IMPACT OF THE COVID-19 PANDEMIC ON ROUTINE HIV CARE AND ANTIRETROVIRAL TREATMENT OUTCOMES IN KENYA: A NATIONALLY REPRESENTATIVE ANALYSIS (preprint)

Background: The COVID-19 pandemic adversely disrupted global health service delivery. We aimed to assess impact of the pandemic on same-day HIV diagnosis/ART initiation, six-months non-retention and initial virologic non-suppression (VnS) among individuals starting antiretroviral therapy (ART) in Kenya. Methods: Individual-level longitudinal service delivery data were analysed. Random sampling of individuals aged >15 years starting ART between April 2018 - March 2021 was done. Date of ART initiation was stratified into pre-COVID-19 (April 2018 - March 2019 and April 2019 - March 2020) and COVID-19 (April 2020 - March 2021) periods. Mixed effects generalised linear, survival and logistic regression models were used to determine the effect of COVID-19 pandemic on same-day HIV diagnosis/ART initiation, six-months non-retention and VnS, respectively. Results: Of 7,046 individuals sampled, 35.5%, 36.0% and 28.4% started ART during April 2018 - March 2019, April 2019 - March 2020 and April 2020 - March 2021, respectively. Compared to the pre-COVID-19 period, the COVID-19 period had higher same-day HIV diagnosis/ART initiation (adjusted risk ratio [95% CI]: 1.09 [1.04-1.13], p<0.001) and lower six-months non-retention (adjusted hazard ratio [95% CI]: 0.66 [0.58-0.74], p<0.001). Of those sampled, 3,296 (46.8%) had a viral load test done at a median 6.2 (IQR, 5.3-7.3) months after ART initiation. Compared to the pre-COVID-19 period, there was no significant difference in VnS during the COVID-19 period (adjusted odds ratio [95% CI]: 0.79 [95% CI: 0.52-1.20], p=0.264). Conclusions: In the short term, the COVID-19 pandemic did not have an adverse impact on HIV care and treatment outcomes in Kenya. Timely, strategic and sustained COVID-19 response may have played a critical role in mitigating adverse effects of the pandemic and point towards maturity, versatility and resilience of the HIV program in Kenya. Continued monitoring to assess long-term impact of the COVID-19 pandemic on HIV care and treatment program in Kenya is warranted.

Mode of Hospital Rheumatology Appointments in People with Rheumatoid Arthritis: The Impact of the Pandemic in England

Background/Aims During the COVID-19 pandemic rheumatology services were advised to limit face to face contact, with remote telemedicine used instead. Although suitable for some people, issues have been highlighted with telemedicine. The frequency and proportion of remote appointments during the pandemic has not been described, or the socio-demographic characteristics of those accessing remote or in-person rheumatology care. This study aims to describe rheumatology healthcare utilisation and mode of appointment (remote/in-person) in people with rheumatoid arthritis (RA), prior to, and during the pandemic in England. Methods A retrospective prevalent cohort study of people with RA, identified using a validated algorithm, as of 1st April 2019 using electronic health record data (OpenSAFELY). Outpatient rheumatology appointments between 1st April 2019 and 31st March 2022 were identified. For each year, the number of outpatient appointments, mode of appointment (remote/in-person) and patient socio-demographic characteristics were described. Results 130,884 people with RA were identified. Since the start of the pandemic, the proportion of people without any appointments in a 12-month period increased from 28.5% in 2019/20 to 33.3% in 2020/ 21 and has not recovered. Older people were most frequently not seen (51% of people >80 years in 2020/21 and 2021/22). Of appointments where mode was known, 54.4% of people with appointments in the year from April 2020 were only seen remotely, reducing to 35.1% in the year from April 2021 (Table 1). The proportion with all remote appointments increased with increasing age, comprising 62% of people >80 years in 2020. This age gradient persisted in 2021, though proportions of those >80 years with all-remote appointments was lower (44%). Compared to urban dwellers, a higher proportion of those living in rural areas had all remote appointments in 2020 (58% vs 53%) and 2021 (38% vs 34%). Conclusion During the pandemic, one third of people with RA were not seen at all over a 12-month period and these were more frequently older people. Over half of people were only seen remotely in 2020, decreasing to one-third in 2021. Given the limitations of remote appointments it is unknown whether this increased frequency of remote appointments will impact long-term outcomes.

