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1.
Atmospheric Environment ; 278, 2022.
Article in English | EMBASE | ID: covidwho-1814146

ABSTRACT

Air pollution during the COVID-19 epidemic in Beijing and its surrounding regions has received substantial attention. We collected observational data, including air pollutant concentrations and meteorological parameters, during January and February from 2018 to 2021. A statistical and a numerical model were applied to identify the formation of air pollution and the impact of emission reduction on air quality. Relative humidity, wind speed, SO2, NO2, and O3 had nonlinear effects on the PM2.5 concentration in Beijing, among which the effects of relative humidity, NO2, and O3 were prominent. During the 2020 epidemic period, high pollution concentrations were closely related to adverse meteorological conditions, with different parameters having different effects on the three pollution processes. In general, the unexpected reduction of anthropogenic emissions reduced the PM2.5 concentration, but led to an increase in the O3 concentration. Multi-scenario simulation results showed that anthropogenic emission reduction could reduce the average PM2.5 concentration after the Chinese Spring Festival, but improvement during days with heavy pollution was limited. Considering that O3 enhances the PM2.5 levels, to achieve the collaborative improvement of PM2.5 and O3 concentrations, further research should explore the collaborative emission reduction scheme with VOCs and NOx to achieve the collaborative improvement of PM2.5 and O3 concentrations. The conclusions of this study provide a basis for designing a plan that guarantees improved air quality for the 2022 Winter Olympics and other international major events in Beijing.

2.
Disease Surveillance ; 37(1):67-71, 2022.
Article in Chinese | GIM | ID: covidwho-1789474

ABSTRACT

Objective: To analyze the epidemiologic characteristics of common respiratory virus infection in hospitalized children in Wuhan Children's Hospital from January to December 2019, and provide evidence for clinical diagnosis and treatment.

3.
2021 International Conference on Cyber-Physical Social Intelligence, ICCSI 2021 ; 2021.
Article in English | Scopus | ID: covidwho-1788704

ABSTRACT

Currently, as COVID-19 spreads around the world, epidemic prevention departments from different provinces and regions often need to carry out cross-regional cooperation. In the paper, some new office platforms based on some office needs of the joint prevention and control work are tried to build. In the paper, the platforms built is capable of visualizing the risk map of regional risks, covering a multi-segment integrated joint prevention and control collaborative business platform system of the CDC, customs, relevant medical institutions and health tracking management departments. For the staff in each business link, they can access the data of cases, close contacts and key health tracking objects through the platform. Based on the work, it's necessary to print relevant certificates online, and at the same time, they also supplement the business data of the link to the data chain, providing better information services for improving the efficiency of joint prevention and control. In the process of making an analysis of the business needs, it is found that when building the platform, it will face problems such as many functional modules, variable demand, and too large amount of concurrency at a certain time. In the paper, the implemented architecture techniques would be explained, the details of the key technology implementation adopted by micro-services in realizing the platform would be clarified, and the significance of the platform to the epidemic prevention work would be finally discussed. © 2021 IEEE.

4.
Middle East Studies Journal (MESJ) ; 26(99):170-172, 2022.
Article in Arabic | Academic Search Complete | ID: covidwho-1781745
5.
Sustainability ; 14(7):3995, 2022.
Article in English | ProQuest Central | ID: covidwho-1785928

ABSTRACT

The water supply in drylands mainly relies on groundwater, making it a crucial resource. Springs in southern Africa are often underutilized, and are neither protected nor monitored. Thus, the aim of this study was to evaluate their quality in a sample area in northwestern Namibia and to propose solutions for the sustainable use of springs. In total, 35 springs and hot springs were evaluated in the study area located in the drier part of Namibia (Pmean = 150–400 mm/year), an area highly impacted by ongoing climate change with longer and more frequent drought seasons. The springs there are mostly uncaptured and the discharge is in the form of surface runoff, which is mainly lost to the atmosphere by evaporation. Most of the studied springs were perennial, despite a severe drought period. Local communities rely on the springs mainly for livestock and human consumption, as well as for irrigation. However, 71% of the springs do not have any protective measures. The temperature, pH, conductivity and alkalinity were tested in situ. In total, 20 samples were collected and analyzed for major ions (boron, fluoride, silica and strontium) and total dissolved solids (TDS). The physical and inorganic results mostly indicated good and excellent quality water for human consumption, while the hot springs tended to have poor water quality in terms of Namibian standards, indicating that the water was not fit for human consumption.

