Discharge disposition and clinical outcomes of patients hospitalized with COVID-19.

OBJECTIVES: By better understanding the long-term effects of COVID-19 and assessing rehabilitation placement among the patients in our study, we hope to determine the predictors of rehabilitation needs in individuals suffering from the long-term sequelae of COVID-19. METHODS: A retrospective chart review was performed of adult patients with a positive COVID-19 polymerase chain reaction test among multiple hospitals in a regional health system. The main outcomes measured were discharge disposition, total length of hospital stay, and overall all-cause mortality and readmission rates within 30 and 90 days of discharge. RESULTS: Of the 2502 patients included in the study, we found that 65.2% were discharged to home, while the remaining patients were discharged to home healthcare (33.6%), skilled nursing facilities (31.7%), or long-term acute rehabilitation centers (11.6%). The overall all-cause mortality rate at 30 and 90 days were 2.7% and 4.4%, respectively. The overall all-cause 30-day and 90-day readmission rates were 7.0% and 7.6%, respectively. CONCLUSION: Younger age and shorter hospitalization stays were the most important predictors of home discharge. Discharge to home was also significantly associated with lower all-cause mortality rates at 30 and 90 days after discharge.

Discharge Disposition and Clinical Outcomes of Patients Hospitalized with COVID-19

Objective By better understanding the long-term effects of COVID-19 and assessing rehabilitation placement among the patients in our study, we hope to determine the predictors of rehabilitation needs in individuals suffering from the long-term sequelae of COVID-19. Methods A retrospective chart review was performed of adult patients with positive COVID-19 PCR test among multiple hospitals in a regional health system. Main outcomes measured were discharge disposition, total length of hospital stay, and overall all-cause mortality and readmission rates within 30- and 90-days of discharge. Results Of the 2,502 patients included in the study, we found that 65.2% were discharged to home, while the remaining patients were discharged to home healthcare (33.6%), skilled nursing facilities (31.7%), or long-term acute rehabilitation centers (11.6%). The overall all-cause mortality rate at 30- and 90-days were 2.7% and 4.4%, respectively. The overall all-cause 30- and 90-day readmission rates were 7.0% and 7.6%, respectively. Conclusion Younger age and shorter hospitalization stay were the most important predictors of home discharge. Discharge to home was also significantly associated with lower all-cause mortality rates at 30- and 90-days post-discharge.

Covid-19 and Ukrainian Crisis Exponentiates the Need for the Inclusion of Conflict and Disaster Medicine in Medical Curriculum.

Conflict medicine is an age-old branch of medicine which focuses on delivering healthcare services to the injured in the setting of conflicts, wars, disasters, and/or other calamities. The course in its purest form has been traditionally given only in military medical schools while civilian medical students are usually taught parts of the course in other overlapping subjects like surgery, infectious diseases, etc. However, in a crisis situation, civilian doctors are expected to double up as military doctors, which leads to emotional, mental, and physical stress for the civilian doctors along with logistical and organizational challenges. The current Covid-19 pandemic and the Russo-Ukrainian conflict have highlighted once again the emergent need for the implementation of conflict medicine courses in regular medical curricula, so as to make the medical students situation-ready. With our present discussion, we aim to provide a brief overview of the course, its core modules, challenges to its implementation, and possible solutions. We believe that the complex management skills gained by this course are not only useful in conflict scenario but are also valuable in managing day-to-day medical emergencies.

European Countries Step-up Humanitarian and Medical Assistance to Ukraine as the Conflict Continues.

On the 24th of February 2022, the Russian Federation began an unprovoked invasion of Ukraine, marking the biggest military attack in Europe since the second world war. Over 4 million people have fled their homeland within the first month of the war and have triggered a large refugee crisis with impacts far beyond the Ukrainian border. People in the neighboring countries have shown tremendous support by stepping forward to donate food, clothes, medications, money, and other essential supplies. The governments and other regional stakeholders have also been supportive in accommodating and easing regulations for the incoming refugees. Herein, we summarize the humanitarian measures and medical donations that have been made by European countries as they stepped up their efforts to provide refugees with all necessary basic services. We further highlight potential oncoming challenges in Ukraine and the host countries along with relevant solutions to these challenges. The current scenario highlights the need for multi-party and multi-level collaborations (both public and private) to tackle the emerging situation.

INITIAL SYMPTOMS AND DEVELOPMENT OF COGNITIVE OR SLEEP DEFICITS AFTER COVID-19 HOSPITALIZATION

Our findings suggest that initial COVID-19 symptom burden may be an important risk factor for the development of sleep impairment among survivors of COVID-19 hospitalization. We examined whether initial symptom burden, the number of symptoms at time of COVID-19 presentation, is associated with self- reported cognition and sleep scores 30 days after COVID-19 hospitalization discharge. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Patient-worn endoscopy mask to protect against viral transmission.

