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1.
Water Res ; 226: 119306, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2086834

ABSTRACT

Genomic surveillance of SARS-CoV-2 has provided a critical evidence base for public health decisions throughout the pandemic. Sequencing data from clinical cases has helped to understand disease transmission and the spread of novel variants. Genomic wastewater surveillance can offer important, complementary information by providing frequency estimates of all variants circulating in a population without sampling biases. Here we show that genomic SARS-CoV-2 wastewater surveillance can detect fine-scale differences within urban centres, specifically within the city of Liverpool, UK, during the emergence of Alpha and Delta variants between November 2020 and June 2021. Furthermore, wastewater and clinical sequencing match well in the estimated timing of new variant rises and the first detection of a new variant in a given area may occur in either clinical or wastewater samples. The study's main limitation was sample quality when infection prevalence was low in spring 2021, resulting in a lower resolution of the rise of the Delta variant compared to the rise of the Alpha variant in the previous winter. The correspondence between wastewater and clinical variant frequencies demonstrates the reliability of wastewater surveillance. However, discrepancies in the first detection of the Alpha variant between the two approaches highlight that wastewater monitoring can also capture missing information, possibly resulting from asymptomatic cases or communities less engaged with testing programmes, as found by a simultaneous surge testing effort across the city.


Subject(s)
COVID-19 , Waste Water , Humans , SARS-CoV-2/genetics , Reproducibility of Results , COVID-19/epidemiology , Wastewater-Based Epidemiological Monitoring , Genomics
2.
Proceedings of the 2021 Asia-Pacific International Symposium on Aerospace Technology (Apisat 2021), Vol 2 ; JOUR:599-617, 913.
Article in English | Web of Science | ID: covidwho-2085303

ABSTRACT

The Electronic Navigation Research Institute and Korea Aerospace University have proposed an initial Free Route Airspace (FRA) concept for the Fukuoka and Incheon Flight Information Regions (FIR) to improve air traffic flows and air traffic management in northeast Asia. We are now working to elaborate the concept, quantify benefits, and identify implementation issues. This paper examines two air traffic flows in Fukuoka FIR: (1) Japanese domestic flights between the highest traffic city pairs, and (2) overflight traffic between Korea and North America across radar-controlled airspace. From an analysis of operations based on flight plan and radar data for 2019, prior to the COVID-19 pandemic, FRA design and implementation issues are considered. Our analysis and findings are expected to contribute to the planning of FRA implementation in Northeast Asia.

