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1.
ACM Web Conference 2023 - Proceedings of the World Wide Web Conference, WWW 2023 ; : 3592-3602, 2023.
Article in English | Scopus | ID: covidwho-20244490

ABSTRACT

We study the behavior of an economic platform (e.g., Amazon, Uber Eats, Instacart) under shocks, such as COVID-19 lockdowns, and the effect of different regulation considerations. To this end, we develop a multi-agent simulation environment of a platform economy in a multi-period setting where shocks may occur and disrupt the economy. Buyers and sellers are heterogeneous and modeled as economically-motivated agents, choosing whether or not to pay fees to access the platform. We use deep reinforcement learning to model the fee-setting and matching behavior of the platform, and consider two major types of regulation frameworks: (1) taxation policies and (2) platform fee restrictions. We offer a number of simulated experiments that cover different market settings and shed light on regulatory tradeoffs. Our results show that while many interventions are ineffective with a sophisticated platform actor, we identify a particular kind of regulation - fixing fees to the optimal, no-shock fees while still allowing a platform to choose how to match buyers and sellers - as holding promise for promoting the efficiency and resilience of the economic system. © 2023 ACM.

2.
Topics in Antiviral Medicine ; 31(2):77-78, 2023.
Article in English | EMBASE | ID: covidwho-2314271

ABSTRACT

Background: Neurocognitive symptoms are common in acute as well as convalescent (post-acute sequelae of COVID-19 [PASC]) COVID-19, but mechanisms of CNS pathogenesis are unclear. The aim of this study was to investigate cerebrospinal fluid (CSF) biomarker evidence of CNS infection, immune activation and neuronal injury in convalescent compared with acute infection. Method(s): We included 68 (35% female) patients >=18 years with CSF sampled during acute (46), 3-6 months after (22) SARS-CoV-2 infection or both (17), and 20 (70% female) healthy controls from longitudinal studies. The 22 patients sampled only at 3-6 months were recruited in a PASC protocol. CSF N-Ag was analyzed using an ultrasensitive antigen capture immunoassay platform (S-PLEX SARS-CoV-2 N Kit, Meso Scale Diagnostics, LLC. Rockville, MD). Additional analyses included CSF beta2-microglobulin (beta2M)], IFN-gamma, IL-6, TNF-alpha neurofilament light (NfL), and total and phosphorylated tau. Log-transformed CSF biomarkers were compared using ANOVA (Tukey post-hoc test). Result(s): Patients sampled during acute infection had moderate (27) or severe (19) COVID-19. In patients sampled at 3-6 months, corresponding initial severity was 10 (mild), 14 (moderate), and 15 (severe). At 3-6 months, 31/39 patients reported neurocognitive symptoms;8/17 patients also sampled during acute infection reported full recovery after 3-6 months. CSF biomarker results are shown in Figure 1. SARS-CoV-2 RNA was universally undetectable. N-Ag was detectable only during acute infection (32/35) but was undetectable in all follow up and control samples. Significantly higher CSF concentrations of beta2M (p< 0.0001), IFN-gamma (p=0.02), IL-6 (p< 0.0001) and NfL (p=0.04) were seen in acute compared to post-infection. Compared to controls, beta2M (p< .0001), IL-6 (p< 0.0001) and NfL (p=0.005) were significantly higher in acute infection. No biomarker differences were seen post-infection compared with controls. No differences were seen in CSF GFAp, t-tau or p-tau. Conclusion(s): We found no evidence of residual infection (RNA, N-Ag), inflammation (beta2M, IL-6, IFN-gamma, TNF-alpha), astrocyte activity (GFAp) or neuronal injury (NfL, tau) 3-6 months after initial COVID-19, while significantly higher concentrations of several markers were found during acute infection, suggesting that PASC may be a consequence of earlier injury rather than active CNS damage. CSF beta2M, IL-6, IFN-gamma and NfL were significantly lower after 3-6 months than during acute COVID-19 and not different from healthy controls. (Figure Presented).

