Alfredo Urdaneta

All Publications

• Sex Differences in Long COVID. JAMA network open Shah, D. P., Thaweethai, T., Karlson, E. W., Bonilla, H., Horne, B. D., Mullington, J. M., Wisnivesky, J. P., Hornig, M., Shinnick, D. J., Klein, J. D., Erdmann, N. B., Brosnahan, S. B., Lee-Iannotti, J. K., Metz, T. D., Maughan, C., Ofotokun, I., Reeder, H. T., Stiles, L. E., Shaukat, A., Hess, R., Ashktorab, H., Bartram, L., Bassett, I. V., Becker, J. H., Brim, H., Charney, A. W., Chopra, T., Clifton, R. G., Deeks, S. G., Erlandson, K. M., Fierer, D. S., Flaherman, V. J., Fonseca, V., Gander, J. C., Hodder, S. L., Jacoby, V. L., Kotini-Shah, P., Krishnan, J. A., Kumar, A., Levy, B. D., Lieberman, D., Lin, J. J., Martin, J. N., McComsey, G. A., Moukabary, T., Okumura, M. J., Peluso, M. J., Rosen, C. J., Saade, G., Shah, P. K., Sherif, Z. A., Taylor, B. S., Tuttle, K. R., Urdaneta, A. E., Wallick, J. A., Wiley, Z., Zhang, D., Horwitz, L. I., Foulkes, A. S., Singer, N. G. 2025; 8 (1): e2455430

  Abstract

  A substantial number of individuals worldwide experience long COVID, or post-COVID condition. Other postviral and autoimmune conditions have a female predominance, but whether the same is true for long COVID, especially within different subgroups, is uncertain.To evaluate sex differences in the risk of developing long COVID among adults with SARS-CoV-2 infection.This cohort study used data from the National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER)-Adult cohort, which consists of individuals enrolled in and prospectively followed up at 83 sites in 33 US states plus Washington, DC, and Puerto Rico. Data were examined from all participants enrolled between October 29, 2021, and July 5, 2024, who had a qualifying study visit 6 months or more after their initial SARS-CoV-2 infection.Self-reported sex (male, female) assigned at birth.Development of long COVID, measured using a self-reported symptom-based questionnaire and scoring guideline at the first study visit that occurred at least 6 months after infection. Propensity score matching was used to estimate risk ratios (RRs) and risk differences (95% CIs). The full model included demographic and clinical characteristics and social determinants of health, and the reduced model included only age, race, and ethnicity.Among 12 276 participants who had experienced SARS-CoV-2 infection (8969 [73%] female; mean [SD] age at infection, 46 [15] years), female sex was associated with higher risk of long COVID in the primary full (RR, 1.31; 95% CI, 1.06-1.62) and reduced (RR, 1.44; 95% CI, 1.17-1.77) models. This finding was observed across all age groups except 18 to 39 years (RR, 1.04; 95% CI, 0.72-1.49). Female sex was associated with significantly higher overall long COVID risk when the analysis was restricted to nonpregnant participants (RR, 1.50; 95%: CI, 1.27-1.77). Among participants aged 40 to 54 years, the risk ratio was 1.42 (95% CI, 0.99-2.03) in menopausal female participants and 1.45 (95% CI, 1.15-1.83) in nonmenopausal female participants compared with male participants.In this prospective cohort study of the NIH RECOVER-Adult cohort, female sex was associated with an increased risk of long COVID compared with male sex, and this association was age, pregnancy, and menopausal status dependent. These findings highlight the need to identify biological mechanisms contributing to sex specificity to facilitate risk stratification, targeted drug development, and improved management of long COVID.

  View details for DOI 10.1001/jamanetworkopen.2024.55430

  View details for PubMedID 39841477

  View details for PubMedCentralID PMC11755195

• 2024 Update of the RECOVER-Adult Long COVID Research Index. JAMA Geng, L. N., Erlandson, K. M., Hornig, M., Letts, R., Selvaggi, C., Ashktorab, H., Atieh, O., Bartram, L., Brim, H., Brosnahan, S. B., Brown, J., Castro, M., Charney, A., Chen, P., Deeks, S. G., Erdmann, N., Flaherman, V. J., Ghamloush, M. A., Goepfert, P., Goldman, J. D., Han, J. E., Hess, R., Hirshberg, E., Hoover, S. E., Katz, S. D., Kelly, J. D., Klein, J. D., Krishnan, J. A., Lee-Iannotti, J., Levitan, E. B., Marconi, V. C., Metz, T. D., Modes, M. E., Nikolich, J. Ž., Novak, R. M., Ofotokun, I., Okumura, M. J., Parthasarathy, S., Patterson, T. F., Peluso, M. J., Poppas, A., Quintero Cardona, O., Scott, J., Shellito, J., Sherif, Z. A., Singer, N. G., Taylor, B. S., Thaweethai, T., Verduzco-Gutierrez, M., Wisnivesky, J., McComsey, G. A., Horwitz, L. I., Foulkes, A. S. 2024

  Abstract

  Classification of persons with long COVID (LC) or post-COVID-19 condition must encompass the complexity and heterogeneity of the condition. Iterative refinement of the classification index for research is needed to incorporate newly available data as the field rapidly evolves.To update the 2023 research index for adults with LC using additional participant data from the Researching COVID to Enhance Recovery (RECOVER-Adult) study and an expanded symptom list based on input from patient communities.Prospective, observational cohort study including adults 18 years or older with or without known prior SARS-CoV-2 infection who were enrolled at 83 sites in the US and Puerto Rico. Included participants had at least 1 study visit taking place 4.5 months after first SARS-CoV-2 infection or later, and not within 30 days of a reinfection. The study visits took place between October 2021 and March 2024.SARS-CoV-2 infection.Presence of LC and participant-reported symptoms.A total of 13 647 participants (11 743 with known SARS-CoV-2 infection and 1904 without known prior SARS-CoV-2 infection; median age, 45 years [IQR, 34-69 years]; and 73% were female) were included. Using the least absolute shrinkage and selection operator analysis regression approach from the 2023 model, symptoms contributing to the updated 2024 index included postexertional malaise, fatigue, brain fog, dizziness, palpitations, change in smell or taste, thirst, chronic cough, chest pain, shortness of breath, and sleep apnea. For the 2024 LC research index, the optimal threshold to identify participants with highly symptomatic LC was a score of 11 or greater. The 2024 index classified 20% of participants with known prior SARS-CoV-2 infection and 4% of those without known prior SARS-CoV-2 infection as having likely LC (vs 21% and 5%, respectively, using the 2023 index) and 39% of participants with known prior SARS-CoV-2 infection as having possible LC, which is a new category for the 2024 model. Cluster analysis identified 5 LC subtypes that tracked quality-of-life measures.The 2024 LC research index for adults builds on the 2023 index with additional data and symptoms to help researchers classify symptomatic LC and its symptom subtypes. Continued future refinement of the index will be needed as the understanding of LC evolves.

