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Background: Vaccine safety monitoring systems worldwide have reported cases of venous thromboembolism and arterial thromboembolism following a COVID-19 vaccination. However, evidence shows that the association between thromboembolism and SARS-CoV-2 infection is stronger, compared to SARS-CoV-2 vaccination. Hence, weighing the risks and benefits of vaccination should also encounter the roles of vaccination in reducing infection rate, and potentially indirectly lowering the risk of thromboembolism caused by infection. Methods: We conducted a self-controlled case series study (SCCS) from Dec 1st 2020 to 31st August 2022 (before the bivalent vaccine was available) to examinate the association between the first two doses Pfizer/Moderna vaccination and thrombotic events among patients in Corewell Health East (CHE, formerly known as Beaumont Health) healthcare system. We also investigated the effect SARS-CoV-2 infection on the risk of thrombosis events and observed a significant increased risk using the SCCS design. However, because of misclassification bias, SCCS indeed overestimated incidence rate ratio (IRR) of acute event after infection, we then proposed a case-control study addressing this misclassification issues and obtained odd ratio comparing effect of exposure on thrombosis and a subset of controls group. Finally, we analyzed the risk of thromboembolism between vaccinated and unvaccinated groups by a simple diagram, explaining possible factors that affects the probability of experiencing an acute thromboembolism event after a COVID-19 vaccination. Results: Using EHR data at Corewell East, we found an increased risk of thrombosis after the first two doses of COVID-19 vaccination, with incidence rate ratios after the first dose is 1.16 (CI: [1.04, 1.29]), and after the second dose of 1.19 (CI: [1.07,1.32]). The association between thromboembolism and SARS-Cov-2 infection depends on prior vaccination status, as the conditional OR among unvaccinated and vaccinated groups are 1.77 (CI: [1.48,\ 2.1]) and 1.34 (CI: [1.09,\ 1.66]) respectively. Encountering the vaccine efficacy (VE), receiving the COVID-19 vaccine decreases the risk of thromboembolism, and the benefits of COVID-19 vaccines are much stronger in the period of high infection rate.
Subject(s)
Thromboembolism , Venous Thromboembolism , Thrombosis , COVID-19ABSTRACT
Higher education has undergone substantial digital change due to the impacts of the COVID-19 pandemic, which altered the status quo in education. Universities across the globe have initiated and adapted various course delivery modes to mitigate this unprecedented situation. Among these responses, online classes continue to be the most common. Therefore, this study examines institutional knowledge management and readiness to sustain online course delivery. Adopting a qualitative research design, this study used two methods, semi-structured interviews (n15) and online open questionnaires (n42), to gather data. Reflexive thematic analysis was then used to analyse the data. The study findings underline that the adaptability, flexibility, and approachability of the virtual learning experience are critical to determining an institution's readiness for online classes. Based on student perceptions, the faculties of digital skills, integration of innovative pedagogies, student readiness, skills and experience, and integration of learning resources are the main aspects that determine the readiness of universities for online learning.
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The COVID-19 outbreak has challenged the global tourism sector, and it has posed a significant threat to the existence of tourism business across the globe, especially in emerging economies. This study examines the effect of the COVID-19 pandemic on travel intermediary businesses in India and their strategies to overcome the present predicament. The study draws on the interviews with 15 executives of selected travel intermediary firms located around the country. The findings emphasise the economic downturn, customer retention policies, resilience strategies and current shifts in the industry. The outcomes also identify the recent tendency towards the traditional travel booking/holiday-booking trend towards traditional intermediaries. This research contributes to a better understanding and implementation of business continuity methods in tourist studies, and its results have practical implications for administrators and governments. Copyright © 2022 Inderscience Enterprises Ltd.
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Creating a comprehensive didactic curriculum for breast imaging fellows can be a demanding undertaking, especially considering that most breast practices are understaffed because of the COVID-19 pandemic and amid rising clinical volumes. This leaves little time for didactic education. In this article, we present our approach to creating a collaborative weekly multidisciplinary didactic lecture series involving multiple institutions, using the Society of Breast Imaging's suggested fellowship curriculum as the foundation. We discuss the advantages for both trainees and faculty, including fostering camaraderie, networking, and engagement among breast imaging fellows. Faculty have the opportunity for professional development by leveraging their clinical expertise through selecting didactic topics in their niche. This creates a pathway for speaking faculty to be recognized as regional and national experts.
