Managing health education during the COVID-19 pandemic: the RCSI Bahrain experience

The pandemic of Coronavirus disease- 2019 (COVID-19) introduced great challenges to the higher education sector and at the same time opened the door for future opportunities. This review aims to present the experience of Royal College of Surgeons in Ireland-Medical University of Bahrain in managing teaching and learning during COVID-19 pandemic. In response to the pandemic, the university implemented several initiatives in ensuring that final year students graduate on time and quality of assessment in a fully digitised environment. The guiding principle for the university as the examination were redesigned, was to ensure that they remained valid to ensure students could demonstrate achievements of the core learning outcomes and be safely assessed as competent graduates. In achieving these goals, the university has well-developed formal and informal mechanisms to ensure the student voice is heard and listened to, and it was of paramount importance to ensure that this was continued and enhanced during these times. While university was successful in managing this unprecedented situation, more work must be done on analysing the author's experience, and that of others, to implement the needed changes to ensure student access to learning, without compromising their safety or that of the staff. The university sees the current impetus to provide education through technology enhanced learning as an opportunity to expand and diversify learning opportunities and resources for students. In universities such as ours, which has only healthy subjects, practice become essential components of the programme, making a blended model of face-to-face and online delivery the ideal fit.

Secukinumab treatment results in sustained drug survival in biologic-naive and biologic-experienced patients with moderate-to-severe plaque psoriasis: analysis of 24 months of follow-up data from the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR)

Secukinumab is a fully human anti-interleukin-17A monoclonal antibody for the treatment of moderate-to-severe plaque psoriasis. In a previous analysis of the ongoing, longitudinal pharmacovigilance register BADBIR (data cutoff 31 August 2020), secukinumab showed sustained drug survival over 24 months in biologic-naive patients (86%) comparable to that of biologic-naive patients treated with ustekinumab (84%) and greater than that of biologic-naive patients treated with adalimumab (71%). In this updated analysis, we report drug survival for a larger cohort of biologic-naive and biologic-experienced patients with psoriasis treated with secukinumab (- data cutoff 31 August 2021). Patients prescribed secukinumab at baseline (biologic-naive) or after switching therapies during follow-up (biologic-experienced) were included. Drug survival up to 24 months (Kaplan-Meier method) was defined as the duration between date of first secukinumab exposure and date of stopping secukinumab or the end of the study censoring period. Data from 2850 patients were analysed (949 biologicnaive;1901 biologic-experienced). Mean duration of followup was 2.9 years (median 2.9 years) for biologic-naive and 2.7 years (median 2.5 years) for biologic-experienced patients. Among biologic-naive and biologic-experienced patients, respectively, most were male (61.3% and 55.6%), mean age was 46.5 and 45.1 years, mean body mass index was 31.6 and 32.5 kg m-2, mean age of disease onset was 25.6 and 23.7 years, and mean disease duration was 20.9 and 21.4 years. For biologic-experienced patients, the mean (SD) number of prior biologics received was 1.8 (1.0). Fewer biologicnaive patients had psoriatic arthritis (21.2% vs. 33.2%) and had received prior ciclosporin (50.1% vs. 60.1%), and prior methotrexate use was similar between subgroups (74.3% vs. 76.8%). Overall drug survival for biologic-naive and biologicexperienced patients was comparably high after 12 months (89% vs. 78%) and 24 months (78% vs. 62%). Drug survival for biologic-experienced patients was similar to that previously reported [77% (12 months) and 59% (24 months)]. With a median follow-up of 2.9 and 2.5 years for biologic-naive and biologic-experienced patients, respectively, these data represent the longest follow-up of any BADBIR analysis to date supporting and extending previous findings of sustained drug survival of secukinumab in patients with moderate-to-severe plaque psoriasis in real-world practice. As expected, drug survival was higher in patients who initiated secukinumab at baseline than those who switched to secukinumab after other biological therapy. However, overall drug survival of 78% and 62% at 12 and 24 months in biologic-experienced patients was similar to that reported previously [77% (12 months) and 59% (24 months)], and just slightly lower than was reported before the COVID-19 pandemic [81% (12 months) and 63% (24 months)].

