Applicant Assessment During Virtual Interview as Compared to In-Person Ratings

Rationale: Pulmonary and Critical Care Medicine (PCCM) Fellowship interviews transitioned to virtual format 2020 due to the COVID-19 pandemic, yet the impact of virtual interviewing on interviewer assessments remains unknown. Virtual interviewing has the potential to negatively impact interviewer perceptions of interpersonal skills given the challenges of video-based conferencing. We aimed to assess differences in quantitative ratings across four interview domains for in-person compared to virtual interviews, as well as for sentiment differences in accompanying narrative comments. Methods: We performed a single-center retrospective cohort study of all interview assessments completed for the University of Pennsylvania PCCM fellowship program for the 2019 interview season (in-person) and 2020 interview season (virtual). Interview assessments consisted of four discrete domains (leadership, interpersonal and communication skills [ICS], scholarship, and clinical skills) on a 5-point rating scale, submitted via an online evaluation. Each numeric rating was accompanied by optional free-text comments, in addition to a free-text field for overall impressions. Summary statistics of ratings were calculated for each domain, and t-tests (p 0.05) were used to assess for statistically significant differences between years. Free-text comments were assessed using Linguistic Inquiry and Word Count (LIWC) analysis, which calculates the degree to which various categories of words are used in a text and quantifies the overall sentiment of text. Results: 104 unique residents where included in the cohort, with 52 in each season. The cohort consisted of 52% (n=54) women. Fifteen-percent (n=16) of candidates identified as under-represented in medicine. (Table) Overall mean ratings in each of the four domains (leadership, ICS, scholarship, and clinical skills) were 3.76 (+/-0.79), 3.55 (+/-1.09), 3.69 (+/-0.89), and 3.97 (+/-0.76), respectively. There were no significant differences between in-person and virtual formats in mean ratings for clinical skills (p=0.25), leadership (p=0.73), or scholarship (p=0.48). However, the mean ICS rating was significantly higher during virtual interviews compared to in-person interviews (3.96 versus 3.15, p < 0.001). There was no significant difference in LIWC sentiment analysis rating in the free-text domains, including for comments in the ICS domain. Conclusions: Virtual interviews led to higher mean ratings in ICS, compared to in-person interviews, with no text-based differences in narrative comments. These differences were not demonstrated in other domains, including leadership, clinical skills, and scholarship. This finding was unexpected, especially given the decreased proportion of women applicants in 2020, and may suggest leniency bias in ratings of ICS in virtual interview formats.

Temporal Trendsin Humoral and Cellular Immune Responsesto SARS-CoV-2 mRNA Vaccines Among Multiple Sclerosis Patients TreatedWith Natalizumab, Ocrelizumab or Fumarates

Objective: To examine the temporal trends of humoral and cell-mediated immune responses to SARS-CoV-2 mRNA vaccines among multiple sclerosis (MS) patients on different immunomodulatory therapies. Background: The impact of various MS medications on the immune responses to SARS-CoV-2 vaccine is of acute interest to patients and clinicians. Design/Methods: 22 MS patients treated with ocrelizumab (OCR, n=9), natalizumab (NTZ, n=8), fumarates (FUM, n=5;diroximel fumarate, 3 and dimethyl fumarate, 2) received BNT162b2 (Pfizer, n=15) or mRNA-1273 (Moderna, n=7) vaccines. Blood samples were collected before and after each of the two vaccine doses, and 2 months after second vaccine dose. AntiSARS-CoV-2 spike protein titers were measured using quantitative assay (Labcorp). Antibody neutralization was measured with a lentivirus-based pseudovirus particle expressing the D614 spike protein (Labcorp-Monogram Biosciences). T-cell reactivity was determined by measuring interferon-gamma and interleukin-2 in response to stimulation with SARS-CoV-2 peptides. Results: All patients in NTZ and FUM cohorts, but only 22% (2/9) of OCR cohort developed anti-spike and neutralizing antibodies. The highest titers were measured after the second vaccine dose, without significant difference between the NTZ and FUM cohorts in anti-spike IgG (69.7+/-55.1 vs 56.0+/-36.7 arbitrary units/ml) or neutralizing ID50 (1513+/-1317 vs 942+/ -566). Two months after the second vaccine, the antibody titers and neutralizing ID50 decreased by 72% and 79% in NTZ cohort, respectively, and by 45% and 49% in FUM cohort. T-cell reactivity was observed in all cohorts as early as 7 days after the first vaccine, and further increased following the second vaccine. Conclusions: Patients on NTZ and FUM mounted robust antibody responses to SARS-CoV-2 mRNA vaccines, in contrast to OCR-treated patients. T-cell responses were comparable among all three treatment cohorts. Two months after the second vaccine, the serological responses decreased by 45-79%. These findings may inform the optimal timing of additional vaccine doses for MS patients.