Derivation and validation of clinical phenotypes and associated treatment responses in critically ill COVID-19 patients

Introduction: Due to variability in the host response, a uniform treatment strategy for severe COVID-19 may be inadequate. We applied unsupervised clustering methods to large cohorts of COVID-19 ICU patients to derive and validate clinical phenotypes, and to explore treatment responses in these phenotypes. Method(s): Phenotypes were derived in 13.279 critically ill COVID-19 patients admitted to 82 Dutch ICUs from September 2020 to February 2022. Twenty-one features were selected from clinical characteristics measured within 24 h after ICU admission. Phenotypes were assigned using consensus k means clustering. External validation was performed in 6225 critically ill COVID-19 patients admitted to 55 Spanish ICUs from February 2020 to December 2021. Individual patient data on corticosteroids therapy enabled us to investigate phenotype-specific responses in this cohort. Result(s): Three distinct clinical phenotypes were derived (Fig. 1A). Patients with phenotype 1 (43%) were younger, had lower APACHE IV scores, higher BMI as well as a lower P/F ratio and 90-day in-hospital mortality (18%, Fig. 1A). Phenotype 2 patients (37%) were older and had slightly higher APACHE IV scores compared with phenotype 1, a lower BMI, and higher mortality compared to phenotype 1 (24%, p = 2.95e-07). Phenotype 3 (20%) included the oldest patients with the most comorbidities and highest APACHE IV scores, severe renal and metabolic impairment, and the worst outcome (47% mortality, p = 6.6e-16 and p = 6.6e-16 versus phenotypes 1 and 2, respectively). Phenotype distribution and outcome were very similar in the validation cohort (Fig. 1B). This cohort also revealed that corticosteroid therapy only benefited phenotype 3 (65% vs. 54% mortality, p = 2.5e-03, Fig. 1C). Conclusion(s): COVID-19 ICU phenotypes based on clinical data are related to outcome and treatment responses. This can inform treatment decisions as well as randomized trials employing precision medicine approaches.

Use of Donor-Derived Cell Free Dna in Heart/Lung Transplant Recipients

Donor derived cell free DNA (ddcfDNA) is a noninvasive blood test used to assess the risk of allograft rejection in both lung and heart transplant recipients. The normal value for lung transplant recipients with a quiescent graft is <0.5%, while that for heart transplant recipients is <0.12%. There is no data on the expected normal level for combined organ transplants including heart and lung transplants. Here we present longitudinal ddcfDNA data on two combined heart/lung transplant recipients. Immunosuppression regimens for both consisted of prednisone, tacrolimus, and mycophenolate after basiliximab for induction. Patient 1 is a 25 year old female who received combined bilateral lung and heart transplant for primary ciliary dyskinesia and severe MR. Her 1 month ddcfDNA level was 2.1%, which correlated with A4 cellular rejection. Her 2 month ddcfDNA level was 1% and then was under the 0.5% from 3 months onward. She has not had any further cellular or AMR. Cardiac allograft function has been normal on serial echos. Patient 2 is a 35 year old female who received combined bilateral lung and heart transplant for scleroderma related ILD with PAH. Her 1 month ddcfDNA level was 2%, with A3 cellular rejection. Her ddcfDNA level at 2 months was 1.2%, she had DSA that was treated. Her 3 month level was 0.84%, at which time she had a non-covid coronavirus. Since month 4 her ddcfDNA has remained under 0.5% and she has not had any recurrent cellular or AMR. Cardiac allograft function was initially normal, declined to mildly impaired at 2 months, has since recovered and remains normal on serial echos. ddcfDNA is a useful tool for assessing allograft dysfunction in both lung and heart transplant recipients. It is conceivable that due to the size and immunogenicity of the lung allograft, there is little increase in ddcfDNA in these recipients above that of isolated lung transplant recipients. Our experience with these two recipients does attest to this theory. However, larger studies are necessary to evaluate this further. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Low Serum Albumin at Admission Is Associated with Mortality among Inpatients with Cirrhosis: A Multi-National Experience

