The impact of the implementation of medication for opioid use disorder and COVID-19 in a statewide correctional system on treatment engagement, postrelease continuation of care, and overdose.

BACKGROUND: People with opioid use disorder (OUD) are overrepresented in US correctional facilities and experience disproportionately high risk for overdose after release. Medications for OUD (MOUD) are highly efficacious but not available to most incarcerated individuals. In 2018, Vermont began providing MOUD for all incarcerated individuals with OUD statewide. In 2020, the COVID-19 state of emergency began. We assessed the impact of both events on MOUD utilization and treatment outcomes. METHODOLOGY: Analyses linked Vermont Department of Corrections administrative data and Medicaid claims data between 07/01/2017 and 03/31/2021. The study used logistic regression to analyze treatment engagement among all incarcerated individuals in Vermont. Multilevel modeling assessed change in clinical outcomes among release episodes that occurred among individuals with an OUD diagnosis Medicaid claim. RESULTS: Prescriptions for MOUD while incarcerated increased from 0.8% to 33.9% of the incarcerated population after MOUD implementation (OR = 67.4) and subsequently decreased with the onset of COVID-19 to 26.6% (OR = 0.7). After MOUD implementation, most prescriptions (63.1%) were to individuals who had not been receiving MOUD prior to incarceration, but this figure decreased to 53.9% with the onset of COVID-19 (OR = 0.7). Prescriptions for MOUD within 30 days after release increased from 33.9% of those with OUD before to 41.0% after MOUD implementation (OR = 1.4) but decreased to 35.6% with the onset of COVID-19 (OR = 0.8). Simultaneously, opioid-related nonfatal overdoses within 30 days after release decreased from 1.2% before to 0.8% after statewide MOUD implementation (OR = 0.3) but increased to 1.9% during COVID-19 (OR = 3.4). Fatal overdoses within 1 year after release decreased from 27 deaths before to ≤10 after statewide MOUD implementation and remained ≤10 during COVID-19. CONCLUSIONS: This longitudinal evaluation demonstrated increased treatment engagement and a decrease in opioid-related overdose following implementation of MOUD in a statewide correctional system. In contrast, these improvements were somewhat attenuated with the onset of COVID-19, which was associated with decreased treatment engagement and an increase in nonfatal overdoses. Considered together, these findings demonstrate the benefits of statewide MOUD for incarcerated individuals as well as the need to identify and address barriers to continuation of care following release from incarceration in the context of COVID-19.

Global Communications Newsletter Conferenc Report

From November 30 to December 02 2022, the IEEE Latin-American Conference on Communications (LATINCOM) returned to Brazil for its fourteenth edition. LATINCOM was held in the wonderful city of Rio de Janeiro, which had the privilege to offer attendees all its fantastic beauties comprising landscapes with a series of green mountains cascading down to the coast. LATINCOM's journey to Rio de Janeiro started in Medellín, Colombia, in 2009, Bogotá, also in Colombia, in 2010. It first appeared in Brazil, Belém, in 2011. Then it moved to Cuenca, Ecuador, in 2012, Santiago, Chile, in 2013, Cartagena de Indias, Colombia, in 2014, Arequipa, Peru, in 2015, Medellin, Colombia, in 2016, Guatemala City, Guatemala, in 2017, and Guadalajara, Mexico, in 2018. LATINCOM was held for a second time in Brazil, in Salvador, 2019. The conference was forced to go online in 2019, hybrid in 2021, in Santo Domingo, Dominican Republic, and then finally returning to the face-to-face format in 2022, in Rio de Janeiro. This brought to the 14th edition a remarkable characteristic, as it represented the return to in-presence conferences after the Covid-19 outbreak. LATIN-COM is held annually and attracts submissions and participants from around the globe. In 2022, the program was organized in three intensive days, including four keynote speeches, four tutorials, two workshops, and 16 technical sessions.

Tailored text message and web intervention for smoking cessation in U.S. socioeconomically-disadvantaged young adults: A randomized controlled trial.

