FEASIBILITY of LINKING UNIVERSAL WELL-CHILD HEALTHCARE and FINANCIAL COUNSELLING: FINDINGS from the AUSTRALIAN HEALTHIER WEALTHIER FAMILIES (HWF) PILOT RANDOMISED CONTROLLED TRIAL

Background: We pilot-tested the feasibility and short-term impacts of "Healthier Wealthier Families" (HWF), which seeks to reduce financial hardship by developing a referral pathway between universal child and family health (CFH) services and financial counselling. Method(s): Setting: CFH services in five sites (Victoria, New South Wales), coinciding with the COVID-19 pandemic. Participant(s): Caregivers of children aged 0-5 years. Eligible clients disclosed financial hardship using a study-designed screening tool. Design(s): Pilot randomised controlled trial (RCT). With mixed progress in Sites 1-3, we conducted an implementation evaluation and adapted the protocol to a simplified RCT (Site 4) and direct referral with pre-post evaluation (Site 5). Intervention(s): Financial counselling. The comparator was usual care. Measures: Feasibility was assessed via proportions of clients screened, enrolled, followed-up, and who accessed financial counselling. Impacts (quantitative surveys, qualitative interviews) included finances to 6 months post-enrolment. Result(s): 72%-100% of clients across sites answered the financial screen. In RCT sites (1-4), less than one-quarter enrolled. In Site 5, n = 44/64 (64%) clients were eligible and engaged with financial counselling. Common challenges facing these clients were utility debts (73%), obtaining government entitlements (43%) and material aid/emergency relief (27%). On average, their household income increased $250 per fortnight ($6504 annually), and families received average single payments of $784. Caregivers identified benefits including reduced stress, practical help, increased knowledge and empowerment. Conclusion(s): Financial hardship screening via CFH, and direct referral, were acceptable to caregivers. Individual randomisation was infeasible. Matching between populations and CFH practice is necessary to incorporate a HWF model of care.

Prostheses used in hip, knee, ankle, elbow and shoulder replacement procedures 2020

This document reports the numbers of prostheses recorded and reported to the NJR between 1 January and 31 December 2020. The tables show volumes of components as they have been entered into the registry, regardless of construct. The procedure counts in this document are presented without adjustment and may vary from counts found in the corresponding main NJR Annual Report analysis. If a procedure has been submitted with missing implant information this will also cause numbers to differ. Procedure counts below four have been suppressed. Components are listed and described according to the current classifications used in the registry. It must be noted that due to COVID-19, the ratio of revision to primary procedures increased in 2020 and this may affect the relative changes in the types and brands of implants used in comparison to previous years. As this document was not published for 2019 Annual Report data, comparison has been made with the 2018 Annual Report data.

Socially distanced but virtually connected: pandemic fieldwork with Black Bostonians

The Eastern Massachusetts Life and Language project was in its planning stages when the COVID-19 pandemic began to make headway in the United States in 2020. We contribute to the conversation about conducting linguistic fieldwork during a major social upheaval by providing a description of our shift to virtual methodologies, which include utilizing Instagram for participant recruitment and Zoom for conducting sociolinguistic interviews. Virtual data collection remains underexplored, as there has never been a widespread need for such practices until the recent lockdowns resulting from the pandemic. Likewise, social media appears to be underutilized as a recruitment tool in linguistic fieldwork. Nevertheless, it is effective in producing a heterogeneous participant sample in a short amount of time. We are delighted to engage in discussions about the effects of virtual recruitment and data collection on linguistic fieldwork and the data itself. We offer a description of our pivots to virtual recruitment and interviewing and the racial justice initiatives that become achievable because of these changes. We hope this contribution is beneficial to researchers looking to incorporate virtual methodologies into their research program.

