CRO Update: Where are Contract Research Organizations Headed?

Goliath dynamic The CRO space has seen a flurry of merger and acquisition activity in recent years. 2016 saw the merger of IMS Health with Quintiles, resulting in the birth of IQVIA. "In a commoditized service area, scale is important, because it gives you a depth of business development and sales coverage in the market," Getz explains. John Kreger, an equity research analyst with William Blair in Chicago, IL, says the pharma industry's source of innovation has aggressively shifted from large pharmaceutical companies to small biotech startups. Coldwell says most CROs will forge partnership agreements with DCT software developers, but three or four of the world's largest CROs are building DCT technology in-house.

Epidemiological Population Study of Sars-Cov-2 in Lake County, Illinois: Contact: Health-Related Quality of Life Assessment

Objectives: The prospective, longitudinal, community-based CONTACT study aimed to improve our understanding of COVID-19 immunity, and other characteristics related to SARS-CoV-2 long-term, including the assessment of health-related quality of life (HRQoL) at baseline and over time by infection status. Method(s): Participants living or working in Lake County, IL were recruited between November 2020 and January 2021. At baseline and follow up visits (3-, 6-, and 9-Months-M-), participants self-reported their occupational exposure, COVID-19 vaccination status and provided nasal and blood serum specimens for molecular (RT-PCR) and serologic (IgG) testing to detect current or previous SARS-CoV-2 infection. HRQoL questionnaires EQ-5D-5L were completed online approximately within two weeks post-testing (at 0.5, 3.5, 6.5, and 9.5 months) after results were communicated. EQ-5D-5L information was described and stratified by COVID-19 status at baseline, 3M, 6M and 9M - software: SAS-v9.4. Result(s): Data from 1008 participants were analyzed. Participants testing positive to COVID-19 were 56/952, 48/751, 40/693, and 19/654, respectively, at baseline, 3M, 6M, and 9M. Of the five domains of EQ-5D-5L, a higher percentage of participants who tested positive for COVID-19 reported having no anxiety or depression versus those who tested negative: at baseline (55.4% [31/56] vs 50.5% [481/952]);3M (68.8% [33/48] vs. 56.3% [423/751]);6M (67.5% [27/40] vs. 56.3% [390/693]);and 9M (73.7% [14/19] vs. 60.4% [395/654]). Median Visual Analogue Scale (VAS) score was at least 2 points higher at all time- points for participants who tested positive except at last visit (baseline: 89.0 vs. 87.0;3M: 88.0 vs. 86.0;6M: 87.5 vs. 85.0;9M: 85.0 vs. 87.0) Conclusion(s): This analysis provides insight into participant HRQoL burden at enrollment and over time when a positive test to COVID-19 was communicated. At all time-points, anxiety or depression was experienced by more participants who tested negative versus those who didn't.Copyright © 2023

Tracking the Transit Divide: A Multilevel Modelling Approach of Urban Inequalities and Train Ridership Disparities in Chicago

Using a multilevel modelling approach, this study investigates the impact of urban inequalities on changes to rail ridership across Chicago's "L” stations during the pandemic, the mass vaccination rollout, and the full reopening of the city. Initially believed to have an equal impact, COVID-19 disproportionally impacted the ability of lower socioeconomic status (SES) neighbourhoods' to adhere to non-pharmaceutical interventions: working-from-home and social distancing. We find that "L” stations in predominately Black or African American and Hispanic or Latino neighbourhoods with high industrial land-use recorded the smallest behavioural change. The maintenance of higher public transport use at these stations is likely to have exacerbated existing health inequalities, worsening disparities in users' risk of exposure, infection rates, and mortality rates. This study also finds that the vaccination rollout and city reopening did not significantly increase the number of users at stations in higher vaccinated, higher private vehicle ownership neighbourhoods, even after a year into the pandemic. A better understanding of the spatial and socioeconomic determinants of changes in ridership behaviour is crucial for policymakers in adjusting service routes and frequencies that will sustain reliant neighbourhoods' access to essential services, and to encourage trips at stations which are the most impacted to revert the trend of declining public transport use.

