'I Just Never Wanted Them to Feel Uncomfortable -Barriers to Pharmacy-Based Identification and Treatment of Hepatitis C in Victoria, British Columbia

Background: Canada is currently on target to reach the 2030 WHO goal of HCV elimination. Continued high rates of treatment initiation are required to meet this goal. Novel models such as Tayside, Scotland pharmacy-based HCV screening and treatment have proven successful to engage people who use drugs (PWUD) in HCV therapy with a simplified, task-shifted cascade of care. This study seeks to determine whether these successes can be replicated at community pharmacies in Victoria BC. Method(s): Four community pharmacies known to work with PWUD and provide opioid agonist therapy (OAT) were trained to provide consent and perform point of care HCV antibody screening and given a standardized tool kit of resources. They were supported by a study nurse to link to HCV RNA testing when antibody positive patients were identified, with initiation of HCV treatment offered to those found to be RNA positive. Qualitative interviews were conducted with five pharmacy staff to explore their experiences with HCV testing and treatment and the feasibility of pharmacists in HCV care cascade. Result(s): Pharmacy staff completed 200 HCV OraQuick tests: 64 tested positive for HCV antibodies: 26 people were HCV RNA negative, 23 previously treated and 3 self-cleared, 2 bloodwork is pending. Of the 26 RNA positive participants, 2 are pending treatment start, 24 people have started treatment, with 12 achieving SVR. While treating identified people has been successful, less than half of projected OraQuick tests have been completed. Although the onset of the Covid 19 pandemic was a fundamental barrier incorporating HCV testing at pharmacies, stigma related to HCV and illicit drug use continues to impact this process. Pharmacists described feeling hesitant about approaching participants, especially after receiving negative responses from clients about HCV testing. Some worried their relationship would change with clients as asking about HCV implied risky drug use. Conclusion(s): This innovative pharmacy-based approach found people with limited connection to primary health care to test and treat HCV but requires more training and support to be more widely feasible.

COVID-19

When most of the world went into lockdown in 2020 due to the Covid-19 pandemic, theatres closed and audiences were reconfigured. The so-called ‘pivot to online’ affected organisations and their audiences in different ways, with institutions that had already invested in digital transmission infrastructure and skills more able to take advantage of the pivot, commanding audiences if not always revenue. This Short asks how we understand, construct and value audiences in uncertain times. How does a repositioning of the global and the local open access to arts and culture but also introduce a new kind of competition? © 2022 selection and editorial matter, Matthew Reason, Lynne Conner, Katya Johanson, Ben Walmsley.

Using quality improvement to develop transition to adult care at a UK cystic fibrosis (CF) centre

Objective: Following the creation of a quality improvement (QI) lead in the Oxford adult CF service, key areas for development were identified. Increased use of virtual care and CFTR modulators highlighted a need to adapt our transition process to meet the changing needs of young people with CF (pwCF). Our aim was to facilitate collaboration across adult and paediatric teams to identify areas for improvement. Method: We led a process of stakeholder engagement including meeting with other CF and non-CF transition services. Multidisciplinary Team (MDT) QI meetings were held within the adult service to identify whatwas considered a successful transfer of care. We observed the first in-person transition clinic since the pandemic, and distributed electronic surveys of the clinic experience to pwCF, carers, and staff. Lastly, we held a virtual cross-service QI meeting to present findings, aiming to reach consensus on areas for change. Results: 5/5 pwCF and 5/5 carers completed the clinic surveys. Both identified their main priorities: to meet the adult team and receive a clinical review. Comments identified anxiety discussing future life plans too young or repetitively. 3/5 pwCF and 3/5 carers preferred the carer to be present throughout the visit. 7/9 staff completed the survey. There was general agreement of clinic objectives that 6/7 felt were met. Comments were around clinic location, pre-meeting, and coordinating MDTreviewcontent. Holding a face-to-face clinic was perceived as important. Overall, the MDTs agreed on 5 areas for improvement: documentation;patient information;clinic meetings;individual profession handovers;and identifying pwCF requiring bespoke transition. Conclusion: Protected time for QI provided a forum to bring paediatric and adult CF teams together to identify shared priorities for improvement of local transition care. A QI lead role has allowed us to drive service development during the COVID-19 pandemic and introduction of CFTR modulators.

