Analysis and Applications of Population Flows in a Networked SEIRS Epidemic Process (preprint)

Transportation networks play a critical part in the spread of infectious diseases between populations. In this work, we define a networked susceptible-exposed-infected-recovered epidemic process with loss of immunity over time (SEIRS) that explicitly models the flow of individuals between sub-populations, which serves as the propagating mechanism for infection. We provide sufficient conditions for local stability and instability of the healthy state of the system and show that no perturbation of population flows can change the local stability of any healthy state. We also provide sufficient conditions for the existence and uniqueness of an endemic state. We then develop tools and methods for applying our model to real-world data, including spreading parameter estimation and disease arrival time prediction, and apply them in a case study using both travel and infection data from counties in Minnesota during the first year of the COVID-19 pandemic.

Critical role of diagnostic SARS-CoV-2 T cell assays for immunodeficient patients

After almost 3 years of intense study, the immunological basis of COVID-19 is better understood. Patients who suffer severe disease have a chaotic, destructive immune response. Many patients with severe COVID-19 produce high titres of non-neutralising antibodies, which are unable to sterilise the infection. In contrast, there is increasing evidence that a rapid, balanced cellular immune response is required to eliminate the virus and mitigate disease severity. In the longer term, memory T cell responses, following infection or vaccination, play a critical role in protection against SARS-CoV-2. Given the pivotal role of cellular immunity in the response to COVID-19, diagnostic T cell assays for SARS-CoV-2 may be of particular value for immunodeficient patients. A diagnostic SARS-CoV-2 T cell assay would be of utility for immunocompromised patients who are unable to produce antibodies or have passively acquired antibodies from subcutaneous or intravenous immunoglobulin (SCIG/IVIG) replacement. In many antibody-deficient patients, cellular responses are preserved. SARS-CoV-2 T cell assays may identify breakthrough infections if reverse transcriptase quantitative PCR (RT-qPCR) or rapid antigen tests (RATs) are not undertaken during the window of viral shedding. In addition to utility in patients with immunodeficiency, memory T cell responses could also identify chronically symptomatic patients with long COVID-19 who were infected early in the pandemic. These individuals may have been infected before the availability of reliable RT-qPCR and RAT tests and their antibodies may have waned. T cell responses to SARS-CoV-2 have greater durability than antibodies and can also distinguish patients with infection from vaccinated individuals.

Questioning Potentials of the Electrorganic aFrame in Music Therapy: Two Client Case Studies with a Single Music Therapist

A multi-phase investigation was conducted to question potentials within music therapy of a new electrorganic frame drum musical instrument from Japan titled the ‘aFrame'. Two professional music therapists collaborated in this third phase of testing under the work in progress. One of the two music therapists tested the aFrame within numerous sessions with two profoundly disabled clients across generations i.e., an adolescent male and an adult woman. Observations including video recordings as baseline analysis. A goal of the study was to identify strengths and weaknesses of the new instrument in the field of (re)habilitation, especially across spectrums of those with profound dysfunction, special needs situations, and across ages. A goal of the overall work of some four decades, titled SoundScapes, is to achieve an ultimate compendium of tools for human performance to create specific interactive environments to support therapists, caregivers, and for own self-training through engaged and motivated creativity, self-expression, and play. Such environments as created by the first author have been used in his stage performances and installations (e.g., at Museums of Modern Art). The tools are thus considered transdisciplinarity forming a new holistic approach aligned to his six patents. Results from the investigation question the contextual potential of the aFrame due to a typical lack of motoric control aligned to the fragility and expense of the instrument – challenges were evident for those with diminished or lack of physical limb control. To optimize use, add-on footswitches and pedals are recommended with the aFrame instrument. These give added options including remote switching and an audio streaming interface mixer for optimal Online streaming of instrument (and voice) that would have been especially useful during the Coronavirus pandemic so that the music therapists could have continued their interactions with clients remotely (i.e., beyond video conferencing quality). Alternatives to the aFrame are posit and selected from the new generation of instruments and pedals controlling digital media as presented at the end of the text. © 2023, ICST Institute for Computer Sciences, Social Informatics and Telecommunications Engineering.

Sustainable financing for Immunization Agenda 2030.

