A COVID-19 vaccine candidate based on SARS-CoV-2 spike protein and immune-stimulating complexes.

Spike protein from SARS-CoV-2, the etiologic agent of the COVID-19 pandemic disease, constitutes a structural protein that proved to be the main responsible for neutralizing antibody production. Thus, its sequence is highly considered for the design of candidate vaccines. Animal cell culture represents the best option for the production of subunit vaccines based on recombinant proteins since they introduce post-translational modifications that are important to mimic the natural antigenic epitopes. Particularly, the human cell line HEK293T has been explored and used for the production of biotherapeutics since the products derived from them present human-like post-translational modifications that are important for the protein's activity and immunogenicity. The aim of this study was to produce and characterize a potential vaccine for COVID-19 based on the spike ectodomain (S-ED) of SARS-CoV-2 and two different adjuvants: aluminum hydroxide (AH) and immune-stimulating complexes (ISCOMs). The S-ED was produced in sHEK293T cells using a 1-L stirred tank bioreactor operated in perfusion mode and purified. S-ED characterization revealed the expected size and morphology. High N-glycan content was confirmed. S-ED-specific binding with the hACE2 (human angiotensin-converting enzyme 2) receptor was verified. The immunogenicity of S-ED was evaluated using AH and ISCOMs. Both formulations demonstrated the presence of anti-RBD antibodies in the plasma of immunized mice, being significantly higher for the latter adjuvant. Also, higher levels of IFN-γ and IL-4 were detected after the ex vivo immune stimulation of spleen-derived MNCs from ISCOMs immunized mice. Further analysis confirmed that S-ED/ISCOMs elicit neutralizing antibodies against SARS-CoV-2. KEY POINTS: Trimeric SARS-CoV-2 S-ED was produced in stable recombinant sHEK cells in serum-free medium. A novel S-ED vaccine formulation induced potent humoral and cellular immunity. S-ED formulated with ISCOMs adjuvant elicited a highly neutralizing antibody titer.

Assessment Of Prevalence And Severity Of Digital Eye Strain Amongst Children Using Online Learning During Covid-19

Background- The pandemic affected the education of the children and thus online classes were initiated using digital devices, which resulted in excessive use of digital devices. The present study was therefore conducted at a tertiary care center to determine the burden and severity of Digital strain syndrome among children attending online classes during the pandemic. Methodology- This study was conducted as an online survey-based cross-sectional study on children studying in higher secondary school belonging to the age group of 12 to 16 years attending online classes in Bhopal India. during the pandemic. Using a standard questionnaire, the prevalence and severity of DES were assessed. Results- The mean age of children was 15.82+/-3.93 years. DES was present in 139 (53.9%) children. The most common symptom was headache followed by itching in the eyes. The majority of children had mild DES (37.2%), whereas 13.2% and 3.5% of children had moderate and severe DES respectively. Conclusions- We reported a much higher prevalence of DES during the COVID era, which was due to an increase in the time spent on digital devices for online classes. As the education of children is essential, it should be a continuous process. A concentrated effort must be done to increase awareness regarding DES due to digital device usage and e-learning technologies Copyright © 2023 Ubiquity Press. All rights reserved.

Adapting a Picu for Adult Patients during a Pandemic: Impacts and Learning from Interprofessional Care of Critically Ill Adults with Covid-19

BACKGROUND AND AIM: Worldwide health systems have been strained by the COVID-19 pandemic. Surging numbers of critically ill adult patients demanded urgent system-wide responses. Our Paediatric Intensive Care Unit (PICU) underwent a care delivery model redesign and rapid shift in processes and resources to care for critically ill adults at the peak of the pandemic. We describe novel adaptions made to accommodate adult patients for the first time in this paediatric setting. Personal insights of clinical staff, leaders and adult care partners about the experience of caring for critically ill adult patients are shared. METHOD(S): Program components included;preparation, education, collaboration (both interprofessional and interorganizational), continuous process improvement, and staff well-being initiatives. Interprofessional team impacts gathered during the implementation phase of the program and 10 months following were analysed using Havelock's Theory of Change framework1. RESULT(S): The Adult COVID-19 program facilitated rapid team capacity building and supported responsive care for adult patients. Over 12 weeks, 35 adults (426 patient days) received care in the PICU. Staff acknowledged;1] the burden of providing high quality care for adults, 2] the opportunity for individual and team growth and 3] guiding paediatric principals of strength-based, family-centered care enhanced the quality of care provided and provider perceptions of accomplishment. CONCLUSION(S): This program facilitated a rapid transformation and expansion in models of care and processes, successfully enhanced the team's capacity to deliver quality evidence-based service to adults with COVID-19 and was a source of personal growth and meaning for the health care team.

Design of IMC Based PI Controllers for Three Tank Interacting Level Control Process

India is a country that consists of most process industries, where most of the end products are related to water or other liquid state materials. In recent days pharmaceutical industries have grown on a larger scale due to the COVID'19 situation. One of the major processes is to maintain the level of the liquid for having a continuous process. In this proposed process, Proportional Integral (PI), Internal Model Controller (IMC) based PI is implemented on a three-tank integrating system with two input and two output (TITO). IMC-PI gain values are acquired and decoupled using the decoupler matrix by determining RHP poles and zeros for the TITO system. Since two input tanks are involved, therefore two different gain values are calculated keep the liquid at the given level. The proposed system has given has resulted with 180 seconds and 190 seconds for Settling time and 5% and 0% of Overshoot for two tanks. © 2022 IEEE.

