Telehealth Utilization in Trauma Care: The Effects on Emergency Department Length of Stay and Associated Outcomes.

INTRODUCTION: Since the onset of the Covid-19 Pandemic, Telehealth utilization has grown rapidly; however, little is known about its efficacy in specific areas of healthcare, including trauma care in the emergency department. We aim to evaluate telehealth utilization in the care of adult trauma patients within United States emergency departments and associated outcomes over the past decade. METHODS: PubMed, Google Scholar, EMBASE, ProQuest, and Cochrane were searched for relevant articles published from database conception to Dec 12th, 2022. Our review includes studies that assessed the utilization of telehealth practices within a United States emergency department for the treatment of adult (age ≥ 18) trauma patients. Evaluated outcomes included emergency department length of stay, transfer rates, cost incurred to patients and telehealthimplementing hospitals, patient satisfaction, and rates of left without being seen. RESULTS: A total of 11 studies, evaluating 59,319 adult trauma patients, were included in this review. Telehealth practices resulted in comparable or reduced emergency department length of stay for trauma patients admitted to the emergency department. Costs incurred to the patient and rates of leaving without being seen were significantly reduced following telehealth implementation. There was no difference in transfer rates or patient satisfaction for telehealth practices compared to in-person treatment. CONCLUSION: Emergency department telehealth utilization significantly reduced trauma patient care-related costs, emergency department length of stay, and rates of leaving without being seen. No significant differences were found in patient transfer rates, patient satisfaction rates, or mortality rates following emergency department telehealth utilization.

An Autonomous Discord Bot to Improve Online Course Experience and Engagement: Lessons Learned Amid the COVID-19 Pandemic

The COVID-19 pandemic pushed many educational institutions to adopt online learning models for most or all of their courses. As a result, the effectiveness of remote learning is more important now than ever before. In this paper, we report on work that was conducted in the Spring of 2021 at Utah Valley University. We explored the use of Discord as a delivery mechanism for online course content during the 2020-2021 school year. We also developed a Discord bot to autonomously track attendance. Based on our experience to date, the Discord bot appears to enhance remote learning. We describe the design, implementation, and deployment of our bot. We also discuss what worked well, as well as areas for improvement. In future semesters we plan to collect data by which we may begin to answer fundamental questions about the impact of such bots on remote learning. © 2022 IEEE Computer Society. All rights reserved.

Ethics, rigour and agility of research and evaluation methods in a changing social and clinical context: Reflections from a psychosocial research centre on the implications of the COVID-19 pandemic

The Centre for Psychosocial Research in Cancer conducts world-leading research and service evaluations to support well-being and quality of life amongst those affected by cancer. This paper reflects on how we adapted our research management and study methods during the COVID-19 pandemic, and the implications for ongoing research practice. We use four case studies to consider the benefits and challenges of adapting to remote approaches to research and evaluation delivery: maintaining high ethical standards and data security in evaluation projects with remote approvals;recruiting for and running online discussion groups to inform intervention development;designing and delivering an in-person intervention via video conferencing;and adapting a longitudinal qualitative study to focus on newly emerging issues. We reflect on how we can maintain quality and rigour when conducting remote research and evaluation, and how this can affect our experience as researchers. We also consider possible implications of the uncertainty created by the COVID-19 pandemic for the funding and design of future research and evaluations. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Sexualising weight loss in British tabloids:: Celebrities ‘flaunting' their bodies during a pandemic

This paper explores the relationship between weight loss, sex and beauty by analysing a corpus of 285 articles about celebrity weight loss published in the UK national press between 23 March 2020 and 6 July 2020. Taking a corpus-assisted critical discourse analysis approach, we examine the use of the statistically salient lemma flaunt*. Ninety-seven per cent of the instances of flaunt* in our corpus are attributed to female celebrities, and the respective protagonists are reported by the UK press to flaunt their bodies and their weight loss on their social media pages. By critically analysing the use of flaunt*, we are able to demonstrate the manner in which celebrity social media posts are repackaged to sexualise female celebrities and to sexualise the process of weight loss in general. We argue that describing social media images shared by female celebrities as flaunting could at best, misrepresent their intentions, and at worst contribute towards the pervasive unsolicited sexualisation of women, and exacerbate adverse body image and mental health issues during the COVID-19 pandemic which in and of itself has exacerbated these issues. © 2023, equinox publishing.

