Changes in Prostate Specific Antigen Screening Following the 2018 United States Preventive Services Task Force Guidelines and through the Covid-19 Pandemic

INTRODUCTION AND OBJECTIVE: In 2018, The US Preventive Services Task Force (USPSTF) changed its recommendations for prostate specific antigen (PSA) screening from "non-recommended" to "shared decision-making among men aged 55-69". Thereafter, COVID-19 Pandemic disrupted cancer care with evidence suggesting overall reduced access to and utilization of health care services including preventive screening. We aim to examine the impacts of both events on PSA screening for men aged 55-69. METHOD(S): We analyzed 2013, 2015, 2018, 2019, and 2021 National Health Interview Survey data. Men >54 who reported PSA testing within 12 months preceding survey were considered to have undergone screening. Adjusted difference in differences (DID) analyses were performed to compare changes in screening in men aged 55-69 with reference to men >70 between 2015 and 2019 (pre- and post- 2018 USPSTF recommendation) and between 2019 and 2021 (pre- and post-Pandemic). RESULT(S): A total of 24,308 men were included. PSA screening prevalence was 35.4% (95%CI: 33.7%, 37.1%), 32.1% (95%CI: 30.3%, 33.9%), 33.3% (95%CI: 31.6%, 34.9%), 37.2% (95%CI: 35.7%, 38.8%), and 34.9% (95%CI: 33.3%, 36.5%) respectively for included years. From 2015 to 2019, PSA screening increased 4.6% among men aged 55-69 (95%CI: 1.7, 7.5%) and increased 6.5% among men >70 (95% CI: 2.7, 10.4%). From 2019 to 2021, PSA screening decreased 3.1% among men aged 55-69 (95%CI: 0.58%, 5.8%);PSA screening also decreased 0.8% among older men but did not reach significance (95% CI: -2.6%, 4.2%). DID analysis did not show difference in changes between men aged 55-69 in reference to men >70 from both 2015 to 2019 (DID=-1.9%, 95%CI, -6.7%, 2.9%) and 2019 to 2021 (DID =-2.3%, 95%CI, -6.5%, 1.9%). CONCLUSION(S): We saw an increase in PSA screening after 2018 USPSTF recommendations among its target population e men aged 55-69 and also among older men >70. In contrast, the period from 2019 to 2021 saw a significant decrease in PSA screening in those aged 55-69. The lack of significant DID between groups as well as the downward trend of PSA screening in men >70 together suggest an overall trend of decrease in PSA screening post-Pandemic.

Decreased Utilization of Low-Value Health Care Services during the Covid-19 Pandemic

INTRODUCTION AND OBJECTIVE: Low value health care is defined as care in which the potential to cause harm is greater than benefit. We hypothesize that rationing of health care services during the pandemic decreased the delivery of low value services. METHOD(S): Data was retrieved from the Mass General Brigham Research Patient Data Registry. High value care services were defined by U.S. Preventive Services Task Force guidelines, while low value care services were adapted for claims as described in the literature. Twenty-one services (4 high value and 17 low value) had adequate volume for analysis. Three month periods were considered, consisting of the pandemic period (Q4: 3/2/20 to 6/1/20) and control periods preceding the pandemic (Q1: 12/1/18 to 3/1/19;Q2: 3/2/19 to 6/1/19;and Q3: 12/1/19 to 3/1/20). Ratio measures of services per period were used to account for seasonality and differences in frequency.The 2019 high value (H) care ratio (Y0H = NHQ2/NHQ1) illustrates relative service counts during a typical year and the 2020 ratio (Y1H = NHQ4/NHQ3) represents the change due to the pandemic. Difference in ratios YH=Y1H-Y0H less than zero reflects a reduction in high value services during the pandemic. The same calculation was made for low value (L) procedures;YL=Y1LY0L. The difference between YL and YH is the difference in differences (DID) estimator and illustrates the differential decline in services. YH- YL greater than zero suggests that low value care declined to a greater degree than high value care. Subdivision DID in ratio analyses were performed for cancer and non-cancer care. RESULT(S): Included in this analysis were 3,271,957 patients. Mean age was 51.4 years, 59.1% of patients were female, and 71.7% were non-Hispanic. Of 21 identified services, 18 had a reduction in volume during the pandemic. The YL for PSA testing in men older than 75 was -0.81. The DID in ratios of all care was 0.08 (p<0.01), suggesting a modest decline in low-value care (Figure 1). The reduction was more pronounced for cancer care with a DID in ratios of 3.39 (p<0.01). CONCLUSION(S): We observed a reduction in both low and high value care with a greater reduction in low value services, especially for cancer care. Limitations include use of data from a single health system, limited number of services, and short time periods given the rapid onset of the pandemic.

