How Did Levels of Psychological Distress and Perceptions of Workplace Support amongst Children's Social Work Staff Change during the Covid-19 Pandemic?

Covid-19 brought about drastic changes in day-to-day life and working practices, and had a profound impact on the mental health and well-being of the general population. Certain professional groups have also been particularly affected. This study sought to explore how levels of psychological distress and perceptions of workplace support amongst social work staff changed during the pandemic. We present the results from a series of surveys conducted in four local authorities (LAs) in England, before and during the Covid-19 pandemic. Social workers and other social care staff (n  = 62) were asked about their experiences of psychological distress, using the twelve-item General Health Questionnaire. Overall, we found the proportion of staff reporting elevated levels of psychological distress increased and, in line with previous studies involving social workers, was high relative to the general population. Yet, most staff also said they had high levels of support from managers and colleagues, whilst a small proportion reported an increased perception of workplace support during the pandemic, compared to before. We consider these findings in relation to Organisational Support Theory and reflect on the ability of LAs to provide effective support for social care staff.

Supporting Weight Management during COVID-19 (SWiM-C): twelve-month follow-up of a randomised controlled trial of a web-based, ACT-based, guided self-help intervention.

OBJECTIVES: We developed a guided self-help intervention (Supporting Weight Management during COVID-19, "SWiM-C") to support adults with overweight or obesity in their weight management during the COVID-19 pandemic. This parallel, two-group trial (ISRCTN12107048) evaluated the effect of SWiM-C on weight and determinants of weight management over twelve months. METHODS: Participants (≥18 years, body-mass-index ≥25 kg/m2) were randomised to the SWiM-C intervention or to a standard advice group (unblinded). Participants completed online questionnaires at baseline, four months, and twelve months. The primary outcome was change in self-reported weight from baseline to twelve months; secondary outcomes were eating behaviour (uncontrolled eating, emotional eating, cognitive restraint of food intake), experiential avoidance, depression, anxiety, stress, wellbeing and physical activity. INTERVENTIONS: SWiM-C is based on acceptance and commitment therapy (ACT). Participants had access to an online web platform with 12 weekly modules and email and telephone contact with a trained, non-specialist coach. Standard advice was a leaflet on managing weight and mood during the COVID-19 pandemic. RESULTS: 388 participants were randomised (SWiM-C: n = 192, standard advice: n = 196). The baseline-adjusted difference in weight change between SWiM-C (n = 119) and standard advice (n = 147) was -0.81 kg (95% CI: -2.24 to 0.61 kg). SWiM-C participants reported a reduction in experiential avoidance (-2.45 [scale:10-70], 95% CI: -4.75 to -0.15), uncontrolled eating (-3.36 [scale: 0-100], 95% CI: -5.66 to -1.06), and emotional eating (-4.14 [scale:0-100], 95% CI: -7.25 to -1.02) and an increase in physical activity (8.96 [MET-min/week], 95% CI: 0.29 to 17.62) compared to standard advice participants. We found no evidence of an effect on remaining outcomes. No adverse events/side effects were reported. CONCLUSIONS: Whilst we were unable to conclude that the intervention had an effect on weight, SWiM-C improved eating behaviours, experiential avoidance and physical activity. Further refinement of the intervention is necessary to ensure meaningful effects on weight prior to implementation in practice. TRIAL REGISTRATION NUMBER: ISRCTN 12107048.

A Prospective Audit Comparing Optos Widefield Imaging to Fundus Examination for Von Hippel-Lindau Retinal Screening.

Background Von Hippel-Lindau (VHL) disease is an autosomal dominant multisystem disorder caused by germline mutations at chromosome 3p25-26 in the VHLtumour suppressor gene. Retinal manifestations include capillary haemangiomas that develop in up to 80% of gene carriers. Lifelong retinal surveillance involves yearly assessment usually by fundoscopy and often as part of a VHL multidisciplinary clinic. Optos ultra-widefield retinal imaging is now becoming more widely used in virtual retinal screening clinics. We aimed to assess discrepancies in the pickup rate of angioma and angiomatous-associated disease between slit-lamp fundoscopy and Optos ultra-widefield imaging. Methodology A total of 49 patients had both Optos ultra-widefield retinal imaging and slit-lamp fundoscopy over 16 months in VHL retinal surveillance clinics at the John Radcliffe Hospital, Oxford, UK. Optos images were analysed for image quality and presence of angioma(s) by a Consultant Ophthalmologist who was masked to the fundoscopy findings. The pickup rate was compared between slit-lamp fundoscopy and Optos imaging. Results In total, data on 94 eyes were collected. Of the total Optos retinal images, 12.8% were positive for angiomas compared to 11.7% from the slit-lamp examination. There was a discrepancy of 1.1% (one value) where the Optos image analysis suggested a possible angioma, which was not identified on slit-lamp examination. Optos imaging identified all angiomas in this cohort. Conclusions Optos imaging was non-inferior to slit-lamp examination in this sample of 94 eyes. In the current COVID-19 climate, reducing clinician-patient interaction is important. This research supports providing retinal imaging as an acceptable alternative to the yearly slit-lamp fundus examination.