Rethinking the 'one-stop' neck lump clinic: a novel pathway beyond coronavirus disease 2019.

OBJECTIVES: UK guidelines advocate 'one-stop' neck lump assessment for cancer referrals. This paper reports the pilot of a novel pre-clinic ultrasound pathway, presents outcomes, and discusses strengths and limitations in the context of the coronavirus disease 2019 pandemic. METHODS: Two-week-wait cancer referral patients with a neck lump were allocated a pre-clinic ultrasound scan followed by a clinic appointment. Demographic, patient journey and outcome data were collected and analysed. RESULTS: Ninety-nine patients underwent ultrasound assessment with or without biopsy on average 8 days following referral. Patients were followed up on average 14.1 days (range, 2-26 days) after initial referral. At the first clinic appointment, 45 patients were discharged, 10 were scheduled for surgery, 12 were diagnosed with cancer, 6 were referred to another specialty and cancer was excluded in 19 patients. Retrospectively, four ultrasounds were performed unnecessarily. CONCLUSION: Pre-clinic ultrasound scanning is an alternative to the one-stop neck lump pathway. This study demonstrates fewer clinic visits, faster diagnosis and a low proportion of unnecessary scans, whilst minimising face-to-face consultations and aerosol-generating procedures.

On the Front Lines: Nonprofits in the Homeless-Serving Sector During the COVID-19 Pandemic

This article examines the experiences of the nonprofit, homeless-serving sector during the first wave of the COVID-19 pandemic. Qualitative interviews were conducted with staff and volunteers from frontline organizations in the two largest communities in Nova Scotia, Canada. Participants reported much strain on their organizations' human resources, but also the ability to adjust service delivery mechanisms quickly in order to continue offering supports. Most reported greater in-kind contributions from businesses and community members as well as more funding from the federal government in particular, albeit with administrative burdens and defined timelines. Nonprofits played a leadership role in developing responses to serve the needs of those experiencing home-lessness, including developing comfort centres, installing portable toilets in downtown locations, and moving those without housing into hotels. They also advocated to government for state-level responses to those without housing, including calls to invest in new units and enhance funding for frontline service providers. At the same time, nonprofits reported working across sectors, noting better communication and relationships with state actors as well as other nonprofit organizations as a result of their COVID-19 response.

Influenza Surveillance of Families in an Observational Household Study 2019-2021

Background. Families with children may be at higher risk for influenza infection. Community transmission can suffer from underreporting as testing is often not performed. We studied the epidemiology of influenza in households with school-aged children using home-based sample collection. Methods. We conducted a remote household study surveilling respiratory viruses from November 2019-June 2021, in King County, Washington (WA), USA. Households with school-aged children were enrolled, mailed home specimen collection kits, and asked to self-assess for weekly acute respiratory illness (ARI) using remote survey platforms. Participants with ARI symptoms were prompted to complete serial illness surveys and self-collect/parent collect mid-turbinate nasal swabs. Samples were sent to a University of Washington study laboratory for RT-PCR influenza testing. Influenza rates were compared to WA Department of Health (DOH) reporting. Results. A total of 1861 ARI events were reported among 992 adults and 869 children in 470 households;75 influenza cases were detected (36 influenza A and 39 influenza B). The study participant median age was 32 years (0-84), 10 years (1-49) for influenza A, and 11 years (3-49) for influenza B cases. Overall 13% of households had an influenza case, of which 13 (22%) reported >1 case. A total of 81% of participants reported receipt of one dose of the 2019-2020 influenza vaccine, including 91% of influenza A and 90% of influenza B cases, and 84% received the 2020-2021 influenza vaccine. Like WA DOH, we observed a wave of influenza B cases followed by influenza A in 2019-2020. During influenza season 2020-2021, WA DOH reported 9 positive influenza tests and none observed in our study. Commonly, influenza case-patients reported were fever, cough, rhinorrhea, and fatigue. GI symptoms were more common in children than adults. Of the cases, 92% of influenza A and 78% of influenza B occurred in children. Conclusion. Influenza illness in 2019-2020 was initially influenza B, and subsequently replaced by influenza A. Most cases were in children and adolescents, despite at least one dose of influenza vaccine. Symptoms were widely distributed and similar between influenza A and B. Influenza incidence in our cohort declined to zero with the rise of SARS-CoV-2 cases and widespread mitigation efforts. (Figure Presented).

