When the novel coronavirus (COVID-19) outbreak began to ring alarm bells worldwide, rapid, efficient diagnosis was critical to the emergency response. The limited ability of medical systems and the increasing number of daily cases pushed researchers to investigate automated models. The use of deep neural networks to help doctors make the correct diagnosis has dramatically reduced the pressure on the healthcare system. Promoting the improvement of diagnosis networks depends not only on the network structure design but also on the activation function performance. To identify an optimal activation function, this study investigates the correlation between the activation function selection and image classification performance in balanced or imbalanced datasets. Our analysis evaluates various network architectures for both commonly used and novel datasets and presents a comprehensive analysis of ten widely used activation functions. The experimental results show that the swish and softplus functions enhance the classification ability of state-of-the-art networks. Finally, this thesis distinguishes the neural networks using ten activation functions, analyzes their pros and cons, and puts forward detailed suggestions on choosing appropriate activation functions in future work. / Master of Science / When the novel coronavirus (COVID-19) outbreak began to ring alarm bells worldwide, the rapid, efficient diagnosis was critical to the emergency response. The manual diagnosis of chest X-rays by radiologists is time and cost-consuming. Compared with traditional diagnostic technology, the artificial intelligence medical system can simultaneously analyze and diagnose hundreds of medical images and speedily obtain high precision and high-efficiency returns. As we all know, machines are brilliant in learning new things and never sleep. Suppose machines can be used to replace human beings in some positions. In that case, it can significantly relieve the pressure on the medical system and buy time for medical practitioners to concentrate more on the research of new technologies. We need to know that the critical decision unit of the intelligent diagnosis system is the activation function. Therefore, this work provides an in-depth evaluation and comparison of the traditional and widely used activation functions with the emerging activation functions, which helps to improve the accuracy of the most advanced diagnostic model on the COVID-19 image dataset. Besides, the results of this study also summarize the cons and pros of using various neural functions and provide many suggestions for future work.

The influence of the COVID-19 pandemic on unemployment rates in several US locations is examined in this research article. We investigate the intricate relationships between COVID-19 cases, mortality, GDP per capita, and unemployment rates through a thorough study of the data. The study sheds insight into the complex interaction between health crises and labor markets by revealing considerable differences in how these factors affect unemployment in various geographic locations.Unexpectedly, key findings show that places with higher COVID-19 cases frequently have lower unemployment rates. This trend is related to several variables, including critical sectors and public health activities. The positive correlation between increased COVID-19 deaths and increased unemployment highlights the significant economic impact of the COVID-19 pandemic. The findings suggest that the relationship between GDP per capita and unemployment rates during the COVID-19 pandemic varied across different regions of the United States. These findings have broad ramifications, highlighting the connection between the economy and public health. Policymakers are urged to consider regional differences when creating focused measures to solve problems with the job market brought on by the pandemic. This study advances the knowledge of the COVID-19 pandemic's impact on the labor market. It emphasizes the value of concerted actions to save people's lives and way of life in times of crisis.

Yes / This study aims to examine the drivers and impact of et-moone on relational governance within B2B relationships in the Arab Asian region. Building on commitment and trust theory, this study proposes how et-moone could be driven by IT-enabled interactions during the COVID-19 pandemic. Data were collected using an online questionnaire survey from the food, pharmaceutical, detergent and sterilizer industries in Jordan and Saudi Arabia. A two-stage structural equation modelling approach was used to test the model. The results largely support the significant impact of et-moone predictors. A strong and significant relationship was also found between et-moone and relational governance. This study expands the theoretical horizon of et-moone by considering a new driver (i.e., IT-enabled interactions) and its consequences in terms of relational governance. The outcomes of the current study also make contributions for both practitioners and researchers who are interested in socio-cultural values (i.e., et-Moone) in Arabic countries. An in-depth discussion on the above is presented in the subsections on theoretical and practical implications.

