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During the COVID-19 pandemic, pregnant people and mothers in the United States have faced untenable conditions as they grapple with simultaneous professional and personal demands without access to adequate financial, career, or caregiving support. These simultaneous demands are not new to women, but the pandemic set inequities between working mothers and childfree workers and between women and men in even starker contrast. This article explores responses from 110 (self-identified) women participants about how their role of mother has changed, how their professional and personal lives have changed, how they have adapted to the pandemic era, and what kinds of support have or would have been helpful during this time. The participants' words point to areas of positive benefit and areas of needed growth and change in dance industries and workplaces and reframe the ways we construct our ideas of motherhood and expectations of mothers. I centralize their experiences for the benefit of everyone working in dance so that we may support each other in a revolution of dance as an inclusive, accessible, diverse field of equity and opportunity. © 2023 Informa UK Limited, trading as Taylor & Francis Group.
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Introduction: Olfactory dysfunction (OD) affects more than 3 million US adults. The number of patients with post viral olfactory dysfunction (PVOD) is expected to increase secondary to the worldwide COVID-19 pandemic. Preliminary studies have demonstrated the efficacy of platelet-rich plasma (PRP) in restoration of smell in both animals and humans. To date, human studies have utilized injectable PRP only. We describe our pilot study investigating the use of topical PRP as a novel delivery method for smell restoration and contribute to existing literature demonstrating the promise of PRP as a therapeutic. Method(s): Pilot study from September 2020 to January 2022. Patients >18 years with hyposmia diagnosed via Brief Smell Identification Test (B-SIT) score <8 were included. PRPimpregnated Surgifoam was placed into bilateral olfactory clefts monthly for at least 3 months. Patients completed the B-SIT at baseline and 1 month after each treatment. Result(s): Eight patients underwent at least 3 treatments and completed the B-SIT at month 4. Average age was 56.3 years;mean smell loss duration was 19.3 months. Etiologies included PVOD, post-COVID (5), and idiopathic. Mean change in B-SIT after 3 treatments was +1.06. Of patients, 62.5% had achieved the minimal clinically significant difference of >1 on B-SIT after treatments 2 and 3. Patients with smell loss <12 months demonstrated greater B-SIT scores at 4 months (+1.6 vs +0.2). Two patients achieved B-SIT >8 after 3 treatments. Of patients who have returned thus far for a fourth treatment, 1 additional patient scored >8. Conclusion(s): We present the largest pilot study to date for the use of PRP in treatment of OD and the first study to develop methods for topical delivery in human subjects. Topical PRP may serve as a less invasive, efficacious therapy for patients. Further, randomized control trials are warranted to investigate the required number of topical PRP treatments for smell restoration.
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Introduction: Almost 30% of olfactory dysfunction (OD) arises after a viral infection with increased incidence due to COVID-19. Hypothesized SARS-CoV-2 viral attachment to the olfactory epithelium differs from the traditional postviral OD (PVOD) mechanism. Hence, manifestations of OD may differ between the two etiologies. This study evaluates the difference in smell perception between post-COVID-19 OD and postviral or idiopathic etiologies. Method(s): This observational study, approved by the institutional review board, was conducted between September 2020 and January 2022 in adult patients with more than 6 months nontraumatic OD with no perceived improvement in smell even after 3 months of conservative treatment. OD in these patients was categorized as COVID-19 or non-COVID-19 related. Demographics, duration of OD, and Brief Smell Identification Test (B-SIT) scores were analyzed. Continuous variables were compared by t test, while categorical variables were compared by chi2 test using SPSS 27 (IBM Corp). Result(s): Of the 26 patients included in the study, 42.3% reported persistent OD following COVID-19 infection, while 57.7% had non-COVID-19-related OD. The mean B-SIT score in post-COVID-19 OD was 6.81+/-2.15 compared with 3.87+/-2.2 in the non-COVID-19 OD group, with the difference being statistically significant at 3.40 (P=.001). While race and gender ratios were similar between the groups, age (42 vs 54, P=.048) and duration of loss of smell (10 months vs 49 months, P<.001) had significant differences. Conclusion(s): This study shows that patients suffering from COVID-19-related OD may have normal scores on scratch and sniff smell tests, possibly because of the difference in the affected site of the olfactory pathway. Current hypotheses focus on olfactory epithelial damage in COVID-19 vs neuronal in PVOD. Differences seen in age and duration of smell loss between groups may be secondary to newfound worldwide attention to OD, while patients with OD etiologies predating COVID-19 may have newly sought treatment at this time. Olfactory threshold testing may be required for accurate assessment of post- COVID-19 OD. Larger studies are required to help delineate differences between these olfactory disturbance etiologies.