“Like what? You think I have that?”-Impact of stigma on pharmacy-based identification and treatment of hepatitis C in Victoria, British Columbia

Background and aims: Canada is currently on target to reach the 2030 WHO goal of HCV elimination. Continued high rates of treatment initiation are required to meet this goal. Novel models have proven successful to engage populations who use drugs (PWUD) in HCV therapy with a simplified, task-shifted cascade of care: Tayside, Scotland pharmacy-based HCV screening and treatment has demonstrated excellent outcomes and progress towards local HCV elimination. The EPIC Study seeks to determine whether pharmacybased treatment successes can be replicated at community pharmacies in Victoria BC. Method: Four community pharmacies known to work with PWUD and provide opioid agonist therapy (OAT) were provided training sessions to equip staff with a standardized tool kit of resources. In fall 2020, pharmacy staff were trained to provide verbal informed consent and perform point of care HCV OraQuick antibody screening. Pharmacies were supported by a study nurse to link to HCV RNA testing when antibody positive patients were identified, with initiation of HCV treatment offered to those found to be RNA positive. (Figure Presented) Figure: (: THU296): Antibody responses after the COVID-19 vaccination in patients with AILD and healthy controls. (A-B) The seropositivity rate (A) and titers (B) of anti-RBD-IgG in patients with AILD and healthy controls. (D-E) The seropositivity rate (D) and titers (E) of NAbs in patients with AILD and healthy controls. The distribution of anti-RBD-IgG (C) and NAbs (F) antibody titers over time in patients with AILD and healthy controls. AILD, autoimmune liver disease;anti-RBD-IgG, spike receptor-binding domain IgG antibody;NAbs, neutralizing antibodies. The study nurse worked with pharmacy staff to strategize adherence and support as needed by study subjects. Qualitative interviews have been conducted with five pharmacy staff to explore their experiences with testing and monitoring HCV treatment and the feasibility of involving pharmacists in the HCV care cascade. Results: To date pharmacy staff completed 171 HCV OraQuick tests finding 53 tested positive for HCV antibodies: 23 people were HCV RNA negative, (20 previously treated and 2 self-cleared), 8 unk/LTF. Of the 22 RNA positive participants, 1 is pending treatment start, 21 people have started treatment, with 8 achieving SVR. While great success has been achieved in treating identified people, less than half of projected OraQuick tests have been completed. Although the onset of the Covid 19 pandemic was a fundamental barrier incorporating HCV testing at pharmacies, stigma related to HCV and illicit drug use continues to impact this process. Pharmacists described feeling hesitant about approaching participants, especially after receiving negative responses from clients about HCV testing. Some worried their relationship would change with clients as asking about HCV implied risky drug use. Conclusion: This innovative and novel approach to HCV therapy in PWUD attempted to use a pharmacy-based approach to find people with limited connection to primary health care to test and treat HCV. Increased training of pharmacy staff related to stigma around drug use and HCV is required both before and ongoing for successful integration of pharmacy-led HCV testing and treatment in Canada.

