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Journalist Soledad O'Brien reflects on the past two years of the COVID-19 pandemic, the media's role in dispensing enough legitimate information, and lessons she learned about what's most important. © 2022 American Society on Aging. All rights reserved.
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Purpose: The purpose of this study is to contribute to the understanding of how micro and small firm owners/managers cope with an extreme event, as this has implications on how firms make decisions. The study considers self-efficacy and stakeholder theory as tools to gain more in-depth knowledge. Design/methodology/approach: The perspectives of owners/managers of 308 micro and small firms operating in the food, wine and hospitality industries in Italy, one of the most affected nations, were drawn through an online questionnaire. Findings: The importance of determination, passion, family support and a sense of responsibility towards internal and external stakeholders emerged as fundamental factors helping firms confront the crisis. Five theoretical dimensions that help explain how firm owners/managers make decisions to safeguard their firms during the COVID-19 crisis are identified. Three of these, “motivational”, “stepping up” and “firm-based”, are directly associated with tenets of self-efficacy theory, and two, “human-moral” and “entity-based”, with stakeholder theory. Further complementing this second contribution, a theoretical framework underlining conceptual and practical implications is proposed. Originality/value: The study delves into the challenges and survival of a key group of firms facing an extreme crisis. The identified dimensions provide useful conceptual depth and practical insights that, together, form part of a proposed framework. For instance, the “human-moral” dimension reflects upon aspects that have wider implications, notably, for firms' employees and the wider society. © 2022, Emerald Publishing Limited.
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Timely, accurate and clear communication is essential in crisis response. Given the multilingual and multicultural nature of many parts of today's populated world, it should be evident that translation is key to enabling crisis communication. Although receiving little attention previously, the COVID-19 pandemic has highlighted the important role of translation in responding to crises. Nevertheless, how prepared are jurisdictions for crisis translation? One way of measuring this is to use a maturity model assessment. In this article, we apply the Organisational Maturity for Disaster Preparedness (OMDP) model Mohamed & Qu (2018) to the Republic of Ireland, assessing the level of response through documentary and interview-based evidence. All considered, we place the response between June and November 2020 at Level 2 on the OMDP. Recommendations for moving up in the maturity model are provided and could be applied to many more jurisdictions.
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Background: SARS-CoV-2 is responsible for the respiratory illness, coronavirus infection disease 2019 (COVID-19). Case reporting may underestimate infection in a population because some infections will not cause illness, others may not be severe enough for people to seek testing and testing may be disproportionately directed to outbreaks. Therefore, seroprevalence studies that monitor SARS-CoV-2 antibodies bridge the gap left from case detection and vaccination records, are important to understand what proportion of the population have detectable antibodies (the seroprevalence), and to monitor trajectories over the course of the pandemic. Aims: Using residual blood from healthy Canadian Blood Services blood donors, the aim of this study was to evaluate Canada-wide SARS-CoV-2 seroprevalence of the spike and nucleocapsid antibodies over vaccine deployment. Methods: Between January and November 2021 serial cross-sectional samples from blood donors at all Canadian Blood Services locations were included. The Roche Elecsys anti-SARS-CoV-2 antibody assays detect total antibodies to spike (S) and nucleocapsid (N) proteins. Anti-S was analysed neat and 1:10 dilution from January until August;from September onward, the dilution changed to 1:400. Seroprevalence was standardized to population-level demographics and assay characteristics adjusted using the Rogan-Gladen equation. Results: Of 149,522 samples, the percentage anti-S positive increased from 2.78% (95%CI 2.6, 3.0) to 97.0% (95%CI 96.6, 97.4) and anti-N from 2.24% (95%CI 2.2, 2.4) to 5.1% (95%CI 4.6, 5.5). The percentage anti-N positive peaked highest in Alberta (9.3%;95% CI 7.7, 10.8) and the Prairies (8.6%;95% CI 6.6, 10.6);lowest in Atlantic region (1.0%;95% CI 0.2, 1.8);was higher in 17-24-year old's (8.1%;95% CI 7.2, 9.0) and racialized donors (8.9%;95% CI 7.5, 10.4). The percentage anti-S positive increased in donors over 60 first;all peaked by July. Beginning in September, the median anti-S concentration (IQ range) was: September 3652 U/ml (2041,6245);October 2807 U/ml (1616,4855);November 2460 U/ml (1253,4388). In a linear regression model of September to November data, with anti-S concentrations as the dependent variable, there was a negative slope with older age group and later month (p < 0.001). Summary/Conclusions: SARS-CoV-2 seroprevalence due to natural infection was below or around 5% from January to November 2021, but cumulative seroprevalence was likely higher as waning antibody was not considered. Anti-S seroprevalence was largely due to vaccination. The early increase in older donors is consistent with vaccine roll-out policies prioritized by age. Lower anti-S concentrations in older individuals are likely related to waning antibody with longer time since their second vaccine dose;a muted response with older age has not been ruled out. Ongoing monitoring of seroprevalence continues to be important for public health policies including potential third dose of vaccine.
