Artificial Intelligence and Environmental Health Teaching: Impacts for the Wider Profession

ChatGPT, a new, easily accessible, and user-friendly artificial intelligence (AI) platform, as well as other emerging AI platforms, allow for the creation of well-crafted essays complete with citations, and quickly and mostly correct answers to multiple-choice questions. These types of platforms pose significant concerns for academic programs, including environmental health, as much of the students' learning is guided by written assignments. Academic integrity is an educational and professional attribute and breaches of ethical conduct risk the reputations of organizations and by association, those who work in them. To address this threat, the Environmental Health Community of Practice (CoP)--a group of academic professionals in environmental health from across the globe--has developed potential approaches to address AI within the academic and professional realms of environmental health.

VACCINE-INDUCED IMMUNE THROMBOTIC THROMBOCYTOPENIA: A POSSIBLE PATHOGENETIC ROLE OF CHADOX1 NCOV- 19 VACCINE ENCODED SOLUBLE SARS-COV-2 SPIKE PROTEIN

Background and aims: Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare syndrome of unclear aetiology occurring after vaccinations against COVID-19. The aim of this study was to investigate the DNA vaccine-encoded Sars-cov-2 soluble spike protein (SP) as a potential trigger of platelet activation in VITT. Methods: We studied three VITT patients and seven healthy controls (HCs) within 3 weeks from the first dose of ChAdOx1 nCoV-19. Serum levels of SP, soluble angiotensin-converting enzyme 2 (sACE2), and platelet response to VITT serum stimulation were studied. A thrombus retrieved from middle cerebral artery during mechanical thrombectomy of one VITT patient, was analysed by immunohistochemistry for SP and ACE2. Neutrophil extracellular traps (NETs) markers and coagulation parameters were also measured. Results: We detected SP and sACE2 in all VITT patients, and in two and three out of 7 HCs, respectively. VITT sera markedly activated platelets and this activation was inhibited by both anti-SP and anti-FcγRIIA blocking antibodies. The retrieved thrombus showed positive immunohistochemical labelling of platelets using an anti-SP antibody with reduced ACE2 expression, compared to a thrombus from a pre-pandemic stroke patient. Markers of endothelial dysfunction, NETs and hypercoagulability state were present in VITT sera. Conclusions: The present data provide first evidence that DNA vaccineencoded Sars-cov-2 SP is detectable in VITT sera (up to several weeks post-vaccination) and in a platelet-rich thrombus, and suggest that SP may contribute to the initial platelet stimulation in VITT patients. Anti-PF4/ polyanion antibodies development could represent an epiphenomenon, which amplifies platelet aggregation, NETosis, and coagulation cascade.

POST-VACCINE-INDUCED IMMUNE THROMBOTIC THROMBOCYTOPENIA (VITT) STROKE: LITERATURE REVIEW AND PROPOSAL OF A THERAPEUTIC ALGORITHM FOR THE ACUTE PHASE

Background and aims: Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but catastrophic syndrome characterized by venous and arterial thrombosis, with thrombocytopenia and antibodies against platelet factor-4 (PF4)/polyanion, typically 5-30 days from the first dose of a DNA viral vector vaccine. Very rarely, acute ischemic stroke (AIS) can be the result of VITT. The aim of this study was to define the clinical and radiological characteristics, outcome and therapeutic options of VITT patients with AIS. Methods: We carried out a systematic review of the literature till October 27, 2021 using MEDLINE, PUBMED and Google Scholar databases in order to collect all the published articles related to the development of AIS after vaccination against SARS-CoV-2. Results: We identified 16 patients from case reports or case series published in peer-reviewed journals affected by AIS and confirmed VITT. All patients had received the first dose of ChAdOx1 ncov19 vaccine within 10 days (median). 81% (n=13/16) of the patients had occlusion of the middle cerebral artery (MCA) or its branches, 43.7% (n=7/16) also had thrombotic occlusion of the intracranial internal carotid artery. 45.4% (n=5/16) of the patients with proximal MCA occlusion developed a malignant MCA infarct. Only one patient received intravenous thrombolysis, while three patients underwent mechanical thrombectomy. Conclusions: The management of AIS due to large vessel occlusion in VITT is challenging. Based on the available literature, we propose a therapeutic protocol for acute stroke patients presenting to the Emergency Department within the time window for reperfusion strategies.

