Rise in Out-of-Hospital Cardiac Arrest Cases in Chicago in 2020

Background: Italy, France and New York City have reported an increase in out-of-hospital cardiac arrest (OHCA) incidence during the COVID-19 pandemic. The purpose of our study was to assess the effect of COVID-19 on OHCA cases in Chicago. Method(s): Cardiac Arrest Registry to Enhance Survival (CARES) database was used. Bivariate analysis was conducted to assess changes in demographic and other characteristics. We excluded the cases that occurred in a healthcare facility or a nursing home. We compared the cases reported in 2020 to 2019 (and prior years). ArcGIS was used to geocode incident addresses and to show the temporal distribution by community areas. Bivariate analysis was done using chi-square tests. Result(s): A total of 3221 OHCA cases were reported in Chicago in 2020, which is 31.5% higher than those reported in 2019 (n=2450 cases). This increase was higher than what has been noticed historically (for instance, the increase from 2018 to 2019 was only 17%). There was an increase in Hispanic OHCA cases (17.3% in 2020 vs. 13.5% in 2019, p<0.01) but a decrease in White cases (20.5% vs. 23.1%). The cases in 2020 were less likely to be reported at public location (22% vs. 26%, p<0.001) or have shockable rhythm (10% vs. 13%, p=0.0002). There was a marked increase in those that were declared dead in the field in 2020 (37% vs. 27%, p<0.001). However, there were no statistically significant differences in age distribution, gender, witnessed arrest (49% vs. 51%, p=0.07) or bystander cardiopulmonary resuscitation (BCPR) (23% vs. 22%, p=0.3). Conclusion(s): A better understanding of the causes of the excess cardiac arrest numbers will be important to help plan and better prepare for future public health interventions. The effect of COVID19 on OHCA survival needs to be examined further in future studies.

Brief Educational and Process Change Quality Improvement Intervention Increases HIV, Hepatitis C, and Syphilis Screening in Psychiatric Inpatients Admitted from a Psychiatric Emergency Service

Background: Psychiatric disorders increase risk for infection with human immunodeficiency virus (HIV), hepatitis C virus (HCV), and syphilis, and these infections carry implications for psychiatric symptoms and treatment (Campos, 2008). At the University of New Mexico Psychiatric Center (UNMPC), no standardized protocol existed for HIV, HCV, and syphilis screening among patients admitted for psychiatric hospitalization. Method(s): In January 2020, residents and faculty at UNMPC began a quality improvement intervention aimed at increasing screening rates of HIV, HCV, and syphilis among patients admitted for hospitalization from the psychiatric emergency service. The intervention consisted of four components: Safe Zone training for residents;addition of HIV, HCV, and syphilis testing prompts to the admission orders in the electronic health record (EHR);resident education about screening and consent;and posted reminders at resident workstations. Retrospective evaluation of de-identified EHR admissions data compared screening rates over the nine months post-intervention versus the nine months pre-intervention. Secondary evaluations investigated whether onset of the COVID-19 in New Mexico in March 2020, or the start of the new resident class in July 2020, affected screening rates post-intervention. Pearson chi-square analyses tested for screening rate differences. This study was approved by the UNM Human Research Protections Office. Result(s): Screening rates for all conditions increased post-intervention. HIV screening increased from 7.7 to 14.4%, X2 (1, 1838) = 20.89, p <.001, HCV from 4.9 to 15.3% X2 (1, 1838) = 54.66, p <.001, and syphilis from 15.6 to 21.5%, X2 (1, 1838) = 10.60, p =.001. Neither COVID-19, X2 (1, 488) = 0.31, p =.579, nor start of the new resident class, X2 (1, 679) = 0.03 p =.863, impacted screening rates post-intervention. Discussion(s): This brief quality improvement intervention significantly increased screening rates for HIV, HCV, and syphilis in psychiatric inpatients admitted from the psychiatric emergency service. However, even post-intervention, screening rates remained low. These findings mirror previously published data on the impact of a low-intensity administrative advocacy and in-service training intervention on HIV screening rates in psychiatric inpatients (Shumway, 2018). Conclusion/Implications: In light of the bidirectional risks of psychiatric disorders and infection with HIV, HCV, and/or syphilis, and in keeping with United States Preventive Service Task Force guidelines pertaining to screening for these infectious diseases, further quality improvement initiatives remain necessary for increasing screening amongst persons admitted for psychiatric hospitalization (USPSTF, 2022). References: Campos LN, Guimaraes MD, Carmo RA, et al. HIV, syphilis, and hepatitis B and C prevalence among patients with mental illness: a review of the literature. Cad Saude Publica. 2008 24(Suppl 4):s607-20 Shumway M, Mangurian C, Carraher N, et al. Increasing HIV testing in inpatient psychiatry. Psychosomatics 2018 59(2):186-192 United States Preventive Services Taskforce. (n.d.). Retrieved April 3, 2022, from Copyright © 2022

