Pandemic Produce: Impacts of COVID-19 on Florida's Fruit and Vegetable Industries

Florida has one of the most diverse agricultural economies in the United States, producing several dozen types of fruits and vegetables that are consumed within the state, across the country, and around the world. The COVID-19 pandemic and resulting policy responses occurred during the peak of spring harvest season for many crops in Florida, abruptly removing market demand from the food service industry and shifting consumer purchasing habits, which enabled insights into several aspects of the fruit and vegetable supply chain. This article examines how the COVID-19 pandemic impacted fruit and vegetable industries in Florida, how these industries responded to COVID-19 impacts, and how Florida's experience compared to that of other states. Data are derived from several sources including a statewide survey that measured agricultural production losses in Florida resulting from COVID-19 in early 2020, interviews with Florida operations that provided insights into how the pandemic induced change across the food supply chain, and a survey of food supply chain operations in three regions of the United States conducted in 2021. © 2022 Walter de Gruyter GmbH, Berlin/Boston.

Stocking up and stocking out: Food retail stock-outs, consumer demand, and prices during the COVID-19 pandemic in 2020

Monitoring food retail stock-outs or the unplanned unavailability of certain food items for purchase assists policymakers in responding to food supply chain disruptions. This study focuses on identifying food stock-outs using store-level scanner data on US grocery store sales during the COVID-19 pandemic in 2020. The total median stock-out rates of fixed-weight items increased by approximately 130% after March 15, 2020. Categories such as meat and poultry products, some convenience and frozen foods, baby formula, and carbonated beverages had the highest stock-out rates. The analysis also explores the relationship between stock-out rates, sales increases, and food prices during the pandemic. Published 2023. This article is a U.S. Government work and is in the public domain in the USA.

Diversification and resilience of firms in the agrifood supply chain

Are diversified firms more resilient to negative market shocks than specialized firms? We answer this question in the context of the COVID-19 pandemic by analyzing data from small- and medium-sized firms in the U.S. agrifood supply chain. We first develop revenue-based measures of firms' vertical (across supply-chain segment) and horizontal (within supply-chain segment) diversification. We then compare post pandemic outcomes of more diversified and less diversified firms using several inverse-probability weighting techniques. We find that vertical diversification reduces firms' resilience, whereas horizontal diversification increases firms' resilience. © 2023 The Authors. American Journal of Agricultural Economics published by Wiley Periodicals LLC on behalf of Agricultural & Applied Economics Association.

Ultrahypofractionated breast radiotherapy during SARS-CoV-2 virus pandemic, beyond fast-forward trial: a local experience

Background: During the SARS-CoV-2 virus pandemic, University Hospital Birmingham NHS Trust Oncology Department incorporated the ultrahypofractionated regime of 26Gy/5 fractions alongside the moderate hypofractionated regime of 40Gy/15 fractions as part of local adjuvant breast radiotherapy treatment (RT) for eligible patients. We conducted a local study to assess the real-life experience of patients undergoing ultrahypofractionated schedule to compare feasibility and toxicity to the fast-forward trial during the COVID - 19 pandemic. Methods: A single institution, retrospective, qualitative study. Patients included had early-stage breast cancer and received adjuvant radiotherapy between 23 March 2020 and 31 May 2020, a total of 211 patients. Inclusion was irrespective of any other neoadjuvant/adjuvant treatments. Data were collected retrospectively for treatment dose, boost dose and toxicity. Results: Of the total 211 patients, 85 were treated with 26Gy in 5# and 19 patients received a boost as per the fast-forward protocol. Of these 85 patients, 15.9% did not report any skin toxicity post-treatment. 63.5% of patients reported RTOG Grade 1, 15.9% had RTOG Grade 2, and 1.6% reported RTOG Grade 3 skin toxicity. 3.2% of the patients could not be contacted for follow-up. Of the 19 patients who received a breast boost, 10.53% reported no skin changes. 78.9% reported Grade 1 skin toxicity. Both Grades 2a and 2b skin toxicity were reported by 5.26% each. The patient demographics and tumour characteristics in our study cohort were comparable to those within the fast-forward trial. In terms of post-RT skin toxicity, fewer patients reported any toxicity in the UHB patient cohort versus those in the trial, and the number of Grade 2/3 toxicities reported was also low. A delay in toxicity reporting from 2 weeks for 40Gy/15 to 3 weeks for 26Gy/5 was observed. Conclusion: Our study concluded that offering ultrahypofractionation was convenient for patients;reducing the number of hospital visits during the SARS-CoV-2 virus pandemic appeared safe in terms of acute post-RT-related skin toxicity. The reduced hospital visits limited exposure of patients and staff to the SARS-CoV-2 virus while also ensuring efficient use of Radiotherapy Department resources. Local follow-up protocols have been amended to ensure review at 3 weeks for the 26Gy/5 schedule to acknowledge the delay in acute toxicity development. To date, there is only 5-year toxicity and relapse data available from the fast-forward trial;therefore, hypofractionation schedules should be offered to patients as long as they fulfil the criteria and understand the limitations of the study as well as accelerated peer review processes in the face of the pandemic. © 2022 The Author(s).