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Background: All donations at Canadian Blood Services (CBS) are screened for syphilis using a serology screening and confirmation test algorithm. Currently, syphilis repeat-reactive (RR) results lead to the indefinite deferral of CBS donors regardless of supplementary test results. We have previously described a temporal association of RR results with seasonal public health influenza vaccination campaigns that generally start in September and continue through winter. As of December 2020, there has also been an intensive COVID-19 public health vaccination campaign in Canada. Aims: To track temporal associations between RR, unconfirmed syphilis results among CBS blood donors and Canadian influenza and COVID-19 vaccination campaigns. Methods: All donations were tested on the PK 7300 instrument (Beckman Coulter;Brea, CA, USA) with the PK TP system test kit. Confirmatory laboratory testing was undertaken at reference laboratories using the Treponema pallidum particle agglutination (TP-PA) test. Syphilis RR results that did not confirm were obtained for CBS donations between September 2017 to January 2022. Data on donor influenza and COVID-19 vaccination histories, within 3 months of donation, were extracted. The temporal periodicity of unconfirmed syphilis RR results was graphed against vaccination data. Respiratory virus data were acquired from the Public Health Agency of Canada Respiratory Virus Detection Surveillance System. Results: Periodicity of RR, unconfirmed syphilis rates: September 2017-January 2022. Summary/Conclusions: We have previously noted a cyclical temporal trend in the number of RR, unconfirmed syphilis specimens with peaks corresponding to influenza vaccine campaigns or widespread community circulation of respiratory viruses. Although insufficient to establish a causal association, this analysis suggests that incidence of RR, unconfirmed syphilis results in Canadian blood donors may be variably influenced at different times of year by one or more of at least three factors: (1) influenza vaccination campaigns, (2) the COVID-19 vaccination campaign, and (3) circulation of respiratory viruses in the presence or absence of circulating seasonal influenza. Moreover, other mechanisms may affect these trends. For example, syphilis assays such as the PK TP test kit that detect IgM may be prone to false positive results that do not confirm either after influenza vaccine, COVID- 19 vaccination or during a respiratory virus season. (Table Presented).
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Covid-19 highlighted shortcomings in the ability of critical infrastructure organisations to manage and operate their systems and assets. While the possibility of a pandemic was not unknown, management protocols fell short of preparing for this 'tail-risk' scenario. This paper assesses organisational response to the global pandemic and what this reveals in terms of: (a) attitudes towards risks that do not typically manifest as operational priorities to address and (b) the implications for organisational resilience. Covid-19 impact management strategies developed by critical infrastructure organisations and their potential implications on wider risks and management capabilities are reviewed. The complex and evolving nature of critical infrastructure system management is demonstrated through examples of risk interconnectivity and resource scarcity. For example, the pandemic did not directly impact physical infrastructure, yet cascading issues are revealed that relate to the forced delay of planned asset maintenance and the impacts of supply chain disruptions. This paper demonstrates the need for holistic, multi-hazard management approaches in critical infrastructure organisations to ensure a level of operational resilience that is required for the 21(st) Century. This paper also views critical infrastructure organisations as sociotechnical entities and highlights how building a resilience-oriented working culture can support effective risk planning and investment decisions.
