scholarly journals The COVID-19 Hospitalization Metric in the Pre- and Post-vaccination Eras as a Measure of Pandemic Severity: A Retrospective, Nationwide Cohort Study

2022 ◽  
pp. 1-24
Author(s):  
Nathanael R. Fillmore ◽  
Jennifer La ◽  
Chunlei Zheng ◽  
Shira Doron ◽  
Nhan Do ◽  
...  
Keyword(s):  
Severe Disease ◽  
Supplemental Oxygen ◽  
Oxygen Supplementation ◽  
Treatment Algorithms ◽  
Penalized Spline ◽  
Highly Correlated ◽  
Definition Of ◽  
Pandemic Severity ◽  
Vaccine Availability ◽  
The Impact

Abstract Background: COVID-19 hospitalization definitions do not include a disease severity assessment. Thus, we sought to identify a simple and objective mechanism for identifying hospitalized severe cases and to measure the impact of vaccination on trends. Methods: All admissions to a Veterans Affairs (VA) hospital, where routine screening is recommended, between 3/1/2020-11/22/2021 with SARS-CoV-2 were included. Moderate-to-severe COVID-19 was defined as any oxygen supplementation or any SpO2 <94% between one day before and two weeks after the positive SARS-CoV-2 test. Admissions with moderate-to-severe disease were divided by the total number of admissions, and the proportion of admissions with moderate-to-severe COVID-19 was modelled using a penalized spline in a Poisson regression and stratified by vaccination status. Dexamethasone receipt and its correlation with moderate-to-severe cases was also assessed. Results: Among 67,025 admissions with SARS-CoV-2, the proportion with hypoxemia or supplemental oxygen fell from 64% prior to vaccine availability to 56% by November 2021, driven in part by lower rates in vaccinated patients (vaccinated, 52% versus unvaccinated, 58%). The proportion of cases of moderate-to-severe disease identified using SpO2 levels and oxygen supplementation was highly correlated with dexamethasone receipt (correlation coefficient, 0.95), and increased after 7/1/2021, concurrent with delta variant predominance. Conclusions: A simple and objective definition of COVID-19 hospitalizations using SpO2 levels and oxygen supplementation can be used to track pandemic severity. This metric could be used to identify risk factors for severe breakthrough infections, to guide clinical treatment algorithms, and to detect trends in changes in vaccine effectiveness over time and against new variants.

scholarly journals The COVID-19 Hospitalization Metric in the Pre- and Post-vaccination Eras as a Measure of Pandemic Severity: A Retrospective, Nationwide Cohort Study

2022 ◽  
Author(s):  
Nathanael Fillmore ◽  
Jennifer La ◽  
Chunlei Zheng ◽  
Shira Doron ◽  
Nhan Do ◽  
...  
Keyword(s):  
Severe Disease ◽  
Supplemental Oxygen ◽  
Oxygen Supplementation ◽  
Treatment Algorithms ◽  
Penalized Spline ◽  
Highly Correlated ◽  
Definition Of ◽  
Pandemic Severity ◽  
Vaccine Availability ◽  
The Impact

Abstract Background: COVID-19 hospitalization definitions do not include a disease severity assessment. Thus, we sought to identify a simple and objective mechanism for identifying hospitalized severe cases and to measure the impact of vaccination on trends.Methods: All admissions to a Veterans Affairs (VA) hospital, where routine screening is recommended, between 3/1/2020-11/22/2021 with SARS-CoV-2 were included. Moderate-to-severe COVID-19 was defined as any oxygen supplementation or any SpO2 <94% between one day before and two weeks after the positive SARS-CoV-2 test. Admissions with moderate-to-severe disease were divided by the total number of admissions, and the proportion of admissions with moderate-to-severe COVID-19 was modelled using a penalized spline in a Poisson regression and stratified by vaccination status. Dexamethasone receipt and its correlation with moderate-to-severe cases was also assessed. Results: Among 67,025 admissions with SARS-CoV-2, the proportion with hypoxemia or supplemental oxygen fell from 64% prior to vaccine availability to 56% by November 2021, driven in part by lower rates in vaccinated patients (vaccinated, 52% versus unvaccinated, 58%). The proportion of cases of moderate-to-severe disease identified using SpO2 levels and oxygen supplementation was highly correlated with dexamethasone receipt (correlation coefficient, 0.95), and increased after 7/1/2021, concurrent with delta variant predominance.Conclusions: A simple and objective definition of COVID-19 hospitalizations using SpO2 levels and oxygen supplementation can be used to track pandemic severity. This metric could be used to identify risk factors for severe breakthrough infections, to guide clinical treatment algorithms, and to detect trends in changes in vaccine effectiveness over time and against new variants.

