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This paper describes a redeployment programme developed by Kaiser Permanente Northern California (KP NCAL) to meet physician staffing needs during five COVID-19 surges in Northern California. By leveraging two existing programmes, creating a flexible system of redeployment levels, and supporting the system with a robust training programme, the physician redeployment programme effectively addressed physician staffing needs, maximised excellent patient care, and supported KP NCAL physicians during the pandemic. The programme delivered care to over 131,000 outpatients with COVID-19 infection and redeployed physicians into more than 800 inpatient shifts. © Henry Stewart Publications, 1749–9216.
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BACKGROUND: Urban and rural areas have different types of built environments and community infrastructure, which lead to different types of successful community-based physical activity initiatives. Temporary Play Streets are a supported way to increase physical activity and perceptions of the built environment as a space for active lifestyles. PURPOSE: Within the field of public health, public libraries constitute an underutilized community partner. To begin to understand the capacity of rural librarians to support rural Play Streets, a cross-sectional questionnaire was developed for distribution to rural librarians. METHODS: The sampling frame targeted members of the membership-based U.S. Association for Rural & Small Libraries (ARSL). Among respondents, 65% reported offering outdoor physical activity programs in the past, and 61% reported continuing to offer versions of this programming during the COVID-19 pandemic. Librarians work with a broad range of community partners on this programming, and already own much of the equipment necessary for a successful Play Streets initiative. CONCLUSIONS: The results of this study corroborate claims from previous research, which shows that in small and rural communities, public libraries have the capacity to play a role in promoting physical activity through involvement in community partnerships. Additional work is needed to understand, evaluate, and support this opportunity to weave rural librarians into community-based physical activity promotion efforts more fully.
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Video games are part of everyday life for many Americans despite concerns for social isolation and depressive symptoms. Preliminary studies show gamers may compensate for lack of in-real-life (IRL) support with online connections. This longitudinal social network study investigated the social structure of an online gaming site and how social support, sense of community, and depressive symptoms relate to communication. Members (N = 40) of an online gaming site reported online and IRL support, sense of community, depressive symptoms, and usernames of other members whom they spoke to about important life matters. IRL and online social support, sense of community, and depressive symptoms significantly influenced changes in online gaming network structure over time. These results are timely given social isolation and mental health impacts related to the COVID-19 pandemic. Exploring how to healthfully build online connections through gaming may be an avenue for greater social support when IRL social support is lacking. © 2023 North Central Sociological Association.
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The Sydney Children's Hospitals Network (SCHN) addressed the challenges of the COVID-19 pandemic by implementing innovative changes which made their health system resilient and responsive. For other healthcare systems, there are important takeaways. In the United States and Canada, an urgent widespread response is needed to address the overdose crisis, driven by potent synthetic opioids (ie, fentanyl and its derivates). We project the COVID-19 System Shock Framework (CSSF) on to the North American healthcare systems and suggest a Fentanyl System Shock Framework, which provides a framework for necessary changes and innovations to address the overdose crisis. To become resilient to the fentanyl system shock, core components as well as overarching values, health policy, and online technologies need to be adapted to reduce the death count and meet the evolving needs of marginalised individuals who use opioid. Future research should focus on scientifically assessing such implementations to guide evidence-based decision making. Keywords: Opioid Overdose Crisis, Fentanyl, COVID-19, Canada Copyright: © 2023 The Author(s);Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/ licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation: Meyer M, Westenberg JN, Krausz RM. The fentanyl system shock – are there lessons to learn from the COVID-19 system shock framework? Comment on "The COVID-19 system shock framework: capturing health system innovation during the COVID-19 pandemic.” Int J Health Policy Manag. 2023;12:7409. doi:10.34172/ijhpm.2023.7409. © 2023, Kerman University of Medical Sciences. All rights reserved.
