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COVID-19‘s impact on the daily lives of millions of urban residents around the world has been significant, yet next to many humans are companion animals who have shared the "lockdown” experience. Much as the pandemic has upended human socio-economic lives, the pandemic has also upended companion animal lives, as well as the organizations working to help them in urban areas. This chapter, grounded in the perspective of animal geography, explores the positive and negative effects of COVID-19 on three U.S. animal advocacy organizations: two in Chicago, Illinois and one in Kansas City, Missouri. From early lockdown closures that temporarily stopped all direct care and outreach services, to a post-lockdown recognition of the increasing need for economic support to help families care for their companion animals, to the time lost managing feral populations, we show that the impact of COVID-19 cannot be seen as purely a human phenomenon, but must be seen as a more-than-human experience with long-term ramifications for human-animal relations in urban areas and beyond. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
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BACKGROUND AND AIM: Burnout Syndrome (BS) is an illness that became more noticeable due to Coronavirus Disease 2019 (COVID-19) pandemic in result of the increased demand of healthcare systems. The objective of this study is to investigate BS in the participating Pediatric Intensive Care Units (PICU). METHOD(S): This is a cross-sectional observational study, in which the same survey was sent in 2020 and 2021 to the same population. It included questions about demographic data and the Maslach Burnout Inventory - Human Services Survey, that comprises three sub scales: Depersonalizaition (DP), Emotional Exhaustion (EE) and Personal Accomplishment (PA). The questionnaire was electronically sent to the healthcare workers caring for children in the PICU of participating hospitals. The units had both patients with COVID-19 and other illnesses. There was an overall response rate of 28% in both years analyzed. The answers were analyzed by interpreting the answers to the MBI-HSS and possible relations to dependent and independent variables. Also, simple and multiple linear regression models were assembled to compare the mean scores between the categories of the independent variables of interest. RESULT(S): In the year 2020 there was a majority of participants with low DP, moderate PA and low EE. In the following year, there was an increase in PA levels, which were now mainly high, and both of the other two sub scales remained the same. CONCLUSION(S): Although the second wave of COVID presented historically, with a higher number of cases in general, the healthcare workers showed some overall improvement regarding their burnout syndrome levels.
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Background. In the United States, booster vaccines for persons 18 years and older were approved under Emergency Use Authorization (EUA) in September 2021. Waning immunity following SARS-CoV-2 primary vaccination series led to recommendations for booster vaccination. Emerging data suggest that providing boosters different from the primary series (heterologous vaccination) may provide a broader immune response than boosting with the same vaccine (homologous vaccination). CDC recommended the Pfizer-BioNTech BNT162b2 30-mug mRNA booster vaccine to clinical trial participants >6 months post study vaccines if not planned for boosting within the study. Methods. We conducted an observational study of persons who received 2 doses of Novavax protein-based NVX-CoV2373 vaccine 21 days apart, in a Phase 3 clinical trial, and subsequently received a Pfizer BNT162b2 booster vaccine under EUA. Serologic assays, including the Roche anti-nucleocapsid (N) IgG and anti-Spike (S) IgG, were performed on blood collected pre-booster (D0) and on days 18 (D18) and 34 (D34) post-booster vaccine. The anti-S IgG geometric means (GMTs) were calculated over study time points. Wilcoxon signed rank test was performed to compare anti-S IgG response between D0 and D18 and D0 and D34. Results. Of 26 participants enrolled, 16 (57%) were women;the median age was 47 years (range 29-67). Roche anti-N antibodies were negative at all visits. Time from second NVX-CoV2373 vaccine to Pfizer BNT162b2 booster was a median of 10.4 months in 54% of participants and 7 months in 46% of participants. Anti-S IgG GMTs were 222 BAU/ml D0, 24,723 BAU/ml D18, and 24,584 BAU/ml D34 (p< 0.0001 for comparisons of D0 with D18 & D34). Overall, participants tolerated the booster vaccine without significant adverse events. Cell mediated immunity and D614G pseudovirus neutralizing antibody assays are in progress. Figure 1. Anti-S IgG titers pre and post-booster vaccine 16 participants included with all 3-time study time points for comparison. Conclusion. Two doses of NVX-CoV2373 vaccine followed by the Pfizer BNT162b2 booster vaccine resulted in ~100-fold increase in anti-S IgG against SARS-CoV-2. No participant had evidence of prior SARS-CoV-2 infection by anti-N IgG. Two doses of NVX-CoV2373 vaccine followed by one dose of Pfizer BNT162b2 vaccine is an effective and well-tolerated regimen for boosting anti-S IgG against SARS-CoV-2.
