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BACKGROUND: Specialty public health training consists of 48 months of practice across the domains of health protection, healthcare public health and health improvement.With the onset of the COVID-19 pandemic, activity pivoted towards pandemic management and the response became a significant element of registrar practice.This research aimed to understand the impact of this shift in focus on registrars' role and training. METHODS: Participatory action research comprising (i) a reflective survey sent to all specialty registrars in the East Midlands training region and (ii) Delphi rounds with survey respondents to generate consensus and define themes. RESULTS: Sixteen (44%) registrars completed the survey with 12 (75%) participating in the Delphi rounds. The early pandemic response stages both challenged and re-affirmed registrars' role and identity in public health and training while providing unique and diverse learning and development. Underpinning these themes is a variability in experience depending on prior experience, placement and training stage. CONCLUSIONS: The pandemic impacted the practice, training and home-life of registrars who were required to negotiate significant challenge and uncertainty. This original work adds to a growing body of correspondence and opinion pieces articulating the experiences and challenges of medical and public health education during a pandemic.
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In the past decade, the demand for home-based care has been amplified by the Coronavirus disease 2019 pandemic. Home-based care has significant benefits for patients, their families, and healthcare systems, but it relies on the often-invisible workforce of family and friend caregivers who shoulder essential health care responsibilities, frequently with inadequate training and support. Hematopoietic cell transplantation (HCT), a potentially curative but intensive treatment for many patients with blood disorders, is being increasingly offered in home-based care settings and necessitates the involvement of family caregivers for significant patient care responsibilities. However, guidelines for supporting and preparing HCT caregivers to effectively care for their loved ones at home have not yet been established. Here, informed by the literature and our collective experience as clinicians and researchers who care for diverse patients with hematologic malignancies undergoing HCT, we provide considerations and recommendations to better support and prepare family caregivers in home-based HCT and, by extension, family caregivers supporting patients with other serious illnesses at home. We suggest tangible ways to screen family caregivers for distress and care delivery challenges, educate and train them to prepare for their caregiving role, and create an infrastructure of support for family caregivers within this emerging care delivery model.
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COVID-19 , Hematopoietic Stem Cell Transplantation , Home Care Services , Humans , Caregivers/education , OutpatientsABSTRACT
This paper discusses the impact of the Covid-19 pandemic on global debt and on debt management practices, with a focus on the state of debt management prior to the pandemic, the responses of country authorities to the challenge, and how debt management is likely to change in the future. © Multinational Finance Society, a nonprofit corporation. All rights reserved.
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Background: COVID-19 disease arises from infection with severe acute respiratory cornonavirus-2 (SARS-CoV- 2). Severe disease is associated with a coagulopathy characterised by elevated D-dimer levels, fibrin deposition in the lung, and a thrombotic incidence of approximately 30%, indicating catastrophic derailment of the haemostatic system. Aim(s): To investigate whether SARS-CoV- 2- induced coagulopathy arises due to an imbalance in the fibrinolysis. Method(s): Citrated plasma was collected from 139 patients presenting with symptomatic COVID-19, 24 patients with non-COVID- 19 respiratory infection and 30 healthy controls in a dual-centre study. Fibrinolytic biomarkers were evaluated including plasminogen activator inhibitor 1 (PAI-1), tissue plasminogen activator (tPA), plasminogen, vitronectin and thrombin activatable fibrinolysis inhibitor (TAFI). Furthermore, diagnostic biomarkers including, fibrinogen, C-reactive protein (CRP), D-dimer and inflammatory cytokines were quantified. Clot lysis was evaluated using turbidity assays, plasma clot structure visualised by confocal microscopy and plasmin generation quantified by chromogenic substrate. Result(s): PAI-1 antigen, activity, and the cofactor for this serpin, vitronectin, were significantly elevated in patients with COVID-19 compared to healthy controls and non-COVID- 19 respiratory infection. Patients with COVID-19 exhibit attenuated plasmin generation compared to healthy volunteers despite significant elevation in tPA. PAI-1 correlated with inflammatory cytokines (IL-1beta, IL-8 and TNF-alpha). In line with this acute phase proteins, fibrinogen and CRP were high in patients with COVID-19 but only CRP was increased compared to non-COVID- 19 respiratory infections. Levels of PAI-1 and vitronectin were associated with escalating oxygen support and a corresponding decrease in plasminogen. Importantly, patients with COVID-19 disease exhibit resistance to fibrinolytic degradation by Actilyse, however, this could be overcome by the PAI-1 resistant form of tPA, Metalyse. Conclusion(s): We reveal that COVID-19 disease promotes a hypofibrinolytic state due to elevated PAI-1 and its stabilizing cofactor vitronectin. PAI-1 correlates with inflammatory cytokines and disease severity thereby highlighting its potential prognostic power in the development of severe COVID-19 disease.