Will they or won't they?: Understanding nascent entrepreneurship and entrepreneurial emergence through authentic leadership behaviours

Our society faces many obstacles in its continuing growth and development. With the shared anxiety of recent threats such as COVID-19, individuals around the world are forming their own ways to combat change and degradation. Even small hospitality businesses in Tasmania have been deeply impacted, with many close to closing their doors due to the reliance on the tourism industry. The absence of relevant and extensive research into nascent entrepreneurship continues to limit the pragmatic and theoretical application of the potential individuals have to instigate change. As such, the authors highlight the need for further study into the emergence and potential of entrepreneurs to further explore their behavioral development and growth. In doing so, they look to answer our research question: How can authentic leadership behaviors provide a clearer understanding to the phenomena of nascent entrepreneurial emergence and aid in their ethical development? © 2021, IGI Global. All rights reserved.

SARS-CoV-2-SPECIFIC T CELLS ASSOCIATED with LUNG DYSFUNCTION in LONG COVID-19

Background: After infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a significant number of individuals develop post-acute sequelae of COVID-19 (PASC) marked by prolonged symptoms, including persistent pulmonary dysfunction. An estimated 5-20% of those infected with SARS-CoV-2 will go on to develop PASC. T cells and inflammation contribute significantly to severe COVID-19 and similar chronic conditions;however, little is known about the role of persistent inflammation and SARS-CoV-2-specific immunity in PASC. The objective of this study is to compare inflammatory markers, frequencies of SARS-CoV-2-specific T cells, and pulmonary function in subjects who recovered from acute COVID infection (AC) and PASC. Methods: We collected blood samples from 35 individuals after recovery from SARS-CoV-2 infection and divided the cohort by symptom duration into AC or PASC. We measured T cell responses to SARS-CoV-2 surface proteins, assessed levels of inflammatory markers in the plasma and measured pulmonary function. The Mann-Whitney U test were utilized to examine differences between groups. Correlations were calculated using the nonparametric Spearman test. P values of <0.05 were considered statistically significant. Results: Compared to AC, subjects with PASC had significantly elevated plasma CRP and IL-6 and up to a hundred-fold increase in the frequency of IFN-γ-and TNF-α-producing SARS-CoV-2-specific CD4+ and CD8+ T cells in blood. Importantly, the frequency of SARS-CoV-2-specific, TNF-α-producing CD4+ and CD8+ T cells in PASC positively correlated with plasma IL-6 and negatively correlated with measures of lung function, including FEV1, while increased frequencies of IFN-γ-producing T cells were associated with the duration of respiratory symptoms during the post-acute period. Conclusion: Significant immunological differences exist between subjects with PASC and AC that are associated with increased inflammation and pulmonary dysfunction, suggesting that persistent immunologic differences may drive ongoing symptoms in PASC. The persistence of SARS-CoV-2-specific T cells in PASC suggests the presence of persistent viral reservoirs as a possible mechanism behind PASC etiology.

Anti-BCMA-CAR-T-Zell-Therapie bei einem Patienten mit rezidiviertem und refraktärem Multiplen Myelom nach einer COVID-19-Infektion: ein Fallbericht

Hintergrund: Über das Risiko einer Virusinfektion mit dem schweren akuten Atemwegssyndrom Coronavirus 2 (SARS-CoV-2) bei Krebspatienten, von denen viele immungeschwächt und damit anfälliger für eine Vielzahl von Infektionen sind, ist sehr wenig bekannt. Als Vorsichtsmaßnahme haben viele klinische Studien während der ersten Welle der weltweiten Pandemie des neuartigen Coronavirus (COVID-19) die Aufnahme von Patienten pausiert. In diesem Fallbericht beschreiben wir die erfolgreiche Behandlung eines Patienten mit rezidiviertem und refraktärem Multiplem Myelom (MM), der unmittelbar nach der klinischen Genesung von COVID-19 mit einer chimären Antigenrezeptor (CAR)-T-Zelltherapie mit Anti-B-Zellreifungsantigen (BCMA) behandelt wurde. Fallvorstellung: Der 57-jährige weiße männliche Patient war seit 4 Jahren an MM erkrankt und galt bei der Vorstellung zur CAR-T-Zelltherapie als pentarefraktär. Er hatte eine Immunsuppression in seiner medizinischen Vorgeschichte und er erhielt am Tag vor der COVID-19-Diagnose eine Dosis lymphdepletierender Chemotherapie (LDC). Dieser Patient konnte eine erhebliche Immunantwort gegen das SARS-CoV-2-Virus aufbauen, und antivirale Antikörper bleiben auch 2 Monate nach Erhalt einer Anti-BCMA-CAR-T-Zelltherapie noch nachweisbar. Die kürzliche SARS-CoV-2-Infektion bei diesem Patienten führte nicht zu einer Exazerbation des CAR-T-assoziierten Zytokin-Freisetzungssyndroms (CRS) und umgekehrt führte die CAR-T-Zelltherapie nicht zu Komplikationen im Zusammenhang mit COVID-19. Einen Monat nach der CAR-T-Zell-Infusion wurde bei dem Patienten ein unbestätigtes partielles Ansprechen nach den Kriterien der International Myeloma Working Group (IMWG) festgestellt. Schlussfolgerung: Unser Fall liefert einen wichtigen Kontext für die Wahl der Behandlung von MM-Patienten in Zeiten von COVID-19 sowie für die Frage, ob die CAR-T-Therapie auch bei Patienten verabreicht werden kann, die von COVID-19 genesen sind. Da die COVID-19-Pandemie weltweit anhält, ist eine umfangreiche Diskussion über die Entscheidung, ob mit der CAR-T-Zelltherapie fortgefahren werden soll, erforderlich, wobei die potenziellen Risiken und Vorteile der Therapie gegeneinander abgewogen werden müssen. Dieser Fall legt nahe, dass es möglich ist, die Anti-BCMA-CAR-T-Zelltherapie nach der Genesung von COVID-19 erfolgreich abzuschließen. Die Studie CRB-402 wurde am 6. September 2017 bei clinicaltrials.gov registriert (NCT03274219).

