Can We Detect Urban‐Scale CO2 Emission Changes Within Medium‐Sized Cities?

The COVID‐19 pandemic resulted in a widespread lockdown during the spring of 2020. Measurements collected on a light rail system in the Salt Lake Valley (SLV), combined with observations from the Utah Urban Carbon Dioxide Network observed a notable decrease in urban CO2 concentrations during the spring of 2020 relative to previous years. These decreases coincided with a ∼30% reduction in average traffic volume. CO2 measurements across the SLV were used within a Bayesian inverse model to spatially allocate anthropogenic emission reductions for the first COVID‐19 lockdown. The inverse model was first used to constrain anthropogenic emissions for the previous year (2019) to provide the best possible estimate of emissions for 2020, before accounting for emission reductions observed during the COVID‐19 lockdown. The posterior emissions for 2019 were then used as the prior emission estimate for the 2020 COVID‐19 lockdown analysis. Results from the inverse analysis suggest that the SLV observed a 20% decrease in afternoon CO2 emissions from March to April 2020 (−90.5 tC hr−1). The largest reductions in CO2 emissions were centered over the northern part of the valley (downtown Salt Lake City), near major roadways, and potentially at industrial point sources. These results demonstrate that CO2 monitoring networks can track reductions in CO2 emissions even in medium‐sized cities like Salt Lake City.Alternate :Plain Language SummaryHigh‐density measurements of CO2 were combined with a statistical model to estimate emission reductions across Salt Lake City during the COVID‐19 lockdown. Reduced traffic throughout the COVID‐19 lockdown was likely the primary driver behind lower CO2 emissions in Salt Lake City. There was also evidence that industrial‐based emission sources may of had an observable decrease in CO2 emissions during the lockdown. Finally, this analysis suggests that high‐density CO2 monitoring networks could be used to track progress toward decarbonization in the future.

Investigating the impacts of COVID-19 on aviation safety based on occurrences captured through flight data monitoring.

The COVID-19 pandemic led to growing concerns about pilots' proficiency due to the significant decrease in flight operations. The objective of this research is to provide a proactive approach to mitigate potential risks in flight operations associated with the impact of the COVID-19 pandemic using flight data monitoring (FDM). The results demonstrated significant associations between the pandemic impacts and FDM exceedance categories, flight phases and fleets. Manual flying skill decay, lack of practice effects on use of standard operating procedures and knowledge of flight deck automation should be considered by airlines when preparing for the return to normal operations. An FDM Programme allows prediction of the probability and severity of occurrences for developing an effective SMS within an airline. To mitigate the impacts of the pandemic, tailored training sessions must be implemented, and airlines should strive to avoid additional optional procedures where practicable. Practitioner summary: The COVID-19 pandemic has raised concerns regarding pilot proficiency due to lack of practice effects. Results from the Flight Data Monitoring Programme show significant associations between the pandemic impacts and occurrence categories, fleets, and flight phases. FDM can be applied to mitigate the probability and severity of occurrences for airlines developing effective safety management systems.HIGHLIGHTSThere is a significant association between the COVID-19 pandemic stages and FDM events in different flight phases, FDM categories, and aircraft typesThe COVID-19 pandemic led to a significant increase in FDM exceedances, especially for precursors on runway excursion and go-aroundsAirlines should carefully plan training sessions for pilots as the disruptions due to the pandemic led to a lack of practice effect in flight operationsReviewing FDM data may have contributions to establish proactive SMS and mitigate COVID-19 impacts to aviation safety.

Mortality Risk in Pediatric Sepsis Based on C-reactive Protein and Ferritin Levels.

