Long-Term Neurologic Sequelae Among Patients with Varying COVID-19 Severity: An Administrative Claims Database Analysis

Objectives: Examine the long-term incident neurologic sequelae post COVID recovery and assess relationship with COVID severity using real-world data. Method(s): This retrospective cohort study was conducted using Optum Research Database between 01July2019 to 30Sep2022. Patients included were >=18 years with COVID diagnosis (index date) between 01Jan2020 and 31Oct2020, with continuous enrollment 6 months before and >=12 months after index date, known demographics, not pregnant, and with no baseline neurologic conditions. Patients were stratified into COVID severity cohorts as mild (index diagnosis), moderate (inpatient visit within 15 days of index), or severe (evidence of acute respiratory distress) and followed for a minimum of 12-months post-index. Neurologic sequelae examined were persistent headache, migraine, anosmia, sleep disturbance, cognitive dysfunction, post-traumatic stress disorder, suicidality, anxiety, depression, attention deficit hyperactivity disorder, cerebrovascular disease (CVD), fatigue/myalgia and tremors. Descriptive statistics and incidence rate ratios (IRR) were calculated to assess outcomes. Result(s): Of 534,843 patients, 107,656 (Mild 96,637;Moderate 3,371;Severe 7,648) met the study inclusion criteria. Median follow up time was 750, 774 and 768 days in the mild, moderate and severe cohorts, respectively. About 20% of patients in the mild, 32% in moderate and 35% in the severe cohort experienced >=3 neurologic sequelae during the follow-up period. A significantly higher incidence of any neurologic sequelae was observed in moderate and severe cohorts compared with the mild cohort (IRR 3.1 and 3.0, respectively;p<0.001). Cognitive dysfunction (moderate IRR 5.4, severe IRR 5.7;p<0.001), and CVD (moderate IRR 4.8, severe IRR 4.0;p<0.001) were the most commonly occurring manifestations in moderate and severe cohorts compared with the mild cohort. Conclusion(s): These results highlight the need for long-term monitoring and preventative strategies for neurologic conditions post COVID recovery that might impair quality of life and increase overall healthcare burden in the U.S.Copyright © 2023

THE IMPACT OF ABSORPTIVE CAPACITY, CORPORATE SOCIAL INNOVATION, AND E-BUSINESS PROACTIVENESS ON SMES' SURVIVAL

This study examines the role of absorptive capacity on corporate social innovation, e-business proactiveness, and SMEs' survival. It also investigates the impact of corporate social innovation and e-business proactiveness, and SMEs' survival. Data were collected from 384 managers and owners of 62 SMEs in Jordan. Smart PLS, version 3, was employed to test hypotheses. The findings reveal that absorptive capacity significantly impacts e-business proactiveness and social innovation. They also show that absorptive capacity, e-business proactiveness, and social innovation significantly impact SMEs' survival. This study enriches the literature on renewable dynamic capabilities, exploring how e-business entrepreneurial orientation and social innovation contribute to SMEs' resilience and survival during global crises. © Vilnius University, 2002-2023.

CROI 2021: Neurologic Complications of HIV-1 Infection or Covid-19

The 2021 Conference on Retroviruses and Opportunistic Infections (CROI) featured a timely review of the neurologic complications of COVID-19 as well as new research findings on mechanisms by which SARS-CoV-2 may affect the brain. CROI included new and important findings about the neurologic complications of HIV-1, human polyomavirus 2 (also known as JC Virus), and cryptococcus. New long-term analyses of cognition in people with HIV-1 identified that cognitive decline over time is associated with multimorbidity, particularly diabetes, chronic lung disease, and vascular disease risk conditions. These conditions are associated with aging, and the question of whether people with HIV are at risk for premature aging was addressed by several reports. New findings from large analyses of resting state networks also provided valuable information on the structural and functional networks that are affected by HIV-1 infection and cognitive impairment. Several reports addressed changes after initiating or switching antiretroviral therapy (ART). Findings that will improve understanding of the biologic mechanisms of brain injury in people with HIV were also presented and included evidence that host (eg, myeloid activation, inflammation, and endothelial activation) and viral (eg, transcriptional activity and compartmentalization) factors adversely affect brain health. Other research focused on adjunctive therapies to treat HIV-1 and its complications in the central nervous system. This summary will review these and other findings in greater detail and identify key gaps and opportunities for researchers and clinicians.Copyright © 2021, IAS-USA. All rights reserved.

