How attachment styles predict changes in sexual desire: A study of sexual dynamics in COVID-19

The COVID-19 pandemic has had far-reaching impacts on many aspects of life, including sexual behaviours and preferences. In this longitudinal study, the authors used attachment theory to investigate changes in an individual's sexual desire for their partner as well as changes in their sexual desire for someone other than their primary romantic partner (extradyadic desire) over the first wave of the pandemic in Canada. Based on past research that has shown that avoidant individuals tend to avoid intimacy, the authors reasoned that increased contact with their romantic partner due to physical distancing guidelines and lockdown rules would contribute to avoidant individuals' experiencing less sexual desire for their partner and greater extradyadic desire over time. In contrast, individuals high on attachment anxiety tend to seek proximity, especially during times of stress. The authors predicted that individuals' sexual desire for their partner would increase and their extradyadic desire would decrease. They tested these hypotheses using a cohabiting, dyadic sample (N = 308 individuals);study participants were contacted at 1-month intervals for three successive months and asked to complete an online survey. Our hypotheses were partially supported. As predicted, individuals high on attachment avoidance experienced higher levels of extradyadic desire, and individuals high on attachment anxiety reported lower extradyadic desire over time. Contrary to predictions, however, neither attachment pattern was associated with changes in sexual desire for the partner. The authors examine the theoretical implications of these findings, highlighting the need for a more fine-grained assessment of stress and the interaction between stress and attachment orientations in future research.Copyright © Sex Information and Education Council of Canada, 2023.

A collaborative approach to research study recruitment in PLWH during the SARS CoV-2 pandemic

Background: Since COVID there are fewer site investigator meetings for non-CTIMP studies to discuss recruitment barriers. Additionally, literature highlights various research trials that have successfully recruited do not report their strategies, consequently impacting ability to learn from success. The pandemic has had considerable impact on enrolment to clinical research, thus services have needed to revaluate their approach. Following the pandemic, patients report more likely to engage in research if offered remote or combined visits. Method(s): We reviewed recruitment strategies at our clinic for two observational studies with large targets (SCAPE-HIV, Positive Voices). SCAPE-HIV, a prospective study exploring immune responses of PLWH to SARS CoV2 infection and vaccination. Positive Voices, a crosssectional questionnaire study. Minimum recruitment targets, 600 and 262 respectively. SCAPE involves open-offer enrolment, Positive Voices from a defined pre-selected cohort. Initial approaches identified people opportunistically at clinic visits, with research staff offering information. However, reaching our targets through COVID became challenging and a move to virtual appointments condensed our opportunities to approach. To increase recruitment, engagement and training of NHS nursing and clinical staff was undertaken alongside remote patient contact. Result(s): After implementing collaborative methods, Positive Voices recruitment increased to 170 in July/ August 2022 (73 in May/June). SCAPE recruitment also improved. Hybrid nurse practitioners dedicating time to approach people during clinic visits and clinic staff involvement attributed to this rise, representing over half of consents (Table A). The clinic team's substantial knowledge of our cohort, combined with their openness to research, leads to greater understanding of how likely individuals are to accept studies. Conclusion(s): Positive Voices and SCAPE-HIV studies have been successful with recruitment due to a collaborative approach, resulting in our site being the highest current recruiting site involved in Positive Voices. This approach has helped motivate the NHS team to become more involved and has become an exemplar for clinical trial delivery within our Trust. (Table Presented).

Impact on quality of life from multi-modality treatment for lung cancer: a randomised controlled feasibility trial of surgery versus no surgery as part of multi-modality treatment in potentially resectable stage III-N2 NSCLC (the PIONEER trial)