T cell repertoire profiling in allografts and native tissues in recipients with COVID-19 after solid organ transplantation: Insight into T cell-mediated allograft protection from viral infection.

Introduction: The effects of the SARS-CoV-2 virus on the body, and why the effects are more severe in certain patients, remain incompletely understood. One population of special interest is transplant recipients because of their immunosuppressed state. Understanding the pathophysiology of graft dysfunction in transplant patients with the COVID-19 viral syndrome is important for prognosticating the risk to the graft as well as understanding how best to prevent and, if necessary, treat graft injury in these patients. Methods: We analyzed multiple types of solid organ transplant recipients (liver, kidney, heart or lung) at our institution who died from SARS-CoV-2 and underwent autopsy (n = 6) or whose grafts were biopsied during active SARS-CoV-2 infection (n = 8). Their serum inflammatory markers were examined together with the histological appearance, viral load, and TCR repertoire of their graft tissue and, for autopsy patients, several native tissues. Results: Histology and clinical lab results revealed a systemic inflammatory pattern that included elevated inflammatory markers and diffuse tissue damage regardless of graft rejection. Virus was detected throughout all tissues, although most abundant in lungs. The TCR repertoire was broadly similar throughout the tissues of each individual, with greater sharing of dominant clones associated with more rapid disease course. There was no difference in viral load or clonal distribution of overall, COVID-associated, or putative SARS-CoV-2-specific TCRs between allograft and native tissue. We further demonstrated that SARSCoV-2-specific TCR sequences in transplant patients lack a donor HLArestricted pattern, regardless of distribution in allograft or native tissues,suggesting that recognition of viral antigens on infiltrating recipient cells can effectively trigger host T cell anti-viral responses in both the host and graft. Discussion: Our findings suggest a systemic immune response to the SARS-CoV-2 virus in solid organ transplant patients that is not associated with rejection and consistent with a largely destructive effect of recipient HLA-restricted T cell clones that affects donor and native organs similarly.

Supporting Weight Management During COVID (SWiM-C): A Randomized Trial of an ACT-Based Intervention

Background: We developed a web-based, acceptance-based, guided self-help intervention (Supporting Weight Management during COVID-19, "SWiM-C") which aimed to support adults with over-weight or obesity in their weight management and emotional well-being during the COVID-19 pandemic. This study evaluates the effect of SWiM-C on weight and determinants of weight over twelve months. Methods: We randomized 388 participants (>18 years, BMI >25kg/m2) to the SWiM-C intervention (n=192) or a control group (n=196). SWiM-C is based on acceptance and commitment therapy (ACT) and is delivered remotely via an online web platform (12 weekly modules) and contact via telephone and email with a trained, non-specialist coach. The control group received a leaflet on weight management and wellbeing during the pandemic. Participants completed online questionnaires at baseline, 4 months, and 12 months. The primary outcome was change in self-reported weight from baseline to 12 months;secondary outcomes were eating behavior, experiential avoidance, mental health, wellbeing and physical activity. Results: At 12 months, the adjusted difference in weight between SWiM-C and control group participants was -0.81kg (95% CI: -2.24 to 0.61kg). SWiM-C participants reported a greater reduction in experiential avoidance (-2.45, 95% CI: -4.75 to -0.15), uncontrolled eating (-3.36, 95% CI: -5.66 to -1.06), and emotional eating (-4.14, 95% CI: -7.25 to -1.02), and an increase in physical activity (8.96, 95% CI: 0.29 to 17.62) compared to the control group. No differences in mental health or wellbeing were observed at 12 months. Conclusions: Whilst the effect of the SWiM-C intervention on weight was inconclusive, SWiM-C improved eating behaviors, physical activity and psychological flexibility. These variables have been previously identified as determinants of successful weight management. Further refinement of the intervention is necessary to ensure meaningful effects on weight prior to implementation in practice. By being remotely delivered using non-specialists, SWiM-C enhances scalability and population reach while minimizing cost.

