Changes in Disease Etiology of Deceased Donor Liver Transplantations Following Acuity Circles Policy Implementation

Introduction: The Acuity Circles (AC) allocation policy was implemented on February 4, 2020, with the primary intent of reducing disparities in access to deceased donor liver transplants (DDLTs). Overall, it has been successful at achieving this goal. However, changes in end-stage liver disease etiology following the policy change have not been well-characterized. Our goal was to understand how primary etiology of disease in DDLTs has changed since implementation of AC. Method(s): Data from the Organ Procurement Transplantation Network (OPTN) and United Network of Organ Sharing (UNOS) were analyzed to compare the primary classified etiologies of liver disease for DDLTs overall and based on allocation Model-for-end-stage-liver-disease (aMELD) categories used for AC sharing: aMELD>=37, aMELD 33-36, aMELD 29-32, aMELD 15-28, and aMELD<=14 DDLTs. Time was divided into four equivalent "eras" of 256 days duration by date of transplantation: 1) 9/10/18-5/23/19 (Era 1);2) 5/24/19-2/3/20 (Era 2);3) 2/4/20-10/16/20 (Era 3);and 4) 10/17/20-6/29/21 (Era 4). Result(s): The percentage of all DDLTs for alcohol-related liver disease (ARLD) increased from 32.3% pre-AC to 38.7% of DDLTs post AC. This was met with a corresponding decrease in the relative percentage of DDLTs related to Hepatitis C Virus (from 17.0% of DDLTs pre-AC to 12.2% post-AC), with the relative differences of other etiologies being a less than 1% difference pre- vs post- AC. There is a consistent increase in the share of DDLTs due to ARLD across each Era. The rise in adult DDLTs for ARLD was most pronounced among aMELD >=37 recipients, although similar trends were seen among aMELD 33-36 and aMELD 29-32 groups, but not aMELD 15-28 and aMELD <=14 groups. The median age of adult DDLTs for ARLD decreased consistently over time for the aMELD >=37 group, but not for the aMELD 33-36 and aMELD 29-32 groups. (Figure) (Table) Conclusion(s): Following implementation of AC, there was a relative increase in DDLTs due to ARLD. The younger age and high aMELD scores of these patients suggests these may be largely among patients with acute alcoholic hepatitis. This would align with published data on the overall increase in liver transplantation due to ARLD during the COVID-19 pandemic. (Figure Presented).

Impact of COVID-19 & Response Measures on HIV-HCV Prevention Services and Social Determinants in People Who Inject Drugs in 13 Sites with Recent HIV Outbreaks in Europe, North America and Israel.

HIV/HCV prevention among people who inject drugs (PWID) is of key public health importance. We aimed to assess the impact of COVID-19 and associated response measures on HIV/HCV prevention services and socio-economic status of PWID in high-HIV-risk sites. Sites with recent (2011-2019) HIV outbreaks among PWID in Europe North America and Israel, that had been previously identified, were contacted early May 2020. Out of 17 sites invited to participate, 13 accepted. Semi-structured qualitative site reports were prepared covering data from March to May 2020, analyzed/coded and confirmed with a structured questionnaire, in which all sites explicitly responded to all 103 issues reported in the qualitative reports. Opioid maintenance treatment, needle/syringe programs and antiretroviral treatment /hepatitis C treatment continued, but with important reductions and operational changes. Increases in overdoses, widespread difficulties with food and hygiene needs, disruptions in drug supply, and increased homelessness were reported. Service programs rapidly reformed long established, and politically entrenched, restrictive service delivery policies. Future epidemic control measures should include mitigation of negative side-effects on service provision and socio-economic determinants in PWID.

