Hygiene theater: an important risk reduction signal for the future of retailing

Purpose: Hygiene theater is a new phenomenon that has emerged from the ongoing Coronavirus (Covid-19) global pandemic. The authors propose and test the concept of hygiene theater – comprised of purposeful and visible dynamic performance and static staging cues – on customers' approach-avoidance intentions in the retail environment. The authors explore the underlying process and show when environmental conditions such as human crowding dilute the positive effects of hygiene theater. Design/methodology/approach: Across three experiments, participants evaluated a video or scenario related to a shopping experience in a retail store. Sequential mediation and moderated sequential mediation using PROCESS were performed. Findings: The results show a positive and direct effect of hygiene visibility on approach responses, due to a reduction in perceived risk and increased psychological comfort. This positive effect is diluted when crowding in the retail environment is high. Originality/value: As society adapts to a new normal, this study offers contributions to improve theoretical knowledge of the impact of hygiene theater on customer approach responses, helping retailers to develop and implement health and safety policies, better equipping them to manage similar situations going forward. The authors provide insights for academics and practitioners alike. © 2023, Emerald Publishing Limited.

Bedside naso-jejunal placement is more difficult, but successful in patients with COVID-19 in critical care: A retrospective service evaluation of a dietitian-led service

The COVID-19 pandemic presented clinical and logistical challenges in the delivery of adequate nutrition in the critical care setting. The use of neuromuscular-blocking drugs, presence of maxilla-facial oedema, strict infection control procedures, and patients placed in a prone position complicated feeding tube placement. We audited the outcomes of dietitian-led naso-jejunal tube (NJT) insertions using the IRIS (Kangaroo, USA) device, before and during the COVID-19 pandemic. NJT placement was successful in 78% of all cases (n = 50), and 87% of COVID-19 cases. Anaesthetic support was only required in COVID-19 patients (53%). NJT placement using IRIS was more difficult but achievable in patients with COVID-19.Copyright © The Intensive Care Society 2023.

Social networks and health information sharing in COVID-19 pandemic : Tetine Sentell

Background Understanding health information flow in social networks is important for designing effective health communications strategies and to achieve health literacy. Limited information is known about variation in social networks and health information sharing in the COVID-19 pandemic by demographic factors. Young people are of particular interest given their heavy exposure to digital media sources, which include considerable health misinformation. Methods Hawai'i (n = 324) residents between 18-35 completed a Spring 2021 online survey including questions on health information flow in social networks: (1) how many they talked to and (2) listened to about health. Two Poisson regression models were fit with gender, education, and race/ethnicity predicting social network size. Results Respondents were 67.6% female. Respondents discussed their own health with 2-3 people (M = 2.18, SD = 2.95) and listened to roughly the same number. Respondents who talked with a greater number of individuals about their own health were significantly more likely to have larger networks for listening to others (r (317) = .614;p< .001). In the model for discussing their own health, as education increased so did social network size. For the model predicting discussing others’ health, gender was significant (p = 0.003);women listened to 30.6% more individuals than men. Most (73%) respondents had conducted a recent digital health search for either themselves or someone else, including for parents, grandparents, and children. Facebook (63%) and Instagram (58%) were the most popular online sources for COVID-19 health information. Conclusions Understanding social networks and digital health sources in young people are important for designing effective health communications to reach all communities, especially those experiencing health inequities, given the amount of health misinformation circulating and the need to build trust in public health communication. Key messages • Social networks provide access to critical health information including information obtained from digital sources. • Gender and education were important predictors of social network size in COVID-19 health communications.

Using Dialogic Feedback to Create Learning Communities During COVID-19: Lessons for Future Teacher Development

The COVID-19 pandemic substantively impacted educational processes and posed urgent questions regarding how teachers can adapt their practices to create supportive learning communities in online environments. The purpose of this study was to understand how teachers provided dialogic feedback using technologies to create learning communities despite the unexpected switch to online learning during the COVID-19 lockdowns. Ten pre-service teachers and six in-service teachers were interviewed to understand their experiences using technology-assisted feedback during the COVID-19 lockdowns. Our findings show that the focus of feedback shifted during the pandemic. Over time, both teachers and students became more comfortable navigating online environments, going from self-level feedback that provided little support for learning to using technologies in innovative ways to create opportunities for dialogue around feedback and learning. We provide directions for future research and suggestions on how these findings can inform the creation of teacher training opportunities. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Critically ill patients with and without SARS-CoV-2 better achieve energy and protein targets with a high-energy, high-protein peptide-based enteral tube feed;insights from a multicentre clinical audit performed during the COVID-19 pandemic

