Be in the Digital Room Where it Happens, Part II: Social Media for Neurology Educators.

Social media has changed the way we communicate and interact. Unsurprisingly, it has also changed how we teach and learn. Younger generations of learners have transitioned from traditional educational sources to digital ones. Medical educators need to adapt to trends in medical education and develop fluency in the digital methods used by medical learners today. This is part two of a two-part series on social media and digital education in neurology. This article provides an overview of how social media can be used as a teaching tool in medical education and provides an overview in which it is grounded. We offer practical strategies on how social media can promote lifelong learning, educator development, educator support, and foster educator identity with accompanying neurology-specific examples. We also review considerations for incorporating social media into teaching and learning practices and future directions for integrating these tools in neurology education.

Practical guidance for telemedicine use in neuro-oncology.

While the COVID-19 pandemic has catalyzed the expansion of telemedicine into nearly every specialty of medicine, few articles have summarized current practices and recommendations for integrating virtual care in the practice of neuro-oncology. This article identifies current telemedicine practice, provides practical guidance for conducting telemedicine visits, and generates recommendations for integrating virtual care into neuro-oncology practice. Practical aspects of telemedicine are summarized including when to use and not use telemedicine, how to conduct a virtual visit, who to include in the virtual encounter, unique aspects of telehealth in neuro-oncology, and emerging innovations.

Translational Science 22 conference proceedings.

The Translational Science TS22 conference in Chicago in April 2022 was the first time post-pandemic that members of the Association of Clinical and Translational Science were able to meet up in person to share scientific advances. Given the remaining level of risk due to COVID-19, the meeting was designed as hybrid allowing virtual participation to some of the presentations. Prior to the meeting, JCTS Junior Editors were invited to report on the plenary sessions of the meeting. The present perspective constitutes a summary of three plenary sessions.

Combined Use of RT-qPCR and NGS for Identification and Surveillance of SARS-CoV-2 Variants of Concern in Residual Clinical Laboratory Samples in Miami-Dade County, Florida.

Over the course of the COVID-19 pandemic, SARS-CoV-2 variants of concern (VOCs) with increased transmissibility and immune escape capabilities, such as Delta and Omicron, have triggered waves of new COVID-19 infections worldwide, and Omicron subvariants continue to represent a global health concern. Tracking the prevalence and dynamics of VOCs has clinical and epidemiological significance and is essential for modeling the progression and evolution of the COVID-19 pandemic. Next generation sequencing (NGS) is recognized as the gold standard for genomic characterization of SARS-CoV-2 variants, but it is labor and cost intensive and not amenable to rapid lineage identification. Here we describe a two-pronged approach for rapid, cost-effective surveillance of SARS-CoV-2 VOCs by combining reverse-transcriptase quantitative polymerase chain reaction (RT-qPCR) and periodic NGS with the ARTIC sequencing method. Variant surveillance by RT-qPCR included the commercially available TaqPath COVID-19 Combo Kit to track S-gene target failure (SGTF) associated with the spike protein deletion H69-V70, as well as two internally designed and validated RT-qPCR assays targeting two N-terminal-domain (NTD) spike gene deletions, NTD156-7 and NTD25-7. The NTD156-7 RT-qPCR assay facilitated tracking of the Delta variant, while the NTD25-7 RT-qPCR assay was used for tracking Omicron variants, including the BA.2, BA.4, and BA.5 lineages. In silico validation of the NTD156-7 and NTD25-7 primers and probes compared with publicly available SARS-CoV-2 genome databases showed low variability in regions corresponding to oligonucleotide binding sites. Similarly, in vitro validation with NGS-confirmed samples showed excellent correlation. RT-qPCR assays allow for near-real-time monitoring of circulating and emerging variants allowing for ongoing surveillance of variant dynamics in a local population. By performing periodic sequencing of variant surveillance by RT-qPCR methods, we were able to provide ongoing validation of the results obtained by RT-qPCR screening. Rapid SARS-CoV-2 variant identification and surveillance by this combined approach served to inform clinical decisions in a timely manner and permitted better utilization of sequencing resources.

Patient Experiences With Ambulatory Telehealth in Neurology: Results of a Mixed-Methods Study.

OBJECTIVE: To assess patient experiences with rapid implementation of ambulatory telehealth during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: A mixed-methods study was performed to characterize the patients' experience with neurology telehealth visits during the first 8 weeks of the COVID-19 response. Consecutive patients who completed a telehealth visit were contacted by telephone. Assenting patients completed a survey quantifying satisfaction with the visit followed by a semistructured telephone interview. Qualitative data were analyzed using the principles of thematic analysis. RESULTS: A total of 2,280 telehealth visits were performed, and 753 patients (33%) were reached for postvisit feedback. Of these, 47% of visits were by video and 53% by telephone. Satisfaction was high, with 77% of patients reporting that all needs were met, although only 51% would consider telehealth in the future. Qualitative themes were constructed, suggesting that positive patient experiences were associated not only with the elimination of commute time and associated costs but also with a positive physician interaction. Negative patient experiences were associated with the inability to complete the neurologic examination. Overall, patients tended to view telehealth as a tool that should augment, and not replace, in-person visits. CONCLUSION: In ambulatory telehealth, patients valued convenience, safety, and physician relationship. Barriers were observed but can be addressed.

