• Males Receive Low-Tidal Volume Component of Lung Protective Ventilation More Frequently than Females in the Emergency Department

      Isenberg, Derek L.; Bloom, Benjamin; Gentile, Nina; Reimer, Hannah; Glaze, Owen D.; Palumbo, Paige; Fenstermacher, Rachel (2020)
      Introduction: Mechanical ventilation is a commonly performed procedure in the emergency department (ED). Approximately 240,000 patients per year receive mechanical ventilation in the ED representing 0.23% of ED visits. An ED-based trial published in 2017 showed that a bundle of interventions in mechanically ventilated patients, including low tidal volume ventilation, reduced the development of acute respiratory distress syndrome by nearly 50%. Prior literature has shown that as many as 40% of ED patients do not receive lung protective ventilation. Our goal was to determine whether differences exist between the percent of males vs females who are ventilated at ≥ 8 milliliters per kilogram (mL/kg) of predicted body weight. Methods: We conducted this study at Temple University Hospital, a tertiary care center located in Philadelphia, Pennsylvania. This was a planned subgroup analysis of study looking at interventions to improve adherence to recommended tidal volume settings. We used a convenience sample of mechanically ventilated patients in our ED between September 1, 2017, and September 30, 2018. All adult patient > 18 years old were eligible for inclusion in the study. Our primary outcome measure was the number of patients who had initial tidal volumes set at > 8 mL/kg of predicted body weight. Our secondary outcome was the number of patients who had tidal volumes set at ≥ 8 mL/kg at 60 minutes after initiation of mechanical ventilation. Results: A total of 130 patients were included in the final analysis. We found that significantly more females were initially ventilated with tidal volumes ≥ 8 mL/kg compared to men: 56% of females vs 9% of males (p=<0.001). Data was available for 107 patients (82%) who were in the ED at 60 minutes after initiation of mechanical ventilation. Again, a significantly larger percentage of females were ventilated with tidal volumes ≥ 8 mL/kg at 60 minutes: 56% of females vs 10% of males (p<0.001). Conclusion: The vast majority of tidal volumes ≥ 8 mL/kg during mechanical ventilation occurs in females. We suggest that objective measurements, such as a tape measure and tidal volume card, be used when setting tidal volumes for all patients, especially females.
    • Individual Hurricane Preparedness During the COVID-19 Pandemic: Insights for Risk Communication and Emergency Management Policies

      Botzen, W.J.W.; Mol, Jantsje M.; Robinson, Peter John; Zhang, Juan; Czajkowski, Jeffrey (2020-01-01)
      Climate change adaptation strategies should anticipate that the 2020 situation which resembles an above average hurricane season coinciding with a pandemic may occur more frequently in the future. This study draws lessons on how individual hurricane preparedness is influenced by a pandemic, which turns out to be a combination of perceptions of flood and pandemic risks that have opposite effects on preparedness behavior. We conducted three waves of surveys during 2019-2020 to monitor hurricane preparedness activities in flood-prone coastal areas in Florida, including a survey of 600 respondents in early June 2020 to obtain insights into households’ risk perceptions and preparedness for this hurricane season under COVID-19. The results show that this hurricane season is dominated by concerns over COVID-19 which influences people’s evacuation intentions. Whereas hotel costs were the main obstacle to evacuating during Hurricane Dorian in 2019, the main evacuation obstacle identified in the 2020 hurricane season is COVID-19. Our statistical analyses that investigates the factors influencing evacuation intentions consistently show that older individuals are less likely to evacuate voluntarily, because they are concerned about becoming infected by COVID-19. We discuss the implications of our findings for adaptation policies that aim to improve hurricane preparedness in situations of a pandemic, such as risk communication and emergency management policies.
    • Beauty and the Mask

      Patel, Viren; Mazzaferro, Daniel M.; Sarwer, David; Bartlett, Scott P.; Sarwer, David B|0000-0003-1033-5528 (2020-01-01)
      Coronavirus disease 2019 has profoundly changed society, culture, commerce, and perhaps most importantly, human interaction. As the citizens of the world followed government-imposed stay-at-home orders, and as the phrase “social distancing” became part of the daily lexicon in a matter of weeks, the public largely adopted the use of face coverings in public places to reduce potential transmission of the virus. The practice of using face coverings for the nose and mouth, whether with homemade fabrics or with surgical masks, undoubtedly has effects on facial perception. Although emotions such as intense fear can be communicated with contraction of the muscles of the brow and those around the eyes, communication of genuine happiness requires contraction of the muscles around the mouth, which is unlikely to be seen behind a face covering. 1 Additionally, the lower half of the face, and specifically the perioral area, has been shown to be vital for determinations of attractiveness. In the 1980s, Dr. Leslie Farkas, widely recognized as the father of craniofacial anthropometry, sought to define the facial measurements and proportions associated with attractive faces.2 When comparing attractive and unattractive faces, Dr. Farkas found that the greatest differences in facial measurements and proportions were centered around the perioral area, including but not limited to a narrow philtrum, a wider oral commissure distance, and a greater protrusion of the upper vermilion.3 With this in mind, it is interesting to consider how masks concealing the lower half of the face would affect perceived attractiveness, which has been shown to influence judgments of a range of interpersonal characteristics, such as competence and trustworthiness.1,4,5 The present study was undertaken to assess whether judgments of attractiveness differ when the lower face is covered by a surgical mask. We anticipated that faces covered with surgical masks would be judged as more attractive than faces not covered by a mask.
    • A Statistical Approach to Batched Prevalence Testing for Coronavirus

