Longitudinal lung function assessment of patients hospitalised with COVID-19 using 1H and 129Xe lung MRI

Introduction: The progression of pathophysiological pulmonary changes in patients following acute COVID-19 is not well established. Method(s): Patients hospitalised with COVID-19 pneumonia without signs of ILD, had MRI exams at a median of 6 (n=9), 12 (n=9), 25 (n=7), and 52 (n=3) weeks. MRI sequences included: dynamic contrast enhanced (DCE) lung perfusion,129 Xe diffusion weighted (DW-MRI), 129Xe ventilation and 129Xe 3D dissolved phase imaging. Result(s): 9 patients (age 56+/-9 years;7 male;1 required treatment in an ICU) were recruited. Median RBC:TP was abnormally low at all visits compared to reference age and sex matched data. An individual's RBC:TP was significantly and positively associated with an increase in their pulmonary blood volume (p=0.026). For patients with 52 week data available, one showed a continued increase in RBC:TP, 2 patients maintained a low RBC:TP (Figure 1). Ventilation defect percentage, and ventilation heterogeneity significantly decreased at 25 weeks compared to 6 129 129 129 weeks (p=0.010 and p=0.048). DW-MRI was normal at all visits. Dissolved phase xenon imaging showed RBC:TP significantly increased at 12 and 25 weeks compared to 6 weeks (p=0.048). Conclusion(s): In patients recovering after COVID-19, poor gas transfer is reflected by impaired xenon transfer, which improves alongside pulmonary blood volume.

Trust Dynamics of Community Health Workers in Frontier Food Banks and Pantries: a Qualitative Study.

BACKGROUND: Medical mistrust has had devastating consequences during the COVID-19 pandemic, particularly in rural communities. Community Health Workers (CHWs) have been shown to build trust, but there is little research on trust-building by CHWs in rural communities. OBJECTIVE: This study aims to understand the strategies that CHWs use to build trust with participants of health screenings in frontier Idaho. DESIGN: This is a qualitative study based on in-person, semi-structured interviews. PARTICIPANTS: We interviewed CHWs (N=6) and coordinators of food distribution sites (FDSs; e.g., food banks and pantries) where CHWs hosted a health screening (N=15). APPROACH: Interviews were conducted with CHWs and FDS coordinators during FDS-based health screenings. Interview guides were initially designed to assess facilitators and barriers to health screenings. Trust and mistrust emerged as dominant themes that determined nearly every aspect of the FDS-CHW collaboration, and thus became the focus of interviews. KEY RESULTS: CHWs encountered high levels of interpersonal trust, but low institutional and generalized trust, among the coordinators and clients of rural FDSs. When working to reach FDS clients, CHWs anticipated confronting mistrust due to their association with the healthcare system and government, especially if CHWs were perceived as "outsiders." Hosting health screenings at FDSs, which were trusted community organizations, was important for CHWs to begin building trust with FDS clients. CHWs also volunteered at FDS locations to build interpersonal trust before hosting health screenings. Interviewees agreed that trust building was a time- and resource-intensive process. CONCLUSIONS: CHWs build interpersonal trust with high-risk rural residents, and should be integral parts of trust building initiatives in rural areas. FDSs are vital partners in reaching low-trust populations, and may provide an especially promising environment to reach some rural community members. It is unclear whether trust in individual CHWs also extends to the broader healthcare system.

Core protocol for the adaptive Platform Trial In COVID-19 Vaccine priming and BOOsting (PICOBOO).

BACKGROUND: The need for coronavirus 2019 (COVID-19) vaccination in different age groups and populations is a subject of great uncertainty and an ongoing global debate. Critical knowledge gaps regarding COVID-19 vaccination include the duration of protection offered by different priming and booster vaccination regimens in different populations, including homologous or heterologous schedules; how vaccination impacts key elements of the immune system; how this is modified by prior or subsequent exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and future variants; and how immune responses correlate with protection against infection and disease, including antibodies and effector and T cell central memory. METHODS: The Platform Trial In COVID-19 priming and BOOsting (PICOBOO) is a multi-site, multi-arm, Bayesian, adaptive, randomised controlled platform trial. PICOBOO will expeditiously generate and translate high-quality evidence of the immunogenicity, reactogenicity and cross-protection of different COVID-19 priming and booster vaccination strategies against SARS-CoV-2 and its variants/subvariants, specific to the Australian context. While the platform is designed to be vaccine agnostic, participants will be randomised to one of three vaccines at trial commencement, including Pfizer's Comirnaty, Moderna's Spikevax or Novavax's Nuvaxovid COVID-19 vaccine. The protocol structure specifying PICOBOO is modular and hierarchical. Here, we describe the Core Protocol, which outlines the trial processes applicable to all study participants included in the platform trial. DISCUSSION: PICOBOO is the first adaptive platform trial evaluating different COVID-19 priming and booster vaccination strategies in Australia, and one of the few established internationally, that is designed to generate high-quality evidence to inform immunisation practice and policy. The modular, hierarchical protocol structure is intended to standardise outcomes, endpoints, data collection and other study processes for nested substudies included in the trial platform and to minimise duplication. It is anticipated that this flexible trial structure will enable investigators to respond with agility to new research questions as they arise, such as the utility of new vaccines (such as bivalent, or SARS-CoV-2 variant-specific vaccines) as they become available for use. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12622000238774. Registered on 10 February 2022.

