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1.
Proceedings of the National Academy of Sciences of the United States of America ; 120(4):e2202820120, 2023.
Article in English | MEDLINE | ID: covidwho-2186688

ABSTRACT

Human coronavirus 229E (HCoV-229E) and NL63 (HCoV-NL63) are endemic causes of upper respiratory infections such as the "common cold" but may occasionally cause severe lower respiratory tract disease in the elderly and immunocompromised patients. There are no approved antiviral drugs or vaccines for these common cold coronaviruses (CCCoV). The recent emergence of COVID-19 and the possible cross-reactive antibody and T cell responses between these CCCoV and SARS-CoV-2 emphasize the need to develop experimental animal models for CCCoV. Mice are an ideal experimental animal model for such studies, but are resistant to HCoV-229E and HCoV-NL63 infections. Here, we generated 229E and NL63 mouse models by exogenous delivery of their receptors, human hAPN and hACE2 using replication-deficient adenoviruses (Ad5-hAPN and Ad5-hACE2), respectively. Ad5-hAPN- and Ad5-hACE2-sensitized IFNAR-/- and STAT1-/- mice developed pneumonia characterized by inflammatory cell infiltration with virus clearance occurring 7 d post infection. Ad5-hAPN- and Ad5-hACE2-sensitized mice generated virus-specific T cells and neutralizing antibodies after 229E or NL63 infection, respectively. Remdesivir and a vaccine candidate targeting spike protein of 229E and NL63 accelerated viral clearance of virus in these mice. 229E- and NL63-infected mice were partially protected from SARS-CoV-2 infection, likely mediated by cross-reactive T cell responses. Ad5-hAPN- and Ad5-hACE2-transduced mice are useful for studying pathogenesis and immune responses induced by HCoV-229E and HCoV-NL63 infections and for validation of broadly protective vaccines, antibodies, and therapeutics against human respiratory coronaviruses including SARS-CoV-2.

2.
Australian Journal of Social Issues ; 2022.
Article in English | Web of Science | ID: covidwho-2172365

ABSTRACT

In 2020, Australia's successful COVID-19 public health restrictions comprised a national "initial lockdown " (March-May) and "ongoing lockdown " (July-November) for metropolitan Victorian residents only. We evaluated associations between ongoing lockdown and family finances and mental health. In the June and September 2020 Royal Children's Hospital National Child Health Polls, caregivers of children in Victoria and New South Wales (NSW) reported the following: job/income loss;material deprivation (inability to pay for essential items);income poverty;mental health (Kessler-6);perceived impact on caregiver/child mental health;and caregiver/child coping. Data from caregivers (N = 1207/902) in June/September were analysed using difference-in-difference modelling (NSW provided the comparator). During Victoria's ongoing lockdown, job/income loss increased by 11% (95%CI: 3%-18%);Kessler-6 poor mental health by 6% (95%CI: -0.3%-12%) and perceived negative mental health impacts by 14% for caregivers (95%CI: 6%-23%) and 12% for children (95%CI: 4%-20%). Female (vs. male) caregivers, metropolitan (vs. regional/rural) families, and families with elementary school-aged children (vs. pre-/high-school) were the most affected. The ongoing lockdown was associated with negative experiences of mental health, employment and income, but not deprivation or poverty, likely because of government income supplements introduced early in the pandemic. Future lockdowns require planned responses to outbreaks and evidence-informed financial and mental health supports.

3.
COVID-19 in the Environment: Impact, Concerns, and Management of Coronavirus ; : 325-344, 2021.
Article in English | Scopus | ID: covidwho-2075808

ABSTRACT

This study investigates the transport of air pollutants around the Yangtze River Delta with an aim to identify if there would be a relationship towards health effects during the COVID-19 lockdown period. It is well-known that due to lockdown, the number of socio-economical activities are reduced and hence there is an observable reduction in air pollution. We would like to investigate if this consequential reduction of air pollution would lead to improvement in health amongst its population. A number of integrated methodologies are utilized, including collection and correlation of statistical data and numerical modeling to correlate the mortality rates difference with and without COVID-19 lockdown. In particular air quality changes during the COVID-19 lockdown period are compared with similar periods of the previous years using Brute Force Method. It is found that in general there is significant reduction in air-pollution related mortality, like stroke, ischemic cardio diseases, obstructive pulmonary disease, lung cancer and acute lower respiratory infection are all reduced as a result of relative improvement in PM2.5 level during the lockdown period. Further investigation of the trajectories suggests that these PM2.5 originate from afar with multiple sources, and do not suggest COVID-19 are transported to the region via long-range transport. Our results demonstrate the need for more stringent policy measure to tackle air pollution as it has strong evidence that it increases mortality rate. © 2022 Elsevier Inc. All rights reserved.