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Background: Currently, asymptomatic patients with CLL/SLL are observed without treatment until development of symptoms or cytopenias. Historically, early intervention studies in patients with CLL/SLL with non-specific chemoimmunotherapy agents have not resulted in an overall survival (OS) benefit and have resulted in toxicity. The introduction of targeted therapies, such as venetoclax (an oral BCL2 inhibitor;V) and obinutuzumab (an intravenous anti-CD20 monoclonal antibody;O), have provided tolerable/efficacious options for patients with CLL. In the CLL14 study, symptomatic patients with CLL receiving frontline therapy with VO had longer progression-free survival (PFS) and deeper remissions [more undetectable minimal residual disease (uMRD)] compared with those receiving chlorambucil and O (Fischer 2019). The CLL-International Prognostic Index (CLL-IPI;Table 1) is a validated prognostic model to predict which patients are at highest risk of a shorter time to first therapy and shorter OS. A score of ≥4 is considered high-risk on this scale. We aim to use VO as early intervention in asymptomatic, high-risk CLL patients, assessed by CLL-IPI, to potentially improve OS and thus alter the natural history of the disease. Methods: On 12/14/20, we activated the S1925 study (NCT#04269902 ) for adult patients with CLL or SLL, who were diagnosed within 12 months of enrollment. Eligible patients have a CLL-IPI score ≥4 (Table 1) or complex cytogenetics (≥3 cytogenetic abnormalities) and do not meet any criteria for initiation of treatment by the International Working Group for CLL (IWCLL;Hallek 2018) guidelines. Enrolled patients are randomized in a 2:1 manner to early versus delayed (at the time IWCLL indication for treatment is met) therapy with VO (Figure 1). VO is administered as previously described (Fischer 2019). The primary endpoint is OS. We hypothesize that early intervention with VO will improve the rate of 6-year OS from 60% to 80%. This design requires 222 eligible patients for 88% power (2-sided a=0.05) for the primary comparison. To allow for 10% ineligibility, we will enroll 247 patients. Estimated accrual time is 4 years. Secondary endpoints include: rates of response, PFS, and relapse-free survival;safety;time to second CLL-directed therapy;and quality of life (assessed by FACT-Leukemia). As COVID19 is an infection with particularly high morbidity and mortality in patients with CLL, incidence of this infection and complications including death will be recorded and compared between patients followed on the early versus delayed intervention arms. The primary translational objective is to evaluate the prognostic association between OS and peripheral blood MRD status at 15 months after treatment initiation by flow cytometry. Secondary translational objectives include describing the association of other clinical outcomes, baseline prognostic factors, and IWCLL-defined response with MRD status at multiple timepoints. Current Status: At the time of submission, 7 patients have been registered and randomized per protocol. Accrual is ongoing. [Formula presented] Disclosures: Stephens: Adaptive: Membership on an entity's Board of Directors or advisory committees;TG Therapeutics: Membership on an entity's Board of Directors or advisory committees;Epizyme: Membership on an entity's Board of Directors or advisory committees;Beigene: Membership on an entity's Board of Directors or advisory committees;Innate Pharma: Membership on an entity's Board of Directors or advisory committees;AstraZeneca: Consultancy;CSL Behring: Consultancy;Celgene: Consultancy;Novartis: Research Funding;Abbvie: Consultancy;JUNO: Research Funding;Arqule: Research Funding;Mingsight: Research Funding;Karyopharm: Membership on an entity's Board of Directors or advisory committees, Research Funding. Moseley: BioSight Ltd: Consultancy. Hill: AbbVie: Consultancy, Honoraria, Research Funding;Gentenech: Consultancy, Honoraria, Research Funding;Beigene: Consultancy, Honoraria, Research Funding;Pfizer: Consultancy, Honoraria;Kite, Gilead Company: Consultancy, Honoraria, Other: Travel Support, Research Funding;Karyopharm: Consultancy, Honoraria, Research Funding;AstraZenica: Consultancy, Honoraria;Celgene (BMS): Consultancy, Honoraria, Research Funding;Novartis: Consultancy, Honoraria, Research Funding;Epizyme: Consultancy, Honoraria;Incyte/Morphysis: Consultancy, Honoraria, Research Funding. Pagel: Pharmacyclics/AbbVie: Consultancy;Actinium Pharmaceuticals: Consultancy;Incyte/MorphoSys: Consultancy;BeiGene: Consultancy;Epizyme: Consultancy;Kite, a Gilead Company: Consultancy;AstraZeneca: Consultancy;Gilead: Consultancy;MEI Pharma: Consultancy. Shadman: Mustang Bio, Celgene, Bristol Myers Squibb, Pharmacyclics, Gilead, Genentech, Abbvie, TG Therapeutics, Beigene, AstraZeneca, Sunesis, Atara Biotherapeutics, GenMab: Research Funding;Abbvie, Genentech, AstraZeneca, Sound Biologics, Pharmacyclics, Beigene, Bristol Myers Squibb, Morphosys, TG Therapeutics, Innate Pharma, Kite Pharma, Adaptive Biotechnologies, Epizyme, Eli Lilly, Adaptimmune, Mustang Bio and Atara Biotherapeutics: Consultancy. Danilov: Genentech: Consultancy, Honoraria, Research Funding;Takeda Oncology: Research Funding;TG Therapeutics: Consultancy, Research Funding;Abbvie: Consultancy, Honoraria;Beigene: Consultancy, Honoraria;Pharmacyclics: Consultancy, Honoraria;Gilead Sciences: Research Funding;Bristol-Meyers-Squibb: Honoraria, Research Funding;Rigel Pharm: Honoraria;Bayer Oncology: Consultancy, Honoraria, Research Funding;SecuraBio: Research Funding;Astra Zeneca: Consultancy, Honoraria, Research Funding. Mato: Pharmacyclics LLC, an AbbVie Company: Consultancy, Research Funding;DTRM BioPharma: Consultancy, Research Funding;Acerta/AstraZeneca: Consultancy, Research Funding;Sunesis: Consultancy, Research Funding;BeiGene: Consultancy, Research Funding;Johnson and Johnson: Consultancy, Research Funding;Genentech: Consultancy, Research Funding;AbbVie: Consultancy, Research Funding;Nurix: Research Funding;Genmab: Research Funding;LOXO: Consultancy, Research Funding;Janssen: Consultancy, Research Funding;AstraZeneca: Consultancy;Adaptive Biotechnologies: Consultancy, Research Funding;MSKCC: Current Employment;TG Therapeutics: Consultancy, Other: DSMB, Research Funding. Brander: Juno Therapeutics/Celgene/Bristol Myers Squibb: Research Funding;Pfizer: Consultancy, Other: Biosimilars outcomes research panel;TG Therapeutics: Consultancy, Research Funding;Novartis: Research Funding;ArQule/Merck: Consultancy;Verastem: Consultancy;BeiGene: Research Funding;ArQule: Research Funding;NCCN: Other: panel member;AstraZeneca: Research Funding;Pharmacyclics LLC, an AbbVie Company: Consultancy, Research Funding;LOXO: Research Funding;Ascentage: Research Funding;Genentech: Consultancy, Research Funding;DTRM: Research Funding;MEI Pharma: Research Funding;AbbVie: Consultancy, Other: informCLL registry steering committee, Research Funding. Coutre: Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding;Pharmacyclics: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding;AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;AstraZeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees;Beigene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Data Safety Monitoring Committee, Research Funding;Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees;Acerta: Other: Data Safety Monitoring Committee, Research Funding. O'Brien: Kite, Regeneron, Acerta, Caribou, Gilead, Pharmacyclics, TG Therapeutics, Pfizer, Sunesis: Research Funding;Amgen, Astellas, Celgene, GlaxoSmithKline, Janssen Oncology, Aptose Biosciences Inc., Vaniam Group LLC, AbbVie, Alexion, Verastem, Juno Therapeutics, Vida Ventures, Autolus, Johnson and Johnson, Merck, Bristol Myers Squibb, NOVA Research Company, El Lill: Consultancy. Erba: AbbVie Inc;Agios Pharmaceuticals Inc;Bristol Myers Squibb;Celgene, a Bristol Myers Squibb company;Incyte Corporation;Jazz Pharmaceuticals Inc;Novartis: Speakers Bureau;AbbVie Inc: Other: Independent review committee;AbbVie Inc;Agios Pharmaceuticals Inc;ALX Oncology;Amgen Inc;Daiichi Sankyo Inc;FORMA Therapeutics;Forty Seven Inc;Gilead Sciences Inc;GlycoMimetics Inc;ImmunoGen Inc;Jazz Pharmaceuticals Inc;MacroGenics Inc;Novartis;PTC Therapeutics: Research Funding;AbbVie Inc;Agios Pharmaceuticals Inc;Astellas;Bristol Myers Squibb;Celgene, a Bristol Myers Squibb company;Daiichi Sankyo Inc;Genentech, a member of the Roche Group;GlycoMimetics Inc;Incyte Corporation;Jazz Pharmaceuticals Inc;Kura Oncology;Nov: Other: Advisory Committee. OffLabel Disclosure: The trial studies early intervention with venetoclax and obinutuzumab in patients with CLL/SLL who are asymptomatic and observation would be standardly recommended.