Assessment of Healthcare Professionals' Wellbeing During a Peak of the COVID-19 Pandemic in the United States

Methods: Healthcare professionals were invited to participate across the University Hospitals healthcare system in Ohio, USA. Participants (N = 6397) completed online questionnaires on their wellbeing, including healthy behaviors, safety and security, mental and physical health concerns, and social support. Differences in wellbeing across demographics were also assessed. Results: Overall, healthcare professionals' mean subjective wellbeing was 7.98 (1.50) and their future health score was 3.98 (1.13). Room for improvement was noted for diet, sleep, and positive thinking. Males reported significantly higher levels of overall wellbeing and future health scores, including fruit and vegetable intake and physical activity, and alcohol use, whereas females reported higher levels of positive thinking and tobacco use. Of the three largest racial groups, White and Asian employees scored significantly higher on future health, M = 4.00 (1.17) and M = 4.10 (1.13), than Black or African American employees, M = 3.74 (1.10). Background: The purpose of this cross-sectional study was to evaluate multiple indices of wellbeing in healthcare professionals during the COVID-19 pandemic. Conclusion: This cross-sectional study assessed the wellbeing of healthcare workers during the initial peak of the COVID-19 pandemic prior to vaccine delivery. Future work will implement strategies to improve healthcare workers' wellbeing in an individualized way based on our findings, as well as evaluate changes in wellbeing and future health scores across time.

COVID-19 Impact on Poultry Production and Distribution Networks in Bangladesh

The COVID-19 pandemic has severely affected numerous economic sectors across the world, including livestock production. This study investigates how the pandemic has impacted the poultry production and distribution network (PDN), analyses stakeholders' changing circumstances, and provides recommendations for rapid and long-term resilience. This is based on a literature review, social media monitoring, and key informant interviews (n = 36) from across the poultry sector in Bangladesh. These included key informants from breeder farms and hatcheries, pharmaceutical suppliers, feed companies, dealers, farmers, middlemen, and vendors. We show that the poultry sector was damaged by the COVID-19 pandemic, partly as a result of the lockdown and also by rumors that poultry and their products could transmit the disease. This research shows that hardly any stakeholder escaped hardship. Disrupted production and transportation, declining consumer demand and volatile markets brought huge financial difficulties, even leading to the permanent closure of many farms. We show that the extent of the damage experienced during the first months of COVID-19 was a consequence of how interconnected stakeholders and businesses are across the poultry sector. For example, a shift in consumer demand in live bird markets has ripple effects that impact the price of goods and puts pressure on traders, middlemen, farmers, and input suppliers alike. We show how this interconnectedness across all levels of the poultry industry in Bangladesh makes it fragile and that this fragility is not a consequence of COVID-19 but has been revealed by it. This warrants long-term consideration beyond the immediate concerns surrounding the COVID-19 pandemic. © Copyright © 2021 Sattar, Mahmud, Mohsin, Chisty, Uddin, Irin, Barnett, Fournie, Houghton and Hoque.

Delivering quality improvement coaching in a virtual world: the use of digital technology to empower and engage CFDigiCare clinicians to undertake quality improvement activities nationally

Background: CFDigiCare is a community of practice using digital adherence data, FEV1 and BMI to inform clinical decision-making and comprehensive digital behaviour change tools to support patient self-care. The 16 UK adult CF centres that form CFDigiCare work together using improvement science to embed digital data into routine care. The collaborative uses the Dartmouth Microsystems approach to build quality improvement (QI) capability Most CFDigiCare teams attended a one-day class-based QI training pre-COVID-19, with subsequent coaching delivered online. We discuss digital QI refresher training and coaching to the nationally dispersed improvement collaborative during the COVID crisis. Methods: 1-hour QI refresher training was delivered via MS Teams. Dartmouth improvement ramp activities were undertaken during subsequent 3 sessions. Results: Average attendance was 9. We explored two areas for improvement, teams participated in group ‘Fishbone’ exercises, silent brainstorming, discussed change ideas and planned PDSA cycles. Staff rated the meetings 9.4/10, commenting: • Useful QI demonstration and collaboration of ideas • Jamboard is a useful tool for gathering ideas • Can deliver it to the team • Good feedback for PDSAs Attendance was high with staff valuing practical interactive sessions using facilitated MS Teams calls and tools such as Google Jamboard. Virtual sessions connected clinicians from 16 centres providing a national “hive brain” perspective on system optimisation. The Dartmouth microsystems paradigm focused attention on specific aims, providing a structure to deliver iterative change. Virtual connectivity allowed QI to continue despite COVID-19. Familiarity with MS Teams increased over time with shared mastery of the technology a clear improvement outcome. Conclusion: Digital technology not only supports the delivery of QI training and coaching but can enhance it;clinical teams quickly mastered platforms such as MS Teams and Google Jamboard.