6.
Atmosphere ; 13(3):22, 2022.
Article in English | Web of Science | ID: covidwho-1785505

ABSTRACT

In recent years, air pollution has become a serious threat, causing adverse health effects and millions of premature deaths in China. This study examines the spatial-temporal characteristics of ambient air quality in five provinces (Shaanxi (SN), Xinjiang (XJ), Gansu (GS), Ningxia (NX), and Qinghai (QH)) of northwest China (NWC) from January 2015 to December 2018. For this purpose, surface-level aerosol pollutants, including particulate matter (PMx, x = 2.5 and 10) and gaseous pollutants (sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O-3)) were obtained from China National Environmental Monitoring Center (CNEMC). The results showed that fine particulate matter (PM2.5), coarse particulate matter (PM10), SO2, NO2, and CO decreased by 28.2%, 32.7%, 41.9%, 6.2%, and 27.3%, respectively, while O-3 increased by 3.96% in NWC during 2018 as compared with 2015. The particulate matter (PM2.5 and PM10) levels exceeded the Chinese Ambient Air Quality Standards (CAAQS) Grade II standards as well as the WHO recommended Air Quality Guidelines, while SO2 and NO2 complied with the CAAQS Grade II standards in NWC. In addition, the average air quality index (AQI), calculated from ground-based data, improved by 21.3%, the proportion of air quality Class I (0-50) improved by 114.1%, and the number of pollution days decreased by 61.8% in NWC. All the pollutants' (except ozone) AQI and PM2.5/PM10 ratios showed the highest pollution levels in winter and lowest in summer. AQI was strongly positively correlated with PM2.5, PM10, SO2, NO2, and CO, while negatively correlated with O-3. PM10 was the primary pollutant, followed by O-3, PM2.5, NO2, CO, and SO2, with different spatial and temporal variations. The proportion of days with PM2.5, PM10, SO2, and CO as the primary pollutants decreased but increased for NO2 and O-3. This study provides useful information and a valuable reference for future research on air quality in northwest China.

7.
Pharmaceutics ; 13(11)2021 Oct 22.
Article in English | MEDLINE | ID: covidwho-1771229

ABSTRACT

Swift vaccination is necessary as a response to disease outbreaks and pandemics; otherwise, the species under attack is at risk of a high fatality rate or even mass extinction. Statistics suggest that at least 16 billion injections are administered worldwide every year. Such a high rate of needle/syringe injection administration worldwide is alarming due to the risk of needle-stick injuries, disease spread due to cross-contamination and the reuse of needles, and the misuse of needles. In addition, there are production, handling, and disposal costs. Needle phobia is an additional issue faced by many recipients of injections with needles. In addition to a detailed literature review highlighting the need for needle-free injection systems, a compressed air-driven needle-free jet injection system with a hydro-pneumatic mechanism was designed and developed by employing an axiomatic design approach. The proposed injection system has higher flexibility, uninterrupted force generation, and provides the possibility of delivering repeated injections at different tissue depths from the dermis to the muscle (depending on the drug delivery requirements) by controlling the inlet compressed air pressure. The designed needle-free jet injector consists of two primary circuits: the pneumatic and the hydraulic circuit. The pneumatic circuit is responsible for driving, pressurizing, and repeatability. The hydraulic circuit precisely injects and contains the liquid jet, allowing us to control the volume of the liquid jet at elevated pressure by offering flexibility in the dose volume per injection. Finally, in this paper we report on the successful design and working model of an air-driven needle-free jet injector for 0.2-0.5 mL drug delivery by ex vivo experimental validation.

