Efficacy and Safety of Ensovibep for Adults Hospitalized With COVID-19 : A Randomized Controlled Trial.

BACKGROUND: Ensovibep (MP0420) is a designed ankyrin repeat protein, a novel class of engineered proteins, under investigation as a treatment of SARS-CoV-2 infection. OBJECTIVE: To investigate if ensovibep, in addition to remdesivir and other standard care, improves clinical outcomes among patients hospitalized with COVID-19 compared with standard care alone. DESIGN: Double-blind, randomized, placebo-controlled, clinical trial. (ClinicalTrials.gov: NCT04501978). SETTING: Multinational, multicenter trial. PARTICIPANTS: Adults hospitalized with COVID-19. INTERVENTION: Intravenous ensovibep, 600 mg, or placebo. MEASUREMENTS: Ensovibep was assessed for early futility on the basis of pulmonary ordinal scores at day 5. The primary outcome was time to sustained recovery through day 90, defined as 14 consecutive days at home or place of usual residence after hospital discharge. A composite safety outcome that included death, serious adverse events, end-organ disease, and serious infections was assessed through day 90. RESULTS: An independent data and safety monitoring board recommended that enrollment be halted for early futility after 485 patients were randomly assigned and received an infusion of ensovibep (n = 247) or placebo (n = 238). The odds ratio (OR) for a more favorable pulmonary outcome in the ensovibep (vs. placebo) group at day 5 was 0.93 (95% CI, 0.67 to 1.30; P = 0.68; OR > 1 would favor ensovibep). The 90-day cumulative incidence of sustained recovery was 82% for ensovibep and 80% for placebo (subhazard ratio [sHR], 1.06 [CI, 0.88 to 1.28]; sHR > 1 would favor ensovibep). The primary composite safety outcome at day 90 occurred in 78 ensovibep participants (32%) and 70 placebo participants (29%) (HR, 1.07 [CI, 0.77 to 1.47]; HR < 1 would favor ensovibep). LIMITATION: The trial was prematurely stopped because of futility, limiting power for the primary outcome. CONCLUSION: Compared with placebo, ensovibep did not improve clinical outcomes for hospitalized participants with COVID-19 receiving standard care, including remdesivir; no safety concerns were identified. PRIMARY FUNDING SOURCE: National Institutes of Health.

Casirivimab and Imdevimab for the Treatment of Hospitalized Patients With COVID-19.

BACKGROUND: The open-label RECOVERY study reported improved survival in hospitalized, SARS-CoV-2 seronegative patients treated with casirivimab and imdevimab (CAS + IMD). METHODS: In this phase 1/2/3, double-blind, placebo-controlled trial conducted prior to widespread circulation of Delta and Omicron, hospitalized COVID-19 patients were randomized (1:1:1) to 2.4 g or 8.0 g CAS + IMD or placebo, and characterized at baseline for viral load and SARS-CoV-2 serostatus. RESULTS: In total, 1336 patients on low-flow or no supplemental (low-flow/no) oxygen were treated. The primary endpoint was met in seronegative patients, the least-squares mean difference (CAS + IMD versus placebo) for time-weighted average change from baseline in viral load through day 7 was -0.28 log10 copies/mL (95% confidence interval [CI], -.51 to -.05; P = .0172). The primary clinical analysis of death or mechanical ventilation from day 6 to 29 in patients with high viral load had a strong positive trend but did not reach significance. CAS + IMD numerically reduced all-cause mortality in seronegative patients through day 29 (relative risk reduction, 55.6%; 95% CI, 24.2%-74.0%). No safety concerns were noted. CONCLUSIONS: In hospitalized COVID-19 patients on low-flow/no oxygen, CAS + IMD reduced viral load and likely improves clinical outcomes in the overall population, with the benefit driven by seronegative patients, and no harm observed in seropositive patients. CLINICAL TRIALS REGISTRATION: NCT04426695.

