Telemedicine Expansion in Pediatric Gastroenterology in Response to COVID-19: Early Results of an International Physician Survey.

The COVID-19 pandemic triggered an unprecedented expansion of telemedicine, leading to development of new workflows. We conducted a survey of telemedicine practice among pediatric gastroenterology practitioners on March 26, 2020. Responses were coded and analyzed. The survey garnered 33 responses. Most centers were 3 weeks into the implementation. The most commonly used telemedicine software was Zoom followed by FaceTime, telephone, and Epic software. Provider education was through online meetings, webinars, and tip sheets. Patient education was by nonclinical staff at the time of visit scheduling or tip sheets. A major barrier was the need for patients to enroll in an electronic portal. Two thirds of practices offered telemedicine to both new and return patients. Most sites billed based on time. This represents a record of the very early response of the pediatric gastroenterology community to the COVID-19 telemedicine expansion and can inform follow-up studies.

How Businesses Can Claim COVID-19 Relief before Time Runs Out: Certified Public Accountant

According to a study of the pandemic's impact on small businesses from the Proceedings of the National Academy of Sciences (PNAS), more than 41% of companies reported needing to close due to COVID-19 (Alexander W. Bartik, Marianne Bertrand, Zoe Cullen, Edward L. Glaeser, Michael Luca, and Christopher Stanton, "The Impact of COVID-19 on Small Business Outcomes and Expectations," Proceedings of the National Academy of Sciences, July 28, 2020, https://doi.org/10.1073/pnas.2006991117). [...]of this devastation, Congress stepped in to provide critical relief to American businesses that were forced to shut down, turn away projects, and lay off employees. [...]taxpayers and their CPAs should be ready and willing to provide records in the case of an audit, including documentation establishing how an employer determined whether it was a "large employer," records that illustrate a significant decline in gross receipts, government orders that might apply, and detailed credit calculations. According to the SBA, the administration will consider a variety of factors when reviewing PPP loans claimed, including-but not limited to-eligibility, the loan amount, and the use of the proceeds granted.

Physician Perspectives about Telemedicine: Considering the Usability of Telemedicine in Response to Coronavirus Disease 2019.

OBJECTIVE: Use of telemedicine in pediatric gastroenterology has increased dramatically in response to the coronavirus disease 2019 (COVID-19) pandemic. The goal of this study was to systematically assess the usability of telemedicine in the field of pediatric gastroenterology. METHODS: The previously validated Telehealth Usability Questionnaire was distributed to physician pediatric gastroenterologist members of North American Society for Pediatric Gastroenterology Hepatology and Nutrition. Physician demographic and practice characteristics were collected. Data were analyzed using descriptive, linear mixed-effect, and ordinary least squares regression methods. RESULTS: One hundred sixty pediatric gastroenterologists completed the survey. The majority were from academic practice (77%) with experience ranging from trainee (11%) to over 20 years of clinical practice (34%). Most (82%) had no experience with telemedicine before the pandemic. The average usability score (scale 1-5) was 3.87 (σ = 0.67) with the highest domain in the usefulness of telemedicine (µâ€Š= 4.29, σ = 0.69) and physician satisfaction (µâ€Š= 4.13, σ = 0.79) and the lowest domain in reliability (µâ€Š= 3.02, σ = 0.87). When comparing trainees to attending physicians, trainees' responses were almost one point lower on satisfaction with telemedicine (trainee effect = -0.97, Bonferroni adjusted 95% confidence interval = -1.71 to -0.23). CONCLUSION: Pediatric gastroenterologists who responded to the survey reported that the technology for telemedicine was usable, but trainees indicated lower levels of satisfaction when compared to attending physicians. Future study is needed to better understand user needs and the impacts of telemedicine on providers with different levels are experience to inform efforts to promote implementation and use of telemedicine beyond the pandemic.

Logistical Considerations and Clinical Outcomes Associated With Converting Operating Rooms Into an Intensive Care Unit During the Coronavirus Disease 2019 Pandemic in a New York City Hospital.

BACKGROUND: Coronavirus disease 2019 (COVID-19) emerged as a public health crisis that disrupted normal patterns of health care in the New York City metropolitan area. In preparation for a large influx of critically ill patients, operating rooms (ORs) at NewYork-Presbyterian/Columbia University Irving Medical Center (NYP-Columbia) were converted into a novel intensive care unit (ICU) area, the operating room intensive care unit (ORICU). METHODS: Twenty-three ORs were converted into an 82-bed ORICU. Adaptations to the OR environment permitted the delivery of standard critical care therapies. Nonintensive-care-trained staff were educated on the basics of critical care and deployed in a hybrid staffing model. Anesthesia machines were repurposed as critical care ventilators, with accommodations to ensure reliable function and patient safety. To compare ORICU survivorship to outcomes in more traditional environments, we performed Kaplan-Meier survival analysis of all patients cared for in the ORICU, censoring data at the time of ORICU closure. We hypothesized that age, sex, and obesity may have influenced the risk of death. Thus, we estimated hazard ratios (HR) for death using Cox proportional hazard regression models with age, sex, and body mass index (BMI) as covariables and, separately, using older age (65 years and older) adjusted for sex and BMI. RESULTS: The ORICU cared for 133 patients from March 24 to May 14, 2020. Patients were transferred to the ORICU from other ICUs, inpatient wards, the emergency department, and other institutions. Patients remained in the ORICU until either transfer to another unit or death. As the hospital patient load decreased, patients were transferred out of the ORICU. This process was completed on May 14, 2020. At time of data censoring, 55 (41.4%) of patients had died. The estimated probability of survival 30 days after admission was 0.61 (95% confidence interval [CI], 0.52-0.69). Age was significantly associated with increased risk of mortality (HR = 1.05, 95% CI, 1.03-1.08, P < .001 for a 1-year increase in age). Patients who were ≥65 years were an estimated 3.17 times more likely to die than younger patients (95% CI, 1.78-5.63; P < .001) when adjusting for sex and BMI. CONCLUSIONS: A large number of critically ill COVID-19 patients were cared for in the ORICU, which substantially increased ICU capacity at NYP-Columbia. The estimated ORICU survival rate at 30 days was comparable to other reported rates, suggesting this was an effective approach to manage the influx of critically ill COVID-19 patients during a time of crisis.

