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1.
IDCases ; 28: e01512, 2022.
Article in English | MEDLINE | ID: covidwho-1851189

ABSTRACT

COVID-19 is now an established morbidity across races, regions and clinical risks around the world. From its first detection in Wuhan city-China in 2019 to the recent breakthrough of approved vaccines, that are determinants and deterrents and gradually becoming apparent. The phenotype of its presentation however is both variable and challenging especially. For those presenting with unique skin dermatosis such as erythema multiforme. Case report Our case is on a 36 year- old gentleman who presented to the hospital complaining, initially of only urticarial rash (later established to be erythema multiform), which improved with symptomatic treatment. He was discharged, only to be re-admitted a week later with exacerbation of the former cutaneous manifestation, accompanied by fever and gastrointestinal symptoms. He ultimately made complete recovery and was discharged home.

2.
Ann Allergy Asthma Immunol ; 2022 May 21.
Article in English | MEDLINE | ID: covidwho-1850617

ABSTRACT

BACKGROUND: mRNA-COVID-19 vaccines have been associated with allergic reactions. A history of anaphylaxis has been suggested as a risk factor for such reactions. Polyethylene glycol (PEG) has been proposed as a possible culprit allergen. OBJECTIVE: To investigate possible PEG or polysorbate allergy among patients reporting prior reactions to COVID-19 vaccines or PEG, and to report their subsequent tolerance of COVID-19 vaccines. METHODS: From January 1 st to October 31 st, 2021, adult patients referred to the MUHC allergy clinics who were considered at risk of anaphylaxis were prospectively recruited. The entry criteria were any documented history of reaction to a COVID-19 vaccine or reported allergy to PEG or polysorbate. Evaluated patients underwent skin-prick-testing (SPT) with PEG and polysorbate. Following SPT, placebo-controlled vaccine challenges were carried out. RESULTS: Of the 44 patients recruited, 40 (90.1%) had reacted to the first vaccine dose, 18 (45%) of them had anaphylactic reaction. All patients underwent SPT and 5 (11.3%) had a positive test. Thirty-nine patients (88.6%) underwent COVID-19 vaccine challenge at the allergy clinic. The majority tolerated the vaccine, 18 (40.1%) received a single full-dose, 20 (45.4%) 2-split-doses and 6 (13.6%) using a graded dosing protocol. Two out of the 40 patients who reacted to 1 st dose, had immediate non-severe allergic reactions to the second dose. CONCLUSION: In this cohort of patients with a history of anaphylaxis and increased risk of allergic reactions to the COVID-19 vaccines, following allergist evaluation, including negative PEG skin testing, the vaccine was safely administered without any serious adverse events.

3.
IEEE Access ; 2022.
Article in English | Scopus | ID: covidwho-1840228

ABSTRACT

The coronavirus disease (COVID-19) outbreak has become a global public health threat. The influx of COVID-19 patients has prolonged the length of stay (LOS) in the emergency department (ED) in the United States. Our objective is to develop a reliable prediction model for COVID-19 patient ED LOS and identify clinical factors, such as age and comorbidities, associated with LOS within a “4-hour target.”Data were collected from an urban, demographically diverse hospital in Detroit for all COVID-19 patients’ED presentations from March 16 to December 29, 2020. We trained four machine learning models, namely logistic regression (LR), gradient boosting (GB), decision tree (DT), and random forest (RF), across different data processing stages to predict COVID-19 patients with an ED LOS of less than or greater than 4 hours. The analysis is inclusive of 3,301 COVID-19 patients with known ED LOS, and 17 significant clinical factors were incorporated. The GB model outperformed the baseline classifier (LR) and tree-based classifiers (DT and RF) with an accuracy of 85% and F1-score of 0.88 for predicting ED LOS in the testing data. No significant accuracy gains were achieved through further splitting. This study identified key independent factors from a combination of patient demographics, comorbidities, and ED operational data that predicted ED stay in patients with prolonged COVID-19. The prediction framework can serve as a decision-support tool to improve ED and hospital resource planning and inform patients about better ED LOS estimations. Author

