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Category Archives: Covid-19
Posted: June 20, 2022 at 2:00 pm
There were more positive COVID-19 cases in the Watertown School District during the 2021-22 school year than the previous year.
That's something members of the Watertown School Board learned recently during their June meeting.
In conjunction with the American Rescue Plan, we had a Safe Return to School Plan for 2021-22. It was probably much less strict than the 2021 plan, said Superintendent Jeff Danielsen.
He explained that part of theplan was that masks were optional. Changes were also made to how the school handled positive cases and close contacts.
We only kept COVID positives home, Danielsen said, not close contacts.
During the 2021-22 school year, Watertown schools saw647 COVID-19 cases, of which 525 were in students.
Compared to a total of 575 last year, we had more positives this year, Danielsen said.
There were times when the district struggled to keep classrooms staffed because there were 122 COVID-19 cases among teachers.
We saw a couple of big spikes this year, said Danielsen. In September, we had 14 staff and 96 students. Our big month was in January. We had 58 COVID-positive staff members and 250 students.
Watertown schools had to depend on their substitute teacher pool, and Danielsen said the district is again seeking substitute teacher applicants.
I want to thank the principals and staff members for helping to keep the school running. There was a lot of coverage to be done with our substitute pool, said Danielsen. We feel our year went fairly well with the reduced options this year.
Next years Safe Return to School plan will be ready closer to the start of school. The district is waiting for guidance from the federal Centers for Disease Controland the state.
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As the coronavirus disease 2019 (COVID-19) pandemic continues, it may be useful to elucidate its impact on services in the emergency department (ED). This research project aims to identify and analyze changes in patient presentations and disease severity within the ED at Hurley Medical Center (HMC) in Flint, Michigan, due to the COVID-19 pandemic.
The study is a retrospective chart review focusing on adults 18 years and above who presented to HMCs ED. The data collected for the study was obtained from patient charts from February 1, 2019, to July 31, 2019, and from February 1, 2020, to July 31, 2020. Data from the years 2019 and 2020 were analyzed using a combination of independent t-test, chi-square analysis, and regression modeling.
There were a total of 59,345 visits analyzed within the study; 33,648 ED visits within the study were in 2019 compared to 25,697 visits in 2020. There was a significant difference in patient sex between 2019 and 2020 with a larger percentage of males presenting in 2020 versus 2019 (p<0.001). Dispositions also significantly differed in 2020 compared to 2019 with more patients being admitted or dying in the ED (p<0.001). Patients who presented to the ED often presented with more severe illness in 2020 as reflected in increased length of stay in 2020 (p=0.01) and increased case mix index (p<0.001).
The COVID-19 pandemic significantly reduced the total number of ED visits to HMC in Flint, Michigan, in 2020 than in 2019. Notably, patients were more likely to have a longer length of stay, present with more severe illness, andbe admitted or die in the ED when compared to 2019. The results from this study can be used for future planning for the next public health emergency.
This article was previously presented as a meeting abstract at the 2021 ACEP Annual Scientific Meeting Research Forum on October 25-28, 2021.
The World Health Organization marked March 11, 2020, as the beginning of the COVID-19 pandemic . The state of Michigan declared a state of emergency in response to COVID-19 on March 10, 2020, and enacted a lockdown order on March 23, 2020, via an executive order from the Michigan Governors office . As the pandemic continues, there is a need to highlight the impact of COVID-19 on patients accessing services in the emergency department (ED). Current investigations highlight trends in volume, diagnoses, and disease severity. Ultimately, the current data demonstrate how COVID-19 has affected which patients are presenting and when they are presenting.
The National Syndromic Surveillance Program (NSSP) has been collecting real-time data regarding emergency department visits in the United States during the COVID-19 pandemic and comparing the data to the same time period in 2019. The NSSP data suggests that the number of emergency department visits declined by 42% during the early months of the COVID-19 pandemic; visits decreased from 2.1 million per week in March and April 2019 to 1.2 million per week in March and April 2020 . Not only did the volume of emergency department visits change, but the conditions for which patients sought treatment also changed. Eight of the most common diagnostic categories saw an increase in visits, including diagnoses related to exposure and screening for infectious disease, pneumonia, respiratory failure, and cardiac arrest . Similarly, emergency department services for opioid overdoses have also increased in regional studies . Other diagnostic categories, however, saw declines in visits. In particular, visits for abdominal pain, musculoskeletal pain, essential hypertension, and nonspecific chest pain decreased .Most concerning, however, is the steep decline in visits for acute, life-threatening conditions. NSSP data indicates a 23% decline in visits for myocardial infarction, a 20% decline for cerebrovascular accidents, and a 10% decline for a hyperglycemic crisis .
While it is clear that COVID-19 has altered the number of patients utilizing the ED and impacted what complaints people are willing to come to the ED for, data also suggests that COVID-19 has impacted the severity of presentations. In a multicenter study across five healthcare systems in five states, increases in hospital admission rates in the ED ranged from 22% to 149%, suggesting that patients were presenting with more severe concerns . While limited studies in the United States suggest that ED visits have increased in severity, other studies conducted outside of the United States also found similar results. In one international study, individuals with scores of 1 or 2 on the Canadian Triage and Acuity Scale corresponding to threat to immediate life/limb requiring resuscitation and those potentially requiring resuscitation, respectively, saw the steepest decline in ED visits in comparison to less severe triage scores . The correlation between increased disease severity upon presentation and COVID-19 is not entirely clear as other international studies found no significant difference in triage levels between pre-COVID-19 and COVID-19 .
Despite the robust data collection by NSSP, several gaps remain in the knowledge regarding COVID-19 and emergency department changes. First, the current data is largely national and regional. There are no current studies detailing the effects of the COVID-19 pandemic on emergency department visits in Michiganor communities in Michigan such as Flint. Furthermore, although data elucidating the changes in severity for emergency department visits suggests an increase in severity, some studies internationally suggest that there has been no increase in severity, perhaps indicating that severity changes are more specific to geographical locations.
This study was reviewed by the institutional review board (IRB) and was found to be an exempt study. It was a retrospective chart review study investigating emergency department patient visits. The datacollected for the study was obtained from existing information recorded in medical charts from February 1, 2019, to July 31, 2019, and from February 1, 2020, to July 31, 2020. Data were aggregated based on month, and each months data in 2020 were compared to its respective month in 2019. These six months in 2020 were chosen as this was a six-month snapshot of ED visits that reflect the impact of the pandemic at various times of viral impact in the community.
