Alcohol use trends in Dallas County during the COVID-19 pandemic

Alcohol (ethanol) is the most widely detected drug in forensic toxicology casework and an increase in consumption of alcohol was reported during the COVID-19 pandemic. The increase in consumption could be attributed to rising stress levels and social isolation. To determine whether the pandemic had an impact on ethanol positivity and concentrations in cases analyzed by the Dallas County Southwestern Institute of Forensic Sciences, blood ethanol results were evaluated from January 1, 2019, through December 31, 2021. This time frame captured ethanol prevalence and concentrations before, during, and immediately following the pandemic for comparison. The average ethanol concentration in postmortem casework over the three years for each quarter ranged from 0.116 g/100 mL to 0.142 g/100 mL while the average concentration in driving while intoxicated (DWI) was higher, ranging from 0.173 g/100 mL to 0.188 g/100 mL. The ethanol positivity rate for postmortem casework remained relatively the same at approximately 20% during the time frame, while there was a decrease in ethanol positivity rate for DWI casework during the pandemic in April - June (Q2) 2020. However, the positivity rate returned to pre-pandemic levels by the end of 2020. Despite the self-reported surveys of increased alcohol consumption during the pandemic, a corresponding increase in average ethanol concentrations was not observed in Dallas County and the surrounding area.Copyright © 2023

Covid-19 Induced Biventricular Takotsubo Cardiomyopathy

Background Takotsubo Cardiomyopathy (TTS) is a syndrome of transient LV dysfunction. Myocardial injury (MCI) has been reported in acute COVID-19 (C19) infections, however, the exact pathophysiology is unclear. Association of rising cardiac biomarkers with inflammatory markers suggests systemic inflammatory response in C19 infection in causing MCI. Case A 52-year-old AA male with history of HTN presents with complaint of worsening shortness of breath and atypical chest pain. Diagnosed with C19 and intubated due to respiratory failure. Chest pain workup included TTE which showed biventricular (BV) systolic dysfunction with apical ballooning and LVEF 25-30%. Left heart catheterization showed non-obstructing coronary disease. Repeat TTE 2 weeks later showed normal BV systolic function with LVEF greater than 55%. Decision-making BV TTS is associated with more hemodynamic instability than is isolated LV TTS. Mayo Clinic diagnostic criteria for TTS requires absence of obstructive CAD or plaque rupture. Rapid recovery of BV function is consistent with TTS with transient BV dysfunction. LV TTS is common in COVID-19 infections, but BV TTS is a less common complication of COVID. Conclusion Due to the propensity of C19 to cause hemodynamic instability it is important to not relate to a patient's instability to C19 alone. It is important to consider TTE in patients with C19, as the patient may be experiencing TTS. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

MANAGEMENT OF RITUXIMAB REACTION FOR NOVICE ONCOLOGY NURSES: AN IN-PERSON EDUCATION PROGRAM

Oncology Nursing Practice The COVID-19 pandemic had a profound impact on the healthcare field and negatively impacted the onboarding experience of new graduate nurses. (statistics). At NewYork Presbyterian: Weill Cornell Medical Center, the Magnet supported Nurse Residency Program was done virtually. Virtual learning greatly decreased the amount of hands-on training that was provided to previous nurse residency graduates. As a result, new graduate nurses voiced that they did not feel comfortable administering Rituximab and would benefit from a skills training session. The purpose of the program is to increase novice oncology nurse confidence and knowledge in Rituximab administration and reaction management by 15% through attendance of a nurse-led education program. Expert hematology/oncology nurses and leadership developed an in-person education program to educate the novice nurses in safe rituximab administration and reaction management. Reaction management included rescue medication, pertinent labs, intravenous vein placement, oxygen titration and escalation of care. Formal written education was followed by mock situations and hands-on learning. Novice nurses' experience with the program was evaluated using an electronic survey. Nurses evaluated themselves based on Brenner's Stages of Nursing Development from novice to expert. Post-surveys showed 56% of nurses deemed themselves competent or higher when caring for a patient receiving rituximab. Designing an in-person education program with high-volume oncology emergencies

The Young were not Spared: What Death Certificates Reveal about Non-Covid Excess Deaths.

