SARS-CoV-2 infection alters the breast milk glycomic profile

Breast milk is generally accepted as the perfect source of nutrition for the health and development of infants. It also assists in infant innate and adaptive immunity through many proteins that are decorated with glycans. Examples of these glycoproteins include IgA, IgG, and innate immune lectins. Maternal diet and environmental exposure such as pathogens and pollutants affect human milk composition including its glycoprofile. Despite altered glycosylation can have a consequence on the nursing infant's health and immunity, the current knowledge is still emerging in this area of study. COVID-19 has gained attention in recent years by causing severe morbidity and mortality. Similar to other infectious diseases such as influenza, our lab recently revealed alterations in glycome of plasma and different tissue samples of COVID-19 infected patients. Inspired by these findings, we are interested in disclosing the effect of SARS-CoV-2 on glycosylation of breast milk proteins. Toward this, we performed a large-scale systematic study using our high-throughput lectin microarray analysis technology. We analyzed 132 control samples (breast milk collected pre- COVID) and breast milk from 78 COVID-19 infected mothers. Our data showed there is a 4-fold increase in -2,3 sialic acid on glycoproteins that is associated with SARS-CoV-2 infection in lactating mothers. Lectin pulldown experiments further testified to these findings. Given the significance of -2,3 sialic acid glycan signature in infectious diseases, our finding could provide valuable insight into therapeutic development.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.

Epilepsy Mortality in Wales during Covid-19

Purpose We aimed to compare mortality rates in people with epilepsy in Wales during the pandemic with pre-pandemic rates. Methods We performed a retrospective study using populationscale anonymised health records. We identified deaths in people with epilepsy (DPWE), those with a diagnosis of epilepsy, and deaths associ- ated with epilepsy (DAE), where epilepsy was recorded as a cause of death. We compared death rates in 2020 with average rates in 2015-2019 using Poisson models. Results There were 188 DAE and 628 DPWE in Wales in 2020 (death rates: 7.7/100,000/year and 25.7/100,000/year). The average rates for DAE and DPWE from 2015 to 2019 were 5.8/100,000/year and 23.8/100,000/year, respectively. Death rate ratios (2020 compared to 2015-2019) for DAE were 1.34 (95%CI 1.14-1.57, p<0.001) and for DPWE were 1.08 (0.99-1.17, p = 0.09). The death rate ratios for non- COVID deaths (deaths without COVID mentioned on death certificates) for DAE were 1.17 (0.99-1.39, p = 0.06) and for DPWE were 0.96 (0.87-1.05, p = 0.37). Conclusions The significant increase in DAE in Wales during 2020 could be explained by the direct effect of COVID-19 infection. Non-COVID-19 deaths have not increased significantly but further work is needed to assess the longer-term impact.

Using trust-based philanthropy with community-based organizations during the COVID-19 pandemic

Community-based organizations (CBOs) fill a critical role in acting as public health partners and trusted resources for their communities, especially in an emergency. The CDC Foundation, an independent, nonprofit organization, used trust-based philanthropy to manage more than 110 COVID-19 grants focused on equitable vaccine information, outreach, and access. The CDC Foundation team uses a trust-based philanthropy paradigm by applying five out of six of the grantmaking practices: do the homework;simplify and streamline paperwork;be transparent and responsive;solicit and act on feedback;and offer support beyond the check. By applying trust-based philanthropy practices, the CDC Foundation is empowering CBOs through flexible grant management and more equitable power dynamics as grantee and grantor. This has been essential to CBOs in their efforts of tackling health inequities during the COVID-19 pandemic and improving community resilience. Lessons learned will inform future collaborations with CBOs where the power dynamics are shared. © 2023 National Foundation for the Centers for Disease Control and Prevention. Journal of Philanthropy and Marketing published by John Wiley & Sons Ltd.

An intra-action review conducted by the CDC Foundation during COVID-19 to evaluate emergency response procedures.

OBJECTIVES: During times of emergency response, the CDC Foundation leverages partnerships and relationships to better understand the situation and respond rapidly to save lives. As the COVID-19 pandemic began to unfold, an opportunity became clear to improve our work in emergency response through documentation of lessons learned and incorporating them into best practices. STUDY DESIGN: This was a mixed methods study. METHODS: The CDC Foundation Response, Crisis and Preparedness Unit conducted an internal evaluation via an intra-action review to evaluate and rapidly improve emergency response activities to provide effective and efficient response-related program management. RESULTS: The processes developed during the COVID-19 response to conduct timely and actionable reviews of the CDC Foundation's operations led to the identification of gaps in the work and management processes and to creation of subsequent actions to address these issues. Such solutions include surge hiring, establishing standard operating procedures for processes not yet documented, and creating tools and templates to streamline emergency response operations. CONCLUSIONS: The creation of manuals and handbooks, intra-action reviews, and impact sharing for emergency response projects led to actionable items meant to improve processes and procedures and the ability of the Response, Crisis and Preparedness Unit to quickly mobilize resources directed toward saving lives. These products are now open-source resources that can be used by other organizations to improve their own emergency response management systems.

