Hyperpolarized 129xenon Mri Gas Exchange Research in Pulmonary Vascular Disease and Interstitial Lung Disease: The Xchange Clinical Study

Assessing small airway functional impairment, therapeutic response and disease progression in patients with pulmonary vascular and/or interstitial lung disease (ILD) continues to be challenging. Hyperpolarized Xenon (Xe) MRI enables noninvasive evaluation and regional quantification of alveolar gas exchange via three-dimensional mapping of ventilation, interstitial membrane uptake and red blood cell transfer. This global, open-label, multicenter study will implement harmonized methodology to evaluate safety and tolerability of hyperpolarized Xe gas in patients with pulmonary hypertension and ILD. Adult patients (n=200) with pulmonary arterial hypertension, chronic thromboembolic pulmonary hypertension, idiopathic pulmonary fibrosis or ILD-associated systemic sclerosis (SSc-ILD) will be enrolled and undergo Xe MRI for evaluation of treatment response and comparison with standard-of-care diagnostic measurements. Eligible patients will be initiating/changing therapy or undergoing a disease-specific procedure. An exploratory cohort (n=50) will allow Xe MRI in patients with long-COVID, unexplained dyspnea, possible transplant (lung or stem cell) rejection, World Health Organization group 3 pulmonary hypertension or other ILDs. Healthy volunteers (n=50) will be enrolled to evaluate Xe MRI reproducibility. Changes in Xe MRI (within patient groups) at 1, 3, 6 and 12 months;Cross-sectional and longitudinal relationships of Xe MRI with spirometry, including diffusing capacity of carbon monoxide (DLCO);Xe MRI measurements compared with right heart catheterization (RHC) and echocardiogram [PH patients] and computed tomography (CT) [ILD patients]. Relationship of Xe MRI quantitative measures across compartments (air/tissue/blood) to treatment response;Changes in Xe MRI parameters to assess temporal relationship to changes in standard diagnostics, healthcare utilization, quality-of-life andmorbidity/mortality;Relationship of Xe MRI cardiogenic oscillation signals of pulmonary-vascular hemodynamics with RHC and clinical outcomes. Patients will begin enrollment within the USA in mid-2022. All patients will participate for at least 1 year (and up to 3 years). Interim analyses will be conducted yearly, with additional snapshots periodically.

Vaccine hesitancy: the Grenada experience

Objective: Vaccine hesitancy became a global issue of public health importance following vaccine introduction for SARS-CoV-2 in early 2021. Here, we present the everchanging reasons for vaccine hesitancy in a Small Island Developing State which has an enviably high childhood vaccination rate for other vaccinatable infectious diseases. Design and Methods: Longitudinal data on the stated objections to vaccination were recorded from individuals living in all 6 parishes of Grenada from the introductions of vaccines to the country in February 2021 until mid-February 2022. Result(s): The expressed unwillingness to be vaccinated arose initially from a distrust of the speed of the production of vaccines, then the perceived blood clot risks from the AstraZeneca vaccine and numerous other factors including fear of needles, potential sterility, and a mistrust in the short and long term benefits of the vaccine. A second COVID-19 wave occurred in December which recorded approximately an equal number of vaccinated and unvaccinated individuals becoming infected, which increased hesitancy. Increased vaccine uptake was observed when vaccines were expiring, with the introduction of vaccine choices, and vaccine mandates for entering restaurants, employment, and latterly, travel regulations. Conclusion(s): Despite being one of the first countries to receive vaccines, Grenada has recorded one of the lowest vaccine uptake rates in the region. The complex issues and lessons learned from frontline workers have shown that vaccine hesitancy in Grenada is multifactorial and constantly evolving. The key findings in this study can inform and help develop targeted public health measures regarding vaccination.

Pre-hospital prediction of adverse outcomes in patients with suspected COVID-19: Development, application and comparison of machine learning and deep learning methods.

BACKGROUND: COVID-19 infected millions of people and increased mortality worldwide. Patients with suspected COVID-19 utilised emergency medical services (EMS) and attended emergency departments, resulting in increased pressures and waiting times. Rapid and accurate decision-making is required to identify patients at high-risk of clinical deterioration following COVID-19 infection, whilst also avoiding unnecessary hospital admissions. Our study aimed to develop artificial intelligence models to predict adverse outcomes in suspected COVID-19 patients attended by EMS clinicians. METHOD: Linked ambulance service data were obtained for 7,549 adult patients with suspected COVID-19 infection attended by EMS clinicians in the Yorkshire and Humber region (England) from 18-03-2020 to 29-06-2020. We used support vector machines (SVM), extreme gradient boosting, artificial neural network (ANN) models, ensemble learning methods and logistic regression to predict the primary outcome (death or need for organ support within 30 days). Models were compared with two baselines: the decision made by EMS clinicians to convey patients to hospital, and the PRIEST clinical severity score. RESULTS: Of the 7,549 patients attended by EMS clinicians, 1,330 (17.6%) experienced the primary outcome. Machine Learning methods showed slight improvements in sensitivity over baseline results. Further improvements were obtained using stacking ensemble methods, the best geometric mean (GM) results were obtained using SVM and ANN as base learners when maximising sensitivity and specificity. CONCLUSIONS: These methods could potentially reduce the numbers of patients conveyed to hospital without a concomitant increase in adverse outcomes. Further work is required to test the models externally and develop an automated system for use in clinical settings.

