ABSTRACT
Purpose: Studies conducted prior to COVID-19 suggested that racial/ethnic disparities in breast cancer screening percentages have substantially reduced over time. COVID-19 has had devastating effects on racial/ethnic minorities and resulted in delays in preventive breast cancer screening. Our purpose was to determine if racial/ethnic minorities were less likely to receive recommended breast cancer screening after the resumption of preventive care during the COVID19 pandemic. Method(s): HIPAA-compliant, institutional review board exempt retrospective cohort study was performed at a multi-location academic medical center located in the Midwest. Patients included women aged 50-74 years old between June 2021 and May 2022, derived from the electronic medical records. Primary outcomes variables included receipt of screening mammogram within the last two years. Primary exposure variables included race (American Indian/Alaska Native, Asian/Native Hawaiian/Other Pacific Islander, Black or African American, White) and ethnicity (Hispanic/Latino, and Not Hispanic/Latino). Binary outcomes were analyzed using logistic regression, adjusted for potential confounders (insurance, age, preferred language, employment status, rural status). Result(s): 37,509 female patients without histories of mastectomies were included (mean age 63.1). 73.8% of eligible patients received a mammogram within the last two years. By race, 74.7% of White patients, 57.6% of Black patients, 67.0% of Asian/Pacific Islander patients, and 60.1% of American Indian patients received a screening mammogram within the last two years. In our unadjusted analyses, Black (OR 0.46, 95% CI 0.41 to 0.52, p < 0.001), Asian (OR 0.69, 95% CI 0.60 to 0.79, p < 0.001), and American Indian patients (OR 0.51, 95% CI 0.39 to 0.66, p < 0.001) were less likely to receive recommended mammography screening. In our adjusted analyses, Black (OR 0.54, 95% CI 0.47 to 0.61, p < 0.001), Asian (OR 0.79, 95% CI 0.68 to 0.92, p = 0.003), and American Indian patients (OR 0.63, 95% CI 0.48 to 0.82, p = 0.001) were less likely to receive recommended mammography screening. By ethnicity, 74.1% of Non-Hispanic patients and 64.2% of Hispanic patients received a screening mammogram within the last two years. In our unadjusted analyses, Hispanic patients (OR 0.62, 95% CI 0.55 to 0.71, p < 0.001) were less likely to receive recommended mammography screening. In our adjusted analyses, Hispanic patients (OR 0.92, 95% CI 0.79 to 1.08, p = 0.338) were comparably likely to receive recommended mammography screening. Patients with non-English preferred languages, uninsured or Medicaid patients, and patients living in rural areas were less likely to receive recommended mammography screening (p < 0.001). Conclusion(s): Racial/ethnic minority patients were less likely to receive recommended cancer screening after the resumption of preventive breast cancer screening during the COVID-19 pandemic. Targeted outreach efforts are required to ensure equitable access to breast cancer screening for racial/ethnic minorities, patients with non-English preferred languages, uninsured, Medicaid, and rural patients.
ABSTRACT
Background: The COVID-19 pandemic was declared the greatest challenge the NHS would face since its creation. As a means of combatting the unprecedented strains COVID-19 was expected to force upon hospitals and their staff, NHS England sanctioned the postponement of all non-urgent elective surgery during the first wave of the COVID-19 pandemic. Approximately 70 000 cholecystectomies are performed every year in the UK, with the vast majority of these being elective laparoscopic cholecystectomies (LC). However, in the early stages of the pandemic, both national and international surgical bodies warned of the potential risks of aerosol virus transmission with the use of laparoscopy. Therefore, conservative management for emergency general surgical pathologies was recommended where possible. Delays in performing LC are associated with recurrent cholecystitis, pancreatitis and cholangitis;all of which present as emergencies with significant associated morbidity and mortality. This in turn has an economic impact on the NHS. We aimed to evaluate if patients undergoing emergency LC during the COVID-19 pandemic at our site, had different outcomes compared to those treated prior to the pandemic. Has the COVID-19 pandemic negatively impacted their patient journey? Furthermore, has the pandemic led to increased costs for our site? Methods: A retrospective data collection was performed to identify all patients who had an emergency LC from March 2019 - March 2021. Patients were subsequently categorised into 'pre-COVID-19' and 'during COVID-19' groups. Hospital computer systems were used to review operative admission length of stay (LoS), rate of conversion to open surgery/subtotal cholecystectomy, operative time, post-operative complications/return to theatre and readmission rate. Histopathology reports were analyzed to assess if the 'during COVID-19' cohort had a higher rate of complicated cholecystitis. Finally costs of the operative admission and associated admissions (pre and post-operatively), as well as the tariff for investigations performed for gallstone disease were calculated for each cohort of patients. Result(s): 158 patients were included in the study. A 42% reduction in emergency LC cases was observed during the COVID-19 pandemic compared to pre-pandemic. No statistically significant differences were seen between the two groups when reviewing the rate of conversion to open surgery or the incidence of post-operative