Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 26
Filter
1.
Phys Sportsmed ; : 1-6, 2022 Oct 21.
Article in English | MEDLINE | ID: covidwho-2069955

ABSTRACT

INTRODUCTION: ACL reconstruction is commonly performed in school-aged patients for whom missed time from school can have an impact on their education. Additionally, the COVID-19 pandemic has led to different ways of accessing school content. We sought to determine how many days of school school-aged patients should expect to miss following ACL reconstruction and how the availability of remote learning during the COVID-19 pandemic affected this. METHODS: We evaluated 53 ACL reconstruction patients in grades 7-12 undergoing surgery during the school year. Demographic, medical, and educational information were collected. Patients were placed into 1 of 2 cohorts: Group A (surgery before the COVID-19 pandemic) or Group B (surgery during the COVID-19 pandemic). We calculated days missed from school after surgery until return to either virtual or in-person school. RESULTS: Overall, patients returned to school after missing an average of 4.4 (SD, 3.0) days of school after ACL reconstruction surgery. Patients in Group A missed an average of 5.5 (SD, 2.9) school days, while patients in Group B missed an average of 2.3 (SD, 1.4) school days (p <.001). Eighty-nine percent of Group B patients first returned to school utilizing a virtual option. Among those returning virtually, these patients missed an average of 1.9 (SD, 0.9) school days. CONCLUSIONS: A virtual distance learning option results in fewer missed days of school post ACL reconstruction. When given this option, school-aged patients can expect to return to school within two days post-op. Otherwise, patients should expect to miss about one week of in-person schooling. In this regard, the COVID-19 pandemic has positively impacted educational opportunities for students post-surgery, and physicians should advocate for continuing virtual options for students receiving medical treatment.

2.
International Journal of Ethics Education ; : 1-29, 2022.
Article in English | EuropePMC | ID: covidwho-2034231

ABSTRACT

Engineering ethics can be divided into three spheres, namely the technical, the professional, and the social. Ideally, engineering students should engage with all three spheres of ethics, but the literature suggests that this might not be the case. How do engineering students engage with the three spheres of engineering ethics during a global pandemic? The COVID-19 pandemic represents a dramatic and ongoing real-world challenge affecting many students personally. This research explores the extent to which engineering students engage with each sphere of engineering ethics by examining how engineering students understand their roles in addressing the pandemic and its implications. We conducted a survey with undergraduate engineering students (n = 410) at a university in the Midwest. Qualitative analysis suggests that there was low engagement with both social ethics and professional ethics among respondents, while there was higher engagement with technical ethics. Quantitative analysis suggests that non-conservative engineering students from less wealthy families in our study show higher engagement with technical ethics as compared to conservative engineering students from less wealthy families. Non-conservative engineering students from wealthy families, however, show similar engagement with technical ethics as compared to conservative engineering students from wealthy families. In addition, engineering students from both wealthy and less wealthy families show higher engagement with technical ethics if they reside in urban areas as compared to engineering students from both wealthy and less wealthy families in non-urban areas. In addition, the difference in terms of engagement with technical ethics between non-urban engineering students from less wealthy families and urban engineering students from less wealthy families is larger than the difference in terms of engagement with technical ethics between non-urban engineering students from wealthy families and urban engineering students from wealthy families. Further investigation will be needed to explain these findings. However, qualitative results confirm that, despite the potential for the pandemic to encourage engagement with all three spheres of ethics, there continues to be low engagement with ethics beyond the technical level. Supplementary Information The online version contains supplementary material available at 10.1007/s40889-022-00156-4.

