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1.
Clinical Immunology ; Conference: 2023 Clinical Immunology Society Annual Meeting: Immune Deficiency and Dysregulation North American Conference. St. Louis United States. 250(Supplement) (no pagination), 2023.
Article in English | EMBASE | ID: covidwho-20242997

ABSTRACT

Introduction: Macrophage activation syndrome (MAS) is a severe hyper inflammatory condition caused by the over-activation and proliferation of T cells, NK cells and macrophages. It is often associated with complications of rheumatic/immune diseases. We present a case of a 15-year-old female who experiences recurrent episodes of MAS without any known definitive underlying etiology. Case Presentation: A 15-year-old previously healthy female developed fatigue, fevers, myalgia, chest pain, splenomegaly and lymphadenopathy 10 days after receiving her first Pfizer COVID-19 vaccine. Her symptoms recurred 10 days after receiving the second dose. Her myocarditis, MIS-C, and infectious work up was negative except for positive EBV IgG. Laboratory studies revealed anemia, hypertriglyceridemia, hypofibrinogenemia, and hyperferritinemia. She initially responded to decadron;however, her symptoms recurred with steroid taper. Bone marrow biopsy revealed hemophagocytosis. Whole exome sequencing (WES) revealed a heterozygous variant of uncertain significance in UNC13D c.962C>A (p.Thr321Asn). She had multiple re-admissions with significantly elevated inflammatory markers, including extremely high IL2-R, IL-18 and CXCL9. Each episode was complicated by an acute viral infection. She responds to high dose steroids, anti-IL-1, and JAK inhibitors. Nonetheless, it has been difficult to wean decadron without triggering a flare. She continues to require increasing doses of baricitinib. Discussion(s): MAS may be seen as a complication of rheumatic diseases, as well as inborn errors of immunity. However, none of these conditions have been diagnosed in this patient despite extensive testing, including WES. The degree of her immune dysregulation has been very severe making her disease process unpredictable and extremely difficult to control. She has frequent flares precipitated by viral infections or attempts at adjusting her immunomodulators. Weaning her medications has been challenging as she continues to require increasing doses of baricitinib and corticosteroids. The UNC13D gene is associated with autosomal recessive familial hemophagocytic lymphohistiocytosis type 3 (FHL3). Our patient is heterozygous for an UNC13D variant of uncertain significance. Additional genetic inquiries with whole genome sequencing to help elucidate the underlying etiology of her severe condition is being conducted. We hypothesize she developed MAS due to a combination of genetic predisposition, prior EBV infection, and immune stress associated with the COVID-19 vaccine. [Formula presented] [Formula presented] [Formula presented]Copyright © 2023 Elsevier Inc.

2.
British Journal of Dermatology ; 185(Supplement 1):151, 2021.
Article in English | EMBASE | ID: covidwho-2286423

ABSTRACT

Biological therapies are increasingly being used in dermatology to treat conditions such as psoriasis and eczema. These medications are prescribed and dispensed in secondary care;however, it is important that they are present in the patient's primary care record, as this is often used by both the primary care provider and the hospital clerking doctor when the patient presents with other health concerns. Biologics are immunosuppressive medications, and it is thus important that any practitioner treating a patient who has been prescribed them is aware of this. Using a departmental record, all patients prescribed biological therapies or subcutaneous methotrexate were identified (n = 157). Their primary care medication record was then interrogated to assess whether the biological therapy was recorded. Forty-five (29%) patients on biological therapies or subcutaneous methotrexate did not have this recorded on their general practitioner (GP) record. The most common medications not recorded were ustekinumab (n = 14) and dupilumab (n = 13). There was no clear pattern indicating that a particular GP surgery was recording these medications poorly, and the patients were cared for evenly between the dermatology consultants in the department. This brief piece of work demonstrates that there is a problem with these prescriptions being accurately recorded on the GP record. Almost one-third of patients in the department did not have their biological therapy listed on their primary care record. Practitioners must be aware that a patient is on an immunosuppressive medication, especially when diagnosing and treating infections and assessing patient priority for COVID-19 vaccination, as well as including the need to avoid live vaccines. Furthermore, the GP record was used by Welsh Government agencies to identify patients needing to shield during the COVID-19 pandemic. These 45 patients recognized in the study would not necessarily have been identified as potentially high risk (depending on other comorbidities) and may therefore not have been advised to shield (in line with British Association of Dermatologists guidance for self-isolation and immunosuppressed patients). To rectify this problem in the short term, each GP surgery was contacted regarding the particular patients identified and were advised to add their biological therapy to their primary care record. Discussions between primary and secondary care and pharmacy are ongoing in order to identify how to prevent this problem from continuing.

