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Background Thymosin-α-1 (Tα1) may be a treatment option for coronavirus disease 2019 (COVID-19), but efficacy and safety data remain limited. Methods Prospective, open-label, randomized trial assessing preliminary efficacy and safety of thymalfasin (synthetic form of Tα1), compared with the standard of care, among hospitalized patients with hypoxemia and lymphocytopenia due to COVID-19. Results A total of 49 patients were included in this analysis. Compared with control patients, the incidence of clinical recovery was higher for treated patients with either baseline low-flow oxygen (subdistribution hazard ratio, 1.48 [95% confidence interval, .68–3.25]) or baseline high-flow oxygen (1.28 [.35–4.63]), although neither difference was significant. Among patients with baseline low-flow oxygen, treated patients, compared with control patients, had an average difference of 3.84 times more CD4+ T cells on day 5 than on day 1 (P = .01). Nine serious adverse events among treated patients were deemed not related to Tα1. Conclusions Tα1 increases CD4+ T-cell count among patients with baseline low-flow oxygen support faster than the standard of care and may have a role in the management of hospitalized patients with hypoxemia and lymphocytopenia due to COVID-19. Clinical Trials Registration NCT04487444.

Background Clinical trials for coronavirus disease 2019 (COVID-19) have struggled to achieve diverse patient enrollment, despite underrepresented groups bearing the largest burden of the disease and, presumably, being most in need of the treatments under investigation. Methods To assess the willingness of patients to enroll into inpatient COVID-19 clinical trials when invited, we conducted a cross-sectional analysis of adults hospitalized with COVID-19 who were approached regarding enrollment. Associations between patient and temporal factors and enrollment were assessed by multivariable logistic regression analysis. Results A total of 926 patients were included in this analysis. Overall, Hispanic/Latinx ethnicity was associated with a nearly half-fold decrease in the likelihood to enroll (adjusted odds ratio [aOR], 0.60 [95% confidence interval {CI}, .41–.88]). Greater baseline disease severity (aOR, 1.09 [95% CI, 1.02–1.17]), age 40–64 years (aOR, 1.83 [95% CI, 1.03–3.25]), and age ≥65 years (aOR, 1.92 [95% CI, 1.08–3.42]) were each independently associated with higher likelihood to enroll. Over the course of the pandemic, patients were less likely to enroll during the summer 2021 wave in COVID-19–related hospitalizations (aOR, 0.14 [95% CI, .10–.19]) compared with patients from the first wave in winter 2020. Conclusions The decision to enroll into clinical trials is multifactorial. Amid a pandemic disproportionately affecting vulnerable groups, Hispanic/Latinx patients were less likely to participate when invited, whereas older adults were more likely. Future recruitment strategies must consider the nuanced perceptions and needs of diverse patient populations to ensure equitable trial participation that advances the quality of healthcare for all.

BACKGROUND: Ensovibep (MP0420) is a designed ankyrin repeat protein, a novel class of engineered proteins, under investigation as a treatment of SARS-CoV-2 infection. OBJECTIVE: To investigate if ensovibep, in addition to remdesivir and other standard care, improves clinical outcomes among patients hospitalized with COVID-19 compared with standard care alone. DESIGN: Double-blind, randomized, placebo-controlled, clinical trial. (ClinicalTrials.gov: NCT04501978). SETTING: Multinational, multicenter trial. PARTICIPANTS: Adults hospitalized with COVID-19. INTERVENTION: Intravenous ensovibep, 600 mg, or placebo. MEASUREMENTS: Ensovibep was assessed for early futility on the basis of pulmonary ordinal scores at day 5. The primary outcome was time to sustained recovery through day 90, defined as 14 consecutive days at home or place of usual residence after hospital discharge. A composite safety outcome that included death, serious adverse events, end-organ disease, and serious infections was assessed through day 90. RESULTS: An independent data and safety monitoring board recommended that enrollment be halted for early futility after 485 patients were randomly assigned and received an infusion of ensovibep (n = 247) or placebo (n = 238). The odds ratio (OR) for a more favorable pulmonary outcome in the ensovibep (vs. placebo) group at day 5 was 0.93 (95% CI, 0.67 to 1.30; P = 0.68; OR > 1 would favor ensovibep). The 90-day cumulative incidence of sustained recovery was 82% for ensovibep and 80% for placebo (subhazard ratio [sHR], 1.06 [CI, 0.88 to 1.28]; sHR > 1 would favor ensovibep). The primary composite safety outcome at day 90 occurred in 78 ensovibep participants (32%) and 70 placebo participants (29%) (HR, 1.07 [CI, 0.77 to 1.47]; HR