Background: MELD and Child-Pugh scores have traditionally been used as prognostic indicators in patients with cirrhosis. Albumin infusions in outpatients have been associated with improved outcomes, but not in transplant waitlisted patients or inpatients. This aim of this study was to assess whether low serum albumin (sAlb) on admission alone is a poor prognostic indicator among cirrhotic inpatients from a new multi-national cohort. Method(s): The CLEARED study is a global study that enrolled consecutive non-electively admitted inpatients without organ transplant or COVID-19 from 6 continents. Admission demographics, medical history, laboratory data, inpatient course, death/hospice transfer and mortality at 30 days post-discharge were recorded. Patients were divided into 3 groups: sAlb <28gm/L(A), sAlb >=28 but <35gm/L (B), and sAlb>=35gm/L (C) were compared. Multi-variable logistic regression was performed using inpatient mortality and overall 30-day mortality as outcomes. Result(s): 2429 patients were enrolled from 21 countries worldwide. The distribution was A:49%, B:39%, C:12%. Gp A patients were significantly younger (54yrs vs. 57yrs vs 58yrs p<0.0001) but with similar gender distribution, and higher MELD-Na score of 25 vs. 20 vs. 17 (p<0.0001). Gp A patients were more likely to have alcohol as etiology of cirrhosis (49% vs. 45% vs 38%, p=0.004), and were more likely to have either infection (27% vs. 18% vs. 13%, p<0.0001), HE (39% vs. 33% vs. 23%, p=0.005) or fluid related issues as a reason for admission (p<0.0001). More patients in Gp A received albumin infusion during their hospital stay (120gm vs. 100gm vs. 100gm p=0.0004), mostly for the indications of AKI (47% vs. 49% vs. 47%, p=0.79) and performance of large volume paracentesis (44% vs. 42% vs. 41%, p=0.80), followed by bacterial peritonitis indication (22% vs. 17% vs. 11%, p=0.01). Group A patients had longer hospital stays (9 days vs. 8 days vs. 7 days (p<0.001), but similar ICU transfer (23% vs. 22% vs. 20%, p=0.55). group A patients were more likely to die while inpatients (19% vs. 11% vs. 5%, p<0.0001), or by 30 days post-discharge (29% vs. 20% vs. 9%, p<0.0001). Table shows the admission variables associated with a poor outcome. Conclusion(s): Hypoalbuminemia is extremely common among admitted cirrhotic patients, with sAlb of <28gm/L occurring in almost half. Together with MELD-Na score and infection at admission, a low sAlb is associated with a poor outcome in these patients. Future studies will need to validate these findings and to assess whether albumin infusions will improve the outcome of these patients. (Figure Presented).

Differences in Mortality Rates in Inpatients with Cirrhosis Depends on the Low, Middle or High Income Country Location: Multi-National Cleared Consortium Experience

