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1.
Lung India ; 39(SUPPL 1):S158-S159, 2022.
Article in English | EMBASE | ID: covidwho-1857718

ABSTRACT

Background: Covid-19 affected our population in multiple waves. We have looked for the differences in frequency and the weight/impact of symptoms between the first and the second waves. Method: The post-covid-19 subjects attending our out-patient department for post-covid-19 problems after the 1st and he 2nd waves were enquired retrospectively about the demography with the frequency and severity of different symptoms cough, breathlessness, throat pain, nasal discharge, fever, body-ache, weakness, diarrhoea, constipation, pedal/finger swelling, headache, expectoration. anosmia, and loss of taste) that they suffered from. The weight/impact of a symptom was derived by multiplying the duration of symptoms (in days) with the severity (in Likert scale;0 to 5;0=none and 5=maximum possible symptoms). The data was analysed statistically using unpaired 't-test' and 'chi-square test' to compare between the two covid-19 waves. Result: 185 and 222 subjects' data were included for the 1st and the 2nd waves of covid-19 respectively. The gender ratio was similar but the mean age was significantly lower in the victims of the second wave (56.17±13.64, 51.32±15.59;p=0.0017). As regards the symptom-frequency, fever (p=0.0154), constipation (p=0.0243), headache (p=0.0014), anosmia (p=<0.0001) and loss of taste (p=0.0009) were significantly worse in the 2nd wave. The symptom severity of cough (p=0.0184), throat pain (p=0.039), mild weakness (p=0.0063), anosmia (p=0.0004) and loss of taste (p=0.0026) were also higher in the 2nd wave of Covid-19. Conclusion: It appears that each wave of the pandemic was distinct as regards the symptomatology. Such peculiarity in the clinical dynamics of Covid-19 needs to be noticed and followed in future.

2.
Journal of the American College of Cardiology ; 79(9):1312-1312, 2022.
Article in English | Web of Science | ID: covidwho-1849195
3.
Enterprise Development & Microfinance ; 32(1):4-18, 2021.
Article in English | CAB Abstracts | ID: covidwho-1834350

ABSTRACT

Somalia has a significant place in the livestock sector in the Horn of Africa;livestock trade and export is one of the key economic contributors. Most of the livestock trade happens with the Middle East, the Kingdom of Saudi Arabia being one of its biggest importers. The COVID-19 pandemic has led to both massive loss of life and huge economic losses as the result of measures to contain the virus. In June 2020, the Kingdom of Saudi Arabia took the decision to restrict the number of pilgrims for the annual Hajj. Impacts resulted in a decline in income from the seasonal Hajj of 80 per cent, though domestically prices of livestock remained stable and local markets were used for livestock sales. This paper, besides highlighting the effects, provides recommendations which could inform strategic planning, humanitarian aid, and resilience building for the livestock value chain in Somalia and the Horn of Africa.

4.
Journal of Marine and Island Cultures ; 10(2):105-116, 2021.
Article in English | Scopus | ID: covidwho-1687693

ABSTRACT

Remoteness is an attribute that has often been negatively attached to island-spaces like the Andaman Islands, separated from the Indian mainland by the vast Bay of Bengal, located at the ‘liquid borderlands’ of South and Southeast Asia. The Covid-19 pandemic, on the other hand, has popularised the use of ‘remote’ methods of enabling religio-social interaction. The islanders of these geographically ‘remote’ locations use these ‘remote’ ways of connecting to perform their religious practices and maintain their faith networks, which is otherwise compromised due to the pandemic-induced restrictions on social gatherings. By exploring the ‘online’ global faith networks of the little-known Matua religion, as well as, the social, technical and logistical constraints in the devotees’ access to ‘remote’ religion, the paper addresses two questions: first, how do individuals play out their identities, both as islander and as devotee, ‘online’;second, what are the corresponding technological and logistical conditions that enable their ‘presence’ and who are the ‘absent’ actors. Drawing from remotely collected data, particularly online ethnography and telephonic interviews, the paper explores the mediating role of technology in destabilizing, as well as, solidifying concepts of remoteness and isolation, particularly in the peripheries of nation, during times of restricted mobility. © 2021 Institution for Marine and Island Cultures, Mokpo National University.

