Using smartphones to disseminate home learning support to primary caregivers: An exploratory proof-of-concept study

During the Covid-19 pandemic, kindergartens in Hong Kong have sought ways in which to support children's learning at home while schools were closed. We report on a proof-of-concept study: short videos intended to support playful learning at home were distributed to parents/caregivers of preschool children via a smartphone app;toys and a storybook were provided to their children. No significant changes were observed in the importance attached to literacy and numeracy by parents/caregivers over time, perhaps because parents/caregivers place high value on children's academic progress in Hong Kong. However, significant increases in mean scores were observed for the intervention group but not the control group with regard to reported frequency of playing counting games and discussing/participating in weighing or measuring activities. Readily accessible opportunities to recognize learning in playful activities may have contributed to changed practices at homes.Highlights Reports the extent of the impact of short videos distributed via a smartphone app on parents'/caregivers' HLE practices during Covid-19 kindergarten closures.Survey data reveal parent/caregiver practice unchanged by 4x weekly videos. However, practices increased across waves in the intervention group.Smartphone dissemination of HLE demonstration videos holds promise as a strategy, but threshold conditions require further research.

Causal Associations Between Body Fat Accumulation and Covid-19 Severity: A Mendelian Randomization Study

Background: Previous studies reported associations between obesity measured by body mass index (BMI) and coronavirus disease 2019 (COVID-19). However, BMI is calculated only with height and weight and cannot distinguish between body fat mass and fat-free mass. Thus, it is not clear if one or both of these measures are mediating the relationship between obesity and COVID-19. Aims: To elucidate the independent causal relationships of body fat mass and fat-free mass with COVID-19 severity using Mendelian randomization (MR). Results: We identified single nucleotide polymorphisms associated with body fat mass and fat-free mass in 454,137 and 454,850 individuals of European ancestry from the UK Biobank, respectively. We then performed two-sample MR to ascertain their effects on severe COVID-19 (cases: 4,792;controls: 1,054,664) from the COVID-19 Host Genetics Initiative. We found that an increase in body fat mass by one standard deviation was associated with severe COVID-19 (odds ratio (OR)body fat mass = 1.61, 95% confidence interval [CI]: 1.28-2. 04, P = 5.51×10-5;ORbody fat-free mass = 1.31, 95% CI: 0.99-1.74, P = 5.77×10-2). Considering that body fat mass and fat-free mass were genetically correlated with each other (r = 0.64), we further evaluated the independent causal effects of body fat mass and fat-free mass using multivariable MR and revealed that only body fat mass was independently associated with severe COVID-19 (ORbody fat mass = 2.91, 95%CI: 1.71-4.96, P = 8.85×10-5 and ORbody fat-free mass = 1. 02, 95%CI: 0.61-1.67, P = 0.945). Conclusions: This study demonstrates the causal effects of body fat accumulation on COVID-19 severity and indicates that the biological pathways influencing the relationship between COVID-19 and obesity are likely mediated through body fat mass.Presentation: No date and time listed

DIMENSIONALITY REDUCTION for STEPWISE ANALYSIS of IMMUNE RESPONSE DYNAMICS in COVID19

Background: COVID-19 is highly heterogeneous in clinical severity and outcome. Considerable advances have uncovered biomolecular traits associated with fatal outcome. However, novel analytical tools are needed to rapidly and accurately delineate patient subgroups with various immunovirological profiles, analyze diverging disease trajectories and prioritize in-depth molecular studies. Methods: To find how immunovirological features are interrelated, we profiled 12 plasma analytes (SARS-CoV-2 vRNA, SARS-CoV-2-specifc antibodies, cytokine and tissue injury markers) in 500 acute longitudinal plasma samples collected from 214 hospitalized COVID-19 patients. We analyzed them simultaneously using PHATE algorithm (potential of heat diffusion for affinity-based transition embedding, Moon et al, Nature Biotech 2019), which can reduce multiple input variables to two salient features for visualization. We performed whole blood transcriptomic analyses to identify molecular signatures associated with survival vs death in a patient cluster identified as being at extreme mortality risk. Results: PHATE analysis of samples collected 11 days after symptom onset (DSO11) revealed four distinct k-means clusters of patients, which aligned with disease severity and outcome. Two groups were highly enriched in critical patients requiring mechanical ventilation: a high-fatality critical cluster 1 accounted for 59% of fatal outcomes (16/27) by DSO60, while critical cluster 2 had good prognosis. Clusters 3 and 4 consisted almost entirely of non-critical survivors delineated respectively by low and high antibody responses. Averaged trajectories between DSO3 to DSO30 diverged between clusters. All patients of the high-fatality cluster had detectable plasma vRNA, which lingered unlike the critical survivor cluster. Their antibody response had a 4-day delay, while their cytokine profile diverged from the other clusters by DSO8, remaining distinct until DSO22. Transcriptome profiles differed between deceased and survivors of the high-fatality cluster 1, with differential expression of GO terms associated with metabolic processes, protein regulation, cell signaling and immune pathways. Conclusion: This unbiased approach gives an integrated view of dysregulated immune response components in fatal COVID-19, which may be explained through differences in molecular pathways. This approach allows to efficiently target detailed investigations on very high-risk patient subgroups who may most likely benefit from new therapeutic interventions.

