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T-cell recognition of antigenic peptides presented by HLA molecules at the cell surface is critical for mounting an efficient adaptive immune response during acute viral infection such as COVID-19 caused by SARS-CoV-2. Recent data suggest that the depth of peptide coverage and the breadth of T cells that are able to respond are both important parameters associated with disease outcome. Strong T-cell responses against SARS-CoV-2 have also been reported in unexposed individuals, pointing to a possible role of heterologous immunity. In this study, we performed immunosequencing of the TCR CDR3beta region in a large cohort of 116 alloHSCT recipients and their corresponding healthy donors collected prior to the emergence of SARS-CoV-2. We used bioinformatics analyses and a large database of about 150,000 SARS-CoV-2 specific T-cell sequences in order to investigate the composition of the TCR repertoire regarding the presence of SARS-CoV-2 specific clonotypes in unexposed subjects among the more than 3.5 million CDR3beta sequences that we retrieved by immunosequencing. We also performed peptide binding predictions based on the reference proteome of the virus and by using the HLA class I high resolution typing data of the 116 patients. We could show that every individual is equipped with a large and diverse repertoire of clonotypes sharing their CDR3beta sequence with a SARS-CoV-2 specific T cell. Furthermore, the composition of the anti-SARSCoV- 2 repertoire was very similar among individuals, in healthy donors but also in the context of immune reconstitution in recipients, despite significant differences previously reported when accounting for the whole repertoire or for CMV-specific clonotypes only. In addition, each individual had the potential to cover a diverse repertoire of SARS-CoV-2 derived peptides (i.e., a few thousands strong and weak binders), but, interestingly, some interindividual differences were observed when only accounting for a strong affinity level of binding.
ABSTRACT
AIMS: The mounting evidence for effective delivery of psychological interventions by non-specialists in low- and middle-income settings has led to a rapid expansion of mental health and psychosocial support trainings globally. As such, there is a demand for strategies on how to train and implement these services to attain adequate quality. This study aims to evaluate the added value of a competency-driven approach to training of facilitators for a group intervention for children with severe emotional distress in Lebanon. METHODS: In a controlled before and after study, 24 trainees were randomly allocated to participate in either a competency-driven training (CDT) or training-as-usual (TAU) (1 : 1) for a psychological intervention for children with severe emotional distress. We assessed the change in demonstrated competencies, using standardised role-plays, before and after the training. Measures included the 13-item Working with children-Assessment of Competencies Tool (WeACT), the 15-item ENhancing Assessment of Common Therapeutic factors (ENACT) and the 6-item Group facilitation: Assessment of Competencies Tool (GroupACT). The trainer in the experimental arm used pre-training and during training competency assessment scores to make real-time adjustment to training delivery. Due to COVID-19 pandemic restrictions, all activities were done remotely. RESULTS: CDT resulted in significantly better outcomes on increasing competencies on the WeACT (repeated measures analysis of variance; F(1, 22) = 6.49, p < 0.018) and on the GroupACT (Mann-Whitney U = 22, p < 0.003), though not statistically significant on the ENACT. There is no significant between-group difference on the reduction of harmful behaviours, mainly because both forms of training appear equally successful in eliminating such behaviours. CONCLUSIONS: This proof-of-concept study demonstrates the potential of CDT, using standardised assessment of trainee competencies, to contribute to better training outcomes without extending the duration of training. CDT can result in up to 18% greater increase in adequate competency, when compared to TAU. The study also yields recommendations for further enhancing the benefits of competency-driven strategies. A fully powered trial is needed to confirm these findings.
