Navigation of Chronic Shoulder Pain with Peripheral Nerve Stimulation under Covid-19 Restrictions: E-Poster Viewing

Introduction: Peripheral nerve stimulation (PNS) is an emerging modality for treatment of chronic pain. We describe the positive outcome with PNS of a patient whose surgical intervention for severe bilateral glenohumeral osteoarthritis was delayed to COVID-19 restrictions. Materials / Methods: 66 year-old male with severe bilateral glenohumeral osteoarthritis needed bilateral total shoulder arthroplasty however surgical intervention was delayed for months by COVID-19 restrictions. Conservative therapies including physical therapy, intra-articular injections, and oral opioids had previously failed thus we offered PNS. Placement of the right suprascapular PNS system was followed 2 weeks later by left suprascapular PNS system placement. The systems were placed without complication under ultrasound guidance with leads overlying the suprascapular nerves inferior to the suprascapular notch. [Formula presented] Results: At 2 weeks right shoulder pain was reduced by 60% while left shoulder pain was reduced by 70%. His pain decreased by 90% at 4 weeks. Most remarkably he noted significant increases in quality of life and improved independence in daily activities. Discussion(s): Osteoarthritis (OA) is a common cause of joint pain and dysfunction, a result of progressive mechanical and biochemical joint degeneration. OA results in a U.S. economic burden of $130 billion annually(1) with shoulder OA affecting over 30% of U.S. adults over 60 years old(2). COVID-19 delays in surgical cases, as with our patient, extends nationwide with a projected backlog of 1 million total joint and spine cases by 2022(3). Peripheral nerve stimulation originates from the gate control theory noted in 1965. PNS works through activation of large diameter fibers that attenuate nociceptive signaling in the dorsal horn. Through stimulation of afferent fibers, peripherally-induced plasticity can reverse central features of chronic pain. PNS is used in treatment of an expanding multitude of conditions such as peripheral neuralgia and complex regional pain syndrome. PNS involves targeting specific nerve trunks with electrical stimulation, providing directed therapy with a less invasive approach. Pain relief is expected to last beyond treatment duration and in a majority of cases lasts for one year or more. Studies of percutaneous PNS systems propose the prolonged relief following interim treatment periods results from a widened therapeutic window. Selective activation of Aalpha and Abeta fibers generate comfortable sensations in the painful area initiating a cascade of analgesic mechanisms from the periphery to the dorsal horn and cortex. Conclusion(s): An increasing number of studies continue to show significant pain relief with use of PNS(3)(4) providing an exciting opportunity for patients who fail conservative therapies. Learning Objectives: 1.) Highlight the use of emerging pain treatment modalities while navigating healthcare systems affected by COVID-19 2.) Highlight the use of peripheral nerve stimulation (PNS) for chronic pain syndromes typically treated surgically 3.) Showcase the quality of pain relief achieved by less invasive, interim treatments such as peripheral nerve stimulation (PNS). Keywords: peripheral nerve stimulation Copyright © 2022

Barcode Enabled Antigen Mapping (Beam) and Single-Cell Sequencing Enables Next-Generation Systems Immunology Analysis of the Postcovid- 19 Immune Landscape

Background The adaptive immune system identifies foreign antigens based on a series of highly specific interactions involving multiple immune cell types. Identifying the exact mechanisms of said interactions can be difficult to achieve using bulk sequencing methods due to poor resolution. Single cell sequencing offers the ability to match a specific antigen to an immune cell receptor sequence at the cellular level. Methods We used Barcode Enabled Antigen Mapping (BEAM) and Single Cell Immune Profiling technology to profile hundreds of thousands of human peripheral blood mononuclear cells (PBMCs) from a donor following their recovery from COVID-19. These cells were screened for potential binding interactions with multiple antigens from SARS-CoV-2 and other viral pathogens. Sequencing data were also generated for gene expression and paired sequences for both BCRs and TCRs. Results The combination of these two techniques allowed us to identify a number of antigen-specific clonotypes of T cells and B cells. The high throughput of the experiment allowed us to gain understanding on a global scale of the state of the immune system following recovery from a COVID-19 infection, as well as to identify potentially rare clonotypes that may not have been discerned from a smaller sample size. Conclusions This experiment demonstrates the ability of BEAM to both profile the entire immune system at the cellular level at a given point in time as well as distinguish specific antigen-receptor interactions with the same resolution. Insights provided by similar experiments could be invaluable in the creation of precision cell therapies for use in cancer treatment, as well as the development of vaccines and analysis of allergic and autoimmune responses.