4.
Investigative Ophthalmology and Visual Science ; 63(7):1381-A0077, 2022.
Article in English | EMBASE | ID: covidwho-2058693

ABSTRACT

Purpose : Age-related macular degeneration (AMD), diabetic retinopathy (DR), and glaucoma are vision-threatening diseases (VTDs) affecting 36 million people in the USA. With 5.7 ophthalmologists per 100,000 Americans, over 50% of VTDs go undetected. We assessed deep learning Artificial Intelligence (DLAI) in VTD detection in community and clinical settings. Methods : 223 subjects (mean age 54.6, 58% male) from community screenings (A) and clinic (B) underwent 45-degree retinal imaging. In A (non-dilated), an onsite telemedicine reader (R1) and remote ophthalmologist (R2) graded image quality (gamma and alignment, 1-5 scale) and referable VTD using the international grading scales for AMD and DR, and cup-to-disc ratio and nerve fiber layer for glaucoma. In B (dilated), gradings were collected from R1 and the clinical diagnosis (d). A senior ophthalmologist (R3) adjudicated disputed findings. In A, DLAI VTD referral was compared to R1/R2/R3 consensus (S);in B, overall referral was compared to R1/d/R3 consensus (C). Images were uploaded to a cloud-based DLAI (SELENA+, EyRIS Pte Ltd) (Fig 1). Cohen's kappa assessed intergrader agreement. Results : R1 and R2 found 4.7% eyes ungradable. DLAI marked 55.6% ungradable;74.6% of them were for AMD. Of the DLAI ungradable eyes, image quality was ≤ 3, and 56.2% had ≥ 1+ cataract (R1). Compared to in A, in B DLAI had higher sensitivity (97.1% vs. 63.2%) and positive predictive value (69.4% vs. 32%). In A, DLAI had higher specificity (94.5% vs.16.7%) and negative predictive value (98.4% vs. 75.0%) (Table 1). In A, Cohen's kappa was 0.946 between R1 and R2, with a 13% disagreement rate. In 56% of the disagreements, R3 agreed with R1. In B, Cohen's kappa was 0.874 for R1 and d;R1 referred more than d. In A and B, DLAI referred more than R1, R2, and H/C. DLAI referred all eyes with > 1 VTD (1%) for further examination. Grading times for DLAI, R1, and R2 were 30, 129, and 68 seconds. Conclusions : DLAI performed best in DR and glaucoma detection;a potential solution for the high ungradable rate can be for DLAI to re-center uploaded images. DLAI can increase efficiency and accessibility of screenings for multiple VTDs, in both underserved populations and clinic. The ability to minimize direct contact confers an advantage during COVID-19. Further studies will investigate DLAI use in VTD progression.

5.
Investigative Ophthalmology and Visual Science ; 63(7):1385-A0081, 2022.
Article in English | EMBASE | ID: covidwho-2058685

ABSTRACT

Purpose : The most common cause of blurry vision in the United States is refractive error. Despite being a correctable condition, over 8.2 million people are estimated to have their refractive error go undiagnosed or untreated. Minorities and low-income groups in particular have significantly increased odds of inadequate correction and double the rates of near-vision impairment. We aimed to address this gap in care through the provision of refractive glasses during community-based tele-ophthalmology screenings. Methods : Eight free eye screening events were held in Newark and West New York, NJ. Demographic information, intraocular pressure, visual acuity, auto-refraction, retinal imaging, and optical coherence tomography were obtained from each subject as part of a comprehensive tele-ophthalmology protocol. Reading glasses were provided as needed based on the recommendation of a certified telemedicine reader. Eligible recipients completed surveys on site regarding access to eye care. They were surveyed again by phone after one month to assess degree of satisfaction and vision improvement. Results : 38 subjects (mean age 53, 47% male) qualified for presbyopia correction and received reading glasses. 97% were Hispanic and 3% were African American. Of the 33 that returned surveys, 88% reported not seeing an eye doctor annually. The most common reason was lack of insurance or inability to pay (71%). Others included having no need to see an eye doctor (10%), disliking eye doctors (7%), not knowing the importance of regular eye exams (3%), and COVID-19 (3%). Of the 25 subjects that were reached for follow-up, 92% reported using the glasses daily. Those that did not reported the power was too strong or they did not feel they needed them. Subjects noted an average improvement in vision of 4.4 out of 5 and an average satisfaction of 4.7 out of 5 (Figure 1). Conclusions : Glasses distribution is an effective way to address refractive error in underserved communities. Given the gaps in knowledge and utilization of eye care identified in our study, there is an obvious need for continued outreach to these areas. Further studies will include larger populations and evaluate mobile refraction devices to increase ease and reach of glasses provision.

6.
Investigative Ophthalmology and Visual Science ; 63(7):1386-A0082, 2022.
Article in English | EMBASE | ID: covidwho-2058677

ABSTRACT

Purpose : Over 50% of individuals with vision-threatening disease (VTD) (e.g., diabetic retinopathy, glaucoma, macular degeneration) are unaware of their condition, and once diagnosed, 80% will not follow up for clinical care, especially since the onset of SARS-CoV-2 in 2020. Remote teleophthalmology with real-time robotic teleconsultation was implemented to include automated puff-tonometry (APT) as pre-triage to identify patients who require more detailed clinical assessment and treatment. Methods : 224 subjects (58% male) of average age 55 years were screened over 8 events. Following COVID-19 protocols screenings took place in New Jersey churches and health fairs featuring a high prevalence of African American and Hispanic subjects. Masked and self-reported vaccinated subjects underwent medical history, blood pressure, visual acuity (with pinhole), automated puff-tonometry (APT) for intraocular pressures (IOP), automated refraction, non-mydriatic retinal imaging, optical coherence tomography (OCT), and wearable visual field device (WVFD) testing. Face masks were fitted with surgical tape on the nose bridge to limit instrument fogging. To minimize equipment contact, all subjects were screened in the standing position, including APT and retinal imaging (Fig.1). Chi-square and t-tests were performed to assess factors associated with glaucoma referral. Subjects without IOP readings were excluded;significance was set at p<0.05. Results : 10.29% of measured eyes had an IOP>18 and underwent additional testing including OCT-B of the optic nerve head, nerve fiber layer, and ganglion cell complex. 31.43% of eyes with IOP>18 underwent teleconsultation with a glaucoma specialist, vs. 8.85% of eyes with IOP≤18 ((p<0.001), Table 1). The difference in mean age in subjects with glaucoma referral vs. without (57.42 vs. 51.61 years) was significant (p=0.008). Conclusions : APT was useful in supporting on-site OCT-B imaging and WVFD referral (37.67%, 8.52% of total subjects) that yielded 17.94% referral to on-site teleconsultation through a real-time telerobot. Future investigation will include larger and more diverse community-based populations.