OBJECTIVES: Interest in using bedside C-reactive protein (CRP) and ferritin levels to identify patients with hyperinflammatory sepsis who might benefit from anti-inflammatory therapies has piqued with the COVID-19 pandemic experience. Our first objective was to identify patterns in CRP and ferritin trajectory among critically ill pediatric sepsis patients. We then examined the association between these different groups of patients in their inflammatory cytokine responses, systemic inflammation, and mortality risks. DATA SOURCES: A prospective, observational cohort study. STUDY SELECTION: Children with sepsis and organ failure in nine pediatric intensive care units in the United States. DATA EXTRACTION: Two hundred and fifty-five children were enrolled. Five distinct clinical multi-trajectory groups were identified. Plasma CRP (mg/dL), ferritin (ng/mL), and 31 cytokine levels were measured at two timepoints during sepsis (median Day 2 and Day 5). Group-based multi-trajectory models (GBMTM) identified groups of children with distinct patterns of CRP and ferritin. DATA SYNTHESIS: Group 1 had normal CRP and ferritin levels ( n = 8; 0% mortality); Group 2 had high CRP levels that became normal, with normal ferritin levels throughout ( n = 80; 5% mortality); Group 3 had high ferritin levels alone ( n = 16; 6% mortality); Group 4 had very high CRP levels, and high ferritin levels ( n = 121; 11% mortality); and Group 5 had very high CRP and very high ferritin levels ( n = 30; 40% mortality). Cytokine responses differed across the five groups, with ferritin levels correlated with macrophage inflammatory protein 1α levels and CRP levels reflective of many cytokines. CONCLUSIONS: Bedside CRP and ferritin levels can be used together to distinguish groups of children with sepsis who have different systemic inflammation cytokine responses and mortality risks. These data suggest future potential value in personalized clinical trials with specific targets for anti-inflammatory therapies.

Perceptions of Research and Research-Oriented Careers Among College-Level Baccalaureate-MD Students in the United States.

A survey was administered to describe research perceptions among college-level students in combined baccalaureate-MD (BA/MD) programs in the United States. Descriptive statistics were used to analyze participant research perceptions. The estimated response rate was 26% (430/1653). Most respondents conducted scientific research in high school and college and reported barriers to research participation. Key barriers to research participation included lack of time, research knowledge or experience, and sufficient research guidance as well as the disruptions of COVID-19. Most respondents reported that research-supporting programs were available at their institution and perceived faculty mentorship programs as the most helpful for broadening their research experience. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01619-5.

Strategies to Optimize ICU Liberation (A to F) Bundle Performance in Critically Ill Adults With Coronavirus Disease 2019.

OBJECTIVES: The severe acute respiratory syndrome coronavirus 2 pandemic has stretched ICU resources in an unprecedented fashion and outstripped personal protective equipment supplies. The combination of a novel disease, resource limitations, and risks to medical personnel health have created new barriers to implementing the ICU Liberation ("A" for Assessment, Prevention, and Manage pain; "B" for Both Spontaneous Awakening Trials and Spontaneous Breathing Trials; "C" for Choice of Analgesia and Sedation; "D" for Delirium Assess, Prevent, and Manage; "E" for Early Mobility and Exercise; and "F" for Family Engagement and Empowerment [ABCDEF]) Bundle, a proven ICU care approach that reduces delirium, shortens mechanical ventilation duration, prevents post-ICU syndrome, and reduces healthcare costs. This narrative review acknowledges barriers and offers strategies to optimize Bundle performance in coronavirus disease 2019 patients requiring mechanical ventilation. DATA SOURCES STUDY SELECTION AND DATA EXTRACTION: The most relevant literature, media reports, and author experiences were assessed for inclusion in this narrative review including PubMed, national newspapers, and critical care/pharmacology textbooks. DATA SYNTHESIS: Uncertainty regarding coronavirus disease 2019 clinical course, shifts in attitude, and changes in routine behavior have hindered Bundle use. A domino effect results from: 1) changes to critical care hierarchy, priorities, and ICU team composition; 2) significant personal protective equipment shortages cause; 3) reduced/restricted physical bedside presence favoring; 4) increased depth of sedation and use of neuromuscular blockade; 5) which exacerbate drug shortages; and 6) which require prolonged use of limited ventilator resources. Other identified barriers include manageable knowledge deficits among non-ICU clinicians unfamiliar with the Bundle or among PICU specialists deploying pediatric-based Bundle approaches who are unfamiliar with adult medicine. Both groups have been enlisted to augment the adult ICU work force to meet demand. Strategies were identified to facilitate Bundle performance to liberate patients from the ICU. CONCLUSIONS: We acknowledge current challenges that interfere with comprehensive management of critically ill patients during the coronavirus disease 2019 pandemic. Rapid response to new circumstances precisely requires established safety mechanisms and protocols like the ABCDEF Bundle to increase ICU and ventilator capacity and help survivors maximize recovery from coronavirus disease 2019 as early as possible.

Coping With Stress: The Mitokine GDF-15 as a Biomarker of COVID-19 Severity.

