Automated System for Multiplexing Detection of COVID-19 and Other Respiratory Pathogens.

OBJECTIVE: Infectious diseases are global health challenge, impacted the communities worldwide particularly in the midst of COVID-19 pandemic. The need of rapid and accurate automated systems for detecting pathogens of concern has always been critical. Ideally, such systems shall detect a large panel of pathogens simultaneously regardless of well-equipped facilities and highly trained operators, thus realizing on-site diagnosis for frontline healthcare providers and in critical locations such as borders and airports. METHODS & RESULTS: Avalon Automated Multiplex System, AAMST, is developed to automate a series of biochemistry protocols to detect nucleic acid sequences from multiple pathogens in one test. Automated processes include isolation of nucleic acids from unprocessed samples, reverse transcription and two rounds of amplifications. All procedures are carried out in a microfluidic cartridge performed by a desktop analyzer. The system was validated with reference controls and showed good agreement with their laboratory counterparts. In total 63 clinical samples, 13 positives including those from COVID-19 patients and 50 negative cases were detected, consistent with clinical diagnosis using conventional laboratory methods. CONCLUSIONS: The proposed system has demonstrated promising utility. It would benefit the screening and diagnosis of COVID-19 and other infectious diseases in a simple, rapid and accurate fashion. Clinical and Translational Impact Statement- A rapid and multiplex diagnostic system proposed in this work can clinically help to control spread of COVID-19 and other infectious agents as it can provide timely diagnosis, isolation and treatment to patients. Using the system at remoted clinical sites can facilitate early clinical management and surveillance.

Longitudinal Analysis of T cells in COVID-19 Survivors with Post-Acute Sequelae of COVID-19 Reveals Associations between Individual Symptoms and Inflammatory Indexes

Background. Many individuals infected with SARS-CoV-2 are left with persistent symptoms of COVID-19. Post-acute sequelae of COVID-19 (PASC) can affect quality of life and functionality. The mechanism underlying PASC is unknown but elevated inflammatory markers several months post infection have been found in those with PASC. Methods. Individuals diagnosed with COVID-19 were evaluated longitudinally for PASC and persistent symptoms. CD4+ and CD8+ cellular markers and intracellular cytokines were assessed at each follow-up time point and analyzed by individual PASC symptoms reported. Results. Participants who reported persistent dyspnea, forgetfulness, confusion, and chest pain had significantly higher levels of CD8+Ki67+ cells. Those with dyspnea also had significantly higher levels of CD8+CD38+, CD8+Granzyme B+, and CD8+IL10+ cells. Those who suffered from forgetfulness, chest pain, and joint pain had significantly higher levels of CD4+CD25+ cells. Conclusion. These findings suggest continued CD8+ T cell and CD4+CD25+ T cell activation and response following SARS-CoV-2 infection in patients with PASC. An increase in T regulatory cells suggests an ongoing attempt to control host inflammation in a subset of these patients. These results shed further light on continued immune system activation and chronic inflammation as a link to symptoms in COVID-19 survivors suffering from PASC. (Figure Presented).

Relations between higher- and lower-order alcohol and cannabis expectancies and simultaneous use frequency among undergraduate dual users

Background: Simultaneous alcohol and cannabis (i.e. marijuana;[SAM]) use is prevalent among college students. There is limited research on expectancy effects for SAM use, which are known correlates of use frequency and mediators of treatment outcomes. We examined the unique associations of both positive and negative alcohol and cannabis expectancies with frequency of SAM use among college students. Method: Participants were 1012 college students (70.9% female, 51.8% white, M age = 19.63) from seven US universities who reported past-month alcohol and cannabis use (77.2% of the sample reported SAM use). Students completed measures of past-month typical weekly alcohol and cannabis frequency and quantity, alcohol and cannabis expectancies, and SAM frequency through an online self-reported survey. Results: A negative binomial regression revealed that higher-order positive, but not negative, alcohol and cannabis expectancies were significant predictors of SAM frequency above and beyond frequency of alcohol and cannabis use, biological sex, and whether the survey was completed pre- or post-COVID-19 campus closures. Specifically, higher frequency SAM use was associated with weaker positive alcohol and stronger positive cannabis expectancies. A second negative binomial regression including lower-order expectancies found that SAM frequency was associated with weaker social and cognitive and behavioral impairment alcohol expectancies and stronger sexual and social facilitation cannabis and liquid courage alcohol expectancies, specifically. Conclusions: Results highlight the importance of comprehensively examining both higher- and lower-order alcohol and cannabis expectancies when examining SAM frequency, and provide avenues of targeted intervention to reduce SAM use among dual users. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Increasing access to cognitive–behavioural therapy for patients with psychosis by evaluating the feasibility of a randomised controlled trial of brief, targeted cognitive–behavioural therapy for distressing voices delivered by assistant psychologists: the GiVE2 trial