Addressing immediate public health needs as part of Afghan evacuees' resettlement to the United States during the COVID-19 pandemic.

OBJECTIVES: Since the removal of US troops from Afghanistan in 2021, the United States welcomed Afghan evacuees through Operation Allies Welcome. Using cell phone accessibility, the CDC Foundation worked with public-private partners to protect evacuees from the spread of COVID-19 and provide accessibility to resources. STUDY DESIGN: This was a mixed methods study. METHODS: The CDC Foundation activated its Emergency Response Fund to accelerate public health components of Operation Allies Welcome, including testing, vaccination, and COVID-19 mitigation and prevention. The CDC Foundation began the provision of cell phones to evacuees to ensure access to public health and resettlement resources. RESULTS: The provision of cell phones provided connections between individuals and access to public health resources. Cell phones provided means to supplement in-person health education sessions, capture and store medical records, maintain official resettlement documents, and assist in registration for state-administered benefits. CONCLUSIONS: Phones provided necessary connectivity to friends and family for displaced Afghan evacuees and higher accessibility to public health and resettlement resources. As many evacuees did not have access to US-based phone services upon entry, provision of cell phones and plans for a fixed amount of service time provided a helpful start in resettlement while also being a mechanism to easily share resources. Such connectivity solutions helped to minimize disparities among Afghan evacuees seeking asylum in the United States. Provision of cell phones by public health or governmental agencies can help to provide equitable resources to evacuees entering the United States for social connection, healthcare resources, and resources to assist in the process of resettlement. Further research is needed to understand the generalizability of these findings to other displaced populations.

Code De-Escalation: Effectiveness and Feasibility Pilot Study of Intervention to Decrease Restraint Use and Health Inequities in Agitation Management in a Community Hospital Emergency Department

Study Objectives: Restraint use in the emergency department (ED) has been shown to pose significant physical, psychological, and medicolegal risk to both patients and health care workers. Recent studies have demonstrated racial disparities in restraint application in the ED setting. This study aimed to evaluate the effectiveness of Code De-escalation, a standardized team-based approach for agitation management and assessment of perception of threatening behaviors, in reducing restraint use and racial disparities in restraint application in a community hospital emergency department. Study Design/Methods: We performed a retrospective observational study of the effect of introduction of the Code De-escalation pathway on violent restraint use among ED patients who had been placed on an involuntary psychiatric hold in a community emergency department. This new pathway includes a built-in step for the team members to systematically assess the perception of threat related to the patient behavior and the threat perceived by the patient. We used a Chi-squared test to compare incidence of restraints per ED encounter during the eight- month period after the intervention (May 2021-Dec 2021) with an eight-month period pre-intervention. We used a Cochran-Mantel- Haenszel test to look for differences in restraint use among racial and ethnic groups. To avoid confounding by the dramatic changes in patient volume and type during the peak of the COVID pandemic, we chose a pre-intervention period that pre-dated this (May 2019-Dec 2019). We compared our results to rates at neighboring community hospitals within the same hospital network during the same period. Results/Findings: Our sample size included 434 ED encounters pre intervention and 535 ED encounters post intervention. Over the study period, we observed a significant decrease in the violent restraint use among patients on an involuntary psychiatric hold from a rate of 7.4% to 3.7% (p=0.02). This was despite an overall increase in the number of patients requiring an involuntary psychiatric hold over the same period. This decrease was observed across all racial and ethnic groups. The same decrease in violent restraint use was not observed at the two other community hospitals within our hospital network and in the same metro area. Conclusion(s): A standardized de-escalation algorithm may be an effective tool in helping EDs decrease their use of restraints and may be one tool to help close the racial gap in restraint use among patients experiencing agitation. * Note Dana Im and Alice Bukhman contributed equally to conception and writing of this No, authors do not have interests to disclose Copyright © 2022

Reduction of Rabbit Anti-Thymocyte Globulin Dosing for Induction of Kidney Transplant During the COVID-19 Pandemic

