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Background: Limited data exist regarding the immune benefits of fourth COVID-19 vaccine doses in people with HIV (PWH) receiving antiretroviral therapy (ART), particularly given that most have now experienced SARS-CoV-2 infection. We measured the effect of fourth doses on SARS-CoV-2 neutralization in 63 PWH, including 19 SARS-CoV-2-naive and 44 SARS-CoV-2-experienced participants. Method(s): Wild-type (WT)-, Omicron-BA.5 and Omicron-BQ.1-specific neutralization activities were longitudinally quantified using live virus assays up to one month post-fourth vaccine dose. Multiple linear regression was used to investigate the relationship between sociodemographic, health and vaccinerelated variables and SARS-CoV-2 neutralization. Result(s): Participants (54 male;9 female) received monovalent (44%) or bivalent (56%) mRNA fourth doses. In COVID-19-naive PWH, a fourth dose enhanced WT- and BA.5-specific neutralization modestly above three-dose levels (p=0.1). In COVID-19-experienced PWH, a fourth dose enhanced WT neutralization modestly (p=0.1) and BA.5 neutralization significantly (p=0.002). Consistent with the humoral benefits of 'hybrid' immunity, the highest neutralization was observed in COVID-19-experienced PWH after a fourth dose. Of note, PWH with Omicron-era infections exhibited higher WT-specific (p=0.04), but comparable BA.5- or BQ.1-specific neutralization, compared to PWH with pre-Omicron-era infections. Overall, BA.5 neutralization was significantly lower than WT in all participants regardless of COVID-19 experience, and BQ.1 neutralization was significantly lower than BA.5 (all p< 0.0001). In multivariable analyses, fourth dose valency did not significantly affect neutralization magnitude, nor did sex, age nor CD4+ T-cell count (neither recent nor nadir). Rather, an mRNA-1273 fourth dose (versus a BNT162b2 one) was the strongest correlate of WT-specific neutralization, while prior COVID-19, regardless of infection era, was the strongest correlate of BA.5 and BQ.1-specific neutralization post-fourth dose. Conclusion(s): Fourth COVID-19 vaccine doses, irrespective of valency, benefit PWH regardless of prior SARS-CoV-2 infection, but the highest neutralization of Omicron-BA.5 and BQ.1 variants post-fourth dose occurred in PWH with hybrid immunity. These results support existing recommendations that all adults receive a fourth immunization within 6 months of their third vaccine dose (or their most recent SARS-CoV-2 infection). (Figure Presented).
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Foreign direct investments (FDI) are considered long-term and less sensitive to global shocks as they involve large amounts of capital investment that are costly to reverse. This study examines whether there was a reallocation of FDI flows from destination markets more affected by the pandemic, resulting in a pandemic arbitrage. Using bilateral FDI inflows data from January 2019 to December 2020, we show that FDI flows declined to destination markets that performed worse than source markets in COVID-19 infection rates, with the effect more evident in greenfield FDI. Our results also show that bilateral colonial ties and destination market COVID-19 policy stringency impact the pandemic arbitrage in FDI flows, especially for M&As.
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Background: Published data suggest no increased rate of fare of autoimmune infammatory rheumatic diseases (AIIRD) after COVID-19 mRNA vaccination;however, the studies are limited by small sample size, short follow up or at risk of selection bias (voluntary physician reports or patient surveys). Objectives: To study fares of AIIRD within three months of the frst dose of an anti-SARS-COV2 mRNA vaccine. Methods: A retrospective cohort study of consecutive AIIRD patients ≥ 12 years old, across six public hospitals in Singapore who received at least one dose of an mRNA (Pfzer/BioNTech or Moderna) vaccine. Data were censored at the frst post-vaccine clinic visit when the patient had fared or if ≥ three months had elapsed since the frst dose of the vaccine, whichever came frst. Predictors of fare were determined by Cox proportional hazards analysis and time to fare was examined using a Nelson Aalen cumulative hazard estimate (Figure 1). Results: 2339 patients (74% Chinese, 72% female) of median (IQR) age 64 (53, 71) years were included in the interim analysis (Table 1). 2112 (90%) had the Pfzer/BioNTech vaccine and 195 (8%) had Moderna, with a median (IQR) interval of 21 (21, 23) days between the two doses. The most common AIIRD diagnoses were Rheumatoid arthritis (1063, 45%), Psoriatic arthritis (296, 12.6%) and Systemic lupus erythematosus (SLE) (288, 12.3%). 