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1.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-314989

ABSTRACT

Background: The need for healthcare workers (HCWs) to wear personal protective equipment (PPE) during the COVID-19 pandemic heightens thermal stress. We assessed the knowledge, attitudes, and practices of HCWs from developed and developing countries on PPE usage and heat stress when performing treatment and care.Methods: One hundred and sixty-five HCWs from India (n=110) and Singapore (n=55) participated in this survey. Thirty-seven HCWs from Singapore provided thermal comfort ratings before and after ice slurry ingestion. Responses between India and Singapore HCWs were compared. A p- value cut-off of 0·05 depicted statistical significance.Results: Median wet-bulb globe temperature was higher in India (30·2°C [IQR 29·1-31·8°C]) than in Singapore (22·0°C [IQR 18·8-24·8°C]) ( p <0·001). Majority of the respondents reported thirst (144;87%), excessive sweating (145;88%), exhaustion (128;78%), and desire to go to comfort zones (136;84%). In Singapore, reports of air-conditioning at worksites (34;62%), dedicated rest area availability (55;100%) and PPE removal during breaks (54;98.2%) were higher than in India (27;25%, 46;42%, and 66;60%, respectively) ( p <0·001). Median thermal comfort rating improved from 2 (IQR 1-2) to 0 (IQR 0-1) after ice slurry ingestion in Singapore ( p <0·001). Conclusion: HCWs are cognisant of the effects of heat stress but might not adopt best practices due to various constraints. Thermal stress management is better in Singapore than in India. Ice slurry ingestion is shown to be practical and effective in promoting thermal comfort under these conditions. Adverse effects of heat stress on productivity and judgement of HCWs warrant further investigation.Funding: This study was not funded in part or whole by any companies or agencies.Declaration of Interests: The authors declare that there are no competing financial interests.Ethics Approval Statement: In India, ethics approval was granted by Sri Ramachandra Institution of Higher Education and Research (Reference No.: IECNI/17/APR/59/54). In Singapore, ethics approval was granted by the National Healthcare Group Domain Specific Review Board (NHG DSRB;Reference No.: 2020/00590).

2.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-314222

ABSTRACT

Background: The COVID-19 pandemic has stripped many medical students worldwide of their right to quality education. In response, we developed hybrid courses involving aspects of both online and in-person teaching for radiation oncology medical student clerkship.MethodsWe entitled students to customize their own rotation schedule using Google Forms and developed a flipped learning online class, which consisted of at least one video clip on basic knowledge of radiation oncology per day (yonsei-radonc.com). Students were instructed to watch online videos before the next day’s discussion session. Required components of the medical education program (e.g., target drawing, site visits to treatment facilities) were also prepared and conducted in accordance with the appropriate level of social distancing measures. Finally, we conducted questionnaire surveys after the completion of the week-long course and clerkship.ResultsFrom March to June 2020, 110 fourth-year medical students undertook a clinical module in our one-week radiation oncology program course. Each day, students completed the flipped learning prior to meeting with the educator and then participated in the online discussion session and conference. All activities were well performed as scheduled. Students’ motivation was high, as was their overall satisfaction with the course. The students were satisfied with the online contents, flipped learning strategy, and instructors.ConclusionsWe successfully integrated open and virtual educational platforms to improve access to and satisfaction with student clerkship. In the future “new normal,” minimized face-to-face learning interactions, such as flipped learning, should be actively utilized for medical and other students’ education.

