The Kaiser Permanente Northern California COVID-19 physician redeployment experience: Redeploying physicians to meet the demands of the pandemic

This paper describes a redeployment programme developed by Kaiser Permanente Northern California (KP NCAL) to meet physician staffing needs during five COVID-19 surges in Northern California. By leveraging two existing programmes, creating a flexible system of redeployment levels, and supporting the system with a robust training programme, the physician redeployment programme effectively addressed physician staffing needs, maximised excellent patient care, and supported KP NCAL physicians during the pandemic. The programme delivered care to over 131,000 outpatients with COVID-19 infection and redeployed physicians into more than 800 inpatient shifts. © Henry Stewart Publications, 1749–9216.

Decision-Making by and for Academic Libraries during COVID-19

Academic libraries are fundamental in promoting equitable access to education but are often overlooked and underfunded. The COVID-19 pandemic amplified these inequities. This study investigates how 39 library deans and directors perceived decision-making by university administration during COVID-19's onset. Open-ended survey questions were sent to deans and directors asking them to describe their experiences working with university administration to adjust library services during the crisis. Some library leaders reported that working closely with other departments strengthened their campus connections. Others commented that disagreement between library personnel and university administration caused discord. Some deans and directors were forced to cut staff funding or felt pressured to reopen, while others were trusted to choose their budget and service priorities. The authors recommend that library leaders be more consistently relied upon for their expertise during university decision-making. © 2023 by Johns Hopkins University Press, Baltimore, MD 21218.

A Dual Adjuvant System for Intranasal Boosting of Local and Systemic Immunity for Influenza Vaccination.

Systemically vaccinated individuals against COVID-19 and influenza may continue to support viral replication and shedding in the upper airways, contributing to the spread of infections. Thus, a vaccine regimen that enhances mucosal immunity in the respiratory mucosa is needed to prevent a pandemic. Intranasal/pulmonary (IN) vaccines can promote mucosal immunity by promoting IgA secretion at the infection site. Here, we demonstrate that an intramuscular (IM) priming-IN boosting regimen with an inactivated influenza A virus adjuvanted with the liposomal dual TLR4/7 adjuvant (Fos47) enhances systemic and local/mucosal immunity. The IN boosting with Fos47 (IN-Fos47) enhanced antigen-specific IgA secretion in the upper and lower respiratory tracts compared to the IM boosting with Fos47 (IM-Fos47). The secreted IgA induced by IN-Fos47 was also cross-reactive to multiple influenza virus strains. Antigen-specific tissue-resident memory T cells in the lung were increased after IN boosting with Fos47, indicating that IN-Fos47 established tissue-resident T cells. Furthermore, IN-Fos47 induced systemic cross-reactive IgG antibody titers comparable to those of IM-Fos47. Neither local nor systemic reactogenicity or adverse effects were observed after IN delivery of Fos47. Collectively, these results indicate that the IM/IN regimen with Fos47 is safe and provides both local and systemic anti-influenza immune responses.

B Cells Induce Hypertension, AT1AA, And Complement Activation In Preeclampsia Or In Response To A Prior Covid-19 Infection During Pregnancy