8.
Osteoarthritis and Cartilage ; 30:S403, 2022.
Article in English | EMBASE | ID: covidwho-1768343

ABSTRACT

Purpose: Knee Osteoarthritis (KOA) is a leading cause of physical disability worldwide. Individuals who suffer from KOA experience pain, reduced mobility, and lower quality of life. Considering the upward trend in KOA diagnoses, the economic burden of knee replacement, and the surgical backlog from COVID-19, the need for alternative conservative treatments is pressing. Bracing is an economical and accessible form of conservative treatment. Traditional KOA braces only offload one knee compartment. However, over 50% of the KOA population suffers from cartilage damage in multiple compartments. The Levitation™ “Tri-Compartment Offloader” (TCO) knee brace contains embedded liquid springs that provide flexion support and extension assist to simultaneously offload joint forces in all three knee compartments. Similar to the effect of weight loss, biomechanical studies have demonstrated that the TCO provides clinically relevant reductions in tibiofemoral and patellofemoral joint contact forces ranging between 30-50%. However, there is a need to validate whether the TCO improves real world outcomes in KOA patients. Therefore, the current objective is to examine the influence of a TCO brace on knee pain and function in a population suffering from KOA. Methods: Individuals with KOA who purchased the TCO are being enrolled in the ongoing study following informed consent (n=113). Participants receive 4 online surveys administered using Qualtrics (USA). The first survey is completed before brace wear commences (0-months), and follow-up surveys are scheduled after 1-month, 3-months and 9-months of TCO brace wear. The surveys contain validated questionnaires including the Visual Analog Scale (VAS) for pain, Knee Injury and Osteoarthritis Outcome Score (KOOS), EuroQol 5D-5L, International Physical Activity Questionnaire, Orthotics and Prosthetics Users Survey;as well as custom questionnaires to collect demographic information. This preliminary analysis includes 54 participants who completed the 1-month and 3-months surveys (mean age 55.7±9.1 yrs;43 male). Variables of interest include knee pain (VAS) and function (KOOS). Pain was assessed during four common activities: 1) walking on a flat surface (Flat Walking);2) rising from seated (Sit & Stand);3) going up and down stairs (Stairs);and 4) Squatting. A VAS pain score of 0 represents no pain, and 100 represents the worst pain imaginable. KOOS domains included: 1) Pain;2) Symptoms;3) function in activities of daily living (ADL);4) function in sport and recreation (S&R);and 5) knee-related quality of life (QoL). A KOOS score of 0 represents severe problems, and 100 represents no problems. Statistical analysis was conducted using SPSS (IBM, USA). Pain (VAS score) between timepoints was assessed using four one-way repeated measures ANOVAs with Bonferroni correction for multiple comparisons (α = 0.0125). Post-hoc analyses were used to compare timepoints. Effects of TCO use on knee function were assessed using Wilcoxon's signed-rank test with Bonferroni correction (α = 0.01). Results: Participants wore the TCO for an average of 5.1±3.4 hours/day, and 5.2±1.8 days/week at 1-month and 5.0±3.1 hours/day and 4.9±1.7 days/week at 3-months. One participant did not complete the 1-month survey. Further, two participants did not provide complete VAS responses (Table 1) and a number of participants did not provide answers to all KOOS domains (Table 2). Significant effects of TCO use on pain were observed during all activities (p<0.001) (Figure 1, Table 1). Post-hoc analyses indicated significantly decreased pain for all activities at 1-month (p <0.001) and 3-months (p-value range 0.001-0.01) compared to baseline (0-months). There were no significant differences in pain between 1-month and 3-months of TCO use (p-value range 0.318-1). The scores for all 5 domains of KOOS increased after 1-month and 3-months of TCO brace wear compared to baseline. TCO use resulted in a significant increase in ADL (0-1 months: p<0.001;0-3 months: p<0.001), Pain (0-1 months: p<0.001), and S&am ;R (0-1 months: p<0.002) (Figure 2, Table 2). [Formula presented] [Formula presented] [Formula presented] [Formula presented] Conclusions: This study demonstrates that the TCO brace significantly decreased knee pain for KOA patients when worn during common daily activities. The mean difference in pain scores after 1-month of TCO wear was greater than the minimally clinically important difference (-19.9mm) for all activities suggesting a clinically significant improvement in pain. These significant reductions in pain were maintained after 3-months of TCO wear, demonstrating continued pain management benefits at 3-months. This suggests that the TCO is an effective conservative treatment option over a moderate period of time. Brace usage data indicated good compliance and consistent duration of brace wear between 1-month and 3-months, which could be a result of the continued reduction in knee pain. An improvement in all 5 dimensions of KOOS was also observed, with significant improvements in Pain, ADL, and S&R after 1-month of wearing the TCO. These findings indicate that the Levitation™ TCO brace has a strong potential to manage pain and improve knee function for patients suffering from KOA. Future work includes continued data collection and investigating the effects of the TCO on pain and function in the KOA population over a longer time period.

9.
Working Paper Series - National Bureau of Economic Research (Massachusetts)|2021. (w28737):unpaginated. many ref. ; 2021.
Article in English | CAB Abstracts | ID: covidwho-1760213

ABSTRACT

Were workers more likely to be infected by COVID-19 in their workplace, or outside it? Although both economic models of the pandemic and public health policy recommendations often presume that the workplace is less safe, economic theory predicts that group cooperation significantly increases the per capita demand for public goods. Disease prevention may also have scale economies in supply. The available data from schools, hospitals, nursing homes, warehouses, grocery stores, food processing plants, hair stylists, and airlines - covering more than a million employees and students - show employers adopting mitigation protocols in the spring of 2020. Coincident with the adoption, infection rates in workplaces typically dropped from well above household rates to well below. When this occurs, the sign of the disease externality from participating in large organizations changes from negative to positive, even while individuals continue to have an incentive to avoid large organizations due to the prevention costs they impose on members. Rational cooperative prevention sometimes results in infectious-disease patterns that are opposite of predictions from classical epidemiology.