      Berger, William; Dabrowski, Konrad; Robinson, Jake; Sales, Adam (2020-03-30)
      As cases of novel coronavirus mount, the ability to conduct expeditious prevalence testing becomes paramount. A statistical approach to batched prevalence testing offers a more rapid and efficient means of monitoring at-risk populations.
    • COVID-19 Law and Policy Briefings, Series One: Impacts and Implications for US Prisons

      George Consortium; Center for Health Policy and Law (Northeastern University School of Law); Center for Public Health Law Research (Temple University Beasley School of Law); APHA Law Section (2020-03-31)
      As COVID-19 continues to spread around the world, vulnerable populations like those in the US prison system are at particular risk. This live COVID-19 Law and Policy Briefing will describe the current situation and explore legal issues of COVID-19 in jails and prisons. These include the steps prisons and jails may take to protect inmate populations and employees, the rights prisoners have to care and prevention, and what happens next for prisoners who are released.
    • COVID-19 Law and Policy Briefings, Series One: Commandeering Private Property for Pandemic Response

      George Consortium; Center for Health Policy and Law (Northeastern University School of Law); Center for Public Health Law Research (Temple University Beasley School of Law); APHA Law Section (2020-03-31)
      As the number of cases grows in this pandemic, one specific medical resource in short supply is bed space. One solution to this issue is for governments to commandeer private property, such as hotels, convention centers, university dormitories, or even defunct hospitals. The legal question here is one of authority.
    • COVID-19 Law and Policy Briefings, Series One: Legality and Challenges to Rationing Medical Resources (Part I)

      George Consortium; Center for Health Policy and Law (Northeastern University School of Law); Center for Public Health Law Research (Temple University Beasley School of Law); APHA Law Section (2020-04-02)
      In light of the current rationing of personal protective equipment for medical professionals, and ventilators and other life-saving and sustaining medical resources, legal experts for this live COVID-19 Law and Policy Briefing discuss the legality of and potential legal challenges to rationing of medical resources. The guests also review disability rights and access in the context of medical resource rationing.
    • COVID-19 Law and Policy Briefings, Series One: Legality and Challenges to Rationing Medical Resources (Part II)

      George Consortium; Center for Health Policy and Law (Northeastern University School of Law); Center for Public Health Law Research (Temple University Beasley School of Law); APHA Law Section (2020-04-02)
      In light of the current rationing of personal protective equipment for medical professionals, and ventilators and other life-saving and sustaining medical resources, legal experts for this live COVID-19 Law and Policy Briefing discuss the legality of and potential legal challenges to rationing of medical resources. The guests also review disability rights and access in the context of medical resource rationing.
    • A deficit of more than 250,000 public health workers is no way to fight Covid-19

      Taylor Wilson, Robin; Troisi, Catherine L.; Gary-Webb, Tiffany L. (2020-04-05)
    • COVID-19 Law and Policy Briefings, Series One: Issues and Boundaries of Federalism

      George Consortium; Center for Health Policy and Law (Northeastern University School of Law); Center for Public Health Law Research (Temple University Beasley School of Law); APHA Law Section (2020-04-07)
      This COVID-19 Law and Policy Briefing explores vertical and horizontal federalism to address how the federal government and state governments can act and interact during the pandemic.
    • COVID-19 Law and Policy Briefings, Series One: Protecting the Vulnerable Substance Use Disorder Population During COVID-19

      George Consortium; Center for Health Policy and Law (Northeastern University School of Law); Center for Public Health Law Research (Temple University Beasley School of Law); APHA Law Section (2020-04-09)
      This Briefing will explore the legal and policy questions around substance use disorder (SUD) exceptionalism. Panelists discuss how different legal rules apply to access to medications for opioid use disorder and other services compared to those provided to the majority with access to care; and, how we can construct social support, services, and safe housing for a population that has strong overlaps with other extremely vulnerable cohorts such as the homeless or newly released prisoners.
    • COVID-19 Q&A for Philadelphia Workers

