Establishing SARS-CoV-2 Membrane protein-specific antibodies as a valuable serological target via high-content microscopy

The prevalence and strength of serological responses mounted towards SARS-CoV-2 proteins other than nucleocapsid (N) and spike (S), which may be of use as additional serological markers, remains underexplored. Using high content microscopy to assess antibody responses against full length StrepTagged SARS-CoV-2 proteins, we found that 85% (166/196) of unvaccinated individuals with RT-PCR confirmed SARS-CoV-2 infections and 74% (31/42) of individuals infected after being vaccinated developed detectable IgG against the structural protein M, which is higher than previous estimates. Compared with N antibodies, M IgG displayed a shallower time-dependent decay and greater specificity. Sensitivity for SARS-CoV-2 seroprevalence was enhanced when N and M IgG detection was combined. These findings indicate that screening for M seroconversion may be a good approach for detecting additional vaccine breakthrough infections and highlight the potential to use HCM as a rapidly deployable method to identify the most immunogenic targets of newly emergent pathogens. Graphical

Administrators' preparedness to address physician burnout before and during COVID-19.

Occupational burnout has become widespread. The syndrome can be especially harmful in health care settings, affecting clinicians, organizational effectiveness, and patient safety. Certain approaches have proven helpful in some cases in combatting the syndrome. The coronavirus pandemic presented physicians with unique challenges, which appeared to have magnified work stress This national survey specifically explored interventions used by health care leaders to reduce burnout and whether these interventions proved effective during a pandemic. We also discuss effective and appropriate organizational measures to reduce physician burnout and its associated risks during crises.

Self-care barriers and facilitators in older adults with T1D during a time of sudden isolation.

Older adults with type 1 diabetes (T1D) have unique challenges and needs. In this mixed-methods study, we explored the impact of isolation during a pandemic on diabetes management and overall quality of life in this population. Older adults (age ≥ 65 years) with T1D receiving care at a tertiary care diabetes center participated in semi-structured interviews during COVID-19 pandemic isolation between June and August 2020. A multi-disciplinary team coded transcripts and conducted thematic analysis. Thirty-four older adults (age 71 ± 5 years, 97% non-Hispanic white, diabetes duration of 38 ± 7 years, A1C of 7.4 ± 0.9% (57.3 ± 10.1 mmol/mol) were recruited. Three themes related to diabetes self-care emerged regarding impact of isolation on: (1) diabetes management and self-care behaviors (how isolation prompted changes in physical activity and dietary habits); (2) emotional stress and anxiety (related to isolation and lack of support system, economic concerns); and (3) concerns regarding the COVID-19 pandemic (impact on timely medical care and access to information). Our findings identify modifiable barriers and challenges faced by older adults with T1D during isolation. As this population has a higher risk of decline in physical and psychosocial support even during non-pandemic times, clinicians will benefit from understanding these issues to improve care of this population.

Thinking about developing business leadership for the post-COVID world

PurposeThe purpose of this paper is to provide an overview of a successful model on how to prepare business students to be successful in a new, post-pandemic world that faces enormous social challenges.Design/methodology/approachThe article discusses the current business and social movements that suggest the relevance of social entrepreneurship and explain the pedagogical model developed at the Center for Nonprofits at Sacred Heart University.FindingsThe article suggests how this pedagogical model may provide students with the skills, attitudes and values required for successful social entrepreneurship processes.Research limitations/implicationsThe article presents the current picture which will undoubtedly change over time. Thus the context is time constrained. The article presents one model to develop leaders' skills. There are many other models and experiences that should be considered and evaluated.Practical implicationsThe case explains a key initiative that can help universities improve pedagogical tools on building students' social entrepreneurship skills and extend this impact to their success in the post-pandemic environment and impact on surrounding communities.Social implicationsThere is a growing need for business leaders to have sophisticated business skills and purpose beyond financial profit. The article looks at the dual roles of social entrepreneurs as a model for the leaders and the Nonprofit Center at Sacred Heart University to develop the skills of the future leaders.Originality/valueThe article presents a new vision of the skills necessary for a leader in today's environment. It draws from the literature on social entrepreneurship. It also presents one model that has been successful for 15 years and the pedagogical underpinnings of that model.