3.
BMJ Open ; 12(9), 2022.
Article in English | ProQuest Central | ID: covidwho-2020040

ABSTRACT

IntroductionHeart failure (HF) symptoms improve through self-care, for which adherence remains low among patients despite the provision of education for these behaviours by clinical teams. Open Access Digital Community Promoting Self-Care, Peer Support and Health Literacy (ODYSSEE–vCHAT) combines automated digital counselling with social network support to improve mortality and morbidity, engagement with self–care materials, and health-related quality of life.Methods and analysisUse of ODYSSEE-vCHAT via Internet-connected personal computer by 162 HF patients will be compared with a control condition over 22 months. The primary outcome is a composite index score of all-cause mortality, all-cause emergency department visits, and HF-related hospitalisation at trial completion. Secondary outcomes include individual components of the composite index, engagement with self-care materials, and patient-reported measures of physical and psychosocial well-being, disease management, health literacy, and substance use. Patients are recruited from tertiary care hospitals in Toronto, Canada and randomised on a 1:1 ratio to both arms of the trial. Online assessments occur at baseline (t=0), months 4, 8 and 12, and trial completion. Ordinal logistic regression analyses and generalised linear models will evaluate primary and secondary outcomes.Ethics and disseminationThe trial has been approved by the research ethics boards at the University Health Network (20-5960), Sunnybrook Hospital (5117), and Mount Sinai Hospital (21-022-E). Informed consent of eligible patients occurs in person or online. Findings will be shared with key stakeholders and the public. Results will allow for the preparation of a Canada-wide phase III trial to evaluate the efficacy of ODYSSEE-vCHAT in improving clinical outcomes and raising the standard of outpatient care.Trial registration numberNCT04966104

5.
Subst Abus ; 43(1): 1317-1321, 2022 12.
Article in English | MEDLINE | ID: covidwho-1960702

ABSTRACT

Background: Racial, sex, and age disparities in buprenorphine treatment have previously been demonstrated. We evaluated trends in buprenorphine treatment disparities before and after the onset of the COVID pandemic in Massachusetts. Methods: This cross-sectional study used data from an integrated health system comparing 12-months before and after the March 2020 Massachusetts COVID state of emergency declaration, excluding March as a washout period. Among patients with a clinical encounter during the study periods with a diagnosis of opioid use disorder or opioid poisoning, we extracted outpatient buprenorphine prescription rates by age, sex, race and ethnicity, and language. Generating univariable and multivariable Poisson regression models, we calculated the probability of receiving buprenorphine. Results: Among 4,530 patients seen in the period before the COVID emergency declaration, 57.9% received buprenorphine. Among 3,653 patients seen in the second time period, 55.1% received buprenorphine. Younger patients (<24) had a lower likelihood of receiving buprenorphine in both time periods (adjusted prevalence ratio (aPR), 0.56; 95% CI, 0.42-0.75 before vs. aPR, 0.76; 95% CI, 0.60-0.96 after). Male patients had a greater likelihood of receiving buprenorphine compared to female patients in both time periods (aPR: 1.05; 95% CI, 1.00-1.11 vs. aPR: 1.09; 95% CI, 1.02-1.16). Racial disparities emerged in the time period following the COVID pandemic, with non-Hispanic Black patients having a lower likelihood of receiving buprenorphine compared to non-Hispanic white patients in the second time period (aPR, 0.85; 95% CI, 0.72-0.99). Conclusions: Following the onset of the COVID pandemic in Massachusetts, ongoing racial, age, and gender disparities were evident in buprenorphine treatment with younger, Black, and female patients less likely to be treated with buprenorphine across an integrated health system.


Subject(s)
Buprenorphine , COVID-19 , Buprenorphine/therapeutic use , Cross-Sectional Studies , Female , Humans , Male , Massachusetts/epidemiology , Pandemics
6.
Aerosol and Air Quality Research ; 22(8):17, 2022.
Article in English | Web of Science | ID: covidwho-1917970

ABSTRACT

The COVID-19 pandemic has drastically changed human life and the world's environment. Most of the major cities of the USA went under full or partial lockdown in the first half of 2020. However, it started gradually reopening, and in 2021, most of the public activity restrictions were lifted. Many studies reported a significant improvement in air quality during the COVID-19 pandemic in the USA, corresponding with the reduced human activity. We hypothesized that this improved air quality was followed by the decline to air quality again due to the normalization of human activity in 2021. This study is a novel approach of studying air quality using spatio-temporal analysis at the finer spatial level within a city in the USA. It assessed the change in six air quality parameters from the pre-COVID era to the post-COVID era in Chicago city in Illinois, USA. The study found that reduced human activities during COVID-19, improved air quality by reducing the concentration of some air pollutants, especially PM2.5, NO2, and CO. However, this improvement was transitory, and it reverted in the post-COVID era. Therefore, policies should be formulated and practiced to improve air quality in the long term.

