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Background/Purpose: Adolescent and young adult (AYA) cancer survivors experience acute and long-term challenges, including disruptions to developmental milestones, altered relationships, and difficulty managing follow-up care. The COVID-19 pandemic likely exacerbated these challenges, but, to date, we know little about young survivors' day-to-day lives during this time. Here, we qualitatively assessed AYA cancer survivors' pandemic-related experiences. Method(s): Thirty-five AYA cancer survivors (85% female, Mage = 32.7 years, 71% White, September 2020-March 2021) wrote factual details about their day-to-day lives (e.g., "what is a typical day like?") as part of a larger randomized controlled trial. Participants were, on average, 5.9 years post-diagnosis;the majority were diagnosed with lymphoma (25.7%) or thyroid cancer (17.1%). Data were analyzed using constant comparative method. Result(s): Five themes emerged: (1) job changes (e.g., inability to work due to immunosuppression, fear career would become less viable);(2) limited interactions/relational depth (e.g., feeling "left out" due to immunosuppression, inability to date, risky family behaviors limit meaningful connection);(3) varying reactions to virtual communication (e.g., gratitude for online schooling, exercise, and social media, withdrawing from friendships due to "zoom burn out," not attending therapy due to lack of engagement);(4) difficulty engaging in health-promoting behaviors and attending/interacting in medical appointments (e.g., problems maintaining nutrition and exercise routines, postponing surveillance appointments, missing family member presence in medical appointments), and (5) disruptions/ delays to post-treatment milestones/plans (e.g., delaying vocational changes, wedding and family planning, and celebratory travel). Notably, no themes associated with positive adjustment emerged. Conclusions and Implications: Goals within multiple domains were obstructed and unmet needs were identified, namely, assistance navigating isolation, relationship disruptions, career/financial barriers, and access to medical care. Results are limited due to the methodology, as this was not a structured interview. Nonetheless, individual counsel with AYA cancer survivors is recommended to provide resources and address pandemic-induced barriers to health and well-being.
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New work has been a topic for a few years now and the COVID-19 pandemic has brought this trend more into focus, i.e., working remotely became more popular. However, besides various advantages, there is the risk of loneliness in employees, which can negatively affect their work performance and mental health. Research in different domains suggests that social robots could reduce loneliness. Since we were interested in whether and how such findings are transferable to the office context, we developed and tested a concept for a social office robot. More specifically, we first conducted a cultural probes study with white-collar workers to gain information about workplace loneliness and its drivers. Second, we explored design possibilities for a social office robot in a focus group. Based on the results, we created a concrete concept, Luca, which we finally evaluated and optimized with the help of interviews with participants from various industries. The present work contributes to HRI research and practice, e.g., by providing design recommendations for the implementation of a social office robot. Future research could investigate the effectiveness of a social office robot intervention in field studies. Next to implications for research and practice, potential limitations are discussed. © 2023 the author(s), published by De Gruyter, Berlin/Boston 2023.