Subject(s)
COVID-19 , Psychosocial Intervention , Child , Humans , Lebanon , Mental Health , PandemicsABSTRACT
Background Knee osteoarthritis is one of the main causes of disability and mobility impairment in the elderly population. This is associated with suffering and high medical costs. Non-surgical therapy such as exercise therapy, physical activity interventions and self-management support can reduce pain and improve function and health-related quality of life. Home exercise programs are considered an important component of therapy, but adherence is often insufficient. Digital health applications are a promising option, especially under the conditions of the current COVID-19 pandemic to reduce this barrier. Objective To investigate the feasibility of implementing a mHealth home exercise program for patients with knee osteoarthritis in terms of usability, user experience, user behaviour and outcome. Method Patients with knee osteoarthritis carried out the mHealth home exercise program (mhexos) for 4 weeks. The program was implemented via tablet computer with a total of 39 exercise videos on strengthening, balance and coordination, which could be configured in 3 difficulty levels. Data on pain intensity and self-perceived exertion were recorded via the app. Guided interviews were conducted and questionnaires were used to assess usability and user experience as well as health-related outcomes at 2 measurement points. Results 10 patients and 7 therapists were included. The mHealth home exercise programme could be implemented in the practice and the everyday life of the subjects. The app was predominantly rated as user-friendly and motivating, adherence to therapy was high with an exercise frequency of 2.7 times per week (SD 0.6). The health-related outcomes showed small, statistically non-significant and clinically not relevant changes following the intervention. Conclusion The mhexos seems to be suitable to support home exercise programs for knee osteoarthritis under given conditions. Controlled studies are needed to assess its effectiveness.
ABSTRACT
Objectives: As delivery of psychological interventions by nonspecialists becomes more commonplace, assurance that training and supervision methods achieve minimum competency standards is needed. The United Nations Children’s Fund and World Health Organization (UNICEF-WHO) Ensuring Quality in Psychological Support (EQUIP) platform is a digital tool to provide guidance on conducting competency-based trainings of nonspecialists. The platform includes competency assessment tools for adults (the ENhancing Assessment of Common Therapeutic Factors [ENACT] tool) and for children (Working with children—Assessment of Competencies Tool [WeACT]), as well as a suite of treatment-specific competency tools for adult- and child-focused psychological interventions. Methods: Role-play based (RPB) competency assessment tools were evaluated in a range of global settings for feasibility and acceptability. Study sites included Ethiopia, Kenya, Lebanon, Nepal, the occupied Palestinian territory, Peru, Uganda, and Zambia. In addition, a US pilot of the tool was conducted in New York City (NYC). Acceptability and feasibility were evaluated through both qualitative assessments and evaluation of interrater reliability (IRR) and responsivity to change. Results: IRR ranged from 0.54 to 0.80 across sites and tools. The use of microcompetency video demonstrations of helpful vs potential harmful/unhelpful techniques helped increase IRR. Most individual competencies showed responsivity to change when evaluated pre- vs posttraining. For child competencies, youth drama clubs were feasibly trained to be actors in the standardized role-plays. Competencies were also modified for remote delivery of psychological interventions, which is of particular importance to deliver services during the COVID-19 pandemic. Conclusions: RPB assessments of competencies can be implemented in diverse settings ranging from refugee camps in low-income countries to urban centers of high-income countries (HICs). Rater training and standardized actors require a significant time investment, which can then yield high rates of IRR for observational assessments. With the transition to more remote care, RPB structured competency assessments are increasingly feasible even in low-resource settings. Reciprocal learning with the NYC site demonstrated that the tool can also be beneficial in an HIC. R, OTH
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Problem Management Plus (PM+) is used to address mental health needs in humanitarian emergencies, including in response to COVID-19. Because PM+ is designed for non-specialist facilitators, one challenge is ensuring that trainees have the necessary competencies to effectively deliver the intervention and not cause unintended harm. Traditional approaches to evaluating knowledge of an intervention, such as written tests, may not capture the ability to demonstrate PM+ skills. As part of the World Health Organization Ensuring Quality in Psychological Support (EQUIP) initiative, we developed a structured competency rating tool to be used with observed standardised role plays. The role plays were designed to elicit demonstration of the key mechanisms of action for PM+. These role plays can be objectively rated by trainers, supervisors or other evaluators to determine facilitators' competency levels in PM+. These competency assessments can highlight what skills require additional attention during training and supervision, thus supporting facilitators to fill gaps in competencies. The integration of role plays in training and supervision also allows organisations to establish quality control metrics for competency standards to deliver PM+. We describe lessons learned from piloting the PM+ competency role plays with the Center for Victims of Torture programme with Eritrean refugees in Ethiopia. © 2021 Lippincott Williams and Wilkins. All rights reserved.
