Disruption Of Life Research Articles

Impact of COVID-19 pandemic on adherence to noninvasive ventilation in children.

The aim of this study was to measure changes in adherence to noninvasive ventilation (NIV) in children during the first year of the COVID-19 pandemic. Retrospective chart review of children (0-18 years) using home NIV through the Stollery's Pediatric NIV program in Edmonton, Canada during March 2019 to March 2021. Demographics, clinical characteristics, and adherence information from machine downloads were collected prior to and during the first year of the COVID-19 pandemic. Paired t tests and Chi-square compared adherence prepandemic and during pandemic and repeated analysis of variance tests compared adherence pre- and 0-6 and 6-12 months during pandemic. Eighty-two children met inclusion criteria (62% male; age 8.6 ± 4.6 years). Overall, there were no changes in NIV adherence during pandemic (average NIV minutes pre- and during pandemic of 390 ± 219 and 405 ± 300 minutes, respectively). When separated into increased vs decreased adherence groups, adherence differences pre- compared to during pandemic became significant, with no differences across demographic/clinical variables or prepandemic adherence. There were no changes in NIV adherence during the initial 6 months of pandemic compared to prepandemic, but NIV use significantly increased by 9-57 minutes during the following 6-12 months. Bilevel positive airway users had longer NIV use than continuous positive airway pressure users at all time points, with an overall increasing trend over time. Despite the significant life disruption created by COVID-19 and changes to virtual care, children using home NIV maintained adequate adherence. Qualitative research is needed to understand the nuances of using NIV during the pandemic and potential advantages of virtual care for support of these children and families. Halperin H, Chalifour M, Bedi PK, etal. Impact of COVID-19 pandemic on adherence to noninvasive ventilation in children. J Clin Sleep Med. 2023;19(1):179-188.

“Negotiating a new normality” - a longitudinal qualitative exploration of the meaning of living with an open surgical wound

ABSTRACT Purpose Little is known about the experiences of people living with open surgical wounds. These wounds are common and predominantly affect young and actively working people. The aim of this qualitative study was to explore the meaning of living with open surgical wounds. Methods A qualitative exploratory study was conducted. We collected data using two individual interviews with each of ten participants (aged between 18–73 years) who had open surgical wounds. Our analytical approach was based on qualitative content analysis. Methods are reported using COREQ guidelines. Results We found that the meaning of living with open surgical wounds is shaped by five subthemes: “enduring healing”, “life disruption”, “adapting to a new reality”, “striving for healing” and “returning to normal life;” all under an overarching theme of “negotiating a new normality”. Conclusion Participants’ well-being and everyday living are greatly impacted by open surgical wounds. Findings from this study emphasize that open surgical wounds are a long-term condition with a typical “chronicity” trajectory; this brings a new perspective to previous findings of studies on living with complex wounds. This study has also highlighted areas for further research, related to improving individuals’ experience of living with open surgical wounds.

Is time-restricted eating a robust eating regimen during periods of disruptions in daily life? A qualitative study of perspectives of people with overweight during COVID-19

BackgroundTime-restricted eating (TRE) has been suggested as a feasible dietary strategy in individuals with overweight. Disruptions in daily life e.g., severe illness can affect engagement in lifestyle interventions to obtain healthier body weight. This study examined if and how the engagement with TRE among people with overweight was affected by the Danish COVID-19 lockdowns as an example of disruptions in daily life.MethodsFifteen participants with overweight enrolled in a TRE intervention, i.e. restricting all eating and drinking except water to the same daily ten-hour window, were interviewed about their experiences and engagement with TRE during COVID-19 lockdowns. Interviews were semi-structured and conducted by phone or face-to-face with safe social distancing. Data analysis was grounded in a reflexive thematic analysis approach.ResultsDaily life rhythms were disrupted by lockdowns by preventing participants from performing ordinary daily activities such as going to work, socialising, eating out or exercising. For some, this challenged their TRE engagement, while most were able to undertake the TRE eating window but reported increased snacking and consumption of take-away food within their eating window. For all, exercise habits became unhealthier. The negative impact on TRE engagement primarily occurred during daytime, as social distancing made it easier to engage with TRE during evenings.ConclusionsThis study showed that even people highly motivated to obtain healthier lifestyles practices struggled to maintain engagement with healthy behaviours, whereas sticking to the TRE window was manageable during COVID-19. TRE as a weight loss strategy was challenged which calls for more attention to supporting people in daily life to obtain healthier practices, also in case of periods of other disruptions such as divorce, serious illness etc.

