Ventilation during COVID-19 in a school for students with intellectual and developmental disabilities (IDD). (preprint)

Background: This study examined the correlation of classroom ventilation (air exchanges per hour (ACH)) and exposure to CO2 [≥]1,000 ppm with the incidence of SARS-CoV-2 over a 20-month period in a specialized school for students with intellectual and developmental disabilities (IDD). These students were at a higher risk of respiratory infection from SARS-CoV-2 due to challenges in tolerating mitigation measures (e.g. masking). One in-school measure that is suspected to help mitigate the risk of SARS-CoV-2 infection in schools is classroom ventilation. Methods: We established a community engaged research partnership between the University of Rochester and the Mary Cariola Center school for students with IDD. Ambient CO2 levels were measured in 100 rooms in the school, and air changes per hour (ACH) were calculated. The number of SARS-CoV-2 cases for each room was collected over 20 months. Results: 97% of rooms had an estimated ACH [≤]4.0, with 7% having CO2 levels [≥]1,000 PPM for up to 3 hours per school day. A statistically significant correlation was found between the time that a room had CO2 levels [≥]1,000 PPM and per-room SARS-CoV-2 PCR confirmed cases, accounting for 21% of the variance. No statistically significant correlation was found for room ACH and per-room SARS-CoV-2 cases. These findings led to ongoing efforts to upgrade the ventilation systems in this community engaged research project. Conclusions: There was a statistically significant correlation between the total time of room CO2 levels [≥]1,000 PPM during the school day and SARS-CoV-2 cases in that room in an IDD school. This research partnership identified areas for improving in-school ventilation.

Mental health care before and during the COVID-19 pandemic in public healthcare centers of a Chilean municipality

IntroductionGlobally, the COVID- 19 pandemic has affected people's mental health care. This study aims to describe mental health care in the first semester of the COVID- 19 pandemic of the year 2020 compared to the first semester of the year 2019 in the public health establishments of the com-mune of Chillan, Chile.MethodsA descriptive ecological study. The treated cases were analyzed in aggregate, considering the pandemic, amount of admissions, the reason for consultation, sex, and age for the years 2019 and 2020Prevalence, percentages and statistical analisis were evaluated using nonparametric tests.ResultsThe prevalence of cases due to admissions to the mental health program in primary health care remained similar between the first semester of 2019 and the first semester of 2020. Most mental health cases concentrate on mood (affective) and anxiety disorders. Statistically significant dif-ferences were observed between 2019 and 2020 in the number of mental health admissions for mental and behavioral disorders due to psychotropic substances, harmful use disorders, drug dependence, and personality disorders.ConclusionsIt is a priority for Chile to increase coverage in primary mental health care. The data provided in this study show at an exploratory level that the initial situation of the pandemic could have af-fected access to timely care for the most vulnerable people with mental disorders.

Plitidepsin Is a Broad-Spectrum Antiviral Shaping the Cell Proteostatic Balance

Background: Different viruses employ similar pathways for replication, revealing key intracellular hotspots to target with host-directed therapies and achieve a broad-spectrum antiviral activity. Plitidepsin is a clinically approved antitumoral agent that blocks the elongation factor eEF1A required for protein translation. This drug counteracts SARS-CoV-2 replication and shows a favorable safety profile in COVID-19 patients. Yet, the precise antiviral mechanism of action of plitidepsin remains unknown. Method(s): Here we used a deep quantitative proteomic analysis to measure the impact of plitidepsin on the proteome of SARS-CoV-2-infected Vero E6 cells. This was complemented with transmission electron microscopy assays, which unraveled the subcellular and morphological changes associated to plitidepsin treatment. In addition, we performed functional in vitro assays to dissect the antiviral activity of plitidepsin against SARS-CoV-2 and other viruses. Result(s): We found that this drug inhibited the synthesis of all SARS-CoV-2 proteins in a dose-dependent manner. These included the R1AB polyproteins, which facilitate the synthesis of non-structural proteins involved in the formation of double membrane vesicles (DMV) required for viral replication. Plitidepsin reduced DMV formation and the morphogenesis of new viruses, having a greater impact on viral than on host proteins. Less than 14% of the cellular proteome was significantly affected by plitidepsin, inducing the up-regulation of key molecules associated with protein biosynthesis, such as the translation initiation factors eIF4A2 and eIF2S3. Therefore, plitidepsin induced a compensatory state that rescued protein translation. This proteostatic response explains how cells preserve the cellular proteome after treatment with a translation inhibitor such as plitidepsin. In addition, it suggests that plitidepsin could inhibit other RNA-dependent and non-integrated DNA viruses, as we confirmed in vitro using Zika virus, Hepatitis C virus replicon and Herpes simplex virus. However, the compensatory proteostasis induced by plitidespin also explains why this drug failed to inhibit the replication of integrated DNA proviruses such as HIV-1. Conclusion(s): Unraveling the mechanism of action of host-directed therapies like plitidepsin is imperative to define the indications and antiviral profile of these compounds. This knowledge will be key to develop broad-spectrum treatments and have them ready to deploy when future pandemic viruses break through.

