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1.
SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-332147

ABSTRACT

Background The neurological manifestations of COVID-19 have not been well characterized. Our goals were to determine the prevalence of neurological diagnoses among COVID-19 patients hospitalized in intensive care unit (ICU) and non-ICU settings and ascertain differences between adults and children. Methods We analysed the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) database, which collects data from 61 countries and 1507 sites. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalisation using generalised linear models. Findings Overall, 161 239 patients (158 267 adults;2972 children) hospitalized with COVID-19 were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37·4%;children: 20·4%), altered consciousness (20·9%;6·8%), myalgia (16·9%;7·6%), dysgeusia (7·4%;1·9%), anosmia (6·0%;2·2%), and seizure (1·1%;5·2%). Among adults, rates were significantly higher in the ICU cohort than in the non-ICU cohort for myalgia (19·9% vs. 16·1%, p<0·001) and anosmia (6·3% vs. 5·9%, p=0·01) but lower in the ICU cohort for altered consciousness (10·8% vs. 24%, p<0·001) and seizure (0·8% vs. 1·2%, p<0·001). In children, rates were significantly higher in the ICU cohort than in the non-ICU cohort for fatigue (30·4% vs. 18·7%, p<0·001), myalgia (12·8% vs. 6·7%, p<0·001), and altered consciousness (12% vs. 5·7%, p<0·001). In adults, the most frequent in-hospital neurological complications were stroke (1·5%), seizure (1%), and central nervous system (CNS) infection (0·2%). Each occurred more frequently in ICU than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU than in non-ICU patients (7·1 vs. 2·3, p<0·001). Hypertension, chronic neurological disease, and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure, and stroke. All neurological complications reported during hospitalisation were associated with increased odds of death. Interpretation Adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Hypertension and previous neurological disease are risk factors for in-hospital neurological complications, which are associated with an increased probability of death in both adults and children.

2.
Sci Rep ; 12(1): 2693, 2022 02 17.
Article in English | MEDLINE | ID: covidwho-1692531

ABSTRACT

The global pandemic response to COVID-19 has led to the generation of huge volumes of unrecyclable plastic waste from single use disposable face coverings. Rotary hearth furnaces can be used to recover Zn and Fe from non-recyclable steelmaking by-product dusts, and waste plastic material such as facemasks could be utilized as a supplementary reductant for the rotary hearth furnace (RHF), but their fibrous form makes milling and processing to appropriate sizing for RHF application extremely challenging. A scalable method of grinding facemasks to powder by melting and mixing with Welsh coal dust reported herein provides a solution to both environmental challenges. The melt-blended PPE/coal dust shows a dramatically improved CO2 gasification reactivity (Ea = 133-159 kJmol-1) when compared to the untreated coal (Ea = 183-246 kJmol-1), because of improved pore development in the coal during the pyrolysis stage of heating and the catalytic activity of the CaO based ash present in the facemask plastic. The results are promising for the application of waste facemasks in recycling steelmaking by-product dusts in rotary hearth furnaces and may also be suitable for direct injection to the blast furnace subject to further study.


Subject(s)
Coal Industry , Masks , Metallurgy , Recycling/methods , Waste Management/methods
3.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-305795

ABSTRACT

Background: Up to 32% of patients with COVID-19 pneumonia may require ICU admission or mechanical ventilation(1, 2). Data from low- and middle-income countries for COVID-19 ARDS are limited. Groote Schuur Hospital in Cape Town, South Africa expanded its ICU service to support patients with COVID-19 ARDS requiring invasive mechanical ventilation (IMV). We report on patients' characteristics and outcomes from two pandemic waves. Methods: All adult patients with COVID-19 ARDS admitted to ICU for IMV were included in this prospective cohort study. Data were collected from 5th April 2020 to 5th April 2021. Ethical approval was granted (HREC: 362/2020). Results: Over the 12-month study period 461 patients were admitted to the designated COVID-19 ICU. Three-hundred-and-eighty patients met study criteria and 377 had confirmed hospital discharge outcomes. The median age of patients was 51 years (range 17–71), 50.5% were female and the median BMI was 32kg/m 2 (IQR 28–38). The median P/F ratio was 97 (IQR 71.5-127.5) after IMV was initiated. Co-morbidities included diabetes (47.6%), hypertension (46.3%) and HIV infection (10.5%). Of the patients admitted, 30.8% survived to hospital discharge with a median ICU length of stay of 19.5 days (IQR 9–36). Predictors of mortality after multivariate analysis were: male (OR:1.79), increasing age (OR:1.04), higher SOFA score (OR:1.29). Conclusion: In a resource limited environment, escalation of ICU IMV support achieved a 30.8% hospital survival in patients with COVID-19 ARDS. The ability to predict survival remains difficult given this complex disease.

