Openness relates to COVID-19 vaccination rates across 48 United States but politics Trump personality

Does geographic variation in personality across the United States relate to COVID-19 vaccination rates? To answer this question, we combined multiple state-level datasets: (a) Big Five personality averages (i.e., extraversion, agreeableness, conscientiousness, neuroticism, and openness;Rentfrow et al., 2008), (b) COVID-19 full-vaccination rates (CDC, 2021a), (c) health-relevant demographic covariates (population density, per capita gross domestic product, and racial/ethnic data;Webster et al., 2021), and (d) political and religiosity data. Analyses showed openness as the strongest correlate of full-vaccination rates (r = 0.51). Controlling for other traits, demographic covariates, and spatial dependence, openness remained significantly related to full-vaccination rates (r(p) = 0.55). Adding political and religiosity data to this model diminished openness effects for full-vaccination rates to non-significance (r(p) = 0.26);however, extraversion emerged as a significant correlate of full-vaccination rates (r(p) = 0.37). Although politics are paramount, we suspect that states with higher average openness scores are more conducive to novel thinking and behavior-dispositions that may be crucial in motivating people to take newly-developed vaccines based on new technologies to confront a novel coronavirus.

Adolescents' Suicide Rates by Ethnicity - Data from the National Vital Statistics System 2015-2020

Background/Aim: Since the COVID-19 pandemic, emergency departments across the United States have seen an increase in patients seeking care for psychiatric complaints to include suicidal ideation and attempts. A recent national study reported that the suicide rate has decreased since 2018 but this decrease may not be equal across all age groups and ethnicities especially the younger aged. Using mortality data from the National Vital Statistics System (NVSS), we investigated the trends in the suicide death rate among those aged 10-19 by gender, ethnicity and mode of suicide between 2015-2020. Method(s): We identified individuals with intentional self-harm reported on death certificates as a leading cause of death or contributory cause of death from 2015-2020 using ICD-10 codes *U03,X60-X84,Y87.0. Annual percent change was calculated;ANOVA was used to determine differences. Result(s): From 2015 to 2020, overall, there were 16,600 (12,310 males;4,290 females) deaths from suicide among those aged 10-19;average age was 16.6+/- 2.1 males;16.02+/- 2.22 females, 84% of males had some college;77% females had some college;99% were single in both groups. Non-Hispanic whites accounted for over 50% of all suicides followed by Hispanics at >20%. The number of deaths by suicide increased over time for males but decreased for females- both groups' age at death decreased over time. By ethnicity, both non-Hispanic black males and females saw a significant increase in their suicide rates from 10.3% (2015) to 12.3% (2020, P=0.03) males and 11.1% to 13.9% (P=0.05) females. Similar findings were noted for Hispanic males (13.3% to 18.3%, P=0.0001) and females (18.7% to 23.4%, P=0.006) while suicide rates decreased for non-Hispanic whites and Asians. The top three most frequent modes of suicide for females were hanging, strangulation and suffocation (>50%);discharge of firearms (>20%) and intentional self-poisoning by and exposure to drugs and other biological substances (>15%). The largest increase of over 250% was intentional self-poisoning (suicide) by and exposure to other and unspecified solid or liquid substances and their vapors. For males the top three most frequent methods used for suicide were discharge of firearms (>50%);hanging, strangulation and suffocation (>35%) and intentional self-poisoning by and exposure to drugs and other biological substances (>15%) while the largest increase (100%) was the same as for females- intentional self-poisoning (suicide) by and exposure to other and unspecified solid or liquid substances and their vapors. Conclusion(s): Although suicide deaths have been reported to be decreasing, we found among those aged 10-19, suicide rates were increasing for both non-Hispanic blacks and Hispanic males and females but not for whites or Asians. The most vulnerable time may be when this age group starts college suggesting more support is needed for those transitioning from home for the first time. The large increase of 250% for females and 100% for males related to intentional self-poisoning and correlation with exposure and access to drugs and other biological substances requires further investigation as well. This includes evaluating the role of social media platforms particularly during the COVID-19 pandemic in promoting and facilitating access to drugs and biological substances. No, authors do not have interests to disclose Copyright © 2022

Provider-Only Patients: A Novel Approach to ED Volume Surge and Covid-19

Because of staff shortages and the increasing need for health care, leaders at Inova Fairfax Hospital developed an ED care delivery model for a subset of triaged low-severity patients with Covid-19 that produced a reduction in nurse and provider hours, as well as reduced ED length of stay, in a safe manner.

