CLADRIPLAS: Does cladribine Target CNS plasma cells and reduce neuro-axonal damage in people with MS?

Introduction: Cladribine is a CNS penetrant disease-modifying treatment, which - in an oral preparation (Mavenclad) - was licensed for people with highly active relapsing MS in August 2017. Our experience with cladribine dates back to 2014 when we started using subcutaneously injected cladribine as a compassionate immunotherapy in people with MS (pwMS) off-label. This programme enabled us to embed CLADRIPLAS, a mechanistic study of the effect on intrathecal B cell and plasma cell function and axonal damage focussing on progressive MS (PMS) (IRAS # 240360). Objective(s): To study the effect of cladribine on peripheral and intrathecal B and plasma cells. Aim(s): To study the effect of cladribine on oligo-clonal bands (OCB) and the level of neurofilament light (NfL) chain. Method(s): Observational study involving two lumbar punctures and phlebotomies, 6-12 months apart, to collect B cell subsets, and intrathecal plasma cell as well as neurofilament light chain (NfL) level in pwMS eligible and not eligible for cladribine treatment based on cerebro-spinal fluid (CSF) NfL, clinical and/or MRI evidence of inflammatory disease activity. Here, we report baseline cohort characteristics. Result(s): Thirty-eight pwMS were recruited (19 women, 19 men) and had their first sample collections. Eight pwMS were eligible for cladribine treatment (7 based on elevated NfL, 1 due to MRI activity). Follow-up samples have been collected in 21. Mean age at baseline was 55 years (40-76). Fourteen had primary, 24 secondary PMS. Median EDSS=6.5 (3.5-8). Twenty-one pwMS had been treated with DMT before consideration of cladribine, 17 were immunotherapy-naive. Mean CSF-NfL level was 552 (176- 2072) pg/ml. Conclusion(s): Despite restrictions due to COVID-19, 38 of 40 planned pwMS were enrolled. 7/8 were eligible based on CSFNfL level indicating the importance of using biomarkers other than MRI to establish disease activity in PMS. We expect our cohort to enable meaningful comparison between groups. CLADRIPLAS will finish in early 2023.

Peer Mentors Forging a Path in Changing Times

This complete evidence-based practice paper examines the experience of two peer mentors, known as Student Engagement Liaisons (SEL), as they worked to cultivate community and sense of belonging for first year engineering students. Over the past two years, the educational pendulum has swung wildly as students have gone from in-person to online learning and back again. Many students continue to navigate a changing landscape as they straddle between the two worlds of in-person and remote learning with some classes continuing to meet online and others being fully in person. These abrupt transitions have left many students struggling to develop meaningful connections with their peers, faculty, and their educational programs, all of which have negative ramifications on their academic progress and sense of belonging. This investigation uses a critical constructivist theoretical approach to explore how two SELs, who were tasked with enhancing student engagement and building social networks for first year engineering students, modified support mechanisms in response to the changing teaching and learning modalities. Of particular interest is how the SEL program has evolved during this tumultuous time, the mentors' experiences exploring and developing new ways of connecting students, and the impact of the experience on the mentors themselves. The results indicate a shift in focus solely driven by the mentors, along with a willingness to reframe activities, events, and support measures to meet the dynamic needs of the students. Their ability to listen, pivot, and adapt to changing needs of students indicates a commitment to creating inclusive and accessible social environments through community centered solutions. We recognize that these new ways might be innovative because of the circumstances, but they can also continue to be integrated as ways to support and engage students, particularly because they were created by students. The SELs used the COVID-19 pivots as an opportunity to reinvent what it means to mentor their peers and, with that, have explored and experimented with new ways of creating community. © American Society for Engineering Education, 2022.

The impact of COVID-19 on rheumatology health care workers and their scientific output: Heavy lies the crown on female rheumatologists

