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Oscar Wilde (1891/1909) declared that it is not Art that imitates Life but Life that imitates Art. What happens when an artistic work, pitched as "soft sci-fi”, predicts something both decidedly unpleasurable and, later, alarmingly prophetic? Such is the case with Watchlist (2020), a new Australian theatrical work written prior to COVID-19, which warns of impending environmental catastrophe and ends with the release of a zoonotic pathogen. The debut production in 2021 was performed amid the global reality of the continuing pandemic which rendered the play a prescient cultural artefact and complicated the audience reception of the work. This study expands from Wilde's concept of counter-mimesis into the theoretical frameworks of Hans Robert Jauss (1982) and Susan Bennett (1997), who provide an alternative to author-centric, practice-led research while laying the blueprint for a dialectical exchange between Life and Art. The dialectical exchange is then explored in the genre of science fiction more broadly, including both literature and franchise filmmaking. Through this analysis, the authors break down the binary of Life and Art, building from Jauss and Bennett, to demonstrate the advantages of this alternative critical vocabulary. © 2023, Australasian Association of Writing Programs. All rights reserved.
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Background: People living with cancer are reported to be at increased risk of hospitalization and death following infection with acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This is proposed to be dependent on a combination of intrinsic patient and cancer factors such as cancer subtype, and emerging SARS-CoV-2 variants with differing pathogenicity. However, COVID-19 phenotype evolution across the pandemic from 2020 has not yet been systematically evaluated in cancer patients. Method(s): This study is a population-scale real-world evaluation of Coronavirus outcomes in the United Kingdom for cancer patients from 1st November 2020-31st August 2022. The cancer cohort comprises individuals from Public Health England's national cancer dataset, excluding individuals less than 18 years old. Case-outcome rates, including hospitalization, intensive care and casefatality rates were used to assess the evolution in disease phenotype of COVID-19 in cancer patients. Multivariable logistic regression models were fitted to compare risk of Coronavirus outcomes in the cancer cohort relative to the non-cancer population during the Omicron wave in 2022. Result(s): The cancer cohort comprised of 198,819 positive SARS-CoV-2 tests from 127,322 individual infections. Coronavirus case-outcome rates were evaluated by reference to 18,188,573 positive tests from 15,801,004 individual infections in the non-cancer population. From 2020 to 2022, the SARS-CoV-2 disease phenotype became less severe in both patients with cancer and the non-cancer population, though cancer patients remain at higher risk. In 2022, the relative risk of Coronavirus hospital admission, inpatient hospitalization, intensive care admission and mortality in cancer patients was 3.02x, 2.10x, 2.53x and 2.54x compared to the non-cancer population following multivariable adjustment, respectively. Higher risk of hospital admission and inpatient hospitalization were associated with receipt of B/T cell antibody and/or targeted therapy which also corresponded with an increased risk of Coronavirus mortality. Conclusion(s): The disease phenotype of SARS-CoV-2 in cancer patients in 2022 has evolved significantly from the disease phenotype in 2020. Direct effects of the virus in terms of SARS-CoV-2 hospitalization, intensive care and case fatality rates have fallen significantly over time. However, relative to the general population, people living with cancer and hematological malignancies remain at elevated risk. In order to mitigate the indirect effects of the SARS-CoV-2 pandemic in terms of disruption to cancer care, there should be increased focus on preventative measures. Used in conjunction with vaccination and early treatment programs, this will maximize quality of life for those with cancer during the ongoing pandemic and ensure the best cancer outcomes.
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The UK's city centre apartment markets have been affected by the coronavirus pandemic and a building safety crisis in ways not experienced by its suburban and rural housing markets. Sellers and estate agents have encountered falling demand and prices, elevated safety concerns, reluctant lenders and changes in buyers' preferences. Against this backdrop, we investigated the narratives and images used to sell what have sometimes appeared to be 'less sellable' homes. Analysing the textual and visual content of 100 adverts for city centre flats, we explored the possible effects of the pandemic on property advertising, the positioning within adverts of building safety and, noting growing interest in sustainability, the presence of sustainability messages. Findings suggest that the core narratives used to sell city centre flats remain largely unchanged from those deployed to first market the concept of 'city living' to UK buyers in the late 1990s. Messages about building safety and sustainability appear uncommon. The implications of the findings are considered.
