January May Research Articles

Detections of house mice on Gough Island approach zero within days of aerial baiting

Context House mice (Mus musculus) on temperate Gough Island (6500 ha) are known for their large size, boldness, and tendency to kill large prey such as albatross chicks and even adults. To remove this threat, a mouse eradication operation was implemented in June–August 2021. How mice react to bait during eradications is not well understood, so we capitalised on this operation and conducted the first study with wild house mice during an actual eradication. Aim To document how rapidly mouse activity declined after application of rodent bait, to improve eradication guidelines. Methods We set up a monthly monitoring regime using 10 trail cameras without lures, active for three nights in various habitats around a research station, because this area supported the highest abundance of mice and was logistically feasible. Monitoring commenced before the mouse eradication operation (January–May 2021), and continued when rodent bait was spread (from June 2021), when mouse activity was monitored for 17 consecutive nights, starting the day before baiting. In addition, an increasing number of cameras (up to 15) associated with lures were set further afield in July–August to detect survivors. Key results In the months before bait application, mean daily mouse activity was 3.2 detections/camera (range: 0–56 detections/camera). Immediately after the first bait application, detection rates declined dramatically, from 9.6 to zero detections/camera per day on Day 4 post-baiting. From 1 week post-baiting, mouse detections were extremely rare on both cameras with and without lures. Our last mouse record, 27 days after the first bait application, may be related to initial rapid bait disappearance. Opportunistic camera traps first detected surviving mice 6 months after the first bait drop. Conclusions The rapid decline in detections suggests that most mice consumed bait as soon as it became available, which is faster than what laboratory trials suggest. Future similar operations can expect that mouse activity will decline sharply within 1 week, although some mice may survive longer. Implications Documenting similar declines in mouse activity using cameras could inform operational decisions such as timing of a second bait application or non-target monitoring on future eradication projects. Cameras, particularly with attractive lures, are an effective addition to the mouse detection toolkit, and facilitated a timely confirmation of eradication outcome.

Tracheostomy in COVID-19 acute respiratory distress syndrome patients and follow-up: A parisian bicentric retrospective cohort.

Tracheostomy has been proposed as an option to help organize the healthcare system to face the unprecedented number of patients hospitalized for a COVID-19-related acute respiratory distress syndrome (ARDS) in intensive care units (ICU). It is, however, considered a particularly high-risk procedure for contamination. This paper aims to provide our experience in performing tracheostomies on COVID-19 critically ill patients during the pandemic and its long-term local complications. We performed a retrospective analysis of prospectively collected data of patients tracheostomized for a COVID-19-related ARDS in two university hospitals in the Paris region between January 27th (date of first COVID-19 admission) and May 18th, 2020 (date of last tracheostomy performed). We focused on tracheostomy technique (percutaneous versus surgical), timing (early versus late) and late complications. Forty-eight tracheostomies were performed with an equal division between surgical and percutaneous techniques. There was no difference in patients' characteristics between surgical and percutaneous groups. Tracheostomy was performed after a median of 17 [12-22] days of mechanical ventilation (MV), with 10 patients in the "early" group (≤ day 10) and 38 patients in the "late" group (> day 10). Survivors required MV for a median of 32 [22-41] days and were ultimately decannulated with a median of 21 [15-34] days spent on cannula. Patients in the early group had shorter ICU and hospital stays (respectively 15 [12-19] versus 35 [25-47] days; p = 0.002, and 21 [16-28] versus 54 [35-72] days; p = 0.002) and spent less time on MV (respectively 17 [14-20] and 35 [27-43] days; p<0.001). Interestingly, patients in the percutaneous group had shorter hospital and rehabilitation center stays (respectively 44 [34-81] versus 92 [61-118] days; p = 0.012, and 24 [11-38] versus 45 [22-71] days; p = 0.045). Of the 30 (67%) patients examined by a head and neck surgeon, 17 (57%) had complications with unilateral laryngeal palsy (n = 5) being the most prevalent. Tracheostomy seems to be a safe procedure that could help ICU organization by delegating work to a separate team and favoring patient turnover by allowing faster transfer to step-down units. Following guidelines alone was found sufficient to prevent the risk of aerosolization and contamination of healthcare professionals.

