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Objectives: Post COVID-19 conditions or long COVID continues to burden the healthcare system. With the introduction of new code in October 2021 to appropriately capture this condition (U09.9), we have enough data to understand the detailed demographic and clinical characterization of the patients with long COVID. As this new clinical entity continues to evolve, our study will provide insights for care management and planning. Method(s): We conducted a retrospective cohort study from a large deidentified database of US health insurance claims. The study population included all individuals with at least one ICD-10 code for COVID (U07.1) between June 1, 2021, and November 30, 2022. Individuals with at least one ICD-10 code for long COVID (U09.9), at least 7 days after COVID diagnosis were termed "Long COVID" patients. Index date was defined as the first long COVID diagnosis date. We also assessed the most prevalent diagnosis codes within the 30 days pre- and post-index to understand top symptoms. Result(s): A cohort of 253,145 patients (62% female patients;38% male patients) were identified. Among this cohort, 3.2% were pediatric patients aged 0 - 17 years;73.3 % aged 18 - 64 years and 23.5 % aged 65+ years. Most prevalent symptoms that increased in the 30 day pre- and post-index: Nervous system symptoms (6 fold), fatigue (7 fold), Dyspnea (4.3 fold), esophagitis (1.6 fold) chronic kidney disease (1.3 fold) among others. Conclusion(s): Our findings indicate that long COVID is more prevalent in females, with fatigue and dyspnea emerging as top symptoms. These findings are consistent with the published literature. However, we uncovered additional symptoms such as nervous system symptoms, chronic kidney disease among others. Additional analysis is planned to evaluate the association of these symptoms with sociodemographic features to understand the health inequity aspects of long COVID.Copyright © 2023
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Background: Cystic fibrosis-related diabetes (CFRD) is the most common comorbidity in people with cystic fibrosis (CF), affecting approximately 20% of adolescents and 40% to 50% of adults [1]. CF care guidelines recommend screening for CFRD using the 75-gram 2-hour oral glucose tolerance test (OGTT) yearly beginning at 10 years old. Our CF center had a below-average percentage of eligible patients adequately screened for CFRD (65% total screened [only 36% with recommended OGTT] vs ~63% nationally) because of use of a non-preferred screening method and a wide clinic catchment area.We initiated a quality improvement project to increase the percentage of eligible people with CF appropriately screened according to recommended CF care guidelines. Method(s): We began in 2019 by reviewing current data and processes to understand our baseline, goals, and anticipated barriers. We then established the goals of our project with proposed interventions and obtained institutional reviewboard approval. The three goals of our project were to fully eliminate use of the non-preferred screening method by the end of 2020, streamline local OGTT location options for families that live far from our CF center, and increase the percentage of eligible patients screened via OGTT by 20% by the end of 2020.We accomplished these goals by educating families regarding the recommended CFRD screening by OGTT in our CF newsletter;surveying families on how, when, and where they would like to complete their OGTT;and creating an OGTT informational brochure including three selected locations across our clinic geographical coverage area where OGTT can be reliably obtained. An additional goal was added in January 2022 because our percentage of appropriately screened patients dropped in 2021.We aimed to increase our percentage of eligible patients screened by 10% for the year. We are doing this by changing the location of an outlying OGTT facility after receiving negative feedback from our patients. Result(s):We fully eliminated use of the non-preferred screening method by 2020;all patients screened in 2020 were done by OGTT. We increased our total screening percentage from 65% in 2019 to 86% percent in 2020, despite difficulties created by the COVID pandemic. Our screening percentage dropped to 78% in 2021, but we have worked to offer OGTT at one of our associated pediatric clinic locations to better serve families. Conclusion(s): Using traditional quality improvement methods and processes, we eliminated use of a non-preferred CFRD screening method in our pediatric CF clinic. We have increased our screening rates to above the national average and continue to work on improving the CFRD screening process for our patients and families.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved
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Background Prolonged wait times for Transcatheter Aortic Valve Replacement (TAVR) are associated with increased mortality. Rural health care systems may have challenges in efficiency due to travel related delays. We determined temporal trends and predictors of Short TAVR Wait Time (STWT: TAVR <=30 days from first referral). Methods We identified 918 consecutive patients with Aortic Stenosis (AS) undergoing TAVR from 1/1/19-6/30/22 at a rural tertiary care center. Patients with wait times?>90 days (N=87) were excluded due to patient preferences or treatment of comorbidities. We assessed TAVR wait times (means and STWT%) over time and determined the impact of COVID 19 onset (3/1/20) and driving distance on TAVR efficiency. Results Half of the cohort achieved STWT (51%). TAVR volumes, patient age, sex, and comorbidities were generally stable over time. Mean wait times decreased despite the onset of COVID 19: pre-COVID 36+/- 19 vs post-COVID 31+/- 19 days (p=0.003) (Figure). There was no interaction of travel distance and mean wait time: 33+/- 19 days <= 60 miles vs 32+/- 19 days?> 60 miles (P=NS). Conclusion TAVR efficiency improved over the past 4 years with one half of patients experiencing a STWT. Neither COVID 19 nor long travel distance negatively impacted TAVR efficiency in a rural health care network. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
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The aim of the study was to investigate the presence of volatility among the Energy Indices of Asia Pacific Stock Markets. To test the volatility among the daily returns of Energy Indices of Asia Pacific Stock Markets, the study selected five sample Asian Pacific stock markets' Energy Indices on the basis of availability of data. The findings of descriptive statistics and the ADF Test revealed, that the daily returns of the sample energy indices of Asian Pacific stock markets were not normally distributed and achieved stationarity at level difference, over the research period. Hence the data may be used for additional analysis. The data were then analysed, by using the GARCH (1,1) model to assess the considerable volatility of daily returns of sample energy indices and the study, which revealed that during the study period, all of the sample energy indices were volatile.
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This study examined the impacts of COVID-19 on changes in route-level transit demand across five transit agencies in the state of Florida. Data for 120 routes from five transit agencies were used to develop two-stage instrumental variable models. Data from January of 2019 to December of 2020 were used in the analysis. Routes that served a greater mix of land-uses experienced a smaller decline in ridership. The impacts of several other land-use variables were, however, not consistent across the five transit agencies. Fare suspension was estimated to have a positive impact on ridership. In contrast, occupancy reduction measures (to promote social distancing within the transit vehicle) had a very strong negative impact on demand. The magnitude of the negative impact of occupancy reduction was larger than the positive impacts of fare suspension. Extending this analysis to a larger set of routes across more agencies would be useful in enhancing the robustness of the findings from our models. Extending our analysis to include data from 2021 and later to capture the recovery phase is also an important direction for future work. © 2022
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Introduction: Risk of congenital heart disease (CHD) for in vitro fertilization (IVF) pregnancies is higher than the general population, though other factors may be involved. IVF is an indication for fetal echocardiogram (FE), however there is center variation to perform FE without a secondary indication if the anatomy ultrasound (AU) is normal. We aim to assess the number of new CHD diagnoses following normal AU in IVF-only pregnancies. Hypothesis: We hypothesize that there is minimal benefit to a FE in IVF-only pregnancies with a normal AU and may result in overutilization of resources. Method(s): Retrospective chart review from 2016-2021 of all IVF pregnancies with and without a secondary indication for FE at our center. Those without FE during the COVID-19 pandemic were included to assess postnatal CHD detection. Patients were classified as IVF-only if they had a normal AU and no secondary indication for FE;all others classified as IVF+other. Maternal and fetal demographics, AU, FE, and postnatal echo (post-echo) data was obtained. Result(s): A total of 556 maternal and 628 fetal patients from IVF pregnancies were included;401 fetuses were IVF-only with a FE, 116 were IVF-only with no FE, the remaining were IVF+other. There was no complex CHD (CCHD) in either IVF-only groups, the FE group detected several minor findings, and the no FE group detected three small septal defects on post-echo (Table 1). The probability of a normal postnatal evaluation in IVF-only with a normal FE was 94% and with no FE was 96%. Minor variations found on FE triggered additional testing (71 total FE in 43 fetuses) and detected a few minor CHD, none requiring intervention. Conclusion(s): Given low-risk for CCHD in IVF-only pregnancies, there is minimal benefit to a FE in the setting of a normal comprehensive AU and raises questions of cost vs. benefit of FE. This may impact future recommendations for indications for FE in the setting of IVF-only without added risk factors for CHD.