8.
Clin Infect Dis ; 75(7): 1232-1234, 2022 Sep 30.
Article in English | MEDLINE | ID: covidwho-1806304

ABSTRACT

In an exploratory trial treating "long COVID" with the CCR5-binding antibody leronlimab, we observed significantly increased blood cell surface CCR5 in treated symptomatic responders but not in nonresponders or placebo-treated participants. These findings suggest an unexpected mechanism of abnormal immune downmodulation in some persons that is normalized by leronlimab. Clinical Trials Registration. NCT04678830.


Subject(s)
COVID-19 , Chemokines, CC , Humans , Immunosuppression Therapy , Receptors, CCR5
9.
Front Immunol ; 12: 794638, 2021.
Article in English | MEDLINE | ID: covidwho-1731769

ABSTRACT

CCR5 plays a central role in infectious disease, host defense, and cancer progression, thereby making it an ideal target for therapeutic development. Notably, CCR5 is the major HIV entry co-receptor, where its surface density correlates with HIV plasma viremia. The level of CCR5 receptor occupancy (RO) achieved by a CCR5-targeting therapeutic is therefore a critical predictor of its efficacy. However, current methods to measure CCR5 RO lack sensitivity, resulting in high background and overcalculation. Here, we report on two independent, flow cytometric methods of calculating CCR5 RO using the anti-CCR5 antibody, Leronlimab. We show that both methods led to comparable CCR5 RO values, with low background on untreated CCR5+CD4+ T cells and sensitive measurements of occupancy on both blood and tissue-resident CD4+ T cells that correlated longitudinally with plasma concentrations in Leronlimab-treated macaques. Using these assays, we found that Leronlimab stabilized cell surface CCR5, leading to an increase in the levels of circulating and tissue-resident CCR5+CD4+ T cells in vivo in Leronlimab-treated macaques. Weekly Leronlimab treatment in a chronically SIV-infected macaque led to increased CCR5+CD4+ T cells levels and fully suppressed plasma viremia, both concomitant with full CCR5 RO on peripheral blood CD4+ T cells, demonstrating that CCR5+CD4+ T cells were protected from viral replication by Leronlimab binding. Finally, we extended these results to Leronlimab-treated humans and found that weekly 700 mg Leronlimab led to complete CCR5 RO on peripheral blood CD4+ T cells and a statistically significant increase in CCR5+CD4+ T cells in peripheral blood. Collectively, these results establish two RO calculation methods for longitudinal monitoring of anti-CCR5 therapeutic antibody blockade efficacy in both macaques and humans, demonstrate that CCR5+CD4+ T cell levels temporarily increase with Leronlimab treatment, and facilitate future detailed investigations into the immunological impacts of CCR5 inhibition in multiple pathophysiological processes.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , CD4-Positive T-Lymphocytes/immunology , COVID-19/drug therapy , Flow Cytometry/methods , HIV Antibodies/therapeutic use , HIV Infections/drug therapy , HIV-1/physiology , Receptors, CCR5/metabolism , SARS-CoV-2/physiology , Simian Acquired Immunodeficiency Syndrome/drug therapy , Simian Immunodeficiency Virus/physiology , Animals , CD4 Lymphocyte Count , Female , Humans , Primates , Protein Binding , Receptors, CCR5/immunology , Treatment Outcome
10.
JMIR Hum Factors ; 9(1): e29973, 2022 Feb 08.
Article in English | MEDLINE | ID: covidwho-1714891

