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1.
Applied Geography ; : 102869, 2023.
Article in English | ScienceDirect | ID: covidwho-2165068

ABSTRACT

The direct effect of pandemic induced lockdown (LD) on environment is widely explored, but its secondary impacts remain largely unexplored. Therefore, we assess the response of surface greenness and photosynthetic activity to the LD-induced improvement of air quality in India. Our analysis reveals a significant improvement in air quality marked by reduced levels of aerosols (AOD, −19.27%) and Particulate Matter (PM 2.5, −23%) during LD (2020) LD (2020) from pre-LD (March–September months for the period 2017–2019). The vegetation exhibit positive response reflected by increase in surface greenness [Enhanced Vegetation Index (EVI, +10.4%)] and photosynthetic activity [Solar Induced Florescence (SiF, +11%)] during LD from pre-LD that coincides with two major agricultural seasons of India;Zaid (March–May) and Kharif (June–September). In addition, the croplands show a higher response [two-fold in EVI (14.45%) and four-fold in SiF (17.7%)] than that of forests. The prolonged growing period (phenology) and high rate of photosynthesis (intensification) led to the enhanced greening during LD owing to reduced pollution. This study, therefore, provides new insights into the response of vegetation to the improved air quality, which would give ideas to counter the challenges of food security in the context of climate pollution, and combat global warming by more greening.

4.
17th European Conference on Computer Vision, ECCV 2022 ; 13681 LNCS:437-455, 2022.
Article in English | Scopus | ID: covidwho-2148610

ABSTRACT

Federated learning (FL) is a distributed machine learning technique that enables collaborative model training while avoiding explicit data sharing. The inherent privacy-preserving property of FL algorithms makes them especially attractive to the medical field. However, in case of heterogeneous client data distributions, standard FL methods are unstable and require intensive hyperparameter tuning to achieve optimal performance. Conventional hyperparameter optimization algorithms are impractical in real-world FL applications as they involve numerous training trials, which are often not affordable with limited compute budgets. In this work, we propose an efficient reinforcement learning (RL)-based federated hyperparameter optimization algorithm, termed Auto-FedRL, in which an online RL agent can dynamically adjust hyperparameters of each client based on the current training progress. Extensive experiments are conducted to investigate different search strategies and RL agents. The effectiveness of the proposed method is validated on a heterogeneous data split of the CIFAR-10 dataset as well as two real-world medical image segmentation datasets for COVID-19 lesion segmentation in chest CT and pancreas segmentation in abdominal CT. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

5.
India Higher Education Report 2021: Private Higher Education ; : 205-225, 2022.
Article in English | Scopus | ID: covidwho-2144588

