Inegalites en vaccination contre la COVID-19 au Canada en 2021.

Contexte: Pour mesurer les inegalites dans la vaccination contre la COVID-19 chez les adultes au Canada, nous avons analyse les donnees de l'Enquete sur la sante dans les collectivites canadiennes de juin a septembre 2021 et identifie les facteurs sociodemographiques associes a la non-vaccination et a l'intention de ne pas se faire vacciner. Methodes: Les donnees proviennent d'une enquete annuelle transversale et representative a l'echelle nationale menee par Statistique Canada. Des modeles de regression logistique ajustes ont ete utilises pour mesurer les associations entre, d'une part, des variables sociodemographiques et liees a la sante (region, age, sexe, scolarite, statut autochtone, statut de minorite visible, etat de sante percu et acces regulier a un professionnel de la sante) et d'autre part la non-vaccination et l'intention de ne pas se faire vacciner. Resultats: La non-vaccination etait associee a un faible niveau de scolarite (RCa jusqu'a 3,5), a la presence d'enfants de moins de 12 ans dans le menage (RCa 1,6), a l'absence d'acces regulier a un professionnel de la sante (RCa 1,6) et a une mauvaise perception de sa propre sante (RCa 1,8). Seuls 5 % des adultes n'avaient pas l'intention de se faire vacciner. L'intention de ne pas se faire vacciner etait associe au jeune age (RCa jusqu'a 4,0), a une scolarite moindre (RCa jusqu'a 3,8), a la non-appartenance a une minorite visible (RCa 3,0), a la presence d'enfants de moins de 12 ans (RCa 1,8) et a une mauvaise perception de sa propre sante (RCa 2,0). Discussion/Conclusion: Des disparites ont ete observees dans la couverture vaccinale et l'intention de ne pas se faire vacciner. Les strategies de promotion de la vaccination devraient tenir compte de ces disparites. Declaration de liens d'interets: Les auteurs declarent ne pas avoir de liens d'interets.Copyright © 2022

ADAMTS13 activity and non-parallel vWF Ristocetin CoFactor activity are associated with severity of COVID-19 infection

Background: Increased von Willebrand factor (VWF) is common in COVID-19 infection. vWF levels are reported at levels where pre-dilution of samples is required. The assumption is that such dilutions respond linearly across the measurement range, and that this response is consistent across patient subgroups. ADAMTS13 levels have also been reported as reduced in those most severely affected. The interaction of these biomarkers has potential consequences to understanding pathophysiology of COVID-19. Aim(s): To investigate the linearity of dilution of high VWF levels in patients with COVID-19 To compare the response in those mildly affected to those requiring more intensive therapy Methods: This is a laboratory bases study investigating a convenience sample of fifty age and gender matched patients hospitalised during the first wave of the COVID-19 pandemic (March to June 2020). Patients had been hospitalised for >24 hours before enrolment. Platelet RiCof activity was using the VW Select assay (BioData Corps, Horsham, USA). Dilutions were made using assay buffer provided in the kit. Data was collected in Microsoft Excel, before being analysed in both Microsoft Excel and the statistical programming environment R (R Core Team (2021)). Result(s): The findings of Mancini et al were replicated here in that locale of patient admission was associated with a statistically significant reduction of ADAMTS13 activity (ITU mean 60.21 v non-ITU mean 92.23). The activity of ADAMTS13 remained within what would be a reference range for diagnosis of TTP. VWF activity by Platelet RiCof was markedly raised. Serial dilution of samples demonstrated non-parallelism, the response being most marked in severely affected patients. Conclusion(s): Very high VWF levels disrupt the balance with mildly reduced ADAMTS13. In severe COVID-19 infection, the effect manifests as non-parallelism in platelet RiCof parameters. This calculated parameter classifies patients both by presence and severity of disease across all parameters in the platelet Ristocetin CoFactor assay. (Figure Presented).

Assessing endothelial activation and risk of bleeding in patients receiving VV-ECMO supportive therapy for COVID-19 using non-standard laboratory assays

