DANCE AFTER LOCKDOWN Living with Paradox

This writing explores the experiences of people in the UK's contemporary dance sector during the COVID-19 pandemic.1 It draws on qualitative data from a small research project—Dance after Lockdown—to examine how that sector understands their work, and how the language and ideology of the creative industries have shaped the lives and experiences of contemporary dance artists and institutions in the UK. The paper offers a range of diverse voices as one of the goals of the research was to examine the breadth of experiences, which we hope makes a case for the need to have a dance sector that is flexible and responsive to the needs of many freelance dance artists. © Ateneo de Manila University.

A Series of Catastrophic Events

Case report - Introduction: Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening disease occurring in up to 1% of antiphospholipid syndrome (APS) cases. It was first defined in 1992 and remains a difficult to treat entity with a mortality rate of 37%. We describe a patient with systemic lupus erythematosus (SLE) and CAPS presenting with simultaneous multi-organ injuries who was successfully managed with 'triple' therapy including cyclophosphamide. Case report - Case description: A 42-year-old female presented to her local hospital with chest pain and worsening vision. She had a background of SLE, triple antibody-positive APS (previous DVT, pregnancy loss and strokes), hypertension, a metallic mitral valve, a previous myocardial infarction and pre-existing visual impairment due to a prior intra-cerebral bleed related to anticoagulation. Examination revealed a faint malar rash, cortical blindness and long tract neurological signs. Her ECG showed ischaemic changes and the admission troponin was significantly raised (3773ng/L). An echocardiogram showed new left ventricular dysfunction and a subsequent cardiac MRI was in keeping with coronary artery disease. Investigations showed an acute kidney injury, newly deranged liver function tests and a raised INR (>11, with no bleeding). Complement was normal with a low dsDNA titre. Urinalysis revealed proteinuria and a protein creatinine ratio measured 176mg/mmol. MRI diffusion weighted brain imaging showed acute bilateral occipital and left fronto-parietal infarcts. She had symptoms of a lupus flare with arthralgia and a butterfly facial rash. COVID-19 PCR tests were negative and she had not been recently vaccinated. She was diagnosed with CAPS and transferred to St Thomas' hospital intensive care. On arrival, she received 1mg intravenous vitamin K followed by triple therapy for CAPS: an unfractionated heparin infusion, oral prednisolone 40mg daily, 5 days of plasma exchange and, given her background of SLE, she was treated with intravenous cyclophosphamide (according to the EUROLUPUS regimen). Intravenous methylprednisolone was avoided due to a previous hypertensive encephalopathy reaction. She responded rapidly. Her troponin fell from a peak of 5054 to 294ng/ L, her creatinine settled at a new baseline (232umol/L) and her liver function normalised. She was switched back to warfarin due to her metallic valve and started on aspirin for cardiovascular secondary prevention. She required physical and occupational therapy due to her strokes but recovered well. Case report - Discussion: According to the 2003 criteria, CAPS can be classified as definite when there is evidence of: -3 organs involved, development of manifestations simultaneously or within a week, confirmation by imaging and/or histopathology of small vessel occlusion and positive antiphospholipid antibodies. Probable CAPS is when 3 out of the 4 criteria are present. In this case, three organs were confirmed to be involved with imaging showing cerebral and cardiac ischaemia. Her creatinine rose from a base of 190 to 289umol/L coupled with a high protein creatinine ratio confirming renal involvement. A Budd-Chiari syndrome was also suspected due to deranged liver function tests and INR, though imaging performed after therapy did not confirm this. A biopsy of any of these four organs was not feasible given the severity of her presentation and coagulopathy. There are no randomised controlled trials but data from the CAPS registry guides treatment and management follows a logical approach: anticoagulation to treat thrombosis, glucocorticoids for inflammation and plasma exchange (or IVIG) to remove the circulating autoantibodies. Triple therapy was associated with a reduced mortality compared to no treatment (28.6% versus 75%, respectively). Following analyses from the CAPS registry we also chose to treat with cyclophosphamide, which is associated with improved survival in patients with SLE. This decision was based on the clinical features of an SLE flare as opposed to serological grounds. There have b en reports of rituximab and eculizumab being used successfully in CAPS, though generally as a last resort. As complement activation is seen in animal models of antiphospholipid syndrome thrombosis and rituximab is often used in refractory SLE, they may prove to be promising agents for refractory CAPS. Case report - Key learning points: 1. Prompt recognition and early treatment is vital in managing CAPS 2. Triple therapy with anticoagulation, glucocorticoids and plasma exchange / IVIG is associated with better survival in CAPS 3. Cyclophosphamide is associated with better survival in patients with CAPS and concomitant SLE.