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Background The aim of this study was to investigate the effect of various immunosuppressants on the humoral immune responses after vaccination against SARS-CoV-2 in patients with immune-mediated inflammatory diseases (IMIDs). Methods The Target to B! SARS-CoV-2 study is a multicentre study, taking place in 7 Dutch academic hospitals. Patients with the following IMIDs were recruited: Crohn’s disease (CD), ulcerative colitis (UC), auto-immune hepatitis, rheumatic (e.g. rheumatoid arthritis), neurological (e.g. multiple sclerosis) and dermatological IMIDs (e.g. atopic dermatitis). Patients were recruited based on immunosuppressants (table 1) and previous SARS-CoV-2 infection. The control group consisted of healthy subjects and IMID patients without immunosuppressants. SARS-CoV-2 receptor binding domain (RBD) antibodies were measured 28 days after completed SARS-CoV-2 vaccination. Seroconversion was defined as anti-RBD IgG >4 AU/mL. In this , we focus on therapies relevant for inflammatory bowel diseases (IBD) and present results for these treatments from patients with IBD, but also other IMIDs. Results Numbers of recruited patients with each immunosuppressant are shown in table 1. Amongst these patients, 312 patients had CD and 176 UC, the rest was diagnosed with another IMID. Seroconversion was reduced in patients receiving sphingosine 1-phosphate (S1P) modulators (all multiple sclerosis patients) while seroconversion was similar to controls in the other treatment groups. However, use of Anti-tumour necrosis factor (TNF), methotrexate, janus kinase (JAK) inhibitor monotherapy and all combination therapies (except for corticosteroids combined with other immunosuppressants) were associated with reduced Sars-CoV-2 antibody titres. Patients with a previous SARS-CoV-2 infection had higher median antibody titres after second vaccination than those without a previous SARS-CoV-2 infection. The type of IMID did not affect seroconversion rates. Conclusion No immunosuppressant, registered for IBD, reduced the rates of seroconversion after vaccination against SARS-CoV-2. Some immunosuppressants were associated with lower antibody titres. However, the clinical relevance of lower antibody titres remains unknown. S1P modulators, had a clear negative impact on the humoral response against SARS-CoV-2 after vaccination. This might be relevant in the future as this therapy is currently being approved for UC. Disease aetiology did not impair immunity against SARS-CoV-2 immunity after vaccination. Disclaimer: Absolute numbers of antibody titres and rates of seroconversion will be reported at the conference and are not reported in this as this might negatively impact the current submission process.
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Background. Tissue donors are evaluated for communicable disease in order to minimize the risk of transmission to recipients. Although there are data suggesting SARS-CoV-2 viremia across a wide spectrum of illness, prevalence in deceased tissue donors and the potential for transplant transmission are unknown. Methods. Eight tissue banks participated in a retrospective analysis of samples from eligible deceased tissue donors from Oct 2019 through June 2020, one participant in Canada and the remainder located in the United States. All four Census regions of the continental US and all major racial-ethnic groups were represented. EDTA or sodium citrate plasma aliquots were tested in singlicate with the Research Use Only Procleix SARS-CoV-2 Assay on the Procleix Panther System, which uses transcription-mediated nucleic acid amplification (TMA) technology for detection of the SARSCoV-2 RNA. Plasma (or if unavailable, serum) aliquots were sent to Grifols for an alternate SARS-CoV-2 nucleic acid amplification (NAT) test to verify reactivity and also sent for antibody testing using the emergency use authorization Ortho VITROS Immunodiagnostic Products Anti-SARS-CoV-2 Total test. The VITROS assay uses immunometric technology for qualitative measurement of total antibody (IgG, IgA and IgM) to SARS-CoV-2. The proportion of donors with confirmed RNAemia (i.e., presence of SARS-CoV-2 RNA in plasma or serum) and 95% confidence intervals were computed. Results. Of 3,455 donor samples with valid final results, 26 (0.76%) were initially positive for SARS-CoV-2 RNA;of these, 3 were confirmed by alternate NAT. Of donor samples collected in 2019 0.00% (95% CI: 0.00%,0.43%) were confirmed RNAemic, while of those collected in 2020, 0.12% (0.04%,0.34%) were confirmed RNAemic. One of 26 initial positive, and none of the three samples confirmed by alternate NAT, tested positive for anti-SARS-CoV-2 Spike antibodies by serology. Infectivity studies are pending on one sample with sufficient available volume. Conclusion. The rate of SARS-CoV-2 RNAemia in deceased tissue donors is approximately 1 per 1,000, and it is unknown whether this RNAemia reflects the presence of infectious virus. Given these results, the risk of transmission through tissue is most likely to be low.