ABSTRACT

BACKGROUND: Diabetes and its complications account for 10% of annual health care spending in the United Kingdom. Digital health care interventions (DHIs) can provide scalable care, fostering diabetes self-management and reducing the risk of complications. Tailorability (providing personalized interventions) and usability are key to DHI engagement/effectiveness. User-centered design of DHIs (aligning features to end users' needs) can generate more usable interventions, avoiding unintended consequences and improving user engagement. OBJECTIVE: MyDiabetesIQ (MDIQ) is an artificial intelligence engine intended to predict users' diabetes complications risk. It will underpin a user interface in which users will alter lifestyle parameters to see the impact on their future risks. MDIQ will link to an existing DHI, My Diabetes My Way (MDMW). We describe the user-centered design of the user interface of MDIQ as informed by human factors engineering. METHODS: Current users of MDMW were invited to take part in focus groups to gather their insights about users being shown their likelihood of developing diabetes-related complications and any risks they perceived from using MDIQ. Findings from focus groups informed the development of a prototype MDIQ interface, which was then user-tested through the "think aloud" method, in which users speak aloud about their thoughts/impressions while performing prescribed tasks. Focus group and think aloud transcripts were analyzed thematically, using a combination of inductive and deductive analysis. For think aloud data, a sociotechnical model was used as a framework for thematic analysis. RESULTS: Focus group participants (n=8) felt that some users could become anxious when shown their future complications risks. They highlighted the importance of easy navigation, jargon avoidance, and the use of positive/encouraging language. User testing of the prototype site through think aloud sessions (n=7) highlighted several usability issues. Issues included confusing visual cues and confusion over whether user-updated information fed back to health care teams. Some issues could be compounded for users with limited digital skills. Results from the focus groups and think aloud workshops were used in the development of a live MDIQ platform. CONCLUSIONS: Acting on the input of end users at each iterative stage of a digital tool's development can help to prioritize users throughout the design process, ensuring the alignment of DHI features with user needs. The use of the sociotechnical framework encouraged the consideration of interactions between different sociotechnical dimensions in finding solutions to issues, for example, avoiding the exclusion of users with limited digital skills. Based on user feedback, the tool could scaffold good goal setting, allowing users to balance their palatable future complications risk against acceptable lifestyle changes. Optimal control of diabetes relies heavily on self-management. Tools such as MDMW/ MDIQ can offer personalized support for self-management alongside access to users' electronic health records, potentially helping to delay or reduce long-term complications, thereby providing significant reductions in health care costs.

11.
J Clin Med ; 11(3)2022 Feb 07.
Article in English | MEDLINE | ID: covidwho-1674681

ABSTRACT

Viscoelastic hemostatic assay (VHAs) are whole blood point-of-care tests that have become an essential method for assaying hemostatic competence in liver transplantation, cardiac surgery, and most recently, trauma surgery involving hemorrhagic shock. It has taken more than three-quarters of a century of research and clinical application for this technology to become mainstream in these three clinical areas. Within the last decade, the cup and pin legacy devices, such as thromboelastography (TEG® 5000) and rotational thromboelastometry (ROTEM® delta), have been supplanted not only by cartridge systems (TEG® 6S and ROTEM® sigma), but also by more portable point-of-care bedside testing iterations of these legacy devices (e.g., Sonoclot®, Quantra®, and ClotPro®). Here, the legacy and new generation VHAs are compared on the basis of their unique hemostatic parameters that define contributions of coagulation factors, fibrinogen/fibrin, platelets, and clot lysis as related to the lifespan of a clot. In conclusion, we offer a brief discussion on the meteoric adoption of VHAs across the medical and surgical specialties to address COVID-19-associated coagulopathy.

12.
J Osteopath Med ; 122(3): 119-123, 2022 01 21.
Article in English | MEDLINE | ID: covidwho-1650778

ABSTRACT

COVID-19 infection may involve the nervous system and has been associated with a number of neuropsychiatric complications, including impairment of cognition and dementia. Such complications are more likely to occur in (but are not limited to) patients with severe COVID-19 infections and those with concomitant risk factors. In this case report, the authors describe a normally functioning 51-year-old woman who developed cognitive impairment of a degree that rendered her unable to care for herself most likely related to a relatively nonsevere infection with COVID-19 about 2 months earlier. A detailed report of her deficits of different areas of cognitive functioning is provided. This report aims to make clinicians more aware of the potential for cognitive impairment in patients who have suffered from COVID-19, including those with infections that were not severe.


Subject(s)
COVID-19 , Cognitive Dysfunction , Female , Humans , Middle Aged , SARS-CoV-2
13.
Healthc (Amst) ; 9(4): 100592, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1525796

ABSTRACT

There has been an increased focus on the opioid epidemic in the United States, yet policy-based interventions such as prescription limits, restrictions on doctor shopping, and notification programs for high-volume prescribers have had no significant impact. In this paper, the authors explore a novel public health policy: a joint public-private partnership between the federal government and hospitals to establish long-term treatment centers for patients admitted to the emergency department after an overdose. These centers would provide medication for opioid use disorder, give individuals the necessary support for recovery, and reduce healthcare expenditures. Similar longitudinal strategies may be used in other areas of public health.


