Effectiveness of various COVID-19 vaccine regimens among 10.4 million patients from the National COVID Cohort Collaborative during Pre-Delta to Omicron periods - United States, 11 December 2020 to 30 June 2022.

OBJECTIVE: This study reports the vaccine effectiveness (VE) of COVID-19 vaccine regimens in the United States, based on the National COVID Cohort Collaborative (N3C) database. METHODS: Data from 10.4 million adults, enrolled in the N3C from 11 December 2020 to 30 June 2022, were analyzed. VE against infection and death outcomes were evaluated across 13 vaccine regimens in recipient cohorts during the Pre-Delta, Delta, and Omicron periods. VE was estimated as (1-odds ratio) × 100% by multivariate logistic regression, using the unvaccinated cohort as reference. RESULTS: Natural immunity showed a highly protective effect (70.33%) against re-infection, but the mortality risk among the unvaccinated population was increased after re-infection; vaccination following infection reduced the risk of re-infection and death. mRNA-1273 full vaccination plus mRNA-1273 booster showed the highest anti-infection effectiveness (47.59%) (95% CI, 46.72-48.45) in the overall cohort. In the type 2 diabetes cohort, VE against infection was highest with BNT162b2 full vaccination plus mRNA-1273 booster (61.19%) (95% CI, 53.73-67.75). VE against death was also highest with BNT162b2 full vaccination plus mRNA-1273 booster (89.56%) (95% CI, 85.75-92.61). During the Pre-Delta period, all vaccination regimens showed an anti-infection effect; during the Delta period, only boosters, mixed vaccines, and Ad26.COV2.S vaccination exhibited an anti-infection effect; during the Omicron period, none of the vaccine regimens demonstrated an anti-infection effect. Irrespective of the variant period, even a single dose of mRNA vaccine offered protection against death, thus demonstrating survival benefit, even in the presence of infection or re-infection. Similar patterns were observed in patients with type 2 diabetes. CONCLUSIONS: Although the anti-infection effect declined as SARS-CoV-2 variants evolved, all COVID-19 mRNA vaccines had sustained effectiveness against death. Vaccination was crucial for preventing re-infection and reducing the risk of death following SARS-CoV-2 infection.

Health Disparities Investigator Development through a Team-Science Pilot Projects Program.

Profound health disparities are widespread among Native Hawaiians, other Pacific Islanders, and Filipinos in Hawai'i. Efforts to reduce and eliminate health disparities are limited by a shortage of investigators trained in addressing the genetic, socio economic, and environmental factors that contribute to disparities. In this conference proceedings report from the 2022 RCMI Consortium National Conference, we describe our mentoring program, with an emphasis on community-engaged research. Elements include our encouragement of a team-science, customized Pilot Projects Program (PPP), a Mentoring Bootcamp, and a mentoring support network. During 2017-2022, we received 102 PPP preproposals. Of these, 45 (48%) were invited to submit full proposals, and 22 (19%) were awarded (8 basic biomedical, 7 clinical, 7 behavioral). Eighty-three percent of awards were made to early-career faculty (31% ethnic minority, 72% women). These 22 awards generated 77 related publications; 84 new grants were submitted, of which 31 were awarded with a resultant return on investment of 5.9. From 5 to 11 investigators were supported by PPP awards each year. A robust usage of core services was observed. Our descriptive report (as part of a scientific conference session on RCMI specialized centers) focuses on a mentoring vehicle and shows how it can support early-stage investigators in pursuing careers in health disparities research.

Medical School Faculty and Staff Well-being in Fall 2020 during the COVID-19 Pandemic.

The COVID-19 pandemic increased stress and worry among faculty and staff members at universities across the US. To assess the well-being of university faculty and staff, a survey was administered at a medical school in the state of Hawai'i during early fall 2020. The purpose of the exploratory study was to assess and gauge faculty and staff members' well-being regarding the school's response to COVID-19. Participants in this study represented a convenience sample of compensated teaching, research, and administrative faculty and staff members. A total of 80 faculty and 73 staff members participated. Overall, faculty and staff reported relatively low levels of worries and stress. Staff members reported greater levels of worry and stress than faculty members in 8 of the 11 questions. Statistical differences were detected in 3 questions, with staff reporting higher levels of worry and stress in their health and well-being of themselves (P < .001), paying bills (P < .001), and losing their jobs (P < .001). Both faculty and staff reported good overall satisfaction on the timeliness and clarity of messages that they received, support from leadership and the school, and support to adjust to changes in response to COVID-19. For both faculty and staff, the greatest worry or concern for the open-ended question on worry and stress was related to financial and economic issues. Data from this survey and can contribute to an understanding of medical school employee well-being during a major operational disruption and may help develop policies and programs to assist employees in different employment categories during future disruptions.

Can lacrimal punctum size link to the severity of dry eye disease?

