Multiple early factors anticipate post-acute COVID-19 sequelae

Post-acute sequelae of COVID-19 (PASC) represent an emerging global crisis. However, quantifiable risk factors for PASC and their biological associations are poorly resolved. We executed a deep multi-omic, longitudinal investigation of 309 COVID-19 patients from initial diagnosis to convalescence (2-3 months later), integrated with clinical data and patient-reported symptoms. We resolved four PASC-anticipating risk factors at the time of initial COVID-19 diagnosis: type 2 diabetes, SARS-CoV-2 RNAemia, Epstein-Barr virus viremia, and specific auto-antibodies. In patients with gastrointestinal PASC, SARS-CoV-2-specific and CMV-specific CD8+ T cells exhibited unique dynamics during recovery from COVID-19. Analysis of symptom-associated immunological signatures revealed coordinated immunity polarization into four endotypes, exhibiting divergent acute severity and PASC. We find that immunological associations between PASC factors diminish over time, leading to distinct convalescent immune states. Detectability of most PASC factors at COVID-19 diagnosis emphasizes the importance of early disease measurements for understanding emergent chronic conditions and suggests PASC treatment strategies.

Remdesivir and Mortality in Patients with COVID-19

Background

The impact of remdesivir (RDV) on mortality rates in coronavirus disease 2019 (COVID-19) is controversial, and the mortality effect in subgroups of baseline disease severity has been incompletely explored. The purpose of this study was to assess the association of RDV with mortality rates in patients with COVID-19.

Methods

In this retrospective cohort study we compared persons receiving RDV with those receiving best supportive care (BSC). Patients hospitalized between 28 February and 28 May 2020 with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection were included with the development of COVID-19 pneumonia on chest radiography and hypoxia requiring supplemental oxygen or oxygen saturation ≤94% with room air. The primary outcome was overall survival, assessed with time-dependent Cox proportional hazards regression and multivariable adjustment, including calendar time, baseline patient characteristics, corticosteroid use, and random effects for hospital.

Results

A total of 1138 patients were enrolled, including 286 who received RDV and 852 treated with BSC, 400 of whom received hydroxychloroquine. Corticosteroids were used in 20.4% of the cohort (12.6% in RDV and 23% in BSC). Comparing persons receiving RDV with those receiving BSC, the hazard ratio (95% confidence interval) for death was 0.46 (.31–.69) in the univariate model (P < .001) and 0.60 (.40–.90) in the risk-adjusted model (P = .01). In the subgroup of persons with baseline use of low-flow oxygen, the hazard ratio (95% confidence interval) for death in RDV compared with BSC was 0.63 (.39–1.00; P = .049).

Conclusion

Treatment with RDV was associated with lower mortality rates than BSC. These findings remain the same in the subgroup with baseline use of low-flow oxygen.

Multi-Omics Resolves a Sharp Disease-State Shift between Mild and Moderate COVID-19

We present an integrated analysis of the clinical measurements, immune cells, and plasma multi-omics of 139 COVID-19 patients representing all levels of disease severity, from serial blood draws collected during the first week of infection following diagnosis. We identify a major shift between mild and moderate disease, at which point elevated inflammatory signaling is accompanied by the loss of specific classes of metabolites and metabolic processes. Within this stressed plasma environment at moderate disease, multiple unusual immune cell phenotypes emerge and amplify with increasing disease severity. We condensed over 120,000 immune features into a single axis to capture how different immune cell classes coordinate in response to SARS-CoV-2. This immune-response axis independently aligns with the major plasma composition changes, with clinical metrics of blood clotting, and with the sharp transition between mild and moderate disease. This study suggests that moderate disease may provide the most effective setting for therapeutic intervention.

Multiomic Immunophenotyping of COVID-19 Patients Reveals Early Infection Trajectories

Host immune responses play central roles in controlling SARS-CoV2 infection, yet remain incompletely characterized and understood. Here, we present a comprehensive immune response map spanning 454 proteins and 847 metabolites in plasma integrated with single-cell multi-omic assays of PBMCs in which whole transcriptome, 192 surface proteins, and T and B cell receptor sequence were co-analyzed within the context of clinical measures from 50 COVID19 patient samples. Our study reveals novel cellular subpopulations, such as proliferative exhausted CD8 ⁺ and CD4 ⁺ T cells, and cytotoxic CD4 ⁺ T cells, that may be features of severe COVID-19 infection. We condensed over 1 million immune features into a single immune response axis that independently aligns with many clinical features and is also strongly associated with disease severity. Our study represents an important resource towards understanding the heterogeneous immune responses of COVID-19 patients and may provide key information for informing therapeutic development.

Exploring the feasibility of using routinely collected data to produce antibiotic prescribing profiles for general dental practitioners in Wales

This article describes a project that assessed whether routinely collected antibiotic prescribing and NHS dental treatment data could be linked to produce personalised prescribing profiles for general dental practitioners working in Wales, UK. Dental public health competencies required for this work included: Multi-agency working to develop a sustainable system of monitoring antibiotic prescribing in primary dental care in Wales, Dental public health intelligence, Development of dental service quality indicators.