RESUMEN: La prevención del VIH/VHC entre las personas que se inyectan drogas (PWID) es de vital importancia para la salud pública. Nuestro objetivo fue evaluar el impacto de COVID-19 y las medidas de respuesta asociadas en los servicios de prevención del VIH/VHC y el estado socioeconómico de las PWID en sitios de alto riesgo de VIH. Se contactó con sitios con brotes recientes (2011­2019) de VIH entre PWID en Europa, América del Norte e Israel, que habían sido previamente identificados, a principios de mayo de 2020. De los 17 sitios invitados a participar, 13 aceptaron. Se prepararon informes cualitativos semiestructurados del sitio que cubrían los datos de marzo a mayo de 2020, analizados/codificados y confirmados con un cuestionario estructurado, en el que todos los sitios respondieron explícitamente a los 103 asuntos reportados en los informes cualitativos. El tratamiento de mantenimiento con opiáceos, los programas de agujas/jeringas y el tratamiento antirretroviral/tratamiento de la hepatitis C continuaron, pero con importantes reducciones y cambios operativos. Se reportaron aumentos en las sobredosis, dificultades generalizadas con las necesidades alimentarias y de higiene, interrupciones en el suministro de medicamentos y aumento de personas sin hogar. Los programas de servicios reformaron rápidamente las políticas restrictivas de prestación de servicios, establecidas desde hace mucho tiempo y políticamente arraigadas. Las futuras medidas de control de epidemias deben incluir la mitigación de los efectos secundarios negativos en la prestación de servicios y los determinantes socioeconómicos en las PWID.

The U.S. power sector emissions of CO2 and NOx during 2020: Separating the impact of the COVID-19 lockdowns from the weather and decreasing coal in fuel-mix profile

In recent years, the United States power sector emissions of CO2 and NOx have decreased due to declining coal and increasing natural gas and renewables in the fuel-mix. In April 2020, the COVID-19 social restrictions in the United States led to a decline in electricity demand from the commercial and industrial sectors. In this study, we estimate the changes in the emissions of CO2 and NOx from the U.S. power sector due to three factors: 1) weather, 2) the fuel-mix change in the past five years, and 3) the COVID-19 social restrictions. We use a multivariate adaptive regression splines (MARS) model to separate the impacts of outdoor temperature and type-of-day from the COVID-19 on power generation, and the daily operation status of 3013 power units to account for the fuel-mix change. We find that electricity demand changes due to COVID occurred mostly from March to June 2020, with electricity demand generally returning to 2015–2019 levels starting in July 2020. We find the U.S. power sector CO2 emissions, reported by EPA, dropped by 29.8 MTCO2 (−26%) in April 2020, relative to the average April emissions between 2015 and 2019. Of that reduction, we attribute declines of 18.3 ± 4.0 MTCO2 (−18 ± 4%) to the COVID-19 lockdowns, declines of 13.7 ± 4.2 MTCO2 (−12 ± 4%) to a fuel-mix change, and increases of 2.3 ± 1.1 MTCO2 (+2 ± 1%) due to weather variability compared to the five prior years. For the same month, the power sector NOx emissions dropped by 27.6 thousand metric tons (−42%) in April 2020, relative to the past five-year monthly average. Of that reduction, we attribute declines of 10.5 ± 2.4 thousand metric tons (−22 ± 5%) to the COVID-19 lockdowns, declines of 18.5 ± 2.5 thousand metric tons (−28 ± 4%) to a fuel-mix change, and increases of 1.4 ± 0.6 thousand metric tons (+2 ± 1%) due to weather variability. This result highlights the importance of accounting for weather and fuel-mix changes when estimating the impact of COVID-19 on the power sector emissions.

KNOWLEDGE AND PRACTICES REGARDING COVID19 IN INNER-CITY PATIENTS WITH CHRONIC KIDNEY DISEASE (CKD) OR KIDNEY TRANSPLANT (KTX)

