A Tale of Two Counties With the Same Telehealth Story: Experience with Cancer Genetics Testing During COVID-19 at a Community Hospital

Introduction: With the onset of the COVID-19 pandemic in 2020, the utilization of telemedicine now offered an alternative diagnostic and treatment resource to providers in many areas of medicine including oncology and cancer genetics. This care option paired with genetic testing labs' ability to send saliva-based DNA collection kits to patients, enabled our community hospital in Detroit to offer diagnostic testing without the patient coming to a healthcare setting for a host of reasons. Social determinants of health have been found to influence success with telehealth, and this study sought to analyze how successful telehealth cancer genetics care was throughout the Detroit Metro area. Methods: Patient demographics for in person visits six months before COVID were analyzed, and then compared with demographics of patients during the 2020-2021 pandemic period where visits were telehealth. Results: Pre-pandemic there were , 192 unique patients seen in person with the top three cities patients were from were Detroit (12.1%), Clinton Township (8.3%), and Saint Clair Shores (10.4%). During the pandemic, with telehealth as the major modality, the top three cities were Macomb (7.2%), Detroit (7%), and Clinton Township (7%). Detroit is in Wayne County, while St.Clair Shores and Clinton Township are in Macomb County. Per the US Census Bureau Macomb county has a median income of $64,641 and Wayne county has a median income of $49,359, and poverty level in Macomb county is 9.2% versus in Wayne the level is 20%. Conclusions: This paper outlines the challenges of initiating a telemedicine program in an urban community area and highlights the benefits of a concierge service in serving cancer patients who may have economic and historically poor perceived technologic abilities.

Passive swab versus grab sampling for detection of SARS-CoV-2 markers in wastewater.

Early detection of the COVID-19 virus, SARS-CoV-2, is key to mitigating the spread of new outbreaks. Data from individual testing is increasingly difficult to obtain as people conduct non-reported home tests, defer tests due to logistics or attitudes, or ignore testing altogether. Wastewater based epidemiology is an alternative method for surveilling a community while maintaining individual anonymity; however, a problem is that SARS-CoV-2 markers in wastewater vary throughout the day. Collecting grab samples at a single time may miss marker presence, while autosampling throughout a day is technically challenging and expensive. This study investigates a passive sampling method that would be expected to accumulate greater amounts of viral material from sewers over a period of time. Tampons were tested as passive swab sampling devices from which viral markers could be eluted with a Tween-20 surfactant wash. Six sewersheds in Detroit were sampled 16-22 times by paired swab (4 h immersion before retrieval) and grab methods over a five-month period and enumerated for N1 and N2 SARS-CoV-2 markers using ddPCR. Swabs detected SARS-CoV-2 markers significantly more frequently (P < 0.001) than grab samples, averaging two to three-fold more copies of SARS-CoV-2 markers than their paired grab samples (p < 0.0001) in the assayed volume (10 mL) of wastewater or swab eluate. No significant difference was observed in the recovery of a spiked-in control (Phi6), indicating that the improved sensitivity is not due to improvements in nucleic acid recovery or reduction of PCR inhibition. The outcomes of swab-based sampling varied significantly between sites, with swab samples providing the greatest improvements in counts for smaller sewersheds that otherwise tend to have greater variation in grab sample counts. Swab-sampling with tampons provides significant advantages in detection of SARS-CoV-2 wastewater markers and are expected to provide earlier detection of new outbreaks than grab samples, with consequent public health benefits.

Urban Farming: The Reluctant Utopia

The old conceptual dichotomy between the city and the countryside has often been a historical stumbling block for architects and urban planners. Whilst there have been many attempts to bring the city closer to the natural environment, some on grand scales, more modest experiments have often gleaned better results. Daniele Belleri is a partner at design and innovation office CRA-Carlo Ratti Associati, where he is in charge of all editorial and curatorial projects. He and the practice's founder, architect and engineer Carlo Ratti – who is director of the Senseable City Lab at the Massachusetts Institute of Technology (MIT) – together explore our contemporary options. Copyright © 2023 John Wiley & Sons, Ltd.

Urban Farming: The Reluctant Utopia

The old conceptual dichotomy between the city and the countryside has often been a historical stumbling block for architects and urban planners. Whilst there have been many attempts to bring the city closer to the natural environment, some on grand scales, more modest experiments have often gleaned better results. Daniele Belleri is a partner at design and innovation office CRA-Carlo Ratti Associati, where he is in charge of all editorial and curatorial projects. He and the practice's founder, architect and engineer Carlo Ratti – who is director of the Senseable City Lab at the Massachusetts Institute of Technology (MIT) – together explore our contemporary options. Copyright © 2023 John Wiley & Sons, Ltd.