Did the UK's public health shielding policy protect the clinically extremely vulnerable during the COVID-19 pandemic in Wales? Results of EVITE Immunity, a linked data retrospective study.

INTRODUCTION: The UK shielding policy intended to protect people at the highest risk of harm from COVID-19 infection. We aimed to describe intervention effects in Wales at 1 year. METHODS: Retrospective comparison of linked demographic and clinical data for cohorts comprising people identified for shielding from 23 March to 21 May 2020; and the rest of the population. Health records were extracted with event dates between 23 March 2020 and 22 March 2021 for the comparator cohort and from the date of inclusion until 1 year later for the shielded cohort. RESULTS: The shielded cohort included 117,415 people, with 3,086,385 in the comparator cohort. The largest clinical categories in the shielded cohort were severe respiratory condition (35.5%), immunosuppressive therapy (25.9%) and cancer (18.6%). People in the shielded cohort were more likely to be female, aged ≥50 years, living in relatively deprived areas, care home residents and frail. The proportion of people tested for COVID-19 was higher in the shielded cohort (odds ratio [OR] 1.616; 95% confidence interval [CI] 1.597-1.637), with lower positivity rate incident rate ratios 0.716 (95% CI 0.697-0.736). The known infection rate was higher in the shielded cohort (5.9% vs 5.7%). People in the shielded cohort were more likely to die (OR 3.683; 95% CI: 3.583-3.786), have a critical care admission (OR 3.339; 95% CI: 3.111-3.583), hospital emergency admission (OR 2.883; 95% CI: 2.837-2.930), emergency department attendance (OR 1.893; 95% CI: 1.867-1.919) and common mental disorder (OR 1.762; 95% CI: 1.735-1.789). CONCLUSION: Deaths and healthcare utilisation were higher amongst shielded people than the general population, as would be expected in the sicker population. Differences in testing rates, deprivation and pre-existing health are potential confounders; however, lack of clear impact on infection rates raises questions about the success of shielding and indicates that further research is required to fully evaluate this national policy intervention.

‘Every day was a learning curve’: implementing COVID-19 triage protocols in UK ambulance services – a qualitative study

BackgroundTRIM is an evaluation of the triage models used by emergency ambulance services caring for patients with suspected COVID-19 during the pandemic’s first wave in 2020. We aimed to understand experiences and concerns of staff about implementation of triage protocols.MethodResearch paramedics interviewed stakeholders from four ambulance services (call handlers, clinical advisors, paramedics, managers) and ED clinical staff from receiving hospitals. Interviews (n=23) were conducted remotely using MS Teams, recorded, and transcribed in full. Analysis generated themes from implicit and explicit ideas within participants’ accounts (Braun and Clarke 2021), conducted by researchers and PPI partners working together.ResultsWe identified the following themes:Constantly changing guidelines – at some points, updated several times a day.The ambulance service as part of the wider healthcare system - changes elsewhere in the system left ambulance services as the default.Peaks and troughs of demand - fluctuating greatly over time, and varying across the staff groups.A stretched system - resources were overextended by staff sickness and isolation, longer job times, and increased handover delays at ED.Emotional load of responding to the pandemic - including call centre staff. Doing the best they can in the face of uncertainty - a rapidly evolving situation unlike any which ambulance services had faced before.ConclusionImplementing triage protocols in response to the COVID-19 pandemic was complex and had to be actively managed by a range of frontline staff, dealing with external pressures and a heavy emotional load.Conflict of interestNone.FundingUKRI-DHSC Covid-19 Rapid Response Funding.

