Increase in traumatic injury burden amidst COVID-19 was disproportionately shouldered by racial and ethnic minority patients: An urban case study

Background: When the COVID-19 pandemic intersected with the longstanding global pandemic of traumatic injury, it exacerbated racial and ethnic disparities in injury burden. As Milwaukee, Wisconsin is a racially diverse yet segregated urban city due to historic and ongoing systemic efforts, this populace provided an opportunity to further characterize injury disparities. Method(s): We analyzed trauma registry data from the only adult Level 1 trauma center in Milwaukee, WI before and during the COVID-19 pandemic (N = 19,908 patients from 2015-2021). We retrospectively fit seasonal ARIMA models to monthly injury counts to determine baseline injury burden pre-COVID-19 (Jan 2015-Mar 2020). This baseline data was used to forecast injury by race and ethnicity from April 2020 to December 2021 and was compared to actual injury counts. Result(s): For all mechanisms of injury (MOI), counts during the pandemic were significantly higher than forecasted for Black or African American (mean absolute percentage error, MAPE = 23.17) and Hispanic or Latino (MAPE = 26.67) but not White patients (MAPE = 12.72). Increased injury for Black or African American patients was driven by increases in motor vehicle crashes (MVCs) and firearm-related injury;increased injury for Hispanic or Latino patients was driven by falls and MVCs. Conclusion(s): The exacerbation of injury burden disparities during COVID-19, particularly in specific MOI, underscores the need for primary injury prevention within specific overburdened communities. Injury prevention requires intervention through social determinants of health, including addressing the impact of structural racism, as primary drivers of injury burden disparities.Copyright © The Author(s) 2023.

Effects of the Pandemic on Observing the Global Ocean

The years since 2000 have been a golden age in in situ ocean observing with the proliferation and organization of autonomous platforms such as surface drogued buoys and subsurface Argo profiling floats augmenting ship-based observations. Global time series of mean sea surface temperature and ocean heat content are routinely calculated based on data from these platforms, enhancing our understanding of the ocean's role in Earth's climate system. Individual measurements of meteorological, sea surface, and subsurface variables directly improve our understanding of the Earth system, weather forecasting, and climate projections. They also provide the data necessary for validating and calibrating satellite observations. Maintaining this ocean observing system has been a technological, logistical, and funding challenge. The global COVID-19 pandemic, which took hold in 2020, added strain to the maintenance of the observing system. A survey of the contributing components of the observing system illustrates the impacts of the pandemic from January 2020 through December 2021. The pandemic did not reduce the short-term geographic coverage (days to months) capabilities mainly due to the continuation of autonomous platform observations. In contrast, the pandemic caused critical loss to longer-term (years to decades) observations, greatly impairing the monitoring of such crucial variables as ocean carbon and the state of the deep ocean. So, while the observing system has held under the stress of the pandemic, work must be done to restore the interrupted replenishment of the autonomous components and plan for more resilient methods to support components of the system that rely on cruise-based measurements. © 2023 American Meteorological Society.

