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1.
Journal of Research in Health Sciences ; 22(2), 2022.
Article in English | EMBASE | ID: covidwho-1970045

ABSTRACT

Background: The highest-income countries procured 50 times as many COVID-19 vaccines as low-income countries, a global health inequity that resulted in only 4.6% of the poorest 5th of the world receiving a COVID-19 vaccine. High-income countries are considering vaccine mandates and passports to contain the spread of COVID-19. This study is a curated discourse aimed at examining how vaccine mandates and passports may impact global vaccine equity from an ethics perspective. Study Design: Narrative review adapted for a debate. Methods: In November 2021, we conducted a review of studies examining global vaccine mandates for an upper-level global health course at Northeastern University, Boston, United States (U.S.). In total, 19 upper-level students, one research assistant, and one instructor participated in the data collection, analysis, and discussion. Results: The review showed vaccine mandates are ethical and effective if autonomy-centered alternatives like soft mandates are first exhausted. Unwarranted stringent public health measures degrade public trust. In the U.S. alone, COVID-19-related deaths hovered above 300 000 before COVID-19 vaccination began in mid-December 2020. Since then, the number of COVID-19 deaths more than doubled, despite the wide availability of the vaccine. For many low-and middle-income countries (LMICs) vaccines are not available or easily accessible. Global collaboration to facilitate vaccine availability in LMICs should be a priority. Conclusions: It is essential to get as many people as possible vaccinated to return to some normality. However, vaccine mandates and passports need to be used only sparingly, especially when other options have been exhausted.

2.
44th AMOP Technical Seminar on Environmental Contamination and Response 2022 ; : 148-157, 2022.
Article in English | Scopus | ID: covidwho-1958484

ABSTRACT

Environment and Climate Change Canada’s (ECCC’s) Emergencies Science and Technology Section (ESTS) is tasked with providing scientific and technical advice to its federal partners during environmental emergencies including oil spill incidents. In addition, ESTS maintains a wide array of field instrumentation and equipment, which is available to support different areas of a spill response such as detection and monitoring, health and safety, and sampling. During a response, ESTS needs to quickly, and effectively, convey to ECCC Environmental Emergencies Officers what tools and equipment could be available for the response, and how they can help meet ECCCs objectives for the response. This can often be a challenge, especially when ESTS personnel cannot deploy on-site alongside the instrumentation and equipment, as the information must be provided in an easily understandable format, yet thorough enough to ensure proper usage of the particular tool or piece of equipment. To address these challenges, ESTS has begun the development of a suite of job aids or “Tactical Sheets”. Each Tactical Sheet contains necessary, condensed, information on a field method or equipment maintained by ESTS for use at an environmental emergency. The goal of these Tactical Sheets is to highlight what the specific objectives for ECCC are, and how a given piece of equipment or method can help meet that objective at a response. These Tactical Sheets come with a number of features including a standardized format, a visually appealing design layout, a required equipment list, a simplified procedure, and a summary of the typical use for the particular tool or piece of equipment. ESTS has begun trialing these Tactical Sheets at certain incidents throughout the Covid-19 pandemic to increase ESTS’ capability of providing remote support when on-site presence is not an option. These Tactical Sheets are meant to bolster ESTS’ portfolio of support options available to our partners during environmental emergency responses. This paper will present information on the program to update field methods used during an environmental emergency by ECCC. © 2022 44th AMOP Technical Seminar on Environmental Contamination and Response. All rights reserved.

3.
European Journal of Human Genetics ; 30(SUPPL 1):466-466, 2022.
Article in English | Web of Science | ID: covidwho-1819264
4.
Open Forum Infectious Diseases ; 8(SUPPL 1):S595-S596, 2021.
Article in English | EMBASE | ID: covidwho-1746333

ABSTRACT

Background. Several COVID-19 vaccines have been authorized, and the need for rapid, further modification is anticipated. This work uses a Model-Based Meta-Analysis (MBMA) to relate, across species, immunogenicity to peak viral load (VL) after challenge and to clinical efficacy. Together with non-clinical and/or early clinical immunogenicity data (ECID), this enables prediction of a candidate vaccine's clinical efficacy. The goal of this work was to enable the accelerated development of vaccine candidates by supporting Go/No-Go and study design decisions, and the resulting MBMA can be instrumental in decisions not to progress candidates to late stage development. Methods. A literature review with pre-specified inclusion/exclusion criteria enabled creation of a database including nonclinical serum neutralizing titers (SN), peak VL after challenge with SARS-CoV-2 (VL), along with data from several clinical vaccine candidates. Rhesus Macaque (RM) and golden hamster (GH) were selected (due to availability and consistency of data) for MBMA modeling. For both RM and GH, peak post-challenge VL in lung and nasal tissues were used as surrogates for clinical disease and were related to pre-challenge SN via the MBMA. The VL predictions from the RM MBMA were scaled to incidence rates in humans, with a scaling factor between RM and human SN estimated using early Phase 3 efficacy data. This enabled clinical efficacy predictions based on ECID. To qualify the model's predictive power, efficacies of COVID-19 vaccine candidates were compared to those predicted from the MBMA and their respective Ph1/2 SN data. More recently available clinical data enable building a clinical MBMA;comparing this to the RM MBMA further supports SN as predictive. Results. The MBMA analyses identified a sigmoidal decrease in VL (increasing protection) with increase in SN in all three species, with more SN needed (in both RM and GH) for protection in nasal swabs than in BAL (see figure). The comparison between predicted and reported clinical efficacies demonstrated the model's predictive power across vaccine platforms. RM and GH MBMA Protection Models and Translational Prediction with Observed Efficacies Sizes of circles indicate relative weight of the data in the respective quantitative model. Model and data visualizations have been harmonized (across tissue-types) separately for each of RM and GH using VACHER (Lommerse, et al., CPT:PSP, in press). Conclusion. By quantifying adjustments needed between species and assays, translational MBMA can inform development decisions by using nonclinical SN and VL, and ECID to predict protection from COVID-19.