10.
European Urology ; 79:S1184-S1185, 2021.
Article in English | EMBASE | ID: covidwho-1747418

ABSTRACT

Introduction & Objectives: Men have a higher risk of death from COVID-19 than women and androgens facilitate entrance of the SARS-CoV-2 virus into respiratory epithelial cells. Thus, androgen deprivation therapy (ADT) may mitigate the course of COVID-19. The aim of the study was to estimate the impact of ADT on mortality from COVID-19 in men with prevalent prostate cancer by comparing all-cause mortality in the spring of 2020 to the same time period in previous years. Materials & Methods: All men with prevalent prostate cancer in Prostate Cancer data Base Sweden (PCBaSe) on March 1 each year in 2015-2020 were followed until June 30 the same year. Exposure to ADT was ascertained from filled prescriptions for bicalutamide, Gonadotropin Releasing Hormone agonists and antagonists (GnRH), and from The Patient Registry data on orchidectomy. The mortality rates by calendar day for each exposure group and calendar time period were calculated and plotted with locally weighted smoothing. Using Poisson regression, the rate of death was compared between 2020 and the average in previous years. Results: 9,822 men with Pca died in March-June in the years 2015-2020, of whom 5,034 men were on ADT. There was an excess mortality in 2020 vs previous years in men on GnRH, bicalutamide and men not on ADT (Figure). The crude relative mortality rate ratio in men on ADT in 2020 vs 2015-2019 was 0.86 (95% confidence interval 0.78 to 0.95). After multivariable adjustment this ratio was attenuated to 0.96 (95% CI 0.87 to 1.06). When restricting the analysis to regions with the highest incidence of COVID-19 and to the two months when mortality in 2020 was highest, the results were similar to those in the main analysis. Conclusions: We found little support for the hypothesis that androgen deprivation therapy mitigates the disease course of COVID-19. (Figure Presented)

11.
Open Forum Infectious Diseases ; 8(SUPPL 1):S88-S89, 2021.
Article in English | EMBASE | ID: covidwho-1746777

ABSTRACT

Background. Serial testing for SARS-CoV-2 is necessary to prevent spread from patients early in infection. Testing intervals are largely derived from viral kinetic studies performed early in the COVID-19 pandemic. Laboratory and epidemiologic data accrued over the past year present an opportunity to use empiric models to define optimal serial testing intervals and features predictive of early infection. Methods. Retrospective analysis of 15,314 inpatients within the Mass General Brigham healthcare system who had two tests within a 36-hour period between May 1 2020 and May 29 2021. Early infection was defined as having a negative test followed by a positive test. Patients with prior positive tests were excluded. The primary outcome was the proportion of patients in early infection over the total number tested serially, stratified by 4-hour testing intervals from the timestamp of the first test. Multivariate modeling was used to identify features predictive of early infection. Covariates included demographics, body site, PCR assay, location, community incidence, percent positivity, and median / skew of Ct value distributions. Results. Of 19,971 test pairs, 193 (0.97%) were characterized as a negative followed by a positive within 36 hours. Bivariate analysis showed a close association between negative to positive test pairs during the first surge in spring 2020 that was not present during the winter surge. Negative to positive test pairs were most common in the 12 to 16 hour time interval (51/193, 26%, Figure 1). After controlling for covariates, the Roche cobas assay was more likely to identify patients with a negative to positive test pair relative to the Cepheid Xpert, Hologic Panther Fusion and Roche Liat assays. A second specimen from the lower respiratory tract was more likely to lead to a positive relative to other body sites. Community incidence and Ct value distributions were not predictive and there were no differences between nasal and nasopharyngeal swabs. All 4-hour time intervals from 16 to 36 hours were significant for predicting a negative to positive test pair (Table 1). Conclusion. The likelihood of detecting early infection is dependent on PCR platform and body site of sampling. A range of time intervals between 16 to 36 hours after the initial test were likely to identify positive cases.

