COVID-19 and the Motorcycle Taxi Sector in Sub-Saharan African Cities: A Key Stakeholders' Perspective

This article assesses the impact of the COVID-19 outbreak on the urban motorcycle taxi (MCT) sector in Sub-Saharan Africa (SSA). MCToperators in SSA provide essential transport services and have shown ingenuity and an ability to adapt and innovate when responding to different challenges, including health challenges. However, policymakers and regulators often remain somewhat hostile toward the sector. The article discusses the measures and restrictions put in place to reduce the spread of COVID-19 and key stakeholders' perspectives on these and on the sector's level of compliance. Primary data were collected in six SSA countries during the last quarter of 2020. Between 10 and 15 qualitative interviews with key stakeholders relevant to the urban MCT sector were conducted in each country. These interviews were conducted with stakeholders based in the capital city and a secondary city, to ensure a geographically broader understanding of the measures, restrictions, and perspectives. The impact of COVID-19 measures on the MCT and motor-tricycle taxi sector was significant and overwhelmingly negative. Lockdowns, restrictions on the maximum number of passengers allowed to be carried at once, and more generally, a COVID-19-induced reduction in demand, resulted in a drop in income for operators, according to the key stakeholders. However, some key stakeholders indicated an increase in MCT activity and income because of the motorcycles' ability to bypass police and army controls. In most study countries measures were formulated in a non-consultative manner. This, we argue, is symptomatic of governments' unwillingness to seriously engage with the sector. © National Academy of Sciences: Transportation Research Board 2021.

Data-Driven Real-Time Strategic Placement of Mobile Vaccine Distribution Sites

The deployment of vaccines across the US provides significant defense against serious illness and death from COVID-19. Over 70% of vaccine-eligible Americans are at least partially vaccinated, but there are pockets of the population that are under-vaccinated, such as in rural areas and some demographic groups (e.g. age, race, ethnicity). These pockets are extremely susceptible to the Delta variant, exacerbating the healthcare crisis and increasing the risk of new variants. In this paper, we describe a data-driven model that provides real-time support to Virginia public health officials by recommending mobile vaccination site placement in order to target under-vaccinated populations. Our strategy uses fine-grained mobility data, along with US Census and vaccination uptake data, to identify locations that are most likely to be visited by unvaccinated individuals. We further extend our model to choose locations that maximize vaccine uptake among hesitant groups. We show that the top recommended sites vary substantially across some demographics, demonstrating the value of developing customized recommendation models that integrate fine-grained, heterogeneous data sources. We also validate our recommendations by analyzing the success rates of deployed vaccine sites, and show that sites placed closer to our recommended areas administered higher numbers of doses. Our model is the first of its kind to consider evolving mobility patterns in real-time for suggesting placement strategies customized for different targeted demographic groups.

Using natural language processing on free-Text clinical notes to identify patients with long-Term COVID effects

As of May 15th, 2022, the novel coronavirus SARS-COV-2 has infected 517 million people and resulted in more than 6.2 million deaths around the world. About 40% to 87% of patients suffer from persistent symptoms weeks or months after their original infection. Despite remarkable progress in preventing and treating acute COVID-19 conditions, the clinical diagnosis of long-Term COVID remains difficult. In this work, we use free-Text clinical notes and natural language processing (NLP) techniques to explore long-Term COVID effects. We first obtain free-Text clinical notes from 719 outpatient encounters representing patients treated by physicians at Emory Clinic to detect patterns in patients with long-Term COVID symptoms. We apply state-of-The-Art NLP frameworks to automatically identify patients with long-Term COVID effects, achieving 0.881 recall (sensitivity) score for note-level prediction. We further interpret the prediction outcomes and discuss potential phenotypes. Our work aims to provide a data-driven solution to identify patients who have developed persistent symptoms after acute COVID infection. With this work, clinicians may be able to identify patients who have long-Term COVID symptoms to optimize treatment. © 2022 Owner/Author.

