Humoral Response to 3rd Dose Sars-Cov-2 Vaccine in Patients with Idiopathic Inflammatory Myopathies

Background. Vaccine-induced SARS-CoV-2 antibody responses are reduced in patients taking lymphocyte-depleting therapies, which are commonly prescribed for patients with idiopathic inflammatory myopathies (IIM). While a third vaccine dose (D3) augments the SARS-CoV-2 anti-spike response in some patients, there is a paucity of data on the humoral response following D3 in patients with IIM. Furthermore, the durability of antibody response is unknown. In this study, we evaluated serial antibody response for three months following a 3rd dose SARS-CoV-2 vaccination in IIM patients. Methods. Adults with a patient-reported diagnosis of idiopathic inflammatory myopathy who completed three-dose SARS-CoV-2 vaccination (two-dose BNT162b2 or mRNA-1273 followed by single mRNA or adenoviral vector dose) were recruited via social media campaign. Demographics and clinical characteristics were collected via patient report. Informed consent was provided electronically. Serial antibody responses were evaluated by the Roche Elecsys anti-SARS-CoV-2 S enzyme immunoassay, which measures total antibody to the SARS-CoV-2 S-receptor binding domain (RBD) protein (range 0. 4-2500U/ mL;positive >0.8U/mL). Poor antibody response was defined as anti-RBD titer <500U/mL based on predicted correlates of protective plasma neutralizing capacity. Those with prior COVID-19 infection were excluded. Associations were evaluated using Fisher's exact and Wilcoxon rank-sum tests as appropriate. Results. We evaluated serial anti-RBD titers in 59 participants (Table I). Most (93%) were female with median (IQR) age of 51 (41-62) years. Mycophenolate mofetil was the most frequently prescribed medication (45.6%). Participants completed primary vaccination with two-dose BNT162b2(54%) or mRNA-1273(46%). Median pre-D3 anti-RBD titer (IQR) was 65.8U/mL (4.6,473) at 158 (136-183) days following primary vaccination. Dose 3 included BNT162b2(47%), mRNA-1273(47%) or Ad.26.COV2.S (6%). Most (89.9%) received homologous D3 vaccination. 39% of participants reported holding peri-D3 immunosuppression with mycophenolate mofetil being the most commonly held medication in the peri-D3 period. Repeat anti-RBD testing was performed at a median (IQR) 30 (28-32) days post-D3. A higher antibody titer was seen in 89.9% participants following D3 with median (IQR) titer of 2500 U/mL (92,2500). Thirty-seven percent remained <500U/mL following D3;a greater proportion of these participants reported use of rituximab and greater number of immunosuppressive therapies compared to those with anti-RBD >=500U (72.7% versus 5.4%, p<0.001;3 therapies versus 2 therapies, p=0.03). Furthermore, 13.5% (8/59) remained below the threshold of positivity following D3;7/8 reported use of rituximab, 5/8 mycophenolate mofetil, or combination of these agents (4/8). There was not a significant difference in antibody titers among recipients of homologous/heterologous vaccination (p=0.22). Dose 3 was well tolerated with only 2 (3.4%) participants reporting disease flare requiring treatment within one month of vaccination;neither required intravenous therapy or hospital admission. Thirty-four (57.6%) participants underwent repeat anti-RBD testing three months following D3 with median (IQR) 2500U/mL (456,2500);73.53% (25/34) remained above threshold of >=500U/mL. Limitations of this study include small sample size and absence of healthy control group. Diagnosis was based on participant report and we did not routinely collect information on disease activity. Conclusion. We observed an augmented humoral response in most IIM patients following 3rd dose SARS-CoV-2 vaccination;antibody response was durable at three months. Dose 3 was well tolerated. Over 1/3 participants failed to develop adequate response following D3, namely those on rituximab therapy and on higher number of immunosuppressive therapies. These patients should be prioritized for prophylactic therapies to enhance protection against COVID-19 infection.

