Precision recruitment for high-risk participants in a COVID-19 cohort study.

Background: Studies for developing diagnostics and treatments for infectious diseases usually require observing the onset of infection during the study period. However, when the infection base rate incidence is low, the cohort size required to measure an effect becomes large, and recruitment becomes costly and prolonged. We developed a model for reducing recruiting time and resources in a COVID-19 detection study by targeting recruitment to high-risk individuals. Methods: We conducted an observational longitudinal cohort study at individual sites throughout the U.S., enrolling adults who were members of an online health and research platform. Through direct and longitudinal connection with research participants, we applied machine learning techniques to compute individual risk scores from individually permissioned data about socioeconomic and behavioral data, in combination with predicted local prevalence data. The modeled risk scores were then used to target candidates for enrollment in a hypothetical COVID-19 detection study. The main outcome measure was the incidence rate of COVID-19 according to the risk model compared with incidence rates in actual vaccine trials. Results: When we used risk scores from 66,040 participants to recruit a balanced cohort of participants for a COVID-19 detection study, we obtained a 4- to 7-fold greater COVID-19 infection incidence rate compared with similar real-world study cohorts. Conclusion: This risk model offers the possibility of reducing costs, increasing the power of analyses, and shortening study periods by targeting for recruitment participants at higher risk.

Epidemiology and Disease Burden of Alcohol Associated Liver Disease.

Consumption of alcohol in excess leads to substantial medical, economic, and societal burdens. Approximately 5.3% of all global deaths may be attributed to alcohol consumption. Moreover, the burden of alcohol associated liver disease (ALD) accounts for 5.1% of all disease and injury worldwide. Alcohol use disorder (AUD) affects men more than women globally with significant years of life loss to disability in low, middle and well-developed countries. Precise data on global estimates of alcohol related steatosis, alcohol related hepatitis, and alcohol related cirrhosis have been challenging to obtain. In the United States (US), alcohol related steatosis has been estimated at 4.3% based on NHANES data which has remained stable over 14 years. However, alcohol-related fibrotic liver disease has increased over the same period. In those with AUD, the prevalence of alcohol related hepatitis has been estimated at 10-35%. Globally, the prevalence of alcohol-associated cirrhosis has been estimated at 23.6 million individuals for compensated cirrhosis and 2.46 million for those with decompensated cirrhosis. The contribution of ALD to global mortality and disease burden of liver related deaths is substantial. In 2016 liver disease related to AUD contributed to 50% of the estimated liver disease deaths for age groups 15 years and above. Data from the US report high cost burdens associated with those admitted with alcohol-related liver complications. Finally, the recent COVID-19 pandemic has been associated with marked increase in alcohol consumption worldwide and will likely increase the burden of ALD.

Relative risk reduction: Misinformative measure in clinical trials and COVID-19 vaccine efficacy.

Treatment and vaccine efficacy in clinical trials are often reported in the media and medical journals as the relative risk reduction. The present article explains why the relative risk reduction is a misinformative measure that promotes disinformation when reporting efficacy in clinical research studies such as randomized controlled trials for COVID-19 vaccines. The relative risk reduction is based on the relative risk, a proportional measure or ratio used in epidemiologic studies to estimate the probability of a disease associated with an exposure. The present article demonstrates how the relative risk reduction and relative risk obscure the magnitude of disease risk reduction in clinical research. The absolute risk reduction is shown to be a more precise and reliable measure of treatment and vaccine efficacy in clinical research studies. The absolute risk reduction reciprocal also measures the number needed to treat or vaccinate, and is a more accurate measure than the relative risk reduction for comparing risk reductions of clinical studies. Additionally, the present article reviews consequences of COVID-19 vaccine efficacy misinformation disseminated through media reports. The article concludes that relative risk reduction should not be used to measure treatment and vaccine efficacy in clinical trials. What is new?: •Unreliability of relative measures in clinical trials is graphically illustrated, demonstrating constant relative measures as absolute measures change.•Misuse of relative measures in clinical research is historically linked to misinterpretation of Jerome Cornfield's advice on measuring causative and associative effects.•Consequences of disinformation and misinformation related to COVID-19 vaccine efficacy and modern clinical medicine are described.•The proper use of absolute measures in meta-analyses is explained.