Real-Time Forecasting of COVID-19 Cases Using Human Mobility in Ontario, Canada

Purpose To minimize the impact of the COVID-19 pandemic, local public health authorities are often required to make prompt and informed decisions on anticipated case-loads, resource allocation for surveillance and testing, and public health intervention appropriateness. The objective of this research was to develop a near-term forecasting model to predict COVID-19 cases using real-time human mobility information in Ontario, Canada to assist public health authorities with outbreak response. Methods & Materials We utilized a deep neural network model to generate a short-term forecast of new COVID-19 cases by two weeks from May to August 2021. Variable selection was informed by a recent literature review and our ongoing research associating COVID-19 cases with human mobility, demographic and socio-economic factors. A real-time human mobility statistics consisting of a weekly summary of short and long-distance movement, demographic characteristics, weather, vaccination coverage, geo-location, and reported COVID-19 cases two weeks prior were included as predictors. We considered weeks as temporal and health regions as geographic units to account for population-level variabilities. We used a holdout method for model validation of over 300 iterations. Average mean squared error (MSE) and 95% confidence interval (CI) along with overlaying forecasted COVID-19 cases over the reported were used to evaluate the overall model fit. The model predictions were summarized as means and 95% CIs. Results Our best forecasting model had a mean MSE of 0.53 (95% CI: 0.49 – 0.56). Since May 2021, the overall trend of the reported COVID-19 cases in Ontario closely followed the forecasted cases, about 89% of the reported cases were within 1.5 times the interquartile range (IQR) and all were within the entire range of the distribution of the predictions. Forecasting accuracy also varied by health region characteristics, such a population size and density, remoteness, and reported COVID-19 case volume during the most recent weeks. Conclusion A near-term prediction of new COVID-19 cases with real-time population-level data could help public health authorities anticipate, plan and monitor disease burden in a population. Such predictions also allow the assessment of population-level health interventions to minimize new COVID-19 cases on a real-time basis and inform prompt decision making.

Role of troponin levels, grace score, and timi score in predicting mortality in covid-19 related myocardial injury

Introduction: COVID-19 infection is associated with troponin elevation, which is associated with increased mortality. We wanted to evaluate whether troponin levels, GRACE scores, and TIMI scores were independently associated with mortality in COVID-19 patients. Methods: Out of 1500 COVID-19 patients admitted to our hospitals, 217 patients with troponin levels were included. Key variables were collected manually, and survival analysis was done. Results: Mortality was 26.5% in the normal troponin group and 54.6% in the elevated troponin group. Patients with elevated troponins had increased frequency of hypotension (P=0.01), oxygen support (P<0.01), low absolute lymphocyte count (P<0.01), elevated blood urea nitrogen (P<0.01), higher C-reactive protein (P<0.01), higher D-dimer (P<0.01), higher lactic acid (P<0.01), and higher qSOFA, SOFA, TIMI, and GRACE scores (all scores P<0.01). On cox regression, troponin elevation (HR 1.85, 95% CI 1.18-2.88, P<0.01), TIMI score >3 (HR 1.79, 95% CI 1.11-2.75, P=0.01), GRACE score >140 (HR 2.27, 95% CI 1.45-3.55, P<0.01) were highly associated with mortality whereas cardiovascular disease (HR 1.40, 95% CI 0.89-2.21, P=0.129) and cardiovascular risk factors (HR 1.15, 95% CI 0.73-1.81, P=0.52) were not. We created four separate multivariate cox regression models for troponin, GRACE score, TIMI score, and SOFA score while adjusting for age, use of nonrebreather or high flow nasal cannula, hemoglobin<8.5, suspected or confirmed source of infection, and qSOFA score. GRACE (HR 1.02, 95% CI 1.01-1.04, P<0.01) and SOFA scores (HR 1.19, 95% CI 1.08-1.31, P<0.01) were independently associated with mortality whereas Troponin (HR 1.08, 95% CI 0.63-1.85, P=0.76) and TIMI score (HR 1.02, 95% CI 0.99-1.06, P=0.12) were not. SOFA scores are positively correlated with GRACE scores (r=+0.39). Conclusion: Troponin elevation in COVID-19 patients is mostly due to demand ischemia rather than acute coronary syndrome-related. This was shown by the association of troponin with a higher degree of systemic inflammation and end-organ dysfunction. We recommend SOFA scores and GRACE scores in risk stratifying COVID-19 patients with myocardial injury.

Should Symptom and Urgent Review Clinic (SURC) be a standard model of care across all cancer services?