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Body Arterial and venous thrombosis were documented in moderately and critically ill COVID-19 patients. They included peripheral deep venous thrombosis, pulmonary thrombo-embolism and major arterial thrombosis.In this pictorial review, we share the spectrum of thrombo-embolic manifestations we encountered in patients with Sars-Cov-2 infection. Learning Objectives: To be aware of spectrum of thrombotic complications of COVID-19 Background: COVID-19 has been linked to hypercoagulability as well as a high rate of thrombotic events in clinically unwell patients. Conclusion(s): Prompt thrombo-prophylaxis helped in reducing the incidences and complications.
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Aim: To evaluate the change in the quality of student’s life, mindset, and their varied addiction levels before and during the COVID-19 lockdown. Materials and methods: This survey was conducted among the student community involving 487 participants from various courses. The questions were structured in a multiple-choice format and the questionnaire was circulated among the student body through various online forums using Google Forms. The questionnaire consisted of 19 questions apart from the demographic data of the participants, out of which, 18 were close-ended questions and one question was open-ended. The participants were questioned in detail about their lifestyle before and after the lockdown period, change in mindset, gadget addiction, and sleep pattern. The participants were allowed to answer the questionnaire for a month. All the responses were collected and tabulated in an Excel sheet. The tabulated data were later statistically analyzed using SPSS software. Results: In total, 487 persons participated in the survey;92.6% of the participants agreed to an increase in their screen time during the COVID-19 quarantine. Participants also admitted that the number of hours spent with gadgets among participants was only 2–4 or 4–6 hours before the lockdown to longer hours of mobile usage (6–8 hours and 8–10 hours) during the lockdown. About 58.3% of participants felt that their sleep pattern was adversely affected which has led to 44.8% of the individuals feeling lethargic and sleepy during the daytime. Conclusion: These findings suggest that there is a significant spike in the amount of screen time among the participants. This sudden increase in gadget usage has also been shown to have a negative influence on the individual’s physical and psychological well-being by altering their sleep cycle and making them increasingly irritable. Clinical significance: COVID-19 lockdown has brought a paradigm shift in our dependence on technology to perform key tasks in our everyday life. This increase in technological dependency has also resulted in a proportional increase in the number of young adults suffering from a myriad of mental illnesses. It is essential for parents and educational institutions to be aware of the ill effects of gadget addiction, so as to recognize and offer the appropriate help when required. © The Author(s). 2022.
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BACKGROUND: Gastrointestinal (GI) symptoms such as nausea and diarrhea have been reported in patients with SARS-CoV-2 coronavirus (COVID-19). However, outcomes of patients with COVID-19 and GI symptoms and risk factors associated with poor outcomes in this patient population have not been assessed. METHODS: The study cohort was derived from the Cerner Real World Data (CRWD) COVID-19 Database inclusive of emergency department and hospital encounters with COVID-19 infection from December 1, 2019, to November 30, 2020. Baseline demographics, comorbidities, hospital characteristics, and GI symptoms were obtained. The outcomes of interest were mortality, acute respiratory distress syndrome (ARDS), sepsis, and ventilator requirement/oxygen dependence. Multivariate logistic regression analysis was performed to assess predictors of poor outcomes in hospitalized COVID-19 patients with GI symptoms. RESULTS: Of 100,902 patients with COVID-19 infection, 19.7% reported GI symptoms. Those with GI symptoms had a significantly higher prevalence of comorbidities and underlying chronic GI conditions (Table 1). In patients with COVID-19 and GI symptoms, advanced age was associated with a higher risk of overall mortality, ARDS, sepsis, and ventilator requirement/oxygen dependence (Table 2);whereas the female gender was associated with a lower risk of mortality (OR 0.68, 95% CI 0.61, 0.76), ARDS (OR 0.68, 95% CI 0.60, 0.77), and sepsis (OR 0.70, 95% CI 0.64, 0.75). A higher Charlson Comorbidity Index was also associated with higher mortality, ARDS, sepsis, and ventilator requirement/oxygen dependence-Table 2. Finally, history of PPI and H2RA use (minimum duration 1 month) was associated with an increased risk of mortality (OR 1.48, 95% CI 1.32, 1.66) and (OR 1.78, 95% CI 1.57, 2.02), ARDS (OR 2.19, 95% CI 1.91, 2.50) and (OR 3.75, 95% CI 3.29, 4.28), sepsis (OR 1.88, 95% CI 1.73, 2.05) and (OR 2.50, 95% CI 2.28, 2.73);and ventilator requirement/oxygen dependence (OR 1.73, 95% CI 1.48, 2.02) and (OR 1.97, 95% CI 1.68, 2.30) respectively. CONCLUSION: GI symptoms are reported by 1 in 5 patients admitted to the hospital with COVID-19. Advanced age, male gender, a higher comorbidity score, and use of acid suppression medications (PPI/ H2RA) were associated with poor outcomes including death
