Nirsevimab binding-site conservation in respiratory syncytial virus fusion glycoprotein worldwide between 1956 and 2021: an analysis of observational study sequencing data

BACKGROUND: Nirsevimab is an extended half-life monoclonal antibody to the respiratory syncytial virus (RSV) fusion protein that has been developed to protect infants for an entire RSV season. Previous studies have shown that the nirsevimab binding site is highly conserved. However, investigations of the geotemporal evolution of potential escape variants in recent (ie, 2015-2021) RSV seasons have been minimal. Here, we examine prospective RSV surveillance data to assess the geotemporal prevalence of RSV A and B, and functionally characterise the effect of the nirsevimab binding-site substitutions identified between 2015 and 2021. METHOD(S): We assessed the geotemporal prevalence of RSV A and B and nirsevimab binding-site conservation between 2015 and 2021 from three prospective RSV molecular surveillance studies (the US-based OUTSMART-RSV, the global INFORM-RSV, and a pilot study in South Africa). Nirsevimab binding-site substitutions were assessed in an RSV microneutralisation susceptibility assay. We contextualised our findings by assessing fusion-protein sequence diversity from 1956 to 2021 relative to other respiratory-virus envelope glycoproteins using RSV fusion protein sequences published in NCBI GenBank. FINDINGS: We identified 5675 RSV A and RSV B fusion protein sequences (2875 RSV A and 2800 RSV B) from the three surveillance studies (2015-2021). Nearly all (25 [100%] of 25 positions of RSV A fusion proteins and 22 [88%] of 25 positions of RSV B fusion proteins) amino acids within the nirsevimab binding site remained highly conserved between 2015 and 2021. A highly prevalent (ie, >40.0% of all sequences) nirsevimab binding-site Ile206Met:Gln209Arg RSV B polymorphism arose between 2016 and 2021. Nirsevimab neutralised a diverse set of recombinant RSV viruses, including new variants containing binding-site substitutions. RSV B variants with reduced susceptibility to nirsevimab neutralisation were detected at low frequencies (ie, prevalence <1.0%) between 2015 and 2021. We used 3626 RSV fusion-protein sequences published in NCBI GenBank between 1956 and 2021 (2024 RSV and 1602 RSV B) to show that the RSV fusion protein had lower genetic diversity than influenza haemagglutinin and SARS-CoV-2 spike proteins. INTERPRETATION: The nirsevimab binding site was highly conserved between 1956 and 2021. Nirsevimab escape variants were rare and have not increased over time. FUNDING: AstraZeneca and Sanofi.Copyright © 2023 Elsevier Ltd. All rights reserved.

Choice architecture for tourist decision-making in the context of the covid-19 pandemic

As more information became available on the Covid-19 outbreak worldwide, some propositions aimed at containing its spread had their roots in the behavioral sciences. Given the need to change individual behaviors inherent to the type of transmission of the new coronavirus, it is believed that the theoretical framework on choice architecture and nudges presents itself as an important instrument to guide the debate. In this sense, this article aims to identify and categorize the measures taken by tourism companies for their reopening in the context of the Covid-19 pandemic. For this, a study of multiple cases is carried out with a hotel, an airport and an international tourist attraction, which had to undergo interventions in their physical structures and processes in order to start operating again. From the analysis, it was found that most of the nudges had techniques of information translation, visibility of external information, decrease of physical effort and provision of reminders. Techniques of social norms and increase of visibility of behavior were not as explored by the companies analyzed in this study. Finally, the work documents a holistic intervention strategy in tourist behavior, which combines nudges with financial incentives and harsher forms of paternalism.

Retail sales forecasting for a Brazilian supermarket chain: An empirical assessment

Time series forecasting is a consolidated, broadly used approach in several fields, such as finance and industry. Retail can also benefit from forecasting in many areas such as stock demand, price optimization, and sales. This study addresses retail sales forecasting in Nordestão, a large Brazilian supermarket chain that respectively ranks 3rd and 27th in sales regionally and nationally. The data considered spans five years of daily transactions from eight different stores. Knowingly effective machine learning techniques for forecasting are adopted, namely linear regression, random forests, and XGBoost. We further improve their performance with features we engineer to address seasonal effects. The best algorithm varies per store, but for most stores at least one of the methods proves effective. Importantly, the models display effective performance across multiple testing weeks, and improve over the current approach of Nordestão by a significant margin. Besides the traditional relevance of sales forecasting, our work is a means for Nordestão to evaluate the impact of the COVID-19 pandemics on sales. © 2022 IEEE.

