Structural Racism through Sundown Towns and its relationship to COVID-19 local risk and diversity.

"Sundown towns" across the US prevented racial and ethnic minorities from living and working within their borders as they forced minorities to leave these towns after sunset. The objective of this study was to explore the relationship between historic sundown town status, COVID-19 local risk index and racial/ethnic city-level diversity. We used a multi-level hierarchical model was used to examine the effect of historic sundown town status on the COVID-19 local risk index and city-level diversity. Over 2,400 Sundown towns were cataloged across the United States, with the greatest density in the Midwest. Sundown towns, which historically excluded racial/ethnic minorities, had significantly less racial/ethnic diversity as measured and lower COVID-19 local risk index compared to non-Sundown towns. Findings show that residual segregation enforced by historic Sundown towns continues to impact current inequities among racial/ethnic minorities related to risk for COVID-19 at the neighborhood level. We recommend that public health officials for pandemic preparedness should devote greater resources to these historically segregated racial/ethnic minority areas because of the higher risk these areas possess because of structural racism brought on my historical segregation policies.

Classical Presentation of Disseminated Blastomycosis in a 44-Year-Old Healthy Man 3 Months After Diagnosis of COVID-19.

BACKGROUND During the COVID-19 pandemic, the incidence of opportunistic infections, including fungal infections, has increased. Blastomycosis is caused by inhalation of an environmental fungus, Blastomyces dermatides, which is endemic in parts of the USA and Canada. This case report is of a 44-year-old man from the American Midwest who presented with disseminated blastomycosis infection 3 months following a diagnosis of COVID-19. CASE REPORT Our patient initially presented to an outpatient clinic with mild upper-respiratory symptoms. He tested positive for SARS-CoV-2 via polymerase chain reaction (PCR). Three months later, he presented to our emergency department due to some unresolved COVID-19 symptoms and the development of a widely disseminated, painful rash of 1-week duration. A positive Blastomyces urine enzyme immunoassay was the first indication of his diagnosis, which was followed by the identification of the pathogen via fungal culture from bronchoscopy samples and pathology from lung and skin biopsies. Given the evidence of dissemination, the patient was treated with an intravenous and oral antifungal regimen. He recovered well after completing treatment. CONCLUSIONS The immunocompetent status of patients should not exclude disseminated fungal infections as a differential diagnosis, despite the less frequent manifestations. This is especially important when there is a history of COVID-19, as this may predispose once-healthy individuals to more serious disease processes. This case supports the recent recommendations made by the U.S. Centers for Disease Control and Prevention (CDC) for increased vigilance regarding fungal infections in patients with a history of COVID-19.

Home cardiorespiratory sleep studies in children and young people: experience of a UK Regional Service

Background: Cardiorespiratory sleep studies (CRSS) consisting of effort, flow, oxygen saturation, ECG traces and video is traditionally undertaken in hospital with an attendant physiologist. Over the last 10 years our service has increasingly undertaken such studies in the child or young person's (CYP) home. This is now our default means of undertaking such studies. Objective(s): To determine the technical adequacy and clinical utility of home cardiorespiratory sleep studies in our patient group. Method(s): Retrospective data service evaluation. Patient demographics, underlying diagnosis and clinical question were recorded for those for whom home video CRPSG was attempted between July 2020-August 2021. The adequacy of each study component was scored (1=inadequate;2=variable;3=excellent) using the narrative in the study report. A total adequacy score (TAS) was calculated for each study. Result(s): 50 studies were identified (mean age of CYP was 5.5 years (IQR=8.5)). A clinical conclusion was possible for 96% of studies. 36% of studies were positive for a breathing disorder. Electrocardiography had the highest percentage (85.7%) of 'excellent' scores. Nasal thermistor had the highest percentage (32.7%) of 'inadequate' scores. Age of CYP and adequacy scores were not related. There was no association between underlying diagnosis and clinical utility/adequacy of study. Conclusion(s): For a service without access to in-hospital attended studies, we can achieve a high rate of technical adequacy and clinical utility for home CRSS irrespective of age and underlying diagnosis for CYP. We have been able to continue our service despite the COVID pandemic.

