From a generational disembodiment to the opening of an inheritance box: a current clinic with children of Holocaust survivors, former Jewish children hidden during the Occupation

This article reports on a particular clinic with caregivers of spouses and parents suffering from Alzheimer's disease who are survivors of the Shoah, more precisely former Jewish children hidden in France during the Second World War. After a description of this innovative system and the particularity of the psychopathology of the former hidden Jewish children and their descendants, we will show how the lockdown imposed in 2020 due to the health crisis produced by the circulation of Covid-19 impacted these clinical follow-ups and functioned as a magnifying glass effect of the "telescoping of generations”, like a generational nesting. From a particular clinical follow-up, we will show how the reception of an inherited box made it possible to work on a generational disembedding and to support a dynamic of elaboration. © 2023 Boeck Universite. All rights reserved.

Colorectal two-week wait service and quantitative FIT: it's not just about colon cancer

IntroductionThe aim of this study was to assess faecal immunochemical test (FIT) negativity in terms of its effect on cancer risk in the local symptomatic two-week wait (2WW) population. FIT was introduced to the colorectal 2WW pathway at the start of the pandemic. This study analyses the FIT-negative (<10µg Hb/g) cohort and calculates the relative risk and odds ratio associated with a negative FIT test.MethodsFIT tests were sent to symptomatic 2WW patients without rectal bleeding, iron-deficient anaemia or palpable mass. Where FIT was <10µg Hb/g investigations were moved to a radiology protocol.ResultsThe test return rate was 91% with a FIT-negative (<10µg Hb/g) rate of 82%. The FIT-negative group in the symptomatic referral pathway in Cornwall have a low (1.4%) risk of colon cancer but a significant risk (6.6%) when all cancer types are considered. The impact of a negative quantitative FIT changes the odds ratio of a patient having a luminal cancer by 0.26. The odds ratio for ‘all cancer' risk was affected by 0.83.ConclusionA negative FIT test within the local NG12 symptomatic patient group signifies a low risk of colon cancer and identifies patients who can be initially investigated with cross-sectional imaging. However, when all cancer types are considered, cancer prevalence in this group remains above 6%. In relative risk terms a negative FIT represents a small change in overall risk and this patient group still qualify for investigation through 2WW pathways.

Trainee Perspectives on Internship and Fellowship Training Experiences in Pediatric Health Service Psychology during a Global Pandemic

The impact of COVID-19 on the psychology training community has included modifications to internship and postdoctoral fellowship training programs to assure the safety of patients, trainees, and staff. Studies assessing the impact of COVID-19 on training in health service psychology are emerging;however, few studies have provided the opportunity for psychology trainees to candidly report about their experiences during the ongoing pandemic. This paper aims to describe how the pandemic effected internship and fellowship training experiences from the trainee’s perspective. Participants included 58 trainees from pediatric psychology internship and postdoctoral fellowship programs in the United States. A survey containing open- and close-ended questions was distributed to trainees via their training directors to assess training experiences during COVID-19. Qualitative analysis of responses revealed four themes describing 1) reduced depth and breadth of training opportunities, 2) social isolation and limited professional and personal support, 3) increased use of telepsychology and reduced in-person training, and 4) increased levels of stress and burnout combined with decreased morale. Many internship trainees described pandemic-related challenges to completion of dissertation, and postdoctoral fellows experienced altered or delayed professional trajectories due to financial, mental health, and career readiness factors. Implications and future directions include the need for increased support both professionally and personally for trainees who are completing internship and postdoctoral fellowship training in the midst of COVID-19.