Persistent high prevalence of pulmonary tuberculosis in a resource-limited setting: threat to India's TB Free campaign

Tuberculosis (TB) is a major public health problem among Saharia, a particularly vulnerable tribal group residing in remote rural areas in central India. This article presents the findings from the baseline survey among Saharias and provides comprehensive prevalence data of pulmonary TB (PTB) in this marginalised community. A community-based cross-sectional PTB prevalence survey was carried out during January-May 2019 in selected villages using multistage stratified cluster sampling. All eligible adults (≥15years of age) were screened for the symptoms of PTB. Sputum samples were collected and processed for microscopy and culture for Mycobacterium tuberculosis. A total of 20114 eligible individuals were screened for symptoms of PTB. Among these, 3001 (14.9%) individuals reported at least one PTB symptom and sputum was collected from 2890 (96.3%) individuals. Among these, 273 (9.4%) were bacteriologically positive for PTB. The overall prevalence was 1357 per 100000 population. The findings indicate that TB continues to be a major health problem in this marginalised community despite large investments by the government for TB control. This emphasizes the need to look into the causes and barriers in implementation of the TB elimination programme in the community, especially in view of India's TB elimination goal by 2025.

111. Assessment of Empiric Management Practices of Common Infections in Solid Organ Transplant Recipients at a Canadian Tertiary Care Centre - A Retrospective Cohort Study

BackgroundPost-transplant infections remain a leading cause of morbidity and mortality in solid organ transplant recipients (SOTR). Standardized antimicrobial treatment guidelines for infectious syndromes may contribute to improved clinical care. Our study seeks to assess the rate of therapeutic compliance with local standard guidelines in the treatment of common infections in SOTR, and their associated outcomes.MethodsConsecutive adult SOTR admitted to the transplant floor from January–May 2020 for treatment of an infectious syndrome of interest were reviewed for study inclusion. Patients were followed until discharge or for 30 days following the date of diagnosis, whichever was shorter. Data was extracted from electronic medical records.Results475 SOTR were admitted to the transplant floor, of which 156 patients (33%) were admitted with infectious syndromes. Guidelines were applicable to 117 patients, constituting the following 122 syndromes: 51 pneumonias; 34 urinary tract infections (UTI); 22 bacteremias and 15 intra-abdominal infections (Fig. 1). Intra-abdominal infections occurred earliest at a median time of 9 months post-transplant followed by bacteremias, pneumonias, and UTIs (medians 10, 38 and 54 months respectively) (Table 1). 47% of patients were empirically treated with a regimen compliant with guidelines and 66% were provided compliant tailored therapies. Non-compliance with empiric management guidelines resulted in a significantly higher proportion of patients requiring ICU transfer when compared to compliance (25% vs. 9%; P = .02) (Table 2). Non-compliance with tailoring protocols resulted in an increased overall length of stay (medians 11 days vs. 8 days; P = .04). Within 30 days of discharge, no differences in readmission, development of Clostridium difficile infection, rejection, graft loss or death were observed between patients receiving compliant or non-compliant regimens.Figure 1. Study Flow Diagram Table 1. Baseline Characteristics of Patient Cohort Table 2. Outcomes of compliant vs. non-compliant treatment in patients receiving antimicrobial therapy for an infectious syndrome ConclusionNon-compliance with locally developed antimicrobial management guidelines resulted in a higher proportion of patients being transferred to the ICU and an increased length of stay in our cohort, highlighting the benefits of adherence. Future studies will assess long-term outcomes associated with compliance to infection management guidelines.Disclosures All Authors: No reported disclosures

Biological carbon pump efficiency enhanced by atmospheric dust deposition in the North Pacific Subtropical Gyre

We examine the flux and composition of sinking particles collected at 4500 m depth in the southeastern part of the North Pacific Subtropical Gyre (NPSG) from August 2011 to June 2012. Satellite-derived net primary production was higher in January–May 2012 compared with the rest of the study period. Both the biogenic and lithogenic particle fluxes were significantly higher in spring (March–May 2012) than at other times. The export efficiency via the transfer of produced organic carbon to the deep ocean interior (i.e., carbon sequestration) doubled during this time. Two prominent particle flux peaks were observed in March and May 2012, coinciding with the atmospheric dust-deposition peaks within the temporal resolution of the data. Coincident increases in the biogenic and lithogenic particle fluxes suggest that dust deposition in the NPSG enhances the biological carbon-pump efficiency. Strong coupling between the particulate organic carbon and biogenic opal fluxes implies that nutrient supply via atmospheric dust deposition stimulated diatom growth in this area. Dust deposition during the productive season therefore plays an important role in carbon sequestration.