This work was conducted at Hurley Medical Center (HMC) in Flint, Michigan, a Level I Trauma Center, Level II Pediatric Trauma Center, and regional burn center that services the Genesee, Lapeer, and Shiawassee counties in Michigan. From the United States Census data, we found that Flint has a larger minority population, lower average property values, lower overall education rate, and higher poverty and unemployment rates than the national average .
The study population included adults 18 years and older. We obtained data via the health information technology (HIT) departments summary of patient medical records from emergency visits during the time period studied.
We aggregated yearly data on demographic variables in terms of sex and race, severity markers such as length of stay hours, and case mix index from the EPIC electronic medical record system. Diagnoses through the categorization of ICD-10 codes were also collected. Each of these elements was compared between data collected in February 2019-July 2019 and February 2020-July 2020. Data were analyzed using an independent t-test and chi-square, as appropriate, using SPSS version 27.0(IBM Corp., Armonk, NY, USA).
There were a total of 59,345 visits analyzed within the study, of which 33,648 ED visits occurredin 2019 compared to 25,697 visits in 2020 (Table 1).
There was a significant difference in patient sex between 2019 and 2020 with an increase in males in 2020 at 47% (n=12,067) in comparison to 2019 at 44.2% (n=15,025). However, there was a decrease in the presentation of females in 2020 at 53% (n=13,630) in comparison to 2019 at 55.8% (n=18,791). There was no statistical difference in the presentation of racial demographics between 2019 and 2020 (Table 2).
The length of stay and case mix index were used as proxy indicators of severity, which displayed a statistically significant increase in 2020. The average length of stay was measured at 6.97 hours in 2020 in comparison to 6.81 hours in 2019. Additionally, the case mix index was 1.93 in 2020 in comparison to 1.65 in 2019 (Table 3). There were also statistically significant changes in disposition with an increase in patient admissions, discharges, and deaths but a decrease in disposition to skilled nursing facilities (Table 4).
Multiple ICD-10 diagnoses differed between 2019 and 2020. There was an increase in the percentage of infectious diseases, COVID-19, and pneumonia. Respiratory failure/insufficiency/arrest increased in comparison to 2019 (4% (n=1,035) in 2020 versus 2.9% (n=989) in 2019). There was also an increase in nausea/vomiting and generalized signs and symptoms at 8.2% (n=2,107) and 3.7% (n=942) in comparison to 2019 at 6.9% (n=2,320) and 3.2% (n=1,089).
In addition, there was an increase in patients with socioeconomic factors and mental health diagnoses. Socioeconomic factors increased to 1.8% (n=437) in 2020 from 1.6% (n=542) in 2019, and mental health increased to 4.5% (n=1,161) from 4.1% (n=1,376).
An increase in patients with a history or family history of chronic disease and disorders of lipid metabolism was also seen in 2020. In addition, 24.8% (6,373) of the patients with a personal or family history of chronic disease and 6.5% (n=1,660) of patients with disorder of lipid metabolism presented to the ED in 2020 in comparison to 22.9% (n=7,691) and 5.8% (n=1,941) in 2019 (Table 5).
There was a significant increase in indicators of severity such as emergency department length of stay, overall admissions to the hospital, and case mix index (CMI) in 2020 when compared to 2019. There was a statistically significant difference in patient presentation in 2020 by sex, but not by race. In regard to patient disposition, there was a statistically significant increase in the percentage of hospital admissions, discharges, and deaths in 2020 compared to 2019. There was a statistically significant decrease in the number of patients discharged to skilled nursing facilities in 2020 compared to 2019.
The diagnoses for which individuals visited the emergency department also varied between 2019 and 2020. There was a statistically significant increase in the percentage of infectious disease, COVID-19, generalized symptoms, pneumonia, respiratory failure/insufficiency/arrest, patients with socioeconomic factors, mental health, nausea/vomiting, and myocardial infarction presentations in 2020 compared to 2019.
Despite increases in the percentage of the diagnoses listed above, there was an overall decrease in the number of patients presenting with the above diagnoses except for COVID-19, pneumonia, and respiratory failure/insufficiency/arrest. There was a statistically significant decrease in the percentage of sprain, unspecified injury, urinary tract infection, and sexually transmitted infection presentations in 2020 compared to 2019.
This study is the first of its kind to study the impact of COVID-19 on patient presentations to the emergency department in our region in Michigan. The information gathered from this study can be used to prepare the emergency department and downstream hospital operations for subsequent public health emergencies.
Our data further suggestthat there was no statistically significant decline in time-sensitive emergencies for myocardial infarction, cerebral infarction, or cardiac arrest despite the constraints of COVID-19. Further work should be directed to investigate the interplay between the social determinants of health in Flint, Michigan, and the safety net in place at HMC in the context of COVID-19.
Due to the large sample size of the study, it is difficult to visualize substantial changes in patient presentations using percentages alone. When analyzing large numerical populations, it is observed that small percentage changes represent hundreds of patients. Variable percentages may also be attributed to the decrease in patient presentations in 2020 due to COVID-19.
Our study compared data from February 1, 2019, to July 31, 2019, and February 1, 2020, to July 31, 2020. Therefore, the conclusions and discussion made reflect only part of the ongoing COVID-19 pandemic. Additionally, this study evaluated emergency department hospital visits at a single hospital in Flint, Michigan. Thus, this data is specific to the local population and may not indicate what other hospitals or geographic areas are experiencing in Michigan or the United States. Lastly, one investigative measure, severity, may not be directly comparable to other studies looking at ED visit severity as there are other markers to assess for severity.
During the first major wave of COVID-19 at Hurley Medical Center in Flint, Michigan, emergency department visits dropped approximately 13% compared to the previous year. However, patients who did present to the emergency department were found to be sicker and tended to get admitted to the hospital. Unlike previous research on this topic, the rate of time-sensitive emergencies (myocardial infarction, stroke, and cardiac arrest) remained flat despite COVID-19 constraints.
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The COVID-19 pandemic has not only affected peoples health, but also their economic security, mental well-being and ability to work.