scholarly journals The COVID-19 Hospitalization Metric in the Pre- and Post-vaccination Eras as a Measure of Pandemic Severity: A Retrospective, Nationwide Cohort Study

2021 ◽  
Author(s):  
Nathanael Fillmore ◽  
Jennifer La ◽  
Chunlei Zheng ◽  
Shira Doron ◽  
Nhan Do ◽  
...  
Keyword(s):  
Disease Severity ◽  
Severe Disease ◽  
Supplemental Oxygen ◽  
Case Definition ◽  
Vaccination Status ◽  
P Value ◽  
Case Definitions ◽  
Pandemic Severity ◽  
Vaccine Availability ◽  
The Impact

Abstract Importance: Since the early days of the pandemic, COVID-19 hospitalizations have been used as a measure of pandemic severity. However, case definitions do not include assessments of disease severity, which may be impacted by prior vaccination.Objective: To measure how the severity of respiratory disease changed among inpatients with documented SARS-CoV-2 infection and to measure the impact of vaccination status on these trends, in order to evaluate the accuracy of the metric of “hospitalization plus a positive SARS-CoV-2 test” for tracking pandemic severity.Design: Retrospective cohort of inpatients with laboratory-confirmed SARS-CoV-2. All data were obtained from electronic health records.Setting: Multi-center, nationwide study conducted in the healthcare system of the US Department of Veterans Affairs (VA) from March 1, 2020, through June 30, 2021.Participants: All VA patients admitted to a VA hospital with a laboratory-confirmed SARS-CoV-2 infection within the 14-days prior to admission or during the hospital admission.Main Outcome: Moderate-to-severe COVID-19 disease, defined by use of any supplemental oxygen or documented SpO2 <94%, during an inpatient hospitalization between one day before and two weeks after a positive SARS-CoV-2 test.Exposure: SARS-CoV-2 vaccination status at the time of hospitalization. Patients were regarded as fully vaccinated starting 14 days after receiving the second of a 2-dose regimen or 14 days after receipt of a single-dose vaccine.Results: Among 47,742 admissions in 38,508 unique patients with laboratory-confirmed SARS-CoV-2, N=28,731 met the criteria for moderate-to-severe COVID-19. The proportion with moderate-to-severe disease prior to widespread vaccine availability was 64.0% (95% CI, 63.1-64.9%) versus 52.0% in the later period (95% CI, 50.9-53.2%), p-value for non-constant effect, <0.001. Disease severity in the vaccine era among hospitalized patients was lower among both unvaccinated (55.0%, 95% CI, 53.7-56.4%) and vaccinated patients (42.6%, 95% CI, 40.6-44.8%).Conclusions and Relevance: The proportion of hospitalizations that are due to severe COVID-19 has changed with vaccine availability, thus, increasing proportions of mild and asymptomatic cases are included in hospitalization reporting metrics. The addition of simple measures of disease severity to the case definition of a SARS-CoV-2 hospitalization is a straightforward and objective change that should improve the value of the metric for tracking SARS-CoV-2 disease burden.

scholarly journals Impact of SARS-CoV-2 Infection Among Non-Invasive Ventilated ALS Patients

2021 ◽  
pp. 1-3
Author(s):  
Miguel Oliveira Santos ◽  
Sara Domingues ◽  
Marta Gromicho ◽  
Susana Pinto ◽  
Mamede de Carvalho
Keyword(s):  
Age Of Onset ◽  
Severe Disease ◽  
Neuromuscular Diseases ◽  
Supplemental Oxygen ◽  
Total Recovery ◽  
Non Invasive ◽  
Respiratory Involvement ◽  
Als Patients ◽  
The Impact ◽  
Lateral Sclerosis

