Post-Secondary Student Belonging in a Virtual Learning Environment during Covid-19

Psychological and social adjustment and academic success in post-secondary institutions are supported by a sense of belonging to a social group and having meaningful relationships with other students, staff, and faculty members. This exploratory study used a qualitative approach to investigate post-secondary students' sense of belonging in the virtual learning environment during the COVID-19 pandemic. The study was conducted at a small Western Canadian university. Semi-structured interviews were conducted with 20 participants who were undergraduate students, from various faculties, and in different years in their programs. Findings were clustered into three themes: (1) student expectations of university, (2) impact of virtual learning environments on students, and (3) the role of educators. Recommendations are included to enhance support and belonging for post-secondary students in virtual learning environments.

The Informal Safety Net: Social Network Activation among Hispanic Immigrants during COVID-19

During times of crisis, individuals may activate members of their social networks to fulfill critical support functions. However, factors that may facilitate or inhibit successful network activation are not fully understood, particularly for structurally marginalized populations. This study examines predictors of network activation among recent and established Hispanic immigrants during the COVID-19 pandemic. Specifically, using unique, longitudinal data from the VidaSana study and its supplemental survey, the COVID-19 Rapid Response study (N = 400), we ask: How are COVID-related stressors associated with goal-oriented network activation (e.g., health-focused activation) among Hispanic immigrants? How might structural and compositional characteristics of social networks facilitate or inhibit successful network activation during COVID-19? Results align with theories of network activation (i.e., functional specificity) that imply that individuals engage in selective and deliberate activation of networks. That is, we observe a congruency between COVID-related stressors and social network characteristics, and distinct types of network activation. Moreover, we find that respondents experiencing pandemic-induced economic difficulties engage in activation for financial assistance only if they are embedded in a higher-educated network. We discuss the implications of these findings and provide recommendations for future research. © American Sociological Association 2023.

Public Health and Political Corporate Social Responsibility: Pharmaceutical Company Engagement in COVAX

Pharmaceutical companies developed Covid-19 vaccines in record time. However, it soon became apparent that global access to the vaccines was inequitable. Through a qualitative inquiry as the pandemic unfolded (to mid-2021), we provide an in-depth analysis of why companies engaged with the Covid-19 Vaccines Global Access Facility (COVAX), identifying the internal (to the company) and external factors that facilitated or impeded engagement. While all producers of the World Health Organization (WHO)-approved vaccines engaged with COVAX, our analysis highlights the differential levels of COVAX engagement and identifies contractual obligations, opportunities and company strategy, and reputational pressures as key explanatory factors. We discuss our empirical findings relative to the literature on political corporate social responsibility (PCSR). Accordingly, we question whether pharmaceutical companies lived up to their responsibilities as corporate citizens and conclude that they failed to fulfill the implied responsibility of combating inequitable vaccine distribution. We conclude with implications of our research for practice, in relation to the challenges of global access to Covid-19 vaccines and for access to medicines more generally. © The Author(s) 2023.

Real-world effectiveness of remdesivir for hospitalized patients with COVID-19: systematic review and metaanalysis

Introduction: Trials of remdesivir (RDV) for COVID-19 have provided evidence for regulatory approval. This is the first meta-analysis (MA) to evaluate the real-world effectiveness of RDV in patients hospitalized with COVID-19. Objective(s): To synthesize RDV observational data. Method(s): A systematic literature review identified observational studies of RDV. Outcomes were all-cause mortality and progression to invasive mechanical ventilation (IMV) assessed at early (day 14/15) and late (day 28/29/30) timepoints. MAs were conducted using standard random effects models;analyses were performed with R statistical software. Result(s): Of 1,069 studies identified, 29 met inclusion criteria for mortality data, 18 were excluded for low quality based on the ROBINS-I tool;11 studies from the United Kingdom, European Union, United States and Japan were included in the MA (N=166,399 patients). RDV was associated with a significant improvement in mortality at early (5 studies;risk ratio [RR] 0.71, 95% confidence interval [CI] 0.64-0.79) and late (10 studies, RR 0.82, 95%CI 0.71-0.95;Figure) timepoints. No significant effect was shown on the proportion of patients requiring IMV (evaluable only in the 3 studies denoted by asterisk in Figure, RR 1.07, 95%CI 0.84-1.34). Results were robust to scenario analyses. Conclusion(s): In a real-world setting, RDV is effective in reducing mortality in hospitalized COVID-19 patients.