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We present a status update for MagAO-X, a 2000 actuator, 3.6 kHz adaptive optics and coronagraph system for the Magellan Clay 6.5 m telescope. MagAO-X is optimized for high contrast imaging at visible wavelengths. Our primary science goals are detection and characterization of Solar System-like exoplanets, ranging from very young, still-accreting planets detected at H-alpha, to older temperate planets which will be characterized using reflected starlight. First light was in Dec, 2019, but subsequent commissioning runs were canceled due to COVID-19. In the interim, MagAO-X has served as a lab testbed. Highlights include implementation of several focal plane and low-order wavefront sensing algorithms, development of a new predictive control algorithm, and the addition of an IFU module. MagAO-X also serves as the AO system for the Giant Magellan Telescope High Contrast Adaptive Optics Testbed. We will provide an overview of these projects, and report the results of our commissioning and science run in April, 2022. Finally, we will present the status of a comprehensive upgrade to MagAO-X to enable extreme-contrast characterization of exoplanets in reflected light. These upgrades include a new post-AO 1000-actuator deformable mirror inside the coronagraph, latest generation sCMOS detectors for wavefront sensing, optimized PIAACMC coronagraphs, and computing system upgrades. When these Phase II upgrades are complete we plan to conduct a survey of nearby exoplanets in reflected light.
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PURPOSE: Benefit from convalescent plasma therapy for coronavirus disease 2019 (COVID-19) has been inconsistent in randomized clinical trials (RCTs) involving critically ill patients. As COVID-19 patients are immunologically heterogeneous, we hypothesized that immunologically similar COVID-19 subphenotypes may differ in their treatment responses to convalescent plasma and explain inconsistent findings between RCTs . METHODS: We tested this hypothesis in a substudy involving 1239 patients, by measuring 26 biomarkers (cytokines, chemokines, endothelial biomarkers) within the randomized, embedded, multifactorial, adaptive platform trial for community-acquired pneumonia (REMAP-CAP) that assigned 2097 critically ill COVID-19 patients to either high-titer convalescent plasma or usual care. Primary outcome was organ support free days at 21 days (OSFD-21) . RESULTS: Unsupervised analyses identified three subphenotypes/endotypes. In contrast to the more homogeneous subphenotype-2 (N = 128 patients, 10.3%; with elevated type i and type ii effector immune responses) and subphenotype-3 (N = 241, 19.5%; with exaggerated inflammation), the subphenotype-1 had variable biomarker patterns (N = 870 patients, 70.2%). Subphenotypes-2, and -3 had worse outcomes, and subphenotype-1 had better outcomes with convalescent plasma therapy compared with usual care (median (IQR). OSFD-21 in convalescent plasma vs usual care was 0 (- 1, 21) vs 10 (- 1, to 21) in subphenotype-2; 1.5 (- 1, 21) vs 12 (- 1, to 21) in suphenotype-3, and 0 (- 1, 21) vs 0 (- 1, to 21) in subphenotype-1 (test for between-subphenotype differences in treatment effects p = 0.008). CONCLUSIONS: We reported three COVID-19 subphenotypes, among critically ill adults, with differential treatment effects to ABO-compatible convalescent plasma therapy. Differences in subphenotype prevalence between RCT populations probably explain inconsistent results with COVID-19 immunotherapies.
