

Wastewater-based epidemiology has played a significant role in monitoring the COVID-19 pandemic, yet little is known about degradation of SARS-CoV-2 in sewer networks. Here, we used advanced sewershed modeling software to simulate SARS-CoV-2 RNA degradation in sewersheds across Houston, TX under various temperatures and decay rates. Moreover, a novel metric, population times travel time (PT), was proposed to identify localities with a greater likelihood of undetected COVID-19 outbreaks and to aid in the placement of upstream samplers. Findings suggest that travel time has a greater influence on RNA degradation across the sewershed as compared to temperature. SARS-CoV-2 RNA degradation at median travel times was approximately two times greater in 20 degrees C wastewater between the small sewershed, Chocolate Bayou, and the larger sewershed, 69th Street. Lastly, placement of upstream samplers according to the PT metric can provide a more representative snapshot of disease incidence in large sewersheds. This study helps to elucidate discrepancies between SARS-CoV-2 viral load in wastewater and clinical incidence of COVID-19. Incorporating travel time and SARS-CoV-2 RNA decay can improve wastewater surveillance efforts.

Comparing Rates of Change in SARS-CoV-2 Wastewater Load and Clinical Cases in 19 Sewersheds Across Four Major Metropolitan Areas in the United States

There is no standard approach to interoperate the during the pandemic. We tested several data processing approaches on wastewater surveillance data sets generated from 19 sewersheds across four major metropolitan areas in the United States from May 2020 through October 2021. First, we explored the effect of different data processing techniques on the correlation between SARS-CoV-2 wastewater RNA load and clinical case counts and found that locally weighted smoothing (LOESS) smoothing applied to multivariate imputation by chain equations (MICE)-imputed wastewater viral load led to the strongest correlations in 16 out of 19 sewersheds (84%). Next, we calculated the rate of change (RC) in wastewater viral load and in clinical cases and found that imputing missing viral load data on a 28-day window produced the strongest correlation (Spearman's rho = 0.63). Furthermore, we determined an average sensitivity threshold of 2.4 new COVID-19 cases per day resulted in a significant RC in wastewater, but sensitivity varied with the laboratory method used. Our retrospective analysis using RC highlighted certain methodological insights, reduced site-specific impacts, and estimated a wastewater sensitivity threshold-supporting the use of relative, rather than absolute, measures of SARS-CoV-2 wastewater data for more interoperable data sets.

Impact of remote continuous positive airway pressure set-up on treatment usage and effectiveness

Introduction: Initiating treatment with continuous positive airway pressure (CPAP) traditionally relies on in-person visits with trained therapists to provide hands-on instruction regarding CPAP usage and mask fit. To overcome geographic barriers and reduce COVID-19 transmission, health systems increasingly rely on remote set-ups of mailed equipment. Despite a strong rationale for the mailed approach, relative effectiveness is unclear. Methods: Our VA medical center shifted from in-person to mailed CPAP dispensation during the COVID-19 pandemic in March 2020. Using VA administrative and wireless CPAP usage data, we assembled a cohort of patients with newly diagnosed obstructive sleep apnea (OSA) who initiated CPAP for the first time from July 2019 to August 2020. Our primary outcome was mean nightly usage over the first 90 days. We compared patients with in-person vs. mailed CPAP dispensation using generalized linear models adjusted for age, gender, race, and Charlson Comorbidity Index. Among patients with >1 hour of overall usage, we compared secondary outcomes of leak, apnea hypopnea index (AHI), and obstructive/central apnea indices. Results: We identified 693 patients with newly diagnosed OSA whose CPAP was provided in-person and 296 who had CPAP mailed. Nightly usage in the first 90 days was modest in both groups (in-person: 149.7, mailed: 152.9 min/night), and we did not detect a difference in adjusted models (+7.6 min/night, 95%CI -13.6-28.8). We also did not detect a difference in 95th percentile leak (-1.2 liter/minute, 95%CI -3.3-0.9). Device-detected AHI was relatively low overall (in-person: 3.2, mailed: 4.1 events/hour), but was greater in the mailout group (+1.0/hour, 95%CI 0.2-1.7). AHI differences appeared to be driven by obstructive (+0.5/hour, 95%CI 0.2-0.8) but not central events (-0.1, 95% CI -0.2-0.4). Risk of AHI>5 was comparable between groups (in-person: 17.3%, mailed: 19.0%, OR 1.2, 95%CI 0.8-1.7). Conclusion: We were able to switch from an in-person to a mailbased system of CPAP initiation without a change in CPAP adherence or mask leak. While AHI was slightly greater in the mailed group, the clinical significance of this finding is unclear. Future work will need to evaluate the impact of remote CPAP dispensation on patient-centered outcomes.

Patient experiences with telehealth in sleep medicine: A qualitative evaluation

Rationale: The field of sleep medicine has been an avid adopter of telehealth, particularly during the COVID-19 pandemic. While numerous randomized trials support the efficacy of telehealth to treat conditions such as obstructive sleep apnea (OSA) and insomnia, relatively little is known about patients' experiences and perceptions of telehealth in typical practice. Methods: We recruited a purposive sample of patients who had sleep provider encounters via one of three telehealth modalities: in-clinic video, home-based video, and telephone. We conducted semi-structured interviews to assess general telehealth experiences, elicit perceptions around most and least helpful aspects, and contrast their experiences with in-person care. Two analysts coded transcripts using content analysis. After review of coding and categorization, the analysts identified emergent themes that cut across participants and categories. Results: We conducted interviews with 35 patients (in-clinic video n=12, home-based video n=11, telephone n=12) at two VA medical centers from June 2019 to May 2020. Five themes emerged including access to care, security and privacy, personalization of care, patient empowerment, and unmet needs. 1) Access to care: Patients perceived that telehealth provided access to sleep care in a timely and convenient manner, especially during the COVID-19 pandemic. Patients also saw telehealth as a way to improve continuity of care with their preferred providers. 2) Security and Privacy: Patients described how home-based telehealth afforded them greater feelings of safety and security within appointments due to avoidance of anxiety provoking triggers (e.g. crowds). However, patients also noted a potential loss of privacy when telehealth was delivered at home. 3) Personalization of care: Patients outlined ways in which telehealth both improved and hindered their ability to communicate their individual needs to providers. In turn, this communication translated into the delivery of personalized care and positive health impacts. 4) Patient Empowerment: Patients described how telehealth empowered them to engage in self-management for their sleep disorders. 5) Unmet Needs: Patients recognized that there were specific areas where telehealth was not meeting their needs, including lack of follow-through with PAP therapy. Patients also expressed concerns around the lack of a physical examination. Conclusion: Patients described both positive and negative experiences with telehealth, highlighting areas where care can be further adapted to better suit their needs. As we continue to refine telehealth practices, we encourage providers and hospital systems to consider these aspects of the patient experience.