Genetic Characterization and Evolution of Porcine Deltacoronavirus Isolated in the Republic of Korea in 2022.

Porcine deltacoronavirus (PDCoV) is an emerging coronavirus that causes diarrhea in nursing piglets. Since its first outbreak in the United States in 2014, this novel porcine coronavirus has been detected worldwide, including in Korea. However, no PDCoV case has been reported since the last report in 2016 in Korea. In June 2022, the Korean PDCoV strain KPDCoV-2201 was detected on a farm where sows and piglets had black tarry and watery diarrhea, respectively. We isolated the KPDCoV-2201 strain from the intestinal samples of piglets and sequenced the viral genome. Genetically, the full-length genome and spike gene of KPDCoV-2201 shared 96.9-99.2% and 95.8-98.8% nucleotide identity with other global PDCoV strains, respectively. Phylogenetic analysis suggested that KPDCoV-2201 belongs to G1b. Notably, the molecular evolutionary analysis indicated that KPDCoV-2201 evolved from a clade different from that of previously reported Korean PDCoV strains and is closely related to the emergent Peruvian and Taiwanese PDCoV strains. Furthermore, KPDCoV-2201 had one unique and two Taiwanese strain-like amino acid substitutions in the receptor-binding domain of the S1 region. Our findings suggest the possibility of transboundary transmission of the virus and expand our knowledge about the genetic diversity and evolution of PDCoV in Korea.

Sustainability, Scalability, and Resiliency of the Town of Innisfil Mobility-on-Demand Experiment: Preliminary Results, Analyses, and Lessons Learned

In 2017, the town of Innisfil, Ontario, launched Innisfil Transit in partnership with Uber, a transportation network company, to provide a subsidized on-demand public mobility service as an alternative to investing in a new fixed-route bus service. The performance of Innisfil Transit is documented in a 2021 Ryerson University report by Sweet, Mitra, and Benaroya, which shows greater cost effectiveness of the mobility provided over the proposed bus alternative. This paper expands on those findings by assessing Innisfil Transit with respect to sustainability, scalability, and resiliency. First, we quantify the energy and emissions of this program relative to traditional transit and driving alone across varying powertrains. We then characterize a conservative firstorder estimate of the percentage of US communities that fall within a similar spatial-demographic tier as Innisfil. Replicability also hinges on service cost and performance in comparison to average values for low-density transit in the US. Lastly, most transit agencies experienced a significant drop in demand (as much as 90%) with slowly rebounding ridership since the onset of the COVID-19 pandemic. The resiliency of the Innisfil program to the pressures induced by the pandemic is examined in comparison to other transit operations. The lessons learned across these three dimensions complement prior work to better understand the efficiency and sustainability of on-demand public mobility service for low-density communities like Innisfil.

Hydration Practices of Long-Distance Trail Runners Competing in Connecticut Events during COVID-19

Overhydration is the primary cause of exercise-associated hyponatremia (EAH). If intended hydration practices are different than actual practices, this may lead to overhydration and will increase the risk of EAH. The purpose of this research was to assess and compare the self-reported hydration practices of long-distance trail runners during an intended long training run, an intended event, and during an actual event. The researchers hypothesized hydration volumes and strategies intended would be different than actual. In a cross-sectional pre and post-online survey design, the participants completed a pre-race survey (n = 26) and a post-race survey (n = 17) in two different Connecticut trail races. A moderate correlation (R = 0.52, P = 0.05) was found when comparing volumes during the actual event to the intended event. In addition, moderate agreement (64-85%) was found to be significant by the Kappa statistic when comparing the hydration strategies in the intended and the actual events. Finally, this study found that 50% of participants reported knowledge and awareness of EAH, while 62% felt they had a solid understanding of an effective hydration plan. These findings indicate the need for ongoing and further education in the trail running community. © 2022, Journal of Exercise Physiology Online. All Rights Reserved.