5.
Blood ; 138:4023, 2021.
Article in English | EMBASE | ID: covidwho-1582390

ABSTRACT

BACKGROUND: Autologous stem cell transplantation (ASCT) for multiple myeloma (MM) entails sudden life changes including acute symptom burden, changes in physical function, and shifting caregiver dynamics. Several studies have shown that anxiety, insomnia, and distress rise in the initial weeks following ASCT before slowly recovering. Long-term consequences of these acute exacerbations include persistent quality of life (QOL) impairments (El-Jawahri 2016), post-traumatic stress disorder (Griffith 2020), and the usage of potentially inappropriate medications (PIMs) for symptom management (Banerjee 2021). We have recently completed a pilot study of digital life coaching (DLC), whereby life coaches work with patients via phone calls and text messages to provide longitudinal support, education, and accountability to meet wellbeing-related goals. Our pilot study of 15 patients demonstrated the feasibility of DLC during this period, with bidirectional patient-coach engagement occurring every 5-7 days even during index hospitalizations for ASCT (Banerjee 2021). Based on these positive results, we have now launched a randomized Phase 2 study of DLC versus usual care among patients with MM undergoing ASCT. STUDY DESIGN: Our study is registered at clinicaltrials.gov as NCT04589286. We plan to enroll 60 adult patients with MM undergoing first ASCT at our institution. Inclusion criteria include English language proficiency and ownership of a personal cellphone. However, neither smartphones nor specific mobile apps are required for study participation. All patients, including those in the control arm, receive brief wellness-related tips with each request for PRO data as outlined below. As shown in the Figure, patients in the DLC arm are paired with a trained life coach beginning at Day -10 before ASCT. Coaches use structured frameworks to assist patients longitudinally with identifying and accomplishing wellbeing-related goals. Specific coaching topics can vary from week to week and are set by each patient. In addition to weekly coach-led phone calls, patients are encouraged to maintain bidirectional communication via phone/text/email as often as desired. Patients in the control arm do not receive access to DLC. Our primary endpoint is the total usage of sedative-class PIMs - including lorazepam, temazepam, zolpidem, and other similar medications - prescribed for anxiety or insomnia during each of 4 four-week study subperiods identified in the Figure. Secondary endpoints include patient-reported outcome (PRO) assessments of QOL (PROMIS Global Health), distress (NCCN Distress Thermometer), and insomnia (PROMIS Sleep Disturbances 4A). PRO assessments are collected exclusively using automated REDCap emails every 1-2 weeks as shown in the Figure. PROGRESS TO DATE: As of the data cutoff (7/31/21), 19 patients have enrolled onto our study and 5 have completed all follow-up. The median age of enrolled patients is 62 (range: 31-77), with 26% of patients aged 70 or older. As shown in our pilot study (Banerjee 2021), PRO collection via automated REDCap emails is feasible. Specifically, of 93 email-based requests for PRO assessments as of the data cutoff, 92 (99%) have been completed. Analyses of PRO assessment responses and PIM usage will be conducted after study completion. DISCUSSION: Improving patient wellbeing during the acute peri-ASCT period is an unmet need in multiple myeloma. Published supportive strategies during this time include music therapy (Bates 2017), acupuncture (Deng 2018), palliative care (El-Jawahri 2017), and programmed hospital room lighting (Valdimarsdottir 2018). DLC may offer unique advantages given its easy accessibility and unified patient-facing interface across hospital/clinic/home transitions. These strengths may be particularly relevant in light of the COVID-19 pandemic, where home-based follow-up after ASCT has become more common. That being said, broadening the accessibility of DLC to include patients with limited English proficiency or patients without personal cell phones are important priorities for fu ure studies. In summary, our randomized Phase 2 study of DLC versus usual care is ongoing. If shown to reduce PIM prescription rates while improving wellbeing-related PRO trajectories longitudinally, DLC may become a standard of care for patients with hematologic malignancies undergoing ASCT. [Formula presented] Disclosures: Banerjee: Pack Health: Research Funding;SparkCures: Consultancy;Sanofi: Consultancy. Knoche: Amgen: Honoraria. Brassil: Abbvie: Research Funding;Astellas: Research Funding;BMS: Research Funding;Daiichi Sankyo: Research Funding;Genentech: Research Funding;GSK: Research Funding;Sanofi: Research Funding;Pack Health: Current Employment. Jackson: Pack Health: Current Employment. Patel: Pack Health: Current Employment. Lo: Oncopeptides: Consultancy;EUSA Pharma: Consultancy. Chung: Caelum: Research Funding. Wong: Amgen: Consultancy;Genentech: Research Funding;Fortis: Research Funding;Janssen: Research Funding;GloxoSmithKlein: Research Funding;Dren Biosciences: Consultancy;Caelum: Research Funding;BMS: Research Funding;Sanofi: Membership on an entity's Board of Directors or advisory committees. Wolf: Adaptive Biotechnologies: Consultancy;Teneobio: Consultancy;Sanofi: Consultancy;Amgen: Consultancy. Martin: Oncopeptides: Consultancy;Sanofi: Research Funding;Amgen: Research Funding;Janssen: Research Funding;GlaxoSmithKline: Consultancy. Shah: Bluebird Bio: Research Funding;GSK: Consultancy;Janssen: Research Funding;Indapta Therapeutics: Consultancy;BMS/Celgene: Research Funding;CareDx: Consultancy;CSL Behring: Consultancy;Kite: Consultancy;Nektar: Research Funding;Karyopharm: Consultancy;Amgen: Consultancy;Oncopeptides: Consultancy;Poseida: Research Funding;Precision Biosciences: Research Funding;Sanofi: Consultancy;Sutro Biopharma: Research Funding;Teneobio: Research Funding.