Lay Summary . Monoclonal antibody therapies that block the virus that causes COVID-19 (SARS-CoV-2) can prevent patients from being hospitalized. We hypothesized that these antibodies may also benefit patients who are already hospitalized with COVID-19. Therefore, we performed a study to determine if the monoclonal antibody combination of casirivimab and imdevimab (CAS + IMD) can decrease the amount of virus in the nose of hospitalized patients and prevent the disease from becoming more severe. The study, conducted from June 2020 to April 2021, found that CAS + IMD treatment reduced the amount of virus in these patients, and may reduce their chance of dying or needing a ventilator (a machine that helps patients breathe). Patients were examined in 2 groups: those whose immune systems, at the start of the study, had not produced their own antibodies to fight SARS-CoV-2 (seronegative patients); or those that had already produced their own antibodies (seropositive patients) at the start of the study. Seronegative patients benefited the most from CAS + IMD. No safety concerns related to CAS + IMD were observed. These results demonstrate that monoclonal antibody therapy can help hospitalized patients with COVID-19 and may decrease their chances of needing assistance to breathe or dying.

Efficacy and Safety of Sarilumab in Hospitalized Patients With Coronavirus Disease 2019: A Randomized Clinical Trial.

BACKGROUND: Open-label platform trials and a prospective meta-analysis suggest efficacy of anti-interleukin (IL)-6R therapies in hospitalized patients with coronavirus disease 2019 (COVID-19) receiving corticosteroids. This study evaluated the efficacy and safety of sarilumab, an anti-IL-6R monoclonal antibody, in the treatment of hospitalized patients with COVID-19. METHODS: In this adaptive, phase 2/3, randomized, double-blind, placebo-controlled trial, adults hospitalized with COVID-19 received intravenous sarilumab 400 mg or placebo. The phase 3 primary analysis population included patients with critical COVID-19 receiving mechanical ventilation (MV). The primary outcome was proportion of patients with ≥1-point improvement in clinical status from baseline to day 22. RESULTS: There were 457 and 1365 patients randomized and treated in phases 2 and 3, respectively. In phase 3, patients with critical COVID-19 receiving MV (n = 298; 28.2% on corticosteroids), the proportion with ≥1-point improvement in clinical status (alive, not receiving MV) at day 22 was 43.2% for sarilumab and 35.5% for placebo (risk difference, +7.5%; 95% confidence interval [CI], -7.4 to 21.3; P =.3261), a relative risk improvement of 21.7%. In post hoc analyses pooling phase 2 and 3 critical patients receiving MV, the hazard ratio for death for sarilumab vs placebo was 0.76 (95% CI, .51 to 1.13) overall and 0.49 (95% CI, .25 to .94) in patients receiving corticosteroids at baseline. CONCLUSIONS: This study did not establish the efficacy of sarilumab in hospitalized patients with severe/critical COVID-19. Post hoc analyses were consistent with other studies that found a benefit of sarilumab in patients receiving corticosteroids. CLINICAL TRIALS REGISTRATION: NCT04315298.

Prone Positioning in Moderate to Severe Acute Respiratory Distress Syndrome Due to COVID-19: A Cohort Study and Analysis of Physiology.

