ABSTRACT
Throughout life, humans experience repeated exposure to viral antigens through infection and vaccination, building diverse antigen-specific antibody repertoires. In recent years, these repertoires have become an important source for novel antibody-based antiviral therapeutics, yet there is still limited understanding of the determinants of antibody-antigen specificity. Here, we generated a large dataset mapping antibody sequence to antigen specificity for thousands of B cells, by screening the repertoires of a set of healthy individuals against twenty viral antigens representing diverse pathogens of biomedical significance. Analysis revealed antigen-specific patterns in variable gene usage, gene pairing, and somatic hypermutation, as well as the presence of convergent antiviral signatures across multiple individuals. These results help define the characteristics of human antibody repertoires simultaneously against an unprecedented number and diversity of viral targets. Understanding the fundamental rules of antibody-antigen interactions can lead to transformative new approaches for the development of antibody therapeutics and vaccines against current and emerging viruses.
ABSTRACT
Rationale: To reduce transmission of SARS-CoV-2, non-pharmaceutical interventions (NPIs), including school closures, hand hygiene, mask mandates, and social distancing, were enforced in Arkansas from 3/2020-2/2021. We hypothesized that the presence of NPIs would correlate with a decrease in asthma exacerbations and viral infections. Methods: Demographic information was collected on subjects with asthma exacerbations or viral infections from 3/2018-5/2022, including age, race, ethnicity, and sex. To evaluate the effects of NPIs, three periods were considered: pre- (03/2018-02/2020), during (03/2020-02/2021), and post- (03/2021-05/2022) NPIs. ANOVA analysis and generalized linear models were performed to determine statistical significance. The stringency of NPIs was evaluated using publicly available data (Oxford Covid-19 Government Response Tracker), which allows for direct comparison of Arkansas NPI status to exacerbation data during the same time periods. Results: 5055 asthma exacerbations (3322 unique subjects) occurred between 3/2018-5/2022. Asthma exacerbations decreased from 3/2020-3/2021 and returned to pre-pandemic numbers by summer 2021 (p<0.0001). Similar downward trends occurred for respiratory syncytial virus (RSV) with out-of-season return in summer 2021 (p<0.0001). Rhinovirus was present throughout NPIs. The mean age of exacerbations decreased by 0.9 years when comparing the during NPIs and after NPIs periods (p = 0.0002). An increase in the proportion of exacerbations was noted for non-black and other/unknown ethnicity subjects during and after NPIs. Conclusions: Fewer asthma exacerbations occurred during the most significant NPI employment period (03/2020-02/2021), and an increase in exacerbations was seen as mitigation strategies were relaxed, which correlated with timing of increasing RSV infections.
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COVID-19 amplified system burdens and health risks within the housing care continuum, in which older adults with chronic serious illness are disproportionately represented. We present retrospective chart review data about the health experiences of older adults with serious illness living in and moving through temporary avoidance hotels during the COVID-19 pandemic. Through narratives of fourteen residents, we illustrate trends across two nine-month phases. Trends illustrate how avoidance hotels created opportunities for continuity of care, connection to services, and health-affirming relationships with place. We also identified challenges in catering to diverse medical, behavioral, and psychosocial-spiritual needs of older and seriously ill residents, as well as negative consequences to the geographic dispersion caused by de-congregating homeless shelters. Avoidance hotels present important lessons in considering future housing and healthcare intervention and implementation for older people facing homelessness while seriously ill.
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This chapter explores care in Black rural education through the lens of critical caring pedagogy. The authors consider the impact of COVID-19 on Black rural education and, consequently, the need for teacher education post-COVID to better prepare teacher candidates to meet the needs of their Black rural students. Through critical caring pedagogy, teacher candidates can learn to center and care for students in Black rural spaces while understanding how complex history and biases about families and communities can impact issues of care and equity. © 2023 selection and editorial matter, Melanie Shoffner and Angela W. Webb;individual chapters, the contributors.
