10-year follow-up of interventional electrophysiology: updated German survey during the COVID-19 pandemic.

INTRODUCTION: This study provides an update of survey-based data providing an overview of interventional electrophysiology over the last decade. Overall infrastructure, procedures, and training opportunities in Germany were assessed. METHODS: By analyzing mandatory quality reports, German cardiology centres performing electrophysiological studies were identified to repeat a questionnaire from 2010 and 2015. RESULTS: A complete questionnaire was returned by 192 centers performing about 75% of all ablations in Germany in 2020. In the presence of the COVID-19 pandemic, a total of 76.304 procedures including 68.407 ablations were reported representing a 38% increase compared to 2015. The median number of ablations increased from 180 in 2010 to 377 in 2020. AF was the most common arrhythmia ablated (51 vs. 35% in 2010). PVI with radiofrequency point-by-point ablation (64%) and cryo-balloon ablation (34%) were the preferred strategies. Less than 50 (75) PVI were performed by 31% (36%) of all centres. Only 25 and 24% of participating centres fulfilled EHRA and national requirements for training centre accreditation, respectively. There was a high number of EP centres with no fellows (38%). The proportion of female fellows in EP increased from 26% in 2010 to 33% in 2020. CONCLUSION: Comparing 2020, 2010 and 2015, an increasing number of EP centres and procedures were registered. In 2020, more than every second ablation was for therapy of AF. In the presence of an increasing number of procedures, training opportunities were still limited, and most centres did not fulfill recommended EHRA or national requirements for accreditation.

Characterizing injury patterns and outcomes in hospitalized trauma patients with non-English Language Preferences.

INTRODUCTION: Patients with Non-English Language Preferences (NELP) experience challenges navigating the US healthcare system which can lead to disparate outcomes. This study sought to investigate injury patterns and outcomes in hospitalized trauma patients with NELP. METHODS: A retrospective review was performed at a trauma center from January 2019-December 2020. An institutional database of all emergency department video consultations for interpreter services was cross-referenced with the trauma registry and comparisons were made between NELP and English-preferred (EP) speaking patients. RESULTS: During the study, 257 NELP patients were hospitalized after traumatic injury. Twenty-two percent had work related injuries compared to only 3.0% in the EP cohort (p < 0.001). When propensity score matched, there were no significant differences in ICU and hospital length of stay or mortality between NELP and EP patients. DISCUSSION: Trauma patients are linguistically diverse and understanding their injury patterns and outcomes is crucial for guiding culturally and linguistically appropriate injury prevention.

Anti-SARS-CoV-2 vaccination immune response in MS patients: interim results of a multicentre, prospective cohort study

Introduction: Understanding the impact of disease-modifying drugs (DMDs) on vaccine-mediated immunity and knowledge of a patient's immunisation status are essential for balancing medical decisions between beneficial multiple sclerosis (MS) therapy and protection against SARS-CoV-2. Method(s): This ongoing study investigates the immune response to authorised SARS-CoV-2 vaccines in MS patients (planned sample size: n=200) by collecting clinical and serological data at 10 centres across Germany. Eligible patients include those with planned vaccination, first dose given, vaccination completed within the last 6 weeks, or vaccination completed >6 weeks ago and booster dose planned within the next 90 days. In addition, patients must have recovered from any previous COVID-19 infection. The primary endpoint is the number (%) of patients with immune response approx. 30 days after their last vaccination (baseline for SARS-CoV-2 S1-specific IgG after booster dose: serum level >=3 months after complete vaccination). The persistence of humoral immunity after initial and booster doses is followed over time. Result(s): At data cut-off (12 April 2022), 156 patients (66.0% female, age: 41.7+/-10.7 yrs) had been enrolled of whom 117 (75.0%) had received 3 vaccine doses, 32 (20.5%) 2 doses, 3 (1,9%) 1 dose, and 1 (0.6%) 4 doses. Most patients were on MS DMDs at inclusion (136/156, 87.2%). After the first booster, 54/82 patients (65.9%) showed IgG-S1 response (increase >100 BAU/mL vs baseline). Adequate immune response was less frequent among patients treated with anti-CD20 agents or S1P-R modulators (7/32, 21.9%) compared to untreated patients or those treated with other DMDs (47/50, 94.0%). Tozinameran (Comirnaty) was the most frequently used vaccine (367/422 vaccinations, 87.0%);of the triple-vaccinated patients, 83 (70.9%) had received 3 tozinameran doses and 22 (18.8%) 2 tozinameran doses with an elasomeran (Spikevax) booster (other vaccine combinations: <5%). Patient-reported vaccine tolerability was 'as expected' or 'better than expected' for 348/422 (82.5%) vaccinations. Tolerability of the second dose was more often rated as 'worse than expected' than the first dose (11.3% vs 7.2%). Eight patients developed COVID-19 during the study, and 2 patients experienced an MS relapse. Conclusion(s): The preliminary results of this ongoing study show that the immune response to SARS-CoV-2 vaccination is generally good in MS patients but may be impaired under treatment with certain DMDs.

