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1.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2005728

ABSTRACT

Background: Cancer-related cognitive impairment (CRCI) can include persistent memory symptoms, and affects many cancer survivors. Memory and Attention Adaptation Training (MAAT) is an evidencebased cognitive behavioral therapy (CBT) that improves CRCI with demonstrated efficacy in telehealth delivery. MAAT consists of 8 weekly (45-minute) video visits. The aims of this study are to confirm MAAT telehealth efficacy in a phase III RCT (MAAT versus Supportive Therapy;ST) across large catchment areas of two comprehensive cancer centers. A secondary aim is to evaluate treatment-induced brain activation as assessed by functional MRI (fMRI) in a subset of participants. We present remote treatment and data capture methods of this open NCI-sponsored (R01CA244673) randomized clinical trial (NCT 04586530). These methods have high success in participant accrual despite COVID-19 pandemic conditions, and can be readily adopted to other clinical trials to enhance rural/underserved enrollment. Methods: We are enrolling 200 adult, stage I-III breast cancer survivors 1-5 years post-chemotherapy with cognitive complaints. Individuals with CNS disease, previous brain injury, dementia or psychiatric disorder are excluded. All study procedures are completed from the participant's home (except fMRI). Eligibility screening is a semi-structured phone interview followed by detailed informed consent online (Research Electronic Data Capture: REDCap) with staff phone guidance. Consented participants complete baseline brief phone-based neurocognitive assessment and validated patient-reported outcome measures (PROs) of cognition and quality of life via REDCap. Participants are randomized to MAAT or ST and assigned treating clinicians at respective cancer centers. All 8 visits are completed through secure telehealth platforms, followed by repeat phone/online assessment posttreatment and again at 6 months. Enrollment began in 3/2021. As of 1/2022 (9 months), 56 participants are enrolled (28% of the planned sample), 47 randomized (MAAT 24;ST 23), with 24 completing post-treatment assessments. If all assessments and treatment visits were in person, travel burden per participant is 968 miles/20.5 hours driven, and $542 (US 2021 Federal rate). Thus, study travel savings to date are $30,352. Participant feedback indicates telehealth makes participation possible, similar to previous MAAT research. The current RCT demonstrates utility, efficiency and cost-savings of telehealth and remote data capture technology in the conduct of cancer control research. Elements of methods described can also be adopted for cancer therapeutic trials. Comprehensive cancer centers, where most clinical trials are based, can enhance participation of remote and/or underserved populations that have higher rates of cancer, more disease burden and less opportunity for trial participation.

2.
American Journal of Respiratory and Critical Care Medicine ; 205:2, 2022.
Article in English | English Web of Science | ID: covidwho-1880570
3.
Molecular Genetics and Metabolism ; 132:S216, 2021.
Article in English | EMBASE | ID: covidwho-1735097

ABSTRACT

It is difficult to assign a precise frequency of infections that defines an increased susceptibility to infections reflecting an impaired immune response given the majority of patients with intact immune systems still contract multiple upper respiratory infections each year, usually of viral origin. In fact, the average child may experience up to six to eight upper respiratory infections each year. The frequency of these infections may be related to environmental exposures but also may be triggered by genetic susceptibility. As an example, respiratory disease complicates the management of several inherited metabolic diseases, either at presentation or as late-onset features. More recently, children of all ages have been shown to contract COVID-19;however, children with underlying medical conditions are at increased risk. COVID-19 has been known for almost a year now, with several studies identifying genetic risk factors are associated with severe COVID-19. In the context of a health system wide genomic medicine program “Genomic Answers for Kids” at Children’s Mercy, Kansas City, we performed a retrospective analysis of rare variants predicted to be deleterious at 12 known loci known to govern TLR3- and IRF7- dependant type I Interferon immunity of all patients/families (>2000) tested for suspected genetic disorders. We bioinformatically extracted all rare variants in those 12 genes linked to type I interferon pathway from our internal warehouse. From those, ~340 variants were further analyzed based on inheritance, minor allele frequency in population datasets, and in silico prediction. The vast majority of this subgroup of GA4 K patients were referred for a suspected neurological disorder with or without multiple congenital anomalies (~75%). Only 15% were referred for metabolic disorders. Of those, 50% have a known genetic diagnosis unrelated to Immune deficiency. Of the selected index cases, the medical records, and if available the outpatient records, were reviewed to document the occurrence of recurrent infection and/or COVID-19. Preliminary data showed 46 “extremely” rare variants were detected in 37 GA4 K patients;6/37 (16%) have ≥2 in 1–12 genes, one GA4 K patient has 4 “extremely” rare variants in IRF7, and 3/37 GA4 K patients are deceased (~1%). Moreover, a novel disease gene was uncovered in a previously undiagnosed family, of which we identified an additional two affected individuals from an international collaboration. Finally, in a family with apparently dominant transmission of tumid lupus we observe putative causal variant in gene UNC93B1 – linking chronic inflammatory disorder (with known type I interferon association) to mutations predisposing to COVID-19. Recurrent or persistent infection is usually a manifestation of primary immunodeficiency. While most children with recurrent infections have a normal immunity, it is important to remember a subset of patients have an unrecognized genetic susceptibility to infection. Further analysis and monitoring are on-going. As we are continuing to struggle with the COVID-19 pandemic, combined with flu season, understanding precisely who may be at higher risk of infection and complications is critical and could play an important role in ongoing efforts to in disease prevention and the development of better treatment protocols