OBJECTIVES: To design and evaluate patient-worn personal protective equipment (PPE) that allows providers to perform endoscopy while protecting against droplet and airborne disease transmission. STUDY DESIGN: Single subject study. METHODS: Mask efficacy was evaluated using a cough simulator that sprays dye visible under ultra-violet light. User-testing was performed on an airway trainer mannequin where each subject performed the endoscopy with and without the mask in random orders. Their time to completion and number of attempts before successful completion were recorded, and each subject was asked to fill out a NASA Task Load Index (TLX) form with respect to their experience. RESULTS: The mask has a filtration efficiency of 97.31% and eliminated any expelled particles with the cough simulator. Without the mask, a simulated cough is visualized as it progresses away from the cough origin. Subjects who performed trans-nasal endoscopy spent 27.8 ± 8.0 s to visualize the vocal cords for the no mask condition and 28.7 ± 13.6 s for the mask condition (mean ± SD, p > .05). There was no statistically significant difference found in the mental demand, physical demand, temporal demand, performance, effort, and frustration of endoscopy under the no mask and mask conditions (all p > .05). CONCLUSION: The designed PPE provides an effective barrier for viral droplet and airborne transmission while allowing the ability to perform endoscopy with ease. LEVEL OF EVIDENCE: 3 Laryngoscope, 2021.

Assessment of N95 and K95 respirator decontamination: fiber integrity, filtration efficiency, and dipole charge density

Personal protective equipment (PPE) including N95 respirators are critical for persons exposed to SARS-CoV-2. KN95 respirators and N95 decontamination protocols have been described as solutions to a lack of such PPE. However, there are a few materials science studies that characterize the charge distribution and physical changes accompanying disinfection treatments particularly heating. Here, we report the filtration efficiency, dipole charge density, and fiber integrity of pristine N95 and KN95 respirators before and after various decontamination methods. We found that the filter layer of N95 is 8-fold thicker than that of KN95, which explains its 10% higher filtration efficiency (97.03 %) versus KN95 (87.76 %) under pristines condition. After 60 minutes of 70 degrees C treatment, the filtration efficiency and dipole charge density of N95 became 97.16% and 12.48 microC/m2, while those of KN95 were 83.64% and 1.48 microC/m2 ;moreover, fit factor of N95 was 55 and that of KN95 was 2.7. In conclusion, the KN95 respirator is an inferior alternative of N95 respirator. In both systems, a loss of electrostatic charge does not directly correlate to a decrease in performance.

Assessing the Physiological Relevance of Cough Simulators for Respiratory Droplet Dispersion.

Various breathing and cough simulators have been used to model respiratory droplet dispersion and viral droplets, in particular for SARS-CoV-2 modeling. However, limited data are available comparing these cough simulations to physiological breathing and coughing. In this study, three different cough simulators (Teleflex Mucosal Atomization Device Nasal (MAD Nasal), a spray gun, and GloGermTM MIST) that have been used in the literature were studied to assess their physiologic relevance. Droplet size, velocity, dispersion, and force generated by the simulators were measured. Droplet size was measured with scanning electron microscopy (SEM). Slow-motion videography was used to 3D reconstruct and measure the velocity of each simulated cough. A force-sensitive resistor was used to measure the force of each simulated cough. The average size of droplets from each cough simulator was 176 to 220 µm. MAD Nasal, the spray gun, and GloGermTM MIST traveled 0.38 m, 0.89 m, and 1.62 m respectively. The average velocities for the MAD Nasal, spray gun, and GloGermTM MIST were 1.57 m/s, 2.60 m/s, and 9.27 m/s respectively, and all yielded a force of <0.5 Newtons. GloGermTM MIST and the spray gun most closely resemble physiological coughs and breathing respectively. In conclusion, none of the simulators tested accurately modeled all physiologic characteristics (droplet size, 3-D dispersion velocity, and force) of a cough, while there were various strengths and weaknesses of each method. One should take this into account when performing simulations with these devices.

