Late January Research Articles

The effect of human mobility restrictions on the COVID-19 transmission network in China.

COVID-19 poses a severe threat worldwide. This study analyzes its propagation and evaluates statistically the effect of mobility restriction policies on the spread of the disease. We apply a variation of the stochastic Susceptible-Infectious-Recovered model to describe the temporal-spatial evolution of the disease across 33 provincial regions in China, where the disease was first identified. We employ Bayesian Markov Chain Monte-Carlo methods to estimate the model and to characterize a dynamic transmission network, which enables us to evaluate the effectiveness of various local and national policies. The spread of the disease in China was predominantly driven by community transmission within regions, which dropped substantially after local governments imposed various lockdown policies. Further, Hubei was only the epicenter of the early epidemic stage. Secondary epicenters, such as Beijing and Guangdong, had already become established by late January 2020. The transmission from these epicenters substantially declined following the introduction of mobility restrictions across regions. The spatial transmission network is able to differentiate the effect of the local lockdown policies and the cross-region mobility restrictions. We conclude that both are important policy tools for curbing the disease transmission. The coordination between central and local governments is important in suppressing the spread of infectious diseases.

Love during lockdown: findings from an online survey examining the impact of COVID-19 on the sexual health of people living in Australia

IntroductionAustralia recorded its first case of COVID-19 in late January 2020. On 22P March 2020, amid increasing daily case numbers, the Australian Government implemented lockdown restrictions to help ‘flatten the...

The evolving portrait of a virus

In late January 2020, as researchers began to gauge the public health threat posed by COVID-19, the Centers for Disease Control and Prevention (CDC) released an illustration of the virus. In that memorable three-dimensional depiction, the viral envelope appeared as a textured, almost carpeted, gray sphere. Spike proteins, which help the virus bind to and invade cells in a person’s respiratory tract, emerged from the surface like a landscape of disquieting red shrubs. Other membrane proteins dotted the surface in yellow. The entire viral particle, or virion, floated before a charcoal gradient background as though it were sitting for a portrait (1). Just weeks after the release of the image, it had become the public face of a global menace. Over the course of a week—and based on knowledge about other coronaviruses—artists at the CDC produced this now-iconic image of the COVID-19 pathogen, the first to be widely distributed. It quickly became the face of the pandemic. Image credit: Centers for Disease Control and Prevention/Alissa Eckert, MSMI; Dan Higgins, MAMS. Already, the image has become iconic, says Michael Rossi, an historian of medicine and science at the University of Chicago, IL. “We can see evidence of its iconicity in the most unexpected places,” says Rossi. “I was hiking through these ruins with my daughters, and someone had graffitied the particle with the spikes and everything. It’s instantly recognizable.” Rossi suspects no other microbiological image has ever become so popular or ubiquitous so fast; reports about the flu or flu shots, for example, only sporadically depict the virus (which bears a striking similarity to SARS-CoV-2). Other infamous viruses have fared much the same. “I don’t think images of HIV got the same kind of traction,” says David Jones, an historian of science at Harvard University in Cambridge, MA. The CDC’s portrait, …

Non-alcoholic Wernicke’s encephalopathy in a kidney transplant recipient

Background. Non-alcoholic Wernicke’s encephalopathy occurs in various somatic conditions with thiamine deficiency, excessive excretion of thiamine, or impaired thiamine metabolism. Very few cases of this pathology have been described in chronic kidney disease (CKD). We present a unique case of non-alcoholic Wernicke’s encephalopathy in a patient with a kidney transplant is presented.Past medical history. The patient underwent kidney transplantation in 2008. Outpatient follow-up by a nephrologist was irregular. Renal graft function remained relatively stable: blood creatinine 200–240 μmol/L, estimated glomerular filtration rate 40–30 mL/min, tacrolimus plasma concentrations tended to increase (5.7–7.6–8.4–10.4 ng/mL); repeated graft biopsy (in 2015 and in 2017) determined the chronic toxicity of calcineurin inhibitors. The patient’s condition worsened in late January 2020: body temperature increased to 38°C, nausea, vomiting, loose, watery stools for up to 5 times per day, 8 kg weight loss, decreased diuresis. A few days later, double vision, shaky gait and then immobility appeared. Biochemical examination results: potassium 3.8 mmol/L, sodium 139 mmol/L, alpha-amylase 159 units/L (norm 0–100 units/L), creatinine 242 mmol/L, urea 13.2 mmol/L; ultrasound signs of pancreatitis. Magnetic resonance imaging (MRI) of the brain: bilateral diffuse lesions of the midbrain, thalamus, and cerebellum. Based on the clinical picture and on brain MRI results, Wernicke’s encephalopathy was diagnosed. Parenteral administration of thiamine had a good effect.Conclusion. Possible mechanisms of the development of Wernicke’s encephalopathy in a patient were discussed. Vigilance is required regarding this disease when metabolic disorders occur in patients with CKD.

