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The chapter examines the economic responses of US mainline Protestant churches to the COVID-19 crisis. It focuses on ways that churches are providing economic support and wealth transfer between more privileged and marginalized (racially, economically, etc.) church members both within congregations and between congregations, as well as within wider communities. It examines the relationship between the short-term crisis of COVID-19 and long-standing systemic inequalities and the ways that responses to the COVID-19 crisis either integrate or do not draw those connections, and whether arrangements are intended to be short-term or whether longer-term or more transformative change is proposed. It draws on specific case studies and interview data to root my analysis in grassroots church communities and conclude with constructive ethical recommendations for ecclesial economic transformation beyond COVID-19. © The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature Switzerland AG 2023.
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The COVID-19 vaccine rollout has as of yet received little attention from geographers. This chapter seeks to look at the spatial aspects of the vaccine distribution, starting with a review of previous vaccination campaigns, then looking at the various types of COVID-19 vaccine. Paying attention to issues of disparities in access, this chapter investigates the U.S. rollout as well as that of other countries. A look is also taken into the emerging vaccine diplomacy, as well as the international program COVAX designed to help distribute the vaccine. This chapter finds that the U.S. vaccine rollout is flawed with people of color more likely to experience difficultly in receiving the vaccine. It is also a spatially uneven rollout, with states distributing vaccine at varying rates across the country. The U.S. response on the international stage also faces some difficulty, with states such as China and Russia pulling ahead in the field of vaccine diplomacy at the expense of American influence abroad. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
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Background: To reduce the spread of coronavirus disease 2019 (COVID-19), many substance use disorder treatment programs have transitioned to telemedicine. Emergency regulatory changes allow buprenorphine initiation without an in-person visit. We describe the use of videoconferencing for buprenorphine initiation combined with street outreach to engage 2 patients experiencing homelessness with severe opioid use disorder (OUD). Case Presentation: Patient 1 was a 30-year-old man with severe OUD who had relapsed to injection heroin/fentanyl after incarceration. A community drop-in center outreach harm reduction specialist facilitated a videoconference with an addiction specialist at an OUD bridge clinic. The patient completed a community buprenorphine/naloxone initiation and self-titrated to his prior dose, 8/2 mg twice daily. One week later, he reconnected with the outreach team for a follow-up videoconference visit. Patient 2, a 36-year-old man with severe OUD, connected to the addiction specialist via a syringe service program harm reduction specialist. He had been trying to connect to a community buprenorphine/naloxone provider, but access was limited due to COVID-19, so he was using diverted buprenorphine/naloxone to reduce opioid use. He was restarted on his previous dose of 12/3 mg daily which was continued via phone follow-up 16 days later. Conclusion(s): COVID-19-related regulatory changes allow buprenorphine initiation via telemedicine. We describe 2 cases where telemedicine was combined with street outreach to connect patients experiencing homelessness with OUD to treatment. These cases highlight an important opportunity to provide access to life-saving OUD treatment for vulnerable patients in the setting of a pandemic that mandates reduced face-to-face clinical interactions.Copyright © 2020 Lippincott Williams and Wilkins. All rights reserved.