The Effect of Povidone-Iodine Nasal Spray on Nasopharyngeal SARS-CoV-2 Viral Load: A Randomized Control Trial.

OBJECTIVES/HYPOTHESIS: To determine the effect of povidone-iodine (PVP-I) nasal sprays on nasopharyngeal (NP) viral load as assessed by cycle threshold (Ct) on quantitative polymerase chain reaction (qPCR) of SARS-CoV-2 in outpatients. STUDY DESIGN: Three arm, triple blinded, randomized, placebo-controlled clinical trial. METHODS: Participants were randomized within 5 days of testing positive for COVID-19 to receive nasal sprays containing placebo (0.9% saline), 0.5% PVP-I, or 2.0% PVP-I. NP swabs for qPCR analysis were taken at baseline, 1-hour post-PVP-I spray (two sprays/nostril), and 3 days post-PVP-I spray (20 sprays/nostril). Symptom and adverse event questionnaires were completed at baseline, day 3, and day 5. University of Pennsylvania Smell Identification Tests (UPSIT) were completed at baseline and day 30. RESULTS: Mean Ct values increased over time in all groups, indicating declining viral loads, with no statistically significant difference noted in the rate of change between placebo and PVP-I groups. The 2.0% PVP-I group showed statistically significant improvement in all symptom categories; however, it also reported a high rate of nasal burning. Olfaction via UPSIT showed improvement by at least one category in all groups. There were no hospitalizations or mortalities within 30 days of study enrollment. CONCLUSIONS: Saline and low concentration PVP-I nasal sprays are well tolerated. Similar reductions in SARS-CoV-2 NP viral load were seen over time in all groups. All treatment groups showed improvement in olfaction over 30 days. These data suggest that dilute versions of PVP-I nasal spray are safe for topical use in the nasal cavity, but that PVP-I does not demonstrate virucidal activity in COVID-19 positive outpatients. LEVEL OF EVIDENCE: 2 Laryngoscope, 132:2089-2095, 2022.

COVID-19 epidemic forecasting based on a comprehensive ensemble method

Since December 2019, COVID-19 epidemic is continuing to spread globally. It not only jeopardizing the lives and health of people around the world seriously and putting a severe test on the public medical and health system, but also causes a huge impact on economic and trade activities and has a deep influence on the international community. In order to help researchers and policy makers understand the mechanism of virus transmission and adopt reasonable anti-epidemic policies to inhibit the further spread of the virus, some studies have adopted mathematical prediction models to simulate the spread of the virus and the development of the epidemic. However, the existing research has certain limitations, such as single method selection, excessive reliance on model parameters selection, and virus transmission and policy adjustments caused time variability of data. To solve the above problems, this paper proposes a comprehensive ensemble forecasting framework, which bases on six single prediction models, including time-varying Jackknife model averaging (TVJMA), time-varying parameters (TVP), time-varying parameter SIR (vSIR), logistic regression (LR), polynomial regression (PNR), autoregressive moving average (ARMA). The proposed method is used to predict the cumulative number of confirmed cases in the 6 most severely affected countries in different regions. Empirical results show that for a single prediction method, the TVJMA method outperforms the other five methods;the comprehensive ensemble forecasting method is significantly better than any single method in most cases, especially, the multi-model combined forecasting method based on error correction weights improves the prediction accuracy significantly. For different prediction steps, the comprehensive ensemble forecasting method is robust. © 2022, Editorial Board of Journal of Systems Engineering Society of China. All right reserved.