Psychological responses, mental health, and sense of agency for the dual challenges of climate change and the COVID-19 pandemic in young people in the UK: an online survey study

BackgroundThe COVID-19 pandemic and climate change are both significant and pressing global challenges, posing threats to public health and wellbeing. Young people are particularly vulnerable to the distress both crises can cause, but understanding of the varied psychological responses to both issues is poor. We aimed to investigate these responses and their links with mental health conditions and feelings of agency.MethodsWe conducted an online survey between Aug 5 and Oct 26, 2020, targeting a diverse sample of young people (aged 16–24 years, n=530) in the UK. The survey was distributed using a combination of a survey panel (panel sample) and direct approaches to youth groups and schools who shared the survey with young people in their networks (community sample). We collected data on respondents’ psychological responses to both climate change and the COVID-19 pandemic, their sense of agency to respond to each crisis, and the range of impacts on their lives. We also collected demographics data and screened for mental health and wellbeing indicators. We used non-parametric tests for most statistical comparisons. For paired samples, we used Wilcoxon's signed-rank test, and used Mann-Whitney U-tests or Kruskal-Wallis tests for two or more independent samples. Summed scale scores were considered as interval-level data and analysed with Student's t tests and ANOVAs. Effect sizes are reported as Cohen's d and partial eta-squared (η·2p), respectively.FindingsAfter excluding 18 suspected bots and 94 incomplete responses, 530 responses were retained for analysis. Of the 518 respondents who provided demographic data, 63% were female, 71·4% were White, and the mean family affluence score was 8·22 (SD 2·29). Most participants (n=343; 70%) did not report a history of diagnosis or treatment for a mental health disorder, but mental health scores indicated a common experience of (relatively mild) symptoms of anxiety, depression, and stress. Although UK youth reported more life disruption and concern for their future due to the COVID-19 pandemic, climate change was associated with significantly greater distress overall, particularly for individuals with low levels of generalised anxiety. The COVID-19 pandemic was more associated with feelings of anxiety, isolation, disconnection, and frustration; distress around loss and grief; and effects on quality of life. Climate change was more likely to evoke emotions such as interest and engagement, guilt, shame, anger, and disgust. The greater distress attributed to climate change overall was due, in particular, to higher levels of guilt, sense of personal responsibility, and greater distress triggered by upsetting media coverage. Agency to address climate change was associated with greater climate distress, but pandemic-related distress and agency were unrelated.InterpretationThe COVID-19 pandemic and climate change are affecting the wellbeing of UK young people in distinct ways, with implications for health service, policy, and research responses. There is a need for mental health practitioners, policy makers, and other societal actors to account for the complex relationship between climate agency, distress, and mental wellbeing in young people.FundingImperial College London.

Improved methodology for affordable, reliable deep building renovations

European Union energy efficiency goals put refurbishments in focus as the existing building stock takes a high share in the final energy consumption meanwhile current refurbishment rates are lower than expected. This research attempts to answer the question: How can renovation processes be improved to raise renovation rates? The methodology development process consisted of identifying the methodological background, the phases and steps of the renovation process and the validation strategies. As a result, five methodological phases were identified. Renovations start with the Feasibility phase where a simple financial and technical assessment is carried out. During the Preparation phase necessary information is collected which results in a calibrated simulation model that can support the design. In the Design phase the renovation options are developed and assessed together with a business plan for financing the implementation through renovation cycles. The renovation measures are carried out during the Implementation phase. In the Operation phase the performance of the refurbished building is monitored and improved. The developed methodology is expected to provide more affordable, reliable building renovations, which reduces the performance gap, the upfront investment and the disruption of user life by reducing overall time on site. This results in an increased investment efficiency leading to higher uptake of refurbishments.