Severity of COVID-19 in Patients with Dermatomyositis: A Single Center, Retrospective Observational Cohort Study

Although dermatomyositis (DM) patients have been included in studies evaluating for COVID-19 risk and severity in large cohorts of chronic immune mediated disease patients, there have been few studies looking specifically at cohorts of DM patients. We performed a single-center, retrospective cohort study of DM patients seen at the Cleveland Clinic who were diagnosed with COVID-19 via PCR test between March 2020 – July 2021. To assess for risk factors for severe COVID-19 disease course in the DM patient population, we utilized several characteristics known to impact COVID-19 disease course including age, BMI, and medications at time of diagnosis. We additionally included characteristics unique to the DM patient population including DM subtype and autoantibody status. Our results showed that risk factors for COVID-19 hospitalization in our DM cohort include age, BMI, and systemic medication use at time of COVID-19 infection. Despite our small sample size, our study is one of the first to elucidate characteristics important for COVID-19 disease course in DM specifically, rather than having it grouped alongside other disease processes. Awareness of this risk is important for clinicians caring for DM patients in order to optimize their care and protect them from a severe COVID-19 disease course. © 2022 THE AUTHORS. Published by the National Society for Cutaneous Medicine.

Remote mental health care interventions during the COVID-19 pandemic: An umbrella review.

Mitigating the COVID-19 related disruptions in mental health care services is crucial in a time of increased mental health disorders. Numerous reviews have been conducted on the process of implementing technology-based mental health care during the pandemic. The research question of this umbrella review was to examine what the impact of COVID-19 was on access and delivery of mental health services and how mental health services have changed during the pandemic. A systematic search for systematic reviews and meta-analyses was conducted up to August 12, 2022, and 38 systematic reviews were identified. Main disruptions during COVID-19 were reduced access to outpatient mental health care and reduced admissions and earlier discharge from inpatient care. In response, synchronous telemental health tools such as videoconferencing were used to provide remote care similar to pre-COVID care, and to a lesser extent asynchronous virtual mental health tools such as apps. Implementation of synchronous tools were facilitated by time-efficiency and flexibility during the pandemic but there was a lack of accessibility for specific vulnerable populations. Main barriers among practitioners and patients to use digital mental health tools were poor technological literacy, particularly when preexisting inequalities existed, and beliefs about reduced therapeutic alliance particularly in case of severe mental disorders. Absence of organizational support for technological implementation of digital mental health interventions due to inadequate IT infrastructure, lack of funding, as well as lack of privacy and safety, challenged implementation during COVID-19. Reviews were of low to moderate quality, covered heterogeneously designed primary studies and lacked findings of implementation in low- and middle-income countries. These gaps in the evidence were particularly prevalent in studies conducted early in the pandemic. This umbrella review shows that during the COVID-19 pandemic, practitioners and mental health care institutions mainly used synchronous telemental health tools, and to a lesser degree asynchronous tools to enable continued access to mental health care for patients. Numerous barriers to these tools were identified, and call for further improvements. In addition, more high quality research into comparative effectiveness and working mechanisms may improve scalability of mental health care in general and in future infectious disease outbreaks.

Technology Development for the Removal of Covid-19 Pharmaceutical Active Compounds from Water and Wastewater: A Review

The novel coronavirus (SARS-CoV-2) outbreak has given rise to an inevitable worldwide application of a wide variety of drugs. Some of these pharmaceutical active compounds excreted from the human body pass through water and wastewater treatment processes and appear in treated water, wastewater and biosolids. These have posed potential risks to the water quality of aquatic ecosystems and public health. As a result, the failure to lessen coronavirus drugs’ negative environmental impacts is the subject of criticism. Hence, there is an urgent need for water utilities to upgrade their existing water and wastewater treatment processes to increase the removal efficiencies of these emerging micropollutants from coronavirus drugs, especially endocrine disruptor compounds. This review paper will present different treatment technologies, including physical, chemical, and biological, used in water and wastewater treatment plants to further remove pharmaceutical micropollutants from coronavirus drugs. Also, different classes of these drugs, their occurrence, and risks to aquatic ecosystems and human health have been discussed in the current study. © 2022 ISEIS All rights reserved.