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INTRODUCTION: Serum albumin (ALB) is inversely associated with COVID-19 severity through an unclear mechanism. We addressed this gap using machine learning to identify traits exhibiting explanatory variance (EV%) in mortality risk within 12h of admission versus near end of hospitalization in the context of hypoalbuminemia. METHOD(S): Data were extracted under IRB exemption from medical records of COVID-19 patients at least 18 years old in the ICU with at least two ALB measures from March 2020 through September 2021. ALB, COVID-19 inflammation and injury traits were characterized across hospitalization. Hypoalbuminemia present on admission (POA) was defined as ALB < 3.2 g/dL. Traits associated with mortality were controlled for age, sex, COVID-19 directed treatment and the four COVID surges. Bootstrap Forest (BF) evaluated EV% of traits in mortality. Continuous data were compared using KruskalWallis. Discrete data were compared with chi-squared test. RESULT(S): Among 878 patients, 631 (72%) vs. 247 (28%) POA respectively with ALB < 3.2g/dL vs. >3.2g/ dL. Median age 68(57,77) years distributed across 64% males with 75% Whites, 10% Blacks and 15% other races exhibiting hypertension (53%), coagulopathy (28%), chronic pulmonary disease (22%) and heart failure (22%). Excess comorbidity associated with hypoalbuminemia included obesity (48% vs. 38%, p=.004), anemias (42% vs. 28%, p<.0001), and diabetes (39% vs. 32%, p=.03). Respective hypoalbuminemia near end of hospitalization increased to 97% (p<.0001) and 84% (p<.0001) with hospital mortality of 51% vs. 31% (p=<.0001). Associated ALB declines were 0.5(0.1, 1.0) vs. 1.0 (0.6, 1.0) g/dL. BF modeling (RSquared=0.69) identified POA traits EV% including CRP (21%), AST/SGOT (11%), proBNP (9%), WBC (9%), and ferritin (9%) among others. BF modeling (RSquared=0.84) identified near end visit traits EV% including WBC (31%), CRP (13%), platelet (12%), and ANC (11%) among others. CONCLUSION(S): The EV% of CRP at presentation corroborates an inverse relationship with ALB suggesting acute phase signaling may evoke hypoalbuminemia. Specifically, increased endothelial permeability allowing ALB extravasation as evidenced by proBNP EV%. Secondary etiology may derive from inhibited albumin synthesis secondary to liver injury as suggested by AST/SGOT at presentation and visit end.
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Background: In spring 2021, various groups described Vaccine-induced immune thrombotic thrombocytopenia (VITT) a rare thrombotic syndrome associated with COVID-19 vaccine ChAdOx1-S (incidence 1:100,000 exposures). In the UK, reporting at a national level depended on specialists reporting cases through a variety of mechanisms, as national datafeeds were insufficiently granular to identify the VITT phenotype. Real-world data analytics of EHRs to identify vaccine complications could strengthen national reporting. Aim(s): We developed an algorithm to define VITT using a regional hospital and primary care data system. Secondary aims included a reporting dashboard for specialists and generalisable methods for identifying rare events in admitted inpatients. Method(s): A linked primary-secondary care, near real-time datafeed of patients admitted to Barts Health NHS Trust covering a 2.2 M population. An algorithm was developed to identify clinical features of VITT and categorise patients by likelihood of VITT, using SNOMED-coded admission, vaccine and laboratory data (Table 1). Clinical validation of the algorithm's output was completed. Result(s): The algorithm identified 698 cases in routine data within Barts Health [definite (n = 1) probable (n = 10) and possible (n = 687)]. 91 patients were validated. The algorithm had low precision for defining separate VITT categories (9.1% 'definite and probable' and 32% 'definite, probable and possible') but identified the one definite case of VITT. Inter-validator agreement was moderate (Randolph's kappa 0.45). All cases identified clinically and included in the full dataset were also found by the algorithm (high recall). Dashboard design for care teams to flag future VITT cases for hospital in-patients will be presented. Conclusion(s): We have successfully demonstrated identification of thrombotic complications from COVID-19 vaccines in EHR data. Alternative diagnosis trends could improve precision of the algorithm. Barriers to progress are lack of pathology data standards and complex approvals for data sharing. This study was supported by HDR-UK. (Table Presented).
