Scaling law of COVID-19 cases and city size and its evolution over time

Urban scaling law quantifies the disproportional growth of urban indicators with urban population size, which is one of the simple rules behind the complex urban system. Infectious diseases are closely related to social interactions that intensify in large cities, resulting in a faster speed of transmission in large cities. However, how this scaling relationship varies in an evolving pandemic is rarely investigated and remains unclear. Here, taking the COVID- 19 epidemic in the United States as an example, we collected daily added cases and deaths from January 2020 to June 2022 in more than three thousand counties to explore the scaling law of COVID- 19 cases and city size and its evolution over time. Results show that COVID- 19 cases super- linearly scaled with population size, which means cases increased faster than population size from a small city to a large city, resulting in a higher morbidity rate of COVID- 19 in large cities. Temporally, the scaling exponent that reflects the scaling relationship stabilized at around 1.25 after a fast increase from less than one. The scaling exponent gradually decreased until it was close to one. In comparison, deaths caused by the epidemic did not show a super-linear scaling relationship with population size, which revealed that the fatality rate of COVID-19 in large cities was not higher than that in small or medium-sized cities. The scaling exponent of COVID- 19 deaths shared a similar trend with that of COVID- 19 cases but with a lag in time. We further estimated scaling exponents in each wave of the epidemic, respectively, which experienced the common evolution process of first rising, then stabilizing, and then decreasing. We also analyzed the evolution of scaling exponents over time from regional and provincial perspectives. The northeast, where New York State is located, had the highest scaling exponent, and the scaling exponent of COVID- 19 deaths was higher than that of COVID-19 cases, which indicates that large cities in this region were more prominently affected by the epidemic. This study reveals the size effect of infectious diseases based on the urban scaling law, and the evolution process of scaling exponents over time also promotes the understanding of the urban scaling law. The mechanism behind temporal variations of scaling exponents is worthy of further exploration. © 2023 Science Press. All rights reserved.

Three-month Clinical Status of A Cohort of Adult Hospitalized COVID-19 Pimpaka Srisiriwanna M.D., Poolsuk Janepanish Visudtibhan Ph.D., Kumthorn Malathum M.D

Background: A significant portion of individuals with SARS-CoV-2 infection have persistent COVID-19 symptoms after recovery. Symptoms may be new or persistent from the initial illness, which could cause both psychological and physical difficulty to the patients. These symptoms are collectively known as "long COVID-19 syndrome". There is limited information about this syndrome in the Thai population. Objectives: We aimed to describe and evaluate the risk for post COVID-19 symptoms among hospitalized COVID-19 patients in a university hospital. Methods: A prospective descriptive study was conducted on symptomatic COVID-19 patients admitted in Ramathibodi Hospital from July 1 to September 10, 2021. All surviving COVID-19 patients received a telephone assessment every month until 3 months after discharge and electronic medical records were reviewed. Information collected included symptoms, severity, treatment, duration of symptom, complication of COVID-19 and treatment. The New York Heart Association (NYHA) functional classification was used to categorized severity of dyspnea. Results: Among 253 evaluable patients, 57.3% were female and the mean age was 59.3 years old. Of these, 66% and 24.1% had moderate (pneumonia and SpO2 90%) and severe COVID-19 (pneumonia with severe respiratory distress and SpO2 90%), respectively. Almost all patients were inadequately vaccinated (unvaccinated 53.3%, partially vaccinated 41.9%). Overall, complete resolution of symptoms before 1 month after onset were noted in 47 patients (18.5%) and 72 (28.5%) patients had at least one persistent symptom at three months. The most common symptom is sleep disturbance (11.9%);29.2% remain in NYHA II and 0.8% in NYHA III and IV each. Female gender (OR 1.94;[95% CI 1.09-3.48], p=0.024), history of receiving dexamethasone (OR 1.04;[95% CI 1.01-1.08], p=0.004) and length of hospitalization (OR 1.04;[95% CI 1.00-1.08], p=0.034) were associated with being in NYHA II. Additionally, 5.9% had bacterial infection, and most were urinary tract infection and pneumonia, respectively. The risk factor associated with post-COVID-19 bacterial infection is bed ridden status (OR 23.3;[95% CI 5.79-93.72], p=<0.001). Conclusions: A significant number of COVID-19 patients had residual COVID-19 symptoms and still not fully functional at least 3 months after recovery. A major limitation of this study is obtaining information by telephone interview since hospital visit were not encouraged to limit mobility of people during pandemic, which may have led to a recall bias.