Meeting energy and protein requirements in critically ill patients is important for prognosis, yet difficult to achieve as a consequence of disease, management and/or altered nutritional intake[1]. Improvements in achieving energy and protein requirements with a high-energy, high-protein peptide-based tube feed were observed in community patients with impaired gastrointestinal function[2]. To establish whether this remained true in the critical care setting, where feeding intolerance is observed frequently in patients with[3] and without SARS-CoV-2[4], a retrospective multicentre audit was performed. Adults (> 18years) with or without SARS-CoV-2, admitted to critical care across 6 UK hospitals between May 2020 and December 2020, were retrospectively included if they received a peptide-based enteral tube feed (Nutrison Peptisorb Plus HEHP®, Nutricia Ltd), containing 1.5kcal/ml and 7.5g protein/100ml (herein referred to as HEHP). Data were collected from 15 critically ill patients (52±12y;87% male), with mean length of hospital stay being 26days (range: 7-49days). Of these, 10 were SARS-CoV-2 positive, with the remainder having pancreatitis (n=3), delayed gastric emptying (n=1) or unconfirmed diagnosis (n=1). HEHP was used second line (after whole protein) and indications (multiple were cited for some) for use included tolerance issues (n=10), elevated energy and protein requirements (n=5) or due to primary diagnosis (n=2). Estimated energy and protein intakes (% of requirements achieved) were recorded before and during use of HEHP. In addition, Dietitians were asked whether HEHP allowed patients to better meet their nutrient target Mean intake of HEHP was 2008±461kcal/day and 100±23g protein/day provided over a mean of 12days (range: 3-29days). The percentage of estimated energy and protein targets achieved increased albeit non significantly with the use of HEHP (from 76% before vs 87% during use of HEHP for both) and the direction of effect remained true regardless of SARS-CoV-2 status. Two thirds (67%, n=10 of 15) of Dietitians reported HEHP helped patients better meet their nutrient targets and 87% (n=13 of 15) of Dietitians perceived the high protein content of HEHP as beneficial for this patient group. Gastrointestinal tolerance (anecdotal reports) remained largely unchanged in approximately half of SARS-CoV-2 positive patients when using HEHP yet improved for others including non-SARS-CoV-2 patients. Enteral tube feeding in critically ill patients poses numerous difficulties, especially in SARS-CoV-2 positive patients. This audit in critically ill patients demonstrates that a high-energy, high-protein, peptide-based enteral tube feed can help complex patients better achieve energy and protein targets in patients with and without SARS-CoV-2. References 1.Pullen K, Colins R, Stone T et al. Are energy and protein requirements met in hospital? Clin Nutr 2017;31(2): 178-187. 2.Green B, Sorensen K, Phillips M et al. Complex Enterally Tube-Fed Community Patients Display Stable Tolerance, Improved Compliance and Better Achieve Energy and Protein Targets with a High-Energy, High-Protein Peptide-Based Enteral Tube Feed: Results from a Multi-Centre Pilot Study. Nutrients. 2020, 12, 3538. 3.Liu R, Paz M, Siraj L et al. Feeding intolerance in critically ill patients with COVID-19. Clin Nutr 2021. 4.Gungabissoon U, Hacquoil K, Bains C et al. Prevalence, Risk Factors, Clinical Consequences, and Treatment of Enteral Feed Intolerance During Critical Illness. J. Parenter. Enteral. Nutr. 2015, 39, 441–448.

Patients asthmatiques hospitalisés pour infection à SARS-CoV-2 ou pour grippe : facteurs de risques de mauvais pronostic

