Academic Analytics Applied in the Study of the Relationship Between the Initial Profile of Undergraduate Students and Early Drop-Out Rates. Defining the Variables of a Predictor Instrument

The field of university dropout research is of utmost importance especially in the current context arising from the Covid-19 pandemic. Students who started their degrees in the last two years completed their pre-university studies during various phases of confinement and by combining traditional and virtual training. In this scenario, students' motivation and the way they cope with the difficulties of their first year of university are very relevant and will depend on a multitude of personal and social variables in their immediate environment. Previous studies have shown that many university students drop out of their studies early, but what factors and to what extent they affect this dropout is still a field under study. This paper focuses on the identification, classification and evaluation of a set of indicators based on teacher and tutor perception in different fields of study by applying quantitative and qualitative techniques. The results of pilot studies developed support the approach adopted, as they show how teachers can identify students at risk of dropping out at the beginning of the course and take proactive measures to monitor and motivate them, thus reducing the possibility of dropout. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Clinical utility of SARS-CoV-2 subgenomic RT-PCR in a pediatric quaternary care setting.

BACKGROUND: During active transcription, SARS-CoV-2 generates subgenomic regions of viral RNA. While standard SARS-CoV-2 RT-PCR amplifies region(s) of genomic RNA, it cannot distinguish active infection from remnant viral genomic material. However, screening for subgenomic RNA (sgRNA) by RT-PCR may aid in the determination of actively transcribing virus. OBJECTIVES: To evaluate the clinical utility of SARS-CoV-2 sgRNA RT-PCR testing in a pediatric population. STUDY DESIGN: Retrospective analysis was performed on inpatients from February-September 2022 positive for SARS-CoV-2 by RT-PCR with a concomitant order for sgRNA RT-PCR. Chart abstractions were conducted to determine clinical outcomes, management, and infection prevention and control (IPC) practices. RESULTS: Of 95 SARS-CoV-2 positive samples from 75 unique patients, 27 (28.4%) were positive by sgRNA RT-PCR. A negative sgRNA RT-PCR test allowed for de-isolation in 68 (71.6%) patient episodes. Regardless of age or sex, a positive sgRNA RT-PCR result significantly correlated with disease severity (P = 0.007), generalized COVID-19 symptoms (P = 0.012), hospitalization for COVID-19 (P = 0.019), and immune status (P = 0.024). Moreover, sgRNA RT-PCR results prompted changes in management in 28 patients (37.3%); specifically, therapeutic escalation in 13/27 (48.1%) positives and de-escalation in 15/68 (22.1%) negatives. CONCLUSIONS: Taken together, these findings underscore the clinical utility of sgRNA RT-PCR testing in a pediatric population as we report significant associations between sgRNA RT-PCR results and clinical parameters related to COVID-19. These findings align with the proposed use of sgRNA RT-PCR testing to guide patient management and IPC practices in the hospital setting.

Sars-CoV-2 in critical immunocompromised patients. Evolution and prognosis

Introduction: In this study, we share the results of immunosuppressed patients who suffered from acute respiratory distress syndrome (ARDS) secondary to COVID-19 pneumonia managed in our ICU. Method(s): We tracked all patients admitted to ICU of a Tertiary Hospital diagnosed with severe SARS-COV2 pneumonia from March 1, 2020 to January 31, 2022. The definition of Immunocompromised patient is based on history of transplantation, active neoplasia, autoimmune diseases or HIV. Collected data includes: sex, age, type of immunosuppression, vaccination, mechanical ventilation, ECMO VV, incidence of superinfections and mortality. Result(s): From a cohort of 425 patients, 55 met the inclusion criteria. 33% were women and 67% male. The average age was 58 years for women and 62 years for men. Out of these patients, 27% had solid organ transplants. 40% suffered from neoplasic disease. 27% had autoimmune diseases and were under treatment with immunosuppressants. 3 had HIV. Only the 29% had received at least 1 dose of COVID 19 vaccine. 80% required orotracheal intubation. 3.64% (2) required Veno-Venous ECMO. 61% presented bacterial superinfection, with the most frequent germs being Pseudomonas aeruginosa and Enterococcus. 36% had viral superinfection, being cytomegalovirus the most frequent one. 32% had fungal superinfection, mainly by Aspergillus fumigatus. 27% did not suffer any superinfection. 40% of the total sample died. After logistic regression, in our model (AUC 83,4% (Se 57.1%, Sp 87.9%), we identified need of intubation as independent variable of mortality (OR 27,06 IC95% 1.76-415.55, p = 0.018). Conclusion(s): Immunocompromised patients with ARDS secondary to COVID-19 pneumonia present high mortality, with statistically significant difference when mechanical ventilation is needed. The most frequently isolated germs causing superinfection in this group of patients are bacterias. We believe that this group of patients require special care in our ICU units and an in-depth analysis and study to optimize their prognosis.