5.
Hormone Research in Paediatrics ; 95(Supplement 1):90-91, 2022.
Article in English | EMBASE | ID: covidwho-2223852

ABSTRACT

Objectives The incidence of type 2 diabetes mellitus (T2DM) in children and adolescents is increasing worldwide. During the COVID-19 pandemic, most children in the United States attended school remotely for at least several months to control community spread. However, the broader impacts of lockdowns and reduced attendance at school may have exacerbated risk factors associated with unintentional pediatric weight gain. The primary objective of this study was to determine the change in incidence of newly diagnosed T2DM in pediatric patients by comparing the 5- years before the COVID-19 pandemic (2015-2020) against the rate observed March 2020-March 2021. Methods We conducted a retrospective chart review of 164 pediatric patients seen in a community-based tertiary care Pediatric Endocrinology practice from 2015-2021 who were newly diagnosed with T2DM (ages 9 to 18). Changes in the demographic and clinical characteristics of newly diagnosed cases since the start of the COVID-19 pandemic were compared against pre-pandemic characteristics. Results We observed a significant increase in the number of pediatric patients diagnosed with T2DM during the first year of the COVID-19 pandemic (n=46) relative to the 5 years prior (average 23.6+/-4.6 per year prior to pandemic, range 19-29 per year, one-sided Grubb's outlier test p=0.03). Upon comparing pre- and during-pandemic characteristics, there was no difference in sex among new diagnoses (42.2% female prior vs 56.8% during, p=0.08, Fisher's exact test), no difference in average BMI at diagnosis (35.2 kg/m2 prior vs 36.9 kg/m2 during, p=0.15, t-test), no difference in average age at diagnosis (14.3 years vs 14.6 years, p=0.49, t-test), no difference in HbA1c at diagnosis (9.4% prior vs 10.0% during, p=0.33, t-test), and no difference in incidence of diabetic ketoacidosis at presentation (21.7% prior vs 16.1% during, p=0.49, Fisher's exact). Conclusions Since the start of the COVID-19 pandemic, we observed a significant increase in incidence of newly diagnosed T2DM in pediatric patients, relative to the five years prior to the pandemic. However, there were no clear demographic or clinical factors differentiating pre-pandemic from during-pandemic diagnoses. Further monitoring and combination with larger datasets will be required to determine whether the increased incidence of T2DM will be a sustained trend and whether clinical or demographic characteristics of newly diagnosed pediatric patients may shift over time.

6.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128130

ABSTRACT

Background: Immune thrombocytopenia (ITP) has been reported following COVID-19 vaccination. From a population of over 20 million eligible vaccine recipients in Australia, over 32 million doses have been administered: 19,600,000 Pfizer BNT162b2 (BNT), 12,600,000 AstraZeneca ChAdOx1 nCoV-19 (ChAd), and 397,000 Moderna mRNA-1273. Aim(s): Describe a comprehensive series of ITP after vaccination with clinical outcomes. Method(s): After obtaining IRB approval (2021/ETH00723), we collected data on all ITP cases diagnosed by haematologists in Australia within six weeks of any COVID-19 vaccination. We analysed their outcomes using international consensus definitions of responses and WHO bleeding. Result(s): Demographics (n = 50), treatments, and platelet outcomes (Figures A and B). Bleeding was mostly minor: 35/50 (70%) WHO score <2. Compared to relapses of prior ITP, new presentations of ITP were significantly associated with ChAd over BNT (OR 7.1: 95% CI 1.7 to 25.7, p = 0.0124*). Most patients responded quickly and deeply: Median TTR 4 days (IQR 2-7), median TTCR 7 days (IQR 4-19), overall RR 45/47 (96%), and CR 40/45 (89%). Gender, age, antecedent influenza vaccination and severity of thrombocytopenia had no significant impact on: Bleeding at presentation, response rates, relapse rates, time to response, or the need for ongoing treatments at day 90. No patients presented with thrombosis. PF4 ELISA was positive in one of 18 cases after ChAd (functional testing was negative). Conclusion(s): We diagnosed ITP more frequently after ChAd than BNT vaccination, occurring de novo after 1st doses. Ascertainment bias cannot be excluded due to greater scrutiny for platelet related complications, but almost all patients in this cohort needed treatment. Standard first-line treatments for ITP are highly effective for both de novo and prior ITP (96%), but second-line therapies are often required (34%). Our data reaffirms the safety of vaccinating patients with pre-existing ITP, as bleeding is mild (92% WHO < 2) and platelets respond quickly (TTCR 5 days).