Integrating Expert ODEs into Neural ODEs: Pharmacology and Disease Progression

Modeling a system's temporal behaviour in reaction to external stimuli is a fundamental problem in many areas. Pure Machine Learning (ML) approaches often fail in the small sample regime and cannot provide actionable insights beyond predictions. A promising modification has been to incorporate expert domain knowledge into ML models. The application we consider is predicting the patient health status and disease progression over time, where a wealth of domain knowledge is available from pharmacology. Pharmacological models describe the dynamics of carefully-chosen medically meaningful variables in terms of systems of Ordinary Differential Equations (ODEs). However, these models only describe a limited collection of variables, and these variables are often not observable in clinical environments. To close this gap, we propose the latent hybridisation model (LHM) that integrates a system of expert-designed ODEs with machine-learned Neural ODEs to fully describe the dynamics of the system and to link the expert and latent variables to observable quantities. We evaluated LHM on synthetic data as well as real-world intensive care data of COVID-19 patients. LHM consistently outperforms previous works, especially when few training samples are available such as at the beginning of the pandemic. © 2021 Neural information processing systems foundation. All rights reserved.

Epidemics, Convergence, and Common Prosperity: Evidence from China

This article investigates the impact of previous epidemics on rural development and convergence, and identifies the impact's mechanism based on convergence tests. Using a balanced panel of 31 provinces, the empirical results from 2002 to 2019 show that epidemics decelerated convergence in rural per capita income. The mechanism analysis shows that the accelerated divergence in wages and the decelerated convergence in business income were the major drivers, which also led to decelerated convergence in rural per capita consumption. Although epidemics have not threatened rural food consumption and the Engel coefficient of rural households, these two indicators of basic living needs have failed to achieve convergence across regions. The overall impact of an epidemic on convergence in rural-urban income disparity has also been insignificant, indicating that epidemics have affected rural and urban development simultaneously. Finally, COVID-19 is likely to decelerate convergence in rural income, rural consumption, and urban income.

Construction and practice about the fine management of cancer patients during the epidemic of Covid-19

Purpose: This paper explored the construction and practice of the fine management of cancer patients during the Covid-19 outbreak. Methods: To establish the medical groups for the fine management of cancer patients during the Covid-19 outbreak, 6 doctors and 6 backbone nurses were selected from the oncology department since January 28th, 2020. And then the medical needs of cancer patients were obtained through telephone follow-up network. Next, the medical group was further divided and the we-media was used for the fine management of cancer patients based on patients' needs. When the we-media failed to solve problems in some special or emergent situations, a pattern combining hospitals, communities with patients was used to provide continuous medical care for cancer patients. Results: The medical group effectively completed the information collection registration of 198 cancer patients through the telephone follow-up network. The current needs of 198 patients were ranked from high to low, and they were: knowledge of diseases, psychological support, PICC maintenance, complication treatment, medication use instructions, rehabilitation exercise instructions and diet combination methods, respectively. Based on patients' needs, the medical group has carried out the fine management for 198 patients through the following activities: 16 live broadcast, 4 recorded videos, 27 group activities targeted at patients, 48 one-to-one telephone counselling, 1 disease brochure, 1 nutritional diet recipe and 1 list for self-monitoring patients' diseases. During the epidemic outbreak, no death or infection cases were found. Conclusion: The fine management effectively helped meet the urgent needs of cancer patients who sought medical service and treatment during the epidemic outbreak. © 2021 A. CARBONE Editore. All rights reserved.