3.
Chest ; 162(4):A1383-A1384, 2022.
Article in English | EMBASE | ID: covidwho-2060812

ABSTRACT

SESSION TITLE: COVID-19 Infections: Issues During and After Hospitalization SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm PURPOSE: Pneumothorax and pneumomediastinum (PTX/PM) has been associated with patients hospitalized with COVID-19 infections. The aim of our study was to assess the risk factors, hospital length of stay, and mortality of PTX/PM among hospitalized patients with COVID-19 infection in a matched case-controlled study. METHODS: Adult patients with confirmed COVID-19 infections who were hospitalized at 5 Mayo Clinic hospitals (Minnesota, Arizona, Florida, Wisconsin) between March 2020 and January 2022 were retrospectively screened. PTX and or PM in at least two consecutive imaging studies were included. They were matched to control patients based on age, gender, hospital admission period, severity on admission day and the day preceding the incident. Summary statistics, Mann Whitney-U, and chi-square tests were performed RESULTS: A total of 197 patients were included in the descriptive analyses.The median age was 61 years and the majority were men (70.8%). Patients with underlying pulmonary comorbidities was 2.27 (OR 1.42-3.62, p value < 0.001) times more likely to develop PTX/PM. Ten percent of the total cases had these complications present upon hospital admission.Patients who developed PTX/PM had a longer hospital length of stay compared to controls, 20 versus 12 days, OR 4.53 (p=0.002). On the day prior to developing PTX/PM, 42 (31%) of patients had been on high-flow nasal cannula only and 14 on non-invasive ventilation (10.4%). The highest recorded positive end-expiratory pressure, plateau, and driving pressures were recorded in our case group on the day before the complication and all were significantly higher than matched controls. In-hospital mortality in patients whose COVID-19 course was complicated by PTX/PM was 44.2% vs. those without, 21.1%, adjusted OR 2.71 (p=0.001). Sixty two percent were treated conservatively without any intervention. CONCLUSIONS: We have demonstrated in the largest study to date, that patients who were hospitalized with COVID-19 infection and had a PTX/PM had a longer hospital length of stay, were associated with higher mechanical ventilatory pressures, and had a higher in-hospital mortality, when compared with matched controls. CLINICAL IMPLICATIONS: Complications of PTX/PM in patients with COVID-19 infections can occur spontaneously and in barotrauma. Pre-existing lung disease is a risk factor for the development of these complications. Patients with PTX/PM have a longer hospital length of stay and higher in-hospital mortality which is in contrast with existing published data. DISCLOSURES: No relevant relationships by Natalya Azadeh No relevant relationships by Meghan Brown No relevant relationships by Rodrigo Cartin-Ceba No relevant relationships by Anusha Devarajan No relevant relationships by Juan Pablo Domecq No relevant relationships by Sandeep Khosa No relevant relationships by Amos Lal No relevant relationships by Shahraz Qamar No relevant relationships by Kenneth Sakata No relevant relationships by Mayank Sharma No relevant relationships by Nikhil Sharma No relevant relationships by Jamil Taji No relevant relationships by Fahimeh Talaei No relevant relationships by Aysun Tekin No relevant relationships by Diana Valencia Morales No relevant relationships by Stephanie Welle

4.
Whitewashing Race: The Myth of a Color-Blind Society ; : 1-382, 2023.
Article in English | Scopus | ID: covidwho-2045097

ABSTRACT

Whitewashing Race argues that contemporary racism manifests as discrimination in nearly every realm of American life, and is further perpetuated by failures to address the compounding effects of generations of disinvestment. Police violence, mass incarceration of Black people, employment and housing discrimination, economic deprivation, and gross inequities in health care combine to deeply embed racial inequality in American society and economy. Updated to include the most recent evidence, including contemporary research on the racially disparate effects of the Covid-19 pandemic, this edition of Whitewashing Race analyzes the consequential and ongoing legacy of "disaccumulation" for Black communities and lives. While some progress has been made, the authors argue that real racial justice can be achieved only if we actively attack and undo pervasive structural racism and its legacies. © 2003, 2023 by The Regents of the University of California. All rights reserved.

5.
Cardiovascular Digital Health Journal ; 3(4):S19-S20, 2022.
Article in English | EMBASE | ID: covidwho-2041653

ABSTRACT

Introduction: The COVID-19 pandemic catalyzed growth of virtual medicine, challenging providers to adapt their standard protocols for telehealth. During this time, cardiologists were unable to gather numerical/graphical heart data to guide therapy. Many examination technologies exist in-person to obtain this data, but they are not engineered for patient use during virtual visits. Objective: The team sought to develop an inexpensive diagnostic point-of-care device designed to work with telehealth applications and provide patients with the ability to transmit data on cardiovascular function to physicians in real time. Methods: The AusculBand used clinician and patient input for final design format. The AusculBand is shaped like a wristband and encapsulates a custom bell, microphone, and novel circuitry to facilitate self-auscultation for live transmission to a virtual physician. Frequency response testing was designed to verify the AusculBand’s captured cardiac sound frequency range. A comparative study was designed to test audio quality against and the Eko Duo’s, a leading competitor. Repeated cardiac auscultation signals at different points and background noise using both devices were obtained to quantify signal-to-noise ratio (SNR) on one user. Results: During frequency response analysis, the AusculBand captured frequencies up to 1997Hz in response to a signal that swept through a range of 0-3kHz. These results were within 0.2% of the 2kHz upper-limit of the cardiac range. SNR testing showed 27.29dB for the AusculBand and 24.02dB for the Eko Duo. The AusculBand is nearly twice as loud as the Eko Duo, and maintains a projected price of $80 (Eko Duo $320). Conclusions: The AusculBand is an inexpensive, patient-oriented digital stethoscope that beats industry standards in SNR and is compatible with existing telehealth platforms. Future modifications will add a single-lead ECG to promote the device as an all-in-one telemedicine tool for virtual cardiac analysis. [Formula presented] [Formula presented]