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Background & Aim: Funded in 2015, the NEPHSTROM EU-H2020 consortium aimed to translate pre-clinical evidence of efficacy of “off-the-shelf” intravenous (i.v.) allogeneic mesenchymal stromal cells (allo-MSC) in diabetic nephropathy to early-phase clinical investigation in patients with progressive diabetic kidney disease (DKD). Methods, Results & Conclusion: Methods: The trial IMP, NEPHSTROM ORBCEL-M, consists of cryopreserved, CD362-selected bone marrow allo-MSCs or matching placebo (cryopreservation fluid). The protocol for a multi-site, randomised, placebo-controlled, double- blind, dose-escalation phase-1b clinical trial in adults with DKD due to type 2 diabetes was designed collaboratively by a group of academic nephrologists and cell therapy specialists from Italy, the UK, Ireland and the Netherlands. Inclusion criteria included age 40-85 yrs and type 2 diabetes with evidence of progressive DKD [eGFR 25- 55mL/min/1.73m2, urine albumin creatinine ratio >88mg/g and rapid eGFR decline or ≥15% risk of ESRD within 5 years]. Three dose cohorts were planned, each with n=12 NEPHSTROM ORBCEL-M recipients + n=4 Placebo recipients and 18 months follow-up. Results: Following regulatory approval of the trial dossier through the EMA’s Voluntary Harmonisation Procedure and ethical approvals at the Sponsor site (Bergamo, Italy) and three other sites (Galway, Ireland;Birmingham and Belfast, UK), the NEPHSTROM trial (NCT02585622) opened March 2018. To date, 27 patients have been treated and 14 have completed the trial protocol. We report here our (as-yet blinded) experiences with the first fixed-dose cohort (80x10e6 cells/placebo i.v.), consisting of 16 subjects enrolled at 3 sites and followed for 18 months. The trial intervention proved safe, with one quickly-resolved infusion reaction and no subsequent SAEs ascribed to the IMP. Two patients died of unrelated causes between 12 and 18 months. Serial serum assays for anti-HLA antibodies indicated no persistent allo-immune sensitisation. NEPHSTROM ORBCEL-M effects on trends in eGFR, true GFR (iohexol clearance), albuminuria, serum/plasma inflammatory biomarkers and immune cell profiles will be analysed after unblinding. Following DSMB approval and COVID-19-related trial pauses, 11 second dose cohort subjects (160x10e6 cells/placebo i.v.) have been treated and are undergoing follow-up with no IMP-related adverse events to date. Conclusion: A novel, off-the-shelf, i.v. allo-MSC IMP has thus far proven safe and feasible in adults with progressive DKD.
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Background. There are few real-world data on the use of remdesivir (RDV) looking at timing of initiation in relation to symptom onset and severity of presenting disease. Methods. We conducted multi-country retrospective study of clinical practice and use of RDV in COVID-19 patients. De-identified medical records data were entered into an e-CRF. Primary endpoints were all-cause mortality at day 28 and hospitalization duration. We assessed time from symptom onset to RDV start and re-admission. We included adults with PCR-confirmed symptomatic COVID-19 who were hospitalized after Aug 31, 2020 and received at least 1 dose of RDV. Descriptive analyses were conducted. Kaplan-Meier methods were used to calculate the mortality rate, LogRank test to compare groups defined by severity of disease. Competing risk regression with discharge and death as competing events was used to estimate duration of hospitalization, and Gray's test to compare the groups. Results. 448 patients in 5 countries (12 sites) were included. Demographics are summarized (table) by 3 disease severity groups at baseline: no supplemental oxygen (NSO), low flow oxygen ≤6 L/min (LFO), and high-flow oxygen > 6L/min (HFO). No demographic differences were found between groups except for the higher percentage of cancer/chemotherapy patients in NSO group. Corticosteroids use was HFO 73.6%, LFO 62.7%, NSO 58.0%. Mortality rate was significantly lower in NSO, and LFO groups compared with HFO (6.2%, 10.2%, 23.6%, respectively;Fig1). Median duration of hospitalization was 9 (95%CI 8-10), 9 (8-9), 13 (10-15) days, respectively (Fig2). Median time from first symptom to RDV start was 7 days in all 3 groups. Patients started RDV on day 1 of hospitalization in HFO and LFO and day 2 on NSO groups. And received a 5 day course (median). Readmission within 28-days of discharge was < 5% and similar across all 3 groups. Conclusion. In this real-world cohort of COVID-19 positive hospitalized patients, RDV use was consistent across countries. RDV was started within a median of 7 days from symptom within 2 days of admission and given for a median of 5 days. Higher mortality rate and duration of hospitalization was seen in the HFO group and similar rates seen in the LFO and NSO groups. Readmission was consistently low across all 3 groups.