BACKGROUND: Coronavirus disease 2019 (COVID-19) can lead to acute respiratory distress syndrome (ARDS) but it is unknown whether prone positioning improves outcomes in mechanically ventilated patients with moderate to severe ARDS due to COVID-19. METHODS: A cohort study at a New York City hospital at the peak of the early pandemic in the United States, under crisis conditions. The aim was to determine the benefit of prone positioning in mechanically ventilated patients with ARDS due to COVID-19. The primary outcome was in-hospital death. Secondary outcomes included changes in physiologic parameters. Fine-Gray competing risks models with stabilized inverse probability treatment weighting (sIPTW) were used to determine the effect of prone positioning on outcomes. In addition, linear mixed effects models (LMM) were used to assess changes in physiology with prone positioning. RESULTS: Out of 335 participants who were intubated and mechanically ventilated, 62 underwent prone positioning, 199 met prone positioning criteria and served as controls and 74 were excluded. The intervention and control groups were similar at baseline. In multivariate-adjusted competing risks models with sIPTW, prone positioning was significantly associated with reduced mortality (SHR 0.61, 95% CI 0.46-0.80, P < 0.005). Using LMM to evaluate the impact of positioning maneuvers on physiological parameters, the oxygenation-saturation index was significantly improved during days 1-3 (P < 0.01) whereas oxygenation-saturation index (OSI), oxygenation-index (OI) and arterial oxygen partial pressure to fractional inspired oxygen (PaO2: FiO2) were significantly improved during days 4-7 (P < 0.05 for all). CONCLUSIONS: Prone positioning in patients with moderate to severe ARDS due to COVID-19 is associated with reduced mortality and improved physiologic parameters. One in-hospital death could be averted for every 8 patients treated. Replicating results and scaling the intervention are important, but prone positioning may represent an additional therapeutic option in patients with ARDS due to COVID-19.

Impact of 2018 ASCO/CAP guidelines on HER-2 reporting categories of IHC and reflex FISH in breast cancer.

Human epidermal growth factor receptor 2 (HER-2) is an established prognostic and predictive biomarker for breast cancer. To ensure accuracy and uniformity for HER-2 testing, ASCO/CAP published guidelines in 2007 which were updated in 2013 and recently in 2018. In this first study from Indian Oncology center, we evaluated the impact of 2018 ASCO/CAP guidelines. We found a substantial decrease in equivocal IHC cases (P-value < .00001). On reclassification, a total of 5.6% cases from equivocal and positive categories (2013 guidelines) shifted to the negative FISH result category (P-value < .0001), with adoption of 2018 guidelines and eliminated the double equivocal cases.

Vitamin C Therapy for Routine Care in Septic Shock (ViCTOR) Trial: Effect of Intravenous Vitamin C, Thiamine, and Hydrocortisone Administration on Inpatient Mortality among Patients with Septic Shock.

BACKGROUND: Sepsis remains a leading cause of death worldwide despite advances in management strategies. Preclinical and observational studies have found mortality benefit with high-dose vitamin C in sepsis. Our study aims to prospectively evaluate the effect of intravenous hydrocortisone, vitamin C [ascorbic acid (AA)], and thiamine (HAT) administration in reducing inpatient all-cause mortality among patients with septic shock. MATERIALS AND METHODS: Our single-center, prospective, open-label, randomized controlled trial recruited patients with admitting diagnosis of septic shock and assigned eligible patients (1:1) into either intervention (HAT) or control group (routine). The HAT group received intravenous combination of vitamin C (1.5 g every 6 hours), thiamine (200 mg every 12 hours), and hydrocortisone (50 mg every 6 hours) within 6 hours of onset of septic shock admission. The treatment was continued for at least 4 days, in addition to the routine standard of care provided to the control group. Thiamine and hydrocortisone use in control arm was not restricted. Vitamin C levels were estimated at baseline and at the end of the 4 days of treatment for both groups. The primary outcome evaluated was mortality during inpatient stay. RESULTS: Among 90 patients enrolled, 88 patients completed the study protocol. The baseline characteristics between the HAT (n = 45) and the routine (n = 43) groups were comparable. The all-cause mortality in the HAT cohort was 57% (26/45) compared to 53% (23/43) in the routine care group (p = 0.4, OR 1.19, 95% CI 0.51-2.76). The time to reversal of septic shock was significantly lower in the HAT (34.58 ± 22.63 hours) in comparison to the routine care (45.42 ± 24.4 hours) (p = 0.03, mean difference -10.84, 95% CI -20.8 to -0.87). No significant difference was observed between the HAT and the routine care with respect to changes in sequential organ failure assessment (SOFA) scores at 72 hours (2.23 ± 2.4 vs 1.38 ± 3.1), the use of mechanical ventilation (48% vs 46%), and mean Vasoactive Inotropic Score (7.77 ± 12.12 vs 8.86 ± 12.5). CONCLUSION: Intravenous administration of vitamin C, thiamine, and hydrocortisone did not significantly improve the inpatient all-cause mortality among patients with septic shock. CLINICAL SIGNIFICANCE: HAT protocol does not reduce hospital mortality but decreases time to shock reversal in septic shock. HOW TO CITE THIS ARTICLE: Mohamed ZU, Prasannan P, Moni M, Edathadathil F, Prasanna P, Menon A, et al. Vitamin C Therapy for Routine Care in Septic Shock (ViCTOR) Trial: Effect of Intravenous Vitamin C, Thiamine, and Hydrocortisone Administration on Inpatient Mortality among Patients with Septic Shock. Indian J Crit Care Med 2020;24(8):653-661.