ABSTRACT

Over last two decades, private higher education institutions have been making new inroads in the Indian education scenario. This phenomenon is marked by commodification of higher education and culture of capitation fee for admission in professional courses. This has raised major concerns with regard to affordability and equity in the higher education in India. Globally and in India, the discourse on commercialised higher education is polarised on the ground of inclusivity of aspiring students of the socio-culturally and economically marginalised sections on the one hand and opening the door of higher education for those who can pay ‘user fees’. Other philosophical questions are: Is higher education a marketable product or a public good that needs to be supported by the state funding? Does higher education merit state support or ‘user fee model’ is most efficient for crowding out? How to make higher education affordable and accessible to meritorious students, who have been historically neglected, through affirmative action so that higher education markets do not throw them out? How to deal with paradoxical situation where private sectors in professional educational institutions have a large number of vacant seats and aspiring meritorious students do not get admission due to inability to pay highly inflated fees? Relative decline in budgetary allocations for higher education since 1991 and falling government expenditure in higher education and its implications for economic development of the region have been an important area of research in India in the millennium focused on economic growth through expansion of knowledge economy. Augmenting expenditure on education as well as better utilisation of allocated funds is an essential component of the developmental strategy of the state to fulfil its long-term priorities of human development that are essential for economic growth. The COVID pandemic has brought into foreground these perennials and developing issues that reveal the fact that education has been treated as a privilege or a commodity rather than a fundamental right. The pandemic has heightened existing injustices-push out of a large number of students due to circular migration, exposing and deepening of the ‘digital divide’, and profiteering by private managements. Along with the students, the teachers are also bearing the brunt of contractualisation of their services, pressurised to adapt to new technologies in the absence of sufficient support, working without remuneration, and facing job loss. The onslaught of Information and Communication Technology (ICT)-based market forces raise serious concern for the access to the socioeconomically marginalised at the intersections of class, caste, ethnicity, physical and cognitive disabilities, location, and gender. The health emergency has made it mandatory for India to increase seats in medical and nursing education as more doctors, nurses, and health administration personnel are required. Even in arts, commerce, and science degree courses, the platform-based education has forced out a large proportion of students who do not have access to digital education. Digital divide due to gender, class, caste, and location needs to be addressed seriously by the state and private higher education institutions mushrooming in the urban, peri-urban, and rural areas. In this context, a case for enhancing the public funding for higher education to 6 per cent of gross domestic product (GDP) as per the recommendation of National Education Policy 2020 needs immediate implementation. In the last two decades, India has witnessed some praiseworthy examples of support under corporate social responsibility (CSR) in terms of scholarships, fellowships, and freeships for the college and university students/scholars from the marginalised sections. Governments around the world are exploring different ways to involve the private sector in providing higher education. Contracting out educational services is controversial. One criticism that is often made of public-private partnerships (PPPs) is that these initiatives lead to the privatisation of education and thus reduce the government responsibility towards a public service. Another fear expressed is that increasing the educational choices available to students and their families may increase socioeconomic segregation if economically and socio-culturally better placed students end up self-selecting into high-quality universities further improving their outcomes. A third concern is centred on the poorer students that are left behind in the deteriorating state universities and getting ghettoised for general BA/BCom degrees resulting in unemployable degree holders. Currently, centres and departments of women’s studies, dalit studies, tribal studies, and disability studies are facing major crisis in terms of funds and positions. These disciplines are extremely important for creation of a responsible citizenry, still are marginalised in the academic hierarchy and are kept on oxygen. These disciplines need serious attention of not only the state and publicly funded universities but also of the private higher educational institutions. So far as the marginalised sections are concerned, distance education and Open Educational Resources (OERs) have proved to be a blessing with concerns such as recognition of such degrees at par with degrees offered under regular mode, employability of students graduated from distance education, learning of students, etc. Such limitations may end up with further marginalisation of student from poor social and economic background. Learning issues may be addressed through interactive sessions and face-to-face sessions. The supreme concern in the higher education must be equity, accessibility, and affordability for the historically neglected sections which demands affirmative action of the state so that they are not forced out of colleges and universities. For this, expansion, excellence, and equity in higher education are a must. This can be attained only by transcending binaries of profit and not for profit as well as meritocracy-based elitism and money-based elitism. © 2023 selection and editorial matter, National Institute of Educational Planning and Administration.

6.
British Journal of Surgery ; 109(Supplement 5):v31, 2022.
Article in English | EMBASE | ID: covidwho-2134900

ABSTRACT

Aims: Measure performance and cost effectiveness of a Virtual Consultation (VC) clinic, compared to face-to-face (FF) clinic, for 2-week-wait (2WW) colorectal Cancer (CRC) referrals, which did not meet The criteria for nurse-led Telephone Assessment Service. Method(s): 2WW CRC referrals were triaged by a colorectal surgeon to either a doctor-led VC or FF clinic. Demographics, referral indications, and primary outcome measures (time to clinic/results;investigation type;Cancer detection rate) were compared pre-pandemic (November 2019-January 2020) and during The pandemic (May-June 2021). Result(s): 158 (pre-pandemic) and 160 (pandemic) consecutive patients were analysed, with no difference in age (74 vs. 75 years, p=0.936). During The pandemic, patients were referred with an increased number of positive FIT tests (29 vs. 13%, p<0.001), were more likely to have computerised tomography (65 vs. 45%, p=0.003), had a longer time from referral to clinic assessment (10 vs. 8 days, p=0.002), but were informed of results more promptly (59 vs. 138 days, p<0.001) than pre-pandemic patients. During The pandemic patients were assessed earlier via VC than FF clinics (9 vs. 11 days, p=0.049). There were no significant differences in Cancer detection rate pre or during The pandemic (12 vs. 8%, p=0.187), or between VC and FF clinic during The pandemic (6 vs. 12%, p=0.294). Cost effective analysis showed 15,000 per annum saving with doctor-led VC clinic. Conclusion(s): Virtual consultation for 2WW CRC referrals may improve efficiency without compromising The Cancer detection rate, as well as reducing risk of Covid-19 transmission and being more cost effective.