  View details for DOI 10.1001/jama.2024.24184

  View details for PubMedID 39693079

• Measurement of circulating viral antigens post-SARS-CoV-2 infection in a multicohort study. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases Swank, Z., Borberg, E., Chen, Y., Senussi, Y., Chalise, S., Manickas-Hill, Z., Yu, X. G., Li, J. Z., Alter, G., Henrich, T. J., Kelly, J. D., Hoh, R., Goldberg, S. A., Deeks, S. G., Martin, J. N., Peluso, M. J., Talla, A., Li, X., Skene, P., Bumol, T. F., Torgerson, T. R., Czartoski, J. L., McElrath, M. J., Karlson, E. W., Walt, D. R., RECOVER consortium authors, Abraham, R., Ager, A., Aguilar, F. A., Ahmadi-Izad, G., Ahmed, D. R., Alvarez, A., Anderson, B., Asencios, W. D., Atha, M., Beaty, C. L., Bedi, B., Berry, J. A., Boone, D., Bower, M., Bremner, J. D., Brent, C., Brown-Smith, K., Bull, R., Bush, P. A., Capo, G., Carl-Igwe, K., Chitadze, C., Chukwumerije, N., Clyburn, E., Collins, S., Costello, J., Couture, G., Craft, A., Cribbs, S. K., Cui, X., Dandy, A., Rio, C. D., Jasarevic, R., Detelich, J. F., Dixon, C., Dow, J., Doyle, D., Elchommali, J., Ibeawuchi, C., Elsey, I., Fineman, R., Francis, A. G., Franks, N., Gallini, J., Gander, J. C., Gray, N., Grimes, A., Gutter, E., Han, J. E., Hang, T. P., Harding, J., Hernandez, L., Hewitt, L. N., Holloway, C., Hudgins, A. F., Huerta, C., Ibeawuchi, C., Ifejika, C., Ingram, K. D., Javia, V. N., Jeter, M., Johnson, B., Joseph, Y., Juarez, M., Kajan, D., Khalil, L., Kirkpatrick, C. M., Kleinhenz, D., Kolailat, I., Koumanelis, A., Koumanelis, A., Kozoman, R., Krishnan, S., Lainez, J., Lawrence, B., Lee, M. A., Leon, J. D., Lew, V., Lewis, K. C., Litvack, M., Maroney, M., Maier, C. L., Makkaoui, N., Marconi, V. C., Martin, C. F., Martinez, M., Mbogo, L., McCaslin, A., McIntyre, J., Moanna, A., Montoya, M., Morales, E., Moran, C. A., Morgan-Billingslea, J., Murray, C., Nelson, R., Neuman, R. B., Nguyen, T., Ofotokun, I., Ojemakinde, E. I., Ojoawo, B., Osinski, E., Oviedo, S., Panganiban, B., Paredes-Gaitan, Y., Patzer, R. E., Pemu, P., Prude, M., Rahman, K., Ramakrishnan, G., Rebolledo, P. A., Roberts, M., Robinson, K., Rogers, C., Rouphael, N. G., Searles, C., Shah, A., Segall, M., Shaw, R. M., Silva, R., Simpson, C., Simpson-Derrell, K., Sirajud-Deen, T., Smith, V. E., Stringer, A., Stroud, J., Suthar, M. S., Sylber, C., Sylvera, A., Tanner, T., Teunis, L. J., Tolbert, M., Thomas, K. M., Thompson, S. G., Titanji, K., Toy, C., Traenkner, J., Truong, A., Unterberger, K., Vaccarino, V., Varney, K., Vyas, K., Vyas, K., Walker, T. A., Walkow, M., Wang, D., Wesley, T., Wiley, Z., Wimberly, E., Winston, J. R., Winter, T. J., Wongtrakool, C., Aikawa, M., Alba, G. A., Aung, T. N., Baden, L., Baslet, G., Bassett, I. V., Bennett, L., Bhattacharyya, S., Blazey-Martin, D., Buring, J., Cagnina, R. E., Chen, L. Q., Clark, C. R., Cohen, P., Collier, A., Czeisler, C., Duffy, E., Estill, P., Fong, T., Gay, E., Ghamloush, M., Ginns, L. C., Haack, M., Haas, J., Hamburg, N., Hauser, K. S., John, J., Jordan, M., Juelg, B. D., Kanjilal, D. G., Kim, A. Y., Klerman, E. B., Kobayashi, M., Kogelman, L., Lamas, D., Levy, B. D., Levy-Carrick, N., Lewis, G., Maley, J. H., Manson, J., Marathe, J. G., Mullington, J. M., O'Connor, G. T., Ojikutu, B., Perlis, R., Quintana, Y., Redline, S., Remis, E. J., Rosand, J., Sesso, H. D., Shaughnessy, L., Shepherd, F. M., Solomon, S., Sparks, J. A., Spencer, L. L., Stephenson, K., Systrom, D., Thomas, R. J., Min Thu, P. P., Ticotsky, A., Torres, R., Wallace, Z. S., Walt, D., Ward, H. D., Washko, G., Whittelsey, M., Wiener, R., Williams, C. T., Xerras, D., Zhang, H., Zionts, D., Armstrong, D., Binkley, S. E., Blackwell, K., Brown, T., Carton, T. W., Causey, A., Cook, F., Daniel, C. L., Datri, P., Domingo, J., Donahue, C., Eady, M., Edberg, J., Erdmann, N., Fuloria, J., Garcia-McClaney, N., Garner, M., Gillespie, M., Gray, B., Hagensee, M., Hall, W., Hansel, J., Hart, C., Hebson, C. L., Hidalgo, B., Holtzapfel, K., Jinright, A., Judd, S. E., Kennedy, T., Kirkwood, L., Leggio, C., Levitan, E. B., Maier, M., McCormack, P., Miele, L., Mitchell, K., Montgomery, A., Peralta-Carcelen, M., Perkins, A., Pilco, J. P., Powell, L., Shevin, R., Skipworth, S., Spurgeon, L., Sutherland, E., Tita, A. T., Trauth, A., Trotter, S., Van Deerlin, A., Ware, G., Weiser, S., Wilson, R., Woodruff, D., Wu, J., Young, M., Alemu, M., Anderson, J., Ashktorab, H., Brim, H., Chang, L., Chauhan, M., Cho, S., Durrani, S., Gentil, M. P., Goodman, K., Laiyemo, A. O., Lanke, G., Lebron, R., Maheshwari, A., Mehari, A., Nezamloo, A., Ngwa, J., Njoku, N., Ok, J., Sherif, Z. A., Solemani, A., Thuluvath, P., To, C., Spikes, L. A., James, J. A., Luciano Roman, C. A., Chow, D. C., Marshall, G. D., Dickinson, J. D., Hoover, S. E., Warren, D. E., Emery, I. F., Sukhera, F. I., Rosen, C. J., Greenway, F. L., Hodder, S. L., Shikuma, C. M., VanWagoner, T. M., Bardes, J. M., Kirwan, J. P., Wood, J. P., Whiteheart, S. W., Shellito, J., Miele, L., Roelke, T., Black, L., Tjarks, B., Fonseca, V., Gupta, S., Longo, M., Yang, M., MarGangcuangco, L., Bengtson, C., Castro, M., Howard, T., Garvy, B., Simmons, C., Garla, V., Kuebler, J., Nandi, U., Vasey, A., Bogie, A., Scott, J., Frontera, S. P., Bagur, J. S., Dominique-Villanueva, D., Juskowich, J., Reece, R., Sarwari, A., Hagensee, M., Aponte-Soto, L., Adams, D., Baker, A., Barbera, S., Basu, S., Bleasdale, S., Bolliger, D., Boyd, A. D., Boyineni, J., Breiter, T., Brown, D., Buhimschi, I. A., Carrithers, M. D., Certa, M., Chalamalla, R., Chebrolu, P., Chestek, D., Chessier, E., Cook, J. A., Cranford, S., Curry, H. L., Darbar, D., Dasgupta, R., Blakley, F. D., DeLisa, J. A., Del