A smaller auto show

The North American International Auto Show (NAIAS) returned to Detroit in September after a three-year hiatus due to the COVID-19 pandemic, and it could fairly be described as weird. Becker usually attends to see not just the latest automobile designs but the newest technology. This year, the show was smaller than ever, had fewer automakers participating and had almost no displays on the inner workings of the vehicles. How did the public react? One measure would be attendance, which in prepandemic years often exceeded 800,000 people. Unfortunately, the Detroit Auto Dealers Association (DADA), which runs the show, has announced it will not be releasing attendance figures this year. A DADA spokesperson, Frank Buscemi, didn't explain the reason behind this decision. His guess is that the number would be embarrassingly small.

Implementation of Telemedicine in a Tertiary Hospital-Based Ambulatory Practice in Detroit During the COVID-19 Pandemic: Observational Study.

BACKGROUND: The COVID-19 pandemic, caused by SARS-CoV-2, has forced the health care delivery structure to change rapidly. The pandemic has further widened the disparities in health care and exposed vulnerable populations. Health care services caring for such populations must not only continue to operate but create innovative methods of care delivery without compromising safety. We present our experience of incorporating telemedicine in our university hospital-based outpatient clinic in one of the worst-hit areas in the world. OBJECTIVE: Our goal is to assess the adoption of a telemedicine service in the first month of its implementation in outpatient practice during the COVID-19 pandemic. We also want to assess the need for transitioning to telemedicine, the benefits and challenges in doing so, and ongoing solutions during the initial phase of the implementation of telemedicine services for our patients. METHODS: We conducted a prospective review of clinic operations data from the first month of a telemedicine rollout in the outpatient adult ambulatory clinic from April 1, 2020, to April 30, 2020. A telemedicine visit was defined as synchronous audio-video communication between the provider and patient for clinical care longer than 5 minutes or if the video visit converted to a telephone visit after 5 minutes due to technical problems. We recorded the number of telemedicine visits scheduled, visits completed, and the time for each visit. We also noted the most frequent billing codes used based on the time spent in the patient care and the number of clinical tasks (eg, activity suggested through diagnosis or procedural code) that were addressed remotely by the physicians. RESULTS: During the study period, we had 110 telemedicine visits scheduled, of which 94 (85.4%) visits were completed. The average duration of the video visit was 35 minutes, with the most prolonged visit lasting 120 minutes. Of 94 patients, 24 (25.54%) patients were recently discharged from the hospital, and 70 (74.46%) patients were seen for urgent care needs. There was a 50% increase from the baseline in the number of clinical tasks that were addressed by the physicians during the pandemic. CONCLUSIONS: There was a high acceptance of telemedicine services by the patients, which was evident by a high show rate during the COVID-19 pandemic in Detroit. With limited staffing, restricted outpatient work hours, a shortage of providers, and increased outpatient needs, telemedicine was successfully implemented in our practice.

Surveillance of SARS-CoV-2 in nine neighborhood sewersheds in Detroit Tri-County area, United States: Assessing per capita SARS-CoV-2 estimations and COVID-19 incidence.

Wastewater-based epidemiology (WBE) has been suggested as a useful tool to predict the emergence and investigate the extent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this study, we screened appropriate population biomarkers for wastewater SARS-CoV-2 normalization and compared the normalized SARS-CoV-2 values across locations with different demographic characteristics in southeastern Michigan. Wastewater samples were collected between December 2020 and October 2021 from nine neighborhood sewersheds in the Detroit Tri-County area. Using reverse transcriptase droplet digital polymerase chain reaction (RT-ddPCR), concentrations of N1 and N2 genes in the studied sites were quantified, with N1 values ranging from 1.92 × 102 genomic copies/L to 6.87 × 103 gc/L and N2 values ranging from 1.91 × 102 gc/L to 6.45 × 103 gc/L. The strongest correlations were observed with between cumulative COVID-19 cases per capita (referred as COVID-19 incidences thereafter), and SARS-CoV-2 concentrations normalized by total Kjeldahl nitrogen (TKN), creatinine, 5-hydroxyindoleacetic acid (5-HIAA) and xanthine when correlating the per capita SARS-CoV-2 and COVID-19 incidences. When SARS-CoV-2 concentrations in wastewater were normalized and compared with COVID-19 incidences, the differences between neighborhoods of varying demographics were reduced as compared to differences observed when comparing non-normalized SARS-CoV-2 with COVID-19 cases. This indicates when studying the disease burden in communities of different demographics, accurate per capita estimation is of great importance. The study suggests that monitoring selected water quality parameters or biomarkers, along with RNA concentrations in wastewater, will allow adequate data normalization for spatial comparisons, especially in areas where detailed sanitary sewage flows and contributing populations in the catchment areas are not available. This opens the possibility of using WBE to assess community infections in rural areas or the developing world where the contributing population of a sample could be unknown.