Participants' experiences of mental health during a COVID-19 tailored ACT-based behavioural weight management intervention: a qualitative study.

PURPOSE: We aimed to explore participants' experiences of mental health during an acceptance and commitment therapy (ACT)-based guided self-help intervention to support weight management in adults with overweight or obesity during the COVID-19 pandemic (SWiM-C: Supporting Weight Management during COVID-19). METHODS: We conducted semi-structured telephone interviews with twenty participants and used reflexive thematic analysis to identify patterns of meaning across the dataset relevant to mental health. RESULTS: Four themes were conceptualized: i) Mental health changes associated with SWiM-C, ii) External factors negatively impacted mental health and intervention engagement, iii) Use and impact of coping responses, and iv) Intervention preferences based on psychological needs. CONCLUSIONS: Findings suggest that participants were exposed to multiple factors, both related to and external to the intervention, that negatively impact their mental health, yet ACT-based aspects of the SWiM-C intervention appeared to support participants to adaptively manage the decline in their mental health. The findings can be used to inform the development of future weight management interventions, such as through intervention personalization and the inclusion of more strategies that target emotional regulation.Trial registration: ISRCTN 12107048, https://www.isrctn.com/ISRCTN12107048.

Perceived weight-related stigma, loneliness, and mental wellbeing during COVID-19 in people with obesity: A cross-sectional study from ten European countries.

BACKGROUND: Increased weight-related stigma during the COVID-19 pandemic has amplified the need to minimise the impacts on mental wellbeing. We investigated the relationship between the perceived changes in the representation of obesity in the media and mental wellbeing during the pandemic in a sample of people with obesity across 10 European countries. We also investigated the potential moderating effect of loneliness. METHODS: Between September to December 2020 during the COVID-19 pandemic, participants reported data on demographics, mental wellbeing (measured by World Health Organisation Five Wellbeing Index and Patient Health Questionaire-4), loneliness (measured by De Jong Gierveld short scale), and perceived change in the representation of obesity in media (measured by a study-specific question) using the online, cross-sectional EURopean Obesity PatiEnt pANdemic Survey (EUROPEANS). Data were analysed using linear mixed-effects models, controlling for age, gender, body mass index, and shielding status, with random incept for country. RESULTS: The survey was completed by 2882 respondents. Most identified as female (56%) and reported their ethnicity as White or White-mix (92%). The total sample had a mean age of 41 years and a BMI of 35.4 kg/m2. During the peak of the pandemic, compared to pre-pandemic, perceiving more negative representation of people with obesity on social media was associated with worse psychological distress, depression, and wellbeing. Perceiving more positive representation, compared to no change in representation, of people with obesity on television was associated with greater wellbeing, yet also higher psychological distress and anxiety. Loneliness, as a moderator, explained ≤0.3% of the variance in outcomes in any of the models. CONCLUSIONS: Perceiving negative representation of obesity on social media was associated with poorer mental wellbeing outcomes during the pandemic; positive representation on television was associated with both positive and negative mental wellbeing outcomes. We encourage greater media accountability when representing people with obesity.

Supporting Weight Management during COVID-19: A Randomized Controlled Trial of a Web-Based, ACT-Based, Guided Self-Help Intervention.