Rios, M., Diaz, M. Z., Diviak, K. R., Dixon, J., Donlon, M. F., Donohue, S. E., Dworkin, M. S., Edmonds, S., Ellison, A., Everett, E., Flanigan, C., Freedman, M. B., Gale, L., Gerald, L. B., Giles, W. H., Gordon, H. S., Hafner, J., Hammad, B., Hanson, K. A., Harris, P. C., Hartwig, K., Hasek, S., Hasse, W., Hendrickson, M., Hobbs, B., Hryniewicka, M., Hammerl, S., Hutton, R., Ibanez, A. L., Illendula, S. D., Ismail, N., Jain, A., Jennette, K. J., Kadubek, G., Kent, D., Kotini-Shah, P., Kelly, S. W., Kent, D. A., Kim, K. S., Kindred, E., Klein, J. D., Krishnan, J. A., Large, L., Lash, J., Lin, J. Y., Lu, J., Mahamed, A. M., Maholovich, P., Malchenko, S., Martinez, M., Mauntel-Medici, C., Madineni, A., McCauley, M., Menchaca, M., Mermelstein, R., Moreno, D. J., Morrissy, L., Muramatsu, N., Musick, H., Noland, S., Norwick, L., Novak, R. M., Olds, L., Ortiz, M., Patel, K., Perez, N. L., Pliskin, N. H., Pope, S., Prabhakar, B. S., Prasad, B., Predki, B., Prendergast, H. M., Quigley, J. G., Ramchandran, R., Ramirez, A., Rappe, S., Rehman, J., Rolon, C., Rowley, M., Rudraraju, G., Rutherfoord, M., Sader, S. B., Sculley, J. A., Smith-Mack, J., Swearingen, P., Stewart de Ramirez, S. A., Sudhindra, P., Sun, J., Tartt, N., Terlinde, T., Thompson, T., Vanden Hoek, T. L., Kelly, S. W., Villanueva, L., Welter, H., Woolley, B., Yazici, C., Charney, A. W., Kovatch, P., Merad, M., Nadkarni, G. N., Wisnivesky, J. P., Aberg, J. A., Ascolillo, S., Assenso, E., Bagiella, E., Bartram, L., Becker, J., Beckmann, N. D., Bendl, A., Chen, B. K., Civil, A., Dhar, K., Evo-Ortega, L., Fierer, D., Gallagher, E. J., Garcia-Sastre, A., Gnjatic, S., Guliyeva, S., Harvey-Ingram, L., Herrera-Moreno, J., Hill, M., Horowitz, C. R., Jackson, R., Kastrat, D., Lala-Trindade, A., Lin, J., Macaluso, N., Marcon, K., Meyer, D., Morinigo, J., Natelson, B. H., Nussenzweig, M., Padua, T., Putrino, D., Quazi, N., Ramos, M., Richardson, L., Russo, S., Seifert, A. C., Serri, A., Walker, J., Yee, M., Adolphi, N. L., Alekhina, N., Archuleta, D. A., Barlocker, J., Bateman, L., Bradfute, S. B., Brito, R., Bryan, T. W., Buck, K. E., Davis, D., Deakyne Davies, S. J., Decker, L. A., Elifritz, J., Erlandson, K. M., Facelli, J. C., Fudge, H. Z., Tran, H., Pitch, C., Feuerriegel, E. M., Ford, I., Friedman, N. P., Garcia-Soberanez, N. D., Gardner, E. M., Stringham, C., Ling, L., Gebremariam, T. H., Gentry, F. D., Gouripeddi, R., Graham, P., Gronert, E. G., Harkins, M. S., Hawkins, K. L., Hess, R., Johnny, J. D., Johnson, B. M., Jolley, S. E., Lloyd, J., Ludwig, K. R., Martinez, N. I., McCandless, S. A., Montoya, L. A., Oakes, J. L., Parada, A. N., Quinn, D. K., Raissy, H., Ramos, A., Reid, K. M., Reusch, J. E., Sheehan, E. B., Sokol, R. J., Treacher, I. S., Trinity, J. D., Truong, D. T., West, S. C., Molden, J., Sharareh, N., Weaver, L. J., Spivak, A. M., Brown, J. P., Shah, K. S., Pace, L. A., Bateman, L., Scholand, M. B., Velinder, M., Cortez, M., Morimoto, S. S., Vernon, S. D., Lu, Y., Owen, M., Hermansen, J. A., Lindsay, A. M., Donohue, D. K., Garg, L., Wodushek, T., Higgins, J., Lockie, T., Brightman, M., Thurman, B., Powell, J. M., Freston, D. C., Medina, J. C., Aguirre, B., Anderson, J., Bair, T., Bosh, L., Evans, L., Garrett, C., Harris, D., Herrera, K., Horne, B. D., Juan, J., Knight, S., Knowlton, K., Leither, L., Maestas, H., May, H. T., Najarian, G., Woller, S. C., Zubal, S., Jensen, M. M., Webb, T., Iverson, L., Ayache, M., Baloi, A., Barnboym, E., Boldt, N., Bukulmez, H., Chesnick, H., Conrad, A., Consolo, M., Curtis, L., D'anza, B., DiFrancesco, K., Edminston, M., Eteshola, E., Gallagher, M., Gibson, K. S., Gordesky, L., Greenwood, C., Haghiac, M., Harris, P., Hernandez, C., Iqbal, S., Kaelber, D. C., Kaufman, E. S., Kennedy, O., Labbato, D., Lengu, K., Levert, A., Levin, J., Lowenthal, R., Mackin, B., Malakooti, S. K., McComsey, G. A., Minium, J., Mouchati, C., Oleson, C., Pearman, A., Hershey, M., Rivera, A., Rodgers, M., Rodgers, T., Roy, A., Russ, K., Scott, S., Sheth, N., Singer, N. G., Smith, B., Smith, C., Stancin, T., Temple, D., Tribout, M., Weinberger, E., Zhang, D., Zisis, S. N., Atieh, O., Yendewa, G., Baissary, J., Pettinato, K., Lim, J., Jacob, J., Adams, C., Tejani, V., Algren, H. A., Alicic, R., Baxter, J., Brennan, C., Caudill, A., Chen, P., Chopra, T., Chu, H. Y., Del Alcazar, J., Duven, A. M., Edmark, R., Emerson, S., Goldman, J. D., Gutierrez, V., Hadlock, J., Harteloo, A., Heath, J. R., Hood, S., Jackman, S., Kaneko, J., Kemp, M., Kim, C., Kuykendall, K., Li, S., Logue, J. K., Magis, A. T., Manner, P., Mason, C., McCaffrey, K., McDonald, C., McDonald, D., Murray, K. M., Nackviseth, C., Nguyen, H., Parimon, T., Poussier, R., Rowen, L., Satira, R., Torbati, S., Tuttle, K. R., Wallick, J. A., Yuan, D., Watanabe, K., Wilcox, L. E., Contreras, F., Dahlke, L., Gudipudi, L., Modes, M., Muttera, N., Salinas, N., Tadeo, J., White, S., Alvarado, S., Anderson, R., Arellanes, A., Barajas, R. A., Chauhan, S. P., Clarke, G. D., Farner, C. E., Fischer, M. S., Goldberg, M. P., Hasbani, K., Hastings, G., Heard, P., Herrera, I., Infante, E., Johnson, H., Jones, J., Kellogg, D. L., Kraig, E., Longoria, L., Nambiar, A. M., Okafor, E., Paredes, C. C., Patterson, T. F., Patterson, J. E., Pinones, A., Potter, J. S., Reeves, W. B., Saade, G. R., Salehi, M., Scholler, I., Seshadri, S., Shah, D. P., Shah, P., Sharma, K., Sharma, K., Soileau, B., Solis, P., Stoebner, C., Sullivan, M., Taylor, B. S., Tragus, R., Tsevat, J., Verduzco-Gutierrez, M., Ahuja, N., Blish, C. A., Blomkalns, A. L., Bonilla, H., Brotherton, R., Clinton, K., Dingankar, V., Geng, L. N., Go, M., Haddad, F., Jagannathan, P., Jamero, C., Jee, K., Jia, X. K., Khurana, N., Kumar, A., Maldonado, Y., Miglis, M. G., O'Conor, E., Olszewski, K., Pathak, D., Quintero, O., Scott, J., Singh, U., Urdaneta, A. E., Utz, P. J., Varkey, M. R., Saperia, C., Autry, L., Bime, C., Borwege, S., Copeland, J., DiLise-Russo, M., Ernst, K. C., Esquivel, D. R., Fadden, S., Gomez, I., Grischo, G., Hansen, L., Harris, D. T., Harris, S., Hartley, W., Hernandez, M., Hillier, L., Hsu, H., Hughes, T., Ismail, H., Iusim, S., James, M., Kala, M., Karnafel, M., Kim, D., Knox, K. S., Koleski, A., LaFleur, B., Lambert, B., LaRue, S., Lee-Iannotti, J. K., Lieberman, D., Lutrick, K., Merchant, N., James, M., Morton, C., Mosier, J. M., Murthy, G., Nikolich, J. Z., Olorunnisola, T., Parthasarathy, S., Peralta, J., Pilling, W., Pogreba-Brown, K., Reiman, E. M., Rischard, F. P., Ryan, L. T., Smith, T., Snyder, M., Soto, F., Subbian, V., Suhr, K., Unzek, S., Vadovicky, S., Velarde, D., Veres, S., Wilson, C., Anderson, G., Anglin, K., Argueta, U., Asare, K., Buitrago, M., Chang