DEATH LANDSCAPES AND COVID-19 IN THE AMERICAS: NORMATIVE RESPONSES OF THE INTER-AMERICAN COMMISSION OF HUMAN RIGHTS TOWARDS VULNERABILITY-DEATH

The article engages with the death landscapes of the Americas' two largest democracies – Brazil and the United States – during the Covid-19 crisis, offering a conceptual tool entitled vulnerability-death binomial to consider the extent to which a politics of tragedy is a turning point in the ways institutional politics addresses vulnerability and death, emphasizing the work of the Inter-American Commission on Human Rights (IACHR). When analyzing the normative responses of IACHR, no articulation was found between vulnerability and death but, instead, a bifurcation of each. Although it reveals that there is not a normative interplay between vulnerability and death, the bifurcation does not mean a choice between binary paths. While the two democracies have raised institutional challenges, the IACHR deepened certain senses of vulnerability and a normative movement towards death: issues historically absent from the international basic structure and capable of challenging the international justice theory © 2023, Lua Nova.All Rights Reserved.

Towards A Framework for Implementing Remote Patient Monitoring From an Integrated Care Perspective: A Scoping Review

Background: Remote patient monitoring (RPM) has been increasingly adopted over the last decade, with the COVID-19 pandemic fostering its rapid development. As RPM implementation is recognised as complex and highly demanding in terms of resources and processes, there are multiple challenges in providing RPM in an integrated logic. Methods: To examine the structural elements that are relevant for implementing RPM integrated care, a scoping review was conducted in PubMed, Scopus, and Web of Science, leveraging a search strategy that combines terms relative to (1) conceptual models and real-life initiatives;(2) RPM;and (3) care integration. Results: 28 articles were included, covering nine conceptual models and 19 real-life initiatives. Eighteen structural elements of RPM integrated care implementation were identified among conceptual models, defining a structure for assessing real-life initiatives. 78.9% of those initiatives referred to at least ten structural elements, with patient education and self-monitoring promotion, multidisciplinary core workforce, ICTs (information and communications technologies) and telemonitoring (TM) devices, and health indicators measurement being present in all studies, and therefore being core elements to the design of RPM initiatives. Conclusion: RPM goes far beyond technology, with underlying processes and involved actors playing a central role in care provision. The structural elements identified can guide RPM implementation and promote maturity in adoption. Future research may focus on assessing design completeness, evaluating impacts, and analysing related financial arrangements.

Distinct clinical phenotypes of critically ill COVID-19 patients: a cohort observational study

Introduction: COVID-19 presents a complex pathophysiology and evidence collected points towards an intricated interaction of viraldependent and individual immunological mechanisms. The identification of phenotypes, through clinical and biological markers, may provide a better understanding of the subjacent mechanisms and an early patient-tailored characterization of illness severity. Method(s): Multicenter prospective cohort study performed in 5 hospitals of Portugal and Brazil, during one year, between 2020-2021. All adult patients with an Intensive Care Unit admission with SARS-CoV-2 pneumonia were eligible. COVID-19 was diagnosed using clinical and radiologic criteria with a SARS-CoV-2 positive RT-PCR test. A two-step hierarchical cluster analysis was made using several class-defining variables. Result(s): 814 patients were included. The cluster analysis revealed a three-class model, allowing for the definition of three distinct COVID- 19 phenotypes: 244 patients in phenotype A, 163 patients in phenotype B, and 407 patients in phenotype C. Patients included in the phenotype C were significantly older, with higher baseline inflammatory biomarkers profile, and significantly higher requirement of organ support and mortality rate (Table 1 ( P062)). Phenotypes A and B demonstrated some overlapping clinical characteristics but different outcomes. Phenotype B patients presented a lower mortality rate, with consistently lower C-reactive protein, but higher procalcitonin and interleukin-6 serum levels, describing an immunological profile significantly different from phenotype A (Table 1). Conclusion(s): Severe COVID-19 patients exhibit three different clinical phenotypes with distinct profiles and outcomes. Their identification could have an impact in patients' care, justifying different therapy responses and inconsistencies identified across different randomized control trials results.

Safety of the NVX-CoV2373 COVID-19 vaccine in randomized placebo-controlled clinical trials.