4.
Radiat Oncol ; 16(1): 204, 2021 Oct 16.
Article in English | MEDLINE | ID: covidwho-1468071

ABSTRACT

BACKGROUND: The COVID-19 pandemic has stripped many medical students worldwide of their right to quality education. In response, we developed hybrid courses involving aspects of both online and in-person teaching for radiation oncology medical student clerkship. METHODS: We entitled students to customize their own rotation schedule using Google Forms and developed a flipped learning online class, which consisted of at least one video clip on basic knowledge of radiation oncology per day (yonsei-radonc.com). Students were instructed to watch online videos before the next day's discussion session. Required components of the medical education program (e.g., target drawing, site visits to treatment facilities) were also prepared and conducted in accordance with the appropriate level of social distancing measures. Finally, we conducted questionnaire surveys after the completion of the week-long course and clerkship. RESULTS: From March to June 2020, 110 fourth-year medical students undertook a clinical module in our 1-week radiation oncology program course. Each day, students completed the flipped learning prior to meeting with the educator and then participated in the online discussion session and conference. All activities were well performed as scheduled. Students' motivation was high, as was their overall satisfaction with the course. The students were satisfied with the online contents, flipped learning strategy, and instructors. CONCLUSIONS: We successfully integrated open and virtual educational platforms to improve access to and satisfaction with student clerkship. In the future "new normal," minimized face-to-face learning interactions, such as flipped learning, should be actively utilized for medical and other students' education.


Subject(s)
COVID-19/epidemiology , Education, Medical , Radiation Oncology/education , SARS-CoV-2 , Virtual Reality , Cross-Sectional Studies , Curriculum , Humans , Program Evaluation , Students, Medical , Teaching , Telemedicine
5.
J Pharm Policy Pract ; 14(1): 61, 2021 Jul 19.
Article in English | MEDLINE | ID: covidwho-1317130

ABSTRACT

This commentary shares the experience of a hospital pharmacy department in providing healthcare services during the COVID-19 outbreak in Malaysia. During this pandemic, the medication delivery system is redesigned to minimize contact among patients and the health care providers. Also, the remote medication monitoring system was implemented to deliver pharmaceutical care for inpatients. Communication technology was used to assist the pharmacist in medication counseling. QR codes to access videos demonstrating the use of devices were made available for patients. Pharmacists were also tasked with the procurement of personal protective equipment and medications needed requiring special approval from the Ministry of Health.

6.
J Vasc Surg ; 74(4): 1354-1361.e4, 2021 10.
Article in English | MEDLINE | ID: covidwho-1237797

ABSTRACT

OBJECTIVE: Integrated vascular surgery residency is among the most competitive specialties, but little is known about the applicant perspective. The coronavirus disease 2019 outbreak impacted the 2021 integrated vascular surgery residency match because of travel restrictions. We sought to better understand pre-pandemic applicant recruitment strategies, logistics of away rotations, and the residency interview process to identify areas for improvement in the application process. METHODS: An anonymous survey was sent to matched students in 2020, inquiring about motivations for pursuing vascular surgery (VS), logistic of away rotations and interviews, and factors influencing students' rank lists. RESULTS: Seventy of the 73 matched students completed the survey (95.9% response rate). The median age was 27 (range, 25-41); 32.9% were female, 91.4% were U.S. medical students, and 77.1% were from institutions with a VS training program. Factors most strongly influencing the decision to choose VS as a career were interest in open vascular procedures, endovascular procedures, perceived job satisfaction, emerging technologies, and influence of a mentor. The prospect of the job market, future salary, and competitiveness of the application process had the least impact. Of the matched students, 82.9% completed an away rotation (median, 2; range, 1-4), with 51.7% of students paying a total cost of more than $2500. Fifty percent of students matched either at their home institution or where they had performed an away rotation. Students reported application submissions to a median of 50 programs (range, 1-70) and interviewed at 17 (range, 1-28), with 40% of students paying a total of more than $4000 for interview costs. The most significant factors affecting students' rank lists included program culture, open aortic surgical volume, geography, and complex endovascular procedure volume. Tours of facilities, resident salary, and male/female distribution had the least importance. CONCLUSIONS: Successfully matched applicants in 2020 prioritized operative case volume and program collegiality when ranking programs. Despite their high cost, away rotations played an important role in the Match, suggesting that time spent at potential institutions allowed ideal assessment of factors for students. The high average number of away rotations and in-person interviews performed in 2019-2020 was limited for the 2021 Match due to coronavirus disease 2019 restrictions. Programs will have to continue developing creative alternatives or additions to away rotations and the application processes to assure continued success in future post-pandemic Match cycles.