Special Issue: Making it count: applying science to support universal broadband. (Special Issue: Making it count: applying science to support universal broadband.)

This special issue presents six papers resulting from a two-conference series about closing the digital divide, especially for rural areas. The issue explores how to apply the best information and processes to guide effective investments of limited resources to expand broadband access in the USA. The papers specifically deal with: the need for better data to inform broadband policy decisions and targeted funding;the contribution of integrating research and extension in improving community participation in broadband projects;policy approaches for rural broadband provision;the influence of COVID-19 on telecommuting;and federal funding challenges for rural broadband.

Furin as a therapeutic target in cystic fibrosis airways disease.

Clinical management of cystic fibrosis (CF) has been greatly improved by the development of small molecule modulators of the CF transmembrane conductance regulator (CFTR). These drugs help to address some of the basic genetic defects of CFTR; however, no suitable CFTR modulators exist for 10% of people with CF (PWCF). An alternative, mutation-agnostic therapeutic approach is therefore still required. In CF airways, elevated levels of the proprotein convertase furin contribute to the dysregulation of key processes that drive disease pathogenesis. Furin plays a critical role in the proteolytic activation of the epithelial sodium channel; hyperactivity of which causes airways dehydration and loss of effective mucociliary clearance. Furin is also responsible for the processing of transforming growth factor-ß, which is increased in bronchoalveolar lavage fluid from PWCF and is associated with neutrophilic inflammation and reduced pulmonary function. Pathogenic substrates of furin include Pseudomonas exotoxin A, a major toxic product associated with Pseudomonas aeruginosa infection and the spike glycoprotein of severe acute respiratory syndrome coronavirus 2, the causative pathogen for coronavirus disease 2019. In this review we discuss the importance of furin substrates in the progression of CF airways disease and highlight selective furin inhibition as a therapeutic strategy to provide clinical benefit to all PWCF.

Telemedicine among Adults Living in America during the COVID-19 Pandemic.

Background and Objectives Telemedicine can expand healthcare access to populations, but relying on technology risks a digital divide. Therefore, it is important to understand who utilizes telemedicine. This study explores telemedicine usage across socio-demographic groups in the United States during COVID-19. Methods Data came from the Household Pulse Survey (HPS) between 14 April 2021, to 11 April 2022. HPS is a rapid online response survey that assesses household experiences during COVID-19. We calculated descriptive statistics and used cross-correlation to test each pair of the time series curves. Results High school graduates used the least telemedicine (20.58%), while those with some college (23.29%) or college graduates (22.61%) had similar levels, and those with less than a high school education fluctuated over time. Black people had higher levels of use (26.31%) than Asians (22.01%). Individuals with disabilities (35.40%) used telemedicine more than individuals without disabilities (20.21%). Individuals 80 years or over (27.63%) used telemedicine more than individuals 18 to 29 years old (18.44%). Cross-correlations for the time series pairs across demographics revealed significant differences in telemedicine use for all demographic groups over time. Conclusions Overall, elderly, Black people, individuals with some college, and persons with disabilities report higher levels of telemedicine use. Telemedicine may improve healthcare access post-pandemic, but more research is needed to understand factors that drive differences among groups.

