LIBERTY AND ITS EXCEPTIONS

Article 5 of the European Convention on Human Rights enshrines the right to liberty, one of the oldest and most fundamental rights in the human rights tradition, and one of the core rights in the Convention. Central to the judicial understanding of Article 5 is the 'exhaustive justification principle': unlike with other rights, such as the right to privacy, interferences with liberty can only be justified by one of the specific reasons listed in Article 5 itself. This article shows that this rigidity has posed problems in practice: faced with modern developments unforeseeable at the time of the Convention's writing, such as the use of novel policing techniques and the COVID-19 pandemic, judges have interpreted Article 5 in an unusual and artificial way, sacrificing the exhaustive justification principle in doing so, in order to achieve sensible outcomes. The integrity of Article 5 has been threatened, with serious consequences for the future protection of the right to liberty. This trend is explained, evidenced and evaluated, and some (partial) solutions and concessions are considered. Copyright © 2023 The Author(s).

Revisiting Handwashing - As It Is Absolutely Essential.

As the coronavirus pandemic continues into the second half of 2020, states across the US remain steadfast in their search to determine the safest methods of returning to normalcy. Without a readily available, effective COVID-19 vaccine, and as the numbers of infected individuals continues to climb, the best practices to ensure public safety are rooted in good personal hygiene and prevention of transmission of the novel coronavirus SARS-CoV-2. To that end, in addition to properly wearing adequate facial covering, individuals should properly wash their hands to prevent direct auto-inoculation. J Drugs Dermatol. 2020;19(11): 1127-1129 doi:10.36849/JDD.2020.5557.

A Multidisciplinary Approach to Learning from Incidents

Introduction Butterfly ward and Caterpillar outpatients within the International and Private Care division at Great Ormond Street Hospital look after children needing a wide range of specialty services including haematology, oncology, bone marrow transplant, immunology, gene therapy, and thymus transplant. It has been a longstanding practice within the division to ensure the delivery of high-quality patient care using collaborative efforts when reviewing incident reports. Methods To strengthen this partnership, we have continued weekly Datix Review Meetings (DRMs) through the coronavirus pandemic. Our aim is to discuss as a multidisciplinary team (MDT) 1 to 2 incidents per week followed by identifying specific learning objectives. Virtual meetings are led by Butterfly ward manager or matron with participation from the ward consultant, pharmacists, ward doctors, nurses in charge, and practice education team who facilitate the distribution of learning. Knowledge disseminated across the MDT takes the form of meeting notes linking to Trust policies, 'Take 3' measures and bite-sized education at safety huddles, 1:1 teaching sessions with ward staff, other written resources, and tailored local inductions. Results Weekly DRMs have contributed to increased patient safety in our clinical areas. It has increased patient satisfaction with positive comments from Friends and Family forms. We have seen better teamwork and communication across the MDT as it has allowed for the sharing of cohesive working strategies, including MDT presence at safety huddles. We have also received positive feedback when onboarding new staff due to the tailored education provided. Discussion & Conclusion Weekly DRMs have promoted discussing incidents without engaging in blame culture. This initiative has put patient safety at the forefront of our practice by strengthening both collective partnerships and individual teams. Ongoing work is being done to drive education in proactive ways with the aim to reduce the number of incidents within our directorate.

NURSE AND PHYSICIAN BURNOUT AND DISTRESS: COMPARISON OF ONCOLOGY AND CARDIOVASCULAR PROGRAMS AT A CANADIAN QUATERNARY HOSPITAL NETWORK

Introduction Clinician burnout and distress are pervasive and exacerbated by the COVID-19 pandemic, but the drivers may vary by provider discipline and care setting. We surveyed the wellbeing of nurses and physicians in oncology and cardiovascular programs at a Canadian hospital network. Methods Nurses (n=261) and physicians (n=167) completed measures of the WellBeing Index to assess distress levels and rated perceived workplace fairness, staffing levels, professional satisfaction and impact of COVID-19 on work and personal life. Associations between high distress and outcomes of interest were explored using chi-squared tests and in multivariable models. Results Of 428 participating clinicians, 82% of nurses and 62% of physicians reported high distress with no significant differences between programs. High distress in nurses was linked to impact of COVID-19 on personal life [OR=4.4 (1.8-10.6), p=0.001], and in physicians, insufficient staffing [OR=3.7 (1.6-8.7), p=0.003], professional dissatisfaction [OR=5.4 (1.4- 21.8), p=0.017], and impact of COVID-19 on work [OR=3.9 (1.5-10.3), p=0.006]. High distress in oncology and cardiovascular nurses was linked to unfair treatment [OR=4.9 (1.1-23.0), p=0.042], and impact of COVID19 on work [OR=4.0 (1.1-14.2, p=0.035], respectively. Conclusions High distress is common in nurses and physicians in oncology and cardiovascular programs but drivers vary by clinician discipline and care setting. Multifaceted approaches to mitigate burnout and distress may improve clinician wellbeing.