Objective : Explore potential racial/ethnic differences, describe general clinical characteristic, and severe outcomes [intensive care unit (ICU) admission, mechanical ventilation (intubation), and death] between Hispanic/Latinx (hereafter: Hispanics or Latinx community) and non-Hispanic patients hospitalized with COVID-19. Methods : Retrospective cohort of 326 patients hospitalized with COVID-19 through April 19, 2020. Sociodemographic and hospital course data were collected and analyzed. A multivariate logistic regression analysis was implemented to examine associations. Results : Compared with non-Hispanic Whites (NHW), Hispanics were younger (53 years, median age) and had higher rates of Medicaid and less commercial/HMO/PPO coverage (p

Thymosin-α-1 (Tα1) may be a treatment option for COVID-19, but efficacy and safety data remain limited.Prospective, open-label, randomized trial assessing preliminary efficacy and safety of thymalfasin (synthetic form of Tα1), compared with standard of care, among hospitalized patients with hypoxemia and lymphocytopenia due to COVID-19.49 patients were included in this analysis. Compared with control patients, the incidence of clinical recovery was higher for treated patients with either baseline low flow oxygen (subdistribution hazard ratio [SHR]: 1.48; 95% CI: 0.68-3.25) or baseline high flow oxygen (SHR: 1.28; 95% CI: 0.35-4.63), although neither were significant. Among patients with baseline low flow oxygen, treated patients, compared with control patients, had an average difference of 3.84 times more CD4+ T cells on Day 5 than on Day 1 (p = 0.0113). Nine serious adverse events among treated patients were deemed not related to Tα1.Tα1 increases CD4+ T cell count among patients with baseline low flow oxygen support faster than standard of care and may have a role in the management of hospitalized patients with hypoxemia and lymphocytopenia due to COVID-19.

Objectives. To identify spatiotemporal patterns of epidemic spread at the community level. Methods. We extracted influenza cases reported between 2016 and 2019 and COVID-19 cases reported in March and April 2020 from a hospital network in Rhode Island. We performed a spatiotemporal hotspot analysis to simulate a real-time surveillance scenario. Results. We analyzed 6527 laboratory-confirmed influenza cases and identified microepidemics in more than 1100 neighborhoods, and more than half of the neighborhoods that had hotspots in a season became hotspots in the next season. We used data from 731 COVID-19 cases, and we found that a neighborhood was 1.90 times more likely to become a COVID-19 hotspot if it had been an influenza hotspot in 2018 to 2019. Conclusions. The use of readily available hospital data allows the real-time identification of spatiotemporal trends and hotspots of microepidemics. Public Health Implications. As local governments move to reopen the economy and ease physical distancing, the use of historic influenza hotspots could guide early prevention interventions, while the real-time identification of hotspots would enable the implementation of interventions that focus on small-area containment and mitigation.

Introduction The COVID-19 pandemic has caused an unprecedented health and economic worldwide crisis. Innovative solutions are imperative given limited resources and immediate need for medical supplies, healthcare support and treatments. Aim The purpose of this review is to summarize emerging technologies being implemented in the study, diagnosis, and treatment of COVID-19. Results Key focus areas include the applications of artificial intelligence, the use of Big Data and Internet of Things, the importance of mathematical modeling for predictions, utilization of technology for community screening, the use of nanotechnology for treatment and vaccine development, the utility of telemedicine, the implementation of 3D-printing to manage new demands and the potential of robotics. Conclusion The review concludes by highlighting the need for collaboration in the scientific community with open sharing of knowledge, tools, and expertise.

Vaccination remains the most effective way to prevent influenza infection, albeit vaccine effectiveness (VE) varies by year. Compared to other age groups, children and elderly adults have the highest risk of developing influenza-related complications and requiring hospitalization. During the last years, “test negative design” (TND) studies have been implemented in order to estimate influenza VE. The aim of this systematic review and meta-analysis was to summarize the findings of TND studies reporting influenza VE against laboratory-confirmed influenza-related hospitalization in children aged 6 months to 17 years. We searched the PubMed and Embase databases and identified 2615 non-duplicate studies that required detailed review. Among them, 28 met our inclusion criteria and we performed a random-effects meta-analysis using adjusted VE estimates. In our primary analysis, influenza vaccine offered significant protection against any type influenza-related hospitalization (57.48%; 95% CI 49.46–65.49). When we examined influenza VE per type and strain, VE was higher against H1N1 (74.07%; 95% CI: 54.85–93.30) and influenza B (50.87%; 95% CI: 41.75–59.98), and moderate against H3N2 (40.77%; 95% CI: 25.65–55.89). Notably, influenza vaccination offered higher protection in children who were fully vaccinated (61.79%; 95% CI: 54.45–69.13), compared to those who were partially vaccinated (33.91%; 95% CI: 21.12 – 46.69). Also, influenza VE was high in children less than 5 years old (61.71%; 95% CI: 49.29–74.12) as well as in children 6–17 years old (54.37%; 95% CI: 35.14–73.60). In conclusion, in the pediatric population, influenza vaccination offered significant protection against influenza-related hospitalization and complete annual vaccination should be encouraged.

