TRACHEOBRONCHIAL ASPIRATION IN THE ELDERLY

CASE: A 68-year-old male with a past medical history of hypertension and null smoking history presented with insidious onset dyspnea for the past three days. On physical exam, he had inspiratory rhonchi and was hypoxic, saturating to 88% in room air, requiring 6L oxygen. Laboratory studies were unremarkable, including a negative COVID PCR test. Chest X-ray demonstrated right-sided hilar prominence, and CT of the chest revealed an 8 mm endobronchial. On the day of his bronchoscopy evaluation, the patient expectorated a brownish undercooked pea while receiving nebulizer treatment and repeat chest CT revealed the resolution of the previous endobronchial lesion. IMPACT/DISCUSSION: Foreign body aspiration (FBA) has a bimodal presentation with a second peak in adults above 50 years. Although FBA most commonly presents with abrupt onset cough and dyspnea, the immediate presentation may not be evident in the geriatric population given the lack of cough reflex and cognitive decline. A retrospective study performed with data from 140 patients with FBA noted that 44.3% of patients did not present to the emergency in the first 24 hours of aspiration. Physical exam findings depend on the location of foreign body(FB) dislodgement, but around half the time, the exam could be unremarkable. A radiograph could reveal the object if the aspirated FB is radiopaque;hence a negative radiograph does not rule out the diagnosis of FBA. However, when present, the most common radiographic findings are inspiratory-expiratory abnormalities. High clinical suspicion is required to diagnose FBA to prevent chronic respiratory manifestations. An undiagnosed FB could travel distally and present as pneumonia, bronchiectasis, atelectasis, asthma/COPD-like illness. However, our patient presented with an endobronchial mass that was suspicious for malignancy. We found a similar presentation described by Bader et al. in a case about a 41-year-old woman who underwent chest CT for chronic cough, revealing a mass lesion in the right main bronchus. Bronchoscopic examination showed no growth;instead, the team found a plastic foreign body. The patient admitted aspirating this plastic object in her early 20s. If FBA is suspected, bronchoscopy is the study of choice to evaluate the airway, and extraction of FB can be performed with flexible or rigid bronchoscopy. Although flexible bronchoscopy requires only local anesthesia and a rigid bronchoscopy requires general anesthesia, the latter is safer in preventing damage to the airway. Given that each case of FBA can present unique challenges and might occasionally need endotracheal intubation or tracheostomy, only experts should perform bronchoscopic extraction of FB. CONCLUSION: In this COVID era, it is very reasonable to be anchored to a diagnosis of COVID for every patient who presents with dyspnea. FBA should be one of the differential diagnoses for geriatric patients presenting with newonset respiratory symptoms even when no physical or radiographic signs are evident.

Rapid and Effective Inactivation of SARS-CoV-2 with a Cationic Conjugated Oligomer with Visible Light: Studies of Antiviral Activity in Solutions and on Supports.

This paper presents results of a study of a new cationic oligomer that contains end groups and a chromophore affording inactivation of SARS-CoV-2 by visible light irradiation in solution or as a solid coating on paper wipes and glass fiber filtration substrates. A key finding of this study is that the cationic oligomer with a central thiophene ring and imidazolium charged groups gives outstanding performance in both the killing of E. coli bacterial cells and inactivation of the virus at very short times. Our introduction of cationic N-methyl imidazolium groups enhances the light activation process for both E. coli and SARS-CoV-2 but dampens the killing of the bacteria and eliminates the inactivation of the virus in the dark. For the studies with this oligomer in solution at a concentration of 1 µg/mL and E. coli, we obtain 3 log killing of the bacteria with 10 min of irradiation with LuzChem cool white lights (mimicking indoor illumination). With the oligomer in solution at a concentration of 10 µg/mL, we observe 4 log inactivation (99.99%) in 5 min of irradiation and total inactivation after 10 min. The oligomer is quite active against E. coli on oligomer-coated paper wipes and glass fiber filter supports. The SARS-CoV-2 is also inactivated by oligomer-coated glass fiber filter papers. This study indicates that these oligomer-coated materials may be very useful as wipes and filtration materials.