Song, C., Clark, A., Conway, E., Deeks, S. G., Del Castillo, N., Deswal, M., Durstenfeld, M. S., Eilkhani, E., Eun, A., Fehrman, E., Figueroa, T., Flores, D., Grebe, H., Henrich, T. J., Hoh, R., Hsue, P., Huang, B., Ibrahim, R., Kelly, J. D., Kerbleski, M., Kirtikar, R., Lew, M. T., Lombardo, J., Lopez, M., Luna, M., Marquez, C., Martin, J. N., Munter, S., Ngo, L., Peluso, M. J., Pineda-Ramirez, J., Rhoads, K., Rodriguez, A., Romero, J., Ryder, D., So, M., Somsouk, M., Tai, V., Tran, B., Uy, J., Valdivieso, D., Verma, D., Williams, M., Zamora, A., Newman, L. T., Abella, J., Barnette, Q., Bevc, C., Beverly, J., Ceger, P., Croxford, J., Enger, M., Fain, K., Farris, T., Hanlon, S., Hines, D., Johnson-Lawrence, V., Jordan, K., Lefebvre, C., Linas, B., Luukinen, B., Mandal, M., McKoy, N. J., Nance, S., Pasquarelli, D., Quiner, C., Sembajwe, R., Shaw, G., Thornburg, V., Tosco, K., Wright, H., Gross, R. S., Hochman, J. S., Horwitz, L. I., Katz, S. D., Troxel, A. B., Adler, L., Akinbo, P., Almenana, R., Aschalew, M., Balick, L., Bello, O., Bhuiyan, S., Blachman, N., Branski, R., Briscoe, J., Brosnahan, S., Bueler, E., Burgos, Y., Caplin, N., Chaplin, D., Chen, Y., Cheng, S., Choe, P., Choi, J., Chung, A., Church, R., Cobos, S., Croft, N., Irving, A. C., Del Boccio, P., Diaz, I., Divers, J., Doshi, V., Dreyer, B., Ebel, S., Esquenazi-Karonika, S., Faustin, A., Febres, E., Fine, J., Fink, S., Freeland, C., Frontera, J., Gallagher, R., Gonzalez-Duarte, A., Gross, R., Hasson, D., Hill, S., Hochman, J., Horwitz, L., Hossain, J., Islam, S., Jean, C. S., Johnson, S., Kansal, N., Katz, S., Kenney, R., Kershner, T., Kewlani, D., Kwak, J., Lamendola-Essel, M. F., Laury, S., Laynor, G., Lei, L., Leon, T., Linton, J., Logan, M., Malik, N., Mamistvalova, L., Mandel, H., Maranga, G., Mattoo, A., Mei, T., Mendelsohn, A., Mercier, E., Vernetti, P. M., Miller, M., Mitchell, M., Moreira, A., Mudumbi, P. C., Nahin, E., Nair, N., Nekulak, J., Owens, K., Parent, B., Patibandla, N., Petrov, P., Postelnicu, R., Pratt, F., Randall, I., Rao, P., Rapkiewicz, A., Rizzo, J., Rosas, J., Rose, C., Saint-Jean, C., Santacatterina, M., Shah, B., Shaukat, A., Simon, N., Simsir, A., Stinson, M., Tang, W., Tatapudi, V., Thawani, S., Thomas, M., Thorpe, L., Tom, M., Treiha, E., Troxel, A., Truong, J., Udosen, M., Valencia, C., Velazquez-Perez, J., Vernetti, P. M., Vidal, C., Viswanathan, A., Willerford, A., Williams, N., Wong, C., Wood, M. J., Wuller, S., Yin, S. H., Young, C., Zaretsky, J., Zavlunova, S., Ahirwar, S., Ahmed, S., Ainsworth, L. L., Atchley-Challenner, R., Avilach, P., Balan, T. T., Benik, N., Benoit, B., Bind, M. C., Bonaventura, W. J., Boutin, N., Brion, B., Cagan, A., Cai, T., Cao, T., Castro, V. M., Cerretani, X. R., Chan, J. G., Cheng, D., Chibnik, L. B., Ciriello, M., Costenbader, K., Dimitrov, D. S., Estiri, H., Fayad, M., Feldman, C. H., Foulkes, A., Gainer, V., Ghosh, B., Gollub, R., Guan, Z., Harris, A., Helmer, K., Hendrix, A., Holzbach, A., Huang, W., Karlson, E. W., Kaufman, D., Keogh, D., Kerr, J. D., Klann, J. G., Krishnamoorthy, A., Lasky-Su, J. A., Liao, K. P., MacFadden, D., Maram, A., Martel, M. W., Mendis, M., Metta, R., Monteiro, J., Morales, E., Morse, R. E., Murphy, S., Nazaire, M., Neils, G., Nguyen, A. N., Norman, J., Paik, H. H., Pant, D., Park, H., Rabideau, D. J., Reeder, H. T., Rossi-Roh, K., Santacroce, L. M., Schlepphorst, K., Schulte, C., Selvaggi, C. A., Shinnick, D. J., Simons, W., Simpson, L. A., St Jean Flanders, M. L., Strasser, Z., Thakrar, M. R., Thaweethai, T., Thorn, M., Trewett, P., Van Fleet, D., Wagholikar, K. B., Wang, T. D., Wattanasin, N., Weber, G., Williams, M. A., Zhang, R. Z., Cicek, M., Chang, N., Wirkus, S., Zahnle, N., Flotte, T. J., Frisch, E., Boysen, E. M., Welch, G., Akintonwa, T., Blancero, F., Brown, H., Carmilani, M., Cerda, M., Clash, V. H., Copeland, D., Blakley, F. D., Hall, Y., Kevin Kondo, Lerma, L., Lindsay, J., Marti, H., Maughan, C., Minor, T., Taylor, B., Vincent, H., Zissis, M., Anderson, B., Bardhan, S., Castro-Baucom, L., Chisolm, D., Corchado, C., Damian, A. J., Daniel, C., DasGupta, S., Dehority, W., Feldman, C., Fessel, J., Rosas, L. G., Horowitz, C., John, J., Khullar, D., Lopez, K., Lutrick, K., Marquez, C., McDonald Pinkett, S., Myaskovsky, L., Regino, L., Rhoads, K., St John Thomas, G., Stewart de Ramirez, S., Tsevat, J., Valencia, C., Vangeepuram, N., Walden, A., Wiley, Z., Williams, N., Yin, S., Blachman, N., Boutin, N., Burton, P., Catallozzi, M., Clark, C., Dworetzky, B., Edwards, B., Ferrer, R. L., Huang, B., Judd, S., Laury, S., Musick, H., Pathak, D., Pogreba-Brown, K., Raissy, H., Richardson, L., Rothman, R., Wagner, L., Wallace, A., Adams, S. R., Akintonwa, T., Aragon, L., Bander, B., Bishof, K., Blancero, F., Brooks, G., Carignan, E., Carmilani, M., Castro-Baucom, L., Cerda, M., Coombs, K., Copeland, D., Corchado, C., Davis, H., Blakley, F. D., Diggs, M., Edwards, B., Brown, H. E., Favors, U., Fields, W., Fisher, L., Fitzgerald, M., Gaffney, A., Witvliet, M. G., Garcia, R., Gustafson, T., Guthe, N., Hall, Y., Holmes, V., Hornig, M., Hornig, M., Jefferson, W., Kim, C., Kochis, N., Kondo, K., Lam, J., Lawrence, F., Lerma, L., Letts, R., Lewis, J., Lindsay, J., Lopez, S., Marti, H., Martinez, T., Maughan, C., McCorkell, L., McGrath, R., Minor, T. T., Moore, C., Nguyen, K., Nichols, L., O'Brien, L., Olson, H., Peddie, A., Perlowski, A., Lorenzo, E. P., Prentiss, L., Raytselis, N., Regino, L., Roberts, M., Rochez, N., Rockwell, M., Rutter, J., Rochez, N., Seibert, E., Sekar, A., Smith, C., Stiles, L., Taylor, B., Taylor, E., Thompson, J., Trapp, S., Valdiva, S., Vincent, H., Wallace, A., Wilensky, R., Williams, M., Williams, N., Dawson, K. W., Wylam, A., Zissis, M. 2024