Influenza is a contagious respiratory illness and can lead to hospitalization and even death. Understanding how comorbidities affect the severity of influenza can help clinical management. The aim of this study is to offer more information about comorbidities that might be associated with the severity of influenza in children. We used a statewide network in Rhode Island, USA, to extract data for laboratory-confirmed influenza cases among children 19 years old or younger. We identified 1169 lab-confirmed influenza cases. The most common comorbidities were asthma (17.1%), neurodevelopmental disorders (10.3%), gastrointestinal disorders (7.6%), atopic dermatitis (7%), and endocrine and metabolic diseases (6.8%). Interestingly, 80.8% (63 out of 78) of children who had an influenza-related hospital admission had at least one comorbidity, and among hospitalized children with influenza, the most common comorbidities were neurological diseases (28.2%, 22/78), gastrointestinal disorders (25.6%, 20/78), endocrine and metabolic diseases (24.4%, 19/78), and neurodevelopmental disorders (23.1%, 18/78). Children with endocrine or metabolic diseases were 8.23 times more likely to be admitted to the hospital, and children with neurological disorders were 6.35 times more likely to be admitted (OR: 8.23, 95% CI: 4.42–15.32 and OR: 6.35, 95% CI: 3.60–11.24, respectively). In summary, we identified specific comorbidities associated with influenza hospitalization and length of hospital stay, and these groups should be prioritized for public health interventions.