9.
Sci Rep ; 12(1): 18792, 2022 Nov 05.
Article in English | MEDLINE | ID: covidwho-2106466

ABSTRACT

The gut is of importance in the pathology of COVID-19 both as a route of infection, and gut dysfunction influencing the severity of disease. Systemic changes caused by SARS-CoV-2 gut infection include alterations in circulating levels of metabolites, nutrients and microbial products which alter immune and inflammatory responses. Circulating plasma markers for gut inflammation and damage such as zonulin, lipopolysaccharide and ß-glycan increase in plasma along with severity of disease. However, Intestinal Fatty Acid Binding Protein / Fatty Acid Binding Protein 2 (I-FABP/FABP2), a widely used biomarker for gut cell death, has paradoxically been shown to be reduced in moderate to severe COVID-19. We also found this pattern in a pilot cohort of mild (n = 18) and moderately severe (n = 19) COVID-19 patients in Milan from March to June 2020. These patients were part of the first phase of COVID-19 in Europe and were therefore all unvaccinated. After exclusion of outliers, patients with more severe vs milder disease showed reduced FABP2 levels (median [IQR]) (124 [368] vs. 274 [558] pg/mL, P < 0.01). A reduction in NMR measured plasma relative lipid-CH3 levels approached significance (median [IQR]) (0.081 [0.011] vs. 0.073 [0.024], P = 0.06). Changes in circulating lipid levels are another feature commonly observed in severe COVID-19 and a weak positive correlation was observed in the more severe group between reduced FABP2 and reduced relative lipid-CH3 and lipid-CH2 levels. FABP2 is a key regulator of enterocyte lipid import, a process which is inhibited by gut SARS-CoV-2 infection. We propose that the reduced circulating FABP2 in moderate to severe COVID-19 is a marker of infected enterocyte functional change rather than gut damage, which could also contribute to the development of hypolipidemia in patients with more severe disease.


Subject(s)
COVID-19 , Humans , Enterocytes/metabolism , SARS-CoV-2 , Fatty Acid-Binding Proteins/metabolism , Biomarkers , Cell Death , Lipids
10.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | Web of Science | ID: covidwho-2092473
11.
Chest ; 162(4):A264, 2022.
Article in English | EMBASE | ID: covidwho-2060547

ABSTRACT

SESSION TITLE: Cardiovascular Complications in Patients with COVID-19 SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Cardiac tamponade is a medical emergency that requires rapid diagnosis and intervention to prevent hemodynamic collapse. Although COVID-19 typically manifests with pulmonary symptoms, cardiac involvement is becoming better studied through increasingly frequently reported cases [1]. We present a case of COVID-19 cardiac involvement presenting as a rapidly progressive pericardial effusion turning into tamponade. This highlights the importance of a high index of suspicion for patients who develop sudden and atypical respiratory compromise with hypotension in the setting of COVID-19 infection. CASE PRESENTATION: A 76-year-old male with a history of ESRD presented with fatigue after missing hemodialysis. Laboratory investigations revealed a mild troponin elevation and positive SARS-CoV-2 PCR. Initial TTE demonstrated an EF of 60-65% with a small pericardial effusion and thickened calcified pericardium. After a few days, the patient was noted to be encephalopathic and hypotensive. Labs revealed leukocytosis, lactic acidosis as well as an elevated troponin and D-dimer. Chest CTA was significant for a large pericardial effusion with reduced size of the right ventricle, concerning for cardiac tamponade. Repeat TTE had a moderate pericardial effusion and right atrial collapse, consistent with tamponade. Given significantly elevated INR in the setting of anticoagulation, pericardiocentesis was deferred while the patient was transfused FFP. The patient subsequently suffered PEA arrest and expired despite attempted hemodynamic stabilization. DISCUSSION: Cardiac tamponade is a result of accumulating pericardial fluid culminating in decreased cardiac output and shock. Clinicians should be prompted by characteristic findings, including Beck’s triad (JVD, hypotension, and muffled heart sounds) and Kussmaul’s sign of paradoxically elevated JVP with inspiration [2]. However, the diagnosis of tamponade based solely on clinical finding is difficult and may lead to unnecessary intervention [3]. Ultimately, a diagnosis of tamponade requires both hemodynamic instability and pericardial effusion. Echocardiography, including TTE and POCUS, plays a central role in the identification of cardiac tamponade. While it is essential to note the presence of a pericardial effusion, it is important to be familiar with core echocardiographic signs of tamponade: systolic RA collapse (earliest sign), diastolic RV collapse, IVC with minimal respiratory variation, and exaggerated respiratory cycle changes in MV and TV in-flow velocities (a surrogate for pulsus paradoxus) [3]. CONCLUSIONS: Despite the classic association between COVID-19 and pulmonary manifestation, pericardial involvement has been noted in 20% of COVID-19 patients. It is therefore imperative to maintain a high index of suspicion and familiarity of characteristic echocardiogram findings of tamponade to prompt intervention and curtail cardiac hemodynamic collapse. Reference #1: Lala A, Johnson KW, Januzzi JL, et al. Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection. J Am Coll Cardiol. 2020;76(5):533-546. doi:10.1016/j.jacc.2020.06.007 Reference #2: Stashko E, Meer JM. Cardiac Tamponade. [Updated 2021 Dec 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431090/ Reference #3: Alerhand S, Carter JM. What echocardiographic findings suggest a pericardial effusion is causing tamponade?. Am J Emerg Med. 2019;37(2):321-326. doi:10.1016/j.ajem.2018.11.004 DISCLOSURES: No relevant relationships by Christopher Allahverdian No relevant relationships by John Javien No relevant relationships by Vishal Patel No relevant relationships by Sarah Youkhana