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Introduction: During the Covid-19 pandemic the Dutch government implemented its so-called 'intelligent lockdown' in which people were urged to stay at home. This life changing event may have caused changes in lifestyle-behavior. Methods: Life-style related changes were studied among a random representative sample of adults in the Netherlands using an online survey (22-27 May 2020). Differences in COVID-19-related lifestyle changes between Complementary and Alternative Medicine (CAM) users and non-CAM users were determined. The survey included a modified version of the I-CAM-Q and 26 questions on lifestyle-related-measures and changes since the COVID-19-outbreak. Results: 1004 respondents were included in the study, aged between 18 and 88 years (50.7% females). Changes to a healthier lifestyle were observed in 19.3% of the population, mainly due to a change in diet habits, physical activity and relaxation, of whom 56.2% reported to be motivated to maintain this in a post-COVID-19 era. Fewer respondents (12.3%) changed into an unhealthier lifestyle. Multivariable logistic regression analyses revealed that changing into a healthier lifestyle was positively significantly associated with the variables 'Worried/Anxious getting COVID-19′ (OR:1.56, 95% C.I. 1.26-1.93), 'CAM use' (OR:2.04, 95% C.I. 1.38-3.02) and 'stress in relation to financial situation' (OR:1.89, 95% C.I. 1.30-2.74). 'Age' (OR18-25:1.00, OR25-40:0.55, 95% C.I. 0.31-0.96, OR40-55:0.50 95% C.I. 0.28-0.87 OR55+:0.1095% C.I. 0.10-0.33), 'stress in relation to health' (OR:2.52, 95% C.I. 1.64-3.86) and 'stress in relation to the balance work and home' (OR:1.69, 95% C.I. 1.11-2.57) were found predicting the change into a more unhealthy direction. Conclusion: These findings suggest that the coronavirus crisis results in a healthier-lifestyle in one part and, to a lesser extent, in an unhealthier-lifestyle in another part of the Dutch population. Further studies are warranted to see whether this behavioral change is maintained over time, and how different lifestyle factors can affect the susceptibility for and the course of COVID-19. Keywords: COVID-19, Life-style, CAM, Integrative Medicine
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Introduction: This study was initiated to determine consultations with health care providers and use of self-management strategies such as herbal remedies, dietary supplements and self-help techniques for prevention and treatment of COVID-19 related symptoms in countries with a full lockdown (Norway), a partial lockdown (the Netherlands) and no lockdown (Sweden) during the first three months of the COVID-19 pandemic. Methods: Data were collected in April-June 2020 during the first wave of the COVID-19 pandemic. An adapted version of the I-CAM-Q was used in which the categories 'for prevention of COVID-19′ and 'to treat COVID-19-related symptoms were added as reasons for use. Data were collected among a representative sample using data assisted telephone interviews (Norway, n=990 and Sweden, n=500), and an online survey (the Netherlands, n=1004). Total response rate was 30%. Results: Only a very small number of people in any of the three countries consulted a health care provider with the intention to treat or prevent COVID-19 (1.2% and 1.0% respectively) with medical doctors mostly visited (1.0% and 0.9%). Similarly, the use of self-management strategies to prevent or treat COVID-19 was low (3.4% and 0.2% respectively);most commonly used were vitamins and minerals (2.8%) for prevention of COVID-19, primarily vitamin C (1.7%), vitamin D (0.9%), and multivitamins (0.5%). Consultations with health care providers and use of self-management strategies for prevention of COVID-19 were positively associated with worries of being infected with COVID-19. No such associations were found for worries about loved ones or the perception that COVID-19 is more dangerous than ordinary influenza. Conclusion: The COVID-19 pandemic does not seem to have evoked a large-scale difference in behaviour related to consultations with health care providers or the use of self-management strategies such as dietary supplements and self-help techniques in any of the three countries, despite different containment and mitigation measures. Keywords: COVID-19;Consultations with health care providers;Self-management