Using Descriptive Inquiry to Make and Do Philosophy in School: Creating Shared Educational Principles at City-As-School during the Coronavirus Pandemic

This piece describes how the faculty of City-As-School used Descriptive Inquiry to generate shared educational principles during the 2020-21 school year during the coronavirus pandemic. City-As-School is a public experiential learning school in New York City serving older adolescents seeking an alternative to traditional high school. Descriptive Inquiry is an inquiry process developed by Patricia Carini and faculty at the Prospect School in Bennington, Vermont, that supports educators in understanding children and their own educational practice to teach for human dignity, ethical well-being, and holistic growth. The piece provides an introduction to City-As-School and briefly describes how faculty members have used Descriptive Inquiry to foster whole school professional learning and growth. The piece then details how the faculty used Descriptive Inquiry to surface and concretize shared educational principles during the 2020-21 school year, a poignant example of Patricia Carini's notion of "making and doing philosophy in a school."

Pandemic related mental health

OnTrackNY is a nationally recognized Coordinated Specialty Care model disseminated across New York state for young people experiencing early non-affective psychosis. OnTrackNY is a network of 22 teams located in licensed outpatient clinics, serving over 2500 individuals. OnTrackNY offers medication management, case management, individual and group cognitive behaviourally oriented therapy, family support and psychoeducation, supported employment and education, and peer support services. Teams receive training for implementation through an intermediary organization called OnTrack Central. OnTrackNY was selected as a regional hub of the National Institute of Mental Health Early Psychosis Intervention Network (EPINET), a national learning healthcare system (LHS) for young adults with early psychosis. This symposium will present the different ways in which EPINET OnTrackNY implemented systematic communitybased participatory processes to ensure robust stakeholder involvement to improve the quality of OnTrackNY care. Florence will present results of an assessment of stakeholder feedback experiences used to develop strategies for assertive outreach and engagement of program participants, families and providers. Bello will present on mechanisms for integrating of co-creation principles to design, develop and execute quality improvement projects in EPINET OnTrackNY. Stefancic will present on quality improvement projects that used rapid cycle qualitative methods, tools, and strategies to build team capacity and flexibility to respond to an LHS. Montague will present adaptations to OnTrackNY services during the COVID-19 pandemic using an implementation science framework. Finally, Patel will lead a discussion on the implications of involving individuals with lived experiences in all phases of the process to maximize learning in an LHS.

Postgraduate Architectural Education In Situ

From 2005 to 2017, William E Massie held the position of Architect-in-Residence/Head of Department at Cranbrook. Making is in Massie's lifeblood and his tenure was characterised by students making larger-scale constructions. Dismantling the rather insular personal studio, Massie reintroduced a communal studio culture where students learn from each other and create in mutual association.

Does the absence of zoo visitors during the COVID-19 pandemic impact Gorilla behavior?

Whether or not primates are behaviorally affected by the presence of visitors in a zoo setting is a question of great relevance to zoo animal well-being. The situation imposed by the COVID-19 pandemic provided an unusual opportunity to examine how the absence of visitors impacts behavior. We took advantage of this opportunity to study the behavior of a gorilla troop during periods of no-visitors compared to our long-term database on gorilla behavior during normal zoo operations. While there were notable individual differences in response to visitors, we found no significant relationship between presence of visitors and behavior. These results suggest that the presence of visitors does not have a significant impact on behavior and well-being of zoo-housed gorillas.