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Background: Adults living with HIV may have higher risk of SARS-CoV- 2 infection than HIV negative adults. There are no published data on seroprevalence of SARS-CoV-2 in children and adolescents living with HIV (CALWHIV). Method(s): We did a repeat SARS-CoV-2 seroprevalence study in 7 paediatric HIV observational cohorts in 5 countries in the European Pregnancy & Paediatric Infections Cohort Collaboration (EPPICC;Belgium, Greece, Spain, Ukraine, United Kingdom (UK)) and also the Cape Town Adolescent Antiretroviral Cohort (CTAAC), South Africa (SA) (CALWHIV and HIV negative adolescents). Participants gave 2 blood samples for SARS-CoV-2 antibody testing ~6 months apart during routine visits between May 2020 and July 2022, and completed questionnaires on SARS-CoV-2 exposure/infection and vaccine status. Clinical and demographic data were extracted from clinic records. Result(s): Of 906 participants, 53%(477) were female, 89%(803) CALWHIV, median [IQR] age at first visit 17[15-19] years. Most were enrolled in SA (45%, 410/906), UK (23%, 205/906) or Ukraine (18%, 160/906). 85%(767/906) had 2 blood samples and the rest a single sample. For CALWHIV, at time of first sample, 99%(761/765) were on antiretroviral therapy, median CD4 count was 666[478-858] cells/mL, 70%(535/764) had HIV-1 viral load < 50c/mL. Of those with known SARS-CoV-2 vaccine status, 23%(181/773) CALWHIV and 22% (22/100) HIV negative participants received >=1 vaccine dose. 6%(43/762) of CALWHIV had a documented prior SARS-CoV-2 positive PCR (including 2 hospitalised for COVID, neither severe), and 16%(124/762) self-reported previous positive test and/or COVID-19 symptoms, giving a total of 17%(128/762) with any previous infection. Based on serum testing, 63%(562/898) of participants overall were seropositive on at least one sample (55% (269/488) Europe, 67% (205/307) SA CALWHIV, 85% (88/103) SA HIV negative group), and among the unvaccinated subgroup, 53%(408/765) were seropositive (41% (167/412) Europe, 64% (168/263) SA CALWHIV, 81% (73/90) SA HIV negative). Among samples taken prior to or in absence of vaccination, the proportion testing antibody positive increased over time (Figure). Of unvaccinated CALWHIV with >=1 positive result, 17%(52/299) reported any previous SARS-CoV-2 infection. Conclusion(s): Most CALWHIV were SARS-CoV-2 seropositive by mid-2022 despite low vaccine coverage. Fewer had documented or self-reported COVID-19 infection or disease, suggesting most infections were mild or asymptomatic. Seroprevalence of SARS-CoV-2 antibodies in Europe and South Africa, by HIV status and calendar quarter of sampling. Colours indicate dominant variant based on GISAID data for adults and children.
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This article presents the results of an opportunistic, cross-sectional, self-report survey of the well-being of staff working in prisons throughout the UK. The survey was completed by 594 participants in the early part of 2021 at the height of the Covid-19 pandemic. Self-report measures indicated concerning levels of burnout and 43.4% of participants were above the established cut-offs on the Generalised Anxiety Disorder (GAD-7) scale. Eighty-one per cent reported that their mental and physical health had deteriorated and many said emotional support was lacking. Further research is required to establish how typical and persistent these concerns are. © 2023 The Authors. The Howard Journal of Crime and Justice published by Howard League and John Wiley & Sons Ltd.
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Recognizing and remembering various people is the most frequent task, which the human brain performs. With regard to this, the process of attendance becomes one of the hectic tasks, which requires subsequent modernization. The spread of COVID- 19 is also drastically increasing and are pushed to the situation of wearing mask the entire time. This brings in a situation of misidentifying the individuals and are also prone to impersonation in many official gatherings such as exams, meetings, etc. This cannot be decreased by unmasking their face in this pandemic situation just for the purpose of verification as it may lead to increase in COVID risk. Here, this research study implements a contactless face recognition system with a simple and smart database, which can take in any form of data as per the convenience. This system solves the above problem by making the face recognition smart using Histogram of Oriented Gradients (HOG) and Support Vector Machine (SVM) classifier. The main task of the system is to recognize the user's face (live) and automatically mark the time of recognition directly in the Google sheet along with the alphabets of P(Present), A(absent) or L(late) according to the given time range. This system makes effective use of google sheet for easy share ability, accessibility, and error free management. This can be used for number of purposes such as exam centers, schools, colleges, companies, hospitals and various other places in order to verify the people (contact less). © 2023 IEEE.