Hermansky-Pudlak Syndrome

CLINICAL CHARACTERISTICS: Hermansky-Pudlak syndrome (HPS) is characterized by oculocutaneous albinism, a bleeding diathesis, and, in some individuals, pulmonary fibrosis, granulomatous colitis, and/or immunodeficiency. Ocular findings include nystagmus, reduced iris pigment, reduced retinal pigment, foveal hypoplasia with significant reduction in visual acuity (usually in the range of 20/50 to 20/400), and strabismus in many individuals. Hair color ranges from white to brown;skin color ranges from white to olive and is usually at least a shade lighter than that of other family members. The bleeding diathesis can result in variable degrees of bruising, epistaxis, gingival bleeding, postpartum hemorrhage, colonic bleeding, and prolonged bleeding with menses or after tooth extraction, circumcision, and/or other surgeries. Pulmonary fibrosis, colitis, and/or neutropenia have been reported in individuals with pathogenic variants in some HPS-related genes. Pulmonary fibrosis, a restrictive lung disease, typically causes symptoms in the early 30s and can progress to death within a decade. Granulomatous colitis is severe in about 15% of affected individuals. Neutropenia and/or immune defects occur primarily in individuals with pathogenic variants in AP3B1 and AP3D1. DIAGNOSIS/TESTING: The clinical diagnosis of HPS can be established in a proband with hypopigmentation of the skin and hair, characteristic eye findings, and demonstration of absence of platelet delta granules (dense bodies) on electron microscopy. Identification of biallelic pathogenic variants in AP3B1, AP3D1, BLOC1S3, BLOC1S5, BLOC1S6, DTNBP1, HPS1, HPS3, HPS4, HPS5, or HPS6 confirms the diagnosis if clinical features are inconclusive. MANAGEMENT: Treatment of manifestations: Correction of refractive errors and use of low vision aids;preferential seating in school;low-vision consultant as needed;UV-blocking sunglasses;surgery for strabismus as needed;protection from sun exposure with protective clothing and sunscreen;standard treatment for skin cancer;thrombin-soaked Gelfoam R for skin wounds with prolonged bleeding;medical alert bracelet and bleeding management plan;humidifier to reduce frequency of epistaxis;oral contraceptives and IUD for menorrhagia;DDAVP R (desmopressin acetate) for wisdom tooth extraction and invasive procedures;platelet or red blood cell transfusions for surgery or protracted bleeding;HLA-matched single-donor platelets as needed;maximize pulmonary function with prompt treatment of asthma and pulmonary infections;influenza, pneumococcal, and COVID-19 vaccines;regular moderate exercise;supplemental oxygen for advanced-stage pulmonary fibrosis;lung transplantation for end-stage pulmonary disease;steroids, other anti-inflammatory agents, and/or Remicade R for granulomatous colitis. Immunodeficiency, when present, is lifelong and granulocyte colony-stimulating factor responsive, and affected individuals benefit from an infection prevention plan. Surveillance: Annual ophthalmologic examination including assessment for refractive errors;annual skin examination for evidence of sun-induced skin damage (e.g., solar keratoses [premalignant lesions], basal cell carcinoma, and squamous cell carcinoma);annual pulmonary function testing in those older than age 20 years;colonoscopy in those with symptoms of colitis (e.g., cramping, mucoid stools, hematochezia, melena);assessment for clinical and laboratory manifestations of immunodeficiency. Agents/circumstances to avoid: Over-the-counter nonsteroidal anti-inflammatory products, aspirin-containing products, and other anticoagulants unless medically indicated;activities that increase the risk of bleeding;all tobacco and vaping products and inhalation of chemical and physical substances injurious to the lungs;unprotected and direct sun exposure. Evaluation of relatives at risk: In families with HPS3-, HPS5-, or HPS6-related HPS (milder types of HPS in which hypopigmentation and nystagmus may not be clinically evident), it is appropriate to clarify the status of apparently asymptomatic at-risk sibs in order to identify as early as possible those who would benefit from prompt initiation of treatment and preventive measures. GENETIC COUNSELING: HPS is inherited in an autosomal recessive manner. If both parents are known to be heterozygous for an HPS-causing pathogenic variant, each sib of an affected individual has at conception a 25% chance of being affected, a 50% chance of being an asymptomatic carrier, and a 25% chance of being unaffected and not a carrier. Once the HPS-causing pathogenic variants are identified in an affected family member, carrier testing for at-risk family members, prenatal testing for a pregnancy at increased risk, and preimplantation genetic testing are possible. Copyright © 1993-2023, University of Washington, Seattle. GeneReviews is a registered trademark of the University of Washington, Seattle. All rights reserved.

The role of extraversion in the Great Resignation: A burnout-quitting process during the pandemic

The Great Resignation is a global economic trend that began during the COVID-19 pandemic in which quitting rates increased to unusually high levels. Although this phenomenon has been attributed to burnout, scarce research exists to explain the role of individual differences in the increased quitting rate. To address this gap, we investigate the progression from burnout to voluntary turnover during the pandemic in US in two studies. Study 1 uses data from full-time employees (n = 360) in a multiphasic data collection spanning February 2021 to February 2022 (during the Great Resignation). The results demonstrate that people higher in extraversion report less burnout. This, in turn, leads to fewer voluntary turnover behaviors. Study 2 uses data from an additional sample (n = 137) of employees collected during the pandemic (June 2020). These results indicate that extraversion may buffer the effect of role overload encountered in the pandemic context. Because other pandemics and social withdrawal phenomenon (e.g., quiet quitting) are sure to emerge, it is necessary to continue studying employee characteristics and outcomes in these situations. © 2023 Elsevier Ltd

AMulti-institutional Study Evaluating Pediatric Burn Injuries During the COVID19 Pandemic

