Returning to work: a qualitative study of the experiences of head and neck cancer survivors.

BACKGROUND: UK head and neck cancer incidence and prevalence in working-age people are increasing. Work is important for individuals and society. Head and neck cancer survivors return to work less than other cancer survivors. Treatment affects physical and psychological functioning long-term. Evidence is limited, with no UK qualitative studies. METHODS: A qualitative study was conducted, underpinned by a critical realism approach, involving semi-structured interviews with working head and neck cancer survivors. Interviews were conducted using the Microsoft Teams communication platform and interpreted using reflexive thematic analysis. RESULTS: Thirteen head and neck cancer survivors participated. Three themes were drawn from the data: changed meaning of work and identity, return-to-work experiences, and the impact of healthcare professionals on returning to work. Physical, speech and psychosocial changes affected workplace interactions, including stigmatising responses by work colleagues. CONCLUSION: Participants were challenged by returning to work. Work interactions and context influenced return-to-work success. Head and neck cancer survivors want return-to-work conversations within healthcare consultations, but perceived these as absent.

The Role of Social Work Education in Relation to Empathy and Self-Reported Resilience: Results from Entry to Exit of Social Work Education on the Island of Ireland during the COVID-19 Pandemic

The COVID-19 pandemic has affected all aspects of people's lives worldwide, including the work of social workers and the education of social work students. Field placements are a significant part of social work education, but during the pandemic they were cut short and most teachings moved online. The current mixed methods study examined the effects of social work education on social work students' empathy and resilience during the COVID-19 pandemic on the island of Ireland. A matched sample of forty-nine students completed an online survey at the start (T1) of their degree and at the end (T2). A further 229 students who only completed the T1 survey were compared to 70 others who only completed the T2 survey. The results showed improved resilience in the cohort comparison. There were no differences in empathy in the matched sample nor between the cohorts. Thematic analysis of students' narratives showed that they found the switch to online learning difficult, with some reporting negative impacts on their mental health and the abrupt ending of placements impacting their feelings of preparedness for practice. Implications of this study and future research areas are discussed. In this article, we examined the possible effects of the COVID-19 pandemic on the education of social work students. The data come from a wider study, in which social work students at six universities in Northern Ireland and the Republic of Ireland completed an online survey. Relevant to the current article were questions about resilience, empathy and how the students' education was impacted by the pandemic. Forty-nine students completed the survey twice: at the start of their education and at the end. This was our matched sample. A further 229 students only completed the survey at the start of their degree and 70 students only completed it at the end of their degree. We compared these two cohorts of students separately from the matched sample. We found that (i) the cohort of final year students was more resilient than the cohort of the first year students;(ii) there were no differences in empathy either in the matched sample or between the cohorts from the beginning to the end of their training;and (iii) students reported that the move towards online learning negatively impacted their education.

The brave new world of tertiary teaching: The intricacies of an online blended learning environment

The recent COVID pandemic illustrated a shift in both the type and ways that a range of digital technologies and learning designs have been employed in online teaching across the tertiary context. Of relevance, were the use of blended approaches that integrated online delivery (virtual) while students also attended classes in person. This chapter investigates the affordances, opportunities, and challenges that arose while two academics utilised blended synchronous learning (BSL) within a graduate arts class in Semester One, 2022. Wang's (2008) generic ICT model and the core components of pedagogy, social interaction, and technology were used to observe, interpret, and understand how two lecturers employed digital technologies in their practice. Using a collaborative self-study methodology (Samaras, 2011), via an online collaboration and regular Zoom meetings, emergent themes related to the opportunities and challenges that existed are presented, with consideration given to future adaption of BLS delivery within the tertiary teaching environment. © 2023, IGI Global.

