Search

The COVID-19 pandemic transformed many aspects of health and daily life. A subset of people who were infected with the virus have ongoing chronic health issues that range in type of symptom and severity. In this study, we conducted a qualitative assessment of self-reported post-COVID symptoms from patients' electronic health records (EHR, n=564) and a randomized collection of Reddit and Twitter posts (n=500 for each). We show the inconsistencies in what types of symptoms are shared between platforms in addition to assessing the severity of the symptoms and how social media characterizations of post-COVID do not tell a complete story of this phenomenon. This research contributes to CSCW health literature by connecting digital traces of post-COVID with EHR data, critiquing the use of social media as a health proxy and points to its potential to add context to the analysis of traditional health data extracted from the EHR.

Background: Coronavirus disease (COVID-19) was declared a global pandemic by the World Health Organization (WHO) on March 11, 2020. Now a subset of individuals are experiencing post- acute sequelae of COVID-19, more colloquially known as Long-COVID. Research surrounding the long-term consequences of COVID-19 is now at the height of importance as approximately 5.8% of individuals will be diagnosed with new psychiatric illnesses. Mind long consequences of COVID-19 include brain fog, difficulties with memory, and focusing. Objective/Methods: While many of the symptoms associated with Long-COVID have been summarized, the cognitive impairment that takes place was quantified in this study using BrainCheck cognitive assessment. The aim of this study was to utilize a database of over 500 individuals suffering from Long-COVID symptoms and analyze differing levels of cognitive impairment to find correlations with different predispositions and demographics. The focused variables were age, gender, weight, (body mass index) BMI, and hospitalization status. A retrospective chart review was conducted on subjects’ data that was included in the Parkview Post-COVID Clinic (PPCC) registry database. Results: The data analysis showed that age was correlated with mental flexibility (p-value =

Objective: A retrospective study was conducted to examine the relationship between long-COVID peripheral neuropathy and patient demographics and comorbid medical conditions. Methods: Electronic health records of 543 patients from the Parkview Post-COVID Clinic were reviewed for their demographic information, past medical histories, and post-COVID clinic visit summaries. Based on whether patients had peripheral neuropathy as a post-COVID clinical visit diagnosis and whether they had had a history of neuropathy prior to COVID infection, the patients were assigned into the new-onset neuropathy group, progressing and non-progressing neuropathy groups, and non-neuropathy group. Age and BMI were compared among the four groups using two-sampled t test. Sex, prior COVID hospitalization status, and chronic comorbidities including hypertension, diabetes, and anemia were compared using chi-squared test. Results: 19 of 543 (3.5%) patients had new-onset neuropathy and 18 (3.3%) were found to have progressing neuropathy. The study’s incidence of new-onset peripheral neuropathy (3.5% over two years) in long-COVID patients is higher than the incidence of non-COVID-related neuropathy indicated in literature (0.76% each year, p = 0.025). Compared with patients with no neuropathy, patients with new-onset neuropathy were of older age (p = 0.042), more male (p = 0.022), and more frequently hospitalized for COVID (p = 0.003). Compared to patients with no neuropathy, patients with progressing neuropathy were of older age (p < 0.001), had more COVID hospitalization (p = 0.033), diabetes (0.014), hypertension (p < 0.001), and anemia (p = 0.02). Conclusion: Age and COVID hospitalization were found to be risk factors for both new-onset and progressing neuropathy. Being male was a risk factor for new-onset neuropathy only. Diabetes, anemia, and hypertensionwere risk factors for both progressing and non-progressing neuropathy but not for new-onset neuropathy. The results can prompt clinicians to assess peripheral neuropathy in long-COVID patients that have high demographic and medical risk factors.

