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1.
Gynecologic Oncology ; 166:S68-S69, 2022.
Article in English | EMBASE | ID: covidwho-2031753

ABSTRACT

Objectives: Our previously presented pilot study evaluated a web-based tool to collect family cancer history (FCH). It demonstrated that this tool resulted in significantly higher quality FCH compared to standard of care face-to-face physician interviews. However, the true value of FCH requires translation into the utilization of genetic services. Here, we aimed to evaluate referral rates and completion of genetic services for patients completing the web-based tool versus standard of care. Methods: Patients scheduled for a gynecologic oncology new patient visit between September 2019 and September 2021 were eligible for enrollment in this institutional review board-approved prospective trial. The trial had three arms: 1) Standard of care (FCH collection by physicians) 2) Web-based tool administered by email prior to the visit, 3) Web-based tool administered in the office prior to the visit (this arm closed early due to COVID-19 restrictions). Individuals were identified as high-risk for familial cancer if they met National Comprehensive Cancer Network (NCCN) guidelines in the standard of care arm, or if the validated cancer risk models embedded in the web-based tool returned a lifetime cancer risk >20% or mutation risk?>2.5% in the web-based tool arms. Validated risk assessment models included breast and ovarian BRCAPRO, Claus, Tyrer-Cuzick, Gail, colorectal and endometrial MMRPRO, MELAPRO, PANCPRO, and PREMM. The primary endpoint was the percentage of high-risk patients referred for genetic counseling/testing. Secondary endpoints included the completion of genetic counseling and genetic testing. Results: Two hundred and fifty patients were enrolled (Arm 1: 110;Arm 2: 105;Arm 3: 35). Among patients randomized to the web-based tool, 88 (63%) completed the tool. In the control arm, 31 patients (28%) met the criteria for referral to genetics, among which 18 (58%) had previously completed genetic testing. In the web-based tool arm, 26 patients (30%) met the criteria, among which 12 (46%) had previously completed genetic testing, and one was deceased soon after her visit. In the control arm, 54% of high-risk patients were referred to genetic counseling, 23% completed genetic counseling, and 23% completed genetic testing. In the web-based tool arm, 100% of high-risk patients were referred to genetic counseling, 54% completed genetic counseling, and 38% completed genetic testing (Table 1). Conclusions: When successfully completed, the use of a web-based tool for FCH collection facilitated the process of referral to genetics, resulting in significantly higher referral rates to genetic counseling than the standard of care physician interviews (100% vs 54%, p = 0.01). However, 37% of patients could not complete the web-based tool. Our findings demonstrate the potential power of health information technology to identify millions of individuals unknowingly carrying familial cancer syndromes and highlight those tools must be designed in a way to maximize patient participation.[Formula presented]

2.
25th International Conference on Miniaturized Systems for Chemistry and Life Sciences, MicroTAS 2021 ; : 857-858, 2021.
Article in English | Scopus | ID: covidwho-2012689

ABSTRACT

Paper microfluidics has had a rich history in medical diagnostics owing to their portability, low-cost and capacity for mass manufacture. While nitrocellulose has widespread use in commercial paper-based assays, shortages can become a bottleneck for deployment. Here, we seek to overcome this limitation by enabling swift and efficient production of cellulose-based paper assays with minimal substrate processing via protein engineering. We demonstrate good clinical and lab-based performance for both serological and antigen rapid tests and their compatibility with roll-to-roll mass manufacturing, which validates our proposed workflow for commercialization. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.

3.
Innovation in Aging ; 5:248-248, 2021.
Article in English | Web of Science | ID: covidwho-2012573
4.
Innovation in Aging ; 5:157-158, 2021.
Article in English | Web of Science | ID: covidwho-2012116
6.
Qualitative Research Journal ; 2022.
Article in English | Scopus | ID: covidwho-1992557

ABSTRACT

Purpose: The paper draws upon autoethnographic accounts from two academic staff in a private higher education institution (HEI) in London, UK who try to make sense of their teaching and learning practices during the pandemic. Even though studies have looked into the impact of Covid-19 on teaching and learning and on students, this paper reflects on the experience of lecturers with a focus on their emotional labour and stressors during remote teaching and working. Design/methodology/approach: This is a small case study of two colleagues from a small private institution in London, UK, which is based on autoethnography. The authors draw on personal notes, emails and other written artefacts alongside our memories of our lived experiences of the pandemic. Findings: The authors’ reflections focus on the need for institutional collegiality as avenues to network and collaborate beyond institutions which have been limited (despite the increased interactions online) and the need to acknowledge emotional labour while providing spaces for staff to discuss their everyday experiences. The authors argue for a renewed importance for creating a sense of community during times of uncertainty and beyond. If these structures are put into place, the conditions to support teaching and learning will also strengthened. Originality/value: There is a dearth in research which discusses emotional labour and the importance of community and collegiality on campuses and in the new way of working remotely. This paper adds to the empirical basis of such research and hopes to encourage others to share their experiences of emotional labour in the academy. © 2022, Emerald Publishing Limited.

