Particulate matter air pollution and COVID-19 risk: A systematic review

Introduction/Aim: Ecological studies indicate ambient particulate matter >=2.5 mm (PM 2.5) air pollution is associated with poorer COVID-19 outcomes. However, these studies cannot account for individual heterogeneity and often lack precision in estimates of PM 2.5 exposure. We summarise evidence relating on individual-level data to determine whether PM 2.5 exposure increases the risk of COVID-19 infection, severe disease and death. Method(s): We conducted a systematic review of relevant case-control and cohort studies, searching Medline, Embase and the WHO COVID-19 databases. Study quality was evaluated using the Newcastle-Ottawa Scale. Result(s): N = 18 studies met the inclusion criteria. Generally, PM 2.5 exposure was significantly associated with higher rates of COVID-19 infection (all 7 studies positive) and severe COVID-19 disease (8 of 9 studies positive, 1 null). The effects on mortality were mixed but indicative of a positive association (4 of 6 studies positive, 2 null). Most studies were rated 'good' quality (13 of 18 studies), though there were still methodological issues;few used individual-level data to adjust for important confounders like socioeconomic status (3 of 18 studies), instead using area-based indicators (12 of 18 studies) or not adjusting for it at all (3 of 18 studies). Most studies with severe disease (9 of 10 studies) and mortality outcomes (5 of 6 studies) were based on people already diagnosed COVID-19, potentially introducing collider bias. Conclusion(s): There is strong evidence that ambient particulate matter air pollution increases the risk of COVID-19 infection, and weaker evidence of increases in risk of severe disease and mortality.

Comparison of three methods of semen analysis: A novel at-home sperm test kit, a computer-assisted assessment and an embryologist

Study question How does computer-assisted semen analysis (CASA) (Lenshooke, LOGIXX) and at-home sperm testing (ExSeed) compare with manual methodology assessment of male fertility based on WHO criteria (5thEdition);a three-method comparison study. Summary answer All methods showed good agreement for concentration and limited agreement for motility highlighting the need for further development of alternatives to manual assessment. What is known already Several studies have shown good correlation between CASA systems and laboratory-based manual semen analysis, but only a few have carried out a three-way comparison study. One of which showed positive correlation with motility and concentration between a smartphone-based semen analysis and laboratory-based CASA system and positive correlation between concentration and motility between the smartphone-based CASA system and microscopic-based results. The at-home sperm test kit may play a role in motivating infertile males to visit clinics for early diagnosis and also reducing the need for multiple visits to the fertility clinic for repeat semen analyses. Study design, size, duration Fifty patients (between 29 and 56 years) attending a fertility clinic were included in the study between September 2021 to December 2021. Semen samples were split into 3 aliquots and evaluated using manual semen assessment (MSA) according to the WHO 5th Edition (2010) guidelines, the ExSeed Home Sperm Test (HST) and the LensHooke® X1 PRO Semen Quality Analyzer (CASA). Participants/materials, setting, methods The semen samples were collected from fifty participants at CARE Fertility Tunbridge Wells. The samples were placed in an incubator at 37°C for 30 minutes to liquefy. After liquefaction, sperm concentration, total motility, total motile sperm count (TMSC) and normal morphology were evaluated. Spearman’s Rank correlations (>0.7) and Chi-squared tests were used and the p-value < 0.05 was considered as statistically significant. Main results and the role of chance All variables were highly significantly (p < 0.0002) positively correlated between all 3 methods. The greatest correlations were obtained for sperm concentration (CASA/HST: r = 0.826;MSA/HST: r = 0.870;MSA/CASA: r = 0.871) and TMSC (MSA/CASA: p = 0.792;CASA/HST: r = 0.800;MSA/HST: r = 0.854). Correlations for motility were markedly lower (MSA/HST: r = 0.611;CASA/HST: r = 0.717;MSA/LCASA: r = 0.750). The lowest correlation was found for morphology (MSA/CASA: r = 0.500). The HST device does not determine morphology. As compared to MSA, using the HST device agreement for normal or low sperm concentration (≥15 × 106/mL or < 15 × 106/mL respectively) was identified in 84.3% of the cases, whereas 94.0% with CASA. The agreement between CASA and HST was 82.0%. For total motility ≥ or < 40%, the agreements were 68.0% (CASA/HST), 56.9% (MSA/HST) and 82.0% (MSA/CASA), respectively. For the identification of patients with normal morphology >4%, the agreement between MSA and CASA was 30%. Limitations, reasons for caution The small sample size was 50 cases. The home testing device does not assess morphology. Furthermore, it is difficult to ascertain whether a consumer would carry out the analysis with this device with the same accuracy as an embryologist. Wider implications of the findings The need for repeated semen analyses, the effect of the COVID-19 pandemic and the discomfort some patients feel in a clinical setting, necessitate the need for evaluation of novel semen analysis approaches. These emerging technologies have potential to be more patient friendly, convenient and efficient than standard semen assessment methods. Trial registration number not applicable