Evaluation of nasal swab collection methods on a university campus during the SARS-CoV-2 pandemic

Background. Characterizing SARS-CoV-2 outbreaks on university campuses is critical for informed public health measures and understanding transmission dynamics. Figure 1. Dropbox and Kiosk Samples Collected September 10, 2021 to April 23, 2022. Methods. Faculty, staff, and students at a major public university in Seattle, WA, USA were enrolled in a COVID-19 testing study. Individuals could test using observed self-swabs at on-campus kiosks or unobserved self-swabs using a kit and returning it to a dropbox on campus. Sample collection volume for observed self-swabs was limited by staffing and space. All samples were returned to the laboratory and tested for SARS-CoV-2 by qRT-PCR. Results. From September 10, 2021 to April 23, 2022, 38,400 individuals were enrolled in the study. Of these individuals, 5,089 used dropboxes only, 14,421 used kiosks only, and 5,820 used both. A total of 21,653 dropbox swabs and 75,493 observed self-swabs were collected. Median age was similar between individuals using dropboxes and observed self-swabs (20 vs. 22 years). A greater proportion of dropbox users were students compared to faculty and staff (students made up 83% of dropbox only population, 75% of kiosk only, and 86% of both, chi2 p-value< 0.0001). Symptom data was reported for 65,349 swabs. Dropbox users were less likely to have symptoms compared to observed self-swab users (24% of swabs vs. 54%, chi2 p-value< 0.0001). SARS-CoV-2 positivity was slightly lower for dropboxes compared to kiosks (4% vs. 5%;p=0.001). Dropboxes were highly utilized during periods of increased testing demand, including after academic breaks and variant emergence (Figure 1). Of the total tests distributed for use, a greater proportion of dropbox kits were unable to be resulted (6%) compared to observed self-swab kits (0.02%). Conclusion. Dropboxes provided a flexible, high-volume collection method at times of increased testing demand. Individuals who used dropboxes were less likely to report symptoms and slightly less likely to test positive, suggesting a role for dropbox utilization in high-risk asymptomatic individuals during periods of high community transmission on a university campus.

Health Behavioral Trends and Absenteeism Associated with Acute Respiratory Illness Before and During the SARS-CoV-2 Pandemic in a Community Household Cohort, King County, Washington

Background. Non-pharmaceutical interventions (NPIs), such as masking and social distancing, can reduce SARS-CoV-2 transmission. Longitudinal behavioral data in individuals with acute respiratory illness (ARI) during the COVID-19 pandemic are limited. We describe changes in adherence to NPIs and the impact of ARIs on work or school in families before and during the COVID-19 pandemic. Methods. From November 2019 to June 2021, households with school-aged children in King County, WA, were remotely monitored on a weekly basis for symptoms of respiratory illness. Participants with ARI (cough or >=2 qualifying symptoms) were asked about illness-related behavior changes (e.g. masking, isolation, hand hygiene, surface cleaning, public transit use) and impacts on school/work 7 days after initial symptom report. Using generalized estimating equations for household clusters, we compared the frequency of behavior changes and school/work impact during 3 time periods: the pre-/early COVID-19 pandemic period (11/14/19-3/22/20), prevaccine period (3/23/20-12/10/20), and post-COVID-19 vaccine period (12/11/ 20-6/19/21). Results. Of 1861 participants in 470 households, 695 (37%, from 70% of households) reported 1157 ARIs. Over the 3 time periods, the percent of ill participants who reported staying home (34 vs 34 vs 54%, respectively, P< .001), avoiding contact with others (25 vs 28 vs 45%, P< .001), and masking (3 vs 23 vs 38%, P< .001) increased (Fig 1A). Other illness-related behaviors, including washing hands and disinfecting surfaces, were unchanged over time. The percent of ill participants who worked from home (7 vs 9 vs 3%, P= .02) and missed work due to ARI (13 vs 8 vs 8%, P= .03) decreased over time (Fig 1B). Figure 1A. Participant reported illness-related health behaviors in the past week-Seattle, WA, 2019-2021. Figure 1B. Participant reported illness-related school or work impact in the past week due to illness - Seattle, WA, 2019-2021 Time periods were defined as: Period 1: 11/14/19 - 3/22/20 (pre-/early COVID-19 pandemic), Period 2: 3/23/20 - 12/10/20 (post-Washington State Stay at Home order), and Period 3: 12/11/20 - 6/19/21 (United States Food and Drug Administration Emergency Use Authorization for the Pfizer-BioNTech COVID-19 vaccine for those 16 years and older). Illness was defined per Acute Respiratory Illness (ARI) case definition: cough or two qualifying symptoms (fever, sore throat, runny nose, muscle or body aches, headache, difficulty breathing, fatigue, nausea or vomiting;for participants < 18 years of age, ear pain or drainage, rash, and diarrhea were also qualifying symptoms). Conclusion. As theCOVID-19 pandemic progressed, households with school-aged children engaged in isolation, social distancing, and masking more frequently in response to ARI. The impact of ARIs on work decreased during the pandemic.

