Virome-wide detection of natural infection events and the associated antibody dynamics using longitudinal highly-multiplexed serology.

Current methods for detecting infections either require a sample collected from an actively infected site, are limited in the number of agents they can query, and/or yield no information on the immune response. Here we present an approach that uses temporally coordinated changes in highly-multiplexed antibody measurements from longitudinal blood samples to monitor infection events at sub-species resolution across the human virome. In a longitudinally-sampled cohort of South African adolescents representing >100 person-years, we identify >650 events across 48 virus species and observe strong epidemic effects, including high-incidence waves of Aichivirus A and the D68 subtype of Enterovirus D earlier than their widespread circulation was appreciated. In separate cohorts of adults who were sampled at higher frequency using self-collected dried blood spots, we show that such events temporally correlate with symptoms and transient inflammatory biomarker elevations, and observe the responding antibodies to persist for periods ranging from ≤1 week to >5 years. Our approach generates a rich view of viral/host dynamics, supporting novel studies in immunology and epidemiology.

[Knowledge about COVID-19 and correct mask use in workers at a Peruvian university during the pandemic]. / Conocimiento sobre la COVID-19 y uso correcto de mascarilla en trabajadores de una universidad de Perú durante la pandemia: estudio transversal.

INTRODUCTION: The COVID-19 pandemic led to massive use of personal protective equipment (PPE). However, evidence on the frequency of appropriate use is sparse. In this study, we evaluated the level of knowledge about COVID-19 and biosafety measures, and the frequency of correct use of masks in workers at a university in Lima, Peru. METHODS: Cross-sectional study conducted in a population of 109 workers of a private university who were physically onsite. We used a structured questionnaire to measure knowledge of COVID-19, together with use of and training in PPE. In addition, we explored factors associated with the correct use of masks and an adequate level of knowledge about COVID-19 and related biosafety measurSpain. Results were expressed as prevalence, using student's T-test and Pearson chi-square tests. RESULTS: We evaluated 82 workers, 35.4% of whom showed an adequate level of knowledge about COVID-19 and biosafety measurSpain. Younger participants and those who regularly washed their hands at work had an adequate level of knowledge, with 90.2% of these reporting correct use of their masks. Workers in general service areas or with a low level of education reported less frequent correct use of their mask compared to those who did not have these characteristics.  Conclusion: We found a low level of knowledge about COVID-19 and biosafety measures among the workers of a private university; a higher level of education was associated with a greater prevalence of correct mask use. Training programs by work areas are needed, to improve biosafety practices among workers.

Introducción: La pandemia por la COVID-19 llevó al uso masivo de equipos de protección individual (EPI). Sin embargo, la evidencia sobre la frecuencia de su uso adecuado es escasa. El objetivo de este estudio es evaluar el nivel de conocimiento sobre la COVID-19 y medidas de bioseguridad, y la frecuencia de uso correcto de mascarilla en los trabajadores de una universidad en Lima, Perú, durante la pandemia. Métodos: Estudio transversal realizado en los 109 trabajadores de una universidad privada que se encontraban en modalidad presencial entre junio y septiembre 2021. Se utilizó un cuestionario estructurado. Se estimaron las prevalencias del nivel de conocimiento y uso correcto de EPIs, y los factores asociados mediante la T student y Chi-2 de Pearson.  Resultados: Participaron en total 82 trabajadores (75%). El 35% mostró un adecuado nivel de conocimiento sobre la COVID-19 y medidas de bioseguridad. Los más jóvenes y los que se lavaban las manos en el trabajo mostraron un mayor conocimiento, refiriendo el 90% utilizar correctamente su mascarilla. Los trabajadores de áreas de servicios generales o con bajo nivel de educación refirieron un menor uso correcto de su mascarilla.  Conclusión: El nivel de conocimiento sobre la COVID-19 y las medidas de bioseguridad entre los trabajadores de una universidad privada fue bajo y el nivel de educación se mostró inversamente asociado al uso correcto de mascarilla. Es necesario implementar programas de capacitación por áreas de trabajo para mejorar las prácticas de bioseguridad en los trabajadorSpain.

Physical Inactivity is Associated with Job Burnout in Health Professionals During the COVID-19 Pandemic.