Subject(s)
Career Choice , Internship and Residency/statistics & numerical data , Specialties, Surgical/statistics & numerical data , Students, Medical/statistics & numerical data , Vascular Surgical Procedures/education , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/standards , Female , Humans , Internship and Residency/organization & administration , Internship and Residency/standards , Male , Mentors , Motivation , Pandemics/prevention & control , Personnel Selection/organization & administration , Personnel Selection/standards , Personnel Selection/statistics & numerical data , Specialties, Surgical/education , Specialties, Surgical/organization & administration , Students, Medical/psychology , Surveys and Questionnaires/statistics & numerical data , Travel
7.
The FASEB Journal ; 35(S1), 2021.
Article in English | Wiley | ID: covidwho-1234025

ABSTRACT

The SARS-CoV-2 (COVID-19) outbreak adversely affected medical school education and drastically reduced in-person learning, specifically affecting gross anatomy laboratory dissection. Depending on the academic calendar schedule, some schools were interrupted in the middle of anatomy teaching while others had more lead time to prepare but schools suddenly faced an imposed demand for a transition to distance learning. SUNY Downstate had its anatomy education interrupted due to the Covid-19 shut down. To gap the previous laboratory experience of students and complete the semester anatomy curriculum, a series of dissected abdominal videos were created and distributed to all first-year medical students (n=208). The video-based curriculum and the current student experience taking anatomy without cadaveric dissections were assessed via pre/post-tests and a five-question survey. A paired single tailed t-test comparing student responses (n=164) in the pre- versus post-test was statistically significant (P < 0.002) while 92% of students (n=136) reported that their previous time dissecting prepared them to learn through videos without the benefit of hands-on dissection. Icahn School of Medicine adopted digital Grant's Dissector utilizing their accompanying narrated videos. Faculty voiced over the narration, however, permitting emphasis of material, directing pacing of course, and tying content to lecture and physical exams. Complete anatomy was used to augment the experience, with 3D virtual dissections and enhance the visualization of the structures, however the videos remained as the driver of content delivery. Weill Cornell Medicine created, and customized anatomy prosected material videotaping the show and tell sessions integrating powerpoint slides to tie in lecture content and clinical correlates. Results from all three schools highlight the technical success of implementing an anatomy video-based curriculum in response to COVID-19. Survey findings describe a unique cohort of students who were compelled to participate in a video-based curriculum after having learned anatomy in a donor body laboratory environment and student performance on summative exams in general equaled or exceeded scores from previous years. Overall, anatomy education through videos, digital platforms, and apps can offer a reliable stop-gap solution in the absence of traditional cadaveric dissection in a short-term, provisional model. However, the experience of learning anatomy from a human body in laboratory is irreplaceable and the future now seems to point to a combination of these modalities, and others, such as virtual reality or augmented reality, yet to be adapted and customized to our educational settings.

8.
Environ Res ; 198: 111153, 2021 07.
Article in English | MEDLINE | ID: covidwho-1184966

ABSTRACT

Heat waves and Covid-19 overlap, as this pandemic continues into summer 2021. Using a narrative review, we identified overlapping risk groups and propose coping strategies. The high-risk groups for heat-related health problems as well as for high-risk COVID-19 groups overlap considerably (elderly with pre-existing health conditions). Health care facilities will again be challenged by Covid-19 during heat waves. Health care personnel are also at risk of developing heat related health problems during hot periods due to the use of personal protective equipment to shield themselves from SARS-CoV-2 and must therefore be protected from excessive heat periods. Some existing recommendations for heat health protection contradict recommendations for COVID-19 protection. This paper provides a preliminary overview of possible strategies and interventions to tackle these ambiguities. The existing recommendations for protection against heat-related illnesses need revisions to determine whether they include essential aspects of infection control and occupational safety and how they may be supplemented.