The COVID-19 pandemic required a rapid expansion of teledermatology services

Background: The COVID-19 pandemic required a rapid expansion of tele dermatology services. Objective(s): Analyse demographic shifts in a pediatric dermatology practice session with children of colour. Method(s): A retrospective chart review of pediatric dermatology patients seen in the four practice weeks preceding the New York COVID-19 lockdown and comparable tele dermatology visits during the COVID-19 pandemic lockdown. Demographic differences (e.g., race, age, gender and household income) were analysed. Result(s): A greater proportion of patients seen were White during lockdown (59.7%), compared to pre-lockdown (43.6%), with a reduction in Asian patients seen in lockdown (6.0%) compared to prelockdown (24.5%). A lower proportion of no-show patients (4.3%, 3/70 scheduled) were noted in lockdown compared to pre-lockdown (16%, 18/112). Preferred provider organizations and higher-income zip codes were more common for children seen during lockdown. Limitation(s): The sample addresses a limited New York pediatric dermatology practice during a short time-period. Conclusion(s): White patients and patients with preferred provider organizations were more likely to access telehealth, supporting disparity in tele dermatology services. These results demonstrate reduced healthcare access for lower-income and Asian children during the COVID-19 pandemic lockdown.

U.S. Public Transportation Ridership Analysis and Prediction based on COVID-19

In this paper, a research was conducted to analyse and predict the impacts of COVID-19 on public transportation ridership in the U.S. and 5 most populous cities of the U.S. (New York City, Los Angeles, Chicago, Houston, Philadelphia). The paper aims to exploit the correlation between COVID-19 and public transportation ridership in the U.S. and make the reasonable prediction by machine learning models, including ARIMA and Prophet, to help the local governments improve the rationality of their policy implementation. After correlation analyses, high level of significant and negative correlations between monthly growth rate of COVID-19 infections and monthly growth rate of public transportation ridership are decidedly validated in the total U.S., and New York City, Los Angeles, Chicago, Philadelphia, except Houston. To analyse the errors of Houston, we consult the literature and made a discussion of Influencing factors. We find that the level of public transportation in quantity and utilization is terribly low in Houston. In addition, the factors, such as the lack of planning law and estimation of urban expressways, the high level of citizens' dependence on private cars and pride of owning cars play a considerable roll in the errors. And the impacts can be predicted to a certain extent through two forecasting models (ARIMA and Prophet), although the precision of our models is not enough to make a precise forecast due to the limitations of model tuning and model design. According to the comparison of the two models, ARIMA models' forecasting accuracy is between 6% and 10%, and Prophet's forecasting accuracy is between 8%-12%, depending on the city. Since the insufficient stationarity, periodicity, seasonality of time series, the Prophet models are hard be more refined. © 2023 SPIE.

Symptoms Predicting SARS-CoV-2 Test Results in Resident Physicians and Fellows in New York City

Accurate prediction of SARS-CoV-2 infection based on symptoms can be a cost-efficient tool for remote screening in healthcare settings with limited SARS-CoV-2 testing capacity. We used a machine learning approach to determine self-reported symptoms that best predict a positive SARS-CoV-2 test result in physician trainees from a large healthcare system in New York. We used survey data on symptoms history and SARS-CoV-2 testing results collected retrospectively from 328 physician trainees in the Mount Sinai Health System, over the period 1 February 2020 to 31 July 2020. Prospective data on symptoms reported prior to SARS-CoV-2 test results were available from the employee health service COVID-19 registry for 186 trainees and analyzed to confirm absence of recall bias. We estimated the associations between symptoms and IgG antibody and/or reverse transcriptase polymerase chain reaction test results using Bayesian generalized linear mixed effect regression models adjusted for confounders. We identified symptoms predicting a positive SARS-CoV-2 test result using extreme gradient boosting (XGBoost). Cough, chills, fever, fatigue, myalgia, headache, shortness of breath, diarrhea, nausea/vomiting, loss of smell, loss of taste, malaise and runny nose were associated with a positive SARS-CoV-2 test result. Loss of taste, myalgia, loss of smell, cough and fever were identified as key predictors for a positive SARS-CoV-2 test result in the XGBoost model. Inclusion of sociodemographic and occupational risk factors in the model improved prediction only slightly (from AUC = 0.822 to AUC = 0.838). Loss of taste, myalgia, loss of smell, cough and fever are key predictors for symptom-based screening of SARS-CoV-2 infection in healthcare settings with remote screening and/or limited testing capacity. [ FROM AUTHOR] Copyright of COVID is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Early COVID-19 Hospitalizations Among New York State Residents with a History of Invasive Cancer.