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Over the course of a clinical trial, changes in the practice environment have the potential to reduce internal and external validity and impact change in patient outcomes. Such ''history effects''1 can take the form of changes in standard of care, clinical guidelines and recommendations, new drug/device availability in the marketplace, testing and screening procedures, and, as recently experienced, a global pandemic. Clinical trials conducted over many years are particularly susceptible to history effects. Such effects can impact foundational ability to continue a trial, including clinician equipoise and ability to implement trial interventions, necessitating awareness and action planning. For example, Curtis et al.2 acknowledged challenges with clinical guideline history effects and issued recommendations for addressing them such as consideration of participant wellbeing, stakeholder engagement, safety monitoring, review of guideline and policy changes, and development of rules for protocol changes. This session will explore how four multisite clinical trials conducted with VA Cooperative Studies Program sponsorship and coordination have weathered history effects during prolonged periods of enrollment. Topics to be covered include the implementation of pragmatic designs, monitoring of clinical guidelines, assessing control group treatment conditions, modifying protocols, adjusting quality assurance procedures, refining recruitment pathways, and training site investigators. The speakers, Study Chairs, will describe best practices and provide recommendations for navigating history effects in prolonged multisite clinical trials that can ensure outcomes remain relevant and compelling to inform public health at trial commencement. The CSP 2008/PTXRx study is a pragmatic, randomized, double-blind, placebo-controlled, multicenter clinical trial of Veteran patients with diabetic kidney disease (DKD) examining whether pentoxifylline (PTX), when added to usual care, can delay time to end-stage renal disease or death. Enrollment for the study began in 2019, and it is anticipated that 9 years of follow-up will be required to observe the required number of primary events. Given the long duration of the study, changes in clinical guidelines were anticipated and have occurred, including the approval of new DKD therapies and introduction of a new formula for estimated glomerular filtration rate (eGFR) calculation. In anticipation of these changes, the study design allows for whatever standard of care is extant at any time during the course of the study. PTXR's pragmatic trial design and protocol leverage the VA's research infrastructure and remote platforms allowing the study to be responsive to external changes and to safely continue during a global pandemic. The CSP 596/OPTION study is a randomized, double- blind, multicenter trial of Veteran patients with a first or second recurrent Clostridium difficile infection (CDI) comparing (1) fidaxomicin and (2) vancomycin, followed by a taper and pulse to (3) a standard vancomycin regimen. Since enrollment began in 2016, significant changes in CDI epidemiology and clinical management have impacted the study. The COVID-19 pandemic also resulted in an administrative hold on all trial activity followed by staggered reopening of sites due to variable COVID-19 activity and clinical priorities. Many clinical laboratories switched to algorithms that included free toxin assays in addition to polymerase chain reaction (PCR) tests out of concern for overdiagnosis based on PCR testing alone, reducing the number of potentially enrollable cases. There has been increased empirical vancomycin treatment for recurrent CDI without confirmation by stool testing, a requirement for enrollment, and a recruitment strategy for identifying potential cases. Finally, conflicting clinical guidelines for recurrent CDI has created potential equipoise when considering enrollment. Ongoing educational efforts have been made to clarify the protocol and emphasize the validity of the research question as well as protoco changes to allow safe enrollment and follow-up of participants in the face of the ongoing COVID-19 pandemic. The CSP 2005/VALOR is a phase III randomized, open label, multicenter clinical trial of Veteran patients with operable stage I non-small cell lung cancer that compares stereotactic radiotherapy and anatomic pulmonary resection with a primary outcome measure of overall survival. The study was activated in 2017 and recruitment to the trial has been affected by ongoing changes in public and clinician perceptions about stereotactic radiotherapy and surgery that have interfered with equipoise and willingness of participants to enroll. The study team perpetually addresses this challenge through group conversations with local site investigators, study coordinators, and other research personnel to preserve group equipoise across the study. Since the study's activation, new safety information about stereotactic radiotherapy has emerged necessitating protocol modifications while aiming to preserve internal and external validity. The includes modifying standard operating procedures for the study's centralized quality assurance program that has had to adapt its process to remain contemporary. STARPORT, funded by VA CSRD with CSP collaboration, is a randomized, open label, multicenter clinical trial of Veteran patients with oligorecurrent prostate cancer comparing the effects of standard systemic therapy (SST) alone or with PET-directed local therapy using surgery or radiation. Although enrollment was initiated in 2021, changes are already evident in clinical practice guidelines regarding the use of imaging in workup in this patient population. Shortly before the start of accrual, 18F-DCFPyL PSMA PET/CT received FDA-approval. Consequently, it is being rapidly adopted at the STARPORT VA medical centers and the use of conventional imaging using CT or bone scan prior to PET/CT imaging-part of the original eligibility criteria-quickly is falling out of favor. Furthermore, shortly after the start of enrollment, NCCN guidelines adopted the stance that conventional imaging was no longer required in the setting of PSMA PET/CT imaging, solidifying the transition away from conventional imaging. Thus, the protocol is being amended to remove the requirement for conventional imaging as part of workup for oligorecurrence. In addition, to be generalizable, the study is designed to integrate future PSMA radiotracers that are incorporated into practice as well as changes in SST regimens over the time of the study.
