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1.
BMC Med Educ ; 22(1): 696, 2022 Sep 29.
Article in English | MEDLINE | ID: covidwho-2053898

ABSTRACT

BACKGROUND: Physicians' behavior may unknowingly be impacted by prejudice and thereby contribute to healthcare inequities. Despite increasingly robust data demonstrating physician implicit bias (The Office of Minority Health. Minority Population Profiles, 2021; COVID-19 Shines Light on Health Disparities, National Conference of State Legislatures 2021), the evidence behind how to change this with training programs remains unclear. This scoping review therefore reports on the implementation, outcomes, and characteristics of post-graduate physician implicit bias curricula. METHODS: The authors conducted a literature review using scoping review methodology. They searched 7 databases in February and November 2020 for English-language academic and gray literature on implicit bias curricula for physicians at all levels of post-graduate training. Ten reviewers screened studies for eligibility independently, then extracted data from these studies and compiled it into a chart and analytical summary. RESULTS: Of the 4,599 articles screened, this review identified 90 articles on implicit bias interventions for post-graduate physicians. Inductive data analysis revealed a spectrum of educational approaches, which were categorized int o 4 educational models called Competence, Skills-Based, Social Contact, and Critical Models. The most commonly reported strength was the interactive nature of the curricula (26%), and the most frequently identified challenges were related to time and resources available (53%). Half of the interventions discussed facilitator preparation, and the majority (62%) evaluated outcomes using pre and post self-assessments. CONCLUSIONS: This review provides a comprehensive synthesis of the literature on physician implicit bias curricula. It is our goal that this supports medical educators in applying and improving aspects of these interventions in their own programs.


Subject(s)
COVID-19 , Physicians , Bias, Implicit , COVID-19/epidemiology , Curriculum , Humans , Models, Educational
2.
LANCET ; 399(10342):2212-2225, 2022.
Article in English | Web of Science | ID: covidwho-1935221

ABSTRACT

Background Vaccination of children and young people against SARS-CoV-2 is recommended in some countries. Scarce data have been published on immune responses induced by COVID-19 vaccines in people younger than 18 years compared with the same data that are available in adults. Methods COV006 is a phase 2, single-blind, randomised, controlled trial of ChAdOx1 nCoV-19 (AZD1222) in children and adolescents at four trial sites in the UK. Healthy participants aged 6-17 years, who did not have a history of chronic respiratory conditions, laboratory-confirmed COVID-19, or previously received capsular group B meningococcal vaccine (the control), were randomly assigned to four groups (4:1:4:1) to receive two intramuscular doses of 5 x 10(1)degrees viral particles of ChAdOx1 nCoV-19 or control, 28 days or 84 days apart. Participants, clinical investigators, and the laboratory team were masked to treatment allocation. Study groups were stratified by age, and participants aged 12-17 years were enrolled before those aged 6-11 years. Due to the restrictions in the use of ChAdOx1 nCoV-19 in people younger than 30 years that were introduced during the study, only participants aged 12-17 years who were randomly assigned to the 28-day interval group had received their vaccinations at the intended interval (day 28). The remaining participants received their second dose at day 112. The primary outcome was assessment of safety and tolerability in the safety population, which included all participants who received at least one dose of the study drug. The secondary outcome was immunogenicity, which was assessed in participants who were seronegative to the nucleocapsid protein at baseline and received both prime and boost vaccine. This study is registered with ISRCTN (15638344). Findings Between Feb 15 and April 2, 2021, 262 participants (150 [57%] participants aged 12-17 years and 112 [43%] aged 6-11 years;due to the change in the UK vaccination policy, the study terminated recruitment of the younger age group before the planned number of participants had been enrolled) were randomly assigned to receive vaccination with two doses of either ChAdOx1 nCoV-19 (n=211 [n=105 at day 28 and n=106 at day 84]) or control (n=51 [n=26 at day 28 and n=25 at day 84]). One participant in the ChAdOx1 nCoV-19 day 28 group in the younger age bracket withdrew their consent before receiving a first dose. Of the participants who received ChAdOx1 nCoV-19, 169 (80%) of 210 participants reported at least one solicited local or systemic adverse event up to 7 days following the first dose, and 146 (76%) of 193 participants following the second dose. No serious adverse events related to ChAdOx1 nCoV-19 administration were recorded by the data cutoff date on Oct 28, 2021. Of the participants who received at least one dose of ChAdOx1 nCoV-19, there were 128 unsolicited adverse events up to 28 days after vaccination reported by 83 (40%) of 210 participants. One participant aged 6-11 years receiving ChAdOx1 nCoV-19 reported a grade 4 fever of 40.2 degrees C on day 1 following first vaccination, which resolved within 24 h. Pain and tenderness were the most common local solicited adverse events for all the ChAdOx1 nCoV-19 and capsular group B meningococcal groups following both doses. Of the 242 participants with available serostatus data, 14 (6%) were seropositive at baseline. Serostatus data were not available for 20 (8%) of 262 participants. Among seronegative participants who received ChAdOx1 nCoV-19, anti-SARS-CoV-2 IgG and pseudoneutralising antibody titres at day 28 after the second dose were higher in participants aged 12-17 years with a longer interval between doses (geometric means of 73 371 arbitrary units [AU]/mL [95% CI 58 685-91 733] and 299 half-maximal inhibitory concentration [IC 50;95% CI 230-390]) compared with those aged 12-17 years who received their vaccines 28 days apart (43 280 AU/mL [95% CI 35 852-52 246] and 150 IC 50 [95% CI 116-194]). Humoral responses were higher in those aged 6-11 years than in those aged 12-17 years receiving their second dose at the same 112-day interval (geometric mean ratios 1.48 [95% CI 1.07-2.07] for anti-SARS-CoV-2 IgG and 2.96 [1.89-4.62] for pseudoneutralising antibody titres). Cellular responses peaked after a first dose of ChAdOx1 nCoV-19 across all age and interval groups and remained above baseline after a second vaccination. Interpretation ChAdOx1 nCoV-19 is well tolerated and immunogenic in children aged 6-17 years, inducing concentrations of antibody that are similar to those associated with high efficacy in phase 3 studies in adults. No safety concerns were raised in this trial. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