The Rising Epidemic of Mass Shootings in the US and Its Association with Gun Legislation, Laws, and Sales

Introduction: Mass shootings pose a considerable threat to public safety. This study aims to (1) assess US mass shootings, firearm-related sales, laws, and regional differences from 2015-2021 and (2) investigate changes in mass shootings and firearm sales before and during the Coronavirus Disease 2019 (COVID-19) pandemic. Method(s): A retrospective review of mass shootings, gun sales, and laws regarding the minimum age required to purchase a firearm within the US from 2015-2021. The 10 states/regions with the greatest mean mass shootings/capita from 2015-2021 were selected for further analysis. Result(s): Mass shootings correlated significantly with firearm sales from 2015-2021 nationwide (p< 0.02 for all). The growth in mass shootings, the number killed/injured, and gun sales were greater in 2020 and 2021 compared withthe years prior. The 10 states with the highest mean mass shooting/capita over the study period were Alabama, Arkansas, the District of Columbia, Illinois, Louisiana, Maryland, Mississippi, Missouri, South Carolina, and Tennessee. No significant correlation was found between the number of mass shootings/capita and the minimum age to purchase a firearm. Conclusion(s): Firearm sales correlated significantly with mass shootings from 2015-2021. Mass shootings and gun sales increased at greater rates during the COVID-19 pandemic compared withthe years before the pandemic. Mass shootings exhibited inconsistent trends with state gun laws regarding the minimum age to purchase a firearm. Future studies may consider investigating the methods by which firearms used in mass shootings are obtained to further identify targets for prevention.

Communities in Transitions: Reflection on the Impact of the Outbreak of COVID-19 on Urban China

"Community”, as a basic category of urban socio-space, has undergone evolution within academic, policy, and day-to-day life contexts in China. Through years of transitions, a kind of dual community emerged in Chinese cities before the epidemic. It encompassed a "conceptual community” based on the concept of (social) co-governance and an "experiential community” based on citizens' daily living. The disparity between the two had given rise to a paradoxical situation in local community governance practices. The outbreak of COVID-19 brought fundamental changes to the transition process. Through the analysis of 21 recording reports during the outbreak period, we found that to contain the pandemic, the community epidemic prevention measures necessitated both these communities to overlap within a brief time frame. This led to reinforced community boundaries, the coexistence of multiple actors, the reconstruction of a sense of security-based belongingness, and the reformulation of the governance symbolic system that temporarily resolved the paradoxical governance practices. What happened under the preface of co-governance logic during the outbreak period was the coverage and shaping of the conceptual community over the experiential community, which may continue during the post-epidemic era. This study offers a relatively new approach and valuable insights into examining the long-lasting impact of the epidemic on urban social space and sustainable development in the post-epidemic era.

Exploring violent crimes in Chicago during the COVID-19 pandemic: do location, crime type, and social distancing type matter?

The current study estimates the impact of the SAH order on violent crimes across public and residential locations: assault, battery, homicide, robbery, and sexual assault. Using interrupted time series analyses, it analyzes weekly crime data in Chicago, Illinois, from 2017 to 2020. The SAH order caused significant decreases in battery and sexual assault across public and residential locations. It also decreased assault in public locations only. Such decreases in assault, battery, and sexual assault were greater under the SAH order when social distancing was strictly enforced, as opposed to during the relaxation of social distancing. On the other hand, there were significant increases in homicide across public and residential locations. Robbery increased in public locations only. There were greater increases in homicide and robbery during the relaxation of social distancing, as opposed to under the SAH order. The study ultimately indicates that the impacts of the containment measures are conditional upon the offense location, type of crime, and level of social distancing being mandated. From a public policy perspective, it is important to allocate staffing and resources for law enforcement accordingly during the enduring pandemic.