Telehealth in cancer care during the COVID-19 pandemic.

INTRODUCTION: The Victorian COVID-19 Cancer Network (VCCN) Telehealth Expert Working Group aimed to evaluate the telehealth (TH) experience for cancer patients, carers and clinicians with the rapid uptake of TH in early 2020 during the COVID-19 pandemic. METHODS: We conducted a prospective multi-centre cross-sectional survey involving eight Victorian regional and metropolitan cancer services and three consumer advocacy groups. Patients or their carers and clinicians who had TH consultations between 1 July 2020 and 31 December 2020 were invited to participate in patient and clinician surveys, respectively. These surveys were opened from September to December 2020. RESULTS: The acceptability of TH via both video (82.9%) and phone (70.4%) were high though acceptability appeared to decrease in older phone TH users. Video was associated with higher satisfaction compared to phone (87.1% vs 79.7%) even though phone was more commonly used. Various themes from the qualitative surveys highlighted barriers and enablers to rapid TH implementation. DISCUSSION: The high TH acceptability supports this as a safe and effective strategy for continued care and should persist beyond the pandemic environment, where patient preferences are considered and clinically appropriate. Ongoing support to health services for infrastructure and resources, as well as expansion of reimbursement eligibility criteria for patients and health professionals, including allied health and nursing, are crucial for sustainability.

Use of Telecommunication and Diabetes-Related Technologies in Older Adults With Type 1 Diabetes During a Time of Sudden Isolation: Mixed Methods Study.

BACKGROUND: The COVID-19 lockdown imposed a sudden change in lifestyle with self-isolation and a rapid shift to the use of technology to maintain clinical care and social connections. OBJECTIVE: In this mixed methods study, we explored the impact of isolation during the lockdown on the use of technology in older adults with type 1 diabetes (T1D). METHODS: Older adults (aged ≥65 years) with T1D using continuous glucose monitoring (CGM) participated in semistructured interviews during the COVID-19 lockdown. A multidisciplinary team coded the interviews. In addition, CGM metrics from a subgroup of participants were collected before and during the lockdown. RESULTS: We evaluated 34 participants (mean age 71, SD 5 years). Three themes related to technology use emerged from the thematic analysis regarding the impact of isolation on (1) insulin pump and CGM use to manage diabetes, including timely access to supplies, and changing Medicare eligibility regulations; (2) technology use for social interaction; and (3) telehealth use to maintain medical care. The CGM data from a subgroup (19/34, 56%; mean age 74, SD 5 years) showed an increase in time in range (mean 57%, SD 17% vs mean 63%, SD 15%; P=.001), a decrease in hyperglycemia (>180 mg/dL; mean 41%, SD 19% vs mean 35%, SD 17%; P<.001), and no change in hypoglycemia (<70 mg/dL; median 0.7%, IQR 0%-2% vs median 1.1%, IQR 0%-4%; P=.40) during the lockdown compared to before the lockdown. CONCLUSIONS: These findings show that our cohort of older adults successfully used technology during isolation. Participants provided the positive and negative perceptions of technology use. Clinicians can benefit from our findings by identifying barriers to technology use during times of isolation and developing strategies to overcome these barriers.

Through a Screen Darkly: by Ahron Friedberg and Sandra Sherman, Abingdon, Routledge, 2021, 182 pp., £96 (hb), £19.99 (pb), ISBN 9780367771515 (hb), 9780367764043 (pb), 9781003169994 (ebook)

With his patient Bethany, Friedberg learnt that ([2], p. 83) 'COVID-19 was a license, as it were, to manipulate reality .... Conventions didn't matter. I find myself haunted by Bosch", who (2021:84) 'found truths around corners .... So, I am inclined to give Bernadine a pass' The sequence about Bernadine and Bosch exemplifies the book. His patients are discussed in colloquial, chatty, conversational mode, but sometimes, Friedberg's wisdom in relation to the case studies takes us down interesting paths. [Extracted from the article] Copyright of Psychodynamic Practice is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Advanced imaging of disease unrelated to the coronavirus disease 2019 (COVID-19) during the pandemic: effect of patient demographics in a pediatric emergency department.

