The COVID-19 pandemic had dramatic impacts on educational systems worldwide.  The current study aimed to investigate whether some students experienced different patterns of mathematics and language arts achievement before and during the pandemic. Therefore, we used latent class trajectory analyses to investigate the distinct trajectories of 50,100 primary and 14,600 secondary school students’ academic achievement between fall of 2018 and spring of 2021. We identified four classes of primary school achievement trajectories and five classes of secondary school student achievement. Overall, with the exception of a minority of students in at-risk trajectories, we found that most students’ achievement remained relatively stable over time. Furthermore, all trajectories reflected trends that already appeared to be present prior to the pandemic. We also examined sociodemographic characteristics associated with students’ membership in different classes. The results revealed that boys and students with special needs were overrepresented in at-risk achievement trajectories. Although our results highlight that the consequences of COVID-19 for students’ achievement were less dramatic than expected, they also point out the need to develop interventions for at-risk students.

In this paper, we investigate the economic impact of the COVID-19 pandemic on European and Chinese unsustainable and non-recyclable plastic markets, specifically those used for the production of Personal Protective Equipment (PPE). We explore exogenous economic and commodity price impacts on polypropylene, acrylonitrile and polyvinylchloride, via VECM and Granger causality analysis, with the results remaining robust under testing. We find that price shocks from rubber and EUROSTOXX are significantly correlated with PPE materials, to a greater extent than crude oil, unexpectedly relating price declines in PPE materials to factors beyond medical demand. This will aid a policymakers and industry understand the factors that affect the price of unsustainable and non-recyclable PPE materials, respond to the need for pandemic PPE provision and reduce the potential environmental impact of future pandemics.

Background: The term ‘deaths of despair’ has been coined to describe deaths from alcohol use, substance use, suicide, and mental ill health. Earlier studies have shown that mortality rates are increasing and that they vary significantly by socio-economic group. We explore trends in deaths of despair in England before, during, and after the COVID-19 pandemic. We examine the differences in the mortality rates by sex and socio-economic group. Methods: Deaths of despair were identified using a routine administrative dataset and grouped by sex, deprivation, and underlying cause of death, each year between 2014 and 2022. Annual years of life lost and directly standardised mortality rates were calculated for all deaths of despair, and for deaths of despair by sex and deprivation quintile. Annual absolute and relative differences in mortality rates between men and women and between the most and least deprived quintile of areas, were estimated. Log-linear models were fitted to these trends to test whether mortality rates and inequalities in mortality rates diverged from the secular trend during the COVID-19 pandemic. Findings: Directly standardised mortality rates increased from 22.6 per 100,000 population (95% CI 22.2 to 23) in 2014 to 30.1 (95% CI 29.6 to 30.5) in 2022. Absolute differences between men and women grew from 19.4 (95% CI 18.6 to 20.2) in 2014 to 24.7 (95% CI 23.8 to 25.6) in 2022. There were also changes in the absolute difference in mortality rates between the most and least deprived areas, increasing from 28.7 (95% CI 27.3 to 30.1) in 2014 to 35.8 (95% CI 34.2 to 37.4) in 2022. Relative differences by sex and deprivation were similar in 2014 and 2022, but decreased significantly (p < 0.05) during the COVID-19 pandemic by sex, and increased significantly (p < 0.05) by deprivation. Approximately one sixth (16.6 %) of all years of life lost in 2022 were due to deaths of despair. Interpretation: Deaths of despair are rising, and increased more rapidly during the COVID-19 pandemic. Relative differences in mortality rates by sex and deprivation were similar in 2014 and in 2022, but the gap between the sexes closed during the COVID-19 pandemic, whilst the gap increased between the most and least deprived areas. Funding: The project was funded by the Health Foundation. Declaration of Interest: The authors have no competing interests to declare.