Vaccines for COVID-19 arm RSV: An update

[...]in this case, the Pfizer/BioNTech response-which is appropriate-is that if the level of antibodies is too low, we may need a third dose in the age group of 2 to 5 years. All that said, it seems the existing vaccines now have a 3-dose series in adults;we don't know necessarily yet for children if 2 or 3 doses will be necessary for all the mRNA vaccines, but there are reasonably good data that the immune responses induced may still provide a level of protection that is reasonable. Whenever there is a new variant, there are basic science laboratories in various parts of the world that are poised to immediately do studies with model systems in which they can put the variants into a virus that is not pathogenic and ask the question "Do the antibodies from some of the recipients of the vaccine provide some level of protection in a laboratory study?" With the Omicron surge being so big, we were able to get a pretty good idea of whether people who had received the vaccine were significantly less likely to have significant consequences from infection. William J. Muller is an attending physician of infectious diseases and scientific director of clinical and community trials at the Stanley Manne Children's Research Institute at Ann & Robert H. Lurie Children's Hospital of Chicago and an associate professor of pediatrics at Northwestern University Feinberg School of Medicine in Chicago, Illinois.

At last, a silver lining

Medical Director, International Patient Services Program, Co-Director, Pediatric Travel Medicine Clinic, Director, International Adoptee Clinic, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois contributing editors Bernard A. Cohen, MD Section Editor for Dermcase, Professor of Pediatrics and Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland Jon Matthew Farber, MD Section Editor for Journal Club, pediatrician, ALL Pediatrics, Woodbridge, Virginia Carlton K.K. Lee, PharmD.MPH, FASHP.FPPAG Section Editor for The Clinical Pharmacologist's Notebook, Pediatric Clinical Pharmacy Specialist, Department of Pharmacy, and Associate Professor, Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, Maryland MinaL.Alfieri.MD, MS nstructor of Pediatrics, Feinberg Schoo of Medicine, Northwestern University Attending Physician, Academic General Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois AminJ. MSCE Assistant Professor of Pediatrics, George Washington University School of Medicine and Health Sciences;Pediatric Infectious Diseases Attending, Director, Antimicrobial Stewardship Program, Associate Fellowship Program Director, Children's National Hospital, Washington, DC Michael S. Jellinek, MD Professor of Psychiatry and of Pediatrics, Harvard Medical School, Boston, Massachusetts Candice Jones, MD Board-certified general pediatrician in group practice in Orlando, Florida, former National Health Service Corps Scholar, AAP member, spokesperson and author Andrew J. Schuman, MD Clinical Assistant Professor of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire Steven M. Selbst, MD Professor of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, Attending Physician, Pediatric Emergency Medicine, Nemours/Alfred I duPont Hospital for Children, Wilmington, Delaware As 2021 gets underway and an increasing number of coronavirus disease 2019 (COVID-19) vaccines are administered, I believe that 2021 will be much more of a "normal" year, especially with the hope of COVID-19 vaccine availability for children by fall 2021. Issues discussed include illnesses more prevalent in children of color, such as asthma, sickle cell disease, and COVID-19;the difference in pain managementfor White children versus children of color;and how bias impacts mental health issues in children of color.

Abolition as Durational Performance: Mutual Aid Aesthetics in Chicago's Southeast Asian Neighborhood

Responses to rising anti-Asian violence during the COVID-19 pandemic prompted multiple, often conflicting, actions including calls to defund the police, calls for more police, bystander interventions, and the exploitation of violence to promote influencers' brands. In Chicago's "Argyle" Uptown neighborhood, an area known as a Southeast Asian refugee business district, Asian Americans and local white government officials promoting liberal multiculturalist urban renewal projects used the news after the Atlanta spa shooting to advance their plans for gentrification and increased policing. How do we understand the colliding narratives of racial antagonisms, racial solidarities, and the genocidal logics of urban renewal, as they emerge at the intersection of settler colonialism and the afterlife of slavery? How is this question complicated by the entwined issues of refugee resettlement and multiculturalist solutions to anti-Asian violence? In this article, I argue abolition as durational performance offers an embodied, performance studies based analytic and methodology for the study and praxis of abolition. Abolition as durational performance centers the creation of life-affirming institutions, relations, and spaces while navigating the histories and bodily impacts of white supremacy, anti-Blackness, native genocide, and US liberal war on refugee resettlement as it is enacted through urban renewal and redevelopment projects. I focus on Axis Lab, a community-based arts and architecture organization based in Chicago, which launched its mutual aid and public arts project in June 2020. This is an abolitionist project inspired by the Black Panther breakfast and political education programs.