International Conference on Transportation and Development 2022

In 2017, the town of Innisfil, Ontario, launched Innisfil Transit in partnership with Uber, a transportation network company, to provide a subsidized on-demand public mobility service as an alternative to investing in a new fixed-route bus service. The performance of Innisfil Transit is documented in a 2021 Ryerson University report by Sweet, Mitra, and Benaroya, which shows greater cost effectiveness of the mobility provided over the proposed bus alternative. This paper expands on those findings by assessing Innisfil Transit with respect to sustainability, scalability, and resiliency. First, we quantify the energy and emissions of this program relative to traditional transit and driving alone across varying powertrains. We then characterize a conservative first-order estimate of the percentage of US communities that fall within a similar spatial-demographic tier as Innisfil. Replicability also hinges on service cost and performance in comparison to average values for low-density transit in the US. Lastly, most transit agencies experienced a significant drop in demand (as much as 90%) with slowly rebounding ridership since the onset of the COVID-19 pandemic. The resiliency of the Innisfil program to the pressures induced by the pandemic is examined in comparison to other transit operations. The lessons learned across these three dimensions complement prior work to better understand the efficiency and sustainability of on-demand public mobility service for low-density communities like Innisfil. © ASCE. All rights reserved.

Quantifying Movement Motivations, Demand, and Inflow-Outflow Dynamics in Four Cities (New York, Chicago, Austin, and San Diego) during COVID-19

The COVID-19 pandemic has impacted a wide range of human activities, from food delivery habits to major moving and travel decisions. Results indicate multiple pandemic-related factors have influenced millions of relocation decisions by Americans (e.g., health risk, financial pressures, more space, and employment), and there are various positive economic and social outcomes of this influence (e.g., remote work and education), enabling more affordable living and opportunity. This paper addresses COVID-19 impacts on mobility, especially involving permanent relocations. Survey design and data analysis with U-Haul targeted customers in Austin, New York, San Diego, and Chicago to understand mobility, new moving dynamics, and motivations. © ASCE. All rights reserved.

Implementing the National Heart, Lung, and Blood Institute's Strategic Vision in the Division of Cardiovascular Sciences-2022 Update.

Spurred by the 2016 release of the National Heart, Lung, and Blood Institute's Strategic Vision, the Division of Cardiovascular Sciences developed its Strategic Vision Implementation Plan-a blueprint for reigniting the decline in cardiovascular disease (CVD) mortality rates, improving health equity, and accelerating translation of scientific discoveries into better cardiovascular health (CVH). The 6 scientific focus areas of the Strategic Vision Implementation Plan reflect the multifactorial nature of CVD and include (1) addressing social determinants of CVH and health inequities, (2) enhancing resilience, (3) promoting CVH and preventing CVD across the lifespan, (4) eliminating hypertension-related CVD, (5) reducing the burden of heart failure, and (6) preventing vascular dementia. This article presents an update of strategic vision implementation activities within Division of Cardiovascular Sciences. Overarching and cross-cutting themes include training the scientific workforce and engaging the extramural scientific community to stimulate transformative research in cardiovascular sciences. In partnership with other NIH Institutes, Federal agencies, industry, and the extramural research community, Division of Cardiovascular Sciences strategic vision implementation has stimulated development of numerous workshops and research funding opportunities. Strategic Vision Implementation Plan activities highlight innovative intervention modalities, interdisciplinary systems approaches to CVD reduction, a life course framework for CVH promotion and CVD prevention, and multi-pronged research strategies for combatting COVID-19. As new knowledge, technologies, and areas of scientific research emerge, Division of Cardiovascular Sciences will continue its thoughtful approach to strategic vision implementation, remaining poised to seize emerging opportunities and catalyze breakthroughs in cardiovascular sciences.

CHANGE IN COLORECTAL CANCER SCREENING PATTERNS IN A SAFETY-NET HOSPITAL AND A PRIVATE HEALTH SYSTEM DURING THE COVID-19 PANDEMIC