7.
Journal of Adolescent Health ; 70(4):S30, 2022.
Article in English | EMBASE | ID: covidwho-1936666

ABSTRACT

Purpose: Compared to cisgender peers, gender diverse youth (GDY) face significant mental health disparities. Parent affirmation reduces these disparities, but there are few evidence-based support programs for parents of GDY and none centered on 1:1 parent peer support, which has shown promise in other pediatric settings. This study aimed to evaluate a 1:1 peer mentor program for parents of GDY, the Parent Outreach Program (POP). Methods: We created anonymous online surveys consisting of open-ended questions about the POP distributed via email to program mentors (parents providing support) and mentees (parents receiving support). Participants were asked why they became involved, benefits and challenges, and how this program compared to others they had participated in. Open-ended responses were coded by two authors using two iteratively developed codebooks (one each for mentors and mentees);codes were adjudicated to consensus and key themes were identified for both participant types. Results: In total, 20 participants (6 mentors, 14 mentees) completed parallel surveys. Themes identified for mentors included feeling giving back was important, their mentoring experience, challenges, and personal growth resulting from being a mentor. Mentors wanted to help other families, “[POP was] rewarding in knowing that by helping the parents you can ultimately help the kids”. They shared logistical challenges like “coordinating schedules” as well as the potential for conversations to be triggering;“Sometimes it brings up a memory of my own family that evokes an emotion”. Mentors also noted their participation was a positive experience: “[POP] offers us the opportunity to grow in our knowledge and feelings in regard to our own child”. Themes identified for mentees included the importance of finding community through the POP, receiving education, relating to their mentors, practical considerations, and qualities of a good mentor. Parent mentees shared relief in finding a “sense of community”;as one mentee said, “It was a lifeline to some sanity”. They also noted that the POP gave them specialized information and that they connected with mentors based on shared experiences: “We craved parents with a true understanding of the many feelings, changes, activities…”. They addressed practical considerations like the intimacy of 1:1 support and that recommendations from a provider mattered to them: “This [program] is more intimate and focused on our stories;” “When the social worker offered it, I had no doubt.” Mentees stressed that mentors “being non-judgmental, willing to listen” was critical. All mentees noted that they would recommend POP to other parents. Conclusions: Both parent mentors and mentees shared that 1:1 peer support was valuable and allowed mentors to give back and experience personal growth, while providing community and resources to mentees who were struggling to understand and support their GDY’s journey. The POP also provides an alternative to large support groups given the ongoing COVID-19 pandemic. This program and others offering 1:1 parent peer support may fill an important gap in supporting parents of GDY, ultimately improving mental health outcomes for their young people. Sources of Support: Dr. Kidd was supported by the National Center for Advancing Translational Science of the NIH, Award Number TL1TR001858.