To shed light on the pandemics adverse impacts across multiple dimensions beyond the direct effects of COVID-19 itself, the University of Hawaii Economic Research Organization is debuting its first quarterly public health report.
The report, Health Effects and Views of COVID-19 in Hawaii, takes a detailed and comprehensive look at numerous aspects of the pandemic how it has affected peoples jobs, their ability to buy food and their mental well-being, as well as how vaccination status factors into the picture.
It looks at a variety of impacts on public health, which obviously impacts economics, said Ruben Juarez, an economics professor at the UH Manoa College of Social Sciences. Its just a start at this point. Im hoping this will service policymakers and the community to continue the conversation with stakeholders on what strategies we need to move forward.
The report is based on survey responses from a cohort of more than 2,000 Hawaii adults from across the state in May, when the state was in the midst of its fourth wave of COVID-19 cases, according to Juarez, also UHEROs HMSA Endowed Professor of Health Economics.
UHERO put the cohort together in partnership with the state, and will be conducting monthly surveys following the same individuals for a long period of time.
What the report found is that the pandemic has had a significant, negative impact on much of the population two out of every three people surveyed.
It also has caused economic hardship, with about 23% of respondents reporting that their savings were depleted due to the pandemic, while about 15% say they were unable to pay their bills, 9% lost their jobs and 8% did not have enough food for their household.
Additionally, 12.5% reported having been furloughed or having their work hours reduced.
In other aspects of life, nearly 18% reported troubles with the education of their children and 8.7% had trouble with child care.
There was also personal loss, with 12.4% reporting a close friend who died and 9.2% reporting the loss of a family member due to COVID-19.
Accessing medical care, however, did not seem to be a major concern, with only 2.6% saying they were unable to get medical care for serious problems for themselves and 3% saying they were unable to get medical care for serious problems for their family members.
The pandemic took a toll on mental health, as well, with one out of every three residents surveyed reporting some symptoms of depression. Even more alarming, 4.2% of survey respondents said they had contemplated suicide during the past year.
UHERO also found that 31.3% of respondents that tested positive for COVID were suffering from long COVID, or long-term symptoms following the infection.
The most common symptoms were cough and shortness of breath, followed by extreme fatigue, mental fog and headaches.
Of those suffering from long COVID, about half reported symptoms that were medium to severe.
This potentially affects the size of Hawaiis workforce when many sectors of the economy are struggling from staffing shortages, said Juarez.
The report also takes a dive into the characteristics of those who remain unvaccinated, including where they get their sources of information on the pandemic, and how they are faring.
The unvaccinated tend to be younger, the report found, with a higher percentage among those in their 30s than those ages 50 and older.
Also, the higher the level of education, the more likely individuals were to be vaccinated, the survey found. Individuals with an advanced or bachelors degree reported very low rates of being unvaccinated, at 3% and 4%, respectively. The highest percentage of those unvaccinated, 41%, had no high school diploma.
Those who were unvaccinated tended to get more of their information from social media and faith leaders than from medical providers, government sources or the Centers for Disease Control and Prevention.
There continue to be disparities among ethnic groups, and the highest percentage of unvaccinated in the state at 21% are Pacific Islanders.
This could be useful for the state Health Department, said Juarez, in refining its messaging or target strategies for vaccination outreach.
Those who remain unvaccinated tended to experience greater hardship, food insecurity and depression, the survey found, likely reflecting socioeconomic disparities.
Most respondents, about 58%, saw the current impact of COVID-19 on their life as a health concern, while about 31% found it to be more of an inconvenience; 7% found it to be neither, and about 4% were unsure how it affects them.
Should there be another large COVID-19 wave, the majority of respondents, 92%, expressed a willingness to wear a mask in indoor public spaces.
In a separate question, however, 8.2% said they believed the pandemic was already over.
The May survey included 2,030 adults statewide, with a higher proportion of females, at 62%, and age range of 18 to 70 and above. More than 40% were ages 60 or older. The sample cohort was also more educated than the state as a whole.
Of those surveyed, about 25% had reported testing positive for COVID.
The report noted that the data has limitations, and that participants who self- report can provide more socially desirable answers.
UHERO conducted the surveys in partnership with the Pacific Alliance Against COVID-19. The surveys are supported, in part, by federal coronavirus funding.
Juarez said in coming months the surveys will offer a better understanding of the states public health issues, document changes over time and offer insight into new challenges that may arise.
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The number of residency applications submitted by medical students has risen at an alarming rate, causing increased cost of applications and subsequent interview travel. These both contribute to increased cost for medical students. In light of these concerns, specialty governing bodies have proposed ideas to fight these trends including, application limits, interview limits, using a preference signaling system, and continuing virtual interviews. During the Covid-19 pandemic, all residency interviews were performed virtually, essentially making travel expenses negligible. However, this created a new concern with regards to assessing program and applicant compatibility, as compared to in-person interactions and did nothing to combat the increases in application numbers.Therefore, we want to critically assess the effects of virtual interviews on number of applications submitted, number of interview invites received, and number of interviews attended. We also aim to analyze how applicants viewed the virtual process.
600 medical students were eligible to participate. 456 students from years 2018-2020 were eligible to be surveyed following the NRMP match. 144 students were eligible to be surveyed following 2021 NRMP match. The survey was distributed to medical school graduates just prior to graduation andasked how many programs each student applied to, how many interview invites they received, and how many interviews they attended. The 2021 survey also asked, How did virtual interviews affect your interview experience? The quantitative results were compared with student's t-test and qualitative results are presented below.
The averagenumber of programs each applicant applied to increased from 35.4 to 47.7(p-value=0.002) when residency interviews switched from in-person to virtual. However, interview invites received and interviews attended did not change (16.8 vs 16.3, p-value=0.91, 11.8 vs 12.7, p-value=0.18). There were 188 participants in the in-person interview group (response rate=41.2%) and 128 participants in the virtual interview group (response rate=83.3%). The standard deviation and range also increased for number of applications, number of interview invites received, and number of interviews attended.
There were 123 responses to the free response question. 36 had a positive experience, 44 were neutral, 47 were negative. The positive themes included 15 noted less expenses, 18 noted more convenient/less time, and 18 were able to attend more interviews. Negative themes included, 38 noted difficulty assessing program fit, 19 wanted to see the program or city in person, eight had increased interest in home/local programs, six found it difficult to make connections or stand out.
