Immunotherapy: RAPID ACCESS TO VIRUS-SPECIFIC T CELLS FOR ADOPTIVE IMMUNOTHERAPY FOR COMPASSIONATE USE IN AUSTRALIA

Background & Aim: Adoptive T cell immunotherapy holds great promise for the treatment of viral complications. Our group has been developing and trialling virus-specific T cell therapies for more than 20 years. Recently, we have generated a repository of multi-virus-specific T cells for our clinical trials. Unfortunately, for many patients with viral complications, there is no suitable trial through which to access these therapies. In Australia, the Therapeutic Goods Administration has a Special Access Scheme (SAS) to enable provision of unapproved therapies for compassionate use. Our research group is now a leading Australian provider of "off-the-shelf" and custom-grown allogeneic virus-specific T cells to hospitals for patients with no other treatment options. Methods, Results & Conclusion(s): We have generated a repository of multi-virus-specific T cells from 20 healthy donors, with up to 150 doses of T cells per donor generated from a single blood sample. Each product batch is thoroughly characterised in terms of viral antigen specificity, HLA restriction and alloreactivity. These T cells target a combination of Epstein-Barr virus, cytomegalovirus, BK polyomavirus, John Cunningham virus and adenovirus epitopes. We have also generated a repository of SARS-CoV-2-specific T cells and occasionally grow custom patient-specific batches of T cells from nominated donors, on request. Since 2008, we have provided virus-specific T cells to 15 hospitals across Australia, and the volume of supply requests has significantly increased in recent years, as clinicians have gained interest in adoptive immunotherapy. In 2022, we provided T cells for 26 patients via the SAS. The majority were experiencing post-transplant complications, including cytomegalovirus disease, BK virus-associated haemorrhagic cystitis and post-transplant lymphoproliferative disorder. Through our clinical trials, we have developed rigorous processes for T cell therapy manufacture and characterisation, in addition to a computer-based selection algorithm, which we apply to SAS cases. As these cases are not part of a clinical trial, concomitant therapy varies, and monitoring is not uniform. However, we have received reports of clinical benefit from adoptive T cell therapy. These include cases of reduction in viral load, improvement in symptoms, and complete resolution of infection. We believe that these promising T cell therapies should be available to hospitals through a nationally funded centre for cellular therapies for critically ill patients.Copyright © 2023 International Society for Cell & Gene Therapy

Immunotherapy: ADOPTIVE T CELL IMMUNOTHERAPY FOR SARS-COV-2

Background & Aim: Despite the successful implementation of vaccines worldwide, COVID-19 remains a risk in patients with a compromised immune system. Emerging viral variants have also reduced the effectiveness of monoclonal antibody therapies in these patients. New treatment options are therefore required to improve clinical outcomes. Methods, Results & Conclusion(s): T cell immunotherapy has proven effective for the treatment of a number of refractory viral diseases in patients with a compromised immune system. We have now completed the manufacture of a bank of SARS-CoV-2 specific T cells and commenced an open-label phase I clinical trial at the Royal Brisbane and Women's Hospital, Australia. Patients enrolled in the study receive two doses of partially HLA-matched allogeneic T cells at a fortnightly interval. We have thus far recruited and treated three immune compromised patients with SARS-CoV-2 T cells. In two of the three patients treated thus far, the administration of T cell therapy was coincident with the clearance of viral load after 28 days. Viral clearance in these patients was also associated with an increase in circulating SARS-CoV-2 specific T cells. Our preliminary observations suggest that SARS-CoV-2 specific T cell therapy is well tolerated and has the potential to impact viral control in immune compromised patients.Copyright © 2023 International Society for Cell & Gene Therapy

Building a risky-safe-space: Using refllective pedagogies and values to support writing development in work based learning