Responses of paediatric emergency departments to the first wave of the COVID-19 pandemic in Europe: a cross-sectional survey study

ObjectiveUnderstanding how paediatric emergency departments (PEDs) across Europe adapted their healthcare pathways in response to COVID-19 will help guide responses to ongoing waves of COVID-19 and potential future pandemics. This...

Five‐Year Analysis of Evaposublimation Characteristics and Its Role on Surface Energy Balance SEB on a Midlatitude Continental Glacier

AbstractAs a principal pathway of moisture loss of cryosphere, the sublimation of snow or ice needs to absorb a high amount of energy to complete the phase transition, while related researches on how sublimation affects surface energy balance (SEB) are still insufficient, causing unclear conclusions. To characterize the seasonal variation of a mountain glacier's sublimation or evaporation and analysis its role on SEB, the meteorological and glaciological data over five‐year measurement period (2016–2020) were obtained on the top of August‐one glacier. In the non‐melt period of a year (January–May and October–December), sensible heat flux H was the dominant energy contributor to glacier surface (76%), followed by net radiation Rnet (22%). Sublimation removed average 85 mm (0.4 mm/day) of water vapor from surface for the dry and windy weather, and the latent heat flux of sublimation LEE accounted for 33% of energy sinks (67% of energy was stored in the glacier Qs). In the melt period (June–September), evaposublimation (mainly composed of evaporation) reached to 36 mm (0.3 mm/day), but LEE only played a small heat sink (14%) and the Qm (the energy for melting) had the largest proportion (70%). Rnet and H contributed 81% and 15% of surface energy, respectively. Obviously, under the global climate warming, the sublimation of non‐melt period seems to be effective in decrease the heating rate of glacier surface.

Household and climate factors influence Aedes aegypti presence in the arid city of Huaquillas, Ecuador.

Arboviruses transmitted by Aedes aegypti (e.g., dengue, chikungunya, Zika) are of major public health concern on the arid coastal border of Ecuador and Peru. This high transit border is a critical disease surveillance site due to human movement-associated risk of transmission. Local level studies are thus integral to capturing the dynamics and distribution of vector populations and social-ecological drivers of risk, to inform targeted public health interventions. Our study examines factors associated with household-level Ae. aegypti presence in Huaquillas, Ecuador, while accounting for spatial and temporal effects. From January to May of 2017, adult mosquitoes were collected from a cohort of households (n = 63) in clusters (n = 10), across the city of Huaquillas, using aspirator backpacks. Household surveys describing housing conditions, demographics, economics, travel, disease prevention, and city services were conducted by local enumerators. This study was conducted during the normal arbovirus transmission season (January—May), but during an exceptionally dry year. Household level Ae. aegypti presence peaked in February, and counts were highest in weeks with high temperatures and a week after increased rainfall. Univariate analyses with proportional odds logistic regression were used to explore household social-ecological variables and female Ae. aegypti presence. We found that homes were more likely to have Ae. aegypti when households had interruptions in piped water service. Ae. aegypti presence was less likely in households with septic systems. Based on our findings, infrastructure access and seasonal climate are important considerations for vector control in this city, and even in dry years, the arid environment of Huaquillas supports Ae. aegypti breeding habitat.

Diversity of COVID-19 News Media Coverage across 17 Countries: The Influence of Cultural Values, Government Stringency and Pandemic Severity.