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Background: Patients with rhinitis to pollen can exhibit asthma. To control the spread of SARS-CoV-2, the use of face masks has become widespread worldwide. There is no clinical evidence that medical masks are efficient in birch pollen-induced asthma. Objective(s): To study the efficacy of medical face masks in reducing asthma in patients allergic to birch in ALYATEC Environmental Exposure Chamber (EEC). Method(s): 24 GINA 1 birch-related asthma patients, were exposed to 60 ng/m3 of airborne Bet v 1 in ALYATEC EEC. All patients had positive skin prick tests and specific IgE to birch at screening. Baseline exposures lasted 1 hour to assess asthma responses (20% drop in Forced Expiratory Volume in 1 second (FEV1). Patients with asthma were randomized into 2 groups: with and without a KOLMI face mask (OP-Air), for a 6-hour exposure to birch allergen. Result(s): At baseline, asthma occurred within 30 minutes. In group without mask, the median time for drop in FEV1 was 37 minutes, and 67 min in the group with mask (p=0.219). There was a threshold difference of time for onset of asthma between the 2 groups. At 1 hour-exposure, patients with masks still present in the EEC was twice as much as the group without masks. Asthma questionnaire was not statistically significant in both groups, but was highly correlated with the drop in FEV1 at 30 min exposure. The Kaplan Meyer graph showed that survival probability in EEC was higher for the group with masks than without masks. Borg's scale for dyspnea suggest a difference between the 2 groups starting at 2 hour-exposure. Conclusion(s): This pilot study showed a tendency of face masks to increase the time to develop asthma. Some patients reported mask effectiveness during pollen season.
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Aim of the study: Currently, there is no clinical evidence that face masks are efficient in birch pollen-induced asthma. As the use of face masks has become widespread worldwide to limit the spread of SARS-CoV-2, it was chosen to demonstrate the clinical efficacy of medical masks in patients allergic to birch in the same way that clinical trial with drugs. Patients and Methods: 24 birch-related asthmatic patients, were exposed to 60 ng/m3 of airborne Bet v 1 in ALYATEC environmental exposure chamber. All patients had positive skin prick tests and specific IgE to birch at screening visit. Patients with asthma response during 1-hour baseline exposure were randomized into 2 groups: with and without a KOLMI surgical face mask (OP-Air), for a 6-hour exposure to birch allergen. Result(s): The median time to obtain an early asthma response in the group without mask was 37 minutes, and 67 min in the group with mask (P = 0.219). At 1 hour-exposure, patients with masks still present in the environmental exposure chamber was twice as much as the group without masks. Conclusion(s): This pilot study showed a tendency of face masks to increase the time to develop allergic symptoms. Copyright © 2022
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Résumé But de l’étude À ce jour, aucune étude clinique n’a mis en évidence l’efficacité des masques médicaux dans l’asthme induit par le pollen de bouleau. Suite à la généralisation de l’utilisation des masques dans le monde afin de limiter la propagation du SARS-CoV-2, il a été choisi de démontrer l’efficacité des masques chirurgicaux chez des patients allergiques au pollen de bouleau, en suivant les mêmes principes que les études cliniques avec médicaments. Patients et méthodes 24 patients asthmatiques au pollen de bouleau ont été exposés à 60ng/m3 de Bet v 1 dans la chambre d’exposition environnementale ALYATEC. Tous les patients avaient des tests cutanés et des taux d’IgE spécifiques au pollen de bouleau positifs lors de la visite de sélection. Les patients présentant une réponse asthmatique pendant l’exposition baseline de 1h ont été randomisés en 2 groupes : avec et sans masque chirurgical KOLMI® (OP-Air), pour une exposition de 6h aux allergènes de pollen de bouleau. Résultats Le temps médian d’apparition d’une réponse bronchique immédiate dans le groupe sans masque était de 37minutes, et de 67min dans le groupe avec masque (p=0,219). À 1h d’exposition, le nombre de patients dans le groupe avec masque encore présents dans la chambre d’exposition environnementale était deux fois plus important que dans le groupe sans masque. Conclusion Cette étude pilote a montré une tendance des masques à retarder le temps d’apparition des symptômes allergiques. Aim of the study Currently, there is no clinical evidence that face masks are efficient in