Experiences related to the COVID-19 pandemic among U.S. physicians in office-based settings, 2020-2021

Objective-To assess final estimates of physician experiences related to COVID-19 and to compare preliminary estimates used in NCHS early-release dashboards with final estimates in this report. Methods-Physicians interviewed in periods 3 and 4 (December 15, 2020, through May 5, 2021) of the 2020 National Ambulatory Medical Care Survey (NAMCS) were asked a series of questions about experiences related to COVID-19 (n = 422). This report presents final nationally representative estimates for selected measures of COVID-19-related experiences among physicians in the United States and compares preliminary and final estimates for these measures. Results-Between September 2020 and May 2021, 31.1% of office-based physicians in the United States experienced shortages of personal protective equipment, and 38.4% of physicians had to turn away COVID-19 patients or refer them elsewhere for care. The percentage of physicians using telemedicine for patient care increased from 43.1% before the pandemic to 88.4% after the start of the pandemic. No statistically significant differences were seen between preliminary and final estimates for the measures assessed in this report. Conclusions-By making changes to NAMCS partway through the survey year, the National Center for Health Statistics was able to produce nationally representative estimates of physician experiences related to an emerging health threat, the COVID-19 pandemic. Additionally, the similarity between preliminary and final estimates for measures of interest provides evidence of the value of developing preliminary earlyrelease estimates.

Humanitarian supply chains and innovation: a focus on US food banks

Purpose: To effectively meet their social objectives, humanitarian organizations need to be more innovative and find novel ways to stay competitive. Yet there has been limited focus on innovation by humanitarian organizations. Part of the issue is the lack of new practices and novel approaches that can be used as benchmarks. This study focuses on food banks, a critical hub for the delivery of food in humanitarian supply chains and where the use of innovation seems to be more reported on. Design/methodology/approach: Focusing on resource scarcity, a commonly referenced constraint by humanitarian organizations, the authors study how food and fund scarcity (versus abundance) influence the innovation efforts of twelve food banks in the United States. This study observes variations in behavior before and during the coronavirus disease 2019 (COVID-19) pandemic. Findings: The authors find that food banks operating in high resource scarcity (food-scarce and fund-scarce) settings focus on process innovations. Food banks operating in low resource scarcity (food-abundant and fund-abundant) settings focus on product innovations. Food banks operating in food-abundant and fund-scarce settings focus on marketing innovations. Food banks operating in food-scarce and fund-abundant settings show the most extensive focus on innovation by relying on imitative innovations. The innovation focus for most food banks switches to process innovation during the COVID pandemic. Originality/value: The study breaks down resource scarcity specific to food banks by differentiating food and funds, a novel approach to studying scarcity. Findings are novel as they suggest that operating context has a highly differentiating effect on what food banks focus on in terms of innovation. Operating context can lead to focus on process, product, imitative of market-related innovations. Finally, the study is novel because it explores how change in the environmental context due to disruptions can drastically modify the innovation focus of food banks. © 2023, Emerald Publishing Limited.

Anxiety, stress, and depression in Australian pregnant women during the COVID-19 pandemic: A cross sectional study.

BACKGROUND: The COVID-19 pandemic necessitated rapid responses by health services to suppress transmission of the virus. AIM: This study aimed to investigate predictors of anxiety, stress and depression in Australian pregnant women during the COVID-19 pandemic including continuity of carer and the role of social support. METHODS: Women aged 18 years and over in their third trimester of pregnancy were invited to complete an online survey between July 2020 and January 2021. The survey included validated tools for anxiety, stress, and depression. Regression modelling was used to identify associations between a range of factors including continuity of carer, and mental health measures. FINDINGS: 1668 women completed the survey. One quarter screened positive for depression, 19% for moderate or higher range anxiety, and 15.5% for stress. The most significant contribution to higher anxiety, stress, and depression scores was a pre-existing mental health condition, followed by financial strain and a current complex pregnancy. Protective factors included age, social support, and parity. DISCUSSION: Maternity care strategies to reduce COVID-19 transmission restricted women's access to their customary pregnancy supports and increased their psychological morbidity. CONCLUSION: Factors associated with anxiety, stress and depression scores during the COVID-19 pandemic were identified. Maternity care during the pandemic compromised pregnant women's support systems.

