Comparison of Scenarios for the Mexican Electricity System for 2050 Energy Transition Law Objectives - Pre COVID-19 Analysis

In recent years, the reports presented on climate change and its consequences highlight the need to create public policy agendas that address the problem of adaptation and mitigation of anthropogenic greenhouse gas (GHG) emissions. Globally, the energy sector is responsible for a significant percentage of GHG emissions, while it is one of the most important sector for economic growth. In particular, the electricity sector in Mexico relies heavily on fossil fuels for electricity generation. This problem has made it essential to design plans and policies that contribute to GHG mitigation. The General Law on Climate Change, whose objective is to determine the guidelines towards a low-carbon economy, has established a goal of reducing emissions by 50% by 2050 concerning the baseline from the year 2000 and proposes to produce 50% of electricity with clean energy by 2050 following the Mexican Energy Transition Law. For this reason, the challenge is to design and develop an environmentally sustainable energy model for the National Electric System (NES). Different scenarios are defined and evaluated considering six probable growing electricity demands, as well as mature technologies considering the potential of renewable resources in Mexico, fossil fuel reserves, efficiencies of each technology, investment costs, operation costs, and maintenance costs along with the price of the fuels. The results showed that it is possible to reduce about 50% of the emissions from the electricity sector by 2050 considering a scenario of low population growth and a yearly per capita consumption of 2.0 MWh, as well as a diversification of the electricity generation matrix.

VRCT: Randomized Controlled Trial Evaluating the Impact of Virtual Reality Therapy on BPSD and QoL of Acute Care In-Patients With Dementia

Background: Virtual Reality (VR) is increasingly considered a valuable therapy tool for managing behavioural and psychological symptoms (BPSDs) and quality of life (QoL) in dementia (Parsons, 2013). However, rigorous studies are still needed to evaluate its impact in acute care settings (Appel, 2021). This study evaluated the impact of VR-therapy on managing BPSDs, falls, and length of stay (LoS) and QoL for inpatients with dementia admitted to an acute care hospital. Method(s): An open longitudinal interventional randomized controlled trial was conducted between April 2019 and March 2020 (ClinicalTrials.gov, ID:NCT03941119). A total of 69 participants (age >=65, diagnosis of dementia, did not meet exclusion criteria) (Figure 1) who were randomly assigned either followed standard of care (Control Arm, n = 35 or received VR-therapy every 1-3 days (Intervention Arm, n = 34) (Figure 2). VR-therapy entailed watching 360-degree-VR-films on a HMD for up to 20 minutes (Figures 3 and 4). Instances of daily BPSDs documented in EMR nursing notes were categorized based on the Neuropsychiatric Inventory (NPI). QoL measures included the Quality of Life in Late-Stage Dementia scale (QUALID) and semi-structured interviews conducted at scheduled visits. Structured observations (including the standardized "ObsRVR" tool) and interviews were used to measure treatment feasibility (Figure 5). Result(s): VR-therapy had a statistically significant effect (p =.014) in reducing aggressivity (i.e., physical aggression and loud vociferation). A sentiment analysis of patient responses to the semi-structured interviews on QoL revealed a statistically significant impact of VR therapy (p =.013). No statistically significant impact of VR therapy was found for other BPSDs (e.g., apathy), falls, or LoS or QoL as measured by the QUALID. VR-therapy was overall an acceptable and enjoyable experience for participants and no adverse events occurred as a result of VR-therapy. Conclusion(s): Immersive VR-therapy appears to have an effect on aggressive behaviours and QoL in acute care patients with dementia. Although the RCT was stopped before reaching the intended sample size due to COVID-19 restrictions, trends in the results are promising. We suggest conducting future trials with larger samples and, in some cases, more sensitive data collection instruments. Copyright © 2022 the Alzheimer's Association.

