Pulmonary influenza infection promotes the awakening of dormant metastatic breast cancer cells

Breast cancer is the most common form of cancer and the second cancer-causing death in females. Although remission rates are high if detected early, survival rates drop substantially when breast cancer becomes metastatic. The most common sites of metastatic breast cancer are bone, liver and lung. Respiratory viral infections inflict illnesses on countless people. The latest pandemic caused by the respiratory virus, SARS-CoV-2, has infected more than 600 million worldwide, with documented COVID-related death upward of 1 million in the United States alone. Respiratory viral infections result in increased inflammation with immune cell influx and expansion to facilitate viral clearance. Prior studies have shown that inflammation, including through neutrophils, can contribute to dormant cancer cells reawakening and outgrowth. Moreover, inhibition of IL6 has been shown to decrease breast cancer lung metastasis in mouse models. However, how respiratory viral infections contribute to breast cancer lung metastasis remains to be unraveled. Using MMTV/PyMT and MMTV/NEU mouse models of breast cancer lung metastasis and influenza A virus as a model respiratory virus, we demonstrated that acute influenza infection and the accompanying inflammation and immune cell influx awakens and dramatically increased proliferation and expansion of dormant disseminated cancer cells (DCC) in the lungs. Acute influenza infection leads to immune influx and expansion, including neutrophils and macrophages, with increased proportion of MHCII+ macrophages in early time points, and a sustained decrease in CD206+ macrophages starting 6 days post-infection until 28 days after the initial infection. Additionally, we observed a sustained accumulation of CD4+ T cells around expanding tumor cells for as long as 28 days after the infection. Notably, neutrophil depletion or IL6 knockout reversed the flu-induced dormant cell expansion in the lung. Finally, awakened DCC exhibited downregulation of vimentin immunoreactivity, suggesting a role for phenotypic plasticity in DCC outgrowth following viral infection. In conclusion, we show that respiratory viral infections awaken and increase proliferation of dormant breast cancer cells in the lung, and that depletion of neutrophils or blocking IL6 reverses influenza-induced dormant cell awakening and proliferation.

Americans' COVID-19 risk perceptions and risk perception predictors changed over time

Identifying and understanding risk perceptions—"how bad are the harms” to humans or to what they value that people see as potentially or actually arising from entities or events—has been critical for risk analysis, both for its own sake, and for expected associations between risk perceptions and subsequent outcomes, such as risky or protective behavior, or support for hazard management policies. Cross-sectional surveys have been the dominant method for identifying and understanding risk perceptions, yielding valuable data. However, cross-sectional surveys are unable to probe the dynamics of risk perceptions over time, which is critical to do while living in a dynamically hazardous world and to build causal understandings. Building upon earlier longitudinal panel studies of Americans' Ebola and Zika risk perceptions using multi-level modeling to assess temporal changes in these views and inter-individual factors affecting them, we examined patterns in Americans' COVID-19 risk perceptions in six waves across 14 months. The findings suggest that, in general, risk perceptions increased from February 2020 to April 2021, but with varying trends across different risk perception measures (personal, collective, affective, affect, severity, and duration). Factors in baseline risk perceptions (Wave 1) and inter-individual differences across waves differed even more: baseline ratings were associated with how immediate the threat is (temporal distance) and how likely the threat would affect people like oneself (social distance), and following the United States news about the pandemic. Inter-individual trend differences were shaped most by temporal distance, whether local coronavirus infections were accelerating their upward trend, and subjective knowledge about viral transmission. Associations of subjective knowledge and risk trend with risk perceptions could change signs (e.g. from positive to negative) over time. These findings hold theoretical implications for risk perception dynamics and taxonomies, and research design implications for studying risk perception dynamics and their comparison across hazards. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Conclusion: Emerging Trends in Outdoor Environmental Education in the Post-COVID World