Introduction: Post-acute sequelae of COVID (PASC) is an emerging postviral syndrome affecting patients who have recovered from acute COVID infection. Symptoms can affect many different organ systems, including the CNS. Neuropsychiatric complications are common in PASC, affecting roughly 1 in 3 patients who recover from COVID. The present study aims to investigate relationships between depressive, anxious, somatic, and general psychiatric symptom burden and cognitive impairment in PASC. Methods: Patients were recruited from the Parkview Post-COVID Clinic (PPCC) from April 2021 to March 2022. Patients were deemed eligible if data were available for both Brief Symptomatic Inventory (BSI) and BrainCheck scores. Eligible patients were divided into low or normal cognitive function based on BrainCheck guidelines, and differences in psychiatric symptom severity were assessed via Mann-Whitney U testing. Strength and direction of associations were determined using Pearson’s correlation coefficient. A smaller subset of patients was analyzed for differences in PASC symptom severity based on Omicron or Delta infection. Results: Generalized cognitive and mental flexibility complaints were associated with more severe psychiatric symptom burden in all domains measured by BSI (p = 0.003 and p = 0.01, respectively). Impaired attention was not related to any psychiatric symptom domain (p > 0.05). Impaired memory was related to more severe symptom burden in all psychiatric domains except depression (immediate recall p = 0.015; delayed recall p = 0.015). Conclusion: General cognitive and mental flexibility complaints can be used to prompt clinical suspicion of concurrent psychiatric symptoms. Complaints regarding attention are not linked to any psychiatric symptom domain. Complaints regarding memory can also provide impetus for investigating concurrent psychiatric symptoms, excluding depression. These associations can be used to facilitate earlier diagnosis and treatment of cognitive impairment and psychiatric illness in the context of PASC.

Genetic disorders are a leading contributor to mortality in neonatal and pediatric intensive care units (ICUs). Rapid whole-genome sequencing (rWGS)-based rapid precision medicine (RPM) is an intervention that has demonstrated improved clinical outcomes and reduced costs of care. However, the feasibility of broad clinical deployment has not been established. The objective of this study was to implement RPM based on rWGS and evaluate the clinical and economic impact of this implementation as a first line diagnostic test in the California Medicaid (Medi-Cal) program. Project Baby Bear was a payor funded, prospective, real-world quality improvement project in the regional ICUs of five tertiary care children's hospitals. Participation was limited to acutely ill Medi-Cal beneficiaries who were admitted November 2018 to May 2020, were

Genetic disorders presenting in the neonatal period can have a significant impact on morbidity and mortality. Early diagnosis can facilitate timely prognostic counseling to families and possibility of precision care, which could improve outcome. As availability of diagnostic testing expands, the required knowledge base of the neonatologist must also expand to include proper application and understanding of genetic testing modalities, especially where availability of clinical genetics consultation is limited. Herein, we review genetic tests utilized in the neonatal intensive care unit (NICU) providing background on the technology, clinical indications, advantages, and limitations of the tests. This review will span from classic cytogenetics to the evolving role of next generation sequencing and its impact on the management of neonatal disease.

Objective: This retrospective study examined the relationship between post-COVID (PC) fatigue and the presence of chronic illnesses. Materials and Methods: Electronic health records of 122 Parkview PC Clinic patients were reviewed for demographics (age, gender, race), chronic illnesses (diabetes, hypothyroidism, hypertension, congestive heart failure, anemia, cancer, orthostatic hypotension), obesity (weight, BMI), complaint of fatigue, and activities affected by fatigue. Data was analyzed using Chi-square tests for categorical variables (or Fisher’s exact test for small cell sizes) and t-tests for continuous variables. Open thematic coding of activities most affected by PC fatigue was performed. Results: 95 out of 122 patients (77.9%) were found to have PC fatigue. Except for measures related to obesity, none of the chronic illnesses assessed were correlated with the presence of fatigue. The weight of PC fatigue patients was significantly higher than those without fatigue (p=0.04). Examination of BMI and obesity status also indicated significantly higher BMI (p=0.01) and levels of obesity (p= 0.004) in PC fatigue groups compared to the PC non-fatigue groups. No significant differences were observed between the groups in either PT test. Examination of patient described activities effected by PC fatigue found work (30.4%), daily stamina (28.6%) and ability to exercise (16.7%) most impacted by PC fatigue. Other activities affected by PC fatigue included housework (5.6%), hobbies (3.7%), shopping (1.9%) and driving (1.9%). Conclusion: 77.9% of our PC patients showed symptoms of fatigue. This is comparable with existing literature. None of the demographic variables and PT tests, or most of the chronic health conditions investigated, were correlated with the presence of fatigue in PC patients. In contrast, measures associated with obesity, including high BMI and weight, were significantly associated with increased PC fatigue presentation. Open thematic coding of qualitative variables indicated work, daily stamina, and exercise were most affected in PC patients.