4.
Front Digit Health ; 4: 818705, 2022.
Article in English | MEDLINE | ID: covidwho-1834377

ABSTRACT

BACKGROUND: Emergency departments (ED) are an important intercept point for identifying suicide risk and connecting patients to care, however, more innovative, person-centered screening tools are needed. Natural language processing (NLP) -based machine learning (ML) techniques have shown promise to assess suicide risk, although whether NLP models perform well in differing geographic regions, at different time periods, or after large-scale events such as the COVID-19 pandemic is unknown. OBJECTIVE: To evaluate the performance of an NLP/ML suicide risk prediction model on newly collected language from the Southeastern United States using models previously tested on language collected in the Midwestern US. METHOD: 37 Suicidal and 33 non-suicidal patients from two EDs were interviewed to test a previously developed suicide risk prediction NLP/ML model. Model performance was evaluated with the area under the receiver operating characteristic curve (AUC) and Brier scores. RESULTS: NLP/ML models performed with an AUC of 0.81 (95% CI: 0.71-0.91) and Brier score of 0.23. CONCLUSION: The language-based suicide risk model performed with good discrimination when identifying the language of suicidal patients from a different part of the US and at a later time period than when the model was originally developed and trained.

6.
Healthcare (Basel) ; 10(4)2022 Mar 25.
Article in English | MEDLINE | ID: covidwho-1809812

ABSTRACT

AIM: The aim of the study was to analyze whether a patient's opinion is related to the effect of analgesic treatment. METHODS: The study was conducted using a survey questionnaire among adult patients admitted to the hospital emergency department in March 2021. The Numerical Rating Scale (NRS) was used to assess pain. Patients were asked to rate the intensity of pain during their stay in the emergency department in three situations: (1) at admission; (2) during the stay; and (3) upon discharge. The relationships between qualitative variables were assessed by the chi-squared test. Significance was set at p < 0.05. RESULTS: There was no statistical dependence between the patient's opinion about the medical institution and results of the effectiveness of analgesic treatments (p = 0.056). The highest percentage of patients satisfied with the received treatment were those who did not feel pain during ED discharge (94.12%), and the lowest were those who complained of severe pain during ED discharge (63.91%). The average mark for the functioning and organization of the emergency department was 7.44 (±2.04). Only 54 patients (29.83%) had taken pain medication before deciding to visit ED. CONCLUSIONS: No statistical dependency between the effect of the analgesic treatment and the patient's opinion has been observed. The majority of patients with pain discomfort visit emergency departments without looking for consultation in other locations or without taking analgesics. In the considered institution, patients were satisfied with the analgesic treatment, staff performance, and with the organization of the department.

7.
Int Emerg Nurs ; 62: 101170, 2022 May.
Article in English | MEDLINE | ID: covidwho-1804221

ABSTRACT

INTRODUCTION: Emergency Department (ED) nurses and Emergency Medical Services (EMS) Staff are faced with several stressors daily, such as the COVID 19 pandemic situation, which affects the health and the quality of services to patients. Spiritual coping with stress is an attempt to overcome the stress on the basis of what is transcendent. The use of spiritual coping strategies helps a person to overcome tensions caused by the work environment. OBJECTIVE: The current study aimed to investigate occupational stress and its relationship with spiritual coping among ED nurses and EMS staff. MATERIALS AND METHODS: This study was descriptive-correlational research. Using convenience sampling methods, 516 ED nurses and EMS staff were enrolled in the study. The study instruments included demographic information, HSE Occupational Stress, and spiritual coping questionnaires. Data were analyzed using SPSSv.22 software and the descriptive statistics, Pearson correlation test, t-test, ANOVA, and multiple linear regression. RESULTS: The highest and lowest levels of occupational stress were the dimensions of "demand" (2.96 ± 0.65) and "role" (3.89 ± 0.81) respectively. Multiple linear regression analysis showed that positive spiritual coping, negative spiritual coping, workplace, service location, type of employment, and work position were important factors affecting the occupational stress of ED nurses and EMS staff, which accounted for 0.34% of the variance. CONCLUSION: The findings showed the need to improve the work environment for ED nurses and EMS staff, including changes in physical working conditions, salaries, and better employment conditions. Training programs are recommended to reduce stress through the use of positive spiritual coping strategies.


