Observational study of organisational responses of 17 US hospitals over the first year of the COVID-19 pandemic

Objectives The COVID-19 pandemic has required significant modifications of hospital care. The objective of this study was to examine the operational approaches taken by US hospitals over time in response to the COVID-19 pandemic. Design, setting and participants This was a prospective observational study of 17 geographically diverse US hospitals from February 2020 to February 2021. Outcomes and analysis We identified 42 potential pandemic-related strategies and obtained week-to-week data about their use. We calculated descriptive statistics for use of each strategy and plotted percent uptake and weeks used. We assessed the relationship between strategy use and hospital type, geographic region and phase of the pandemic using generalised estimating equations (GEEs), adjusting for weekly county case counts. Results We found heterogeneity in strategy uptake over time, some of which was associated with geographic region and phase of pandemic. We identified a body of strategies that were both commonly used and sustained over time, for example, limiting staff in COVID-19 rooms and increasing telehealth capacity, as well as those that were rarely used and/or not sustained, for example, increasing hospital bed capacity. Conclusions Hospital strategies during the COVID-19 pandemic varied in resource intensity, uptake and duration of use. Such information may be valuable to health systems during the ongoing pandemic and future ones

Controlling the net: European approaches to content and access regulation

This article has been accepted for publication in the journal, Journal of Information Science [© CILIP] and the final (edited, revised and typeset) version of this paper will be published in Journal of Information Science, by SAGE Publications Ltd, All rights reserved. © CILIP. For more information please visit: http://jis.sagepub.co.uk

Robust Tests for Pareto Density Estimation

A common practice to determine the extension and heaviness of heavy tails of income, return and size distributions is the sequential estimation and fitting of one or several models, starting from a group of the largest observations and adding one observation at a time [14]. In the early stages this kind of procedure shows high sensitivity of the shape parameter estimates to single observations, the end of the search being fixed when the shape parameter value estimates reach a plateau. In this paper we propose a stepwise fitting of a heavy-tailed model, the Pareto II distribution [1], previously applied to the size distribution of business firms. The procedure, based on the forward search technique, is data-driven since observations to be added at each iteration are determined according to the results of the estimation carried out at the preceding step and not, as in sequential fitting, according to their rank

ISTH guidelines for antithrombotic treatment in COVID-19

Antithrombotic agents reduce risk of thromboembolism in severely ill patients. Patients with coronavirus disease 2019 (COVID-19) may realize additional benefits from heparins. Optimal dosing and timing of these treatments and benefits of other antithrombotic agents remain unclear. In October 2021, ISTH assembled an international panel of content experts, patient representatives, and a methodologist to develop recommendations on anticoagulants and antiplatelet agents for patients with COVID-19 in different clinical settings. We used the American College of Cardiology Foundation/American Heart Association methodology to assess level of evidence (LOE) and class of recommendation (COR). Only recommendations with LOE A or B were included. Panelists agreed on 12 recommendations: three for non-hospitalized, five for non-critically ill hospitalized, three for critically ill hospitalized, and one for post-discharge patients. Two recommendations were based on high-quality evidence, the remainder on moderate-quality evidence. Among non-critically ill patients hospitalized for COVID-19, the panel gave a strong recommendation (a) for use of prophylactic dose of low molecular weight heparin or unfractionated heparin (LMWH/UFH) (COR 1); (b) for select patients in this group, use of therapeutic dose LMWH/UFH in preference to prophylactic dose (COR 1); but (c) against the addition of an antiplatelet agent (COR 3). Weak recommendations favored (a) sulodexide in non-hospitalized patients, (b) adding an antiplatelet agent to prophylactic LMWH/UFH in select critically ill, and (c) prophylactic rivaroxaban for select patients after discharge (all COR 2b). Recommendations in this guideline are based on high-/moderate-quality evidence available through March 2022. Focused updates will incorporate future evidence supporting changes to these recommendations