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OBJECTIVE: To understand community seroprevalence of SARS-CoV-2 in children and adolescents. This is vital to understanding the susceptibility of this cohort to COVID-19 and to inform public health policy for disease control such as immunisation. DESIGN: We conducted a community-based cross-sectional seroprevalence study in participants aged 0-18 years old recruiting from seven regions in England between October 2019 and June 2021 and collecting extensive demographic and symptom data. Serum samples were tested for antibodies against SARS-CoV-2 spike and nucleocapsid proteins using Roche assays processed at UK Health Security Agency laboratories. Prevalence estimates were calculated for six time periods and were standardised by age group, ethnicity and National Health Service region. RESULTS: Post-first wave (June-August 2020), the (anti-spike IgG) adjusted seroprevalence was 5.2%, varying from 0.9% (participants 10-14 years old) to 9.5% (participants 5-9 years old). By April-June 2021, this had increased to 19.9%, varying from 13.9% (participants 0-4 years old) to 32.7% (participants 15-18 years old). Minority ethnic groups had higher risk of SARS-CoV-2 seropositivity than white participants (OR 1.4, 95% CI 1.0 to 2.0), after adjusting for sex, age, region, time period, deprivation and urban/rural geography. In children <10 years, there were no symptoms or symptom clusters that reliably predicted seropositivity. Overall, 48% of seropositive participants with complete questionnaire data recalled no symptoms between February 2020 and their study visit. CONCLUSIONS: Approximately one-third of participants aged 15-18 years old had evidence of antibodies against SARS-CoV-2 prior to the introduction of widespread vaccination. These data demonstrate that ethnic background is independently associated with risk of SARS-CoV-2 infection in children. TRIAL REGISTRATION NUMBER: NCT04061382.
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Background Cardiac rehabilitation is accessed by only ~50% of eligible patients. Virtual options have become more important since Covid. The Our Hearts Our Minds (OHOM) programme used wearable technology (Fitbit) for virtual physical activity monitoring. Aim To examine whether a Fitbit smartwatch/dashboard component was an acceptable option to improve physical activity levels in the absence of supervised exercise classes. Methods Initial multidisciplinary assessments were conducted via telephone/video as per patient preference. Patients were offered a Fitbit, if they did not have their own smartwatch and to synchronise to a cloud based dashboard visible to the clinical team. Using behaviour change techniques, tailored physical activity advice was provided including personalised notifications pushed to the patient's Fitbit app. Patients also received coaching calls and virtual group education sessions. Average daily step count and active minutes (over a 7 day period) were calculated at the start and end of programme. Results 1066 referrals were received from 01/04/20 to 30/ 03/22, of which 1043 patients (98%) had an initial assessment. Of these, 407 wore a Fitbit device (33% provided by programme, 6% own Fitbit) and synchronised to OHOM Fitbit dashboard (39% uptake). 6% had their own non-Fitbit smartwatch. 55% declined Fitbit (5% didn't own a smartphone for app download or access the internet, 3% weren't interested in technology, 2% medical reasons, 2% didn't collect, 43% weren't interested in virtual monitoring). Physical activity outcomes pre and post programme are shown in table 1. Conclusion Fitbit (and other) smartwatches coupled with centralised monitoring provided a viable alternative to supervised exercise classes in approximately half of those attending cardiac rehabilitation with evidence of increased physical activity.
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This paper considers how the course syllabus, an often-overlooked document, can function as an instrument for naming and enacting more inclusive, accessible, and learner-centered classrooms. A syllabus is a powerful tool with the potential to make visible the practices and policies of an instructor's pedagogy, to facilitate trust between instructors and students, and to set the tone for a course. Despite the gravity of this document, however, the language and form of written syllabi have tended to be passed down, either institutionally or through generations of instructors, rather than revised and redesigned to meet the needs of students in a changing world. Observing renewed interest in inclusivity and accessibility in pedagogical conversations in the wake of the COVID-19 pandemic, the authors conducted this study of twelve digital rhetoric syllabi to systematically and precisely analyze the ways language is used to create learner-centered syllabi in service of more just classrooms. The findings demonstrate the need for creating accessible learning experiences for students, showing empathy through various learner-centered tools, and using positive and inclusive language to promote diversity, equity, and social justice. © 2023 Elsevier Inc.