Palliative Care Movement Disorders Multidisciplinary Meeting

Introduction It is well recognised that patients with Parkinson's disease (PD) have significant symptom burden in advanced stages of their disease. Integration of movement disorder and palliative care services has been limited by concerns about resource and sustainability. We present our experience of establishing a movement disorders palliative care multidisciplinary meeting. Method In 2019 we established a multidisciplinary virtual bimonthly meeting between movement disorders and palliative care specialists. Referrals were accepted from movement disorder specialists, community Parkinson's practitioners and palliative care specialists. Referring clinicians all actively applied primary palliative care approaches within their existing services. Aims of the meeting were to facilitate holistic management of complex needs, support advance care planning (ACP) and consider referral to specialist palliative care services. Result 37 patients in total were discussed over a 2-year period (although the service was limited for a time due to COVID pressures). On average 3 new patients were discussed per meeting. Reasons for referral included motor and non-motor symptoms, support with ACP, medication advice, caregiver concerns and emotional distress. Meeting outcomes included medication adjustments, expediting reviews, hospice support, carer support, and referral to other services. Since the meetings started 23 (62%) patients have died. Of these, 30% died in hospital compared with the national average of 43.4%. The average between discussion at the meeting and death was 139 days. The meeting has generated education opportunities, triggered joint assessments and a professionals' framework for the palliative management of patients with a movement disorder. Conclusions We present the experience of an MDT embedded within an early integrated palliative care service for movement disorders. The MDT has strengthened partnership working and findings suggest that alongside active primary palliative care, specialist palliative care for PD can be sustainable and resource efficient in a UK setting.

The love song of Nelly and Marion: Céline Sciamma's Petite maman (2021)

Céline Sciamma's fifth feature film, Petite maman, premiered at the Berlin Film Festival in March 2021. Shot in autumn 2020 during the COVID-19 pandemic, it is a brief film (72 mins) and a return to the work with child actors which typified Sciamma's first two features, Naissance des pieuvres (2007) and Tomboy (2011). After the death of her grandmother, a child, Nelly (Joséphine Sanz), helps her parents clear out her mother's childhood home. She meets another girl of her own age in the woods, Marion (Gabrielle Sanz), who turns out to be her mother as a child. Petite maman offers space for love and care between mothers and daughters and opens out feminist perspectives on memory and grief. Drawing on representations of the mother as a child in Roland Barthes, Sophie Calle and others, as well as discussion of memory and secrecy in the work of Anne Dufourmantelle, this article explores the reimagining of love between mothers and daughters in Petite maman. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Implications of novel Adenovirus-Host interactions in Thrombosis with Thrombocytopenia Syndrome

In this study we investigated a link between adenovirus-based vaccines, deployed to fight the SARS-CoV-2 pandemic, and lifethreatening thromboembolisms after vaccination. Post-marketing surveillance showed that, following vaccination, Vaxzevria (ChAdOx1 based, AstraZeneca) and Jcovden (Adenovirus type 26 based, Johnson & Johnson) are associated with reduced platelet counts (thrombocytopenia) and blood clots (thrombosis) in some individuals. This extremely rare condition, with a rate between 1:50,000 - 1:350,000 cases per vaccinated individual, is above background rates of thrombosis in the population and can lead to fatal ischemic events including cerebral venous thrombosis, intracranial haemorrhage, and pulmonary embolism. It has been termed vaccine induced thrombotic thrombocytopenia (VITT) or thrombosis with thrombocytopenia syndrome (TTS). Heparin induced thrombocytopenia (HIT) is another condition with a similar clinical presentation to TTS. In HIT, immunoaggregates are formed due to the presence of strong anti-selfantibodies directed against Platelet Factor 4 (PF4). When similar anti-PF4 antibodies were detected in TTS patients, we investigated whether there could be a link between the adenovirus vectors used in the vaccines and PF4. This study demonstrates a direct interaction between adenovirus capsids and PF4 using surface plasmon resonance. We then utilized an integrative structural biology workflow including cryo-electron microscopy and molecular dynamics to characterize and demonstrate the mechanism of this interaction. These results demonstrate a previously unknown adenovirushost interaction and provide critical clues as to the underlying mechanism which causes TTS, including how these pathogenic anti-PF4 antibodies may be induced. We are therefore able to present a hypothesis as to the route of pathogenesis in TTS.