Rise in Out-of-Hospital Cardiac Arrest Cases in Chicago in 2020

Background: Italy, France and New York City have reported an increase in out-of-hospital cardiac arrest (OHCA) incidence during the COVID-19 pandemic. The purpose of our study was to assess the effect of COVID-19 on OHCA cases in Chicago. Method(s): Cardiac Arrest Registry to Enhance Survival (CARES) database was used. Bivariate analysis was conducted to assess changes in demographic and other characteristics. We excluded the cases that occurred in a healthcare facility or a nursing home. We compared the cases reported in 2020 to 2019 (and prior years). ArcGIS was used to geocode incident addresses and to show the temporal distribution by community areas. Bivariate analysis was done using chi-square tests. Result(s): A total of 3221 OHCA cases were reported in Chicago in 2020, which is 31.5% higher than those reported in 2019 (n=2450 cases). This increase was higher than what has been noticed historically (for instance, the increase from 2018 to 2019 was only 17%). There was an increase in Hispanic OHCA cases (17.3% in 2020 vs. 13.5% in 2019, p<0.01) but a decrease in White cases (20.5% vs. 23.1%). The cases in 2020 were less likely to be reported at public location (22% vs. 26%, p<0.001) or have shockable rhythm (10% vs. 13%, p=0.0002). There was a marked increase in those that were declared dead in the field in 2020 (37% vs. 27%, p<0.001). However, there were no statistically significant differences in age distribution, gender, witnessed arrest (49% vs. 51%, p=0.07) or bystander cardiopulmonary resuscitation (BCPR) (23% vs. 22%, p=0.3). Conclusion(s): A better understanding of the causes of the excess cardiac arrest numbers will be important to help plan and better prepare for future public health interventions. The effect of COVID19 on OHCA survival needs to be examined further in future studies.

An exploratory factor analysis of long COVID

An exploratory factor analysis (EFA) can provide a window into the latent dimensions of a disease, such as Long COVID. Discovering the latent factors of Long COVID enables researchers and clinicians to better conceptualize, study and treat this disease. In this study, participants were recruited from social media sites dedicated to COVID and Long COVID. Among the 480 participants, those who completed at least 90% of the survey, reported symptoms for two or more months since COVID-19 symptom onset, and had not been hospitalized for COVID were used in the EFA. The mean duration since initial symptom onset was 74.0 (37.3) weeks. A new questionnaire called The DePaul Symptom Questionnaire-COVID was used to assess self-reports of the frequency and severity of 38 Long COVID symptoms experienced over the most recent month. The most burdensome symptoms were "Symptoms that get worse after physical or mental activities (also known as Post-Exertional Malaise)," "Fatigue/extreme tiredness," "Difficulty thinking and/or concentrating," "Sleep problems," and "Muscle aches." The EFA resulted in a three-factor model with factors labeled General, PEM/Fatigue/Cognitive Dysfunction, and Psychological, consisting of 16, 6, and 3 items respectively (25 items in total). The reliability of the items in the EFA was .90 using a split-half reliability test. Finally, participant self-reported level of functional impairment was analyzed across the three EFA factors. Interpretations and applications to research and practice are provided.

