Impact of COVID-19 on Hepatitis B Screening in Sierra Leone: Insights from a Community Pharmacy Model of Care (preprint)

Background: There are limited studies evaluating the impact of COVID-19-related interruptions on hepatitis B virus (HBV) screening in endemic countries in Sub-Saharan Africa. Methods: We conducted a retrospective study of HBV testing in a community pharmacy in Freetown, Sierra Leone, from October 1, 2019, through September 30, 2022. We compared participant characteristics using Pearson's chi-square test. We evaluated trends in HBV screening and diagnosis using one-way ANOVA with Tukey's or Dunnett's post-test. Results: Of 920 individuals screened, 161 had detectable HBsAg (seroprevalence 17.5% [95% CI 14.9-20.4]). There was a 100% decrease in HBV screening during January-June of 2020; however, screening increased by 27% and 23% in the first and second year after COVID-19, respectively. Mean quarterly tests showed a significant upward trend: 55 - 6 tests during January-March (baseline), 74 - 16 tests during April-June, 101 - 3 tests during July-September, and 107 - 17 tests during October-December (one-way ANOVA test for trend, F = 7.7, p = 0.0254) but not the mean quarterly number of people diagnosed with HBV (F = 0.34, p = 0.7992). Conclusion: Community-based HBV screening dramatically improved following temporary disruptions related to COVID-19. Seasonal variation in HBV screening, but not HBV diagnosis, may have implications for HBV elimination efforts in Sierra Leone and other West African countries.

Shifting mediates gendered racial microaggressions and perceived racism among Asian American women.

INTRODUCTION: Microaggressive attacks on Asian American women increased during the COVID-19 pandemic. The present study tested whether Asian American women's shifting, a coping strategy employed by some women of color to alter their self-presentation in response to perceived racism, mediated the association between gendered racial microaggressions and self-perceived subtle and blatant racism. METHODS: A convenience sample of 253 Asian American adult women completed the gendered racial microaggressions scale for Asian American women (GRMSAAW), the Asian American women's shifting scale (AsAWSS), and the subtle and blatant racism scale for Asian American college students (SABR-A2 ). RESULTS: Results from a structural equation model indicated a partial mediation effect; experiences with increased gendered racial microaggressions were associated with greater levels of shifting, which in turn, were associated with greater perceived subtle and blatant racism. DISCUSSION: These data extend our understanding of the shifting coping mechanism used by some Asian American women. Implications for clinical practice and future research are also discussed.

A 2-week course of Exclusive Enteral Nutrition followed by the Crohn Disease Exclusion Diet is effective for Induction and Maintenance of Remission in children with Crohn Disease;the DIETOMICS-CD trial

Background: Exclusive enteral Nutrition (EEN) is considered a first line therapy for children with active Crohn disease (CD). CD Exclusion Diet (CDED)+Partial Enteral Nutrition (PEN) is effective for induction of remission in mild-moderate CD at weeks 6 and 12, with better tolerance than EEN. We assessed whether a 2-week course of EEN, followed by CDED+PEN is superior to 8 weeks of EEN in sustaining clinical remission at week 14, outcomes of CDED up to 24 weeks, and the utility of CDED in mild-severe CD. Method(s): This international, multicenter, randomized-controlled trial compared 2 weeks of EEN (Modulen, Nestle Health Science) followed by 3 phases of the CDED+PEN to 8 weeks of EEN, followed by PEN with free diet, both up to week 24. Children aged 8-18 with CD<3 years, mild-severe disease [paediatric CD activity index (PCDAI) 15-47.5], and active inflammation [elevated C-reactive protein (CRP) or faecal calprotectin (FCP)] were included. Stable immunomodulator (IM) treatment was allowed. Naive patients were allowed to start an IM from week 4. Result(s): Of the 63 eligible patients enrolled, 55 were randomized and included in the final intention to treat analysis (target recruitment failed due to COVID);Group 1 (CDED+PEN;29) and group 2 (EEN;26), mean age 12.7+/-2.4. Steroids-free sustained remission at week 14 was obtained in 20/29(69%) in group 1 and 16/26(61.5%) in group 2, p=0.56. Remission at week 8 was obtained in 22/29(76%) in group 1 and 14/26(54%) in group 2, p=0.08. 16/29(55%) in group 1 and 9/26(34%) in group 2 maintained clinical remission at week 24;p=0.12. Median PCDAI declined from 32.5[20-36.2] to 2.5[0-5.6] and 1.2[0-5.6] in group 1 (p<0.001 for all), and from 22.5[20-29.3] to 0[0-4.3] and 0[0-2.5] in group 2 (p<0.005 for all) at baseline, week 8 and 14 respectively. Median CRP improved in group 1 from 32 mg/L[6-69] to 5[2-16] and 3[2-10.1] (p<0.001 for both) and in group 2 from 10.35 mg/L[5-33] to 3.7[2.2-7.2], p=0.012 and 3.2[2.8-5], p=0.006 at baseline, week 8 and 14 respectively. Median FCP declined in group 1 from 1946 mug/g [862-3304] to 802[196-1312] at week 8 and 241[82-1175] at week 14 (p<0.01 for both), and in group 2 from 1615[605-2692] at baseline to 436[252-1389] at week 8, which then increased to 731[349-1305] at week 14 (p<0.01 for both). At week 14, 12/22(54%) received IM from group 1 and 15/16(93%) from group 2;p= 0.009. Conclusion(s): Two weeks of EEN followed by CDED&lPEN and EEN were successful in induction of clinical and biochemical remission in mild-severe paediatric CD, and most CDED+PEN patients-maintained remission to 24 weeks. Sustained clinical remission at week 14 was similar despite higher IM use in the EEN Group, suggesting that CDED might prevents diet-induced inflammation regardless of IM use.