Background Cognitive-behavioural therapy (CBT) is recommended for all patients with psychosis, but is offered to only a minority. This is attributable, in part, to the resource-intensive nature of CBT for psychosis. Responses have included the development of CBT for psychosis in brief and targeted formats, and its delivery by briefly trained therapists. This study explored a combination of these responses by investigating a brief, CBT-informed intervention targeted at distressing voices (the GiVE intervention) administered by a briefly trained workforce of assistant psychologists. Aims To explore the feasibility of conducting a randomised controlled trial to evaluate the clinical and cost-effectiveness of the GiVE intervention when delivered by assistant psychologists to patients with psychosis. Method This was a three-arm, feasibility, randomised controlled trial comparing the GiVE intervention, a supportive counselling intervention and treatment as usual, recruiting across two sites, with 1:1:1 allocation and blind post-treatment and follow-up assessments. Results Feasibility outcomes were favourable with regard to the recruitment and retention of participants and the adherence of assistant psychologists to therapy and supervision protocols. For the candidate primary outcomes, estimated effects were in favour of GiVE compared with supportive counselling and treatment as usual at post-treatment. At follow-up, estimated effects were in favour of supportive counselling compared with GiVE and treatment as usual, and GiVE compared with treatment as usual. Conclusions A definitive trial of the GiVE intervention, delivered by assistant psychologists, is feasible. Adaptations to the GiVE intervention and the design of any future trials may be necessary.

Loneliness in adults awaiting liver transplantation at 7 u.s. transplant centers during the COVID-19 pandemic

Purpose: Loneliness, defined by the National Academy of Medicine as “a subjective feeling of being isolated”, has recently emerged as a strong predictor of adverse health effects and is of increasing concern given the COVID-19 pandemic. We aimed to characterize loneliness in patients with end-stage liver disease (ESLD) awaiting liver transplantation (LT). Methods: We surveyed adult ambulatory cirrhosis patients awaiting LT at 7 U.S. sites during the COVID-19 pandemic (May2020-Jan2021) using the validated UCLA Three-Item Loneliness Scale by phone or video. Participants were asked to report if they felt: 1) they lack companionship, 2) left out, or 3) isolated using a 3-point scale (1=hardly ever, 2=some of the time, or 3=often). Participants were classified as “lonely” if they reported a score of ≥2 in at least 1 category. Frailty was assessed with the Liver Frailty Index (LFI);“frail”=LFI≥4.4. Logistic regression was used to associate loneliness and other factors. Results: Of 454 participants, 36% were female, median age was 60 years (IQR 53-64), median MELDNa was 14 (IQR 10-19), and 14% were frail. 181 (40%) met criteria for “lonely” in at least 1 category;49 (11%) met criteria for “lonely” in all 3 categories. Compared to those who were not lonely, those who reported feeling lonely were younger (58 v. 61y) and more likely to be female (46% v. 29%), frail (19 v. 11%), or have hepatic encephalopathy (62 v. 50%). There were no differences by race/ethnicity, disease etiology, ascites, or MELDNa score. In univariable analysis, age (OR 0.97, 95% CI 0.96-0.99), female sex (OR 2.16, 95% CI 1.46-3.21), frailty (OR 1.88, 95% CI 1.09-3.2), and hepatic encephalopathy (OR 1.60, 95% CI 1.09- 2.35) were associated with loneliness. After multivariable adjustment, younger age (OR 0.97, 95% CI 0.95-0.99), female sex (OR 1.95, 95% 1.30-2.90), and frailty (OR 1.5, 95% CI 1.2-1.96), remained significantly associated with loneliness. Conclusions: During the COVID-19 pandemic, loneliness was prevalent in patients with ESLD awaiting LT (40%). This is similar to rates reported in the general population (20-50%) during the pandemic, despite LT candidates being a select subgroup in which social support is a criterion for listing. In our cohort, younger age, female sex, and frailty were independently associated with loneliness. These data lay the foundation for future work investigating the extent to which loneliness impacts health outcomes in LT patients, as it does in the general population, and how targeting loneliness in interventions may facilitate improvements in frailty.

Age differences in the association of comorbid burden with adverse outcomes in SARS-CoV-2.

BACKGROUND: Older age and comorbid burden are both associated with adverse outcomes in SARS-CoV-2, but it is not known whether the association between comorbid burden and adverse outcomes differs in older and younger adults. OBJECTIVE: To compare the relationship between comorbid burden and adverse outcomes in adults with SARS-CoV-2 of different ages (18-64, 65-79 and ≥ 80 years). DESIGN, SETTING, AND PARTICIPANTS: Observational longitudinal cohort study of 170,528 patients who tested positive for SARS-CoV-2 in the US Department of Veterans Affairs (VA) Health Care System between 2/28/20 and 12/31/2020 who were followed through 01/31/2021. MEASUREMENTS: Charlson Comorbidity Index (CCI); Incidence of hospitalization, intensive care unit (ICU) admission, mechanical ventilation, and death within 30 days of a positive SARS-CoV-2 test. RESULTS: The cumulative 30-day incidence of death was 0.8% in cohort members < 65 years, 7.1% in those aged 65-79 years and 20.6% in those aged ≥80 years. The respective 30-day incidences of hospitalization were 8.2, 21.7 and 29.5%, of ICU admission were 2.7, 8.6, and 11% and of mechanical ventilation were 1, 3.9 and 3.2%. Median CCI (interquartile range) ranged from 0.0 (0.0, 2.0) in the youngest, to 4 (2.0, 7.0) in the oldest age group. The adjusted association of CCI with all outcomes was attenuated at older ages such that the threshold level of CCI above which the risk for each outcome exceeded the reference group (1st quartile) was lower in younger than in older cohort members (p < 0.001 for all age group interactions). LIMITATIONS: The CCI is calculated based on diagnostic codes, which may not provide an accurate assessment of comorbid burden. CONCLUSIONS: Age differences in the distribution and prognostic significance of overall comorbid burden could inform clinical management, vaccination prioritization and population health during the pandemic and argue for more work to understand the role of age and comorbidity in shaping the care of hospitalized patients with SARS-CoV-2.