The prevalence of cigarette smoking in young adults is higher among those with socioeconomic disadvantage than those without. Low treatment-seeking among young adult smokers is compounded by few efficacious smoking cessation interventions for this group, particularly socioeconomically-disadvantaged young adults (SDYA) who smoke cigarettes. The goal of this study was to test a tailored smoking-cessation intervention for SDYA. 343 SDYA aged 18-30 living in the U.S. (85% female) who smoke cigarettes with access to a smartphone and interest in quitting smoking in the next six months were recruited online in Spring 2020 and randomized to referral to online quit resources (usual care control; n = 171) or a 12-week tailored text message smoking-cessation program with a companion web-based intervention (n = 172). Intent to treat analyses examined associations between study condition, self-reported 30-day point prevalence abstinence (PPA), and confidence to quit smoking at 12 weeks, controlling for potential confounders. Intervention group participants had greater self-reported 30-day PPA at 12-weeks than controls (adjusted relative risk 3.93, 95% CI 2.14-7.24). Among those who continued smoking, the intervention increased confidence to quit (0.81 points, 95% confidence interval 0.08-1.53). Weekly engagement in the intervention predicted greater cessation. A tailored text message intervention for SDYA increased smoking abstinence and confidence to quit at the end-of-treatment. Findings may have been influenced by recruitment at the start of the COVID pandemic but suggest that text messaging is an acceptable and efficacious cessation strategy for SDYA smokers. Future studies should examine the impact on longer-term smoking-cessation and importance of intervention tailoring for SDYA.

Sindrome De Embolia Gordurosa Na Doenca Falciforme: Serie De Casos

Introducao: A Sindrome de embolia gordurosa e uma complicacao rara da doenca falciforme, descrita principalmente na doenca nao homozigotica. Resulta de extensa necrose da medula ossea (MO), durante crise vasoclusiva (CVO), com liberacao de embolos de gordura na circulacao e disfuncao organica multipla. Os criterios diagnosticos sao envolvimento de multiplos/unico orgao histologicamente comprovado por embolia gordurosa e/ou medular necrotica ou desenvolvimento de insuficiencia respiratoria aguda (IRpA) e manifestacoes neurologicas ou falencia de multiplos orgaos com evidencia de necrose medular (laboratorial ou histologica). Objetivos: Descrever caracteristicas clinicas, laboratoriais e de tratamento de 5 pacientes com sindrome de embolia gordurosa atendidos no HCFMUSP entre 10/2021 e 07/2022. Resultados: Os 5 casos eram HbSS (4 mulheres),1 em uso de hidroxiureia (HU), 2 sem HU por hepatotoxicidade e em programa transfusional, 1 interrompeu o tratamento e 1 nunca havia usado. Mediana de idade no evento: 34 (22-52) anos. Fatores desencadeantes provaveis em 3 pacientes: infeccoes por Influenza, Covid19 e S.aureus Oxacilina resistente. A admissao, todos apresentavam dor generalizada e dessaturacao;4 apresentavam confusao mental e rebaixamento do nivel de consciencia com TC de cranio normal;3 com consolidacao pulmonar sendo iniciado antibiotico. Medianas e ranges de exames a admissao: Hb 5,7 (3,6-7,2)g/dL;leucometria 30900 (8620-51600)/mm3, 2 com desvio ate mielocitos, 2 ate metamielocitos e 1 ate bastoes;eritroblastos 38,5 (2,5-53,8) EOC/100 leucocitos;plaquetas 208 (46-507) mil/mm3;DHL 1296 (502->6000)mg/dL;Cr 1,59 (0,94-3,72)mg/dL;BI/BD 2,32 (2,09-4,84)/3,4 (2,57-12,8)mg/dL;TGO 101 (44-289)mg/dL;TGP 19 (18-29)mg/dL;GGT 185 (118-423)mg/dL;FA 369 (142-1060)mg/dL. Durante a internacao, todos evoluiram com reacao leucoeritroblastica (desvio ate mielocitos/promielocitos), aumento de DHL, TGO, TGP, GGT, FA, BI, BD (predominio de BD) e lesao renal aguda, 3 evoluiram com plaquetopenia e 2 com reticulocitopenia. Todos receberam concentrado de hemacias nas primeiras 24h e durante a internacao (mediana 13;range 2-19), 2 iniciaram hemodialise e 2 foram intubados e receberam drogas vasoativas (DVA). Nenhum desenvolveu CIVD. A biopsia de MO de 1 paciente mostrou tecido hematopoietico difusamente necrotico de padrao isquemico. A mediana de internacao foi 11 dias (range 2-22). 1 paciente faleceu em 48h, 1 foi extubado e teve DVA suspensa apos 17 dias, 4 pacientes receberam alta com Hb proxima ao basal e leucometria, plaquetas e funcao renal normais. Discussao: A sindrome de embolia gordurosa e caracterizada por IRpA e manifestacoes neurologicas, podendo haver comprometimento das funcoes renal e hepatica alem de reacao leucoeritroblastica ou pancitopenia, quadro apresentado por nossos pacientes embora nossos casos destoem da literatura quanto ao genotipo, onde apenas 15% sao HbSS. Suspeitar do diagnostico e fundamental para o desfecho dos casos. Na suspeita, a instituicao rapida de terapia transfusional, para reduzir HbS, e determinante para a sobrevida. Uma revisao sistematica descreveu mortalidade de 29, 61 e 91% para quem recebeu troca, reposicao ou nenhuma transfusao, respectivamente. Conclusao: A falta de suspeita diagnostica dificulta o reconhecimento da sindrome, determinando taxas altas de mortalidade. Familiaridade com o quadro clinico e inicio imediato de terapia transfusional tem se mostrado os unicos indicadores de sobrevida. Copyright © 2022