Subject(s)
COVID-19 , Emergency Medical Services , Occupational Stress , Adaptation, Psychological , Cross-Sectional Studies , Emergency Service, Hospital , Humans , Surveys and Questionnaires
8.
17th International Scientific Conference on eLearning and Software for Education, eLSE 2021 ; : 42-46, 2021.
Article in English | Scopus | ID: covidwho-1786286

ABSTRACT

In 2020, education has been hardly hit by the COVID-19 pandemic. Thousands of schools and universities around the world have been forced to close their doors, millions of pupils and students have faced the risk of interrupting their educational path and millions of other teachers have faced the risk of academic freeze. However, the current pandemic, similar to other great plagues that preceded it, through the medical crisis it triggered, has forced states and societies to adapt, to find solutions, to innovate, to progress. A solution to such educational crisis has been the development and large-scale implementation of the e-learning. Considered, until the beginning of the pandemic, an alternative system for traditional education, e-learning has turned into an "essential-learning", becoming the saving solution that has taken the academic year out of the impasse. The change in the status of digital education has led to the development of a new industry, known as ed-tech, and has highlighted the advantages and disadvantages of such an education system. On the one hand stand the advantages of unlimited access to information, the qualitative increase of the teaching performance, the diversity of means of graphic expression and mass media, the development of computer management skills and of graphic editing of teaching materials, advantages shared both by the teaching staff and students. On the other hand, poverty, underdevelopment and technical problems, inherent in the process of data transmission, risk to deepen the gap between the poor and the rich of this world. Therefore, to what extent will e-learning be able to maintain its "essential-learning" status even after the end of the pandemic? What are the strengths and weaknesses of digital education? © 2021, National Defence University - Carol I Printing House. All rights reserved.

9.
Int J Surg Case Rep ; 94: 107074, 2022 May.
Article in English | MEDLINE | ID: covidwho-1783430

ABSTRACT

Introduction: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Laryngotracheitis (croup) is a rare manifestation of COVID-19 in adults. Presentation of case: A 52-year-old female presented to the emergency department (ED) with shortness of breath and inspiratory stridor. Clinical findings and investigations: Physical examination of the head and neck revealed a congested posterior pharyngeal wall. Laryngeal endoscopy with a 70-degree rigid endoscope demonstrated an edematous, bilaterally moving vocal cords. Chest radiographs showed tapering of the upper trachea (the "steeple" sign), which is observed in parainfluenza-associated croup infections. Interventions and outcome: The patient was admitted to the intensive care unit (ICU) for close observation for possible airway compromise and the need for intubation. Upon which, she tested positive for COVID-19 by polymerase chain reaction testing of nasopharyngeal samples. A regimen of ceftriaxone, nebulized racemic epinephrine, and dexamethasone was initiated. Conclusion: During the current COVID-19 pandemic, early diagnostic testing for SARS-Cov-2 are strongly recommended even when symptoms are not typical of COVID-19.

10.
J Anal Psychol ; 67(1): 170-182, 2022 02.
Article in English | MEDLINE | ID: covidwho-1784560

ABSTRACT

In his essay The Spiritual Problem of Modern Man, Jung states that 'The spiritual problem of modern man is one of those questions which are so much part of the age we live in that we cannot see them in proper perspective. Modern man is an entirely new phenomenon; a modern problem is one which has just arisen and whose answer still lies in the future' (Jung 1928, para. 148). During the pandemic, analytic treatment largely moved to online platforms. I propose an examination of the implications of video therapy for our experience and understanding of the analytic frame and container. Through the introduction of Marina Abramovic's performance piece entitled The Artist is Present, which took place at MoMA, New York, in 2010, I explore some reverberations of technologically-mediated sessions. By putting Abramovic's piece in context with some of my experiences, I draw conclusions regarding a technologically-mediated therapeutic paradigm. Supported by writings from authors André Sassenfeld, Tor Nørretranders and Iain McGilchrist, I introduce the concept of 'exformation' and investigate different neuroscientific presets of human perception and communication. I will ask how they might affect online therapeutic work and our experience of an embodied versus a virtual co-presence.