Adapting a Narrative Curriculum to a Remote Format in the Context of Socially Distanced Middle School Education Resulting from COVID-19

This paper describes the development of two versions of an NGSS-aligned principles of engineering design unit for use in middle schools. By employing a narrative framework that can help students to connect more deeply with the human contexts and consequences of the engineering design process, our goal was to enhance students' cognitive and emotional engagement in the learning of engineering design concepts. We first detail the design of an initial version of the unit, titled The Survivorama, which used narrative to enrich a primarily traditional, in-person teaching approach. We then describe the adapted version of the unit, titled the Molasses Disaster, and the modifications we made to the stories and transmedia story elements that facilitated the creation of a fully remote version of the unit. To investigate questions related to the effectiveness of the remote curriculum in sustaining student engagement in the remote context, we carried out a mixed-methods study that looked at (1) teachers' characterizations of the effect of the curriculum on student engagement and (2) student learning outcomes as measured by performance assessment tasks. Qualitative analysis of teacher interviews supported the notion that teachers found both versions of the curriculum to be highly engaging for their students, though with some important caveats regarding younger students and students who were less literate. Quantitative analysis comparing 2019 and 2020 student response data for students in the 2019 nontreatment, 2019 treatment, and 2020 treatment groups found statistically significant differences in the pattern of responses for both problem-solving and conceptual drawing performance assessment tasks. The pattern of responses supported the inference that student engagement was similar for students in both the 2019 in-person context and the 2020 remote context, and that both differed significantly from the 2019 nontreatment group. © 2022, Purdue University Press. All rights reserved.

A Series of Catastrophic Events

Case report - Introduction: Catastrophic antiphospholipid syndrome (CAPS) is a rare, life-threatening disease occurring in up to 1% of antiphospholipid syndrome (APS) cases. It was first defined in 1992 and remains a difficult to treat entity with a mortality rate of 37%. We describe a patient with systemic lupus erythematosus (SLE) and CAPS presenting with simultaneous multi-organ injuries who was successfully managed with 'triple' therapy including cyclophosphamide. Case report - Case description: A 42-year-old female presented to her local hospital with chest pain and worsening vision. She had a background of SLE, triple antibody-positive APS (previous DVT, pregnancy loss and strokes), hypertension, a metallic mitral valve, a previous myocardial infarction and pre-existing visual impairment due to a prior intra-cerebral bleed related to anticoagulation. Examination revealed a faint malar rash, cortical blindness and long tract neurological signs. Her ECG showed ischaemic changes and the admission troponin was significantly raised (3773ng/L). An echocardiogram showed new left ventricular dysfunction and a subsequent cardiac MRI was in keeping with coronary artery disease. Investigations showed an acute kidney injury, newly deranged liver function tests and a raised INR (>11, with no bleeding). Complement was normal with a low dsDNA titre. Urinalysis revealed proteinuria and a protein creatinine ratio measured 176mg/mmol. MRI diffusion weighted brain imaging showed acute bilateral occipital and left fronto-parietal infarcts. She had symptoms of a lupus flare with arthralgia and a butterfly facial rash. COVID-19 PCR tests were negative and she had not been recently vaccinated. She was diagnosed with CAPS and transferred to St Thomas' hospital intensive care. On arrival, she received 1mg intravenous vitamin K followed by triple therapy for CAPS: an unfractionated heparin infusion, oral prednisolone 40mg daily, 5 days of plasma exchange and, given her background of SLE, she was treated with intravenous cyclophosphamide (according to the EUROLUPUS regimen). Intravenous methylprednisolone was avoided due to a previous hypertensive encephalopathy reaction. She responded rapidly. Her troponin fell from a peak of 5054 to 294ng/ L, her creatinine settled at a new baseline (232umol/L) and her liver function normalised. She was switched back to warfarin due to her metallic valve and started on aspirin for cardiovascular secondary prevention. She required physical and occupational therapy due to her strokes but recovered well. Case report - Discussion: According to the 2003 criteria, CAPS can be classified as definite when there is evidence of: -3 organs involved, development of manifestations simultaneously or within a week, confirmation by imaging and/or histopathology of small vessel occlusion and positive antiphospholipid antibodies. Probable CAPS is when 3 out of the 4 criteria are present. In this case, three organs were confirmed to be involved with imaging showing cerebral and cardiac ischaemia. Her creatinine rose from a base of 190 to 289umol/L coupled with a high protein creatinine ratio confirming renal involvement. A Budd-Chiari syndrome was also suspected due to deranged liver function tests and INR, though imaging performed after therapy did not confirm this. A biopsy of any of these four organs was not feasible given the severity of her presentation and coagulopathy. There are no randomised controlled trials but data from the CAPS registry guides treatment and management follows a logical approach: anticoagulation to treat thrombosis, glucocorticoids for inflammation and plasma exchange (or IVIG) to remove the circulating autoantibodies. Triple therapy was associated with a reduced mortality compared to no treatment (28.6% versus 75%, respectively). Following analyses from the CAPS registry we also chose to treat with cyclophosphamide, which is associated with improved survival in patients with SLE. This decision was based on the clinical features of an SLE flare as opposed to serological grounds. There have b en reports of rituximab and eculizumab being used successfully in CAPS, though generally as a last resort. As complement activation is seen in animal models of antiphospholipid syndrome thrombosis and rituximab is often used in refractory SLE, they may prove to be promising agents for refractory CAPS. Case report - Key learning points: 1. Prompt recognition and early treatment is vital in managing CAPS 2. Triple therapy with anticoagulation, glucocorticoids and plasma exchange / IVIG is associated with better survival in CAPS 3. Cyclophosphamide is associated with better survival in patients with CAPS and concomitant SLE.