Low incidence and severity of SARS-CoV-2 infections in people with PCD

Background: There is little data on SARS-CoV-2 infections in people with rare diseases. We studied incidence and severity of SARS-CoV-2 in people with primary ciliary dyskinesia (PCD). Method(s): We used data from COVID-PCD, an international participatory study including people with PCD, which started recruitment on 30.05.2020. Participants completed weekly online questionnaires on SARS-CoV-2 infections and symptoms. We studied severity of infections reported at baseline or during follow-up while we calculated incidence rates including only infections reported during follow-up. We used Cox proportional hazard regression to study predictors of getting infected. Result(s): By January 23, 2022, 726 people participated (40% male, median age 27 years;range 0-85). 90% of persons above 14 years have been vaccinated against COVID-19 and most (93%) wore facemasks in public. Only 62 (8.5%) had a confirmed SARS-CoV-2 infection. Severity of disease was mainly mild;11 (18%) were asymptomatic, 47 (76%) had symptoms among whom 4 (6%) were hospitalized (none in the ICU, nobody died). Severity of disease was not associated with age, sex, co-morbidity or vaccination. We had follow-up data from 651 (90%). During 633 person-years of follow-up (median 59 weeks per person), 43 incident SARS-CoV-2 infections were reported (incidence rate 6.9 per 100 person years;95% CI 5.2-9.2). Children (0-14 years) had a higher risk of infection (hazard ratio 3.0;95% CI 1.3-6.8) compared to 15-49 year-olds. Conclusion(s): SARS-CoV-2 incidence rates remained low and severity mainly mild in people with PCD, probably reflecting high vaccination rate and personal protective behaviour.

Diagnostic testing in people with primary ciliary dyskinesia around the world: where do we stand?

Background: In the past, few patients with primary ciliary dyskinesia (PCD) were diagnosed with the test combination recommended by guidelines (nasal nitric oxide (nNO), genetic testing, and biopsy for electron or video microscopy) [Halbeisen, ERJ, 2019]. In a large international participatory study of people with PCD, we assessed the current situation. Method(s): We used data from COVID-PCD, an international study of people with PCD, who participated between 2020 and 2022. Participants described their diagnostic tests in an online questionnaire, and we used logistic regression to identify explanatory factors. Result(s): 728 participated (median age 27 years, IQR: 12-43;60% female). Among them, 92% reported that any diagnostic testing had been done: 49% nNO, 59% genetics, and 75% biopsy for electron or video microscopy. Most did not know whether the sample had been analysed with TEM or video microscopy. Biopsy was most frequent in all countries except in North America where genetic testing predominated. Only 36% of participants reported all three tests. This proportion was highest in Germany (61%) and lowest in Australia (19%). Recently diagnosed patients reported more tests (nNO OR 1.7, 95%CI 1.1-2.6, genetics OR 4.5, 95%CI 2.9-6.9), and those with situs inversus less (nNO OR 0.5, 95%CI 0.3-0.7, biopsy OR 0.4, 95%CI 0.3-0.7, genetics OR 0.7, 95%CI 0.5-0.97). Conclusion(s): Diagnostic testing in people with PCD differed by country and few reported having undergone all recommended tests. Patients diagnosed long ago should be recalled for supplementary testing to improve diagnostic characterisation as a prerequisite for personalised medicine.

Blood Inflammatory Biomarkers Differentiate Inpatient and Outpatient Coronavirus Disease 2019 From Influenza.