Background: Ixekizumab, an interleukin-17A (IL-17A) inhibitor used in psoriasis treatment, has been linked to drug-induced interstitial lung disease (DI-ILD). The pathophysiological mechanisms and histopathological features of this adverse effect remain poorly documented. Case Presentation: A 69-year-old male with familial psoriasis developed respiratory symptoms after 18 months of ixekizumab therapy. His medical history included mild smoking-related interstitial pneumonia and chronic obstructive pulmonary disease. One month after treatment, he presented with cough and dyspnea. High-resolution chest CT showed bilateral ground-glass opacities, accompanied by elevated Krebs von den Lungen-6 and surfactant protein-D levels. Transbronchial lung cryobiopsy (TBLC) revealed a fibrotic non-specific interstitial pneumonia pattern with granulomatous changes. Immunohistochemical analysis demonstrated a predominance of CD4-positive cells and IL-17A-positive lymphocytes, suggesting Th17 cell involvement in the pathogenesis. The patient's condition improved following ixekizumab discontinuation. Conclusions: This case identifies distinct histopathological features in ixekizumab-induced DI-ILD, particularly the presence of granulomatous changes and Th17 cell involvement. The findings suggest that IL-17A inhibition may trigger pulmonary inflammation through Th17 cell function dysregulation. This observation supports the importance of careful pulmonary monitoring in patients receiving biologic therapies for psoriasis, particularly those with pre-existing lung conditions. TBLC may contribute to understanding the pathogenesis of this drug-induced complication.

Identifying high-risk patients, particularly in intensive care units (ICUs), enhances treatment and reduces severe outcomes. Since the pandemic, numerous studies have examined COVID-19 patient profiles and factors linked to increased mortality. Despite six pandemic waves, to the best of our knowledge, there is no extensive comparative analysis of patients' characteristics across these waves in Portugal. Thus, we aimed to analyze the demographic and clinical features of 1041 COVID-19 patients admitted to an ICU and their relationship with the different SARS-Cov-2 variants in Portugal. Additionally, we conducted an in-depth examination of factors contributing to early and late mortality by analyzing clinical data and laboratory results from the first 72 h of ICU admission. Our findings revealed a notable decline in ICU admissions due to COVID-19, with the highest mortality rates observed during the second and third waves. Furthermore, immunization could have significantly contributed to the reduction in the median age of ICU-admitted patients and the severity of their conditions. The factors contributing to early and late mortality differed. Age, wave number, D-dimers, and procalcitonin were independently associated with the risk of early death. As a measure of discriminative power for the derived multivariable model, an AUC of 0.825 (p < 0.001; 95% CI, 0.719-0.931) was obtained. For late mortality, a model incorporating age, wave number, hematologic cancer, C-reactive protein, lactate dehydrogenase, and platelet counts resulted in an AUC of 0.795 (p < 0.001; 95% CI, 0.759-0.831). These findings underscore the importance of conducting comprehensive analyses across pandemic waves to better understand the dynamics of COVID-19.

BACKGROUND: Stroke represents a major source of mortality and morbidity globally. The role of a stroke Clinical Nurse Specialist (CNS) as an expert team member in early supported discharge (ESD) for stroke, is not well defined or described although it is well established in other models of after-hospital and out-reach specialist care in the community. A greater focus has been on patients receiving rehabilitation post-stroke, however there is a need for a more holistic approach to care which clinical nurse specialists can offer to patients as part of ESD. Nurses are often the cohesive point of contact for other after-hospital services, managing many aspects of secondary prevention. OBJECTIVE: The aim of this scoping review is to explore the evidence in relation to the role of the stroke nurse providing secondary prevention interventions to stroke patients in a community setting. METHODS: We will conduct a scoping review in accordance with the Arksey and O'Malley, 2005 1 scoping review framework and the PRISMA-ScR guidelines to map available literature on the role of the stroke nurse in post-stroke care of patients in the community. The Cochrane Central Register of Controlled Trials and Systematic literature searches including databases MEDLINE, EMBASE, CINAHL, google scholar and grey literature will be searched using keyword searches. Data will be charted and synthesised and a narrative synthesis will be conducted. CONCLUSIONS: This scoping review will be used to identify gaps in the current literature and identify areas for future research in the role of the stroke nurse in ESD in relation to secondary prevention for stroke patients and inform the development of a pathway for stroke nursing in ESD.