99 Feasibility and convenience of immunotherapy at home for patients with cancer: a single-centre audit

Background: Immune checkpoint inhibitors (ICIs) are widely used in the treatment of melanoma, renal and lung cancer. ICIs are currently administered intravenously over short hours at variable time intervals and doses. Home-based immunotherapy could be a feasible and convenient option for older patients with comorbidities. Objective: This study aimed to ascertain the feasibility and convenience of home-based immunotherapy administration in our centre for patients with lung, melanoma and renal cancer. Method: We conducted a retrospective audit of patients receiving immunotherapy at home after receiving at least 2 hospital administrations. Patient underwent telephone consultation before each administration, had home blood check organized by district nurse and a 24-hour emergency number given. Result: 43 patients with median age of 71 years with underlying lung (n=14), melanoma (n=25) and renal (n=4) cancer were treated with immunotherapy at home. Male to female ratio was 58:42%. 80% of patients had stage IV disease at commencement with 21% and 7% presenting with de novo bony and brain metastases, respectively. 72% had PS >1;21% >2 co-morbidities with an autoimmune disease in 9%, CVD and COPD in 56% and 19% respectively. 81% of patients received home-based ICIs as palliative first-line. Median time from hospital to home-based ICI switch was 5.1 months (range, 0.9-22.7). 24% of patients had PD, 44% CR/PR and 32% stable disease. In 5% of patients, treatment had to be discontinued due to toxicity;47% had G1/G2 immune-related adverse events;7% had G3/G4 irAEs with skin and/or joints involvement. None had to be switched back to hospital-based. All patients preferred home-based treatment. Conclusion: Immunotherapy at home is feasible and convenient particularly in older patients with poor performance status, comorbidities and at-risk metastases (i.e bone, brain) with a 5% toxicity-related discontinuation rate. No conversion to hospital administration and 100% patients' preference. Patients' and NHS convenience is evident during the unprecedented COVID-19 pandemic, through risk reduction related to regular trips to the hospital, improvement of patients' experience and outpatient clinic capacity. Disclosure: No significant relationships.

Nurse and nurse practitioner-lead monoclonal antibody initiative for solid organ transplant (SOT) recipients with COVID-19

Purpose: Monoclonal antibody (mAB) infusion (bamlanivimab or casirivimab/ imdevimab) for symptomatic, non-hypoxemic, high-risk outpatients with COVID-19 infection, is an available early intervention for COVID-19+ SOT recipients. We aimed to assess efficiency in time from diagnosis to treatment, and outcomes in a retrospective cohort of SOT recipients with COVID-19 who received mAB. Methods: We developed a Nurse Coordinator-led initiative to screen, refer, and facilitate mAB infusion for COVID-19+ SOT recipients within 10 days of symptom onset. SOT recipients received electronic messaging to promptly report potential COVID-19 symptoms to the transplant team. Data were collected on time from symptom onset to diagnosis, mAB infusion, and follow-up > 21 days, and hospital admissions, disease severity, mortality, and rejection. Results: 34 out of 36 referred SOT recipients with symptomatic COVID-19 disease without hypoxia received mAB therapy (3 heart, 8 lung, 16 kidney, 2 Liver-Kidney, 2 Pancreas-Kidney, 3 Kidney-Heart). Median time from symptom onset to diagnosis was 2 days and from date of diagnosis to mAB infusion was 4 days. Of those 34, 88% did not require hospitalization and recovered uneventfully. 12% required hospitalization for COVID disease progression, two on the same day as mAB infusion, and the other 2, more than 26 days post infusion. Of these, 2 patients had mild-moderate hypoxia, and 2 had critical disease. Only 1 patient died from COVID-19 complications and no episodes of rejection or graft loss were observed. Conclusions: The Nurse Coordinator-led initiative efficiently facilitated mAB therapy for COVID-19+ SOT recipients and was associated with excellent outcomes. Compared to prior published COVID-19 outcomes in SOT recipients, patients who received mAB may have reduce hospitalization and low mortality. As mAB therapy may be underutilized in the general population, these results support efforts to educate transplant centers to implement efficient interventions for the screening and referral of COVID+ SOT recipients for mAB therapy.