Growth differentiation factor 15 (GDF-15) is a transforming growth factor (TGF)-ß superfamily cytokine that plays a central role in metabolism regulation. Produced in response to mitochondrial stress, tissue damage or hypoxia, this cytokine has emerged as one of the strongest predictors of disease severity during inflammatory conditions, cancers and infections. Reports suggest that GDF-15 plays a tissue protective role via sympathetic and metabolic adaptation in the context of mitochondrial damage, although the exact mechanisms involved remain uncertain. In this review, we discuss the emergence of GDF-15 as a distinctive marker of viral infection severity, especially in the context of COVID-19. We will critically review the role of GDF-15 as an inflammation-induced mediator of disease tolerance, through metabolic and immune reprogramming. Finally, we discuss potential mechanisms of GDF-15 elevation during COVID-19 cytokine storm and its limitations. Altogether, this cytokine seems to be involved in disease tolerance to viral infections including SARS-CoV-2, paving the way for novel therapeutic interventions.

Combining Direct PCR Technology and Capillary Electrophoresis for an Easy-to-Operate and Highly Sensitive Infectious Disease Detection System for Shrimp.

Infectious diseases are considered the greatest threat to the modern high-density shrimp aquaculture industry. Specificity, rapidity, and sensitivity of molecular diagnostic methods for the detection of asymptomatic infected shrimp allows preventive measures to be taken before disease outbreaks. Routine molecular detection of pathogens in infected shrimp can be made easier with the use of a direct polymerase chain reaction (PCR). In this study, four direct PCR reagent brands were tested, and results showed that the detection signal of direct PCR in hepatopancreatic tissue was more severely affected. In addition, portable capillary electrophoresis was applied to improve sensitivity and specificity, resulting in a pathogen detection limit of 25 copies/PCR-reaction. Juvenile shrimp from five different aquaculture ponds were tested for white spot syndrome virus infection, and the results were consistent with the Organization for Animal Health's certified standard method. Furthermore, this methodology could be used to examine single post larvae shrimp. The overall detection time was reduced by more than 58.2%. Therefore, the combination of direct PCR and capillary electrophoresis for on-site examination is valuable and has potential as a suitable tool for diagnostic, epidemiological, and pathological studies of shrimp aquaculture.

In vivo characterization of emerging SARS-CoV-2 variant infectivity and human antibody escape potential.

As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads, variants with enhanced virulence and transmissibility have emerged. Although in vitro systems allow rapid characterization, they do not fully recapitulate the dynamic interaction of virions and neutralizing antibodies in the airway. Here, we demonstrate that the N501Y variant permits respiratory infection in unmodified mice. We utilize N501Y to survey in vivo pseudovirus infection dynamics and susceptibility to reinfection with the L452R (Los Angeles), K417N + E484K (South Africa), and L452R + K417N + E484Q (India) variants. Human coronavirus disease 2019 (COVID-19)+ or vaccinated antibody isotypes, titers, variant receptor binding domain (RBD) binding, and neutralization potential are studied, revealing numerous significant correlations. Immune escape of the K417N + E484K variant is observed because infection can be appreciated in the nasopharynx, but not lungs, of mice transferred with low-antibody-tier plasma. Conversely, near-complete protection is observed in animals receiving high-antibody-tier plasma, a phenomenon that can only be appreciated in vivo.

In vivo characterization of emerging SARS-CoV-2 variant infectivity and human antibody escape potential

Lam et al. develop a model of SARS-CoV-2 infection in laboratory mice. This allows the researchers to study the threat of emerging variants in a more physiological context than cell culture systems. Interactions between SARS-CoV-2 variants and immunity is explored in the airway of mice.

College-level Baccalaureate-MD Student Perceptions of Research and Research-Oriented Careers

PURPOSE: Concern about the decline in physician scientists has generated interest in promoting research participation among medical students. This study aimed to examine perceptions of research and research-oriented careers among college-level baccalaureate-MD (BA/MD) students at one institution in the United States. METHODS: A cross-sectional survey was distributed to a sample of 241 BA/MD students. Descriptive statistics were used to examine research perceptions of participants. RESULTS: The response rate was 52% (126/241). Most respondents conducted scientific research in high school and were interested in research-oriented careers. Most students participated in a research program (research course, faculty mentorship, or research grant), disseminated their research, and believed that research programs would be helpful for their research participation. The most common perceived barriers were a lack of time, interest, and prior research experience. CONCLUSIONS: College-level BA/MD students had positive perception of research-oriented careers and found student research programs helpful. However, addressing key barriers such as lack of time, interest and experience will help expand BA/MD student engagement in research.