Transforming physical enterprise into a remote organization Transformation impact: digital tools, processes and people

This paper aims to define a problem to be studied and summarize previous research work done. Remote work or telework enterprise model has been a growing trend. The Covid-19 pandemic forced businesses to adopt a temporary remote-working mode. Now managers are investigating whether this d"new" working-mode is, or not, a better approach than the traditional working mode known as the "office model". The proposed framework will support the transformation process from a physical into a remote work model supported by applying digital tools and methods. Furthermore, the framework proposed in this work aims to help business decision makers to decide which organizational model they should adopt after Covid-19: full-remote;"hybrid" or partially remote;or physical, also known as "going back to the office". A simple and pragmatic framework is proposed to help organizations: understand if it's possible to transform a business from a physical ("at the office") to a full or partial remote model;define the main goals of this transformation;create a simple template to map the new digital enterprise architecture in terms of tools, data management, business processes and human resources (job functions and digital skills).

Development of a Mechanical Ventilation Curriculum for Internal Medicine Residents

RATIONALE: Competency in mechanical ventilation (MV) is essential for clinicians caring for critically ill patients and requires complex knowledge and skills to achieve optimal clinical outcomes. Most programs lack a structured MV curriculum and trainees report perception of insufficient training. Our objective was to create a MV curriculum for internal medicine residents. METHODS: We developed a MV curriculum in an academic hospital in Brazil, offered as an extensive eight-month course. Educational design followed principles to increase retention, interactivity and effectiveness of learning: self-directed learning modules, clinical scenarios, simulation, and continuous assessment with feedback. The course was structured in eight monthly synchronous online meetings that included the use of an online simulator (Xlung, Brazil). Participants completed a pre-course survey that included demographics, prior MV training, and confidence on MV skills, using Likert scales. We assessed baseline knowledge with an online multiple choice questionnaire (MCQ) with 24 questions, scored on a normalized scale of 0 to 10, that will be repeated at the end of the program. The project was submitted to the ethics committee and all residents in the first (PGY1) and second (PGY2) enrolled in the program were invited to participate and provide informed consent. We report baseline data on knowledge and confidence in MV for all participants. RESULTS: We included 137 internal medicine residents in April 2021, amidst the COVID-19 pandemic. Median age was 26 years-old (IQR 25-27), and 77 (56%) were males. The majority of participants reported critical care training during medical school, with 61% in the form of lectures and 78% in rotations, but only 43% reported having managed a mechanical ventilator during medical school. Sufficient training in MV prior to entering this study was reported by 17,6% of PGY1 and 51% of PGY2 . The majority of residents reported not being confident in setting MV parameters in obstructive lung disease and identifying patient-ventilator asynchrony (Figure 1). The median baseline MCQ score was 6,7 (IQR 5,8-7,5) for PGY1 and 7,1 (IQR 6,2-8,3) for PGY2. CONCLUSION: We developed an extensive eight month course encompassing MV competencies for internal medicine residents, combining self-directed learning modules with synchronous online meetings that include simulation. We found that prior to the course, most residents report not having received enough training in MV to perform their activities, do not feel confident in MV competencies, and have low to moderate performance on a knowledge test.

Brazilian Guidelines for the pharmacological treatment of patients hospitalized with COVID-19

Objective: Several therapies are being used or proposed for COVID-19, and many lack appropriate evaluations of their effectiveness and safety. The purpose of this document is to develop recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil. Methods: A group of 27 experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method. Results: Sixteen recommendations were generated. They include strong recommendations for the use of corticosteroids in patients using supplemental oxygen, the use of anticoagulants at prophylactic doses to prevent thromboembolism and the nonuse of antibiotics in patients without suspected bacterial infection. It was not possible to make a recommendation regarding the use of tocilizumab in patients hospitalized with COVID-19 using oxygen due to uncertainties regarding the availability of and access to the drug. Strong recommendations against the use of hydroxychloroquine, convalescent plasma, colchicine, lopinavir + ritonavir and antibiotics in patients without suspected bacterial infection and also conditional recommendations against the use of casirivimab + imdevimab, ivermectin and rendesivir were made. Conclusion: To date, few therapies have proven effective in the treatment of hospitalized patients with COVID-19, and only corticosteroids and prophylaxis for thromboembolism are recommended. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and promote economical resource use. © 2022 Associacao de Medicina Intensiva Brasileira - AMIB. All rights reserved.

