Processing a White Supremacist Insurrection Through Hip-Hop Mixtape Making: A School Counseling Intervention

In this New York City, New York-based study, we made use of a Critical Cycle of Mixtape Creation (CCMC) intervention to examine a Bangladeshi high school student's understanding of justice, and the impact of injustice on his well-being, through his creation of and reflection on original hip-hop song lyrics. The student participated in the CCMC intervention amid the COVID-19 pandemic, the ongoing Black Lives Movement, and crucially the white supremacist insurrection on January 6, 2021. Findings indicate that the CCMC enabled the student to process systemic racism and injustices with peers on his own terms and to further develop a knowledge of self. This study offers practical insights for school counselors to use hip-hop interventions with youth to collectively process the world around them.

Bictegravir/Emtricitabine/Tenofovir Alafenamide (B/F/ TAF) for the Treatment of People Living with HIV (PLWH): 12-month (12M) Effectiveness, Persistence, and Safety in a Multi-country Cohort Study

Introduction: BICSTaR (GS-EU-380-4472/GS-CA-380-4574/GS-IL-380- 5335) is an ongoing, multinational, observational cohort study evaluating real-world effectiveness and safety of B/F/TAF in ART naïve (TN) and ARTexperienced (TE) PLWH. Materials and Methods: This 12M pooled analysis included PLWH starting B/F/TAF in clinical practice from June 2018 to September 2020 (latterly during the COVID-19 pandemic) in Europe/Israel/Canada. Outcomes included virological effectiveness (HIV-1 RNA <50 copies/ml [missing=excluded]), persistence, drug-related adverse events (DRAEs), and laboratory parameters. Results: One-thousand one hundred thirty-five PLWH were included (Table 1). The TE group had older median age than TN. Of TE participants, 65%/20%/16% switched from INSTI/NNRTI/PI-based regimens (36% TDF/46% TAF/13% ABC);12% had prior virologic failure. Baseline resistance was documented in 124/535 participants (NRTI/NNRTI/PI/ INSTI=6%/6%/3%/0.2%). Prevalence of comorbidities (47%/72% TN/TE) and concomitant medication usage was high. At 12M, 97% (149/154) of TN and 96% (771/800) of TE participants had HIV-1 RNA <50 copies/ml, and persistence on B/F/TAF was high [91% (1032/1135)]. In a multivariable analysis, TE participants with neuropsychiatric disorder ongoing at baseline had lower odds for viral suppression (odds ratio=0.45, 95% CI: 0.21-0.96). There was no emergence of resistance to the components of B/F/TAF. DRAEs occurred in 13% (148/1135) of participants;gastrointestinal and neuropsychiatric DRAEs were the most common (3% each). Discontinuations due to DRAEs were low (TN 4%;TE 6%). Serious DRAEs were rare (0.2%;2 TE participants with depression). Lipidchanges are shown (Figure 1). Conclusion: B/F/TAF was associated with high levels of effectiveness and persistence after 12M in this large real-world cohort of TN and TE PLWH with a high comorbidity burden. Effectiveness was demonstrated across key subgroups (females, older participants, late presenters). Importantly, there were no new or unexpected safety findings. Collectively, these real-world data continue to support the use of B/F/TAF in clinical practice.

Safety and efficacy of bnt162b2 mrna vaccine among liver transplant recipients

Background: BNT162b2 mRNA vaccine has been shown to be safe and effective in healthy subjects. The safety and efficacy of this vaccine in liver transplant (LT) recipients is still a subject of evaluation. The objective of this study was to assess the safety and efficacy of BNT162b2 mRNA vaccine among LT recipients. Methods: Immune response of two dose of BNT162b2 mRNA vaccine in 76 LT recipients was compared to 174 age-matched immunocompetent subjects with no exposure to SARS-CoV-2 infection. Postvaccination IgG antibodies against the RBD of SARS-CoV-2 IgG S-protein serology and neutralizing antibodies (NA) to the BNT162b2 mRNA vaccine were determined at least 14 days after the second dose of vaccine. AB titer ≥1.1 was considered protective. Side effects were monitored during study period. Results: Following the administration of the BNT162b2 mRNA two dose vaccines, LT recipients (median age 64 (range 22-83 years), 56.6% males) showed reduced immune response as compared with immunocompetent controls (72% vs. 94.2%, p<0.0001). The geometric mean of titer IgG antibody of SARS-CoV-2 and NA was significantly lower in LT recipients who received combine immunosuppression (combination of CNI and prednisone, and/or MMF and/or everolimus) vs CNI monotherapy 1.1±3.1 vs. 3.5±2.1, p<0.0001, 59.0±3.2 vs. 256.0±4.7, p=0.002. In multivariate analysis, the antibody response was reduced in LT recipients who received combined immunosuppression and in those with impaired renal function. Overall most self-reported side effects that were detected in 39 (51%) LT recipients were mild. The immune response did not correlate with more severe side effects. The side effects occurred more often in women than in men. Conclusion: Compared with immunocompetent subjects, liver transplant recipients had reduced immune response. Factors affecting serological antibodies response include renal function and type of immunosuppression used. Side effects were mild in most cases and more often in women. The durability of immune response to BNT162b2 mRNA vaccine among LT recipients needs further investigation.