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Medical misinformation is more pervasive today because of widespread and near instantaneous dissemination of information via the internet and social media platforms. Consequences of medical misinformation may include decreased uptake of needed health care resources, delays in seeking care, vaccine hesitancy, medication non-compliance, increased disease outbreaks and/or burden, and increased hospitalization and mortality. It disproportionately impacts underserved populations, including Black patients, those who identify as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and more), and patients with reduced health literacy skills or who are digitally disadvantaged. Medical misinformation challenges health care professionals not only to provide the best care possible, but to assist patients in finding accurate information. Preprint publications, although potentially beneficial in rapidly disseminating new scientific discoveries, often have not undergone peer review and may contribute to the widespread propagation of inaccurate or overstated results, thereby perpetuating the spread of medical misinformation when it exists. The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of practicing evidence-based medicine and the need for cautious review of preprint publications and articles from predatory publishers in addition to usual and customary literature evaluation techniques. Everyone plays a role in preventing the spread of medical misinformation, with pharmacists uniquely positioned as trusted and highly accessible professionals who may help combat its spread. The goal of this article is to define medical misinformation and related terms, outline mechanisms by which it is spread, describe its clinical impact, highlight how it disproportionately impacts underserved populations, provide actionable strategies to prevent its spread, and give examples of practical tactics to help identify, correct, and alert individuals about the possible presence of medical misinformation.Copyright © 2023 Pharmacotherapy Publications, Inc.
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Background: Perioperative SARS-CoV-2 infection has been associated with increased adverse outcomes. Research conducted early in the COVID-19 pandemic suggested an 8 week delay after SARSCoV-2 infection prior to undergoing surgery. The aim of this study is to determine if prior COVID-19 infection is an independent risk factor for adverse outcomes following surgery for urologic cancers. A secondary objective was to determine the optimal duration to delay surgery, specifically cystectomy, prostatectomy, or nephrectomy, after COVID-19 infection. Method(s): Data from the National COVID Cohort Collaborative (N3C) data enclave was used to conduct this retrospective cross-sectional study. Patients with cancer diagnoses that underwent surgery for urologic cancers after January 2020 were included in the analyses. Urologic surgeries were queried using standard SNOMED concepts corresponding to cystectomy, nephrectomy, and prostatectomy. Patients were assessed for adverse postoperative events that were defined using standard SNOMED clinical concepts. COVID-19 positive patients were identified via the N3C Knowledge Store using positive lab measurement or a positive SARS-CoV-2 diagnosis. Analyses were conducted in the N3C data enclave. Result(s): The study cohort included 38,974 total patients with 15,216, 14,778, and 8,980, undergoing cystectomy, prostatectomy, and nephrectomy, respectively. 2,807 had a history of COVID-19 infection greater than 20 days prior to surgery. Prior history of COVID-19 was independently associated with adverse outcomes for cystectomy (OR 1.21 [1.03-1.43], p<0.05) and nephrectomy (OR 1.27 [1.06-1.52], p<0.05), but not prostatectomy (OR 1.14 [0.95-1.36]). Multivariable regression assessing time to surgery and risk for any adverse events, did not reveal significant benefit to waiting greater than 20 days after COVID-19 infection to operate. Conclusion(s): Patients with known prior COVID-19 infection who underwent surgical treatment of urologic cancers experienced increased risk of adverse surgical outcomes. Among this group, those who delayed surgery greater than 20 days after infection did not demonstrate decreased risk of these negative outcomes across the procedures studied. Optimal surgical delay in the treatment of urologic cancers after COVID-19 infection does not appear to be greater than 20 days.