Readiness of Community Health Agents for COVID19 : Anya Vieira-Meyer

Brazil is one of the countries with the highest COVID19 mortality numbers. COVID19 deaths affected disproportionally different populations/communities, tending to be higher among more vulnerable ones. Brazil has a public-funded unified health system (SUS) built on the aegis of equity and social control. Its Primary Health Care (PHC) is organized by the Family Health Strategy (FHS) through Family Health Teams (FHT), which comprise a family doctor, a nurse, a dentist, nurse auxiliaries and Community Health Agents (CHAs). CHAs are individuals from the community trained to provide a range of services in the territories, including home visits, health promotion activities, and serve as liaisons between health units and communities. In this context, CHAs have the potential to play an important role in fighting the pandemic by working on contact tracing, collecting information on infected people, and providing guidance to them and the community in order to contain community transmission. However, not much is known about their readiness regarding the COVID19 pandemic in one of the Brazil's poorest regions. Thus, this study evaluated, though CHA perspective, aspects related to their preparedness for COVID19 in Brazil's northeast region. Questionnaires were applied to CHAs from 8 different municipalities - 4 capitals and 4 country-side municipalities. A total of 1935 CHAs were interviewed at their workplace in 2021. 77.8% said that they were acting in the COVID19 frontline, but only 16% referred to have received training for this function. Furthermore, only 13.7% mention to have had access to adequate individual protective equipment during their work, and 91.6% believe that they can get infected by SAR-COV-2 during their work duties. Additionally, 93.9% considered themselves a transmission vehicle due to work. Despite their potential in the fight against COVID19, CHAs did not received enough training, nor were equipped adequately during the COVID19 pandemic. Key messages • CHAs did not received enough training, nor were equipped adequately during the COVID19 pandemic. • Addequate trainning and work environment are essencial for proper work development.

Young People's Geographies in the Times of Covid-19: System Threat as a Chance for System Change?

The far-reaching consequences of the Covid-19 pandemic have not only demonstrated the economic vulnerability of the current capitalistic system, but also the positive ecological consequences of rapid policy action. Previous studies have shown that economic threats lead to a sense of lost control along with a subsequent differentiation of oneself in comparison to others. The question that arises is whether young people as drivers of the sustainability transformation will see the pandemic's impact as a positive example of fast action and therefore an opportunity, or whether they will view the phenomenon as a threat to their status quo. In this study 150 young people ages 15-24 were interviewed using an online questionnaire. The results show that young people see the Covid-19 crisis as an example of rapid, consistent action by politics and society. They demand that restrictions benefitting the climate be maintained to mitigate the climate crisis. This suggests that it is helpful to show positive examples of successful communal efforts to overcome massive threats and uncertainties, as such examples motivate young people and give them a sense of collective efficacy.