SARS: Reception and interpretations in three Chinese cities

In November 2002 a middle-aged government official in southern China fell ill with a virulent pneumonia that did not respond to typical therapies.1 A month later a young chef who worked in a restaurant specializing in exotic wildlife in the booming city of Shenzhen presented similar symptoms and sought treatment at a county hospital near his parents' home. Unable to improve the young chef's breathing, the hospital transferred him to a Guangzhou military hospital, and after three weeks on a ventilator he recovered. Many months later, laboratory results would identify both men as infected by the SARS virus;initially, though, neither case suggested a novel virus or the specter of a global epidemic. (Abraham 2005: 31) By late January, however, the situation had become more ominous. The number of cases of atypical pneumonia multiplied and several cases could be directly traced to contact between the chef and those who had treated or visited him in the hospital. The resistance of the disease to antibiotic treatment and the rapid spread among hospital staff and then to their family members alarmed provincial public health experts who quickly alerted the Chinese Centers for Disease Control (CDC). Soon after, a team traveled from Beijing to Guangzhou to meet with Dr. Zhong Nanshan, head of the Guangdong Institute for Respiratory Disease. (Abraham 2005: 32) Led by Dr. Zhong, they discovered that the atypical pneumonia spread via respiratory droplets and outlined preventive measures of quarantine and infection control within hospitals. (Abraham 2005: 33) Despite their clear recommendations and professional expertise, central government officials failed to follow through and the virus continued to spread. © 2007 Editorial selection, Deborah Davis and Helen Siu;individual chapters, the contributors.

The Pandemic and Organized Crime in Urban Latin America: New Sovereignty Arrangements or Business as Usual?

Using a focus on the ways that Covid-19 has impacted everyday life in urban Latin America, this article examines the shifting activities of organized criminal groups in the context of a global pandemic. Using grounded ethnographic fieldwork drawn from Brazil, it asks whether a health crisis with direct life and death consequences has empowered illicit actors, and by so doing changed longstanding relationships between illicit actors and citizens on one hand, and/or illicit actors and local authorities on the other. Its larger aim is to understand whether and how the global pandemic has impacted governance by producing new scalar and sovereignty tensions between state and non-state actors at the scale of the city, and with what implications for the legitimacy of national authorities and democratic governance more generally. © 2022 Davis, DE and Hilgers, T.

A Study on the Implementation of UV Disinfection Module on an Existing Autonomous Platform

The COVID-19 pandemic demanded innovative approaches to handle the situation around the globe. The Coronavirus challenged the effectiveness and practice of conventional surface disinfection methods. Existing disinfection methods rely on the manual administration of disinfectants. They are time-consuming, costly, and subject to human error. The paper proposes the implementation of an Ultraviolet Disinfection module that can be attached to any autonomous mobile robot. The autonomous Ultraviolet-C (UV-C) disinfection robot helps the user disinfect the premise without human intervention. The proposed system ensures proper disinfection by discovering near-optimal paths through the environment in minimum time. © 2022 IEEE.

Decreasing Student Stress Through Multi-Attempt Digital Engineering Assessments with Rotating Questions

This paper will discuss building multi-attempt quizzes and exams that use the Canvas Learning Management System (LMS) to deliver engineering assessments designed to lower overall student stress and anxiety. These assessments use practice-focused questions that force students to build programs (C++ and Matlab), draft engineering drawings (AutoCAD and Solidworks), and apply engineering design, ethics, and intellectual property concepts to solve open-response questions. Each time a student takes the assessment, the questions shift randomly within topical areas facilitated by question banks that rotate among questions of similar difficulty for each new attempt. Each assessment is composed of 1-5 question banks to ensure all topics were covered throughout the various assessments. In total, 17 assessments used this framework across two fall semesters and one spring semester in the 2020 and 2021 school years. Over the course of 10 unique assessments and 3 semesters, 54.7% of students used more than one attempt on each quiz or exam when averaged across all assessments in the study. Using LMS analytics and open-ended questions administered through an end-of-term student survey, 86.2% of students reported positive experiences regarding the assessment methods, 51.2% of students reported decreased anxiety, and 22.6% of students appreciated the greater flexibility provided by the assessments. From this data, multi-attempt assessments had a positive impact on students' wellbeing in three semesters that were particularly challenging due to the COVID-19 pandemic. © American Society for Engineering Education, 2022.

