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1.
94th Annual Water Environment Federation Technical Exhibition and Conference, WEFTEC 2021 ; : 293-305, 2021.
Article in English | Scopus | ID: covidwho-1801533

ABSTRACT

The objective of emergency repairs for TRA is to put critical infrastructure that has failed back in to service immediately to prevent or reduce environmental impacts and to restore wastewater collection and transmission service for our customers. After significant rainfall event in March 2020, the Collection Systems Group for the Trinity River Authority of Texas inspected the external conditions of all of the major interceptor lines in the Central Regional Wastewater System for possible line breaks. On March 26, CSG staff identified a major pipeline failure on the 102-inch pipeline for the West Fork interceptor. The pipeline failed in a section immediately adjacent to the West Fork of the Trinity River while the river was in flood stage from the latest significant rain event. The interceptor was passing over 150 MGD of wastewater meant for the CRWS treatment facility, but a portion of the wastewater flow was escaping from the collapsed pipeline in to the river. Once CSG notified the Construction Services group, of the on-call construction contractor, Flow Line Construction, was contacted and immediately mobilized to stop wastewater leakage and to begin pipeline repairs on the collapsed portion of the pipeline. The solution for the emergency repair was multi-faceted: 1)Construction a massive sandbag wall between the failed pipe and the Trinity River to stop wastewater leaking in to the river and to keep the river from washing out the pipeline work are;2) Build a working surface for excavators to access the pipeline site and to setup of bypass pumps;3) Remove the failed section of pipe from the flow path of the wastewater;4) Install bypass piping and pumping equipment and divert flow from the failed pipeline section;5) Install new segments of pipe to restore the pipeline to serviceable conditions;6) Restore bypass flow back to the interceptor and remove bypass pumps and piping;and 7) Perform all of the work listed above while adhering to rapidly changing conditions due to COVID-19 pandemic without having losing one member of the work force to COVID-19. The Roles and Responsibilities of the project team were: 1) Inspection Supervisor – The owner representative that provides direction to the contractor and coordinates construction plans with in-house engineers;2) Engineer – Provided flow ranges for bypass pumping design, collaborated with the contractor to size and layout the bypass pumps, and oversaw the re-installation of the collapsed pipeline;3) Contractor – The contractor staff includes a professional engineer who collaborated with TRA staff to rapidly develop and implement a plan for demolition and reconstruction. In conclusion, while the work took place in a difficult to access area during a period of greater than normal rain and a pandemic, the pipeline was put back in to service in less than 3 weeks. This was through communication, cooperation, and coordination from the contractor, engineers, and inspection staff. Additionally, the river bank was stabilized and armored to prevent future erosion of the pipeline alignment. Copyright © 2021 Water Environment Federation

2.
Journal of Investigative Medicine ; 70(1):287-287, 2022.
Article in English | Web of Science | ID: covidwho-1613067
3.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-296897

ABSTRACT

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus has infected over 115 million people and caused over 2.5 million deaths worldwide. Yet, the molecular mechanisms underlying the clinical manifestations of COVID-19, as well as what distinguishes them from common seasonal influenza virus and other lung injury states such as Acute Respiratory Distress Syndrome (ARDS), remains poorly understood. To address these challenges, we combined transcriptional profiling of 646 clinical nasopharyngeal swabs and 39 patient autopsy tissues, matched with spatial protein and expression profiling (GeoMx) across 357 tissue sections. These results define both body-wide and tissue-specific (heart, liver, lung, kidney, and lymph nodes) damage wrought by the SARS-CoV-2 infection, evident as a function of varying viral load (high vs. low) during the course of infection and specific, transcriptional dysregulation in splicing isoforms, T cell receptor expression, and cellular expression states. In particular, cardiac and lung tissues revealed the largest degree of splicing isoform switching and cell expression state loss. Overall, these findings reveal a systemic disruption of cellular and transcriptional pathways from COVID-19 across all tissues, which can inform subsequent studies to combat the mortality of COVID-19, as well to better understand the molecular dynamics of lethal SARS-CoV-2 infection and other viruses.

