A relevant portion of patients with disease caused by the severe acute respiratory syndrome coronavirus 2 (COVID-19) experience negative outcome, and several laboratory tests have been proposed to ...predict disease severity. Among others, dramatic changes in peripheral blood cells have been described. We developed and validated a laboratory score solely based on blood cell parameters to predict survival in hospitalized COVID-19 patients. We retrospectively analyzed 1,619 blood cell count from 226 consecutively hospitalized COVID-19 patients to select parameters for inclusion in a laboratory score predicting severity of disease and survival. The score was derived from lymphocyte- and granulocyte-associated parameters and validated on a separate cohort of 140 consecutive COVID-19 patients. Using ROC curve analysis, a best cutoff for score of 30.6 was derived, which was associated to an overall 82.0% sensitivity (95% CI: 78-84) and 82.5% specificity (95% CI: 80-84) for detecting outcome. The scoring trend effectively separated survivor and non-survivor groups, starting 2 weeks before the end of the hospitalization period. Patients' score time points were also classified into mild, moderate, severe, and critical according to the symptomatic oxygen therapy administered. Fluctuations of the score should be recorded to highlight a favorable or unfortunate trend of the disease. The predictive score was found to reflect and anticipate the disease gravity, defined by the type of the oxygen support used, giving a proof of its clinical relevance. It offers a fast and reliable tool for supporting clinical decisions and, most important, triage in terms of not only prioritization but also allocation of limited medical resources, especially in the period when therapies are still symptomatic and many are under development. In fact, a prolonged and progressive increase of the score can suggest impaired chances of survival and/or an urgent need for intensive care unit admission.
Previous studies on the immunogenicity of SARS‐CoV‐2 mRNA vaccines showed a reduced seroconversion in cancer patients. The aim of our study is to evaluate the immunogenicity of two doses of mRNA ...vaccines in solid cancer patients with or without a previous exposure to the virus. This is a single‐institution, prospective, nonrandomized study. Patients in active treatment and a control cohort of healthy people received two doses of BNT162b2 (Comirnaty, BioNTech/Pfizer, The United States) or mRNA‐1273 (Spikevax, Moderna). Vaccine was administered before starting anticancer therapy or on the first day of the treatment cycle. SARS‐CoV‐2 antibody levels against S1, RBD (to evaluate vaccine response) and N proteins (to evaluate previous infection) were measured in plasma before the first dose and 30 days after the second one. From January to June 2021, 195 consecutive cancer patients and 20 healthy controls were enrolled. Thirty‐one cancer patients had a previous exposure to SARS‐CoV‐2. Cancer patients previously exposed to the virus had significantly higher median levels of anti‐S1 and anti‐RBD IgG, compared to healthy controls (P = .0349) and to cancer patients without a previous infection (P < .001). Vaccine type (anti‐S1: P < .0001; anti‐RBD: P = .0045), comorbidities (anti‐S1: P = .0274; anti‐RBD: P = .0048) and the use of G‐CSF (anti‐S1: P = .0151) negatively affected the antibody response. Conversely, previous exposure to SARS‐CoV‐2 significantly enhanced the response to vaccination (anti‐S1: P < .0001; anti‐RBD: P = .0026). Vaccine immunogenicity in cancer patients with a previous exposure to SARS‐CoV‐2 seems comparable to that of healthy subjects. On the other hand, clinical variables of immune frailty negatively affect humoral immune response to vaccination.
What's new?
Although mRNA‐based vaccines that protect against infection with SARS‐CoV2, the causative virus of COVID‐19, are highly immunogenic in healthy individuals, the extent to which they provoke immune responses in cancer patients is less certain. Here, the immunogenicity of two doses of either of two SARS‐CoV2 mRNA vaccines was investigated in cancer patients with solid tumors. Patients previously exposed to SARS‐CoV2 exhibited strong immune responses to vaccination, similar to responses in healthy controls. Responses were more muted among patients with no prior SARS‐CoV2 exposure. Antibody responses to vaccination also were negatively impacted by comorbidities, use of G‐CSF and vaccine type.
Introduction
Cancer patients are frail individuals, thus the prevention of SARS‐CoV‐2 infection is essential. To date, vaccination is the most effective tool to prevent COVID‐19. In a previous study, ...we evaluated the immunogenicity of two doses of mRNA‐based vaccines (BNT162b2 or mRNA‐1273) in solid cancer patients. We found that seroconversion rate in cancer patients without a previous exposure to SARS‐CoV‐2 was lower than in healthy controls (66.7% vs. 95%, p = 0.0020). The present study aimed to evaluate the clinical efficacy of the vaccination in the same population.
Methods
This is a single‐institution, prospective observational study. Data were collected through a predefined questionnaire through phone call in the period between the second and third vaccine dose. The primary objective was to describe the clinical efficacy of the vaccination, defined as the percentage of vaccinated subjects who did not develop symptomatic COVID‐19 within 6 months after the second dose. The secondary objective was to describe the clinical features of patients who developed COVID‐19.
Results
From January to June 2021, 195 cancer patients were enrolled. Considering that 7 (3.59%) patients tested positive for SARS‐CoV‐2 and 5 developed symptomatic disease, the clinical efficacy of the vaccination was 97.4%. COVID‐19 disease in most patients was mild and managed at home; only one hospitalization was recorded and no patient required hospitalization in the intensive care unit.