7.
Investigative Ophthalmology and Visual Science ; 63(7):1384-A0080, 2022.
Article in English | EMBASE | ID: covidwho-2058605

ABSTRACT

Purpose : Retinal imaging is the gold standard in tele-ophthalmology. Limitations in twodimensional imaging can lead to poor triage or unnecessary clinical referrals, especially during COVID-19. Combined retinal imaging with Optical Coherence Tomography-B scan (OCT-B) in detecting vision threatening diseases (VTDs) such as glaucoma in communitybased screenings adds a third dimension to subject data. Methods : A non-mydriatic Topcon 3D Maestro1 imaging system was deployed in this pilot study to screen 120 subjects (43.3% male, mean age 55.1) in community-based screenings. Measurements of vertical cup-to-disc ratio (VCDR), nerve fiber layer (NFL) thickness and macular and ganglion cell layer (GCL) thickness were collected along with color retinal images by the Maestro1. Visual acuity and intraocular pressures (IOP) were obtained as part of the screening protocol. Four types of OCTs were acquired: 78.33% 3D Wide, 13.33% 3D Macula, 5.83% 3D Disc, and 2.51% 5-Line Cross. An on-site certified reader (CR) interpreted results and provided consultation follow-up to a remote ophthalmic subspecialist. Results : Of 222 eyes, OCT-B confirmed follow-up in 86.94%. 88.3% of subjects had referable eye pathology: 23.33% to general or specialty eye clinic and 65% to telemedicine. CR glaucoma referral based on OCT-B scan, VCDR and NFL defects was compared to OCT-B referral based on VCDR ≥0.65. Cohen's kappa was 0.546 with 30% disagreement. Compared to CR, OCT-B generated VCDR had a 91.1% specificity and 42.3% sensitivity in detecting glaucoma. VCDR, IOP, NFL, and GCL measurements were significantly correlated with CR glaucoma referral (p<0.05). Only VCDR, NFL, and GCL were significantly correlated with Maestro 1 glaucoma referral (p<0.05). Conclusions : OCT-B images provide valuable added diagnostic information about referrals in glaucoma. Its ability to capture greater depth of information about the eye, such as NFL and GCL measurements, compared to traditional two-dimensional retinal photography, warrants consideration for OCT-B as a replacement for non-mydriatic retinal photography as the gold standard in ophthalmic diagnostics. Further studies can investigate the utility trend analysis of OCT-B in predicting VTD's progression over time.

8.
Investigative Ophthalmology and Visual Science ; 63(7):1379-A0075, 2022.
Article in English | EMBASE | ID: covidwho-2058539

ABSTRACT

Purpose : Vision Threatening Diseases (VTDs) (age-related macular degeneration, cataracts, diabetic retinopathy, glaucoma) affect 36 million individuals in the United States. 50% are unaware they have a VTD, disproportionally affecting minorities and lowincome groups with less access to eye care. While screening programs in underserved communities result in early detection, less than half of subjects with findings follow up with a specialist. This number is four times lower during COVID-19. Methods : Robotic Telepresence (RT) was implemented in this pilot study during COVID19 to increase real-time access to specialist care. 58 subjects (age 56, 45% male) underwent a non-mydriatic screening protocol over five screenings. They were divided into three groups for consult: In Person (IP) followed by RT (N = 21), RT followed by IP (N = 19), and IP only (N = 18). IP consult was done by an on-site certified reader. RT consult was done by an off-site glaucoma or retina specialist with access to blood pressure, visual acuity, intraocular pressure, 45° retinal images, and ocular coherence tomography Bscans via cloud-based software. Video connection for RT was established via HIPAAcompliant mobile hotspot. Subject demographics and preferences were collected afterwards via survey. Results : Of 40 RT consults, 26 were second opinion for VTD suspect and 14 were wellness encounters. 24 reported their last eye care visit >3 years ago or never. Following RT consult, 18 subjects received one or multiple VTD diagnosis and 3 with glaucoma were referred for pressure-lowering eye drops. In the group with IP consult first, preferences were 5% RT, 52% IP, and 43% none. In the group with RT consult first, preferences were 5% RT, 58% IP, and 37% none. There was no significant difference in number of questions asked, wait time, or encounter length between IP and RT consults. Conclusions : RT consults proved valuable in community-based VTD screenings, particularly during COVID-19 when access to eye care is further limited. Most subjects preferred IP. However subjects with VTD that face socioeconomic barriers benefit from immediate RT consult and management directives from remote subspecialists. Further studies should incorporate consults from additional specialties (endocrinologists, general practitioners, social workers) and include telehealth CPT code for reimbursement.