3.
Journal of the Intensive Care Society ; 23(1):145-146, 2022.
Article in English | EMBASE | ID: covidwho-2043001

ABSTRACT

Introduction: The COVID -19 pandemic presented a new range of challenges to clinicians across the world in caring for patients affected by a virus with what at the time was an unknown pathophysiology.1 In meeting this challenge physiotherapists utilised their knowledge and experience in treating patients with acute respiratory distress syndrome (ARDS) to provide the best possible care. Objectives: The aim of this paper is to reviewand reflect on physiotherapy treatment for a patient with COVID - 19 who received ECMOsupport, from admission to discharge home. Methods: A case study design to provide a detailed review of the treatments used with the patient during their journey, including feedback from the patient. Figure 1 outlines a timeline of key events during their patient journey. Results: • Historically the Physiotherapy team within the ECMO centre have believed that chest physiotherapy would be mostly ineffective on patients with low lung volumes. However, in this case study it was shown that with tidal volumes of between 30 - 100mls, expiratory vibrations with saline instillation and suctioning cleared more secretions then suctioning alone. • Despite the use of foot splinting whilst sedated we still faced challenges with contractures in calves which subsequently limited standing. • Effective and safe use of SOEOB and tilt-table built up-to standing with support whilst having ECMO in situ. • The use of PMV whilst ventilated allowed the wider MDT to provide effective support for the patient's overall wellbeing. The use of PMV was timed with chaplaincy and psychology input, in addition to enabling twoway communication during video and phone calls with the patient's wife, who at the time was unable to visit due to restrictions. Patient feedback on the use of the PMVTo be able to communicate normally was wonderful, as you are locked into a world where no one understands you and it can be so frustrating to make people understand what you want. Conclusions: The patient was successfullyweaned fromthe ECMO, ventilator and tracheostomy was de-cannulated;they were transferred back to their local hospital for ongoing rehab and were eventually discharged home. This case study introduces a debate as to the effectiveness of manual techniques and suctioning with saline on patients with low lung volumes as it appeared to be beneficial compared to suctioning alone. The use of the PMV within the ventilator circuit enabled vocalisation much earlier during their admission which not only progressed their swallowing and cough strength rehabilitation but also significantly increased the amount of psychological support they were able to access. On reflection it seemed appropriate to utilise similar rehabilitation treatment options used in the management of ARDS patients on ECMO, despite the challenges associated with the complex logistical and safety factors when managing this patient group.

4.
Journal of the Intensive Care Society ; 23(1):143-144, 2022.
Article in English | EMBASE | ID: covidwho-2042974

ABSTRACT

Introduction: Due to the COVID-19 pandemic there has been an unprecedented number of hospital and Intensive Care Unit (ICU) admissions for respiratory failure. This has required a significant and sudden increase in ICU capacity. 1,2 Due to severe pulmonary infection and inflammation, patients have presented with acute respiratory distress syndrome (ARDS) with an associated inability to ventilate lungs with poor compliance. This has led to an increased requirement for extra corporeal membrane oxygenation (ECMO) support. This is only available in six commissioned centres across the United Kingdom.3 Objectives: The objective of this is to present a case study of a long-term patient in ICU with a prolonged duration on ECMO. This highlights the complex, mutli-dimensional physiological and psychological impact of recovery and rehabilitation in patients following a severe physical illness. Methods: Figure 1 shows the timeline of significant events during the patient's hospitalisation and admission at the ECMO centre. Due to the nature of a long ICU admission, the patient's condition fluctuated throughout their stay. Rehabilitation was impacted physically by the patient's limited ventilatory reserve caused by lung damage due to COVID. A severe sacral moisture lesion also limited their ability to sit in a chair for longer than one hour and perform sustained sitting on the edge of the bed activities. Psychologically the patient was limited due to significant anxiety and agitation. There were a number of barriers and challenges to rehabilitation whilst the patient was on ECMO as well as post ECMO decannulation. These challenges are detailed in Figure 2. Results: Despite the challenges, the patient was able to participate in physical rehabilitation and was provided psychological support by the psychology team. At their peak ability, the patient was able to perform 12 steps with maximal assistance of three staff. The patient's Chelsea Critical Care Physical Assessment Tool (CPAx) scores can be seen in Figure 3. There was marked difference in the patient's ability to meet the physiological demand of rehabilitation with the ECMO support and without. Following ECMO decannulation the patient struggled with fatigue, hypercapnia and increasing dependency on the ventilator. These issues led to a decline in ability and longer periods of tachypnoea and recovery. Conclusion: Supporting patients after a critical illness requires physical and psychological rehabilitation from the whole MDT. This example of a patient's recovery both during and post ECMO support due to COVID-19 shows the complex relationships affecting the patient's ability to improve and progress.

