ABSTRACT
Background: Wastewater represents a broad, immediate, and unbiased accounting of the pathgens in the population. We aimed to develop methods to track HIV in wastewater utilizing a viral detection pipeline adapted from platforms developed to track SARS-COV-2. Method(s): We used samples from 6 wastewater treatment plants in the Houston area. We focused on regions of higher prevalence and lower prevalence. First, employing wastewater processing and nucleic acid extraction methods described by our group to detect SARS-COV-2, we tested a single high and low prevalence site in triplicate with all 3 primer sets. nucleic acid extracts from HIV and SIV cell culture supernatants were used as controls. Next, in subsequent samples, RT-PCR reactions with detections were subjected to gel electrophoresis to determine the amplified product sizes. To further confirm HIV detection, we sequenced the RT-PCR products and compared the proportion of reads which mapped to the expected amplified product. In a later set of studies, we fractionated samples into supernatant and pellet. We further tested HIV presence by performing whole virome sequencing on the extracts from some samples that produced detections and mapped reads to published genomes. A crAssphage genome was used as a negative control. Result(s): Samples from all sites resulted in signal detection at least once. Only reactions with gag and pol primers appeared to amplify the expected product. Products from the HIV positive control mapped almost exclusively to the HIV genome (97-100% of reads), with a fraction of reads from the SIV negative control doing the same (16-18% of reads). The ltr and pol products did not map the HIV genome while gag products did (34-44% of reads). Among the fractionated sample, in total, 6 supernatant fractions produced no detection compared to 7 of 8 pellet fractions. The whole virome sequencing produced reads that mapped to the HIV genome with at least 8X depth coverage. The sample with the lowest Ct detection (26) yielded HIV coverage several logs greater than those samples with higher Ct detection (37). Reads from all samples mapped to at least 20% of the HIV genome. Conclusion(s): This work provides the first evidence that HIV can be detected in municipal wastewater systems and has the potential to be developed into a new public health tool.
ABSTRACT
OBJECTIVE: External validation of the Oldham Composite Covid-19 associated Mortality Model (OCCAM), a prognostic model for Covid-19 mortality in hospitalised patients comprised of age, history of hypertension, current or previous malignancy, admission platelet count < 150 × 103/µL, admission CRP ≥ 100 µg/mL, acute kidney injury (AKI), and radiographic evidence of > 50% total lung field infiltrates. PATIENTS AND METHODS: Retrospective study assessing discrimination (c-statistic) and calibration of OCCAM for death in hospital or within 30 days of discharge. 300 adults admitted to six district general and teaching hospitals in North West England for treatment of Covid-19 between September 2020 and February 2021 were included. RESULTS: Two hundred and ninety-seven patients were included in the validation cohort analysis, with a mortality rate of 32.8%. The c-statistic was 0.794 (95% confidence interval 0.742-0.847) vs. 0.805 (95% confidence interval 0.766 - 0.844) in the development cohort. Visual inspection of calibration plots demonstrate excellent calibration across risk groups, with a calibration slope for the external validation cohort of 0.963. CONCLUSION: The OCCAM model is an effective prognostic tool that can be utilised at the time of initial patient assessment to aid decisions around admission and discharge, use of therapeutics, and shared decision-making with patients. Clinicians should remain aware of the need for ongoing validation of all Covid-19 prognostic models in light of changes in host immunity and emerging variants.
ABSTRACT
The definitive care component of the National Disaster Medical System (NDMS) may not be able to effectively manage tens of thousands of casualties resulting from a catastrophic disaster incident or overseas conflict. To address this potential national security threat, Congress authorized the US Secretary of Defense to conduct the NDMS Pilot Program to improve the interoperability, special capabilities, and patient capacity of the NDMS. The pilot's first phase was the Military-Civilian NDMS Interoperability Study, designed to identify broad themes to direct further NDMS research. Researchers conducted a series of facilitated discussions with 49 key NDMS federal and civilian (private sector) stakeholders to identify and assess weaknesses and opportunities for improving the NDMS. After qualitative analysis, 6 critical themes emerged: (1) coordination, collaboration, and communication between federal and private sector NDMS partners; (2) funding and incentives for improved surge capacity and preparedness for NDMS partners; (3) staffing capacity and competencies for government and private NDMS partners; (4) surge capacity, especially at private sector healthcare facilities; (5) training, education, and exercises and knowledge sharing between federal and private sector NDMS partners; and (6) metrics, benchmarks, and modeling for NDMS partners to track their NDMS-related capabilities and performance. These findings provide a roadmap for federal-level changes and additional operations research to strengthen the NDMS definitive care system, particularly in the areas of policy and legislation, operational coordination, and funding.