186 (8%) were treated with biologics/targeted disease modifying agents. 2125 (91%) patients were in low disease activity or remission. Treatment was interrupted for vaccination in only 18 (0.8%) patients. Seven (0.3%) patients had previous COVID-19 infection. 452 (19%) fares were recorded during 9798.8 patient-months [4.6/100 patient-months, median (IQR) follow up duration 4.2 (3.3, 5.3) months], of which 272 (11.6%) patients fared within the 3-month period of interest and 180 (7.7%) fared outside of the 3-month period (Table 1). Median (IQR) time-to-fare was 40.5 (18, 56.6) days. 60 (22.1%) were mild and self-limiting, 170 (62.5%) were mild-moderate and 42 (15.4%) were severe. 190 (69.8%) of those who fared required escalation of treatment and 15 (5.5%) required hospital admission. 239 (10.2%) had improved disease activity after the vaccine. On multivariate Cox regression analysis, patients in the oldest age tertile [median (IQR) 74 (71, 79) years] were less likely to fare [HR 0.80 (95% CI 0.63, 1.00), p = 0.05] Patients with infammatory arthritis (compared with connective tissue disease, vasculitis and others) and patients with baseline active disease were more likely to fare [HR 1.72 (95% CI 1.35, 2.20), p < 0.001 and 1.82 (95% CI 1.39, 2.39), p < 0.001 respectively] Conclusion: There was a moderately high rate of AIIRD fares after mRNA vaccination;however, there was no clustering of fares in the immediate post-vaccine period to suggest causality. Older patients were less likely to fare, while those with infammatory arthritis and active disease at baseline were more likely to fare.
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Aim: To discuss and share experiences in implementing Family centered care (FCC) models in Hong Kong - Shenzhen Hospital (HKU-SZH). Met hods: At present, FCC has not been wel l implemented in China and most NICU adopt closed management. Since December 2013, our department has introduced the FCC concept and implemented 24-hour opening ward, providing family members with a series of services including ward rounds, progressive health education, palliative care, breast-feeding, cold chain support of breast milk, breast milk bank, family visit, followup after discharge, and mutual support group for family members. The above services were maintained during the COVID-19 period. Results: 10,615 newborns were treated from December 2013 to December 2020, the minimum gestational age of preterm infants treated successfully was 22+6 weeks and the minimum weight was 500g. The patient satisfaction rate in 2020 was 99.9%, and the average breastfeeding rate in 2020 was 84% while 83.4% of full-term infants and 90.2% of premature infants were breast-fed. (A multi-center survey of 974 cases of nutrition-related status of preterm infants in NICU in China reported that 13.6% of preterm infants were breast-fed during 2005-2006) The nosocomial infection rate from 2014 to 2020 was controlled between 0.41% and 2.02%. Literature showed that the incidence rate of nosocomial infection in neonatal care units of 17 grade A general hospitals in China from 2013 to 2014 was 3.35%. Conclusion: An open NICU based on the FCC concept is feasible and contributes to increased breastfeeding rates and patient satisfaction without increasing the incidence of nosocomial infections.
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Background. Donning personal protective equipment (PPE) and performing cardiopulmonary resuscitation (CPR) are stressful tasks for healthcare professionals, particularly during the COVID-19 pandemic. This study aimed to assess the effectiveness of simulation training on donning PPE and performing CPR with PPE put on for nurses at a geriatric step-down hospital. Methods. A lecture and simulation training on donning PPE and performing CPR were provided for nurses. Confidence in donning PPE and performing CPR, knowledge of CPR, and satisfaction of participants were assessed before training (baseline), after the lecture, and after the simulation training. Results. 50 nurses (33 women and 17 men) attended both the lecture and simulation training, accounting for 90% of nurses in the department. Self-rated confidence in donning PPE and performing CPR improved significantly after the lecture (both p<0.001) and again after the simulation training (both p<0.001). Knowledge of CPR improved significantly after the lecture (p<0.001). Self-rated satisfaction of participants was high (9.3±0.3). Conclusion. Simulation training on donning PPE and performing CPR with PPE put on significantly improves the knowledge and confidence of nurses in a geriatric step-down hospital. This may contribute to improved patient outcomes, particularly during the COVID-19 pandemic. © 2022 The Hong Kong Geriatrics Society and Hong Kong Association of Gerontology.