Who was wearing a mask in 2021? Update on gender-, age-, and location-related differences during the COVID-19 pandemic (preprint)

Previous observational work from 2020 demonstrated gender-, age-, and location-related differences in mask-wearing behavior, despite the efficacy and public health messaging that emphasized face coverings in combatting the spread of COVID-19. In 2021, COVID-19 vaccinations and a corresponding change in public health policy became new considerations in deciding personal protective behaviors. To provide an update on mask wearers and resistors approximately one year after our initial study, we observed shoppers (n = 6,118) entering retail stores using the same experimental methodology. Approximately 26% of individuals wore a mask. Mask wearing has decreased across demographic groups compared to 2020. Aligning with previous findings, females were ~1.5x more likely to be observed wearing a mask than males, and the odds of observing a shopper wearing a mask in a suburban or urban area was far greater than at rural stores (~5.7x and ~3.3x, respectively). Gender and location are confirmed to be significant and stable factors that impact mask-wearing behavior in the United States during the COVID-19 pandemic. The impact of age on mask wearing was heavily reduced compared to 2020, potentially due to the availability of COVID-19 vaccines and change in mask guidance for vaccinated individuals.

Malignant cerebral infarction after ChAdOx1 nCov-19 vaccination: a catastrophic variant of vaccine-induced immune thrombotic thrombocytopenia.

Vaccine-induced thrombotic thrombocytopenia with cerebral venous thrombosis is a syndrome recently described in young adults within two weeks from the first dose of the ChAdOx1 nCoV-19 vaccine. Here we report two cases of malignant middle cerebral artery (MCA) infarct and thrombocytopenia 9-10 days following ChAdOx1 nCoV-19 vaccination. The two cases arrived in our facility around the same time but from different geographical areas, potentially excluding epidemiological links; meanwhile, no abnormality was found in the respective vaccine batches. Patient 1 was a 57-year-old woman who underwent decompressive craniectomy despite two prior, successful mechanical thrombectomies. Patient 2 was a 55-year-old woman who developed a fatal bilateral malignant MCA infarct. Both patients manifested pulmonary and portal vein thrombosis and high level of antibodies to platelet factor 4-polyanion complexes. None of the patients had ever received heparin in the past before stroke onset. Our observations of rare arterial thrombosis may contribute to assessment of possible adverse effects associated with COVID-19 vaccination.

The Zoom Effect: Exploring the Impact of Video Calling on Appearance Dissatisfaction and Interest in Aesthetic Treatment During the COVID-19 Pandemic.

BACKGROUND: The popularity of videoconferencing platforms has skyrocketed during the COVID-19 pandemic; however, concerns have been expressed regarding the potential for video calls to promote appearance dissatisfaction because individuals are exposed to an image of themselves on camera for extended periods. OBJECTIVES: The aim of the current study was to characterize current video usage behaviors and their relation to appearance dissatisfaction and interest in aesthetic procedures in the general population. METHODS: An online survey was completed by 335 adults currently living in Australia. Multiple aspects of video usage were assessed, including engagement in video-manipulation techniques to enhance appearance and the focus of visual attention (ie, on self or others) while on video calls. The Dysmorphic Concern Questionnaire was administered to determine if video-use behaviors were associated with greater body image disturbance. RESULTS: Over one-third of participants had identified new appearance concerns while on video. Dysmorphic concern was associated with self-focused attention, greater engagement in video-manipulation behaviors, and increasing appearance concerns due to their time on video calls. Individuals who identified new video-based appearance concerns reported greater interest in obtaining future beauty treatments (eg, waxing) and aesthetic procedures (eg, nonsurgical procedures such as antiwrinkle injections). CONCLUSIONS: This is one of first empirical studies to report the potential consequences of video-call usage for increasing appearance dissatisfaction and dysmorphic concern, and to demonstrate a link between the use of video calls and interest in cosmetic procedures.

Thrombolysis and bridging therapy in patients with acute ischaemic stroke and Covid-19.

