scholarly journals Epidemiological and evolutionary considerations of SARS-CoV-2 vaccine dosing regimes

Science ◽  
2021 ◽  
pp. eabg8663
Author(s):  
Chadi M. Saad-Roy ◽  
Sinead E. Morris ◽  
C. Jessica E. Metcalf ◽  
Michael J. Mina ◽  
Rachel E. Baker ◽  
...  
Keyword(s):  
Immune Escape ◽  
Vaccine Dose ◽  
Short Term ◽  
Viral Loads ◽  
Population Immunity ◽  
Infection Dynamics ◽  
Critical Issues ◽  
The Face ◽  
Antigenic Evolution ◽  
Partial Population

In the face of vaccine dose shortages and logistical challenges, various deployment strategies are being proposed to increase population immunity levels to SARS-CoV-2. Two critical issues arise: how will the timing of delivery of the second dose affect both infection dynamics and prospects for the evolution of viral immune escape via a build-up of partially immune individuals. Both hinge on the robustness of the immune response elicited by a single dose, compared to natural and two-dose immunity. Building on an existing immuno-epidemiological model, we find that in the short-term, focusing on one dose generally decreases infections, but longer-term outcomes depend on this relative immune robustness. We then explore three scenarios of selection and find that a one-dose policy may increase the potential for antigenic evolution under certain conditions of partial population immunity. We highlight the critical need to test viral loads and quantify immune responses after one vaccine dose, and to ramp up vaccination efforts throughout the world.

scholarly journals Epidemiological and evolutionary considerations of SARS-CoV-2 vaccine dosing regimes

2021 ◽  
Author(s):  
Chadi M. Saad-Roy ◽  
Sinead E. Morris ◽  
C. Jessica E. Metcalf ◽  
Michael J. Mina ◽  
Rachel E. Baker ◽  
...  
Keyword(s):  
Immune Response ◽  
Immune Responses ◽  
Immune Escape ◽  
Vaccine Dose ◽  
Short Term ◽  
Viral Loads ◽  
Population Immunity ◽  
The World ◽  
The Face ◽  
Antigenic Evolution

As the threat of Covid-19 continues and in the face of vaccine dose shortages and logistical challenges, various deployment strategies are being proposed to increase population immunity levels. How timing of delivery of the second dose affects infection burden but also prospects for the evolution of viral immune escape are critical questions. Both hinge on the strength and duration (i.e. robustness) of the immune response elicited by a single dose, compared to natural and two-dose immunity. Building on an existing immuno-epidemiological model, we find that in the short-term, focusing on one dose generally decreases infections, but longer-term outcomes depend on this relative immune robustness. We then explore three scenarios of selection, evaluating how different second dose delays might drive immune escape via a build-up of partially immune individuals. Under certain scenarios, we find that a one-dose policy may increase the potential for antigenic evolution. We highlight the critical need to test viral loads and quantify immune responses after one vaccine dose, and to ramp up vaccination efforts throughout the world.

Plebiscitary Politics and the Threats to Legality

2019 ◽  
pp. 275-289
Author(s):  
Claudius Härpfer
Keyword(s):  
The State ◽  
Short Term ◽  
Political Processes ◽  
The Face ◽  
State Of Affairs ◽  
The Relationship

In recent times we find many plebiscitary acts that seek to democratically legitimize political processes in any direction. They have in common that they interrupt the normal routine of representative democracies to a certain degree and create an extra-daily state of affairs, which entails not only direct but also indirect consequences. The text attempts to systematize some of these mechanisms from a Weberian perspective using Brexit as an example. After a brief overview of Weber’s short-term politically inspired statements on plebiscitary democracy, the text systematizes Weber’s understanding of the state as a bureaucratic apparatus that requires any kind of leader to be controlled. Subsequently, the text discusses the relationship between domination, legality, and rationality in order to finally point out the danger of erosion of truth and legality through the emergence of competing consensus communities in the face of competing conceptions of order.