A COST AND TIME ANALYSIS OF PARTICIPANT RECRUITMENT AND URINE SAMPLE COLLECTION THROUGH SOCIAL MEDIA OPTIMIZATION

INTRODUCTION AND OBJECTIVE: Clinical research study can be expensive and time consuming due to high cost and/or long duration of a study. We hypothesized that research studies using online recruitment and engaging patients via social medial channels have the potential to reach a large population in a small timeframe, at a reasonable cost. This is an especially appropriate adaptation during COVID-19, with limited hospital and clinic access. To our knowledge, no prior study has performed a detailed cost analysis of the use of online recruitment of clinical sample collection. We sought to address this knowledge gap by comparing cost and efficiency of the recruitment of urine samples online compared to recruitment of urine samples at clinical research sites. METHODS: We performed a retrospective cost analysis of a cohort study comparing cost per sample and time per sample for both online and clinically recruited participants. The retrospective review was conducted from August 2020 to September 2021. During this time, cost data was collected based on patient surveys, urine sample analyses, invoices, and budget spreadsheets. The data was subsequently subjected to statistical analysis. This study was performed with full institutional IRB approval. RESULTS: Each sample collection kit contained 3 urine cups, 1 for the IC sample and 2 for control samples. Out of the 3576 (1192 IC + 2384 control) total sample cups mailed, 1,211 (677 control) samples were returned, with a return rate of 44.8% for IC samples and 28.4% for controls. Comparatively, the two clinical sites collected 305 samples in the same period. Men and women of all age groups (18+) and ethnicities enrolled in the study, representing all 50 states. Although the initial startup cost of online recruitment was higher, cost per sample for online recruited was found to be $147.06 compared to $398.14 for clinic sample. CONCLUSIONS: We conducted a nationwide, contactless, urine sample drive through online participant recruitment, in the midst of the COVID-19 pandemic. Results were compared with the samples collected in traditional clinical setting. Online patient recruitment can be utilized to collect urine sample rapidly, efficiently and at a cost per sample that was 37% of in an in-person clinic and without risk of COVID-19 exposure.

CONDUCTING UROLOGY RESEARCH DURING COVID-19: SOCIAL MEDIA-BASED CROWDSOURCING OF URINE SAMPLES FOR BIOMARKER DEVELOPMENT

INTRODUCTION AND OBJECTIVE: Conductingresearch during the COVID-19 pandemic remains a challenge for the entireurologic community. We hereby report our effort to use social mediabasedcrowdsourcing methodology to recruit participants from the entire UnitedStates, including Alaska and Hawaii. We developed a novel research model thatcan engage multiple stakeholders and allows for fast and broad participationfor urine biomarker development towards a diagnostic tool for InterstitialCystitis (IC). METHODS: We partneredwith a patient advocacy group, the Interstitial Cystitis Association (ICA), toaid in recruitment efforts. A website with study information and links to theHIPAA-compliant enrollment questionnaire was created. The study was advertisedthough Google, and Beaumont's and ICA's social media using Twitter, emails,YouTube videos, Facebook posts, websites, and TikTok. Enrolled participants wereshipped at-home collection kits containing urine cups with preservative, a prepaidreturn mailing envelope, instructions, and survey materials. RESULTS: National publicparticipation was strong, and enrollment was closed within three months. Menand women of all age groups and ethnicities enrolled in the study, representingall 50 United States. Currently, 1,211 crowdsourced samples have been returned,including 677 asymptomatic control samples. Surprisingly, most participantsaccessed the website via mobile devices, as opposed to via desktop computer ortablet. Potential participants were referred to the website primarily by directlinks (i.e. email links), with other referring sites being Facebook, GoogleAdvertisements, the ICA's website, and Beaumont Hospital's website. CONCLUSIONS: Following COVID-19 safety guidelines, we conducted a nationwide crowdsource collection ofurine samples. Social media and web-based recruitment tools were used torecruit participants. Having a website user-friendly on mobile devices wasessential. Nontraditional recruitment methods, such as TikTok videos,encouraged study participation. Utilizing various social media platforms, it ispossible to crowdsource urine samples from across the United States quickly,economically, and most importantly during the COVID-19 pandemic, safely. (Figure Presented).

THE INCIDENCE OF NEW OR WORSENING OAB SYMPTOMS IN PATIENTS WITH PRIOR SARS COV-2 INFECTION

INTRODUCTION AND OBJECTIVE: Investigators from our institution were the first US group to identify de novo genitourinary symptoms, such as frequency, urgency, nocturia, and pain/pressure, in individuals with prior COVID-19 infection. They termed this condition COVID-19 associated cystitis (CAC). Our study aims to establish the incidence of worsening or de-novo CAC, and to determine the correlation of CAC with serology status and antibody levels. METHODS: After IRB approval, 19,128 individuals from the largest COVID-19 serology study (BLAST COVID Study Group) were invited to participate in a follow-up study, with 1,895 subsequent respondents. Participants were retrospectively asked to score their OAB symptoms at three different time points: prior to the pandemic, 2 months after COVID-19 infection (if applicable), and at the present time. Genitourinary symptoms were assessed using the ICIQ-OAB. RESULTS: Of the 1,895 participants, 81.7% (n=1,548) were female, 16.5% male (n=312), 1.9% other/unknown (n=35). Most were Caucasian (85.8%), followed by African American (4.1%), Asian (3.8%), and Hispanic (1.4%). A third of participants (n=605) were COVID-19 positive as defined by positive serology or PCR test. Of these, 492 had 2 months post infection data with 36.4% (n=179/492) reporting an increase of ≥1 unit on the ICIQ-OAB compared to pre-pandemic. Out of these, 22% (n=40/179) were de novo. Comparing prepandemic to present symptoms, 35.7% (n=219) of participants with prior COVID-19 infection had an increase of ≥1 unit on the ICIQOAB, compared to 15.7% (n=202) of uninfected patients (OR: 2.99, 99.6Cl, 2.21, 4.05, p <0.001). The minimal important difference (MID) of ICIQ-OAB of 1 is considered a significant change. Antibody levels were not correlated with OAB symptoms in those with a positive PCR (ρ==-0.10) and were weakly correlated in those with a positive serology test (ρ= 0.14). CONCLUSIONS: In this study, we demonstrate that patients infected with COVID-19 are at increased risk for developing new or worsening OAB symptoms. No correlation was found between antibody levels and OAB symptoms in patients with prior COVID-19 infection. Participants are being followed prospectively to assess the progression of OAB symptoms in patients with CAC.

