Acute Central Nervous System Demyelination Following COVID-19 Vaccination

Objective To describe features of central nervous system (CNS) demyelinating events following vaccination against coronavirus disease 19 (COVID- 19). Background Several reports suggest a potential association between COVID-19 vaccines and acute CNS inflammation. Design/Methods A case series was performed at the BARLO MS Centre in Toronto, Ontario, Canada. Clinicians reported patients who experienced an acute CNS demyelinating event within 60 days after receiving at least one COVID-19 vaccination from March 2021 to January 2022. Clinical characteristics were evaluated. Results Twenty patients were identified (median age 39 years (range 25-82);13 (65.0%) female). Two had pre-existing multiple sclerosis (MS). Individuals received the Pfizer (n = 14), Moderna (n = 5) or Astrazeneca (n = 1) COVID-19 vaccines. Within 1-53 days (median 12) of the first (n = 8) or second (n = 12) vaccine dose, patients developed transverse myelitis (TM) (n = 15), optic neuritis (n = 4) or brain demyelination (n = 4). Diagnoses at last follow up (median 114 days (range 39-255)) were relapsing remitting MS (n = 8), post-vaccine TM (n = 5), clinically isolated syndrome (n = 3), myelin oligodendrocyte glycoprotein antibody disease (n = 2), MS relapse (n = 1) and neuromyelitis optica spectrum disorder (n = 1). Thirteen patients received pulse corticosteroids, and of these, 4 received plasma exchange. Seven did not receive acute treatment. 20.0% returned to baseline (n = 4), 75.0% partially recovered (n = 15) and 5.0% worsened (n = 1). At last follow up, 11 were on disease modifying therapy and 9 were not. Nine patients received a subsequent COVID-19 vaccine. Of these, one experienced symptom recrudescence without radiologic evidence of a new demyelinating attack. Conclusions To our knowledge, this is the largest series to date describing acute CNS demyelination after vaccination against COVID-19. The rate of vaccination in the eligible general population was high during the time of the cases and we could not determine whether the number of demyelinating events was higher than expected. Repeat vaccination was not associated with recurrent adverse events in this small observational series.

Layered Audio Descriptions for Videos

The increasing availability of online video content, partially fueled by the Covid-19 pandemic and the growing presence of social media, adds to the importance of providing audio descriptions as a media alternative to video content for blind and visually impaired persons. To address concerns as to what can be sufficiently described, we developed a concept providing audio descriptions in three levels of detail. We included an additional feature for providing optional explanations to terms and abbreviations, helping users without specific knowledge or persons with neurodiversity in comprehending complex video content. We implemented these features in a prototype based on the open-source Able Player, using an XML-based data structure to store information for all layers of audio descriptions. A qualitative user test focused on the benefits of multi-layered audio descriptions and optional explanatory content. Findings suggest that the choice on several levels of detail is received positively by users. They also appreciated the concept of optional explanations and came up with further use cases for such a practice. Participants preferred a higher level of detail for a high-paced action video and a lower level for informative content. © 2022, Springer Nature Switzerland AG.

The Impact of COVID-19 on People with Parkinson's: Insights from Wearable Sensors