Dans son essai « Le Problème Spirituel de l'Homme Moderne ¼, Jung déclare que « Le problème spirituel de l'homme moderne est l'une de ces questions qui font tellement partie de l'époque que l'on vit que nous ne pouvons pas les voir à partir d'une perspective appropriée. L'homme moderne est un phénomène entièrement nouveau ¼ (1928, para.148). Pendant la pandémie les cures analytiques se sont largement déplacées de la salle de consultation aux plateformes en ligne. Je propose un examen des conséquences de la thérapie par vidéo pour notre expérience et notre compréhension du cadre analytique et du contenant. En m'appuyant sur la représentation de la performance de Marina Abramovic, « L'artiste est là ¼, qui s'est tenue au MoMa (New-York) en 2010, j'étudie certaines répercussions de séances utilisant la médiation technologique. En mettant la performance d'Abramovic dans le contexte de mes expériences, je tire des conclusions concernant le paradigme thérapeutique quand cette thérapie s'appuie sur la médiation technologique. Soutenu par les écrits d'auteurs tels qu'André Sassenfeld, Tor Norretranders et Ian McGilchrist, je présente le concept d' « exformation ¼ et j'explore différents préréglages neuroscientifiques de la perception et de la communication humaines. Je soulève la question de comment ceux-ci peuvent affecter le travail thérapeutique en ligne et notre expérience d'une co-présence incarnée par opposition à virtuelle.


En su ensayo 'El Problema Espiritual del Hombre Moderno', Jung afirma que 'El problema espiritual del hombre moderno es una de aquellas cuestiones que forma parte de la edad en que vivimos, en cuanto a que no podemos verla desde una correcta perspectiva. El hombre moderno es enteramente un nuevo fenómeno; un problema moderno es aquel que acaba de emerger y cuya respuesta yace todavía en el futuro' (1928, para.148). Durante la pandemia, el tratamiento analítico se movió en gran medida a plataformas virtuales. Propongo una exploración de las implicancias de la terapia virtual en virtud de nuestra experiencia y comprensión del encuadre analítico y del espacio contenedor. A través de la introducción de la performance titulada 'La Artista está Presente', de Marina Abramovic, llevada a cabo en el MoMA, Nueva York, en 2010, exploro algunas reverberaciones de las sesiones virtuales. Al poner la pieza de Abramovic en contexto con algunas de mis experiencias, saco conclusiones respecto a un paradigma terapéutico mediado por la tecnología. Basándome en los escritos de autores como André Sassenfeld, Tor Nørretranders y Iain McGilchrist, introduzco el concepto de 'exformación' e investigo diferentes programas neurocientíficos sobre la percepción y la comunicación humana. Pregunto cómo podrían afectar el trabajo terapéutico online y nuestra experiencia de una co-presencia corporizada versus una co-presencia virtual.


Em seu ensaio O Problema Espiritual do Homem Moderno, Jung afirma que 'O problema espiritual do homem modern é uma daquelas questões que fazem parte da época em que vivemos e que não podemos vê-las em perspectiva adequada. O homem moderno é um fenômeno totalmente novo; um problema moderno é aquele que acabou de surgir e cuja resposta ainda está no futuro' (1928, parágrafo. 148). Durante a pandemia, o tratamento analítico mudou-se em grande parte para plataformas on-line. Proponho um exame das implicações da videoterapia para nossa experiência e compreensão do quadro analítico e do recipiente. Através da introdução da peça de performance de Marina Abramovic intitulada, que aconteceu no MoMA, Nova York, em 2010, exploro algumas reverberações de sessões tecnologicamente mediadas. Ao contextualizar a peça de Abramovic com algumas das minhas experiências, tiro conclusões sobre um paradigma terapêutico mediado tecnologicamente. Apoiado por escritos dos autores André Sassenfeld, Tor Nørretranders e Iain McGilchrist, introduzo o conceito de "exformação" e investigo diferentes predefinições neurocientíficas da percepção e comunicação humanas. Perguntarei como eles podem afetar o trabalho terapêutico on-line e nossa experiência de uma copresença incorporada versus virtual.