6.
PUBMED; 2021.
Preprint in English | PUBMED | ID: ppcovidwho-293068

ABSTRACT

BACKGROUND: The COVID-19 pandemic has greatly impacted school operations. To better understand the role of schools in COVID-19 transmission, we evaluated infections at two independent schools in Nashville, TN during the 2020-2021 school year. METHODS: The cumulative incidence of COVID-19 within each school, age group, and exposure setting were estimated and compared to local incidence. Primary attack rates were estimated among students quarantined for in-school close contact. RESULTS: Among 1401 students who attended school during the study period, 98 cases of COVID-19 were reported, corresponding to cumulative incidence of 7.0% (95% confidence interval (CI): 5.7-8.5). Most cases were linked to household (58%) or community (31%) transmission, with few linked to in-school transmission (11%). Overall, 619 students were quarantined, corresponding to >5000 person-days of missed school, among whom only 5 tested positive for SARS-CoV-2 during quarantine (primary attack rate: 0.8%, 95% CI: 0.3, 1.9). Weekly case rates at school were not correlated with community transmission. CONCLUSION: These results suggest that transmission of COVID-19 in schools is minimal when strict mitigation measures are used, even during periods of extensive community transmission. Strict quarantine of contacts may lead to unnecessary missed school days with minimal benefit to in-school transmission.