12.
Open Forum Infectious Diseases ; 8(SUPPL 1):S250-S251, 2021.
Article in English | EMBASE | ID: covidwho-1746705

ABSTRACT

Background. The COVID-19 pandemic has disproportionately impacted minorities in the United States. John H. Stroger Jr. Hospital (JSH) is a tertiary care hospital within the safety-net system for Cook County in Chicago, Illinois. In this study we report demographics, clinical characteristics and outcomes of patients admitted with COVID-19 in our hospital during the spring surge of 2020. Methods. A retrospective study was done including patients > 18 years of age admitted to JSH with positive PCR for SARS-CoV2 from March 18 to May 30th, 2020. Outcomes, clinical and demographic characteristics were extracted from the electronic medical record. Moderate and severe disease were defined as radiographic evidence of pulmonary infiltrates and SpO2 > 94% on room air or SpO2< 94% on room air, respectively. Bivariate analysis and logistic regression were performed to assess for risk factors for admission to the intensive care unit and mortality. Results. 625 patients were included, 424 (68%) were male. Median age was 44 years (44,63). 364 (58%) were Hispanic and 222 (36%) non-Hispanic Blacks. 113 (18%) of patients presented with mild disease, 204 (33%) with moderate disease, 298 (48%) with severe disease. 73 patients (12%) died. 153 (24%) required ICU admission, 84 (13%) required intubation [Table 1]. In bivariate analysis, increasing age and diabetes (DM) were associated with increased mortality and ICU admission (p=0.001, Tables 2 and 3). Race/ethnicity was not associated with increased mortality or ICU admission. In the multivariate analysis, elevated glucose on admission regardless of DM and CKD were associated with mortality (p < 0.001). Conclusion. JSH is a safety net hospital that provides care for the most vulnerable population of Chicago. The proportion of Hispanic patients increased in the later weeks of the pandemic until they represented most of the inpatient population and presented with more severe disease (Figure 1). Although race was not associated with mortality or ICU admission, the high prevalence of chronic diseases such as hypertension and DM in our population may explain the higher rate of admissions. Strengthening of preventive medicine and social engagement with minorities must be a crucial effort to decrease the burden of COVID-19 in this population. Graph showing disease severity on admission by Race/Ethnicity (upper). Notice the predominance of severe disease (orange) in Hispanic patients. Graph showing Race/ Ethnicity Distribution by Week (lower). Notice the gradual increase and predominance of Hispanic patients (orange) in the later weeks of the study period compared to Black (blue) and White (green) patients.

13.
J Affect Disord Rep ; 8: 100335, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1747849

ABSTRACT

Background: The aim of this study was to: 1) assess mental health symptoms in Canadian school staff during the second year of the pandemic (Spring 2021) and compare these same outcomes to national representative samples, and 2: examine whether the number of hours of direct contact with students was a significant predictor of anxiety symptoms. Methods: Online data on anxiety symptoms, psychological distress, overall mental health, and demographic information was collected from 2,305 school staff in the greater Vancouver area between February 3 and June 18, 2021, as part of a seroprevalence study. Results: School staff reported significantly higher anxiety symptoms than a national representative survey in Spring 2021 and higher exposure contact time with students was significantly associated with anxiety symptoms, in addition to sex and age, but not level of education and ethnicity. School staff also reported poorer mental health and higher levels of psychological distress compared to pre-pandemic population measures. Limitations: Cross-sectional design, self-report measures. Conclusions: These results show that priorities to reduce mental health challenges are critical during a public health crisis, not only at the beginning, but also one year later. Ongoing proactive prevention and intervention strategies for school staff are warranted.

14.
Open Forum Infectious Diseases ; 8(SUPPL 1):S574, 2021.
Article in English | EMBASE | ID: covidwho-1746341

ABSTRACT

Background. The COVID-19 pandemic obligated academic medical programs to substantially alter the traditional Internal Medicine (IM) rounding model to decrease risk of inpatient nosocomial viral transmission. Our study aimed to describe how IM rounding practices changed during the COVID-19 pandemic and to understand the impacts of these changes on medical education. Methods. We conducted a two-phase, mixed-methods study of inpatient IM rounding team practices at a large academic hospital in Houston, TX. In the first phase (January-February 2021), we organized and audio-recorded 4 virtual (Zoom) focus groups. Each included 5-6 rounding team members, divided by: attendings;senior residents;interns;and medical and physician assistant students. In the second phase (March-May 2021), we performed 6 direct observations of IM teams during rounds. Two observers systematically recorded variables such as time spent on non-bedside versus bedside rounds, number of each team member type entering patient rooms for bedside teaching, and types of personal protective equipment (PPE) worn. Results. Topics discussed during focus groups included comparisons of rounding team size, rounding duration, physical distancing and PPE use, bedside education, communication methods, and patient safety before and after March 2020. Perceptions of changes in each topic were generally consistent across groups (Table 1). Direct observation data showed that team rounding styles remained diverse in the proportion of rounding time spent in an office versus on the wards, and in the number and types of team members entering patient rooms. IM team members uniformly wore respiratory PPE when entering all patient rooms;use of eye protection varied. Teams spent more total time discussing patients with or suspected to have COVID-19 compared to patients without COVID-19 (median 24 min versus 13 min, p< 0.0001). Conclusion. Our results suggest that the COVID-19 pandemic adversely impacted bedside medical education, even into Spring of 2021. Conclusions from this study can be used to 1) address educational gaps related to COVID-19 pandemic-associated rounding changes and 2) create innovative methods of providing high-quality clinical education that will be minimally impacted by future respiratory virus pandemics.

