The Effect of Senate Bill-159 on the Provision of Hiv Pre- and Post-Exposure Prophylaxis in Sacramento, California

Purpose of Study: The passing of Senate Bill (SB)-159 in May, 2019 allows California pharmacies to provide HIV pre-exposure (PrEP) & post-exposure prophylaxis (PEP) to patients without a physician's prescription. The goal of this study is to investigate whether Sacramento pharmacies are familiar with SB-159 and carry PrEP/PEP, evaluate SB-159's progress over the past three years, and elucidate possible avenues for further improvement in implementation. Methods Used: This study reports findings from surveys of state-licensed pharmacies in Sacramento conducted in 2020-2021 (Year 1) and 2022-2023 (Year 2) using an IRB-approved script. The script assessed the pharmacy's stock, promotion of PrEP/PEP, and familiarity with SB-159. Surveys for Year 2 are still ongoing. Respondent pharmacies were identified as carriers or non-carriers based on whether they carried prophylaxis. Respondents that scored a familiarity >= 3 for SB-159 were assigned as "familiar." The survey also investigated reasons for not furnishing Prophylaxis, advertising of Prophylaxis without prescription, comfort with dispensing protocol, and future plans for staff training to dispense Prophylaxis. Summary of Results: We first examined if pharmacies in Sacramento, California carried stock of PEP/PrEP. In Year 1 (2020-21), 14% of surveyed pharmacies reported carrying PEP/PrEP (7 out of 50). In Year 3 (2022-2023), this increased to 62% (24 out of 39 surveyed pharmacies). Next, we examined the familiarity of pharmacies and pharmacists with SB-159. In Year 1, 43% of carriers (3/7) and 16% of non-carriers (7/43) were familiar with SB-159. By Year 3, pharmacies were more familiar with the law, with 67% of carriers (16/24) and 54% of non-carriers (7/13) reporting to be familiar with SB-159. Finally, we examined whether the pharmacies advertised the ability to obtain PEP/PrEP prophylaxis without a prescription. In Year 1, 28.6% of carriers and 6.98% of non-carriers stated they advertise the ability to obtain PEP/PrEP prophylaxis without a prescription. In Year 3, the values decreased to 4.2% and 0%, respectively. Conclusion(s): Compared to Year 1, there was an increase in the percent of Year 3 pharmacies surveyed that stock PrEP/PEP. However, data from the past 2 years show that carriers and non-carriers showed similar responses to questions related to familiarity with SB-159 and advertising. Taken together, this would suggest that the passing of SB-159 has increased access to HIV PrEP/PEP, yet has not significantly improved pharmacy advertising and awareness. Possible explanations include the focus that pharmacies have put into vaccination efforts against the COVID 19 pandemic instead of fulfilling SB-159. Future studies should include survey questions that objectively assess a pharmacy's familiarity with SB-159, and follow up with pharmacies that plan to implement training for their staff to dispense PrEP/PEP.

A Protective HLA Extended Haplotype Outweighs the Major COVID-19 Risk Factor Inherited from Neanderthals in the Sardinian Population

During the first and second waves of coronavirus-19 disease, Sardinia had one of the lowest hospitalization and related mortality rates in Europe. However, in contrast with this evidence, the Sardinia population showed a very high frequency of the Neanderthal risk locus variant rs35044562, considered to be a major risk factor for a severe SARS-CoV-2 disease course. We evaluated 358 patients who had tested positive for SARS-CoV-2 and 314 healthy Sardinian controls (Italy). Patients were divided according to WHO classification: 120 patients asymptomatic, 90 pauci-symptomatic, 108 with a moderate disease course and 40 severely ill. The allele frequencies of Neanderthal-derived genetic variants reported as being protective (rs1156361) or causative (rs35044562) for severe illness were calculated in patients and controls. The Thalassemia variant (rs11549407), the HLA haplotypes, the KIR genes, as well as KIRs and their HLA class I ligand combinations were also investigated. The rs35044562 and rs1156361 Neanderthal variants revealed a distribution in Hardy-Weinberg equilibrium (HWE) both in SARS-CoV-2 patients and the control population (X2HWE = 0.82, p = 0.37 and X2HWE = 0.13, p = 0.72, respectively). Our findings reported an increased risk for severe disease in Sardinian patients carrying the rs35044562 high-risk variant [OR 5.32 (95% CI 2.53-12.01), p<0.0001]. Conversely, the protective effect of the HLA-A*02:01~B*18:01~DRB1*03:01 three-loci extended haplotype in the Sardinian population was shown to efficiently contrast the high risk of a severe and devastating outcome of the infection predicted for carriers of the Neanderthal locus [OR 15.47 (95% CI 5.8 - 41.0), p<0.0001]. This result suggests that the balance between risk and protective immunogenetic factors plays an important role in the evolution of COVID-19. A better understanding of these mechanisms may well turn out to be the biggest advantage in the race for the development of more efficient drugs and vaccines.

