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The acquisition or reactivation of Epstein-Barr virus (EBV) after allogeneic Hematopoietic Stem Cell Transplant (HSCT) can be associated with complications including the development of post-transplant lymphoproliferative disorder (PTLD), which is associated with significant morbidity and mortality. A number of risk factors for PTLD have been defined, including T-cell depletion, and approaches to monitoring EBV, especially in high-risk patients, with the use of preemptive therapy upon viral activation have been described. Newer therapies for the preemption or treatment of PTLD, such as EBV-specific cytotoxic T-cells, hold promise. Further studies to help define risks, diagnosis, and treatment of EBV-related complications are needed in this at-risk population.

Bacteriophage therapy is the use of viruses to kill bacteria for the treatment of antibiotic-resistant infections. Little is known about the human immune response following phage therapy. We report the development of phage-specific CD4 T cells alongside rising phage-specific immunoglobulin G and neutralizing antibodies in response to adjunctive bacteriophage therapy used to treat a multidrug-resistant Pseudomonas aeruginosa pneumonia in a lung transplant recipient. Clinically, treatment was considered a success despite the development phage-specific immune responses.

BACKGROUND: Pre-exposure prophylaxis for COVID-19 with tixagevimab/cilgavimab (T/C) received Emergency Use Authorization (EUA) based on results of a clinical trial conducted prior to the emergence of the Omicron variant. The clinical effectiveness of T/C has not been well described in the Omicron era. We examined the incidence of symptomatic illness and hospitalizations among T/C recipients when Omicron accounted for virtually all local cases. METHODS: Through retrospective electronic medical record chart review, we identified patients who received T/C between January 1 -July 31, 2022 within our quaternary referral health system. We determined the incidence of symptomatic COVID-19 infections and hospitalizations due to or presumed to be caused by early Omicron variants before and after receiving T/C (pre-T/C and post-T/C). Chi square and Mann-Whitney Wilcoxon two-sample tests were used to examine differences between the characteristics of those who got COVID-19 before or after T/C prophylaxis, and rate ratios (RR) and 95% confidence intervals (CI) were calculated to assess differences in hospitalization rates for the two groups. RESULTS: Of 1295 T/C recipients, 105 (8.1%) developed symptomatic COVID-19 infection before receiving T/C, and 102 (7.9%) developed symptomatic disease after receiving it. Of the 105 patients who developed symptomatic infection pre-T/C, 26 (24.8%) were hospitalized, compared with six of the 102 patients (5.9%) who were diagnosed with COVID-19 post-T/C (RR = 0.24; 95% CI = 0.10-0.55; p = 0.0002). Seven of the 105 (6.7%) patients infected pre-T/C, but none of the 102 infected post-T/C required ICU care. No COVID-related deaths occurred in either group. The majority of COVID-19 cases among those infected pre-T/C treatment occurred during the Omicron BA.1 surge, while the majority of post-T/C cases occurred when Omicron BA.5 was predominant. In both groups, having at least one dose of vaccine strongly protected against hospitalization (pre-T/C group RR = 0.31, 95% CI = 0.17-0.57, p = 0.02; post-T/C group RR = 0.15; 95% CI = 0.03-0.94; p = 0.04). CONCLUSION: We identified COVID-19 infections after T/C prophylaxis. Among patients who received T/C at our institution, COVID-19 Omicron cases occurring after T/C were one-fourth as likely to require hospitalization compared to those with Omicron prior to T/C. However, due to the presence of changing vaccine coverage, multiple therapies, and changing variants, the effectiveness of T/C in the Omicron era remains difficult to assess.