BACKGROUND: NVX-CoV2373 (Nuvaxovid™ or the Novavax COVID-19 Vaccine, Adjuvanted), the first protein-based COVID-19 vaccine, received emergency use authorization (EUA) as a primary series/booster and is available globally. NVX-CoV2373 primary series demonstrated efficacy rates of 89.7-90.4 % and an acceptable safety profile. This article summarizes safety in adult recipients (aged ≥ 18 years) of primary series NVX-CoV2373 in four randomized placebo-controlled trials. METHODS: All participants who received NVX-CoV2373 primary series or placebo (pre-crossover) were included according to actual received treatment. The safety period was from Day 0 (first vaccination) to unblinding/receipt of EUA-approved/crossover vaccine, end of each study (EOS), or last visit date/cutoff date minus 14 days. The analysis reviewed local and systemic solicited adverse events (AEs) within 7 days after NVX-CoV2373 or placebo; unsolicited AEs from after Dose 1 to 28 days after Dose 2; serious AEs (SAEs), deaths, AEs of special interest, and vaccine-related medically attended AEs from Day 0 through end of follow-up (incidence rate per 100 person-years). FINDINGS: Pooled data from 49,950 participants (NVX-CoV2373, n = 30,058; placebo, n = 19,892) were included. Solicited reactions after any dose were more frequent in NVX-CoV2373 recipients (local, 76 %/systemic, 70 %) than placebo recipients (local, 29 %/systemic, 47 %), and were mostly of mild-to-moderate severity. Grade 3+ reactions were infrequent, with greater frequency in NVX-CoV2373 recipients (local, 6.28 %/systemic, 11.36 %) than placebo recipients (local, 0.48 %/systemic, 3.58 %). SAEs and deaths occurred with similarly low frequency in NVX-CoV2373 (SAEs: 0.91 %, deaths: 0.07 %) and placebo recipients (SAEs: 1.0 %, deaths: 0.06 %). INTERPRETATION: To date, NVX-CoV2373 has displayed an acceptable safety profile in healthy adults. FUNDING: Supported by Novavax, Inc.

Teachers' wellbeing, affects, and burnout during the pandemic in Chile

The COVID19 pandemic has had a dramatic impact upon teachers across the world. In Chile, the confinement also had a negative effect on teachers' well-being. However, there are no studies assessing teachers' mental health, affect, burnout, or social support during this period. Consequently, our study tested a mediation moderation model with Macro from SPSS in a sample of 635 teachers examining subjective well-being with the Pemberton Happiness Index, their emotions using the Positive and Negative Affect Schedule, their burnout with the Questionnaire for the Evaluation of Burnout Syndrome and their social support with the Social Support Questionnaire-Short Form. The study results suggest that the impact of burnout on teachers' well-being is mediated by negative and positive emotions. Additionally, this mediation was moderated by social support levels perceived by teachers. These results confirm the importance of providing additional support to teachers during the Pandemic. © 2022 Universidad de País Vasco

Providing Evidence for Dogma: Risk of Epistaxis After COVID-19 Nasal-Screening Swab.

OBJECTIVE: There is anecdotal evidence SARS-CoV-2 (COVID) RT-PCR screening nasal swabs confer an elevated epistaxis risk. We aimed to assess the association between epistaxis and exposure to a COVID nasal swab. STUDY DESIGN: A matched pairs design was used. SETTING: The study was performed in a single, integrated health care system. METHODS: All patients who received a single COVID nasal swab at our institution between April 2020 and March 2021 were included. McNemar's test was used to compare rates of epistaxis between the 7 days following the index COVID swab (hazard period), and the 7 days preceding the index COVID swab (control period). Conditional logistic regression was used to evaluate sociodemographic and clinical risk factors for epistaxis. RESULTS: A total of 827,987 participants were included, with 1047 epistaxis encounters. The prevalence of epistaxis during the hazard and control periods were 0.08% and 0.04%, respectively. Swab exposure was associated with 1.92-fold odds of epistaxis during the hazard period (95% confidence interval [1.73, 2.12]). Older age, Asian/Pacific Islander (PI) (compared to white), male sex, hypertension, prior facial trauma, and warfarin or direct-acting oral anticoagulant use were also associated with significantly increased odds of epistaxis (p ≦ 0.01). CONCLUSION: COVID nasal swabs are associated with increased odds of epistaxis. Physicians should counsel patients, particularly those at the highest risk, including a history of prior facial trauma, anticoagulants/antiplatelets, or hypertension.