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Purpose: Adjuvant radiation plays a significant role in reducing loco-regional recurrences in uterine cancers. Standard treatment consists of daily radiation for five weeks which can be challenging for patients and the healthcare system, especially during the COVID-19 pandemic. Hypofractionated radiotherapy has been evaluated and established in other pelvic malignancies. This study aims to evaluate the acute urinary and bowel toxicities, and patient reported outcomes following stereotactic hypofractionated adjuvant radiation for endometrial cancer. Materials and Methods: This is a prospective phase I/II trial in which patients with endometrial cancer planned for adjuvant radiation received 30Gy in 5 fractions, every other day or once weekly. Treatment was delivered at two centres with volumetric arc radiation therapy with a body-vacuum immobilization, bowel enema and 3D image-guidance. Toxicity assessment, outcomes and patient reported quality of life (QOL, EORTC core QLQ-C30 and endometrial EN24) were collected at baseline, fractions (F) 3 and 5, and at regular follow-up intervals. Higher scores represent better global QOL/health status or worse symptoms (scale 0 -100). Changes in QOL over time were investigated with linear mixed-effects models. A p-value threshold of 0.05 was used for statistical significance. A change in QOL score of > 10 points was considered clinically significant. Results: The median age of the 41 enrolled patients is 66 (range: 51 - 88). Histologies included 29 endometrioid adenocarcinoma, eight serous/clear cell, one carcinosarcoma, and three dedifferentiated. Thirty patients had Stage I disease while three had Stage 2 and eight Stage 3. Seven patients received sequential chemotherapy and 3 had additional vault brachytherapy. Median follow-up is nine months, with worst toxicity (GI or GU) of Grade 1 and 2 in 63% and 24% respectively. No patients have experienced a Grade 3 or higher toxicity. Patient-reported diarrhea and gastrointestinal domain scores were statistically significantly worse than baseline at F5 (mean paired difference = 27.2;8.7, p<.005) and six weeks (mean paired difference = 7.9;5.1, p<0.05), and returned to baseline levels at 12 weeks. The only clinically significant change (>10) from baseline was in diarrhea at F5. There were no significant changes in urinary domain, overall health and quality of life scores. No loco-regional recurrences have been found;three patients recurred distantly, of which two died of metastatic disease. Conclusions: Stereotactic hypofractionated radiation is feasible and well-tolerated with short-term follow-up. Longer follow-up and future randomized studies are needed to further evaluate this treatment.
ABSTRACT
Adjuvant radiation plays a significant role in reducing locoregional recurrences in uterine cancers. Standard treatment consists of daily radiation for 5 weeks which can be challenging for patients and the healthcare system, especially during the COVID pandemic. Hypofractionated radiotherapy has been evaluated and established in other pelvic malignancies. This study aims to evaluate the acute urinary and bowel toxicities, and patient reported outcomes following stereotactic hypofractionated adjuvant radiation for endometrial cancer. This is a prospective phase I/II trial in which patients with endometrial cancer planned for adjuvant radiation received 30 Gy in 5 fractions, every other day or once weekly. Treatment was delivered at two centers with volumetric arc radiation therapy with a body-vacuum immobilization, bowel enema and 3D image-guidance. Toxicity assessment, outcomes and patient reported quality of life (QOL, EORTC core QLQ-C30 and endometrial EN24) were collected at baseline, fractions (F) 3 and 5, and at regular follow-up intervals. Higher scores represent better global QOL/health status or worse symptoms (scale 0 – 100). Changes in QOL over time were investigated with linear mixed-effects models. A P -value threshold of 0.05 was used for statistical significance. A change in QOL score of ≥ 10 points was considered clinically significant. The median age of the 41 enrolled patients is 66 (range: 51 – 88). Histologies included 29 endometrioid adenocarcinoma, 8 serous/clear cell, 1 carcinosarcoma, and 3 dedifferentiated. Thirty patients had stage 1 disease while 3 had stage 2 and 8 stage 3. Seven patients received sequential chemotherapy and 3 had additional vault brachytherapy. Median follow-up is 9 months, with worst toxicity (GI or GU) of grade 1 and 2 in 63% and 24% respectively. No patients have experienced a grade 3 or higher toxicity. Patient-reported diarrhea and gastrointestinal domain scores were statistically significantly worse than baseline at F5 (mean paired difference = 27.2;8.7, P <.005) and 6 weeks (mean paired difference = 7.9;5.1, P < 0.05), and returned to baseline levels at 12 weeks (Table 1). The only clinically significant change (≥ 10) from baseline was in diarrhea at F5. There were no significant changes in urinary domain, overall health and quality of life scores. No locoregional recurrences have been found;3 patients recurred distantly, of which 2 died of metastatic disease. Stereotactic hypofractionated radiation for uterine cancers is feasible and well-tolerated with short-term follow-up. Longer follow-up and future randomized studies are needed to further evaluate this treatment. [ABSTRACT FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science 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 abstract 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 abstract. (Copyright applies to all Abstracts.)