Background: The pandemic has drastically impacted lifestyles, including the frequency, duration, and intensity of physical activity, which, in turn, leads to negative effects on job burnout among healthcare workers. Objective: This study evaluated the association between the level of physical activity and job burnout in a sample of health professionals during health emergency. Methods: In this cross-sectional study, 300 workers working in a public hospital, located in the city of Rioja, Department of San Martin, Peru, were considered. Data were collected through an online and face-to-face survey. Job burnout was assessed using a validated questionnaire adapted to the Peruvian population and physical activity was assessed based on a single item. Crude and adjusted linear regression models were created to assess the association between the frequency of physical activity performed weekly and the level of job burnout. Results: In the crude models, it was observed that participants who performed physical activity 1-2 times, 3-4 times, or more than 4 times per week had, respectively, 6.29 (95% CI, 11.00-1.59), 14.28 (95% CI, 21.70-6.85), and 14.95 (95% CI, 25.17-4.72) lower job burnout points compared to those who never performed physical activity. In the model adjusted for confounding variables, the association of this result was maintained, showing a dose-response effect. Conclusion: These findings suggest the need for the implementation of health education programs that include physical activity to minimize the negative effects of job burnout and ensure better medical care by health professionals for the benefit of patients.

In-person versus virtual administration of the American College of Rheumatology gold standard cognitive battery in systemic lupus erythematosus: Are they interchangeable?

OBJECTIVE: During the COVID-19 pandemic, many research studies were adapted, including our longitudinal study examining cognitive impairment (CI) in systemic lupus erythematosus (SLE). Cognitive testing was switched from in-person to virtual. This analysis aimed to determine if the administration method (in-person vs. virtual) of the ACR-neuropsychological battery (ACR-NB) affected participant cognitive performance and classification. METHODS: Data from our multi-visit, SLE CI study included demographic, clinical, and psychiatric characteristics, and the modified ACR-NB. Three analyses were undertaken for cognitive performance: (1) all visits, (2) non-CI group visits only and (3) intra-individual comparisons. A retrospective preferences questionnaire was given to participants who completed the ACR-NB both in-person and virtually. RESULTS: We analysed 328 SLE participants who had 801 visits (696 in-person and 105 virtual). Demographic, clinical, and psychiatric characteristics were comparable except for ethnicity, anxiety and disease-related damage. Across all three comparisons, six tests were consistently statistically significantly different. CI classification changed in 11/71 (15%) participants. 45% of participants preferred the virtual administration method and 33% preferred in-person. CONCLUSIONS: Of the 19 tests in the ACR-NB, we identified one or more problems with eight (42%) tests when moving from in-person to virtual administration. As the use of virtual cognitive testing will likely increase, these issues need to be addressed - potentially by validating a virtual version of the ACR-NB. Until then, caution must be taken when directly comparing virtual to in-person test results. If future studies use a mixed administration approach, this should be accounted for during analysis.

Evaluation of Electronic Patient-Reported Outcomes (ePROs) Systems used in Nephrology settings -a mixed methods study

Aims: Patients with chronic and end-stage kidney Disease often experience a high symptom burden and diminished health-related quality of life. Data on these constructs can be collected, directly from patients, and measured using electronic Patient Reported Outcomes (ePROs). Responses can be used at an individual level to facilitate optimal care and shared-decision making. At an aggregate level, these data can be used for audit and benchmarking to improve services. This research aims to identify existing and emerging ePRO systems used in nephrology, to explore and summarize key system characteristics, and identify the core factors which contribute to successful implementation. Method(s): 3-phase mixed-methods study: Semistructured review to identify ePRO Systems used in nephrology that assess ePROs and summarize patients' responses to their care provider. Web-based survey of system experts to identify key system characteristics: including administration, levels of automation, integration into existing systems, reporting and management of patient safety.Optional follow-up semi-structured interviews, with system experts, to explore survey responses.The semi-structured interviews were analyzed using Codebook Thematic Analysis utilizing domains from the Consolidated Framework for Interventional Research (CFIR) allowing comparison of the ePRO Systems and associated implementation strategies to highlight best practice. Result(s): Fifteen nephrology ePRO systems were identified in North America, Europe and Australia. Ten experts completed the survey (nine full responses and one partial response). Remote follow up interviews were undertaken with seven respondents.Key components of system characteristics were summarized and compared including: (i) purpose, (ii) population, (iii) PRO measures used, (iv) levels of automation, (v) reporting, (vi) integration into existing workflow and (vii) links to electronic health records/national registries. Common barriers to implementation included user engagement, accessibility issues and the effects of COVID on implementation plans and evaluation. Important facilitators were early and sustained patient involvement in system design and implementation, clinician advocates and expanding existing electronic systems to integrate ePROs. Conclusion(s): An increased understanding of the range of features and functionality of ePRO systems, including potential barriers and facilitators to use and integration in existing work flows, will help ensure such systems are optimized to improve care and maximize outcomes for patients with chronic and end-stage kidney disease.