Biochemical, biophysical, and immunological characterization of respiratory secretions in severe SARS-CoV-2 infections.

Thick, viscous respiratory secretions are a major pathogenic feature of COVID-19, but the composition and physical properties of these secretions are poorly understood. We characterized the composition and rheological properties (i.e., resistance to flow) of respiratory secretions collected from intubated COVID-19 patients. We found the percentages of solids and protein content were greatly elevated in COVID-19 compared with heathy control samples and closely resembled levels seen in cystic fibrosis, a genetic disease known for thick, tenacious respiratory secretions. DNA and hyaluronan (HA) were major components of respiratory secretions in COVID-19 and were likewise abundant in cadaveric lung tissues from these patients. COVID-19 secretions exhibited heterogeneous rheological behaviors, with thicker samples showing increased sensitivity to DNase and hyaluronidase treatment. In histologic sections from these same patients, we observed increased accumulation of HA and the hyaladherin versican but reduced tumor necrosis factor-stimulated gene-6 staining, consistent with the inflammatory nature of these secretions. Finally, we observed diminished type I interferon and enhanced inflammatory cytokines in these secretions. Overall, our studies indicated that increases in HA and DNA in COVID-19 respiratory secretion samples correlated with enhanced inflammatory burden and suggested that DNA and HA may be viable therapeutic targets in COVID-19 infection.

Biochemical, Biophysical, and Immunological Characterization of Respiratory Secretions in Severe SARS-CoV-2 (COVID-19) Infections (preprint)

Thick, viscous respiratory secretions are a major pathogenic feature of COVID19 disease, but the composition and physical properties of these secretions are poorly understood. We characterized the composition and rheological properties (i.e. resistance to flow) of respiratory secretions collected from intubated COVID19 patients. We find the percent solids and protein content are greatly elevated in COVID19 compared to heathy control samples and closely resemble levels seen in cystic fibrosis, a genetic disease known for thick, tenacious respiratory secretions. DNA and hyaluronan (HA) are major components of respiratory secretions in COVID19 and are likewise abundant in cadaveric lung tissues from these patients. COVID19 secretions exhibit heterogeneous rheological behaviors with thicker samples showing increased sensitivity to DNase and hyaluronidase treatment. In histologic sections from these same patients, we observe increased accumulation of HA and the hyaladherin versican but reduced tumor necrosis factor stimulated gene 6 (TSG6) staining, consistent with the inflammatory nature of these secretions. Finally, we observed diminished type I interferon and enhanced inflammatory cytokines in these secretions. Overall, our studies indicate that increases in HA and DNA in COVID19 respiratory secretion samples correlate with enhanced inflammatory burden and suggest that DNA and HA may be viable therapeutic targets in COVID19 infection.

Working remotely to deliver research in care homes in a pandemic

Keywords: Remote working;Care homes;Postural assessment Purpose: The HARP (How to Assess Residents’ Posture) study aims to establish the validity and reliability of a Postural Assessment Tool (PAT) to assess care home residents’ seated posture. We planned to recruit three care homes’ residents and staff to take part in this project, and meet with them in person to: obtain consent, train care staff to use the PAT, and undertake postural assessments. COVID-19 restrictions meant that face-to-face physiotherapist/researcher contact has not been possible;we thus applied for and received ethics approval to explore the feasibility of delivering all aspects of the project remotely, mainly via video platform. We report on our project aim of assessing the feasibility and acceptability of remote working. Methods: All interactions with participating care home staff and residents take place via video link-up, using the home's preferred platform. Immediately after each contact, detailed (anonymous) field notes are made by the researcher, documenting staff members’ and residents’ reactions to and comments about the remote platform, and any challenges experienced during the encounter. Once the project is complete, semi-structured interviews will be conducted with care home staff and physiotherapists involved in remote procedures. Qualitative content analysis is ongoing – to produce qualitative descriptions of our experiences. Results: To date, we have been able to engage with two care homes via video link-up – to initiate the project and recruit participants. It took a number of attempts to arrange meetings and engage staff – due to equipment availability, occasional poor WiFi connection, staff unavailability or forgetfulness. However, remote connection was usually good, there were minimal disruptions once meetings started, and staff and residents expressed no concerns about using this platform for recruitment and consent. Staff were familiar with the use of remote platforms following regular use for resident contact (family and medical) during the pandemic, which facilitated the use of this method for research. For residents it was important that they were with a member of staff during a video call to support communications with the researcher - for example, where English was not their first language, or in case they had sensory impairment. Work with care homes continues (until July 2021) – we will report physiotherapists’, care staff's, researchers’ and residents’ experiences of receiving training in the use of the PAT and completing postural assessments remotely. To date, training has been successfully adapted for remote provision, and delivered to three staff members. Conclusion(s): We have shown that remote contact with care homes for research is feasible, and will report on the feasibility of undertaking postural assessments remotely. Impact: The pandemic has forced care homes to engage with remote technology, and these technologies can also be ultilised by researchers to undertake research – whilst Covid-19 restrictions remain and in other cases where in-person visits are not possible. Working remotely promotes research efficiency by eliminating travel time and offering the potential to work with a larger number of homes. Funding acknowledgements: This work was supported by a Grant from the Chartered Society of Physiotherapy Charitable Trust (Grant number PRF/18/B10).