7.
2022 IEEE Aerospace Conference, AERO 2022 ; 2022-March, 2022.
Article in English | Scopus | ID: covidwho-2037817

ABSTRACT

L'Ralph is the primary science instrument on the Lucy mission to encounter the Trojan asteroids at the Jupiter L4 and L5 Lagrange points. In December of 2019, the main instrument subassemblies were finishing their build-up and testing. The team was getting ready for integration and testing with comfortable schedule margin to our required delivery date in support of the planetary launch window. When COVID-19 started to spread, the flight hardware ground to a halt but the planets kept moving. The L'Ralph team used a risk-based process to strategically descope activities from the integration and test flow and to negotiate a late delivery to the spacecraft. They changed the entire risk posture, investing in infrastructure to allow more remote test support to protect the team's health and reduce the schedule risk in case of an outbreak. Despite multiple technical hurdles, the team was able to make an on-time delivery to the spacecraft, and Lucy was successfully launched in October 2021. © 2022 IEEE.

8.
Journal of General Internal Medicine ; 37:S319, 2022.
Article in English | EMBASE | ID: covidwho-1995717

ABSTRACT

BACKGROUND: Subgroups of the general population, including Hispanic/ Latinx individuals, report higher rates of COVID-19 vaccine hesitancy than Non-Hispanic White individuals. The purpose of this study involved identifying factors that influence attitudes toward COVID-19 vaccines among unvaccinated Hispanic adults utilizing a free community clinic in Orlando, Florida. METHODS: From May 2021 to July 2021, we used convenience sampling to recruit 20 self-identified Hispanic adults who were unvaccinated to complete an individual, semi-structured interview. We developed the interview guide based on constructs from the Health Belief Model. Interviews ranged from 15 to 60 minutes in duration and were conducted in-person or via telephone in Spanish or English, depending on participant preference. Interviews were audio-recorded, transcribed, translated (when necessary), and qualitatively analyzed using inductive content analysis to identify recurring themes. RESULTS: Of the 20 participants in this study, 65% were female (n=13) and they ranged from 21 to 73 years of age (median age =42.5). We identified three primary themes in participant responses regarding their beliefs about COVID19 vaccines: 1) trust and clarity of COVID-19 vaccine information 2) personal contextual factors and 3) lack of confidence, yet willingness, to get vaccinated. Participants reported receiving information on COVID-19 vaccines from various sources, but the trustworthiness and clarity of this information were concerns for participants. Most participants indicated preferring information from government-based sources and scientific professionals over information from news outlets or social media. We found personal contextual factors, such as underlying health conditions, immigrant status, and personal perceptions of COVID-19, to be recurring themes for not getting a COVID-19 vaccine. While some variation existed in participants' attitudes towards COVID-19 vaccines, participants indicated feeling a lack of confidence in these vaccines. However, most participants also indicated a willingness to be vaccinated in the future. CONCLUSIONS: Overcoming vaccine hesitancy in vulnerable populations, such as the Latinx community will require addressing issues of message clarity through trusted sources while considering an individual's personal context. Health care professionals can begin by initiating discussions with patients to understand individual circumstances and concerns and provide information on COVID-19 vaccines that clarify confusion points and are personally relevant to patients.