Cov2MS: An Automated and Quantitative Matrix-Independent Assay for Mass Spectrometric Measurement of SARS-CoV-2 Nucleocapsid Protein.

The pandemic readiness toolbox needs to be extended, targeting different biomolecules, using orthogonal experimental set-ups. Here, we build on our Cov-MS effort using LC-MS, adding SISCAPA technology to enrich proteotypic peptides of the SARS-CoV-2 nucleocapsid (N) protein from trypsin-digested patient samples. The Cov2MS assay is compatible with most matrices including nasopharyngeal swabs, saliva, and plasma and has increased sensitivity into the attomole range, a 1000-fold improvement compared to direct detection in a matrix. A strong positive correlation was observed with qPCR detection beyond a quantification cycle of 30-31, the level where no live virus can be cultured. The automatable sample preparation and reduced LC dependency allow analysis of up to 500 samples per day per instrument. Importantly, peptide enrichment allows detection of the N protein in pooled samples without sensitivity loss. Easily multiplexed, we detect variants and propose targets for Influenza A and B detection. Thus, the Cov2MS assay can be adapted to test for many different pathogens in pooled samples, providing longitudinal epidemiological monitoring of large numbers of pathogens within a population as an early warning system.

Home-Based Respiratory Physiotherapy and Telephone-Based Psychological Support for COVID-19 Survivors in Peru: Protocol for a Randomized Controlled Trial.

BACKGROUND: Both pulmonary and mental health are affected following hospitalization for COVID-19 pneumonia. Pulmonary rehabilitation therapy has demonstrated benefits in improving mental health, but no validated combined programs that include mental health have been proposed. OBJECTIVE: This article presents the design of a trial that aimed to assess whether the participation in a combined rehabilitation program that includes home-based respiratory physiotherapy and telephone-based psychological support is associated with a greater improvement of pulmonary and mental health outcomes 7-12 weeks after COVID-19 hospitalization discharge compared with posthospital usual care provided by a public Peruvian hospital. METHODS: WAYRA (the word for air in the Quechua language) was an open-label, unblinded, two-arm randomized controlled trial. We recruited 108 participants aged 18-75 years who were discharged from the hospital after COVID-19 pneumonia that required >6 liters/minute of supplemental oxygen during treatment. Participants were randomly assigned at a 1:1 ratio to receive the combined rehabilitation program or usual posthospital care provided by a public Peruvian hospital. The intervention consisted of 12 at-home respiratory rehabilitation sessions and 6 telephone-based psychological sessions. The primary outcome was the 6-minute walk distance. Secondary outcomes included lung function, mental health status (depression, anxiety, and trauma), and quality of life. Outcomes were assessed at baseline (before randomization) and at 7 and 12 weeks after hospital discharge to assess the difference between arms. RESULTS: This study was funded by the Peruvian National Council of Science Technology and Technology Innovation in July 2020. Ethics approval was obtained on September 2, 2020. Recruitment and data collection occurred between October 2020 and June 2021. Results are expected to be published by the end of 2022. CONCLUSIONS: WAYRA was the first randomized controlled trial evaluating combined pulmonary-mental health rehabilitation for hospitalized COVID-19 survivors in resource-limited settings, potentially providing a foundation for the cost-effective scale-up of similar multidisciplinary rehabilitation programs. TRIAL REGISTRATION: ClinicalTrials.gov NCT04649736; https://clinicaltrials.gov/ct2/show/NCT04649736. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/36001.