Does an inner city London virtual pulmonary rehabilitation programme produce clinically significant improvements in patient outcomes?

P66 Table 1Patient demographic data of those patients assessed and completed the Virtual PR programme Patient demographic (n=53) Female (%) 33 (62.3%) Smoker (%) 16 (30.2%) Non Smoker (%) 8 (15.1%) Age (years) (range) 60 (37 to 81) Primary Disease COPD 33 (62.3%) Asthma 10 (18.9%) Other (bronchiectasis, ILD, lung cancer) 10 (18.9%) FEV1/FVC ratio 0.68 FEV1% predicted 66.08% (20 to116%) MRC (Range) 3 (1 to 5) Outcomes Pre (n=53) Post (n=26) Mean change ISW (m) (range) 297.14m (40 to 1020 m) 382.66m (80m to 650m) 31.25m (-80m to +110m) CAT (range) 23.73 (8 to 36) 19.83 (5 to 32) 1.26 (-13 to +11) COPD PREM 9 (range) 19.20 (0 to 32) 16.31 (3 to 34) 2.35 (-18 to +21) HADS A (range) 9.56 (0 to 21) 8.13 (1 to 18) 1.56 (-18 to +11) HADS D (range) 8.51 (1 to 14) 7.54 (1 to 18) 0.86 ( -7 to +9) Key: COPD: Chronic Obstructive Pulmonary Disease (COPD), ILD: Interstitial Lung Disease, FEV1: Forced expiratory Volume in one second, FVC: Forced Expiratory Volume, MRC: medical research council breathlessness scale, ISW: Incremental Shuttle Walk Test;CAT: COPD Assessment Test, COPD PREM: Chronic Obstructive Pulmonary Disease Patient Reported Experience Measure 9;HADS: Hospital Anxiety and Depression Scale: A: anxiety domain, D: depression domainConclusionCompletion of an inner City London VPR programme did improve levels of anxiety and improved patient experience of living with disease, clinically significant improvements in exercise tolerance or symptom burden were not demonstrated. VPR provided a solution for delivering PR during the pandemic, however greater comparison against traditional face to face PR models is required to ensure it delivers the same healthcare and patient outcomes.

Drug and Alcohol Prevalence in Seriously and Fatally Injured Road Users Before and During the COVID-19 Public Health Emergency

A gap in knowledge exists regarding drug use among drivers and other road users (pedestrians, bicyclists) who are seriously or fatally injured in crashes in the United States. This study examines the prevalence of alcohol as well as selected over-the-counter, prescription, and illegal drugs in the blood of seriously or fatally injured drivers and other crash victims near the time of their crashes before and during the COVID-19 public health emergency. Data was collected at Level 1 trauma centers and medical examiner offices. The 3,003 participants represent a convenience sample of roadway users who were seriously or fatally injured during the study period. Trauma centers and medical examiners made available small volumes of blood for toxicological analyses from the total collected during their normal clinical procedures. The results indicate drug prevalence was high among seriously and fatally injured roadway users before the public health emergency began and was even higher during, especially for alcohol, cannabinoids (active THC), and opioids. Drivers in particular showed significantly higher overall drug prevalence during the public health emergency, with 64.7% testing positive for at least one active drug, compared to 50.8% before. Drivers also showed an increase in testing positive for two or more categories of drugs going from 17.6% before to 25.3% during the public health emergency. Of particular note, active THC was more prevalent among drivers during the public health emergency than alcohol (32.7% versus 28.3%), and opioid use among drivers almost doubled from 7.5% to 13.9%. Overall, the results of this study suggest the highway safety community should be concerned about the impact of other drugs as well as alcohol. In particular, the observed cannabis and opioid prevalence rates before and during the public health emergency could be indicative of a growing problem. These findings are prevalence rates only and cannot be used to determine whether the people were impaired at the time of their crash.

