ABSTRACT
IntroductionCOVID-19 has had significant impacts on the provision of pre-hospital care. Media and academic reports have heavily covered the impacts of Covid-19 on society and health care but have primarily focused on the densely packed urban environments which were hardest hit. This study examines the impact of COVID-19 on pre-hospital care outside of major urban centers.MethodsThe electronic patient care records (ePCR) of 3 Ontario paramedic services were compared for 365 days starting March 13 (start of lockdown for Ontario in 2020) for Historic (2018-2019), PreCOVID (2019-2020) and COVID (2020-2021) periods. Demographics were examined using t-Tests and proportion (Goodness of Fit) tests. Call counts in temporal categories were analysed using Chi-Squared tests of goodness of fit, while changes in the distribution of call time intervals were examined using a LR test for equivalence. Ethics for the study was approved by the Trent University Ethics Review Board.Results89,126 ePCRs were examined (Historic: 30,070;PreCOVID: 30,576;COVID: 28,480). Small but statistically significant differences between COVID and PreCOVID were found in the gender and primary problem of patients (p < 0.01) as well as in all temporal fields (p < 0.03), except day-of-the-week (p = 0.87). In time interval comparison, time-on-scene and time-to-patient-contact were significantly increased in the COVID-19 era while time-to-offload (in the ER) was much shorter. Response times were found to be marginally slower, while transport-time-to-ED was found to be significantly faster during COVID.PreCOVID versus Historic comparisons found no significant difference, except in age and CTAS, which had significant differences in both the COVID vs PreCOVID and PreCOVID vs Historic periods (p < 0.001 for both).ConclusionCOVID-19 has had many impacts on prehospital care. However, the practical significance of COVID on rural pre-hospital care may not be as large as that reported in higher density area.
ABSTRACT
Introduction: Vaccine hesitancy is a major barrier to achieving herd immunity against COVID-19. This is especially apparent in patients with autoimmune diseases, such as multiple sclerosis (MS), who were largely excluded from seminal vaccine trials. Objectives/Aims: To assess COVID-19 vaccine hesitancy and early safety/tolerability in patients with MS and related disorders. Methods: Participants were recruited from multiple academic centers as part of the MS Resilience to COVID-19 (MSReCOV) Study Consortium. Statistical analysis was performed on responses to vaccine-specific questionnaires completed between February 24th and April 28th, 2021. Results: 1761 participants completed the vaccine questionnaire, including 1081(62%) with MS or another neuroinflammatory disease (NID), and 657(38%) controls. By survey completion, 1150(65%) participants had been vaccinated against SARS-CoV-2 with Pfizer(n=526, 54%), Moderna(n=415, 43%), Johnson & Johnson(n=22, 2%), AstraZeneca(n=2, 0.2%), or unknown(n=3, 0.3%). 82%(n=568) of MS/NID were on disease modifying therapy at the time of vaccination. Hesitancy rates were similar between MS/NID and controls(p=0.39), with 32% of unvaccinated participants(n=597, 34%) either unsure or not planning to be vaccinated. The most common reasons for hesitancy in patients with MS/NID pertained to vaccines being understudied in the autoimmune population(n=35, 54%), triggering a demyelinating event(n=30, 46%), or being too new(n=24, 37%). Of the MS/NID participants vaccinated with mRNA vaccines, 42%(n=240) and 45%(n=178) reported side effects(SE) after the first and second doses, respectively. Higher rates of SEs were noted in the MS/NID group after the second dose (67% vs. 45%;p<0.0001;RR 1.5, 95%CI:1.3 - 1.7). Most common SEs in the MS/NID groups were arm soreness(n=278, 85%), flu-like symptoms(n=139, 42%), and headache(n=23, 7%). Only 1 MS/ NID patient (vs. 3 controls) reported a neurologic SE other than headache, described as transient numbness. When comparing vaccinated and unvaccinated MS/NID patients, there was no difference in rates of recurrent neurologic symptoms(p=0.45), new neurologic symptoms(p=0.65) or new/ active lesions detected on MRI(p=0.35). Conclusions: Reasons for vaccine hesitancy in MS/NID population include lack of study in autoimmune population and fear of relapse. In this early analysis we found a higher rate of expected SEs after second mRNA dose but no evidence of worsening neurologic disease.
ABSTRACT
The U.S. Naval Academy matriculates similar to 1,100 new undergraduate students each year, all of whom are required to complete two semesters of introductory chemistry, regardless of major selection. Thus, each of the similar to 50 sections of introductory chemistry comprises students with a broad range of interests, prior chemistry experience, and analytical skills. A survey of 28 chemistry instructors that taught introductory and upper-level courses remotely in the wake of the COVID-19 pandemic showed that most met with their students during every scheduled class period and delivered new content synchronously, though methods of instruction varied widely within those parameters. Student engagement decreased in the remote environment, but a small number of instructors reported improvements when a web-based classroom response system was implemented. Extra instruction was requested by fewer students, was generally conducted in group sessions, and was more time-consuming for the faculty. Most faculty teaching introductory chemistry used more multiple-choice assessments than they would in a live setting, because of compatibility with online testing platforms, and most faculty reported little evidence of academic dishonesty during online teaching, in spite of negative preconceptions. The dominant faculty perception is that student performance did not decline after the switch to online learning. Collaborative, supportive, and frequent communication among faculty and staff in the chemistry department was instrumental in facilitating the transition to online teaching.