This chapter summarizes and critically reflects on the emerging trends discussed in the preceding chapters, tracing the developments in the OEE field that have occurred in response to the changing world. The chapter highlights certain tendencies, such as reviving the importance of place, empowering teachers, students, and other stakeholders to actively plan and conduct OEE, blurring the boundaries between indoor, outdoor, and cyberspace learning and promoting a post-human, non-anthropocentric perspective in OEE. At the same time, the chapter deals with some of the more traditional OEE approaches and their virtues that are still pertinent for the future. The evolution of the OEE field needs to be shaped by a pluralistic discussion of a variety of approaches. This calls for mutual openness and consideration of both theory and practice. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Emphasizing Self-Regulation in Teaching: Reducing Disruption to Students' Learning during Unplanned Instructional Mode Transition

In Spring 2020, engineering faculty transitioned to emergency remote instruction due to COVID-19. This mixed-methods study was done to understand the correlation between self-regulated learning and how students experienced the emergency transition to remote learning. The participants were from an upper-level engineering course, with 33 students surveyed four times during the semester. Seven students were interviewed after the semester. Findings revealed that during the transition to remote learning, students perceived less change if they had higher degrees of self-regulation. The qualitative analysis also revealed that transparency in learning and teaching also played an important role in students' perceptions. © 2023 Taylor & Francis Group, LLC.

Accessing justice in criminal courts during the COVID-19 pandemic: The transition to virtual courts

• In Canada, the COVID-19 pandemic necessitated an unprecedented closure of criminal courts. The Ontario government's solution to these physical closures was to conduct proceedings virtually. Long touted as a way to expand access to justice, some have raised concerns that the use of audiovisual technologies will in certain respects actually decrease access to justice. This research thus sought to understand how the pandemic-era migration to a virtual environment impacted access to justice, conceived narrowly as the ability to access courts and lawyers. This research employed ethnographic methods in Ontario's criminal courts. It found that while the transition to a virtual environment could contribute to greater access to the courts for a majority of defendants, it also complicated access for those living in rural areas, those who were self-represented or those who were incarcerated pending trial. This article explores these issues before discussing the post-pandemic future of these technologies in criminal courts. © The Author(s) 2022.

RE-AIM EVALUATION OF A VIRTUAL "AGING WITH PAIN” INTEGRATIVE HEALTH EDUCATION PROGRAM DURING THE COVID-19 PANDEMIC

Literature suggests integrative pain management strategies reduce chronic pain and opioid use. However, many older adults are unaware of these options. The Aging and Integrative Pain Assessment and Management Initiative (AI-PAMI) launched in 2020, providing webinars and recorded presentations on integrative pain management for adults > age 50, caregivers and healthcare providers. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was used to evaluate AI-PAMI via the following measures: participant demographics, survey results, program elements and qualitative findings. Reach: There have been > 20,000 views of recorded content and 48% (885/1,859) of registrants attended a live webinar. Effectiveness: Survey results demonstrate 75% of providers and 73% of older adults/caregivers reported new knowledge gain;and 80% of providers and 60% of older adults/caregivers reported changing their pain management practice/routine. Adoption: Presentations were delivered by 33 multidisciplinary experts from 12 different institutions. Six regional stakeholders promoted AI-PAMI using their dissemination networks. Implementation: The COVID-19 pandemic changed program delivery from an in-person model to virtual. To date, AI-PAMI has delivered 17 live webinars and 25 recorded presentations. Live webinars are delivered with a didactic, Q&A discussion and follow-up email. To refine AI-PAMI, 11 healthcare providers and 16 older adults participated in focus groups or in-depth interviews. Maintenance: AI-PAMI is in its third year and will be maintained under a long-standing institution-wide program. Website content will be sustained and remain free access. AI-PAMI is a valuable educational resource for older adults, caregivers, and healthcare providers. Virtual delivery is accommodating for a post-COVID environment.

Adapting and responding to a pandemic: Patient and family advisory councils in children's hospitals during COVID-19