6.
Clinical Infection in Practice ; 15, 2022.
Article in English | EMBASE | ID: covidwho-2041630

ABSTRACT

Introduction: Neutralising monoclonal antibodies (nMAbs), available in UK for patients meeting “high risk” criteria, reduce the risk of hospitalisation and death in unvaccinated patients with mild/moderate covid. However, in vaccinated cohorts infected predominantly with omicron variant, immune responses may be sufficiently strong that nMAbs have limited added benefit. We assessed anti-SARS COV2 anti-S antibody responses in those attending North Central London (NCL) Covid Medicines Delivery Unit (CMDU) for Sotrovimab, and stratified patients by degree of immunosuppression. Methods: Adult patients attending for Sotrovimab infusion between 20/12/21 to 20/03/22 had baseline anti-S antibody levels checked prior to administration of Sotrovimab. Data from these patients were manually extracted from patient notes and analysed in Microsoft excel. Patients were categorised into “higher risk” – Group 1 and “lower risk”- Group 2, according to degree of immunosuppression. Results: 399 patients received Sotrovimab. Serology was available for 375. 17 patients were unvaccinated (1 vaccination or less), all had antibody levels <250 iU/ml. Antibody levels for vaccinated patients can be seen in Table 1and shows undetectable antibody levels in 13% of Group 1 patients and 0% of Group 2 patients. Discussion: Patients who meet national criteria for treatment can be stratified according to degree of immunosuppression that is reflected in anti-S antibody levels. This may help define which patients would benefit most from nMAbs, and provides support for a risk stratification tool. However further data on outcomes, and neutralising efficacy of prior anti-S level on omicron variant, is needed.

8.
Strategic Airport Planning ; : 1-166, 2022.
Article in English | Scopus | ID: covidwho-2024938

ABSTRACT

This book will explore a new approach to airport planning that better captures the complexities and velocity of change in our contemporary world. As a result, it will lead to higher performing airports for users, business partners, investors and other stakeholders. This is especially pertinent since airports will need to come back better from the Covid-19 pandemic. The book explains the importance of articulating a clear strategy, based on a rigorous analysis of the competitive landscape while avoiding the pitfalls of ambiguity and 'virtue signalling'. Having done so, demand forecasts can be developed that resemble S-curves, not simple straight lines, that reflect strategic opportunities and threats from which a master plan can be developed to allocate land and capital in a way that maximizes return on assets and social licence. The second distinctive feature of this book is the premise that planning an airport as an island, a fortress even, does not work anymore given how interconnected airports are with other components of the transportation system, the economies and communities they serve and the rapid pace of social and technological change. In summary, the book argues that airport planning needs to move beyond its traditional boundaries. The book is replete with real examples from airports of all sizes around the world and includes practical advice and tools for executives and managers. It is recommended reading for individuals working in the airport business or the broader air transport industry, members of airports' board of directors, who may be new to the business, elected officials, policy makers and urban planners in jurisdictions hosting or adjacent to airports, regulators, economic development professionals and, finally, students. © 2022 Mike Brown. All rights reserved.

