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1.
Educational Researcher ; 2023.
Article in English | Scopus | ID: covidwho-2251717

ABSTRACT

To address the unprecedented challenges of the COVID-19 pandemic, Congress authorized the Higher Education Emergency Relief Fund (HEERF I) in March 2020 with over $6 billion allocated for emergency financial aid. In this paper, we utilize the administrative burden framework to analyze HEERF I implementation for a stratified random sample of colleges, focusing on the implications for equity. We find that disbursement policies varied along two dimensions: (1) whether they imposed burdens on students by requiring applications and proof of hardship and (2) whether they targeted needy students and varied the amount of aid according to need. When we examine sectoral differences, we find that private for-profit colleges were more likely to place higher burden on students, whereas public and minority-serving institutions were more likely to reduce burden. © 2023 AERA.

2.
Open Forum Infectious Diseases ; 9(Supplement 2):S554-S555, 2022.
Article in English | EMBASE | ID: covidwho-2189830

ABSTRACT

Background. Infectious Disease (ID) physicians have historically had higher levels of burnout compared to other medical specialties. Fellows are not immune to the pressures that attendings experience in the course of clinical care. The Accreditation Council for Graduate Medical Education now requires programs to formally promote well-being amongst trainees. We created a structural intervention to improve fellow well-being and conducted a before-and-after study demonstrating effectiveness. Methods. We restructured our institution's inpatient ID clinical services, which increased attending presence on weekends and afternoons to help with clinical volume. A survey including the Maslach Burnout Inventory for Medical Personnel (MBI-HSS(MP)) and wellness metrics was completed by our 5 fellows before and after the intervention. Consult volume and efficiency were assessed before and after the intervention. Descriptive statistics, paired t-tests or Wilcoxon signed-rank tests were utilized as appropriate for data normality. Qualitative survey responses were coded into key domains until saturation was reached for analysis. Results. Post-intervention MBI-HSS(MP) mean scores significantly improved for emotional exhaustion (EE) [3.3 to 2.3, p-value .0089]. Personal accomplishment and depersonalization metrics improved but were not significant. Survey items assessing time for education, learning to service balance, satisfaction and wellness all improved but were not significant (Table 1). Consult volume was the most frequent domain associated with dissatisfaction, and was described as the most improved domain since intervention (Table 2). Clinical work volumes were the same, if not higher, in the post intervention period (Table 3). All 5 fellows completed surveys before and after the intervention. The pre and post intervention means with standard errors (SE) or frequency of responses are listed in the table as well as p- values for Wilcoxon-signed rank or paired t-test (depending on normality of that variable). For 'education versus service balance' fellows used a visual analogue scale (0-100) to assess their views of balance of education (lower values) to service (higher values) while on General Infectious Disease consults (GID). Fellows were asked to rate their 'satisfaction' with GID on a visual analogue scale from 0-100 with lower values as dissatisfaction and higher values as satisfaction. EE, DP, and PA are metrics used in the Maslach Burnout Inventory for Medical Personnel (MBI-SS(MP)). The values of the MBI questions are mean responses across items in their respective inventories, with higher values for EE and DP meaning more frequent negative experiences, and higher values for PA meaning more frequent positive experiences. For MBI, scores indicate how frequently feelings occur: 1, a few times/year;2, monthly;3, a few times monthly;4, weekly;5, a few times/week. Fellows were also asked to give the frequency at which they were able to teach or complete responsibilities at home (such as childcare, cleaning, cooking, grocery shopping) while on GID. Responses truncated only to frequencies selected by respondents. Responses to the last two questions were numerically coded for statistical analysis. * Indicates statistical significance (p < .05). Free text survey responses were analyzed by authors, resulting in the generation of key conceptual response domains;this process continued until saturation was reached, leading to the coding of text responses as above. Examples from text responses included in parenthesis. Prompt 1 was given to the 5 fellows before and after the intervention leading to 10 responses. Prompt 2 was given to the 5 fellows only following intervention. Variables were assessed pre and post intervention. Max list size is the maximum number of patients on the general infectious disease (GID) consult service, bumped consults is the number of consults not seen until the following work day, curbside consults is the number of consults where recommendations were given without seeing the patient, last rec is the t me of delivery of the last recommendation, pages is the raw number of pages received in a day by the GID fellow and COVID-19 census is the total number of patients admitted to our center with COVID-19. *Indicates statistical significance (p < .05) by paired t-test. IQR signifies inter-quartile range. Conclusion. We found that an intervention addressing structural contributors to burnout was effective in reducing EE and perception of clinical volume. This finding was significant despite stable to increased clinical volumes and the added stress of the cotemporaneous Omicron outbreak of COVID-19.

