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Introduction: With the increasing detection of incidental pulmonary nodules (IPNs), there is a clinical need for a dedicated IPN service to ensure that growing PNs are managed in a timely manner. Pre COVID-19, our centre ran a virtual nodule service, delivered on an ad-hoc basis by the lung cancer physicians. We hypothesised that efficiency of the service would improve with a dedicated nodule team. We were awarded a pump priming grant by the Thames Valley Cancer Alliance to implement a nodule navigator run service. We report the initial outcomes of this project here. Objective(s): To evaluate the PN navigator service. Method(s): Retrospective data pre-service development was collected from patients presenting to the PN service between April and June 2022. The service was established in October 2022 and data from October and November 2022 collected. Student t-test was used to compare means. [Table presented] Results: 107 patients were included pre-service and 92 patients in the post-service development cohorts. Data for time to CT report and patient contact are summarised in Table 1. There was no reduction in mean time from CT scan date to CT report (Table 1;31vs 27;p=0.143) but a reduction was seen between CT report and patient contact (Table 1, 45 vs 20;p<0.001). Conclusion(s): This small cohort study shows an improvement in the time between CT scan and patient contact following the introduction of a dedicated PN service. This may reduce delays in the diagnosis of early-stage lung cancer. Whilst there was no significant difference between the CT scan date and CT report, these data highlight an area in the pathway that can improve. Further aims of the project are to collect patient satisfaction and IPN discharge. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.
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Purpose: The purpose of the pilot study is to explore patient and caregiver (i.e., spouse, parent, grandparent, child, and grandchild) satisfaction regarding telepractice versus in-person services provided at a university speech, language, and hearing clinic. Methods: Survey data were collected from 70 respondents (24 received in-person services only, 13 received telepractice only, and 33 received both in-person services and telepractice) during the onset of the COVID-19 pandemic. Results: Results indicated that patients and caregivers rated overall in-person services significantly higher than the overall telepractice services. Patients' and caregivers' perceived technology skills were not significantly related to their satisfaction of telepractice. However, graduate clinicians' technology skills, professionalism, and the quality of materials used in sessions were significantly associated with patients' and caregivers' satisfaction of telepractice. Also, patients' and caregivers' interaction with graduate students and supervisors was significantly correlated to their satisfaction of telepractice. Conclusions: Areas of improvement for telepractice-based services were discussed. The significance of adopting telepractice clinical and technical skills in preservice speechlan¬guage pathology pedagogy was also highlighted. © 2022 The Korean Association of Speech-Language Pathologists.
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While access to library and archival collections in mainland China remains unclear due to the ongoing covid-19 pandemic and increasing government scrutiny, past experiences in Chinese archives are still relevant for scholars going forward, in the event that the People's Republic of China reopens the doors to these collections. In surveying the digital, print publication, and manuscript collections pertaining to the Chinese history of World War ii, this article shows how access to new kinds of sources redefined the pre-pandemic state of the field. In particular, curated volumes that emphasized perspectives from the Chinese Communist Party and leftist intellectuals gradually have given way to a more representative collection of the documentary evidence, and Taiwanese collections continue to be important to the historiography. The article begins with coverage of well-known guides and published catalogues of mainland and Taiwanese collections. It then covers some military documents that Chinese scholars occasionally have referenced. It emphasizes the richness of accessible material on the social and cultural history of the war era as part of a call to colleagues and future students to expand the scope of what is traditionally thought to be "military history.” There is ample opportunity for major interventions into our understanding of wartime China, which shaped the course of modern history overall, and major innovations in historiography that scholars usually make from the dusty reading rooms of the libraries and archives. © Aaron William Moore, 2022