The concepts of 'graduateness' and graduate attributes became contested terrain before COVID-19 destabilised even the most assured of shared learning constructions. Indeed, for those of us immersed in the delivery of work-based learning (WBL), this has long been the case. Promotion of reductive notions of 'skills' acquisition to comply neatly with an employability agenda holds little relevance for those students already engaged in full time careers, and with a wealth of professional experience. What can hold influence and interest, however, is the opportunity to engage in meaningful, agentic, professionally-aligned reflective practices as a scaffolded route to promoting self-awareness and developing confidence in mapping competences from the professional domain to the academic (and vice versa).This paper shares an account of taking an embedded approach to supporting the development of academic literacies amongst work-based learners in one UK HEI. In particular, it will consider the use of reflective pedagogical tools and values in supporting work-based learners to become confident and adaptable writers. Discussion considers how work-based pedagogies and approaches may have far-reaching relevance in a post-pandemic landscape, where reskilling and professional agility are likely to become more prolific aspects of education and work. Writing itself is framed as an integrated communication practice that encompasses literature retrieval, reading, evaluation, synthesis and articulation of argument. The paper will describe pre-pandemic academic support activities and share qualitative survey data in which students consider their confidence as both professional and academic writers. It concludes with consideration of how some of the approaches outlined may have relevance for the wider academic community.

Through a Glass Darkly: Oral Histories of Teaching During the Pandemic

Professors in the Faculty of Arts and Sciences, American University of Beirut, a US accredited, English-language University in Lebanon, were interviewed about their online teaching experiences during the COVID-19 pandemic and 2020–2021 lockdown. Faculty were approached non-systematically and interviewed anonymously in a semi-structured format in person and in writing. Thirteen interviews are included in the chapter. The interviews are briefly analyzed for coalescent and divergent experiences and for insights as to the potential future of higher education. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Entrepreneurs' Response to the Dark Side of Knowledge During Covid19

Small business entrepreneurs faced tremendous knowledge-based challenges during COVID19. Some entrepreneurs, even in the same industry sector and city, with similar offerings, responded to these knowledge challenges in diverse ways. For instance, some chose to adopt online store technologies while others did not. In this study, we investigate differences in retail small business entrepreneurs' COVID19 resilience enactment using a qualitative retroductive-analytic approach. Identity motives were uncovered as a likely explanatory construct, as those with externally-focused identity motives generally adopted these technologies while those with internally-focused identity motives generally did not. In addition, identity motives appear to influence entrepreneurs' perceptions of technology affordances, potentially moderating the impact of these perceptions on technology adoption decisions. Contrary to conceptualizations of individual resilience being a trait, we find support that resilience is a mindset. Implications for entrepreneurship theory, practice, and education are discussed. © 2022 IEEE Computer Society. All rights reserved.

COVID-19 in a patient with Good's syndrome and in 13 patients with common variable immunodeficiency

Antibody deficiencies constitute the majority of primary immunodeficiencies in adults. These patients have a well-established increased risk of bacterial infections but there is a lack of knowledge regarding the relative risks upon contracting COVID-19. In this monocentric study the disease course of COVID-19 in 1 patient with Good's syndrome and in 13 patients with common variable immunodeficiency (CVID) is described. The severity of disease ranged from very mild to severe. Several patients required hospitalization and immunomodulatory treatment but all survived. Although viral infections are not a typical feature of humoral immunodeficiencies we recommend that vigilance is increased in the management of patients with Good's syndrome and CVID during the COVID-19 pandemic.Copyright © 2021

SARS-CoV-2 Antibodies in Commercial Immunoglobulin Products Show Markedly Reduced Cross-reactivities Against Omicron Variants.