Η παρακίνηση στον εργασιακό χώρο αναφέρεται στα στοιχεία εκείνα που υποκινούν τους εργαζόμενους να εισέλθουν στην εργασία, να συμμετέχουν ενεργά σ’ αυτήν, καθώς και να παραμείνουν αποτελεσματικοί και αποδοτικοί στον επαγγελματικό τους χώρο. Η παρακίνηση, ως μέσo ενεργοποίησης της ανθρώπινης συμπεριφοράς, διαμορφώνεται υπό το πρίσμα διαφορετικών παραγόντων (Matheson, 2012). Η παρούσα διατριβή αναπτύσσεται στη θεωρητική θέση του Armstrong (2006), ότι ο εργασιακός οργανισμός μπορεί να επιτύχει υψηλά επίπεδα παρακίνησης των εργαζομένων παρέχοντας ανταμοιβές και κίνητρα (οικονομικά ή μη) καθώς και πρόσβαση σε ευκαιρίες για εκπαίδευση και επαγγελματική ανάπτυξη του ανθρώπινου δυναμικού της. Στη διάρκεια της οικονομικής κρίσης, οι δυσμενείς οικονομικές και κοινωνικές συνθήκες που αναπτύχθηκαν ως αποτέλεσμα των δημοσιονομικών και των διαρθρωτικών εργασιακών αλλαγών, επιβάλλουν στα ανώτατα στελέχη του Δημόσιου Τομέα να λειτουργήσουν σε ένα ιδιαίτερα απαιτητικό περιβάλλον το οποίο χαρακτηρίζεται από τη δυναμική επίτευξης υψηλών στόχων, διαθέτοντας όμως περιορισμένα οικονομικά μέσα. Εντούτοις, η επίδραση των συνεχιζόμενων μέτρων λιτότητας τόσο στην συμπεριφορά όσο και στην αποδοτικότητα των εργαζομένων στο δημόσιο τομέα, δεν έχει ακόμη μελετηθεί εκτενώς. Στην Ελλάδα, η ένταση της οικονομικής δυσπραγίας ανάγκασε τη Δημόσια Διοίκηση να αντιληφθεί τη σπουδαιότητα της παρακίνησης των εργαζομένων ως μέσο αποτελεσματικής προσαρμογής στις αλλαγές που προκλήθηκαν (Mitsakis, 2017). Επομένως, ο σχεδιασμός και η εφαρμογή ενός πλάνου παρακίνησης στο Δημόσιο Τομέα που θα περιλαμβάνει τόσο οικονομικές όσο και μη οικονομικές ανταμοιβές καθίσταται πιο αναγκαίος από ποτέ. Η παρούσα διατριβή έχοντας στο επίκεντρό της τον εργαζόμενο, υπό το πλαίσιο της οικονομικής κρίσης, επιδιώκει να καλύψει το κενό που υπάρχει στη βιβλιογραφία σχετικά με τους παράγοντες που επηρεάζουν την παρακίνηση των εργαζομένων στη Δημόσια Διοίκηση. Συγκεκριμένα, προκειμένου να διερευνήσουμε τις αντιλήψεις των εργαζομένων του Δημόσιου Τομέα υιοθετούμε την προσέγγιση του ολοκληρωμένου συστήματος αμοιβών (total reward system) το οποίο αναγνωρίζει τη συμβολή τόσο της εξωτερικής (extrinsic) όσο και της εσωτερικής παρακίνησης (intrinsic motivation). Όσον αφορά την εξωτερική (ή εξωγενή) παρακίνηση, η παρούσα μελέτη παρέχει νέα εμπειρικά δεδομένα για εναλλακτικούς, μη οικονομικούς παράγοντες που εν τούτοις επηρεάζουν την ικανοποίηση των εργαζομένων με το επίπεδο των αμοιβών τους στο Δημόσιο Τομέα. Λαμβάνοντας υπόψη ότι οι αλλεπάλληλες μειώσεις των αποδοχών των δημοσίων υπαλλήλων, ως αποτέλεσμα της εφαρμογής του ενιαίου μισθολογίου, της κατάργησης των επιδομάτων-δώρων και το «πάγωμα» των μισθολογικών αυξήσεων, αντικατοπτρίζει το πρόβλημα των περιορισμένων οικονομικών πόρων και συνεπώς της έλλειψης των οικονομικών κινήτρων, στρέφουμε την προσοχή μας σε μη οικονομικούς παράγοντες που μπορούν να επηρεάσουν τόσο την παρακίνηση όσο και την αποδοτικότητα των εργαζομένων. Συγκεκριμένα, επικεντρωνόμαστε στην έννοια της δίκαιης αμοιβής που συνιστά «τη σύγκριση μεταξύ της αξίας που πιστεύουν οι εργαζόμενοι ότι πρέπει να πληρωθούν και της αξίας που άλλοι εργαζόμενοι πρέπει να λάβουν». Υιοθετώντας τη θεωρία του ψυχολογικού συμβολαίου, η παρούσα διατριβή παρέχει μία πληρέστερη κατανόηση του βαθμού επηρεασμού της αποδοτικότητας των εργαζομένων από το επίπεδο της ικανοποίησής τους με τις χρηματικές αμοιβές, όπως όμως αυτό καθορίζεται από τις αντιλήψεις τους για την ύπαρξη οργανωσιακής δικαιοσύνης (organizational justice). Για τον σκοπό αυτό διενεργήθηκε έρευνα πεδίου σε εργαζόμενους στο Δημόσιο Τομέα και µε τη χρήση ερωτηματολογίου συγκεντρώθηκαν δεδομένα από δημοσίους υπαλλήλους στην Ελλάδα. Τα αποτελέσματα της έρευνας υποδεικνύουν μία στατιστικά σημαντική θετική σχέση της αποδοτικότητας των εργαζομένων όχι μόνο με το επίπεδο ικανοποίησης αυτών με τις αμοιβές, αλλά και με τις αντιλήψεις των εργαζομένων σχετικά με την ύπαρξη υψηλής διανεμητικής (distributive) και διαδικαστικής δικαιοσύνης (procedural justice). Υπό συνθήκες λιτότητας και περιορισμένων διαθέσιμων πόρων, τα αποτελέσματα της παρούσας έρευνας παρέχουν στα στελέχη της Διεύθυνσης Ανθρώπινου Δυναμικού της Δημόσιας Διοίκησης σημαντικές κατευθύνσεις για την ανάπτυξη τόσο της παρακίνησης όσο και της αποδοτικότητας των απασχολουμένων, μέσω εναλλακτικών, μη οικονομικών παραγόντων παρακίνησης. Αναφορικά με την εσωτερική (ή ενδογενή) παρακίνηση και λαμβάνοντας υπ’ όψη ότι η εκπαίδευση και η ανάπτυξη των εργαζομένων αποτελεί θεμέλιο λίθο τόσο για την προσωπική τους εξέλιξη όσο και την εξέλιξη ενός οργανισμού, η παρούσα διατριβή διερευνά τους παράγοντες που ενισχύουν τις αντιλήψεις των εργαζομένων σχετικά με το βαθμό επένδυσης του οργανισμού σε παροχές δράσεων ανάπτυξης και εξέλιξης του ανθρώπινου δυναμικού (perceived investment in employee development - PIED). Στη συγκεκριμένη έρευνα θεωρούμε ότι η υποστήριξη που αντιλαμβάνονται ότι δέχονται οι εργαζόμενοι τόσο σε επίπεδο οργανισμού (perceived organizational support - POS) όσο και σε επίπεδο προϊσταμένου (perceived supervisor support - PSS) αποτελούν σημαντικούς διαθέσιμους εργασιακούς πόρους (job resources). Με βάση αυτή τη θεώρηση αξιολογούμε την επίδραση αυτών των δύο αντιλήψεων κοινωνικής υποστήριξης (POS, PSS) στον καθορισμό των αντιλήψεων που έχουν οι εργαζόμενοι ως προς την παροχή δράσεων ανάπτυξης του ανθρώπινου δυναμικού (PIED) από τον οργανισμό. Τα αποτελέσματα δείχνουν ότι η αντιλαμβανόμενη υποστήριξη σε επίπεδο οργανισμού (POS) αποτελεί ισχυρότερο δείκτη πρόβλεψης του PIED σε σχέση με το βαθμό υποστήριξης σε επίπεδο προϊσταμένου (PSS). Το εύρημα αυτό ενισχύει το ρόλο του προϊσταμένου ως παράγοντα του οργανισμού (organizational agent). Επιπρόσθετα, σε συμφωνία τόσο με το μοντέλο των επαγγελματικών απαιτήσεων και των εργασιακών πόρων (job demands-resources model) όσο και με τη θεωρία της κοινωνικής ανταλλαγής (social exchange theory) τα αποτελέσματα της έρευνας τονίζουν τη θετική επίδραση της μεταβλητής PIED στις στάσεις και στις συμπεριφορές των εργαζομένων και συγκεκριμένα στην οργανωσιακή δέσμευση (organizational commitment) και στην φιλότιμη εργασιακή συμπεριφορά (οrganizational citizenship behavior - OCB). Επίσης, η μεταβλητή PIED βρέθηκε ότι είναι στατιστικά σημαντικός μεσολαβητής στις σχέσεις μεταξύ της κοινωνικής υποστήριξης (POS και PSS) και των συμπεριφορικών επιδράσεων στους εργαζόμενους (organizational commitment, OCB). Επιπλέον, λαμβάνοντας υπ’ όψη τη σημασία της εκπαίδευσης και της ανάπτυξης, η παρούσα διατριβή διερεύνησε τους παράγοντες που ενισχύουν την παρακίνηση των εργαζομένων να συμμετάσχουν σε προγράμματα κατάρτισης και ανάπτυξης (motivation to learn and develop - MLD). Τα εμπειρικά δεδομένα καταδεικνύουν ότι αναπτύσσονται θετικές σχέσεις μεταξύ των αντιλήψεων των εργαζομένων αναφορικά με την ύπαρξη κοινωνικής υποστήριξης (POS, PSS) και την επιθυμία τους να λάβουν μέρος σε προγράμματα εκπαίδευσης και ανάπτυξης (MLD). Περαιτέρω όμως διαφαίνεται ότι η θετική επίδραση της υποστήριξης του προϊσταμένου (PSS) στη μεταβλητή MLD είναι πιθανόν να μειωθεί όταν οι εργαζόμενοι ταυτόχρονα θεωρούν ότι ο οργανισμός που απασχολούνται αποτελεί ένα μη υποστηρικτικό περιβάλλον (POS). Τέλος, σύμφωνα με τη θεωρία της κοινωνικής ανταλλαγής και δεδομένου ότι οι αμοιβαίες ανταλλαγές μεταξύ του εργαζομένου και του προϊσταμένου βασίζονται στην οργανωσιακή δέσμευση, τα αποτελέσματα της έρευνας φανερώνουν ότι η οργανωσιακή δέσμευση (τόσο η συναισθηματική όσο και η κανονιστική δέσμευση) αποτελεί μεσολαβητική μεταβλητή στις ανωτέρω θετικές σχέσεις μεταξύ των μεταβλητών POS, PSS και MLD.