Sensitive detection of SARS-CoV-2 molecular markers in urban community sewersheds using automated viral RNA purification and digital droplet PCR.

Wastewater based epidemiology (WBE) has emerged as a strategy to identify, locate, and manage outbreaks of COVID-19, and thereby possibly prevent surges in cases, which overwhelm local to global health care networks. The WBE process is based on assaying municipal wastewater for molecular markers of the SARS-CoV-2 virus. Standard processes for purifying viral RNA from municipal wastewater are often time-consuming and require the handling of large quantities of wastewater, negatively affecting throughput, timely reporting, and safety. We demonstrate here an automated, faster system to purify viral RNA from smaller volumes of wastewater but with increased sensitivity for detection of SARS-CoV-2 markers. We document the effectiveness of this new approach by way of comparison to the PEG/NaCl/Qiagen method prescribed by the State of Michigan for SARS-CoV-2 wastewater monitoring and show its application to several Detroit sewersheds. Specifically, compared to the PEG/NaCl/Qiagen method, viral RNA purification using the PerkinElmer Chemagic™ 360 lowered handling time, decreased the amount of wastewater required by ten-fold, increased the amount of RNA isolated per µl of final elution product by approximately five-fold, and effectively removed ddPCR inhibitors from most sewershed samples. For detection of markers on the borderline of viral detectability, we found that use of the Chemagic™ 360 enabled the measurement of viral markers in a significant number of samples for which the result with the PEG/NaCl/Qiagen method was below the level of detectability. The improvement in detectability of the viral markers might be particularly important for early warning to public health authorities at the beginning of an outbreak. Applied to sewersheds in Detroit, the technique enabled more sensitive detection of SARS-CoV-2 markers with good correlation between wastewater signals and COVID-19 cases in the sewersheds. We also discuss advantages and disadvantages of several automated RNA purification systems, made by Promega, PerkinElmer, and ThermoFisher.

Five-week warning of COVID-19 peaks prior to the Omicron surge in Detroit, Michigan using wastewater surveillance.

Wastewater-based epidemiology (WBE) is useful in predicting temporal fluctuations of COVID-19 incidence in communities and providing early warnings of pending outbreaks. To investigate the relationship between SARS-CoV-2 concentrations in wastewater and COVID-19 incidence in communities, a 12-month study between September 1, 2020, and August 31, 2021, prior to the Omicron surge, was conducted. 407 untreated wastewater samples were collected from the Great Lakes Water Authority (GLWA) in southeastern Michigan. N1 and N2 genes of SARS-CoV-2 were quantified using RT-ddPCR. Daily confirmed COVID-19 cases for the City of Detroit, and Wayne, Macomb, Oakland counties between September 1, 2020, and October 4, 2021, were collected from a public data source. The total concentrations of N1 and N2 genes ranged from 714.85 to 7145.98 gc/L and 820.47 to 6219.05 gc/L, respectively, which were strongly correlated with the 7-day moving average of total daily COVID-19 cases in the associated areas, after 5 weeks of the viral measurement. The results indicate a potential 5-week lag time of wastewater surveillance preceding COVID-19 incidence for the Detroit metropolitan area. Four statistical models were established to analyze the relationship between SARS-CoV-2 concentrations in wastewater and COVID-19 incidence in the study areas. Under a 5-week lag time scenario with both N1 and N2 genes, the autoregression model with seasonal patterns and vector autoregression model were more effective in predicting COVID-19 cases during the study period. To investigate the impact of flow parameters on the correlation, the original N1 and N2 gene concentrations were normalized by wastewater flow parameters. The statistical results indicated the optimum models were consistent for both normalized and non-normalized data. In addition, we discussed parameters that explain the observed lag time. Furthermore, we evaluated the impact of the omicron surge that followed, and the impact of different sampling methods on the estimation of lag time.