Mixed-methods study protocol: do national reporting and learning system medication incidents in palliative care reflect patient and carer concerns about medication management and safety?

IntroductionApproximately 20% of serious safety incidents involving palliative patients relate to medication. These are disproportionately reported when patients are in their usual residence when compared with hospital or hospice. While patient safety incident reporting systems can support professional learning, it is unclear whether these reports encompass patient and carer concerns with palliative medications or interpersonal safety.AimTo explore and compare perceptions of (un)safe palliative medication management from patient, carer and professional perspectives in community, hospital and hospice settings.Methods and analysisWe will use an innovative mixed-methods study design combining systematic review searching techniques with cross-sectional quantitative descriptive analysis and interpretative qualitative metasynthesis to integrate three elements: (1) Scoping review: multiple database searches for empirical studies and first-hand experiences in English (no other restrictions) to establish how patients and informal carers conceptualise safety in palliative medication management. (2)Medication incidents from the England and Wales National Reporting and Learning System: identifying and characterising reports to understand professional perspectives on suboptimal palliative medication management. (3) Comparison of 1 and 2: contextualising with stakeholder perspectives.Patient and public involvementOur team includes a funded patient and public involvement (PPI) collaborator, with experience of promoting patient-centred approaches in patient safety research. Funded discussion and dissemination events with PPI and healthcare (clinical and policy) professionals are planned.Ethics and disseminationProspective ethical approval granted: Cardiff University School of Medicine Research Ethics Committee (Ref 19/28). Our study will synthesise multivoiced constructions of patient safety in palliative care to identify implications for professional learning and actions that are relevant across health and social care. It will also identify changing or escalating patterns in palliative medication incidents due to the COVID-19 pandemic. Peer-reviewed publications, academic presentations, plain English summaries, press releases and social media will be used to disseminate to the public, researchers, clinicians and policy-makers.

Patient-safety incidents during COVID-19 health crisis in France: an exploratory sequential multi-method study in primary care

Background. The COVID-19 pandemic has resulted in rapid reorganization of health and social care services. Patients are already at significant risk of healthcare-associated harm and the wholesale disruption to service delivery during the pandemic stood to heighten those risks. Objective. We explored the type and nature of patient safety incidents in French primary care settings during the COVID-19 first wave to make tentative recommendations for improvement. Methods. A national patient safety incident reporting survey was distributed to General Practitioners (GPs) in France on April 28, 2020. Reports were coded using a classification system aligned to the WHO International Classification for Patient Safety (incident types, contributing factors, incident outcomes and severity of harm). Analysis involved data coding, processing, iterative generation of data summaries using descriptive statistical and thematic analysis. Clinicaltrials.gov: NCT04346121. Results. Of 132 incidents, 58 (44%) related to delayed diagnosis, assessments and referrals. Cancellations of appointments, hospitalizations or procedures was reported in 22 (17%) of these incidents. Home confinement-related incidents accounted for 15 (10%) reports, and inappropriate stopping of medications for five (4%). Patients delayed attending or did not consult their general practitioner or other healthcare providers due to their fear of contracting COVID-19 infection at an in-person visit in 26 (10%) incidents, or fear of burdening their GPs in eight (3%) incidents. Conclusion. Constraints arising from the first wave of the COVID-19 pandemic have contributed to patient safety incidents during non-COVID-19 care. Lessons from these incidents pinpoint where primary care services in France can focus resources to design safer systems for patients.

Ultrahypofractionated breast radiotherapy during SARS-CoV-2 virus pandemic, beyond fast-forward trial: a local experience

