Implementation of genomic surveillance of SARS-CoV-2 in the Caribbean: Lessons learned for sustainability in resource-limited settings

The COVID-19 pandemic highlighted the importance of global genomic surveillance to monitor the emergence and spread of SARS-CoV-2 variants and inform public health decision-making. Until December 2020 there was minimal capacity for viral genomic surveillance in most Caribbean countries. To overcome this constraint, the COVID-19: Infectious disease Molecular epidemiology for PAthogen Control & Tracking (COVID-19 IMPACT) project was implemented to establish rapid SARS-CoV-2 whole genome nanopore sequencing at The University of the West Indies (UWI) in Trinidad and Tobago (T&T) and provide needed SARS-CoV-2 sequencing services for T&T and other Caribbean Public Health Agency Member States (CMS). Using the Oxford Nanopore Technologies MinION sequencing platform and ARTIC network sequencing protocols and bioinformatics pipeline, a total of 3610 SARS-CoV-2 positive RNA samples, received from 17 CMS, were sequenced in-situ during the period December 5th 2020 to December 31st 2021. Ninety-one Pango lineages, including those of five variants of concern (VOC), were identified. Genetic analysis revealed at least 260 introductions to the CMS from other global regions. For each of the 17 CMS, the percentage of reported COVID-19 cases sequenced by the COVID-19 IMPACT laboratory ranged from 0·02% to 3·80% (median = 1·12%). Sequences submitted to GISAID by our study represented 73·3% of all SARS-CoV-2 sequences from the 17 CMS available on the database up to December 31st 2021. Increased staffing, process and infrastructural improvement over the course of the project helped reduce turnaround times for reporting to originating institutions and sequence uploads to GISAID. Insights from our genomic surveillance network in the Caribbean region directly influenced non-pharmaceutical countermeasures in the CMS countries. However, limited availability of associated surveillance and clinical data made it challenging to contextualise the observed SARS-CoV-2 diversity and evolution, highlighting the need for development of infrastructure for collecting and integrating genomic sequencing data and sample-associated metadata

Genomics-informed outbreak investigations of SARS-CoV-2 using civet

The scale of data produced during the SARS-CoV-2 pandemic has been unprecedented, with more than 13 million sequences shared publicly at the time of writing. This wealth of sequence data provides important context for interpreting local outbreaks. However, placing sequences of interest into national and international context is difficult given the size of the global dataset. Often outbreak investigations and genomic surveillance efforts require running similar analyses again and again on the latest dataset and producing reports. We developed civet (cluster investigation and virus epidemiology tool) to aid these routine analyses and facilitate virus outbreak investigation and surveillance. Civet can place sequences of interest in the local context of background diversity, resolving the query into different ’catchments’ and presenting the phylogenetic results alongside metadata in an interactive, distributable report. Civet can be used on a fine scale for clinical outbreak investigation, for local surveillance and cluster discovery, and to routinely summarise the virus diversity circulating on a national level. Civet reports have helped researchers and public health bodies feedback genomic information in the appropriate context within a timeframe that is useful for public health

Friends of Musselman Library Newsletter Spring 2020

From the Dean (Robin Wagner) Library News Mini-Golf Get Acquainted Day Edible Books Festival Moves Online! (Kim Longfellow \u2716) What do librarians do when a campus suddenly closes? (Janelle Wertzberger) Blotchy Scribblings and Spider-like Initials (Jim Ramos, Carolyn Sautter) Boxed Belongings (Natalie Hinton) Notes from the Field (Kerri Odess-Harnish) Who is helping you via email, chat & text with those questions? Our awesome librarians & sometimes their pets! (Kevin Moore) ZOOM: Teaching Moves Online (Kevin Moore, Mallory Jallas, Clint Baugess) Vietnam (Devin McKinney) Quarantined on Campus (Betsy Bein, Chakriya Ou, ’23, Dung Doan, ’23, Precious Ozoh, ’20) Conservation in the Age of Lock Down (Mary Wootton, Abigail Coakley ’20) Documenting COVID-19: Primary Sources for the Future (Amy Lucadamo ’00, Maci Mark ’21) Campus Quarantines (Carolyn Sautter) Library Bookshelf Reading Without Walls Pandemic Book Club (Janelle Wertzberger) Rev. John Vannorsdall (1924–2020) (Rev. John W. Vannorsdall) Alumni Reminiscences (Edson Whitney ‘70, Rev. Donna Schaper ’69, Mike Hobor ‘69, Richard Hutch ‘67) Focus on Philanthropy: Robert Eastlack (Robert Eastlack \u2770, John Eastlack ‘42, Carolyn Sautter) Through Our Eyes: A Digital Exhibition (R.C. Miessler, Austin Stiegemeier, Emma Lewis ’20) Battlefield Bingo (Kevin Aughinbaugh ’18) Nurses on the Front Lines Can You Piece It Together? (Amy Lucadamo \u2700

