Climate Change and Animal Health

This benchmark publication assembles information on the current and anticipated effects of climate change on animal health. It empowers educators, managers, practitioners, and researchers by providing evidence, experience, and opinions on what we need to do to prepare for, and cope with, the largest threat ever to have faced animals on this planet. With expert contributors from across the globe, the text equips the reader with information and means to develop sustainable adaptation or mitigation actions. After introducing animal health in a climate change context, chapters look at specific animal health impacts arising from climate change. The book concludes with suggestions on teachable and actionable ideas that could be used to mobilize concepts provided into education or advocacy. This book was written amid the COVID-19 pandemic and in the face of ever-increasing reports of on-the-ground, real-life climate impacts. Large scale wildfire and ocean heat waves killed unprecedented numbers of animals, while droughts in some areas and floods in others displaced thousands of livestock and made food scarce for even more. Climate change is real, and it is here. How we respond will have profound implications for people, biodiversity, welfare, conservation, societies, economies, and ecosystems. Today's veterinary educators are awakening to the need to adapt and train a new generation of animal health professionals who can understand and plan for climate change, and this book is an essential resource. © 2023 Craig Stephen and Colleen Duncan.

Meeting a Planetary Launch Window in a Pandemic

L'Ralph is the primary science instrument on the Lucy mission to encounter the Trojan asteroids at the Jupiter L4 and L5 Lagrange points. In December of 2019, the main instrument subassemblies were finishing their build-up and testing. The team was getting ready for integration and testing with comfortable schedule margin to our required delivery date in support of the planetary launch window. When COVID-19 started to spread, the flight hardware ground to a halt but the planets kept moving. The L'Ralph team used a risk-based process to strategically descope activities from the integration and test flow and to negotiate a late delivery to the spacecraft. They changed the entire risk posture, investing in infrastructure to allow more remote test support to protect the team's health and reduce the schedule risk in case of an outbreak. Despite multiple technical hurdles, the team was able to make an on-time delivery to the spacecraft, and Lucy was successfully launched in October 2021. © 2022 IEEE.

COVID-19 management in a UK Tertiary Centre Intensive Care Unit: Nutritional status, intervention and outcome

Coronavirus disease 2019 (COVID-19) has rapidly spread across the globe. Large numbers of patients with severe acute respiratory syndrome associated with COVID-19 have required Intensive Care (ICU) input to manage their condition.1 Requirements such as proning patients may impact on the ability to successfully deliver nutritional support. To date, little data has been published on the nutritional management of these patients whilst on ICU. We previously reported a retrospective analysis of the management and 28-day outcomes of 316 consecutive adult patients with SARS-CoV-2 PCR-confirmed COVID-19 admitted to our centre, within the first wave of the pandemic between 8th January 2020 and 16th April 2020.2 The study was registered as a clinical service evaluation and was exempt from ethical approval. A total of 316 patients (55% male) were identified with a median (IQR) [range] age of 75 (60 – 83) [23 – 101] years. Fifty-nine (19%) patients were admitted to ICU, median age 60. In total, 84 (27%) patients died within 28 days of admission (or before discharge where admission duration >28 days). Of those patients admitted to IC4 (24%) died. We here present further hitherto unpublished analyses of the nutritional status, intervention and outcomes of those patients admitted to ICU. Thirty-one (52%) of patients required intubation during their ICU stay, 6 (10%) required tracheostomy and 16 (27%) required proning during their stay. When required, proning lasted on average 2.7 days. Median length of stay on ICU was 8.5 days (range 1-51). Mean admission weight for those patients admitted to ICU was 102kg and was recorded in 26 (44%) of those admitted to ICU. This compared to the wider hospital admission cohort, where weight was recorded in 151/316 (48%) patients, with a median [range] 74.5kg [32.4-168]. Where measured (20 [34%]), there was significant weight loss observed during admission in those patients whose stay included ICU;mean (SD) weight 100kg (22.2) at admission and 91.1kg (21.4)) last recorded weight during admission (P=0.04). Thirty-five (59%) of patients who were admitted to ICU received dietetic input, compared to 48 (19%) patients admitted elsewhere in the hospital. Thirty-four (58%) of patients admitted to ICU required enteral feeding, all occurring via nasogastric tube. Fifty-three (17%) of patients received oral nutritional supplements whilst an inpatient and 38 (12%) received enteral feeding. Of those patients receiving enteral feeding on ICU, 33 (97%) had tube placement confirmed by chest x-ray. Information on feed regime was available on 30 patients on ICU. Mean (SD) prescribed feed calories was 1507 kcal/24 hours (255), compared to mean (SD) feed delivered 1321 kcal/24 hours (372) (P=0.0001). Mean (SD) prescribed protein was 86g/24 hours (20) versus mean protein delivered was 67g/24 hours (P=0.0001). Median duration of enteral feeding on ICU was 12.5 days (range 2-52). Results indicate that enteral feeding on ICU can be successfully delivered in patients with COVID-19. Updated advice on enteral tube feeding safety including confirmation of tube placement was followed in the majority of cases.2 Future studies should aim to establish greater depth of understanding on the impact of different enteral feeding regimes on COVID-19 outcome. 4. Armstrong, R.A., Kane, A.D., Cook, T.M. Anaesthesia. 2020 Oct;75(10):1340-1349 Outcomes from intensive care in patients with COVID-19: a systematic review and meta-analysis of observational studies 5. Baker KF, Hanrath AT, Schim van der Loeff I, Tee SA, Capstick R, Marchitelli G, Li A, Barr A, Eid A, Ahmed S, Bajwa D, Mohammed O, Alderson N, Lendrem C, Lendrem DW, COVID-19 Control Group, COVID-19 Clinical Group, Pareja-Cebrian L, Welch A, Field J, Payne BAI, Taha Y, Price DA, Gibbins C, Schmid ML, Hunter E, Duncan CJA. COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis. Med Sci (2021);9(1):6. 6. Nasogastric tube safety Special Interest Group. May 2020. Enteral tube feeding safety in COVID-19 pat ents. BAPEN. )

