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1.
Int J Health Plann Manage ; 2022 Apr 13.
Article in English | MEDLINE | ID: covidwho-1787662

ABSTRACT

Resurgences of COVID-19 cases are a grave public health concern. Hence, there is an urgent need for health care systems to rapidly and systematically learn from their responses to earlier waves of COVID-19. To meet this need, this article delineates how we adapted the World Health Organization's After Action Review (AAR) framework to use within our health care system of the United States Department of Veterans Affairs. An AAR is a structured, methodical evaluation of actions taken in response to an event (e.g., recent waves of COVID-19). It delivers an actionable report regarding (i) what was expected, (ii) what actually happened, (iii) what went well, and (iv) what could have been done differently, and thus what changes are needed for future situations. We share as an example our examination of Mental Health Residential Rehabilitation and Treatment Programs in Massachusetts (a COVID-19 hotspot). Our work can be further adapted, beyond residential treatment, as a consistent framework for reviewing COVID-19 responses across multiple health care programs. This will identify both standardized and tailored preparations that the programs can make for future waves of the pandemic. Given the expected resurgences of COVID-19 cases, the time to apply AAR is now.

2.
Journal of Crohn's and Colitis ; 16:i190-i191, 2022.
Article in English | EMBASE | ID: covidwho-1722305

ABSTRACT

Background: The characteristics of SARS-CoV-2 vaccine-induced immunity in inflammatory bowel disease (IBD) patients on immune modifying agents has not been clearly defined due to their exclusion in vaccine trials. Emerging results suggest infliximab impairs antibody response compared to vedolizumab. However there has not been direct comparison to controls. We evaluated this with both humoral and T cell response in IBD patients. Methods: Antibody and T cell response were analysed in IBD patients who received BNT162b2 (Pfizer-BioNTech) or ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccination from a single Australian centre. The control group were healthcare workers (HCW) without IBD. Blood samples were taken at 4 time points: at baseline V0 (before vaccination);V1 (7-14 days after vaccine 1);V2 (7-14 days after vaccine 2);V3 (21-42 days after vaccine 2). Antibodies to the S1/2 IgG subunit and receptor-binding protein (RBD) were measured and reported here. Results: 88 (28 ulcerative colitis, 50 Crohn's disease) IBD patients were included and compared to 53 healthy controls (Table 1). IBD patients medications included 6 5ASA (6.8%), 6 immunomodulator monotherapy (6.8%), 14 anti-TNF monotherapy (15.9%), 32 anti- TNF combination therapy with immunomodulator (36%), 16 IL12/23 (18%) and 13 vedolizumab (14%). Pre-vaccine baseline sera showed absence of anti-RBD antibodies in all participants. 84 patients (87%) received BNT162b2 and 4 (4.5%) received ChAdOx1 nCoV-19 vaccines. Geometric mean [SD] anti-S1/2 antibody concentrations at 4 weeks after second vaccination (V3) were significantly lower in IBD TNF treated patients (162.6[1.7]) compared to IBD non TNF treated patients (325.2[1.3]), and healthy controls (325.2[1.3]), p<0.0001 (Figure 1). There was no difference between non-TNF treated patients including those on vedolizumab or IL12/23 compared to controls. Similarly there was a significant difference between anti-RBD IgG titres between TNF and non-TNF IBD patients at V3 but not when compared to controls (Figure 2). There was no difference in RBD IgG and anti-S1/2 antibodies between anti-TNF monotherapy and combination anti-TNF with immunomodulator. All IBD and healthy controls seroconverted at V3 (Figure 3). Conclusion: TNF agents influence SARS-CoV-2 vaccine-induced antibody response in IBD patients, with lower anti-S1/2 IgG concentrations compared to non-TNF IBD patients and healthy controls. However, there was no difference in RBD IgG titres between controls and IBD patients overall. It is unclear whether these subtle differences in antibody response in IBD patients on TNF agents is biologically meaningful, as all groups seroconverted after second dose vaccination. Neutralising antibody and T cell data (CD4+/CD8+) from this study to come.