COVID-19 and Pulmonary Angiogenesis: The Possible Role of Hypoxia and Hyperinflammation in the Overexpression of Proteins Involved in Alveolar Vascular Dysfunction.

COVID-19 has been considered a vascular disease, and inflammation, intravascular coagulation, and consequent thrombosis may be associated with endothelial dysfunction. These changes, in addition to hypoxia, may be responsible for pathological angiogenesis. This research investigated the impact of COVID-19 on vascular function by analyzing post-mortem lung samples from 24 COVID-19 patients, 10 H1N1pdm09 patients, and 11 controls. We evaluated, through the immunohistochemistry technique, the tissue immunoexpressions of biomarkers involved in endothelial dysfunction, microthrombosis, and angiogenesis (ICAM-1, ANGPT-2, and IL-6, IL-1ß, vWF, PAI-1, CTNNB-1, GJA-1, VEGF, VEGFR-1, NF-kB, TNF-α and HIF-1α), along with the histopathological presence of microthrombosis, endothelial activation, and vascular layer hypertrophy. Clinical data from patients were also observed. The results showed that COVID-19 was associated with increased immunoexpression of biomarkers involved in endothelial dysfunction, microthrombosis, and angiogenesis compared to the H1N1 and CONTROL groups. Microthrombosis and vascular layer hypertrophy were found to be more prevalent in COVID-19 patients. This study concluded that immunothrombosis and angiogenesis might play a key role in COVID-19 progression and outcome, particularly in patients who die from the disease.

Efficacy And Safety Of Bivalent Respiratory Syncytial Virus (RSVpreF) Vaccine In Older Adults

Background. Respiratory syncytial virus (RSV) is an important cause of disease in older adults and is associated with high morbidity and mortality, especially in those with high-risk conditions. Illness can vary from mild upper respiratory tract symptoms to more severe lower respiratory tract disease. After over 50 years of research, there is now hope for an RSV vaccine for any population, including older adults. An investigational bivalent RSV A and B, stabilized RSV prefusion F subunit vaccine (RSVpreF) was assessed successfully in a pivotal phase 3 efficacy study in older adults. (NCT05035212). Methods. The primary efficacy objective of this Phase 3, global, multicenter, randomized, double-blinded, placebo-controlled study was to evaluate the prevention of RSV associated lower respiratory tract illness (LRTI-RSV) in up to 40,000 adults >=60 years of age during the first winter season (September 2021-June 2022). Two primary endpoints were tested sequentially - LRTI-RSV with >=2 and >=3 symptoms. A pre-planned efficacy interim analysis (IA) was to be conducted by an external Data Monitoring Committee (DMC) upon accrual of at least 29 cases of LRTI-RSV with >=2 symptoms. With efficacy demonstrated for cases with >=2 symptoms and sufficient cases with >= 3 symptoms accrued, an efficacy analysis of cases with >= 3 symptoms was to be conducted. The ongoing study is collecting additional safety and descriptive efficacy data. Results. At the time of the IA, approximately 34,000 participants received either RSVpreF 120 mug (60 mug each of RSVpreF from RSV A and RSV B) or placebo (1:1 randomization). Forty-four LRTI-RSV cases with >=2 symptoms were accrued with 11 cases in the RSVpreF group and 33 cases in the placebo group corresponding to a VE of 66.7% (96.66% CI: 28.8%, 85.8%). Sixteen LRTI-RSV cases with >=3 symptoms were accrued with 2 cases in the RSVpreF group and 14 cases in the placebo group corresponding to a VE of 85.7% (96.66% CI: 32.0%, 98.7%). The investigational vaccine was well-tolerated with no safety concerns. Conclusion. Despite unpredictable RSV activity due to the COVID-19 pandemic, the primary objective of the study was met demonstrating that RSVpreF had a favorable safety profile and was highly efficacious in preventing LRTI-RSV with >=2 symptoms and >=3 symptoms in older adults 60 years and older.