Studies have shown that COVID19 is associated with worse outcomes in older pts (OPs) with underlying conditions. We studied an inner-city population to look for differences in attitudes and behaviors in older vs younger pts in a high-risk population with CKD or KTx. A random sample of pts from Kidney Transplant (40) and CKD clinics (20) were interviewed by phone, concerning views of, knowledge of, and practices relating to COVID19. There were no differences noted in between clinics so all data were analyzed together. Pts were grouped as older (OP, age>65, n=40) and younger, (YP, age<65, n=20). Analysis was by Chi-square or t-test as appropriate. Mean age overall was 58.7±12.0 yrs. There were 28 (47%) men and 32 (53%) women with 42 (70%) Black, 6 (10%) Hispanic, 3 (5%) White, and 9 (15%) others. 31 (52%) had a current history of diabetes, 53 (88%) had a current history of HTN, 10 (17%) had not completed high school and 30 (50%) not attended college. OP were more likely to have DM (p<0.01) with no difference for HTN or hypercholesterolemia. There was no difference in gender or educational level between the two populations, but OP were more likely to be retired, unemployed, or on disability (p=0.01). Regarding beliefs about COVID19, OP were less afraid (p=0.015), with no difference regarding the importance of social distancing, knowing how to protect oneself or fear of getting the infection from family or friends. Regarding knowledge of COVID, OP were more likely to believe that white people are less likely to get it (p=0.049) and that vitamins can help prevent it (p=0.03). There were no significant differences between the populations regarding knowledge of asymptomatic presentation, droplet-based spread, or on whether the virus is preventable. Both populations were adequately knowledgeable on these topics based on their abilities to identify the correct answer to the yes/no questions we provided. Regarding patient health and social distancing practices, we found that OP were more likely to avoid leaving their home (p=0.043), equally likely to cover their face/nose while sneezing/coughing, wash their hands, and use face masks in crowds, and more likely to take a vitamin supplement (p=0.039) compared to YP. In our CKD and KTx population: 1. Pts at an increased risk for contracting and dying from COVID19 due to older age are more likely to have DM when compared to YP, placing them further at risk for COVID19 related complications. 2. Older pts feel less threatened by COVID than younger pts, despite their increased risks. 3. Older pts avoid leaving their home more than younger pts, which may allow them to feel less threatened by COVID19. In part this may be due to older pts being retired or unemployed with younger pts having to leave home for work. 4. Older pts are more likely to believe that vitamins can prevent COVID19 and are more likely to take a vitamin supplement than younger pts. This misinformation may also lead them to feel less threatened by COVID19, although their acceptance of public health recommendations seems equal to that of younger pts. 5. Further examination of the beliefs, knowledge, and practices relating to COVID19 in this high-risk population is warranted to create educational programs for them in order to best protect them during the current and future pandemics.

Influence of conducive weather on ozone in the presence of reduced NOx emissions: A case study in Chicago during the 2020 lockdowns

This study analyzes the response of near-surface O3 in Chicago to the COVID-19 lockdowns using observational data at the surface and from satellite. Even though the lockdowns caused NOx emissions to decrease by 18%, Chicago still experienced 17 high-O3 (>70 ppb) days in 2020, and the mean O3 mixing ratio did not show a significant change in 2020 compared with 2015–2019. Ozone production in summer 2020 in Chicago was in the “transitional” regime (HCHO/NO2 column ratio = 2.9), and not sensitive to changes in NOx in either direction. The primary driver for Chicago's O3 exceedances in 2020 was the dry tropical (DT) weather, which was associated with hot, dry, and stagnant meteorological conditions. There were 15 DT days in 2020, which led to more efficient production and greater accumulation of O3. The results suggest that a dramatic one-year 18% NOx reduction can be overcome by conducive meteorology and that NOx and VOC controls need to be more substantial and wide-ranging. This study also highlights the important role of different climate regimes, and not solely temperature, on the formation of O3. © 2022 Turkish National Committee for Air Pollution Research and Control

National population prevalence of antibodies to SARS-CoV-2 among pregnant women in Scotland during the second wave of the COVID-19 pandemic: a prospective national serosurvey.

OBJECTIVES: This study aimed to determine SARS-CoV-2 seroprevalence among pregnant women in the Scottish population during the second wave of the COVID-19 pandemic. STUDY DESIGN: Prospective national serosurvey. METHODS: We tested 13,428 residual samples retrieved from pregnant women participating in the first trimester combined ultrasound and biochemical screening for fetal trisomy across Scotland for SARS-CoV-2 antibodies over a 6-month period from November 2020 to April 2021. Seroprevalence estimates were adjusted for the sensitivity and specificity of the assays and weighted to reference populations. RESULTS: Seroprevalence rates in the antenatal samples significantly increased from 5.5% (95% confidence interval [CI] 4.7%-6.5%) in the 5-week period up to and including International Organization for Standardization (ISO) Week 51 (w/b Monday 14 December 2020) to 11.3% (95% CI 10.1%-12.6%) in the 5-week period up to and including ISO Week 14 (w/b Monday 5 April 2021). Increasing seroprevalence trends across the second wave were observed among all age groups. CONCLUSIONS: By the end of the second wave of the COVID-19 pandemic, approximately one in 10 women tested around the end of the first trimester of pregnancy had antibodies to SARS-CoV-2, suggesting that the vast majority were still susceptible to COVID-19 as they progressed to the later stages of pregnancy, when risks from infection are elevated for both mother and baby.

