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Background. Prior research has shown that viruses may trigger JDM, although the degree to which COVID-19 may serve as a trigger for JDM remains unknown. We present two case reports of JDM occurring after COVID-19 infection. We also provide case numbers of new JDM diagnoses pre-and post-COVID-19 as well as an analysis of JDM population characteristics pre-and post-COVID-19. A 5year-old female developed upper respiratory infection (URI) symptoms and was diagnosed with COVID-19 in December of 2020. She developed Gottron's sign, heliotrope rash, and weakness resulting in admission in February of 2021. She had elevated CK, AST, ALT, LDH, and aldolase. Her CMAS (childhood myositis assessment scale) was 24. An MRI showed diffuse myositis. Myositis specific antibody (MSA) testing revealed a positive MJ antibody. She was diagnosed with JDM and started on steroids, methotrexate, hydroxychloroquine, and IVIG with improvement. The second patient was a 4year-old female who was diagnosed with COVID-19 in October 2020. In January 2021, she developed heliotrope rash and Gottron's papules. She developed decreased exercise tolerance in May 2021 found to have elevated Aldolase and LDH. Her CMAS was 34. An MRI showed diffuse myositis. MSA testing was significant for a positive P155/140 antibody. She was started on hydroxychloroquine, steroids, IVIG and methotrexate with improvement. Due to the aforementioned cases a retrospective analysis was performed assessing the characteristics of JDM pre-and post-COVID-19 at Lurie Children's Hospital. Methods. The Cure JM biorepository houses clinical data, laboratory data, and patient samples obtained at the onset of JDM. The following information was obtained from newly diagnosed JDM patients: MSA, DAS (disease activity score), flow cytometry results, vWF antigen, neopterin, CMAS, capillary end row loop(ERL), LDH, Aldolase, ESR, CRP, IgG, complements, ANA, and age at diagnosis. We identified 10 patients with a diagnosis of JDM from January 1st 2020 -July 1st 2021 who were designated as the post-COVID-19 group. This population was compared to a total of 51 patients diagnosed with JDM between Jan 1st 2010 and December 31st 2019 who were designated as the pre-COVID-19 group. Data analysis was performed using Welch T-testing. Research enrollment was impacted due to the COVID-19 pandemic. To better assess JDM rates, chart review and EMR reports were obtained to determine the total number of JDM diagnoses. Results. T-testing showed no significant change in DAS, ERL count, T or B cell flow cytometry, vWF antigen, CK, CMAS, CRP, Aldolase, LDH, IgG, complements or ANA titer between the pre-and post-COVID-19 JDM groups. The analysis showed a significant change in NK cell population with a decrease in the absolute NK cell number (pre 163, post 90.75. P value 0.03), and NK cell percentage (pre 6.6%, post 3.625%, P value 0.008). Both of the patients presented in this case report showed a low NK cell number (1% and 3% respectively). The total number of new JDM cases rose from an average of 6.3 cases per year to an average 9 cases per year from January 1st 2020 to December 31st 2021. Conclusion. This study provides two case reports of COVID-19 likely triggering JDM. This study also shows a modest increase in the number of new JDM cases since the onset of the pandemic. Interestingly, the NK cell population in the post-COVID-19 JDM patients were significantly decreased. NK cells have multiple roles in not only immune regulation, but also the immune response to viruses. This study suggests that NK cells play a role in the development of in virally mediated JDM, specifically in cases triggered by COVID-19. Future studies will be important to further delineate the function of NK cells in these patients. Markers of JDM disease severity, including DAS, Neopterin, CK, and CMAS, did not significantly change in our institution's JDM population after the onset of the COVID-19 pandemic.