Validation of Sperm Chromatin Dispersion (Scd) Test Using a Mail-in, at-Home Semen Collection Kit

Objective: The covid-19 pandemic has accelerated the use of direct-to-consumer offerings of at-home, mail-in kits for sperm DNA fragmentation. However, mail-in semen collection kits involve incubation in transport media and overnight shipping. DNA fragmentation can be confounded by multiple extrinsic factors such as storage temperatures, transportation media, handling conditions, time after ejaculation, and oxidative stress. The objective of this study was to validate the sperm chromatin dispersion test using at-home, mail-in sperm collection kits. To do so, we evaluated and assessed the effect of transportation media and shipping on sperm DNA integrity using a Halosperm G2 kit in normozoospermic human sperm samples. Material(s) and Method(s): We included a control group of ten healthy normozoospermic humans whose semen samples were analyzed for sperm DNA fragmentation using a Halosperm G2 kit. Fifty healthy normozoospermic human semen samples were included in the study group.The mean age of men in the entire cohort was 34.9 +/- 8 years. These samples were divided into two equal groups. The first group was directly analyzed for sperm DNA fragmentation using a Halosperm G2 kit in the lab. The second group samples were incubated for 24 hours in transportation media (TM), then these incubated semen samples were packaged. Shipping simulation was achieved by putting the semen samples in a cargo van for 5 hours, where temperatures, pressure, and handling fluctuated. The samples were then returned to the lab, where they were subsequently analyzed for sperm DNA fragmentation using a Halosperm G2 kit. To estimate the inter-observer variability in the scoring of sperm cells with fragmented DNA, 20 aliquots from 10 different frozen semen specimens of the control group were processed at our internal lab. The other 10 aliquots were shipped to an independent, third-party CLIA-certified laboratory and processed using the same Halosperm G2 kit technique. Result(s): The Sperm DNA fragmentation index was not statistically significantly different between the non-incubated freshly analyzed sperm samples (20 %, SD +/-9%) and the 24-hour incubated samples with shipping conditions (24% SD +/- 13) (p-value: 0.0549). During the external validation study, when the internal and external lab technicians scored the same samples, the sperm DNA fragmentation percentage (SDFs) were not statistically significantly different (p-value: 0.1213) correlated (r = 0.85, p = 0.0016). Conclusion(s): This study revealed that the sperm DNA fragmentation index of normozoospermic human sperm sample is not statically significant impacted by a 24-hour transport media incubation and subsequent exposure to shipments conditions. Impact Statement: Our study showed that the accuracy and validity of DNA fragmentation detection using the Halosperm G2 kit of TM-incubated and shipped human sperm samples was comparable to those of fresh samples analyzed at the lab in normozoospermic human sperm samples. Therefore, at-home mail-in kits may provide a viable testing option for DNA fragmentation index, helping to mitigate the barriers to access of affordable fertility care. Support: None. Copyright © 2022

Information Environments and Support for COVID-19 Mitigation Policies

This research assesses how the environment for coronavirus disease (COVID) information contributed to the public’s willingness to support measures intended to mitigate the spread and transmission of the virus in the early stages of the pandemic. A representative sample of 600 Floridians was surveyed in April 2020. After controlling for sociodemographic factors, COVID anxiety, and knowledge about the virus, we find that components of the information environment mattered for public opinion related to mitigation policies. Television news sources, including local and national network news, center-left cable news (i.e., CNN, MSNBC), and Fox News, contributed to shaping policy support. The results highlight the importance of televised news coverage in shaping public opinion toward healthcare-related policies. © 2022 SAGE Publications.

COVID-19 the catalyst for a new paradigm in vocational education and training

This paper examines the response by a Vocational Education and Training (VET) provider in the Northern Territory (NT) of Australia to the travel and social distancing restrictions brought about by COVID-19. The paper commences with a description of the impact of COVID-19 on the VET sector. The paper then describes the VET regulatory environment prior to February 2020 and the responsibility of VET providers to comply with the requirements of the Australian Skills Quality Authority (ASQA), in the delivery of VET programs to domestic and international students. A discussion of the lack of a specific vocational education pedagogy, the complexity of delivering VET programs online as well as current research findings in this area follows. A description of the College provides the context to examine the impact of COVID-19 on the delivery of programs in the Northern Territory VET sector. The paper describes how the College, which had a high international student cohort, migrated their courses online in order to remain viable in the highly volatile and unforeseen circumstances brought about by COVID-19. In order to ascertain the effectiveness of the online delivery of course offerings, a questionnaire and a series of face to face and telephone interviews were conducted with key stakeholders. The mixed method approach employed in this research was consistent with contemporary social and educational research. The paper concludes with the call for a new paradigm and policy shift in Vocational Education and Training post COVID-19. © 2022, Adult Learning Australia. All rights reserved.