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Background: In 2020, the COVID19 pandemic disrupted the health system and potentially affected the presentation and care of stroke patients. The Auckland Regional Community Stroke Study (ARCOS V) provided an opportunity to study the impact of the pandemic on stroke hospitalisation. Aim(s): To compare stroke hospitalisation and time from stroke onset to admission during COVID19 lockdowns with post-lockdown periods. Method(s): ARCOS V is a prospective, population-based, study of stroke and TIA incidence and outcomes in those aged >=15 years in the Greater Auckland region. Case ascertainment commenced on 1 March 2020 but was paused on 31 August 2020 (Phase 1) due to the observed impact of COVID19 on health service use. ARCOS V case ascertainment recommenced from 1 September 2020 for 12 months (Phase 2). We compared incidence of stroke, and time from onset to hospitalisation for two equivalent 6-month periods (March to August 2020 and 2021). Result(s): In Phase 1, 1144 stroke cases were hospitalised. The mean time to admission was 0.8 days [SD=3.9]. In Phase 2 (preliminary), 1250 stroke cases were hospitalised, and the mean time to admission was 1 day [SD=4.7]. In both Phases, males, younger [15-64 years] people, and Pacific people presented to hospital later. More detailed findings (analyses underway) including the comparative proportion of cases receiving neuroimaging, and revascularisation procedures by age, sex and ethnicity in the two phases will be presented. Conclusion(s): Fewer cases were admitted and time from stroke onset to admission was shorter during the peak of the pandemic in 2020, compared to 2021. Reduced time may be due to reduced traffic and fewer people in the emergency department during complete lockdown. The reasons for fewer people presenting to hospital during lockdown need to be explored further.
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In COVID-19 time, finding medication was the tedious process. Proposed work explains about the segregation of covid-19 CT scan images into categories like mild, moderate and severe on the basis of pneumonia. The dataset uses 227 CT scan images which have been collected manually from hospitals. At first, the CT scan input images are preprocessed using K-means clustering algorithm. Then Watershed algorithm is used for the segmentation of the pre-processed images to get the affected region. After getting the affected region, VGG-16 model is used for feature extraction process, for model training 53 CT scan images are used as the testing dataset from 185 CT images. Using extracted feature, SVM model will classify the Covid19 pneumonia as mild, moderate, or severe. Finally the classifier has given an accuracy of 96.15% for the prediction of Covid-19 pneumonia stages. © 2022 IEEE.
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Objectives: The Auckland Regional Community Stroke Studies (ARCOS) are population-based studies conducted in Auckland, New Zealand in adults (<15 yrs). In 2020, the SARS-CoV-2 pandemic disrupted the health system and potentially affected the presentation and care of stroke patients. We aimed to utilise this opportunity to study the impact of the pandemic on stroke incidence, and hospitalisation during this extended phase of the ARCOS V study. Methods: Between 1st March and 31st August 2020, stroke cases were identified through multiple case ascertainment methods, including public hospitals and emergency departments;CT/MRI records;hospital discharge registers;private hospitals, rest homes, and community health services. During this time, the Auckland (population 1,257,690) was in various phases of lockdown, including Level 4 during which everything except essential services was shut down. Completion of case ascertainment from the death registry is currently underway, hence preliminary findings are presented. Results: Of the 1198 registered stroke cases, 50.8% were women, 29.4% were aged between 15-64 years 84.1% were first-ever strokes. The age standardised attack rate of stroke in the 6-month period was 72 [95% CI 72 to 80] per 100,000 and the incidence of first ever stroke was 64 [95% CI 60 to 68] per 100,000. The majority (81%) presented to hospital via ambulance, and 96.1% received brain imaging within 24 hours of admission. While the majority sought attention within minutes or hours of symptom onset, 22% delayed seeking attention by a day or more. Conclusions: Robust and well-established online data collection protocols allowed the continuation of the ARCOS V study during the peak of the SARS-CoV-2 pandemic. The number of people presenting to hospital with stroke was close to expected levels. However, a significant number of people delayed seeking medical attention. Learnings from this study will be important to plan for stroke services during future pandemics.