Forecasting the COVID-19 Increment Rate in DKI Jakarta Using Non-Robust STL Decomposition and SARIMA Model

The Corona virus known as COVID-19 was first present in Wuhan, China at this time has troubled many countries and its spread is very fast and wide. Data on daily confirmed COVID-19 cases were collected from the DKI Jakarta province between early May 2020 and late January 2021. The daily increase in confirmed COVID-19 cases has a percentage of the value of increase in total cases. In this study, modeling and analysis of forecasting the increment rate in daily number of new cases COVID-19 DKI Jakarta was carried out using the Seasonal-Trend Loess (STL) Decomposition and Seasonal Autoregressive Integrated Moving Average (SARIMA) models. STL Decomposition is a form of algorithm developed to help decompose a Time Series, and techniques considering seasonal and non-stationary observation. The results of the best forecasting accuracy are proven by STL-ARIMA, there are MAPE and MSE which only have an error value of 0.15. This proposed approach can be used for consideration for the DKI Jakarta government in making policies for handling COVID-19, as well as for the public to adhere to health protocols.

Combating the COVID-19 Pandemic: The Role of the SARS Imprint

We provide evidence of delayed attention and inaction in response to COVID-19 in countries that did not experience SARS in 2003. Using cross-country data, we find that individuals in countries that had SARS infections in 2003 searched more intensively for COVID-19-related information on Google in late January 2020, the time of the first known outbreak in Wuhan, China. Early attention to the novel virus, as measured by Google searches, is associated with deeper stock market drops in countries with SARS experience. In contrast, people in countries without SARS experience started to pay more attention much later, in March. Moreover, governments in these countries responded significantly more slowly in implementing social distancing policies to combat domestic COVID-19 outbreaks than governments in countries with SARS experience. Moreover, such early responses of individuals and governments in countries with SARS experience are prevalent within continent, even in non-Asian countries. Furthermore, people in countries with SARS experience are more compliant with social distancing rules. These timely attention and proactive responses of individuals and governments are more pronounced in countries that reported deaths caused by SARS, which left deeper imprints. Our findings suggest that the imprint of similar viruses’ experience is a fundamental mechanism underlying timely responses to COVID-19. This paper was accepted by Haoxiang Zhu, finance.

News, Events, Publications, and Awards

News, Events, Publications, and Awards

FASA Designation Awards Dedication and Leadership in Anesthesiology

Career Connection| June 2021 FASA Designation Awards Dedication and Leadership in Anesthesiology Gordon Glantz Gordon Glantz Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor June 2021, Vol. 85, 23. https://doi.org/10.1097/01.ASM.0000754232.47491.6a Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Gordon Glantz; FASA Designation Awards Dedication and Leadership in Anesthesiology. ASA Monitor 2021; 85:23 doi: https://doi.org/10.1097/01.ASM.0000754232.47491.6a Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search nav search search input Search input auto suggest search filter All ContentAll PublicationsASA Monitor Search Advanced Search Topics: awards and prizes, leadership In late January 2021, it was announced that more than 1,100 ASA members had been designated as Fellows of the American Society of Anesthesiologists. Launched in 2017, the FASA designation is the society's highest acknowledgment that recognizes years of dedication to exceptional education, leadership, and commitment to the specialty. Gary Schwartz, MD, FASA, is a private practice interventional pain physician and regional anesthesiologist, as well as Chair of the FASA subcommittee. He sought involvement with ASA several years ago and applied to be a part of the Committee on Membership, which oversees the FASA program and its eligibility criteria. Dr. Schwartz stressed that the FASA is a privileged fellowship designation for those who demonstrate leadership, advocacy, education, and dedication to the specialty of anesthesiology. “The FASA designation shows years-long commitment to the field of anesthesiology,” he said, adding that it is a large benefit to receive recognition as being a... You do not currently have access to this content.