"COVID vaccine" Google searches predict increases in percent anxiety and depression within the United States

BACKGROUND: The recent COVID-19 pandemic continues to have a profound impact on people's lives worldwide. Apart from the physical threat of the virus, COVID-19 poses varying psychological risks to mental health. In this study, we explore relationships between the frequency of web searches for "COVID vaccine based on Google Trends (Google LLC, Mountain View, CA, USA) time series data and percent anxiety/depression expressed by USA adults using preprocessed CDC data from April 23, 2020, to July 21, 2020. METHODS: We employed the Pearson's correlation coefficient and descriptive statistics to quantify the correlation between two variables, Google searches and anxiety as well as Google searches and depression. RESULTS: We find that both significant and positive correlations exist between Google searches for a vaccine and percent anxiety (r=0.81;P value = 0.001) and depression (r=0.77;P value = 0.003) expressed by adults nationally. Furthermore, we find that positive associations exist between statewide Google searches and levels of anxiety (Indiana leading with r=0.90;P value <0.001) and depression (Idaho leading with r=0.85;P value <0.001). CONCLUSIONS: We found that there is significant positive correlation between Google searches and anxiety and depression in the USA.

Making Sense of Security

This Article theorizes “security” as a site of continuing struggle in the international system between competing approaches to identifying and responding to urgent threats. Rather than endorsing a single approach, this Article argues that a claim to “security” can imply any one of four approaches to law and policy, each of which has radically divergent implications for who is empowered by a security claim and how that power interacts with existing legal rules. By moving among these four approaches, security claims can disrupt established systems of knowledge-production and redescribe the world in new ways.

Magnitude and Dynamics of the T-Cell Response to SARS-CoV-2 Infection and Vaccination

Background. T cells are central to the early identification and clearance of viral infections and support antibody generation by B cells, making them desirable for assessing the immune response to SARS-CoV-2 infection and vaccines. We combined 2 high-throughput immune profiling methods to create a quantitative picture of the SARS-CoV-2 T-cell response that is highly sensitive, durable, diagnostic, and discriminatory between natural infection and vaccination. Methods. We deeply characterized 116 convalescent COVID-19 subjects by experimentally mapping CD8 and CD4 T-cell responses via antigen stimulation to 545 Human Leukocyte Antigen (HLA) class I and 284 class II viral peptides. We also performed T-cell receptor (TCR) repertoire sequencing on 1815 samples from 1521 PCR-confirmed SARS-CoV-2 cases and 3500 controls to identify shared public TCRs from SARS-CoV-2-associated CD8 and CD4 T cells. Combining these approaches with additional samples from vaccinated individuals, we characterized the response to natural infection as well as vaccination by separating responses to spike protein from other viral targets. Results. We find that T-cell responses are often driven by a few immunodominant, HLA-restricted epitopes. As expected, the SARS-CoV-2 T-cell response peaks about 1-2 weeks after infection and is detectable at least several months after recovery. Applying these data, we trained a classifier to diagnose past SARS-CoV-2 infection based solely on TCR sequencing from blood samples and observed, at 99.8% specificity, high sensitivity soon after diagnosis (Day 3-7 = 85.1%;Day 8-14 = 94.8%) that persists after recovery (Day 29+/convalescent = 95.4%). Finally, by evaluating TCRs binding epitopes targeting all non-spike SARS-CoV-2 proteins, we were able to separate natural infection from vaccination with > 99% specificity. Conclusion. TCR repertoire sequencing from whole blood reliably measures the adaptive immune response to SARS-CoV-2 soon after viral antigenic exposure (before antibodies are typically detectable) as well as at later time points, and distinguishes post-infection vs. vaccine immune responses with high specificity. This approach to characterizing the cellular immune response has applications in clinical diagnostics as well as vaccine development and monitoring.

The Perils of Pandemic Exceptionalism

In response to the pandemic, most states have enacted special measures to protect national economies and public health. Many of these measures would likely violate trade and investment disciplines unless they qualify for one of several exceptions. This Essay examines the structural implications of widespread anticipated defenses premised on the idea of “exceptionalism.” It argues that the pandemic reveals the structural weakness of the exceptions-oriented paradigm of justification in international economic law.