Lack Of Access To Technology Among Youth Of Color: An Unbalanced Impact Of Covid-19

Throughout the world, people from all walks of life are enduring tremendous hardship and trauma amid one of the worst disasters noted in U.S. History, the COVID-19 pandemic. The United States reportedly lost over 500,000 citizens to the virus with variants lingering domestically and abroad [1]. Subsequently, the virus and overall global pandemic conditions have had unforeseen changes. These changes included disruptions in everyday life, from the way we work, play, and socialize with others at home and in outside settings. Suddenly society was faced with urgent needs to secure new means of delivering quality education primarily through virtual learning platforms. Learning Management Systems (LMS) were operationalized and entailed the implementation of delivering learning outcomes. Unfortunately, youth and particularly young adults of color, found themselves on the losing end of the technology gap. They not only lacked necessary resources such as updated computer models, but also lacked highspeed internet service and/or proper knowledge for surviving the abrupt transition [2]. Key issues will be discussed related to student and faculty experiences. Specific discussions related to the digital divide of students by household social economic status, as is represented by K-12 data from the National Center for Education Statistics (NCES) and other sources. Additionally, the impact of COVID-19 on faculty and on college level youth and the impact of sudden change in educational deliverables as reflected in their qualitative responses and interactive experiences are explored.

Students' perceptions, educational challenges and hope during the COVID-19 pandemic.

IntroductionThe COVID‐19 pandemic has disrupted the lives of US students both at home and at school. Little is known regarding how adolescents perceive COVID‐19 has impacted (both positively and negatively) their academic and social lives and how protective factors, such as hope, may assist with resilience. Importantly, not all pandemic experiences are necessarily negative, and positive perceptions, as well as potential protective factors, are key to understanding the pandemic's role in students' lives.MethodUtilizing quantitative and qualitative approaches, the present study descriptively examined 726 6th through 12th grade (51% female, 53% White) students' perceptions of how COVID‐19 related to educational and life disruptions, and positive aspects of their lives, within the United States. Analyses additionally explored the role of pre‐pandemic hope in improving feelings of school connectedness during the pandemic.ResultsResults showed that most students felt that switching to online learning had been difficult and their education had suffered at least moderately, with a sizeable proportion of students feeling less academic motivation compared with last year. When asked to share qualitative answers regarding perceived challenges and positive aspects of life, themes were consistent with quantitative perceptions. Students' pre‐pandemic hope positively predicted students' feelings of school connectedness.ConclusionsFindings paint a complex picture of youth's COVID‐19 experiences and have implications for proactive ways to support students as COVID‐19 continues to affect daily life and educational structures and practices.

The Relationship between Posttraumatic-Growth and Care Burden in Caregivers of Schizophrenia

vWe assessed the relationship between the posttraumatic growth of caregivers of patients with schizophrenia and their care burden. The sample was determined using a “sample calculation formula from groups with a definite universe,” and the study included 146 caregivers. Sociodemographic Data Form, Posttraumatic Growth Inventory (PTGI), and Zarit Burden Interview (ZBI) were used in the research. The mean PTGI score of the caregivers was 65.23 ± 16.90, while the mean ZBI score was 52.68 ± 13.72. It can be stated that the caregivers of patients with schizophrenia have a moderate care burden, but their posttraumatic growth is above a moderate level. As the posttraumatic growth of caregivers increases, the values of mental stress and disruption of private life, mental strain and restriction, and deterioration in social relations decrease.

The Covid-19 Pandemic: Territorial, Political and Governance Dimensions of Bordering

ABSTRACT Whether we talk about the global scale of the threat or focus on the disruption and potential reversal of processes and realities that we assumed immutable, the epochal significance of the COVI-19 pandemic is indisputable. Since the 9/11 terrorist attacks, no other event has revived territorial borders and sent territorialist shockwaves across the world as COVID-19. The wave of contagion and fear that shadowed the discovery of the coronavirus at the end of 2019 was followed by a wave of bordering in the spring of 2020 when borders were broadly closed as a kneejerk reaction to a threat perceived largely as external. With a focus on Europe, North America and Africa, this special issue aims to advance our knowledge of the multiscalar and multidimensional dynamics triggered by the COVID-19 pandemic in various border contexts. The articles in this special issue investigate the response of institutional structures and the agency of regional actors in the face of rebordering, the securitización of the pandemic, the essentialization of fear, the disruption of daily life and livelihoods, the contestation of border closures vis-à-vis questions of survival, and the re/deconstruction of borders dictated by shifting power balances supporting contested border regimes. In the aggregate, this collection of articles reminds us that territory and territoriality remain vigorous and fitting instruments in the toolbox of nation states as demonstrated by the rebordering shocks triggered by the coronavirus pandemic across the world.

"Not Sure Sharing Does Anything Extra for Me": Understanding How People with Cardiovascular Disease Conceptualize Sharing Personal Health Data with Peers.