6.
Journal of Clinical Oncology ; 39(15):2, 2021.
Article in English | Web of Science | ID: covidwho-1529366
7.
Journal of the American College of Cardiology ; 77(18):1482-1482, 2021.
Article in English | Web of Science | ID: covidwho-1395973
8.
Age and Ageing ; 50(SUPPL 2), 2021.
Article in English | EMBASE | ID: covidwho-1343613

ABSTRACT

Introduction: During the first covid surge, 25% of Belfast HSC Trust (BHSCT) care homes were affected, rising to 44% by surge 3, resulting in limited face to face access for healthcare professionals. Nursing home residents required medicine reviews post-covid infection to optimise medicines and reduce pill burden. Method: The Care Home Nursing Support Team (CHNST), consultant pharmacist for older people and the lead care home pharmacist medicines optimisation older people (MOOP), rapidly established a multidisciplinary virtual round. Four main steps included: • establishing Standard Operating Procedure (SOP) • proforma template design • inclusion of resident • evaluation An SOP was established to ensure consistent pathway for nursing home inclusion criteria and team roles. The inclusion group included residents who were furthest from their baseline including weight loss, swallowing difficulties, decreased mobility, altered sitting balance and polypharmacy. The pharmacist developed a proforma template for completion by the nursing home staff to gather key information ahead of the round to improve efficiency eg swallow, renal function, pain, falls risk. The care home resident was included on video link by ipad following careful consent processes. Benefits included enhanced assessment of frailty, mobility, dexterity and adherence. Results: • 40% residents reviewed had increased Rockwood frailty score • 50% residents reviewed had weight loss post-covid- average 4.8 kg • Average 2.4 pharmacy medicines interventions per resident including: •Reducing doses & nephrotoxic medicines due to poor renal function •Deprescribing •Onward referral to psychiatry for signs of depression •Formulation changes due to swallowing difficulties •Evaluation from the multidisciplinary team and nursing home staff was overwhelmingly positive, emphasising the opportunity for shared learning Conclusion: The multidisciplinary care home rounds provided an efficient means to collaborate with other professionals, while providing holistic&patient-focussed care. Plans are underway for development of an NI MOOP care home pathway.

9.
Journal of Clinical Oncology ; 39(15 SUPPL), 2021.
Article in English | EMBASE | ID: covidwho-1339320

ABSTRACT

Background: The Coronavirus-19 (COVID-19) pandemic has disrupted cancer screening for reasons including healthcare resource preservation, infection control efforts, and patient factors. There is limited literature quantifying this interruption of care, particularly in vulnerable and racial/ethnic minorities. Methods: We compared the volume of cancer screening at the University of Illinois Hospital & Health Sciences System before and during the COVID-19 pandemic using data obtained from the electronic medical record. Modalities included mammogram, ultrasound, and MRI for breast;Pap test for cervical;colonoscopy, CT colonography, and flexible sigmoidoscopy for colorectal;low-dose CT for lung;and prostate-specific antigen test for prostate. Of note, screening and diagnostic tests could not be distinguished for colorectal cancer. We examined percent changes in cancer screening counts for each month from February 2020-August 2020, using January 2020 as a reference. Results were stratified by gender, race, and ethnicity. Results: Screening volume declined rapidly after January 2020, with the nadir for each cancer site occurring in April 2020: breast (n = 0, -100%), cervical (n = 169, -84%), colorectal (n = 35, -89%), lung (n = 0, -100%), and prostate (n = 108, -72%). Values recovered by August 2020 for most cancer sites except cervical cancer, which remained decreased (-23%). There were no differences in screening trends by gender. With respect to race, breast screening volume in Black patients decreased earlier and exhibited slower recovery compared to White patients. White patients had poorer cervical screening recovery than Black patients by August 2020 (-60% vs. -23%). Hispanics had poorer recovery of breast screening compared to non-Hispanics by August 2020 (-23% vs. 6%). Conclusions: We observed widely decreased cancer screening attributable to COVID-19. Breast cancer screening data specifically showed persistent disparities affecting Black and Hispanic patients. Despite the reassuring recovery of multiple screening methods by August 2020, an increase above baseline is needed to compensate for initial declines. Further studies will likely reveal long-term consequences of this unprecedented situation.

