Public Health Need Research Articles

A Derivative of the D5 Monoclonal Antibody That Targets the gp41 N-Heptad Repeat of HIV-1 with Broad Tier-2-Neutralizing Activity.

ABSTRACTHIV-1 infection is initiated by the viral glycoprotein Env, which, after interaction with cellular coreceptors, adopts a transient conformation known as the prehairpin intermediate (PHI). The N-heptad repeat (NHR) is a highly conserved region of gp41 exposed in the PHI; it is the target of the FDA-approved drug enfuvirtide and of neutralizing monoclonal antibodies (mAbs). However, to date, these mAbs have only been weakly effective against tier-1 HIV-1 strains, which are most sensitive to neutralizing antibodies. Here, we engineered and tested 11 IgG variants of D5, an anti-NHR mAb, by recombining previously described mutations in four of D5’s six antibody complementarity-determining regions. One variant, D5_AR, demonstrated 6-fold enhancement in the 50% inhibitory dose (ID50) against lentivirus pseudotyped with HXB2 Env. D5_AR exhibited weak cross-clade neutralizing activity against a diverse set of tier-2 HIV-1 viruses, which are less sensitive to neutralizing antibodies than tier-1 viruses and are the target of current antibody-based vaccine efforts. In addition, the neutralization potency of D5_AR IgG was greatly enhanced in target cells expressing FcγRI, with ID50 values of <0.1 μg/ml; this immunoglobulin receptor is expressed on macrophages and dendritic cells, which are implicated in the early stages of HIV-1 infection of mucosal surfaces. D5 and D5_AR have equivalent neutralization potency in IgG, Fab, and single-chain variable-fragment (scFv) formats, indicating that neutralization is not impacted by steric hindrance. Taken together, these results provide support for vaccine strategies that target the PHI by eliciting antibodies against the gp41 NHR and support investigation of anti-NHR mAbs in nonhuman primate passive immunization studies.IMPORTANCE Despite advances in antiretroviral therapy, HIV remains a global epidemic and has claimed more than 32 million lives. Accordingly, developing an effective HIV vaccine remains an urgent public health need. The gp41 N-heptad repeat (NHR) of the HIV-1 prehairpin intermediate (PHI) is highly conserved (>90%) and is inhibited by the FDA-approved drug enfuvirtide, making it an attractive vaccine target. However, to date, anti-NHR antibodies have not been potent. Here, we engineered D5_AR, a more potent variant of the anti-NHR antibody D5, and established its ability to inhibit HIV-1 strains that are more difficult to neutralize and are more representative of circulating strains (tier-2 strains). The neutralizing activity of D5_AR was greatly potentiated in cells expressing FcγRI; FcγRI is expressed on cells that are implicated at the earliest stages of sexual HIV-1 transmission. Taken together, these results bolster efforts to target the gp41 NHR and the PHI for vaccine development.

An Intramuscular DNA Vaccine for SARS-CoV-2 Decreases Viral Lung Load but Not Lung Pathology in Syrian Hamsters.

The 2019 novel coronavirus, SARS-CoV-2, first reported in December 2019, has infected over 102 million people around the world as of February 2021 and thus calls for rapid development of safe and effective interventions, namely vaccines. In our study, we evaluated a DNA vaccine against SARS-CoV-2 in the Syrian hamster model. Hamsters were vaccinated with a DNA-plasmid encoding the SARS-CoV-2 full length spike open reading frame (ORF) to induce host cells to produce spike protein and protective immune responses before exposure to infectious virus. We tested this vaccine candidate by both intranasal (IN) and intramuscular (IM) routes of administration and complexing with and without an in vivo delivery reagent. Hamsters receiving prime-boost-boost IM-only vaccinations recovered body weight quicker, had decreased lung viral loads, and increased SARS-CoV-2-specific antibody titers compared to control vaccinated animals but, surprisingly, lung pathology was as severe as sham vaccinated controls. The IM/IN combination group showed no efficacy in reducing lung virus titers or pathology. With increasing public health need for rapid and effective interventions, our data demonstrate that in some vaccine contexts, significant antibody responses and decreased viral loads may not be sufficient to prevent lung pathology.