Subject(s)
COVID-19 , Aged , Delivery of Health Care , Health Personnel , Hot Temperature , Humans , Pandemics , Personal Protective Equipment , SARS-CoV-2
9.
Int J Environ Res Public Health ; 18(8)2021 04 12.
Article in English | MEDLINE | ID: covidwho-1178265

ABSTRACT

The current understanding of ambient temperature and its link to the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear. The objective of this study was to explore the environmental and climatic risk factors for SARS-CoV-2. For this study, we analyzed the data at the beginning of the outbreak (from 20 January to 31 March 2020) to avoid the influence of preventive or control measures. We obtained the number of cases and deaths due to SARS-CoV-2, international tourism, population age, universal health coverage, regional factors, the SARS-CoV-2 testing rate, and population density of a country. A total of 154 countries were included in this study. There were high incidence rates and mortality risks in the countries that had an average ambient temperature between 0 and 10 °C. The adjusted incidence rate for temperatures between 0 and 10 °C was 2.91 (95% CI 2.87-2.95). We randomly divided the data into a training set (80% of data) for model derivation and a test set (20% of data) for validation. Using a random forest statistical model, the model had high accuracy for predicting the high epidemic status of a country (ROC = 95.5%, 95% CI 87.9-100.0%) in the test set. Population age, temperature, and international tourism were the most important factors affecting the risk of SARS-CoV-2 in a country. An understanding the determinants of the SARS-CoV-2 outbreak can help to design better strategies for disease control. This study highlights the need to consider thermal effect in the prevention of emerging infectious diseases.


Subject(s)
COVID-19 , COVID-19 Testing , Humans , Population Density , SARS-CoV-2 , Temperature
10.
Int J Environ Res Public Health ; 18(8)2021 04 09.
Article in English | MEDLINE | ID: covidwho-1178255

ABSTRACT

This study aimed to assess the knowledge of the Malaysian public on the coronavirus disease 2019 (COVID-19) and antibiotics, the practice of preventive measures and attitude towards the new norms. The web-based questionnaire was disseminated online from 1 to 31 October 2020. Out of 2117 respondents, 1405 (66.4%) knew that transmission of COVID-19 virus could happen in asymptomatic people. In term of antibiotics knowledge, 779 (36.8%) respondents were aware that taking antibiotics could not speed up the recovery process of all infections. Less than half of the respondents (49.0%) knew that antibiotics are effective against bacterial infection only. Majority (92.3%) practiced good preventive measures. Majority of the respondents strongly agreed that quarantine should be made mandatory for all arrival from overseas (97.2%) and wearing face masks should be made mandatory in all public areas (94.0%). Respondents of Chinese ethnicity (p = 0.008), middle-aged (p = 0.002), with tertiary education (p = 0.015) and healthcare related education (p < 0.001), from the higher income groups (p = 0.001) were more likely to have better knowledge on COVID-19. The Malaysian public demonstrated good knowledge towards COVID-19, adequate practice of preventive measures and high acceptance towards the new norm. Knowledge on antibiotics use and resistance was poor, which warrants attention from the health authorities.


Subject(s)
COVID-19 , Anti-Bacterial Agents , Cross-Sectional Studies , Health Knowledge, Attitudes, Practice , Humans , Middle Aged , SARS-CoV-2 , Surveys and Questionnaires
12.
Int J Environ Res Public Health ; 18(8)2021 04 07.
Article in English | MEDLINE | ID: covidwho-1175588