10.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277558

ABSTRACT

Rationale The pulmonary vasculature is critical for gas exchange, impacts both pulmonary and cardiac function, and has renewed importance due to COVID-19. Pulmonary blood volume is, however, technically difficult to assess, generally requiring invasive methodology for quantification. Prior studies are limited in size and participant enrollment was selective;therefore, variation in the general population is largely unknown. We performed contrast-enhanced dual-energy computed tomography (DECT) in a multicenter, community-based cohort to describe variation in pulmonary perfused blood volume (PBV) in the community. MethodsThe Multi-Ethnic Study of Atherosclerosis (MESA) recruited adults from six sites. The MESA Lung Study invited all MESA participants attending Exam 6 (2017-18), excluding those with kidney disease and contrast allergy, to undergo DECT at functional residual capacity via Siemens Flash or Force scanner: CareDose on, pitch 0.55, 0.25 sec exposure, 0.5mm slice thickness, iterative reconstruction (Admire) with Qr40 Kernel. Half concentration 370mg/ml Iopamidol was delivered at 4ml/s for the full scan, starting 17 seconds prior to scanning, including a ∼4 sec breath hold. PBV was calculated by material decomposition and normalized with iodine concentration in the pulmonary trunk. Generalized linear regression models included age, sex, race/ethnicity, height, weight, smoking status, site, and education.ResultsDECT scans were acquired for 714 participants, 36 of which were excluded due to image quality. Mean age of the remaining 678 participants was 71 years (range 63 - 79), 55% were male, 51% were ever smokers, and the race/ethnic distribution was 41% White, 29% Black, 17% Hispanic, and 13% Asian. Mean PBV was 468 + 151mL. The strongest demographic correlate was lower PBV with greater age (-30 mL per 10 years, 95% CI: -43, -18, p<0.001). Pulmonary PBV was positively associated with height, weight, and male sex (all P<0.001). PBV was lower in former compared to never smokers (p =0.04) and in Black than White participants (p=0.002), but not in Hispanic or Asian participants. There were no consistent differences across education or study site. Results were similar after adjustment for lung function and percent emphysema on CT.ConclusionsTo our knowledge, this is the first assessment of pulmonary PBV in a large, multiethnic, general community sample. Pulmonary PBV assessed by contrast-enhanced DECT was substantially reduced with advancing age and varied with body size, sex, former smoking, and, to a lesser extent, Black race. Understanding variation in pulmonary PBV in the general population may elucidate risk of cardiopulmonary disease and physical function.

12.
Neurotherapeutics ; 17(SUPPL 1):39-39, 2020.
Article in English | Web of Science | ID: covidwho-1094989
13.
JACCP Journal of the American College of Clinical Pharmacy ; 3(8):1538-1539, 2020.
Article in English | EMBASE | ID: covidwho-1092552

ABSTRACT

Introduction: Although direct oral anticoagulants (DOACs) are considered high-risk medications, many patients discharged on a DOAC do not receive adequate counseling. The use of technology (e.g., educational videos, mobile devices) may be able to assist with DOAC counseling and reduce healthcare resources. The objective of this study was to compare the impact of video-assisted counseling (VAC) versus traditional counseling (TC) by a pharmacist on DOAC comprehension in patients being discharged from an inpatient cardiology service. Research Question or Hypothesis: VAC and TC by a pharmacist will result in similar patient comprehension of their prescribed DOAC. Study Design: Prospective, randomized, open-label, parallel-group study Methods: Counseling transcripts (for both groups) and animated videos with voiceover and images (VAC group only) were created for DOAC counseling. Patients were randomized to the VAC or TC group. Patient comprehension was assessed before and after counseling with the validated Knowledge Of Direct Oral Anticoagulants (KODOA)-test on a mobile tablet device. A mixed-model ANOVA was used to analyze differences in KODOA test scores by treatment and time. The goal was to enroll 40 patients. Results: A total of 15 patients were enrolled;7 in the VAC group and 8 in the TC group. Enrollment was halted due to Coronavirus disease- 2019. Mean KODOA score increased from 9.1 to 11.5 (out of 15) in the TC group and from 9.3 to 11.6 in the VAC group (F = 51.87, P < 0.0001, Eta-squared = 0.80). The mean KODOA test score did not differ between groups according to type of counseling intervention (P = 0.74). Conclusion: KODOA scores after counseling were significantly higher than before counseling in both groups. VAC resulted in similar patient comprehension of their prescribed DOAC as TC. VAC may be a viable alternative to TC while saving resources (e.g., pharmacist time and salary).

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