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Introduction: In the beginning of the COVID-19 pandemic in spring 2020, much was unknown regarding nosocomial transmission of the disease. During that time, both elective and oncologic surgical cases were canceled. At our institution, a tiering system was used to determine which cases were pursued vs rescheduled. After adequate safety protocols were established, each subspecialty within otolaryngology faced unique challenges in reengaging patients for surgical scheduling. Method: Patients whose surgeries were canceled between March and May 2020 due to COVID-19 hospital precautions were identified at an academic institution. Rescheduling rates were analyzed by subspecialty. Results: Of the 833 otolaryngology cases scheduled between March 16, 2020, and May 29, 2020, 555 (66.63%) were canceled due to COVID-19 precautions. For the entire department, 395 (71.17%) of the canceled surgeries were rescheduled within 6 months of the originally scheduled surgery date. Total number of scheduled, canceled, and rescheduled canceled cases for each subspeciality were as follows: head and neck: 208, 89 (42.79%), and 79 (88.76%);sleep surgery: 199, 167 (83.92%), and 107 (64.07%);rhinology: 172, 125 (72.67%), and 81 (64.80%);facial plastics: 150, 120 (80.00%), and 89 (74.17%);otology/neurotology: 38, 27 (71.05%), and 18 (66.67%);and laryngology: 35, 24 (68.57%), and 19 (79.17%). The overall case completion rate for the subspecialties was as follows: head and neck, 95.19%;sleep surgery, 69.85%;rhinology, 74.42%;facial plastics, 79.33%;otology/ neurotology, 76.32%;and laryngology, 85.71%. Conclusion: Head and neck had the highest number of cases originally scheduled, lowest number of cases canceled, and highest number of cases rescheduled. In contrast, sleep surgery had the most cases canceled and fewest cases rescheduled. Differences between subspecialties are presumably multifactorial and likely include both surgeon and patient perceptions of time sensitivity of interventions. Our experience demonstrates that subspecialties that function on a more elective nature faced increased scheduling difficulty during the COVID-19 pandemic.
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Introduction: With the surge of SARS-CoV-2 cases in March of 2020 came strained health care resources, and much was unknown regarding mechanism of transmission. Surgical prioritization and tiering systems were developed nationwide to determine which patients were to still undergo surgery. At our institution, head and neck cancer patients were categorized as high priority for surgery scheduling during the COVID-19 pandemic. Method: Patients who were planned to undergo head and neck cancer procedures during the lockdown between March and May 2020 were included. Patients were categorized into 3 tiers based on suspected pathology, anatomic subsites, and anticipated severity of disease progression without intervention (high priority, mid priority, elective). For rescheduled surgeries, time to procedure was calculated with medians compared across tiers. Patients were considered to have clinically significant changes to treatment plans if further surgical intervention or adjuvant treatment was warranted based on surgical pathology. During this time period, the total number of COVID-positive patients in our 908-bed hospital ranged from 48 to 195 each day. Results: Of 208 cases scheduled between March 16 and May 29, 2020, 89 (42.79%) were canceled due to COVID-19 lockdown precautions. Some 79 (88.76%) of the canceled surgeries were rescheduled, with tier 1 having a median of 42 days, tier 2 having a median of 60 days, and tier 3 having a median of 53.5 days after the originally scheduled date. All rescheduled tier 1 patients did not experience any clinically significant changes to their originally planned treatment course. No patients treated during this time frame contracted COVID-19 during their surgery or consequent hospital stay. Conclusion: Our findings substantiate that use of guidelines to tier head and neck cancer surgical candidates facilitates timely and appropriate rescheduling to prevent progression of disease. With appropriate precautions, surgery can be safely performed during the COVID-19 pandemic, as evidenced by our lack of transmission to patients during their hospitalizations.
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Research has struggled to answer a critical question: why would people share fake news if they have no intention to deceive, and they run a risk of social censure for doing so? Working on the basis that sharers do not know whether the news is fake, we propose the term "dubious news" to help answer that question. The term describes news which exists in two states simultaneously, both true and false until it has been established which it is. People who would be reluctant to knowingly share fake news might nonetheless share dubious news. Focus groups run in Singapore during the early stages of the 2020 Covid-19 pandemic - when uncertainty ran high - explored why people share dubious news, its value in establishing truth, and its impact on group cohesion. We identify a difference between the motivation of the sharer and how that motivation is perceived by a recipient, which further illustrates the distinction between dubious and fake news. We conclude that, despite the potential for discord in the group and censure for the individual, dubious news may still perform social functions like that of rumour: group cohesion;personal status;and a sense of control in situations of uncertainty.