ABSTRACT

The pandemic has been afflicting the planet for over a year and from the occupational point of view, healthcare workers have recorded a substantial increase in working hours. The use of personal protective equipment (PPE), necessary to keep safe from COVID-19 increases the chances of overheating, especially during the summer seasons which, due to climate change, are becoming increasingly warm and prolonged. A web survey was carried out in Italy within the WORKLIMATE project during the summer and early autumn 2020. Analysis of variance (ANOVA) was used to evaluate differences between groups. 191 questionnaires were collected (hospital doctor 38.2%, nurses 33.5%, other healthcare professionals 28.3%). The impact of PPE on the thermal stress perception declared by the interviewees was very high on the body areas directly covered by these devices (78% of workers). Workers who used masks for more than 4 h per day perceived PPE as more uncomfortable (p < 0.001) compared to the others and reported a greater productivity loss (p < 0.001). Furthermore, the study highlighted a high perception of thermal stress among healthcare workers that worn COVID-19-PPE and this enhances the need for appropriate heat health warning systems and response measures addressed to the occupational sector.


Subject(s)
COVID-19 , Personal Protective Equipment , Health Personnel , Humans , Italy/epidemiology , Pandemics , SARS-CoV-2 , Surveys and Questionnaires
13.
Int J Environ Res Public Health ; 18(5)2021 03 02.
Article in English | MEDLINE | ID: covidwho-1125868

ABSTRACT

This study aimed to identify knowledge gaps regarding coronavirus disease 2019 (COVID-19) and develop an integrated educational program for healthcare workers. First, we designed and validated ten multiple-choice questions to identify knowledge gaps among healthcare workers. Within one month of the online test and curriculum offering, 5533 staff had completed the test, with a completion rate of 84.97%. There were 2618 healthcare workers who answered the pre-test 100% correctly. Those who did not answer the pre-test 100% correctly took multiple tests after learning through the online teaching materials. Eventually, 5214 staff passed the test (pre-test or post-test with 100% correct answers). The result showed that all staff had a low correct rate for personal protective equipment (PPE) use recommendations. The Infection Control Center conducted training sessions for hospital staff on how to wear protective clothing. Information on the selection and use of PPE for infection prevention was provided, and participants were allowed time to practice and familiarize themselves with the correct way to wear PPE. Moreover, the Department of Education and Research continued updating the online learning materials based on the most important updated peer-reviewed published articles. The attending teaching physicians helped to search, translate, and take notes on articles in the local language (traditional Chinese) for other colleagues to read easily. We expect to increase learning opportunities for healthcare workers, even during uncertain times such as the current coronavirus pandemic through (1) the hospital-wide course announcements, (2) the continuous placement of test questions and learning files on the digital learning platform, (3) the placement of journal highlights in cloud folders, and (4) the use of the digital learning platform on mobile phones accessible outside the hospital.


Subject(s)
COVID-19 , Coronavirus , Education, Continuing , Health Personnel , Humans , Pandemics , SARS-CoV-2 , Taiwan/epidemiology
14.
EBioMedicine ; 65: 103259, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1116568

ABSTRACT

BACKGROUND: SARS-CoV-2 serology is used to identify prior infection at individual and at population level. Extended longitudinal studies with multi-timepoint sampling to evaluate dynamic changes in antibody levels are required to identify the time horizon in which these applications of serology are valid, and to explore the longevity of protective humoral immunity. METHODS: Healthcare workers were recruited to a prospective cohort study from the first SARS-CoV-2 epidemic peak in London, undergoing weekly symptom screen, viral PCR and blood sampling over 16-21 weeks. Serological analysis (n =12,990) was performed using semi-quantitative Euroimmun IgG to viral spike S1 domain and Roche total antibody to viral nucleocapsid protein (NP) assays. Comparisons were made to pseudovirus neutralizing antibody measurements. FINDINGS: A total of 157/729 (21.5%) participants developed positive SARS-CoV-2 serology by one or other assay, of whom 31.0% were asymptomatic and there were no deaths. Peak Euroimmun anti-S1 and Roche anti-NP measurements correlated (r = 0.57, p<0.0001) but only anti-S1 measurements correlated with near-contemporary pseudovirus neutralising antibody titres (measured at 16-18 weeks, r = 0.57, p<0.0001). By 21 weeks' follow-up, 31/143 (21.7%) anti-S1 and 6/150 (4.0%) anti-NP measurements reverted to negative. Mathematical modelling revealed faster clearance of anti-S1 compared to anti-NP (median half-life of 2.5 weeks versus 4.0 weeks), earlier transition to lower levels of antibody production (median of 8 versus 13 weeks), and greater reductions in relative antibody production rate after the transition (median of 35% versus 50%). INTERPRETATION: Mild SARS-CoV-2 infection is associated with heterogeneous serological responses in Euroimmun anti-S1 and Roche anti-NP assays. Anti-S1 responses showed faster rates of clearance, more rapid transition from high to low level production rate and greater reduction in production rate after this transition. In mild infection, anti-S1 serology alone may underestimate incident infections. The mechanisms that underpin faster clearance and lower rates of sustained anti-S1 production may impact on the longevity of humoral immunity. FUNDING: Charitable donations via Barts Charity, Wellcome Trust, NIHR.


