INTRODUCTION

This part introduction presents an overview of the key concepts discussed in the subsequent chapters. The part argues that the COVID-19 pandemic made evident the importance of having good political leaders since, as the author explains, "poor leadership costs lives.” It focuses on translanguaging, and creating the perfect opportunity for teachers to implement the use of its strategies even in these challenging times. The part focuses on current research in the ELT field and describes the characteristics that 21st century English language teachers need to have to help their learners cope with 21st century challenges. It focuses on the development and implementation of the program known as "Verify Information for Education”, which concludes that the COVID-19 pandemic brought to light a pre-existing need for innovation in teaching and learning practices in EMI environments. © 2023 Taylor and Francis.

Incidence of Viral Infections in Kidney Transplant Recipients Using Reduced Induction and Steroid Free Maintenance Immunosuppression

Purpose: Viral infections (VI) commonly occur in the post-transplant period and higher cumulative doses of rATG have been correlated with higher rates of infection. However, basiliximab (BAS) has decreased risk of infection but increased risk of rejection due to a lower immunosuppressive profile. There is a shortage of literature evaluating choice and dosing of induction agent and the incidence of VI in kidney transplant recipients (KTR) receiving tacrolimus, mycophenolate and early steroid withdrawal. This study evaluated the incidence of VI in KTR receiving BAS, rATG low (< 3mg/kg), or high dose (> 3mg/kg) within 180 days post-transplant. Method(s): This single-center, retrospective study included adult KTR from July 2020-March 2021. KTR were excluded if they received a multi-organ transplant, no induction, or maintenance immunosuppression other than tacrolimus and mycophenolate. Induction was given based on patients' immunologic risk factors for rejection which included: age, race, cPRA, retransplantation, and DR HLA mismatch. The primary objective compared the incidence of VI with BAS, rATG low and high dose. Secondary outcomes included incidence of CMV, BKV, EBV, HSV, COVID-19, DGF, BPAR, de novo DSA, eGFR, tacrolimus levels, graft loss, and mortality within 180 days post-transplant. Result(s): There were 44 KTR who received BAS, 43 who received low rATG dose, and 129 who received high rATG dose. Statistically significant differences in baseline demographics included age, race, mean peak cPRA, and mean KDPI (due to institutional induction guidelines) [Table 1]. A larger proportion of high rATG patients experienced VI, followed by low rATG patients, p<0.01 [Table 2]. Increased incidence of CMV, BKV, and COVID-19 occurred in patients receiving rATG [Table 2]. Infections generally occurred earlier in the rATG groups [Table 2]. DSA was highest in the high dose rATG (14%) which was attributed to high risk factors for rejection, p=0.0146 [Table 3]. No differences in BPAR, DGF, graft failure, or mortality were seen between all groups within 180 days. Conclusion(s): KTR that received induction with any rATG dose had a higher incidence of viral infections compared to basiliximab. Induction with rATG may lead to an earlier onset of viral infections compared to basiliximab. Further review of data at one year post-transplant is planned to strengthen the results of this study.

Health-care staff beliefs and coronavirus disease 2019 vaccinations: A cross-sectional study from Iran

Introduction: Health-care worker desire to receive coronavirus disease-2019 (COVID-19) vaccination can affect public perception and adoption of vaccination. The present study surveyed the health beliefs of health-care staff regarding COVID-19 vaccination. Methods: In this cross-sectional online survey conducted in Iran between May and June 2021, 537 health-care staff (73.8% females) participated. Health-care staff were assessed on the following constructs: health locus of control, trust in the health-care system, subjective norms, fear of COVID-19, attitude and feelings toward vaccination, physical distancing, intention to engage in preventative behaviors, and perceived behavioral control. Multivariate logistic regression models were used to examine the influence of demographic, clinical factors, fear of COVID-19, and health beliefs, in predicting openness toward vaccination. Results: About 67.5% of subjects received COVID-19 vaccination (first or second dose), with 57.2% reporting feeling confident in getting vaccinated and 32% expressing hesitancy in getting vaccinated. Trust in the health-care system, fear of COVID-19, and positive attitude toward vaccination were significantly higher in vaccinated participants than unvaccinated ones, P < 0.05. Conclusion: Being vaccinated and openness toward vaccination are influenced by health-care professionals' demographic and clinical characteristics, and health perceptions (i.e., fear of COVID-19). Whereas being overwhelmed with fear of COVID-19 is unadvisable, realistic concern balanced with appropriate action (e.g., vaccination) may be reasonable. © 2022 Medknow. All rights reserved.