The COVID-19-Related Lockdown in Qatar: Associations Among Demographics, Social Distancing, Mood Changes, and Quality of Life

The worldwide spread of the coronavirus disease (COVID-19), the absence of medical treatment and vaccination, the delayed onset of symptoms, and the rapid human-to-human transmission have led the vast majority of countries to impose strict social distancing procedures. Whereas it appears that social distancing is an effective strategy for mitigating spread, it may also result in a variety of unintended negative consequences to individuals’ psychological well-being and mental health. During the peak of the COVID-19 pandemic, the present study examined associations among some demographic variables (gender, age, marital and working statuses, and having a family member or a friend infected with COVID-19), acceptance of social distancing, mood changes, and quality of life (QoL) in Qatar, a high-income Middle Eastern Arabic-speaking country. Older, married, and working participants were more accepting of social distancing than younger, unmarried, and non-working participants, respectively. Participants indicated that, during this time, they became more distressed, upset, scared, irritable, nervous, and afraid, and less inspired and determined. In a stark contrast, more individuals indicated that they became more interested, alert, and attentive, whereas higher percentages of participants reported feeling less guilty, hostile, and ashamed. Social distancing correlated positively with negative affect, whereas social avoidances correlated positively with positive affect and with physical, psychological, social, and environmental QoL. Finally, positive affect correlated positively, and negative affect correlated negatively, with these four domains of QoL. These results highlight the need for public health and clinical providers to consider peoples’ psychological well-being and mental health during the COVID-19 pandemic.

Pediatric Emergency Departments and Urgent Care Visits in Houston after Hurricane Harvey.

IntroductionNatural disasters are increasingly common and devastating. It is essential to understand children’s health needs during disasters as they are a particularly vulnerable population. The objective of this study was to evaluate pediatric disease burden after Hurricane Harvey compared to the preceding month and the same period in the previous year to inform pediatric disaster preparedness.MethodsThis was a retrospective cross-sectional study of patients seen at pediatric emergency departments (ED) and urgent care centers (UCC) 30 days before (late summer) and after (early fall) the hurricane and from the same time period in 2016. We collected demographic information and the first five discharge diagnoses from a network of EDs and UCCs affiliated with a quaternary care children’s hospital in Houston, Texas. We calculated the odds of disease outcomes during various timeframes using binary logistic regression modeling.ResultsThere were 20,571 (median age: 3.5 years, 48.1% female) and 18,943 (median age: 3.5 years, 47.3% female) patients in 2016 and 2017, respectively. Inpatient admission rates from the ED a month after Harvey were 20.5%, compared to 25.3% in the same period in 2016 (P<0.001). In both years, asthma and other respiratory illnesses increased from late summer to early fall. After controlling for these seasonal trends, the following diseases were more commonly seen after the hurricane: toxicological emergencies (adjusted odds ratio [aOR]: 2.61, 95% [confidence interval] CI, 1.35–5.05); trauma (aOR: 1.42, 95% CI, 1.32–1.53); and dermatological complaints (aOR: 1.34, 95% CI, 1.23–1.46).ConclusionWe observed increases in rashes, trauma, and toxicological diagnoses in children after a major flood. These findings highlight the need for more medication resources and public health and education measures focused on pediatric disaster preparedness and management.

Impact of Sexualized Substance Use and Other Risk Practices on HCV Microelimination in gbMSM Living with HIV: Urgent Need for Targeted Strategies. Results of a Retrospective Cohort Study.

