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1.
Value in Health ; 26(6 Supplement):S203, 2023.
Article in English | EMBASE | ID: covidwho-20239044

ABSTRACT

Background: The COVID-19 pandemic catalyzed innovation in infection control measures, including widespread deployment of digital contact tracing systems. However, these technologies were not well understood by the general public and were complex for the public health community to implement, hampering adoption. Objective(s): To provide an overview of existing digital contact tracing systems, creating a framework for understanding design elements that impact their effectiveness as public health tools and offering a rubric for decision-makers to evaluate different systems for selection and implementation. Method(s): Scientific literature and publicly available information from relevant health authorities and other stakeholders was reviewed. Information was synthesized to develop a conceptual framework explaining how key design elements impact effectiveness of digital contact tracing systems and highlighting opportunities for future improvement. Result(s): A range of digital contact tracing interventions were deployed by governments worldwide and several professional sports leagues. Key design elements of the systems include: (1) data architecture (i.e., centralized versus decentralized systems, impacting privacy guarantees and data availability);(2) proximity detection technology (e.g., type of device signaling);(3) alert logic and timing (e.g., time- and distance-based criteria affecting sensitivity and specificity of alerts;real-time proximity alerts and/or bidirectional contact tracing, determining scope of infection prevention);(4) population (eligibility and availability);and (5) the structural and public health context of intervention (e.g., availability and timeliness of testing). Several systems demonstrated effectiveness in preventing transmission during COVID-19, though numerous limitations have also been documented in the literature. Conclusion(s): Digital contact tracing systems have the potential to mitigate the economic and public health impact of future infectious disease outbreaks, reducing community transmission and detecting potential cases earlier in the disease course. Lessons learned from solutions deployed during the COVID-19 pandemic provide an opportunity to improve multiple aspects of these systems, enhancing preparedness for future outbreaks.Copyright © 2023

3.
Frontiers in Education ; 6, 2022.
Article in English | Scopus | ID: covidwho-1662574

ABSTRACT

Social distancing during the COVID-19 pandemic forced the education system to instantly transition to online learning and teaching. Studies show that the challenges of emergency remote teaching (ERT) differ from those of online learning during routine times. Do student’s perceptions of teachers’ roles during online learning differ between ERT and routine online classes as well? Addressing this question can illuminate different aspects of the role of a teacher at different times, thus facilitating the improvement of online learning. This study compares students’ perceptions of their teachers’ roles in the online courses they attended during the pandemic, with perceptions of students who attended online courses in routine times when distance learning was a regular part of the academic program. The participants who attended online courses during routine times were 520 undergraduates in a teacher-education college. A second group of 475 undergraduates from the same college responded at the end of a semester of emergency online learning during the pandemic. Both groups answered questionnaires regarding their perception of four aspects of the role of online teachers: pedagogical, technical, affective, and differentiating. The findings showed that during emergency times, students had significantly higher expectations for teachers’ technical and affective roles than in routine times. However, students had lower expectations regarding teachers’ differentiating role during emergencies, and similar expectations for teachers’ pedagogical role in both situations. These findings highlight the need to plan curricula to suit different situations and different needs, and emphasize the different characteristics of the teachers’ role in different situations, in order to optimally address students’ needs in times of routine and emergency alike. Copyright © 2022 Sason, Wasserman, Safrai and Romi.