Background: The impact of SARS-CoV-2 infection among neuromuscular diseases with respiratory involvement, including amyotrophic lateral sclerosis (ALS), is still to be elucidated. Objectives: We aim to characterize the clinical outcome of ALS patients non-invasive ventilated (NIV), following SARS-CoV-2 infection. Methods: We analyzed retrospectively our patients followed regularly at our ALS clinic, from the beginning of the COVID-19 pandemic (middle March 2020) to March 2021. We included patients on NIV with a documented SARS-CoV-2 infection. We recorded demographic and clinical data, including from the acute infectious illness. Results: Three men with spinal-onset ALS are described, mean age of onset was 55±9.1 years (45–61), and mean disease duration was 17.5±15.9 months (6.1–41). All of them were wheelchair-bounded, with a mean ALSFRS-R of 15.3±0.6 (15–16). One patient used NIV 15 hours/day, 2 between 4 to 7 hours/day, and all used assisted coughing twice daily. None had coexistent comorbidities. They were managed for SARS-CoV-2 infection as outpatients with fluticasone, bronchodilators, azithromycin and increasing frequency of assisted coughing. Supplemental oxygen (mean of 2 liters per minute) was needed in two patients, and one required NIV also during the daytime. Total recovery from SARS-CoV-2 infection was observed in all, despite being in an advanced stage of their disease, with severe respiratory involvement. Conclusions: Prompt medical treatment is recommended for ALS patients with severe disease infected by SARS-CoV-2.

scholarly journals Age and chest radiography as possible parameters for rapid triage in COVID-19 outbreak surge

2020 ◽  
Author(s):  
Wei Enli Wycliffe ◽  
Tan Cher Heng ◽  
Monica Chan ◽  
Tan Thuan TOng ◽  
Surinder Kaur Pada ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Chest Radiography ◽  
Disease Surveillance ◽  
Characteristic Curve ◽  
Severe Disease ◽  
Clinical Status ◽  
Supplemental Oxygen ◽  
Receiver Operator Characteristic Curve ◽  
Receiver Operator Characteristic ◽  
Oxygen Supplementation

Abstract BackgroundTo evaluate the utility of age and chest radiography(CXR) in triaging COVID-19 patients for hospitalization versus isolation in non-hospital facilities, we examined how age and CXR at diagnosis were associated with clinical needs from late-January to early-April. MethodsClinical status of all COVID-19 cases was monitored for national disease surveillance. Cases were isolated in hospitals until SARS-CoV-2 RNA was undetectable on PCR. Age and CXR results on admission were analysed for association with oxygen supplementation and mechanical ventilation, the outcomes of interest.ResultsTill 4 April 2020, there were 1,481 COVID-19 cases in Singapore. Overall, 11.4% required supplemental oxygen while 4.8% required mechanical ventilation and intensive care. The respective proportions increased to 40.9% and 16.5% for cases aged ≥70 years. As a predictor of subsequent mechanical ventilation, age had an area under the receiver operator characteristic curve(AUROC) of 0.772 (95%CI:0.699-0.845). A combined criterion of either an abnormal CXR or age≥55 years had a sensitivity of 86.7% and specificity of 58.0% for the same outcome. A similar performance was observed for predicting oxygen supplementation needs.ConclusionsAge and CXR at diagnosis may be valuable in excluding severe disease, allowing safe triage for isolation in non-hospital facilities.

scholarly journals #37: Description of Moderate-Severe Cases of COVID-19 in Pediatric Cancer at the Unidad Nacional de Oncologia Pediatrica, Guatemala

2021 ◽  
Vol 10 (Supplement_2) ◽  
pp. S19-S19
Author(s):  
Susana María Godoy Escobar ◽  
Thelma Beatriz Velásquez Herrera ◽  
Roy Enrique Rosado ◽  
Alicia Chang Cojulun ◽  
Mario Augusto Melgar Toledo ◽  
...  
Keyword(s):  
Induction Therapy ◽  
Pediatric Cancer ◽  
Severe Disease ◽  
Supplemental Oxygen ◽  
Severe Illness ◽  
Nasopharyngeal Swab ◽  
Initial Symptom ◽  
Risk Of Death ◽  
Pediatric Cancer Patients ◽  
The Impact