Sixty-three percent of students reported a positive or neutral experience with virtual interviews. Students applied to more programs when interviews were virtual, but did not receive more interview invites or attendmore interviews. These results suggest that virtual interviews are sufficient to conduct residency interviews, however the number of applications continues to rise with no increase in the number interview invites received or number of interviews attended. The increase in the standard deviation and range for all three variables may point to some applicants being able to get more invites and attend more interviews leaving less available spots for other applicants.
Medical students are currently applying to more residency programs than they ever have before, and we are continuing to see an increase each year [1,2]. Increased application numbers can be fueled by a fear of not matching and can lead to increased costs for students [1,3]. During the 2020-2021 Electronic Residency Application Service (ERAS) cycle, due to the Covid-19 pandemic, the Association of American Medical Colleges (AAMC) recommended doing all interviews virtually .
Subsequently, changes have been proposed for upcoming interview cycles, including continuing with virtual interviews, and implementing application/interview limits, in an attempt to maximize efficiency and minimize cost [1,5,6]. However, one concern for students is they may have adequate exposure to programs, allowing them to confidently make an informed decision.Applicants thoughts on virtual interviews have been an emerging research topic in an attempt to obtain guidance on the ideal process for future interview cycles .
While the trend of increased application numbers for individual specialties has been published [8-16], the comparison between applications, interview invites, and interviews attended across the spectrum of virtual and in-person interviews has not been examined.
This study aims to identify variations between the number of residency applications completed, interview invites received, and interviews attended during the two separate styles of interviews: virtual and in-person. We also aim to summarize applicants thoughts and feelings toward virtual interviews, identifying themes that may lead to future improvements.
All graduating medical students from the years 2018 to 2021 were eligible to participate (601 students). For the in-person interview group, 457students from the years 2018 to 2020 were invited to participate in this study following the National Resident Matching Program (NRMP) match. For the virtual interview group, 144 students were invited to participate in this study following the 2021 NRMP match. No participants were excluded from the study other than those that chose not to complete the survey.This study was reviewed by the University of Iowa Institutional Review Board at a single United States allopathic medical school and granted IRB exemption due to the survey nature of the study (IRB number: 201308718). Informed consent was waived by the IRB, however, it was readily available for all participants.
This is a retrospective cohort study with the experimental groups being the in-person interview group and virtual interview group. We retrospectively reviewed the data following the match process and participants were separated into the two experimental groups according to their graduation year and the type of interviews that they underwent i.e., in-person interviews for the batch of 2018 to 2020 or virtual interviews for the batch of 2021.
Paper surveys were distributed to participants when they picked up their graduation materials by members of the research team. They were completed and returned immediately. All surveys asked, the number of programs each student applied to, interview invites received, and interviews attended. The 2021 survey also asked, How did virtual interviews affect your interview experience? The survey responses were reviewed by the research team and deidentified in an excel database. The quantitative data was recorded as numerical values. The qualitative data was recorded exactly as the participant had written it for further analysis. The qualitative free response answers were categorized into positive, negative, or neutral responses as well as seven emerging themes. Each response could have more than one comment classified to each theme. If a student listed a positive and negative response, then it was classified as neutral. Each response was classified as a single data point as positive, negative, or neutral. Then all other comments were treated individually totaling 124 individual data points. Any responses that simply stated, virtual interviews were not good, virtual interviews had no effect, or virtual interviews were good, were only classified as negative, neutral, or positive accordingly, and not included in themes analysis. The themes that were considered positive were fewer expenses, more convenience/less time, and the ability to attend more interviews. Negative themes included difficulty assessing program fit, wanting to see more of the city/hospital, increased interest in home/local programs, and difficulty making connections/standing out. Assigning comments to positive, negative, or neutral and developing themes was performed independently by two authors (AM, AH). Any discrepancies were discussed, and an agreement was obtained.
We compared the number of programs applied to, interview invites received, and interviews attended for the in-person interview cohortto the virtual interview cohort using Students t-test. Statistical analysis was performed using Stata 19 (College Station, TX). Qualitative data was only available for the virtual interview cohort, therefore it is discussed and displayed visually in the results section.
Response rates for years 2018 to 2020 were (188/457) 41.1%, and 83.3% (124/144) for 2021. There were no differences in age, gender, or ethnicity between the two experimental groups (Table 1). There was an increase in the number of programs applied to in the virtual interview group. This group applied to an average of 47.7programs per applicant compared to 35.4 programs per applicant for the in-person interview group. There was no difference in the number ofinterview invites received between the virtual interview group and the in-person interview group (16.3 vs 16.8 p-value=0.91) (Table 2). There was also no difference in the average number of interviews attended in the virtual interview group compared to the in-person interview group (12.7 vs 11.8 p-value=0.18)(Table 2).
There were 128 responses to the free-response question (response rate=128/144, 88.9%). Thirty-six had a positive experience, 44 were neutral, and 48 were negative (Figure 1). Therefore, 62.5% of respondents noted a positive or neutral experience with virtual interviews.Of the 128 overall responses, 124 comments were categorized into either one of the three positive themes or one of the four negative themes. The positive themes included 19 noting fewer expenses/cheaper, 18 noted more convenient/less time, and 17 were able to attend more interviews (Figure 2). Negative themes included 36 indicating difficulty assessing program fit, 22 wanted to see the program or city in person, six had increased interest in home/local programs, and six said it was difficult to make connections or stand out (Figure 2).
We saw an increase in the number of applications submitted during virtual interviews, but we did not see an increase in interview invites received or interviews attended. As mentioned above, this was likely because interview invites are a relatively fixed variable. We postulate that applicants likely were aware of the upcoming decreased cost of virtual interviews and may have already set aside or borrowed funds to complete the interview cycle, therefore allowing more spending on the total number of submitted applications. Even with a slight increase in application fees, the process was considerably cheaper than in prior cycles. This further supports the recommendations for application limits, as the increase in applications had diminishing returns, as it did not result in increased interview invites or interviews attended [1,5,6].As mentioned above, it can be disadvantageous to many students.
Overall, almost two-thirds of participants reported a positive or neutral experience with virtual interviews. Therefore, in conjunction with the decreased time and cost, and consistent with other published findings , virtual interviews may be a reasonable option for future interview cycles. The most prevalent positive responses were fewer expenses, more convenient/less time commitment, and the ability to attend more interviews.
