• Genomics and epidemiology of the P.1 SARS-CoV-2 lineage in Manaus, Brazil

      Faria, Nuno R.; Mellan, Thomas A.; Whittaker, Charles; Claro, Ingra M.; Candido, Darlan da S.; Mishra, Swapnil; Crispim, Myuki A. E.; Sales, Flavia C.S.; Hawryluk, Iwona; McGrone, John T.; Hulswit, Ruben J.G.; Franco, Lucas A.M.; Ramundo, Mariana S.; De Jesus, Jaqueline G.; Andrade, Pamela S.; Coletti, Thais M.; Ferreira, Giulia M.; Silva, Camila A.M.; Manuli, Erika R.; Pereira, Rafael H.M.; Peixoto, Pedro S.; Kraemaer, Moritz U.G.; Gaburo Jr., Nelson; Camilo, Cecilia da C.; Hoeltgebaum, Henrique; Souza, William M.; Rocha, Esmenia C.; de Souza, Leandro M.; de Pinho, Mariana C.; Araujo, Leonardo J.T.; Malta, Frederico S.V.; de Lima, Aline B.; Silva, Joice do P.; Zauli, Danielle A.G.; Ferreira, Alessandro C. de S.; Schnekenberg, Ricardo P.; Laydon, Daniel J.; Walker, Patrick G.T.; Schluter, Hannah M.; dos Santos, Ana L.P.; Vidal, Maria S.; Del Caro, Valentina S.; Filho, Rosinaldo M.F.; dos Santos, Helem M.; Aguiar, Renato S.; Proenca-Modena, Jose L.; Nelson, Bruce; Hay, James A.; Monod, Melodie; Miscouridou, Xenia; Coupland, Helen; Sonabend, Raphael; Vollmer, Michaela; Gandy, Axel; Prete Jr., Carlos A.; Nascimento, Vitor H.; Suchard, Marc A.; Bowden, Thomas A.; Pond, Sergei; Wu, Chieh-Hsi; Ratmann, Oliver; Ferguson, Neil M.; Dye, Christopher; Loman, Nick J.; Lemey, Philippe; Rambaut, Andrew; Fraiji, Nelson A.; Carvalho, Maria do P.S.S.; Pybus, Oliver G.; Flaxman, Seth; Bhatt, Samir; Sabino, Ester C.; Pond|0000-0003-4817-4029 (2021-05-21)
      Cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Manaus, Brazil, resurged in late 2020 despite previously high levels of infection. Genome sequencing of viruses sampled in Manaus between November 2020 and January 2021 revealed the emergence and circulation of a novel SARS-CoV-2 variant of concern. Lineage P.1 acquired 17 mutations, including a trio in the spike protein (K417T, E484K, and N501Y) associated with increased binding to the human ACE2 (angiotensin-converting enzyme 2) receptor. Molecular clock analysis shows that P.1 emergence occurred around mid-November 2020 and was preceded by a period of faster molecular evolution. Using a two-category dynamical model that integrates genomic and mortality data, we estimate that P.1 may be 1.7- to 2.4-fold more transmissible and that previous (non-P.1) infection provides 54 to 79% of the protection against infection with P.1 that it provides against non-P.1 lineages. Enhanced global genomic surveillance of variants of concern, which may exhibit increased transmissibility and/or immune evasion, is critical to accelerate pandemic responsiveness.
    • Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease

      GOLD Science Committee (2021-01-01)
      The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has raised many questions about the management of patients with chronic obstructive pulmonary disease (COPD) and whether modifications of their therapy are required. It has raised questions about recognizing and differentiating coronavirus disease (COVID-19) from COPD given the similarity of the symptoms. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Science Committee used established methods for literature review to present an overview of the management of patients with COPD during the COVID-19 pandemic. It is unclear whether patients with COPD are at increased risk of becoming infected with SARS-CoV-2. During periods of high community prevalence of COVID-19, spirometry should only be used when it is essential for COPD diagnosis and/or to assess lung function status for interventional procedures or surgery. Patients with COPD should follow basic infection control measures, including social distancing, hand washing, and wearing a mask or face covering. Patients should remain up to date with appropriate vaccinations, particularly annual influenza vaccination. Although data are limited, inhaled corticosteroids, long-acting bronchodilators, roflumilast, or chronic macrolides should continue to be used as indicated for stable COPD management. Systemic steroids and antibiotics should be used in COPD exacerbations according to the usual indications. Differentiating symptoms of COVID-19 infection from chronic underlying symptoms or those of an acute COPD exacerbation may be challenging. If there is suspicion for COVID-19, testing for SARS-CoV-2 should be considered. Patients who developed moderate-to-severe COVID-19, including hospitalization and pneumonia, should be treated with evolving pharmacotherapeutic approaches as appropriate, including remdesivir, dexamethasone, and anticoagulation. Managing acute respiratory failure should include appropriate oxygen supplementation, prone positioning, noninvasive ventilation, and protective lung strategy in patients with COPD and severe acute respiratory distress syndrome. Patients who developed asymptomatic or mild COVID-19 should be followed with the usual COPD protocols. Patients who developed moderate or worse COVID-19 should be monitored more frequently and accurately than the usual patients with COPD, with particular attention to the need for oxygen therapy.
    • Guillain-Barre Syndrome in a Patient With Asymptomatic Coronavirus Disease 2019 Infection and Major Depressive Disorder

      Mokhashi, Nikita; Narla, Gowtham; Marchionni, Christine; Mokhashi|0000-0001-9510-3747 (2021-03-28)
      Coronavirus disease 2019 (COVID-19) has had a devastating effect on all aspects of society, including the economy, healthcare, and educational institutions. One underrecognized effect of the pandemic is the decline of mental health in our communities. Studies have shown that pandemic-related stress is associated with increased depression and anxiety. In addition to worsening mental health, COVID-19 infection has been shown to have neurological manifestations. We report the case of a 56-year-old woman with a history of major depressive disorder and alcohol use with no recent history of infection or vaccination who presented with hand and foot paresthesias over the past six weeks, 30 lb weight loss, dysphoric mood, and acutely progressive ambulatory dysfunction over the past two weeks, for which she required assistance to ambulate. Psychiatric evaluation was significant for depressive symptoms. On neurologic examination, she had decreased deep tendon reflexes and ataxic, jerky gait. She was found to be positive for COVID-19. Labs and findings demonstrated albuminocytologic dissociation which suggests presumptive diagnosis of Guillain-Barre syndrome, prompting treatment with intravenous immunoglobulin for five days. She was noted to be deficient in zinc, folate, copper, and borderline B-12, as well as mild hyponatremia, hypokalemia, and hypomagnesemia likely secondary to depression-induced loss of appetite and alcohol use disorder. Guillain-Barre is a severe and debilitating outcome that must be considered when evaluating neuromuscular weakness in the setting of COVID-19, even in asymptomatic patients. Our case highlights the multifactorial intersection between Guillain-Barre syndrome, COVID-19, and concomitant mental health and alcohol use disorder.
    • Healthcare resource use among solid organ transplant recipients hospitalized with COVID‐19

      Heldman, Madeleine R.; Kates, Olivia S.; Haydel, Brandy M.; Florman, Sander S.; Rana, Meenakshi M.; Chaudhry, Zohra S.; Ramesh, Mayur S.; Safa, Kassem; Kotton, Camille N.; Blumberg, Emily A.; Besharatian, Behdad D.; Tanna, Sajal D.; Ison, Michael G.; Malinis, Maricar; Azar, Marwan M.; Rakita, Robert M.; Morillas, Jose A.; Majeed, Aneela; Sait, Afrah S.; Spaggiari, Mario; Hemmige, Vagish; Mehta, Sapna A.; Neumann, Henry; Badami, Abbasali; Jeng, Amy; Goldman, Jason D.; Lala, Anuradha; Hemmersbach‐Miller, Marion; McCort, Margaret E.; Bajrovic, Valida; Ortiz‐Bautista, Carlos; Friedman‐Moraco, Rachel; Sehgal, Sameep; Lease, Erika D.; Limaye, Ajit P.; Fisher, Cynthia E. (2020-12-22)
    • Heart failure in COVID‐19: the multicentre, multinational PCHF‐COVICAV registry

