Subgroup analysis reveals higher reliability of the new comprehensive evaluation of Global Initiative for Chronic Obstructive Lung Disease 2019

To estimate the severity of the disease in outpatients with chronic obstructive pulmonary disease (COPD) in Hunan Province, China and use the subgroup analysis to evaluate the reliability of the new comprehensive evaluation of Global Initiative for Chronic Obstructive Lung Disease (GOLD). COPD outpatients from 12 medical centers in Hunan Province, China were stratified into groups A–D, and group D patients were further stratified into subgroups D1–D3 according to the GOLD 2016 and 2019 comprehensive assessment. Demography, clinical characteristics and medications were compared among groups. In 1017 COPD outpatients, the distribution from group A to D and subgroup D1 to D3 was 41 (4.0%), 249 (24.5%), 17 (1.7%), 710 (69.8%) and 214 (30.2%), 204 (28.7%), 292 (41.1%), according to GOLD 2016. In terms of demographic and clinical characteristics related to A–D groups, there was a significant difference in COPD assessment test (CAT), modified Medical British Research Council (mMRC), the clinical COPD questionnaire(CCQ), age, BMI, education level, smoking history, comorbidities, the course of chronic bronchitis/emphysema, number of exacerbations/hospitalisations in the previous year, treatment protocols, forced expiratory volume in one second (FEV1) % predicted, and FEV1/forced vital capacity (FVC) (p < 0.01). Furthermore, some patients in groups C–D regrouped to groups A–B were all C1 and D1 subgroups according to GOLD 2019. Comparing subgroup D1 with group B, subgroup D2 and subgroup D3, it was found that the demography, clinical characteristics and medications of subgroup D1 were the closest to group B, according to GOLD 2016 (p < 0.01). The disease severity of outpatients with COPD in Hunan Province was more pronounced in group B and D and patients in groups A–D had different demography, clinical characteristics and medications. Subgroup analysis can explain to a certain extent that GOLD2019’s new comprehensive assessment is more reliable than GOLD 2016.

TINGKAT PENGETAHUAN MASYARAKAT TENTANG FAKTOR PREDISPOSISI PENYAKIT ASMA DI PUSKESMAS PEMBANTU BERNGAM KOTA BINJAI TAHUN 2020

Asma adalah penyakit paru kronik yang sering terjadi di dunia. Data mengenaikematian akibat asma mengalami peningkatan dalam beberapa dekade terakhir.Menurut Global Initiative for Asthma (GINA) tahun 2008, asma didefinisikansebagai penyakit inflamasi kronis pada saluran pernafasan. Asma merupakanpenyakit saluran napas kronis yang dapat bersifat ringan, akan tetapi dapat menetapserta mengganggu aktivitas sehari-hari. Meskipun jarang menimbulkan kematian,penyakit ini sering menimbulkan masalah dalam beraktifitas. Peneliti melakukansurvei awal yang di lakukan pada Bulan Januari 2020 di Puskesmas PembantuBerngam Kota Binjai ditemukan prevalensi asma di wilayah kerja PuskesmasPembantu Berngam Binjai pada tahun 2019 sebesar 42 orang. Tujuan penelitian iniuntuk mengetahui tentang tingkat pengetahuan masyarakat tentang faktorpredisposisi penyakit asma. Adapun jenis penelitian bersifat deskriptif, instrumenyang digunakan adalah kuesioner. Data kemudian dianalisa dalam bentuk tabelkarakteristik pengetahuan responden kemudian dipersentasikan.. Hasil penelitianmenunjukkan bahwa mayoritas masyarakat memiliki pengetahuan kurang sebanyak55%, kemudian pengetahuan baik sebanyak 30%, dan pengetahuan cukup sebanyak15%

Economic Analysis For Sustainable Utilization of Ethanol Production Residues From Grain and Inedible Plant Wastes

