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Objective: Eating disorders (EDs), fear of COVID-19, and insomnia have all increased during the COVID-19 pandemic in Western societies. Additionally, fear of COVID-19 and sleep disturbances relate to ED symptoms in Western societies. However, it is unknown whether fear of COVID-19 and insomnia relate to ED symptoms in non-Western countries, such as Iran. Thus, this study examined the relation between fear of COVID-19, insomnia, and ED symptoms among Iranian college students. Specifically, we hypothesized that insomnia and fear of COVID-19 would each uniquely relate to ED symptoms and the interaction between insomnia and fear of COVID-19 would also associate with increased ED symptoms. Method: College students (N =1,043) filled out measures assessing fear of COVID-19, insomnia, and ED symptoms. We ran moderation analyses using linear regression for global ED symptoms and negative binomial regressions for binge eating and purging. Results: Fear of COVID-19 and insomnia had unique effects on global ED symptoms and binge eating. Insomnia, but not fear of COVID-19, had a unique effect on purging. No significant interaction effect was found. Discussion: This study was the first to examine the association between fear of COVID-19 and insomnia on ED symptoms in Iran. Fear of COVID-19 and insomnia should be incorporated into novel assessments and treatments for EDs.
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Introduction: There are many challenges in using outcome measures to monitor quality of organ transplant programs. In heart transplantation, both patient and donor characteristics affect outcomes, and therefore, risk adjustment models are needed to evaluate center outcomes. Variation in risk-adjusted heart transplant waitlist mortality rates remain underexplored. Method(s): Data from the publicly available Scientific Registry of Transplant Recipients (SRTR) Transplant Program-Specific Report were used for this analysis. Data on waiting list mortality rates in which the reference population is defined as deaths on the waiting list at any time during the observed period were used. Cohorts evaluated in this analysis began on January 1, 2020 and ended on December 31, 2021. Centers with < 10 years of patient follow-up were excluded. Data from time on the waiting list between March 13, 2020-June 12, 2020, which corresponded to the COVID-19 exception period, were excluded. Linear regression was used to evaluate the differences in weighted averages of hazard ratio of risk-adjusted waitlist mortality by region. Result(s): A total of 104 centers were included in this analysis. When rank ordering centers, substantial variation in hazard ratios was observed by center (Figure 1A). When stratified by region, there were significant differences in average risk-adjusted waitlist mortality (Figure 1B). Weighted average hazard ratio of risk-adjusted waitlist mortality for the Northeast region was 0.84 while weighted average hazard ratio of risk-adjusted waitlist mortality for the South region was 1.17 (p = 0.02). Conclusion(s): Further inquiry is needed to understand the drivers of regional variation in risk adjustment for heart transplant waitlist mortality. Possibilities drivers include differences in patient populations served by centers, patient-related factors, hospital and center-related factors, varying strategies in waitlisting, and inability of SRTR formulas to adequately capture risk.Copyright © 2022
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Introduction: Malignancies are a major complication of heart transplant (HT). Noninvasive surveillance after HT using gene expression (GEP) profiling and donor derived cell free DNA (dd-cfDNA) are noninferior to biopsy and are widely utilized. The interpretation of % dd-cfDNA, is not well understood in malignancies with a conceptual increase in the recipient fraction. The effect of chemotherapy on GEP in the setting of post-HT surveillance has not been described to the best of our knowledge. Hypothesis: Induction of chemotherapy will cause global transcriptional reduction in GEP. Method(s): GEP was performed with AlloMap (AM, CareDx), which evaluates expression levels of 11 mononuclear cell genes, involved in lymphocyte activation, T-cell priming, cell migration, hematopoietic proliferation, steroid sensitivity, and platelet activation. Scores range from 0-40, higher scores have a stronger correlation with rejection. At our center a total of 995 draws were analyzed from 2019-2022. In parallel dd-cfDNA, which informs about graft injury was analyzed using AlloSure (AS, CareDx). Case Events: A 71-year-old male HT recipient for nonischemic cardiomyopathy and no rejection history was diagnosed with metastatic gastric adenocarcinoma at 16 months post-HT. Following diagnosis, mycophenolic acid was stopped, prednisone 5 mg was started, and tacrolimus trough goal was gradually lowered to 4-6 given infectious complications. Palliative chemotherapy with folinic acid, fluorouracil (5-FU), oxaliplatin (FOLFOX) was initiated at 18 months post-HT with planned dose reduction of oxaliplatin and holding of 5-FU bolus to reduce risk of myelosuppression given comorbidities. Oxaliplatin was stopped at 18 months post HT. Due to COVID he last received 5-FU at 33 months post-HT. Graft function remained stable and DSA negative. At 36 months post-HT, he developed a bowel obstruction without surgical options for interventions and expired shortly thereafter. Result(s): With initiation of prednisone and following chemotherapy there was a drastic decrease in AM scores (Fig. A). Steroid therapy led to an 18% decline in AM scores, the greatest decrease occurred with chemotherapy, with 67% decline from the mean when compared to all center patients (Fig B). Dd-cfDNA levels remained stable during the course aside from one early elevation. Conclusion(s): To the best of our knowledge this is the first published case on the effect of chemotherapy on GEP profiling in the setting of post-HT surveillance. This case advises caution when interpreting GEP in the setting of chemotherapy showing great reduction in GEP scores. While dd-cfDNA levels remained relatively stable after malignancy diagnosis and treatment initiation further studies will need to inform on the use of both GEP and dd-cfDNA in these patients.Copyright © 2022
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This article investigates the Bangladeshi garment industry that supplies ready-made garments for global brands and the corporate social responsibilities (CSRs) of the brands/multinational corporations (MNCs) towards their supply chains. Although outsourcing and global trade have boosted the living standards of many people in the Bangladeshi garment industry, there are some significant concerns regarding the working conditions and treatment of workers in these supply chains. This, in turn, cannot, and should not, be detached from the legal relationship between the Bangladeshi supply chains and the MNCs contracting with them. This article examines the impact of COVID-19, which has exposed the fragility and the pre-existing flaws in the relationship between the MNCs and their suppliers more clearly than at any other time in history. There is a huge governance gap between MNCs and supply chains that needs to be addressed urgently. This article assesses the legality of the cancellation of orders by the brands that invoked the force majeure clause. In doing so, this paper briefly deals with the responses of three American retail companies, namely Sears, Kohl's, and the Arcadia Group, in the wake of the COVID-19 pandemic. It illustrates that the power asymmetry between the MNCs and their suppliers has put the supply chains in an unreasonably disadvantageous position, creating unfair and even unconscionable conduct by several MNCs. This article also looks at solutions for the existing problems, focusing, inter alia, on non-financial reporting requirements in the US and the EU to implement CSR in supply chains. However, disappointingly, the authors had to conclude that MNCs typically have the propensity to disregard CSR, whenever it is convenient for them and use CSR for mere "greenwashing" purposes for their strategic benefit only. It is a problem that requires constant attention and continuing research to find long-term solutions. The article employs doctrinal methodology and, by conducting a meta-analysis of literature and case-studies, it provides a comprehensive understanding of how the industry works.