Subject(s)
COVID-19 , Illusions , Humans , Male
11.
Embase; 2022.
Preprint in English | EMBASE | ID: ppcovidwho-332237

ABSTRACT

The emergence of SARS-CoV-2 variants continues to be a major obstacle for controlling the global pandemic. Despite the currently authorized SARS-CoV-2 vaccines ability to reduce severe disease and hospitalization, new immunization strategies are needed that enhance mucosal immune responses, inhibit community transmission, and provide protection against emerging variants. We have developed a mucosally delivered, non-replicating recombinant adenovirus vector (rAd5) vaccine, that has proven efficacy in the clinic against other respiratory viruses [1]. Here we evaluated the immunogenicity of three candidate SARS-CoV-2 vaccines in cynomolgus macaques that contained spike (S) and/or nucleocapsid (N) from either the Wuhan or the beta variant to select a candidate for future clinical development. Mucosal immunization with the Wuhan specific S vaccine (ED90) induced significant cross-reactive serum IgG responses against to Wuhan, beta, gamma and delta lineages, and generated substantial serum neutralizing activity. In nasal samples, ED90 immunization induced 1000-fold increases in IgA to all variants of concern tested and had neutralizing activity against Wuhan and delta. While immunization with the beta specific vaccine (ED94) enhanced IgG and IgA responses to homologous beta variant S and RBD, this approach resulted in less cross-reactive responses to other variants in the serum and nasal passages compared to ED90. As ED90 immunization induced the most robust cross-reactive systemic and mucosal antibody responses, this candidate was chosen for future clinical development.

12.
21st IEEE International Conference on Bioinformatics and Bioengineering (IEEE BIBE) ; 2021.
Article in English | Web of Science | ID: covidwho-1764809

ABSTRACT

Since the novel SARS-CoV-2 virus appeared, interest in developing epidemiological mechanisms that would help in prevention of its spread has increased. Epidemiological models are the most important mechanisms for examining the spread of the virus. For that purpose, we propose deep learning approach, LSTM neural network model. LSTM is a special kind of neural network structure capable of learning long-term dependencies in sequence prediction problems. The model was fed with official statistical data available online for Belgium in the period of March 15th, 2020 to March 15th, 2021. Results show that LSTM is capable of predicting in long-term manner with the low values of RMSE and MAE. Higher values of RMSE and MAE are observed in the infected cases (RMSE was 397.23 and MAE was 315.35) which is expected due to thousands of infected people per day in Belgium. In future studies, we will include more phenomena, especially medical intervention and asymptomatic infection, in order to better describe the COVID-19 spread and development.

13.
J Family Med Prim Care ; 11(3): 976-981, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1753784

ABSTRACT

Background: The COVID-19 pandemic resulted in a complete nationwide lockdown on March 24, 2020. The months of April and May had stringent lockdown measures followed by a gradual loosening of restrictions in a graded manner. Methods: This observational study was performed in the emergency department (ED) of a tertiary hospital in south India triage Priority 1 and Priority 2 patients presented during the COVID-19 lockdown and unlock periods spanning from April 2020 to August 2020. The three different lockdown periods and the subsequent unlock periods were categorized as lockdown 1 (LD1), lockdown 2 (LD2), lockdown 3 (LD3), and unlock phase (UL), and a 7-day time period in each were taken for 7-day incidence analysis. Results: During the 5-month study period, a total of 1,954 patients were analyzed for the study that included 405, 440, 492, and 617 patients during the 7-day time periods in the LD1, LD2, LD3, and UL periods, respectively. The 7-day incidence of COVID-19 suspects increased significantly by 101.9% from LD1 to UL phases, whereas trauma cases increased by 52.9% in the same two time periods. Compared with LD1, in the UL phase, the 7-day ED admission and in-hospital mortality rates increased by 50.3% and 66.7%, respectively. Conclusion: The number of COVID-19 suspects saw a near-constant increase through the different phases of lockdown, culminating in the UL phase. The stringent lockdown measures resulted in a significant reduction in the incidence of trauma with a rebound increase in the UL phase.