3.
Canadian Journal of Surgery ; 64, 2021.
Article in English | ProQuest Central | ID: covidwho-1678775

ABSTRACT

Background: There are well-established provincial guidelines surrounding target wait times for patients diagnosed with cancer. Wait 1 is the time from initial referral to a patient's first surgical oncology appointment. Wait 2 is the time from the decision to operate to the actual operation. During the first wave of the COVID-19 pandemic in March 2020, elective operations decreased and the majority of in-person appointments were cancelled or changed to telephone appointments. Oncologic operations were allowed to continue;however, routine screening temporarily stopped. The objective of this study is to determine the effect of the COVID-19 pandemic on overall case counts, Wait 1 and Wait 2. Methods: All patients diagnosed with cancer and referred for surgical management at our centre from Mar. 15 to June 30, 2019, were compared with those in the same time period in 2020. Results: In 2020, there was a significant decrease in new cases, from 666 to 588 (p < 0.001). Surgical specialties varied greatly in how much the case volume was affected. When we compared Wait 1 from 2019 to 2020, significantly more patients (p = 0.019) met the target time for Wait 1 in 2020 (89.4%) compared with 2019 (85.0%). However, significantly fewer (p < 0.001) patients met the target time for Wait 2 in 2020 (71.6%) than in 2019 (88.4%). Again, there was variability in the ability to meet target wait times for both Wait 1 and Wait 2 by surgical specialty. The decrease in overall case counts from 2019 to 2020 (11.7%) was less than the provincial decrease in cases (23.2%) over the same time period. Conclusion: While overall case volumes dropped, the decrease was not universal across surgical specialties. Further, the majority of subspecialties improved in Wait 1, while the majority had a lengthening of Wait 2. It remains to be seen whether individual patient outcomes will suffer because of the first wave of the COVID-19 pandemic.

4.
Vaccine ; 39(52): 7578-7583, 2021 12 20.
Article in English | MEDLINE | ID: covidwho-1569116

ABSTRACT

INTRODUCTION: In Australia, the 2017 and 2019 influenza seasons were severe. High-dose or adjuvanted vaccines were introduced for ≥65 year-olds in 2018. AIM: To compare influenza-associated mortality in 2017 and 2019 with the average for 2010-2019. METHODS: We used time series modelling to obtain estimates of influenza-associated death rates for influenza A(H1N1)pdm09, A(H3N2) and B in Australia, in persons of all ages and <65, 65-74 and ≥75 years. Estimates were made for pneumonia and influenza (P&I, 2010-2018), respiratory (2010-2018), and all-cause outcomes (2010-2019). RESULTS: During 2010 through 2018 (and 2019 for all-cause), influenza was estimated to be associated with an annual average of 2.1 (95% confidence interval (CI) 1.9, 2.4), 4.0 (95% CI 3.4, 4.6), and 11.6 (95% CI 8.4, 15.0) P&I, respiratory and all-cause deaths per 100,000 population, respectively. Influenza A(H1N1)pdm09 was estimated to be associated with less than one quarter of influenza-associated P&I and respiratory deaths, while A(H3N2) and B were each estimated to contribute approximately equally to the remaining influenza-associated deaths. In 2017, the respective rates were 7.8 (95% CI 7.1, 8.4), 12.3 (95% CI 10.9, 13.6) and 26.0 (95% CI 20.8, 32.0) per 100,000. In 2019, the all-cause estimate was 20.8 (95% CI 14.9, 26.7) per 100,000. CONCLUSIONS: Seasonal influenza continues to be associated with substantial mortality in Australia, with at least double the average occurring in 2017. Age-specific monitoring of vaccine effectiveness is needed in Australia to understand higher mortality seasons.


Subject(s)
Influenza A Virus, H1N1 Subtype , Influenza Vaccines , Influenza, Human , Australia/epidemiology , Humans , Influenza A Virus, H3N2 Subtype , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Seasons
5.
British Journal of Surgery ; 108(SUPPL 6):vi124, 2021.
Article in English | EMBASE | ID: covidwho-1569600