12.
J Food Prot ; 84(10): 1683-1697, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1810927

ABSTRACT

ABSTRACT: The International Food Safety Authorities Network (INFOSAN) is a global network of national food safety authorities from 190 countries, managed jointly by the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) that aims to facilitate the rapid exchange of information during food safety incidents. A three-phase study of INFOSAN was launched in 2019 to characterize and examine the network as a functional community of practice and determine its value systematically and rigorously from its members' perspectives. The first two phases of the study involved analyzing the INFOSAN Community Website and surveying of all of its members. The main objective of this third and final phase of the study was to understand the experiences of a small group of INFOSAN members as they relate to various dimensions of membership. A qualitative methodology was used to provide a deeper understanding of members' experiences and supplement the results from the first two quantitative study phases. Interviews were conducted with 10 INFOSAN members from 10 geographic regions, transcribed verbatim, and analyzed using interpretative phenomenological analysis. The results offer an understanding of INFOSAN members' experiences in the context of what participation in this global network means to them and relate to five themes concerning trust, learning, health protection, sense of community, and future potential. The findings suggest that focusing on outreach to sustain personal interest, training to improve technical capacity, and advocacy to obtain political buy-in are ways in which the INFOSAN Secretariat could enable participation and create value at the individual, organizational, and national level, respectively. Such engagement could translate into more effective international communication during urgent food safety incidents and fewer cases of foodborne illness worldwide.


Subject(s)
Food Safety , Foodborne Diseases , Humans , Surveys and Questionnaires , World Health Organization
13.
Perspectives: Policy and Practice in Higher Education ; 2022.
Article in English | Scopus | ID: covidwho-1806050

ABSTRACT

This article considers the difficulty of implementing change in a university workplace and discusses the popularity of ‘the Valley of Despair’ change curve as a way of predicting and managing resistance to change. The Valley of Despair is based on Elisabeth Kübler-Ross’s (1970;2005) work with the dying and bereaved, and posits that people going through change will experience a predictable series of emotions: denial, anger, bargaining, depression and acceptance (a sequence often termed ‘DABDA’). Questions are raised about both the validity of this model and its value as a lens through which to view change in the Higher Education sector. It is suggested, however, that other metaphors of bereavement may provide helpful insights to those hoping to guide university staff through change. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

14.
2021 IEEE International Symposium on Antennas and Propagation and North American Radio Science Meeting, APS/URSI 2021 ; : 1467-1468, 2021.
Article in English | Scopus | ID: covidwho-1774566

ABSTRACT

This paper describes methods we are using in ECE at the University of Utah to support a Hybrid Flexible (HyFlex) classes. Classes are offered both in person and online. We describe the teaching approach for two asynchronous online courses - Intro. to EM and Numerical EM and a synchronous freshman circuits course. We will also describe three hands-on take-home labs - Intro. to EM. Microwave Eng I, and Intro. to ECE (freshman circuits). Finally, we will report on an undergraduate research project on what students want in post-Covid education. © 2021 IEEE.