Post-Secondary Student Belonging in a Virtual Learning Environment During COVID-19

Psychological and social adjustment and academic success in post-secondary institutions are supported by a sense of belonging to a social group and having meaningful relationships with other students, staff, and faculty members. This exploratory study used a qualitative approach to investigate post-secondary students' sense of belonging in the virtual learning environment during the COVID-19 pandemic. The study was conducted at a small Western Canadian university. Semi-structured interviews were conducted with 20 participants who were undergraduate students, from various faculties, and in different years in their programs. Findings were clustered into three themes: (1) student expectations of university, (2) impact of virtual learning environments on students, and (3) the role of educators. Recommendations are included to enhance support and belonging for post-secondary students in virtual learning environments. © 2022, Canadian Society for Studies in Higher Education. All rights reserved.

Magnetic hydrogel particles improve nanopore sequencing of SARS-CoV-2 and other respiratory viruses.

Presented here is a magnetic hydrogel particle enabled workflow for capturing and concentrating SARS-CoV-2 from diagnostic remnant swab samples that significantly improves sequencing results using the Oxford Nanopore Technologies MinION sequencing platform. Our approach utilizes a novel affinity-based magnetic hydrogel particle, circumventing low input sample volumes and allowing for both rapid manual and automated high throughput workflows that are compatible with Nanopore sequencing. This approach enhances standard RNA extraction protocols, providing up to 40 × improvements in viral mapped reads, and improves sequencing coverage by 20-80% from lower titer diagnostic remnant samples. Furthermore, we demonstrate that this approach works for contrived influenza virus and respiratory syncytial virus samples, suggesting that it can be used to identify and improve sequencing results of multiple viruses in VTM samples. These methods can be performed manually or on a KingFisher automation platform.

Implementation of Federalism in Nepal: The Devil is in the Detail

After a long period of instability, Nepal adopted a new Constitution in 2015, creating a multiparty federal republic. Previously Nepal had been a unitary state, albeit with a long period of political instability and insurgencies. In 2017 the two competing communist parties merged to form the ruling Nepal Communist Party (NCP), which operated with a 2/3rd majority in the House of Representatives. The implementation of federalism has been slow and uneven. Despite assurances to the contrary, the government's response to the COVID-19 pandemic has been lacking, with Constitutional obligations ignored. The machinations of the then Prime Minister have exacerbated this, apparently supported by the President to overcome constitutional norms to keep the Prime Minister in power. The paper analyses the devolution of powers to the provincial and local levels described in the constitution. There have been successes and failures. There appeared to be a concerted effort from the federal parliament and some in the bureaucracy to continue to centralize power. This early inaction has hindered its response to the pandemic. Of even more concern is the then prime minister's role as he sought to maintain his hold on power by ignoring the provisions of the Constitution. © 2022, Universitas Negeri Semarang. All rights reserved.

Utilizing Genomic Epidemiology to Explore SARS CoV-2 Transmission Patterns and Support Outbreak Investigations in Long Term Care Facilities, Washington State, April-October 2021