BACKGROUND AND PURPOSE: Comorbidity of acute ischaemic stroke with Covid-19 is a challenging condition, potentially influencing the decision of whether to administer intravenous thrombolysis (IVT). We aimed to assess the 1-month outcome in ischaemic stroke patients with Covid-19 infection who received IVT alone or before thrombectomy (bridging therapy). METHODS: As a collaboration initiative promoted by the Italian Stroke Organization, all Italian stroke units (n = 190) were contacted and invited to participate in data collection on stroke patients with Covid-19 who received IVT. RESULTS: Seventy-five invited centers agreed to participate. Thirty patients received IVT alone and 17 received bridging therapy between 21 February 2020 and 30 April 2020 in 20 centers (n = 18, Northern Italy; n = 2, Central Italy). At 1 month, 14 (30.4%) patients died and 20 (62.5%) survivors had a modified Rankin Scale (mRS) score of 3 to 5. At 24 to 36 hours, asymptomatic intracerebral hemorrhage (ICH) was reported in eight (17.4%) patients and symptomatic ICH (sICH) in two (4.3%) patients. Causes of death were severe ischaemic stroke (n = 8), a new ischaemic stroke (n = 2), acute respiratory failure (n = 1), acute renal failure (n = 1), acute myocardial infarction (n = 1), and endocarditis (n = 1). In survivors with a 1-month mRS score of 3 to 5, baseline glucose level was higher, whereas endovascular procedure time in cases of bridging therapy was longer. Baseline National Institutes of Health Stroke Scale glucose and creatinine levels were higher in patients who died. CONCLUSIONS: Intravenous thrombolysis for patients with stroke and Covid-19 was not a rare event in the most affected areas by pandemic, and rates of 1-month unfavorable outcomes were high compared to previous data from the pre-Covid-19 literature. However, risk of sICH was not increased.

Who is wearing a mask? Gender-, age-, and location-related differences during the COVID-19 pandemic.

Masks are an effective tool in combatting the spread of COVID-19, but some people still resist wearing them and mask-wearing behavior has not been experimentally studied in the United States. To understand the demographics of mask wearers and resistors, and the impact of mandates on mask-wearing behavior, we observed shoppers (n = 9935) entering retail stores during periods of June, July, and August 2020. Approximately 41% of the June sample wore a mask. At that time, the odds of an individual wearing a mask increased significantly with age and was also 1.5x greater for females than males. Additionally, the odds of observing a mask on an urban or suburban shopper were ~4x that for rural areas. Mask mandates enacted in late July and August increased mask-wearing compliance to over 90% in all groups, but a small percentage of resistors remained. Thus, gender, age, and location factor into whether shoppers in the United States wear a mask or face covering voluntarily. Additionally, mask mandates are necessary to increase mask wearing among the public to a level required to mitigate the spread of COVID-19.

The COVID-19 pandemic: Psychological and behavioral responses to the shutdown of the beauty industry.

OBJECTIVE: During the COVID-19 pandemic, Australia implemented widespread closure of beauty and cosmetic services to control the virus spread. The effect of these restrictions is unknown, given that beauty services are widely used for stress relief or to enhance confidence. The current study explored the relationship between engagement in appearance-focused behaviors and distress regarding beauty service closure. Participants with high and low levels of dysmorphic concern were compared to determine whether COVID-19 restrictions may affect these groups differently. METHOD: An online survey was completed by 216 participants living in Australia. Questions addressed engagement in appearance-focused behaviors during the COVID-19 pandemic and attitudes toward beauty service closure. The Dysmorphic Concern Questionnaire (DCQ) was used to group participants by low and high dysmorphic concern. RESULTS: Appearance-focused behaviors decreased in the low DCQ group (n = 163) during the COVID-19 pandemic, while such behaviors in the high DCQ group (n = 53) remained unchanged. Individuals who were living alone, younger, reported higher dysmorphic concern and greater distress over beauty service closure engaged in more frequent appearance-focused behaviors (R2 = .57, p < .001). The high DCQ group reported greater distress over beauty service closure and increased desire to obtain future beauty treatments. DISCUSSION: While COVID-19 restrictions may have provided a break from societal appearance pressure for those with low dysmorphic concern, appearance-focused behaviors persisted in individuals with high dysmorphic concern. A greater understanding of the long-term impacts on appearance-related distress is needed to determine mental health priorities emerging from the COVID-19 pandemic.

Who is wearing a mask? Gender-, age-, and location-related differences during the COVID-19 pandemic (preprint)

Masks are an effective tool in combatting the spread of COVID-19, but some people still resist wearing them and mask-wearing behavior has not been experimentally studied in the United States. To understand the demographics of mask wearers and resistors, and the impact of mandates on mask-wearing behavior, we observed shoppers (n = 9935) entering retail stores during periods of June, July, and August 2020. Approximately 41% of the June sample wore a mask. At that time, the odds of an individual wearing a mask increased significantly with age and was also 1.5x greater for females than males. Additionally, the odds of observing a mask on an urban or suburban shopper were ~4x that for rural areas. Mask mandates enacted in late July and August increased mask-wearing compliance to over 90% in all groups, but a small percentage of resistors remained. Thus, gender, age, and location factor into whether shoppers in the United States wear a mask or face covering voluntarily. Additionally, mask mandates are necessary to increase mask wearing among the public to a level required to mitigate the spread of COVID-19.