No / Wellbeing is a growing concern for educators and students alike and is especially significant in the light of the Covid-19 pandemic, which has brought the importance of wellbeing into sharp focus. Elsewhere, the authors (Cobb and Croucher) have written about a new pedagogic approach they have developed, specifically related to archaeology, although applicable across higher education. In this approach, they draw on relational theories and archaeology's “material turn” to focus on “Inclusive Learning Assemblages”. They explore the material and social assemblages that students encounter, both in different learning contexts and outwith learning, arguing that if we foreground learning assemblages, then student diversity and the student learning experience will be enhanced. In this paper, the authors take a step further by exploring the value of this approach for student wellbeing. They argue that taking an assemblage approach to teaching and learning in archaeology, and foregrounding diversity, actively improves student wellbeing too. This paper brings into dialogue mental health issues, with the diversity of student experiences, and the broad material engagements of an archaeology degree, in order to suggest a series of concrete steps that practitioners can implement to enhance student wellbeing.

Forskning visar att sjuksköterskor påverkades personligen av en ökad arbetsbelastning under COVID-19 pandemin. Sjuksköterskor beskrev emotionellt och fysiskt utmanande arbetsmiljöer samt en minskad patientsäkerhet och vårdkvalitet under pandemin. Forskning visar även att närstående till patienter under pandemin beskrev kommunikationssvårigheter med patienter och vårdpersonal samt erfarenheter av informationsbrist. Med Erikssons vårdteori som bakgrund kan patienters erfarenheter av isolering under COVID-19 bidra till en ökad kunskap av isolerade patienters behov för att uppnå hälsa. Syfte: Syftet var att beskriva patienters erfarenheter av isolering efter genomgången COVID-19 på sjukhus. Metod: Kvalitativ litteraturstudie med beskrivande syntes enligt Evans metod. Resultat: Resultatet presenterades med två teman och sex subteman. Första temat beskriver patienters avsaknad av samhörighet med fyra subteman: ”Att vara instängd”, ”Att vara stigmatiserad”, ”Att inte erhålla information” samt “Att inte kunna kommunicera”. Andra temat beskriver isoleringens silverkant med två subteman; ”Att få nya insikter” samt ”Att finna sociala resurser ”. Slutsats: Patienter som isolerades under COVID-19 beskrev erfarenheter av ensamhet, opersonlig vård samt begränsad fysisk kontakt och kommunikation. Patienters erfarenheter belyser ett behov av ett etiskt vårdvetenskapligt perspektiv för sjuksköterskor som kan erbjuda mänsklig kontakt, samtal och empati för isolerade patienter.

Die Bauchlagerung von intubierten ARDS-Patient/innen mit einer schlechten Oxygenierung wird laut Leitlinie seit mehreren Jahren als supportive Therapiemaßnahme empfohlen. Im Rahmen der COVID-19 Pandemie wurde nun erstmalig die Bauchlagerung auch bei hypoxämischen, nicht-intubierten Patient/innen untersucht. Diese Fragestellung wurde in der vorliegenden Arbeit mittels einer systematischen Übersichtsarbeit betrachtet. Aufgrund der aktuellen Pandemiesituation wurden neben ARDS-Patient/innen im Allgemeinen insbesondere COVID-19 Patient/innen mit einem akuten Lungenversagen als Subgruppe untersucht. Am 21.11.2020 wurde eine systematische Suche nach Studien in den Datenbanken MEDLINE, Cochrane COVID-19 Study Register und Living Overview of the Evidence platform durchgeführt. Die Ergebnisse wurden, wo möglich, in Form einer Meta-Analyse zusammengefasst, in Tabellen darstellt oder deskriptiv beschrieben. Das Risiko für Bias wurde jeweils für die eingeschlossenen kontrollierten Studien mittels ROBINS-I beurteilt. Die Vertrauenswürdigkeit der Evidenz der gesamten Arbeit wurde mit Hilfe des GRADE-Ansatzes untersucht. Insgesamt wurden 30 Studien eingeschlossen, davon 4 kontrollierte Studien, keine RCTs. In 3 der kontrollierten Studien wurde die Bauchlagerung bei COVID-19 Patient/innen untersucht, in einer bei Patient/innen mit einem anderweitig verursachten ARDS. Es ist unklar, ob die Bauchlagerung die Intubationsrate (RR = 0,92; 95% KI: 0,59 - 1,44; I² = 65%; sehr niedrige Vertrauenswürdigkeit der Evidenz), die Mortalität (RR = 0,55; 95% KI: 0,23 - 1,30; I² = 60%; sehr niedrige Vertrauenswürdigkeit der Evidenz) und die