5.
Topics in Antiviral Medicine ; 30(1 SUPPL):49, 2022.
Article in English | EMBASE | ID: covidwho-1880191

ABSTRACT

Background: The underlying CNS pathogenesis in COVID-19 is not clear and viral RNA is rarely detected in cerebrospinal fluid (CSF). We measured viral antigen and biomarker profiles in CSF in relation to neurological symptoms and disease severity. Methods: We included 44 (32% female) hospitalized patients (26 moderate, 18 severe COVID-19) and 10 healthy controls (HC). 21 patients were neuroasymptomatic (NA), 23 neurosymptomatic (NS;encephalopathy=21, encephalitis=1, GBS=1). For antigen and cytokine analyses, a patient control (PC;n=41) group (COVID-negative with no sign of CNS infection in clinical CSF samples) was used. CSF nucleocapsid antigen (N-Ag) was analyzed using an ultrasensitive antigen capture immunoassay platform, S-PLEX direct detection assay, S-PLEX SARS-CoV-2 N Kit (MesoScale Diagnostics, LLC. Rockville, MD). Additional analyses included CSF neopterin, β2-microglobulin, cytokines and neurofilament light (NfL). Results: CSF N-Ag was detected in 31/35 patients (0/41 controls) while viral RNA was negative in all. CSF N-Ag was significantly correlated with CSF neopterin (r=0.38;p=0.03) and IFN-γ (r=0.42;p=0.01) adjusted for sampling day. No differences in CSF N-Ag concentrations were found between patient groups. All patient groups had markedly increased CSF neopterin, β2M, IL-6, IL-10 and TNF-α compared to controls, while IL-2, IL-1β and IFN-γ were significantly increased only in the NS group. CSF biomarkers were associated with time from symptom onset to CSF sampling. After adjusting for time of sampling, the NS group had significantly higher CSF IFN-γ (p=0.03), and showed a statistical trend towards significantly higher CSF neopterin, IL-6 and TNF-α (p=0.056-0.06) than the NA group. Additionally, age-adjusted CSF NfL was higher in the NS compared to the HC (p=0.01) group. No differences were seen in any CSF biomarkers in moderate compared to severe disease. Conclusion: Viral antigen is detectable in CSF in a majority of patients with COVID-19 despite the absence of detectable viral RNA, and is correlated to CNS immune activation markers. Patients with neurological symptoms had a more marked immune activation profile compared to NA patients, as well as signs of neuroaxonal injury compared to controls. These observations could not be attributed to a difference in COVID-19 severity. Our results highlight the importance of neurological symptoms and indicate that the CNS immune response and CNS pathogenesis can be initiated by viral components without direct viral invasion of the CNS.

6.
Orthopedics ; 44(5): 274-279, 2021.
Article in English | MEDLINE | ID: covidwho-1444386

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic forced many institutions to implement telemedicine to facilitate continued patient care at a distance. The quality of patient care with telemedicine in orthopedic oncology has not been assessed. Between March and June 2020, a telephone survey of 64 patients was conducted in an academic orthopedic oncology practice. Patient satisfaction was assessed with a Likert scale metric, open-ended feedback, and direct comparisons between telemedicine and in-office visits. Billing and collection financial data of the telemedicine cohort and of a separate cohort of in-office visits during the same time period were compared. The clinical competency of telemedicine visits was measured by delayed or missed diagnoses and surgical site infections that may be attributable to lack of an in-person physical examination. Overall, patients were largely satisfied with their telemedicine experience. More than 90% of patients described telemedicine as equal to or better than in-office visits regarding convenience, time, privacy, and overall quality. Patients reported that better assessment of their physical condition may be indicated, particularly in early postoperative and early sarcoma surveillance visits. Two of 64 patients had adverse events (both local recurrences) potentially attributable to lack of an in-person physical examination. Institutional financial reimbursement of telemedicine visits was comparable to that of in-office visits. These findings have supported continued use of telemedicine in our practice, particularly for patients traveling significant distance and those returning for sarcoma surveillance. However, the limitations of lack of an in-person physical examination should be considered on a case-by-case basis. [Orthopedics. 2021;44(5):274-279.].