IMMUNE EXHAUSTION IS ASSOCIATED with PERSISTENT SARS-CoV-2 VIREMIA and SEVERE DISEASE

Background: SARS-CoV-2 viremia is associated with adverse outcomes in COVID-19. The immunologic mediators of this relationship remain under-explored. In this study, we aimed to evaluate the correlation between immune exhaustion markers, SARS-CoV-2 viremia clearance and clinical outcomes. Methods: We included 126 participants with confirmed SARS-CoV-2 infection who were hospitalized at an urban hospital in Boston, Massachusetts, during the first surge of the COVID-19 pandemic in early 2020. Plasma samples from days 0, 3, and 7 of hospitalization were available for analyses. The plasma SARS-CoV-2 viral load was determined by reverse transcription quantitative PCR (RT-qPCR). Proteomics data were generated using the Olink platform and neutralization level was assessed using a pseudovirus neutralization assay. Viremia persistence was defined as >40 copies/ml (detection limit) if the baseline detectable viremia was <1000 copies/ml, or >100 copies/ml (quantification limit) if the baseline viremia was ≥1000 copies/ml at day 7 of admission. Partial least-squares discriminant analysis (PLS-DA) was used to select exhaustion markers that could distinguish viremia persistence and clearance. An exhaustion score was generated based on features selected by PLS-DA and was divided into four quartiles. Differentially expressed proteins between 1st and 4th quartiles were determined by linear model adjusting for baseline characteristics. R (4.1.0) was used for statistics. Results: Viremia persistence was associated with a higher level of baseline viremia, a higher rate of severe diseases and mortality within 28 days of follow-up. Viremia persistence was associated with elevation of certain exhaustion protein markers including TIM3, PDL1, LGALS9, LAG3 and IL2RA. With PLS-DA, we selected TIM3, PDL1, and LGALS9 into the exhaustion score modeling. A higher exhaustion score was associated with higher baseline viremia, persistent viremia, severe disease, and death (Figure). When compared to the lowest exhaustion score (1st quartile), the highest exhaustion score (4th quartile) was associated with elevation in proteins belonging to IL-18 signaling pathway, lung fibrosis, and immune evasion in COVID-19. The immune exhaustion level was not associated with the neutralization level. Conclusion: In participants with COVID-19, soluble exhaustion markers are associated with delayed viremia clearance, immune evasion independent of humoral immunity development, and adverse outcomes.

Training Directors’ Perspectives of Psychology Intern and Postdoctoral Fellow Training Experiences during COVID-19: A Changing Landscape

The COVID-19 pandemic has affected professional training in health service psychology. Although training provided by psychology internship and postdoctoral fellowship programs has continued, programs have altered the opportunities available to assure the safety of patients and providers. This paper aims to describe training directors’ (TD) perspectives of how COVID-19 has impacted training experiences. Participants included 63 TDs from child and adolescent psychology internship and postdoctoral fellowship programs, most of which are located in the United States. A survey containing open- and close-ended questions was distributed to TDs to assess alterations to training experiences due to COVID-19. Responses described increased use of telehealth, video/virtual supervision, safety precautions/procedures, reduced in-person clinical opportunities, and decreased morale. Assessment, communication and interpersonal skills, intervention, and consultation and interprofessional/interdisciplinary skills were the profession-wide competencies most negatively impacted. Qualitative analysis revealed five themes describing how COVID-19 (1) affected the depth and breadth of training;(2) reduced organic, in the moment experiences;(3) increased stress and decreased trainee and staff morale;(4) limited in-person assessment training;and (5) altered and reduced interdisciplinary collaboration. The ongoing pandemic has had positive and negative impacts on the experiences of trainees completing internship and postdoctoral fellowship programs. Although TDs reported increased opportunity to train in telehealth service provision, it is imperative that trainees are able to gain clinical experiences in the context of this pandemic that meet training expectations in depth and breadth of skills needed to assure readiness to transition into the field of independent practice as emerging psychologists.