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Introduction: WHO declared a pandemic of COVID-19 in March 2020. This study analyses the impact of COVID-19 on beta-cell replacement therapy in the UK. Method(s): Pancreas and islet donation and transplant activity in the period March 2020/2021 was compared with the same period the previous year. Result(s): 2,180 patients had a functioning graft during March 2020/2021. 5.8%(n=126) tested positive for COVID-19 and two died (1%). In this period there was a 43% reduction in solid organ donors n=1,615, compared with the previous year, n=2,840. Of the 625 solid organ donors with a pancreas offered, 32% had the pancreas retrieved compared with 51% the previous period. 97 whole pancreas and islet transplants were performed in the UK down 54% from the prior period. Of the 84 pancreas transplant recipients;four tested positive for COVID-19 but none died, and two grafts failed within the first week from vascular thrombosis (neither were COVID-19 positive). Of the 13 SIK and islet alone transplant recipients, two tested positive for COVID-19 but neither died. Of these SIK transplants, one is known to have failed within a month and this is equivalent to that seen in the previous time period. To our knowledge, no patient receiving beta cell replacement therapy died of COVID during the first year of the pandemic despite immunosuppression. Conclusion(s): In the UK, pancreas, and islet transplantation have continued during the pandemic at a lower rate. Outcomes following transplantation within the COVID era are, so far, similar to those in the period prior. Take-home message: Outcomes following transplantation within the COVID era are, so far, similar to those in the period prior.
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Background and objectives: Pembrolizumab monotherapy given 3-weekly (3w) (200mg) is approved for the treatment of nonsmall cell lung cancer (NSCLC). In June 2019, NICE endorsed the 6w regimen (400mg) based on computer modelling data (Lala, Eur J Cancer 2020), which has been used during the COVID-19 pandemic to reduce hospital visits. This study compared immune-related adverse events (irAEs), discontinuation rates, and patient experience of 3w vs 6w patients treated at The Christie NHS Foundation Trust, Manchester, UK. Methodology: Pharmacy records were used to identify NSCLC patients treated with pembrolizumab, 1st, 2nd or 3rd line. IrAEs and discontinuation rates were analysed using Kaplan Meier curves to compare the 3w vs 6w cohorts. A sample of the cohort who received 3w then 6w undertook a questionnaire assessing patient experience. Results: 38 patients received pembrolizumab 6w, and 91 received pembrolizumab 3w, of the 3w, 51 switched to 6w. Baseline characteristics were similar. Any grade irAEs and G1-2 irAEs were significantly higher in the 6w cohort (p=0.006 and p=0.04, respectively). Both cohorts showed low rates of G3-5 irAEs at 6 months, 2.3% vs 14.5%, 3w vs 6w, p=0.3. Discontinuation rates at 6 months due to any irAES, G1-2 irAEs or G3-5 irAEs were insignificant in both cohorts (3w to 6w respectively): 4.5% vs 11.2%, p=0.2;2.8% vs 8.7%, p=0.4;2.0% vs 2.5%, p=0.3. Quality of life questionnaires showed stability (60%) or improvement (20%) in the 6w cohort compared to 3w. 90% said their mental health did not differ between regimens. 45% and 40% of patients preferred 6w and 3w respectively, 15% had no preference. Conclusion: NSCLC patients treated with 6w pembrolizumab appear to experience more low-grade irAEs compared to 3w. Highgrade irAEs and discontinuation rates due to irAEs were insignificant in both cohorts. Patients preferred the 6w regiment and found it tolerable.
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Objective: To survey the impact of the Covid-19 pandemic, (April 2020-April 2021), on access to specialist care for people with multiple sclerosis (PwMS) within the Belfast Health and Social Care (HSC) Trust. Background: The challenges of healthcare service provision have been significantly heightened during the covid-19 pandemic. For PwMS, access to healthcare is of permanent importance, and has been greatly challenged during this timeframe. Design/Methods: In March/April 2021, we posted an anonymised survey to 2342 pwMS receiving care in the Belfast HSC Trust. Data was analysed on returns received by mid-May 2021. Results: In total, 1072 (45.8%) pwMS responded, mean age 53 years, female: male 2.6:1. Of these, 895 (84.2%) were ambulant with or without aid. Wheelchair use was reported in 14.6%. Relapsing remitting MS, Secondary progressive MS and primary progressive MS patients made up 67.7%, 15.5% and 5.9% of indicative responses, respectively. In all, 179 (17%) experienced a confirmed relapse during the pandemic, with 37.4% of these receiving steroids. Perceived delays in appointments were most frequent in: clinic review (17.9%), imaging (13.3%), physiotherapy (11.6%). Over half (52.8%) reported no delays. In total, 64.5% were taking disease-modifying therapy (DMT), most frequently: dimethyl fumarate (34.9%), betainterferon (18.0%), teriflunomide (12.4%). With new DMT commencement during the pandemic, 11.5% experienced delay. In those already DMT-established, 6.6% had a delay with infusion, 4.3% in switching DMT, whilst 89% experienced no delay. Only 2.0% of pwMS on DMT had their treatment stopped directly due to Covid-19. During the pandemic, 13.8% pwMS reported difficulty contacting the MS team, while 40.7% reported physical deconditioning. A majority (88%) had received a covid-19 vaccine dose. Conclusions: Whilst most patients experienced normal standard care, Covid-19 has impacted service provision for some pwMS, with delays reported across a multi-faceted service. The downstream effects of this may be seen moving beyond the pandemic.