      The Sheller Center for Social Justice (Temple University) (2020-04-10)
    • Mathematical Modeling Study of the 2020 CoVID-19 Outbreak in the United States

      Sinha, Durgesh; Klahn, Nicholas; 0000-0001-7749-3710 (2020-04-12)
      A mathematical model was developed for the currently evolving COVID-19 outbreak. Data analysis and model fitting using Latin Hypercube Sampling partial Correlation Coefficient Method was used to determine the model’s parameters and basic reproduction numbers. The infectivity values from symptomatic infectious people was 0.118461389 (95% CI [0.1136278, 0.12329497]), asymptomatic transmission was 0.100111427 (95% CI [0.1000297, 0.10019314]), and quarantined transmission was 0.057337278 (95% CI [0.0504738, 0.0642008]). The United states reached its peak basic reproduction number on March 10th where R0=58, but it has since lowered to 1.47 as of April 5th. Also, those in quarantine had contributed the most to the basic reproduction number, with asymptomatic people being second, and regular symptomatic people contributing the least. Our simulations showed that the United States has reached its peak occurred on April 11, 2020 with a total 461,700 number of cases and it will reach on June 12, 2020 where the confirmed case count would reach 1.439 million. As for the longevity of the virus, our prediction shows that it could be under preventive measure within two years by February 10, 2022, would be 14,130.
    • COVID-19 Law and Policy Briefings, Series One: Travel Restrictions and Cordon Sanitaire

      George Consortium; Center for Health Policy and Law (Northeastern University School of Law); Center for Public Health Law Research (Temple University Beasley School of Law); APHA Law Section (2020-04-14)
      This Briefing reviews the differences among the various movement restrictions imposed at the local and state levels. Specially, they will discuss restrictions popping up in the South and New England, and how these restrictions may play a part in the “unlocking” of the American public once the pandemic is in decline.
    • COVID-19 Law and Policy Briefings, Series One: Drug Development, the Role of the FDA, and Emergency Use

      George Consortium; Center for Health Policy and Law (Northeastern University School of Law); Center for Public Health Law Research (Temple University Beasley School of Law); APHA Law Section (2020-04-15)
      This Briefing seeks to demystify drug development — offering a crash in the development process and clinical trials, the role the FDA plays in reviewing and approving drugs, and the differences between off-label and compassionate use.
    • COVID-19 Law and Policy Briefings, Series One: Medicaid and the ACA

      George Consortium; Center for Health Policy and Law (Northeastern University School of Law); Center for Public Health Law Research (Temple University Beasley School of Law); APHA Law Section (2020-04-16)
      As it becomes clearer that the impacts of COVID-19 will be felt disproportionately by those already facing disparities, one question that keeps arising is the role insurance will play in the fall-out. This Briefing focuses on Medicaid and the ACA, particularly the implications of not re-opening the exchanges.
    • Addressing the Question of Dermatologic Manifestations of SARS-CoV-2 Infection in the Lower Extremities: A Closer Look at the Available Data and its Implications

      Basatneh, Rami; Vlahovic, Tracey; Vlahovic|0000-0002-5310-4706 (2020-04-20)
      The first case of SARS-CoV-2 infection, also known as the Coronavirus Disease of 2019 (COVID-19) was reported in December of 2019 by doctors in Wuhan, China.(1) Since then, physicians have reported a peculiar sequelae for the novel coronavirus involving various manifestations and courses of the disease as well as a predilection for morbidity and mortality based on certain pre-existing conditions and age groups. Recently, there has been growing interest in anecdotal findings of skin manifestations by several healthcare providers who are postulating a possible correlation to COVID-19.
    • Mobilization and Preparation of a Large Urban Academic Center During the COVID-19 Pandemic

      Chowdhury, Junad M.; Patel, Maulin; Zheng, Matthew; Abramian, Osheen; Criner, Gerard J. (2020-04-21)
    • COVID-19 Law and Policy Briefings, Series One: Evictions in the Age of COVID-19

      George Consortium; Center for Health Policy and Law (Northeastern University School of Law); Center for Public Health Law Research (Temple University Beasley School of Law); APHA Law Section (2020-04-21)
      As the coronavirus continues to take its toll on unemployment in the United States, one of the biggest questions for Americans is how they will afford to pay rent. To protect renters, a growing number of cities and states are have temporarily halted evictions. During this Briefing, our guests describe the government authority to act and prevent evictions, and consider the sustainability of these orders and implications for the economy and public health going forward.