Transport of Nitric Oxide Via Lagrangian Coherent Structures Into the Top of the Polar Vortex.

The energetic particle precipitation (EPP) indirect effect (IE) refers to the downward transport of reactive odd nitrogen (NOx = NO + NO2) produced by EPP (EPP‐NOx) from the polar winter mesosphere and lower thermosphere to the stratosphere where it can destroy ozone. Previous studies of the EPP IE examined NOx descent averaged over the polar region, but the work presented here considers longitudinal variations. We report that the January 2009 split Arctic vortex in the stratosphere left an imprint on the distribution of NO near the mesopause, and that the magnitude of EPP‐NOx descent in the upper mesosphere depends strongly on the planetary wave (PW) phase. We focus on an 11‐day case study in late January immediately following the 2009 sudden stratospheric warming during which regional‐scale Lagrangian coherent structures (LCSs) formed atop the strengthening mesospheric vortex. The LCSs emerged over the north Atlantic in the vicinity of the trough of a 10‐day westward traveling planetary wave. Over the next week, the LCSs acted to confine NO‐rich air to polar latitudes, effectively prolonging its lifetime as it descended into the top of the polar vortex. Both a whole atmosphere data assimilation model and satellite observations show that the PW trough remained coincident in space and time with the NO‐rich air as both migrated westward over the Canadian Arctic. Estimates of descent rates indicate five times stronger descent inside the PW trough compared to other longitudes. This case serves to set the stage for future climatological analysis of NO transport via LCSs.

Factors associated with reported likelihood to get vaccinated for COVID-19 in a nationally representative US survey

ObjectivesAlthough general principles related to vaccination hesitancy have been well researched, reports on reluctance to be vaccinated for coronavirus disease 2019 (COVID-19) in the United States are somewhat surprising, given the disease's substantive disruption of everyday life. However, the landscape in which people are making COVID-19 vaccination decisions has recently evolved with releases of encouraging vaccine-related data and changes to official messaging about the virus. Therefore, this study sought to identify factors associated with reported likelihood to get vaccinated for COVID-19 among US adults in late January 2021. Study designWe used the Prolific online research panel to survey a nationally representative sample of 1017 US adults. MethodsRespondents were asked about their behavioral intentions toward COVID-19 vaccination, trust in science, perceptions related to COVID-19, and selected sociodemographic factors. We computed associations between those 11 independent variables and likelihood to get vaccinated for COVID-19 using multiple linear regression. ResultsAround 73.9% of respondents indicated at least some likelihood to get vaccinated for COVID-19. Trust in science and perceived seriousness of COVID-19 were positively associated with intention to get vaccinated, and identifying as Black or African American was negatively associated with intention to get vaccinated. Other factors were moderately, weakly, or not at all associated with intention. ConclusionsBuilding trust in science and truthfully emphasizing the seriousness of catching COVID-19 should be further researched for their potential to support campaigns to encourage COVID-19 vaccination. Data continue to suggest the importance of dialogue with Black communities about COVID-19 vaccination.

