Economic policy uncertainty and international tourist arrivals: a disaggregated analysis of the Croatian Adriatic coast

This is the first study to examine the differential impact of Croatian and European economic policy uncertainty indices while controlling for the real effective exchange rate and industrial production on international tourist arrivals for the seven coastal counties of Croatia and the country as a whole. The Toda-Yamamoto long-run causality modeling approach with a Fourier approximation is employed to capture structural shifts. This approach is particularly useful in light of the disruption from the COVID-19 pandemic on the tourism sector. The results show unidirectional causality from both Croatian and European economic policy uncertainty indices to international tourist arrivals with the impact of the economic policy uncertainty indices negative and statistically significant across the respective coastal counties. Moreover, the findings show that European economic policy uncertainty exhibits a greater adverse impact on international tourist arrivals relative to Croatian economic policy uncertainty.

CRT-700.32 Utility of Routine 45-Day Imaging After Watchman Procedure Before Stopping Anticoagulation

Background: Based on the PROTECT AF and PREVAIL trials, transesophageal echocardiogram (TEE) is typically performed 45 days after WATCHMAN (Boston Scientific, DE) implantation to rule out device-related thrombus (DRT) or peri-device leak (PDL) before stopping oral anticoagulation (OAC). The utility of imaging before discontinuing OAC is uncertain. During the COVID-19 pandemic, when elective TEEs were cancelled or delayed, many patients were taken off OAC without imaging. Method(s): Patients undergoing WATCHMAN implant followed by short-term OAC from January 2018 to June 2022 at a university hospital were analyzed retrospectively. Patients who did not have imaging performed at 45 days (+/-7 days) after WATCHMAN implantation were compared with those who did. Outcomes included 1) a composite of ischemic stroke and transient ischemic attack (TIA), 2) a composite of DRT or PDL >=5 mm in patients who had 45-day imaging, and 3) a composite of DRT or PDL >=5 mm in patients who were taken off OAC at 45 days without imaging but underwent delayed imaging (within 1 year of WATCHMAN implantation). Result(s): 258 patients were followed for 1 year. 232 patients (89.9%) had TEE or cardiac computed tomography (CT) at 45 days (Figure). 3 had DRT (1.3%), which was treated successfully with 90 days of anticoagulation, and none had PDL >=5 mm. There were 4 ischemic strokes and 2 TIAs during the follow up period (2.6%), none of which were preceded by DRT. 26 patients (10.1%) were taken off OAC at 45 days without imaging. No stroke or TIA occurred in this group. No DRT or PDL >=5 mm was seen in the 15 of these 26 (58%) patients who underwent delayed imaging. Conclusion(s): A primary strategy of 45-day post-WATCHMAN imaging is still indicated, given a ~1% DRT rate, however the risk associated with discontinuing anticoagulation without imaging is low in cases where 45-day imaging is not possible. [Formula presented]Copyright © 2023

Economic Policy Uncertainty, COVID-19, and Tourist Stays in Croatia: Evidence from a Fourier Toda-Yamamoto Modeling Approach

This study extends the literature with respect to economic policy uncertainty measures and tourism flows to Croatia through the use of the Toda and Yamamoto modeling approach with a Fourier approximation to capture structural breaks. The results show that domestic economic policy uncertainty does not have a significant impact on tourist overnight stays. However, an increase in European economic policy uncertainty reduces total and domestic tourist overnight stays. An increase in COVID-19 cases has a negative and significant impact on total, domestic, and foreign tourist overnight stays, and contributes to increases in both Croatian and European economic policy uncertainty. © 2022 Taylor & Francis Group, LLC.