7.
Hepatology ; 74(SUPPL 1):317A, 2021.
Article in English | EMBASE | ID: covidwho-1508765

ABSTRACT

Background: In patients infected with the SARS-CoV-2 (COVID-19) virus, obesity is associated with an increase in hospital admission, use of mechanical ventilation and patient mortality. Elevated liver fat, body mass index (BMI) and male sex are significant predictors of hospitalisation risk following COVID-19. BMI, however, is a poor indicator of body fat distribution. Here, we aim to characterise body composition and liver health through multiparametric magnetic resonance (mpMR) and compare participants hospitalised and not hospitalised following COVID-19. Methods: Participants with laboratory confirmed or clinically suspected SARSCoV-2 infection were recruited to the COVERSCAN study (NCT04369807) and underwent a multi-organ mpMR scan (median time from initial symptom = 177 days). Measures of liver fat (PDFF), liver fibroinflammation (cT1) and body composition (VAT, subcutaneous adipose tissue [SAT], skeletal muscle index [SMI]) were analysed. Differences between hospitalised (n=60) and non-hospitalised participants (n=354) were assessed using Wilcoxon signed-rank tests. Univariate and multivariate analysis were performed on all biomarkers to assess the risk of hospitalisation. Presented data are median values. Results: Hospitalised participants were older (50yrs vs 43yrs;p<0.01) and had significantly elevated liver fat (3.5% vs 2.4%;p<0.01) and liver cT1 (734ms vs 708ms;p<0.01). Though hospitalised participants had a significantly elevated BMI (27kg/m2 vs 25kg/m2;p=0.011), it was VAT, but not SAT or SMI, that was significantly elevated in hospitalised participants (131cm2 vs 80 cm2;p<0.01). Univariate analysis revealed male sex, advanced age and elevated BMI, VAT, liver fat and liver cT1 were all significantly predictive of hospitalisation. In multivariate analysis, only age remained significantly predictive of hospitalisation. In obese participants, VAT and liver fat, but not BMI nor cT1, remained significantly elevated in hospitalised participants (VAT: 200cm2 vs 159cm2, p=0.041;liver fat: 9.8% vs 4.6%, p=0.012). Conclusion: mpMR revealed significantly elevated visceral and ectopic liver fat in hospitalised participants following COVID-19 infection. In obese participants, BMI was not significantly different in hospitalised and non-hospitalised patients whereas visceral and liver fat remained significantly elevated. Our work highlights body fat distribution as an important consideration for COVID-19 risk profiling which is not sufficiently evaluated based on BMI alone.

8.
Intelligent Systems Conference, IntelliSys 2021 ; 296:877-884, 2022.
Article in English | Scopus | ID: covidwho-1391762

ABSTRACT

A novel coronavirus disease has emerged (later named COVID-19) and caused the world to enter a new reality, with many direct and indirect factors influencing it. Some are human-controllable (e.g. interventional policies, mobility and the vaccine);some are not (e.g. the weather). We have sought to test how a change in these human-controllable factors might influence two measures: the number of daily cases against economic impact. If applied at the right level and with up-to-date data to measure, policymakers would be able to make targeted interventions and measure their cost. This study aims to provide a predictive analytics framework to model, predict and simulate COVID-19 propagation and the socio-economic impact of interventions intended to reduce the spread of the disease such as policy and/or vaccine. It allows policymakers, government representatives and business leaders to make better-informed decisions about the potential effect of various interventions with forward-looking views via scenario planning. We have leveraged a recently launched open-source COVID-19 big data platform and used published research to find potentially relevant variables (features) and leveraged in-depth data quality checks and analytics for feature selection and predictions. An advanced machine learning pipeline has been developed armed with a self-evolving model, deployed on a modern machine learning architecture. It has high accuracy for trend prediction (back-tested with r-squared) and is augmented with interpretability for deeper insights. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