Bronchoscopic Lobar Lavage in the Treatment of a Single Lung Transplant Recipient with Pulmonary Alveolar Proteinosis: A Case Report

Introduction: Pulmonary alveolar proteinosis (PAP) is a rare disorder that results from impaired clearance of surfactant. The classic radiographic appearance on chest computed tomography (CT) is patchy, ground glass opacities with interlobular septal thickening frequently described as a “crazy paving” pattern. Although the diagnosis can sometimes be established by transbronchial biopsy, surgical lung biopsy is the gold standard. There are few case reports of PAP in lung transplant recipients. Case Description: We report the case of a 57 year-old man with chronic hypersensitivity pneumonitis who underwent left single lung transplantation. His post-operative course was complicated by persistent Coronavirus HKU1 infection or shedding. Approximately one year after transplant, he was diagnosed with PAP by surgical lung biopsy showing periodic acid-Schiff (PAS)-positive lipoproteinaceous material within alveoli. While whole lung lavage is the mainstay of treatment for PAP, given his severely fibrotic native lung and significant hypoxemia, he was successfully treated with bronchoscopic lobar lavage of his allograft in two sessions one week apart. Unfortunately, he was later was diagnosed with peritoneal mesothelioma. Discussion: We highlight the challenges in the diagnosis, discuss potential etiologies and describe a unique therapy of this rare disorder in lung transplant recipients. In addition to more common etiologies, such as infection, pulmonary edema, and allograft rejection, PAP should be considered in the differential diagnosis for lung transplant recipients presenting with hypoxemia and ground glass opacities in their allograft. In some cases, such as this one, PAP can be the initial manifestation prior to the diagnosis of a malignancy;however, while hematologic malignancies are commonly associated with PAP, there is only one prior reported case of a patient with long-standing PAP and later diagnosis of mesothelioma. In addition to the association between PAP and mesothelioma, this case suggests the possibility of an association between PAP and transplant immunosuppression or persistent Coronavirus infection/shedding. Therapeutic bronchoscopic lobar lung lavage can be an effective intervention in lieu of whole-lung lavage, particularly for single lung transplant recipients who would not tolerate whole-lung lavage.

Black Lives Experiencing Homelessness Matter: A Critical Conceptual Framework for Understanding How Policing Drives System Avoidance among Vulnerable Populations

This paper examines racialized encounters with the police from the perspectives of people experiencing homelessness in San Diego, California in 2020. By some estimates, homelessness doubled in San Diego during the first year of the COVID-19 pandemic. We conducted a survey of (n = 244) and interviews with (n = 57) homeless San Diegans during initial shelter-in-place orders, oversampling for Black respondents, whose voices are often under-represented despite high rates of homelessness nationally. Our respondents reported high rates of police contact, frequent lack of respect;overt racism, sexism, and homophobia;and a failure to offer basic services during these encounters. Centering our Black respondents' experiences of criminalization and racism in what Clair calls "criminalized subjectivity," we develop a conceptual framework that brings together critical theoretical perspectives on the role of race in the governance of poverty and crime. When people experiencing extreme poverty face apathy, disrespect, and discrimination from police-as our data show-the result is a reluctance to seek services and to engage with outreach when offered. This reinforces stereotypes of unhoused people as not "wanting" help or "choosing" to be homeless. We reflect on these findings and our framework for envisioning a system of public safety that supports and cares for-rather than punishes-the most vulnerable members of our society.