National population prevalence of antibodies to SARS-CoV-2 in Scotland during the first and second waves of the COVID-19 pandemic.

OBJECTIVES: Studies that measure the prevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ('seroprevalence') are essential to understand population exposure to SARS-CoV-2 among symptomatic and asymptomatic individuals. We aimed to measure seroprevalence in the Scottish population over the course of the COVID-19 pandemic - from before the first recorded case in Scotland through to the second pandemic wave. STUDY DESIGN: The study design of this study is serial cross sectional. METHODS: We tested 41,477 residual samples retrieved from primary and antenatal care settings across Scotland for SARS-CoV-2 antibodies over a 12-month period from December 2019-December 2020 (before rollout of COVID-19 vaccination). Five-weekly rolling seroprevalence estimates were adjusted for the sensitivity and specificity of the assays and weighted to reference populations. Temporal trends in seroprevalence estimates and weekly SARS-CoV-2 notifications were compared. RESULTS: Five-weekly rolling seroprevalence rates were 0% until the end of March, when they increased contemporaneously with the first pandemic wave. Seroprevalence rates remained stable through the summer (range: 3%-5%) during a period of social restrictions, after which they increased concurrently with the second wave, reaching 9.6% (95% confidence interval [CI]: 8.4%-10.8%) in the week beginning 28th December in 2020. Seroprevalence rates were lower in rural vs. urban areas (adjusted odds ratio [AOR]: 0.70, 95% CI: 0.61-0.79) and among individuals aged 20-39 years and 60 years and older (AOR: 0.74, 95% CI: 0.64-0.86; AOR: 0.80, 95% CI: 0.69-0.91, respectively) relative to those aged 0-19 years. CONCLUSIONS: After two waves of the COVID-19 pandemic, less than one in ten individuals in the Scottish population had antibodies to SARS-CoV-2. Seroprevalence may underestimate the true population exposure as a result of waning antibodies among individuals who were infected early in the first wave.

COVID-19 Induced Fingerprints of a New Normal Urban Air Quality in the United States

Abstract Most countries around the world including the United States took actions to control COVID-19 spread that led to an abrupt shift in human activity. On-road NOx emissions from light and heavy-duty vehicles decreased by 9% to 19% between February and March at the onset of the lockdown period in the middle of March in most of the US;between March and April, the on-road NOx emissions dropped further by 8% to 31% when lockdown measures were the most stringent. These precipitous drops in NOx emissions correlated well (r = 0.75) with tropospheric NO2 column amount observed by the Sentinel 5 Precursor TROPOspheric Monitoring Instrument (S5P TROPOMI). Furthermore, the changes in TROPOMI tropospheric NO2 across the continental US between 2020 and 2019 correlated well with changes in on-road NOx emissions (r = 0.68) but correlated weakly with changes in emissions from the power plants (r = 0.35). At the height of lock-down related unemployment in the second quarter of 2020, the tropospheric NO2 values decreased at the rate of 0.8 µmoles/m2 per unit percentage increase in the unemployment rate. Despite the lifting of lockdown measures, parts of the US continued to have ?20% below normal on-road NOx emissions. To achieve this new normal urban air quality in the US, continuing remote work policies that do not impede economic growth may become one of the many options.

Programming in a Pandemic: Attaining Academic Integrity in Online Coding Courses

The coronavirus disease of 2019 (COVID-19) pandemic has necessitated a transition to online courses, prompting widespread consequences for higher education. Ensuring academic integrity poses a serious concern in these circumstances. Drawn from my experiences teaching online programming courses, I discuss the considerable and manifold flaws in our current anti-cheating measures. I propose a series of strategies that instructors can pursue to make assessments more resilient to cheating. Although there is no panacea, we must begin by acknowledging the problem facing us and discussing earnestly how we can refortify academic integrity.