Pre-teen pregnancy in South Africa: (just) the tip of the iceberg

In South Africa in 2020, of the recorded 34 587 births from teen mothers, 688 were nine and 10 years young.1,2 These girls are called pre-teens. The SA Births and Deaths Registration Amendment Act (Act No. 18 of 2010) stipulates that all births must be registered within 30 days from date of occurrence.3 The data in 2020, show a slowdown in registrations within the first 30 days for months of April, October and November, coinciding with lockdown measures instituted by the government to stem rising COVID-19 cases.1

Upgrading Steel Dynamics Inc. - Flat Roll Group Columbus Division's Continuous Pickling and Cold Rolling Operation for Increased Throughput and Production of Advanced High-Strength Steels

In 2018, Steel Dynamics (SDI) authorized a strategy to increase proportion of value-added products produced at the Columbus Division. The strategy included construction of a new No. 3 Coating line with a capacity of 400,000 net tons/year of galvanized and aluminized products and upgrading the existing No. 1 Galvanizing Line to produce Advanced High Strength Steels (AHSS). To fulfill this strategy, an upgrade was approved for the existing continuous pickle-tandem cold mill (PLTCM) to increase cold roll production capacity and to enhance welding capability for current and future grades of AHSS steels. The upgrade consisted of a thorough time-study of the operation to select the most appropriate design & equipment, new logistics for bringing coils to the entry-end, a new entry-end with two pay-off reels and a laser welder. A key requirement of the upgrade was minimal interruptions to ongoing production. The project was carried out in steps. COVID-19 pandemic delayed equipment deliveries and equipment supplier's personnel were not available as planned. Video-calls, helmet-cams, and other innovative techniques were used for installation and commissioning of the state-of-the-art laser welder. With the use of strict safety & health protocols, the PLTCM upgrade was completed successfully without any OSHA recordable injuries or COVID-19 infections during the project. © 2022 by the Association for Iron & Steel Technology

Wastewater-based epidemiology in hazard forecasting and early-warning systems for global health risks.

With the advent of the SARS-CoV-2 pandemic, Wastewater-Based Epidemiology (WBE) has been applied to track community infection in cities worldwide and has proven succesful as an early warning system for identification of hotspots and changingprevalence of infections (both symptomatic and asymptomatic) at a city or sub-city level. Wastewater is only one of environmental compartments that requires consideration. In this manuscript, we have critically evaluated the knowledge-base and preparedness for building early warning systems in a rapidly urbanising world, with particular attention to Africa, which experiences rapid population growth and urbanisation. We have proposed a Digital Urban Environment Fingerprinting Platform (DUEF) - a new approach in hazard forecasting and early-warning systems for global health risks and an extension to the existing concept of smart cities. The urban environment (especially wastewater) contains a complex mixture of substances including toxic chemicals, infectious biological agents and human excretion products. DUEF assumes that these specific endo- and exogenous residues, anonymously pooled by communities' wastewater, are indicative of community-wide exposure and the resulting effects. DUEF postulates that the measurement of the substances continuously and anonymously pooled by the receiving environment (sewage, surface water, soils and air), can provide near real-time dynamic information about the quantity and type of physical, biological or chemical stressors to which the surveyed systems are exposed, and can create a risk profile on the potential effects of these exposures. Successful development and utilisation of a DUEF globally requires a tiered approach including: Stage I: network building, capacity building, stakeholder engagement as well as a conceptual model, followed by Stage II: DUEF development, Stage III: implementation, and Stage IV: management and utilization. We have identified four key pillars required for the establishment of a DUEF framework: (1) Environmental fingerprints, (2) Socioeconomic fingerprints, (3) Statistics and modelling and (4) Information systems. This manuscript critically evaluates the current knowledge base within each pillar and provides recommendations for further developments with an aim of laying grounds for successful development of global DUEF platforms.

