The Use of Geographic Information Systems to Shape COVID-19 Policies Regarding Masking and Distancing with a Partially Vaccinated Population

Geographic information systems (GIS) and choropleth maps for COVID-19 cases as well as COVID-19 test and vaccination rates proved very valuable to informing decision-making on the local and regional levels of government in Shelby County, Tennessee, USA. The authors have all served on the City of Memphis and Shelby County COVID Joint Task Force and share here their observations about the challenges and promises related to these techniques in the context of a fast-changing environment. As the pandemic unfolded, new virus variants emerged and the population became increasingly vaccinated. Consequently, the use of GIS changed, and maps needed to be continually adapted to the shifting needs of decision makers. The authors describe their approaches to leveraging GIS techniques to monitor the spread of the disease, draw conclusions about the effect of policy measures, and address health disparities. They outline the strengths and weaknesses of choropleth maps, reflect on how best to facilitate interorganizational communication of the derived information, and suggest desirable aspects of educational courses for GIS as well as skill sets in personnel that they came to appreciate as essential. © 2023 Taylor and Francis Group, LLC.

Quality of Life in Adolescents and Young Adults With a Chronic Medical Condition: The Role of Perceived Maturity and Transition Readiness.

INTRODUCTION: Adolescents and young adults (AYA) with a chronic medical condition (CMC) attending college must learn to manage their own healthcare (i.e., transition readiness). Maturity has been linked to positive outcomes in AYAs. Research has established a positive relationship between transition readiness and quality of life. The current study aimed to examine a model of perceived maturityàtransition readinessàmental and physical quality of life. METHOD: AYA (N = 153) with a CMC completed self-report questionnaires. RESULTS: The perceived maturity→transition readiness→mental quality of life indirect path was significant (ab = 1.96, 95% CI = 0.53 to 3.62). The perceived maturity→transition readiness→physical quality of life direct and indirect paths were not significant. DISCUSSION: Results showed that maturity and transition readiness are positively associated. Transition readiness may be one mechanism by which maturity results in enhanced quality of life. PRACTICE IMPLICATIONS: Findings highlight the value of enhancing strengths such as maturity to promote AYA independence/autonomy.

The Big Sibling program: Impact of a medical student-resident mentorship program during the surgery clerkship.

BACKGROUND: We created a Big Sibling mentorship program for medical students and studied the program effects. METHODS: Between July 2019 to December 2020, students completing their surgery clerkship were paired with a Big Sibling surgical research resident. Participation in and perceptions of the program were assessed by survey. RESULTS: 81 medical students and 25 residents participated with a 79% and 95% survey response rate, respectively. The most valuable topics discussed included ward skills, personal development and career advising. Students who interacted >2 times with their Big Sibling were more likely to perceive the operating room as a positive learning environment, view attendings as role models, and receive mentoring and feedback from residents and attendings (p = 0.03, 0.02, 0.01 respectively). 78% of residents thought the program was a positive experience and no residents found it burdensome. CONCLUSION: The Big Siblings program enhances the surgery clerkship learning environment. Students who engaged with their Big Sibling had a more positive view of the clerkship and the mentorship provided by residents and attendings.

Exploring the Untapped Potential of Library-University Partnerships: A Focus on Early Learning

US Public libraries are ideal contexts to support early learning and family engagement. However, they are still not fully connected with the early childhood systems within their communities, limiting their potential impact to prepare children and families for the transition to formal schooling. Further, COVID-19 has exacerbated existing barriers to library access, particularly for historically marginalized populations. To address this gap, we contend that public library-university partnerships are one way public libraries can improve their impact and expand their reach. Public libraries and developmental researchers share similar goals and possess complementary expertise that makes a partnership approach to collaboration mutually beneficial. © 2021 The Author(s). Published with license by Taylor & Francis Group, LLC.