CLINICAL OUTCOMES BY SARS-CoV-2 VARIANT AT A SINGLE ACADEMIC MEDICAL CENTER

Background: SARS-CoV-2 continues to change over time due to genetic mutations and viral recombination.1 Given the changing landscape of COVID-19 variants and availability of COVID-19 vaccinations, disease severity during acute infection has also been variable. However, most research related to COVID-19 to date has not focused on evaluating differences in outcomes by the dominant variant and the impact it might have on post-acute sequalae of COVID-19 (PASC). Method(s): We developed a data mart of electronic health record data pertaining to COVID-19 in a single North American metropolitan health system (RUSH University Medical Center). Patients were selected for analysis if they had at least one documented infection of COVID-19. Date ranges were established per dominant variant, and the date of diagnosis was matched to variant. Variants were determined by the most prominent variant of concern (VOC) circulating in the city of Chicago. Variants were categorized by the following by date ranges: Wildtype+D614G (3/7/20-3/20/21), Alpha (3/21/21-6/19/21), Delta (6/20/21-12/11/21), Omicron BA.1 (12/12/21-3/19/22), Omicron BA.2 (3/20/22- 6/18/22), and Omicron BA.4/BA.5 (6/19/22-present (9/30/22). Subsequent clinical outcomes were examined, including hospitalization, intensive care unit admission, or death. We characterized our sample by conducting descriptive statistics including frequency and percent of outcome by variant. Result(s): 44,499 patients were included in this analysis with 30.23% requiring hospitalization, 4.25% being admitted to intensive care unit (ICU), and 2.35% resulting in death. The greatest percentage of hospitalizations occurred with the Alpha variant at 41.88% (N=928), and the greatest percentage of ICU admissions (6.43%) and death (3.15%) occurred with the Delta variant. The latest Omicron variant (Wave 6) showed an increase in hospitalizations (35.18%), as compared to early Omicron waves (Wave 4 and 5) but maintained similar ICU rates. Death rates continued to decline during the Omicron waves (Table 1). Conclusion(s): Although Alpha and Delta variants seem to have more severe outcomes compared to other variants, it is important to note that COVID-19 prevention, treatment access, and management continues to change, potentially influencing how outcomes may differ over time. Future work should determine factors to adjust for when examining variant-level differences.

Challenges and Results of Haploidentical Stem Cell Transplantation for Adult Patients in Cuba

The Hermanos Ameijeiras Hospital (HAH) in Havana is the only center performing allogeneic hematopoietic stem cell transplantation (HSCT) in adult patients in Cuba. Because transplants from unrelated donors are not possible due to political restrictions and economic embargo, in 2016 HAH and University of Illinois at Chicago (UIC) started a collaboration to support the training of a physician, annual educational programs and exchange of guidelines and protocols to perform haploidentical transplants. The first haploidentical transplant was performed at HAH in 2016. Because of limited resources, disease risk stratification is based on morphologic assessment, as cytogenetic is tested on an irregular basis. Peripheral blood stem cells (PBSC) were infused based on total nucleated cell count (TNC) due to lack of reagents for flow cytometry. Posttransplant chimerism and CMV monitoring cannot be performed. Transplant activity was stopped in 2020 due to high expenses allocated for COVID19 pandemic in Cuba. From 2016 to 2020, 16 haploidentical HSCT in 15 patients (9 males/ 6 females) were completed at HAH. The median age of patients was 34 years (range:21-54). Diagnoses included: acute leukemia, n=12, myelodysplastic syndrome, n=1, Hodgkin disease, n=1, and severe aplastic anemia, n=1. At the time of transplant, 11 patients were in morphologic remission and 5 had active disease. Conditioning regimens utilized were myeloablative (Flu/Bu) in 10 cases and at reduced intensity (Flu/Cy/ TBI200 +/- ATG) in 6 cases, and GVHD prophylaxis was standard PTCy on D3 and 4, CsA and mycophenolate. The donors were mother (n=10), father (n=1), child (1), or sibling (n=3) and the median age was 48 years (range: 26-68). All patients received fresh stem cells from PBSC(n=13) or bone marrow (n=3). Median cell dose infused was 5.5x108 TNC/kg (range: 2.2-8). All patients but 1 engrafted and median time to neutrophil and platelet engraftment was 17 days (range:12-28) and 16 days (range:11-30), respectively. Acute graft-versus-host disease (GVHD) grade 2-3 occurred in 50% of patients and chronic GVHD in 2 out of 8 that were evaluable. Day 100 and 2-year overall survival rates were 73% and 40%, respectively. With a medium follow-up of 18.8 months (range: 0.3-64), 5 of 15 patients (30%) are alive and complete remission. Causes of death in the remaining 10 patients included relapse of original disease, n= 4;bacterial infection, n=2;brain hemorrhage, n=1;VOD, n=1;graft failure, n=1;and multi-organ failure, n=1. Despite significant difficulties, HAH implemented a haploidentical transplant program for adult patients in Cuba. Among future steps, improving access to molecular testing and using younger donors will be pursued to improve on the results. The partnership between HAH and UIC has been instrumental in building clinical and research capacity and continues to support HAH in its mission to provide care to patients in Cuba.(Figure Presented)Copyright © 2023 American Society for Transplantation and Cellular Therapy

