Impact of P-selectin-PSGL-1 Axis on Platelet-Endothelium-Leukocyte Interactions in Fatal COVID-19.

In critically ill patients infected with SARS-CoV-2, early leukocyte recruitment to the respiratory system was found to be orchestrated by leukocyte trafficking molecules accompanied by massive secretion of proinflammatory cytokines and hypercoagulability. Our study aimed to explore the interplay between leukocyte activation and pulmonary endothelium in different disease stages of fatal COVID-19. Our study comprised 10 COVID-19 postmortem lung specimens and 20 control lung samples (5 acute respiratory distress syndrome, 2 viral pneumonia, 3 bacterial pneumonia, and 10 normal), which were stained for antigens representing the different steps of leukocyte migration: E-selectin, P-selectin, PSGL-1, ICAM1, VCAM1, and CD11b. Image analysis software QuPath was used for quantification of positive leukocytes (PSGL-1 and CD11b) and endothelium (E-selectin, P-selectin, ICAM1, VCAM1). Expression of IL-6 and IL-1ß was quantified by RT-qPCR. Expression of P-selectin and PSGL-1 was strongly increased in the COVID-19 cohort compared with all control groups (COVID-19:Controls, 17:23, P < .0001; COVID-19:Controls, 2:75, P < .0001, respectively). Importantly, P-selectin was found in endothelial cells and associated with aggregates of activated platelets adherent to the endothelial surface in COVID-19 cases. In addition, PSGL-1 staining disclosed positive perivascular leukocyte cuffs, reflecting capillaritis. Moreover, CD11b showed a strongly increased positivity in COVID-19 compared with all controls (COVID-19:Controls, 2:89; P = .0002), indicating a proinflammatory immune microenvironment. Of note, CD11b exhibited distinct staining patterns at different stages of COVID-19 disease. Only in cases with very short disease course, high levels of IL-1ß and IL-6 mRNA were observed in lung tissue. The striking upregulation of PSGL-1 and P-selectin reflects the activation of this receptor-ligand pair in COVID-19, increasing the efficiency of initial leukocyte recruitment, thus promoting tissue damage and immunothrombosis. Our results show that endothelial activation and unbalanced leukocyte migration play a central role in COVID-19 involving the P-selectin-PSGL-1 axis.

Assessment of a Comparative Bayesian-Enhanced Population-Based Decision Model for COVID-19 Critical Care Prediction in the Dominican Republic Social Security Affiliates.

INTRODUCTION: The novel coronavirus disease 2019 (COVID-19) has been a major health concern worldwide. This study aims to develop a Bayesian model to predict critical outcomes in patients with COVID-19. METHODS: Sensitivity and specificity were obtained from previous meta-analysis studies. The complex vulnerability index (IVC-COV2 index for its abbreviation in Spanish) was used to set the pretest probability. Likelihood ratios were integrated into a Fagan nomogram for posttest probabilities, and IVC-COV2 + National Early Warning Score (NEWS) values and CURB-65 scores were generated. Absolute and relative diagnostic gains (RDGs) were calculated based on pretest and posttest differences. RESULTS: The IVC-COV2 index was derived from a population of 1,055,746 individuals and was based on mortality in high-risk (71.97%), intermediate-risk (26.11%), and low-risk (1.91%) groups. The integration of models in which IVC-COV2 intermediate + NEWS ≥ 5 and CURB-65 > 2 led to a "number needed to (NNT) diagnose" that was slightly improved in the CURB-65 model (2 vs. 3). A comparison of diagnostic gains revealed that neither the positive likelihood ratio (P = 0.62) nor the negative likelihood ratio (P = 0.95) differed significantly between the IVC-COV2 NEWS model and the CURB-65 model. CONCLUSION: According to the proposed mathematical model, the combination of the IVC-COV2 intermediate score and NEWS or CURB-65 score yields superior results and a greater predictive value for the severity of illness. To the best of our knowledge, this is the first population-based/mathematical model developed for use in COVID-19 critical care decision-making.