A 2-week course of Exclusive Enteral Nutrition followed by the Crohn Disease Exclusion Diet is effective for Induction and Maintenance of Remission in children with Crohn Disease;the DIETOMICS-CD trial

Background: Exclusive enteral Nutrition (EEN) is considered a first line therapy for children with active Crohn disease (CD). CD Exclusion Diet (CDED)+Partial Enteral Nutrition (PEN) is effective for induction of remission in mild-moderate CD at weeks 6 and 12, with better tolerance than EEN. We assessed whether a 2-week course of EEN, followed by CDED+PEN is superior to 8 weeks of EEN in sustaining clinical remission at week 14, outcomes of CDED up to 24 weeks, and the utility of CDED in mild-severe CD. Method(s): This international, multicenter, randomized-controlled trial compared 2 weeks of EEN (Modulen, Nestle Health Science) followed by 3 phases of the CDED+PEN to 8 weeks of EEN, followed by PEN with free diet, both up to week 24. Children aged 8-18 with CD<3 years, mild-severe disease [paediatric CD activity index (PCDAI) 15-47.5], and active inflammation [elevated C-reactive protein (CRP) or faecal calprotectin (FCP)] were included. Stable immunomodulator (IM) treatment was allowed. Naive patients were allowed to start an IM from week 4. Result(s): Of the 63 eligible patients enrolled, 55 were randomized and included in the final intention to treat analysis (target recruitment failed due to COVID);Group 1 (CDED+PEN;29) and group 2 (EEN;26), mean age 12.7+/-2.4. Steroids-free sustained remission at week 14 was obtained in 20/29(69%) in group 1 and 16/26(61.5%) in group 2, p=0.56. Remission at week 8 was obtained in 22/29(76%) in group 1 and 14/26(54%) in group 2, p=0.08. 16/29(55%) in group 1 and 9/26(34%) in group 2 maintained clinical remission at week 24;p=0.12. Median PCDAI declined from 32.5[20-36.2] to 2.5[0-5.6] and 1.2[0-5.6] in group 1 (p<0.001 for all), and from 22.5[20-29.3] to 0[0-4.3] and 0[0-2.5] in group 2 (p<0.005 for all) at baseline, week 8 and 14 respectively. Median CRP improved in group 1 from 32 mg/L[6-69] to 5[2-16] and 3[2-10.1] (p<0.001 for both) and in group 2 from 10.35 mg/L[5-33] to 3.7[2.2-7.2], p=0.012 and 3.2[2.8-5], p=0.006 at baseline, week 8 and 14 respectively. Median FCP declined in group 1 from 1946 mug/g [862-3304] to 802[196-1312] at week 8 and 241[82-1175] at week 14 (p<0.01 for both), and in group 2 from 1615[605-2692] at baseline to 436[252-1389] at week 8, which then increased to 731[349-1305] at week 14 (p<0.01 for both). At week 14, 12/22(54%) received IM from group 1 and 15/16(93%) from group 2;p= 0.009. Conclusion(s): Two weeks of EEN followed by CDED&lPEN and EEN were successful in induction of clinical and biochemical remission in mild-severe paediatric CD, and most CDED+PEN patients-maintained remission to 24 weeks. Sustained clinical remission at week 14 was similar despite higher IM use in the EEN Group, suggesting that CDED might prevents diet-induced inflammation regardless of IM use.

Perceptions of the European Space Sector: Youth Engagement With Space Education Events

Space education not only plays a key role in helping young people understand the natural world and their impact on the planet but is also vital in ensuring that future generations can make meaningful contributions to the space sector at all levels. Positive perceptions of the space sector can lead young people to take roles where they can contribute to new knowledge, develop new technologies, and tackle societal challenges. As the relationship between science and society is tested by global events-such as climate change and the COVID-19 pandemic-scientific trust and accountability have become topics of frequent and public debate. The way in which young people engage with space education and perceive their potential involvement with the space sector is of greater importance now than ever before. This paper describes a two-year European space education project that was carried out before and during the COVID-19 global pandemic. An evaluation of the project activities showed that young people are generally enthusiastic about space, but their perceptions of the European space sector-and their connections to it-are less positive. Recommendations are made on the challenges facing the space sector and how it needs to adapt to better support the development of a more inclusive space education community.