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Background. Infectious diarrhea is a common cause of emergency department (ED) visits and hospital admissions. Polymerase chain reaction (PCR) testing allows for quick and expansive pathogen identification and facilitates earlier targeted treatment. We implemented a multiplex gastrointestinal (GI) PCR panel in 2014. In collaboration with the Antimicrobial and Diagnostic Advisement Program (ADAP), post-launch optimization strategies have changed test use. We evaluate the impact of diagnostic stewardship initiatives. Methods. GI PCR testing was initially unrestricted for ED or inpatients within 72 hours of admission. After fielding many questions regarding interpretation, the ADAP developed a guidance document in June 2019 regarding treatment considerations for all potential organisms detected. In January 2020, organism-specific treatment considerations were embedded in the test results real-time treatment guidance (figure 1). A pre-post quality improvement assessment of the changes was performed. In August 2021, individual GI PCR panel orders were replaced with an order set containing a decision tree to provide passive guidance evaluating acute vs chronic diarrhea, assessing recent antibiotic use (to consider C. difficile testing), no testing scenarios, and avoiding repeat testing (figure 2). Results. GI PCR panel use peaked in 2019 with 3,142 tests processed. The guidance document was less helpful, requiring an external site link. Embedding organismspecific GI PCR guidance significantly improved appropriate antibiotic prescribing (77.9 vs 89.1%, p=0.001). A precipitous drop off in GI PCR test orders occurred after the COVID-19 pandemic began (1,774 in 2020), partly attributed to supply chain issues. When comparing intra-pandemic years (2020 vs 2021), implementation of a smart order set was associated with a 51.3% reduction in orders (1,774 vs 864) and $131,000 in savings despite significant patient volume increases in 2021. Low use rates have persisted into the first quarter of 2022 (n=229). Conclusion. Diagnostic stewardship changes should be proactive and contextually relevant at the time of result interpretation. Antimicrobial stewardship programs are uniquely positioned to lead optimization initiatives and drive clinical and costeffective solutions. (Figure Presented).
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The COVID-19 pandemic has exposed the precarious demand-capacity balance in Canadian hospitals, including critical care where there is an urgent need for trained health care professionals to dramatically increase ICU capacity. The impact of the pandemic on ICUs varied significantly across the country with provinces that implemented public health measures later and relaxed them sooner being impacted more severely. Pediatric ICUs routinely admitted adult patients. Non-ICU areas were converted to ICUs and staff were redeployed from other essential service areas. Faced with a lack of critical care capacity, triage plans for ICU admission were developed and nearly implemented in some provinces. Twenty eight percent of patients in Canadian ICUs who required mechanical ventilation died. Surviving patients have required prolonged ICU admission, hospitalization and extensive ongoing rehabilitation. Family members of patients were not permitted to visit, resulting in additional psychological stresses to patients, families, and healthcare teams. ICU professionals also experienced extreme psychological stresses from caring for such large numbers of critically ill patients, often in sub-standard conditions. This resulted in large numbers of health workers leaving their professions. This pandemic is not yet over, and it is likely that new pandemics will follow. A review and recommendations for the future are provided. © 2022 Gibney et al.
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The BlackGEM array Phase I consists of three wide field, optical telescopes, located at the ESO La Silla Observatory, Chile. Each telescope is of a modified Dall-Kirkham design, using an 0.6m primary mirror and a 110 Mpix STA1600 CCD to give a 2.7 square degrees field-of-view sampled at 0.56 ''/pixel. Preliminary commissioning data shows performance on-par with design specifications. Data obtained with the BlackGEM prototype MeerLICHT highlights the capabilities of the design with a 5-sigma limiting magnitude of m(AB)=22.2 in 300s of integration under dark-sky conditions. Extrapolation to the 1 '' seeing-conditions expected at La Silla shows that the main goal of BlackGEM to probe down to m(AB)=23 in 300s can be met. The project suffered a 2-year COVID-19 delay. Commissioning of the array has currently been resumed and science operations are expected to start in Q3/Q4 of 2022. The science programs include the follow-up of gravitational wave alerts from LIGO/Virgo/KAGRA, a six-filter Southern Sky Survey, a Fast Synoptic Survey on selected fields, a Local Universe intra-night monitoring program and a inter-night single-band monitoring for slower transients.