INTRODUCTION: Adults with overweight and obesity are vulnerable to weight gain and mental health deterioration during the COVID-19 pandemic. We developed a web-based, guided self-help intervention based on Acceptance and Commitment Therapy (ACT) that aims to support adults with overweight and obesity to prevent weight gain by helping them to manage their eating behaviours, be more physically active, and protect their emotional wellbeing ("SWiM-C"). SWiM-C is a guided self-help programme using non-specialist guides to enhance scalability and population reach while minimizing cost. This study evaluated the effect of SWiM-C on bodyweight, eating behaviour, physical activity, and mental wellbeing in adults with overweight and obesity over 4 months during the COVID-19 pandemic in the UK. METHODS: We randomized adults (BMI ≥25 kg/m2) to SWiM-C or to a wait-list standard advice group. Participants completed outcome assessments online at baseline and 4 months. The primary outcome was self-measured weight; secondary outcomes were eating behaviour, physical activity, experiential avoidance/psychological flexibility, depression, anxiety, stress, and wellbeing. We estimated differences between study groups in change in outcomes from baseline to 4 months using linear regression, adjusted for outcome at baseline and the randomization stratifiers (BMI, sex). The trial was pre-registered (ISRCTN12107048). RESULTS: 486 participants were assessed for eligibility; 388 participants were randomized (196 standard advice, 192 SWiM-C), and 324 were analysed. The adjusted difference in weight between SWiM-C and standard advice was -0.60 kg (-1.67 to 0.47, p = 0.27). SWiM-C led to improvements in uncontrolled eating (-3.61 [-5.94 to -1.28]), cognitive restraint (5.28 [2.81-7.75]), experiential avoidance (-3.39 [-5.55 to -1.23]), and wellbeing (0.13 [0.07-0.18]). CONCLUSIONS: SWiM-C improved several psychological determinants of successful weight management and had a protective effect on wellbeing during the pandemic. However, differences in weight and some other outcomes were compatible with no effect of the intervention, suggesting further refinement of the intervention is needed.

How Did Levels of Psychological Distress and Perceptions of Workplace Support amongst Children’s Social Work Staff Change during the Covid-19 Pandemic?

Covid-19 brought about drastic changes in day-to-day life and working practices, and had a profound impact on the mental health and well-being of the general population. Certain professional groups have also been particularly affected. This study sought to explore how levels of psychological distress and perceptions of workplace support amongst social work staff changed during the pandemic. We present the results from a series of surveys conducted in four local authorities (LAs) in England, before and during the Covid-19 pandemic. Social workers and other social care staff (n = 62) were asked about their experiences of psychological distress, using the twelve-item General Health Questionnaire. Overall, we found the proportion of staff reporting elevated levels of psychological distress increased and, in line with previous studies involving social workers, was high relative to the general population. Yet, most staff also said they had high levels of support from managers and colleagues, whilst a small proportion reported an increased perception of workplace support during the pandemic, compared to before. We consider these findings in relation to Organisational Support Theory and reflect on the ability of LAs to provide effective support for social care staff. Long before most of us had heard of coronavirus, social workers were already reporting high levels of psychological distress compared to the general public. In this study, we explored how levels of psychological distress changed amongst staff working in children's social services during the pandemic. We asked sixty-two people working in children's social services in four local authorities in England to complete a survey about their well-being and to tell us whether the support they received changed during Covid-19. We found the proportion of staff reporting elevated levels of psychological distress was high and that it increased over the pandemic. But social work staff also said they had high levels of support from managers and colleagues, and some reported an increased perception of workplace support during the pandemic, compared to before.

Trauma-Informed Education in Nursing: A Concept Analysis.

BACKGROUND: Trauma-informed education provides a framework for a collaborative, relational trauma awareness model when working with nursing students. This concept analysis provides clarification, explicates the conceptual meaning of trauma-informed education, and lays a foundation for nurse educators navigating the challenge of meeting student needs during and after the coronavirus disease 2019 (COVID-19) pandemic. METHOD: Using Walker and Avant's concept analysis method, exhaustive multi-disciplinary and ancestry searches conducted in PubMed, CINAHL, ERIC, and PsychINFO identified 31 relevant article that were evaluated for relevance to the concept analysis as it relates to the context of nursing education. RESULTS: This analysis proposes a new definition of trauma-informed education to support future practice and research endeavors, providing a framework for transforming the nurse educator-student dyadic relationship. CONCLUSION: Trauma-informed education can provide a collaborative relational model with students based on trauma awareness as affecting one's being and self. [J Nurs Educ. 2022;61(6):296-302.].