Service Deserts and Periphery Neighborhoods in Detroit: Understanding People in Their Social Worlds

Before Covid-19, Downtown Detroit was enjoying an urban renaissance, but periphery neighborhoods that were lower priority for revitalization remained “service deserts.” These service deserts resulted in coping strategies, behavioral health outcomes, and neighbors becoming service providers. Residents of these areas also experienced increased vulnerability to the pandemic due to lack of access to information and pre-existing health conditions. This article recounts how residents experience living in a service desert and the subsequent impacts of Covid-19.

An innovative telephone outreach program to seniors in Detroit, a city facing dire consequences of COVID-19

This reprinted chapter originally appeared in the Journal of Gerontological Social Work, 2020, 63[6-7], 713-716. (The following of the original article appeared in record 2021-00510-033.) We write this letter to call attention to the implications of loneliness and social isolation to the wellbeing of minority older adults, especially during the time of COVID-19, and describe our program aimed at mitigating these challenges. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

CHINESE RESTAURANTS: A HISTORY OF RESILIENCE

Chin asserts that before the COVID-19 pandemic, over 40,000 Chinese restaurants were operating across America. That's more than all the McDonalds, KFC's, Wendy's and Pizza Huts combined. Located in nearly every community and corner of the country, these ubiquitous establishments, big and small, are as American as apple pie, and, of course, more delicious. The $15 billion Chinese restaurant industry, which includes many independently owned family businesses, was amongst the first to be hit, and hit hard, by the economic crisis wrought by the coronavirus. The first Chinese restaurant in America, the Canton Restaurant, opened in San Francisco in 1849. Thousands of Chinese men had left Southern China to mine for treasures on Gold Mountain. These bachelors needed a place to eat. By 1850, there were five such establishments. However, the growing wave of anti-Asian immigration policies, including the Chinese Exclusion Act, kept the community small and limited the number of Chinese restaurants to a dozen or so.

Detroit's efforts to meet the needs of seniors: Macro responses to a crisis

This reprinted chapter originally appeared in Journal of Gerontological Social Work, 2020, 63[6-7], 706-708. (The following of the original article appeared in record 2021-00510-031.) The Senior Housing Preservation-Detroit Coalition (SHP-D), a volunteer organization without paid staff, organized to protect low income senior housing in the urban core and promote development of naturally occurring affordable housing. But as the COVID-19 pandemic took hold in the city, the coalition found itself asking who should look after the seniors in these buildings. Social workers with training in gerontology have great opportunity to participate in coalitions like SHP-D as ways to use their backgrounds and training to be part of concrete solutions. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Affordable Senior Housing Maintenance and Renovations, COVID-19, and the Precarity of Residents' Health Safety

Low-income older people in particular face a number of risks and precarities related to health, housing, and care. This article offers case studies from members of a city-wide advocacy group, Senior Housing Preservation-Detroit. Although the coalition's work began in raising awareness about risks arising from displacement due to HUD building contracts expiring, its work was altered by COVID-19. Thus the article outlines how community-based initiatives protected older residents from risks at the intersections of poverty, housing, and health amidst the COVID-19 pandemic.

GeoHealth Perspectives on Integrated, Coordinated, Open, Networked (ICON) Science

GeoHealth research both characterizes and predicts problems at the nexus of earth and human systems like climate change, pollution, and natural hazards. While GeoHealth excels in the area of integrated science, there is a need to improve coordinated and networked efforts to produce open science to enable environmental justice. There is a need to resource and empower frontline populations that are disproportionately marginalized by environmental injustice (i.e., the unequal protection from environmental harms and lack of access and meaningful engagement in decision making for a healthy environment;EPA, 2022, https://www.epa.gov/environmentaljustice). GeoHealth practice has the opportunity to advance environmental justice or the “fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income” with respect to how research and collaboration of GeoHealth professionals supports the “development, implementation, and enforcement of environmental laws, regulations, and policies” that produce equal protection from environmental and health hazards and access to the decision making for a health environment (EPA, 2022, https://www.epa.gov/environmentaljustice). Here we highlight barriers and opportunities to apply an equity‐centered ICON framework to the field of GeoHealth to advance environmental justice and health equity.