The global initiative to find alternative fuel sources to fossil fuels is an ongoing process. As such, bioethanol is used as a fuel blend with petrol. However, large number of solid wastes is produced from ethanol plants sourcing from grain and inedible plant wastes, for example, WDGS (wet distiller’s grain with soluble) and DDGS (dry distiller’s grain with soluble) produced from ethanol plants using corn. This study investigates alternative methods for using these co-products through combustion and anaerobic digestion. Process simulation and economic analysis were conducted using current market prices to evaluate the viability of the processes. Products in the form of energy are produced. Optimization of the corn ethanol plant was also explored for re-using the heat and electricity produced in those processes. The profits of combustion and anaerobic digestion were compared. It was found that these processes will supply more viable options to simply selling the grain as feed for livestock. The anaerobic digestion of WDGS to produce electricity scenario was found to have the biggest profit among the four scenarios which can bring the annual income of 14.1 million Australian dollar to the ethanol plant. An environmental analysis of the CO2 emissions was also conducted. Using the Australian state emission factor, the amount of CO2 offset through both combustion and anaerobic digestion can be seen. The anaerobic digestion of WDGS to supply heat to the plant was proved having the largest CO2 abatement with the value of 0.58 kg-CO2e/L-EtOH.

Cooccurrence of N501Y, P681R and other key mutations in SARS-CoV-2 Spike

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has produced five variants of concern (VOC) to date. The important Spike mutation N501Y is common to Alpha, Beta, Gamma and Omicron VOC, while the P681R is key to the spread of Delta. We have analysed circa 4.2 million SARS-CoV-2 genome sequences from the largest repository Global Initiative on Sharing All Influenza Data (GISAID) and demonstrated that these two mutations have cooccurred on the Spike D614G mutation background at least 3,678 times from 17 October 2020 to 1 November 2021. In contrast, the Y501-H681 combination, which is common to Alpha and Omicron VOC, is present in circa 1.1 million entries. Two-thirds of the 3,678 cooccurrences were in France, Turkey or US (East Coast), and the rest across 57 other countries. 55.5% and 4.6% of the cooccurrences were Alpha Q.4 and Gamma P.1.8 sub-lineages acquiring the P681R; 10.7% and 3.8% were Delta B.1.617.2 lineage and AY.33 sub-lineage acquiring the N501Y; the remaining 10.2% were in other variants. Despite the selective advantages individually conferred by N501Y and P681R, the Y501-R681 combination counterintuitively did not outcompete other variants in every instance we have examined. While this is a relief to worldwide public health efforts, in vitro and in vivo studies are urgently required in the absence of a strong in silico explanation for this phenomenon. This study demonstrates a pipeline to analyse combinations of key mutations from public domain information in a systematic manner and provide early warnings of spread.

Bringing a Global Perspective to Students via Telesimulation

The aim of this Simulation Based Experience (SBE) was to replicate a global initiative via a telesimulated environment. Due to COVID-19, all study abroad trips were canceled by both the University and the governments of both the United States and Peru. In order to facilitate the learning goals and objectives, faculty developed a fully functional, online module via Zoom, which simulated in-country experiences. Three four-hour Zoom sessions allowed faculty to utilize INASCL standards of best practice to facilitate SBE activities such as pre and post-operative education for an Embedded Participant (EP) playing the role of patient (INACSL Standards Committee, 2016; Lioce et al., 2020). 80% of students attempted to speak Spanish over the course of the SBE. During the debrief process, students were asked to provide affective words regarding the SBE which indicated trepidation in utilizing the Spanish language and not understanding content. On the final day of simulation, all students found value and collaboration in the process. Telesimulation via Zoom allowed students to be immersed in an unknown culture, and the use of breakout rooms encouraged engagement with EP one-on-one. Zoom for remote simulation is a plausible replacement for HFPS due to the COVID-19 pandemic. Research is needed to explore and compare cultural gains and sensitivity to students in-country versus through remote learning.

Case Report: Self-Administration of Omalizumab in an Adolescent With Severe Asthma During SARS-CoV-2 Infection

Acute asthma remains one of the most frequent causes of children's access to healthcare. Asthma exacerbation is an essential defining characteristic of its severity, and respiratory infections entail increased risks of exacerbations with potential hospitalization. In the literature, contradictory findings have been reported about the risk and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients affected by asthma, with several implications for its management. Anti-IgE monoclonal antibody therapy is meant for patients affected by severe persistent allergic asthma without adequate control with other treatments. Indeed, biological therapies, such as omalizumab, are used as add-on treatments (step 5 in the Global Initiative for Asthma report) for severe asthma with several benefits, including a reduction in the frequency of exacerbations. To the best of our knowledge, we hereby report the first case in which an adolescent with severe allergic asthma treated with omalizumab has switched to self-administration at home during SARS-CoV-2 infection. Based on our peculiar experience, physicians may consider switching to self-administration of omalizumab at home, even during the coronavirus disease 2019 pandemic. However, more extensive research data from future studies are needed to confirm these first findings.