Background: During the SARS-CoV-2 virus pandemic, University Hospital Birmingham NHS Trust Oncology Department incorporated the ultrahypofractionated regime of 26Gy/5 fractions alongside the moderate hypofractionated regime of 40Gy/15 fractions as part of local adjuvant breast radiotherapy treatment (RT) for eligible patients. We conducted a local study to assess the real-life experience of patients undergoing ultrahypofractionated schedule to compare feasibility and toxicity to the fast-forward trial during the COVID - 19 pandemic. Methods: A single institution, retrospective, qualitative study. Patients included had early-stage breast cancer and received adjuvant radiotherapy between 23 March 2020 and 31 May 2020, a total of 211 patients. Inclusion was irrespective of any other neoadjuvant/adjuvant treatments. Data were collected retrospectively for treatment dose, boost dose and toxicity. Results: Of the total 211 patients, 85 were treated with 26Gy in 5# and 19 patients received a boost as per the fast-forward protocol. Of these 85 patients, 15.9% did not report any skin toxicity post-treatment. 63.5% of patients reported RTOG Grade 1, 15.9% had RTOG Grade 2, and 1.6% reported RTOG Grade 3 skin toxicity. 3.2% of the patients could not be contacted for follow-up. Of the 19 patients who received a breast boost, 10.53% reported no skin changes. 78.9% reported Grade 1 skin toxicity. Both Grades 2a and 2b skin toxicity were reported by 5.26% each. The patient demographics and tumour characteristics in our study cohort were comparable to those within the fast-forward trial. In terms of post-RT skin toxicity, fewer patients reported any toxicity in the UHB patient cohort versus those in the trial, and the number of Grade 2/3 toxicities reported was also low. A delay in toxicity reporting from 2 weeks for 40Gy/15 to 3 weeks for 26Gy/5 was observed. Conclusion: Our study concluded that offering ultrahypofractionation was convenient for patients;reducing the number of hospital visits during the SARS-CoV-2 virus pandemic appeared safe in terms of acute post-RT-related skin toxicity. The reduced hospital visits limited exposure of patients and staff to the SARS-CoV-2 virus while also ensuring efficient use of Radiotherapy Department resources. Local follow-up protocols have been amended to ensure review at 3 weeks for the 26Gy/5 schedule to acknowledge the delay in acute toxicity development. To date, there is only 5-year toxicity and relapse data available from the fast-forward trial;therefore, hypofractionation schedules should be offered to patients as long as they fulfil the criteria and understand the limitations of the study as well as accelerated peer review processes in the face of the pandemic.

Changes in Cannabis Consumption Among College Students During COVID-19

OBJECTIVE: College campuses closed in March 2020 because of the COVID-19 pandemic, disrupting the lives of students. The goal of the present study was to examine whether cannabis use changed from before campus departures prompted by COVID-19 to after campus departures and after the semester ended--and if living situation explained observed changes. We also examined changes in specific formulations of cannabis and self-reported reasons for perceived changes in use frequency. METHOD: A sample of 223 college student cannabis users (61% female) from three universities completed two online surveys (one in May 2020 assessing cannabis use pre-campus closure [pre-closure] and since campus closed [post-closure-1], and another in September 2020 assessing cannabis use since remote classes ended [post-closure-2]). RESULTS: Any use of cannabis and use of each specific formulation (leaf, edibles, concentrates) declined from pre-closure to post-closure-1, whereas the frequency of use did not change. Any cannabis use declined for those who stayed living dependently or moved to dependent living. Leaf use declined for all groups, concentrate use declined only for those who moved from independent to dependent living, and edible use declined only for those who stayed living dependently or moved to dependent living. Cannabis use did not change between post-closure-1 and post-closure-2, regardless of living situation stability or transition. CONCLUSIONS: Overall, among a sample of cannabis-using college students, the prevalence of any cannabis use, but not frequency of use, was reduced during the pandemic. Living with parents appears to be protective against frequent cannabis use.

Virtual Mentoring: A Novel Approach to Facilitate Medical Student Application to General Surgery Residency

Introduction: COVID-19 altered the landscape of medical education, disrupting the general surgery residency application process. Decreased access to clinical rotations, limited access to in-person mentors, and lack of in-person interviews, highlighted the need for mentorship programs. We examined the impact of virtual mentoring following the implementation of a novel program for trainees entering the field of general surgery. Methods: We designed an exclusively online virtual mentoring program that focused on an individualized, tailored approach in five domains: requesting letters of support, personal statement composition, resume editing, interview skills, and residency program ranking. Immediately following completion of the program, a nineteen-question electronic survey was administered. Results: 18 out of 19 participants completed the survey. Following the completion of the program participants were more confident in all five domains targeted by the program when responding to survey stems (5-point Likert scale (5-strongly agree)). Utility of the program, likelihood to recommend, and likelihood to participate again in virtual mentoring were all positive 5 [4-5]. Respondents reported less concern about the impact of COVID-19 on the application cycle. Trainees reported that virtual mentoring is likely to play an increasingly important role in training programs 5[4-5]. Participants also reported an increased confidence in the match, with a pre-program median of 67 [50 - 65] and post-program median of 84 [75-91] (0.004). Conclusion: Virtual mentoring tailored for medical students entering the match is well received and increases participant confidence. This data should be used as a framework to expand and develop virtual mentoring programs.

