US state-level economic freedom during the COVID-19 pandemic

The COVID-19 pandemic led to extensive new government regulations and lockdown policies that significantly reduced economic freedom across US states. Many of these new pandemic-related regulatory restrictions on economic freedom varied significantly from state to state but are largely missed by the existing Economic Freedom of North America Report (EFNA). This paper adjusts the Our World in Data COVID-19 Stringency Index into a state-level measure of lockdown regulatory freedom and then merges it into the EFNA index to better measure relative economic freedom across US states in 2020. We find significant differences in the relative ranking of economic freedom between states once we adjust for lockdown regulatory restrictions. © 2023 American Journal of Economics and Sociology, Inc.

External validation of the Oldham composite Covid-19 associated mortality model (OCCAM), a prognostic model for death in patients hospitalised with Covid-19.

OBJECTIVE: External validation of the Oldham Composite Covid-19 associated Mortality Model (OCCAM), a prognostic model for Covid-19 mortality in hospitalised patients comprised of age, history of hypertension, current or previous malignancy, admission platelet count < 150 × 103/µL, admission CRP ≥ 100 µg/mL, acute kidney injury (AKI), and radiographic evidence of > 50% total lung field infiltrates. PATIENTS AND METHODS: Retrospective study assessing discrimination (c-statistic) and calibration of OCCAM for death in hospital or within 30 days of discharge. 300 adults admitted to six district general and teaching hospitals in North West England for treatment of Covid-19 between September 2020 and February 2021 were included. RESULTS: Two hundred and ninety-seven patients were included in the validation cohort analysis, with a mortality rate of 32.8%. The c-statistic was 0.794 (95% confidence interval 0.742-0.847) vs. 0.805 (95% confidence interval 0.766 - 0.844) in the development cohort. Visual inspection of calibration plots demonstrate excellent calibration across risk groups, with a calibration slope for the external validation cohort of 0.963. CONCLUSION: The OCCAM model is an effective prognostic tool that can be utilised at the time of initial patient assessment to aid decisions around admission and discharge, use of therapeutics, and shared decision-making with patients. Clinicians should remain aware of the need for ongoing validation of all Covid-19 prognostic models in light of changes in host immunity and emerging variants.

Soundtrap usage during COVID-19: A machine-learning approach to assess the effects of the pandemic on online music learning

The COVID-19 pandemic prompted a sudden rethinking of how music was taught and learned. Prior to the pandemic, the web-based digital audio workstation Soundtrap emerged as a leading platform for creating music online. The present study examined the growth of Soundtrap's usage during the COVID-19 pandemic. Using machine-learning methods, we analyzed anonymized user data from Soundtrap's 1.6 million educational users in the United States to see if the pandemic affected Soundtrap's education user base and, if so, to what extent. An exploratory data analysis demonstrated a large increase in Soundtrap's user base beyond five standard deviations beginning in March 2020. A subsequent changepoint analysis identified March 17, 2020, as the day this shift occurred. Finally, we created a SARIMAX model using data prior to March 17 to forecast expected growth. This model was unable to account for user growth after March 17, showing highly anomalous growth rates outside of the model's confidence interval. We discuss how this shift affects music education practices and what it portends for our field. In addition, we explore the role of machine learning and artificial intelligence as a method for research in the music education field.

Using Q method to investigate the influence of inclusive water, sanitation and hygiene (WASH) on tourists' hotel choice in Fiji

Consequent to the COVID-19 pandemic and the reopening of international borders, tourists are increasingly concerned about sanitation and hygiene practices in tourism destinations. There is an evident need to investigate how the COVID-19 pandemic has transformed tourist choices. This paper investigates the perceptions of hotel staff and tourists on the influence of inclusive water, sanitation, and hygiene (WASH) practices on tourists' hotel choices in Fiji. This study explores the value of Q-methodology through a case study of Fiji with data collected from 80 hotel staff and 75 tourists. The findings demonstrate that Q-methodology is effective in identifying three tourist types who have a strong interest in WASH impacts and aspects of their safety including concerns about how their visit impacts the local community and environment. Similarly, the Q method was useful in identifying four perspectives of staff understanding on WASH impacts that are significant to tourists' choice of hotel. The findings suggest a significant potential for hotel operators to enact socially inclusive WASH practices to enhance their appeal in the ‘new normal'. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Safer destinations, healthier staff and happier tourists: opportunities for inclusive water, sanitation and hygiene in tourism. (Special Issue: Consumer experience management and customer journeys in tourism, hospitality and events.)