Association between Receipt of COVID-19, Influenza, and Pneumococcal Vaccination

Background. Whether receipt of COVID-19 vaccine associates with receipt of other routinely-recommended adult vaccines such as, influenza and pneumococcal vaccines is not well described. We evaluated this relationship in a population of adults who were hospitalized for acute respiratory infection (ARI). *Odds ratio describing odds of receiving at least one COVID-19 vaccine (vs not) by influenza vaccination status adjusted for race, employment status, chronic cardiac diseases, cancer, solid organ transplant, and chronic kidney disease. **Odds ratio describing odds of receiving at least one COVID-19 vaccine (vs not) by pneumococcal vaccination status adjusted for race and chronic kidney disease. Methods. We enrolled adults (>= 18 years of age) who were hospitalized at Emory University Hospital and Emory University Hospital Midtown with symptoms consistent with ARI. Participants were interviewed and medical records ed to gather demographic information, including social behaviors during the pandemic, medical history, and prior vaccination history (i.e., COVID-19, influenza, and pneumococcal). Using two separate logistic regression analyses, we determined the association between i) receipt of influenza vaccine in the prior year among adults >= 18 years and ii) receipt of any pneumococcal vaccine in the prior 5 years among adults >= 65 years on the receipt of at least one COVID-19 vaccine>= 14 days prior to admission. Adjusted models included demographic information (e.g., age, sex, race/ethnicity, employment status), social behaviors, and history of chronic medical conditions. Results. Overall, 1056 participants were enrolled and had vaccination records available. Of whom, 509/1056 (48.2%) had received at least one dose of COVID-19 vaccine. Adults >= 18 years who received influenza vaccine were more likely to have received >=1 dose of COVID-19 vaccine compared to those who did not (267/373 [71.6%] vs 242/683 [35.4%] P=< .0001;adjusted odds ratio [OR]: 3.3 [95%CI: 2.4, 4.4]). Similarly, adults >=65 years who received pneumococcal vaccine were more likely to have received >= 1 dose of COVID-19 vaccine compared to those who did not (195/257 [75.9%] vs 41/84 [48.8%] P=< .0001;adjusted odds ratio [OR]: 3.0 [95% CI: 1.8, 5.1]). Conclusion. In this study of adults hospitalized for ARI, receipt of influenza and pneumococcal vaccination strongly correlated with receipt of COVID-19 vaccination. Continued efforts are needed to reach adults who remain hesitant to not only receive COVID-19 vaccines, but also other vaccines that lessen the burden of respiratory illness.

Social Risk Factors for COVID-19-Related Hospitalizations in Adults

Background. During the COVID-19 pandemic, social interventions such as social distancing and mask wearing have been encouraged. Social risk factors for SARS-CoV-2 infection and subsequent hospitalization remain uncertain. Methods. Adult patients were eligible if admitted to Emory University Hospital or Emory University Hospital Midtown with acute respiratory infection (ARI) symptoms (<= 14 days) or an admitting ARI diagnosis from May 2021 - Feb 2022. After enrollment, an in-depth interview identified demographic and social factors (e.g., employment status, smoking history, alcohol use), household characteristics, and pandemic social behaviors. All patients were tested for SARS-CoV-2 using PCR. We evaluated whether these demographic and social factors were related to a positive SARS-CoV-2 test upon admission to hospital with ARI using a logistic regression model. Results. 1141 subjects were enrolled and had SARS-CoV-2 PCR results available (700 positive and 441 negative). The median age was greater in the SARS-CoV-2 negative cohort than in the positive cohort (60 and 53 years, respectively;P< .0001). Those who tested positive were more likely to have had at least some college education compared to those who tested negative (64.3% vs 52.3%, P< .0001;adjusted odds ratio [aOR]: 1.4 [95%CI: 1.1, 2.0]). Compared to those who tested negative, those who were SARS-CoV-2 positive were also more likely to be employed (48.9% vs 26.5%, P< .0001;aOR: 1.7 [95%CI: 1.1, 2.3]), have children 5-17 yo at home (27.6% vs 17.9%, P=.0002;aOR: 1.5 [95%CI: 1.1, 2.1]). Those with COVID-19 were less likely to receive home healthcare (6.2% vs 13.3%, P< .0001;aOR: 0.5 [95%CI: 0.4, 0.9]) and to be a current or previous smoker (7.6% vs 17.7%, P< .0001;aOR: 0.3 [95%CI: 0.2, 0.5]). Conclusion. Among adults admitted to the hospital for ARI, those who tested positive for SARS-CoV-2 were typically younger, more likely to care for school-aged children, more likely to work outside the home, but were less likely to receive home healthcare or smoke. Personal and public health strategies to mitigate COVID-19 should take into consideration modifiable social risk factors.