Dengue virus transmission from live donor liver graft.

Arboviral transmission through transplanted organs is rare. We report a highly probable case of dengue viral transmission during live donor liver transplantation. Fever with severe thrombocytopenia was observed in the donor and recipient within 6 and 9 days after transplantation, respectively. Dengue diagnosis was confirmed by testing blood and explant tissue from the donor and recipient using dengue-specific NAT (nucleic acid testing) and serology. Serology indicated the donor had secondary dengue infection that ran a mild course. However, the dengue illness in the recipient was severe and deteriorated rapidly, eventually proving fatal. The recipient's explant liver tissue tested negative for viral RNA indicative of a pretransplant naïve status. The prM-Envelope gene sequence analysis of the donor and recipient viral RNA identified a similar serotype (DENV1) with almost 100% sequence identity in the envelope region. Molecular phylogenetic analysis of donor and recipient viral envelope sequences with regional and local dengue strains further confirmed their molecular similarity, suggesting a probable donor-to-recipient transmission via organ transplantation. Screening of living donors for dengue virus may be considered in endemic regions.

Analyzing candidemia guideline adherence identifies opportunities for antifungal stewardship.

Candidemia epidemiology varies significantly by region; thus, local data are essential for evidence-based decision-making in prophylaxis and treatment. Current management strategies are derived from large randomized controlled trials mostly executed in large high-volume tertiary care centers. Results may not be entirely transferable to smaller hospitals. This study investigates epidemiology, diagnosis, and treatment standards in six hospitals in the Cologne metropolitan area (number of inhabitants approx. one million). We assessed adherence to the current guideline of the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and the Infectious Diseases Society of America (IDSA) using the EQUAL Candida Score of the European Confederation of Medical Mycology (ECMM). Data were documented by trained medical students as part of an integrated research and teaching concept at the University of Cologne. Between January 2014 and June 2017, 77 patients had candidemia, corresponding to an incidence of 0.2 cases/1000 admissions. While 55 patients were enrolled, 22 patients were excluded due to incompletely retrievable health records. Fluconazole monotherapy was the preferred first-line treatment in cases with Candida albicans infection (21/29). A central vascular catheter was present in 40 patients and was removed in 17 (43%) during treatment. Overall mortality at 30 days was 44%. Patients reached a mean EQUAL Candida Score of 9.9 (range 8-14), which was well below the maximum score of 22 for perfect guideline adherence. In summary, management of candidemia differed from current European recommendations. It remains unclear to what extent enhanced adherence would improve patient outcome. Larger prospective studies need to answer that question.

EQUAL Candida Score: An ECMM score derived from current guidelines to measure QUAlity of Clinical Candidaemia Management.