Kidney dysfunction is associated with adverse outcomes in internal medicine COVID-19 hospitalized patients.

OBJECTIVE: In this study, we aimed to evaluate the kidney involvement assessed by estimated glomerular filtration rate (eGFR), the associations with specific clinical disease variables and laboratory findings, and the predictive role of eGFR on clinical outcomes of patients admitted with COVID-19 in Internal Medicine ward in the first wave. PATIENTS AND METHODS: Clinical data of 162 consecutive patients hospitalized in the University Hospital Policlinico Umberto I in Rome, Italy, between December 2020 to May 2021 were collected and retrospectively analyzed. RESULTS: The median eGFR was significantly lower in patients with worse outcomes than in patients with favorable outcomes [56.64 ml/min/1.73 m2 (IQR 32.27-89.73) vs. 83.39 ml/min/1.73 m2 (IQR 69.59-97.08), p<0.001]. Patients with eGFR < 60 ml/min/1.73 m2 (n=38) were significantly older compared to patients with normal eGFR [82 years (IQR 74-90) vs. 61 years (IQR 53-74), p<0.001] and they had fever less frequently [39.5% vs. 64.2%, p<0.01]. Kaplan-Meier curves demonstrated that overall survival was significantly shorter in patients with eGFR < 60 ml/min/1.73 m2 (p<0.001). In multivariate analysis, only eGFR < 60 ml/min/1.73 m2 [HR=2.915 (95% CI=1.110-7.659), p<0.05] and platelet to lymphocyte ratio [HR=1.004 (95% CI=1.002-1.007), p<0.01] showed a significant predictive value for death or transfer to intensive care unit (ICU). CONCLUSIONS: Kidney involvement on admission was an independent predictor for death or transfer to ICU among hospitalized COVID-19 patients. The presence of chronic kidney disease could be regarded as a relevant factor in risk stratification for COVID-19.

Knowledge and Attitude towards General Prevention of Covid-19 Other Than Vaccination among Malaysian Undergraduate Students

COVID-19 is a disease that can lead to acute respiratory distress syndrome (ARDS). It spread to 200 nations and has been declared a worldwide pandemic by the World Health Organisation (WHO). Until now, there have been more than 237 million positive COVID-19 cases recorded, with around 4.84 million deaths worldwide. General preventive practises such as face masks, hand washing, social distancing, frequent hand sanitising, and other prevention and control (IPC) measures have helped to reduce the risk of getting infected. The aim of this study was to determine the knowledge and attitude towards general prevention of COVID-19 other than vaccination among undergraduate students as prevention is better than cure. Therefore, we believe that this study will give us an opportunity to increase the knowledge as well as to promote their attitude towards general prevention of COVID-19 other than vaccination among undergraduate students. Cross-sectional and convenience sampling method was used throughout the research whereby the responses of 342 undergraduate students with 109 Malays, 159 Chinese and 74 Indians from both medical and non-medical fields were collected through online platforms. The data was analysed by using Statistical Package for the Social Science (SPSS). Based on the data collected regarding comparison of the knowledge between medical and non-medical undergraduate students about general prevention of COVID-19 other than vaccination, questions 6 and 11 were statistically significant with P values less than 0.05 (P < 0.05) while questions 1,2,3,4,5,7,8,9, and 10 showed statistically not significant as their P values were greater than 0.05 (P > 0.05). In addition, for the comparison of attitudes between medical and non-medical towards general prevention of COVID-19 other than vaccination among undergraduate students, questions 1 to 20 were shown statistically not significant as their P values were greater than 0.05 (P > 0.05). Therefore, in conclusion, our study revealed that there was no significant difference between knowledge and attitudes towards the general prevention of COVID-19 other than vaccination among medical and non-medical undergraduate students. The findings obtained from our study may be utilised as an extension for implementing awareness campaigns between the undergraduate students. Copyright © 2023 Authors. All rights reserved.