ABSTRACT

Background: In response to the COVID-19, the NHS has implemented significant workforce changes to manage the increased and changing demand on healthcare services. We aimed to investigate the impact of such changes on the wellbeing of redeployed doctors. Method: We conducted a survey at three NHS trusts over 2 weeks during the peak of the pandemic, asking redeployed doctors to rate their morale, work-life balance, perceived support and safety, and to voice concerns. Results: 172 redeployed doctors responded to the survey. On exploring morale, 114 (66.3%) respondents felt confident in their new role, 113 (65.7%) felt satisfied or neutral with their new role and only 54 (31.4%) felt stressed at work. 114 (66.3%) doctors felt valued by their team and 136 (79%) felt valued by the general public. 111 (64.5%) had noticed an increase in the length of breaks and 153 (89%) felt that their rotas provided sufficient respite. 95 respondents (55.2%) did not feel confident in the Public Health personal protective equipment (PPE) guidance and similarly 94 (54.7%) did not feel safe while wearing PPE. The three most common concerns were training opportunities-105 (61%), PPE-99 (57.6%) and family health-95 (55.2%). Conclusions: Our findings suggest that, among the doctors surveyed, morale is higher than might be expected, with doctors feeling valued, confident, and well rested in their new role. Concerns about training opportunities/career progression, PPE and family safety need to be addressed to minimise the adverse effects on doctor's wellbeing due to redeployment.

6.
[Unspecified Source]; 2020.
Preprint in English | [Unspecified Source] | ID: ppcovidwho-292791

ABSTRACT

New therapeutics are urgently needed to inhibit SARS-CoV-2, the virus responsible for the on-going Covid-19 pandemic. Nsp15, a uridine-specific endoribonuclease found in all coronaviruses, processes viral RNA to evade detection by RNA-activated host defense systems, making it a promising drug target. Previous work with SARS-CoV-1 established that Nsp15 is active as a hexamer, yet how Nsp15 recognizes and processes viral RNA remains unknown. Here we report a series of cryo-EM reconstructions of SARS-CoV-2 Nsp15. The UTP-bound cryo-EM reconstruction at 3.36 Å resolution provides molecular details into how critical residues within the Nsp15 active site recognize uridine and facilitate catalysis of the phosphodiester bond, whereas the apo-states reveal active site conformational heterogeneity. We further demonstrate the specificity and mechanism of nuclease activity by analyzing Nsp15 products using mass spectrometry. Collectively, these findings advance understanding of how Nsp15 processes viral RNA and provide a structural framework for the development of new therapeutics.

7.
JAMA Netw Open ; 4(11): e2132548, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1499192

ABSTRACT

Importance: Compared with the general population, veterans are at high risk for COVID-19 and have a complex relationship with the government. This potentially affects their attitudes toward receiving COVID-19 vaccines. Objective: To assess veterans' attitudes toward and intentions to receive COVID-19 vaccines. Design, Setting, and Participants: This cross-sectional web-based survey study used data from the Department of Veterans Affairs (VA) Survey of Healthcare Experiences of Patients' Veterans Insight Panel, fielded between March 12 and 28, 2021. Of 3420 veterans who were sent a link to complete a 58-item web-based survey, 1178 veterans (34%) completed the survey. Data were analyzed from April 1 to August 25, 2021. Exposures: Veterans eligible for COVID-19 vaccines. Main Outcomes and Measures: The outcomes of interest were veterans' experiences with COVID-19, vaccination status and intention groups, reasons for receiving or not receiving a vaccine, self-reported health status, and trusted and preferred sources of information about COVID-19 vaccines. Reasons for not getting vaccinated were classified into categories of vaccine deliberation, dissent, distrust, indifference, skepticism, and policy and processes. Results: Among 1178 respondents, 974 (83%) were men, 130 (11%) were women, and 141 (12%) were transgender or nonbinary; 58 respondents (5%) were Black, 54 veterans (5%) were Hispanic or Latino, and 987 veterans (84%) were non-Hispanic White. The mean (SD) age of respondents was 66.7 (10.1) years. A total of 817 respondents (71%) self-reported being vaccinated against COVID-19. Of 339 respondents (29%) who were not vaccinated, those unsure of getting vaccinated were more likely to report fair or poor overall health (32 respondents [43%]) and mental health (33 respondents [44%]) than other nonvaccinated groups (overall health: range, 20%-32%; mental health: range, 18%-40%). Top reasons for not being vaccinated were skepticism (120 respondents [36%] were concerned about side effects; 65 respondents [20%] preferred using few medications; 63 respondents [19%] preferred gaining natural immunity), deliberation (74 respondents [22%] preferred to wait because vaccine is new), and distrust (61 respondents [18%] did not trust the health care system). Among respondents who were vaccinated, preventing oneself from getting sick (462 respondents [57%]) and contributing to the end of the COVID-19 pandemic (453 respondents [56%]) were top reasons for getting vaccinated. All veterans reported the VA as 1 of their top trusted sources of information. The proportion of respondents trusting their VA health care practitioner as a source of vaccine information was higher among those unsure about vaccination compared with those who indicated they would definitely not or probably not get vaccinated (18 respondents [26%] vs 15 respondents [15%]). There were no significant associations between vaccine intention groups and age (χ24 = 5.90; P = .21) or gender (χ22 = 3.99; P = .14). Conclusions and Relevance: These findings provide information needed to develop trusted messages used in conversations between VA health care practitioners and veterans addressing specific vaccine hesitancy reasons, as well as those in worse health. Conversations need to emphasize societal reasons for getting vaccinated and benefits to one's own health.