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Background: Diarrhea is present in up to 36.6% of patients with COVID-19. The mechanism of SARS-CoV-2-induced diarrhea remains unclear. We hypothesized that enterocyte-enteric neuron interactions were important in SARS-CoV-2-induced diarrhea. SARS-CoV-2 induces endoplasmic reticulum (ER) stress in enterocytes causing the release of Damage Associated Molecular Patterns (DAMPs). The DAMPs then stimulate the release of enteric neurotransmitters that disrupt gut electrolyte homeostasis. The influence of ER stress and enteric neuronderived vasoactive intestinal peptide (VIP) on the expression of Na+/H+ exchanger 3 (NHE3), an important transporter that mediates intestinal Na+/fluid absorption, was further examined. Methods: SARS-CoV-2 propagated in Vero-E6 cells was used to infect Caco-2, a human colon epithelial cell line that expresses SARS-CoV-2 entry receptor ACE2. The expression of ER stress markers, phospho-PERK, Xbp1s, and DAMP proteins, was examined by Western blotting. Primary mouse enteric neurons were treated with a conditioned medium of Caco- 2 cells that were infected with SARS-CoV-2 or treated with tunicamycin. VIP expression by cultured enteric neurons was assessed by RT-qPCR, Western blotting, and ELISA. Membrane expression of NHE3 was determined by surface biotinylation. Results: SARS-CoV-2 infection of Caco-2 cells led to increased expression of phospho-PERK and Xbp1s indicating increased ER stress. Infected Caco-2 cells secreted DAMP proteins, including HSP70 and calreticulin, as revealed by proteomic and Western analyses. The expression of VIP mRNA in enteric neurons was up-regulated after treatment with a conditioned medium of SARS-CoV-2- infected Caco-2 cells (Mock, 1 ± 0.0885;and SARS-CoV-2, 1.351 ± 0.020, P=.005). CD91, a receptor for HSP70 and calreticulin, is abundantly expressed in cultured mouse and human enteric neurons and was up-regulated by a conditioned medium of SARS-CoV-2-infected Caco-2 cells. Tunicamycin, an inducer of ER stress, also induced the secretion of HSP70 and calreticulin, mimicking SARS-CoV-2 infection. Moreover, co-culture of enteric neurons with tunicamycin-treated Caco-2 cells stimulated VIP production as determined by ELISA. Co-treatment of Caco-2 cells with tunicamycin (apical) and VIP (basolateral) induced a synergistic decrease in the membrane expression of NHE3. Conclusions: Our findings demonstrate that SARS-CoV-2 infection of enterocytes leads to ER stress and the release of DAMPs that up-regulate the expression and release of VIP by enteric neurons. The presence of ER stress together with the secreted VIP, in turn, inhibits fluid absorption through the downregulation of brush-border membrane expression of NHE3 in the enterocytes. These data highlight epithelial-neuronal crosstalk in COVID-19 related diarrhea. (Figure Presented)
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Background: Prior studies have shown no additional risk of severe outcomes in patients with inflammatory bowel disease (IBD) from COVID-19 infection unless they are experiencing disease flare or on steroids. Whether COVID-19 infected patients with IBD have worse outcomes than those without IBD is not clear. Aims: To examine risk factors for worse outcomes related to COVID-19 infection in IBD patients. Methods: The study cohort was derived from the Cerner Real World Data (CRWD) COVID-19 Database inclusive of hospitalized patients with COVID-19 infection from December 1, 2019 through November 30, 2020. Baseline demographics, comorbidities, and hospital characteristics were acquired. IBD patients were propensity-matched in 1:2 fashion to controls (those without IBD) to compare proportions of patients who experienced death, or worse outcomes such as acute respiratory distress syndrome (ARDS), mechanical ventilation and sepsis using odds ratio (OR) with 95% confidence intervals (CI). The impact of immune suppressing medications (steroids and biologics) among patients with ulcerative colitis (UC) and Crohn's disease (CD) was also examined. Results: Of 100,902 COVID-19 positive hospitalized patients, 316 (0.3%) were found to have a personal history of IBD: UC=148 and CD=172 (mean age: 49.5±20.9 years, 56% females;Table 1). Overall mortality was not significantly higher in COVID-19 hospitalized patients who had IBD compared to those without IBD (10.8% vs 8.5%;p= 0.79). On propensity-matching, there was no significant difference found between IBD patients on steroids (n=124) and non-IBD patients on steroids (n=161) for mortality (p= 0.45), mechanical ventilation (p=0.68), ARDS (p=0.30) or sepsis (p=0.50) -table 2. IBD patients on biologics (and other immunosuppressors) were not found to have any significant difference in these outcomes when compared to matched non-IBD patients on other immunosuppressors: mortality (p=0.23), ARDS (p=0.056) or sepsis (p=0.19). Conclusion: In this large real-world data of hospitalized COVID-19 patients, IBD accounted for < 0.5% of total admissions and those with IBD did not have worse outcomes or increased mortality compared to those without IBD, including those takings immune suppressive medications (Table Presented) (Table Presented)