Introduction: Optimal treatment of stage III-N2 NSCLC requires multi-modality treatment: local treatment (surgery or radiotherapy) and systemic anti-cancer therapy. There is no clear evidence of superiority for survival between surgical and non-surgical approaches and little research has explored quality of life as an endpoint (QOL). Methods: Randomised controlled feasibility study. Patients are randomised to receive multi-modality treatment 1) with surgery OR 2) without surgery. Eligible patients have ‘potentially resectable’ N2 NSCLC and have received an MDT recommendation for multimodality treatment. Sixty-six patients and their carers will be recruited from 8 UK centres. Patient/carer QOL questionnaires will be administered at baseline, weeks 6, 9, 12 and month 6, data will be analysed descriptively. Semi-structured interviews will be conducted and framework analysis applied. Results: Recruitment is ongoing (opened November 2020). Despite COVID-19 related challenges, we have opened six sites, approached 14 patients and successfully recruited nine patients (64% consent rate) and five carers. Four patients and two carers have completed the trial. Five patients (55%) have completed all outcome data to date and eight patients (89%) have received their allocated treatment. NSCLC N2 patients being assessed at MDTs at recruiting sites are being assessed for eligibility. Forty-seven N2 patients have been identified as ineligible. Reasons for ineligibility include: not suitable for surgery;referred for best supportive care;MDT decision regarding most appropriate treatment;patient choice regarding treatment;other. Conclusion: There have been challenges to site opening due to sites focusing on COVID related studies only. Three sites have only opened in the past 6 months and a further two are due to open which should increase recruitment. Despite delays we have successfully recruited nine participants and all but one have received their allocated treatment. Results will inform the design of a future fully powered randomised trial with QOL as the primary outcome.

A nurse-led cardiovascular disease prevention clinic

Background: Patients who present to our hospital with a vascular event receive appropriate preventative measures and are discharged to Primary Care without further specialist review. We have initiated a Cardiovascular Disease Prevention Clinic to provide specialist review for all patients at one year following their index event. Purpose: This project was undertaken to assess the implementation of guideline-directed preventative treatment within our current patient pathway, thereby establishing the need for, and the likelihood of benefiting from a secondary care specialist clinic. Methods: The medical notes of all patients on our angiography database over a 6 month period were scrutinised. This included the majority of patients diagnosed with acute coronary syndromes [ACS] and symptomatic coronary artery disease [CAD] over this period. Patients with confirmed atheromatous CAD were screened for clinical features that would put them at high risk of recurrent events. These risk factors were identified in recent landmark trials[1,2] and include: diabetes, eGFR <60, age >65 years, multi-vessel disease, recurrent events within 3 years, and heart failure. Of the high risk patients, those whose management was deemed suboptimal were invited to attend the clinic that is nurse led, protocol driven, with a Consultant available for advice. All appointments were conducted via telephone in view of COVID precautions. Patients were assessed according to guideline targets for cardiovascular risk factors[3,4,5]. Lifestyle habits were reviewed with appropriate guidance provided for the patient. Results: 833 patients were screened, of which 175 patients fulfilled the above criteria and so invited to the clinic. 2 patients declined the appointment. Table 1 summarises the guideline targets not achieved by the high risk cohort. 132 patients (75.8%) met the criteria for consideration for DOAC[6]. Of these, 80 (60%) had a relative bleeding contraindication or declined therapy. 155 (88.6%) met the criteria for consideration for longer-term P2Y12i[7]. Of these 139 (89.7%) had relative bleeding contraindications or declined therapy. Interventions implemented at this clinic are summarised in Table 2. All patients were given advice with regard to lifestyle modification strategies. Conclusion: The discharge pathway for patients diagnosed with ACS and symptomatic CAD includes cardiologist prescribing, cardiac rehabilitation nurse review and primary care follow-up. Despite this, we showed that a significant number of patients with CAD and at high risk of recurrent events failed to achieve secondary prevention targets at one year following their index event. A specialist CVD prevention follow-up clinic can result in significant improvements in patient management over and above the usual standard of care and we should anticipate a reduction in cardiovascular events as a result of this. A nurse led clinic with prescribing protocols based on current guidelines is a successful clinic model. (Figure Presented).

Providing Virtual Technological Training to Older Adults in Response to COVID-19 Social Distancing

