D-dimers in omicron versus delta: A retrospective analysis.

Background: Infection with SARS-CoV-2 has shown to cause an increase in D-dimers, which correlate with severity and prognosis for in-hospital mortality. The B.1.617.2 (delta) variant is known to cause a raised D-dimer level, with data on D-dimers in the B.1.1.529 (omicron) variant being scarce. Objectives: To determine the effect of age, gender and SARS-CoV-2 variant on the D-dimer in South Africans admitted to tertiary medical centres from May 2021 to December 2021. Method: The study was performed retrospectively on 16 010 adult patients with a SARS-CoV-2 infection. Age, gender, SARS-CoV-2 PCR and D-dimer levels on admission were collected from two national laboratories. Admissions from 01 May 2021 to 31 October 2021 were classified as B.1.617.2, whereas admissions from 01 November 2021 to 23 December 2021 were classified as B.1.1.529 infections. Results: Omicron infections had a median D-dimer level of 0.54 µg/mL (95% CI: 0.32, 1.08, p < 0.001). Multivariable regression analysis showed that infection with omicron had a 34.30% (95% CI: 28.97, 39.23) reduction in D-dimer values, compared with delta infections. Middle aged, aged and aged over 80 years had D-dimer results greater than the adult baseline (42.6%, 95% CI: 38.0, 47.3, 124.6%, 95% CI: 116.0, 133.7 and 216.1%, 95% CI: 199.5, 233.3). Males on average had a 7.1% (95% CI: 4.6, 9.6) lower D-dimer level than females. Conclusion: Infection with the B.1.1.529 variant, compared with B.1.617.2 variant, had significantly lower D-dimer levels, with age being a more significant predictor of D-dimer levels, than gender and SARS-CoV-2 variant of infection. Contribution: This study provides novel insight into the hypercoagulable impact of various SARS-CoV-2 variants, which can guide the management of patients.

Identifying the effects of COVID-19 on visitor place attachment of state parks in Arkansas

During the COVID-19 pandemic, recreation sites around the country experienced a rise in visitation numbers as residents looked for alternatives to staying home. The researchers hypothesized that the social and cultural changes associated with the pandemic have increased the level of visitor place attachment towards these sites. This research works to identify the level of connection guests have towards Arkansas State Parks (ASP) during COVID-19. Results from this study have shown that attachment towards ASP has grown throughout the pandemic and has increased the likelihood that these visitors will return to the site in the future. © 2023 World Leisure Organization.

Circadian Timing, Information processing and Metabolism (TIME) study: protocol of a longitudinal study of sleep duration, circadian alignment and cardiometabolic health among overweight adults.

BACKGROUND: Both short sleep duration and circadian rhythm misalignment are risk factors for metabolic dysfunction, but the underlying mechanisms are unknown. The goal of this study is to examine how sleep duration and circadian alignment predict changes in cardiometabolic risk factors over a 12-month period, and test cognitive function and hedonic eating tendencies as potential mechanisms. METHODS: We will recruit a sample of 120 working aged adults with BMI 25-35 kg/m2 (overweight to class I obesity). The protocol includes 5 visits over a 12-month period. Study visits include wrist actigraphy to measure sleep behaviors, 24-h diet recalls, dim light melatonin collection, a computerized neurobehavioral assessment, eating in the absence of hunger task, and frequently sampled IV glucose tolerance test. DISCUSSION: The results of the TIME study will advance the understanding of how both short sleep duration and circadian misalignment contribute to behavioral aspects of obesity and metabolic dysfunction. TRIAL REGISTRATION: ClinicalTrials.Gov, NCT04759755 , registered retrospectively February 13, 2021.

Acquired Tracheomalacia Requiring Urgent Tracheostomy Exchange in Patients With COVID-19.

Tracheostomy for prolonged ventilation of patients with COVID-19 was often delayed due to high viral loads and persistent high ventilatory requirements. With prolonged intubation and significant dose corticosteroid use, patients with COVID-19 are at risk for tracheomalacia, and urgent tube exchange may be required to address persistent cuff leak and to maintain adequate mechanical ventilation. We sought to describe our single center experience with COVID-19 patients requiring tracheostomy and the tracheal complications that followed. We performed a review of patients with COVID-19 who underwent tracheostomy from June 2020 to October 2021. 45 patients were identified; 82.2% survived their index hospitalization. Tracheostomy was performed after 16.4 days of mechanical ventilation. 22.2% required urgent exchange to an extended length tracheostomy tube after 7.2 days from initial tracheostomy. Placement of an extended length tracheostomy tube can reduce cuff leak in ventilated COVID-19 patients and may be considered during initial tracheostomy placement.