Wahrscheinlichkeit für eine Aufnahme auf die Intensivstation (RR = 0,94; 95% KI: 0,54 - 1,63; I2 = 71%; sehr niedrige Vertrauenswürdigkeit der Evidenz) verringern kann. Auch für die anderen betrachteten Endpunkte konnte kein signifikanter Effekt der Bauchlagerung nachgewiesen werden Im Vergleich der Subgruppen „Nicht-COVID-19“ (8 Studien) und „COVID-19“ (22 Studien) konnten in Bezug auf alle betrachteten Endpunkte keine relevanten Unterschiede festgestellt werden. Insgesamt ist die Evidenz nicht ausreichend, um Vor- und Nachteile der Bauchlagerung für nicht-intubierte ARDS Patient/innen gegenüber der üblichen Rückenlagerung aufzuzeigen und diese für die Praxis zu empfehlen. / Prone positioning of intubated ARDS patients with poor oxygenation has been recommended as a supportive therapy for several years. In the context of the COVID-19 pandemic, prone positioning has now been investigated for the first time in hypoxemic, non-intubated patients. This issue was examined by our systematic review. Because of the current pandemic situation, we assessed the effects of prone positioning in COVID-19 patients with acute respiratory failure in particular as a subgroup in addition to ARDS patients in general. A systematic search for studies was performed in MEDLINE, Cochrane COVID-19 Study Register, and Living Overview of the Evidence platform databases on 21 November 2020. Where possible, results were analyzed in the form of meta-analysis, presented in tables, or described descriptively. Risk of bias was assessed for each of the included controlled studies using ROBINS-I. The quality of evidence for the entire systematic review was assessed using the GRADE approach. A total of 30 studies were included, 4 of which were controlled trials, but no RCTs. 3 of the controlled trials investigated prone positioning in COVID-19 patients, one trial in patients with ARDS caused by other means. It is unclear whether prone positioning can reduce intubation rate (RR =0.92; 95% CI: 0.59-1.44; I²=65%; very low quality evidence), mortality (RR =0.55; 95% CI: 0.23-1.30; I²=60%; very low quality evidence), and the likelihood of ICU admission (RR =0.94; 95% CI: 0.54-1.63; I2 =71%; very low quality evidence). No significant effect of prone positioning was demonstrated for the other outcomes considered either. When comparing the "non-COVID-19" (8 studies) and "COVID-19" (22 studies) subgroups, no relevant differences were found for all outcomes assessed. Overall, the evidence is insufficient to demonstrate benefits and harms of prone positioning for non-intubated ARDS patients compared with usual care and to translate the results into practice.

Special education faces persistent challenges with teacher attrition and retention in the ever-changing landscape of education post COVID-19. Using empirical research and scholarly insights, this systematic review investigates the factors that influence whether special educators choose to continue or leave their jobs following the pandemic. Central to this investigation are the aspects that influence educators' career decisions pre pandemic, such as job satisfaction, working conditions, support systems and opportunities for professional growth. Through this exploration, we gain insights into the reasons why special education teachers choose to stay or leave their roles. The study emphasizes the pressing need to address the issue of losing education teachers and finding replacements. Teacher turnover not only affects student success by reducing teacher effectiveness, but it also disrupts collaborations and negatively impacts those who remain. Drawing on Bronfenbrenner's ecological systems theory framework adds depth to our understanding of these dynamics by providing information that can help improve teacher training programs and assist policymakers in addressing the pressing challenges of special education teacher attrition and retention. This study contributes to a deeper understanding of the factors post COVID-19 that are crucial for making empirical-based changes to support and retain education teachers. Although this study sheds light on the factors influencing teacher turnover and retention it acknowledges its limitations in establishing causal relationships among these factors. Nevertheless, the study's findings lay a groundwork for research and interventions based on evidence to strengthen the special education workforce in the aftermath of the pandemic.