IntroductionThe objective of the present study is to describe the incidence of recently acquired hepatitis C (RAHCV) in a large cohort of people living with HIV (PLWHIV) and sexualized drug use and other related risk behaviours.MethodsObservational study including all PLWHIV with a RAHCV episode between June 2005 and December 2019 at the Hospital Clinic of Barcelona, Spain. Incidence of RAHCV was determined per person calendar year (py) in those patients who were HCV RNA negative. Data were collected on high-risk sexual practices for HCV transmission focused on gay, bisexual and other men having sex with men (gbMSM). ResultsA total of 340 RAHCV were diagnosed in 290 PLWHIV; 274 (94%) of them were gbMSM and developed 324 RAHCV, mainly since 2010 (90%). Overall incidence rate (IR) of RAHCV in gbMSM was 0.10 py (95% CI 0.09–0.11), with a 40% decreased observed since 2017 (IR 0.06, 95% CI 0.03–0.09 in 2019). Sixty reinfections were detected in 50 gbMSM (n = 244, 20%). The overall reinfection IR was 0.17 per py (95% CI 0.12–0.23) and the proportion of reinfection among total RAHCV increased to 47% cases in 2019, mainly in patients engaged in sexualized substance use (76%), unprotected anal intercourse (94%), sex partying (80%), fisting (43%), slamming (14%) and 60% of concomitant sexually transmitted infections (STIs).ConclusionsDespite RAHCV incidence decline in our cohort since 2017, HCV reinfection increased. High sexualized substance use and other risk behaviours are described in this context, indicating the need for public health tailored strategies to reduce this transmission and achieve HCV microelimination in gbMSM living with HIV.

Tele-Mentoring and Monitoring of the National Mental Health Program: A Bird’s-Eye View of Initiatives from India

Objective: To provide a glimpse of various digital programs and modules that are being implemented across the country by the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India (an institution of national importance under the Ministry of Health and Family Welfare, Government of India; one of its mandates is to develop innovative strategies to improve mental health capacity building as part of the National Mental Health Program, a publicly funded health program to cater to the public health need posed by psychiatric disorders). Design: The information is presented in a narrative fashion by organizing the activities into three categories of digital training methods: webinar mode, blended mode and hybrid mode. Results: Cadres ranging from lay-counsellors (volunteers in the community), non-specialist health workers to professionals including medical officers are covered with these initiatives. During the period from August 2016 till December 2020, more than 16 million man hours of training is delivered for more than 35,000 participants from across the country. Conclusions: These have a tremendous potential to exponentially increase skilled human resources capable of providing quality care to hitherto unserved remote areas of the rural hinterland and ultimately reduce the burgeoning treatment gap. In-depth outcome assessments are the need of the hour.

Effectiveness of the Recombinant Zoster Vaccine for Herpes Zoster Ophthalmicus in the United States

To examine the effectiveness of the recombinant zoster vaccine (RZV) for preventing herpes zoster ophthalmicus (HZO) in the general United States population. Retrospective, observational cohort study. Individuals enrolled in the OptumLabs Data Warehouse (OLDW; OptumLabs, Cambridge, MA) who were age eligible for herpes zoster (HZ) vaccination (≥50 years of age) from 2018 through 2019. The OLDW is a longitudinal, de-identified administrative claims and electronic health record database of patients in the United States with commercial insurance, Medicare Part D, or Medicare Advantage METHODS: Patients were required to have 365 days or more of continuous enrollment to be eligible. Those with a diagnosis code of HZ or an immunocompromising condition within 1 year before study inclusion were excluded. Vaccination with the RZV was ascertained by Current Procedural Terminology codes, and HZO was ascertained by International Classification of Diseases, Tenth Revision, codes. Cox proportional hazards regression models were used to estimate the hazard ratio of HZO associated with RZV, and inverse-probability weighting was used to control for confounding. Vaccine effectiveness was calculated from hazard ratios. Incidence of HZO in vaccinated versus unvaccinated person-times and vaccine effectiveness were assessed. From January 1, 2018, through December 31, 2019, a total of 4 842 579 individuals were included in this study. One hundred seventy-seven thousand two hundred eighty-nine (3.7%) received 2 valid doses of RZV. The incidence rate of HZO was 25.5 cases (95% confidence interval [CI], 17.4-35.8 cases) per 100 000 person-years in the vaccinated group compared with 76.7 cases (95% CI, 74.7-78.7 cases) in the unvaccinated group. The overall adjusted effectiveness of RZV against HZO was 89.1% (95% CI, 82.9%-93.0%). The effectiveness of RZV against HZO in individuals 50 years of age and older is high in a clinical setting. However, the low vaccination rate in this study highlights the public health need to increase HZV use. Ophthalmologists can play an important role in recommending vaccination to eligible patients.

