2020-04-16 DAILY UNM GLOBAL HEALTH COVID-19 BRIEFING

Executive Summary: Daily NM recap. Public Catholic masses resume. Chaplains stand down. Food delivered to tribal communities. Governors order face coverings use. Campfires restricted. NY hospitalizations fall. Nursing home probe in NJ. GOP call WHO Chief resignation. Africa cases up 51% and deaths up 60%. Sub-Saharan Africa prediction. Resurgence in Japan. UK conditions to reopen. France deaths up. UNMH protests over PPE. Med center financial stress. Hospitals bailout insufficient. 55% US healthcare worker cases hospital spread. Cruise ship transmission. Essential contact tracing. JAMA editors discuss policy. Guideline updates: treatment, emergency dep, ophthalmology, cath lab, telemedicine, liver disease, caregiver, health care facilities, FEMA, homeless services. Calcium channel blocker reduces fatality. Interferon lambda treatment. No benefit for lopinavir/ritonavir or arbidol in RCT. Donate plasma. Mixed results for antivirals on clearance. 37 new trials. Population-scale testing proposed. New rapid assay. Serology + RT-PCR needed. Hemoglobin monitoring. Co-infection of SARS-CoV-2. Urine glucose and proteinuria predict severity. Use damp cloth covers

2020-05-08 DAILY UNM GLOBAL HEALTH COVID-19 BRIEFING

Executive Summary: UNM drug repurposing. NM cases. Doctors Without Borders. SNAP benefits online. NM 7th highest unemployment. Virtual LemonAid tonight. New N98 masks. Healthcare supply chain challenge. EMS lack resources. Infection risk in healthcare workers. COVID-19 on medical education. Human disinfectant chambers. Evidence of seroconversion. Dangers of considering herd immunity. Wastewater-based surveillance. More youths infected. Reconstructing ship spread. Pharmacoepidemiologic analysis. Clinicopathologic characteristics. Cancer treatment impact. Reduced voluntary psychiatric admission in Italy. Operating room management. Humidifiers reduce transmission. Phone contact tracing ethics. Call for patient database. Immunity certification program. Guidelines on tracheostomy, IBD, nose bleeding, pituitary tumors, and hematopoietic stem cells transplantation, benefits of low-PEEP, and of molecular diagnostics. FDA authorizes at-home test. Cephid Xpert test. MRSA nasal swabs. NIH remdesivir+barictinib RCT. Corticosteroid caution. Arbidol active in vitro. ACE/ARB systematic review. In silico phytochemical and virus protease candidates. Potential zinc benefit. 31 new clinical trials. Glycemic control benefit. Psychological effects meta-analysis and survey. Disease course model. Liver injury. Environmental and health perspectives. Olfactory and gustatory dysfunction. Vitamin D. Disease map

2020-04-24 DAILY UNM GLOBAL HEALTH COVID-19 BRIEFING

Executive Summary: NYT praises NM. NM Governor update. NM cases. NM antibody tests. State hiring freeze. Navajo Nation sues. Navajo Nation CA doctors. Mental health funding. Balloon Fiesta proceeding. Trump Lysol remarks. $484B business relief. 50k US deaths. US no to WHO initiatives. US crime reductions. Moscow 10% infections. Quebec elderly deaths. Italy psychiatric sequelae. Global vaccines summit. French nicotine sales restrictions. Adaptive cyclic exit strategies. Mask reuse techniques. Mask steaming method. Legionnaire’s reopening risks. Youth mental health. US disease models. Covid phobia treatment avoidance. Nursing home testing. Home nursing demand. CDC home cleaning. Guidelines on: convalescent plasma transfusion, H2O2 nasal use, pre-op testing, respiratory distress, ophthalmological practice, GI department reopening. FDA hydroxychloroquine cautions. Chloroquine high-dose mortality. HCQ+azithromycin long-QT. Iron reduction adjuvant. Repurposing prioritization. Pediatric HCQ dosing. HCQ enrollment up. 107 trials registered. PPE skin injuries. LDL and severity. 32 ECMO patients. Worse outcomes older monkeys

2020-05-04 DAILY UNM GLOBAL HEALTH COVID-19 BRIEFING

Executive Summary: NM convalescent plasma call. NM case counts. Gallup lockdown continues. Tribal federal relief delay. Childcare demand drops. Polling open for primaries. Non-US world funds R&D. South Korea eases more. Soft quarantine inefficiency. Chinese interventions. Transmission window. December French case. CDC on law enforcement, essential errands. NEJM on telemedicine. Practice guidelines for: ECMO, pneumonia, nuclear medicine SOP. FDA antibody test restrictions. Africa testing differences. PCR assay sensitivity. Wuhan antibody tracking. Hydroxychloroquine toxicity. Remdesivir mechanism. Tocilzumab study inconclusive. SARs-CoV-2 structure. 28 new trials. Immunology and exercise. Synthetic SARS-CoV-2. IgM and IgG responses. Bacterial and fungal coinfection. Youth mental health challenges

The Global Alliance for Infections in Surgery : defining a model for antimicrobial stewardship-results from an international cross-sectional survey

Background: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p <0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). Conclusion: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.Peer reviewe

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice

Measures of retention in HIV care: A protocol for a mixed methods study.

