Polymorphism and Selection Pressure of SARS-CoV-2 Vaccine and Diagnostic Antigens: Implications for Immune Evasion and Serologic Diagnostic Performance.

The ongoing SARS-CoV-2 pandemic has triggered multiple efforts for serological tests and vaccine development. Most of these tests and vaccines are based on the Spike glycoprotein (S) or the Nucleocapsid (N) viral protein. Conservation of these antigens among viral strains is critical to ensure optimum diagnostic test performance and broad protective efficacy, respectively. We assessed N and S antigen diversity from 17,853 SARS-CoV-2 genome sequences and evaluated selection pressure. Up to 6-7 incipient phylogenetic clades were identified for both antigens, confirming early variants of the S antigen and identifying new ones. Significant diversifying selection was detected at multiple sites for both antigens. Some sequence variants have already spread in multiple regions, in spite of their low frequency. In conclusion, the N and S antigens of SARS-CoV-2 are well-conserved antigens, but new clades are emerging and may need to be included in future diagnostic and vaccine formulations.

Appreciative inquiry of a non-profit organization transitioning to teletherapy

Mental health professionals have been required to make a transition to delivering services using technology during the COVID-19 pandemic. The non-profit agency participating in this study had already listed on its strategic plan the delivery of teletherapy. In 2020, due to the pandemic, the agency decided to expedite the delivery of teletherapy services. This study explored the experiences of the agency's team, to determine what worked well while making this transition, as well as future dreams regarding the delivery of teletherapy. Appreciative inquiry was used as the method of data collection. Findings indicated the agency's clinicians found keeping a positive attitude themselves, receiving support from clients, and equal funding for teletherapy as for in person services on the part of the funders, were key to making the initial transition (Discovery phase);that agency clinicians considered that sustained outreach to both publicize and educate about teletherapy to clients and other community agencies had already proved helpful and is in need of more expansion (Dream phase);and that long term, agency clinicians would like to keep using teletherapy even after the pandemic (Design phase), with improved technology and additional training about teletherapy for both clients and clinicians (Destiny phase). The findings of this study may provide a foundation for other agencies that are in the process of transitioning from in person to virtual services. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Towards online delivery of Dialectical Behaviour Therapy: A scoping review.

Dialectical Behaviour Therapy (DBT) programmes are often the only available treatment for people diagnosed with borderline personality disorder and were rapidly converted to online delivery during the COVID-19 pandemic. Limited research exists surrounding how the major elements of DBT are delivered in an online environment. This scoping review considered the operationalization of online delivery of DBT and its effectiveness. EBSCO host databases were searched using free text. Of 127 papers, 11 studies from 2010 to 2021 investigating online DBT for any clinical population were included in the review. A narrative synthesis of papers selected was undertaken. Seven articles reported results from five clinical trials (n = 437). Most adaptations mirrored face-to-face programmes although there was considerable variation in how therapy was facilitated. Attendance was reported to be greater online with comparable clinical improvements to face-to-face for those who remained in therapy. Additional challenges included managing risk, therapist preparedness and technology difficulties. Online delivery of DBT programmes is feasible and may be more accessible, acceptable and as safe and effective as face-to-face delivery. However, mirroring face to face delivery in an online environment may not be the most effective and efficient way to adapt DBT to online provision. Research is needed to identify areas which require further adaptation.

A Nonprofit's Transition to Teletherapy Due to the COVID-19 Crisis: Learning How to Adapt

Due to the state of the COVID-19 in Florida, a community-based agency serving children and families had to transition abruptly to teletherapy. This agency adapted to pandemic-related challenges by transitioning from in-person to virtual therapy, which played a key role in safely serving community members. This article explores the unique benefits and difficulties of the transition to teletherapy under those circumstances. The agency clinical staff utilized their brief therapy skills and strengths-oriented perspective to aid in this abrupt transition, as illustrated by a case study. Ultimately, the agency's transition was a successful one as evidenced by a survey of both agency clinicians and clients, and by uninterrupted services at the same volume of cases and level of care. Suggestions are made for other providers seeking to cope with similar transitions.