15.
Open Forum Infectious Diseases ; 8(SUPPL 1):S695, 2021.
Article in English | EMBASE | ID: covidwho-1746311

ABSTRACT

Background. We developed a syndromic algorithm for COVID-19 like illness (CLI) to provide supplementary surveillance data on COVID-19 activity. Methods. The CLI algorithm was developed using the Electronic Medical Record Support for Public Health platform (esphealth.org) and data from five clinical practice groups in Massachusetts that collectively care for 25% of the state's population. Signs and symptoms of CLI were identified using ICD-10 diagnosis codes and measured temperature. The algorithm originally included three categories: Category 1 required codes for coronavirus infection and lower respiratory tract infections (LRTI);Category 2 required an LRTI-related diagnosis and fever;Category 3 required an upper or lower RTI and fever. The three categories mirrored statewide laboratory-confirmed case trends during spring and summer 2020 but did not detect the increase in late fall. We hypothesized this was due to the requirements for fever and LRTI. Therefore, we added three new categories defined by milder symptoms without fever: Category 4 requires LRTIrelated diagnoses only;Category 5 requires upper or lower RTI or olfactory/taste disorders;and Category 6 requires at least one sign of CLI not identified by another category. Results. The six-category algorithm detected the initial surge in April 2020, the summer lull, and the second surge in late fall (see figure). Category 1 cases were not identified until mid-March, which coincides with the first laboratory-confirmed cases in Massachusetts. Categories 2 and 3, which required fever, were prominent during the initial surge but declined over time. Category 5, the broadest category, declined during February and March 2020, likely capturing the end of the influenza season, and successfully detected the spring surge and fall resurgence. Weekly number of COVID-19 like illnesses by category, February 2, 2020 through May 8, 2021 Conclusion. A syndromic definition that included mild upper RTI and olfactory/ taste disorders, with or without fever or LRTI, mirrored changes in laboratory-confirmed COVID-19 cases better than definitions that required fever and LRTI. This suggests a shift in medically attended care and/or coding practices during initial vs subsequent surges of COVID-19, and the importance of using a broad definition of CLI for ongoing surveillance.

16.
Open Forum Infectious Diseases ; 8(SUPPL 1):S286-S287, 2021.
Article in English | EMBASE | ID: covidwho-1746626

ABSTRACT

Background. As the SARS-CoV-2 (SCV-2) virus evolves, diagnostics and vaccines against novel strains rely on viral genome sequencing. Researchers have gravitated towards the cost-effective and highly sensitive amplicon-based (e.g. ARTIC) and hybrid capture sequencing (e.g. SARS-CoV-2 NGS Assay) to selectively target the SCV-2 genome. We provide an in silico model to compare these 2 technologies and present data on the high scalability of the Research Use Only (RUO) workflow of the SARS-CoV-2 NGS Assay. Methods. In silico work included alignments of 383,656 high-quality genome sequences belonging to variant of concern (VOC) or variant of interest (VOI) isolates (GISAID). We profiled mismatches and sequencing dropouts using the ARTIC V3 primers, SARS-CoV-2 NGS Assay probes (Twist Bioscience) and 11 synthesized viral sequences containing mutations and compared the performance of these assays using clinical samples. Further, the miniaturized hybrid capture workflow was optimized and evaluated to support high-throughput (384-plex). The sequencing data was processed by COVID-DX software. Results. We detected 101,432 viruses (27%) with > = 1 mismatch in the last 6 base pairs of the 3' end of ARTIC primers;of these, 413 had > = 2 mismatches in one primer. In contrast, only 38 viruses (0.01%) had enough mutations ( > = 10) in a hybrid capture probe to have a similar effect on coverage. We observed that mutations in ARTIC primers led to complete dropout of the amplicon for 4/11 isolates and diminished coverage in additional 4. Twist probes showed uniform coverage throughout with little to no dropouts. Both assays detected a wide range of variants (~99.9% coverage at 5X depth) in clinical samples (CT value < 30) collected in NY (Spring 2020-Spring 2021). The distribution of the number of reads and on target rates were more uniform among specimens within amplicon-based sequencing. However, uneven genome coverage and primer dropouts, some in the spike protein, were observed on VOC/VOI and other isolates highlighting limitations of an amplicon-based approach. Conclusion. The RUO workflow of the SARS-CoV-2 NGS Assay is a comprehensive and scalable sequencing tool for variant profiling, yields more consistent coverage and smaller dropout rate compared to ARTIC (0.05% vs. 7.7%).