The current media studies of COVID-19 devote asymmetrical attention to social media; in contrast, newspapers have received comparatively less attention. Newspapers are an integral source of current information that are syndicated and amplified by social media to a wide global audience. This is one of the first known studies to operationalize news media diversity and examine its association with cultural values during the pandemic. We tracked the global diversity of COVID-19 coverage in a news media database of 12 billion words, collated from 28 million articles over 7000 news websites, across 8 months. Media diversity was measured weekly by the number of unique descriptors of 10 target terms of the pandemic (e.g., COVID-19, coronavirus) and normalized by the corpus size for the respective countries per week. Government Stringency was taken from the Oxford COVID-19 Government Response Tracker and cultural scores were taken from Hofstede’s Cultural Values global database. Results showed that Media Diversity Rate increased 6.7 times over 8 months, from the baseline period (October–December 2019) to during the pandemic (January–May 2020). Mixed effects modelling revealed that higher COVID-19 prevalence rates and governmental stringency predicted this increase. Interestingly, collectivist cultures are linked to more diverse media coverage during COVID-19. It is possible that news outlets in collectivist societies are motivated to present a diverse array of topics given the impact of COVID-19 on every segment of society. Of broader significance, we provided a framework to design targeted public health communications that are culturally nuanced.

Media Systems and Attention Cycles: Volume and Topics of News Coverage on COVID-19 in the United States and China

We examined initial newspaper coverage of the COVID-19 outbreak (January–May 2020) in the United States and China, countries with contrasting media systems and pandemic experiences. We join the context-rich media systems literature and the longitudinal nature of the issue-attention literature to expand each by providing more system-level context for explaining how media cover an issue over time. U.S. coverage peaked later and stayed consistently high, while Chinese coverage was more variable. The most prominent topics in Chinese coverage were related to domestic outbreak response, while U.S. coverage focused on politics, highlighting how issue-attention cycles differ across countries.

Association Between Parental Divorce and Anger, Aggression, and Hostility in Adolescents: Results of a National Lebanese Study

To evaluate the association between divorce and aggression patterns (physical and verbal aggression and hostility) in Lebanese adolescents. This cross-sectional study enrolled 1810 (90.5%) students (January–May 2019) using a proportionate random sample of participants aged 12–17 years, drawn from private schools of all Lebanese districts. Parental divorce was significantly associated with more physical and verbal aggression and anger and hostility in adolescents. Significantly higher adjusted means of physical aggression (32.53 vs. 31.32; p = .013), verbal aggression (19.00 vs. 17.73; p &lt; .001), anger (26.10 vs. 23.43; p &lt; .001), and hostility (29.68 vs. 26.73; p &lt; .001) were found among adolescents whose parents are divorced. Verbal and physical aggression, anger, and hostility were more shown in adolescents whose parents were divorced compared to adolescents whose parents are non-separated. Therefore, divorced parents must be motivated to provide their children with social, economic, and psychological needs to overcome these negative behaviors.

All-cause mortality in COVID-19 patients receiving statin therapy: analysis of veterans affairs database cohort study.

Statins have been advocated as a potential treatment for coronavirus disease-2019 (COVID-19) due to its pleotropic properties. The aim of the study was to elucidate the association between antecedent statin exposure and 30-day all-cause mortality, intensive care unit (ICU) admission and hypoxic respiratory failure requiring mechanical ventilation in patients diagnosed with COVID-19. Observational cohort study derived from the VA Corporate Data Warehouse of all veterans tested positive for COVID-19 between January 1st and May 31st, 2020. Antecedent use of statins was defined as a redeemed drug prescription in the 6 months prior to COVID-19 diagnosis. Propensity-matched mixed-effects logistic regression was performed, stratified by statin use. The study population comprised 14,268 patients with COVID-19 (median age 66 years (25th–75th percentile, 53–74), 90.7% men), of whom 7,168 were receiving a prescription for statins. Patients with statin exposure had a greater prevalence of comorbidities and a higher risk of mortality (Odd ratio [OR] 1.52; 95% confidence interval [CI] 1.37–1.68). After adjusting for covariates, statin exposure was not associated with a decreased mortality in the overall cohort by either Cox proportional hazards stratified model (HR 0.99; 95% CI 0.88–1.12) or propensity matching (HR .86; 95% CI 0.74–1.01). Similarly, there was no demonstrated advantage of statins in reducing the risk of ICU admission (HR 0.92; 95% CI 0.74–1.31) or hypoxic respiratory failure requiring mechanical ventilation (HR 1.02; 95% CI 0.81–1.29). Antecedent statin exposure in patients with COVID-19 was not associated with a decreased risk of 30-day all-cause mortality or need for mechanical ventilation.