As people deal with cardiovascular disease (CVD), they are to self-monitor routinely and be aware of complications and the corresponding course of action. Engaging in these self-care behaviors is conducive to gaining knowledge of health status. Even so, knowledge of the self may be insufficient in making sense of chronic conditions. In constructing a new normal after health-related life disruptions, people often turn to peers (others facing similar health issues) and share personal health information with each other. Although health information-sharing behavior is well-documented, it remains underexplored what attitudes individuals with chronic conditions, such as CVD, have toward disclosing personal health data to peers and exploring those of others with similar conditions. We surveyed 39 people who reported being diagnosed with CVD to understand how they conceptualize sharing personal health data with their peers. By analyzing qualitative survey data thematically, we found that respondents expressed themselves as uncertain about the benefits of interacting with peers in such a manner. At the same time, they recognized an opportunity to learn new ideas to enhance CVD self-care in mutual data sharing. We also report participants’ analytical orientation toward this sort of data sharing herein and elaborate on what sharing a range of personal health data could mean. In light of the existing literature, this study unpacks the notion of sharing in a different population/pathology and with more nuance, particularly by distinguishing between disclosing one’s data and exploring others’.

The impact of the COVID‐19 pandemic on patients with chronic liver disease: Results from the Global Liver Registry

Patients with preexisting chronic liver disease (CLD) may experience a substantial burden from both coronavirus 2019 (COVID‐19) infection and pandemic‐related life disruption. We assessed the impact of the COVID‐19 pandemic on patients with CLD. Patients enrolled in our Global Liver Registry were invited to complete a COVID‐19 survey. As of June 2021, 2500 patients (mean age ± SD, 49 ± 13 years; 53% men) from seven countries completed the survey. Of all survey completers, 9.3% had COVID‐19. Of these patients, 19% were hospitalized, 13% needed oxygen support, but none required mechanical ventilation. Of all patients including those not infected with COVID‐19, 11.3% reported that the pandemic had an impact on their liver disease, with 73% of those reporting delays in follow‐up care. The Life Disruption Event Perception questionnaire confirmed worsening in at least one area (food/nutrition, exercise, social life, vocation/education, financial situation, housing, or health care) in 81% and 69% of patients with and without a history of COVID‐19, respectively (p = 0.0001). On a self‐assessed Likert health score scale (range, 1–10; 10 indicates perfect health), patients with a COVID‐19 history scored lower (mean ± SD, 6.7 ± 2.2 vs. 7.4 ± 2.2, respectively; p < 0.0001) despite reporting similar health scores if there was no pandemic (mean ± SD, 8.5 ± 1.4 vs. 8.4 ± 1.6, respectively; p = 0.59). After adjustment for country of enrollment, liver disease etiology and severity, age, sex, body mass index, diabetes, and history of psychiatric comorbidities, COVID‐19 was found to be independently associated with lower self‐assessed health scores (beta = −0.71 ± 0.14; p < 0.0001). The COVID‐19 pandemic resulted in a substantial burden on the daily life of patients with CLD.

Complete Vestibulectomy in Women with Persistent Entrance Dyspareunia Following Partial Posterior Vestibulectomy