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Background: The COVID-19 pandemic continues to worsen economic inequality, political unrest and violence resulting in unprecedented numbers of refugees and asylees globally. Various stressors related to forced displacement may impact cognitive function as refugees age in hosting countries. However, little is known about how forced displacement impacts perceptions and attitudes towards dementia and dementia risk reduction. Method(s): In-depth interviews with 61 older refugees aged 55-86 who were resettled in San Diego, California from Iraq and Syria, conducted between April-December of 2021. A phenomenological long-table approach was used to identify themes and categorize data on dementia knowledge, risk and attitudes. Result(s): The mean age of participants was 64.61 (SD: 7.19), 50.82% were female, 14.75% were employed, Median income was USD $15,001 - %25,000, median years since resettlement was 8 (SD7.06), 32.79% reported they could read and write English, 81.97% were Iraqis, 80.33% were married was. 16.39% have contracted COVID-19, and 85.25% reported being more forgetful since the pandemic started. Participants' responses about their attitudes about dementia were classified into three distinctive thematic domains: fear, acceptance, and practical challenges. Participants identified fear of developing dementia and the need to improve dementia knowledge as major motivators towards adopting healthier lifestyle and health behaviors. Acceptance emerged in relationship to the following areas: 1) religious;aging mentioned in the holy books as an experience associated with feelings of humiliation and helplessness, 2) cultural;dementia as an unavoidable part of normal aging, 3) experiential;displacement and war-related trauma increase risk of dementia. Practical challenges included the lack of age-friendly and trauma-informed care and services available for refugees which were identified as a major barrier for preventive, behavioral and lifestyle change. Conclusion(s): These findings can be used to develop effective and refugee-focused interventions that increase motivators and reduce barriers by tailoring interventions to refugees' dementia risk reduction literacy and motivations to change behaviors. Copyright © 2022 the Alzheimer's Association.
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BACKGROUND: The importance of involving stakeholders in research is widely recognised but few studies provide details to implementation in practice. The use of real-time technology involving patients, carers and professionals in project design, monitoring, delivery and reporting could maximise contribution. Stakeholder engagement was included as part of a Dementia Analytics Research User Group project which applied machine learning to the Trinity-Ulster-Department of Agriculture (TUDA) data set, identifying clinical and lifestyle factors associated with cognitive health in 5000 community-dwelling older Irish adults.
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Barring Freedom, a travelling exhibition featuring artworks engaging the histories and current conditions of prisons and policing in the United States, was to open in April 2020. While COVID-19 disrupted that plan, the realities of inequity in the United States placed into stark relief by the pandemic and the uprisings of summer 2020 brought urgency to rethinking the curatorial vision of the exhibition to reach audiences beyond the gallery walls. Buoyed by the idea that, in the words of Angela Davis, art can ‘propel people towards social emancipation’, the exhibition and related programming was reconceived as an ongoing, interdiscipli-nary, public scholarship initiative reaching across the borders normally perceived between museums, prisons and universities. Opportunities arose for expanded forms of community building and participation that welcomed different forms of knowledge, furthering the political and aesthetic aims of the project to shift the social attachment to prisons. © 2022 Intellect Ltd Curatorial Reflection. English language.
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In this chapter, the first 18 months of the COVID-19 pandemic are revisited from the perspective of Indiana University’s Europe Gateway Director in Berlin, Germany. She describes how, within a matter of days in March 2020, the global mobility on which the Gateway’s programs depended came to a screeching halt and, in the bigger picture, the entire international education industry unraveled. Yet the author and her colleagues made their proverbial lemonade from the lemons they were given, developing innovative program ideas that addressed needs the pandemic brought upon international education only weeks into the initial shock and sudden new normal of remote work and virtual interaction. Online-only programming brought challenges, but great benefits as well. The crisis affected internal and external university partnerships in both nuanced and sea-change ways, and with potentially lasting impact. A glimpse at the post-pandemic horizon has come into view at the Indiana University Europe Gateway—and beyond. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Introduction: Ultrasound guided sampling (USGS) of supraclavicular lymph nodes (SCLN) is a minimally invasive method for obtaining cytological diagnosis in metastatic lung cancer. Same day USGS service may improve timeliness of investigations, minimise hospital visits and reduce invasive procedures. Methods: We performed a 3-year retrospective analysis of patients with SCLN amenable to biopsy detect-ed on 2 week-wait (2WW) CT. We identified those who underwent USGS or other procedures, diagnostic yield and their timeliness were determined. Results: 49 patients (26%) had amenable SCLN, of whom 37 (75.5%) had USGS. USGS alone sufficient for 27 (73%) patients. Diagnostic yield is better for larger nodes (<1cm 62.5% positive;≥1cm 86.2% positive, 95% CI 0.13-0.93, p=0.011). The overall diagnostic yield of USGS SCLN was 81% (30/37, 95% CI 65% to 92%). Al-though faster to obtain USGS, no statistically significant difference was reached between USGS and other methods (USGS median 15.5 days (IQR 11.2), other procedures median 17.5 days (IQR 26.5), Mann-Whitney U p=0.42). Conclusion: USGS SCLN has potential utility in early lung cancer diagnosis, even in lymph nodes <1cm, and is an underutilized diagnostic investigation. A prospective study of same day 2WW outpatient clinic and USGS procedure is now required to assess its effect on an accelerated diagnostic pathway. © 2022, Zita Medical Managent. All rights reserved.