Purpose: Rabbit anti-thymocyte globulin (rATG) is a polyclonal antibody utilized for induction immunosuppression in high immunologic risk kidney transplant recipients. However, the optimal total dose of rATG has not been identified. Higher cumulative doses of rATG may be associated with an increased risk of adverse infectious and hematologic outcomes, while lower cumulative doses may not provide adequate immunosuppression to prevent acute rejection. In March 2020, the total rATG dose in our institution's induction protocol for kidney transplant recipients was reduced from 6 mg/kg to 4.5 mg/kg to avoid potential infectious complications from COVID- 19. The objective of this study is to compare the efficacy and safety between two different doses of rATG. Method(s): This was a single center, retrospective chart review of adult kidney transplant recipients who received rATG for induction between September 1, 2019 and August 31, 2020. Patients who received a total dose of 6 mg/kg rATG were compared to patients who received a total dose of 4.5 mg/kg. The primary outcome was biopsy proven acute rejection (BPAR) within 90 days of transplant. Secondary outcomes assessed incidence of infection, leukopenia, neutropenia, thrombocytopenia, and delayed graft function within 90 days of transplant. Result(s): Eighty-one adult kidney transplant recipients were included in this study;37 received 6 mg/kg of rATG and 44 received 4.5 mg/kg of rATG. Incidence of BPAR was significantly lower in the 6 mg/kg rATG group compared to the 4.5 mg/ kg group (2.7% vs 20.5%, p=0.02). The majority of rejection episodes were classified as borderline. Patients who had BPAR were treated with corticosteroids. The number of patients who had an infection was significantly lower in the 6 mg/kg group compared to 4.5 mg/kg group (21.6% vs 47.7%, p=0.02). There was a numerically lower incidence of delayed graft function in the 6 mg/kg group compared to the 4.5 mg/kg group (25.0% vs 43.2%, p=0.18). Incidence of leukopenia, neutropenia, and thrombocytopenia were similar between groups. Conclusion(s): In conclusion, a lower cumulative dose of rATG was associated with an increased risk of borderline rejection and a numerically higher incidence of delayed graft function.

Psychosocial experiences of people living with advanced colorectal cancer: A qualitative exploration

Aims: Survival of people with advanced colorectal cancer (CRC) can be prolonged through treatment pathways including cytoreductive surgery and hypothermic intraperitoneal chemotherapy (CRS-HIPEC), pelvic exenteration, liver resection, and palliative chemotherapy without surgery. Virtually no qualitative research has compared the experiences and needs of advanced CRC survivors who receive these treatments. This study aims to fill this gap. Methods : Adult survivors of CRC who have undergone the aforementioned treatments are being recruited 0.5-2 years post-surgery or, for palliative chemotherapy participants, 0.5-2 years post-diagnosis of advanced CRC. Recruitment will continue until approximately N = 40 or data saturation is reached. Quantitative data include: demographic and clinical data, Functional Assessment of Cancer Therapy - Colorectal (FACT-C), Distress Thermometer, and Comprehensive Score for Financial Toxicity (COST). Quantitative data will undergo descriptive analysis to characterise the sample. All participants will participate in a qualitative semi-structured telephone interview exploring quality of life, employment, finances, stigma, supportive care needs, social functioning, perceptions of survivorship, and impacts of COVID-19. Interviews are analysed via the framework approach of thematic analysis. Results : Preliminary analysis of 36 interviews (n = 10 CRS-HIPEC, n = 10 pelvic exenteration, n = 9 liver resection, n = 7 palliative chemotherapy) reveals some advanced CRC survivors report post-surgical complications and chemotherapy-induced peripheral neuropathy, which can limit physical activity. CRC impacted some participants' psychosocial well-being ability to work, and sense of identity. Participants reportedly manage these impacts through distraction, positive reframing, and contact with other CRC survivors. Most participants appeared satisfied with their cancer treatment teams. Some viewed GPs as important healthcare coordinators. COVID-19 made some participants more cautious when leaving the house. Telehealth was considered less personal, but convenient. Conclusions : The study's findings will help guide development of interventions to improve the survivorship experience of patients who receive treatment for advanced CRC. This may include an information booklet, patient-reported outcome measure, clinical pathway, or targeted intervention.