[Parents' perceptions and intention to vaccinate their children under 12 years of age against COVID-19: a cross-sectional study in Peru]. / Percepciones e intención de los padres de vacunar a sus hijos bajo 12 años de edad contra la COVID-19: estudio transversal en Perú.

BACKGROUND: Despite the proven efficacy and safety of COVID-19 vaccines, pediatric vaccination coverage remains low in many countries. There are still doubts and fears in parents about vaccination in their children under 12 years of age. AIM: To evaluate the perceptions and intention of parents to vaccinate their children under 12 years of age. METHODS: Analytical cross-sectional study based on an online survey that evaluated the parents' perceptions regarding the risk of COVID-19 infection, the need for a vaccine, and the vaccine adverse events in their children under 12 years. We assessed the factors associated with the intention to vaccinate through crude (cPR) and adjusted prevalence rates (aPR), with confidence interval of 95% (CI 95%). RESULTS: 83.5% of respondents had the intention to vaccinate their children under 12 years of age. In the multivariate analysis, the factors associated with a decrease in the intention to vaccinate were to believe that the vaccine was not necessary (aPR 0.65; 95% CI 0.44 - 0.94), that it would not protect (aPR: 0.14; 95% CI 0.03 - 0.63), it would not be safe (aPR: 0.80; 95% CI 0.70 - 0.92) and it would cause long-term side effects (aPR: 0.92; 95% CI 0.85 - 1.00). On the other hand, living on the highlands or jungle was associated with an increase in the intention. CONCLUSION: In Peru, 16.5% of parents would not vaccinate their children under 12 years of age, because they perceived that the vaccine was not necessary and would not protect against COVID-19. In addition, they expressed concerns about the development of possible adverse events.

Self-Measured Doppler Blood Pressure Readings in Continuous-Flow LVAD Patients are Reliable

Background: Blood pressure (BP) management is imperative in reducing risk of adverse events in continuous flow (CF) left ventricular assist device (LVAD) patients. The gold standard for non-invasive blood pressure (BP) measurement in these patients is Doppler ultrasound, which requires training and dexterity and is not routinely used in the outpatient setting. In the current COVID-19 pandemic era, telehealth assessment has become mandatory to assess and monitor patients. At our institution, we have issued all CF-LVAD patients with a Doppler ultrasound device and an oscillometric BP monitor, and provided training to correctly use these devices. Accuracy of BP measurements in this setting has not been confirmed. Aim: We examined whether Doppler BP obtained by CF-LVAD patients (pts) correlates to Doppler BP obtained by health care workers (HCWs). Methods: CF-LVAD pts were recruited between November 2020 and January 2022. During these routine outpatient follow-up visits, Doppler BP measurements were obtained simultaneously and independently by pts and HCW. BP was taken in a comfortable seating position following 5 minutes rest. Results: A total 223 pairs of simultaneous patient Doppler BP readings and HCW Doppler BP readings were obtained from 38 CF-LVAD patients (87% male, mean age at implant 52 + 14 years, 15 HeartMate3 and 23 HeartWare HVAD, with support duration range 28 - 3492 days). Patient Doppler BP (average 85.9 + 9.8 mmHg) correlated closely with HCW Doppler BP (average 86.1 + 9.6 mmHg), r2=0.90, p<0.0001. There was no significant difference between BP taken by the patient and HCW (p=0.4). The mean difference between the two methods was -0.17 mmHg and the standard deviation was 0.22 mmHg (figure) using Bland-Altman analysis. Conclusions: These results demonstrate that in our patient-population, Doppler-derived blood pressure measurements in CF-LVAD patients were accurate and reliable. This supports the routine use of home Doppler BP measurement and monitoring by CF-LVAD patients, especially in the telehealth era. (Figure Presented).