Prior SARS-CoV-2 infection and risk of subsequent COVID-19-related hospitalization: a test negative design

Background. Studies show that past SARS-CoV-2 infection provides a protective immune response against subsequent COVID-19, but the degree of protection from prior infection has not been determined. History of previous SARS-COV-2 Infection and Current SARS-COV-2 Infection Status at Admission. *Adjusted for chronic respiratory disease and prior COVID-19 vaccination Methods. From May 2021 through Feb 2022, adults (>= 18 years of age) hospitalized at Emory University Hospital and Emory University Hospital Midtown with acute respiratory infection (ARI) symptoms, who were PCR tested for SARS-CoV-2 were enrolled. A prior history of SARS-CoV-2 infection was obtained from patient interview and medical record review. Previous infection was defined as a self-reported prior SARS-CoV-2 infection or previous evidence of a positive SARS-CoV-2 PCR test >= 90 days before ARI hospital admission. We performed a test negative design to evaluate the protection provided by prior SARS-CoV-2 infection against subsequent COVID-19-related hospitalization. Effectiveness was determined using logistic regression analysis adjusted for patient sociodemographic and clinical characteristics and COVID-19 vaccination status. Results. Of 1152 adults hospitalized for ARI, 704/1152 (61%) were SARS-CoV-2 positive. 96/1152 (8%) had a prior SARS-CoV-2 infection before hospital admission. Patients with a previous history of SARS-CoV-2 infection were less likely to test positive for SARS-CoV-2 upon admission for ARI compared to those who did not have evidence of prior infection (31/96 [32%] vs 673/1056 [64%];adjustedOR: 0.25 [0.15, 0.41] (Table). Conclusion. Reinfections represented a small proportion (< 10%) of COVID-19-related hospitalizations. Prior SARS-CoV-2 infection provided meaningful protection against subsequent COVID-19-related hospitalization. The durability of this infection-induced immunity, variant-specific estimates, and the additive impact of vaccination are needed to further elucidate these findings.

FINANCIAL HARDSHIPS AND DEPRESSIVE SYMPTOMS DURING COVID: THE MODERATING ROLE OF RESILIENCE

Financial hardships during COVID (FHDC) are a particularly salient stressor that older people faced during the pandemic. Financial stress is associated with increased depressive symptoms and may be especially consequential to mental health among older people who have fewer resources (i.e., financially vulnerable). Recent evidence shows that psychological resilience has important protective effects for mental health among older adults who experience major stressors. This study, based on the recently released full 2020 core wave of the Health and Retirement Study, examines the association between having experienced one or more major financial setbacks following the start of the pandemic and depressive symptoms. We evaluate the consequences of FHDC for mental health, how FHDC are associated with previous financial vulnerability, and the role of psychological resilience in shaping the effects of FHDC. Results show that having experienced FHDC is associated with an increase in depressive symptoms. In addition, reporting financial vulnerabilities four years prior to the pandemic was also associated with increased depressive symptoms. Finally, psychological resilience was associated with a significant, protective effect on depressive symptoms, and moderated the consequences of FHDC. Specifically, we find that those who had FHDC and had average or below average resilience experienced significant increases in depressive symptoms, but those with above average resilience did not experience increases in depressive symptoms despite having FHDC, accounting for the consequences of previous financial vulnerabilities. These results suggest that psychological resilience has potential to be a protective resource for mental health consequences of financial stress among older adults.

Functionalized Fullerene for Inhibition of SARS-CoV-2 Variants.

As virus outbreaks continue to pose a challenge, a nonspecific viral inhibitor can provide significant benefits, especially against respiratory viruses. Polyglycerol sulfates recently emerge as promising agents that mediate interactions between cells and viruses through electrostatics, leading to virus inhibition. Similarly, hydrophobic C60 fullerene can prevent virus infection via interactions with hydrophobic cavities of surface proteins. Here, two strategies are combined to inhibit infection of SARS-CoV-2 variants in vitro. Effective inhibitory concentrations in the millimolar range highlight the significance of bare fullerene's hydrophobic moiety and electrostatic interactions of polysulfates with surface proteins of SARS-CoV-2. Furthermore, microscale thermophoresis measurements support that fullerene linear polyglycerol sulfates interact with the SARS-CoV-2 virus via its spike protein, and highlight importance of electrostatic interactions within it. All-atom molecular dynamics simulations reveal that the fullerene binding site is situated close to the receptor binding domain, within 4 nm of polyglycerol sulfate binding sites, feasibly allowing both portions of the material to interact simultaneously.