Carbon nanotube-paper composite-capacitive sensor for respiratory monitoring

Recent COVID-19 pandemic highlights the importance of monitoring and prediction of acute respiratory illness. Few options are available for convenient respiratory monitoring in both hospital and community settings. This paper presents a novel respiratory monitoring sensor made of carbon nanotube-paper composites (CPC). A CPC capacitive sensor fabricated with tensional fracture consists of numerous cellulose fibers coated with carbon nanotubes (CNTs). The high aspect ratio structure significantly enhances the capacitive sensitivity due to the high electric field. A CPC-wearable sensor is characterized in comparison to a sensor made of aluminum electrodes followed by monitoring of respiratory efforts. © 2020 CBMS-0001

Infection control of coronavirus disease 2019 patients receiving hyperbaric oxygen therapy in mobile single air compression chamber

Objective To study the infection control of patients with coronavirus disease 2019 (COVID-19) during the hyperbaric oxygen therapy, so as to provide references for hyperbaric oxygen therapy in public health events in the future. Methods A hyperbaric oxygen therapy and nursing team in wards and a full-time infection control nurse post were set up, the responsibilities of infection control nurses were defined, nosocomial infection monitoring was carried out, and meticulous management in all aspects of infection control was carried out. The hand hygiene compliance rates (number of hand hygiene execution/total number of hand hygiene indicators 100%) of doctors, nurses and patients were compared before and after supervision by full-time infection control nurses. After the implementation of the hyperbaric oxygen chamber disinfection, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid test was performed on multiple sites inside and outside the hyperbaric oxygen chamber and wards every week. Hyperbaric oxygen therapy was given to four COVID-19 patients in mobile single air compression chamber and the therapy effects were observed. Results After supervision by fulltime infection control nurses, the hand hygiene compliance rates of the doctors, nurses and patients were all improved (82.94% [175/211] vs 73.27% [148/202], 94.70% [268/283] vs 89.39% [236/264], and 78.41% [69/88] vs 46.64% [24/55]), and the differences were significant (χ2=5.663 5, 5.308 4, and 17.997 2, all P<0.05). After the implementation of the hyperbaric oxygen chamber disinfection, the SARS-CoV-2 nucleic acid test results were negative on the door handle, inside and outside of the hyperbaric oxygen chamber, the surface of the transfer bed and the surface of ward supplies during the first and second weeks. The pulse oxygen saturation (SpO2) and the walking distance in six minutes of patients were both increased after hyperbaric oxygen therapy compared with those before hyperbaric oxygen therapy [( 91.62±3.65]% vs[ 85.63±4.52]% and [346.3±43.6] m vs [272.2±61.9] m), and the differences were significant (t=2.062 1 and 1.957 4, P=0.042 and 0.049). The symptoms such as chest tightness and shortness of breath were significantly improved after hyperbaric oxygen therapy. Computed tomography reexamination showed that the inflammatory lesions of lungs had subsided to different extents. Conclusion Hyperbaric oxygen nursing team and infection control nurse post can promote and supervise the implementation of the infection control system and infection control measures, ensuring the infection monitoring of COVID-19 patients and the safety of patients and medical staff.

[Effects of angiotensin converting enzyme inhibitor/angiotensin receptor blocker on clinical characteristics of coronavirus disease 2019 patients with hypertension].