Improving Health Literacy Training and Communication Competencies for Health Professionals in Austria and Canada: A Comparative Study

Background Canada is a leader in health promotion, public health, interprofessional curricula, intercultural competencies and has a longer history of health literacy (HL) developments. Austria is in the early stages of HL capacity building and developing communication training for health professionals treating people in vulnerable situations. The primary aim of our project is to analyze the education of health professionals (medical, nursing and pharmacy students) regarding HL, intercultural and inter professional communication skills and patient-centered interactions with underserved populations inAustria and Canada. The importance of communication in healthcare has increased significantly during the COVID-19pandemic;thus the question of how communication training has changed in the light of the pandemic is also explored. Methods The study design included four methods: a literature review, a document analysis, a curricula survey, and expert interviews. Results Recognizing the importance of HL and improved quality of health communication;the Austrian government along with educational institutions have looked abroad to identify best practises, e.g., from Canada. Moreover, a national train-the-trainer program was developed but is yet to be integrated in all universities. Expert interviews and curricula surveys as well as a document analysis indicate that communication training varies by province in Austria and Canada in terms of both course content and longitudinal integration. COVID-19 has changed clinical communication practises and hindered training for young professionals. Conclusion The development of communication curricula and HL competencies is a long and continuous process in both countries.

Clinical genomic population health testing for 431 genes implemented through family medicine practices: the Vermont experience

Integration of genomics into health practice depends on successful implementation in non-research settings. We describe a medical home-centered implementation at the intersection of genomic medicine and population health in the UVM Health Network. In this clinical implementation, the hospital laboratory orchestrates a collaboration involving primary care providers (PCPs), patient and family advisors, health system administrators, clinical genetics services, oncologists and cardiologists, Vermont’s accountable care organization, and a commercial CLIA genomic testing laboratory. Phenotypically unselected adult primary care patients are offered “The Genomic DNATest” at no cost as part of their regular care. Testing is introduced by primary care providers and their staff using a brief animated video and printed decision aids with graded detail. Question resolution and pre- and post-test genetic counseling is offered at no cost using telephone, video, or in-person visits, and is coordinated bya single phone and email contact point, the Genomic Medicine Resource Center. 431 genes are sequenced for germline health risk and recessive carrier variants;only pathogenic and likely-pathogenic variants are reported. New reports are issued when reported and unreported variants are later reclassified. Test reports are reviewed by a clinical geneticist and genetic counselor. Two brief "action plans" are developed with PCP and patient focus in a single messaging document. This is prepended to the lab reports before release to the PCP, who reviews and then conveys them to the patient. PCPs and their staff receive initial training on the test and process and are invited to participate in an online community with monthly video case discussions. Among the first 72 patients tested, 17% had a health risk identified. This included dominantly inherited disorders and bi-allelic or hemizygous variants for common recessive disorders. Care pathways created in advance using multi-disciplinary expertise were activated for those. Free testing for blood relatives was made available. 76% of tested patients had at least one heterozygous recessive disease variant identified, and low-cost partner testingwas made available. Frequency of positive test results was in line with population frequency predictions. Pre- and post-test genetic counseling uptakewas lower than expected. This raised the question of unmet informational needs. A 2-page anonymous process quality survey mailed twice to the first 61 tested patients had a 31% return rate. Key findings included (1) pre-test engagement methods and decision aids were helpful;(2) the testing decision was influenced equally by value for the individual’s health, for their family’s health, and for researchers;(3) emotions during the ∼4-week time to results were neutral or excited, with none experiencing anxious feelings, and none reported the wait time as too long;(4) 21% reported contacting the Genomic Medicine Resource Center;(5) 16% reported referral to a specialist due to their result;(6) about half reported sharing the results with family members, but none reported any family members getting tested;(7) none indicated they were dissatisfied with the testing and result process, and only one responded they would not recommend others get the test;and (8) all agreed or somewhat agreed that the PCPs officewas the right place to do this testing.While this implementation was designed with scalability and a low management profile in mind, several systems-level barriers were encountered that contributed to lower engagement efforts and slower expansion than planned. This included lack of institutional information technology resources to surmount paper-based systems for requisitions, sample-routing, and consent forms;dependency of the patient engagement process during PCP visits on rooming and nursing staff during times of staffing shortages;susceptibility to practice model disruptions and priorities caused by the Covid-19 pandemic;and PCP time distraction resulting from user interface and polic changes in our EHR during the pilot. These barriers are targets for study and continuous process improvement activities. In summary, an example of clinical genomic population health testing using a medical-home focus has been successfully implemented in a non-research setting, supported by multi-disciplinary collaboration. This implementation depends on minimal staff, avoids financial barriers to access and genetic counseling, and offers a short, defined, test turnaround time as compared to similar biobank-based research programs. Tested patients find the program satisfactory, and meaningful test results are at least as common as in existing population health risk screening archetypes.