Abstract Introduction Guatemala reported the first confirmed SARS-CoV-2 case on March 13th 2020. Up to now, more than 140,000 confirmed cases have been documented, with 8% of them being &lt;20 years-old. The impact of COVID-19 in pediatric cancer in not well known, even though pediatric oncological institutions did some initial recommendations, this new disease still represents a challenge in this population. The objective of the report is to describe the moderate-severe cases of COVID-19 in pediatric cancer during the first 8 months of the pandemic in the Unidad Nacional de Oncologia Pediatrica (UNOP). Methods This is a descriptive, prospective report of pediatric cancer patients &lt;20 years-old and SARS-CoV-2 infection confirmed by nasopharyngeal swab with PCR technique at UNOP from May to December 2020. The SARS-CoV-2 test was performed to all patients who developed symptoms of infection or as screening in patients who were admitted to UNOP regardless of symptoms. Information about sex, age, primary oncological diagnosis, confirmed coinfections and treatment received at time of COVID-19 was collected. Moderate illness was considered if the patient required supplemental oxygen and severe illness if admitted to Intensive Care Unit -ICU- secondary to COVID-19. Results Two hundred one patients with pediatric cancer with the SARS-CoV-2 infection were confirmed. Sixty four percent were male (n=128), median of age was 9.5 years (5-m to 18-y). The primary oncologic diagnosis was leukemia 65% (n=129), and other solid tumors 35% (n=72), 5% (n=10) of patients were in palliative care. In leukemia patients, 40% were receiving induction therapy (n=51), 25% consolidation (n=32), and 19% maintenance (n=25). The most common initial symptom was fever in 32% (n=64) and 33% were asymptomatic (n=67). Twenty two percent developed moderate disease (n=44) and 13% severe disease (n=26). A total of 13 patients died during COVID-19 period (6%) and 7 of them died receiving active treatment (3%). The risk of developing moderate-severe disease was not higher in leukemia patients compared to patients with other tumors who were receiving intense chemotherapy (OR=0.7), but there might be a higher risk of death (OR=1.41). In patients with leukemia, the risk of developing moderate-severe disease was higher for patients receiving induction therapy compared with those in consolidation (OR=6.7) or maintenance (OR=3.04). Mortality risk seems to be higher in patients with leukemia during induction therapy (OR=1.94). Confirmed coinfections correlated with higher risk of severe illness (OR=1.95) and death during the COVID-19 period (OR=5.2). Conclusions The mortality due to COVID-19 in pediatric cancer is low and could be related to coinfections or intensive chemotherapy. Important limitation of our report is the lack of analysis of underlying clinical conditions in moderate-severe disease (neutropenia or other comorbidities), factors that could have an impact on our data analysis.

9 CAN ONE PREDICT THE RESISTANCE OF BULL SPERM TO CRYOPRESERVATION BY ANALYZING MOTILITY PARAMETERS BEFORE FREEZING?

2007 ◽  
Vol 19 (1) ◽  
pp. 123
Author(s):  
L. Defoin ◽  
A. Granados ◽  
I. Donnay
Keyword(s):  
Poor Quality ◽  
Computer Assisted ◽  
Sperm Analysis ◽  
Straight Line ◽  
Pearson Coefficient ◽  
Before And After ◽  
Highly Correlated ◽  
Definition Of ◽  
The Impact