Thèse ou mémoire avec insertion d'articles. / Selon l’université Johns Hopkins, plus de 600 millions de cas de coronavirus 2019 (COVID - 19) infectés par le SRAS-CoV-2 ont été signalés dans le monde depuis décembre 2019. La COVID-19 a causé une catastrophe énorme dans le monde, tuant plus de six millions de personnes. Il est donc essentiel de trouver des médicaments ou des vaccins efficaces. L'ARN polymérase ARN - dépendante (RdRp) joue un rôle clé dans la réplication du virus SARS-CoV-2. Nous avons constaté que la RdRp du SRAS-CoV-2 présentait 98,1% de similitude avec la RdRp du SRAS-CoV, alors que la similitude génomique de virus n'était que de 80%. Les alignements de séquences des coronavirus ont montré une homologie plus élevée entre les RdRps (60% - 98%) et une homologie plus faible entre les protéines Spike (24% - 77%). Les structures 3D de la RdRp et de la nucléotide transférase (NiRAN) ont été rapidement déterminées par modélisation à partir des structures correspondantes du SRAS. Dans le nouveau coronavirus, trois substitutions apparaissent dans le motif RdRp, ainsi qu'une liaison hydrogène supplémentaire, mais la structure des régions des doigts et du pouce est légèrement modifiée. La structure NiRAN est très conservatrice dans le COV. Les homologies de séquence et de structure entre RdRp et NiRAN sont donc supposées être des cibles médicamenteuses potentielles pour le traitement du COV émergent. La protéase principale (Mpro), également connue sous le nom de protéase 3-chymotrypsine-like (protéase 3CL), joue un rôle important dans le clivage des polyprotéines virales pour former des complexes de réplication fonctionnelle. Mpro est donc une cible pharmaceutique prometteuse pour le traitement de la COVID-19. Grâce à la modélisation moléculaire, à l'amarrage et à la détermination de l'activité protéasique, nous avons trouvé quatre nouveaux inhibiteurs ciblant le Mpro avec une affinité de liaison révélée par la moitié de la concentration maximale inhibitrice (IC50) et des constantes de dissociation (KD). Nos nouveaux inhibiteurs CB-21, CB-25, CP-1 et LC24-20 ont des CI50s de 14,88 µM (IC à 95%: 10,35 µM à 20,48 µM), 22,74 µM (IC à 95%: 13,01 µM à 38,16 µM), 18,54 µM (IC à 95%: 6,54 µM à 36,30 µM) et 32,87 µM (IC à 95%: 18,37 µM à 54,80 µM), respectivement. L'évaluation des interactions a montré que chaque inhibiteur avait des liaisons hydrogène ou des interactions hydrophobes avec des résidus importants, y compris les résidus catalytiques les plus importants: his41 et Cys145. La dose létale à 50% (DL50) des quatre inhibiteurs est beaucoup plus élevée que celle de l'inhibiteur bien connu de la Mpro, GC376, ce qui indique une faible toxicité. Ces quatre inhibiteurs peuvent servir de médicaments potentiels pour d'autres études in vitro et in vivo contre la COVID-19. Dans l'ensemble, pour RdRp et Mpro, nos résultats fournissent des informations utiles pour la recherche et le traitement de la COVID-19. / According to the data from Johns Hopkins University, more than 600 million Coronavirus Virus Disease 2019 (COVID-19) cases infected by SARS-CoV-2 has been reported worldwide since December 2019. COVID-19 brought huge disaster to the world with more than 6 million death cases. Therefore, finding efficient drugs or vaccines is of vital importance. RNA-dependent-RNA-polymerase (RdRp) plays a key role in SARS-CoV-2 viral replication. We found that SARS-COV-2 RdRp shares 98.1% of similarity with SARS-CoV RdRp while the genome similarity is only 80%. Sequence alignment of coronaviruses demonstrated higher identity among RdRps (60% – 98%) and lower identity among Spike proteins (24% – 77%). The RdRp and nucleotide-transferase (NiRAN) 3D-structures were quickly determined by modelling starting from the SARS counterpart structures. In COVID-19, three substitutions appeared in RdRp motifs with an additional hydrogen-bonding, but slight structural change shown in the finger and