The Impact of COVID-19 on Teaching and Learning in Higher Education

The outbreak of the COVID-19 pandemic has generated much uncertainty around the HE landscape. Global lockdown measures led to university campuses closing and moving to an online mode for teaching and learning. Scholars have reported that the physical closure of HE institutions has been detrimental to student learning worldwide, whilst others have advocated the possible opportunities that may arise from reshaping HE through technologies. The disruption caused to education by the pandemic has had a significant impact on the learning experience for students;self-directed study time has increased, levels of stress and anxiety experienced by students has increased, and the lack of face-to-face interaction with lecturers and other students has led to feelings of isolation. Educators have reported that due to the immediate urgency of the lockdown there was little time to plan in advance for online delivery and assessment. From a financial perspective, the effects of the pandemic led to a loss for UK universities of £790 million during 2020, which is forecast to increase to a loss of £2.6bn during 2021. Enrolment numbers have declined, and the recruitment of international students, who make up a high number of the market sector, has been severely impacted. It is clear that HE institutions as a whole are facing significant challenges in these uncertain times. This edited collection addresses the need to examine the far-reaching impacts of the COVID-19 pandemic upon teaching and learning in higher education, examining the challenges and opportunities associated with the impact of the COVID-19 pandemic and outlining current perspectives, practices and innovations which will contribute to an understanding of the current situation for higher education institutions. Research and best practices on adapting to online modes of delivery and the implications of this are reported upon. The need for this edited collection is to share best practices with educators during this time of uncertainty. © 2021 by Nova Science Publishers, Inc. All rights reserved.

Summing up the impact of Covid-19 on student experience and expectations

Amongst the many important questions that the public health crisis of 2020/21 has forced the higher education (HE) sector to confront is that of the student experience. This chapter brings together the themes from the previous chapters of this book and suggests at least some possible ways forward as the sector begins a recovery. The interest in student experience stems from the continued rise of commercialisation in university provision where the role of the student is more akin to that of consumers. However, the pandemic has added a nuance to this relationship as students have of necessity had to become more participative and actively involved in their studies so that the relationship is more of a partnership than consumer/producer. The holistic package of the student experience has undoubtedly been radically shaken by COVID. The chapters in this book are testament to the way that some institutions have moved incredibly far and incredibly fast to preserve what they feel is valued by their students. Only a detailed future evaluation will show if we focussed on the right things. The conclusion of this chapter sets out some effective steps forward as we see them. © 2021 Nova Science Publishers, Inc.

Dysphagia presentation and management following COVID-19: an acute care tertiary centre experience.

OBJECTIVES: As the pathophysiology of COVID-19 emerges, this paper describes dysphagia as a sequela of the disease, including its diagnosis and management, hypothesised causes, symptomatology in relation to viral progression, and concurrent variables such as intubation, tracheostomy and delirium, at a tertiary UK hospital. RESULTS: During the first wave of the COVID-19 pandemic, 208 out of 736 patients (28.9 per cent) admitted to our institution with SARS-CoV-2 were referred for swallow assessment. Of the 208 patients, 102 were admitted to the intensive treatment unit for mechanical ventilation support, of which 82 were tracheostomised. The majority of patients regained near normal swallow function prior to discharge, regardless of intubation duration or tracheostomy status. CONCLUSION: Dysphagia is prevalent in patients admitted either to the intensive treatment unit or the ward with COVID-19 related respiratory issues. This paper describes the crucial role of intensive swallow rehabilitation to manage dysphagia associated with this disease, including therapeutic respiratory weaning for those with a tracheostomy.

Pneumothorax and Pneumatocoele Formation in a Patient with COVID-19: a Case Report.

Coronavirus disease 2019 (COVID-19) causes significant morbidity and mortality for a proportion of infected patients, and our knowledge and understanding of its clinical, radiological and histopathological features are still evolving. An association between COVID-19 and pneumothorax has been described in an increasing number of case reports and series in the literature, which have largely focused on clinical and imaging features. We report the case of a patient who developed COVID-19 complicated by pneumothorax, requiring surgical intervention. We describe the histopathological features seen in the thorascopically resected bullectomy specimen-this is, to our knowledge, the first reported description of the morphological features of pneumothorax in this important clinical setting.