Development and evaluation of a fluidic facemask for airborne transmission mitigation.

Recently, a fluidic facemask concept was proposed to mitigate the transmission of virus-laden aerosol and droplet infections, such as SARS-CoV-2 (COVID-19). This paper describes an experimental investigation of the first practical fluidic facemask prototype, or "Air-Screen". It employs a small, high-aspect-ratio, crossflow fan mounted on the visor of a filter-covered cap to produce a rectangular air jet, or screen, in front of the wearer's face. The entire assembly weighs less than 200 g. Qualitative flow visualization experiments using a mannequin clearly illustrated the Air-Screen's ability to effectively block airborne droplets (∼100 µm) from the wearer's face. Quantitative experiments to simulate droplets produced during sneezing or a wet cough (∼102 µm) were propelled (via a transmitter) at an average velocity of 50 m/s at 1 m from the mannequin or a target. The Air-Screen blocked 62% of all droplets with a diameter of less than 150 µm. With an Air-Screen active on the transmitter, 99% of all droplets were blocked. When both mannequin and transmitter Air-Screens were active, 99.8% of all droplets were blocked. A mathematical model, based on a weakly-advected jet in a crossflow, was employed to gain greater insight into the experimental results. This investigation highlighted the remarkable blocking effect of the Air-Screen and serves as a basis for a more detailed and comprehensive experimental evaluation.

Axillary Lymphadenopathy associated with COVID-19 vaccination: updates and recommendations.

Lymphadenopathy associated with vaccination has been documented as complicating the evaluation of metastatic malignancy (Bychokovsky & Lin, 2017) (Choi, Ko, Han, J, & Kang S, 2009) (Mohseni, et al., 2014). In the past this was a limited finding, primarily documented in association with smallpox and H1N1 vaccination (Mingos, Howard, Giacalone, Kozone, & Jacene, 2016) (Fry, et al., 2021) (Panagoitidis, Exarhos, Housianakou, Bournazos, & Datseris, 2010).The advent of the novel mRNA vaccine for Covid-19 in December of 2021, and subsequent large scale vaccination effort, has resulted in a marked increase in the identification of lymphadenopathy (LAD) associated with vaccination. Because axillary lymphadenopathy is a concerning sign of metastatic disease in breast cancer, identifying the difference between benign inflammatory reaction and concerning LAD, and avoiding unnecessary additional imaging and biopsy is an essential skill. This article describes the current literature, recommendations for follow up and interventions to improve diagnostics.

SARS-CoV-2 and HIV co-infection; clinical features, diagnosis, and treatment strategies: A systematic review and meta-analysis.

Background and aim: Coronavirus disease 2019 (COVID-19) in people living with human immunodeficiency virus (HIV) who has a compromised immune system can be associated with more significant risks for severe complications. To date, no comprehensive study has been performed to evaluate HIV in patients with COVID-19. In the present study, we assessed the status of patients co-infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and HIV as a systematic review and meta-analysis. Methods: A systematic literature search strategy was conducted via reviewing original research articles published in Medline, Web of Science, and Embase databases in 2019 and 2020. Statistical analysis was performed using STATA software, version 14.0 (Stata Corporation, College Station, Texas, USA), to report the prevalence of HIV among patients with COVID-19. Case reports/case series were also evaluated as a systematic review. Results: Sixty-three studies (53 case reports/case series and ten prevalence studies) were included in our study. A meta-analysis of prevalence studies showed that HIV infection among patients with COVID-19 was reported in 6 countries (Uganda, China, Iran, USA, Italy, and Spain) with an overall frequency of 1.2% [(95% CI) 0.8-1.7] among 14,424 COVID-19 patients. According to the case reports and case series, 111 patients with HIV have been reported among 113 patients with COVID-19 from 19 countries. Most of the cases were in the USA, China, Italy, and Spain. Conclusion: The small number of SARS-CoV-2-HIV co-infected patients reported in the literature makes it difficult to draw precise conclusions. However, since people with HIV are more likely to develop more severe complications of COVID-19, targeted policies to address this raised risk in the current pandemic should be considered. Our findings highlight the importance of identifying underlying diseases, co-infections, co-morbidities, laboratory findings, and beneficial treatment strategies for HIV patients during the COVID-19 pandemic.

