Biodefense: Expanding Nursing Strategies after the SARS-CoV-2 Threat

The COVID-19 pandemic has impacted the nursing profession and its existence in terms of preventing infection from spreading at the levels of patient care and management. Vigilance is essential in combating potential re-emerging diseases in the future. Hence, exploring a new framework, biodefense, is the best way to reframe nursing preparedness for new biological threats or new pandemics at any level of nursing care.

Mental Health Outcomes Among American Indian and Alaska Native U.S. Army Soldiers: A Serial Cross-Sectional Analysis.

INTRODUCTION: American Indian and Alaska Native (AI/AN) individuals in the USA experience higher rates of mental illness and preventable death than the general population. Published research demonstrates that AI/AN veterans experience similar disparities to other minorities compared to non-minority veterans; few studies, however, have assessed mental health outcomes in AI/AN active duty military members. The objective of this study was to determine differences in depression, anxiety, hazardous alcohol consumption, and suicidal ideation among AI/AN soldiers compared to soldiers of other races during the Coronavirus Disease 2019 (COVID-19) pandemic. MATERIALS AND METHODS: We conducted repeated cross-sectional electronic surveys to assess the mental health of active duty and activated reserve U.S. Army soldiers within three commands in the Northwestern Continental United States , Republic of Korea, and Germany during May-June 2020 (T1) and December 2020-January 2021 (T2). The primary exposure of interest in the present analysis was race and ethnicity, and the primary outcomes were probable depression with functional impairment (subsequently "depression"), probable anxiety with functional impairment (subsequently "anxiety"), hazardous alcohol use, and suicidal ideation. Multivariable logistic regression models were used to determine the association between demographics and COVID-19 concerns on mental health outcomes for each time point. RESULTS: A total of 21,293 participants responded to the survey at T1 (participation rate = 28.0%), and 10,861 participants responded to the survey at T2 (participation rate = 14.7%). In the multivariable model, AI/AN participants had 1.36 higher adjusted odds of suicidal ideation (95% CI: 1.02-1.82) at T1 and 1.50 greater adjusted odds of suicidal ideation at T2 (95% CI: 1.00-2.24), when compared to non-Hispanic White participants. During T1, there was no significant difference detected between AI/AN and non-Hispanic White participants for anxiety (adjusted odds ratio: 1.21; 95% CI: 0.91-1.60) (Table IV). However, AI/AN participants had 1.82 greater adjusted odds of anxiety when compared to non-Hispanic White participants at T2 (adjusted odds ratio: 1.82; 95% CI: 1.29-2.57). There were no significant differences detected between AI/AN participants and non-Hispanic White participants in multivariable models for either depression or hazardous alcohol use at both time points. CONCLUSIONS: Although we hypothesized that all adverse mental health outcomes would be higher for AI/AN service members at both time points, there were no significant differences at each of the time points analyzed for most of the outcomes analyzed. However, differences in suicidal ideation were found at both time points. Analyses and proposed interventions should account for diversity and heterogeneity of AI/AN populations.

Transit communication via Twitter during the COVID-19 pandemic

Transit providers have used social media (e.g., Twitter) as a powerful platform to shape public perception and provide essential information, especially during times of disruption and disaster. This work examines how transit agencies used Twitter during the COVID-19 pandemic to communicate with riders and how the content and general activity influence rider interaction and Twitter handle popularity. We analyzed 654,345 tweets generated by the top 40 transit agencies in the US, based on Vehicles Operated in Annual Maximum Service (VOM), from January 2020 to August 2021. We developed an analysis framework, using advanced machine learning and natural language processing models, to understand how agencies' tweeting patterns are associated with rider interaction outcomes during the pandemic. From the transit agency perspective, we find smaller agencies tend to generate a higher percentage of COVID-related tweets and some agencies are more repetitive than their peers. Six topics (i.e., face covering, essential service appreciation, free resources, social distancing, cleaning, and service updates) were identified in the COVID-related tweets. From the followers' interaction perspective, most agencies gained followers after the start of the pandemic (i.e., March 2020). The percentage of follower gains is positively correlated with the percentage of COVID-related tweets, tweets replying to followers, and tweets using outlinks. The average like counts per COVID-related tweet is positively correlated with the percentage of COVID-related tweets and negatively correlated with the percentage of tweets discussing social distancing and agency repetitiveness. This work can inform transportation planners and transit agencies on how to use Twitter to effectively communicate with riders to improve public perception of health and safety as it relates to transit ridership during delays and long-term disruptions such as those created by the COVID-19 public health crisis.