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With the rise of the COVID-19 pandemic, many undergraduates were forced to transition from in-person to remote learning. In order to hold live synchronous classes, institutions adopted online videoconferencing platforms such as Zoom. This study examined student experiences during Zoom classes with regard to perceptions of unproductive cognitive load stemming from factors such as personal software settings, instructor-determined class features, teaching methods, feelings toward the class, internal state, and external environment. For comparison, a parallel survey was administered to instructors regarding student perceptions. The top five factors students reported to increase unproductive load were life stress, tiredness, sickness, negative emotions, and auditory distractions;the factors linked most strongly to decrease unproductive load were enjoyment of the class, interest in the class topic, relevance to future goals, presentation of information in manageable and meaningful chunks, and ability to focus. Instructor ratings overall aligned with those of students. Participants also reported overall higher mental fatigue during Zoom, as framed in comparison to prior in-person classes;this was correlated with number and time spent in these classes, but not with demographic variables nor with several other independent measures of self-regulated learning and academic self-efficacy. Implications for improving the student experience in online learning are discussed, emphasizing that many of the factors reported as helpful to cognitive load management are applicable to all classrooms. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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Introduction: Legionella pneumophila is an opportunistic pathogen that is a key contributor to drinking water-associated disease outbreaks in the United States. Prolonged water stagnation periods in building plumbing systems due to low occupancy, especially during building shutdowns, breaks, and holidays, can lead to water quality deterioration and (re)colonization of buildings with L. pneumophila. Water monitoring in buildings typically relies on grab samples with small datasets. Methods: In this study, a larger dataset was created by sampling a Leadership in Energy and Environmental Design (LEED)-certified data-rich commercial building for L. pneumophila and physical-chemical water quality during the COVID-19 pandemic after reduced building occupancy. A proxy for human occupancy rates using WIFI logins was recorded throughout the study period. Results: L. pneumophila was observed in grab samples taken throughout the building, where concentrations generally increased with greater distances from the building point of entry to locations throughout the building. Factors conducive to microbial growth were identified in the building including fluctuations in water temperatures, lack of chlorine residual, a low water heater setpoint, colonized water-saving fixtures, prolonged stagnation throughout the building;especially in an expansion tank designed to reduce pressure issues during demand fluctuations, and the presence of oversized softener tanks with ion exchange resin that contributed to chlorine residual removal as well as colonization of the resin with L. pneumophila. Discussion: Flushing and thermal disinfection alone did not resolve the problem, and replacement of the expansion tank ultimately resolved the L. pneumophila issue. As ad-hoc approaches are logistically- and time-intensive, more proactive approaches are needed for informing preventative and corrective actions for reducing the risk of exposure to opportunistic pathogens in the building plumbing. Copyright © 2023 Joshi, Richard, Levya, Harrison, Saetta, Sharma, Crane, Mushro, Dieter, Morgan, Heida, Welco, Boyer, Westerhoff and Hamilton.
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The adverse impacts caused by the COVID-19 pandemic reinforced and magnified issues of sexual assault and harassment (SASH) with consequences on seafarers' mental health and wellbeing which in turn negatively affects recruitment and attrition rates of seafarers. The Center for Ocean Policy & Economics (COPE) hosted by the Northeast Maritime Institute's College of Maritime Science, which was established to tackle wicked problems in the maritime and ocean related fields, established a working group to aid the International Maritime Organization (IMO) to amend and develop training for SASH in IMO Model Course 1.21 Personnel Safety and Social Responsibilities. The working group facilitates global participation through digital accessibility to ensure diverse viewpoints on SASH in the maritime sector.
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The COVID-19 pandemic exacerbated many underlying issues regarding seafarers in the maritime industry, known as the 'human element';at the International Maritime Organization. The challenges were a result of a global crew change crisis and issues with repatriation as a result of travel lockdowns, pay insecurity, mental health challenges, lack of digital access, and flaws within the Maritime Labour Convention (MLC) that resulted in serious questions of liability and rights and responsibilities for seafarers. The Center for Ocean Policy & Economics (COPE), hosted by the Northeast Maritime Institute's College of Maritime Science, observed and participated in several initiatives to promote human rights at sea to improve the livelihood of seafarers. The initiatives underscore pathways and methods of improvement for maritime and ocean related issues.
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Aims: • Covid-19 infection is associated with new-onset diabetes and worse glucose control in pre-existing diabetes. • During the pandemic, our hospital experienced a rise in diabetic specialist-nurse (DSN) referrals similar to across the UK. • The existing DSN referral-form was time-consuming to complete and difficult to interpret. A new form was created to facilitate earlier DSN involvement to reduce delays in treatment. Methods: • The new form was piloted on 3 hospital wards. • The completion of 10 factors (addressograph, location, type of diabetes, referral reason, oral intake, HbA1c, e-GFR, oral and injectable diabetes medication and referrer details) were compared between 25 old and 25 new forms. • Data were analysed using SPSS 27. Results: New forms demonstrated significantly higher completion of 4 parameters compared to old forms: location (96% vs. 76%, p = 0.01), type of diabetes (92% vs. 32%, p < 0.001), e-GFR (60% vs. 16%, p = 0.001), referrer details (100% vs. 44%, p < 0.001). A positive trend was identified for: oral intake (52% vs. 48%), HbA1c (40% vs. 20%), oral diabetes medication (56% vs. 48%), injectable diabetes medications (88% vs. 72%) when comparing new vs. old forms respectively. Referral reason was completed in 88% of new forms and 96% of old forms. All forms had an addressograph. Conclusions: The new referral-form improved documentation of factors required to effectively prioritise patients. We aim to distribute the form across our hospital wards. Future work will focus on educating clinicians regarding indications for DSN input and importance of biochemical parameters to guide choice of hypoglycaemic agents.