Background: Although cirrhosis is a major cause of mortality worldwide, there could be disparities in outcomes. This needs a global consortium to study disparities in inpatient cirrhosis care Aim: Define the impact of location in prediction of outcomes in inpts with cirrhosis. Method(s): CLEARED prospectively enrolled non-electively admitted cirrhosis pts without COVID from all continents. To ensure equity, we allowed only 50 pts/site. Admission details, cirrhosis history, inpatient & 30-day course were recorded. World bank classification of low/low middle income (LMI), upper middle (UMI) & High income (HI) were used. Cirrhosis details, inpatient & 30-day outcomes were compared between groups. Multi-variable regression was performed using inpatient & 30-day mortality as outcomes. Result(s): 2758 pts from 21 countries from all continents, including Africa & Australia, were included.727 were L/LMI, 1050 UMI & 981 pts were from HICs. More men & younger pts were in LMI. Cirrhosis details: More pts in HI gp had 6M hospitalizations & infections, HE & ascites while prior variceal bleeding was higher in LMI . Prior HCC & transplant listings were lower in LMI but similar in UMI/HI. Alcohol & NASH was highest in HI. Viral hepatitis & cryptogenic were highest in UMI.Admissions: Admission MELD was highest in LMI. LMI pts were admitted more for GI Bleed, HE, & DILI, while anasarca & HBV flares were higher in UMI. Higher SBP (36% vs 24% vs 21% p<0.0001) & lowest skin/soft-tissue infections were in LMI (5% vs 5% vs 10% p=0.008);rest were similar. Nosocomial infections, driven by UTI were highest in LMI & HI pts (15% vs 14% vs 11% UMI, p=0.03). Admission diuretics, PPIs, Lactulose & statins were highest & antivirals lower in HI. SBP prophylaxis & rifaximin were highest in LMI pts. Outcome(s): More LMI pts needed ICU & had more organ failures (Fig B). Discharge MELD was highest in LMI. In-hospital mortality was highest & transplant lowest in LMI. This extended to 30-day mortality & transplant in LMI patients vs HI pts.Regression: In-hospital mortality was linked with age, infections, MELD & being in a LMI/UMI vs HIC while being on a transplant list, diabetes, & SBP prophylaxis were protective (Fig C). 30-day mortality predicted by age, ascites, HCC, discharge MELD, organ failures, LMI/UMI vs HIC but rifaximin was protective(Fig D). In-hospital transplant was higher with high MELD, admission rifaximin & listed pts &lower in LMI (OR 0.26) & UMI (OR 0.22) & age. 30-day transplant was higher in those with hyponatremia, ascites & HRS, on the list & on rifaximin and lower in LMI (OR 0.24) & UMI (OR 0.59) vs HI. Conclusion(s): In a global study of inpatients with cirrhosis, there were major differences in outcomes. Not being in a high-income country significantly increased the risk of inpatient and 30-day mortality independent of demographics, medications, in-hospital course, and cirrhosis severity likely due to disparities in access to transplant, which should be accounted for in global models. (Figure Presented).

Incidence of Acute Achilles Repair Surgeries in the Peri-Pandemic COVID Era: And Parallels to the Current 2021-22 NFL Season

Category:: Sports;Ankle Introduction/Purpose:: The World Health Organization declared the outbreak of COVID-19 a pandemic on March 11, 2020, leading to lockdowns, quarantines, and increased sedentary behaviors. As the general population as well as athletes returned to their normal physical activities or sport in 2021, the risk for musculoskeletal injury increases after inactivity. Thus, the purpose of this study was (1) to investigate the rates of AATR requiring repair in a single academic center in NYC, and (2) see if a corollary exists in the NFL. Our hypothesis is that after a decrease in AATRs in 2020 from decreased physical activity due to a combination of lockdown sanctions and COVID pandemic-induced fears, there is a rebound increase in AATRs in 2021, possibly even to greater than pre-pandemic levels. Methods:: All study protocols were approved by the Institutional Review Board at the senior author's institution. A retrospective search was conducted using current procedural terminology to identify the total number of Achilles acute primary repair surgeries performed from years 2017 to 2021 at a sincle academic center. NFL data was obtained from publicly available sites according to previously validated studies. Chi-square analysis was conducted between proportion of Achilles surgeries performed in 2021 and 2017-2020 at a single academic center. Additional Chi-square analysis was performed in a similar manner, however between each year and 2021. Results:: A total of 588 patients who sustained AATRs and underwent primary surgical repair were identified, primarily men (75.7%, n = 445), with an average age of 43.22+-14.4 years. The incidence of the total number of AATR repairs per year was: 2017: 21.1% (n = 124), 2018: 18.7% (n = 110), 2019: 22.1% (n = 130), 2020: 14.6% (n = 86), 2021: 23.5% (n = 138), indicating a 7.5% decrease in rate of AATRs from 2019 to 2020, followed by an 8.9% increase in incidence from 2020 to 2021. Within the NFL, the number of AATRs resulting in an IR stint increased every regular season from 2019-2020: 21.2% (n = 11), to 2020-2021: 32.7% (n = 17), to this past 2021-2022 season: 46.2% (n = 24). Conclusion:: The main finding of our study is a decrease in the incidence of AATRs during the height of the COVID pandemic quarantine in 2020, with a 8.9% increase in 'post-COVID' 2021 at a single academic institution. There was also a 2.9% higher incidence of AATR in 2021 compared to 'pre-COVID' normal levels when averaged between 2017 to 2019, findings that are mirrored in the NFL. This information provides important information for providers when counseling patients and athletes on return to sport in this current pandemic, especially with possible future lockdowns or quarantines due to new variants such as Omicron.