Graduate Medical Education in Otolaryngology: Making Dollars and Sense of Reform

2021 ◽  
pp. 019459982110042
Author(s):  
Jenny X. Chen ◽  
Shivani A. Shah ◽  
Vinay K. Rathi ◽  
Mark A. Varvares ◽  
Stacey T. Gray
Keyword(s):  
Medical Education ◽  
Graduate Medical Education ◽  
Resident Training ◽  
Short Term ◽  
Graduate Medical ◽  
Departmental Leadership ◽  
Key Stakeholders ◽  
The Face ◽  
Funding Cuts

Graduate medical education (GME) is funded by the Centers for Medicare and Medicaid Services through both direct and indirect payments. In recent years, stakeholders have raised concerns about the growth of spending on GME and distribution of payment among hospitals. Key stakeholders have proposed reforms to reduce GME funding such as adjustments to statutory payment formulas and absolute caps on annual payments per resident. Otolaryngology departmental leadership should understand the potential effects of proposed reforms, which could have significant implications for the short-term financial performance and the long-term specialty workforce. Although some hospitals and departments may elect to reduce resident salaries or eliminate positions in the face of GME funding cuts, this approach overlooks the substantial Medicare revenue contributed by resident care and high cost of alternative labor sources. Commitment to resident training is necessary to align both the margin and mission of otolaryngology departments and their sponsoring hospitals.

scholarly journals SARS-CoV-2 within-host diversity and transmission

Science ◽  
2021 ◽  
Vol 372 (6539) ◽  
pp. eabg0821 ◽  
Author(s):  
Katrina A. Lythgoe ◽  
Matthew Hall ◽  
Luca Ferretti ◽  
Mariateresa de Cesare ◽  
George MacIntyre-Cockett ◽  
...  
Keyword(s):  
United Kingdom ◽  
Severe Acute Respiratory Syndrome ◽  
Phylogenetic Tree ◽  
Immune Escape ◽  
Clinical Samples ◽  
Diversity Patterns ◽  
Host Diversity ◽  
Viral Loads ◽  
The United Kingdom ◽  
Low Levels

Extensive global sampling and sequencing of the pandemic virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have enabled researchers to monitor its spread and to identify concerning new variants. Two important determinants of variant spread are how frequently they arise within individuals and how likely they are to be transmitted. To characterize within-host diversity and transmission, we deep-sequenced 1313 clinical samples from the United Kingdom. SARS-CoV-2 infections are characterized by low levels of within-host diversity when viral loads are high and by a narrow bottleneck at transmission. Most variants are either lost or occasionally fixed at the point of transmission, with minimal persistence of shared diversity, patterns that are readily observable on the phylogenetic tree. Our results suggest that transmission-enhancing and/or immune-escape SARS-CoV-2 variants are likely to arise infrequently but could spread rapidly if successfully transmitted.

scholarly journals Intergroup and intragroup dimensions of COVID-19: A social identity perspective on social fragmentation and unity

2021 ◽  
Vol 24 (2) ◽  
pp. 201-209 ◽  
Author(s):  
Dominic Abrams ◽  
Fanny Lalot ◽  
Michael A. Hogg
Keyword(s):  
Social Identity ◽  
Group Dynamics ◽  
Short Term ◽  
Social Fragmentation ◽  
The Social ◽  
The Face ◽  
Political Management ◽  
Psychological Challenge ◽  
And Behavior ◽  
People’S Perceptions

COVID-19 is a challenge faced by individuals (personal vulnerability and behavior), requiring coordinated policy from national government. However, another critical layer—intergroup relations—frames many decisions about how resources and support should be allocated. Based on theories of self and social identity uncertainty, subjective group dynamics, leadership, and social cohesion, we argue that this intergroup layer has important implications for people’s perceptions of their own and others’ situation, political management of the pandemic, how people are influenced, and how they resolve identity uncertainty. In the face of the pandemic, initial national or global unity is prone to intergroup fractures and competition through which leaders can exploit uncertainties to gain short-term credibility, power, or influence for their own groups, feeding polarization and extremism. Thus, the social and psychological challenge is how to sustain the superordinate objective of surviving and recovering from the pandemic through mutual cross-group effort.