Early cross-coronavirus reactive signatures of humoral immunity against COVID-19

The introduction of vaccines has inspired hope in the battle against SARS-CoV-2. However, the emergence of viral variants, in the absence of potent antivirals, has left the world struggling with the uncertain nature of this disease. Antibodies currently represent the strongest correlate of immunity against SARS-CoV-2, thus we profiled the earliest humoral signatures in a large cohort of acutely ill (survivors and nonsurvivors) and mild or asymptomatic individuals with COVID-19. Although a SARS-CoV-2-specific immune response evolved rapidly in survivors of COVID-19, nonsurvivors exhibited blunted and delayed humoral immune evolution, particularly with respect to S2-specific antibodies. Given the conservation of S2 across 0-coronaviruses, we found that the early development of SARS-CoV-2-specific immunity occurred in tandem with preexisting common I3-coronavirus OC43 humoral immunity in survivors, which was also selectively expanded in individuals that develop a paucisymptomatic infection. These data point to the importance of cross-coronavirus immunity as a correlate of protection against COVID-19.

What Do Values Have to Do With It?: Resilience of Two Types of Farmers in Hawai‘i to the COVID-19 Pandemic

A history of agriculture and socio-cultural formation has led to a complex local food system in Hawai‘i. Customary agricultural systems built by Kānaka ‘Ōiwi (Indigenous Hawaiian) are now rested within a landscape filled with many different crops tended by farmers from a variety of ethnic backgrounds. Value systems dictating farming practices and crop selling decisions differ. In Hawai'i, values of food security or food sovereignty are of particular importance, especially as growing movements seek to increase local production and decrease the state's reliance on imported food in the wake of the COVID-19 pandemic. In this study, we systematically compare two different groups of farmers in Hawai'i and their values related to production and distribution. We then analyze the experiences of these two groups of farmers during the COVID-19 pandemic and their responses to them. The study is based on interviews with 22 Indigenous Kānaka ‘Ōiwi (IF) and Non-Indigenous local farmers (LF) from the island of O‘ahu. Ninety percent of IF say values associated with both food security and sovereignty drive their production and distribution decisions, while 75% of LF describe food security as the sole driver. Sixty percent of IF follow a non-profit economic model and emphasize cultural and educational values in their production decisions. LF follow profit-driven models and emphasize the influence the market has in their decisions. Prior to the COVID-19 pandemic, IF sold or donated the bulk of their crops to the local community through farm pickups, while restaurants were the primary buyers of LF crops. During the pandemic, the local community continues to be the primary recipient for IF, and due to the closure of many restaurants, LF have pivoted their sales to the community as well. Farmer interviews are augmented by three interviews with Hawai'i food system experts and relevant literature to suggest multiple pathways state agencies and local organizations could implement to support farmers from different backgrounds through COVID-19 and into the future. © Copyright © 2021 Hutchins and Feldman.

Community health worker knowledge, attitudes and practices towards COVID-19: learnings from an online cross-sectional survey using a digital health platform, UpSCALE, in Mozambique

Healthcare workers (HCWs) are at the frontline of the Coronavirus Disease 2019 (COVID-19) pandemic response, yet there is a paucity of literature on their knowledge, attitudes and practices (KAP) in relation to the pandemic. Community Health Workers (CHWs) in Mozambique are known locally as agentes polivalentes elementares (APEs). While technical guidance surrounding COVID-19 is available to support APEs, communicating this information has been challenging due to restrictions on travel, face-to-face group meetings and training, imposed from May to August 2020. A digital health platform, upSCALE, that already supports 1,213 APEs and 299 supervisors across three provinces, is being used to support APEs on effective COVID-19 management by delivering COVID-19 sensitive SMS messages, training modules and a COVID-19 KAP survey. The KAP survey, conducted from June 2020 to August 2020, consisted of 10 questions. Of 1,065 active upSCALE APEs, 28% completed the survey. Results indicate that only a small proportion of APEs listed the correct COVID-19 symptoms, transmission routes and appropriate prevention measures (n = (25%), n = (16%) and n = (39%), respectively) specifically included in national health education materials. Misconceptions were mainly related to transmission routes, high risk individuals and asymptomatic patients. 84% said they followed all government prevention guidelines. The results from the KAP survey were used to support the rapid development and deployment of targeted COVID-19 awareness and education materials for the APEs. A follow-up KAP survey is planned for November 2020. Adapting the existing upSCALE platform enabled a better understanding, in real time, of the KAP of APEs around COVID-19 management. Subsequently, supporting delivery of tailored messages and education, vital for ensuring a successful COVID-19 response.