A Place for Space: The Shift to Online Space Education During a Global Pandemic

The COVID-19 global pandemic has transformed the relationship between science and society. The ensuing public health crisis has placed aspects of this relationship in harsh relief;perceptions of scientific credibility, risk, uncertainty, and democracy are all publicly debated in ways unforeseen before the pandemic. This unprecedented situation presents opportunities to reassess how certain disciplines contribute to the public understanding of science. Space education has long provided a lens through which people can consider the intersection of the natural world with society. Space science is critical to understanding how human activity and pollution affect global warming, which in turn, inextricably links it to perceptions of the natural world, environmental change, science communication, and public engagement. The pandemic has caused a dramatic shift in how space education projects connect with public audiences, with participation pivoting to online engagement. This transition, coupled with the renewed societal examination of trust in science, means that it is an ideal time for the field of space education to reflect on its development. Whether it evolves into its own distinct field, or remains an area that straddles disciplinary boundaries, such as science education, communication, and public engagement, are crucial considerations when scientific trust, accountability, and responsibility are in question. This paper describes the current state of space education, recent advances in the field, and relevant COVID-19 challenges. The experience of an international space education project in adapting to online engagement is recounted, and provides a perspective on potential future directions for the field. © Copyright © 2021 Roche, Bell, Hurley, D’Arcy, Owens, Jensen, Jensen, Gonzalez and Russo.

ARMED to ESCAPE COVID-19: The impact of COVID-19 on a mixed methods feasibility study of a weight management, education and physical function programme for patients with knee osteoarthritis at the primary/secondary care interface

Objectives: This study was designed to test the feasibility of running a trial to compare the effectiveness of a combined weight management and physical function programme for patients with knee osteoarthritis ARMED (Arthritis Rehabilitation through the Management of Exercise and Diet) with usual care ESCAPE pain (Enabling Self-management and Coping with Arthritic Pain using Exercise). The COVID-19 pandemic interruption allowed additional measurement of the qualitative 'lived in' experiences of this patient group during the pandemic and also their appetite for virtual health. Participants: Thirty-two patients with knee osteoarthritis were recruited from a combined primary/secondary care waiting list and were allocated to either a six-week intervention group (ARMED) or to the six-week usual care ESCAPE pain group (Enabling Self-management and Coping with Arthritic Pain using Exercise) group. Results: The intervention programme was interrupted after three weeks by COVID-19. Fifteen patients were reassessed after the first stage. The average attendance was 92% with 6 patients attending all sessions, 5 attending 5/6, 1 attending 4/6 and 2 attending 3/6. One subject dropped out and 15/16 patients completed all outcome measurements. All patients completed the KOOS knee score and the Short Warwick-Edinburgh Mental Well Being Scale to evaluate anxiety and depression. There was a statistically significant improvement in pain, activities of daily living, quality of life and mental health and well-being scores from time one to time 2. The mean weight, BMI and waist measurements were reduced also from time one to time 2, but these failed to reach significance. The semi-structured interviews provided rich information on enablers and barriers to coping in lockdown, benefits of the ARMED programme to increasing physical activity and weight management and enablers and barriers to redesigning the programme for online delivery. Conclusions: Evaluation of preliminary data from this feasibility study supports the three-week intervention combining education, exercise and weight management in this patient group even during a pandemic. Based on the results of the qualitative interviews, we have now redesigned our programme to present it virtually. We hope to present the results of our virtual feasibility study later in 2021. ©

The OARSI “joint effort initiative” repository of online osteoarthritis management programmes: an implementation rapid response during covid-19