ABSTRACT
Rationale: Identification and control of environmental triggers is one of the cornerstones of asthma management. Access to homes, underscored during the COVID-19 pandemic, frequently limits mitigation efforts. We sought to determine the feasibility of telemedicine for identification of home asthma triggers. Methods: Patients age 5-18 years with persistent asthma, recent exacerbation, home Internet access, and stable residency were eligible. Families were randomized to standard of care (SOC) or telemedicine (TELE);virtual assessments were performed at 2, 4, and 6 months. Data included demographics and standardized assessment of the home environment. Results: Eighteen participants were enrolled (9 TELE, 9 SOC). There were no significant differences in baseline demographics between groups. Sensitization to pollens and dust mites was most common in both groups. Housing conditions were similar. In both groups, 89% lived in detached homes with forced air (standard filter) being the most common heating source (33%). Visible signs of pests/mold were seen in <12%. 89% use scented air fresheners/candles/potpourri. The SOC group had more pets (67% versus 33%) and smoking in the home (22% versus 11%). There was less evidence of mold in the TELE group (0 versus 22%). All SOC participants use bleach/ammonia cleaning products (78% in TELE). Thirteen participants (72%) completed at least one virtual home visit. No significant barriers were identified to telemedicine encounters. All participants reported “completely” or “very” satisfied with telemedicine visits. Conclusions: Virtual home assessments for identification of asthma triggers is a feasible alternative to in-person home visits, and it is well accepted by patients.
ABSTRACT
Background/Introduction (a brief statement of purpose or why the study was done). In March 2020, all face-to-face mandatory teaching was suspended in the Trust due to the Covid pandemic. However, many staff who had been office based were now recalled to the frontline and needed urgent updates on safe practice of Blood Transfusion. The obvious choice was eLearning and the national courses. The bigger challenge was to bring these staff up to date on local transfusion practice. Methods or Study Design (a description of the methods used or work done). We decided that the easiest way to do this was to record voice over our classroom presentation slides. This was a relatively easy process as we had just had our computers upgraded and used Office 365. We looked through each presentation, wrote the narrative to each slide and then recorded. To confirm that staff understood the content we added 12 multi choice questions (MCQs) to be completed and 100% achieved to pass the eLearning. Local videos on sampling and the Serious Hazards of Transfusion (SHOT) Pre-administration Blood Component Transfusion Bedside Check video are also included in each package and these must be watched to allow progression to the next slides. Now we had to work out how to make the presentation accessible to staff. The library at the Trust uploaded our new eLearning with voice over to the Electronic Staff Record (ESR) system which is used by staff to access all statutory and mandatory training. We tested the eLearning, once available on ESR, and it worked well with some minor changes in the order slides were shown. All wards were informed of this new way to access and complete transfusion theory and the learning went live. Results (a summary of the results observed). Previously staff had to attend a 90-min classroom session. It is now possible for staff to complete their transfusion mandatory training with local practice information in 40 min. We can now use ESR for checking our eLearning courses and can see if staff have enrolled in the course, failed the course, attempted the course or passed. Going forward we will be required to update the packages and currently we review every 6 months and make changes as required. Staff feedback is positive and new starters like that they get an introduction to transfusion a few weeks before they attend for competency assessments. To date we have 12 eLearning packages uploaded on ESR covering transfusion and local practice ranging from induction for new staff to a package for foundation doctors and paediatric nursing staff. Conclusions (a statement of the conclusions based on the reported results, including any recommendations). As Transfusion Practitioners we had often talked about doing this type of teaching and if the Covid pandemic had not happened we would still be talking about it. Our transfusion mandatory training compliance is 89% currently. The real benefit to using this method of teaching is we have more hours now to do other Transfusion Practitioner activities and can check transfusion compliance at the touch of a button. It's a win win!!.
ABSTRACT
Background/Introduction (a brief statement of purpose or why the study was done). Incidents in transfusion require feedback to those involved and learning within the wider Trust. Often lessons learned get disseminated to a few staff and the importance of learning from incidents can be overlooked. With movement about the hospital restricted during Covid it became even more difficult to get the learning out to staff. Ward managers were helpful and included changes and recommendations in morning Huddles (when these were allowed) or in departmental newsletters/ WhatsApp groups. However, we had no way of knowing who had read the information and similar incidents were reoccurring. We needed another way to get information out to staff and the answer came to us whilst on a Teams call - why do not we use Teams? Methods or Study Design (a description of the methods used or work done). An incident was reported relating to major haemorrhage activation (MHP) and during the investigation it became apparent that most of the staff on the ward were unclear about the activation process and communication with blood bank was poor. We really needed to do a MHP teaching sessions with all the staff on that ward and Biomedical scientists (BMS) which in normal times would be virtually impossible and during Covid pandemic was impossible. The solution was to produce a PowerPoint presentation, invite all the staff via Teams to attend the Teams presentation and we booked six 30-minute meetings on various dates and times. Most staff accepted the invitation and we had between 4 and 10 staff at each session. Staff were able to attend from work or home, useful as many were isolating due to Covid requirements, and one attended from her car in the hospital car park using her phone! The presentation was delivered live but also recorded so it could then be shared with other staff unable to access on the dates and times provided. At the end of the presentation a 10-min question and answer slot provoked discussion including appreciation of jobs roles during a MHP activation this enabled the transfusion practitioners to tailor the presentation for the next session. Results (a summary of the results observed). The trial delivering learning from incidents via this method was 100% successful. The ward manager liked this method as she could see who had attended and remind those that had missed a session to book on to another. The lab staff got an understanding of pressures in the clinical area, and the clinical staff learned about the Biomedical scientist (BMS) role. It was beneficial to have these small sessions and to discuss specific details with staff and staff felt comfortable talking and sharing experiences. Another benefit is that we can with confidence know who has received the feedback and learning from an incident. The presentation is available to be used by other wards as and when required. Conclusions (a statement of the conclusions based on the reported results, including any recommendations). We have decided to continue with this use of TEAMS to disseminate learning from incidents and will shortly be doing sessions on transfusion reactions as an action from a recent incident. This use of TEAMS is an example of how we have advanced shared learning from incidents.