Background: In America there are currently many older adults living alone in hopes of maintaining their independence. COVID-19 emphasized the pre-existing issue of social isolation among older adults, especially with society's ever-increasing dependence on technology. In response to the pandemic, the HealthWise program was created to teach older adults about technology, using Zoom©, to increase comfortability and confidence when using technology. Methods: To participate in HealthWise, participants needed to be 55 or better, have WIFI connection and the ability to participate in sessions for the duration of the program. All participants were assigned to trained coaches, who were students at Eastern Virginia Medical School. During the first session each participant signed a consent form and completed a 14-question survey. Questions included multiple choice and Likert scales pertaining to age, race, educational level, frequency of technology use, and their level of comfort using technology. One-hour sessions were conducted twice a week for three months. The goal was for participants to gain proficiency in the following skills: WIFI, Zoom ©, email and the Birdsong App, an internet- based software for older adults. Results: There were 66 participants total. 56% of all participants lived alone, while 24% lived with their spouse. 24% completed some college but have no degree, 20% had a bachelor's degree, 18% had a master's degree, 15% had a high school degree (or equivalent) and 12% had an associate degree. 88% of participants use technology more than five plus times per week, while only 12% use technology less than five times. Of those using technology consistently, only 40% are comfortable with their abilities. Participants with an associate degree or higher reported to be more comfortable using technology compared to participants with a high school education or lower (p-value, 0.025). Conclusion: The pre-survey data demonstrates there is a need within the older adult population to receive technological training. In addition, the data shows an interest among older adults to receive training despite education level and current levels of comfort using technology. Additional research will be conducted to gather data on retention of skills and comfortability using technology.

Home care professionals' views on working conditions during the COVID-19 pandemic: the case of Ireland

This article examines home care professionals' views on working conditions during the COVID-19 pandemic. In particular, it identifies similarities and differences between private, public and non-profit providers. The article seeks to shed light on the impacts of marketisation/privatisation on working conditions during the pandemic. Statistical tests on 350 questionnaires received from care workers in Ireland demonstrate the difficult working conditions during COVID-19 and variations by type of employer. We discuss an apparent 'return of the state' in home care provision during the pandemic, which may have dampened differences between types of providers.

Structure/Function Analysis of Truncated Amino-Terminal ACE2 Peptide Analogs That Bind to SARS-CoV-2 Spike Glycoprotein

The global burden of the SARS-CoV-2 pandemic is thought to result from a high viral transmission rate. Here, we consider mechanisms that influence host cell–virus binding between the SARS-CoV-2 spike glycoprotein (SPG) and the human angiotensin-converting enzyme 2 (ACE2) with a series of peptides designed to mimic key ACE2 hot spots through adopting a helical conformation analogous to the N-terminal α1 helix of ACE2, the region experimentally shown to bind to the SARS-CoV-2 receptor-binding domain (RBD). The approach examines putative structure/function relations by assessing SPG binding affinity with surface plasmon resonance (SPR). A cyclic peptide (c[KFNHEAEDLFEKLM]) was characterized in an α-helical conformation with micromolar affinity (KD = 500 µM) to the SPG. Thus, stabilizing the helical structure of the 14-mer through cyclization improves binding to SPG by an order of magnitude. In addition, end-group peptide analog modifications and residue substitutions mediate SPG binding, with net charge playing an apparent role. Therefore, we surveyed reported viral variants, and a correlation of increased positive charge with increased virulence lends support to the hypothesis that charge is relevant to enhanced viral fusion. Overall, the structure/function relationship informs the importance of conformation and charge for virus-binding analog design.

Hospital Course of Patients Receiving Bamalanivimab: A Real World Analysis

Background. Monoclonal antibodies for the outpatient treatment of the novel Coronavirus Disease 2019 (COVID-19) first received emergency use authorization from the Food and Drug Administration in November 2020. These antibodies have been associated with a reduction in emergency department visits and hospitalization through randomized controlled trials. However, modest data is available to describe the outcomes of patients who were hospitalized despite treatment. This study describes real-world outcomes concerning the treatment of COVID-19 with the first approved monoclonal antibody for COVID-19, bamlanivimab, as well as hospital courses associated with patients admitting after receiving the therapy. Methods. This single-center, retrospective study evaluated real-world data of patients treated with bamlanivimab. The primary endpoint was a composite of emergency department (ED) visits or hospitalization due to worsening COVID-19. Data was analyzed from November 23, 2020 to March 5, 2021. Descriptive statistics were used to analyze the primary endpoint. Secondary endpoints include reported symptoms 24-hours post-infusion and time to symptom resolution in days. Additionally, clinical course of patients hospitalized were analyzed and include average oxygen requirements, median length of stay, and mortality. A subgroup analysis was conducted between patients less than sixty-five years of age and those sixty-five and older. Results. 619 patients received bamlanivimab during the specified timeframe. The primary endpoint occurred in 34 patients;11 ED visits and 23 hospitalizations. Baseline characteristics of the patients hospitalized include median age 69 years (IQR 55, 74), 56.5% male, and 82.6% Caucasian. The most common risk factors for severe disease among those hospitalized were age ≥ 65 years and history of diabetes. The clinical course of hospitalized patients varied but 52.9% required nasal cannula for respiratory support and the average length of stay was 4.5 + 4.5 days. Other COVID-19 therapies included dexamethasone in 76.5% of patients and remdesivir in 47.1% of patients. There were no major differences in the subgroup analysis. Conclusion. Bamlanivimab appears to attenuate the clinical course of COVID-19 in patients who are hospitalized despite treatment.