COVID-19 management in a UK Tertiary Centre with High Consequence Infectious Diseases Centre: Nutritional status, intervention and outcome

Coronavirus disease 2019 (COVID-19) has rapidly spread across the globe. Elderly individuals and patients with comorbidities such as obesity, diabetes, and hypertension have been shown to have a higher risk of hospitalization, severe disease, and mortality.1 To date, little data has been published on the timely identification and correction of undernutrition in patients hospitalised with COVID-19. We previously reported a retrospective analysis of the management and 28-day outcomes of 316 consecutive adult patients with SARS-CoV-2 PCR-confirmed COVID-19 admitted to our centre, within the first wave of the pandemic between 8th January 2020 and 16th April 2020.2 The study was registered as a clinical service evaluation and was exempt from ethical approval. A total of 316 patients (55% male) were identified with a median (IQR) [range] age of 75 (60 – 83) [23 – 101] years. Twenty-seven of 316 (9%) patients were healthcare workers, and 60 (19%) were admitted from a care home. The median (IQR) duration of admission was 8 (4 – 14) days, and 59 (19%) patients were admitted to critical care. In total, 84 (27%) patients died within 28 days of admission (or before discharge where admission duration >28 days). We here present further hitherto unpublished analyses of the nutritional status, intervention and outcomes of this cohort. Gastrointestinal symptoms present at admission were: anorexia (97 [31%]), diarrhoea (64 [20%]), vomiting (43 [14%]) and abdominal pain (33 [10%]). Admission weight was recorded in 151 (48%) patients, with a median [range] 74.5kg [32.4-168.0]. Where measured (62 [20%] patients), there was significant weight loss observed during admission;median (IQR) weight 77.4kg (65.5-96) at admission and 73.7kg (61.4-94.5) last recorded weight on admission (P=0.0001, paired Wilcoxon signed-rank test). Forty-eight (15%) patients were assessed by a dietitian during their admission. Fifty-three (17%) patients received oral nutritional supplements whilst an inpatient and 38 (12%) received enteral feeding. Of those patients receiving enteral feeding, 30 (79%) had tube placement confirmed by chest x-ray. In conclusion, gastrointestinal symptoms that are commonly associated with reduced nutritional intake were common in these patients hospitalised with COVID-19. There was evidence of reduced nutritional screening on admission compared with pre-COVID practice. This may have been associated with barriers associated with initial infection prevention and control requirements as well as focus on respiratory issues, and should be addressed in future waves of infection. Updated safety advice on enteral tube feeding including confirmation of tube placement was followed in the majority of cases.3 Future studies should aim to better establish the particular circumstances in COVID-19 where nutritional support impacts outcome. 1. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention 2020 Apr 7;323(13):1239-1242. 2. Baker KF, Hanrath AT, Schim van der Loeff I, Tee SA, Capstick R, Marchitelli G, Li A, Barr A, Eid A, Ahmed S, Bajwa D, Mohammed O, Alderson N, Lendrem C, Lendrem DW, COVID-19 Control Group, COVID-19 Clinical Group, Pareja-Cebrian L, Welch A, Field J, Payne BAI, Taha Y, Price DA, Gibbins C, Schmid ML, Hunter E, Duncan CJA. COVID-19 Management in a UK NHS Foundation Trust with a High Consequence Infectious Diseases Centre: A Retrospective Analysis. Med Sci (2021);9(1):6. 3. Nasogastric tube safety Special Interest Group. May 2020. Enteral tube feeding safety in COVID-19 patients. BAPEN. )