Background: The ongoing circulation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a diagnostic challenge because symptoms of coronavirus disease 2019 (COVID-19) are difficult to distinguish from other respiratory diseases. Our goal was to use statistical analyses and machine learning to identify biomarkers that distinguish patients with COVID-19 from patients with influenza. Methods: Cytokine levels were analyzed in plasma and serum samples from patients with influenza and COVID-19, which were collected as part of the Centers for Disease Control and Prevention's Hospitalized Adult Influenza Vaccine Effectiveness Network (inpatient network) and the US Flu Vaccine Effectiveness (outpatient network). Results: We determined that interleukin (IL)-10 family cytokines are significantly different between COVID-19 and influenza patients. The results suggest that the IL-10 family cytokines are a potential diagnostic biomarker to distinguish COVID-19 and influenza infection, especially for inpatients. We also demonstrate that cytokine combinations, consisting of up to 3 cytokines, can distinguish SARS-CoV-2 and influenza infection with high accuracy in both inpatient (area under the receiver operating characteristics curve [AUC] = 0.84) and outpatient (AUC = 0.81) groups, revealing another potential screening tool for SARS-CoV-2 infection. Conclusions: This study not only reveals prospective screening tools for COVID-19 infections that are independent of polymerase chain reaction testing or clinical condition, but it also emphasizes potential pathways involved in disease pathogenesis that act as potential targets for future mechanistic studies.

Antibody-mediated immunity to SARS-CoV-2 spike.

Despite effective spike-based vaccines and monoclonal antibodies, the SARS-CoV-2 pandemic continues more than two and a half years post-onset. Relentless investigation has outlined a causative dynamic between host-derived antibodies and reciprocal viral subversion. Integration of this paradigm into the architecture of next generation antiviral strategies, predicated on a foundational understanding of the virology and immunology of SARS-CoV-2, will be critical for success. This review aims to serve as a primer on the immunity endowed by antibodies targeting SARS-CoV-2 spike protein through a structural perspective. We begin by introducing the structure and function of spike, polyclonal immunity to SARS-CoV-2 spike, and the emergence of major SARS-CoV-2 variants that evade immunity. The remainder of the article comprises an in-depth dissection of all major epitopes on SARS-CoV-2 spike in molecular detail, with emphasis on the origins, neutralizing potency, mechanisms of action, cross-reactivity, and variant resistance of representative monoclonal antibodies to each epitope.

SARS-CoV-2 booster vaccination rescues attenuated IgG1 memory B cell response in primary antibody deficiency patients.

Background: Although SARS-CoV-2 vaccines have proven effective in eliciting a protective immune response in healthy individuals, their ability to induce a durable immune response in immunocompromised individuals remains poorly understood. Primary antibody deficiency (PAD) syndromes are among the most common primary immunodeficiency disorders in adults and are characterized by hypogammaglobulinemia and impaired ability to mount robust antibody responses following infection or vaccination. Methods: Here, we present an analysis of both the B and T cell response in a prospective cohort of 30 individuals with PAD up to 150 days following initial COVID-19 vaccination and 150 days post mRNA booster vaccination. Results: After the primary vaccination series, many of the individuals with PAD syndromes mounted SARS-CoV-2 specific memory B and CD4+ T cell responses that overall were comparable to healthy individuals. Nonetheless, individuals with PAD syndromes had reduced IgG1+ and CD11c+ memory B cell responses following the primary vaccination series, with the defect in IgG1 class-switching rescued following mRNA booster doses. Boosting also elicited an increase in the SARS-CoV-2-specific B and T cell response and the development of Omicron-specific memory B cells in COVID-19-naïve PAD patients. Individuals that lacked detectable B cell responses following primary vaccination did not benefit from booster vaccination. Conclusion: Together, these data indicate that SARS-CoV-2 vaccines elicit memory B and T cells in most PAD patients and highlights the importance of booster vaccination in immunodeficient individuals.

Diagnostic testing in people with primary ciliary dyskinesia around the world: where do we stand?