birch pollen-induced asthma. As the use of face masks has become widespread worldwide to limit the spread of SARS-CoV-2, it was chosen to demonstrate the clinical efficacy of medical masks in patients allergic to birch in the same way that clinical trial with drugs. Patients and methods 24 birch-related asthmatic patients, were exposed to 60ng/m3 of airborne Bet v 1 in ALYATEC environmental exposure chamber. All patients had positive skin prick tests and specific IgE to birch at screening visit. Patients with asthma response during 1-hour baseline exposure were randomized into 2 groups: with and without a KOLMI® surgical face mask (OP-Air), for a 6-hour exposure to birch allergen. Results The median time to obtain an early asthma response in the group without mask was 37minutes, and 67min in the group with mask (P=0.219). At 1 hour-exposure, patients with masks still present in the environmental exposure chamber was twice as much as the group without masks. Conclusion This pilot study showed a tendency of face masks to increase the time to develop allergic symptoms.
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Disruptive events such as natural disasters become increasingly frequent, demonstrating the need for resilient supply systems. Additive manufacturing (AM) is an emerging technology which can help to solve supply bottlenecks as seen during SARS-CoV-2. AM was able to mitigate supply bottlenecks of medical spare parts, in times when globally arranged traditional supply sources failed. This chapter presents and discusses how AM can help to increase resilience. For this purpose, our contribution examines modern portfolio theory and the interplay of a hedged sourcing approach (traditional, formative with AM). This is assessed by using a single case study. The results indicate that using AM as a hedged source of supply to traditional supply sources increases the overall resilience of the supply system. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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In martial arts, as in dance, embodiment is of the utmost importance (Zarrilli 2009;Minarik 2014), especially in experiencing and interpreting the movements of the opponent in ground combat and responding with the body. Also in striking martial arts, the performative altercation and bodily communication with the opponent is based on corporeal sensitivity. The Covid-19 pandemic, on the other hand, has led to a widespread digitalisation in martial arts courses–a trend that will presumably continue after the pandemic, as the study by Meyer et al. (2021) indicates. The results also showed that martial arts clubs and teachers have succeeded in adapting to digital teaching and practice in very different ways, e.g. through Zoom workshops or online lessons. Especially during a pandemic, when physical contact and activities are reduced to a minimum, data suggests that martial artists have become even more aware of the importance of embodiment and physical exercise. As digitalisation almost always leads to disembodiment, these dynamics seem to be opposed to each other. This development is also connected to the didactics and the training motives of martial artists, and how these are changed and/or replaced by effects of digitalisation before, during and after the pandemic. The article analyses the different methods and approaches to a digitalised martial arts teaching and practice and ventures a look into the future of digital movement practices in virtual reality. © 2022 Informa UK Limited, trading as Taylor & Francis Group.
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Aggregated data from mobile network operators (MNOs) can provide snapshots of population mobility patterns in real time, generating valuable insights when other more traditional data sources are unavailable or out-of-date. The COVID-19 pandemic has highlighted the value of remotely-collected, high-frequency, localized data in inferring the economic impact of shocks to inform decision-making. However, proper protocols must be put in place to ensure end-to-end user-confidentiality and compliance with international best practice. We demonstrate how to build such a data pipeline, channeling data from MNOs through the national regulator to the analytical users, who in turn produce policy-relevant insights. The aggregated indicators analyzed offer a detailed snapshot of the decrease in mobility and increased out-migration from urban to rural areas during the COVID-19 lockdown. Recommendations based on lessons learned from this process can inform engagements with other regulators in creating data pipelines to inform policy-making.
