Tourism and emerging infectious diseases: more connections than first meet the eye

Disease outbreaks can severely disrupt the global tourism sector. New approaches for preventing infectious diseases from emerging and spreading are urgently needed to secure the prosperity of the tourism industry. This conceptual article proposes a comprehensive framework of interrelationships between tourism and emerging infectious disease. The conceptual framework highlights the pathways in which the tourism industry itself can potentially contribute to the emergence and spread of infectious diseases, including tourism-induced land changes, sourcing meat from intensive animal farms, global movement and close proximity of people, and high-risk sexual activities. Based on the interrelationships, the framework proposes tangible managerial action recommendations for tourism businesses and policy makers to contribute to the prevention of future disease outbreaks. This paper concludes with a research agenda on how scholars can support tourism practitioners and governments in reducing the likelihood of future epidemics and pandemics.

Pediatric emergency department physicians' perceptions of virtual mental health assessments for urgent needs.

PURPOSE: Pressures related to the COVID-19 pandemic have created the need to develop innovative ways to deliver mental health care, especially for urgent needs. After the launch of a pediatric Emergency Department (ED) Virtual Care service, we aimed to evaluate pediatric ED physicians' experiences with the use of ED virtual care for mental health assessments. METHODS: This mixed-methods study was conducted at a pediatric academic health center in Ontario, Canada. Pediatric ED physicians who conducted ED virtual mental health assessments from May to December 2020 were eligible. Participants completed a 22-question novel survey and were invited to participate in a focus group. Descriptive and thematic analyses were used to analyze the data. RESULTS: Twenty-nine physicians provided mental health services through the ED virtual care platform. Twenty-five physicians (86% response rate) completed the survey and 3 (10%) participated in a focus group. While many agreed that virtual care benefits patients (67%), key barriers identified included time constraints, lack of mental health clinician support, and uncertainty around the pediatric ED physicians' role in these types of assessments. Despite these barriers, physicians recognized the potential benefit of the ED virtual care service for mental health assessments and were largely amenable to improving this process should mental health support be available. CONCLUSIONS: While many physicians agreed that there is a potential benefit of the ED virtual care platform for urgent mental health assessments, time constraints and lack of confidence in providing satisfactory virtual mental health care with minimal mental health support limited its acceptability. These findings can inform the future implementation of mental health services using an innovative virtual ED platform.

RéSUMé: OBJECTIF: Les pressions liées à la pandémie de COVID-19 ont créé le besoin de développer des moyens innovants pour fournir des soins de santé mentale, en particulier pour les besoins urgents. Après le lancement d'un service de soins virtuels aux urgences pédiatriques, nous avons cherché à évaluer les expériences des médecins des urgences pédiatriques avec l'utilisation des soins virtuels aux urgences pour les évaluations de la santé mentale. MéTHODOLOGIE: Cette étude à méthodes mixtes a été menée dans un centre universitaire de santé pédiatrique en Ontario, au Canada. Les médecins pédiatriques qui ont effectué des évaluations virtuelles de la santé mentale aux urgences de mai à décembre 2020 étaient admissibles. Les participants ont rempli une enquête inédite de 22 questions et ont été invités à participer à un groupe de discussion. Des analyses descriptives et thématiques ont été utilisées pour analyser les données. RéSULTATS: Vingt-neuf médecins ont fourni des services de santé mentale par le biais de la plateforme de soins virtuels des urgences. Vingt-cinq médecins (taux de réponse de 86 %) ont répondu au sondage et trois (10 %) ont participé à un groupe de discussion. Si beaucoup s'accordent à dire que les soins virtuels sont bénéfiques pour les patients (67 %), les principaux obstacles identifiés sont les contraintes de temps, le manque de soutien des cliniciens en santé mentale et l'incertitude quant au rôle des urgentistes pédiatriques dans ces types d'évaluations. Malgré ces obstacles, les médecins ont reconnu l'avantage potentiel du service de soins virtuels de l'urgence pour les évaluations de la santé mentale et étaient largement disposés à améliorer ce processus si un soutien en santé mentale était disponible. CONCLUSIONS: Bien que de nombreux médecins s'accordent à dire que la plateforme de soins virtuels des urgences présente un avantage potentiel pour les évaluations urgentes de la santé mentale, les contraintes de temps et le manque de confiance dans la prestation de soins de santé mentale virtuels satisfaisants avec un soutien minimal en matière de santé mentale ont limité son acceptabilité. Ces résultats peuvent éclairer la mise en œuvre future des services de santé mentale à l'aide d'une plateforme virtuelle d'urgence innovante.

