Lung Abnormalities in Severe Acute Respiratory Syndrome Coronavirus 2 Infection: An Analysis of Paired Computed Tomography Scans Before and After Infection.

Background: Studies on the pulmonary consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are impeded by limited access to pre-SARS-CoV-2 examinations. Methods: We invited Copenhagen General Population Study participants with a confirmed SARS-CoV-2 polymerase chain reaction (PCR) test during the first and second coronavirus disease 2019 waves in Denmark for a repeat chest computed tomography (CT) scan. Paired CT scans were independently assessed for interstitial and noninterstitial abnormalities by 2 trained radiologists. A semiquantitative CT score (ranging from 0 to 20) was used to quantify the extent of interstitial abnormalities. Results: Of 111 SARS-CoV-2-infected individuals, 102 (91.2%) experienced symptoms and 12 (11.2%) were hospitalized. Follow-up examination was performed at median of 5.4 (interquartile range, 4.1-7.8) months after a positive SARS-CoV-2 PCR test. Of 67 individuals with paired CT scans, ground glass opacities and reticulation were present in 31 (46.3%) individuals post-SARS-CoV-2 compared to 23 (34.1%) pre-SARS-CoV-2 (mean CT score, 3.0 vs 1.3; P = .011). Results were similar for nonhospitalized individuals. We did not detect development of bronchiectasis, emphysema, or nodules. Conclusions: SARS-CoV-2 infection in predominantly nonhospitalized individuals with mild disease was associated with a small increase in only interstitial lung abnormalities.

Compartmental immunophenotyping in COVID-19 ARDS: A case series.

BACKGROUND: Severe immunopathology may drive the deleterious manifestations that are observed in the advanced stages of coronavirus disease 2019 (COVID-19) but are poorly understood. OBJECTIVE: Our aim was to phenotype leukocyte subpopulations and the cytokine milieu in the lungs and blood of critically ill patients with COVID-19 acute respiratory distress syndrome (ARDS). METHODS: We consecutively included patients less than 72 hours after intubation following informed consent from their next of kin. Bronchoalveolar lavage fluid was evaluated by microscopy; bronchoalveolar lavage fluid and blood were assessed by 10-color flow cytometry and a multiplex cytokine panel. RESULTS: Four mechanically ventilated patients (aged 40-75 years) with moderate-to-severe COVID-19 ARDS were included. Immature neutrophils dominated in both blood and lungs, whereas CD4 and CD8 T-cell lymphopenia was observed in the 2 compartments. However, regulatory T cells and TH17 cells were found in higher fractions in the lung. Lung CD4 and CD8 T cells and macrophages expressed an even higher upregulation of activation markers than in blood. A wide range of cytokines were expressed at high levels both in the blood and in the lungs, most notably, IL-1RA, IL-6, IL-8, IP-10, and monocyte chemoattactant protein-1, consistent with hyperinflammation. CONCLUSION: COVID-19 ARDS exhibits a distinct immunologic profile in the lungs, with a depleted and exhausted CD4 and CD8 T-cell population that resides within a heavily hyperinflammatory milieu.

Positioning TVET Lecturer Identities at the Centre of TVET Lecturer Education and Training in a Post-COVID-19 Context

The Technical and Vocational Education and Training (TVET) college sector in South Africa is seen as central to skills development and the revival of the economy. However, the sector remains one of the weakest in the post-school system. This chapter provides a synopsis of the evolution of the post-apartheid college sector context in South Africa, the nature of the new programme offerings for pre- and in-service training as well as increasing moves towards professionalisation of the sector. This discussion is presented against the backdrop of the broader policy context in the country, specifically considering the different needs of current TVET lecturers, who range from unqualified;academically qualified, but without workplace pedagogy;trained for the schooling sector;to the ideal—those who are both academically and professionally qualified. While this rather lopsided continuum is not unique to South Africa, the way it is being addressed is important to articulate and reflect on. The changes in the management and governance of the colleges prior to the establishment of the Department of Higher Education and Training (DHET) and the impact these changes had on lecturers’ job security and conditions of employment are key factors that we will explore in our contribution. The college sector lost lecturing staff during this time, further reducing its capacity to meet the training needs of the country. While seemingly intractable problems such as slow uptake of newly introduced qualifications for TVET lecturers and compliance oriented continuing professional development (CPD) programmes can be overcome, the impact of COVID-19 on this sector should not be underestimated. Of course, this uncertain future also offers an opportunity to make changes that may previously have been politically unpalatable. In this chapter, we try to imagine what a more explicitly conceptualised workplace pedagogy would comprise to produce a pipeline of well-trained and professionally orientated TVET lecturers. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Centrifugal forces in a hegemonic environment: the rise of small-state coalitions in the Economic and Monetary Union

A hegemonic power can guarantee the status quo in an international economic system. However, domestic or international changes may unsettle a hegemon’s priorities. In such phases, smaller states benefiting from the existing system may fear that the hegemon will fail to keep the system stable. How do they react if they lose trust in the hegemon’s ability or will to maintain the status quo? This article argues that in such cases, free riding becomes less rewarding. Therefore, smaller states build publicly visible coalitions to ‘voice’ their preferences. Applying this argument to the role of small ‘creditor states’ in the Economic and Monetary Union (EMU), the article draws on original in-depth interviews to analyze the ‘New Hanseatic League’ as a strategy to defend the present euro regime and counterbalance the Franco–German tandem. By elaborating and tracing a fine-grained causal mechanism, the article thus explains the emergence of vocal small-state coalitions in a hegemonic environment.

Lung Function Decline in Relation to COVID-19 in the General Population: A Matched Cohort Study With Prepandemic Assessment of Lung Function.

BACKGROUND: To quantify the potential decline in dynamic lung volumes following coronavirus disease 2019 (COVID-19) in the general population. METHODS: A prospective matched cohort study of adult Copenhagen General Population Study (CGPS) participants with a prepandemic spirometry available. CGPS individuals with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test performed repeat spirometry, a questionnaire regarding respiratory symptoms, and diffusing capacity test for carbon monoxide. A matched uninfected CGPS control sample was used, and simple regression and linear mixed effect models were computed to study lung function decline. RESULTS: A total of 606 individuals were included; 92/107 (85.9%) with positive SARS-CoV-2 PCR test experienced coronavirus disease 2019 (COVID-19) symptoms and 12 (11.2%) were hospitalized. Spirometry was performed at median 5.6 months (interquartile range, 3.9-12.8) after positive SARS-CoV-2 PCR test. COVID-19 was associated with adjusted 7.3 mL (95% confidence interval [CI], .3-14.3) and 22.6 mL (95% CI, 13.1-32.0) steeper decline in annual forced expiratory volume in first second (FEV1) and FVC or total 113.8 and 301.3 mL lower FEV1 and FVC from baseline to follow-up. Results were robust in analyses restricted to individuals not requiring hospitalization. CONCLUSIONS: COVID-19-related declines of dynamic lung volume in the general population not requiring hospitalization were small but measurable.