Qualitative methods in a learning healthcare system: Balancing rigour and the need for rapid analysis and dissemination

Qualitative methods are used to capture stakeholder perspectives within learning healthcare systems (LHS), but there is a need to specify methods that balance rigour and pragmatic approaches to inform quality improvement (QI). Utilizing examples from two QI projects within the OTNY LHS, we illustrate methods and strategies that build team capacity and flexibility to respond to an evolving LHS. Method(s): Qualitative methods were tailored to fit each project's timelines and goals, to inform both practice and research. Tools to facilitate rapid cycle feedback included interview/focus group summary templates, aggregate summaries that synthesize findings by stakeholder group, case matrix templates for rapid extraction and systematic categorization of data along topic areas, and dissemination materials adapted for stakeholder audience and project phases. Strategies to maintain rigour included processes for data reduction and interpretation, a multi-disciplinary approach for analysis, frequent consensus-based meetings, data triangulation, and member checks. Result(s): Rapid cycle approaches yielded interim results that reshaped research questions or identified critical gaps. Case summary analysis exploring the impact of COVID-19 revealed limited information on telehealth challenges amongst OTNY participants, necessitating a shift in recruitment and interview focus. For another project, analytic methods were sequenced to rapidly inventory suggestions from interview summaries on how to enhance OTNY practice to better address racism, while subsequent thematic analysis of transcripts captured participants' experiences of racism for context. Challenges included concurrent alignment of data collection and analysis, tailoring summary templates to maximize utility for rapid analysis, and maintaining flexibility to respond to evolving findings and LHS stakeholder input. Conclusion(s): The diverse methods and strategies illustrated by these projects offer guidance for balancing.

Autologous Conditioned Serum in Lumbar and Cervical Radiculopathy: A Systemic Review

Background: Intervertebral disc degeneration causing radiculopathy is driven by catabolic cytokines like IL-1β and TNFα. Autologous conditioned serum (ACS) was found to be rich in IL-1Ra (Interleukin-1 Receptor Antagonist), and thus, can impede disc degeneration. A systematic review of available literature was conducted to ascertain the potential therapeutic application of ACS in radiculopathy. Methods: Systematic literature reviews were conducted in PubMed, Scopus and Embase databases, up to September 2020. Randomised controlled trials (RCTs), prospective, retrospective studies and case series with lumbar or cervical radiculopathy and reporting use of ACS were included, with at least one of the outcome measures like VAS (Visual Analogue Scale) for pain, SF-12 (Short Form of Health Survey-12), Oswestry Disability Index, with a minimum follow up of 3 months. Animal studies, s, review articles and case reports were excluded. Results: A total of four studies, including 107 patients who received ACS were included based on the eligibility criteria. Two were RCTs and two were prospective non-comparative studies. Three studies evaluated the effect of IL-1Ra on lumbar radiculopathy and one on cervical radiculopathy. The mean age of patients in the studies ranged from 37.15 to 53.9. The dose of ACS used was 2-4 mL injection. In 1 RCT, methylprednisolone was used as control, in the other 5 mg and 10 mg triamcinolone was used. All studies reported a statistically significant reduction in pre-injection and post-injection VAS, there was also a significant difference as compared to 5 mg triamcinolone. Three studies reported significant improvement in ODI. Two studies reported statistically significant improvement in SF-12 scores post injection (p < 0.001). For cervical radiculopathy, Neck pain disability score showed a decrease of 73.76% from pre-injection to final follow up and Neck disability index showed a decrease of 74.47%. Conclusion: All of the four studies concluded that epidural perineural injection with ACS, reduced pain scores (VAS, NPDS) and improved functional scores (ODI, SF-12 and NPDS), as compared to placebo and other conventional therapeutic modalities like steroids, and analgesic-anaesthetic-steroid cocktail. Hence, ACS is a promising new therapeutic modality in both lumbar and cervical radiculopathy, and further studies can strengthen the present evidence regarding its efficacy and safety profile. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.