Intersectoral collaboration in the COVID-19 response in Latin America and the Caribbean

World Health Organization (WHO) / Pan American Health Organization (PAHO) encouraged the utilization of whole-of-society and whole-of-government strategic approaches to increase countries’ resilience towards mitigating the impact of the COVID-19 pandemic. Strategies included the implementation of multi-sectoral, multi-partner and multi-stakeholder planning, coordination, consultation, and action. We reviewed the experiences of three Latin American and Caribbean countries, related to the implementation of collaborative strategies in tackling COVID-19, specifically the nature of the collaboration, the dynamics and the stakeholders involved. A systematic literature review identified relevant publications and content analysis was conducted to determine the collaborative strategies. Colombia, Costa Rica, and Trinidad and Tobago were selected as case studies since they were from different LAC subregions and because of the accessibility of relevant literature. In the three countries, the pandemic response was coordinated by a national executive committee, led by the Ministry of Health. Intersectoral collaboration was evident in each, with the key stakeholders being public sector agencies, the private/corporate sector, private/non-profit, academic institutions, and international agencies. It was used primarily to facilitate data-driven, evidenced-informed decision-making and guidelines; to expand clinical care capacity and strengthen the national medical response; and to provide support for the most vulnerable populations. While the institutionalization of intersectoral collaboration can be recommended for the health sector beyond the pandemic, research is needed to evaluate the impact of specific collaborative strategies as well as barriers and facilitators

Perceptions of High Stakes Testing and Burnout as Predictors of Quality of Life Among Primary School Teachers in Trinidad and Tobago

Problem This study explored how high-stakes testing (HST) and burnout affected the quality of primary school teachers in Trinidad and Tobago. HST refers to school exams often required by government agencies that are used to make key decisions pertaining to students, teachers, and schools (Embse & Hanson, 2012). Burnout is defined operationally as a psychological syndrome of emotional exhaustion, depersonalization, and impaired personal accomplishment induced by repeated workplace stressors (Maslach & Schaufeli, 2017). Quality of life (QoL) is the measure of an individual’s ability to function physically, emotionally, and socially within his/her environment at a level consistent with his/her own expectations (World Health Organization [WHO] 2002). In Trinidad and Tobago, primary school teachers face high levels of stress and burnout due to the pressure of HST, which have been criticized for its negative impact on student, learning, curriculum, and equity. (Gowrie et al., 2015). The paucity of literature regarding how HST affects teacher QoL (Cunningham 2021) was cause for concern as teacher QoL has implications for their professional development, retention, and satisfaction, as well as for the quality of education they provide to their students. Methodology This quantitative study adopted a non-experimental correlational design to examine the relationship among the predictor variables of perceptions of HST and burnout and the dependent variable, QoL. The data were collected by a survey administered to 322 teachers who taught standards four and five. Descriptive and inferential statistics using structural equation modelling were used to answer the following research questions. • What is the quality of life among primary school teachers in Trinidad and Tobago? • What perceptions do primary school teachers have of high stakes standardized testing? • What are the levels of burnout among the teachers? • To what extent do perceptions of high stakes standardized testing and burnout predict quality of life among primary school teachers? Findings The impact of HST on burnout among teachers preparing students for the Secondary Entrance Assessment in Trinidad and Tobago was positive and significant (β = 0.26, t = 3.319, p = \u3c .001); the impact of burnout on QoL of the teachers was positive and significant (β = .79, t = 6.749, p = \u3c .001). The impact of HST on QoL without burnout was positive and significant (β = .181, t = 2.764, p = .006), and the impact of HST on QoL in the presence of burnout was negative and insignificant (β = -0.03, t = -.501, p = .620). Therefore, burnout fully mediated the impact of HST on QoL. Conclusion In general, teachers of the Secondary Entrance Assessment classes in Trinidad and Tobago experienced a moderately satisfactory QoL; they were not sure how they felt about HST. The stress and pressure associated with HST, and specifically the Secondary Entrance Assessment, contributed significantly to burnout, specifically to high emotional exhaustion. However, approximately 2% of the teachers presented with high burnout, approximately 1% presented with medium burnout, and approximately 3% presented with low burnout

