Covid-19 as a Catalyst for Digital Education and Inclusive Learning

Background The education of our healthcare professionals is key to the success and safety of the patient experience (Grafton- Clarke et al, 2021). Over the past two years the need to continue access to this education despite the restrictions of the global pandemic was paramount, to limit the impact on service delivery and patient care. Prior to the pandemic the majority of training at Great Ormond Street hospital was in-person, most of the digital learning produced was for mandatory training. In March 2020, with the world in lockdown and all non-essential education now online, the demand for accessible and inclusive learning was highlighted and in July 2021, a new Virtual Learning Environment (VLE), the GOSH Digital Education Network (DEN), was launched. Methods The DEN was launched at pace in July 2021. An intensive comms plan was implemented with regular Trustwide communications sent via screensavers, emails, social media, and live virtual drop-ins to encourage engagement. A critical evaluation of the DEN was undertaken 9 months post launch via two methods: 1. An online survey 2. Focus groups via Microsoft Teams Results The DEN was launched with 10 live courses, one year on there are 124 courses. In total there have been 2,937 people logging in to access the DEN. The online feedback survey found 100% of external users and 54.72% of internal users rated their experience using the DEN as 'Very positive' or 'Positive'. Conclusion Continuing access to education during a global pandemic was a key reason to launch the DEN at pace in July 2021 but online learning still plays a pivotal role in education and will continue to do so in the future. The shift to online learning amplified the need for robust systems to support the delivery as well as an ongoing programme of learning for the course leaders.

ME/CFS and Post-Exertional Malaise among Patients with Long COVID.

This study sought to ascertain the prevalence of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) among a sample of 465 patients with Long COVID. The participants completed three questionnaires: (1) a new questionnaire measuring both the frequency and severity of 38 common symptoms of COVID and Long COVID, (2) a validated short form questionnaire assessing ME/CFS, and (3) a validated questionnaire measuring post-exertional malaise. The population was predominantly white, female, and living in North America. The mean duration since the onset of COVID-19 symptoms was 70.5 weeks. Among the 465 participants, 58% met a ME/CFS case definition. Of respondents who reported that they had ME/CFS only 71% met criteria for ME/CFS and of those who did not report they had ME/CFS, 40% nevertheless did meet criteria for the disease: both over-diagnosis and under-diagnosis were evident on self-report. This study supports prior findings that ME/CFS occurs with high prevalence among those who have persistent COVID-19 symptoms.

Predictors of impaired functioning among long COVID patients.

BACKGROUND: There is limited information on which acute factors predict more long-term symptoms from COVID-19. OBJECTIVE: Our objective was to conduct an exploratory factor analysis of self-reported symptoms at two time points of Long COVID-19. METHODS: Data from patients with Long COVID-19 were collected at the initial two weeks of contracting SARS CoV-2 and the most recent two weeks, with a mean duration of 21.7 weeks between the two-time points. At time point 2, participants also completed the Coronavirus Impact Scale (CIS), measuring how the COVID-19 pandemic affected various dimensions of their lives (e.g., routine, access to medical care, social/family support, etc.). RESULTS: At time 1, a three-factor model emerged consisting of Cognitive Dysfunction, Autonomic Dysfunction and Gastrointestinal Dysfunction. The analysis of time 2 resulted in a three-factor model consisting of Cognitive Dysfunction, Autonomic Dysfunction, and Post-Exertional Malaise. Using factor scores from time 1, the Autonomic Dysfunction and the Gastrointestinal Dysfunction factor scores significantly predicted the CIS summary score at time two. In addition, the same two factor scores at time 1 predicted the occurrence of myalgic encephalomyelitis/chronic fatigue syndrome at time 2. CONCLUSION: Cognitive and Autonomic Dysfunction emerged as factors for both time points. These results suggest that healthcare workers might want to pay particular attention to these factors, as they might be related to later symptoms and difficulties with returning to pre-illness family life and work functioning.

Improvement of Long COVID symptoms over one year.