Optimising Return to Elective Total Hip Arthroplasty (THA) Following the COVID-19 Pandemic: Lessons Learned and Future Directions

Aim COVID-19 has led to unprecedented waiting times for elective surgery. Optimising patient pathways is paramount in tackling the backlog. Length of hospital stay (LOS) is an accepted surrogate for successful elective surgery. The aims of our study were: 1) report on changes in LOS after restarting our elective THA service;2) identify barriers to early discharge, 3) investigate effectiveness of implemented changes. Method A retrospective review of consecutive patients undergoing elective THA, comparing three groups: 1) enhanced care pathway (n=96;09/2019–12/2019);2) COVID group (n=56;03/2021–04/2021);3) intervention group (n=96;05/2021–08/2021). Results LOS in the enhanced care pathway group was 2.6 ±2.1 days. During initial resumption of elective operating (COVID group) the LOS was 4.8 ±4.5 days (statistically significant increase;p=0.011). Factors affecting LOS included reduced physiotherapy provision;lack of pre-operative occupational therapy review;loss of educational classes and worse pre-operative functional status. To address these our department employed three new physiotherapists, introduced training for nursing staff and created a post-operative proforma. The LOS subsequently reduced to 3.7 ±4.6days (p=0.166). Subgroup analysis of the intervention group showed age <75 (p<0.001) and ASA1–2 (p=0.036) were associated with reduced LOS (2.1±1.5 days). Other variables analysed did not significantly affect LOS. Conclusions COVID-19 has had a significant effect on LOS, which is still not reversed. For effective resumption of THA services, pre-pandemic enhanced care pathways should be reinstated. With current restrictions preventing face-to-face classes, online educational sessions could be offered. Those younger than 75 years and ASA1–2 are most likely to be discharged without delay.

THE PSYCHOLOGICAL IMPACT OF LIVING WITH ASTHMA DURING THE COVID-19 PANDEMIC

Background Underlying chronic conditions could make individuals particularly vulnerable to environmental stress during the coronavirus-19 disease (COVID-19) pandemic. Comorbid psychopathology frequent in asthma could increase the vulnerability of this population. As psychological symptoms are intimately linked with asthma control, research is needed to uncover potential mental health considerations for the clinical management of asthma in a pandemic setting. Objective We investigated whether differences exist between asthmatics relative to non-asthmatics in various dimensions of psychological health during a pandemic. We then investigated how perceived COVID-19 vulnerability, asthma and COVID-19 symptom experience, and symptom-related worry may mediate group differences in psychological distress. Methods Survey data on the physical, psychological, and pandemicrelated health of 234 adults was collected from July-November 2020. Controlling for demographic and health-related confounds, multiple regression analyses examined differences in psychological distress between asthmatics (n=111) and nonasthmatic controls (n=123) during a pandemic. Mediation analyses investigated roles of perceived COVID-19 vulnerability, symptom experience, and symptom-related worry in this model. Results Compared to non-asthmatics, scores on anxiety, stress, and symptoms of burnout were significantly higher for individuals with asthma (P<.05). Emotional exhaustion, represented by a subscale of the Maslach Burnout Inventory, remained elevated beyond general anxiety and depression. Experience of symptoms typical in both asthma and COVID-19 (i.e., chest tightness) mediated 42% of this effect (95%CI=[0.72, 2.51]). Conclusion The mental health of individuals with asthma is differentially impacted in a pandemic environment compared to individuals without asthma. Characteristics of burnout, partially mediated by physical symptoms related to asthma and COVID-19, may constitute a new ?symptom burnout? phenomenon related to viral pandemics. This phenomenon emerged over and above comorbid anxiety and depression, which are commonly observed in asthma. Our findings can contribute to an optimization of asthma management, and more research is needed to understand whether ?symptom burnout? exists beyond the limited access to care and heightened environmental stress of a viral pandemic.