BACKGROUND: Coronavirus disease 2019 (COVID-19) disproportionately affected children from underrepresented minorities and marginalized populations, but little is understood regarding the pandemic's effect on non-COVID-19-related illnesses. OBJECTIVE: To examine the effect of the COVID-19 pandemic and related stay-at-home orders on pediatric emergency department (ED) imaging of non-COVID-19-related diseases across patient demographic groups. MATERIALS AND METHODS: We retrospectively reviewed radiology reports from advanced imaging (US, CT, MRI and fluoroscopy) on children in the ED during the month of April for the years 2017, 2018, 2019 and 2020, excluding imaging for respiratory illness and trauma. We used imaging results and the electronic medical record to identify children with positive diagnoses on advanced imaging, and whether these children were admitted to the hospital. Demographic variables included age, gender, race/ethnicity and insurance type. We used multivariable Poisson regression models to report rate ratio (RR) and binomial logistic regression models to report odds ratio (OR) with 95% confidence interval (CI). RESULTS: We included 1,418 ED encounters for analysis. Compared to pre-2020, fewer children underwent ED imaging in April 2020 (RR 0.63, 95% CI 0.52, 0.76). The odds of positive imaging results increased (OR 2.18, 95% CI 1.59, 3.00) overall, and for all racial/ethnic groups except Hispanic patients (OR 0.83, 95% CI 0.34, 2.03). No differences occurred in admission rates for positive imaging results in 2020 compared to pre-2020. CONCLUSION: In April 2020 compared to pre-2020, there were decreased imaging and increased positivity rates for imaging for non-respiratory and non-trauma ED visits. COVID-19 stay-at-home advisories might have resulted in triaging for urgent health care by families or referring clinicians during this month of the pandemic.

Emergency pediatric radiology imaging trends for non-COVID-19-related illnesses through different stages of the pandemic.

PURPOSE: To evaluate how the COVID-19 pandemic affected the imaging utilization patterns for non-COVID-19-related illness in a pediatric emergency department (ED). METHODS: We retrospectively reviewed radiology reports for ultrasound, CT, MRI, and fluoroscopy studies performed at a pediatric ED in April from 2017 to 2021, excluding studies for respiratory symptoms and trauma. Radiology reports and medical records were reviewed to determine if patients had a positive radiology diagnosis, the type of diagnosis, and whether it required hospital admission. Results from during the pandemic were compared to predicted rates based on pre-pandemic years. RESULTS: A total of 2198 imaging studies were included. During the COVID-19 pandemic, fewer ED imaging studies were performed compared to predicted. The decrease was greater in April 2020 (RR = 0.56, p < 0.001) than in April 2021 (RR = 0.80, p = 0.038). The odds of positive diagnosis was higher during the pandemic than before, and higher in 2020 (OR 2.53, p < 0.001) than in 2021 (OR 1.38, p = 0.008). The expected numbers of positive diagnoses and hospital admittances remained within the predicted range during the pandemic (p = 0.505-0.873). CONCLUSIONS: Although imaging volumes decreased during the studied months of the pandemic, the number of positive findings was unchanged compared to prior years. No differences were demonstrated in the percentage of patients admitted to the hospital with positive imaging findings. This suggests that, at our institution, the pandemic did not lead to a substantial number of missed diagnoses or severely delay the diagnosis of non-COVID-related conditions. While still lower than expected, imaging volumes increased in April 2021 suggesting a return towards baseline patient behavior as the pandemic conditions improved.

Rationing and Disparities in Health Care: Implications for Radiology Clinical Practice Guidelines.