8.
Journal of Adolescent Health ; 70(4):S69-S70, 2022.
Article in English | EMBASE | ID: covidwho-1936616

ABSTRACT

Purpose: Juvenile court involved youth (JCIY) experience unique psychosocial challenges. The COVID-19 pandemic generated additional stressors for this vulnerable population. Promoting mindfulness strategies may increase well-being among JCIY, but few such interventions have been developed. We sought to evaluate the impact of a longitudinal mindfulness intervention incorporating healing-centered, anti-oppression yoga delivered through a virtual platform on multiple psychological outcomes among JCIY involved in community-based monitoring. Methods: We partnered with YogaRoots on Location (YROL), a healing-centered, anti-oppression yoga instruction group, to implement a longitudinal mindfulness training program to youth aged 11-21 involved in the Allegheny County Community Intensive Supervision Program (CISP). Starting in March 2020, this program transitioned to a remote format in light of the COVID-19 pandemic. Sessions were delivered via Zoom and incorporated Raja yoga practice, breathing techniques, meditation and mindfulness exercises, and strengths-based social justice exploration. Sessions lasted one hour and occurred weekly. Youth attending nine sessions completed end-of-program (EOP) evaluations. Baseline surveys assessed demographic characteristics and prior experiences with racism and trauma. EOP surveys were administered to assess for changes in multiple psychological outcomes: mindfulness, acceptance and action, resilience, future orientation, emotion dysregulation, and psychological distress. Demographic data were summarized with descriptive statistics. McNemar or Wilcoxon signed rank tests were used to compare outcomes at baseline and EOP. Results: 99 youth completed baseline assessments. Mean age of participants was 16.2 (SD: 1.4). 85 (86%) were male. 60 (61%) identified as Black/African-American, 17 (17%) White, and 14 (14%) other racial identities. 7 (7%) were Hispanic/Latino. 74 (75%) youth reported prior experiences of trauma, with 47 (47%) reporting three or more. Perceptions of racism were common, with 63 (64%) youth reporting being treated unfairly by a police officer and 67 (68%) being accused of something they did not do at school. 16 youth (16%) completed EOP surveys. No significant changes in any psychological outcomes were noted from baseline to EOP among this cohort of youth who completed nine or more sessions. Many reported likelihood of using yoga in the future to deal with stress (11;69%), to calm down (12;75%), and to deal with racism (8;50%). Conclusions: JCIY face significant psychosocial stressors, and many report histories of trauma and discrimination. The COVID-19 pandemic may exacerbate existing challenges for these youth, and further supports are needed to engender well-being in this population, including strategies to retain youth in programming. Despite its feasibility and acceptability among JCIY, mindfulness training, particularly in a virtual format, may have limited immediate impact on psychological outcomes due to broader structures of oppression and situational factors. Reflecting the transiency of this population, changing living situations, going “on the run,” and other challenges, retaining youth in ongoing programming is challenging. Additional follow-up is needed to determine the effects of such interventions on long-term youth coping and resilience as well as to elucidate implementation facilitators to increase receipt of such skills-building programs for this population. Sources of Support: Heinz Endowments.

9.
BMJ Open ; 12(Suppl 1):A16, 2022.
Article in English | ProQuest Central | ID: covidwho-1871566

ABSTRACT

BackgroundTRIM is an evaluation of the triage models used by emergency ambulance services caring for patients with suspected COVID-19 during the pandemic’s first wave in 2020. We aimed to understand experiences and concerns of staff about implementation of triage protocols.MethodResearch paramedics interviewed stakeholders from four ambulance services (call handlers, clinical advisors, paramedics, managers) and ED clinical staff from receiving hospitals. Interviews (n=23) were conducted remotely using MS Teams, recorded, and transcribed in full. Analysis generated themes from implicit and explicit ideas within participants’ accounts (Braun and Clarke 2021), conducted by researchers and PPI partners working together.ResultsWe identified the following themes:Constantly changing guidelines – at some points, updated several times a day.The ambulance service as part of the wider healthcare system - changes elsewhere in the system left ambulance services as the default.Peaks and troughs of demand - fluctuating greatly over time, and varying across the staff groups.A stretched system - resources were overextended by staff sickness and isolation, longer job times, and increased handover delays at ED.Emotional load of responding to the pandemic - including call centre staff. Doing the best they can in the face of uncertainty - a rapidly evolving situation unlike any which ambulance services had faced before.ConclusionImplementing triage protocols in response to the COVID-19 pandemic was complex and had to be actively managed by a range of frontline staff, dealing with external pressures and a heavy emotional load.Conflict of interestNone.FundingUKRI-DHSC Covid-19 Rapid Response Funding.

11.
Am J Transplant ; 22 Suppl 2: 438-518, 2022 03.
Article in English | MEDLINE | ID: covidwho-1735852

ABSTRACT

For the first time in a decade, both the number of candidates added to the waiting list and the number of lung transplants performed decreased from the year prior; the number of lung donors also declined. This slowing of transplant activities in 2020 was associated with a modest increase in waitlist mortality. The year 2020 was notable for the global outbreak of the COVID-19 pandemic, which undoubtedly influenced all trends noted in lung transplantation. Time to transplant continued to decrease, with a median time to transplant of 1.4 months across all waitlist candidates. Posttransplant survival remained stable, with 89.4% of transplant recipients surviving to 1 year, 74.8% to 3 years, and 61.2% to 5 years.