Nurse and nurse practitioner-lead monoclonal antibody initiative for solid organ transplant (SOT) recipients with COVID-19

Purpose: Monoclonal antibody (mAB) infusion (bamlanivimab or casirivimab/ imdevimab) for symptomatic, non-hypoxemic, high-risk outpatients with COVID-19 infection, is an available early intervention for COVID-19+ SOT recipients. We aimed to assess efficiency in time from diagnosis to treatment, and outcomes in a retrospective cohort of SOT recipients with COVID-19 who received mAB. Methods: We developed a Nurse Coordinator-led initiative to screen, refer, and facilitate mAB infusion for COVID-19+ SOT recipients within 10 days of symptom onset. SOT recipients received electronic messaging to promptly report potential COVID-19 symptoms to the transplant team. Data were collected on time from symptom onset to diagnosis, mAB infusion, and follow-up > 21 days, and hospital admissions, disease severity, mortality, and rejection. Results: 34 out of 36 referred SOT recipients with symptomatic COVID-19 disease without hypoxia received mAB therapy (3 heart, 8 lung, 16 kidney, 2 Liver-Kidney, 2 Pancreas-Kidney, 3 Kidney-Heart). Median time from symptom onset to diagnosis was 2 days and from date of diagnosis to mAB infusion was 4 days. Of those 34, 88% did not require hospitalization and recovered uneventfully. 12% required hospitalization for COVID disease progression, two on the same day as mAB infusion, and the other 2, more than 26 days post infusion. Of these, 2 patients had mild-moderate hypoxia, and 2 had critical disease. Only 1 patient died from COVID-19 complications and no episodes of rejection or graft loss were observed. Conclusions: The Nurse Coordinator-led initiative efficiently facilitated mAB therapy for COVID-19+ SOT recipients and was associated with excellent outcomes. Compared to prior published COVID-19 outcomes in SOT recipients, patients who received mAB may have reduce hospitalization and low mortality. As mAB therapy may be underutilized in the general population, these results support efforts to educate transplant centers to implement efficient interventions for the screening and referral of COVID+ SOT recipients for mAB therapy.

Computational Skills for Multivariable Thinking in Introductory Statistics

Since the publishing of Nolan and Temple Lang’s “Computing in the Statistics Curriculum” in 2010, the American Statistical Association issued new recommendations in the revised GAISE college report. To reflect modern practice and technologies, they emphasize giving students experience with multivariable thinking. Students develop multivariable thinking when they analyze real data in the context of investigating research questions of interest, which typically involve complex relationships between many variables. Proficiency in a statistical programming language facilitates the development of multivariable thinking by giving students tools to investigate complex data on their own. However, learning a programming language in an introductory course is difficult for many students. In this article, we recommend a set of computational skills for introductory courses, demonstrate them using R tidyverse, and describe a classroom activity to develop computational skills and multivariable thinking. We provide a tidyverse tutorial for introductory students, our course guide, and classroom activities. Supplementary materials for this article are available online at https://github.com/bryaneadams/Computational-Skills-for-Multivariable-Thinking-in-Introductory-Statistics. © 2021 The Author(s). Published with license by Taylor and Francis Group, LLC.

How pets factor into healthcare decisions for COVID-19: A One Health perspective

There is evidence that prioritizing pets' welfare can impact the health and well-being of their owners, especially when pet owners have a strong bond with their pet. This carries public health implications, particularly in a global public health emergency such as COVID-19. The study objective was to understand pet owners' consideration of their pets' welfare when making personal healthcare decisions specific to COVID-19. A large sample (n = 1356) of adult pet owners in the U.S. completed an online survey in April and May of 2020, coinciding with the onset of social distancing measures to prevent the spread of COVID-19. Respondents were asked if they would delay or avoid testing or treatment for COVID-19 due to concern for their pets' welfare, and a follow-up question asked them to elaborate. Multinomial logistic regression models showed that attachment to pets and socioeconomic resources were important factors in pet owners' hypothetical decisions regarding testing and treatment for COVID-19. Qualitative analysis of responses to the follow-up question revealed explanations across three themes: (1) the need to find pet accommodation prior to seeking healthcare;(2) pet-related concerns;and, (3) human-related concerns. Pet owners often cited concern for their pets' welfare as a factor contributing to their decision making;participants' lack of a concrete plan for pet care was most commonly cited as the reason for their delay in seeking healthcare. Results from this study indicate that pet owners experience unique obstacles to accessing healthcare related to COVID-19, which has implications for future public health emergencies. Increased disease spread and prevalence of poor health outcomes could result if pet owners delay or avoid testing or treatment. Communities can benefit from a One Health/One Welfare approach to collaboration between human and animal health and service providers to reduce COVID-19 spread and secure the well-being of people and their pets.