Recommendations for rheumatologists on pharmacological management during the COVID-19 health emergency: Expert group opinion

Coronavirus 2019 (COVID-19) is an unexpected pandemic that has caused a state of emergency, as well as generating drastic changes in clinical care protocols. Some drugs commonly used in rheumatoid arthritis, systemic lupus erythematosus, and other systemic autoimmune diseases have been described for its treatment. Therefore, there is an imminent risk of shortages. The aim of this narrative review and expert opinion is to present general recommendations on the clinical and administrative management of outpatients with autoimmune or systemic inflammatory disease, in the context of the COVID-19 pandemic. Resumen La enfermedad por Coronavirus 2019 (COVID-19) es una pandemia inesperada que ha provocado un estado de emergencia y que ha generado cambios drásticos en los protocolos de atención clínica. Para su tratamiento se ha descrito el papel de algunos medicamentos usados habitualmente en artritis reumatoide, lupus eritematoso sistémico y otras enfermedades autoinmunitarias sistémicas. Debido a ello, existe un inminente riesgo de desabastecimiento, por lo cual el objetivo de esta revisión narrativa y opinión de expertos es formular recomendaciones generales clínicas y administrativas sobre el manejo de pacientes ambulatorios con enfermedad autoinmunitaria o inflamatoria sistémica en el contexto de la pandemia por COVID-19.

Genomic Signatures of SARS-CoV-2 Associated with Patient Mortality.

Infections with SARS-CoV-2 can progress toward multiple clinical outcomes, and the identification of factors associated with disease severity would represent a major advance to guide care and improve prognosis. We tested for associations between SARS-CoV-2 genomic variants from an international cohort of 2508 patients and mortality rates. Findings were validated in a second cohort. Phylogenetic analysis of SARS-CoV-2 genome sequences revealed four well-resolved clades which had significantly different mortality rates, even after adjusting for patient demographic and geographic characteristics. We further identified ten single-nucleotide polymorphisms (SNPs) in the SARS-CoV-2 genome that were associated with patient mortality. Three SNPs remained associated with mortality in a generalized linear model (GLM) that also included patient age, sex, geographic region, and month of sample collection. Multiple SNPs were confirmed in the validation cohort. These SNPs represent targets to assess the mechanisms underlying COVID-19 disease severity and warrant straightforward validation in functional studies.

Recommendations for rheumatologists on pharmacological management during the COVID-19 health emergency: Expert group opinion / Recomendaciones para reumatólogos sobre el manejo farmacológico durante la emergencia sanitaria por COVID-19: opinión de un grupo de expertos

RESUMEN La enfermedad por Coronavirus 2019 (COVID-19) es una pandemia inesperada que ha pro vocado un estado de emergencia y que ha generado cambios drásticos en los protocolos de atención clínica. Para su tratamiento se ha descrito el papel de algunos medicamen tos usados habitualmente en artritis reumatoide, lupus eritematoso sistémico y otras enfermedades autoinmunitarias sistémicas. Debido a ello, existe un inminente riesgo de desabastecimiento, por lo cual el objetivo de esta revisión narrativa y opinión de expertos es formular recomendaciones generales clínicas y administrativas sobre el manejo de pacien tes ambulatorios con enfermedad autoinmunitaria o inflamatoria sistémica en el contexto de la pandemia por COVID-19.

ABSTRACT Coronavirus 2019 (COVID-19) is an unexpected pandemic that has caused a state of emergency, as well as generating drastic changes in clinical care protocols. Some drugs commonly used in rheumatoid arthritis, systemic lupus erythematosus, and other systemic autoimmune diseases have been described for its treatment. Therefore, there is an imminent risk of shortages. The aim of this narrative review and expert opinion is to present general recommendations on the clinical and administrative management of outpatients with autoimmune or systemic inflammatory disease, in the context of the COVID-19 pandemic.