The effect of the initial months of the COVID-19 national lockdown on MMed training activities at the University of the Free State, South Africa

AFRICAN DEVELOPMENT : Background. Shortly after the first case of SARS-CoV-2 infection (COVID-19) had been reported in South Africa, a national lockdown was declared. Subsequently, the University of the Free State (UFS) changed from a contact delivery mode to remote multimodal teaching, learning and assessment.Objectives. To determine the effect of the initial months of the COVID-19 lockdown on MMed training activities at the UFS, specifically the demographic and health profile of students, research progress, academic activities and the clinical training environment.Methods. A cross-sectional study using an anonymous self-administered questionnaire was used. All registered MMed students at the UFS were eligible to participate.Results. A response was obtained from 134 (51.9%) of 258 registrars, most of whom were included in the analysis (n=118;45.7%). Significant associations between the effect of the COVID-19 lockdown on day-to-day clinical work and the ability to work on MMed research (p<0.01) and self-directed learning time (p<0.01) were noted. Changes in domestic circumstances affecting MMed research were reported by 26.9% of respondents. Worsening or new symptoms of stress were reported by 40.0% of respondents.Conclusion. The initial months of the COVID-19 lockdown might have far-reaching implications for registrars' academic progress. Registrars experienced adverse psychosocial consequences that might impede their academic progress

Surveillance with FDG PET/CT after Completion of Therapy for NSCLC: A Status Update on Inclusion in the SUPE_R Trial

Introduction: Even after completion of curative treatment for non-small cell lung cancer (NSCLC), patients have a high risk of recurrence and consequently, active surveillance is recommended. The SUPE_R trial is an ongoing trial, designed to explore whether surveillance with F-18 fluoro-deoxy-glucose positron emission tomography/computed tomography (FDG PET/CT) and cell-free tumor DNA sequencing (ctDNA) can improve recurrence detection and increase the number of treatable relapses. Methods: Patients diagnosed with NSCLC who are candidates for curative therapy, are recruited prior to therapy to obtain a baseline blood sample for ctDNA analysis (part 1). After successful completion of curative treatment verified at the first post-treatment surveillance CT scan, patients are randomized to either continue standard surveillance or surveillance with FDG PET/CT replacing CT every 6 months, for two years or until recurrence (part 2). Baseline characteristics were recorded for all patients, as well as reasons for dropout or exclusion of patients not randomized for part 2. [Formula presented] Results: Patient enrollment started in 2018 and the inclusion goal of 750 randomized patients was met in November 2021. As of February 2022, 40.4% (n = 303) of randomized patients have completed the intervention. 923 patients were enrolled in part 1 (table 1). 492 (53.3%) patients included in part 1 were not randomized for part 2. This was most frequently due to dropout before screening for part 2 (n = 203, 41.3%), refusal to participate in part 2 (n = 118, 12.8%), exclusion due to unmet inclusion criteria for part 2 (n = 97, 10.5%) or progressive disease (n = 62, 6.7%). Twenty-two patients missed screening for part 2 due to Covid-19. 319 patients were included in part 2 without prior inclusion in part 1. The proportion of patients not randomized for part 2 was higher for patients with advanced disease at diagnosis (stage III) compared to patients with localized disease (stage I-II, 64.7 vs 47.8%, p < 0.001), which is partially explained by a higher risk of death (6.3 vs 2.2%, p = 0.008) and disease progression (9.5 vs 5.5%, p = 0.063) in these patients. Conclusions: Enrollment in the SUPE_R trial was recently completed after 3 years of patient recruitment. Half of patients included in part 1 were not randomized for part 2 and the proportion of patients not randomized was higher for patients with more advanced disease at diagnosis. Whether this will affect the outcome of the SUPE_R trial remains to be explored. Keywords: Surveillance, PET/CT, ctDNA

Increased Hair Cortisol Levels are Associated With a Shift Towards Exploitative Decision-Making in Health Care Workers in the COVID-19 Pandemic