Haemophagocytic lymphohistiocytosis in an adult with postacute COVID-19 syndrome.

Haemophagocytic lymphohistiocytosis (HLH) causing multiorgan failure has been reported as an acute clinical presentation of COVID-19. However, the literature surrounding HLH in the context of a postacute COVID-19 syndrome is limited. This report presents a case of a life-threatening HLH occurring 6 weeks after a pauci-symptomatic COVID-19 infection in a previously healthy adult. A bone marrow aspirate confirmed the HLH and the patient was successfully treated with dexamethasone and etoposide. To our knowledge, this is the first case of HLH occurring as a postacute COVID-19 syndrome following a pauci-symptomatic initial infection.

Rapid Screening of COVID-19 Directly from Clinical Nasopharyngeal Swabs Using the MasSpec Pen.

The outbreak of COVID-19 has created an unprecedent global crisis. While the polymerase chain reaction (PCR) is the gold standard method for detecting active SARS-CoV-2 infection, alternative high-throughput diagnostic tests are of a significant value to meet universal testing demands. Here, we describe a new design of the MasSpec Pen technology integrated to electrospray ionization (ESI) for direct analysis of clinical swabs and investigate its use for COVID-19 screening. The redesigned MasSpec Pen system incorporates a disposable sampling device refined for uniform and efficient analysis of swab tips via liquid extraction directly coupled to an ESI source. Using this system, we analyzed nasopharyngeal swabs from 244 individuals including symptomatic COVID-19 positive, symptomatic negative, and asymptomatic negative individuals, enabling rapid detection of rich lipid profiles. Two statistical classifiers were generated based on the lipid information acquired. Classifier 1 was built to distinguish symptomatic PCR-positive from asymptomatic PCR-negative individuals, yielding a cross-validation accuracy of 83.5%, sensitivity of 76.6%, and specificity of 86.6%, and validation set accuracy of 89.6%, sensitivity of 100%, and specificity of 85.3%. Classifier 2 was built to distinguish symptomatic PCR-positive patients from negative individuals including symptomatic PCR-negative patients with moderate to severe symptoms and asymptomatic individuals, yielding a cross-validation accuracy of 78.4%, specificity of 77.21%, and sensitivity of 81.8%. Collectively, this study suggests that the lipid profiles detected directly from nasopharyngeal swabs using MasSpec Pen-ESI mass spectrometry (MS) allow fast (under a minute) screening of the COVID-19 disease using minimal operating steps and no specialized reagents, thus representing a promising alternative high-throughput method for screening of COVID-19.

Cytomegalovirus as an Uninvited Guest in the Response to Vaccines in People Living with HIV.

In stark contrast to the rapid development of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an effective human immunodeficiency virus (HIV) vaccine is still lacking. Furthermore, despite virologic suppression and CD4 T-cell count normalization with antiretroviral therapy (ART), people living with HIV (PLWH) still exhibit increased morbidity and mortality compared to the general population. Such differences in health outcomes are related to higher risk behaviors, but also to HIV-related immune activation and viral coinfections. Among these coinfections, cytomegalovirus (CMV) latent infection is a well-known inducer of long-term immune dysregulation. Cytomegalovirus contributes to the persistent immune activation in PLWH receiving ART by directly skewing immune response toward itself, and by increasing immune activation through modification of the gut microbiota and microbial translocation. In addition, through induction of immunosenescence, CMV has been associated with a decreased response to infections and vaccines. This review provides a comprehensive overview of the influence of CMV on the immune system, the mechanisms underlying a reduced response to vaccines, and discuss new therapeutic advances targeting CMV that could be used to improve vaccine response in PLWH.

COVID-19 and Public Interest in Ophthalmic Services and Conditions.

OBJECTIVE: To assess the impact of the COVID-19 pandemic and associated lockdowns on public interest in ophthalmology. METHODS: Search interest data for ophthalmic services and conditions were collected from January 1, 2019 to June 21, 2020. Temporal statistical analysis was used to identify significant trends. Weekly data on ophthalmic services and conditions search interest obtained from Google Trends were analyzed with analysis of variance testing and the generalized linear model based on dates. RESULTS: Ophthalmic services searches decreased after the first COVID-19 case in the country (p<0.001); ophthalmic services and conditions search interest also declined after the first COVID-19 case and lockdown orders in each state (p<0.001). Following the first in-state COVID-19 case, search interest in ophthalmic services fell more than for ophthalmic conditions (p=0.0088). Lockdown and COVID-19 had similar effects on ophthalmic services search interest (p=0.2246), but interest in ophthalmic conditions decreased more after lockdown than after the first in-state case (p<0.0001). CONCLUSIONS: Most of the decrease in search interest in ophthalmic services was associated with COVID-19 rather than lockdown orders, suggesting that public interest in ophthalmic care may be more sensitive to changes in the COVID-19 pandemic than lockdown orders.