Objective: To describe changes in daily activity measured by wearable sensors in participants with Parkinson's disease (PD) following the COVID-19 pandemic. Background: Digital tools provide objective, frequent and sensitive data collection in real-world settings. In a natural history study of PD, participants used wearable sensors before and after COVID-19 shutdowns. Design/Methods: At research visits throughout this two-year study at the University of Rochester Medical Center, participants wore sensors with accelerometer and gyroscopic capabilities and completed questionnaires. Following each visit, participants wore sensors remotely for 7 days during waking hours. Participant position and activity from days 1-6 of wear was classified from sensor data. Results: Prior to March 14 2020, when COVID-19 shutdowns began in Monroe County, NY, 17 participants with PD (70.4 (6.3) years) and 13 controls (61.1 (13.5) years) completed a baseline visit. All 30 later completed a month 12 visit after COVID-19 shutdowns. Sensor wear was comparable at baseline (13.9 (1.4) hours/day) and month 12 (13.74 (2.1) hours/day). At month 12, PD participants walked an average of 1709 (1457) steps/day, approximately 17% less than at baseline (2048 (1416) steps/day), with considerable individual variation. PD participants spent approximately 20% more time lying while awake at month 12 (112.7 (149.9) min) than at baseline (93.6 (103.1) min). Daytime sleep did not increase from baseline (39.6 (39.3) min) to month 12 (39.2 (32.8) min). PD and control participants reported greater anxiety and depression at month 12. From baseline to month 12, controls had similar activity trends as participants with PD, but walked more, spent less time lying, had less daytime sleep, and reported less depression and anxiety at both time points. Conclusions: Following the emergence of COVID-19, participants with PD walked less and spent more time resting. These data provide an objective measure of the pandemic's impact on a small cohort of individuals with PD.

Moving Forward from the COVID-19 Pandemic: Needed Changes in Movement Disorders Care and Research.

PURPOSE OF REVIEW: The COVID-19 pandemic has dramatically affected the health and well-being of individuals with movement disorders. This manuscript reviews these effects, discusses pandemic-related changes in clinical care and research, and suggests improvements to care and research models. RECENT FINDINGS: During the on-going COVID-19 pandemic, individuals with movement disorders have experienced worsening of symptoms, likely due to decreased access to care, loss of social connection, and decreased physical activity. Through telemedicine, care has moved out of the clinic and into the home. Clinical research has also been significantly disrupted, and there has been a shift to decentralized approaches. The pandemic has highlighted disparities in access to care and representation in research. We must now translate these experiences into better care and research models with a focus on equitable integration of telemedicine, better support of patients and caregivers, the development of meaningful digital endpoints, and optimization of decentralized research designs.

PAWG Pilot Study on Quantification of SARS-CoV-2 Monoclonal Antibody - Part 1

Under the auspices of the Protein Analysis Working Group (PAWG) of the Comité Consultatif pour la Quantité de Matière (CCQM) a pilot study, CCQM-P216, was coordinated by the Chinese National Institute of Metrology (NIM), National Research Council of Canada (NRC) and the Bureau International des Poids et Mesures (BIPM). Eleven Metrology Institutes or Designated Institutes and the BIPM participated in the first phase of the pilot study (Part 1). The purpose of this pilot study was to develop measurement capabilities for larger proteins using a recombinant humanized IgG monoclonal antibody against Spike glycoprotein of SARS-CoV-2 (Anti-S IgG mAb) in solution. The first phase of the study was designed to employ established methods that had been previously studies by the CCQM Protein Analysis Working Group, involving the digestion of protein down to the peptide or amino acid level.The global coronavirus pandemic has also led to increased focus on antibody quantitation methods. IgG are among the immunoglobulins produced by the immune system to provide protection against SARS-CoV-2. Anti-SARS-CoV-2 IgG can therefore be detected in samples from affected patients. Antibody tests can show whether a person has been exposed to the SARS-CoV-2, and whether or not they potentially show lasting immunity to the disease. With the constant spread of the virus and the high pressure of re-opening economies, antibody testing plays a critical role in the fight against COVID-19 by helping healthcare professionals to identify individuals who have developed an immune response, either via vaccination or exposure to the virus. Many countries have launched large-scale antibody testing for COVID-19. The development of measurement standards for the antibody detection of SARS-CoV-2 is critically important to deal with the challenges of the COVID-19 pandemic. In this study, the SARS-CoV-2 monoclonal antibody is being used as a model system to build capacity in methods that can be used in antibody quantification. Amino acid reference values with corresponding expanded uncertainty of 36.10 ± 1.55 mg/kg, 38.75 ± 1.45 mg/kg, 18.46 ± 0.78 mg/kg, 16.20 ± 0.67 mg/kg and 30.61 ± 1.30 mg/kg have been established for leucine, valine, phenylalanine, isoleucine and proline, respectively. Agreement between nearly all laboratories was achieved for the amino acid analysis within 2 to 2.5 %, with one participant achieving markedly higher results due to a technical issue found in their procedure;this result was thus excluded from the reference value calculations. The relatively good agreement within a laboratory between different amino acids was not dissimilar to previous results for peptides or small proteins, indicating that factors such as hydrolysis conditions and calibration procedures could be the largest sources of variability.Peptide reference values with corresponding expanded uncertainty of 4.99 ± 0.28 mg/kg and 6.83 ± 0.65 mg/kg have been established for ALPAPIEK and GPSVFPLAPSSK, respectively. Not surprisingly due to prior knowledge from previous studies on peptide quantitation, agreement between laboratories for the peptide-based analysis was slightly poorer at 3 to 5 %, with one laboratory's result excluded for the peptide GPSVFPLAPSSK. Again, this level of agreement was not significantly poorer than that achieved in previous studies with smaller or less complex proteins.To reach the main text of this paper, click on Final Report.