SARS-CoV-2 Antibody Response by mRNA Vaccine Platform in Incrementally Immunosuppressed Patients

Purpose: This study compares SARS-CoV-2 antibody responses between the twodose mRNA-1273 and BNT162b2 vaccine series across groups of incrementally immunosuppressed patients. Method(s): Semiquantitative testing for antibodies against the receptor binding domain (RBD) of the SARS-CoV-2 spike protein was performed using the Roche Elecsys anti-SARS-CoV-2 S enzyme immunoassay (EIA), 15-45 days after the second vaccine dose for SARS-CoV-2 naive patients with rheumatic and musculoskeletal disease (RMD), and solid organ transplant recipients (SOTRs) from an observational cohort. Anti-RBD titers were divided into categories of >=50, >=100 and >=250 U/mL based on levels associated with plasma neutralizing capacity in COVID-19 convalescent patients. Participants were stratified by increasing intensity of immunosuppression: RMD not on immunosuppression, RMD on immunosuppression, SOTR not on mycophenolate (MMF), and SOTR on MMF. Response rates between mRNA-1273 and BNT162b2 recipients were compared using modified Poisson regression weighted for age, time since vaccination, and number of immunosuppressive medications. This analysis was repeated for several thresholds of positive response: 50, 100, and 250 U/mL. Result(s): Of 1868 participants, 55.8% of RMD and 52.7% of SOTRs received BNT162b2;the remainder received mRNA-1273. Demographics, diagnoses, and immunosuppressive regimens were similar across vaccine groups. Among RMD participants not on immunosuppression, the chance of anti-RBD >=250U/ml was comparable among BNT162b2 and mRNA-1273 recipients (IRR= 0.91 1.03 1.16 p= 0.67). mRNA-1273 recipients had a higher chance than BNT162b2 recipients to achieve anti-RBD >=250U/ml among RMD participants on immunosuppression (IRR = 1.15 1.241.34, p<0.001);SOTRs not on MMF (IRR = 1.24 1.561.96, p <0.001);and SOTRs on MMF (IRR=1.28 2.625.37, p= 0.01). Similar trends were observed with titer cutoffs of >=100 and >=50 U/mL (Table 1). Conclusion(s): The two-dose mRNA-1273 vaccine series was more likely to induce stronger humoral immunogenicity compared to BNT162b2 in immunosuppressed patients;this effect was more pronounced with greater immunosuppression. These findings suggest importance in the choice of mRNA vaccine platform in optimizing immune responses to SARS-CoV-2 vaccination and can help inform vaccination strategies for booster doses in high-risk, immunosuppressed populations.

Charting the psychological literacy landscape: Systematic review highlighting psychology education

The aim of this systematic review is to provide, for the first time, a broad overview of the scope and nature of the current English language concept of ‘psychological literacy' (PL) as evidenced in the literature, primarily since 2010. Covidence systematic review methodology yielded 112 papers that were scored on 23 specific criteria/questions relevant to addressing predetermined research questions. PL has been conceptualized as both a general capability (e.g., ethical application of psychological knowledge) and a group of capabilities (discipline-specific knowledge and research methods, and more generic capabilities such as communication). Variability in the constellation of group capabilities has led to challenges in operationalization and thus measurement, signaling the need for international consensus and improved measurement. We propose a model for how PL is related to psychologically literate citizenship and global citizenship. Key papers explore PL as an integrative concept in psychology. All papers were relevant to psychology education, with most prevalent being undergraduate level, and least prevalent being graduate level. There were numerous papers providing practical PL teaching and assessment strategies. PL as a pedagogical approach has been a necessary and richly diverse focus. Finally, a revisioning of PL within the context of psychology education, as well as recommendations for further research and development, are suggested. Copyright © 2022 Cranney, Morris, Norris and Connolly.

CLINICAL PREDICTORS of ATTENUATED ANTIBODY RESPONSE to PRIMARY SARS-COV-2 VACCINATION in A LARGE PROSPECTIVE STUDY of PATIENTS with RHEUMATIC and MUSCULOSKELETAL DISEASES

Background: An attenuated humoral response to SARS-CoV-2 vaccination has been observed in some patients with rheumatic and musculoskeletal diseases (RMD) (1). We sought to identify clinical factors associated with poor humoral response following primary (two-dose mRNA or single adenoviral vector dose) SARS-COV-2 vaccination in patients with RMD on immunosuppression. Objectives: To identify clinical predictors of an attenuated antibody response to primary SARS-CoV-2 vaccination in RMD patients on immunosuppression. Methods: We included patients ≥18 years old with RMD on immunosuppres-sion who received either two-dose mRNA or single dose Janssen/Johnson and Johnson (J&J) vaccination. Demographics, diagnoses, and therapeutic regimens were collected via participant report;those with prior COVID-19 infection were excluded. One month after vaccination, participants underwent SARS-CoV-2 antibody testing on the semi-quantitative Roche Elecsys anti-SARS-CoV-2 S enzyme immunoassay, which measures antibody to the SARS-CoV-2 S-recep-tor binding domain (RBD) protein (ceiling >250U/mL later expanded to >2500U/mL). Associations were evaluated using Fisher's exact and Wilcoxon rank sum tests. Logistic regression analyses were performed to evaluate for clinical factors associated with antibody response. We adapted survival methods to address right-truncation of titers;this methodology was used to calculate medians. Participants provided informed consent electronically and the study was approved by the local Institutional Review Board. Results: We studied 1138 RMD participants on immunosuppression;most were female (93%) and white (91%) (Table 1). One-hundred and ffteen (10%) had anti-RBD response in the negative range at a median (IQR) of 29 days (28-34) following completion of vaccine series. A greater proportion of participants with negative response were non-white, received J&J vaccine, reported use of myco-phenolate, rituximab, or glucocorticoids. Antibody response differed by immuno-suppressive regimen, with those receiving rituximab having poorest response (Figure 1). Use of mycophenolate (aOR 9.92, p=0.001), rituximab (aOR 56.99, p=0.001), glucocorticoids (aOR 2.99, p=0.001) or receipt of J&J (aOR 3.13, p=0.039) were associated with negative antibody response. Conclusion: Use of mycophenolate, glucocorticoids, rituximab and receipt of J&J vaccine were the strongest predictors of an attenuated antibody response to primary SARS-CoV-2 vaccination;these data support use of an additional primary dose in RMD patients.

