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Despite extensive research, the specific factor associated with SARS-CoV-2 infection that mediates the life-threatening inflammatory cytokine response in patients with severe COVID-19 remains unidentified. Herein we demonstrate that the virus-encoded Open Reading Frame 8 (ORF8) protein is abundantly secreted as a glycoprotein in vitro and in symptomatic patients with COVID-19. ORF8 specifically binds to the NOD-like receptor family pyrin domain-containing 3 (NLRP3) in CD14+ monocytes to induce inflammasomal cytokine/chemokine responses including IL1ß, IL8, and CCL2. Levels of ORF8 protein in the blood correlate with severity and disease-specific mortality in patients with acute SARS-CoV-2 infection. Furthermore, the ORF8-induced inflammasome response was readily inhibited by the NLRP3 inhibitor MCC950 in vitro. Our study identifies a dominant cause of pathogenesis, its underlying mechanism, and a potential new treatment strategy for severe COVID-19.
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Summary (methods and approach) : Social workers support clients' psychosocial and resource needs across care settings. Social workers are typically not, however, trained to engage in emergency response practices such as the ones that may be necessary to support needs brought on by the COVID-19 pandemic. This article reports findings from a cross-sectional survey of social work students and recent graduates entering the field of social work during COVID-19, exploring their preparation, perceived readiness, and training needs. Findings : The study sample (N = 94) included 70 students and 24 recent graduates. The sample was 52% White, 22% Hispanic, and 21% Black/African American. Respondents reported training needs in the areas of trauma-informed care (70%), behavioral health (57%), culturally competent practice (49%), telehealth (48%), loss and grief (44%), and emergency management (43%). No significant differences emerged in self-efficacy ratings of students and recent graduates;both groups reported low self-efficacy in their ability to apply advanced practice skills. After controlling for demographics, receiving training specific to the COVID-19 pandemic (β =.271, p <.05), perceived readiness (β =.779, p <.001), and satisfaction with training/preparation (β =.4450, p <.001) significantly contribute to levels of perceived self-efficacy among SW students and recent graduates. Applications : Social work curricular developments, and continuing education, are needed to prepare and support emerging social workers for practice in the context of COVID-19 and its long-term implications. This includes enhancing social workers' readiness to engage in telehealth, trauma-informed practice, emergency management, policy interpretation, self-care, and grief support. © The Author(s) 2023.
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In the summer of 2021 I organized and facilitated a short series of three online workshops to launch the Ways of Writing in Art and Design Research Network (WoW). This article reviews the collaborative writing exercises I devised for the workshops, designed to explore potential approaches to writing in/on/about/beside/with art and design beyond the conventional academic essay and in relation to the condition and experience of living and working through the COVID-19 pandemic and subsequent lockdowns. The article adheres to academic convention in its presentation and format, while gently pushing against academic orthodoxies in its playful execution, as the text is interwoven with anecdotal asides, subjectivity, description and metaphor. Alongside familiar staples of academic art writing, such as Barthes and Csikszentmihalyi, I draw on a broader range of resources that include poetry and song lyrics. Rather than set out to efficiently argue or prove a point or position, the writing takes a more meandering path (it is littered with the academically maligned word 'perhaps') that resembles the 'carrier bag' approach of the gatherer, rather than the target driven spear trajectory of the hunter. © 2022 Intellect Ltd Article. English language.
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BACKGROUND: Hospital transmission of SARS-CoV-2 has proved difficult to control, with healthcare-associated infections troublesome throughout. AIM: To understand factors contributing to hospital transmission of infections, which is necessary for containing spread. METHODS: An outbreak of 56 staff and patient cases of COVID-19 over a 31-day period in a tertiary referral unit is presented, with at least a further 29 cases identified outside of the unit and the hospital by whole genome sequencing (WGS). FINDINGS: Transmission is documented from staff to staff, staff to patients, and patients to staff, showing disruption of a tertiary referral service, despite implementation of nationally recommended control measures, superior ventilation, and use of personal protective equipment. There was extensive spread from the index case, despite this patient spending only 10 h bed bound on the ward in strict cubicle isolation and with an initial single target low level (CT = 32) polymerase chain reaction test. CONCLUSION: This investigation highlights how effectively and rapidly SARS-CoV-2 can spread in certain circumstances. It raises questions about infection control measures in place at the time and calls into question the premise that transmissibility can be reliably detected by using lower sensitivity rapid antigen lateral flow tests. We also highlight the value of early intervention in reducing impact as well as the value of WGS in understanding outbreaks.