Objective: To analyze the effects of angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) on coronavirus disease 2019 (COVID-19) patients with hypertension, and to provide an evidence for selecting antihypertensive drugs in those patients. Methods: Clinical data were retrospectively analyzed in 58 COVID-19 patients with hypertension admitted to Shanghai Public Health Clinical Center from January 20 to February 22, 2020, including epidemiological history, clinical manifestations, laboratory findings, chest CT and outcome. Patients were divided into ACEI/ARB group and non-ACEI/ARB group. Results: Twenty-six patients were in ACEI/ARB group and the other 32 patients in non-ACEI/ARB group, with median age 64.0 (49.5, 72.0) years and 64.0 (57.0, 68.8) years respectively. The median time to onset was 5(3, 8) days in ACEI/ARB group and 4 (3, 7) days in non-ACEI/ARB group, the proportion of patients with severe or critical illness was 19.2% and 15.6% respectively. The main clinical symptoms in two groups were fever (80.8% vs. 84.4%) and cough (23.1% vs. 31.3%). The following parameters were comparable including lymphocyte counts, C-reactive protein, lactate dehydrogenase, D-dimer, bilateral involvement in chest CT (76.9% vs. 71.9%), worsening of COVID-19 (15.4% vs. 9.4%), favorable outcome (92.3% vs. 96.9%) between ACEI/ARB group and non-ACEI/ARB group respectively (all P>0.05). However, compared with non-ACEI/ARB group, serum creatinine [80.49 (68.72, 95.30) µmol/L vs. 71.29 (50.98, 76.98) µmol/L, P=0.007] was higher significantly in ACEI/ARB group. Conclusions: ACEI/ARB drugs have no significant effects on baseline clinical parameters (serum creatine and myoglobin excluded) , outcome, and prognosis of COVID-19 patients with hypertension. Antihypertensive drugs are not suggested to adjust in those patients, but the potential impairment of renal function as elevation of serum creatinine should be paid attention in patients administrating ACEI/ARB drugs.

Analysis of false negative results in throat swab nucleic acid test of severe acute resporatory syndrome coronavirus 2

Objective To investigate the false negative rate of throat swab nucleic acid test of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to analyze the causes, so as to provide references for the prevention and control of coronavirus disease 2019 (COVID-19) in China. Methods A retrospective analysis was conducted on the throat swab nucleic acid test results of 1 452 COVID-19 patients admitted to Guanggu Branch of Maternity and Child Healthcare Hospital of Hubei Province from Feb. 19 to Mar. 20, 2020. The negative results before positive results at discharge were judged as false negative results, and the false negative rate was calculated. The discharged patients were followed up to screen for the patients who were positive for nucleic acid test again, and the relationship between the times of consecutive negative nucleic acid tests before discharge and the positive again results was analyzed. Results Among the 1 452 COVID-19 patients, 592 (40.77%) were males and 860 (59.23%) were females. A total of 212 cases (14.60%) had false negative results. Twenty-eight cases (1.93%) were discovered nucleic acid positive again after discharge. Among the 918 patients whose nucleic acid tests were negative for two consecutive times, 24 (2.61%) were positive again, which was significantly higher than that of the patients whose nucleic acid tests were negative for three consecutive times (0.75%, 4/534;χ2=6.21, P=0.012 7). Conclusion The throat swab nucleic acid test of SARS-CoV-2 has a certain proportion of false negative results, which is one of the reasons for COVID-19 patients are found nucleic acid positive again after discharge. Multiple and continuous tests by different testers are recommended before discharge, and negative nucleic acid test for three or more consecutive times can reduce the incidence of nucleic acid positive results again after discharge.

Culture Matters in Communicating the Global Response to COVID-19.

Current communication messages in the COVID-19 pandemic tend to focus more on individual risks than community risks resulting from existing inequities. Culture is central to an effective community-engaged public health communication to reduce collective risks. In this commentary, we discuss the importance of culture in unpacking messages that may be the same globally (physical/social distancing) yet different across cultures and communities (individualist versus collectivist). Structural inequity continues to fuel the disproportionate impact of COVID-19 on black and brown communities nationally and globally. PEN-3 offers a cultural framework for a community-engaged global communication response to COVID-19.

Epidemiological and clinical characteristics analysis of severe and critical coronavirus disease 2019