9.
Investigative Ophthalmology and Visual Science ; 63(7):4100-F0064, 2022.
Article in English | EMBASE | ID: covidwho-2058436

ABSTRACT

Purpose : The COVID-19 pandemic has highlighted the need for telemedicine across all specialties. Though its utilization has increased since the start of the pandemic, ophthalmology has been reported to be among the specialties least likely to utilize telemedicine in practice. We evaluated the potential utility of portable slit lamp exam (SLE) videos and anterior segment photos as telemedicine modalities by comparing the findings from these modalities to those identified in-person in the clinic. Methods : Data was collected from 98 subjects at Rutgers Institute of Ophthalmology and Visual Science by non-ophthalmic trained staff, which included portable SLE videos and anterior segment photos, collected with Microclear digital hand-held slit lamp (Suzhou, China) and Canon non-mydriatic retinal camera CR-2 Plus AF (Tokyo, Japan), respectively. Analysis included anterior segment photos taken from 92 patients (183 eyes) and SLE videos taken from 91 patients (177 eyes), which were interpreted and compared to exam findings identified in-person in the clinic. Sample t-tests were used for statistical analysis. Results : Nuclear sclerotic cataract (NSC) had the most agreement between telemedicine interpretation and in-person exam (photo 93.8%, video 93.75%). Cortical cataract showed less agreement (photo 65.63%, video 45.16%) and posterior subcapsular cataract (PSC) showed the least agreement (photo 8.33%, video 0%) among cataract findings. Cornea findings were among those least likely to be identified (photo 12.5%, video 14.86%). Findings that showed statistically significant differences between photo and video included pinguecula (p=0.00032). PSC (p=0.044) and posterior capsule opacification (p=0.00098) showed statistically significant differences regarding identifying findings on telemedicine interpretation that were not documented in clinic. Conclusions : Portable SLE videos and anterior segment photos may have potential for utility as means of telemedicine, particularly for NSC. Portable SLE requires more training to display a full ophthalmic exam whereas photographs can easily be done by non-ophthalmic trained staff, displaying similar findings. Differences in exam findings may be attributed to lack of documentation when patients present to the clinic for more urgent concerns and lack of focus on slit lamp videos by non-ophthalmic trained staff. (Figure Presented).

10.
Investigative Ophthalmology and Visual Science ; 63(7):1383-A0079, 2022.
Article in English | EMBASE | ID: covidwho-2058064

ABSTRACT

Purpose : The COVID-19 pandemic exposed the need for increased mobilization of teleophthalmology resources. Artificial intelligence (AI) may serve as a tool to assist physicians in triaging highest need patients if the AI's assessment of disease is comparable to the physician's assessment. This study assesses the ability of AI software to diagnose diabetic retinopathy (DR) as compared to Tele-ophthalmology and in-person examination by a retina specialist. Methods : Records of forty patients (average age 55.1±10.9 years) presenting to an urban retina clinic were reviewed retrospectively for factors including demographics, retinal photos taken by Canon CR-2 Plus AF Retinal Imaging camera (Tokyo, Japan), and diagnosis of DR based on the International Clinical Diabetic Retinopathy (ICDR) classification scale during an in-person clinic visit in which a fundus exam was performed. Retinal photos were graded by AI software, EyeArt (EyeNuk, CA), as Normal, Mild DR, or More than Mild DR. Retinal images were also graded remotely by a retina specialist using the ICDR classification scale via TeamViewer software (Tele). Agreement between Tele, AI, and inperson DR diagnosis was assessed using Cohen's Kappa (κ) coefficient using IBM® SPSS® Statistics software. Results : Among 80 eyes, 33 were diagnosed in-person with no DR, 5 with mild nonproliferative DR (NPDR), 9 with moderate NPDR, 3 with severe NPDR, 7 with proliferative diabetic retinopathy (PDR), and 23 with regressed PDR. Eleven and 26 eyes could not be graded by Tele or AI, respectively. κ±SE for in-Person diagnosis vs Tele was 0.859±0.058 (p<.001), in-person vs AI was 0.751±0.082 (p<.001), and Tele vs AI was 0.883±0.063 (p<.001). Conclusions : AI is a reliable tool for screening patients for DR and referring them for physician evaluation since AI had a substantial rate of agreement with the in-person diagnosis and near perfect agreement with Tele. Tele grading was in near perfect agreement with the in-person diagnosis, showing that Tele is a reliable option for a physician to remotely screen patients that may be ungradable by AI. However, improvements are needed due to the high number of images that are ungradable via Tele and AI. Further studies should assess ways to reduce the number of ungradable images via Tele and AI and create a trend analysis for multiple visits for a given patient.

