A holistic approach for suppression of COVID-19 spread in workplaces and universities

As society has moved past the initial phase of the COVID-19 crisis that relied on broad-spectrum shutdowns as a stopgap method, industries and institutions have faced the daunting question of how to return to a stabilized state of activities and more fully reopen the economy. A core problem is how to return people to their workplaces and educational institutions in a manner that is safe, ethical, grounded in science, and takes into account the unique factors and needs of each organization and community. In this paper, we introduce an epidemiological model (the “Community-Workplace” model) that accounts for SARS-CoV-2 transmission within the workplace, within the surrounding community, and between them. We use this multi-group deterministic compartmental model to consider various testing strategies that, together with symptom screening, exposure tracking, and nonpharmaceutical interventions (NPI) such as mask wearing and physical distancing, aim to reduce disease spread in the workplace. Our framework is designed to be adaptable to a variety of specific workplace environments to support planning efforts as reopenings continue. Using this model, we consider a number of case studies, including an office workplace, a factory floor, and a university campus. Analysis of these cases illustrates that continuous testing can help a workplace avoid an outbreak by reducing undetected infectiousness even in high-contact environments. We find that a university setting, where individuals spend more time on campus and have a higher contact load, requires more testing to remain safe, compared to a factory or office setting. Under the modeling assumptions, we find that maintaining a prevalence below 3% can be achieved in an office setting by testing its workforce every two weeks, whereas achieving this same goal for a university could require as much as fourfold more testing (i.e., testing the entire campus population twice a week). Our model also simulates the dynamics of reduced spread that result from the introduction of mitigation measures when test results reveal the early stages of a workplace outbreak. We use this to show that a vigilant university that has the ability to quickly react to outbreaks can be justified in implementing testing at the same rate as a lower-risk office workplace. Finally, we quantify the devastating impact that an outbreak in a small-town college could have on the surrounding community, which supports the notion that communities can be better protected by supporting their local places of business in preventing onsite spread of disease.

Criterion validity of the ActiGraph and activPAL in classifying posture and motion in office-based workers: A cross-sectional laboratory study

Background The ActiGraph and activPAL monitors are the most frequently used thigh-worn devices to measure motion and posture, but the criterion validity to measure sitting, standing and postural transfer in the office setting is not known. Research question: To examine the criterion validity of the ActiGraph and activPAL activity monitors in repeatedly measuring a variety of different postures and motion in the office setting. Methods Twenty office workers from the University of Zurich wore an ActiGraph and activPAL during two identical laboratory experiments lasting approximately 60 minutes each, within a maximum of 7 days. The experimental setting consisted of a standard computer office workstation with an electrically powered height-adjustable desk, a swivel chair without arm rests, a standard chair, a footrest, and a bookcase. The protocol consisted of 24 pre-defined tasks mimicking sitting, standing, stepping, and postural transitions around the workplace. All tasks were supervised and observed by the same experimenter. Results In repeated measurements (40 individual experiments), the percentages of correctly classified tasks for the ActiGraph and activPAL were, respectively, 100% vs. 85% for sitting, 87% vs. 100% for standing, and 100% vs. 73% for postural transitions. Both monitors correctly identified all stepping tasks. The activPAL misclassified sitting with legs outstretched, and sitting with both feet placed beneath the chair, as standing ~25–70% and 45% of the time, respectively. The ActiGraph misclassified standing with the right foot on a footrest as sitting in 65% of events. Conclusions The ActiGraph appears to be slightly more sensitive than the activPAL with respect to the measurement of sitting and postural transitions of short duration, whereas the activPAL seems to be slightly more accurate in capturing standing postures. This knowledge will help guide researchers to choose the best suitable monitor for their research setting.

Site of service trend and chemotherapy costs of commercial insured patients in 2020 compared to 2014.

e18858 Background: Over the past decade, chemotherapy site of service has shifted from the physician’s office setting to the hospital outpatient setting. This trend has led to a concern that cancer care costs increase when patients are administered chemotherapy in the hospital outpatient setting (H) compared to a physician’s outpatient office setting (O). In 2014, we published data on the impact of site of service and chemotherapy costs. The purpose of this study is to evaluate the site of service trend and cost differential in a Commercial Insured (CI) population over time. Methods: We examined (CI) claims paid for chemotherapy by a large national payor from February 2019 through January 2020 for breast, colon, and lung cancer (BCL) patients. We then compared these changes to our July 2013 through June 2014 chemotherapy paid claims for BCL patients. Results: From February 2019 through January 2020, paid chemotherapy claims for approximately 23,000 unique patients with BCL had an increase of 23% from 2014. For all patients receiving chemotherapy with BCL, 56% received chemotherapy in the H setting and 44% received chemotherapy in the O setting. This was a significant shift from 2014 where 24% received chemotherapy in H and 76% in O settings. In 2020, the chemotherapy allowable reimbursement share was 67% for H and 33% in the O, a change from 2014 where the chemotherapy allowable reimbursement share was 34% in H and 66% in O. The overall cost per patient increased 57% from 2014 to 2020. When examining costs per patient by site of service, there was a statistically significant increase in H costs from $35,460 to $45,273 (p < 0.0001) per patient and a statistically significant increase in O costs from $21,577 to $28,270 (p < 0.0001) per patient treated in 2014 compared to 2020. Conclusions: In this study, the majority of BCL patients received chemotherapy in the H; this trend has led to substantially higher costs of care for patients treated with chemotherapy in the H compared to the O. Future studies are needed to determine the impact of clinical characteristics, genetic factors and treatment choice on these differences.

Subfascial‐located contraceptive devices requiring surgical removal

Background Subdermal etonogestrel implants are highly effective contraceptive methods. Despite standardization of insertion technique by the manufacturer, some implants are inadvertently placed too deeply within or below the plane of the biceps brachii fascia. Placement of these implants in a deep tissue plane results in more difficult removal, which is not always possible in the office setting. In rare cases, surgical removal by an upper extremity surgeon is warranted. Case presentation Here we present 6 cases of etonogestrel implants located in a subfascial plane requiring removal by an upper extremity surgeon. Implants were all localized with plain radiography and ultrasound prior to surgical removal. All cases had implants located in the subfascial plane and one was identified intramuscularly. The average age was 28 years (19–33) and BMI was 24.0 kg/m^2 (19.1–36.5), with the most common reason for removal being irregular bleeding. The majority of cases (5/6) were performed under monitored anesthesia care with local anesthetic and one case utilized regional anesthesia. All implants were surgically removed without complication. Conclusions Insertion of etonogestrel contraceptive implants deep to the biceps brachii fascia is a rare, but dangerous complication. Removal of these implants is not always successful in the office setting and referral to an upper extremity surgeon is necessary to avoid damage to delicate neurovascular structures for safe removal.

Effect of Lighting Illuminance and Color Temperature on Mental Workload in Office Setting

The mental workload of subjects was tested in different lighting conditions, with color temperature ranging from 3000K to 6500K and illuminance 300 lx to 1000 lx. We used both psychological and physiological responses for evaluation. The former was based on the NASA-TLX scores, and the latter was based on EEG P3b analysis of event-related potentials with the “oddball” paradigm experimental task. Results show that the P3b amplitudes are significantly affected by color temperature (P = 0.009) and illuminance (P = 0.038) levels. Office environment with 3000K color temperature and 750 lx illumination, which exerts the lowest mental workload, is the most suitable for working. However, the interaction between color temperature and illuminance in affecting the mental workload of participants is not clear. This work provides more appropriate lighting choices with color temperature and illuminance in order to reduce people’s mental workload in office setting.