Changing Higher Education in the United Kingdom: Examining Three Trends through a Neoliberal Lens

Perry discusses how neoliberalism has had a dramatic impact on higher education in the UK. She traces the history of neoliberalism in broad strokes from the pre-Thatcher years to the post-Thatcher years and identifies three key trends in higher education: widening participation and the politics of aspiration, the emergence of the student entrepreneur-consumer, and the marketization of higher education. With specific reference to the third trend, she discusses the use of Internet-based education by higher education institutions and its potential impact on students. The coronavirus pandemic has posed major challenges for student recruitment and increased the precariousness of students in the instructional process.

Opportunity in uncertainty: small business response to COVID-19: Revista de Administracao e Inovacao

PurposeThe global spread of coronavirus brought the economy to a screeching halt as entrepreneurs faced constraints in their ability to transact business. Mandatory shutdowns of businesses, travel restrictions and other measures were taken. This study aimed to explore adaptations of small businesses for surviving in such a turbulent environment.Design/methodology/approachThe authors conducted exploratory research with detailed interviews with 15 small business owners from various industries in rural communities in the Midwestern United States.FindingsThe study revealed a variety of strategic responses and highlighted creativity and flexibility in coping with uncertainty. Business owners adapted their strategies regarding processes, products and target customers to remain flexible and reallocate resources to meet ever-changing demands. Some created and strengthened relationships with other business owners, clients, customers and the community. Several showed optimism for the long-term, whereas others viewed survival as contingent on a speedy return to normalcy.Research limitations/implicationsA modest sample of fifteen small business owners were interviewed in similar communities in the Midwest using snowball sampling. With a larger sample size and more variance in age and gender, interview responses may be more diverse and potentially more generalizable. However, the current research may provide some unique insights for younger, up-and-coming entrepreneurs in smaller cities and communities regarding some effective small business and community response to uncertainty and change.Originality/valueThe coronavirus pandemic provided a unique environment to gain insight into entrepreneurial adaptation to unpredictable crisis situations and highlights the importance of assessing and adjusting business strategies to constantly changing demands. The authors also present an emergent theoretical process model of small business adaptive responses to uncertainty that summarizes the major themes derived from the interview responses.

U.S. HATE CRIME TRENDS: WHAT DISAGGREGATION OF THREE DECADES OF DATA REVEALS ABOUT A CHANGING THREAT AND AN INVISIBLE RECORD

When prejudice-related data are combined and analyzed over time, critical information is uncovered about overall trends, related intermittent spikes, and less common sharp inflectional shifts in aggression. These shifts impact social cohesion and grievously harm specific sub-groups when aggression escalates and is redirected or mainstreamed. These data, so critical to public policy formation, show that we are in such a historic inflection period now. Moreover, analysis of the latest, though partial Federal Bureau of Investigation hate crime data release, when overlaid with available data from excluded large jurisdictions, reveals hate crimes hit a record high in 2021 in the United States that previously went unreported. This Essay analyzes the most recent national data as well as various numerical and policy milestones that accompanied the historic, yet incomplete, implementation of hate crime data collection and related statutes over recent decades. This analysis of emerging trends in the United States is undertaken in the context of bigoted aggression broken down over time.

Reducing the Risk of Perioperative Transmission of Candida auris: The Official Voice of Perioperative Nursing

