scholarly journals Impact of Residential Neighborhood and Race/Ethnicity on Outcomes of Hospitalized Patients with COVID-19 in the Bronx

2021 ◽  
Author(s):  
Dwayvania Miller ◽  
Amara Sarwal ◽  
Bo Yu ◽  
Edgar Gomez ◽  
Victor Perez-Gutierrez ◽  
...  
Keyword(s):  
Severity Of Illness ◽  
Hospitalized Patients ◽  
The South ◽  
South Bronx ◽  
Disadvantaged Area ◽  
Residential Neighborhood ◽  
Major Disaster ◽  
Comorbidity Burden ◽  
Race Ethnicity ◽  
The Impact

AbstractThe socially vulnerable have been most affected due to the COVID-19 pandemic, similar to the aftermath of any major disaster. Racial and social minorities are experiencing a disproportionate burden of morbidity and mortality.The aim of this study was to evaluate the impact of residential location/community and race/ethnicity on outcomes of COVID-19 infection among hospitalized patients within the Bronx. This was a single center retrospective observational cohort study that included SARS-CoV2 positive adult residents of the Bronx (stratified as residents of South Bronx vs Rest of Bronx) hospitalized between March-May 2020. Data extracted from hospital electronic medical records included residential addresses, race, comorbidities, and insurance details. Comorbidity burden other clinical and laboratory details were also assessed to determine their correlation to COVID-19 severity of illness and outcomes of mortality and length of stay.As expected, the COVID-19 pandemic differentially affected outcomes in those in the more socially disadvantaged area of the South Bronx versus the rest of the Bronx borough. Residents of the South Bronx had a significantly higher comorbidity burden and had public insurance to access medical care in comparison to the remainder of the Bronx. Interestingly, for the patient population studied there was no observed difference in 30-day mortality by race/ethnicity among those infected with COVID- 19 in spite of the increased disease burden observed.This adds an interesting perspective to the current literature, and highlights the need to address the social/economic factors contributing to health access disparity to reduce the adverse impact of COVID-19 in these communities.

scholarly journals Impact of remdesivir on 28 day mortality in hospitalized patients with COVID-19: February 2021 Meta-analysis

2021 ◽  
Author(s):  
Robert Robinson ◽  
Vidhya Prakash ◽  
Raad Al Tamimi ◽  
Nour Albast ◽  
Basma Al-Bast ◽  
...  
Keyword(s):  
Usual Care ◽  
English Language ◽  
Meta Analysis ◽  
Severity Of Illness ◽  
Hospitalized Patients ◽  
Randomized Controlled ◽  
Analysis Process ◽  
All Cause Mortality ◽  
The Impact

AbstractBackgroundThe COVID-19 pandemic has stimulated worldwide investigation into a myriad of potential therapeutic agents, including antivirals such as remdesivir. The first RCT reporting results on the impact of remdesivir on COVID-19 in a peer reviewed journal was the ACTT-1 trial published in November, 2020. The ACTT-1 trial showed more rapid clinical improvement and a reduced risk of 28-day mortality in patients who received remdesivir.This study is a meta-analysis of peer reviewed RCTs aims to estimate the association of remdesivir therapy compared to the usual care or placebo on all-cause mortality in hospitalized patients with COVID-19. Software based tools to accelerate the analysis process.MethodsMeta-analysis of peer reviewed RCTs comparing remdesivir to usual care or placebo. The protocol for this meta-analysis was registered and published in the PROSPERO database (CRD42021229985) on February 5, 2021.ResultsFour English language RCTs were identified, including data from 7,333 hospitalized patients worldwide using remdesivir in COVID-19 positive patients.Meta-analysis of all identified RCTs showed no difference in survival in patients who received remdesivir therapy compared to usual care or placebo. The random effects meta-analysis has a summary odd ratio is 0.89 (95% CI 0.65-1.21, p = 0.30). Considerable variability in the severity of illness is noted with the rates of IMV at the time of randomization ranging from 0% to 27%.ConclusionsThis meta-analysis of randomized controlled trials published in peer-reviewed literature by February 1, 2021 did not show reduced mortality in hospitalized patients with COVID-19 who received remdesivir. Further research is needed to clarify the role of remdesivir therapy in the management of COVID-19.