Health Equity for Individuals With Intellectual and Developmental Disabilities.

This Viewpoint discusses 3 types of systemic health inequity experienced by individuals with intellectual and developmental disabilities­stigma, exclusion, and devaluation of worth; underrepresentation in population epidemiology and research; and inadequate access to care and social services­and suggests potential approaches to ameliorating inequities in each of these areas.

Longitudinal 129xe and 1h Lung Mri Assessment of Lung Structure, Ventilation, Perfusion, and Gas Transfer Following Hospitalization with Covid-19

The long-term effects of coronavirus disease 2019 (COVID- 19) pneumonia on the lungs and pulmonary circulation require further characterization. We assessed progression of pathophysiological pulmonary changes during 1 year of follow-up of patients who had been hospitalized because of COVID-19. After discharge, recruited patients had up to four MRI examinations at a median of 6 (n=9), 12 (n=9), 25 (n=7) and 52 (n=3) weeks. Lung MRI examinations included: ultra-short echo time (UTE), dynamic contrastenhanced (DCE) lung perfusion, 129Xe diffusion weighted (DW-MRI), 129Xe ventilation and 129Xe 3D dissolved phase imaging. Nine patients (age 56 +/-9 years;six male) were recruited. Ventilation defect percentage and whole lung coefficient of variation of lung ventilation decreased significantly at 25 weeks (visit 3) compared with visit 1 at 6 weeks (p=0.010 and p=0.048). The UTE imaging indicated no evidence of lung scarring, and DW-MRI indicated normal lung microstructure across all visits. Dissolved phase xenon imaging showed that RBC:TP increased significantly at visits 2 and 3 compared with visit 1 (p=0.048). Median RBC:TP was abnormally low at all visits compared with reference age- and sex-matched data. An individual's RBC:TP was associated significantly and positively with an increase in their pulmonary blood volume (p=0.026). For patients with 52-week data available, one showed a continued improvement in RBC:TP;however, two of the patients maintained a low RBC:TP. In patients recovering from COVID-19, xenon gas transfer improves alongside pulmonary blood volume. Further work is needed to establish the proportion of post-COVID-19 patients who have longer-term impairment in xenon transfer and to correlate changes in lung MRI parameters with symptoms, lung function tests and other imaging modalities. Persistent impairment of xenon transfer might represent a physiological mechanism underlying ongoing symptoms in some patients and might indicate damage to the pulmonary microcirculation.

New Horizons-Addressing Healthcare Disparities in Endocrine Disease: Bias, Science, and Patient Care.

Unacceptable healthcare disparities in endocrine disease have persisted for decades, and 2021 presents a difficult evolving environment. The COVID-19 pandemic has highlighted the gross structural inequities that drive health disparities, and antiracism demonstrations remind us that the struggle for human rights continues. Increased public awareness and discussion of disparities present an urgent opportunity to advance health equity. However, it is more complicated to change the behavior of individuals and reform systems because societies are polarized into different factions that increasingly believe, accept, and live different realities. To reduce health disparities, clinicians must (1) truly commit to advancing health equity and intentionally act to reduce health disparities; (2) create a culture of equity by looking inwards for personal bias and outwards for the systemic biases built into their everyday work processes; (3) implement practical individual, organizational, and community interventions that address the root causes of the disparities; and (4) consider their roles in addressing social determinants of health and influencing healthcare payment policy to advance health equity. To care for diverse populations in 2021, clinicians must have self-insight and true understanding of heterogeneous patients, knowledge of evidence-based interventions, ability to adapt messaging and approaches, and facility with systems change and advocacy. Advancing health equity requires both science and art; evidence-based roadmaps and stories that guide the journey to better outcomes, judgment that informs how to change the behavior of patients, providers, communities, organizations, and policymakers, and passion and a moral mission to serve humanity.

Cherry Blossoms, COVID-19, and the Opportunity for a Healthy Life.

To date, short-term funding and policy fixes for the coronavirus disease 2019 (COVID-19) pandemic have focused on saving the current health care system; policies have not maximized the population's health, prioritized the safety net, nor addressed the fundamental problems that have hindered our nation's response for our most vulnerable neighbors. We need to plan more lasting equity-specific reforms now. I explain 3 lessons that should inform reforms to the health care delivery and payment systems to reduce health disparities and maximize the public's health: (1) Proven roadmaps and processes for reducing health care disparities already exist, as do themes of successful interventions. Implement them; (2) Payment reform needs to create a business case for health care organizations to address social determinants of health and implement care interventions to reduce health disparities; (3) We as a nation need to have hard conversations about whether we truly value the opportunity for everyone to have a healthy life.