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The vulnerability of supply chains is more evident during crises. Recently, the COVID-19 pandemic, container ship blockades, and marine traffic jams in the Suez Canal have caused severe supply disruptions. Additive manufacturing (AM) often referred to as 3D printing, at demand sites, can solve supply disruptions. This study investigates how AM in different configurations affects supply availability. To this end, we simulate a healthcare supply chain. The simulation considers daily business demand and operational and disruptive supply risks. We measure demand, orders, stock levels, and availability indicators and compare them across supply configurations. The simulation allows identifying the most effective resilience configuration related to the cost-per-availability ratio. Overall, simulations support using AM as a risk-mitigation strategy. Copyright © 2022 Inderscience Enterprises Ltd.
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Introduction: The COVID-19 pandemic has impacted sleep, with some populations such as essential workers reporting insomnia and poor sleep health. Prior research has suggested (but not tested) that this worsening of sleep may be tied to a lack of control over one's health or safety during the pandemic. This study tests this prediction and examines the role of perceived control as a protective factor against poor sleep in essential workers. Methods: This study uses data from the NDSU National COVID Study, which has followed 301 nationally-representative American adults across four waves of data collection since April 2020. The current analysis includes data from wave 1 (April 2020) in 279 participants who had complete demographic, essential worker, perceived control (including domain general perceived control as well as health, COVID, work-specific control), and sleep health (RU SATED) data. Using t-tests and correlations, we hypothesized: (1) sleep health would be worse in essential workers compared with others;(2) perceived control would relate to better sleep health;and (3) perceived control would be a stronger predictor of sleep health in essential workers relative to others. Results: There were no significant differences in sleep health between essential workers (N=44, M=8.27, SD=2.72) and others (N=235, M=8.46, SD=2.54;t=-0.44, p=.66). In the full sample, all indices of perceived control were significantly related to better sleep health (rs=.17-.31, ps<.004). Associations were stronger in essential workers (N=44, rs=.30-.56, ps<.05) than in others (N=235, rs=.13- .31, ps<.04). In sensitivity analyses that excluded participants not working for pay (e.g., people who were unemployed, retired, or receiving disability) from the other category, moderation effects were stronger;only COVID-related perceived control was significantly related to sleep health (N=110;r=.24, p=.01) in non-essential workers. Conclusion: This is the first study to demonstrate links between perceived control and sleep. Although sleep health was not significantly different between essential and non-essential workers, we found that perceived control was especially beneficial for essential workers' sleep. Our results suggest interventions to improve perceived control, a modifiable psychosocial resource, might improve sleep health for essential workers.
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We estimate changes in the rates of five FBI Part 1 crimes during the 2020 spring COVID-19 pandemic lockdown period and the period after the killing of George Floyd through December 2020. We use weekly crime rate data from 28 of the 70 largest cities in the United States from January 2018 to December 2020. Homicide rates were higher throughout 2020, including during early 2020 prior to March lockdowns. Auto thefts increased significantly during the summer and remainder of 2020. In contrast, robbery and larceny significantly declined during all three post-pandemic periods. Point estimates of burglary rates pointed to a decline for all four periods of 2020, but only the pre-pandemic period was statistically significant. We construct a city-level openness index to examine whether the degree of openness just prior to and during the lockdowns was associated with changing crime rates. Larceny and robbery rates both had a positive and significant association with the openness index implying lockdown restrictions reduced offense rates whereas the other three crime types had no detectable association. While opportunity theory is a tempting post hoc explanation of some of these findings, no single crime theory provides a plausible explanation of all the results. Supplementary materials for this article are available online.