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Hypoxic patients with coronavirus disease 2019 (COVID-19) are at high risk of adverse outcomes. Inhaled nitric oxide (iNO) has shown anti-viral and immunomodulatory effects in vitro. However, in vivo evidence of efficacy in hypoxic COVID-19 is sparse. This open label feasibility study was conducted at a single referral center in South India and evaluated the effectiveness of repurposed iNO in improving clinical outcomes in COVID-19 and its correlation with viral clearance. We recruited hypoxemic COVID-19 patients and allocated them into treatment (iNO) and control groups (1:1). Viral clearance on day 5 favored the treatment group (100% vs 72%, P < 0.01). The speed of viral clearance as adjudged by normalized longitudinal cycle threshold (Ct) values was positively impacted in the treatment group. The proportion of patients who attained clinical improvement, defined as a ≥2-point change on the World Health Organization ordinal scale, was higher in the iNO cohort (n = 11, 79%) as compared to the control group (n = 4, 36%) (odds ratio 6.42, 95% confidence interval 1.09-37.73, P = 0.032). The proportion of patients progressing to mechanical ventilation in the control group (4/11) was significantly higher than in the treatment group (0/14). The all-cause 28-day mortality was significantly different among the study arms, with 36% (4/11) of the patients dying in the control group while none died in the treatment group. The numbers needed to treat to prevent an additional poor outcome of death was estimated to be 2.8. Our study demonstrates the putative role of repurposed iNO in hypoxemic COVID-19 patients and calls for extended validation. Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
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Purpose: The tourism sector’s fragility lends significance to mental health and wellbeing, especially amongst workers in the hotel and tourism sectors. However, stakeholders’ subjective wellbeing and mental health in these sectors due to the coronavirus disease 2019 (COVID-19) pandemic remain under-researched, especially for destinations with unique selling propositions (USPs). Thus, this study investigates the effects of the worldwide COVID-19 pandemic on various stakeholders in Kerala, India. In particular, the authors assess the mental health and welfare of those involved in the tourism sector with an eye on how the COVID-19 pandemic has influenced the field’s psychological and technical developments. Design/methodology/approach: This study employs an ethnographic approach to understanding the idiosyncratic experiences of stakeholders using in-depth interviews (n = 68), focus group interviews (n = 3) and participant observation for 14 months. Reflexive thematic analysis was used to analyse the data. Findings: The findings reveal the shifting perceptions in the tourism sector’s workforce by detailing various societal, technical and physical transformations, especially amongst the younger generations. The resultant psychological mapping generates a framework of the emotional perspectives of stakeholders during each stage of the pandemic. This study also highlights the urgency of crisis-management training for the workforce. Originality/value: The COVID-19 pandemic has affected all spheres of global business, resulting in unprecedented challenges in both personal and professional life. The sector’s fragility lends significance to mental health and wellbeing, especially amongst workers in the hotel and tourism sectors. However, the subjective wellbeing and mental health of stakeholders in these sectors due to the COVID-19 pandemic remain under-researched, especially for the developing destinations with USPs. © 2022, Emerald Publishing Limited.
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The COVID-19 pandemic has created enormous pressure on the tourism and hospitality industries. In the post-COVID-19 era, destinations ought to attain the right balance between public security and economic recovery. Many destinations are trying to achieve this equilibrium by limiting international tourism and, instead, by targeting domestic tourists. Given that the future of tourism relies on the survival of the safest and smartest destinations, it is essential to work together on the recent advances in the sector. To this end, this research examines the current trends and practise by applying an explorative qualitative study design incorporated with data triangulation. The study findings point out two prevailing schools of thought, viz. the new normal and back to normal. The technological innovations support the ‘new normal’ waves, call for sustainability, rebuild current tourism to create a more sustainable form, and regenerate domestic and special interest tourism such as solo tourism. At the same time, the ‘back to normal’ philosophies are fuelled by the past global crises and the exceptional bouncy characteristics of the tourism sector to recover. However, both of these viewpoints are further direct towards the growing body of uncertainties, which can be unique to the COVID-19 pandemic, where predictions were found to be off beam. © 2021 Publishing India Group. All rights reserved.
