The Pennsylvania Environmental Resource Consortium: A State-Wide Collaborative Network for Sustainable Outreach, Education, and Action

This paper explores the organizational theory, programs, and concomitant challenges faced by a state-level higher education consortium for sustainability in the United States, the Pennsylvania Environmental Resource Consortium (PERC). We provide insights for other institutions of higher education that may want to form consortia or consider changes to existing consortia. PERC members collaborate to advance sustainability on member campuses, in local communities, and across the Commonwealth. PERC envisions thriving, just communities on a healthy planet, and seeks to inspire higher education communities throughout the Commonwealth to lead transformational sustainability efforts through example, expertise, and collaboration. This chapter provides a brief theoretical background in PERC as a collaborative. It shares history and context for PERC's mission and activities as well as an overview of its programs. It includes reflections on challenges to collaboration and coordination, including from COVID-19, changing digital technology, disparities among PERC institutions, accelerating sustainability challenges in the Anthropocene, anti-intellectualism and hyperpartisanship in the Commonwealth and the United States, and PERC's own staffing, volunteerism, participation, and funding challenges. The chapter closes by revisiting the organization's 2021–2025 Strategic Plan as an invitation to consider how cooperation, coordination, and collaboration among higher education institutions can positively impact sustainability across sectors. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Anaesthesia for vascular emergencies - a state of the art review.

In this state-of-the-art review, we discuss the presenting symptoms and management strategies for vascular emergencies. Although vascular emergencies are best treated at a vascular surgical centre, patients may present to any emergency department and may require both immediate management and safe transport to a vascular centre. We describe the surgical and anaesthetic considerations for management of aortic dissection, aortic rupture, carotid endarterectomy, acute limb ischaemia and mesenteric ischaemia. Important issues to consider in aortic dissection are extent of the dissection and surgical need for bypasses in addition to endovascular repair. From an anaesthetist's perspective, aortic dissection requires infrastructure for massive transfusion, smooth management should an endovascular procedure require conversion to an open procedure, haemodynamic manipulation during stent deployment and prevention of spinal cord ischaemia. Principles in management of aortic rupture, whether open or endovascular treatment is chosen, include immediate transfer to a vascular care centre; minimising haemodynamic changes to reduce aortic shear stress; permissive hypotension in the pre-operative period; and initiation of massive transfusion protocol. Carotid endarterectomy for carotid stenosis is managed with general or regional techniques, and anaesthetists must be prepared to manage haemodynamic, neurological and airway issues peri-operatively. Acute limb ischaemia is a result of embolism, thrombosis, dissection or trauma, and may be treated with open repair or embolectomy, under either general or local anaesthesia. Due to hypercoagulability, there may be higher numbers of acutely ischaemic limbs among patients with COVID-19, which is important to consider in the current pandemic. Mesenteric ischaemia is a rare vascular emergency, but it is challenging to diagnose and associated with high morbidity and mortality. Several peri-operative issues are common to all vascular emergencies: acute renal injury; management of transfusion; need for heparinisation and reversal; and challenging postoperative care. Finally, the important development of endovascular techniques for repair in many vascular emergencies has improved care, and the availability of transoesophageal echocardiography has improved monitoring as well as aids in surgical placement of endovascular grafts and for post-procedural evaluation.

INITIATING CGM OVER TELEHEALTH IS WELL ACCEPTED BY PARENTS OF NEWLY DIAGNOSED YOUTH WITH T1D

Background and Aims: Initiating continuous glucose monitoring (CGM) shortly after T1D diagnosis has potential glycemic and quality of life benefits for youth with T1D and their families. The COVID-19 pandemic necessitated a rapid shift to virtual delivery of CGM initiation visits. We aimed to understand parents' experiences with receiving virtual care to guide starting CGM within 30 days of diagnosis. Methods: We held focus groups and interviews with parents of T1D youth who initiated CGM over telehealth within a month of diagnosis during the COVID-19 pandemic. We used a semistructured interview guide to understand experiences of starting CGM virtually. Groups and interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Results: Participants were 16 parents (age 43±6 years;63% female) of youth (age 9±4 years;47% female;47% non-Hispanic White, 20% Hispanic, 13% Asian, 7% Black, 13% other;diabetes duration 9±3 months) who started CGM through a virtual visit within 30 days of diagnosis. Parents described multiple benefits of the virtual visit: convenience and ease of scheduling;user friendliness;and being in the comfort of home, especially for young children. Most preferred the virtual format to in-person;three parents would have preferred in-person to develop their confidence in starting CGM. Participants felt that clinics should offer families a choice of virtual and in-person for CGM initiation in the future. Conclusions: Despite initial reservations, most parents appreciated receiving telehealth CGM initiation education and felt it should be an option offered to all families. Further efforts can continue to enhance CGM initiation teaching virtually to address identified barriers.

