VASA: an exploratory visualization tool for mapping spatio-temporal structure of mobility–a COVID-19 case study

Exploratory data analysis tools designed to measure global and local spatial autocorrelation (e.g. Moran's (Formula presented.) statistic) have become standard in modern GIS software. However, there has been little development in amending these tools for visualization and analysis of patterns captured in spatio-temporal data. We design and implement an exploratory mapping tool, VASA (Visual Analysis for Spatial Association), that streamlines analytical pipelines in assessing spatio-temporal structure of data and enables enhanced visual display of the patterns captured in data. Specifically, VASA applies a set of cartographic visual variables to map local measures of spatial autocorrelation and helps delineate micro and macro trends in space-time processes. Two visual displays are presented: recency and consistency map and line-scatter plots. The former combines spatial and temporal data view of local clusters, while the latter drills down on the temporal trends of the phenomena. As a case study, we demonstrate the usability of VASA for the investigation of mobility patterns in response to the COVID-19 pandemic throughout 2020 in the United States. Using daily county-level and grid-level mobility metrics obtained from three different sources (SafeGraph, Cuebiq, and Mapbox), we demonstrate cartographic functionality of VASA for a swift exploratory analysis and comparison of mobility trends at different regional scales. © 2023 Cartography and Geographic Information Society.

Vax the Max, a Gamification Intervention for COVID-19 Vaccination Task Engagement in the Inpatient Setting.

The development of vaccines for SARS-CoV-2 has offered game-changing protection from severe disease and death from COVID-19. Despite efforts to vaccinate individuals in the ambulatory setting, a sizable minority of the US population remains unvaccinated for COVID-19. For unvaccinated patients, hospitalization for non-COVID-19 illness offers another opportunity for vaccination. In the summer of 2021, the authors noted that COVID-19 vaccination rate for medicine inpatients at their hospital had fallen to 5.3 vaccine doses administered per 4-week block. In response, they created Vax the Max, a gamification program of COVID-19 vaccination tasks where internal medicine resident teams were awarded points for completing these tasks. Residents were anonymously surveyed after participation. The hospital demonstrated higher rates of administering the initial COVID-19 vaccine dose and completing the vaccine series in the inpatient setting per 4-week plan-do-study-act cycle after implementation of Vax the Max (5.3 versus 8.8 doses per plan-do-study-act cycle). Among residents, 76.8% reported that Vax the Max spurred their COVID-19 task engagement, and 66% reported that a similar gamification model could be utilized for a different clinical task in the future. An increase was observed in the COVID-19 vaccination rate for medicine inpatients after launching the Vax the Max competition. This occurred in the setting of resident turnover every 4 weeks, which normally makes practice sustainment more challenging. Despite this, a high degree of engagement was produced by itinerant residents. There is potential to explore similar gamification approaches involving resident physicians in areas of quality improvement and patient safety.

Increase in kawasaki disease incidence observed in 30-year population-based study in scandinavia

Background and Aim: World-wide, Kawasaki disease (KD) is known to affect predominantly children under the age of 5, mostly boys. An increasing incidence has been reported from select countries, as well as seasonal differences, although with great variation among reports. Sweden has unique population-based health registers which can be linked to population registers via a personal number. In this study we therefore utilized population-based data over a period of more than 30 years to investigate demographics and epi-demiology of Kawasaki disease in a Scandinavian country. Method(s): Individuals receiving a diagnosis of Kawasaki disease in Sweden from 1987-2018 (before the occurrence of MIS-C) were identified by ICD9 and ICD10 discharge diagnoses in the Patient register at the National Board of Health and Welfare, and basic demographic information obtained by cross-linking with popula-tion registers at Statistics Sweden. Age-stratified population statis-tics were also retrieved during the corresponding time-period. Result(s): A total of 1,785 individuals with a KD diagnosis during the study period were identified, confirming a relatively low incidence in the Scandinavian population. Less than 5% of the cases were born in another country. The majority of cases (78%) occurred before 5 years of age, and there was a male dominance (61%). Sweden has a temperate climate of the northern hemisphere, and analysis of case distribution over the yearly cycle revealed peak incidence during the winter months. Notably, the incidence rose from around 6/100,000 lt;5-year-olds to 15/100,000 lt;5-year-olds during the 30-year study period. Two years with prominently higher incidence than prior and following years were observed. A large part of the rise in incidence seems to be associated with immigration and occurred before the occurrence of Multisystem Inflammatory Syndrome in Children related to SARS-CoV-2. Conclusion(s): Demographic parameters for Kawasaki disease in Sweden regarding age and sex distribution are similar to previous reports from other countries. Our data from a 30-year study period of population-based observations confirm peak incidence during the cold period, and a rising incidence during recent years, even before the occurrence of MIS-C. Our data also indicate outbursts during two years and immigration-associated patterns in rise in incidence.