Mink-413: A Next Generation Armored Allogenic Bcma Car Inkt Product

Background We are developing MiNK-413;a novel allogeneic CAR-iNKT product targeting BCMA and secreting soluble IL-15 for treatment of relapsed/refractory Multiple Myeloma (rrMM). Chimeric Antigen Receptor (CAR)-T cell therapy has revolutionized treatment of rrMM with two autologous products already approved by the FDA. However, current treatments come with significant toxicity, cost, and logistical challenge and many patients relapse, with 60% of relapsed patients still expressing BCMA. To address these, we propose the use of invariant Natural Killer T (iNKT) cells as a platform for BCMA-targeted allogenic cell therapy for rrMM. iNKT cells have potent immunostimulatory activity and intrinsic CD1d-and NK receptor ligand targeted cytotoxicity, and do not cause Graft versus Host Disease due to their invariant T cell receptor. In our native iNKT cell (agenT-797) clinical trials for COVID, solid tumors and Multiple Myeloma we observe excellent tolerability to up to 1 billion cell dosing with minimal treatment-related adverse events, absence of signs of CRS or peripheral neuropathy, and early signs of biological activity. AgenT-797 is administered without prior lymphodepletion, which is an approach we intend to pursue with MiNK-413. Methods Our proprietary CARDISTM platform consists of highly diverse (>1010) scFv library screening followed by library-based direct functional selection in CAR format using mammalian display. Candidates can be further optimized using affinity tuning to ensure optimal and highly selective on-target/ on-tumor activity. We developed a manufacturing approach to engineer and specifically expand CAR and soluble IL-15-expressing allogeneic iNKT cells. Lead candidates are assessed in vitro and in vivo for cytotoxicity, cytokine secretion, exhaustion, tumor homing and persistence. Results Discovery using our CARDISTM platform generated a fully human, potent, and specific anti-BCMA CAR which forms the basis for MiNK-413. Xenograft in vivo studies demonstrate effective bone marrow homing, and potent cytotoxic activity, with soluble IL-15 prolonging persistence. In vitro data show potent immunomodulatory activity and lack of exhaustion against BCMA+ human hematologic tumor cell lines in vitro and in vivo. Conclusions Combination of our proprietary CARDISTM and iNKT platforms enabled rapid discovery and development of MiNK-413, a next generation armored allogeneic BCMA-targeting CAR therapies. MiNK-413 is eligible to target a broader rrMM patient population due to intrinsic iNKT cell properties such as effective bone-marrow homing, high BCMA specific activity augmented by natural CD1d and NK receptorligand mediated activity. We believe MiNK-413 will provide additional benefits to rrMM patients beyond currently available treatments.

Marking 2-Years of New Thinking in Clinical Trials: The Estimand Journey.

The ICH E9(R1) addendum on Estimands and Sensitivity Analyses in Clinical Trials has introduced a new estimand framework for the design, conduct, analysis, and interpretation of clinical trials. We share Pharmaceutical Industry experiences of implementing the estimand framework in the first two years since the final guidance became available with key lessons learned and highlight what else needs to be done to continue the journey in embedding the estimand framework in clinical trials. Emerging best practices and points to consider on strategies for implementing a new estimand thinking process are provided. Whilst much of the focus of implementing ICH E9(R1) to date has been on defining estimands, we highlight some of the important aspects relating to the choice of statistical analysis methods and sensitivity analyses to ensure estimands can be estimated robustly with minimal bias. In particular, we discuss the implications if complete follow-up is not possible when the treatment policy strategy is being used to handle intercurrent events. ICH E9(R1) was introduced just before the start of the COVID-19 pandemic, but a positive outcome from the pandemic has been an acceleration in the adoption of the estimand framework, including differentiating intercurrent events related or not related to the pandemic. In summary, much has been learned on the estimand journey and continued sharing of case studies will help to further advance the understanding and increase awareness across all clinical researchers of the estimand framework.

Should I stay or should I go? An exploration of the decision-making behavior of acute cardiac patients during the COVID-19 pandemic.

BACKGROUND: During the SARS-COV-2 (COVID-19) pandemic efforts to reduce virus transmission resulted in non-emergency patients being deterred from seeking help. The number of patients presenting with acute cardiac conditions reduced, significantly OBJECTIVES: To explore the decision-making process, and influential factors in that process, of patients and their family during an acute cardiac event. METHODS: A qualitative research design was employed using purposive sampling of patients who experienced an acute cardiac event during the social containment mandates. Semi-structured interviews were conducted, with thematic analysis of interview transcripts. RESULTS: Twenty-five participants were recruited from three UK hospitals. Themes identified were reliance on informal support network, lack of awareness of cardiac symptoms leading to delayed help-seeking, and an indirect COVID-19 effect (e.g. avoiding treatment). CONCLUSIONS: These results highlight the need for informed public health messages, targeting patients and their support networks, that allow those in need of treatment to access care.