DEVELOPMENT AND IMPLEMENTATION OF A MULTICOMPONENT INTERVENTION TO IMPROVE GUIDELINECONCORDANT MANAGEMENT OF PULMONARY NODULES

BACKGROUND: Adherence to guideline-concordant management of incidentally detected pulmonary nodules (PNs) is frequently poor. We designed and implemented a division-level intervention to improve Fleischner society guideline adherence at our institution. METHODS: Our intervention included: (1) radiology report templates for documentation of PNs, (2) generation of daily reports of incidentally identified PNs, (3) a population health coordinator who documented PN identification in the electronic health record (EHR) and managed patient outreach, and (4) EHR templates for clinician documentation of disclosure to patients and clinical care plan. Outcomes were rates of PN disclosure and completion of recommended surveillance chest computed tomography (CT) or sub specialist evaluation. Outcomes were assessed in patients with a PN identified before (01/02/ 2018-03/31/2019) and after (04/01/2019-09/30/2020) implementation of the intervention in 4 primary care practices. RESULTS: Pre-and post-implementation cohorts included 395 and 432 patients, respectively. Mean age was 65.1±10.8 vs 65.0±11.8 (p=0.881) and 59.5% vs 60.2% were female (p=0.895). Race was White in 52.4% vs 43.3%, Black in 39.5% vs 45.1%, and other 8.1%vs 11.6%(p=0.166). Recommended management was surveillance chest CT (72.4% vs 73.6%), subspecialist referral (21.0% vs 13.7%), or no further imaging (6.6% vs 12.7%;p=0.001). Disclosure of PNs increased from 78.5% to 94.9%, an improvement of 16.4% (95% CI 11.9-21.0%). Surveillance CT ordering increased from 66.4% [n=190/286] to 88.7% [n=282/318], an improvement of 22.3% (95% CI 15.8-28.7%) and CT completion increased from 67.1% [n=192/286] to 85.5% [n=272/318], an improvement of 18.4% (95% CI 11.7-25.1%). When CT was completed >30 days after the recommended time interval, median delay was reduced by 66.5 days (163.5 [n=72] vs 97.0 [n=97], p=0.004), despite post-intervention overlapping with the COVID-19 pandemic (Figure 1). The rate of completed sub specialist evaluation was similar (94.0% [n=78/83] vs 93.9% [n=46/49], p=1). CONCLUSIONS: A multicomponent division-level intervention improved rates of PN disclosure and surveillance CT ordering and completion. Our findings support expansion of system-level approaches that standardize and automate processes to improve guideline adherence.

Virtual Field Trips: Experience from a Global Pandemic and Beyond

Traditionally, field geology and the use of outcrop analogues have been crucial to aid subsurface understanding, with fieldwork and excursions playing an important role in the training and continued professional development of multidisciplinary geoscientists. The COVID-19 pandemic caused a major disruption to industry training programs and university geoscience courses as travel restrictions and lockdowns created the need for digital alternatives. Although virtual field trips (VFTs) had been gaining traction prior to the pandemic, the sudden need to replace physical field activities has driven a rising interest to allow geologists and geoscientists to keep in touch with the rocks. In this contribution we present the state of the art of virtual field trips, covering the process of conceptualizing and building a VFT, as well as delivery methods available. We argue that VFTs have an important place in geoscience education, not as a replacement for physical field trips, but as a complement to assist participants' orientation prior to a course, retention of learning outcomes post-trip, as well as an enabler of accessible and non-discriminatory experience of field geology to a wider group of people than those conventionally given the opportunity for physical excursions. Central to the successful creation of virtual field trips is the availability of 3D virtual outcrops and other geospatial data to populate a VFT. Databases of virtual outcrops, such as SAFARI and V3Geo, make it efficient to create a high-resolution framework for a field trip, which is then used to integrate conventional field or subsurface data. Finally, the VFT leader adds their narrative and learning process around the 3D virtual environment and delivers the content to participants. A VFT can be organized by topic (e.g. depositional environment or structural setting) rather than restricted to a limited geographical area. In addition, a VFT can be created to fit any available timescale, from a tour lasting minutes to look at a particular geological feature, through to a multi-day agenda mirroring a conventional field trip. We illustrate our contribution using example VFTs designed for different audiences and geological topics. Copyright © 2022, Society of Petroleum Engineers