Background: Individuals with a history of cancer may be more susceptible to severe COVID-19 due to immunosuppression, comorbidities, or ongoing treatment. We linked inpatient claims data on COVID-19 hospitalizations to cancer diagnoses from the New York State Cancer Registry (NYSCR) to examine associations between prior cancer diagnoses and hospitalizations for COVID-19, and factors associated with death at discharge after COVID-19 hospitalization. Methods: New York State (NYS) residents diagnosed with invasive cancer before July 1, 2021, who were alive on January 1, 2020, were identified from NYSCR data. We obtained claims data for discharge year 2020 and the first half of 2021 from NYS's Statewide Planning and Research Cooperative System (SPARCS), and we linked inpatient records with COVID-19 as the primary diagnosis to cancer data from the NYSCR using deterministic matching methods. We calculated descriptive statistics and conducted multivariable-adjusted logistic regression analyses to examine associations of cancer case characteristics with COVID-19 hospitalization and with vital status at discharge among patients with a history of cancer. All analyses were conducted in SAS 9.4. Results: Our analysis included 1,257,377 individuals with a history of cancer, 10,210 of whom had a subsequent primary COVID-19 hospitalization. Individuals with a history of cancer were 16% more likely to be hospitalized with COVID-19, compared to the general population of NYS, after adjusting for age and sex (95% CI, 14%-19%). Factors independently associated with COVID-19 hospitalization among cancer patients included older age, male sex, non-Hispanic Black race or Hispanic ethnicity, diagnosis with late-stage cancer or with multiple tumors, more recent cancer diagnosis, and New York City (NYC) residency at the time of cancer diagnosis. Factors independently associated with death at discharge among individuals with COVID-19 hospitalization and a prior cancer diagnosis included older age, male sex, non-Hispanic Black or non-Hispanic Asian/Pacific Islander race or Hispanic ethnicity, residence in NYC at the time of COVID-19 hospitalization, and an active cancer diagnosis claim code at the time of COVID-19 hospitalization. Conclusion: This claims-based study identified higher risks of COVID-19 hospitalization and death at discharge among individuals with a history of cancer, and particularly those in certain demographic and diagnostic groups.

The Case of the Missing 2020 Cancers: Using Claims Data to Investigate a Deficit in Incident Cancer Case Reports to the New York State Cancer Registry in 2020.

Background: As the February 2022 Surveillance, Epidemiology, and End Results (SEER) Call for Data deadlines approached, the New York State Cancer Registry had received reports for approximately 10% fewer consolidated incident cases for 2020 than expected. We used claims data to examine changes in the volume of cancer claim records during the COVID-19 pandemic and possible contributors to the deficit in cancer reports. Methods: The New York State (NYS) Statewide Planning and Research Cooperative System (SPARCS) requires reporting of all patient encounters from licensed ambulatory surgery, emergency department, and hospital inpatient and outpatient providers. Each record includes patient demographics and up to 17 diagnosis codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). For this project, we extracted 6,725,416 SPARCS records with any malignant neoplasm code for 2018 through June 2021 for NYS residents. Using SAS 9.4, we focused on comparing the cancer-related records for 2020 to the records from 2019. Results: Overall, there were 5% more cancer-related records in 2019 than in 2018 (2,009,600 vs 1,914,364), but 8.2% fewer records in 2020 (1,844,054 total) than in 2019. Looking by month and year, the number of claims in the first 2 months of 2020 exceeded the numbers from 2019 by 5%. However, a decrease in the number of claims started in March 2020, with the biggest drop in April 2020, where there was a deficit of 38.8% for cancer-related encounter reports relative to the same month the previous year. Although the numbers rose after April, the number of claims for the last half of 2020 was still 4% lower than the same time frame in 2019. There were substantial decreases in the number of records in 2020 for all encounter types and across levels of each covariate examined, including age, sex, race/ethnicity, and facility region of NYS. In analyses of all reporting facilities, facilities in New York City had a more pronounced and more prolonged drop in reporting in 2020 than facilities in the rest of the state. Conclusion: Although SPARCS data do not provide definitive evidence of decreases in incident cancer diagnoses, these data suggest that there were fewer cancers diagnosed among NYS residents in 2020. Additional analyses are needed to assess the impacts of COVID-19-related delays in cancer diagnosis and treatment on stage at diagnosis and outcomes.