Heart and Lung Transplant Unit - Western Australia Covid-19 Experience

To describe the COVID-19 experience among the highly immunosuppressed heart and lung transplant patient cohort at the West Australian Heart and Lung Transplant Unit. Retrospective observational cohort study between January 2020 and October 2022 at the states only quaternary hospital. The WA state heart-lung transplant service supports 297 recipients, 152 under the advanced heart failure unit and 145 patients under the care of the advanced lung disease unit. WA was in a unique position with COVID-19 secondary to border closures, high vaccination rates and community transmission with the Omicron wave. A total of 74 patients (24.9%) across the WA unit contracted COVID-19 during the study period. The median age was 53 years (IQR 42-60) with a male gender predominance (63.5%). The heart transplant cohort had a 23.0% (n=35) COVID-19 infection prevalence. The lung transplant cohort had 31.0% (n=45) COVID-19 positive patients across the study period. Bilateral sequential lung transplants BLST (n=38, 84.4%) was the most common transplant type, followed by heart-lung transplant (n=5, 11.1%) and then single lung transplant (n=2, 4.5%). Most patients across both units were classified as mild COVID-19, with only a small proportion of patients requiring hospitalisation (n=24, 32.4%). Cough (60.0%) and sore throat (55.6%) were the most common initial symptoms reported by the patients. COVID-19 vaccination status at the time of infection was higher than 80%. Pre-exposure prophylaxis was given to 35% of the patients who had COVID-19 infection. Most patients had stable graft function despite COVID-19 as measured by left ventricular ejection fraction on trans-thoracic echocardiogram or forced expiratory volume. Overall the WA COVID-19 case numbers and disease severity in the highly immunocompromised transplant cohort were minimal. Disease severity, morbidity and mortality were low when compared to the predicted modelling for this at-risk cohort released by the Department of Health. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Timing and Trends for Municipal Wastewater, Lab-Confirmed Case, and Syndromic Case Surveillance of COVID-19 in Raleigh, North Carolina.

Objectives. To compare 4 COVID-19 surveillance metrics in a major metropolitan area. Methods. We analyzed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in wastewater influent and primary solids in Raleigh, North Carolina, from April 10 through December 13, 2020. We compared wastewater results with lab-confirmed COVID-19 cases and syndromic COVID-like illness (CLI) cases to answer 3 questions: (1) Did they correlate? (2) What was the temporal alignment of the different surveillance systems? (3) Did periods of significant change (i.e., trends) align? Results. In the Raleigh sewershed, wastewater influent, wastewater primary solids, lab-confirmed cases, and CLI were strongly or moderately correlated. Trends in lab-confirmed cases and wastewater influent were observed earlier, followed by CLI and, lastly, wastewater primary solids. All 4 metrics showed sustained increases in COVID-19 in June, July, and November 2020 and sustained decreases in August and September 2020. Conclusions. In a major metropolitan area in 2020, the timing of and trends in municipal wastewater, lab-confirmed case, and syndromic case surveillance of COVID-19 were in general agreement. Public Health Implications. Our results provide evidence for investment in SARS-CoV-2 wastewater and CLI surveillance to complement information provided through lab-confirmed cases. (Am J Public Health. Published online ahead of print November 10, 2022:e1-e11. https://doi.org/10.2105/AJPH.2022.307108).