Prognostic accuracy of triage tools for adults with suspected COVID-19 in a prehospital setting: An observational cohort study

Aims/Objectives/Background Emergency Medical Service (EMS) and other practitioners assessing patients with suspected COVID-19 in the community must rapidly determine whether patients need treatment in hospital or can self-care. Tools to triage patient acuity have only been validated in hospital populations. We aimed to estimate the accuracy of five risk-stratification tools recommended to predict severe illness and compare accuracy to existing clinical decision-making in a pre-hospital setting. Methods/Design An observational cohort study using linked ambulance service data for patients assessed by EMS crews in the Yorkshire and Humber region of England between 18th March 2020 and 29th June 2020 was conducted to assess performance of the PRIEST tool, NEWS2, the WHO algorithm, CRB-65 and PMEWS in patients with suspected COVID-19 infection. The primary outcome was death or need for organ support. Results/Conclusions Of 7550 patients in our cohort, 17.6% (95% CI:16.8% to 18.5%) experienced the primary outcome. The NEWS2, PMEWS, PRIEST tool and WHO algorithm identified patients at risk of adverse outcomes with a high sensitivity (>0.95) and specificity ranging between 0.3 (NEWS2) and 0.41 (PRIEST tool). The high sensitivity of NEWS2 and PMEWS was achieved by using lower thresholds than previously recommended (NEWS2;0-1 vs 2+ and PMEWS;0-2 vs 3+). On index (first) assessment, 65% of patients were transported to hospital and EMS decision to transfer patients achieved a sensitivity of 0.84 (95% CI 0.83 to 0.85) and specificity of 0.39 (95% CI 0.39 to 0.40) to the primary outcome. This does not account for clinical reasons not to convey patients to hospital who subsequently deteriorated. Use of NEWS2, PMEWS, PRIEST tool and WHO algorithm could therefore potentially improve EMS triage of patients with suspected COVID-19 infection. Use of the PRIEST tool could significantly increase the sensitivity of triage without increasing the number of patients conveyed to hospital. (Table Presented).

Improving lung cancer screening in community oncology programs

Background: Lung Cancer Screening provides a mechanism to detect lung cancers at stages more amendable to curative resection. Nonetheless, data suggests Low Dose Computed Tomography (LDCT) is underutilized as a screening tool;preventing medically eligible patients from diagnosis at earlier stages;leading to reduced treatment options and, ultimately, decreased survival. The Duke Cancer Network (DCN) consists of 12 affiliated cancer programs in 5 states. As several affiliates shared a common goal of improving the uptake of LDCT screening in the community, the DCN created a platform for process improvement in LDCT screening, individualized for participating sites. Methods: DCN-developed surveys for patients and providers explored attitudes toward LDCT screening, and identified targetable access issues and barriers to LDCT screening at DCN-affiliated community cancer centers (aCCC). Armed with the survey data, five aCCC self-selected to work with an experienced Quality/Process Improvement coach to develop individualized projects focusing on one or more aspects of the LDCT screening process. The Q/PI coaches utilized Bite-Size-QI software to facilitate the project and train participants in the QI/PI process. Results: Information from 312 patient and 28 of 50 surveyed providers identified numerous targetable LDCT screening barriers: Lack of knowledge about and educational materials to address the benefits of LDCT and tools/analytics to track patients following LDCT screening. Additional, more systematic, barriers identified included: Lack of consistent national guidelines for screening, variable insurance coverage and limited availability of smoking cessation programs. Five aCCC self-selected to create individualized process improvement activities were matched to experienced Q/PI coaches. Four sites completed the yearlong project. Three of the aCCC were able to realize improvement in LDCT screening rates with 38%, 27% and 8% increase in rates, respectively, despite overlap with COVID-19 driven shutdowns. Conclusions: An assessment of current state linked to formal Q/PI activities improved uptake of LDCT screening in the majority of participating community cancer programs despite limited resources. Geographically variable COVID-19 required closures did compromise the outcomes. The process led to creation of a number of tools and process improvements to increase awareness of LDCT screening through education and foster collaboration among providers with streamlined referral processes and improved mechanisms of tracking patients. Funding: Provided by AstraZeneca in collaboration with the Duke Cancer Network. .

Practising piety in a (Post-) pandemic time: A spatial reading of piety in psalm 66 from the perspectives of memory and bodily imagery

Situated in the larger collection of Psalms 51–72, also known as the second Davidic Psalter, the smaller group of Psalms 65–68 is found. This smaller collection of psalms can be classified mostly as psalms of praise and thanksgiving. The relation and compositional work in this cluster of psalms become apparent on many points in the pious expressions between groups and persons at prayer, especially in the universal praise of God, and in the imagery referring to the exodus, the Jerusalem cult and blessing. Such piety becomes most discernible in the imagery and expressions in Psalm 66. The psalm’s two main sections may be described as praise, with verses 1–12 being praise by the group or the ‘we’, and verses 13–20 being praise by the individual or the ‘I’. Personal or individual piety and private piety are expressed by the desire of the ‘we’ and the ‘I’, and the experienced immediacy to God by transposing the past into the present through the memory of the exodus narrative, the Jerusalem cultic imagery and the use of body imagery. In this research article, an understanding of piety in Psalm 66 in terms of the memory of past events and body imagery is discussed from a perspective of space and appropriated for a time of (post-) pandemic where normal or traditional ecclesiological formal practices cannot take place. Contribution: This article makes an interdisciplinary contribution based on knowledge from the Psalms in the Old Testament, social anthropology, literary spatial theories and practical theological perspectives on the church in order to contribute to the relevance and practice of theology today, during a time of turmoil and a global pandemic. © 2021. The Authors. Licensee: AOSIS.