14.
CJEM ; 24(4): 390-396, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1750912

ABSTRACT

BACKGROUND: The COVID-19 pandemic forced emergency departments (EDs) to change operations to minimize nosocomial infection risk. Many EDs cohort patients using provincial screening tools at triage. Despite cohorting, staff exposures occurred in the 'cold zone' due to lack of personal protective equipment (PPE) use with patients deemed low risk, resulting in staff quarantines. The cohorting strategy was perceived to lengthen time to physician initial assessment and ED length of stay times in our ED without protecting staff well enough due to varying PPE use. The objective of this study was to assess the impact of hot/cold zones for patient cohorting during a viral pandemic on ED length of stay. METHODS: We conducted an interrupted time series analysis 3 weeks before and after the removal of hot/cold zone care space cohorting in our ED. In the before period, staff did not routinely wear full PPE to see cold zone patients. After removal, staff wore full PPE to see almost all patients. We collected data on ED length of stay, physician initial assessment times, arrival-to-room times, patient volumes, Canadian Triage Acuity Score (CTAS), admissions, staff hours of coverage, as well as proportions of patients on droplet/contact precautions and COVD-19 positive patients. The primary outcome was median ED length of stay. RESULTS: After the removal of the hot/cold divisions, there was a decrease in the adjusted median ED length of stay by 24 min (95% CI 14; 33). PPE use increased in the after arm of the study. The interrupted time series analysis suggested a decrease in median ED length of stay after removal, although the change in slope and difference did not reach statistical significance. CONCLUSION: Cohorted waiting areas may provide a safety benefit without operational compromise, but cohorting staff and care spaces is likely to compromise efficiency and create delays.


RéSUMé: CONTEXTE: La pandémie de COVID-19 a contraint les services d'urgence (SU) à modifier leur fonctionnement afin de minimiser le risque d'infection nosocomiale. De nombreux SU regroupaient des patients à l'aide d'outils de dépistage provinciaux au triage. Malgré la constitution de cohortes, les expositions du personnel se sont produites dans la "zone froide" en raison du manque d'utilisation d'équipements de protection individuelle (EPI) avec des patients jugés à faible risque, ce qui a entraîné la mise en quarantaine du personnel. Dans notre service d'urgence, la stratégie de cohorte a été perçue comme prolongeant l'évaluation initiale des médecins et la durée du séjour dans le service sans pour autant protéger suffisamment le personnel en raison de l'utilisation variable des EPI. L'objectif de cette étude était d'évaluer l'impact des zones chaudes/froides pour le regroupement de patients lors d'une pandémie virale sur la durée du séjour à l'urgence. MéTHODES: Nous avons réalisé une analyse de séries chronologiques interrompues trois semaines avant et après la suppression de la cohorte d'espace de soins en zone chaude/froide dans nos urgences. Au cours de la période précédente, le personnel ne portait pas systématiquement un EPI complet pour voir les patients des zones froides. Après le retrait, le personnel a porté un EPI complet pour voir presque tous les patients. Nous avons recueilli des données sur la durée du séjour aux urgences, les délais d'évaluation initiale par les médecins, les délais d'arrivée en salle, le volume de patients, L'échelle canadienne de triage et de gravité (ÉTG), les admissions, les heures de couverture du personnel, ainsi que les proportions de patients ayant reçu des précautions contre les gouttelettes et les contacts et de patients positifs au COVD-19. Le critère de jugement principal était la durée médiane du séjour aux urgences. RéSULTATS: Après la suppression des divisions chaudes/froides, la durée médiane ajustée du séjour aux urgences a diminué de 24 minutes (IC à 95 % : 14 ; 33). L'utilisation des EPI a augmenté dans le groupe suivant de l'étude. L'analyse des séries chronologiques interrompues suggère une diminution de la durée médiane de séjour aux urgences après le retrait, bien que le changement de la pente et de la différence n'ait pas atteint la signification statistique. CONCLUSION: Les zones d'attente en cohorte peuvent offrir un avantage en matière de sécurité sans compromis sur le plan opérationnel, mais le regroupement du personnel et des espaces de soins est susceptible de compromettre l'efficacité et de créer des retards.