COLONOSCOPY WAITING LIST VALIDATION ACHIEVES TWO-THIRDS REDUCTION OF NUMBERS AWAITING POST-POLYPECTOMY SURVEILLANCE

Introduction Waiting lists in Northern Ireland are the worst in the UK, representing a growing problem and one exacerbated by the Covid-19 pandemic. Those currently awaiting diagnostic services in NI total 147,543 including 31,313 endoscopy investigations (60% of which are waiting >26 weeks). By applying recent BSG/ACPGBI/PHE Guidelines for post-polypectomy surveillance, this study aimed to reduce the numbers of those awaiting planned colonoscopy within our Trust. The Guidelines suggest patients with polyps and high-risk findings should receive a one-off surveillance colonoscopy at 3 years, compared to previous 1-year interval advice. Patients who previously required follow up endoscopy at 5 years may be safely discharged with invitation to screening if no high risk features. Methods Validation of the waiting list was undertaken by consultants and nurse endoscopists with reference made to the current Guidelines. Patient records were reviewed using the Unisoft GI Reporting Tool v14.40.10 and the NI Electronic Care Record. Those relevant to polyp surveillance were identified (n=2001). Each request was categorised to either 'Remove', 'Proceed' or 'Defer'. Outcomes were recorded in an Excel spreadsheet. Patients were informed by letter of any change to their management plan, reasons for removal from the waiting list and given advice on seeking new referral if further symptoms developed. Participation in the Bowel Cancer Screening Programme (BCSP) was encouraged. The NHS England 2021-22 National Tariff for colonoscopy with biopsy (£548) was referenced in calculation of potential cost savings. Results A total of 5403 requests were on the endoscopy waiting list. 84 patients were deceased and were removed from the list. 1964 related to polyp surveillance and 37 to polyp site check. Following validation of 2001 tests, 1286 (64%) were categorised as 'Remove', 588 (29%) 'Proceed' and 127 (6%) 'Defer'. Reasons for removal included no high-risk features, age over 75 or life expectancy less than 10 years. Potential cost savings following removal of 1286 requests totalled £704,728.00. Conclusion Validation of the waiting list, considering updated or incorrect adherence to the current surveillance guidelines, achieved almost two thirds reduction. If applied nationally, this may greatly reduce the burden of outstanding endoscopy procedures and improve access to these services. Current guidelines state that patients >10 years younger than the BCSP who have polyps without high-risk features should be considered for colonoscopy at 5 or 10 years. In Northern Ireland, the BCSP lower age limit is 60 years. If this were reduced in line with England's 50 years, this may further reduce some surveillance burden allowing suitable patients to be invited to the Screening pathway rather than repeat endoscopy.

CLEARED Global consortium results highlight regional variation and need for equity in inpatient outcomes in hospitalized patients with Chronic Liver Disease

Background and aims: A global study with equitable participation for cirrhosis and chronic liver disease (CLD) outcomes is needed. We initiated the Chronic Liver disease Evolution And Registry for Events and Decompensation (CLEARED) study to provide this global perspective. Aim to evaluate determinants of inpatient mortality and organ dysfunction in a multi-center worldwide study. Method: We prospectively enrolled pts with CLD/Cirrhosis >18 years without organ transplant or COVID-19 who were admitted non-electively. To maintain equity in outcome analysis, a maximum of 50 pts/site were allowed. Data for admission variables, hospital course, and inpatient outcomes (ICU, death, organ dysfunction [ODF]) were recorded. This was analyzed for death and ODs using significant variables on admission and including World Bank classification of low/middle-income countries (LMIC). A model for in-hospital mortality for all variables during the hospital course, including ODs) was analyzed. Results: 1383 pts (55 ± 13 yrs, 64% men, 39% White, 30% Asian, 10% Hispanic, 9% Black, 12% other) were enrolled from 49 centers (Fig A). 39% were from high-income while the rest were from LMICs. Admission MELDNa 23 (6–40) with history in past 6 months of hospitalizations 51%, infections 25%, HE 32%, AKI 23%, prior LVP 15%, hydrothorax 8% and HCC 4%. Leading etiologies were Alcohol 46% then NASH 23%, HCV 11% and HBV 13%. Most were on lactulose 52%, diuretics 53%, PPI 49% and statins 11%, SBP prophylaxis 16%, beta-blockers 35% and rifaximin 31%. 90% were admitted for liver-related reasons;GI bleed 30%, HE 34%, AKI 33%, electrolyte issues 30%, anasarca 24% and 25% admission infections. In-hospital course: Median LOS was 7 (1–140) days with 25% needing ICU. 15% died in hospital, 3% were transplanted, 46% developed AKI,15% grade 3–4 HE, 14% shock, 13% nosocomial infections and 13% needed ventilation. Logistic Regression: Fig B shows that liver-related/unrelated factors on admission which predicted in-hospital mortality and development of organ dysfunction with MELDNa and Infections being common among all models. Nosocomial infections and organ dysfunctions predicted mortality when all variables were considered. High-income countries had better mortality outcomes likely due to transplant and ICU availability. AUCs were >0.75 (Figure Presented) Conclusion: In this worldwide equitable experience, admission cirrhosis severity and infections are associated with inpatient outcomes, which are greater in low-income settings. Liver-related and unrelated factors and regional variations are important in defining critical care goals and outcome models in inpatients with cirrhosis.