Background: During the COVID-19 pandemic, healthcare workers (HCWs) were required to make flexible decisions in a rapidly changing environment under significant stress. Linking subjective and physiological markers of stress to quantitative measures of decision-making is critical for understanding the resilience of healthcare workers during the pandemic. The aim of this study was to utilize an explore-exploit computational psychiatry paradigm to measure the effects of COVID-19 related stress on decision-making flexibility. Methods: We utilized biomarker and survey data to query chronic stress;123 participants completed the survey and 54 hair samples were collected. Cortisol was measured with LC/MS/MS. We evaluated explore/exploit behavior with a resting three-arm bandit task, and 66 completed the task. Results: Eighty-seven met criteria for COVID-19 related PTSD, however, we found no significant correlation between hair cortisol and symptoms measures. In contrast, we found that participants with higher hair cortisol exhibited greater exploitation (Pearsons’ r=-0.36, p=0.046). Additionally, explore-state reward-dependent switching behavior, a state-specific measure of learning from reward, significantly decreased with increasing cortisol (r=-0.49, p=0.007). Further, in a basic 3-parameter reinforcement learning model, the learning rate alpha inversely correlated with cortisol (r =-0.467, p=0.007). Conclusions: Computational model-derived decision-making variables demonstrated a robust correlation with hair cortisol concentrations. Without this task, biomarker data may appear independent of chronic stress. This study highlights the importance of quantitative behavioral tasks and physiological signals to understanding the interaction of mood and cognition with stress. Supported By: This work was supported by the University of Minnesota Office of Academic and Clinical Affairs COVID-19 Rapid Response Grant. Research in this publication was also supported in part by the Office Of The Director, National Institutes of Health under Award Number P51OD011106 to the Wisconsin National Primate Research Center, University of Wisconsin-Madison. This research was conducted in part (as applicable) at a facility constructed with support from Research Facilities Improvement Program grant numbers RR15459-01 and RR020141-01. Keywords: Cognitive Flexibility, Hair Cortisol, COVID-19 Pandemic, Computational Psychiatry

Presentation, clinical course and complications in trauma patients with concomitant COVID-19 infection.

BACKGROUND: This study investigated the impact of COVID-19 infection on hospitalized trauma patients. METHODS: A retrospective review of hospitalized trauma patients at a level I trauma center was performed from March-December 2020. Data pertaining to patient demographics, presentation and hospital course was compared between COVID positive and negative trauma patients. RESULTS: There were 4,912 patients and 179 (3.64%) were COVID-19 positive. Demographics and clinical presentation did not differ significantly between those with and without concomitant COVID-19. However, COVID positive trauma patients had higher rates of acute kidney injury (p = 0.016), sepsis (p = 0.016), unplanned intubation (p = 0.002) and unplanned return to the ICU (p = 0.01). The COVID positive cohort also had longer hospital stays (p < 0.01) with no significant difference in mortality. CONCLUSIONS: In the setting of an ongoing pandemic, awareness of the complications COVID positive trauma patients are predisposed to is important for providers.

THE GRAND "MAKE-OVER" OF THE UNITED STATES: TIME FOR DRAMATIC CHANGE

This research addresses how we will imagine, administer and manage governmental enterprises in the post-pandemic world. If previous pandemics serve as a guide, the environment that public administration will need to adapt to may feature the following: A more volatile economy and recovery where recovery comes quickly to some and not to others;an intense "greening" of the economy, market systems, environmental policies and conservation practices to meet needs of a world population and sustain the ability to meet needs for generations;major reduction in revenues for local and state governments remembering that governments must balance their budgets;state and city planning departments response to an increased demand for civic participation in life and design of cities and how will technology impact this piece of our environment;and in addition the widening gap between those who are economically advantaged and those who are not, the impact of advanced technology and digitalization, and, among other topics, the "Overton Window"-what was previously thought to be impossible, now becomes feasible, if not necessary.