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This paper presents the findings of a research project that explored the experiences of psychoanalytic psychotherapists based in the UK during the first period of lockdown in the COVID 19 pandemic. Groups of therapists met regularly to share and reflect on the impact of the sudden changes to their practice, and this paper pulls together the key themes which emerged from these discussions. The overarching preoccupations of the psychotherapists were those of loss and survival, with sub-themes of difficulty holding the frame;reduced security and safety;challenged analytic technique;and altered relationship dynamics. The groups were highly valued by participants as offering support during times of unprecedented stress, while also providing a forum to learn from and make creative use of the challenges presented by working remotely. Copyright © 2022 The Authors. British Journal of Psychotherapy published by BPF and John Wiley & Sons Ltd.
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Background. Return of infections caused by common respiratory viruses (RV)may be expected with the relaxation and/or removal of infection preventionmeasures instituted during the COVID-19 pandemic. Therefore, we examined respiratory virus detection (RVD) rates in Wisconsin during the COVID-19 period, and whether ambulatory antibiotic prescribing for respiratory complaints has increased with return of typical RVs. Methods. The Wisconsin State Laboratory of Hygiene's Viral Surveillance program collects RVD data from >130 laboratories across the state for influenza (FLU), respiratory syncytial virus (RSV), seasonal coronaviruses (sCOR), parainfluenza virus (PARA), enteroviruses/rhinoviruses (E/R), and human metapneumovirus (hMPV). Data were collected from 1/1/2015 to 4/30/2022. Antibiotic prescribing for ambulatory care patients presenting with respiratory complaints was collected from our EHR, which utilizes a required order form for all ambulatory antibiotic prescriptions. Statistical analysis was performed using Mann-Whitney Rank Sum and Spearman's rank correlation. Results. In the first year after COVID-19 onset, E/R and sCOR were detected at low levels while other RVs were essentially nil. After 4/2021, when infection prevention measures (i.e. mask mandates) were significantly relaxed or removed, RVDs increased for all viruses. At present, RVDs have returned to typical rates (except of FLU, Fig. 1) and seasonality variation (except of RSV, Fig. 1). Antibiotic prescribing for respiratory complaints has increased 57% in this period (3.5 to 5.5 prescriptions/1000 encounters, Fig. 2) and continues to trend up with RV activity. Prescribing rates are strongly correlated with RVD rates, but most strongly correlated with non-FLU, non-RSV RVD rates (Spearman correlation 0.71). Conclusion. In general, RVs have returned to pre-pandemic rates with seasonality. Interestingly, this return was associated with the relaxation/removal of infection prevention measures in the second year post-COVID-19 onset, and does not appear to be impacted by ongoing COVID-19 waves. Antibiotic prescribing in ambulatory care continues to be highly associated with RV activity, indicating this should remain a high priority of ambulatory stewardship education and intervention. (Figure Presented).