12.
International Journal of Radiation Oncology, Biology, Physics ; 114(3):e610-e611, 2022.
Article in English | Academic Search Complete | ID: covidwho-2036128

ABSTRACT

Cutaneous squamous cell carcinoma (CSCC) is the second most common skin cancer with an incidence of 1 million cases per year in the US. While the surgical cure rate for CSCC is >95%, some patients have high risk of recurrence as assessed by immune status, primary disease stage, extent of nodal involvement, presence of extracapsular extension, and prior treatment. Postoperative radiation therapy (RT) is recommended for these patients, but relapse with locoregional recurrence or distant metastases may still occur. C-POST is evaluating the efficacy of cemiplimab as adjuvant therapy for patients with high-risk CSCC. Here, we provide a summary of the most recent study protocol amendment. C-POST is a randomized, placebo-controlled, double-blind, multicenter Phase 3 study to evaluate cemiplimab as adjuvant treatment for patients with high-risk CSCC, based on surgical and clinicopathologic findings, who completed surgery and postoperative RT (minimum total dose 50 Gy, within 10 weeks before randomization) (NCT03969004). Patients with at least one of the following high-risk features are eligible: (1) nodal disease with (a) extracapsular extension and at least one node ≥20 mm or (b) at least three lymph nodes positive on surgical pathology report, regardless of extracapsular extension;(2) in-transit metastases;(3) T4 lesion;(4) perineural invasion;and (5) recurrent CSCC with at least one other risk factor. Patients with CSCC involvement in at least three lymph nodes (feature 1b) were added to the eligibility criteria, as this group was found to be at similar risk of CSCC recurrence as the initially planned study population. Protocol amendment now allows patients with chronic lymphocytic leukemia (CLL) who are not on active treatment to be enrolled. The study has two parts. In Part 1 (blinded), patients are randomly assigned 1:1 to receive cemiplimab 350 mg or placebo intravenously every 3 weeks for 12 weeks, followed by cemiplimab 700 mg or placebo every 6 weeks for 36 weeks. In optional Part 2 (unblinded), patients in the placebo arm who experience disease recurrence and patients in the cemiplimab arm who experience disease recurrence ≥3 months after completion of 48-week treatment in Part 1 are eligible to receive open-label cemiplimab 350 mg Q3W for up to 96 weeks. The trial is expected to enroll 412 patients from about 100 sites in North and South America, Europe, and Asia-Pacific regions. Key primary objective is to compare disease-free survival;secondary objectives include evaluating overall survival, freedom from locoregional relapse, and distant relapse with adjuvant cemiplimab versus placebo in patients with high-risk CSCC. This study is once again open for enrolment following interruptions owing to the COVID-19 pandemic. Not applicable (trial in progress) Not applicable (trial in progress) [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