Sustainable tourism development, including tourism's COVID-19 recovery, requires a holistic view of environmental and community benefits, including access to water, sanitation and hygiene (WASH). This study presents a system-wide Inclusive WASH in tourism framework for destinations. Using a qualitative approach including interviews and focus groups, the framework is applied at three system scales: hotels, the community and wider destination to assess the current WASH situation in Mandalika, Lombok, Indonesia, a water-scarce destination earmarked for rapid development. Findings highlight differences in Inclusive WASH practices between hotels and communities, the potential for conflict and gendered inequalities. Barriers linked to system elements, structure and the enabling environment are identified. Addressing inequitable planning processes, improving stakeholder engagement and creating tools for hotels to improve Inclusive WASH can contribute to improving destination value. Findings are relevant for practitioners, government and community organisations integrating Sustainable Development Gaols 5 and 6 into tourism development and recovery.

The application of MJF in the design of 3D printed nasal mid-turbinate swabs for the detection of COVID-19

This study evaluated the feasibility of various 3D printed mid-turbinate swab designs in terms of both manufacturability and liquid retention. Earlier studies showed that mid-turbinate swab testing was a preferred SARS-CoV2 test method[1]. We chose to use HP Multi Jet Fusion (MJF) for manufacturing due to the need for rapid, cost-effective production. For each of the swab designs, we looked at their ability to hold fluid. The assumption was that the larger the test sample, the more likely the test would be accurate. We then looked at the manufacturing yield of each swab. After investigating each design configuration's liquid retention, quality, and production yield, we ranked these swabs based on three metrics: 3D print quality, post-print process quality, and sample collection efficiency. We found that our "wavy design" topped all three metrics. © 2021 SPIE.

Pronation response as a predictor of COVID-19-related acute respiratory distress syndrome mortality

INTRODUCTION: Severe acute respiratory failure is a common complication of COVID-19, with refractory hypoxemia being a hallmark finding in severe illness and a common cause of mortality. With limited therapeutic strategies, management centers on good supportive care. Prone positioning has been shown to improve oxygenation and survival in patients with moderate-to-severe acute respiratory distress syndrome (ARDS) but the impact of prone positioning in COVID-19 with severe hypoxemia is unknown. This study aims to examine the response to proning as a predictor of COVID-19 related mortality. METHODS: This is a single-center, retrospective analysis of critically ill patients with COVID-19 confirmed by PCR. Patients were included if they were invasively ventilated, and if supportive care included prone positioning for management of refractory hypoxemia. Data points collected include demographics, ventilator settings, rates of mortality and progression to ECMO, ventilator-days, and time between symptom onset and intubation, hospital and ICU admission. Endpoints included response in oxygenation (PaO2:FiO2) and mortality. RESULTS: Forty-nine patients were included in the analysis. The average age was 56.9, and 61% of the patients were male. Patients had an average of 19 ventilator-days (2-52), 21 ICU-days (4-54), 26 hospital-days (8-65), an ECMO rate of 27%, and a mortality rate of 55%. Of the 22 survivors, there was an average increase in PaO2:FiO2 by 108, 93.1, and 93 for each of the first three pronations respectively. For the 27 nonsurvivors, there was an average increase in PaO2:FiO2 by 76.1, 84.3, and 50.9 for the first three pronations. The difference in improvement in PaO2:FiO2 was not statistically significant between survivors and non-survivors. There was no inflection point that could be determined that provided a high sensitivity and specificity to predict mortality or need for ECMO based on response to pronation at any of the time points. CONCLUSIONS: Proning improves PaO2:FiO2 in patients with severe hypoxemia related to COVID-19. Survivors in our study had a numerically greater response to proning, but this finding was not statistically significant. The clinical significance remains unclear. Larger studies assessing the efficacy of proning in critically ill patients with COVID-19 are needed.

