COVID-associated pernio: Mechanistic insights to an abortive, seronegative SARS-CoV-2 infection

Introduction: SARS-CoV-2 replicates primarily in the airways but generates a systemic immune response mediated by Type I interferons (IFN-I). Pernio is a rare skin manifestation of disorders characterized by excessive IFN-I signalling. Although pernio increased in incidence during the pandemic, the relationship to SARS-CoV-2 remains controversial. Because of the pivotal nature of interferons in COVID-19 outcomes, pernio offers a window to investigate the biology underlying host resiliency to SARS-CoV-2 infection. Method(s): To further assess COVID-associated pernio, we characterized clinical samples from affected patients across 4 waves of the pandemic and investigated mechanistic feasibility in a rodent model. Patients were followed longitudinally with banking of blood and tissue. Golden hamsters were mock-treated or intra-nasally infected with SARS-CoV-2 and harvested at 3-and 30-days post-infection. Result(s): In affected tissue, immunophenotyping utilizing multiplex immunohistochemistry profiled a robust IFN-1 signature characterized by plasmacytoid dendritic cell activation. Viral RNA was detectable in a subset of cases using in situ hybridization for the SARS-CoV-2 S gene transcript. Profiling of the systemic immune response did not reveal a durable type 1 interferon signature. Consistent with previous literature, antibody and T-cell specific responses to SARS-CoV-2 were not detected. Nasopharyngeal SARS-CoV-2 inoculation in hamsters resulted in rapid dissemination of viral RNA and the generation of an IFN-I response that were both detectable in the paws of infected animals. Conclusion(s): Our data support a durable local IFN signature, with direct evidence of viral SARS-CoV-2 RNA in acral skin and suggest that COVID-associated pernio results from an abortive, seronegative SARS-CoV-2 infection.

The forensic pathologist's public health role

While historically some have viewed the work of medical examiners/coroners (ME/C) and death investigators as predominantly serving the criminal justice system, in fact, the act of certifying a death is—in and of itself—a public health endeavor. The purpose of the death certificate is to track how and why individuals die as a means of helping others survive. Death certificates do save lives. In addition to generating these vital statistics, which guide public health policy, ME/C also perform a public health service in a variety of other ways. For instance, autopsy pathologists report unsafe consumer products, warn of recreational hazards (e.g., the dangers of snowmobile or all-terrain vehicle use), publicize and report occupational hazards (e.g., falls and electrocution risks), identify toxic exposures (e.g., carbon monoxide from defective heating units), and evaluate the safety of medical therapies. At autopsy, ME/C perform infectious disease surveillance, diagnosing and reporting communicable diseases such as bacterial meningitis, tuberculosis, and Legionella, thereby helping to mitigate disease spread in the community. They identify and characterize emerging infectious threats, such as COVID-19. They track violent deaths, including homicides, suicides, accidents, child and domestic abuse deaths, maternal mortality, and overdose deaths—to name a few—and participate as members of death review teams that attempt to identify systemic issues and prevent further such deaths. © 2023 Elsevier Inc. All rights reserved.

Pandemic Autopsy Biosafety Considerations

At autopsy, prosectors have always risked exposure to a wide array of infectious agents. With the recent advent of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic, such exposure concerns have increased dramatically. Careful assessment of facility infrastructure and appropriate biosafety training, however, can minimize risks and allow for safe autopsy performance. As with other disease outbreaks, the living have much to learn from the dead. To date, autopsy studies have been critical in elucidating the mechanisms by which COVID-19 (coronavirus disease 2019) may critically compromise not only pulmonary but also cerebral, cardiac, and renal function. Much remains unknown, though, and further tissue-based research is called for. The following review is intended to detail best practices and principles for autopsy biosafety, with a focus on issues specific to the current pandemic. Copyright © Wolters Kluwer Health, Inc. All rights reserved.

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.

To educate citizens and citizen-leaders for our society: Renewing character education in universities

Seventy-five years ago, the Universal Declaration of Human Rights promoted a vision of education "directed to the full development of the human personality and to the strength-ening of respect for human rights and fundamental freedoms" (United Nations, 1948, 26.2). In 2015, the UN Sustainable Development Goals (SDGs) took this further, stating in SDG 4 that "the knowledge, skills, values and attitudes required by citizens to lead pro-ductive lives, make informed decisions and assume active roles locally and globally in facing and resolving global challenges can be acquired through education for sustainable development and global citizenship educa-tion” (United Nations Educational, Scientific and Cultural Organization [UNESCO], 2016, p. 14). What might the adoption of this educational mission involve for higher education? And what does it mean in a chal-lenging global context following the COVID pandemic and the Russian invasion of Ukraine? This paper argues that the current global tu-mult should catalyse reflection as to the purpose and content of higher education. It focuses on the importance of education for "values and attitudes”, emphasized as an essential component of global citizenship and leadership education in the rubric of SDG 4. It pro-poses a return to the philosophical categories of "character” and "virtue”, arguing that the societal orientation of global universities and their aspiration "to educate the citizens and citizen-leaders for our society” (Harvard College, 2022) necessitates a renewal of theoretically rigorous, pedagogically effective, and practically relevant character education. © 2023, Universidad Internacional de la Rioja. All rights reserved.

European Union health policy after the pandemic: an opportunity to tackle health inequalities?