13.
Lessons from COVID-19: Impact on Healthcare Systems and Technology ; : 19-40, 2022.
Article in English | Scopus | ID: covidwho-2027811

ABSTRACT

After recovery from COVID-19, a person may become infected again due to reactivation of the virus inside the human body or reinfection with a genetically distinct mutant virus owing to reinfection. The COVID-19 reinfection has been recorded all around the world, albeit it is still uncommon. The reinfection with COVID-19 raises several questions about virus characteristics such as mutation, growth, functioning, and transmissibility, level and durability of immunity, diagnosis, therapy, and efficacy of vaccine(s) on genetically modified viruses and their durability and safety. This chapter focuses on various aspects of COVID-19 reinfection, including its severity, frequency, immunopathogenesis, immune responses, effect on vaccine development, Corona waves and herd immunity, management and prevention strategies. COVID-19 reinfections are often asymptomatic or mildly symptomatic, and are milder than first infections, with a few exceptions. The management of reinfection should be the same as the treatment of the first COVID-19 infection. The deep, extensive, rapid and real-time whole-genome sequencing studies, as well as an enhanced vaccination drive, and rigorous adherence to COVID-19 appropriate behavior, would be critical in limiting the severity of transmission and reinfection. © 2022 Elsevier Inc. All rights reserved.

14.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009660

ABSTRACT

Background: CSCC is the second most common skin cancer with an estimated incidence of 1 million cases per year in the US. While the surgical cure rate for CSCC is > 95%, some pts have high risk of recurrence as assessed by immune status, primary disease stage, extent of nodal involvement, presence of extracapsular extension (ECE), and prior treatment. Postoperative RT is recommended for these pts but relapse with locoregional recurrence or distant metastases may still occur. C-POST is evaluating the efficacy of cemiplimab as adjuvant therapy for pts with high-risk CSCC. Here, we provide summary of the most recent study protocol amendment. Methods: C-POST is a randomized, placebo-controlled, double-blind, multicenter Phase 3 study to evaluate cemiplimab as adjuvant treatment for pts with high-risk CSCC, based on surgical and clinicopathologic findings, who completed surgery and postoperative RT (minimum total dose 50Gy, within 10 weeks before randomization) (NCT03969004). Pts with at least one of the following high-risk features are eligible: (1) nodal disease with (a) ECE and at least one node ≥20 mm or (b) at least three lymph nodes positive on surgical pathology report, regardless of ECE;(2) in-transit metastases;(3) T4 lesion;(4) perineural invasion;and (5) recurrent CSCC with at least one other risk factor. Pts with CSCC involvement in at least three lymph nodes (feature 1b) were added to the eligibility criteria, as this group was found to be at similar risk of CSCC recurrence as the initially planned study population. Protocol amendment now allows patients with chronic lymphocytic leukemia (CLL) who are not on active treatment to be enrolled. The study has two parts. In Part 1 (blinded), pts are randomly assigned 1:1 to receive cemiplimab 350 mg or placebo intravenously every 3 weeks for 12 weeks, followed by cemiplimab 700 mg or placebo every 6 weeks for 36 weeks. In optional Part 2 (unblinded), pts in the placebo arm who experience disease recurrence and pts in the cemiplimab arm who experience disease recurrence ≥3 months after completion of 48-week treatment in Part 1 are eligible to receive open-label cemiplimab for up to 96 weeks. The trial is expected to enrol 412 pts from about 100 sites in North and South America, Europe, and Asia-Pacific regions. Key primary objective is to compare disease-free survival;secondary objectives include evaluating overall survival, freedom from locoregional relapse, and distant relapse with adjuvant cemiplimab versus placebo in patients with high-risk CSCC. This study is once again open for enrolment following interruptions owing to the COVID-19 pandemic.