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ß-Hydroxy-ß-methylbutyrate (HMB), a leucine metabolite, can increase skeletal muscle size and function. However, HMB may be less effective at improving muscle function in people with insufficient Vitamin D3 (25-OH-D < 30 ng/mL) which is common in middle-aged and older adults. Therefore, we tested the hypothesis that combining HMB plus Vitamin D3 (HMB + D) supplementation would improve skeletal muscle size, composition, and function in middle-aged women. In a double-blinded fashion, women (53 ± 1 yrs, 26 ± 1 kg/m2, n = 43) were randomized to take placebo or HMB + D (3 g Calcium HMB + 2000 IU D per day) during 12 weeks of sedentary behavior (SED) or resistance exercise training (RET). On average, participants entered the study Vitamin D3 insufficient while HMB + D increased 25-OH-D to sufficient levels after 8 and 12 weeks. In SED, HMB + D prevented the loss of arm lean mass observed with placebo. HMB + D increased muscle volume and decreased intermuscular adipose tissue (IMAT) volume in the thigh compared to placebo but did not change muscle function. In RET, 12-weeks of HMB + D decreased IMAT compared to placebo but did not influence the increase in skeletal muscle volume or function. In summary, HMB + D decreased IMAT independent of exercise status and may prevent the loss or increase muscle size in a small cohort of sedentary middle-aged women. These results lend support to conduct a longer duration study with greater sample size to determine the validity of the observed positive effects of HMB + D on IMAT and skeletal muscle in a small cohort of middle-aged women.
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Cholecalciferol , Muscle Strength , Humans , Middle Aged , Female , Aged , Cholecalciferol/pharmacology , Dietary Supplements , Muscle, Skeletal , Double-Blind MethodABSTRACT
Background: Cancer patients undergoing systemic anti-cancer therapies (SACT) invariably experience toxicities precipitating presentations to Emergency Departments (ED). With the ongoing COVID-19 pandemic, it is imperative to continue to keep vulnerable immunocompromised patients out of hospital and encourage patients to contact SURC when symptoms develop. Peninsula Health (PH), SURC service was initiated post completion of a 12-month funded grant through the Victorian Government and has grown rapidly since its commencement. This nurse-led SURC model of care has been reported to achieve an investment return of $1.73 for every dollar invested. Method(s): ED presentations of Peninsula Health Oncology/Haematology patients pre- and post-SURC commencement were examined if potentially avoidable presentations have reduced. Ongoing SURC Episodes of care (Educations, phone, and physical attendances) between January 2022 to September 2022 captured in the SURC Access Database. Patient experience surveys were conducted post SURC phone contact and physical attendance if unwell. Patients and clinicians' surveys are ongoing. Result(s): Intermediate statistical data (COSA2021) collated June 2021 to December 2022 post-grant, we observed 43.30% reduction in ED presentations within SURC operation hours by patients considered SURC eligible when compared to pre-SURC figures. The SURC from January 2022 to September 2022 has recorded, 2567 episodes of care, provided to 601 individuals;educations (12.43%), incoming phone triage (45.77%), outgoing phone triage (31.40%), and attendances (10.40%). Most frequent SURC contacts were for care-coordination (28.43%), gastrointestinal symptoms (17.97%), diagnostics (8.81%), pain management (7.56%),)and medication advice (6.23%). Notably, more than one-third indicated they would have done nothing (36.93%) with 7.13% indicating they would have presented to ED without SURC. Closely aligning with the local cancer prevalence rates, the commonest tumour streams are breast (22.63%), lung (17.14%), and colorectal (15.64%). Conclusion(s): The SURC model of care continues to be an invaluable resource at PH to support cancer patients undergoing SACT which allows prompt access to specialist care while avoiding emergency presentations in the ambulatory setting. The model continues to expand post an additional government grant "SURC-additional support during COVID-19 and recovery" to increase additional support to vulnerable populations. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest. Copyright © 2022
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We present an outbreak of 56 staff and patient cases of COVID-19 over a 31 day period in a tertiary referral unit, with at least a further 29 cases identified outside of the unit and the hospital by whole genome sequencing (WGS). We document transmission from staff-to-staff, staff-to-patients and patients-to-staff and show disruption of a tertiary referral service, despite implementation of nationally recommended control measures, superior ventilation and use of PPE. We demonstrate extensive spread from the index case, despite them spending only 10 hours bed bound on the ward in strict cubicle isolation and with an initial single target low level (CT=32) PCR test. This investigation highlights critical issues including how effectively and explosively SARS-CoV-2 can spread in certain circumstances. It raises questions about infection control measures in place at the time and calls into question the premise that transmissibility can be reliably detected using lower sensitivity rapid antigen lateral flow tests. We also highlight the value of early intervention in reducing impact as well as the value of WGS in understanding outbreaks.