The purpose of this study was to evaluate the characteristics of neonates with congenital diaphragmatic hernia (CDH) undergoing enteral access procedures (gastrostomy or jejunostomy) during their initial hospitalization, and establish a clinical scoring system based on these characteristics.Data were obtained from the multicenter, multinational CDH Study Group database (CDHSG Registry) between 2007 and 2019. Patients were randomly partitioned into model-derivation and validation subsets. Weighted scores were assigned to risk factors based on their calculated β-coefficients after logistic regression.Of 4537 total patients, 597 (13%) underwent gastrostomy or jejunostomy tube placement. In the derivation subset, factors independently associated with an increased risk for enteral access included oxygen requirement at 30-days, chromosomal abnormalities, gastroesophageal reflux, major cardiac anomalies, ECMO requirement, liver herniation, and increased defect size. Based on the devised scoring system, patients could be stratified into very low (0-4 points;10% risk), low (5-6 points; 10-20% risk), intermediate (7-9 points; 30-60% risk), and high risk (≥10 points; 70% risk) groups for enteral access.This study identifies risk factors associated with enteral access procedures in neonates with congenital diaphragmatic hernia and establishes a novel scoring system that may be used to guide clinical decision making in those with poor oral feeding.Prognosis study.

The second Newborn Sequencing in Genomic Medicine and Public Health (NSIGHT2) study was a randomized, controlled trial of rapid whole-genome sequencing (rWGS) or rapid whole-exome sequencing (rWES) in infants with diseases of unknown etiology in intensive care units (ICUs). Gravely ill infants were not randomized and received ultra-rapid whole-genome sequencing (urWGS). Herein we report results of clinician surveys of the clinical utility of rapid genomic sequencing (RGS). The primary end-point-clinician perception that RGS was useful- was met for 154 (77%) of 201 infants. Both positive and negative tests were rated as having clinical utility (42 of 45 [93%] and 112 of 156 [72%], respectively). Physicians reported that RGS changed clinical management in 57 (28%) infants, particularly in those receiving urWGS (p = 0.0001) and positive tests (p < 0.00001). Outcomes of 32 (15%) infants were perceived to be changed by RGS. Positive tests changed outcomes more frequently than negative tests (p < 0.00001). In logistic regression models, the likelihood that RGS was perceived as useful increased 6.7-fold when associated with changes in management (95% CI 1.8-43.3). Changes in management were 10.1-fold more likely when results were positive (95% CI 4.7-22.4) and turnaround time was shorter (odds ratio 0.92, 95% CI 0.85-0.99). RGS seldom led to clinician-perceived confusion or distress among families (6 of 207 [3%]). In summary, clinicians perceived high clinical utility and low likelihood of harm with first-tier RGS of infants in ICUs with diseases of unknown etiology. RGS was perceived as beneficial irrespective of whether results were positive or negative.

Genetic disorders presenting in the neonatal period can have a significant impact on morbidity and mortality. Early diagnosis can facilitate timely prognostic counseling to families and possibility of precision care, which could improve outcome. As availability of diagnostic testing expands, the required knowledge base of the neonatologist must also expand to include proper application and understanding of genetic testing modalities, especially where availability of clinical genetics consultation is limited. Herein, we review genetic tests utilized in the neonatal intensive care unit (NICU) providing background on the technology, clinical indications, advantages, and limitations of the tests. This review will span from classic cytogenetics to the evolving role of next generation sequencing and its impact on the management of neonatal disease.

The second Newborn Sequencing in Genomic Medicine and Public Health study was a randomized, controlled trial of the effectiveness of rapid whole-genome or -exome sequencing (rWGS or rWES, respectively) in seriously ill infants with diseases of unknown etiology. Here we report comparisons of analytic and diagnostic performance. Of 1,248 ill inpatient infants, 578 (46%) had diseases of unknown etiology. 213 infants (37% of those eligible) were enrolled within 96h of admission. 24 infants (11%) were very ill and received ultra-rapid whole-genome sequencing (urWGS). The remaining infants were randomized, 95 to rWES and 94 to rWGS. The analytic performance of rWGS was superior to rWES, including variants likely to affect protein function, and ClinVar pathogenic/likely pathogenic variants (p < 0.0001). The diagnostic performance of rWGS and rWES were similar (18 diagnoses in 94 infants [19%] versus 19 diagnoses in 95 infants [20%], respectively), as was time to result (median 11.0 versus 11.2days, respectively). However, the proportion diagnosed by urWGS (11 of 24 [46%]) was higher than rWES/rWGS (p = 0.004) and time to result was less (median 4.6days, p < 0.0001). The incremental diagnostic yield of reflexing to trio after negative proband analysis was 0.7% (1 of 147). In conclusion, rapid genomic sequencing can be performed as a first-tier diagnostic test in inpatient infants. urWGS had the shortest time to result, which was important in unstable infants, and those in whom a genetic diagnosis was likely to impact immediate management. Further comparison of urWGS and rWES is warranted because genomic technologies and knowledge of variant pathogenicity are evolving rapidly.

By informing timely targeted treatments, rapid whole-genome sequencing can improve the outcomes of seriously ill children with genetic diseases, particularly infants in neonatal and pediatric intensive care units (ICUs). The need for highly qualified professionals to decipher results, however, precludes widespread implementation. We describe a platform for population-scale, provisional diagnosis of genetic diseases with automated phenotyping and interpretation. Genome sequencing was expedited by bead-based genome library preparation directly from blood samples and sequencing of paired 100-nt reads in 15.5 hours. Clinical natural language processing (CNLP) automatically extracted children’s deep phenomes from electronic health records with 80% precision and 93% recall. In 101 children with 105 genetic diseases, a mean of 4.3 CNLP-extracted phenotypic features matched the expected phenotypic features of those diseases, compared with a match of 0.9 phenotypic features used in manual interpretation. We automated provisional diagnosis by combining the ranking of the similarity of a patient’s CNLP phenome with respect to the expected phenotypic features of all genetic diseases, together with the ranking of the pathogenicity of all of the patient’s genomic variants. Automated, retrospective diagnoses concurred well with expert manual interpretation (97% recall and 99% precision in 95 children with 97 genetic diseases). Prospectively, our platform correctly diagnosed three of seven seriously ill ICU infants (100% precision and recall) with a mean time saving of 22:19 hours. In each case, the diagnosis affected treatment. Genome sequencing with automated phenotyping and interpretation in a median of 20:10 hours may increase adoption in ICUs and, thereby, timely implementation of precise treatments.

The umbilical cord is tissue that is normally discarded after the delivery of the infant, but it has been shown to be a rich source of stem cells from the cord blood, Wharton's jelly, and umbilical endothelial cells. Patient-specific human induced pluripotent stem cells (hiPSCs) reprogrammed from patient specific human umbilical vein endothelial cells in the neonatal intensive care unit (NICU) population (specifically, premature neonates) have not been shown in the literature. This unit describes a protocol for the generation and expansion of hiPSCs originating from umbilical cords collected from patients in the NICU. Curr. Protoc. Stem Cell Biol. 29:1C.16.1-1C.16.13. © 2014 by John Wiley & Sons, Inc. Keywords: umbilical cord; HUVEC; reprogramming; iPS