Environmental and Nasal Pathogen Surveillance in Seattle Area Homeless Shelters

Background. The need for community surveillance of respiratory viruses in high-risk settings such as homeless shelters has been underscored by the COVID-19 pandemic. Here, we show that sampling high-touch surfaces is a low-cost, minimally intensive means of community respiratory virus surveillance. Methods. Environmental samples were collected weekly from adult and family homeless shelters in King County, WA from November 2019 - April 2020. At times when residents were present, a 10cm2 area of selected high-touch surfaces were swabbed and bioaerosol samples were collected in high-traffic areas. Surfaces included entrance and restroom doorknobs, counters, and surfaces unique to each shelter. Study staff collected mid-turbinate swabs from shelter resident participants aged > 3 months with symptoms of acute respiratory illness (ARI). All samples were tested by RT-PCR for 27 viruses. From January 1, 2020 onward, samples were also tested for SARS-CoV-2. Results. A total of 788 environmental swabs, 1509 nasal swabs, and 98 bioaerosol samples from 6 adult and 3 family shelters were tested. Adenovirus (109 positive swabs, 13.8% of tested swabs), rhinovirus (107, 13.6%) and human bocavirus (62, 7.9%) were the most frequently detected viruses in surface swabs. Rhinovirus (160, 10.6%), human coronaviruses (79, 5.24%) and influenza B (43, 2.85%) were the most detected in nasal swabs. All viruses detected in nasal swabs were found in surface swabs. Of 9 surfaces, exterior bathroom doorknobs were the physical location with the highest number of pathogens detected. SARS-CoV-2 was first detected in surface swabs on 3/20/20, and in nasal swabs on 3/10/20. Bioaerosol samples detected virus in a low percentage of samples relative to surface and nasal swabs. Table 1 Count and period prevalence of environmental viral detection by shelter type, November 18, 2019 - April 10, 2020. (Figure Presented) Conclusion. Respiratory viruses detected through environmental sampling in homeless shelters were similar to the viruses detected from ARI episodes in study participants. Environmental surface sampling presents a plausible, minimally invasive method of surveillance for both endemic and emerging respiratory pathogens, as evidenced by the detection of SARS-CoV-2 during the early stages of the pandemic. Further research could focus on sampling public locations for broader community surveillance and culturing viruses found on these surfaces.