Abstract Background Simulation is a useful education tool for high-stakes clinical skills and decision-making. Recommending whether to accept or reject an organ for transplantation based on infection risk is a critical core competency in Transplant Infectious Disease (ID), however there are no published data that learners have opportunities to practice this during training. We created a novel simulation to expose learners to this real-life clinical scenario and evaluated their clinical decision-making in these situations. Methods We created 6 simulations with common ID consult questions about whether to accept or reject an organ for transplant based on infection risk (Table 1). During learners’ Transplant ID rotations, faculty periodically texted or paged them with the simulation cases as though they were the transplant coordinator. Learners had 15 minutes to ask follow up questions before deciding to accept or reject the organ and explain their decision-making process in a survey. Learners completed a survey 1 month after the simulation experience to evaluate its effectiveness. Results Between October 2021 and April 2022, 16 learners from 7 medical centers participated in the simulation (Table 2) and 94% (15/16) completed the follow up survey. Eighty-seven percent (13/15) of ID learners reported that the simulation was effective in teaching them when to accept or reject organs and 80% (12/15) felt more prepared to make these decisions in practice. Most learners correctly identified acceptable organs for transplant during the simulations (Figure 1). Of the 100 clinical reasoning decisions made during the activity, 19% were discordant, where the learner correctly decided to accept or decline the organ but with incorrect or incomplete reasoning for this decision (Figure 2). Conclusion ID learners perceived our transplant ID simulation as an effective educational tool to learn when to accept or reject an organ for transplant. By evaluating the clinical reasoning behind these decisions our simulation provides ID educators with nuanced insight into their learners' thought process and allows for targeted coaching to correct deficits in reasoning. Disclosures Rebecca Kumar, MD, Gilead: Grant/Research Support|Regeneron: Grant/Research Support Jonathan Hand, MD, GlaxoSmithKline: Grant/Research Support|Janssen: Grant/Research Support|Pfizer: Grant/Research Support Roderick Go, DO, Aptose Biosciences: Stocks/Bonds|Bristol Meyers Squibb: Stocks/Bonds|Cytodyn Inc.: Stocks/Bonds|Scynexis: Grant/Research Support Erica J. Stohs, MD, MPH, bioMerieux: Grant/Research Support.

To expand the use of cognitive diagnosis models (CDMs) to longitudinal assessments, this study proposes a bias-corrected three-step estimation approach for latent transition CDMs with covariates by integrating a general CDM and a latent transition model. The proposed method can be used to assess changes in attribute mastery status and attribute profiles and to evaluate the covariate effects on both the initial state and transition probabilities over time using latent (multinomial) logistic regression. Because stepwise approaches generally yield biased estimates, correction for classification error probabilities is considered in this study. The results of the simulation study showed that the proposed method yielded more accurate parameter estimates than the uncorrected approach. The use of the proposed method is also illustrated using a set of real data.

Efforts to realize the potential of learning analytics (LA) to contribute to improving student learning and learning design have brought important advances. A review of successful cases of learning analytics applications reveals that: (1) there is a tight coupling between the learning outcome (LO) goals, task sequence design, and the learning analytics and feedback in each case; and (2) the learning analytics to be deployed and the feedback to be provided to learners and/or teachers are integral to the learning design (LD) rather than constructed after the LD is completed. Learning design frameworks in the literature have focused on generic learning task taxonomies and are unable to scaffold LA-integrated LD practice. This paper proposes a multilevel framework for LA-integrated LD, which provides a hierarchically nested multilevel structure for the design of LD and LA elements based on 60 STEM curriculum units collected from authentic classrooms. The framework includes a design process model in the form of a Learning Design Triangle and the concept of Learning Analytics integrated Curriculum Component Design Patterns (LACCDP). Operationalization of the framework is illustrated using one STEM curriculum unit. This framework can be adopted for professional learning and technology development to support LA-integrated LD practices.

Hong Kong was one of the first places hit with the COVID-19 outbreak in January 2020 and has since responded with several periods of full or partial school suspension, during which teaching and learning often occurred remotely using digital means. During this time, collecting research data and testing students have become more difficult than before. In this article, we report on a large-scale digital literacy (DL) performance assessment in Hong Kong that had to be conducted in a mix of modes--onsite, online supported, and online self-directed--during the pandemic. We discuss the administrative and methodological challenges of assessing DL, and explore preliminary data on the associations between student performance and the assessment mode adopted. We further discuss potential implications, including for high-stakes testing, and make recommendations for assessing DL remotely.

In the learning design community, there has been an increasing recognition of the value of positioning teaching as a design science, in which teachers craft and test effective learning conditions through a goal-oriented and evidence-based procedure. However, the existing models and tools supporting teachers' design practice focus primarily on learning task configurations; very little account has been taken of the later phases of the design lifecycle, such as evaluation and redesign. The shortage of tools for articulating and supporting reflective design practice is a major barrier preventing design science from growing into mainstream educational practice. To bridge the gap between research and practice, this paper proposes an outcome-oriented and pattern-based model, capable of enabling teachers to design a course and test its effectiveness using principled methods appropriate to a design science. This model conceptualizes course design as a goal-oriented process of crafting and strategizing the use of design patterns to address different types of learning outcomes, and conducting pattern-informed learning analytics to inform intervention and redesign. When applied to the development of a real course, the preliminary results suggest that the model has some potential in engaging the teaching team in exercising reflective design practice featured with a disciplined course design procedure, rigorous testing, as well as evidence-based intervention and redesign, which in turn led to improved learning outcomes. This paper concludes with a discussion on the limitations of the model and the directions for future research.