Introduction Lors de l’émergence du coronavirus SARS-CoV-2, les patients asthmatiques ont été initialement considérés comme des patients à risque, comme pour les virus respiratoires et notamment celui de la grippe. Par la suite, ce surisque n'a pas été retrouvé, avec des prévalences d'asthmatiques parmi les patients hospitalisés pour Covid-19 inférieures à la prévalence de l'asthme en population générale. L'objectif de ce travail a été de comparer la prévalence de l'asthme et les facteurs de risque associés à un mauvais pronostic chez des patients asthmatiques hospitalisés pour Covid-19 ou grippe. Methodes Cette étude rétrospective a été conduite à partir des données de l'Entrepôt de Données de Santé (EDS) de l'AP-HP, regroupant les données médico-administratives des séjours hospitaliers. Les patients adultes hospitalisés entre le 01/01/2020 et le 30/06/2020 avec une PCR SARS-CoV2 positive dans les 15 jours précédents le séjour ou au cours de leur séjour ont constitué la cohorte patients Covid-19. A partir des séjours hospitaliers ayant un code CIM-10 J09, J10 ou J11, deux cohortes de patients grippe ont été construites : cohorte grippe saison 2018-2019 (séjours ente le 01/11/2018 et le 31/03/2019) et cohorte grippe saison 2017-2018 (séjours ente le 1/11/2017 et le 31/03/2018). Les antécédents d'asthme et les autres comorbidités ont été recherchés dans les codages des séjours hospitaliers grippe ou Covid-19 et antérieurs. L'obésité et tabagisme ont été également recherchés spécifiquement par REGEX dans les compte-rendu. Les facteurs associés à un passage en réanimation ou à un décès hospitalier ont été recherchés par des régression logistiques multivariées, avec une sélection pas à pas descendante sur le critère AIC. Resultats 9009 patients ont été hospitalisés à l'AP-HP pour Covid-19 entre 01/2020 et 06/2020, 3119 pour grippe pendant la saison 2017-2018, 3266 pendant le saison 2018-2019. La prévalence de l'asthme était significativement plus élevée parmi les patients hospitalisés pour grippe (n=283, 9.1%, IC95% [8.1 -10.1] en 2017-2018 et n=309, 9.5%, IC95% [8.5 - 10.5] en 2018-2019) contre 4.5% pour les patients Covid-19 (n=402, IC95% [4-4.9], p<0.001 pour les deux comparaisons). L'obésité a été retrouvée comme facteur de risque de mauvais pronostic chez les patients asthmatiques lors de la saison 2017-2018 de grippe (ORa=2.22, IC95%[1.25-3.96]), le tabagisme (ORa=2.95, IC95% [1.67- 5.39]) et l'insuffisance cardiaque pour la saison 2018-2019 (ORa= 2.05, IC95%[1.03-4.15]). Chez les asthmatiques Covid-19, le tabac et l'obésité étaient des facteurs de risque de forme grave (ORa=1.57, IC95% [1.03-2.40]) et ORa=1.55, IC95%[1.00-2.41] respectivement). Avoir plus de 70 ans (ORa=0.64 IC95%[0.42-0.97]) et le sexe féminin (ORa=0.38, IC95%[0.25-0.58]) étaient associés à un moindre risque de forme grave. Conclusion Nos résultats montrent une prévalence plus faible de l'asthme parmi les patients hospitalisés pour Covid-19 que parmi ceux hospitalisés pour grippe. Les facteurs de risque de forme grave, sauf l'obésité, diffèrent pour les 2 virus, et selon la saison grippale.Ceci pourrait être lié entre autres à une forte adhérence des patients asthmatiques aux mesures de confinement et des gestes barrières, mais également à une différence de susceptibilité aux virus respiratoires. Mots clés Covid 19 ;Asthme ;Grippe ;Mortalité ;Réanimation Déclaration de liens d'intérêts Camille Taillé déclare des rémunérations de la part de Novartis, GSK, sanofi, Astrazeneca, Chiesi, sans lien avec le travail présenté