scholarly journals Bloodstream infections in hospitalized patients before and during the COVID-19 surge in a community hospital in the South Bronx

2021 ◽  
Author(s):  
Afsheen Afzal ◽  
Victor Perez Gutierrez ◽  
Edgar Gomez ◽  
Aye Myat Mon ◽  
Carolina Moreira Sarmiento ◽  
...  
Keyword(s):  
Community Hospital ◽  
Bloodstream Infections ◽  
Hospitalized Patients ◽  
The South ◽  
South Bronx

scholarly journals 208. Comparison of Bloodstream Infections in Hospitalized Patients Before and During the COVID-19 Surge in a Community Hospital in the South Bronx: An Observational Study

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S212-S213
Author(s):  
Afsheen Afzal ◽  
Edgar Gomez ◽  
Victor Perez Guttierrez ◽  
Aye Myat Mon ◽  
Carolina Moreira Sarmiento ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Community Hospital ◽  
Positive Culture ◽  
Bloodstream Infections ◽  
Blood Stream ◽  
Hospitalized Patients ◽  
Control Measures ◽  
Rectal Tube ◽  
The South ◽  
South Bronx

Abstract Background There is a paucity of data of bloodstream infections (BSI) before and during the COVID-19 pandemic. The aim of our study was to compare the incidence and characteristics of blood stream infections (BSI) in hospitalized patients before and during the surge of COVID-19 pandemic in a community hospital in South Bronx. Methods This is a retrospective observational comparative study of adult hospitalized patients with BSI admitted before (Jan 1-Feb 28, 2020) and during COVID-19 surge (Mar 1- May 1,2020). The incidence of BSI, patient demographics, clinical and microbiological characteristics of infections including treatment and outcomes were compared. Results Of the 155 patients with BSI, 64 were before COVID and 91 were during the COVID surge (Table 1). Incidence of BSI was 5.84 before COVID and 6.57 during surge (p = 0.004). Majority of patients during COVID period had ARDS (39.6%), required mechanical ventilation (57%), inotropic support (46.2%), therapeutic anticoagulation (24.2%), proning (22%), rectal tube (28.6%), Tocilizumab (9.9%), and steroids (30.8%) in comparison to pre-COVID (Table 2). Days of antibiotic therapy prior to BSI was 5 days before COVID and 7 during COVID. Mortality was higher among patients with BSI admitted during COVID surge (41.8% vs. 14.1% p < 0.0001). Of 185 BSI events, 71 were Pre-COVID and 114 during surge. Primary BSI were predominant (72%) before COVID contrary to secondary BSI (46%) (CLABSI) during COVID. Time from admission to positive culture was 2.5 days during COVID compared to 0.9 pre-COVID. Majority of BSI during COVID period were monomicrobial (93%) and hospital acquired (50%) (p=0.001). Enterococcus (20.2%), E.coli (13.2%), and MSSA (12.3%) were predominant microbes causing BSI during COVID vs. MRSA (15.5%), Streptococci (15.5%), and S. pneumoniae (14.1%) before COVID (Figure 1). In multivariate logistic regression, Enterococcal coinfection was associated with COVID positivity (OR 2.685, p = 0.038), mechanical ventilation (OR 8.739, p = 0.002), and presence of COPD/Asthma (OR 2.823, p = 0.035). Comparison of Microorganisms Isolated in the BSI X-axis represents the total number of BSI events whereas the number at the end of each bar represents the percentage Conclusion Higher incidence of secondary BSI (CLABSI) due to Enterococcus spp. was observed during the surge of COVID-19 infection in the South Bronx. Breakdown of infection control measures during the COVID-19 pandemic could have been contributory. Disclosures All Authors: No reported disclosures

scholarly journals Battling in the Bronx: Social Choreography and Outlaw Culture Among Early Hip-Hop Streetdancers in New York City

