The Medical College of Georgia (MCG) responded to the COVID-19 pandemic's challenges to medical education with a novel, comprehensive curriculum. The Pandemic Medicine Elective was an effective solution with a safe, virtual alternative to traditional clinical experiences. As the elective evolved to include pre-clinical students and service initiatives across Georgia, students and faculty navigated online platforms to execute critical community-based projects. This curricular development utilized an interdisciplinary approach by faculty across each of MCG's regional campuses. We describe the curriculum of the electives, the student initiatives, and lessons learned while quickly adapting curriculum during the COVID-19 pandemic.
| INTRODUC TI ONLimiting immune-mediated damage of the allograft while maintaining protective immunity following transplantation requires precise regulation of the immune system. These processes are carefully controlled by the balance of costimulatory and coinhibitory signals T cells receive. The CD28/CTLA-4 pathway is the prototypic cosignaling pathway in T cells, with CTLA-4 coinhibition acting as the counter-signal to CD28 costimulation as they compete for the same ligands (CD80 and CD86). Because CD28 costimulation is necessary for optimal T cell activation, immunomodulation via blockade of this pathway has been a promising approach to prevent inappropriate T cell activation in the setting of transplantation.Belatacept, a recombinant CTLA-4Ig fusion protein, which binds to CD80/86 thus preventing CD28-mediated T cell activation was the first costimulation blocker to be approved by the US Food and CTLA-4Ig (belatacept) blocks the CD80/CD86 ligands for both CD28 and CTLA-4;thus, in addition to the intended effect of blocking CD28-mediated costimulation, belatacept also has the unintended effect of blocking CTLA-4-mediated coinhibition.Recently, anti-CD28 domain antibodies (dAb) that selectively target CD28 while leaving CTLA-4 intact were shown to more effectively inhibit alloimmune responses and prolong graft survival. However, the impact of selective CD28 blockade on protective immunity has not been extensively investigated. Here, we sought to compare the impact of CTLA-4Ig vs anti-CD28dAb on CD8 + T cell immunity to a transplant-relevant pathogen, a murine homolog of Epstein-Barr virus. Mice were infected with murine gammaherpesvirus-68 (MHV) and treated with vehicle, CTLA-4Ig, or anti-CD28dAb. Although anti-CD28dAb resulted in a decrease in virus-specific CD8 + T cell numbers as compared to CTLA-4Ig, cytolytic function and the expression of markers of high-quality effectors were not different from CTLA-4Ig treated animals.Importantly, MHV-68 viral load was not different between the treatment groups.These results suggest that preserved CTLA-4 coinhibition limits MHV-specific CD8 + T cell accumulation, but the population that remains retains cytolytic function and migratory capacity and is not inferior in its ability to control viral burden relative to T cell responses in CTLA-4Ig-treated animals. K E Y W O R D Sanimal models: murine, basic (laboratory) research/science, cellular biology, Epstein-Barr Virus, immunosuppressant-fusion proteins and monoclonal antibodies: belatacept, immunosuppressant-fusion proteins and monoclonal antibodies: costimulation molecule specific, lymphocyte biology: differentiation/maturation, T cell biology
Since late 2019, SARS-CoV-2 has differentially impacted geographies and population demographics as it spread. As of June 30, 2020, two hotspots within the United States of America—the states of Georgia and Michigan—exhibited similar numbers of cases while Michigan had over twice the case fatality rate (CFR) of Georgia. Given the similar populations, land areas, and pandemic timelines of these states, such a large difference is unexpected. The primary goal of this paper is to examine why Michigan experienced much higher COVID-19 mortality than Georgia, which may point to at-risk comorbidities and vulnerable populations. We examined publicly available data on demographics, rates of comorbidities, environmental factors, and other population differences at the state and local levels (the cities of Detroit, Michigan; Atlanta, Georgia; and Albany, Georgia) that have known or identified associations with health outcomes. We also outlined the timeline of the pandemic in each state to determine if the actions of state governments may have contributed to the observed difference in CFR. While the difference in state CFR may imply that Michigan handled the pandemic poorly, the data show that inherent characteristics of Detroit may have led to the higher statewide CFR. Notable differences between the states include elderly populations, agricultural statistics, and drinking habits. Notable differences between the cities included population density, health system quality, per capita income, race, education, media access, and air pollution. Hypertension (among blacks), diabetes (at the city level), chronic kidney disease, asthma, heart disease, and cancer differed in prevalence by location and were associated with increased severity and/or mortality of COVID-19. There were more deaths due to COVID-19 in African American communities and nursing homes in Michigan. A combination of these factors likely explains the differential impact between these two states.
In Spring 2020, when the COVID-19 pandemic reached the United States, schools closed to mitigate the spread of the virus. While online learning platforms provided alternatives to in-person education, children of all ages and educational needs faced unique challenges adapting to new methods of education delivery. Developmental and educational effects varied between children at different grade levels. Through this review, we outline challenges faced by students based on their stage of education. We also consider the effects of the pandemic on special education, disadvantaged populations, and students with mental health challenges. Moreover, we suggest that in-person activities are paramount to a child’s educational and personal development, and they should be continued in the setting of appropriate safety guidelines, even in the midst of a global pandemic.
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