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Background: Rapid and large-scale deployment of COVID-19 mRNA vaccines highlights the potential utility of developing nucleic acid vaccines (such as RNA and DNA vaccines) against infectious diseases, including HIV-1. However, as compared to SARS-CoV-2, HIV-1 pose some unique challenges-induction of neutralizing antibodies (NAbs) against HIV-1 (frequently a correlate of protection) requires presentation of trimeric and highly conformational epitopes to the immune system, and whether nucleic acid vaccines can enable direct in vivo production of antigens that retain critical antigenic profile has not yet been elucidated. Additionally, it was previously reported that Tier 2 NAbs cannot be induced in mice due to a lack of antibody repertoire, and vaccine studies were suggested to be performed in larger mammals such as rabbits/NHPs, inadvertently slowing down and increasing the costs of preclinical HIV-1 vaccine studies. Methods: In our study, we used the Antigen Conformation Tracing In Vivo by ELISA (ACTIVE) assay developed in house to characterize antigenic profiles of vaccines produced in vivo (from transfected muscle tissues). We analyzed induced cellular responses, using stimulation with overlapping peptides followed by intracellular cytokine staining and IFN-g ELIspot assays. We analyzed induced humoral responses by using both binding ELISA assays and TZM-BL based neutralizing assays, and attempted to map induced NAb epitopes by engineering selectively mutated pseudovirus. We performed antigen-specific B-cell sorting, and used the 10x genomics pipeline to characterize antibody sequences of proliferating B-cell clones. Results: We confirmed that in vivo produced vaccines retained key trimeric conformational epitopes and glycan profiles. Compared to protein vaccination, DNA vaccination uniquely and strongly induced both TFH, CD4+, CD8+ T-cell responses, and Tier 2 NAbs mapped to a previously unreported Env C3/V5 epitope. 5 unique NAbs were isolated, and confirmed to bind to the epitope using a Cryo-EM structure of NAb-MD39 complex at 3.8Å resolution. Conclusion: Our study confirmed that with appropriate vaccine delivery technology, murine models can be appropriately used for HIV-1 vaccine studies aimed at generating NAb responses. In addition, beyond potential functional immunity gains, DNA vaccines permit in vivo folding of structured antigens and provide significant cost and speed advantages for enabling rapid evaluation of new HIV vaccines.