Background. In Washington State, COVID-19 cases in long-term care facilities (LTCF) have accounted for less than 3% of all cases, yet 30% of all COVID-19 deaths. Understanding transmission patterns and outbreak epidemiology informs outbreak management. From April to October 2021, two large LTCFs experienced COVID-19 outbreaks. Whole genome sequencing and phylogenetic analysis were leveraged to explore transmission patterns and complement outbreak epidemiology. Methods. Epidemiologic data was exported from the Washington Disease Reporting System. Sequences, retrieved from GISAID, were aligned to the Wuhan-1 reference genome using Nextalign version 1.11.0. Pairwise single nucleotide polymorphism (SNP) distance matrices were calculated using SNP-Dists version 0.8.2. Phylogenetic trees for each outbreak were generated using IQ-Tree multicore version 2.2.0-beta COVID-edition using the GTR+F+G4 nucleotide substitution model with 1000 bootstrap replicates. MicrobeTrace was used to visualize the phylogeny, SNP heatmap, and identify clusters among sequences. Results. Weekly, LTCF A tested 162 residents and 800 staff, and LTCF B tested 60 residents and 144 staff. Of all cases in LTCF A (n= 119), 23% (n =27) were residents and 77% (n = 92) were staff, compared to 78% (n =28) residents and 22% (n =7) staff among total LTCF B cases (n=36). In LTCF A, 34% (n=40) of the cases had highquality sequences available. Seven clusters of two or more genetically related sequences and thirteen genetically unrelated sequences were identified. Five of the clusters involved resident and staff cases, linked by unit. Two clusters and remaining unrelated sequences were among staff. In LTCF B, 40% (n=14) of the cases had high-quality sequences available. One cluster of genetically related sequences was identified, all from residents of two floors. The SNP differences between sequences from LTCF A ranged from 0 to 70, whereas SNP differences between LTCF B sequences ranged from 0 to 6. Conclusion. Phylogenetic analysis of the two outbreaks confirms differences in disease transmission patterns. Multiple independent introductions of SARS-CoV-2 were identified in LTCF A, compared to a single introduction in LTCF B. Genomic epidemiology is a valuable resource for outbreak investigation and management.

SARS-CoV-2 Illness Severity and Early Hospitalization Outcomes in a Multicenter Prospective Cohort Study Among Veterans

Background. Over 600,000 SARS-CoV-2 infections and 20,000 deaths have occurred among users of the Veterans Health Administration, the US's largest integrated health care system. We explored early outcomes of SARS-COV-2 infection in Veterans. Methods. An ongoing, prospective longitudinal cohort study of Veterans ages >= 18 enrolled 1,826 participants (29.0% inpatient;49.1% vaccinated;68.3% SARS-CoV-2-positive;85.0% male, mean age = 57.1 years) seeking inpatient or outpatient care after SARS-CoV-2 testing at 15 Department of Veterans Affairs medical centers in July 2020 to February 13, 2022. Using multivariable regression, we estimated relationships of baseline demographic characteristics, COVID-19 vaccination, and clinical history to illness severity and cumulative length of hospital stay within 60 days of study entry. Illness severity was defined by a Veterans Affairs adaptation of the WHO COVID-19 severity scale and included 4 levels (mild, moderate, severe, or death). We derived the Charlson co-morbidity index (CCI) and other baseline characteristics from electronic health data and study questionnaires, and reported qualitative SARS-CoV-2 IgG responses using inpatients' study-collected blood specimens. Results. High CCI scores (>= 5) occurred in 47 (42.7%) vaccinated SARS-CoV-2-positive inpatients and 47 (21.2%) unvaccinated. Severe illness occurred in 17 (15.5%) vaccinated inpatients, 37 (16.7%) unvaccinated inpatients, 4 (0.9%) vaccinated outpatients, and 3 (0.7%) unvaccinated outpatients. Eleven (10%) of 110 vaccinated SARS-CoV-2-positive inpatients died, as did 15 (6.8%) of the 222 unvaccinated. In SARS-CoV-2-positive inpatients, a one-step higher CCI was associated with more severe illness (aOR 1.10, 95%CI 1.01-1.20) and more hospitalization days (aIRR 1.06, 95% CI 1.03-1.10), adjusting for vaccination status. Respectively, 93% of vaccinated and 63% of unvaccinated SARS-CoV-2 positive inpatients with baseline antibody results had an anti-spike IgG response. Conclusion. In an ongoing longitudinal cohort study of COVID-19 in US Veterans, comorbidity burden was higher among vaccinated than unvaccinated inpatients and was associated with more severe illness and hospitalization days, independent of vaccination status.