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COVID-19 , Adult , Humans , COVID-19/therapy , Critical Illness/therapy , Biomarkers , Cytokines , Treatment Outcome , COVID-19 SerotherapyABSTRACT
Latin America and the Caribbean are often placed in the same geographical and economic grouping. However, too little is known in either region about the other's business cultures and marketplaces. Marketing in Latin America and the Caribbean is a casebook that analyses the marketing histories, challenges, strategies and vision of small, medium and large indigenous businesses from South America, Central America, Mexico and the Caribbean. The book is divided into three core sections: Marketing Tactics, including product development, pricing and digital marketing;Marketing Strategy, which considers brand development, targeting and positioning, and competitive advantage and, Global and Regional Marketing, considering strategic alliances, global expansion and supply chain management. The work also captures the competitive strategies used by indigenous firms to drive regional and global expansion in the face of sometimes turbulent marketing environments: several of the cases in the book encourage student readers to assess the impact of the COVID-19 pandemic on the strategies and futures of Latin American and Caribbean firms. Filling a gap in the literature by focusing on this understudied region and its indigenous firms, this text is essential and recommended reading for advanced undergraduate and postgraduate students studying International Marketing, Marketing Management and Strategy. It will also be of use to academic faculty seeking classroom material that captures authentic Latin American and Caribbean marketing realities. The work is supplemented by detailed Teaching Notes for each chapter, available online for instructors. © 2022 selection and editorial matter, Joseann J. Knight, Fabrizio Noboa S and Barney G. Pacheco. All rights reserved.
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Background/aims: Care homes in Europe have been profoundly impacted by the COVID-19 pandemic with increased resident mortality. They needed to respond to shifting government guidelines for infection control procedures and restrictions in visiting. This all occurred under the scrutiny of the media. Aim: to evaluate end of life a care experiences in care homes in the UK. Methods: A mixed method approach. We used a database of about 6000 care home residents were we could track when they interacted with health care services including community nursing input, admission to hospital (and A&E) and clinic appointments. We also conducted interviews (n=24) with care home staff, residents and families from 8 care homes which were analysed using framework analysis. Results: A large spike in deaths occurred in April/May 2020. This coincided with only about a quarter of outpatient appointments taking place. Inpatient admissions dropped by half and A&E attendance by a quarter. Community nursing input to care homes reduced by a third. Interviews suggested that staff were inundated with COVID-19 information via email but felt 'abandoned' with few nursing services operating in person. At the beginning of the pandemic some community nursing staff helped produce emergency care plans, usually over the phone, but some care homes interpreted this to mean residents were going to be 'left to die'. Care home staff felt guilt about deaths related to COVID-19 and this took a toll on their emotional well-being. This was exacerbated by needing to 'police' family visiting with residents who were actively dying. Conclusions: Care home residents experienced a dramatic reduction in services outside of the care home coupled with a large increase in deaths. Many staff wanted greater input from external services especially community nursing teams to support them.
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Background/Purpose: There is limited information on how the COVID-19 pandemic has impacted those living with cancer and those delivering their psychosocial care. The goals of this study were to understand: (1) psycho-oncology providers' perspectives on and observations of the psychological responses and coping of their patients living with cancer during the COVID-19 pandemic, and (2) psychooncology providers' own experiences delivering care during this time. Methods: In this concurrent mixed method study, a survey was distributed to psychosocial providers who were members of the American Psychosocial Oncology Society (APOS). Survey respondents were invited to participate in a one-on-one audiorecorded interview via phone or secure Zoom® with a member of the study team. Results: There were 76 self-identified psycho-oncology providers who responded to the survey and 11 who participated in a one-onone interview. Approximately half of those surveyed reported that patients responded in unique ways to COVID-19 stress relative to other populations. Three themes emerged from qualitative analyses: (1) unique burden on patients, (2) cancer patients' pandemic response and its relationship to their cancer experience, and (3) unexpected positive changes. Providers emphasized that the cancer experience may have prepared patients for the existential distress of the pandemic and described patients' resiliency. Two themes emerged regarding providers' delivery of care during the pandemic: (1) new professional and personal challenges and (2) provider resiliency. Psycho-oncology providers used innovative strategies to support patients, such as triaging patients in a different way and helping patients find more meaning and purpose in their lives. They also fostered their own mental health as providers through deep reflection and gratitude. Conclusions and Implications: Individual and systems-based strategies are needed to address sustainability of the quality of care in times of high patient volume and increased distress levels for both patients and providers during a pandemic.