Sharing CD4+ T Cell Loss: When COVID-19 and HIV Collide on Immune System.

COVID-19 is a distinctive infection characterized by elevated inter-human transmission and presenting from absence of symptoms to severe cytokine storm that can lead to dismal prognosis. Like for HIV, lymphopenia and drastic reduction of CD4+ T cell counts in COVID-19 patients have been linked with poor clinical outcome. As CD4+ T cells play a critical role in orchestrating responses against viral infections, important lessons can be drawn by comparing T cell response in COVID-19 and in HIV infection and by studying HIV-infected patients who became infected by SARS-CoV-2. We critically reviewed host characteristics and hyper-inflammatory response in these two viral infections to have a better insight on the large difference in clinical outcome in persons being infected by SARS-CoV-2. The better understanding of mechanism of T cell dysfunction will contribute to the development of targeted therapy against severe COVID-19 and will help to rationally design vaccine involving T cell response for the long-term control of viral infection.

Convalescent Plasma: The Relay Baton in the Race for Coronavirus Disease 2019 Treatment.

Coronavirus disease 2019 (COVID-19) is a pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Most infected people have mild or moderate symptoms and recover without the need for extensive treatment. However, for seriously ill patients, no specific treatments are currently available. Convalescent plasma therapy (CPT), a passive immunotherapy, involves infusing plasma from recovered people into actively infected people, and is thought to be a specific intervention to improve outcome in patients with severe COVID-19. The presumed mechanism involves neutralizing antibodies and antibody dependent cytotoxicity/phagocytosis. Previous CPT trials showed an effect in SARS and pilot studies suggest CPT is an effective and safe strategy for seriously ill COVID-19 patients. CPT is currently being tested in large randomized clinical trials. Herein, we critically review the mechanism, applications and the challenges for CPT in the treatment of severe COVID-19, paving the way toward vaccine and immunotherapy development.

Delayed Development of Coronary Artery Dilitation in Suspected Severe Acute Respiratory Syndrome Coronavirus 2 Multisystem Inflammatory Syndrome: More Research Needed.

Although significant disease burden in the severe acute respiratory syndrome coronavirus 2 pandemic has been relatively uncommon in children, worldwide cases of a postinfectious multisystem inflammatory syndrome in children and possible atypical Kawasaki-like disease attributing to severe acute respiratory syndrome coronavirus 2 infection have arisen. Original thinking for coronavirus disease-19 disease was that an overwhelming proinflammatory response drove disease pathogenesis. Emerging reports suggest that a robust immune suppression may be more relevant and predominant. Recently reported data on children with multisystem inflammatory syndrome in children have demonstrated a heterogeneity of immune phenotypes among these patients, with concern for a strong initial proinflammatory state; however, data are lacking to support this. Likewise, understanding development of certain clinical findings to changes in the immune system is lacking. CASE SUMMARY: We report a 12-year-old multiracial male with negative coronavirus disease-19 nasopharyngeal RNA polymerase chain reaction testing but positive severe acute respiratory syndrome coronavirus 2 serology, subsequent development of vasodilatory shock with myocardial depression, and subsequent delayed development of coronary artery dilatation after resolution of myocardial depression. Unlike previous reported cases of multisystem inflammatory syndrome in children, he exhibited profound lymphopenia without specific inflammatory cytokines elevations, whereas nonspecific markers (ferritin and C-reactive protein) were increased. He subsequently was discharged on day 12 of hospitalization with complete recovery. CONCLUSION: Our representative case of a patient with coronavirus disease-19-associated multisystem inflammatory syndrome in children without robust hyperinflammation and a delayed finding of coronary artery dilatation compared with reported case series highlights the need for further mechanistic understanding of coronavirus disease-19 disease and subsequent multisystem inflammatory syndrome in children or Kawasaki disease development. This report offers a number of disease mechanisms and clinical evolution considerations for further elucidation to guide development of potential therapies.