'Socially Distanced Community Engagement' -Teaching GIS Site-Analysis during COVID

In the era of COVID, project-based classes that incorporate community engagement (i.e., interacting with both a physical site and members of the community) as part of their learning approach, have taken a significant blow. When connecting with people becomes an unhealthy practice, how can site-based learning remain embedded in engineering teaching and practice while accommodating virtual education instruction? Within civil and environmental engineering (CEE), GIS mapping has allowed students to step outside the classroom and engage with site-based work while focusing on spatial learning technologies. The open-ended processes of spatial data gathering can be used to draw students into community observation, inviting a focus on ecological and social interactions of infrastructure, site, community, and equity. However, in the era of COVID, the full range of site-based learning processes, including community engagement, are impossible to implement. This paper describes two amended processes for site-based learning through GIS data practices during the post-COVID shutdown period. Pre-COVID versions of the exercises asked student teams to explore a single site by observing and mapping infrastructure. This involved documenting community use of space and interacting with the local community to obtain multi-layered data on social equity, economic, and physical aspects of the site. However, two primary changes were made: in one class students were asked to explore their own local environment rather than travel to a shared site of focus. In the other, student teams collected only visual site-data foregoing the community engagement component. These students then connected electronically with community partners to gather social data. The study draws on data from student participation in two different classes: a large introductory class and a smaller advanced class. Data includes a qualitative analysis of exit interviews with a sub-set of both undergraduate and graduate student participants. This paper examines to what extent the site-based practices retain value given the limits imposed by social distancing, and whether these workarounds reveal unexpected strategies which might be applicable to future remote learning, and to community-based learning even when physical reconnection is allowed. © American Society for Engineering Education, 2022.

Mental Health Support of Frontline Medical Personnel in the Javits New York Medical Station Federal COVID-19 Treatment Center

Background The federal government responded to the early epicenter of the COVID-19 pandemic in the United States by mobilizing uniformed services and other federal medical personnel to treat patients at the Javits New York Medical Station. Deployment of large numbers of personnel required flexible psychiatric and psychological support. Observations This report details the establishment of mental health support services for frontline personnel in a large convention center and explores lessons learned to encourage future mental health professionals to apply creative and assertive mental health interventions in disaster settings. Conclusions Timely and effective interventions included securing safe therapeutic space in high-traffic areas, developing relationships with leadership and frontline workers in their own work environments, and disseminating services throughout the civilian medical system. We suggest mental health supplementation during the medical response mission strengthened morale in frontline workers in a disaster scenario.

Implementation strategies for improving vitamin D status and increasing vitamin D intake in the UK: current controversies and future perspectives: proceedings of the 2nd Rank Prize Funds Forum on vitamin D.

A multi-disciplinary expert group met to discuss vitamin D deficiency in the UK and strategies for improving population intakes and status. Changes to UK Government advice since the 1st Rank Forum on Vitamin D (2009) were discussed, including rationale for setting a reference nutrient intake (10 µg/d; 400 IU/d) for adults and children (4+ years). Current UK data show inadequate intakes among all age groups and high prevalence of low vitamin D status among specific groups (e.g. pregnant women and adolescent males/females). Evidence of widespread deficiency within some minority ethnic groups, resulting in nutritional rickets (particularly among Black and South Asian infants), raised particular concern. Latest data indicate that UK population vitamin D intakes and status reamain relatively unchanged since Government recommendations changed in 2016. Vitamin D food fortification was discussed as a potential strategy to increase population intakes. Data from dose-response and dietary modelling studies indicate dairy products, bread, hens' eggs and some meats as potential fortification vehicles. Vitamin D3 appears more effective than vitamin D2 for raising serum 25-hydroxyvitamin D concentration, which has implications for choice of fortificant. Other considerations for successful fortification strategies include: (i) need for 'real-world' cost information for use in modelling work; (ii) supportive food legislation; (iii) improved consumer and health professional understanding of vitamin D's importance; (iv) clinical consequences of inadequate vitamin D status and (v) consistent communication of Government advice across health/social care professions, and via the food industry. These areas urgently require further research to enable universal improvement in vitamin D intakes and status in the UK population.