Pandemic related mental health

OnTrackNY is a nationally recognized Coordinated Specialty Care model disseminated across New York state for young people experiencing early non-affective psychosis. OnTrackNY is a network of 22 teams located in licensed outpatient clinics, serving over 2500 individuals. OnTrackNY offers medication management, case management, individual and group cognitive behaviourally oriented therapy, family support and psychoeducation, supported employment and education, and peer support services. Teams receive training for implementation through an intermediary organization called OnTrack Central. OnTrackNY was selected as a regional hub of the National Institute of Mental Health Early Psychosis Intervention Network (EPINET), a national learning healthcare system (LHS) for young adults with early psychosis. This symposium will present the different ways in which EPINET OnTrackNY implemented systematic communitybased participatory processes to ensure robust stakeholder involvement to improve the quality of OnTrackNY care. Florence will present results of an assessment of stakeholder feedback experiences used to develop strategies for assertive outreach and engagement of program participants, families and providers. Bello will present on mechanisms for integrating of co-creation principles to design, develop and execute quality improvement projects in EPINET OnTrackNY. Stefancic will present on quality improvement projects that used rapid cycle qualitative methods, tools, and strategies to build team capacity and flexibility to respond to an LHS. Montague will present adaptations to OnTrackNY services during the COVID-19 pandemic using an implementation science framework. Finally, Patel will lead a discussion on the implications of involving individuals with lived experiences in all phases of the process to maximize learning in an LHS.

Using the framework for reporting adaptations and modifications for evidence-based interventions (FRAME) for reporting adaptations to coordinated specialty care during the COVID-19 pandemic

Throughout the COVID-19 pandemic, OnTrackNY teams provided coordinated specialty care (CSC) in a radically shifted environment. This presentation describes adaptations to OnTrackNY's model implemented during the pandemic. Method(s): OnTrackNY providers were recruited to participate in indepth, qualitative interviews conducted using phone and video platforms. The project team co-developed the qualitative interview guides with OnTrack Central trainers for each of the six team member roles. A coding team used the FRAME to identify the top three role-based adaptations to the OnTrackNY model from transcripts of qualitative interviews. Result(s): Twenty-three providers (n = 3-4 providers per role) discussed challenges and adaptations of providing CSC services during the pandemic. Use of telehealth was a major adaptation applied across all roles. Adaptations to outreach included narrowing community outreach to inpatient and emergency settings, increasing communication with referral sources, increasing contact with newly referred participants and families. Peer specialist adaptations include conducting physically-distanced groups, discussing current events and expanding online resources for engagement. SEES adaptations included monitoring evolving employment opportunities, conducting mock job interviews remotely, and supporting online learning. Adaptations to PCP/RN roles included sending equipment home for monitoring heath, changing methods and frequency of administering medication, and providing education regarding COVID-19 and vaccination. Adaptations to the Primary Clinician role included increasing informal 'check-ins', using screen sharing to complete assessments and safety plans, and addressing increased stress due to the pandemic. Conclusion(s): Adaptations to CSC were common with providers most frequently making changes to format and setting of care delivery and content modifications. Future work will examine implications of adaptations and OnTrackNY fidelity indicators.

MEDICLOUD: a holistic study on the digital evolution of medical data

The Corona Virus Disease 2019 (COVID-19) pandemic has taught us many valuable lessons regarding the importance of our physical and mental health. Even with so many technological advancements, we still lag in developing a system that can fully digitalize the medical data of each individual and make it readily accessible for both the patient and health worker at any point in time. Moreover, there are also no ways for the government to identify the legitimacy of a particular clinic. This study merges modern technology with traditional approaches, thereby highlighting a scenario where artificial intelligence (AI) merges with traditional Chinese medicine (TCM), proposing a way to advance the conventional approaches. The main objective of our research is to provide a one-stop platform for the government, doctors, nurses, and patients to access their data effortlessly. The proposed portal will also check the doctors' authenticity. Data is one of the most critical assets of an organization, so a breach of data can risk users' lives. Data security is of primary importance and must be prioritized. The proposed methodology is based on cloud computing technology which assures the security of the data and avoids any kind of breach. The study also accounts for the difficulties encountered in creating such an infrastructure in the cloud and overcomes the hurdles faced during the project, keeping enough room for possible future innovations. To summarize, this study focuses on the digitalization of medical data and suggests some possible ways to achieve it. Moreover, it also focuses on some related aspects like security and potential digitalization difficulties.Copyright © 2022 Digital Chinese Medicine