PURPOSE: Patients with antibody deficiencies often receive maintenance treatment with donor plasma-derived immunoglobulin (Ig) preparations to decrease the incidence and severity of infections. We have previously shown that IgG antibodies to the original SARS-CoV-2 strain were not consistently present in off-the-shelf Ig batches produced up to approximately 18 months after the first identified case of COVID-19 in the USA and that Ig batches with anti-SARS-CoV-2 IgG primarily contained vaccine-induced spike specific antibodies. This study aimed to investigate the degree of cross-reactivity between vaccine-induced anti-SARS-CoV-2 antibodies against Wuhan strain and subsequent viral variants. METHODS: Samples were collected from 74 Ig batches supplied by three different commercial manufacturers. All batches were used at the Immunodeficiency Unit at the Karolinska University Hospital from the start of the SARS-CoV-2 pandemic until September 2022. Antibody quantity and potential to neutralize virus entry into host cells were assessed against the original SARS-CoV-2 Wuhan strain and the following nine variants: Alpha, Beta, Delta, IHU, and the Omicron BA.1, BA.1.1, BA.1 with spike mutation L452R, BA.2, and BA.3. RESULTS: Ig batches produced approximately 18 months after the SARS-CoV-2 outbreak (from around July 2021) and later consistently contained high quantities of antibodies that bind the Wuhan strain. The Ig batches had overall low reactivity to the SARS-CoV-2 nucleocapsid, which implies that plasma donor spike IgG essentially is the result of vaccination. We assessed the degree of cross-reactivity towards each virus variant by plotting the variant/Wuhan strain ratio, which was consistent regardless of production date, suggesting cross-reactivity with vaccine-induced antibodies rather than virus exposure in the plasma donor population. Viral variants that emerged later during the pandemic systematically had a lower reactivity ratio, except for the Delta and IHU variants. The Ig batches displayed markedly low neutralizing potential towards the Beta variant and all tested Omicron variants. CONCLUSION: Commercial Ig batches currently contain large quantities of SARS-CoV-2 vaccine-induced antibodies. Cross-reactivity with variant strains is evident but varies, with markedly low neutralizing potential observed against Omicron variants.

Chicago's Citywide COVID-19 Vaccine Equity Program: Protect Chicago Plus.

Vaccination is one of the most effective strategies to control the spread of COVID-19 and reduce morbidity and mortality; however, rapid and equitable vaccine distribution is required to achieve such outcomes. We conducted a basic interrupted time-series analysis to examine the short-term impacts of a citywide vaccine equity plan, the Protect Chicago Plus (PCP) plan. We compared vaccine coverage in zip codes in Chicago with high COVID-19 vulnerability, as identified from the Chicago COVID-19 Community Vulnerability Index, with coverage in all other zip codes in Chicago. From our analysis, we observed that implementation of PCP coincided with reduced vaccination disparities between Chicago communities with low and high vulnerability indexes over time. In our analysis of vaccination coverage before program implementation, vaccination coverage climbed nearly twice as fast among non-PCP zip codes (0.19% per day) than among PCP zip codes (0.10% per day) or by 0.09 percentage points (P < .001). In model analysis after program implementation, zip codes prioritized for the program had 0.42% additional coverage per day as compared with 0.27% per day for non-PCP zip codes. Our findings suggest that such programs may improve vaccine equity, but additional research is needed to better understand the longer-term effects of citywide vaccination strategies on vaccine uptake.

Investigating neutrophil function during SARS-CoV2 infection in human airway epithelial cells from elderly and young individuals

The COVID-19 pandemic caused by the SARS-CoV2 virus poses a global health threat with over 5 million deaths recorded. There is little understanding regarding SARS-CoV2 pathogenesis in the human airways and disease severity increases with age. Neutrophils are white blood cells found in large numbers in the airways of the lungs in severe COVID-19 patients. It is not known whether this influx of neutrophils into the airway has a protective or detrimental effect. We aim to understand the role of neutrophils during COVID-19 pathology, using an experimental infection model of the airway epithelium from the eldelry and children. To do this, we collect nasal airway cells from healthy elderly and children and grow them at air-liquid interface. Once differentiation and ciliation of these cells is reached, we infect the cells with SARS-CoV2 virus and allow neutrophils to migrate from the basolateral (blood) to the apical (air) side of the epithelium, similar to a physiological airway. Using flow cytometric analyses, we measure the expression of activation markers and the number of neutrophils that migrate across the epithelium of different ages in response to SARS-CoV2 infection. Preliminary work shows less viable neutrophils recovered from the elderly epithelium, more activated neutrophils when migrating through the elderly epithelium, as well as increased numbers of neutrophils remaining on the basolateral (blood) side of the elderly epithelium. These findings point to an inflammatory neutrophil phenotype influenced by the damaged elderly epithelium and supports the hypothesis that neutrophils are responsible for the severity of disease.