SARS-CoV-2 Cycle threshold (Ct) values predict future COVID-19 cases

Background. The threat of surging COVID-19 cases prompted many hospitals in the United States to preemptively suspend elective procedures throughout the pandemic. Utilizing samples from a large hospital in Los Angeles, we sought to determine if temporal trends in SARS-CoV-2 Cycle threshold (Ct) values (proxy for viral RNA loads) were predictive for the number of future COVID-19 cases. Methods. Nasopharyngeal specimens on symptomatic patients and asymptomatic admissions were tested using the Xpert Xpress SARS-CoV-2 and SARS-CoV-2/ Flu/RSV assays (Cepheid). Ct values for all SARS-CoV-2 detections between October 2020 to March 2021 were compiled for analysis. Results. A total of 2,114 SARS-CoV-2-positive samples were included. The number of tests performed per week increased dramatically in December peaking the first week of January before returning to pre-surge numbers by Mid-February. Ct values fell during this same period with values in December and January (25.6±7.8 and 27±7.9, respectively) significantly lower than those of the other months (30±9.3 to 37.7±6.3). Average weekly Ct values for all patients were significantly, negatively correlated with the number of tests run the following week (R= -0.71, P< 0.001) and two weeks later (R= -0.75, P< 0.0001). Ct values for patients who were asymptomatic at the time of testing most strongly correlated with total number of tests performed one month later (R= -0.86, P< 0.0001). Average weekly Ct values and number of test run As cases (light grey) increased during December and January, there was a significant decrease in Ct values (dark grey) during that same time period. Average Ct values are a leading indicator of cases Average weekly Ct values for all patients (light grey) were significantly, negatively correlated with the number of tests run the following week (R= -0.71, P<0.001) and two weeks later (R= -0.75, P<0.0001). Ct values for patients who were asymptomatic at the time of testing (dark grey) most strongly correlated with total number of tests performed one month later (R= -0.86, P<0.0001). Conclusion. Lower Ct values, representing higher levels of viral RNA, have been associated with risk of intubation and infectivity. During the winter surge, we observed significantly lower Ct values suggesting that the increased transmission and morbidity of COVID-19 was temporarily associated with higher viral loads. Interestingly, Ct values for asymptomatic patients were most strongly associated with number of cases observed 1 months in the future, suggesting that asymptomatic viral load may be a leading indicator for forthcoming outbreaks. Given this association, Ct values may be a useful tool for predicting regional outbreaks of COVID-19 and more judicious cessation of elective procedures.

An uncommon case of hypoxia in a pediatric patient

INTRODUCTION: Pulmonary arteriovenous malformations (PAVM) are typically associated with hereditary hemorrhagic telangiectasia. Isolated PAVM are uncommon and usually present between the 4th-6th decades of life;they are rarely seen in children and infrequently necessitate ICU admission. DESCRIPTION: A healthy 3-year-old boy presented to his pediatrician with a 3 day history of fever and rhinorrhea. He was hypoxic (SpO2=85%), so was placed on oxygen and transferred to an outside ED where he was found to have (non-COVID) coronavirus. He was admitted for supportive care but clinically deteriorated over the next 24 hours requiring intubation, ventilatory support with 100% FiO2, and inhaled nitric oxide. Despite these interventions he remained hypoxic. Echocardiogram demonstrated a structurally normal heart. Computed tomography angiogram showed multiple large peripheral PAVM in the left lower and upper lobes and no differentiation between arterial and venous phases indicating pulmonary shunting. He was transferred to our quaternary ICU for intervention. He underwent embolization of ~70% of his PAVM (limited due to contrast load). He initially improved, but 2 days post-intervention he declined with worsening hypoxia likely secondary to pulmonary vascular remodeling following intervention and residual shunt burden within the left lung. Given his instability, as well as an oxygenation index of 34, he was cannulated for venoarterial extracorporeal membrane oxygenation (ECMO). Following cannulation, his remaining PAVM were embolized. ECMO support was subsequently weaned and he was decannulated after 4 days. His ventilator support was weaned, and he was transferred back to the referring hospital on minimal settings. He was extubated the next day and quickly weaned to room air. He was discharged after 2.5 weeks and was doing well (SpO2=95%) at his pediatrician follow-up. DISCUSSION: This is the first case of a previously healthy child requiring cannulation for ECMO due to PAVM. This case is unique among patients with PAVM due to the early presentation, likely related to an acute respiratory illness disturbing previously well-compensated ventilation-perfusion mismatch. As highlighted in this case, ECMO can be used to support patients who require interventions for PAVM and during the transition to a new physiologic state.

COVID-19 impacts and adaptations in Asia and Africa's aquatic food value chains. (Working Paper: FISH-2021-02.)

The COVID-19 pandemic is a systemic shock that affects all areas of the global food system. A growing range of impacts on aquatic food producers, value chain actors and consumers is evident. In response, the report provides the impacts of COVID-19 on aquatic food value chains in Bangladesh, Egypt, India, Myanmar and Nigeria. Results show that: (1) COVID-19 and associated containment measures severely disrupted aquatic food value chains, but effects on supply were relatively short-lived;(2)Demand for aquatic foods has yet to recover to pre-pandemic levels;(3) prices of aquatic foods have downward trend while prices of manufactured feeds have risen;and (4) COVID-19 has exacerbated pre-existing inequalities. As COVID-19 pandemic reversed years of progress on key human development indicators, it is important to revitalize aquatic food value chains to protect livelihoods and human nutrition. The paper also provides policy recommendations for both supply and demand sides.