A Family-based Child Health Education Curriculum for Refugee Families

Background: Refugees are at risk for low health literacy and high rates of illness and hospitalization. A partnership between medical professionals at Yale and two New-Haven, CT-based refugee resettlement organizations aimed to create and implement a family-based, interactive pediatric healthcare curriculum with a goal of increasing childhood health knowledge among refugee families. Methods: Seven 1-hour, in-person classes and 1 virtual class were taught by pediatric residents with real-time translation in Pashto, Dari, Arabic, Swahili, and Kinyarwanda on the topics of child nutrition, safety, parenting, and oral health. Each class incorporated play-based activities for toddlers-a My Healthy Plate puzzle, street-crossing simulation, teeth-brushing demonstration, and block play-which were integrated into parental discussion with visual aids. Knowledge acquisition and satisfaction was assessed using pre- and posttests. Results: 67 adult participants had an 85% response rate. Average knowledge test scores increased in 5 of 7 classes, reaching significance in a class on parenting (mean 52% vs 90%, paired t-test p = 0.03) and child safety (mean 80% vs 97%, p = 0.04). 100% of respondents (67% response rate) reported increased understanding of the topic and would recommend the class to a friend. There were 5 participants for the virtual class. Conclusion: Child health education classes conducted for refugee families can improve knowledge of pediatric healthcare topics and provide positive experiences. A close relationship between healthcare providers and community refugee organizations has the potential to improve health education in refugee families. Future studies will assess efficacy and satisfaction of virtual classes during the COVID-19 pandemic.

Understanding the Health care Needs of Migrant Children in Government Custody

Background: There are increasing numbers of immigrant children held in government custody at the US-Mexico border and across the US. Further, anti-immigrant policies and the US COVID-19 pandemic response exacerbated detention conditions under the Trump administration. Thus, there is a greater need to identify the health concerns and challenges clinicians face when caring for these children. Methods: A national cross-sectional 66- question online survey was distributed from October 2020 to January 2021 through national pediatric and migrant health listservs including the Academy of Pediatrics (AAP). The reported total number of listserv members was 6200, but the degree of redundancy among these groups was not able to be assessed. Clinicians were asked about care delays, health problems encountered, and resources needed while caring for children under government custody. “Children in government custody” was defined as children (0-17 years) who currently or previously (in the past 5 years) were under the custody of the US Immigration Customs Enforcement, Customs Border Protection and/or the Office of Refugee and Resettlement. Results: Eightytwo clinicians responded and cared for children clinically. Thirty four cared for children who were in government custody. About 1/3 of this subset of respondents noted care delays while in custody and delays in establishing primary care after custody release. The two main health issues seen were a lack of routine health maintenance and traumatic exposures. Most commonly, children were behind on vaccinations and needed mental health screening. Exposure to violence was the most common traumatic exposure. Furthermore, 47% of clinicians felt that their current resources were inadequate and requested legal assistance and mental health support. Importantly, 58% of respondents were not aware of or were unsure of the Centers for Disease Control and Prevention domestic refugee health guidelines for the care of migrant children and adults. Conclusion: Children who experience detention have significant healthcare needs, many of which clinicians do not feel equipped to address. The reported health complications emphasize the need for policy measures, such as those recommended by the AAP, namely, the provision of evidence-based medical evaluations, trauma-informed care, and family-centered medical homes with comprehensive primary care and embedded mental health and legal support systems. Child detention should end. If present, children should be released to ORR shelters with pediatric clinicians providing healthcare and oversite until children can be safely released to vetted legal guardians and established in medical homes. This process should be swift with improved integration of detainment and post-detainment healthcare. Clinicians can be supported with training on immigrant screening guidelines. Of note, the low response rate and inability to distinguish between ICE, CBP, and ORR on the survey limits these results. Nonetheless, these findings support further research and recommendations for policy changes to improve the health and well-being of newly-arrived immigrant children.

“We Are Trying to Communicate the Best We Can”: Understanding Districts’ Communication on Twitter During the COVID-19 Pandemic

While educators’ uses of social media for purposes such as professional learning and networking are now well-established, our understanding of how educational institutions use social media—including to engage key stakeholders during periods of crisis—is limited. In this study, we used a public data mining research approach to examine how K–12 school districts in the United States used Twitter as a communication tool during a critical period of the COVID-19 pandemic, March-April, 2020. Through a three-step grounded theory approach of 1,357 district tweets from 492 school districts, we found that districts worked to build community and share time-sensitive announcements in alignment with social media crisis communication recommendations. Announcements were more common during the early stages of the pandemic (and were engaged more collaboratively), with community-building posts more common later on. This study demonstrates how researchers can use publicly available (social media) data to understand districts’ communication priorities and strategies during and beyond periods of crisis. © The Author(s) 2022.