Candida species frequently cause blood stream infections and are reported to be the third to tenth most commonly isolated pathogens. Guidelines and standardised treatment algorithms provided by professional organisations aim to facilitate decision-making regarding diagnosis, management and treatment of candidaemia. In routine clinical practise, however, it may be challenging to comply with these guidelines. The reasons include lack of familiarity or feasibility to adherence, but also their length and complexity. There is no tool to measure guideline adherence currently. To provide such a tool, we reviewed the current guidelines provided by the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and by the Infectious Diseases Society of America (IDSA), and selected the strongest recommendations for management quality as the bases for our scoring tool. Factors incorporated were diagnostic (blood cultures, echocardiography, ophthalmoscopy, species identification) and follow-up procedures (repeat blood cultures until negative result) as well as key treatment parameters (echinocandin treatment, step down to fluconazole depending on susceptibility result, CVC removal). The EQUAL Candida Score weighs and aggregates factors recommended for the ideal management of candidaemia and provides a tool for antifungal stewardship as well as for measuring guideline adherence.

Asymmetric Flows in the Intercellular Membrane during Cytokinesis.

Eukaryotic cells undergo shape changes during their division and growth. This involves flow of material both in the cell membrane and in the cytoskeletal layer beneath the membrane. Such flows result in redistribution of phospholipid at the cell surface and actomyosin in the cortex. Here we focus on the growth of the intercellular surface during cell division in a Caenorhabditis elegans embryo. The growth of this surface leads to the formation of a double-layer of separating membranes between the two daughter cells. The division plane typically has a circular periphery and the growth starts from the periphery as a membrane invagination, which grows radially inward like the shutter of a camera. The growth is typically not concentric, in the sense that the closing internal ring is located off-center. Cytoskeletal proteins anillin and septin have been found to be responsible for initiating and maintaining the asymmetry of ring closure but the role of possible asymmetry in the material flow into the growing membrane has not been investigated yet. Motivated by experimental evidence of such flow asymmetry, here we explore the patterns of internal ring closure in the growing membrane in response to asymmetric boundary fluxes. We highlight the importance of the flow asymmetry by showing that many of the asymmetric growth patterns observed experimentally can be reproduced by our model, which incorporates the viscous nature of the membrane and contractility of the associated cortex.

Critical role of dopant in NiOx hole transport layer for mitigating redox reactivity at NiOx/absorber interface in mixed cation perovskite solar cells.

Redox chemistry transpiring at the interface of NiOx hole transport layer (HTL) and perovskite absorber is a critical phenomenon leading to relatively low values of open circuit voltage (VOC) and fill factor (FF), in turn hampering the overall device performance and stability. In this work, for the first time, the hard acid electronic nature of vanadium (V) dopant in nickel oxide HTL is opportunely exploited to mitigate the undesirable Lewis acid-base reactions occurring at the HTL/mixed-cation perovskite interface. The findings of the study show that vanadium doping results in improved interfacial energetics along with decreased VOC loss, confirming that despite the increase in Ni3+/Ni2+ ratio with the vanadium dopant, the redox reaction catalyzed by Ni3+ ions is kept under check. Vanadium doping also aided in the realization of superior perovskite films with lower Urbach energy, which translated into one order increase in maximum photoinduced carrier generation rate per unit volume. Carrier dynamics investigations show fewer defect states (lower VTFL) and trap-assisted recombination (lower diode ideality factor), which optimize the devices' photovoltaic performance. These benefits collectively contribute to low-loss charge transfer across the NiOx/mixed-cation perovskite interface, which increases the relative efficiency by ∼30% for 5 wt% V-doped NiOx devices compared to pristine NiOx devices, augmented by an increase in device J-V parameters like open circuit voltage (VOC), short circuit current density (JSC), and fill factor (FF).

Rational Design, Synthesis, and Structure-Property Relationship Studies of a Library of Thermoplastic Polyurethane Films as an Effective and Scalable Encapsulation Material for Perovskite Solar Cells.