Alcohol Misuse, Binge Drinking, and their Associations with Psychosocial Factors during COVID-19 among Harlem Residents in New York City.

This study examined alcohol misuse and binge drinking prevalence among Harlem residents, in New York City, and their associations with psycho-social factors such as substance use, depression symptom severity, and perception of community policing during COVID-19. An online cross-sectional study was conducted among 398 adult residents between April and September 2021. Participants with a score of at least 3 for females or at least 4 for males out of 12 on the Alcohol Use Disorders Identification Test were considered to have alcohol misuse. Binge drinking was defined as self-reporting having six or more drinks on one occasion. Modified Poisson regression models were used to examine associations. Results showed that 42.7% used alcohol before COVID-19, 69.1% used it during COVID-19, with 39% initiating or increasing alcohol use during COVID-19. Alcohol misuse and binge drinking prevalence during COVID-19 were 52.3% and 57.0%, respectively. Higher severity of depression symptomatology, history of drug use and smoking cigarettes, and experiencing housing insecurity were positively associated with both alcohol misuse and binge drinking. Lower satisfaction with community policing was only associated with alcohol misuse, while no significant associations were found between employment insecurity and food insecurity with alcohol misuse or binge drinking. The findings suggest that Harlem residents may have resorted to alcohol use as a coping mechanism to deal with the impacts of depression and social stressors during COVID-19. To mitigate alcohol misuse, improving access to mental health and substance use disorder services, and addressing public safety through improving relations with police could be beneficial.

The Most Vulnerable Hispanic Immigrants in New York City: Structural Racism and Gendered Differences in COVID-19 Deaths.

This paper explores the structural and group-specific factors explaining the excess death rates experienced by the Hispanic population in New York City during the peak years of the coronavirus pandemic. Neighborhood-level analysis of Census data allows an exploration of the relation between Hispanic COVID-19 deaths and spatial concentration, conceived in this study as a proxy for structural racism. This analysis also provides a more detailed exploration of the role of gender in understanding the effects of spatial segregation among different Hispanic subgroups, as gender has emerged as a significant variable in explaining the structural and social effects of COVID-19. Our results show a positive correlation between COVID-19 death rates and the share of Hispanic neighborhood residents. However, for men, this correlation cannot be explained by the characteristics of the neighborhood, as it is for women. In sum, we find: (a) differences in mortality risks between Hispanic men and women; (b) that weathering effects increase mortality risks the longer Hispanic immigrant groups reside in the U.S.; (c) that Hispanic males experience greater contagion and mortality risks associated with the workplace; and (d) we find evidence corroborating the importance of access to health insurance and citizenship status in reducing mortality risks. The findings propose revisiting the Hispanic health paradox with the use of structural racism and gendered frameworks.

Non-fatal drug overdose among persons who inject drugs during first two years of the COVID-19 pandemic in New York City: Prevalence, risk factors.

Background: We examined non-fatal drug overdoses during the COVID-19 pandemic among persons who inject drugs (PWID) in New York City (NYC). Methods: We recruited 275 PWID through respondent driven sampling and staff outreach from Oct. 2021-Sept. 2022 and enrolled in a cross-sectional survey. Information was collected on demographics, drug use behaviors, overdose experiences, substance use treatment history and strategies for coping with overdose threat. We compared PWID who did and did not experience non-fatal overdoses during lifetime and during the COVID-19 pandemic. Results: Participants were 71% male, and the mean age was 49 (SD 10). Heroin was the most frequently reported drug used (79%), 82% were fentanyl positive at enrollment urinalysis, 60% had overdosed in their lifetime and 34% had overdosed during the COVID-19 pandemic. In multivariable logistic regression, having previous overdosed, having a received a psychiatric diagnosis, and having a regular group of injectors were independently associated with experiencing an overdose during the pandemic. Overdose during the pandemic was unexpectedly high (approximately 30%) among persons reporting less than daily use of their main drug. Among PWID, 95% reported practicing at least one and 75% at least two overdose coping strategies. Practicing the different strategies, however, was generally not associated with a lower probability of experiencing an overdose. Conclusions: There has been a high rate of non-fatal overdoses among PWID in NYC during the pandemic. Fentanyl is almost ubiquitous in the drug supply in the city. PWID coping strategies are not yet providing strong protective effects against non-fatal overdose.