Fc-γR-dependent antibody effector functions are required for vaccine-mediated protection against antigen-shifted variants of SARS-CoV-2.

Emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with antigenic changes in the spike protein are neutralized less efficiently by serum antibodies elicited by legacy vaccines against the ancestral Wuhan-1 virus. Nonetheless, these vaccines, including mRNA-1273 and BNT162b2, retained their ability to protect against severe disease and death, suggesting that other aspects of immunity control infection in the lung. Vaccine-elicited antibodies can bind Fc gamma receptors (FcγRs) and mediate effector functions against SARS-CoV-2 variants, and this property correlates with improved clinical coronavirus disease 2019 outcome. However, a causal relationship between Fc effector functions and vaccine-mediated protection against infection has not been established. Here, using passive and active immunization approaches in wild-type and FcγR-knockout mice, we determined the requirement for Fc effector functions to control SARS-CoV-2 infection. The antiviral activity of passively transferred immune serum was lost against multiple SARS-CoV-2 strains in mice lacking expression of activating FcγRs, especially murine FcγR III (CD16), or depleted of alveolar macrophages. After immunization with the pre-clinical mRNA-1273 vaccine, control of Omicron BA.5 infection in the respiratory tract also was lost in mice lacking FcγR III. Our passive and active immunization studies in mice suggest that Fc-FcγR engagement and alveolar macrophages are required for vaccine-induced antibody-mediated protection against infection by antigenically changed SARS-CoV-2 variants, including Omicron strains.

Thirty-year follow-up of the NICHD Study of Early Child Care and Youth Development (SECCYD): the challenges and triumphs of conducting in-person research at a distance.

PURPOSE: The purpose of the current study, The National Institute of Child Health and Human Development (NICHD) Study of Health in Early and Adult Life (SHINE), was to build on the landmark Study of Early Child Care and Youth Development (SECCYD), a longitudinal birth cohort initiated in 1991, by conducting a health-focused follow-up of the now adult participants. This effort has produced an invaluable resource for the pursuit of life course research examining links between early life risk and resilience factors and adulthood health and disease risk. PARTICIPANTS: Of the 927 NICHD SECCYD participants available for recruitment in the current study, 705 (76.1%) participated in the study. Participants were between 26 and 31 years and living in diverse geographic locations throughout the USA. FINDINGS TO DATE: In descriptive analyses, the sample exhibited risk on health status indicators, especially related to obesity, hypertension and diabetes. Of particular concern, the prevalence of hypertension (29.4%) and diabetes (25.8%) exceeded national estimates in similar-age individuals. Health behaviour indicators generally tracked with the parameters of poor health status, showing a pattern of poor diet, low activity and disrupted sleep. The juxtaposition of the sample's relatively young age (mean=28.6 years) and high educational status (55.6% college educated or greater) with its poor health status is noteworthy, suggesting a dissociation between health and factors that are typically health protective. This is consistent with observed population health trends, which show a worsening of cardiometabolic health status in younger generations of Americans. FUTURE PLANS: The current study, SHINE, lays the groundwork for future analyses in which the uniquely robust measures collected as a part of the original NICHD SECCYD will be leveraged to pinpoint specific early life risk and resilience factors as well as the correlates and potential mechanisms accounting for variability in health and disease risk indicators in young adulthood.