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Background: Inpatients with COVID-19 have a high rate of venous thromboembolism (VTE), yet those that are most unwell have been shown to exhibit excess bleeding following thromboprophylaxis. Risk profiling of those at highest thrombotic risk may therefore improve outcomes. Aim(s): To derive and validate a risk assessment model for VTE in COVID-19 inpatients. Method(s): Electronic health records were used to assess all patients admitted for >=1 night with laboratory-confirmed COVID-19 between March 2020 and July 2021 to Barts Health NHS Trust in East London. The primary event of interest was VTE within 28 days from diagnosis. The study population was split into derivation (n = 4655) and validation sets (n = 1844). Potential predictors of VTE included demographic and lifestyle variables, clinical characteristics, and biomarkers. A logistic regression model was developed with predictors identified using least absolute shrinkage and selection operator (LASSO) methodology. Result(s): The study population comprised 6499 patients (45% women, median age 60). 394 patients (6.1%) were diagnosed with >=1 VTE event (30 DVT, 364 PE +/-DVT) within 28 days of diagnosis. D-dimer on admission was the strongest predictor for VTE. The risk of VTE was associated with increasing D-dimer up to 10 mg/L. Further rises in D-dimer above this level did not confer additional risk. Chronic cardiac disease, chronic obstructive pulmonary disease, and oxygen flow rate were also independently associated with increased risk. High peripherally measured oxygen saturations, ischaemic heart disease and supraventricular arrhythmias were associated with a reduced risk of VTE (Figure 1). The risk assessment model offered a strong discriminatory value (c-index 0.77) and achieved good calibration in both the derivation and validation set (Table 1). Conclusion(s): The proposed model was robust in predicting VTE risk in successive waves of COVID-19 infection (original, alpha and delta variants) and supports the use of the D-dimer level for guiding thromboprophylaxis. (Table Presented).
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SESSION TITLE: ECMO and ARDS in COVID-19 Infections SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Inhaled nitric oxide (iNO) is a potent vasodilator of pulmonary vasculature improving perfusion to ventilated alveoli in ARDS and other lung pathologies. During the pandemic, intensivists turned to iNO as “salvage” therapy in COVID-19 patients. Rationale was driven by vasodilatory effect and antiviral properties despite lack of evidence of clear benefit even in patients without COVID. We hypothesized that iNO would provide reduced increases in pulmonary perfusion and subsequent gas exchange improvement in COVID-19 patients due to extensive endothelial damage and coagulopathy throughout the pulmonary vasculature. METHODS: Our IRB exempt analysis examined patients hospitalized with and without COVID-19 from January 2020 to September 2021 who received at least 24h of invasive mechanical ventilation with iNO (15-20ppm). Effectiveness outcomes were PaO2/FIO2 ratio(PFR), PEEP/CPAP level, and PaCO2 serially measured and observed up to 24 hours prior to initiation of iNO and for up to 120h post iNO administration. Data were statistically controlled for age, sex, race, time to initiation of therapy and COVID-19 directed treatment. RESULTS: From January 2020 and September 2021, 42 patients were admitted to the ICU and received invasive mechanical ventilation and iNO. Results are sequenced as ARDS COVID-negative, ARDS COVID-positive, viral pneumonia COVID-negative, viral-pneumonia