SARS-CoV-2 SEROPREVALENCE AND RISKS FACTORS IN AFRICAN WLHIV ON ART AND THEIR INFANTS

Background: SARS-CoV-2 seroprevalence data in women living with HIV (WLHIV), their infants and associated risk factors in this subpopulation remain limited. We retrospectively measured SARS-CoV-2 seroprevalence from 09/2019- 12/2021 among WLHIV and their children in the PROMOTE observational cohort in Uganda, Malawi, and Zimbabwe prior to widespread SARS-CoV-2 vaccination in those countries. Method(s): Sociodemographic, clinical data and blood were collected q6 months. Plasma stored during 3 waves of the COVID-19 pandemic in East/ Southern Africa were tested for SARS-CoV-2 specific IgG antibodies (Ab) using serological assays that detect adaptive immune responses to SARS-CoV-2 spike protein. Modified-Poisson regression models were used to calculate prevalence rate ratios (PRR) and 95% confidence intervals (CI) to identify sociodemographic and clinical risk factors. Result(s): Plasma samples from 979 PROMOTE mothers and 1332 children were analysed. We found no significant differences in baseline characteristics between participants testing positive (+) and negative (-) for SARS-CoV-2 Ab. Overall maternal SARS-CoV-2 seroprevalence was 57.6% (95%CI: 54.5-60.7) and 39.3% (95%CI: 36.7-41.9) for infants. The earliest + result was detected from a sample collected on 09/2019, in Malawi. Factors significantly associated with SARS-CoV-2 seropositivity were country of origin (reference Uganda, aPRR 1.45, 95%CI: 1.24-1.69) and non-breastfeeding mother (aPRR=1.22, 95%CI: 1.02-1.48). Children above 5 years had a 10% increased risk of SARS-CoV-2 seropositivity (aPRR=1.10, 95%CI: 0.90-1.34) when compared to younger children. We found no statistically significant association with sanitation, household density, distance to clinic, maternal employment, ART regimen or viral load. Mother/infant SARS-CoV-2 serostatuses were discordant in 373/865 (43.1%) families tested: mothers+/children- in 51.2%;mothers-/children+ in 12%;child+/sibling+ concordance was 21.4%. Conclusion(s): These SARS-CoV-2 seroprevalence data indicate that by late 2021, about half of mothers and about a third of children in a cohort of HIV-affected families in eastern/southern Africa had been infected with SARS-CoV-2. Breastfeeding was protective for mothers, likely because of the need to stay home for young children. Discordant results between children within same families underscores the need to further understand transmission dynamics within households.

HostSeq: a Canadian whole genome sequencing and clinical data resource.

HostSeq was launched in April 2020 as a national initiative to integrate whole genome sequencing data from 10,000 Canadians infected with SARS-CoV-2 with clinical information related to their disease experience. The mandate of HostSeq is to support the Canadian and international research communities in their efforts to understand the risk factors for disease and associated health outcomes and support the development of interventions such as vaccines and therapeutics. HostSeq is a collaboration among 13 independent epidemiological studies of SARS-CoV-2 across five provinces in Canada. Aggregated data collected by HostSeq are made available to the public through two data portals: a phenotype portal showing summaries of major variables and their distributions, and a variant search portal enabling queries in a genomic region. Individual-level data is available to the global research community for health research through a Data Access Agreement and Data Access Compliance Office approval. Here we provide an overview of the collective project design along with summary level information for HostSeq. We highlight several statistical considerations for researchers using the HostSeq platform regarding data aggregation, sampling mechanism, covariate adjustment, and X chromosome analysis. In addition to serving as a rich data source, the diversity of study designs, sample sizes, and research objectives among the participating studies provides unique opportunities for the research community.

Group Testing Matrix Design for PCR Screening with Real-Valued Measurements.

Single-step nonadaptive group testing approaches for reducing the number of tests required to detect a small subset of positive samples from a larger set require solving two algorithmic problems. First, how to design the samples-to-tests measurement matrix, and second, how to decode the results of the tests to uncover positive samples. In this study, we focus on the first challenge. We introduce real-valued group testing, which matches the characteristics of existing PCR testing pipelines more closely than combinatorial group testing or compressed sensing settings. We show a set of conditions that allow measurement matrices to guarantee unambiguous decoding of positives in this new setting. For small matrix sizes, we also propose an algorithm for constructing matrices that meet the proposed condition. On simulated data sets, we show that the matrices resulting from the algorithm can successfully recover positive samples at higher positivity rates than matrices designed for combinatorial group testing setting. We use wet laboratory experiments involving SARS-CoV-2 nasopharyngeal swab samples to further validate the approach.