15.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009564

ABSTRACT

Background: Social media platforms such as Twitter are highly utilized to communicate about cancer care. Although surgery is the primary treatment for solid malignancies, little is known about public perceptions or communication behaviors regarding this treatment modality. Further, prolonged lockdowns and widespread delays of planned operations during the COVID-19 pandemic have magnified the importance of virtual communication about surgical cancer care. Methods: Tweets referencing cancer surgery were collected from January 2018 to January 2022 using Twitter's Application Programming Interface. Account metadata was used to predict user demographic information and to compare tweeting metrics across users. Natural language processing models were applied to tweet content to resolve common topics of conversation and to classify tweets by cancer type. Results: There were 442,840 original tweets about cancer surgery by 262,168 users. Individuals accounted for most users (65%) while influencers accounted for the least (1.4%). Influencers made the most median impressions (19,139). Of 240,713 tweets discussing surgery for specific cancers, breast (20%) and neurologic (17%) cancers were most mentioned. When adjusting for national rates of procedures performed, tweets about surgery for neurologic cancers were the most common (231 tweets per 1000 procedures) whereas those for urologic cancers were the least common (15 tweets per 1000 procedures). Discussions about cancer surgery research made up 31% of tweets before the pandemic but only 11% of tweets during the pandemic. During the pandemic, concern regarding COVID-19 related delays was the most tweeted topic (23%). Cancer surgery research was most cited by oncologists, as well as in tweets about hepatopancreatobiliary and colorectal cancers. The cost of surgery was commonly mentioned in tweets about breast and gynecologic cancers and contained the most negative sentiment score (-0.7). Conclusions: Twitter was highly utilized to discuss surgical cancer care during the COVID- 19 pandemic. During the pandemic, conversations shifted focus from research to survivorship and reflected real-time events such as COVID-19-related surgical delays. We identified the financial burden of cancer care as a commonly held concern among patients discussing cancer surgery on social media. Future public health outreach about cancer surgery may be optimized by coordinating with influencers and by targeting topics of concern like cost of surgery and undermentioned content like urologic cancers. Twitter's role as a platform for research dissemination was disrupted by the COVID-19 pandemic, and further tracking is needed regarding online research discussions after the pandemic.

16.
Gastroenterology ; 162(7):S-675, 2022.
Article in English | EMBASE | ID: covidwho-1967358

ABSTRACT

Introduction: Room turnover time (TOT) is a measurement of endoscopy unit efficiency and delays in procedures lead to wasted health care expenditures. Several factors have been identified to influence turnover time including communication, staffing, case complexity, and specific surgeon. Previous research has indicated stereotypes about perceptions of physicians based on their gender or experience. For instance, women in surgical subspecialties endure gender discrimination from conscious and unconscious bias, that produce obstacles to career development and lead to burnout. It is unclear if these biases affect work flow in an endoscopy unit. Here, we sought to evaluate if endoscopists gender or academic experience affected their endoscopy room turnover time. Methods: We evaluated 2,917 inpatient and outpatient endoscopic procedures performed at our large academic tertiary care center between July 2019 and July 2021. TOT was calculated by taking the difference between a prior patient “out of room time” and the next patient “in room time”. TOT was averaged for each endoscopist and T-tests were used to evaluate for any statistical difference between groups. Academic experience was differentiated by having £5 years or >5 years since completing GI fellowship, or holding a leadership position. Results: The average room TOT was 31:28 minutes amongst 26 different gastroenterology providers. There was no statistically significant difference in TOT by gender (p=0.99), serving in a leadership position (p=0.46), or being >5 years since completing fellowship (p=0.63). TOT was longest for advanced endoscopic procedures (p=0.025). TOT increased and case volume decreased in April and May 2020, following the onset of the COVID-19 pandemic. Conclusion: Neither gender or years of academic experience were associated with differences in endoscopic room TOT. More research is needed in gender or professional bias as related to work flow in medicine. Our other future directions include identification and analysis of other endoscopy efficiency metrics for endoscopy suite quality improvement. References: Day, L.W et al. Quality and Efficiency in Gastrointestinal Endoscopy Units. 2018, Springer International Publishing. p. 587- 601. Stephens EH et al. The Current Status of Women in Surgery: How to Affect the Future. JAMA Surg. 2020 Sep.