Recovery from Work: An Umbrella Review of Systematic Reviews and Meta-Analysis

Work is a fundamental condition of human life, but it can become dysfunctional because in certain situations it may lead to undesirable and harmful consequences. In this context, recovery from work (recovery) is conceived as a counterpoint to the straining processes to which the employee is exposed in the workplace. Among the different recovery strategies adopted by workers, those carried out outside working hours are especially relevant. Scientific interest in this filed is evidenced by the publication of numerous systematic reviews in recent years. The aim of this study is to shed light and provide evidence on the results of the systematic reviews carried out to date. Thus, it was conducted an umbrella review of systematic reviews and meta-analyses on work recovery outside working hours. To this end, a systematic search of potentially relevant documents was implemented in six databases, both thematic and multidisciplinary. Eight systematic reviews and meta-analyses that met the established inclusion criteria were retrieved. The content analysis of the selected papers enabled us to identify different approaches to the study of external work recovery: (a) time period;(b) work characteristics;(c) recovery experiences;(d) recovery activities;(e) processes that hinder effective recovery;and (f) variables proxy to the recovery process. Likewise, the main considered substantive occupational and psychosocial variables were systematized. It is discussed the scarce attention paid in the reviewed studies to possible cultural differences that could potentially influence the recovery process. Furthermore, no research has made special reference to the COVID-19 pandemic in work recovery, nor to the potential influence of new emerging work realities such as teleworking or co-working.

Risk stratification through extensive allergy work-up in COVID-19-mRNA vaccine allergic reactions

Introduction (contexte de la recherche) Polyethylene glycol (PEG) allergies through IgE activation and a complement activation-related pseudoallergy mechanism have been suggested during reactions to COVID-19-mRNA vaccines. Objectif Reported allergy work-up and outcomes of subsequent COVID-19 vaccinations in patients with a suspicion of hypersensitivity to COVID-19-mRNA vaccines to determine risk factors for anaphylaxis at the next dose. Méthodes In total, 190 patients were referred to two European allergy centers for suspicion of hypersensitivity to COVID-19-mRNA. These patients have been an allergy work-up [skin tests (ST) with COVID-19-mRNA vaccine and PEGs with different molecular weight, and basophil activation tests (BAT) to PEG-2000]. Immediate, delayed reactions compatible with hypersensitivity and reactions not suggestive of hypersensitivity, after a detailed analysis of the medical history, were reported in 69, 84 and 37 patients, respectively. Thirty-one cases with index anaphylaxis (16%);with only 3 severe anaphylaxis, all occurred within one hour after vaccine administration. One hundred and sixty patients (84%) were revaccinated with good tolerance in 139 cases (87%). In 145 patients, revaccination was performed with the culprit vaccine, which was well tolerated in 126 of the patients;with an alternative COVID-19 vaccine (other mRNA vaccine for 12) in 15, well tolerated in 13. Among the 31 patients reporting index anaphylaxis, 23 were revaccinated with the culprit vaccine under hospital supervision, with good tolerance in 15 (65%). The eight immediate reactions after revaccination were less severe than the index one. The work-up was positive in 9 patients (4.7%);among them, four tolerated the culprit vaccine (n=1) or another COVID-19 vaccine (n=3), and five refused further vaccination. Résultats Our results are in accordance with the literature and with ENDA/EAACI recommendations for allergies to COVID-19 vaccines. Although more studies are needed to determine the ST and BAT predictive value. Conclusions This series strongly argues for re-vaccinating in suspected vaccine allergies. And we suggest to refer for allergy work-up only patients with reactions occurring within the first hour after COVID-19-mRNA vaccine administration.

Assessing risk among frail older adults in Ontario, Canada, during the COVID-19 pandemic: a mixed methods evaluation of a telephone outreach program

We developed a pandemic telephone outreach protocol to identify risk for social isolation, health destabilization, medication issues, inadequate services and supports, and caregiver stress among older adults at high risk of destabilization. Screening, conducted between April 1, 2020, and May 8, 2020, was targeted to those who had previously been screened as frail or who were identified as vulnerable by their family physician. This study describes the implementation and results of this risk screening protocol and describes patient, caregiver, and health professional perceptions of this outreach initiative. Mixed methods included satisfaction surveys and interviews completed by patients/caregivers (N = 300 and N = 26, respectively) and health professionals (N = 18 and N = 9, respectively). A medical record audit collected information on patient characteristics and screening outcomes. A total of 335 patients were screened in the early weeks of the pandemic, of whom 23% were identified with at least one risk factor, most commonly related to the potential for health destabilization and medication risk. Follow-up referrals were made most frequently to physicians, a pharmacist, and a social worker. The outreach calls were very well received by patients and caregivers who described feeling cared for and valued at a time when they were socially isolated and lonely. The outreach calls provided access to trusted COVID-19 information and reassurance that health care was still available. The majority of health professionals (>86%) were "very" or "extremely" satisfied with the ease of completing the screening via telephone and value for time spent;for 79% the protocol was "very" or "extremely" feasible to implement. Health professional interviews revealed that patients were unaware they could access care during the pandemic lockdown but were reassured that care was available, potential crises were averted, and they supported future implementation. Risk screening provides a significant opportunity to provide information, support, and mitigate potential risks and is an important and feasible component of pandemic planning in primary care.