Introduction In the past, only few patients with primary ciliary dyskinesia (PCD) were diagnosed with the test combination recommended by guidelines (nasal nitric oxide (nNO), genetic testing, and biopsy for electron or video microscopy) [Halbeisen, ERJ, 2019]. In a large international participatory study of people with PCD, we assessed the current situation. Methods We used data from COVID-PCD, an international study of people with PCD, who participated between 2020 and 2022. Participants described their diagnostic tests in an online questionnaire, and we used logistic regression to identify explanatory factors. Results 728 participated (median age 27 years, IQR: 12-43;60% female). Among them, 92% reported that any diagnostic testing had been done: 49% nNO, 59% genetics, and 75% biopsy for electron or video microscopy. Most did not know whether the biopsy sample had been analysed with transmission electron microscopy or video microscopy. Biopsy was most frequent in all countries except in North America where genetic testing predominated. Only 36% of participants reported all three tests. This proportion was highest in Germany (61%) and lowest in Australia (19%). Recently diagnosed patients reported more tests (nNO OR 1.7, 95%CI 1.1-2.6, genetics OR 4.5, 95%CI 2.9-6.9), and those with situs inversus less (nNO OR 0.5, 95%CI 0.3-0.7, biopsy OR 0.4, 95%CI 0.3-0.7, genetics OR 0.7, 95%CI 0.5-0.97). Conclusion Diagnostic testing in people with PCD differed by country and few reported having undergone all recommended tests. Patients diagnosed long ago should be recalled for supplementary testing to improve diagnostic characterisation as a prerequisite for personalised medicine.

Incidence and severity of SARS-CoV-2 infections in people with primary ciliary dyskinesia

Introduction After two years of COVID-19 pandemic, there is still little data on incidence and severity of SARS-CoV-2 infections in people with primary ciliary dyskinesia (PCD). We aimed to study incidence of SARS-CoV-2, severity of disease vaccination status, and social contact behaviour in people with PCD and study factors associated with risk of infection and risk of severe disease. Method COVID-PCD is an international participatory cohort study which started recruitment on 30.05.2020. Participants completed weekly online questionnaires on SARS-CoV-2 infections and symptoms. We studied severity of infections reported at baseline or during follow-up while we calculated incidence rates including only infections reported during followup. We studied factors associated with risk of infection using Poisson regression. Results By 10.05.2022, 728 people with PCD participated (40% male, median age 27 years;range 0-85). 90% of persons above 14 years were vaccinated against COVID-19 and most (93%) wore facemasks in public. In total, 87 (11.7%) reported a SARS-CoV-2 infection. We had follow-up data from 664 persons (90%) and during 716 person-years (median 61 weeks per person), 62 incident SARS-CoV-2 infections were reported (incidence rate 8.7 per 100 person years;95%CI 6.8- 11). Risk of infection was lower in adults compared to children (IRR: 0.39, 95%CI 0.20-0.77), higher in the United Kingdom compared to other countries (IRR: 1.85, 95%CI 1.08-3.19), and higher between Sep 2021 - May 2022 compared to MarNov 2020 (IRR: 1.20, 95%CI 1.05-1.38). Severity of disease was mainly mild;12 (14%) were asymptomatic, 75 (86%) had symptoms among whom 4 were hospitalized (none in the ICU, nobody died). Severity was not associated with age sex, co-morbidity, or vaccination. Conclusion SARS-CoV-2 incidence rates remained low and severity mainly mild in people with PCD, probably reflecting high vaccination rate and personal protective behaviour.

Etiology-Specific Olfactory Phenotypes for COVID-19 and Mild Cognitive Impairment