Background The COVID-19 pandemic led to significant alterations in the delivery of cancer screening. The resulting decrease in outpatient visits and cancellations of non-urgent procedures have negatively affected colorectal cancer (CRC) screening, though the impact on different types of healthcare systems remains unclear. We aimed to quantify and compare the effect of the first wave of the pandemic on CRC screening uptake at a safety-net hospital and a private health system based in New York City (NYC). Methods In this retrospective study, we identified individuals aged 50 to 75 years presenting for outpatient care at a safety-net public hospital (Bellevue Hospital) and private health system (NYU Langone Health) in March through September of 2019 and 2020 (first wave of the pandemic in NYC). We excluded those who were up-to-date with CRC screening before each study period or had a prior diagnosis of CRC, hereditary cancer syndrome, inflammatory bowel disease, or colectomy. The primary outcome was the proportion of screening-eligible patients seen in the outpatient setting who underwent CRC screening. Results The safety-net hospital had a total of 9,569 outpatient visits in 2019 and 7,280 in 2020. Overall, 552 (5.8%) and 289 (4.0%) screening tests were completed in 2019 and 2020, respectively (p < 0.01). Of these, there were 382 (69.2%) fecal immunochemical tests (FIT) in 2019 and 256 (88.6%) in 2020 (p < 0.01). For individuals who had positive FIT results, 17.2% in 2019 and 25.0% in 2020 had colonoscopy follow-up within 6 months (p = 0.62). A total of 5 and 3 cases of CRC were diagnosed in 2019 and 2020, respectively. In the private health system, there were 99,889 visits in 2019 and 33,849 in 2020. Overall, 658 (0.66%) and 250 (0.74%) completed screening tests in 2019 and 2020, respectively (p = 0.13). Of the screening tests, 518 (78.7%) were FIT in 2019 and 206 (82.4%) were in 2020 (p = 0.22). Of the positive FIT results, 29.4% in 2019 and 27.0% in 2020 had colonoscopy follow-up within 6 months (p = 0.80). A total of 97 and 43 CRC cases were diagnosed in 2019 and 2020, respectively. Conclusion In our study of a safety-net hospital and a private health system in NYC, outpatient volume and absolute numbers of screening tests and CRC diagnoses decreased for both institutions during the COVID-19 pandemic. We observed a decrease in screening rate and increase in proportional FIT use in the public hospital but not the private health system. Although colonoscopy follow-up rate after positive FIT results were low for both institutions, which may reflect incomplete capture of colonoscopy examinations, there were no differences before and during the pandemic. (Table Presented) (Table Presented)

Addressing disaster vulnerability among homeless populations during COVID-19

During the COVID-19 pandemic, disruptions to key services for populations experiencing homelessness may lead to secondary effects in the context of a disaster, including effects on health and safety, which require additional population-specific support. Reducing disaster vulnerability for people experiencing homelessness during the COVID-19 pandemic requires adapting existing preparedness guidance to an evolving situation. Addressing Disaster Vulnerability among Homeless Populations during COVID-19 reviews research on disaster vulnerability, homelessness, the pandemic, and intersecting hazards and disasters. This rapid expert consultation includes considerations for alternative shelter facilities for homeless populations during a disaster;suggestions on how to navigate service reductions and support population-specific needs;and guidance for supporting populations experiencing homelessness in the aftermath of disasters. © National Academy of Sciences. All rights reserved.

New Discovery of Myeloid-Derived Suppressor Cell's Tale on Viral Infection and COVID-19.

Myeloid-derived suppressor cells (MDSCs) are generated under biological stress such as cancer, inflammatory tissue damage, and viral infection. In recent years, with occurrence of global infectious diseases, new discovery on MDSCs functions has been significantly expanded during viral infection and COVID-19. For a successful viral infection, pathogens viruses develop immune evasion strategies to avoid immune recognition. Numerous viruses induce the differentiation and expansion of MDSCs in order to suppress host immune responses including natural killer cells, antigen presenting cells, and T-cells. Moreover, MDSCs play an important role in regulation of immunopathogenesis by balancing viral infection and tissue damage. In this review article, we describe the overview of immunomodulation and genetic regulation of MDSCs during viral infection in the animal model and human studies. In addition, we include up-to-date review of role of MDSCs in SARS-CoV-2 infection and COVID-19. Finally, we discuss potential therapeutics targeting MDSCs.

State Responsibility for COVID-19: Does International Contagion Constitute Transboundary Harm?

As the damage caused by COVID-19 has increased exponentially, so too has the insistence that China bears some international responsibility for the unquantifiable damage sustained as a direct result of the state having failed to contain the virus, and to notify the international community of its existence. Some have suggested that the international contagion of the virus may be classified as transboundary harm. The current article analyses the law of transboundary harm, and proposes a set of criteria based on treaty and precedent that may be relied on to properly classify an event as such. It concludes that it is not only incorrect to classify international contagion as transboundary harm, but that to do so would pose a significant risk to the position and treatment of the individual in international law.