Computerized-Adaptive vs. Traditional Ratings of Depression and Suicidal Thoughts: An Assay Sensitivity Pilot Study in a Ketamine Clinical Trial.

There is a public health need for improved suicide risk assessment tools. This pilot methodology study compared the assay sensitivity of computerized adaptive tests (CAT) of depression and suicidal ideation vs. traditional ratings in a randomized trial subgroup. The last 20 persons to enroll in a published ketamine trial in suicidal depression were studied. This subgroup received traditional and CAT ratings at baseline, 24 h post-infusion and follow-up week 2, 4, and 6: Hamilton Depression Rating Scale, Beck Depression Inventory, and Beck Scale for Suicidal Ideation vs. the CAT-Depression Inventory and CAT-Suicide Scale. Results showed larger effect sizes (ES) for CAT compared with traditional clinician-rated and self-report scales. Coefficients of variation for baseline measurements were lower for CAT compared with traditional scales. This is the first study to show that CAT may have greater assay sensitivity for treatment effects, particularly for suicidal ideation, compared with traditional clinician-rated and non-adaptive self-rated scales in a randomized trial. The findings suggest CAT can enable quick long-term follow-up assessments via cellphone, tablet, or computer while minimizing response bias due to repeated measurement of the same symptom items.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT01700829.

Reducing hearing loss through safe listening: An initiative of the World Health Organization

Globally, over one billion people are estimated to be at risk of hearing loss due to the common practice of listening to loud sounds in recreational settings. Given the current situation and projected rise in need for hearing care over the coming decades, prevention of hearing loss has become an urgent public health need. To address this, WHO, in 2015, launched the Make Listening Safe initiative. Focused on adolescents and young adults, this aims at raising awareness among this group about the need for and the means of safe listening. At the same time, it works to influence societal and political change so as to facilitate the practice of safe listening. Toward this end, WHO is working to ensure that personal devices such as smartphones and MP3 players include safe listening features and that entertainment venues can create a safe listening environment. Through this talk, WHO will share information of its evidence-based recommendations for safe listening, as well as efforts to promote their implementation.

Public Interest in Distal Upper Extremity Pain and Workstation Ergonomics in the Context of COVID-19

To describe trends in public interest in distal upper extremity (UE) pain and workstation ergonomics in the context of the COVID-19 pandemic. Descriptive ecological. Not applicable. Not applicable. Not applicable. Aggregated, anonymous Google Trends data of relative search frequency in the United States between 09/01/2019 and 08/31/2020 for each of these terms: (1) coronavirus OR COVID-19; (2) hand pain OR wrist pain OR finger pain; (3) ergonomic desk OR ergonomic chair OR ergonomic mouse OR ergonomic keyboard. Relative search frequency of coronavirus peaked (100%) the week of 03/15/2020, with a corresponding dip for distal UE pain as per its lowest relative search frequency (57%). Interest in distal UE pain returned to near-pre-pandemic levels as per a 2-point decrease in mean relative frequency before the week of 03/15/2020 versus after (compared to a 16-point decrease for a control search term of cancer). Interest in ergonomics increased in mid-March, corresponding with interest in coronavirus (from a relative frequency of 43% the week of 03/08/2020 to 55% on 03/15/2020 and 75% on 03/22/2020; with a previous high of 44% on 01/12/2020). Interest in ergonomics remained elevated, with a mean relative frequency of 84% after the week of 03/15/2020 and peak relative frequency (100%) on 08/16/2020. In the context of COVID-19, relatively stable public interest in distal UE pain combined with increased interest in ergonomics may suggest motivations to minimize or prevent pain associated with telecommuting-related makeshift workstations. Continued elevated interest in ergonomics highlights a potential public health need relative to ongoing pandemic-related workplace restrictions. Rehabilitation professionals should consider optimizing individual- and population-level musculoskeletal health in this regard.