Children's digital play as collective family resilience in the face of the pandemic

In this article we explore how digital play as conducted through various social media and online meeting platforms facilitated resiliency and confidence building in children during the COVID-19 pandemic. Using day-in-the-life methodology and narrative inquiry, we disseminate and examine observations collected on children aged 2-10 during lockdown in a Newfoundland neighbourhood. Children utilized platforms such as TikTok, YouTube, and Zoom to embrace their agentic digital play in ways that repurposed the platforms to fulfil life milestones and social needs otherwise impacted and disrupted by pandemic restrictions. Through a series of vignettes and interviews, our research not only examines how such digital play benefits children and their healthy development, but how parents reacted to and assisted with their children's agentic digital platform manipulation and how this provided positive benefits and enriching experiences to the entire family. We additionally explore the conflicts and tensions both children and parents encountered in securely implementing free play via digital platforms, including fears of excess screen-time, digital dependency, and online threats, all of which risk limiting children's ability to independently explore their creativity and identities through digital play if not handled sensitively. Despite the hurdles to implementing digital play, this study exposes why it is essential for families to navigate this online terrain;this study ultimately poses that digital play and online platforms not only were beneficial to maintaining and building family resilience during the pandemic but will be vital assets in sustaining resiliency and positive mindsets moving forward with pandemic recovery. © The Author(s) 2023.

Media literacy's role in the mitigation of disinformation effects on substance misuse

Objective: Misinformation and substance use both increased substantially during the COVID-19 pandemic. This study examined potential links between misinformation beliefs and substance use among adults, along with the potential for media literacy to mitigate misinformation's influences on problematic use of widely available substances of misuse. Method(s): Structural equation modeling (SEM) was used to test a theoretical model of media literacy's effects on substance use, fully mediated by disinformation beliefs, with a nationally representative sample of U.S. adults recruited through a Qualtrics panel of adults using census-based quotas for geographic region, population density, ethnic diversity and gender (N = 1264). The sample was 51.5% male (N = 651);46.7% female (N = 591);1.1% nonbinary (N = 13);and 0.7% (N = 9) not reporting. Result(s): Media literacy for source of news positively associated with media literacy for content of news (b = 0.814, p < 0.001). Media literacy for content of news then positively associated with science media literacy (b = 0.192, p < 0.001). Science media literacy then negatively associated with disinformation beliefs (b = -0.586, p < 0.001), and COVID-19 disinformation beliefs associated with an increase in substance use (b = 0.466, p < 0.001). Disinformation beliefs also associated with alcohol and sleep medication co-use (odds = 1.956, p < 0.05). Conclusion(s): Results demonstrate media literacy's value for substance misuse prevention and effective public health messaging.Copyright © 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.

ONLINE CO-DESIGN OF A UNIVERSITY WORK-BASED LEARNING DEGREE PROGRAMME: LESSONS LEARNED FROM COMPARING CASES IN UNITED KINGDOM AND ESWATINI

Greater collaboration is required between universities, industry and society to provide the engineering education that will tackle society's challenges. Work-based learning (WBL) programmes offer an industry-aligned, academically-informed education to support such socio-economic development. Co-design of such programmes is vital with responses to the COVID-19 pandemic innovating alternative ways to design programmes. Knowles et al (2021) [1] outlined an approach to online programme co-design in the UK university context, framed using Signature Pedagogy and through online conferencing and Miro (online whiteboard). Subsequently, the approach has been utilised to co-design a WBL degree programme in Electrical Engineering in Eswatini, supported by Knowles and other UK and Eswatini colleagues. This paper compares and contrasts cases from UK and Eswatini, and from this address the research question, "What considerations are required to support an effective online process to co-design a work-based learning programme in Engineering?” A collaborative autoethnographic methodology based around field notes, observations and reflections is used to allow exploration across pedagogy, technology, work practices, expectations and challenges. Many aspects of the approach worked well in both cases (for example, effectiveness of Signature Pedagogy, Miro as shared space), whereas differences arose related to limitations in the synchronous use of technologies, and readiness to adopt an outcome-focused approach. Addressing these differences, along with balancing progress against full participation and having clear expectations of participants, are key considerations in online co-design of WBL programmes. Moreover, the approach of Knowles (ibid) has shown to be adaptable with potential for broader adoption. © 2022 SEFI 2022 - 50th Annual Conference of the European Society for Engineering Education, Proceedings. All rights reserved.

Impact of COVID-19 & Response Measures on HIV-HCV Prevention Services and Social Determinants in People Who Inject Drugs in 13 Sites with Recent HIV Outbreaks in Europe, North America and Israel.