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Introduction: The coronavirus disease 2019 (COVID-19) pandemic is disrupting health services worldwide. Women's health care is often acute and in continual demand, with poor health outcomes seen in women's health in particular in the recent Ebola and Swine flu epidemics. Regrettably, early reports globally and in the UK have shown a rise in the stillbirth rate. We aimed to evaluate the provision of obstetrics and gynaecology services in the UK during the acute phase of the COVID-19 pandemic. Methods: We undertook an interview-based national survey of junior doctors in obstetrics and gynaecology in women's healthcare units in the National Health Service using the network of the UK Audit and Research Collaborative in Obstetrics and Gynaecology. We sought responses on general training, labour ward care, antenatal and postnatal care, benign gynaecology and gynaecology oncology services. Results: We received responses from 148/155 units (95%) contacted. Most completed specific training drills for managing obstetric and gynaecological emergencies (89/148, 60.1%) and two-person donning and doffing of personal protective Equipment (PPE) (96/148, 64.9%). The majority of surveyed units implemented COVID-19-specific protocols (130/148, 87.8%), offered adequate PPE (135/148, 91.2%) and operated dedicated COVID-19 emergency theatres (105/148,70.8%). Most units suspended elective gynaecology services (131/148, 88.5%). The 2-week referral pathway for oncological gynaecology was not affected in half of the units (76/148,51.4%), but half reported a planned reduction in oncology surgery (82/148, 55.4%) Discussion: Women's health care services have responded well to the acute phase of the COVID-19 pandemic, however further planning is required for the long term.
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Background/Case Studies: Multiple assays to detect SARS-COV-2 antibodies are available but no gold standard exists. Due to many factors including waning antibodies and differences in test designs, discordance between SARS-CoV-2 serology assays is common. Given these limitations we used multiple assays and methodological approaches to estimate SARS-COV-2 seroprevalence during the first COVID-19 wave in Canada. Study Design/Methods: This serial cross-sectional study was conducted using residual plasma from healthy blood donors between April-September 2020. Qualitative (Table Presented) assessment of SARS-CoV-2 IgG antibodies was based on four assays: Abbott Architect SARS-Cov-2 IgG assay (target nucleocapsid) (Abbott-NP) and three in-house IgG ELISA assays (target spike glycoprotein (Spike), spike receptor binding domain (RBD), and nucleocapsid (NP)) based on thresholds set by the manufacture or 3-standarddeviations from the negative mean. We compared seroprevalence rates by multiple composite reference standards (CRS) and by a series of Bayesian Latent Class Models (BLCM) (using uninformative, weakly and informative priors). Using the BLCM we estimated assay characteristics, bimonthly to evaluate changes over time. Results/Findings: In total, 8999 blood samples were tested. The Abbott-NP assay consistently estimated seroprevalence to be lower than the ELISA-based assays. A priori, choosing a combination of 2 assays resulted in a range of seroprevalence estimates that ranged from 0.2% to 0.5% in April to 0.4% to 1.5% in September. From 16 possible diagnostic phenotypes, 13 were observed, only 33 samples (0.4%) were positive by all four assays. BLCM with non-informative priors provided the best model fit and predicted seroprevalence increased from 0.7% (95% CrI;0.6, 0.8%) in April/May to 1.0% (0.8, 1.1%) in June/ July to 1.5% (1.3, 1.8) in August/September. Assay characteristics varied considerably over time. Overall RBD had the highest sensitivity 82.2% (69.3, 92.9%) with a specificity of 99.6% (99.4, 99.7%). In contrast the sensitivity of the Abbott-NP assay was the lowest and waned from 63.2% (41.4, 83.1%) in April/May to 33.9% (19.7, 53.1%) by August/September. Conclusions: Regardless of the analytical method we found at the end of the first COVID-19 wave, SARSCoV- 2 seroprevalence among a healthy population of blood donors was low (<2%). While the sensitivity of all assays waned, the rates did vary. We found significant limitations to using a single assay to estimate SARSCoV- 2 seroprevalence in a low prevalence setting, such as healthy Canadian blood donors during the first wave of the COVID-19 pandemic.