Subject(s)
Disaster Planning , Disasters , Military Personnel , Carbolines , Communication , Disaster Planning/methods , HumansABSTRACT
Background: Musculoskeletal conditions such as spinal pain and osteoarthritis are among the leading causes of years lived with disability worldwide. With the COVID-19 pandemic forcing many healthcare providers to change the way in which care for chronic conditions is delivered, telehealth is an alternative to face-to-face consultations that can be used for both assessment and provision of therapy and support. Objectives: To identify, appraise and synthesise findings from all randomised controlled trials (RCTs) that compared telehealth to face-to-face consultations for patients with any type of musculoskeletal condition. Methods: Systematic review and meta-analysis. We used the GRADE approach to assess the quality of evidence related to all outcomes. We searched three electronic databases (PubMed, Embase, CENTRAL), clinical trial registries and citing-cited references of included studies. Results: Five RCTs were includable: one in patients with osteoarthritis of the knee, one in patients with osteoarthritis of the knee or hip in preparation for a total joint arthroscopy and three after total knee replacement. Telehealth was conducted by video in four trials and by phone in one. A total of 402 participants were analysed across the five trials. There were no significant differences in pain outcomes (WOMAC) between telehealth and face-to-face therapy immediate post-intervention (mean difference (MD): 0.12 (95% CI −2.3 to 2.6, p =.92) or two months post-intervention (MD): 1.2, (95% CI: −2.7 to 5.1, p =.55). Similarly, outcomes related to function, quality of life and satisfaction were comparable between the two modes of delivery immediate post-intervention, with no significant differences reported. Conclusion: There is limited low quality evidence that there is no significant differences between telehealth-based delivery of rehabilitation to patients with osteoarthritis or following knee surgery and face-to-face therapy for pain, function, quality of life and satisfaction. These findings should be should be interpreted with caution due to the small number of included studies and small sample size. © 2023 Informa UK Limited, trading as Taylor & Francis Group.
ABSTRACT
Background: Previous research demonstrates that congressional communication on Twitter is gendered. Congresswomen are more likely to tweet about issues than Congressmen during elections, and they are also more likely to tweet about "women's issues” (healthcare, education, reproductive rights, welfare) than their male counterparts. Objectives: Given the partisan and gendered coronavirus disease (COVID-19) pandemic effects researchers have documented, we examine whether Congressmembers. communication about COVID-19 is also gendered and partisan. Methods: To examine how Senators and House Representatives were discussing the pandemic online, we collected the tweets sent by members of both the U.S. House and U.S. Senate from February 1st until May 14th, 2020. Results: Gender and partisanship shape how members communicate about COVID-19 on Twitter, and this is especially pronounced in the framing of COVID-19 in terms of "women's issues.”. Conclusion: We find evidence that there is a gendered partisan divide in both the frequency and framing of the issue on Twitter. This divide is likely to continue to shape how the public thinks about the pandemic and how elites. respond to the pandemic. © 2023 The Authors. Social Science Quarterly published by Wiley Periodicals LLC on behalf of Southwestern Social Science Association.
