Did virtual consultations during Covid-19 improve diabetes transition clinic attendance compared to face to face clinic attendance

We have an established transition clinic for the patients with diabetes aged 16 to 19. Our Transition clinic covers a vast area including deprived areas such as Ellesmereport. We do have 3 monthly follow up in addition to the home visits by paedatric diabetes specialist nurses. The team involves paediatric consultants, pdsn and dietcician from adult and paedatrics departments. Virtual consultation were the main mode of consultations during covid. We used Accu Rx, Attendanywhere and telephone consultations. We compared the clinic attendance pre and post covid. We compared clinic attendance for 9 months from March 2019 to December 2019 which were pre Covid to March 2020 to December 2020 during Covid. We had 150 appointments in 2019 and 112 appointments in 2020. The DNAs were 21 during covid with virtual consultations and 28 pre Covid with face to face appointments. The DNA rates were 18.6% in 2019 as face to face review and 18.75% during covid as virtual consultations. Surprisingly, the DNA rates did not improve when the clinics were virtual as we expected. In Conclusion, the virtual consultations did not improve the attendance in this vulnerable age group. Due to vulnerability of this age group, we felt that the face to face consultations were more appropriate. All of our appointments for the diabetes transition clinics are face to face in person due to above findings.

Women's Lives: A PSYCHOLOGICAL EXPLORATION, Fifth Edition

Women's Lives integrates the most current research and social issues to explore the psychological diversity of girls and women varying in age, ethnicity, social class, nationality, immigrant experience, sexual orientation, gender identity, ableness and body size and shape. The text embeds a lifespan perspective within each topical chapter and has an intersectional approach that integrates women's diverse identities. It includes rich coverage of women with disabilities and on middle-aged and older women throughout. Taking a deeper transnational focus, it also examines the impact of social, cultural, and economic factors in shaping women's lives around the world. This edition explores the latest areas of research and tackles important contemporary topics such as: • feminization of immigration • media portrayals of LGBTQ individuals and immigrants • regulating testosterone levels in women's sports;disorders of sexual development;nonbinary identity • the effects of social media on body image;sizeism • new classification of sexual disorders • menstrual equity and the "tampon tax” • migrant women as transnational mothers • academic environment for low-income, ethnic minority, and immigrant women • effects of the COVID-19 pandemic on women's employment and work-family balance • the dilemma of unpredictable work hours • healthcare barriers experienced by immigrant women and LGBTQ individuals • #MeToo movement;vigilante gender violence • the fourth wave of feminism • the role of immigrant women and ethinc minority women in grassroots feminist activism • men's support of feminist issues and more Boasting a new full-color design and rich with pedagogy, the book includes several boxed elements in each chapter. "In The News” boxes present current news items designed to engage students in thinking critically about current gender-focused events and issues. The "What You Can Do” boxes give students examples of applied activities that they can engage in to promote a more egalitarian society. "Get Involved” boxes ask students to collect data and to critically think about the explanations and implications of the activity's findings. "Learn About the Research” boxes expose students to a variety of research methods and highlight the importance of diversity in research samples by including studies of underrepresented groups. At the end of each chapter, "What Do You Think” questions foster skills in critical thinking, synthesis, and evaluation by asking the student to apply course material or personal experiences to provocative issues from the chapter. The "If You Want to Learn More” feature provides names of the most current books available on various topics that are discussed in the chapter. Combining up-to-date research with an approachable and engaging writing style, Women's Lives is an invaluable resource for all students of gender from psychology, women's studies, gender studies, sociology, and anthropology. © 2023 Taylor and Francis.

Impact of Influenza Virus and E-cigarette Vaping Pre-Exposures on Outcomes of SARS-CoV-2 Infection in Hamster