Unforeseen consequences of the COVID-19 pandemic: Increased frequency of kite-string injuries in magnificent frigatebirds (Fregata magnificens) in Rio de Janeiro state, Brazil

Kite flying is a popular hobby and sport for children and adults. Despite being illegal in Rio de Janeiro state, Brazil, the use of abrasive threads remains widespread and poses a health risk to both humans and animals. In this study, we analysed the records of 462 magnificent frigatebirds (Fregata magnificens) submitted to rehabilitation centres or found dead along the southern coast of Rio de Janeiro state from October 2016 to August 2020. Of these, 244 individuals (52.8%) presented wing lesions consistent with kite-string injury, which can have a critical impact on the ability of frigatebirds to fly and will ultimately cause their death. Even when veterinary care is provided, only a small proportion of the individuals (2%) will fully recover the ability to fly in order to be released back to the wild. In 2020, an atypical increase in the number of individuals with kite-string injuries (similar to 1,200% increase compared to other years) was noted in the weeks following the suspension of school activities and commerce in response to the COVID-19 pandemic. The number of frigatebirds with kite-string injuries recorded in a given week was positively correlated with internet searches for kite-related terms, which also peaked during the quarantine period of the COVID-19 pandemic. This illustrates how pandemic events may aggravate existing human-wildlife conflicts, and how preparedness plans need to incorporate measures to help communities cope with boredom and isolation during quarantine in ways that do not negatively impact the welfare and conservation of wildlife.

Complex differences in infection rates between ethnic groups in Scotland: a retrospective, national census-linked cohort study of 1.65 million cases.

BACKGROUND: Ethnicity can influence susceptibility to infection, as COVID-19 has shown. Few countries have systematically investigated ethnic variations in infection. METHODS: We linked the Scotland 2001 Census, including ethnic group, to national databases of hospitalizations/deaths and serological diagnoses of bloodborne viruses for 2001-2013. We calculated age-adjusted rate ratios (RRs) in 12 ethnic groups for all infections combined, 15 infection categories, and human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV) viruses. RESULTS: We analysed over 1.65 million infection-related hospitalisations/deaths. Compared with White Scottish, RRs for all infections combined were 0.8 or lower for Other White British, Other White and Chinese males and females, and 1.2-1.4 for Pakistani and African males and females. Adjustment for socioeconomic status or birthplace had little effect. RRs for specific infection categories followed similar patterns with striking exceptions. For HIV, RRs were 136 in African females and 14 in males; for HBV, 125 in Chinese females and 59 in males, 55 in African females and 24 in males; and for HCV, 2.3-3.1 in Pakistanis and Africans. CONCLUSIONS: Ethnic differences were found in overall rates and many infection categories, suggesting multiple causative pathways. We recommend census linkage as a powerful method for studying the disproportionate impact of COVID-19.

Enhanced surveillance of COVID-19 in Scotland: population-based seroprevalence surveillance for SARS-CoV-2 during the first wave of the epidemic.

OBJECTIVES: The impact of the COVID-19 pandemic in Scotland has been amongst the most severe in Europe. Serological surveillance is critical to determine the overall extent of infection across populations and to inform the public health response. This study aimed to estimate the proportion of people who have antibodies to SARS-CoV-2 ('seroprevalence') in the general population of Scotland and to see if this changes over time. STUDY DESIGN/METHODS: Between International Organization for Standardization (ISO) week 17 (i.e. week commencing 20th April) and ISO week 25 (week commencing 15 June), 4751 residual blood samples were obtained from regional biochemistry laboratories in six participating regional health authority areas covering approximately 75% of the Scottish population. Samples were tested for the presence of anti-SARS-CoV-2 IgG antibodies using the LIAISON®SARS-CoV-2 S1/S2 IgG assay (DiaSorin, Italy). Seroprevalence rates were adjusted for the sensitivity and specificity of the assay using Bayesian methods. RESULTS: The combined adjusted seroprevalence across the study period was 4.3% (95% confidence interval: 4.2%-4.5%). The proportion varied each week between 1.9% and 6.8% with no difference in antibody positivity by age, sex or geographical area. CONCLUSIONS: At the end of the first wave of the COVID-19 pandemic, only a small fraction of the Scottish population had antibodies to SARS-CoV-2. Control of COVID-19 requires the ability to detect asymptomatic and mild infections that would otherwise remain undetected through existing surveillance systems. This is important to determine the true number of infections within the general population which, in turn, can help to understand transmission, inform control measures and provide a denominator for the estimation of severity measures such as the proportion of infected people who have been hospitalised and/or have died.