Manchester's early critical care nurses -a history -educating our today and tomorrow by learning from our past

Introduction: Acquire new knowledge whilst thinking over the old, and you may become a teacher of others1 Critical care nursing in the 21st Century is at a crossroads. COVID-19 has demonstrated more than ever the central importance of well-educated critical care nurses to the delivery of high quality and safe care. The world has woken up to the fact that neither beds nor ventilators an intensive care unit make. There is much to learn from the past two years that will inform our future. But I believe there is another history -an earlier one that has not yet been told. This is equally important to our learning and identity as nurses. But is in danger of being lost. The contemporary history of intensive care medicine in Britain describes how innovations and advancements in medicine, surgical techniques, pharmacology, engineering, and science have -since the 1950s -interconnected to create today's 21st Century critical service.2 We read of the medical greats, the barriers they overcame to become the 'firsts' in application of techniques that are commonplace and readily accepted canons in treating the critically ill in our care. The history occasionally alludes to the nursing role or misses it completely. There is no doubt nursing was fundamental to the proliferation of intensive care in Britain from the 1960s. Yet, this is largely missing from the historical record or written from the medical perspective. A nurse contributor to the Wellcome Witnesses Seminar reflecting on the nursing contribution wrote: 'If you did a nursing/ICU seminar you'd get another perspective and more nurses attending'2 This is the basis for this research. The finding of nurses lost voices. Captured critical care nurses' stories will, through a process of narrative analysis, be critically evaluated and shared. Not simply as interesting anecdotes -but as a basis for enhancing professional identity and belonging -to learn from, inspire, and inform the future. 'Thinking historically does not just mean thinking about the past;it involves seeing oneself in time, as an inheritor of the legacies of the past and as a maker of the future'3 Objectives: Research aim -to explore this history form the perspective of retired nurses and one ICU at North Manchester General Hospital working between 1967 & 2000. To share with conference emerging findings. To stimulate a conversation about this hidden history and the possibilities it offers future professional learning. Methods: Oral history and narrative analysis. Oral history is described as a research methodology that collects histories of neglected ordinary people that would otherwise be lost.4 And deemed crucial to the capturing of nursing work.5 Results: Ongoing archival work -13 interviews recorded (2 male nurses/1 consultant). Thematic analysis. Emerging themes: unique professional relationships built as hierarchies flattened. Shared education. Increased autonomy. Separate. Special. Pushed boundaries. Conclusion: Incomplete, yet this work and sharing stories from the foundations of critical care nursing has the power to motivate and inspire the professional critical care nurse of 2021 - more than education -history, legacy, pride.

Real-Valued Group Testing for Quantitative Molecular Assays

Combinatorial group testing and compressed sensing both focus on recovering a sparse vector of dimensionality n from a much smaller number m< n of measurements. In the first approach, the problem is defined over the Boolean field – the goal is to recover a Boolean vector and measurements are Boolean;in the second approach, the unknown vector and the measurements are over the reals. Here, we focus on real-valued group testing setting that more closely fits modern testing protocols relying on quantitative measurements, such as qPCR, where the goal is recovery of a sparse, Boolean vector and the pooling matrix needs to be Boolean and sparse, but the unknown input signal vector and the measurement outcomes are nonnegative reals, and the matrix algebra implied in the test protocol is over the reals. With the recent renewed interest in group testing, focus has been on quantitative measurements resulting from qPCR, but the method proposed for sample pooling were based on matrices designed with Boolean measurements in mind. Here, we investigate constructing pooling matrices dedicated for the real-valued group testing. We provide conditions for pooling matrices to guarantee unambiguous decoding of positives in this setting. We also show a deterministic algorithm for constructing matrices meeting the proposed condition, for small matrix sizes that can be implemented using a laboratory robot. Using simulated data, we show that the proposed approach leads to matrices that can be applied for higher positivity rates than combinatorial group testing matrices considered for viral testing previously. We also validate the approach through wet lab experiments involving SARS-CoV-2 nasopharyngeal swab samples. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Video review to ensure qa during emergency intubations in a global pandemic: A pilot study