Problems of Development of the Medical Industry in Ukraine in the Context of the Decentralisation Reform

The relevance of the study is that healthcare reform constitutes an important component of decentralisation. The old model of functioning of medical institutions is inefficient; therefore, there is a need for reorganisation, which is carried out by making appropriate decisions. The medical sector is one of the most problematic in Ukraine, especially in terms of organisation of medical care in local communities. Therefore, reform in a decentralised environment is a complex process to address and implement. Reforming the medical sector involves the creation of a new system of territorial organisation, the development of local self-government and the improvement of regional national policy. The development of the medical industry is one of the main factors in achieving the well-being of the population and national security. Most medical facilities are low-capacity hospitals with outdated technical equipment and worn-out fixed assets. New approaches to public health need to be introduced. The purpose of the study is to identify the main problems that negatively affect the development of the medical sector in Ukraine in the context of decentralisation reform. Decentralisation embodies the ability of communities to manage resources and have the authority to implement them. The mechanism of decentralisation reform involves the redistribution of financial resources and powers from central government to regional or local governments. The reform of the healthcare sector stipulates specific steps to improve the quality of life and services rendered, it has a conceptual content and a clear framework. In the process of decentralisation, a wide scope of reforms of regional policy and local self-government are being implemented. Its achievements are reducing corruption, improving governance and activating communities. However, this process is accompanied by numerous problems, challenges, and risks in the medical system, which need to be refined and taken into account for further successful implementation. The practical significance lies in identifying problematic factors in the development of the medical system and establishing relationships that hinder healthcare reform

A Student's Guide to the Classification and Operationalization of Variables in the Conceptualization and Design of a Clinical Study: Part 2.

Students without prior research experience may not know how to conceptualize and design a study. This is the second of a two-part article that explains how an understanding of the classification and operationalization of variables is the key to the process. Variables need to be operationalized; that is, defined in a way that permits their accurate measurement. They may be operationalized as categorical or continuous variables. Categorical variables are expressed as category frequencies in the sample as a whole, while continuous variables are expressed as absolute numbers for each subject in the sample. Continuous variables should not be converted into categorical variables; there are many reasons for this, the most important being that precision and statistical power are lost. However, in certain circumstances, such as when variables cannot be accurately measured, when there is an administrative or public health need, or when the data are not normally distributed, it may be justifiable to do so. Confounding variables are those that increase (or decrease) the apparent effect of an independent variable on the dependent variable, thereby producing spurious (or suppressing true) relationships. These and other concepts are explained with the help of clinically relevant examples.

The promise of public health ethics for precision medicine: the case of newborn preventive genomic sequencing

Precision medicine aims to tailor medical treatment to match individual characteristics and to stratify individuals to concentrate benefits and avoid harm. It has recently been joined by precision public health-the application of precision medicine at population scale to decrease morbidity and optimise population health. Newborn preventive genomic sequencing (NPGS) provides a helpful case study to consider how we should approach ethical questions in precision public health. In this paper, I use NPGS as a case in point to argue that both precision medicine and precision public health need public health ethics. I make this argument in two parts. First, I claim that discussions of ethics in precision medicine and NPGS tend to focus on predominantly individualistic concepts from medical ethics such as autonomy and empowerment. This highlights some deficiencies, including overlooking that choice is subject to constraints and that an individual's place in the world might impact their capacity to 'be responsible'. Second, I make the case for using a public health ethics approach when considering ethics and NPGS, and thus precision public health more broadly. I discuss how precision public health needs to be construed as a collective enterprise and not just as an aggregation of individual interests. I also show how analysing collective values and interests through concepts such as solidarity can enrich ethical discussion of NPGS and highlight previously overlooked issues. With this approach, bioethics can contribute to more just and more appropriate applications of precision medicine and precision public health, including NPGS.