      Sokolski, Mateusz; Trenson, Sander; Sokolska, Justyna M.; D'Amario, Domenico; Meyer, Philippe; Poku, Nana K.; Biering-Sørensen, Tor; Højbjerg Lassen, Mats C.; Skaarup, Kristoffer G.; Barge-Caballero, Eduardo; Pouleur, Anne-Catherine; Stolfo, Davide; Sinagra, Gianfranco; Ablasser, Klemens; Muster, Viktoria; Rainer, Peter P.; Wallner, Markus; Chiodini, Alessandra; Heiniger, Pascal S.; Mikulicic, Fran; Schwaiger, Judith; Winnik, Stephan; Cakmak, Huseyin A.; Gaudenzi, Margherita; Mapelli, Massimo; Mattavelli, Irene; Paul, Matthias; Cabac-Pogorevici, Irina; Bouleti, Claire; Lilliu, Marzia; Minoia, Chiara; Dauw, Jeroen; Costa, Jérôme; Celik, Ahmet; Mewton, Nathan; Montenegro, Carlos E.L.; Matsue, Yuya; Loncar, Goran; Marchel, Michal; Bechlioulis, Aris; Michalis, Lampros; Dörr, Marcus; Prihadi, Edgard; Schoenrath, Felix; Messroghli, Daniel R.; Mullens, Wilfried; Lund, Lars H.; M.C. Rosano, Giuseppe; Ponikowski, Piotr; Ruschitzka, Frank; Flammer, Andreas J.; Wallner|0000-0001-7692-892X (2021-09-17)
      Aims: We assessed the outcome of hospitalized coronavirus disease 2019 (COVID-19) patients with heart failure (HF) compared with patients with other cardiovascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia). We further wanted to determine the incidence of HF events and its consequences in these patient populations. Methods and results: International retrospective Postgraduate Course in Heart Failure registry for patients hospitalized with COVID-19 and CArdioVascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia) was performed in 28 centres from 15 countries (PCHF-COVICAV). The primary endpoint was in-hospital mortality. Of 1974 patients hospitalized with COVID-19, 1282 had cardiovascular disease and/or risk factors (median age: 72 [interquartile range: 62–81] years, 58% male), with HF being present in 256 [20%] patients. Overall in-hospital mortality was 25% (n = 323/1282 deaths). In-hospital mortality was higher in patients with a history of HF (36%, n = 92) compared with non-HF patients (23%, n = 231, odds ratio [OR] 1.93 [95% confidence interval: 1.44–2.59], P < 0.001). After adjusting, HF remained associated with in-hospital mortality (OR 1.45 [95% confidence interval: 1.01–2.06], P = 0.041). Importantly, 186 of 1282 [15%] patients had an acute HF event during hospitalization (76 [40%] with de novo HF), which was associated with higher in-hospital mortality (89 [48%] vs. 220 [23%]) than in patients without HF event (OR 3.10 [2.24–4.29], P < 0.001). Conclusions: Hospitalized COVID-19 patients with HF are at increased risk for in-hospital death. In-hospital worsening of HF or acute HF de novo are common and associated with a further increase in in-hospital mortality.
    • History of Respiratory Stimulants

      Peppin, John F.; Pergolizzi Jr., Joseph V.; Fudin, Jeffrey; Meyer, Tricia A.; Raffa, Robert B. (2021-04-16)
      The interest in substances that stimulate respiration has waxed and waned throughout the years, intensifying following the introduction of a new class of drugs that causes respiratory depression, and diminishing when antidotes or better drug alternatives are found. Examples include the opioids––deaths increasing during overprescribing, diminishing with wider availability of the opioid receptor antagonist naloxone, increasing again during COVID-19; the barbiturates––until largely supplanted by the benzodiazepines; propofol; and other central nervous system depressants. Unfortunately, two new troubling phenomena force a reconsideration of the status-quo: (1) overdoses due to highly potent opioids such as fentanyl, and even more-potent licit and illicit fentanyl analogs, and (2) overdose due to polysubstance use (the combination of an opioid plus one or more non-opioid drug, such as a benzodiazepine, sedating antidepressant, skeletal muscle relaxant, or various other agents). Since these now represent the majority of cases, new solutions are again needed. An interest in respiratory stimulants has been revived. This interest can be informed by a short review of the history of this interesting class of medications. We present a short history of the trajectory of advances toward more selective and safer respiratory stimulants.
    • HLA Expression Correlates to the Risk of Immune Checkpoint Inhibitor-Induced Pneumonitis

