Educating about mass vaccinations in a post-truth era

The development of vaccines against a range of deadly or debilitating diseases represents one of the major medical advances of our time, saving many millions of lives. The COVID-19 pandemic has led to extensive media coverage on vaccination. As a consequence, vaccination views and varied sides of the debate have become a common topic of social conversation and argument worldwide. Despite the undoubted benefits vaccines have provided, there is still skepticism about their safety amongst some sections of society. Anti-vaccine messages are being amplified and disseminated widely by social media, sometimes invoking either pseudo-science or anti-scientific justification. The prevalence and apparent influence of the current anti-vaccine movement suggest that the goals of science education including scientific literacy, critical thinking and argumentation based on reliable evidence, and sound reasoning are not being met for a substantial proportion of the population. This chapter will examine some of the non-scientific arguments currently being communicated about mass vaccination on social media platforms and the implications for science education in engaging with this problematic socio-scientific issue. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023. All rights reserved.

Hiv Viral Load and Time-to-Covid-19 Vaccination among People Who Inject Drugs

Background: Structural barriers to care among people who inject drugs (PWID) raise concerns about disproportionate access to essential services like COVID-19 vaccination. Given the heightened risk of serious complications resulting from SARS-CoV-2 infection, particularly among people living with HIV (PWH) with unsuppressed viral load, its critical to understand the role of HIV care among other factors associated with timely vaccination. We aimed to assess the role of HIV care on COVID-19 vaccination uptake among PWID. Method(s): We included 960 adult PWUD participating in the ALIVE (AIDS Linked to the Intravenous Experience) longitudinal study in Baltimore, Maryland, who were alive and in follow up as of April 2020. We ed COVID-19 vaccination data from electronic medical records linked to participants via the regional health information exchange. We conducted survival analysis to estimate time from broad vaccine eligibility (April 6, 2021) to completion of the COVID-19 vaccination primary series by HIV status (uninfected, virally suppressed PWH [HIV-RNA< 400 copies/mL], unsuppressed PWH [HIV-RNA >400 copies/mL]) and Cox Proportional Hazards regression to adjust for potential confounding by health status and substance use variables. Result(s): Our sample (N=960) was primarily black (77%) and male (65%) with 31% reporting recent injection drug use. Among 265 people living with HIV (PWH) in our sample (27%), 84% were virally suppressed. As of February 22, 2022, 539 (56%) completed the primary series, 131 (14%) received a single dose of mRNA vaccine and 290 (30%) remained unvaccinated. Compared to PWID without HIV, virally suppressed PWH were significantly more likely to complete the primary series (Adjusted Hazard Ratio [AHR]:1.23,95% Confidence Interval [95%CI]:1.07,1.50), while PWH with higher viral loads were less likely (AHR:0.72,95%CI:0.45,1.16). Sensitivity analyses with a subsample restricted to PWH confirmed significant differences in time to vaccination by viral load status (log-rank p-value: 0.016) and modeling with an origin of Dec. 12, 2020, yielded similar adjusted results. Conclusion(s): Among PWID with HIV, viral suppression is associated with quicker vaccination uptake, likely due to HIV care engagement. Alongside interventions targeting social determinants (e.g. low income, homelessness) and substance use behaviors (e.g. active injecting, stimulant use), targeted improvements along the HIV care continuum and other efforts to engage PWID may bolster vaccine uptake. Figure 1. Kaplan-Meier survival curve demonstrating time-to-vaccination (completion of COVID-19 primary series) in weeks by HIV status accounting for viral load (HIV-, HIV+ [VL <= 400 cells/muL], HIV+ [VL > 400 cells/muL]), including results for Log-rank tests for homogeneity among strata (p-value).