Creating 3D Cerebral Cortex Stereoscopic Anatomic Model for Virtual Learning

Research has shown that three-dimensional (3D) stereoscopic virtual anatomic models can help students understand the complex spatial relationships of human structures that are not easily accessible via dissection. For instance, the cerebral cortex is located within the cranial vault;however, it can be difficult to view the relationship between the cerebral cortex and skull via dissection. This project goes into discussing the creation of a 3D stereoscopic model of the cerebral cortex. The cerebral cortex model was segmented via Amira 5.6 software from computed tomography angiography (CTA) data. Amira 5.6 surface rendering methods were used to create the cerebral cortex, and volume rendering methods were used to create the skull. The segmentations were performed using the axial view and paintbrush tools in Amira 5.6 along with the Wacom pen and tablet. After completing the initial segmentation across 155 slides, the CTA scans were compiled in Amira 5.6 to create the 3D model of the cerebral cortex. A smoothing filter was then applied to the initial surface render of the cerebral cortex to smooth the transition from slide to slide. The cerebral cortex model generated can be viewed from any angle at any magnification level. In addition, the model can also be overlayed orthoslice CTA data to allow the user to have a stronger understanding of the relationship between each individual two-dimensional CTA image and the three-dimensional model. Moreover, the cerebral cortex virtual model can be created into video clips using the Amira 5.6 movie maker, which can be inserted into PowerPoint presentations. As a result, the cerebral cortex virtual model has the potential to be used for online distance anatomical learning, which has become the adopted method of teaching due to the COVID-19 pandemic. The flexibility of this model allows it to also be used in the classroom setting as a virtual learning tool where students may view the models via a 3D screen with 3D glasses.

Development of 3D Stereoscopic of the Cerebellum Model for Anatomic Virtual Learning

Virtual learning has become the popular and adopted form of teaching due to the COVID-19 pandemic, including learning the parts of the human body. As we move through this pandemic and look into the future of medical education, anatomic virtual models have the potential to be a key educational tool in learning the unique engineering of the human body. In this project, we look into the making of an anatomical structure, the cerebellum, which is located at the base of the skull in the posterior cranial fossa. The cerebellum largely controls the coordination of voluntary movement sequences of the body. Computed tomography angiography (CTA) data and surface and volume rendering technology found in the Amira 5.6 software was used in the creation of a three-dimensional (3D) stereoscopic virtual model of the cerebellum. An outlining process was used for each CTA image that comprised the cerebellum;a total of 73 slices of CTA data were outlined. Each outline was made using the paintbrush, blow, and lasso tools found in Amira 5.6. To refine the selected areas, the paintbrush tool along with the coronal and sagittal views were employed. Each segmented slice was then stacked to create the surface of the cerebellum, generating the 3D stereoscopic model. A smoothing filter was also applied to correct human error. End results show a 3D stereoscopic cerebellum model that can be integrated at various angles and magnifications with orthoslice CTA data and project as a 3D stereoscopic presentation in a virtual environment with a dim light background. We find that the cerebellum stereoscopic model can serve as a virtual learning tool in a classroom setting and allow students to view the cerebellum in a 3D stereoscopic presentation in order to better grasp the spatial relationship of the cerebellum with other structures in the cranial vault. Three-dimensional stereoscopic presentations along with video clips created within Amira 5.6 can be used for online anatomical learning, which allows for different visual perspectives than the traditional two-dimensional presentations.

Real-Time UV Measurement With a Sun Protection System for Warning Young Adults About Sunburn: Prospective Cohort Study.

BACKGROUND: Melanoma is attributable to predisposing phenotypical factors, such as skin that easily sunburns and unprotected exposure to carcinogenic UV radiation. Reducing the proportion of young adults who get sunburned may reduce the incidence of melanoma, a deadly form of skin cancer. Advances in technology have enabled the delivery of real-time UV light exposure and content-relevant health interventions. OBJECTIVE: This study aims to examine the feasibility of young adults performing the following tasks daily: wearing a UV dosimeter, receiving text messages and real-time UV-B doses on their smartphone, and responding to daily web-based surveys about sunburn and sun protection. METHODS: Young adults aged 18-39 years (n=42) were recruited in the United States in June 2020 via social media. Participants received the UV Guard sun protection system, which consisted of a UV dosimeter and a smartphone app. During 3 consecutive periods, intervention intensity increased as follows: real-time UV-B dose; UV-B dose and daily behavioral facilitation text messages; and UV-B dose, goal setting, and daily text messages to support self-efficacy and self-regulation. Data were self-reported through daily web-based surveys for 28 days, and UV-B doses were transmitted to cloud-based storage. RESULTS: Patients' median age was 22 years (IQR 20, 29), and all patients had sun-sensitive skin. Sunburns were experienced during the study by fewer subjects (n=18) than those in the preceding 28 days (n=30). In July and August, the face was the most commonly sunburned area among 13 body locations; 52% (22/42) of sunburns occurred before the study and 45% (19/42) occurred during the study. The mean daily UV-B dose decreased during the 3 periods; however, this was not statistically significant. Young adults were most often exercising outdoors from 2 to 6 PM, walking from 10 AM to 6 PM, and relaxing from noon to 2 PM. Sunburn was most often experienced during exercise (odds ratio [OR] 5.65, 95% CI 1.60-6.10) and relaxation (OR 3.69, 95% CI 1.03-4.67) relative to those that did not exercise or relax in each category. The self-reported exit survey indicated that participants felt that they spent less time outdoors this summer compared to the last summer because of the COVID-19 pandemic and work. In addition, 38% (16/42) of the participants changed their use of sun protection based on their app-reported UV exposure, and 48% (20/42) shifted the time they went outside to periods with less-intense UV exposure. A total of 79% (33/42) of the participants were willing to continue using the UV Guard system outside of a research setting. CONCLUSIONS: In this proof-of-concept research, young adults demonstrated that they used the UV Guard system; however, optimization was needed. Although some sun protection behaviors changed, sunburn was not prevented in all participants, especially during outdoor exercise. TRIAL REGISTRATION: ClinicalTrials.gov NCT03344796; http://clinicaltrials.gov/ct2/show/NCT03344796.