INTRODUCTION: The COVID-19 pandemic has provided many obstacles for healthcare providers. One challenge has been ensuring safety during high risk procedures such as Emergency Department (ED) intubations. The risks include: little preparation time, aerosolizing nature of the procedure, and unknown COVID status. Video review has shown effectiveness in quality improvement in critical care scenarios. We aimed to determine the feasibility of using video review of ED intubations in order to gather data about these events and enact change to improve provider safety. METHODS: We captured select videos of intubations that occurred in the COVID-19 pandemic in an audiovisual capable critical care bay. Each video was captured in real time and reviewed for intubation characteristics, intubator characteristics, exposure risk, and PPE compliance. RESULTS: The majority of the intubations were emergent (88.9%). Five patients (55.6%) were in cardiac arrest. The final COVID status was negative in 8 patients (88.9%). In most cases, a senior resident or attending was the intubating provider (77.8%). The mean number of intubation attempts was 1.1 (SD 0.33). The mean number of providers present at intubation was 3.9 (SD 1.97). The mean number of nurses and technicians present was 3 (SD 0.67) and 1.4 (SD 0.97), respectively. On average, the door to the room was opened 13.67 times (range: 1-40). Provider PPE compliance was 100%. All intubating providers wore a powered air purifying respirator. All others present wore an N95 mask, gloves, gown, and eye protection. CONCLUSIONS: Video review of emergency intubations was a feasible means of evaluating provider safety and quality assurance during a global pandemic. Video review is an effective manner of evaluating adherence to PPE guidelines. It can also identify areas for improvement, such as limiting the number of providers in the room and limiting exposure to others by minimizing door-opening. These data were used to improve our intubation process. We implemented the use of pre-prepared airway boxes for each critical care bay, and walkie-talkies to communicate to those outside of the room to minimize door opening. Video review remains a fruitful and open space for quality improvement innovation and furthering the safety of patients and providers.

Emergence of SARS-CoV-2 B.1.1.7 lineage - United States, December 29, 2020-January 12, 2021

This report focuses on the emergence of the B.1.1.7 variant in the United States. As of 12 January, 2021, neither the B.1.351 nor the P.1 variants have been detected in the United States. For information about emerging SARS-CoV-2 variants of concern, CDC maintains a webpage dedicated to providing information on emerging SARS-CoV-2 variants. The B.1.1.7 variant has a mutation in the S protein that affects the binding domain of the receptor. It also has 13 other lineage-defining variants that are related to the S protein. These variants, which include a deletion at position 69 and 70, have been known to cause S-gene target failure. Multiple lines of evidence show that B.1.1.7 is a more efficiently transmitted variant of SARS-CoV-2 than other variants. In the UK, infections with this variant were more common than those with other variants. The potential increase in the number of cases of B.1.1.7 in the U.S. could affect the trajectory of the pandemic. A simple two-variant compartmental model has been developed to model this phenomenon. The potential impact of vaccinations was simulated assuming that 1 million doses were administered each day starting in 2021. It was estimated that 95% immunity was achieved 14 to 30 days after receiving 2 doses, and although B.1.1.7 is still the dominant strain, its transmission was significantly reduced after becoming the dominant variant. Currently, there is no evidence that the COVID-19 variants cause better clinical outcomes than the SARS-CoV-2 strains. However, a higher transmission rate increases the number of patients requiring hospitalisation, which could result in more deaths. The experiences of the UK and the B.1.1.7 variant illustrate the importance of having a coordinated and comprehensive approach to control the spread of this highly contagious variant. This approach involves the use of both mitigation and vaccination measures. The increased transmissibility of B.1.1.7 warrants the implementation of robust public health strategies to minimize its impact and prevent further spread. Data from the Centers for Disease Control and Prevention show that increasing the use of effective mitigation measures, such as vaccinations, is critical to curbing the spread of the disease.

Ten considerations for conservation policy makers for the post-covid-19 transition

Public health and safety concerns around the SARS-CoV-2 novel coronavirus and the COVID-19 pandemic have greatly changed human behaviour. Such shifts in behaviours, including travel patterns, consumerism, and energy use, are variously impacting biodiversity during the human-dominated geological epoch known as the Anthropocene. Indeed, the dramatic reduction in human mobility and activity has been termed the “Anthropause”. COVID-19 has highlighted the current environmental and biodiversity crisis and has provided an opportunity to redefine our relationship with nature. Here we share 10 considerations for conservation policy makers to support and rethink the development of impactful and effective policies in light of the COVID-19 pandemic. There are opportunities to leverage societal changes as a result of COVID-19, focus on the need for collaboration and engagement, and address lessons learned through the development of policies (including those related to public health) during the pandemic. The pandemic has had devastating impacts on humanity that should not be understated, but it is also a warning that we need to redefine our relationship with nature and restore biodiversity. The considerations presented here will support the development of robust, evidence-based, and transformative policies for biodiversity conservation in a post-COVID-19 world. © 2021, Canadian Science Publishing. All rights reserved.