Family law professionals' views of post-separation parenting apps

The rapid proliferation of smartphones has led to a bewildering array of post-separation parenting apps, especially since the Covid-19 pandemic. These apps usually comprise a messaging tool, shared calendar, expense tracker, and a means to download messages and documents for courts. In Australia, as elsewhere, family law professionals are increasingly being asked about, or asked to recommend, smartphone apps to clients. There is also an emerging trend for courts to mandate the use of post-separation parenting apps in high conflict cases. The present study sought to explore the views and experiences of family law professionals on post-separation parenting smartphone apps (N = 344). Data were collected in Australia and New Zealand through an online survey, distributed to a diverse population of family law professionals. We found that (i) family law professionals generally reported little knowledge of co-parenting apps;(ii) around one third of family law professionals reported that their clients had experienced, or concerns about, coercive control through an app;(iii) around two thirds of family law professionals who had recommended an app had not tried it;and yet (iv) three quarters reported recommending apps to clients. Our central argument is that family law professionals and separated parents alike need a comprehensive and more nuanced understanding of the benefits and risks of post-separation parenting apps and their features.

Thromboelastography Six: Redefining heparin resistance in post COVID syndrome

Background: In the literature there has been minimal discussion of heparin resistance with regards to the post-COVID syndrome. Since the COVID pandemic began, patients with COVID were suffering complications from VTE that suggested the presence of a hypercoagulable state. Generally this hypercoagulable state is described through the use of thromboelastogram six (TEG6) with a short R time, wide alpha angle and a very large amplitude. Aim(s): In this case we were using the TEG6 as a guide for heparin therapy by following the CK-R time compared to the CKH-R time (with heparinase). We observed no bleeding or clotting events. While the patient was on ECMO, there were no changes in the delta-P and the circuit was not replced during his clinical course. Additionally, he required no blood transfusions during this time. Method(s): An observational analysis of TEG6 in COVID-19 ECMO patient while using an anti-Xa heparin based protocol for therapeutic heparin therapy. Result(s): On the initial TEG6, there was a significantly prolonged R time that was partially corrected with heparinase -with heparin dosing of 24 IU/kg/h (65,000 IU/day), see figure one. With the prolonged R time, heparin was descalated to 16 IU/kg/h and the coagulation profile was resent, see figure two. Additionally, the TEG6 MA remained elevated -consistent with the hypercoagulable post-COVID syndrome. This occurred in the setting of a normal anti-thrombin three level and platelet counts. Conclusion(s): Through the use of TEG6, we were able to better characterize his coagulation profile and we were able to deescalate his dosing of heparin using the CK and CKH-R time comparison. We propose using TEG6 to redefine heparin resistance in the post-COVID syndrome of hypercoagulopathy, as older modalities may not be accurately reflecting this modern pathology. (Figure Presented).

Economic Policy Uncertainty, COVID-19, and Tourist Stays in Croatia: Evidence from a Fourier Toda-Yamamoto Modeling Approach

This study extends the literature with respect to economic policy uncertainty measures and tourism flows to Croatia through the use of the Toda and Yamamoto modeling approach with a Fourier approximation to capture structural breaks. The results show that domestic economic policy uncertainty does not have a significant impact on tourist overnight stays. However, an increase in European economic policy uncertainty reduces total and domestic tourist overnight stays. An increase in COVID-19 cases has a negative and significant impact on total, domestic, and foreign tourist overnight stays, and contributes to increases in both Croatian and European economic policy uncertainty. © 2022 Taylor & Francis Group, LLC.