Subject(s)
Analgesics, Opioid , Opioid-Related Disorders , Analgesics, Opioid/therapeutic use , Humans , Opioid Epidemic , Opioid-Related Disorders/epidemiology , Public Health , Public-Private Sector Partnerships , United States
15.
BMJ Open ; 11(10): e055435, 2021 10 22.
Article in English | MEDLINE | ID: covidwho-1480255

ABSTRACT

OBJECTIVES: The steroid hormone vitamin D has roles in immunomodulation and bone health. Insufficiency is associated with susceptibility to respiratory infections. We report 25-hydroxy vitamin D (25(OH)D) measurements in hospitalised people with COVID-19 and influenza A and in survivors of critical illness to test the hypotheses that vitamin D insufficiency scales with illness severity and persists in survivors. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Plasma was obtained from 295 hospitalised people with COVID-19 (International Severe Acute Respiratory and emerging Infections Consortium (ISARIC)/WHO Clinical Characterization Protocol for Severe Emerging Infections UK study), 93 with influenza A (Mechanisms of Severe Acute Influenza Consortium (MOSAIC) study, during the 2009-2010 H1N1 pandemic) and 139 survivors of non-selected critical illness (prior to the COVID-19 pandemic). Total 25(OH)D was measured by liquid chromatography-tandem mass spectrometry. Free 25(OH)D was measured by ELISA in COVID-19 samples. OUTCOME MEASURES: Receipt of invasive mechanical ventilation (IMV) and in-hospital mortality. RESULTS: Vitamin D insufficiency (total 25(OH)D 25-50 nmol/L) and deficiency (<25 nmol/L) were prevalent in COVID-19 (29.3% and 44.4%, respectively), influenza A (47.3% and 37.6%) and critical illness survivors (30.2% and 56.8%). In COVID-19 and influenza A, total 25(OH)D measured early in illness was lower in patients who received IMV (19.6 vs 31.9 nmol/L (p<0.0001) and 22.9 vs 31.1 nmol/L (p=0.0009), respectively). In COVID-19, biologically active free 25(OH)D correlated with total 25(OH)D and was lower in patients who received IMV, but was not associated with selected circulating inflammatory mediators. CONCLUSIONS: Vitamin D deficiency/insufficiency was present in majority of hospitalised patients with COVID-19 or influenza A and correlated with severity and persisted in critical illness survivors at concentrations expected to disrupt bone metabolism. These findings support early supplementation trials to determine if insufficiency is causal in progression to severe disease, and investigation of longer-term bone health outcomes.


Subject(s)
COVID-19 , Influenza A Virus, H1N1 Subtype , Influenza, Human , Vitamin D Deficiency , Critical Illness , Cross-Sectional Studies , Humans , Influenza, Human/complications , Influenza, Human/epidemiology , Pandemics , SARS-CoV-2 , Survivors , Vitamin D , Vitamin D Deficiency/complications , Vitamin D Deficiency/epidemiology
17.
Sexually Transmitted Infections ; 97(SUPPL 1):A165-A166, 2021.
Article in English | EMBASE | ID: covidwho-1379667