Effect of Chronic Oral Therapeutic Anticoagulation on Thrombotic Morbidity and Mortality in Patients Hospitalized with COVID-19

Introduction: Infection with SARS-CoV-2 increases the risk of thrombosis and subsequently mortality. The impact of chronic anticoagulation prior to infection, however, is not well defined. Research Question or Hypothesis: Does the use of indicated chronic anticoagulation alter morbidity and mortality from thrombotic complications of COVID-19 in hospitalized patients? Study Design: Single-centered, retrospective chart review from March to December 2020. Method(s): Hospitalized adult patients with a positive COVID-19 test with or without chronic therapeutic anticoagulation were included. Exclusion criteria included pregnancy and hypercoagulable comorbidity not on anticoagulation. The primary endpoint was a combined incidence of venous thromboembolism, arterial thrombosis, myocardial infarction, ischemic stroke, and disseminated intravascular coagulation. Additional endpoints included ventilation or high-flow oxygen requirement, development of acute respiratory distress syndrome (ARDS) or respiratory failure, and bleeding. 152 patients per group would provide 80% power and a two-sided alpha of 0.05 for the primary outcome. Outcomes were analyzed with Chi-square or Fisher's exact tests using SPSS software. Result(s): 733 patients were included (453 not on anticoagulation (No- AC) and 280 on chronic anticoagulation (AC)). There were no differences in baseline characteristics between groups except for the Charlson Comorbidity Index score (No-AC: 4.8, AC: 5.8;p < 0.001). For the primary endpoint, events occurred in 133 patients (29.4%) in the No- AC group versus 27 patients (9.6%) in the AC group (p < 0.001). For the secondary endpoints, there were differences in need for ventilation [No-AC: 101 (22.3%), AC: 39 (13.9%);p = 0.005] and development of ARDS [No-AC: 252 (55.6%), AC: 124 (44.3%);p = 0.003], with no difference in bleed [No-AC: 5 (1.1%), AC: 7 (2.5%);p = 0.15]. Conclusion(s): Patients hospitalized with COVID-19 infection on chronic anticoagulation had lower incidence of thrombosis and mortality.

Validation of a hospital-acquired venous thrombosis risk assessment model: The medical inpatient thrombosis and hemostasis (MITH) study

Background: To reduce the risk of hospital-acquired venous thrombosis (HA-VTE) in medical patients, guidelines recommend assessing HA-VTE risk and providing prophylaxis for those at high risk. Risk assessment models (RAMS) including objective risk factors available at admission remain an unmet clinical need. Aim(s): To develop and validate a RAM for HA-VTE in medical inpatients using data available to providers within 24-h of hospital admission. Method(s): We developed a HA-VTE RAM at the University of Vermont Medical Center (Burlington, Vermont, USA, Table 1) and validated this RAM at Michigan Medicine (Ann Arbor, Michigan, USA, Table 2). HA-VTE and the risk factors were identified using previously validated computable phenotypes. The RAM was developed using a Bayesian LASSO approach with model performance assessed using area under the receiver operating curves (AUC) and the slope of observed versus expected plot. People admitted with VTE were excluded. The research was approved by the Institutional Review Board funded by the National Institutes of Health and the Centers for Disease Control and Prevention, USA. Result(s): Table 1 presents the risk factors, odds ratios (OR) and 95% credible intervals (CI) for the HA-VTE RAM, which included 11 risk factors. For the development cohort, based on 219 events among 62,468 admissions, the AUC of the model was 0.75 and the observed versus expected slope was 1.11 (Table 2). In the validation cohort there were 48,265 admissions and 363 HA-VTE events with a younger population and a higher incidence of HA-VTE. The AUC and the observed versus expected slope were 0.69 and 0.89 (Table 2). Conclusion(s): We developed and validated a HA-VTE RAM in populations. The model fit and calibration are promising especially given these are two geographically diverse institutions. Further validation is in progress at additional hospitals as well as in people hospitalized with COVID-19.