D-dimers in omicron versus delta: A retrospective analysis

Background Infection with SARS-CoV-2 has shown to cause an increase in D-dimers, which correlate with severity and prognosis for in-hospital mortality. The B.1.617.2 (delta) variant is known to cause a raised D-dimer level, with data on D-dimers in the B.1.1.529 (omicron) variant being scarce. Objectives To determine the effect of age, gender and SARS-CoV-2 variant on the D-dimer in South Africans admitted to tertiary medical centres from May 2021 to December 2021. Method The study was performed retrospectively on 16 010 adult patients with a SARS-CoV-2 infection. Age, gender, SARS-CoV-2 PCR and D-dimer levels on admission were collected from two national laboratories. Admissions from 01 May 2021 to 31 October 2021 were classified as B.1.617.2, whereas admissions from 01 November 2021 to 23 December 2021 were classified as B.1.1.529 infections. Results Omicron infections had a median D-dimer level of 0.54 µg/mL (95% CI: 0.32, 1.08, p < 0.001). Multivariable regression analysis showed that infection with omicron had a 34.30% (95% CI: 28.97, 39.23) reduction in D-dimer values, compared with delta infections. Middle aged, aged and aged over 80 years had D-dimer results greater than the adult baseline (42.6%, 95% CI: 38.0, 47.3, 124.6%, 95% CI: 116.0, 133.7 and 216.1%, 95% CI: 199.5, 233.3). Males on average had a 7.1% (95% CI: 4.6, 9.6) lower D-dimer level than females. Conclusion Infection with the B.1.1.529 variant, compared with B.1.617.2 variant, had significantly lower D-dimer levels, with age being a more significant predictor of D-dimer levels, than gender and SARS-CoV-2 variant of infection. Contribution This study provides novel insight into the hypercoagulable impact of various SARS-CoV-2 variants, which can guide the management of patients.

Fc-gamma receptor-dependent antibody effector functions are required for vaccine protection against infection by antigenic variants of SARS-CoV-2 (preprint)

Emerging SARS-CoV-2 variants with antigenic changes in the spike protein are neutralized less efficiently by serum antibodies elicited by legacy vaccines against the ancestral Wuhan-1 virus. Nonetheless, these vaccines, including mRNA-1273 and BNT162b2, retained their ability to protect against severe disease and death, suggesting that other aspects of immunity control infection in the lung. Although vaccine-elicited antibodies can bind Fc gamma receptors and mediate effector functions against SARS-CoV-2 variants, and this property correlates with improved clinical COVID-19 outcome, a causal relationship between Fc effector functions and vaccine-mediated protection against infection has not been established. Here, using passive and active immunization approaches in wild-type and Fc-gamma receptor (FcgR) KO mice, we determined the requirement for Fc effector functions to protect against SARS-CoV-2 infection. The antiviral activity of passively transferred immune serum was lost against multiple SARS-CoV-2 strains in mice lacking expression of activating FcgRs, especially murine FcgR III (CD16), or depleted of alveolar macrophages. After immunization with the preclinical mRNA-1273 vaccine, protection against Omicron BA.5 infection in the respiratory tract also was lost in mice lacking FcgR III. Our passive and active immunization studies in mice suggest that Fc-FcgR engagement and alveolar macrophages are required for vaccine-induced antibody-mediated protection against infection by antigenically changed SARS-CoV-2 variants, including Omicron strains.

Thriving in the post-pandemic classroom: Promoting engagement in health professions' students

This chapter focuses on promoting student engagement in heath profession education. Discussions will include the longstanding issues related to student engagement that were evident before the COVID-19 pandemic, how these issues associated with engagement were magnified during the pandemic, and how these issues have been transformed into new opportunities to enhance student engagement as we collectively enter the post-pandemic era. Elements of wellbeing, resiliency, and motivation, as they relate to engagement, are explored in depth. Strategies to promote student engagement in the future classroom are discussed in addition to considerations for stronger faculty engagement surrounding teaching. Throughout the chapter, the experiences of one school of pharmacy will be described, providing examples of strategies for enhancing engagement in the post-pandemic classroom. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Smell, History, and Heritage

Now seems to be a particularly interesting time to be working on or with smell. The COVID-19 virus has caused symptomatic smell loss;government-mandated lockdowns have altered our smellscapes;and the Zoomification of work, education, and sociability has produced a hankering for sensory experiences beyond the audiovisual. There is therefore a heightened attention to the role of the olfactory in everyday life. The last few years have also seen a boom in exciting new studies of smell's histories and blockbuster olfactory events in museums.

A qualitative study of patient experiences with telemedicine opioid use disorder treatment during COVID-19.