BACKGROUND: Omicron sub-variants breakthrough infections (BTIs) have led to millions of coronavirus disease 2019 (COVID-19) cases worldwide. The acute-phase immune status is critical for prognosis, however, the dynamic immune profiling of COVID-19 during the first month after BTIs remains unclear. METHODS: In this study, we monitored the immune dynamics at various timepoints in a longitudinal cohort during the first month post-BTIs through clinical evaluation, single-cell RNA sequencing (scRNA-seq), T cell receptor (TCR)/B cell receptor (BCR) sequencing, and antibody mass spectrometry. FINDINGS: Serological analysis revealed limited impairment to functions of major organs, active cellular and humoral immunity at 2 weeks post-BTI, with significant increases in cytokines (CKs) and neutralizing antibody levels. However, 1 month post-BTI, organ function parameters and CK levels reverted to pre-infection levels, whereas neutralizing antibody levels remained high. Notably, scRNA-seq showed that lymphocytes maintained strong antiviral activity and cell depletion at 2 weeks and 1 month post-BTI, with genes CD81, ABHD17A, CXCR4, DUSP1, etc. upregulated, and genes PFDN5, DYNLRB1, CD52, etc. downregulated, indicating that lymphocytes status take longer to recover to normal levels than that routine blood tests revealed. Additionally, T cell-exhaustion associated genes, including LAG3, TIGIT, PDCD1, CTLA4, HAVCR2, and TOX, were upregulated after BTI. TCRs and BCRs exhibited higher clonotypes, mainly in CD8Tem or plasmablast cells, at 2 weeks post-BTI comparing 1 month. More IgG and IgA-type BCRs were found in the groups of 1 month post-BTI, with higher somatic hypermutation, indicating greater maturity. Verification of monoclonal antibodies corresponding to amplified BCRs highlighted the antigen-specific and broad-spectrum characteristics. INTERPRETATION: Our study elucidated the dynamic immune profiling of individuals after Omicron BA.5 sublineages BTI. Strong immune activation, antiviral response, antibody maturation and class transition at 2 weeks and 1 month after BTI may provide essential insights into pathogenicity, sequential immune status, recovery mechanisms of Omicron sublineage BTI. FUNDING: This study was supported by the National Key R&D Program of China, the China Postdoctoral Science Foundation, Guangdong Basic and Applied Basic Research Foundation, the National Natural Science Foundation of China, CAS Project for Young Scientists in Basic Research, and the Air Force Special Medical Center Science and Technology Booster Program.

BACKGROUND: The vaccine supply chain (VSC) integrates all activities from production to dispensing, characterized by complexity and low responsiveness. This study aims to define key performance indicators (KPIs) to evaluate the logistic and operational performance during the COVID-19 National Vaccination Plan in Colombia. METHODS: This study employed the design science research (DSR) methodology to develop a dashboard for monitoring COVID-19 vaccination progress. DSR is a problem-solving paradigm focused on conceiving, testing, and evaluating artifacts to tackle specific challenges. The dashboard integrated a set of Key Performance Indicators (KPIs) that incorporated three dimensions: epidemiological, humanitarian, and logistical. Both, the dashboard and the KPIs underwent validation through three iterative DSR cycles, in collaboration with both private and public health stakeholders. RESULTS: A set of 38 validated KPIs, grouped into eight categories, was consolidated into an online dashboard. This tool enabled real-time tracking of the National Vaccination Plan at both national and departmental levels, providing stakeholders with a comprehensive view of the vaccine supply chain. It also allowed for the assessment and comparison of the execution and effectiveness of public policies. CONCLUSIONS: These KPIs supported decision-making from a logistical standpoint, enhancing the planning, preparation, and continuous improvement of mass vaccination processes, thereby increasing their potential impact even further.

The NIH's RECOVER Initiative aims to ease the suffering of those living with Long Covid.

BACKGROUND: The COVID-19 pandemic's "Great Online Transition" significantly impacted teachers. Existing research on Emergency Remote Teaching (ERT) lacks longitudinal designs and consideration of subject-specific contexts. This study, using the Stressor-Strain-Outcome framework, investigates psychological needs thwarting (PNT) during ERT on teachers' well-being and online teaching intentions, considering subject of instruction as a potential factor. METHODS: Data were collected from 1,369 Chinese primary and middle school teachers of Chinese literature, mathematics, and English as a Foreign Language (EFL) at two time points: two weeks after ERT implementation (Time 1, mid-November 2021) and two months later, after returning to face-to-face teaching (Time 2, mid-January 2022). PNT, emotional exhaustion, psychological distress, and intention towards online teaching were evaluated. RESULTS: Among the types of PNT, competence thwarting emerged as the strongest predictor of emotional exhaustion, which was, in turn, associated with reduced online teaching intention and increased psychological distress. EFL teachers showed stronger associations between PNT, emotional exhaustion, and adverse outcomes, indicating higher susceptibility to strain during ERT. CONCLUSION: Subject of instruction, particularly for EFL teachers, significantly influences the relationship between PNT and teacher outcomes during ERT. Our findings underscore the need for subject-specific support strategies in online teaching environments.