      Center for Biotechnology, Sbarro Institute for Cancer Research and Molecular Medicine (Temple University) (2020-08-25)
      Tumor-infiltrating T cell rescue by programmed cell death receptor-1 (PD-1)/PD-1 ligand-1 (PD-L1) immune checkpoint blockade is a recommended treatment for malignant diseases, including metastatic non-small-cell lung cancer (mNSCLC), malignant melanoma (MM), head and neck, kidney, and urothelial cancer. Monoclonal antibodies (mAbs) against either PD-1 or PD-L1 are active agents for these patients; however, their use may be complicated by unpredictable immune-related adverse events (irAEs), including immune-related pneumonitis (IRP). We carried out a retrospective multi-institutional statistical analysis to investigate clinical and biological parameters correlated with IRP rate on a cohort of 256 patients who received real-world treatment with PD-1/PD-L1 blocking mAbs. An independent radiological review board detected IRP in 29 patients. We did not find statistical IRP rate correlation with gender, tumor type, specific PD-1 or PD-L1 blocking mAbs, radiation therapy, inflammatory profile, or different irAEs. A higher IRP risk was detected only in mNSCLC patients who received metronomic chemotherapy +/− bevacizumab compared with other treatments prior PD-1/PD-L1 blockade. Moreover, we detected a strong correlation among the IRP rate and germinal expression of HLA-B*35 and DRB1*11, alleles associated to autoimmune diseases. Our findings may have relevant implications in predicting the IRP rate in mNSCLC patients receiving PD-1/PD-L1 blockade and need to be validated on a larger patient series.
    • HLA-B*44 and C*01 Prevalence Correlates with Covid19 Spreading across Italy

      Center for Biotechnology, Sbarro Institute for Cancer Research and Molecular Medicine (Temple University) (2020-07-23)
      The spread of COVID-19 is showing huge, unexplained, differences between northern and southern Italy. We hypothesized that the regional prevalence of specific class I human leukocyte antigen (HLA) alleles, which shape the anti-viral immune response, might partly underlie these differences. Through an ecological approach, we analyzed whether a set of HLA alleles (A, B, C), known to be involved in the immune response against infections, correlates with COVID-19 incidence. COVID-19 data were provided by the National Civil Protection Department, whereas HLA allele prevalence was retrieved through the Italian Bone-Marrow Donors Registry. Among all the alleles, HLA-A*25, B*08, B*44, B*15:01, B*51, C*01, and C*03 showed a positive log-linear correlation with COVID-19 incidence rate fixed on 9 April 2020 in proximity of the national outbreak peak (Pearson’s coefficients between 0.50 and 0.70, p-value < 0.0001), whereas HLA-B*14, B*18, and B*49 showed an inverse log-linear correlation (Pearson’s coefficients between −0.47 and −0.59, p-value < 0.0001). When alleles were examined simultaneously using a multiple regression model to control for confounding factors, HLA-B*44 and C*01 were still positively and independently associated with COVID-19: a growth rate of 16% (95%CI: 0.1–35%) per 1% point increase in B*44 prevalence; and of 19% (95%CI: 1–41%) per 1% point increase in C*01 prevalence. Our epidemiologic analysis, despite the limits of the ecological approach, is strongly suggestive of a permissive role of HLA-C*01 and B*44 towards SARS-CoV-2 infection, which warrants further investigation in case-control studies. This study opens a new potential avenue for the identification of sub-populations at risk, which could provide Health Services with a tool to define more targeted clinical management strategies and priorities in vaccination campaigns.
    • Homemade Face Shield Assembly Guide