Greening of the syllabus in faculties of education sciences through sustainable development goals: the case of public Andalusian universities (Spain)

Purpose>The purpose of this paper is to analyse the presence of the sustainable development goals (SDGs) proposed by the UN (2015) in university degrees within the fields of education, humanities and environmental sciences (ES) at Andalusian public institutions (Spain).Design/methodology/approach>This paper shows an empirical analysis from a mixed methodological model on a total of 99 syllabi and training programs from nine different universities. The collection of information has been carried out through a rubric specifically designed within the framework of this body of research.Findings>The results show that the syllabus of the subjects in the faculties of education includes the SDGs related to the social aspect of sustainability, with special focus on SDG4, SDG5, SDG10, SDG16 and SDG17, whereas others like SDG6 and SDG7 are less represented. SDGs are present in the majority of syllabus of the subjects analysed. It is certainly a positive finding which shows predisposition and a high interest on by the teachers involved. However, this is not enough as there is still a long way to go until achieving a thorough and complete incorporation of the principles of sustainability.Originality/value>This research sheds light on the changes and transformations that the discourse linked to sustainability is generating in the university syllabi. Taking the SDG as a framework this paper highlights the most original aspects: a replicable methodology that allows diagnosing the level of curricular greening of the university syllabi is provided to other contexts the innovative value of connecting teaching with local and global environmental problems in their physical-chemical social and economic dimensions is shown and it has been possible to compare the difficulties of some universities in addressing compliance with the SDGs and curricular sustainability from a systemic and integrative perspective that will lead to methodological transformation and pedagogical renewal.

Post-Discharge Health Status and Symptoms in Patients with Severe COVID-19.

BACKGROUND: Little is known about long-term recovery from severe COVID-19 disease. Here, we characterize overall health, physical health, and mental health of patients 1 month after discharge for severe COVID-19. METHODS: This was a prospective single health system observational cohort study of patients ≥ 18 years hospitalized with laboratory-confirmed COVID-19 disease who required at least 6 l of oxygen during admission, had intact baseline cognitive and functional status, and were discharged alive. Participants were enrolled between 30 and 40 days after discharge. Outcomes were elicited through validated survey instruments: the PROMIS® Dyspnea Characteristics and PROMIS® Global Health-10. RESULTS: A total of 161 patients (40.6% of eligible) were enrolled; 152 (38.3%) completed the survey. Median age was 62 years (interquartile range [IQR], 50-67); 57 (37%) were female. Overall, 113/152 (74%) participants reported shortness of breath within the prior week (median score 3 out of 10 [IQR 0-5]), vs 47/152 (31%) pre-COVID-19 infection (0, IQR 0-1), p < 0.001. Participants also rated their physical health and mental health as worse in their post-COVID state (43.8, standard deviation 9.3; mental health 47.3, SD 9.3) compared to their pre-COVID state, (54.3, SD 9.3; 54.3, SD 7.8, respectively), both p < 0.001. Physical and mental health means in the general US population are 50 (SD 10). A total of 52/148 (35.1%) patients without pre-COVID oxygen requirements needed home oxygen after hospital discharge; 20/148 (13.5%) reported still using oxygen at time of survey. CONCLUSIONS: Patients with severe COVID-19 disease typically experience sequelae affecting their respiratory status, physical health, and mental health for at least several weeks after hospital discharge.

Student Affiliates of Seventeen (SAS) 2020 Report: Transitioning to Leadership in a Historic Year

The University of Missouri?Columbia was selected to host the Student Affiliates of Seventeen (SAS) Executive Board from 2019?2022 and began their term in August 2019, following a successful three-year tenure by Ball State University. The new executive board has anchored its term in four pillars?Growth and Sustainability, Justice and Equity, Excellence and Innovation, and Wellness and Positive Development?which have guided the organization over the past year. This report reviews the purpose of SAS and discusses membership development, programming, advocacy, and the organizational development activities of the organization, including progress on goals to increase and engage membership and foster a more equitable and socially just organization that embraces liberation as a value. Counseling psychology students? and the organization?s response and adjustment to the COVID-19 pandemic and national reckoning with police brutality and anti-Black racism are also discussed.