Caution on Plasma Cytokine Findings in 2019 Novel Coronavirus Cases

In the initial 41 cases of 2019 novel coronavirus published in Lancet, elevated blood IL-10 cytokine data from these patients and four healthy subjects were presented as argument to not consider immunosuppressive therapy. We propose this is an erroneous interpretation of the cytokine measures, as parallel increases in pro- and anti-inflammatory cytokines indicate an intact immune axis and do not diminish the potential role of immunosuppression. We show data in healthy control subjects strong correlations between pro- and anti-inflammatory cytokines, and immunosuppressive therapies should be considered in 2019 novel coronavirus cases. Funding: This study was funded by NIH K01AG42498 (WW) and R01AG54046 (WTH). The funders have no role in the data analysis or manuscript preparation. Declaration of Interest: WTH has served as a consultant to ViveBio LLC, Biogen Inc., and AARP Inc.;received research support from Fujirebio USA;and has a patent on CSF-based diagnosis of FTLD-TDP (assigned to Emory University).

Silver lining of a very dark cloud: Telehealth virtually perfect in the COVID-19 era

Background and Aim: Public hospital outpatient departments are a critical interface between acute and specialist hospital services and primary care. Failure of patients to attend is an expensive and persistent issue worldwide, with reported did-not-attend (DNA) rates of up to 30% in some centers. Non-attendance is influenced by many factors, such as logistics in getting to the hospital, work commitments, financial hardship, transportation access, and competing health interests. Telehealth has been available for some years, but its implementation and uptake have been limited. Telehealth is defined as “information and communications technologies to deliver health and transmit health information over both long and short distances,”1 and it can be conducted via videoconferencing or telephone. It represents an attractive model to increase outpatient clinic appointments, which is important given the long waiting times for many clinics. Telehealth also provides avenues to continue critical outpatient management during the coronavirus disease 2019 (COVID-19) pandemic and for ongoing clinical management for furloughed or isolated staff who can still be engaged in outpatient care. At our institution, the COVID-19 pandemic stimulated the immediate and almost universal implementation of the telehealth model of care for outpatient appointments. We aimed to evaluate the experience of the telehealth model in the first 3 months of the COVID-19 pandemic in Victoria, focusing on the impact of telehealth on the number of scheduled appointments and clinic DNA rates. Methods: Over a 9-week period during the first COVID-19 lockdown in Melbourne, scheduled appointment numbers and patient attendance rates at 13 gastroenterology and hepatology outpatient clinics at a single tertiary hospital were evaluated through the hospital's online patient administration system, following rapid implementation of the telehealth model of outpatient care. Appointment numbers and attendance were compared with the average attendance rate over the same period in the preceding 5 years. Data collected included patient DNA rates for every scheduled clinic and appointment type (videoconferencing, telephone, or face-to-face consultation). Results: A total of 2626 outpatient clinic appointments were scheduled during the first 9-week COVID-19 lockdown, with 2237 appointments (85%) attended and 389 DNAs (15%), an improvement of 2.2% in attendance rate compared with the average attendance rate during the same 9-week period in the preceding 5 years (P = 0.035). Of the 2626 appointments, 1319 (50%) were video consultations, and 1307 (50%) were telephone consultations. In the preceding 5 years, an average of 2304 outpatient clinic appointments (322 fewer appointments) were scheduled during the same 9-week period, with 1912 appointments (83%) attended and 392 (17%) not attended. Of these 2304 appointments, 2271 (99%) were face-to-face consultations and only 33 (1%) were video consultations. Attendance rates differed according to clinic type. Compared with previous years, outpatient clinics with significantly lower DNA rates during COVID-19 included combined general gastroenterology (15% vs 20%, P = 0.014), satellite inflammatory bowel disease (2% vs 10%, P = 0.033), satellite liver clinic (20% vs 28%, P = 0.198), and privatized liver clinic (13% vs 18%, P = 0.051). Clinics with higher numerical DNA rates included hepatoma (18% vs 12%, P = 0.731) and weight management (20% vs 15%, P = 0.343). When evaluating the appointment type, we found that consultations carried out by telephone resulted in a significantly lower DNA rate, compared with video consultations (9% vs 21%;P < 0.001). Furthermore, an additional 37 clinic lists occurred during this 9-week period, equivalent to four additional lists per week, compared with the average number in the preceding 5 years. Conclusion: Despite the upheaval of clinical services during the COVID-19 pandemic, the major and rapid systems change to overhaul outpatient clinics to an almost exclusively telehealth model was highly succes ful. A total of 1319 video consultations occurred during the 9-week period, compared with just 43 in the preceding year, demonstrating the rapid and widespread implementation of telehealth. Importantly, there was a significant overall reduction in DNA rates, by 2.2%, using the telehealth model. Phone calls were particularly effective for clinic consultations, with DNA rates of only 9.0%. Telehealth has the potential to improve outpatient clinic attendance and efficiency, and our data strongly advocate for ongoing support for telehealth models, including both video and telephone consultation, beyond the COVID-19 era.