Telehealth visits for contraception during the covid-19 pandemic: A national survey

To examine demographic, socioeconomic, and regional differences between in-person and telehealth contraception visits and telehealth visit quality in the US during the COVID-19 pandemic. In July 2020 and January 2021, we surveyed reproductive-aged women about experiences seeking contraception. We created a COVID-19 hardship score assessing pandemic-related job, income, and housing loss and a telehealth quality score assessing telehealth visit convenience, communication, and privacy. We used chi-square tests and multivariable logistic regression to examine relationships between baseline variables and in-person vs. telehealth visits and telehealth quality scores. Among 2,028 respondents who answered questions about contraception visits, 1,490 (73.4%) reported any visit, of which 530 (35.6%) were telehealth. In adjusted analyses, respondents identifying as Hispanic/Latina and mixed race/other (adjusted OR (aOR), 0.59 and 0.36, respectively), from the South, Midwest, or Northeast (aOR, 0.63, 0.64, 0.52, respectively), without insurance (aOR 0.63), and with greater COVID-19 hardship (aOR 0.52) had significantly lower odds of attending any visit (all p<0.05). Among respondents with any visit for contraception, respondents from the Midwest and South had significantly lower odds of having a telehealth versus in-person visit (aOR 0.63 and 0.54 respectively, p<0.01). Hispanic/Latina respondents and those in the Northeast had significantly lower odds of reporting high telehealth quality (≥75th percentile) (aOR 0.53 and 0.65, respectively, p<0.05). Disparities in telehealth usage for contraception among people identifying as Hispanic/Latina and people in the South and Midwest, and in telehealth quality among Hispanic/Latina people. Further research should focus on patients' desires around telehealth and increasing access to telehealthcare. [ FROM AUTHOR]

Characterization, Contributing Factors, And Outcomes Of Bleeding Complication In Extracorporeal Membrane Oxygenation for SARS-CoV-2 Pneumonia: A Single-Institution Experience

Background: SARS-CoV-2 (i.e., COVID-19) has brought extracorporeal membrane oxygenation (ECMO) into the forefront of critical care. Its unique pathophysiology has added a level of complexity to ECMO therapy, particularly, the hematologic manifestations. Here we detail the spectrum and outcomes of bleeding complications in ECMO for COVID-19 and identify potential contributing factors. Methods: All patients who received ECMO for SARS-CoV-2 pneumonia severe acute respiratory distress syndrome at our institution between March 1, 2020 and April 12, 2021 were reviewed. Patient characteristics, laboratory results, and overall outcomes were recorded. Bleeding events were reviewed with regard to the type/location and intervention required. Severity was graded according to the degree of intervention for treatment (1 [conservative or minor] - 3 [major, life-threatening, or operative]). Laboratory results and patient characteristics were compared between patients with bleeding events and those without to identify factors associated with bleeding risk. Results: Fifty-four patients (mean age 53.2 years, 61.1% female, 51.9% Caucasian) underwent ECMO cannulation for SARSCoV-2 pneumonia at our institution. Thirty-eight (70.4%) received veno-pulmonary artery ECMO. The mean duration of support was 33.2 days with an in-hospital mortality of 42.6%. 68.5% of patients experienced at least one bleeding event during their ECMO course with 92 bleeding events (n=23 [grade 1], n=31 [grade 2], n=38 [grade 3]) over 1804 cannulation days. The most common types of bleeding types were nasal/oropharyngeal (n=30, 32.6%), pulmonary (n=18, 19.6%), and gastrointestinal (n=11, 12.0%). Eight (16.0%) patients required operative intervention and 11 (20.3%) died as a result of a bleeding event, mainly due to intracranial hemorrhages (n=5, 9.3%). There was no difference in the mean cumulative function for bleeding events between different ECMO support modalities (p=0.85) which demonstrated a linear pattern over time. Factors that increased the risk of bleeding included patient cumulative volume balance (OR 1.22 per 1000 mL increase from admission, p<0.001) while higher platelet count (OR 0.83 per 50x103/uL increase, p=0.03) was protective. Conclusion: ECMO for SARS-CoV-2 pneumonia is associated with a diverse and unique profile of bleeding complications. The incidence of bleeding complications is linearly related to cannulation duration. Certain patient factors may affect the risk of bleeding while on ECMO.