Introduction: The use of mechanical ventilation associated with acute hypoxemic respiratory failure, the most common complication in critically ill COVID-19 patients, defines a high risk population that requires specific consideration of outcomes and treatment practices.Areas covered: This review evaluates existing information about mortality rates and effectiveness of antiviral, immune-modulating, and anticoagulation treatments in COVID-19 patients who received mechanical ventilation. The mortality rate and follow-up periods in patients receiving mechanical ventilation ranged widely. Antivirals, including remdesivir and convalescent plasma, have shown no definitive mortality benefit in this population despite positive results in other COVID-19 patients. Dexamethasone was associated with an absolute reduction in 28-day mortality by 12.3% (95% CI, 6.3 to 17.6), after adjusting for age. Reduced mortality has been demonstrated with tocilizumab use alongside corticosteroids. Evidence is inconclusive for therapeutic anticoagulation, and further studies are needed to determine the comparative benefit of prophylactic anticoagulation.Expert opinion: Significant variation and high mortality rates in mechanically ventilated patients necessitate more standardized outcome measurements, increased consideration of risk factors to reduce intubation, and improved treatment practices. Anticoagulation and dexamethasone should be incorporated in the treatment of patients receiving invasive mechanical ventilation, while more rigorous studies are required for other potential treatments.