Effectiveness of portable air filtration on reducing indoor aerosol transmission: preclinical observational trials.

BACKGROUND: While the range of possible transmission pathways of severe acute respiratory syndrome coronavirus-2 in various settings has been investigated thoroughly, most authorities have recently acknowledged the role of aerosol spread in its transmission, especially in indoor environments where ventilation is poor. Engineering controls are needed to mitigate aerosol transmission in high-risk settings including hospital wards, classrooms and offices. AIM: To assess the effectiveness of aerosol filtration by portable air cleaning devices with high-efficiency particulate air filters used in addition to a standard building heating ventilation and air conditioning (HVAC) system. METHODS: Test rooms, including a single-bed hospital room, were filled with test aerosol to simulate aerosol movement. Aerosol counts were measured over time with various portable air cleaning devices and room ventilation systems to quantify the overall aerosol clearance rate. FINDINGS: Portable air cleaning devices were very effective for removal of aerosols. The aerosols were cleared five times faster in a small control room with portable air cleaning devices than in the room with HVAC alone. The single-bed hospital room had an excellent ventilation rate (∼14 air changes per hour) and cleared the aerosols in 20 min. However, with the addition of two air cleaning devices, the clearance time was three times faster. CONCLUSIONS: Inexpensive portable air cleaning devices should be considered for small and enclosed spaces in healthcare settings, such as inpatient rooms and personal protective equipment donning/doffing stations. Portable air cleaning devices are particularly important where there is limited ability to reduce aerosol transmission with building HVAC ventilation.

Load Balancing Schemes for Large Synthetic Population-Based Complex Simulators

We present our development of load balancing algorithms to efficiently distribute and parallelize the running of large-scale complex agent-based modeling (ABM) simulators on High-Performance Computing (HPC) resources. Our algorithm is based on partitioning the co-location network that emerges from an ABM's underlying synthetic population. Variations of this algorithm are experimentally applied to investigate algorithmic choices on two factors that affect run-time performance. We report these experiments' results on the CityCOVID ABM, built to model the spread of COVID-19 in the Chicago metropolitan region.

Neurological manifestations of patients hospitalized with COVID-19 Diagnosis at OLSU-S

Objective: To determine the spectrum of neurological manifestations among COVID-19 patients admitted to Ochsner-Louisiana State University Health Sciences Center, Shreveport (OLSU-S) after SARS-CoV-2 positive results. Background: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is associated with increased incidence and prevalence of well-defined neurological manifestations. Based on clinical reports there is vast spectrum of neurological disorders associated with COVID-19 patients including metabolic encephalopathy, cerebrovascular disease, seizure disorder, and myelopathies. Design/Methods: We conducted a retrospective, observational study of hospitalized adult patients (age > 18 years) admitted to OLSU-S with laboratory confirmed SARS-COV-2. All clinical data was reviewed including epidemiology, clinical features, laboratory data, neuroradiological findings, hospital management and course from 150 patients hospitalized for COVID-19 management at OLSU-S. Results: We screened 150 patients admitted to OLSU-S with COVID-19 for the development of neurological diagnosis during their hospital course. 19 (12.66%) patients presented with new neurological signs and symptoms and were subsequently diagnosed with a neurological disorder With in the active COVID-19 infection period. The most common new neurological manifestation seen with COVID-19 was acute cerebrovascular accidents (CVA) (6%) followed by encephalopathy (4.66%), seizures (4%) and Guillain-Barre like syndrome (1.33%). The mean age of patients with neurological diagnosis was 60.74 ± 14.58 (standard deviation) (age range 25-76). The common neuroradiological diagnosis on COVID-19 patients with acute CVA includes middle cerebral artery infarction, venous infarction and hemorrhagic CVA. The most common EEG findings was diffuse background slowing consistent with moderate encephalopathy. 26% of the patients with new neurological diagnosis during acute COVID-19 had rapid clinical deterioration resulting in death. Conclusions: Our observations confirm the increased incidence of neurological manifestations seen in COVID-19 patients, with the elderly population being more susceptible. The subsequent development of a neurological disorder during COVID-19 was found to be associated with worse clinical outcomes and an overall poor prognosis.