Subject(s)
Attitude , Intention , Vaccination/psychology , Veterans/psychology , Adult , Aged , COVID-19/mortality , COVID-19/prevention & control , COVID-19 Vaccines/immunology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2 , Surveys and Questionnaires , United States/epidemiology , Vaccination/statistics & numerical data , Veterans/statistics & numerical data
8.
Journal of Clinical Oncology ; 39(28 SUPPL), 2021.
Article in English | EMBASE | ID: covidwho-1496279

ABSTRACT

Background: Oncology Care Model (OCM) requires cancer programs to provide depression screening during each care episode to meet the quality measure benchmark of 85% screening rate. This quality improvement (QI) project aims to assess 1) key strategies to integrate systemwide depression screening into routine cancer care, and 2) early outcomes of depression screening implementation. Methods: A mixed method study design was used to assess strategies to implement routine depression screening in a southeast comprehensive cancer center between July 2019 and December 2020. Two top high-volume hematological oncology clinics that covers sixty percent of ambulatory care participated in the depression screening implementation. Data were collected using 1) depression screening completion rate during OCM performance periods, 2) needs assessment to identify barriers and facilitators of implementation, and 3) semi-structured interviews to assess staff and provider feedback on sustainable implementation strategies. Data were analyzed using descriptive analysis for quantitative outcomes and thematic analysis for qualitative outcomes. Results: A total of 64 hematological oncology providers (n = 22) and staff (n = 42) participated in the depression screening implementation training during three OCM performance periods. Depression screening rate of total ambulatory oncology care increased from 12% (OCM-PR 5, Jul-Dec 19), to 51% (OCM-PR 6, Jan-Jun 20) to 77% (OCM-PR 7, Jul-Dec 20) after the two top-volume clinics integrated depression screening into clinic intake process. Themes emerged from needs assessment revealed multi-level implementation strategies including 1) patient education and psycho-oncological care, 2) staff training and practice modification, 3) provider education & interdisciplinary Care, 4) leadership, administration, and staffing support, and 5) clinical informatics collaboration to build the infrastructure for integrating depression screen with clinic intake in the electronic medical record (EMR). Feedback from staff and provider interviews indicated high receptiveness and buy-in, especially during the COVID-19 pandemic to improve timely identification and triage of patients with depressive symptoms across all oncology care services. Conclusions: Depression screening is a key component of quality comprehensive cancer care that aims to provide timely identification and triage of cancer patients needing follow-up psychosocial care. Early implementation outcomes revealed significant improvement in depression screening completion rate after two clinics adopted depression screening into intake process. Further investigation is needed to refine system-wide implementation strategies across all ambulatory oncology sites and to assess long-term implementation outcomes meet the psychosocial care needs of cancer patients.

9.
Int J Pharm Compd ; 25(4):268, 2021.
Article in English | PubMed | ID: covidwho-1481484
10.
J Laryngol Otol ; 135(10): 848-854, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1454702

ABSTRACT

OBJECTIVE: The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery. METHOD: A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay. RESULTS: A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay. CONCLUSION: Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.


