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Objective: To understand the psychosocial stressors reported by caregivers of severe acute brain injury (SABI) patients recovering from coma in neuroICUs. Background: Caregivers of SABI patients are at risk of developing long-term adverse psychological outcomes following neuroICU discharge, particularly those of patients admitted in a comatose state and remaining disabled. Understanding the top psychosocial stressors reported by these caregivers is critical for design of interventions to improve psychological outcomes. Design/Methods: At the time of neuroICU discharge, we conducted semi-structured, recorded interviews with 15 primary caregivers of SABI patients, all of whom were comatose for greater than 24 hours and needed tracheostomy and/or feeding tube placement. Participants were recruited as a convenience sample from 6 US centers. A codebook for psychosocial stressors was developed from open coding of the first 5 interview transcripts amongst 9 study team members. Using NVivo software, two team members then independently coded each transcript, refined the codebook, and resolved coding discrepancies. Results: Fourteen of 15 caregivers provided demographic data: 13 (92.9%) were female, 5 (35.7%) were racial minorities, and 9 (64.3%) reported fewer than 4 years of college. Six of the 15 (40.0%) patients had recovered to a Glasgow Coma Scale of 9 or higher at the time of interview. The psychosocial stressors most commonly reported by participants were: navigation of the healthcare system, including hospital visitor restrictions due to COVID-19;uncertainty about prognosis;communication with healthcare providers;juggling of practical matters beyond the hospitalization;and navigation of social relationships. Caregivers also referenced challenges with direct caregiving responsibilities, changes to the relationship dynamic with the hospitalized patient, and loss of normality. Conclusions: Across multiple US centers, caregivers of SABI patients in various stages of coma recovery at time of neuroICU discharge share a wide variety of psychosocial stressors. Interventions designed to improve psychological outcomes will need to acknowledge these stressors directly.
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The first wave of the COVID-19 pandemic hit North America in March 2020, disrupting personal and professional lives, and leading to work-from-home mandates in many jurisdictions. In this paper, we examine two years of empirical network traffic measurement data from the University of Calgary’s campus network to study the effects of the pandemic on a post-secondary education environment. Our study focuses on the online meeting applications and services used, as well as traffic volumes, directionality, and diurnal patterns, as observed from our campus edge network. The main highlights from our study include: changes to inbound and outbound traffic volumes;reduced traffic asymmetry;significant growth in Zoom, Microsoft Teams, and VPN traffic;structural changes in workday traffic patterns;and a more global distribution of campus network users. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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INTRODUCTION: Clinical phenotypes of acute hypoxic respiratory failure (AHRF) in COVID-19 have been proposed- Gattinoni type ?L? with less interstitial edema/ lung weight and greater compliance vs type ?H? with a more classic acute respiratory distress syndrome (ARDS) pattern of interstitial edema, higher lung weight and lower compliance. Lung ultrasound (LUS) is a sensitive tool for the detection of interstitial pulmonary edema. Our objective was to describe lung US profiles in COVID-19 induced AHRF, in association with markers of severity and outcomes. METHODS: Retrospective observational study. Consecutive critically-ill adult COVID-19 patients with AHRF and P/F ratio <300mmHg who underwent LUS performed by a single provider in March-April 2020 were included. Patients with an established alternate etiology of AHRF, or chronic lung parenchymal pathology, were excluded. LUS was performed in the anterior and lateral zones. LUS phenotypes were: A (<3 B-lines per intercostal space (ICS) permitted), B (at least 3 B-lines in any ICS) and C (consolidation >1cm thickness). B and C profiles could overlap. The A-profile was compared to all others in the analyses of statistical significance. Outcomes included the need for and duration of mechanical ventilation, need for tracheostomy and mortality. RESULTS: Ten patients met eligibility criteria. 3 demonstrated A-profile, 6 B-profile and 1 C-profile. Median days (interquartile range) from symptom onset to LUS was: A- 6 (6-14, p=0.20), B- 18 (8-30), C- 6. Median P/F ratio at the time of LUS was: A- 152 (103-269, p=0.31), B- 131 (112- 146), C-98. Median C-reactive protein (mg/dL): A- 8 (5-10, p=0.3), B- 18 (6-31), C- 12. Median Lactate Dehydrogenase (IU/L) was: A- 528 (287-594, p=0.36), B- 622 (528-787), C- 258. Median D-Dimer (mg/L FEU) was: A- 0.88 (0.64- 3.12, p=0.57), B- 2.50 (1.74-35.00), C- 0.35. Mechanical ventilation was required in: A- 1 (33%, p=0.067), 6 (100%), C- 1 (100%). Median days of mechanical ventilation was: A- 0 (0-20, p=0.03), B- 36 (32-52), C- 88. Median static compliance (mL/cmH2O) was: A- 18, B- 27 (25-28), C- 37. Tracheostomy was performed in: A- 0 (0%, p=0.008), B- 6 (100%), C- 1 (100%). Mortality was: A- 0, B- 1 (17%), C- 0. CONCLUSIONS: An A-profile on LUS appeared to be associated with less severe respiratory illness in COVID-19 AHRF with P/F< 300mmHg.
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This assessment by the Environmental Effects Assessment Panel (EEAP) of the United Nations Environment Programme (UNEP) provides the latest scientific update since our most recent comprehensive assessment (Photochemical and Photobiological Sciences, 2019, 18, 595-828). The interactive effects between the stratospheric ozone layer, solar ultraviolet (UV) radiation, and climate change are presented within the framework of the Montreal Protocol and the United Nations Sustainable Development Goals. We address how these global environmental changes affect the atmosphere and air quality; human health; terrestrial and aquatic ecosystems; biogeochemical cycles; and materials used in outdoor construction, solar energy technologies, and fabrics. In many cases, there is a growing influence from changes in seasonality and extreme events due to climate change. Additionally, we assess the transmission and environmental effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for the COVID-19 pandemic, in the context of linkages with solar UV radiation and the Montreal Protocol.
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INTRODUCTION: Data are emerging showing the adverse consequences on mental health of the general public due to the COVID-19 pandemic. Little is known about the needs of veterans with pre-existing mental health difficulties during the COVID-19 pandemic. METHODS: Data were collected through a cross-sectional online survey from a randomly selected sample (n=1092) of military veterans who have sought help for mental health difficulties from a veteran-specific UK-based charity. The response rate was 25.2% (n=275). Participants were asked to complete a range of standardised mental health outcomes (post-traumatic stress disorder (PTSD): Post-traumatic Stress Disorder Checklist, common mental health difficulties (CMDs): 12-Item General Health Questionnaire, difficulties with anger: 5-Item Dimensions of Anger Reactions-Revised and alcohol misuse: Alcohol Use Disorders Identification Test) and endorse a list of potential stressors related to changes to daily life resulting from COVID-19. Regression analyses were fitted to explore predictors of mental health severity. RESULTS: It was observed that symptoms of common mental disorder and PTSD (69.3% and 65.0%, respectively) were the most commonly reported to have been exacerbated by the pandemic. Lack of social support and reporting increasing numbers of stressors related to COVID-19 were consistently associated with increasing severity of a range of mental health difficulties. CONCLUSIONS: Our findings suggest veterans who had pre-existing mental health difficulties prior to the outbreak of COVID-19 may be at increased risk of experiencing CMDs as a result of the pandemic. Intervening to improve levels of social support and offering practical guidance to better manage any additional stressors relating to the pandemic may provide strategies to help reduce the burden of mental health symptoms.