11.
Investigative Ophthalmology and Visual Science ; 63(7):1421-A0117, 2022.
Article in English | EMBASE | ID: covidwho-2057824

ABSTRACT

Purpose : Limited access to eye-care among Latinos can lead to missed Vision Threatening Diseases (VTDs) defined as Age-related Macular Degeneration (AMD), cataracts, Diabetic Retinopathy (DR) and glaucoma. As 50% of the people with VTD's are unaware of their condition made worse during COVID-19, comprehensive eye screenings to assess ocular wellness was implemented using telemedicine, Artificial Intelligence (AI) and robotic consultations. Methods : State-sponsored screenings were conducted at a church in West New York, NJ (78% Latino, mostly from Colombia) over 3 weekends during the 2021 Pandemic. All participants had received two-dose vaccinations and wore a surgical mask during screenings. Nine first-year medical students and 6 community volunteers took part in the wellness evaluation including: medical history, blood pressure, visual acuity, automated refraction, puff tonometry, 45-degree non-mydriatic retinal photography AI. To confirm findings: 6-micron resolution ocular coherence tomography (OCT) B-scan was performed. Screened subjects had their data reviewed by an onsite ophthalmic grader using a Spanish-speaking interpreter. As 80% of screened subjects are lost to follow-up, remote robotic ophthalmology consultation via HIPAA compliant Wi-Fi was utilized in real-time to connect with an off-site ophthalmologist. Results : 153 subjects, (71 Female (46%), median age 55) had 127 ocular findings (Table 1) found in 85 (55%) subjects, of which 98% of findings were previously unknown and 40 (47%) classified as VTD. 23(15%) subjects had multiple findings. OCT confirmed 23 cases of AMD and glaucoma. AI referred 39 cases. 36 individuals took part in robotic virtual consults. Findings were: cataracts 70 (45%), glaucoma 32 (20%), and AMD 25(16%). Among those with findings, 82% were uninsured and 90% had >2 years since last eye exam. 32 (32/153) subjects had undertreated or untreated hypertension. 93% were un-familiar with telemedicine. Conclusions : Latinos without health insurance and ease of access to eyecare may have a higher burden of multi-VTDs. An exception was DR which could be a limitation of population bias. This pilot study supports comprehensive wellness eye screenings that may allow for early detection, confirmation, and referral of single or multiple VTD in high-risk low-income communities. Further studies are needed using larger sample populations. (Figure Presented).

12.
Investigative Ophthalmology and Visual Science ; 63(7):1389-A0085, 2022.
Article in English | EMBASE | ID: covidwho-2057429

ABSTRACT

Purpose : 57.5 million people worldwide are affected by glaucoma. However, 50% of those with glaucoma are unaware, and 80% of those identified for follow-up in community screenings (CS) fail to do so. Current standards of visual field testing are usually limited to the clinic. As such, a wearable perimetry headset was used to perform Virtual Reality Visual Field Acuity (VRVFA) examination for suspected visual field loss in the community minimizing exposure to COVID-19 and the need for follow-up. Methods : 31 subjects from 4 CS were screened by an onsite certified telemedicine reader (CR) who considered family history, visual acuity, intraocular pressures, cup-to-disc ratio, nerve fiber layer defects, and ganglion cell complex captured by non-mydriatic photography and ocular coherence tomography (OCT-B). Cataracts were also graded. Supervised VRVFA testing with a multilingual Palmscan VF2000 Analyzer (Fig.1) was performed in 6 minutes on average. Eyes with fixation losses >20% or false positive/negative ratios >0.375 were excluded. Visual field index (VFI), mean deviation (MD), pattern standard deviation (PSD), and mean sensitivity (MS) from VRVFA were compared to CR glaucoma referral and cataract grading. Descriptive statistics, independent samples t-tests, and Mood's median tests were performed. Subjects with positive findings underwent same-day robotic glaucoma specialist telepresence evaluation. Results : 37 eyes from 31 subjects met inclusion criteria (mean age 51.42 ± 14.57 years, 56.76% male, 94.59% Hispanic). 7 (18.92%) eyes were referred for glaucoma evaluation. Glaucoma referrals had significantly different VFI (66.86% vs 86.40%, p=0.027), MD (-9.60 vs -4.04, p=0.031), and MS (19.94 vs 26.01, p=0.027) (Fig. 2). 30 (81.08%) eyes were 0-1+ in cataract grading, 5 (13.51%) were 2-3+, and 2 (5.41%) were intra-ocular lenses (IOL);respectively, these subgroups were not significantly different in VFI (84.20% vs 92.80% vs 35.00%, p=0.147), MD (-4.70 vs -2.11 vs -18.41, p=0.147), PSD (3.52 vs 2.25 vs 9.69, p=0.053), or MS (25.38 vs 27.75 vs 9.91, p=0.147) (Fig. 2). Conclusions : VRVFA testing yielded valuable information on the extent of vision loss as a supportive screening tool for glaucoma congruent with referrals. Expanded testing is needed. Future studies may evaluate VRVFA utility in evaluating other peripheral vision threatening diseases.

13.
GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry ; 2022.
Article in English | Scopus | ID: covidwho-1908100

ABSTRACT

Fear of choking is a relatively understudied phenomenon in older adults, despite the higher incidence of choking to death in this population and the associated mental health burden. This case report presents the use of a cognitive-behavioral (CBT) approach to treating choking phobia in an older adult in her 80s, with sessions conducted over the telephone during the COVID-19 pandemic. A reliable change in self-reported avoidance of solid food was observed, although indices of general distress appeared to have remained stable. By placing a seemingly focal problem (choking phobia) within a comprehensive conceptualization framework using gerontology, we were able to consider additional complexity related to aging-related beliefs and experiences of distress to address therapeutic opportunities and challenges, including the COVID-19 context. © 2022 Hogrefe AG.