HIV/HCV prevention among people who inject drugs (PWID) is of key public health importance. We aimed to assess the impact of COVID-19 and associated response measures on HIV/HCV prevention services and socio-economic status of PWID in high-HIV-risk sites. Sites with recent (2011-2019) HIV outbreaks among PWID in Europe North America and Israel, that had been previously identified, were contacted early May 2020. Out of 17 sites invited to participate, 13 accepted. Semi-structured qualitative site reports were prepared covering data from March to May 2020, analyzed/coded and confirmed with a structured questionnaire, in which all sites explicitly responded to all 103 issues reported in the qualitative reports. Opioid maintenance treatment, needle/syringe programs and antiretroviral treatment /hepatitis C treatment continued, but with important reductions and operational changes. Increases in overdoses, widespread difficulties with food and hygiene needs, disruptions in drug supply, and increased homelessness were reported. Service programs rapidly reformed long established, and politically entrenched, restrictive service delivery policies. Future epidemic control measures should include mitigation of negative side-effects on service provision and socio-economic determinants in PWID.

RESUMEN: La prevención del VIH/VHC entre las personas que se inyectan drogas (PWID) es de vital importancia para la salud pública. Nuestro objetivo fue evaluar el impacto de COVID-19 y las medidas de respuesta asociadas en los servicios de prevención del VIH/VHC y el estado socioeconómico de las PWID en sitios de alto riesgo de VIH. Se contactó con sitios con brotes recientes (2011­2019) de VIH entre PWID en Europa, América del Norte e Israel, que habían sido previamente identificados, a principios de mayo de 2020. De los 17 sitios invitados a participar, 13 aceptaron. Se prepararon informes cualitativos semiestructurados del sitio que cubrían los datos de marzo a mayo de 2020, analizados/codificados y confirmados con un cuestionario estructurado, en el que todos los sitios respondieron explícitamente a los 103 asuntos reportados en los informes cualitativos. El tratamiento de mantenimiento con opiáceos, los programas de agujas/jeringas y el tratamiento antirretroviral/tratamiento de la hepatitis C continuaron, pero con importantes reducciones y cambios operativos. Se reportaron aumentos en las sobredosis, dificultades generalizadas con las necesidades alimentarias y de higiene, interrupciones en el suministro de medicamentos y aumento de personas sin hogar. Los programas de servicios reformaron rápidamente las políticas restrictivas de prestación de servicios, establecidas desde hace mucho tiempo y políticamente arraigadas. Las futuras medidas de control de epidemias deben incluir la mitigación de los efectos secundarios negativos en la prestación de servicios y los determinantes socioeconómicos en las PWID.

A Systems 'Analysis of Latine Education in Massachusetts: A Call for Critical Intercultural Integration

Despite attending schools in a state internationally recognized for innovation, research and education, Latine students in Massachusetts, USA continue to disproportionately experience discrimination, economic segregation, health disparities and racial inequities that have shaped their schooling experiences and outcomes across the educational pipeline (Colon, "We are beautiful people": The schooling experiences of Puerto Rican school-aged mothers [PhD Thesis]. Tufts University, 2019). Grounded in critical analysis of intercultural education towards social justice (Pica-Smith et al., Social justice education in European multi-ethnic schools. Addressing the goals of intercultural education. Routledge Taylor & Francis Group, London, 2019), this paper critically examines publicly available data to highlight barriers, opportunities and the need for educational researchers, policymakers and administrators to collectively reimagine an educational project that attends to the needs of this population. In the context of the unyielding disparate impact of COVID-19, we argue that more ever, this reimagination needs to be grounded in the dynamic conception of culture (Levitt et al., International Migration Review, 38, 1002, 2004), intercultural perspectives on education that are based on critical notions of intergroup contact, dialogue and exchange (Allport, Forms and techniques of altruistic and spiritual growth: a symposium, 1954, 367;Council of Europe, White paper on intercultural dialogue. Living together as equals in dignity, Strasburgo, 2008) and multidimensional notion of belonging at the micro and macro levels for a more just education writ large.