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Background and Aims: Delivering technological innovations while abiding by strict data privacy protocols has become increasingly complex. The rise of online data sharing and COVID-19 restrictions presents unique challenges in the current landscape. This presentation discusses the challenges faced during this transformation process, especially during the COVID-19 substudy of The Auckland Regional Community Stroke Study (ARCOS V). Methods: ARCOS V is a semicentennial population-based study aiming to determine trends in stroke and TIA (transient ischaemic attack) incidence and outcomes, also experienced a digital transformation in its fifth phase. This paper shares the technological innovations adopted by the research team. It discusses some specialised options that can be applied to tackle such challenges for the smooth implementation of research studies during lockdowns. Results: The sub-study was remotely conducted and was primarily paperless. Face-to-face interactions with the participants were replaced with teleconferences, and remote data collection methods were implemented as permitted by the university's COVID-19 prevention guidelines. The research data was protected by robust IT systems, and patient data was securely stored on REDCap database. The database was managed with range and logic checks as specified by study protocol, and monitored for completeness of consent processes, data collection, and confidentiality while adhering to NZ health privacy protocols. Privacy impact assessments were undertaken to ensure the incorporation of data safety principles. Conclusions: The data management team identified technological strategies using secure platforms for effective implementation of the study during these times while abiding by data privacy protocols and attempted to delineate a technocentric solution-based approach for managing this study during lockdowns.
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Background: At the outset of the COVID-19 pandemic, concerns for the safety of patients receiving anti-cancer treatment coupled with pressures on healthcare services prompted review of standard clinical care pathways in the UK. Revised consensus treatment guidelines were generated. Individual patient-level data regarding actual treatment modifications implemented in clinical practice are lacking. Methods: All anti-cancer treatment plans of patients with breast, lung, renal, hepatopancreatobiliary, CNS cancers and melanoma attending a single academic cancer centre in the UK between 16 March and 31 May 2020 were reviewed and any modifications to standard practice were documented. The effect of patient (age, ECOG performance status [PS], sex) and cancer (site, stage, treatment intent) characteristics on likelihood of treatment modifications were analysed using univariable and multivariable models. Results: Treatment plans for 925 patients were reviewed: median patient age was 63 (range 19-97);66% were female;73% were PS 0-1;45% were on a curative pathway. Overall, 47% of all patients had one or more modifications made to their treatment plans: 53% of surgeries (primarily being delayed);41% of radiotherapy (primarily reduced fractions delivered);39% of systemic therapy prescriptions. 96-100% of all systemic therapy modifications resulted in treatment deescalation, excluding endocrine therapy used as a bridge to defer primary breast cancer surgery. Biological therapy was predominantly interrupted (49%), immunotherapy was mostly omitted entirely (36%), and chemotherapy varied between interruptions (39%) or omissions (31%). Relative to the likelihood of modification to chemotherapy, surgery was significantly more likely to be modified (OR 1.69 95%CI 1.20-2.38). Chemotherapy, radiotherapy, biological therapy and immunotherapy were all modified to a similar degree. Multivariate analysis identified PS ≥2 (OR 1.79, 95% CI 1.18- 2.75), but not patient age, as a predictor of treatment modification. Some tumour types were less likely to undergo any modification: stage 1-3 lung (OR 0.13, 95%CI 0.04-0.37), stage 4 lung (OR 0.26 95%CI 0.24-0.60) and stage 4 renal cancer (OR 0.22 95%CI 0.09-0.52). Conclusions: This single centre analysis demonstrated almost half of cancer patients had their treatment modified, the overwhelming majority resulting in treatment de-escalation. The impact of the treatment modifications on overall cancer patient outcomes remains to be determined.
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The COVID-19 pandemic has halted activities in the global tourism industry, and the situation has only been worsened by the general air of uncertainty and lack of effective vaccinations. Consequently, people have begun testing various remedies to enhance their immunity, primarily turning to traditional medical practices and home remedies. The medicinal use of spices, given their immune-boosting properties, is increasingly popular globally and has enhanced global awareness of spices and their products. In light of this surging popularity, this study examines spice tourism as a concept of niche tourism. This study proposes spice tourism as a valuable post-COVID-19 strategy by providing four different approaches to position spice tourism within special interest tourism. This paper also suggests a tourism development plan for spice tourism and proposes a strategy for its resilience post-COVID-19. © 2021, The Author(s).