Introduction: Olfactory dysfunction is a common symptom associated with COVID-19 infection. While often transient, nearly 1 in 8 patients experience persistent dysfunction after initial infection resolution. Given the known association between impaired olfaction and mild cognitive impairment (MCI), this persistent COVID-19 olfactory dysfunction may impede early detection of cognitive decline. Method(s): Patients with confirmed COVID-19-associated hyposmia (n=73), MCI (n=58), and normal controls (n=86) were prospectively enrolled. Demographic data were collected alongside formal olfactory testing via AROMA (Affordable Rapid Olfaction Measurement Assay) at time of initial enrollment. MCI was assessed via MoCA (Montreal Cognitive Assessment). Multivariate logistic regressions were utilized to evaluate for associations between variables and etiology of olfactory dysfunction. Result(s): After controlling for age and gender, when compared against normal controls, the inability to smell licorice, cinnamon, and lemon at the lowest 3 concentrations increased odds of COVID-19 hyposmia by 10.8 (95% CI, 4.6-25.6), 5.7 (95% CI, 2.7-11.7), and 5.3 (95% CI, 2.6-10.8), respectively. While the inability to smell coffee (9.9 odds ratio [OR];95% CI, 2.02-48.1), eucalyptus (6.7 OR;95% CI, 2.2-20.0), and rose (4.0 OR;95% CI, 1.7-9.7) were associated with MCI, decreased ability to smell licorice, cinnamon, and lemon were not. When combined into a composite score and compared against controls, decreased detection of licorice, cinnamon, and lemon was associated with a 16.5 OR (95% CI, 6.6-41.3) for COVID-19 hyposmia. This composite score was not significantly associated with MCI (1.2 OR;95% CI, 0.6-2.2) and, as such, performed well at discriminating between COVID-19 and MCI patients (receiver operating characteristic area under the curve=0.76). Conclusion(s): Distinct patterns of impaired olfaction were noted for COVID-19. We show that this etiology-specific phenotype has good discriminative performance when differentiating from MCI-associated hyposmia, which may allow for continued utilization of olfactory screening for MCI even among those with previous COVID-19 infection.

Role of Alternative Auditory Testing in Newborn Hearing Screens

Introduction: This study investigates the role of distortion product otoacoustic emissions (DPOAE), tympanometry, and acoustic stapedial reflex testing (ASR) and their combined potential utility in the setting of replacing classic automated auditory brainstem response (AABR) testing in newborns with referred hearing screens. This was done to determine whether these tests could be used in isolation so to reduce the follow-up burden on families and improve compliance with our screening protocols by replacing the need for additional tests, especially in a health care system with limited resources and with current travel and visitor restrictions. Method(s): Data were prospectively collected on new clinic patients with the following inclusion criteria: children 0 to 6 months old with referred newborn hearing screens via AABR from August 2020 to October 2020 at Children's Hospital of Michigan. All patients were initially rescreened with repeat AABR. ASR, DPOAE, and tympanometry data from selected patients were collected. Patients were noted to have either normal or abnormal responses from each test using preset parameters. Screening methods were then compared. Result(s): Thirty-eight children were recruited in the study including 76 ears. On repeat AABR, 13% of children and 6% of ears were referred again. Of those that failed the second AABR, 40% had abnormal tympanometry compared with 6% of those that passed. The DPOAE results correlated with AABR findings in all but 1 patient. Acoustic reflex testing was abnormal in 2.6% of patients, which all correlated with referred AABRs. Further statistical analysis is being done to evaluate for significant correlations. Conclusion(s): AABR revealed equivocal results when compared with results of DPOAE, ASR, and tympanometry. This study was limited by the number of patients included, given the current COVID-19 pandemic. Many sites lack AABR capabilities, and given our findings, these alternative auditory tests can be considered in health care settings with limited resources. With further research and greater sample size, these readily available audiologic tests may be considered as simple, reproducible, and sensitive screening alternatives.

Detecting False Claims in Low-Resource Regions: A Case Study of Caribbean Islands

The COVID-19 pandemic has created severe threats to global health control. In particular, misinformation circulated on social media and news outlets has undermined public trust in government and health agencies. This problem is further exacerbated in developing countries or low-resource regions where the news may not be equipped with abundant English fact-checking information. This poses a question: "are existing computational solutions toward misinformation also effective in low-resource regions?" In this paper, to answer this question, we make the first attempt to detect COVID 19 misinformation in English, Spanish, and Haitian French populated in the Caribbean region, using the fact-checked claims in US-English. We started by collecting a dataset of real & false claims in the Caribbean region. Then we trained several classification and language models on COVID-19 from high-resource language regions and transferred this knowledge to the Caribbean claim dataset. The experimental results show the limitations of current false claim detection in low-resource regions and encourage further research toward the detection of multi-lingual false claims in long tail.

SARS-CoV-2 and other respiratory pathogens are detected in continuous air samples from congregate settings.