The integration of principles of co-creation for promoting quality improvement within a learning healthcare system providing coordinated specialty care for people with FEP

Co-creation places key stakeholders at the centre of development processes for quality improvement projects to reduce gaps between research and practice. We describe an Amplify OnTrackNY project that used principles of community-based participatory research to meaningfully partner with individuals with lived experience and describe lessons learned. Method(s): Two individuals with lived experience were hired and coled decision-making about project selection and design. The project examined OnTrackNY provider, participant, and family perspectives on the impact of COVID-19 on service delivery. To enhance the lived experience perspective, we hired two OnTrackNY graduates and a family member, and created mechanisms for team building and integration, and co-planning sessions. All team members contributed to the development of research questions, co-facilitated interviews/ focus groups, and participated in data analysis and dissemination. Result(s): Team members conducted focus groups and semi-structured interviews with 13 participants and five family members, presented results to various stakeholder groups, and are contributing to scientific publications. To ensure participation, our flexible working structure focused on promoting equity and building trust. Dedicated time ensured opportunities for meetings focused on mutual support, sharing, capacity building, and training in qualitative methods. Individuals with lived experience were in decision-making roles, created content, and led project activities embodying principles of power-sharing, reciprocity, and mutual learning. Orienting new team members to the office culture required extra effort. Conclusion(s): Provided sufficient time and infrastructure, it is feasible to meaningfully involve individuals with lived experience in quality improvement projects. Co-creation ensures that important perspectives are incorporated from the outset and procedures improve the relevance and uptake of research findings in the real world.

Self-Medication Among Medical Students During the COVID19 Pandemic

Introduction: During the different wave of pandemic, due to various reasons self-medication practices among the public increased. Medical students are prone to such practices due to relevant background knowledge, and access to drugs. This study assessed the self-medication practice among the medial students during the different waves of pandemic of south Gujarat. Material and Methods: This descriptive study was conducted during May to June 2022 through self-administered form among medical students of south Gujarat, India. Study questionnaire included general de-mography;most frequently practice of self-medication. drug and the reason behind it. Result: Out of total 512 respondents, 381 (74.4%) did self-medication during the pandemic. 358 individuals (94.0%) did self-medication at least one drug since the start of pandemic. The most commonly utilizing medi-cines as prophylactic was Ayurvedic preparation, Multivitamins, Zinc and Vitamin C. For treatment of symptoms during the pandemic paracetamol (650 mg) was frequently used specially for body ache and fever. The main source of information of self-medication was internet. Conclusion: This study depicted common self-medication practices among medical students during the pan-demic. It is a significant health issue especially during the pandemic times, with high consumption reported as a prevention or treating symptoms of COVID-19. © 2023, MedSci Publications. All rights reserved.

Outcomes of COVID-19 in children with cancer - Report from the Indian Pediatric Oncology Group (InPOG) COVID-19 registry in India

Introduction: The clinical outcomes of COVID-19 infection in children with cancer have been variable worldwide. Therefore, we aimed to collect data from all regions in India through a national collaborative study and identify factors that cause mortality directly related to COVID-19 infection. Method(s): Data was collected prospectively on children across India on cancer therapy and diagnosed with COVID-19 infections from 47 centers from April 2020 to October 2021. Information was recorded on the demographics, the number of children that required intervention, and the outcome of the infection. In addition, we analyzed the impact of the delta variant in 2021. Result(s): A total of 659 children were studied, of whom 64% were male and 36% were female. The data from the eastern region was sparse, and this was a collection bias. COVID-19 infection was predominantly seen in children less than five years. The delta variant had a higher impact in the southern region, and this was statistically significant. Of the 659 children, 30 children died (4.5%), however only 7 of the deaths were directly attributed to COVID-19 infection (1%). Conclusion(s): The study reports the largest nationally representative cohort of children with cancer and COVID-19 to date in India. We identified demographic and clinical factors associated with increased all-cause mortality in patients with cancer. Complete characterization of the cohort has provided further insights into the effects of COVID-19 on cancer outcomes. The low mortality allows us to recommend that specific cancer treatments be continued without delays in therapy.Copyright © 2022

Balancing Growth and Grief: Narratives of an Immigrant Doctoral Student Navigating Academia During the COVID-19 Pandemic