Redesigning a mixed-method research study during a pandemic: A case study from Nigeria and Australia

One major challenge researchers have faced during the disruptions resulting from the Covid-19 pandemic is how to adapt to the global virus and, at the same time, make good progress in their research pursuits. Also, many international researchers have suspended ongoing research in developing countries due to inadequate online facilities in these countries. This article identifies innovative methodologies that can be employed to carry out mixed-method research in a non-technologically advanced country and reflects on the benefits and limitations of carrying out such rigorous research during difficult times. The mixed-method research design reported here combines tests and open-ended reasons for procedures to explore the impacts of two pedagogical practices on students' mathematical understanding. In particular, the methodological framework leverages the aims of the research, the theoretical background, standard ethical practice, and Covid-19 safety precautions. This article contributes to the methodological approaches for carrying out mixed-method research during unprecedented times. © 2023, Western Australian Institute for Educational Research Inc.. All rights reserved.

Personas, the Pandemic, and Inclusive, Synthetic, Smart City Planning

In the era of COVID-19, planners, and more broadly, city administrators and policy makers, have learned to cope with the accelerated pace of change, the broad band of uncertainty, and the need for rapid decision-making strategies. In the context of ever more diverse communities and greater reliance on technology as an effective response to the social and public health challenges of the pandemic, "smart" cities harness distributed communication and service delivery technologies to enhance the quality of urban life. The voices of citizens from marginalized and under-served populations, such as older adults and people with disabilities, are vital to the development of inclusive smart cities. In this paper, expanding an inclusive policy design approach is proposed that uses `personas' to actively engage those citizens.

High-flow nasal cannulae for respiratory support in adult intensive care patient

Background High-flow nasal cannulae (HFNC) deliver high flows of blended humidified air and oxygen via wide-bore nasal cannulae and may be useful in providing respiratory support for adults experiencing acute respiratory failure, or at risk of acute respiratory failure, in the intensive care unit (ICU). This is an update of an earlier version of the review. Objectives To assess the effectiveness of HFNC compared to standard oxygen therapy, or non-invasive ventilation (NIV) or non-invasive positive pressure ventilation (NIPPV), for respiratory support in adults in the ICU. Search methods We searched CENTRAL, MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane COVID-19 Register (17 April 2020), clinical trial registers (6 April 2020) and conducted forward and backward citation searches. Selection criteria We included randomized controlled studies (RCTs) with a parallel-group or cross-over design comparing HFNC use versus other types of non-invasive respiratory support (standard oxygen therapy via nasal cannulae or mask;or NIV or NIPPV which included continuous positive airway pressure and bilevel positive airway pressure) in adults admitted to the ICU. Data collection and analysis We used standard methodological procedures as expected by Cochrane.

CYTOSPONGE IN THE REAL-WORLD: TRIAGE OF BARRETT'S SURVEILLANCE AND REFLUX IN A SINGLE NON-SPECIALIST HOSPITAL

Introduction During the COVID-19 pandemic gastroscopy was halted with large burden on recovery and risk of late diagnosis. We established an early diagnosis service using Cytosponge to triage patients to timely gastroscopy and management Methods 2 patient cohorts were used: 1. Barrett's oesophagus (BO) on endoscopic surveillance 2. Patients with symptoms of gastro-oesophageal reflux referred for routine gastroscopy. Exclusions were patients with dysplasia on last gastroscopy, fundoplication, pregnancy and patient preference. Triage of patients on the waiting list was from endoscopy referrals, Barrett's surveillance database and telephone triage. 2 research nurses and 2 clinical nurse specialists were trained in delivering Cytosponge. A patient satisfaction survey was completed. All cytology specimens were analysed by Cyted. Results were relayed to patients within 4 weeks by consultant led nurse-run teleclinic and letter. Clinical triage was according to the table below. TFF3+ was used as a marker for intestinal metaplasia (IM), P53+ve and atypia for potential dysplastic change. Results 470 patients agreed to Cytosponge over 14 months November 2020-January 2022. 22 cancelled-mostly COVID related. 34 failed to swallow (5.5% of Barrett's, 8.9% reflux). of those successfully swallowing the sponge 6% were inadequate samples in Barrett's and 9% reflux. No major adverse events occurred. Conclusion We report on the largest single site series of Cytosponge in non-specialist clinical practice in England and its pragmatic use in patients management and pandemic recovery. Significant benefits in the Barrett's cohort were timely identification of dysplasia and those longer requiring surveillance. Benefits in the reflux group include identification of new BO, avoiding unnecessary gastroscopy and early discharge. Overall reduced endoscopy resulted in reduced cost, lower carbon footprint and improved patient experience. Careful follow up and longer-term outcomes will provide confidence to continue this new technique in routine clinical practice.