Future Uses of Telesimulation: National Survey of Emergency Medicine Residency Simulation Directors

Study Objective: The COVID-19 pandemic accelerated the need for virtual learning opportunities including telesimulation. Many Emergency medicine (EM) simulation directors were forced to halt their in-person simulation curriculum and adapt to telesimulation, but specifics on their utilization practices and plans for future use is unknown. We sought to describe the patterns of telesimulation usage in recent times and its anticipated utility in medical education moving forward. Method(s): We developed a confidential, Web-based survey after literature review, using survey research best practices. The survey consisted of multiple choice and free response items pertaining to use of telesimulation before, during, and after in-person learning restrictions due to COVID-19. The survey was piloted prior to use and disseminated to emergency medicine simulation directors in January-February 2022. Programs were identified via the EMRA Match Web site and simulation director's contact information was obtained via the residency program's Web site if available. When not available on the Web site, contact information was obtained by emailing the program coordinator and/or program director. Result(s): Contact information was obtained for 139 residency simulation directors. Survey response rate was 68% (94/139), with 3 participants opting out of the survey, leaving 91 responses. Seventy percent of respondents were from PGY 1-3 programs and 30% from PGY 1-4 programs. During in-person learning restrictions, 62% (56/91) of programs used some form of telesimulation. Assuming all in-person education restrictions lifted, 38% (34/90) of respondents plan to use telesimulation in some capacity in their curricula, compared to 9% (8/91) who reported they were using telesimulation prior to the pandemic. Most who plan to use telesimulation in the future plan to integrate it with their in-person simulation curricula, using telesimulation for 25% of the time of less (30/34), with only few planning to use telesimulation for more than 25% of their simulation curriculum (4/34). While many different types of simulation cases and activities were trialed using telesimulation, the majority of survey respondents that plan to continue using telesimulation plan to use it for medical knowledge (76%, 26/34) and communication/teamwork focused cases (68%, 23/34), rather than for procedure focused cases (21%, 7/34) or dedicated procedure training (15%, 5/34). Conclusion(s): Despite relatively low use of telesimulation in emergency medicine residencies prior to the COVID-19 pandemic, experience using telesimulation during the pandemic has led to an increased number of residency programs who plan to incorporate it into their simulation curricula. This plan for continued use opens opportunities for further innovation and scholarship within this area of simulation education. [Formula presented] No, authors do not have interests to disclose Copyright © 2022

Microbiological Quality of Ready-to-Eat Salad Products Collected from Retail and Catering Settings in England during 2020 to 2021.

ABSTRACT: Salad and other fresh produce were collected in England from retail and catering businesses during 2020 to 2021 and were tested for Salmonella, Shiga toxin-producing Escherichia coli (STEC), Listeria, Bacillus cereus, and E. coli. Of the 604 samples collected, 57% were from retail settings and 43% were from catering settings; 61% were either salad leaves or salad leaves mixed with other products. Equal numbers of samples were prepacked or loose, and 50% were refrigerated at the time of sampling. Combining results for all microbiological parameters, 84% were interpreted as satisfactory, 12% were interpreted as borderline, and 4% were interpreted as unsatisfactory. One sample (prepacked leaves, cucumber, and tomato from a caterer) was categorized as unacceptable and potentially injurious because of detection of STEC O76; no STEC from human infections in the United Kingdom matched this isolate. No Salmonella enterica was detected, but Listeria monocytogenes was recovered from 11 samples: 1 at 20 CFU/g and the remainder at <20 CFU/g. B. cereus was detected at borderline levels (103 to ≤105 CFU/g) in 9% of samples and at an unsatisfactory level (>105 CFU/g) in one sample. E. coli was detected in 3% of samples at borderline levels (20 to ≤102 CFU/g) and in 4% at unsatisfactory levels (>102 CFU/g). There was a significant association between detection of L. monocytogenes and borderline or unsatisfactory levels of E. coli. There were no specific risk profiles associated with products with the higher levels of B. cereus, STEC, or Listeria, but elevated levels of E. coli were predominantly confined to loose products from the United Kingdom collected from caterers in summer or autumn 2021 and may have resulted from relaxation of COVID-19 restrictions. Among the L. monocytogenes isolates, only one matched those from human cases and was recovered from a prepacked mixed salad from a catering business in 2021. This isolate was the same strain as that responsible for a multicountry outbreak (2015 to 2018) associated with Hungarian-produced frozen sweet corn; no link to the outbreak food chain was established.