      TUCAT (Temple University) (2020-05-07)
    • Human-Dog Relationship during the First COVID-19 Lockdown in Italy

      Sbarro Institute for Cancer Research and Molecular Medicine (Temple University); Center for Biotechnology (Temple University) (2021-08-07)
      The SARS-CoV2 pandemic forced an abrupt interruption of social contacts and interpersonal affective relationships all over the world, according to national directives. Many considerable inconveniences occurred with important repercussions also on the emotional state of people and their pets. We carried out a national survey to evaluate the human-dog relationship in a social isolation context using an adapted version of Monash Dog Owner Relationship Scale, the perception of the dogs’ discomfort by their human owners, and the resilience of the dog through the quantification of symptoms, in time of the first lockdown of the COVID-19 pandemic. The results highlighted that the human-dog interaction was similar during quarantine; however, there was lower owner’s perception of a dog’s cost during the quarantine than before it.
    • Hyperlipidemia May Synergize with Hypomethylation in Establishing Trained Immunity and Promoting Inflammation in NASH and NAFLD

      Center for Cardiovascular Research and Inflammation (Temple University); Center for Translational and Clinical Lung Research (Temple University) (2021-11-23)
      We performed a panoramic analysis on both human nonalcoholic steatohepatitis (NASH) microarray data and microarray/RNA-seq data from various mouse models of nonalcoholic fatty liver disease NASH/NAFLD with total 4249 genes examined and made the following findings: (i) human NASH and NAFLD mouse models upregulate both cytokines and chemokines; (ii) pathway analysis indicated that human NASH can be classified into metabolic and immune NASH; methionine- and choline-deficient (MCD)+high-fat diet (HFD), glycine N-methyltransferase deficient (GNMT-KO), methionine adenosyltransferase 1A deficient (MAT1A-KO), and HFCD (high-fat-cholesterol diet) can be classified into inflammatory, SAM accumulation, cholesterol/mevalonate, and LXR/RXR-fatty acid β-oxidation NAFLD, respectively; (iii) canonical and noncanonical inflammasomes play differential roles in the pathogenesis of NASH/NAFLD; (iv) trained immunity (TI) enzymes are significantly upregulated in NASH/NAFLD; HFCD upregulates TI enzymes more than cytokines, chemokines, and inflammasome regulators; (v) the MCD+HFD is a model with the upregulation of proinflammatory cytokines and canonical and noncanonical inflammasomes; however, the HFCD is a model with upregulation of TI enzymes and lipid peroxidation enzymes; and (vi) caspase-11 and caspase-1 act as upstream master regulators, which partially upregulate the expressions of cytokines, chemokines, canonical and noncanonical inflammasome pathway regulators, TI enzymes, and lipid peroxidation enzymes. Our findings provide novel insights on the synergies between hyperlipidemia and hypomethylation in establishing TI and promoting inflammation in NASH and NAFLD progression and novel targets for future therapeutic interventions for NASH and NAFLD, metabolic diseases, transplantation, and cancers.
    • IEEE Access Special Section Editorial: Security and Privacy in Emerging Decentralized Communication Environments

      Cheng, Xiaochun; Liu, Zheli; DU, XIAOJIANG; Yu, Shui; Mostarda, Leonardo; Du|0000-0003-4235-9671 (2021-05-13)
      Due to the COVID-19 epidemic, face-to-face team working has changed into distanced work from home. Modern, decentralized digital communication environments are changing with the availability of new technologies and the development of new real-world applications, which lead to novel challenges in security and privacy protection. 5G/6G mobile applications, the smart Internet of Things (IoT) devices, big data applications, and cloud systems are developing to better meet new requirements. Mobile–cloud architecture is emerging as 5G /6G mobile IoT devices are generating large volumes of data which need cloud infrastructure to process. Many IoT systems and cloud systems are decentralized, and new security and privacy protection solutions are emerging in decentralized networks. The increasing interdependence of IT solutions accepted by society has led to a sharp increase in data. As a result, the chances of data leakage or privacy infringement also increase, along with the need for new solutions for digital security and privacy protection.
    • Impact of Tobacco Smoking Status on Morbidity and Mortality in Patients Hospitalized with COVID-19 Pneumonia: Observational study