4.
Environmental Science & Technology Letters ; 9(1):3-9, 2022.
Article in English | Web of Science | ID: covidwho-1655414

ABSTRACT

In situ measurements have suggested vehicle emissions may dominate agricultural sources of NH3 in many cities, which is alarming given the potential for urban NH3 to significantly increase human exposure to ambient particulate matter. However, confirmation of the prevalence of vehicle NH3 throughout a city has been challenging because of mixing with agricultural sources, and the latter are thus routinely assumed to dominate. Here we report vehicle NH3 emissions based on TROPOMI NO2 and CrIS NH3 (0.152 kg s(-1)) that are consistent with a model-based estimate (0.178 kg s(-1)) and show that COVID-19 lockdowns provide a unique opportunity for making the first satellite-based constraints on vehicle NH3 emissions for an entire urban region (western Los Angeles), which we find make up 60-95% of total NH3 emissions, substantially higher than the values of 13-22% in state and national inventories. This provides a new means of constraining a component of transportation emissions whose impacts may rival those of NOx yet which has been largely under-recognized and uncontrolled.

5.
Journal of Geophysical Research. Atmospheres ; 126(24), 2021.
Article in English | ProQuest Central | ID: covidwho-1595324

ABSTRACT

Nitrogen oxides (NOx) are air pollutants critical to ozone and fine particle production in the troposphere. Here, we present fuel‐based emission inventories updated to 2018, including for mobile source engines using the Fuel‐based Inventory of Vehicle Emissions (FIVEs) and oil and gas production using the Fuel‐based Oil and Gas (FOG) inventory. The updated FIVE emissions are now consistent with the NEI17 estimates differing within 2% across the contiguous US (CONUS). Tropospheric NO2 columns modeled by the Weather Research and Forecasting with Chemistry model (WRF‐Chem) are compared with those observed by TROPOspheric Monitoring Instrument (TROPOMI) and Ozone Monitoring Instrument (OMI) during the summer of 2018. Modeled NO2 columns show strong temporal and spatial correlations with TROPOMI (OMI), identified with biases of −3% (−21%) over CONUS, and +8% (−6%) over point sources plus urban regions. Taking account of the negative bias (∼20%) in early version of TROPOMI over polluted regions, WRF‐Chem shows good performance with updated FIVE and FOG emissions. Our model tends to under‐predict the tropospheric NO2 columns over background and rural regions (bias of −21% to −3%). Through model sensitivity analyses, we demonstrate the important roles of emissions from soils (11.7% average over CONUS), oil and gas production (4.1%), wildfires (10.6%), and lightning (2.3%) with greater contributions at regional scales. This work provides a roadmap for satellite‐based evaluations for emission updates from various sources.Alternate :Plain Language SummarySatellite observations of tropospheric NO2 columns provide important constraints on air pollutants from space, which have been widely used to validate the performance of atmospheric models. To gain better knowledge of the accuracy of the recently updated fuel‐based emissions inventory, we conducted NO2 assessments between a regional chemical transport model (Weather Research and Forecasting with Chemistry model, WRF‐Chem), with the TROPOspheric Monitoring Instrument (TROPOMI) and Ozone Monitoring Instrument (OMI) over the contiguous United States. We find that model simulation results show strong spatial and temporal correlations with satellite observations across point sources, urban, oil and gas production, and rural regions. With updated emissions, our regional atmospheric model can reconcile with satellite retrievals differing from −3% (TROPOMI) to −21% (OMI) overall. Soils, oil and gas production, wildfires and lightning emissions can play key roles in regional air quality. This work provides an important baseline of a pre‐COVID year by which sharp changes in anthropogenic NOx emissions due to the pandemic can be assessed.