"Not a perfect situation, but..." A single-practice survey of patient experience of phone consultations during COVID-19 Alert Level 4 in New Zealand

AIM: To explore patients' experiences of virtual consultations during the COVID-19 Alert Level 4 lockdown in New Zealand. METHOD: A single-practice retrospective phone survey exploring patients' satisfaction with the phone consultation process during Alert Level 4 lockdown. RESULTS: Of 259 eligible patients, 108 (42%) participated in the survey. Overall satisfaction with phone consultations was high, with a median score 9 out of 10 (95% CI 9-9). Participants were highly likely to recommend phone consultations to others, with a median score of 9 (95% CI 7-9). This was consistent across age groups, ethnicities and socioeconomic groupings. Men were less satisfied with phone consultations than women, with a 2 point (95% CI -3--1) lower median score than women, but they were not less likely to recommend phone consultations. Most participants found phone consultations to be convenient and time-saving and considered not seeing the doctor to be acceptable in the context of the lockdown. Few participants experienced technical difficulties over the phone. Issues of communication and appropriateness of consultations to the medium of the phone were raised. CONCLUSION: This single-centre study demonstrates the acceptability of phone consults for most patients presenting to general practice during a pandemic. These findings need further exploration in broader general practice settings and non-pandemic contexts.

Dress syndrome potentially induced by carbamazepine and triggered by CMV viremia

Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction that manifests with fever, rash with visceral organ involvement and hematological abnormalities. It can occur due to many etiological factors, here we present a case of DRESS that is potentially induced by carbamazepine and triggered by CMV viremia. Case Description/Methods: A 53-year-old male with a history of DM, neuropathy and HTN who presented for acute liver failure (ALF). He endorsed a mild rash after his 1st dose of mRNA COVID vaccine, with full resolution. After receiving his 2nd dose, he developed a diffuse rash with nausea, vomiting, fever and malaise within 72 hrs. He denied supplements, alcohol. Labs were remarkable for eosinophilia, hyponatremia, AST/ALT greater than 10x the ULN, ALP 567, Tbil 8.3, INR 1.9, ammonia 94. Autoimmune panel, drug toxicology screen, viral hepatitis panel with work up including varicella, HSV, EBV, HEV were negative except CMV IgG reactive with low CMV viremia 34 IU/ML. He was initially suspected to have COVID vaccine induced ALF due to temporal association. However, on review, he reported that he was started on carbamazepine for neuropathy ∼7wks prior to initial presentation. He was also evaluated for liver transplant due to jaundice and coagulopathy. Pt met RegiSCAR criteria for DRESS syndrome and was started on steroids. Liver biopsy showed liver injury with resolving eosinophilia not specific. Pt showed significant improvement in liver enzymes and clinical symptoms after 6 days of high dose PO steroids;he was eventually discharged on steroid taper. Discussion: DRESS syndrome has a latency period of about 2-8weeks between drug initiation and onset of symptoms. Although pathogenesis is unknown, it involves two mechanisms- drug-specific immune response and reactivation of human Herpesviridae with a subsequent antiviral response. We hypothesize that DRESS was induced by initiation of carbamazepine and triggered by CMV infection. This case indicates prompt diagnosis and steroids can be lifesaving in this rare presentation of DRESS as ALF. There are case reports of influenza vaccine triggering DRESS. In our case vaccine initially appear to be responsible for ALF, but on review was likely a bystander since mRNA vaccine does not have viral particles like influenza vaccine. Hence this case also highlights the importance of detailed history and complete lab evaluation before correlating organ injury to new mRNA COVID vaccine.

Water insecurity compounds the global coronavirus crisis

Household water insecurity may exacerbate the COVID-19 pandemic and exact an even greater toll on people, especially in Africa, Asia and Latin America, simply because too many people do not have access to safe and secure water services, including water supply and sanitation, at home. Recent studies have shown that as many as a quarter of households in the Global South may be unable to practise necessary hand hygiene. Megacities may be at particular risk of being unable to manage the COVID-19 pandemic due to sheer population density as well as a lack of reliable clean water and sanitation. Problems of water insecurity are not restricted to the Global South but extend into higher-income countries as well. The steady decline in provision of public sanitation around the world, even in wealthy countries, makes adequate hygiene an even more intractable problem.