Subject(s)
Dissection/adverse effects , Facial Nerve/surgery , Hemostasis, Surgical/instrumentation , Parotid Gland/surgery , Blood Loss, Surgical/statistics & numerical data , Drainage/trends , Electrocoagulation/adverse effects , Facial Paralysis/epidemiology , Female , Humans , Length of Stay/statistics & numerical data , Male , Meta-Analysis as Topic , Middle Aged , Operative Time , Outcome Assessment, Health Care , Postoperative Period , Surgical Instruments/adverse effects
11.
New Microbes New Infect ; 44: 100944, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1433695

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is the cause of the current global pandemic and has affected more than 188 countries worldwide. Infection by the virus can have diverse clinical manifestations, with one of the most severe clinical manifestation being respiratory failure and the development of acute respiratory distress syndrome. Clinical manifestations of acute respiratory distress syndrome secondary to SARS-CoV-2 are also diverse with a lack of diagnostic tools to distinguish between primary viral infection and secondary bacterial infections. This was a single-centre, retrospective case-control study of bronchoalveolar lavage fluid cell counts, flow cytometry and culture results from mechanically ventilated patients with SARS-CoV-2 (COVID-19) pneumonia and acute respiratory distress syndrome. Neutrophils were the predominant cell type in bronchoalveolar fluid samples up to 2 weeks into mechanical ventilation. There also was a strong correlation between positive respiratory cultures and significant elevation in bronchoalveolar fluid neutrophil counts/percentages and serum C-reactive protein levels. Absolute levels of T cell subtypes correlated with reduced lung compliance measurements. Patients with SARS-CoV-2 and severe respiratory disease are at risk for secondary infections. In some COVID-19 patients, serum C-reactive protein and bronchoalveolar fluid neutrophils may be correlated with a secondary infection.

12.
Vaccine X ; 9: 100116, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1433617

ABSTRACT

Although COVID-19 vaccines have been available to many U.S. Veterans Affairs (VA) healthcare system employees and Veteran patients since early 2021, vaccine receipt data indicates some groups are not receiving them. Our objective was to conduct a rapid qualitative assessment of Veterans' and VA employees' views on COVID-19 vaccination to inform clinical leaders' ongoing efforts to increase vaccine uptake across the VA. We employed semi-structured interviews and a focus group involving employees and Veterans as part of a quality improvement project between January and June 2021 at three VA medical centers. Thirty-one employees and 27 Veterans participated in semi-structured interviews; 5 Veterans from a national stakeholder organization participated in a focus group. Data were analyzed using directed content analysis, involving an a priori coding framework comprised of four domains with subcodes under each: contextual influences, barriers and facilitators, vaccine-specific issues, and VA/military experiences. We then classified initial codes into five categories of hesitancy: vaccine deliberation, dissent, distrust, indifference and skepticism. A subset of Veterans (n = 14) and employees (n = 8) identified as vaccine hesitant. Vaccine hesitancy categories were represented by subcodes of religion, culture, gender or socio-economic factors, perceptions of politics and policies, role of healthcare providers, and historical influences; (contextual influences); knowledge or awareness of vaccines, perceived susceptibility to COVID-19, and beliefs and attitudes about health and illness (barriers and facilitators); vaccine development process (vaccine-specific issues) and military experiences (VA/military factors). Facilitators involved talking with trusted others, ease of vaccine access, and perceptions of family and societal benefits of vaccines. Vaccine hesitancy is multi-faceted and likely requires multiple strategies for engaging in conversations to address Veteran and VA employee concerns. Messages should involve patient-centered communication strategies delivered by trusted healthcare providers and peers and should focus on addressing expected benefits for family, friends, and society.

13.
Student Success ; 12(2):1-12, 2021.
Article in English | Scopus | ID: covidwho-1436227

ABSTRACT

The COVID-19 pandemic has disrupted higher education globally. Teaching staff have pivoted to online learning and employed a range of strategies to facilitate student success. Aside from offering a testing ground for innovative teaching strategies, the pandemic has also provided an opportunity to better understand the pre-existing conditions that enable higher education systems to be resilient-that is, to respond and adapt to disturbances in ways that retain the functions and structures essential for student success. This article presents a case study covering two transdisciplinary undergraduate courses at the University of Technology Sydney, Australia. The results highlight the importance of information flows, feedbacks, self-organisation, leadership, openness, trust, equity, diversity, reserves, social learning and nestedness. These results show that resilience frameworks developed by previous scholars are relevant to university teaching systems and offer guidance on which system features require protection and strengthening to enable effective responses to future disturbances. © The Author/s 2021.