Importance: Early and accurate diagnosis and treatment of Long COVID, clinically known as post-acute sequelae of COVID-19 (PASC), may mitigate progression to chronic diseases such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Our objective was to determine the utility of the DePaul Symptom Questionnaire (DSQ) to assess the frequency and severity of common symptoms of ME/CFS, to diagnose and monitor symptoms in patients with PASC. Methods: This prospective, observational cohort study enrolled 185 people that included 34 patients with PASC that had positive COVID-19 test and persistent symptoms of >3 months and 151 patients diagnosed with ME/CFS. PASC patients were followed over 1 year and responded to the DSQ at baseline and 12 months. ME/CFS patients responded to the DSQ at baseline and 1 year later. Changes in symptoms over time were analyzed using a fixed-effects model to compute difference-in-differences estimates between baseline and 1-year follow-up assessments. Participants: Patients were defined as having PASC if they had a previous positive COVID-19 test, were experiencing symptoms of fatigue, post-exertional malaise, or other unwellness for at least 3 months, were not hospitalized for COVID-19, had no documented major medical or psychiatric diseases prior to COVID-19, and had no other active and untreated disease processes that could explain their symptoms. PASC patients were recruited in 2021. ME/CFS patients were recruited in 2017. Results: At baseline, patients with PASC had similar symptom severity and frequency as patients with ME/CFS and satisfied ME/CFS diagnostic criteria. ME/CFS patients experienced significantly more severe unrefreshing sleep and flu-like symptoms. Five symptoms improved significantly over the course of 1 year for PASC patients including fatigue, post-exertional malaise, brain fog, irritable bowel symptoms and feeling unsteady. In contrast, there were no significant symptom improvements for ME/CFS patients. Conclusion and relevance: There were considerable similarities between patients with PASC and ME/CFS at baseline. However, symptoms improved for PASC patients over the course of a year but not for ME/CFS patients. PASC patients with significant symptom improvement no longer met ME/CFS clinical diagnostic criteria. These findings indicate that the DSQ can be used to reliably assess and monitor PASC symptoms.

Evaluation of roost culling as a management strategy for reducing invasive rose-ringed parakeet (Psittacula krameri) populations.

Rose-ringed parakeets (Psittacula krameri) are one of the most widespread invasive avian species worldwide. This species was introduced to the island of Kaua'i, Hawai'i, USA, in the 1960s. The rapidly increasing population has caused substantial economic losses in the agricultural and tourism industries. We evaluated the efficacy of a roost culling program conducted by an independent contractor from March 2020 to March 2021. We estimated island-wide minimum abundance was 10,512 parakeets in January 2020 and 7,372 in April 2021. Over 30 nights of culling at four roost sites, approximately 6,030 parakeets were removed via air rifles with 4,415 (73%) confirmed via carcasses retrieval. An estimated average of 45 parakeets were removed per hour of shooter effort. The proportion of adult females removed in 2020 was 1.9 × greater when culled outside of the estimated nesting season. Of the four roosts where culling occurred, the parakeets fully abandoned three and partially abandoned one site. Of the three fully abandoned roosts, an estimated average of 29.6% of birds were culled prior to roost abandonment. The roost culling effort was conducted during the COVID-19 pandemic, when tourist numbers and foot traffic were greatly reduced. It is unknown how public perception of roost culling in public areas may impact future efforts. Findings suggest roost culling can be utilized for management of nonnative rose-ringed parakeet populations when roost size is small enough and staff size large enough to cull entire roosts in no greater than two consecutive nights (e.g., if two shooters are available for three hours per night, roost culling should only be attempted on a roost with ≤ 540 rose-ringed parakeets). Supplementary Information: The online version contains supplementary material available at 10.1007/s10530-022-02984-3.