Background: Cancer patients undergoing systemicanti-cancer therapies (SACT) invariably experience toxicities precipitating presentations to Emergency Departments (ED). With the ongoing COVID-19 pandemic, it is imperative to keep vulnerable immunocompromised patients out of hospital and encourage patients to contact SURC when symptoms develop. This nurse-led SURC model of care has been reported to achieve an investment return of $1.73 for every dollar invested. At Peninsula Health (PH), we recently established SURC supported by the Victorian Government and are evaluating its uptake and effectiveness. Methodology: Episodes of care (Educations, phone, and physical attendances) occurring between 31/08/2020 to 30/06/2021 were captured in the SURC Access Database and analysed. ED presentations pre-and post-SURC commencement were examined if potentially avoidable presentations have reduced. Baseline patient experience and post-SURC implementation surveys were conducted amongst patients and clinicians with local ethics approval. Results : 1923 SURC episodes of care were provided to 540 individuals (educations 28.2%, phone triage 63.3%, and attendances 8.5%). The commonest tumour stream was breast (23.0%), lung (20.1%) and colorectal (17.2%), closely aligning with the local cancer prevalence rates. Most frequent SURC contacts were for gastrointestinal symptoms (16.9%), pain management (9.5%), care-coordination (9.1%) and medication advice (6.5%). Notably, more than one-third indicated they would have done nothing (38.5%) or delayed seeking medical advice (10.9%) without SURC. During the first five months post-SURC commencement we observed a 47.0% decrease in avoidable presentations within SURC operation hours, and a 29.3% decrease in after-hours ED presentations. The results from the patient and clinician surveys will be updated at the meeting. Conclusions : The SURC model of care is an invaluable resource to support cancer patients undergoing SACT which allows prompt access to specialist care while avoiding emergency presentations in the ambulatory setting. Resources permitting, it should be standard of care across all health services providing cancer care.

Characteristics and outcomes of patients with copd and COVID-19 in the united states

Rationale. Chronic obstructive Pulmonary Disease (COPD) has been associated with severe coronavirus disease 2019 (COVID-19) in Chinese and European cohorts. To date, no studies have evaluated the outcomes of COVID-19 in a selected cohort of patients with COPD in the United States (USA). We hypothesize that patients with COPD infected with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2) will have higher likelihood of 14-day hospitalization, mechanical ventilation use, and mortality compared to non-COPD SARS-CoV2 positive patients. Methods. We performed a retrospective analysis of electronic health records (EHR) from facilities across the 4 geographical regions of the USA (Optum Covid-19 Biweekly Data). We defined COVID-19 positive as having International Classification of Disease-10 (ICD-10) code of U07.1, or positive laboratory test results. COPD patients are defined by having at least 2-outpatient visits or 1- inpatient visit with any COPD diagnosis codes within a year prior to COVID-19 positive date. Results. We studied a cohort of 150,775 patients with COVID-19 between March and August 2020 in the United States. COPD was identified in 6,056 (4%) patients. The baseline characteristics of the cohort are presented in table 1. The percentage of patients with COPD and COVID-19 admitted to the hospital in 14-days for any cause was greater than that for non-COPD COVID-19 patients (28.7% vs 10.42%, p< 0.0001). The mean length of stay was longer for COPD with COVID-19 individuals than that for non-COPD COVID-19 patients (12.3 days vs 9.0 days, p<0.001). Amongst all hospitalized, the percentage of patients who required ICU was greater for COPD patients with COVID-19 than that for non-COPD patients (26.4% vs 16.11%, p<0.001). In addition, mechanical ventilation use was higher in COPD vs non-COPD COVID-19 patients (26.4% vs 16.11%, p<0.001) Moreover, the percentage of patients who died in 30 days was greater for COPD than that for non-COPD COVID-19 patients (13.6% vs 7.25%, p<0.0001). Discussion. Patients with COPD and COVID-19 have worse outcomes compared to non-COPD COVID-19 patients.

Association of smoking status with severe COVID-19

Rationale. The association between smoking status and severe Coronavirus Disease-2019 (COVID-19) remains controversial. To assess the risk of 14-day hospitalization, as a marker of severe COVID-19, in patients who are ever-smokers and tested positive for the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) compared to those who are never smokers and tested positive for the virus in a single academic health system in the United States. Methods. We conducted a retrospective cohort study of patients who tested positive for SARS-CoV-2 in the University of Texas Medical Branch Health System between March 1st and October 30th 2020 to identify the risk of 14-day hospitalization in ever-smokers compared to non-smokers. Results. In our study period, we identified 5,738 patients who met the inclusion criteria and had documentation of smoking habits. Out of this group, 636 (11%) were consider to be ever-smokers. One hundred and ninety one patients were current smokers and 445 were former smokers. Of the 5,738 patients, 35.1% were male, average age was 43.8 (SD± 17.6), 37.4% were Caucasian, 51.5% were obese (BMI≥30), 3.19 % had vaping history, and 76.5% had at least one comorbidity. We identified 624 (10.8%) patients who were admitted in 14 days and 49(0.8%) who died in 14 days during hospitalization. The percentage of ever smokers admitted in 14 days was greater than that of never smokers (17.9% vs 10%, p<0.0001). In addition, the percentage of smokers who died in 14 days was greater than that of never smokers (2.8% vs 0.6%, p<0.0001). However, after adjusting for other covariates the odds for 14-day hospitalization among ever smokers with COVID-19 was not significant (OR 0.96, 95% CI 0.7-1.2). Conclusions. In our single center study, smoking status was not associated with severe COVID-19 infection.