Background: Critically ill patients infected with the SARS-CoV- 2 virus are known to have a coagulopathy with a risk of thrombosis due to endothelial activation and systemic inflammation. Veno-venous extracorporeal membrane oxygenation (VV ECMO) is recommended by the World Health Organisation (WHO) as a supportive therapy for patients with severe COVID-19 infection when conventional ICU methods have proven ineffective. VV ECMO comes with haematological complications, including loss of high molecular weight von Willebrand factor multimers, consumption of clotting factors and premature activation of platelets. Laboratory methods to characterise haemostasis in these patients are required and may be clinically useful in predicting clinical outcome. Aim(s): Can non-standard methods provide clinically meaningful results in COVID-19 positive patients supported by VV ECMO? Methods: Tissue plasminogen activator and von Willebrand factor were quantified via Abcam SimpleStep ELISA in VV ECMO supported Covid-19 patients and normal controls. Fibrinogen antigen concentration was quantified via Liaphen Fibrinogen Antigen assay in VV ECMO supported Covid-19 patients and normal controls. VW Select ristocetin cofactor assay was used to assess von Willebrand Factor activity in VV ECMO supported COVID-19 patients. Result(s): Tissue plasminogen activator and von Willebrand factor concentrations are significantly increased in COVID-19 patients supported by VV ECMO compared to healthy controls, which reflects endothelial damage displayed in critically unwell COVID patients. Fibrinogen levels were not significantly different between the two patient groups. The VW Select ristocetin cofactor assay detected patients with low vWF activity that would have otherwise been overlooked by standard methods. Conclusion(s): Non-conventional laboratory methods can be used to represent the extent of endothelial damage and risk of bleeding in patients who are COVID-19 positive and anticoagulated on VV ECMO support. The assays help to characterise pathology of COVID-19 used in conjunction with standard tests by providing clinically relevant results. (Figure Presented).

Pre-analytical screening and removal of Argatroban interference for haemostasis assays

Background: Argatroban is a direct thrombin inhibitor licenced in the UK and USA for treatment of Heparin Induced Thrombocytopenia and has been utilised as alternative anticoagulation for critically ill COVID-19 patients. Interferences in specialised haemostasis assays may be clinically important when bridging anticoagulant regimens or investigating thrombotic and bleeding complications common in critically ill patients. Aim(s): * Assess effect of Argatroban on specialised haemostasis assays * Assess effectiveness of DOAC-Remove (DR) in removing Argatroban interference Methods: Argatroban calibration plasma, spanning concentrations of 0 mug/ml-2.08 mug/ml, was tested for Antithrombin (IIa activator), Factors IX, and XI, and dilute Russel's viper venom time (dRVVT) to assess Argatroban interference. Samples were treated with DOAC-Remove and re-run for these assays. A p value of <0.05 was used to assess significance using paired t-tests Results: * Antithrombin results were significantly and linearly increased by increasing Argatroban concentrations (R -0.99). * Factor IX and XI concentrations were significantly decreased by increasing Argatroban concentrations from 83.4 IU/dl at 0 mug/ml to 3.79 IU/ dL at 2.07 mug/ml Argatroban * dRVVT screen results were significantly increased by increasing Argatroban concentrations (DRVVT ratio 1.07 (no Argatroban) to 3.79 at 2.07 ng/ml Argatroban) * Pre-treatment of samples with DOAC-Remove completely removes Argatroban interference to baseline. Conclusion(s): Argatroban has significant effects on specialist haemostasis assays. Antithrombin overestimation was observed when IIa activator is used, a Xa activator should be considered in such patients. dRVVT screen ratios were significantly increased, which could lead to false positive Lupus anticoagulant results. Factors IX and XI results were significantly decreased. Similar results have been published for direct oral anticoagulants with the need for pre-analytical screening, where anticoagulant status is unknown, becoming more important. For Argatroban, dilute thrombin time can be used as a pre-analytical screening tool. (Table Presented).

Dilute thrombin time versus activated partial thromboplastin time to monitor Argatroban in critically ill patients

Background: Argatroban is a direct thrombin inhibitor currently licenced in the UK and USA for treatment of Heparin Induced Thrombocytopenia (HIT) and has been utilised as an alternative anticoagulant for critically ill COVID-19 patients. UK and US guidelines recommend Argatroban monitoring via activated partial thromboplastin time (aPTT), in critically ill patients, recommending ratios of between 1.5-3 times patient's baseline, without exceeding 100 s. This guidance is based on spiked pooled platelet poor plasma with increasing concentrations of Argatroban. Aim(s): * Does the aPTT demonstrate suitable linearity for Argatroban monitoring? * Are readily available alternatives more useful to indicate extent of Argatroban anticoagulation? Methods: From May to July 2021, 97 residual blood samples from 12 patients receiving Argatroban were processed for HemosIL APTT-SS, Thrombin time, Argatroban, and dilute thrombin time using ACL-TOP750 (Werfen, Bedford, USA). Performance was compared to commercial calibrators, across a therapeutic range from 0-2.08 mug/ml mimicking spiked plasma. Result(s): * No linearity was observed between Argatroban concentration and aPTT ratio (R2 value of 0.0778) in critically ill patient plasma compared to linearity for APTT ratios (R2 value of 0.9346) in commercial calibrators * Thrombin time produced good linearity with Argatroban (R2 value of 0.8473). Non-specific clot curve kinetic issues and exceeding acquisition times were noted. * Dilute thrombin time produced very good linearity with Argatroban (R2 value of 0.9443) Conclusion(s): In critically ill patients, aPTT ratio lacks a demonstrable linear response, unlike spiked and commercial plasmas. Non linearity is most likely due to other effects on the aPTT than Argatroban alone. 10.3% of patients exceeded an Argatroban concentration of 2.08 mug/ml with an aPTT ratio within guideline quoted ranges. Thrombin time and dTT demonstrated linearity. However, the thrombin time had non-specific clot curve kinetic abnormalities and some results exceeded acquisition time. No issues were seen with dilute thrombin time.