Safety or service? Effects of employee prosocial safety-rule-breaking on consumer satisfaction.

The COVID-19 pandemic makes restaurants implement new safety rules. However, because of consumers' and employees' resistance, employees may break these rules to improve the service experience. This paper examines how employees' prosocial safety-rule-breakings (PSRB) affect consumer satisfaction. We propose that PSRB has two competing effects on consumers' (including both requesters and bystanders) satisfaction via the mediating roles of service performance and perceived safety. We tested our proposed model in two experiments, adopting a 2 (Consumer role: Requesters vs. Bystanders) × 2 (PSRB level: Low vs. High) between-subject experimental design. Our findings suggest that PSRB has a strong negative relationship with bystanders' service performance rating. PSRB harms both requesters' and bystanders' perceived safety. PSRB reduces consumer satisfaction, and the relationship is stronger for bystanders (vs. requesters). This study demonstrates the importance for hospitality organizations to ensure safety rule compliance during and after the pandemic.

A multicriteria decision analysis framework to measure equitable healthcare access during COVID-19.

The ongoing novel coronavirus (COVID-19) pandemic has highlighted the need for individuals to have easy access to healthcare facilities for treatment as well as vaccinations. The surge in COVID-19 hospitalizations during 2020 also underscored the fact that accessibility to nearby hospitals for testing, treatment and vaccination sites is crucial for patients with fever or respiratory symptoms. Although necessary, quantifying healthcare access is challenging as it depends on a complex interaction between underlying socioeconomic and physical factors. In this case study, we deployed a Multi Criteria Decision Analysis (MCDA) approach to uncover the barriers and their effect on healthcare access. Using a least cost path (LCP) analysis we quantified the costs associated with healthcare access from each census block group in the Los Angeles metropolitan area (LA Metro) to the nearest hospital. Social vulnerability reported by the Centers for Disease Control and Prevention (CDC), the daily number of COVID-19 cases from the Los Angeles open data portal and built environment characteristics (slope of the street, car ownership, population density distribution, walkability, traffic collision density, and speed limit) were used to quantify overall accessibility index for the entire study area. Our results showed that the census block groups with a social vulnerability index above 0.75 (high vulnerability) had low accessibility owing to the higher cost of access to nearby hospitals. These areas were also coincident with the hotspots for COVID-19 cases and deaths which highlighted the inequitable exposure of socially disadvantaged populations to COVID-19 infections and how the pandemic impacts were exacerbated by the synergistic effect of socioeconomic status and built environment characteristics of the locations where the disadvantaged populations resided. The framework proposed herein could be adapted to geo-target testing/vaccination sites and improve accessibility to healthcare facilities in general and more specifically among the socially vulnerable populations residing in urban areas to reduce their overall health risks during future pandemic outbreaks.

Cov19VaxKB: A Web-based Integrative COVID-19 Vaccine Knowledge Base.

The development of SARS-CoV-2 vaccines during the COVID-19 pandemic has prompted the emergence of COVID-19 vaccine data. Timely access to COVID-19 vaccine information is crucial to researchers and public. To support more comprehensive annotation, integration, and analysis of COVID-19 vaccine information, we have developed Cov19VaxKB, a knowledge-focused COVID-19 vaccine database (http://www.violinet.org/cov19vaxkb/). Cov19VaxKB features comprehensive lists of COVID-19 vaccines, vaccine formulations, clinical trials, publications, news articles, and vaccine adverse event case reports. A web-based query interface enables comparison of product information and host responses among various vaccines. The knowledge base also includes a vaccine design tool for predicting vaccine targets and a statistical analysis tool that identifies enriched adverse events for FDA-authorized COVID-19 vaccines based on VAERS case report data. To support data exchange, Cov19VaxKB is synchronized with Vaccine Ontology and the Vaccine Investigation and Online Information Network (VIOLIN) database. The data integration and analytical features of Cov19VaxKB can facilitate vaccine research and development while also serving as a useful reference for the public.