9.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2005675

ABSTRACT

Background: The National Cancer Institute (NCI) estimates that approximately one-quarter of adults with cancer are parents to children less than 18 years. Further, it is estimated that 2.85 million minor children in the United States have a parent undergoing cancer treatment. Previous studies have demonstrated that parents with cancer experience significant stress and disruptions to familial life following a cancer diagnosis. In a study of women with breast, gynecologic cancer and other cancers undergoing cancer therapy, 48.7% of women endorsed needing help with childcare and 64.1% needing help with household management. Despite this evidence supporting both a need for childcare among patients with cancer, data regarding the availability of on-site childcare programs and resources at NCI-designated cancer centers is limited. The objective of this cross-sectional study was to assess the availability of childcare resources for parents who are undergoing cancer treatment at NCI-Designated Cancer Centers. Methods: The availability of childcare resources for parents undergoing cancer treatment at all 51 NCI-designated comprehensive cancer centers and 13 NCI-designated cancer was assessed in January 2021 and February 2021. Childcare resources were assessed via online search and telephone calls. Specifically, centers were queried regarding availability of daycare programs for children of patients undergoing treatment and whether resources were available to assist patients in need of childcare. Descriptive statistics were performed. Results: In total, only 1/64 (1.6%) of NCI-designated cancer centers currently offer childcare resources for patients undergoing cancer treatment. This center offers childcare for children ages 2-8, free of charge with multiple outpatient locations. One additional institution previously provided patients with access to daycare, but has closed due to the COVID-19 pandemic. Further, only 1/64 (1.6%) NCI-designated cancer center offers financial assistance grants to aid patients to subsidizing childcare costs during cancer treatment. Conclusions: Institution sponsored options for childcare for patients undergoing cancer treatments are highly limited, even in the best resourced cancer care settings. The COVID-19 pandemic has limited options further, and many hospitals now restrict visitors under the age of 18. Patient grants or institutionally sponsored childcare provider networks may represent an avenue for supporting parents who are facing a cancer diagnosis. Supporting families of patients with cancer has great potential to impact quality of life, economic and psychological stress.

10.
Journal of Hepatology ; 77:S551, 2022.
Article in English | EMBASE | ID: covidwho-1996642

ABSTRACT

Background and aims: Hepatitis C virus (HCV) infection is a major global health problem in adults & children. The recent efficacy of Direct Acting Anti-viral therapy (DAA) has cure rates of 99% in adults and adolescents. These drugs were licensed for children 3–12 yrs during the recent coronavirus pandemic. To ensure equitable access, safe & convenient supply during lockdown, we established a virtual national treatment pathway for children with HCV in England & evaluated its feasibility, efficacy & treatment outcomes. Method: A paediatric Multidisciplinary Team Operational Delivery Network (pMDT ODN), supported by NHS England (NHSE), was established with relevant paediatric specialists to provide a single point of contact for referrals & information. Referral & treatment protocolswere agreed for HCV therapy approved byMHRA& EMA. On referral the pMDT ODN agreed the most appropriate DAA therapy based on clinical presentation & patient preferences, including ability to swallow tablets. Treatment was prescribed in association with the local paediatrician & pharmacist, without the need for children & families to travel to national centres. All children were eligible for NHS funded therapy;referral centres were approved by the pMDT ODN to dispense medication;funding was reimbursed via a national NHSE agreement. Demographic & clinical data, treatment outcomes & SVR 12 were collected. Feedback on feasibility & satisfaction on the pathway was sought from referrers. Results: In the first 6 months, 34 childrenwere referred;30- England;4-Wales;median (range) age 10 (3.9–14.5) yrs;15M;19F: Most were genotype type 1 (17) & 3 (12);2 (1);4 (4). Co-morbidities included: obesity (2);cardiac anomaly (1);Cystic Fibrosis (1);Juvenile Arthritis (1). No child had cirrhosis. DAA therapy prescribed: Harvoni (21);Epclusa (11);Maviret (2). 27/34 could swallow tablets;3/7 received training to swallowtablets;4/7 are awaiting release of granules.11/27 have completed treatment and cleared virus;of these 7/11 to date achieved SVR 12. 30 children requiring DAA granule formulation are awaiting referral and treatment. Referrers found the virtual process easy to access, valuing opportunity to discuss their patient’s therapy with the MDT & many found it educational. There were difficulties in providing the medication through the local pharmacy. However there are manufacturing delays in providing granule formulations because suppliers focused on treatments for COVID, leading to delays in referring and treating children unable to swallow tablets. Conclusion: The National HCV pMDT ODN delivers high quality treatment & equity of access for children & young people, 3–18 yrs with HCV in England, ensuring they receive care close to home with 100% cure rates.