9.
Blood ; 136:2-3, 2020.
Article in English | EMBASE | ID: covidwho-1348286

ABSTRACT

BACKGROUND: Patients undergoing autologous stem cell transplantation (ASCT) for multiple myeloma (MM) face sudden exacerbations of anxiety, insomnia, and other symptoms within the initial weeks following ASCT. Even as these symptoms abate in subsequent months, long-term consequences include post-traumatic stress disorder (Griffith 2020), quality of life (QOL) impairments (El-Jawahri 2016), and chronic reliance on higher-risk medications such as benzodiazepines (Banerjee 2020). These findings are particularly relevant to MM patients given their older age at diagnosis, longer expected post-ASCT survival, and poorer QOL at baseline compared with other cancer patients (Kent 2015). Compared to other integrative interventions in the peri-ASCT setting, life coaching transcends a symptomatic focus while directly addressing the root determinants of impaired QOL. Life coaches work with patients using structured frameworks (Figure 1A) to provide longitudinal support, education, and accountability to meet patient-identified wellness goals. Digital life coaching (DLC) combines the strengths of life coaching with the capabilities of digital health by channeling patient-coach communication through patients' personal phones. Compared to in-person coaching, DLC is location-agnostic and allows patients to work their coaches more conveniently and frequently. DLC is feasible among ASCT survivors (Chen 2016) but has not yet been studied in the active peri-ASCT setting. We are conducting a pilot study of a 16-week DLC subscription to assess its feasibility and effects on QOL during an intensive period spanning from pre-ASCT hospitalization through Day +100 after ASCT. If successful, we plan to then pursue a randomized Phase II study comparing DLC versus usual care in the peri-ASCT setting. METHODS: Our study is registered at clinicaltrials.gov as NCT04432818. We plan to enroll 27 adult patients with MM undergoing first ASCT at our institution. Inclusion criteria include English language proficiency and ownership of a personal cellphone. Notably, neither ownership of a smartphone nor installation of a specific mobile app is required for patient enrollment. Enrolled patients will receive unlimited access to a certified life coach beginning at Day -5 before ASCT;bidirectional communication is encouraged via phone, text, or email. The life coaches will reach out at least once per week to help patients accomplish self-identified goals such as symptom management, stress reduction, and physical activity. Our study's primary endpoint is ongoing patient engagement, defined as least one patient-initiated outreach to their coach during each of four 4-week study subperiods. Our study's secondary endpoints include patient-reported outcome (PRO) assessments of QOL, distress, and sleep disturbances (to be collected using electronic surveys every 1-2 weeks as shown in Figure 1B). Exploratory endpoints include benzodiazepine usage and rates of electronic/phone communication with patients’ treatment teams. We will analyze endpoints using descriptive methods, including stratification of secondary & exploratory endpoints by DLC usage and specific 4-week study subperiod. PROGRESS TO DATE: Of 18 approached patients as of the data cutoff (8/1/20), 15 (83%) have expressed interest. Reasons for non-enrollment include skepticism about the value of interactions with coaches who do not themselves have MM. Of the 15 patients who have expressed interest in the study, the median age is 65 (range: 50-81) and all but one patient report owning a personal smartphone. All 6 patients with finalized ASCT hospitalization dates have been enrolled and paired with life coaches. Adherence to weekly electronic PRO assessments has been 100% (n = 9 timepoints) to date, consistent with previous studies (Wood 2013). CONCLUSIONS: Our pilot study is ongoing. Our findings to date suggest that certain MM patients are phone-savvy and would be interested in digital health tools, which will continue to gain prominence in light of the ongoing COVID-19 pandemic. Strengths of DLC include it scalability across institutional lines and its ability to reach patients at home in an integrative manner. Results of this study will inform innovative approaches to support the wellbeing of patients with hematologic malignancies, both in the peri-transplantation setting and beyond. [Formula presented] Disclosures: Brassil: Pack Health: Current Employment. Patel: Pack Health: Current Employment. Jackson: Pack Health: Current Employment. Wong: Janssen: Research Funding;Roche: Research Funding;Amgen: Consultancy;Sanofi: Membership on an entity's Board of Directors or advisory committees;GSK: Research Funding;Bristol Myers Squibb: Research Funding;Fortis: Research Funding. Wolf: Adaptive: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Martin: Seattle Genetics: Research Funding;AMGEN: Research Funding;GSK: Consultancy;Sanofi: Research Funding;Janssen: Research Funding. Shah: BMS, Janssen, Bluebird Bio, Sutro Biopharma, Teneobio, Poseida, Nektar: Research Funding;GSK, Amgen, Indapta Therapeutics, Sanofi, BMS, CareDx, Kite, Karyopharm: Consultancy.