Hybrid organic-inorganic metal halide perovskite solar cell (PSC) technology is experiencing rapid growth due to its simple solution chemistry, high power conversion efficiency (PCE), and potential for low-cost mass production. Nevertheless, the primary obstacle preventing the upscaling and widespread outdoor deployment of PSC technology is the poor long-term device stability, which stems from the inherent instability of perovskite materials in the presence of oxygen and moisture. To address this issue, in this work, we have synthesized a series of thermoplastic polyurethanes (TPUs) through a rational design by utilizing polyols having different molecular weights and diverse isocyanates (aromatic and aliphatic). Thorough characterization of these TPUs (ASTM and ISO standards) along with structure-property relationship studies were carried out for the first time and were then used as the encapsulation material for PSCs. The prepared TPUs were robust and adhered well with the glass substrate, and the use of low temperature during the encapsulation process avoided the degradation of the perovskite absorber and other organic layers in the device stack. The encapsulated devices retained more than 93% of their initial power conversion efficiency (PCE) for over 1000 h after exposure to harsh environmental conditions such as high relative humidity (80 ± 5% RH). Furthermore, the encapsulated perovskite absorbers showed remarkable stability when they were soaked in water. This article demonstrates the potential of TPU as a suitable and easily scalable encapsulant for PSCs and pave the way for extending the lifetime and commercialization of PSCs.

Post-Intensive Care Syndrome Among Survivors in a Safety Net Hospital in South Bronx: A Comparison of Patients With and Without Coronavirus Disease 2019.

Comparison of post-intensive care syndrome between critically ill survivors with or without coronavirus disease 2019 (CovP and CovN, respectively) showed that fewer CovP were able to return to work full time at >1 year and none at <1 year after discharge and that the majority of CovP survivors were able to work part time during both evaluation periods compared to CovN.

Healthcare worker trauma and related mental health outcomes during the COVID-19 outbreak in New York City.

Healthcare workers (HCWs) faced a range of stressors during the coronavirus (COVID-19) pandemic, contributing to psychological stress. We use a psychological trauma framework to characterize the mental health burden for clinical and non-clinical healthcare worker occupations during the COVID-19 pandemic. The objective was to measure and characterize risk factors for trauma and anxiety-related mental health problems among HCWs at a public hospital in the epicenter of the COVID-19 pandemic in New York City (NYC). This study reports findings from a cross-sectional survey of NYC HCWs shortly after the initial 2020 infection surge. Over 800 hospital employees completed the survey that assessed professional quality of life indicators (compassion satisfaction [CS], burnout [BO], secondary traumatic stress [STS]), Coronavirus Anxiety (CS), Obsession with Coronavirus (OC), and PTSD symptoms. The survey also assessed pandemic-related work and life circumstances such as "do you have a family member or friend who tested positive for COVID". Relatively small percentages of HCWs endorsed probable Coronavirus Anxiety (6%), PTSD (13%), and Coronavirus Obsession (21%). We observed higher proportions of Burnout (29%), Moderate or High Secondary Traumatic Stress (45%), and High Compassion Satisfaction (52%). Adjusted regression models showed important implications for prior behavioral/emotional health concerns among HCWs, providing care for a patient that died from COVID-19, and other characteristics. This study supports prior studies documenting the mental health consequences for the healthcare workforce during the COVID-19 pandemic. This study builds on that base by including non-clinical staff in the sample and assessing pandemic life-stressors such as caring for sick family members.

Renal recovery after acute kidney injury in a minority population of hospitalized COVID-19 patients: A retrospective cohort study.