The decreased expenses are expected and primarily due to the lack of travel expenses. Fogel et al. found that the expenses for each typical orthopedic surgery residency interview were $250 to $499. Around 13% of those study participants spent more than $7,500 on interviews, and 41% stated they declined interviews due to financial reasons . Additionally, Blackshaw et al. found that each in-person emergency medicine residency interview costs an average of $342 for an average total of $8,312 on applications and interviews . Orthopedic surgery, neurosurgery, emergency medicine, ophthalmology, internal medicine, radiology, and otolaryngology have all published papers highlighting the increased cost of applying to residency in each of their particular specialties [8,10-12,16,18,19]. Continuing virtual interviews certainly will decrease the financial burden placed on students.
Along with the cost savings, many respondents reported increased convenience and decreased time commitment with virtual interviews. These findings are associated with students reporting the ability to attend more interviews. This was classified as a positive in this study since more interviews will likely increase the likelihood of an applicant matching a residency position. However, as demonstrated by Whipple et al., while applying for more programs can be advantageous for one applicant, it can be a disadvantage to the group of applicants, overall.When the entire cohort applies to more programs the benefit of increased matching likelihood is lost, yet the overall cost is increased . They found when all applicants applied to the maximal number of programs it led to a poorer result for the majority of students. These findings make sense because if one applicant applies to more programs than the other applicants, they are more likely to receive more interviews. If they receive more interviews, they can have a longer rank list thus increasing their chance of matching to one of those programs. However, the total number of interview slots available is relatively fixed. If stronger applicants complete more interviews, they may cause the undesired effects of decreasing the number of interviews available for average or below-average applicants, therefore decreasing their likelihood of matching into their desired specialty.For example, if a strong applicant is now able to attend 20 instead of 15 interviews, another applicant who previously may have received and attended 10 interviews may now only receive five interviews. In both theoretical scenarios, the average is unchanged at 12.5 interviews, but the applicant with more interviews and a longer rank list is more likely to match.As seen in our study, the average number of interviews attended for in-person and virtual interviews was similar. This was in the context of multiple students reporting being able to attend more interviews, yet the average number of interviews remained the same. This phenomenon of some students getting more interviews while some receiving fewer occurred in our study population, as seen with the much larger standard deviation and range during virtual interviews (Table 2). These findings are the basis of capping residency interviews at 12 per applicant, as proposed by Morgan et al. . We find this to be one of the most concerning issues with virtual interviews as they currently are being conducted. Averagebut competitive applicants may not match within the current algorithm just because they were unable to receive the same number of interviews as they previously might have during in-person interviews.
The negative aspects of virtual interviews demonstrated in this study are difficulty assessing program fit, wanting to see the program or city in person, increased interest in home/local programs, and difficulty in making connections or standing out. Assessing fit may be the more difficult item to rectify using virtual platformsdue to the lack of organic in-person interactions. One potential solution to this issue is one round of virtual interviews, followed by another round of in-person interviews . The opportunity to see more of the city or hospital facilities is an easier obstacle to overcome.With additional time and careful planning, programs may be able to provide more adequate videos and photos of the hospital facilities and surrounding city. Some programs such as the Rutgers New Jersey Medical School Med-Peds residency program are using virtual reality with 66% of respondents stating that virtual reality was superior or non-inferior to in-person tours . We classified increased interest in home/local programs as a negative responsebecause it likely decreases diversity in residency programs. A lack of diversity in medical training has been highlighted in both orthopedic and otolaryngology literature [23,24]. Therefore, in an attempt to continue to decrease these disparities, we classified it as a negative response in our survey. These obstacles can be addressed by interviewing more applicants from other regions and other medical schools. However, before virtual interviews, as shown by Loh et al., students were already more likely to match in the same region they attended medical school . The final negative response students reported was difficulty making connections or standing out. However, as students may feel this is a concern, each student is given more equal opportunity for total virtual face time, as compared to informal dinners and gatherings.Additionally, some students may have similar feelings about in-person interviews. There is also published literature by Sarac et al. on how to optimize the virtual interview experience and how to best prepare . Therefore, we feel like this is a real, but correctable concern with virtual interviews.
A potential limitation to this study is the classification of positive, negative, or neutral responses. For one student, increased interest in home/local programs may be positive, while for another it may be negative. We also classified responses with a positive and negative theme as neutral responses. For example, decreased cost and difficulty assessing fit were both positive and negative responses, respectively, which were analyzed as such and were also included in the neutral group. For each student, these factors hold different weight, and it is impossible to accurately discern how much each factor plays into a students decision. In the future, we want to examine the trends over time with a larger multi-institutional study population.
In conclusion, conducting virtual interviews correlated with an increased number of residency program applications, but not an increased number of interview invites nor interviews attended. Overall, most applicants felt the virtual interviews did not cause a negative interview experience and saved considerable expenses. Therefore, we conclude that with concentrated efforts to improve concerns identified in this study such as assessing fit and being able to see more of the hospital/city even virtually, virtual interviews are an effective method for conducting residency interviews.
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Posted: at 2:00 pm
A new COVID-19 testing site has opened in Windsor amid rising positivity rates in Weld County.
The site, operated by Curative, is open 9 a.m. to 3:30 p.m. weekdays at Eastman Park.The location offers PCR and antigen testing.
Insurance is required, but there is also a self-pay option available at the site for those who would like to be tested without insurance. A lab-based PCR cost $99 for patients who opt for self-pay, while there is no cost to the insured patients.
If the patient does the self-pay, the cost for the Lab-based PCR is $99. If they have insurance, there is no cost to the patient as we will bill the insurance.
Weld Countys one-week cumulative incident rate per 100,00 residents is at 201.9 with 664 new cases reported in the last week, according to Weld County COVID-19 data.
The countys one-week average positive test rate is 12.11% up from 10% two weeks ago a significant spike since the positive test rate of 4.92% in the second to last week in April.
In January 2021, the U.S. Food and Drug Administrationreleased an alert about the risk of false results, particularly negative, with the Curative SARS-Cov-2 test. Curative testing sites have since halted the use of the tests.
The companys two sites in Greeley a kiosk at the University of Northern Colorado and a drive-thru in west Greeley also stopped testing patients with the Curative SARS-Cov-2 test due to the alert.