Relationship between Course-Level Social Belonging (Sense of Belonging and Belonging Uncertainty) and Academic Performance in General Chemistry 1

Students' social belonging in a general chemistry course has been shown to predict academic performance in that course. Additionally, students' social belonging at the beginning of a general chemistry course has been shown to differ across demographics, such as gender. This social belonging exists as both an absolute sense of belonging in the course and as an uncertainty in that belonging. Both social-belonging components are important for students' performance and retention in science, technology, engineering, and mathematics (STEM) fields. In addition to differential social belonging across demographics at the beginning of the course, social belonging can change in response to course performance. This change in social belonging may further affect performance which may further affect social belonging in a recursive spiral. In this study, we investigated the recursive effect between course-level social belonging (measured as two separate, but correlated, components: sense of belonging and belonging uncertainty) and course performance in a general chemistry 1 course delivered in a hybrid online format due to the COVID-19 pandemic. We found evidence that course-level social belonging and course performance interact with each other through a recursive mechanism during a semester of general chemistry 1. These findings highlight the importance of implementing inclusive interventions continuously throughout a general chemistry 1 course, particularly after key assessments, such as exams. © 2021 American Chemical Society and Division of Chemical Education, Inc.

A systematic review of international guidelines regarding the role of radiography in the diagnosis of osteoarthritis

Background: A substantial proportion of primary care osteoarthritis (OA) consultations are associated with an X-ray request (1,2). Uncertainty exists regarding the ability of radiography to improve a clinical OA diagnosis, and the over-use of radiography may lead to inappropriate referrals due to severe radiographic features that do not correlate with patients' symptoms. Additionally, there are cost implications of unnecessarily imaging such a prevalent disease. As evidence questions the utility of routine radiography in OA, the extent to which radiography is supported by international guidelines is unknown. Objectives: To undertake a systematic review and narrative synthesis of UK and international guideline recommendations on the role of radiography in the diagnosis of OA. Methods: A systematic search of eleven electronic databases (including EMBASE, MEDLINE CINAHL, Epistemonikos and Guideline Central) and the websites of nine professional organisations (including NICE, Royal College of Radiologists (RCR), EULAR, and the American College of Radiology (ACR)) identified the most recent evidence-based guidelines produced by professional organisations on the role of imaging in OA. Guidelines not addressing the role of radiography in the diagnosis of OA were excluded, as were non-English and spinal OA guidelines. Each title was screened by one reviewer whilst each abstract and full text underwent dual screening. A single reviewer, using a standard proforma, undertook data extraction. Each guideline was independently appraised by two reviewers using the AGREE II tool. A narrative synthesis of the nature and consistency of OA radiographic recommendations was performed. Results: 18 evidence-based OA guidelines published between 1998-2019 were included. These guidelines considered OA at any joint (n=8), or at the knee (n=3), hip (n=2), hand (n=2), wrist (n=1), foot (n=1), and ankle (n=1). Seven guidelines were produced by European organisations;four guidelines were produced by EULAR. Guidelines were targeted at general practitioners (n=11), radiologists (n=7), rheumatologist (n=4) and orthopaedic surgeons (n=3). Using the AGREE II tool, the identified guidelines scored highly on rigour of development (mean score 69%) but poorly on applicability (32%). All 18 guidelines recommended X-rays as the first-line modality, where imaging was indicated. A clinical diagnosis of OA without radiographic confirmation was recommended by all eleven guidelines produced by organisations represented general practitioners, with seven guidelines justifying this due to a poor correlation between radiographic features and clinical symptoms. Only three guidelines explicitly discouraged the routine use of radiography for the diagnosis of OA and only two guidelines reassured practitioners of a low probability of missing serious pathology when not routinely requesting radiographs. Guidelines produced by organisations representing radiologists were more supportive of radiography. The ACR recommended radiographic confirmation in patients suspected to have OA at the hand, wrist, hip, knee, ankle, and foot. Conversely, the RCR recommended radiographic confirmation in patients suspected to have OA at the hand, feet, and hip, but not the knee. Conclusion: Differences in guideline recommendations on the utility of radiography in OA appear related to country/region, professional organisation, and joint. The use and utility of radiography in OA may need to be reviewed in light of a shift towards remote consultations, a change that has been accelerated by COVID-19 in many countries.