Subject(s)
COVID-19 , Tissue and Organ Procurement , COVID-19/epidemiology , Graft Survival , Humans , Lung , Pandemics , SARS-CoV-2 , Tissue Donors , United States/epidemiology , Waiting Lists
14.
Critical Care Medicine ; 50(1 SUPPL):474, 2022.
Article in English | EMBASE | ID: covidwho-1691839

ABSTRACT

INTRODUCTION: Post-Intensive care syndrome (PICS) is the culmination of cognitive, psychological and physical issues critical illness survivors encounter. More than half of critically ill patients may experience cognitive impairment after hospital discharge. There is limited information on cognitive impairment surrounding PICS in COVID-19 survivors. This study aims to evaluate the impact anticholinergic cognitive burden has on cognitive function in the COVID-19 survivor patient population. METHODS: This retrospective, observational cohort study included patients from the post-intensive care survivor clinic at Indiana University Health that were discharged from April 2020 to March 2021. Patients were excluded if they did not have an admitting diagnosis of respiratory failure secondary to COVID-19 or did not have discharge documentation. Cognitive impairment was evaluated using the Montreal Cognitive Assessment (MoCA). Demographics and anticholinergic cognitive burden (ACB) scores were compared between patients with cognitive impairment (MoCA < 26) versus those without cognitive impairment (MoCA > 26). RESULTS: Twenty-six patients were included in this evaluation. Twelve patients had cognitive impairment and fourteen patients did not have cognitive impairment. ACB score at discharge for those with and without cognitive impairment had a median (IQR) score of 2.5 (0.75-4.25) and 1 (0.25-2), respectively (p=0.208). The patients with cognitive impairment had a median (IQR) ACB score at the start and end of the initial appointment of 1.5 (0.75-2.5) and 1.5 (0.75-2.25), respectively. The median (IQR) ACB score at the start and end of the initial appointment for patients without cognitive impairment was 1 (0-1.75). Delirium was reported 7 patients (58%) with cognitive impairment compared to 5 patients (36%) without cognitive impairment (p=0.431). The Charlston comorbidity score was higher in those with cognitive impairment, with a median (IQR) score of 3.5 (2.75-5) compared to 0 (0-2) for those without cognitive impairment (p=0.002). CONCLUSIONS: The difference in ACB scores at discharge was not statistically different between patients with and without cognitive impairment. Patients with cognitive impairment post ICU discharge tended to have a higher Charlston comorbidity score.

15.
MEDLINE;
Preprint in English | MEDLINE | ID: ppcovidwho-326704

ABSTRACT

To characterize Coronavirus Disease 2019 (COVID-19) transmission dynamics in each of the 15 most populous metropolitan statistical areas (MSAs) in the United States (US) from January 2020 to September 2021, we extended a previously reported compartmental model accounting for effects of multiple distinct periods of social distancing by adding consideration of vaccination and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) variants Alpha (lineage B.1.1.7) and Delta (lineage B.1.617.2). For each MSA, we found region-specific parameterizations of the model using daily reports of new COVID-19 cases available from January 21, 2020 to August 24, 2021. In the process, we obtained estimates of the relative infectiousness of Alpha and Delta as well as their takeover times in each MSA. We find that 14-d ahead forecasts are reasonably accurate;these forecasts are being updated daily. Projections made on August 24, 2021 suggest that 5 of the 15 MSAs have already achieved herd immunity.

16.
Circulation ; 144(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1638951

ABSTRACT

Introduction: There is limited literature on the cardiovascular manifestations of post-acute sequelae of SARS-CoV-2 infection (PASC). Methods: All consecutive adult patients presenting to the cardiology clinic at Yale-New Haven Hospital since July 2020, with positive COVID-19 serologic testing, were included. Results: Of 71 patients, average age was 46 years (range 19-74 years), 44 (62%) were female. 51 (72%) were White. 19 (27%) patients were hospitalized for COVID-19 (Table). Comorbidities included Hypertension (27%), hyperlipidemia (25%), diabetes (24%), and obesity (30%). On average, patients presented four months after COVID-19 diagnosis. The most common symptoms at presentation were dyspnea (45%, almost all exertional), palpitations (49%), and chest pain/pressure (49%). Patients also had memory impairment (20%), fatigue (39%), and headache (14%). There was no significant difference in cardiopulmonary symptoms (dyspnea, palpitations, and chest pain/pressure) by hospitalization status (p=0.70). TTE was abnormal in 13 of 62 patients and cardiac MRI was abnormal in 10 of 17 patients. Women experienced more cardiopulmonary symptoms (p=0.02) than men. Hospitalized patients were more likely to have ventricular dysfunction than non-hospitalized patients, although there were no significant differences in abnormal MRI findings (p=0.38). Diagnostic yield included: nonischemic cardiomyopathy (6%);new ischemia (3%);coronary vasospasm (1%);new atrial fibrillation (1%);possible myocarditis based on symptoms, MRI LGE (8%) or inflammation (3%). Two people met POTS criteria;majority of patients had evidence of sinus tachycardia and exertional fatigue consistent with orthostatic intolerance and deconditioning. Conclusions: In this cohort of patients referred to a cardiology clinic for PASC, cardiopulmonary symptoms did not differ by hospitalization status, however women were more likely to experience these symptoms than men.