Background: COVID-19 has changed daily practice in medicine and affected teaching as well as research activities of medical personnel. Meanwhile, the pandemic 's impact on private life and responsibilities for dependents also affected health care workers in rheumatology. Objectives: To examine the adaptability of clinician-researchers in rheumatology in a time of crisis focusing on academic output in the first six months of the COVID-19 pandemic and to investigate the professional and private burden experienced by health care workers in rheumatology. Methods: A systematic search in PubMed, medRxiv and bioRxiv for reports of rheumatic diseases and COVID-19/SARS-CoV-2 submitted (or published) from January 1 to June 30 2020 was carried out. As comparison, publications from April 6 to 13 2019 of the same rheumatic diseases without COVID-19 were analysed in terms of author characteristics and journal metrics. Additionally, a questionnaire was circulated via EULAR countries rheumatology societies and individual working group members. The participants were asked to answer 43 questions regarding their family situation, professional background, research output, changes in work and private responsibilities during the pandemic as well as the burden experienced. Responses were collected using an online survey tool and data analyses performed with SPSS Statistics 25;missing variable analysis was performed, excluding records with >15% missing responses. Descriptive and summary statistics were calculated for the entire dataset and split by gender. Results: Whereas the overall number of publications and authors was equal between 2020 and 2019, the portion of female first authors of review articles and original studies decreased substantially in the first phase of the pandemic (Table 1). The numerical contribution of female authors in highly ranked journals (impact factor>6) was comparable in 2019 and 2020, however, the percentage of female first authors dropped from 50% to 32% (P=0.07). In the survey, a total dataset was available for N=180 responders. On average, female respondents (52.5%) were younger, more likely to live alone (19,1% vs 10,5%) and have no caring responsibilities (51.1% vs. 36.3%) than male respondents. Male doctors were more often tenure-track/tenured or chairmen (31.4% vs 12.8% female) and worked less often part-time (9,3% vs. 19.1%). Unpaid overtime hours of all participants were striking with 46.3/44,2% (female/male) reporting to accumulate >10 hours/ week. Regarding gender differences in scientific output, male respondents more frequently revealed >20 publications as first (57,6% vs. 26,9%) or last authors (34.1% vs. 10,1%). Similarly, 44,7% of male respondents reported a last author publication during COVID-19 vs. 26,4% of female respondents. While female and male respondents reported similar experience of burden during the pandemic, more female respondents reported increased family care as a major source of this (38,2% vs. 22,2%). Both genders would like to see increased support from superiors and official institutions. Conclusion: In a time of acute crisis, the adaptability of scientifically active female health care workers in rheumatology is lower than that of their male counterparts. This is reflected in a lower scientific output, especially as first or last authors. However, the burden experienced in the current pandemic is similar between the genders. (Table Presented).

Remote wayfaring and virtual fieldwork

Regular users of the methods and techniques of digital landscape architecture (DLA), were presumably little disrupted by the paralysing impact of the current Covid-19 pandemic. But these digital operators have a front row seat in seeing how the global virus vaulted the field in a forward direction, rapidly increasing its prevalence. It was not only those in the business community that stopped travel-ling, became home-bound, and were tied to their desktop and computer screen. The scientific and aca-demic communities were in the exact same position. Digitizing a workspace does not affect everyone equally, but it is particularly restrictive for landscape architects where “groundtruthing” is fundamental. It is not possible to completely replace real-world action and mobility with digital technology. How-ever, with few options left, alternatives are necessary for those who usually develop their project and research work based on fieldwork, associated with travelling. A notable developmental leap in digital technologies in landscape architecture thus came in the most trivial and mundane form thinkable. In this paper, we describe how we conducted fieldwork in places that could not be reached without trav-elling, using commonly accessed digital tools as our forms of wayfaring. © 2021, VDE VERLAG GMBH. All rights reserved.

Risk factors, epidemiological and clinical outcome of close contacts of covid-19 cases in a tertiary hospital in southern india

Introduction: The knowledge of epidemiologic characteristics and transmission dynamics of a novel pathogen, such as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) among close contacts can help in planning and development of effective control policies in different parts of the world. Aim: To assess the epidemiological and clinical outcome of close contacts of Coronavirus Disease (COVID-2019) cases admitted in a tertiary COVID hospital and to assess the role of risk factors in predicting the epidemiological outcome of these contacts. Materials and Methods: The current retrospective cohort study was conducted among 1286 close contacts of COVID-19 patients admitted to Government Medical College, Thrissur, Kerala. The data collection was done by a semi-structured telephonic interview by the contact tracing team. The questions included the type of exposure to the index case, symptoms if any, date of last exposure with COVID-19 patient, and final COVID-19 status of the contact at the end of 14 days. The association of risk factors of COVID-19 positivity was done using binary logistic regression. Results: Proportion of close contacts of COVID-19 who developed the disease was 24.2% (21.87-26.52%). The mean incubation period was found to be 4.22 days (C.I-3.71-4.65). The serial interval was found to be a mean of 5.24 days (C.I 4.764-5.716). The proportion of household contacts of COVID-19 cases who developed the disease was found to be 26% (C.I-23%-29%). The majority (52.4%) of infections among contacts were asymptomatic. Most common symptom among the COVID-19 +ve was fever (32.8%) followed by cough (16.1%). The most common risk factors of infection among primary close contacts were sharing the same room (adjusted odds ratio-2.394) and common use of fomites (adjusted odds ratio-1.953) while use of a mask was found to be protective (adjusted odds ratio-0.570). Significant factors associated with the type of contact with infection were workplace-related contact (adjusted odds ratio-6.629), household contact (adjusted odds ratio-4.856), and travel-related contact (adjusted odds ratio-2.899). Conclusion: The study concludes important risk factors of transmission among close contacts of COVID-19 as being in a household, workplace and travel related contact where the use of mask was found to be protective. The study also concludes that most of the COVID-19 infections in close contacts are asymptomatic.