ABSTRACT: This study aimed to characterize survivors of Coronavirus disease 2019 (COVID-19) infection and acute kidney injury (AKI) that recover their renal function or progress to acute kidney disease (AKD) on discharge; and determine factors associated with progression to AKD during hospital stay.One thousand seventy four patients with COVID-19 infection were followed up until discharge/death. The incidence of AKI was 59.7%. Two hundred and sixty-six patients were discharged alive and included in the analysis, 71.8% had renal recovery (RR) while 28.2% were discharged with AKD. The AKD subset has higher rate of chronic kidney disease (CKD) ≥3 (33.4% vs 14.1%, P = .001), congestive heart failure (18.7% vs 5.8%, P = .001), use of non-invasive mechanical ventilation (10.7% vs 3.7%, P = .026) and vasopressors (25.3% vs 12.0%, P = .007). Of 19 patients in the AKI survivor cohort who received renal replacement therapy, 1 had RR while 18 progressed to AKD on discharge. Predictors to progression to AKD were CKD ≥3 (Odds Ratio [OR]: 3.23, 95% confidence interval [CI] 1.59-6.56, P = .001), congestive heart failure (OR: 4.59, 95% CI 1.76-11.78, P = .002), AKI on admission (OR: 2.71, 95% CI, 1.14-6.46, P = .025), and ongoing diarrhea (OR: 3.19, 95% CI, 1.02-9.96, P = .025).This study demonstrates a higher proportion of RR among survivors of COVID-19 infection in our minority predominant cohort. Early identification and appropriate management of patients at-risk to progress to AKD could improve outcomes, reduce long term sequalae of CKD/end stage renal disease, and have a major impact on health outcome and financial strain on healthcare system.

Epidemiology of Community-Acquired Sepsis: Data from an E-Sepsis Registry of a Tertiary Care Center in South India.

The study aims to characterize community-acquired sepsis patients admitted to our 1300-bedded tertiary care hospital in South India from the Surviving Sepsis Campaign (SSC) guideline-compliant e-sepsis registry stratified by focus of infection. The prospective observational study recruited 1009 adult sepsis patients presenting to the emergency department at the center based on Sepsis-2 criteria for a period of three years. Of the patients, 41% were between 61 and 80 years with a mean age of 57.37 ± 13.5%. A total of 13.5% (136) was under septic shock and in-hospital mortality for the study cohort was 25%. The 3 h and 6 h bundle compliance rates observed were 37% and 49%, respectively, without significant survival benefits. Predictors of mortality among patients with bloodstream infections were septic shock (p = 0.01, OR 2.4, 95% CI 1.23-4.79) and neutrophil-to-lymphocyte ratio (p = 0.008, OR 1.01, 95% CI 1.009-1.066). The presence of Acinetobacter (p = 0.005, OR 4.07, 95% CI 1.37-12.09), Candida non-albicans (p = 0.001, OR16.02, 95% CI 3.0-84.2) and septic shock (p = 0.071, OR 2.5, 95% CI 0.97-6.6) were significant predictors of mortality in patients with community-acquired pneumonia. The registry has proven to be a key data source detailing regional microbial etiology and clinical outcomes of adult sepsis patients, enabling comprehensive evaluation of regional community-acquired sepsis to tailor institutional sepsis treatment protocols.

Role of a Chest X-ray Severity Score in a Multivariable Predictive Model for Mortality in Patients with COVID-19: A Single-Center, Retrospective Study.

Predicting the mortality risk of patients with Coronavirus Disease 2019 (COVID-19) can be valuable in allocating limited medical resources in the setting of outbreaks. This study assessed the role of a chest X-ray (CXR) scoring system in a multivariable model in predicting the mortality of COVID-19 patients by performing a single-center, retrospective, observational study including consecutive patients admitted with a confirmed diagnosis of COVID-19 and an initial CXR. The CXR severity score was calculated by three radiologists with 12 to 15 years of experience in thoracic imaging, based on the extent of lung involvement and density of lung opacities. Logistic regression analysis was used to identify independent predictive factors for mortality to create a predictive model. A validation dataset was used to calculate its predictive value as the AUROC. A total of 628 patients (58.1% male) were included in this study. Age (p < 0.001), sepsis (p < 0.001), S/F ratio (p < 0.001), need for mechanical ventilation (p < 0.001), and the CXR severity score (p = 0.005) were found to be independent predictive factors for mortality. We used these variables to develop a predictive model with an AUROC of 0.926 (0.891, 0.962), which was significantly higher than that of the WHO COVID severity classification, 0.853 (0.798, 0.909) (one-tailed p-value = 0.028), showing that our model can accurately predict mortality of hospitalized COVID-19 patients.