Low SARS-CoV-2 seroprevalence and no active infections among dogs and cats in animal shelters with laboratory-confirmed COVID-19 human cases among employees

Human-to-animal and animal-to-animal transmission of SARS-CoV-2 has been documented;however, investigations into SARS-CoV-2 transmission in congregate animal settings are lacking. We investigated four animal shelters in the United States that had identified animals with exposure to shelter employees with laboratory-confirmed COVID-19. Of the 96 cats and dogs with specimens collected, only one dog had detectable SARS-CoV-2 neutralizing antibodies;no animal specimens had detectable viral RNA. These data indicate a low probability of human-to-animal transmission events in cats and dogs in shelter settings with early implementation of infection prevention interventions.

Practicing Emotionally Focused Therapy online: Calling all relationships.

In the midst of a global pandemic, couples are dealing a range of impacts that call for a cohesive unit while the virus frays at the edges of our most important relationships. Emotionally Focused Therapy (EFT) is an evidence-based approach to working with relationships rooted in attachment theory. As a process-oriented psychotherapy, EFT is an ideal approach to working with relationships during this pandemic helping to solidify an "in it together" approach required to survive both as a couple and the pandemic. In this paper, we briefly review the adaptations for moving a couple therapy practice online through an EFT lens, drawing on an EFT macro-intervention called the "Tango" as a focus in this process. We conclude the paper with a case example providing the reader with an illustration of the process and ideas for what to pay attention to when working online with a couple from an EFT perspective.

Anti-BCMA CAR T administration in a relapsed and refractory multiple myeloma patient after COVID-19 infection: a case report.

BACKGROUND: Very little is known about the risk that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection poses to cancer patients, many of whom are immune compromised causing them to be more susceptible to a host of infections. As a precautionary measure, many clinical studies halted enrollment during the initial surge of the global Novel Coronavirus Disease (COVID-19) pandemic. In this case report, we detail the successful treatment of a relapsed and refractory multiple myeloma (MM) patient treated with an anti-B cell maturation antigen (BCMA) chimeric antigen receptor (CAR) T cell therapy immediately following clinical recovery from COVID-19. CASE PRESENTATION: The 57 year old Caucasian male patient had a 4-year history of MM and was considered penta-refractory upon presentation for CAR T cell therapy. He had a history of immunosuppression and received one dose of lymphodepleting chemotherapy (LDC) the day prior to COVID-19 diagnosis; this patient was able to mount a substantial immune response against the SARS-CoV-2 virus, and antiviral antibodies remain detectable 2 months after receiving anti-BCMA CAR T cell therapy. The recent SARS-CoV-2 infection in this patient did not exacerbate CAR T-associated cytokine release syndrome (CRS) and conversely the CAR T cell therapy did not result in COVID-19-related complications. One month after CAR T cell infusion, the patient was assessed to have an unconfirmed partial response per International Myeloma Working Group (IMWG) criteria. CONCLUSION: Our case adds important context around treatment choice for MM patients in the era of COVID-19 and whether CAR T therapy can be administered to patients who have recovered from COVID-19. As the COVID-19 global pandemic continues, the decision of whether to proceed with CAR T cell therapy will require extensive discussion weighing the potential risks and benefits of therapy. This case suggests that it is possible to successfully complete anti-BCMA CAR T cell therapy after recovery from COVID-19. CRB-402 study registered 6 September 2017 at clinicaltrials.gov (NCT03274219).