Liver Transplant Outreach Service: Assessment of Outcomes Sept 2019-Dec 2020

IntroductionDistance from a transplant centre may present a barrier to liver transplant referrals and transplant recipients report disliking travel for long-term follow-up. A liver transplant outreach service based at Manchester Royal Infirmary (MRI) was established collaboratively between the MRI and a transplant centre in Sept 2019. We report the outcomes from this service.MethodsThe service runs one day/month and includes post-transplant reviews, transplant assessment triage clinic and a ‘working lunch’ complex case meeting. Baseline transplant assessment + listing data between April 2017- March 2019 for chronic liver disease indications were collected and compared with those between Sept 2019-Dec 2020, in addition to other service activity data.ResultsIn the 24 month period in 2017-19 there were 11 chronic liver disease (CLD), excluding HCC, transplant assessments from the MRI. Only 8 were assessed as outpatients. Median referral UKELD was 56. 7/11 were listed with an assessment:listing conversion of 63%.In the 15 month period Sept 2019-Dec 20 there were 27 pre-transplant reviews with 20 new patients, 4 with HCC and 16 with CLD. One CLD patient had associated HCC. The commonest liver disease indication for review was alcohol related in 8 patients. Nineteen (90%) patients were reviewed for transplant assessment suitability. 12 (63%) were referred for assessment with investigations done locally. 9 (75%) were for chronic liver disease indications and 3 (25%) were for HCC. Median UKELD was 53.5.9 assessments have been completed, with 8 wait-listed. None were converted to inpatient assessments. Overall assessment:listing conversion is high: 8/9(88.8%) overall. 3 transplanted to date. 2 HCC patients had bridging therapies locally.Of 7 not referred for assessment, 1 was suitable for a TIPSS locally, 1 needed pre-habilitation and is under follow-up, 1 was out-with HCC criteria + is managed locally (still alive). 3 were too advanced/frail + all have since died. 1 was initially thought suitable for assessment but did not progress due to alcohol relapse. During the period April 20-Aug 20 only 1 pre-transplant patient was referred as NHS services were curtailed due to the Covid-19 pandemic.112 post-transplant reviews have been delivered, in 82 recipients. 98% gave positive feedback. Post-transplant interventions delivered locally include 2 liver biopsies, 1venogram + the management of 1patient with acute rejection.ConclusionDespite the pandemic this service provided improved pre-transplant outcomes in a shorter time frame cf. the preceding 2 years and saved 139 appointments in the transplant centre. The service is efficient, popular with patients, and adds to the case for the widespread adoption of similar partnerships within liver transplant networks.

Experience of shielding during first wave of COVID-19 amongst uk patients with autoimmune hepatitis (AIH)

IntroductionIn March 2020, severe acute respiratory syndrome SARS-CoV-2 was declared a pandemic. Specific shielding guidance produced by PHE aimed to protect clinically extremely vulnerable individuals. This included people with AIH on immunosuppressants. In the first wave, advice included not leaving home. The practicalities of this and impact of enforced shielding on mental health (MH) and well-being is not well documented, although suicide theories emphasise the negative effect of social isolation and loneliness. We conducted a patient survey to assess the impact of shielding in our AIH cohort.MethodsBetween 1Jul -10 Aug 2020,292 patients with AIH, fulfilling shielding criteria were invited to participate in a clinician designed survey on MSForms® online or by hand. Paper responses were entered online for analysis.Results36%(104)participated;79% female,74% age 25-69. Immunosuppression burden:50% single agent,47%dual, 3%on ≥3.Shielding compliance was ranked on a scale from 0-10:60% 9-10/10,29%7-8/10,11%0-6/10. Reasons for breaches included: exercise, shopping, to have a drive. Responses demonstrated assessment of risk by those breaching guidance. Ease with practical aspects of living were assessed on a scale from 0-10. One third found this ‘very easy’,1/3 ‘quite easy’,1/3 ‘not very easy’. For shopping, respondents used family members(49%),online(39%),shop in person(8%),other(4%).NHS volunteers were not used for shopping. Obtaining prescriptions was reported as easy in 79%: 76% used family/online pharmacy deliveries, other methods included: friend/neighbour, hospital delivery, NHS volunteer, collection in person. Of those with long-term partners 95% continued co-habiting but 4% lived separately in this period, remaining respondents previously lived alone. Respondents were asked to rank their MH and physical well-being. 27% reported MH as ‘high’, 27%‘moderate’,46%‘low’.Whilst 87% had access to outdoor space, only 46% had access to space large enough to exercise. Questions on the impact of shielding on other household members highlighted the perceived loss of independence and ‘guilt’ associated with the negative impact of shielding on others. Pertaining to work/employment, 38%(40/104) were employed in March 2020. Of those answering the question ‘How did you work during the shielding period’: 54% worked from home (WFH), prior to COVID-19 only 5% WFH. 2% continued to commute to work.ConclusionThis survey has provided a unique insight into shielding attitudes and behaviours in patients with AIH during the pandemic first wave demonstrating its negative impact on MH and well-being. As further evidence emerges regarding the risk of COVID-19 in adults taking immunosuppressants, more detailed risk stratification may be possible;this would be advantageous from a patient perspective.