11.
Heart Lung and Circulation ; 31:S308, 2022.
Article in English | EMBASE | ID: covidwho-1977309

ABSTRACT

Introduction: Right heart catheterisation is the gold standard for assessing patients with pulmonary hypertension. Doctors require training in this procedure in a safe and friendly environment with minimal risk to patients. During the COVID-19 pandemic, we sought to develop a Virtual Reality Right Heart Catheterisation (VRRHC) training program to fulfil this area of need without face-to-face contact. The aim was to improve procedure competency, aid diagnosis and reduce medical error. Method: We approached a health technology company to design a VRRHC training module based on our current RHC simulation workshops. Phase 1 required virtual insertion of RHC via right internal jugular vein using a micro-puncture, double-Seldinger technique under ultrasound guidance, followed by insertion of the RHC to the right atrium, right ventricle, pulmonary artery, pulmonary artery occlusion position using real time pressure tracings and fluoroscopy. Thermodilution cardiac outputs were performed and measured. Using real-time performance tracking and haptic feedback, we collected analytics and data on user engagement, experience, retention, learning outcomes and curve, improved interpretation and diagnosis and reduction in operating costs, procedure times and complications. Results: The program was launched in October 2021. Preliminary data shows a short learning curve for VR itself (10-15 minutes) and RHC (initial 30-40 minutes reducing to 20-30minutes and <15 minutes in experts). Completion rates increase with experience from 40-50% to 100%. Error rate also reduces with frequency of completion. Conclusion: Virtual Reality Right Heart Catheter training is feasible with a short learning curve and results in improved competence and error rate with frequency of use.

12.
Supportive Care in Cancer ; 30:S41, 2022.
Article in English | EMBASE | ID: covidwho-1935781

ABSTRACT

Introduction A global trial is currently investigating the impact of high-intensity interval training (HIIT) on survival in advanced prostate cancer (the INTERVAL trial). To ensure greater accessibility, we designed a parallel trial (EXACT), to determine the feasibility of exercise in those contraindicated to HIIT. Methods Men with metastatic castrate-resistant prostate cancer being actively treated with androgen deprivation therapy and a novel hormone therapy (abiraterone acetate or enzalutamide) are eligible to participate in 12- weeks of home-based walking and strengthening. Participants complete physical (e.g. 6-min walk test and timed sit-to-stand) and quality of life (e.g. BPI-SF;EQ-5D-5L;FACIT-fatigue;FACT-P) outcomes at baseline (T1), 12 (T2) and 24 weeks (T3). This trial was adapted to enable remote recruitment and delivery during the COVID-19 pandemic. Results To date, 118 patients have been screened, with 33 approached by their clinician to participate. 25 patients have consented, with 12 completing the trial without any intervention-related adverse events and 6 withdrawn. Recruitment and trial delivery was operational throughout the COVID-19 pandemic. Currently positive trends are evident for physical and quality of life outcomes at T2 and T3. Conclusions Although this trial is ongoing, early trends suggest this intervention is safe and feasible for men with advanced castration resistant prostate cancer and could improve physical capacity and quality of life.

13.
CMES - Computer Modeling in Engineering and Sciences ; 132(1):81-94, 2022.
Article in English | Scopus | ID: covidwho-1904175

ABSTRACT

Edge detection is an effective method for image segmentation and feature extraction. Therefore, extracting weak edges with the inhomogeneous gray of Corona Virus Disease 2019 (COVID-19) CT images is extremely important. Multiscale morphology has been widely used in the edge detection of medical images due to its excellent boundary detection accuracy. In this paper, we propose a weak edge detection method based on Gaussian filtering and single-scale Retinex (GF_SSR), and improved multiscale morphology and adaptive threshold binarization (IMSM_ATB). As all the CT images have noise, we propose to remove image noise by Gaussian filtering. The edge of CT images is enhanced using the SSR algorithm. In addition, based on the extracted edge of CT images using improved Multiscale morphology, a particle swarm optimization (PSO) algorithm is introduced to binarize the image by automatically getting the optimal threshold. To evaluate our method, we use images from three datasets, namely COVID-19, Kaggle-COVID-19, and COVID-Chestxray, respectively. The average values of results are worthy of reference, with the Shannon information entropy of 1.8539, the Precision of 0.9992, the Recall of 0.8224, the F-Score of 1.9158, running time of 11.3000. Finally, three types of lesion images in the COVID-19 dataset are selected to evaluate the visual effects of the proposed algorithm. Compared with the other four algorithms, the proposed algorithm effectively detects the weak edge of the lesion and provides help for image segmentation and feature extraction. © 2022 Tech Science Press. All rights reserved.

