Observational study of organisational responses of 17 US hospitals over the first year of the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic has required significant modifications of hospital care. The objective of this study was to examine the operational approaches taken by US hospitals over time in response to the COVID-19 pandemic. DESIGN, SETTING AND PARTICIPANTS: This was a prospective observational study of 17 geographically diverse US hospitals from February 2020 to February 2021. OUTCOMES AND ANALYSIS: We identified 42 potential pandemic-related strategies and obtained week-to-week data about their use. We calculated descriptive statistics for use of each strategy and plotted percent uptake and weeks used. We assessed the relationship between strategy use and hospital type, geographic region and phase of the pandemic using generalised estimating equations (GEEs), adjusting for weekly county case counts. RESULTS: We found heterogeneity in strategy uptake over time, some of which was associated with geographic region and phase of pandemic. We identified a body of strategies that were both commonly used and sustained over time, for example, limiting staff in COVID-19 rooms and increasing telehealth capacity, as well as those that were rarely used and/or not sustained, for example, increasing hospital bed capacity. CONCLUSIONS: Hospital strategies during the COVID-19 pandemic varied in resource intensity, uptake and duration of use. Such information may be valuable to health systems during the ongoing pandemic and future ones.

Rapid Mobilization of Medical Students to Provide Health Care Workers With Emergency Childcare During the COVID-19 Pandemic.

PROBLEM: In March 2020, the novel coronavirus 2019 (COVID-19) pandemic spread rapidly within the United States and began overwhelming the health care system. To conserve personal protective equipment, reduce the spread of the virus, and keep student learners safe, leaders of medical schools across the country made the difficult decision to suspend in-person clinical experiences. As medical students were sent home and hospital systems ramped up their response to the virus, many essential health care workers (HCWs) faced an immediate challenge. As "nonessential" services such as schools and daycare centers abruptly closed, HCWs serving on the frontlines in inpatient settings needed a way to both fight the pandemic and care for their children. APPROACH: Medical students at Oregon Health & Science University were able to rapidly OR organize to provide childcare for essential HCWs. For roughly 8 weeks following the state of emergency (March 13 through May 15, 2020), students used Twitter and emerging technology to match families in need of childcare with a trainee volunteer. OUTCOMES: By May 15th, the service had successfully fulfilled 181 of the 202 requests for childcare (90%) over the course of 8 weeks. Of the 181 completed childcare requests, 172 (95%) were fulfilled by an individual (1:1 volunteer-to-household pairing), and 9 (5%) were fulfilled by 2 or more volunteers. NEXT STEPS: The trainees who provided childcare will apply the skills learned (e.g., clear communication, grassroots organizing, triaging, leveraging new technology) to patient care. Broader applications for this system include organizing volunteers to conduct contract tracing or to provide public health information in languages other than English. Future research includes examining the effect of the service on the productivity, morale, and mental health of both those who provided and received childcare.

Does spatial attention modulate the C1 component? The jury continues to deliberate.

The thoughful comments on our study (Baumgartner et al., this issue) that failed to replicate the C1 attention effect reported by a previous study roughly fall into three broad categories. First, the commentators identified specific differences between the two studies that may have contributed to the discrepant results. Second, they highlighted some of the theoretical and methodological problems that are encountered when trying to demonstrate attention effects on the initial evoked response in primary visual cortex. Third, they offered a number of proposals for optimizing experimental designs and analysis methods that may increase the likelihood of observing attention-related modulations of the C1. We consider each of these topics in turn.

Does spatial attention modulate the earliest component of the visual evoked potential?

Whether visual spatial attention can modulate feedforward input to human primary visual cortex (V1) is debated. A prominent and long-standing hypothesis is that visual spatial attention can influence processing in V1, but only at delayed latencies suggesting a feedback-mediated mechanism and a lack of modulation during the initial afferent volley. The most promising challenge to this hypothesis comes from an event-related potential (ERP) study that showed an amplitude enhancement of the earliest visual ERP component, called the 'C1', in response to spatially attended relative to spatially unattended stimuli. In the Kelly et al. study, several important experimental design modifications were introduced, including tailoring the stimulus locations and recording electrodes to each individual subject. In the current study, we employed the same methodological procedures and tested for attentional enhancements of the C1 component in each quadrant of the visual field. Using the same analysis strategies as Kelly et al., we found no evidence for an attention-based modulation of the C1 (measured from 50-80 ms). Attention-based amplitude enhancements were clear and robust for the subsequent P1 component (90-140 ms). Thus, despite using methods specifically designed to reveal C1 attention effects, the current study provided no confirmatory evidence for such effects.