Batches of straws often need to be thrown away after freezing due to a too-few-number of motile or progressive sperm cells (spz), whereas the quality of the fresh sperm was considered as acceptable. Our objective was to evaluate whether variables related to velocity or linearity for fresh spz could help to predict the resistance to freezing and allow the discard of poor-quality batches before freezing. Motility traits of 20 ejaculates from 20 Belgian Blue bulls collected at an AI center were evaluated for motile spz both before and after freezing using Computer-Assisted Sperm Analysis (CASA, Spermvision; Minit�b, Tiefenbach, Germany). Only six traits of motility showed a normal distribution in the population of motile spz and were kept for further analysis together with the proportion of motile (%mot) and progressive (%prog) spz: velocity on the curved line (VCL), velocity on the straight line (VSL), velocity on the average path (VAP), linearity (LIN = VSL/VCL), beat cross frequency (BCF), and average orientation change of the head (AOC). Significant variation between bulls was observed both before and after freezing for all of the analyzed traits (ANOVA2; P &lt; 0.001). Moreover, freezing significantly altered the motility measures (ANOVA2; P &lt; 0.001). For each variable, a significant correlation was observed between the values (mean or percentage) obtained for each bull before and after freezing (Pearson coefficient: R = 0.43 to 0.72; P &lt; 0.05). However, the impact of freezing on the quality of motility differed between bulls, with low impact for some bulls and major impact for others. Three motility traits measured before freezing were highly correlated with %mot or %prog after freezing: VAP, VSL, and %prog (R = 0.75 to 0.82; P &lt; 0.001). When we evaluated the prediction of rejection or acceptance of a batch of straws after freezing (based on a threshold of 15% progressive spz) by using motility measures recorded before freezing, five traits allowed us to discriminate low-quality batches: %mot, %prog, VAP, VSL, and LIN. Applying to fresh sperm a threshold of 92 �m s-1 for VAP or 84 �m s-1 for VSL allowed us to predict, respectively, 6 and 7 out of the 9 batches that would be rejected after freezing, without discarding batches of acceptable quality. Moreover, using the %mot or %prog before freezing caused us to discard only 3 and 4 batches, respectively. Combining different traits did not add to the precision. In conclusion, analysis of velocity traits for fresh sperm seems more efficient than analysis of %mot or %prog to discard batches that will be of poor quality after freezing. Such analysis could prevent useless work and expense related to straw filling and freezing. However, the definition of thresholds needs further analysis with a larger number of batches of semen and will vary from one AI center to another, depending, for example, on the breed characteristics, the number of spz per straw, the CASA system, or the freezing procedure. This work was supported by the programme FIRST Objective 3 of the European Commission and the Ministery of the R�gion wallonne de Belgique.

scholarly journals Stewardship of Remdesivir Use in a Rural Community Hospital During the COVID-19 Pandemic

2021 ◽  
Vol 1 (S1) ◽  
pp. s45-s45
Author(s):  
Raghavendra Tirupathi ◽  
Melissa Gross
Keyword(s):  
Mechanical Ventilation ◽  
Severe Disease ◽  
Antibiotic Use ◽  
Supplemental Oxygen ◽  
Second Phase ◽  
Prior Authorization ◽  
Maximum Benefit ◽  
Days Of Therapy ◽  
Unrestricted Access ◽  
The Impact

Background: Remdesivir was granted EUA followed by full FDA approval for treatment of hospitalized COVID-19 patients on October 22, 2020, based on the results from the ACTT1 trial. Remdesivir use was initially restricted to infectious disease (ID) physicians in our hospital with prescription needing formal ID consultation until complete approval. Due to increasing case counts in our hospital, a decision was made to allow intensivists and hospitalists the authorization to prescribe remdesivir in a phased manner. In this retrospective study, we assessed the impact of phased-in prescribing on remdesivir utilization and days of therapy of antimicrobials. Methods: Remdesivir prescribing was streamlined by real-time institutional guidelines developed by a COVID-19 treatment committee constituting ID and other clinicians. Eligibility for remdesivir included positive SARS-CoV-2 PCR test, severe disease defined as persistent hypoxia (<94% oxygen saturation on room air), requiring supplemental oxygen and/or on mechanical ventilation (MV) for <72 hours, and symptom onset of <10 days. We retrospectively reviewed cohorts of 3 periods during which remdesivir was prescribed. In the first cohort A, between October 23, 2020, and November 12, 2020, remdesivir was restricted to ID physicians with formal ID consultation. Cohort B comprised inpatients between November 13, 2020, and December 6, 2020, when hospitalists and intensivists were allowed to prescribe remdesivir through an EMR order set after prior authorization by an ID physician via curbside or telephonic consultation. Cohort C, from December 7, 2020, to December 26, 2020, comprised inpatients with unrestricted prescribing of remdesivir by hospitalists and intensivists. We also evaluated antibiotic use. Results: In cohort A, SARS CoV-2 positivity was 20.3%; 64 inpatients tested positive and 35 patients (54.7%) who met the criteria were prescribed remdesivir after a formal consultation with an ID physician. In cohort B, requiring prior authorization by an ID physician, SARS-CoV-2 positivity rapidly increased to 34%; 193 patients tested positive and 97 patients (50.3%) received remdesivir. In cohort C, during unrestricted access, positivity further increased to 38%; 235 inpatients tested positive and 123 (52.5%) received remdesivir. Remdesivir use remained steady during the 3 phases of gradual de-escalation of restricted prescribing and safe handoff in the context of clear guidelines, as well as ongoing curbside education provided by ID physicians during the second phase. Cohort B demonstrated the best prescribing rates. Antimicrobial prescribing data were also collected during the 3 cohort phases (Figures 1–3). Conclusions: Remdesivir is an expensive antiviral with limited utility and maximum benefit in COVID-19 inpatients who are hypoxic but do not require mechanical ventilation. Stewardship of remdesivir with safe, gradual handoff to inpatient can be achieved without overuse.Funding: NoDisclosures: None