Co-creating a Teaching Module on the Impacts of COVID-19 on Various Transportation Systems and Stakeholders

COVID-19 has affected all aspects of life, including how we travel. As faculty members responsible for teaching infrastructure courses across four universities, the authors collaborated on creating a teaching module addressing this critical issue. The module focuses on the impacts of COVID-19 on different transportation systems from various stakeholder perspectives. The module was implemented in two universities (n = 25): Southern Methodist University (SMU) and New Mexico Institute of Mining and Technology (New Mexico Tech, NMT) in fall 2020 and will be implemented again at other schools in fall 2021. This paper presents the results obtained during the first implementation of the COVID-19 teaching module during the fall semester of 2020 and addresses how instructors can enhance the module for future offerings. Findings from the module's implementation demonstrate increased knowledge and understanding of the impacts of COVID-19 on different transportation systems from various stakeholder perspectives. SMU students' mean scores showed high post-evaluation scores, and NMT students' scores increased from pre to post evaluation. Additionally, the reflective writing assignment revealed students' awareness of various issues, including operational and economic impacts on operators and users. This paper offers contributions to our engineering community by focusing on lessons learned from the COVID-19 experience while providing recommendations for improving this co-create module. © American Society for Engineering Education, 2021

Impact of the COVID-19 pandemic on Creutzfeldt-Jakob disease surveillance and patient care in the United Kingdom.

BACKGROUND AND PURPOSE: Creutzfeldt-Jakob disease (CJD) is lethal and transmissible. We assessed the impact of the COVID-19 pandemic on UK CJD surveillance. We hypothesized that (i) disruptions prolonged diagnostic latency; (ii) autopsy rates declined; and (iii) COVID-19 infection negatively affected diagnosis, care, and survival. METHODS: We retrospectively investigated the first year of the pandemic, using the preceding year as a comparator, quantifying numbers of individuals assessed by the UK National CJD Research & Surveillance Unit for suspected CJD, time to diagnosis, disease duration, and autopsy rates. We evaluated the impact of COVID-19 status on diagnosis, care, and survival in CJD. RESULTS: A total of 148 individuals were diagnosed with CJD in the pandemic (from a total of 166 individuals assessed) compared to 141 in the comparator (from 145 assessed). No differences were identified in disease duration or time to diagnosis. Autopsy rates were unchanged. Twenty individuals had COVID-19; 60% were symptomatic, and 10% had severe disease. Disruptions in diagnosis and care were frequently identified. Forty percent of COVID-19-positive individuals died; however, COVID-19 status did not significantly alter survival duration in CJD. CONCLUSIONS: The COVID-19 pandemic has not impacted UK CJD case ascertainment or survival, but diagnostic evaluation and clinical care of individuals have been affected.

COVID-19-associated psychosis: A systematic review of case reports.

OBJECTIVES: To describe the comorbidities, presentations, and outcomes of adults with incident psychosis and a history of COVID-19. METHODS: We completed a descriptive systematic review of case reports according to PRISMA guidelines, including cases of adult patients with incident psychosis and antecedent or concurrent COVID-19. We extracted patient demographics, comorbidities, clinical course, and outcomes, and assessed cases for quality using a standardized tool. RESULTS: Of 2396 articles, we included 40 reports from 17 countries, comprising 48 patients. The mean age of patients was 43.9 years and 29 (60%) were males. A total of 7 (15%) had a documented psychiatric history, 6 (13%) had a substance use history and 11 (23%) had a comorbid medical condition. Delusions were the most common (44 [92%]) psychiatric sign and psychosis lasted between 2 and 90 days. A total of 33 (69%) patients required hospitalization to a medical service and 16 (33%) required inpatient psychiatric admission. The majority (26 [54%]) of cases did not assess for delirium and 15 (31%) cases were judged to be of high risk of bias. CONCLUSIONS: Despite the growing awareness of COVID-19's association with incident psychosis at a population level, cases of COVID-19-associated psychosis often lacked clinically relevant details and delirium was frequently not excluded. PROSPERO registration number: CRD42021256746.

Psychiatric Care in a Novel Federal COVID-19 Treatment Center: Development of a Consultation-Liaison Psychiatry Service at the Javits New York Medical Station.

At the outset of the 2019 coronavirus disease (COVID-19) pandemic, New York City faced the highest burden of COVID-19 cases in the United States. In response, the U.S. Federal Government deployed medical providers from various uniformed services to treat patients with COVID-19 at the Jacob Javits Convention Center in New York City. There quickly arose a need for psychiatric services for patients with COVID-19 and psychological support for medical staff. Psychiatrists were tasked with establishing a consult-liaison psychiatry service in this unique environment. The authors detail the establishment of a novel consultation-liaison psychiatry service in a large convention center and explore lessons learned from this experience with the aim to empower uniformed psychiatrists to prepare for and deliver patient-focused care in pandemic settings.