      Fernandez Romero, Gustavo; Dominguez-Castillo, Eduardo; Zheng, Matthew; Yousef, Ibraheem; Darnell, Melinda; Ganghemi, Andrew; Dorey-Stein, Zack; Zantah, Massa; Townsend, Ryan; Myers, Catherine; Ku, Tse-Shuen; Patel, Maulin; Patlakh, Nicole; Jacobs, Michael; Zhao, Huaqing; Gupta, Rohit; Rali, Parth; Criner, Gerard J. (2020-11-14)
      Background: Determine the impact of tobacco smoking status on patients hospitalized with COVID-19 pneumonia in the need for ICU care, mechanical ventilation and mortality. Methods: We performed a retrospective cohort study, that involved chart review. All adults 18 years or older with a diagnosis of COVID-19 pneumonia hospitalized from March 15th, 2020 to May 06th, 2020 with a positive reverse transcription polymerase chain reaction (RT-PCR) nasopharyngeal swab for COVID-19. We used chi-squared test for categorical variables and student t-tests or Wilcoxon rank sum tests for continuous variables. We further used adjusted and unadjusted logistic regression to assess risk factors for mortality and intubation. Results: Among 577 patients hospitalized with COVID-19 pneumonia, 268 (46.4%) had a history of smoking including 187 former and 81 active smokers. The former smokers when compared with non-smokers were predominantly older with more comorbidities. Also, when compared with never smokers D Dimer levels were elevated in active (p=0.05) and former smokers (p<0.01). The former smokers versus non-smokers required increased need for advanced non-invasive respiratory support on admission (p<0.05), ICU care (p<0.05) and had higher mortality [1.99 (CI 95% 1.03-3.85, p<0.05)]. Active smokers versus non-smokers received more mechanical ventilation [OR 2.11 (CI 95% 1.06-4.19, p<0.05)]. Conclusions: In our cohort of hospitalized patients with COVID-19 pneumonia, former smokers had higher need for non-invasive respiratory support on admission, ICU care, and mortality compared to non-smokers. Also, active smokers versus non-smokers needed more mechanical ventilation.
    • Implications of COVID-19−associated Coagulopathy on Reconstructive Surgery: A Case of Ongoing Tissue Necrosis

      Dugue, David; Hsu, Kun-Tai; Wagner, I. Janelle; Jones, Christine M. (2020-12-16)
    • Incorporating Geographic Information Science and Technology in Response to the COVID-19 Pandemic

      Smith, Charlotte D.; Mennis, Jeremy; 0000-0001-6319-8622 (2020-07-09)
      Incorporating geographic information science and technology (GIS&T) into COVID-19 pandemic surveillance, modeling, and response enhances understanding and control of the disease. Applications of GIS&T include 1) developing spatial data infrastructures for surveillance and data sharing, 2) incorporating mobility data in infectious disease forecasting, 3) using geospatial technologies for digital contact tracing, 4) integrating geographic data in COVID-19 modeling, 5) investigating geographic social vulnerabilities and health disparities, and 6) communicating the status of the disease or status of facilities for return-to-normal operations. Locations and availability of personal protective equipment, ventilators, hospital beds, and other items can be optimized with the use of GIS&T. Challenges include protection of individual privacy and civil liberties and closer collaboration among the fields of geography, medicine, public health, and public policy.
    • Individual Hurricane Preparedness During the COVID-19 Pandemic: Insights for Risk Communication and Emergency Management Policies

