Covid Shielding Stories: Co-Produced Research to Understand the Voice of People Living with Arthritis and Auto-Immune Disease

Background/Aims Up to one-third of people with rheumatological conditions were required to 'shield' from COVID-19. This co-produced, qualitative research aimed to understand experiences of the shielding process and the impact of shielding upon people's lives. Methods Adults who shielded due to rheumatological disease participated in audio-recorded interviews and focus groups (FGs). Framework analysis combined inductive and deductive approaches. Creative materials were collected. Two patient contributors proposed the study, are co-investigators, and conducted the research alongside a clinical academic and four-member patient advisory group. COREQ and GRIPP2 guidelines were followed. Full ethical approval was granted by the University of Manchester Research Ethics Committee (2021- 11544-20348). Results Data were generated from 28 interview and 12 FG participants between October 2021-January 2022. 15 people contributed creative materials. Characteristics included 44/48 (85%) female, ages 18-75 years, non-white 10/48 (21%), all UK regions (Table 1). Corbin & Strauss's theory, 'Three lines of work: Managing chronic illness', frames the findings. Shielding increased and shifted the burden of 'illness work' onto patients, e.g., in gaining access to vaccines and navigating risks and uncertainties due to COVID-19. 'Life work' was increased as participants struggled to access food and medicines. Participants' self-identity was re-appraised in the context of their illness. Many feared for their lives because of their diagnosis for the first time, increasing 'biographical work'. Participants' perceived value to society changed over time: feeling equal to the general population at the first UK national lockdown;abandoned by society due to 'freedom day' and formal shielding's end. 'Emotional work' was added to 'Three lines of work'. Shielding notification induced fear, stress, devastation, shock and disbelief, balanced by a feeling of being protected. Emotions experienced include anxiety, guilt, anger and frustration. Mental health problems were experienced, often for the first time. Many continued to shield beyond formal shielding's end. Conclusion This co-produced, qualitative research highlights experiences and impact of shielding including increased illness, life, biographical and emotional work. Clearer, personalised information would help shielders to understand their risk and vaccine response, informing re-integration into society.

What is the relationship between fatigue, pain and urgency in people with inflammatory bowel disease? Results of the IBD-BOOST survey in 8486 participants

Background: Fatigue, pain and faecal incontinence are common in people with IBD. However, little is known about co-existence of these multiple symptoms, how they inter-relate and whether people want help for these symptoms. In qualitative interviews, patients have reported that these symptoms are often ignored in clinical consultations where the focus is on inflammation, but that they are very bothered by these symptoms, even when disease is apparently in remission The aim of this study was to determine the presence and relationship between fatigue, pain and incontinence in people with inflammatory bowel disease, and desire for intervention for these symptoms Methods: A purpose-designed survey (online or postal), incorporating validated tools and demographic details, was sent to unselected UK clinic and UK IBD-BioResource adult patients. When the covid-19 pandemic halted clinic recruitment, additional self-selected UK recruits were solicited via social media. Using the validated PROMIS tools the following definitions were used for presence of symptoms: Fatigue: PROMIS fatigue T-score of 60 or more;pain: PROMIS pain intensity T-score of 60 or more;PROMIS bowel incontinence: Raw score of 50 or more. Participants also reported disease activity using the relevant PRO-2 score, IBD-Control, anxiety (GAD-7), depression (PHQ-9) and quality of life (EQ-5D-5L) which will all be reported elsewhere Results: A total of 8486 useable responses were received (7716 online 770 postal). 4176 reported Crohn's disease, 4255 had ulcerative colitis or other form of IBD. There were 3281 men and 4883 women. Median age was 51 years (range 18 - 92). 2550 (30%) reported fatigue 1766 (21%) pain and 4565 (54%) faecal incontinence according to the above definitions;925 (10.9%) reported having all three symptoms Demographics by symptom are shown in Table 1. Table 2 reports those participants indicating the presence of each symptom and each combination of symptoms. Table 3 shows a summary of self-defined severity and impact of symptoms (scoring scale 0-10 for both severity and impact of each symptom). Participants scored severity and impact a mean between 3.3 and 4.8, with a wide variation. 56% of all respondents (not just those with symptoms) "definitely" wanted help for fatigue;42% wanted help for pain;53% wanted help for incontinence. 29% reported "definitely" wanting help for all three symptoms (Table 4) Conclusion(s): This study confirms that fatigue, pain and urgency are common in IBD and for the first time reports the co-existence and unmet need for help with these symptoms.