3.
American Journal of Kidney Diseases ; 77(4):650, 2021.
Article in English | EMBASE | ID: covidwho-1768922

ABSTRACT

The ANCA-associated vasculitis (AAV) shares similar pathophysiological pathways with SARS-CoV-2 infection such as neutrophil extracellular traps, complement cascades, and IL-6. Patients with AAV have a higher risk for SARS-CoV-2 infection. In turn, the viral infection could trigger the relapse of AAV. We are presenting a case of a SARS-CoV-2 infection who developed relapsing AAV and discussion about management. A 25-year-old Hispanic male who was recently diagnosed with X-ANCA vasculitis with diffuse alveolar hemorrhage (DAH), AKI treated with pulse steroids, plasmapheresis (PLEX), two doses of rituximab (375mg/kg) was admitted with fever, hemoptysis, hypoxemia, and positive COVID-19 nasopharyngeal swab. Due to DAH and worsening oxygen requirements by day 3, IV pulse methylprednisolone 1000mg x3, rituximab 1g x2 and PLEX x 5 given, and on day 6 convalescent plasma was given. He developed non-oliguric AKI on CKD due to acute tubular injury superimposed on biopsy proven pauci-immune necrotizing crescentic glomerulonephritis needing hemodialysis from day 8 to 18. On day 9, patient developed ARDS requiring BiPAP and increased inflammatory markers, secondary to cytokine storm and got two dose of tocilizumab (8mg/kg). After this patient improved clinically and was discharged on room air with improving serum creatinine from peak 5.98mg/dL to 3.94mg/dL with oral prednisone of 60mg daily. The treatment for the AAV in the setting of COVID-19 has been controversial. Though the risk of infection increases with Rituximab use, current literature supports cautious use of the B-cell depleting agents for AAV indications during the pandemic with favorable riskbenefit ratio. Tocilizumab may also have dual beneficial effects in treating the AAV flare and managing the cytokine storm of COVID infection. Our case study showed this presumed dual benefit. Large scale studies are required to both prove the safety of Rituximab use in the setting of risk of COVID infection and Tocilizumab use for AAV flare with COVID infection. Clinicians should not shy away from using the Rituximab in AAV treatment due to the ongoing pandemic as the risk of not using may be much worse where it is clinically indicated. Tocilizumab may have dual beneficial effects of treating the Cytokine storm and AAV flare as we saw in our case.