ABSTRACT
Reduction in immunosuppression (IS) is universally recommended in the setting of infection, but its effect on outcomes in the setting of COVID-19 has not been established. The purpose of this study is to characterize the impact of IS reduction strategies on disease severity and outcomes of COVID infection in heart transplant patients (HTPs). This was a single center, retrospective review of HTPs with COVID infection managed inpatient or outpatient, examined in cohorts by approach to IS reduction. Demographics, severity at diagnosis and peak based on NIH Classification of COVID Illness Severity, and secondary clinical outcomes were collected (Table 1). The primary outcome was the difference in COVID severity score after IS regimen changes at time of diagnosis. Descriptive statistics, ANOVA, independent t-tests, and chi square analyses were used to evaluate baseline characteristics, primary outcome, and secondary outcomes. Data was collected for 110 patients with 113 COVID infections between March 2020 and June 2022. Patients were on average 54 years old, 75% white, 15% Hispanic ethnicity, and 5 years post HT at the time of their infection. Approaches to IS changes were antimetabolite (antiM) reduction (62%), all IS reduced (6%), or no change (32%). There was a significant difference in clinical severity from diagnosis to peak across all groups (p = 0.004), contributed largely by the All IS Reduced group with significantly higher peak severity (p = 0.002) leading to drastic IS reductions. In a sub-analysis to compare the protocolized approach of antiM reduction to no change in IS, no difference was noted in mortality, superimposed infections, or treated graft rejection (Table 1). Change in severity of infection over time is noted by variant in Figure 1. As COVID vaccination and therapeutic agents evolve, drastic IS modifications may not be necessary if baseline infection is mild. However, reduced duration IS reduction did not lead to more treated graft rejection. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. 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.)
ABSTRACT
Purpose: In 2021, an opportunity arose to place four counselling and psychotherapy (C&P) students in three care homes across Greater Manchester as part of a 6-week interprofessional education (IPE) care home scheme. Whilst, due to ethical concerns around confidentiality, the C&P students could not participate in interprofessional activities as intended, they still undertook their clinical placement in the home to provide accessible therapy support for care home staff. This paper aims at reporting on the varied factors that influenced the implementation of C&P student placements in care homes. Methods: At the start and end of their placement, four C&P students were interviewed about their experiences. We draw on data from these eight interviews and two reflective vignettes: one from a C&P student and the other from the C&P programme coordinator (C&PPC). Results: The data were thematically analysed, and two key themes and six subthemes were constructed. They broadly unpack the factors that facilitate and challenge the implementation of C&P student placements in care homes. Conclusion: This paper highlights the value of utilising care homes as placement sites for C&P students. We propose four key recommendations for future practice: (1) it is important to establish clear lines of communication, support and collaboration;(2) a dual-space supervisory approach supports student learning in this "new” placement environment;(3) preplacement supportive frameworks are important to clarify initial role uncertainties within the care home;and (4) opportunities to provide therapy services should be well defined and referral processes put in place before the student arrives. © 2023 The Authors. Counselling and Psychotherapy Research published by John Wiley & Sons Ltd on behalf of British Association for Counselling and Psychotherapy.
ABSTRACT
Background: Knowing the prevalence of true asymptomatic coronavirus disease 2019 (COVID-19) cases is critical for designing mitigation measures against the pandemic. We aimed to synthesize all available research on asymptomatic cases and transmission rates. Methods: We searched PubMed, Embase, Cochrane COVID-19 trials, and Europe PMC for primary studies on asymptomatic prevalence in which (1) the sample frame includes at-risk populations, and;(2) follow-up was sufficient to identify pre-symptomatic cases. Meta-analysis used fixed-effects and random-effects models. We assessed risk of bias by combination of questions adapted from risk of bias tools for prevalence and diagnostic accuracy studies. Results: We screened 2,454 articles and included 13 low risk-of-bias studies from seven countries that tested 21,708 at-risk people, of which 663 were positive and 111 asymptomatic. Diagnosis in all studies was confirmed using a real-time reverse transcriptase–polymerase chain reaction test. The asymptomatic proportion ranged from 4% to 41%. Meta-analysis (fixed effects) found that the proportion of asymptomatic cases was 17% (95% CI 14% to 20%) overall and higher in aged care (20%;95% CI 14% to 27%) than in non-aged care (16%;95% CI 13% to 20%). The relative risk (RR) of asymptomatic transmission was 42% lower than that for symptomatic transmission (combined RR 0.58;95% CI 0.34 to 0.99, p = 0.047). Conclusions: Our one-in-six estimate of the prevalence of asymptomatic COVID-19 cases and asymptomatic transmission rates is lower than those of many highly publicized studies but still sufficient to warrant policy attention. Further robust epidemiological evidence is urgently needed, including in subpopulations such as children, to better understand how asymptomatic cases contribute to the pandemic.
