Peer Support Specialist Work and Experiences During the COVID-19 Pandemic: A National Longitudinal Study.

OBJECTIVE: The study followed up with peer support specialists (PSSs) responding to an earlier survey to assess the pandemic's continued employment and personal effects. METHODS: A December 2020 online survey was conducted with respondents to a May 2020 survey. Items on employment status, work tasks, challenges, support, and benefits were included. Responses were analyzed with descriptive and inferential statistics. RESULTS: A total of 496 PSSs completed both surveys. Unemployment remained at 7%. The proportion with full-time employment increased by December, but financial instability also increased. Tasks involving individual support and group facilitation, which had decreased significantly, rebounded somewhat by December, when nearly all PSSs (86%) reported having some new tasks. Job satisfaction remained stable and high. In both surveys, about 75% reported pandemic-related benefits. Symptoms and housing instability among clients increased. CONCLUSIONS: Pandemic-related PSS unemployment was relatively stable, and work tasks evolved. Respondents reported increasing needs among clients, as well as pandemic-related work benefits.

Early Cardiac Marker of Mortality in COVID-19

Background. Epicardial adipose tissue (EAT) is a highly inflammatory depot of fat, with high concentrations of IL-6 and macrophages, which can directly reach the myo-pericardium via the vasa vasorum or paracrine pathways. TNF-α and IL-6 diminish cardiac inotropic function, making EAT inflammation a potential cause of cardiac dysfunction. Methods. A retrospective cohort study assessing EAT Thickness and Density from CT scans, without contrast, from adult patients during index admission for COVID-19 infection at Mount Sinai Medical Center from March 2020 to January 2021. A total of 1,644 patients were screened, of which 148 patients were included. Follow-up completed until death or discharge. The descriptive analysis was applied to the general population, parametric test of normality for comparisons between groups. Kaplan survival analysis was conducted after survival distribution was confirmed significant. It was followed by the assumption of normality by Q-Q Plot, prior to performing a multiple regression analysis in the vulnerable group using a K-Matrix input for cofounders. A log-rank test was conducted to determine differences in the survival distributions for the different ranges of EAT thickness. Results. A total of 148 Participants were assigned to two groups based on epicardial adipose tissue in order to classify them as increased or decreased risk of cardiovascular risk: >5mm (n = 99), < 5mm (n = 49). The survival percentage was higher in the group with no EAT inflammation compared to the group with EAT inflammation (95.0% and 65%, respectively). Participants with EAT >5mm had a median day of hospital stay of 18 (95% CI, 16.86 to 29.92). The survival distributions for the two categories were statistically significantly different, χ2(2) = 6.9, p < 0.01. A Bonferroni correction was made with statistical significance accepted at the p < 0.025 level. There was a statistically significant difference in survival distributions for the EAT >5 mm vs EAT < 5 mm, χ2(1) =6.953, p = 0.008. Conclusion. There was an association with increased EAT thickness and increased mortality. These findings suggest that EAT thickness can be used as a prognostic factor and as a risk factor for increased mortality in patients with COVID-19.

Epicardial adipose tissue thickness as a mortality risk marker in covid-19

Intro: Cardiac involvement in COVID-19 infection is common. Epicardial adipose tissue functions as an inflammatory depot, and a thickness (EAT-T) >5mm is associated with increased cardiovascular risk. The present study assessed the significance of increased EAT-T in patients with COVID-19. Methods: A retrospective cohort study of 149 consecutive patients diagnosed with COVID-19 between March 2020 to January 2021 was performed. Inclusion criteria were lab-confirmed COVID19 infection and having a Chest CT scan without contrast during hospitalization. EAT-T was measure in right ventricle free wall (Figure 1). Characteristic of patients and comparisons were analyzed by T-Test and Chi-square. Log-linear analysis and cumulative logistic regression was carried out to predict effect between EAT-T and mortality Results: The mean age was 67 ± 15 years, 65% were male, and time from onset of symptoms was 7 ± 5 days. Forty-seven (31.5%) patients required mechanical ventilation, and 34 (22.8%) required vasopressors. Medical therapy included convalescent plasma (36%), Remdesivir (28%), Tocilizumab (46%), Enoxaparin (64%), and Dexamethasone (39%). There were 36 (24.2%) inhospital deaths, with a greater incidence amongst patients with an EAT-T > 5 mm versus ≤ 5 mm (95 vs 5%, p=.001). Notably, age was not significantly different on patients with in-hospital mortality (69 vs 66 years, p=0.5), and higher EAT-T by 2.17 mm on patient with acute respiratory distress syndrome (p=.001) and 10.9 mm in myocardial infarction (p=.02). In multivariable analysis an EAT-T >5mm was associated with an increased risk of mortality (OR 12.3, 95% CI 3-55, p=.001). In the presence of EAT-T > 5 mm, no effect was observed by chronic kidney disease, hypertension, coronary artery disease, dyslipidemia, or body mass index (p >0.5). Conclusions: In patients with COVID-19, an EAT-T > 5 mm is associated with increased risk of inhospital mortality and may provide important risk stratification.