6.
Breast Cancer Res Treat ; 190(2): 287-293, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1404658

ABSTRACT

PURPOSE: Older cancer survivors required medical care during the COVID-19 pandemic, but there are limited data on medical care in this age group. METHODS: We evaluated care disruptions in a longitudinal cohort of non-metastatic breast cancer survivors aged 60-98 from five US regions (n = 321). Survivors completed a web-based or telephone survey from May 27, 2020 to September 11, 2020. Care disruptions included interruptions in seeing or speaking to doctors, receiving medical treatment or supportive therapies, or filling prescriptions since the pandemic began. Logistic regression models evaluated associations between care disruptions and education, medical, psychosocial, and COVID-19-related factors. Multivariate models included age, county COVID-19 death rates, comorbidity, and post-diagnosis time. RESULTS: There was a high response rate (n = 262, 81.6%). Survivors were 32.2 months post-diagnosis (SD 17.5, range 4-73). Nearly half (48%) reported a medical disruption. The unadjusted odds of care disruptions were higher with each year of education (OR 1.22, 95% CI 1.08-1.37, p = < 0.001) and increased depression by CES-D score (OR 1.04, CI 1.003-1.08, p = 0.033) while increased tangible support decreased the odds of disruptions (OR 0.99, 95% CI 0.97-0.99, p = 0.012). There was a trend between disruptions and comorbidities (unadjusted OR 1.13 per comorbidity, 95% CI 0.99-1.29, p = 0.07). Adjusting for covariates, higher education years (OR1.23, 95% CI 1.09-1.39, p = 0.001) and tangible social support (OR 0.98 95% CI 0.97-1.00, p = 0.006) remained significantly associated with having care disruptions. CONCLUSION: Older breast cancer survivors reported high rates of medical care disruptions during the COVID-19 pandemic and psychosocial factors were associated with care disruptions. CLINICALTRIALS. GOV IDENTIFIER: NCT03451383.


Subject(s)
Breast Neoplasms , COVID-19 , Cancer Survivors , Aged , Aged, 80 and over , Breast Neoplasms/epidemiology , Breast Neoplasms/therapy , Female , Humans , Middle Aged , Pandemics , SARS-CoV-2
7.
Kidney International Reports ; 6(4):S88-S88, 2021.
Article in English | PMC | ID: covidwho-1385523

ABSTRACT

Introduction: Solid organ transplant (SOT) recipients are vulnerable to severe infection during induction therapy. We report a case of a 67-year-old male who died unexpectedly 10 days after receiving a kidney transplant (KTx) on February 10, 2020. There was no clear cause of death, but COVID-19 was considered, retrospectively, as the death occurred shortly after the first confirmed case of COVID-19 in Canada. We confirmed the presence of SARS-CoV-2 components in the allograft and patient lung tissue using immunohistochemistry (IHC) for SARS-CoV-2 spike (S) protein and RNA scope in situ hybridization for SARS-CoV-2 RNA. Results were confirmed with the FDA EUA-approved Bio-Rad SARS-CoV-2 ddPCR for the kidney specimen. Our case highlights the importance of patient autopsies in an unfolding global pandemic and demonstrates the utility of molecular assays to diagnose SARS-CoV-2 post-mortem. SARS-CoV-2 infection during induction therapy may portend a severe or fatal clinical outcome. We also suggest COVID-19 may be transmittable via KTx. Methods: We acquired autopsy specimens of the allograft and lung tissue for analysis by IHC (Figure 4A). RNA scope in situ hybridization and immunohistochemistry verified the presence of viral particles. Results were confirmed with RT-PCR and dd-PCR. Results: Remarkably, antibodies directed against SARS-CoV-2 S protein were positive in the allograft and native lung tissue of the patient (Figure 4B). RNA scope in situ hybridization, RNA scope in situ hybridization was used to detect SARS-CoV-2 RNA in the allograft (Figure 4C) as previously described.3,7 With both IHC and RNAscope, we noted very few viral particles, with more in the donor kidney compared to native lung tissue. To confirm this finding, we used RT-PCR, but were unable to detect SARS-CoV-2 RNA (data not shown). Next, we turned to a FDA-EUA clinically validated BioRad ddPCR assay approved for human diagnosis,previously used to detect SARS-CoV-2 RNA in RT-PCR negative samples.Using ddPCR, we confirmed SARS-CoV-2 nucleocapsid N1 gene in the allograft (Figure 5). A smaller signal was observed in lung tissue, but lower than the clinically validated threshold (Figure 5). Conclusions: Using three methods of viral protein and/or RNA detection we present a COVID-19 positive patient who died on February 10, 2020 which precedes the first confirmed case in Alberta, Canada and first Canadian COVID-19 fatality previously established as a travel-related case on March 5, 2020 and nursing home death on March 9, 2020, respectively. Our patient demonstrates the possibility of a severe adverse outcome for COVID-19 infection during induction therapy and the potential for SARS-Cov-2 renal allograft invasion mediated SOT transmission. This case carries significant epidemiologic consequences and highlights the vital role of autopsy in an unfolding pandemic in providing valuable diagnostic information. These sensitive methods can be applied to future disease outbreaks in the absence of pre-mortem testing. No conflict of interest