Handmade face mask can be sterilized without compromising their efficacy

Background and Objectives: COVID-19 caused by SARS-CoV-2 is transmitted by contact, droplets and aerosols. The World Health Organization recommends the mandatory use of surgical masks for health professionals and encourages countries to adhere to their use, en masse, in order to minimize the transmission of the virus. Since the lack of this personal protective equipment is a cause for concern, the objective of this study was to evaluate the characteristics of facial masks regarding (i) the mechanical properties of elongation, rupture stress and resistance to air passage and (ii) the morphometric properties of thickness, fiber diameter and pore distribution after autoclave sterilization. Methods: The masks were made in TNT Spunbonded (100% polypropylene, 60 g/m(2)), autoclaved at 70 degrees C for 5 minutes and stored in plastic films at room temperature. Then, the mechanical properties were determined in an Instron universal testing machine and Gurley type automatic densimeter and the morphometric properties in a semi-automatic thickness gauge and scanning electron microscope. Results: It was observed that a cycle of sterilization of facial masks, by moist heat under pressure, increased the blanket's stiffness, did not produce physical damage and did not reduce the blanket's barrier capacity. Conclusion: The sterilization of face masks made of TNT can be considered a strategy to increase safety in their production and use.

Trajectories of an English Language Teacher in Emergency Remote Teaching

The Covid-19 pandemic impacted several sectors of society, causing not only a health crisis, but also economic, political, and educational crisis, leading us to reflect on how everything is interconnected in some way. In this article, we aim to analyze, from the Complexity Theory, the practice of a teacher teaching the English language (EL) in a context of Emergency Remote Teaching (ERT). The methodology used is a qualitative approach, in which a longitudinal case study was carried out based on the narratives written by the teacher during 7 months of ERT. The results show that the teacher’s initial conditions were favorable for her practice in the ERT. It is not possible to generalize the conditions of this specific context, but based on this study, the teaching practices of EL and the importance of technology in teacher education stand out. © 2021, Universidade Federal de Minas Gerais, Faculdade de Letras. All rights reserved.

A Model to Manage Organizational Collaborative Networks in a Pandemic (Covid-19) Context

The pandemics situation has brought unforeseen challenges to all organizations at a global scale. While some strongly profit from it, others thrive to survive or already died. In such times the bulk of leadership and management related skills, gains a disproportional importance especially for organizations where most of their workforce strongly depends on remote collaboration. Being aware of the difficulties to manage collaboration within and between teams in “normal times”, the “still” ongoing situation has only brought more complexity to organizations in that aspect. In this work is proposed a model to manage organizational remote collaborative networks in order to identify collaboration extremes (lack of collaboration, or collaborative overload) which emerges as people work together in projects or operations, developed based in three pillars (collaborative networks, social network analysis, and business intelligence). A real case study is presented to illustrate the functioning principles of the model. © 2021, IFIP International Federation for Information Processing.

Clinical characteristics and in-hospital outcomes of patients coinfected with Chagas disease and SARS-CoV-2

Background: Underlying comorbidities have been widely associated with a worse prognosis for COVID-19 patients, since viral infections could act as triggers for worsening of chronic diseases. Although Chagas disease (CD) is endemic in Latin America, it has been recognized that the disease is now a worldwide concern. Information on the interplay between COVID-19 and CDis lacking. Purpose: To assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients. Methods: Patients with COVID-19 diagnosis were selected from the Brazilian COVID-19 Registry, a prospective multicenter cohort, from March to September, 2020. CD diagnosis was based on hospital record at the time of admission. Study data were collected by trained hospital staff using Research Electronic Data Capture (REDCap) tools. Genetic matching for sex, age, hypertension, DM and hospital was performed in a 4:1 ratio. Results: Of the 7,018 patients who had confirmed infection with SARSCoV- 2 in the registry, 31 patients with CD and 124 matched controls were included. Overall, the median age was 72 (64.-80) years-old and 44.5% were male. At baseline, heart failure (25.8% vs. 9.7%) and atrial fibrillation (29.0% vs. 5.6%) were more frequent in CD patients than in the controls (p<0.05 for both). C-reactive protein levels were lower in CD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). Seventy-two (46.5%) patients required admission to the intensive care unit. In-hospital management, outcomes and complications were similar between the groups (Table 1). Conclusions: In this large Brazilian COVID-19 Registry, CD patients had a higher prevalence of atrial fibrillation and chronic heart failure compared with non-CD controls, with no differences in-hospital outcomes. The lower C-reactive protein levels in CD patients require further investigation. (Figure Presented).