Discussion
Our study suggests that increasing vaccination coverage, including booster doses, could improve the prevention of infection, hospitalization, serious illness, and death in the frail population of cancer patients.
Prevention of SARS‐CoV‐2 infection is crucial for cancer patients given their frailty and vaccination is the most effective method to achieve this goal. The present study aimed to evaluate the clinical efficacy of the first two doses of anti‐SARS‐CoV‐2 vaccines in treated solid cancer patients. The clinical efficacy was 97.4%. COVID‐19 disease in most patients was mild and managed at home; only one hospitalization was recorded and no patient required hospitalization in the intensive care unit.
Urban activities, including urban mobility, play a crucial role in climate change mitigation. Urban mobility is currently at a crossroads. In a business as usual scenario, CO2 emissions from urban ...transportation will grow by one fourth by 2050. Nevertheless, during this period, it may drop by about one third. To make the drop happen, we need to introduce comprehensive policies and measures. Electrifying urban transit is one feasible solution. This study investigates whether and how urban water transit systems have been electrified—a means of transport which has not been well researched in this respect. A multilevel perspective and the comparative case study method were employed to answer the research questions. The comprehensive study focussed on 24 cities representing the current experience in planning and operating water transport, based mainly on secondary, primarily qualitative, data, such as industry reports, feasibility studies, urban policies, and scientific papers. The primary outcome is that urban electric passenger ferries left their market niches and triggered a radical innovation, diffusing into mainstream markets. However, urban diversity results in various paths to electrification, due to the system’s physical characteristics, local climate and transport policies, manufacturing capacity, green city branding, and the innovativeness of international ferry operators. Three dominant transition pathways were identified—a comprehensive carbon neutral policy, a transport sector policy, and a research and development policy. From a multilevel perspective, cities can be considered a bridge between niches and regimes that provide the actual conditions for implementing sociotechnical configurations.
The research on the sustainability transitions – a fundamental change in socio-technological systems consisting in increasing the degree of sustainability of production and consumption processes – ...gained significant dynamics in the second decade of the 21st century, manifested by the expansion and integration of the research community and the growth of article numbers. As part of this trend, the geography of sustainability transitions has emerged. It explains how and why transitions are similar or different across locations. The article’s main aim is to outline the socio-technological perspective of the geographical research on sustainable urban mobility and place within it the achievements of research on Polish cities. Literature studies were bidirectional: (i) identifying possible applications and benefits that the concept of sustainability transitions provides to mobility research in Polish cities, (ii) analysing of peer-reviewed scientific articles published in the Transport Geography Papers of Polish Geographical Society on urban mobility in the context of the identified geographic factors of transitions. The study outcomes showed the dominance of the shift in modal split framed by formal visions, strategies and development policies. The significance of this issue resulted from the importance of public transport in research on transport geography and the dependence of transportation branches on local authorities. The insertion of the analysed achievements within the framework of the multi-level perspective showed that the vast majority of the works concerned the functioning of socio-technological regimes rooted in the structures of cities. The marginal treatment of the macro-level (socio-technological landscape) and the micro-level (innovation in niches) and focusing on selected regularities in the functioning of regimes resulted in a narrowing of the time perspective of the research. A particular challenge for the study of transport geography seems to be the issue of reducing transport needs and its impact on the spatial structure and the functioning of urban transport systems and mobility patterns. The breadth of the issues of transition paths towards sustainable mobility seems to favour the integration of a new, administratively separated scientific discipline, which is socio-economic geography and spatial management. In practical terms, it inspires the territorialisation of development policies.
An increase in energy-efficient transportation is one way that cities try to mitigate climate change. In coastal cities, public water transit is also undergoing transitions. A small zero-emission ...autonomous ferry seems to be a cutting-edge technology in this field. This study aims to decrease the knowledge gap in research on the impacts of autonomous passenger ferry development on urban mobility. In particular, the central theme regards the extent to which the new transport solution can help improve sustainable mobility patterns. This study explores the local spatial context of ferry development, land-use patterns, and transport network structure, and moderates the shift in urban mobility practices. Regarding land use patterns, the case of the coastal city of Gdańsk has been documented in secondary qualitative and quantitative data, including in a large body of policy documents, accompanying expert opinions, and scholarly literature. This study strongly emphasises that a typical short river crossing, due to autonomous vessels, can regain a competitive position, which was partially lost due to linear routes along the river. The research identified crucial benefits of autonomous ferry shipping on urban mobility by increasing public transport network connectivity, reducing travel distance, and creating modal shifts towards foot travel and bike riding. It appears as an exciting scalable solution for cities where limited or dispersed demand prevents achievement of economies of scale, therefore diminishing the necessary expenditures.
This article describes the impact of limiting human mobility related to the COVID-19 pandemic on the level of air pollution related to transport. The city of Krakow and the emission level of nitrogen ...oxides (NO
) were used as a case study. This article describes the air quality monitoring system in Krakow and the measurement results from the measurement station at Krasinskiego Avenue. The average values of the pollution level in April 2018–2020 were compared. For the selected range of data, a significance test was performed, which resulted in no grounds for rejecting the hypothesis of the equality of the mean levels of nitrogen oxides concentrations in the spring. The analysis takes into account the average monthly temperatures in the discussed years.
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