10.
Journal of Clinical Oncology ; 39(15 SUPPL), 2021.
Article in English | EMBASE | ID: covidwho-1339304

ABSTRACT

Background: Patients with multiple myeloma (MM) experience acute quality of life (QOL) exacerbations following autologous stem cell transplantation (ASCT) that can lead to long-term complications. Life coaching can improve QOL in a structured & personalized manner. We investigated the feasibility of a digital life coaching (DLC) platform, where coaching is accomplished through phone calls and text messages, for patients with MM during ASCT. Methods: Our pilot study (clinicaltrials.gov ID: NCT04432818) enrolled adult patients with MM, English proficiency, and cellphone ownership (smartphone not required). The 16-week DLC program, beginning at Day -5 before ASCT, included unlimited digital access to a certified life coach to help with identifying and accomplishing wellness-related goals. Our primary outcome was ongoing DLC engagement (≥ 1 bidirectional conversation every 4 weeks). Secondary outcomes were ePRO assessments of QOL (PROMIS Global Health), insomnia (PROMIS Sleep Disturbances), and distress (NCCN DT). Electronic patient-reported outcome (ePRO) assessments were delivered via automated REDCap emails every 1-2 weeks. Results: Of 18 screened patients, 15 (83%) enrolled in our study;2 patients dropped out before initiating DLC (including 1 who was unable to connect with her coach between Day -5 and 0). Of 13 remaining patients, median age was 65 (range 50-81) and 23% had an ECOG performance status of 1 (remainder 0). DLC conversations occurred a mean of every 7.6 days (range 3-28) overall and every 6.5 days (range 2.8-14) during the initial 28- day period including high-dose melphalan and hospitalization. 80% of patients maintained ≥ 1 conversation every 4 weeks. Selected ePRO results (mean ± standard error) are shown in the table. Conclusions: Certain MM patients are able to engage digitally with a life coach and complete email-based ePRO assessments during and after ASCT. Limitations of our study include selection bias and the Day -5 start date, which may be too late logistically and symptom-wise (given our ePRO findings suggestive of peak distress pre- ASCT). DLC may play an innovative and scalable role given the emphasis on remotely delivered care during the COVID-19 pandemic. A Phase II randomized study of DLC versus usual care is under way (clinicaltrials.gov ID:.

11.
International Journal of Public Law and Policy ; 7(1):74-96, 2021.
Article in English | Scopus | ID: covidwho-1247676

ABSTRACT

Disease outbreaks in the form of epidemics and pandemics are known to destabilise the existing global public health infrastructure and to put nation-states in an alarming set of circumstances, thereby posing quite a few questions before us, including: can there be a solution to such problem in international law? In light of this question, the present essay tries to discern the role of international law in handling disease outbreaks. It wants to know whether there are sufficient international legal safeguards to address disease outbreaks and whether liability can be fastened on nation-states (including their people), international organisations, etc., if they are found to be directly and substantially responsible for such outbreaks. It dissects theoretical frameworks, analyses and interprets the existing literature to conclude that a 'one-size-fits-all' international legal approach is required to control disease outbreaks. It eventually recommends the need to have a Pandemic Convention. Copyright © 2021 Inderscience Enterprises Ltd.

