Cartas al editor / Revisión por pares

We have read with interest the short communication published by Segovia-Juarez et al., 2020 in Respiratory Physiology & Neurobiology establishing that high altitude reduces the infection rate of COVID-19 but not the case fatality rate in the Peruvian setting. We support this hypothesis, however there could be an important number of under registered deaths on account of a low rate of diagnostic tests performed per inhabitant and mostly in symptomatic patients (Pasquariello and Stranges, 2020). / Revisión por pares

The field of guideline development has made considerable progress in the past twenty years, particularly after the introduction of GRADE in 2004. However, there are many shortcomings in current guideline development including failure to use GRADE, low quality systematic reviews, and excessive delays from the publication of practice changing evidence to new recommendations. The objective of this thesis is to describe the development of evidence-based recommendations, to document methodological issues that arose and describe how the research team addressed the questions, and to document how the ultimate guidelines contributed to optimization of treatment in clinical practice. The relevant guidelines address the issues of gastrointestinal bleeding prophylaxis and coronavirus disease 2019 (COVID-19). The thesis begins by presenting three methodological issues that arose during the planning and implementation of the guideline process and the initial process of how the research team addressed the challenges. The thesis subsequently presents a published paper that documents recommendations regarding gastrointestinal bleeding prophylaxis in critically ill patients. Then, this thesis presents a published systematic review and meta-analysis addressing efficacy and safety of corticosteroids in COVID-19 based on direct evidence from patients with COVID-19, and indirect evidence from acute respiratory distress syndrome, community-acquired pneumonia, severe acute respiratory syndrome, middle east respiratory syndrome and influenza. Further, the thesis includes a published paper describing recommendations regarding corticosteroids, convalescent plasma and antiviral drugs in COVID-19 on the basis of evidence available very early during the pandemic. This thesis ends by presenting how the methodological issues were ultimately addressed in the relevant guidelines, the importance of the guidelines themselves, and presents perspectives on future research and opportunities in guideline development. / Thesis / Candidate in Philosophy

We conducted a cross-sectional survey to assess the anxiety, distress, and turnover intention (likelihood to leave their current job) of healthcare workers in Peru during the COVID-19 pandemic. Our results reported that 21.7% healthcare workers in Peru experienced severe anxiety, whereas 26.1% of them experienced severe mental distress. A higher level of education related with a lower level of anxiety. Younger workers had a higher level of turnover intention than their older colleagues did. Healthcare workers in the private sector had a higher turnover intention than those in the public sector. Most importantly, people who were geographically far from Lima, the epicenter in Peru, during the outbreak experienced less anxiety and mental distress, corroborating the ripple effect and disconfirming the typhoon eye theory. However, the direction of these relationships can change depending on the type of institutions (public versus private) and the type of employees' contract (full time versus part time). Our research helps provide insights for clinical professionals in identifying the vulnerable groups to mental disorders in Peru. This is the first study to assess anxiety, mental distress, and turnover intention in healthcare workers in Peru during the COVID-19 pandemic. Copyright

U.S. state governments have implemented numerous policies to help mitigate the spread of COVID-19. While there is strong biological evidence supporting the wearing of face masks or coverings in public spaces, the impact of public masking policies remains unclear. We aimed to evaluate how early versus delayed implementation of state-level public masking orders impacted subsequent COVID-19 growth rates. We defined “early” implementation as having a state-level mandate in place before September 1, 2020, the approximate start of the school-year. We defined COVID-19 growth rates as the relative increase in confirmed cases 7, 14, 21, 30, 45, 60-days after September 1. Primary analyses used targeted maximum likelihood estimation (TMLE) with Super Learner and considered a wide range of potential confounders to account for differences between states. In secondary analyses, we took an unadjusted approach and calculated the average COVID-19 growth rate among early-implementing states divided by the average COVID-19 growth rate among late-implementing states. At a national level, the expected growth rate after 14-days was 4%lower with early vs. delayed implementation (aRR: 0.96; 95%CI: 0.95-0.98). Associations did not plateau over time, but instead grew linearly. After 60-days, the expected growth rate was 16% lower with early vs. delayed implementation (aRR:0.84; 95%CI: 0.78-0.91). Unadjusted estimates were exaggerated (e.g. 60-day RR:0.72; 95%CI: 0.60-0.84). Sensitivity analyses varying the timing of the masking order yielded similar results. In both the short and long term, state-level public masking mandates were associated with lower COVID-19 growth rates. Given their low-cost and minimal (if any) impact on the economy, masking policies are promising public health strategies to mitigate further spread of COVID-19.