Rationale. Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the third leading cause of death in the United States. While many risk factors for severe COVID-19 are emerging, the effects by which other inhalational exposures affect susceptibility are not well defined. Patients with COVID-19 demonstrate high rates of co-infection with respiratory viruses, including influenza A (IAV). When infected with IAV, human small airway epithelial cells (SAEC) exhibit increased abundance of angiotensin-converting enzyme 2 (ACE2), the primary receptor for SARS-CoV-2. However, it remains unknown if this effect increases the risk for COVID-19. Similarly, there are conflicting reports of the effect of e-cigarette (E-cig) vaping on COVID-19 manifestations. We hypothesized that exposures to IAV or E-cig increase the severity of SARS-CoV-2 infection. Methods. Golden Syrian hamsters (male and female) were exposed to E-cig vapor via nebulization for 5d. IAV was administered intranasally once on day 6 (A/California/07/2009 H1N1, 106 PFU/hamster). On day 3 post-IAV infection, SARSCoV- 2 was administered intranasally (WA01;104 PFU/hamster). On day 7 post-SARS-CoV-2 infection animals were sacrificed, bronchoalveolar lavage fluid (BALF) cell differentials were obtained, and inflated lung sections were stained and scored for immunohistology. Lung RNA was quantified for ACE2, TMPRSS2, STAT1, CXCL10, IFN-gamma, gene expression using RT-qPCR. Results: SARS-CoV-2 infection caused progressive weight loss that was less pronounced in animals pre-infected with IAV. SARS-CoV-2 titers from nasal swabs peaked at day 2 in both groups. IAV pre-infection reduced PMN and eosinophils in the BALF, and the overall inflammatory cell infiltration in the lung parenchyma of SARS-CoV-2-infected animals. IAV pre-infection reduced lung levels of STAT1, CXCL10 (2.5-fold;p<0.01), CCL5, and IFN-gamma in SARS-CoV-2-infected animals compared to animals that were only infected with SARS-CoV-2. Pre-exposure to E-cig worsened the SARS-CoV-2-induced weight loss in female animals only. E-cig pre-exposure increased lymphocytes and decreased PMN and eosinophils in the BALF compared to animals that were only infected with SARS-CoV-2. E-cig pre-exposure increased lung levels of STAT1, CXCL10 (2.5-fold;p<0.05), CCL5, and IFN-gamma in SARS-CoV-2-infected animals compared to animals that were only infected with SARS-CoV-2. Conclusion: Pre-infection with IAV resulted in decreased inflammatory response to SARS-CoV-2 infection. In contrast, pre-exposure to E-cig vaping increased the severity of the inflammatory response to SARS-CoV-2 with notable differences between sexes. Whereas anti-viral priming effects of prior viral infection are well described, the mechanisms that explain the worsening effects of E-cig on SARS-CoV-2 outcomes remain unknown.

Patient preferences for health information technologies: A systematic review

Background: Advances in patient-facing health information technology (HIT) promise to improve health care delivery and patient outcomes. Low utilization of HIT suggests that the preferences of patients may not be adequately guiding the development of these technologies. This systematic review offers an assessment of published evidence regarding patient preferences for HIT. Methods: Articles addressing preferences for HIT from patient and other end-user groups published up through 2020 were identified from PubMed, Web of Science, Scopus and via hand searching. Articles that used quantitative stated-preference methods to explore preferences for HIT were eligible for inclusion. Studies that explored attitudes towards HIT without eliciting trade-offs were excluded. Critical appraisal of study quality was conducted using the PREFS checklist and quality criteria identified by the US Food and Drug Administration including heterogeneity analysis and patient engagement in study design. We conducted thematic analysis of the main preference findings from each study to synthesize patient and enduser preferences for HIT. The review was not registered and authors received no funding to conduct the review. Results: The search yielded 7,299 unique articles, 59 of which were ultimately included in the review. Studies explored preferences for telemedicine (n=30), patient portals (n=12), mHealth (n=9) or multiple HITs (n=8). Preference elicitation methods included direct elicitation (n=26), discrete-choice experiments (n=13), conjoint analysis (n=6), contingent valuation (n=5), and ranking exercises (n=9). Studies had a mean PREFS score of 3.51 out of 5. Forty-two studies conducted preference heterogeneity analysis and only 20 included patients in study design. Thematic meta-analysis indicated that patients prefer HIT that is convenient and lower cost, but does not sacrifice quality, and preferences varied by demographic features such as age as well as depending on the type of health information being communicated. Conclusions: Patient and end-users have distinct preferences for the use of HIT in their medical care. It is timely that researchers and healthcare administrators consider these preferences for HIT given its rapid uptake amidst the COVID-19 pandemic. Although this literature demonstrates that patients can be engaged as participants in preference studies to identify meaningful aspects of HIT, the field was limited in its inclusion of patients in the design of such studies. Future development of HIT should be guided by high-quality preference research that integrates patients in all stages in the design and implementation of HIT. © Journal of Hospital Management and Health Policy. All rights reserved.