CLUSTER Trial An 82 U.S. Hospital Cluster Randomized Trial (CRT) to Assess the Impact of an Automated Statistical Outbreak Detection Tool and Response Protocol to Limit Hospital Transmission

Background. The CLUSTER trial assessed the impact of prospective identification of clusters coupled with a response protocol on the containment of hospital clusters. Methods. This 82-hospital CRT in 16 states compared clusters of bacterial and fungal healthcare pathogens using a statistical outbreak detection tool (WHONET-SaTScan) coupled with a standardized response protocol (automated cluster detection arm) compared to routine surveillance with the response protocol (control arm). Trial periods: 24 mo Baseline (2/17-1/19);5 mo Phase-in (2/19-6/ 19);30 mo Intervention (7/19-1/22). The primary outcome was the number of additional cases occurring after initial cluster detection. Analyses used generalized linear mixed models to assess differences in additional cases between the intervention vs baseline periods across arms, clustering by hospital. Results were assessed overall and, to account for the effect of COVID-19 on hospital operations, stratified into pre-COVID-19 (7/19-6/20) and during COVID-19 (7/20-1/22) intervention periods. We also assessed the probability that a patient was in a cluster. Results. In the baseline period, the automated cluster detection and control arms had 0.09 and 0.07 additional cluster cases/1000 admissions, respectively. The automated cluster detection arm had a 22% greater relative reduction in additional cluster cases in the intervention vs baseline period compared to control (P=0.5). Within the intervention period, the automated cluster detection arm had a significant 64% relative reduction pre-COVID-19 (P< 0.05) and a non-significant 6% relative reduction during COVID-19 (P=0.9) compared to control (Figure). When evaluating patient risk of being part of a cluster across the entire intervention period, the automated cluster detection arm had a significant 35% relative reduction vs control (P< 0.01). Conclusion. A statistical automated tool coupled with a response protocol improved cluster containment by 64% pre-COVID-19 but not during COVID-19;there were no significant differences between the arms when using the entire intervention period. Automated cluster detection may substantially improve outbreak containment in non-pandemic periods when infection prevention programs are able to optimize containment protocols. (Figure Presented).

siRNA silencing of cellular entry proteins as a gene therapy strategy for Covid-19

SARS-CoV-2 remains a significant public health threat, causing severe respiratory illness in susceptible individuals. Several effective Covid-19 vaccines have been developed but novel SARS-CoV-2 variants continuously emerge that are more transmissible and have potential to evade vaccine immune responses. We are developing a novel therapy that does not depend on an immune response, based on siRNA-mediated silencing of Angiotensin-converting enzyme 2 (ACE2) receptor and Transmembrane Serine Protease 2 (TMPRSS2). SARS-CoV-2 requires these host proteins to enter respiratory epithelial cells at the cell surface, through binding and priming of its Spike protein. As a cell model for SARS-CoV-2 infection, we have utilised primary nasal epithelial cells (NHNE), as well as HEK293T cells overexpressing ACE2 and TMPRSS2. siRNA transfection in NHNE cells led to a 78%-88% knockdown of ACE2 and TMPRSS2, as determined by qRT-PCR and western blot data. TMPRSS2 knockdown in the overexpressing HEK293T cells resulted in an 87% reduction in infectivity from SARS-CoV-2 Spike-pseudotyped lentiviruses expressing a luciferase transgene, indicative of a significant reduction in virus entry (p < 0.0001 by one-way ANOVA). We are now working to confirm these results with live SARS-CoV-2 and to test lipid nanoparticle delivery of the siRNAs to air-liquid interface grown NHNEs to more accurately model the respiratory airway. This siRNA approach could provide a novel therapy for immunocompromised individuals who do not gain sufficient protection from SARS-CoV-2 vaccines. Additionally, by targeting host proteins rather than virus components, our therapy is likely to remain effective in spite of emerging SARS-CoV-2 variants that circumvent pre-existing immune responses.