Subject(s)
COVID-19 , Pandemics , COVID-19/epidemiology , Canada/epidemiology , Emergency Service, Hospital , Humans , Infection Control , Length of Stay , Pandemics/prevention & control , Triage/methods
15.
Addiction ; 117(7): 1952-1960, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1691646

ABSTRACT

BACKGROUND AND AIMS: Recreational cannabis was legalized in Canada in October 2018. Initially, the Government of Ontario (Canada's largest province) placed strict limits on the number of cannabis retail stores before later removing these limits. This study measured changes in cannabis-attributable emergency department (ED) visits over time, corresponding to different regulatory periods. DESIGN: Interrupted time-series design using population-level data. Two policy periods were considered; recreational cannabis legalization with strict store restrictions (RCL, 17 months) and legalization with no store restrictions [recreational cannabis commercialization (RCC), 15 months] which coincided with the COVID-19 pandemic. Segmented Poisson regression models were used to examine immediate and gradual effects in each policy period. SETTING: Ontario, Canada. PARTICIPANTS: All individuals aged 15-105 years (n = 13.8 million) between January 2016 and May 2021. MEASUREMENTS: Monthly counts of cannabis-attributable ED visits per capita and per all-cause ED visits in individuals aged 15+ (adults) and 15-24 (young adults) years. FINDINGS: We observed a significant trend of increasing cannabis-attributable ED visits pre-legalization. RCL was associated with a significant immediate increase of 12% [incident rate ratio (IRR) = 1.12, 95% confidence interval (CI) = 1.02-1.23] in rates of cannabis-attributable ED visits followed by significant attenuation of the pre-legalization slope (monthly slope change IRR = 0.98, 95% CI = 0.97-0.99). RCC and COVID-19 were associated with immediate significant increases of 22% (IRR = 1.22, 95% CI = 1.09-1.37) and 17% (IRR = 1.17, 95% CI = 1.00-1.37) in rates of cannabis-attributable visits and the proportion of all-cause ED visits attributable to cannabis, respectively, with insignificant increases in monthly slopes. Similar patterns were observed in young adults. CONCLUSIONS: In Ontario, Canada, cannabis-attributable emergency department visits stopped increasing over time following recreational cannabis legalization with strict retail controls but then increased during a period coinciding with cannabis commercialization and the COVID-19 pandemic.


Subject(s)
COVID-19 , Cannabis , Carcinoma, Renal Cell , Kidney Neoplasms , Canada , Emergency Service, Hospital , Humans , Legislation, Drug , Ontario/epidemiology , Pandemics , Young Adult
16.
J Pers Med ; 12(2)2022 Feb 14.
Article in English | MEDLINE | ID: covidwho-1686863

ABSTRACT

It is certain and established that overcrowding represents one of the main problems that has been affecting global health and the functioning of the healthcare system in the last decades, and this is especially true for the emergency department (ED). Since 1980, overcrowding has been identified as one of the main factors limiting correct, timely, and efficient hospital care. The more recent COVID-19 pandemic contributed to the accentuation of this phenomenon, which was already well known and of international interest. Considering what would appear to be a trivial definition of overcrowding, it may seem simple for the reader to hypothesize solutions for what seems to be one of the most avoidable problems affecting the hospital system. However, proposing solutions to overcrowding, as well as their implementation, cannot be separated from a correct and precise definition of the issue, which must consider the main causes and aggravating factors. In light of the need of finding solutions that can put an end to hospital overcrowding, this review aims, through a review of the literature, to summarize the triggering factors, as well as the possible solutions that can be proposed.