Families prefer in-person visits to telehealth for pediatric weight management during the pandemic

Background: The COVID-19 pandemic has presented multiple challenges to families participating in pediatric weight management programs (PWMP) and to medical providers in accessing and offering care. To accommodate patient/family needs our PWMP turned to telehealth exclusively early in the COVID-19 Pandemic. After in-person clinic visits were reestablished, telehealth was offered as an alternative option. The purpose of this study was to compare whether families chose in-person or telehealth visits when both options were available during the pandemic. Methods: A retrospective review of patient visits was analyzed from July 1, 2020, through December 31, 2020, of all visits to our PWMP. During this period, families were given the option of scheduling in-person clinic visits in our PWMP or being seen by telehealth for both new and follow- up visits. Families could be seen by a doctor, dietitian, and exercise physiologist at both types of visits. Descriptive statistics, frequencies, and percentages, for patient demographics and visit type, were determined, and associations were analyzed using logistic regression. Results: There were 1356 completed PWMP visits, with 977 (72.1%) done in-person and 379 (27.9%) by Telehealth. Patients had a mean age of 12.5 years, were 51.2% female, 51.9% White, 28.8% Black, 10.2% Hispanic, and 64.5% had Medicaid. The age of telehealth patients was greater (12.9 years versus 12.3 years, P = 0.041), and the percentage of follow-up visits was greater (81.5% versus 65.5%, P < 0.0001). There was no significant difference in race/ethnicity or insurance type. Telehealth was selected more often for follow-up visits compared to new visits [odds ratio (OR) = 2.052, P = 0.008]. Compared to White patients, Black patients selected Telehealth more often (OR = 1.371;P = 0.03) whereas Hispanic patients did not (OR = 0.819;P = 0.412). Conclusions: A solid majority of families choose in-person visits over telehealth when given the opportunity during the COVID-19 Pandemic. Factors favoring telehealth were being Black and having a follow-up visit. While telehealth increases flexibility and increases options to families, in-person clinic visits seem to be preferred especially for an initial visit.

Rapid and Effective Inactivation of SARS-CoV-2 by a Cationic Conjugated Oligomer with Visible Light: Studies of Antiviral Activity in Solutions and on Supports (preprint)

This paper presents results of a study of a new cationic oligomer that contains end groups and a chromophore affording inactivation of SARS-Cov-2 by visible light irradiation in solution or as a solid coating on wipes paper and glass fiber filtration substrates. A key finding of this study is that the cationic oligomer with a central thiophene ring and imidazolium charged groups give outstanding performance in both killing of E. coli bacterial cells and inactivation of the virus at very short times. Our introduction of cationic N-Methyl Imidazolium groups enhances the light-activation process for both E. coli and SARS-Cov-2 but dampens the dark killing of the bacteria and eliminates the dark inactivation of the virus. For the studies with this oligomer in solution at concentration of 1 g/mL and E. coli we obtain 3 log killing of the bacteria with 10 min irradiation with LuzChem cool white lights (mimicking indoor illumination). With the oligomer in solution at a concentration of 10 g/mL, we observe 4 logs inactivation (99.99 %) in 5 minutes of irradiation and total inactivation after 10 min. The oligomer is quite active against E. coli on oligomer-coated wipes papers and glass fiber filter supports. The SARS-Cov-2 is also inactivated by the oligomer coated glass fiber filter papers. This study indicates that these oligomer-coated materials may be very useful as wipes and filtration materials.

Social capital, language and host country nationals (HCNs) as global talent

Purpose: In expatriate-reliant countries, the challenge of attracting and retaining overseas talent remains, despite the COVID-19 global pandemic restricting international travel. Expatriates depend on formal organizational and host country national (HCN) support to facilitate their adjustment when moving abroad. To date, there has been a limited focus on the centrality of language in spanning boundaries between HCNs and expatriates that enables bridges to be formed. This study explored how language influences the social capital accrual and the support received by expatriates from HCNs. Design/methodology/approach: Rooted in social constructionism, the authors used semi-structured interviews with a purposive sample of 20 Nigerian HCNs from two Italian organizations in the construction industry. Findings: The findings highlight how language is key to effective social capital bridging and show how HCNs act as boundary spanners between local talent and expatriates on assignment. In this study, HCNs have superior language skills and can thus fill the semantic void in communication between the two parties. It emerged that expatriates receive more significant support and higher levels of social capital accrual than HCNs from this relationship. Practical implications: Consideration should be given to providing formal language training to both expatriates and HCNs. Embedding networking relationships, such as buddying schemes or reverse mentoring, would enhance the social capital of both parties and improve performance. In addition, global talent management policies should be adjusted to provide definitive career paths and clearer promotion criteria for HCNs. Originality/value: The authors find that through their language ability, HCNs may have more power over expatriates than previously considered, repositioning their status from a talent perspective. The authors argue that expatriates should not be considered by organizations the only source of global talent in such a context, and that organizations need to offer more definitive talent policies and support that accounts for both expatriates and HCNs. © 2021, Emerald Publishing Limited.