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The use of health apps on mobile devices by healthcare providers and receivers (patients) is proliferating. This has elevated cybersecurity concerns owing to the transmittal of personal health information through the apps. Research literature has mostly focused on the technology aspects of cybersecurity in mobile healthcare. It is equally important to focus on the ethical and regulatory perspectives. This article discusses cybersecurity concerns in mobile healthcare from the ethical perspective, the regulatory/compliance perspective, and the technology perspective. The authors present a comprehensive framework (DeTER) that integrates all three perspectives through which cybersecurity concerns in mobile healthcare could be viewed, understood, and acted upon. Guidance is provided with respect to leveraging the framework in the decision-making process that occurs during the system development life cycle (SDLC). Finally, the authors discuss a case applying the framework to a situation involving the development of a contact tracing mobile health app for pandemics such as COVID-19. © 2021 IGI Global. All rights reserved.
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Introduction: Majority of ESKD patients in India avail in centre dialysis services. India imposed a nation-wide lockdown for over two months during the COVID-19 pandemic. Essential healthcare services including dialysis were disrupted. Patients on dialysis faced severe consequences as they as could not seek care at the health care facilities.1,2,3These disruptions have impacted the continuum of care and altered the care-seeking behaviour among dialysis patients.4,5 We monitored the care-seeking behaviour among dialysis patients enrolled in the India Dialysis Outcomes Registry during the lockdown. Methods: The India dialysis outcomes registry is a nationally representative study following up 1000 ESKD patients starting dialysis across 10 Indian states. The registry has established a mechanism for routine data collection on clinical, socio economic outcomes and patient reported quality of life. We contacted the participants telephonically to understand the continuum of care during the lockdown. Efforts were directed to describe reasons for missing dialysis session(s) and document any complications due to disruptions to the dialysis services. Results: We followed-up 526 participants at 9 dialysis centres after the onset of the Pandemic in India, 149 (28)% were not contactable after 3 attempts. 377 participants (61% males and 39% females) consented and participated in the telephonic survey. Of these, 270 (72 %) were continuing on hemodialysis, 83 (22%) died, 7 (2%) switched to Peritoneal Dialysis, while 3 % (12) had either received or were awaiting kidney transplant and 5(1%) had stopped dialysis. During the interviews, 31 (8 %) reported having missed prescribed dialysis sessions ranging from one missed session to 24 missed sessions. The reasons being, travel ban on account of the COVID-19 pandemic (68%), financial challenges (19%), transfer to another site (3%) and other reasons (29%) like hike in dialysis cost during pandemic, non-availability of dialysis sessions as facilities were designated as COVID-19 management units, absence of dialysis facilities in COVID-19 wards and non-availability of dialysis staff as they were quarantined (Figure 1). Out of those continuing dialysis, 15% reported being hospitalized during the pandemic. They were admitted due to poor vascular access (61%), infections (29%) and 8 patients reported testing positive for COVID-19. Other reasons for hospitalizations were cardiovascular complications and stroke.(Figure 2) Conclusions: The disruption to continuum of care for patients on dialysis due to travel restrictions during COVID-19 lockdown, not only resulted in difficulty in accessing the dialysis care but also contributed to worsening of their overall health. Our study also elicits patient’s experiences and their perspectives on the challenges faced by them during the lockdown. They identified lack of clear communications by health facilities, lack of adequate dialysis treatment facilities and non-availability of staff at dialysis units. The India Dialysis Registry helped understand the disruptions in continuity of services among a representative population across the country during the COVID19 pandemic, this iterates the significance of establishing disease registries to monitor outcomes longitudinally. Insights as gained from our registry will be critical to inform policy makers in time and thereby address gaps in health delivery systems in India. Conflict of Interest: OJ is recipient of a UIPA scholarship from University of New South Wales, Sydney.