14.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1880450
15.
American Journal of Respiratory and Critical Care Medicine ; 205:2, 2022.
Article in English | English Web of Science | ID: covidwho-1880202
16.
Oncology Nursing Forum ; 49(2):E78-E79, 2022.
Article in English | Web of Science | ID: covidwho-1848793
17.
Journal of Heart and Lung Transplantation ; 41(4):S324-S325, 2022.
Article in English | Web of Science | ID: covidwho-1848352
18.
Journal of the American College of Cardiology ; 79(9):2345-2345, 2022.
Article in English | Web of Science | ID: covidwho-1848313
19.
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation ; 41(4):S324-S325, 2022.
Article in English | EuropePMC | ID: covidwho-1781797

ABSTRACT

Purpose Management of COVID-19 has evolved over the course of the pandemic, with new therapies contributing to a decline in mortality in the general population. Immunosuppressed heart transplant (HT) recipients are at high risk of infection, but questions remain regarding their optimal management as these patients were excluded from many clinical trials on COVID-19 therapeutics and vaccines. Methods Retrospective search of electronic health records identified 41 HT recipients who tested positive for SARS-CoV-2 from February 1, 2020-October 13, 2021. Results Among the 41 HT recipients infected with SARS-CoV-2, 15 (36%) were monitored as outpatient, and of these, 4 received casirivimab/imdevimab and 1 received oral steroid. No COVID-19 related deaths were observed in this group. The remaining 26 patients (64%) were admitted for pneumonia or hypoxia. Five required admission to the intensive care unit (ICU), of which 3 required intubation and pressor support and 2 died (7.7% in-hospital mortality, 4.9% overall mortality). Of those admitted, 15 were treated with remdesivir and 7 received steroids. After vaccines were available in January 2021, 10 patients developed breakthrough COVID-19 occurring 2 weeks after the second Pfizer dose (n=6) and second Moderna dose (n=4). 8 of these patients were admitted for pneumonia or hypoxia and treated with COVID-19 directed therapies (4 received remdesivir, 2 received dexamethasone, 3 received casirivimab/imdevimab). 2 patients were monitored as outpatient where they received casirivimab/imdevimab. There was no severe illness or deaths observed in vaccinated patients. Conclusion We present 41 HT recipients at UCSD infected with COVID-19. By using outpatient isolation, monoclonal antibody infusions, and admission for treatment of hypoxic patients with remdesivir and steroid, we have demonstrated a lower mortality from COVID-19 compared to other studies on HT recipients. No mortality was observed in the breakthrough cases.

20.
Journal of Medical Devices-Transactions of the Asme ; 16(1):6, 2022.
Article in English | Web of Science | ID: covidwho-1779290

ABSTRACT

The COVID-19 pandemic created an unprecedented shortage of personal protective equipment (PPE) for healthcare workers-especially respirators. In response to a lack of commercial respirator equipment, a multidisciplinary prototyping hackathon was held and the key components required to develop an inexpensive, scalable "COVID-19 reusable elastomeric respirator" (RER-19) were identified. Available hospital supplies were assessed based on their published technical specifications to meet each of the key component requirements. The fully assembled prototype was then validated through user testing, and volunteers underwent standard fit testing with cardiopulmonary monitoring while wearing the RER-19 in a small pilot study. Multiple social media platforms were then used to disseminate educational information on respirator assembly, use, and maintenance. Here, we present our institution's initial experience with prototyping to meet a specific healthcare challenge, in combination with prompt dissemination of information to educate and empower healthcare workers in the face of a critical PPE shortage during an unprecedented and evolving pandemic.

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