  Abstract

  OBJECTIVES: To determine the proportion of individuals with detectable antigen in plasma or serum after SARS-CoV-2 infection and the association of antigen detection with postacute sequelae of COVID-19 (PASC) symptoms.METHODS: Plasma and serum samples were collected from adults participating in four independent studies at different time points, ranging from several days up to 14months post-SARS-CoV-2 infection. The primary outcome measure was to quantify SARS-CoV-2 antigens, including the S1 subunit of spike, full-length spike, and nucleocapsid, in participant samples. The presence of 34 commonly reported PASC symptoms during the postacute period was determined from participant surveys or chart reviews of electronic health records.RESULTS: Of the 1569 samples analysed from 706 individuals infected with SARS-CoV-2, 21% (95% CI, 18-24%) were positive for either S1, spike, or nucleocapsid. Spike was predominantly detected, and the highest proportion of samples was spike positive (20%; 95% CI, 18-22%) between 4 and 7months postinfection. In total, 578 participants (82%) reported at least one of the 34 PASC symptoms included in our analysis ≥1month postinfection. Cardiopulmonary, musculoskeletal, and neurologic symptoms had the highest reported prevalence in over half of all participants, and among those participants, 43% (95% CI, 40-45%) on average were antigen-positive. Among the participants who reported no ongoing symptoms (128, 18%), antigen was detected in 28 participants (21%). The presence of antigen was associated with the presence of one or more PASC symptoms, adjusting for sex, age, time postinfection, and cohort (OR, 1.8; 95% CI, 1.4-2.2).DISCUSSION: The findings of this multicohort study indicate that SARS-CoV-2 antigens can be detected in the blood of a substantial proportion of individuals up to 14months after infection. While approximately one in five asymptomatic individuals was antigen-positive, roughly half of all individuals reporting ongoing cardiopulmonary, musculoskeletal, and neurologic symptoms were antigen-positive.

  View details for DOI 10.1016/j.cmi.2024.09.001

  View details for PubMedID 39389851

• Differentiation of Prior SARS-CoV-2 Infection and Postacute Sequelae by Standard Clinical Laboratory Measurements in the RECOVER Cohort. Annals of internal medicine Erlandson, K. M., Geng, L. N., Selvaggi, C. A., Thaweethai, T., Chen, P., Erdmann, N. B., Goldman, J. D., Henrich, T. J., Hornig, M., Karlson, E. W., Katz, S. D., Kim, C., Cribbs, S. K., Laiyemo, A. O., Letts, R., Lin, J. Y., Marathe, J., Parthasarathy, S., Patterson, T. F., Taylor, B. D., Duffy, E. R., Haack, M., Julg, B., Maranga, G., Hernandez, C., Singer, N. G., Han, J., Pemu, P., Brim, H., Ashktorab, H., Charney, A. W., Wisnivesky, J., Lin, J. J., Chu, H. Y., Go, M., Singh, U., Levitan, E. B., Goepfert, P. A., Nikolich, J. Ž., Hsu, H., Peluso, M. J., Kelly, J. D., Okumura, M. J., Flaherman, V. J., Quigley, J. G., Krishnan, J. A., Scholand, M. B., Hess, R., Metz, T. D., Costantine, M. M., Rouse, D. J., Taylor, B. S., Goldberg, M. P., Marshall, G. D., Wood, J., Warren, D., Horwitz, L., Foulkes, A. S., McComsey, G. A. 2024

  Abstract

  There are currently no validated clinical biomarkers of postacute sequelae of SARS-CoV-2 infection (PASC).To investigate clinical laboratory markers of SARS-CoV-2 and PASC.Propensity score-weighted linear regression models were fitted to evaluate differences in mean laboratory measures by prior infection and PASC index (≥12 vs. 0). (ClinicalTrials.gov: NCT05172024).83 enrolling sites.RECOVER-Adult cohort participants with or without SARS-CoV-2 infection with a study visit and laboratory measures 6 months after the index date (or at enrollment if >6 months after the index date). Participants were excluded if the 6-month visit occurred within 30 days of reinfection.Participants completed questionnaires and standard clinical laboratory tests.Among 10 094 participants, 8746 had prior SARS-CoV-2 infection, 1348 were uninfected, 1880 had a PASC index of 12 or higher, and 3351 had a PASC index of zero. After propensity score adjustment, participants with prior infection had a lower mean platelet count (265.9 × 109 cells/L [95% CI, 264.5 to 267.4 × 109 cells/L]) than participants without known prior infection (275.2 × 109 cells/L [CI, 268.5 to 282.0 × 109 cells/L]), as well as higher mean hemoglobin A1c (HbA1c) level (5.58% [CI, 5.56% to 5.60%] vs. 5.46% [CI, 5.40% to 5.51%]) and urinary albumin-creatinine ratio (81.9 mg/g [CI, 67.5 to 96.2 mg/g] vs. 43.0 mg/g [CI, 25.4 to 60.6 mg/g]), although differences were of modest clinical significance. The difference in HbA1c levels was attenuated after participants with preexisting diabetes were excluded. Among participants with prior infection, no meaningful differences in mean laboratory values were found between those with a PASC index of 12 or higher and those with a PASC index of zero.Whether differences in laboratory markers represent consequences of or risk factors for SARS-CoV-2 infection could not be determined.Overall, no evidence was found that any of the 25 routine clinical laboratory values assessed in this study could serve as a clinically useful biomarker of PASC.National Institutes of Health.