Evaluating an outreach education program to increase uptake and knowledge of hepatitis B testing in Melbourne's Chinese community: CHINA-B study

Background and Aim: Hepatitis B is underdiagnosed in Australia, with an estimated 32% of affected people not aware of their hepatitis status. Australia's Chinese community is among the most at-risk populations for hepatitis B: an estimated 18% of people living with chronic hepatitis B in Australia were born in China. Identified barriers for hepatitis B testing include lack of awareness and limited knowledge about hepatitis B, and stigma associated with the disease. However, limited data are available on effective approaches to engage Chinese people in hepatitis B testing and care. We therefore conducted an evaluation study of an outreach education program among the Chinese community in Melbourne. The primary aim was to assess the efficacy of the education program on hepatitis B testing uptake and compare the efficacy between two educational resources. The secondary aim was to assess the impacts of the education program on hepatitis B-related knowledge. A nested qualitative study was conducted to assess the feasibility and acceptability of the education program. Methods: We conducted a pilot randomized controlled trial in community sites in Melbourne between July 2019 and June 2020. Adults attending the sites who self-identified as having Chinese ethnicity and were unsure of their hepatitis B status were invited to participate. After completing a baseline hepatitis B knowledge questionnaire, participants were randomly assigned to one of two groups to receive educational information (in either English or Chinese): standard hepatitis B information (Arm 1) or liver cancer prevention information focusing on hepatitis B testing (Arm 2). Participants were followed up by telephone after 6 months to determine whether they had a hepatitis B test and to complete a follow-up questionnaire. The follow-up questionnaire repeated the hepatitis B knowledge questions asked at baseline and explored participants' perceived barriers to testing. A before-and-after comparison of hepatitis B-related knowledge was undertaken. Results: Fifty-four participants were recruited from seven community sites. Participants' median age was 33 years (range, 18-90 years), and most (33, 69%) were female. Thirty-three participants (61%) completed follow-up at 6 months, of whom 22 (67%) were female (median age, 29 years). Among participants followed up, 20 (61%) reported visiting a doctor in the 6 months of follow-up and one third of those (n = 7) reported discussing hepatitis B testing at this GP appointment. Four participants (12%) self-reported having had hepatitis B testing: one of 15 (7%) in the standard hepatitis B information group and three of 18 (17%) in the liver cancer prevention information group. Six of 33 participants (18%) reported barriers to having a hepatitis B test, including concerns about accessing health care due to coronavirus disease 2019 and lack of knowledge about how to access health care. Twenty of 33 participants (67%) reported no intention of having a hepatitis B test at follow-up, with the main reason given being do not perceive the risk, do not feel the need. At follow-up after the education program, a significantly lower proportion of participants had the misconception of hepatitis B being transmitted via eating food or sharing eating utensils (8/33, 24%) than at baseline (29/55, 53%) (P < 0.001). The education session was well accepted by participants. Conclusion: A single education session with language-appropriate resources was effective for improving hepatitis B-related knowledge, which was retained at 6 months. However, despite knowledge improvement, a low rate of hepatitis B testing uptake was observed in both groups, with the main barrier being low risk perception in the community.

The provision of a time-critical elective surgical service during the COVID-19 Crisis: a UK experience.