COVID-positive. Patient n = 8/14/6/14. Median age was 56/55/63/62 years. Demographics split 64-62% male vs 36-38% female in ARDS without/with COVID, 50%/83% male vs 50%/17% female in viral pneumonia without/with COVID. Racial distribution resulted 75%/93%/86%/83% White vs 25%/0%/17%/14% Black. Other races constituted less than 7% of patient total in any category. PFR delta from -24h to +120h post-iNO = +35/+35/+41/+22. PEEP/CPAP delta from -24h to +120h = -4/-1/-3/-2. PaCO2 delta mmHg from -24h to +120h = -21/-23/-9/-13. Median Hospital LOS = 26/26.5/17/19 days. Median ICU LOS = 15.8/19.0/13.8/17.6 days. Hospital mortality = 100% across all 4 subgroups. CONCLUSIONS: ARDS patients with or without COVID showed similar rates of PFR response to iNO, however viral pneumonia patients with COVID exhibited a blunted PFR response vs those without COVID. No statistically significant difference was observed with respect to PEEP/CPAP levels, PaCO2 mmHg, hospital or ICU LOS, or mortality. CLINICAL IMPLICATIONS: Our findings suggest that the presence of COVID-19 did not significantly inhibit response to iNO in ARDS or other viral pneumonia patients. Further evaluation of other indirect markers of gas exchange could provide further evidence of responsiveness. DISCLOSURES: No relevant relationships by Katherine Burns No relevant relationships by Karen Hamad No relevant relationships by Bobby Malik No relevant relationships by Richard Walo Jr No relevant relationships by Wilhelmine Wiese-Rometsch No relevant relationships by Stephanie Williams
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SESSION TITLE: Critical Care Management of COVID-19 SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm PURPOSE: We hypothesized that supplementation of NIH recommended remdesivir (REM) and dexamethasone (DEX) combination treatment with tocilizumab (TOCI) or baricitinib (BARI) initiated inside 48h of index hospitalization would enhance reduction of inflammatory markers and discharges to home in adults over 18 years old who received intensive care. METHODS: Electronic medical record data were extracted under IRB exemption. Treatment responsiveness was estimated using delta in C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH) and D-dimer levels from assays respectfully respectively first within 24h and last between 25-72h of initiating REM/DEX with vs without TOCI or BARI. Confounder balanced multigroup contrasts were significant when p<.017. RESULTS: Between March 10, 2020 and January 31, 2022, 891 COVID-19 patients were admitted to the ICU with 459 receiving REM/DEX (n=326) or supplemented with BARI (n=85) or TOCI (n=41). Results are sequenced as REM/DEX, REM/DEX/BARI, REM/DEX/TOCI. Age was 67[57,77] (p<.0001) vs. 61[51,69] and 62[48,68] among statistically similar sex (male, 65%;female, 35%) and race (White, 76%;Black, 8%;Other, 16%) distributions and BMI (32[27,38] kg/m2). Hypertension (70%), obesity (59%), diabetes (38%), deficiency anemia (36%), coagulopathy (29%) chronic pulmonary disease (22%), and renal failure (17%) were similarly distributed. Initial CRP, ferritin, LDH and D-dimer levels -24h to +24h of REM/DEX first dose respectively were 12.1[7.1,18.2], 11.4[7.5,15.7], 14.0[11.2,21.0] mg/dL;811[441,1390], 1178[529,1956], 1110[653,1810] ng/mL (REM/DEX, p=.013);437[321,576], 516[403,695], 518[397,692] U/L (REM/DEX, p=.0001);and 1.02[0.67,2.28], 0.97[0.72,1.88], 1.47[0.86,2.19] ug/mL. Responsiveness quantified using last levels 25h-72h post REM/DEX first dose respectively included -3.4[-7.2,-0.6], -4.3[-7.7,-1.9], -7.2[-10.1,-3.6] mg/dL (REM/DEX/TOCI, p=.014);7[-125,202], -94[-329,69], -29[-181, 535] U/L;-3[-74,80], 85[-58,273], -33[-188,-3] U/L (p=.051);and 0.00[-0.50,1.05], 0.88[-0.45,10.52], -0.01[-0.38,0.50] ug/mL. ICU length of stay (LOS) was 6[3,13], 6[3,12], 8[5,15] days (p<.00001) with hospital LOS of 16[10,24], 20[12,33], 17[11,23] days (REM/DEX/BARI, p<.021). Hospital mortality was 51%, 71%, 43%, with REM/DEX/BARI exhibiting increase (p=.0019), but REM/DEX/TOCI numerically lowest (p>.017). Discharge to home was 24%, 18%, 43%, with REM/DEX/TOCI demonstrating increase (p=.0038). CONCLUSIONS: REM/DEX/TOCI combination therapy provided largest reduction of inflammatory markers and mortality while substantially increasing percentage of discharges to home. REM/DEX treatment responsiveness was adversely impacted by addition of baricitinib, while augmented by tocilizumab. CLINICAL IMPLICATIONS: Our findings highlight need to refine early longitudinal biomarker-tracking to identify patient-centric COVID-19 treatment responsiveness to COVID-19 directed treatments. DISCLOSURES: No relevant relationships by Qassem Abdelal No relevant relationships by Kevin Dawkins No relevant relationships by Karen Hamad No relevant relationships by Natalia Lattanzio No relevant relationships by Richard Walo Jr No relevant relationships by Wilhelmine Wiese-Rometsch No relevant relationships by Stephanie Williams
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Given the increase in the provision of telehealth services during the COVID-19 pandemic, it is important for medical and psychology providers to promote evidence-based treatments that can also demonstrate clinical utility through telehealth (1). This proof-of-concept study provides preliminary support for the clinical utility of the Williams and Zahka Cognitive Behavioral Therapy (CBT, 2) approach in reducing functional impairment and pain for pediatric patients with a Disorder of Gut-Brain Interaction (DGBI) when delivered through telehealth. A retrospective chart review was completed to examine psychological treatment duration and response among pediatric patients with DGBIs including functional abdominal pain and irritable bowel syndrome. CBT was delivered via telehealth with a licensed psychologist or supervised psychology trainee embedded in a pediatric gastroenterology clinic. Participants were 24 youth who completed initial evaluations between February and July of 2021 during the COVID-19 pandemic. Demographics, treatment characteristics, and statistical analyses are presented in Tables 1 and 2 (3,4). The Williams and Zahka CBT (2) approach utilizes a biopsychosocial framework that includes an initial focus on psychoeducation and function. Consistent with study hypotheses, non-parametric statistical analyses demonstrated statistically significant reductions in functional disability and pain with large effect sizes following treatment via telehealth. On average, patients attended approximately five sessions, including one initial evaluation and four treatment sessions, and this was not substantially different depending upon initial severity of impairment. These findings are in line with average treatment duration reported as 3 to 5 sessions in prior studies (5,6). Given the average length of treatment, patient care involved predominately psychoeducation on somatic symptoms and DGBIs along with a strong focus on functional restoration through behavioral activation, including a daily schedule and gradual return to routines and meaningful activities independent of school term status. Findings are similar to prior studies reporting reductions in functional impairment and pain following evidence-based treatment through a biopsychosocial framework for pediatric patients with DGBIs delivered in-person (5). (Table Presented).