COVID-19 has exposed and exacerbated the health inequalities across and between European Union member states. It has also raised the profile of EU health policy and the highlighted the value of European cooperation in health. Early failures to respond adequately, coupled with this increased salience, have given rise to a series of initiatives designed to strengthen and expand the EU's role in health. This presents an opportunity to address the imbalances in the EU's institutional and legal structure which prevent it from addressing health inequalities more effectively. Drawing on changes underway in the public health, internal market and fiscal governance elements of EU health policy, this paper explores the potential for the post-pandemic EU health policy framework to better support the reduction of health inequalities. © 2022. All Rights Reserved.

Reflections on involving Experts by Experience in interviews for the Doctorate in Clinical Psychology

A discussion of the value of having Experts by Experience involved in interviews and assessments of trainees for the DClinPsy course at the University of Bath, especially in the context of digital interviewing due to the Covid-19 pandemic. © 2022, British Psychological Society. All rights reserved.

The Distressed State of Primary Care in Virginia Pre-Medicaid Expansion and Pre-Pandemic.

BACKGROUND: Primary care is crucial to the health of individuals and communities, but it faces numerous structural and systemic challenges. Our study assessed the state of primary care in Virginia to prepare for Medicaid expansion. It also provides insight into the frontline of health care prior to an unprecedented global COVID-19 pandemic. METHODS: We surveyed 1622 primary care practices to understand organizational characteristics, scope of care, capacity, and organizational stress. RESULTS: Practices (484) varied in type, ownership, location, and care for medically underserved and diverse patient populations. Most practices accepted uninsured and Medicaid patients. Practices reported a broad scope of care, including offering behavioral health and medication-assisted therapy for opioid addiction. Over half addressed social needs like transportation and unstable housing. One in three practices experienced a significant stress in 2019, prepandemic, and only 18.8% of practices anticipated a stress in 2020. CONCLUSIONS: Primary care serves as the foundation of our health care system and is an essential service, but it is severely stressed, under-resourced, and overburdened in the best of times. Primary care needs strategic workforce planning, adequate access to resources, and financial investment to sustain its value and innovation.

SARS-CoV-2-associated ‘covid toes:’ multiplex immunofluorescent characterization of pathophysiology

Coincident with the start of the COVID-19 pandemic, dermatologists worldwide have reported an uncharacteristic increase in pernio or chilblains (aka ‘COVID toes’). However, the lack of systemic illness, low PCR positivity and lack of consistent seroconversion have led some authors to postulate an epiphenomenon. SARS-CoV-2 spike protein has been identified in a limited number of skin biopsies in few publications, yet there remain conflicting reports regarding other SARS-CoV-2 associated proteins, the presence or absence of viral RNA, and a unifying pathophysiology. In cooperation with the COVID Human Genome Effort, our “COVID toes” biobank was established to identify both the genetic and immunologic basis and provide clinically relevant insights into targeted therapeutics. As of March 2021, we have enrolled 96 patients, creating a prospective biorepository with clinical data, saliva, serial blood collection, and skin biopsies. Here we aim to comprehensively investigate the conflicting findings, detail the inflammatory response, and identify the source of interferon signaling with multiplex immunofluorescence (IFA) and the RNAscope fluorescent assay to detect viral mRNA. Median patient age was 17 (range 2 – 72) and 44/96 (46%) were male. Preliminary IFA results demonstrate detection of SARS-CoV-2 components, robust MxA detection and plasmacytoid dendritic cell (pDC) colocalization, identifying PDCs as the likely primary source of IFN-I production and implicates an excessive localized IFN-I response in affected patients.

SARS-CoV-2-Associated Myocarditis at Autopsy

The COVID-19 pandemic has been a major cause of mortality worldwide. While respiratory pathology seems to be the major mechanism of disease, cardiovascular pathology has increasingly been reported to play a role in adverse outcomes. A variety of different cardiovascular histopathologies have been reported at postmortem examination including myocarditis. Because of limited autopsy numbers and lack of standardized reporting of such cases, however, the prevalence of COVID-19 (2019 coronavirus disease)-associated myocarditis is unknown. The current autopsy case report illustrates how COVID-19 pulmonary pathology can be accompanied by right ventricular myocarditis. The discussion reviews the pathophysiology of myocarditis, as well as diagnostic strategies, adding to the growing body of literature describing myocarditis in association with COVID-19 disease.

The covid-19 pandemic: Failing forward in public health

Although most governments were heavily scrutinized and looked bad early in the COVID-19 pandemic, the EU was most noticeable for its absence. This might seem strange, for an institution whose public health role has been forged through crisis—from the thalidomide tragedy and the scandal of HIV-infected blood supplies, to “mad cow disease” and the underwhelming H1N1 influenza pandemic. A closer review of the EU’s health governance, however, reveals it to have performed exactly as expected and intended. An initial phase of disorganization and national egotism, unavoidable given that member states have historically restricted the EU’s health capacities, has been followed by a substantial new health policy agenda and a reinforcement of the EU’s market- and fiscal-based health influence. This is leading, we posit, to further integration. © The Author(s) 2021.

The development of EU health policy and the Covid-19 pandemic: trends and implications

EU health policy is a policy forged in crisis. Whilst maintaining the strict limitations on the EU’s role that are described in the treaties, crises have historically been followed by incremental but integrative policy change. Given this trend, should we be expecting a radical expansion of EU health policy in the aftermath of Covid-19? And, if so, what parameters and characteristics might this new agenda have? As we enter the period in which the EU will try to elaborate its new health policy, this paper uses a Complexity perspective to assess how the emerging agenda compares to existing and historical EU action on health, the kind of decision-making that we are likely to see in the different areas of action, and the limitations of EU health policy development as it pushes into more political and complex areas of policy. © 2020 Informa UK Limited, trading as Taylor & Francis Group.