A random priming amplification method for whole genome sequencing of SARS-CoV-2 and H1N1 influenza A virus. (preprint)

Background: Non-targeted whole genome sequencing is a powerful tool to comprehensively identify constituents of microbial communities in a sample. There is no need to direct the analysis to any identification before sequencing which can decrease the introduction of bias and false negatives results. It also allows the assessment of genetic aberrations in the genome (e.g., single nucleotide variants, deletions, insertions and copy number variants) including in noncoding protein regions. Methods: The performance of four different random priming amplification methods to recover RNA viral genetic material of SARS-CoV-2 were compared in this study. In method 1 (H-P) the reverse transcriptase (RT) step was performed with random hexamers whereas in methods 2-4 RT incorporating an octamer primer with a known tag. In methods 1 and 2 (K-P) sequencing was applied on material derived from the RT-PCR step, whereas in methods 3 (SISPA) and 4 (S-P) an additional amplification was incorporated before sequencing. Results: The SISPA method was the most effective and efficient method for non-targeted/random priming whole genome sequencing of COVID that we tested. The SISPA method described in this study allowed for whole genome assembly of SARS-CoV-2 and influenza A(H1N1)pdm09 in mixed samples. We determined the limit of detection and characterization of SARS-CoV-2 virus which was 103 pfu/ml (Ct, 22.4) for whole genome assembly and 101 pfu/ml (Ct, 30) for metagenomics detection. Conclusions: The SISPA method is predominantly useful for obtaining genome sequences from RNA viruses or investigating complex clinical samples as no prior sequence information is needed. It might be applied to monitor genomic virus changes, virus evolution and can be used for fast metagenomics detection or to assess the general picture of different pathogens within the sample.

Whole-Genome Sequencing Protocols for IBV and Other Coronaviruses Using High-Throughput Sequencing.

This chapter reports the high-throughput sequencing protocol for sequencing Coronaviruses and other positive strand viruses to produce a dataset of significant depth of coverage. The protocol describes sequencing of infectious bronchitis virus propagated in embryonated eggs and harvested in the allantoic fluid. The protocol is composed of three main steps-enrichment of the allantoic fluid using ultracentrifugation, extraction of total RNA from allantoic fluid, and library preparation from total RNA to DNA sequencing libraries. The workflow will be suitable for all coronaviruses using high-throughput sequencing platforms.

Multiple novel non-canonically transcribed sub-genomic mRNAs produced by avian coronavirus infectious bronchitis virus.

Coronavirus sub-genomic mRNA (sgmRNA) synthesis occurs via a process of discontinuous transcription involving complementary transcription regulatory sequences (TRSs), one (TRS-L) encompassing the leader sequence of the 5' untranslated region (UTR), and the other upstream of each structural and accessory gene (TRS-B). Several coronaviruses have an ORF located between the N gene and the 3'-UTR, an area previously thought to be non-coding in the Gammacoronavirus infectious bronchitis virus (IBV) due to a lack of a canonical TRS-B. Here, we identify a non-canonical TRS-B allowing for a novel sgmRNA relating to this ORF to be produced in several strains of IBV: Beaudette, CR88, H120, D1466, Italy-02 and QX. Interestingly, the potential protein produced by this ORF is prematurely truncated in the Beaudette strain. A single nucleotide deletion was made in the Beaudette strain allowing for the generation of a recombinant IBV (rIBV) that had the potential to express a full-length protein. Assessment of this rIBV in vitro demonstrated that restoration of the full-length potential protein had no effect on viral replication. Further assessment of the Beaudette-derived RNA identified a second non-canonically transcribed sgmRNA located within gene 2. Deep sequencing analysis of allantoic fluid from Beaudette-infected embryonated eggs confirmed the presence of both the newly identified non-canonically transcribed sgmRNAs and highlighted the potential for further yet unidentified sgmRNAs. This HiSeq data, alongside the confirmation of non-canonically transcribed sgmRNAs, indicates the potential of the coronavirus genome to encode a larger repertoire of genes than has currently been identified.