Outbreak and Management of COVID-19 and Infection Prevention Control Practices at a Community Living Center in Veterans Administration Hospital, North Texas

Background. The increase in SARS-CoV-2 cases due to the omicron wave led to significant utilization of healthcare resources and reduced acute care hospital beds at the Veterans Administration Hospital, North Texas Health Care System (VANTHCS). As a result, veterans with non-severe disease were managed at a VANTHCS community living center (CLC) during a COVID-19 outbreak. Methods. Veterans residing at the CLC with laboratory-confirmed cases of SARS-CoV-2 (the virus that causes COVID-19) by polymerase chain reaction diagnosed from January 1 to February 15, 2022, were included in the descriptive analysis. We described resident characteristics and outcomes and infection control practices (IPC) implemented to control the outbreak. Resident data was ascertained from the COVID-19 facility dashboard and medical record system. Results. From January 1-February 15, 2022, 33 adults residing at the CLC were diagnosed COVID-19. Most infections (93.9%) occurred between January 12-24 (figure 1). The median age was 76 years [interquartile range, 71-80 years] and 30 (90.9%) were men and 25 (75.8%) were white and 5 (15.2%) African American (table 1). Among the total cases, 9 (27.3%) resided in the dementia unit. Nineteen of 33 (57.6%) were asymptomatic. Overall, 28 (84.8%) were documented to be fully vaccinated against SARS-CoV-2 and 24 (72.7%) were boosted. Obesity, ischemic heart disease, chronic obstructive pulmonary disease, and stroke were the most common comorbidities. Residents were cohorted based on COVID-19 results. A multidisciplinary team was convened, and staff were fit tested for appropriate personal protective equipment (PPE) and received refresher training on hand hygiene, donning and doffing of PPE. Most residents were determined to have mild or moderate COVID-19 and managed at the CLC while 7 (21.2%) were hospitalized in the acute care hospital. For management of COVID-19, 11 (33.3%) received dexamethasone and 25 (75.8%) received remdesivir. Overall, 32 (97%) residents survived while one hospice resident was transferred to acute care and died;only 1 resident required ICU admission. Epidemic curve of laboratory-confirmed coronavirus disease 2019 (COVID-19) disease at a Community Living Center, Veterans Administration Hospital, North Texas Health Care System, January-February 2022. Table 1 Epidemiological Characteristics, and Outcomes of Laboratory-confirmed COVID-19 cases (N=33) Abbreviation: BMI, body mass index;COPD, Chronic Obstructive Pulmonary Disease;ESRD, end stage renal disease 1Other comorbidity (asthma n=1 and chronic liver disease n=2) Conclusion. It is feasible to administer COVID-19therapies to high-risk residents with mild-moderate disease in a CLC with a multidisciplinary team and IPC strategies.

Tourism and Emerging Infectious Diseases: More Connections Than First Meet the Eye

Disease outbreaks can severely disrupt the global tourism sector. New approaches for preventing infectious diseases from emerging and spreading are urgently needed to secure the prosperity of the tourism industry. This conceptual article proposes a comprehensive framework of interrelationships between tourism and emerging infectious disease. The conceptual framework highlights the pathways in which the tourism industry itself can potentially contribute to the emergence and spread of infectious diseases, including tourism-induced land changes, sourcing meat from intensive animal farms, global movement and close proximity of people, and high-risk sexual activities. Based on the interrelationships, the framework proposes tangible managerial action recommendations for tourism businesses and policy makers to contribute to the prevention of future disease outbreaks. This paper concludes with a research agenda on how scholars can support tourism practitioners and governments in reducing the likelihood of future epidemics and pandemics. © The Author(s) 2022.