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Background: Severe restrictions on in-person encounters and endoscopic procedures for digestive care have occurred as a result of the COVID-19 pandemic. This has exacerbated pre-existing barriers in access to gastroenterology (GI) care across Nova Scotia (NS) for patients and primary healthcare providers (PHCPs). In response, a provincial PHCP-GI consultative service (GUT LINK) was implemented at a single tertiary care center with the goal of supporting PHCPs in the management of non-urgent GI referral conditions. Aims: To implement and evaluate the acceptability, feasibility, appropriateness, and early effectiveness of the GUT LINK PHCP-GI consultation service. Methods: This is an ongoing prospective observational cohort study. All referrals received through the EMR-based referral and triage management system between May and November 2020 that were deemed to be amenable to management within primary care with specialist support were returned to the PHCP with the suggestion to arrange a GUT LINK telephone consultation. GUT LINK appointments were scheduled through an administrative support telephone line with the PHCP and a GI specialist. A post-consultation e-questionnaire was distributed to PHCPs who consented to participate. Feasibility (number of and indication for referrals, PHCP participation rates), acceptability and appropriateness (satisfaction, future use, likelihood to recommend) metrics and outcomes (case resolution, re-referrals, proportion requiring endoscopic investigations) were recorded. Patient charts were reviewed to determine whether the patient ultimately required GI speciality care. Analyses were descriptive and expressed as frequencies, means (+/-SD), medians (+/-SE), and proportions (%). Results: A total of 45 GUT LINK consultations were completed between May and November 2020. Of these, 20% required GI specialist care and 80% have remained within primary care, with a median follow-up of 101 (+/-9.1) days. The indications for GUT LINK consultation included lower GI symptoms (64%), abnormal imaging or investigations (17%), and upper GI symptoms (19%). been completed. All PHCPs reported that GUT LINK consultation was easy to access, while 90% found the advice helpful and 80% reported that that it resolved the issue. Following the GUT LINK appointment, 80% felt they would not need to refer their patient to GI. Conclusions: The implementation of GUT LINK was acceptable, feasible, and improved access to specialist support for management of undifferentiated GI symptoms. Future research will focus on comprehensive stakeholder engagement in order to design, implement, and evaluate GUT LINK PHCP care pathways.
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Introduction As more specialists become dual accredited in internal medicine, non-gastroenterology specialists have greater exposure to gastroenterology patients over the course of their training, especially via the acute take. Simultaneously, the COVID pandemic has meant most regular local teaching has moved online with varying quality. This project aimed to evaluate 1) whether a standardised protocol can be used to successfully deliver large scale digital gastroenterology teaching that 2) is non-inferior when compared with traditional face to face teaching. Methods Teaching was delivered to internal medical trainees on the acute management of ulcerative colitis and chronic liver disease. Two sessions were delivered a year apart, initially regionally, and then nationally. This was delivered via Zoom, using a standardised protocol based on guidelines to ensure consistency, with live-polled multiple-choice questions to encourage interaction. Each session was followed by Q&A related to that topic. Feedback was taken after each session. Outcome measures analysed were: number in attendance, whether viewers would recommend this teaching to others, whether they thought it ran smoothly, and how they felt about it when compared with face-to-face teaching as measured on a Likert scale. Given the subjective nature of our hypotheses, we accept that these are surrogate markers. Results 171 trainees attended the initial regional teaching session and 469 the subsequent session. Following the first session, 98.9% of trainees would recommend the teaching to others, rising to 99.7% after the second session. 99% and 99.5% respectively agreed or strongly agreed with the statement the initial session ran smoothly, while 84.5% and 88.8% agreed or strongly agreed that digital teaching was as effective as face to face. The benefits of digital teaching were no travel (90%) ability to watch later (86%), whereas the downsides were loss of social interaction (60%) and harder to get study leave (39%). Conclusions Gastroenterology teaching for non-specialists can be delivered successfully at a large scale using a standardised protocol for digital teaching. The vast majority of trainees felt that digital sessions were as effective as face-to-face teaching with a lack of travel and flexibility on viewing time the main reported benefits.