Living with dementia during the COVID-19 pandemic: insights into identity from the IDEAL cohort

The continuing COVID-19 pandemic and social restrictions have impacted on the cognitive decline and mental health of people with dementia. Social isolation and loss of activities due to social restrictions may also have implications as to sense of identity for people with dementia. As part of the INCLUDE (Identifying and Mitigating the Individual and Dyadic Impact of COVID-19 and Life Under Physical Distancing on People with Dementia and Carers) component of the IDEAL (Improving the Experience of Dementia and Enhancing Active Life) cohort study, the overall aim of this subtle realist qualitative study was to explore the perspectives of people with dementia on living through the COVID-19 pandemic within the context of the 'post-vaccine' period and the national lockdowns in England and Wales;and to determine perceived challenges to and facilitators of 'living well' during the COVID-19 pandemic and beyond as restrictions were eased. In addition, the study findings are considered in relation to understandings of identity in dementia which the broader accounts of living through the pandemic have highlighted. Seven people with mild-to-moderate dementia were interviewed and themes were derived using framework analysis. Themes suggest interviewees' stoic acceptance of the pandemic and social restrictions but also fear of decline related to the temporality of their condition as well as loss of self-confidence to re-engage with the world. Interviewees managed threats to social identity by striving to maintain social and emotional connections, where the importance of a shared, social identity, particularly for people with young-onset dementia, was also apparent. Unlike in previous studies during the pandemic, the relevance of occupation for identity was observed, where maintaining previous or new activities or occupations was important to facilitate identity as well as to keep a sense of purpose. Therefore, as well as supporting people with dementia as the pandemic eases, future research into occupation and identity in dementia is of potential value.

The Ments Criteria - Can We Apply It in Dialysis Access Surgery?

Introduction: Dialysis access surgery, in the UK, is almost always performed in NHS healthboard-run hospitals. During the height of the COVID-19 pandemic, in which access to elective operating theatres became limited, arrangements were made in our vascular access service, to perform some dialysis access surgery in a local private hospital. Patients were selected such that those deemed suitable as day-case and unlikely to require in-patient stay were chosen. A scoring system, 'Medically Necessary Time-Sensitive' (MeNTS) criteria, was proposed recently to assist in such decision-making processes by considering procedural, disease, and patient factors (Prachand et al, J Am Coll Surg.2020). The cumulative MeNTS score ranges from 21 to 105, with a score >65 signifying a 'too high risk to be justified' procedure. The aim of this study was to use MeNTS scores retrospectively to determine whether correct decisions were made in performing dialysis-access operations in the usual NHS university healthboard (UHB) setting vs local private hospital (Spire). Method(s): MeNTS scores were calculated for all patients who underwent dialysis access surgery at both sites between March 2020 - March 2021. Outcomes assessed included patient survival and COVID-19 infection Results: 213 Patients underwent dialysis access surgery at UHB and 76 at Spire. Mean cumulative MeNTS scores were 40.03(+/-0.30) and 39.97(+/-0.46) for the UHB and Spire groups, respectively (P=.922). COVID-19 infection occurred in four patients at UHB, and none in Spire (P=.576). Successful dialysis access was achieved in 76.06% and 69.74% in UHB and Spire patients, respectively (P=.287). At 30 days, one UHB patient had died whilst all Spire patients were alive (P>.999). Discussion and conclusion: Dialysis access surgery can take place safely during the COVID-19 pandemic, with necessary precautions. A modified version of the MeNTS score to make it more renal-specific would allow maximum benefit to be achieved from it in this field.