HERDSA TATAL tales: Reflecting on academic growth as a Community for Practice

This chapter tells the story of 13 higher education (HE) practitioners (academics and academic developers) from 10 universities across Australia and New Zealand leveraging the COVID-19 disruption as a ‘disorienting dilemma’ that precipitated transformation from a Community of Practice (CoP) to a Community for Practice (CfP). The aim is to show how the group commenced as a CoP to ‘Talk About Teaching and Learning’ (TATAL) and support one another towards HE fellowships, and grew into a CfP that supports holistic growth that benefits each member based on their specific contexts, needs, and goals. With reflections woven throughout as evidence of transformation, the purpose of this chapter is to demonstrate how an interdisciplinary, multiuniversity group has created and nurtured a sustainable CfP. Experiential learning and reflective practice models, which are underpinned by considerations of action research and collaborative autoethnography, support and account for insights into the transformative changes. © 2022 Elsevier Ltd. All rights reserved.

Persistent blood DNA methylation changes one year after SARS-CoV-2 infection.

We recently reported the COVID-19-induced circulating leukocytes DNA methylation profile. Here, we hypothesized that some of these genes would persist differentially methylated after disease resolution. Fifteen participants previously hospitalized for SARS-CoV-2 infection were epityped one year after discharge. Of the 1505 acute illness-induced differentially methylated regions (DMRs) previously identified, we found 71 regions with persisted differentially methylated, with an average of 7 serial CpG positions per DMR. Sixty-four DMRs persisted hypermethylated, and 7 DMR persisted hypomethylated. These data are the first reported evidence that DNA methylation changes in circulating leukocytes endure long after recovery from acute illness.

Predicting the COVID-19 in the Metropolitan Region (Chile) using a GCN-LSTM neural network

COVID-19 is considered one of the largest pandemics in recent times. Predicting the number of future COVID-19 cases is extremely important for governments in order to make decisions about mobility restrictions, and for hospitals to be able to manage medical supplies, as well as health staff. Most of the predictions of COVID-19 cases are based on mathematical-epidemiological models such as the SEIR and SIR models. In our work, we propose a model of neural networks GCN-LSTM (Graph Convolutional Network - Long Short Term Memory) to predict the spatio-temporal rate incidence of COVID-19 in the Metropolitana Region, Chile. While the GCN network incorporates the spatial correlation in the nearby municipalities, the LSTM network considers the temporal correlation for the prediction over time. To interpolate the missing daily data for the network input, the use of the GAM (Generalized Additive Model) model is proposed. The results show better predictions for some municipalities with higher habitat density. © 2021 IEEE.

Bromodomain and extraterminal (BET) protein inhibitor, apabetalone, reduces ACE2 expression and attenuates SARS-CoV-2 infection in vitro