This autoethnographic chapter explores the complex experiences of an immigrant doctoral student during the COVID-19 pandemic, particularly one who juggles multiple roles in everyday life. Personal narratives offer insights into how I balanced my duties to work as an immigrant early childhood (EC) educator, support remote schooling for two children, manage household chores, continue with my aspirations to pursue a doctoral degree, and maintain personal emotional-mental health challenges. To reflect on my lived experiences, visual images are used as provocations to facilitate the self-inquiry process. Drawing upon Appadurai's theory helped me examine factors influencing my decision-making capacity, wellbeing and identity as an immigrant EC educator, researcher, and mother during the pandemic. My story demonstrates the role of aspirations and imaginations on my wellbeing and identity, particularly as a source of motivation to overcome grief and depression. The purpose is to raise awareness about the unbalanced journeys of immigrant doctoral students and create a research community that is supportive, avoids judgement, and privileges open discussions of immigrant doctoral students' wellbeing. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.

Adopting a Telemedicine Model of Asthma Care during the Covid-19 Pandemic

Purpose of study The IMPACT DC Asthma Clinic is an intervention program designed to transition children who are heavily dependent on the emergency department for episodic care to more effective longitudinal asthma care in their primary medical homes. We sought to study the implementation of a telemedicine model for IMPACT DC during the COVID-19 pandemic in order to address barriers to care. Methods used A telemedicine model of IMPACT DC was implemented using rapid-cycle improvements and process mapping. Measures for adoption of services including visit completion, show rates, primary language, and patient satisfaction were collected for six months. Healthcare utilization data for the six months prior to the IMPACT DC clinical intervention was collected. This data was compared to in- person clinic visits over the same six-month period the previous year. Summary of results 360 patients successfully completed a telemedicine visit between April 2020 and September 2020 with an average visit show rate of 52%. Primary language was English in 89%. These patients were most frequently classified as having mild-persistent asthma and were assessed as well-controlled. Satisfaction survey response rate was 33%;overall average satisfaction was high. In the comparison group, 701 patients successfully completed an in-person clinic visit between April 2019 and September 2019 with a visit show rate of 39%. Primary language was English in 84%. These patients were most frequently classified as having mild-persistent asthma, not well-controlled. Healthcare utilization data for both groups six months prior to their visit are displayed Conclusions The use of telemedicine provides IMPACT DC a feasible and adoptable model to continue caring for children with asthma, with overall high patient satisfaction. This model addresses access barriers during the pandemic, and promises to be an adjunctive tool for reaching families with low show rates and high healthcare utilization. (Table Presented).

COVID-19 and Type II NSTEMI: A Comprehensive Overview

Introduction: Data on the incidence of type 2 NSTEMI (T2MI) in hospitalized patients with COVID-19 infection has been limited to single-center studies. We propose to define the incidence of T2MI in a national cohort and identify pre-hospital patient characteristics associated with a diagnosis of T2MI in hospitalized patients with COVID-19. We will also examine the impact of T2MI on morbidity and mortality. Method(s): We performed a retrospective analysis on data from the American Heart Association COVID-19 Cardiovascular Disease Quality Improvement Registry. This national registry contains data on tens of thousands of patients hospitalized with COVID-19 from at least 122 centers across the United States. From January 2020 through May 2021, there were 709 (2.2%) out of 32,015 patients with a coded diagnosis of T2MI. We performed Wilcoxon tests, chi-squared test, and multivariable logistic regression to (1) identify predictive pre-hospital patient characteristics (Table 1) of T2MI for patients hospitalized with COVID-19 and (2) investigate the impact of T2MI on mortality and morbidity. Result(s): Patients in the T2MI group were older (71 vs. 63 years, p<0.001), and in forward selection analyses, patients with a diagnosis of T2MI had higher odds of known HTN (OR 1.79 [1.01-3.1], p=0.026) and heart failure (OR 3.46 [2.24-5.34], p<0.001). Increased age, admission troponin, CRP, and d-dimer were also associated with higher odds of T2MI. Hispanic race (OR 0.517 [0.289-0.924], p=0.026) and use of antihyperglycemics (OR 0.562 [0.377-0.836], p=0.005) were both associated with lower odds of T2MI. T2MI led to increased mortality (HR 1.32, [1.17-1.5], P<0.001) and morbidity including cardiac arrest, major bleeding, and stroke. Conclusion(s): A history of heart failure was the strongest predictor of T2MI in hospitalized COVID19 patients. Patients with a T2MI compared to those without, had significantly higher mortality and morbidity. Limitations include the heterogenous ascertainment of the T2MI diagnosis across sites in this registry.