Building Back Better–Using an Ecological Lens to Argue for Strengthening Mesosystemic Connections for Young People in a Post Pandemic World

It is a truism to state that across the world the COVID-19 pandemic brought about and continues to cause disruption on a scale not seen before. As the pandemic is still very much ongoing, its lasting impact will take time to fully unfold. This article uses ecological theory to map the impact of the COVID-19 pandemic on young people and their wellbeing, based on some initial published studies. It reviews how their micro system contexts, especially access to school and youth services were further disrupted adding to the pressure and isolation experienced by many. Continuing the ecological framework the paper explores the policy spaces within the exosystem where stakeholders are engaged in promoting youth wellbeing and support. It is this policy “space” that this article argues has the potential to scaffold positive youth development and supports in the aftermath of the pandemic. It will argue in particular for the need to extend and enhance mesosystem connections, especially for those without strong natural support networks.

PACE-IT: designing blended learning for accounting education in the challenging context of a global pandemic

This paper describes the design of a blended learning intervention to enhance the student learning experience, incorporating innovative technologies and pedagogies within introductory accounting. The design-based research (DBR) methodology involved 68 learners in the participatory design of the intervention across three design iterations. Emerging from the design process, a framework informed by the key themes of Pedagogy, Autonomy, Collaboration, Engagement, Interaction and Technology (PACE-IT) was conceptualised, tested and developed. This study presents the PACE-IT model which offers guidelines to practitioners who seek to design blended learning to provide students with a rich and meaningful learning experience. The emergence of COVID-19 underscores the relevance of these findings. PACE-IT provides direction to accounting educators working within an unfamiliar educational context, today and in the future, where there is an imperative to develop new approaches to accounting education that combine face-to-face with online interaction and learning. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Student perceptions of rapid transition to emergency remote learning in a hands-on agricultural college

The COVID-19 pandemic in spring 2020 led to university closures and little time to convert all face-to-face courses online. We investigated how students in the College of Agriculture, Food, and Environmental Sciences at Cal Poly, San Luis Obispo, CA perceived emergency remote teaching during the early stages of the pandemic. The college maintains a hands-on pedagogy and “Learn by Doing” approach that is challenging to replicate in a remote setting. We conducted a survey of student experiences (n = 304) during the spring of 2020. We found that most students had a negative experience with aspects of emergency remote teaching during the study period. Approximately two-thirds perceived courses to be less effective at increasing knowledge and career-related skills;approximately three-quarters stated group problem solving was less effective;and approximately two-thirds were dissatisfied with the quantity and quality of course content. Around 10% of students felt courses were more effective in these areas. Familiar instructional modes (synchronous and pre-recorded lectures) were the most common and preferred by students (with 70 to 85% finding them useful vs 7 to 15% finding them useless), even though other instructional modes can be more effective strategies for online teaching. Our results highlight the need for concrete experiences in agriculture and natural resources courses. We suggest strategies for faculty and students to improve remote teaching outcomes in agriculture and natural resources disciplines. © 2021 The Authors. Natural Sciences Education © 2021 American Society of Agronomy

Is it feasible to use a humanoid robot to promote hand hygiene adherence in a hospital setting?