Introduction

DeLucia and colleagues report results from another REU program, which focuses on real-world applications of psychological research. Interestingly, they found a decrease in the desire to attend graduate school, but their overall results support prior work demonstrating the incredible value of research experiences in student development. The second vignette by Halpern and colleagues discusses the creation of a hybrid, cross-country experience during the academic year for an REU, particularly adaptations of professional development activities for the virtual environment during the COVID-19 pandemic.

What Divides Us Also Connects Us: Roman Frontiers, World Heritage and Community

Roman Frontiers (Limes) run through several countries across Europe, the Near East and North Africa. In addition to those territories on the boundaries of the Empire, Roman military remains and artefacts are recorded in other countries, reflecting the development, expansion and contraction of the Roman Empire as well as trade within and beyond its borders. Since the early 2000s, a project has been on-going to create a series of transnational World Heritage properties for the Frontiers of the Roman Empire, building on existing networking connections established through the International Congress of Roman Frontier Studies and establishing new collaborations and partnerships, from local to international. In recognising the outstanding value to all humanity of our shared cultural heritage, the Limes provide an opportunity to connect communities and countries, as well as engender a sense of local pride in the global importance of remains. This paper is derived from a keynote given at the European Association of Archaeologists virtual conference in 2020, and asks how, when wrestling with global challenges such as Climate Change and the Covid19 pandemic, can World Heritage and Roman Frontiers contribute to our 21st century society? [ABSTRACT FROM AUTHOR] Copyright of Historic Environment: Policy & Practice is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Trauma informed education in nursing: A call for action.

Principles of trauma-informed care and resiliency building guides this call to action for trauma awareness in nursing education, aiming to guide nursing educators, researchers, and leaders in support, retention, and building foundational skill-sets in a now traumatized nursing student population. Nursing students have been greatly affected by the COVID-19 pandemic, resulting in documented trauma, complicated grief, depression, anxiety, and secondary stress syndrome. Students entering health care in a new landscape of ongoing trauma and chronic stress exposure require a shift in the nurse educators' role and position. Extensive outcome-based synthesis of trauma-informed education in other disciplines served as basis to create a pedagogical context using the Substance Abuse and Mental Health Services Administration (SAMHSA) framework for trauma-informed schools. Utilizing Watson's strategies for human caring theory in nursing education, a trauma-informed pedagogy is proposed for nurse educators. This framework for nurse educators and leaders will assist in navigating how to approach trauma-informed education in the context of higher education in nursing. It is time for a paradigm shift in nursing education towards a more collaborative, relational model with students, based on trauma-informed care; where trauma awareness and the impact on one's being serves purpose for the nursing student.

Independent visiting with children in care during the pandemic: Disruptions and discoveries

This essay describes the impact of the pandemic on our experiences as Independent Visitors (IVs) forchildren who are looked-after. Independent Visitors are volunteers who visit, advise and befriend children with the aim of helping them develop a positive, long-term relationship beyond the care system. Based on our personal experiences of being matched with and visiting two young people, we consider how supporting the children remotely during the pandemic has helped us reflect on our relationships with them and our role as IVs. We discuss the role that foster carers play in supporting the IV relationship, the significance of developing routines and rituals with young people, and the challenges and opportunities offered by the transition from visits to virtual contact. We conclude with an outline of the response of service providers to the pandemic, and suggest that increased support for Independent Visiting might improve provision and allow more children to benefit from a relationship with an Independent Visitor. [ABSTRACT FROM AUTHOR] Copyright of Qualitative Social Work is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Distance-learning collaborations for rapid knowledge sharing to the occupied Palestinian territory during the COVID-19 response: experience from the OxPal partnership.