INFLAMMATORY BOWEL DISEASE AND COVID-19: A LARGE INTEGRATED HEALTHCARE EXPERIENCE

Background: Southern California Kaiser cares for 4.7 million patients of which thousands carry a diagnosis of Inflammatory Bowel Disease (IBD). As the SARS-COV2 Virus has rapidly become a worldwide pandemic that causes the deadly COVID-19 respiratory syndrome, particular attention has been paid to patients with chronic IBD, who often take immunosuppressive medications that pose greater infectious risk than those in the general population. Although recent international studies have not shown worsening outcomes among IBD patients with COVID 19, not much is known about the local, regional characteristics of this population. In this study, we aim to describe the characteristics of IBD patients in the Southern California Kaiser healthcare system who have been diagnosed with COVID-19. Methods: We retrospectively gathered data from the electronic medical records of adult IBD patients who carry an ICD-10 diagnosis of Ulcerative colitis (UC) or Crohns disease (CD) and who were also diagnosed with COVID-19 with a positive lab result and ICD 10 code between the dates of January 1, 2020 and October 31, 2020. We then tabulated descriptive data among non-hospitalized, hospitalized, and deceased patients of this population. This data was verified through manual chart review. Results: Among 13,262 patients with IBD, 475 cases with suspected COVID were obtained and 280 patients had a confirmed positive COVID-19 test on manual review (89 CD, 191 UC). Average age was 49 years old with a female predominance of 59%. 14%(n=39) of patients were hospitalized and 2.5% (n=7) died. The population was predominantly White (48%) and Hispanic (37.5%). 36% of patients were not on any IBD medications while 38.9% were on aminosalicylates, 21% were on biologic agents, 9.3% were on thiopurines, and 4.3% were on corticosteroids. Among the hospitalized patients, 67%(n=26) were admitted for COVID-19. Hospitalized patients had an average age of 61 years old, 51% were female, and had an average length of stay of 7.7 days. 56.4% (n=22) were not on any IBD medications, while 7.7% (n=3) were on corticosteroids, and 18% (n=7) were on biologic agents. Among patients that died, 71%(n=5) died of COVID-19 related complications and 14% (n=1) died of renal failure. None were on biologic agents and 71% (n=5) were not on any medications for IBD. Conclusion: This study did not show increased risk of mortality among patients with IBD who are on biologic therapy. Mortality rate is comparable to published data in patients without IBD. Overall, the diagnosis of COVID 19 was associated with patients that were predominantly women, White or Hispanic, and patients not on any medications for IBD. Further research will be conducted to analyze risk factors such as medical co-morbidities in this population. (Table Presented) (Table Presented) (Table Presented)

Modification in immunosuppression regimens to safely perform kidney transplants amid the COVID-19 pandemic