REACTIVE INFECTIOUS MUCOCUTANEOUS ERUPTION (RIME) THROUGH REASON: EVALUATING ORAL SWELLING IN A PATIENT WITH COVID-19

CASE: A 22-year-old woman with h/o asthma initially presented to the hospital with lip swelling and sore throat. She tested positive for COVID-19 and received a casirivimab-imdevimab (monoclonal antibody) infusion. She returned a week later with worsening lip swelling, dysphagia and conjunctivitis. Physical exam revealed edematous lips with vesicular lesions, no tongue swelling, tonsillar exudate, 4+ conjunctival injection bilaterally with purulent discharge, and shallow clean based clitoral ulceration. She reports no history of allergic reactions, angioedema or exposure to new medications. Nasopharyngolaryngoscopy showed no laryngeal edema but visualized exudates throughout the supraglottis and glottis. C4, ANA, CMV, EBV, throat and blood cultures were negative. STI testing was trichomonas positive and gonorrhea/chlamydia negative. Respiratory virus panel remained positive for COVID-19. HSV swab of lip lesion, HSV 1/2 IgG and IgM were negative. Mycoplasma pneumoniae IgG was elevated (0.60, negative is ≤0.09), IgM equivocal (0.85, negative is ≤0.76), and nasopharyngeal PCR negative. Conjunctival culture showed rare bacteria (S. Aureus) and no leukocytes. She initially received methylprednisolone IV due to concern for angioedema, acyclovir for empiric HSV treatment and empiric antibacterial moxifloxacin eye drops. Given lack of infectious trigger, her presentation was concerning for reactive infectious mucocutaneous eruption (RIME) associated with SARSCoV-2 or Mycoplasma. Prednisone 1mg/kg daily was initiated followed by improvement in oral mucositis and conjunctivitis within days. IMPACT/DISCUSSION: A broad differential is important when evaluating oral swelling and mucositis. Her lack of cutaneous involvement, medication exposure or family history and negative infectious, autoimmune and inflammatory workup make other causes including Stevens-Johnson syndrome, erythema multiforme, angioedema, and HSV less likely. Our final diagnosis of RIME describes mucocutaneous eruptions likely due to an immune response triggered by bacterial or viral infection. Our patient's RIME may be due to COVID-19 or Mycoplasma given her equivocal Mycoplasma IgM. Eruptions generally involve two or more mucosal sites and occur mostly in children and adolescents. Common presentations include oral erosions and ulcers, purulent bilateral conjunctivitis, or urogenital lesions, which were all seen in our patient. As this is a relatively rare and new condition, no standard of care treatment exists for RIME but systemic steroids have been effective in case reports for initial treatment and subsequent flares. CONCLUSION: RIME is a rare, newly described condition in young patients who develop postinfectious mucocutaneous eruptions of two or more mucosal sites. It has been recently reported in association with COVID-19 and its association with Mycoplasma infection is important to evaluate. This condition is important to recognize and treat given the requirement for higher dose steroids than that used for angioedema.

A tale of two pandemics: Fake news and COVID-19

Whilst fake news has been around since the time of Aesop and, COVID-19 has been around for over two millennia less, they joined ranks in 2020. This paper looks at the interface between fake news and governments’ responses to the COVID-19. It compares the approaches of Australia, Singapore and Thailand. Australia relies on a non-legislative approach, where the major digital service providers sign an industry code of practice that must meet the Australian Communications and Media Authority guidelines. As of mid-2021, Twitter, Google, Facebook, Microsoft, Redbubble, TikTok, Adobe, and Apple have signed the industry code of practice. In addition, online advertising that does comply with the requirements of the Therapeutic Drugs Administration can result in sanctions and financial penalties. Australians need to check for the required information on the appropriate government website. Singapore is one of a small number of countries that has specific anti-fake news legislation. Its fact-checking site does not appear to be widely used. Thailand uses its more overarching cybercrime legislation, which does not define fake news. It has developed a comprehensive social media monitoring organization to identify fake news. In addition, it has a website that citizens can check whether news on social media is correct or not. This site has proven extremely popular with several million hits since it commenced operation in late 2019. The paper examines the efficacy of each of the approaches in controlling the twin pandemics. © 2022 Kasetsart University.