POSB425 Methodological Challenges to Coronavirus Disease (COVID-19) Evidence Generation to Inform Health Technology Assessment (HTA)

Objectives: COVID-19 standard of care (SoC) has rapidly evolved, and many treatments are now in development which will require HTA following regulatory approval. Given the evolving COVID-19 treatment landscape, up-to-date evidence synthesis may challenge HTA. The aim of this study was to evaluate the methodological implications of the rapidly evolving evidence base required for HTA. Methods: A systematic literature review (SLR) in Embase and Medline of published clinical, economic and health-related quality of life (HRQoL) COVID-19 literature was conducted to generate evidence for HTA. Results: COVID-19 entries have increased exponentially compared to other diseases. A ‘COVID-19’ search in Embase generated 146,882 hits from October 2019-May 2021. Of these, 1,305 (estimated number per week (ENPW): 101) were published in 2019, 88,098 (ENPW: 1,694) in 2020 and 57,479 (ENPW: 2,699) in 2021. In comparison, there were 14,073 entries for multiple myeloma (MM), with 4,322 (ENPW: 333) in 2019, 7,224 (ENPW: 139) in 2020 and 2,527 (ENPW: 119) in 2021. An Embase and Medline search for COVID-19 clinical studies (October 2019 to May 2021), resulted in 7,279 entries, with only 63 (ENPW: 5) in 2019 (October to December), 3,746 (ENPW: 72) in 2020 and 3,470 (ENPW: 163) up to May 2021. In comparison, the MM SLR resulted in fewer clinical publications (1,964 entries, 614/47, 1,056/20 and 294/14 in 2019-2021). Similar trends were observed for economic and HRQoL studies. Overall, the COVID-19 SLR reported >70% clinical and >90% economic and HRQoL studies compared to a MM SLR intended for HTA. Conclusions: COVID-19 entries in databases are rapidly increasing weekly. Due to the evolving landscape and abundant evidence, challenges remain to synthesise evidence that is current and reflective of SoC. Based on this experience, a six-month time limit is recommended. COVID-19 evidence generation for HTA requires consensus around the requirements to ensure recommendations are based on up-to-date evidence.

Lessons learned from the first 50 COVID-19 critical care transfer missions conducted by a civilian UK Helicopter Emergency Medical Service team.

BACKGROUND: The COVID-19 pandemic has placed exceptional demand on Intensive Care Units, necessitating the critical care transfer of patients on a regional and national scale. Performing these transfers required specialist expertise and involved moving patients over significant distances. Air Ambulance Kent Surrey Sussex created a designated critical care transfer team and was one of the first civilian air ambulances in the United Kingdom to move ventilated COVID-19 patients by air. We describe the practical set up of such a service and the key lessons learned from the first 50 transfers. METHODS: Retrospective review of air critical care transfer service set up and case review of first 50 transfers. RESULTS: We describe key elements of the critical care transfer service, including coordination and activation; case interrogation; workforce; training; equipment; aircraft modifications; human factors and clinical governance. A total of 50 missions are described between 18 December 2020 and 1 February 2021. 94% of the transfer missions were conducted by road. The mean age of these patients was 58 years (29-83). 30 (60%) were male and 20 (40%) were female. The mean total mission cycle (time of referral until the time team declared free at receiving hospital) was 264 min (range 149-440 min). The mean time spent at the referring hospital prior to leaving for the receiving unit was 72 min (31-158). The mean transfer transit time between referring and receiving units was 72 min (9-182). CONCLUSION: Critically ill COVID-19 patients have highly complex medical needs during transport. Critical care transfer of COVID-19-positive patients by civilian HEMS services, including air transfer, can be achieved safely with specific planning, protocols and precautions. Regional planning of COVID-19 critical care transfers is required to optimise the time available of critical care transfer teams.

Frailty score before admission as risk factor for mortality of renal patients during the first wave of the COVID pandemic in London

Background: Frailty is a known predictor of mortality and poor outcomes during hospital admission. In this large renal retrospective cohort study, we investigated whether frailer COVID-19 positive renal patients had worse outcomes. Design: All SARS-Cov-2 positive renal patients aged >=18 years who presented to the emergency department at the Royal Free Hospital or at the satellite dialysis centres from 10th of March until the 10th of May 2020, with recent data on frailty, were included. The follow up was until 26th of May 2020. Age, gender, ethnicity, body mass index, chronic kidney disease stage, modality of renal replacement therapy, co-morbidities, Rockwood clinical frailty score (CFS), C reactive protein and the neutrophil-to-lymphocyte count were collected at presentation. The primary outcome was the overall mortality rate following COVID-19 diagnosis. Secondary outcomes included the need for hospital admission.

VECMAtk: a scalable verification, validation and uncertainty quantification toolkit for scientific simulations.