Preeclampsia (PE), new onset hypertension (HTN) during pregnancy, is associated with placental ischemia and chronic inflammation that includes increased CD4+ T cells, B cells secreting agonistic autoantibodies against the angiotensin II type 1 receptor (AT1AA), and activation of the complement system. Previous studies have shown AT1-AA is produced in patients with COVID-19 infection. Interestingly, having had COVID-19 during pregnancy is associated with increased incidence of developing a PE phenotype during pregnancy. We have previously shown an important role for B cell depletion or AT1AA inhibition to attenuate HTN in rat models of PE. Collectively, this data suggests B cells contribute to PE development and that B cells may increase incidence of PE in patients with a history (Hx) of COVID-19 during pregnancy through production of the AT1AA. We hypothesize B cells from PE or CV Hx PE patients produce AT1AA resulting in HTN and complement activation in pregnancy. Placental B cells were isolated from normal pregnant (NP), PE, normotensive (NT) CV Hx, or PE CV Hx patients at delivery. B cells were transferred i.p. into pregnant athymic rats at gestation (GD) 12. On GD18, carotid catheters were inserted. On GD19, blood pressure was measured and tissues collected. PE B cell recipients had increased Mean Arterial Pressure (MAP) (115+/-3 mmHg n=6) compared to NP B cell recipients (97+/-4 mmHg n=6 p<0.05). PE B cell recipients had increased AT1AA (20+/-2 DELTABPM n=4) compared to NP B cell recipients (6+/-1 DELTABPM n=4 p<0.05). PE B cell recipients had increased markers of complement activation such as reduced plasma C4 (1302+/-169 mug/mL n=4) and C3 (516+/-45 mug/mL n=4) compared to recipients of NP B cells (2348+/-338 mug/mL n=4 p<0.05) and (790+/-66 mug/mL n=4 p<0.05) respectively. CV Hx PE B cell recipients had elevated MAP (108+/-3 mmHg n=4) compared to CV Hx NT B cell recipients (101+/-7 mmHg n=4) and increased AT1AA (24+/-3 DELTABPM n=3) compared to CV Hx NT B cell Recipients (4+/-1 DELTABPM n=4 p<0.05). Collectively, this study demonstrates an important role for B cells to cause HTN during pregnancy;and indicates that B cells contribute to a higher incidence of PE in women with a Hx of CV infection during pregnancy possibly by secreting AT1-AA.

Making sense of a mess: “doing” resilience in the vortex of a crisis

Purpose: The purpose of the paper is to investigate how human resource professionals (HRPs), in a variety of organizations, responded to the crisis brought about by the event of COVID-19. In particular, it aims to show how organizations, across all sectors, in Western Australia responded with urgency and flexibility to the crisis and showed “resilience in practice”. Design/methodology/approach: The study is based on 136 questionnaire responses, 32 interviews and 25 managerial narratives. The mixed qualitative methodology was designed to enable an investigation of the impact of COVID-19 and the response of HRPs. Findings: HRPs have responded with agility and flexibility to the impact of COVID-19. They have done so through extensive trial and error, sometimes succeeding, sometimes failing. They have not simply activated a preconceived continuity plan. Research limitations/implications: The research indicates that resilience is an ongoing accomplishment of organizations and the people in them. The objective was description rather than prescription, and the research does not offer solutions to future pandemic-like situations. Practical implications: The research suggests that, given the impact of COVID-19 on organizations, HR practices, processes and policies will need to be thoroughly reconsidered for relevance in the post-COVID world. Possible future directions are highlighted. Originality/value: The research considers the actions of HRPs as they responded to a global crisis as the crisis unfolded. © 2022, Emerald Publishing Limited.

A review of the selection process and decontamination methods with the use of face shields in UV phototherapy during the SARS-CoV-2 pandemic.

Targeted ultraviolet (UV) phototherapy has been used in the management of a wide variety of dermatological clinical conditions including moderate to severe psoriasis unresponsive to topical therapies, vitiligo, severe atopic dermatitis and lymphoproliferative disorders. To date there are no uniform, standardised guidelines for the selection and decontamination process for UV personal protective equipment (PPE) and facial shields used in phototherapy. In the current climate, Coronavirus 2019 (COVID-19) pandemic, standards regarding all decontamination and disinfection processes are under significant scrutiny. In terms of the UV-PPE and facial shields used in phototherapy, careful disinfection procedures need to be implemented to ensure that the decontamination practice is effective enough to neutralise the virulent virus whilst maintaining maximal protection to the user from UV-rays and safeguard the equipment from damage during the cleaning process. The aim of this report is to provide an evidence based review of the current and international practice standards guiding the selection, use and decontamination processes of UV facial shields in phototherapy. The complications and concerns that the COVID-19 pandemic has had on this practice is highlighted. As such, we performed a comprehensive evaluation of the literature to provide recommendations as to the most effective, time efficient and safest practices for disinfection and decontamination of UV facial shields used in phototherapy during these unprecedented times.