A Different Experience in a Different Moment? Teachers’ Social Media Use Before and During the COVID-19 Pandemic

Teachers participate in professional learning activities to enhance their pedagogical knowledge and share best practices—and the increasing role of technologies in education, including social media, is shifting how this professional learning occurs. The COVID-19 pandemic provided an opportunity to consider the role of social media for professional learning. Using intensive longitudinal methods, we repeatedly surveyed 14 teachers’ use of social media both before and during the pandemic (N = 386 total responses). We found patterns in social media platforms uptake and their purposes, but teachers’ use of social media was largely idiosyncratic. Also, teachers demonstrated notable shifts in social media use after the pandemic started;multilevel models indicated that teachers were more likely to use social media to connect and share, especially, as well as learn and follow, compared with before the pandemic. Higher levels of COVID-19-related family stress were also associated with more use of social media to find materials. © The Author(s) 2021.

Impact of COVID-19 pandemic on otolaryngology clinical and surgical volume

Introduction: The COVID-19 pandemic has upended regular otolaryngology practices in myriad ways. However, there remains a relative dearth of data quantifying the impact of this pandemic on the clinical and surgical volume of otolaryngology practices at large, urban, multicenter hospital systems. Method: The monthly totals of relative value units (RVUs), surgical cases, patient visits, and paid time off (PTO) in departments of otolaryngology were gathered from January to October of 2019 and 2020. Monthly and yearly values were compared using Wilcoxon signed-rank test. Results: RVU totals of 323,791 and 239,735 were performed from January to October of 2019 and 2020, respectively (P = .018). While overall surgical volume decreased significantly from 2019 to 2020 (6027 cases in 2019 vs 4181 in 2020, P = .008), this was largely due to a decrease in ambulatory cases (5148 vs 3383, P = .006), as inpatient surgical volume did not change markedly (879 vs 798, P = .323). Follow-up visits remained relatively constant (58,163 vs 47,802, P = .222), but significantly fewer new patients were seen (36,172 vs 24,545, P = .006). Increased prevalence of telemedicine visits compensated for the decrease in new patient visits in 2020 (6535 in 2020 vs 0 in 2019), yielding an overall insignificant change in total visit volume (94,335 vs 78,882, P = .192). Personal PTO precipitously declined in 2020 compared with 2019 (683 vs 192, P = .003), as did academic PTO, although to a lesser extent (233 vs 24 days, P = .01). Conclusion: Overall, RVUs decreased by 26% from 2019 to 2020, which is largely attributable to significantly fewer ambulatory surgeries and new patient visits during the COVID-19 pandemic. Increased utilization of telemedicine is a potentially lasting adaptation that has enabled providers to maintain patient care at a time when clinical volume is limited.