17.
Gastroenterology ; 162(7):S-666-S-667, 2022.
Article in English | EMBASE | ID: covidwho-1967356

ABSTRACT

Introduction: In response to the coronavirus disease 2019 (COVID-19) pandemic, hospitals nationwide opted to temporarily replace traditional in-person visits with telehealth visits. Unfortunately, due to socio-economic disparities, some groups may be at a disadvantage as a result of these changes. This observational study aimed to determine the temporal trends in demographic, socio-economic, and educational factors contributing to the disparities in access to health care during and after the lockdown. Methods: Due to the COVID-19 pandemic, a state of emergency was declared in Ohio between March 9th, 2020 and June 18th, 2020. The study cohort consisted of patients receiving outpatient care in the Cleveland Clinic Gastroenterology department during this period. To assess disparities, this group was compared to patients receiving care during the corresponding time periods in 2019 and 2021. The following variables were collected and compared between the three groups: demographics, substance abuse, education status, household income, insurance data, employment status, and type of visit (in person, virtual, or telephone). Chi-square test was used to compare categorical variables and student's t-test for continuous variables. A p value of <0.05 was considered statistically significant. SPSS software was used. Results: There were a total of 66,796 visits scheduled during the three study periods of which 19,764 patients had multiple visits. Only the first visit was considered for study purposes, thus yielding 47,032 visits. The mean age was 56.3 ± 17.6 years of which 36.9% were ³ 65 years. The cohort was predominantly female (61.9%), white (76.4%), and had private insurance (61.7%). The characteristics of patients seen in 2019, 2020, and 2021 are presented in table 1. Patients age ≥65 years, whites, those with Medicare insurance, non-English speakers and retired individuals sought healthcare less frequently during and after the pandemic. Women utilized healthcare more often than men before, during, and after the pandemic. There were also variations depending upon education level and median house hold income (table 1). The number of in-person visits rapidly declined during the pandemic, yet have not returned to pre-pandemic levels in 2021. The number of no shows/cancelled visits and tobacco, alcohol, and illicit drug use have steadily increased during and after the pandemic. Conclusion: There was reduced utilization of healthcare services during the COVID-19 pandemic among elderly, non-English speaking, retired, and less educated individuals;these negative effects persisted for elderly and non-English speaking individuals even after the lockdown was lifted. The continued increase in no show/cancellation rates and substance abuse is an alarming trend. Therefore, efforts should be targeted on improving healthcare access for these vulnerable groups.

18.
Gastroenterology ; 162(7):S-472-S-473, 2022.
Article in English | EMBASE | ID: covidwho-1967311

ABSTRACT

Introduction: With the emergence of the COVID-19 pandemic, there was a dramatic increase in telehealth services in lieu of traditional in-person clinic visits throughout hospitals in the United States. Several factors such as patient demographics, socioeconomic factors, and access to internet/smart phones can impact the utilization of telehealth services. Therefore, we aimed to determine the influence of COVID-19 and social determinants of health on utilization of telehealth services. Methods: In response to the COVID-19 pandemic, a state of emergency was declared in Ohio on March 9th, 2020 and lifted on June 18th, 2020. The study population consisted of patients receiving outpatient care in the Cleveland Clinic Gastroenterology department during this lock-down period and representative samples from corresponding periods in 2019 before COVID-19 and in 2021 after the flattening of the COVID-19 surge. Telehealth visits were defined as those that involved real-time face-to-face video conferencing. All in-person visits and telephone only visits were classified as “other visits.” The following variables were collected and compared between the two groups: demographic data, substance abuse, insurance data and employment status. Education level and median household income were obtained from zipcode. Univariate and multivariable logistic regression analyses were performed to determine factors associated with utilization of telehealth visits. Results: During the COVID-19 lockdown in 2020, 11,999 patient visits were completed with 16,600 and 14,664 visits during respective time periods in 2019 and 2021, leading to a total of 43,263 visits. During the 2019, 2020, and 2021 study periods, the number of in-person visits were 16,577 (99.9%), 3,213 (26.8%) and 11,197 (76.4%) respectively;the number of virtual visits were 2 (0.01%), 2,743 (22.9%), 2,607 (17.8%);and the number of telephone visits were 21 (0.1%), 6,043 (50.4%) and 860 (5.9%). Telehealth visits were less frequently utilized in the following groups: older age, non-white race, Medicaid or other public insurance, higher education level, lower median household income, employed or retired status, and non-English-speaking status (Table 1). On multivariate analysis (Table 2), reduced utilization of telehealth was noted in older patients, those of the black or Hispanic race, higher education levels, those with Medicaid or other public insurance, unemployed individuals, and non-English/Spanish speakers. Conclusion: In spite of a dramatic increase in telehealth services during the COVID-19 pandemic, reduced utilization is observed in certain segments of population who might have additional barriers to health care. Further research is needed to study and determine the measures needed to overcome these barriers and optimize access to telehealth services as they continue to be utilized even after the pandemic.(Table Presented) Table 1: Univariate Analysis (Table Presented) Table 2: Multivariate Analysis