COVID-19 associated pulmonary aspergillosis (CAPA): An added potential burden on India's pre-existing fungal superinfection.

The ongoing pandemic that initiated in Wuhan, China, has been an international public health emergency since January 2020. India has been battling a brutal COVID-19's second wave since April 2021. The healthcare system was struggling with a substantial increase in COVID-19 cases when the lack of necessary resources further aroused a major setback. Opportunistic fungal infections, specifically mucormycosis and candidiasis have become a pressing matter of concern. Recent cases of aspergillosis have also heightened public alarm. Hence, call for an immediate response to this public health crisis is the need of the hour by establishing countrywide surveillance, diagnostic, and management system, as well as public awareness to alleviate the burden of COVID-19 and fungal infections in India.

Mutual Pan-African support paradigm to produce scientific evidence of traditional medical practices for use against COVID-19 and emerging pandemics.

Africa is endowed with a profoundly rich and diverse system of plants and other bio-resources out of which, by traditional medicine practice, the people have satisfied their healthcare needs right from antiquity. In contemporary times, it has become necessary to modernize this traditional medical care system via scientific studies. Validation of the efficacy of health-enhancement products and drugs from plants and other bio-resources is predicated on diligent and intensive research accompanied by rigorous and conclusive clinical trials. Africa has eminently qualified human resources but due to the finance-intensive nature of medical research, individual African states on their own cannot fund the level of research desired for dealing with such serious issues as the COVID-19 pandemic. A collaboration among African states guided by a Mutual Pan-African support paradigm (MPASP) is a unique strategy for achieving success in any such a high-impact global project as the use of traditional medicine against COVID-19 and emerging pandemics; and this is hereby advocated.

Influenza Management During the COVID-19 Pandemic: A Review of Recent Innovations in Antiviral Therapy and Relevance to Primary Care Practice.

Seasonal influenza requires appropriate management to protect public health and resources. Decreasing the burden of influenza will depend primarily on increasing vaccination rates as well as prompt initiation of antiviral therapy within 48 hours of symptom onset, especially in the context of the current coronavirus disease 2019 pandemic. A careful approach is required to prevent health services from being overwhelmed by a surge in demand that could exceed capacity. This review highlights the societal burden of influenza and discusses the prevention, diagnosis, and treatment of influenza as a complicating addition to the challenges of the coronavirus disease 2019 pandemic. The importance of vaccination for seasonal influenza and the role of antiviral therapy in the treatment and prophylaxis of seasonal influenza, including the most up-to-date recommendations from the Centers for Disease Control and Prevention for influenza management, will also be reviewed.

What is the availability, affordability, and quality of foods and beverages aligned with dietary guidance in Louisiana Supplemental Nutrition Assistance Program (SNAP) authorized stores?

Healthy food retail strategies are delivered by Cooperative Extension Services in Louisiana to improve public health among communities with lower income. To guide Cooperative Extension Services Programming, the aim of this study was to assess healthy food access among SNAP-authorized stores. This included comparing the availability, affordability, and quality of healthy foods sold in these stores by geography, ownership, and store type. Seventy-five Louisiana SNAP-authorized stores were selected for measurement. Between October 2019 and March 2020 (prior to the COVID-19 national emergency declaration), trained researchers used the Nutrition Environment Measures Survey in Stores (NEMS-S) to assess the availability, affordability, and quality of healthy versus less healthy foods and beverages in 42 SNAP-authorized stores, including: grocery (n = 12, 29%), convenience (n = 17, 41%), drug (n = 1, 2%), dollar (n = 11, 26%), and butcher/meat (n = 1, 2%). Multivariate analysis of variance (a priori, p < 0.05) determined if differences in total NEMS-S scores or subscores existed by geography (urban versus rural), ownership (corporate/chain versus independent), or store type. No urban/rural differences were identified. Corporate/chain SNAP-authorized stores scored higher on average than independent SNAP-authorized stores for the total NEMS-S score (17.2 versus 8.1; p = 0.009) and availability subscore (13.1 versus 6.1; p = 0.02). SNAP-authorized grocery stores scored higher than all other store types (total NEMS-S score 27.6), followed by SNAP-authorized dollar stores (total NEMS-S score 10.7), and SNAP-authorized convenience stores (total NEMS-S score 5) (p < 0.001). Louisiana Cooperative Extension Services should explore ways to scale healthy food retail strategies statewide with a specific emphasis on independent and smaller SNAP-authorized retailers.