B Cells Induce Hypertension, AT1AA, And Complement Activation In Preeclampsia Or In Response To A Prior Covid-19 Infection During Pregnancy

Preeclampsia (PE), new onset hypertension (HTN) during pregnancy, is associated with placental ischemia and chronic inflammation that includes increased CD4+ T cells, B cells secreting agonistic autoantibodies against the angiotensin II type 1 receptor (AT1AA), and activation of the complement system. Previous studies have shown AT1-AA is produced in patients with COVID-19 infection. Interestingly, having had COVID-19 during pregnancy is associated with increased incidence of developing a PE phenotype during pregnancy. We have previously shown an important role for B cell depletion or AT1AA inhibition to attenuate HTN in rat models of PE. Collectively, this data suggests B cells contribute to PE development and that B cells may increase incidence of PE in patients with a history (Hx) of COVID-19 during pregnancy through production of the AT1AA. We hypothesize B cells from PE or CV Hx PE patients produce AT1AA resulting in HTN and complement activation in pregnancy. Placental B cells were isolated from normal pregnant (NP), PE, normotensive (NT) CV Hx, or PE CV Hx patients at delivery. B cells were transferred i.p. into pregnant athymic rats at gestation (GD) 12. On GD18, carotid catheters were inserted. On GD19, blood pressure was measured and tissues collected. PE B cell recipients had increased Mean Arterial Pressure (MAP) (115+/-3 mmHg n=6) compared to NP B cell recipients (97+/-4 mmHg n=6 p<0.05). PE B cell recipients had increased AT1AA (20+/-2 DELTABPM n=4) compared to NP B cell recipients (6+/-1 DELTABPM n=4 p<0.05). PE B cell recipients had increased markers of complement activation such as reduced plasma C4 (1302+/-169 mug/mL n=4) and C3 (516+/-45 mug/mL n=4) compared to recipients of NP B cells (2348+/-338 mug/mL n=4 p<0.05) and (790+/-66 mug/mL n=4 p<0.05) respectively. CV Hx PE B cell recipients had elevated MAP (108+/-3 mmHg n=4) compared to CV Hx NT B cell recipients (101+/-7 mmHg n=4) and increased AT1AA (24+/-3 DELTABPM n=3) compared to CV Hx NT B cell Recipients (4+/-1 DELTABPM n=4 p<0.05). Collectively, this study demonstrates an important role for B cells to cause HTN during pregnancy;and indicates that B cells contribute to a higher incidence of PE in women with a Hx of CV infection during pregnancy possibly by secreting AT1-AA.

EXPOSURE OF OVARIES TO COVID-19 VACCINATION DOES NOT IMPAIR FERTILITY

OBJECTIVE: Misinformation regarding Covid vaccination has contributed to vaccine hesitancy. Initially, there were claims that immune cross reactivity between the SARS CoV-2 spike protein and syncytin-1 would prevent embryo implantation. We previously demonstrated no difference in implantation and sustained implantation rates between previously vaccinated or infected women compared to other women.1 More recently, misinterpretation of vaccine biodistribution data has led to a second claim that mRNA containing lipid nanoparticles are concentrated in the ovaries and spike protein produced there would also cause infertility. The purpose of this study is to determine whether prior in vivo ovarian exposure to lipid nanoparticle-mRNA vaccination against SARS-CoV2 spike protein reduces subsequent fertility in women. MATERIALS AND METHODS: This is an ongoing observational study of women undergoing frozen embryo transfer with a single expanded blastocyst. This is an interim report (n =128) encompassing transfers between Jan 1 and Jul 02. All patients had serum analyzed prior to starting stimulation for egg retrieval to quantitatively determine the level of AntiSARS-CoV-2 Spike IgG. Reactive (antibody positive) patients were questioned to determine a history of vaccination or infection. Patients were divided into three groups based on their status. Women who were vaccinated (n = 26);women who had previous infection with SARS-CoV-2 (n=11) and women without a history of either vaccination or infection (n=91). Only patients receiving the mRNA vaccines from BioNTech / Pfizer (BNT162b2) and Moderna (mRNA-1273) were analyzed. Outcome measure for the three groups were initial implantation rate (serum hCG level > 5 mIU/mL obtained 8 days after embryo transfer followed by a rising level two to three days later), sustained implantation rate (transvaginal ultrasound documented positive FHTs at two time points at least one week apart) and miscarriage rate (the difference between initial and sustained implantation rates). Baseline characteristics were analyzed using ANOVA. Chi square analysis was used to compare pregnancy rates. RESULTS: CONCLUSIONS: Embryos produced from oocytes exposed in vivo to lipid nanoparticles containing mRNA for the SARS CoV-2 spike protein are not less likely to produce pregnancy or more likely to miscarry. IMPACT STATEMENT: This data refutes the rumors that Covid-19 vaccinations are “toxic” to the ovaries & adds to the growing body of evidence that vaccinations do not cause infertility. (Table Presented).