CAUSES OF C AURIS TRANSMISSION In 2009, laboratory personnel isolated C auris from discharge originating in the external ear canal of a hospitalized patient in Japan and named it accordingly.5 Although C auris is closely related to other Candida species, it behaves much differently;rather than originating in the host's flora, it is most often acquired through contact with contaminated surfaces or fomites shed from colonized or infected individuals.6 Patients infected or colonized with C auris shed the pathogen from their skin, which can contaminate the environment-including shared medical equipment.7 Because the pathogen can remain viable on surfaces for prolonged periods (eg, four weeks8), it can be transmitted to patients and lead to systemic infection.9 Traditional biochemical tests for yeast identification may misidentify C auris as another yeast,9,10 and ineffective environmental cleaning can allow it to persist on surfaces, thereby increasing the risk of an outbreak.9 The first reported health care-associated C auris outbreak occurred between April 2015 and July 2016 in a cardiothoracic center in London.11 In June 2016, the CDC issued a clinical alert to health care facilities, noting that one isolate of C auris was detected in 2013 and that the pathogen had been in identified in nine countries on four continents since 2009.12 The number of clinical C auris cases has increased each year since 2016;from 2020 to 2021, that number almost doubled (755 to 1,470).13 In December 2022, there were 1,994 clinical cases and 5,071 screening cases (ie, indicating colonization) of C auris in the United States, with the highest incidence in California, Florida, Illinois, Nevada, New York, and Texas.13 In contrast, from 2013 to 2016, there had only been 63 clinical cases and 14 screening cases reported, occurring only in Illinois, Maryland, New Jersey, and New York. The patient risk factors for acquiring C auris are comparable to those associated with other types of Candida infections, such as Candida albicans, and include * recent surgery,4 * hospitalization in an endemic country outside the United States,4 * extended stays in an intensive care unit,17 * recent care in a postacute setting (eg, long-term care facility),4 * recent therapy with broad-spectrum antimicrobials,4 * the presence of invasive medical devices (eg, central venous catheter, feeding tube, endotracheal tube),4 and * chronic conditions or immunosuppression.18 The risk of healthy individuals (eg, health care workers [HCWs]) contracting C auris is very low. STRATEGIES TO CONSIDER Preventing transmission of epidemiologically important pathogens, such as C auris, in the perioperative practice setting requires strict compliance with infection prevention and control (IPC) measures, including * adhering to hand hygiene requirements, * using transmission-based (ie, contact) precautions, * communicating effectively, and * cleaning and disinfecting the health care environment with approved products.23 In addition, appropriate screening to identify patients colonized or infected with C auris and laboratory surveillance to identify the pathogen also are needed. When caring for patients with possible or confirmed C auris colonization or infection, HCWs should use contact precautions in addition to standard precautions.23 When implementing contact precautions in perioperative areas, personnel should consult with a facility infection preventionist on required personal protective equipment (PPE), patient transport protocol, patient placement in the facility, and enhanced environmental cleaning practices.25 Effective communication may help to ensure that HCWs implement IPC measures correctly and consistently.

Impact of COVID-19 on Individuals with TBI: Nationwide Cross-Sectional Study...American Congress of Rehabilitation Medicine (ACRM) 99th Annual Conference, November 8-11, 2022, Chicago, Illinois

To investigate the impact of the COVID-19 pandemic on the health and life quality of individuals living with traumatic brain injury (TBI) in the United States. Cross-Sectional. General community. 1,440 adults with mild (49%), moderate (22%), and severe (29%) TBI. 3,857 adults from general population. N/A. Self-report measures of extent to which pandemic/stay-at-home orders have impacted mental health, isolation, financial stress, and access to medical care;brief assessment of vaccine hesitancy. Self-report psychometric measures of depression (PHQ-9), anxiety (GAD-7), comorbid disease burden, substance use, and domestic violence victimization. In this diverse nationwide sample, 55% of individuals with TBI lost wages due to the COVID-19 pandemic;only 16% felt they were able to pay for basic needs (food, shelter, heat). Those with TBI reported substantially elevated worry and isolation;29% reported their cognitive function and 36% felt their mood (36%) had changed due to social-distancing and/or shelter-in-place orders. The majority met criteria for clinically significant depression (78%) and/or anxiety (76%). Only 11% reported increased alcohol use, and 24% reduced use;however, 24% reported high-risk prescription pain medication use. Recent physical and verbal violence was common: only 30% indicating that others "never" physically hurt them, and only 42% said they were "never" verbally abused. Control comparison data suggest disproportionate burden among those with TBI. Individuals with TBI are at unique risk for financial loss, unmet care needs, medication misuse, and domestic violence during the ongoing pandemic. The extent to which observed disparities among those with TBI are limited to the early stages of the pandemic (i.e., 2020-2021) warrants further investigation;regardless, immediate remediation is required. None.