Improvement of Long COVID symptoms over one year

Importance Early and accurate diagnosis and treatment of Long COVID, clinically known as post-acute sequelae of COVID-19 (PASC), may mitigate progression to chronic diseases such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Our objective was to determine the utility of the DePaul Symptom Questionnaire (DSQ) to assess the frequency and severity of common symptoms of ME/CFS, to diagnose and monitor symptoms in patients with PASC. Methods This prospective, observational cohort study enrolled 185 people that included 34 patients with PASC that had positive COVID-19 test and persistent symptoms of >3 months and 151 patients diagnosed with ME/CFS. PASC patients were followed over 1 year and responded to the DSQ at baseline and 12 months. ME/CFS patients responded to the DSQ at baseline and 1 year later. Changes in symptoms over time were analyzed using a fixed-effects model to compute difference-in-differences estimates between baseline and 1-year follow-up assessments. Participants Patients were defined as having PASC if they had a previous positive COVID-19 test, were experiencing symptoms of fatigue, post-exertional malaise, or other unwellness for at least 3 months, were not hospitalized for COVID-19, had no documented major medical or psychiatric diseases prior to COVID-19, and had no other active and untreated disease processes that could explain their symptoms. PASC patients were recruited in 2021. ME/CFS patients were recruited in 2017. Results At baseline, patients with PASC had similar symptom severity and frequency as patients with ME/CFS and satisfied ME/CFS diagnostic criteria. ME/CFS patients experienced significantly more severe unrefreshing sleep and flu-like symptoms. Five symptoms improved significantly over the course of 1 year for PASC patients including fatigue, post-exertional malaise, brain fog, irritable bowel symptoms and feeling unsteady. In contrast, there were no significant symptom improvements for ME/CFS patients. Conclusion and relevance There were considerable similarities between patients with PASC and ME/CFS at baseline. However, symptoms improved for PASC patients over the course of a year but not for ME/CFS patients. PASC patients with significant symptom improvement no longer met ME/CFS clinical diagnostic criteria. These findings indicate that the DSQ can be used to reliably assess and monitor PASC symptoms.

Evaluation of roost culling as a management strategy for reducing invasive rose-ringed parakeet (Psittacula krameri) populations

Rose-ringed parakeets (Psittacula krameri) are one of the most widespread invasive avian species worldwide. This species was introduced to the island of Kaua‘i, Hawai‘i, USA, in the 1960s. The rapidly increasing population has caused substantial economic losses in the agricultural and tourism industries. We evaluated the efficacy of a roost culling program conducted by an independent contractor from March 2020 to March 2021. We estimated island-wide minimum abundance was 10,512 parakeets in January 2020 and 7,372 in April 2021. Over 30 nights of culling at four roost sites, approximately 6,030 parakeets were removed via air rifles with 4,415 (73%) confirmed via carcasses retrieval. An estimated average of 45 parakeets were removed per hour of shooter effort. The proportion of adult females removed in 2020 was 1.9 × greater when culled outside of the estimated nesting season. Of the four roosts where culling occurred, the parakeets fully abandoned three and partially abandoned one site. Of the three fully abandoned roosts, an estimated average of 29.6% of birds were culled prior to roost abandonment. The roost culling effort was conducted during the COVID-19 pandemic, when tourist numbers and foot traffic were greatly reduced. It is unknown how public perception of roost culling in public areas may impact future efforts. Findings suggest roost culling can be utilized for management of nonnative rose-ringed parakeet populations when roost size is small enough and staff size large enough to cull entire roosts in no greater than two consecutive nights (e.g., if two shooters are available for three hours per night, roost culling should only be attempted on a roost with ≤ 540 rose-ringed parakeets). Supplementary Information The online version contains supplementary material available at 10.1007/s10530-022-02984-3.

Mindfulness Meditation Interventions for Long COVID: Biobehavioral Gene Expression and Neuroimmune Functioning.

Some individuals infected with SARS CoV-2 have developed Post-Acute Sequelae of SARS CoV-2 infection (PASC) or what has been referred to as Long COVID. Efforts are underway to find effective treatment strategies for those with Long COVID. One possible approach involves alternative medical interventions, which have been widely used to treat and manage symptoms of a variety of medical problems including post-viral infections. Meditation has been found to reduce fatigue and unrefreshing sleep, and for those with post-viral infections, it has enhanced immunity, and reduced inflammatory-driven pathogenesis. Our article summarizes the literature on what is known about mindfulness meditation interventions, and reviews evidence on how it may apply to those with Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Evidence is reviewed suggesting effective and sustainable outcomes may be achieved for symptomatology and underlying pathology of post-viral fatigue (PASC and ME/CFS).