This mixed-methods study investigated the effects of the COVID-19 pandemic on Patient and Family Advisory Councils (PFACs) within children’s hospitals in the United States. Specifically, the study sought to understand how PFACs adapted operations as a result of the COVID-19 pandemic, how patient and family advisors (PFAs) were engaged in the response to COVID-19, and the intersection of the COVID-19 pandemic with PFAC diversity, equity, and inclusion. The study consisted of a survey distributed to 228 children’s hospitals, with a 73% response rate, and in-depth interviews with selected survey respondents (n=12). While COVID-19 temporarily disrupted PFAC operations and forced rapid adaptations, most children’s hospital PFACs transitioned successfully to virtual meetings, with 86% reporting that their PFAC met at least once from March to December 2020 and 84% indicating that their PFAC planned to meet as frequently or more frequently than before the pandemic. The majority of respondents (72%) reported that attendance at virtual PFAC meetings was the same as or better than with in-person meetings. Interview participants reported benefits associated with virtual meetings, including the potential ability to recruit and engage PFAs who better reflected the diversity of the patients and families served by the hospitals. Children’s hospitals are well-positioned to be leaders in the field, contributing to the development of new approaches, lessons learned, and best practices moving forward. This is especially true as hospitals continue to navigate the evolving realities of the COVID-19 pandemic, and as PFACs address challenges associated with maintaining diverse, equitable, and inclusive councils. © The Author(s), 2022.

Patient factors associated with COVID-19 loss of taste or smell patient factors in smell/taste loss COVID-19.

Objectives: Dysfunction in smell or taste is well recognized phenomenon in patients infected with SARS-CoV-2. This study aimed to quantify the incidence and associated co-morbidities of reported olfactory or gustatory dysfunction in patients who tested positive for SARS-CoV-2. Methods: From March 23, 2020 through July 31, 2020, 192,683 patients were tested for SARS-CoV-2 at Mayo Clinic. These patients with a positive test were contacted via telephone by physicians at Mayo Clinic and information gathered on patient demographics, comorbidities, symptoms and clinical risk stratification based on these factors. Results: Two thousand two hundred and fifty patients tested positive for SARS-CoV-2 (1.2%). Six hundred and sixty-seven (29.6%) of these patients reported loss of smell or taste. Factors found to be correlated with reporting loss of smell or taste on multivariate analysis were: younger age, female sex, or symptoms of chest pain or tightness, cough, or headache and lower clinical risk category. Coronary artery disease (CAD) was associated with not reporting loss of taste or smell. Conclusion: Of 2250 patients testing positive for SARS-CoV-2 at Mayo Clinic, 667 reported loss of taste and smell. Patients who reported loss of smell or taste were younger, female and more likely to report cough, chest pain, headache, or history of chronic obstructive pulmonary disease (COPD), but overall had fewer high-risk comorbidities. Those who were older, male, and a reported history of CAD were less likely to report chemosensory dysfunction. Our data are the largest single institution data reporting COVID-19 associated loss of smell or taste, and the first to associate COPD and CAD as factors that affect rates of reported chemosensory dysfunction. Level of evidence: IIB.

Perceptions of the Virtual Interview Process: A National Survey of Rhinology Fellowship Directors

Introduction: To limit the spread of COVID-19 and keep faculty and applicants safe, many otolaryngology subspecialties conducted their fellowship interviews via a virtual format, including within the field of rhinology. Given the novel virtual format of interviews during the 2021 rhinology interview cycle, our study looked to determine how virtual interviews compared with in-person interviews from the perspective of rhinology fellowship directors. Method(s): A web-based anonymous survey was developed consisting of 15 questions. Electronic letters were sent to all fellowship directors participating in the 2021 rhinology match requesting their participation. Fourteen of the 15 questions from our survey were based on a 5-point Likert-type scale, with 1 representing strong disagree and 5 representing strongly agree;there was 1 one open-ended question. Result(s): Overall, 70% of rhinology fellowship directors responded. Fellowship directors were divided on whether they were satisfied with the virtual interview but overall felt the process was convenient (74%). Most (74%) reported that virtual interviews did not allow them to sufficiently display their program. In addition, 70% felt that the virtual interview process did not allow them to establish rapport with applicants and also to determine who would be the best fit for their program (70%). Most also reported placing more emphasis on applicants' curriculum vitae and letters of recommendation. Overall, 65% said they would not plan to offer virtual interviews in the future despite similar or better match results. Conclusion(s): While virtual interviews result in notable cost reductions and increased convenience to programs and applicants, fellowship directors were mixed in their level of satisfaction with the overall process. This was primarily related to the perceived inability to accurately reflect their program remotely and also an increased difficulty evaluating applicants via a virtual format. These limitations led to most fellowship directors not planning to offer virtual interviews in the future despite similar match results to when conducting traditional interviews.