Obituary: Janet L. Langlois (1946–2021)

An obituary for Janet L. Langlois, a leading legend scholar, who died on May 22, 2021, is presented. Langlois received a master's degree in Library Science and then joined the doctoral program in folklore at Indiana University, receiving her PhD in 1977. That same year, she became Professor of English and Folklore Studies at Wayne State University, where she taught for 38 years. A two-time winner of Wayne State's President';s Award for Excellence in Teaching, she influenced countless students and fellow scholars, both in classes at Wayne State and through her folklore publications and talks.

The Impact of Systemic Racism on Responses to and Recovery from COVID-19: A Comparative Analysis of Policy and Practice in New York City and Detroit

When COVID-19 was first reported in the United States in spring 2020, it illuminated society to the vast inequities that racially marginalized populations face in comparison to their White counterparts. Metropolitan areas, in particular, were hit the hardest by the pandemic. New York City and Detroit, cities with large numbers of racially marginalized populations, experienced high COVID-19 test positivity rates during the pandemic's first and second waves. It is the aim of this research note to provide policymakers, practitioners, and healthcare personnel with an overview of response and recovery efforts through an analysis of the intersection between racially marginalized groups and access to healthcare in New York City and Detroit. We propose three recommendations: 1) increased centralized data on the differences between racially marginalized populations and non-minorities;2) additional federal funding to local health departments;and 3) the utilization of faith-based and community-based organizations as additional COVID-19 testing sites.

RESOURCES

[...]the principal aspects of heterogeneity that produce complexity in MOFs, their effects in the structure chemistry, performance and applications have been thoroughly reported. Since there is no other book that covers all of the aspects of complexity in MOFs with heterogeneous structures, the findings can be seen as essential concepts, with introducing complexity to design, the new platforms of materials with advanced and better properties in the future. Visitors from both the lubricant community and end-user OEMs will find a comprehensive showcase of all lubricant technologies, including finished lubricants, additives, process equipment and machinery, condition monitoring, automation systems, testing and analysis, data technologies, lubricant manufacturing equipment, end-user application systems and more. The Lubricant Expo will provide a dedicated showcase of the technology and knowledge needed to reduce costs, improve efficiency, maximize the performance of lubricants, achieve the requirements of the products they enable and preserve the health of machinery across operating environments.

Dynamic Panel Data Modeling and Surveillance of COVID-19 in Metropolitan Areas in the United States: Longitudinal Trend Analysis.

BACKGROUND: The COVID-19 pandemic has had profound and differential impacts on metropolitan areas across the United States and around the world. Within the United States, metropolitan areas that were hit earliest with the pandemic and reacted with scientifically based health policy were able to contain the virus by late spring. For other areas that kept businesses open, the first wave in the United States hit in mid-summer. As the weather turns colder, universities resume classes, and people tire of lockdowns, a second wave is ascending in both metropolitan and rural areas. It becomes more obvious that additional SARS-CoV-2 surveillance is needed at the local level to track recent shifts in the pandemic, rates of increase, and persistence. OBJECTIVE: The goal of this study is to provide advanced surveillance metrics for COVID-19 transmission that account for speed, acceleration, jerk and persistence, and weekly shifts, to better understand and manage risk in metropolitan areas. Existing surveillance measures coupled with our dynamic metrics of transmission will inform health policy to control the COVID-19 pandemic until, and after, an effective vaccine is developed. Here, we provide values for novel indicators to measure COVID-19 transmission at the metropolitan area level. METHODS: Using a longitudinal trend analysis study design, we extracted 260 days of COVID-19 data from public health registries. We used an empirical difference equation to measure the daily number of cases in the 25 largest US metropolitan areas as a function of the prior number of cases and weekly shift variables based on a dynamic panel data model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. RESULTS: Minneapolis and Chicago have the greatest average number of daily new positive results per standardized 100,000 population (which we refer to as speed). Extreme behavior in Minneapolis showed an increase in speed from 17 to 30 (67%) in 1 week. The jerk and acceleration calculated for these areas also showed extreme behavior. The dynamic panel data model shows that Minneapolis, Chicago, and Detroit have the largest persistence effects, meaning that new cases pertaining to a specific week are statistically attributable to new cases from the prior week. CONCLUSIONS: Three of the metropolitan areas with historically early and harsh winters have the highest persistence effects out of the top 25 most populous metropolitan areas in the United States at the beginning of their cold weather season. With these persistence effects, and with indoor activities becoming more popular as the weather gets colder, stringent COVID-19 regulations will be more important than ever to flatten the second wave of the pandemic. As colder weather grips more of the nation, southern metropolitan areas may also see large spikes in the number of cases.