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Purpose Boys & Girls Clubs of America (BGCs) provide numerous avenues for youth to connect, be physically active and have healthy meals/snacks. These services are often provided to low-income families at reduced cost to bridge the gap in after school and summer childcare. However, many of these clubs were forced to dramatically change their services during the COVID-19 pandemic. This study aims to examine how 13 BGCs in Texas, USA, experienced COVID-19 and persevered to provide services. Design/methodology/approach Interviews were conducted with 16 BGC leaders from 13 different BGCs. Open-ended questions were used to elicit leaders' experiences with the pandemic, services their clubs were able to offer, barriers overcome and supports crucial to their ability to serve their communities. Thematic analysis was used to generate findings from these interviews. Findings BGC services changed significantly during the pandemic. Normal activities were no longer possible;however, leaders (alongside their communities) continually provided services for their families. Further, leaders reiterated the power of the community coming together in support of their families. Social implications While BGC leaders had to adapt services, they found ways to reach families and serve their community. These adaptations can have dramatic impacts on the social and physical well-being of children in their communities. Learning from this adversity can improve services as clubs start to build back. Originality/value This study provides vital context to the changing care and setting children were exposed to during the pandemic response. Additionally, these results provide understanding of the adaptations that took place in these services.
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The COVID-19 pandemic continues to affect the daily life of college students, impacting their social life, education, stress levels and overall mental well-being. We study and assess behavioral changes of N=180 undergraduate college students one year prior to the pandemic as a baseline and then during the first year of the pandemic using mobile phone sensing and behavioral inference. We observe that certain groups of students experience the pandemic very differently. Furthermore, we explore the association of self-reported COVID-19 concern with students' behavior and mental health. We find that heightened COVID-19 concern is correlated with increased depression, anxiety and stress. We evaluate the performance of different deep learning models to classify student COVID-19 concerns with an AUROC and F1 score of 0.70 and 0.71, respectively. Our study spans a two-year period and provides a number of important insights into the life of college students during this period. © 2022 Owner/Author.
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Introduction: Social distancing, extensive bans on contacts, curfews, and required wearing of masks in public places have -while unavoidable for disease containment purposes -caused major disruptions to everyday life in face of the Coronavirus Disease 2019 (COVID-19) pandemic. The aim of this study was to figure out how the COVID-19 pandemic affects the Health-related Quality of Life (HRQoL) of children and adolescents with CHD, as well as how the parents perceive the HRQoL of their children. Methods: HRQoL was assessed by KINDL® questionnaire during the COVID-19 pandemic and compared to the children's most recent completion of the questionnaire out of the FOOTLOOSE study setting (German-Clinical-Trial-Register-ID: DRKS00018853) at the outpatient department of the German Heart Center Munich (DHM). From May 27th to June 29th 2020, 160 German children with various CHD (15.2 ± 2.5 years, 62 girls) completed this re-assessment of HRQoL. Mean follow-up period was 2.1 ± 1.7 years. Difference between children's self-reported HRQoL and parents' proxy report was calculated with a paired student T-Test, and agreement of the respective ratings with intraclass correlation coefficient (ICC) and their 95% confidence intervals. Results: HRQoL in children with CHD was significantly lower during COVID-19 pandemic compared to before in total KINDL® score (by -2.1 ± 12.3, p=.030), and the subcategories emotional well-being (by -5.4 ± 1.2, p<.001) and friends (by -4.5 ± 1.7, p=.009). Parents of children with CHD rate the HRQoL in total KINDL® score (mean difference: 3.9 ± 1.2, p=.002), and the subcategories family (mean difference: 8.8 ± 1.7 SEE, p<.001) and friends (mean difference: 7.6 ± 2.2 SEE, p<.001) even worse than their children. Only moderate degree of agreement was found between most of the sub-categorical HRQoL assessment of children with CHD and their parents. Conclusions: The COVID-19 pandemic had a negative impact on HRQoL in children and adolescents with CHD and their families. Furthermore, parents rate the HRQoL of their chronically ill children even worse than the children themselves. Specifically, psychological concerns of children with CHD and their families should also be considered by health care providers during the COVID-19 pandemic.