Early Clinical Experience with ALVR109, a Partially HLA-Matched SARS-CoV-2 Specific T-Cell Therapy, in Immunocompromised Patients with COVID-19

Purpose: Therapies for COVID-19 in immunocompromised (IC) patients (pts), including transplant (tx) pts, are limited. We describe our experience with ALVR109, an allogeneic, partially HLA-matched T-cell product, given through emergency investigational new drug (eIND) application to 4 consecutive IC pts with protracted COVID-19. Method(s): To measure SARS-CoV-2 viral loads, SARS-2 RNA was quantified by RT-PCR (N gene) in plasma and saliva. ALVR109 was manufactured for Allovir at Baylor College of Medicine. Result(s): Between May and October 2021, ALVR109 was given to 4 IC pts with COVID-19 (details in Table 1). 2 pts had lymphoma (1 post auto-tx) and 2 had lung tx. All pts had SARS-CoV-2 RNA detected in plasma (viremia) in the weeks leading up to ALVR109 administration. Infusions (20-40 million cells (MC) per dose) were well-tolerated with no adverse events. Prior to ALVR109, pts 1 and 3 had progressive COVID-19 and ongoing SARS-CoV-2 viremia despite monoclonal antibodies (mABs) and remdesivir. Following ALVR109 administration both patients had a decrease in viremia with marked clinical improvement in pt 1, but both eventually died from their underlying disease. Viral loads (plasma/saliva) and functional scores for pt 1 are shown in the figure. Autopsy of pt 3 showed no evidence of SARS-CoV-2 infection by lung in-situ hybridization (ISH). Pts 2 and 4 received ALVR109 as adjunctive therapy to mABs and remdesivir;viremia continued to decline following ALVR109 and both pts survived and were discharged home. Conclusion(s): This initial experience suggests a potential role of ALVR109 in the treatment of IC and tx pts with COVID-19. SARS-CoV-2-specific T-cells appear to be safe and may control viremia in IC pts. Larger studies are needed to confirm this observation, define the best candidates for ALVR109, and determine optimal timing of administration. (Table Presented).

National Nonprofit Sector Advocacy During the COVID-19 Pandemic

When the COVID-19 pandemic hit Canada in March 2020, charitable and nonprofit sector leaders quickly realized the survival of many organizations was at risk. Three national coalitions formed to seek support for the sector from the federal government. Their efforts produced several concrete policy outcomes, including the inclusion of charities and nonprofits in all major federal relief programs and two support programs designed for charities and nonprofits. They also contributed to significantly increased awareness among policymakers of the role and challenges of charities and nonprofits. This has opened a policy window that the sector can use to advance several long-standing goals. © 2021, University of Alberta Library. All rights reserved.

Local News in Colorado: Comparing Journalism Quality Across Four Counties

Local journalism is a pillar of democratic societies, and its role becomes more critical during crises. But despite its critical importance, local news has faced immense challenges that jeopardize its sustainability in the U.S. This study examines the Colorado media ecology by comparing local news sources across four different counties during Summer 2020 and exploring the factors behind similarities and differences in coverage. Building on Napoli et al.’s (2017) framework to assessing the health of local news, the study uses content analysis to examine original, local reporting and coverage of critical information needs as well as type of framing in over 600 online stories appearing on the home pages of all news sources in the four counties. The findings reveal that the Colorado journalism ecosystem post-Covid outpaces U.S. local news in quality in the pre-Covid era yet aligns with disturbing trends pointing to inequities and disparities. In other words, rural, poorer, and more racially and ethnically diverse Colorado communities tend to have weaker news ecosystems and are more likely to become news deserts. The study also introduces thematic coverage as a necessary dimension to add to journalism quality assessment frameworks and discusses several approaches to salvage local news. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Oncology clinical trial disruption during the COVID-19 pandemic: a COVID-19 and cancer outcomes study.