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Immune homeostasis is the state where the immune system maintains stability in the absence of insult. Much of the analysis of immune homeostasis has focused on systemic immunity, but it is also likely to be important in an organ specific manner. There is evidence that homeostatic immunity can affect subsequent responses to infection or vaccination. Since the lungs are a major site of infection, we used the Collaborative Cross (CC) mouse genetic reference population to study the genetic regulation of the breadth of baseline immune cell populations in the lung and identify loci regulating these cells at the steady state. We found that all immune cell populations measured showed strong genetic (i.e. strain-specific) variation in cell type abundances. We identified 12 quantitative trait loci (QTL) associated with variation in 12 immune cell populations or the relationships between cell populations. Given the role of various immune cells in the lungs during respiratory virus pathogenesis, we asked whether any of the mapped QTL correlated with influenza A virus (IAV) or Severe acute respiratory syndrome associated coronavirus (SARS-CoV) disease following infection in the same strains of mice. Notably, a locus we mapped for baseline abundance of CD8+ T cells in the lungs was associated with peak weight loss following IAV infection. Additionally, a locus mapped for variation in Ly6C+ monocyte/macrophage abundance was associated with SARS-CoV titer at days 2 and 4 post-infection. These data suggest that abundance of lung leukocyte populations prior to infection could serve as predictors of immune responses to respiratory viruses.
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The objective was to analyze trends and inequalities in the prevalence of food insecurity during the COVID-19 pandemic according to sociodemographic factors and social distancing measures. We analyzed data from four serial epidemiological surveys on COVID-19 in May and June 2020, with adults and elderly living in Bage, Rio Grande do Sul State, Brazil. Food insecurity was assessed with the short version of the Brazilian Food Insecurity Scale (EBIA), with the recall period adapted to the beginning of the social distancing period in the city. Sociodemographic characteristics and the adoption of social distancing measures were analyzed, and their associations with food insecurity were assessed with chi-square test. The temporal trend in food insecurity according to these characteristics was assessed via linear regression. Inequalities in food insecurity were assessed with the angular inequality index and concentration index. Of the 1,550 individuals studied, 29.4% (95%CI: 25.0;34.4) presented food insecurity. Analysis of inequality showed higher concentration of food insecurity among the younger and less educated and those living with five or more residents in the same household. Over the course of the four surveys, prevalence of food insecurity decreased most sharply among the younger, those living in households with up to two residents, and those with two or more workers. There was a strong association between food insecurity and sociodemographic factors, which may indicate the pandemic's potential economic impact on households' food situation.
ABSTRACT
The objective was to analyze trends and inequalities in the prevalence of food insecurity during the COVID-19 pandemic according to sociodemographic factors and social distancing measures. We analyzed data from four serial epidemiological surveys on COVID-19 in May and June 2020, with adults and elderly living in Bage, Rio Grande do Sul State, Brazil. Food insecurity was assessed with the short version of the Brazilian Food Insecurity Scale (EBIA), with the recall period adapted to the beginning of the social distancing period in the city. Sociodemographic characteristics and the adoption of social distancing measures were analyzed, and their associations with food insecurity were assessed with chi-square test. The temporal trend in food insecurity according to these characteristics was assessed via linear regression. Inequalities in food insecurity were assessed with the angular inequality index and concentration index. Of the 1,550 individuals studied, 29.4% (95%CI: 25.0;34.4) presented food insecurity. Analysis of inequality showed higher concentration of food insecurity among the younger and less educated and those living with five or more residents in the same household. Over the course of the four surveys, prevalence of food insecurity decreased most sharply among the younger, those living in households with up to two residents, and those with two or more workers. There was a strong association between food insecurity and sociodemographic factors, which may indicate the pandemics potential economic impact on households' food situation.