Tiredness Detection for a Robotic Mobility Aid

The proportion of elderly people in society is predicted to continue to rise in the coming decades. Mobility is a key aspect of many daily activities, but falls become an increasingly significant health risk with age. With the COVID-19 pandemic, many elderly users prefer or require assistive devices, rather than human support, in walking and carrying out daily tasks. However, prior work has shown that when using passive assistive mobility devices, fall risks can actually increase. This presents an opportunity for assistive robots to help maintain and improve the mobility of elderly users, with an additional emphasis on safety, made possible through sensing capabilities. In this paper, we present a computer vision system that detects the eye blink and face angle patterns for exhibiting signs of tiredness. In addition to the frame-based detection, we also introduce a time-window collation with a machine learning classifier. The system proposed here is critical in monitoring the user, performing real-time detection, and recommending they take a break if tiredness is detected. The overall system architecture and algorithmic details are presented, then a series of experiments are conducted to validate the performance of the approach. © 2022 IEEE.

LOWER INCIDENCE OF COVID-19 BUT HIGHER MORTALITY IN PATIENTS WITH INFLAMMATORY ARTHRITIS COMPARED TO CONTROLS IN WALES, UNITED KINGDOM: A POPULATION EPIDEMIOLOGICAL STUDY

Background/Aims To investigate whether inflammatory arthritis (rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS)) and/or their treatments predisposes patients with an increased risk of contracting COVID-19 and/or more severe infection. Methods A retrospective, population-based cohort study using linked, Welsh anonymised electronic health data from SAIL Databank, comprising primary care, secondary care, rheumatology clinic data, Office of National Statistics Mortality data and laboratory COVID-19-related datasets. Individuals aged 18 years or over who tested positive for COVID-19 in Wales for the period of analysis from 1st March 2020 to 12th May 2021 with READ Codes present for RA, PsA and AS in their primary care records formed the study population cases. The controls were individuals without IA codes present in their records. Results Over 3 million COVID-19 tests had been administered in Wales, UK during the study period. A total of 1966 IA patients and 166,602 controls had tested positive for COVID-19 and were included in analysis. The incidence rate was 3.5% (1966/56,914) for IA patients and 6% in controls (166,602/2,760,442) (Chi Square: p-value is<0.00001). Individuals with IA were older and significantly more comorbid compared to controls. Significantly more patients with IA were hospitalised (difference: 13.9%;95% CI: 12-15.8) or deceased (difference: 8%;95% CI: 6.7-9.5) following COVID-19 infection compared to controls. In a cox proportional hazard model, adjusted for significant covariates, IA was not associated with higher risk of death following COVID infection (HR: 0.42, 95% CI: 0.14 to 1.29). Significant risk factors associated with increased risk of death included shielded status (HR: 1.38, 95% CI: 1.27 to 1.50), increasing age (HR: 1.08;95% CI: 1.07-1.08), smoking (HR: 1.24;95% CI: 1.15-1.35), diabetes (HR: 1.31;95% CI: 1.22-1.41), hypertension (HR: 1.15;95% CI: 1.07-1.23), cancer (HR: 1.07;95% CI: 1.00-1.15) and previous serious infections (HR: 1.13;95% CI: 1.06-1.21) were associated with increased risk of death in IA patients compared to controls. Hospitalisations 1-year prior to COVID-19 were associated with a more than threefold increased risk of death in IA patients compared to controls (HR: 3.15;95% CI: 2.89-3.44). Conclusion Conclusion: IA patients had a lower risk of contracting COVID, probably as a result of shielding. IA was not directly associated with increased risk of death compared to controls following COVID-19 infection. Rather, being older and vulnerable with more comorbidities were associated with increased risk. This has implications on identifying individuals with IA most at risk. In addition, identifying those who were hospitalised 1-year prior to COVID-19 is a quick and economical way of identifying those most at risk from COVID-19.