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Background: In 2020, the American College of Cardiology Fellows-in-Training (FIT) Section Leadership Council piloted a virtual mock interview (MI) initiative in response to the transition to cardiovascular disease (CVD) fellowship virtual recruitment during the Coronavirus Disease 2019 pandemic. The impact of the expanded MI initiative in 2021 was evaluated. Methods: Through ACC outreach, applicants voluntarily enrolled to participate in virtual 30-minute MI followed by a feedback session conducted by volunteer FIT. Pre- and post-MI surveys utilizing Likert scales were analyzed with paired Wilcoxon rank sum tests. Results: A total of 100 FIT interviewed 159 applicants (34% female, mean age 30 years). Applicants were of diverse racial and ethnic backgrounds (45% Asian, 28% White, 7% Black, 4% Hispanic, 7% multi-ethnic). 26% cited no cardiology-specific mentorship from their institution or outside institutions, and 65% had no prior experience with a virtual interview format. 129 applicants completed both preand post-MI surveys. Compared to pre-MI, applicants’ confidence, preparation, and comfort with a virtual platform improved significantly (p<0.001 for all, Figure). More than 85% of applicants agreed that FIT feedback during the MI helped identify strengths and weaknesses and enhanced their interview skills. Conclusion: The ACC FIT MI initiative improved confidence and subjective virtual interview skills in a diverse cohort of applicants to CVD fellowship. [Formula presented]
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Background: The COVID-19 pandemic created numerous challenges for graduate medical education, including defining the role of asynchronous virtual education in general cardiovascular (CV) fellowship training. The CardioNerds podcast introduced the CardioNerds Case Report (CNCR) series to provide continued high-quality cardiovascular education during the pandemic. Moving forward, the role and value of asynchronous education, and specifically medical podcasts, remain unknown. Methods: The CNCR series included a wide range of case-based episodes involving cardiology fellows, content experts, and program leadership from participating programs. Every accredited general cardiology fellowship program in the United States was invited. A survey assessing attitudes on a likert scale towards cased-based cardiology podcasts and medical podcasts was administered to all participating programs. Results: 44 cardiology fellowship programs participated in the CNCR series representing 137 fellows and 59 program directors and leaders (PDs). At this time, 76% of fellows and 63% of program directors have responded. 90% of both fellows and PDs agreed that the CNCR series was an effective way to teach core CV concepts and 74% of fellows felt that contributing to the CNCR series improved their clinical reasoning skills. 70% of PDs and 94% of fellows felt that medical podcasts in general added to their knowledge base. Fellows were more likely to strongly agree that medical podcasts changed their clinical practice compared to PDs (46% vs 8%, p = 0.02). Conclusion: Medical podcasts are becoming increasingly popular in cardiovascular education and training. Specifically, the CNCR platform has been well received by fellowship programs and has potentially influenced clinical practice. CV training programs and professional societies should invest in ensuring high quality medical podcasts are incorporated into CV training moving forward to supplement traditional CV education.
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The COVID-19 "infodemic"has resulted in the widespread dissemination of counterfeit medical advice, hoaxes, fake products, and phoney information about the virus and responses. As a result, computational methods for determining any information's authenticity to improve trust in public health awareness and policy decisions are profoundly discussed in the scientific community. Even before the pandemic, mis- and disinformation, including fake news, have been observed in the online world in significant numbers for numerous business, political and personal reasons. Moreover, many of these fake news was published from sources believed to be reliable. In contrast, some other fake news was fabricated in a way that would be easily trusted and shared by the general people in social media. COVID-19 related fake news has enormous effects on both the offline and online community, and thus, it challenges government initiatives for proper health intervention. Therefore, interest in research in this area has risen to understand the problem both socially and technically. In this paper, we attempt to understand how we can help student Internet users of colleges from the lower-middle-income country, Bangladesh, in Southeast Asia, to distinguish COVID-19 misinformation. Our study reveals that providing related news as supplementary information to any online news helps students make better decision about news authenticity. Statistical analyses on the survey data show that male students were found to be more accurate than female students to detect mis- and disinformation;students from the urban areas could detect misleading news better than students from villages;and that students from Science background demonstrated overall best performance, while students from Madrasah background, who are all male, could not produce a significant improvement. We conclude that the female students in general and male students of Madrasah, who spend the least amount of time online among all the student Internet users, are the most vulnerable groups to fake news. © 2021 ACM.