17.
Open Forum Infectious Diseases ; 8(SUPPL 1):S352-S353, 2021.
Article in English | EMBASE | ID: covidwho-1746497

ABSTRACT

Background. Anti-spike monoclonal antibodies (mAb) including Bamlanivimab (BAM) and Bamlanivimab-Etesevimab (BAM/E) have shown reduced hospitalization rates for non-severe coronavirus disease 2019 (COVID-19) in clinical trials. Recent studies provided real-world hospitalization rates for BAM. But, similar data on those who received BAM/E are lacking. In spring 2021, Michigan experienced a surge of COVID-19 with more cases per capita than any other state. We sought to quantify the impact of BAM monotherapy versus BAM/E combination on hospitalization and mortality among a real-world high-risk cohort of outpatients with COVID-19. Methods. This retrospective cohort study evaluated outpatients ≥18 years with laboratory-confirmed mild/moderate COVID-19 who received mAb in a Detroit health system based on emergency use authorization criteria. Inclusion began on December 3rd 2020 with BAM monotherapy, changed to BAM/E combination on March 27, 2021, and included patients until April 19th 2021 (Figure 1). Demographics, comorbidities, and clinical characteristics were compared between patients who received BAM verses BAM/E using Chi-square and Mann-Whitney U test. Primary outcome was 30-day COVID-19 related hospitalization. Secondary outcomes were 30-day mortality and length of stay (LOS). Inclusion began on December 3rd 2020 with BAM monotherapy, changed to BAM/E combination on March 27, 2021, and included patients until April 19th 2021. In spring 2021, Michigan experienced a surge of COVID-19 with more cases per capita than any other state resulting in a large sample of real-world patients for analysis. Results. 643 patients received mAb (294 in BAM group and 349 in BAM/E group). Patients in the BAM/E cohort were younger and more obese with lower rates of diabetes, myocardial infarction, and cancer. Other characteristics were similar (Table 1). BAM/E patients had longer time from symptom onset to infusion (6 vs 4 days, p< 0.001). COVID-19 related 30-day hospitalization rates did not differ between groups (7.8 vs 7.2%, p=0.751). LOS and 30-day mortality (1% vs 0.3%, p=0.238) were also similar (Table 2). Patients in the BAM/E cohort were younger and more obese with lower rates of diabetes, myocardial infarction, and cancer. Other characteristics were similar BAM/E patients had longer time from symptom onset to infusion (6 vs 4 days, p<0.001). COVID-19 related 30-day hospitalization rates did not differ between groups. Length of stay and 30-day mortality were also similar. Conclusion. Rates of hospitalization in our study were higher than in clinical trials of mAB and may reflect differences in study populations (Table 3). Compared to other real-world studies, our cohort of young, obese, and Black patients, had similar hospitalization rates of 7.5%. The lack of difference in outcomes noted among the mAB formulations in our study may be related to longer time from symptom onset to infusion in the BAM/E combination group. Our patients were older with higher rates of obesity and other comorbidities than those in clinical trials (shown in orange). Compared to other real-world studies (in blue), our cohort of younger, more obese Black patients had similar hospitalization rates of 7.5%.

18.
Osteoporosis International ; 32(SUPPL 1):S139, 2022.
Article in English | EMBASE | ID: covidwho-1744275

ABSTRACT

Objective: During this exceptional and particular period of confinement, we have observed and analyzed the rheumatologists' (Rh) feelings, reactions, and attitudes that may have emerged. Methods: During the first lockdown in France, during spring 2020, 13 questions, 9 appendices, ranking of the most frequently cited reactions were asked to 38 private practice Rh from the Ile-de-France region, average age 63 yo, 58% male (M). Results: Fear of being contaminated and of transmitting M 91/F 69%, concern about an unknown pandemic M 86/F 69%, anger M 71/F 84% were the main feelings expressed. Anger at the indifference to the exposure of doctors in the city 84%, the unpreparedness of the authorities M 95/F 62%, the mortality in EHPAD (nursing homes) 81%, the media cacophony 79%, the hidden reality 71%. On a personal level, according to 61%, the Rh is not anxious about the world after, has no psychological repercussions (sleep, melancholy, family relations, frustration) 58% and his degree of commitment was guilt-free 55%. Professionally: perplexity in the face of the contradictions of experts and scientific journals 79%, wide acceptance of constraints in the practice (10 h/d maskwearing, 92%, spaced reception of patients 95%, education of barrier gestures and social distancing 97%), adaptation of the medical practice (teleconsultation, telephone consultation) 78%, fear of abandoning treatment or diagnostic delay M 82/F 62%, financial arrangements necessary M 86/F 53%. For M: worries about the pandemic, anger and uncertainty about what will happen next predominate in this order. For F, anger (untruths and lack of means) is the main feeling. Anger, fear and uncertainty are the most frequently cited feelings for both male and female. Conclusion: The Rh at the end of the period of confinement during spring of 2020, is worried M>F and anger especially in front of the sanitary unpreparedness M>F. On a personal level the private life has been little affected F>M and he has been able to adapt professionally. Nevertheless, the deconfinement has not been a banal return to normal 63% M=F.