Evolving oncology provider perspectives on care delivery during the COVID-19 pandemic.

e18609 Background: The COVID-19 pandemic prompted rapid changes in cancer care delivery. We sought to examine oncology provider perspectives on clinical decisions and care delivery during the pandemic and to compare provider views early versus late in the pandemic. Methods: We invited oncology providers, including attendings, trainees and advanced practice providers, to complete a cross-sectional online survey using a variety of outreach methods including social media (Twitter), email contacts, word of mouth and provider list-serves. We surveyed providers at two time points during the pandemic when the number of COVID-19 cases was rising in the United States, early (March 2020) and late (January 2021). The survey responses were analyzed using descriptive statistics and Chi-squared tests to evaluate differences in early versus late provider responses. Results: A total of 132 providers completed the survey and most were white (n = 73/132, 55%) and younger than 49 years (n = 88/132, 67%). Respondents were attendings in medical, surgical or radiation oncology (n = 61/132, 46%), advanced practice providers (n = 48/132, 36%) and oncology fellows (n = 16/132, 12%) who predominantly practiced in an academic medical center (n = 120/132, 91%). The majority of providers agreed patients with cancer are at higher risk than other patients to be affected by COVID-19 (n = 121/132, 92%). However, there was a significant difference in the proportion of early versus late providers who thought delays in cancer care were needed. Early in the pandemic, providers were more likely to recommend delays in curative surgery or radiation for early-stage cancer (p < 0.001), delays in adjuvant chemotherapy after curative surgery (p = 0.002), or delays in surveillance imaging for metastatic cancer (p < 0.001). The majority of providers early in the pandemic responded that “reducing risk of a complication from a COVID-19 infection to patients with cancer” was the primary reason for recommending delays in care (n = 52/76, 68%). Late in the pandemic, however, providers were more likely to agree that “any practice change would have a negative impact on patient outcomes” (p = 0.003). At both time points, the majority of providers agreed with the need for other care delivery changes, including screening patients for infectious symptoms (n = 128/132, 98%) and the use of telemedicine (n = 114/132, 86%) during the pandemic. Conclusions: We found significant differences in provider perspectives of delays in cancer care early versus late in the pandemic which reflects the swiftly evolving oncology practice during the COVID-19 pandemic. Future studies are needed to determine the impact of changes in treatment and care delivery on outcomes for patients with cancer.

CATTLE HYPODERMATOSIS IN SOUTH TAJIKISTAN

The article presents data on the infestation of cattle by subcutaneous gadflies in the southern regions of Tajikistan. It has been established that two species of subcutaneous gadfly parasitize in cattle – Hypoderma bovis and Hypoderma lineatum. The prevalence of gadfly larva in cattle is 11.4–31.1% and the intensity of infection is 2–21 specimens, and Hypoderma lineatum larva is 4.6–11.3% and the intensity of infection is 5–15 specimens of connective tissue capsules per animal, respectively. Connective tissue capsules Hypoderma bovis in the back area of animals appeared in late January and early February, and Hypoderma lineatum in late December and early January. Development of larvae under the skin of animals lasted on average 50–55 days. The release of the Hypoderma lineatum larva was noted in the second and third decades of February, and the gadfly in mid-March. The flying of the Hypoderma lineatum imago is from mid-April to the second decade of June, and the gadfly from the second decade of May to early July at an optimal air temperature of 18–25°C. This is due to the fact that there are favorable natural and climatic conditions in these areas for the development of larvae in the pupation stage and a fairly dense population of animals (cattle) per a hectare of pasture.

The benefits of ensemble prediction for forecasting an extreme event: The Queensland Floods of February 2019

AbstractFrom late January to early February 2019, a quasi-stationary monsoon depression situated over northeast Australia caused devastating floods. During the first week of February, when the event had its greatest impact in northwest Queensland, record-breaking precipitation accumulations were observed in several locations, accompanied by strong winds, substantial cold maximum temperature anomalies and related wind chill. In spite of the extreme nature of the event, the monthly rainfall outlook for February issued by Australia’s Bureau of Meteorology on 31st January provided no indication of the event. In this study, we evaluate the dynamics of the event and assess how predictable it was across a suite of ensemble model forecasts using the UK Met Office numerical weather prediction (NWP) system, focussing on a one week lead time. In doing so, we demonstrate the skill of the NWP system in predicting the possibility of such an extreme event occurring. We further evaluate the benefits derived from running the ensemble prediction system at higher resolution than used operationally at the Met Office and with a fully coupled dynamical ocean. We show that the primary forecast errors are generated locally, with key sources of these errors including atmosphere-ocean coupling and a known bias associated with the behaviour of the convection scheme around the coast. We note that a relatively low resolution ensemble approach requires limited computing resource, yet has the capacity in this event to provide useful information to decision makers with over aweek’s notice, beyond the duration of many operational deterministic forecasts.