IDENTIFYING THE TOP 10 RESEARCH PRIORITIES FOR FAMILY CARERS: THE INTERFACE PROJECT

Background In assessing the global impact of the COVID-19 pandemic on society, it is important to understand the communities most affected and develop methods of support. Family carers provide a vital, yet often invisible role in our society and healthcare system. Identifying research priorities for carers helps establish overall gaps in the research agenda and increases awareness of the role of carers in the community. Methods A priority setting partnership methodology was engaged and through collaboration with carers, healthcare professionals and researchers, a participatory process was conducted to identify gaps in the current literature and prioritise research questions and uncertainties. Focus group discussions followed, the first consisted of family carers (n = 5). The second (n = 3) interviewed stakeholders namely healthcare professionals, researchers and policy makers. After collating the data, researchable questions were developed through an iterative process with a Multi Stakeholder Advisory Committee to identify the top 10 research priorities for Family Carers Ireland. Results The top 10 researchable questions were distilled from a list of 16 and fit into 7 broad categories. 1) economic impact and financial strain 2) Systemic issues, education, resources and policy 3) technology 4) support services and infrastructure 5) mental health and wellbeing of the carer 6) carers in society 7) Recognition and acknowledgment of the family carer. Conclusion The partnership focus of this project allowed the ‘ground-up’ development of research priorities for carers by carers. The COVID-19 pandemic served to magnify systemic issues already present in society, as well as highlight new burdens. As a result, the subsequent development of 10 researchable questions will guide further investigation to improve the support and wellbeing of family carers.

Adapting services during the COVID-19 pandemic – a patient evaluation of physiotherapy telephone reviews within multidisciplinary team virtual clinics

Background: The COVID-19 pandemic forced the evolution of face-to-face cystic fibrosis (CF) multidisciplinary team (MDT) clinics into an entirely remote service. Our virtual clinics included telephone reviews with specialist physiotherapists. Aims: To understand the experiences of our People with CF (PwCF) during their physiotherapy telephone review;to support the collaborative development of our service. Methods: Patient representatives assisted in the development of a user-friendly questionnaire. With patient consent, the questionnaire was distributed via email to patients attending clinics between 28th August–25th September 2020. Results: Of the 142 patients who consented to receiving a questionnaire, 61 (43%) responded. 90% (n = 55) of PwCF were satisfied with their telephone physiotherapy review. 33% (n = 20) of PwCF were not aware they would be called by a physiotherapist. 93% (n = 57) of PwCF found it useful to speak to a physiotherapist, covering the “same (topics) as a face-to-face review.” When stable, some felt a review was not required. PwCF felt good aspects of their review included discussing physiotherapy-related concerns (18%, n = 11) and gaining specialist advice (26%, n = 16). The main area for improvement was providing an allocated appointment time (33%, n = 20). Patient preference for time of call was 26% (n = 16) morning;26% (n = 16) afternoon;49% (n = 29) said call anytime. Conclusions: Feedback was positive for the new entirely remote clinic service. The service now allocates time slots to improve the user experience. Continuing to develop this service with user feedback is an ongoing priority as virtual services will be at the forefront of future CF care.

Are medical procedures that induce coughing or involve respiratory suctioning associated with increased generation of aerosols and risk of SARS-CoV-2 infection? A rapid systematic review.

BACKGROUND: The risk of transmission of SARS-CoV-2 from aerosols generated by medical procedures is a cause for concern. AIM: To evaluate the evidence for aerosol production and transmission of respiratory infection associated with procedures that involve airway suctioning or induce coughing/sneezing. METHODS: The review was informed by PRISMA guidelines. Searches were conducted in PubMed for studies published between January 1st, 2003 and October 6th, 2020. Included studies examined whether nasogastric tube insertion, lung function tests, nasendoscopy, dysphagia assessment, or suctioning for airway clearance result in aerosol generation or transmission of SARS-CoV-2, SARS-CoV, MERS, or influenza. Risk of bias assessment focused on robustness of measurement, control for confounding, and applicability to clinical practice. FINDINGS: Eighteen primary studies and two systematic reviews were included. Three epidemiological studies found no association between nasogastric tube insertion and acquisition of respiratory infections. One simulation study found low/very low production of aerosols associated with pulmonary lung function tests. Seven simulation studies of endoscopic sinus surgery suggested significant increases in aerosols but findings were inconsistent; two clinical studies found airborne particles associated with the use of microdebriders/drills. Some simulation studies did not use robust measures to detect particles and are difficult to equate to clinical conditions. CONCLUSION: There was an absence of evidence to suggest that the procedures included in the review were associated with an increased risk of transmission of respiratory infection. In order to better target precautions to mitigate risk, more research is required to determine the characteristics of medical procedures and patients that increase the risk of transmission of SARS-CoV-2.