thumb domains. The NiRAN structure is well conserved in CoV. The sequence and structural homology among RdRp and NiRAN thus postulate them as potential drug targets to treat emerging CoVs. Main protease (Mpro), also called 3-chymotrypsin-like protease (3CL protease), plays an essential role in cleaving virus polyproteins for the functional replication complex. Therefore, Mpro is a promising drug target for COVID-19 therapy. Through molecular modelling, docking and a protease activity assay, we found four novel inhibitors targeting Mpro with the half maximal inhibitory concentration (IC50) and their binding affinities shown by the dissociation constants (KDs). Our new inhibitors CB-21, CB-25, CP-1 and LC24-20 have IC50s at 14.88 µM (95% Confidence Interval (95% CI): 10.35 µM to 20.48 µM), 22.74 µM (95% CI: 13.01 µM to 38.16 µM), 18.54µM (95% CI: 6.54 µM to 36.30 µM) and 32.87µM (95% CI: 18.37 µM to 54.80 µM)), respectively. The evaluation of interactions suggested that each inhibitor has a hydrogen bond or hydrophobic interactions with important residues, including the most essential catalytic residues: His41 and Cys145. All the r inhibitors have a much higher 50% lethal dose (LD50) compared with the wellknown Mpro inhibitor GC376, demonstrating its low toxicity. These four inhibitors can be potential drug candidates for further in vitro and in vivo studies against COVID-19.Overall, targeting RdRp and Mpro, our findings provide useful information for the research and treatment of COVID-19.

Thèse ou mémoire avec insertion d'articles / Introduction : Le programme d'immunisation contre le SARS-CoV-2, était initialement composé de deux doses de vaccins, et priorisait les groupes à risque élevé de complications de l'infection à COVID-19 tel que les patients souffrant de maladie pulmonaire obstructive chronique (MPOC). Avec l'évolution de la campagne et la recherche active dans le domaine, la campagne de vaccination québécoise a ajouté une dose de rappel en cours d'étude. Les vaccins contre le SARS-CoV-2 à vecteur viral tel que le ChAdox nCoV-19 d'AstraZeneca (Vaxzevria) ou à ARN messager tels que le BNT162b2 de Pfizer-BioNTech (Comirnaty) et le mRNA-1273 de Moderna (Spikevax) visent à générer des anticorps dirigés contre la protéine S (Spike) du virus qui est responsable de l'attachement du virus aux cellules humaines. Bien que plusieurs études d'envergure aient démontré l'efficacité de la vaccination contre la COVID-19 pour la population générale, les patients souffrant de maladie chronique comme MPOC y étaient sous-représentés. Ce manque de données était préoccupant puisque les effets indésirables et la protection n'y étaient pas bien décrits chez cette population à risque des complications sévères d'une infection à SARS-CoV-2. Objectifs : Les objectifs de cette étude étaient de décrire la réponse vaccinale chez les patients MPOC au Québec notamment quant à la sécurité (exacerbations, réactions locales et systémiques), l'efficacité (sérologie des anticorps anti-S pour la vaccination) et le portait de la vaccination (vaccin reçu et la réception ou non d'une 3ᵉ dose). Devis : Compte tenu du peu de données sur le phénomène d'intérêt, un devis d'étude descriptive quantitative de type enquête descriptive longitudinale a été utilisé. Méthodologie : L'échantillonnage a été effectuée de manière non-probabiliste intentionnelle au sein des 415 patients de la clinique MPOC de l'IUCPQ. Sur les 415 patients de la clinique, 407 ont acceptés d'être vaccinés, et 327 ont participé au projet de recherche. Sur les 327 patients de l'étude, 191 ont eu des prélèvements sanguins. La collecte de données a débuté à la fin du mois de février 2021 et s'est terminée au mois de juin 2022. La collecte de données a été effectuée à l'aide de questionnaires téléphoniques standardisés avec des questions directes et à l'aide de prises de sang, de sérologies et d'immunodosage des anticorps dirigés contre la