Background: The drug-related overdose crisis worsened during the COVID-19 pandemic. Recent drug policy changes to increase access to medications for opioid use disorder (MOUD) during COVID-19 shifted some outpatient MOUD treatment into virtual settings to reduce the demand for in-person care. The objective of this study was to qualitatively explore what is gained and lost in virtual patient encounters for patients with opioid use disorder at a low-threshold, addiction treatment clinic that offers buprenorphine and harm reduction services. Methods: Patients were included in this study if they received care at the Harm Reduction and BRidges to Care (HRBR) clinic and utilized virtual visits between November 2019 and March 2021. The study was conceptualized using a health care access framework and prior studies of telemedicine acceptability. Semi-structured interviews were completed between March and April 2021. Interviews were dual-coded and analyzed using directed content analysis. Results: Nineteen interviews were conducted. The sample was predominantly White (84%) and stably housed (79%) with comparable gender (male, 53%) and employment status (employed, 42%). The majority (63%) of patients preferred virtual visits compared to in-person visits (16%) or a combination of access to both (21%). Two overarching tandem domains emerged: availability-accommodation and acceptability-appropriateness. Availability-accommodation reflected participants' desires for immediate services and reduced transportation and work or caregiving scheduling barriers, which was facilitated by virtual visits. The acceptable-appropriate domain articulated how participants felt connected to their providers, whether through in-person interactions or the mutual trust experienced during virtual visits. Conclusions: Virtual visits were perceived by participants as a valuable and critical option for accessing treatment for OUD. While many participants preferred virtual visits, some favored face-to-face visits due to relational and physical interactions with providers. Participants desired flexibility and the ability to have a choice of treatment modality depending on their needs.

COVID-19 Vaccination Gap in Admitted Trauma Patients: A Critical Opportunity.

BACKGROUND: Coronavirus disease 2019 (COVID-19) vaccination is the core strategy for pandemic management. We hypothesized that a vaccination gap might exist between emergency department (ED) patients admitted for trauma and other ED patients. STUDY DESIGN: This was an observational quality improvement study using electronic health record data at an academic level-1 trauma center. Participants were all patients presenting to the adult ED with a Tennessee home address between January 1 and June 1, 2021. We measured the proportional difference in vaccination between admitted trauma patients and other ED patients over time (by week) and association via Spearman's rank correlation coefficient. Binary logistic regression facilitated covariate analysis to account for age, sex, race, home county, and ethnicity without and then with interaction between trauma admission and time. Geographic visual analysis compared county-level vaccination rates with odds of trauma admission by home county using a bivariate chloropleth map. RESULTS: The proportional difference in vaccination between trauma-admitted and other ED patients increased over time (Spearman's = 0.699). Adjusting for age, sex, race, home county, and ethnicity, there was a statistically significant vaccination difference between trauma-admitted and other ED patients (odds ratio = 0.53, 95% CI 0.43-0.65, p < 0.0001). Geographic analysis revealed increased trauma admission odds and lower vaccination rates in surrounding counties compared with Davidson County. CONCLUSIONS: We observed a widening COVID-19 vaccination gap between trauma-admitted and other ED patients. Vaccine outreach during trauma admission may provide a valuable point of contact for unvaccinated patients.

Pulmonary endothelial NEDD9 and the prothrombotic pathophenotype of acute respiratory distress syndrome due to SARS-CoV-2 infection.