Human Parainfluenza Epidemiology in Homeless Shelters - King County, Washington

Background. Human parainfluenza viruses (HPIV) cause respiratory illness in individuals of all ages. However, HPIV epidemiology data in people experiencing homelessness (PEH) are limited. Methods. We analyzed cross-sectional data from a clinical trial and SARS-CoV-2 surveillance study in 23 homeless shelters in King County, Washington from October 2019-May 2021. Questionnaires and nasal swab specimens were obtained from eligible participants at enrollment. Between October 2019-March 31, 2020, participants included those aged > 3 months with acute respiratory illness. Monthly shelter surveillance was also conducted where participants were recruited regardless of symptoms. With the community spread of SARS-CoV-2, the study design transitioned from a clinical trial to a SARS-CoV-2 surveillance study which expanded enrollment eligibility to include participants with or without symptoms from April 1, 2020, onward. Participants were not followed longitudinally but were permitted to enroll multiple times during the study period. Specimens were tested for HPIV 1-4 and other respiratory viruses using RT-PCR. Results. Among 14,464 specimens, 32 were HPIV-positive from 29 participants (median age 9 years, range 0.3-64 years;45% female;28% Black;10% with chronic conditions) of which 59% were children. Family shelters had the highest percentage of HPIV infections (Table). HPIV was detected every month before the community spread of SARS-CoV-2. All HPIV-positive samples in May 2021 came from a single family shelter (Figure). Only 67% of HPIV-positive participants had symptoms with runny nose, cough and sore throat the most commonly reported. HPIV codetection with other respiratory viruses occurred in 19% of HPIV-positive specimens;Rhinovirus co-detection (16%) was the most common. Human Parainfluenza Encounters by Shelter Type Before and After April 1, 2020 Human Parainfluenza Positive Samples by Shelter Type Among Unique Participants Conclusion. HPIV affected PEH of all ages with most cases in shelters with children. Coinciding with community-wide SARS-CoV-2 mitigation efforts, the number of HPIV infections were reduced. However, a cluster of HPIV infections still occurred within one family shelter. Shelter-specific public health measures including nonpharmaceutical interventions used during the COVID-19 pandemic may reduce HPIV infections among residents.

Making the shift to virtual professional learning

This qualitative research involved the development of 12 weeks of twice-weekly virtual maker professional learning (PL) sessions for K-12 and post-secondary educators at the beginning of the COVID-19 pandemic. The sessions were developed by four researchers from a maker lab in Ontario, Canada that moved entirely online in March 2020. The research question driving the study was: what are best practices related to virtual maker professional learning? Findings and implications related to this question include: a) technical issues should be anticipated and addressed in advance of each session;b) simple, hands-on activities are most effective for online maker professional learning;c) collaboration are pivotal to a rich online maker professional learning experience;d) using free, virtual tools is imperative for equitable access and learning;and e) adaptability is key when working with a diversity of learners/teachers from varied subjects and divisions.

A telemedical interface for at-home cognitive testing

BACKGROUND: The COVID-19 pandemic has limited in-lab cognitive testing. While at-home alternatives exist (testing over the phone), differences in test design and delivery complicate direct comparison of most in-lab and at-home tests. Here we describe the design, infrastructure, and implementation of the California Cognitive Assessment Battery (CCAB), a cognitive test battery and administration system. Using automated remote administration over cellular networks, identical computerized cognitive tests can be administered at-home or in the lab.

Hcv Testing Pattern Improvements after New Universal Screening Ehr Alert Implementation at a Large Healthcare System

Background: Screening for HCV is the first critical decision point for preventing morbidity and mortality from HCV cirrhosis and hepatocellular carcinoma, and will ultimately contribute to global elimination of a curable disease. This study aims to portray the changes over time in HCV screening rates and the screened population characteristics following the 2020 implementation of an EHR alert for universal screening in the outpatient setting in a large healthcare system in the US mid-Atlantic region. Method(s): Data was ed from the EHR on all outpatients from 1/1/2017 through 10/31/2021, including individual demographics and their HCV antibody screening dates. Mixed effects multivariable regression analyses were performed to compare the timeline and characteristics of those screened and un-screened for a limited period from 1/1/2020 to 10/31/2020 and centered on the EHR alert implementation. Result(s): Absolute number of screens increased by 103% after the implementation of the EHR alert. When comparing the five-month period before and after the EHR alert, the odds of being screened at an outpatient visit increased by 62% from 17 to 27 screens per 1,000 outpatient visits. Also during this time period, patients with Medicaid were more likely to be screened than private insurance (ORadj 1.10, [CI95: 1.05, 1.15]), females more likely than males (1.26, [1.20, 1.32]);Black race more than White (1.59, [1.53, 1.64]);while those with Medicare were less likely than private insurance (0.62, [0.62, 0.65]). Over the entire 58-month period, the HCV Ab positivity rate decreased from 4.2% to 1.5%. Conclusion(s): Implementation of a universal HCV screening EHR alert was followed by a large increase in absolute screens and screening rates in the outpatient setting, despite the concurrent onset of the COVID-19 pandemic. These findings support that such an alert could play a crucial role in identification and subsequent elimination of HCV. Females, Black race and Medicaid patients were screened at higher rates, suggesting possible bias toward certain groups. Targeted testing in addition to universal screening remains a need despite much higher screening rates -expectedly, the proportion screened decreased, however the absolute number of HCV positive individuals decreased over time (data not shown). Our findings suggest that an EHR alert for universal screening could play a crucial role as the first step in identification and then elimination of HCV.