To investigate if larger punctum size links to the severity of dry eye disease (DED) and perhaps, punctum size inspection can be adopted to become one of the DED evaluations for practitioners. The records of 200 eyes of 114 patients that had temporary collagen punctum plugs due to severe DED (Level 2 to Level 4) from January 1, 2017, to July 31, 2018, were reviewed for the size of the plugs. Lacrimal punctum size of those eyes was approximated according to the size of vertical canalicular soft collagen plug (from 0.3 to 0.5 mm diameter, Oasis, Lacrimedics, Glendora, CA, USA). The dry eye severity grading from the International Dry Eye WorkShop was used to grade the level of the severity of DED. Those eyes classified as Level 2 and above were considered as severe due to the presentation of moderate-to-diffuse corneal staining and symptomatic. To assess if there is a correlation between punctum size and the severity of DED, the Spearman's rank correlation coefficient was calculated. Of the 200 Level 2 and above eyes, 131 (66%) eyes had a large punctum (≥0.5 mm). Punctum size larger than 0.4 mm was 95%. The estimated Spearman's ρ was 0.16. This indicates a statistical significant positive correlation (P = 0.02) between larger punctum size and higher level of DED. The larger size of lacrimal punctum may link to the severity of DED. Punctum inspection may be adopted to become one parameter for DED evaluation for practitioners.

Strengthening and Sustaining Inter-Institutional Research Collaborations and Partnerships.

Inter-institutional collaborations and partnerships play fundamental roles in developing and diversifying the basic biomedical, behavioral, and clinical research enterprise at resource-limited, minority-serving institutions. In conjunction with the Research Centers in Minority Institutions (RCMI) Program National Conference in Bethesda, Maryland, in December 2019, a special workshop was convened to summarize current practices and to explore future strategies to strengthen and sustain inter-institutional collaborations and partnerships with research-intensive majority-serving institutions. Representative examples of current inter-institutional collaborations at RCMI grantee institutions are presented. Practical approaches used to leverage institutional resources through collaborations and partnerships within regional and national network programs are summarized. Challenges and opportunities related to such collaborations are provided.

Research and Scholarly Projects.

The idea of doing a research or scholarly project can be very daunting, however, the satisfaction of seeing a project to its completion is very rewarding. In this article, we provide medical students with guidance on whether they should take on a research or scholarly project during medical school, and how to get started, publish, and then present their project. We also highlight how such a project can benefit an applicant applying for residency training.

The Research Centers in Minority Institutions (RCMI) Translational Research Network: Building and Sustaining Capacity for Multi-Site Basic Biomedical, Clinical and Behavioral Research.

The Research Centers in Minority Institutions (RCMI) program was established by the US Congress to support the development of biomedical research infrastructure at minority-serving institutions granting doctoral degrees in the health professions or in a health-related science. RCMI institutions also conduct research on diseases that disproportionately affect racial and ethnic minorities (ie, African Americans/Blacks, American Indians and Alaska Natives, Hispanics, Native Hawaiians and Other Pacific Islanders), those of low socioeconomic status, and rural persons. Quantitative metrics, including the numbers of doctoral science degrees granted to underrepresented students, NIH peer-reviewed research funding, peer-reviewed publications, and numbers of racial and ethnic minorities participating in sponsored research, demonstrate that RCMI grantee institutions have made substantial progress toward the intent of the Congressional legislation, as well as the NIH/NIMHD-linked goals of addressing workforce diversity and health disparities. Despite this progress, nationally, many challenges remain, including persistent disparities in research and career development awards to minority investigators. The continuing underrepresentation of minority investigators in NIH-sponsored research across multiple disease areas is of concern, in the face of unrelenting national health inequities. With the collaborative network support by the RCMI Translational Research Network (RTRN), the RCMI community is uniquely positioned to address these challenges through its community engagement and strategic partnerships with non-RCMI institutions. Funding agencies can play an important role by incentivizing such collaborations, and incorporating metrics for research funding that address underrepresented populations, workforce diversity and health equity.

Academic Response to Storm-Related Natural Disasters-Lessons Learned.

On 30 October 2017, selected faculty and administrators from Research Centers in Minority Institutions (RCMI) grantee institutions gathered to share first-hand accounts of the devastating impact of Hurricanes Harvey, Irma, and Maria, which had interrupted academic activities, including research, education, and training in Puerto Rico, Florida, and Texas. The presenters reviewed emergency response measures taken by their institutions to maintain community health care access and delivery, the storm-related impact on clinical and research infrastructure, and strategies to retain locally grown clinical expertise and translational science research talent in the aftermath of natural disasters. A longer-term perspective was provided through a comparative review of lessons learned by one New Orleans-based institution (now more than a decade post-storm) in the aftermath of Hurricane Katrina. Caring for the internal and external communities associated with each institution and addressing the health disparities exacerbated by storm-related events is one key strategy that will pay long-term dividends in the survival of the academic institutions and the communities they serve.