Development of an organotypic tonsil epithelium model to investigate tonsillitis

Introduction/Aim: The tonsils are a secondary lymphoid organ uniquely located at the back of the oropharynx, where they are believed to play an important role in immune surveillance and mucosal immunity. Several pathogens are known to target the tonsils during infection, such as Group A Streptococcus, Epstein-Barr virus, human rhinovirus, respiratory syncytial virus and SARS-CoV2. Most research has been conducted in cell lines which are likely poor models of terminally-differentiated in vivo tissues, or explanted tissue obtained during tonsillectomy, which are unlikely to model the epithelium from healthy individuals. This study aimed to develop an organotypic in-vitro model of this organ to study pathogen-tonsillar interactions. Methods: Primary human tonsil epithelial cells were co-cultured with fibroblasts embedded in a matrix of Matrigel and/or collagen on transwell inserts under a variety of experimental conditions. All inserts were grown at air liquid interface (ALI) for 15 days before being fixed for histological sectioning, immunocytochemical staining, scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Results: We established optimal culture conditions to differentiate primary tonsil epithelial cells into a stratified squamous epithelium that resembled the in vivo tonsil epithelium as observed by H&E staining, immunocytochemistry with CD44, MUC1 and CK13, SEM and TEM. The degree of differentiation was highly dependent on culture conditions. Conclusion: This study has successfully established a robust and reproducible experimental system to produce an organotypic tonsil epithelium model. Establishing such a model will facilitate research into pathogen-host interactions for this organ and advance research into how these interplay with the development of upper and lower airway infections and airway disease.

Persistent COVID-19-associated neurocognitive symptoms in non-hospitalized patients.

As cases of coronavirus disease 2019 (COVID-19) mount worldwide, attention is needed on potential long-term neurologic impacts for the majority of patients who experience mild to moderate illness managed as outpatients. To date, there has not been discussion of persistent neurocognitive deficits in patients with milder COVID-19. We present two cases of non-hospitalized patients recovering from COVID-19 with persistent neurocognitive symptoms. Commonly used cognitive screens were normal, while more detailed testing revealed working memory and executive functioning deficits. An observational cohort study of individuals recovering from COVID-19 (14 or more days following symptom onset) identified that among the first 100 individuals enrolled, 14 were non-hospitalized patients reporting persistent cognitive issues. These 14 participants had a median age of 39 years (interquartile range: 35-56), and cognitive symptoms were present for at least a median of 98 days (interquartile range: 71-120 following acute COVID-19 symptoms); no participants with follow-up evaluation reported symptom resolution. We discuss potential mechanisms to be explored in future studies, including direct viral effects, indirect consequences of immune activation, and immune dysregulation causing auto-antibody production.

From public good to public value: arts and culture in a time of crisis

This paper argues that the crisis sweeping over the Australian cultural sector as a result of COVID-19 presents an existential threat to current (“normal science”) methods of evaluation, and to instrumental, predominantly economic, understandings of value. Outlining ways the concept of value is changing, we respond to Mariana Mazzucato’s call to go “from public goods to public value” in considering the role of government policy in key sectors of society. We note the broader approach to value called for by a range of mainstream economists and provide three recent examples of challenges to existing evaluation methods in the Australian cultural sector. In conclusion, we touch on the essential features of a re-constructed category of public value and the implications for value research. During COVID-19, the public role of arts and culture has become self-evident. The challenge is to match this realization with a new understanding of their public value. © 2020 Informa UK Limited, trading as Taylor & Francis Group.