The Impact of African-American Nurses: How the Implementation of a Community-Based Model Increased Vaccination Rates in Marginalized Communities in NYC

The COVID-19 pandemic exposed the inequity and injustice that African-Americans and those in minority communities face when it comes to their fundamental health rights. The prejudice they see in social situations, politics, and finances has resulted in unfair, organized, and socially manufactured health inequities, especially in those minority communities in New York City. These disparities result in a mistrust of the healthcare system and, ultimately, hesitancy toward COVID-19 vaccines. To combat these issues, healthcare leaders such as those from the Greater New York City Black Nurses Association have partnered with community organizations to combat racism in our healthcare system and establish and successfully operate vaccination sites in these communities. These efforts led to the inoculation of over 22,000 people with COVID-19 vaccines. This shows that African-American nurse leaders are best suited to address the healthcare disparities that African-Americans face, especially during public health emergencies, and guide the conversation on racial equity in healthcare.

Virtual shadowing as an effective approach to gaining exposure to the field of emergency medicine

Learning Objectives: Expose students to the field of EM during the COVID-19 pandemic in a virtual setting. Facilitate mentor-mentee relationships between EM staff and students. Foster a peer-to-peer support network among similarly interested students. : Introduction: Shadowing is an important part of the education of medical students. The COVID-19 pandemic has limited medical students' hospital access during their first two years. In response, we implemented a novel virtual shadowing system to provide students with convenient and safe exposure to the ED. Curricular Design: Six EM faculty hosted 2-hour virtual shadowing experiences. Up to 10 students per shift signed up via signupgenius.com. Before each shift, students were given a chapter from the EMRA/CORD student advising guide about EM. Virtual shadowing was conducted using a HIPAA-compliant Zoom account on an ED issued mobile telehealth iPad. The physician would bring the iPad into the room, obtain consent from patients, and ensure students were able to see the encounter. Between visits, students were encouraged to ask questions using the chat function. A short de-briefing followed each shift. Students were sent a post-encounter survey via Google Forms. Impact/effectiveness: Survey responses were collected between October 20, 2020 and November 20, 2020. The overall response rate was 96.6% (56/58 surveys completed). Of respondents, 46 (82.1%) rated the experience as “effective” or “very effective” at providing exposure to EM. 53 (94.6%) said they would participate in virtual shadowing in the ED again, and 48 (85.7%) would do virtual shadowing in another specialty were it available. Further results are included in Table 1. Themed feedback from students is shown in Table 2. We found virtual shadowing to be an easy to implement and effective way for students to shadow physicians in the ED. Even in post-pandemic times, virtual shadowing should be explored as an accessible and effective way to expose students to a broad array of specialties.

Meeting Dermatologic Needs in an Uninsured Population: Lessons Learned from a Referrals Cohort at a Student-Run Free Clinic

Unmet dermatologic needs of the uninsured patient population are important to identify and address, especially as the COVID-19 pandemic has introduced additional barriers of access to care. We describe the successful collaboration between a student-run free clinic and dermatology practice since 2012, highlighting excellent time to appointment intervals and resolution rates as well as the associated modest financial cost. We believe that the information provided in our report may serve as a proof of concept and facilitate the implementation of such collaborations throughout the United States.