ABSTRACT
Following COVID-19 exposure, the Centers for Disease Control (CDC) recommends a 10–14-day quarantine for asymptomatic individuals and more recently a 7-day quarantine with a negative PCR test. A university-based prospective cohort study to determine if early polymerase chain reaction (PCR) negativity predicts day 14 negativity was performed. A total of 741 asymptomatic students in quarantine was screened and 101 enrolled. Nasopharyngeal swabs were tested on days 3 or 4, 5, 7, 10, and 14, and the proportion of concordant negative results for each day versus day 14 with a two-sided 95% exact binomial confidence interval was determined. Rates of concordant negative test results were as follows: day 5 vs. day 14 = 45/50 (90%, 95% CI: 78–97%);day 7 vs. day 14 = 47/52 (90%, 95% CI: 79–97%);day 10 vs. day 14 = 48/53 (91%, 95% CI:79–97%), with no evidence of different negative rates between earlier days and day 14 by McNemar's test, p > 0.05. Overall, 14 of 90 (16%, 95% CI: 9–25%) tested positive while in quarantine, with seven initial positive tests on day 3 or 4, 5 on day 5, 2 on day 7, and none on day 10 or 14. Based on concordance rates between day 7 and 14, we anticipate that 90% (range: 79–97%) of individuals who are negative on day 7 will remain negative on day 14, providing the first direct evidence that exposed asymptomatic students ages 18–44 years in a university setting are at low risk if released from quarantine at 7 days if they have a negative PCR test prior to release. In addition, the 16% positive rate supports the ongoing need to quarantine close contacts of COVID-19 cases.
ABSTRACT
Doctoral graduates in philosophy are an excellent source of information about the discipline: they are at the cutting edge of research trends, have an inside view of research-focused departments, and their employment prospects provide early insights on the future health of the discipline. This report details the results of a survey sent in 2021 to recent Ph.D. graduates and current students, as well as data-gathering efforts by Academic Placement Data and Analysis that have taken place over the past ten years. The report especially focuses on demographic representation, program ratings, academic job placement, and nonacademic careers.
ABSTRACT
Background/Introduction: Cardiaovascular prevention/rehabilitation programmes continue to reduce cardiovascular mortality even with contemporary treatment. During covid the majority of face-to-face programmes were suspended but these services have never been more crucial as control of cardiovascular risk factors can mitigate the morbidity/mortality risk from covid. Programmes must now however be delivered in a way that reduces patient exposure. Here we describe how we rapidly transitioned our previously fully face to face cardiovascular prevention/programme to a completely virtual platform adopting Fitbit as wearable technology. Methods: The previously face-to-face initial assessment (IA) conducted by the multidisciplinary team (MDT) - nurse, dietician and physiotherapist is now delivered via video/phone as per patient preference. Patients are provided with equipment kits (tape measures, blood pressure monitors (BP), Fitbit smartwatches and Fibricheck app as required. The virtual IA includes assessment of: Smoking habit, blood pressure (BP), heart rate, lipid profile and HbA1c (taken in community phlebotomy hub), cardioprotective medications, weight, BMI, waist circumference, Mediterranean Diet Score, functional capacity via the Duke Activity Status Index, habitual activity levels, risk stratification for exercise, hospital anxiety and depression scores (HADS) and quality of life (QOL). Patients receive education and tailored advice with SMART goals as well as a written care plan. The subsequent 12 programme is comprised of • Weekly virtual meeting with cardiologist to optimise BP/lipids and medications • Alternate weekly virtual coaching consultation by MDT for monitoring/ goal resetting • Alternate weekly video group education sessions on key cardiovascular health topics • Online educational videos filmed by the MDT Monitoring of physical activity (step count, active minutes) in real time via Fibit dashboard with personalised messages sent to patients via the Fitbit app • Provision of Fibricheck app via Fibit for rhythm assessment • End of programme (EOP) assessments are then also conducted virtually Results: Between April and November 2020 n=262 had a virtual IA (94% of those offered and n=114 (95% of those offered) attended an end of programme assessment. 64% were male and the mean age was 64.1 years. Acceptance of the Fitbit device was 72% of those offered. Table 1 below shows the main clinical and patient-reported outcomes in those attending both an IA and EOP with the data for the same 6 months the year prior (face to face programme) also for comparison. Programme satisfaction ratings were high with 85% rating the programme as excellent or very good. Conclusions: Transitioning a previously fully face to face cardiac rehabilitation programme to a wholly virtual platform was feasible and acceptable to patients. Early data analysis would suggest that the virtual programme achieves similar clinical and patient reported outcomes. (Figure Presented).