An evaluation of telemedicine for new outpatient neurological consultations

Background and aims: The COVID-19 pandemic has broadened the use of teleneurology, how this compares to face-to-face (F2F) clinics is unclear. This study compared virtual with F2F new neurological consultations. Methods: We retrospectively evaluated new outpatient consultations in neurology clinics in Aberdeen Royal Infirmary. We compared sociodemographic data, time to consultation, time to diagnosis, the need for reassessment and re-investigation between traditional F2F and virtual clinics using the web-based video platform (Near Me) or telephone into patients own homes (or chosen location) without a trained assistant. We calculated the relative risk of the need for reassessment and re-investigation over sixmonth periods by the suspected neurological diagnosis. Results: 73% of consultations were virtual (Near Me or telephone) between June and October 2020, this was almost non-existent (<0.1%) in June-October 2019. We analysed 352 F2F (June-July 2019) and 225 virtual consultations (June-July 2020). Compared to F2F clinics, virtual clinics had a longer time to diagnosis (p=0.019), were more likely to be re-assessed (RR: 2.2, 95% CI: 1.5-3.2;p<0.0001) and re-investigated (RR: 1.50, 95% CI: 0.88-2.54;p=0.133), this was likelier in those aged ≥60 years. Patients with headaches and suspected seizures were less likely to need reassessment or re-investigation following virtual clinics than multiple sclerosis & neuroinflammatory disorders, spinal cord disorders and functional neurological disorders. Conclusion: This study demonstrates that virtual clinics have higher rates of reassessment and re-investigation than F2F clinics. As virtual clinics become a potential consultation alternative, this study should instruct the selection of patients for either consultation type.

Ambient Air Pollutant Exposures and COVID-19 Severity and Mortality in a Cohort of Patients with COVID-19 in Southern California.

Rationale: Ecological studies have shown air pollution associations with coronavirus disease (COVID-19) outcomes. However, few cohort studies have been conducted. Objectives: To conduct a cohort study investigating the association between air pollution and COVID-19 severity using individual-level data from the electronic medical record. Methods: This cohort included all individuals who received diagnoses of COVID-19 from Kaiser Permanente Southern California between March 1 and August 31, 2020. One-year and 1-month averaged ambient air pollutant (particulate matter ⩽2.5 µm in aerodynamic diameter [PM2.5], NO2, and O3) exposures before COVID-19 diagnosis were estimated on the basis of residential address history. Outcomes included COVID-19-related hospitalizations, intensive respiratory support (IRS), and ICU admissions within 30 days and mortality within 60 days after COVID-19 diagnosis. Covariates included socioeconomic characteristics and comorbidities. Measurements and Main Results: Among 74,915 individuals (mean age, 42.5 years; 54% women; 66% Hispanic), rates of hospitalization, IRS, ICU admission, and mortality were 6.3%, 2.4%, 1.5%, and 1.5%, respectively. Using multipollutant models adjusted for covariates, 1-year PM2.5 and 1-month NO2 average exposures were associated with COVID-19 severity. The odds ratios associated with a 1-SD increase in 1-year PM2.5 (SD, 1.5 µg/m3) were 1.24 (95% confidence interval [CI], 1.16-1.32) for COVID-19-related hospitalization, 1.33 (95% CI, 1.20-1.47) for IRS, and 1.32 (95% CI, 1.16-1.51) for ICU admission; the corresponding odds ratios associated with 1-month NO2 (SD, 3.3 ppb) were 1.12 (95% CI, 1.06-1.17) for hospitalization, 1.18 (95% CI, 1.10-1.27) for IRS, and 1.21 (95% CI, 1.11-1.33) for ICU admission. The hazard ratios for mortality were 1.14 (95% CI, 1.02-1.27) for 1-year PM2.5 and 1.07 (95% CI, 0.98-1.16) for 1-month NO2. No significant interactions with age, sex or ethnicity were observed. Conclusions: Ambient PM2.5 and NO2 exposures may affect COVID-19 severity and mortality.