VRCT: Randomized Controlled Trial Evaluating the Impact of Virtual Reality Therapy on BPSD and QoL of Acute Care In-Patients With Dementia

Background: Virtual Reality (VR) is increasingly considered a valuable therapy tool for managing behavioural and psychological symptoms (BPSDs) and quality of life (QoL) in dementia (Parsons, 2013). However, rigorous studies are still needed to evaluate its impact in acute care settings (Appel, 2021). This study evaluated the impact of VR-therapy on managing BPSDs, falls, and length of stay (LoS) and QoL for inpatients with dementia admitted to an acute care hospital. Method(s): An open longitudinal interventional randomized controlled trial was conducted between April 2019 and March 2020 (ClinicalTrials.gov, ID:NCT03941119). A total of 69 participants (age >=65, diagnosis of dementia, did not meet exclusion criteria) (Figure 1) who were randomly assigned either followed standard of care (Control Arm, n = 35 or received VR-therapy every 1-3 days (Intervention Arm, n = 34) (Figure 2). VR-therapy entailed watching 360-degree-VR-films on a HMD for up to 20 minutes (Figures 3 and 4). Instances of daily BPSDs documented in EMR nursing notes were categorized based on the Neuropsychiatric Inventory (NPI). QoL measures included the Quality of Life in Late-Stage Dementia scale (QUALID) and semi-structured interviews conducted at scheduled visits. Structured observations (including the standardized "ObsRVR" tool) and interviews were used to measure treatment feasibility (Figure 5). Result(s): VR-therapy had a statistically significant effect (p =.014) in reducing aggressivity (i.e., physical aggression and loud vociferation). A sentiment analysis of patient responses to the semi-structured interviews on QoL revealed a statistically significant impact of VR therapy (p =.013). No statistically significant impact of VR therapy was found for other BPSDs (e.g., apathy), falls, or LoS or QoL as measured by the QUALID. VR-therapy was overall an acceptable and enjoyable experience for participants and no adverse events occurred as a result of VR-therapy. Conclusion(s): Immersive VR-therapy appears to have an effect on aggressive behaviours and QoL in acute care patients with dementia. Although the RCT was stopped before reaching the intended sample size due to COVID-19 restrictions, trends in the results are promising. We suggest conducting future trials with larger samples and, in some cases, more sensitive data collection instruments. Copyright © 2022 the Alzheimer's Association.

Facteurs prédictifs d'une poussée de psoriasis après une infection par le SARS-CoV-2 chez l'enfant

Introduction: La pandémie à SARS-CoV-2 a été source de nombreuses questions quant à l'impact de l'infection sur les dermatoses inflammatoires chroniques, et de l'impact des traitements de ces dermatoses sur la sévérité de l'infection. Le registre international Chi-PsoCov (enfants psoriasique souffrant de psoriasis et ayant développé une infection à SARS-CoV-2) a permis de montrer que les biothérapies n'augmentaient pas le risque de formes sévères de COVID-19 chez les enfants atteints de psoriasis. Par ailleurs, il était montré que le COVID-19 était responsable du développement de psoriasis de novo ou de l'aggravation d'un psoriasis connu chez certains enfants.Dans cette partie du travail nous nous sommes concentrés sur les enfants ayant développé une poussée de psoriasis après l'infection : aspects phénotypiques des poussées, et recherche de facteurs de risque liés à la maladie, au psoriasis, ou aux traitements, associés à l'aggravation du psoriasis après l'infection. Matériel et méthodes: Les données ont été collectées de février 2021 à mai 2022 en provenance de 14 pays. Les enfants étaient inclus s'ils avaient moins de 18 ans, un antécédent de psoriasis ou psoriasis apparu dans le moins suivant l'infection COVID-19, et avaient été infectés par le SARS-CoV-2 avec ou sans symptômes. Les enfants ayant développé un psoriasis de novo étaient exclus de cette étude. Résultats: Sur les 152 inclusions du registre Chi-PsoCov, dix enfants ont développé un psoriasis dans le mois suivant l'infection et n'ont pas été retenus dans ce travail. L'analyse a porté sur 135 enfants ayant développé 142 COVID-19. Le psoriasis était stable dans 120 cas (84,5 %) et s'aggravait dans le mois suivant l'infection dans 22 cas (15,5 %).Dans 20 cas, lors de la poussée, le phénotype était inchangé, et dans 2 cas, il y avait un changement de phénotype : psoriasis en plaques en psoriasis en gouttes (n = 1) ou inversé (n = 1).Ni les caractéristiques démographiques, ni les aspects du psoriasis (notamment psoriasis actif vs en rémission), ni la sévérité de l'infection à SARS-CoV-2 n'étaient associés à des poussées de psoriasis. Seule l'utilisation de traitements systémiques du psoriasis, conventionnels ou biothérapies, lors de l'infection semblait protectrice de la survenue de poussées (50,0 % dans le groupe stable vs 27,3 % dans le groupe poussées, p = 0,049). Discussion: L'infection à SARS-CoV-2 est responsable dans environ 15 % des cas de poussées de psoriasis. Dans la grande majorité des cas, le phénotype précédent l'infection est conservé. Ces poussées ne sont pas associées à la sévérité du psoriasis, de l'infection ou autres paramètre cliniques. Seuls les traitements systémiques semblent réduire ce risque, probablement en « contrôlant » la poussée. Il est possible qu'une susceptibilité d'ordre génétique, non explorée ici, explique aussi cette susceptibilité à l'infection.