Exit and transition: Exploring the survival status of Airbnb listings in a time of professionalization

This study analyzes the survival status of shared and non-shared listings in the peer-to-peer accommodation market. Using a large data set from Airbnb in Beijing, we identify 8640 shared listings and 50,741 non-shared listings. We then investigate the exit event and the identity transition event for both types of listings by applying a discrete-time hazard model. Our results suggest that, for the exit event, the two types of listings show significant differences in terms of survival determinants, including response time, tourism specialization, market volume, professionalization, and Covid-19. For the identity transition event, we find that internal flow exists in the market, mainly from shared listings to non-shared listings, and this flow is influenced by certain factors (i.e., capacity, facility, rating, reviews, minimum stay, service quality, tourism specialization, market volume, plat-form professionalization, and Covid-19).

MALAYSIA SPONDYLARTHRITIS ACCELERATED MANAGEMENT (SAM) MODEL: EXPEDITING AXSPA PATIENT JOURNEY from EARLY REFERRAL, DIAGNOSIS and ACCESS to OPTIMAL CARE

Background: Axial spondyloarthritis (axSpA) is an important cause of infam-matory back pain (IBP). It is under-recognized, leading to signifcant delays in diagnosis. Early recognition and diagnosis are crucial to achieve the best outcomes for patients and in Malaysia, signifcant gaps in the clinical management of axSpA remain. Therefore, we sought to implement a strategy to improve the time to diagnosis and management of axSpA in Malaysia by collaborating and adopting guidance from an international axSpA expert. Objectives: The objectives were to improve disease recognition among healthcare practitioners (HCPs), reducing time to specialist referral and diagnosis whilst improving disease management by developing and implementing a new patient care model called the Spondyloarthritis Accelerated Management (SAM) and measure its effectiveness in 3 Rheumatology centers in Malaysia. Methods: The SAM initiative was developed by the Malaysian SpA Consortium Working Group involving 8 Malaysian rheumatologists from 3 local centers and 1 international axSpA expert from the UK as part of the steering committee. Selections were based on clinical expertise. The frst local alignment meeting on model structure was held in July 2020 with subsequent meetings held to address key barriers to early axSpA diagnosis and timely access to quality care. A care model with feasible key performance indicators (KPIs) was established, adapted and tracked monthly in the 3 rheumatology centers (Figure 1). Referral tools were developed to facilitate early referrals to rheumatologists. These included a QR-coded '3-R' referral guide1 and a patient self-screening tool with a patient self-referral letter all hosted on the Malaysian Society of Rheumatology (MSR) website, educational talks to HCPs and public awareness forums on IBP and axSpA. Data were collected on referral source, duration of referrals, knowledge on IBP in HCPs by surveys and imaging accessibility at baseline and at 1 year after the initiative was launched. Baseline data collected were from August to October 2020 and 1 year data were from November 2020 to November 2021. Results: At 1 year, the SAM initiative showed a 44.4% (Median: 1.33 [IQR 1-1.7] vs 1.92 [IQR 1.6-2.1]) increase in IBP referrals, a reducing trend from 9.5 (IQR 8-11.1) to 5.9 (IQR 5.1-6.8) weeks of waiting time to a frst Rheumatology visit and an increase of 37.2% (34% vs 71%) in IBP patients who were seen at the rheumatology clinic within 6 weeks. All patients with IBP had X-rays (sacroiliac joints or pelvis). MRI requests in X-ray negative patients suspected of axSpA was increased by 13.9% (77.8% vs 91.7%) and waiting time for MRI was reduced by 3.1 weeks (12 vs 8.9 weeks). The IBP knowledge among 224 HCPs improved by 40.6% (45.7% vs 86.3%). The number of patients newly diagnosed with axSpA increased by 40% (Median: 5 [IQR 4-9.5] vs 7 [IQR 6.5-7]) despite the COVID-19 pandemic. Conclusion: The SAM initiative has shown promising initial results in improving referrals of patients with IBP, promoting earlier diagnosis and establishing the importance of having timely access to optimal care. A nationwide implementation is being planned to improve the recognition of the axSpA in Malaysia.