4.
Chest ; 160(4):A2405, 2021.
Article in English | EMBASE | ID: covidwho-1466211

ABSTRACT

TOPIC: Sleep Disorders TYPE: Medical Student/Resident Case Reports INTRODUCTION: Excessive dynamic airway collapse (EDAC) and Obstructive Sleep Apnea (OSA) are two entities which could cause significant negative intrathoracic pressure with resulting pulmonary edema. We present a case of obese patient with Down syndrome, severe OSA and EDAC who developed noncardiogenic pulmonary edema. CASE PRESENTATION: A 22-year-old male with a past medical history of Down syndrome, morbid obesity (BMI 44) and severe OSA not on CPAP, was admitted for shortness of breath and an episode of emesis. He was reportedly sleeping at home when suddenly started vomiting and developed severe shortness of breath. On exam, bilateral wheezing and a dry cough were present. He was hemodynamically stable, afebrile, hypoxic with saturation to 80%, requiring supplemental oxygen through a high flow delivery circuit. Labs were significant for WBC 16.1, a negative COVID-19 test, a negative procalcitonin, normal lactate and normal BNP, blood culture negative. Chest X-ray (CXR) showed bilateral pulmonary congestion, and CT of the chest confirmed bilateral diffuse pulmonary edema and showed dynamic tracheal collapse. The patient was aggressively diuresed and was quickly weaned off of supplemental oxygen with aggressive diuresis and was discharged home with recommendations to follow up with his primary pulmonologist for further investigation into the high suspicion for EDAC and for evaluation for CPAP therapy. DISCUSSION: EDAC occurs when there is a greater than 50% reduction of the sagittal diameter of the trachea in forced expiration or while coughing that results in an excessive collapse of the posterior membranous trachea towards the lumen without a collapse of cartilage. EDAC may present with coughing, difficulty clearing secretions, dyspnea, and stridor and often is mislabeled as COPD, asthma, or laryngeal edema. The diagnosis of EDAC can be made through dynamic bronchoscopy or dynamic radiologic imaging, like dynamic CT. An association between OSA and EDAC is theorized to exist, as repeated tension during inspiration against an occluded glottis during sleep may promote the development of EDAC. Moreover, an elevation in dynamic intra-thoracic central airway collapse may be associated with increasingly severe OSA, measured by obstructive respiratory events and degree of hypoxia. Ultimately, pulmonary edema may develop due to the effects of severe hypoxemia and/or extreme negative intrathoracic pressure which may result from severe OSA, with the possibility of EDAC playing a role in certain patient populations. CONCLUSIONS: EDAC is an underrecognized entity that may result in mild symptoms including cough and wheezing, to outright pulmonary edema and respiratory failure. OSA is theorized to be associated with EDAC, but additional research is needed to provide more definitive evidence of the relationship between the two conditions. REFERENCE #1: MURGU, Septimiu D., and Henri G. COLT. "Tracheobronchomalacia and Excessive Dynamic Airway Collapse." Wiley Online Library, John Wiley & Sons, Ltd, 31 May 2006, onlinelibrary.wiley.com/doi/10.1111/j.1440-1843.2006.00862.x. REFERENCE #2: Park, Jisoo, et al. "Successful High Flow Nasal Oxygen Therapy for Excessive Dynamic Airway Collapse: A Case Report." Tuberculosis and Respiratory Diseases, The Korean Academy of Tuberculosis and Respiratory Diseases, Oct. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4620351/. REFERENCE #3: Crowhurst, Thomas David, et al. "Obstructive Sleep Apnoea Is Associated with Dynamic Intra-Thoracic Central Airway Collapse: Results of a 10-Year Multi-Centre Retrospective Analysis." Sleep Science and Practice, BioMed Central, 16 June 2020, sleep.biomedcentral.com/articles/10.1186/s41606-020-00045-z. DISCLOSURES: No relevant relationships by Kamran Manzoor, source=Web Response No relevant relationships by Resham Pawar, source=Web Response No relevant relationships by Nikola Perosevic, source=Web Response No relevant relationships by Meher Singha, source=Web Response No relevant relationships by Evan Wasserman, source=Web Response