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Background: With the growing acceptance of the role for the expansion of suitable indications for liver transplantation, such as selected cases of hilar cholangiocarcinoma and unresectable colorectal liver metastases, the imbalance between clinical need for liver transplantation and supply of suitable donor organs is likely to widen in Europe for the foreseeable future. Novel organ perfusion technologies are likely to play a fundamental role in maximising utilisation of all donor organs and facilitating the safe transplantation of marginal grafts. Herein we describe the initial experience of implementing Normothermic Machine Perfusion (NMP) in a liver transplant centre just before the onset of the COVID-19 pandemic. Methods: Retrospective analysis of a prospectively-maintained comprehensive database encompassing donor characteristics, perfusion parameters and post-transplantation outcomes. Results: Between February 2020 and October 2021 (20 months), 37 liver grafts were perfused with NMP and 23 proceeded to transplantation. The indications for NMP included logistics - 16 grafts (69%), further assessment of marginal grafts - 5 (22%) livers and facilitation of a predicted difficult hepatectomy (e.g. redo transplant) - 2 livers (9%). Overall, a total of an additional 15 livers, 3 kidneys and one pancreas were transplanted that absolutely could not have been transplanted without NMP (e.g. logistics, unacceptable cold ischaemic time with static cold storage) and a further 7 livers were successfully transplanted that may have been declined without the additional reassurance of dynamic functional assessment and safe prolongation of preservation time. No grafts were lost as a result of perfusion with NMP. Conclusions: NMP is a safe and effective technique for improving graft utilisation in liver transplantation and has become an integral component of routine clinical practice since its introduction in Edinburgh. As collective experience with NMP increases, the prognostic predictive ability of serum (and potentially bile) analysis on the machine is likely to improve graft utilisation further.
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Objectives: To evaluate the epidemiology of rapid response team (RRT) reviews that led to intensive care unit (ICU) admissions, and to evaluate the frequency of in-hospital cardiac arrests (IHCAs) among ICU patients with confirmed coronavirus disease 2019 (COVID-19) in Australia. Design: Multicentre, retrospective cohort study. Setting: 48 public and private ICUs in Australia. Participants: All adults (aged ≥ 16 years) with confirmed COVID-19 admitted to participating ICUs between 25 January and 31 October 2020, as part of SPRINT-SARI (Short PeRiod IncideNce sTudy of Severe Acute Respiratory Infection) Australia, which were linked with ICUs contributing to the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS APD). Main outcome measures and results: Of the 413 critically ill patients with COVID-19 who were analysed, 48.2% (199/413) were admitted from the ward and 30.5% (126/413) were admitted to the ICU following an RRT review. Patients admitted following an RRT review had higher Acute Physiology and Chronic Health Evaluation (APACHE) scores, fewer days from symptom onset to hospitalisation (median, 5.4 [interquartile range (IQR), 3.2–7.6] v 7.1 days [IQR, 4.1–9.8];P < 0.001) and longer hospitalisations (median, 18 [IQR, 11–33] v 13 days [IQR, 7–24];P < 0.001) compared with those not admitted via an RRT review. Admissions following RRT review comprised 60.3% (120/199) of all ward-based admissions. Overall, IHCA occurred in 1.9% (8/413) of ICU patients with COVID-19, and most IHCAs (6/8, 75%) occurred during ICU admission. There were no differences in IHCA rates or in ICU or hospital mortality rates based on whether a patient had a prior RRT review or not. Conclusions: This study found that RRT reviews were a common way for deteriorating ward patients with COVID-19 to be admitted to the ICU, and that IHCA was rare among ICU patients with COVID-19. © 2022, College of Intensive Care Medicine. All rights reserved.
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Background: The kinetics and functional profiles (granzyme-B production) of HIV-specific T-cell responses support that those targeting the early viral gene product Nef disproportionately recognize residual antigen expression during long-term antiretroviral therapy (ART). Here, we leveraged this insight to test whether SARS-CoV2 mRNA vaccines-which activate TLR and inflammatory signaling pathways-would reactivate latent HIV, stimulating T-cell responses with these characteristics. Methods: T-cell responses to individual HIV gene products were measured by IFN-g or granzyme B ELISPOT, and by activation induced marker (AIM) assays at baseline and ∼2 weeks after SARS-CoV-2 mRNA vaccine prime and boost, in 13 long-term ART treated adults. Total and unspliced HIV mRNA, as well as intact and defective (IPDA) HIV DNA were measured in parallel by digital droplet PCR (ddPCR). Results: We observed transient increases Nef-specific T-cell responses following vaccine prime by granzyme B ELISPOT (3.1-fold increase, p=0.002) and a trend by AIM assay (1.5-fold increase, p=0.06). Such increases were not observed in granzyme B responses to late gene products nor in any IFN-g responses. Both unspliced and total HIV mRNA decreased significantly across the study, unspliced-1.6-fold decrease p = 0.03;total-1.5-fold decrease p = 0.05. Changes in total HIV mRNA correlated inversely with Nef-specific granzyme B-producing (spearman's ρ =-0.73, p = 0.006) and Nef-specific CD8+ AIM T-cell responses (ρ =-0.76, p = 0.006) following vaccine prime. These reductions in HIV RNA were not accompanied by significant changes in total or intact HIV DNA. Conclusion: Consistent with our hypothesis, a restricted profile of HIV-specific T-cell responses showed significant increases following SARS-CoV-2 vaccine prime, each of which were then correlated with reductions in HIV RNA. This supports that vaccination promoted productive interactions between Nef-specific CTL and HIV-infected cells in vivo. We propose three scenarios for why this was not reflected in reductions in intact or total HIV DNA: i) meaningful depletions in inducible proviruses occurred but were lost against the background of non-inducible proviruses ii) interactions with CTL involved only a fraction of inducible proviruses, or iii) substantive proviral depletions occurred, but were counterbalanced by clonal expansion of HIV-infected cells.