4.
Physica A: Statistical Mechanics and its Applications ; 585, 2022.
Article in English | Scopus | ID: covidwho-1447057

ABSTRACT

Starting on February 20, 2020, the global stock markets began to suffer the worst decline since the Great Recession in 2008, and the COVID-19 has been widely blamed on the stock market crashes. In this study, we applied the log-periodic power law singularity (LPPLS) methodology based on multilevel time series to unravel the underlying mechanisms of the 2020 global stock market crash by analyzing the trajectories of 10 major world stock market indexes from both developed and emergent stock markets, including the S&P 500, the DJIA, and the NASDAQ from the United State, the FTSE from the United Kingdom, the DAX from Germany, the NIKKEI from Japan, the CSI 300 from China, the HSI from Hong Kong, the BSESN from India, and the BOVESPA from Brazil. In order to effectively distinguish between endogenous crash and exogenous crash in stock market, we proposed using the LPPLS confidence indicator as a classification proxy. The results show that the apparent LPPLS bubble patterns of the super-exponential increase, corrected by the accelerating logarithm-periodic oscillations, have indeed presented in the price trajectories of the seven indexes: S&P 500, DJIA, NASDAQ, DAX, CSI 300, BSESN, and BOVESPA, indicating that the large positive bubbles have formed endogenously prior to the 2020 stock market crash, and the subsequent crashes for the seven indexes are endogenous, stemming from the increasingly systemic instability of the stock markets inherently, while the well-known external shocks, such as the COVID-19 pandemic, the corporate debt bubble, and the 2020 Russia–Saudi Arabia oil price war, only served as sparks during the 2020 global stock market crash. In contrast, the crashes in the three remaining indexes: FTSE, NIKKEI, and HSI, are exogenous and hence are perhaps the only crashes truly due to the COVID-19 pandemic. We also found that in terms of the regime changes of the stock markets, no obvious LPPLS negative bubble pattern has been observed in the price trajectories of the 10 stock market indexes, indicating that the regime changes from a bear market to a bull market in late March 2020 are exogenous, stemming from external factors. The unprecedented market and economy rescue efforts from federal reserves and central banks across the world in unison may have played a critical role in quelling the 2020 global stock market crash in the nick of time. This paper creates a paradigm for future studies in real-time crash detection and underlying mechanism dissection. It serves to warn us of the imminent risks in not only the stock market but also other financial markets and economic indexes. © 2021 Elsevier B.V.

5.
27th ACM SIGKDD Conference on Knowledge Discovery and Data Mining, KDD 2021 ; : 1634-1644, 2021.
Article in English | Scopus | ID: covidwho-1430229

ABSTRACT

Severe infectious diseases such as the novel coronavirus (COVID-19) pose a huge threat to public health. Stringent control measures, such as school closures and stay-at-home orders, while having significant effects, also bring huge economic losses. In the face of an emerging infectious disease, a crucial question for policymakers is how to make the trade-off and implement the appropriate interventions timely given the huge uncertainty. In this work, we propose a Multi-Objective Model-based Reinforcement Learning framework to facilitate data-driven decision-making and minimize the overall long-term cost. Specifically, at each decision point, a Bayesian epidemiological model is first learned as the environment model, and then the proposed model-based multi-objective planning algorithm is applied to find a set of Pareto-optimal policies. This framework, combined with the prediction bands for each policy, provides a real-time decision support tool for policymakers. The application is demonstrated with the spread of COVID-19 in China. © 2021 ACM.

6.
International Journal of Clinical and Experimental Medicine ; 14(8):2228-2234, 2021.
Article in English | EMBASE | ID: covidwho-1391368

ABSTRACT

Pneumonia associated with COVID-19 had been a concerning and serious public health threat around the world. In this article, we retrospectively explored the value of unenhanced chest CT in the diagnosis and supervision of infants and children infected with COVID-19 from Beijing, China. A total of 25 infants and children who were confirmed to have COVID-19 by reverse transcription polymerase chain reaction (RT-PCR) were included. All cases underwent unenhanced chest CT upon admission day, some cases underwent chest CT during hospitalization and during follow-up after discharge, and the CT imaging characteristics were analyzed. Basic information, treatment and follow-up results were recorded. There were 6 infants and 19 children and the median age was 6.5 (3.1-9.5) years old. There were 18 patients upon admission who had negative CT images, 10 with initial negative images that had secondary negative CT scans and 3 children with initial negative images who had third negative CT scans. There were 16 children who were cured and discharged, 7 that were positive in the pharyngeal swab test of nucleic acids during the follow-up period, and all them had initial negative CT images. Leukocytopenia, lymphocytosis, evaluated T lymphocyte and CD4 T lymphocyte counts were found in some cases. We found that the vast majority of infants and children with confirmed COVID-19 had negative CT scans at the initial presentation and follow-up period and this result might suggest a low need for chest CT, meanwhile, some children seemed to have a higher re-positive test of nucleic acids.