12.
Open Forum Infectious Diseases ; 7(SUPPL 1):S683-S684, 2020.
Article in English | EMBASE | ID: covidwho-1185954

ABSTRACT

Background. It is unclear how the COVID-19 pandemic has impacted outpatient pediatric antibiotic prescribing. Methods. We compared diagnoses and antibiotic prescription rates for children pre- vs post-COVID-19 in 5 ambulatory settings affiliated with Vanderbilt University Medical Center: emergency department (ED), urgent care clinics (including pediatric-only after-hours clinics [AHC]s and walk-in clinics [WIC] for all ages), primary care clinics (PCC), and retail health clinics (RHC). Time periods were pre-COVID-19 3/1/19 - 5/15/19 (P1);and post-COVID-19 3/1/20 - 5/15/20 (P2). Diagnoses and percent of encounters with an antibiotic prescription were analyzed by encounter (in-person vs telemedicine [TMed]), clinic and provider type. We also interviewed 16 providers about perceived COVID-19 impact on pediatric ambulatory antibiotic prescribing. Student's T and χ 2 tests were used as appropriate. Results. The number of pediatric ambulatory visits was 16671 in P1 and 7010 in P2. There were no TMed visits in P1 vs 188 in P2 (2.7% of total P2 visits);186 (99% of TMed visits) were in PCC (Table). In all settings, the number of encounters was lower in P2 vs P1 (p< 0.001). The percent of encounters with an antibiotic prescription was lower in P2 (32%) than in P1 (38.2%) (p< 0.001) (Table) overall and in all settings except RHCs. Only 14 (7.4%) TMed visits resulted in an antibiotic prescription. There were no differences in antibiotic prescribing rates by provider type. Diagnoses varied significantly between periods in all clinic types except the ED, with noninfectious diagnoses being higher in P2 vs P1 (Figure 1). Providers felt that COVID-19 led to fewer but sicker patients presenting for care, and variable impact on antibiotic prescribing Conclusion. The proportion of encounters with non-infectious diagnoses increased and antibiotic prescribing rates decreased significantly in all pediatric ambulatory settings post-COVID-19 except RHCs. Almost all TMed encounters occurred in the primary care setting, and few resulted in an antibiotic prescription. Providers felt they saw fewer patients and higher acuity of illness post COVID-19.

13.
Open Forum Infectious Diseases ; 7(SUPPL 1):S248-S249, 2020.
Article in English | EMBASE | ID: covidwho-1185724

ABSTRACT

Background: Little is known regarding the full spectrum of illness among children with SARS-CoV-2 infection across integrated healthcare settings, as many published pediatric cohorts focus on hospitalized patients with SARS-CoV-2 infection. Methods: Active surveillance was performed for SARS-CoV-2 detections among symptomatic and asymptomatic children and adolescents ≤18 years of age in a quaternary care academic hospital laboratory in the Southeastern U.S. For symptomatic patients with a positive respiratory specimen for SARS-CoV-2 by polymerase chain reaction (PCR), and for neonates born to SARS-CoV-2-positive mothers, we performed phone follow-up and medical record review at days 2, 7, and 30 after diagnosis. Testing was initiated 3/12/20 for symptomatic patients and 5/4/20 for screening asymptomatic patients. Results: By 6/14/20, SARS-CoV-2 tests were positive in 193/5306 (3.6%) specimens from unique patients ≤18 (Table 1), compared to 2653/36503 (7.2%) specimens in patients >18 years. Specimens from 181/2638 (6.8%) symptomatic and 12/2768 (0.4%) asymptomatic children were positive. Nine infants born to SARS-CoV-2 infected mothers had negative PCR tests at birth;1 infant subsequently acquired SARS-CoV-2 infection at 5 weeks of age. Sociodemographic and clinical data for 181 SARS-CoV-2-positive symptomatic children are displayed in Table 2 and Figure 1. The most common symptoms were cough (59%), fever (50%), and rhinorrhea (39%). Nine/181 symptomatic patients (5%) were hospitalized, primarily for respiratory symptoms. Symptom resolution occurred by follow-upday 2 in 82/178 (46%) and day 7 in 128/164 (78%) patients with complete assessments to date. 131/181 (72%) of children had known SARS-CoV-2 positive contacts. We observed no cases of multisystem inflammatory syndrome in children. Conclusion: In our community, pediatric SARS-CoV-2 prevalence was low, but was much higher among symptomatic than asymptomatic children. Symptoms were mild, and the duration of symptoms brief, in the majority of these patients captured within an integrated ambulatory and hospital-based healthcare system, capturing the full spectrum of the disease profile in this age group.