Development of digital and science, technology, engineering, and mathematics skills in chemistry teacher training

Citizens of the twenty-first century use specific skills to solve real-life problem situations, propose interdisciplinary solutions, and sustainably solve their communities’ socio-scientific and technological problems, locally and globally. Science, technology, engineering, and mathematics (STEM) education is an integrated and interdisciplinary teaching-learning space. STEM careers are subject to gender gaps in terms of access to higher education, and only a quarter of female students follow a STEM career. Moreover, later in their professional careers, women often obtain lower salaries and income in the STEM professions. STEM education seeks to actively engage students by incorporating technologies into teaching-learning processes since, favoring searching, analysis, solution, and simulation of socio-scientific problems. The latter has become highly visible during the pandemic caused by COVID-19, particularly in emergency remote education measures. Information and communication technologies (ICT) plays a role in online education, either via the knowledge involved in school curricula or an understanding of how the pandemic has evolved. This is a triple task for professors since they must have the right skills to train citizens of the twenty-first century, build new stimulating learning spaces for their highly technologized students, and develop these skills in their students. This article reviews the concepts associated with digital and STEM skills by analyzing a case study, exploring the perception of students in terms of their development of these competencies, and the commitments required in the study plans made by a Professor of Chemistry in a Chilean state university. A mixed investigation was undertaken, considering three phases with different methodologies. The first phase consisted of a bibliographic study, comparing both the digital and STEM skills of several organizations in Chilean education (UNESCO, MINEDUC, and ISTE). ISTE was used as the basis of the applied questionnaire to establish coherence in the dimensions coming from different reference frames. A second phase refers to the analysis of the study plan programs associated with STEM, ICT, and chemistry teaching, through an Analysis Matrix of Aprioristic Categories. In a third phase, the development of digital skills in undergraduate Chemistry students and professors were evaluated through the Digital Competence Questionnaire of Higher Education Students. Based on UNESCO information, the STEM competencies address both the content and its application to problems related to STEM careers in a manner consistent with the training model for science and chemistry teachers. In the case of digital skills, UNESCO integrates international reference frameworks respecting each country’s laws, enabling them to adapt them. In Chile, MINEDUC focuses on teachers’ use of digital tools to improve the teaching-learning processes of students;and ISTE is focused on the skills of higher education. The analysis of the study programs shows that students’ digital skills do not meet the requirements of the Chilean Ministry of Education (MINEDUC). However, the programs enhance more complex cognitive levels when the curricula advance, promoting STEM skills. The digital competence questionnaire for higher education students (CDAES) survey showed a development proportional to the curricular pursuit of the students where, in the first year of the degree, the students declare positive answers in 60.5% of the items consulted. This trend increases in the second and third years (90.7% of positive answers) and the fourth and fifth years (93.0 and 95.4% of positive answers). It remains a challenge to develop skills to design, create or modify technological educational media that promote the use of digital and STEM skills. In conclusion, this research proposes digital and STEM skills for teacher training, discussing the relevance of their integration in STEM teaching and learning. The teacher training curriculum does not have an explicit association with digital and STEM skills, lthough it addresses the skills required by national and international benchmarks. However, the students indicate positive attitudes toward the digital skills developed progressively during their training as teachers. As future Chemistry teachers, they value the development of digital teaching skills that allow them to address the challenges that arise in the classroom and thus promote the appreciation of STEM careers, which helps form citizens with more sustainable intentions. Copyright © 2022 Elías, Pérez, Cassot, Carrasco, Tomljenovic and Zúñiga.