A phase II study of pomegranate extract for men with rising prostate-specific antigen following primary therapy

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Background: Pomegranate extract (POMx) demonstrates promising antitumor effects in prostate cancer (PCA). Prior published work reveals an increase in PSA doubling time (PSADT) in a single arm study of pomegranate juice (POM) in PCA patients (pts) with a rising PSA after local therapy. We sought to determine the effects of low (1 gram) or high (3 grams) daily POMx on PSADT in a similar but broader population of men seeking to defer androgen deprivation therapy.

Methods: Our multi-center, double bind phase II trial randomized men with rising PSA and without metastases to receive high or low dose POMx, stratified by baseline PSADT and Gleason score, and with no restrictions for PSADT and no upper limit PSA value. Men were treated until progression or for 18 months. PSA levels were obtained every 3 months. This study was designed to detect a 6 month increase in PSADT from baseline.

Results: 104 patients were enrolled and treated for up to 6 (92%), 12 (70%) and 18 months (36%). Median PSADT lengthened in the Intent to treat population (96% white, median age 74.5 years, median Gleason score 7) from baseline 11.9 (range 1.6-54.6) compared to 18.5 (2-1523) months after treatment (p<.001).There was no significant treatment difference on PSADT between the dose groups (p=.920). Declining PSA levels were observed in 13 pts (13%) during the study. No significant changes occurred in testosterone in either group. Although no clinically significant toxicities were seen, mild to moderate diarrhea was seen in 8 pts (7.7%).

Conclusions: POMx treatment significantly increased the PSADT by over 6 months in both treatment arms, with no effect on testosterone. This IND-conducted study confirms slowing of PSADT after treatment with POMx as was found with POM, yet in a PCA patient population with greater high risk progression features.

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Managing Medicaid managed care: are states becoming prudent purchasers?

This paper examines the extent to which five states are becoming "prudent purchasers" in their oversight of Medicaid managed care. Our conclusions are mixed. These states are making more sustained efforts along these lines than most private purchasers are and have improved the amount and quality of the data they collect on the experiences of Medicaid clients when compared with the traditional fee-for-service program. They have been less successful in ensuring data quality that is adequate to support contracting decisions and in developing the analytical or political capacity to use data to "manage" the managed care system. Becoming a prudent purchaser appears to be a complex task for states that may prove difficult to achieve.

Inter-Observer Reliability

Abstract

This paper examines the methods used in expressing agreement between observers both when individual occurrences and total frequencies of behaviour are considered. It discusses correlational methods of deriving inter-observer reliability and then examines the relations between these three methods. Some of the factors that affect reliability are reported. These include problems of definition such as how a behaviour may change with age and how reliability depends on which recipient of behaviour is considered. Frequency of occurrence of a behaviour pattern is discussed both in relation to itself and to other behavioural categories, as well as its effect on observer vigilance. The effect of partitioning data in different ways is also discussed. Finally the influence of different observers on inter-observer reliability is noted. Examples are taken from studies of children and kittens.

The Sn mechanism in aromatic compounds. XXXVIII. Comparative reactivity of 1-Halogeno-2,6-dinitrobenzenes and some other halogenonitrobenzenes

The reactivity of 1-halogeno-2,6-dinitrobenzenes with methanolic methoxide has been studied quantitatively and compared with the results of similar studies of o- and p-halogenonitrobenzenes and 1-halogeno- 2,4-dinitrobenzenes. Adverse steric interactions of the ortho-nitro group are very small in the o-halogenonitro- and 1-halogeno-2,4- dinitrobenzenes. The interactions are substantially larger in the reactions of 1-halogeno-2,6-dinitrobenzenes in displacement of Cl, Br, and I, but not of F, but they are small compared to steric interactions found in many other classes of reactions. ��� Steric effects are observed as a reduction in rates affecting values of the Substituent Rate Factors of the o-nitro group, and affecting also the mobility as a leaving group of Cl, Br, and I, but not of F. However, since Cl is the usual reference standard for leaving group mobility, that of F appears as having an unusually high value. Nevertheless a depression of the mobility of iodine from its typical range is also evident.

The anomalous paramagnetism of iron(III) NN-dialkyldithiocarbamates

The magnetic moments of a series of 19 NN-disubstituted dithiocarbamates of iron(III), [Fe(S2C.NR?R")3], are anomalous in that their behaviour is neither "high-" nor "low-spin". Values of μeff. at room temperature lie between 2.62 and 5.83 B.M., the datum for each compound depending on the chemical nature of the substituents R' and R". This anomalous situation persists in benzene or chloroform solution. Cryoscopic and ebullioscopic molecular weight determinations establish that all the compounds are monomeric, which excludes the possibility that the magnetic behaviour arises from the presence of antiferromagnetic exchange interactions of either the inter- or intra-molecular type. These observations strongly support the early and generally overlooked work of Cambi who in 1932 proposed a thermal equilibrium between "magnetic isomers" of spins S = � and S = 5/2 to account for the origin of the magnetic anomaly.