The plight of racialised minorities during a pandemic: migrants and refugees in Italy and Australia

Purpose: The purpose of this paper is to draw on data from interviews with six Italian migrant service providers and media stories in Italy and Australia to weave a comparative snapshot of the plight of precarious migrant and refugee communities in these two countries during the COVID-19 pandemic. Design/methodology/approach: The article draws attention to prejudicial shortcomings towards vulnerable migrant communities enacted by the states of Italy and Australia in response to COVID-19. Findings: While the unequal ecology of the pandemic has flared up the need for the State to strengthen participation and inclusion policies, it has also provided opportunities to foreground the disadvantages vulnerable communities face that also demand policy attention and sustained funding. Governments in migrant-receiving countries like Australia and Italy need to articulate culturally sensitive and inclusive responses that foreground agencies give vulnerable migrants, asylum seekers and refugees clear, supportive messages of solidarity leading to practical solutions. Originality/value: This paper relays preliminary data from the coalface (migrant service providers) and media as the pandemic evolved in the two countries, whose support mechanisms had never before been critically compared and evaluated through the lens of racial inequality in the face of a health and social crisis. © 2021, Emerald Publishing Limited.

Impact of COVID-19 on radiology training: Royal College of Radiologists Junior Radiologists Forum national survey.

AIM: To obtain a national snapshot of radiology trainees' experience during the first wave of the pandemic. MATERIALS AND METHODS: A 25-item questionnaire was disseminated to representatives from all training regions across the UK in July 2020. Each representative collated the collective experiences of trainees in their training programme in key domains, including redeployment, shielding, training, and teaching. RESULTS: Ninety-five percent (38 of 40) of representatives completed the questionnaire. Trainees in up to 76% of training programmes were redeployed to wards and some trainees were shielding in 81% of programmes. Only 27% of programmes enabled remote reporting for isolating or shielding trainees. Sixty-two percent of respondents felt their well-being needs were supported. There was an overall increase in the attendance, volume, and quality of teaching and training nationally due to improved accessibility via remote-learning methods. Significant challenges were described with reporting, interventional procedures, and multidisciplinary team meeting attendance, although 62% of programmes noted an increase in service provision. Less in-person feedback was reported with in-person training still deemed necessary for practical skills. The Royal College of Radiologists Junior Radiologists Forum webinars were well received by all trainees with continuation of the series recommended. CONCLUSION: The COVID-19 pandemic has had a clear impact on many areas of radiology training in the UK. Early strategies have been adopted to mitigate the challenges faced by trainees and opportunities for future improvement are highlighted.

LATE-BREAKING AND COVID-19 ORAL COMMUNICATION SESSION ABSTRACTS

FLT180a is an investigational gene therapy medicinal product candidate intended for treating HB patients. It includes a novel synthetic capsid, AAVS3, with a higher liver transduction efficiency than wild type AAV, and a codon optimised F9 gene with a gain of function mutation. To assess the safety and efficacy of a single systemic adminis-tration of FLT180a in adult patients with HB. Phase 1/2, multi- centre, ongoing, open- label and long- term follow- up study assessing FLT180a dose levels in an escalating/descending adaptive design, to identify a dose that consistently normalises FIX activity (50- 150%). Participants have severe or moderately severe HB and are negative for neutralis-ing AAVS3 antibodies. Pre- emptive immunosuppression is given to mitigate vector related transaminitis and associated reduction in FIX expression. Ten patients with severe HB have been treated across 4 dose levels, with week 3 FIX activity levels ranging between 24 and 168%. The first two patients, receiving the 4.5e11vg/Kg dose, have stable, therapeutic, FIX activity levels through week 104. No patient has had a bleeding episode requiring FIX concentrates. The most common drug related serious adverse event was transient transaminitis (in four patients) requiring supplemental immunosup-pression. FIX activity levels above 150% have been observed, which were individually assessed for risk of thrombosis, and one patient is being treated with DOACs. Refinement of the immunosuppression regimen for the latest three patients (9.75e11 vg/kg dose) prevented transaminitis during the critical phase (4- 16 weeks). FLT180a achieves clinically meaningful, dura-ble FIX activity levels in patients with HB, associated with in-dependence from FIX replacement therapy and zero treated bleeds. Transient transaminitis was largely averted by prophy-lactic immunosuppression. A dose between 7.5 to 9.75e11vg/Kg can potentially create sustained, normal FIX activity levels in patients with severe HB.