Neutropenia in patients treated with clozapine during COVID-19 infection

Introduction Clozapine is the most effective antipsychotic for treatment resistant schizophrenia but adverse reactions to clozapine include neutropenia. Patients with COVID-19 infection frequently experience lymphopenia, but not neutropenia.The impact of clozapine treatment in the presence of COVID-19 is unknown Objectives Show 2 cases of neutropenia in patients treated with long-term clozapine during COVID-19 infection. Methods Subjects: 48 admitted patients to a long-stay psychiatric unit. COVID-19 infection confirmed by positive nasopharyngeal swab for viral ribonucleic acid of SARS-CoV-2. Hematological controls between March and April 2020. Results 16 patients (33%) treated with clozapine.18 patients (37’5%) had COVID-19 infection, of which 5 (10’4%) were treated with clozapine;2 presented neutropenia. 1- 56-year-old woman diagnosed with schizophrenia on clozapine since 2009. Begins to have a dry cough and fever with positive COVID-19 swab (day 0). Slight leukopenia without neutropenia was observed on day 1. On day 7, neutropenia was observed with an absolute neutrophil count (ANC) of 1100. We decided to suspend clozapine and to initiate daily hematological controls. The ANC on day 8 was 970. Over the next few days the ANC will progressively improve until neutropenia resolved (day 22). 2- 55-year-old woman who required a transfer to a general hospital because of respiratory complications from COVID-19. She presented significant leukopenia (1’01x 10

RISK FACTORS for SEVERE COVID-19 INFECTION among PATIENTS with AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES (AIRD) and the IMPACT of VACCINATIONS-AN ISRAELI, MULTICENTER EXPERIENCE