Background Hospital readmissions are associated with poor patient outcomes and increased health resource utilisation. The need to study readmission patterns is even bigger during a pandemic because the burden is further stretching the healthcare system. Methods We reviewed the initial hospitalisation and subsequent readmission for 19 patients with confirmed COVID-19 in the largest statewide hospital network in Rhode Island, US, from March 1st through April 19th, 2020. We also compared the characteristics and clinical outcomes between readmitted and non-readmitted patients. Results Of the 339 hospitalised patients with COVID-19, 279 discharged alive. Among them, 19/279 were readmitted (6.8%) after a median of 5 days. There was a significantly higher rate of hypertension, diabetes, chronic pulmonary disease, liver disease, cancer and substance abuse among the readmitted compared with non-readmitted patients. The most common reasons of readmissions happening within 12 days from discharge included respiratory distress and thrombotic episodes, while those happening at a later time included psychiatric illness exacerbations and falls. The length of stay during readmission was longer than during index admission and more demanding on healthcare resources. Conclusion Among hospitalised patients with COVID-19, those readmitted had a higher burden of comorbidities than the non-readmitted. Within the first 12 days from discharge, readmission reasons were more likely to be associated with COVID-19, while those happening later were related to other reasons. Readmissions characterisation may help in defining optimal timing for patient discharge and ensuring safe care transition.

BackgroundThe efficacy of convalescent plasma (CP) for the treatment of coronavirus disease 2019 (COVID-19) remains unclear.MethodsIn a matched cohort analysis of hospitalized patients with severe COVID-19, the impact of CP treatment on in-hospital mortality was evaluated using univariate and multivariate Cox proportional-hazards models, and the impact of CP treatment on time to hospital discharge was assessed using a stratified log-rank analysis.ResultsIn total, 64 patients who received CP a median of 7 days after symptom onset were compared to a matched control group of 177 patients. The incidence of in-hospital mortality was 12.5% and 15.8% in the CP and control groups, respectively (P = .52). There was no significant difference in the risk of in-hospital mortality between the 2 groups (adjusted hazard ratio [aHR] 0.93, 95% confidence interval [CI] .39–2.20). The overall rate of hospital discharge was not significantly different between the 2 groups (rate ratio [RR] 1.28, 95% CI .91–1.81), although there was a significantly increased rate of hospital discharge among patients 65-years-old or greater who received CP (RR 1.86, 95% CI 1.03–3.36). There was a greater than expected frequency of transfusion reactions in the CP group (2.8% reaction rate observed per unit transfused).ConclusionsWe did not demonstrate a significant difference in risk of mortality or rate of hospital discharge between the CP and control groups. There was a signal for improved outcomes among the elderly, and further adequately powered randomized studies should target this subgroup when assessing the efficacy of CP treatment.

Influenza is increasingly recognized as a leading cause of morbidity and mortality in patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation (HSCT). However, the impact of influenza on this population has not been previously evaluated in a systematic review. This study systematically reviewed and summarized the outcomes of influenza infection as to in-hospital influenza-related mortality, development of lower respiratory tract infection and acute respiratory distress syndrome, need for hospitalization, intensive care unit admission, and mechanical ventilation.We conducted a systematic search of literature using the PubMed and EMBASE databases for articles published from January 1989 through January 19, 2020, reporting laboratory-confirmed influenza in patients of any age with hematologic malignancies and HSCT. Time from transplantation was not included in the search criteria. The impact of antiviral therapy on influenza outcomes was not assessed due to heterogeneity in antiviral treatment provision across the studies. Patients with influenza-like illness, solid-tumor cancers, or nonmalignant hematologic diseases were excluded from the study. A random-effects meta-analysis was performed to estimate the prevalences and 95% CIs of each outcome of interest. A subgroup analysis was carried out to assess possible sources of heterogeneity and to evaluate the potential impact of age on the influenza infection outcomes. Heterogeneity was assessed using the IData from 52 studies providing data on 1787 patients were included in this analysis. During seasonal epidemics, influenza-related in-hospital mortality was 16.60% (95% CI, 7.49%-27.7%), with a significantly higher death rate in adults compared to pediatric patients (19.55% [95% CI, 10.59%-29.97%] vs 0.96% [95% CI, 0%-6.77%]; P0.001). Complications from influenza, such as lower respiratory tract infection, developed in 35.44% of patients with hematologic malignancies and HSCT recipients, with a statistically significant difference between adults and children (46.14% vs 19.92%; P0.001). However, infection resulted in a higher hospital admission rate in pediatric patients compared to adults (61.62% vs 22.48%; P0.001). For the 2009 H1N1 pandemic, no statistically significant differences were found between adult and pediatric patients when comparing the rates of influenza-related in-hospital mortality, lower respiratory tract infection, and hospital admission. Similarly, no significant differences were noted in any of the outcomes of interest when comparing H1N1 pandemic with seasonal epidemics.Regardless of influenza season, patients, and especially adults, with underlying hematologic malignancies and HSCT recipients with influenza are at risk for severe outcomes including lower respiratory tract infection and in-hospital mortality.