Safety of the NVX-CoV2373 COVID-19 Vaccine in Randomized Placebo-Controlled Clinical Trials (preprint)

Background: NVX-CoV2373 (Nuvaxovid or the Novavax COVID-19 Vaccine, Adjuvanted), the first protein-based COVID-19 vaccine, received emergency use authorization (EUA) as a primary series/booster and is available globally. NVX-CoV2373 primary series demonstrated efficacy rates of 89.7-90.4 % and an acceptable safety profile. This article summarizes safety in adult recipients (aged [≥]18 years) of primary series NVX-CoV2373 in four randomized placebo-controlled trials. Methods: All participants who received NVX-CoV2373 primary series or placebo (pre-crossover) were included according to actual received treatment. The safety period was from Day 0 (first vaccination) to unblinding/receipt of EUA-approved/crossover vaccine, end of each study (EOS), or last visit date/cutoff date minus 14 days. The analysis reviewed local and systemic solicited adverse events (AEs) within 7 days after NVX-CoV2373 or placebo; unsolicited AEs from after Dose 1 to 28 days after Dose 2; serious AEs (SAEs), deaths, AEs of special interest, and vaccine-related medically attended AEs from Day 0 through end of follow-up (incidence rate per 100 person-years). Findings: Pooled data from 49,950 participants (NVX-CoV2373, n=30,058; placebo, n=19,892) were included. Solicited reactions after any dose were more frequent in NVX-CoV2373 recipients (local, 76%/systemic, 70%) than placebo recipients (29%/47%), and were mostly of mild-to-moderate severity. Grade 3+ reactions were infrequent, with greater frequency in NVX-CoV2373 recipients (6.28%/11.36%) than placebo recipients (0.48%/3.58%). SAEs and deaths occurred with similarly low frequency in NVX-CoV2373 (0.91% and 0.07%, respectively) and placebo recipients (1.0% and 0.06%). Interpretation: To date, NVX-CoV2373 has displayed an acceptable safety profile in healthy adults.

Implementation of a telerehabilitation program for children with neurodevelopmental disorders during the lockdown caused by COVID-19

Introduction: Telerehabilitation is a tool for patients who, for different reasons, cannot participate in person with their physical presence. We aimed to identify the factors associated with satisfaction with telerehabilitation in families with children with neurodevelopmental disorders through a program that included physiotherapy, occupational therapy, and speech therapy. Methods: The program was developed during the COVID-19 lockdown period. Outcome measures: Child's age, the school stage to which they belonged, the person of reference in their daily care at home. The resources provided to the families, as well as the frequency of activities and difficulties detected, were evaluated through a survey. Findings: One hundred thirteen families responded to the survey. The general assessment resources were classified as very good. The average frequency of carrying out the activities was two times a week, with an average of 30 minutes per session. The ability to understand the information in the manual was not affected by the academic status of the caregivers (p = 0.286). Conclusions: This is the first study to quantify the multidisciplinary approach to children with neurodevelopmental disorders using telerehabilitation. The results show high levels of participation and satisfaction. The resources could be shared for their applicability in other countries whose families have similar needs conditioned by COVID-19.

Optimization of the layout of meeting rooms, in the fight against COVID- 19, trough the web application sala planejada

Conscience, Responsibility and Solidarity, are important pillars to which large companies are guided in this scenario of combating the pandemic generated by COVID-19. In this paper, the application of optimization techniques is addressed though the Planned Room web application, motivated by the need for a safe return to work, respecting the social distancing criteria pointed out by the World Health Organization. The objective is to propose an optimized layout for the meeting rooms and other living spaces, maximizing the number of places available from the physical dimensions of the environments of the tables and chairs offered. The use of the Planned Room proved to be advantageous for generating an optimized plan with the coordinates foreseen for each chair and for guaranteeing the minimum distance necessary to avoid contagion among workers, which can be replicated to the other units of the company.

Teachers’ wellbeing, affects, and burnout during the pandemic in Chile

The COVID19 pandemic has had a dramatic impact upon teachers across the world. In Chile, the confinement also had a negative effect on teachers’ well-being. However, there are no studies assessing teachers’ mental health, affect, burnout, or social support during this period. Consequently, our study tested a mediation moderation model with Macro from SPSS in a sample of 635 teachers examining subjective well-being with the Pemberton Happiness Index, their emotions using the Positive and Negative Affect Schedule, their burnout with the Questionnaire for the Evaluation of Burnout Syndrome and their social support with the Social Support Questionnaire-Short Form. The study results suggest that the impact of burnout on teachers’ well-being is mediated by negative and positive emotions. Additionally, this mediation was moderated by social support levels perceived by teachers. These results confirm the importance of providing additional support to teachers during the Pandemic. © 2022 Universidad de País Vasco