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Just as students experience productive struggle or spend time in the ‘zone of confusion’ when engaging with challenging tasks, teachers also experience similar difficulties and periods of confusion when engaging with new pedagogical approaches. Prior to a 19-week lockdown due to Coronavirus (COVID-19) during 2020, two Foundation teachers implemented a student-centred pedagogical approach when teaching with challenging tasks. While they had some initial success implementing the pedagogical approach and a three-phase lesson structure, they struggled to do so online during the lockdown. It is the experiences of these teachers, in particular their experience of confusion relating to aspects of the pedagogical approach, and how this confusion was overcome, that is reported in this paper. Central to our findings is the importance of teachers reflecting on their own experiences of struggle and the impact this had on their professional learning, as well as the notion that adversity can be a catalyst for change. © 2022 Published by KURA Education & Publishing.
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Introduction Sarcoidosis is a granulomatous disease with protean manifestations. The aetiology is not fully understood. Infectious agents are considered to potentially contribute to its pathogenesis. This case report highlights the emergence of neurosarcoidosis after COVID-19 infection. Case: A 48 year old female developed cough, myalgia and fatigue and was diagnosed with COVID-19 based on serological testing in April 2020. Post-infection, she developed a reactive arthritis, then presented in June with left facial lower motor neuron weakness, initially treated as a Bell's palsy with a significant neuralgic component. This pain resolved with steroid treatment. One month later she developed multiple cranial neuropathies and bilateral leg weakness. MRI brain showed bilateral enhancement of the trigeminal and facial nerves. CSF was abnormal (CSF protein 0.95g/L, WCC 9/uL). Leg power rapidly improved with intravenous immunoglobulins, and FDG-PET identified mediastinal and axillary hilar lymphadenopathy. A neck node showed non-necrotising granulomatous inflammation. CSF angiotensin converting enzyme was elevated (2.07umol/min/L). She has since commenced high dose steroids for probable neurosarcoidosis. Discussion This case suggests a possible association between COVID-19 and the emergence of sarcoidosis. At present the strength of any association is uncertain and putative mechanisms remain to be determined.
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Background Within our service, all scheduled face-to-face neurology clinics were cancelled from March 2020 due to Covid-19. Telephone reviews were initiated to provide continuity of MS care. Objective To assess patient satisfaction with MS telephone clinics during the pandemic and opinion regarding potential future use. Design/Methods Anonymised questionnaires were posted to 635 patients receiving MS specialist medical telephone review, March to July 2020. Results 279 (44%) patient questionnaires were returned, mean age 49 years, 72% female, 87% having an EDSS <7.0. On a rating scale, (0'10, 10 = completely satisfied), 95% of patients reported a satisfaction score ≥7. For 99% of patients, clinical interaction was caring/sensitive by telephone. Satisfaction was high with: call duration (96%), opportunity to ask questions (99%) and understanding advice given (98%). During the pandemic, 87% of patients preferred the virtual appointment. Of all patients, 45% expressed preference for telephone review moving forward, rising to 55% among both wheelchair-using patients and those living >50 miles from clinic. Many felt that video call would further improve virtual review (54%). Conclusions During the COVID-19 pandemic, satisfaction is high with MS review by telephone. A signifi-cant body of patient opinion supports telephone clinics beyond Covid-19. This is influenced by EDSS and distance from clinic.
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Background Providing care to Multiple Sclerosis (MS) patients has been a challenge during the Covid-19 pandemic. Locally, surge plans necessitated an abrupt change of facility for infusional services, now supervised by MS nurses, from an acute site (Royal Victoria Hospital, RVH) to a non-acute site at Musgrave Park Hospital (MPH). Objective To assess patient satisfaction with MS infusional therapies at a new, non-acute location and supervision of the service by MS Specialist nurses in comparison with previous arrangements. Methods Anonymous patient surveys were developed and collected in order to assess patient demo-graphics and levels of satisfaction across various service domains. Results All 120 offered surveys were returned. Overall, 97% recorded a satisfaction score of ≥8/10 (0'10, 10 = extremely satisfied). Key areas of improvement: difficulty parking (0.8% vs 50% in RVH), difficulty of unit access (0.8% vs 38% previously), appointment punctuality (95% on time vs 35% previously), and comfort (83% vs 55% previously). Thematic analysis revealed several key improvement areas: access to MS nursing knowledge, cannulation, and punctuality. Conclusion The urgently relocated service, with better access and specialist nursing input, was associ-ated with substantial improvements in patient experience. Despite current unprecedented pressures on healthcare delivery, unique opportunities remain for service improvement.