Impact of Local and Demographic Factors on Early COVID-19 Vaccine Hesitancy among Health Care Workers in New York City Public Hospitals.

Despite the development of several effective vaccines, SARS-CoV-2 continues to spread, causing serious illness among the unvaccinated. Healthcare professionals are trusted sources of information about vaccination, and therefore understanding the attitudes and beliefs of healthcare professionals regarding the vaccines is of utmost importance. We conducted a survey-based study to understand the factors affecting COVID-19 vaccine attitudes among health care professionals in NYC Health and Hospitals, at a time when the vaccine was new, and received 3759 responses. Machine learning and chi-square analyses were applied to determine the factors most predictive of vaccine hesitancy. Demographic factors, education, role at the hospital, perceptions of the pandemic itself, and location of work and residence were all found to significantly contribute to vaccine attitudes. Location of residence was examined for both borough and neighborhood, and was found to have a significant impact on vaccine receptivity. Interestingly, this borough-level data did not correspond to the number or severity of cases in the respective boroughs, indicating that local social or other influences likely have a substantial impact. Local and demographic factors should be strongly considered when preparing pro-vaccine messages or campaigns.

An automated microfluidic sample preparation system for laser scanning cytometry.

Laser scanning cytometry (LSC) is emerging as a clinical tool. In one application a "Clatch" slide, named after the inventor, is used in conjunction with LSC for cell surface marker immunophenotyping of patient samples. The slide requires time consuming and laborious pipetting steps, making a test tedious and prone to handling errors. The Clatch slide also uses a significant number of cells, limiting the number of analyses on paucicellular samples. This paper presents an automated microfluidic system consisting of a control circuit, a microfluidic system, and an aluminum frame, capable of performing immunophenotyping procedures. This prototype system reduces 36 pipetting steps to 1, reduces the amount of cell sample from 180 µL to 56 µL, and shortens the time used by technicians.

Acquisition of Teamwork and Communication Skills Using High-Technology Simulation for Preclerkship Medical Students.

INTRODUCTION: Teamwork failures are a major source of preventable error in medicine. Acquisition of skills early in training seems beneficial for impacting system-level change. Simulation-based curricula provide a psychologically safe and formative environment to learn and practice team skills. This project aims to assess teamwork and communication skill acquisition in preclerkship medical students during a longitudinal simulation-based curriculum. METHODS: This is a prospective, observational study of medical students participating in a high-technology simulation curriculum on team principles. Students, in groups of 5 to 7, participated in 6 mannequin-based simulation sessions over 10 months coordinated with an organ system-based preclerkship course. Each scenario was executed by a simulation technologist and guided by a simulation educator who functioned as a bedside nurse and led a postsimulation debrief. Likert-based, self- and global assessments completed by students and facilitators, respectively, were used to evaluate the teams. Descriptive statistics and Mann-Whitney U test were used to analyze data using a P value of less than 0.05 for statistical significance and a null hypothesis stating that there would be no change in behavior. The primary outcome measure was improvement in the teamwork and communication domains of both assessments. RESULTS: Students (N = 231) were divided into the same 32 groups during every session. At the end of every session, each student completed a self-assessment and each educator completed the team's global assessment for teamwork. Median scores for teamwork and communication domains increased between the first and sixth sessions on both assessments. Mann-Whitney U analysis of self-assessment scores showed Z values between -5.30 and -8.83 and P values of less than 0.00001. Mann-Whitney U analysis of global assessment scores showed Z values ranging from -3.43 to -5.24 and P values between 0.0031 and less than 0.00001. CONCLUSIONS: There was meaningful improvement in scores in the domains of teamwork and communication over the 10-month, simulation-based curriculum designed to teach and hone teamwork skills.