19.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927721

ABSTRACT

Introduction: First synthesized in 1869, Hydroxyurea is known for its efficacy in treating myeloproliferative disorders, cervical cancer, and sickle cell disease. Usually well-tolerated, Hydroxyurea has numerous documented adverse effects, including bone marrow suppression, fevers, gastrointestinal upset, anorexia, and maculopapular rash. In addition, one rare side effect is interstitial pneumonitis, a potentially devastating complication if overlooked. We present one such case of Hydroxyurea-induced interstitial pneumonitis. Case Description: A 65-year-old man with a six-month diagnosis of Chronic Granulocytic Leukemia (CGL) on Hydroxyurea developed acute hypoxemic respiratory failure saturating 80% on room air with HR 102, RR 24, and increasing oxygen requirements (10 Lpm) after being admitted with complaints of worsening dyspnea, fatigue, and productive cough with yellow/green sputum. Physical examination was notable for cachexia, ill appearance, generalized weakness, hoarse voice, tachycardia, tachypnea, diffusely diminished breath sounds, and scattered rales on auscultation of lung fields. Initial imaging was notable for bilateral airspace disease and pulmonary opacities on chest radiography and bilateral pneumonia (concerning for COVID-19 pneumonia), mediastinal adenopathy, and splenomegaly on chest computed tomography. Initial laboratory results were notable for leukocytosis 62.5 th/uL, lactic acidosis 2.5 mmol/L, procalcitonin level 4.95 ng/mL, and negative COVID-19 PCR test. Prompt initiation of Vancomycin/Cefepime therapy ensued upon collection of blood cultures in light of possible sepsis. Flagyl, Valacyclovir, and Posaconazole were added to antimicrobial coverage, along with steroid therapy, due to minimal clinical improvement. Tachycardia with significant oxygen requirements alternating between BiPAP and heated high flow nasal cannula with FiO2 ranging from 70-85% persisted. Daily imaging also showed worsening airspace disease. Negative viral, bacterial, and fungal cultures led to subsequent discontinuation of Hydroxyurea therapy due to suspicion of medicationinduced pneumonitis. Three days after cessation of Hydroxyurea, the patient's oxygen requirements began to decrease and imaging revealed interval resolution of pneumonitic changes in the absence of antimicrobial therapy. The patient was later transitioned to Ruxolitinib for his underlying CGL prior to his discharge home without the need for home oxygen therapy. Discussion: Thought to be caused by hypersensitivity pneumonitis, pulmonary toxicity from Hydroxyurea can easily be misdiagnosed. Unfortunately, while much is known about the pancytopenic, gastrointestinal, and cutaneous side effects of Hydroxyurea, few cases in the literature highlight the potentially fatal interstitial pneumopathy caused by Hydroxyurea, first reported in 1999. Thus, this case serves as an additional contribution to the minutiae of literature detailing Hydroxyurea's adverse pulmonary side effect profile. (Figure Presented).

20.
Journal of Indian College of Cardiology ; 12(2):79-81, 2022.
Article in English | EMBASE | ID: covidwho-1887282

ABSTRACT

Long-Term sequelae following COVID-19 infection are not well established. Hence, COVID-19 sequelae are been studied extensively as cases are being followed up to reduce avoidable prolonged morbidity and mortality in the country. COVID-19 and currently available drugs for treatment are both reasons for a change in immune status of patients leading to reactivation or increase the chance of infection of common diseases like tuberculosis (TB), particularly in India. A case of post-COVID-19 disease (2 months back) presented with breathlessness and chest pain. On history, workup, and evaluation, the case was diagnosed with massive tubercular pericardial effusion suggesting reactivation of latent TB in a post-COVID-19 disease. Due to COVID-19 disease itself and possible immunomodulatory drugs used for treatment, reactivation of latent TB has to be considered in post-COIVD-19 disease with nonspecific presentation and unexplained prolonged clinical course of the disease. This case highlights the need of further follow-up of COVID-19 patients to understand the effects of disease on the immune system and the possibilities of opportunistic infections, especially after this second wave of COVID-19.

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