Covid Sepsis Gene Expression Subphenotypes Manifest Differential Plasma Protein Signatures

INTRODUCTION: Transcriptome-derived sepsis subphenotypes, termed 'adaptive', 'inflammopathic' and 'coagulopathic', have been reliably identified in sepsis cohorts, however plasma proteomics in these groups have not been well characterized. We hypothesized that inflammatory and vascular injury markers would be elevated in the inflammopathic and coagulopathic groups compared to the adaptive group. METHOD(S): We prospectively enrolled and obtained blood from 130 inpatients with COVID19-related sepsis. Severity was classified by NIH ordinal scale. Gene expression analysis was performed by Nanostring nCounter (Inflammatix). Inflammatory proteins interleukin (IL)-6, IL8, IL10, IL1RA, IL1RL1, and IFNg and vascular markers ANGPT2, sICAM, vWF, ADAMTS13, and protein C were measured with OLINK proximity extension assay. Clinical variables were compared by chi-square and protein levels were compared using ANOVA with Bonferroni adjustment. RESULT(S): The transcriptomic classifier identified 32% (41) inflammopathic, 50% (65) adaptive and 18% (24) coagulopathic subjects. The inflammopathic group had more patients requiring mechanical ventilation (39% vs 9% vs 21%;p < 0.001) and higher 90-day mortality (32% vs 8% vs 13%, p = 0.016). Inflammatory cytokines IL8 and IL10 were significantly higher in inflammopathic compared to adaptive (p=0.038 and p=0.017 respectively), but not compared to coagulopathic (p>0.99 and p=0.24, respectively). Both the inflammopathic and coagulopathic groups expressed higher IL1RL1 and interferon-gamma compared to adaptive (IL1RL1;p< 0.001, p=0.002, IFNg;p=0.007, p=0.001). Plasma IL6 and IL1RA did not differ between groups, nor did many vascular proteins. The inflammopathic group expressed higher sICAM (p=0.049 vs adaptive) and lower ADAMTS13 compared to the adaptive group, and the coagulopathic group did not differ in its vascular protein expression. CONCLUSION(S): Transcriptomic subphenotypes are present in COVID-19 sepsis at similar proportions to non-COVID-19 sepsis. Inflammopathic subjects manifested higher severity of illness at admission, higher expression of inflammatory proteins and higher mortality. Markers of vascular injury did not distinguish the coagulopathic group. Integrating RNA and protein expression may offer new insights to host immune dysregulation during COVID sepsis.

An Investigation into an Approach to Updating the Governance of Satellite Communications to Enhance Cyber Security

The UK is keen to be part of the Global Space market that has seen the recent activities of Virgin Galactic and SpaceX. This research will take into consideration the UKs operability parameters in relation to International Space agreements to investigate whether the Governance surrounding Satellite communications prepares for the new Spaceports that are being developed and the impact on UK Government departments. The research aim for A Qualitative Approach to Updating the Governance of Satellite Communications to Enhance Cyber Security is to produce a set of guidelines to be used for the Governance of Satellite communications through researching the level of Governance that exists for Satellite communications. The research includes which techniques and technology that satellites use, the impact of Governance on Satellite communications within Government departments, COBIT 2019 in Satellites, a review of literature to pinpoint current research of legislation, a critical review of current Government frameworks for satellite communications and what public organisations will be taken into consideration. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The creation of an autoimmune hepatitis register and a nurse-led service: A worthy lock-down pastime

Introduction Autoimmune Hepatitis (AIH) is a relapsing chronic inflammatory condition1 that waxes and wanes irrespective of outpatient clinic scheduling. York Teaching Hospital NHS Foundation Trust (YTHT) covers a wide geographical area.2 The COVID-19 pandemic has demonstrated that not all patients require regular clinical review in person. Aim To update the clinical registry of AIH patients within YTHT, ensuring appropriate monitoring during Covid-19, and prompt review for those requiring it. Methods An IT-based search identified individuals' with a diagnosis of AIH within YTHT. An electronic note review established demographic details, risk factors for co-existing liver disease, severity of AIH, disease treatment, and current blood results. Results 128 patients were identified, 81% of whom were female. The average age was 68 years (range 17-88). 51% were local to York Hospital and 34% closer to Scarborough Hospital, as demonstrated in figure 1. The remainder travel to their closest hub. 55% of the cohort had an elevated ALT suggesting ongoing disease activity (arguably ALT >31UI/L in males and ALT >21 UI/L in females). 62% were taking significant immunosuppression;Azathioprine 32%, Mycophenolate Mofetil 14.4%, Tacrolimus 9.6% and Prednisolone >20 mg/ day 6.4%. Discussion The COVID-19 pandemic has demonstrated the need to identify and offer timely follow-up for our most unwell patients, allowing those with a stable condition to safely shield. Virtual monitoring of patients is important to identify asymptomatic flares. We advocate incorporating nurseled monitoring of such patients, in combination with patient initiated follow-up for those with symptomatic disease.

US Department of Agriculture Summer Meals Program: what's hot?

This article provides an overview of the US Department of Agriculture Summer Meals Program (SMP) and highlights opportunities to strengthen SMP's public health impacts. We also discuss initial SMP implications of 2 relevant policy provisions of the Families First Coronavirus Response Act (P.L. 116-127), signed into law on March 18, 2020. Ensuring access to summer meals among high-risk students can provide (1) supplemental nutrition assistance to families that helps address food insecurity during the summer months when there are no school meals, (2) healthy meals in structured settings that might help reduce obesity risk, and (3) support to other programs that offer other benefits such as education, physical activity, or job training.