Immunogenicity of COVID-19 mRNA Vaccines in Patients with Lymphoid Malignancies

Background. Patients with lymphoid malignancies are at high risk of severe COVID-19 disease and were not included in the phase 3 mRNA vaccine trials. Many patients with lymphoid malignancies receive immunosuppressive therapies, including B-cell depleting agents, that may negatively impact humoral response to vaccination. Methods. We recruited patients with lymphoid malignancies and healthy participants who planned to receive two doses of SARS-CoV-2 mRNA vaccine (BNT162b2 or mRNA-1273). Blood was drawn at baseline, prior to second dose of vaccine, and 28 days after last vaccination. Disease characteristics and therapies were extracted from patients' electronic medical record. An ultrasensitive, single molecule array (Simoa) assay detected anti-Spike (S), anti-S1, anti-receptor binding domain (RBD), and anti-Nucleocapsid (N) IgG from plasma at each timepoint. Results. 23 healthy participants and 37 patients with lymphoid malignancies were enrolled (Table 1). Low titers of anti-N (Fig 1A) demonstrate no prior exposure or acquisition of COVID-19 before vaccination or during the study. 37.8% of the lymphoid malignancy cohort responded to the vaccine, using an internally validated AEB cutoff of 1.07. A significantly higher magnitude of anti-S (p< 0.0001), anti-S1 (p< 0.0001) and anti-RBD (p< 0.0001) are present in the healthy as compared to lymphoid malignancy cohort at the second dose and day 28 post-series (Fig 1B, Fig 1C and Fig 1D). Anti-S IgG titers were compared between the healthy cohort, treatment naI&Die;ve, and treatment experienced groups (Fig 2). The treatment naI&Die;ve cohort had high titers by series completion which were not significantly different from the healthy cohort (p=0.2259), although the treatment experienced group had significantly decreased titers (p< 0.0001). Of the 20 patients who had received CD20 therapy, there was no clear correlation of anti-S IgG response with time from CD20 therapy, although most patients who received CD20 therapies within 12 months from the vaccine had no response (Figure 3). Conclusion. The vaccine-induced immune response was poor among treatment-experienced patients with lymphoid malignancies, especially among those who received CD20 therapies within 12 months.

Opportunities for fellowship education: the first year of the Medical Biochemical Genetics Clinical Core Seminar Series