‘Online Pre-service Teacher Placements’ during COVID-19: A Compromise or an Opportunity?

The nationwide closures of schools due to the outbreak of COVID-19 are impacting almost 70% of the world's student population . While most teaching has been undertaken remotely and on digital platforms, trainee teachers in many countries are uncertain what the future holds as placements are put on hold. In Hong Kong, all schools suspended since late January 2020. Kindergartens, primary and secondary school only resumed classes by phases in a gradual and orderly manner starting from late May 2020, but has closed again from early December 2020 (Education Bureau, 2020; Information Services Department, 2020). Meanwhile, most tertiary schools have suspended face-to-face classes for almost a whole year already. Without interrupting learning, most students -from kindergarten to university -are resorting to online learning at home. The sudden transformation from face-to-face instruction to online learning has posed challenges not only for in-service teachers but also for trainee teachers,...

Services and surveillance during the pandemic lockdown: Residents’ committees in Wuhan and Beijing

The COVID-19 pandemic caused a lockdown of Wuhan, and strict control was imposed in many major Chinese cities, including the national capital of Beijing. Residents’ committee workers at the grass-roots level have played a critical role in the enforcement of the government’s pandemic prevention and control measures, through their day-to-day service and surveillance as local community managers. This article examines their work in Wuhan and Beijing neighbourhoods during the most critical periods of the outbreak, from late January to June 2020, and the challenges the workers faced as executors of the government’s community-based prevention policy. The two cities have developed different community strategies because of very different epidemiological situations and city functions.

842 PAP Therapy in a Pandemic: Management of Severe Mixed Apnea Predominant OSA & CSA during the COVID-19 Pandemic

IntroductionIntroduction/Background: A new protocol and standard of care was created amidst the COVID-19 Pandemic that began in 2020. Traditional split night studies fell out of favor and were replaced by solely diagnostic studies with placement on Auto-PAP therapy if treatment of sleep disordered breathing was required. Some patients, however, required a more tailored approach if diagnostic polysomnogram (PSG) was particularly concerning. Our case report describes the treatment of a patient with severe Mixed Apnea Predominant Obstructive Sleep Apnea (OSA) with accompanying Central Sleep Apnea (CSA) using COVID-19 Precautions.Report of case(s)Case Description: A 48 year old AAM patient with a PMH of HTN, pre-diabetes, GERD, obesity and tobacco abuse initially presented to Sleep Medicine in late January 2020 with complaints of snoring, witnessed apneas, waking up gasping, excessive daytime sleepiness, fatigue, and non-restorative sleep for many years with ESS 24 and FSS 48 on initial evaluation. Diagnostic PSG showed AHI 76.9 with O2 desaturation to 59% and demonstrated the presence of severe Mixed Apnea predominant OSA and CSA with worsening during REM sleep. Because of the severity, he underwent a PAP titration in August 2020 using the AASM COVID-19 sleep study precautions which included use of a negative pressure room. Optimal control of snoring, apneic respiratory events and oxygen desaturations was achieved at 14 cm H2O in the supine body position during REM sleep. Follow up with Sleep Medicine in October and December 2020 showed objective compliance over a 30 day period not completely at goal due to issues with mask desensitization and sleep hygiene, however the patient subjectively reported that he noticed great improvement in snoring, excessive daytime sleepiness and fatigue.Conclusion: Discussion/ConclusionWith a diagnosis of Severe Mixed Apnea Predominant OSA as well as CSA noted during the study, the differential diagnosis included CHF, Chiari malformation, opioid abuse and idiopathic CSA as the cause. Despite a dangerous pandemic, appropriate therapy for certain patients must still be attained. Special protocols developed during the COVID-19 Pandemic allowed for our patient to receive adequate treatment, while ensuring the safety of all involved.Support (if any)References COVID 19: FAQs for Sleep Clinicians. AASM official website. https://aasm.org/covid-19-resources/covid-19-faq/