Sustainable financing for immunization refers to the sufficient and predictable allocation and use of resources to support the achievement of immunization goals within the framework of overall health financing. The Immunization Agenda 2030 (IA2030) agenda spells out four important focus areas needed for sustainable financing: (1) ensuring sufficient and predictable resources, (2) making optimal use of resources, (3) aligning partnerships, and (4) supporting sustainable transitions from external assistance. This paper summarizes the evidence and proposes interventions under each area. While immunization is one of the best investments and justifies public financing, the COVID-19 pandemic has led to the worst economic recession since the Great Depression and threatens countries' ability to mobilize funding to ensure continuity and access to essential services, including immunization. Strategies for ensuring adequate resources differ by income group but include raising more revenues, reprioritizing the budget towards health, and ensuring that health resources favor Primary Health Care (PHC) and immunization. In low- and lower-middle income countries, support from Gavi, the Vaccine Alliance, which channels the largest amount of external financing, will remain important, but some lower-middle income countries will need to prepare for transition. Countries benefitting from the Global Polio Eradication Initiative (GPEI) are also experiencing a transition from GPEI financing to domestic and other external financing. This paper outlines ways in which countries can improve the use of domestic and external resources to better incentivize high-quality PHC and immunization services and align immunization programs with health sector reforms. While governments must lead, collective action from development partners, the private sector, and civil society is needed to promote health system financing systems that ensure that the world is better prepared for future outbreaks and pandemics, while reinforcing the IA2030 vision and making progress towards universal health coverage and the Sustainable Development Goals.

Endless Study, Infinite Debt: On study inside and outside the university classroom

This paper begins by considering the state of higher education in Australia, following structural changes facilitated by the COVID-19 pandemic. We consider the longer-term effects of neoliberal ideology on the sector, charting the way that ongoing crises of/in higher education work to co-opt university workers and students into a position in which they are required to defend the idea of the university as a site of enlightenment. We then discuss the erosion of funding in the arts and argue that in concert with the diminished resourcing of the university, ad hoc social spaces within contemporary art have become temporary communities for study. We analyse a project of our own – Endless Study, Infinite Debt – which seeks to engage in the collective study of infrastructure, settlement, and racial capitalism. We consider how the university and art might be ambivalently engaged to practise forms of care and study against privatisation/professionalisation and towards solidarity. © 2022, University of the Western Cape. All rights reserved.

The impact of COVID-19 on access and availability of radiological imaging and surgical intervention at the east Midlands major trauma centre: An icon trauma study

Introduction: During the COVID-19 pandemic, Major Trauma services were subject to significant challenges including reduced access to Computed Tomography (CT) scanning and restrictions on operative intervention due to limited intensive care beds. This study evaluated the pandemic's impact on access and timeliness of imaging and surgical intervention Method: This observational study compared 2 cohorts of patients admitted in a 10-week period during the COVID-19 pandemic and a similar time period in 2019. Variables included demographics, time to CT scan and to surgery and operative characteristics. Statistical comparisons were undertaken using Mann Whitney U, Fisher's exact and Chisquared tests Result: Of 642 patients, 405 were admitted in 2019 and 237 in 2020 representing a 41.5% absolute reduction in trauma admissions during the pandemic. There were no statistical differences (P=0.2585) between arrival to the Emergency Department and time to CT scan across both years (median 42 minutes) or between operative approach (P=0.728) and level of post-operative care (P=0.788). However, there were statistical differences in time to surgery (P=0.0193) and operative length (P=0.0141) with a 2-fold increase in overnight operating, 31.2% increase in patients operated on<24 hours from admission, and 42.9% reduction in surgery lasting >120 minutes during the COVID-19 pandemic Conclusion: Early robust restructuring of trauma services during the COVID-19 pandemic ensured timely access to appropriate imaging and surgery for major trauma injured patients. The higher rates of overnight surgery and shorter duration of procedure were likely explained by the increased onsite availability of suitably trained trauma surgical teams Take-home Message: COVID-19 had the potential to significantly impact Major Trauma services, however excellence in patient care was maintained by quick restructuring to staff, space and services Improvements to the Major Trauma pathway have become ingrained into daily practice and optimised for future outbreaks .

Infinity biologix-how did a biorepository pivot from biobanking to COVID testing and vaccine storage and distribution?