      Botzen, W.J.W.; Mol, Jantsje M.; Robinson, Peter John; Zhang, Juan; Czajkowski, Jeffrey (2020-01-01)
      Climate change adaptation strategies should anticipate that the 2020 situation which resembles an above average hurricane season coinciding with a pandemic may occur more frequently in the future. This study draws lessons on how individual hurricane preparedness is influenced by a pandemic, which turns out to be a combination of perceptions of flood and pandemic risks that have opposite effects on preparedness behavior. We conducted three waves of surveys during 2019-2020 to monitor hurricane preparedness activities in flood-prone coastal areas in Florida, including a survey of 600 respondents in early June 2020 to obtain insights into households’ risk perceptions and preparedness for this hurricane season under COVID-19. The results show that this hurricane season is dominated by concerns over COVID-19 which influences people’s evacuation intentions. Whereas hotel costs were the main obstacle to evacuating during Hurricane Dorian in 2019, the main evacuation obstacle identified in the 2020 hurricane season is COVID-19. Our statistical analyses that investigates the factors influencing evacuation intentions consistently show that older individuals are less likely to evacuate voluntarily, because they are concerned about becoming infected by COVID-19. We discuss the implications of our findings for adaptation policies that aim to improve hurricane preparedness in situations of a pandemic, such as risk communication and emergency management policies.
    • Inside the Clockwork of the ECHO Factorial Trial: A Conceptual Model With Proposed Mediators for Prevention of Emotional Problems in Children

      Ingul, Jo Magne; Martinsen, Kristin; Adolfsen, Frode; Sund, Anne Mari; Ytreland, Kristin; Valmyr Bania, Elisabeth; Lisøy, Carina; Potulski Rasmussen, Lene-Mari; Haug, Ida Mari; Patras, Joshua; Collins, Linda M.; Kendall, Philip C.; Neumer, Simon Peter; Kendall|0000-0001-7034-6961 (2021-06-21)
      Having interventions that are not only evidence-based and effective but also cost-effective and efficient is important for the prevention and treatment of child and adolescent emotional problems. A randomized clinical trial (RCT) tests the total interventions effect but does not address specific components of the intervention. In this article the hypothesis and a conceptual model of the ECHO study are presented and discussed. The ECHO intervention consists of three different components each containing two levels of intervention. By using a cluster randomized factorial design, children aged 8–12 at 40 schools across Norway will be randomized to eight different experimental conditions investigating the optimal balance between effect, cost-effectiveness, and efficiency. The article presents the design and the different components being tested and discusses how optimalization can be reached through this innovative design. The article also discusses how interventions can be improved by investigating and understanding the mechanisms of change within psychological interventions. For each of the three components in the study we consider the mediators that could be active within the intervention and how the study investigates such mediation. The results will contribute to a better understanding of how psychological interventions work and how we intend to optimize the EMOTION intervention.
    • International Law as Hedging: Perspectives from Secondary Authoritarian States

      Nguyen, Trang (Mae) (2020-08-17)
      Tom Ginsburg's important article comes at a critical time. The COVID-19 crisis has spurred heated debates about political regimes vis-à-vis countries’ bureaucratic capacity. Political regime type is the core independent variable in Ginsburg's conceptualization of authoritarian international law—a global projection of authoritarian states’ domestic politics. This essay echoes Ginsburg's insightful observation but complicates it by shifting the focus to the less-known perspectives of secondary authoritarian countries. I use a matrix case study of two smaller states, Vietnam and Cambodia, on two prominent issues, the South China Sea (SCS) and the Belt and Road Initiative (BRI), to demonstrate small states’ effort to use international law to “hedge” big powers. As the case studies show, small authoritarian states, not unlike other small states, prefer a pluralist vision of international law, even if they may at times embrace the alternative model offered by big authoritarian powers. These states thus have an important, perhaps unexpected, role to play in preserving the pluralist international legal order and mitigating the hegemonic tendencies of authoritarian international law.
    • Internet Access and Usage Among Stroke Survivors and Their Informal Caregivers: Cross-sectional Study