Developing guidance for psychological professionals on inpatient mental health wards during the covid-19 pandemic

Due to the challenges faced by mental health inpatient psychological professionals working during the Covid-19 pandemic, we aimed to produce guidelines on best practice through consultations with psychological professionals, patients and ward staff. © 2021, British Psychological Society. All rights reserved.

Dancing With Non-duality for Healing Through the Shadows of the COVID-19 Pandemic

The COVID-19 pandemic has unleashed torrents of global suffering at a devastating scale, necessitating a strong response to alleviating suffering. This paper begins with noting that the conventional approach to suffering in North America is to be positive and not to be negative. The paper summarily explores the philosophy of positive psychology underlying the first- and the second-wave of positive psychology, commenting on the evolution from dualism and a binary conceptualization in the first wave (PP 1.0) to a non-dualism of integrating binaries in the second wave (PP 2.0). PP 2.0’s enhanced therapeutic efficacy is noted for its non-dual framework. The paper then explores and suggests a different conceptualization possibility of non-duality, fundamental non-duality, that is related to but distinct from the one in PP 2.0. A case is made that fundamental non-duality has a radical possibility of therapeutic efficacy. Being consistent with the philosophy of non-duality, further suggestions are made that non-duality of PP 2.0 and fundamental non-duality can be therapeutically deployed together for greatest efficacy. The exploration contained in the paper is largely philosophical, arts-based, and autobiographical, creating an enacted and lived experience of applying theory to practice. © Copyright © 2021 Bai, Berry, Haber and Cohen.

Impact of reported level of exposure to COVID-19 patients on physicians in residency and fellowship training programs

Background: During the novel coronavirus-2019 (COVID-19) pandemic, physicians in residency and fellowship training programs are serving as essential healthcare workers while also attempting to continue their preparation for eventual independent practice in their field. We aimed to determine how level of exposure patients with COVID-19 affected the experience of graduate medical trainees in terms of their safety, professional development, and well-being during March and April 2020 Methods: We administered an anonymous, voluntary, web-based survey to physicians enrolled in residency or fellowship training programs in any specialty worldwide A convenience sampling of trainees was obtained through distribution of the survey by email and social media posts from April 20th to May 11th, 2020 To investigate the impact of burden of exposure to COVID-19 the trainee experience, we categorized respondents according to their self-reported estimate of the number of patients with COVID-19 that they provided care for in March and April 2020 (0, 1-30, 31-60, >60). Descriptive statistics were performed and the chi square test was used to evaluate for statistical significance. A multivariable logistic regression analysis was conducted to determine independent predictors of physician burnout Results: Surveys were completed by 1420 trainees, of whom 1031 (73%) were residents Most of the fellows who responded to the survey were training in gastroenterology/ hepatology (27%, 85/280) Trainees who cared for a greater number of COVID-19 patients were more likely to report limited access to PPE and COVID-19 testing and more likely to report testing positive for COVID-19 (Figure 1A) Compared to trainees who did not take care of COVID-19 patients, those who took care of 1-30 patients (adjusted odds ratio [AOR] 1 80, 95% CI 1 29-2 51), 31-60 patients (AOR 3.30, 95% CI 1.86-5.88) and >60 patients (AOR 4.03, 95% CI 2 12-7 63) were increasingly more likely to report burnout More than half (835, 58%) of trainees reported concern about their future preparedness for independent practice Trainees who cared for >60 COVID-19 patients compared to those who did not care for any COVID-19 patients reported similar levels of concern about their preparedness for independent practice (56%, 372/636 vs 58%, 71/125 respectively, p-value 0 57, Figure 1B) Conclusion: Physician trainees who were involved in the care of patients with COVID-19 were more likely to report unsafe working conditions and suffered from higher rates of physician burnout Trainees were concerned about the effects of lost training opportunities on their professional development irrespective of the number of COVID-19 patients they cared for.

Anchors away: reconciling the dream of teaching in COVID-19

This essay examines teaching failure in the context of COVID-19. It uses autoethnography to convey and explore the impact the pandemic has on teaching, as situated against and within my life-long dream to be a teacher. I explore four performances as a teacher that resulted from the transition at my institution from on the ground to fully remote instruction. Overall, I consider the ways COVID-19 has disrupted what it means to participate in communication instruction and to be a teacher, more generally. © 2020 National Communication Association.