Patient preferences for telehealth versus in-person oncology visits

Background: The COVID-19 pandemic led to rapid adoption of telehealth (video or phone) visit modalities for oncology encounters not requiring in-person visits. We surveyed oncology patients regarding preferences for in-person versus telehealth modalities for different types of clinical encounters. Method(s): We surveyed adults who were undergoing treatment at Kaiser Permanente Northern California infusion centers between 11/2021 - 05/2022 using a self-administered questionnaire. Patients were asked about modality preferences for 6 types of clinical discussions, overall advantages and disadvantages of telehealth versus in-person encounters, and barriers to video visit use. Result(s): A total of 757 patients who completed surveys in English answered questions about visit modality preferences for different types of discussions with their oncologist. Respondents were 63% female, median age 63y, and majority White (61% White, 19% Asian, 11% Latino, 7% Black) and college-educated (28% some college, 45% > bachelor's degree). For the first post-diagnosis discussion, most patients preferred inperson (IP) visits (83%), followed by video visits (27%) and phone visits (18%). For follow-up visits during treatment, patients preferred IP (52%), video (50%) and phone (37%) visits. For discussions of bad news and sensitive topics, IP visits were preferred by 68% and 62%, video visits by 44% and 48%, and phone visits by 32% and 41%, respectively. Good news could come at IP (49%), video (52%) or phone (49%) visits. Approximately 20% of patients had no overall preference for IP versus telehealth visits. However, 58% of patients felt more personally connected with their doctor at IP visits. Patients also had more confidence in IP examinations (73%) and felt IP was easier for showing things (67%) and talking (51%) to the doctor. Patients felt telehealth visits saved them time (72%), reduced infection exposure (64%) and travel issues (45%), were cheaper (38%), and enabled inclusion of more people (28%). Of 24% of patients who felt video visits would be hard, 51% cited poor internet, 41% lack of an adequate device, and 28% difficulty signing on. Conclusion(s): The majority of oncology patients consider telehealth visits acceptable for most types of clinical discussions, with the exception of the first post-diagnosis visit. Only one-fourth of patients indicated potentially modifiable barriers to video visits. Our results support use of telehealth visits for most types of oncology encounters.

ADOPTION OF ELECTRONIC CONSENT (E-CONSENT) IN THE LEAP1 STUDY

Background: The use of electronic consent to recruit eligible women to the LEAP1 Study contributed greatly to the study reaching its target sample size of 900 women with, or who were likely to develop, mild to moderate iron deficiency in pregnancy. The COVID-19 pandemic in Australia between 2020-2021 greatly reduced the capacity for recruiting centres to provide in-person informed consent to potential study participants, and as such several centres adopted some form of electronic consent. Recruitment to LEAP1 was completed on the 27th of Oct 2021, when the 907th participant was enrolled. Methods: Adobe Sign was implemented at 1 recruiting centre (Epworth Freemasons), whilst 4 other centres (Monash Medical Centre, Angliss Hospital, Royal Brisbane and Women's Hospital, St George Hospital) adopted fillable PDF consent forms to obtain consent from eligible study participants. Electronic methods of consent were approved by the lead HREC and local RGOs prior to implementation. The remaining 9 participating sites in Australia continued using traditional paper informed consent. Results: A total of 5 recruiting centres implemented at least 1 form of electronic consent. These centres were able to continue study recruitment through the pandemic in 2020 and 2021. Conclusions: Electronic informed consent has shown to be a useful tool in supporting study recruitment in a perinatal context, particularly during the COVID-19 pandemic in Australia between 2020 and 2021. Future trials may benefit from adopting similar methods of informed consent for their participants.

Victorian anaphylaxis mandatory reporting outcomes: Results from paediatric population 2019-2020

Background: Victoria introduced mandatory anaphylaxis reporting for all hospitals in 2018 to allow rapid identification and removal of undeclared food allergens in packaged food to prevent further allergic events. To our knowledge this is the first mandatory anaphylaxis surveillance system in the world and the most comprehensive Victorian dataset. We describe the 2019-2020 paediatric data including demographics, anaphylaxis trigger, recurrent anaphylaxis episodes, clinical outcomes and geographical distribution. Method: Registered medical practitioners are required to notify the Victorian Department of Health of anaphylaxis cases within 1-5 days of diagnosis. Cases entered from the 2019-2020 period were analysed. Results: There were 3822 total anaphylaxis notifications, with 1493 (39%) in those aged <18 years. Numbers were similar in both years (despite COVID19 restrictions for the majority of 2020). Anaphylaxis was more common in males under 12 years and in females from ages 12-18 years. An allergen in packaged food was the most common anaphylaxis trigger in children (34%). 46% of notifications were for a first episode of anaphylaxis. Recurrent anaphylaxis despite a known trigger was most common amongst children aged 12-18 years, and these were the most likely to require ICU admission (5%). In 2019, based on residential address and anaphylaxis cases per 100,000 population aged <18 years, the Local Government Areas (LGAs) with the highest anaphylaxis rates were Melbourne (186.9), Hepburn (137.9) and Banyule (134.4). In 2020, Queenscliffe (241.5), Ararat (135.4) and Port Phillip (110.6) had the highest rates, however results were influenced by the small populations of some rural areas. Conclusions: 1. Victorian paediatric anaphylaxis rates are high compared to published data and were unaffected by COVID-19 restrictions. 2. Older children are more likely to present with recurrent anaphylaxis and require ICU. 3. Paediatric anaphylaxis service provision is centred in Melbourne, but high case numbers are present in other LGAs with less access to allergy services.