BNT162b2 mRNA COVID-19 Vaccine Effectiveness in the Prevention of SARS-CoV-2 Infection and Symptomatic Disease in Five-Month Follow-Up: A Retrospective Cohort Study.

To combat the COVID-19 pandemic, a mass vaccination campaign was initiated in Italy on 27 December 2020. The vaccine available to immunize Italian healthcare workers (HCWs) was the BNT162b2 mRNA COVID-19 vaccine (Comirnaty). This study evaluated the effectiveness of the vaccine against documented SARS-CoV-2 infection and symptomatic diseases in the medium- to long-term. HCWs at Bari Policlinico University-Hospital (Italy) who completed the vaccination schedule were matched with HCWs who had refused vaccination; the two groups were followed-up for 5 months (January–May 2021). Vaccine effectiveness (VE) against infection was 97.7% (95.4–99.0%) at 14–34 days after the first dose, and 94.8% (87.0–97.8%), 83.0% (65.0–92.0%), and 81.0% (42.0–94.0%) at 14–41, 42–69, and >69 days, respectively, after the second dose. The estimated VE for documented symptomatic disease was 99.2% (96.4–99.8%) at 14–34 days after the first dose and 97.2% (90.3–99.2%), 85.0% (63.0–94.2%), and 88.0% (42.0–97.6%) at 14–41, 42–69, and >69 days, respectively, after the second dose. Efforts to increase vaccination rates should be strengthened, including mandatory vaccination for HCWs and greater incentives to increase vaccine acceptance by the general population.

DRIVING RESTRICTION AND EARLY ARRHYTHMIAS IN PATIENTS RECEIVING A SUBCUTANEOUS IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (DREAM SICD STUDY)

BACKGROUND Subcutaneous defibrillators (SICD) are being used increasingly for selected patients. Although there are established Canadian driving guidelines post transvenous ICD implantation, none exist for SICDs. The purpose of this study is to evaluate the rate of appropriate and inappropriate therapies and sudden cardiac incapacitation (SCI) after implantation of a SICD in contemporary practice. These data will help ascertain current driving guidelines in Canada following SICD implantation. The primary endpoint was incidence of appropriate and inappropriate ICD therapy within 7 days, 14 days, 30 days, 60 days, 90 days, 180 days and one-year post SICD implantation. The secondary variable was annualized risk of harm (ARH) while driving; ARH < 0.00005 while driving is considered acceptable in Canada. METHODS AND RESULTS We performed retrospective chart reviews of consecutive patients who received a SICD at eight Canadian centers between January 1st, 2016 and May 31st, 2020, including 198 patients in the final analysis. Both primary and secondary prevention SICDs were included. We reviewed device clinic electronic medical records and charts from immediate post-implant and subsequent follow-up visits. The baseline patient demographics are described in table 1. The overall incidence of syncope was 2.5%. The adjusted incidence rate of any ICD therapy and ARH while driving remained below the acceptable risk of harm for secondary prevention patients, except in the first 7 days post implantation (Figure 2a). The ARH while driving remained below the acceptable risk for primary prevention patients at all of the time periods (Figure 2b) till 12 months of follow up. CONCLUSION The rate of appropriate ICD therapy in a contemporary patient population implanted with an SICD is very low and the ARH while driving remains below acceptable harm threshold, except in first seven days for secondary prevention population. To our knowledge, this is the first study to assess the risk of harm while driving in a contemporary patient population with SICDs. Subcutaneous defibrillators (SICD) are being used increasingly for selected patients. Although there are established Canadian driving guidelines post transvenous ICD implantation, none exist for SICDs. The purpose of this study is to evaluate the rate of appropriate and inappropriate therapies and sudden cardiac incapacitation (SCI) after implantation of a SICD in contemporary practice. These data will help ascertain current driving guidelines in Canada following SICD implantation. The primary endpoint was incidence of appropriate and inappropriate ICD therapy within 7 days, 14 days, 30 days, 60 days, 90 days, 180 days and one-year post SICD implantation. The secondary variable was annualized risk of harm (ARH) while driving; ARH < 0.00005 while driving is considered acceptable in Canada. We performed retrospective chart reviews of consecutive patients who received a SICD at eight Canadian centers between January 1st, 2016 and May 31st, 2020, including 198 patients in the final analysis. Both primary and secondary prevention SICDs were included. We reviewed device clinic electronic medical records and charts from immediate post-implant and subsequent follow-up visits. The baseline patient demographics are described in table 1. The overall incidence of syncope was 2.5%. The adjusted incidence rate of any ICD therapy and ARH while driving remained below the acceptable risk of harm for secondary prevention patients, except in the first 7 days post implantation (Figure 2a). The ARH while driving remained below the acceptable risk for primary prevention patients at all of the time periods (Figure 2b) till 12 months of follow up. The rate of appropriate ICD therapy in a contemporary patient population implanted with an SICD is very low and the ARH while driving remains below acceptable harm threshold, except in first seven days for secondary prevention population. To our knowledge, this is the first study to assess the risk of harm while driving in a contemporary patient population with SICDs.