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Background/Case Studies: The COVID-19 pandemic resulted in disruption in blood drive planning, changes in donor room procedures, and fluctuations of hospital demand, making it difficult for blood centers to maintain the adequacy of the blood supply. Failing the hemoglobin (Hb) screen constitutes our single biggest deferral category, and changes do not impact the safety of blood components and are relatively easy to implement operationally. Furthermore, eligibility cannot be assessed before arrival on the donation site. We therefore temporarily lowered minimum Hb levels from 130 to 125 g/L for males and 125 to 120 g/L for females, in July 2020, when a shortage appeared possible;this was reversed after 4 months, in Nov 2020 when inventory and drive planning stabilized. We evaluated the impact of these changes on Hb deferral rates and blood availability. Study Design/Methods: Female and male Hb monthly deferral rates were followed in our operational data base. Deferrals for July 1-Oct 31,2020, inclusively, were compared with rates in the 4 months preceding and 4 months following the criteria change, as well as the same time period, (July 1 to Oct 31) in 2019. Results/Findings: Hb deferral rates decreased to 1.7%, compared to 3.4% in the same time period in 2019, resulting in a gain of approximately 1,200 units/month (see Table 1). There were 2 complaints from male donors, who felt unwell post-donation, saw their physicians, and were found to be anemic. Conclusions: A temporary decrease in donor Hb criteria had a significant positive impact on inventory. The decrease in deferrals is particularly large in female donors, since so many have a Hb slightly below the 125 g/L cut-off. Although many of these donors have low iron stores, a point of care ferritin test available at the donation site would be useful to determine how many have adequate iron stores and could safely donate. We are following return rates and Hb deferrals in these donors accepted with the lower Hb thresholds. (Table Presented).
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Background/Case Studies: Several commercial and laboratory-developed approaches are available to quantify the level of antibodies to the spike glycoprotein of SARSCoV- 2. Plaque reduction neutralization test (PRNT)50 titers can also be used to quantify the neutralizing capacity of anti- SARS-CoV-2 antibodies in plasma. Here we describe the ability of the Elecsys anti-SARS-CoV-2 S assay (Roche, Mississauga, ON, Canada) to quantitatively determine the level of total antibodies to SARS-CoV-2 spike glycoprotein receptor binding domain in plasma specimens previously assessed by PRNT50 as well as the GenScript SARS-CoV-2 Surrogate Virus Neutralization Test (sVNT) Kit (Piscataway, NJ). Study Design/Methods: Plasma specimens were collected from blood donors that self-identified with a COVID-19 diagnosis (either SARS-CoV-2-positive nucleic acid test [NAT], or risk factors and signs/symptoms of COVID-19 disease, ≥2 weeks after cessation of clinical symptoms). 18 specimens that were previously tested by both the sVNT assay as well as by PRNT50 (National Microbiology Laboratory, Winnipeg, MB, Canada) were included in this analysis. 40 plasma specimens collected prior to November 2019 were also included in the analysis as a negative control. Specimens were analyzed using the Elecsys anti-SARS-CoV-2 S assay on the Cobas e801 analyzer (Roche, Mississauga, ON, Canada). If individual specimens were analyzed multiple times during a run, the median result in Units/ml was calculated. If specimens were further analyzed between runs, then the median between runs was calculated as the result in Units/ml. Data was stored (Microsoft Excel;Redmond, WA) and statistically analyzed (GraphPad Prism 5;San Diego, CA). Results/Findings: Of the 40 pre-pandemic specimens analyzed, all were negative for anti-SARS-CoV-2 S antibodies (<0.8 U/ml) on the Elecsys anti-SARS-CoV-2 S assay. These specimens were not orthogonally tested by other assays. Results from the other specimens tested were: Elecsys anti-SARS-CoV-2 S assay (median 63 U/ml;range 1-456 U/ml), PRNT50 (median 1:60;range 0-1:640), sVNT (median 62% neutralizing capacity;range 16-87% neutralizing capacity), PRNT50 (median 1:80;range 0-1:640). There was no correlation between the Elecsys anti-SARS-CoV-2 S assay and sVNT assays (Spearman r=0.4, p=0.1, Gaussian approximation). There was a correlation between the Elecsys anti-SARS-CoV-2 S assay and PRNT50 (Spearman r=0.8, p<0.0001, Gaussian approximation). Conclusions: This preliminary data suggests that the Elecsys anti-SARS-CoV-2 S assay may be able to act as a proxy for the quantification of neutralizing capacity in plasma specimens from individuals who have been previously infected with SARS-CoV-2.