Practical manual COVID-19 For the prevention, detection, control and surveillance of SARS-CoV-2 Strategy for hospitalized patients and health workers in a pediatric hospital

The aim of this COVID-19 Practical Manual for the prevention, detection, control and surveillance of SARS-CoV-2 is to standardize and regulate the best strategy for the prevention and control of SARS-CoV-2 infections. All of this to provide better care quality to patients and their families/caregivers, and to promote a safe working environment for health personnel within the institution. The manual has been prepared with the aim of guiding health personnel in decision-making for the prevention, detection, control and surveillance of SARS-CoV-2 infections. This document describes various multidisciplinary care algorithms in different scenarios, considering the recommendations for isolation, use of personal protective equipment, transfer within various services in the hospital, admission to procedures and recommendations for healthcare personnel. Copyright © 2022 Hospital Infantil de Mexico Federico Gomez. Publicado por Permanyer.

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.

Long-term commuting times and air quality relationship to COVID-19 in São Paulo.

The Coronavirus Disease 2019 (COVID-19) epidemic is an unprecedented global health crisis and the effects may be related to environmental and socio-economic factors. In São Paulo, Brazil, the first death occurred in March 2020 and since then the numbers have grown to 175 new deaths per day in April 2021, positioning the city as the epicenter of the number of cases and deaths in Brazil. São Paulo is one of the largest cities in the world with more than 12 million inhabitants, a fleet of about 8 million vehicles and frequent pollutant concentrations above recommended values. Social inequalities are evident in the municipality, similarly to other cities in the world. This paper focuses on transportation activities related to air pollution and associated with cardiovascular and respiratory diseases especially on people who developed comorbidities during their whole life. This study relates travel trip data to air quality analysis and expanded to COVID-19 disease. This work studied the relationship of deaths in São Paulo due to COVID-19 with demographic density, with family income, with the use of public transport and with atmospheric pollution for the period between March 17th, 2020 and April 29th, 2021. The main results showed that generally passenger kilometers traveled, commuting times and air quality related diseases increase with residential distance from the city center, and thus, with decreasing residential density. PM2.5 concentrations are positively correlated with COVID-19 deaths, regions with high urban densities have higher numbers of deaths and long-distance frequent trips can contribute to spread of the disease.

Case report of Curtobacterium isolated from a catheter tip sample misidentified as Cronobacter.

The Curtobacterium genus is a member of the family Microbacteriaceae, and Curtobacterium species are recognized as plant pathogens. The aim of this study was to investigate a dubious result of species identification for an infection located on a catheter tip of a patient with Covid-19. A strain isolated from a catheter tip sample, identified by VITEK® 2 as Cronobacter spp., was submitted to polyphasic analysis: Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) using VITEK® MS, real-time polymerase chain reaction targeting dnaG gene, and 16S rRNA full gene Sanger sequencing analysis for confirmation. The strain presented negative result using qPCR and could not identified by MALDI-TOF MS. 16S rRNA full gene Sanger sequencing analysis identified the strain as Curtobacterium spp. The Gram-variable characteristic (Gram-negative instead of Gram-positive) of the isolated strain was the responsible for the misidentification by VITEK® 2 and VITEK® MS did not identify the strain. 16S rRNA full gene sequencing analysis identified the strain as Curtobacterium genus, but other complementary techniques are necessary to identify at species level.

THE CHALLENGES OF THE COVID-19 PANDEMIC FOR TEACHING IN ELEMENTARY SCHOOLS IN PORTUGAL

This article, concerning a study still under development, seeks to understand the challenges currently facing teachers at elementary school, in Portugal, resulting from the world pandemic Covid-19. In this article, through documentary collection and analysis, the authors present and reflect on the main implications of the pandemic, for teachers, in the Portuguese educational system, with particular focus on the legislation produced for this purpose and on the measures adopted by the central administration in order to implement e-learning using digital technologies and its implications for students' learning, not forgetting the principles of inclusion, equity and equality in the education system.

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

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 and detected 106 SARS-CoV-2 positive samples, demonstrating SARS-CoV-2 can be detected in air collected from daily and weekly sampling intervals. 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 the community. In addition, we obtained SARS-CoV-2 genome sequences from air samples to identify variant lineages. Collectively, this shows air surveillance is a scalable, cost-effective, and high throughput alternative to individual testing for detecting respiratory pathogens in congregate settings.

