Evaluating Racial/Ethnic Differences in Care Escalation Among COVID-19 Patients in a Home-Based Hospital.

The novel coronavirus disease 2019 (COVID-19) has infected over 414 million people worldwide with 5.8 million deaths, as of February 2022. Telemedicine-based interventions to expand healthcare systems' capacity and reduce infection risk have rapidly increased during the pandemic, despite concerns regarding equitable access. Atrium Health Hospital at Home (AH-HaH) is a home-based program that provides advanced, hospital-level medical care and monitoring for patients who would otherwise be hospitalized in a traditional setting. Our retrospective cohort study of positive COVID-19 patients who were admitted to AH-HaH aims to investigate whether the rate of care escalation from AH-HaH to traditional hospitalization differed based on patients' racial/ethnic backgrounds. Logistic regression was used to examine the association between care escalation within 14 days from index AH-HaH admission and race/ethnicity. We found approximately one in five patients receiving care for COVID-19 in AH-HaH required care escalation within 14 days. Odds of care escalation were not significantly different for Hispanic or non-Hispanic Blacks compared to non-Hispanic Whites. However, secondary analyses showed that both Hispanic and non-Hispanic Black patients were younger and with fewer comorbidities than non-Hispanic Whites. The study highlights the need for new care models to vigilantly monitor for disparities, so that timely and tailored adaptations can be implemented for vulnerable populations.

Adrenal Crisis Mimicking COVID-19 Encephalopathy in a Teenager with Craniopharyngioma.

There is an increasing number of reported cases with neurological manifestations of COVID-19 in children. Symptoms include headache, general malaise, ageusia, seizure and alterations in consciousness. The differential diagnosis includes several potentially lethal conditions including encephalopathy, encephalitis, intracranial hemorrhage, thrombosis and adrenal crisis. We report the case of a 17-year-old boy with a positive antigen test of COVID-19 who presented with fever for one day, altered mental status and seizure, subsequently diagnosed with adrenal insufficiency. He had a history of panhypopituitarism secondary to a suprasellar craniopharyngioma treated with surgical resection; he was treated with regular hormone replacement therapy. After prompt administration of intravenous hydrocortisone, his mental status returned to normal within four hours. He recovered without neurologic complications. Adrenal insufficiency can present with neurological manifestations mimicking COVID-19 encephalopathy. Prompt recognition and treatment of adrenal insufficiency, especially in patients with brain tumors, Addison's disease or those recently treated with corticosteroids, can rapidly improve the clinical condition and prevent long-term consequences.

Continuance Usage Intention toward E-Payment during the COVID-19 Pandemic from the Financial Sustainable Development Perspective Using Perceived Usefulness and Electronic Word of Mouth as Mediators

Digital transformation is essential to financial sustainable development. Since the beginning of 2020, the whole world has been under the influence of the COVID-19 pandemic, which has accelerated the pace of financial digitization. According to the perceived usefulness of the technology acceptance model (TAM) and the perceived seriousness of the health belief model (HBM), this study developed and explored the theoretical framework of consumers' continuance usage intention toward e-payment. A questionnaire survey was conducted to explore this continuance usage intention among consumers who have used e-payment in Taiwan during the COVID-19 pandemic, with a total of 387 valid samples. The overall model was analyzed by structural equation modeling (SEM). The empirical results showed that the security, perceived seriousness, and perceived usefulness of e-payment significantly affect electronic word of mouth (eWOM), while the security and perceived seriousness of e-payment have a significant effect on continuance usage intention through perceived usefulness and eWOM. During the COVID-19 pandemic, e-payment providers should encourage consumers to use e-payment via eWOM, perceived usefulness, and consumers' perceived health seriousness and should improve the use efficiency of e-payment through e-payment financial services, thus encouraging consumers' continuance usage intention toward e-payment.

Original Research: Well-Being and Resilience Among Health Care Workers During the COVID-19 Pandemic: A Cross-Sectional Study.

BACKGROUND: Poor well-being among health care workers, often observed as professional burnout, is a well-documented phenomenon. The coronavirus disease 2019 (COVID-19) pandemic has further stressed the health care workforce, but its specific effects on this workforce remain unknown. This study examined well-being and resilience among health care workers during the COVID-19 pandemic. METHODS: The study used a cross-sectional survey design. Data collection took place through anonymous surveys of nurses (LPNs and RNs), advanced practice providers (NPs, physician assistants, and certified nurse midwives), certified registered nurse anesthetists, respiratory therapists, health care technicians, and therapy service professionals (physical, occupational, and speech therapists). Of the 6,120 health care workers recruited to participate in the study, data from 2,459 participants were analyzed using logistic regression and linear regression. RESULTS: The study found that several factors significantly increased the likelihood of at-risk well-being. These included having a lower level of resilience, using support resources, feeling the organization lacked understanding of the emotional support needs of health care workers during the pandemic, believing the workload had increased, believing there was insufficient personal protective equipment, believing there was inadequate staffing to safely care for patients, and having a lower degree of psychological safety. After controlling for health care workers' role and employment location, several factors were found to be significantly associated with higher levels of resilience. These included having positive perceptions about the organization's understanding of the emotional support needs of health care workers during the pandemic, believing sufficient educational resources were available regarding the care of COVID-19 patients, having positive perceptions of leadership support from direct managers, having positive perceptions of the redeployment policy, and having a higher degree of psychological safety. CONCLUSIONS: This study identified several work environment factors that have significantly affected health care workers' well-being and resilience during the COVID-19 pandemic. This knowledge has practical relevance for health care leaders who aim to better understand and address the well-being and resilience of the health care workforce during this pandemic and beyond.

An Optimal Compensation Agency Model for Sustainability under the Risk Aversion Utility Perspective

This paper explores how to construct a fair and optimal compensation system between the principal and the agent in the face of financial compensation agency problems during a limited period in relation to the concept of sustainability. In the construction of the principal’s compensation system, the agent’s degree of operational financial effort will affect the overall revenue function for reaching sustainability. Both the principal and the agent have a maximum expected utility in the negative exponential pattern of the general hyperbolic absolute risk aversion (HARA) utility function that satisfies their respective objective functions. The proposed model and numerical example analysis results prove that the compensation system for sustainability can provide a fair and optimal financial system, from a sustainability perspective. The main contribution of this study is the construction and development of an optimal compensation agency model for risk management, which is derived by considering the effect of risk aversion utility on revenue. The proposed model can provide a fair and feasible approach within the issue of compensation, from the viewpoint of sustainability, for an optimal compensation agency problem.