Assembling atmospheres, encountering care: risk, affect, and safety in the cystic fibrosis clinic

This paper explores the design of hospital environments, in order to investigate how issues of infection control, spatial layout, and embodied practices intersect in the accomplishment of ‘care-ful’ geographies. Specifically, we trace how the material environments of three UK cystic fibrosis (CF) clinics are assembled in order to orchestrate routines that minimise the risk of cross-infection between patients and safeguard their wellbeing. Our analysis of these clinics, derived from interviews with staff and patients and ethnographic observation, reveals the importance of environmental factors in brokering affective atmospheres that can alleviate patients’ anxieties. Theoretically, we draw on Ben Anderson's understanding of how affect works as, simultaneously, an object-target, bodily capacity, and collective condition, in order to draw out the architectural atmospherics of the CF clinic. That is, we first report how clinic staff anticipate cross-infection risks and configure the physical environment in order to minimise these risks. We then describe the embodied practices of patients as they move through hospital spaces in ways that protect themselves, and others, from cross-infection. Finally, we analyse how this choreography of material environments by staff and the movement of patients’ bodies combine to evoke a shared understanding of the clinic as a safe space, in contrast to perceptions of the hospital as a threatening environment. Our focus on the affective atmospheres of the CF clinic allows us to develop an in-depth analysis of the role of materialities, mobilities, and design in the social construction of risk, especially in a post-COVID pandemic age.

Clinical Outcomes and the Impact of Oral Anticoagulants Prior to Diagnosis of COVID-19 on Clinical Outcomes in Patients Admitted to Hospitals in the UK – a Multicentre Observational Study (preprint)

Coagulation dysfunction and thrombosis are major complications in patients with coronavirus disease-19 (COVID-19). Patients on oral anticoagulants prior to diagnosis of COVID-19 may therefore have better outcomes. We aimed:To first document the frequency of thrombosis, major bleeding and multiorgan failure (MOF) in patients admitted with COVID-19 and the contribution of these complications to 90-day mortality.To then determine the effects of oral anticoagulation, use prior to admission on the same outcomes as well as the requirement for Intensive Care Unit (ICU) admission, when compared to a propensity matched cohort of patients not taking oral anticoagulants prior to admission.Methods: This was a multicentre observational cohort including adult patients (≥18 years) admitted to 26 UK hospitals between 1st of April 2020 and 31 July 2020.Findings: A total of 5883 patients were included in the study. Overall mortality was 29.2%. Incidences of thrombosis, major bleeding and MOF were 5.4%,1.7% and 3.3% respectively. The presence of thrombosis, major bleeding, or MOF were associated with a 1.8, 4.5 or 5.9-fold increased risk of dying, respectively. Of the 5883 patients studied, 83.6% (n= 4920) were not on oral anticoagulants (OAC) and 16.4% (n=963) were taking OAC at the time of admission. There was no difference in mortality between patients on OAC vs no OAC prior to admission when compared in an adjusted multivariate analysis (HR 1.05 (95%CI 0.93-1.19) P=0.15) or in an adjusted propensity score analysis (HR 0.92 (95%CI 0.58-1.450, P=0.18). In multivariate and adjusted propensity score analyses, the only significant association of no anticoagulants prior to admission was treatment in ICU (HR 1.98 [95%CI 1.37-2.85]).Interpretation: Thrombosis, major bleeding, and MOF were associated with higher mortality. Our results indicate that patients may continue to benefit from OAC after admission, especially reduced admission to ICU, without any increase in bleeding.Funding: Bayer plc supported the study by providing the investigator-initiated funding (P87339) to setup the multicentre database of the study.Declaration of Interest: DJA received funding from Bayer plc to setup the multicentre database of the study as an investigator-initiated funding and received research grant from Leo Pharma. ML received consultation and speaker fees from Astra-Zeneca, Sobi, Leo-Pharma, Takeda and Pfizer. PN received research grants from Novartis, Principia and Rigel, unrestricted grants from Sanofi, Chugai and Octapharma and honoraria from Bayer. RA received fees from Alexion, Bayer, BMS, Pfizer and Portola. SS has received meeting sponsorship, speaker fees and/or consultancy from Bayer, Pfizer, NovoNordisk, Sobi, Chugai/Roche and Shire/Takeda. SS receives funding support from the Medical Research Council (MR/T024054/1). The research was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC). SL has received speaker fees from Bayer, BMS and Pfizer. Others have no conflict of interests to declare. Ethical Approval: The study was approved by the Health Research Authority (HRA), Health and Care Research Wales (HCRW) and received local Caldicott Guardian support in Scotland (reference number: 20/HRA/1785). Data was collected both retrospectively and prospectively from patient clinical records by the treating medical team with no breach of privacy or anonymity by allocating a unique study number with no direct patient identifiable data; therefore, consent was waived by the HRA.