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Aim: NICE guidelines set out the criteria for the treatment of patients with acute cholecystitis and the operative timescales for cholecystectomy. These targets were greatly affected during the Covid-19 pandemic. Therefore, we aimed to assess the impact that COVID-19 had on patients presenting with acute cholecystitis at a busy district general hospital. June 2020, compared with patients who presented with the same in June 2019. Method: Patient cohorts were identified for matching seasons pre- and post-covid-19 (June 2019 and June 2020). Data of all patients who presented with acute cholecystitis was obtained using an electronic patient management system. Statistical analyses were performed using a Wilcoxon test. Results: The results of the study indicate that waiting times post-covid are going down (p<0.05). Thus, days until cholecystectomy have decreased but the number of patients being operated on too has decreased thus further worsening waiting times for elective patients. The median and IQR's of days to surgery post-covid are 198 (121.5-278) and pre-covid are 251 (89.5-586.5). Presentations of gallstone complications almost doubled post-covid and the percentage of patients operated on decreased by over 20%. Conclusions: It is clear from the data that the NICE guidance on the management of acute cholecystitis has been difficult to adhere to during the pandemic. While the time from diagnosis to operation has reduced post-covid the total number of operations has decreased drastically, putting further strain on elective waiting lists. This, inevitably, will result in further presentations of complications from gallstones and adverse patient outcomes.
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INTRODUCTION: This study examines the impact of the COVID-19 pandemic on influenza and Tdap (tetanus, diphtheria, pertussis) vaccine uptake in a pregnant, low-income population. METHODS: This retrospective cohort study included women initiating prenatal care before (May-November 2019) or during the COVID-19 pandemic (May-November 2020) at two large Medicaid clinics. All patients entered prenatal care before 20 weeks of gestation and delivered full-term. Medical records were reviewed for vaccine uptake and demographic data. Multivariate logistic regression analysis was used to compare vaccination rates prior to and during the COVID-19 pandemic. Additional analysis was performed to identify association of demographic factors with vaccine uptake. Institutional review board- approval was obtained for this study. RESULTS: A total of 939 patients were included, with 462 initiating care prior to and 477 initiating care during the COVID-19 pandemic. Influenza vaccination uptake was 78% (362/462) in the pre-pandemic group, significantly decreasing to 61% (291/477) in the pandemic group (P<.01;OR, 0.38;95% CI, 0.26-0.53). Tdap vaccination uptake was 85% (392/462) in the pre-pandemic group, significantly decreasing to 76% (361/477) in the pandemic group (P<.01;OR, 0.56;95% CI, 0.40-0.79). Unvaccinated patients were significantly more likely to be non-Hispanic Black patients when compared to Hispanic patients both pre-pandemic (P<.01;OR, 0.34;95% CI, 0.21-0.56) and during the pandemic (P<.01;OR, 0.24;95% CI, 0.15-0.38), while there was no significant difference in age or parity in relation to vaccination status. CONCLUSION: Routine vaccination uptake significantly decreased during the COVID-19 pandemic in a low-income population of pregnant women, with decrease more pronounced on influenza vaccine than on Tdap vaccine uptake.