PERTANGGUNGJAWABAN KERUGIAN NEGARA DALAM PENGELOLAAN KEUANGAN DAERAH

EDUKASI ◽  
2018 ◽  
Vol 16 (1) ◽  
Author(s):  
Hendra Karianga
Keyword(s):  
Financial Management ◽  
Criminal Liability ◽  
The State ◽  
Legal Proceedings ◽  
Regional Finance ◽  
Regional Budget ◽  
State Finance ◽  
Budget Policy ◽  
Definition Of ◽  
The Impact

Sources of revenue and expenditure of APBD (regional budget) can be allocated to finance the compulsory affairs and optional affairs in the form of programs and activities related to the improvement of public services, job creation, poverty alleviation, improvement of environmental quality, and regional economic growth. The implications of these policies is the need for funds to finance the implementation of the functions, that have become regional authority, is also increasing. In practice, regional financial management still poses a complicated issue because the regional head are reluctant to release pro-people regional budget policy, even implication of regional autonomy is likely to give birth to little kings in region causing losses to state finance and most end up in legal proceedings. This paper discusses the loss of state finance and forms of liability for losses to the state finance. The result of the study can be concluded firstly,  there are still many differences in giving meaning and definition of the loss of state finace and no standard definition of state losses, can cause difficulties. The difficulty there is in an effort to determine the amount of the state finance losses. The calculation of state/regions losses that occur today is simply assessing the suitability of the size of the budget and expenditure without considering profits earned by the community and the impact of the use of budget to the community. Secondly, the liability for losses to the state finance is the fulfillment of the consequences for a person to give or to do something in the regional financial management by giving birth to three forms of liability, namely the Criminal liability, Civil liability, and Administrative liability.Keywords: state finance losses, liability, regional finance.

Empowering Women Entrepreneurs Through Microfinance - A Case of Rural Bangladesh

2017 ◽  
Vol 3 (2) ◽  
pp. 7
Author(s):  
Saida Parvin
Keyword(s):  
Women's Empowerment ◽  
Assessment Tools ◽  
Women’S Empowerment ◽  
Case Study Method ◽  
Policy Makers ◽  
Theoretical Contribution ◽  
Donor Agencies ◽  
Definition Of ◽  
The Impact

Women’s empowerment has been at the centre of research focus for many decades. Extant literature examined the process, outcome and various challenges. Some claimed substantial success, while others contradicted with evidence of failure. But the success remains a matter of debate due to lack of empirical evidence of actual empowerment of women around the world. The current study aimed to address this gap by taking a case study method. The study critically evaluates 20 cases carefully sampled to include representatives from the entire country of Bangladesh. The study demonstrates popular beliefs about microfinance often misguide even the borrowers and they start living in a fabricated feeling of empowerment, facing real challenges to achieve true empowerment in their lives. The impact of this finding is twofold; firstly there is a theoretical contribution, where the definition of women’s empowerment is proposed to be revisited considering findings from these cases. And lastly, the policy makers at governmental and non-governmental organisations, and multinational donor agencies need to revise their assessment tools for funding.

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