2018 ◽  
Vol 50 (2) ◽  
pp. 62-75 ◽  
Author(s):  
Imani Kai Johnson
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Hip Hop ◽  
Growing Up ◽  
The South ◽  
South Bronx ◽  
Life Lessons ◽  
Social Choreography ◽  
The Impact

This article closely examines oral histories of b-boys Aby and Kwikstep, b-girl Baby Love, and poppers Cartoon and Wiggles, and the social choreography necessary to navigate the streets of the South Bronx in the 1970s and 1980s that has an indelible link to four core battling principles as articulated by 1970s b-boy Trac2: survivalism, strategizing, nomadism, and illusionism. By comparing and contrasting foundational elements of battling techniques with life lessons about growing up in the Bronx, the comparison signals the impact of “outlaw culture” within hip-hop, and the counterdominant sensibilities taught in battle cyphers.

scholarly journals DELIRIUM SEVERITY AND COGNITIVE OUTCOMES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S921-S921
Author(s):  
Sarah A Welch ◽  
E Wesley Ely ◽  
Jin H Han
Keyword(s):  
Severity Of Illness ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Cognitive Outcomes ◽  
Illness Cognition ◽  
Point Increase ◽  
Comorbidity Burden ◽  
Factor Interactions ◽  
The Impact

Abstract Delirium is heterogeneous and can vary by severity. The impact of its severity is unclear. This prospective cohort study enrolled emergency department (ED) patients who were > 65 years old and admitted to the hospital. Delirium severity was determined by the Confusion Assessment Method for the Intensive Care Unit Severity (CAM-ICU-S) Scale measured at enrollment. This scale ranges from 0 (no symptoms) to 7 (most severe). Premorbid and 6-month cognition were determined using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) which ranges from 1 to 5 (severe cognitive impairment). Multiple linear regression was performed to determine if delirium severity was associated with 6-month function and cognition adjusted for pre-illness IQCODE, baseline functional status, comorbidity burden, severity of illness, and central nervous system diagnosis. Two-factor interactions were incorporated to determine if pre-illness cognition modified the relationship between delirium severity as measured by the CAM-ICU-S and 6-month cognition. A total of 228 older patients were enrolled in the ED and of these, 105 were delirious. Median (interquartile range) CAM-ICU-S scores was 2 (0, 5). In patients with intact pre-illness cognition, a point increase in the CAM-ICU-S significantly increased the 6-month IQCODE by 0.06 (95%CI: 0.01 to 0.12) points. In patients with impaired pre-illness cognition, there was no significant association between the CAM-ICU-S and 6-month IQCODE. Thus delirium severity is associated with poorer 6-month cognition, but this association is more prominent in those with intact pre-illness cognition.

scholarly journals 3258 The Relationship Between the Severity of Influenza-Related Illness and Timing of Seasonal Influenza Vaccination in Hospitalized Patients with Influenza

2019 ◽  
Vol 3 (s1) ◽  
pp. 56-57
Author(s):  
Julia Haston ◽  
Shikha Garg ◽  
Angela Campbell ◽  
Jill Ferdinands ◽  
Monica Farley ◽  
...  
Keyword(s):  
Influenza Vaccination ◽  
Seasonal Influenza ◽  
Influenza Season ◽  
Severity Of Illness ◽  
Hospitalized Patients ◽  
Seasonal Influenza Vaccination ◽  
Catchment Population ◽  
Icu Admission ◽  
Duration Of Hospitalization ◽  
The Impact