Barriers to maternal and reproductive health care in India due to COVID-19

COVID-19 and its associated lockdowns and restrictions on movement may be impacting women and men’s access to and use of health care services including contraceptive, prenatal, and postnatal care. Yet we know little of its impact to date, especially in low- and middle-income countries, including India. Understanding how COVID-19 impacts the use of these services now, and as it persists, is essential for improving access and use today. Additionally, these data are necessary to understand fertility and other health-related outcomes we may see in the future. The objectives of this study are to understand a Facebook sample of respondent’s perceived barriers to contraceptive, prenatal, and postnatal care in India and how these changed over 4 months of the COVID-19 pandemic. To meet this need, we conducted four rounds of monthly online surveys with men and women (N = 9,140) recruited using Facebook ads in India between April and July 2020, a period when the national lockdown was tapered from the strictest to restricted. While about 75% of respondents reported no barriers to contraception due to COVID-19, about half of those pregnant or postpartum reported barriers to pre- and postnatal care. Barriers to care for contraception, prenatal, and postnatal care increased significantly over time. Most respondents reported some change on fertility preferences, with more respondents reporting desire to delay, rather than to have a child sooner, due to COVID-19. Overall, as the early COVID-19 pandemic persisted, barriers to reproductive and maternal health care increased in India, suggesting that as the pandemic continued there have likely been additional challenges for people seeking these services. It is essential that health care providers begin to address these barriers to ensure access to care throughout these important time periods. © 2022 The Author(s).

Impaired mRNA Based COVID-19 Vaccine Response in Patients with B-Cell Malignancies after CD19 Directed CAR-T Cell Therapy