4.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-322724

ABSTRACT

The Covid pandemic has had a significant impact on law school pedagogy, although how much that impact will remain and be a benefit post-pandemic remains to be seen. This article argues that we should leverage what we learned and use it to redesign our courses for a future world of hybrid teaching, so as not to lose what we gained by returning to in-person teaching as if nothing happened to us or our students. It offers suggestions about how to go about doing that—how to capture the benefits of what has been learned about online teaching in the 2020–21 Academic Year, and apply it to our teaching going forward. Among those suggestions is to redesign our courses from back to front, starting with articulating our learning outcomes and then developing modules designed to meet those outcomes, with formative assessment for each module as the semester progresses. It also suggests maximizing the precious in-person time we will regain post-pandemic by intentionally moving some of our content online, and deliberately choosing how to deliver that online content best. Doing these things deliberately will contribute to making us more effective teachers, and help our students become more effective learners—in law school, and in their future lives as practitioners.

6.
International Journal of Technology Assessment in Health Care ; 37(S1):14, 2021.
Article in English | ProQuest Central | ID: covidwho-1550199

ABSTRACT

IntroductionWith unprecedented times, comes accelerated change. Hospitals in our region have begun to facilitate safe discharge for COVID-19 patients in the form of “The virtual COVID ward”. This has enabled patients to be monitored safely in the community using pulse oximetry, Florence (a telehealth mobile app) and remote consultations. Our objective is to expand upon this model by providing home oxygen therapy for these patients facilitated by telemedicine.MethodsPatients were discharged with an oxygen concentrator if they had an oxygen requirement equal to or less than four litres/minute. Fraction of inspired oxygen needed to be stable and an early warning score of less than four was also required. Once admitted, the Florence app and daily remote consultations were crucial to closely monitor the patient's clinical status. The patient was instructed to enter oxygen saturations and heart rate into the app four times daily. The app would then alert our team if any patients observations deteriorate, triggering immediate assessment.ResultsWe have discharged ninety patients to the virtual ward, fifty-six of these with home oxygen. The average age was fifty-seven and the Clinical Frailty Score ranged between one and six. At present, ten patients have been re-admitted, four with increasing oxygen requirements, and six with unrelated symptoms. Two patients had oxygen concentrators installed at home after we were alerted to their desaturation by the Florence App. The re-admission rate is eleven percent, which mirrors that of other virtual wards (who do not provide home oxygen). In total, the ward has saved the trust 627 hospital inpatient ‘days’. Patients report increased satisfaction at playing a meaningful role in monitoring their own healthcare using the app.ConclusionsOur novel model of supported discharge with oxygen therapy using telehealth demonstrates that it is possible to manage such patients, safely, in the community. Other trusts could utilise this model to reduce inpatient bed occupancy. Looking to the future, could telehealth be utilised further to facilitate other “Virtual wards” in the community?

7.
Front Med (Lausanne) ; 8: 738086, 2021.
Article in English | MEDLINE | ID: covidwho-1441122

ABSTRACT

Background: In a disease that has only existed for 18 months, it is difficult to be fully informed of the long-term sequelae of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Evidence is growing that most organ systems can be affected by the virus, causing severe disabilities in survivors. The extent of the aftermath will declare itself over the next 5-10 years, but it is likely to be substantial with profound socio-economic impact on society. Methods: This is an international multi-center, prospective long-term follow-up study of patients who developed severe coronavirus disease-2019 (COVID-19) and were admitted to Intensive Care Units (ICUs). The study will be conducted at international tertiary hospitals. Patients will be monitored from time of ICU discharge up to 24 months. Information will be collected on demographics, co-existing illnesses before ICU admission, severity of illness during ICU admission and post-ICU quality of life as well as organ dysfunction and recovery. Statistical analysis will consist of patient trajectories over time for the key variables of quality of life and organ function. Using latent class analysis, we will determine if there are distinct patterns of patients in terms of recovery. Multivariable regression analyses will be used to examine associations between baseline characteristics and severity variables upon admission and discharge in the ICU, and how these impact outcomes at all follow-up time points up to 2 years. Ethics and Dissemination: The core study team and local principal investigators will ensure that the study adheres to all relevant national and local regulations, and that the necessary approvals are in place before a site may enroll patients. Clinical Trial Registration:anzctr.org.au: ACTRN12620000799954.