  View details for DOI 10.7326/M24-0737

  View details for PubMedID 39133923

• Air Medical Transport for Acute Ischemic Stroke Patients: A Retrospective Cohort Study of National Trends Over an 8-Year Period. Air medical journal Urdaneta, A., Fisk, C., Tandel, M. D., Garcia, A., Govindarajan, P. 2023; 42 (6): 423-428

  Abstract

  OBJECTIVE: Optimal management of ischemic stroke is time dependent. An understanding of patterns of air medical transport may identify disparities that could affect patient care.METHODS: In this 8-year (2007-2014) observational, retrospective, cohort study, we abstracted a 20% national sample of Medicare data from patients ≥ 66 years of age hospitalized with a primary diagnosis of acute ischemic stroke who presented to the emergency department by ambulance (air or ground).RESULTS: Among 149,751 hospitalized stroke patients who arrived by ambulance, the mean age was 81.6 years (standard deviation=8.0 years), 62.1% were female (n=93,007), and 86.3% were White (n=129,268). Of these, 5,534 patients (3.7%) used any form of air ambulance. Air ambulance use (2007: 2.5%, 2014: 4.9%; P < .001) and arrival at certified stroke centers (2007: 40.3%, 2014: 63.2%; P < .001) increased over time. Air ambulance use was less likely among older patients (76-85 years and >85 years vs. 66-75 years; odds ratio [OR]=0.68; 95% confidence interval [CI], 0.64-0.72 and OR=0.34; 95% CI, 0.32-0.37, respectively) and all racial minorities except American Natives (OR=2.07; 95% CI, 1.57-2.73) and more likely among sicker patients (Charlson Comorbidity Index ≥ 2 vs. 1, OR=1.23; 95% CI, 1.09-1.38) and rural residents (OR=1.34; 95% CI, 1.09-1.64). After adjustment for covariates, air ambulance use was associated with higher odds of thrombolysis (adjusted OR=2.57; 95% CI, 2.38-2.79).CONCLUSION: Air ambulance use is independently associated with increased thrombolysis use for stroke, but disparities exist in both air ambulance and thrombolysis use. Further research into underlying causes for these disparities would be beneficial for systems and public health-based interventions for improving outcomes for ischemic stroke.

  View details for DOI 10.1016/j.amj.2023.06.007

  View details for PubMedID 37996176

• Researching COVID to Enhance Recovery (RECOVER) adult study protocol: Rationale, objectives, and design. PloS one Horwitz, L. I., Thaweethai, T., Brosnahan, S. B., Cicek, M. S., Fitzgerald, M. L., Goldman, J. D., Hess, R., Hodder, S. L., Jacoby, V. L., Jordan, M. R., Krishnan, J. A., Laiyemo, A. O., Metz, T. D., Nichols, L., Patzer, R. E., Sekar, A., Singer, N. G., Stiles, L. E., Taylor, B. S., Ahmed, S., Algren, H. A., Anglin, K., Aponte-Soto, L., Ashktorab, H., Bassett, I. V., Bedi, B., Bhadelia, N., Bime, C., Bind, M. C., Black, L. J., Blomkalns, A. L., Brim, H., Castro, M., Chan, J., Charney, A. W., Chen, B. K., Chen, L. Q., Chen, P., Chestek, D., Chibnik, L. B., Chow, D. C., Chu, H. Y., Clifton, R. G., Collins, S., Costantine, M. M., Cribbs, S. K., Deeks, S. G., Dickinson, J. D., Donohue, S. E., Durstenfeld, M. S., Emery, I. F., Erlandson, K. M., Facelli, J. C., Farah-Abraham, R., Finn, A. V., Fischer, M. S., Flaherman, V. J., Fleurimont, J., Fonseca, V., Gallagher, E. J., Gander, J. C., Gennaro, M. L., Gibson, K. S., Go, M., Goodman, S. N., Granger, J. P., Greenway, F. L., Hafner, J. W., Han, J. E., Harkins, M. S., Hauser, K. S., Heath, J. R., Hernandez, C. R., Ho, O., Hoffman, M. K., Hoover, S. E., Horowitz, C. R., Hsu, H., Hsue, P. Y., Hughes, B. L., Jagannathan, P., James, J. A., John, J., Jolley, S., Judd, S. E., Juskowich, J. J., Kanjilal, D. G., Karlson, E. W., Katz, S. D., Kelly, J. D., Kelly, S. W., Kim, A. Y., Kirwan, J. P., Knox, K. S., Kumar, A., Lamendola-Essel, M. F., Lanca, M., Lee-Lannotti, J. K., Lefebvre, R. C., Levy, B. D., Lin, J. Y., Logarbo, B. P., Logue, J. K., Longo, M. T., Luciano, C. A., Lutrick, K., Malakooti, S. K., Mallett, G., Maranga, G., Marathe, J. G., Marconi, V. C., Marshall, G. D., Martin, C. F., Martin, J. N., May, H. T., McComsey, G. A., McDonald, D., Mendez-Figueroa, H., Miele, L., Mittleman, M. A., Mohandas, S., Mouchati, C., Mullington, J. M., Nadkarni, G. N., Nahin, E. R., Neuman, R. B., Newman, L. T., Nguyen, A., Nikolich, J. Z., Ofotokun, I., Ogbogu, P. U., Palatnik, A., Palomares, K. T., Parimon, T., Parry, S., Parthasarathy, S., Patterson, T. F., Pearman, A., Peluso, M. J., Pemu, P., Pettker, C. M., Plunkett, B. A., Pogreba-Brown, K., Poppas, A., Porterfield, J. Z., Quigley, J. G., Quinn, D. K., Raissy, H., Rebello, C. J., Reddy, U. M., Reece, R., Reeder, H. T., Rischard, F. P., Rosas, J. M., Rosen, C. J., Rouphael, N. G., Rouse, D. J., Ruff, A. M., Saint Jean, C., Sandoval, G. J., Santana, J. L., Schlater, S. M., Sciurba, F. C., Selvaggi, C., Seshadri, S., Sesso, H. D., Shah, D. P., Shemesh, E., Sherif, Z. A., Shinnick, D. J., Simhan, H. N., Singh, U., Sowles, A., Subbian, V., Sun, J., Suthar, M. S., Teunis, L. J., Thorp, J. M., Ticotsky, A., Tita, A. T., Tragus, R., Tuttle, K. R., Urdaneta, A. E., Utz, P. J., VanWagoner, T. M., Vasey, A., Vernon, S. D., Vidal, C., Walker, T., Ward, H. D., Warren, D. E., Weeks, R. M., Weiner, S. J., Weyer, J. C., Wheeler, J. L., Whiteheart, S. W., Wiley, Z., Williams, N. J., Wisnivesky, J. P., Wood, J. C., Yee, L. M., Young, N. M., Zisis, S. N., Foulkes, A. S. 2023; 18 (6): e0286297

  Abstract

  SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis.RECOVER-Adult is a combined prospective/retrospective cohort currently planned to enroll 14,880 adults aged ≥18 years. Eligible participants either must meet WHO criteria for suspected, probable, or confirmed infection; or must have evidence of no prior infection. Recruitment occurs at 86 sites in 33 U.S. states, Washington, DC and Puerto Rico, via facility- and community-based outreach. Participants complete quarterly questionnaires about symptoms, social determinants, vaccination status, and interim SARS-CoV-2 infections. In addition, participants contribute biospecimens and undergo physical and laboratory examinations at approximately 0, 90 and 180 days from infection or negative test date, and yearly thereafter. Some participants undergo additional testing based on specific criteria or random sampling. Patient representatives provide input on all study processes. The primary study outcome is onset of PASC, measured by signs and symptoms. A paradigm for identifying PASC cases will be defined and updated using supervised and unsupervised learning approaches with cross-validation. Logistic regression and proportional hazards regression will be conducted to investigate associations between risk factors, onset, and resolution of PASC symptoms.RECOVER-Adult is the first national, prospective, longitudinal cohort of PASC among US adults. Results of this study are intended to inform public health, spur clinical trials, and expand treatment options.NCT05172024.