Agreement between cardiac output measurements by pulse wave analysis using the Pressure Recording Analytical Method and transthoracic echocardiography in patients with veno-venous extracorporeal membrane oxygenation therapy: An observational method comparison.

BACKGROUND: Measuring cardiac output (CO) is important in patients treated with veno-venous extracorporeal membrane oxygenation (vvECMO) because vvECMO flow and CO need to be balanced. Uncalibrated pulse wave analysis with the Pressure Recording Analytical Method (PRAM) may be suitable to measure CO in patients with vvECMO therapy. OBJECTIVE: To assess the agreement between CO measured by PRAM (PRAM-CO; test method) and CO measured by transthoracic echocardiography (TTE-CO; reference method). DESIGN: A prospective observational method comparison study. SETTING: The ICU of a German university hospital between March and December 2021. PATIENTS: Thirty one adult patients with respiratory failure requiring vvECMO therapy: 29 of the 31 patients (94%) were treated for COVID-19 related respiratory failure. MAIN OUTCOME MEASURES: PRAM-CO and TTE-CO were measured simultaneously at two time points in each patient with at least 20 min between measurements. A radial or femoral arterial catheter-derived blood pressure waveform was used for PRAM-CO measurements. TTE-CO measurements were conducted using the pulsed wave Doppler-derived velocity time integral of the left ventricular outflow tract (LVOT) and the corresponding LVOT diameter. PRAM-CO and TTE-CO were compared using Bland-Altman analysis and the percentage error (PE). We defined a PE of <30% as clinically acceptable. RESULTS: Mean ±â€ŠSD PRAM-CO was 6.86 ±â€Š1.49 l min -1 and mean TTE-CO was 6.94 ±â€Š1.58 l min -1 . The mean of the differences between PRAM-CO and TTE-CO was 0.09 ±â€Š0.73 l min -1 with a lower 95% limit of agreement of -1.34 l min -1 and an upper 95% limit of agreement of 1.51 l min -1 . The PE was 21%. CONCLUSIONS: The agreement between PRAM-CO and TTE-CO is clinically acceptable in adult patients with vvECMO therapy.

Evaluating the Regional Differences in Pediatric Injury Patterns During the COVID-19 Pandemic.

INTRODUCTION: Reports of pediatric injury patterns during the COVID-19 pandemic are conflicting and lack the granularity to explore differences across regions. We hypothesized there would be considerable variation in injury patterns across pediatric trauma centers in the United States. MATERIALS AND METHODS: A multicenter, retrospective study evaluating patients <18 y old with traumatic injuries meeting National Trauma Data Bank criteria was performed. Patients injured after stay-at-home orders through September 2020 ("COVID" cohort) were compared to "Historical" controls from an averaged period of equivalent dates in 2016-2019. Differences in injury type, intent, and mechanism were explored at the site level. RESULTS: 47,385 pediatric trauma patients were included. Overall trauma volume increased during the COVID cohort compared to the Historical (COVID 7068 patients versus Historical 5891 patients); however, some sites demonstrated a decrease in overall trauma of 25% while others had an increase of over 33%. Bicycle injuries increased at every site, with a range in percent change from 24% to 135% increase. Although the greatest net increase was due to blunt injuries, there was a greater relative increase in penetrating injuries at 7/9 sites, with a range in percent change from a 110% increase to a 69% decrease. CONCLUSIONS: There was considerable discrepancy in pediatric injury patterns at the individual site level, perhaps suggesting a variable impact of the specific sociopolitical climate and pandemic policies of each catchment area. Investigation of the unique response of the community during times of stress at pediatric trauma centers is warranted to be better prepared for future environmental stressors.