Background: The Medical Biochemical Genetics (MBG) Fellowship is an Accreditation Council of Graduate Medical Education (ACGME) subspecialty,one-year training program designed to prepare ClinicalMedical Genetics and Genomics graduates for practice in the diagnosis and treatment of inborn errors of metabolism (IEM). The ACGMErequires each program to provide “structured education, includingformal coursework in the basic sciences and clinical areas pertinent tobiochemical genetics”. There are currently 19 programs around theUnited States (US). Most have only one fellow per year. An average of18 MBG fellows every two years sit for the board examination. Eachprogram has a separate, individual curriculum. This puts a potentiallylarge burden on faculty to generate and teach didactic lectures for asingle fellow per year, and limits the fellow to learn in isolation,without interaction with the greater US IEM community. In 2020,amidst the COVID-19 pandemic, faculty at the University of Coloradoapproached the program directors of the individual MBG programsacross the US to establish a unified MBG curriculum to meet the“formal coursework” requirement. Twelve MBG programs opted totake part.Methods: A curriculum, designated as the MBG Clinical Core SeminarSeries (CCSS),was established to included 13 lectures covering contentfrom the American Board of Medical Genetics and GenomicsBiochemical Genetics Blueprint. Sessions were held weekly fromAugust through November of 2020 using a virtual platform (https://zoom.us/). Each session was designated to be 90 minutes: 75 min fordidactic teaching and 15 min for questions/interaction with the facultyspeaker and one another. Lectures were taught by expert faculty,boarded in Medical/Clinical Biochemical Genetics and well-known inthe field for the lecture subject matter. Invitations were sent out toMBG programs nationwide, and responding participants were addedto an email listserv that was kept through the MBG program at theUniversity of Colorado. Attendance was not limited to MBG fellows,but faculty were instructed to focus on MBG fellows as the primaryaudience. After each lecture, opportunity was given to all participantsto engage in a brief survey to evaluate the class using 3 generalquestions (see below) and response both by free text and using a Likertscale (5 = Strongly Agree to 1 = Strongly Disagree). Lectures wererecorded on ZOOM, and recordings with accompanying referencematerialwere distributed to the entire listserv using a Dropbox link, aswell as uploaded and stored on the Society for Inherited MetabolicDisease website.Results: The number of participants on the listservwas 217 by the endof the lecture series. Synchronous participation included an average of75 participants per session. In total, there were 98 responses to thethree questions in the survey. Respondents include both MBG andClinical Biochemical Genetics (CBG) fellows (22 responses), as well asattending physicians, genetics/pediatrics residents, genetic counselors,advanced practice providers, and nurses. Participants scored thethree questions as follows: “This session will improve my ability todiagnose and manage metabolic patients” (4.60 ± 0.59);“This sessionmade me feel more connected to the larger metabolic community”(4.62 ± 0.65);and “This session was high-yield given breadth anddepth of content and time allotted” (4.61 ± 0.65). Of note, MBG andCBG fellow responses to the three questions were 4.73 ± 0.54,4.36 ± 0.83, and 4.77 ± 0.41, respectively. Free text comments weregenerally positive, with the major critiques being the large amount ofcontent for time allotted and the desire for board-related practicequestions.Conclusions: The MBG-CCSS endeavored to create a unique opportunityfor trainees to network, facilitate teaching by nationallyrecognized experts, and minimize duplication of effort in individualtraining programs. These goals were all achieved with great success.An unexpected finding was the level of interest from a much largernumber of individuals than expected, far more than th US cohort ofMBG fellows. This points to a significant unmet demand for IEMfocusededucation at all levels around the country. Evaluation scoresfrom fellows, as well as comments, indicate several areas forimprovement including 1) less content per session 2) more participantinteraction 3) incorporated board practice questions and 4) formalassessment of knowledge using a written final exam. We will alsostrive to improve fellow-fellow and fellow-faculty dialogue through interactive questions and smaller fellow-faculty-only discussions.Moving forward, we will continue to build on the success of the firstyear, to prepare and inspire IEM providers for independent clinicalpractice

Multi site comparative study of three heparin induced thrombocytopenia (HIT) test methods and preliminary consideration of their utility in suspected vaccine induced thrombocytopenia and thrombosis (VITT)

Heparin induced thrombocytopenia (HIT) occurs when patients generate an antibody response against the heparin/platelet factor 4 (PF4) complex. In some cases, these antibodies cause platelet activation and clinical thrombosis. The 'Four-T's' score assesses clinical likelihood of HIT. Anti-PF4 antibodies have been detected in patients suffering from vaccine-induced immune thrombotic thrombocytopenia (VITT) following SARS-CoV-2 vaccination and testing by ELISA is recommended. Various platelet activation and pF4/heparin complex antigen assays are employed to detect HIT antibodies. High test sensitivity increases likelihood of detecting of antibodies that do not cause clinical HIT. We compared the BioRad ID-PGIA test with the Werfen Acustar assay and the Werfen immunoassay in a comparative study of 12? HIT patients and two UKNEQAS supplementary exercises. The specificity of the BioRad ID-PGIA Heparin/PF4 gel filtration test is considered poor, although its negative predictive value is more reliable. The Werfen Acustar chemiluminescence assay and the Werfen HaemosIL HIT-ab latex immunoassay have comparable sensitivity and superior specificity to the BioRad test. Preliminary studies suggest all three assays have limited sensitivity to VITT. BioRad HIT results were positive for 10/12 patient samples. The two negative samples were also negative by Acustar and immunoassay. One additional sample was negative by Acustar but positive by immunoassay. Four further samples were negative by immunoassay but positive by Acustar. Patients deemed HIT positive by Acustar were switched to fondaparinux or argatroban. Continued heparin infusion did not cause clinical deterioration in the patient who tested HIT positive by immunoassay but not Acustar. The BioRad method obtained expected results for UKNEQAS distributions S20 and S21. Both Werfen methods obtained expected results for S20 but demonstrated poor sensitivity to VITT and HIT in S21. Agreement between results of the three HIT assays is limited but typical of expected patterns. Heparin is variable in terms of chain length and degree of sulphation, which affects degree of conformational change, and therefore antigenic presentation, of PF4 in complex with heparin. Variable antigenic profile in different assays leads to poor comparability of results. It is important to distinguish between HIT and VITT for the purposes of assay selection.