Omphalopagus conjoined twins separation during coronavirus disease-19 pandemic era: A case report.

INTRODUCTION AND IMPORTANCE: Conjoined twin is a rare congenital anomaly characterized by a fusion of certain anatomical structures. Coronavirus-19 (COVID-19) is a new emerging infectious respiratory disease affecting worldwide and potentially leads to acute respiratory distress (ARDS) in children. COVID-19 has reconstructed the healthcare system, including surgical care and decision-making. CASE PRESENTATION: Herein we describe a surgical separation of 2.5 months old omphalopagus conjoined twins, with one of them (Baby A) presenting COVID-19-associated respiratory distress, as well as the challenges faced during the preparation and the execution of the complex surgical procedure. CLINICAL DISCUSSION: Baby A underwent antiviral therapy, oxygen supplementation, and ventilation in the ICU, while baby B remained stable and confirmed negative for SARS-CoV-2. The separation surgery was conducted after baby A had become clinically stable. Defect closure and reconstruction were accomplished. At one week follow-up, Baby A died of lung infection, while baby B remained well after one year. CONCLUSION: The complexity of surgical separation requires careful planning by a multidisciplinary team. Surgical separation of conjoined twins during the pandemic era has not been reported much in the literature, more reports are required to provide further insight.

Vaccine induced thrombotic thrombocytopenia: The shady chapter of a success story.

The recognition of the rare but serious and potentially lethal complication of vaccine induced thrombotic thrombocytopenia (VITT) raised concerns regarding the safety of COVID-19 vaccines and led to the reconsideration of vaccination strategies in many countries. Following the description of VITT among recipients of adenoviral vector ChAdOx1 vaccine, a review of similar cases after Ad26.COV2·S vaccination gave rise to the question whether this entity may constitute a potential class effect of all adenoviral vector vaccines. Most cases are females, typically younger than 60 years who present shortly (range: 5-30 days) following vaccination with thrombocytopenia and thrombotic manifestations, occasionally in multiple sites. Following initial incertitude, concrete recommendations to guide the diagnosis (clinical suspicion, initial laboratory screening, PF4-polyanion-antibody ELISA) and management of VITT (non-heparin anticoagulants, corticosteroids, intravenous immunoglobulin) have been issued. The mechanisms behind this rare syndrome are currently a subject of active research and include the following: 1) production of PF4-polyanion autoantibodies; 2) adenoviral vector entry in megacaryocytes and subsequent expression of spike protein on platelet surface; 3) direct platelet and endothelial cell binding and activation by the adenoviral vector; 4) activation of endothelial and inflammatory cells by the PF4-polyanion autoantibodies; 5) the presence of an inflammatory co-signal; and 6) the abundance of circulating soluble spike protein variants following vaccination. Apart from the analysis of potential underlying mechanisms, this review aims to synopsize the clinical and epidemiologic features of VITT, to present the current evidence-based recommendations on diagnostic and therapeutic work-up of VITT and to discuss new dilemmas and perspectives that emerged after the description of this entity.

The consequential impact of JUUL on youth vaping and the landscape of tobacco products: The state of play in the COVID-19 era.

JUUL is a groundbreaking electronic cigarette (e-cig) and the preeminent vaping product on the market. We present an overview of the rapid and spectacular rise of JUUL and its remarkable fall within the timespan of 2015 - 2020. We highlight JUUL's entering the market in June 2015, becoming the industry leader in mid 2017, and experiencing a litany of setbacks by late 2019 through to early 2020. We address the role played by JUUL in the ongoing epidemic of youth vaping. We also feature competing views on the public health impact of JUUL use (in particular), and e-cig vaping (in general). We further highlight the latest trends in youth vaping and sales records for JUUL and tobacco cigarettes. In view of the ongoing pandemic of COVID-19, we briefly summarize the existing evidence on the relationship between vaping and smoking and the prevalence, disease course, and clinical outcomes of COVID-19.