Background: During the COVID-19 pandemic, children were out of school due to Stay-at-Home orders, and were potentially unsupervised, increasing their risk for unintentional injury. The objective of this study was to investigate how these events impacted the incidence of burn injuries in children. Methods: A total of 9 Level I pediatric trauma centers participated in a retrospective study evaluating children <18 years of age with traumatic injuries as defined by the National Trauma Data Bank were included. Patients with burn injuries were defined by ICD10 Diagnosis and/or External Cause of Injury Codes. Historical controls from March-September 2019 (“Control” cohort) were compared to patients injured after the implementation of the Stay-at-Home Orders from March through September 2020 (“COVID” cohort). Results: A total of 13,177 pediatric trauma patients were included, of which 987 patients had burn injuries. The total number of children with burn injury increased by 48.6% in 2020, compared to 2019 (COVID cohort 590 patients vs. Control cohort 397 patients;p-value < 0.001), of which 94% was explained by unintentional injury. School aged children accounted for the largest difference in burn injuries between the two cohorts [Table 1]. The average number of burn-injured patients admitted per month increased over time and the difference between 2019 and 2020 peaked in July [Figure 1]. Compared to 2019, the proportion of children sustaining flame burns increased significantly in 2020 (Control 19.1% vs. COVID 26.1%, p=0.0014). Conclusion: During the COVID-19 pandemic, families experienced unprecedented increased social and financial pressure, and children were out of school for extended periods of time. This time period coincided with a considerable increase in burn injuries. The disproportionate increase in burn injuries in July may reflect the cancellation of professional firework shows across the nation and an increase in amateur pyrotechnicians experimenting with their own fireworks. The onset of the COVID pandemic introduced an extraordinary set of events with unclear consequences. (Table Presented).

Impact of “Stay-at-Home”Orders on Non-accidental Trauma: A Multi-institutional Study

Background: In response to the COVID-19 pandemic, local and regional Stay-at-Home orders (SHO) were implemented. Families experienced job loss, financial strain, and children were unable to attend school. It is unclear how this combination of events and social stress affected the welfare of children and rates of pediatric injury nationwide. We hypothesized that the rate of non-accidental trauma (NAT) would increase during the SHO as children did not have access to mandatory reporters, such as schoolteachers and primary care physicians. Methods: A multi-center, retrospective study was conducted evaluating patients <18 years old with traumatic injuries as defined by National Trauma Data Bank. Patients with ICD-10 Diagnosis and/or External Cause of Injury codes meeting criteria for NAT were included. “Historical” controls from an averaged period of March-September 2016-2019 were compared to patients injured after the implementation of SHO through September 2020 (“COVID” cohort). SHO were defined at the state level for each site. An interrupted time series analysis was utilized to evaluate the effect of the implementation of SHO. Results: A total of 9 Level I pediatric trauma centers were included, contributing 39,331 pediatric trauma patients, of which 2,064 met criteria for NAT. During the initial SHO, the rate of NAT dropped below what was expected based on the historical trends, however, thereafter the rate increased above the expected rates of NAT [Figure 1]. The COVID cohort experienced a significant increase in the proportion of NAT patients age >5 years (Historical 36 patients [13.5%] vs. COVID 103 patients [30.8%], p<0.001). Ultimately, 2020 experienced an increased cumulative burden of NAT cases as reported to institutional trauma registries when compared to the Historical cohort [Figure 2]. Conclusion: The COVID-19 pandemic affected the presentation of children with NAT to the hospital. For school-aged children sequestered at home by the pandemic, increased NAT may reflect the absence of normal safeguards provided by the educational system, potentially leaving a vulnerable population at risk. Particularly in times of public health crisis, maintaining systems of protection for children remains essential.

The Efficacy of a Mental Skills Training Course for Collegiate Athletes

Background: Psychological skills training has been shown to improve performance in athletes. However, few studies have looked at the efficacy of mental skills training programs in young athletes. Hypothesis/Purpose: The purpose of this study was to evaluate satisfaction of collegiate athletes with a 6-session mental skills course, and to assess changes in mental toughness and coping skills before and after the course. Methods: We conducted a 6-session mental skills training program with Division I female collegiate athletes during the fall of 2020. Athletes completed pre-course, post-course, and 4-month questionnaires to assess efficacy of the course, as well as their satisfaction. Due to the COVID-19 pandemic, none of the athletes were actively competing at the time of the course or during follow-up surveys. Demographic information was collected and the Athletic Coping Skills Inventory (ACSI, range=0-84) and Mental Toughness Inventory (MTI, range=8-56) were used to assess coping skills and mental toughness at all time points. Satisfaction was assessed on a ten-point scale, with 10 being most satisfied. Results: Fifty-four Division I female athletes participated in the program. Mean age was 19.8 years, 61% reported training in their sport for 8 or more months a year, 26% reported history of mental health conditions, and 22% reported being injured or recovering from injury at the time of participation. For participants with paired pre- and post-course data (n=37, 68.5%), MTI scores improved by a mean 2.6 points (95% CI=1.1-4.1;p=0.001) and ASCI scores improved by a mean 4.0 points (95% CI=0.6-7.4;p=0.02) from pre- to postcourse. For participants with paired data for pre-course and four-month follow-up (n=25, 46.2%), no change was detected in mean MTI score (p=0.72). There was, however, a mean increase of 3.4 points in mean ASCI from pre-course to four-month follow-up (95% CI=0.4-6.4;p=0.03). Overall satisfaction had a median score of 9/10 at the post-course assessment, and eighteen participants (18/37, 48.6%) shared positive free-text comments regarding course delivery, content, and impact. No negative feedback was reported. Conclusion: Following a 6-session mental skills course in collegiate female athletes, mental toughness and coping skills scores significantly improved at post-course assessment. Athletes reported being highly satisfied with the content of the course and reported overall positive experiences.