14.
Francis, J. M.; Leistritz-Edwards, D.; Dunn, A.; Tarr, C.; Lehman, J.; Dempsey, C.; Hamel, A.; Rayon, V.; Liu, G.; Wang, Y.; Wille, M.; Durkin, M.; Hadley, K.; Sheena, A.; Roscoe, B.; Ng, M.; Rockwell, G.; Manto, M.; Gienger, E.; Nickerson, J.; Moarefi, A.; Noble, M.; Malia, T.; Bardwell, P. D.; Gordon, W.; Swain, J.; Skoberne, M.; Sauer, K.; Harris, T.; Goldrath, A. W.; Shalek, A. K.; Coyle, A. J.; Benoist, C.; Pregibon, D. C.; Jilg, N.; Li, J.; Rosenthal, A.; Wong, C.; Daley, G.; Golan, D.; Heller, H.; Sharpe, A.; Abayneh, B. A.; Allen, P.; Antille, D.; Armstrong, K.; Boyce, S.; Braley, J.; Branch, K.; Broderick, K.; Carney, J.; Chan, A.; Davidson, S.; Dougan, M.; Drew, D.; Elliman, A.; Flaherty, K.; Flannery, J.; Forde, P.; Gettings, E.; Griffin, A.; Grimmel, S.; Grinke, K.; Hall, K.; Healy, M.; Henault, D.; Holland, G.; Kayitesi, C.; LaValle, V.; Lu, Y.; Luthern, S.; Schneider, J. M.; Martino, B.; McNamara, R.; Nambu, C.; Nelson, S.; Noone, M.; Ommerborn, C.; Pacheco, L. C.; Phan, N.; Porto, F. A.; Ryan, E.; Selleck, K.; Slaughenhaupt, S.; Sheppard, K. S.; Suschana, E.; Wilson, V.; Carrington, M.; Martin, M.; Yuki, Y.; Alter, G.; Balazs, A.; Bals, J.; Barbash, M.; Bartsch, Y.; Boucau, J.; Carrington, M.; Chevalier, J.; Chowdhury, F.; DeMers, E.; Einkauf, K.; Fallon, J.; Fedirko, L.; Finn, K.; Garcia-Broncano, P.; Ghebremichael, M. S.; Hartana, C.; Jiang, C.; Judge, K.; Kaplonek, P.; Karpell, M.; Lai, P.; Lam, E. C.; Lefteri, K.; Lian, X.; Lichterfeld, M.; Lingwood, D.; Liu, H.; Liu, J.; Ly, N.; Hill, Z. M.; Michell, A.; Millstrom, I.; Miranda, N.; O'Callaghan, C.; Osborn, M.; Pillai, S.; Rassadkina, Y.; Reissis, A.; Ruzicka, F.; Seiger, K.; Sessa, L.; Sharr, C.; Shin, S.; Singh, N.; Sun, W.; Sun, X.; Ticheli, H.; Trocha-Piechocka, A.; Walker, B.; Worrall, D.; Yu, X. G.; Zhu, A..
Sci Immunol ; : eabk3070, 2021.
Article in English | PubMed | ID: covidwho-1519187

ABSTRACT

[Figure: see text].

15.
Otolaryngology - Head and Neck Surgery ; 165(1 SUPPL):P79, 2021.
Article in English | EMBASE | ID: covidwho-1467805

ABSTRACT

Introduction: The COVID-19 pandemic has been a financially challenging time for health care organizations with some ear, nose, and throat (ENT) clinics reporting about a 50% drop in completed scheduled ENT visits during the first wave compared with 2019. In this study, we assessed the economic impact of COVID-19 on otolaryngology practices by identifying businesses that received Paycheck Protection Program (PPP) funding from the Small Business Administration (SBA). Method: In December 2020 a cross-sectional study was conducted using publicly available data published on PPP loans greater than $0.15M by the SBA. Otolaryngology clinics benefiting from this funding were filtered using the following terms: “otolaryngology,” “otolaryngologist,” “sinus,” “head and neck,” “throat,” “ENT,” and “facial plastic.” The study criteria identified 481 clinics that met inclusion criteria following manual confirmation and duplicate removal. Loan amount, business type, geographic region, owner race, owner gender, and the number of jobs per business were recorded for each clinic. Chi-square analysis was performed to determine the significance (P < .05) of each characteristic. Results: There were significant differences in loan distribution based on business type (P < .001) and jobs reported (P < .001). Higher proportions of Subchapter S corporations (60.00%) received smaller loans of $0.15 to $0.35M than limited liability companies (39.13%) and corporations (51.69%), which generally employ more people. Similarly, 100% of loans ranging from $0.15 to $0.35M went to micro and small practices, whereas 33% of medium-sized practices received loans greater than $1M. All businesses employing greater than 250 people (n = 5) received loans of $2M+. Conclusion: This study suggests PPP funding was distributed equitably to applicant ENT clinics with larger clinics receiving larger loans.