Is Your Disaster Plan Ready for Post-pandemic Normal?

As disaster plans failed miserably for world governments and industry when deployed against the COVID-19 pandemic, it appears that some industries adapted far better than others. Those that had plans that only revolved around natural disasters and utility outages needed to make swift adjustments. Amassing feed and supplies does not compute when decisions about cutting down rodent populations have to be made to follow stay-at-home guidelines or staffing absences due to COVID-19. We surveyed lab animal institutions across North America to determine effectiveness and impacts on disaster plans. Over 91% of respondents (n = 32) indicated their disaster plan would require modifications to address a pandemic situation. While our survey was focused on disaster plans, we were also interested in the human components that are not usually addressed in disaster plans. Survey topics included corrective actions, budgets, feed, supplies, vendor access, the working environment, plus staffing schedules, policies, and training. As our organization is geared towards sharing data for continuous improvement, the Vivarium Operational Excellence Network (VOEN) developed the survey specifically about this situation with the intent of sharing results of the survey for learning purposes. Briefly, we were able to identify trends which emerged from diverse organizations that implemented various disaster plan alterations and assessed human impacts that have sometimes been overlooked as an element of disaster planning. Staffing and staff-related issues were a reoccurring theme at most locations. The sharing of information allows others to improve their disaster plans and use the data to effectively navigate novel disaster situations in the future.

Ethnic disparities in outcomes among COVID-19 patients in our nation's capital

INTRODUCTION: African American and Hispanic patients have been disproportionately affected by infection with SARS-CoV-2 and subsequent coronavirus disease (COVID-19). Initial data suggests that these populations are more likely to suffer severe illness requiring hospitalization compared to Whites. We sought to further investigate the effects of race and ethnicity on critical care outcomes in hospitalized COVID-19 patients within the ethnically diverse area of the District of Columbia. METHODS: We performed a single-center, review of a prospective registry of 233 patients hospitalized with COVID-19 at an urban, academic hospital in Washington, D.C. Demographic and clinical data was gathered from chart review. We compared mean admission SOFA and APACHE scores, along with rates of ICU admission, intubation and mortality between White, Black, Hispanic, and Other ethnicities. RESULTS: Of the admitted patients 3.8% (n=9) were White, 70% (n=166) were Black, and 17% (n=41) Hispanic, with 7.7% (n=18) unknown or other race. The mean admission SOFA score for White, Black and Hispanic patients were 3.14, 2.65 and 1.88, respectively. The mean APACHE scores for Whites, Blacks, and Hispanics were 15.25, 17.85, and 14.75, respectively. 56% (n=5) of Whites, 29% (n=48) of Blacks, and 41% (n=17) of Hispanics were admitted to the ICU. Intubations occurred in 44% (n=4) of Whites, 17% (n=28) of Blacks, and 37% (n=15) of Hispanics. Mortality rates were 22% (n=2), 30% (n=49), and 29% (n=12) in Whites, Blacks, and Hispanics, respectively. CONCLUSIONS: According to estimates by the US census bureau, the population of the District of Columbia is 46% White, 46% Black, and 11.3% Hispanic. Our data demonstrates a disproportionate hospitalization rate in minorities affected by COVID-19. Despite lower ICU admission and intubation rates, Blacks had a high mortality rate. There was a disproportionately high utilization of the ICU care, intubation and mortality amongst Hispanics. Further investigation is necessary to examine causes of these significant health disparities and to prevent further health inequalities amongst minorities.

Can it wait? do delays in presentation affect outcomes in COVID-19 patients?