4.
Yearb Med Inform ; 30(1): 105-125, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1392946

ABSTRACT

OBJECTIVE: The year 2020 was predominated by the coronavirus disease 2019 (COVID-19) pandemic. The objective of this article is to review the areas in which clinical information systems (CIS) can be and have been utilized to support and enhance the response of healthcare systems to pandemics, focusing on COVID-19. METHODS: PubMed/MEDLINE, Google Scholar, the tables of contents of major informatics journals, and the bibliographies of articles were searched for studies pertaining to CIS, pandemics, and COVID-19 through October 2020. The most informative and detailed studies were highlighted, while many others were referenced. RESULTS: CIS were heavily relied upon by health systems and governmental agencies worldwide in response to COVID-19. Technology-based screening tools were developed to assist rapid case identification and appropriate triaging. Clinical care was supported by utilizing the electronic health record (EHR) to onboard frontline providers to new protocols, offer clinical decision support, and improve systems for diagnostic testing. Telehealth became the most rapidly adopted medical trend in recent history and an essential strategy for allowing safe and effective access to medical care. Artificial intelligence and machine learning algorithms were developed to enhance screening, diagnostic imaging, and predictive analytics - though evidence of improved outcomes remains limited. Geographic information systems and big data enabled real-time dashboards vital for epidemic monitoring, hospital preparedness strategies, and health policy decision making. Digital contact tracing systems were implemented to assist a labor-intensive task with the aim of curbing transmission. Large scale data sharing, effective health information exchange, and interoperability of EHRs remain challenges for the informatics community with immense clinical and academic potential. CIS must be used in combination with engaged stakeholders and operational change management in order to meaningfully improve patient outcomes. CONCLUSION: Managing a pandemic requires widespread, timely, and effective distribution of reliable information. In the past year, CIS and informaticists made prominent and influential contributions in the global response to the COVID-19 pandemic.


Subject(s)
COVID-19 , Information Systems , Medical Informatics , Telemedicine , Artificial Intelligence , COVID-19/diagnosis , COVID-19 Testing , Contact Tracing , Decision Support Systems, Clinical , Electronic Health Records , Epidemics , Health Information Exchange , Health Information Interoperability , Humans , Information Dissemination
6.
J Med Internet Res ; 23(2): e24785, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1040102

ABSTRACT

The telehealth revolution in response to COVID-19 has increased essential health care access during an unprecedented public health crisis. However, virtual patient care can also limit the patient-provider relationship, quality of examination, efficiency of health care delivery, and overall quality of care. As we witness the most rapidly adopted medical trend in modern history, clinicians are beginning to comprehend the many possibilities of telehealth, but its limitations also need to be understood. As outcomes are studied and federal regulations reconsidered, it is important to be precise in the virtual patient encounter approach. Herein, we offer some simple guidelines that could assist health care providers and clinic schedulers in determining the appropriateness of a telehealth visit by considering visit types, patient characteristics, and chief complaint or disease states.


Subject(s)
COVID-19/prevention & control , Health Services Accessibility , Patient Selection , Telemedicine/methods , Health Personnel , Humans , Practice Guidelines as Topic , Risk Assessment , SARS-CoV-2 , Telemedicine/standards
7.
J Am Coll Health ; : 1-7, 2020 Nov 12.
Article in English | MEDLINE | ID: covidwho-919339

ABSTRACT

OBJECTIVE: To detail the implementation, benefits and challenges of onboarding campus-based health services onto a health system's electronic health record. PARTICIPANTS: UC San Diego Student Health and Well-Being offers medical services to over 39,000 students. UC San Diego Health is an academic medical center. METHODS: 20 workstreams and 9 electronic modules, systems, or interfaces were converted to new electronic systems. RESULTS: 36,023 student-patient medical records were created. EHR-integration increased security while creating visibility to 19,700 shared patient visits and records from 236 health systems across the country over 6 months. Benefits for the COVID-19 response included access to screening tools, decision support, telehealth, patient alerting system, reporting and analytics, COVID-19 dashboard, and increased testing capabilities. CONCLUSION: Integration of an interoperable EHR between neighboring campus-based health services and an affiliated academic medical center can streamline case management, improve quality and safety, and increase access to valuable health resources in times of need. Pertinent examples during the COVID-19 pandemic included uninterrupted and safe provision of clinical services through access to existing telehealth platforms and increased testing capacity.

8.
J Am Med Inform Assoc ; 27(6): 853-859, 2020 06 01.
Article in English | MEDLINE | ID: covidwho-631869

ABSTRACT

OBJECTIVE: To describe the implementation of technological support important for optimizing clinical management of the COVID-19 pandemic. MATERIALS AND METHODS: Our health system has confirmed prior and current cases of COVID-19. An Incident Command Center was established early in the crisis and helped identify electronic health record (EHR)-based tools to support clinical care. RESULTS: We outline the design and implementation of EHR-based rapid screening processes, laboratory testing, clinical decision support, reporting tools, and patient-facing technology related to COVID-19. DISCUSSION: The EHR is a useful tool to enable rapid deployment of standardized processes. UC San Diego Health built multiple COVID-19-specific tools to support outbreak management, including scripted triaging, electronic check-in, standard ordering and documentation, secure messaging, real-time data analytics, and telemedicine capabilities. Challenges included the need to frequently adjust build to meet rapidly evolving requirements, communication, and adoption, and to coordinate the needs of multiple stakeholders while maintaining high-quality, prepandemic medical care. CONCLUSION: The EHR is an essential tool in supporting the clinical needs of a health system managing the COVID-19 pandemic.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Electronic Health Records , Medical Records Systems, Computerized , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Telemedicine , User-Computer Interface , Academic Medical Centers/organization & administration , COVID-19 , California/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Databases, Factual , Decision Support Systems, Clinical , Humans , Medical Informatics , Patient Care Team/organization & administration , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , SARS-CoV-2
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