Tissue-Specific Immunopathology in Fatal COVID-19.

Rationale: In life-threatening coronavirus disease (COVID-19), corticosteroids reduce mortality, suggesting that immune responses have a causal role in death. Whether this deleterious inflammation is primarily a direct reaction to the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or an independent immunopathologic process is unknown.Objectives: To determine SARS-CoV-2 organotropism and organ-specific inflammatory responses and the relationships among viral presence, inflammation, and organ injury.Methods: Tissue was acquired from 11 detailed postmortem examinations. SARS-CoV-2 organotropism was mapped by using multiplex PCR and sequencing, with cellular resolution achieved by in situ viral S (spike) protein detection. Histologic evidence of inflammation was quantified from 37 anatomic sites, and the pulmonary immune response was characterized by using multiplex immunofluorescence.Measurements and Main Results: Multiple aberrant immune responses in fatal COVID-19 were found, principally involving the lung and reticuloendothelial system, and these were not clearly topologically associated with the virus. Inflammation and organ dysfunction did not map to the tissue and cellular distribution of SARS-CoV-2 RNA and protein between or within tissues. An arteritis was identified in the lung, which was further characterized as a monocyte/myeloid-rich vasculitis, and occurred together with an influx of macrophage/monocyte-lineage cells into the pulmonary parenchyma. In addition, stereotyped abnormal reticuloendothelial responses, including excessive reactive plasmacytosis and iron-laden macrophages, were present and dissociated from viral presence in lymphoid tissues.Conclusions: Tissue-specific immunopathology occurs in COVID-19, implicating a significant component of the immune-mediated, virus-independent immunopathologic process as a primary mechanism in severe disease. Our data highlight novel immunopathologic mechanisms and validate ongoing and future efforts to therapeutically target aberrant macrophage and plasma-cell responses as well as promote pathogen tolerance in COVID-19.

The Emerging Chronic Sequelae of COVID-19 and Implications for North Carolina.

The acute morbidity and mortality of COVID-19 have been well described. Evidence is emerging that COVID-19 may also result in negative long-term medical and psychiatric outcomes. A broad response from the public health community in North Carolina that includes robust surveillance and catch-up care is needed to reduce the long-term sequelae of COVID-19.

Application of telehealth for comprehensive Creutzfeldt-Jakob disease surveillance in the United Kingdom.

Creutzfeldt-Jakob disease (CJD) is a fatal human prion disease. Surveillance systems operate globally with the goals of accurate in-life case ascertainment, appropriate public health interventions to minimise secondary transmission, and monitoring trends in disease epidemiology. The UK experienced the highest incidence of variant CJD (vCJD) in the world following widespread population exposure to bovine spongiform encephalopathy (BSE). 178 cases of vCJD have been identified in the UK by the National CJD Research & Surveillance Unit (NCJDRSU), including three cases of secondary transmission via blood transfusion. The NCJDRSU performs high-fidelity surveillance, assessing all cases of suspected CJD referred to the unit. COVID-19 has caused widespread disruption to healthcare and poses a threat to services. The NCJDRSU converted to telehealth-based surveillance in March 2020. We report the results of the application of telehealth for comprehensive CJD surveillance during the first four months of the pandemic. 59 cases were assessed for suspected CJD. In 52 cases the relatives were interviewed for an informant history, by video conference or telephone call. 34 patients underwent video examination; 1 case was examined in-person. MRI images were assessed in all cases and 46 underwent CSF testing. Feedback was obtained from interviewees and the NCJDRSU team on their experiences. 50 cases were diagnosed with sporadic CJD; 5 received an alternative diagnosis, and the remaining 4 remained unresolved, with further investigations underway. Telehealth significantly reduced time taken to assessment compared to in-person assessments in 2019. Telehealth is an effective way to provide comprehensive CJD surveillance at a national level.

COVID-19-associated brief psychotic disorder.

A 36-year-old previously healthy woman with no personal or family history of mental illness presented with new-onset psychosis after a diagnosis of symptomatic COVID-19. Her psychotic symptoms initially improved with antipsychotics and benzodiazepines and further improved with resolution of COVID-19 symptoms. This is the first case of COVID-19-associated psychosis in a patient with no personal or family history of a severe mood or psychotic disorder presenting with symptomatic COVID-19, highlighting the need for vigilant monitoring of neuropsychiatric symptoms in these individuals.