COVID-19 clinical course and outcomes in a predominantly black, vulnerable patient population in New York City

Introduction: A study examining the impact of social determinants of health on COVID-19 outcomes is necessary to identify which aspects of a vulnerable population make it more susceptible. We describe the epidemiological and clinical characteristics of a patient population disproportionately impacted by COVID-19 and situate the findings within the broader context of health determinants. Materials and Methods: A descriptive study of 527 laboratory-confirmed COVID-19 patients hospitalized from March 12 to April 13, 2020, evaluated patient demographics, comorbidities, presentation, and outcomes. The study took place at an academic medical center serving a low-income, Black community (predominantly Caribbean-born) in Brooklyn, New York. Results: Compared to previous studies, we report a higher median age of 70 (interquartile range 59-80), a higher percentage of Blacks (91%), a higher prevalence of comorbidities (hypertension [83%], diabetes [53%], and obesity [42%]), a higher prevalence of abnormal findings on presentation (altered mental status [30%], Quick sequential organ failure assessment score ≥2 [27%], elevated random-glucose [77%], elevated creatinine [57%]), and a higher incidence of negative in-hospital outcomes (intensive care unit admission [21%], mechanical ventilation [21%], acute kidney injury [31%], acute respiratory distress syndrome [17%] and acute cardiac injury [18%], and age-adjusted fatality rate [40%.]). Conclusions: This study shows the characteristics of a patient population disproportionately impacted by COVID-19. The intersectionality of the Black race, older age, a high prevalence of comorbidities, and residency in a locale severely affected by COVID-19, deserves further consideration to better address health outcomes in vulnerable patient groups. The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and Procedural skills, Systems-based practice. © 2021 Wolters Kluwer Medknow Publications. All rights reserved.

A sparse bayesian model selection algorithm for forecasting the transmission of COVID-19

Introduction: Many variations of the Kermack-McKendrick SIR model were proposed in the early stages of the SARS-CoV-2 pandemic to study the transmission of COVID-19. The current state-of-the-art 16 compartment model developed by Tuite et. al (2020) is used to simulate the influence of government policies and leverage early available clinical information to predict the dynamics of the disease. As much of the world is now experiencing a second wave and vaccines have been approved and are being deployed;it is critical to be able to accurately predict the trajectory of cases while integrating information about these new model states and parameters. Challenges for accurate predictions are two-fold: firstly, the mechanistic model must capture the essential dynamics of the pandemic as well provide meaningful information on quantities of interest (e.g. demand for hospital resources), and secondly, the model parameters need to be calibrated using epidemiological and clinical data. Methods: To address the first challenge, we propose a compartmental model that expands upon model developed by Tuite et al. (2020) to capture the effects of vaccination, reinfection, asymptomatic carriers, inadequate access to hospital resources, and long-term health complications. As the complexity of the model increases, the inference task becomes more difficult and prone to over-fitting. As such, the nonlinear sparse Bayesian learning (NSBL) algorithm is proposed for parameter estimation. Results: The algorithm is demonstrated for noisy and incomplete synthetic data generated from an SIRS model with three uncertain parameters (infection rate, recovery rate and the rate temporary immunity is lost). As an example, Figure 1 shows the calibration of the three uncertain model parameters within a Bayesian framework while avoiding over-fitting by inducing sparsity in the parameters. Assuming there is little prior information available for the parameters, they are first assigned non-informative priors. Before NSBL, the model (red curve) is over-parameterized, and fails to predict the decline of the (blue) infection curve. The NSBL algorithm makes use of automatic relevance determination (ARD) priors, and finds one of the model parameters to be irrelevant to the dynamics. Removing the irrelevant parameter and re-calibrating enables the model (green curve) to capture the peak of the infection curve. Conclusion: An optimally calibrated model will allow for the concurrent forecasting of many hypothetical scenarios and provide clinically relevant predictions.