From April 2020 through at least the end of 2021, Americans died from non-Covid causes at an average annual rate of 97 000 in excess of previous trends. Hypertension and heart disease deaths combined were elevated 32 000. Diabetes or obesity, drug-induced causes, and alcohol-induced causes were each elevated 12 000 to 15 000 above previous (upward) trends. Drug deaths especially followed an alarming trend, only to significantly exceed it during the pandemic to reach 108 000 for calendar year 2021. Homicide and motor-vehicle fatalities combined were elevated almost 10 000. Various other causes combined to add 18 000. While Covid deaths overwhelmingly afflict senior citizens, absolute numbers of non-Covid excess deaths are similar for each of the 18 to 44, 45 to 64, and over-65 age groups, with essentially no aggregate excess deaths of children. Mortality from all causes during the pandemic was elevated 26% for working-age adults (18-64), as compared to 18% for the elderly. Other data on drug addictions, non-fatal shootings, weight gain, and cancer screenings point to a historic, yet largely unacknowledged, health emergency.

Point-of-Care Testing of COVID-19: Current Status, Clinical Impact, and Future Therapeutic Perspectives

The effective management of the coronavirus disease 2019 (COVID-19) pandemic depends on the bedrock of rapid and accurate testing to enable promptness in quarantining, contact tracing, epidemiologic characterization, evaluating vaccine response, and strategic decision-making. In this context, point-of-care (POC) tests are of utmost importance as they facilitate rapid and decentralized testing without much instrumentation and technical expertise. The review describes the current status of POC COVID-19 testing in three broad categories: molecular, antigen, and antibody. The advantages, limitations, and adaption of each of the three types of POC tests are discussed while highlighting their clinical impact in real-world settings. The role of POC testing for COVID-19 screening, diagnosis, and surveillance has been highlighted, focusing on recent advances in the field. The difference between POC and at-home tests is discussed while elaborating on the necessity for the latter. A spotlight on the impact of variants on the performance of COVID-19 tests is provided. The clinical impact of POC testing in hospitals with regard to improving therapeutic options, patient flow, enhancing the infection control measures, and early recruitment of patients into clinical trials is discussed. Finally, the future perspectives that will aid the research community in the development of POC tests for COVID-19 or any infectious disease, in general, are presented. Overall, we believe this review can benefit the research community as it (i) presents a comprehensive understanding of current COVID-19 POC testing methods (ii) highlights features required to transform the current tests developed during the past year as POC diagnostics, and (iii) provides insights to address the unmet challenges in the field. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Three Misconceptions about Federal Regulation

Three common misconceptions persist about federal regulations. The first misconception is that most new regulations concern the environment, but in fact, only a small minority of regulatory flows are environmental. The second misconception is that regulators offer reasonable justifications and quantitative evidence for the majority of regulations. However, quantitative estimates rarely appear in published rules, negating the impression given by executive orders and Office of Management and Budget guidance, which require cost-benefit analysis (CBA) and clearly articulate sound economic principles for conducting CBA. Environmental rules have relatively higher-quality CBAs, at least by the standards of other federal rules. The third misconception, which is particularly relevant to the historic regulations promulgated during the COVID-19 pandemic, is that regulatory costs are primarily clerical, rather than opportunity or resource costs.

KURZARBEIT/SHORT TIME WORKING: EXPERIENCES AND LESSONS FROM THE COVID-INDUCED DOWNTURN

Following the covid-induced lockdowns, many commented on the role the German model of Kurzarbeit could play in reducing unemployment. Other countries emulated the model. Looking at the experiences of Germany, the UK, Sweden and the USA, the article analyses the strengths and weaknesses of short-time working (STW) schemes. It asks whether STW has been well designed to have optimal short and longer run impact. It is quite effective as a short-term palliative, but in longer downturns, its weaknesses come to the fore. It is by no means clear that the UK needs a permanent replacement for the furlough.

Economic Activity and the Value of Medical Innovation during a Pandemic

The “shutdown” economy of April 2020 is compared to a normally functioning economy both in terms of market and nonmarket activities. Three novel methods and data indicate that a full shutdown of “nonessential” activities puts market production about 25 % below normal in the short run. At an annual rate, a full shutdown costs $9 trillion, or about $18,000 per household per quarter. Employment already fell 24 million by early April 2020. These costs indicate, among other things, the value of innovation in both health and general business sectors that can accelerate the time when, and the degree to which, normal activity resumes.