Sickle Cell Disease (SCD) As a Risk for COVI19 Compared to Those without SCD Among Patients Admitted in a Large Urban Center, As Estimated By PCR Sars-v-2 Positive Vs Negative Testing

A diagnosis of SCD is considered to be at risk for COVD19. To further define the association between SCD and infection with COVID-19, we estimated risk, by comparing presence or absence of COVID19 infections in individuals with and without SCD admitted concurrently to a large urban health care facility (Grady Memorial Hospital, Atlanta, GA;960 beds, 5th largest public hospital in the US). Primary outcome was a positive or negative COVID-19 diagnosis as defined bySARS-CoV-2 PCR testing. A patient was considered to be COVID-19 positive if tested positive withSARS-CoV-2 PCR for the first time, anytime during the study period, irrespective of number of tests. A patient was considered to be COVID-19 negative if patient had no positive tests during the study period, and had one or moreSARS-CoV-2 PCR negative tests. For COVID19 positive patients, the admission of theSARS-CoV-2 PCR positive test was included in the analysis. For COVID19 negative patients, the first admission with aSARS-CoV-2 PCR negative test was considered for analysis. For this interim analysis, SCD was defined by ICD10 and registry data. Clinical diagnosis such as obesity and respiratory failure were defined by ICD10 coding. Data was obtained from quarterly centralized Epic EMR data extractions. Analysis of outcome of COVID19 positive vs negatives was stratified in four separate analysis: all admissions, ICU admissions, those with respiratory failure and those who died. Multivariate dichotomous logistic regression analyses modeled binary outcome effect of SCD, adjusted for age (<40 vs. > 40 years), sex at birth (females vs. males) and obesity (SAS version 9.4 was used for statistical analyses and overall significance level was set at 0.05). To ensure population homogeneity analysis was conducted on patient ages 20 to 60 years that were Black/African American and admitted from the Emergency Department for a short stay and/or the medicine service (variable interactions at a p<0.01). The study was approved by the institutional review board and by the hospital research oversight committee. Overall, between 3/23/2020 and 6/30/2020, 23697 patients were admitted once or more to Grady Memorial Hospital with one or more PCR sars-cov-2 test, of these 405 were patients with SCD (1.7%). Of the total, 2566 patients (10.8%) tested positive for COVID-19, and 48 patients with SCD (11.8%) were positive. Of 7041 (29.7%) were part of the study population, 332 (4.7%) where patients with SCD (hemoglobin [hb] SS/Sbeta0 =252, hbSC n=55, hbS beta thalassemia+ or hbS beta thalassemia undetermined n=21). Among patients without SCD, 36.3% were female, (n=2557) and among patients with SCD, 53.6% (n=178). The mean age of patients without SCD was: 51.1 years (standard deviation [std]) +/- 19.5 years), and for those with SCD: 35.0 years (std +/- 12.0 years). Results of univariate and multivariate analysis are presented in the table. In conclusion, in a Black/African American patients admitted from the Emergency Room for observation and/or the internal medicine service, when adjusted for age, gender and obesity, with SCD are at a significant increased risk for admissions with COVID-19 infection in general as well as ICU admission or admission with respiratory failures. Further studies can help articulate the risk associated with SCD as well as its potential interaction with other factors, with attention to confounders. [Formula presented] Disclosures: No relevant conflicts of interest to declare.