5.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925265

ABSTRACT

Objective: To investigate the humoral immune response following SARS-CoV-2 vaccination in patients with multiple sclerosis (pwMS) and to determine the effect of disease modifying therapies (DMT) on the vaccination response. Background: Coronavirus disease 19 (COVD-19), a highly transmissible and potentially fatal illness caused by SARS-CoV-2, emerged as a global pandemic in early 2020. Several vaccines, including 2 innovative mRNA vaccines, were developed against this virus. To reduce relapse rates and slow disability accumulation, pwMS are often treated with DMTs which have anti-inflammatory properties and regulate adaptive immunity. An important clinical issue concerns the impact of DMTs on the efficacy of SARS-CoV-2 vaccination, and the eventual need for booster doses. In this study, we measured the titers of anti-SARS-CoV-2 neutralizing antibodies (nAbs) in pwMS following SARS-CoV-2 vaccination. Design/Methods: We conducted a prospective longitudinal study in pwMS at the Ohio State University (OSU) MS Center. Longitudinal serum samples were obtained from pwMS prior to and after the administration of the SARS-CoV-2 vaccine. These samples were analyzed for nAbs against SARS-CoV-2 spike protein using a novel pseudotyped-lentivirus-based virus neutralization assay. OSU health care workers (HCWs) served as healthy controls. Results: Of eighty-three consented subjects, fifty-two had post vaccination serum samples analyzed. Although pwMS did not exhibit drastically different nAb titers compared to HCWs, 21% (n=11) did not have detectable nAb titers post-vaccination (NT50 < 40)-including 9 patients on B-cell depleting therapies, 1 on sphingosine 1-phosphate modulator, and 1 on no DMT. Compared to patients not on DMT, pwMS on B-cell depleting therapies exhibited 7-fold lower nAb titers, while those on fumarates or beta-interferon exhibited no significant difference to patients not on DMT. Conclusions: Humoral immune response to the SARS-CoV-2 vaccine may be attenuated by certain DMTs, most notably B-cell depleting drugs. Further studies are underway to determine the effect of booster vaccine on nAb levels.

6.
Multiple Sclerosis Journal ; 28(1_SUPPL):80-80, 2022.
Article in English | Web of Science | ID: covidwho-1865951
7.
Open Forum Infectious Diseases ; 8(SUPPL 1):S572, 2021.
Article in English | EMBASE | ID: covidwho-1746344

ABSTRACT

Background. The incorporation of effective treatments is critical to improving patient care for COVID-19. We assessed the educational impact of a series of continuing medical education (CME) activities on knowledge, competence, and confidence changes in US and OUS physicians related to the use of monoclonal antibodies (mAbs) for COVID-19. Methods. 10 online, CME-certified activities were delivered in multiple formats. For individual activities, educational effect was assessed with a repeated pairs pre-/ post-assessment study including a 1 to 7-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question. To assess changes in knowledge, competence, and confidence, data were aggregated across activities and stratified by learning theme. McNemar's test or paired samples t-test (P< .05) assessed educational effect. The activities launched between November 2020 and May 2021;data were collected through May 2021. Results. To date, the 10 activities have reached over 50,000 clinicians, including 24,627 physicians. Selected improvement/reinforcement in knowledge/competence measured as relative % change in correct responses pre/post education across the learning themes are reported. (i) 89% improvement/reinforcement among US ID specialists in knowledge/competence incorporating mAbs into patient care and 83% improvement among outside the US (OUS) ID specialists (P < .001). (ii) 70% improvement/ reinforcement among US PCPs in knowledge/competence incorporating mAbs into patient care and 55% improvement among OUS PCPs (P < .001). (iii) 52% improvement/ reinforcement in knowledge/competence among US PCPs regarding clinical data for mAbs and 44% among OUS PCPs (P < .001). (iv) 42% of US ID specialists and 29% of OUS ID specialists had a measurable improvement in confidence in identifying patients who would benefit from mAbs (P < .001). Conclusion. This series of online, CME-certified educational activities resulted in significant improvements in knowledge, competence, and confidence regarding the appropriate use of mAbs for SARS-CoV-2 in clinical practice. These results demonstrate the effectiveness of global curriculum-based education for clinicians designed to address specific gaps in care.

