Effect of Pneumothorax and Pneumomediastinum on Survival in Patients with Covid-19 Ards in the Icu

INTRODUCTION: There is a wide range in the reported incidence of pneumothorax (PTX) and pneumomediastinum (PMN) in patients with coronavirus disease 2019 (COVID-19). PTX alone and PTX/PMN combined has also been associated with higher mortality in patients with COVID-19 related acute respiratory distress syndrome (ARDS), however, current data regarding outcomes or predictors of PTX and PMN in COVID-19 ARDS is limited. The purpose of this study was to determine if the incidence of PTX/PMN in a large cohort with COVID-19 related respiratory failure was associated with mortality. Further, we looked to determine which clinical factors or ventilator management strategies may have impacted mortality in underserved patient population with PTX. METHOD(S): We conducted a retrospective analysis of data from a single center COVID-19 intensive care unit of an urban tertiary safety net hospital including all adult patients admitted with COVID-19 associated ARDS requiring mechanical ventilation between March 2020 and January 2021. Following identification of a cohort with radiographic evidence of PTX and/or PMN, demographics, ventilator data, radiographic data, position, information regarding chest tube and sedation management and outcome data were obtained from the electronic medical record. RESULT(S): Among 502 patients admitted to the ICU with COVID-19 related ARDS, PTX was identified in 103/ 502 (20.5%), predominantly affecting Hispanic (88%) and male (66%) patients. Thirty-four patients had PMN (18.7%) alone. Of patients with documented PTX, 60 (50.8%) had preceding or co-morbid PMN. PTX with/without PMN was associated with increased mortality (OR 2.19, p=0.0027) even after adjustment for ventilator days. There was no significant association between PMN alone and mortality (OR 0.82, p=0.60). Conservative management without tube thoracostomy was rarely possible (18.4% of PTX). Time to development of PTX was not associated with mortality, but PTX was associated with longer survival times (HR 2.10;p< 0.001). CONCLUSION(S): There is a high incidence of PTX/PMN in critically ill patients with COVID-19. PTX, but not PMN alone, is associated with higher mortality in ICU patients.

Actually Existing Commons: Using the Commons to Reclaim the City

In Paraisópolis, a slum in São Paulo (Brazil) housing over 100.000 inhabitants, the Covid crisis seemed to have less of a death toll (0,0217%) than in other areas of the city (an average of 0,0652% as of May 2020);or at least it did at first. The sense of community in the area is strong, leading to many community initiatives and organisations to rise to the challenge of combating the pandemic with little help from the authorities. The community’s initial efficient response to the Covid crisis relied heavily on self‐reliance and self‐organization to mobilise common resources. Despite their later failure in containing the virus, the community’s response to the pandemic is exemplary of a well‐known phenomenon: how communities are able to mobilise the commons to create general welfare. The commons concept is used in this contribution to help us better understand slum governance and the power and limitations of community reliance. At the same time, we aim to refine our understanding of the commons as a contentious category rooted in agonistic relationships instead of the romanticised leftist social imaginary that views the commons as purely anti‐capitalist. Thus, we explicitly argue for a view of the commons and commoning that transcends the narrow “Leftist imaginary” of the commons as egalitarian, inclusive, anti‐capitalist, horizontal, and as expressions of sharing (and caring), and instead views the commons as embedded in everyday realities, where commoning practices emerge as practises that support the reproduction of (social) life. © 2022 by the author(s);.

The impact of COVID-19 on epilepsy care: Perspectives from UK healthcare workers.

The COVID-19 pandemic has created an immense pressure on healthcare providers, resulting in a shift to remote consultations and the redeployment of healthcare workers (HCWs). We present survey data from the United Kingdom (UK) HCWs to outline how changes in healthcare provision impact clinicians' wellbeing and ability to provide adequate care. We designed an online survey to gather the experiences of HCWs providing care to people with epilepsy. We received seventy-nine responses from UK-based HCWs, of whom 43% reported an impact on their mental health. Changes to service delivery have resulted in 71% of clinicians performing > 75% of their consultations remotely. Diagnosing and treating epilepsy has changed, with a fifth of respondents being significantly less confident in diagnosing epilepsy. Ultimately, these results show that COVID-19 has had an overall negative impact on HCWs and their ability to provide epilepsy care. These results must be considered when reorganizing health services to ensure optimal outcomes for people with epilepsy.

A Practical Guide to Doing Behavioral Research on Fake News and Misinformation

Coincident with the global rise in concern about the spread of misinformation on social media, there has been influx of behavioral research on so-called "fake news" (fabricated or false news headlines that are presented as if legitimate) and other forms of misinformation. These studies often present participants with news content that varies on relevant dimensions (e.g., true v. false, politically consistent v. inconsistent, etc.) and ask participants to make judgments (e.g., accuracy) or choices (e.g., whether they would share it on social media). This guide is intended to help researchers navigate the unique challenges that come with this type of research. Principle among these issues is that the nature of news content that is being spread on social media (whether it is false, misleading, or true) is a moving target that reflects current affairs in the context of interest. Steps are required if one wishes to present stimuli that allow generalization from the study to the real-world phenomenon of online misinformation. Furthermore, the selection of content to include can be highly consequential for the study's outcome, and researcher biases can easily result in biases in a stimulus set. As such, we advocate for pretesting materials and, to this end, report our own pretest of 224 recent true and false news headlines, both relating to U.S. political issues and the COVID-19 pandemic. These headlines may be of use in the short term, but, more importantly, the pretest is intended to serve as an example of best practices in a quickly evolving area of research.