ABSTRACT Introduction Neuroproliferative vestibulodynia (NPV), characterized in 2004, is associated with increased density of mast cells and nerves as demonstrated by immunohistochemical staining of multiple regions of excised vestibular specimens, showing it to be a field disease. It has been reported that 16% of women experience persistent entrance dyspareunia which may lead to abstinence, disruption of social life, and/or depression. In patients with suspected NPV, complete vestibulectomy with vaginal advancement flap reconstruction, performed by providers trained in sexual medicine, has resulted in resolution of persistent entrance dyspareunia in approximately 80% of patients. Objective Many surgeons not trained in sexual medicine perform only a partial posterior vestibulectomy with vaginal advancement flap reconstruction in patients with suspected NPV. Recent pathologic evidence, however, shows NPV to be a field disease of the entire vestibule. To salvage patients who have not experienced resolution of their persistent entrance dyspareunia following a partial posterior vestibulectomy, we perform a complete vestibulectomy. We herein report on the results of complete vestibulectomy in this population. Methods This is a review of complete vestibulectomy surgeries performed by a sexual medicine specialist since January 2019 (n=47). Post-operatively patients were assessed for the ability to have pain-free penetration. Immunohistochemical staining was performed on all vestibular specimens in multiple locations using CD 117 and PGP 9.5 to assess for density of mast cells and nerves, respectively. Results 14 (30%) patients (mean age 26 ± 7 years) with persistent entrance dyspareunia following partial posterior vestibulectomy presented to our clinic, two of whom had undergone partial posterior vestibulectomy twice and one, three times. All patients had a history consistent with NPV after excluding all other forms of vestibulodynia. Cotton tipped swab testing showed severe pain primarily around the urethral meatus between 1:00 and 3:00 and between 9:00 and 11:00; 79% also had pain at 12:00. All had a positive response to vestibular anesthesia testing. During complete vestibulectomy surgery in patients with prior partial posterior vestibulectomy, vestibular fibrosis in the posterior vestibule resulted in more difficult dissection with approximately 33% increased blood loss (mean 200 ml vs 150 ml in women without prior partial posterior vestibulectomy). Surgical techniques were otherwise similar in women with or without prior partial posterior vestibulectomy. The vestibule was excised from around the urethral meatus and Hart's line to the hymen, and the urethral meatus and vulva were anastomosed to the vagina. All vestibular specimens exhibited high density of CD117 and PGP 9.5 positive staining cells consistent with NPV. Most importantly, 71% of women who had persistent entrance dyspareunia after partial posterior vestibulectomy had pain-free penetration post complete vestibulectomy. Conclusions Women with persistent entrance dyspareunia from NPV have a field disease involving excess density of mast cells and nerves in the entire vestibule, therefore performing a partial posterior vestibulectomy in women with suspected NPV is not a logical surgical strategy. Salvaging such patients with complete vestibulectomy is safe and effective. Disclosure No

Responding to a surge in overdose deaths: perspectives from US syringe services programs

BackgroundUS overdose deaths have reached a record high. Syringe services programs (SSPs) play a critical role in addressing this crisis by providing multiple services to people who use drugs (PWUD) that help prevent overdose death. This study examined the perspectives of leadership and staff from a geographically diverse sample of US SSPs on factors contributing to the overdose surge, their organization’s response, and ongoing barriers to preventing overdose death.MethodsFrom 2/11/2021 to 4/23/2021, we conducted semi-structured interviews with leadership and staff from 27 SSPs sampled from the North American Syringe Exchange Network directory. Interviews were transcribed and qualitatively analyzed using a Rapid Assessment Process.ResultsRespondents reported that increased intentional and unintentional fentanyl use (both alone and combined with other substances) was a major driver of the overdose surge. They also described how the COVID-19 pandemic increased solitary drug use and led to abrupt increases in use due to life disruptions and worsened mental health among PWUD. In response to this surge, SSPs have increased naloxone distribution, including providing more doses per person and expanding distribution to people using non-opioid drugs. They are also adapting overdose prevention education to increase awareness of fentanyl risks, including for people using non-opioid drugs. Some are distributing fentanyl test strips, though a few respondents expressed doubts about strips’ effectiveness in reducing overdose harms. Some SSPs are expanding education and naloxone training/distribution in the broader community, beyond PWUD and their friends/family. Respondents described several ongoing barriers to preventing overdose death, including not reaching certain groups at risk of overdose (PWUD who do not inject, PWUD experiencing homelessness, and PWUD of color), an inconsistent naloxone supply and lack of access to intranasal naloxone in particular, inadequate funding, underestimates of overdoses, legal/policy barriers, and community stigma.ConclusionsSSPs remain essential in preventing overdose deaths amid record numbers likely driven by increased fentanyl use and COVID-19-related impacts. These findings can inform efforts to support SSPs in this work. In the face of ongoing barriers, support for SSPs—including increased resources, political support, and community partnership—is urgently needed to address the worsening overdose crisis.

Prenatal Pollutant Exposures and Hypothalamic Development: Early Life Disruption of Metabolic Programming.

Environmental contaminants in ambient air pollution pose a serious risk to long-term metabolic health. Strong evidence shows that prenatal exposure to pollutants can significantly increase the risk of Type II Diabetes (T2DM) in children and all ethnicities, even without the prevalence of obesity. The central nervous system (CNS) is critical in regulating whole-body metabolism. Within the CNS, the hypothalamus lies at the intersection of the neuroendocrine and autonomic systems and is primarily responsible for the regulation of energy homeostasis and satiety signals. The hypothalamus is particularly sensitive to insults during early neurodevelopmental periods and may be susceptible to alterations in the formation of neural metabolic circuitry. Although the precise molecular mechanism is not yet defined, alterations in hypothalamic developmental circuits may represent a leading cause of impaired metabolic programming. In this review, we present the current knowledge on the links between prenatal pollutant exposure and the hypothalamic programming of metabolism.