The pathobiology of in situ pulmonary thrombosis in acute respiratory distress syndrome (ARDS) due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is incompletely characterized. In human pulmonary artery endothelial cells (HPAECs), hypoxia increases neural precursor cell expressed, developmentally downregulated 9 (NEDD9) and induces expression of a prothrombotic NEDD9 peptide (N9P) on the extracellular plasma membrane surface. We hypothesized that the SARS-CoV-2-ARDS pathophenotype involves increased pulmonary endothelial N9P. Paraffin-embedded autopsy lung specimens were acquired from patients with SARS-CoV-2-​​​​​​ARDS (n = 13), ARDS from other causes (n = 10), and organ donor controls (n = 5). Immunofluorescence characterized the expression of N9P, fibrin, and transcription factor 12 (TCF12), a putative binding target of SARS-CoV-2 and known transcriptional regulator of NEDD9. We performed RNA-sequencing on normal HPAECs treated with normoxia or hypoxia (0.2% O2) for 24 h. Immunoprecipitation-liquid chromatography-mass spectrometry (IP-LC-MS) profiled protein-protein interactions involving N9P relevant to thrombus stabilization. Hypoxia increased TCF12 messenger RNA significantly compared to normoxia in HPAECs in vitro (+1.19-fold, p = 0.001; false discovery rate = 0.005), and pulmonary endothelial TCF12 expression was increased threefold in SARS-CoV-2-ARDS versus donor control lungs (p < 0.001). Compared to donor controls, pulmonary endothelial N9P-fibrin colocalization was increased in situ in non-SARS-CoV-2-ARDS and SARS-CoV-2-ARDS decedents (3.7 ± 1.2 vs. 10.3 ± 3.2 and 21.8 ± 4.0 arb. units, p < 0.001). However, total pulmonary endothelial N9P was increased significantly only in SARS-CoV-2-ARDS versus donor controls (15 ± 4.2 vs. 6.3 ± 0.9 arb. units, p < 0.001). In HPAEC plasma membrane isolates, IP-LC-MS identified a novel protein-protein interaction between NEDD9 and the ß3-subunit of the αvß3-integrin, which regulates fibrin anchoring to endothelial cells. In conclusion, lethal SARS-CoV-2-ARDS is associated with increased pulmonary endothelial N9P expression and N9P-fibrin colocalization in situ. Further investigation is needed to determine the pathogenetic and potential therapeutic relevance of N9P to the thrombotic pathophenotype of SARS-CoV-2-ARDS.

Disparities in COVID-19-related stressful life events in the United States: Understanding who is most impacted.

Impacts of the COVID-19 pandemic in the United States have been exacerbated by pre-existing inequities in resources and opportunities, leaving the most vulnerable to face a multitude of hardships. The goal of the current study was to characterise COVID-19-related stressful life events in specific life domains and to identify the sociodemographic characteristics of individuals who are more likely to experience such events. Participants (n = 372, 57% female) in a follow-up study of the NICHD Study of Early Child Care and Youth Development completed the Epidemic-Pandemic Impacts Inventory (June-August 2020) to assess COVID-19-related stressors. Sociodemographic factors (gender, race/ethnicity, socioeconomic status and wealth) were examined simultaneously as predictors of the number of stressful life events in separate categories of work/finances, home life, social activity, health and healthcare, adjusted for covariates (household size, community COVID-19 transmission risk). In negative binomial regression analyses, being female (vs. male) predicted a 31%, 64%, 13% and 94% increase in the number of stressful life events in domains of work/finances, home life, social activity and healthcare, respectively, whereas each one standard deviation increase in wealth predicted a 17%, 16% and 21% reduction in the number of stressful life events in domains of work/finances, COVID-19 infection and healthcare, respectively. Findings highlight the pronounced and far-reaching impacts of the COVID-19 pandemic on women as well as the unique role wealth may play in lessening such impacts. This new knowledge may be leveraged to develop intervention and policy-related strategies to remediate impacts of COVID-19-related stressors on those most vulnerable.

Attenuated efficacy of pediatric obesity treatment during the COVID-19 pandemic.

OBJECTIVE: This study examined whether the efficacy of a standard-of-care pediatric obesity treatment was affected by the COVID-19 pandemic. METHODS: Analyses leveraged data from an ongoing pediatric obesity treatment trial involving 230 lower-income, urban children aged 6 to 12 years. Mixed-effects regression models compared children who participated in a 12-month weight-management intervention before versus during the COVID-19 pandemic on change from baseline in BMI z score (ΔzBMI) at 3, 6, 9, and 12 months. RESULTS: The observed pattern of ΔzBMI was significantly different before versus during the pandemic (χ2 = 22.73, p < 0.0001). Children treated before the pandemic maintained an average weight loss of -0.06 ΔzBMI at 12 months, whereas children treated during the pandemic steadily gained weight over time, averaging a net gain of 0.11 ΔzBMI at 12 months (χ2 = 34.99, p < 0.0001). Treatment session completion did not differ before versus during the pandemic (60.4% vs. 55.7%, respectively; p = 0.30) or account for differences in ΔzBMI. CONCLUSIONS: Similar reductions in intervention efficacy may be anticipated in other pediatric obesity treatment trials conducted during the COVID-19 pandemic. Many families that have struggled with managing their child's weight during this period may need encouragement to continue engaging in structured weight management as society renormalizes.