Humoral profiles of toddlers and young children following SARS-CoV-2 mRNA vaccination.

Although young children generally experience mild symptoms following infection with SARS-CoV-2, severe acute and long-term complications can occur. SARS-CoV-2 mRNA vaccines elicit robust immunoglobulin profiles in children ages 5 years and older, and in adults, corresponding with substantial protection against hospitalizations and severe disease. Whether similar immune responses and humoral protection can be observed in vaccinated infants and young children, who have a developing and vulnerable immune system, remains poorly understood. To study the impact of mRNA vaccination on the humoral immunity of infant, we used a system serology approach to comprehensively profile antibody responses in a cohort of children ages 6 months to 5 years who were vaccinated with the mRNA-1273 COVID-19 vaccine (25 µg). Responses were compared with vaccinated adults (100 µg), in addition to naturally infected toddlers and young children. Despite their lower vaccine dose, vaccinated toddlers elicited a stronger functional antibody response than adults, including against variant of concerns (VOCs), without report of side effects. Moreover, mRNA vaccination was associated with a higher IgG3-dependent humoral profile against SARS-CoV-2 compared to natural infection, supporting that mRNA vaccination is effective at eliciting a robust antibody response in toddlers and young children.

Dyadic versus individual delivery of a yoga program for family caregivers of glioma patients undergoing radiotherapy: Results of a 3-arm randomized controlled trial.

BACKGROUND: Despite their significant distress, supportive care interventions for caregivers of glioma patients are generally lacking. And, whether caregivers are more likely to benefit from interventions targeting patient-caregiver dyads or caregivers individually is unknown. This pilot randomized controlled trial compared the feasibility and preliminary efficacy of a dyadic yoga (DY) versus an individual caregiver yoga (CY) intervention as a supportive care strategy for family caregivers. METHODS: Patient-caregiver dyads were randomized to a DY, CY or usual care (UC) arm. DY and CY interventions were delivered over 15 sessions. Caregivers completed assessments of their depressive symptoms, quality of life (QOL), and caregiving reactions at baseline, 6 weeks, and 12 weeks, and a subset completed qualitative interviews at 12 weeks. RESULTS: With a consent rate of 63%, 67 dyads were randomized. Attendance in the DY was higher than in the CY group (session means, DY = 12.23, CY = 9.00; p = 0.06). Caregivers (79% female; 78% non-Hispanic White; mean age, 53 years) reported significantly more subjective benefit in the CY arm than in the DY arm (d = 2.1; p < .01), which was consistent with the qualitative assessment. There were medium effect sizes for improved mental QOL (d = 0.46) and financial burden (d = 0.53) in favor of the CY over the UC group. Caregivers in the CY group reported more caregiving esteem (d = 0.56) and less health decline (d = 0.60) than those in the DY group. CONCLUSION: Individual rather than dyadic delivery may be a superior supportive care approach for this vulnerable caregiver population. A larger, adequately powered efficacy trial is warranted.

Novel in-home COVID-19 vaccination program for vulnerable populations using public-private collaboration.

Background: The continued emergence of new COVID-19 variants highlights the importance of vaccination in the effort to reduce disease transmission and burden. The objective of this study is to evaluate the processes and outcomes associated with a novel in-home COVID-19 vaccination program aimed at vaccinating high-risk populations in New York, USA. Methods: To evaluate program processes, we described the program itself and reflected on some key lessons learned. To evaluate program outcomes, we analyzed data reported by vaccine recipients. These outcomes included the percentage of vaccine recipients that successfully received the full course of vaccinations, and the demographic and health characteristics of vaccine recipients. We additionally assessed demographic differences in motivations for receiving in-home care, using chi-squared tests to assess statistical significance. Data were collected and reported via dynamic online intake forms. Results: The median age of vaccine recipients was 79 ± SD 9.0 years. The oldest vaccine recipient was 107 years old. Of those with non-missing data, more than half of vaccine recipients were female (63%), identified as part of a racial/ethnic minority (66%), reported an annual income of < $25,000 (58%), and received a high school degree or less (68%). Most vaccine recipients reported having one or more health conditions associated with increased risk of severe COVID-19 disease (72%). Vaccine recipients were most likely to report receiving in-home vaccination because they were home-bound due to disability. Motivations for receiving in-home vaccination differed by demographic subgroup. Conclusion: The population receiving vaccinations from this in-home care delivery program comprised seniors who were mostly female and non-white, indicated socioeconomic vulnerability, and reported one or more COVID-related health conditions; this signified that the program met its goal of vaccinating those most at risk for severe COVID-19 disease.

Global Challenges in Access to and Implementation of Precision Oncology: The Health Care Manager and Health Economist Perspective.