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Objectives: To assess the effectiveness of virtual peer teaching in easing neurophobia among preclinical medical students at Cardiff University. Design: Quantitative research. Subjects: 94 Year two medical students at Cardiff University. Methods: An evaluative study was conducted to assess the prevalence of neurophobia and the effects of our teaching on it. This was assessed by comparing confidence, anxiety, and neurophobia levels pre-and post-session on a 5-point Likert scale. The quantitative data were collected based on thematic questions (anatomy, physiology, radiology, bone disease, and pathology) relevant to the session with only one correct answer for each question. Results: 62.7% of the students found neurological and neurosurgical concepts the most difficult to learn in medical school (3.70 ± 1.77). We found that the reported scores of neurophobia (3.22 ± 1.60 to 1.39 ± 1.72) and anxiety (3.59 ± 1.71 to 2.99 ± 1.58) decreased, while confidence (2.79 ± 1.60 to 3.71 ± 1.77) increased after one virtual teaching session. We also saw an overall average increase in knowledge across all five quantitative domains by 20.7%. Conclusions: Neurophobia remains rife amongst medical students, even in their preclinical years. Despite difficulties with face-to-face teaching during the COVID-19 pandemic, our results strongly indicate that virtual teaching sessions can effectively alleviate neurophobia and improve clinical neuroscience knowledge.1,2.
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COVID-19 is a real life-threatening disease which has locked up the whole Globe. In spite of the rapid sharing of information and inculcating social responsibilities by multiple factor such as personal hygiene, social distancing and self-isolation the spread of COVID19 is increasing day by day. Controlling the spread of disease in early stage becomes the primary responsibility of the government. The judicial administration along with the health-care workers struggles tirelessly to flatten the curve by taking measure to reduce the spread of disease. The primary objective of this paper is to help the government in this aspect of buying time to control the spread of virus. World Health Organisation notified that “COVID-19 is transmitted via droplets and fomites during close unprotected contacts between an infector and infected.” Hence the key strategy should focus on preventing the virus before becoming a community transmission. Locating the area of very high possibilities of COVID victims becomes the highest priority to block transmission. This can be done by identifying the parameters which influence the spread of disease and applying on the large volume of data obtained by the area wise survey information. In this paper a decision tree is built using Iterative Dichotomiser (ID3) and it is further compared using Naive Bayes classification algorithm to check the accuracy of the result obtained by ID3. The obtained result of tested data is further solved and an improvised optimal decision tree is build which is used to identify and block the area of highest risk factor. © The Electrochemical Society
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Since 2020 working from home has, for many, become the norm since the outbreak of the COVID-19. Furthermore, with large public gatherings either prohibited, limited, or subject to social distancing measures live theatre performed in front of a live audience have been deeply affected. This project experiments with executing performances from home to enable theatre actors to continue to practice and connect with audiences. A series of experiments were conducted to test the possibility of having performers or actors conducting performance from their personal spaces and integrating their work using virtual reality in a combined space for an audience to engage with. This research aims to examine Virtual Reality as an assistive technology in contexts such as theatre performance and use of digital environmental design for actors and performers. The nature of this research project was to determine various scenarios in which a virtual 3D environment can enable, assist and/or enhance a theatre performance for both audience and the actors. For this project a 3D virtual theatre setup was designed, experienced and evaluated by participants drawn from theatre practitioners in the context of focus groups. This article reports on the design and practitioners’ responses and how it resulted in an informed VR solution for theatre performance. © 2022 IMCIC 2022 - 13th International Multi-Conference on Complexity, Informatics and Cybernetics, Proceedings. All rights reserved.