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Background/Case Studies: Blood donor based serosurveillance is a convenient and cost-effective strategy to monitor the extent of the COVID-19 pandemic and allows the detection of asymptomatic and recovered cases. The RESPONSE (REDS-IV-P Epidemiology, Surveillance and Preparedness of the Novel SARS-CoV-2 Epidemic) study conducted monthly cross-sectional serosurveys of 1000 routinely obtained donor samples in 6 metropolitan regions (see table). Study Design/Methods: Samples were captured monthly from March or April through June 2020. Siteswere selected based on reports of epidemic activity or as low prevalence control regions. Donations from COVID- 19 convalescent plasma donors were excluded. Coded samples, with routinely collected demographic data and zip code of residence, were tested for SARS-CoV-2 antibodies using the Ortho VITROS anti-SARS-CoV-2 S1 Total Ig (data reported below) with planned confirmation of reactivity on Roche Elecsys® NC Anti-SARS-CoV-2 and a pseudovirus-based neutralization assay. Results/Findings: Table 1 shows donor seroreactivity with 95% CI. For all sites, seroreactivity was <1.0% (range 0.1%-0.9%) at the beginning of the surveillance period. Donor seroreactivity in New York City (NYC) was about 10-fold higher in April through June as compared to March and was much higher than in other locations. There were modest increases in seroreactivity over the study timeframe for all other sites. Conclusions: Modest increases in seroreactivity from baseline were found in all sites, with the largest increase in NYC. SARS-CoV-2 antibody testing of routinely obtained blood donor samples allows for detection of asymptomatic and recovered COVID-19 cases and enables future estimation of infection incidence by geographic and other demographic parameters. This approach will be used in a significantly expanded CDC National serosurveillance study involving all 50 states over 18 months.
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Background/Case Studies: The efficacy of COVID-19 convalescent plasma (CCP) to treat COVID-19 is hypothesized to be associated with the concentration of neutralizing antibodies (nAb) to SARS-CoV-2. While high capacity, automated serologic assays to detect binding antibodies (bAb) have been developed, complex nAb assays are not easily adaptable to high-throughput testing. We sought to determine the effectiveness of using surrogate bAb signalto- cutoff ratio (S/CO) in predicting nAb titers using a pseudovirus reporter viral neutralization (RVPN) assay. Study Design/Methods: CCP donor serum collected by 3 large US blood collectors was tested with a bAb assay (Ortho Diagnostic VITROS® Anti-SARS-CoV-2 Total, CoV2T) and a nAb RVPN assay. Although EUA approved as a qualitative assay, CoV2T reports a semi-quantitative S/CO. The RVPN assay uses a pseudovirus construct with native S-protein and target cell lines overexpressing ACE2 receptor and TMPRSS2 protease. Serially diluted serum is mixed with SARS-CoV-2 pseudovirus to assess inhibition of viral entry in culture and reported as titers resulting in 50% neutralization of virus infectivity (NT50) by nonlinear regression analysis. CoV2T prediction effectiveness at several S/CO thresholds was evaluated for various RVPN nAb NT50 titers using receiver operating characteristic analysis. Results/Findings: 753 CCP donations were tested with median CoV2T S/CO of 71.2 (range 0.1-919) and median NT50 of 527.5 (range <40 to >10,240). The prevalence of CCP donors with NT50 over various target n-Ab titers were 86% >80, 76% >160, and 45% >640. Increasing CoV2T reactivity threshold reduces sensitivity to predict the target NT50 titer while specificity to identify those below nAb threshold increases for all targeted NT50s (Table 1). As the targeted NT50 is increased from >80 to >640, the positive predictive value falls dramatically while the negative predictive value increases, thus S/CO thresholds are less able to predict donors who have the target NT50 titer but more able to predict those donors who do not meet it. Conclusions: The selection of targeted nAb titer for clinical use will significantly impact availability of CCP for transfusion. Product release with CoV2T assay S/CO thresholds must balance the risk of releasing products below minimum target nAb titer and the cost of false negatives (CCP units below the threshold with adequate nAb titers). A two-step testing scheme may be optimal, with nAb testing performed on CoV2T reactive samples with S/CO values below the release threshold.