14.
Journal of Clinical Oncology ; 38(29), 2020.
Article in English | EMBASE | ID: covidwho-1076199

ABSTRACT

Background: Accurate performance status (PS) documentation is essential as poor PS is a strong predictor of treatment-related toxicity. At our institution, a baseline chart review revealed missing PS documentation in 28% of Fellow-seen new patient visits (NPV);PS documentation as unstructured text comprised the remainder. The lack of structured PS documentation represents a missed opportunity for accurate data in registries, trial registration, and supportive care referrals. Methods: To improve standardized documentation of PS for NPV, we designed a Fellowled quality improvement (QI) initiative over the course of 2 PDSA cycles. Specifically, we developed and implemented a structured PS smart data element tool (SDET) into our electronic medical record (EMR). PDSA cycle 1 (7/2019-11/2019) included SDET implementation and publicity using flyers & emails. PDSA cycle 2 (12/2019-4/2020) incorporated individualized feedback to Fellows, biweekly email reminders, and outreach to attendings regarding our SDET. We calculated cumulative usage of our SDET for PS documentation during the 2019-2020 academic year among NPV seen by Fellows. Our aim was to assess and document PS in at least 50% of NPV seen in person. Results: During PDSA cycle 1, cumulative structured PS documentation increased from 8% to 31% (Table). Focus groups revealed that Fellows were not consistently incorporating our SDET into their note templates or were relying on attendingwritten templates. Over PDSA cycle 2, the cumulative structured PS documentation rate increased from 24% to 54%. Overall our cumulative documentation rate is 40%, in large part driven by cycle 1 because of a drop in NPVs and the transition to telehealth during the COVID-19 pandemic. Conclusions: Our Fellow-led QI intervention improved cumulative structured PS documentation from 8% to 40% using two rapid PDSA cycles. Our intervention highlights the importance of real-time data review and stakeholder feedback to identify ongoing challenges. Our third PDSA cycle will include expansion to all clinic providers (Fellows, attendings, and advancedpractice providers), as well as the incorporation of telehealth encounters and follow-up visits. We also hope to align our QI initiative with broader steps toward data interoperability via the ASCO-sponsored mCODE initiative.

15.
Journal of Content, Community and Communication ; 12:198-209, 2020.
Article in English | Scopus | ID: covidwho-1061301

ABSTRACT

This study highlights the role of utilitarian shopping, hedonic shopping, and online advertisement on cognitive dissonance. Impulse Buying plays a role as a mediator in this research. The objective of this research is to investigate how utilitarian shopping value, hedonic shopping value, and online advertising influence the cognitive dissonance of customers. 338 response data have been collected from consumers involved in fashion apparel;respondents are majorly from central zone of India. Partial least square (PLS) - Structural equation modelling (SEM) is implemented using Smart PLS 3.0. The simulation result shows that utilitarian shopping value, hedonic shopping value, and online ads are found to be important in predicting cognitive dissonance and impulse buying, whereas impulse buying is impeccable in terms of predicting positive relationships with cognitive dissonance. Moreover, Impulse buying is playing as positive mediating effect in relation with constructs. Hence, this research suggests that a complex representation which may better understanding about consumer shopping behaviour. Conclusively, this research’s major contribution towards authors’ knowledge, and help the marketing expert to focus on important parameter of consumer buying behaviour. © 2020. All Rights Reserved.

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