Dock8 mutations in covid-19 and mis-c cytokine storm syndrome

Background: We recently identified DOCK8 as a novel gene associated with cytokine storm syndrome (CSS)1. Heterozygous missense mutations in DOCK8 diminish NK cell lytic function and contribute to increased pro-inflammatory cytokine production (CSS). CSS is a potential complication of COVID-19 with severe consequences2. Children are at risk of a SARS-CoV-2 post-infectious CSS, multisystem inflammatory syndrome in children (MIS-C)3. Host genetic factors associated with COVID-19 CSS and MIS-C CSS are unknown. Objectives: The goals are to identify and functionally study rare mutations in DOCK8 in patients with SARS-CoV-2 COVID-19 and MIS-C. Methods: To date, 16 adult patients enrolled in a COVID-19 CSS clinical trial at UAB had whole genome sequencing. Four (25%) had rare heterozygous DOCK8 mutations (3 missense, 1 intronic). A COVID-19 CSS adult patient in Seattle also had a DOCK8 missense mutation. In addition, DOCK8 missense mutations were identified in five children (UAB & Northwell) hospitalized with MIS-C. DOCK8 mutations, or wild-type (WT) sequence controls, were introduced into human NK-92 cells by FOAMY virus transduction. WT and mutant DOCK8-expressing NK-92 cells were incubated with K562 target cells and compared for cytolysis and degranulation (CD107a). Results: One COVID-19 patient DOCK8 mutation (Gly523Arg) reduced NK cell degranulation by 30% and cytolysis by 23% (n=3) (Figure 1). Similar studies of 3 MIS-C patients with DOCK8 missense mutations (Arg899Trp, Ala2Thr, Pro-687Leu) revealed up to 31% reduced NK cell degranulation and 48% reduction in cytolysis by 3 distinct mutations (n=3). Two-way ANOVA analysis revealed statistically significant (p<0.05) differences in NK cell degranulation and lysis for four unique DOCK8 mutations. Conclusion: Heterozygous DOCK8 missense mutations may contribute to severe COVID-19 and MIS-C CSS by partial dominant-negative effects yielding decreased NK cell cytolysis.

Mannose Binding Lectin (MBL) and MBL Associated Serine Protease-2 (MASP-2) Amplify SARS-CoV-2 Spike Protein Uptake and Epithelial Cell Injury during Cigarette Smoke Exposure

RationaleThe clinical syndrome associated with SARS-CoV2, known as COVID-19 is characterized by a spectrum of hypercoagulability and complement-mediated microvascular injury in severe but also in mild COVID-19 disease(1-4). Studies have demonstrated that lectin complement pathway (driven by MBL/MASP2 complex) is responsible for the complement-mediated injury via MBL binding of the SARS-CoV virion(5) and via deposition of MBL, MASP-2, and C4 seen in the skin and lung specimens of COVID-19 individuals, where SARS-CoV-2 spike protein (SP) co-localized with C4(4, 6). We hypothesize that in smokers, MBL binding to SARS-CoV-2 and MASP-2 cleavage of SP increase viral internalization with subsequent epithelial cell injury and in-situ complement activation.MethodsWe studied ACE-2 expression in lung homogenates of smokers (n=2), mild COPD (n=2), moderate and severe COPD (n=8) by western blotting and qPCR. We used A549 epithelial cells exposed to air control (AC) or CS (10%, 2h) and primary alveolar type 2 (AT2) from smokers and never-smokers to analyze ACE-2 expression by FACS and western blotting, and cell injury by western blotting before and after treatment with his-tagged SARS-CoV-2 SP (15ug/mL, 2h), recombinant human MBL (2ug/mL, 2h), and serum-derived MBL/MASP-2 complex (50% non-heat-inactivated serum). ResultsIn-vivo, CS increases ACE-2 expression in lung homogenates of smokers and COPD patients vs. healthy individuals (p<0.5). Ex-vivo, CS extract increases ACE-2 expression in A549 and AT2 epithelial cells as detected by FACS and western blotting. Moreover CS-exposed A549 epithelial cells demonstrate higher SP - ACE-2 co-localization, especially after treatment with recombinant MBL. In the presence of recombinant MBL and serum-derived MBL/MASP-2 complex we demonstrated higher co-localization of SP with MBL at the plasma membrane and higher expression of cell injury markers (RAGE, cPARP, and p62/LC3B2) of CS-exposed epithelial cells. Interestingly, transitional AT2 from smokers, expressing AT1 (Cav1) and AT2 (Muc1) markers, had the highest ACE-2 membrane expression by FACS vs. transitional AT2 from never-smokers, AT1, AT2 primary human cells. ConclusionsOur results indicate that MBL and MASP-2 of lectin pathway are linked to higher SARS-CoV-2 SP epithelial uptake and injury in smokers and COPD-ers with COVID-19 disease, suggesting that CS-induced airway inflammation and in-situ complement activation increase distal lung ACE-2 expression and AT2 injury significantly tallying airway injury in COVID-19.