protéine S par chimiluminescence par les machines Abbott et Siemens. Les données ont été analysées de manière bivariée et multivariée, et à l'aide de modèles linéaires mixtes. Ces analyses visaient à déterminer l'influence de différentes variables sur l'intensité de la réponse vaccinale. Résultats : Au terme de la collecte de données, la majorité des deux premières doses de vaccins administrées était composée de deux doses de BNT162b2. La majorité des patients de l'étude (283/312; 90,7%) a reçu une 3ᵉ dose. La majorité des 3ᵉ dose administrées était du mRNA-1273. Plus d'effets indésirables ont été rapportés après la 2ᵉ dose de vaccin. Les plus fréquents effets indésirables observés étaient la douleur au site d'injection chez 47,4% des patients après la 1ᵉʳᵉ dose et 64,5% après la 2ᵉ dose, et la fatigue chez 23,7% des patients après la 1ᵉʳᵉ dose et 34,5% après la 2ᵉ dose. Le risque d'exacerbations était augmenté de manière statistiquement significative dans les 2 semaines suivant la vaccination des doses additionnelles, 2ᵉ et 3ᵉ, lorsque comparé à la première dose. Ce risque montait à 0,2480 exacerbation/patient-année dans les deux semaines après la 1ᵉʳᵉ dose, 0,7439 après la 2ᵉ dose et 0,6999 après la 3ᵉ dose. Concernant l'efficacité des deux premières doses seulement, l'âge supérieur à 70 ans et la réception d'une ou deux doses de vaccins non à ARNm prédisaient des niveaux anticorps anti-S inférieurs, et le sexe féminin et l'utilisation de corticostéroïdes inhalés tendaient à avoir des niveaux d'anticorps plus élevés que les hommes et les non-utilisateurs de corticostéroïdes inhalés, respectivement. La quasi-totalité des patients MPOC (99,7%) ont développé une réponse sérologique dépassant le seuil de protection établi par le fabricant du test utilisé pour le dosage des anticorps après 1 an. L'utilisation de corticostéroïdes inhalés et une histoire d'infection à la COVID-19 semblaient augmenter les niveaux d'anticorps observés tandis qu'un âge supérieur à 70 ans et la réception d'au moins un vaccin non à ARNm semblaient diminuer ces changements. Les autres variables indépendantes observées tel que le sexe, la corticodépendance, le score de Charlson, l'IMC, le statut tabagique, le VEMS, la classification GOLD, le score CAT et l'administration ou non d'une 3ᵉ dose de vaccin n'étaient pas associées à une différence statistiquement significative d'anticorps anti-S au suivi à un an. Conclusion : Bien que la majorité des patients MPOC de l'étude a développé des niveaux d'anticorps suffisant au suivi après la 2ᵉ dose de vaccin et au suivi à 1 an, un âge avancé et/ou supérieur à 70 ans, la réception d'au moins un vaccin non à ARNm et la non-utilisation de corticostéroïdes inhalés étaient associés à une moins bonne réponse sérologique selon les deux études. Les effets indésirables les plus fréquents étaient la fatigue et la douleur au site d'injection, et leur fréquence chez les patients MPOC de cette étude semblaient être moindre que chez le reste de la population âgée de plus de 55 ans présentée dans les études de mRNA-1273 et BNT162b2. Le risque d'exacerbations était augmenté de manière statistiquement significative dans les 2 semaines suivant la vaccination des doses de rappel. Le risque d'exacerbation était supérieur dans les deux semaines suivant l'administration de la 2ᵉ dose de vaccin. / Introduction: The Quebec SARS-Cov-2 vaccination campaign, originally consisting of 2 shots of vaccine, prioritized groups at high risk of developing severe SARS-CoV-2 infection such as elderly people or those suffering from chronic diseases as chronic obstructive pulmonary disease (COPD). With multiple studies published and constant new data brought to light, the campaign recommended a third and booster shot of vaccine while this study was on-going. The vaccines target the spike protein (S-protein), responsible of the attachment of the virus to the human cell, by using viral vector-based