The Politics of New Driving Technologies: Political Ideology and Autonomous Vehicle Adoption

Autonomous vehicles (AVs) typify the nexus of smart Internet-based technology and prior innovations in transportation. A challenge with AV research is that the technology is not yet readily available for consumers to experience. Thus, public perceptions of AVs are often assessed through survey research which has uncovered demographic and socio-economic differences in the willingness to adopt and pay for AVs. It has also provided information about the perceived benefits and riks associated with AVs and how these perceived benefits and risks affects support for self-driving car technology. More recently, studies have found that political ideology is linked to perceived concerns about self-driving cars but has not yet assessed whether this link extends to the intent to adopt AVs. Given this gap in our knowledge, the contributions of the present paper our twofold. One, we will assess whether political ideology impacts the intention to adopt AVs. Two, we will assess whether political ideology directly or indirectly affects the intention to adopt AVs. As regards the latter, we will conduct a mediation analysis with a path model to assess the extent that political ideology indirectly affects the intention to adopt via the perceived benefits and concerns survey respondents expressed about AVs. Our results reveal political ideology is an important predictor of individuals’ intent to adopt AVs, as characterized by both willingness to ride in and to own AVs. Specifically, compared to conservative participants, moderates and liberals reported higher AV adoption intentions. We also find that the effect of political ideology on AV adoption intention is mediated by participants’ perceived benefits and concerns about AVs. Compared to conservatives, political moderates reported AV adoption intention via higher perceived benefits about AVs. Compared to conservatives, liberals reported higher AV adoption intention through both higher perceived benefits and lower perceived concerns about AVs.

Examining the Economic and Environmental Impacts of COVID-19 Using Earth Observation Data

The COVID-19 pandemic has infected almost 73 million people and is responsible for over 1.63 million fatalities worldwide since early December 2019, when it was first reported in Wuhan, China. In the early stages of the pandemic, social distancing measures, such as lockdown restrictions, were applied in a non-uniform way across the world to reduce the spread of the virus. While such restrictions contributed to flattening the curve in places like Italy, Germany, and South Korea, it plunged the economy in the United States to a level of recession not seen since WWII, while also improving air quality due to the reduced mobility. Using daily Earth observation data (Day/Night Band (DNB) from the National Oceanic and Atmospheric Administration Suomi-NPP and NO2 measurements from the TROPOspheric Monitoring Instrument TROPOMI) along with monthly averaged cell phone derived mobility data, we examined the economic and environmental impacts of lockdowns in Los Angeles, California;Chicago, Illinois;Washington DC from February to April 2020—encompassing the most profound shutdown measures taken in the U.S. The preliminary analysis revealed that the reduction in mobility involved two major observable impacts: (i) improved air quality (a reduction in NO2 and PM2.5 concentration), but (ii) reduced economic activity (a decrease in energy consumption as measured by the radiance from the DNB data) that impacted on gross domestic product, poverty levels, and the unemployment rate. With the continuing rise of COVID-19 cases and declining economic conditions, such knowledge can be combined with unemployment and demographic data to develop policies and strategies for the safe reopening of the economy while preserving our environment and protecting vulnerable populations susceptible to COVID-19 infection.

An application to support COVID-19 occupational health and patient tracking at a Veterans Affairs medical center.

OBJECTIVE: Reducing risk of coronavirus disease 2019 (COVID-19) infection among healthcare personnel requires a robust occupational health response involving multiple disciplines. We describe a flexible informatics solution to enable such coordination, and we make it available as open-source software. MATERIALS AND METHODS: We developed a stand-alone application that integrates data from several sources, including electronic health record data and data captured outside the electronic health record. RESULTS: The application facilitates workflows from different hospital departments, including Occupational Health and Infection Control, and has been used extensively. As of June 2020, 4629 employees and 7768 patients and have been added for tracking by the application, and the application has been accessed over 46 000 times. DISCUSSION: Data captured by the application provides both a historical and real-time view into the operational impact of COVID-19 within the hospital, enabling aggregate and patient-level reporting to support identification of new cases, contact tracing, outbreak investigations, and employee workforce management. CONCLUSIONS: We have developed an open-source application that facilitates communication and workflow across multiple disciplines to manage hospital employees impacted by the COVID-19 pandemic.