7.
American Journal of Kidney Diseases ; 77(4):650-650, 2021.
Article in English | Web of Science | ID: covidwho-1176056
8.
Singapore Economic Review ; 2021.
Article in English | Scopus | ID: covidwho-1021112

ABSTRACT

We are the first to explore the effect of economic policy uncertainty (EPU) and the COVID-19 pandemic on the correlation between the cryptocurrency index CRIX and the world stock market portfolio, as well as the hedging properties of CRIX. To this end, we mainly apply the dynamic conditional correlation model with mixed data sampling regressions, a threshold vector autoregressive model and the generalized impulse response function. We demonstrate that the correlation is influenced by the uncertainty stance of the economy and behaves differently in low-, medium-and high-uncertainty periods. Most of the abnormal market relations exist in high levels of EPU or during the COVID-19 period, and the impact of global EPU is greater than that of EPU originating in the United States, Europe, Russia and China. Moreover, the CRIX can serve as a hedge asset against the world stock market. The high (low) level of EPU has a significantly positive (negative) effect on the optimal hedge ratio of CRIX, which increases significantly during the COVID-19 period. Our findings have implications for risk management, portfolio allocations and hedging strategies. © 2020 World Scientific Publishing Company.

9.
IEEE Access ; 2020.
Article in English | Scopus | ID: covidwho-998606

ABSTRACT

Intelligent regulation for human exercise behaviors becomes significantly necessary for exercise medicine after the COVID-19 epidemic. The key issue of exercise regulation and its potential development for intelligent exercise is to describe human exercise physiological behaviors in a more accurate and sufficient manner. Here, a non-parametric modeling method with kernel-based regularization is presented to estimate cardiorespiratory biomarkers (i.e., oxygen uptake (V̇O2 ) and carbon dioxide output (V̇CO2 ) by merely non-invasively monitoring the indicator of exercise intensity (e.g., walking speed). Using the kernel-based non-parametric modeling, we show that V̇O2 and V̇CO2 behaviors in response to continuous and diversified exercise intensity stimulations can be quantitatively described. Furthermore, the dataset from the stairs experiment with a proper protocol is applied in the kernel parameter selection, and this selection approach is compared with the numerical simulation approach. The comparison results illustrate an improvement of 4.18% for oxygen uptake and 7.63% for carbon dioxide output in a half period, and 11.00% for oxygen uptake and 12.60% for carbon dioxide output in one period when using the kernel parameter selected from the stairs exercise. Moreover, the advantages of using the non-parametric model, the necessity of sufficient stimulation for identification and the importance of the kernel regularization term are also addressed in this paper. This method provides fundamental work for the practice of intelligent exercise. CCBY

10.
Journal of the American Society of Nephrology ; 31:291, 2020.
Article in English | EMBASE | ID: covidwho-984843

ABSTRACT

Introduction: Ground glass opacities (GGO) on CT scan are the hallmark of COVID-19. GGO can also be seen in ANCA-associated lung injury. Additionally, both can present with kidney injury. We report a case of presumed COVID-19 with AKI which was actually severe ANCA-associated vasculitis. Case Description: A 74-year old female with a history of hypertension and diabetes, who presented with a week of chills, cough, dyspnea, and watery diarrhea, and a creatinine of 10.2 mg/dl (baseline creatinine 1.02 mg/dl). A month prior to admission, she was treated for presumed bacterial conjunctivitis, followed by otitis media, and then bacterial sinusitis with oral ciprofloxacin. Despite a negative swab, she was admitted with suspicion of COVID-19 given GGO seen on CT scan and an exposure history at her senior home. She was treated per the COVID-19 protocol: IV methylprednisolone 125mg, azithromycin, and ceftriaxone. She had microscopic hematuria and 4 grams of proteinuria. ATN was suspected as urine microscopy showed granular casts and no dysmorphic RBC or cellular/WBC/RBC casts. After a repeat negative swab and improvement in respiratory symptoms yet worsening renal function requiring hemodialysis, a full serologic workup was performed. Positive results include p-ANCA (1:320), MPO (49), and ANA (1:160 homogeneous) without hypocomplementemia. Other autoimmune markers including anti-GBM antibody were negative. A kidney biopsy was performed and showed pauciimmune crescentic glomerulonephritis (GN) with cellular crescents in more than 80% of the glomeruli with minimal interstitial fibrosis and tubular atrophy. Given the frailty of this patient, she was treated with oral prednisone and rituximab instead of cyclophosphamide. She remained on intermittent hemodialysis and tolerated the treatment well. Discussion: This case emphasizes the importance of detecting pulmonary-renal syndrome in the time of COVID-19. Given the current global pandemic and a high volume of infected patients coupled with the lack of sensitivity of the SARS-CoV-2 assays, it is possible to miss this relatively rare ANCA-associated vasculitis. Patient with rapid proliferative GN feature and lung symptoms should be further worked up to avoid missing an ANCA-associated vasculitis. COVID-19 may actually provoke ANCAassociated vasculitis and further testing is underway.