8.
Journal of Geophysical Research: Atmospheres ; n/a(n/a):e2021JD034797, 2021.
Article in English | Wiley | ID: covidwho-1360186

ABSTRACT

Abstract Most countries around the world including the United States took actions to control COVID-19 spread that led to an abrupt shift in human activity. On-road NOx emissions from light and heavy-duty vehicles decreased by 9% to 19% between February and March at the onset of the lockdown period in the middle of March in most of the US;between March and April, the on-road NOx emissions dropped further by 8% to 31% when lockdown measures were the most stringent. These precipitous drops in NOx emissions correlated well (r = 0.75) with tropospheric NO2 column amount observed by the Sentinel 5 Precursor TROPOspheric Monitoring Instrument (S5P TROPOMI). Furthermore, the changes in TROPOMI tropospheric NO2 across the continental US between 2020 and 2019 correlated well with changes in on-road NOx emissions (r = 0.68) but correlated weakly with changes in emissions from the power plants (r = 0.35). At the height of lock-down related unemployment in the second quarter of 2020, the tropospheric NO2 values decreased at the rate of 0.8 µmoles/m2 per unit percentage increase in the unemployment rate. Despite the lifting of lockdown measures, parts of the US continued to have ?20% below normal on-road NOx emissions. To achieve this new normal urban air quality in the US, continuing remote work policies that do not impede economic growth may become one of the many options.

10.
Elementa ; 9(1), 2021.
Article in English | Scopus | ID: covidwho-1215179

ABSTRACT

The coronavirus-19 (COVID-19) pandemic led to government interventions to limit the spread of the disease which are unprecedented in recent history;for example, stay at home orders led to sudden decreases in atmospheric emissions from the transportation sector. In this review article, the current understanding of the influence of emission reductions on atmospheric pollutant concentrations and air quality is summarized for nitrogen dioxide (NO2), particulate matter (PM2.5), ozone (O3), ammonia, sulfur dioxide, black carbon, volatile organic compounds, and carbon monoxide (CO). In the first 7 months following the onset of the pandemic, more than 200 papers were accepted by peer-reviewed journals utilizing observations from ground-based and satellite instruments. Only about one-third of this literature incorporates a specific method for meteorological correction or normalization for comparing data from the lockdown period with prior reference observations despite the importance of doing so on the interpretation of results. We use the government stringency index (SI) as an indicator for the severity of lockdown measures and show how key air pollutants change as the SI increases.The observed decrease of NO2 with increasing SI is in general agreement with emission inventories that account for the lockdown. Other compounds such as O3, PM2.5, and CO are also broadly covered. Due to the importance of atmospheric chemistry on O3 and PM2.5 concentrations, their responses may not be linear with respect to primary pollutants. At most sites, we found O3 increased, whereas PM2.5 decreased slightly, with increasing SI. Changes of other compounds are found to be understudied. We highlight future research needs for utilizing the emerging data sets as a preview of a future state of the atmosphere in a world with targeted permanent reductions of emissions. Finally, we emphasize the need to account for the effects of meteorology, emission trends, and atmospheric chemistry when determining the lockdown effects on pollutant concentrations. Copyright: © 2021 The Author(s).