PHASE 1 CLINICAL TRIALS OF A Q-GRIFFITHSIN NASAL SPRAY FOR SARS-CoV-2 PROPHYLAXIS

Background: The currently approved vaccines do not induce sterilizing immunity against SAR-CoV-2 infection, and immunity wanes over time. A robust broad spectrum topical prophylaxis strategy could protect vulnerable populations in the face of continuous evolution of SARS-CoV-2. The algal antiviral lectin Griffithsin (GRFT), and an engineered oxidation-resistant variant Q-GRFT have robust entry inhibitory activity against SARS-CoV variants of concern, in addition to other respiratory viruses with pandemic potential. We designed a nasal spray to deliver Q-GRFT to the upper respiratory tract mucosa for on-demand use as a broad-spectrum prophylactic. Two clinical trials (Phase 1a and 1b) were conducted to assess safety, tolerability, and pharmacokinetics of Q-GRFT nasal spray in healthy adults. Method(s): Healthy adult volunteers were enrolled in a Phase 1a double blinded, randomized study to receive a single dose of either intranasal Q-GRFT (3.0 mg, 2 sprays per nostril) or placebo at 2:1 ratio. Following a safety review, the Phase 1b study was initiated. Eleven volunteers in Group 1 received 3.0 mg dose once daily, for 7 days. After a safety review, 11 volunteers in Group 2 received a total of 6.0 mg Q-GRFT (3.0 mg twice daily for 7 days). Topical Q-GRFT concentrations were measured by ELISA in collected nasal and nasopharyngeal fluids. Drug levels in plasma were assayed to determine systemic exposure. Viral microneutralization cytopathic effect (CPE) assays were performed against SARS-CoV-2 Omicron BA-5 and MERS-CoV. Result(s): Eighteen adults (24-54 years;Males 58.3%, Females 41.7%;12 Q-GRFT, 6 Placebo), and 22 adults (aged 23-59 years;Males 52.4%, Females 47.6%) were enrolled in Phase 1a and 1b, respectively. In Phase 1a, a single dose of Q-GRFT maintained quantifiable levels in nasal passages and nasopharynx for up to 24 hours. Similarly, Q-GRFT was quantifiable in nasal and nasopharyngeal regions in the Phase 1b study. No dose accumulation effect or systemic exposure was observed. Nasal and nasopharyngeal swab eluates inhibited SARS-CoV-2 Omicron BA.5 and MERS-CoV in CPE assays. Q-GRFT did not modify olfactory sensation. No severe adverse events were reported. Thus, the nasal spray was deemed safe. Conclusion(s): Intranasal Q-GRFT was safe and enhanced mucosal SARSCoV-2 inhibitory activity in human volunteers. The results support further development of Q-GRFT as a broad-spectrum prophylactic against coronaviruses to curb ongoing infections, and for future pandemic preparedness.

Effect of Covid-19 Pandemic on Female Pelvic Medicine and Reconstructive Surgery Fellowship Case Logs: Analysis of the Accreditation Council of Graduate Medical Education National Data Reports