16.
Chest ; 160(4):A1544, 2021.
Article in English | EMBASE | ID: covidwho-1466163

ABSTRACT

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: The Fontan procedure is a palliative surgical procedure performed in children ages 2-4 years old with hypoplastic right heart syndrome by relocating the inferior vena cava from the right atrium to the right pulmonary artery to complete the Fontan circuit[1][2]. This circuit allows for normalization of arterial saturation and abolishment of chronic volume overload at the cost of decreased cardiac output.[1] This adjustment allows for almost all venous blood to return to heart through the right pulmonary artery[3]. We present a case below in a patient with hypoplastic right heart treated with the Fontan procedure who was later diagnosed with testicular choriocarcinoma with hematogenous metastasis through the right pulmonary artery. CASE PRESENTATION: An 18-year-old male with a past medical history of heterotaxia, hypoplastic right heart treated with Fontan palliation and Kawashima surgery initially presented for persistent, worsening dyspnea. On further questioning the patient reported an active lifestyle but over the past several weeks had begun to develop dyspnea with limited ambulation and persistent cough. On presentation, the patient was found to be in acute hypoxic respiratory failure. Computed tomography (CT) imaging of the chest, abdomen and pelvis showed a new large right retroperitoneal mass causing hydronephrosis as well as innumerable right sided pulmonary nodules concerning for metastatic disease. Biopsy of the retroperitoneal mass revealed germ cell tumor, with choriocarcinoma heavily present in the tissue. The patient underwent MRI of the brain for staging, which subsequently revealed numerous embolic strokes. He was started on a chemotherapy regimen of etoposide, ifosfamide, and cisplatin;however, his course was complicated by COVID-19 infection which caused further deterioration in his respiratory status. He unfortunately passed away from respiratory failure. DISCUSSION: In this case, the Fontan procedure provided the patient with excellent oxygenation as the patient was able to exercise and live relatively unbound by his complex cardiovascular history. However, this procedure served as the conduit that allowed his testicular choriocarcinoma to hematogenously spread and predominately seed his right lung. Hospitalization was further complicated by active COVID-19 infection and in concert with his poor lung status, the patient passed. CONCLUSIONS: This case highlights the unique anatomy and physiology of patients treated with the Fontan circulation. This life saving surgery performed in early childhood unfortunately served as the conduit for hematogenously spread of choriocarcinoma. As a consequence of the surgery, the right pulmonary artery receives all the venous return which then allowed the malignancy to spread predominately to the right lung. REFERENCE #1: Gewillig M. The Fontan Circulation. Heart. 2005;91:839-846 REFERENCE #2: Kutty S, Jacobs M, Thompson R, Danford D. Fontan Circulation of Next Generation: Why It's Necessary, What It May Look Like. JAHA. 2020;9:e01 3691 REFERENCE #3: Cowgill LD. The Fontan Procedure: A Historical Review. Ann Thoracic Surgery. 1991;51:1026-30 DISCLOSURES: No relevant relationships by Arjan Ahluwalia, source=Web Response No relevant relationships by Martin Delatorre, source=Web Response No relevant relationships by Kaitlyn Musco, source=Web Response No relevant relationships by Alina Zhu, source=Web Response

17.
Facets ; 6:925-958, 2021.
Article in English | Web of Science | ID: covidwho-1285093

ABSTRACT

Those experiencing homelessness in Canada are impacted inequitably by COVID-19 due to their increased exposure, vulnerability of environment and medical comorbidities, and their lack of access to preventive care and treatment in the context of the pandemic. In shelter environments one is unable to effectively physically distance, maintain hygiene, obtain a test, or isolate. As a result, unique strategies are required for this population to protect them and those who serve them. Recommendations are provided to reduce or prevent further negative consequences from the COVID-19 pandemic for people experiencing homelessness. These recommendations were informed by a systematic review of the literature, as well as a jurisdictional scan. Where evidence did not exist, expert consensus from key providers and those experiencing homelessness throughout Canada was included. These recommendations recognize the need for short-term interventions to mitigate the immediate risk to this community, including coordination of response, appropriate precautions and protective equipment, reducing congestion, cohorting, testing, case and contact management strategies, dealing with outbreaks, isolation centres, and immunization. Longer-term recommendations are also provided with a view to ending homelessness by addressing the root causes of homelessness and by the provision of adequate subsidized and supportive housing through a Housing First strategy. It is imperative that meaningful changes take place now in how we serve those experiencing homelessness and how we mitigate specific vulnerabilities. These recommendations call for intersectoral, collaborative engagement to work for solutions targeted towards protecting the most vulnerable within our community through both immediate actions and long-term planning to eliminate homelessness.

18.
Fertility and Sterility ; 114(3):e60-e61, 2020.
Article in English | EMBASE | ID: covidwho-886901

ABSTRACT

Objective: There has been a rapid expansion of video visits, a form of telehealth, with the COVID-19 pandemic;however, little is known about the feasibility or benefits of video visits for patients seeking male infertility care. Herein we summarize a single institution’s experience using video visits to manage infertility prior to the COVID-19 pandemic. Specifically, we evaluate the number of patients engaging in video visits for the first time, and the patient resources saved by forgoing in-person appointments. Design: Retrospective case series of patients undergoing video visits for follow-up of male-infertility care. Materials and Methods: We identified all video visits performed at our institution between August 21, 2017 and March 17, 2020. We included men seen for male infertility by a single urologist. We used chart review to collect patient demographic information including age, primary language, race, and occupation. Patients were identified as blue collar versus white collar workers with respect to their engagement in manual labor. We determined whether patients had a prior video visit completed at our institution. We used Google MapsTM to calculate round-trip driving distance and time saved based on patients’ city of residence. Driving costs saved were calculated by using American Automobile Association’s cost estimate of >source.59/mile. Finally, salaries were used to estimate wages lost if taking a half or full day off to attend an in-person clinic visit. Results: 70 male infertility video visits were completed by 56 patients. Median age of patients was 36 years old (range 20-56), 96% identified preferred language as English, and 78% self-identified as white. There were a total of 49 unique occupations among the 56 men. 32% were blue collar workers and 68% were white collar workers. For 55 of 56 patients, this study period represented their first use of video visits in our health system. Video visits allowed patients to save a median of 80 miles (interquartile range 46-244) and 97 minutes (IQR 64-250) of travel per visit. This resulted in a median of $47 (IQR 27–144) of driving costs saved per visit. By not having to miss a half or full day of work, patients potentially avoided a median of $102 (IQR $69 – 133) to $205 (IQR $137 – 266) in lost wages, respectively. Total median savings per patient ranged from $149 (half day off) to $252 (full day off). Median salary of our cohort was $51,331. In total, 70 video visits saved 56 patients 11,646 miles and 12,070 minutes in travel. Total estimated savings to patients was $14,539 (half day off) to $22,206 (full day off). Conclusions: Video visits are a feasible option for follow-up infertility care and are a patient-centric modality that reduces travel and financial burdens. 98% of patients were first-time video visit users suggesting that men are amenable to using video visits for male infertility care. Calculated cost savings may have underestimated total expenses as we did not account for meals, parking fees and other expenses incurred by traveling for an in-person appointment.