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Background/Case Studies: SARS-CoV-2 RNA has been detected by PCR in plasma, serum or whole blood specimens from hospitalized patients in studies from multiple countries. For asymptomatic individuals, several reports have described detection of SARS-CoV-2 RNA in plasma in a small number of blood donors, whereas other reports showed no detection of SARS-CoV-2 RNA in whole blood, serum or plasma from asymptomatic individuals including blood donors. No cases of transfusion-transmission of SARS-CoV-2 (or other human coronaviruses) have been reported, nor has virus been isolated from blood samples by tissue culture. We tested residual volumes of donor plasma from mini-pools (MPs) used for routine nucleic acid testing (NAT) screening to determine the frequency of SARS-CoV-2 RNAemia in blood donors in six US metropolitan regions (New York, Seattle, San Francisco, Los Angeles, Boston, Minneapolis). Study Design/Methods: Blood donations collected from 7 March 2020 to 30 June 2020 were tested for SARS-CoV-2 RNA. Donations were tested in plasma MPs of 6 or 16 donations (MP16 format for five regions and MP6 format for Seattle), targeting 500 MPs per region per month, using the Grifols Procleix SARS-CoV-2 transcriptionmediated amplification (TMA) assay on the Procleix Panther system. The test has a 95% limit of detection (LOD) of 16.5 copies/mL (95% CI, 12.8 to 23.6 copies/mL) by probit analysis. A confirmed positive result was defined by the detection of viral RNA upon repeat testing using the same assay and an alternate target region TMA assay (Grifols SARS-CoV-2 confirmatory TMA assay) with comparable sensitivity. Positive MPs were further tested using the Ortho VITROS anti-SARS-CoV-2 Total Ig test to detect antibodies and diluted 4-fold and tested using the Procleix SARS-CoV-2 TMA assay to determine whether the viral load was close to the 95% LOD. Results/Findings: A total of 8,496 MPs16 and 1,998 MPs 6, corresponding to ∼147,000 blood donations, were tested for SARS-CoV-2 RNA. One confirmed positive MP16 sample from a March donation in San Francisco was identified (0.0007% [95% CI 0.000035-0.004%]). The MP was negative for antibody and nonreactive when diluted 4-fold, suggesting a viral load below 1,000 RNA copies/mL in the individual donation. Conclusions: Blood donation MP-NAT indicated that SARS-CoV-2 RNAemia is rare, and when detected the RNA was at low concentration. Although future studies to determine the infectivity of RNA-positive plasma are warranted and in progress, these findings are reassuring with respect to transfusion safety and support current recommendations from WHO and regulatory agencies to not screen donors by NAT.
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The pandemic triggered by coronavirus disease 2019 (COVID-19) has put intensive care medicine into the focus of public attention. The mortality of patients with the disease escalates, particularly at the moment when the treatment possibilities of intensive medical care end. In the routine intensive medical care practice, the challenges due to the special features of infections with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its treatment become obvious. These occur in the development and treatment of respiratory and multiorgan failure as well as the severe inflammatory syndrome. For these severe courses there is still only little evidence available as to which interventions are the most effective. In addition to the knowledge that can be gained from the rapid performance of clinical trials, the treatment is therefore based on analogies to other syndromes, such as sepsis and macrophage activation syndrome.
ABSTRACT
The pandemic triggered by coronavirus disease 2019 (COVID-19) has put intensive care medicine into the focus of public attention. The mortality of patients with the disease escalates, particularly at the moment when the treatment possibilities of intensive medical care end. In the routine intensive medical care practice, the challenges due to the special features of infections with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its treatment become obvious. These occur in the development and treatment of respiratory and multiorgan failure as well as the severe inflammatory syndrome. For these severe courses there is still only little evidence available as to which interventions are the most effective. In addition to the knowledge that can be gained from the rapid performance of clinical trials, the treatment is therefore based on analogies to other syndromes, such as sepsis and macrophage activation syndrome.