Emergence of influenza B/Victoria in the Micronesian US-affiliated Pacific Islands, spring 2019.

Data collected through routine syndromic surveillance for influenza-like illness in the Micronesian United States-affiliated Pacific Islands highlighted out-of-season influenza outbreaks in the spring of 2019. This report describes the data collected through the World Health Organization’s Pacific Syndromic Surveillance System for the Commonwealth of the Northern Mariana Islands (CNMI), Guam, the Federated States of Micronesia (FSM) and the Republic of the Marshall Islands (RMI). Compared with historical data, more cases of influenza-like illness were observed in all four islands described here, with the highest number reported in Guam in week 9, CNMI and FSM in week 15, and RMI in week 19. The outbreaks predominantly affected those aged < 20 years, with evidence from CNMI and RMI suggesting higher attack rates among those who were unvaccinated. Cases confirmed by laboratory testing suggested that influenza B was predominant, with 83% (99/120) of subtyped specimens classified as influenza B/Victoria during January–May 2019. These outbreaks occurred after the usual influenza season and were consistent with transmission patterns in Eastern Asia rather than those in Oceania or the United States of America, the areas typically associated with the United States-affiliated Pacific Islands due to their geographical proximity to Oceania and political affiliation with the United States of America. A plausible epidemiological route of introduction may be the high levels of international tourism from Eastern Asian countries recorded during these periods of increased influenza B/Victoria circulation. This report demonstrates the value of year-round surveillance for communicable diseases and underscores the importance of seasonal influenza vaccination, particularly among younger age groups.

Virological characteristics of cases of COVID-19 in northern Viet Nam, January-May 2020.

BackgroundViet Nam confirmed its first case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on 23 January 2020 among travellers from Wuhan, China, and experienced several clusters of community transmission until September. Viet Nam implemented an aggressive testing, isolation, contact tracing and quarantine strategy in response to all laboratory-confirmed cases. We report the results of SARS-CoV-2 testing during the first half of 2020 in northern Viet Nam.MethodsBetween January and May 2020, 15 650 upper respiratory tract specimens were collected from 14 470 suspected cases and contacts in northern Viet Nam. All were tested for SARS-CoV-2 by real-time RT–PCR. Individuals with positive specimens were tested every three days until two tests were negative. Positive specimens from 81 individuals were cultured.ResultsAmong 14 470 tested individuals, 158 (1.1%) cases of SARS-CoV-2 infection were confirmed; 89 were imported and 69 were associated with community transmission. Most patients (122, 77%) had negative results after two tests, while 11 and 4 still tested positive when sampled a third and fourth time, respectively. SARS-CoV-2 was isolated from 29 of 81 specimens (36%) with a cycle threshold (Ct) value < 30. Seven patients who tested positive again after testing negative had Ct values > 30 and negative cultures.ConclusionEarly, widespread testing for SARS-CoV-2 in northern Viet Nam identified very few cases, which, when combined with other aggressive strategies, may have dramatically contained the epidemic. We observed rapid viral clearance and very few positive results after clearance. Large-scale molecular diagnostic testing is a critical part of early detection and containment of COVID-19 in Viet Nam and will remain necessary until vaccination is widely implemented.