58055 Mothers’ and Fathers’ Parent-Child Aggression Risk, Intimate Partner Violence, and Perceived Child Behavior Problems

ABSTRACT IMPACT: In light of the high co-occurrence between intimate partner violence (IPV) and physical child abuse, studying these forms of aggression simultaneously, bidirectionally, and longitudinally is vital to address this public health need. OBJECTIVES/GOALS: This study examined reciprocal associations between parent-child aggression (PCA) risk, IPV victimization, and perceived child behavior problems, to evaluate whether negative processes can transmit across family subsystems (i.e., spillover hypothesis) and/or across individuals (i.e., crossover hypothesis) over time. METHODS/STUDY POPULATION: Participants were first-time mothers and their male partners enrolled in a prospective longitudinal study, which tracked parenting and PCA risk over the transition to parenthood and into early childhood. The current project examined data from the third and fourth waves, when participants’ child was 18 months old and approximately 4 years old. At both timepoints, parents reported on their PCA risk (i.e., child abuse potential, harsh parenting), physical and psychological IPV victimization and perpetration, and perceived child behavior problems. Mothers and fathers each completed protocol on laptops in separate private rooms. Hypotheses were tested with autoregressive cross-lagged path models, which were estimated for mothers and fathers separately as well as dyadically. RESULTS/ANTICIPATED RESULTS: Findings partially supported the hypotheses, with evidence of spillover occurring bidirectionally for mothers and unidirectionally for both mothers and fathers. Mothers’ PCA risk predicted their subsequent IPV victimization and their reported child behavior problems (i.e., spillover effects) as well as fathers’ reported IPV victimization (i.e., crossover effect). Maternal reports of child behavior problems also predicted mothers’ reported IPV victimization and fathers’ reported child behavior problems, indicating possible child-driven effects. Overall, results demonstrate the mutual influence of individuals and subsystems within the family. Additionally, mothers rather than fathers appear more vulnerable to harmful spillover effects. DISCUSSION/SIGNIFICANCE OF FINDINGS: The need for family prevention and intervention services is clear, given the complex, transactional nature of family violence. Particularly for mothers, higher PCA risk may herald an increased risk for subsequent IPV victimization and vice versa. Clinical implications for parent-focused intervention programs are discussed.

A Novel Patient Values Tab for the Electronic Health Record: A User-Centered Design Approach.

BackgroundThe COVID-19 pandemic has shined a harsh light on a critical deficiency in our health care system: our inability to access important information about patients’ values, goals, and preferences in the electronic health record (EHR). At Memorial Sloan Kettering Cancer Center (MSK), we have integrated and systematized health-related values discussions led by oncology nurses for newly diagnosed cancer patients as part of routine comprehensive cancer care. Such conversations include not only the patient’s wishes for care at the end of life but also more holistic personal values, including sources of strength, concerns, hopes, and their definition of an acceptable quality of life. In addition, health care providers use a structured template to document their discussions of patient goals of care.ObjectiveTo provide ready access to key information about the patient as a person with individual values, goals, and preferences, we undertook the creation of the Patient Values Tab in our center’s EHR to display this information in a single, central location. Here, we describe the interprofessional, interdisciplinary, iterative process and user-centered design methodology that we applied to build this novel functionality as well as our initial implementation experience and plans for evaluation.MethodsWe first convened a working group of experts from multiple departments, including medical oncology, health informatics, information systems, nursing informatics, nursing education, and supportive care, and a user experience designer. We conducted in-depth, semistructured, audiorecorded interviews of over 100 key stakeholders. The working group sought consensus on the tab’s main content, homing in on high-priority areas identified by the stakeholders. The core content was mapped to various EHR data sources. We established a set of high-level design principles to guide our process. Our user experience designer then created wireframes of the tab design. The designer conducted usability testing with physicians, nurses, and other health professionals. Data validation testing was conducted.ResultsWe have already deployed the Patient Values Tab to a pilot sample of users in the MSK Gastrointestinal Medical Oncology Service, including physicians, advanced practice providers, nurses, and administrative staff. We have early evidence of the positive impact of this EHR innovation. Audit logs show increasing use. Many of the initial user comments have been enthusiastically positive, while others have provided constructive suggestions for additional tab refinements with respect to format and content.ConclusionsIt is our challenge and obligation to enrich the EHR with information about the patient as a person. Realization of this capability is a pressing public health need requiring the collaboration of technological experts with a broad range of clinical leaders, users, patients, and families to achieve solutions that are both principled and practical. Our new Patient Values Tab represents a step forward in this important direction.