8.
Journal of Investigative Medicine ; 70(2):644-645, 2022.
Article in English | EMBASE | ID: covidwho-1701075

ABSTRACT

Purpose of Study It is important to identify possible changes in fetal, neonatal, and maternal outcomes in relation to the beginning of the COVID-19 pandemic using population-based data to inform strategies to mitigate the impact of the pandemic on adverse pregnancy outcomes. Objective To test the hypothesis that the COVID-19 pandemic was associated with a higher rate of stillbirth and a lower rate of neonatal mortality. Methods Used Design: This population-based cohort study compares two epochs: calendar weeks 9-52 (defined as week one starting on the first Sunday of the year) of the years 2016 to 2019 (baseline period)) and 2020 (pandemic period). Setting: Data from the Alabama Department of Public Health, Center for Health Statistics database of Alabama state residents who delivered in Alabama. Participants: All pregnant women with stillbirths ≥20 weeks and live births ≥22 weeks gestational age. Primary Outcomes: The stillbirth and neonatal mortality rate. Summary of Results Data on 237,625 pregnant women were included;46,816 were from the pandemic and 190,809 were from the baseline period. On bivariate analysis, the stillbirth rate did not differ (8.1 vs. 8.9/1000 births, p-value=0.104), but the neonatal mortality rate was lower (2.8 vs. 4.5/1000 live births, p-value<0.001), and the maternal mortality rate was higher (102.5 vs. 62.4/100,000 births, p-value=0.003) during the COVID-19 pandemic period as compared to the baseline period. On logistic regression analysis adjusting for socio-demographic variables (maternal race, age, education, and prenatal care), the pandemic period was associated with a decrease in stillbirth (OR=0.76, 95%CI=0.64, 0.91, pvalue= 0.002) and neonatal mortality rate (OR=0.62, 95% CI=0.51-0.75, p-value<0.001) but an increase in maternal mortality rate (OR=1.64, 95% CI=1.17-2.30, P-value=0.003) as compared to the baseline period. Conclusions The current population-based study shows that the COVID-19 pandemic period was associated with no change in the stillbirth rate, a lower neonatal mortality rate, and a higher maternal mortality rate compared to the baseline period.

9.
New Zealand Medical Journal ; 134(1547):121-126, 2021.
Article in English | Web of Science | ID: covidwho-1695290

ABSTRACT

The COVID-19 pandemic has drawn considerable attention to the survival journey and recovery of patients post critical illness. A decade ago, the Society of Critical Care Medicine described the prolonged adverse health effects after a critical illness as the "post intensive care syndrome" (PICS). Evidence is emerging from Australia around the impact critical illness has on disability, mental health, cognitive function and health-related quality of life for patients this side of the world. For example, one study has shown that disability was highly prevalent in survivor's six-month post hospital discharge, with 50% having mild disability and 25% with moderate to severe disability. Currently it is unknown what the survival journey is like for patients in New Zealand;how we should best measure outcomes for our population;and how we should support Maori and Pasifika patients post critical illness. Research is needed in every aspect of PICS in New Zealand. In 2022, the much-anticipated Survivorship of Patients Post Long Intensive Care Stay, Exploration/Experience in a New Zealand Cohort (SPLIT ENZ) study will explore important aspects of recovery and long-term outcomes for New Zealand survivors of critical illness.

10.
Ann. Neurol. ; 90:S184-S185, 2021.
Article in English | Web of Science | ID: covidwho-1473002
11.
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