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OBJECTIVE: We evaluated the efficacy and safety of trifarotene plus oral doxycycline in acne. METHOD(S): This was a randomized (2:1 ratio) 12-week, double-blind study of once-daily trifarotene cream 50microg/g plus enteric-coated doxycycline 120mg (T+D) versus trifarotene vehicle and doxycycline placebo (V+P). Patients were aged 12 years or older with severe facial acne (>=20 inflammatory lesions, 30 to 120 non-inflammatory lesions, and <=4 nodules). Efficacy outcomes included change from baseline in lesion counts and success (score of 0/1 with >=2 grade improvement) on investigator global assessment (IGA). Safety was assessed by adverse events and local tolerability. RESULT(S): The study enrolled 133 subjects in the T+D group and 69 subjects in the V+P group. The population was balanced, with an approximately even ratio of adolescent (12-17 years) and adult (>=18 years) subjects. The absolute change in lesion counts from baseline were: -69.1 T+D versus -48.1 V+P for total lesions, -29.4 T+D versus -19.5 V+P for inflammatory lesions, and -39.5 T+D versus -28.2 for non-inflammatory lesions (P<0.0001 for all). Success was achieved by 31.7 percent of subjects in the T+D group versus 15.8 percent in the V+P group (P=0.0107). The safety and tolerability profiles were comparable between the T+D and V+P arms. CONCLUSION(S): T+D was demonstrated to be safe and efficacious as a treatment option for patients with severe acne.Copyright © 2022 Matrix Medical Communications. All rights reserved.
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Keeping track of scientific challenges, advances and emerging directions is a fundamental part of research. However, researchers face a flood of papers that hinders discovery of important knowledge. In biomedicine, this directly impacts human lives. To address this problem, we present a novel task of extraction and search of scientific challenges and directions, to facilitate rapid knowledge discovery. We construct and release an expert-annotated corpus of texts sampled from full-length papers, labeled with novel semantic categories that generalize across many types of challenges and directions. We focus on a large corpus of interdisciplinary work relating to the COVID-19 pandemic, ranging from biomedicine to areas such as AI and economics. We apply a model trained on our data to identify challenges and directions across the corpus and build a dedicated search engine. In experiments with 19 researchers and clinicians using our system, we outperform a popular scientific search engine in assisting knowledge discovery. Finally, we show that models trained on our resource generalize to the wider biomedical domain and to AI papers, highlighting its broad utility. We make our data, model and search engine publicly available.
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Background. Mucosal vaccination may offer increased protection against SARS-CoV-2 compared to parental immunization. Here, we describe immunogenicity and efficacy following viral challenge in non-human primates after intranasal delivery of three unique non-replicating adenoviral vector vaccine (rAd5) candidates. Methods. African green monkeys (AMG) were prime boost immunized 29 days apart with vaccine candidates either expressing the parental spike protein alone (Wuhan-S), spike plus nucleocapsid(Wuhan-S-N), or the spike protein fromthe beta variant (beta-S). Serumand nasal swabs were collected every 14 days and humoral responses to full length spike (S) and receptor binding domain (RBD) were assessed.AllAMGs were challenged with SARS-CoV-2 B.1.351 (beta variant)onday 56. Viral loadsmeasured every two days by TCID50 in nasal washes and bronchial lavage fluid post challenge. Results. Mucosal immunization with Wuhan-S induced significant increases in serum IgG and IgA responses against the homologous parental lineage, as well as beta, delta, and omicron variants. In nasal samples, Wuhan-S immunization elicited over 500-fold increases in in cross-reactive IgA against multiple variants of concern including delta and omicron. While the beta-S rAd5 vaccine candidate induced enhanced serum IgG responses to homologous S and RBD proteins, this approach resulted in less cross-reactive antibodies to other variants compared to Wuhan-S rAd5 vaccine. Despite the differences in the ability to elicit cross-reactive antibody responses, all vaccinated AMGs challenged with SARS-CoV-2 B.1.351 (beta variant), had a significant reduction in viral titers by TCID50 in the nasal passages and reduced viral load in bronchial lavage fluid compared to unvaccinated controls. Conclusion. These results demonstrate mucosal administration of rAd5 clinical candidate vaccine, Wuhan-S, is immunogenic and offers cross-protective humoral responses in both serum and nasal compartments against a mismatched SARS-CoV-2 challenge virus.