Detection of SARS-CoV-2 RNA in wastewater and comparison to COVID-19 cases in two sewersheds, North Carolina, USA.

Wastewater surveillance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be useful for monitoring population-wide coronavirus disease 2019 (COVID-19) infections, especially given asymptomatic infections and limitations in diagnostic testing. We aimed to detect SARS-CoV-2 RNA in wastewater and compare viral concentrations to COVID-19 case numbers in the respective counties and sewersheds. Influent 24-hour composite wastewater samples were collected from July to December 2020 from two municipal wastewater treatment plants serving different population sizes in Orange and Chatham Counties in North Carolina. After a concentration step via HA filtration, SARS-CoV-2 RNA was detected and quantified by reverse transcription droplet digital polymerase chain reaction (RT-ddPCR) and quantitative PCR (RT-qPCR), targeting the N1 and N2 nucleocapsid genes. SARS-CoV-2 RNA was detected by RT-ddPCR in 100 % (24/24) and 79 % (19/24) of influent wastewater samples from the larger and smaller plants, respectively. In comparison, viral RNA was detected by RT-qPCR in 41.7 % (10/24) and 8.3 % (2/24) of samples from the larger and smaller plants, respectively. Positivity rates and method agreement further increased for the RT-qPCR assay when samples with positive signals below the limit of detection were counted as positive. The wastewater data from the larger plant generally correlated (⍴ ~0.5, p < 0.05) with, and even anticipated, the trends in reported COVID-19 cases, with a notable spike in measured viral RNA preceding a spike in cases when students returned to a college campus in the Orange County sewershed. Correlations were generally higher when using estimates of sewershed-level case data rather than county-level data. This work supports use of wastewater surveillance for tracking COVID-19 disease trends, especially in identifying spikes in cases. Wastewater-based epidemiology can be a valuable resource for tracking disease trends, allocating resources, and evaluating policy in the fight against current and future pandemics.

Prostheses used in hip, knee, ankle, elbow and shoulder replacement procedures 2020

This document reports the numbers of prostheses recorded and reported to the NJR between 1 January and 31 December 2020. The tables show volumes of components as they have been entered into the registry, regardless of construct. The procedure counts in this document are presented without adjustment and may vary from counts found in the corresponding main NJR Annual Report analysis. If a procedure has been submitted with missing implant information this will also cause numbers to differ. Procedure counts below four have been suppressed. Components are listed and described according to the current classifications used in the registry. It must be noted that due to COVID-19, the ratio of revision to primary procedures increased in 2020 and this may affect the relative changes in the types and brands of implants used in comparison to previous years. As this document was not published for 2019 Annual Report data, comparison has been made with the 2018 Annual Report data.

The State of Hospital Infection Services in the UK: National Workforce Survey 2021

Introduction: With the evolution of centralised ‘hub and spoke’ microbiology services, the expansion of infectious diseases as a medical specialty and the advent of joint infection training pathways, the infection services within the United Kingdom (UK) are experiencing a period of rapid change. Despite this, to date there has been no comprehensive description of the distribution of specialty staffing and service provision across the country. To this end, the British Infection Association (BIA), in conjunction with the Royal College of Pathologists (RCPath), has undertaken a national survey of National Health Service (NHS) infection services. Methods: Questions were compiled following consultation with an expert panel including BIA Council members. An online survey was distributed to clinical leads at all UK NHS acute trusts or health boards with inpatient beds and data were collected between April and August 2021. Results: The overall response rate was 72% (108 respondents). The median number of infection consultant full time equivalents (FTE) per service was 6.1 overall (5.6 per 1000 acute beds) although this varied between the devolved nations and was lowest in centres with microbiology specialists only. Forty-three services had three or fewer FTE medically qualified infection specialists. Overall, 17.5% of all funded FTE consultant-level posts were vacant, although this was markedly higher for microbiology-accredited posts (20.3%) than for infectious diseases (ID) (9.3%) or medical virology (14.6%). There were fewer vacancies in centres with ID-accredited consultants;median 1.0 (IQR 0–2.2) versus those with microbiology only;1.8 (IQR 0–2.9). Distribution of non-consultant staff was extremely heterogenous with 44 services having none and 25 having one or less FTE (most of which employed microbiology-only accredited consultants). 30% of organisations reported at least one vacant training post. Half of the responding organisations reported at least one consultant accredited in ID but only 28 provided inpatient care with a total of 520 ‘dedicated’ ID beds, of which 235 were negative pressure side-rooms. Geographically, several large areas of the country lacked inpatient ID capacity and/or ID-accredited consultant expertise. The burden of laboratory-related and reporting work in relation to staffing levels is disproportionately greater at smaller centres;there are a median 7.7 (IQR 5.9–9.5) hours/person/week at centres with three or fewer consultants and 4.0 (IQR 2.1–6.3) at larger centres. Conclusion: Microbiology specialists continue to provide the bulk of infection services across the UK and there is marked geographical variation in staffing with regards to other specialities. With Core Infection Training now producing dual-accredited consultants, there is an untapped potential to expand inpatient ID service provision although the requirement for placements on an existing inpatient ID unit may be limiting this currently. There are extremely high vacancies rates across the country but smaller, microbiology-only centres are hardest-hit with many barely attaining the consultant numbers required to staff a safe on-call rota. Workforce planning with utilisation of the valuable expertise of non-medically-trained staff, such as Clinical Scientists, is urgently needed. The results of this survey, in conjunction with Best Practice Standards recently published by the BIA, RCPath and Royal College of Physicians can inform commissioning and delivery of infection expertise in the context of the aftermath of the COVID-19 pandemic.