To make an appointment, go to curative.com.
Sub-Woofer Market Forecast to 2028 – COVID-19 Impact and Global Analysis By Application and End-user – Yahoo Finance
Posted: at 2:00 pm
The global sub-woofer market is expected to grow from US$ 834. 77 million in 2021 to US$ 1,132. 62 million by 2028; it is estimated to register a CAGR of 4. 5% during 2021-2028. A sub-woofer is used for various applications such as home audio, cinema sound, car audio, sound reinforcement, outdoor entertainment, and others.
New York, June 20, 2022 (GLOBE NEWSWIRE) -- Reportlinker.com announces the release of the report "Sub-Woofer Market Forecast to 2028 - COVID-19 Impact and Global Analysis By Application and End-user" - https://www.reportlinker.com/p06232610/?utm_source=GNW The requirement for sub-woofers is growing with the increasing number of public meetings, stand-up comedy shows, and cinema halls.
Shifting preferences and changing consumer lifestyle toward using on-board infotainment systems in ride-hailing services is anticipated to create promising opportunities in the sub-woofer market.
The sub-woofer market is segmented into application, end-user, and geography.Based on application, the sub-woofer market is segmented into car audio, home audio, cinema sound, sound reinforcement, and others.
In 2020, home audio segment held the largest share in the market.In terms of end-user, the sub-woofer market is segmented into residential and commercial.
In 2020, the commercial segment accounted for a larger share.Geographically, the market is broadly segmented into North America, Europe, Asia Pacific (APAC), the Middle East & Africa (MEA), and South America (SAM).
In 2020, Asia Pacific accounted for a significant share in the global market.
During the COVID-19 pandemic, the sub-woofer industry came to a halt due to minimal resources.The temporary shutdown of the manufacturing units has negatively impacted the growth of the sub-woofer market across the globe and has created many uncertainties in the stock market, decline in the supply chain, falling business confidence, and growing panic among consumers.
Due to the unusual coronavirus outbreak, the production and supply chain procedures have been halted.Also, the research and development (R&D) exercises of key players have been halted across the globe.
The sale of sub-woofer has been decreased during the Covid-19 outbreak due to the operational constraints on sales channels such as specialty stores and e-commerce platforms. Nonetheless, certain manufacturing firms have restarted their plans and prepared to owe to the rests imposed on the restrictions, by the government bodies, in several regions.
In 2020, the US witnessed most severe impact of COVID-19.Sub-woofer manufacturers and service providers were affected due to nationwide lockdowns, travel restrictions, shutdown of production facilities, and shortage of employees.
The pandemic led to health and economic crises in the US.Moreover, it led to disruptions in the consumer electronics industry, impacting various aspects such as supply chain, manufacturing, and sales.
The pandemic has directly and indirectly affected the sub-woofer market, and it is expected to witness growth with decreasing COVID-19 cases.
The overall sub-woofer market size has been derived using both primary and secondary sources.Extensive secondary research has been conducted using internal and external sources to obtain qualitative and quantitative information related to the market.
The research also serves the purpose of obtaining an overview and forecast of the sub-woofer market with all the segments.It also offers an overview and forecast of the market based on the segmentation provided concerning five major regionsNorth America, Europe, Asia Pacific, Middle East & Africa, and South America.
Also, primary interviews were conducted with industry participants and commentators to validate data and gain more analytical insights into the topic. The participants of the research include VPs, business development managers, market intelligence managers, and national sales managersalong with external consultants such as valuation experts, research analysts, and key opinion leadersspecializing in the sub-woofer market.
Dynaudio A/S, K-Array, Harman International, Sony Corporation, SV Sound, Pioneer India Electronics Pvt. Ltd., Paradigm Electronics Inc., LW Speakers professional sound systems, Klipsch Group Inc., and JVC Kenwood Holdings Inc are among the few companies operating in the global sub-woofer market.Read the full report: https://www.reportlinker.com/p06232610/?utm_source=GNW
About ReportlinkerReportLinker is an award-winning market research solution. Reportlinker finds and organizes the latest industry data so you get all the market research you need - instantly, in one place.
Automotive Backing Plate Market Forecast to 2028 – COVID-19 Impact and Global Analysis By Brake Types, Brake Material Type, and Vehicle Type -…
Posted: at 2:00 pm
New York, June 20, 2022 (GLOBE NEWSWIRE) -- Reportlinker.com announces the release of the report "Automotive Backing Plate Market Forecast to 2028 - COVID-19 Impact and Global Analysis By Brake Types, Brake Material Type, and Vehicle Type" - https://www.reportlinker.com/p06279418/?utm_source=GNW However, air enters the compressor via an air filter and is sent to the reservoir by an unloader valve. It then enters the brake chamber via a brake valve, which is used to adjust the amount of braking. Most automobiles include servo braking systems meant to increase the amount of pressure the driver delivers to the brake pedal. The system uses a vacuum in the intake manifold to create the excess pressure necessary for the brake to work. Furthermore, the mechanisms are only functional when the engine is turned on.
When an EV driver releases the accelerator pedal during regenerative braking, the power flow from the battery to the motor is discontinued.However, the spinning component of the engine (the rotor) continues rotating in tandem with the wheels of the still-moving automobile.
Without a constant supply of electricity from the battery, the motor transforms into a generator, transferring kinetic energy from the spinning rotor to the battery, while resistance to the rotor slows the vehicle.Regenerative braking is a new technique that has been in use for over a century, although research continues to improve its efficiency.
Improvements to batteries will enhance the amount of energy that regenerative braking can store.Supercapacitor advancements will also improve braking efficiency.
Regenerative braking is most effective at higher speeds and on long downhill since more kinetic energy is available to be converted. Continued research on regenerative braking system can reduce the energy loss in the braking process to make electric vehicles more efficient, economical, and environmental-friendly. The continuous advancements in regenerative braking systems provide lucrative opportunities for the growth of the automotive backing plate market during the forecast period.
When a driver rapidly applies the brakes to a moving automobile, the wheels are likely to become stuck owing to the sudden braking force and slide on the road.Even if the driver acts swiftly, the automobile will be out of the drivers control.