Utilisation of telehealth in cardiac rehabilitation-patient perspectives

Objectives: Cardiac rehabilitation (CR) exercise classes in Singapore were either cancelled or suspended due to the ongoing COVID-19 pandemic. In response, a hybrid CR programme utilising telehealth was created to reduce reliance on in-person sessions. Our study aimed to assess early patients' impressions of this novel CR delivery method. Methods: Each hybrid CR programme comprises: (a) one CR orientation session via the Zoom video conferencing platform where patients interact with CR nurses and physiotherapists, (b) two 6-minute walk test fitness assessments (at baseline and upon completion), (c) five in-person supervised exercise classes and (d) two teleconsultation sessions (scheduled after exercise sessions 2 and 4) where CR physiotherapists review symptoms and discuss exercise prescriptions with patients over the phone. Upon programme completion, patients filled 2 anonymous online questionnaires - one assessing the videoconferencing component and another assessing the teleconsultation component and overall programme. Results: Seven patients underwent the hybrid CR programme. The majority were male (n=6, 86%), aged between 51 to 65 years (n=4, 57%) and had previously used a wide range of mobile applications (n=6, 86%). 100% of patients either agreed or strongly agreed that both videoconferencing and teleconsultation were: (a) easy to use, (b) as valuable as in-person sessions, (c) saved time and (d) had lower infection risk compared to in-person sessions (Figure). The overall ratings for videoconferencing, teleconsultation and the hybrid programme were 9.3, 9.6 and 9.6 (out of 10) respectively. All patients would definitely recommend the programme to others. Conclusion: Responses by participants of a novel hybrid CR programme utilising telehealth are highly encouraging. From a patient perspective, incorporation of telehealth to enable remote CR is feasible, acceptable and should be considered as an alternative CR delivery method.

Scares and stocks: Evidence from Twitter sentiments during covid-19

This paper examines the investor reaction of firm-specific pessimistic sentiment extracted from Twitter messages during the pandemic period due to the Covid-19. We find that Twitter sentiment predicts stock returns without subsequent reversals. This finding is consistent with the view that tweets provide information not already reflected in stock prices during the pandemic period. We investigate possible sources of return predictability with a Twitter sentiment. The results show that Twitter's pessimistic sentiment towards the Covid-19 provides new information about the investor. This information explains about one-third of the predictive ability of Twitter sentiment for stock returns. Our findings shed new light on the predictive value of social media content for stock returns. © 2021 International Consortium for Electronic Business. All rights reserved.

[Summary and prospect of early warning models and systems for infectious disease outbreaks].

This paper summarizes the basic principles and models of early warning for infectious disease outbreaks, introduces the early warning systems for infectious disease based on different data sources and their applications, and discusses the application potential of big data and their analysing techniques, which have been studied and used in the prevention and control of COVID-19 pandemic, including internet inquiry, social media, mobile positioning, in the early warning of infectious diseases in order to provide reference for the establishment of an intelligent early warning mechanism and platform for infectious diseases based on multi-source big data.

Assessing the impact of coordinated COVID-19 exit strategies across Europe

As rates of new coronavirus disease 2019 (COVID-19) cases decline across Europe owing to nonpharmaceutical interventions such as social distancing policies and lockdown measures, countries require guidance on how to ease restrictions while minimizing the risk of resurgent outbreaks. We use mobility and case data to quantify how coordinated exit strategies could delay continental resurgence and limit community transmission of COVID-19. We find that a resurgent continental epidemic could occur as many as 5 weeks earlier when well-connected countries with stringent existing interventions end their interventions prematurely. Further, we find that appropriate coordination can greatly improve the likelihood of eliminating community transmission throughout Europe. In particular, synchronizing intermittent lockdowns across Europe means that half as many lockdown periods would be required to end continent-wide community transmission.