Evaluating the impact of social distancing on COVID-19 hospitalizations using interrupted time series regression

Introduction: The quasi-experimental approach of interrupted time series analysis has been used to assess public health interventions by statistically comparing preintervention and postintervention rates. In this study, we apply interrupted time series to assess the effectiveness of social distancing on COVID-19 hospitalizations in a patient population in New York City.& nbsp;Materials and Methods: An interrupted time series design was used to evaluate the impact of the New York State on PAUSE executive order (social distancing measure), on admitted COVID-19 patients, and patients on ventilators, at a single center hospital in Brooklyn, NY. Time series data were collected from March 10, 2020 to April 28, 2020 and were modeled using segmented regression analysis, assuming a 2-week delay in the intervention's effect. ARIMA forecasting was also performed to determine the projected COVID-19 hospitalizations and ventilator use in the absence of social distancing.& nbsp;Results: There was a significant change (decrease) in the upward daily trend in the mean number of COVID-19 admissions and patients on ventilators after the assumed effective date of the New York State on PAUSE mandate. For admitted patients, the coefficient of the variable "time after intervention, " or change in slope, was - 9.30 (P = 0.0009), and the corresponding value was - 2.27 (P < 0.0001) for patients on ventilators.& nbsp;Conclusion: The assumed effective period of the implementation of the New York State on PAUSE executive order was shown to be significantly correlated with decreased COVID-19 hospitalizations and ventilator use in the population measured. Similar social distancing measures should be adopted in other cities and locales that are currently seeing a surge in COVID-19 transmissions with an assumption of a 2-week delay in impact.& nbsp;The following core competencies are addressed in this article: Medical knowledge, Systems-based practice.

Ozone Trends and the Ability of Models to Reproduce the 2020 Ozone Concentrations in the South Coast Air Basin in Southern California under the COVID-19 Restrictions

The current U.S. emission control requirements for on-road motor vehicles are driven by the ozone problem in the South Coast Air Basin (SoCAB) in southern California. Based on ozone modeling performed for Air Quality Management Plans (AQMPs), the SoCAB ozone attainment plan requires large (>80%) amounts of emission reductions in oxides of nitrogen (NOx) from current levels with more modest (similar to 40%) controls on Volatile Organic Compounds (VOC). The shelter in place orders in response to the 2020 COVID-19 pandemic resulted in an immediate reduction in emissions, but instead of ozone being reduced, in 2020 the SoCAB saw some of the highest observed ozone levels in decades. We used the abrupt emissions reductions from 2019 to 2020 caused by COVID-19 to conduct a dynamic model evaluation of the Community Multiscale Air Quality (CMAQ) model to evaluate whether the models used to develop ozone control plans can correctly simulate the ozone response to the emissions reductions. Ozone modeling was conducted for three scenarios: 2019 Base, 2020 business-as-usual (i.e., without COVID reductions), and 2020 COVID. We found that modeled ozone changes between 2019 and 2020 were generally consistent with the observed ozone changes. We determined that meteorology played the major role in the increases in ozone between 2019 and 2020;however, the reduction in NOX emissions also caused ozone increases in Los Angeles County and into western San Bernardino County, with more widespread ozone decreases further to the east.