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Introduction: Despite the ongoing roll-out of the vaccination programme in Wales, self-isolation remains a crucial strategy to reduce transmission of COVID-19, especially as cases remain high. Test, Trace, Protect (TTP) is Wales' contact tracing programme where people are asked to isolate and provided with information and resources. Public Health Wales ran a real-time text message survey of contacts of cases of COVID-19 to provide insight as people were starting a period of self-isolation after notification from NHS Wales Test Trace Protect (Adherence Confidence Text Survey (ACTS)). This research study was designed to investigate what those being asked to self-isolate felt was good about their experience with TTP and what do they feel could be done better based on their text responses. Method: Text responses between 15th November 2020 and 2nd May 2021 (N = 12,092) were analysed using an automated content analysis (ACA) and sentiment analysis using the software Leximancer. Next, we conducted a qualitative thematic analysis using the software NVivo to explore further the findings of the ACA, as well as to look more deeply into some of the reasons behind people's views of TTP at two time periods for comparison, T1: 15th November- 5th December 2020 (n=2956) and T2: 1st March - 31st 2021 (n = 515). Results: ACA revealed that there were substantially more (roughly ten times as many) instances of favorable (positive affective) (n=4,963) terms within the data than unfavorable (negative affective) (n=425). NVivo analysis were in keeping with this finding as the majority reported a positive experience with TTP (T1 N = 1717, 58%;T2 N = 355, 69%). One of the sources of confusion was the date of the end of required isolation (T1 N= 101, 3.4%;T2 N = 11, 2.1%) though clarity improved from T1 to T2. Another concern was the time it took to be contacted following a positive test (T1 N = 205, 6.9%, T2 N = 14, 2.7%) again improving with time. Less than 1% reported financial concerns at both time periods. Conclusions: The Welsh population responding to the text sent by PHW had a positive experience with TTP. Automated content analysis is a viable method to process large datasets of qualitative content such as text responses.
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Introduction: The coronavirus pandemic presents the greatest challenge to public health in living memory. To slow the spread of the virus the UK initiated periods of strict social distancing, or lockdown. The ongoing social and psychological impacts of the pandemic and lockdowns are still under investigation. We aimed to explore longitudinally the attitudes and behaviors of members of the UK public from the start of UK lockdowns in March, 2020. We focused on mental health, adherence to health behaviours and government regulations, perceptions of vaccinations, and impact on Black, Asian, Minority Ethnic (BAME) participants. Method: Focus groups (2-8 people, 60 min) and surveys were conducted with 57 UK residents from March 23, 2020 to the present at 5 different timepoints that captured lockdowns and firebreaks (93% retention). Participants were 51% Female, mean age 37.1 (Range: 20-60), 72% White, 5% Mixed or Multiple ethnic groups, 16% Asian or Asian British, and 7% Black, African, Caribbean or Black British. Surveys included the Patient Health Questionnaire - Somatic, Anxiety, and Depressive Symptoms (PHQ-SADS), the Capabilities, Opportunities, Motivations and Behaviours questionnaire (COM-B), and coronavirus specific questions such as vaccination intention. Qualitative results: The central theme was that of loss;'practical losses' e.g. income and 'psychological losses' e.g. motivation. Loss improved, but uncertainty and anticipatory anxiety continued across timepoints. Reported mental health issues improved over Summer 2020 and worsened in Nov 2020. Alert fatigue and learned helplessness emerged as the main themes at that time and marginalization by BAME participants. Behavioural adherence and vaccination uptake focused around perception of risk and community vs individual responsibility. Quantitative results: Data will be analysed following the current wave of data collection (Nov-Dec 2021) and will presented in March, 2022. Conclusion: Mental health fluctuated with the ability to socially connect with others outside of the household. Feelings of loss improved over time. Alert fatigue and general mistrust in government increased as did learned helplessness resulting in a loss of motivation. Results have had a significant policy and media impact in the UK and resulted in several publications to date.