Gemini High-resolution Optical SpecTrograph (GHOST) instrument shipping reflections

The Gemini High-Resolution Optical SpecTrograph (GHOST) is the next in line instrument being integrated for the Gemini south telescope, in a collaboration between the Australian Astronomical Optics (AAO) at Macquarie University, Herzberg Astronomy and Astrophysics (HAA) at the National Research Council Canada, and the Australian National University ( ANU). This paper will discuss shipping considerations and data taken by the NRC-Herzberg and Gemini team to preserve and protect the instrument during a two year hiatus brought on by the COVID-19 pandemic.

Emerging therapeutic opportunities for integrin inhibitors.

Integrins are cell adhesion and signalling proteins crucial to a wide range of biological functions. Effective marketed treatments have successfully targeted integrins αIIbß3, α4ß7/α4ß1 and αLß2 for cardiovascular diseases, inflammatory bowel disease/multiple sclerosis and dry eye disease, respectively. Yet, clinical development of others, notably within the RGD-binding subfamily of αv integrins, including αvß3, have faced significant challenges in the fields of cancer, ophthalmology and osteoporosis. New inhibitors of the related integrins αvß6 and αvß1 have recently come to the fore and are being investigated clinically for the treatment of fibrotic diseases, including idiopathic pulmonary fibrosis and nonalcoholic steatohepatitis. The design of integrin drugs may now be at a turning point, with opportunities to learn from previous clinical trials, to explore new modalities and to incorporate new findings in pharmacological and structural biology. This Review intertwines research from biological, clinical and medicinal chemistry disciplines to discuss historical and current RGD-binding integrin drug discovery, with an emphasis on small-molecule inhibitors of the αv integrins.

Peripartum Outcomes Following COVID-19 Vaccination in Late Pregnancy: Findings from a Population-Based Retrospective Cohort Study in Ontario, Canada

Objectives: Evaluate peripartum outcomes following COVID-19 vaccination during pregnancy. Methods: Ontario population-based retrospective cohort between December 14, 2020 and September 30, 2021 using linkage of provincial birth registry and COVID-19 immunization databases. Poisson regression was used to generate risk ratios (RR) and 95% confidence intervals (CI), adjusted for temporal, socio-demographic, and clinical factors using propensity scores. Obstetric (postpartum hemorrhage, chorioamnionitis, cesarean birth) and newborn (NICU admission and 5-minute Apgar<7) outcomes were compared for those who received ≥1 dose of COVID-19 vaccine during pregnancy with 2 unexposed groups—Group 1: individuals vaccinated postpartum, Group 2: never vaccinated. Results: Among 97 590 individuals, 22 660 (23%) received ≥1 dose of vaccine during pregnancy (64% received dose 1 in 3rd trimester). Compared with those vaccinated postpartum, we found no increased risks of postpartum hemorrhage (aRR 0.91, 95% CI 0.82–1.02);chorioamnionitis (aRR 0.92, 95% CI 0.70–1.21);or cesarean (aRR 0.92, 95% CI 0.89–0.95) following COVID-19 vaccination, nor any increased risk of NICU admission or 5-minute Apgar <7. All findings were similar when compared with individuals who did not receive COVID-19 vaccination at any point. We did not observe any difference according to vaccine product, number of doses received during pregnancy, or trimester of dose 1. Conclusions: As of late 2021, there is limited evidence from comparative studies in large populations on outcomes following COVID-19 vaccination during pregnancy. Our study of births up to September 30, 2021 did not identify any increased adverse peripartum outcomes associated with later pregnancy COVID-19 vaccination. Once more individuals vaccinated earlier in pregnancy deliver, we will report on other important obstetric and perinatal outcomes. Keywords: COVID-19 vaccine;pregnancy;epidemiology

Media Studies: Texts, Production, Context, Third edition

This thoroughly revised and updated third edition provides a comprehensive introduction to the various approaches to the field, explaining why media messages matter, how media businesses prosper and why media is integral to defining contemporary life. The text is divided into three parts – Media texts and meanings;Producing media;and Media and social contexts – 　exploring the ways in which various media forms make meaning;are produced and regulated;and how society, culture and history are defined by such forms. Encouraging students to actively engage in media research and analysis, each chapter seeks to guide readers through key questions and ideas in order to empower them to develop their own scholarship, expertise and investigations of the media worlds in which we live. Fully updated to reflect the contemporary media environment, the third edition includes new case studies covering topics such as Brexit, podcasts, Love Island, Captain Marvel, Black Lives Matter, Netflix, data politics, the Kardashians, President Trump, ‘fake news’, the post-Covid world and perspectives on global media forms. This is an essential introduction for undergraduate and postgraduate students of media studies, cultural studies, communication studies, film studies, the sociology of the media and popular culture. © 2022 Paul Long, Beth Johnson, Shana MacDonald and Schem Rogerson Bader.