19.
Western Journal of Emergency Medicine ; 23(1.1):S31, 2022.
Article in English | EMBASE | ID: covidwho-1743915

ABSTRACT

Learning Objectives: Assess the effectiveness of social media implementation of an Accreditation Council for Graduate Medical Education (ACGME) milestone-based curriculum during the spring 2020 US COVID-19 surge. The hypothesis is that pre-interns will report improvements in PP regarding multiple ACGME milestone topics. Background: Transitioning to residency involves translation of academic knowledge into clinical acumen, and is complicated by variable medical school experiences. The COVID-19 pandemic presented a new challenge by displacing students from clinical rotations. Virtual educational modalities such as the Slack Intern Curriculum (SIC) have increased newly-matched “pre-intern” perceived preparedness (PP) for residency in prior years, but the SIC had never been implemented or evaluated in a pandemic with disrupted medical education. Objective: Assess the effectiveness of social media implementation of an Accreditation Council for Graduate Medical Education (ACGME) milestone-based curriculum during the spring 2020 U.S. COVID-19 surge. The hypothesis is that pre-interns will report improvements in PP regarding multiple ACGME milestone topics. Methods: The SIC was constructed using topics from 8 ACGME milestones in emergency medicine (EM), incorporated into 8 clinical scenarios. Residency recruitment occurred via national EM listservs;of 276 programs, 27 enrolled. Curricular implementation was on Slack workspaces. Cases included stimulus images and clinical questions. Ample discussion time, answers, and resources were provided. Trends in PP were calculated with descriptive statistics and the Wilcoxon Rank Sum test. Results: Of 311 total pre-interns contacted, 289 (92.9%) completed a presurvey in April/May 2020, and 240 (77.2%) completed a post-survey in June/July 2020, for an 83.9% followthrough rate. Pre-interns reported statistically significant increases in PP both overall and regarding 14 of 21 milestones. See Table 1. Conclusions: Amidst the educational disruption of the COVID-19 pandemic, pre-interns participating in the SIC reported statistically significant increases in PP. Limitations include absence of control or pre-pandemic data. Future directions include adapting the SIC to other specialties' ACGME milestones for generalizability across all fields.

20.
Western Journal of Emergency Medicine ; 23(1.1):S24-S25, 2022.
Article in English | EMBASE | ID: covidwho-1743896

ABSTRACT

Learning Objectives: This study aimed to identify and measure effectiveness of common virtual education modalities utilized during the COVID-19 pandemic, as well as which of these modalities are perceived as most effective by medical students. Background: During the 2019 Novel Coronavirus (COVID-19) pandemic, newly-matched “pre-interns” were displaced from clinical rotations and in-person didactics, many of which are bridges to residency preparedness. During this near-total shift towards virtual medical education, several modalities became commonplace. There has been no largescale investigation of utilization or effectiveness of these virtual initiatives. Objectives: This study aimed to identify and measure effectiveness of common virtual education modalities utilized during the COVID-19 pandemic, with the hypothesis that active learning methods would be more used and effective. Methods: In spring 2020, two online surveys were distributed assessing time since last in-person clinical experience, and Likert-scale (1-5) questions regarding use and effectiveness of virtual education modalities. Results were analyzed using descriptive statistics. Results: 27 EM residencies were recruited, with 311 pre-intern participants. 289 (92.9%) completed pre-surveys, and 240 (77.2%) completed post-surveys. They reported the number of weeks since performing a physical examination (median = 8, IQR 7, 12), attending an in-person didactic (median = 10, IQR 8, 15), and of rotation displacement (median = 4, IQR 2, 6). Common education tools included online modules (n=210), podcasts (n=193), and social-media based education (n=195). Effective tools included podcasts (Mean = 4.116, SD = 0.856), online question bank use (Mean = 4.052, SD = 0.872), and FOAMed resources (Mean = 3.994, SD = 0.904). Conclusions: Pre-interns are entering residency disconnected from in-person clinical education, reflecting a need for effective remote teaching. Interactive options (podcasts, question banks, and FOAMed) were cited as more effective than traditional offline options (textbook and journal article reading). Identifying popular, effective virtual modalities can guide education initiatives during the present and future pandemics.

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