complications/need to return to theatre. The rate of subtotal cholecystectomy was higher in the 'during COVID-19' group (12% vs. 3%) and this was found to be statistically significant (p-value 0.024). Operating times were longer during the pandemic (93 vs. 80 mins), as was the LoS for the operative admission (5 vs. 6 days), however these results were not statistically significant. Interestingly, same day emergency care (SDEC) reviews were more frequent in the 'during COVID-19' group (13.1 vs. 29.3%) and this was statistically significant (p-value 0.015). There was no statistically significant difference between the groups in relation to histopathology results. The most prevalent histopathology of both cohorts was chronic cholecystitis (58 vs. 48.28%). Acute on chronic cholecystitis (23 vs. 25.86%) and necrotising/gangranous changes (11 vs. 12.07%) were more prevalent in the 'during COVID-19' group. When reviewing costs between the two groups, no statistically significant differences in LoS, nor investigation tariffs was observed. Conclusion(s): Our study shows that the COVID-19 pandemic has had a negative impact on two clinical aspects of emergency LC - an increase in the rate of subtotal cholecystectomy, as well as SDEC reviews. This could be explained by delays in elective surgery encountered during the pandemic, leading to patients experiencing recurrent infections, or other associated complications of gallstone disease and consequently requiring more frequent clinician/SDEC reviews. These complications can also result in unclear anatomy, diffuse scarring, necrosis and abscess formation, all of which n lead to increasingly complex cases encountered intra-operatively. If surgeons are unable to safely achieve a critical view of safety, guidance recommends subtotal cholecystectomy as a bail out procedure, in order to avoid serious damage to the bile duct or blood vessels. This could justify the statistically significant higher rate of subtotal cholecystectomy in the 'during COVID-19' group. Currently, there are approximately 6 million patients on NHS surgical waiting lists and this issue must be addressed urgently in the COVID-19 recovery phase, so as to prevent adverse outcomes for both patients and the NHS.
ABSTRACT
Tens of thousands of 3D structures of oligosaccharides have been deposited into the Protein Databank (PDB), representing hundreds of thousands of hours of effort by crystallographers. Yet, despite the critical importance of these structures in furthering the development of glycomimetic drugs, in explaining the activity of glycan-processing enzymes, and in providing a deeper understanding of the properties of glycoproteins and vaccines, they remain unnecessarily difficult to locate within the PDB. Part of this is due to limitations in searching for oligosaccharides on the PDB website, even after a recent carbohydrate remediation project completed by the PDB. While several databases have been reported that contain carbohydrate structural information extracted from the PDB, few offer flexible search capabilities and even fewer provide independent assessment of data quality. Here we present the GlyFinder and GlyProbity webtools (glycam.org/gf) and illustrate their application to locating oligosaccharides, carbohydrate derivatives, and glycoproteins stored in the PDB. We highlight the utility of curating the data on the basis of the theoretical conformational (CHI) energies [1] of the glycosidic linkages and illustrate how the deposited data can be employed to generate 3D models of glycoproteins, including the SARS-CoV-2 Spike protein [2].
ABSTRACT
Background. Understanding SARS-CoV-2 transmission dynamics is critical for controlling and preventing outbreaks. The genomic epidemiology of SARS-CoV-2 on college campuses has not been comprehensively studied, and the extent to which campus-associated outbreaks lead to transmission in nearby communities is unclear. We used high-density genomic surveillance to track SARS-CoV-2 transmission across the University of Michigan-Ann Arbor campus and Washtenaw County during the Fall 2020 semester. Methods. We retrieved all available residual diagnostic specimens from the Michigan Medicine Clinical Microbiology Laboratory and University Health Service that were positive for SARS-CoV-2 from August 16th - November 25th, 2020 (n = 2245). We extracted viral RNA, amplified the SARS-CoV-2 genome by multiplex RT-PCR, and sequenced these amplicons on an Illumina MiSeq. We applied maximum likelihood phylogenetic analysis to whole genome sequences to define and characterize transmission lineages. Results. We assembled complete viral genomes from 1659 individual infections, representing roughly 25% of confirmed cases in Washtenaw County across the fall semester. Of these cases, 468 were University of Michigan students. Phylogenetic analysis revealed 203 genetically distinct introductions of SARS-CoV-2 into the student population, most of which were singletons (n = 171) or small clusters of 2 - 8 students. We identified two large SARS-CoV-2 transmission lineages (115 and 73 students, respectively), including individuals from multiple on-campus residences. Viral descendants of these student outbreaks were rare, constituting less than 4% of cases in the community. Conclusion. We identified many SARS-CoV-2 transmission introductions into the University of Michigan campus in Fall 2020. While there was widespread transmission among students, there is little evidence that these outbreaks significantly contributed to the rise in COVID-19 cases that Washtenaw County experienced in November 2020.