The impact of covid-19 on patients with hematological malignancies: The mixed-method analysis of an israeli national survey

Background: The COVID-19 pandemic required reevaluation of the therapeutic approach and added emotional stress for patients with hematological malignancies at high risk of contracting the virus. Aims: We aimed to evaluate how it affected such patients during the second lockdown in Israel. Methods: This national survey included Hebrew-speaking patients with hematological malignancy. This included three tools with 28 items of socio-demographic and medical baseline characteristics, management of hematological disease, and evaluation of emotional coping during COVID- 19 pandemic;the Hebrew version of the Patient Health Questionnaire 9;and 3 qualitative open-ended questions. Data was analyzed by mixed methods which combined both quantitative and qualitative thematic analyses. Results: 408 patients responded to the survey. The management of their hematological disease included a decrease in the number of visits to the hematology clinic (37.0%), delay of some treatment schedules (9.1%), and prescription of replacement therapies permitting less visits to the clinic (2.2%). The frequency and intensity of "feeling afraid" regarding COVID-19 infection was increased (mean±SD: 4±1 to 5±2 in a 1-7 Likert scale), and a high rate of depression was recorded, which appeared to be more evident in patients with chronic myeloid leukemia (CML) (p<0.001). Summary/Conclusion: The management of hematological malignancies during pandemics should always take into consideration patients' fears, as well as the development of depression related to isolation and loneliness, in addition to the high risk of severe disease. Patients with CML had a high rate of depression which obviously needs to be managed very carefully during and after the COVID-19 pandemic.

Covid-19 among patients with hematological malignancies: A national Israeli retrospective analysis

Background: The first COVID-19 patient was diagnosed in Israel in February 2020. It is of importance to evaluate outcomes across patients with hematological malignancies which are generally immunosuppressed and more susceptible to infectious complications. Aims: We aimed to characterize the clinical course of COVID-19 infection among patients with various lymphoid or myeloid malignancies and determine which of these patients were most at risk of severe infection or mortality. Methods: This was a national Israeli multicenter retrospective study. Patients with hematological malignancies who were diagnosed with COVID-19 from February 20, 2020 until January 31, 2021 were centrally reported and included in the retrospective analysis with no need for informed consent signing. Clinical and laboratory data regarding baseline characteristics, hematological management, and course and treatment of the COVID-19 disease were collected. Multivariate regression analyses were used to determine the variables associated with severe disease, hospitalization and mortality. Results: In total, 272 patients from 14 medical centers were included in the analysis. Among them, 140 (51.5%) were men, and the median age was 70yrs. The most frequent malignancies included lymphoma (44.5%), multiple myeloma (22.8%), and chronic lymphocytic leukemia (12.1%). 90 (33.1%) patients developed a severe or critical respiratory infection, and 58 (21.3%) died. According to multivariate regression analyses, both age > 70yrs (OR=2.26;95% CI: 1.04;4.95;p=0.041) and current steroid treatment (OR=3.23;95% CI: 1.06, 9.90;p=0.040) at time of COVID- 19 diagnosis were associated with severe to critical disease, while current treatment with monoclonal antibodies was associated with mild to moderate disease (OR=2.86;95% CI: 1.17, 6.99;p=0.022). Among the 159 hospitalized patients, the hospitalization was longer in patients with severe to critical respiratory infection (IRR=1.53;95% CI: 1.36, 1.72;p<0.001), or treated with dexamethasone (IRR=1.22;95% CI: 1.08, 1.38;p=0.002), with enoxaparin (IRR=1.18;95% CI: 1.06, 1.33;p=0.004) or convalescent plasma (IRR=1.17;95% CI: 1.04, 1.32, p=0.012);while the hospitalization was shorter in patients treated with remdesivir (IRR=0.78;95% CI: 0.69, 0.89;p<0.001). The mortality rate was higher in patients > 70yrs (OR=3.41;95% CI: 1.13, 10.34;p=0.030), with severe to critical infection (OR=27.27;95% CI: 7.40, 100.48, p<0.001), or in those treated with dexamethasone (OR=5.89;95% CI: 1.47, 23.63;p=0.012) for COVID-19 respiratory condition, and lower in patients treated with remdesivir (OR=0.19, 95% CI: 0.04, 0.82, p=0.026). Summary/Conclusion: Respiratory infection with COVID-19 seems to be particularly severe in patients with hematological malignancies. While steroids seem to increase both baseline severity of the infection and mortality, it seems that treatment with remdesivir was associated with reduced mortality and duration of hospitalization. These particularities of haemato-oncological patients may be explained by a remarkably severe COVID-19 viremia that might cause the high mortality rate, while the cytokine release syndrome which generally responds to steroid treatment may be milder in these patients. The management of hematological malignancies during acute COVID-19 infection should be individualized and further investigated.

Early Experience Managing a High-volume Academic Orthopaedic Department During the Coronavirus Pandemic in New York City.

Our orthopaedic surgery department at Montefiore Medical Center and Albert Einstein College of Medicine is located within the Bronx, a borough of New York City, and serves a densely populated urban community. Since the beginning of the novel coronavirus outbreak in New York City, the medical center was forced to rapidly adapt to the projected influx of critically ill patients. The aim of this report is to outline how our large academic orthopaedic surgery department adopted changes and alternative practices in response to the most daunting challenge to public health in our region in over a century. We hope that this report provides insight for others facing similar challenges.