Background/Introduction: SARS-CoV-2 causes life threatening COVID- 19 complications including acute coronary syndrome, venous thromboembolism, hyperinflammation and damage in multiple tissues. The SARSCoV- 2 spike protein binds cell surface receptors including angiotensinconverting enzyme 2 (ACE2) for entry into host cells to initiate infection. Host cell dipeptidyl peptidase-4 (DPP4 / CD26) is implicated as a cofactor in uptake. Recent evidence indicates expression of factors involved in SARS-CoV-2 uptake into host cells is regulated by BET proteins, epigenetic readers modulating gene expression. Apabetalone, the most clinically advanced BET inhibitor (BETi), is in phase 3 trials for cardiovascular disease (CVD) (a, b). In cultured human cardiomyocytes, apabetalone suppressed infection with SARS-CoV-2 and prevented dysfunction of cardiac organoids induced by the cytokine-storm that arises in patients with severe symptoms (c). However, anti-viral properties of apabetalone in other cell types are not known. Purpose: To examine effects of apabetalone on SARS-CoV-2 infection in cell culture via downregulated expression of cell surface receptors involved in viral entry. Cell systems used mimic initial sites of infection in the lung as well as cell types contributing to complications in late stages of infection. Methods: Gene expression was measured by real-time PCR, protein levels by immunoblot or flow cytometry, and binding of recombinant SARSCoV- 2 spike protein by flow cytometry. Infection with SARS-CoV-2 was determined in a BSL3 facility. Infectivity was quantified by determining levels of viral spike protein amongst total cells via imaging on an Operetta CLS. Results: In Calu-3, a human bronchial epithelial cell line, apabetalone dose-dependently downregulated ACE2 gene expression (up to 98%), reduced ACE2 protein levels (up to 84%) and diminished binding of SARSCoV- 2 spike protein (up to 77%, p<0.001 for all parameters). Further, apabetalone abolished infection of Calu-3 cells with live SARS-CoV-2, which was comparable to other antiviral agents. Apabetalone-driven ACE2 downregulation was also observed in extrapulmonary cell types including HepG2, Huh-7 or primary hepatocytes (up to 90%, p<0.001 for all cell types), and Vero E6, a monkey kidney epithelial cell line (up to 38%, p<0.05). DPP4/CD26, a potential cofactor for SARS-CoV-2 uptake, was also downregulated by apabetalone in Calu-3 cells (mRNA ∼65% and protein ∼40%, p<0.001), which may be synergistic with ACE2 reductions to impede SARS-CoV-2 infection. Conclusions: Apabetalone, an investigational drug for CVD, reduced cell surface receptors (ACE2 and DPP4) involved in SARS-CoV-2 uptake into host cells and dramatically attenuated SARS-CoV-2 infection/propagation in vitro. Our results suggest apabetalone can mitigate SARS-CoV-2 replication in multiple organs, which together with an established safety profile supports clinical evaluation of apabetalone to treat.

Patterns of oxygen saturation in prolonged recovery from COVID-19 pneumonia.

During the second wave of the COVID-19 pandemic in South Africa, a recurrent pattern of prolonged recovery after acute COVID-19 pneumonia, characterised by low oxygen saturation levels for >2 weeks, was observed in an intermediate-care facility in Cape Town. A case study together with a series of 12 patients is presented to illustrate this phenomenon, and two types of 'sats gap' are described, which were used by physiotherapists and doctors to monitor daily progress. We attempt to explain this prolonged recovery in terms of the possible pathophysiology, and suggest a number of learning points to guide further research.

Blood DNA methylation and COVID-19 outcomes.

BACKGROUND: There are no prior reports that compare differentially methylated regions of DNA in blood samples from COVID-19 patients to samples collected before the SARS-CoV-2 pandemic using a shared epigenotyping platform. We performed a genome-wide analysis of circulating blood DNA CpG methylation using the Infinium Human MethylationEPIC BeadChip on 124 blood samples from hospitalized COVID-19-positive and COVID-19-negative patients and compared these data with previously reported data from 39 healthy individuals collected before the pandemic. Prospective outcome measures such as COVID-19-GRAM risk-score and mortality were combined with methylation data. RESULTS: Global mean methylation levels did not differ between COVID-19 patients and healthy pre-pandemic controls. About 75% of acute illness-associated differentially methylated regions were located near gene promoter regions and were hypo-methylated in comparison with healthy pre-pandemic controls. Gene ontology analyses revealed terms associated with the immune response to viral infections and leukocyte activation; and disease ontology analyses revealed a predominance of autoimmune disorders. Among COVID-19-positive patients, worse outcomes were associated with a prevailing hyper-methylated status. Recursive feature elimination identified 77 differentially methylated positions predictive of COVID-19 severity measured by the GRAM-risk score. CONCLUSION: Our data contribute to the awareness that DNA methylation may influence the expression of genes that regulate COVID-19 progression and represent a targetable process in that setting.