The Impact of the COVID-19 Pandemic on Consumption: Learning from High-Frequency Transaction Data

We use daily transaction data in 214 cities to study the impact of COVID-19 on consumption after China's outbreak in late January 2020. Based on difference-in-difference estimation, daily offline consumption--via bank card and mobile Quick Response code transactions--fell by 32 percent, or 18.57 million renminbi (RMB) per city, during the 12-week period. The effect is prevalent across cities and is more pronounced in the dining-and-entertainment and travel categories. We infer that China's offline consumption decreased by over 1.22 trillion RMB, or 1.2 percent of China's 2019 GDP, in the 3-month postoutbreak period.

‘Cin ciun cian’ (ching chong): Yellowness and neo-orientalism in Italy at the time of COVID-19

The COVID-19 pandemic has put in the foreground the dramatic actuality of global and local inequalities, undermining neo-liberal, communitarian, democratic or cosmopolitan projects of collective identity. In the light of intersecting inequalities such as class, race/ethnicity and gender, an explosion of Sinophobia, social stigma and physical attacks targeting people of East Asian and Southeast Asian appearance or heritage has been widely reported in Euro-American media. This article will focus on the case of Italy during the initial stage of the pandemic in early 2020. Italy has not only been the first European country to be exposed to the pandemic and to undergo national lockdown but also a country where the wave of racist assaults started in late January 2020, even before the first clusters have been detected. The critical investigation of Italian media discourses will highlight how deep-rooted, colonialist and ambivalent assumptions about the ‘Oriental’, ‘Asian’, ‘Chinese’ and ‘yellow’ other may have been crucial to the reproduction of racism against specific people, cultures and civilizations, regardless of nationality, class and gender. It will refer in particular to the concept of ‘yellowness’, resulting from a process of bio-cultural racialization within the hegemonic frame of ‘Western’, ‘White’ or ‘Italian’ identity. Furthermore, it will indicate how this process of racialized othering has emerged, but has also been contested, within the specific context of citizenship, Asian immigrants and governmental actions in contemporary Italy. The overall aim is not so much to denounce higher levels of racism in Italy compared to other Euro-American countries; rather, this article refers to the Italian case to stress how both global and local trajectories do mutually overlap to shape, and eventually to transform, a national context, offering further insights on the glo-calization of the civilizational ‘West’/’East’ divide in the 21st century.

Linked Clusters of SARS-CoV-2 Variant B.1.351 - Maryland, January-February 2021.

In late January 2021, a clinical laboratory notified the Maryland Department of Health (MDH) that the SARS-CoV-2 variant of concern B.1.351 had been identified in a specimen collected from a Maryland resident with COVID-19 (1). The SARS-CoV-2 B.1.351 lineage was first identified in South Africa (2) and might be neutralized less effectively by antibodies produced after vaccination or natural infection with other strains (3-6). To limit SARS-CoV-2 chains of transmission associated with this index patient, MDH used contact tracing to identify the source of infection and any linked infections among other persons. The investigation identified two linked clusters of SARS-CoV-2 infection that included 17 patients. Three additional specimens from these clusters were sequenced; all three had the B.1.351 variant and all sequences were closely related to the sequence from the index patient's specimen. Among the 17 patients identified, none reported recent international travel or contact with international travelers. Two patients, including the index patient, had received the first of a 2-dose COVID-19 vaccination series in the 2 weeks before their likely exposure; one additional patient had a confirmed SARS-CoV-2 infection 5 months before exposure. Two patients were hospitalized with COVID-19, and one died. These first identified linked clusters of B.1.351 infections in the United States with no apparent link to international travel highlight the importance of expanding the scope and volume of genetic surveillance programs to identify variants, completing contact investigations for SARS-CoV-2 infections, and using universal prevention strategies, including vaccination, masking, and physical distancing, to control the spread of variants of concern.