Detection of SARS-CoV-2 within enteric neurons and in brain

SARS-CoV-2, the causative agent of COVID-19, typically manifests as a respiratory illness although extrapulmonary involvement, such as in the gastrointestinal tract and nervous system, are increasingly recognised. Through immunohistochemistry against the SARS-CoV-2 nucleocapsid protein (NP), we aimed to characterise the multisystem viral tropism of SARS-CoV-2. FFPE tissue was obtained from 16 PCR-confirmed post-mortem COVID cases. Of these cases, 10 were full-body, 5 were brain only and 1 was a brain biopsy. Brain regions studied included frontal cortex, medulla, cerebellum, pons and olfactory bulb. Neurological symptoms featured in the cohort included brainstem encephalitis, acute disseminated encephalomyelitis (ADEM) and brain infarction. Immunohistochemistry of digestive system tissues revealed presence of SARS-CoV-2 NP in neurons of the myenteric plexus, a site of high ACE-2 expression, the entry receptor for SARS-CoV-2 and one of the earliest affected cells in Parkinson's disease (PD). Within the brain, staining was widespread in all sampled regions but limited to endothelial cells only (including in the olfactory bulb). Furthermore, in the full-body post-mortem cases, positivity in brain endothelia was restricted to cases exhibiting multiorgan tissue positivity (3/9 cases). The average time from symptom onset to time of death was shorter in positively versus negatively stained postmortem cases (mean = 10.3 days vs mean = 20.3 days, p = 0.0416) suggesting NP detection was confined to the infectious period. Together, our findings provide evidence for enteric nervous system but not brain neuroinvasion of SARS-CoV-2 as well as potential insights into long-term complications of COVID-19 and PD pathogenesis.

Adapting to the Times: Examining Adaptive Instructional Strategies in Preferred and Non-preferred Class Types

Adaptive training can take place across multiple learning contexts, such as in-person or online class types, and in classroom or simulation environments [1]. Given the COVID-19 pandemic, institutes of higher education were forced to adapt and make instruction available both online and in-person;providing the opportunity to examine how adaptive learning strategies faired in different class types. When examining adaptive strategies across class types, of particular interest are individual learner characteristics and preferences, as students who typically would not take online classes found themselves taking classes in this medium [2]. We sought to evaluate the effectiveness of adaptive learning strategies across preferred and non-preferred class types. A significant interaction was found between instructional strategy presence and preferred class type, with students primarily attending classes in their preferred class type self-reporting significantly lower stress and workload levels than those who did not receive the adaptive instructional strategies. For students attending class primarily in their non-preferred learning environment, the opposite was true. Additionally, students in their preferred class types achieved higher exam scores. The methods, results, discussion and implications are discussed in the context of how to effectively conduct adaptive training. © 2021, Springer Nature Switzerland AG.

National health and nutrition examination survey 2017–march 2020 prepandemic data files-development of files and prevalence estimates for selected health outcomes

Background and objectives-In March 2020, the coronavirus disease 2019 (COVID-19) pandemic halted National Health and Nutrition Examination Survey (NHANES) field operations. As data collected in the partial 2019–2020 cycle (herein referred to as 2019–March 2020) are not nationally representative, they were combined with previously released 2017–2018 data to produce nationally representative estimates. This report explains the creation of the 2017–March 2020 prepandemic data files, provides recommendations for and limitations of the files’ use, and presents prevalence estimates for selected health outcomes based on the files. Methods-The 2019–2020 primary sampling units (PSUs) were reassigned to the 2015–2018 sample design strata and combined with the 2017–2018 data to create a data set that could be used to calculate nationally representative estimates. A PSUlevel adjustment factor was created to equalize the contribution of each stratum to the total survey sample and applied to participant base weights. Interview and examination weights were calculated from the adjusted base weights. The performance of final interview weights was assessed by comparing the demographic characteristics of the weighted NHANES 2017–March 2020 prepandemic sample with nationally representative estimates from the 2018 5-year American Community Survey. Prevalence estimates and 95% confidence intervals were calculated for selected health outcomes. Results-Among children and adolescents aged 2–19 years, the prevalence of obesity was 19.7% and the prevalence of untreated or restored dental caries in one or more primary or permanent teeth was 46.0%. Among adults aged 20 and over, the age-adjusted prevalence of obesity was 41.9%, severe obesity was 9.2%, and diabetes was 14.8%. Among adults aged 18 and over, the age-adjusted prevalence of hypertension was 45.1%. Among adults aged 65 and over, the age-adjusted prevalence of complete tooth loss was 13.8%. Conclusion-A PSU-level adjustment factor and additional weighting adjustments made nationally representative estimates from the 2017–March 2020 prepandemic data files possible;this was the last NHANES data collected before widespread transmission of COVID-19. © 2021, National Center for Health Statistics. All rights reserved.

Decline in Child Vaccination Coverage During the COVID-19 Pandemic — Michigan Care Improvement Registry, May 2016–May 2020

This report describes data analyzed from the Michigan Care Improvement Registry to assess changes in vaccine doses administered to children and the effects of those changes on up-to-date status for vaccinations recommended at milestone ages.