BackgroundThe efficacy of convalescent plasma (CP) for the treatment of COVID-19 remains unclear.MethodsA matched cohort analysis of hospitalized patients with severe COVID-19. The impact of CP treatment on all cause in-hospital mortality was evaluated using univariate and multivariate Cox proportional-hazards models, and the impact of CP treatment on the time to hospital discharge was assessed using a stratified log-rank analysis.Results64 patients who received CP a median of 7 days after symptom onset were compared to a matched control group of 177 patients. Overall in-hospital mortality was 14.9%. There was no significant difference in the risk of in-hospital mortality between the two groups (adjusted hazard ratio [aHR] 0.93, 95% confidence interval [CI] 0.39 – 2.20). There was also no significant difference in the overall rate of hospital discharge (rate ratio [RR] 1.28, 95% CI 0.91 – 1.81), but a subgroup analysis of patients 65-years-old or greater who received CP demonstrated a significantly increased hospital discharge rate among these patients (RR 1.86, 95% CI 1.03 – 3.36). There was a greater than expected frequency of transfusion reactions in the CP group (2.8% reaction rate observed per unit transfused).ConclusionsThe use of CP in this study was a safe treatment for COVID-19. There was no overall significant reduction of in-hospital mortality or increased rate of hospital discharge associated with the use of CP in this study, although there was a signal for improved outcomes among the elderly. Further adequately powered randomized studies should target this subgroup when assessing the efficacy CP treatment.

Background Complications following influenza infection are a major cause of morbidity and mortality, and the Centers for Disease Control Advisory Committee on Immunization Practices recommends universal annual vaccination. However, vaccination rates have remained significantly lower than the Department of Health and Human Services goal. The aim of this work was to assess the vaccination rate among patients who present to health care providers with influenza-like illness and identify groups with lower vaccination rates. Methods We performed a systematic search of the PubMed and EMBASE databases with a time frame of January 1, 2010, to March 1, 2019 and focused on the vaccination rate among patients seeking care for acute respiratory illness in the United States. A random effects meta-analysis was performed to estimate the pooled seasonal influenza vaccination rate, and we used a time trend analysis to identify differences in annual vaccination over time. Results The overall pooled influenza vaccination rate was 48.61% (whites: 50.87%; blacks: 36.05%; Hispanics: 41.45%). There was no significant difference among gender groups (men: 46.43%; women: 50.11%). Interestingly, the vaccination rate varied by age group and was significantly higher among adults aged >65 (78.04%) and significantly lower among children 9–17 years old (36.45%). Finally, we found a significant upward time trend in the overall influenza vaccination rate among whites (coef. = .0107; P = .027). Conclusions In conclusion, because of the significantly lower influenza vaccination rates in black and Hispanic communities, societal initiatives and community outreach programs should focus on these populations and on children and adolescents aged 9–17 years.

Objective The aim of this study was to explore the potential association of obesity and other chronic diseases with severe outcomes, such as intensive care unit (ICU) admission and invasive mechanical ventilation (IMV), in patients hospitalized with coronavirus disease 2019 (COVID-19). Methods This study analyzed a retrospective cohort of 103 patients hospitalized with COVID-19. Demographic data, past medical history, and hospital course were collected and analyzed. A multivariate logistic regression analysis was implemented to examine associations. Results From February 17 to April 5, 103 consecutive patients were hospitalized with COVID-19. Among them, 44 patients (42.7%) were admitted to the ICU, and 29 (65.9%) required IMV. The prevalence of obesity was 47.5% (49 of 103). In a multivariate analysis, severe obesity (BMI ≥ 35 kg/m2 ) was associated with ICU admission (adjusted odds ratio [aOR]: 5.39, 95% CI: 1.13-25.64). Moreover, patients who required IMV were more likely to have had heart disease (aOR: 3.41, 95% CI: 1.05-11.06), obesity (BMI = 30-34.9 kg/m2 ; aOR: 6.85, 95% CI: 1.05-44.82), or severe obesity (BMI ≥ 35 kg/m2 ; aOR: 9.99, 95% CI: 1.39-71.69). Conclusions In our analysis, severe obesity (BMI ≥ 35 kg/m2 ) was associated with ICU admission, whereas history of heart disease and obesity (BMI ≥ 30 kg/m2 ) were independently associated with the use of IMV. Increased vigilance and aggressive treatment of patients with obesity and COVID-19 are warranted.