BACKGROUND: Epilepsy monitoring units (EMUs) provide a safe environment for forming a more illustrative understanding of the patient’s seizure disorder. Patients are admitted to EMUs usually for several days at a time. Upon admission, electroencephalogram (EEG) electrodes are placed and patients are continuously watched via EEG, video, and audio means. By weaning patients off anti-epileptic medications and monitoring brain activity with EEGs, the data will typically allow for a stronger appreciation of the seizure activity. Therefore, it will provide information to develop a more targeted clinical approach for the patient. OBJECTIVE: The purpose of the study is to gain a better understanding of patients’ expectations and experiences with being monitored for seizure activity in an EMU, especially during the Coronavirus Disease 2019 (COVID-19) pandemic METHODS: Patients were interviewed with regards to their inpatient EMU admission for continuous EEG monitoring at Beth Israel Deaconess Medical Center (BIDMC). Phone interviews were conducted both before and after the EMU admission for each patient, using a structured questionnaire that focused on topics such as proclaimed knowledge of personal seizure disorder, quality of life, EMU experience, and hospital admission during the COVID-19 pandemic. Patient responses were documented and analyzed in an exploratory manner to identify relevant themes. The study was conducted according to a protocol approved by the BIDMC Committee on Clinical Investigations. RESULTS: From September 2020 through December 2020, 15 patients were enrolled and interviewed (11 female; age range 26-68 years [median 48]; length of stay range 2-12 days [median 5]). The majority of the population was admitted for event capture or seizure characterization (13/15) and had a history of seizure activity (14/15). The majority of patients had a history of focal seizures (12). Only 4/15 patients had a family history of seizures. Overall, patients felt extremely comfortable speaking with providers. A third (4/12) did not have any notable negative experiences. There were no overarching patterns to the negative experiences that were reported; most responses were specific to the individual. The vast majority (83.3%) applauded providers and staff involved in their EMU admission. CONCLUSIONS: Despite the COVID-19 pandemic, epilepsy patients had mostly positive experiences with their EMU hospitalization at BIDMC. Continuous EEG monitoring remains an important aspect of clinical epilepsy evaluation for some patients, and was a feasible and well-tolerated procedure even during pandemic-altered circumstances.

The COVID-19 epidemic has spawned an "infodemic,"with excessive and unfounded information that hinders an appropriate public health response. This perspective describes a selection of COVID-19 fake news that originated in Peru and the government's response to this information. Unlike other countries, Peru was relatively successful in controlling the infodemic possibly because of the implementation of prison sentences for persons who created and shared fake news. We believe that similar actions by other countries in collaboration with social media companies may offer a solution to the infodemic problem. / Revisión por pares

No description available.

Carta al editor / Revisión por pares

<p>This study investigates cattle futures response to the equities crash in March of 2020 and the subsequent COVID-19 linked production delays at beef packing plants. I observe that the initial declines in cattle futures began prior to the onset of beef packing plant shutdowns. Fitting a Vector Error Correction Model on live cattle futures, feeder cattle futures, and corn futures to the E-Mini S&P 500 futures contract finds evidencethat the S&P 500 had a significant impact on cattle prices during  March  of  2020.  These  results  are  an  example  of  increased  cross-asset  correlation  during periods of financial distress.</p>