ROSEOMONAS GILARDII-ASSOCIATED BACTEREMIA IN THE SETTING OF COVID-19 PNEUMONIA

TOPIC: Chest Infections TYPE: Fellow Case Reports INTRODUCTION: Roseomonas genus was described in 1993 by Rihs et al. as a "pink coccoid", non-fermentative, aerobic, gram-negative bacteria. It has been isolated from environmental sources (e.g., water, soil, air, and plants);however, human infections are rare. We report a case of R. gilardii associated bacteremia in the setting of COVID-19 pneumonia. CASE PRESENTATION: 73-year-old man with history of HIV (on Bictarvy, well controlled), and diabetes presented with progressive shortness of breath. On admission he was tachypneic, hypoxic, and tachycardic. Lab findings showed lactic acidosis, leukocytosis, respiratory acidosis, elevated inflammatory markers, and COVID-19 PCR positive. He was in acute hypoxic respiratory failure requiring escalation of oxygen therapy with eventual intubation. CT angiography of the chest showed diffuse bilateral subpleural ground glass opacities and lower lobe consolidation with air bronchogram. He was started on Dexamethasone 6mg (10 days), Remdesevir (1 dose), and empiric antibiotics for pneumonia. After 5 days of above therapy patient continued to deteriorate and plasma exchange was given as a salvage therapy. Blood cultures from admission grew Roseomonas Gilardii, which was susceptible to Cefepime. After literature review cefepime was switched to imipenem, cilastatin and amikacin due to studies suggesting high amounts of resistance to Cephalosporins. DISCUSSION: Majority of infection due to R. spp occur in immunocompromised patients (e.g., ESRD, cancer and transplant). These organisms are susceptible to quinolones, carbapenems, and cephalosporins with recommended duration of treatment being 15 days. R. mucosa isolates are resistant to ceftazidime, cefepime, piperacillin, tazobactam, and colistin. R. gilardii is more susceptible than R. mucosa to tested antimicrobial agents. CONCLUSIONS: This is the first reported case of R. gilardii associated empyema in a COVID-19 patient. This underlines the impact of superinfections in COVID-19. R spp. infection in humans is rare and have an inherent resistance to cephalosporins, but high susceptibility to Amikacin and Imipenem. REFERENCE #1: Rihs JD, Brenner DJ, Weaver RE, Steigerwalt AG, Hollis DG, Yu VL. 1993. Roseomonas, a new genus associated with bacteremia and other human infections. J. Clin. Microbiol. 31:3275–3283. REFERENCE #2: Petros Ioannou, Vasiliki Mavrikaki & Diamantis P Kofteridis (2020). Roseomonas species infections in humans: a systematic review, Journal of Chemotherapy, 32:5, 226-236, DOI: 10.1080/1120009X.2020.1785742 REFERENCE #3: Dé I, Rolston KV, Han XY. Clinical significance of Roseomonas species isolated from catheter and blood samples: analysis of 36 cases in patients with cancer. Clin Infect Dis. 2004 Jun 1;38(11):1579-84. doi: 10.1086/420824. Epub 2004 May 7. PMID: 15156446. DISCLOSURES: No relevant relationships by Aneeta Kumari, source=Web Response No relevant relationships by Kunal Nangrani, source=Web Response No relevant relationships by Jose Orsini, source=Web Response No relevant relationships by Evgeny Pinelis, source=Web Response No relevant relationships by Priya Raju, source=Web Response No relevant relationships by Keerthi Reddy Ramireddy, source=Web Response Speaker/Speaker's Bureau relationship with Allergan Please note: $20001 - $100000 by Joshua Rosenberg, source=Web Response, value=Honoraria No relevant relationships by Waqqas Tai, source=Web Response No relevant relationships by Viswanath Vasudevan, source=Web Response No relevant relationships by John Zeibeq, source=Web Response