ABSTRACT
Background: Compared to their non-caregiving peers, caregivers of persons with dementia (PWD) endure higher psychological distress, social isolation and increased morbidity and disability. Stress and isolation experienced by caregivers during the COVID-19 pandemic have added to caregiver burden and worsened health. The objective of this study was to obtain a greater understanding of the health and needs of informal caregivers of PWD during the COVID-19 pandemic. Method(s): Using a cross-sectional questionnaire, we attained demographic data, characteristics of caregiving during the COVID-19 pandemic, mental health status, COVID-19 testing and illness, and protective measures taken to prevent infection with COVID-19 among caregivers of PWD. From March 2021 to August 2021, respondents were recruited through the Maya Angelou Center for Health Equity's Alzheimer's disease (AD) registry. Descriptive statistics (frequency and proportions) of demographic, caregiving, health, and COVID-19 related data for caregivers of PWD was conducted using SAS software version 9.4. Result(s): A total of 274 caregivers of PWD participated in the study. More than half of caregivers were women (56.57%), and approximately 73% of caregivers were married. The racial composition of the majority of caregivers included African American (44.16%), Non-Hispanic White (26.64%), and Native American (20.44%). Most caregivers were providing care for parents (59.86%) or a partner (21.17%). Nearly 46% of caregivers reported experiencing stress, but not being burnt out. Almost 47% of caregivers reported high psychological distress during the COVID-19 pandemic. In addition to caregiving stressors due to the COVID-19 pandemic, caregivers also experienced behavioral changes in their household;more than half of caregivers experienced increased interpersonal conflict with loved ones, friends, or co-workers. The top 3 needs reported during the COVID-19 pandemic included support with caregiving, medical care, and food. Conclusion(s): Approximately half of caregivers of PWD experienced stress and psychological distress during the COVID-19 pandemic. In addition to the stress of caregiving, caregivers lacked support for necessary medical services and social needs. The data collected from caregivers during the COVID-19 pandemic will be used to develop recommendations to support informal caregivers during emergency situations. Copyright © 2022 the Alzheimer's Association.
ABSTRACT
Background The National Health and Nutrition Examination Survey (NHANES) produces national estimates that are representative of the total noninstitutionalized civilian U.S. population. The NHANES sample is selected using a complex, four-stage sample design. NHANES sample weights are used by analysts to produce estimates of the health statistics that would have been obtained if the entire sampling frame (the noninstitutionalized civilian U.S. population) had been surveyed. Sampling errors should be calculated for all survey estimates to assess their statistical reliability. Variance approximation procedures are required to provide reasonable, approximately unbiased, and design-consistent variance estimates for complex sample surveys like NHANES. The 2017–March 2020 files represent a unique public-use data release from NHANES. The coronavirus disease 2019 (COVID-19) pandemic required suspension of data collection in March 2020. As a result, the partially completed NHANES 2019–2020 cycle was not nationally representative. Therefore, the 2019–March 2020 data were combined with the data from the 2017–2018 cycle to create the nationally representative 2017–March 2020 prepandemic data files. Objective This report describes the creation of the NHANES 2017–March 2020 prepandemic data files, including the selection of the appropriate NHANES sample design (2015–2018) to create sample weights and variance units for public-use data files. Additionally, the development of a factor applied to the primary sampling units to adjust the 2017–March 2020 data to fit the NHANES 2015–2018 sample design is described. Analyses to assess representativeness of the target population were performed, and a simulation to replicate the impact of interrupted data collection using earlier NHANES cycles was undertaken. Analytic guidance specific to use for prepandemic data files is also included. © 2022, National Center for Health Statistics. All rights reserved.