FREEMASONS CENTRE FOR MALE HEALTH & WELLBEING SPECIAL ISSUE PREVALENCE AND PREDICTORS OF INCREASED AND HAZARDOUS ALCOHOL CONSUMPTION IN A COHORT OF OLDER SOUTH AUSTRALIAN MEN DURING COVID-19 RESTRICTIONS

Background: Increasing levels of risky alcohol consumption in older men observed in many countries, com-bined with trends for increased alcohol-related misuse by men during COVID, indicate a need to examine alcohol use by older men during the pandemic. Aim: To examine the prevalence and predictors of increased and hazardous alcohol consumption in older South Australian men during COVID-19 restrictions. Method: Data collected in the latest (eighth) wave of the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) cohort study were interrogated. Participants were 746 community-dwelling older men (mean age 69 years) who completed a self-report survey on mental health, coping, COVID-related worries, and alcohol consumption during pandemic restrictions. Alcohol-related items asked about changes to over-all consumption (analysed as increased vs. decreased/same) and number of standard drinks per occasion (analysed as <5 drinks [not hazardous consumption] vs. 5+ drinks [hazardous]). Two hierarchical binary logistic regressions were conducted to explore predictors of increased and hazardous alcohol intake. Results: Eight percent of men reported increased alcohol intake and nine percent reported hazardous alcohol consumption during COVID-19 restrictions. Being in a younger age group (‘younger old';OR=0.46, 95%CI=1.03, 2.28), having mild to severe depressive symptoms (OR=1.39, 95%CI=1.10, 5.05), and greater concern about becoming sick with COVID-19 (OR=1.52, 95%CI=1.03, 2.28) were predictive of increased alcohol consumption during restrictions. Younger age group (OR=0.46, 95%CI=0.34, 0.62) and greater concern about becoming sick with COVID-19 (OR=1.67, 95%CI=1.13, 2.51) were also predictive of hazardous alcohol consumption during this time. Discussion: Men participating in longitudinal health study follow-ups may be less inclined to engage in unhelpful coping behaviours such as problematic alcohol use. Clinicians should regularly screen older men for risky alcohol consumption;a particular focus on screening ‘younger old' men, those with more significant concerns around COVID-19, and those with depression symptoms may be warranted. © Nankivell ME, et al.

University students' perceptions of remote laboratory courses necessitated by COVID-19: differences in emergent teaching strategies at a Korean university

In 2020, the COVID-19 pandemic swept the globe and caused formal educational sites to shift from in-person instruction to remote learning. University laboratory courses that were previously hands-on were also transformed into remote courses. This study investigates how university students perceived their experiences of remote laboratory courses across various disciplines. This study was conducted at a large public university in the Republic of Korea that offers a variety of laboratory courses. Adopting a mixed-methods approach, we collected online survey responses from 338 students and conducted in-depth interviews with 18 students. The analysis of variance (ANOVA) and Bonferroni post hoc tests of survey responses found that students' perceptions of their remote laboratory courses differed significantly (p <.05) by discipline (physics, chemistry, biology, earth sciences, etc.). Student interviews revealed that these differences in perceptions were attributable to the different emergent teaching strategies used in each course. Based on these findings, for remote laboratory courses in the post-COVID-19 era, we suggest that course instructors clearly set learning objectives, carefully design videos of experiments, offer collaborative and synchronous online sessions, provide guidance and feedback on lab report writing, and introduce supportive assessments. © 2023, Education Research Institute, Seoul National University.

Evaluating the regional differences in pediatric injury patterns during the COVID-19 pandemic

Background Reports of pediatric injury patterns during the COVID-19 pandemic are conflicting and lack the granularity to explore differences across regions. We hypothesized there would be considerable variation in injury patterns across Pediatric Trauma Centers (PTCs) in the United States. Materials and Methods A multicenter, retrospective study evaluating patients <18-years-old with traumatic injuries meeting National Trauma Data Bank criteria was performed. Patients injured after Stay-at-Home Orders through September 2020 ("COVID” cohort) were compared to "Historical” controls from an averaged period of equivalent dates in 2016–2019. Differences in injury type, intent, and mechanism were explored at the site level. Results 47,385 pediatric trauma patients were included. Overall trauma volume increased during the COVID cohort compared to the Historical (COVID 7,068 patients vs. Historical 5,891 patients);however, some sites demonstrated a decrease in overall trauma of 25% while others had an increase over 33%. Bicycle injuries increased at every site, with a range in percent change from 24% to 135% increase. Although the greatest net increase was due to blunt injuries, there was a greater relative increase in penetrating injuries at 7/9 sites, with a range in percent change from 110% increase to a 69% decrease. Conclusions There was considerable discrepancy in pediatric injury patterns at the individual site level, perhaps suggesting a variable impact of the specific sociopolitical climate and pandemic policies of each catchment area. Investigation of the unique response of the community during times of stress at PTCs is warranted to be better prepared for future environmental stressors.