A comparison of telemedicine and in-person neurology visits: what are the factors that patients consider when selecting future visit type?

OBJECTIVE: To identify factors that patients consider when choosing between future in-person, video, or telephone visits. BACKGROUND: Telemedicine has been rapidly integrated into ambulatory neurology in response to the COVID-19 pandemic. METHODS: Ambulatory neurology patients at a single center were contacted via telephone to complete: (1) a survey quantifying likelihood of scheduling a future telemedicine visit, and (2) a semi-structured qualitative interview following their visit in March 2021. Data were processed using the principles of thematic analysis. RESULTS: Of 2493 visits, 39% assented to post-visit feedback; 74% were in-person visits and 13% video and telephone. Patients with in-person visits were less likely than those with video and telephone visits to "definitely" consider a future telemedicine visit (36 vs. 59 and 62%, respectively; p < 0.001). Patients considered five key factors when scheduling future visits: "Pros of Visit Type," "Barriers to Telemedicine," "Situational Context," "Inherent Beliefs," and "Extrinsic Variables." Patients with telemedicine visits considered convenience as a pro, while those with in-person visits cited improved quality of care. Accessibility and user familiarity were considered barriers to telemedicine by patients with in-person and telephone visits, whereas system limitations were prevalent among patients with video visits. Patients agreed that stable conditions can be monitored via telemedicine, whereas physical examination warrants an in-person visit. Telemedicine was inherently considered equivalent to in-person care by patients with telephone visits. Awareness of telemedicine must be improved for patients with in-person visits. CONCLUSION: Across visit types, patients agree that telemedicine is convenient and effective in many circumstances. Future care delivery models should incorporate the patient perspective to implement hybrid models where telemedicine is an adjunct to in-person visits in ambulatory neurology.

The Transmission, Infection Prevention, and Control during the COVID-19 Pandemic in China: A Retrospective Study.

The first wave of COVID-19 in China began in December 2019. The outbreak was quickly and effectively controlled through strict infection prevention and control with multipronged measures. By the end of March 2020, the outbreak had basically ended. Therefore, there are relatively complete and effective infection prevention and control (IPC) processes in China to curb virus transmission. Furthermore, there were two large-scale updates for the daily reports by the National Health Commission of the People's Republic of China in the early stage of the pandemic. We retrospectively studied the transmission characteristics and IPC of COVID-19 in China. Additionally, we analyzed and modeled the data in the two revisions. We found that most cases were limited to Hubei Province, especially in Wuhan, and the mortality rate was lower in non-Wuhan areas. We studied the two revisions and utilized the proposed transmission model to revise the daily confirmed cases at the beginning of the pandemic in Wuhan. Moreover, we estimated the cases and deaths for the same stage and analyzed the effect of IPC in China. The results show that strong and effective IPC with strict implementation was able to effectively and quickly control the pandemic.

Automation of mass vaccination against COVID-19 at an academic health center.

As vaccines against COVID-19 became available for distribution, the University of Miami addressed several challenges to facilitate vaccine allocation to the highest risk employees, patients, and students. Advanced use of technology allowed for the automation of key processes in the mass vaccination effort, which expedited vaccine outreach and scheduling, while maintaining routine delivery of healthcare services. The University's employees were initially prioritized for vaccination; employees who opted in were stratified into 5 vaccine administration phases. A similar process was implemented for students. When the state of Florida mandated expansion of vaccine allocation to include individuals aged 65 and older, an algorithm for patients was designed, taking into account age, comorbidities, date of last visit, and presence of an activated patient portal account. Innovative use of technology allowed for 19  000 vaccines to be administered within the first 37 days, which comprised 100% vaccine allotment, without wasting a single vaccine dose.