BackgroundDespite increased utilization of hepatitis C virus-infected (HCV+) organs for transplantation into HCV-uninfected recipients, there is lack of standardization in HCV-related patient education/consent and limited data on financial and social impact on patients.MethodsWe conducted a survey on patients with donor-derived HCV infection at our center transplanted between 4/1/2017 and 11/1/2019 to assess: why patients chose to accept HCV+ organ(s), the adequacy of their pre-transplant HCV education and informed consent process, financial issues related to copays after discharge, and social challenges they faced.ResultsAmong 49 patients surveyed, transplanted organs included heart (n = 19), lung (n = 9), kidney (n = 11), liver (n = 4), heart/kidney (n = 4), and liver/kidney (n = 2). Many recipients accepted an HCV-viremic (HCV-V) organ due to perceived reduction in waitlist time (n = 33) and/or trust in their physician's recommendation (n = 29). Almost all (n = 47) felt that pre-transplant education and consent was appropriate. Thirty patients had no copay for direct-acting antivirals (DAA) for HCV, including 21 with household income $1000. Two patients reported feeling isolated due to HCV infection and eight reported higher than anticipated medication costs. Patients' biggest concern was potential HCV transmission to partners (n = 18) and family/friends (n = 15). Overall almost all (n = 47) patients reported a positive experience with HCV-V organ transplantation.ConclusionWe demonstrate that real-world patient experiences surrounding HCV-V organ transplantation have been favorable. Almost all patients report comprehensive HCV-related pre-transplant consent and education. Additionally, medication costs and social isolation/exclusion were not barriers to the use of these organs.

In this study, we review 1830 research articles on artificial intelligence in education (AIED), with the aim of providing a holistic picture of the knowledge evolution in this interdisciplinary research field from 2010 to 2019. A novel three-step approach in the analysis of the keyword co-occurrence networks (KCN) is proposed to identify the knowledge structure, knowledge clusters and trending keywords within AIED over time. The results reveal considerable research diversity in the AIED field, centering around two sustained themes: intelligent tutoring systems (2010-19) and massive open online courses (since 2014). The focal educational concerns reflected in AIED research are: (1) online learning; (2) game-based learning; (3) collaborative learning; (4) assessment; (5) affect; (6) engagement; and (7) learning design. The highly connected keywords relevant to analytic techniques within this field include natural language processing, educational data mining, learning analytics and machine learning. Neural network, deep learning, eye tracking, and personalized learning are trending keywords in this field as they have emerged with key structural roles in the latest two-year period analyzed. This is the first article providing a systematic review of a large body of literature on artificial intelligence in education, and in it we uncover the underlying patterns of knowledge connectivity within the field, as well as provide insight into its future development. The three-step multi-scale (macro, meso, micro) framework proposed in this study can also be applied to map the knowledge development in other scientific research areas.

Bacteriophage therapy (BT) uses bacteriophages to treat pathogenic bacteria and is an emerging strategy against multidrug-resistant (MDR) infections. Experience in solid organ transplant is limited. We describe BT in 3 lung transplant recipients (LTR) with life-threatening MDR infections caused by Pseudomonas aeruginosa (n = 2) and Burkholderia dolosa (n = 1). For each patient, lytic bacteriophages were selected against their bacterial isolates. BT was administered for variable durations under emergency Investigational New Drug applications and with patient informed consent. Safety was assessed using clinical/laboratory parameters and observed clinical improvements described, as appropriate. All patients received concurrent antibiotics. Two ventilator-dependent LTR with large airway complications and refractory MDR P. aeruginosa pneumonia received BT. Both responded clinically and were discharged from the hospital off ventilator support. A third patient had recurrent B. dolosa infection following transplant. Following BT initiation, consolidative opacities improved and ventilator weaning was begun. However, infection relapsed on BT and the patient died. No BT-related adverse events were identified in the 3 cases. BT was well tolerated and associated with clinical improvement in LTRs with MDR bacterial infection not responsive to antibiotics alone. BT may be a viable adjunct to antibiotics for patients with MDR infections.