Background: AIRD patients (pts) may be more susceptible to severe COVID19. Objectives: To determine the risk factors for severe COVID19 and the effect of vaccinations among AIRD pts followed at dedicated rheumatology clinics. Methods: At the onset of the pandemic, we established a national registry of AIRD pts, diagnosed with COVID19, based on voluntary reporting by the treating rheumatologist. 12 centers from Israel participated in the study. COVID19 was confrmed by a positive SARS CoV2 PCR. The indications for PCR testing were clinical symptoms or close contact with an infected person. Severe illness was defned by SpO2 <94% in room air, respiratory rate of >30 breaths/min, PaO2/FiO2 <300 mm Hg, or lung infltrates >50% on imaging. The registry included demographic data, AIRD diagnosis and duration, visceral involvement, co-morbidities, immunomodulatory treatment, date of diagnosis and severity of COVID19 disease, management, complications, duration of hospitalization, the dates of the mRNA vaccinations, lab results and outcome. We analyzed data from 1.3.2020 to 30.11.2021 Results: During the study period we experienced 4 outbreaks of COVID19 infection. Initially social distancing, followed by a lockdown were imposed. The low number of cases led to relaxation of the measures. Two more severe outbreaks followed, which triggered 2 new lockdowns. The 3rd outbreak ended almost 2 months after vaccination started (BNT162b2 mRNA COVID19 vaccine). From March 1st 2020 to April 30, 2021, 298 AIRD pts (70.8% females, mean (SD) age 53.3(15.3)) with confrmed COVID19 infection were included. 43.3%(129) had visceral involvement due to the AIRD. 58.7%(175 pts) were on conventional synthetic disease modifying drugs (csDMARDs), 44.6% (133) on biologic/targeted DMARDs and 40% (120) on prednisone. Almost 2/3 of pts had at least one comorbidity. In a multivariate logistic regression analysis age, AIRD with pulmonary involvement, diabetes and treatment with prednisone, mycophenolate mofetil or JAK inhibitors were associated with hospitalization. Older age, renal and vascular involvement due to the AIRD, and congestive heart failure were associated with higher mortality. The 4th outbreak occurred 6 months after the introduction of vaccines, with spreading of the delta variant: 110 AIRD pts with COVID19 were recorded. Demographic data, clinical AIRD's characteristics, immunomodulatory treatment and comorbidities were similar to the previous outbreaks. However, during the 4th outbreak, the proportion of pts with severe COVID19, the hospitalization and mortality rate were signifcantly lower as compared to the frst 3 outbreaks (15% vs 24%, 27% vs 53%, 6.7% vs 9.1%, respectively). Among COVID19 pts, 25% received a 3rd vaccine dose (booster), 56% contracted infection more than 5 months after the 2nd vaccine dose and 24% were unvaccinated. Most of the pts who received the booster contracted the disease within a week of vaccination. The odds ratio for hospitalization in vaccinated pts compared to unvaccinated was 0.11 (0.01-0.63 95% CI, p=0.041) in those vaccinated within the previous 1-5 months, and 0.38 (0.21-0.67 95% CI, p=0.001) in those vaccinated more than 6 months ago. 9 pts died, 5 were more than 6 months after the 2nd mRNA vaccine, 2 were unvaccinated and 1 patient received the booster on the same day of COVID19 diagnosis. Conclusion: Before the vaccination campaign, the hospitalization and mortality rate in our cohort were similar to the data reported by other registries. COVID19 tends to be more severe, with increased mortality in patients with active AIIRD and visceral involvement (pulmonary, cardiac, renal), advanced age and co-morbidities. The delta outbreak occured 6 months after the implementation of vaccinations and was associated with signifcantly lower hospitalization and mortality rates, despite the increased aggressiveness of the variant. Vaccination of AIIRD pts with 3 doses of mRNA vaccines protects from severe COVID19 disease, hospitalization, and death.

THE EFFECT of SECUKINUMAB on the HUMORAL RESPONSE FOLLOWING TWO and THREE DOSES of the BNT162B2 MRNA VACCINE in PATIENTS with SPONDYLOARTHRITIS

Background: Data on the effect of secukinumab on the humoral response to the BNT162b2 mRNA vaccine are limited. Objectives: We aimed to assess prospectively the humoral response to the BNT162b2 mRNA vaccine in patients with spondyloarthritis (SpA) treated with secukinumab in comparison to immunocompetent controls. Methods: Patients with psoriatic arthritis (PsA) or ankylosing spondylitis (AS) treated with secukinumab for at least 3 months and immunocompetent controls were vaccinated with two-dose regimen of the BNT162b2 mRNA vaccine. Clinical and laboratory assessments were performed at 2-8 weeks [SpA: 37 on secukinumab, (median age 53% female), 122 controls (median age 53, 51% female)], and 6 months [SpA: 27 on secukinumab, 116 controls] after the second vaccine dose. A subgroup of patients (22 SpA on secukinumab, 45 controls) were evaluated after the third vaccine dose. The seropositive response was defned as a detectable S1/S2 IgG ≥15 binding antibody units (BAU)/ml. Results: The two-dose vaccine regimen induced a similar immunogenic response in patients and controls refected by the seropositivity rates of 100% in both groups. After six months, the rate of seropositivity remained as high as 96% in both secukinumab-treated patients and immunocompetent controls. The decline of S1/S2 IgG titer within six months was similar in controls and secukinumab-treated patients,-66.4 (95% CI {-70.9,-39.9}) and-55 BAU/ml (95% CI {-95.42,-36.87)). Following the third vaccine, the seropositivity rate increased to 100 % in both groups. At all-time points, S1/S2 IgG titers were similar in secukinumab treated patients and immunocompetent controls (Figure 1). Conclusion: SpA patients treated with secukinumab consistently demonstrated an adequate humoral response to the BNT162b2 mRNA vaccination similar to immunocompetent controls, both short-term and within six months after two vaccine doses and after the third vaccine dose.