We examine the relationship between the rationing of health care resources and disparities in health care delivery and the specific implications for radiologic resource allocation frameworks such as the ACR Appropriateness Criteria. We explore what rationing is in this context and how it is manifested in radiology. We review how rationing has taken many forms and how rationing has influenced the development of disparities in access and outcomes within health care and specifically within the context of radiology. We describe how the relationship between rationing and health care delivery disparities manifested during the coronavirus disease 2019 pandemic and the corrective measures that were proposed to established rationing frameworks to facilitate more equitable pandemic-related resource distribution. We offer suggestions regarding how such solutions might be brought into radiologic resource allocation schemes to help mitigate disparities in radiologic care in the future.

Impact of Isolation during the COVID-19 Pandemic on the Care of Older Adults with Type 1 Diabetes: A Qualitative Study

Background: Older adults with type 1 diabetes (T1D) face unique challenges, especially when their support structure is disrupted, as happened during the Covid-19 lockdown. We evaluated the clinical and psychological impact of this imposed isolation on the older population with T1D. Methods: We conducted semi-structured interviews with older adults with T1D who were part of an ongoing study, which was paused from March - August 2020. The interviews were performed between May - August 2020, and were transcribed, coded, and analyzed using content analysis to derive theme. A multidisciplinary team of 12 individuals coded the interviews to identify the themes and included geriatricians, endocrinologists, a nurse educator, infomaticists, an economist, a methodologist, and research assistants. Results: We have analyzed 12/35 interviews at this time;mean age 74±4 years, 50% female, 92% non-Hispanic white, mean duration of diabetes 37±18 years, and A1C 7.3±0.7%. Three main themes have emerged. The challenges related to diabetes care included fear of hypoglycemia, interruption in supply chain related to diabetes technology (insulin pump and continuous glucose monitoring (CGM) supplies), use of telehealth, diabetes-related distress, and adapting to new routines in self-care (diet and exercise). Challenges related to the Covid-19 pandemic included fear of getting Covid-19 infection, and a lack of reliable information on pandemic. The challenges related to psychological well-being included a feeling of isolation, loneliness, inability to spend time with family and friends, lack of in-person communication, and lack of recreational activity. Conclusion: The results of this qualitative study help to understand critical areas of need when social support structures are unavailable to older adults with T1D. Our results will help develop intervention strategies to overcome barriers in maintaining support for this vulnerable population.

Time during lockdown: A personal reflection

With the coronavirus pandemic we have fallen out of Freud's preferred world of regulated time and rational scientific discovery and gone, with Rolland's sensation of eternity, to a past, future and present where all memory and the future are with us now. After thirty-five years as a director in the film and TV industry, Stephen qualified from Birkbeck in 2019 with an MSc in Psychodynamic Counselling and Psychotherapy working with Adults "Time was longer, longer, longer in the summer" Iris Murdoch, The Sandcastle (Murdoch, [15]) An Introduction The Lea is a small river, populated by swans .... I generally walked downstream, a little bit further each time, sticking to the river as if clutching a rope while balancing on a narrow footbridge .... I rediscovered bits and pieces of my childhood .... Esther Kinsky, River ([9]) During the first coronavirus lockdown in the spring, I found myself awakening early and walking long distances beside the River Lea. We fall out of existence." from George Szirtes, Backspace ([19]:142) Close, I believe, to this falling out of existence, the "falling out of the world", that Freud finds unconscionable, is "Falling for ever", one of the "primitive agonies" Winnicott ([21]:104) lists in his paper Fear of Breakdown. The Relevance Of The Oceanic Experience When Freud sent his friend the poet Romain Rolland his book The Future of an Illusion, which ([8][1930]:1): "treats religion as an illusion", Freud quotes Rolland's reply, that while he agreed with Freud's judgement on religion, Rolland was (Freud, [8]): 'sorry I had not properly appreciated the true source of religious sentiments' which (Freud, [8]): 'consists in a peculiar feeling, which he himself is never without ... a feeling which he would like to call a sensation of eternity', a feeling as of something limitless, unbounded - as it were, "oceanic"'. [Extracted from the article] Copyright of Psychodynamic Practice is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The impact of COVID-19 on development assistance.

