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In 2000, Ted Freedman was the surprised honoree of an annual award launched by Healthcare Quarterly in cooperation with Agilent Technologies. Mr. Freedman was not only the president and chief executive officer of Mount Sinai Hospital but also an associate professor in the Faculty of Medicine and the Department of Health Administration at the University of Toronto. He is a former chair of the Accrediting Commission on Education for Health Services Administration, Bridgepoint Active Healthcare, the Change Foundation and the Ontario Health Research Alliance and vice chair of Mount Sinai Hospital and Saint Elizabeth Health Care, all organizations committed to research and education. The award recognizes individuals who inspire, advocate and enable education in healthcare.Since early spring, the COVID-19 pandemic has catapulted the healthcare community from a largely comprehensible world of work to unfamiliar territory, where the ground is ever shifting. What does it take to serve the public in this environment? Constant recalibration, endless reserves of energy, quick wits and a wide-open mind willing to look for solutions in new places working with new people.BackgroundVeneto was one of the Italian regions hit hardest by the early phase of the coronavirus disease (COVID-19) pandemic.AimThis paper describes the public health response and epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in the Veneto Region from 21 February to 2 April 2020.MethodsInformation on the public health response was collected from regional health authorities' official sources. Epidemiological data were extracted from a web-based regional surveillance system. The epidemic curve was represented by date of testing. Characteristics of hospitalised COVID-19 cases were described and compared to those never admitted to hospital. Age- and sex-stratified case-fatality ratios (CFRs) were calculated.ResultsKey elements of the regional public health response were thorough case-finding and contact tracing, home care for non-severe cases, creation of dedicated COVID-19 healthcare facilities and activation of sub-intensive care units for non-invasive ventilation. As at 2 April 2020, 91,345 individuals were tested for SARS-CoV-2 and 10,457 (11.4%) were positive. Testing and attack rates were 18.6 per 1,000 and 213.2 per 100,000 population, respectively. The epidemic peaked around 20 to 24 March, with case numbers declining thereafter. Vandetanib Hospitalised cases (n = 3,623; 34.6%) were older and more frequently male compared with never-hospitalised cases. The CFR was 5.6% overall, and was higher among males and people > 60 years of age.ConclusionIn the Veneto Region, the strict social distancing measures imposed by the Italian government were supported by thorough case finding and contact tracing, as well as well-defined roles for different levels of care.The coronavirus disease pandemic was declared in March 2020, as the southern hemisphere's winter approached. Australia expected co-circulation of severe acute respiratory syndrome coronavirus 2, influenza and other seasonal respiratory viruses. However, influenza notifications were 7,029 (March-September) compared with an average 149,832 for the same period in 2015-2109, despite substantial testing. Restrictions on movement within and into Australia may have temporarily eliminated influenza. Other respiratory pathogens also showed remarkably changed activity in 2020.We present preliminary results of a coronavirus disease (COVID-19) impact assessment on testing for HIV, viral hepatitis and sexually transmitted infections in the WHO European Region. We analyse 98 responses from secondary care (n = 36), community testing sites (n = 52) and national level (n = 10). Compared to pre-COVID-19, 95% of respondents report decreased testing volumes during March-May and 58% during June-August 2020. link2 Reasons for decreases and mitigation measures were analysed.Three months after a coronavirus disease (COVID-19) outbreak in Kupferzell, Germany, a population-based study (n = 2,203) found no RT-PCR-positives. IgG-ELISA seropositivity with positive virus neutralisation tests was 7.7% (95% confidence interval (CI) 6.5-9.1) and 4.3% with negative neutralisation tests. We estimate 12.0% (95% CI 10.4-14.0%) infected adults (24.5% asymptomatic), six times more than notified. Full hotspot containment confirms the effectiveness of prompt protection measures. However, 88% naïve adults are still at high COVID-19 risk.INTRODUCTION A significant proportion of the astronauts who spend extended periods in microgravity develop ophthalmic abnormalities, including optic disc edema, optic nerve sheath distention, globe flattening, chorioretinal folds, hyperopic refractive error shifts, and nerve fiber layer infarcts. A constellation of these neuro-ophthalmic findings has been termed spaceflight-associated neuro-ocular syndrome. link3 An increased understanding of factors contributing to this syndrome is one of the top priorities for ESA and NASA because the length of missions is expected to increase substantially in the future. As discussed in the present article, the very recent discovery of an ocular glymphatic clearance system can potentially help to unlock mechanisms underlying microgravity-induced optic disc edema. Observations pertaining to the ocular glymphatic pathway provide supporting evidence for the hypothesis, originally proposed by our group, suggesting that the glymphatic outflow from the eye into the optic nerve may be impeded under prolonged microgravity conditions, leading to optic disc edema.Wostyn P, De Winne F, Stern C, Mader TH, Gibson CR, De Deyn PP. Potential involvement of the ocular glymphatic system in optic disc edema in astronauts. Aerosp Med Hum Perform. 