15.
Molecular Genetics and Metabolism ; 132:S258-S259, 2021.
Article in English | EMBASE | ID: covidwho-1735098

ABSTRACT

Background: Severe acute respiratory syndrome coronavirus (SARSCoV- 2) is a novel virus that causes Coronavirus Disease 2019 (COVID- 19). High-throughput sequencing technologies such as whole genome sequencing (WGS) and sequencing of viral genome DNA are being implemented to identify and report on genetic factors that may influence variability in symptom severity and immune response among patients infected by SARS-CoV-2. Genome sequencing has been useful for clinical diagnostic purposes, and can reveal other useful information such as disease risk factors that might lead to disease prevention or patient management strategies. UsingWGS and bioinformatics software tools, we describe a novel pipeline for the analysis of medically relevant genetic results and other findings identified in COVID-19 positive individuals, and the generation of a genome report that can effectively communicate these results to patients and their physicians. Study design: Enrollment will include up to 1500 patients with a positive COVID-19 nasopharyngeal swab. Blood samples will be collected at baseline, 1 month, 6 months, and 1 year after diagnosis. Antibody isotype (IgG, IgA, and IgM), titers, and viral neutralization will be analyzed. DNA will be isolated from blood lymphocytes and host genomes will be sequenced. Whole genomes will be assessed using ACMG criteria for the interpretation of pathogenic sequence variation using in-house and third-party software tools, and publicly available disease and control databases. Comprehensive gene panels will be implemented to allow for patients to receive clinically significant findings, including risk factor and carrier status, from multiple categories of potential genetic conditions including blood and immunology, endocrine, metabolic/mitochondrial, musculoskeletal, hearing loss, neurology, cardiology, ophthalmology, renal, skin, and gastrointestinal disorders. Common disease risk will be assessed using polygenic risk scores calculated for 6 diseases (atrial fibrillation, coronary artery disease, type 2 diabetes, prostate cancer, colorectal cancer, breast cancer). Pharmacogenomic gene variants that alter metabolizer phenotype and drug response in individuals will be reported, in addition to patient HLA-type. The genomic predictions fromABO and Rh blood types will be summarized and reported. Largescale continental ancestry estimation will be performed using publicly available reference populations. Finally, using viral genome DNA sequencing, the SARS-CoV-2 viral lineage will be identified and reported. An appointment with the study genetic counsellor will be scheduled to discuss results identified in the genome report and manage appropriate clinical referrals if necessary. Serology results will be reported. Regression models will examine associations between antibody response (titer, antigen target, viral neutralization ability), physiological response (biochemical, hematological and clinical characteristics), patient outcomes, viral lineage and genomic results. Significance: This study will link clinically relevant genomic results, in addition to other biological and serological characteristics, to potential factors that contribute to variability in SARS-CoV-2 outcomes. Results will be shared with family physicians for clinical follow up. This study will establish an efficient workflow using highthroughput genomic sequencing technology coupled with emerging bioinformatics platforms for the generation of comprehensive genome reports to aid in COVID-19 patient management and follow-up.

18.
Canadian Journal of Dietetic Practice & Research ; 82(3):155-156, 2021.
Article in English | CINAHL | ID: covidwho-1366115

ABSTRACT

Introduction: Dietetics in Canada has greatly evolved since 1993 when a book describing Canadian dietetic history, Canadian Dietitians: Making a Difference, was published, suggesting a need for an update. Objectives: The purpose of the current research is to collect and document the history of dietetics since 1993 on the topic of consulting, defined as dietitians working in individual or group private practice counselling. Methods: Ten consulting dietitians from across Canada were interviewed. A draft timeline of key events was developed as a starting point for discussion. Interview transcripts were coded for descriptive and interpretive content. Inter-rater reliability was ensured through discussion and comparison between three researchers. Results: The Consulting Dietitians Network of Dietitians of Canada, previously the Consulting Dietitians of Ontario, is thought to be the first consulting dietetic network in Canada, established in the early 1980s. Five meta-themes emerged from the data: (i) challenges of consulting dietetics;(ii) promoting the profession;(iii) influence of COVID-19 on consulting dietetics;(iv) flexibility and variety in consulting dietetics;and, (v) ability to provide a high level of care. Consulting dietitians promote themselves and the profession by advertising their services and through involvement in various forms of media. They are able to engage in a variety of different projects due to the flexibility provided by working in private practice. Additionally, counselling in the private sector allows consulting dietitians to support their patients on an individualized basis, often with short wait times and without a referral. Conclusions: Since its inception, consulting dietetics has continued to grow into the relatively popular dietetic career choice it is today. Despite immense progress, there are still many challenges in the consulting dietetic profession including financial challenges, isolation, and competition between consulting dietitians and with unregulated nutrition professionals. Significance: The results of this study have many relevant implications including identifying areas in which consulting dietetics have helped advance the field of dietetics, areas for improvement and key events that shaped the field. The online timeline produced from this project will be available to dietitians and the public to access and learn about the history of consulting dietetics. Funded by: University of Guelph. In-kind support from Dietitians of Canada.