Purpose: In the USA, there was a 51.1% reduction in kidney transplant (KTx) since March 2020 due to concerns for contraction of COVID-19 in transplant recipients. In our center, cumulative doses of ATG induction were reduced from 4-6mg/kg to 2-4 mg/kg in immunological high risk [HR] [age < 55 years, AA, cPRA > 20%, 2 DR mismatch, KP, retransplant], from ATG 2-4 mg/kg to 1-2 mg/kg in moderate-risk [MR] [age > 55 years, non-AA, CPRA <20% and <2 DR mismatch) and from ATG 0-2mg/kg to basiliximab for low risk [LR] patients [LDKT, age >65 years, cPRA < 20%, with 0 to 1 DR mismatch]. We used Tacrolimus and Myfortic as a maintenance agent and continued with a five-day rapid steroid withdrawal. This study assessed the effect of these changes on our transplant outcomes. Methods: We conducted a retrospective chart review of all adults with KTx or KP from 3/1/2020 to 8/31/2020 with a follow-up of at least two months. Primary outcomes included the incidence of biopsy-proven rejection (BPAR), de-novo DSA, delayed graft function (DGF), infection rate, graft loss, and all causes of mortality. Results: 180 KTx and 5 KP were reviewed with a median follow-up of 161 days [66, 250]. 13% were LDKT, and 11% retransplant. Median recipient age was 55 years [21, 78], and 28% were > 65 years old. 64% were white, and 63% were male. 46% of organs were PHS high-risk, median KDPI was 49 [2, 96], CIT 12 hours (2, 47). Median donor creatinine was 1.3mg/dL (0.2, 7.15). 62% HR received ATG of 3-4mg/ kg, 8% MR received 1-2mg/kg, and 30% LR received basiliximab. Creatinine nadir was 1.35mg/dL (0.52, 3.57). DGF was similar to the national average at 23%. 5% developed new DSA [MFI>2000]. Three patients had Banff 1a rejection. Patient 1 received basiliximab (LR) but likely rejected due to IS reduction during his COVID illness. Patients 2 and 3 both received ATG [HR] and were treated with increased IS and steroids. All three responded well to treatment. Three patients were diagnosed with COVID-19 and responded well to remdesivir, dexamethasone, and convalescent plasma. The median time of diagnosis from transplant was 90 days [12, 210], and the recent creatinine was 1.5mg/dL [1.2, 2.42]. 19% of CMV PCR (+) required dose reductions of IS, while 30% required CMV treatment. BK PCR of >10,000 was noted in 5.4% patients. Two graft losses occurred within a week of transplant secondary to the renal vein thrombosis. No mortality was noted. Conclusions: With careful monitoring and reduction in induction immunosuppression, KT and KP transplants could be performed safely during the COVID pandemic.

Comparison of cannulation approaches for venovenous extracorporeal membrane oxygenation during covid-19

Purpose: Venovenous extracorporeal membrane oxygenation (VV-ECMO) is performed through various cannulation approaches but an optimal strategy remains uncertain. Methods: A retrospective, multi-center study was conducted. Adult patients (≥18 years old) placed on VV-ECMO for severe respiratory failure due to COVID-19 between March 1, 2020, to April 30, 2021, across the United States were included. Patients were divided into the following 3 groups based on initial cannulation: 1) femoral vein-femoral vein or femoral vein-internal jugular vein (Dual-Site, DS), 2) single, dual-lumen cannula in internal jugular vein with tip positioned in the pulmonary artery (PA) and 3) single, dual-lumen cannula in internal jugular vein with tip positioned in the inferior vena cava (IVC). The primary outcome was in-hospital mortality after VV-ECMO placement assessed by a time-toevent analysis. Results: Overall, 435 patients from 17 centers comprised the study cohort. DS cannulation was performed in 247 (age: 47±11, 30% female) cases, 99 (age 50±12, 26% female) received PA, and 89 patients got IVC (age 45±12, 33% female). At 90 days, in-hospital mortality across cannulation groups was 60% (DS), 41% (PA) and 61% (IVC), p=0.06 (Figure 1). After adjustment for clinical covariates, the likelihood of in-hospital mortality in comparison to DS, was lower with PA (aHR: 0.60, 95%CI 0.40-0.91, p=0.02) and similar with IVC (aHR: 0.99, 95%CI 0.68-1.43, p=0.95). Conclusion: Catheter directed flow into the PA with a single dual-lumen cannula is associated with reduced mortality during VV ECMO for COVID-19.

Direct versus indirect thrombin inhibition during extracorporeal membrane oxygenation support for covid-19

Purpose: Anticoagulation during extracorporeal membrane oxygenation (ECMO) for COVID-19 can be carried out by direct or indirect thrombin inhibition. The former agent obviates monitoring of antithrombin III but differences in outcomes with either approach are uncertain. Methods: A retrospective, multi-center study was conducted. Adult patients (≥18 years old) placed on ECMO for severe respiratory or circulatory failure due to COVID-19 between March 1, 2020, to April 30, 2021, in the United States were included. Patient were divided in 2 groups based on the utilized anticoagulation agent during ECMO support: 1) direct thrombin inhibitor (DTi, e.g. bivalirudin and argatroban) and 2) indirect thrombin inhibitor (IDTi, e.g. unfractionated heparin). The primary outcome was in-hospital mortality after ECMO placement assessed by a time-to-event analysis. Results: Overall, 455 patients from 17 centers were placed on ECMO, of whom 44 were excluded due to no reported anticoagulation agent. DTi was used in 160 (age: 47±11, 28% female) cases and 251 patients received IDTi (age 47±12, 29% female). At 90 days, in-hospital mortality was 50% (DTi) and 61% (IDTi), p=0.08, (Figure). After adjustment for clinical covariates, the likelihood of in-hospital mortality was similar with DTi (aHR: 0.79, 95%CI 0.57-1.10, p=0.16) compared to IDTi. Noted prevalence of deep vein thrombosis (DTi 14%, IDHi 12%), ischemic stroke (DTi 2%, IDHi 3%), intracranial hemorrhage (DTi 11%, IDHi 10%) and bleeding requiring transfusion (DTi 71%, IDHi 83%) was comparable between groups. Conclusion: Anticoagulants that directly or indirectly inhibit thrombin are associated with similar outcomes during ECMO for COVID-19.