ABSTRACT

Background Health behaviors in young people tend to cluster. The objective of this study was to determine if condomless sex among young Black men who have sex with women was associated with non-adherence to COVID-19 prevention behaviors. Methods Men previously enrolled in a community-based chlamydia screening program for Black men who have sex with women, aged 15-24, were enrolled in a sub-study between May-June, 2020 and asked about adherence to the City of New Orleans requirements for proper hand-washing, maskwearing, social-distancing, staying-at-home and condomless vaginal sex while COVID-19 restrictions were in place. Results Of 105 men included in analysis, the mean age was 20.5 (s.d.2.0) and 17.3% previously tested positive for chlamydia in the parent study. During COVID-19 stay-at-home orders, 37.1% engaged in at least one act of condomless sex and responded sometime/never to the following: hand-washing for 20 seconds (8.1%), physical-distancing (21.6%), maskwearing (18.8%) and staying-at-home except for essential needs (24.3%). Some men were not able to get PPE (36.9%) or thought a homemade mask would subject them to discrimination (14.4%). Men who engaged in condomless sex were more likely than those who either did use condoms/did not have vaginal sex to not wash their hands properly (19.4% vs. 3.0%, p<0.03) and not wear a mask (30.8% vs. 10.6%, p<0.02);there was a trend for them to not physically distance (28.2% vs. 16.7%, p< 0.17) and there was no association for not following stay-at-home orders (28.2% vs. 22.7%, p<0.54). Age, access to masks, and perception that maskwearing could subject them to discrimination were not associated with mask-wearing (p>0.40). Conclusion Overall, adherence to disease prevention behaviors was high. Non-adherent behaviors such as condomless sex, lack of mask-wearing and lack of hand-washing were associated. Men with one non-adherent behavior may benefit from counseling in other potentially non-adherent behaviors..

19.
Int J Environ Res Public Health ; 18(12)2021 06 20.
Article in English | MEDLINE | ID: covidwho-1282486

ABSTRACT

Sleep health, operationalized as a multidimensional construct consisting of sleep regularity, satisfaction, alertness, timing, efficiency, and duration, is an emerging concept in the field of sleep medicine which warrants further investigation. The purpose of the present study was to: (1) compare sleep health across the lifespan, (2) determine lifestyle factors associated with sleep health, and (3) examine whether lifestyle factors associated with sleep health varied between and within age groups. Participants consisted of 3284 individuals (Mean age = 42.70; 45% male) who participated in a cross-sectional online survey of sleep and health. Sleep health was measured using the RU-SATED scale, while demographic and lifestyle factors (e.g., daily social media use, sedentary activity, fast food consumption, etc.) were all self-reported. Sleep health was the highest among older adults (M = 8.09) followed by middle-aged (M = 7.65) and younger adults (M = 7.16). Across age groups, fast-food consumption, daily regularity, and daily TV, social media, or internet use were all negatively correlated with sleep health (ps < 0.05). Few differences in the association between lifestyle factors and sleep health across age groups were found. Overall, these findings may help to inform sleep health promotion efforts by targeting the most pertinent lifestyle factors for promoting sleep health.


Subject(s)
Life Style , Longevity , Adult , Aged , Cross-Sectional Studies , Fast Foods , Female , Humans , Male , Middle Aged , Sleep
20.
ACS Nano ; 2021 Jun 23.
Article in English | MEDLINE | ID: covidwho-1279811

ABSTRACT

Studies of two SARS-CoV-2 mRNA vaccines suggested that they yield ∼95% protection from symptomatic infection at least short-term, but important clinical questions remain. It is unclear how vaccine-induced antibody levels quantitatively compare to the wide spectrum induced by natural SARS-CoV-2 infection. Vaccine response kinetics and magnitudes in persons with prior COVID-19 compared to virus-naïve persons are not well-defined. The relative stability of vaccine-induced versus infection-induced antibody levels is unclear. We addressed these issues with longitudinal assessments of vaccinees with and without prior SARS-CoV-2 infection using quantitative enzyme-linked immunosorbent assay (ELISA) of anti-RBD antibodies. SARS-CoV-2-naïve individuals achieved levels similar to mild natural infection after the first vaccination; a second dose generated levels approaching severe natural infection. In persons with prior COVID-19, one dose boosted levels to the high end of severe natural infection even in those who never had robust responses from infection, increasing no further after the second dose. Antiviral neutralizing assessments using a spike-pseudovirus assay revealed that virus-naïve vaccinees did not develop physiologic neutralizing potency until the second dose, while previously infected persons exhibited maximal neutralization after one dose. Finally, antibodies from vaccination waned similarly to natural infection, resulting in an average of ∼90% loss within 90 days. In summary, our findings suggest that two doses are important for quantity and quality of humoral immunity in SARS-CoV-2-naïve persons, while a single dose has maximal effects in those with past infection. Antibodies from vaccination wane with kinetics very similar to that seen after mild natural infection; booster vaccinations will likely be required.

SELECTION OF CITATIONS
SEARCH DETAIL