An overview of basic molecular biology of SARS-CoV-2 and current COVID-19 prevention strategies.

Coronavirus Disease 2019 (COVID-19) manifests as extreme acute respiratory conditions caused by a novel beta coronavirus named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) which is reported to be the seventh coronavirus to infect humans. Like other SARS-CoVs it has a large positive-stranded RNA genome. But, specific furin site in the spike protein, mutation prone and phylogenetically mess open reading frame1ab (Orf1ab) separates SARS-CoV-2 from other RNA viruses. Since the outbreak (February-March 2020), researchers, scientists, and medical professionals are inspecting all possible facts and aspects including its replication, detection, and prevention strategies. This led to the prompt identification of its basic biology, genome characterization, structural and expression based functional information of proteins, and utilization of this information in optimizing strategies to prevent its spread. This review summarizes the recent updates on the basic molecular biology of SARS-CoV-2 and prevention strategies undertaken worldwide to tackle COVID-19. This recent information can be implemented for the development and designing of therapeutics against SARS-CoV-2.

Does airborne pollen influence COVID-19 outbreak?

The fast spread of SARS-CoV-2 presented a worldwide challenge to public health, economy, and educational system, affecting wellbeing of human society. With high transmission rates, there are increasing evidences of COVID-19 spread via bioaerosols from an infected person. The current review was conducted to examine airborne pollen impact on COVID-19 transmission and to identify the major gaps for post-pandemic research. The study used all key terms to identify revenant literature and observation were collated for the current research. Based on existing literature, there is a potential association between pollen bioaerosols and COVID-19. There are few studies focusing the impact of airborne pollen on SARS-CoV-2, which could be useful to advance future research. Allergic rhinitis and asthma patients were found to have pre-modified immune activation, which could help to provide protection against COVID-19. However, does airborne pollen acts as a potent carrier for SARS-CoV-2 transport, dispersal and its proliferation still require multidisciplinary research. Further, a clear conclusion cannot be drawn due to limited evidence and hence more research is needed to show how pollen bioaerosols could affect virus survivals. The small but growing literature review focuses on searching for every possible answer to provide additional security layers to overcome near future corona-like infectious diseases.

Severity of COVID-19 in hospitalized patients with and without atopic disease.

BACKGROUND: Data from the 2009 influenza pandemic suggested asthma might protect from severe disease in hospitalized patients. Asthma does not appear to increase risk for hospitalization or mortality with COVID-19. OBJECTIVE: This study was undertaken to see if atopy actually protected those hospitalized with COVID-19. METHODS: Retrospective chart review on all patients testing positive for SARS-CoV-2 over 2 months at a major adult and pediatric tertiary referral center hospital. Charts were evaluated for history of atopic disease, as were the need for ICU admission, requirement for supplemental oxygen and/or intubation, and in hospital mortality. RESULTS: No significant differences in outcomes for patients (n = 275) based on atopic disease were noted: ICU admission, 43% versus 44.7% (atopic versus no atopic disease, respectively; p = 0.84); supplemental oxygen use, 79.1% versus 73.6% (p = 0.36); intubation rate, 35.8% versus 36.5% (p = 0.92); and mortality rate, 13.4% versus 20.7% (p = 0.19). More patients with atopic disease had COPD listed as a diagnosis in their chart (38.8% versus 17.3%, p < 0.001). COPD was associated with an increased rate of ICU admission (aOR = 2.22 (1.15, 4.30) p = 0.02) and intubation (aOR = 2.05 (1.07, 3.92) p = 0.03). After adjusting for COPD, patients with atopic disease had a trend for reduced mortality (aOR 0.55 (0.23, 1.28), p = 0.16), but those with asthma did not (p > 0.2). CONCLUSION: Severity of COVID-19 in hospitalized patients does not differ based on atopic status. However, adjusting for presence of COPD led to a suggestion of possible reduced severity in patients with atopy but not asthma.