Two years after the emergence of SARS-CoV-2, there is still a need for better ways to assess the risk of transmission in congregate spaces. We deployed active air samplers to monitor the presence of SARS-CoV-2 in real-world settings across communities in the Upper Midwestern states of Wisconsin and Minnesota. Over 29 weeks, we collected 527 air samples from 15 congregate settings. We detected 106 samples that were positive for SARS-CoV-2 viral RNA, demonstrating that SARS-CoV-2 can be detected in continuous air samples collected from a variety of real-world settings. We expanded the utility of air surveillance to test for 40 other respiratory pathogens. Surveillance data revealed differences in timing and location of SARS-CoV-2 and influenza A virus detection. In addition, we obtained SARS-CoV-2 genome sequences from air samples to identify variant lineages. Collectively, this shows air sampling is a scalable, high throughput surveillance tool that could be used in conjunction with other methods for detecting respiratory pathogens in congregate settings.

College students report less physical activity and more sedentary behavior during the COVID-19 pandemic.

Objective: To understand the impact of the COVID-19 pandemic on college students' movement behaviors. Participants: College students attending a large Midwestern university during the pandemic. Methods: The Activity Questionnaire for Adults and Adolescents estimated physical activity and sedentary time before, early, and later in the pandemic. Barriers and facilitators to physical activity were assessed at early and later timepoints. Open-ended questions examined additional impacts. Results: Comparing before vs. early/later pandemic assessments, respondents (n = 230, 82% female, 21 ± 5 years) reported a significant decrease in physical activity metabolic equivalent (MET)-minutes/week (7891 ± 7340 vs. 5550 ± 6410/5953 ± 5180) and a significant increase in sedentary MET-minutes/week (1330 ± 1570 vs. 2415 ± 1770/1767 ± 1652). The top barrier was schoolwork (47.7%). The top facilitator was social support (21.5%). Responses to open-ended questions indicated that most individuals reported sitting more during the pandemic, with variation in physical activity patterns. Conclusions: Adverse changes in physical activity and sedentary behavior observed early in the pandemic were sustained.

SARS-CoV-2 booster vaccination rescues attenuated IgG1 memory B cell response in primary antibody deficiency patients (preprint)

SARS-CoV-2 vaccines have proven effective in eliciting an immune response capable of providing protective immunity in healthy individuals. However, whether SARS-CoV-2 vaccination induces a long-lived immune response in immunocompromised individuals is poorly understood. Primary antibody deficiency (PAD) syndromes are among the most common immunodeficiency disorders in adults and are characterized by an impaired ability to mount robust antibody responses following infection or vaccination. Here, we present data from a prospective study in which we analyzed the B and T cell response in PAD patients following SARS-COV-2 vaccination. Unexpectedly, individuals with PAD syndromes mounted a SARS-CoV-2 specific B and CD4+ T cell response that was comparable in magnitude to healthy individuals. Many individuals with PAD syndromes displayed reduced IgG1+ and CD11c+ memory B cell responses following the primary vaccination series. However, the IgG1 class-switching defect was largely rescued following mRNA booster vaccination. Boosting also elicited an increase in the SARS-CoV-2-specific B and T cell response and the development of Omicron-specific memory B cells in COVID-19-naive PAD patients. Together, these data indicate that SARS-CoV-2 vaccines elicit memory B and T cells in PAD patients that may contribute to long-term protective immunity.

mRNA vaccine boosting enhances antibody responses against SARS-CoV-2 Omicron variant in individuals with antibody deficiency syndromes.

Individuals with primary antibody deficiency (PAD) syndromes have poor humoral immune responses requiring immunoglobulin replacement therapy. We followed individuals with PAD after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination by evaluating their immunoglobulin replacement products and serum for anti-spike binding, Fcγ receptor (FcγR) binding, and neutralizing activities. The immunoglobulin replacement products tested have low anti-spike and receptor-binding domain (RBD) titers and neutralizing activity. In coronavirus disease 2019 (COVID-19)-naive individuals with PAD, anti-spike and RBD titers increase after mRNA vaccination but wane by 90 days. Those vaccinated after SARS-CoV-2 infection develop higher and more sustained responses comparable with healthy donors. Most vaccinated individuals with PAD have serum-neutralizing antibody titers above an estimated correlate of protection against ancestral SARS-CoV-2 and Delta virus but not against Omicron virus, although this is improved by boosting. Thus, some immunoglobulin replacement products likely have limited protective activity, and immunization and boosting of individuals with PAD with mRNA vaccines should confer at least short-term immunity against SARS-CoV-2 variants, including Omicron.