ABSTRACT
Methods: Data were pulled from an internal administrative dashboard. Referrals include services for Veterans who live a prescribed driving distance from a VAMC, wait times over threshold, services unavailable, or for reasons of the best medical interest. Data was pulled for fiscal years 2020 through 2021 and included: chiropractic care, acupuncture, biofeedback, neuron feedback, clinical hypnosis, massage therapy, meditation (specifically MBSR), Tai Chi/qigong, and yoga. Standardized tracking of referrals began with the implementation of Standard Episodes of Care (SEOC) which define care requested and include number of visits permitted and timeframe. Results: Referrals increased for all approaches from FY20-21 shown as (FY20;FY21): chiropractic (104,197;197,357), acupuncture (59,787;100,908), massage therapy (5,021;17,646), biofeedback (31;69), neuron feedback (27;74), clinical hypnosis (10;40), MBSR (2;8), Tai Chi (2;8) and Yoga (1;2). Background: The Veterans Health Administration (VHA) Directive 1137: Provision of Complementary and Integrative Health (CIH) identifies the inclusion of evidence-based CIH approaches in the VHA's Medical Benefits Package (acupuncture, biofeedback, clinical hypnosis, guided imagery, massage therapy, meditation, Tai Chi/qigong, and yoga). The purpose of this administrative data review is to identify which approaches are being referred to Community Care from VHA medical centers (VAMC), and to identify if COVID-19 has had an impact on referrals to the community. Conclusion: CIH is expanding across the VHA and could be useful in supporting a cultural transformation that includes integrative health approaches within conventional medical systems. While all VAMCs provide some CIH in-house, a substantial amount is provided through Community Care. As the largest integrated healthcare system in the United States, this could impact growth of CIH and the need for more providers in the community. By hiring CIH professionals onstation and expanding the network to the community, VHA could be one of the largest providers and users of CIH.
ABSTRACT
Background: Head and neck cancer (HNC) treatment has been significantly affected worldwide by the SARS-Cov-2 pandemic due to high viral loads in the upper aerodigestive tract. We present a single-institution experience of successful continued management of HNC patients during the pandemic. Methods: A retrospective audit was conducted comparing operative time, anaesthetic time, case volume and type (aerosol generating vs. non aerosol generating) between equivalent time periods from 2019 and 2020 during the peak of the pandemic in Australia, from a single high-volume, tertiary, academic head and neck centre. Furthermore, we document the multi-level changes instituted for each department involved in the patient cancer journey. Results: The average operative time for aerosol generating procedures (AGPs) was 85 minutes (IQR 455) in March 2019 compared with 180 minutes in March 2020 (IQR 366). Case volume and case type was similar between the two years. With appropriate patient screening, perioperative planning and judicious use of personal protective equipment (PPE), higher-risk AGPs were able to continue essentially as normal. Conclusions: HNC requires timely investigation and treatment, even in the midst of a pandemic, which can be achieved at a dedicated, COVID-free oncology centre utilising clear, rapid communication and a multidisciplinary approach. © Australian Journal of Otolaryngology. All rights reserved.
ABSTRACT
Background: The placement of ureteric stents under local anaesthesia (LA) offers the potential for an effective and safe alternative to general anaesthesia in the context of an increasingly co-morbid population and the ongoing COVID-19 pandemic. Objectives: (1) To assess the outcomes for patients with acute ureteric stones managed with the insertion of an emergency ureteric stent under LA. (2) To report the key procedural and logistical elements required to undertake successful LA stent placement. Methods: Patients presenting with CT confirmed, obstructing ureteric stones between 17/04/2020 and 06/07/2021 were included where insertion of an LA ureteric stent was undertaken as an emergency. The primary outcome was procedure success rate and secondary outcomes were serious post-procedure complication rate (defined as Clavien-Dindo. 3), time from CT diagnosis to stent placement, and patient tolerability (defined as pain from the procedure measured on a numerical rating scale 0-10, and reported concern regarding undergoing the same procedure in the future with the options of: no problem/minor problem/moderate problem/major problem). Results: Twenty-three patients underwent emergency LA ureteric stent placement for obstructing calculi with sepsis (73.9%, n = 17), uncontrolled pain (17.4%, n = 4) or acute kidney injury (8.7%, n = 2). The procedural success rate was 95.7% (n = 22/23), and the total number of serious complications was one (4.3%) (ureteric stent migration in duplex system). The median time from diagnosis to stent was 5.3 hours (interquartile range (IQR) = 16.3). The median pain score was 2 (IQR = 5.8), and most patients (73.9%, n = 17/23) reported they would have no problem or a minor problem undergoing the same procedure again. Conclusion: The placement of ureteric stents under LA represents an effective, safe, and well-tolerated alternative to general anaesthesia. The 24/7 availability of a flexible cystoscopy suite, C-arm, and fluoroscopy and specialist urology nurse within a dedicated urology unit has facilitated the delivery of this service.