vaccine such as AstraZeneca's Vaxzevria, and RNA vaccines such as Pfizer-BioNTech's Comirnaty (BNT162b2) and Moderna's Spikevax (mRNA-1273). The vulnerability of patients with COPD to SARS-CoV-19 makes it important to document the effectiveness and the security of the COVID-19 vaccines. However, data regarding the safety and efficacy of COVID-19 vaccination in patients with COPD patients is lacking. Objectives: This study aims to describe the response to COVID-19 vaccination in patients with COPD by assessing its safety profile (exacerbations, local and systemic side effects) and efficacy (serum anti-S antibodies). Methods: Data collection started in February 2021 and ended in June 2022. Patients were recruited from the IUCPQ COPD clinic having 415 patients. Standardized phone interviews were used to collect information about the safety of the vaccines. Immunization status against SARS-CoV-2 was assessed using a commercially available immunoassay (Siemens, Dimension Vista 1500; COV2T assay) that quantifies IgG and IgM against the spike (S) protein. To differentiate between natural and vaccine-related immunity, an immunoassay (Architect i2000; Abbott system; SARS-CoV-2 IgG assay) measuring IgG directed against nucleocapsid (N) protein was conducted. Statistical analysis was done to identify factors predicting lower serologic responses. Results: The most frequent vaccine combination administered consisted in two shots of BNT162b2. Most patients (90.7%) received three shots of COVID-19 vaccine, the third being mostly mRNA-1273. More adverse effects were reported after the second dose of vaccine than after the first one. The most frequent local and systemic adverse effects reported were pain in 47.4% of the patients and fatigue in 23.7% after the first dose. Pain was observed in 64.5% of the patients and fatigue in 34.5% after the second dose. A higher exacerbation risk was observed in the 2-week period following the booster shots, amounting to 0.7439 exacerbation/patient-year after the second dose and 0.6999 after the third dose compared to 0.2480 exacerbation/patient-year during the 2-week period following the first dose vaccination. When looking at the efficacy of the first two shots only, old age (above 70 years old), and having at least one non-mRNA vaccine predicted lower anti-S antibodies levels, while female sex, and inhaled corticosteroids (ICS) use tended to have higher anti-S antibodies level than males and non-ICS users. Most COPD patients reached the manufacturer's proposed anti-S antibodies threshold indicating immunity one year after the first dose administration. An advanced age (patient aged over 70 years-old) and a combination other than two RNA vaccines were associated to a lower antibody response, while ICS use and a positive history infection to COVID-19 predicted a higher response. The remaining independent variables including sex, corticodependence, Charlson score, BMI, smoking status, FEV1, GOLD classification, CAT score and a third dose administration were not statistically associated with the anti-S protein change in this one-year study. Conclusion: Most patients with COPD involved in this study showed adequate anti-S antibodies levels after the second dose of vaccines and one year after the administration of the first dose. However, being older than 70 years, having at least one non-mRNA vaccine and not using ICS were associated to lower serum anti-S antibodies levels. The most frequent side effects reported by patients with COPD after COVID-19 vaccination were fatigue and pain at the injection site. When compared to general population aged over 55 years old who received mRNA vaccines, the frequencies of these adverse effects were lower in COPD patients. Furthermore, the risk of COPD exacerbation was significantly increased during the 2-week period following the booster shots of vaccine, second and third, being highest after the second shot.

Yes