Understanding Changes in Adolescent Physical Activity Behaviors and Cognitions Prior to and During the COVID-19 Pandemic.

Despite accumulating evidence that has found significant negative declines in physical activity (PA) as a result of the COVID-19 pandemic, little work has sought to understand how PA cognitions have changed during this period and in relation to behavior change during the pandemic. The purpose of the current study was to investigate the changes in adolescents' PA behaviors and cognitions associated with COVID-19 and prospective predictors of PA using the Multi-Process Action Control (M-PAC) framework. Adolescents were recruited from a large school board and a total of 588 participants (Mage = 15.87 ± 0.43 years, 60% female) completed data collection in both Fall 2019 and 2020—prior to and during the COVID-19 pandemic. Participants completed self-reported measures of moderate-to-vigorous PA (MVPA), participation in organized activities, and variables derived from the M-PAC framework. Mixed effects models were computed to examine longitudinal changes in MVPA and cognitions as well as whether cognitions prior to COVID-19 predict MVPA during COVID-19. A generalized estimating equations model was computed to examine longitudinal changes for participation in organized activities. Findings indicated that MVPA (B = −56.41, p < 0.01) and participation in organized activities (OR = 0.33, p < 0.01) significantly decreased during the COVID-19 pandemic. Correspondingly, there were significant decreases in intentions (B = −0.34), identity (B = −0.19), and habit (B = −0.20), though there were increases in behavioral regulation (B = 0.18). No significant changes were found in affective attitudes, instrumental attitudes, perceived opportunity, and perceived capability. Among the baseline M-PAC cognitions, habit (B = 46.28) was the lone significant predictor of MVPA during COVID-19. Overall results suggest that adolescents' PA behaviors and cognitions were negatively impacted by the COVID-19 pandemic, along with promising evidence that restrictions prompted adaptive utilization of behavioral regulation skills. Moreover, habit appears to play a salient role in predicting PA behaviors during uncertain times involving major life disruptions. These findings highlight the need to dedicate additional attention to PA promotion as COVID-19 moves toward an endemic phase, and that interventions targeting habit formation may be critical for helping adolescents better sustain healthy active lifestyles during major life changes.

A Community-Based Youth Diversion Program as an Alternative to Incarceration, Illinois, 2017-2019.

The US justice system unfairly targets youths of color; systemic reform plus interventions to keep youths out of the justice system are needed. The Juvenile Justice Collaborative provided care coordination and wraparound services to adolescents in a diversion program from 2017 to 2019 in Cook County, Illinois. Youths showed increased strengths and decreased needs by program's end. Youths who successfully completed the program showed reduced recidivism compared with nonprogram youths. Community-based alternatives to incarceration may decrease life disruption, promote positive health and social outcomes, and reduce further justice involvement. (Am J Public Health. 2022;112(9):1265-1268. https://doi.org/10.2105/AJPH.2022.306946).

Is the Indian health system resilient? Lessons from COVID-19.

The importance of health system resilience has been brought to the forefront by the COVID-19 pandemic. The dramatic loss of human life, massive economic and social disruption, and collapse of health care services worldwide demonstrate the consequences of an unprecedented disaster on health systems that are not sufficiently built to withstand health shocks [1]. The […]

Electronic Health Record-Based Deep Learning Prediction of Death or Severe Decompensation in Heart Failure Patients