"Education as the practice of freedom?" - prison education and the pandemic

Throughout the COVID-19 pandemic there has been a corner of society where the spotlight has not fallen - the black hole of prisons, confining predominantly poor, minoritised and often younger adults. Globally, during the pandemic, people detained in prison have been locked away in solitary, or near solitary, confinement for up to 23-hours a day. In the UK, this meant choosing between fresh air, exercise or a phone call to loved ones each day. There has been little mention of education. Those in custody endured over a year locked in a cell without access to basic education let alone Higher Education (HE). In examining the state's responsibility to provide "education for all", we demonstrate, through our collective participation in the Inside-Out Prison Exchange Programme, the value and importance of prison education beyond the current focus on risk, responsibility and recidivism. We evidence the transformative and humanising potential of HE in prison through three key elements - the space and learning environment;the role of voice, recognition and agency;and the power of disruptive and transgressive teaching practice. We shine a light on education in prison during the COVID-19 pandemic. The impacts of COVID-19 expose new and deeper forms of structural disadvantage that shape the educational experiences and journeys of people in custody. We consider how we can expedite "education as the practice of freedom" for those who are incarcerated during and beyond the pandemic. We conclude by reimagining HE in UK prisons, reflecting upon alternative, more positive, approaches to prison education.

The impact of COVID-19-delayed elective sports surgery on young patients

Objectives: The COVID-19 pandemic has stressed the US healthcare system in unprecedented ways. As a response to the spread of the virus, elective surgeries throughout the country have been canceled, in an effort to minimize further transmission. To our knowledge, the effects of delayed surgeries on patients have not been investigated. Thus, the purpose of this study was to evaluate the physical and psychological consequences of elective surgery delays on young sports medicine patients. Methods: We conducted a cross sectional study of patients, ages 10-25 years old, who had sports medicine surgery delayed between March and May 2020 due to the COVID crisis. All patients were still awaiting surgery at the time of the initial survey. Electronic surveys were sent to patients and included the 12-item Short Form Health Survey (SF-12), which yields a physical component score (SF12-PCS) as well as a mental component score (SF12-MCS), the PROMIS Psychological Stress Experience survey (PROMIS-PSE), and self-designed questions about patient concerns regarding the COVID crisis and delayed surgery. A higher score on SF-12 subscales signifies better health, whereas a higher score on the PSE indicates more psychological stress. Scores that deviate significantly from a mean of 50 indicate a difference from the general population norm. Results: Of the 146 eligible patients with delayed elective sports surgeries, 89 patients (61%) elected to participate (mean age 17.7±2.9 years, 30% male). The median length of surgical delay was 36 days (range 9-54), and 79% of patients were awaiting surgery on the lower extremity. Delayed surgery patients scored significantly lower than population norms on the SF12-PCS (mean 39.4, CI 36.8-42.1, p<0.001). Males scored significantly higher than females on the SF12-MCS (53 vs 45.1, p=0.003), but the overall mean was not significantly different from the general population (47.2, p=0.08). The mean PSE score was significantly higher than population norms (57.9, CI 56.3-59.6, p<0.001), but did not differ by age or sex. Those with a history of mental health conditions reported higher PROMIS-PSE scores compared to those without (61.2 vs 56.9 p=0.02). Patients who reported being extremely concerned about their surgical delay had lower scores on the SF-PCS and SF-MCS, and higher scores on the PROMIS-PSE (p=0.03, p=0.01, and p<0.001 respectively), suggesting more significant physical and emotional symptoms. The majority of patients indicated that their physical and emotional symptoms were attributed mostly to their injury awaiting surgery, with patients reporting a median 50% attribution (IQR, 32-75%), compared to attributions for COVID or other concerns. The biggest concern with COVID-related surgical delays was a concern about not being back in time for a sports season. Conclusions: Young sports medicine patients reported significant physical and emotional symptoms associated with COVIDrelated surgical delays. Patients were most concerned about delays resulting in missed sport seasons. Those who reported greater levels of concern with surgical delays demonstrated lower physical and mental health scores and higher levels of psychological stress. The physical and psychological impact of surgical delays should be considered when caring for young athletes.