The geohistorical and epidemiological materiality of COVID-19: reflections and analyzes in the context of the Metropolitan Region of Belo Horizonte

The beginning of 2020 was marked by the emergence of COVID-19 in China, with its spreading around the world, which lead the World Health Organization to declare a pandemic. The disease, caused by the coronavirus, reached several countries like Italy, Spain and the United States of America. These countries had their health systems overloaded and collapsed in a few days due to the delay in actions to control the spread of contamination. In Brazil, it is estimated that the disease arrived in late February, spreading to the states in a short time. In this process, several actions regarding policies to combat COVID-19 were observed by different government entities. This meant differentiated approaches, instigating the analysis of the context of the Metropolitan Region of Belo Horizonte, as its integrating towns adopted divergent measures. While strong social isolation measures were determined in Belo Horizonte, in surrounding areas, including neighboring ones, there was a loosening of such measures on April 23, 2020. The analysis of the number of contaminated and dead people published by the Minas Gerais State Health Department allowed some inferences about the current situation of COVID-19 in the making it possible to make some comparisons of the pandemic between Belo Horizonte and the rest of the state of Minas Gerais and, also, between Brazil and the rest of the world.

The profusion of information systems to combat the Covid-19 pandemic: A systematic mapping of the state of the art and Brazilian challenges of technological production

With the arrival of COVID-19, the scientific community was mobilized, not only in researches in the biomedical field but also in searching for ways to support professionals working on the front lines of fighting the virus. In the context of information systems (IS), several systems were developed to contribute to this collective effort. In this study, we provide an overview of the profusion of systems designed to support the fight against COVID-19. To achieve this goal, a systematic mapping of the state of art was carried out in patent documents in 2020. The study compared the national technological production to the international scenario and listed the main challenges regarding technological production during COVID-19. © 2021 ACM.

Recommendations for childcare in the face of the new coronavirus

Objective: To identify in the national and international literature the recommendations for the care of children against the new coronavirus. Methods: An integrative review carried out in April 2020, in the Web of Science, CINAHL, BDENF, IBECS, LILACS, and MEDLINE databases. Recommendation articles published in 2020 were included. Clinical studies on other topics or populations were excluded. Results: The sample consisted of 10 articles, grouped into three categories of recommendations, which deal with the following: the care for children with cancer;the search for the reduction of biopsychosocial harms in confinement;and the possibilities for diagnosis and treatment. Conclusion: The highlighted recommendations are not exhausted, but represent a guide for family members/caregivers and health professionals in the face of the severe situation. For nursing, knowing the current recommendations on child care in the face of COVID-19 makes it possible to carry out actions to promote quality and safe childcare. © 2020, Universidade Federal do Parana. All rights reserved.

Recommendations for home care in COVID-19 pandemic period: joint recommendations - SBMFC home care working group and ABRASAD

One of the consequences of the covid-19 pandemic was the necessity to reorganize health systems. Home care (HC) may be an option to interrupt transmission;early identification and care of infected patients;possibilities of early discharge and continuity of care outside the hospital;and family members guidance. This article aims to present possibilities of care at home by the Primary Health Care (PHC) and HC teams and the necessary care that these teams must have when carrying out their work. It is necessary to keep people safe at home, avoid risk exposure, maintain surveillance and care for those who depend on HC, and teams must reorganize the work process to an effective home care. In PHC, remote care seems to be a viable alternative for health personal to monitor, guide and follow up patients, leaving home visits with the team for those cases indicated. AD in the suspicion or confirmation of COVID-19 is possible, as long as the team is trained, has all the necessary Personal Protection Equipment (PPE) and the compatible home environment. Continuity of care should be ensured for people with chronic diseases during the pandemic, making it possible to consider telemedicine tools and face-to-face care on a case-by-case basis. For patients who have been hospitalized and progressed satisfactorily, it is possible to assess the continuity of care at home by PHC and HC monitoring. Precautionary measures must be put in place for staff and patients, ensuring that all professionals are trained in the PPE uses, in addition to guidelines for preventing infectious agent's transmission at home. HC is essential for access to people with acute conditions, decompensation of chronic diseases, with the challenge of organizing the service using telehealth and HC in a rational way.