      Ali Naqvi, Imama; Montiel, Tahani Casameni; Bittar, Yazan; Hunter, Norma; Okpala, Munachi; Johnson, Constance; Weiner, Mark G.; Savitz, Sean; Sharrief, Anjail; Sanner Beauchamp, Jennifer Elizabeth; Bittar|0000-0001-6788-7310 (2021-08-03)
      Background: Web-based interventions have shown promise for chronic disease management but have not been widely applied to populations with stroke. Existing barriers may inhibit the adoption of web-based interventions among stroke survivors and necessitate the involvement of informal caregivers. However, limited information is available on internet accessibility and usability among stroke survivors and their caregivers. Objective: This study aims to investigate internet access and usage in a cohort of stroke survivors and their caregivers. Methods:A cross-sectional survey was conducted with 375 participants (248 stroke survivors and 127 caregivers). Descriptive statistics were generated using cross-tabulation. Comparisons with categorical data were conducted using the chi-square test, whereas the Mann-Whitney U test was used for comparisons involving ordinal variables. Results: Overall, 86.1% (323/375) of the participants reported having internet access. Caregivers were more likely than stroke survivors to access the internet (N=375, χ21=18.5, P<.001) and used text messaging (n=321, χ21=14.7, P<.001). Stroke survivors and caregivers with internet access were younger than stroke survivors and caregivers without internet access. The highest number of participants who reported internet access were non-Hispanic White. Smartphones were the most common devices used to access the internet. Email was the most common type of internet usage reported. Patients who survived for >12 months after a stroke reported higher internet access than those who survived <3 months (P<.001). The number of hours per week spent using the internet was higher for caregivers than for stroke survivors (P<.001). Conclusions: Future feasibility and acceptability studies should consider the role of the informal caregiver, participant age, race and ethnicity, the use of smartphone apps, email and text correspondence, and the amount of time elapsed since the stroke event in the design and implementation of web-based interventions for populations with stroke.
    • Intersection of the Web-Based Vaping Narrative With COVID-19: Topic Modeling Study

      Janmohamed, Kamila; Soale, Abdul-Nasah; Forastiere, Laura; Tang, Weiming; Sha, Yongjie; Demant, Jakob; Airoldi, Edoardo; Kumar, Navin; Soale|0000-0003-2093-7645; Airoldi|0000-0002-3512-0542 (2020-10-30)
      Background: The COVID-19 outbreak was designated a global pandemic on March 11, 2020. The relationship between vaping and contracting COVID-19 is unclear, and information on the internet is conflicting. There is some scientific evidence that vaping cannabidiol (CBD), an active ingredient in cannabis that is obtained from the hemp plant, or other substances is associated with more severe manifestations of COVID-19. However, there is also inaccurate information that vaping can aid COVID-19 treatment, as well as expert opinion that CBD, possibly administered through vaping, can mitigate COVID-19 symptoms. Thus, it is necessary to study the spread of inaccurate information to better understand how to promote scientific knowledge and curb inaccurate information, which is critical to the health of vapers. Inaccurate information about vaping and COVID-19 may affect COVID-19 treatment outcomes. Objective: Using structural topic modeling, we aimed to map temporal trends in the web-based vaping narrative (a large data set comprising web-based vaping chatter from several sources) to indicate how the narrative changed from before to during the COVID-19 pandemic. Methods: We obtained data using a textual query that scanned a data pool of approximately 200,000 different domains (4,027,172 documents and 361,100,284 words) such as public internet forums, blogs, and social media, from August 1, 2019, to April 21, 2020. We then used structural topic modeling to understand changes in word prevalence and semantic structures within topics around vaping before and after December 31, 2019, when COVID-19 was reported to the World Health Organization. Results: Broadly, the web-based vaping narrative can be organized into the following groups or archetypes: harms from vaping; Vaping Regulation; Vaping as Harm Reduction or Treatment; and Vaping Lifestyle. Three archetypes were observed prior to the emergence of COVID-19; however, four archetypes were identified post–COVID-19 (Vaping as Harm Reduction or Treatment was the additional archetype). A topic related to CBD product preference emerged after COVID-19 was first reported, which may be related to the use of CBD by vapers as a COVID-19 treatment. Conclusions: Our main finding is the emergence of a vape-administered CBD treatment narrative around COVID-19 when comparing the web-based vaping narratives before and during the COVID-19 pandemic. These results are key to understanding how vapers respond to inaccurate information about COVID-19, optimizing treatment of vapers who contract COVID-19, and possibly minimizing instances of inaccurate information. The findings have implications for the management of COVID-19 among vapers and the monitoring of web-based content pertinent to tobacco to develop targeted interventions to manage COVID-19 among vapers.