How SARS-CoV-2 Omicron droplets transport and deposit in realistic extrathoracic airways

The SARS-CoV-2 Omicron variant is more highly transmissible and causes a higher mortality rate compared to the other eleven variants despite the high vaccination rate. The Omicron variant also establishes a local infection at the extrathoracic airway level. For better health risk assessment of the infected patients, it is essential to understand the transport behavior and the toxicity of the Omicron variant droplet deposition in the extrathoracic airways, which is missing in the literature. Therefore, this study aims to develop a numerical model for the Omicron droplet transport to the extrathoracic airways and to analyze that transport behavior. The finite volume method and ANSYS Fluent 2020 R2 solver were used for the numerical simulation. The Lagrangian approach, the discrete phase model, and the species transport model were employed to simulate the Omicron droplet transport and deposition. Different breathing rates, the mouth and nose inhalation methods were employed to analyze the viral toxicity at the airway wall. The results from this study indicated that there was a 33% of pressure drop for a flow rate at 30 l/min, while there was only a 3.5% of pressure drop for a 7.5 l/min. The nose inhalation of SARS-CoV-2 Omicron droplets is significantly more harmful than through the mouth due to a high deposition rate at the extrathoracic airways and high toxicity in the nasal cavities. The findings of this study would potentially improve knowledge of the health risk assessment of Omicron-infected patients. Published under a nonexclusive license by AIP Publishing.

Personalized electronic record supported optimisation when alone for patients with hypertension-pilot study for remote medical management of hypertension during the Covid-19 pandemic (personal covidBP)

Introduction: Hypertension remains a leading cause of disability and preventable death globally. This study tested patient use of a drug-device combination of a smartphone application (App) to record blood pressure (BP), drug (amlodipine) dose and side effects each day at home during the COVID-19 pandemic. Method(s): In this community-based trial with remote monitoring and remote medical management from the investigational site, hypertensive participants aged 18 years + with poor BP control (prior 7 day mean of 135 mmHg systolic BP or above and/ or 85 mmHg diastolic BP and above) were enrolled to intervention with open label dose titration over 14 weeks, allowing personalized dosing of liquid amlodipine (1-2mg steps from 1-10 mg daily). Those with adequate BP control after 7 day baseline recorded BP over the same period. Result(s): 205 patients were enrolled into the intervention group between October 2020 and July 2021. Dose-related wanted (BP reduction) and emergence of unwanted effect plots were produced for individual participants. Average BP in intervention fell from 141/87 to 131/81 (difference -10/6 p < 0.001) and observation from 125/77 to 124/76 (difference -2/1 p < 0.001). Even low doses of 1 or 2 mg amlodipine reduced BP, as did small increments e.g. from 5mg to 6 mg or from 6mg to 8mg. Mean amlodipine dose at study end averaged 5.5mg on those without amlodipine at baseline, and 7.9mg in those starting at 5mg at baseline. Adherence with participant completion of the daily App routines was high and unrelated to age (median >90%). Conclusion(s): Remote clinician assessment of twice daily home BP measurements and side effects recorded in the App may inform more precise amlodipine titration and BP control. Personalised dose-response curves for both wanted and unwanted effects may change the relationship of participant and clinician to dose selection, convincement and help optimize long term care.

HOW HAS COVID-19 AFFECTED REFERRALS TO A TERTIARY HYPER ACUTE STROKE UNIT?

Background and aims: To observe how the Covid-19 pandemic affected trends in referrals to our tertiary hyperacute stroke unit (HASU). Methods: Referrals from emergency departments in hospitals within our sector were made electronically using the online 'Refer-A-Patient' system. We reviewed 150 referrals made post-Covid, from 16th March 2020 (when Covid restrictions were first introduced in the UK) until June 2020. These were compared with 150 referrals made pre-Covid, between March and June in 2019. Results: The patients in the pre-Covid referral cohort were significantly older on average than the post-Covid referral cohort (p=0.0476);there were more referrals under the age of 50, and fewer over the age of 80, post-Covid. We accepted significantly fewer patients for transfer post-Covid compared with pre-Covid (21% vs. 43% respectively, p=0.0001). The percentage of cases with a confirmed stroke diagnosis post-transfer was marginally higher post-Covid than pre-Covid (69% vs. 59% respectively, p=0.2443). Importantly, of the patients not accepted for transfer post-Covid, none had a subsequent stroke diagnosis. Conclusions: The Covid-19 pandemic seems to have led to a more selective approach in accepting referrals for transfer. This in turn appears to have reduced our stroke mimic rate. This poses an argument that there are benefits in being more selective. Video triage is an emerging tool, which can be used in emergency departments to aid the accuracy of selection for transfer and warrants further evaluation.