Digital literacy competence (DL) is an important capacity for students' learning in a rapidly changing world. However, little is known about the empirical structure of DL. In this paper, we review major DL assessment frameworks and explore the dimensionality of DL from an empirical perspective using assessment data collected using authentic software applications, rather than simulated assessment environments. Secondary analysis on representative data collected from primary and secondary school students in Hong Kong using unidimensional and multidimensional item response theory reveals a general dimension of digital literacy performance and four specific, tool-dependent dimensions. These specific DL dimensions are defined by the software applications that students use and capture commonality among students' performance that is due to their familiarity with the assessment tools and contexts. The design of DL assessment is discussed in light of these findings, with particular emphasis on the influence of the nature of digital applications and environments used in assessment on the DL achievement scores measured.

Background: The purpose of this study was to understand how transplant infectious disease (TID) physicians assess a potential donor with known or suspected infection and describe posttransplant management. Methods: We designed a survey of 10 organ offer scenarios and asked questions pertaining to organ acceptability for transplantation and management posttransplant. The survey was distributed to TID clinicians via transplant society listservs and email. Responses were recorded in REDCap, and descriptive statistics were employed. Results: One hundred thirteen infectious disease physicians responded to the survey, of whom 85 completed all cases. Respondents were generally in agreement regarding organ acceptability, although some divergence was seen when evaluating lungs from donors with influenza, tuberculosis, or multidrug‐resistant Acinetobacter infection. Posttransplant management showed more variation. Areas of optimization were identified: (1) Further understanding of where risk‐mitigation strategies within the donor offer process may improve donor acceptability and therefore organ utilization; (2) importance of recipient considerations in assessing degree of infectious risk; and (3) gaps in evidenced‐based data regarding optimal posttransplant management of recipients. Conclusion: Evaluation of donor offers by TID clinicians is a complex process. Although the survey does not itself serve to make recommendations regarding best practices, it highlights areas where generation of data to inform acceptance and management practices may allow for improved organ utilization and recipient management. [ABSTRACT FROM AUTHOR]

This paper is an educationally focused article discussing how transplant infectious diseases (TID) providers balance the risks of accepting or rejecting an organ and have pushed barriers in organ transplantation. We emphasize the role TID providers play in the transplantation process as critical players on the transplant team. We discuss various donor‐derived infections that were previously deemed unacceptable for donation due to concerns for transmission. Advances in medical knowledge have changed some of these situations. We discuss the critical role TID providers have in closing the gap between the thousands of patients on organ waitlists and the organ deficit faced each day. We believe TID providers have a unique opportunity to expand the donor pool by increasing education, expanding acceptable organ definitions, and expanding the boundaries of what we can do with potentially transmissible infections in organ transplantation. [ABSTRACT FROM AUTHOR]

This paper explores the roles of information and communication technology (ICT) coordinators, using architectures for learning as the theoretical framework to identify (a) the structures and mechanisms utilized to decide the role of a coordinator and (b) those organized for the coordinator to realize a role within a school context of ICT-enabled, instructional reform. Data on ICT coordinator roles were collected from semi-structured interviews with ICT coordinators and colleagues, and from school documents. The data were analysed and coded according to the elements of architectures for learning and shown to influence instructional reform. The paper presents four cases of ICT coordinators with roles intended to provide instructional support, technical support, both instructional and technical support, and neither instructional nor technical support. By comparing architectures for learning associated with different intended roles, we find that different conceptualizations of the ICT coordinator are connected to particular decision-making mechanisms and organizational units found in a school. We also uncover differences in architectures for learning organized for ICT coordinators that are intended to provide instructional support compared with those intended to provide technical support. Using an architectures for learning framework in the design of an ICT coordinator role can be foundational to the successful participation of the role in the instructional reform.

This paper reports on a longitudinal study of a network of 10 special education needs schools over a span of 11 years that leveraged the opportunity offered by a government-funded e-learning pilot scheme initiative to further their efforts in providing the same educational opportunities to their students as those in mainstream schools. The trajectory of this network's evolution shows that its robustness lies in the joint leadership network among the schools, and the insight and agency that this leadership network exhibited in the intentional exploration and crafting of a social structure and mechanism to support innovative developments in technology and pedagogical innovation, which we refer to as sociotechnical co-evolution. By adopting a sociotechnical system framework to analyse the changes at the landscape, regime and niches levels, we show that in fact landscape factors play a crucial role in shaping the innovation trajectory through its influence on the niches. Network leadership, within-school leadership and organizational infrastructures evolve and play an important role in the co-construction of the sociotechnical regimes needed to bring about deep and widespread changes in pedagogical practice.