ABSTRACT
Purpose: During the COVID-19 pandemic, inpatient cardiothoracic transplant pharmacists expanded clinical services to include remote telehealth visits to increase patient access to pharmacy services and streamline visits for providers. Pharmacist visit activities included adherence and medication access assessments, adverse effect assessment and management, chart reviews, and medication reconciliation. Methods: A single center retrospective chart review of 80 heart transplant recipients transplanted between January 2020 and December 2020 was completed. From July 2020 - March 2021, pharmacists called patients within the first year of transplant prior to scheduled provider clinic visits. Patients were not called if they had been called within the prior 4 weeks. Activities from clinic visits before and after pharmacist involvement were compared at 1 month, 3 months, 6 months, and 12 months post-transplant. The goal of this analysis was to describe the number and types of interventions made by the pharmacist. Results: A total of 100 patients and 272 clinic visits were analyzed, baseline clinical characteristics did not differ in the two cohorts. Pharmacists performed 233 tele-health visits which resulted in 394 interventions from July 2020 - March 2021, summarized in Figure 1. The most common interventions included adverse effect management (34%) and renal dose adjustment (17.8%). An analysis of outpatient visits before and after pharmacist involvement found no significant difference in reported adherence, appropriate renal dosing of medications or reported neurotoxicity (Table 1). Conclusion: Close to 400 interventions were made by our transplant pharmacy team through tele-health visits over a period of 8 months. Use of pre-visit pharmacist tele-health assessments allowed for expansion of clinical pharmacy services while facilitating more focused provider clinic visits. more consistency in clinic may yield improved post-pharmacist outcomes, though further analysis is warranted.
ABSTRACT
Background. The COVID-19 pandemic has brought vaccination to the forefront of discourse on public health. The rapid speed of COVID-19 vaccine development, utilization of novel technology, and an atmosphere of politicized misinformation have created a perfect storm for vaccine hesitancy. As early adopters of vaccination, HCWs set an example for the general population;as trusted sources of medical information, they educate and inform. However, comparatively little work has investigated HCWs' attitudes toward vaccination and how those attitudes drive their recommendation behavior. Methods. We surveyed hospital employees about their personal reasons for hesitancy and beliefs about patient hesitancies and randomly assigned them to see one of three messages aimed at increasing vaccine confidence. Message themes included an appeal to return to normal life (Normalcy), a risk comparison between vaccinating or not (SDT), and an explanation of the speed of safe and effective vaccine development (Process). Results. Of the 674 NC hospital employees who completed our survey in February 2021, 98% had been offered the COVID-19 vaccine, and 80% had already accepted. For the 20% who had not received the vaccine, the top reasons for hesitancy involved the speed of development and testing, and concerns of vaccine safety and effectiveness. We also found differences in susceptibility to misinformation and vaccine hesitancy across political affiliation, which was higher in Republicans compared to Democrats. HCWs were generally very comfortable recommending the COVID-19 vaccine to patients and supported the idea of sharing the message they read. Although the risk comparison message was most trusted personally, the process message was rated as both the most helpful to patients and the most likely to be shared with them (see Figure 1). This suggests that what is most appealing on a personal level is not necessarily what a HCW would recommend to their patients. Rating of personal opinions of the passages. On a scale from 1 to 7 with 1 = Strongly Disagree and 7 = Strongly Agree. This chart shows the average message ratings across the board when answering whether they thought the passages were understandable, helpful, correct, believable, and trustworthy. (Error bars are 95% CI) There was no significant difference across the messages. The Process message is seen as most helpful and is most likely to be shared with patient than the other messages On left, the average answer on a scale from 1 to 5 for "Do you think the passage you just read would help your patients feel more comfortable about getting the vaccine?" and on right, the average answer for "Would you share this passage with your patients?" Conclusion. HCWs' high uptake and minimal hesitancy in recommending the COVID-19 vaccine is encouraging and merits further exploration for how to increase confidence in HCW who are hesitant to discuss and recommend vaccines to patients, as several highlighted the importance of respecting patient autonomy.