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Background. Fungemia is associated with high rates of morbidity, mortality and increase in length of hospital stay. Several studies have recognized increased rates of candidemia since the COVID-19 pandemic. Methods. A retrospective cohort study was conducted at a tertiary healthcare system in Detroit, Michigan to evaluate the impact of the COVID-19 pandemic on incidence of candidemia. The "pre COVID-19" timeframe was defined as January - May 2019 while the "during COVID-19" timeframe was January - May 2020. To compare incidence and patient characteristics between cohorts, t-tests and chi-square analysis was used. Additional sub-analysis was performed in candidemia patients during COVID-19 timeframe comparing outcomes of patients based on COVID-19 status. A Fisher Exact and Satterthwaite Test were used for analysis of categorical and continuous variables, respectively. Results. Overall, 46 cases of candidemia were identified in both the pre COVID-19 and during COVID-19 periods. Pre COVID-19, the average number of cases was 3.0 ± 1.2 per month. The incidence more than doubled during COVID-19 to 6.2 ± 4.2 cases per month (p = 0.14) (Figure 1). No significant differences in patient demographics were detected between cohorts, however, patients in the COVID-19 cohort had higher rates of corticosteroid use, mechanical ventilation and vasopressors (Table 1). In the 2020 period, 31 patients developed candidemia and 12 (38.7%) patients tested SARS-CoV-2 positive. On average, COVID-19 patients developed candidemia 12.1 days from admission, compared to 17.8 days in the COVID-19 negative cohort (p = 0.340). Additionally, COVID-19 patients with candidemia coinfection were significantly more likely to expire;83.3% (n=10) COVID-19 patients expired compared to 36.8 (n=7) in the COVID-19 negative cohort (p = 0.025) (Table 2). Conclusion. The prevalence of fungemia markedly increased during the COVID-19 surge. Increased use of corticosteroids and broad spectrum antimicrobials, prolonged use of central venous catheters and prolonged ICU length of stay likely contributed to this increase. Patients who developed candidemia co-infection with COVID-19 were found to have poorer outcomes as compared to those who were SARS-CoV-2 negative or untested.
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Background. Pseudomonas aeruginosa is one of the most common causes of healthcare-associated infections in critically ill patients and those with suboptimal immunity. However, the development of multidrug resistant Pseudomonas aeruginosa (MDR Pa) creates an even great disease burden and threat to both the hospital and local community health. The purpose of this study is to illustrate a descriptive analysis of a cluster of MDR Pseudomonas, during a local surge of SARS-CoV-2 (COVID 19) pandemic. The goal is to shed more light on the troublesome parallel during outbreaks, such as COVID-19 and consequential secondary outcomes. Methods. From November 2020 through February 2021, 16 patients exposed to the intensive care units of a tertiary healthcare system were infected or colonized with a multidrug-resistant strain of P. aeruginosa (Figure 1). Outbreak investigation was conducted via retrospective chart review of the first eight cases and prospective analysis of the latter eight cases. The isolates collected prospectively were analyzed for taxonomic identification, antimicrobial resistance profile, and phylogenetic analysis. Clinical characteristics of all patients were collected, and epidemiological investigation was carried out. MDR is defined as resistance to at least four classes of antibiotics: third-generation cephalosporins, fluoroquinolones, aminoglycosides, and carbapenems. Results. Of the 16 cases of MDR Pa infections, seven died within five months (Table 1). Antimicrobial resistance gene profiling detected blaOXA and blaPAO betalactamase genes in all the samples. One sample contained an additional blaVIM resistance gene, although this patient was colonized and not actively infected. The analysis suggests existence of two clusters demonstrating relatedness and possible horizontal transmission. Timing of this cluster of cases coincides with surge of COVID-19 cases. This highlights the importance of infection control measures and antimicrobial stewardship. Conclusion. Since early 2017 studies show there is a growing prevalence worldwide in transferable resistance, particularly for β-lactamases and carbapenemases, MDR Pseudomonas. This study emphasizes an irony paralleled during a pandemic, the needed efforts to prevent unintentional lapses in patient safety.