A Nucleic Acid-Based Orthopoxvirus Vaccine Targeting the Vaccinia Virus L1, A27, B5, and A33 Proteins Protects Rabbits against Lethal Rabbitpox Virus Aerosol Challenge

In the age of COVID, nucleic acid vaccines have garnered much attention, at least in part, because of the simplicity of construction, production, and flexibility to adjust and adapt to an evolving outbreak. Orthopoxviruses remain a threat on multiple fronts, especially as emerging zoonoses. In response, we developed a DNA vaccine, termed 4pox, that protected nonhuman primates against monkeypox virus (MPXV)-induced severe disease. Here, we examined the protective efficacy of the 4pox DNA vaccine delivered by intramuscular (i.m.) electroporation (EP) in rabbits challenged with aerosolized rabbitpox virus (RPXV), a model that recapitulates the respiratory route of exposure and low dose associated with natural smallpox exposure in humans. We found that 4pox-vaccinated rabbits developed immunogen-specific antibodies, including neutralizing antibodies, and did not develop any clinical disease, indicating protection against aerosolized RPXV. In contrast, unvaccinated animals developed significant signs of disease, including lesions, and were euthanized. These findings demonstrate that an unformulated, nonadjuvanted DNA vaccine delivered i.m. can protect against an aerosol exposure. IMPORTANCE The eradication of smallpox and subsequent cessation of vaccination have left a majority of the population susceptible to variola virus or other emerging poxviruses. This is exemplified by human monkeypox, as evidenced by the increase in reported endemic and imported cases over the past decades. Therefore, a malleable vaccine technology that can be mass produced and does not require complex conditions for distribution and storage is sought. Herein, we show that a DNA vaccine, in the absence of a specialized formulation or adjuvant, can protect against a lethal aerosol insult of rabbitpox virus.

Protective efficacy of a SARS-CoV-2 DNA vaccine in wild type and immunosuppressed Syrian hamsters

A worldwide effort to counter the COVID-19 pandemic has resulted in hundreds of candidate vaccines moving through various stages of research and development, including several vaccines in phase 1, 2 and 3 clinical trials. A relatively small number of these vaccines have been evaluated in SARS-CoV-2 disease models, and fewer in a severe disease model. Here, a SARS-CoV-2 DNA targeting the spike protein and delivered by jet injection, nCoV-S(JET), elicited neutralizing antibodies in hamsters and was protective in both wild-type and transiently immunosuppressed hamster models. This study highlights the DNA vaccine, nCoV-S(JET), we developed has a great potential to move to next stage of preclinical studies, and it also demonstrates that the transiently immunosuppressed Syrian hamsters, which recapitulate severe and prolonged COVID-19 disease, can be used for preclinical evaluation of the protective efficacy of spike-based COVID-19 vaccines.

Rapid Autopsy Programs and Research Support: The Pre- and Post-COVID-19 Environments

Each rapid autopsy is a powerful opportunity to supply multiple researchers with many valuable tissue specimens at the same time. Since the beginning of the development of rapid autopsy, the overriding organizing principle for all RAPs has been that the samples or organs must be removed and processed as rapidly as possible. To accomplish this some rapid autopsy programs are focused just on one tumor type, while others accept patients demonstrating all tumor types and sometimes other diseases as well. RAPs are logistically complicated and labor-intensive structures, therefore, the key to their success is program flexibility and maintaining a multidisciplinary focus. The necessary collaborations in the complex relationships between clinicians and researchers can be broken down into a series of thought and action steps that must be understood, accepted, and practiced by all participants. A crucial part of the pre-case steps (prior to death) for a rapid autopsy is the study consenting process. It is extremely important that this individualized consent is obtained for postmortem specimens and that it is written in general enough terms to be used for patients with all types of diseases and for an appropriate range of future research uses. The advent of Sars-CoV-2/COVID-19 has presented new challenges and opportunities to the field of autopsy pathology. Guidelines and practice had to be created and adapted to protect physicians and staff while maximizing diagnostic yield. However, any autopsy performed on a patient dying of or with COVID-19 represents a unique opportunity to contribute to understanding of disease mechanisms and to improve death certification, thus assisting in both clinical care and the development of health public policy.