Men, deprivation and COVID-19

Men living in deprivation are much more likely to die from all causes, and specifically as a result of COVID-19 infection, than men who are least deprived. Here the author argues that both short-term and long-term measures are needed to address this inequality, and that the pandemic has created a real opportunity to 'build back better'.

Prenatal anxiety and obstetric decisions among pregnant women in Wuhan and Chongqing during the COVID-19 outbreak: a cross-sectional study.

OBJECTIVES: To investigate the mental status of pregnant women and to determine their obstetric decisions during the COVID-19 outbreak. DESIGN: Cross-sectional study. SETTING: Two cities in China--Wuhan (epicentre) and Chongqing (a less affected city). POPULATION: A total of 1947 pregnant women. METHODS: We collected demographic, pregnancy and epidemic information from our pregnant subjects, along with their attitudes towards COVID-19 (using a self-constructed five-point scale). The Self-Rating Anxiety Scale (SAS) was used to assess anxiety status. Obstetric decision-making was also evaluated. The differences between cities in all of the above factors were compared and the factors that influenced anxiety levels were identified by multivariable analysis. MAIN OUTCOME MEASURES: Anxiety status and its influencing factors. Obstetric decision-making. RESULTS: Differences were observed between cities in some background characteristics and women's attitudes towards COVID-19 in Wuhan were more extreme. More women in Wuhan felt anxious (24.5 versus 10.4%). Factors that influenced anxiety also included household income, subjective symptom and attitudes. Overall, obstetric decisions also revealed city-based differences; these decisions mainly concerned hospital preference, time of prenatal care or delivery, mode of delivery and infant feeding. CONCLUSIONS: The outbreak aggravated prenatal anxiety and the associated factors could be targets for psychological care. In parallel, key obstetric decision-making changed, emphasising the need for pertinent professional advice. Special support is essential for pregnant mothers during epidemics. TWEETABLE ABSTRACT: The COVID-19 outbreak increased pregnant women's anxiety and affected their decision-making.

Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study.

Healthcare workers involved in aerosol-generating procedures, such as tracheal intubation, may be at elevated risk of acquiring COVID-19. However, the magnitude of this risk is unknown. We conducted a prospective international multicentre cohort study recruiting healthcare workers participating in tracheal intubation of patients with suspected or confirmed COVID-19. Information on tracheal intubation episodes, personal protective equipment use and subsequent provider health status was collected via self-reporting. The primary endpoint was the incidence of laboratory-confirmed COVID-19 diagnosis or new symptoms requiring self-isolation or hospitalisation after a tracheal intubation episode. Cox regression analysis examined associations between the primary endpoint and healthcare worker characteristics, procedure-related factors and personal protective equipment use. Between 23 March and 2 June 2020, 1718 healthcare workers from 503 hospitals in 17 countries reported 5148 tracheal intubation episodes. The overall incidence of the primary endpoint was 10.7% over a median (IQR [range]) follow-up of 32 (18-48 [0-116]) days. The cumulative incidence within 7, 14 and 21 days of the first tracheal intubation episode was 3.6%, 6.1% and 8.5%, respectively. The risk of the primary endpoint varied by country and was higher in women, but was not associated with other factors. Around 1 in 10 healthcare workers involved in tracheal intubation of patients with suspected or confirmed COVID-19 subsequently reported a COVID-19 outcome. This has human resource implications for institutional capacity to deliver essential healthcare services, and wider societal implications for COVID-19 transmission.