INTRODUCTION AND OBJECTIVE: Given widespread disruptions to healthcare during the COVID-19 pandemic, the objective was to assess the national case logs of graduating Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellows for effects on surgical volume. METHOD(S): The nationally aggregated Accreditation Council for Graduate Medical Education case logs were obtained for graduating FPMRS fellows, both urology and obstetrics and gynecology (OBGYN), for available academic years (AYs) 2018-2019, 2019-2020, and 2020- 2021. Standard deviation was derived from percentile data. Case volume differences for tracked index category averages were compared between AYs with one-way analysis of variance. RESULT(S): Graduating fellows logged an average of 517.4 (SD 28.6) and 818.0 (SD 37.9) cases, for urology and OBGYN respectively, over their fellowship training during the examined period. Total surgical procedures were not statistically different between pre-COVID AY 2018- 2019 and COVID-affected AYs 2019-2020 and 2020-2021 for either specialty. For urology fellows, the only index case category with a statistically significant difference was a decrease in AY 2020-2021 compared to 2019-2020 in GI procedures (8.9 vs 4.2, p=0.04). Reclassification of mesh removal cases to genital procedures in 2020- 2021 resulted in a statistical decrease for both specialties of graft/mesh augmentation prolapse cases for that same AY. There were no other statistically significant differences between AYs for OBGYN fellows. CONCLUSION(S): Compared to pre-pandemic case volumes, FPMRS urology and FPMRS OBGYN graduating fellow surgical volume remained stable. Both total surgical procedures and index case categories showed no statistically significant difference between pre-COVID and COVID-affected years. Despite nationwide disruptions in health care, FPMRS trainee case volumes remained consistent.

Patterns and Impact of Burnout among Women in the Urology Workforce

INTRODUCTION AND OBJECTIVE: Contemporary rates of burnout amongst urologists are reported to be 60-80%. These rates have significant implications on physician well-being and retention. We investigated predictors of burnout in female surgeons. METHOD(S): An electronic census survey was distributed to residents, fellows and practicing urologists by the Society of Women in Urology in the United States and territories via email and social media between February and May 2022. We assessed participant demographics, personal and professional characteristics, practice environment, compensation, and burnout with chi-square and t-test analyses. RESULT(S): There were 379 survey participants with an average age of 42 years (SD 10). A majority identified as cis-gendered heterosexual females (96%) and were practicing urologists (74%), while 10% were fellows and 15% residents/interns. Average reported time in practice was 9 years (SD 9 years). Most respondents reported burnout (273, 72%), with 87% agreeing COVID worsened burnout in the community. Those reporting burnout worked an average of 58 (SD 15) hours per week versus 49 (SD 18) hours (p<0.00001). Table 1 demonstrates significant personal and professional characteristics for participants who reported burnout. On multivariable logistic regression analysis, increased hours worked per week (OR 1.03, p=0.002), Relative Value Unit based pay versus salary (OR 4.4, p=0.007), correlated to burnout and feeling income is comparable to peers (OR 0.4, p=0.03) was inversely related. Common shared experiences included lack of staffing, reduced operating room time, lack of administrative support, predominance of non-operative referrals, gender and racial inequity or microaggressions, electronic health records with increased documentation demands, increased non-clinical administrative duties, and insufficient compensation or lack of financial advancement. CONCLUSION(S): A majority of women in urology report burnout with work-hours and compensation inequity as leading contributing factors. Concerns raised in this study such as lack of support staff, racial and gender inequity, and poor referral patterns should be further evaluated to determine a comprehensive plan to reduce burnout. (Figure Presented).

Shifting Trust: Examining How Trust and Distrust Emerge, Transform, and Collapse in COVID-19 Information Seeking

During crises like COVID-19, individuals are inundated with conflicting and time-sensitive information that drives a need for rapid assessment of the trustworthiness and reliability of information sources and platforms. This parallels evolutions in information infrastructures, ranging from social media to government data platforms. Distinct from current literature, which presumes a static relationship between the presence or absence of trust and people's behaviors, our mixed-methods research focuses on situated trust, or trust that is shaped by people's information-seeking and assessment practices through emerging information platforms (e.g., social media, crowdsourced systems, COVID data platforms). Our findings characterize the shifts in trustee (what/who people trust) from information on social media to the social media platform(s), how distrust manifests skepticism in issues of data discrepancy, the insufficient presentation of uncertainty, and how this trust and distrust shift over time. We highlight the deep challenges in existing information infrastructures that influence trust and distrust formation.

Social Media Use and COVID-19 Vaccination Intent: An Exploratory Study on the Mediating Role of Information Exposure

We stumble upon new and repeating information daily. As information comes from many sources, social media continues to play a predominant role in disseminating information, ultimately impacting individuals' perceptions and behaviors. A prime example of this impact was observed during the COVID-19 pandemic, in which social media use was influencing willingness to receive the COVID-19 vaccine. While studies on this relationship between social media use and vaccination intent have been widely investigated, less is known about the mechanisms that link these two variables, specifically the types of information seen on social media platforms and the effects of these different types of information. In this exploratory study, we demonstrate the mediator role of information exposure (to include both types of information and frequency) between social media use and vaccination intent. Our results show that different types of information mediate this relationship differently and demonstrate how these relationships were further moderated by the income level of the participant. We conclude with the implications of these findings and how our findings can inform the direction of future research within the field of human-computer interaction.