Impact of the Covid-19 Pandemic on Children and Families in PICU Follow-Up Clinic

The novel coronavirus disease 2019 (COVID-19) pandemic disrupted the lives of many families, especially those of children with chronic health problems. Little is known about the impact of this pandemic on the health and well-being of critically ill children and their families after their discharge from pediatric intensive care unit (PICU) hospitalization. This study describes the repercussions of the COVID-19-related lockdown on the physical and psychological wellbeing, quality of life, and access to resources of PICU survivors and their families. This was a prospective cohort study of children and families followed at the Centre Hospitaller Universitaire Ste-Justine PICU follow-up clinic from October 2018 to February 2020. There were no interventions. Families were contacted by phone to complete validated questionnaires (Pediatric Quality of Life Inventory, Hospital Anxiety and Depression Scale) and to evaluate the impact of the COVID-19 pandemic on their access to medical care and extrafamilial support. Fifty-five families were contacted between November and December 2020. Quality of life scores were 88.1 +/- 16.9 and 83.8 +/- 13.9 for physical and psychosocial aspects, respectively. Symptoms of anxiety and depression were detected in 23.6 and 3.6% of respondent parents, respectively. A significant proportion of families reported canceled or delayed health care appointments (65.5%) and difficulty with medication access (12.7%). Twenty-five families (45.5%) reported a significant decrease in income. We could not identify any statistically significant predictors for lower quality of life scores. Difficulty accessing medical care was associated with higher symptoms of anxiety and/or depression in parents on multivariate analysis (p = 0.02). In conclusion, the COVID-19 pandemic has had a significant negative impact on PICU survivors' access to medical resources and extrafamilial support.

Use of a cost-efficient Colonoscopy simulation model to improve endoscopy skills

Aims: The use of endoscopic simulators as a learning aid in surgical training has been well established, particularly in those with less experience. In the challenging time of COVID-19, when endoscopic procedures are at a minimum, this can become more valuable. However, their utility for training is countered by the high cost of equipment. We demonstrate a cost-efficient alternative to traditional endoscopy simultators, which can be easily made in any centre. Methods: A polypectomy simulator model was created using a drainpipe and surgical gloves. Junior doctors were timed in their ability to remove the 3 polyps from within the simulator. The exercise was repeated over 6 sessions over the course of 3 weeks. Means were compared using ANOVA. Results: There was a mean relative reduction of 75% in overall time taken to complete the task (p<0.0001). This improvement was seen for both surgical trainees with previous endoscopy experience (p=0.005) and FY1 novices (p<0.0001). Conclusions: In our group, we have seen improvement in performance across both surgical trainees and novices. In today's era of COVID-19, when direct training opportunities may become more scarce, simple alternatives may become vital in ensuring progression of basic surgical skills such as endoscopy. This cheap polypectomy simulator can be easily re-created across surgical units and can be used as an adjunct to traditional endoscopic training.

Use of a cost-efficient Colonoscopy simulation model to improve endoscopy skills during the COVID-19 pandemic

Introduction: The use of endoscopic simulators as a learning aid in surgical training has been well established. In the challenging times of COVID-19 they can become even more valuable. However, their utility for training is countered by the high cost of the equipment, with some of the most basic simulators costing upwards of £50,000. Method: A simple polypectomy simulator model was created using a drain-pipe and surgical gloves. n = 9 junior doctors (n = 4 surgical trainees, n = 5 FY1s) were timed in their ability to remove the 3 'polyps' from the simulator. Basic instructions regarding use of the colonoscope were given to novices unfamiliar with real-life endoscopy. The exercise was repeated over 6 sessions over the course of 3 weeks. Means were compared using ANOVA. Results: There was a mean relative reduction of 75% in overall time taken to complete the task (p <0.0001). This improvement was seen for both surgical trainees (P = 0.005) and FY1 novices (P < 0.0001). All junior doctors involved reported feeling more confident with basic Colonoscopic skills. Conclusion: We have demonstrated an improvement in performance times across both surgical trainees and novices. In the era of COVID-19, when direct training opportunities may become more scarce, simple alternatives may become vital in ensuring progression of basic surgical skills such as endoscopy. This cheap polypectomy simulator can be easily re-created across surgical units and can be used as an adjunct to traditional endoscopic training. Further work is required to determine whether this translates into improvement in clinical endoscopy.