11.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-8428

ABSTRACT

Purpose Older cancer survivors required medical care during the COVID-19 pandemic despite infection risks, but there are limited data on medical care in this age group. METHODS: We evaluated care disruptions in a longitudinal cohort of non-metastatic breast cancer survivors ages 60-98 from five US regions (n=321). Survivors completed a web-based or telephone survey from May 27, 2020 to September 11, 2020. Care disruptions included self-reported interruptions in ability to see doctors, receive treatment or supportive therapies, or fill prescriptions. Logistic regression models evaluated bivariate and multivariate associations between care disruptions and education, medical, psychosocial and COVID-19-related factors. Multivariate models included age, county COVID-19 rates, comorbidity and post-diagnosis time. RESULTS: There was a high response rate (n=262, 81.6%). Survivors were 32.2 months post-diagnosis (SD 17.5, range 4-73). Nearly half (48%) reported a medical disruption. The unadjusted odds of care disruptions were significantly higher with more education (OR 1.23 per one-year increase, 95% CI 1.09-1.39, p =0.001) and greater depression (OR 1.04 per one-point increase in CES-D score, CI 1.003-1.08, p=0.033);tangible support decreased the odds of disruptions (OR 0.99, 95% CI 0.97-0.99 per one-point increase, p=0.012). There was a trend for associations between disruptions and comorbidity (unadjusted OR 1.13 per 1 added comorbidity, 95% CI 0.99-1.29, p=0.07). Adjusting for covariates, only higher education (p=0.001) and tangible social support (p=0.006) remained significantly associated with having care disruptions. CONCLUSIONS: Older breast cancer survivors reported high rates of medical care disruptions during the COVID-19 pandemic and psychosocial factors were associated with care disruptions.

12.
Res Sq ; 2021 Apr 14.
Article in English | MEDLINE | ID: covidwho-1200427

ABSTRACT

PurposeOlder cancer survivors required medical care during the COVID-19 pandemic despite infection risks, but there are limited data on medical care in this age group. METHODS: We evaluated care disruptions in a longitudinal cohort of non-metastatic breast cancer survivors ages 60-98 from five US regions (n=321). Survivors completed a web-based or telephone survey from May 27, 2020 to September 11, 2020. Care disruptions included self-reported interruptions in ability to see doctors, receive treatment or supportive therapies, or fill prescriptions. Logistic regression models evaluated bivariate and multivariate associations between care disruptions and education, medical, psychosocial and COVID-19-related factors. Multivariate models included age, county COVID-19 rates, comorbidity and post-diagnosis time. RESULTS: There was a high response rate (n=262, 81.6%). Survivors were 32.2 months post-diagnosis (SD 17.5, range 4-73). Nearly half (48%) reported a medical disruption. The unadjusted odds of care disruptions were significantly higher with more education (OR 1.23 per one-year increase, 95% CI 1.09-1.39, p =0.001) and greater depression (OR 1.04 per one-point increase in CES-D score, CI 1.003-1.08, p=0.033); tangible support decreased the odds of disruptions (OR 0.99, 95% CI 0.97-0.99 per one-point increase, p=0.012). There was a trend for associations between disruptions and comorbidity (unadjusted OR 1.13 per 1 added comorbidity, 95% CI 0.99-1.29, p=0.07). Adjusting for covariates, only higher education (p=0.001) and tangible social support (p=0.006) remained significantly associated with having care disruptions. CONCLUSIONS: Older breast cancer survivors reported high rates of medical care disruptions during the COVID-19 pandemic and psychosocial factors were associated with care disruptions.

13.
State and Local Government Review ; 52(3):186-194, 2020.
Article in English | Scopus | ID: covidwho-1133411
14.
Journal of Public and Nonprofit Affairs ; 6(3):377-400, 2021.
Article in English | Scopus | ID: covidwho-1016528

ABSTRACT

The outbreak of COVID—19 has raised considerable alarm about public health and safety. The response to the outbreak, however, has also brought concern regarding its impact on local governments in the United States. Local governments have been a primary respondent in the fight against the COVID—19 disease, but the response has also reduced income from a key source of revenue, sales tax. Using North Carolina counties as a case study, we explore the shock to sales and use tax revenue faced by local governments from COVID—19;we, then, estimate its impact on county fiscal health. Our results show that while many local governments were financially struggling before the outbreak, the drop in sales tax revenue severely threatens their ability to provide continued response to the virus as well as their ability to remain solvent. © 2020 Midwest Public Affairs Conference. All rights reserved.

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