14.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-290674

ABSTRACT

Although the respiratory tract is the primary site of SARS-CoV-2 infection and the ensuing immunopathology, respiratory immune responses are understudied and urgently needed to understand mechanisms underlying COVID-19 disease pathogenesis. We collected paired longitudinal blood and respiratory tract samples (endotracheal aspirate, sputum or pleural fluid) from hospitalized COVID-19 patients and non-COVID-19 controls. Cellular, humoral and cytokine responses were analysed and correlated with clinical data. SARS-CoV-2-specific IgM, IgG and IgA antibodies were detected using ELISA and multiplex assay in both the respiratory tract and blood of COVID-19 patients, although a higher receptor binding domain (RBD)-specific IgM and IgG seroconversion level was found in respiratory specimens. SARS-CoV-2 neutralization activity in respiratory samples was detected only when high levels of RBD-specific antibodies were present. Strikingly, cytokine/chemokine levels and profiles greatly differed between respiratory samples and plasma, indicating that inflammation needs to be assessed in respiratory specimens for the accurate assessment of SARS-CoV-2 immunopathology. Diverse immune cell subsets were detected in respiratory samples, albeit dominated by neutrophils. Importantly, we also showed that dexamethasone and/or remdesivir treatment did not affect humoral responses in blood of COVID-19 patients. Overall, our study unveils stark differences in innate and adaptive immune responses between respiratory samples and blood and provides important insights into effect of drug therapy on immune responses in COVID-19 patients.

15.
Nat Commun ; 12(1): 636, 2021 01 27.
Article in English | MEDLINE | ID: covidwho-1387325

ABSTRACT

Nsp15, a uridine specific endoribonuclease conserved across coronaviruses, processes viral RNA to evade detection by host defense systems. Crystal structures of Nsp15 from different coronaviruses have shown a common hexameric assembly, yet how the enzyme recognizes and processes RNA remains poorly understood. Here we report a series of cryo-EM reconstructions of SARS-CoV-2 Nsp15, in both apo and UTP-bound states. The cryo-EM reconstructions, combined with biochemistry, mass spectrometry, and molecular dynamics, expose molecular details of how critical active site residues recognize uridine and facilitate catalysis of the phosphodiester bond. Mass spectrometry revealed the accumulation of cyclic phosphate cleavage products, while analysis of the apo and UTP-bound datasets revealed conformational dynamics not observed by crystal structures that are likely important to facilitate substrate recognition and regulate nuclease activity. Collectively, these findings advance understanding of how Nsp15 processes viral RNA and provide a structural framework for the development of new therapeutics.


Subject(s)
Endoribonucleases/chemistry , Endoribonucleases/ultrastructure , SARS-CoV-2/enzymology , Viral Nonstructural Proteins/chemistry , Viral Nonstructural Proteins/ultrastructure , Amino Acid Sequence , Catalytic Domain , Cryoelectron Microscopy , Endoribonucleases/metabolism , Models, Chemical , Models, Molecular , SARS-CoV-2/chemistry , Uridine Triphosphate/metabolism , Viral Nonstructural Proteins/metabolism
17.
Med Care ; 59(7): 646-652, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1276272

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to a dramatic increase in virtual care (VC) across outpatient specialties, but little is known regarding provider acceptance of VC. OBJECTIVE: The objective of this study was to assess provider perceptions of the quality, efficiency, and challenges of VC versus in-person care with masks. DESIGN: This was a voluntary survey. PARTICIPANTS: Mental health (MH), primary care, medical specialty, and surgical specialty providers across the 8 VA New England Healthcare System medical centers. MEASURES: Provider ratings of: (1) quality and efficiency of VC (phone and video telehealth) compared with in-person care with masks; (2) challenges of VC; and (3) percentage of patients that providers are comfortable seeing via VC in the future. RESULTS: The sample included 998 respondents (49.8% MH, 20.6% primary care, 20.4% medical specialty, 9.1% surgical specialty; 61% response rate). Most providers rated VC as equivalent to or higher in quality and efficiency compared with in-person care with masks. Quality ratings were significantly higher for video versus phone (χ2=61.4, P<0.0001), but efficiency ratings did not differ significantly. Ratings varied across specialties (highest in MH, lowest in SS; all χ2s>24.1, Ps<0.001). Inability to conduct a physical examination and patient technical difficulties were significant challenges. MH providers were comfortable seeing a larger proportion of patients virtually compared with the other specialties (all χ2s>12.2, Ps<0.01). CONCLUSIONS: Broad provider support for VC was stratified across specialties, with the highest ratings in MH and lowest ratings in SS. Findings will inform the improvement of VC processes and the planning of health care delivery during the COVID-19 pandemic and beyond.