Surgical Masks May Hide Neurological Diagnoses.

COVID-19 has disrupted the routine flow of patients through emergency departments (EDs) across the globe, including the need to consider COVID-19 for nearly all presenting complaints. The constraints of mask wearing and isolation have created inherent barriers to timely stroke care. We present a case that highlights one of the many ways in which the pandemic has negatively impacted the care of the non-COVID patient. A patient presented to the ED with a chief complaint of diffuse weakness and a new-onset cough on awakening. His daughter noted that he was slurring his words. An emergency medicine resident evaluated him, ordered laboratory studies, and decided to monitor the patient. The same resident later noted the patient veering to the left when walking, prompting a more detailed neurological examination. On removing the patient's facemask, a left lower facial weakness was evident. The resident called a Code Stroke roughly 50 min after the patient initially presented to the ED. The patient proved to have an acute infarct at the right thalamocapsular junction. Universal masking policies during the COVID-19 pandemic should not prevent the routine assessment of cranial nerve function for all patients presenting to an ED.

Effect of Predeparture Testing on Postarrival SARS-CoV-2-Positive Test Results Among International Travelers - CDC Traveler-Based Genomic Surveillance Program, Four U.S. Airports, March-September 2022.

Beginning December 6, 2021, all international air passengers boarding flights to the United States were required to show either a negative result from a SARS-CoV-2 viral test taken ≤1 day before departure or proof of recovery from COVID-19 within the preceding 90 days (1). As of June 12, 2022, predeparture testing was no longer mandatory but remained recommended by CDC (2,3). Various modeling studies have estimated that predeparture testing the day before or the day of air travel reduces transmission or importation of SARS-CoV-2 by 31%-76% (4-7). Postarrival SARS-CoV-2 pooled testing data from CDC's Traveler-based Genomic Surveillance program were used to compare SARS-CoV-2 test results among volunteer travelers arriving at four U.S. airports during two 12-week periods: March 20-June 11, 2022, when predeparture testing was required, and June 12-September 3, 2022, when predeparture testing was not required. In a multivariable logistic regression model, pooled nasal swab specimens collected during March 20-June 11 were 52% less likely to be positive for SARS-CoV-2 than were those collected during June 12-September 3, after adjusting for COVID-19 incidence in the flight's country of origin, sample pool size, and collection airport (adjusted odds ratio [aOR] = 0.48, 95% CI = 0.39-0.58) (p<0.001). These findings support predeparture testing as a tool for reducing travel-associated SARS-CoV-2 transmission and provide important real-world evidence that can guide decisions for future outbreaks and pandemics.

Duration of Device-Based Fever Prevention after Cardiac Arrest.

BACKGROUND: Guidelines recommend active fever prevention for 72 hours after cardiac arrest. Data from randomized clinical trials of this intervention have been lacking. METHODS: We randomly assigned comatose patients who had been resuscitated after an out-of-hospital cardiac arrest of presumed cardiac cause to device-based temperature control targeting 36°C for 24 hours followed by targeting of 37°C for either 12 or 48 hours (for total intervention times of 36 and 72 hours, respectively) or until the patient regained consciousness. The primary outcome was a composite of death from any cause or hospital discharge with a Cerebral Performance Category of 3 or 4 (range, 1 to 5, with higher scores indicating more severe disability; a category of 3 or 4 indicates severe cerebral disability or coma) within 90 days after randomization. Secondary outcomes included death from any cause and the Montreal Cognitive Assessment score (range, 0 to 30, with higher scores indicating better cognitive ability) at 3 months. RESULTS: A total of 393 patients were randomly assigned to temperature control for 36 hours, and 396 patients were assigned to temperature control for 72 hours. At 90 days after randomization, a primary end-point event had occurred in 127 of 393 patients (32.3%) in the 36-hour group and in 133 of 396 patients (33.6%) in the 72-hour group (hazard ratio, 0.99; 95% confidence interval, 0.77 to 1.26; P = 0.70) and mortality was 29.5% in the 36-hour group and 30.3% in the 72-hour group. At 3 months, the median Montreal Cognitive Assessment score was 26 (interquartile range, 24 to 29) and 27 (interquartile range, 24 to 28), respectively. There was no significant between-group difference in the incidence of adverse events. CONCLUSIONS: Active device-based fever prevention for 36 or 72 hours after cardiac arrest did not result in significantly different percentages of patients dying or having severe disability or coma. (Funded by the Novo Nordisk Foundation; BOX ClinicalTrials.gov number, NCT03141099.).