scholarly journals Behavioral brittleness: the case for strategic behavioral public policy

2021 ◽  
pp. 1-26
Author(s):  
Ruth Schmidt ◽  
Katelyn Stenger
Keyword(s):  
Public Policy ◽  
Problem Solving ◽  
Methodological Approach ◽  
Contextual Cues ◽  
Short Term ◽  
Strategic Approach ◽  
The Face ◽  
The Creation ◽  
Impact Problem

Abstract Despite widespread recognition that behavioral public policy (BPP) needs to move beyond nudging if the field is to achieve more significant impact, problem-solving approaches remain optimized to achieve tactical success and are evaluated by short-term metrics with the assumption of stable systems. As a result, current methodologies may contribute to the development of solutions that appear well formed but become ‘brittle’ in the face of more complex contexts if they fail to consider important contextual cues, broader system forces, and emergent conditions, which can take three distinct forms: contextual, systemic, and anticipatory brittleness. The Covid-19 pandemic and vaccination rollout present an opportunity to identify and correct interventional brittleness with a new methodological approach – strategic BPP (SBPP) – that can inform the creation of more resilient solutions by embracing more diverse forms of evidence and applied foresight, designing interventions within ecosystems, and iteratively developing solutions. To advance the case for adopting a SBPP and ‘roughly right’ modes of inquiry, we use the Covid-19 vaccination rollout to define a new methodological roadmap, while also acknowledging that taking a more strategic approach may challenge current BPP norms.

Challenges MNCs Face in Emerging Markets: The Nestlé Experience

2018 ◽  
Vol 22 (2) ◽  
pp. 222-231
Author(s):  
V.S. Pai
Keyword(s):  
Monosodium Glutamate ◽  
Control Process ◽  
State Governments ◽  
Product Recall ◽  
Quality Control Process ◽  
Critical Issues ◽  
The Face ◽  
The Media ◽  
World Class ◽  
Lab Test

Maggi was the most popular instant noodles brand in India, which children in particular loved to snack on. The brand had a dominant position until suddenly in mid-2015 it got engulfed in controversy. Several state food regulators found that Maggi contained monosodium glutamate as well as lead well above the prescribed limits. Both these substances were harmful especially for children. When Nestlé India was confronted with lab test results it stuck to its position that they had a world class quality control process in place and that their products were safe for consumption. Finally, the national food regulator FSSAI, ordered a ban on the sale of Maggi including product recall. Consequently, several state governments imposed temporary ban on the sale of Maggi noodles in their respective states. The future of the company suddenly looked very bleak. Nestlé India was slow to respond to this fast unfolding crisis. Further, their responses were very brief and not adequately culture-sensitive. This led to the feeling in several quarters that the company was probably guilty of wrongdoing. To set right things Nestlé's worldwide CEO flew into India to douse the flames of the controversy and draw up an appropriate strategy to bail out the brand. He address the media, put in place a new CEO for Nestlé India and set brand Maggi on the path of recovery. However, Nestlé India was still facing a number of critical issues. What should be done to win over the trust of its customers? How should it recover market share lost to competitors both old rivals and new entrants? What strategy should it develop to succeed with the new products, especially hot heads, launched along with the comeback strategy? Should it change its approach to dealing with government health officials to prevent confrontations in future? How should it shorten the response time and make it effective in the face of a media backed public outcry in future?

scholarly journals Religious Engagement and the Migration Issue: Towards Reconciling Political and Moral Duty

Religions ◽  
2020 ◽  
Vol 11 (5) ◽  
pp. 236
Author(s):  
Joanna Kulska
Keyword(s):  
Ethical Issues ◽  
Decision Makers ◽  
Religious Communities ◽  
The Political ◽  
Political Decision ◽  
Short Term ◽  
Nation States ◽  
Religious Engagement ◽  
The Face ◽  
Religious Actors