Subject(s)
Attitude of Health Personnel , Telemedicine , COVID-19/psychology , Humans , Mental Health , Primary Health Care , SARS-CoV-2 , Specialties, Surgical , Surveys and Questionnaires , United States , United States Department of Veterans Affairs
19.
Cell ; 184(11): 2955-2972.e25, 2021 05 27.
Article in English | MEDLINE | ID: covidwho-1237636

ABSTRACT

Natural antibodies (Abs) can target host glycans on the surface of pathogens. We studied the evolution of glycan-reactive B cells of rhesus macaques and humans using glycosylated HIV-1 envelope (Env) as a model antigen. 2G12 is a broadly neutralizing Ab (bnAb) that targets a conserved glycan patch on Env of geographically diverse HIV-1 strains using a unique heavy-chain (VH) domain-swapped architecture that results in fragment antigen-binding (Fab) dimerization. Here, we describe HIV-1 Env Fab-dimerized glycan (FDG)-reactive bnAbs without VH-swapped domains from simian-human immunodeficiency virus (SHIV)-infected macaques. FDG Abs also recognized cell-surface glycans on diverse pathogens, including yeast and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike. FDG precursors were expanded by glycan-bearing immunogens in macaques and were abundant in HIV-1-naive humans. Moreover, FDG precursors were predominately mutated IgM+IgD+CD27+, thus suggesting that they originated from a pool of antigen-experienced IgM+ or marginal zone B cells.


Subject(s)
Antibodies, Neutralizing/immunology , HIV-1/immunology , Immunoglobulin Fab Fragments/immunology , Polysaccharides/immunology , SARS-CoV-2/immunology , Simian Immunodeficiency Virus/immunology , Spike Glycoprotein, Coronavirus/immunology , env Gene Products, Human Immunodeficiency Virus/immunology , Animals , B-Lymphocytes/immunology , Broadly Neutralizing Antibodies/immunology , COVID-19/immunology , Dimerization , Epitopes/immunology , Glycosylation , HIV Antibodies/immunology , HIV Infections/immunology , Humans , Immunoglobulin Fab Fragments/chemistry , Macaca mulatta , Polysaccharides/chemistry , Receptors, Antigen, B-Cell/chemistry , Simian Immunodeficiency Virus/genetics , Vaccines/immunology , env Gene Products, Human Immunodeficiency Virus/chemistry , env Gene Products, Human Immunodeficiency Virus/genetics
20.
Journal of the American Geriatrics Society ; 69(SUPPL 1):S80, 2021.
Article in English | EMBASE | ID: covidwho-1214811

ABSTRACT

Background. Diabetic foot complications are costly and common with a higher prevalence in patients aged 65 years and older.1 Access problems are barriers for rural older adults with history of diabetic foot conditions and contribute to higher risk of hospitalizations, emergency room visits, and complications such as ulcers and amputations.2 To prevent these complications, guidelines recommend diabetes self-management education and support (DSMES) with motivational interviewing to promote enhanced self-management for high risk individuals.3 Provider delivery of DSMES has been challenged due to the novel coronavirus (COVID-19) pandemic.4 Therefore, new interventions are needed for improving rural geriatric DSMES access and providing rural primary care providers with geriatric diabetic foot education support. We developed and implemented a novel geriatric high-risk foot DSMES telehealth program at the Atlanta VA Healthcare System to deliver evidence-based structured intensive high risk foot diabetes education for rural older Veterans along with consultation and education for rural primary care providers. Methods: This telehealth program was developed using evidence-based guidelines and is being implemented currently at the Atlanta VA Healthcare System using a plan-do-study-act cycle. Rural Veterans aged 65 and older with diabetes, at risk for diabetes related foot complications and receiving VA primary care are eligible for this three-month consultation program. Initial program effectiveness outcomes include self-efficacy and self-management behaviors reported at baseline and after the three-month intervention. Results/Conclusion: The implementation of this high-risk foot DSMES program will improve rural older Veteran access to evidenced-based structured diabetic foot focused DSMES consultation to enhance participant self-management behaviors and self-efficacy as well as improve support for primary care provider high risk foot education. Veteran enrollment is currently underway with evaluation outcomes forthcoming. We anticipate initial results will be available in at least 30 Veterans.

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