Purpose: 1) To collate into a repository, best-evidence online osteoarthritis management programmes (OAMPS), and 2) facilitate their implementation, in the context of the COVID-19 pandemic.The Osteoarthritis Research Society International Joint Effort Initiative (OARSI JEI) is a collaboration between international researchers, clinicians and knowledge brokers with an interest in the implementation of OAMPS. OAMPs are defined by the OARSI JEI as “models of evidence-based, non-surgical care that have been implemented in a real world setting and include the following four components: personalised OA care;delivered as a package of care with longitudinal reassessment and progression;comprising two or more elements of the core non-surgical, non-pharmacological interventions (education, exercise and weight loss);with optional adjunct treatments as required (e.g. assistive devices and psychosocial support)”. In 2020, COVID-19 presented a major barrier to the clinical delivery of traditional “in-person” OAMPS. In response, the OARSI JEI implementation group sought to create a repository resource for healthcare professionals (HCPs) seeking to access and signpost patients with OA to online, high-quality OAMPS. The resource also provided access to online HCP training. Methods: An existing community of practice (OARSI JEI implementation group) with access to patient and public involvement, was utilised to create and share an evidence-informed online OAMP repository via social media and OARSI networks. The project involved 5 key stages. Online OAMPS resource investigation: International research, implementation and HCP experts from the JEI implementation group (n=32) were invited to send all online OAMP resources that they were aware of to the reviewers (LS, JQ). These were captured in a spreadsheet with data extracted on programme name;country of origin;whether the resource targeted patients or HCPs;access details relating to required technology, sign in and any access costs;weblink;brief programme content summary;OARSI expert advocating for the programme quality (including whether the content is evidence informed). Screening for repository inclusion: Two reviewers (JQ, LS) screened the resources received against inclusion criteria (matching the OAMP definition, remotely deliverable via the internet, OARSI expert endorsed). Disagreements were resolved through discussion. Creating the online OA repository resource: Academics (JQ, LS, KD) provided content and feedback for a knowledge broker (LC) to create a pdf repository containing included online OAMP information, weblinks and summary information in the form of an infographic. Rapid social media knowledge mobilisation: The repository resource was initially hosted on the Keele Impact Accelerator Unit website and shared on completion with existing OARSI member JEI networks via social media (Twitter)(LC). Owners of online OAMPS also promoted their own programmes via social media. Reflection and learning: Project method strengths and limitations were discussed, critiqued and captured during an OARSI JEI community of practice meeting. Results: The final OARSI online repository included 7 OAMPS and linked training resources. The online repository is available at: with ongoing plans for hosting on the OARSI website. Fig. 1 illustrates the repository cover and Fig. 2 is the infographic repository summary. A relative dearth of online OAMPS meeting our prespecified criteria were identified which included: ESCAPE pain;The Joint Academy;JIGSAW-E (for pharmacists and physiotherapists);PEAK: Join2Move;Osteoarthritis Management Healthy Weight for life. Only JIGSAW-E, PEAK and the Join2Move app were widely available free resources for HCPs at the early stage of the COVID-19 pandemic. All online OAMPs were in English except the Join2Move app which is in Dutch. Content details of the included online OAMPs and online OAMP HCP training packages are summarised in Table 1. The initial Twitter launch tweet sharing the repository infographic and repository link has had 5,679 impre sions and 334 engagements to date and has been shared globally. Reflections and limitations: There is an urgent requirement for more high-quality OAMPs to be freely available for remote delivery and in a wider range of languages. This has relevance both during the COVID pandemic and more generally for rural, geographically isolated populations and low- and middle-income countries. In reacting to an emergency, rapidly evolving, time-pressured clinical pandemic context, there was a tension in matching the highest quality methods for searching, evaluating and synthesising online OAMPs in the shortest possible time. For example, full systematic review methods were deemed inappropriate and the project was not explicitly informed a-priori by a protocol or knowledge mobilisation theory, however, members of the team had knowledge mobilisation expertise. It is possible that we did not identify all online OAMPs. For example, no online OAMPS from South America, Africa or Asia were identified which may, in part, be explained by the geographical representation within the community of practice, with participants mostly from Europe, North America and Australasia. It is acknowledged that the pragmatic and rapid OAMP resource identification, screening and knowledge mobilisation from this project does not guarantee implementation into clinical practice. The existence of the OARSI JEI implementation group facilitated the timely execution of this project whilst the use of social media allowed the repository to be shared rapidly with many stakeholders. Future plans include the hosting of the repository and future JEI work on the OARSI website (to increase resource access);the formal synthesis of knowledge mobilisation metrics relating to the online repository and included OAMPS, and;the ongoing review of repository content in the light of new OAMPS. Conclusions: The OARSI-endorsed JEI implementation group facilitated the creation of an online OAMP repository in response to the COVID-19 pandemic and need for remotely delivered care. There is a dearth of widely available and remotely deliverable OAMPs internationally. This is likely to present a significant barrier to the delivery of best OA care, especially during COVID-19. OARSI can have a key role in supporting the implementation of best OA care. There is a need to actively broaden the diversity and national representation within the JEI implementation group and increase patient and public involvement to best serve the international OA populations, particularly from low- and middle-income countries, it seeks to inform. [Formula presented] [Formula presented] [Formula presented]

Why practices that could be torture or cruel, inhuman and degrading treatment should never have formed part of the public health response to the COVID-19 pandemic in prisons

In this article, we consider the use of restrictive practices in Australian prisons in response to the COVID-19 pandemic, focusing on solitary confinement. We explore the health and human rights implications for people subjected to the practice. An overview is provided of the expansion of powers that have increased the risk of people being detained in conditions that amount to solitary confinement during the pandemic. Australian governments' use of quarantine and lockdowns as tools to address the risks posed by COVID-19 to people in prison is examined and critiqued. To safeguard against the normalisation of these practices, the use of solitary confinement in prisons should be prohibited in law, and any exceptional circumstances in which a person may be separated from others in prison should be clearly defined, with appropriate safeguards. There also needs to be immediate and effective oversight of prisons in compliance with the Optional Protocol to the Convention Against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment.