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The need for rehabilitation and skilled nursing services for coronavirus disease 2019 (COVID-19) survivors has been speculated from the beginning of the pandemic. However, real-world data describing utilization of these services post COVID-19 hospitalization and the factors associated with the same is limited. This retrospective cohort study on COVID-19 patients aims to identify the patients discharged to inpatient rehabilitation or nursing facilities post-hospitalization and the factors associated with the same.A retrospective cohort study on COVID-19 patients during second wave of the pandemic in the state of Michigan. Primary outcome was discharge disposition. Binary logistic regression was conducted to identify the factors associated with discharge to a facility.A total of 559 COVID-19 patients [median age 64 years, interquartile range (IQR) 53-73 years, 48.5% males (n=271), 67.6% Blacks (n=378)] were included in the study. During hospitalization, 17.4% of the patients (n=97) died. Around 65% (n=365) patients were discharged home whereas 12.5% (n=70) were discharged to a facility for inpatient rehabilitation/nursing services. Older patients, males, those with longer hospital stay, and patients who needed new percutaneous endoscopic gastrostomy (PEG) tube, tracheostomy, initiation of hemodialysis or continuous renal replacement therapy (CRRT), or had an acute stroke during admission were more likely to be discharged to a facility post-hospitalization.About 12.5% of hospitalized COVID-19 patients needed discharge to a facility for inpatient rehabilitation/nursing services. Knowledge of the factors associated with discharge to a facility can optimize discharge planning, efficient resource allocation, and improve long-term COVID-19 care.

Background: Interns experience challenges in their transition from medical school to residency. Orientation is traditionally delivered by faculty and administrators and often does not address the intern’s daily duties.Objectives: Address traditional orientation gaps and improve incoming interns’ experience.Methods: We identified opportunities with our intern orientation using a quality improvement methodology. Plan Do Study Act (PDSA) cycle 1 consisted of a pilot boot camp. PDSA cycle 2 was conducted over two weeks, June 9-23, 2021, at the Detroit Medical Center, in Detroit, MI. Participation was voluntary. Residents were assigned incoming interns on a 1:1 basis. Five virtual sessions were conducted addressing: daily workflow, documentation, presentation skills, and utilization of the Electronic Health Records (EHR). All participants received pre- and post-program surveys.Results: 22 rising second-year and third-year residents (26%) and 22 incoming interns (58%) participated. There was a significant improvement in the understanding of daily workflow (mean improved by 0.957, p=0.003), and most tasks associated with EHR including comfort with the sign-out process (mean improved by 1.21; p=0.002), accessing specific team lists (mean improved by 1.75, p=0.001), writing orders (mean improved by 1.41; p=0.002), composing documentation (mean improved by 1.23; p=0.001). Writing notes improved significantly (mean improved by 0.52; p=0.04). Nearly all (93.2%) stated the program effectively achieved its overall goals and believed (92.9%) the program should be continued for each incoming class of interns.Conclusion: A targeted orientation boot camp led by near peers positively impacted the intern experience improving understanding of day-to-day responsibilities and comfort utilizing the electronic health record.

2021 IEEE International Conference on Big Data (Big Data), Intrusion Detection Systems are commonly used by organizations to monitor network traffic and detect attacks or suspicious behaviours. However, many attacks occur across organizations and are often difficult to detect using any single IDS. Collaborative Intrusion Detection Systems could lead to more accurate prediction and detection of cyber threats as well as a reduction of security administrators��� workload as similar threats from different places can be merged. However, most organizations are unwilling to disclose sensitive information about their internal network topology and traffic, lending these systems unusable. Existing solutions using homomorphic encryption and secure multi-party computation are often expensive. In this paper, we propose efficient and privacy preserving techniques to correlate alerts generated at different organizations. We propose skPrototypes, a distributed clustering algorithm for horizontally partitioned mixed data using additive secret sharing. This algorithm can be used to create a privacy preserving, collaborative intrusion detection system. We also propose dpkPrototypes which uses differential privacy on categorical attributes and is more efficient than skPrototypes for categorical attributes with many distinct values. Theoretical and experimental results validate the effectiveness of our algorithms.

There has been an accumulating evidence of association between COVID-19 (coronavirus disease 2019) infection and cardiovascular complications. We describe a case of a 58-year-old lady with a history of systolic heart failure and COVID-19 infection, who developed persistent symptomatic bradycardia, requiring pacemaker placement as unusual conductive tissue involvement of this novel coronavirus.

To claim that environmental law is heavily influenced by science is to make a rather trite assertion. Disputes about the probative value of scientific and technical evidence when used as the basis for a regulatory decision are therefore not uncommon. R. (on the application of Mott) v Environment Agency is an example of this phenomenon. In particular, the key issue was whether the Environment Agency had acted perversely (in judicial review terms) by relying on contested scientific evidence as the justification for imposing catch limitations designed to preserve salmon stocks in the river Wye. In finding for the Agency, the Court of Appeal restated and reaffirmed the established principle that decision makers ought to be afforded a wide margin of appreciation in such cases; a principle which reinforces the view that the courts are not an appropriate forum for the resolution of scientific and technical disputes. In commenting on this decision it is contended that the position of the courts in this regard has the potential to undermine the rationale of evidence-based decision making. However, it is impractical in most instances for a regulator to wait for a scientific consensus to emerge, particularly when acting to protect a threatened species. As a compromise solution, it is suggested that prior consultation at least has the potential to allow affected parties to scrutinise the available science, and offer alternative evidence prior to the final decision.

This paper argues that public consultative procedures undertaken by governments or their public services sometimes go awry because of certain confusions as to the nature and purposes of consultation. One of the most important of these is a tendency to view consultation as an exercise in policy determination by the public rather than as public input into the representative democratic process whose ultimate use is to be defined by the elected decision-makers. The result of this confusion is a tendency to misunderstand or overestimate what public consultations can achieve, and a failure to make a distinction between occasions when such consultations are useful and occasions when they must give way to explicit political contest. Three levels of activity — the technical, the transactional and the political — are analytically distinguished along with the modes of action-response appropriate to each — in order to explain and clarify the nature of good consultative practice.

In an era of democratic discontent, more and better participation in policy making has become a standard expectation. Yet it is rarely clear what counts as participation, and how the many practices loosely bundled under the label should be understood. This paper has a modest undergrowth-clearing objective: to examine assumptions behind competing typologies of participation, and to propose a classification framework less laden by idealist notions of democracy.