COVID-19 Detection by Medical Images with Pretrained Transfer Learning-based Model using CNN: A Systematic Review

A new coronavirus that caused the Covid-19 sickness, has already elevated the threat to humans. The virus is quickly spreading around the planet. Therefore, in order to detect sick individuals and stop the infection from spreading, it is vital that we develop fast diagnostic tests. The advancement of machine learning would make it possible to implement pre- ventative actions as soon as possible by enabling early detection of Covid19. However, insufficient sample sizes, particularly chestX-ray pictures, has made it more challenging to diagnose this ailment. In this study, we examined a number of these recently created transfer learning-based CNN models that can identify COVID-19 in lung CT or images of X-ray to diagnose Covid-19 using images of X-ray. We gathered data on the research resources that are readily available. We looked into and examined datasets, pre-processing methods, segmentation approaches, extraction of features, classification, and experimentation outcomes that could be useful for determining future research paths in the area of applying transfer learning based CNN models to diagnose COVID-19 disease. We have analyzed various models such as ResNet50, DenseNet-21, VGG-16, ImageNet, and some hybrid models and evaluated their performance matrix with a particular set of data used in their research work. Additionally, in orderfor a model to perform at its best, it is observed that there aren't enough data sets of COVID-19-infected individuals. This calls for augmentation, segmentation, and domain adaptation in transfer learning. © 2022 IEEE.

Severe COVID-19 infection predisposes patients to greater burden of hair loss

There is a growing body of evidence suggesting a link between COVID-19 infection and certain forms of hair loss, such as telogen effluvium. The present study aims to determine the prevalence of hair loss following COVID-19 infection and ascertain the role of COVID-19 severity as a risk factor for its development. A retrospective study was conducted using patient data from the Northwestern Medicine Enterprise Data Warehouse with institutional review board approval from Northwestern University. Patients aged >= 18 years with COVID-19 diagnoses between January 2020-June 2022 and >= 1 encounter with dermatology providers within 180 days post-infection were included in the study. History of COVID-19 and documented hair loss diagnoses were recorded along with demographic data. COVID-19 severity was classified based on whether the patient was given outpatient or inpatient/emergency care for COVID-19. Time-to-alopecia onset was calculated relative to the nearest preceding COVID-19 diagnosis. Pearson's chi-squared and Kaplan-Meier analysis were performed to evaluate differences in incidence and time-to-alopecia onset by severity of COVID-19 infection. Analyses were conducted using R 4.2.1. In total, 10,861 patients met the inclusion criteria for the study. Patients were more commonly female (N = 6,974, 64.2%) and White (N = 8,301, 76.4%) with a mean age of 48 years at COVID-19 diagnosis. Overall, 6.5% of COVID-19 patients treated in inpatient/emergency settings developed hair loss compared to 4.7% in outpatient settings (P = 0.009). Patients with outpatient care had a median time to alopecia diagnosis of 73 days, compared to 99 days for patients with inpatient/emergency care (P = 0.019). Our findings demonstrate hair loss following COVID-19 infection as a notable sequela of infection. Clinicians should closely monitor patients following hospitalization for COVID-19, as they may be predisposed to hair loss following infection due to psychological or physiological stress. Future studies should aim to validate our findings and explore this relationship on a larger scale.Copyright © 2023

Older adults' behavioral health during the COVID-19 pandemic

COVID-19's effects go beyond physical health, including impacts to behavioral health such as documented increases in loneliness, depression, anxiety, and alcohol misuse. Research on other disaster and mass trauma events suggests that behavioral health impacts may persist for many years after the initial onset of the event and could be compounded with other disasters. These impacts have not, and will not, be distributed evenly across the population. Of note, evidence from early in the pandemic suggests that older adults' (adults aged 65 and older) behavioral health may not be as adversely affected as expected, given past research on age and disasters. © 2023 The authors.