Healthcare associated infections (HCAI) are a prevalent preventable cause of morbidity and mortality. Improving hand hygiene adherence is important for HCAI prevention. In this feasibility study, the objective was to determine if a humanoid robot could act as a novel single reminder intervention to improve hand hygiene adherence in a hospital setting. DAVE, a social humanoid robot, improved hand hygiene adherence at the entrance to a tertiary hospital and outpatient department, which was low at baseline, by 29%. DAVE shows promise as a novel intervention to improve hand hygiene adherence.

Experiences of COVID-19 isolation in Northern Ireland prisons: a qualitative study

Purpose: The purpose of this study was to capture the experience of people after completing their period of COVID-19 14-day isolation in prison. This study used in-depth interviews to assess the impact of the restricted regime. Design/methodology/approach: This was a cross-sectional qualitative study using an adapted regional survey to record people’s experiences of COVID-19 isolation on entry into prison. This study began in April 2020 and continued to run over eight months. A weekly capture of people’s stories was conducted using a convenience sample. A total of 168 people participated in the study, with in-depth interviews conducted by the health-care team. Content conceptual analysis was used to quantify and analyse the themes of impact of COVID-19 isolation. This information was then used to shape iterative health-care service development. Findings: A number of key themes have emerged from the experiences of COVID-19 isolation, including connection, communication and support. Stories highlighted how isolation had exacerbated depression, anxiety or feelings of self-harm. This was amplified by the uncertainty of the pandemic and lack of information about accessing services in the altered prison regime. A priority for people in COVID-19 isolation was contact with family. Telephone calls and virtual visits were cited as mitigating the mental health impact of social isolation. People who felt supported by health-care or prison staff reported coping with their time in isolation better. Timely, accessible information was pivotal in support, leading to development of Engagement Lead check-ins on the isolation landings. It is crucial that a public health approach is core to the COVID-19 response in prisons. The thematic analysis of the experiences has enabled a focused understanding of the impact of COVID-19 isolation and an accountability of care provision through organisational collaboration and iterative improvements to service delivery. Originality/value: There is a paucity of real-time evidence of the impact of restricted regimes in prison owing to COVID-19. This study gives an important insight. © 2021, Emerald Publishing Limited.

Risk of disease transmission from flexible nasoendoscopy during the coronavirus disease 2019 pandemic.

BACKGROUND: Concerns have emerged regarding infection transmission during flexible nasoendoscopy. METHODS: Information was gathered prospectively on flexible nasoendoscopy procedures performed between March and June 2020. Patients and healthcare workers were followed up to assess for coronavirus disease 2019 development. One-sided 97.5 per cent Poisson confidence intervals were calculated for upper limits of risk where zero events were observed. RESULTS: A total of 286 patients were recruited. The most common indication for flexible nasoendoscopy was investigation of 'red flag' symptoms (67 per cent). Forty-seven patients (16 per cent, 95 per cent confidence interval = 13-21 per cent) had suspicious findings on flexible nasoendoscopy requiring further investigation. Twenty patients (7.1 per cent, 95 per cent confidence interval = 4.4-11 per cent) had new cancer diagnoses. Zero coronavirus disease 2019 infections were recorded in the 273 patients. No. 27 endoscopists (the doctors and nurses who carried out the procedures) were followed up.The risk of developing coronavirus disease 2019 after flexible nasoendoscopy was determined to be 0-1.3 per cent. CONCLUSION: The risk of coronavirus disease 2019 transmission associated with performing flexible nasoendoscopy in asymptomatic patients, while using appropriate personal protective equipment, is very low. Additional data are required to confirm these findings in the setting of further disease surges.

Testing times: governing a pandemic with numbers

Purpose: Using Dean's (2010) analytics of government, this research explores how regimes of governing practices are linked to the underlying policy rationalities in dealing with the UK government's COVID-19 testing policies as a strategy for governing at a distance, including how targets were set and operationalized. Design/methodology/approach: This paper draws on the UK government's policy documents, other official publications (plans) and parliamentary discourse, together with publicly available media information related to its COVID-19 policies. Findings: This research reveals that, with respect to the governance of COVID-19 in the UK, testing has the dual role of inscription for the government's performance and classification for the pandemic risks. The analysis illustrates that the central role of testing is as a technology for classification for identifying and monitoring the virus-related risks. Moreover, our discourse analysis suggests that initially COVID-19 testing was used by the UK government more for performance communication, with the classificatory role of testing and its performativity as a strategic device evolving and only being acknowledged by government gradually as the underlying testing infrastructure was developed. Research limitations/implications: This paper is based upon publicly available reports and other information of a single country's attempts to control COVID-19 over a relatively short period of time. Originality/value: This paper provides a critical understanding of the role of (accounting) numbers in developing an effective government policy for governing COVID-19. © 2021, Emerald Publishing Limited.