Is it Time to Revisit Neuroinflammatory Depression? A Case of COVID-19 Associated Depression and the Role of ECT

Background: The neurobiology of depression can be heterogeneous with multiple hypotheses proposed, including serotonin and neuroinflammatory pathways, each falling short of explaining the complete picture. Several reports describe the increased frequency of depression in the community following the COVID-19 pandemic and reports about neuropsychiatric sequela of the virus are emerging and the possible role of neuroinflammation. We present a patient who developed severe depression with psychotic features subsequent to his COVID-19 infection and was treated successfully with ECT following several failed medication trials. Case: A 49-year-old male with a past medical history of type II diabetes, hyperlipidemia, hypertension, chronic kidney disease, and gastroesophageal reflux disease was diagnosed with COVID-19 in January 2021. Upon initial diagnosis, neither admission nor treatment with steroids was required. He presented to the emergency department four days later with sepsis, pneumonia, and AKI secondary to COVID-19 along with the new onset of suicidal ideations with plans to cut himself and significant psychomotor features despite no previous history of mental illness or treatment. His EEG showed diffuse slow waves, consistent with encephalopathy, but no delirium was noted. He exhibited irritability, anger, anhedonia, negativism, and isolated himself in his room. He demonstrated delusional fear about his apartment exploding due to electricity disconnected for not paying his bills. He misinterpreted the blood draws as someone suspecting he has HIV. Treatment started on the medical floor and he was later transferred to the psychiatric floor. Several psychotropic medications were tried separately including citalopram 20mg, escitalopram 20mg, and bupropion (titrated to 300mg) with the addition of aripiprazole 5 mg without improvement. ECT was considered and his depression and psychosis improved following 6 treatments of bilateral ECT. He was discharged following completion of 10 ECT treatments on 300 mg of bupropion daily and 5mg olanzapine at night. Discussion: Viral infections such as HIV, Hepatitis C, and Influenza are associated with neuropsychiatric sequelae, including depression. COVID-19 infection is occasionally associated with ‘cytokine storm’ which may exacerbate neuroinflammation via increases in cytokines and possible activation of mast cells and microglia.[1] The role of elevated pro-inflammatory cytokines and glucocorticoid receptor resistance is widely studied. Interleukin-6 and CRP are the most strongly linked to depression with a high correlation for anhedonia and psychomotor retardation, prominent features of depression in our case, hinting at a possible role of neuroinflammation. [2] Psychotic features and psychomotor retardation are predictors of ECT response which matched the response to ECT in this case. References: 1. Kempuraj, Duraisamy, et al. COVID-19, mast cells, cytokine storm, psychological stress, and neuroinflammation. The Neuroscientist 2020: 402-414. 2. Tiemeier, Henning, et al. Inflammatory proteins and depression in the elderly. Epidemiology 2003: 103-107.

The Effect of Covid-19 on Spontaneous Pneumothorax

RATIONALE: SARS-COV-2 (COVID-19) has presented challenges to hospitals from its initial onset in 2020. Physicians at Lakeland Regional Medical Center (LRH) suspected an increase of spontaneous pneumothorax (PTX) in patients admitted with COVID-19 through the emergency department (LRH has 220,000 ED-visits per year). The suspicion was supported by a small body of literature reporting COVID-19's association with PTX (mainly in the form of small case series or reports). The purpose of this study was to examine the effect that COVID-19 has on PTX incidence on a much larger scale. METHODS : We conducted a retrospective chart review extracting data on admitted patients between March 2020 and December 2021. Data included age, sex, COVID-19 positivity status, intubation (at any time during hospitalization), and PTX occurrence. We compared PTX rates between COVID-19 positive/negative patients and between patients who were intubated or not. A series of chi-square tests (alpha at < .05) were used for comparisons, as well as to calculate odds ratios (OR). Lastly, a binomial logistic regression was conducted to examine the effect of COVID-19 positivity, intubation status, and the interaction of COVID-19 positivity and intubation status, while controlling for age and sex, on odds for developing PTX. RESULTS : There were 50,456 patients included in our analyses. PTX incidence was 2.3% for COVID-19 positive versus 0.62% for COVID-19 negative. There was a significant association (p<0.0001) and 366% increased odds of developing PTX if patients were COVID-19 positive (95% CI [2.99, 4.46]). Intubation in itself had a significant association (p < 0.0001) and OR of 10.35 (95% CI [8.90, 12.04]) for developing PTX, but results of logistic regression revealed a strong interaction between COVIDpositivity and intubation status. Using COVID-19 negative and intubated patients as our reference group, we found that COVID-19 positive and intubated patients were at 6.56 increased odds of developing a PTX. COVID-19 positivity did not appear to have a significant association with PTX in the non-intubated patients. CONCLUSIONS : PTX is a rare, serious potential complication of COVID-19. This complication has considerable morbidity, especially in patients requiring intubation and should require strong clinical suspicion in COVID-19 positive patients. Research is needed to identify other key factors (i.e. underlying pulmonary disease, oxygen requirements, illness severity) that influence outcomes of patients with COVID-19.