OAB-049: Poor post-vaccination anti-SARS-CoV-2-antibody response in patients with Multiple Myeloma correlates with low CD19+ B-lymphocyte count and anti-CD38 treatment

BackgroundUp to now, only few data are available regarding the efficacy of anti-SARS-CoV-2 vaccines in patients with plasma cell neoplasia. This ongoing observational study aimed to describe the level of post-vaccination anti-SARS-CoV-2-antibodies depending on B lymphocyte count, current therapy, and remission status of patients with multiple myeloma (MM) and related plasma cell dyscrasias, after the first dose of anti-SARS-CoV-2 vaccination.MethodsIn this single-center study, patients aged 18 years and older with a confirmed diagnosis of MM, monoclonal gammopathies of clinical significance (MGCS) or systemic light-chain amyloidosis (AL) who were eligible for Anti-SARS-CoV-2 vaccination according to the International Myeloma Society recommendations were included. Data were collected between January 1st and May 21th, 2021, at the department of oncology and hematology at the University Medical Center Hamburg-Eppendorf, Germany. The primary aim of this study was to evaluate a possible correlation between antibody titers and CD19+ B lymphocyte count and secondary to identify other possible factors influencing immune response. This study is part of the COVIDOUT trial (NCT04779346). Written informed consent was provided by each patient according to local requirements.ResultsA total of 82 patients were included in this study. The median age was 67.5 years (range 40-85 years). 78 patients had MM, 2 MGCS, and 2 AL. Overall, 63 patients were vaccinated with mRNA-based and 19 with vector-based vaccines, respectively. At the time of vaccination, 69 (84.1%) patients were under current anti-myeloma treatment. In total, 34 (41%) patients received anti-CD38-targeting therapies and 52 (63%) patients received IMiD-based therapies. 57 (69.5%) patients were in deep remissions (very good partial remission or better) at the time of vaccination. Assessment of anti-SARS-CoV-2 spike protein antibody titer (SP-AbT) took place on a median of 25 days after the first vaccination (SD ± 11.8). A positive SP-AbT was detected in 23% (17/74) of assessable patients. A cut-off value of ≥ 30 CD19+ B cells/µl was significantly positively correlating with higher SARS-CoV-2 SP-AbT. Individuals with current anti-CD38-antibody treatment showed lower SP-AbT and the likelihood for positive titer results was significantly lower in patients with current anti-CD38 treatment compared to those without. Treatment with immunomodulatory drugs did not harm the development of antibody titers. Furthermore, in multivariable linear regression, higher age and insufficiently controlled disease (≤ partial remission) were significantly negatively correlated with SARS-CoV-2 SP-AbT.ConclusionBased on our results, the majority of myeloma patients respond poorly after receiving the first dose of any anti-SARS-CoV-2 vaccination. Since both low CD19+ B lymphocyte count and CD38-directed therapy negatively impact vaccination response, booster vaccination seems therefore of utter importance.

Initial Blood pH, Lactate and Base Deficit Add No Value to Peri-Arrest Factors in Prognostication of Neurological Outcome After Out-of-Hospital Cardiac Arrest.

Background: In cardiac arrest survivors, metabolic parameters [pH value, lactate concentration, and base deficit (BD)] are routinely added to peri-arrest factors (including age, sex, bystander cardiopulmonary resuscitation, shockable first rhythm, resuscitation duration, adrenaline dose) to enhance early outcome prediction. However, the additional value of this strategy remains unclear.Methods: We used our resuscitation database to screen all patients ≥18 years who had suffered in- or out-of-hospital cardiac arrest (IHCA, OHCA) between January 1st, 2005 and May 1st, 2019. Patients with incomplete data, without return of spontaneous circulation or treatment with sodium bicarbonate were excluded. To analyse the added value of metabolic parameters to prognosticate neurological function, we built three models using logistic regression. These models included: (1) Peri-arrest factors only, (2) peri-arrest factors plus metabolic parameters and (3) metabolic parameters only. Receiver operating characteristics curves regarding 30-day good neurological function (Cerebral Performance Category 1-2) were analysed.Results: A total of 2,317 patients (OHCA: n = 1842) were included. In patients with OHCA, model 1 and 2 had comparable predictive value. Model 3 was inferior compared to model 1. In IHCA patients, model 2 performed best, whereas both metabolic (model 3) and peri-arrest factors (model 1) demonstrated similar power. PH, lactate and BD had interchangeable areas under the curve in both IHCA and OHCA.Conclusion: Although metabolic parameters may play a role in IHCA, no additional value in the prediction of good neurological outcome could be found in patients with OHCA. This highlights the importance of accurate anamnesis especially in patients with OHCA.