Asociación entre alteraciones en el sueño y problemas de salud mental en estudiantes de medicina durante la pandemia de COVID-19 Association between sleep disturbances and mental health problems in medical students during the COVID-19 pandemic

Introducción: Los estudiantes de medicina son una población vulnerable a la mala calidad de sueño y a la privación del mismo;estos problemas se acentuaron durante la pandemia por COVID-19. El objetivo fue evaluar la asociación entre las alteraciones en el sueño con la presencia de depresión y ansiedad en estudiantes de medicina durante la pandemia. Materiales y Métodos: Estudio transversal, analítico en estudiantes de medicina de una universidad privada de Perú. Se recolectaron los datos desde el 22 de mayo al 14 de junio del 2020, después de 3 meses de aislamiento social obligatorio. Para evaluar la depresión, ansiedad e insomnio se emplearon el Patient Health Questionnaire (PHQ-9;≥ 10), el Generalized Anxiety Disorder (GAD-7;≥ 10) scale y el Insomnia Severity Index (ISI;≥ 8) respectivamente. Se usaron regresiones de Poisson con varianza robusta para calcular las razones de prevalencia. Resultados: La prevalencia de depresión, ansiedad e insomnio fue de 28.5%, 29.5% y 60.1% respectivamente. Se encontró que quienes tuvieron sueño corto (RPa: 1.40, IC: 1.05-1.87, p: 0.024), que dormían después de las 2:00 horas (RPa: 2.24, IC: 1.31-3.83, p: 0.003) y que presentaban insomnio (RPa: 7.12, IC: 3.70-13.73, p: < 0.001) tenían una mayor prevalencia de ansiedad. Asimismo, los que dormían después de las 2:00 horas (RPa: 2.13, IC: 1.24-3.64, p: 0.006) y los que presentaban insomnio (RP: 8.82, IC: 4.17-18.68, p: < 0.001) tenían una mayor prevalencia de depresión. Conclusiones: El sueño corto, la hora en la que va a dormir y el insomnio son factores asociados a la prevalencia de depresión y ansiedad.

Auto-memoration, Con-memoration: A 'Self'/Reflection

Exploring who, what and how we remember, this piece proposes that to remember requires, on the one hand, an auto-memoration (the means by which we remember ourselves, and therefore how we shape and present ourselves to others), and at the same time, on the other hand, auto-memoration always detours through the world and through the other, which requires 'con-memoration' (remembering with the other). Referring to Derrida and Nancy, this piece argues that the memories of ourselves, and of others, is always already mediated because structured by differance and the other, and thus entails also a forgetting.

COVID-19 among Amazonian indigenous in Peru: mortality, incidence, and clinical characteristics.

BACKGROUND: Few studies have described the clinical characteristics of patients with COVID-19 from ethnic minority groups. Our objective was to evaluate the mortality and incidence rates, clinical characteristics and factors associated with mortality in cases with COVID-19 belonging to the Amazonian indigenous ethnic group in Peru. METHODS: We performed a retrospective cohort study including all cases from COVID-19 among Peruvian people identified as Amazonian indigenous from 07 March to 31 October 2020. We calculated the standardized mortality and incidence ratios using the indirect age-adjusted method to determine the differences between Amazonian Indigenous and the general population. In addition, we used multivariable logistic regression to determine the risk factors for death. RESULTS: A total of 19 018 laboratory confirmed COVID-19 cases were analyzed. Indigenous people had 3.18 (95% CI, 3.13-3.23) times the risk of infection and 0.34 (0.31-0.37) times the mortality risk of the general Peruvian population. Males had 1.29 (1.04-1.61) times the odds of death compared with females and for each year of age, the odds of mortality increased 1.03 (1.03-1.04) times. Cases with respiratory distress had 2.47 (1.96-3.10) times more likely to die. Having an immunodeficiency was 18.7 (6.12-57.00) times more likely to die. DISCUSSION: The Amazonian indigenous population in Peru was strongly affected by COVID-19 compared with the general Peruvian population.

Feasibility and preliminary efficacy of the LEAD trial: a cluster randomized controlled lifestyle intervention to improve hippocampal volume in older adults at-risk for dementia.