Impact of COVID-19 stress on food insecurity and fruit and vegetable consumption among college students.

Objective: This cross-sectional study utilized structural equation modeling to examine effects of COVID-19 stress on food insecurity and fruit and vegetable consumption mediated through personal agency and behavioral intention. Participants: Students (n = 749) enrolled at one federally designated Hispanic-serving public university during the fall 2020 semester. Methods: A 34-item survey was developed and administered. Results: COVID-19 stress had a statistically significant impact on food insecurity (B = .341; p < .001) and an inverse impact on personal agency to consume fruit and vegetables (B = -.283; p < .001). Personal agency (B = .389; p < .001) and behavioral intention to consume fruit and vegetables were directly associated while food insecurity inversely impacted behavioral intention (B = -.076; p = .034). Conclusions: Pandemic-related stress impacts nutrition behaviors among the student population already at risk of poor fruit and vegetable intake. During periods of high pandemic-related stress, college students need adequate access to fruits and vegetables and health promotion programs emphasizing stress management and healthy dietary behaviors.

Illness stigma, health anxiety, illness intrusiveness, and depressive symptoms in adolescents and young adults: A path model

Adolescents and young adults (AYAs) with a chronic medical condition (CMC) transition to adulthood with the burden of independently managing their health care. AYAs with a CMC are at elevated risk for depression, and available research suggests that illness-related cognitive appraisals play a critical role in this risk. Bakula et al. (2019) demonstrated that illness stigma and illness intrusiveness are two particularly salient cognitive appraisals (illness stigma -> illness intrusiveness -> depressive symptoms). The present study replicated and extended those findings by testing health anxiety as a mediator between stigma and illness intrusiveness in the serial mediation model (illness stigma -> health anxiety -> illness intrusiveness -> depressive symptoms). College students (N = 97) with a CMC completed self-report measures of illness-related stigma, health-related anxiety, illness intrusiveness, and depressive symptoms. The illness stigma -> illness intrusiveness -> depressive symptoms simple mediation path was significant, ab = .50, 95% CI [0.27-0.73]. The illness stigma -> health anxiety -> illness intrusiveness -> depressive symptoms serial mediation path was also significant, a1d21b2 = 0.16, 95% CI [0.05-0.31]. Illness stigma indirectly related to depressive symptoms through the consecutive influence of illness stigma on health anxiety and health anxiety on illness intrusiveness. The present study replicated and extended findings by Bakula et al. by identifying that illness stigma may elicit anxiety about health and amplify perceived illness intrusiveness, thus increasing depressive symptoms in AYAs with a CMC. These findings further confirm the importance of assessing cognitive appraisals among AYAs with a CMC. When working with AYAs with a CMC who endorse depression, it may be particularly important to assess health anxiety, illness stigma, and illness intrusiveness. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Validation of a neighborhood-level COVID Local Risk Index in 47 large U.S. cities.

OBJECTIVES: To present the COVID Local Risk Index (CLRI), a measure of city- and neighborhood-level risk for SARS COV-2 infection and poor outcomes, and validate it using sub-city SARS COV-2 outcome data from 47 large U.S. cities. METHODS: Cross-sectional validation analysis of CLRI against SARS COV-2 incidence, percent positivity, hospitalization, and mortality. CLRI scores were validated against ZCTA-level SARS COV-2 outcome data gathered in 2020-2021 from public databases or through data use agreements using a negative binomial model. RESULTS: CLRI was associated with each SARS COV-2 outcome in pooled analysis. In city-level models, CLRI was positively associated with positivity in 11/14 cities for which data were available, hospitalization in 6/6 cities, mortality in 13/14 cities, and incidence in 33/47 cities. CONCLUSIONS: CLRI is a valid tool for assessing sub-city risk of SARS COV-2 infection and illness severity. Stronger associations with positivity, hospitalization and mortality may reflect differential testing access, greater weight on components associated with poor outcomes than transmission, omitted variable bias, or other reasons. City stakeholders can use the CLRI, publicly available on the City Health Dashboard (www.cityhealthdashboard.com), to guide SARS COV-2 resource allocation.