ABSTRACT
In the ongoing COVID-19 pandemic, detecting the appearance and spread of variants of concern (VOC) is a critical capability in the fight to quell the virus and return to normalcy. Genomic surveillance of the emergence, propagation, and geographical spread of VOCs is thus an important tool for public health officials and government leaders to make policy decisions and advise the public. As part of our role as a major SARS-CoV-2 diagnostic testing facility in New York City, the Pandemic Response Lab (PRL) has been performing genomic surveillance on the large number of positive samples processed by the facility on a daily basis from throughout the New York metropolitan area. Here we describe the development and optimization of a high-throughput SARS-CoV-2 genome sequencing facility at PRL serving New York City.
ABSTRACT
BackgroundCoronavirus disease 2019 (COVID-19), may progress to respiratory failure requiring invasive mechanical ventilation. Due to ventilator shortage and healthcare systems strain, affordable interventions such as awake prone positioning has been used to improve oxygenation, however, the effect of this intervention on patient-important outcomes is uncertain. The COVI-PRONE trial aims to determine if awake prone positioning in hypoxemic COVID-19 patients reduces the need for invasive mechanical ventilation. Study designA pragmatic, multicenter, international, parallel-group, and stratified randomized controlled trial, aiming to enrol 400 hospitalized adults with COVID-19. ParticipantsThe target population is hospitalized adults with confirmed or suspected COVID-19, hypoxemia that requires [≥]40% oxygen or [≥] 5 L/min by nasal cannula, and abnormal chest x-ray. We will exclude patients with any of the following: immediate need for intubation; altered mental status; contraindication to prone positioning; hemodynamic instability; body mass index > 40 kg/m2; third trimester pregnancy; do not intubate status; previous enrolment or intubation within the same hospital admission; and prone positioning for more than one day prior to randomization. Study intervention and controlFollowing informed a priori or deferred consent, eligible patients will be centrally randomized to either the intervention arm (prone positioning) or standard of care (no prone positioning). Patients randomized to the prone position will be required to either self-prone or assist-prone for a total of eight to ten hours per day until they meet pre-specified stopping criteria. Study outcomesThe primary outcome is invasive mechanical ventilation at 30-days of randomization. Other outcomes include mortality at 60 days, invasive and non-invasive mechanical ventilation free days at 30 days, hospital length of stay at 60 days, days alive and outside of the hospital at 60 days, complications of proning, and serious adverse events.
ABSTRACT
The use of skin grafts after lower extremity amputation in pediatric patients remains a controversial decision. A skin graft may help to preserve residual limb length and knee joint function; however, the literature suggests that it may make the patient more susceptible to complications. Directly contrasting children with and without skin grafts on their residual limbs will provide important data for the clinician making this decision. This study compares amputation characteristics, complications, and functional outcomes of these two populations. A retrospective chart analysis was performed on 45 pediatric patients who underwent lower extremity amputation between 1997 and 2006. Patients were divided into two groups: the graft group had skin grafts on their residual lower extremity limb(s) and the no graft group had no skin grafts present on the residual lower extremity limb(s). The mean time from amputation to follow-up was 4.5 years in the graft group and 7.0 years in the no graft group (P = .07). The average age at amputation for the graft group was 9.4 +/- 1.4 years and 5.9 +/- 1.1 years for the no graft group (P = .04). The graft group had a significantly longer hospital stay with 91 inpatient days vs 31 inpatient days in the no graft group (P = .03). There was no increased incidence of surgical revisions or reported problems with prosthetic wear in the graft group. Both groups achieved comparable levels of independence with ambulation. The presence of skin grafts on a child's amputated limb does not adversely affect functional outcome and does not lead to greater prosthetic complications for the child.