OBJECTIVES/SPECIFIC AIMS: The overall goal of this project is to determine whether timing of seasonal influenza vaccination affects the severity of illness in vaccinated individuals who are hospitalized with influenza. This will be assessed with the following aims: 1. To determine whether differences in demographic and clinical characteristics exist among patients with short duration between seasonal influenza vaccination and influenza-related hospitalization and those with longer duration. 2. To determine whether time between seasonal influenza vaccination and hospitalization is associated with the duration of influenza-related hospitalization. 3. To determine whether time between seasonal influenza vaccination and hospitalization is associated with the rate of influenza-related ICU admission among patients hospitalized with influenza. 4. To determine whether time between seasonal influenza vaccination and hospitalization is associated with the rate of influenza-related death among adults hospitalized with influenza. METHODS/STUDY POPULATION: The Influenza Hospitalization Surveillance Network (FluSurv-NET) is a surveillance platform of influenza-related hospitalizations through the CDC Emerging Infections Program (EIP). FluSurv-NET conducts active surveillance for influenza-related hospitalizations of both children and adults in selected counties in California, Colorado, Connecticut, Georgia, Maryland, Michigan, Minnesota, Ohio, Oregon, New Mexico, New York, Tennessee, and Utah with a total catchment population of over 27 million people (~9% of the US population). Using this platform, we will retrospectively evaluate four influenza seasons using FluSurv-NET data to look at the timing of influenza vaccination and severity of illness among patients with influenza-related hospitalization. We will conduct a multivariate analysis to assess for differences in severe outcomes including duration of hospitalization, ICU admission, and death among patients with varying lengths of time between influenza vaccination and influenza-related hospitalization. Separate analyses will be performed among different age groups and influenza type/subtypes, as well as specific seasons as a surrogate for most common circulating strain. RESULTS/ANTICIPATED RESULTS: We hypothesize that patients with chronic medical conditions and those at the extremes of age will have a longer duration between vaccination and hospitalization as they are more likely to get vaccinated earlier. We also hypothesize that patients with longer duration between seasonal influenza vaccination and hospitalization will have a longer duration of hospitalization and a higher rate of other severe outcomes (e.g., ICU admission, death). Such data would suggest that immune protection wanes during the influenza season. DISCUSSION/SIGNIFICANCE OF IMPACT: Limited data suggest that vaccine-induced influenza immunity may wane during the influenza season. It is not known whether the impact of influenza vaccination upon severity of disease might wane with increasing time between vaccination and influenza infection. In contrast to many previous studies evaluating vaccine effectiveness which have assessed medically-attended influenza illness as a primary outcome, our dataset is a large cohort of hospitalized patients which allows us to assess rare yet critical outcomes such as ICU admission and death. This study will also have a substantially larger amount of pediatric data than previous studies, which will provide the opportunity to determine whether timing of vaccination affects children and adults differently. Improving our understanding of whether influenza vaccine-induced protection might wane over time could ultimately impact U.S. influenza vaccination policy resulting in decreased morbidity and mortality attributed to influenza each season.

Tourism Development in the South Pacific: The Cases of Nauru and Tuvalu

2019 ◽  
Vol 39 (1) ◽  
Author(s):  
Nick Towner ◽  
Semisi Taumoepeau
Keyword(s):  
Swot Analysis ◽  
Tourism Development ◽  
Geographic Location ◽  
South Pacific ◽  
The South ◽  
South Pacific Ocean ◽  
Economic Survival ◽  
Processing Centre ◽  
Remote Island ◽  
The Impact

Abstract Tuvalu and Nauru are isolated developing island nations located in the South Pacific Ocean. In contrast to the established larger Pacific destinations such as Fiji and Tahiti, the tourism industries on both Tuvalu and Nauru are in their infancy. Tourism development in these remote island nations faces a myriad of challenges which include a lack of infrastructure, environmental susceptibility, economic vulnerability, difficulties with access and considerable distances from major tourist markets. This paper reviews tourism on Tuvalu and Nauru and evaluates their current situation regarding potential tourism development through workshops with relevant stakeholders, surveys and subsequent SWOT analysis. The results of the paper outlined a large number of challenges faced by Tuvalu and Nauru due to their geographic location but also highlighted that both Islands possess fascinating and unique features that have the potential to attract niche tourism markets. A key finding of this paper is that the tourism stimulus or potential attraction can also be the chief threat to the islands’ economic survival hence the two edges of the sword. Further research is required to assess the effect of the withdrawal of the Refugee Processing Centre on Nauru’s economy and to evaluate the impact of climate change on Tuvalu’s society and potential adaption strategies.

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