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Introduction: Recent studies have shown patients with coronavirus disease 2019 (COVID-19) develop significant coagulopathy with thromboembolic complications including ischemic stroke. However, data are sparse regarding the clinical characteristics, stroke mechanism, and patient outcomes. Methods: We conducted a retrospective cohort study of consecutive patients with ischemic stroke who were hospitalized between March 2020 and June 2021, within at a Regional Medical Center serving three large counties in South Carolina. We further investigated clinical and demographic characteristics, stroke severity as measured by the National Institutes of Health Stroke Scale (NIHSS), and stroke subtype as measured by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria among patients with COVID-19 who also suffered from an acute ischemic stroke. Results: During the study period, out of 1087 hospitalized patients with a diagnosis of COVID-19 infection, 18 patients (1.6%) had an imaging-proven ischemic stroke. Of these 18 patients, 10 (56%) were men, 16 were African-Americans (89%), 2 (11.1%) patients were <55 years of age. All patients had at least one known vascular risk factor. Cryptogenic stroke was more common in patients with COVID-19 (83%). The median time (days) from COVID-19 symptom onset to stroke symptom onset was 11 (IQR 10-28), while the median time from being tested positive for COVID-19 to stroke diagnosis was 10 (IQR 2-24). Our study sample had a median admission NIHSS score of 5 (IQR 3- 11) and a median peak D-dimer level of 2101 (IQR 1349 - 3213). Interestingly, 38% of these patients were already on therapeutic anticoagulation before the diagnosis of stroke. Patients with COVID-19 and stroke had an inpatient mortality rate of 11%. None of these patients met the criteria for IV-tPA treatment or thrombectomy. Conclusion: We observed a modest rate of ischemic stroke in hospitalized patients with COVID-19. Most strokes were cryptogenic, possibly secondary to coagulopathy associated with COVID-19 infection. Further studies are needed to guide management for stroke prevention in patients with COVID-19.
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Situated in the context of current examinations of inequality and underrepresentation in music education in the United Kingdom, this article offers perspectives on a community music school and outreach initiative based in Southwark, London, where King's College London music students, mentored by an experienced local teacher, facilitate small group music-making for primary school children who would not otherwise have opportunities for collaborative performance. Due to COVID-19, the project shifted to fully online delivery, and later to a hybrid model, combining virtual and in-person interaction. Based on ethnographic research amongst pupils, parents, teaching assistants and coordinators, we invoke the collaborative ethos of the project and explore its social and affective impact on participants at a time of great challenge and change.
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Introduction: Cardiovascular symptoms post-acute sequelae of SARS-CoV-2 infection (CV-PASC) have been increasingly recognized, but the underlying pathobiology is unclear. Endothelial and cardiac pericyte ACE2 receptors are important targets of SARS-CoV-2, resulting in virally-induced endothelial activation, which may adversely affect the coronary microvasculature and impair myocardial performance. We hypothesized that athletes with CV-PASC have microvascular and subclinical myocardial dysfunction. Methods: We compared 15 athletes with CV-PASC with 7 control athletes without prior COVID-19 using regadenoson stress cardiac magnetic resonance (CMR). All athletes participated in >6 hours of endurance activities per week. We analyzed CMR volumes, function, global circumferential strain (GCS), late gadolinium enhancement (LGE), and coronary flow reserve (CFR) by coronary sinus method. Values presented as median [IQR]. Results: CMR in CV-PASC athletes occurred 102 [66,123] days post-SARS-CoV-2 infection. There were no differences in chamber volumes, function, or LGE between groups. One CV-PASC athlete had acute myocarditis (7%). CVPASC athletes had decreased CFR compared with control athletes (Figure 1). Multiple CV-PASC participants had CFR below the 95% CI of the controls and reported normal values from the literature (2.9 and 2.5, respectively). GCS was worse in CV-PASC athletes at the base (-23.7% [-21.6,-26.4] vs -31.1% [-27.3,-33.0], p=0.01), mid-LV (-21.5% [-18.5,-22.8] vs -28.5 [-25.4,-29.9], p=0.008), and apex (-27.1% [-24.1,-29.9] vs -30.6% [-27.8,-38], p=0.07), though the apex did not reach statistical significance. Conclusions: This pilot case-control study found CV-PASC athletes had reduced CFR and associated subclinical myocardial dysfunction as assessed by GCS compared to control athletes. These findings suggest coronary microvascular dysfunction related to endothelial injury may mediate CV-PASC symptoms.