Rural parent's experiences of stress and resilience during the COVID-19 pandemic and school closure

The COVID-19 pandemic has generated social and economic disruptions, resulting in cascading e ects on the health and well- being of global citizens. However, little research has focused on how COVID-19 has a ected rural regions, despite rurality being a critical factor for understanding community impact and response to the pandemic. The purpose of this phenomenological study was to explore the experiences of rural Nebraskan parents with young children during the COVID-19 pandemic and school shutdown, and the strategies they used to support their families during that time. We conducted individual and group interviews with 22 white, non-Hispanic mothers living in rural towns, villages, and farms in the Great Plains region of the United States. Thematic analysis was used to generate the following themes related to pandemic challenges: Impacts on Children's Education and Development, Impact on Parent's Work, and Social-Emotional Impacts. Additionally, we generated themes related to the ways that rural parents responded to those challenges: Successful Parenting Strategies, Children's Strategies, Using Community Provided Resources, Finding Unexpected Bene ts, and Hope. This study is meaningful because it documented the impact of the COVID-19 pandemic and school shutdown on rural families with young children, and their responses to pandemic-related stressors. Our ndings provide further insights into families' experiences of how COVID-19 a ected their lives. Limitations and future directions are also discussed.

Improving HIV Pre-Exposure Prophylaxis (PrEP) Uptake During the COVID-19 Pandemic

Background: Acute HIV cases have doubled during the COVID-19 pandemic. We implemented a quality improvement (Ql) project to standardize PrEP telehealth at a large metropolitan medical center in a HIV hotspot to ensure PrEP access and uptake. Methods: A 2-arm recruitment approach was implemented from August 31st, 2020-December 16th, 2020 targeting (1) patients through weekly social medial outreach and (2) providers in high-volume departments through educational in-services and dedicated chart reviews. Results: Provider referrals from the Emergency and Primary Care Departments increased 460% (p=0.03). PrEP users shifted to a majority<35 years old (n=12, 38.7%), but remained mostly Black (n=16, discontinuation during the pandemic. The low percentage of PrEP users may be related to COVID-19 on clinic follow-up. The younger demographic shift may translate to a larger decrease in HIV transmission given the relative risk of different cohorts. © 2022, ResearchTrentz Academy Publishing Education Services. All rights reserved.

An opportunity to build back better? COVID-19 and environmental sustainability of Australian events

Purpose: This study explores (1) the impacts of COVID-19 on the environmental sustainability of Australian events;(2) the measures undertaken to minimise the impacts of COVID-19 on environmental sustainability;(3) the key impediments to incorporating COVID-Safe measures in an environmentally sustainable way;and (4) the expected long-term impact of the COVID-19 situation on the development of the environmental sustainability of the Australian events industry. Design/methodology/approach: The study follows a qualitative approach by undertaking semi-structured interviews with (N = 23) event industry professionals. The data collection phase took place between November 2020 and May 2021 and the study was completed in February 2022. Findings: Adverse environmental impacts included increased waste output and the stagnation of planned or existing environmental practices. The study reveals positive effects such as reduced carbon emission outputs and increased environmental awareness of event participants. Financial costs, time pressure, uncertainty and sourcing issues are significant impediments to organising events in an environmentally sustainable manner during a global pandemic situation. Practical implications: Understanding how COVID-19 impacts the environmental sustainability of events will help the industry to preserve previous progress made, overcome similar obstacles during future crises, and capitalise on opportunities for positive environmental change. Originality/value: This is the first study to examine the impact of the COVID-19 pandemic on the environmental sustainability practices of Australian events. © 2022, Emerald Publishing Limited.

Investigating a psychological model of mental conditions and coping during the COVID-19 pandemic driven by participatory methods.

BACKGROUND: There is evidence of increased mental health problems during the early stages of the COVID-19 pandemic. We aimed to identify the factors that put certain groups of people at greater risk of mental health problems. METHODS: We took a participatory approach, involving people with lived experience of mental health problems and/or carers, to generate a set of risk factors and potential moderators of the effects of COVID on mental health. An online cross-sectional survey was completed by 1464 United Kingdom residents between 24th April and 27th June 2020. The survey had questions on whether respondents were existing mental health service users and or carers, level of depression (PHQ9) and anxiety (GAD7), demographics, threat and coping appraisals, perceived resilience (BRS), and specific coping behaviours (validated as part of this study). The relationship between responses and coping strategies was measured using tetrachoric correlations. Structural equation modelling was used to test the model. RESULTS: A model significantly fit our data (rel χ2 = 2.05, RMSEA = 0.029 95%, CI (0.016, 0.042), CFI = 0.99, TLI = 0.98, SRMR = 0.014). Age and coping appraisal predicted anxiety and depression. Whereas, threat appraisal and ethnicity only predicted anxiety, and resilience only predicted depression. Additionally, specific coping behaviours predicted anxiety and depression, with overlap on distraction. CONCLUSIONS: Some, but not all, risk factors significantly predict anxiety and depression. While there is a relationship between anxiety and depression, different factors may put people at greater risk of one or the other during the pandemic.

Engaging the public in talking about death and dying: Methodological learning

Background: We have little knowledge about public opinion on death and dying in the UK. Previous studies have focused on specific groups e.g. older people or those with life limiting conditions. This paper presents deliberative discussion groups as a novel methodology for investigating the topic which proved adaptable to online data collection following Covid-19 restrictions. Aim: To engage the UK public in discussion about death and dying. Method: Deliberative discussion groups of different topics over four sessions with a range of members of the public. Participants were provided with information resources prior to each meeting as a spur to thought and differing perspectives. Five individual interviews were also undertaken with participants who were unable to attend groups. A thematic approach to analysis was used. Results: Seven discussion groups and five individual interviews involving 41 participants (men n=9/women n=32, age range 30-81yrs). Discussion: We identified three key areas of methodological learning: 1) Recruitment to online groups allowed wider geographical reach and opened contact with sections of the population that would not otherwise have been available e.g. those usually at work. However, the constraints of Covid-19 reduced our ability to recruit by making direct contact with some groups, such as ethnic minorities and younger age groups. 2) Deliberative discussions were an effective way to build rapport among participants and encourage detailed consideration of key topics. Feedback from participants was overwhelmingly positive. 3) Moving to online data collection proved to be feasible, with scheduling made easier, more convenient and cost effective. There were some technical issues, but participants generally considered it to be a convenient way to participate. The online format worked best with smaller groups and shorter sessions, and also without presentation of interactive resources during the discussion.

Contrastive analysis for scatterplot-based representations of dimensionality reduction

Cluster interpretation after dimensionality reduction (DR) is a ubiquitous part of exploring multidimensional datasets. DR results are frequently represented by scatterplots, where spatial proximity encodes similarity among data samples. In the literature, techniques support the understanding of scatterplots’ organization by visualizing the importance of the features for cluster definition with layout enrichment strategies. However, current approaches usually focus on global information, hampering the analysis whenever the focus is to understand the differences among clusters. Thus, this paper introduces a methodology to visually explore DR results and interpret clusters’ formation based on contrastive analysis. We also introduce a bipartite graph to visually interpret and explore the relationship between the statistical variables employed to understand how the data features influence cluster formation. Our approach is demonstrated through case studies, in which we explore two document collections related to news articles and tweets about COVID-19 symptoms. Finally, we evaluate our approach through quantitative results to demonstrate its robustness to support multidimensional analysis.

Use of the 1-minute sit to stand test in Patients presenting with suspected covid-19 to Assess need for hospital admission

Introduction The clinical presentation of Covid-19 varies widely with only a small proportion of those infected requiring hospitalisation. The ability to risk stratify patients upon presentation to the Emergency Department (ED) facilitates early safe discharge, with or without enhanced monitoring, which benefits hospital capacity management and infection control. In other lung parenchymal conditions oxygen desaturation during exercise has been used as an indicator of more severe disease. The exercise modality has typically been a field walking test or a bicycle or treadmill test which are impractical for delivery in ED. We investigated whether an alternative test, the 1-minute sit to stand test (1SST), was deliverable within an ED at the height of the COVID-19 pandemic. Methods During April to June 2020 at two large hospitals we performed 1SST in 201 people presenting with suspected Covid-19 and measured test performance (reps) plus change in pulse and oxygen saturations. Subsequently we identified clinical outcomes for all individuals diagnosed with Covid-19. A positive test was defined as 4% desaturation. Results The test was deliverable with 193/201 (96%) able to complete (2 were too unsteady, 6 failed to complete the minimum 5 reps). 111 (55%) were female, mean age of 49 (SD 16) years and an average of 17 (SD 7) reps completed. Mean fall in saturations was-1.6% and rise in pulse was 22. 34 people were diagnosed with Covid-19 based on a) positive swab or b) negative swab but diagnosed with 'clinical Covid-19' by a senior clinician based on clinical and radiological features. 1 person was unable to complete the 1SST test. The outcomes for people with a positive or negative test are shown in the table 1. In the early part of the study we were only able to swab people admitted to hospital so data from 109 further people is not included in the primary analysis. Conclusion The 1SST is feasible for people presenting acutely with Covid-19. It effectively identifies exercise induced oxygen desaturation and therefore augments the decision making relating to hospital admission.

The development and implementation of a virtual discharge ward for patients with covid-19 pneumonia: Data on the first 300 patients

Introduction There is little described in the current COVID-19 literature about the outcomes of patients discharged from hospital following COVID-19 pneumonia. We describe the rapid establishment of a 'virtual ward' (VW) for followup of patients with a suspected or confirmed diagnosis of COVID-19 pneumonia or pneumonitis upon hospital discharge, characteristics and outcomes for the first 300 patient referrals. Methods Admitted patients with a confirmed/suspected diagnosis of COVID-19 pneumonia/pneumonitis were referred electronically to the VW on discharge. Pulse oximeters were provided if oxygen saturations were <92%. The 'tracking board' was reviewed daily and phone calls carried out to assess patients for symptom improvement, stability or deterioration. If cause for concern was raised, same-day review for the patient at home was arranged via predetermined community pathways or patients were transferred urgently to hospital. Results The M:F ratio was 2:1 and 25% of patients were of black and minority ethnic origin. 71% of patients had at least 1 co-morbidity. 31% of patients were SARS-CoV-2 PCR negative on respiratory tract samples but had high clinical suspicion of COVID-19. 70% of patients had radiological changes on CXR/CT formally reported as being consistent with COVID-19. Median Length of stay (LOS) on the VW was 3.5 days [range 0-19], 85% of patients had a LOS £7 days. Around half (158, 53%) of patients had required oxygen during admission. Pulse oximeters were provided to 31 (10%) of patients. Outcomes are shown in figure 1. Thirty-eight (13%) patients re-attended the Emergency Department;28 were readmitted;of these, 3 were ventilated for respiratory failure, 5 had increasing oxygen requirements and 8 had confirmed pulmonary embolism. 12 had other reasons for admission. 2 patients readmitted by the VW died, both had underlying terminal diagnoses. Conclusions To our knowledge, this is the first description of the characteristics of patients discharged from UK hospitals with COVID-19. We have demonstrated that a virtual COVID-19 ward allowed early discharge of patients, offering a safety net and reassurance for patients and clinicians at the time of discharge. Use of pulse oximeters allowed for early identification of clinical deterioration, enabling prompt readmission when required.

Cpg-adjuvanted hepatitis b vaccination improves seroprotection rates in veterans with hiv

Background. Hepatitis B virus (HBV) remains a global health issue, leading to complications including cirrhosis and hepatocellular carcinoma. Individuals co-infected with Human Immunodeficiency Virus (HIV) and HBV have increased liver- related morbidity and mortality compared to those with HBV mono-infection. Vaccination can effectively prevent HBV infection, but certain critical populations including people living with HIV (PLWH) are less likely to achieve seroprotection (antibody to hepatitis B surface antigen (HBsAb) titer ≥ 10 IU/mL) after vaccination;seroprotection rates (SPR) in PLWH range from 34 to 88% in clinical trials, with improved SPR in those with immunologic reconstitution and viral suppression. With improved immunologic status, SPR have dramatically improved in our Veteran Infectious Disease clinic population. However, a subset of patients remain HBV vaccine nonresponders despite re-vaccination attempts, perhaps due to intrinsic immunologic anergy. We hypothesized that Veterans with HIV who were nonresponders to prior HBV vaccines may respond to a more immunogenic vaccine. Heplisav-B is a 2-dose series, with improved SPR in other classically difficult to vaccinate groups (including the elderly and those with diabetes), but has not yet been studied in individuals with HIV. Methods. HBV vaccine nonresponders who had previously been vaccinated and boosted with median 3 and up to 8 doses of alum-adjuvanted HBV vaccines were re-vaccinated with Heplisav-B. HBsAb titers were assessed at days 0, 30, and 60 to follow vaccine responses. Results. Participants had a median age of 65 (range 44 to 83) and were virologically suppressed on antiretroviral therapy. Enrollment and vaccination was interrupted by the COVID-10 pandemic, but 8 of 10 (80%) enrolled participants had seroprotective titers at day 60, with 6 having titers > 1000 IU/mL. Of the 8 additional participants who had available serologies after the first dose, all were seroprotected, and 3 had titers > 1000 IU/mL.16 of 18 (89%) participants achieved seroprotection with Heplisav-B. Conclusion. Heplisav-B is immunogenic in persons with HIV and should be a reasonable option for HBV vaccination of PLWH who are previous nonresponders.

Visual analytics of COVID-19 dissemination in São Paulo state, Brazil.

Visual analytics techniques are useful tools to support decision-making and cope with increasing data, particularly to monitor natural or artificial phenomena. When monitoring disease progression, visual analytics approaches help decision-makers to understand or even prevent dissemination paths. In this paper, we propose a new visual analytics tool for monitoring COVID-19 dissemination. We use k-nearest neighbors of cities to mimic neighboring cities and analyze COVID-19 dissemination based on comparing a city under consideration and its neighborhood. Moreover, such analysis is performed within periods, which facilitates the assessment of isolation policies. We validate our tool by analyzing the progression of COVID-19 in neighboring cities of São Paulo state, Brazil.

P4 Use of the 1-minute sit to stand test in patients presenting with suspected Covid-19 to assess need for hospital admission

P4 Table 1 Positive 1SST Negative 1SST p value Number of subjects 9 24 Sex – M/F 3/6 13/11 0.26 Age (SD) 50.2 (±14.9) 47.6 (±16.2) 0.68 Reps (SD) 15.6 (±6.75) 18.9 (±7.1) 0.29 Change in oxygen saturations (SD) -7.22 (±3.23) 0.12 (±1.44) <0.01 Change in heart rate (SD) 22.43 (±12.93) 21.69 (±20.18) 0.96 Number admitted to hospital 8/9 (89%) 6/24 (25%) <0.01 Length of stay (days) 6.22 (±9.6) range 0–31 1 (±1.89) range 0–7 0.01 Required oxygen 5 (56%) 1 (4%) 0.01 Required ventilation 1 (11%) 0 (0%) 0.09 ConclusionThe 1SST is feasible for people presenting acutely with Covid-19. It effectively identifies exercise induced oxygen desaturation and therefore augments the decision making relating to hospital admission.