Subject(s)
Antibodies, Neutralizing/blood , Antibodies, Viral/blood , COVID-19/blood , Coronavirus Nucleocapsid Proteins/immunology , SARS-CoV-2/immunology , Spike Glycoprotein, Coronavirus/immunology , Antibodies, Neutralizing/immunology , Antibodies, Viral/immunology , COVID-19/diagnosis , Health Personnel/statistics & numerical data , Humans , Immunoglobulin A/blood , Immunoglobulin G/blood , Phosphoproteins/immunology , Protein Domains/immunology
16.
Int J Environ Res Public Health ; 17(21)2020 Nov 03.
Article in English | MEDLINE | ID: covidwho-921196

ABSTRACT

The need for healthcare workers (HCWs) to wear personal protective equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic heightens their risk of thermal stress. We assessed the knowledge, attitudes, and practices of HCWs from India and Singapore regarding PPE usage and heat stress when performing treatment and care activities. One hundred sixty-five HCWs from India (n = 110) and Singapore (n = 55) participated in a survey. Thirty-seven HCWs from Singapore provided thermal comfort ratings before and after ice slurry ingestion. Differences in responses between India and Singapore HCWs were compared. A p-value cut-off of 0.05 depicted statistical significance. Median wet-bulb globe temperature was higher in India (30.2 °C (interquartile range [IQR] 29.1-31.8 °C)) than in Singapore (22.0 °C (IQR 18.8-24.8 °C)) (p < 0.001). Respondents from both countries reported thirst (n = 144, 87%), excessive sweating (n = 145, 88%), exhaustion (n = 128, 78%), and desire to go to comfort zones (n = 136, 84%). In Singapore, reports of air-conditioning at worksites (n = 34, 62%), dedicated rest area availability (n = 55, 100%), and PPE removal during breaks (n = 54, 98.2%) were higher than in India (n = 27, 25%; n = 46, 42%; and n = 66, 60%, respectively) (p < 0.001). Median thermal comfort rating improved from 2 (IQR 1-2) to 0 (IQR 0-1) after ice slurry ingestion in Singapore (p < 0.001). HCWs are cognizant of the effects of heat stress but might not adopt best practices due to various constraints. Thermal stress management is better in Singapore than in India. Ice slurry ingestion is shown to be practical and effective in promoting thermal comfort. Adverse effects of heat stress on productivity and judgment of HCWs warrant further investigation.