BACKGROUND: COVID-19 disproportionately impacted patients with cancer as a result of direct infection, and delays in diagnosis and therapy. Oncological clinical trials are resource-intensive endeavors that could be particularly susceptible to disruption by the pandemic, but few studies have evaluated the impact of the pandemic on clinical trial conduct. PATIENTS AND METHODS: This prospective, multicenter study assesses the impact of the pandemic on therapeutic clinical trials at two large academic centers in the Northeastern United States between December 2019 and June 2021. The primary objective was to assess the enrollment on, accrual to, and activation of oncology therapeutic clinical trials during the pandemic using an institution-wide cohort of (i) new patient accruals to oncological trials, (ii) a manually curated cohort of patients with cancer, and (ii) a dataset of new trial activations. RESULTS: The institution-wide cohort included 4756 new patients enrolled to clinical trials from December 2019 to June 2021. A major decrease in the numbers of new patient accruals (-46%) was seen early in the pandemic, followed by a progressive recovery and return to higher-than-normal levels (+2.6%). A similar pattern (from -23.6% to +30.4%) was observed among 467 newly activated trials from June 2019 to June 2021. A more pronounced decline in new accruals was seen among academically sponsored trials (versus industry sponsored trials) (P < 0.05). In the manually curated cohort, which included 2361 patients with cancer, non-white patients tended to be more likely taken off trial in the early pandemic period (adjusted odds ratio: 2.60; 95% confidence interval 1.00-6.63), and substantial pandemic-related deviations were recorded. CONCLUSIONS: Substantial disruptions in clinical trial activities were observed early during the pandemic, with a gradual recovery during ensuing time periods, both from an enrollment and an activation standpoint. The observed decline was more prominent among academically sponsored trials, and racial disparities were seen among people taken off trial.

Media Studies: Texts, Production, Context, Third edition

This thoroughly revised and updated third edition provides a comprehensive introduction to the various approaches to the field, explaining why media messages matter, how media businesses prosper and why media is integral to defining contemporary life. The text is divided into three parts – Media texts and meanings;Producing media;and Media and social contexts – 　exploring the ways in which various media forms make meaning;are produced and regulated;and how society, culture and history are defined by such forms. Encouraging students to actively engage in media research and analysis, each chapter seeks to guide readers through key questions and ideas in order to empower them to develop their own scholarship, expertise and investigations of the media worlds in which we live. Fully updated to reflect the contemporary media environment, the third edition includes new case studies covering topics such as Brexit, podcasts, Love Island, Captain Marvel, Black Lives Matter, Netflix, data politics, the Kardashians, President Trump, ‘fake news’, the post-Covid world and perspectives on global media forms. This is an essential introduction for undergraduate and postgraduate students of media studies, cultural studies, communication studies, film studies, the sociology of the media and popular culture. © 2022 Paul Long, Beth Johnson, Shana MacDonald and Schem Rogerson Bader.

Preliminary Results From an Emergency Department Pain Coach Service and Discharge Toolkit Pilot Project During COVID-19