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BACKGROUND: Effectiveness of anticoagulation dosing strategies on outcomes in hospitalized COVID-19 patients was examined by REMAPCAP (standard vs. treatment-dosing and the Inspiration trial (standard vs. “Intermediate” dosing). Intermediate dosing was defined as < 1mg/kg daily but > 30-40mg QD). To our knowledge there has not been a study which compared the three regimens in COVID-19 patients who underwent intensive care. METHODS: Data were ed under IRB exemption from electronic medical records of consecutively discharged or expired patients who received at least one dose of enoxaparin and underwent intensive care. Patients were stratified by primary anticoagulation regimen received during their hospitalization defined as regimen received for 24h consecutively and 51% of their anticoagulation course. Patients receiving oral anticoagulation for other reasons were excluded. Continuous data were summarized with median [IQR] compared using Kruskal-Wallis Test. Discrete data were summarized as proportions compared with chi-squared test. Mortality confounders statistically balanced included age, sex, race, comorbidities, and local 4-surges of pandemic with multiple contrast. p <0.017 was significant. RESULTS: Descriptive statistics for patient characteristics, clinical course and outcomes are presented in attached table. Significantly different age strata were 18-39 and 70-79 years. There were no significant differences in comorbidities, time to anticoagulation, acute physiology score, ventilator days, or ICU and hospital LOS. CONCLUSIONS: No significant difference was observed between standard and intermediate groups with respect to VTE, ventilator days, vasopressor use, ICU or hospital LOS, death, or DC. Mortality and DC to hospice were significantly higher in the treatment dose group vs. the standard and intermediate groups.
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Systemic risk is the name given to impacts that spread within and across systems and sectors (e.g. ecosystems, health, infrastructure and the food sector) via the movements of people, goods, capital and information within and across boundaries (e.g. regions, countries and continents). The spread of these impacts can lead to potentially existential consequences and system collapse across a range of time horizons. Globalization contributes to systemic risk affecting people worldwide. The impacts of climate change or COVID-19 show how the challenges of addressing systemic risk go beyond conventional risk management and governance. Critical system interdependencies, amplified by underlying vulnerabilities, highlight that there is a growing need to better understand cascading impacts, systemic risks and the possible political (governance) and societal responses. This includes improving our understanding of the root causes of systemic risk, both biophysical and socio-economic, and related information needs. Addressing contemporary challenges in terms of systemic risk requires integrating different systems perspectives and fostering system thinking, while implementing key intergovernmental agendas, such as the Paris Agreement, the Sendai Framework for Disaster Risk Reduction and the Sustainable Development Goals.
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The high demand for Covid-19 vaccines due to the pandemic increases the need for vaccine transportation and storage worldwide, and a cold chain is often required for many vaccines. The existing cold chains are confronting some obstacles today but are facing many great opportunities at the same time with the emerging new technologies. This paper aims to address the trend of modern cold chain management of vaccine logistics through a literature review on the topic of Covid-19 vaccine transportation and storage. Empirical studies are needed in future research. The transportation and storage of the Covid-19 vaccines are important for the overall vaccine administrations and can save large amounts of money and lives when improved. Failures of the cold chain can lead to great economic loss and damage of the vaccine potency;therefore, it is essential to study the characteristics of the current cold chain and how related innovations influence its development. © 2021 IEEE.
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OBJECTIVES: Healthcare worker (HCW) SARS-CoV-2 contacts in England have been required to quarantine, creating staff shortages. We piloted daily contact testing (DCT) to assess its feasibility as an alternative. STUDY DESIGN: Observational service evaluation. METHODS: We conducted an observational service evaluation of 7-day DCT using antigen lateral flow devices (LFDs) at four acute hospital trusts and one ambulance trust in England. Mixed methods were used, using aggregate and individual-level test monitoring data, semi-structured interviews, and a survey of eligible contacts. RESULTS: In total, 138 HCWs were identified as contacts of a confirmed SARS-CoV-2 case. Of these, 111 (80%) consented to daily LFD testing, of whom 82 (74%) completed the required programme without interruption and 12 (11%) completed with interruption. Fifty-eight participants (52%) and two non-participants (7.4%) completed the survey. In total, 28 interviews were conducted with participants, site and infection control leads, and union representatives. One participant tested positive on LFD and polymerase chain reaction (PCR) test. Three participants tested positive on PCR but not LFD. DCT was well-accepted by trusts and staff. Participants reported no relaxation of their infection prevention and control behaviours. No incidents of transmission were detected. An estimated 729 potential days of work absence were averted. CONCLUSIONS: DCT can be acceptably operated in a healthcare setting, averting quarantine-related work absences in HCW SARS-CoV-2 contacts.