This article analyzes the impact of the COVID-19 pandemic on foreign aid. Using examples from Canadian foreign aid, it argues that, despite the terrible toll it is exacting, the crisis has accelerated some significant positive pre-existing trends, both by destabilizing the perception of aid as flowing essentially from the Global North to Global South and by reinforcing awareness of the importance of joint efforts for global public goods and humanitarian assistance, as well as debt relief. However, it has also reinforced potentially harmful self-interested justifications for aid, which could align assistance more with donors' priorities than the needs of the poor. An important trend reversal is the renewed emphasis on well-being. Two other crucial trends remain unclear-the COVID-19 pandemic's impact on multilateral approaches and on aid flows. How donors respond to the COVID-19 pandemic and its aftermath over the next few years will depend on their political will, and will profoundly shape the future of development co-operation.

Rapid mobilization of a virtual pediatric chronic pain clinic in Canada during the COVID-19 pandemic.

BACKGROUND: Studies have been conducted describing the potential for using virtual care software during disasters and public health emergencies. However, limited data exist on ways in which the Canadian health care system utilizes virtual care during disasters or public health emergencies. AIMS: Due to the need for social distancing and reduction of nonessential ambulatory services during the COVID-19 pandemic, the SickKids Chronic Pain Clinic sought to transition care delivery from in person to virtual. The virtual clinic aimed to reduce risks associated with physical contact and environmental exposure without reducing access to care itself. METHODS: Harnessing of various digital tools including Ontario Telemedicine Network Guestlink, Zoom, and Microsoft Teams. The Chronic Pain Clinic Team worked together to communicate with patients and families, schedule virtual visits, establish remote access to clinical data collection tools, digitize the after-visit summary, and add resources on pain self-management to the clinic's website. RESULTS: The Chronic Pain Clinic successfully transitioned all clinic appointments (multidisciplinary and individual; 77 appointments) over a 2-week period to virtual care. Virtual clinics did not surpass the usual time taken pre-COVID-19, suggesting that the clinic workflow was readily adaptable to virtual care. CONCLUSIONS: Access to quality virtual care is essential to prevent chronic pain from taking a toll on the lives of patients and families. Rapid establishment of a virtual clinic without gaps in service delivery to patients is possible given institutional support and a team culture centered around collaboration and flexibility.

Contexte: Des études ont été menées pour décrire le potentiel d'utilisation des logiciels de soins virtuels lors de catastrophes et d'urgences de santé publique. Toutefois, il existe peu de données sur les moyens par lesquels le systéme de soins de santé canadien utilise les soins virtuels lors de catastrophes ou d'urgences de santé publique.But: En raison de la nécessité d'une distanciation sociale et de la réduction des services ambulatoires non essentiels pendant la pandémie de COVID-19, la clinique de douleur chronique de SickKids a cherché à assurer une transition de la prestation des soins en personne vers des soins virtuels. La clinique virtuelle visait à réduire les risques liés au contact physique et à l'exposition environnementale sans réduire l'accès aux soins en tant que tels.Méthodes: Exploitation de divers outils numériques, dont le Réseau de télémédecine de l'Ontario Guestlink, Zoom et Microsoft Teams. L'équipe de la Clinique de la douleur chronique a travaillé ensemble pour communiquer avec les patients et les familles, programmer des visites virtuelles, établir un accès à distance aux outils de collecte de données cliniques, numériser le résumé après la visite et ajouter des ressources sur l'auto-prise en charge de la douleur sur le site web de la clinique.Résultats: La Clinique de la douleur chronique a réussi à faire passer tous les rendez-vous de la clinique (multidisciplinaires et individuels; 77 rendez-vous) sur une période de deux semaines à des soins virtuels. Les cliniques virtuelles n'ont pas dépassé le temps habituel avant la COVID-19, ce qui indique que le flux de travail de la clinique était facilement adaptable aux soins virtuels.Conclusions: L'accès à des soins virtuels de qualité est essentiel pour éviter que la douleur chronique ne fasse des ravages dans la vie des patients et des familles. L'établissement rapide déune clinique virtuelle sans interruption dans la prestation des services aux patients est possible grâce à un soutien institutionnel et à une culture d'èquipe centrèe sur la collaboration et la souplesse.