Teaching in Times of COVID-19: The Evaluation of Distance Teaching in Elementary and Secondary Schools in Germany

To depict the situation during the school closures in spring 2020 that were implemented to contain the spread of COVID-19, we conducted a self-constructed online survey on distance teaching among teachers regarding their teaching practices in this new situation, the challenges they experienced, and the prerequisites for successful distance teaching. The sample consisted of voluntarily participating German elementary (n = 857) and secondary school teachers (n = 1,590) from a sample of randomly drawn schools in four federal states in Germany. We describe the main survey findings and examine the importance of different distance teaching aspects for teacher reports of students attaining their learning objectives and students’ learning progress during distance teaching. Our results particularly highlight the necessity for students and teachers to remain in contact in all the surveyed school types. In elementary school, regular contact between teachers and parents is similarly important. The key challenges highlighted inadequate digitalization, the participation of all students, and students’ motivation. Correspondingly, adequate technical equipment for schools, teachers, and students, together with teachers’ and students’ competence to use technical devices and digital media as well as students’ motivation to participate in distance learning were found to be necessary prerequisites for successful distance teaching. We conclude that efforts should be devoted to enabling teachers and students to better communicate using digital devices, for example, expanding the digital infrastructure in combination with training teachers and students in the use of technical devices and digital media. © Copyright © 2021 Schneider, Sachse, Schipolowski and Enke.

Assessing resilience of healthcare infrastructure exposed to COVID-19: emerging risks, resilience indicators, interdependencies and international standards.

In the moment of preparation of this paper, the world is still globally in grip of the Corona (COVID-19) crisis, and the need to understand the broader overall framework of the crisis increases. As in similar cases in the past, also with this one, the main interest is on the "first response". Fully appreciating the efforts of those risking their lives facing pandemics, this paper tries to identify the main elements of the larger, possibly global, framework, supported by international standards, needed to deal with new (emerging) risks resulting from threats like Corona and assess the resilience of systems affected. The paper proposes that future solutions should include a number of new elements, related to both risk and resilience. That should include broadening the scope of attention, currently focused onto preparation and response phases, to the phases of "understanding risks", including emerging risks, and transformation and adaptation. The paper suggests to use resilience indicators in this process. The proposed approach has been applied in different cases involving critical infrastructures in Europe (energy supply, water supply, transportation, etc., exposed to various threats), including the health system in Austria. The detailed, indicator-based, resilience analysis included mapping resilience, resilience stress-testing, visualization, etc., showing, already before the COVID-19, the resilience (stress-testing) limits of the infrastructures. A simpler (57 indicator based) analysis has, then been done for 11 countries (including Austria). The paper links these results with the options available in the area of policies, standards, guidelines and tools (such as the RiskRadar), with focus on interdependencies and global standards-especially the new ISO 31,050, linking emerging risks and resilience.