Introduction: Patients with hematologic malignancies are at an increased risk of morbidity and mortality from COVID-19 disease (Vijenthira, Blood 2020). This is likely a result of combination of immunodeficiency conferred by the disease and the therapeutics. The immunogenicity of the COVID-19 vaccines in patients with exposure to CD19 directed Chimeric Antigen Receptor (CAR)-T cell therapy is not established. CD19 CAR-T cell therapies cause B-cell aplasia, which in turn can affect humoral immune response against novel antigens. Herein, we present results from our prospectively conducted clinical study to evaluate immune responses against mRNA based COVID-19 vaccines in patients with lymphoma who have received CD19 directed CAR-T cell therapy. Methods: All patients and healthy controls were enrolled in a prospective clinical study evaluating immune responses against commercial COVID-19 RNA vaccines in patients with hematologic malignancies. Plasma samples were generated from heparinized peripheral blood of 4 heathy controls (HCs) receiving the same vaccines and 19 B cell lymphoma patients treated with CD19 CAR- T cells. Samples from ~4 weeks post second dose of the vaccine (d56) were available for 14 CAR-T patients, for 5 CAR-T patients samples were available from ~4 weeks after the first dose (d28). Plasma samples were analyzed in an enzyme-linked immunosorbent assay (ELISA) using different full-length recombinant SARS-CoV-2 proteins and control proteins. Neutralizing activity was measured using the cPass Neutralization Antibody Detection Kit (GenScript Biotech). Results: Results from 4 healthy controls and 19 patients (12 males and 7 females) with lymphoma are reported. Median age for the lymphoma patients is 65 years. Eleven patients had large B cell lymphoma, 5 had follicular lymphoma and 3 had mantle cell lymphoma as primary diagnoses. Seventeen patients had advance stage disease (III/IV stage) and had received a median of 3 prior lines of therapy. All patients received CD19 directed CAR-T cell therapy. Ten patients received Moderna vaccine and 9 received Pfizer vaccine. Median time between CAR-T infusion and first COVID-19 vaccine was 258 days. While the peripheral blood plasma from 3/4 HCs already showed substantial SARS-CoV-2 neutralizing activity at ~4 weeks after the first dose of COVID-19 mRNA vaccine, none of the 5 CD19 CAR-T patients analyzed evidenced any antibody-mediated neutralizing activity in their blood at the same point in time (Figure 1A). Around 4 weeks after receiving the second dose of the vaccine, all 4 HCs tested evidenced complete or almost complete neutralizing activity (Figure 1B). In marked contrast, only 1 out of 14 CAR-T patients analyzed evidenced any relevant antibody-mediated SARS-CoV-2 neutralizing activity in their blood (Figure 1B). Interestingly, when we asked whether a globally insufficient antibody-mediated immunity was the underlying cause of the lack of a response to the COVID-19 vaccine in our CAR-T patients, we found that that was clearly not the case since anti-Flu, -TT, and -EBV responses were equivalent to the ones observed in HCs (Figure 2A). However, while at ~4 weeks post second dose of the vaccine the HCs showed marked antibody titers against all the viral spike proteins including their “delta” variants (Figure 2B), that was not the case for our CAR-T patients. The vast majority of our CAR-T patients did not evidence IgG antibody responses against any of the SARS-CoV-2 proteins analyzed such as S1, S1 delta, RBD, RBD delta, or S2 (Figure 2B). Conclusion: In this prospectively conducted clinical study, 18 of 19 patients with lymphoma who have received CD19 CAR-T therapy had poor immunogenicity against mRNA based COVID-19 vaccines as measured by neutralization assays and antibody titers. The antibody titers against B.1.617.2 (delta variant, S1 and RBD protein) were also demonstrably poor. The antibody response to common pathogens (flu, EBV, TT) were preserved, suggesting impaired immune response against novel antigens. Long-term follow-up of this study is ongoin . APR and DJ contributed equally [Formula presented] Disclosures: Dahiya: Kite, a Gilead Company: Consultancy;Atara Biotherapeutics: Consultancy;BMS: Consultancy;Jazz Pharmaceuticals: Research Funding;Miltenyi Biotech: Research Funding. Hardy: American Gene Technologies, International: Membership on an entity's Board of Directors or advisory committees;InCyte: Membership on an entity's Board of Directors or advisory committees;Kite/Gilead: Membership on an entity's Board of Directors or advisory committees.

Teamwork Development and Evaluation for Hybrid Thermal Fluids Laboratory Course

Laboratory courses provide an opportunity for students to practice engineering skills in ways not possible in a traditional classroom environment. Hands-on activities challenge their creativity, problem-solving, and critical thinking. Beyond that, labs are an ideal platform for developing teamwork and communication. In normal circumstances, providing quality lab experiences can be resource intensive and logistically challenging, particularly for large class sizes. This year, new safety measures required by Covid-19 have completely changed the equation, adding constraints few of us could have anticipated a year ago. One solution to the Covid-19 puzzle is remote learning;this might involve video demonstration of experiments, simulations, and/or 'at home' experiments. Another option is to continue to offer in-person labs with added safety measures to include mask wearing, social distancing, and enhanced cleaning. For the Fall 2020 thermal-fluids laboratory course at the University of Virginia (UVA), a hybrid model was adopted. Students were given the option to take the class 100% remotely, or they could attend lab in person every other week. During the second week of the semester, entire sections met online for team forming. Though some attempt was made to group in-person students in the same team, several teams had a mix of in-person and remote students. The curriculum was redesigned into two-week blocks. During the 'on' week, students collected data from an experiment they performed in person or watched virtually. During the 'off' week, they worked in teams on various activities including report peer review workshops, a team project, and post-processing of the previous week's experiments. This paper will discuss how the course design fostered team development in the hybrid learning environment. Metrics from each mode of delivery: in-person and remote, are assessed. These will include performance on individual and team assignments, and team member peer evaluations via Comprehensive Assessment of Team Member Effectiveness (CATME) evaluations. © American Society for Engineering Education, 2021