Subject(s)
Coronavirus Infections , Health Personnel , Hot Temperature , Pandemics , Personal Protective Equipment , Pneumonia, Viral , Stress, Physiological , Adult , Betacoronavirus , COVID-19 , Female , Health Knowledge, Attitudes, Practice , Humans , India/epidemiology , Male , SARS-CoV-2 , Singapore/epidemiology , Surveys and Questionnaires
17.
International Journal of Environmental Research and Public Health ; 17(21):8100, 2020.
Article in English | MDPI | ID: covidwho-896407

ABSTRACT

The need for healthcare workers (HCWs) to wear personal protective equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic heightens their risk of thermal stress. We assessed the knowledge, attitudes, and practices of HCWs from India and Singapore regarding PPE usage and heat stress when performing treatment and care activities. One hundred sixty-five HCWs from India (n = 110) and Singapore (n = 55) participated in a survey. Thirty-seven HCWs from Singapore provided thermal comfort ratings before and after ice slurry ingestion. Differences in responses between India and Singapore HCWs were compared. A p-value cut-off of 0.05 depicted statistical significance. Median wet-bulb globe temperature was higher in India (30.2 °C (interquartile range [IQR] 29.1–31.8 °C)) than in Singapore (22.0 °C (IQR 18.8–24.8 °C)) (p <0.001). Respondents from both countries reported thirst (n = 144, 87%), excessive sweating (n = 145, 88%), exhaustion (n = 128, 78%), and desire to go to comfort zones (n = 136, 84%). In Singapore, reports of air-conditioning at worksites (n = 34, 62%), dedicated rest area availability (n = 55, 100%), and PPE removal during breaks (n = 54, 98.2%) were higher than in India (n = 27, 25%;n = 46, 42%;and n = 66, 60%, respectively) (p <0.001). Median thermal comfort rating improved from 2 (IQR 1–2) to 0 (IQR 0–1) after ice slurry ingestion in Singapore (p <0.001). HCWs are cognizant of the effects of heat stress but might not adopt best practices due to various constraints. Thermal stress management is better in Singapore than in India. Ice slurry ingestion is shown to be practical and effective in promoting thermal comfort. Adverse effects of heat stress on productivity and judgment of HCWs warrant further investigation.

18.
J Am Med Dir Assoc ; 21(11): 1533-1538.e6, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-841605

ABSTRACT

OBJECTIVE: Inform coronavirus disease 2019 (COVID-19) infection prevention measures by identifying and assessing risk and possible vectors of infection in nursing homes (NHs) using a machine-learning approach. DESIGN: This retrospective cohort study used a gradient boosting algorithm to evaluate risk of COVID-19 infection (ie, presence of at least 1 confirmed COVID-19 resident) in NHs. SETTING AND PARTICIPANTS: The model was trained on outcomes from 1146 NHs in Massachusetts, Georgia, and New Jersey, reporting COVID-19 case data on April 20, 2020. Risk indices generated from the model using data from May 4 were prospectively validated against outcomes reported on May 11 from 1021 NHs in California. METHODS: Model features, pertaining to facility and community characteristics, were obtained from a self-constructed dataset based on multiple public and private sources. The model was assessed via out-of-sample area under the receiver operating characteristic curve (AUC), sensitivity, and specificity in the training (via 10-fold cross-validation) and validation datasets. RESULTS: The mean AUC, sensitivity, and specificity of the model over 10-fold cross-validation were 0.729 [95% confidence interval (CI) 0.690‒0.767], 0.670 (95% CI 0.477‒0.862), and 0.611 (95% CI 0.412‒0.809), respectively. Prospective out-of-sample validation yielded similar performance measures (AUC 0.721; sensitivity 0.622; specificity 0.713). The strongest predictors of COVID-19 infection were identified as the NH's county's infection rate and the number of separate units in the NH; other predictors included the county's population density, historical Centers of Medicare and Medicaid Services cited health deficiencies, and the NH's resident density (in persons per 1000 square feet). In addition, the NH's historical percentage of non-Hispanic white residents was identified as a protective factor. CONCLUSIONS AND IMPLICATIONS: A machine-learning model can help quantify and predict NH infection risk. The identified risk factors support the early identification and management of presymptomatic and asymptomatic individuals (eg, staff) entering the NH from the surrounding community and the development of financially sustainable staff testing initiatives in preventing COVID-19 infection.