From ‘Brexhaustion’ to ‘Covidiots’: The United Kingdom and the Populist Future

One consequence of Brexit and the Covid-19 pandemic is the acceleration of Britain’s shift towards populism, and the rejection of expert-informed policymaking in favour of vox populi claims. The continuation of this toxicity beyond Brexit means that nationalist narratives have become Britain’s new ‘politics of everything’ (Valluvan 2019). The past five years have seen growing British contempt for technocracy, with ‘us and them’ populist narratives gaining widespread traction as the United Kingdom’s (UK) volatile political environment moves away from the political procedures and economic values by which the UK has operated since 1945. Since early 2020, this narrative has been significantly accelerated by Covid-19 countermeasures, with anti-EU parties and narratives on the left and right becoming anti-lockdown or anti-vaccine advocates. This commentary approaches the surge in British populism as emblematic of the UK’s shift from centrism towards polarised factions defined not by party, but by cross-spectrum contempt for technical governance. We argue that while populism is a worldwide phenomenon, it is not homogenous and the UK is particularly vulnerable to anti-status quo discourses and narratives. We argue that British populism should be seen not as a temporary phenomenon in response to specific events and conditions, but as a fluid, amorphous and heterogeneous ‘new normal’ which, in an environment of social mistrust, contempt for expertise and disillusionment with traditional politics, is now becoming the defining characteristic of British politics. © 2021, Journal of Contemporary European Research. All Rights Reserved.

Automated bag breathing unit for COVID-19 ventilator shortages

INTRODUCTION: The COVID-19 pandemic resulted in a global mechanical ventilator shortage for treatment of severe acute respiratory failure. Development of novel breathing devices have been proposed as a low cost, rapid solution when full-featured ventilators are unavailable. We report the design, bench testing, and preclinical animal data for an 'Automated Bag Breathing Unit' (ABBU). METHODS: ABBU design uses a motor-driven wheel assembly for bag compression, calibrated for tidal volume (Vt), respiratory rate, inspiratory time, manual PEEP, and pressure-sensing assist with a modified 6' patient circuit. Berkshire pigs (n=5, weight 60.5±21.5 kg) were ventilated for 6 hours. PaCO2 and PaO2 in arterial blood were measured with varying Vt (200, 400, 600, 800 mL), rate (10, 20, 30, 40 bpm), and PEEP (5, 10, 15) in a healthy and injured swine model with synchronous and asynchronous ABBU operation. RESULTS: Bench testing with a Michigan dual-lung simulator yielded consistent Vt delivery at compliances of 0.02, 0.04 and 0.07 (L/cmH20). Dependence of the fraction of inspired oxygen (FiO2) with minute ventilation (VE) for a fixed inlet O2 flow rate (5 L/min) in ABBU was measured (47% - 98% FiO2 for 16-4 L/min VE respectively). FiO2 improved with higher O2 flows up to 15 L/min. Gas exchange was evaluated in a porcine model before and after saline lavage induced lung injury. When increasing Vt or rate, ABBU lowered PaCO2 to physiological levels (≤40 mmHg) from induced-hypercapnia, before and after saline lung injury. Changes from high to low PaCO2 positively correlated with changes in VE. Incremental PEEP trials improved PaO2 levels. Patient assist was studied while the animal was under light anesthesia. Of 1650 breaths, there were 1190 true positives, 416 true negatives, 44 false negatives, and no false positives. ABBU was able to maintain appropriate O2 and CO2 blood concentrations during spontaneous synchronous breathing. CONCLUSIONS: ABBU provides both oxygenation and ventilation across a range of respiratory parameter settings that support a lung protective ventilation strategy in most adults. A human clinical trial is required to establish safety and efficacy for patients with diverse etiologies of respiratory failure.