9.
The Judges' Journal ; 60(3):6-9, 2021.
Article in English | ProQuest Central | ID: covidwho-1338040

ABSTRACT

[...]litigation over public health orders (COVID-19 litigation) reveals important questions surrounding separation of powers, lawful delegation of authority, and the judiciary's role in ensuring against encroachments by the co-equal branches of government onto constitutional guarantees. [...]we improve public confidence in a system whose goal it is to keep the public safe while protecting individual and collective liberty. [...]both of these concerns are complicated by the expediency of the litigation and disputes over the deference allowed to government officials managing the crisis. [...]there appears emerging efforts at the state level to establish legislative oversight over executive powers.12 In the alternative, lawmakers may create more robust administrative procedures to control the governmental decision-making, including judicial review.

11.
Clin Nephrol ; 95(4): 171-181, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1154725

ABSTRACT

The first documented case of SARS-CoV-2 infection was confirmed in South Africa (SA) in March 2020. The Western Cape (WC) province was the initial epicenter. The pandemic peaked in July 2020 when 76,851 cases were documented and 2,323 deaths reported. COVID-19 can have multisystem involvement. Acute kidney injury (AKI) is well-documented and associated with increased mortality. We report our experience as the pandemic evolved in the WC province, focusing on those patients with a SARS-CoV-2 positive test presenting with AKI. We also reviewed our chronic dialysis cohort and renal transplant recipients who tested positive to assess incidence and outcomes. All patients presenting to nephrology services at the four main public hospitals were included. Information regarding demographics, co-morbidities, medical care, laboratory data, and outcomes were recorded. There were 86 patients referred with AKI, 48 required dialysis, and 47 died. There were 52 patients admitted to the intensive care unit with AKI (37 received dialysis, 1 of whom survived). In those presenting with AKI, diabetes, obesity, hypertension, and HIV were the most common comorbidities. Of the 295 patients receiving chronic dialysis within our services, 31 tested positive for SARS-CoV-2, and 6 died. Of the 45 kidney transplant recipients who tested positive, 9 died. Only 3 required dialysis. In conclusion, we report a high rate of AKI and poor prognosis in those requiring kidney replacement therapy, a better prognosis than anticipated was found in our chronic dialysis cohort, and high numbers of admissions were required for renal transplant recipients.


Subject(s)
Acute Kidney Injury/therapy , COVID-19/complications , Renal Replacement Therapy , Acute Kidney Injury/etiology , Acute Kidney Injury/physiopathology , COVID-19/physiopathology , Hospitalization , Humans , Intensive Care Units , Kidney/physiopathology , Pandemics , Prognosis , South Africa
12.
Clin Nephrol ; 95(4): 171-181, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1073679

ABSTRACT

The first documented case of SARS-CoV-2 infection was confirmed in South Africa (SA) in March 2020. The Western Cape (WC) province was the initial epicenter. The pandemic peaked in July 2020 when 76,851 cases were documented and 2,323 deaths reported. COVID-19 can have multisystem involvement. Acute kidney injury (AKI) is well-documented and associated with increased mortality. We report our experience as the pandemic evolved in the WC province, focusing on those patients with a SARS-CoV-2 positive test presenting with AKI. We also reviewed our chronic dialysis cohort and renal transplant recipients who tested positive to assess incidence and outcomes. All patients presenting to nephrology services at the four main public hospitals were included. Information regarding demographics, co-morbidities, medical care, laboratory data, and outcomes were recorded. There were 86 patients referred with AKI, 48 required dialysis, and 47 died. There were 52 patients admitted to the intensive care unit with AKI (37 received dialysis, 1 of whom survived). In those presenting with AKI, diabetes, obesity, hypertension, and HIV were the most common comorbidities. Of the 295 patients receiving chronic dialysis within our services, 31 tested positive for SARS-CoV-2, and 6 died. Of the 45 kidney transplant recipients who tested positive, 9 died. Only 3 required dialysis. In conclusion, we report a high rate of AKI and poor prognosis in those requiring kidney replacement therapy, a better prognosis than anticipated was found in our chronic dialysis cohort, and high numbers of admissions were required for renal transplant recipients.