SARS-COV-2 INFECTION AND VACCINATION PATTERNS DETERMINE LONG-TERM ANTIBODY RESPONSES IN NURSING HOME RESIDENTS: DATA FROM NH-COVAIR

Background: Older Nursing Home Residents (NHRs) are at greatest risk of morbidity and mortality from SARS-CoV-2, particularly in the context of both waning vaccine efficacy and the emergence of Variants-of-Concern (VOCs). However, the determinants of long-term vaccine-induced protective antibody responses are yet to be determined in this group. Methods: NH-COVAIR recruited older NHRs for comprehensive clinical and frailty (NH-FRAIL) assessment. Blood samples were obtained pre-vaccination, at 6-weeks and 6-months following primary vaccination and 6-months following booster vaccination. Antibody titres were measured using both an electrochemiluminescence assay and a custom bead-based array (Luminex™) to measure antibody titre and avidity for Wuhan strain/major VOC antigens. Stepwise adjusted linear regression (log-transformed) assessed longitudinal determinants of vaccine-induced antibody responses. Results: Of 86 participants (81.1 ± 10.8 years;65% female), just under half (45.4%) had evidence of previous SARS-CoV-2 infection. All NHRs mounted a significant antibody-response to vaccination at 5 weeks followed by a significant decrease in antibody titre by 6 months. Previous SARS-CoV-2 infection was the strongest predictor of antibody waning at all timepoints (β: 3.59;2.89, 4.28;P < 0.001 for 6-months). Independent of infection history, both age (β: –0.05;–0.08, –0.02;p<0.001) and frailty (β: –0.22;–0.33, –0.11;p<0.001) were associated with faster antibody waning at 6-months. Cross-reactivity and avidity were significantly lower for Beta (B.1.351) and Gamma (P.1) VOC strains (all p<0.001). Additionally, there was faster antibody waning and significantly reduced antibody avidity to Beta and Gamma VOCs in SARS-CoV-2 naïve NHRs. Conclusion: Older NHRs are capable of mounting protective antibody responses to SARS-CoV-2 vaccination. Responses were more durable, with a greater cross-reactivity to and avidity for VOCs in those with previous SARS-CoV-2 infection. Increasing age and greater frailty in NHRs was associated with faster antibody waning. Our findings support ongoing serological surveillance and use of additional vaccine doses in older NHRs, particularly in those without previous SARS-CoV-2 exposure.

Achieving access to haemophilia care in low-income and lower-middle-income countries: expanded Humanitarian Aid Program of the World Federation of Hemophilia after 5 years.

Highly effective treatment of haemophilia A and B is primarily available to 15% of the world's population, in high-income countries. In low-income countries (LICs) and lower-middle-income countries (LMICs), morbidity and mortality are high because of greatly reduced access to diagnosis, care, and treatment. We report the challenges and impact after the first 5 years (mid-2015-2020) of the expanded World Federation of Hemophilia (WFH) Humanitarian Aid Program (HAP). WFH HAP donated coagulation products were used to treat more than 250 000 acute bleeding episodes, manage approximately 4000 surgeries, and establish bleeding preventive prophylaxis in about 2000 patients in 73 countries. Health-care providers worldwide learned optimal management of patients with complex needs through virtual and in-person training. In response to the programme, some governments increased investment in haemophilia care, including independent purchases of small amounts of treatment products. With unparalleled scope and complexity, and substantial benefits to people with haemophilia and society in general, the WFH HAP is an exemplar of partnership between for-profit and not-for-profit organisations advancing health-care equity in LICs and LMICs, which could be replicated by other organisations supporting people with different monogenic diseases.