Current and future digital therapeutics trends from the payer perspective

BACKGROUND: Digital therapeutics (DTx) represent a growing market, accelerated over the last two years by the COVID-19 pandemic. As more DTx emerge, healthcare decision makers (HCDMs) are tasked with navigating a crowded and highly variable market to ensure patients have access to treatment options that can potentially improve outcomes. There is limited evidence evaluating how DTx products are perceived from the payer perspective. OBJECTIVE(S): To assess payer perceptions on the current and future state of DTx global trends and evidence generation needs. METHOD(S): A double-blind web-based survey was fielded from April 2022 to May 2022 to HCDMs to gather insights on existing and anticipated DTx trends. RESULT(S): There were 50 HCDMs who completed the survey. Respondents predicted that DTx will expand to new disease areas outside of mental health, diabetes, and cardiology (70%) and that more prescription DTx products will be covered (56%) over the next 18 months. Considering COVID- 19, respondents were at least somewhat likely to allow virtual assistance (64%) and API transfer (68%) for benefits verification. A MaxDiff trade-off exercise showed from an evidentiary needs perspective, head-to-head comparison studies (81) followed by prospective randomized controlled trials (74) were considered the best evidence options in terms of usefulness for DTx review, and objective clinical effectiveness (81) and total cost of care offset (66) were priorities for health outcomes data. Respondents (78%) noted that evidence demonstrating long-term efficacy and specific disease-state management were absolutely needed to determine coverage for new DTx. 48% considered two years as the best definition of long-term efficacy and most (68%) were at least interested in discussions about piloting a DTx to gather real-world evidence pending more information. CONCLUSION(S): The results indicate that HCDMs expect the market to continue to expand into new therapeutic areas and that more prescription DTx will obtain coverage. Evidence of long-term efficacy demonstrated over at least two years and pilot programs may be instrumental in optimizing DTx HCDM evaluation. Stakeholder alignment across the industry will help shape the future of DTx and facilitate appropriate patient access.

VaxEquity: A Data-Driven Risk Assessment and Optimization Framework for Equitable Vaccine Distribution

With the continuous rise of the COVID-19 cases worldwide, it is imperative to ensure that all those vulnerable countries lacking vaccine resources can receive sufficient support to contain the risks. COVAX is such an initiative operated by the WHO to supply vaccines to the most needed countries. One critical problem faced by the COVAX is how to distribute the limited amount of vaccines to these countries in the most efficient and equitable manner. This paper aims to address this challenge by first proposing a data-driven risk assessment and prediction model and then developing a decision-making framework to support the strategic vaccine distribution. The machine learning-based risk prediction model characterizes how the risk is influenced by the underlying essential factors, e.g., the vaccination level among the population in each COVAX country. This predictive model is then leveraged to design the optimal vaccine distribution strategy that simultaneously minimizes the resulting risks while maximizing the vaccination coverage in these countries targeted by COVAX. Finally, we corroborate the proposed framework using case studies with real-world data. © 2022 IEEE.

Implementing and Adapting the SAFETY Treatment for Suicidal Youth: The Incubator Model, Telehealth, and the Covid-19 Pandemic

The Safe Alternatives for Teens and Youth (SAFETY) treatment was developed to decrease the risk of repeat suicidal and self-harm behavior in youth presenting with elevated suicide risk. This paper uses case illustrations to demonstrate the SAFETY treatment, building upon the companion paper describing our "incubator " treatment development model and process (Asarnow et al., 2022). As illustrated in the second case illustration, the incubator model approach was particularly useful during the COVID-19 pandemic switch to telehealth. SAFETY specifically targets suicide and self-harm risk reduction using an individually tailored principle-guided approach, grounded in a case conceptualization that identifies cognitive-behavioral processes and reactions that contribute to increased suicide attempt risk and explains the youth's suicidal/self-harm behavior within the context of his or her broader social systems. The SAFETY treatment has been tested in two treatment development trials, and results support the efficacy of SAFETY for preventing suicide attempts in adolescents presenting with recent self-harm.