Tracking the international spread of SARS-CoV-2 lineages B.1.1.7 and B.1.351/501Y-V2

Late in 2020, two genetically-distinct clusters of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with mutations of biological concern were reported, one in the United Kingdom and one in South Africa. Using a combination of data from routine surveillance, genomic sequencing and international travel we track the international dispersal of lineages B.1.1.7 and B.1.351 (variant 501Y-V2). We account for potential biases in genomic surveillance efforts by including passenger volumes from location of where the lineage was first reported, London and South Africa respectively. Using the software tool grinch (global report investigating novel coronavirus haplotypes), we track the international spread of lineages of concern with automated daily reports, Further, we have built a custom tracking website (cov-lineages.org/global_report.html) which hosts this daily report and will continue to include novel SARS-CoV-2 lineages of concern as they are detected.

Smoking and risk of COVID-19 hospitalization

RATIONALE: The association between smoking status and severe Coronavirus Disease 2019 (COVID-19) remains controversial. OBJECTIVE: To assess the risk of hospitalization (as a marker of severe COVID-19) in patients by smoking status: former, current and never smokers, who tested positive for the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV2) at an academic medical center in the United States. METHODS: We conducted a retrospective cohort study in patients with SARS-COV2 between March-1-2020 and January-31-2021 to identify the risk of hospitalization due to COVID-19 by smoking status. RESULTS: We identified 10216 SARS-COV2-positive patients with complete documentation of smoking habits. Within 14 days of a SARS-COV2 positive test, 1150 (11.2%) patients were admitted and 188 (1.8%) died. Significantly more former smokers were hospitalized from COVID-19 than current or never smokers (21.2% former smokers;7.3% current smokers;10.4% never smokers, p<0.0001). In univariable analysis, former smokers had higher odds of hospitalization from COVID-19 than never smokers (OR 2.31;95% CI 1.94-2.74). This association remained significant when analysis was adjusted for age, race and gender (OR 1.28;95% CI 1.06-1.55), but became non-significant when analysis included Body Mass Index, previous hospitalization and number of comorbidities (OR 1.05;95% CI 0.86-1.29). In contrast, current smokers were less likely than never smokers to be hospitalized due to COVID-19. CONCLUSIONS: Significantly more former smokers were hospitalized and died from COVID-19 than current or never smokers. This effect is mediated via age and comorbidities in former smokers.

Examining the Economic and Environmental Impacts of COVID-19 Using Earth Observation Data

The COVID-19 pandemic has infected almost 73 million people and is responsible for over 1.63 million fatalities worldwide since early December 2019, when it was first reported in Wuhan, China. In the early stages of the pandemic, social distancing measures, such as lockdown restrictions, were applied in a non-uniform way across the world to reduce the spread of the virus. While such restrictions contributed to flattening the curve in places like Italy, Germany, and South Korea, it plunged the economy in the United States to a level of recession not seen since WWII, while also improving air quality due to the reduced mobility. Using daily Earth observation data (Day/Night Band (DNB) from the National Oceanic and Atmospheric Administration Suomi-NPP and NO2 measurements from the TROPOspheric Monitoring Instrument TROPOMI) along with monthly averaged cell phone derived mobility data, we examined the economic and environmental impacts of lockdowns in Los Angeles, California;Chicago, Illinois;Washington DC from February to April 2020-encompassing the most profound shutdown measures taken in the U.S. The preliminary analysis revealed that the reduction in mobility involved two major observable impacts: (i) improved air quality (a reduction in NO2 and PM2.5 concentration), but (ii) reduced economic activity (a decrease in energy consumption as measured by the radiance from the DNB data) that impacted on gross domestic product, poverty levels, and the unemployment rate. With the continuing rise of COVID-19 cases and declining economic conditions, such knowledge can be combined with unemployment and demographic data to develop policies and strategies for the safe reopening of the economy while preserving our environment and protecting vulnerable populations susceptible to COVID-19 infection.