The association of\xa0migration and ethnicity with\xa0use of the Improving Access to Psychological Treatment (IAPT) programme: a general population cohort study

BackgroundCommon mental disorders (CMD), such as depression and anxiety, are an important cause of morbidity, economic burden and public mental health need. The UK Improving Access to Psychological Therapies (IAPT) programme is a national effort to reduce the burden and impact of CMD, available since 2008.AimsTo examine ethnic and migration-related differences in use of IAPT-based psychological treatment using a novel epidemiological dataset with linkage to de-identified IAPT records.MethodData from a psychiatric morbidity survey of two South East London boroughs (2008–2010) were individually-linked to data on IAPT services serving those boroughs. We used Poisson regression to estimate association between ethnicity and migration status (including years of UK residence), with rate of subsequent use of psychological treatment.ResultsThe rate of psychological treatment use was 14.4 cases per thousand person years [cases/1000 pyrs, 95% confidence intervals (95% CI) 12.4, 16.7]. There was strong statistical evidence that compared to non-migrants, migrants residing in the UK for less than 10 years were less likely to use psychological treatment after adjustment for probable sociodemographic predictors of need, life adversity, and physical/psychiatric morbidity at baseline [rate ratio (RR) 0.4 (95% CI 0.20, 0.75]. This difference was not explained by migration for asylum/political reasons, or English language proficiency, and was evident for both self- and GP referrals.ConclusionsLower use of IAPT among recent migrants is unexplained by sociodemographics, adversity, and baseline morbidity. Further research should focus on other individual-level and societal barriers to psychological treatment use among recent migrants to the UK, including in categories of intersecting migration and ethnicity.

Induction of SARS-CoV-2 Protein S-Specific CD8+ T Cells in the Lungs of gp96-Ig-S Vaccinated Mice.

Given the aggressive spread of COVID-19-related deaths, there is an urgent public health need to support the development of vaccine candidates to rapidly improve the available control measures against SARS-CoV-2. To meet this need, we are leveraging our existing vaccine platform to target SARS-CoV-2. Here, we generated cellular heat shock chaperone protein, glycoprotein 96 (gp96), to deliver SARS-CoV-2 protein S (spike) to the immune system and to induce cell-mediated immune responses. We showed that our vaccine platform effectively stimulates a robust cellular immune response against protein S. Moreover, we confirmed that gp96-Ig, secreted from allogeneic cells expressing full-length protein S, generates powerful, protein S polyepitope-specific CD4+ and CD8+ T cell responses in both lung interstitium and airways. These findings were further strengthened by the observation that protein-S -specific CD8+ T cells were induced in human leukocyte antigen HLA-A2.1 transgenic mice thus providing encouraging translational data that the vaccine is likely to work in humans, in the context of SARS-CoV-2 antigen presentation.

Successfulimplementationof modern critical care in the low-resources country Bosnia and Herzegovina : Single-center experience.