RUCDR Infinite Biologics (now IBX) has provided the global scientific community with the highest quality biomaterials, technical consultation, complex assays, and logistical support since 1998. On August 17, 2020, Rutgers University completed the sale of RUCDR to create Infinity BiologiX. As Infinity BiologiX, we have the same core mission, advancing research;collecting, storing, and providing high quality biomaterials;providing complex assays and services;and large scale diagnostic testing. As a research organization and a traditional biorepository, with several decades of experience in offering diagnostic assays, IBX was approached by local & state entities to support the global community in expanding COVID testing by offering rapid testing to enable clinicians and patients to make critical decisions. In early 2020, during the height of the pandemic, IBX developed the COVID RT-PCR diagnostic assay. It received FDA Emergency Use Authorization in March 2020 as the first approved saliva diagnostic test and the first test approved for home use. IBX leveraged decades of experience in molecular genetics to overcome issues in working with saliva, such as its viscosity and abundance of RNA-degrading enzymes. To scale the capacity, IBX received support from Operation Warp Speed and a loan through RUCDR. IBX was able to purchase multimillion-dollar laboratory automation to automate the extraction and amplification of each sample using qPCR techniques, requiring IBX to double the lab's workforce almost overnight. IBX also collaborated with two companies, Spectrum Solutions and Accurate Diagnostics Labs, to oversee the manufacturing and distribution of kits, while IBX handled testing and analysis. Since March 2020, IBX has tested 5 million samples through a number of direct to consumer partners including Vault Heath and currently has the capacity to test over one million samples a month, playing a critical role in saving many lives, and providing a practical tool for pandemic control. As the FDA approved several vaccines including Pfizer and Moderna, IBX went a step forward in the fight against the global pandemic by offering state-of-the-art vaccine storage, distribution, and robust cold chain solutions. IBX collaborated with Stirling Ultracold to provide temperature flexibility using modular, ultra-cold freezers fitted with monitoring systems and utilized mobile ULT25 freezers, dry ice, cold packs and data loggers to maintain stability during transportation.

Approaches to Transitioning Computer Science Classes from Offline to Online

As the COVID-19 pandemic spread throughout the United States in Spring 2020, universities around the country conducted the unprecedented feat of moving essentially their entire curricula online. This abrupt mid-semester shift in modality was the first of its kind at scale, but it will not be the last. Now that our experiences during the pandemic have demonstrated that an online transition is possible, we may see similar transitions proposed during smaller scale crises, especially as an alternative to school closures. We present an experience report focusing on computer science instructors at a large Midwestern university during the Spring 2020 online transition: the challenges they faced, as well as the interventions they implemented. As more data and analysis is generated from the first mass, unwilling modality shift, it is nevertheless important to focus on the visceral reactions and lessons learned from teachers and students in the moment as they responded to an unprecedented situation. We therefore also present our analysis of critical challenges and preliminary pedagogical recommendations for consideration during future rapid transition "involuntarily online"semesters. © 2021 ACM.

The icon trauma study: The impact of the COVID-19 lockdown on major trauma workload in the UK

Introduction: Anecdotal evidence suggest a direct impact of the SARSCOV- 2-pandemic on presentation and severity of major trauma. Method: This observational study from a UK Major Trauma Centre matched a cohort of patients admitted during a 10-week period of the SARS-CoV-2-pandemic (09/03/2020 to 18/05/2020) to a historical cohort admitted during a similar time period in 2019 (11/03/2019 to 20/05/ 2019). Demographic differences, injury method and severity were compared using Fisher's and Chi-squared tests. Multivariable logistic regression examined the associated factors predicting 30-day mortality. Results: Of 642 patients, 405 and 237 were in the 2019 and 2020 cohorts respectively. 1.69%(4/237) of the 2020 cohort tested SARS-CoV-2 positive. There was a 41.5% decrease in trauma admissions in 2020. The 2020 cohort was older (median 46 vs.40 years), more comorbid and frailer (p<0.0015). There was a significant difference in injury method with a decrease in vehicle related trauma, but an increase in falls. There was a 2-fold increased risk ofmortality in the 2020 cohort that in adjustedmodels, was explained by higher injury severity and frailty. Positive SARS-CoV-2 status was not associated with increasedmortality onmultivariable analysis. Conclusions: Patients admitted during the SARS-CoV-2-pandemic were older, frailer, more co-morbid and had an increased risk of mortality.