11.
Journal of the American Society of Nephrology ; 31:823, 2020.
Article in English | EMBASE | ID: covidwho-984842

ABSTRACT

Background: Benefits of timely CKD modality education include increased knowledge and home dialysis. At our centre, attendance of scheduled CKD 4/5 patients to education sessions was low. This quality improvement study was initiated and aims to increase the prevalent percentage of CKD 4/5 patients who received CKD modality education from 40% to 55% over one year. Methods: Outcome measure was prevalent weekly percentage of CKD 4/5 patients who completed education. Process measures were 1) weekly percentage of scheduled patient education attendance and 2) weekly number of incident CKD 4/5 patient education referrals by nephrologists. Ishikawa diagram was utilized to determine system gaps and develop changes to test in plan-do-study-act (PDSA) cycles. Changes tested were: a) NPs tracking weekly class attendance, b) NP reminder calls, c) information letter mailed to patients, d) referral data presented to nephrologists, e) reminder emails to nephrologists on education eligible patients. Discussion with primary care colleagues and 5-whys tool resulted in developing an information webpage for patient education including NPs' zoom recorded sessions. Median outcome and processes were calculated and plotted on run charts. Results: Prevalent percentage of CKD 4/5 patients educated decreased from 40.6% to 29.4%. All referred patients have not yet been educated due to COVID19 and number of new patients increased over time. Median weekly session attendance increased from 60-67% with PDSA cycles a-c (Figure 1). Monthly incident education referral number increased from 5-18/month. Conclusions: Weekly session attendance and incident education referrals increased. Prevalent percent patients educated deceased but number of incident referrals increased. To provide a virtual information option for patients with barriers to attending sessions and for use during COVD19 pandemic, the webpage described is a helpful resource developed as a result this project. We anticipate this tool will increase the outcome and both process measures over time.

12.
Journal of the American Society of Nephrology ; 31:294, 2020.
Article in English | EMBASE | ID: covidwho-984814

ABSTRACT

Introduction: AKI in COVID-19 patients are reported in several studies with an incidence of 23%. We report a case of COVID-19 pneumonia with AKI and purpuric rash. Case Description: A 54 y/o female with hypertension, CKD stage 3, with a COVID+ swab, presented with CT chest findings consistent with COVID-19 pneumonia, purpura of the lower limbs concerning for leukocytoclastic vasculitis and non-oliguric AKI. Creatinine on admission was 8.5mg/dl, (baseline of 1.6mg/dL), CBC showed a wbc 26.9, Hb 6.9, platelets 196 and eosinophilia. Serologies were notable for elevated direct coomb, low haptoglobin, low C3/C4, and rheumatoid factor of 26. UA had no hematuria, UPCR 0.75 mg/mg. Home medication, naproxen was stopped one month ago. Renal biopsy showed severe acute tubular injury (ATI), coarse vacuolization of tubular epithelial cells, severe leukocytic infiltration of lymphocytes, neutrophils, eosinophils, severe vascular hyalinosis, global glomerular sclerosis (11 out of 30 glomeruli), severe (60%) interstitial fibrosis & tubular atrophy. Per institutional protocol, Immunofluorescence could not be performed in COVID+ patients. Renal function improved significantly after a 5 day course with IV steroids alone and patient remained stable with a creatinine of 3.4 mg/dL. Discussion: This case features multiple potential mechanisms for AKI in a COVID-19 patient. Viral effects include, acute interstitial nephritis (AIN), severe ATI, and endothelial inflammation leading to vasculitis and purpuric rash. Recently, vasculitis similar to Kawasaki disease has been described in COVID-19 patients. Our case suggests that immune dysregulation from COVID infection may result in autoimmune findings such as elevated RF and hemolytic anemia. AKI improved in our patient after steroids, suggesting that a biopsy with features of AIN should be treated and could change the course of the disease.

14.
IEEE Int. Conf. Intell. Transp. Eng., ICITE ; : 551-555, 2020.
Article in English | Scopus | ID: covidwho-970755

ABSTRACT

Emergency supplies transportation is a key issue during the epidemic period of COVID-19. Considering the potential of high-speed passenger trains to carry time-sensitive goods, this paper studies the transport scheme design problem for emergency transportation to meet the demand in time limit. To address this problem, we develop a multi-commodity flow model based on feasible paths in a space-time network structure. And a modelling method is proposed for k shortest paths generation. The proposed models consider the timeliness of emergency logistics and the characteristic of railway freight transportation. A numerical example is given to test this method. Results show that the model and method are effective and efficient. © 2020 IEEE.

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