IntroductionRetention in HIV care is necessary to achieve adherence to antiretroviral therapy, viral load suppression, and optimal health outcomes. There is no standard definition for retention in HIV care, which compromises consistent and reliable reporting and comparison of retention across facilities, jurisdictions, and studies.ObjectiveThe objective of this study is to explore how stakeholders involved in HIV care define retention in HIV care and their preferences on measuring retention.MethodsWe will use an exploratory sequential mixed methods design involving HIV stakeholder groups such as people living with HIV, people involved in providing care for PLHIV, and people involved in decision-making about PLHIV. In the qualitative phase of the study, we will conduct 20-25 in-depth interviews to collect the perspectives of HIV stakeholders on using their preferred retention measures. The findings from the qualitative phase will inform the development of survey items for the quantitative phase. Survey participants (n = 385) will be invited to rate the importance of each approach to measuring retention on a seven-point Likert scale. We will merge the qualitative and quantitative findings phase findings to inform a consensus-building framework for a standard definition of retention in care.Ethical issues and disseminationThis study has received ethics approval from the Hamilton Integrated Research Ethics Board. The findings will be disseminated through peer-reviewed publications, conference presentations, and among stakeholder groups.LimitationsThis study has limitations; we won't be able to arrive at a standard definition; a Delphi technique amongst the stakeholders will be utilized using the framework to reach a consensus globally accepted definition

Análise estrutural de vagens e sementes de soja submetidas à deterioração por umidade em pré-colheita

The objective of this work was to analyze structurally the pods and seed coats of soybean (Glycine max) cultivars, as well as to determine the quality of seeds when subjected to deterioration by weathering in pre-harvest. A 7×3 factorial arrangement was used – seven cultivars and three volumes of simulated rainfall (0, 54, and 162 mm). Exposure to rainfall was simulated in the R8 phenological stage. Then, the plants were taken to a greenhouse, where they were kept until the time of collection of pods and seeds. After collection, the following evaluations were carried out: tetrazolium test, lignin content in pods and seed coats, and structural analysis of pods (exocarp, mesocarp, and endocarp thickness) and seed coats (epidermis, hypodermis, and parenchymal-cell thickness). Pre-harvest rainfall of 54 and 162 mm reduces the quality of soybean seeds; however, the response to deterioration by weathering differs according to the cultivar. The tolerance to all simulated rainfall was greater for BRSMT Pintado, BRS Jiripoca, and M8210IPRO and lower for BRS 1010IPRO. Pods with a greater thickness of the exocarp, mesocarp, and endocarp and a high lignin content show greater resistance to weathering deterioration and seeds with greater vigor and viability. The thickness of the hypodermis of the testa is related to resistance to weathering deterioration and to the obtainment of high-quality seeds.O objetivo deste trabalho foi analisar estruturalmente as vagens e os tegumentos de cultivares de soja (Glycine max), bem com determinar a qualidade das sementes quando submetidas à deterioração por umidade em pré-colheita. Utilizou-se arranjo fatorial 7×3 – sete cultivares e três volumes de precipitações pluviais simuladas (0, 54 e 162 mm). A exposição à chuva foi simulada no estádio fenológico R8. Em seguida, as plantas foram levadas à casa de vegetação, onde foram mantidas até a coleta das vagens e das sementes. Após a coleta, realizaram-se as seguintes avaliações: teste de tetrazólio, teor de lignina nas vagens e nos tegumentos, e análise estrutural de vagens (espessura do exocarpo, do mesocarpo e do endocarpo) e tegumentos (espessura da epiderme, da hipoderme e das células parenquimatosas). Precipitações de 54 e 162 mm em pré-colheita reduzem a qualidade das sementes de soja; entretanto, a resposta à deterioração por umidade difere de acordo com a cultivar. A tolerância a todas as precipitações pluviais simuladas foi maior para BRSMT Pintado, BRS Jiripoca e M8210IPRO e menor para BRS 1010IPRO. Vagens com maior espessura do exocarpo, do mesocarpo e do endocarpo e elevados teores de lignina apresentam maior tolerância à deterioração por umidade e sementes com maior vigor e viabilidade. A espessura da hipoderme da testa de tegumentos está relacionada à tolerância à deterioração por umidade e à obtenção de sementes de elevada qualidade

Interview guide for the qualitative phase of the study.

Interview guide for the qualitative phase of the study.</p