Initial Evaluation of a Mobile SARS-CoV-2 RT-LAMP Testing Strategy.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) control in the United States remains hampered, in part, by testing limitations. We evaluated a simple, outdoor, mobile, colorimetric reverse-transcription loop-mediated isothermal amplification (RT-LAMP) assay workflow where self-collected saliva is tested for SARS-CoV-2 RNA. From July 16, 2020, to November 19, 2020, surveillance samples (n = 4704) were collected from volunteers and tested for SARS-CoV-2 at 5 sites. Twenty-one samples tested positive for SARS-CoV-2 by RT-LAMP; 12 were confirmed positive by subsequent quantitative reverse-transcription polymerase chain reaction (qRT-PCR) testing, whereas 8 tested negative for SARS-CoV-2 RNA, and 1 could not be confirmed because the donor did not consent to further molecular testing. We estimated the false-negative rate of the RT-LAMP assay only from July 16, 2020, to September 17, 2020 by pooling residual heat-inactivated saliva that was unambiguously negative by RT-LAMP into groups of 6 or fewer and testing for SARS-CoV-2 RNA by qRT-PCR. We observed a 98.8% concordance between the RT-LAMP and qRT-PCR assays, with only 5 of 421 RT-LAMP-negative pools (2493 total samples) testing positive in the more-sensitive qRT-PCR assay. Overall, we demonstrate a rapid testing method that can be implemented outside the traditional laboratory setting by individuals with basic molecular biology skills and that can effectively identify asymptomatic individuals who would not typically meet the criteria for symptom-based testing modalities.

Effects of the COVID-19 Pandemic on the Air Quality of the Metropolitan Region of São Paulo: Analysis Based on Satellite Data, Monitoring Stations and Records of Annual Average Daily Traffic Volumes on the Main Access Roads to the City

This paper presents an analysis of the effects of the COVID-19 pandemic on the air quality of the Metropolitan Region of São Paulo (MRSP). The effects of social distancing are still recent in the society;however, it was possible to observe patterns of environmental changes in places that had adhered transportation measures to combat the spread of the coronavirus. Thus, from the analysis of the traffic volumes made on some of the main access highways to the MRSP, as well as the monitoring of the levels of fine particulate matter (PM2.5), carbon monoxide (CO) and nitrogen dioxide (NO2), directly linked to atmospheric emissions from motor vehicles–which make up about 95% of air polluting agents in the region in different locations–we showed relationships between the improvement in air quality and the decrease in vehicles that access the MRSP. To improve the data analysis, therefore, the isolation index parameter was evaluated to provide daily information on the percentage of citizens in each municipality of the state that was effectively practicing social distancing. The intersection of these groups of data determined that the COVID-19 pandemic reduced the volume of vehicles on the highways by up to 50% of what it was in 2019, with the subsequent recovery of the traffic volume, even surpassing the values from the baseline year. Thus, the isolation index showed a decline of up to 20% between its implementation in March 2020 and December 2020. These data and the way they varied during 2020 allowed to observe an improvement of up to 50% in analyzed periods of the pollutants PM2.5, CO and NO2 in the MRSP. The main contribution of this study, alongside the synergistic use of data from different sources, was to perform traffic flow analysis separately for light and heavy duty vehicles (LDVs and HDVs). The relationships between traffic volume patterns and COVID-19 pollution were analyzed based on time series. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Six-Week Online Multi-component Positive Psychology Intervention Improves Subjective Wellbeing in Young Adults.

Improving mental wellbeing has a range of benefits for society, including increased productivity, longevity, and resiliency. However, interventions designed to improve mental wellbeing are often only compared to waitlist controls, leaving uncertainty regarding the mechanisms of their effectiveness. The current study in 326 participants assessed a six-week positive psychology intervention against an active control (n = 163) in an online randomized control trial. Outcome measures included life satisfaction, wellbeing (subjective and psychological wellbeing), stress, depression and anxiety symptoms, and self-compassion. The potential moderating effect of participating during the ongoing COVID-19 pandemic was also explored. The intervention group showed greater improvements in life satisfaction by week six (ß = 0.18, p = .014) and were maintained through to 7 weeks post-baseline (ß = 0.23, t = 3.07, p = .002) and remained significant when accounting for COVID-19 restrictions. An improvement in composite wellbeing from baseline to 7 weeks post-baseline was detected when accounting for COVID-19 restrictions. Composite wellbeing and total depression and anxiety symptoms improved significantly more in the intervention group for participants with low baseline resiliency resources. These findings support the efficacy of using online multi-component positive psychology interventions in boosting wellbeing and reducing distress symptoms particularly in individuals with fewer resiliency resources who may need added support. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10902-021-00449-3.