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Objective: We measured transmembrane pressure gradient (ΔP) and membrane lung resistance (RML) in Covid-19 patients supported by ECMO when unfractionated heparin (UFH) was administered systemically via a central venous catheter or administered immediately before the membrane lung. Methods: Daily changes in ΔP and RML were recorded during ECMO support (Cardiohelp, Getinge, Germany) in 2 patients where UFH was administered systemically (Sys UFH) and in 2 additional patients where UFH was administered pre-membrane lung (pre-ML UFH). The ECMO cannulation strategy was similar in all patients (bi-femoral cannulation with 25F multistage drainage and 21F return cannulae). Results: There was no difference in the daily APTT and CRP between the two groups (Table 1). The ECMO circuit was changed on day 6 and 7 in Sys UFH patients because of increased ΔP and RML. In pre- ML UFH patients, ΔP and RML remained stable with an unchanged ECMO circuit for 26 and 32 days respectively (Figure 1+2). Conclusions: Although many Covid-19 related factors increase the risk of thrombosis, the pre-ML administration of UFH may contribute to prolonged circuit function.
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Introduction: During the COVID-19 pandemic, surgical service and practice has been adjusted in order to reduce acute surgical admissions. Acute appendicitis accounts for a significant proportion surgical admissions in the UK. Intercollegiate general surgery guidance during the COVID-19 pandemic advised appendicitis should be managed conservatively, or with an open appendicectomy if indicated. Our aim was to determine the efficacy and safety of our ambulation service in the conservative management of acute uncomplicated appendicitis. Method: Data was collected prospectively from 30th March 2020 - 16th August 2020 on all patients presenting with suspected appendicitis. Stable patients with clinically suspected or CT-proven appendicitis were discharged with oral antibiotics as per trust guidance. Readmissions for ambulated patients were recorded. Results: 190 patients presented with suspected appendicitis (range 5- 71years). 49.4% patients were deemed suitable for ambulation on initial assessment, 22% of which had a CT confirmed diagnosis on discharge. 65% of the ambulated patients underwent a telephone review within a 72-hour window. 13.8% of patients represented within a 30-day period, 7.4% of which proceeded to appendicectomy. Conclusions: Patients with uncomplicated appendicitis can be safely managed with antibiotics out of hospital, with low representation rates.
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The bioethanol industry continues improving sustainability, specifically focused on plant energy and GHG emission management. Dried distiller grains with solubles (DDGS) is a byproduct of ethanol fermentation and is used for animal feed. DDGS is a relatively low-value bulk product that decays, causes odor, and is challenging to manage. The aim of this research was to find an alternative, value-added-type concept for DDGS utilization. Specifically, we aimed to explore the techno-economic feasibility of torrefaction, i.e., a thermochemical treatment of DDGS requiring low energy input, less sophisticated equipment, and resulting in fuel-quality biochar. Therefore, we developed a research model that addresses both bioethanol production sustainability and profitability due to synergy with the torrefaction of DDGS and using produced biochar as marketable fuel for the plant. Our experiments showed that DDGS-based biochar (CSF-carbonized solid fuel) lower calorific value may reach up to 27 MJ.kg<sup>-1</sup> d.m. (dry matter) Specific research questions addressed were: What monetary profits and operational cost reductions could be expected from valorizing DDGS as a source of marketable biorenewable energy, which may be used for bioethanol production plant's demand? What environmental and financial benefits could be expected from valorizing DDGS to biochar and its reuse for natural gas substitution? Modeling indicated that the valorized CSF could be produced and used as a source of energy for the bioethanol production plant. The use of heat generated from CSF incineration supplies the entire heat demand of the torrefaction unit and the heat demand of bioethanol production (15-30% of the mass of CSF and depending on the lower heating value (LHV) of the CSF produced). The excess of 70-85% of the CSF produced has the potential to be marketed for energetic, agricultural, and other applications. Preliminary results show the relationship between the reduction of the environmental footprint (~24% reduction in CO2 emissions) with the introduction of comprehensive on-site valorization of DDGS. The application of DDGS torrefaction and CSF recycling may be a source of the new, more valuable revenues and bring new perspectives to the bioethanol industry to be more sustainable and profitable, including during the COVID-19 pandemic and other shocks to market conditions.