A multi-institutional study evaluating pediatric burn injuries during the COVID-19 pandemic.

During the COVID-19 pandemic, children were out of school due to Stay-at-Home orders. The objective of this study was to investigate how the COVID-19 pandemic may have impacted the incidence of burn injuries in children. Eight Level I Pediatric Trauma Centers participated in a retrospective study evaluating children <18 years old with traumatic injuries defined by the National Trauma Data Bank. Patients with burn injuries were identified by ICD-10 codes. Historical controls from March-September 2019 ("Control" cohort) were compared to patients injured after the start of the COVID-19 pandemic from March-September 2020 ("COVID" cohort). A total of 12,549 pediatric trauma patients were included, of which 916 patients had burn injuries. Burn injuries increased after the start of the pandemic (COVID 522/6711 [7.8%] vs. Control 394/5838 [6.7%], p=0.03). There were no significant differences in age, race, insurance status, burn severity, injury severity score, intent or location of injury, and occurrence on a weekday or weekend between cohorts. There was an increase in flame burns (COVID 140/522 [26.8%] vs. Control 75/394 [19.0%], p=0.01) and a decrease in contact burns (COVID 118/522 [22.6%] vs. Control 112/394 [28.4%], p=0.05). More patients were transferred from an outside institution (COVID 315/522 patients [60.3%] vs. Control 208/394 patients [52.8%], p=0.02), and intensive care unit length of stay increased (COVID median 3.5 days [interquartile range 2.0-11.0] vs. Control median 3.0 days [interquartile range 1.0-4.0], p=0.05). Pediatric burn injuries increased after the start of the COVID-19 pandemic despite Stay-at-Home orders intended to optimize health and increase public safety.

Antibody Correlates of Protection for COVID-19 Convalescent Plasma Associated with Reduced Outpatient Hospitalizations (preprint)

SARS-CoV-2 antibody levels associated with reduced hospitalization risk remain undefined. Our outpatient COVID-19 convalescent plasma (CCP), placebo-controlled trial observed SARS-CoV-2 antibody levels decreasing 22-fold from matched donor units into post-transfusion seronegative recipients. Unvaccinated recipients were jointly stratified by a) early or late transfusion (< 5 or >5 days from symptom onset) and b) high or low post-transfusion SARS-CoV-2 antibody levels (< or > geometric mean). Early treatment with high post-transfusion antibody levels reduced hospitalization risk-0/102 (0%) compared to all other CCP recipients-17/370 (4.6%; Fisher exact-p-0.03) and to all control plasma recipients-35/461 (7.6%; Fisher exact p-0.001). A similar donor upper/lower half antibody level and early late transfusion stratified analyses indicated significant hospital risk reduction. Pre-transfusion nasal viral loads were similar in CCP and control recipients regardless of hospitalization outcome. Therapeutic CCP should comprise the upper 30% of donor antibody levels to provide effective outpatient use for immunocompromised and immunocompetent outpatients.

Telematic Education at the University: A Study in Future Teachers

The emergence of Information and Communication Technologies in the educational area has allowed the expansion of learning through telematic means. In addition, the Covid-19 pandemic, and the consequent closure of school institutions, led to the massive application of fully online or combined training (face-to-face and with telematics support). The objective of this research was to know the evaluations of university students who intend to be teachers, about the training they are receiving by telematic means. To do this, an online questionnaire was designed, validated and applied to 523 students from two universities from Spain and one from Portugal. Descriptive and multivariate analyzes were performed, obtaining statistically significant differences. The results show that telematic education is not evaluated in a particularly positive way by the students, highlighting that they miss socializing with their classmates, although they recognize that its implementation also offers advantages such as greater flexibility and a reduction in economic expenses. Finally, the need to transform teaching methodologies for an efficient transition from face-to-face to telematic learning is discussed, and concludes with guidelines to improve the quality and effectiveness of online and combined training plans for higher education students.