SARS-CoV-2 Transmission to Masked and Unmasked Close Contacts of University Students with COVID-19 — St. Louis, Missouri, January–May 2021

Universities open for in-person instruction during the 2020-21 academic year implemented a range of prevention strategies to limit the transmission of SARS-CoV-2, the virus that causes COVID-19, including physical distancing, mask use, vaccination, contact tracing, case investigation, and quarantine protocols (1). However, in some academic programs, such as health-related programs, aviation, and kindergarten through grade 12 (K-12) education, maintaining physical distance while still providing instruction is difficult; for universities with such programs, a single confirmed case of COVID-19 could result in a large number of students, staff members, and instructors being designated close contacts and requiring quarantine if they are not fully vaccinated, even if masks were worn when contact occurred. In January 2021, the St. Louis City Health Department allowed Saint Louis University (SLU) to implement a modified quarantine protocol that considered mask use when determining which close contacts required quarantine.* To assess the impact of the protocol, SLU assessed positive SARS-CoV-2 test result rates by masking status of the persons with COVID-19 and their close contacts. During January-May 2021, 265 students received a positive SARS-CoV-2 test result; these students named 378 close contacts. Compared with close contacts whose exposure only occurred when both persons were masked (7.7%), close contacts with any unmasked exposure (32.4%) had higher adjusted odds ratios (aORs) of receiving a positive SARS-CoV-2 test result (aOR=4.9; 95% confidence interval [CI]=1.4-31.1). Any additional exposures were associated with a 40.0% increase in odds of a positive test result (aOR=1.4; 95% CI=1.2-1.6). These findings reinforce that universal masking and having fewer encounters in close contact with persons with COVID-19 prevents the spread of SARS-CoV-2 in a university setting. Universities opening for in-person instruction could consider taking mask use into account when determining which unvaccinated close contacts require quarantine if enforced testing protocols are in place. However, this study was conducted before the B.1.617.2 (Delta) variant became the dominant strain of SARS-CoV-2 in the United States, which could have affected these findings given that the Delta variant has been found to be associated with increased transmissibility compared to previous variants.

Seasonal life strategy of Prorocentrum minimum in Chesapeake Bay, USA: Validation of the role of physical transport using a coupled physical–biogeochemical–harmful algal bloom model

Over 40 years ago, it was suggested that Prorocentrum minimum in Chesapeake Bay has a seasonal life strategy that depends on the physical transport by estuarine circulation, bringing cells from lower bay to the mid‐bay in spring when they bloom. In this study, a validated hydrodynamic‐biogeochemical model is used to simulate the annual cycles of P. minimum in Chesapeake Bay and track its life history over multiple years. The model reproduces the observed seasonal progression of P. minimum without a seed population. Four life stages of P. minimum are faithfully produced in the model: (1) in winter, overwintering populations from the previous bloom are distributed throughout the water column in the lower bay; (2) in late winter/early spring, cells are transported upstream by the landward bottom flows; (3) in May, P. minimum develops a bloom in the mid‐bay; (4) in late summer/fall, decaying P. minimum populations are transported downstream by the seaward surface flows. Particle tracking shows that it takes about 3–4 months for the overwintering cells to travel from the lower bay to the mid‐bay, but about 6 months for the decaying cells to travel from the mid‐bay to the lower bay, as the estuarine circulation is far stronger during the high runoff months of January–May than during the low runoff months of June–December. With the peak growth rate around 20°C, May provides an optimal window of growth opportunity for P. minimum as phytoplankton assemblage transitions from winter–spring diatoms to summer dinoflagellates in a seasonal succession.