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This study explores the role of religious tourism in revitalising the Indian tourism sector postCOVID-19, with a focus on domestic tourism. This study is guided by the interpretive paradigm and operationalised through Faulker's (2001) model of crisis management. Expert opinions and secondary data sources (newspaper articles, magazines and media reports) were used as the data sources;these were collected through purposive sampling techniques to obtain information-rich and context-specific samples. The results reveal that religious sites could play a substantial role in reviving the Indian tourism sector by promoting staycations and micro-holidays, and by reforming existing projects such as the Swadesh Darshan and the Pilgrimage Rejuvenation and Spiritual Augmentation Drive (PRASAD). The findings of this study suggest that collaboration with other prominent tourist attractions like Yoga, Wellness and Ayurveda, which have deep-seated relationships with Hinduism, could be a vital tool to activate the sector;these results are promising even at this stage of crisis for India. This study also identifies the major practical impediments such a plan would need to overcome, including physical distancing, crowding, festivals and ritual performance. Furthermore, this study offers practical insights into the potential pioneering roles of India's key religious sites, such as Venkateshwara Temple, Vaishno Devi Temple, Golden Temple, Ajmer Dargah Sharif, and Velankanni Church, to create initiatives to rebuild the religious tourism sector.
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COVID-19 has heavily influenced people all around the world and forced us to acclimatise to a New Normal. Post-COVID-19 scenarios are predicted that impose specific criteria on travel choices that could change the present tourism equilibrium. Addressing these impulses is crucial for travel destinations for their resilience and recovery. This paper presents preliminary insights into present travel decisions and speculates about potential future, post-COVID-19 choices. An online survey of 449 participants used to investigate the underlying dimensions of destination selection motivations, and to explore the significant differences between the characteristics of travellers in destination-choice-based motivators (DCBMs) for destination selections post-COVID-19. Three motivators for the choice of destinations were derived: accessibility and discounting, health and hygiene, and the history of low incidences of COVID-19. Results also identified interrelationships between travel history and destination selection motivators: participants who had undergone a prolonged quarantine period were highly motivated by 'accessibility and discounting' and 'health and hygiene' factors. In contrast, people with no international travel experience were more concerned with low COVID-19 incidences in the destination(s).
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COVID-19 has heavily influenced people all around the world and forced us to acclimatise to a New Normal. Post-COVID-19 scenarios are predicted that impose specific criteria on travel choices that could change the present tourism equilibrium. Addressing these impulses is crucial for travel destinations for their resilience and recovery. This paper presents preliminary insights into present travel decisions and speculates about potential future, post-COVID-19 choices. An online survey of 449 participants used to investigate the underlying dimensions of destination selection motivations, and to explore the significant differences between the characteristics of travellers in destination-choice-based motivators (DCBMs) for destination selections post-COVID-19. Three motivators for the choice of destinations were derived: accessibility and discounting, health and hygiene, and the history of low incidences of COVID-19. Results also identified interrelationships between travel history and destination selection motivators: participants who had undergone a prolonged quarantine period were highly motivated by ‘accessibility and discounting’ and ‘health and hygiene’ factors. In contrast, people with no international travel experience were more concerned with low COVID-19 incidences in the destination(s). © 2020, Universidad de Huelva. All rights reserved.
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This study explores the role of religious tourism in revitalising the Indian tourism sector post-COVID-19, with a focus on domestic tourism. This study is guided by the interpretive paradigm and operationalised through Faulker’s (2001) model of crisis management. Expert opinions and secondary data sources (newspaper articles, magazines and media reports) were used as the data sources;these were collected through purposive sampling techniques to obtain information-rich and context-specific samples. The results reveal that religious sites could play a substantial role in reviving the Indian tourism sector by promoting staycations and micro-holidays, and by reforming existing projects such as the Swadesh Darshan and the Pilgrimage Rejuvenation and Spiritual Augmentation Drive (PRASAD). The findings of this study suggest that collaboration with other prominent tourist attractions like Yoga, Wellness and Ayurveda, which have deep-seated relationships with Hinduism, could be a vital tool to activate the sector;these results are promising even at this stage of crisis for India. This study also identifies the major practical impediments such a plan would need to overcome, including physical distancing, crowding, festivals and ritual performance. Furthermore, this study offers practical insights into the potential pioneering roles of India’s key religious sites, such as Venkateshwara Temple, Vaishno Devi Temple, Golden Temple, Ajmer Dargah Sharif, and Velankanni Church, to create initiatives to rebuild the religious tourism sector. © International Journal of Religious Tourism and Pilgrimage