Impact of COVID-19 on hypertension and diabetes clinical outcomes of uninsured patients in a primary care setting

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic caused a rapid shift in outpatient pharmacy services from in-person (IP) to telehealth (TH) visits. The impact of this on glycemic and blood pressure control in uninsured, low socioeconomic populations is not well described. Research is needed on the impact of clinical service visit modalities changes, spurred by the COVID-19 pandemic, on clinical outcomes. Research Question or Hypothesis: To ensure therapy goals for uninsured patients at an urban free clinic were maintained during the pandemic, we compared the proportion at blood pressure (BP) goal (<130/80 mmHg), at A1C goal (<7%), and visit trends 1 year before and after the Declaration of National Emergency (DNE) on March 13, 2020. Study Design: Retrospective chart review. Methods: This retrospective chart review collected the number of missed or canceled visits, IP and TH visits, and average days between visits. Data from visits between March 13-September 13, 2019 (pre-pandemic), January 31-April 24, 2020 (during pandemic), September 13, 2020-March 13, 2021 (post-pandemic) to assess hypertension (HTN) and diabetes (DM) control were also collected. Descriptive statistics, paired t-tests, and Cochran's Q tests were used to analyze the data. Results: Seventy eight patients were included. Visit modality changed from all IP visits before to mostly TH visits after the DNE. Missed appointments decreased (2.63+2.5 v 1.69+1.8 visits per patient, p 0.011) while completed appointments remained consistent (5.31+2.1 v 5.81+2.4, p 0.058). 30% patients had controlled HTN at each time interval with no change between time intervals (p 1.00). 40-64% patients had controlled DM over the time intervals with no overall change in DM control (p 0.061). Conclusion: Visit modality shifts due to the COVID-19 pandemic reduced missed appointments but did not impact clinical patient outcomes related to HTN and DM control.

IMMUNOGENICITY AND SAFETY OF STANDARD AND THIRD DOSE SARS-COV-2 VACCINATION IN PATIENTS WITH IMMUNE-MEDIATED INFLAMMATORY DISEASES;A PROSPECTIVE COHORT STUDY