The increasingly acknowledged post-secular perspective has resulted in the emergence of some new approaches theorizing this phenomenon. One such approach has been the concept of religious engagement, which calls for the redefinition of the perception of religious non-state actors towards including them as important partners in the process of identifying and realizing political goals. According to this view, due to the multidimensional role played by religious communities and non-state religious actors, they need to be recognized as pivotal in creating a new form of knowledge generated through encounter and dialogue of the political decision-makers with these subjects. Among numerous others, the challenge of migration calls for enhanced debate referring to both political and ethical issues. When such a perspective is applied, the question is raised of the duties and limits of nation-states using more or less harsh political measures towards refugees and migrants based on the concept of security, but also short-term political goals. In the face of a state’s lack of will or capacity to deal with the problem of migration, the question of religion serving not only as the service-provider but also as the “trend-setter” with regard to fundamental ethical questions needs to be considered.

An audit of antiretroviral medication offered to patients with HIV attending a district general hospital for outpatient care

2000 ◽  
Vol 11 (3) ◽  
pp. 193-195
Author(s):  
D Ivens ◽  
G Brook
Keyword(s):  
Viral Load ◽  
Outpatient Care ◽  
Surrogate Marker ◽  
District General Hospital ◽  
Prescribing Practices ◽  
Hiv Viral Load ◽  
Viral Loads ◽  
Antiretroviral Medication ◽  
Middlesex Hospital ◽  
The Face

In order to determine if antiretroviral prescribing for patients with HIV infection attending the Central Middlesex Hospital is according to current UK guidelines and effective at reducing the serum HIV viral load, 71 case notes were reviewed. All patients eligible for treatment according to the British HIV Association (BHIVA) guidelines were currently being offered triple therapy. The most recent serum HIV viral loads of patients taking at least 3 antiretrovirals were undetectable in 75% of the 20 patients on their first established regimen and 36% of 14 patients who had failed at least one drug according to previous surrogate marker results. Such work allows an individual clinic to monitor its antiretroviral prescribing practices in the face of constantly updated information and guidelines.

scholarly journals Dynamic interactions of influenza viruses in Hong Kong during 1998-2018

2019 ◽  
Author(s):  
Wan Yang ◽  
Eric H. Y. Lau ◽  
Benjamin J. Cowling
Keyword(s):  
Hong Kong ◽  
Influenza A ◽  
Vaccine Development ◽  
Immune Escape ◽  
Influenza Viruses ◽  
Influenza Surveillance ◽  
Influenza Epidemic ◽  
Inference System ◽  
Population Immunity ◽  
Cross Immunity

AbstractInfluenza epidemics cause substantial morbidity and mortality every year worldwide. Currently, two influenza A subtypes, A(H1N1) and A(H3N2), and type B viruses co-circulate in humans and infection with one type/subtype could provide cross-protection against the others. However, it remains unclear how such ecologic competition via cross-immunity and antigenic mutations that allow immune escape impact influenza epidemic dynamics at the population level. Here we develop a comprehensive model-inference system and apply it to study the evolutionary and epidemiological dynamics of the three influenza types/subtypes in Hong Kong, a city of global public health significance for influenza epidemic and pandemic control. Utilizing long-term influenza surveillance data since 1998, we are able to estimate the strength of cross-immunity between each virus-pairs, the timing and frequency of punctuated changes in population immunity in response to antigenic mutations in influenza viruses, and key epidemiological parameters over the last 20 years including the 2009 pandemic. We find evidence of cross-immunity in all types/subtypes, with strongest cross-immunity from A(H1N1) against A(H3N2). Our results also suggest that A(H3N2) may undergo antigenic mutations in both summers and winters and thus monitoring the virus in both seasons may be important for vaccine development. Overall, our study reveals intricate epidemiological interactions and underscores the importance of simultaneous monitoring of population immunity, incidence rates, and viral genetic and antigenic changes.

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