Quality of inr control during the covid-19 pandemic

Background : The COVID-19 pandemic disrupted anticoagulation clinics with staff re-deployment and patient fears of exposure when getting INR testing. The impact on quality metrics of INR control, timeliness of INR testing, and strategies to mitigate barriers are not well described. Aims : To compare time in therapeutic range (TTR), prescribed interval for next INR, proportion of late INRs, use of extended INR testing > 5 weeks, switch from warfarin to a direct oral anticoagulant (DOAC) and use of home INR testing before and after the beginning of the pandemic in March 2020. Methods : Pre/post comparison of patients in the ongoing MAQI2 quality collaborative registry of 6 anticoagulation clinics in the USA funded by an insurance provider, Blue Cross/Blue Shield of Michigan. Patients initiating warfarin are retrospectively reviewed by trained nurse abstractors. Continuous data was compared with student t-test and categorical with chi square. Results : The number of patients post pandemic did not change and data in the table reflects delays in abstraction secondary to nurse redeployment. There was no change in TTR, and the proportion of patients with late INRs (>1 day overdue) increased by 1%. There was no change in timeliness contacting patients with INR results, and prescribed next INR increased by 1 day. Use of extending testing intervals increased by 1%, switching from warfarin to DOAC decreased by 2% and there was no change in the proportion of patients using home INR testing. Conclusions : We saw no change in INR control or timeliness of patient contact and only slight delays in patient follow up. There was minimal uptake in suggested strategies to mitigate the need for INR testing. Our anticoagulation clinics performed admirably during the pandemic.

A Monitoring and Warning Framework for Risks

After risks are identified, they still needed to be managed, monitored, and regularly communicated in appropriate management forums [1]. Standard management options for risks include deciding to further research, mitigate, watch, or accept. In both the research and watch options, risk managers are not taking immediate mitigation actions but may be gathering additional information to understand the risk better and defining triggers that indicate when action is needed. While intuitively, these steps sound straightforward, as the complexity of the risk increases, effectively monitoring and determining appropriate triggers for risks can be challenging. We discuss setting thresholds for risks that rely on the value of information concept from decision analysis and the example of a traditional warning system (like a fire alarm). We explore the applicability of our framework to two case studies: the impact of additional 5G transmission equipment on critical weather satellites and the risks inherent in developing space mission projects in a socially distanced environment still threatened by the Covid-19 virus.

Impact of COVID-19 on Peer Support Specialists in the United States: Findings From a Cross-Sectional Online Survey.

OBJECTIVE: Peer support specialists (PSS) are an integral part of the mental health workforce. The purpose of this study was to better understand how the COVID-19 pandemic affected their employment status and day-to-day work. METHODS: A cross-sectional, online survey was conducted (May-June 2020). Recruitment occurred through the National Association of Peer Specialists and additional snowball sampling. Closed- and open-ended questions sought information about employment status, work tasks, challenges faced by PSS and by individuals they supported, and positive impacts they experienced. RESULTS: A total of 1,280 surveys were analyzed. Nine percent of respondents reported having lost their job as a result of COVID-19. Of these, 65% reported a length of employment of 2 or more years, and 61% reported working 35 hours or less per week. Job tasks changed dramatically, with 73% reporting engagement in new tasks, including increased reliance on technology (N=717), increased coordination of resources (N=123), and COVID-19-related tasks (N=142). Engagement in some support tasks decreased significantly from prepandemic levels, including individual support provision (p<0.001) and group facilitation (p<0.001). Respondents reported significant challenges among individuals they supported, including increased isolation (92%), substance use (67%), housing instability (38%), and food insecurity (64%). Although respondents also reported challenges, satisfaction with organizational and supervisory support was high. Most respondents (73%) reported positive impacts or benefits from the pandemic. CONCLUSIONS: The changing roles and tasks identified in this study have implications for hiring, training, supervising, and supporting peer staff. The peer workforce demonstrated flexibility and commitment to meeting increasing needs.

COVID-19: relationship between atmospheric temperature and daily new cases growth rate.

Purpose: The novel coronavirus (severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)) first appeared in Wuhan, China, in December 2019, and rapidly spread across the globe. Since most respiratory viruses are known to show a seasonal pattern of infection, it has been hypothesised that SARS-CoV-2 may be seasonally dependent as well. The present study looks at a possible effect of atmospheric temperature, which is one of the suspected factors influencing seasonality, on the evolution of the pandemic. Basic procedures: Since confirming a seasonal pattern would take several more months of observation, we conducted an innovative day-to-day micro-correlation analysis of nine outbreak locations, across four continents and both hemispheres, in order to examine a possible relationship between atmospheric temperature (used as a proxy for seasonality) and outbreak progression. Main findings: There was a negative correlation between atmospheric temperature variations and daily new cases growth rates, in all nine outbreaks, with a median lag of 10 days. Principal conclusions: The results presented here suggest that high temperatures might dampen SARS-CoV-2 propagation, while lower temperatures might increase its transmission. Our hypothesis is that this could support a potential effect of atmospheric temperature on coronavirus disease progression, and potentially a seasonal pattern for this virus, with a peak in the cold season and rarer occurrences in the summer. This could guide government policy in both the Northern and Southern hemispheres for the months to come.