KN95 and N95 Respirators Retain Filtration Efficiency despite a Loss of Dipole Charge during Decontamination.

N95 decontamination protocols and KN95 respirators have been described as solutions to a lack of personal protective equipment. However, there are a few material science studies that characterize the charge distribution and physical changes accompanying disinfection treatments, particularly heating. Here, we report the filtration efficiency, dipole charge density, and fiber integrity of N95 and KN95 respirators before and after various decontamination methods. We found that the filter layers in N95 and KN95 respirators maintained their fiber integrity without any deformations during disinfection. The filter layers of N95 respirators were 8-fold thicker and had 2-fold higher dipole charge density than that of KN95 respirators. Emergency Use Authorization (EUA)-approved KN95 respirators showed filtration efficiencies as high as N95 respirators. Interestingly, although there was a significant drop in the dipole charge in both respirators during decontamination, there was no remarkable decrease in the filtration efficiencies due to mechanical filtration. Cotton and polyester face masks had a lower filtration efficiency and lower dipole charge. In conclusion, a loss of electrostatic charge does not directly correlate to the decreased performance of either respirator.

Assessment of Respiratory Droplet Transmission During the Ophthalmic Slit-Lamp Exam: A Particle Tracking Analysis.

PURPOSE: The global COVID-19 pandemic has resulted in a renewed focus on the importance of personal protective equipment (PPE) and other interventions to decrease spread of infectious diseases. Although several ophthalmology organizations have released guidance on appropriate PPE for surgical procedures and ophthalmology clinics, there is limited experimental evidence that demonstrates the efficacy of various interventions that have been suggested. In this study, we evaluated high-risk aspects of the slit-lamp exam and the effect of various PPE interventions, specifically the use of a surgical mask and a slit-lamp shield. DESIGN: Experimental simulation study. METHODS: This was a single-center study in a patient simulation population. This study examined the presence of particles in the air near or on a slit-lamp, a simulated slit-lamp examiner, or a simulated patient using a fluorescent surrogate of respiratory droplets. RESULTS: Simulated coughing without a mask or slit-lamp shield resulted in widespread dispersion of fluorescent droplets during the model slit-lamp examination. Coughing with a mask resulted in the most significant decrease in droplets; however, particles still escaped from the top of the mask. Coughing with the slit-lamp shield alone blocked most of forward particle dispersion; however, significant distributions of respiratory droplets were found on the slit-lamp joystick and table. Coughing with both a mask and slit-lamp shield resulted in the least dispersion to the simulated examiner and the simulated patient. Scanning electron microscopy demonstrated particle sizes of 3-100 µm. CONCLUSIONS: Masking had the greatest effect in limiting spread of respiratory droplets, whereas slit-lamp shields and gloves also contributed to limiting exposure to droplets from SARS-CoV-2 during slit-lamp examination.

Assessment of N95 and K95 respirator decontamination: fiber integrity, filtration efficiency, and dipole charge density.

Personal protective equipment (PPE) including N95 respirators are critical for persons exposed to SARS-CoV-2. KN95 respirators and N95 decontamination protocols have been described as solutions to a lack of such PPE. However, there are a few materials science studies that characterize the charge distribution and physical changes accompanying disinfection treatments particularly heating. Here, we report the filtration efficiency, dipole charge density, and fiber integrity of pristine N95 and KN95 respirators before and after various decontamination methods. We found that the filter layer of N95 is 8-fold thicker than that of KN95, which explains its 10% higher filtration efficiency (97.03 %) versus KN95 (87.76 %) under pristines condition. After 60 minutes of 70 °C treatment, the filtration efficiency and dipole charge density of N95 became 97.16% and 12.48 µC/m2, while those of KN95 were 83.64% and 1.48 µC/m2 ; moreover, fit factor of N95 was 55 and that of KN95 was 2.7. In conclusion, the KN95 respirator is an inferior alternative of N95 respirator. In both systems, a loss of electrostatic charge does not directly correlate to a decrease in performance.