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"Prete, A."
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Resurgence of COVID-19 in Manaus, Brazil, despite high seroprevalence
[...]immunity against infection might have already begun to wane by December, 2020, because of a general decrease in immune protection against SARS-CoV-2 after a first exposure. [...]SARS-CoV-2 lineages might evade immunity generated in response to previous infection.15 Three recently detected SARS-CoV-2 lineages (B.1.1.7, B.1.351, and P.1), are unusually divergent and each possesses a unique constellation of mutations of potential biological importance.16–18 Of these, two are circulating in Brazil (B.1.1.7 and P.1) and one (P.1) was detected in Manaus on Jan 12, 2021.16 One case of SARS-CoV-2 reinfection has been associated with the P.1 lineage in Manaus19 that accrued ten unique spike protein mutations, including E484K and N501K.16 Moreover, the newly classified P.2 lineage (sublineage of B.1.128 that independently accrued the spike E484K mutation) has now been detected in several locations in Brazil, including Manaus.20 P.2 variants with the E484K mutation have been detected in two people who have been reinfected with SARS-CoV-2 in Brazil,21,22 and there is in-vitro evidence that the presence of the E484K mutation reduces neutralisation by polyclonal antibodies in convalescent sera.15 Fourth, SARS-CoV-2 lineages circulating in the second wave might have higher inherent transmissibility than pre-existing lineages circulating in Manaus. The protocols and findings of such studies should be coordinated and rapidly shared wherever such variants emerge and spread. Since rapid data sharing is the basis for the development and implementation of actionable disease control measures during public health emergencies, we are openly sharing in real-time monthly curated serosurvey data from blood donors through the Brazil–UK Centre for Arbovirus Discovery, Diagnosis, Genomics and Epidemiology (CADDE) Centre GitHub website and will continue to share genetic sequence data and results from Manaus through openly accessible data platforms such as GISAID and Virological.
Journal Article
Strategy and Command
Falling between the \"War of Movement\" in 1914 and the major
attrition battles of 1916, 1915 was a critical year in the First
World War. As France failed in ever-larger offensives to break
through the German trenches, Britain shifted its strategy from
defence of empire to total commitment to the continental war. In
the second of three planned volumes, Roy Prete analyzes the
political and military policies and strategies of Britain and
France and their joint command relationship on the Western Front in
1915. The opposing strategies of the two governments proved to be
the main determinant in the sometimes ragged relations between the
French commander-in-chief, Joseph Joffre, and his British
counterpart, Sir John French, as they sought to drive the German
army out of France and to aid their hard-pressed Russian ally. With
an impressive marshalling of evidence, Strategy and
Command demonstrates that the increased British commitment to
the continental war, manifested in sending Kitchener's New Armies
to France in 1915, was largely due to the disastrous situation of
the Russian army on the Eastern Front and the perceived weakness of
the French government. Based on extensive research in French and
British political and military archives, this new in-depth study of
Anglo-French military relations on the Western Front in 1915 fills
a major gap in the unfolding drama of the First World War.
eBook
Strategy and Command
In the first of three projected volumes, Prete crafts a behind-the-scenes look at Anglo-French command relations during World War I, from the start of the conflict until 1915, when trench warfare drastically altered the situation. Drawing on extensive archival research, Prete argues that the British government's primary interest lay in the defence of the empire; the small expeditionary force sent to France was progressively enlarged because the French, especially Commander-in-Chief Joseph Joffre, dragged their British ally into a progressively greater involvement. Several crises in Anglo-French command relations derived from these competing strategic objectives. New information gleaned from French public and private archives - including private diaries - enlarge our understanding of key players in the allied relationship.
eBook
Dynamics of SARS-CoV-2 infection over two epidemic waves in Manaus, Brazil: A serological study of seven thousand blood donors
Most longitudinal studies of COVID-19 incidence have used unlinked samples. The city of Manaus, Brazil, has a blood donation program which allows sample linkage, and was struck by two large COVID-19 epidemic waves between mid-2020 and early 2021.
We estimated the changing force of infection, i.e. incidence in susceptible individuals. Seroconversion was inferred by a mixture model for serial values from the Abbott Architect SARS-CoV-2 nucleocapsid (N) IgG assay. We estimated the number of suspected COVID-19 hospitalizations arising from each infection over calendar time.
Whole blood donations between April 2020 and March 2021 were included from 6734 people, 2747 with two or more donations. The inferred criterion for seroconversion, and thus an incident infection, was a 6.07 fold increase in N IgG reactivity. The overall force of infection was 1.19 per person year (95% confidence interval 1.14-1.24) during the two main waves. The estimated number of suspected hospitalizations per infection, was approximately 4.1 times higher in the second wave than in the first.
Serial values from this assay can be used to infer seroconversion over time, and in Manaus show a higher number of suspected COVID-19 hospitalizations per infection in the second wave relative to the first.
Journal Article
Modified-Release Hydrocortisone in Congenital Adrenal Hyperplasia
Abstract
Context
Standard glucocorticoid therapy in congenital adrenal hyperplasia (CAH) regularly fails to control androgen excess, causing glucocorticoid overexposure and poor health outcomes.
Objective
We investigated whether modified-release hydrocortisone (MR-HC), which mimics physiologic cortisol secretion, could improve disease control.
Methods
A 6-month, randomized, phase 3 study was conducted of MR-HC vs standard glucocorticoid, followed by a single-arm MR-HC extension study. Primary outcomes were change in 24-hour SD score (SDS) of androgen precursor 17-hydroxyprogesterone (17OHP) for phase 3, and efficacy, safety and tolerability of MR-HC for the extension study.