17.
47th Latin American Computing Conference, CLEI 2021 ; 2021.
Article in Spanish | Scopus | ID: covidwho-1672589

ABSTRACT

Resumen—The COVID-19 pandemic has underlined that Emergency Department (ED) overcrowding is a critical factor in care services. Getting an approximation of the number of patients attending the department can assist in service resources planning and prevent overcrowding. In this manuscript we present the forecasting results for the admissions, inpatients and discharges series in ED by using different time aggregations (eight hours, twelve hours, one day and the service workers official shifts) and classical time series algorithms. Moreover, series forecasting is performed in two terms: long (four months ahead) and short (seven days ahead). The results show that time aggregations strongly influence the forecast quality, decreasing the effectiveness for one-day aggregations. In addition, best metrics are not obtained in the same aggregation, so there is no best aggregation for all cases. Therefore, it is essential to analyse the ED-related problem faced for the time aggregation selection. ©2021 IEEE

18.
Pediatr Rep ; 14(1): 58-70, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1667266

ABSTRACT

Although early evidence reported a substantial decline in pediatric hospital visits during COVID-19, it is unclear whether the decline varied across different counties, particularly in designated Medically Underserved Areas (MUA). The objective of this study is to explore the state-wide impact of COVID-19 on pediatric hospital visit patterns, including the economic burden and MUA communities. We conducted a retrospective observational study of pediatric hospital visits using the Florida State all-payer Emergency Department (ED) and Inpatient dataset during the pandemic (April-September 2020) and the same period in 2019. Pediatric Treat-and-Release ED and inpatient visit rates were compared by patient demographics, socioeconomic, diagnosis, MUA status, and hospital characteristics. Pediatric hospital visits in Florida decreased by 53.7% (62.3% in April-June, 44.2% in July-September) during the pandemic. The Treat-and-Release ED and inpatient visits varied up to 5- and 3-fold, respectively, across counties. However, changes in hospital visits across MUA counties were similar compared with non-MUA counties except for lower Treat-and-Release ED volume in April-May. The disproportional decrease in visits was notable for the underserved population, including Hispanic and African American children; Medicaid coverages; non-children's hospitals; and diagnosed with respiratory diseases, appendicitis, and sickle-cell. Florida Hospitals experienced a USD 1.37 billion (average USD 8.3 million) decline in charges across the study period in 2020. Disproportionate decrease in hospital visits, particularly in the underserved population, suggest a combined effect of the persistent challenge of care access and changes in healthcare-seeking behavior during the pandemic. These findings suggest that providers and policymakers should emphasize alternative interventions/programs ensuring adequate care during the pandemic, particularly for high-risk children.

19.
Journal of Engineering Education Transformations ; 35(Special Issue):34-38, 2022.
Article in English | Scopus | ID: covidwho-1652182

ABSTRACT

Covid-19 has appealed to teachers around the world to adopt a new era of online teaching-learning methods instead of traditional teaching methods. It is a challenge for teachers to engage students in the learning process and measure outcomes with proper tools. The use of online platforms forced every teacher to redesign teaching strategies. A teacher has to think about online learning platforms and design instructional strategies. Different tools are available to make online learning interactive. The selection and application of tools is a skill of the individual teacher. In the present work, outcomes of the course Engine Design (ED) are mentioned. The course is taught online using the MS-Teams platform. During course delivery, various instructional strategies like, Games, quizzes, Discussion forums, Polls, etc. are used. Outcomes, of course, taught using an online platform and active learning tools (batch 2020-21) are measured using attainment of course outcomes CO’s and course end survey (CES). A combination of active learning techniques with online teaching is helpful to deliver the subject effectively. The CO attainment and CES indicate improvement in student communication, perspective thinking, design and modeling skills. © 2022, Rajarambapu Institute Of Technology. All rights reserved.

20.
Int J Emerg Med ; 15(1): 3, 2022 Jan 21.
Article in English | MEDLINE | ID: covidwho-1643107

ABSTRACT

Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), more and more atypical presentations of COVID-19 are being reported. Here, we present and discuss non-convulsive status epilepticus (NCSE) as presenting symptom of SARS-CoV-2 infection at the Emergency Department.

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