INTRODUCTION: Since the outbreak of the COVID-19 pandemic, advising patients on when to seek care for their symptoms has been a challenge. Patients may present to the hospital late in their disease course and only when symptom severity cannot be avoided any longer due to lack of access to healthcare or fear of hospitalization. It is unclear if these delays in care affect clinical treatments or hospital outcomes. We aimed to determine if the reported length of pre-admission symptoms in COVID-19 patients was associated with significant differences in critical care outcomes. We hypothesized that patients who delayed care would experience worse outcomes. METHODS: We utilized registry data on hospitalized COVID-positive patients from an urban, academic, medical center. All patients with a finalized dataset were included. Patients were stratified by length of symptoms (1-5 days, 6-10 days or more than 10 days) prior to admission. We compared the rate of ICU admission, SOFA and APACHE scores on admission, intubation status, and mortality. Chisquare tests and logistic regression models were used. RESULTS: A total of 247 patients were included. The mean age was 62 years and 47.87% were female. Of these patients, 78 (33.5%) were admitted to the ICU. There was no significant difference in ICU admission rate between groups (1-5 days: 26.9%;6-10 days: 35.3%;>10 days: 37.9%;p=0.30). There was no significant difference in SOFA or APACHE score categories by group (p=0.64 and p=0.90, respectively). Additionally, there were no significant differences in rate of intubation (p=0.12), or in-hospital mortality (p=0.33). After controlling for age, BMI, and gender, logistic regression analysis demonstrated no significant difference between groups for rate of ICU admission, rate of intubation, or in-hospital mortality. CONCLUSIONS: We have demonstrated that the reported length of pre-admission symptoms in COVID-positive patients was not a significant predictor of outcomes. We had hypothesized patients with longer duration of pre-admission symptoms would exhibit worse outcomes. However, we posit the expeditious development and implementation of remote monitoring programs and outpatient management by our institution could have allowed for timely intervention in patients whose clinical status was deteriorating.

Reducing the Effect of Functional Disability on Life Satisfaction Among Persons With a Lived Experience of an Infectious Viral Disease in Taiwan: A Tri-Mediation Model

The purpose of the study was to examine whether disability acceptance, hope, and resilience mediate the relationship between functional disability and life satisfaction in people with a lived experience of an infectious viral disease (i.e., polio and postpolio syndrome [PPS]). Participants consisted of 157 individuals diagnosed with polio or PPS who were recruited from two community support organizations in Taiwan. Participants completed self-report questionnaires. Data were analyzed with a simultaneous regression analysis. The tri-mediation model indicated that disability acceptance, hope, and resilience were associated with life satisfaction, accounting for a large effect size of 46% of the variance in the life satisfaction scores. The direct effect of functional disability on life satisfaction became insignificant when the mediators were controlled for in the model. Hope, disability acceptance, and resilience were found to fully explain the association between functional disability and life satisfaction. This study demonstrated that positive psychosocial factors might help to buffer the indirect and direct negative effects of functional disability on life satisfaction. Implications of these findings for future research and clinical practice when supporting individuals with a lived experience of an infectious viral disease, including COVID-19, are discussed. © Hammill Institute on Disabilities 2020.

HYPERSENSITIVITY PNEUMONITIS IN AN 11-MONTH-OLD INFANT SECONDARY TO BIRD ANTIGEN

Introduction: Hypersensitivity pneumonitis (HP) is a group of disorders caused by a non-atopic, immune-mediated reaction resulting from repeat exposures to an inhaled environmental allergen. Immune complex and cell mediated hypersensitivity reactions play a role in HP pathogenesis. Case Presentation: An 11-month-old female presented for evaluation of recurrent infections, uncontrolled rhinitis, cough and difficulty in breathing for several months. She experienced nine ear infections and two sinus infections requiring antibiotics and steroids. Otolaryngology evaluated her for persistent rhinitis and prescribed antihistamines without relief. Her environmental history was significant for cockatiel and parakeet birds at home. A bird fancier precipitin panel returned positive for parakeet and cockatiel. CXR revealed bilateral interstitial prominence without focal alveolar airspace disease. A CT chest was planned but could not be performed due to the COVID-19 pandemic. The birds were removed from her home and her symptoms significantly improved. Discussion: Diagnosing HP can be challenging and oftentimes remains unrecognized or diagnosed late due to its overlapping clinical picture with other childhood respiratory illnesses. The diagnosis is usually revealed through careful history of environmental exposures, presenting symptoms, supportive radiological evidence, and improvement with removal of the causative agent. Steroids may be used in an acute attack or severe cases. Avoidance of inciting agent remains the cornerstone of management of HP. Conclusion: Although considered a disease of the adult population, the fact that our patient was diagnosed with HP at 11 months highlights the importance of considering HP as in the differential diagnosis in all age groups. [Formula presented]