ABSTRACT
The SARS-CoV-2 pandemic with consequential home working has demonstrated how so many open plan offices failed to support the needs of the occupants, noise being the biggest problem. This pilot study used semi-structured interviews to explore the causes of poor acoustic conditions, and potential to improve them using ISO 22955 - Acoustic quality of open office spaces, published May 2021. A purposive sample of leading acoustic practitioners from Europe was consulted, and thematic analysis was used. The key themes identified from the data included the lack of common narrative and knowledge held by stakeholders about the causes of poor acoustic conditions;the adverse effect of occupational density, currently unaccounted for in acoustic assessments;the acoustic risks of bringing the increased teleconference activity into existing office designs. ISO 22955 can consolidate understanding and offers methods to improve acoustic conditions in operation, although it should be expanded to include the personal and sociological drivers of acoustic satisfaction. © 2021 Institute of Acoustics. All rights reserved.
ABSTRACT
This fifty-year retrospective on Virginia's 1971 constitutional revision argues that state constitutional language has both the power and promise to effect policy change in the area of educational equity. In the years after Brown, Virginia dramatically resisted efforts to integrate. Then the Commonwealth embraced a moderate stance on integration, as part of its 1971 constitutional revision, to end de jure segregation and provide a "quality" education for "all children." Looking to new quality standards produced by a Board of educational experts, Virginia optimistically turned to the technocracy movement, hoping to take education out of politics. New aspirational language was meant to deepen the legislature's commitment to public schools and repair Massive Resistance's damage to public schools. Looking back fifty years later, however, it is clear that this constitutional revision, while successfully meeting its goals around Massive Resistance, did not address underlying problems it is often assumed to have solved, such as inadequate funding or persistent de facto segregation. Other states ' journeys battling the same issues have looked different, and these differences highlight some of the strengths and weaknesses of Virginia 's approach. This Note ultimately argues that the 1971 constitutional revision never intended to solve these problems, and thus, the work for educational advocates right now is not to come up with more clever litigation, but to convince Virginians to agree on a fairer school system perhaps through a new constitutional revision. In the context of new public concern about racial justice following George Floyd's death and the Coronavirus crisis, I argue that Virginia today may finally be ready to finish the work started in 1971.
ABSTRACT
Background: Immune checkpoint inhibitors targeting PD-1 and PD-L1 have significantly impacted treatment of Non-Small Cell Lung Cancer (NSCLC). KEYNOTE-189 demonstrated first-line pembrolizumab plus pemetrexed-platinum improves progressionfree survival (PFS) and overall survival (OS) in metastatic nonsquamous NSCLC, regardless of tumour PD-L1 expression [1]. Translating evidence from trials to real-world patient populations can be challenging as a significant proportion of patients in daily practice are often under-represented in randomised control trials due to strict inclusion and exclusion criteria. We aimed to compare real-world data with outcomes from KEYNOTE-189. Methods: We performed a retrospective analysis of 56 patients with metastatic nonsquamous NSCLC without targetable mutations, treated with first line pembrolizumab, pemetrexed and platinum. Data were collected from electronic records between October 2018 and January 2021 in 2 London cancer centres. Results: Our cohort comprised 56 patients with median age 61 years, 75% with smoking history, 59% male and 41% female. PD-L1 expression was <1% in 57% of patients. Median follow-up was 8.7 months. All patients received at least one cycle and 53% completed 4 cycles of chemoimmunotherapy. Treatment was stopped early or pemetrexed maintenance treatment was omitted due to COVID-19 in 4 patients (7%). Median PFS was 7.1 months (range 1.8 to 26.3) and median OS was 8.7 months (range 1.8 to 26.3). OS at 12 months was reached by 21 patients (38%). Adverse events were observed in 30 patients (54%), including grade 3-5 adverse events in 15 patients (27%). Conclusions: Median PFS was similar in our cohort compared to KEYNOTE-189, but not as substantial as that reported in their updated analysis. OS was lower in our cohort, however a significant proportion of our patients recently commenced treatment and had shorter duration follow-up. Safety outcomes were superior in our cohort compared to KEYNOTE-189. Disclosure: No significant relationships.