COMPARISON OF INTRAVESICAL THERAPY AND SURGERY AS TREATMENT OPTIONS FOR RECURRENT BLADDER CANCER (CISTO): UPDATE ON AN ONGOING MULTICENTER PRAGMATIC STUDY

INTRODUCTION AND OBJECTIVE: Patients with non-muscleinvasive bladder cancer (NMIBC) that recurs after treatment with intravesical Bacillus Calmette-Guerin (BCG) must weigh the risk of progression of bladder cancer and loss of a window of potential cure with medical therapy against the risk of morbidity and loss of quality of life (QOL) with radical cystectomy. The CISTO Study (NCT03933826) is a pragmatic, prospective observational cohort study comparing medical therapy (i.e., intravesical therapy or systemic immunotherapy) with radical cystectomy for recurrent highrisk NMIBC. Here we report on the design and progress of the CISTO Study. METHODS: 900 patients with recurrent high-risk NMIBC that has failed first-line BCG and who have chosen to undergo standard of care treatment will be enrolled. Patient stakeholders helped determine the primary outcome: 12-month patient-reported QOL using the EORTC QLQ-C30. Secondary outcomes include urinary and sexual function, decisional regret, financial distress, healthcare utilization, return to work/normal activities, progression, and recurrence-free, metastasis-free, and overall survival. Participants will be followed for up to 3 years. RESULTS: Enrollment is active at 32 sites across the US, including 23 university-based centers and 9 community sites. As of November 1, 2021, 173 participants have been enrolled, 104 of whom chose medical therapy and 69 of whom chose radical cystectomy. The completion rate for the primary outcome of QOL at 12 months is 94% (15 out of 16 participants to date). The inclusion of electronic consent and collection of PROs allowed recruitment and follow-up to continue remotely during the COVID-19 pandemic. Significant pandemic-related challenges have included slow study start-up at sites, staffing, periods of suspension, and delays in patients obtaining care. Strategies to address these challenges include improved methods for onboarding and training sites, all-site communication, confirming study eligibility, ing EHR data, and remote monitoring while adhering to the highest study standards. CONCLUSIONS: The CISTO Study will compare patient reported outcomes for those undergoing medical therapy with radical cystectomy for recurrent high-risk NMIBC. The CISTO Study has the potential to fill critical evidence gaps and provide for personalized, patient-centered care.

A cell-based, spike protein binding assay highlights differences in antibody neutralising capacity for SARS-CoV-2 variants (preprint)

The engagement of the SARS-CoV-2 spike protein with ACE2 is a critical step for viral entry to human cells and accordingly blocking this interaction is a major determinant of the efficacy of monoclonal antibody therapeutics and vaccine-elicited serum antibodies. The emergence of SARS-CoV-2 variants necessitates the development of adaptable assays that can be applied to assess the effectiveness of therapeutics. Through testing of a range of recombinant spike proteins, we have developed a cell based, ACE2/spike protein binding assay that characterises monoclonal anti-spike protein antibodies and neutralising antibodies in donor serum. The assay uses high-content imaging to quantify cell bound spike protein fluorescence. Using spike proteins from the original "Wuhan" SARS-CoV-2 virus, as well as the delta and omicron variants, we identify differential blocking activity of three monoclonal antibodies directed against the spike receptor binding domain. Importantly, biological activity in the spike binding assay translated to efficacy in a SARS-CoV-2 infection assay. Hence, the spike binding assay has utility to monitor anti-spike antibodies against the major known SARS-CoV-2 variants and is readily adaptable to quantify impact of antibodies against new and emerging SARS-CoV-2 variants.