Coping with COVID: pivoting perspectives from teaching a third-year undergraduate financial accounting course

Purpose - Coronavirus (COVID-19) has caused upheaval in university teaching practices. This paper aims to document how the teaching team on a large third-year undergraduate financial accounting course in an Australian university coped with the impact of the virus. Changes in teaching practices when classes shifted from face-to-face to online instruction during the COVID-19 crisis are described and examined using the crisis management process framework of Pearson and Clair (1998). Teaching team members were asked to write brief reflections on their experiences teaching the course during the period from February to July 2020. These were then thematically analysed and included as outcomes within the Pearson and Clair (1998) framework. Design/methodology/approach - Description of COVID-19 induced changes to teaching a large undergraduate financial accounting course at an Australian university. Findings - Six outcomes emerged: learning new technology;collegiality;the course review;the online delivery experience;redesigning assessments and;time investment;conjectures are offered about the survival of some of the changes made during the year. Research limitations/implications - The research only covers one teaching team's experience but that is the purpose of the special issue. Practical implications - Lessons for the future are explored. Social implications - The implications of online teaching are explored. Originality/value - The paper provides a historical record of how the teaching team on a large undergraduate financial accounting course coped with an unexpected, major event that necessitated rapid and radical changes to teaching methods.

Supporting Student Experience During the Pandemic and Beyond

This article reports the findings from a small-scale, qualitative and phenomenological institutional research project, undertaken during the COVID-19 pandemic, on the experiences of undergraduate students from groups who are traditionally under-represented in higher education in the United Kingdom. Documenting the first two phases of a longitudinal study carried out at one university in England, the over-arching research question investigated here using semi-structured interviews was: How has the ongoing COVID-19 pandemic impacted student experiences and learning at university? Key themes identified included worry, a sense of loss, feelings of connection and support, a sense of a new geography of campus life and students' need to feel "in the loop". Evidence of changes with longer-term implications were also found, namely, an evolution in the relationship between students and their institution. A series of suggestions are presented based on the findings aimed at mitigating some of the ongoing negative effects of the pandemic on students.

Hope during the COVID-19 pandemic;compassion, humanity, sharing moral distress, and capturing post traumatic growth in a hospice team

Aims: Our project aims to address staff wellbeing and explore, as a hospice team, some emotional challenges presented by the COVID-19 pandemic. Difficult decision making has caused moral distress amongst staff, and it has been essential to address this in order to prevent overwhelming trauma, promote mental resilience and foster hope. Methods: Providing a safe environment was essential for staff to share their feelings. Under the theme 'Let it go' for one week staff were asked to anonymously write down their feelings and take a treat thanking them for their input. An overwhelming response demonstrated the pressure placed on people's feelings of safety and emotional wellbeing. Hospice staff each received an anonymous personal thank you card, lifting spirits and promoting feelings of value. With staff engagement promising we posed the next question: 'What has COVID taught you?' Another positive response shown that whilst contending with morally traumatic situations in this time, staff demonstrated support for their own psychological resilience in extremely challenging situations. Feedback from this work was anonymised and displayed in the hospice, with staff were invited to view their work. Finally staff were encouraged to share their hopes and wishes for the year ahead, displaying these encouraged our team to begin looking forward and feeling hope in a difficult time. Results: Results have been positive. A new feeling of openness and the ability to understand and reflect upon the challenges of COVID have contributed to a positive feeling in the hospice. The understanding that we all share common emotional responses is a powerful realisation, and staff have shown bravery in sharing their moral injury. Conclusion: This project has had a huge impact. Staff have felt safe to share feelings which is essential to support resilience. It is important that moving forward through the pandemic we continue wellbeing support and nurture self-care skills.