Perspectives of Australian nursing educators on the preparation of nursing students for the care of older people's oral health

Nurses can and need to take a leadership role in improving and maintaining older Australians' oral health in community, hospital, and residential care settings. [...]it is important to investigate the perspectives of nursing educators on the preparation of nursing students for the care of older people's oral health. Keywords: aged care, oral health, nursing, older people, nursing curricula, dental care, interprofessional and collaborative practice INTRODUCTION The oral health of many older Australians (65 years and above) remains poor despite an increased understanding of the importance of oral health and its association with general healths 2 Due to blood-borne pathogens from the mouth, oral diseases worsen heart problems, diabetes, and pneumonia, leading to unplanned hospitalisations.3"5 Poor oral health also increases the severity of complications arising from viral infections, including COVID-19.6,7 Predominant oral health issues for older people include tooth decay, gum diseases, dry mouth, tooth wear, and oral cancer.8 Poor oral health leads to oral pain, difficulties in eating, speaking, and swallowing as well as lower self-esteem due to bad breath and poor facial and dental appearance.9 Maintaining oral health - a mouth free of pain, discomfort and disease - is key to maintaining the quality of life and general health of older people.10 In providing oral healthcare, nurses need to understand the factors affecting people's oral health and oral healthrelated quality of life, ensure daily oral care practice, and be able to complete an oral health screening to identify issues needing timely referral to a dentist, doctor, or allied health specialist.11 Oral healthcare for older people has been promoted by Australian government-funded learning resource packages such as "Better Oral Health in Residential Care" and "Better Oral Health in Home Care".12 These resources were developed a decade ago to educate and assist nurses, nursing assistants, and allied health professionals to collaborate with dental professionals to ensure effective oral healthcare for the older population.12 However, the uptake of these learning resource packages appears limited, and the report of the Royal Commission into Aged Care Quality and Safety highlighted the continuing neglect of older people's oral health, particularly in residential care.13 Similar concerns have been raised about the oral healthcare of older people in hospitals in Australia.14 As people age, many become frail and require assistance with oral care. The importance of nurses in providing oral healthcare has been acknowledged in international reports and studies.15-18 Restrictions to dental services during the COVID -19 pandemic have highlighted the need for the leadership of nurses in oral healthcare, working closely with dentists, doctors, and allied health professionals to maintain older adults' oral and general health.19 Nursing curricula need to specify the knowledge and clinical competence requirements for the effective provision of oral healthcare to ensure that all graduating students are well-prepared to provide such care.11 Despite the acknowledged association between poor oral health and general health, 13, 20-22 there is little known about the extent of the preparation of nursing students in Australia to provide oral healthcare for older people.11 A review of the curricula of Australian Bachelor of Nursing programs, as presented on university websites, by the first author (VB) showed no information regarding the inclusion of units and clinical practice addressing the care of older people's oral health. Competence in oral healthcare may be implied in current Australian Nursing and Midwifery Accreditation Council (ANMAC) Standards (Standard 3.6 does require nursing programs to integrate principles of interprofessional learning and practice in content and learning outcomes) but there is no particular focus on oral healthcare learning objectives.23 To address this apparent lack of focus on oral healthcare, this study aimed to assess the perceptions of nursing educators regarding the preparation of nursing students to understand and provide effective oral healthcare, particularly for older people.

PREVIOUS SARS-COV2 INFECTION, AGE AND FRAILTY PREDICT 6-MONTH BNT162B2 VACCINE-INDUCED ANTIBODY TITRE IN NURSING HOME RESIDENTS