Mendelian Randomization Analyses Show That Higher Acetyl-Carnitine and Carnitine Levels in Blood Protect Against Severe COVID19 (preprint)

Background: Severe Covid19 is characterised by a hyperactive immune response. Carnitine, an essential nutrient, and it’s derivative acetyl-carnitine can downregulate proinflammatory cytokines and has been suggested as a potential treatment for the disease.Methods: We carried out Mendelian randomization analyses using publicly available data from a large genome wide association study (GWAS) of metabolites and a collaborative genome wide study of Covid19 to investigate the nature of the relationship between carnitine and acetyl-carnitine and Covid19 infection, hospitalisation with Covid19 and very severe Covid19. We used the same methodology to determine whether carnitine was associated with co-morbidities commonly found among those with severe Covid19.Findings: We found evidence of a protective effect against very severe Covid19 for both carnitine and acetyl-carnitine, with around a 40% reduction in risk associated with a doubling of carnitine or acetyl-carnitine (carnitine odds ratio (OR) = 0.56, 95% confidence intervals (CI) 0.33 to 0.95, p=0.03 and acetyl-carnitine OR=0.60, 95% CI 0.35 to 1.02, p=0.06), and evidence of protective effects on hopitalisation with Covid19. For acetyl-carnitine the largest protective effect was seen in the comparison between those hospitalised with Covid19 and those infected but not hospitalised (OR=0.34, 95%CI 0.18 to 0.62, p=0.0005).Interpretation: Carnitine and acetyl-carnitine merit further investigation in respect to the prevention of severe Covid19.Funding Information: NK is supported by World Cancer Research Fund (2020/019). SJL and GDS are supported by a Cancer Research UK (C18281/A29019) programme grant (the Integrative Cancer Epidemiology Programme) and GDS is Director of the Medical Research Council Integrative Epidemiology Unit at the University of Bristol supported by the Medical Research Council (MC_UU_00011/1). SJL and NK are affiliated with this unit. SJL and GDS are also supported by the National Institute for Health Research (NIHR) Bristol Biomedical Research Centre which is funded by the National Institute for Health Research (NIHR).Declaration of Interests: The authors do not have any conflicts of interest in relation to the work in this manuscript.

The importance of coaching and learning agility in a high change world

In a 2017 survey, 62 per cent of organisations were facing significant amounts of change. This level will clearly have risen since Covid-19. Psychologists have an understanding about some of the characteristics that allow leaders to remain resilient and engaged, even in the face of substantial change. This study takes the next step. It examined the characteristics of leaders that allow them to provide their teams with a positive work environment in order to keep them engaged. Different work environments, including those involving significant change, were studied. A number of traits and learning agilities were identified that were important. However, it emerged that using coaching as a leadership style is one of the most effective things a leader can do to build team commitment. [ABSTRACT FROM AUTHOR] Copyright of Assessment & Development Matters is the property of British Psychological Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)