Field Testing the "Avoid the Needle" Intervention for Persons at Risk for Transitioning to Injecting Drug Use in Tallinn, Estonia and New York City, USA.

This study aimed to field tested the "Avoid the Needle" (AtN) intervention to reduce transitions from non-injecting to injecting drug use in two different epidemiological settings. Respondent driven sampling was used to recruit current non-injecting drug users (NIDUs) in Tallinn, Estonia in 2018-19 and in New York City (NYC) in 2019-20. Both persons who had never injected and persons who had previously injected but not in the last 6 months were eligible; a structured interview was administered, a blood sample collected, and the intervention administered by trained interventionists. We recruited 19 non-injectors from Tallinn and 140 from NYC. Participants in Tallinn were younger and had begun using drugs at earlier ages than participants in NYC. The primary drugs used in Tallinn were amphetamine, fentanyl, and opioid analgesics, while in NYC they were heroin, cocaine, speedball, and fentanyl. Six-month follow-up data were obtained from 95% of participants in Tallinn. The study was interrupted by COVID-19 lockdown in NYC, but follow-up data were obtained from 59% of participants. There were minimal transitions to injecting: 1/18 in Tallinn and 0/83 in NYC. There were significant declines in the frequencies of using readily injectable drugs (fentanyl, amphetamine, heroin, cocaine) from baseline to follow-up in both sites (Cochran-Armitage tests for trend, χ2 = 21.3, p < 0.001 for New York City; and χ2 = 3.9, p = 0.048 for Tallinn). Reducing transitions into injecting is a potentially very important method for reducing HIV transmission and other harms of drug use. Further investigation and implementation of AtN type interventions is warranted.

Barriers to Barrett's Esophagus Screening Within Veterans Affair Patient Population

Introduction: Barrett's esophagus (BE) is a metaplastic change in the distal esophagus in which squamous epithelium is replaced by columnar epithelium with goblet cells. Chronic gastroesophageal reflux disease (GERD) is strongly linked to the development of BE, which is a known precursor lesion to esophageal adenocarcinoma (EAC). There is no universal guideline for BE screening, however AJG suggest a single screening endoscopy in patients with chronic GERD symptoms and 3 or more addition risk factors, such as male sex, age > 50 years, white race, tobacco smoking, obesity and family history of BE or EAC. Within the Veteran's Affair (VA) hospital in Northport, New York, many veterans possess multiple risk factors for BE. Residents in VA primary care clinic are diligent in colorectal cancer screening, yet there is concern for limited offerings for BE screening. Our project aims to study the barriers to BE screening within a high-risk veteran population. Method(s): This is a survey-based study. A total of 36 internal medicine residents working in VA primary care clinic were asked to fill out a survey regarding their perspective towards BE screening. The results of the survey are compiled in Table. Result(s): 36 residents within the clinic completed the survey. As shown in Table, 35 out of 36 residents expressed that the primary care clinic does not screen for BE adequately. 30 residents expressed uncertainty regarding referral criteria for BE screening, 24 residents revealed having never referred patients for BE screening. When asked about barriers regarding BE screening, consensus polling showed that there is a lack of resident education surrounding indications for screening. Other common barriers include lack of transportation for veterans to appointments, the COVID 19 pandemic, and lack of health literacy within the veteran population. Conclusion(s): Although there is no established guideline for BE screening, per AJG there is recommendation for a one-time screening endoscopy in susceptible population. VA patients pose a high-risk population that appears to have low screening rates. Patients appear to be placed on long term PPIs without re-assessment and endoscopic screening despite possessing multiple risk factors for BE. Our survey shows that within our resident cohort there is concern for lack of awareness regarding screening criteria for BE. With the initiation of this project, we hope to increase awareness of BE screening within the resident group and improve health outcomes within veteran population. (Table Presented).