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Research indicates family engagement yields positive outcomes for children. However, data indicate that educators struggle to engage families. Current evaluation methods assess the number of family services offered and not how families are engaged. It is not known how the Head Start program staff fully engages families. The purpose of this basic qualitative study was to investigate how to fully engage families in Head Start programs as perceived by staff. Bronfenbrenner's ecological systems theory and the complexity theory comprised the conceptual framework. The research question explored perspectives of Head Start staff about how to fully engage families. Selection criteria for participants required a minimum of one year of Head Start experience. Four teachers, four family service workers, and two curriculum specialists participated in semistructured virtual interviews. Data were analyzed with NVivo to identify 5 themes: Family engagement, process of engaging families, engagement activities, barriers, and successful engagement. Six barriers to engagement emerged: COVID-19, lack of trust, pride, home environment, parents with multiple children, and administrative paperwork. Two sub themes, communication and child and family relationship building emerged from the barriers. This study contributes to positive social change by helping families understand work program staff's desire to assist families and inform educators on the need to transition from an academically focused approach to a whole child approach that engages their families. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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BACKGROUND: Dual-consultant operating (DCO) has been introduced in a multitude of surgical specialities. This retrospective cohort comparison study seeks to delineate any benefits DCO may confer on list utilisation, patient safety and training opportunities. METHODS: A retrospective cohort comparison of all free-flap breast reconstruction cases conducted at a single centre by five consultant plastic surgeons in the period May 2016-May 2020. RESULTS: A total of 281 patient records were used for analysis; 146 cases were dual consultants compared with 135 single consultants, representing 186 and 158 free flaps, respectively. Patient demographics were near identical in terms of patient age, BMI and ASA grade. Operating times were significantly reduced for both unilateral (mean reduction 59.49 min) and bilateral cases (mean reduction 38.14 min) with the presence of dual consultants. The mean length of stay for dual-consultant cases was on average 0.35 days less than for single consultant cases (p = 0.04). Dual-consultant case complications were less severe than those of single consultant cases (mean Clavien-Dindo severity 1.35 vs 0.96, p = 0.05). The rates of trainee one-to-one consultant training were increased in dual-consultant cases when preparing vessels (0.08 vs 0.35, p=<0.01) and performing anastomosis (0.63 vs 0.77, p = 0.03). CONCLUSIONS: DCO for complex breast reconstruction confers significant benefits to operating time, list utility and patient safety whilst protecting training opportunities for trainees. Plastic surgery departments looking to redesign services in the post-SARS-CoV-19 era should consider its adoption into their enhanced recovery protocols.
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Free Tissue Flaps , Mammaplasty , Surgeons , Consultants , Humans , Mammaplasty/methods , Retrospective StudiesABSTRACT
INTRODUCTION: The COVID-19 pandemic created unprecedented challenges to residency recruitment. With in-person away rotations prohibited and interviews held virtually, orthopaedic residency programs turned to social media. Studies document the exponential growth of residency program Instagram accounts after March 2020, but few analyze the content of their posts. This study provides an updated assessment of such Instagram accounts including a detailed analysis of their content and a discussion of potentially concerning posts. METHODS: Orthopaedic surgery residency programs participating in the National Resident Matching Program and any Instagram accounts associated with these programs were identified. Instagram accounts were analyzed, and the 25 most recent posts and all highlighted stories for each account were coded for content based on a predetermined list of categories. Specific attention was given to content that may raise legal, ethical, or professionalism concerns. The primary outcome was the most common content code among posts. The secondary outcomes were the number of posts identified as potentially concerning and the types of concerns represented. RESULTS: Overall, 138 of 193 residency programs (72%) had an Instagram account at the time of cross-sectional analysis, 65% of which were created between April and December 2020. All accounts were public. Profiles had on average 1,156 ± 750 followers and 59 ± 75 posts. Of the 3,348 posts analyzed, the most common coded themes were resident introductions (33%), camaraderie (27%), and social life and hobbies (26%). There were 81 concerning posts from 52 separate accounts. Seventy-five of the concerning posts (93%) depicted residents scrubbed alone. CONCLUSION: Orthopaedic residency Instagram accounts are potential tools for residency recruitment and can depict a program's culture through posts over time. However, public accounts are open to scrutiny by other viewers, including patients and their families. Care must be taken to consider multiple perspectives of post content, so as to bolster, not damage, the residency program's reputation.