NOVEL CASE OF PSEUDALLESCHERIA BOYDII PNEUMONIA IN PATIENTS WITH COVID-19 TREATED WITH ISAVUCONAZOLE

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Pseudallescheria boydii is a fungal organism isolated from agricultural soil and polluted water. Pseudallescheria boydii (P. boydii) can rarely cause an invasive disease which is primarily seen in organ transplant patients.1 It is unusual for it to cause a pulmonary infection.1 We present a case of a patient admitted with COVID-19 who was found to be infected with P. boydii. CASE PRESENTATION: A 58-year-old male with a history of heart failure, deep venous thrombosis, stroke was admitted for altered mental status in the setting of sepsis. On admission he complained of dry cough and weakness. Lab findings were significant for lymphopenia, elevated inflammatory makers, anemia, and thrombocytopenia. Chest imaging was suspicious for COVID pneumonia;however, initial COVID-19 PCR was negative. He was started on steroids for suspected COVID pneumonia. 72 hours later there was a significant decline in his mental and respiratory status, requiring mechanical ventilation. A bronchoscopy with bronchoalveolar lavage (BAL) was performed with worsening interstitial infiltrates on chest x-ray and high index of suspicion for a fungal cause of his pulmonary insult. COVID 19 PCR was repeated, which was later found to be positive. Neurological workup with CT head, lumbar puncture and EEG were negative. We were concerned about COVID-19 encephalopathy. He was maintained on steroids for concern of organizing pneumonia. Repeat chest imaging was impressive for cavitary lesion. BAL culture sent earlier was growing a mold prompting utilization of voriconazole for concern of invasive aspergillosis. Final cultures from BAL revealed P. boydii, and he was switched to isavuconazole due to QTc prolongation. Post treatment repeat cultures were negative. DISCUSSION: Pseudallescheria boydiis is commonly seen in immunocompromised patients such as solid organ transplants. Clinical and histological features of P. boydiis and invasive aspergillosis are similar and can be difficult to distinguish in clinical practice. Optimal treatment for this infection has yet to be elucidated due to multiple resistance patterns to drugs such as amphotericin B. Studies have shown that combinations or high dose antifungals have higher success rates for treatment, but there is no regimen that is universally agreed upon.2 Based on literature review this is the first case of P.boydii pneumonia in a COVID-19 patient successfully treated with isavuconazole. CONCLUSIONS: Incidence of P.boydii is rare even in the transplant population and extremely rare to cause pulmonary infection. Additional studies must be done to better understand the pathogenesis and treatment of P. boydii to improve patient outcomes due to its severe morbidity and mortality. Based upon literature review this is the first successfully treated case of P.boydii by Isavuconazole. REFERENCE #1: Bibashi, E et al. "Invasive infection caused by Pseudallescheria boydii in an immunocompetent patient." Hippokratia vol. 13,3 (2009): 184-6. REFERENCE #2: Lackner M, de Hoog GS, Verweij PE, Najafzadeh MJ, Curfs-Breuker I, Klaassen CH, Meis JF. Species-specific antifungal susceptibility patterns of Scedosporium and Pseudallescheria species. Antimicrob Agents Chemother. 2012 May;56(5):2635-42. doi: 10.1128/AAC.05910-11. Epub 2012 Jan 30. PMID: 22290955;PMCID: PMC3346635. DISCLOSURES: No relevant relationships by Obed Adarkwah, source=Web Response No relevant relationships by Joanna DeAngelis, source=Web Response No relevant relationships by Louis Gerolemou, source=Web Response No relevant relationships by Tania Ghorban Azar, source=Web Response No relevant relationships by Ryan Kowalsky, source=Web Response No relevant relationships by Aneeta Kumari, source=Web Response No relevant relationships by Nabil Mesiha, source=Web Response No relevant relationships by Steven Miller, source=Web Response No relevant relationships by Karina Muzykovsky, source=Web Response No relevant relationships by Kunal Nangrani, source=Web Response No relevant relationships by Jose O sini, source=Web Response No relevant relationships by Gaurav Parhar, source=Web Response No relevant relationships by Evgeny Pinelis, source=Web Response Speaker/Speaker's Bureau relationship with Allergan Please note: $20001 - $100000 by Joshua Rosenberg, source=Web Response, value=Honoraria No relevant relationships by jad sargi, source=Web Response No relevant relationships by Viswanath Vasudevan, source=Web Response No relevant relationships by Kiran Zaman, source=Web Response

Caregiver's experience of using telehealth services at a craniofacial center during the COVID-19 pandemic

Background/Purpose: Our craniofacial center, just as many health care systems, adjusted its delivery of care in response to the current pandemic in order to reduce the risk of transmitting SARS-CoV-2, the virus the causes COVID to providers and patients. Considering the craniofacial (CFC) population, patient's treatment plan often requires at least annual follow-up visits with multiple interdisciplinary providers. Many of our patients undergo long commutes;moreover, 70% of the patients are from the underserved and diverse population and receive state-funded medical insurance. Thus, the maintenance of continuity of care is important for the CFC population as appointments are used to prepare and schedule upcoming treatments and surgeries. In response, our center has offered telehealth appointments for all our patients and families. The purpose of this study is to evaluate patient and caregiver experience of using telehealth services to determine its benefits and barriers as the center considers providing virtual care during and beyond the COVID-19 pandemic. Methods/Description: A bilingual, English and Spanish, survey was created using Qualtrics and emailed to the caregivers of patients who recently attended a virtual appointment with any of our providers from our craniofacial team. Families without emails were interviewed via phone call. A total of 60 families were invited to complete the survey. The survey assessed the following: The feasibility of attending telehealth services, benefits and barriers to attending the appointment, patient and caregiver satisfaction with each provider, preference of in-person versus telehealth meeting, and preference of future telehealth appointments (ie, seeing all providers in one day vs separate days). Results: Preliminary data suggest that caregivers are overall satisfied with telehealth appointments. Many participants reported liking the convenience of telehealth visits, specifically the flexibility, the shorter wait time and duration, and not needing to travel. They were overall satisfied with the time spent with the providers and indicated that they received the necessary information during the appointment. In addition, many caregivers indicated that they would rather attend virtual provider appointments on different days instead of the traditional full day of appointments at our center. No barriers or negative experiences were reported. Conclusions: The current findings indicate that with telehealth, caregivers are experiencing a reduction of burden of care without compromising the quality of care. This is extremely valuable considering the diverse and underserved patients our center aims to serve. Although preliminary, the data suggest that telehealth visits could be beneficial even beyond the pandemic as means to increase treatment engagement and decrease barriers to appointments.