Outcomes in COVID-19 patients with and without preexisting chronic liver disease: A retrospective study

Background: Many patients with COVID-19 also present with liver injury, in addition to respiratory symptoms. There is concern that COVID-19 could lead to more severe clinical outcomes in patients with comorbid chronic liver disease and vice versa. Evaluation of demographic data and the clinical COVID-19 disease course in this subset of patients is warranted due to the rapid and severe nature of the virus. Methods: A retrospective cohort study was conducted on patients infected with COVID-19, with and without chronic liver disease, from March 22nd, 2020, to August 1, 2020. A randomized list of 450 patients without (NLD) and 225 patients with chronic liver disease (LD) was compiled and matched on age, gender, and BMI into 150 patient pairs. Six patients were disqualified for not meeting inclusion criteria, resulting in a final number of 147 patients in each cohort. Demographic, clinical, and laboratory data was collected at baseline and post-COVID-19 infection. Descriptive statistics and bivariate analyses were also conducted. IRB approval was obtained prior to the data collection process. Results: Our cohort averaged 59.32 years of age, were 48.98% male and 51.02% female, and had an average BMI of 31.27. The most common causes of chronic liver disease were non-alcoholic fatty liver disease (62.59%) and Hepatitis C (20.41%). Patients with cirrhosis made up 15.65% of the cohort. LD patients were more likely to have comorbidities like hypertension and hyperlipidemia. NLD patients were more likely to have respiratory symptoms than LD patients, who were more likely to have GI symptoms. In a comparison of laboratory results, the LD group had statistically significantly higher baseline and follow up AST levels compared to the NLD group. However, post COVID-19 infection, both groups had a statistically significant increase in AST. NLD patients also had statistically significant increases in creatinine and ALT compared to baseline. Overall mortality rate in the cohort of 294 patients was 10.54%, with a higher mortality in the NLD group, albeit not statistically significant. The incidence of mortality for patients with cirrhosis was 10%. Conclusion: This study found that LD patients were more likely to experience GI symptoms than respiratory symptoms, which were more common in NLD patients. Both groups developed increased liver enzymes post-COVID infection. LD patients were more likely to have metabolic disease as expected, given NAFLD as the main underlying liver disease. Though LD patients had these comorbidities, there was no statistically significant difference in rate of hospitalization, ICU admissions, or mortality between the groups. This could possibly be explained by the high rate of obesity in both groups (average BMI 31). There was also a small percentage of patients with cirrhosis, the majority of whom were well compensated. Further studies are needed to determine the risk of COVID-19 in patients with chronic liver disease and cirrhosis.

Rivalry between human ideation and virus mutation: two competing means of sustainability.

For the first time in human history, obtaining a COVID-19 vaccine has become essential for the sustainability of our species. As an amazing product of collective ideation, remarkably safe and efficient vaccines have been invented, tested, distributed, and administered to the population on a voluntary basis. The fast-mutating individual behavior of the virus is probably guided by a similar goal of the sustainability of the species. With this commentary, we analyze and compare two means of sustainability through adaptability: collective ideation in the case of humans and individual mutations in the case of viruses - two very different species whose behaviors are driven by sustainability.

Rapid Implementation of Outpatient Teleneurology in Rural Appalachia: Barriers and Disparities.

OBJECTIVE: To describe rapid implementation of telehealth during the COVID-19 pandemic and assess for disparities in video visit implementation in the Appalachian region of the United States. METHODS: A retrospective cohort of consecutive patients seen in the first 4 weeks of telehealth implementation was identified from the Neurology Ambulatory Practice at a large academic medical center. Telehealth visits defaulted to video, and when unable, phone-only visits were scheduled. Patients were divided into 2 groups based on the telehealth visit type: video or phone only. Clinical variables were collected from the electronic medical record including age, sex, race, insurance status, indication for visit, and rural-urban status. Barriers to scheduling video visits were collected at the time of scheduling. Patient satisfaction was obtained by structured postvisit telephone call. RESULTS: Of 1,011 telehealth patient visits, 44% were video and 56% phone only. Patients who completed a video visit were younger (39.7 vs 48.4 years, p < 0.001), more likely to be female (63% vs 55%, p < 0.007), be White or Caucasian (p = 0.024), and not have Medicare or Medicaid insurance (p < 0.001). The most common barrier to scheduling video visits was technology limitations (46%). Although patients from rural and urban communities were equally likely to be scheduled for video visits, patients from rural communities were more likely to consider future telehealth visits (55% vs 42%, p = 0.05). CONCLUSION: Rapid implementation of ambulatory telemedicine defaulting to video visits successfully expanded video telehealth. Emerging disparities were revealed, as older, male, Black patients with Medicare or Medicaid insurance were less likely to complete video visits.

Removal of SARS-CoV-2 bioaerosols using ultraviolet air filtration.

Engineering controls play an important role in reducing the spread of severe acute respiratory coronavirus virus 2 (SARS-CoV-2).1 Established technologies such as air filtration, and novel approaches such as ultraviolet (UV)-C light or plasma air ionization, have the potential to support the fight against the coronavirus disease 2019 (COVID-19) pandemic.2 We tested the efficacy of an air purification system (APS) combining UV-C light and high-efficiency particulate air (HEPA) filtration in a controlled environment using SARS-CoV-2 as test organism. The APS successfully removed the virus from the air using UV-C light by itself and in combination with HEPA air filtration.