Study Objectives: Amid the US opioid epidemic, emergency providers and patients are searching for non-opioid or nonpharmacologic pain treatment options. The challenge of managing pain without opioids was escalated by the COVID-19 pandemic with opioid related overdoses and deaths increasing by 20-40%. Most healthcare professionals have limited knowledge, resources or time for pain education, especially in the emergency department (ED). To address these needs a novel pain coaching program was designed including a menu of nonpharmacologic patient discharge toolkit materials. Study objectives were to determine descriptive patient and toolkit utilization data and challenges in the first 4 months of a novel pain program. Methods: Target population consisted of patients ≥14 years of age seen by a new ED Pain Coaching staff from January 4, 2021- April 30, 2021. The two ED sites consisted of an urban, academic center with trauma center, pediatric ED, etc. and an affiliated community ED. Patients were determined by ED rounding, ED census review and consultation by ED staff, physicians, physical therapy, palliative care and pharmacy. Summary statistics for patient demographics, pain type, REALM-SF score, educational topics, toolkit materials, challenges and other data were ed from coaching and patient notes on a daily basis using a REDCap database for analysis. Upon request, there were select inpatient and repeat coaching encounters. Results: During this 4-month pilot, 296 coaching sessions were completed on 276 unique patients;20 screen outs for severe pain, procedures, violent behavior or other obstacles. Average age was 43 with 85% between 20-70 years of age;62% female;60% African American. Pain was 46% acute, 50% acute on chronic and 4% chronic with patients often having multiple pain etiologies: musculoskeletal (74%), inflammatory (71%), post-trauma (15%), headache (14%), post-surgical (4%) and neuropathic (3%). Education topics provided with accompanying toolkit items: hot/cold gel packs (90%), car with 4 flat tires analogy (90%), pain neuroscience education (88%), aromatherapy inhalers (82%), breathing techniques (69%), virtual reality (51%), exercise (38%), stretching (35%), diet (20%), acupressure (11%). The majority of patients were seen in 2 EDs or associated trauma center (87%);however, the coach received referrals for selected inpatients (13%). Seventeen educational brochures were made available to patients with aromatherapy, managing pain, pain and stress, and nonpharmacologic management being most utilized. Challenges to coaching included medical condition (14%), too much pain (11%), time constraints (7%);52% had no challenges. Regarding patient feedback, 61% indicated the session was helpful and 39% were unsure at the time. Conclusion: Results from this novel ED pain coach and discharge toolkit model provide valuable insights for development of a national pain coach model. Coaching scripts, note template, brochures, videos, inventory and other programmatic materials will be published for further implementation. Future plans include longitudinal patient follow-up, staff satisfaction assessment and addition of new modalities.

Employability Framework in the Post- Covid Scenario - A Literature Review

Employability has today become a major problem due to the Covid-19 pandemic. The purpose of this paper is to explore the theoretical concepts and models of employability to ascertain the gap between knowledge and skill imparted by various educational and training institutes and its absorption. The literature review focuses on two aspects, i.e., the existing pre-Covid-19 literature and the emerging concepts of employability, post- Covid-19. Different approaches to employability, starting from the studies by Gazier (1998), Hillage and Pollard (1999) to later ones like 'organisation approach', employability in terms of individual transferable skills, career management, perceived employability, etc.have been analysed. Literature related to the emerging concept of employability post-Covid-19 are focused more on competency, career resilience, learning with experience /problem based learning, innovation and creativity, adaptability and sustainability. An employability framework has been developed and proposed based on the Four Quadrant Model of Human Knowledge by Ken Wilber.

Institutional Supports for Student Experiential Learning in Hybrid/Remote Learning Contexts

Students' experiential learning in out-of-class involvements encompasses a significant part of their engagement and professional development in college. The covid-19 pandemic has challenged the delivery of these experiential learning opportunities, requiring student affairs professionals to significantly adapt their programming to continue serving students in ways that accommodate social distancing guidelines, in-person event capacity limits, and remote participants. While research has investigated online learning in classroom contexts, less is known about the implications of a virtual learning environment on engagement in experiential learning. This study addresses the following research question: How are student affairs professionals adapting their programs and services to support student engagement in response to the covid pandemic? This study captures how student affairs professionals at a large Midwestern research university have adjusted programming and engagement efforts to maintain key elements of experiential learning in hybrid and remote learning contexts, where students' engagement ranges from entirely on-line to various combinations of partial in-person and online participation. The Midwestern university transitioned from predominantly residential to fully online during the spring 2020 semester and then allowed students to choose whether to continue fully online or return to campus for a hybrid learning environment in the fall 2020 semester. This study draws on Schlossberg's transition theory to examine how student affairs professionals transitioned programs and services in the 2020-2021 academic year to respond to the covid-19 pandemic and the associated changing safety guidelines. Facing unique challenges in this varied, constantly changing environment, student affairs professionals described three key elements of successful program and service adaptations: (1) a focus on student needs, (2) collaboration across student support units, and (3) creativity and innovation in approaches to engage students. Through thematic analysis of interviews with 13 student affairs professionals (including student organization advisors and administrators, student programming coordinators, and student support specialists), research findings provide further insight into the challenges and opportunities presented in adapting experiential learning to hybrid and remote formats. Research findings will help inform ongoing efforts to craft hybrid and remote student programming and services that support and engage students in these unprecedented times. These findings can also inform the development of student support programs for the growing body of online students in higher education. © American Society for Engineering Education, 2021