Introduction Older nursing home residents are the population at greatest risk of morbidity and mortality from SARS-CoV-2 infection. No studies have examined the determinants of long-term antibody responses post-vaccination in this group. Method Longitudinal cohort study in residents of 5 nursing homes assessed prior to vaccination and at both 5-weeks and 6-months post SARS-CoV2 vaccine (BNT162b2). Comprehensive clinical assessment was performed, including assessment for comorbidity, frailty (NH-FRAIL) and SARS-CoV-2 infection history. Serum Nucleocapsid and Anti-Spike Receptor Binding Domain (RBD) antibodies were analysed at all timepoints and an in vitro Angiotensin Converting Enzyme (ACE2) Receptor-Spike RBD neutralisation assay used to assess serum neutralisation capacity. Results Of 86 participants (81.1 ± 10.8 years;65% female), just-under half (45.4%;39/86) had evidence of previous SARS-CoV-2 infection. All participants demonstrated a significant antibody response to vaccination at 5-weeks and a significant decline in this response by 6-months. SARS-CoV-2 infection history was the strongest predictor of antibody titre (log-transformed) at both 5-weeks (β: 3.00;95% CI [Confidence Interval]: 2.32, 3.70;p < 0.001) and 6-months (β: 3.59;95% CI: 2.89, 4.28;p < 0.001). Independent of SARS-CoV-2 infection history, both age in years (β: -0.05;95% CI: −0.08, −0.02;p < 0.001) and frailty (β: -0.22;95% CI: −0.33, −0.11;p < 0.001) were associated with a lower antibody titre at 6-months. Antibody titres at both 5-weeks and 6-months significantly correlated with in vitro neutralisation capacity. Conclusion and Implications In older nursing home residents, SARS-CoV-2 infection history was the strongest predictor of anti-spike antibody titres at 6-months, whilst age and frailty were independently associated with lower titres at 6-months. Antibody titres significantly correlated with in vitro neutralisation capacity. Whilst older SARS-CoV-2 naïve nursing home residents may be particularly vulnerable to breakthrough SARS-CoV-2 infection, the relationship between antibody titres, SARS-CoV-2 infection and clinical outcomes remains to be fully elucidated in this cohort.

The association between household and neighborhood characteristics and COVID-19 related ICU admissions.

Introduction: Approaches to COVID-19 mitigation can be more efficiently delivered with a more detailed understanding of where the severe cases occur. Our objective was to assess which demographic, housing and neighborhood characteristics were independently and collectively associated with differing rates of severe COVID-19. Methods: A cohort of patients with SARS-CoV-2 in a single health system from March 1, 2020 to February 15, 2021 was reviewed to determine whether demographic, housing, or neighborhood characteristics are associated with higher rates of severe COVID-19 infections and to create a novel scoring index. Characteristics included proportion of multifamily homes, essential workers, and ages of the homes within neighborhoods. Results: There were 735 COVID-19 ICU admissions in the study interval which accounted for 61 percent of the state's ICU admissions for COVID-19. Compared to the general population of the state those admitted to the ICU with COVID-19 were disproportionately older, male sex, and were more often Black, Indigenous, People of Color. Patients disproportionately resided in neighborhoods with three plus unit multifamily homes, homes built before 1940, homes with more than one person to a room, homes of lower average value, and in neighborhoods with a greater proportion of essential workers. From this our COVID-19 Neighborhood Index value was comparatively higher for the ICU patients (61.1) relative to the population of Rhode Island (49.4). Conclusion: COVID-19-related ICU admissions are highly related to demographic, housing and neighborhood-level factors. This may guide more nuanced and targeted vaccine distribution plans and public health measures for future pandemics.

Recovery homes coping with COVID-19.

Recovery homes are a widespread community resource that might be utilized by some individuals with substance use disorders (SUD) and COVID-19. A growing collection of empirical literature suggests that housing can act as a low-cost recovery support system which could be effective in helping those with SUD sustain their recovery. Such settings could be already housing many residents affected by COVID-19. Many of these residents are at high risk for COVID-19 given their histories of SUD, homelessness, criminal justice involvement, and psychiatric comorbidity. Stable housing after treatment may decrease the risk of relapse to active addiction, and these types of settings may have important implications for those with housing insecurity who are at risk for being infected with COVID-19. Given the extensive network of community-based recovery homes, there is a need to better understand individual- and organizational-level responses to the COVID-19 pandemic among people in recovery homes as well as those managing and making referrals to the houses. At the present time, it is unclear what the effects of COVID-19 are on recovery home membership retention or dropout rates. This article attempts to provide a better understanding of the possible impact of COVID-19 on the infected and on recovery resources in general.