ABSTRACT
Initial and continuing teacher education are increasingly making use of remote and blended modes of education. Conducted in the summer of 2020 during the COVID-19 pandemic, this rapid review brings together literature and evidence to inform planning for remote and blended teacher education during restrictions in face-to-face teaching activity. The review consists of three main parts: first, a descriptive framework of modes of remote and blended teacher education;second, an exploratory review of the affordances and limitations of remote and blended approaches connecting the literature on effective teacher education with reviews of remote and blended approaches;third, a rapid review of evidence on the efficacy of remote and blended approaches, including of a small number of studies comparing these to face-to-face equivalents. We conclude that remote and blended teacher education is likely to become an increasingly important part of the teacher education landscape and there are plausible theoretical reasons suggesting that it can be effective with suitable design. However, we find too few studies presenting robust evidence to enable firm conclusions to be drawn on the relative effectiveness of modes and approaches. The review provides a foundation for further research and practice in this area.
ABSTRACT
Introduction: The acquired coagulopathy associated with cardiac surgery and cardiopulmonary bypass (CPB) has been associated with increased perioperative transfusion requirements, morbidity, and mortality. As the COVID-19 pandemic put significant strain on blood bank resources, our institution implemented recommendations to utilize prothrombin complex concentrate (PCC) and fibrinogen concentrate to either replace or supplement intraoperative FFP and cryoprecipitate administration, respectively during cardiac surgery. Herein, we describe the transfusion patterns when FFP, cryoprecipitate, PCC, and fibrinogen concentrate are available to the intraoperative care team. Methods: On March 4, 2020, the Division of Cardiothoracic Anesthesia in collaboration with the Department of Cardiac Surgery recommended the use of PCC and Fibryga as first-line therapy for non-surgical coagulopathy based on viscoelastic and static testing and visual inspection of the surgical field in all consecutive cardiac surgical patients older than 18 years having coronary artery bypass grafting (CABG), valve surgery, aortic surgery, heart or lung transplantation, left ventricular assist device (LVAD) placement, or some combination of these procedures. We recommended administering PCC 500 units up to 2000 units, and Fibryga 1 gram up to 4 grams in divided doses until the TEG R-value and alpha angle, respectively returned to normal or bleeding in the surgical field stopped. We collected patient demographic information, clinical variables, and outcomes retrospectively from the electronic medical record. Data are described as means (± SD) and percentages. Results: From March 4, 2020, to October 30, 2020, we analyzed 224 patients. The mean age was 58 years ±14.4 and 79 (35.7%) were women. Three patients were excluded, as they had cardiac surgeries without CPB. The majority of patients had CABG and/or valve surgery;29 (13.1%) patients had complex surgery, 37 (16.7 %) had heart or lung transplantation surgery, and 26 (11.7%) an LVAD placed. One hundred and eighteen (53.3%) patients received no blood product or concentrate (NP Group), 40 (18%) patients received factor concentrates with or without platelets (FC Group), 33 (14.9%) patients received FC and allogenic blood product (FC+ABP Group), and 30 (13.3%) patients received only APB (ABP Group). There was no meaningful difference in platelet administration or chest tube output between groups. Group 2 patients who received both FC and ABP received more RBCs (Table 1). There was no clinically meaningful difference between the baseline static and viscoelastic test results (Table 2). Conclusion: In this single-academic center experience, we demonstrate that non-surgical coagulopathy can be managed safely and effectively with factor and fibrinogen concentrates, allogeneic blood products, and combinations thereof in consecutive patients undergoing varying complexities of cardiac surgery. Future analysis will focus on stratifying surgical procedures to identify patterns of administration as they relate to operational and clinical outcomes.