The anti-braking system (ABS) keeps the wheels from locking and instead applies intermittent braking power to allow the wheels to spin slightly.This significantly improves the cars braking effectiveness and enables the driver to guide the vehicle away from the obstacle while braking strongly.
Electronic brake-force distribution (EBD) ensures that brake force is distributed to the wheels as per road conditions and the drivers needs.Speed sensors are used to detect the velocity of the wheels and automobile.
The data is transmitted into the ECU, continually comparing the two numbers. When it detects slippage caused by the wheels higher speed than the cars speed, it transmits the instruction to apply a slight braking force to the sliding wheel. This function determines which wheel requires more braking force and delivers it to that wheel independently. These features lead to the growth of the automotive backing plate market.
An automated braking system is a vital component of car safety technology.It is a powerful system specifically designed to either prevent or limit the speed of a moving vehicle before a collision with another vehicle, a pedestrian, or any other barriers.
These systems employ sensors, such as radar, video, infrared, or ultrasonic, to identify potential objects in front of the vehicle and then use brake control to avoid a collision if the item is identified.An automated braking system can also communicate with a vehicles GPS and utilize its database of stop signs and other traffic data to apply the brakes in time if the driver fails to do so.
For instance, Subarus EyeSight system uses video input in the form of two-color cameras mounted at the top of the windshield to look for contrast with the background and vertical surfaces when scanning the area.The software can then recognize different images, including pedestrians, motorcycles, and rear ends of other vehicles.
These advantages of the automatic braking system will propel the automotive backing plate market.
The automotive backing plate market across the globe continues to grow year-on-year, exhibiting a steady growth rate.The region is concentrated with leading automakers and tier 2 & small vehicle manufacturers.
The economic rise in the region positively impacts the consumption pattern of passenger cars.The automotive backing plate market for premium cars is constantly increasing in North America, owing to steady economic progression.
Due to the increasing demand from North American consumers, the automakers in the region are increasing their production lines.The automotive backing plate market is rising as automakers must comply with strict emission norms.
For instance, the US Department of Energy has approved more than ~US$ 8 billion in loans to support the automobile sector through the advanced technology vehicles manufacturing (ATVM) program, which has assisted firms in redesigning their vehicle parts for improved fuel efficiency, owing to the growth of automotive backing plate market in the region.
Key companies in the automotive backing plate market include Super Circle, NUCAP, MAT Foundry Group Ltd., INDUS Marmara Auto Components Pvt Ltd., Dorman Products, Ridex GMBH, ORTLINGHAUS-WERKE GmbH, Sparex, RSB Tech Solution, and ACDelco. The report also comprises secondary research on other companies that hold a significant share of the automotive backing plate market.
The overall size of the automotive backing plate market has been derived using both primary and secondary sources.To begin the research process, exhaustive secondary research has been conducted using internal and external sources to obtain qualitative and quantitative information related to the automotive backing plate market.
The process also serves the purpose of obtaining an overview and forecast for the automotive backing plate market with respect to all the market segments.Also, multiple primary interviews have been conducted with industry participants to validate the data and gain more analytical insights into the automotive backing plate market.
The participants of this process include industry experts such as VPs, business development managers, market intelligence managers, and national sales managersalong with external consultants such as valuation experts, research analysts, and key opinion leadersspecializing in the automotive backing plate market.Read the full report: https://www.reportlinker.com/p06279418/?utm_source=GNW
About ReportlinkerReportLinker is an award-winning market research solution. Reportlinker finds and organizes the latest industry data so you get all the market research you need - instantly, in one place.
Posted: May 27, 2022 at 2:15 am
LONDON (AP) The number of new coronavirus cases and deaths are still falling globally after peaking in January, the World Health Organization said.
In its latest weekly assessment of the pandemic, the U.N. health agency said there were more than 3.7 million new infections and 9,000 deaths in the last week, drops of 3 percent and 11 percent respectively. COVID-19 cases rose in only two regions of the world: the Americas and the Western Pacific. Deaths increased by 30 percent in the Middle East, but were stable or decreased everywhere else.
WHO said it is tracking all omicron subvariants as variants of concern. It noted that countries which had a significant wave of disease caused by the omicron subvariant BA.2 appeared to be less affected by other subvariants like BA.4 and BA.5, which were responsible for the latest surge of disease in South Africa.
WATCH: What you should know about rapid antigen tests
Salim Abdool Karim, an infectious diseases expert at the University of KwaZulu-Natal, said it appeared that South Africa had passed its most recent wave of COVID-19 caused by the BA.4 and BA.5 subvariants; the country has been on the forefront of the pandemic since first detecting the omicron variant last November.
Karim predicted that another mutated version of omicron might emerge in June, explaining that the large number of mutations in the variant meant there were more opportunities for it to evolve.
Meanwhile in Beijing, authorities in the Chinese capital ordered more workers and students to stay home and implemented additional mass testing Monday as cases of COVID-19 continue to rise. Numerous residential compounds in the city have restricted movement in and out, although lockdown conditions remain far less severe than in Shanghai, where millions of citizens have been under varying degrees of lockdown for two months.
China is vowing to stick to a zero-COVID policy despite the fact that the WHO describes the policy as unsustainable, given the infectious nature of omicron and its subvariants.
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COVID-19 numbers 26 times higher than going into last Memorial Day weekend – The San Diego Union-Tribune
Posted: at 2:15 am
San Diego Countys latest coronavirus numbers show that a persons chances of getting infected this Memorial Day weekend will be much greater than they were one year ago.
Daily case counts updated Thursday afternoon show that there were 1,897 new cases reported Wednesday, nearly 26 times the 73 reported on the same day in 2021. COVID-19-related hospitalizations are also increasing, though at a much slower pace than was the case during the Delta variant surge last summer.
Last year, the states reopening system was still in effect for what is traditionally seen as the start of the summer vacation season. Masks were still required, and some types of businesses and entertainment venues were still closed.
This year, its just the opposite. Everything is open, and masks are not required, even on planes and other forms of shared transportation.
The differences were an unspoken part of a coronavirus-themed news event Thursday organized by county Supervisor Nathan Fletcher and San Diego Councilmember Jennifer Campbell.
While many hours have been spent counseling the public to wear masks and avoid crowds over the last two and a half years of the pandemic, nobody reiterated those messages during Thursdays prepared remarks.