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Corona pandemic has affected the daily routine of life disturbing the trade and economic globally. Wearing a mask has become compulsory and a new tradition. within the close to future, several suppliers can raise the shoppers to wear masks properly. Therefore, detection of face mask has become one of the important tasks to assist the international society. This paper provides a easy and simplified approach to detect the face masks using some of the important Machine Learning packages like TensorFlow, Keras, OpenCV and Scikit-Learn. The projected methodology detects the face from the image properly and so identifies if it's a mask thereon or not. As a police work task performing artist, it may detect a face together with a mask in motion. the tactic gives an accurate output with an accuracy of 96.77% on dataset. The model tendency to find the optimized values of parameters are employed using Convolutional Neural Network (CNN) model to identify whether the masks are worn properly or not while not inflicting over-fitting. © 2021 IEEE.
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Newly emerged pathogens such as SARS-CoV-2 highlight the urgent need for assays that detect levels of neutralizing antibodies that may be protective. We studied the relationship between anti-spike ectodomain (ECD) and anti-receptor binding domain (RBD) IgG titers, andSARS-CoV-2 virus neutralization (VN) titers generated by two different in vitro assays using convalescent plasma samples obtained from 68 COVID-19 patients, including 13 who donated plasma multiple times. Only 23% (16/68) of donors had been hospitalized. We also studied 16samples from subjects found to have anti-spike protein IgG during surveillance screening of asymptomatic individuals. We report a strong positive correlation between both plasma anti-RBD and anti-ECD IgG titers, and in vitro VN titer. Anti-RBD plasma IgG correlated slightly better than anti-ECD IgG titer with VN titer. The probability of a VN titer 160 was 80% or greater with anti-RBD or anti-ECD titers of 1:1350. Thirty-seven percent (25/68) of convalescent plasma donors lacked VN titers 160, the FDA-recommended level for convalescent plasma used for COVID-19 treatment. Dyspnea, hospitalization, and disease severity were significantly associated with higher VN titer. Frequent donation of convalescent plasma did not significantly decrease either VN or IgG titers. Analysis of 2,814 asymptomatic adults found 27 individuals with anti-RBD or anti-ECD IgG titers of 1:1350, and evidence of VN1:160. Taken together, we conclude that anti-RBD or anti-ECD IgG titers can serve as a surrogate for VN titers to identify suitable plasma donors. Plasma anti-RBD or anti-ECD titer of1:1350 may provide critical information about protection against COVID-19 disease.
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In light of Covid-19, McMaster University abruptly transitioned all classes to an online format in Winter 2020, with online classes continuing through the Winter 2021 term. To improve our existing technological framework for the delivery of online courses, we surveyed undergraduate students in McMaster University's engineering program to assess their online learning preferences and their experience of the transition from in-class to strictly online learning. We identified student preferences for educational video type, number, duration and identified barriers to an online learning environment. In addition to outlining the students' perspective, we present our findings in the context of the students' learning by contrasting student learning in the online environment with the learning of earlier cohorts in the in-person environment (i.e., before the pandemic). We assess learning via student performance in exams and assignments for each course. After considering the student's perspective and learning outcomes, we provide recommendations for an optimal content delivery methodology in an online learning environment.