ABSTRACT
Since the beginning of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) virus pandemic, several highly effective and safe vaccines have been produced at remarkable speed. Following global implementation of vaccination programmes, cases of thrombosis with thrombocytopenia following administration of adenoviral vector-based vaccines started being reported. In this review we discuss the known pathogenesis and epidemiology of so-called vaccine induced thrombocytopenia and thrombosis (VITT). We consider the available guidelines, diagnostic laboratory tests and management options for these patients. Finally, we discuss important unanswered questions and areas for future research in this novel pathoclinical entity.
ABSTRACT
Background: Vaccination for SARS-CoV-2 infection has become a mainstay of prevention and mitigation of COVID in the general population. However, there is growing evidence that some subgroups may experience inferior response to currently available vaccine(s). There are few data regarding vaccine responses in subjects with liver disease or subjects immunosuppressed following solid organ transplantation. Methods: Participants were enrolled in a repository cohort study which includes persons with liver disease, as well as nonliver disease subjects classified as either immunocompetent controls or having immunosuppression from solid organ transplant (liver or kidney). Samples were collected following vaccination with any EUA approved SARS-CoV-2 vaccine. Assays performed included a quantitative assay for antibody to spike protein (Euroimmun, NJ), and a neutralization assay that demonstrates the ability of the antibody to block binding to SARS-CoV-2 receptor binding domain (RBD) of the ACE-2 receptor (GenScript, NJ). Results: 40 participants received the full dosing schedule (1 or 2 doses) of an EUA approved vaccine. The majority received 2 doses of the Pfizer/Moderna vaccine (n=35) and 5 the J&J vaccine. These included 13 subjects with chronic liver disease (LD), 18 immunosuppressed (IS) and 9 healthy immunocompetent controls. The majority were white (87.5%), male (50%) with a mean age of 59 years (range: 36-76). Chronic LDs included HCV, HBV, alcoholic hepatitis, and NASH. The IS subjects included 17 liver and 1 kidney recipient on immunosuppressants. Mean days post final dose was 22.6 days (SEM+ 2.76). The mean quantitative antibody to SARS-CoV-2 spike antigen was 522.56 WHO Binding Antibody Units (BAU) in the control group, 391.64 BAU in those with LD and 74.65 BAU with IS. The neutralization assay followed a similar pattern with 89.6% neutralization in the controls compared with 70.4% and 30.2% in the LD and IS groups respectively (p<0.05 for IS vs. other groups). Cirrhosis trended to lower antibody titers and neutralization ability, but this failed to reach statistical significance. Conclusion: Overall SARS-CoV-2 vaccine responses by two assay methodologies suggest lower response rates following a full vaccination series in participants with liver disease and immunosuppressed transplant subjects.
ABSTRACT
BACKGROUND: The purpose of this study was to assess the occupational SARS-CoV-2 infection risk among health care workers (HCW) at University of Kentucky HealthCare (UKHC) by evaluating the prevalence of SARS-CoV-2 antibodies. METHODS: This is a prospective cohort study of HCW at UKHC. SARS-CoV-2 IgG antibody seropositivity was measured in a CLIA-certified laboratory utilizing the Abbott Architect SARS-CoV-2 IgG antibody assay. Demographics and work type were self-reported by study participants via an emailed survey. RESULTS: The overall antibody positivity rate of HCW was 1.55% (5/322; 95% confidence interval: 0.65%-3.71%) at cohort entry. There were no differences in antibody positivity between those that worked directly with SARS-CoV-2 infected patients and those that did not. The antibody rate of positivity of patients during the same time period was similar, 1.8% (9/499; 95% confidence interval 0.94%-3.45%). CONCLUSIONS: Antibody positivity was low and similar between HCW and patients tested during a similar time period. HCW positivity rates did not appear to be impacted by caring for known SARS-CoV-2 infected patients suggesting that appropriate use of personal protective equipment is effective in protecting individuals from transmission.