Background: The reported disproportionate impact of COVID-19 infections on minority populations may be due to living in disinvested communities with a high level of poverty, pollution, inadequate unsafe employment, and overcrowded housing. Objective: To determine the association of county, city, and individual risk factors with COVID-19 infection rates. Methods: Retrospective chart review on COVID-19 tests performed from March through July 2020 at Arrowhead Regional Medical Center (ARMC), Colton, California. Results: A total of 7104 tests were performed with 69% in the drive-through testing center. The mean duration of test-to-results time was 2.36 (+0.02) days. COVID-19 positive tests occurred in 1095 (15.4%). At least one symptom occurred in 414 (33%) with a sensitivity of 37.8, specificity of 86.02, a positive predictive value of 33.01, and a negative predictive value of 72.76. Individual factors significantly associated with testing positive for COVID-19 were diabetes, Hispanic ethnicity, and male gender. Younger age was significantly associated with testing COVID positive with the highest risk in children <10 years. COVID-19 positive persons significantly resided in cities with higher population density, household members, poverty, non-English speaking homes, disability, lower median household income, lack of health insurance and decreased access to a computer and Wi-Fi services. County health rankings showed a significant positive association between testing positive for COVID-19 with increased smoking, air pollution, violent crimes, physical inactivity, decreased education, and access to exercise. Conclusion: Adverse county health rankings, socially and economically disadvantaged cities are associated with an increased risk of testing positive for COVD-19. This information can be used in strategic planning and invention mitigation.

Background: Fluid therapy plays a major role in the management of critically ill patients. Yet assessment of intravascular volume in these patients is challenging. Different invasive and non-invasive methods have been used with variable results. The passive leg raise (PLR) maneuver has been recommended by international guidelines as a means to determine appropriate fluid resuscitation. We performed this systematic review and meta-analysis to determine if using this method of volume assessment has an impact on mortality outcome in patients with septic shock. Methods: This study is a systematic review and meta-analysis. We searched available data in the MEDLINE, CINAHL, EMBASE, and CENTRAL databases from inception until October 2020 for prospective, randomized, controlled trials that compared PLR-guided fluid resuscitation to standard care in adult patients with septic shock. Our primary outcome was mortality at the longest duration of follow-up. Results: We screened 1,425 article titles and abstracts. Of the 23 full-text articles reviewed, 5 studies with 462 patients met our eligibility criteria. Odds ratios (ORs) and associated 95% confidence intervals (CIs) for mortality at the longest reported time interval were calculated for each study. Using random effects modeling, the pooled OR (95% CI) for mortality with a PLR-guided resuscitation strategy was 0.82 (0.52 -1.30). The included studies were not blinded and they ranged from having low to high risk of bias using the Cochrane Risk of Bias Tool. Conclusion: Our analysis showed there was no statistically significant difference in mortality among septic shock patients treated with PLR-guided resuscitation vs. those with standard care.

Background Breathlessness is a common and devastating symptom affecting many patients with advanced malignant and nonmalignant disease. Management comprises non-pharmacological and pharmacological interventions best delivered by a multidisciplinary group. Aim To describe the feasibility of a study testing a newly established Breathlessness Support Service (BSS) at King's College Hospital, London. Methods An innovative BSS with palliative care and respiratory medicine (consultant, nurse, physiotherapy, occupational therapy, and social work) input is offered since October 2010 to patients with refractory breathlessness due to advanced malignant and nonmalignant disease. Patients are seen twice in the clinic and offered a home visit by physiotherapy and occupational therapy. The new service is evaluated in a phase 3 fast track randomised controlled trial (RCT) comparing immediate or delayed (after 6 weeks) access to BSS. Results Between October 2010 and June 2012, 191 patients have been referred to our study, of which 88 patients have consented to partake in the study (48/88 male; median age 68 y (range 40-84 y); 62/88 carer present; COPD 45, Cancer 17, ILD 18, heart failure 6, Asthma 1, other 1). Of these 88 patients, 60 patients have completed the study (primary endpoint at 6 weeks), with 11 patients awaiting their 6 week assessment. The current attrition rate for the primary endpoint of the study (6 weeks) is approximately 19%, much less than 40% we originally anticipated. 40 have completed the 12 week follow up home visit (secondary endpoint), with 12 patients awaiting their 12 week assessment. The current attrition rate for the secondary end point is 34%, reflective of the complexity of retaining palliative care patients in a RCT. The BSS is well received by patients. Main organisational problems relate to transport to the BSS and patients being unwell to attend the second clinic visit. Conclusion Referral to the study is similar to what we expected with the number of patients consenting (46%) to partake similar to that reported in the pulmonary rehabilitation literature. Once in the trial, attrition is low. Overall, the BSS seems to be feasible.