Ambient air pollution and COVID-19 incidence during four 2020-2021 case surges.

BACKGROUND: Air pollution exposure may make people more vulnerable to COVID-19 infection. However, previous studies in this area mostly focused on infection before May 2020 and long-term exposure. OBJECTIVE: To assess both long-term and short-term exposure to air pollution and COVID-19 incidence across four case surges from 03/1/2020 to 02/28/2021. METHODS: The cohort included 4.6 million members from a large integrated health care system in southern California with comprehensive electronic medical records (EMR). COVID-19 cases were identified from EMR. Incidence of COVID-19 was computed at the census tract-level among members. Prior 1-month and 1-year averaged air pollutant levels (PM2.5, NO2, and O3) at the census tract-level were estimated based on hourly and daily air quality data. Data analyses were conducted by each wave: 3/1/2020-5/31/2020, 6/1/202-9/30/2020, 10/1/2020-12/31/2020, and 1/1/2021-2/28/2021 and pooled across waves using meta-analysis. Generalized linear mixed effects models with Poisson distribution and spatial autocorrelation were used with adjustment for meteorological factors and census tract-level social and health characteristics. Results were expressed as relative risk (RR) per 1 standard deviation. RESULTS: The cohort included 446,440 COVID-19 cases covering 4609 census tracts. The pooled RRs (95% CI) of COVID-19 incidence associated with 1-year exposures to PM2.5, NO2, and O3 were 1.11 (1.04, 1.18) per 2.3 µg/m3,1.09 (1.02, 1.17) per 3.2 ppb, and 1.06 (1.00, 1.12) per 5.5 ppb respectively. The corresponding RRs (95% CI) associated with prior 1-month exposures were 1.11 (1.03, 1.20) per 5.2 µg/m3 for PM2.5, 1.09 (1.01, 1.17) per 6.0 ppb for NO2 and 0.96 (0.85, 1.08) per 12.0 ppb for O3. CONCLUSION: Long-term PM2.5 and NO2 exposures were associated with increased risk of COVID-19 incidence across all case surges before February 2021. Short-term PM2.5 and NO2 exposures were also associated. Our findings suggest that air pollution may play a role in increasing the risk of COVID-19 infection.

Near-roadway air pollution associated with COVID-19 severity and mortality - Multiethnic cohort study in Southern California.

BACKGROUND: Air pollution exposure has been associated with increased risk of COVID-19 incidence and mortality by ecological analyses. Few studies have investigated the specific effect of traffic-related air pollution on COVID-19 severity. OBJECTIVE: To investigate the associations of near-roadway air pollution (NRAP) exposure with COVID-19 severity and mortality using individual-level exposure and outcome data. METHODS: The retrospective cohort includes 75,010 individuals (mean age 42.5 years, 54% female, 66% Hispanic) diagnosed with COVID-19 at Kaiser Permanente Southern California between 3/1/2020-8/31/2020. NRAP exposures from both freeways and non-freeways during 1-year prior to the COVID-19 diagnosis date were estimated based on residential address history using the CALINE4 line source dispersion model. Primary outcomes include COVID-19 severity defined as COVID-19-related hospitalizations, intensive respiratory support (IRS), intensive care unit (ICU) admissions within 30 days, and mortality within 60 days after COVID-19 diagnosis. Covariates including socio-characteristics and comorbidities were adjusted for in the analysis. RESULT: One standard deviation (SD) increase in 1-year-averaged non-freeway NRAP (0.5 ppb NOx) was associated with increased odds of COVID-19-related IRS and ICU admission [OR (95% CI): 1.07 (1.01, 1.13) and 1.11 (1.04, 1.19) respectively] and increased risk of mortality (HR = 1.10, 95% CI = 1.03, 1.18). The associations of non-freeway NRAP with COVID-19 outcomes were largely independent of the effect of regional fine particulate matter and nitrogen dioxide exposures. These associations were generally consistent across age, sex, and race/ethnicity subgroups. The associations of freeway and total NRAP with COVID-19 severity and mortality were not statistically significant. CONCLUSIONS: Data from this multiethnic cohort suggested that NRAP, particularly non-freeway exposure in Southern California, may be associated with increased risk of COVID-19 severity and mortality among COVID-19 infected patients. Future studies are needed to assess the impact of emerging COVID-19 variants and chemical components from freeway and non-freeway NRAP.

Asthma Disease Status, COPD, and COVID-19 Severity in a Large Multiethnic Population.