Prospective online survey: SARS-CoV-2 vaccination readiness in people with MS

Background: At the beginning of the SARS-CoV-2 pandemic, the German MS-Registry and the German Multiple Sclerosis Society, started a survey to examine the impact on the behavioral changes of people with MS (PwMS) and the count of SARSCoV- 2 infections, following recommendations of the global data sharing initiative. In prospect of a vaccine against SARS-CoV-2 in Nov-2020, the survey was redesigned to address the participant's attitude towards a SARS-CoV-2-vaccination. Objective: We aim to provide new insights into the vaccination attitude of PwMS. Results: By January 31, 2021, 914 PwMS (77% female) participated in the survey. The average age was 48 (±11.8) years. 72% suffered from relapsing (RR) and 28% from progressive (PP/SP) MS. 71% were on DMT at the time of the survey. 56% of the PwMS wanted to be vaccinated against SARS-CoV-2, 32% considered to be vaccinated, and 12% did not want to be vaccinated. Female PwMS (N=704): 53% wanted to be vaccinated, 34% considered to be vaccinated and 13% (N=94) did not want to be vaccinated. Male PwMS (N=210): 64% wanted to be vaccinated, 28% considered to be vaccinated and 9% did not want to be vaccinated. The highest willingness to be vaccinated was in the age group >65 years old (N=62) with 63%. In the age groups 35-44 years (N=227), 45-54 years (N=252) and 55-64 years (N=232), the willingness proportion in PwMS was over 55%. Under the age of 35 (N=141), the willingness proportion in PwMS was 46%. Objections against a vaccination: 72% feared possible side and long-term effects, 11% doubted the vaccination's efficacy and 18% had other concerns. These 'other' concerns included questions towards compatibility of vaccination with current treatment, the own immune response or the risk of a vaccination induced relapse. Many PwMS mentioned that they still have some questions about the vaccine's mode of action. 73% of the female participants were concerned about side and long-term effects, 18% had other concerns, and 9% wondered whether a vaccination would be effective. On the other hand, 68% of male participants were concerned about side and long-term effects, 13% had other concerns and 19% wondered whether a vaccination is effective (χ2-test,p<0.001). Conclusion: At the time of the survey 88% [CI 85-90%] of PwMS were positive towards being vaccinated which is significantly higher compared to a Germany-wide survey of the general population from November 2021 in which vaccination readiness was 71% [CI 68-74%], p<0.001.

Mild versus severe COVID-19: laboratory markers

The number of COVID-19 patients is dramatically increasing worldwide. Treatment in intensive care units (ICU) has become a major challenge;therefore, early recognition of severe forms is absolutely essential for timely triaging of patients. While the clinical status, in particular peripheral oxygen saturation (SpO2) levels, and concurrent comorbidities of COVID-19 patients largely determine the need for their admittance to ICUs, several laboratory parameters may facilitate the assessment of disease severity. Clinicians should consider low lymphocyte count as well as the serum levels of CRP, D-dimers, ferritin, cardiac troponin and IL-6, which may be used in risk stratification to predict severe and fatal COVID-19 in hospitalised patients. It is more likely that the course of the disease will be unfavourable if some or all of these parameters are altered.

Cross-Border Capacity-Building for Port Ecosystems in Small and Medium-Sized Baltic Ports

One of the key challenges related to the threat posed by the COVID-19 pandemic is preservation of employment and protecting staff who are working in port operations and struggling to keep ports operating for ship calls. These activities performed by port labour are deemed to be crucial for the EU and European ports, since 75% of the EU external trade and 30% of intra-EU transport goods are moved by waterborne transport. As a response to the global lockdown and the vulnerability of global supply chains, the majority of international organisations and maritime ports networks have shortlisted measures necessary to keep the severe effects of the lockdown to a minimum. One of the key measures identified is how to limit physical interaction. As an effect, millions of people and organisations across the globe have had to use and/or increase their deployment of digital technologies, such as digital documentation, tracing information systems and digital group-working platforms. Hence, blockchain and data-enabling systems have become to be recognised as a core element maintaining the uninterrupted flow of goods and services at ports. In pursuing uninterrupted trade and keeping ports open and running, this research paper addresses how the current situation afflicts the small and medium-sized ports located on the Baltic Sea which are argued to be critical actors of the port-centric logistics' ecosystem. Given the topicality of this research and addressing the research gap, the authors suggest a conceptual capacity-building framework for port employees. This suggested framework is based on empirical insights: primary and secondary data collected from the project Connect2SmallPorts, part-financed by the Interreg South Baltic Programme 2014-2020 from the European Regional Development Fund (ERDF). The conceptual framework aims towards a practical training programme dedicated to fill in the missing skills or expand the limited competence of human resources and ports' capacity when adapting or advancing digitalisation in the ports' ecosystems. In particular, specific areas of capacity building are addressed and individual solutions suggested to foster a digital transformation of ports. The conceptual training framework is designed as a training tool indicating opportunities to help ports upgrade their competences with the blockchain technology, and to advance their transportation, environmental and economic performance with improved digitalisation. For this purpose, the conducted research employed mixed methods and applied concepts and approaches based on the field of management. For example, the construct of absorptive capacity, organisational learning, transformation, resource-based view and the concept of dynamic capabilities are included in the ecosystem discourse and are linked with open innovation and service design. The research presented in this article provides both theoretical and practical contributions, in which the affected stakeholders can test and utilise the developed tool as well as transfer it to other regions. © 2021 Christopher Meyer et al., published by Sciendo 2021.