5.
Chest ; 160(4):A150, 2021.
Article in English | EMBASE | ID: covidwho-1458129

ABSTRACT

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Coronavirus-19 (COVID-19) myocarditis showed increased mortality despite team work of experts. We present a case of a middle-aged male with COVID-19 related myocarditis leading to cardiogenic shock. CASE PRESENTATION: 64-year-old male with history of hypertension, hyperlipidemia, hypothyroidism and positive COVID-19 infection with related stroke presented with 2 weeks of myalgias, malaise, and dyspnea. He was tachycardic on exam with bibasilar crackles and mild pedal edema. Labs revealed elevated inflammatory markers, cardiac biomarkers and leukocytosis with peripheral eosinophilia. Pulse dose steroids were initiated for suspected vasculitis. Transthoracic echocardiogram (TTE) revealed global hypokinesis and cardiac catheterization revealed LVEDP of 28 mmHg, LVEF of 10%, and cardiac index of 1.7 L/min/m2 without ischemic disease. Inotropes were started, and the patient was transferred to the center for advanced heart failure and cardiac transplant evaluation. Cardiac MRI (CMRI) revealed late enhancing subendocardial myocardial scarring of anteroseptal segments and endomyocardial biopsy revealed focal ischemic injury suggestive of COVID-19 related myocarditis in the setting of multisystem inflammatory syndrome (MIS-A). DISCUSSION: MIS-A is a rare subacute complication of COVID-19, thought to be caused by direct cell injury from ACE2 upregulation and a dysregulated immune response resulting in acute myocarditis. Elevated troponins have been reported in these patients due to ventricular dilation and direct myocardial injury. Electrocardiograms have poor sensitivity for myocarditis, thus TTE is performed which reveals wall abnormalities with reduced ventricular function and has been reported in 60% of COVID-19 related myocarditis cases. CMRI is preferred to evaluate myocarditis and may reveal hyperemia, edema, and myocardial necrosis. Endomyocardial biopsy (EMB) is the gold standard for diagnosing myocarditis, but should be a shared decision due to lack of studies to support EMB diagnosis in suspected COVID-19 myocarditis. Patients with cardiogenic shock need vasopressors and inotropes, and mechanical circulatory support via extracorporeal membrane oxygenation or intra-aortic balloon pumps if needed. It is unclear if intravenous immunoglobulins or steroids have benefit treating COVID-19-related myocarditis and requires further evaluation. CONCLUSIONS: Myocarditis should be suspected in patients with COVID-19 infection presenting with acute heart failure. Given limited data for COVID-19 related myocarditis, we need more studies to better treat these patients. REFERENCE #1: Morris SB, Schwartz NG, Patel P, et al. Case series of multisystem inflammatory syndrome in adults associated with sars-cov-2 infection — united kingdom and united states, march–august 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1450–1456. REFERENCE #2: Sawalha K, Abozenah M, Kadado AJ, et al. Systematic review of COVID-19 related myocarditis: insights on management and outcome. Cardiovasc Revasc Med. 2021;23,107-113. REFERENCE #3: Siripanthong B, Nazarian S, Muser D, et al. Recognizing covid-19-related myocarditis: the possible pathophysiology and proposed guideline for diagnosis and management. Heart Rhythm. 2020;17(9):1463-1471. DISCLOSURES: No relevant relationships by Suong Nguyen, source=Web Response No relevant relationships by Nikola Perosevic, source=Web Response No relevant relationships by Evan Wasserman, source=Web Response

7.
Critical Care Medicine ; 49(1 SUPPL 1):180, 2021.
Article in English | EMBASE | ID: covidwho-1194017

ABSTRACT

INTRODUCTION: Lyme disease can cause significant cardiovascular complications such as channelopathies, cardiomyopathy, or peri-myocarditis (PM). We present a case of PM in a young patient who was managed with timely initiation of antibiotics. METHODS: A 21-year-old male with no significant medical or family history presented to the hospital with chest pain. He was in his usual state of health when he developed a sudden onset of dull, substernal chest pain, radiating to the bilateral upper extremities. On presentation, his physical examination was unremarkable. Electrocardiogram demonstrated diffuse ST-segment elevations in the precordial leads. Laboratory investigations were notable for a troponin elevation of 12 ng/ml. Echocardiogram was unremarkable. The patient was admitted to the hospital for possible PM and was initiated on colchicine therapy. He underwent cardiac magnetic resonance imaging, which revealed a patchy intramural myocardial enhancement consistent with myocarditis. Workup included testing for COVID-19, Epstein-Barr virus, Coxsackie virus, which was negative, and rheumatologic workup was negative. Upon further investigation, it was revealed that the patient had a tick bite a few weeks ago. Subsequently, he had a positive serological test for Lyme disease with positive IgM antibodies which were confirmed on the immunoblot test. PM was thereby attributed to Lyme disease, and the patient was treated with doxycycline for 21 days with complete resolution. RESULTS: PM is characterized by varying disease manifestations and may rapidly deteriorate into a lifethreatening condition leading to catastrophic outcomes such as arrhythmias, cardiac arrest, or cardiogenic shock. The etiology of PM is broad and can be due to a variety of insults. Lyme carditis occurs when the bacteria disseminate and affect the cardiac muscle and the conduction system. Although the predominant abnormality is heart block, PM is a rare manifestation of Lyme carditis. Physicians should have a high degree of clinical suspicion to diagnose this condition to prevent catastrophic cardiovascular outcomes. Timely introduction of antibiotic therapy is essential to prevent fatal outcomes.

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