BACKGROUND: Current studies of asthma history on coronavirus disease 2019 (COVID-19) outcomes are limited and lack consideration of disease status. OBJECTIVE: To conduct a population-based study to assess asthma disease status and chronic obstructive pulmonary disease (COPD) in relation to COVID-19 severity. METHODS: Patients diagnosed with COVID-19 (n = 61,338) in a large, diverse integrated health care system were identified. Asthma/COPD history, medication use, and covariates were extracted from electronic medical records. Asthma patients were categorized into those with and without clinical visits for asthma 12 or fewer months prior to COVID-19 diagnosis and labeled as active and inactive asthma, respectively. Primary outcomes included COVID-19-related hospitalizations, intensive respiratory support (IRS), and intensive care unit admissions within 30 days, and mortality within 60 days after COVID-19 diagnosis. Logistic and Cox regression were used to relate COVID-19 outcomes to asthma/COPD history. RESULTS: The cohort was 53.9% female and 66% Hispanic and had a mean age of 43.9 years. Patients with active asthma had increased odds of hospitalization, IRS, and intensive care unit admission (odds ratio 1.47-1.66; P < .05) compared with patients without asthma or COPD. No increased risks were observed for patients with inactive asthma. Chronic obstructive pulmonary disease was associated with increased risks of hospitalization, IRS, and mortality (odds ratio and hazard ratio 1.27-1.67; P < .05). Among active asthma patients, those using asthma medications had greater than 25% lower odds for COVID-19 outcomes than those without medication. CONCLUSIONS: Patients with asthma who required clinical care 12 or fewer months prior to COVID-19 or individuals with COPD history are at increased risk for severe COVID-19 outcomes. Proper medication treatment for asthma may lower this risk.

Ligand-protein interactions of plant-isolated (9z,12z)-octadeca-9,12-dienoic acid with Β-ketoacyl-Acp synthase (KasA) in potential anti-tubercular drug designing.

Mycobacterium tuberculosis remains one of the world's contributors to mortality. With the emergence of SARS-CoV-2 coinfections, patients with TB are predisposed to being more heavily weighed down by COVID-19 disease and its opportunistic coinfections. The severity of the disease coupled with drug resistance on the currently used drugs warrants for the search for alternative remedies from synthetic agents, semisynthetics and natural products that include plants. Africa is rich in plant diversity with a promise as sources of drug agents, one of which is Eichhornia crassipes. This work aimed at isolating a fatty acid and dock it to ß-ketoacyl-ACP synthase for possible anti-TB drug development prospects using computational tools. (9z,12z)-Octadeca-9,12-dienoic acid was isolated from Eichhornia crassipes for the first time using chromatographic techniques and identified using 1D and 2D NMR spectroscopic methods (1H NMR, COSY, HSQC, HMBC and 13C NMR). The compound was then docked to ß-ketoacyl-ACP synthase (KasA), an essential member of the b-ketoacyl synthases encoded in the M. tuberculosis genome in comparison with its co-crystallized ligand JSF-3285, also for the first time. (9z,12z)-Octadeca-9,12-dienoic acid interacted with only phenylalanine239 and proline201 while JSF-3285 interacted with proline201, glutamine120, alanine119, leucine116, glutamine199, histadine345, phenylalanine239, glycine240 and glycine200. (9z,12z)-Octadeca-9,12-dienoic acid had a ligand efficiency of 0.24, compared to the co-crystallized ligand's 0.36. The compound was too flexible and elongated with -4.72 KCalmol-1 binding energy. Despite some unfavourable physico-chemical properties, the compound still provides reliable interactions that only require logical structural modifications by the addition of polar regions amongst others to increase interactions and ligand efficiency, which can consequently stand to be a better potential drug lead. For the first time, plant-based (9z,12z)-Octadeca-9,12-dienoic acid isolated from Eichhornia crassipes was shown to interact fairly well with ß-ketoacyl-ACP synthase and proved to be a potential starting material from which anti-tubercular drugs can be designed.

COVID-19: public health management of the first two confirmed cases identified in the UK.

We report key learning from the public health management of the first two confirmed cases of COVID-19 identified in the UK. The first case imported, and the second associated with probable person-to-person transmission within the UK. Contact tracing was complex and fast-moving. Potential exposures for both cases were reviewed, and 52 contacts were identified. No further confirmed COVID-19 cases have been linked epidemiologically to these two cases. As steps are made to enhance contact tracing across the UK, the lessons learned from earlier contact tracing during the country's containment phase are particularly important and timely.