Vaccinating a population is a changing programming problem

How best to apply vaccines to a population is an open problem. It is trivial to derive intuitive strategies, but until tested, their efficacy i s n ot k nown. T his p roblem i s particularly challenging when considering the dynamics of social contact networks and their changes over time. A system for automatically discovering tested vaccination strategies with evolutionary computation has been improved upon to include additional graph metrics and to generate vaccination strategies for dynamic graphs, something that is expected of real social networks within communities. The system’s ability to generate effective strategies was demonstrated along with a comparison of the strategies developed when fit t o a s tatic g raph v ersus a d ynamic g raph. I t w as observed that the additional computational resources required to generate strategies on a dynamic graph may not be necessary as strategies developed for static graphs performed similarly well;however, the authors are careful to acknowledge that results may differ significantly w hen a djusting t he s ystems m any parameters. © IEEE 2021.

Discovering missing edges in drug-protein networks: Repurposing drugs for SARS-CoV-2

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, led to a global health crisis, with more than 157 million cases confirmed infected by May 2021. Effective medication is desperately needed. Predicting drug-target interaction (DTI) is an important step to discover novel uses of chemical structures. Here, we develop a pipeline to predict novel DTIs based on the proteins of the coronavirus. Different datasets (human/SARSCoV-2 Protein-Protein interaction (PPI), Drug-Drug similarity (DD sim), and DTIs) are used and combined. After mapping all datasets onto a heterogeneous graph, path-related features are extracted. We then applied various machine learning (ML) algorithms to model our dataset and predict novel DTIs among unlabeled pairs. Possible drugs identified by the models with a high frequency are reported. In addition, evidence of the efficiency of the predicted medicines by the models against COVID-19 are presented. The proposed model can then be generalized to contain other features that provide a context to predict medicine for different diseases. © 2021 IEEE.

Reflections on New Evidence on Crisis Standards of Care in the COVID-19 Pandemic

Crisis standards of care have been widely developed by healthcare systems and states in the United States during the COVID-19 pandemic, and in some rare cases have actually been used to allocate medical resources. All publicly available U.S. crisis standards of care with a mechanism for allocating scarce resources make use of the Sequential Organ Failure Assessment (SOFA) score in hopes of assigning scarce resources to those patients who are more likely to survive. We reflect on the growing body of evidence suggesting that the SOFA score has limited accuracy in predicting mortality among patients hospitalized with COVID-19 and that the SOFA score systematically disfavors Black patients. Use of the SOFA score for allocating scarce resources may therefore result in Black patients with equal likelihood of survival being deprived of life-saving medical resources. There is also a risk of injustice for patients with non-COVID-19 diagnoses, for whom the SOFA score may be a more accurate prognostic score, but who might nevertheless be unfairly (de)prioritized when assessed alongside COVID-19 patients using the same scoring system. For these reasons we recommend that the SOFA score not be used for triage purposes during the COVID pandemic, and that a national effort be made to develop and empirically test crisis standards of care in advance of the next public health emergency.

We Are Not Pontius Pilate: Acknowledging Ethics and Policy

A new AI system is being developed to optimize vaccination strategies based on the structure and shape of a community's social contact network. The technology is minimally constrained and not hound by preconceived notions or human biases. With this come novel outside the box strategies;however, the system is only capable of optimizing what it is instructed to optimize, and does not consider any ethical or political concerns. With the growing concern for systematic discrimination as a result of artificial intelligence, we acknowledge a number of relevant issues that may arise as a consequence of our new technology and categorize them into three classes. We also introduce four normative ethical approaches that are used as a framework for decision-making. Despite the focus on vaccination strategies, our goal is to improve the discussions surrounding public concern and trust over artificial intelligence and demonstrate that artificial intelligence practitioners are addressing these concerns.