Supporting Educational Needs of Older Adult Learners: Strategies for Virtual Transitioning and Student Engagement

The pandemic has revealed a multitude of challenges disproportionately impacting older adults, including older adult learners. Institutions of higher education are uniquely positioned to respond to various challenges using the guiding framework of the Age-Friendly University global initiative. This presentation highlights how preexisting university student support practices and services were adapted to provide older adult learners with guidance for navigating their educational needs during the pandemic. Specifically, it expands on strategies utilized by Adult Learner Programs and Services to effectively pivot to virtual services to support the advising and programming needs of older adult learners. Survey data identifying areas of interest for virtual programming for older adult students will be explored. Recommendations will be discussed for promoting effective transitioning to virtual support systems, preserving student engagement and intergenerational learning, and advocating for aging to remain central to university diversity and inclusion initiatives.

Implications of using the GLI-2012, GOLD and Australian COPD-X recommendations in assessing the severity of airflow limitation on spirometry among an Indigenous population with COPD: an Indigenous Australians perspective study

BackgroundAssessment of airflow limitation (AFL) is crucial in the clinical evaluation of patients with chronic obstructive pulmonary disease (COPD). However, in the absence of normative reference values among adult Australian Indigenous population, the implications of utilising the Global Lung Function Initiative (GLI-2012), Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the Australian concise COPD-X recommended severity classifications is not known. Moreover, spirometry values (forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)) are observed to be 20%–30% lower in an apparently healthy Indigenous population in comparison to Caucasian counterparts.MethodsAdult Indigenous patients diagnosed to have COPD on spirometry (postbronchodilator (BD) FEV1/FVC <0.7 ((GOLD, (COPD-X)) and ≤lower limit of normal (others/mixed reference equations) for GLI-2012) were assessed for AFL severity classifications on Post-BD FEV1 values (mild, moderate, severe, very severe) as per the recommended classifications.ResultsFrom a total of 742 unique patient records of Indigenous Australians, 253 were identified to have COPD via GOLD/COPD-X criteria (n=238) or GLI-2012 criteria (n=238) with significant agreeance between criteria (96%, κ=0.901). Of these, the majority were classified as having moderate or severe/very-severe AFL with significant variability across classification criteria (COPD-X (40%–43%), GOLD (33%–65%), GLI-2012 (18%–75%)). The FVC and FEV1 values also varied significantly between classification criterion (COPD-X/GOLD/GLI-2012) within the same AFL category, with COPD-X ‘moderate’ AFL almost matching ‘severe’ AFL categorisation by GOLD or GLI-2012.ConclusionsHealth professionals caring for Indigenous patients with COPD should be aware of the clinical implications and consequences of utilising various recommended AFL classifications in the absence of validated spirometry reference norms among adult Indigenous patients.

Advancing Age Inclusivity in a Pandemic: Age-Friendly University (AFU) Campuses Take Action

The COVID-19 pandemic presented extraordinary challenges for professionals in the aging field across campuses and communities, calling for rethinking and redesigning how their work was structured, their programs were delivered, and their connections were sustained. The pandemic also made clear the value of being an age-friendly institution of higher education, especially as we experience historic changes in age demographics. This symposium features campus leaders representing institutional partners of the Age-Friendly University (AFU) global initiative (endorsed by GSA’s Academy for Gerontology in Higher Education) who will discuss how their age-friendly programs were adapted during the pandemic to continue to advance age inclusivity. These diverse responses exemplify the vast potential of age-friendly opportunities. June and Andreoletti (Central Connecticut State University) will discuss how the Scholars for Life! program supported the engagement of older learners in the neighboring community through the engagement of faculty. Elfenbein (University of North Georgia) will describe how learning experiences for older learners and intergenerational exchange were created beyond the classroom through the Personal Enrichment, Action and Knowledge (PEAK) program. Terhune (Northern Kentucky University) will describe how student support practices and services were adapted to provide working adult students with guidance for navigating their educational needs during the pandemic. Kheirbek (University of Maryland, Baltimore) will describe how age-friendly collaborations with the institution’s medical school leveraged intergenerational connections and technology to foster social connection for hospitalized older adults. Gautam and Melillo (UMass Lowell) discuss how a campus partnership with the Learning in Retirement Association (LIRA) adapted efforts around healthy aging.