BackgroundCritical care medicine is a relatively young discipline, developed in the mid-1950s in response to the outbreak of poliomyelitis. The mass application of mechanical ventilation and its subsequent technical advancement helped manage large numbers of patients with respiratory failure. This branch of medicine evolved much faster in high-income (HIC) than low- and middle-income countries (LMIC). Seventy years later, mankind’s encounter with coronavirus disease 2019 (COVID-19) represents another major challenge for critical care medicine especially in LMIC countries where over two thirds of the world population live.MethodsSystematic analysis of written documents related to the establishment of the first multidisciplinary medical intensive care unit (MICU) in Bosnia and Herzegovina and its development to the present day.ResultsWe describe the experience of setting up a modern critical care program under LMIC constraints as a promising way forward to meet the increased worldwide demand for critical care. Successful development is contingent on formal education and continued mentorship from HIC, establishment of a multidisciplinary team, the support from local health care authorities, development of a formal subspecialty training, academic faculty development, and research. Novel technologies including tele-education provide additional opportunities for rapid development and dissemination of critical care medicine programs in LMIC.ConclusionCritical care medicine is a critical public health need in HIC and LMIC alike. The challenges associated with the coronavirus pandemic should serve as a wakeup call for rapid development of critical care programs around the world.

A Nanoparticle-Based Trivalent Vaccine Targeting the Glycan Binding VP8* Domains of Rotaviruses.

Rotavirus causes severe gastroenteritis in children. Although vaccines are implemented, rotavirus-related diarrhea still claims ~200,000 lives annually worldwide, mainly in low-income settings, pointing to a need for improved vaccine tactics. To meet such a public health need, a P24-VP8* nanoparticle displaying the glycan-binding VP8* domains, the major neutralizing antigens of rotavirus, was generated as a new type of rotavirus vaccine. We reported here our development of a P24-VP8* nanoparticle-based trivalent vaccine. First, we established a method to produce tag-free P24-VP8* nanoparticles presenting the VP8*s of P[8], P[4], and P[6] rotaviruses, respectively, which are the three predominantly circulating rotavirus P types globally. This approach consists of a chemical-based protein precipitation and an ion exchange purification, which may be scaled up for large vaccine production. All three P24-VP8* nanoparticle types self-assembled efficiently with authentic VP8*-glycan receptor binding function. After they were mixed as a trivalent vaccine, we showed that intramuscular immunization of the vaccine elicited high IgG titers specific to the three homologous VP8* types in mice. The resulted mouse sera strongly neutralized replication of all three rotavirus P types in cell culture. Thus, the trivalent P24-VP8* nanoparticles are a promising vaccine candidate for parenteral use against multiple P types of predominant rotaviruses.

Mobile Apps for COVID-19 Surveillance: Balancing Public Health Needs with the Privacy of Personal Data

Privacy of personal information is a protected human right both under the international human rights and national laws, statutes and regulations, subject to so exceptions that include protecting public health. The COVID-19 pandemic has challenged and overwhelmed the status quo in every human sphere, including the conventional surveillance of infectious diseases, contact tracing, isolation, reporting and vaccination while simultaneously protecting the privacy of personal data. The pandemic had led national governments, institutions and agencies to adopt mobile applications for collecting, analysing, managing and sharing critical personal data of individuals infected with or exposed to COVID-19. These data may be centralized at a central database, or localized in individuals’ phones. While the benefits of sharing private information for achieving public health needs may not be disputed, the risk of breach of personal privacy is, also, enormous. Consequently, it forced the national governments into a dilemma of either succumbing to public health needs, or strictly respecting and protecting the privacy of individuals, or balancing the two conflicting demands. There is a massive body of literature on the security and privacy of such mobile applications, but none has adequately explored and discussed the public interest justifications under the Saudi Arabian laws for the alleged privacy breaches. This paper explored the COVID-19 surveillance mobile app technologies in use in Saudi Arabia for their potential risks of data breaches under the prevailing data protection laws and regulations with a view to understanding if such breaches are obligated, allowed, or justified under the laws. Our findings suggest that any potential risk of a breach to the individuals’ privacy of personal information under the law would seem to have been properly balanced against (justified by) the public health needs to protect the society during the COVID-19 pandemic.