17.
Journal of the American Society of Nephrology ; 32:539, 2021.
Article in English | EMBASE | ID: covidwho-1489411

ABSTRACT

Background: African Americans are disproportionately affected by hypertension (HTN) and CKD and evidence suggests dietary modifications towards a more Dietary Approaches to Stop Hypertension (DASH)-accordant diet could improve outcomes for this population. We aimed to explicate barriers and facilitators of healthy eating, and the perceived benefits of the intervention among completed participants of a dietary intervention trial for African Americans with HTN and CKD. Participants were randomized to one of two groups: 1) Self-Shopping DASH (S-DASH) diet group with $30/week grocery allowance for 4 mo. but no specific guidance on purchases, followed by no food allowance for 8 mo.;or 2) Coaching DASH (C-DASH) diet advice group with a $30/week food allowance and assistance in purchasing foods for 4 mo., followed by intermittent coaching without food allowance for 8 mo. Methods: We performed a content analysis of transcripts from semi-structured interviews with participants who completed the trial (13 C-DASH;12 S-DASH were randomly selected). Thematic analyses followed 5 stages: 1) reading and rereading all transcripts and utilizing audio recordings as needed for clarity;2) three coders reading two of the same transcripts, coding them, and comparing codes which were then used to create the initial coding framework;3) defining codes, coding additional transcripts, discussing/ revising the coding framework;4) formulating initial themes and 5) diagramming relationships among initial themes to merge overlapping themes. Results: Participants were a mean age of 62 ± 9.3 years, 36% were male. Key themes included healthy diet facilitators (food tracking, motivation, social support, and perception of healthy foods);barriers (transportation, past eating habits, stress and COVID mitigation);and impact of the trial on knowledge and health. Conclusions: Participants of a dietary intervention trial for African Americans with HTN and CKD identified several facilitators and barriers to healthy eating that could inform future efforts to address disease burden in this population.

19.
Sleep ; 44(SUPPL 2):A75, 2021.
Article in English | EMBASE | ID: covidwho-1402567

ABSTRACT

Introduction: Insufficient sleep is highly prevalent among school-age youth and adolescents, which has been exacerbated by the COVID- 19 pandemic. However, it is unclear whether sleep during COVID-19 varies based on whether school is in session. We examined the sleep of school-age youth and adolescents during COVID-19 and described changes in rates of insufficient sleep from summer (Time 1) to school year (Time 2). We further examined whether insufficient sleep is associated with mental health service utilization. Methods: Adults in Southwestern Pennsylvania with children under 18 years old in their household completed a repeated cross-sectional electronic survey. The survey was designed to assess usage of, and unmet need for, health and social service resources, among other health behaviors. As responses were anonymous with no longitudinal linking, we used descriptive statistics and Chi-Square tests to examine our aims at each time point. Insufficient sleep was operationalized as <9 hours (school-age youth) and <8 hours (adolescents) of sleep duration, per National Sleep Foundation standards. Results: Data were analyzed from n=97 school-age youth and n=83 adolescents at Time 1, and n=77 school-age youth and n=82 adolescents at Time 2. Most school-age youth (76.3%) obtained sufficient sleep at Time 1, which was maintained at Time 2. However, while 75.6% of adolescents obtained sufficient sleep at Time 1, that number fell to 63.3% at Time 2. Youth with insufficient sleep were more likely to utilize mental health services than those obtaining sufficient sleep at a borderline level of statistical significance (p-value = 0.097), after controlling for age group. Conclusion: The rate of insufficient sleep among adolescents during COVID-19 is meaningfully higher than non-COVID, school-year rates recently reported among adolescents. Youth with insufficient sleep are more likely to utilize mental health services, though the direction of causality in that association is unknown. Future work should focus on strategies for increasing access to sleep promotion programs that support sleep health and mental health during a time of great stress.

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