Drug offence detection during the pandemic: A spatiotemporal study of drug markets

Purpose: Research on COVID-19 and crime has so far shown that most crime types declined, especially in the early months of the pandemic. Illicit drug offences were a notable exception, however few studies have considered changes at specific drug market locations. This study documents how key drug markets were affected during the lockdown. Methods: Using a spatiotemporal generalised additive model (GAM), this study examines the pattern of drug offence detection throughout the city of Brisbane, Australia and identifies areas of change during lockdown. Statistical meshblock analysis is used to illustrate discrete changes at key market locations. Results: Contrary to aggregate-level analysis, we show that several of the major drug markets experienced a significant decline in drug offence detections, but that these local changes were offset by a displacement to neighbouring areas. We also find some preliminary evidence of the emergence of new outer-urban markets. Conclusions: Existing drug markets were adversely affected by the COVID-19 lockdown, however drug market activity was likely displaced rather than diminished. © 2021

Melatonin for the Early Treatment of COVID-19: A Narrative Review of Current Evidence and Possible Efficacy.

OBJECTIVE: To discuss the use of melatonin as an early treatment option on the first day of diagnosis for COVID-19. METHODS: Medical Subject Headings terms "COVID-19" and "viral diseases" were manually searched on PubMed, and relevant articles were included. RESULTS: The results showed that melatonin acts to reduce reactive oxygen species-mediated damage, cytokine-induced inflammation, and lymphopenia in viral diseases similar to COVID-19. CONCLUSION: These conclusions provide evidence for potential benefits in melatonin use for COVID-19 treatment as early as the day of diagnosis.

Evidence-based approach to early outpatient treatment of SARS-CoV-2 (COVID-19) infection.

Misinformation and promotion of well-intended but disproved therapies for COVID-19 have plagued evidence-based shared decision-making throughout the COVID-19 pandemic. In times of crisis, clinicians may feel that their strong inclination to prescribe potentially harmful, unproven therapies on behalf of their patients is supported by beneficence. Clinicians should mindfully identify and avoid commission bias during this pandemic, especially as more data have accumulated to assist with clinically sound decision-making. We describe a more evidence-based approach to treatment of early outpatient COVID-19, stressing the availability of Food and Drug Administration emergency use authorization therapies and considering plausibly beneficial, nonprescription supplements that are generally regarded as safe.

COVID-19 and Corrections in Australia: A Summary Review of the Available Data and Literature

In March 2020, COVID-19 was declared a global pandemic and at the time of writing, there were more than 13 million known cases and more than 500,000 deaths. Not since the Spanish Flu of 1918 has the world needed to respond to the potential threat of a communicable disease with such a high rate of infection and fatality. Using publicly available data, media sources, and literature, this paper maps Australian corrective services’ responses to COVID-19. We find evidence of a concerted effort to reduce prison population numbers, as well as to recalibrate corrections practice in an effort to meet new social-distancing rules and regulations. Our analysis is motivated by the knowledge that prior to COVID-19, Australia had a rising prison population, a disproportionate growth in female and remand populations, and significant Indigenous overrepresentation. In this paper, we explore whether the immediate benefits of COVID-19 have helped or hindered efforts to address these wider concerns. © 2020 Taylor & Francis Group, LLC.

COVID-19 discharge and follow-up recommendations.

Currently, the world is facing a global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19. So far, there are no clear recommendations regarding hospital discharge and aftercare for COVID-19. Here, we briefly discuss the current understanding of recommendations for discharge criteria, discharge treatment regimens, and follow-up.

Developing L2 productive language skills online and the strategic use of instructional tools

Sequencing language production activities based on the inherent cognitive load of each activity type can improve student performance and self-efficacy on high cognitive load language tasks like conversational speech (either face-to-face or via video chat). This ordering according to cognitive difficulty can scaffold learners in their development of second language (L2) productive skills. This article provides a research-based rationale for this approach and includes several practical suggestions for how to design a rigorous and engaging online language course.