REPRODUCTIVE JOURNEYS OF INDO-CARIBBEAN WOMEN FROM TRINIDAD AND TOBAGO AND GUYANA TO NEW YORK

Given the lack of support by the U.S. federal government for reproductive health, this dissertation examines a puzzle: why are Indo-Caribbean women from Guyana and Trinidad journeying to New York for reproductive health care? I focus on a global community in Queens, New York, to unravel this puzzle. I conducted semi-structured in-depth interviews with 82 Indo-Caribbean women and participant observations in women empowerment groups hosted by activists in New York. Each chapter in this dissertation focuses on various motivations and negotiations during reproductive journeys. First, this dissertation finds that social networks and grassroots organizations in New York facilitated reproductive journeys and challenged gendered norms around motherhood through gender consciousness-raising at events, workshops, and dialogues. I also found that these challenges and negotiations were informed by their class, as women from middle-income households are more likely to challenge gender norms outwardly. In contrast, women from low-income households are more likely to challenge gender norms secretively. Secondly, these journeys became a home away from home that exposed journeyers to new ideas and values within the Indo-Caribbean community while also being surrounded by family, food, and music that reminded them of Guyana and Trinidad. Culture also became important during doctor visits as some health care providers were aware of the norms in the Indo-Caribbean community. Some women wanted culturally distant doctors due to their experiences of discrimination in their home countries. Thirdly, I found that intimate partner violence influenced women to obtain reproductive health care and create distance from abusers. I contextualize their experiences within the histories of colonialism in Guyana and Trinidad to understand the current structural conditions that contribute to IPV and reproductive injustice. Importantly, experiences of intimate partner violence led to reproductive control, lack of access to reproductive health care, and maternal health risks. While these findings serve as reasons why they journeyed, they also navigated various hardships in New York. This dissertation expands on sociological theories of gender, gender-based violence, medical tourism, migration, and grassroots organizing. Importantly, I show the importance of understanding reproductive health experiences through a reproductive justice lens. I center the work of black and brown feminists and womanists in my study and draw from their methodological tools to carry out this research. Ultimately, I shed light on the broader systems influencing transnational reproduction to lead to healthy reproductive lives

Antimicrobial Consumption from 2017 to 2021 in East Trinidad and Tobago: A Study in the English-Speaking Caribbean

An antimicrobial consumption (AMC) study was performed in Trinidad and Tobago at the Eastern Regional Health Authority (ERHA). A retrospective, cross-sectional survey was conducted from 1 November 2021 to 30 March 2022. Dosage and package types of amoxicillin, azithromycin, coamoxiclav, cefuroxime, ciprofloxacin, levofloxacin, moxifloxacin, nitrofurantoin and co-trimoxazole were investigated. Consumption was measured using theWorld Health Organization’s Antimicrobial Resistance and Consumption Surveillance System methodology version 1.0, as defined daily doses (DDD) per 1000 population per day (DID). They were also analyzed using the ‘Access’, ‘Watch’ and ‘Reserve’ classifications. In the ERHA, AMC ranged from 6.9 DID to 4.6 DID. With regards to intravenous formulations, the ‘Watch’ group displayed increased consumption, from 0.160 DID in 2017 to 0.238 DID in 2019, followed by a subsequent drop in consumption with the onset of the COVID-19 pandemic. Oral co-amoxiclav, oral cefuroxime, oral azithromycin and oral co-trimoxazole were the most highly consumed antibiotics. The hospital started off as the higher consumer of antibiotics, but this changed to the community. The consumption of ‘Watch’ group antibiotics increased from 2017 to 2021, with a drop in consumption of ‘Access’ antibiotics and at the onset of COVID-19. Consumption of oral azithromycin was higher in 2021 than 2020.Facultad de Ciencias Médica

Politics and political determinants of health policy and systems research funding in Latin America and the Caribbean

Objectives and importance of study: The importance of health policy and systems research (HPSR) has been acknowledged since 2004 and was recognised by the United Nations World Health Assembly in 2005. However, many factors influence its development. This paper aims to analyse the impact of politics and political determinants on HPSR funding in selected countries of Latin America and the Caribbean. Methods: Using a standardised protocol, we performed an analysis of available data and financing structures for health research and HPSR based on research in eight countries, including interviews with key stakeholders (n = 42). Results: Dollar depreciation and gross national product growth in the region may play a role in how governments fund research. There have been shifts in the political spectrum in governments, which have affected research coordination and funding in positive and negative ways. HPSR funding in some countries was dependent on budget decisions and although some have improved funding, others have regressed by decreasing funding or have completely cancelled financing mechanisms. Caribbean countries rely mainly on institutional funding. HPSR is recognised as important but remains underfunded; stakeholders believed it should be used more in decision making. Conclusion: Although HPSR is recognised as valuable for decision making and policy development it does not have the financial support required to flourish in Latin America and the Carribean. Data on health research financing were not easy to access. There was little or no evidence of published reports or papers about research financing, health research funding, and HPSR funding in particular in the studied countries Because of the fragility of health systems highlighted by the coronavirus disease 2019 (COVID-19) pandemic, HPSR should be of great relevance and value to both policy makers and funders