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Background. Scarcity of therapeutics to treat Coronavirus Disease 2019 (COVID-19) during the surge in cases caused by the Omicron variant raised concerns that structural inequities would decrease access to these medications for racial minorities and patients with lower socioeconomic status. We hypothesized that screening plus outreach would increase identification of eligible patients in these vulnerable patient populations when compared to referrals alone. Methods. A retrospective cohort study of COVID medication allocation was performed at a quaternary pediatric medical care facility between 1/1/22-2/15/22. The two cohorts were patients referred for COVID therapy and patients identified via screening followed by outreach. Screening plus outreach included daily review of laboratory reports for new positive cases of SARS-CoV-2, followed by chart review for high-risk conditions, and communication with providers or directly with eligible patients to offer therapy. Demographic characteristics, chronic medical conditions, socioeconomic parameters, and medication receipt were compared between the two groups. Results. Overall, 51 and 94 patients were identified via referral and screening plus outreach, respectively. Thirty-two patients received medication of which eight (25%) were identified by screening plus outreach alone. Compared to referred patients, patients in the screen plus outreach group were more likely to have moderate, low, or very low childhood opportunity index (COI) scores (74.5% vs 52.9%%, p = 0.009);public health insurance (69.1% vs 37.5%, p < 0.001);asthma/obesity (63.8% vs 21.6%, p < 0.001), and race/ethnicity other than White, Non-Hispanic (79.8% vs 54.9%, p = 0.002). Patients in the referral group were more likely to receive medication (47.1% vs. 8.5%, p < 0.001). Conclusion. Compared to referral, screening plus outreach for COVID medications can increase identification of patients who are racial minorities, have asthma/ obesity, and have lower socioeconomic status. Future studies should investigate communication strategies to improve uptake of these medications after outreach. (Figure Presented).
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Background: Social isolation and loneliness contribute to cognitive decline, and social isolation represents a key modifiable risk factor for dementia. Substantial interruptions in social engagement due to the COVID-19 pandemic have heightened awareness of this issue, but common later-life events may also reduce social connectedness. The neurocognitive impacts of such disruptions are unclear. Using the validated NIH Emotion Toolbox, we examined perceived social support and changes in perceived support as predictors of cognitive function in a sample of middle aged and older adults. Method(s): 672 participants from the Wisconsin Alzheimer's Disease Research Center (ADRC) completed cognitive tests and Emotion Toolbox questionnaires at 2+ visits between 2017 and 2021 (mean interim = 1.7 years). Predictors comprised t-scores on three perceived social support scales: Emotional Support, Instrumental Support, and Loneliness. Cross-sectional analyses examined associations between social support and cognitive outcomes including memory (RAVLT Immediate and Delayed Recall) and processing speed/executive function (Trails A&B times). Using median t scores from the first and last available visit to categorize social support as high or low (for Loneliness, low loneliness was categorized as "high" social support), support over time was classified as stable-high, stable-low, or "change" (high-low or low-high). Mixed-effects regression models examined the demographic-adjusted predictor-outcome relationships between social support and cognition across visits. Result(s): In this ADRC sample (mean age 65.2, SD = 9.2;Table 1), all three social support scores associated cross-sectionally (Table 2) with Trails A and B performance. Relative to stable-high participants, those reporting either stable-low or declines from high to low social support exhibited poorer performance on measures of processing speed/executive function. Conversely, participants in the low-high group performed comparably on cognitive tests to those in the stable-high group (Table 3;Figure 1). Conclusion(s): Social support associated with processing speed/executive function in this sample. Participants who reported a change in social support performed comparably to those with either stable high or stable low support, suggesting that processing speed/executive function associated with social support may be modifiable in the shorter term. These findings underscore the cognitive cost of social isolation and highlight the substantial benefits of maintaining - and improving - social connections among middle aged and older adults. Copyright © 2022 the Alzheimer's Association.