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Background: The coronavirus disease 2019 (COVID-19) has resulted in an unprecedented research response, demonstrating exceptional examples of rapid research and collaboration. There is however a need for greater coordination, with limited resources and the shifting global nature of the pandemic resulting in a proliferation of research projects underpowered and unable to achieve their aims. Methods: The UK Collaborative on Development Research (UKCDR) and Global Research Collaboration for Infectious Disease Preparedness (GloPID-R), two funder coordination groups have collaborated to develop a live database of funded research projects across the world relating to COVID-19. Drawing data continually from their members and further global funding bodies, as of 15 (th) July 2021 the database contains 12,419 projects, funded by 255 funders, taking place across 149 countries representing an investment of at least $4.9 billion. To our knowledge it is one of the most comprehensive databases. The database is aligned to the World Health Organisation and GloPID-R Global Research Roadmap: 2019 Novel Coronavirus. It is being used by the WHO, governments and multi-lateral policy makers, research funders and researchers. This living mapping review aims to supplement the database by providing an open accessible and frequently updated resource summarising the characteristics of the COVID-19 funded research portfolio. Both descriptive and thematic analysis will be presented and updated frequently to aid interpretation of the global COVID-19 funded research portfolio. Results: In this version five analysis we provide an updated detailed descriptive analysis of the database (three months after version four) and focus our thematic analysis on research gaps, research areas in need of coordination, study populations and research locations (with a focus on resource-limited countries). Conclusions: As the global funding response to COVID-19 plateaus, this living mapping review helps both funders and researchers to prioritise resources to areas where there is continued unmet research need.
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The Southern United States, the fastest growing region in the nation, is comprised of the largest number of states and home to the largest population of residents compared to the other three U.S. regions. Americans in the South have been more likely to experience poor health outcomes, to be living in poverty, and to be uninsured than those in other regions. In addition, Southerners' tradition of hospitality, the high value placed on church attendance, and the large numbers of individuals identifying as members of racial and ethnic minority groups render the region particularly vulnerable to COVID-19. These factors intertwine to affect COVID-19's ability to devastate the South.
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BACKGROUND: Transmission in healthcare settings can result in significant infections in healthcare workers and patients. Understanding infection dynamics has important implications for methods employed in hospitals to prevent nosocomial transmission events. METHODS: In this case series report we describe a cluster of COVID-19 (Coronavirus disease 2019) in a tertiary care university hospital, in the early phases of the epidemic, after hospital visiting had been stopped and when the UK lockdown was in place. FINDINGS: A 48 year old patient developed COVID-19 31 days post-admission and four days after admission to a medical ward from ITU. Infection was likely acquired from an asymptomatic or minimally symptomatic healthcare worker (HCW). Subsequent investigation over a 14 day period revealed symptoms in 23 staff members and five linked cases in patients on the same ward.Nine of the 23 affected staff members provided care for and had direct exposure with the index case. Four staff reported caring for the index case without use of personal protective equipment. One was coughed on directly by the patient 24 hours prior to the onset of symptoms. CONCLUSION: SARS CoV2 infection can be introduced to a ward area by asymptomatic and minimally symptomatic healthcare workers. Staff members and patients can act as Trojan horses carrying infection into and around the hospital, setting up unexpected transmission events.Transmission of infection from pre-symptomatic, asymptomatic and minimally symptomatic individuals means that universal use of measures to prevent transmission is required for successful reduction of transmission events in the hospital setting.