Investigating Novel Risk Factors for Training Injuries Among Runners of the New York City Marathon

Purpose: Given the high incidence of injury duringmarathon training, a better understanding of the factors associated with injury is needed. The purpose of the study was to investigate an expanded set of baseline factors of marathon runners to determine the association with injury during training. Method(s): Adult registrants of the 2022 New York City Marathon were recruited by email for a 16-week observational study. The baseline survey included demographics, running/injury/COVID history, race goal, orthotic use, grit scale, risk-taking scale, injury risk self-assessment, happiness and life satisfaction scales, and perceived risks of running. Injury surveys were collected weekly during training. Result(s): A total of 894 runners registered for the study and were uninjured at the start of the study. Average age was 44.5 years (standard deviation 11.8), 55% were female, and 76% had previously participated in a marathon. During the 16 weeks before the race, 221 of 894 (24.7%) experienced an injury, including 36 of 894 (4.0%) who did not participate in the race. Each of the baseline factors were assessed in a logistic regression model controlling for age, sex, body mass index, base weekly mileage, and number of prior marathons. The baseline factors associated with injury were orthotic use (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.12-2.74, P = 0.01), happiness (OR 0.71, 95% CI 0.58-0.88, P = 0.001), and injury risk self-assessment (OR 1.13 for each 10% selfassessed risk, 95% CI 1.05-1.21, P = 0.001). There was no association with age, sex, body mass index, running/injury/ COVID history, race goal, grit, risk-taking behavior, life satisfaction, and perceived risks of running. Conclusion(s): Although age, sex, experience, and history of injury have been previously identified as risk factors for running-related injury, this was not the case in this large cohort of runners training for a marathon. Instead, orthotic use and self-assessed risk of injury were associated with higher rates of injury training, and a higher level of happiness was associated with lower rates of injury. Significance: The results show the value of a comprehensive running injury risk assessment, which could be standardized to facilitate comparative research. Accounting for these factors is important when assessing future injury prevention interventions.

At last, a silver lining

Medical Director, International Patient Services Program, Co-Director, Pediatric Travel Medicine Clinic, Director, International Adoptee Clinic, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois contributing editors Bernard A. Cohen, MD Section Editor for Dermcase, Professor of Pediatrics and Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland Jon Matthew Farber, MD Section Editor for Journal Club, pediatrician, ALL Pediatrics, Woodbridge, Virginia Carlton K.K. Lee, PharmD.MPH, FASHP.FPPAG Section Editor for The Clinical Pharmacologist's Notebook, Pediatric Clinical Pharmacy Specialist, Department of Pharmacy, and Associate Professor, Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, Maryland MinaL.Alfieri.MD, MS nstructor of Pediatrics, Feinberg Schoo of Medicine, Northwestern University Attending Physician, Academic General Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois AminJ. MSCE Assistant Professor of Pediatrics, George Washington University School of Medicine and Health Sciences;Pediatric Infectious Diseases Attending, Director, Antimicrobial Stewardship Program, Associate Fellowship Program Director, Children's National Hospital, Washington, DC Michael S. Jellinek, MD Professor of Psychiatry and of Pediatrics, Harvard Medical School, Boston, Massachusetts Candice Jones, MD Board-certified general pediatrician in group practice in Orlando, Florida, former National Health Service Corps Scholar, AAP member, spokesperson and author Andrew J. Schuman, MD Clinical Assistant Professor of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire Steven M. Selbst, MD Professor of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, Attending Physician, Pediatric Emergency Medicine, Nemours/Alfred I duPont Hospital for Children, Wilmington, Delaware As 2021 gets underway and an increasing number of coronavirus disease 2019 (COVID-19) vaccines are administered, I believe that 2021 will be much more of a "normal" year, especially with the hope of COVID-19 vaccine availability for children by fall 2021. Issues discussed include illnesses more prevalent in children of color, such as asthma, sickle cell disease, and COVID-19;the difference in pain managementfor White children versus children of color;and how bias impacts mental health issues in children of color.