Establishing an adolescence epilepsy transition clinic - An RCPCH EQIP project

Objective: Paediatric patients with epilepsy reaching transition stage to adult neurology were only being offered one joint "handover clinic". Patients and their families had no preparation for this transition. Likewise, there was little preparation by clinicians for which issues needed discussion. A need to improve the transition care of patients was identified and the 'Ready Steady Go' transition model was chosen. Our team were a part of the EQIP pioneers to participate within the first paediatric epilepsy quality improvement collaborative pilot (RCPCH EQIP) in England and Wales, managed by the Epilepsy12. The purpose of the pilot was to provide 12 paediatric epilepsy teams with practical training and support and help them uncover the gaps in service provision and develop interventions that meet their specific needs. Our aim was 90% of 14 to 16 year olds with epilepsy to have been sent 'Ready, Steady, Go' questionnaires by May 2020. Methods: In cycle 1, we established how patients and families would like to receive information about their healthcare. In cycle 2, we tested efficacy of the process by completing questionnaires with one patient in clinic, and with another patient by telephone. In cycles 3 and 4, we established a shared network folder for storing questionnaires and created a 'Watch list' of all transition patients to track process. In cycle 5, due to COVID-19 we had an additional task of piloting a video-clinic with 2 consultants, 1 specialist nurse, patient, and carers all in separate locations. Feedback was collected from all patients. Results: 98% of all 14 to 16-year olds with epilepsy were sent the 'Ready, Steady, Go' questionnaires by May 2020. We have established a bi-monthly consultant led transition clinic and additional nurse led clinics to support this. Conclusion: We have now embedded the routine collection of transition information into regular clinical practice.

Reducing patient harm following inadvertent endobronchial placecement of nasogastric tubes in patients with SARS-COV-2

Introduction: Nasogastric tube (NGT) insertion is essential for enteral feeding but can potentially cause significant injury to the lungs (1). Following a critical incident, we audited our practice of NGT insertion and the consequences of injury in patients with Severe Acute Respiratory Syndrome COVID-19 caused by the (SARS-CoV-2) virus. Methods: NGT insertion followed a local standard safety protocol and were inserted by consultants or senior registrars in anaesthesia and critical care medicine, or advanced critical care practitioners. Individual practitioners were able to choose their technique of insertion. All patients had their post-NGT insertion chest x-ray reviewed and those with misplaced NGTs had their case notes reviewed. Early in the outbreak, blind insertion was recommended in our institution to reduce aerosolisation, this was rapidly changed to direct visualisation with laryngoscopy as our experience managing SARS-CoV-2 patients increased. Results: During the SARS-CoV-2 pandemic, a total of 135 NGTs were inserted into ventilated and/or extracorporeal membrane oxygenation (ECMO) patients. All of NGTs positioned were confirmed by a chest radiograph. Eleven (8.1%) were inadvertently endobronchial, of which four developed pneumothoraces (figure 1). Three patients (including both who had received ECMO) died and a fourth is currently undergoing a prolonged respiratory wean. No patients were fed or received drugs via a misplaced NGT. Chest radiograph of patient with inadvertent NGT placement in right lower lobe. Note the path of the tube suggests breech of the bronchial tree and direct injury to the lung parenchyma (arrowhead). A CT the following day showed a large pneumothorax (arrowhead), some haemothorax (black arrow) and severe ground glass changes consistent with SARS-CoV-2 (white arrow). Discussion: Our inadvertent endobronchial NGT rate is relatively high, compared to our previous clinical experience, which we believe may be related to the challenges of working with cumbersome personal protective equipment and/or changed practice to attempt to reduce transmission of SARS-CoV-2 (2). We suspect the lung parenchyma is particularly fragile in acute respiratory distress syndrome caused by SARS-CoV-2, which contributes to the high rate of pleural breech and subsequent poor outcome (3). We recommend experienced operators place NGTs and do so using direct or videolaryngoscopy to minimise the risk of incorrect placement. We would like to thank the families of our patients for their permission to share the images in this work.