Subject(s)
Coronavirus Infections/transmission , Machine Learning , Nursing Homes , Pneumonia, Viral/transmission , Algorithms , Betacoronavirus , COVID-19 , Forecasting , Humans , Pandemics , Retrospective Studies , Risk Assessment , Risk Factors , SARS-CoV-2 , United States
19.
Eurosurveillance ; 25(19):16, 2020.
Article in English | ProQuest Central | ID: covidwho-833282

ABSTRACT

Introduction It is unclear whether high-dose influenza vaccine (HD) is more effective at reducing mortality among seniors. Aim This study aimed to evaluate the relative vaccine effectiveness (rVE) of HD. Methods We linked electronic medical record databases in the Veterans Health Administration (VHA) and Medicare administrative files to examine the rVE of HD vs standard-dose influenza vaccines (SD) in preventing influenza/pneumonia-associated and cardiorespiratory mortality among VHA-enrolled veterans 65 years or older during the 2012/13, 2013/14 and 2014/15 influenza seasons. A multivariable Cox proportional hazards model was performed on matched recipients of HD vs SD, based on vaccination time, location, age, sex, ethnicity and VHA priority level. Results Among 569,552 person-seasons of observation, 207,574 (36%) were HD recipients and 361,978 (64%) were SD recipients, predominantly male (99%) and white (82%). Pooling findings from all three seasons, the adjusted rVE estimate of HD vs SD during the high influenza periods was 42% (95% confidence interval (CI): 24–59) against influenza/pneumonia-associated mortality and 27% (95% CI: 23–32) against cardiorespiratory mortality. Residual confounding was evident in both early and late influenza periods despite matching and multivariable adjustment. Excluding individuals with high 1-year predicted mortality at baseline reduced the residual confounding and yielded rVE of 36% (95% CI: 10–62) and 25% (95% CI: 12–38) against influenza/pneumonia-associated and cardiorespiratory mortality, respectively. These were confirmed by results from two-stage residual inclusion estimations. Discussion The HD was associated with a lower risk of influenza/pneumonia-associated and cardiorespiratory death in men during the high influenza period.

20.
Am J Rhinol Allergy ; 35(3): 323-333, 2021 May.
Article in English | MEDLINE | ID: covidwho-760510

ABSTRACT

BACKGROUND: Post-viral olfactory dysfunction is a common cause of both short- and long-term smell alteration. The coronavirus pandemic further highlights the importance of post-viral olfactory dysfunction. Currently, a comprehensive review of the neural mechanism underpinning post-viral olfactory dysfunction is lacking. OBJECTIVES: To synthesize the existing primary literature related to olfactory dysfunction secondary to viral infection, detail the underlying pathophysiological mechanisms, highlight relevance for the current COVID-19 pandemic, and identify high impact areas of future research. METHODS: PubMed and Embase were searched to identify studies reporting primary scientific data on post-viral olfactory dysfunction. Results were supplemented by manual searches. Studies were categorized into animal and human studies for final analysis and summary. RESULTS: A total of 38 animal studies and 7 human studies met inclusion criteria and were analyzed. There was significant variability in study design, experimental model, and outcome measured. Viral effects on the olfactory system varies significantly based on viral substrain but generally include damage or alteration in components of the olfactory epithelium and/or the olfactory bulb. CONCLUSIONS: The mechanism of post-viral olfactory dysfunction is highly complex, virus-dependent, and involves a combination of insults at multiple levels of the olfactory pathway. This will have important implications for future diagnostic and therapeutic developments for patients infected with COVID-19.


Subject(s)
COVID-19/complications , Olfaction Disorders/physiopathology , Animals , COVID-19/epidemiology , COVID-19/pathology , COVID-19/physiopathology , Humans , Olfaction Disorders/epidemiology , Olfaction Disorders/pathology , Olfactory Bulb/pathology , Olfactory Mucosa/pathology , Olfactory Pathways/pathology , SARS-CoV-2/genetics , SARS-CoV-2/pathogenicity , Species Specificity
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