Clinician-led transformation of sexual and reproductive healthcare in NI post-decriminalisation of abortion

Objective This paper outlines how, in the absence of commissioning or support from the NI Department of Health (DoH), NHS early medical abortion (EMA) services were rapidly implemented in response to COVID-19 travel restrictions. It demonstrates how clinician-led collaborative working can transform sexual and reproductive healthcare (SRH) despite considerable political resistance. Design Post-decriminalisation in October 2019, clinicians seeking to influence policy established the NI Abortion and Contraception Task group (NIACT), a multidisciplinary, multisector group with representation from clinicians, academics, service users and the charity sector. COVID-19 travel restrictions meant that women were unable to access treatment in England and local services were urgently required. NIACT established a regional central access point through Informing Choices NI (ICNI), facilitating self-referral and counselling. Non-funded EMA services were simultaneously implemented within existing Sexual and Reproductive Health services across all five Trusts. NIACT subsequently developed a strategy report, making evidence-based recommendations on better sex education, accessible contraception and the delivery of safe compassionate abortion care within high-quality SRH services. Method Since April 2020, data has been collected concurrently on the number of women self-referring to ICNI, accessibility to Trust services, waiting times, patient outcomes, contraceptive uptake and service user feedback. This data was used to provide an evidence-base for the NIACT strategy to inform the development of high-quality SRH in NI post-decriminalisation. Results EMA is currently available in all five Trusts but is not yet commissioned and relies heavily on the good will of dedicated clinicians. Demand remains high with over 40 women per week self-referring to ICNI. Waiting times are short, uptake of long-acting reversible contraception is high and service user feedback is excellent. Mifepristone is not permitted for home use in NI, which necessitates a clinic visit. Due to the temporary cessation of two Trust services, the absence of surgical services or treatment beyond 10 weeks gestation, many women still needed to travel to England during the pandemic. Conclusions NIACT have demonstrated how an integrated model of sexual and reproductive healthcare can work well within the NHS in NI. However, to ensure the sustainability of new services and develop a comprehensive abortion service, DoH commitment and commissioning are required. The NI Human Rights Commission have commenced a judicial review;it is anticipated that this will be successful in initiating the commissioning process. It is envisioned that NIACT's strategy will be utilised to inform the development of world-class sexual and reproductive healthcare in NI.

Highly Effective Inactivation of SARS-CoV-2 by Conjugated Polymers and Oligomers.

In the present study, we examined the inactivation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by synthetic conjugated polymers and oligomers developed in our laboratories as antimicrobials for bacteria, fungi, and nonenveloped viruses. The results show highly effective light-induced inactivation with several of these oligomers and polymers including irradiation with near-UV and visible light. In the best case, one oligomer induced a 5-log reduction in pfu/mL within 10 min. In general, the oligomers are more active than the polymers; however, the polymers are active with longer wavelength visible irradiation. Although not studied quantitatively, the results show that in the presence of the agents at concentrations similar to those used in the light studies, there is essentially no dark inactivation of the virus. Because three of the five materials/compounds examined are quaternary ammonium derivatives, this study indicates that conventional quaternary ammonium antimicrobials may not be active against SARS-CoV-2. Our results suggest several applications involving the incorporation of these materials in wipes, sprays, masks, and clothing and other personal protection equipment that can be useful in preventing infections and the spreading of this deadly virus and future outbreaks from similar viruses.

Highly Effective Inactivation of SARS-CoV-2 by Conjugated Polymers and Oligomers (preprint)

The current Covid-19 Pandemic caused by the highly contagious SARS-CoV-2 virus has proven extremely difficult to prevent or control. Currently there are few treatment options and very few long-lasting disinfectants available to prevent the spread. While masks and protective clothing and social distancing may offer some protection, their use has not always halted or slowed the spread. Several vaccines are currently undergoing testing; however there is still a critical need to provide new methods for inactivating the virus before it can spread and infect humans. In the present study we examined the inactivation of SARS-CoV-2 by synthetic conjugated polymers and oligomers developed in our laboratories as antimicrobials for bacteria, fungi and non-enveloped viruses. Our results show that we can obtain highly effective light induced inactivation with several of these oligomers and polymers including irradiation with near-UV and visible light. With both the oligomers and polymers, we can reach several logs of inactivation with relatively short irradiation times. Our results suggest several applications involving the incorporation of these materials in wipes, sprays, masks and clothing and other Personal Protection Equipment (PPE) that can be useful in preventing infections and the spreading of this deadly virus and future outbreaks from similar viruses.