  View details for DOI 10.1371/journal.pone.0286297

  View details for PubMedID 37352211

  View details for PubMedCentralID PMC10289397

• ETHICS BETWEEN INDIVIDUAL RIGHTS AND SOCIAL RESPONSIBILITIES. The Journal of emergency medicine Giwa, A. O., Myers, M., Urdaneta, A. 2023

  View details for DOI 10.1016/j.jemermed.2023.03.066

  View details for PubMedID 37391319

• Association of an Emergency Critical Care Program With Survival and Early Downgrade Among Critically Ill Medical Patients in the Emergency Department. Critical care medicine Mitarai, T., Gordon, A. J., Nudelman, M. J., Urdaneta, A. E., Nesbitt, J. L., Niknam, K., Graber-Naidich, A., Wilson, J. G., Kohn, M. A. 2023

  Abstract

  OBJECTIVES: To determine whether implementation of an Emergency Critical Care Program (ECCP) is associated with improved survival and early downgrade of critically ill medical patients in the emergency department (ED).DESIGN: Single-center, retrospective cohort study using ED-visit data between 2015 and 2019.SETTING: Tertiary academic medical center.PATIENTS: Adult medical patients presenting to the ED with a critical care admission order within 12 hours of arrival.INTERVENTIONS: Dedicated bedside critical care for medical ICU patients by an ED-based intensivist following initial resuscitation by the ED team.MEASUREMENTS AND MAIN RESULTS: Primary outcomes were inhospital mortality and the proportion of patients downgraded to non-ICU status while in the ED within 6 hours of the critical care admission order (ED downgrade <6hr). A difference-in-differences (DiD) analysis compared the change in outcomes for patients arriving during ECCP hours (2 pm to midnight, weekdays) between the preintervention period (2015-2017) and the intervention period (2017-2019) to the change in outcomes for patients arriving during non-ECCP hours (all other hours). Adjustment for severity of illness was performed using the emergency critical care Sequential Organ Failure Assessment (eccSOFA) score. The primary cohort included 2,250 patients. The DiDs for the eccSOFA-adjusted inhospital mortality decreased by 6.0% (95% CI, -11.9 to -0.1) with largest difference in the intermediate illness severity group (DiD, -12.2%; 95% CI, -23.1 to -1.3). The increase in ED downgrade less than 6 hours was not statistically significant (DiD, 4.8%; 95% CI, -0.7 to 10.3%) except in the intermediate group (DiD, 8.8%; 95% CI, 0.2-17.4).CONCLUSIONS: The implementation of a novel ECCP was associated with a significant decrease in inhospital mortality among critically ill medical ED patients, with the greatest decrease observed in patients with intermediate severity of illness. Early ED downgrades also increased, but the difference was statistically significant only in the intermediate illness severity group.

  View details for DOI 10.1097/CCM.0000000000005835

  View details for PubMedID 37010317

• An Ethical Anaylsis of the Arguments Both For and Against COVID-19 Vaccine Mandates for Healthcare Workers JOURNAL OF EMERGENCY MEDICINE Myers, M., Dunikoski, L., Brantner, R., Fletcher, D., Saltzberg, E. E., Urdaneta, A. E., Wedro, B., Giwa, A. 2023; 64 (2): 246-250

  Abstract

  Since the development of the first U.S. Food and Drug Administration-approved vaccine for the prevention of serious disease and death associated with the SARS-CoV-2 virus, health care workers have been expected to comply with mandatory immunization requirements or face potential termination of employment and censure by their state medical boards. Although most accepted this mandate, there have been several who have felt this was an unnecessary intrusion and violation of their right to choose their own health care mitigation strategies, or an infringement on their autonomy and other civil liberties. Others have argued that being a health care professional places your duties above your own self-interests, so-called fiduciary duties. As a result of these duties, there is an expected obligation to do the best action to achieve the "most good" for society. A so-called "utilitarian argument."We explore arguments both for and against these mandatory vaccine requirements and conclude using duty- and consequence-based moral reasoning to weigh the merits of each.Although arguments for and against vaccine mandates are compelling, it is the opinion of the Ethics Committee of the American Academy of Emergency Medicine that vaccine mandates for health care workers are ethically just and appropriate, and the benefit to society far outweighs the minor inconvenience to an individual's personal liberties.

  View details for DOI 10.1016/j.jemermed.2022.11.005

  View details for Web of Science ID 000951686600001

  View details for PubMedID 36746692

  View details for PubMedCentralID PMC9659509

• Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection. JAMA Thaweethai, T., Jolley, S. E., Karlson, E. W., Levitan, E. B., Levy, B., McComsey, G. A., McCorkell, L., Nadkarni, G. N., Parthasarathy, S., Singh, U., Walker, T. A., Selvaggi, C. A., Shinnick, D. J., Schulte, C. C., Atchley-Challenner, R., Horwitz, L. I., Foulkes, A. S., RECOVER Consortium, Alba, G. A., Alicic, R., Altman, N., Anglin, K., Argueta, U., Ashktorab, H., Baslet, G., Bassett, I. V., Bateman, L., Bedi, B., Bhattacharyya, S., Bind, M., Blomkalns, A. L., Bonilla, H., Bush, P. A., Castro, M., Chan, J., Charney, A. W., Chen, P., Chibnik, L. B., Chu, H. Y., Clifton, R. G., Costantine, M. M., Cribbs, S. K., Davila Nieves, S. I., Deeks, S. G., Duven, A., Emery, I. F., Erdmann, N., Erlandson, K. M., Ernst, K. C., Farah-Abraham, R., Farner, C. E., Feuerriegel, E. M., Fleurimont, J., Fonseca, V., Franko, N., Gainer, V., Gander, J. C., Gardner, E. M., Geng, L. N., Gibson, K. S., Go, M., Goldman, J. D., Grebe, H., Greenway, F. L., Habli, M., Hafner, J., Han, J. E., Hanson, K. A., Heath, J., Hernandez, C., Hess, R., Hodder, S. L., Hoffman, M. K., Hoover, S. E., Huang, B., Hughes, B. L., Jagannathan, P., John, J., Jordan, M. R., Katz, S. D., Kaufman, E. S., Kelly, J. D., Kelly, S. W., Kemp, M. M., Kirwan, J. P., Klein, J. D., Knox, K. S., Krishnan, J. A., Kumar, A., Laiyemo, A. O., Lambert, A. A., Lanca, M., Lee-Iannotti, J. K., Logarbo, B. P., Longo, M. T., Luciano, C. A., Lutrick, K., Maley, J. H., Marathe, J. G., Marconi, V., Marshall, G. D., Martin, C. F., Matusov, Y., Mehari, A., Mendez-Figueroa, H., Mermelstein, R., Metz, T. D., Morse, R., Mosier, J., Mouchati, C., Mullington, J., Murphy, S. N., Neuman, R. B., Nikolich, J. Z., Ofotokun, I., Ojemakinde, E., Palatnik, A., Palomares, K., Parimon, T., Parry, S., Patterson, J. E., Patterson, T. F., Patzer, R. E., Peluso, M. J., Pemu, P., Pettker, C. M., Plunkett, B. A., Pogreba-Brown, K., Poppas, A., Quigley, J. G., Reddy, U., Reece, R., Reeder, H., Reeves, W. B., Reiman, E. M., Rischard, F., Rosand, J., Rouse, D. J., Ruff, A., Saade, G., Sandoval, G. J., Schlater, S. M., Shepherd, F., Sherif, Z. A., Simhan, H., Singer, N. G., Skupski, D. W., Sowles, A., Sparks, J. A., Sukhera, F. I., Taylor, B. S., Teunis, L., Thomas, R. J., Thorp, J. M., Thuluvath, P., Ticotsky, A., Tita, A. T., Tuttle, K. R., Urdaneta, A. E., Valdivieso, D., VanWagoner, T. M., Vasey, A., Verduzco-Gutierrez, M., Wallace, Z. S., Ward, H. D., Warren, D. E., Weiner, S. J., Welch, S., Whiteheart, S. W., Wiley, Z., Wisnivesky, J. P., Yee, L. M., Zisis, S. 2023