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BACKGROUND: COVID-19 has had a significant impact on the well-being and job performance of oncology professionals globally. The European Society for Medical Oncology (ESMO) Resilience Task Force collaboration set out to investigate and monitor well-being since COVID-19 in relation to work, lifestyle and support factors in oncology professionals 1 year on since the start of the pandemic. METHODS: An online, anonymous survey was conducted in February/March 2021 (Survey III). Key outcome variables included risk of poor well-being or distress (expanded Well-Being Index), feeling burnout (single item from expanded Well-Being Index), and job performance since COVID-19. Longitudinal analysis of responses to the series of three surveys since COVID-19 was carried out, and responses to job demands and resources questions were interrogated. SPSS V.26.0/V.27.0 and GraphPad Prism V9.0 were used for statistical analyses. RESULTS: Responses from 1269 participants from 104 countries were analysed in Survey III: 55% (n = 699/1269) female, 54% (n = 686/1269) >40 years, and 69% (n = 852/1230) of white ethnicity. There continues to be an increased risk of poor well-being or distress (n = 464/1169, 40%) and feeling burnout (n = 660/1169, 57%) compared with Survey I (25% and 38% respectively, P < 0.0001), despite improved job performance. Compared with the initial period of the pandemic, more participants report feeling overwhelmed with workload (45% versus 29%, P < 0.0001). There remain concerns about the negative impact of the pandemic on career development/training (43%), job security (37%). and international fellowship opportunities (76%). Alarmingly, 25% (n = 266/1086) are considering changing their future career with 38% (n = 100/266) contemplating leaving the profession. CONCLUSION: Oncology professionals continue to face increased job demands. There is now significant concern regarding potential attrition in the oncology workforce. National and international stakeholders must act immediately and work closely with oncology professionals to draw up future-proof recovery plans.
Subject(s)
Burnout, Professional , COVID-19 , Health Personnel , Medical Oncology , Burnout, Professional/epidemiology , COVID-19/epidemiology , COVID-19/psychology , Europe/epidemiology , Female , Health Personnel/psychology , Humans , Pandemics , Societies, MedicalABSTRACT
Background: The COVID-19 pandemic has placed significant strain on both individuals and health services. We report a cluster of adolescent patients with polypharmacy overdose refractory to medical therapy and cannulated to percutaneous femoral veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) during the early phase of the COVID-19 pandemic at our tertiary care center. ECMO is an effective management strategy for the provision of cardiorespiratory support in patients with potentially reversible, lifethreatening conditions that are unresponsive to conventional therapy. Our institutional ECMO database was interrogated for patients requiring ECMO for vasoplegic shock secondary to para-suicidal events. Patient demographics, clinical data, procedural data and outcomes were assessed retrospectively to profile this subgroup of patients who required ECMO support. Four pediatric patients received percutaneous femoral ECMO cannulation and a single patient received surgical ECMO cannulation during this period for similar indications. Herein we describe our procedural approach to percutaneous ECMO in children (>30 kg) and the outcomes of those who underwent ECMO cannulation during the pandemic timeframe. Three patients who had percutaneous ECMO survived and one died secondary to complications of polypharmacy overdose. A single patient who was not suitable for percutaneous ECMO cannulation was surgically cannulated to ECMO and died thereafter. A cluster of adolescent patients with polypharmacy ingestion during the early stage of the COVID-19 pandemic resulted in a temporal increase in percutaneous ECMO utilization at our institution. Percutaneous ECMO is a potentially life-saving procedure for the stabilization of critically-ill pediatric patients and remains an effective modality to improve survival to discharge.
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BACKGROUND: The COVID-19 pandemic has resulted in significant changes to professional and personal lives of oncology professionals globally. The European Society for Medical Oncology (ESMO) Resilience Task Force collaboration aimed to provide contemporaneous reports on the impact of COVID-19 on the lived experiences and well-being in oncology. METHODS: This online anonymous survey (July-August 2020) is the second of a series of global surveys launched during the course of the pandemic. Longitudinal key outcome measures including well-being/distress (expanded Well-being Index-9 items), burnout (1 item from expanded Well-being Index), and job performance since COVID-19 were tracked. RESULTS: A total of 942 participants from 99 countries were included for final analysis: 58% (n = 544) from Europe, 52% (n = 485) female, 43% (n = 409) ≤40 years old, and 36% (n = 343) of non-white ethnicity. In July/August 2020, 60% (n = 525) continued to report a change in professional duties compared with the pre-COVID-19 era. The proportion of participants at risk of poor well-being (33%, n = 310) and who reported feeling burnout (49%, n = 460) had increased significantly compared with April/May 2020 (25% and 38%, respectively; P < 0.001), despite improved job performance since COVID-19 (34% versus 51%; P < 0.001). Of those who had been tested for COVID-19, 8% (n = 39/484) tested positive; 18% (n = 7/39) felt they had not been given adequate time to recover before return to work. Since the pandemic, 39% (n = 353/908) had expressed concerns that COVID-19 would have a negative impact on their career development or training and 40% (n = 366/917) felt that their job security had been compromised. More than two-thirds (n = 608/879) revealed that COVID-19 has changed their outlook on their work-personal life balance. CONCLUSION: The COVID-19 pandemic continues to impact the well-being of oncology professionals globally, with significantly more in distress and feeling burnout compared with the first wave. Collective efforts from both national and international communities addressing support and coping strategies will be crucial as we recover from the COVID-19 crisis. In particular, an action plan should also be devised to tackle concerns raised regarding the negative impact of COVID-19 on career development, training, and job security.