ABSTRACT
The present study describes the experience of Indonesian teachers coping with Emergency Remote Teaching (ERT) during the COVID-19 pandemic. An understanding of their experiences can help teachers better prepare for ERT in the future. Unlike ERT practices in other countries during the pandemic, there is still a lack of evidence of ERT practices in Indonesia. This descriptive study aims to interpret teachers' experience in managing their ERT. Online questionnaires were distributed to 36 Indonesian university lecturers and 40 Indonesian high school teachers. The instructors shared their experience of ERT practices during the pandemic. This study aims to examine their readiness to cope with ERT. The data show that teachers demonstrated their readiness to host ERT in the way they perceived learning management systems (LMS), developed modules, deployed feedback and comments, and scheduled screen time. Teachers' ERT strategies did not hinder students' successful learning as teachers maintained students' engagement in online learning through their knowledge of basic technology, such as choosing a LMS, providing encouragement through feedback, and producing media such as video lessons. Moreover, teachers could manage their screen time without negatively affecting their own mental and physical health. Finally, further research could seek data from a wider range of participants to obtain a wider picture of teachers' experience in Indonesian ERT. © 2021 Asociacion Mexicana de Maestros de Ingles MEXTESOL A.C. All rights reserved.
ABSTRACT
BACKGROUND: JiTT screencasts are effective teaching tools in some medical educational settings, but have not yet been evaluated for trainees on an inpatient adult hematology-oncology service (HOS). Our preceding pilot data identified six high-yield topics for this setting: venous thromboembolism, oncologic emergencies, sickle cell disease, hematologic emergencies, brain metastases, and spinal metastases. This study objective was to determine if the addition of educational screencasts on these six topics would be an effective educational intervention for trainees on a busy HOS. METHODS: All internal medicine residents scheduled to start a rotation on an HOS were eligible. Participants underwent block randomization to the usual educational curriculum either with screencast access (treatment) or without it (control). Allocation was concealed but participants were not blinded. Upon completion of the rotation, all participants received an anonymous online survey about their experiences. The primary outcome was the change in attitude among learners, measured as their self-reported confidence for managing the clinical topics that were covered. All randomized participants received a $20 gift certificate upon completion of the study. Exploratory data was also collected from medical students, fellows, and faculty who opted to participate;they were given access to the screencasts without randomization. RESULTS: Over the 29 week study period (12/9/2019 - 6/30/2020), 67 out of 78 eligible residents (86%) opted to participate;these 67 residents all underwent randomization and were analyzed by intention-to-treat. Enrollment continued to completion of the study. The final participant response rate was high at 91%. Demographic characteristics were well-matched between the arms with the exception of a higher prevalence of male gender (72% vs. 42%, p=0.022) in the screencast arm. The majority (64%) of residents in the screencast arm rated their clinical management comfort level as either “comfortable” or “very comfortable” as compared to just 21% of residents in the usual education arm (p = 0.0008), estimated difference = 43%, (95% CI 21%,66%) using a prespecified cumulative cutoff score. Nearly all participants on the screencast arm either agreed or strongly agreed that the screencasts improved their knowledge base in medical oncology (100%), will improve their care for cancer patients (92%), and enjoyed the format (96%). Most participants on the screencast arm felt that the intervention was optimal in terms of content (96%), length (82%), and accessibility (63%). Preferred viewing speed for the screencasts was 1.5x (52%). Nearly all participants felt that a similar database of screencasts would be helpful for all of their clinical rotations (96%). Medical knowledge as tested by a series of 6 clinical vignette multiple-choice questions was not different between the screencast and control arms (percentage correct: 77% vs. 80%, p=0.56). Burnout as tested by the Maslach Burnout Inventory was not different between the screencast and control arms in terms of total score (71 ± 12 vs. 69 ± 13, p=0.67) or personal accomplishment subscale (46 vs. 45, p=0.71). Exploratory data was also collected from 6 medical students, 8 fellows, and 6 attendings. Half of the students (50%) recommended the screencasts for the IM clerkship. Most fellows and faculty were neutral as to their interest in producing their own educational screencasts (77%) or contributing to a similar project (54%). CONCLUSIONS Resident trainees on a busy inpatient adult hematology-oncology service (HOS) found that a JiTT screencast series increased their clinical comfort level in the management of critical and commonly encountered patient problems unique to the HOS. The screencast content and delivery was overwhelmingly positive with nearly all (96%) wanting screencast series to be created for all their clinical rotations. Furthermore, as evidenced by the COVID-19 pandemic of 2020, novel distance and asynchronous learning platforms may be of increasing importance when raditional in-person methods are not feasible. Disclosures: Williams: Certus Critical Care: Other: My spouse is co-owner of Certus Critical Care, Inc. This is a medical device company;they currently have no devices on the market. Woods: Sanofi: Other: Advisory Board 2020.