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Background: The mechanism of bone loss in antiretroviral-treated HIV-positive patients is poorly understood. Plasma bone turnover markers(BTMs) suggest uncoupling of bone resorption and formation by a treatment effect on bone cells. Switching away from TDF to TAF-containing regimens has been associated with bone mineral density(BMD) gains measured by dual-energy X-ray absorptiometry (DXA). One explanation is reversal of ongoing subclinical bone loss in the TDF to TAF switchers. Quantitative imaging with 18F-PET/CT allows assessment of regional bone formation at specific skeletal sites and can help differentiate if BMD changes are associated with increased bone formation or reduced bone loss. Methods: PETRAM, an open-label, randomised study conducted at a single UK site, enrolled non-osteoporotic virologically suppressed HIV-positive males, on >24 weeks rilpivirine/emtricitabine/TDF (RPV/FTC/TDF). They were randomised 1:1 to remain on RPV/FTC/TDF or switch to RPV/FTC/TAF. The protocol specified scanning by DXA (to measure BMD) and 18F-PET/CT at several regions of interest-with primary focus on the lumbar spine (LS) and total hip (TH)-at baseline, 24 weeks, and 48 weeks. However, the timing of scans was disrupted, and in some cases considerably delayed, by COVID-19. The primary analysis was therefore based on change between the baseline and final scans, adjusting for the interval between them. Regions of interest were drawn on the PET/CT images and the standardised uptake value (SUV) measured. A sample of 30 (15 per arm) was estimated to provide 90% power to detect a difference in change of 25% in SUV between the randomised groups. Results: 32 males, median age 51 years, 76% White ethnicity, median duration RPV/FTC/TDF of 49 months, BMI 25.5 kg/m2 were enrolled;27(16 TAF:11 TDF) were included in the final analysis. The interval between baseline and final scans ranged between 23-103 weeks (median 55 weeks). There was no significant difference in change in SUV(18F-PET/CT) at the LS or TH between the TAF and TDF arms (Table);there was a trend towards improved LS BMD, but not TH BMD, in the TAF arm. Conclusion: As measured by 18F-PET/CT, regional bone formation at the hip or LS in patients replacing TDF with TAF in their ART combination did not differ, and contrary to our hypothesis, switching to TAF vs. remaining on TDF over 23-103 weeks did not change BMD or SUV at these key skeletal sites. The improved LS BMD in those switching to TAF is consistent with findings from other TAF-switch studies.
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Background: There have been few estimates of SARS-CoV-2 seroprevalence in rigorously sampled and geographically broad populations that include children, who have accounted for fewer diagnosed COVID-19 cases compared to adults. The COMPASS study assessed cross-sectional, population-based SARS-CoV-2 seroprevalence and PCR positivity among adults and children in 15 US communities. Methods: Time-location sampling was used to recruit adults and children >2 months of age from randomly selected venues in communities near participating research sites. Demographics, history of COVID-19 and willingness (likely, very likely or already received) to receive an approved COVID-19 vaccine were captured via an interviewer-administered questionnaire. Serologic analysis was performed using a SARS-CoV-2 IgG nucleocapsid antibody (Ab) assay (Abbott Diagnostics, Abbott Park, IL). PCR testing was performed on a mid-turbinate swab using an assay approved by the HPTN Laboratory Center. Prevalence estimates were constructed, overall and by age group (<18 y, 18-39 y, 40-59 y, 60+ y), for each community using survey weights that accounted for the sampling design. Results: A total of 22,732 persons were enrolled (median per community 1,246, range 511 to 2,925) from Jan 2021 to Aug 2021;of these, 2,151 (9.5%) were <18 y. Overall, SARS-CoV-2 seroprevalence (Ab+) ranged from 3.8 to 17.3% (median 12.5%) and SARS-CoV-2 PCR positivity ranged from 0 to 1.9% (median 0.7%). About half of Ab+ and half of PCR+ persons reported no prior or recent (within 14 days) COVID-19 symptoms, respectively [median by community 49.7% (IQR 45.8, 63.9) and 53.6% (IQR 44.3, 58.3)]. Most adults (18+ y) (median 77.3% [69.6 to 92.7%]) reported willingness to get a COVID-19 vaccination;willingness was higher among persons aged 60 y+ [median 88.1%, IQR 83.5, 90.6] compared to those aged 18-39 [median 72.5%, IQR 64.1, 79.8] and 40-59 [median 75.6%, IQR 72.5, 78.4]. The combined prevalence of prior (Ab+) or active (PCR+) SARS-CoV-2 infection across all communities ranged from 4.4 to 17.6% (median 12.7%), and was similar for children (median 12.7%, range 4.4 to 19.7%) and adults (median 12.5%, range 4.4% to 17.8%) among communities enrolling > 25 children (Figure). Conclusion: In this population-based survey, evidence of prior and active SARS-CoV-2 infection varied widely by community but, contrasting with earlier reports, not by age. These findings suggest that acquisition of SARS-CoV-2 is similar across all ages.