BackgroundSurgical mechanical ventricular assistance and cardiac replacement therapies, although life-saving in many heart failure (HF) patients, remain high-risk. Despite this, the difficulty in timely identification of medical therapy nonresponders and the dire consequences of nonresponse have fueled early, less selective surgical referral. Patients who would have ultimately responded to medical therapy are therefore subjected to the risk and life disruption of surgical therapy. ObjectivesThe purpose of this study was to develop deep learning models based upon commonly-available electronic health record (EHR) variables to assist clinicians in the timely and accurate identification of HF medical therapy nonresponders. MethodsThe study cohort consisted of all patients (age 18 to 90 years) admitted to a single tertiary care institution from January 2009 through December 2018, with International Classification of Disease HF diagnostic coding. Ensemble deep learning models employing time-series and densely-connected networks were developed from standard EHR data. The positive class included all observations resulting in severe progression (death from any cause or referral for HF surgical intervention) within 1 year. ResultsA total of 79,850 distinct admissions from 52,265 HF patients met observation criteria and contributed >350 million EHR datapoints for model training, validation, and testing. A total of 20% of model observations fit positive class criteria. The model C-statistic was 0.91. ConclusionsThe demonstrated accuracy of EHR-based deep learning model prediction of 1-year all-cause death or referral for HF surgical therapy supports clinical relevance. EHR-based deep learning models have considerable potential to assist HF clinicians in improving the application of advanced HF surgical therapy in medical therapy nonresponders.

Characteristics of Hospital Workers Using a Wellbeing Center Implemented During the COVID-19 Pandemic to Prevent the Emotional Impacts of the Crisis

IntroductionThe COVID-19 pandemic has posed an unprecedented challenge worldwide for healthcare workers (HCWs) and other hospital employees. Disruptions in work and personal life may have led to mental health problems. To prevent or limit the severity of such issues, a local initiative has been implemented in a French hospital: a dedicated lounge, also called “Bulle” (literally bubble and meaning safe space) has been created to provide a quiet caring environment and health support. Other similar wellbeing centers have been implemented in other countries, but very little data are available on their practical effectiveness. The purpose of our study was to assess what type of hospital workers have frequented the Bulle and to describe their psychological state in terms of anxiety, depression, and post-traumatic stress disorder (PTSD) just after the first wave, compared to those who had not come to the Bulle.MethodsFrom 15 July to 1 October 2020, a cross-sectional survey was conducted among all workers, collecting demographic information, professional data (experience and satisfaction), emotional experience during the first wave of COVID-19, and psychological specificities, including a history of burnout or symptoms of anxiety, depression, and PTSD. We asked them if they had accessed the Bulle or not.ResultsA total of 675 employees (out of 2,408; 28.0%) fully completed the survey. Approximately 199 respondents (29%) reported having accessed the Bulle during the first wave of the pandemic. Significant symptoms of anxiety, depression, and PTSD were reported by, respectively, 41, 20, and 14% of the participants. Logistic regression analysis showed no relationship between the use of the Bulle and the prevalence of later psychological symptoms. However, employees who benefit from the solicitation of the psychological support team in their hospital unit were secondarily more prone to come to the Bulle [odds ratio (OR), 2.24; 95% confidence interval (95% CI): 1.09; 4.59].ConclusionAnxiety, depression, and PTSD were common after the first part of the COVID-19 pandemic, and the attendance in quiet and wellbeing spaces seemed easier with direct internal proactive intervention by psychological teams.

SARS-CoV-2-Specific Memory B Cell Responses Are Maintained After Recovery from Natural Infection and Postvaccination.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), has resulted in major worldwide disruption and loss of life over the last 2 years. Many research studies have shown waning serological SARS-CoV-2-specific IgG antibody titers over time, yet, it is unclear whether these changes are reflected in the potential functional reactivation of SARS-CoV-2 antigen-specific memory B cells (MBC) populations. This is especially true in the contexts of differing COVID-19 disease severity and after vaccination regimens. This study aimed to investigate these by polyclonal in vitro reactivation of MBC populations followed by analysis using SAR-CoV-2 antigen-specific B cell ELISpots and IgG antibody ELISAs. Natural disease-associated differences were investigated in 52 donors who have recovered from COVID-19 with varying disease severity, from asymptomatic to severe COVID-19 disease, accompanied by a longitudinal evaluation in a subset of donors. Overall, these data showed limited disease severity-associated differences between donor groups but did show that COVID-19 serologically positive donors had strong antigen-specific MBC-associated responses. MBC responses were better maintained 6 months after recovery from infection when compared to serological antigen-specific IgG antibody titers. A similar investigation after vaccination using 14 donors showed robust serological antigen-specific antibody responses against spike protein that waned over time. MBC-associated responses against spike protein were also observed but showed less waning over time, indicating maintenance of a protective response 6 months after vaccination. Further research is required to evaluate these putatively functional SARS-CoV-2-specific responses in the context of long-term protection mediated by vaccination against this pathogen.