Several regional telestroke systems now exist to remotely assess stroke patients at community hospitals via wireless technology in order to decrease the time between stroke onset and treatment. More recently, mobile applications have been studied yet the wireless technology was not sufficient to support reliable audiovisual transmission. This study assessed the feasibility of remote stroke assessment via an iPad within a moving ambulance. Connectivity, quality of transmission, and interrater agreement were examined. Using routes between five spoke rural community hospitals and a telemedicine hub hospital in Fort Wayne, Indiana (radius of approximately 45 miles), two blinded, certified NIH Stroke Scale (NIHSS) raters conducted 30 stroke assessments on a standardized patient. An iPad was mounted within an ambulance and the standardized patient was examined by both in-person and remote assessors. The study demonstrated feasibility in 84% of the assessments with kappa coefficient analysis demonstrating strong interrater agreement for subscales with the exceptions of Best Language and Motor Right Leg. The assessors’ total NIHSS scores were found to have an 88% agreement to the expected scores. When compared to the expected NIHSS scores, subscales showed strong agreement, except moderate agreement in the Best Language subscale. The results of this feasibility study demonstrate that remote NIHSS assessments based within a moving ambulance were feasible. This success rate supports further study of the application in a real, live clinical setting.

The negative attitudes of some student teachers towards mathematics and the inadequacy of their mathematical backgrounds have been a concern of mathematics educators for many years. In an attempt to understand the interaction of cognitive and affective factors in mathematics learning, this paper presents a case study of one preservice early childhood/primary teacher education student’s experiences of learning mathematics. The study identifies issues which are of concern both to teachers and to teacher educators.

To test the hypothesis that an educational intervention would improve the resuscitator's ability to provide on-target volume ventilation during pulmonary compliance changes.Neonatal professionals (n = 27) ventilated an electromechanical lung model simulating a 3-kg baby while targeting a tidal volume of 4-6 mL/kg. In this preintervention and postintervention study, a one-on-one educational intervention aimed to improve the primary outcome of on-target tidal volume delivery during high and low compliance. Seventeen subjects were retested 8 months later.When only pressure was displayed, and using a self-inflating bag, participants improved from a mean of 6% of breaths on-target to 21% immediately after education (P.01). Using a flow-inflating bag, participants improved from 1% to 7% of breaths on-target (P.01). Eight-month retention testing demonstrated no difference compared with baseline. With volume displayed, the mean baseline success rate was 84% with the self-inflating bag and 68% with the flow-inflating bag. There was no significant change after education or at 8-month follow-up.When pressure is displayed, resuscitators can improve their ability to respond to changes in compliance after an educational intervention. When volume is displayed, performance is markedly better at baseline, but not improved after the intervention. Our findings reconfirm that resuscitation bags should have volume displays.

This study assessed the effect of beta-aminopropionitrile treatment on the long-term curvature and compliance of corneal tissue subjected to radial keratotomy (RK). beta-Aminopropionitrile is known to inhibit cross-linking of collagen and is expected to enhance the flexibility of scar tissue, thereby reducing wound contracture and regression after RK. Seventeen adult New Zealand rabbits, weighing about 4.5 kg each, underwent RK in both eyes (eight incisions, 90% deep, 3-mm pupillary zone). Their mean preoperative corneal curvature was 44.25 diopters (+/- 0.32D at 95% confidence level). Nine of the rabbits were treated topically with beta-aminopropionitrile ointment (33 weight % in petroleum three times daily), while the control group received the petrolatum base only. The remainder of the animals received bland petrolatum gel as a control. The animals were given periodic keratometric examinations and were killed after six to eight weeks. At that time, the beta-aminopropionitrile group showed a mean reduction of 1.85 +/- 0.13 D in corneal curvature, compared with 1.18 +/- 0.08 D in the control group. The compliance and strength of the corneas were measured in vitro immediately after death. In the pressure range from 10 to 40 mm Hg, the beta-aminopropionitrile-treated corneas changed in curvature by an average of 1.4 D as compared with 0.5-D flattening for the controls. These results indicate the effectiveness of beta-aminopropionitrile treatment in enhancing longterm compliance and reducing refractive regression after RK.