COVID-19 Vaccine Hesitancy among Healthcare Workers and Trainees in Freetown, Sierra Leone: A Cross-Sectional Study.

Despite having safe and efficacious vaccines against COVID-19, vaccine hesitancy is widespread. Although a trusted source of information, vaccine hesitancy has been reported among healthcare professionals, yet few studies have explored this phenomenon in sub-Saharan Africa. We conducted a cross-sectional survey of healthcare professionals in Sierra Leone from January to March 2022. Measures included sociodemographic/health-related information and COVID-19-related concerns. From the responses, we constructed a hesitancy (VAX) score, with higher scores implying negative attitudes or unwillingness to vaccinate. Multivariate linear regression was used to access factors associated with vaccine hesitancy. Overall, 592 participants submitted responses (67.2% female, mean age 29 years, 5.6% physicians/pharmacists, 44.3% medical students, 29.2% nurses, 20.9% nursing students). The mean VAX score was 43.27 ± 8.77, with 60.1% of respondents classified as vaccine hesitant (>50th percentile) and 13.8% as highly hesitant (>75th percentile). Worries about unforeseen future effects (76.3%), a preference for natural immunity (59.5%), and profiteering/mistrust of health authorities (53.1%) were the most common concerns. Being a medical student (ß = 0.105, p = 0.011) and previously refusing a recommended vaccine (ß = 0.177, p < 0.001) were predictors of COVID-19 vaccine hesitancy. Our findings call for addressing vaccine hesitancy among healthcare professionals as an essential component of strategies aimed at increasing COVID-19 vaccine uptake in this setting.

Infant hospitalisations and seasonal respiratory viruses seen at Kidz first in 2021

Introduction: COVID-19 lockdown measures implemented in March 2020 markedly reduced hospitalisations of infants with respiratory infections at Kidz First Hospital. There was no characteristic winter peak of respiratory infections with only three hospitalisations during 1 March-31 August with a positive PCR result for RSV and one for influenza. The commencement of quarantine-free travel between Australia and New Zealand started in April 2021 and within 2 weeks there was a positive PCR panel for RSV at Kidz First, the first RSV positive test for over a year with case numbers steadily increasing thereafter. Methods: To confirm the return of the winter peak we examined respiratory viral PCR test results and infant lower respiratory tract infection (LRTI) hospitalization data from 1 January 2015, through 31 July 2021. All specimens submitted by Kidz First clinicians for respiratory viral PCR testing were identified. ICD codes were used to identify infants <2 years of age hospitalized for >3 h with a LRTI. Results: During the months of March-July the number of inpatient hospitalisations at Kidz First varied from 944 in 2015 to 706 in 2018. There was a dramatic reduction to 144 hospitalisations in 2020 but this has rebounded back to 730 in 2021. The number of positive PCR panels for RSV increased to 803(52%) with a much higher percentage than any previous year. There were no PCR positive tests for influenza A or B. The percentage of positive PCR panels for adenovirus (7%), parainfluenza (4%) and rhinovirus/ enterovirus (53%) have remained similar to previous years. Clinician-directed investigation of infants with respiratory infections has increased in response to COVID-19. Conclusion: Easing of COVID-19 restrictions and commencement of quarantine-free travel with Australia has likely resulted in the return of RSV and LRTI hospitalisations rates similar to previous winter peaks.

Supporting learner social-emotional learning and literacy in virtual environments

An exploratory and descriptive case study of the experiences of secondary learners at a community-based learning center on the Caribbean coast in Latin America, this study explores how the Casa Morpho Community of Learners (CoL) model met the socio-emotional (SEL) and literacy needs of adolescents within various virtual environments during the quarantine in Costa Rica. Using lesson plans, teachers' reflective notes, and a developed Learners reflective survey, the following questions were addressed: 1) How did Casa Morpho's curriculum support learners in virtual environments, and with their SEL and literacy needs during the COVID-19 pandemic? 2) What practices were used and how do learners perceive those experiences?. © 2021, IGI Global.

The 4Cs of academic language and literacy: Facilitating structured discussions in remote classrooms

This chapter describes how teachers have used structured discussions and digital tools to transition from traditional classrooms to remote, online instruction during the COVID-19 pandemic. With emphasis on culturally and linguistically diverse students, the chapter includes examples of how teachers reinforce literacy while supporting 21st century skills such as collaboration, communication, critical thinking, and creativity. Tools and strategies are presented along with examples teachers can use to facilitate student learning across content areas in virtual classrooms. © 2021, IGI Global.