ASSOCIATION OF CONTINUITY OF CARER AND WOMEN'S EXPERIENCES OF MATERNITY CARE DURING THE COVID-19 PANDEMIC: A CROSSSECTIONAL SURVEY

Background: Recent research highlights the impact of the COVID-19 pandemic on maternity services, although none to date have asked women how they feel about the changes to care or analysed the association between continuity of carer and women's experiences. Aim: The aim of our research was to discover pregnant women's self-reported changes to their planned care and associations between continuity of carer and how women felt about changes to their planned care. Methods: A cross-sectional online survey of pregnant women aged over 18 years in their final trimester of pregnancy in Australia was undertaken. Results: 1668 women completed the survey. Most women reported at least one change to pregnancy care and birthing plans. Women receiving full continuity of carer (from an obstetrician or midwife) were more likely to rate the changes to care as positive (p < 0.001) when compared with women who received partial or no continuity. Conclusions: Pregnant women experienced many changes to their planned pregnancy and birth care during the COVID-19 pandemic. Women who perceived they were experiencing full continuity of carer had fewer changes to care and were more likely to feel positive about the changes than women who did not report they received full continuity of carer. Our study demonstrates that women are better together through continuity of carer models.

Takotsubo cardiomyopathy due to hemophagocytic lymphohistocytosis secondary to COVID-19 pneumonia

Case Report Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal disease characterized by excessive immune response and cytopenia. Severe COVID-19 infection induces a life-threatening inflammatory syndrome associated with intense cytokine release that similar to HLH. We present a patient who developed takotsubo cardiomyopathy due to HLH. Case 24-year olrd man with a past medical history of obesity was admitted at the medical intensive care unit (MICU) due to acute respiratory distress syndrome secondary to COVID- 19 pneumonia. During the MICU stay, the patient required a high dose of vasopressors and ventilatory support. For Covid management, the patient received tocilizumab, high dose steroids (20 mg daily of dexamethasone), and empiric antibiotic coverage with vancomycin and cefepime. On day six of MICU admission, the patient developed hypertriglyceridemia (TGL) that was initially thought to be secondary to propofol, but after discontinuing propofol the patient continued to have increasing TGL levels. On day 8 of MICU admission, the suspicion of HLH increased, HSscore was calculated, and the patient had a 70-80% probability of having HLH (181 points: Temperature of 103 °F, ferritin 2580 ng/ml, TGL:771 mg/dl, Fibrinogen 220 mg/dl, AST:116 u/L). On day 10 of MICU admission, troponins increased from 7.5 to 2,966 ng/L, telemetry showed diffuse ST elevations, but ECG did not show any ischemic changes. At that time, his clinical parameters included HR: 96 bpm, BP: 92/42 mmHg, O2 Sat:93% on mechanical ventilation with pressure support FIO2: 100%, Hb: 11.6 g/dl, WBC:10.36 k/dl, Plt: 210 k/dl. Acute stress cardiomyopathy secondary to HLH was suspected. Transthoracic echocardiogram demonstrated preserved ejection fraction and inferoapical akinesia consistan as takotsubo cardiomyopathy. On day 11 of MICU admission, the patient had a cardiac arrest and after 30 minutes of cardiopulmonary resuscitation no return of spontaneous circulation was achieved. Discussion HLH induces a cytokine cascade that causes an excessive inflammatory response and multi-organ dysfunction that can be secondary to infections such as Covid-19. Takotsubo cardiomyopathy also known as stress cardiomyopathy, is a reversible dysfunction characterized by acute hypokinesia/ akinesia of the apical and middle segments of the left ventricle that extends beyond a unique coronary territory. We conclude that the trigger for takotsubo cardiomyopathy in this case was related to excess catecholamine release secondary to HLH.