Three Myths about Federal Regulation

Despite evidence to the contrary, three common myths persist about federal regulations. The first myth is that many regulations concern the environment, but in fact only a small minority of regulations are environmental. The second myth is that most regulations contain quantitative estimates of costs or benefits. However, these quantitative estimates appear rarely in published rules, contradicting the impression given by executive orders and Office of Management and Budget guidance, which require cost-benefit analysis (CBA) and clearly articulate sound economic principles for conducting CBA. Environmental rules have relatively higher-quality CBAs, at least by the low standards of other federal rules. The third myth, which is particularly relevant to the historic regulations promulgated during the COVID-19 pandemic, is the misperception that regulatory costs are primarily clerical, rather than opportunity or resource costs. If technocrats have triumphed in the regulatory arena, their victory has not been earned by the merits of their analysis.

The Incidence and Magnitude of the Health Costs of In-person Schooling during the COVID-19 Pandemic

The health costs of in-person schooling during the pandemic, if any, fall primarily on the families of students, largely due to the fact that students significantly outnumber teachers. Data from North Carolina, Wisconsin, Australia, England, and Israel covering almost 80 million person-days in school help assess the magnitude of the fatality risks of in-person schooling (with mitigation protocols), accounting for the age and living arrangements of students and teachers. The risks of in-person schooling to teachers are comparable to the risks of commuting by automobile. Valued at a VSL of $10 million, the average daily fatality cost ranges from $0.01 for an unvaccinated young teacher living alone to as much as $29 for an elderly and unvaccinated teacher living with an elderly and unvaccinated spouse. COVID-19 risk avoidance may also be more amenable to Bayesian updating and selective protection than automobile fatalities are. The results suggest that economic behaviors can sometimes invert epidemiological patterns when it comes to the spread of infectious diseases in human populations.

Economic Activity and the Value of Medical Innovation during a Pandemic

The “shutdown” economy of April 2020 is compared to a normally functioning economy both in terms of market and nonmarket activities. Three novel methods and data indicate that the shutdown puts market production 25-28 percent below normal in the short run. At an annual rate, the shutdown is costing $7 trillion, or about $15,000 per household per quarter. Employment already fell 28 million by early April 2020. These costs indicate, among other things, the value of innovation in both health and general business sectors that can accelerate the time when normal activity resumes.

Deaths of Despair and the Incidence of Excess Mortality in 2020

Weekly mortality through October 3 is partitioned into normal deaths, COVID, and nonCOVID excess deaths (NCEDs). Before March, the excess is negative for the elderly, likely due to the mild flu season. From March onward, excess deaths are approximately 250,000 of which about 17,000 appear to be a COVID undercount and 30,000 non-COVID. Deaths of despair (drug overdose, suicide, alcohol) in 2017 and 2018 are good predictors of the demographic groups with NCEDs in 2020. The NCEDs are disproportionately experienced by men aged 15-55, including men aged 15-25. Local data on opioid overdoses further support the hypothesis that the pandemic and recession were associated with a 10 to 60 percent increase in deaths of despair above already high pre-pandemic levels.

The Backward Art of Slowing the Spread? Congregation Efficiencies during COVID-19

Were workers more likely to be infected by COVID-19 in their workplace, or outside it? While both economic models of the pandemic and public health policy recommendations often presume that the workplace is less safe, this paper seeks an answer both in micro data and economic theory. The available data from schools, hospitals, nursing homes, food processing plants, hair stylists, and airlines 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.

The incidence and magnitude of the health costs of in-person schooling during the COVID-19 pandemic.

The health costs of in-person schooling during the pandemic, if any, fall primarily on the families of students, largely owing to the fact that students significantly outnumber teachers. Data from North Carolina, Wisconsin, Australia, England, and Israel covering almost 80 million person-days in school during 2020 help assess the magnitude of the fatality risks of in-person schooling, accounting for mitigation protocols as well as the age and living arrangements of students and teachers. The risks of in-person schooling to unvaccinated teachers are, for those not yet elderly, small enough to challenge comprehension. Valued at a VSL of $10 million, the average daily fatality cost ranges from $0.01 for a young teacher living alone to as much as $29 for an elderly teacher living with an elderly spouse. For each 22 million unvaccinated students and teachers schooling in-person for a 5-day week during the pandemic, the expected number of fatalities among teachers and their spouses is one or less.