The COVID-19 pandemic: Public knowledge, attitudes and practices in a central of Iran

Aims There is a rapid increase in the number of people infected with COVID-19 throughout the world. The present study aimed to determine people’s knowledge, attitudes, and practices (KAP) regarding COVID-19 in an Iranian sample. Instruments & Methods This was a population-based cross-sectional study conducted on people over 18 years of age in Saveh city, of Iran, in 2020. A multiple-stage sampling method was used. Participants (N=471) completed an anonymous and self-report questionnaire assessing socio-demographic variables and KAP. Data were analyzed using ANOVA and independent t-tests by SPSS 21. The significance level was considered to be ≤0.05. Findings Of participants, 74.5% did not have accurate knowledge of how the coronavirus is spread. In terms of attitudes, more than 63.2% considered COVID-19 to be a dangerous disease. About 59.6% of participants reported regular use of a mask in the past week. As compared to men, women reported attitudes and practices more aligned with recommended safety standards. Higher education level was significantly related to the mean KAP score (p<0.05). Conclusions Although the sample evidenced appropriate attitudes and some safety practices in general, a significant percentage of individuals did not engage in protective behaviors. Copyright© 2021, the Authors ;Publishing Rights, ASPI. This open-access article is published under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License which permits Share (copy and redistribute the material in any medium or format) and Adapt (remix, transform, and build upon the material) under the Attribution-NonCommercial terms.

Using implementation interventions and peer recovery support to improve opioid treatment outcomes in community supervision: Protocol.

OBJECTIVE: The purpose is to determine whether a facilitated local change team (LCT) intervention improves linkage to medication for opioid use disorder (MOUD) and implementation outcomes, and whether participant-level outcomes are further enhanced by use of peer support specialists (PSS). METHODS: This Type 1 hybrid implementation-effectiveness study involves a pre-post design (implementation study) followed by a randomized trial of PSS (effectiveness study). Participants are at least 114 justice and service staff from 7 sites in three states: probation officers, community treatment providers, a supervisor from each agency, and key stakeholders. The study will recruit up to 680 individuals on probation from seven adult community probation offices; eligible individuals will be recently committed, English speakers, with opioid use disorder (OUD). Core Implementation Study: The study will use the exploration, preparation, implementation, sustainability (EPIS) framework to guide system-change through facilitated LCTs of probation and community treatment staff given a core set of implementation strategies to set goals. The study will collect program-level and staff survey data at the end of each EPIS stage. Implementation outcomes: Organizational engagement in MOUD (primary), plus changes in staff knowledge/attitudes and organizational outcomes (secondary). Effectiveness Study of PSS: After completing implementation, the study will randomize adults on probation to receive PSS vs. treatment as usual, with assessments at baseline, 3, 6 and 12 months. Effectiveness outcomes include participant engagement in MOUD (primary), probation revocation, illicit opioid use, and overdoses. Other aims include identifying barriers and facilitators, and cost-benefit analysis of PSS. Adaptations in response to COVID-19 included moving many procedures to remote methods.

Imaging Features of Acute Encephalopathy in Patients with COVID-19: A Case Series.

Coronavirus disease 2019 was declared a global pandemic by the World Health Organization on March 11, 2020. There is a scarcity of data on coronavirus disease 2019-related brain imaging features. We present 5 cases that illustrate varying imaging presentations of acute encephalopathy in patients with coronavirus disease 2019. MR features include leukoencephalopathy, diffusion restriction that involves the GM and WM, microhemorrhages, and leptomeningitis. We believe it is important for radiologists to be familiar with the neuroradiologic imaging spectrum of acute encephalopathy in the coronavirus disease 2019 population.