Subject(s)
Acute Kidney Injury/therapy , COVID-19/complications , Renal Replacement Therapy , Acute Kidney Injury/etiology , Acute Kidney Injury/physiopathology , COVID-19/physiopathology , Hospitalization , Humans , Intensive Care Units , Kidney/physiopathology , Pandemics , Prognosis , South Africa
13.
Int J Radiat Oncol Biol Phys ; 107(4): 854, 2020 07 15.
Article in English | MEDLINE | ID: covidwho-1065195
14.
Radiother Oncol ; 151: 314-321, 2020 10.
Article in English | MEDLINE | ID: covidwho-929358

ABSTRACT

PURPOSE: Because of the unprecedented disruption of health care services caused by the COVID-19 pandemic, the American Society of Radiation Oncology (ASTRO) and the European Society for Radiotherapy and Oncology (ESTRO) identified an urgent need to issue practice recommendations for radiation oncologists treating head and neck cancer (HNC) in a time of limited resources and heightened risk for patients and staff. METHODS AND MATERIALS: A panel of international experts from ASTRO, ESTRO, and select Asia-Pacific countries completed a modified rapid Delphi process. Topics and questions were presented to the group, and subsequent questions were developed from iterative feedback. Each survey was open online for 24 hours, and successive rounds started within 24 hours of the previous round. The chosen cutoffs for strong agreement (≥80%) and agreement (≥66%) were extrapolated from the RAND methodology. Two pandemic scenarios, early (risk mitigation) and late (severely reduced radiation therapy resources), were evaluated. The panel developed treatment recommendations for 5 HNC cases. RESULTS: In total, 29 of 31 of those invited (94%) accepted, and after a replacement 30 of 30 completed all 3 surveys (100% response rate). There was agreement or strong agreement across a number of practice areas, including treatment prioritization, whether to delay initiation or interrupt radiation therapy for intercurrent SARS-CoV-2 infection, approaches to treatment (radiation dose-fractionation schedules and use of chemotherapy in each pandemic scenario), management of surgical cases in event of operating room closures, and recommended adjustments to outpatient clinic appointments and supportive care. CONCLUSIONS: This urgent practice recommendation was issued in the knowledge of the very difficult circumstances in which our patients find themselves at present, navigating strained health care systems functioning with limited resources and at heightened risk to their health during the COVID-19 pandemic. The aim of this consensus statement is to ensure high-quality HNC treatments continue, to save lives and for symptomatic benefit.

16.
Int J Radiat Oncol Biol Phys ; 108(2): 379-389, 2020 Oct 01.
Article in English | MEDLINE | ID: covidwho-707352

ABSTRACT

PURPOSE: Numerous publications during the COVID-19 pandemic recommended the use of hypofractionated radiation therapy. This project assessed aggregate changes in the quality of the evidence supporting these schedules to establish a comprehensive evidence base for future reference and highlight aspects for future study. METHODS AND MATERIALS: Based on a systematic review of published recommendations related to dose fractionation during the COVID-19 pandemic, 20 expert panelists assigned to 14 disease groups named and graded the highest quality of evidence schedule(s) used routinely for each condition and also graded all COVID-era recommended schedules. The American Society for Radiation Oncology quality of evidence criteria were used to rank the schedules. Process-related statistics and changes in distributions of quality ratings of the highest-rated versus recommended COVID-19 era schedules were described by disease groups and for specific clinical scenarios. RESULTS: From January to May 2020 there were 54 relevant publications, including 233 recommended COVID-19-adapted dose fractionations. For site-specific curative and site-specific palliative schedules, there was a significant shift from established higher-quality evidence to lower-quality evidence and expert opinions for the recommended schedules (P = .022 and P < .001, respectively). For curative-intent schedules, the distribution of quality scores was essentially reversed (highest levels of evidence "pre-COVID" vs "in-COVID": high quality, 51.4% vs 4.8%; expert opinion, 5.6% vs 49.3%), although there was variation in the magnitude of shifts between disease sites and among specific indications. CONCLUSIONS: A large number of publications recommended hypofractionated radiation therapy schedules across numerous major disease sites during the COVID-19 pandemic, which were supported by a lower quality of evidence than the highest-quality routinely used dose fractionation schedules. This work provides an evidence-based assessment of these potentially practice-changing recommendations and informs individualized decision-making and counseling of patients. These data could also be used to support radiation therapy practices in the event of second waves or surges of the pandemic in new regions of the world.