Objective: To analyze the epidemiological and clinical characteristics of severe and critical coronavirus disease 2019(COVID-19) and provide evidence for the discovery and management of COVID-19 cases in these types. Methods: A retrospective observation on the severe or critical COVID-19 cases in Renmin Hospital of Wuhan University was made from January 2020 to February 2020. Epidemiological and clinical data were collected and analyzed. Results: Forty severe cases and 10 critical cases were included, and most cases came from Wuchang District of Wuhan City. 90% of them were familial clustering. The average age was 57.6 years old. The average length of stay was 17 days. The main clinical manifestations were fever (100%) and cough (90%). The majority of laboratory examinations showed normal white blood cells (72%), decreased lymphocytes (30%), increased inflammatory factors (73.9%), accompanied by liver and kidney dysfunction (10% and 14%) and decreased cellular immune function (42.3% and 37.8%). 44% of the patients had moderate or severe hypoxemia at the time of admission and need high-flow nasal cannula, noninvasive ventilation or even mechanic ventilation. Conclusion: The main symptoms of severe and critical COVID-2019 are fever and cough, and increased inflammation and immune function suppression are common. Hypoxemia is severe, and these patients need higher respiratory support technology. © 2020, Editorial Board of Medical Journal of Wuhan University. All right reserved.

[Analysis of baseline liver biochemical parameters in 324 cases with novel coronavirus pneumonia in Shanghai area].

Objective: To summarize the clinical characteristics and liver biochemical parameters of 324 cases admitted with novel coronavirus pneumonia in Shanghai area. Methods: Clinical data and baseline liver biochemical parameters of 324 cases with novel coronavirus pneumonia admitted to the Shanghai Public Health Clinical Center from January 20, 2020 to February 24, 2020 were retrospectively analyzed. Patients were divided into two groups based on the status of illness: mild type (mild and typical) and severe type (severe and critical).The differences in clinical data and baseline liver biochemical parameters of the two groups were described and compared. The t-test and Wilcoxon rank-sum test were used for measurement data. The enumeration data were expressed by frequency and rate, and chi-square test was used. Results: Of the 324 cases with novel coronavirus pneumonia, 26 were severe cases (8%), with median onset of 5 days, 20 cases were HBsAg positive (6.2%), and 70 cases (21.6%) with fatty liver, diagnosed with X-ray computed tomography. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyl transferase (GGT), total bilirubin (TBil), albumin(ALB) and international normalized ratio (INR) of 324 cases at baseline were 27.86 ± 20.02 U/L, 29.33 ± 21.02 U/L, 59.93 ± 18.96 U / L, 39.00 ± 54.44 U/L, 9.46 ± 4.58 µmol / L, 40.64 ± 4.13 g / L and 1.02 ± 0.10. Of which, ALT was > than the upper limit of normal (> ULN), accounting for 15.7% (51/324). ALT and AST > ULN, accounting for 10.5% (34/324). ALP > ULN, accounting for 1.2% (4/324). ALP and GGT > ULN, accounting for 0.9% (3/324). INR > ULN was lowest, accounting for 0.6% (2/324). There were no statistically significant differences (P > 0.05) in ALT [(21.5 vs. 26) U / L, P = 0.093], ALP [(57 vs.59) U/L, P = 0.674], and GGT [(24 vs.28) U/L, P = 0.101] between the severe group and the mild group. There were statistically significant differences in AST (23 U/L vs. 34 U/L, P < 0.01), TBil (10.75 vs. 8.05 µmol / L, P < 0.01), ALB (35.79 ± 4.75 vs. 41.07 ± 3.80 g/L, P < 0.01), and INR (1.00 vs. 1.04, P < 0.01). Conclusion: The baseline liver biochemical parameters of 324 cases with novel coronavirus pneumonia in Shanghai area was comparatively lower and the liverinjury degree was mild, and the bile duct cell damage was rare.

COVID-19 and the Otolaryngologist: Preliminary Evidence-Based Review.

The SARS-CoV-2 virus, which causes coronavirus disease 2019 (COVID-19), has rapidly swept across the world since its identification in December 2019. Otolaryngologists are at unique risk due to the close contact with mucus membranes of the upper respiratory tract and have been among the most affected healthcare workers in Wuhan, China. We present information on COVID-19 management relevant to otolaryngologists on the frontlines of this pandemic and provide preliminary guidance based on practices implemented in China and other countries and practical strategies deployed at Stanford University. Laryngoscope, 130:2537-2543, 2020.