Subject(s)
COVID-19 , Orthopedics/methods , Patient Satisfaction , Telemedicine/methods , Ambulatory Care/statistics & numerical data , COVID-19/epidemiology , Humans , Orthopedics/trends , Pandemics/prevention & control , Physical Examination , SARS-CoV-2 , Telemedicine/trends
7.
Infectious Diseases Now ; 51(5, Supplement):S137-S138, 2021.
Article in French | ScienceDirect | ID: covidwho-1336478

ABSTRACT

Introduction La pandémie de COVID 19 bouleverse le monde depuis plus d’un an. En l’absence de traitement efficace pour endiguer cette dernière, l’accent doit être mis sur les moyens de prévention : gestes barrières, dépistage, signalement et enfin vaccination. Le Service de Maladies Infectieuses comprenant l’activité Centre de Vaccination (CDV), peut se mobiliser pour mettre en place des actions de prévention. Matériels et méthodes Le CDV agit sur un territoire avec de fortes inégalités d’accès à la santé, tant sur le plan géographique que social. Nous avons adapté l’offre de soins en « allant vers » les populations avec mise en place des interventions de prévention. Une équipe mobile, le plus souvent infirmier et médecin, se déplace vers un site à la demande d’un partenaire (institution, association) permettant de délocaliser l’activité de prévention vers ce lieu (dépistage, vaccination). Dotée d’un camping-car médicalisé, l’équipe est autonome. La priorité est d’identifier des lieux dans lesquels la précarité, l’éloignement géographique ou les réticences représentent une entrave au dépistage et/ou à la vaccination. Fort d’une expérience de 12 ans, le service a adapté ces actions à la prévention du virus COVID 19, afin de répondre à l’afflux massif de touristes débordant les structures de dépistage existantes ou de palier à la limite du nombre de centres de vaccination autorisé. L’organisation de ces actions s’est déroulée sur 2 périodes, d’août à octobre 2020 et de février à aujourd’hui en proposant le dépistage par PCR et la vaccination. Résultats Les actions de dépistage par PCR ont permis de dépister 439 personnes dans 6 lieux stratégiques en mobilisant une équipe composée de 3 personnels soignants. Ces équipes ont parcouru le département à la rencontre de publics divers: touristes sur des plages ou des lieux de forte affluence touristique (village, port), lieux libertins, parkings. Les actions de vaccination Covid 19 HLM ont été mises en place par l’intermédiaire de partenariats avec les mairies de communes reculées, en collaboration avec l’agence régionale de santé (ARS) et la préfecture. À ce jour, 4 communes ont bénéficié de ce type d’actions et 340 personnes ont pu avoir accès à la vaccination complète anti-Covid 19. Elles ont concerné surtout des personnes âgées. Le succès de ces campagnes de vaccination réside dans l’implication des partenaires, l’organisation anticipée de la séance et l’adaptabilité des équipes. Un document tutoriel de référence a été rédigé afin d’accompagner les partenaires pour la mise en place de ces actions. Ces actions sont étendues aux structures médico-sociales accueillant des publics précaires éligibles à la vaccination. Conclusion La pandémie amplifie les inégalités d’accès à la santé et les situations critiques où les interventions HLM sont pertinentes. Notre expérience montre la transférabilité de ces actions (dépistage et vaccination) lors d’une situation épidémique sur un territoire très exposé. Par ailleurs ce type d’action de proximité renforce une communication positive autour des moyens de prévention du virus COVID-19 et notamment par rapport à la vaccination.

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