Automated Digital Quantification of Pulmonary Fibrosis in Human Histopathology Specimens

RATIONALE: Pulmonary fibrosis is a progressive disease characterized by abnormal accumulation of extracellular matrix protein, mesenchymal cells, and immune cells in the alveolar interstitium. Methods quantifying fibrosis severity in lung histopathology samples are semi-quantitative, subjective, and analyze only portions of sections. We sought to determine whether automated computerized imaging analysis shown to continuously measure fibrosis in mice could be applied in human samples to quantify pulmonary fibrosis severity and immunostained cells in whole tissue sections. METHODS: Digital images of entire tissue sections from lung explants or biopsies from patients with Hermansky-Pudlak syndrome pulmonary fibrosis (HPSPF) or idiopathic pulmonary fibrosis (IPF) stained with picrosirius red and alcian blue or immunostained with anti-CD68 antibody were analyzed using a dedicated software program to quantify fibrosis, collagen, and macrophage content. Automated fibrosis quantification was compared to pulmonary function measurements or Ashcroft score. RESULTS: Automated quantification of pulmonary tissue density and fibrosis scores of HPSPF lung explants (n=3) was significantly higher than that of IPF lung explants (n=3) or biopsies (n=4). These values were also significantly higher in IPF lung explants than in IPF biopsies. Mean Ashcroft score in HPSPF or IPF explants was significantly higher than that of IPF biopsies. In contrast to automated quantification, Ashcroft scores of HPSPF and IPF explants did not differ significantly from each other. Automated tissue density and fibrosis scores correlated with lung function values and Ashcroft scores. Automated quantification of collagen content was similar in the three groups. Immune cell aggregates were identified in hematoxylin and eosin stained tissue;automated quantification of CD68 immunolabeled cells was significantly higher in HPSPF explants than in IPF biopsies. CONCLUSIONS: Severity of pulmonary fibrosis in stained human tissue can be automatically quantified in entire lung sections using a dedicated software program. This reader-independent method provides a more accurate assessment of pulmonary fibrosis than Ashcroft scores. Automated quantification of fibrosis, collagen content, and immunostained cells in fibrotic lung tissue sections can be performed simultaneously. Robust automated digital image analysis of human lung samples enhances the available tools to quantify and study pulmonary fibrosis and has potential application in preclinical studies and clinical investigations focusing on fibrotic lung disease and other diffuse pulmonary diseases, such as sarcoidosis, hypersensitivity pneumonitis, pneumoconiosis, or COVID-19.

Voice intelligent personal assistant for managing social isolation and depression in homebound older adults

Background: Loneliness and social isolation are both common in older adults in the United States. Social distancing, which may cause increased isolation, is an essential public health strategy during a pandemic such as COVID-19, especially for those older adults at increased risk of morbidity and mortality. Strategies are needed to mitigate the negative effects of social isolation on the mental and physical health of older adults. Voice Intelligent Personal Assistants (VIPAs) (e.g. Google Home) may be useful to homebound older adults with social isolation by connecting them to family, caregivers, and medical care and providing functional, cognitive, and social stimulation. Methods: A panel of stakeholders (n=25) with geriatrics expertise, including geriatricians, nurses, nurse practitioners, older adults, social workers, and caregivers of older adults, independently used a VIPA for 4 weeks. Participants then completed a survey where they were asked to describe the features that would be the most relevant for older adults to help minimize social isolation, provide feedback on ease of use of the device, and share information about use that might be helpful for older adults. Mixed method analysis will be conducted with qualitative responses analyzed using thematic and constant comparative analysis. Results: Participants have been provided VIPAs and are completing surveys about the use. We anticipate the results of the surveys and analysis will provide information pertaining to improving the utility of VIPA for older adults. Conclusions: Stakeholders with geriatrics expertise will identify several features of VIPAs that may be useful to homebound older adults with social isolation. Based on results, a companion booklet to the VIPA will be designed highlighting applications that may benefit older adults with social isolation and providing instructions tailored to older adults to facilitate use of the VIPA in the home. Future research will test the VIPA and companion booklet with homebound older adults to examine the effects on social isolation and depression.