Psychosocial outcomes and QoL in advanced colorectal cancer survivors: A qualitative exploration

Background: Approximately 18% of colorectal cancer (CRC) diagnoses are advanced cancer, whereas 30%-40% of patients develop recurrence after treatment with curative intent. More modern treatments enable longer survival for people with advanced CRC, including cytoreductive surgery and hypothermic intraperitoneal chemotherapy (CRS-HIPEC), pelvic exenteration, liver resection, and palliative chemotherapy without surgery. Yet, virtually no qualitative research has compared the perspectives and quality of life (QoL) experiences of survivors of these different treatments. This study aims to fill this gap. Methods: Approximately N = 40 adult survivors of CRC are being recruited from two major Australian hospitals 0.5-2 years posttreatment or post-diagnosis. All participants will complete the Functional Assessment of Cancer Therapy - Colorectal (FACT-C), Distress Thermometer and Comprehensive Score for Financial Toxicity (COST) questionnaires. Questionnaire data, participant demographics and clinical data will undergo descriptive analysis to characterise the sample. Participants will participate in a qualitative semi-structured telephone interview, analysed via the framework approach of thematic analysis. Qualitative interviews explore QoL, survivorship experiences, employment and finances, supportive care needs, stigma and social functioning and impacts of COVID-19. Results: Preliminary analysis of 30 interviews (n=10 CRS-HIPEC, n=9 pelvic exenteration, n = 5 liver resection, n = 6 palliative chemotherapy) reveals someadvancedCRCsurvivors report post-surgical complications and chemotherapy-induced peripheral neuropathy, which can limit physical activity and daily functioning. Participants reportedly manage these through distraction, positive reframing and contacting other CRC survivors. Most participants appeared satisfied with their cancer treatment teams. Some viewed their GPs as important coordinators in their health care. Some CRC survivors viewed the change to telehealth due to COVID-19 as less personal;however, rural/regional participants prefer its convenience. Conclusions: The study findings will help guide development of interventions to improve the survivorship experience of patients who receive treatment for advanced CRC. This may include an information booklet, patient-reported outcome measure, clinical pathway or targeted intervention.

Implementing a change in practice in a different specialty via the chief registrar (CR) role

Junior doctor feedback from the General Medical Council (GMC) survey and quality panels has consistently highlighted poor handover in Acute Medical Unit (AMU) as a concern. Neglected handover practice has been identified as a key component of poor outcomes in root cause analyses within the unit. There was no formal handover of patients between the incoming and outgoing medical teams. Resolution of this problem was tasked to the chief registrar (CR). As an obstetrics and gynaecology registrar in the CR role there were potential benefits and barriers to taking on a project in a different specialty.The information gathering occurred over six months (surveys, focus groups, incident reporting). The implementation coincided with the COVID-19 surge. All staff were notified of the finalised plans the week before handover was implemented and key staff were individually approached to be champions. Feedback was encouraged and actively sought to highlight teething problems.The results show a clear improvement in handover practice, junior doctor support and multi-professional team working. There had been resistance from some senior clinicians to attend an evening handover in the planning stages, however, implementing change at the height of the pandemic meant that staff had to adapt rapidly to new ways of working and as a result this change was widely accepted and implemented. The next stage is to incorporate more teaching into handover practice by including ‘teaching bites.’Upon starting the CR job this was presented as an unsolvable project. However, by a thorough analysis and formation of a plan for change with buy-in from the entire team we were able to affect a successful change. This demonstrates the value of seconding middle grade doctors to management roles as they can provide a crucial link between medical and management staff and coordinate vital change to improve patient safety.

Applying the health justice framework to address health and health care inequities experienced by people with disabilities during and after covid-19

The COVID-19 pandemic has been especially devastating for people with disabilities, as well as other socially marginalized communities. Indeed, an emerging body of scholarship has revealed that people with disabilities are experiencing striking disparities. In particular, scholars have shined a light on state and hospital triage policies that allow hospitals to ration critical health care and resources, such as ventilators, for people with disabilities if resources become limited and they cannot treat all patients during the pandemic. These injustices deserve extensive consideration from policymakers, legal professionals, and scholars. Elucidating how the inequities that people with disabilities experience during the COVID-19 pandemic result from deeply rooted historical injustices is crucial. This Article comprehensively analyzes the inequalities that people with disabilities experience before and during the pandemic, focused on examining how law and policy affect these disparities. It builds on, incorporates, and extends the existing scholarship about COVID-19 and disabled people by positioning it within the health justice framework. It also proposes normative legal and policy solutions to address deeply entrenched inequities that will affect people with disabilities during the COVID-19 pandemic and beyond. © 2021, University of Washington School of Law. All rights reserved.