Introduction: The immunogenicity and safety following standard two-dose SARS-CoV-2 vaccination in patients with immune-mediated inflammatory diseases (IMIDs) are not well characterised, and data on third dose vaccination in this patient group are currently lacking. Methods & Aims: This prospective, observational cohort study included adult patients on immunosuppressive therapy for Crohn's disease (CD), ulcerative colitis (UC), rheumatoid arthritis (RA), spondyloarthritis (SpA), psoriatic arthritis (PsA), and healthy controls receiving standard two-dose SARS CoV-2 vaccination. Patients with a weak serologic response (<100 AU/ml) were allotted a third vaccine dose. Serum samples were collected prior to, and after vaccination for analyses of antibodies to the receptor-binding domain (RBD) of the SARSCoV- 2 spike protein. The aim of the study was to evaluate the immunogenicity and safety following standard and three dose SARS-CoV-2 vaccination in IMID patients on immunosuppressive therapies. Results: a total of 1641 patients (280 CD, 195 UC, 566 RA, 305 SpA, 295 PsA, median age 52 [IQR 40-63], 899 [55%] women), and 1114 healthy controls (median age 43 [IQR 32-55], 854 [77%] women), were included in the study. After standard SARS-CoV-2 two dose vaccination, 1504 (91%) patients compared to 1096 (98%) healthy controls were responders, p<0,001. Anti-RBD levels were lower in patients (median 619 AU/ml [IQR 192-4191]) than controls (median 3355 AU/ml [IQR 896–7849]), p<0,001. Response was shown in ≤90% of patients receiving methotrexate, tumor necrosis factor inhibitor (TNFi) monotherapy, ustekinumab, tozilizumab and vedolizumab, in 80–90% of patients receiving TNFi combination therapy and secukinumab and in £ 80% for JAK inhibitors (78%), and abatacept (53%) (fig.1). Lower age (OR 0.96 [95% CI 0.95–0.98]) and receiving the mRNA-1273 vaccine (OR 5.4 [95% CI 2.4–11.9]) were predictors of response. Of 153 patients with a weak response receiving a third vaccine dose, 129 (84%) became responders. After standard two dose vaccination, adverse events (AE) were reported in 50% of patients and in 78% of controls, with a comparable safety profile. Following the third dose, 44% of patients reported AEs, without new safety issues emerging. No serious AEs were reported. Conclusion: Response rate as well as anti-RBD levels were lower in IMID patients than healthy controls following standard vaccination. Third dose vaccination in serologically weak responders was safe and resulted in a response in most patients. Our data facilitate identification of patient groups at risk of an attenuated vaccine response eligible for post-vaccination serological monitoring. The data also support a third vaccine dose following standard SARS-CoV-2 vaccination to weak-responding IMID-patients. (Figure Presented) Fig.1 Anti-SARS-CoV-2 IgG antibodies following standard two dose SARS-CoV-2 vaccination according to medication group, compared to healthy controls. Violin plot showing the probability density of the data at different values, smoothed by a kernel density estimator. Each data point is a participant, and the solid orange line show the group median. The last row (CTRL vs) shows p-values for a comparison (Mann-Whitney U test) of anti-SARS-COV 2 antibodies between medication groups and healthy controls. ACE=Angiotensin converting enzyme, FL=full length, CTRL=Controls, TNF=Tumor necrosis factor inhibitor, TNF+= Tumor necrosis factor inhibitor combination therapy, MTX=methotrexate, VDZ=vedolizumab, JAK=Janus kinase inhibitor, TCZ=tocilizumab, UST=ustekinumab, ABA=abatacept, SCK=secukinumab.

Correlates of Compassion for Suffering Social Groups

This study investigates whether multiple factors correlate positively or inversely with compassion felt toward suffering social groups. Data were collected from 367 participants during April 2020 to investigate hypotheses in the context of three suffering social groups in the United States during that time: the Black American community, the LGBTQ community, and those directly affected by COVID-19. Results showed that compassion toward suffering groups covaries inversely with one's own ingroup preference. Compassion toward suffering social groups also covaried positively with the extent to which a person identifies with a suffering social group or knows people in a suffering social group. Additionally, loneliness was inversely correlated with compassion for suffering groups. These results suggest that although compassion is an important emotional motivator for engagement in prosocial behaviors that are vital to maintaining relationships, multiple factors can enhance or inhibit it.

Employing a coaching model of supervision during physiotherapy placements: Charting the student experience

Keywords: Education;Coaching;Qualitative Purpose: Placement capacity during physiotherapy degree programmes is presently under unprecedented stress. In the wake of COVID-19, Health Education England has moved to increase university places across all Allied Health Professions (AHPs) by 50%, without any reduction in quality of education. In order to facilitate this increase in student numbers, Higher Education Institutions (HEIs) and healthcare teams are being asked to change their ways of working and consider alternative supervision models. One such model is the group-based ‘coaching’ approach which is commonly used in the education of medical students but seldom employed on AHP programmes, where one-to-one supervision remains the default. The research reported herein was tasked with qualitatively elucidating student experiences of such a coaching supervision initiative, introduced by the research team across a set of undergraduate and postgraduate physiotherapy placements in two NHS Trusts the north of England during 2020 and 2021. Methods: The research team contacted all students who had (a) completed a placement using the coaching supervision model, while also (b) having prior experience of placement(s) using the more conventional one-to-one approach. These students, registered at a number of UK HEIs, were informed that participation would involve sitting for a semi-structured interview in which they would be afforded the opportunity to critically discuss their experiences of the coaching placement. In accordance with time and budgetary constrictions, the first N = 20 students to register interest in participating were invited to take part in an online interview. All invited students provided interviews, with a mean duration of 25 min. Interviews were transcribed verbatim, with redactions made only for participant identity protection. Transcripts were investigated coordinatively by the full research team using Reflexive Thematic Analysis. Results: Analysis yielded four global themes. (1) Teamwork and Camaraderie;the collective experience engendered by the coaching model was widely lauded and cited as a source of confidence and support, though some participants were conscious that they were too often deferring to the more ‘experienced’ students in their group. (2) Leadership;all students cited opportunities to lead and delegate within their group as important to their professional development, though the experience of being led – and delegated to – by other students was more difficult for some than others. (3) Safety Nets;it was commonly asserted that the coaching model exposed both strengths and weaknesses in performance much more than one-to-one supervision, which was taken to simultaneously boost and undermine confidence. (4) Acceleration and Inertia;while all students argued that they initially learned more quickly in the group environment, a few contended that, as time passed, it began to hold them back. Conclusion(s): Findings indicated that although the coaching model was generally very popular with students, these successes did not come without caveats. Future research might specifically investigate links between these caveats and student profiles over a wider population. Impact: These findings have clear import for nuancing in design of future coaching placements, particularly regarding how to maintain the strengths while further improving the student experience. Funding acknowledgements: The work was supported by a small grant from the University of Cumbria's Internal Research Fund.