Real-world clinical characteristics of covid-19 patients with or without evidence of allergic asthma

RATIONALE: ACE2, a critical SARS-CoV-2 entry receptor, has reduced expression in those with allergic sensitizations. Consequently, SARS-CoV-2 infections may impact patients with allergic asthma (AA) or no evidence of allergic asthma (NEAA) differently. We explore demographics of SARS-CoV-2-infected AA and NEAA patients. METHODS: Retrospective data were obtained from the US-representative COVID-19 Optum Electronic Health Record dataset through 10/15/2020. Index was the earliest date of presumed diagnosis or laboratory-confirmed SARS-CoV-2 infection (CDC guidelines) from 02/20/2020, defined as (1) diagnosis code of U07.1/U07.2, or (2) positive diagnostic test for SARS-CoV-2, (3) diagnosis code of B97.29 without a negative molecular SARS-CoV-2 test within a 14-day window (+/-7 days). Patients SARS-CoV-2-positive with evidence of moderate-to-severe asthma at any time (ICD-10 J45.4X or J45.5X) were included. AA was defined as positive specific IgE (≥0.35 kU/L) serum test or skin prick test (code 95004) ordered by a specialist (eg, allergist, pulmonologist, dermatologist) or omalizumab use. NEAA was defined as failing to meet the AA definition and patients with allergic comorbidities were excluded. Baseline demographic and clinical characteristics were obtained 6-12 months before COVID-19 diagnosis. RESULTS: The database included 242,280 SARS-CoV-2-positive patients;569 (0.2%) had evidence of comorbid AA and 3137 (1.3%) had asthma and NEAA. For AA patients, mean (SD) age at index was 48.2 (18.2) years;70.3% were female, with 54.3% White, 26.4% Black, and 12.5% Hispanic (Table 1). Most AA patients were from the US Midwest and Northeast (80.5%). NEAA patients had similar demographics: mean (SD) age at index was 50.7 (19.5) years;67.6% female;with 60.0% White, 21.5% Black, and 13.0% Hispanic;and 81.5% were from the US Midwest and Northeast. A greater proportion of patients had severe asthma in AA versus NEAA groups (220/569 [38.7%] versus 457/3137 [14.6%]). More patients with AA versus NEAA used asthma biologic treatment (62/569 [10.9%] vs 27/3137 [0.9%]). Comorbid conditions (hypertension, diabetes, pregnancy, chronic obstructive pulmonary disease, and Charlson Comorbidity Index), body mass index, and smoking history were comparable between groups. A higher proportion of NEAA patients were current smokers. CONCLUSIONS: A smaller proportion of patients with SARS-CoV-2 infection in this retrospective analysis had comorbid AA versus NEAA, whereas patient demographics and comorbidities were generally comparable between groups. Differences included the proportion of patients with severe asthma and biologic treatment use (greater in AA), and current smoking (lower in AA). The observed lower prevalence of AA versus NEAA in SARS-CoV-2-positive patients warrants further investigation.