Recommendations to Sustain the Academic Mission Ecosystem at U.S. Medical Schools.

Academic medical center (AMC) faculty, administrators, and leaders have the critical tasks of teaching and training the next generation of health care providers and biomedical researchers, as well as generating new knowledge that improves the health of all. In the United States, medical schools and their affiliated hospitals train remarkably high-quality physicians and scientists, and the research conducted at these institutions results in advances in health. To that end, AMCs have become essential engines for driving better health in the United States and the rest of the world; they also have become essential engines driving the economies of their respective communities and regions. The education and research missions, however, require subsidization because tuition and extramural grant funding do not cover the costs of these endeavors. This subsidization largely has come from revenues generated by AMCs' clinical endeavors. The viability of this cross-subsidization, however, is increasingly threatened in the current clinical environment. The authors of this Perspective discuss these issues in depth and provide some concrete recommendations to address these challenges. They hope to stimulate discussion and, ultimately, ensure the financial viability of U.S. AMCs-a national resource of utmost importance. Recommendations to sustain research include creating strategic biomedical research plans, developing a defined and sustained model to support National Institutes of Health funding that keeps pace with inflation, and evolving funding mechanisms. Recommendations to sustain medical education include limiting student debt, creating more cost-effective curricula, and ensuring that clinical training opportunities that meet national standards are available to students.

Deaths and high-risk trauma patients missed by standard trauma data sources.

BACKGROUND: Trauma registries are used to evaluate and improve trauma care, yet potentially miss certain trauma deaths and high-risk patients. We estimated the number of missed deaths and high-risk trauma patients using commonly available sources of trauma data and resulting bias in quality metrics for field trauma triage. METHODS: This was a preplanned secondary analysis of a population-based prospective cohort of injured patients transported by 44 emergency medical services agencies to 28 hospitals in seven Northwest counties from January 1, 2011 to December 31, 2011 and followed through hospitalization. We used a stratified probability sampling design for 17,633 patients, weighted to represent all 53,487 injured patients transported by emergency medical services. We compared patients meeting National Trauma Data Bank (NTDB) criteria (weighted n = 5,883), all injured patients presenting to major trauma centers (weighted n = 16,859), and all admitted patients (weighted n = 18,433), to the full sample. Outcomes included in-hospital mortality, Injury Severity Score (ISS) of 16 or higher, and critical resource use within 24 hours. RESULTS: Among 53,487 injured patients, there were 520 emergency department and in-hospital deaths, 1,745 with ISS of 16 or higher, and 923 requiring early critical resources. Compared to the full cohort, the NTDB cohort missed 62.1% of deaths, 39.2% of patients with ISS of 16 or higher, and 23.8% requiring early critical resources, especially older adults injured by falls and admitted to nontrauma hospitals. The admission cohort missed the fewest patients-23.3% of deaths, 10.5% with an ISS of 16 or higher, and 13.1% requiring early resources. Compared to triage sensitivity in the full cohort (66.2%), sensitivity estimates ranged from 63.6% (all admissions) to 93.4% (NTDB). Compared to triage specificity in the full cohort (87.8%), estimates ranged from 36.4% (NTDB) to 77.3% (all admissions). CONCLUSION: Common sources of trauma data miss substantial numbers of trauma deaths and high-risk trauma patients and can generate biased estimates for trauma system quality metrics. LEVEL OF EVIDENCE: Epidemiologic, level III.

The Academic RVU: Ten Years Developing a Metric for and Financially Incenting Academic Productivity at Oregon Health & Science University.

PURPOSE: Established metrics reward academic faculty for clinical productivity. Few data have analyzed a bonus model to measure and reward academic productivity. This study's objective was to describe development and use of a departmental academic bonus system for incenting faculty scholarly and educational productivity. METHOD: This cross-sectional study analyzed a departmental bonus system among emergency medicine academic faculty at Oregon Health & Science University, including growth from 2005 to 2015. All faculty members with a primary appointment were eligible for participation. Each activity was awarded points based on a predetermined education or scholarly point scale. Faculty members accumulated points based on their activity (numerator), and the cumulative points of all faculty were the denominator. Variables were individual faculty member (deidentified), academic year, bonus system points, bonus amounts awarded, and measures of academic productivity. Data were analyzed using descriptive statistics, including measures of variance. RESULTS: The total annual financial bonus pool ranged from $211,622 to $274,706. The median annual per faculty academic bonus remained fairly constant over time ($3,980 in 2005-2006 vs. $4,293 in 2014-2015), with most change at the upper quartile of academic bonus (max bonus $16,920 in 2005-2006 vs. $39,207 in 2014-2015). Bonuses rose linearly among faculty in the bottom three quartiles of academic productivity, but increased exponentially in the 75th to 100th percentile. CONCLUSIONS: Faculty academic productivity can be measured and financially rewarded according to an objective academic bonus system. The "academic point" used to measure productivity functions as an "academic relative value unit."