Results
The phase 3 study recruited 122 adult CAH patients. Although the study failed its primary outcome at 6 months, there was evidence of better biochemical control on MR-HC, with lower 17OHP SDS at 4 (P = .007) and 12 (P = .019) weeks, and between 07:00h to 15:00h (P = .044) at 6 months. The percentage of patients with controlled 09:00h serum 17OHP (< 1200 ng/dL) was 52% at baseline, at 6 months 91% for MR-HC and 71% for standard therapy (P = .002), and 80% for MR-HC at 18 months’ extension. The median daily hydrocortisone dose was 25 mg at baseline, at 6 months 31 mg for standard therapy, and 30 mg for MR-HC, and after 18 months 20 mg MR-HC. Three adrenal crises occurred in phase 3, none on MR-HC and 4 in the extension study. MR-HC resulted in patient-reported benefit including menses restoration in 8 patients (1 on standard therapy), and 3 patient and 4 partner pregnancies (none on standard therapy).
Conclusion
MR-HC improved biochemical disease control in adults with reduction in steroid dose over time and patient-reported benefit.
Journal Article
The Brazilian COVID-19 vaccination campaign: a modelling analysis of sociodemographic factors on uptake
ObjectiveDose shortages delayed access to COVID-19 vaccination. We aim to characterise inequality in two-dose vaccination by sociodemographic group across Brazil.DesignThis is a cross-sectional study.SettingWe used data retrieved from the Brazilian Ministry of Health databases published between 17 January 2021 and 6 September 2021.MethodsWe assessed geographical inequalities in full vaccination coverage and dose by age, sex, race and socioeconomic status. We developed a Campaign Optimality Index to characterise inequality in vaccination access due to premature vaccination towards younger populations before older and vulnerable populations were fully vaccinated. Generalised linear regression was used to investigate the risk of death and hospitalisation by age group, socioeconomic status and vaccination coverage.ResultsVaccination coverage is higher in the wealthier South and Southeast. Men, people of colour and low-income groups were more likely to be only partially vaccinated due to missing or delaying a second dose. Vaccination started prematurely for age groups under 50 years which may have hindered uptake in older age groups. Vaccination coverage was associated with a lower risk of death, especially in older age groups (ORs 9.7 to 29.0, 95% CI 9. 4 to 29.9). Risk of hospitalisation was greater in areas with higher vaccination rates due to higher access to care and reporting.ConclusionsVaccination inequality persists between states, age and demographic groups despite increasing uptake. The association between hospitalisation rates and vaccination is attributed to preferential delivery to areas of greater transmission and access to healthcare.
Journal Article
Higher risk of death from COVID-19 in low-income and non-White populations of São Paulo, Brazil
IntroductionLittle evidence exists on the differential health effects of COVID-19 on disadvantaged population groups. Here we characterise the differential risk of hospitalisation and death in São Paulo state, Brazil, and show how vulnerability to COVID-19 is shaped by socioeconomic inequalities.MethodsWe conducted a cross-sectional study using hospitalised severe acute respiratory infections notified from March to August 2020 in the Sistema de Monitoramento Inteligente de São Paulo database. We examined the risk of hospitalisation and death by race and socioeconomic status using multiple data sets for individual-level and spatiotemporal analyses. We explained these inequalities according to differences in daily mobility from mobile phone data, teleworking behaviour and comorbidities.ResultsThroughout the study period, patients living in the 40% poorest areas were more likely to die when compared with patients living in the 5% wealthiest areas (OR: 1.60, 95% CI 1.48 to 1.74) and were more likely to be hospitalised between April and July 2020 (OR: 1.08, 95% CI 1.04 to 1.12). Black and Pardo individuals were more likely to be hospitalised when compared with White individuals (OR: 1.41, 95% CI 1.37 to 1.46; OR: 1.26, 95% CI 1.23 to 1.28, respectively), and were more likely to die (OR: 1.13, 95% CI 1.07 to 1.19; 1.07, 95% CI 1.04 to 1.10, respectively) between April and July 2020. Once hospitalised, patients treated in public hospitals were more likely to die than patients in private hospitals (OR: 1.40%, 95% CI 1.34% to 1.46%). Black individuals and those with low education attainment were more likely to have one or more comorbidities, respectively (OR: 1.29, 95% CI 1.19 to 1.39; 1.36, 95% CI 1.27 to 1.45).ConclusionsLow-income and Black and Pardo communities are more likely to die with COVID-19. This is associated with differential access to quality healthcare, ability to self-isolate and the higher prevalence of comorbidities.
Journal Article
Phasor Measurement Unit-Driven Estimation of Transmission Line Parameters Using Variable Noise Model
Accurate parameters are crucial in modern energy systems to ensure the reliable operation of all components. Given the substantial volume of data in monitored systems, high-performance methods are necessary. This paper proposes a new Bayesian multi-output regressor for estimating the parameters of a three-phase transmission line. The presented approach achieves acceptable accuracy in parameter estimation using only one end of the line. The Bayesian regressor is developed using information derived from the data themselves, eliminating the need to explicitly model the system. This capability allows the method to estimate parameters while accommodating different noise models, even in the presence of systematic errors and non-Gaussian random noise. The methodology was validated on various systems, including a two-bus system, IEEE 14-bus, IEEE 39-bus, and IEEE 118-bus, under diverse conditions such as varying sample sizes, loads, and noise levels. These tests demonstrate the robustness of the proposed approach.
Journal Article
Gut microbiota and hematopoietic stem cell transplantation: where do we stand?
Advances in biological techniques have potentiated great progresses in understanding the interaction between human beings and the ∼10 to 100 trillion microbes living in their gastrointestinal tract: gut microbiota (GM). In this review, we describe recent emerging data on the role of GM in hematopoietic stem cell transplantation, with a focus on immunomodulatory properties in the immune system recovery and the impact in the development of the main complications, as GvHD and infections.
Journal Article