COVID-19 and the growth mindset: Dangerous opportunities

The pervasive shelter in place mandates of March 2020 forced all educators to precipitously migrate to online education. After grappling with myriad technical concerns such as hardware, software, and internet connectivity, educators began addressing more complex issues such as a new, different online pedagogy. Other hurdles to virtual education included appropriate curricular adaptations, modifications to instructional delivery and assessment, and evolving parameters of social engagement. This chapter explores the intersection of the pandemic and the growth mindset which many educators manifested during online migration, often with no preparation and under the duress of immediacy. Successfully navigating such a large magnitude of change challenged educators, and their ability to embrace a growth mindset often facilitated more positive outcomes with online teaching and learning. The silver lining of the dark cloud of COVID-19 was its unexpected intersection with the growth mindset, leading teachers and learners to develop new skills, abilities, and potentialities. © 2021, IGI Global.

Examining the Impact of the COVID-19 Pandemic on Delivery of HIV Care and Prevention Services among Patients in a Ryan White Clinic

Background. We sought to characterize the impact of the COVID-19 pandemic on HIV-related outcomes in a cohort of patients by examining rates of viral load (VL) suppression, retention-in-care, PrEP access, and STIs. Methods. This was a single center, retrospective study of adults receiving HIV treatment or HIV/STI prevention services from 01/2019 - 12/2020. HIV outpatient visits were identified through HRSA's CareWARE. Visits (in-person, telehealth) only included HIV primary care. HRSA core performance measures were utilized (Table 1). STI positivity rates and descriptive characteristics were calculated. New and refill PrEP prescriptions were tabulated. Chi-square tests compared unmatched non-parametric variables;McNemar's test matched non-parametric variables. Multivariable logistic regression identified variables associated with retention in care and viral suppression. Results. 1721 patients received care;1234 were seen in both years, 334 only in 2019, 153 only in 2020. The number of telehealth visits increased significantly: video (0% to 31%, < 0.001), phone (0% to 0.4%, p < 0.001). Though the proportion of kept appointments increased (57.2% vs 61.2%), the annual retention in care rate decreased from 74.5% to 70.9% (p = 0.002). Overall, 9.7% of patients had detectable VLs at any point. Compared to 2019, a lower proportion of patients maintained VL suppression in 2020, (91.6% vs 83.5% p = 0.075). More patients did not have a VL drawn in 2020 than in 2019 (10.3% vs 2.0 %, p < 0.001). Patients with detectable VLs in 2019 were more likely than those who were undetectable to have detectable VLs in 2020 (OR 18.2, 95% CI 9.91-33.42). Black race was associated with higher likelihood of lack of VL suppression (OR = 2.0;95% CI 1.10-3.66). There were no significant differences between gender or age groups in rates of viral suppression, number screened for bacterial STIs or positive results. Visits for new and refill PrEP prescriptions decreased by 59% and 7%, respectively. Conclusion. Rates of viral load suppression and retention in care decreased in 2020 compared to 2019. The proportion of clinic visits attended increased after the integration of telemedicine in 2020. These data may be used to inform evidence-based interventions to improve the HIV continuum of care through telehealth.