INTRODUCTION: With the emergence of the COVID-19 pandemic, all elective surgery was temporarily suspended in the UK, allowing for diversion of resource to manage the anticipated surge of critically unwell patients. Continuing to deliver time-critical surgical care is important to avoid excess morbidity and mortality from pathologies unrelated to COVID-19. We describe the implementation and short-term surgical outcomes from a system to deliver time-critical elective surgical care to patients during the COVID-19 pandemic. MATERIALS AND METHODS: A protocol for the prioritisation and safe delivery of time-critical surgery at a COVID-19 'clean' site was implemented at the Nuffield Health Exeter Hospital, an independent sector hospital in the southwest of England. Outcomes to 30 days postoperatively were recorded, including unplanned admissions after daycase surgery, readmissions and complications, as well as the incidence of perioperative COVID-19 infection in patients and staff. RESULTS: A total of 128 surgical procedures were performed during a 31-day period by a range of specialties including breast, plastics, urology, gynaecology, vascular and cardiology. There was one unplanned admission and and two readmissions. Six complications were identified, and all were Clavien-Dindo grade 1 or 2. All 128 patients had preoperative COVID-19 swabs, one of which was positive and the patient had their surgery delayed. Ten patients were tested for COVID-19 postoperatively, with none testing positive. CONCLUSION: This study has demonstrated the implementation of a safe system for delivery of time-critical elective surgical care at a COVID-19 clean site. Other healthcare providers may benefit from implementation of similar methodology as hospitals plan to restart elective surgery.

Extrafollicular B cell responses correlate with neutralizing antibodies and morbidity in COVID-19.

A wide spectrum of clinical manifestations has become a hallmark of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) COVID-19 pandemic, although the immunological underpinnings of diverse disease outcomes remain to be defined. We performed detailed characterization of B cell responses through high-dimensional flow cytometry to reveal substantial heterogeneity in both effector and immature populations. More notably, critically ill patients displayed hallmarks of extrafollicular B cell activation and shared B cell repertoire features previously described in autoimmune settings. Extrafollicular activation correlated strongly with large antibody-secreting cell expansion and early production of high concentrations of SARS-CoV-2-specific neutralizing antibodies. Yet, these patients had severe disease with elevated inflammatory biomarkers, multiorgan failure and death. Overall, these findings strongly suggest a pathogenic role for immune activation in subsets of patients with COVID-19. Our study provides further evidence that targeted immunomodulatory therapy may be beneficial in specific patient subpopulations and can be informed by careful immune profiling.

Antibody Profiles According to Mild or Severe SARS-CoV-2 Infection, Atlanta, Georgia, USA, 2020.

Among patients with coronavirus disease (COVID-19), IgM levels increased early after symptom onset for those with mild and severe disease, but IgG levels increased early only in those with severe disease. A similar pattern was observed in a separate serosurveillance cohort. Mild COVID-19 should be investigated separately from severe COVID-19.

Caution on Plasma Cytokine Findings in 2019 Novel Coronavirus Cases.

In the initial 41 cases of 2019 novel coronavirus published in Lancet, elevated blood IL-10 cytokine data from these patients and four healthy subjects were presented as argument to not consider immunosuppressive therapy. We propose this is an erroneous interpretation of the cytokine measures, as parallel increases in pro- and anti-inflammatory cytokines indicate an intact immune axis and do not diminish the potential role of immunosuppression. We show data in healthy control subjects strong correlations between pro- and anti-inflammatory cytokines, and immunosuppressive therapies should be considered in 2019 novel coronavirus cases. Funding: This study was funded by NIH K01AG42498 (WW) and R01AG54046 (WTH). The funders have no role in the data analysis or manuscript preparation. Declaration of Interest: WTH has served as a consultant to ViveBio LLC, Biogen Inc., and AARP Inc.; received research support from Fujirebio USA; and has a patent on CSF-based diagnosis of FTLD-TDP (assigned to Emory University).

Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020.

There are few detailed investigations of neurologic complications in severe acute respiratory syndrome coronavirus 2 infection. We describe 3 patients with laboratory-confirmed coronavirus disease who had encephalopathy and encephalitis develop. Neuroimaging showed nonenhancing unilateral, bilateral, and midline changes not readily attributable to vascular causes. All 3 patients had increased cerebrospinal fluid (CSF) levels of anti-S1 IgM. One patient who died also had increased levels of anti-envelope protein IgM. CSF analysis also showed markedly increased levels of interleukin (IL)-6, IL-8, and IL-10, but severe acute respiratory syndrome coronavirus 2 was not identified in any CSF sample. These changes provide evidence of CSF periinfectious/postinfectious inflammatory changes during coronavirus disease with neurologic complications.