Learning from the Long Term Experiences of Patients Recovering from COVID-19: Utilizing a Novel Approach to a Transition of Care Curriculum to Benefit Students and Patients

Study Objective: Medical students interviewed and longitudinally followed COVID-19 patients after discharge from hospitalization and ED settings. Utilizing telehealth, students participated in care, provided support and learned about the disease burden of COVID-19. Students improved care by providing feedback from themes identified from these interviews to improve the transition of care process with care teams. In March 2020 medical students were removed from their clinical experiences due to COVID-19. This disruption to the traditional method of medical education was an impetus to explore new creative approaches to clinical education Transitions of care are an important component of patient care and pose significant risks for complex patients. The use of telehealth grew exponentially during the pandemic and is an important skill set for future physicians. Telehealth allowed medical students to participate in care in meaningful and safe ways. Methods: Patients who either visited the ED or were hospitalized for a COVID-19 infection at two large hospitals from March-September 2020 were identified for inclusion in the study. Medical students contacted these patients over the telephone and administered a questionnaire. Students inquired about symptoms, impact on mental health, impact on financial stability and positive or negative experiences while in the hospital. Students followed up with patients who were still experiencing symptoms every 2 weeks or until symptoms were stable for 4 weeks. Students participated in a weekly meeting with care team leaders and provided feedback with themes related to the patient experience. Improvements to the transition of care and follow up with patients were made in real time based on this feedback. At the end of the project, a structured interview with medical students was collected about the impact of participation. Results: 112 patients were contacted for participation. Of those, 64 individuals consented and completed the interview. 14 patients were interviewed multiple times due to ongoing symptoms. Students noted multiple benefits across Kirkpatrick's Scale on the structured interview. Benefits included learning about a novel disease, collaborating with care teams and creating student led performance improvement projects. Qualitative themes of long COVID patients reflected emotional impact of recovery and resulted in interventions to improve mental health care for recovering patients. Conclusion: A wide variety of disease processes could be applied to transition of care curriculum to simultaneously provide another avenue of support for patients while exposing medical students to the vast complexity of disease burden. [Formula presented]

Underlying Body Dysmorphic Disorder in Patients With Zoom Dysmorphia

The coronavirus 2019 pandemic has caused dramatic changes in daily life, primarily in terms of social connections. Many people are using videoconferencing via Zoom and similar programs as a means of communication for work, school, and social events. As a result, Zoom dysmorphia-which can potentially cause or worsen body dysmorphic disorder (BDD)-is a growing concern. Owing to the lack of FDA-approved agents for BDD, treatment involves psychosocial and pharmacologic therapies that target the underlying issues. It is important to identify underlying BDD in Zoom-dysmorphic patients and to use published guidelines, multimodal treatment strategies, and individual patient response to determine the best approach for effective BDD management.

The utility of paired upper and lower COVID-19 sampling in patients with artificial airways

Background: The Centers for Disease Control and Prevention (CDC) recommends upper respiratory tract (URT) polymerase chain reaction (PCR) testing as the initial diagnostic test for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Lower respiratory tract (LRT) testing for patients requiring mechanical ventilation is also recommended. The goal of this study was to evaluate concordance between paired URT and LRT specimens in children undergoing pre-admission/procedure screening or diagnostic testing. We hypothesized that < 10% of paired tests would have discordant results. Methods: Single center cross-sectional study including children with artificial airways who had paired URT and LRT SARS-CoV-2 PCR testing between 4/1/2020 and 6/8/2020. URT specimens included nasopharyngeal (NP) swabs and aspirates. LRT specimens included tracheal aspirates and bronchoalveolar lavages. URT and LRT specimens were classified as paired if the two specimens were collected within 24 hours. Artificial airways included tracheostomies and endotracheal tubes. Tests were classified as diagnostic versus screening based on the indication selected in the order. Results: 102 paired specimens were obtained during the study period. Fifty-nine were performed for screening and 43 were performed for diagnosis of suspected SARS-CoV-2. Overall, 94 specimens (92%) were concordant, including 89 negative from both sources and 5 positive from both sources. Eight specimens (8%) were discordant, all of which were positive from the URT and negative from the LRT (Figure 1). Among patients undergoing screening, 3 of 4 positive tests were discordant and among symptomatic patients, 5 of 9 positive tests were discordant. There were no instances of a positive LRT specimen with a negative URT specimen. Conclusion: Overall, most paired samples from the URT and LRT yielded concordant results with no pairs positive from the LRT and negative from the URT. These data support the CDC recommendation that URT specimens are the preferred initial SARS-CoV-2 test, while LRT specimens should be collected only from mechanically ventilated with suspected SARS-CoV-2. (Figure Presented).

Why "We Can't Breathe" During COVID-19

Now in the midst of a racial crisis, the United States continues to face challenges from COVID-19. Herein, scholars explain the influence of the virus on health, education, and social interactions within families. Special attention will be placed on the pandemic's effect upon African American/ Black communities.