Political Preferences, Knowledge, and Misinformation About COVID-19: The Case of Brazil

The COVID-19 pandemic has led to a vast research agenda focusing on how citizens acquire knowledge about the virus and the health expert guidelines to protect themselves and their close ones against it. While many countries and regions have been accounted for, there still remains a substantial gap with respect to public opinion about the virus in Latin America, most notably in Brazil, which currently has the second highest in number of fatalities in the world. In this article, we employ a national survey of Brazilians (n = 2,771) to measure and explain knowledge and misinformation about the coronavirus and its illness, COVID-19. Our focus concerns the role of political preferences in a context of high elite polarization with a sitting government that has systematically downplayed the risks associated with the coronavirus and its illness. Our findings are clear: political preferences play a substantial role in explaining differences in knowledge about the coronavirus and COVID-19, more than conventional determinants of learning like motivation, ability, and opportunities. Specifically, we find that supporters of President Jair Bolsonaro—an avid science and COVID-19 denier—know significantly less about the coronavirus and its illness and are more likely to believe in a conspiracy theory that claims that the coronavirus was purposefully created in a Chinese laboratory to promote China's economic power, when compared to Brazilians who are less supportive of him and his government. Our findings carry important implications for how Brazilians take informational cues from political elites in that—even in a major event like a global pandemic—supporters of the president are as likely as ever to “follow their leader” and deny expert-backed scientific evidence. Copyright © 2021 Gramacho, Turgeon, Kennedy, Stabile and Mundim.

Multi-Dimensional Approaches in Transforming Agriculture

Indian agriculture always provides lot of interwoven challenges to the growing farming community. Farmers today face a complicated host of environmental, social and economic pressures: protecting water and air resources, mitigating greenhouse gases, conserving biodiversity and limiting soil erosion, all while trying to make a living. These challenges are linked, yet most agricultural research of the last 80 years has approached them from a reductionist standpoint. To build truly sustainable farming systems, agricultural research must embrace through multidimensional approaches. Multidimensional approaches for agriculture outlines both the theory and practice of agricultural systems research, helping agricultural professionals to study, understand and develop economically, socially and environmentally sustainable production systems. There is need to enhance the crop productivity through the changing innovative breeding and crop management strategies. Environmental impacts on farm food security are largely determined by various factors.

Ligand-protein interactions of plant-isolated (9z,12z)-octadeca-9,12-dienoic acid with Β-ketoacyl-Acp synthase (KasA) in potential anti-tubercular drug designing.

Mycobacterium tuberculosis remains one of the world's contributors to mortality. With the emergence of SARS-CoV-2 coinfections, patients with TB are predisposed to being more heavily weighed down by COVID-19 disease and its opportunistic coinfections. The severity of the disease coupled with drug resistance on the currently used drugs warrants for the search for alternative remedies from synthetic agents, semisynthetics and natural products that include plants. Africa is rich in plant diversity with a promise as sources of drug agents, one of which is Eichhornia crassipes. This work aimed at isolating a fatty acid and dock it to ß-ketoacyl-ACP synthase for possible anti-TB drug development prospects using computational tools. (9z,12z)-Octadeca-9,12-dienoic acid was isolated from Eichhornia crassipes for the first time using chromatographic techniques and identified using 1D and 2D NMR spectroscopic methods (1H NMR, COSY, HSQC, HMBC and 13C NMR). The compound was then docked to ß-ketoacyl-ACP synthase (KasA), an essential member of the b-ketoacyl synthases encoded in the M. tuberculosis genome in comparison with its co-crystallized ligand JSF-3285, also for the first time. (9z,12z)-Octadeca-9,12-dienoic acid interacted with only phenylalanine239 and proline201 while JSF-3285 interacted with proline201, glutamine120, alanine119, leucine116, glutamine199, histadine345, phenylalanine239, glycine240 and glycine200. (9z,12z)-Octadeca-9,12-dienoic acid had a ligand efficiency of 0.24, compared to the co-crystallized ligand's 0.36. The compound was too flexible and elongated with -4.72 KCalmol-1 binding energy. Despite some unfavourable physico-chemical properties, the compound still provides reliable interactions that only require logical structural modifications by the addition of polar regions amongst others to increase interactions and ligand efficiency, which can consequently stand to be a better potential drug lead. For the first time, plant-based (9z,12z)-Octadeca-9,12-dienoic acid isolated from Eichhornia crassipes was shown to interact fairly well with ß-ketoacyl-ACP synthase and proved to be a potential starting material from which anti-tubercular drugs can be designed.