There seemed to be a tacit understanding among the politicians and health care experts who took the podium that the public is going to do what its going to do over the next few days. Those planning to attend parties are not likely to cancel their plans over coronavirus. Those who have remained concerned likely have already limited their social calendars and are already wearing masks when in public places.
But with coronavirus spreading as readily as it has been, it appears inevitable that further increases in new infections will be likely in the coming weeks and months, especially as new variants first spotted overseas appear on the West Coast.
Those who do end up getting sick, experts said, need to understand that they can significantly improve their odds of having a mild coronavirus encounter if they understand and seek out drugs shown to greatly reduces the chances of hospitalization and death if they are taken early enough in the course of illness.
County treatment centers currently offer two different medications capable of preventing the virus from replicating itself after it enters the body, greatly reducing the chances of severe COVID-19 consequences.
Paxlovid, an antiviral medication made by Pfizer, is in pill form and must be taken within five days of symptoms appearing while monoclonal antibody Bebtelovimab must be administered intravenously within seven days.
Treatment is effective and its available, said Dr. Jennifer Tuteur, the countys deputy chief medical officer. If youre at risk of getting severe complications from COVID, please access treatment for yourself and your loved ones.
These drugs remain available only to those said to be at an elevated risk of severe COVID-19 complications. Anyone age 65 years and older is eligible as is anyone with a compromised immune system or a chronic disease such as diabetes, chronic kidney, liver or heart disease, mental health disorders such as depression or schizophrenia, and neurologic conditions such as dementia.
Current and former smokers are also included as is anyone with a body mass index of 30 or greater (180 pounds for a person who is five feet, five inches tall). A full list of qualifying conditions is available from the U.S. Centers for Disease Control and Prevention, though Tuteur urges anyone who thinks they might qualify to discuss the situation with their doctor first.
Appointments are available seven days per week by calling 619-685-2500 or visiting coronavirus-SD.com.
Campbell said she recently became quite ill with a coronavirus infection and received a monoclonal treatment, avoiding progression of the disease.
Whether you have been infected after you were vaccinated and boosted, or whether you were not vaccinated, it doesnt matter, you can still come in and get treatment, Campbell said.
Overall, daily new-case totals have remained over 1,000 in six of the past seven days, according to county records, falling from the 1,578 new cases reported on Tuesday, May 18, to only 917 Tuesday before jumping back up to 1,897 Wednesday.
Total local hospitalizations fell below 100 on May 1 but have gradually risen over the past month, reaching 180 Wednesday.
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Posted: at 2:15 am
COVID-19 transmission in Connecticut appears to be slowing, state numbers show, following several months of steady increase.
As of Thursday, the state averaged 1,137 daily cases over the past week, down from nearly 1,600 at one point earlier this month, though still much higher than immediately before the current wave. The states seven-day positivity rate, meanwhile, has decreased from 14.2 percent last week to 11.8 percent as of Thursday.
Though both case counts and test positivity rate are likely skewed by the popularity of at-home tests, most of which are never reported to authorities, experts say the metrics can still be useful in assessing broad trends.
Additionally, traces of COVID-19 in New Haven wastewater appear to have plateaued or even decreased slightly, data from Yale researchers shows, offering another sign that transmission in Connecticut has reached a peak, at least for now.
As of Thursday, Connecticut had 379 patients hospitalized with COVID-19, down slightly from Wednesday, when hospitalizations hit their highest level since February. Hospitalizations have continued to increase in recent days but not as sharply as earlier this month.
Over the last two weeks, weve seen at least some stabilization in terms of COVID hospitalizations, which we can track, and community transmission, which we can roughly estimate with the current data, said Dr. David Banach, hospital epidemiologist at UConn Health. So Im optimistic, with some caution, for the coming weeks.
Since March, Connecticut has been mired in a COVID-19 spike, which experts have attributed to the BA.2 subvariant. What was initially expected to be a relatively small uptick has instead caused a substantial increase in cases and hospitalizations, lasting more than two months.
Coronavirus-linked deaths have not particularly spiked during the recent wave, which may owe to the fact that deaths lag cases and hospitalizations but may also be a product of vaccine protection, strains of virus that are somewhat less deadly, and improved treatment protocols, including antiviral pills.
Connecticut on Thursday reported 19 COVID-19 deaths over the past week, bringing its total during the pandemic to 10,941.
In terms of severity of the hospitalized patients, we are seeing a smaller number with an intensive-care level of illness, Banach said. I think thats encouraging.
Still, even as Connecticuts case count and positivity rate have dipped slightly in recent days, transmission in Connecticut remains high, with tens of thousands of new infections (both reported and unreported) likely occurring each week.
Dr. Ulysses Wu, chief epidemiologist at Hartford HealthCare, said Thursday that hes not yet ready to celebrate any improvement in the state numbers.
We are at a place where we shouldnt be at all, Wu said. Whether its 383 [hospitalizations] yesterday or 379 today, both numbers are equally bad.
Connecticuts recent COVID-19 uptick, which came almost immediately on the heels of the states devastating omicron-driven winter surge, has led some infectious disease experts to fear the state will see high levels of transmission indefinitely, with new variants emerging one after another.
Already, the state has identified several cases of BA.4 and BA.5, subvariants that caused a dramatic COVID-19 uptick in South Africa.
Wu said recent trends in Connecticuts numbers have not changed his relatively pessimistic outlook about the months to come. As he sees it, Connecticut could return to lower viral levels by the end of June but could also see cases rise again at any time.
With a population that has apathy and doesnt care, whats going to happen is were going to see wave after wave after wave, Wu said. We are going to see a downturn at some point, but it really depends how prolonged that downturn is and then what is the depth of that downturn.
Even as Connecticuts cases decrease, Wu said, they are unlikely to return to the lows recorded last summer.
Its like coming down from Everest to the Tibetan pleateau, he said. Youre still pretty frickin high up in the Tibetan plateau.
Banach offered a slightly more optimistic view, arguing that summer weather, which facilitates outdoor activity, should help Connecticut keep its numbers lower than they have been.
As he sees it, Connecticuts recent decrease in cases and positivity rate could be the start of a lower-risk period.
We still need to be aware that COVID is around us, but here in Connecticut warmer weather, spending more time outdoors is beneficial in reducing the risk of spread, he said. So I think we can maintain some cautious optimism for the next few weeks.