Evaluating student attitudes and learning at remote collegiate soil judging events

As with many aspects of teaching, the COVID-19 pandemic forced soil judging teams to attempt new strategies towards achieving student learning outcomes. Soil judging Regions IV and V hosted remote regional contests in October 2020 in place of traditional, in-person contests typically held each fall. We conducted pre- and post-contest surveys to assess student learning outcomes, attitudes, and reflections on the remote contest experience compared to past, in-person contest experiences. We received 108 total responses from students who participated in the Region IV and Region V remote soil judging contests (>80% response rate). In self-reported learning outcomes, there were no significant gains post-contest and there were minimal differences between students in Regions IV and V. Female students, students with more soil judging experience, and students who had taken more soil science courses agreed more strongly that soil science is important, that they planned to pursue careers in soil science, and that they gained important skills from soil judging. Finally, students who previously participated in contests reported that they gained more knowledge and enjoyed in-person contests more than the remote contests held in Fall 2020. Thus, while it is possible to replicate some aspects of the soil judging experience in a remote contest, other aspects that are critical to student engagement are lost when teams are unable to gather at the contest location and examine soils in the field. © 2021 The Authors. Natural Sciences Education published by Wiley Periodicals LLC on behalf of American Society of Agronomy

A SARS-CoV-2 ferritin nanoparticle vaccine elicits protective immune responses in nonhuman primates

[Figure: see text].

Development Of Puzzle-Based Intervention For Adolescents To Enhance The Knowledge On Depression Management

Informative puzzles can provide knowledge to the adolescents effectively as it was current trend nowadays. According to World Health Organization (WHO), globally it was found that 300 million people of all ages were suffering from depression. Their knowledge about its causes was inaccurate, lacking of understanding about depression and its healing makes this mental health issue remain unnoticed and untreated where they do not seek for any treatment. Therefore, introducing depression education through jigsaw puzzles gain more benefits together enhanced the knowledge and attitude level towards depression. This was a development study focusing on formulating and developing puzzle as an interventional approach to improve knowledge and attitude level on depression. Feasibility and acceptability of the puzzles has face validity by respondents and content validity by experts. The r=.81 which was high consider having high validity. Eight modules of puzzles developed named as (Knowledge, Depression Adolescents [KDA]-Puzzle) which consisted of Module 1 Sign and symptoms, Module 2 Types of depression, Module 3 Causes of depression, Module 4 Risk factors, Module 5 (Pharmacotherapy & medication) Medical treatment A, Module 6 Medical treatment B, Module 7 Alternative treatment and Module 8 Prevention of depression. Respondents and experts commented the puzzles really beneficial for the adolescents to learn and gain knowledge about depression. KDA-Puzzles gained positive feedback from the assessment. Newly develop KDA-Puzzles were feasible and acceptable among adolescents. This puzzles can be alternative game while staying at home during Movement Control Order (MCO) due to pandemic COVID 19, and create awareness towards depression. © 2021,Malaysian Journal of Public Health Medicine.All Rights Reserved