We present the VECMA toolkit (VECMAtk), a flexible software environment for single and multiscale simulations that introduces directly applicable and reusable procedures for verification, validation (V&V), sensitivity analysis (SA) and uncertainty quantication (UQ). It enables users to verify key aspects of their applications, systematically compare and validate the simulation outputs against observational or benchmark data, and run simulations conveniently on any platform from the desktop to current multi-petascale computers. In this sequel to our paper on VECMAtk which we presented last year [1] we focus on a range of functional and performance improvements that we have introduced, cover newly introduced components, and applications examples from seven different domains such as conflict modelling and environmental sciences. We also present several implemented patterns for UQ/SA and V&V, and guide the reader through one example concerning COVID-19 modelling in detail. This article is part of the theme issue 'Reliability and reproducibility in computational science: implementing verification, validation and uncertainty quantification in silico'.

Travel and the climate crisis: exploring COVID-19 impacts and the power of stories to encourage change

Purpose: The natural environment is facing unprecedented times owing to rising temperatures from carbon emissions, which travel-related industries contribute significantly towards. The recent global COVID-19 outbreak should be a wake-up call for the industry, as vulnerabilities have been laid bare. The current challenges should be used as a motivation to change the meaning of travel to support the global warming crisis. This paper aims emphasis that, by means of new stories, new values, beliefs and ultimately travel behaviours can be rewritten. Design/methodology/approach/: This study embraces a pragmatic approach to research. To ensure plausibility, credibility and relevance, the research carried out multi-disciplinary analysis of secondary data, information, knowledge and draws on current developing trends. Findings: The travel community needs to take responsibility and start reducing its carbon footprint and as carbon neutrality is increasingly a global priority. Accordingly, this research considers potential future travel-related behaviours that could support more carbon-neutral travel. Significantly, it notes how the COVID-19 outbreak has offered insights into potential positive changes. To benefit from these changes, new stories for industry providers are necessary to encourage more carbon-neutral travel practices. Originality/value: This paper offers timely and original discussions on the future of travel as a result of COVID-19 impacts. It draws on the power of storytelling as a means of achieving behavioural change in the travel community to support the challenge of climate change. © 2020, Daniel William Mackenzie Wright.

Follow the leader: middle management and supervisors' impacts on work-life balance practices

The current organizational landscape, with its calls for flexibility, innovation, and rapid response to change, has resulted in increased work demands and longer working hours for many employees (Brett & Stroh, 2003;Lewis & Cooper, 2005).Also, access to technology, such as smartphones, widespread internet, social media, and video chatting, has increased the amount of time people spend working (Voydanoff, 1988), thus making work-life balance (WLB) an important social and organizational issue (Kanwar et al., 2009). Many organizations have implemented family-friendly workplaces for their employees (Kossek & Van Dyne, 2008;Lobel & Kossek, 1996). Research has suggested that supportive supervisor behaviors might influence employees' perceptions of family-friendly programs (Batt & Valcour, 2003;Thomas & Ganster, 1995;Thompson & Prottas, 2005). However, few studies have examined the effects of leadership as it relates to promoting the success of family-friendly programs and WLB. The purpose of this qualitative, phenomenological study was to examine the extent to which managers and supervisors practiced and expressed value for work-life balance impacts on their organization's commitment to implementing family-friendly workplace policies. The ultimate goal of this study is to answer the question: "Do middle managers and supervisors practice work-life balance within their own lives?" Both Kahn et al.'s (1981) role theory and Grandey and Cropanzano's (1999) conservation of resources (COR) model were used as theoretical frameworks for this study. This study utilized seven standardized open-ended questions to explore strategies used by 13 managers and supervisors to achieve work-life balance. The findings in this study support the literature surrounding those in the modern-day workforce working long hours and not being able to complete daily tasks by the end of each workday. Also, the managers and supervisors in this study with children at home experienced more challenges in the family domain. Furthermore, the new normal of COVID-19 and its effect on the external environment has created different types of challenges for both the managers and supervisors and the organizations where they are employed. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Acceptance & commitment therapy for school leaders’ well-being: an initial feasibility study

Acceptance and Commitment Therapy (ACT) has evolved a considerable evidence-base in recent years. One area wherein the model has demonstrated strong empirical support is through its application within the workplace. However, little empirical work has been carried out within the educational workforce and even less has been done with school leaders specifically. This paper reports on an initial feasibility study, using a group-based ACT programme to promote the well-being of school leaders. Seven leaders attended the programme, and completed established measures of well-being, burnout and valued living before and after the programme. The patterns of change indicated improvements on all three measures from pre- to post-intervention. Transcripts from semi-structured interviews were thematically analysed, revealing three themes: Increasing Awareness;Building Resilience;and a Safe and Supportive Group. Results and analyses are discussed in terms of future directions for the field and in terms of potential implications for the current COVID-19 pandemic. © 2020 Association of Educational Psychologists.