BACKGROUND: Healthy diet and exercise are associated with reduced risk of dementia in older adults. The impact of diet and exercise interventions on brain health is less consistent, especially with dietary interventions which rely on varying approaches. Our objective was to evaluate the feasibility and preliminary efficacy of a 6-month intervention combining exercise with a novel dietary counseling approach to improve hippocampal volume among older adults at-risk for dementia. METHODS: Participants with vascular risk factors and subjective cognitive decline or early mild cognitive impairment were cluster randomized in groups of 3-4 to the diet intervention (DIET) or control education (ED) group. All participants engaged in 1 h of supervised exercise per week and additional exercise at home. DIET involved 1 h per week of group-based dietary counseling comprising education, goal setting, and strategy training. ED involved 1 h per week of group-based brain health education classes. Our primary outcome was change in hippocampal volume from baseline to 6 months. Secondary outcomes included changes in cognitive function, blood biomarkers, diet, and fitness. Recruitment challenges and early discontinuation of the trial due to COVID-19 necessitated a revised focus on feasibility and preliminary efficacy. RESULTS: Of 190 older adults contacted, 14 (7%) were eligible and enrolled, constituting 21% of our recruitment target. All participants completed the intervention and attended 90% of exercise and DIET/ED sessions on average. All 6-month assessments prior to COVID-19 were completed but disruptions to in-person testing resulted in incomplete data collection. No serious adverse events occurred and all participants expressed positive feedback about the study. Preliminary findings did not identify any significant changes in hippocampal volume; however, substantial improvements in diet and HbA1c were observed with DIET compared to ED (d = 1.75 and 1.07, respectively). CONCLUSIONS: High adherence and retention rates were observed among participants and preliminary findings illustrate improvements in diet quality and HbA1c. These results indicate that a larger trial is feasible if difficulties surrounding recruitment can be mitigated. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03056508 .

Statewide public radiotherapy services in Victoria: Getting out of service provider silos to improve equity of care and access to optimal treatment

Aim: The healthcare technological revolution has seen many treatment innovations become available to optimise cancer treatments. Radiotherapy has benefited from numerous such innovations however some of this unique equipment is expensive and often targeted towards specific anatomy or tumour types. To enable public radiotherapy services to offer these advanced treatments when very high capital cost was involved, the Victorian government-funded particular specialist radiotherapy machines, designating these as statewide services. This approach aimed to ensure Victorian patients that might benefit most could access these services without cost, while still receiving the rest of their care as close to home as possible. Methods : Government funded public MR linear accelerator (MR-linac) and Gamma Knife™ radiotherapy treatment machines. Both are significantly more expensive than a standard linac and only two of each existed in Australia - none in Victoria - prior to their acquisition. The Victorian 'Statewide radiotherapy services framework' was developed and published to underpin these new services and a website created covering indications information to support and facilitate appropriate referrals of suitable patients from within the state. Additionally, patient-reported outcomes were introduced as a routine part of these services. Results : The Victorian Gamma Knife™ service commenced treatments in 2021 and has already delivered over 135 courses of radiotherapy, 25% of these being for new indications. Treatments have been provided to patients from 85 different locations across the state. Although delayed due to the COVID-19 pandemic and limited worldwide installation expertise of this novel technology, the MR-linac service has just commenced clinical treatments. Conclusions : Statewide specialist radiotherapy services have been developed and implemented, providing fee free access to all Victorians irrespective of their place of residence. With more personalised cancer treatments becoming routine, a cost-effective way to have expensive equipment available to treat those who could most benefit has been established.

Audit of vaccination status of health-care workers who tested positive for SARS-CoV-2.

Multiple SARS-CoV-2 vaccinations have shown excellent efficacy during clinical trials. However, post vaccine surveillance is important to confirm 'real-world' findings of vaccine efficacy and safety. It is therefore imperative to identify individuals that become infected with SARS-CoV-2 post vaccination. We investigated the vaccination status of staff that had tested positive in a cohort of healthcare workers in one large tertiary hospital in the UK. At the time of the investigation, 8th December 2020 to 13th March 2021, 11,871 staff had been vaccinated and 225 staff tested positive for SARS-CoV-2. This period coincided with the second wave of SARS-CoV-2 infections in the UK which was driven by the Alpha variant. No healthcare workers who were double vaccinated had a positive PCR test for SARS-CoV-2 during this study period confirming vaccination with Pfizer BioNTec BNT162b2 gives excellent protection against infection of this variant.