David Katzenstein and James Hakim-In Memoriam.

The world lost two wonderful doctors who devoted their lives to the fight against HIV/AIDS in Africa. Ironically, they both died of COVID-19 within hours of each other in late January in Zimbabwe. David Katzenstein, MD, began his career in the early 1980 s working with underserved populations at a Native Tribal clinic in New Mexico and with persons suffering from AIDS at the Haight Ashbury Clinic in San Francisco, conducted CMV research at the University of Minnesota, and then took a position working as a microbiologist at the University of Zimbabwe in Harare between 1985 and 1987. In 1989, David joined the faculty at Stanford University where he remained until his retirement in 2017. Dr Katzenstein, led many important clinical and translational research studies related to HIV. With his colleagues in the AIDS Clinical Trials Group (ACTG), he led studies that resulted in the approval of life-saving antiretroviral medications. David dedicated a major portion of his academic endeavors to study HIV drug resistance, serving as director of one of the Virology Specialty Laboratories for the ACTG for many years. He was a protocol team member and leader on several ACTG studies and served on numerous ACTG committees, including the Performance Evaluation Committee and the original Virology Committee. He was co-chair of ACTG 384 that dealt with protease and/or non-nucleoside reverse transcriptase inhibitors, and was one of the first investigators to call attention to the issues of drug resistance in Africa. Recognizing the disparate impact of HIV in resource limited settings, David was a pioneer in Global HIV Research, in the fields of perinatal HIV transmission prevention, and studying different approaches to optimize antiretroviral treatment and laboratory monitoring in various settings around the world. He worked diligently to bring laboratory technology to Zimbabwe. Following his retirement from Stanford in 2017, David became the director of the Biomedical Research Training Institute in Zimbabwe where he led the molecular diagnostics laboratory to support laboratory monitoring of community-based treatment programs. In all his work, David engaged researchers and trainees from different parts of the world. Generous with his time, effort and ideas, David was a cherished mentor for many young and mid-career physicians and scientists, now scattered throughout different academic institutions and agencies in the U.S. He nurtured careers of clinicians, basic and social scientists, while encouraging multidisciplinary efforts to tackle the global HIV pandemic. He worked tirelessly and with great joy, giving of himself without reserve. James Gita Hakim, MRCP-UK, Professor of Medicine, University of Zimbabwe College of Health Sciences, to COVID-19. Dr Hakim was an accomplished investigator who made seminal contributions in HIV treatment and prevention research. He was known internationally for his accomplishments as a research leader, a builder of African research capacity, a leader of modernizing medical education in Africa, and as a mentor of young African investigators. Dr Hakim was at the forefront of clinical research on HIV/AIDS in Africa for over 20 years. He founded the University of Zimbabwe Clinical Research Centre (UZ-CRC) in 2001 as a site for international clinical trials on HIV treatment and prevention. He was a leader in pivotal international clinical trials including the landmark HIV ‘treatment as prevention’ trial HPTN 052, the MRC-funded “Development of Anti-Retroviral Therapy in Africa” (DART) trial, and the ACTG “Prospective Evaluation of Antiretroviral Therapy in Resource Limited Settings” (PEARLS) study. These studies contributed to the knowledge needed for successful implementation of antiretroviral therapy in southern Africa. Dr Hakim was as Principal Investigator of the University of Zimbabwe's program, the Medical Education Partnership Initiative (MEPI) which serves as a model for medical education in Africa. He was as a representative on the International AIDS Society (IAS) Governing Council from 2016 to 2020 and on the World Health Organization Guidelines Review Committee, the UNAIDS Advisory Committee, and on program committees for IAS Conference on HIV Science, the Conference on Retroviruses and Opportunistic Infections (CROI). Dr Hakim was Co-chair of the World AIDS Conference, Amsterdam, Netherlands in 2018. James Hakim's life demonstrated how investment in biomedical research and modern medical education can pay large dividends and be transformative for Africa. The world is better for the lives you lived, David and James. May light perpetual shine upon you.