Precision medicine changes the landscape of oncology practices by offering the opportunity to optimize care through a more targeted, personalized approach of managing cancer treatments. However, precision oncology is costly and does not benefit all patients with cancer, making it critically important to consider the tradeoff between costs and health benefits. Here, we discuss the global challenges in implementing precision oncology from the perspective of health care management and health economics and emphasize the different challenges for high-income compared with low- and middle-income countries. For health care managers making resource allocation decisions, the decision to adopt, implement, and finance precision oncology must consider opportunity costs, and the allocation must be proportional to the system's capacity. The standard approach of health technology assessment is inadequate because it fails to consider the capacity to pay. From an economic perspective, global implementation of precision oncology must confront the issues of accessibility, affordability, and system readiness. Low- and middle-income countries often have no or delayed access to novel targeted-therapy agents, find these drugs cost-prohibitive, and struggle to build the infrastructure with sufficient workforce and adequate testing and computing facilities to capitalize the benefit of precision oncology. Although high-income countries are better equipped to implement precision oncology, the challenges there lie in implementing strategies to maximize the value of precision oncology through promoting appropriate use while limiting inappropriate applications. The recent rollout of COVID-19 vaccines internationally highlights the importance of information uncertainty and offers valuable insights on global access to and implementation of precision oncology.

COMPARISON OF ACUTE RESPIRATORY FAILURE BETWEEN SARS-COV-2 AND INFLUENZA

Majority of the intubated patients with ARF due to COVID in the ICU met the ARDS criteria relative to Influenza and had a higher mortality rate. B Introduction: b We compared characteristics and outcomes between patients with acute respiratory failure (ARF) from Influenza and SARS-CoV-2 admitted to the ICU. Flu patients were older than COVID (Flu 65.5 ± 14.5 vs COVID 58.6 ± 13.2 years, p=0.0002). [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Patient and Health Care Worker Perceptions of Communication and Ability to Identify Emotion When Wearing Standard and Transparent Masks.

Importance: Adoption of mask wearing in response to the COVID-19 pandemic alters daily communication. Objective: To assess communication barriers associated with mask wearing in patient-clinician interactions and individuals who are deaf and hard of hearing. Design, Setting, and Participants: This pilot cross-sectional survey study included the general population, health care workers, and health care workers who are deaf or hard of hearing in the United States. Volunteers were sampled via an opt-in survey panel and nonrandomized convenience sampling. The general population survey was conducted between January 5 and January 8, 2021. The health care worker surveys were conducted between December 3, 2020, and January 3, 2021. Respondents viewed 2 short videos of a study author wearing both a standard and transparent N95 mask and answered questions regarding mask use, communication, preference, and fit. Surveys took 15 to 20 minutes to complete. Main Outcomes and Measures: Participants' perceptions were assessed surrounding the use of both mask types related to communication and the ability to express emotions. Results: The national survey consisted of 1000 participants (mean [SD] age, 48.7 [18.5] years; 496 [49.6%] women) with a response rate of 92.25%. The survey of general health care workers consisted of 123 participants (mean [SD] age, 49.5 [9.0] years; 84 [68.3%] women), with a response rate of 11.14%. The survey of health care workers who are deaf or hard of hearing consisted of 45 participants (mean [SD] age, 54.5 [9.0] years; 30 [66.7%] women) with a response rate of 23.95%. After viewing a video demonstrating a study author wearing a transparent N95 mask, 781 (78.1%) in the general population, 109 general health care workers (88.6%), and 38 health care workers who are deaf or hard of hearing (84.4%) were able to identify the emotion being expressed, in contrast with 201 (20.1%), 25 (20.5%), and 11 (24.4%) for the standard opaque N95 mask. In the general population, 450 (45.0%) felt positively about interacting with a health care worker wearing a transparent mask; 76 general health care workers (61.8%) and 37 health care workers who are deaf or hard of hearing (82.2%) felt positively about wearing a transparent mask to communicate with patients. Conclusions and Relevance: The findings of this study suggest that transparent masks could help improve communication during the COVID-19 pandemic, particularly for individuals who are deaf and hard of hearing.

Improving the Process of Screening for Medical Financial Hardship in Oncology Practice.

Medical financial hardship, including problems paying medical bills, distress, and forgoing care because of cost, is increasingly common among patients receiving cancer treatment and cancer survivors across the economic spectrum. Little is known, however, about provider practices for identifying patients who experience financial hardship and the strategies for mitigating hardship and addressing patient needs. In this editorial, we discuss a study of practices within the NCI Community Oncology Research Program. McLouth and colleagues found disparities in the use of screening and financial navigation and reliance on inadequate screening methods. To address these disparities, we emphasize the importance of comprehensive and ongoing financial hardship screening throughout the course of cancer treatment and survivorship care, as well as the necessity of accompanying counseling, navigation, and referrals. We also recommend key attributes of screening tools and a process for systematic implementation within clinical practice. With adverse health and economic consequences of the COVID-19 pandemic disproportionately affecting people who are racial or ethnic minorities, uninsured or underinsured, or living in poverty, the need to address medical financial hardship is more urgent than ever, to ensure that all people have an equal opportunity for high quality cancer treatment and survival.See related article by McLouth et al., p. 669.