19.
Canadian Journal of Dietetic Practice & Research ; 82(3):155-155, 2021.
Article in English | CINAHL | ID: covidwho-1366110

ABSTRACT

Introduction: The history of dietetic practice was most recently recorded in the 1993 publication, Canadian Dietitians: Making a Difference. At this time, the role of dietitians working in traditional media (television, radio, newspaper etc.) was emerging. Additionally, social networking websites were non-existent until yr following this book's publication. Thus, historical record in this area of practice is lacking and documentation is required. Objectives: To develop a timeline and conduct key informant interviews to describe the historical experience of dietitians working in traditional and social media from a Canadian perspective since 1993. Methods: A draft timeline of media dietetics was created based on a literature review and descriptions of key media initiatives provided by informants. Eleven key informants completed semi-structured audio-taped telephone interviews, using the draft timeline as a starting point. Recordings were transcribed and coded by six research team members for descriptive and interpretive content using thematic analysis. A social ecologic framework was used to organize themes. Results: Interviewees worked in 9 provinces while involved in the media including Ontario (n = 7), Manitoba (n = 4), Quebec (n = 3), British Columbia (n = 2), Nova Scotia (n = 2), Saskatchewan (n = 2), New Brunswick (n = 1), Alberta (n = 1) and Prince Edward Island (n = 1). They reported 6--41 yr of dietetic work experience in the media (mean: 22.2 yr). Five main meta-themes emerged from the interviews. (i) Media involvement and the expansion from traditional to social media;(ii) advances associated with using media in dietetic practice;(iii) challenges associated with using media in dietetic practice;(iv) media dietetics emerging through DC initiatives and advocacy;and, (v) implications of COVID-19 on the role of media dietitians. Conclusions: Media dietitians play a key role in educating the public and act as trusted and credible sources of nutrition information. Over the past quarter-century, through advances in technology and the development of the internet, Canadian media dietetics has evolved dramatically. Significance: These findings will be used to inform dietitians and students about the history of the profession. A better understanding of dietetic practice in the media can also guide future developments and increase public awareness of the work that dietitians do. Funded by: University of Guelph. In-kind support from Dietitians of Canada.

20.
Open Forum Infectious Diseases ; 7(SUPPL 1):S338, 2020.
Article in English | EMBASE | ID: covidwho-1185905

ABSTRACT

Background: Children and young adults were initially reported as largely spared from severe complications of SARS-CoV-2 infection, but the impact to this population has been significant. Methods: This observational retrospective cohort study includes 420 symptomatic children and young adults with lab confirmed SARS-CoV-2 infection treated between March 15 and June 16, 2020 at Children's National Hospital in Washington DC. We identified and compared cohorts of non-hospitalized (N=324) and hospitalized (N=96) patients, including non-critically ill (N=64) and critically ill hospitalized (N=32) patients. Clinical and demographic data were extracted from medical records Results: Of 420 SARS-CoV-2-infected symptomatic patients, 23% required hospitalization, of which 67% were non-critically ill and 33% were critically ill. All age groups were represented in the symptomatic cohort, with a median age of 8.6 years. Patients > 15 years of age represented 44% of critical care admissions. Males and females were equally represented in all cohorts. Underlying medical conditions were present in 36%, but more common in hospitalized (59 %) and critically ill (66 %) patients. The most frequent underlying diagnosis overall was asthma (16 %), but also included neurologic (6 %), diabetes (3 %), obesity (3 %), cardiac (3 %), hematologic (3 %) and oncologic (1 %) conditions. The majority (66 %) of SARSCoV- 2 infected patients presented with respiratory symptoms with or without fever. Other symptoms were also present, including diarrhea/vomiting (21 %), myalgia (11 %), chest pain (8 %) and loss of sense of smell or taste (7%). Hospitalized patients required varying levels of respiratory support, including mechanical ventilation, BiPAP, RAM cannula and HFNC. Additional presentations included diabetic hyperglycemia, sickle cell vaso-occlusive crisis, vascular complications, and multisystem inflammation. Treatment included remdesivir, convalescent plasma, tocilizumab and other therapies. Conclusion: Although children/young adults have been less affected than elderly adults, the impact of SARS-CoV2 on this population has been significant in Washington DC and informs other regions anticipating their surge.

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