19.
Fertility and Sterility ; 114(3):e181-e182, 2020.
Article in English | EMBASE | ID: covidwho-880485

ABSTRACT

Objective: With the rapid expansion of telehealth use during COVID-19, it remains unknown how video visits are being used to evaluate male infertility particularly when patients are not able to undergo a physical exam. We sought to assess what diagnoses were seen and which tests were pursued as part of the new patient evaluation. Herein we summarize a single institution’s experience with video visits for male infertility during COVID-19. Design: Retrospective case series of patients with male infertility managed via video visits. Materials and Methods: We identified video visits completed at our institution between March 23, 2020 and April 29, 2020 for male infertility. We included new patients visits and return visits for men 18 years of age or older completed by two andrology-trained urologists. We collected and categorized scheduled visit type;visit completion rate;patient demographic and referral information;primary diagnoses;and laboratory and imaging tests ordered for new patient evaluations. Results: There were 51 scheduled video visits with 21 (41.2%) new patient and 30 (58.8%) established patient encounters. Eight (15.7%) video visits were cancelled—7 re-scheduled and 1 converted to a telephone encounter due to technical issues—and 6 (11.8%) were no-shows. The median age was 32 years (range 22 – 48) and most patients were referred by their primary care provider or their partner’s reproductive endocrinologist (53% and 18%, respectively). For the 38 completed video visits, primary diagnoses included 11 (29%) idiopathic cases, 11 (29%) endocrinologic derangements, and 9 (24%) cases had anatomic contributors to infertility such as varicocele, previous vasectomy or ejaculatory duct obstruction. Additional diagnoses included genetic abnormalities (5%), concurrent partner evaluation (3%), sperm DNA integrity concerns (3%), active infection with pyospermia (3%), and post-operative hematoma (3%). Of the 17 completed new patient visits, most were diagnosed with idiopathic 6 (35%) or anatomic (24%) conditions. Only 4 new patients (24%) had previously undergone an examination by a urologist. Eleven new patients (65%) required additional hormonal testing, 5 (29%) required another semen analysis, and 5 (29%) had scrotal ultrasound ordered due to inability to perform a physical exam due to limited use of outpatient clinics during COVID-19. Three (18%) required genetic testing, 2 (12%) a pituitary MRI, and 1 (6%) required DNA fragmentation testing. Conclusions: Due to COVID-19, use of video visit has expanded to include new patient, male infertility evaluations. The most commonly ordered tests for these men included additional hormonal testing, additional semen analyses, and scrotal ultrasounds. While the physical exam is a crucial aspect of the infertility work-up, this series suggests that video visits could help ensure that a complete evaluation takes place even before a man undergoes a physical exam in clinic.

20.
Fertility and Sterility ; 114(3):e25, 2020.
Article in English | EMBASE | ID: covidwho-880459

ABSTRACT

Objective: While the COVID-19 pandemic has resulted in a rapid expansion of telehealth services, it remains unknown how video visits, a form of telehealth, can be used to treat male infertility. We sought to evaluate what infertility diagnoses were see and how they were managed through telehealth. Herein we summarize a single institution’s experience with video visits for male infertility prior to COVID-19. Design: Retrospective case series of patients with male infertility managed via video visits. Materials and Methods: We identified video visits completed at our institution between August 21, 2017 and March 17, 2020 for male infertility. All men had a previous in-person examination. We collected patient demographic and referral information, grouped primary diagnoses, categorize what management steps were taken, and determined whether in-person examinations were needed within 90 days. Results: 70 video visits were completed by 56 men. The median age was 36 years (interquartile range 32 - 40), 78.5% were white, and most patients were referred by their primary care provider or their partner’s reproductive endocrinologist (47% and 33%, respectively). Most men were diagnosed with endocrinologic (29%) or anatomic (21%) contributors to infertility. See Table1A for full diagnostic categories. 73% of video visits involved reviewing results such as semen analysis and hormonal testing. 30% of visits involved counseling for assistive reproductive technologies (ART) and, in 25% of visits, hormonally active medications were prescribed. See Table1B for all management categories. There were only two in-person visits within 90 days after a video visit, both of which were planned post-operative visits. [Formula presented] Conclusions: Video visits can be used with established patients to manage a broad spectrum of diagnoses that contribute to male infertility. In the short-term, these visits are serve as substitutes for clinic visits without resulting in additional in-person encounters.

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