  Abstract

  Importance: SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals.Objective: To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections.Design, Setting, and Participants: Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling.Exposure: SARS-CoV-2 infection.Main Outcomes and Measures: PASC and 44 participant-reported symptoms (with severity thresholds).Results: A total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months.Conclusions and Relevance: A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.

  View details for DOI 10.1001/jama.2023.8823

  View details for PubMedID 37278994

• Call of Duty - What are Physicians' Obligations During Crises? The Journal of emergency medicine Giwa, A. O., Urdaneta, A. E., Wedro, B. 2022

  Abstract

  BACKGROUND: Society allows physicians the privilege and responsibility of caring for patients. Those responsibilities demand that their knowledge and technical expertise meet standards defined and policed by their colleagues, through medical societies or governmental entities. However, the fiduciary duty that patients' interests are held above those of the physicians' is an ethical precept that is tested when society is under threat.DISCUSSION: Disasters that stress society are a constant and can present themselves in a myriad of ways to include medical, meteorological, or political. Minimizing the potential damage to the quality and quantity of life of the population is dependent upon public safety personnel and health care professionals who may put their health and safety in harm's way to care for patients. These acts may be taken for granted or assumed to be part of the professional obligations of physicians and other health care workers who work at the bedside. The obligations of physicians to their patients and society may differ from those not in the medical field, and the level of risk deemed acceptable by the physician and by society should be clearly delineated.CONCLUSION: Despite the conflict between normative and descriptive ethics, in times of disaster, physicians must respond to the call of duty. This duty is contingent on the responsibility being shared with governmental agencies and health care facilities, to mitigate the risks borne by those who answer the call.

  View details for DOI 10.1016/j.jemermed.2022.07.017

  View details for PubMedID 36229319

• Cutting Edge Acute Ischemic Stroke Management. Emergency medicine clinics of North America Urdaneta, A. E., Bhalla, P. 2019; 37 (3): 365–79

  Abstract

  Acute ischemic stroke (AIS) is a medical emergency that requires prompt recognition and streamlined work-up to ensure that time-dependent therapies are initiated to achieve the best outcomes. This article discusses frequently missed AIS in the emergency department, the role of various imagining modalities in the work-up of AIS, updates on the use of intravenous thrombolytics and endovascular therapy for AIS, pearls on supportive care management of AIS, and prehospital and hospital process improvements to shorten door-to-needle time.

  View details for DOI 10.1016/j.emc.2019.03.001

  View details for PubMedID 31262409

• Radiographic and Clinical Predictors of Cardiac Dysfunction Following Isolated Traumatic Brain Injury JOURNAL OF INTENSIVE CARE MEDICINE Urdaneta, A. E., Fink, K. R., Krishnamoorthy, V., Rowhani-Rahbar, A., Vavilala, M. S. 2017; 32 (2): 151-157

  Abstract

  Although cardiac dysfunction after traumatic brain injury (TBI) has been described, there is little data regarding the association of radiographic severity and particular lesions of TBI with the development of cardiac dysfunction. We hypothesize that the Rotterdam or Marshall scores and particular TBI lesions are associated with the development of cardiac dysfunction after isolated TBI.We performed a retrospective cohort study. Adult patients with isolated TBI who underwent echocardiography between 2003 and 2010 were included. A board-certified neuroradiologist assessed the first computed tomography head, assigning the Rotterdam and Marshall scores and the type of TBI. Cardiac dysfunction was defined as either systolic or all cause based on the first echocardiogram after TBI. Demographic, radiological, and clinical variables were used in our analysis.A total of 139 patients were identified, with 20 having isolated systolic dysfunction. The Marshall and Rotterdam scores were not associated with the development of cardiac dysfunction. Only head Abbreviated Injury Scale was found to be an independent predictor of systolic cardiac dysfunction (relative risk: 2.70, 95% confidence interval: 1.19-6.13; P = .02).No specific radiographic variable was found to be an independent predictor of cardiac dysfunction. Further study into clinical or radiological features that would warrant an echocardiogram is warranted, as it may direct patient management.

  View details for DOI 10.1177/0885066615616907

  View details for Web of Science ID 000394894200007

  View details for PubMedID 26584593

• CERVICAL SPINE INJURY: ANALYSIS AND COMPARISON OF PATIENTS BY MODE OF TRANSPORTATION JOURNAL OF EMERGENCY MEDICINE Urdaneta, A. E., Stroh, G., Teng, J., Snowden, B., Barrett, T. W., Hendey, G. W. 2013; 44 (2): 287-291

  Abstract

  Cervical spine injury (CSI) studies have identified different factors contributing to CSI, but none compares the incidence and pattern of injury of patients arriving at the Emergency Department (ED) by private vehicle (PV).We compared the characteristics and injury patterns in CSI patients who were transported to the ED via Emergency Medical Services (EMS) versus PV.We conducted a three-hospital retrospective review of patients with CSI from January 1, 2000 to December 31, 2007. We excluded transfers and follow-up visits. Using a standardized data collection form, we reviewed demographics, mode of transport, mechanism of injury, imaging results, injury type and level, and neurologic deficits. Means and proportions were compared using t-tests and chi-squared as appropriate.Of 1174 charts identified, 718 met all study criteria; 671 arrived by EMS and 47 by PV. There was no difference between groups in age or gender. Ground-level fall was more likely in PV patients (32%, 95% confidence interval [CI] 20-46% vs. 6%, 95% CI 4-9%), whereas motor vehicle collision was less likely (32%, 95% CI 20-46% vs. 67%, 95% CI 63-70%). PV patients more often sustained a stable injury (66%, 95% CI 52-78% vs. 40%, 95% CI 36-44%), and were more often triaged to a lower-acuity area (25%, 95% CI 15-40% vs. 4%, 95% CI 3-6%). The incidence of neurologic deficit was similar (32%, 95% CI 20-46% vs. 24%, 95% CI 21-28%), though more PV patients had spinal cord injury without radiographic abnormality (21%, 95% CI 12-35% vs. 5%, 95% CI 4-7%).A small proportion of patients with CSI present to the ED by PV. Although most had stable injuries, a surprising number had unstable injuries with neurologic deficits, and were triaged to lower-acuity areas in the ED.

  View details for DOI 10.1016/j.jemermed.2012.06.021

  View details for Web of Science ID 000314665400039

  View details for PubMedID 22917652