2020; 91(12)975977.BACKGROUND Increased frequencies of physiological episodes have been a significant concern for Naval Aviation for the last several years. These include several aircraft platforms, but no previously documented E-2D Hawkeye events. This report documents an episode in an E-2D, with multiple aircrew affected at the same time.CASE REPORT While deployed aboard a U.S. aircraft carrier, five E-2D Hawkeyes aircrew were simultaneously exposed to the same over-pressurization during a routine sortie. Out of the five aircrew, four immediately reported hypoxic-like neurocognitive symptoms of mental slowing, difficulty concentrating, and headache. They were evaluated and treated using standard protocol according to the Physiologic Event Clinical Practice Guidelines set by the Naval Safety Center. All aircrew were treated with 100% ground level oxygen with resolution of symptoms.DISCUSSION Although rare, physiological events may occur in multipassenger platforms such as the E-2D Hawkeye. Utilizing and strictly adhering to standard clinical practice guidelines provided an efficient process of evaluation by different flight surgeons concurrently that avoided a possible delay in treatment. After, eliminating other potential etiology for the crews symptoms, a pressure-related mechanism of injury appears to be the most probable cause.Ko SY, Rice GM. Multiple E-2D Hawkeye aircrew with neurocognitive symptoms during a single over-pressurization episode. Aerosp Med Hum Perform. 2020; 91(12)970974.BACKGROUND Olfactory meningiomas are typically benign, slow-growing intracranial tumors with subtle presentations that result in delayed diagnosis. To date, only a few published reports describe meningiomas in airmen. None specifically mention olfactory meningiomas or detail the associated presence of cognitive impairment.CASE REPORT This was a 55-yr-old commercial pilot with over 20 yr of flight experience who presented for a fitness-for-duty evaluation due to alarming performance at work and neurocognitive concerns. On examination, the patient had an odd affect and anosmia. Imaging showed a large, frontal, midline intracranial mass consistent with an olfactory meningioma.DISCUSSION Fitness-for-duty cases are often challenging and even more so when neurocognition is called into question. Symptoms may be subtle and gradual in onset, making recognition and diagnosis difficult. Dementia, alcohol or substance misuse/abuse, and psychiatric diagnoses are often the first conditions considered when evaluating new cognitive impairment in a pilot. This case highlights the importance of keeping a broad differential, including intracranial masses, conducting a thorough neurological examination, and the judicious use of brain imaging.Hong M, Kreykes AJ. Cognitive changes in a commercial pilot secondary to an olfactory meningioma. Aerosp Med Hum Perform. 2020; 91(12)966969.BACKGROUND Emergency helicopter landing at sea is dangerous. Specialized training, known as helicopter underwater escape training (HUET), prepares occupants to quickly exit the helicopter, which often inverts and sinks. In most jurisdictions, helicopter occupants are equipped with a helicopter underwater egress breathing apparatus (HUEBA) to provide sufficient air for escape. HUET trainees report that the HUEBA is easy to use, but it is well known that learners are often overconfident in their judgement of learning. To better understand how the HUEBA affects HUET sequence performance, we investigated whether using the HUEBA influences the sequence movement time and number of errors.METHODS Twelve participants (7 men and 5 women, mean age 25.33 9.57 SD) with no prior experience with HUET performed consecutive trials of the HUET sequence, 5 with the HUEBA and 5 without the HUEBA. Video of each trial recorded the total movement time and enabled movement time analyses of each component of the sequence crossing arms, tucking the head, pushing the window, inserting the regulator, and releasing the seatbelt. These recordings were also used to score performance errors according to a checklist.RESULTS Analyses revealed that using a HUEBA increased the total movement time and time to release the seatbelt by 0.36 and 0.39 s, respectively, in comparison to without the HUEBA.DISCUSSION Our study illustrates that using the HUEBA during the HUET sequence increases total movement time and time to release the seatbelt. However, this difference is marginal and unlikely to have practical significance during underwater escape.King M, Sanli E, Mugford K, Martina S, Brown R, Carnahan H. Evaluation of the helicopter emergency breathing apparatus on egress performance. Aerosp Med Hum Perform. 2020; 91(12)962965.INTRODUCTION Hypergolic propellants can be released in large amounts during space launch contingencies. Whether propellant-contaminated suit fabric poses a significant risk to rescue crews, due to off-gassing, has not been explored in detail. In this study, we addressed this issue experimentally, exposing space suit fabric to propellants (dinitrogen tetroxide [N₂O₄] and monomethyl hydrazine [MMH]).METHODS The NASA Space Shuttle Program Advanced Crew Escape System II (ACES II) is similar to the NASA Orion Crew Survival System (OCSS) and was utilized here. Suit fabric was placed and sealed into permeation cells. Fabric exterior surface was exposed to constant concentrated hypergolics, simulating permeation and leakage. Fabric was rinsed, and permeation and off-gassing kinetics were measured. Experimental parameters were selected, simulating suited flight crewmembers during an evacuation transport without cabin air flow.RESULTS The fabric allows for immediate permeation of liquid or vaporized MMH and N₂O₄. NO₂ off-gassing never exceeded the AEGL-1 8-h level (acute exposure guideline level).