COVID-19 et psoriasis de l'enfant : facteurs associés à une évolution défavorable de la COVID-19 et impact de l'infection sur le psoriasis. Registre Chi-PsoCov

Introduction: La pandémie à SARS-CoV-2 a soulevé de nombreuses questions sur la prise en charge des maladies chroniques et leurs traitements. Les données concernant l'utilisation des biothérapies chez les adultes atteints de psoriasis sont rassurantes, mais manquent chez l'enfant. Par ailleurs, l'infection à SARS-CoV-2 pourrait influencer l'évolution du psoriasis chez l'enfant. L'objectif de cette étude était d'évaluer l'impact de l'infection à SARS-CoV-2 sur le psoriasis, et la sévérité de l'infection selon le traitement systémique reçu. Matériel et méthodes: Les données ont été collectées de février 2021 à février 2022 en provenance de 14 pays. Les enfants étaient inclus s'ils avaient moins de 18 ans, un antécédent de psoriasis ou apparu dans le moins suivant l'infection COVID-19, et avaient été infectés par le SARS-CoV-2 avec ou sans symptômes. Résultats: Au total, 117 enfants ont été inclus (filles : 49,6 %, âge moyen : 12,4 ans) avec 120 infections) SARS-CoV-2. La principale forme de psoriasis était le psoriasis en plaques (69,4 %) ;le psoriasis était actif avant l'infection dans 70,1 % des cas. La majorité des enfants ne prenaient pas de traitement systémique au moment de l'infection (54,2 %), 33 enfants (28,3 %) étaient sous biothérapie (principalement anti-TNF alpha et ustékinumab), et 24 (20,0 %) sous traitement systémique conventionnel (principalement méthotrexate). L'infection était confirmée chez 106 enfants (88,3 %) et 3 ont eu la maladie 2 fois (1 enfant asymptomatique sous ustékinumab et 2 enfants symptomatiques sans traitement systémique). L'infection était symptomatique chez 75 enfants (62,5 %) avec une durée moyenne des symptômes de 6,5 jours, significativement plus longue chez les enfants sous traitement systémique conventionnel (p = 0,002) ou sans traitement systémique (p = 0,006) par rapport aux enfants traités par biothérapies. Six enfants ont nécessité une hospitalisation, dont un enfant en réanimation ;ils étaient plus fréquemment sous traitements systémiques conventionnels par rapport aux autres enfants (p = 0,01), et principalement sous méthotrexate (p = 0,03). Aucun enfant sous biothérapie n'a été hospitalisé, et aucun décès n'a été rapporté.Après l'infection, le psoriasis s'est aggravé dans 17 cas (15,2 %), sans modification du phénotype sauf pour un enfant avec un psoriasis initialement en plaques qui a eu suite à l'infection une poussée de psoriasis en gouttes. Neuf enfants (8,0 %) ont développé un psoriasis de novo dans le mois qui a suivi l'infection, plus souvent un psoriasis en gouttes (p = 0,01) par rapport aux enfants ayant un antécédent connu de psoriasis. Ces enfants avaient un antécédent familial de psoriasis dans 75,0 % des cas. Discussion: L'utilisation des biothérapies semble rassurante sans augmentation du risque de forme sévère de COVID-19 chez les enfants atteints de psoriasis. L'infection à SARS-CoV-2 était responsable du développement de psoriasis de novo ou de l'aggravation d'un psoriasis connu chez certains enfants.