Characterization of cytokine expression in critically ill patients with COVID-19

INTRODUCTION: Early commentary on SARS-CoV-2 infection proposed a mechanism of cytokine release syndrome (CRS) to explain severe acute respiratory failure associated with COVID-19. Management strategies have included targeted immunomodulation with biologic agents. The role of IL-6 and other cytokines in the pathogenesis of COVID-19 is not well defined. Evidence for use of immunomodulators has been mixed and these agents may expose patients to harm. This study aims to characterize the expression of cytokines and their association with inflammatory biomarkers and outcomes in critically ill patients with COVID-19. METHODS: This was a single-center, retrospective analysis of critically ill patients with COVID-19 confirmed by PCR. Patients were included if they had a partial or full cytokine panel drawn while admitted. Descriptive statistics were used to assess demographics, outcomes, and relationships between cytokine levels and inflammatory markers. The Mann- Whitney U Test was used to compare IL-6 levels between survivors and nonsurvivors. RESULTS: Eighty-nine patients were included with 68 full cytokine panels and 108 IL-6 levels. Patients had a mean (range) of 10 ventilator-days (0-47), 15 ICU-days (1-60), 20 hospital-days (3-69) and a mortality rate of 31%. Cytokine levels were assessed a median of 10 days from symptom onset and 1 day from ICU admission. Levels of IL-1B, IL-2, IL-4, IL-5, IL-8, IL-12, IL-13, IL-17, IFN-G, and TNF-A were undetectable in at least 80% of patients, and expression did not correlate with other inflammatory biomarkers (CRP, ferritin), severity of illness (SOFA), or outcome. IL-2R levels were numerically elevated in most patients (n=68;median 1227, range: 76-30670). IL-6 levels were mildly elevated (n=108;median: 31, range: 2-882, SD: 150), and levels were statistically significantly higher in nonsurvivors (p = 0.002). CONCLUSIONS: Assessment of cytokine levels in critically ill patients with COVID-19 does not support a hypothesis of CRS. While IL-6 levels were numerically higher in nonsurvivors, the clinical significance of this finding is unknown. The role of IL-2R in the pathogenesis of COVID-19 remains unclear. Larger studies exploring the role of inflammatory mediators in pathogenesis and targeted immunomudulators in management of COVID-19 are warranted.

Patient characteristics and predictors of mortality in 470 adults admitted to a district general hospital in England with Covid-19.

Understanding risk factors for death from Covid-19 is key to providing good quality clinical care. We assessed the presenting characteristics of the 'first wave' of patients with Covid-19 at Royal Oldham Hospital, UK and undertook logistic regression modelling to investigate factors associated with death. Of 470 patients admitted, 169 (36%) died. The median age was 71 years (interquartile range 57-82), and 255 (54.3%) were men. The most common comorbidities were hypertension (n = 218, 46.4%), diabetes (n = 143, 30.4%) and chronic neurological disease (n = 123, 26.1%). The most frequent complications were acute kidney injury (AKI) (n = 157, 33.4%) and myocardial injury (n = 21, 4.5%). Forty-three (9.1%) patients required intubation and ventilation, and 39 (8.3%) received non-invasive ventilation. Independent risk factors for death were increasing age (odds ratio (OR) per 10 year increase above 40 years 1.87, 95% confidence interval (CI) 1.57-2.27), hypertension (OR 1.72, 95% CI 1.10-2.70), cancer (OR 2.20, 95% CI 1.27-3.81), platelets <150 × 103/µl (OR 1.93, 95% CI 1.13-3.30), C-reactive protein ≥100 µg/ml (OR 1.68, 95% CI 1.05-2.68), >50% chest radiograph infiltrates (OR 2.09, 95% CI 1.16-3.77) and AKI (OR 2.60, 95% CI 1.64-4.13). There was no independent association between death and gender, ethnicity, deprivation level, fever, SpO2/FiO2, lymphopoenia or other comorbidities. These findings will inform clinical and shared decision making, including use of respiratory support and therapeutic agents.