Comparison of Bladder Directed and Pelvic Floor Therapy in Women with Interstitial Cystitis/Bladder Pain Syndrome

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating constellation of symptoms including urinary urgency, frequency, and pain related to the bladder, which predominantly affects women. Although symptoms appear to be bladder related, there has been little solid evidence linking IC/BPS with a dysfunctional bladder epithelium unless ulcers are present. There is growing evidence that the bladder may be an innocent bystander in a more diffuse syndrome with a complex interplay of various systems/factors. It is our objective to assess the role of the pelvic floor muscles as a major contributor to pelvic pain and voiding dysfunction in adult women with IC/BPS symptoms. Our primary focus has been on study recruitment and enrollment. Due to the national shortage of one of the medications that are used for bladder instillations (bladder focused therapy), we only enrolled 1 of 128 total women (64 in each treatment arm) in the first project year. In August 2017 we obtained a limited supply of the medication, and study recruitment and enrollment resumed. In Years 2 and 3, recruitment activities expanded to increase enrollment. In mid-March of Year 4 all in-person research visits, and enrollment and screening activities were halted due to COVID-19. Identification of enrollment barriers and possible resolutions are ongoing. Although our targeted enrollment goals are not met, enrollment has been steadily growing.

Neuro-oncology outpatient satisfaction is maintained in the era of COVID-19 telemedicine

INTRODUCTION: The use of telemedicine increased during the COVID-19 pandemic. However, the impact on patient satisfaction in the Neuro-oncology population is unknown. This quality improvement project compares outpatient satisfaction before and during the COVID-19 pandemic as well as in-person versus telemedicine platforms during the pandemic. METHODS: We performed an IRB-exempt retrospective analysis of aggregate de-identified outpatient satisfaction scores among Neurooncology patients seen at The Preston Robert Tisch Brain Tumor Center (PRTBTC) at Duke University. The Clinician & Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) is a survey developed and distributed by Press Ganey Associates, and is the most widely used outpatient satisfaction survey in the United States. We compared pre- COVID-19 CG-CAHPS scores from patients who received in-person care at the PRBTC between April 2019 and March 2020 to COVID-19 pandemic CG-CAHPS scores (i.e. those who received either telemedicine or in-person care at the PRTBTC) from April 2020 to March 2021. RESULTS: Approximately 1448 surveys were completed for both in-person and telemedicine visits. During the pandemic, 48.6% of surveys represented telemedicine, with monthly variations from 84.6% (April 2020) to 21.4% (March 2021). Patient satisfaction scores pre-COVID-19 were similar to those during the pandemic: overall provider rating from 0-10 (9.28 v 9.36), knowledge of medical history (96.9% v 95.4%), listens carefully (96.6% v 96.9%), shows respect (97.2% v 98.1%), and time spent (93.2% v 95.5%). During the COVID-19 pandemic, in-person and telemedicine demonstrate similar levels of satisfaction: overall provider rating from 0-10 (9.29 v 9.48), knowledge of medical history (94.9% v 96.1%), listens carefully (95.4% v 99.0%), shows respect (97.5% v 99.0%), and time spent (94.7% v 96.7%). CONCLUSION: Outpatient satisfaction prior to and during the COVID-19 pandemic was similar. Patients reported similar satisfaction between in-person and telemedicine platforms. We support the ongoing use of telemedicine for outpatient Neuro-oncology.

Heterotopic ossifications after longterm weaning due to COVID-19

While pneumological, cardiovascular and neurological complications of a SARS-CoV-2 infection are already well researched, relatively little is known about influences on the musculoskeletal system. The case of a 65-year-old patient is reported who suffered a fracture of the humeral head that was treated conservatively. Six weeks after injury he developed cough and temperature and CoVID-19 was diagnosed. He developed a severe course of COVID-19 with ARDS, pulmonary artery embolism, multiple strokes und left-sided hemiparesis, requiring artificial respiration for several weeks. Subsequently, pronounced ossifications developed around the left shoulder and the left elbow. Heterotopic ossifications after craniocerebral trauma, after spinal cord injuries or long-term artificial respiration are known. Further research is still needed to answer the question whether the heterotopic ossifications are caused by proinflammatory processes due to immobilisation and long-time artificial respiration or by still unknown pathomechanisms as a direct consequence of SARS-CoV-2.