Subject(s)
Coronavirus Infections/epidemiology , Dose Fractionation, Radiation , Evidence-Based Medicine/methods , Pandemics , Pneumonia, Viral/epidemiology , Publications , COVID-19 , Humans
17.
Lancet Oncol ; 21(7): e350-e359, 2020 07.
Article in English | MEDLINE | ID: covidwho-593280

ABSTRACT

The speed and scale of the global COVID-19 pandemic has resulted in unprecedented pressures on health services worldwide, requiring new methods of service delivery during the health crisis. In the setting of severe resource constraint and high risk of infection to patients and clinicians, there is an urgent need to identify consensus statements on head and neck surgical oncology practice. We completed a modified Delphi consensus process of three rounds with 40 international experts in head and neck cancer surgical, radiation, and medical oncology, representing 35 international professional societies and national clinical trial groups. Endorsed by 39 societies and professional bodies, these consensus practice recommendations aim to decrease inconsistency of practice, reduce uncertainty in care, and provide reassurance for clinicians worldwide for head and neck surgical oncology in the context of the COVID-19 pandemic and in the setting of acute severe resource constraint and high risk of infection to patients and staff.


Subject(s)
Coronavirus Infections/epidemiology , Head and Neck Neoplasms/surgery , Health Care Rationing , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Surgical Oncology/standards , Betacoronavirus , COVID-19 , Consensus , Coronavirus Infections/prevention & control , Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/pathology , Humans , International Cooperation , Occupational Health , Pandemics/prevention & control , Patient Safety , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Surgical Oncology/organization & administration
18.
Int J Radiat Oncol Biol Phys ; 107(4): 618-627, 2020 07 15.
Article in English | MEDLINE | ID: covidwho-275257

ABSTRACT

PURPOSE: Because of the unprecedented disruption of health care services caused by the COVID-19 pandemic, the American Society of Radiation Oncology (ASTRO) and the European Society for Radiotherapy and Oncology (ESTRO) identified an urgent need to issue practice recommendations for radiation oncologists treating head and neck cancer (HNC) in a time of limited resources and heightened risk for patients and staff. METHODS AND MATERIALS: A panel of international experts from ASTRO, ESTRO, and select Asia-Pacific countries completed a modified rapid Delphi process. Topics and questions were presented to the group, and subsequent questions were developed from iterative feedback. Each survey was open online for 24 hours, and successive rounds started within 24 hours of the previous round. The chosen cutoffs for strong agreement (≥80%) and agreement (≥66%) were extrapolated from the RAND methodology. Two pandemic scenarios, early (risk mitigation) and late (severely reduced radiation therapy resources), were evaluated. The panel developed treatment recommendations for 5 HNC cases. RESULTS: In total, 29 of 31 of those invited (94%) accepted, and after a replacement 30 of 30 completed all 3 surveys (100% response rate). There was agreement or strong agreement across a number of practice areas, including treatment prioritization, whether to delay initiation or interrupt radiation therapy for intercurrent SARS-CoV-2 infection, approaches to treatment (radiation dose-fractionation schedules and use of chemotherapy in each pandemic scenario), management of surgical cases in event of operating room closures, and recommended adjustments to outpatient clinic appointments and supportive care. CONCLUSIONS: This urgent practice recommendation was issued in the knowledge of the very difficult circumstances in which our patients find themselves at present, navigating strained health care systems functioning with limited resources and at heightened risk to their health during the COVID-19 pandemic. The aim of this consensus statement is to ensure high-quality HNC treatments continue, to save lives and for symptomatic benefit.


Subject(s)
Consensus , Coronavirus Infections/epidemiology , Head and Neck Neoplasms/radiotherapy , Medical Oncology , Pandemics , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Societies, Medical , COVID-19 , Humans
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