Cardiac manifestations in the national cohort of Multisystem Inflammatory Syndrome in Children (MIS-C) in Sweden

Introduction: The Covid-19 pandemic has been associated with an upsurge of cases of hyperinflammation in children. Named Multisystem Inflammatory Syndrome in Children (MIS-C) in the USA and parts of Europe and Pediatric Inflammatory Multisystem Syndrome temporally associated with Covid-19 (PIMS-TS) in the UK, the first cases were reported from Europe and the USA in late spring, a few weeks after the culmination of the first wave. Symptoms range from fever and high inflammatory markers via a Kawasaki-like syndrome to multiple organ failure with need of intensive care and ECMO. The Swedish national cohort of children with MIS-C is special in that it is based on a national register with early, very high coverage and validity in a country with a different approach to the pandemic. We describe here the cardiac manifestations of MIS-C in children in Sweden. Methods: Cases were identified in the local hospitals and, after informed consent, reported to national registers. A uniform diagnostic, management and follow-up pathway was adopted early-on. Through retrospective study of electronic health records including ECG and echocardiography, study of intensive care and ECMO data, the cardiac manifestations could be identified. Results: The study awaits consent fron the Swedish Ethical Review Authority. Results can therefore only be presented if authorization is given in time for the annual AEPC meeting 2021. Conclusions: The development of the national consensus diagnostic, management and follow-up guidelines for MIS-C has resulted in the successful uniform case management in Sweden. The cases described in this study illustrate the broad clinical spectrum of MIS-C in a country with a different approach to the pandemic.

Assessing COVID-induced changes in spatiotemporal structure of mobility in the United States in 2020: a multi-source analytical framework

The COVID-19 pandemic resulted in profound changes in mobility patterns and altered travel behaviors locally and globally. As a result, movement metrics have widely been used by researchers and policy makers as indicators to study, model, and mitigate the impacts of the COVID-19 pandemic. However, the veracity and variability of these mobility metrics have not been studied. This paper provides a systematic review of mobility and social distancing metrics available to researchers during the pandemic in 2020 in the United States. Twenty-six indices across nine different sources are analyzed and assessed with respect to their spatial and temporal coverage as well as sample representativeness at the county-level. Finally global and local indicators of spatial association are computed to explore spatial and temporal heterogeneity in mobility patterns. The structure of underlying changes in mobility and social distancing is examined in different US counties and across different data sets. We argue that a single measure might not describe all aspects of mobility perfectly.

Safety Monitoring and Signal Detection for the Novel COVID-19 Vaccines on a Global Scale: An International Journal of Medical Toxicology and Drug Experience

Background/Introduction: Up to 14 June 2021, VigiBase, the World Health Organization (WHO) global database of individual case safety reports (ICSRs) [1], contained over 26 million reports from more than 140 member countries of the WHO Program for International Drug Monitoring (PIDM). VigiBase is managed by Uppsala Monitoring Center (UMC) on behalf of the WHO. Since the end of November 2020, 1.1 million ICSRs for COVID-19 vaccines were entered in VigiBase accounting for 41% of all vaccine reports in the database. The large number of reports received in a short time requires semi-automated data handling and signal prioritization exceeding normal signal detection operations. Objective/Aim: To monitor the safety of the COVID-19 vaccines from a global perspective. Methods: Screenings of VigiBase are performed regularly. Statistically ranked drug-event combination lists that focus on a theme, e.g. low- and middle-income countries, emerging safety signals, or testing new methods are prepared. Multi-disciplinary teams then assess the combinations together. This is typically done during focused multiday workshops. To complement this, general regular screenings are performed and hints from other sources (e.g., scientific literature, media reports, etc.) are followed. Several statistical methods are used in the screening efforts. Disproportionality analysis compares the observed number of reports for a drug-event combination to the expected number based on the overall reporting in the database. vigiRank, [2] an algorithm combining five strength-of-evidence parameters into a score, provides a ranking of drug-event combinations. vigiGroup clustering [3] automatically groups reports with similar adverse event profiles in a data driven way. Its purpose is to uncover clinically coherent pictures that might otherwise evade detection. vigiPoint [4] is a tool to quickly explore differences in one set of reports compared to one or more reference sets. This enables exploration of various covariates. Features that are significantly and robustly different are highlighted for review. Identified preliminary safety signals are subject to weekly prioritization. Points to consider for prioritizing a combination for in-depth assessment include e.g. multinational reporting, the reaction's seriousness, etc. Confirmed safety signals are shared with the WHO PIMD member states. Results: Up to 14 June 2021, ten preliminary safety signals have been identified for in-depth assessment via different signal detection activities. Another 38 preliminary safety signals are being monitored. Conclusion: VigiBase is the world's largest database of ICSRs. Therefore, UMC is in a good position to monitor the COVID-19 vaccines' safety maintaining the global perspective with the potential to find emerging safety signals earlier.

A COVID-19 Airway Management Innovation with Pragmatic Efficacy Evaluation: The Patient Particle Containment Chamber.

The unique resource constraints, urgency, and virulence of the coronavirus disease 2019 pandemic has sparked immense innovation in the development of barrier devices to protect healthcare providers from infectious airborne particles generated by patients during airway management interventions. Of the existing devices, all have shortcomings which render them ineffective and impractical in out-of-hospital environments. Therefore, we propose a new design for such a device, along with a pragmatic evaluation of its efficacy. Must-have criteria for the device included: reduction of aerosol transmission by at least 90% as measured by pragmatic testing; construction from readily available, inexpensive materials; easy to clean; and compatibility with common EMS stretchers. The Patient Particle Containment Chamber (PPCC) consists of a standard shower liner draped over a modified octagonal PVC pipe frame and secured with binder clips. 3D printed sleeve portals were used to secure plastic sleeves to the shower liner wall. A weighted tube sealed the exterior base of the chamber with the contours of the patient's body and stretcher. Upon testing, the PPCC contained 99% of spray-paint particles sprayed over a 90s period. Overall, the PPCC provides a compact, affordable option that can be used in both the in-hospital and out-of-hospital environments.