IMMUNOGENICITY INDUCED by TWO and THREE DOSES of the BNT162B2 MRNA VACCINE in PATIENTS with AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES and IMMUNOCOMPETENT CONTROLS: A LONGITUDINAL MULTI-CENTER STUDY

Background: Data on the kinetics of the immune response to SARS-CoV-2 vaccination in patients with autoimmune infammatory rheumatic diseases (AIIRD) are limited. Objectives: To evaluate the kinetics of the immune response induced by two and three doses of the BNT162b2 mRNA vaccine in adult patients with AIIRD and immunocompetent controls. Methods: A prospective multicenter study investigated the antibody response to the BNT162b2 vaccine by serial measurement of serum anti-SARS-CoV-2 S1/S2 IgG titers at the following time points: 2-6 weeks (AIIRD n=720, controls n=122) and six months (AIIRD n=628, controls=116) after the second vaccine dose, and 2-6 weeks after the third vaccine dose (AIIRD n=169, controls n=45). A seropositive response was defned as a detectable anti-S1/S2 IgG titer ≥ 15 BAU/ml. T-cell immune response was evaluated in a sample of patients (n=28) and controls (n=9) by intracellular staining of S-stimulated CD4+ T-cells for TNFα and IFNγ production. Results: The two-dose vaccine regimen induced a higher humoral response in controls compared to patients, as refected by the post-vaccination seroposi-tivity rates of 100% vs 84.72%, p<0.0001, and 96.55% vs 74.26%, p<0.0001 at 2-to-6 weeks and at 6 months, respectively. The decline of S1/S2 IgG titers within six months was similar in controls and patients. Following the 3rd vaccine, the seropositivity rate increased to 80.47% and 100% in AIIRD and control groups, p=0.0028, with a signifcantly higher increase of S1/S2 IgG titers in controls compared with AIIRD patients, 284.09±76.58 vs 219.39±151.55 BAU/ml, p=0.0016. At all-time points, S1/S2 IgG titers were signifcantly lower in AIIRD patients compared with controls (Figure 1). We further investigated the impact of therapies on the vaccine's immuno-genicity (Figure 1). Glucocorticoids (GC) were associated with a significantly lower seropositivity rate and lower S1/S2 IgG titers compared to controls at all time points. Monotherapy with methotrexate (MTX) was associated with a comparable to controls humoral response at all time points. Anti-cytokine biologics (TNFi, IL6i, IL17i) were associated with an initial high seropositivity rate, similar to controls, followed by a steeper decline at 6 months, 79.82% vs 96.55%, p=0.0001, and restoration of seropositivity after the 3rd vaccine dose in all patients. JAKi were associated with a mildly decreased seroposi-tivity rate after the 2nd vaccine dose and similar to controls response after the 3rd vaccine dose. Abatacept was associated with a reduced immunogenicity after the 2nd vaccine dose, but was restored to 100% seropositivity after the 3rd vaccine dose. Rituximab (RTX) significantly blunted the humoral response at all time points, with a seropositivity rate of 42% after the 2nd vaccine dose, 29% at 6 months, and with increase to 40% after the 3rd vaccine dose. A third of the RTX-treated patients who were seronegative after two vaccine doses, seroconverted after the 3rd dose. The multivariate model for predicting the seropositive response to vaccination found that higher S1/S2 IgG titers after the 2nd vaccine dose was associated with a higher seropositivity rate following the 3rd vaccine dose, OR 1.026 (1.008-1.045), p=0.0027, and that treatment with RTX was associated with a 14.3-fold risk for a negative humoral response, p≤0.0001. Cellular immune response, evaluated mainly in RTX treated patients, was preserved prior to and after the 3rd vaccine dose and was similar to controls. Conclusion: Over a six-month period, the two dose BNTb262 vaccination was associated with a similar extent of waning of the humoral immune response in AIIRD patients and controls. The 3rd vaccine dose restored the response in all controls and in patients treated with MTX monotherapy, anti-cytokine biolog-ics, abatacept, and JAKi. Treatment with GC and RTX was associated with an impaired humoral response at all time points.