Does wearing enhanced personal protective equipment (PPE) in theatre increase surgeon workload and patient morbidity?

Introduction: Delivery of surgical services during the Covid-19 pandemic has required the use of enhanced PPE in the operating theatre. We sought to evaluate the impact of this change on surgeon workload and intraoperative patient outcomes. Method: Surgeons performing as primary operator completed an online procedure-specific questionnaire on workload ratings for each operative case, using an extension of the validated Surgeon Task Load Index (SURG-TLX) tool (reported on a 20-point scale), together with operative details. Local approval was obtained at individual sites. Data was analysed in Stata SE v16. Results: 118 responses (17 surgeons, 7 specialties) were collected from June to September 2020. 77.1% used enhanced PPE. There was no association between enhanced PPE use and overall workload (p=0.151) as measured with SURG-TLX, although surgeons wearing enhanced PPE commonly reported finding individual procedures harder than expected (37% vs 0%, p<0.001). Communication was rated worse when using enhanced PPE use (MD-4.38, 95%CI-6.74 to 02.03;p<0.001). There was no association between enhanced PPE use and intraoperative complications (p=0.745). Conclusions: The use of enhanced PPE is not associated with complications or increased surgeon workload assessed by SURG-TLX. It is, however, associated with difficulty in communicating, and subjectively experiencing more procedural challenge than anticipated.

Elucidating sars-cov-2 t-cell responses in pediatric covid-19 and mis-c

Background: Multisystem Inflammatory Syndrome in Children (MIS-C) can develop 1-2 mo post SARS-CoV-2 infection. MIS-C is characterized by fever, multiorgan dysfunction requiring hospitalization, and systemic inflammation. To evaluate a potential role for aberrant T-cell responses as a potential mechanism for MIS-C pathogenesis, we quantified SARS-CoV-2 -reactive T cells in children with COVID-19, MIS-C, and healthy children (HC). Methods: Hospitalized children ages 0-20 yrs with COVID-19 (n=13) or MIS-C (n=18) were enrolled from May-Sep 2020. Peripheral blood mononucle ar cells (PBMC) were obtained from convalescent phase of infection (28-54 d from illness onset) for COVID-19 or at hospitalization for MIS-C to approximate similar time since infection. Plasma SARS-CoV-2 receptor binding domain (RBD) antibody titers were determined by ELISA. PBMC from HC (n=20) with undetectable RBD antibodies served as controls. T-cell responses were quantified using activation-induced marker (AIM) assay after stimulation with SARS-CoV-2 peptide “megapools” (MP): CD4 MP-S with 253 spike-spanning peptides, CD4 MP-R with 221 remaining non-spike;spike-containing CD8 MP-A and non-spike CD8 MP-B with 314 each. Frequency of AIM+ T-cells and stimulation index (SI) were compared across donor groups. Results: Among COVID-19, majority had SARS-CoV-2 specific CD4+ (100% spike, 83% non-spike) and CD8+ (85% spike-containing, 83% non-spike) T-cells. There was a trend for lower frequencies of AIM+ T-cells to all peptide MP in MIS-C, with significantly lower responses to non-spike antigens in CD4+ (p<0.05) and CD8+ (p<0.05) T-cells compared to those in COVID-19. In addition, COVID-19 had higher reactivity to stimulation, with significantly greater SI for spike CD4+ T-cell responses compared with HC (4.62 vs 1.93, p<0.05) and non-spike compared to both MIS-C (3.27 vs 1.44, p<0.05) and HC (3.27 vs 1.60, p<0.01). Interestingly, most HC also had detectable CD4+ (70% spike, 50% non-spike) and CD8+ T-cells (90% spike, 75% non-spike) against SARS-CoV-2 antigens, possibly attributable to prior infection by endemic coronaviruses. RBD IgG levels were similar between MIS-C and convalescent COVID-19. Conclusion: We find more robust CD4+ and CD8+ T-cell responses against non-spike SARS-CoV-2 peptides in convalescent COVID-19 compared to MIS-C. Equivalent humoral responses against spike RBD among MIS-C and COVID-19 suggest that impaired SARS-CoV-2-specific T-cell response to non-spike antigens may contribute to the immunopathogenesis of MIS-C.