Distance-learning increasingly forms part of many academic and professional courses. OxPal, a collaboration between University of Oxford medical students and doctors and their counterparts in the occupied Palestinian territory (oPt), sought to evaluate the feasibility and efficacy of interactive online distance-learning through a pre-established international partnership as a method for rapid knowledge sharing during the novel coronavirus disease 2019 (COVID-19) response. Two interactive online lectures for medical students and clinicians in the oPt on the COVID-19 pandemic were conducted. The first lecture was an 'Introduction to COVID-19' and the second focused on 'Data-sharing during the pandemic'. 212 and 174 attended each lecture, respectively. Feedback was via an online questionnaire. >95% of respondents indicated the lectures covered a gap in their medical education. 87% and 77% of respondents rated lecture quality 'Good' or 'Excellent' for the two lectures respectively. Qualitative feedback elicited requests for more clinically focused lectures, which have since been provided. Online lectures are feasible and effective for rapid education of medical students and clinicians in the oPt in a public health emergency. We hope this encourages other institutions to provide similar support in the oPt and other 'tutor-deplete' regions facing specific geopolitical challenges to local medical education.

A pneumococcal pneumonia and influenza vaccination quality improvement program for women receiving chemotherapy for gynecologic cancers at a major tertiary cancer Centre.

OBJECTIVE: International guidelines recommend pneumococcal pneumonia and influenza vaccination for all patients with solid organ malignancies prior to initiating chemotherapy. Baseline vaccination rates (March 2019) for pneumococcal pneumonia and influenza at our tertiary cancer centre were 8% and 40%, respectively. The aim of this study was to increase the number of gynecologic chemotherapy patients receiving pneumococcal and influenza vaccinations to 80% by March 2020. METHODS: We performed an interrupted time series study using structured quality improvement methodology. Three interventions were introduced to address vaccination barriers: an in-house vaccination program, a staff education campaign, and a patient care bundle (pre-printed prescription, information brochure, vaccine record booklet). Process and outcome data were collected by patient survey and pharmacy audit and analyzed on statistical process control charts. RESULTS: We identified 195 eligible patients. Pneumococcal and influenza vaccination rates rose significantly from 5% to a monthly mean of 61% and from 36% to a monthly mean of 67%, respectively. The 80% target was reached for both vaccines during one or more months of study. The in-house vaccination and staff education programs were major contributors to the improvement, whereas the information brochure and record booklet were minor contributors. CONCLUSIONS: Three interventions to promote pneumococcal and influenza vaccination among chemotherapy patients resulted in significantly improved vaccination rates. Lessons learned about promoting vaccine uptake may be generalizable to different populations and vaccine types. In response to the global COVID-19 pandemic, initiatives to expand the program to all chemotherapy patients at our centre are underway.

Collaboration for innovative routes to market: COVID-19 and the food system

In a time of global crisis, existing systems are rigorously tested and placed under significant and abnormal strain. This paper uses Welsh case studies to explore how food producers in Wales have collaborated to protect livelihoods while also providing accessible food to the nation. Prior to the coronavirus pandemic, the food and drink supply chain in Wales contributed £22.1bn in annual turnover to the national economy and supported over 200,000 jobs. The coronavirus pandemic however has put the food and drink industry, which is considered a priority sector in Wales, at significant risk. The hospitality sector, which turned over £3 billion in 2019 and is a key end destination for Welsh produce from small businesses, faced months of near total closure, with no certainty of when the sector may be allowed to resume trading as normal. This in turn has significant and long-lasting effects on the country's food producers, facing a decimated sector they once relied upon to bring their produce to market though stable and established supply chains and procurement relationships. This paper explores how both producer-led and organisation-led producer collaboration in Wales has provided new and innovative routes to market for Wales' food producers as a result of the lockdown imposed by Welsh and British government to prevent the spread of coronavirus. The challenges faced by these newly established collaborations are discussed alongside the opportunities for longer term collaboration generated by these organisations which emerged to fill a specifically identified void in this unprecedented crisis. Two innovative, in depth, regional level case studies that have responded to this increased demand for accessible food are discussed. Users range from those choosing to buy local produce contact free, through an online click and collect service, to those most vulnerable, wholly reliant on a food box delivery scheme developed through cross sector collaboration at the outbreak of the crisis. This paper concludes that long term producer cooperation in the region is likely to be established following on from the short-term measures implemented as a direct result of the development of social capital during the Coronavirus lockdown, and further concludes that a crisis of this magnitude can stretch the current centralised and remotely controlled food system to breaking point. A number of lessons are highlighted which are pertinent for actions to integrate policy to support societal change and resilience, in order to prevent catastrophic food (in)access in the future.