AIM To determine the overall rate of chest imaging findings in asymptomatic cases, describe the most common patterns found, and determine the rate of later symptom development in these initially asymptomatic cases. MATERIALS AND METHODS The PubMed and EMBASE databases were searched until 1 May 2020, for studies examining the proportion of positive chest imaging findings in asymptomatic cases diagnosed with COVID-19 and a random-effects meta-analysis of proportions was performed. Heterogeneity was assessed using the I2 statistic. RESULTS Among 858 non-duplicate studies, seven studies with a total of 231 asymptomatic cases met the inclusion criteria. In the primary analysis, the pooled estimate of the overall rate of positive chest computed tomography (CT) findings among asymptomatic cases was 63% (95% confidence interval [CI]: 44–78%). Among 155/231 cases that were followed up for later symptom development, 90/155 remained asymptomatic and 65/155 developed symptoms during the study period (that ranged between seven and 30 days of follow-up). The pooled estimate of the rate of positive chest CT findings was 62% (95% CI: 38–81%) in cases that remained asymptomatic, while it was 90% (95% CI: 49–99%) in cases that developed symptoms. Among CT findings, the pooled estimate of the overall rate of ground-glass opacities (GGO) at CT alone was 71% (95% CI: 50–86%). Among other CT findings reported, 22/231 patients had GGO with consolidation, 7/231 patients had stripe shadows with or without GGO, and 8/231 patients had GGO with interlobular septal thickening. Among initially asymptomatic cases with positive CT findings, the pooled estimate of the overall rate of later symptom development was 26% (95% CI: 14–43%). CONCLUSION In COVID-19, asymptomatic cases can have positive chest CT findings, and COVID-19 should be considered among cases with CT abnormalities even when there are no other symptoms. There is a need for close clinical monitoring of asymptomatic cases with radiographic findings as a significant percentage will develop symptoms., Highlights • In COVID-19, asymptomatic cases can have positive chest CT findings. • COVID-19 should be considered among cases with CT findings even without symptoms. • Clinical monitoring of asymptomatic cases with radiographic findings is needed. • A significant percent of asymptomatic cases with CT findings will develop symptoms.

Supplemental Digital Content is available in the text, We evaluated the statewide burden of obesity and its complications among government and state funded programs (Medicare and Medicaid) and commercial insurance. We calculated the prevalence of obesity and the prevalence of relevant comorbidities among different demographic groups and based on health insurance, among adults (18–65 years old) who visited a statewide health network in the state of Rhode Island, in 2017. The overall prevalence of obesity among 74,089 individuals was 38.88% [Asians 16.77%, Whites 37.49%, Hispanics 44.23%, and Blacks 48.44%]. Medicare or Medicaid beneficiaries were 26% and 27%, respectively, more likely to have obesity than those who had commercial insurance (Odds Ratio:1.26, 95% confidence interval [CI]:1.20–1.32; Odds Ratio:1.27, 95%CI:1.22–1.32). Moreover, Medicaid and Medicare beneficiaries with obesity had a higher prevalence of diabetes compared with privately insured with obesity (10.58% and 10.44% vs 4.45%). Medicare beneficiaries with obesity had a statistically higher prevalence of ischemic heart disease (4.34%, 95%CI: 3.77–4.91) than privately insured (3.21%, 95%CI: 2.94–3.47). Based on statewide data among 18 to 65 years old adults, Medicare and Medicaid provide health coverage to 40% of individuals with obesity and 46% of those with the obesity-related comorbidities and complications. State and federal health care programs need to support and expand obesity-related services and coverage.

Background The complex epidemiology of obesity includes environmental factors. We examined how accessibility to fast food restaurants and green spaces is associated with obesity. Methods We used geocoded body mass index values of 20,927 subjects that visited the largest statewide health care network in Rhode Island. Spatial analysis and logistic regression were used to examine the association of obesity at the individual level, and obesity hot and cold spots with the accessibility to fast food restaurants and green space areas. Results The age-adjusted prevalence of obesity in our sample was 33%. Obese subjects were less likely to live in neighborhoods with the highest accessibility to green space areas (odds ratio [OR] 0.89; 95% confidence interval [CI], 0.81-0.97), compared with neighborhoods with low accessibility. Obese subjects were more likely to live in neighborhoods with medium or high accessibility to fast food restaurants (OR 1.22; 95% CI, 1.14-1.31; OR 1.20; 95% CI, 1.10-1.32, respectively). Looking at obesity clustering, hot spots were 18% and 21% less likely to be located in neighborhoods with medium and high accessibility to green space areas, respectively (OR 0.82; 95% CI, 0.76-0.88; OR 0.79; 95% CI, 0.71-0.86). In contrast, hot spots were 1.65 and 4.81 times more likely to be located in neighborhoods with medium and high accessibility to fast food restaurants, respectively (OR 1.65; 95% CI, 1.53-1.77; OR 4.81; 95% CI, 4.39-5.27, respectively). Conclusions Accessibility to fast food restaurants is positively associated with the presence of obesity hot spots, while access to green space areas is associated with decreased neighborhood obesity rates.