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In September 2020 the UK government announced Operation Moonshot;the remit being to increase testing capacity for COVID 19. Amongst the diagnostic platforms to be considered was mass spectrometry. To facilitate this the Department of Health and Social Care (DHSC) brought together and funded academic mass spectrometry (P1) and specialist NHS laboratories (P2) across the UK With regards to the latter the GOSH Enzyme Lab and the Neurometabolic Unit (National Hospital) were identified as a P2 grouping that would collaborate with the mass spectrometry unit at the UCL Institute of Child Health (P1 - Head Prof K Mills). This P1 lab developed a unique proteomic approach to measure diagnostic proteins associated with the SARS-CoV-2 virus This method was transferred over to our NHS labs for full validation. Rapid progress was made and the DHSC identified us as a 'vanguard lab'. Within 6 months of commencement of the project a validated method was developed that had excellent agreement with PCR testing Our data was used in presentations throughout the DHSC and for briefing of government ministers. Despite the pressures of the pandemic our NHS staff went above and beyond to deliver on time Furthermore close working with an academic partner provided a proof of principle example whereby state of the art mass spectrometry-based methods can successfully be translated across into the NHS environment.
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Healthcare professionals do not have tools needed to track food and nutrient intakes in patients requiring dietary support. Monitoring nutritional intake can promote behaviour change but few existing tools provide electronic dietary recording, comprehensive food composition data, instant nutritional analysis and a platform connecting healthcare teams with patients, providing timely, personalised support. myfood24 has been validated for use in research(1) and is available as an app patients and healthcare professionals. This feasibility randomised controlled trial aimed to assess the use of 'myfood24 Healthcare' in two clinical populations. Tier 3 weight management patients in York and gastroenterology surgery outpatients, Leeds (UK) were randomised into three groups: standard care, myfood24, or myfood24+diet optimisation. Optimisation uses machine learning to suggest diet changes getting patients closer to nutrient targets. Patients were asked to record diet with the app at least four times over eight weeks. Covid restrictions meant all data was collected online. Healthcare professionals viewed patient dietary information and provided semi-structured interview feedback on usability. Patients completed an online survey after 8 weeks to provide demographic details, previous technology experience and feedback on usability and acceptability of myfood24.A total of 48 patients (21 weight management and 27 gastroenterology surgery) were recruited and randomised to the 3 groups. Covid influenced recruitment of patients and altered app delivery. Patients mean age was 51y and self-rated internet ability was only 'fair'. In the app users (n 32) compliance was good, with 25 (78%) using it at least once. Among users, the mean (SD) days recorded was 14.0 (17.5). Mean daily energy intake for weight management patients was 1060kcal (SD 513) and for gastroenterology patients 1209kcal (SD 675). Self-reported nutrient intakes varied by patient group reflecting dietary needs. 9 of the 16 allocated to the optimisation used it. Suggestions were activated on 88% of days recorded, mean 16days (SD 19). Feedback questionnaires were completed by 50%. Despite small numbers, some patients (3/16, 19%) said that symptoms had improved by using myfood24;it gave them confidence to stick to advice (4/16, 25%) and it could help them manage their condition (4/ 16, 25%). Over half said they would use the feedback to ask for advice at their next appointment. The mean System Usability Score was 59 (95% CI, 48 to 70). Patient and healthcare professional feedback indicates that patients found the tool easy to use. Improvements suggested related to user training when using the app and improvement of the search function. This feasibility study conducted during Covid restrictions, led to smaller numbers than anticipated, also potentially affecting response. However, results show that myfood24 Healthcare app is acceptable and useful for patients and healthcare professionals. These data have informed app refinements which are now in place.
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Background: SARS-CoV-2 remains a global threat, despite the rapid deployment but limited coverage of multiple vaccines. Alternative vaccine strategies that have favorable manufacturing timelines, greater ease of distribution and improved coverage may offer significant public health benefits, especially in resource-limited settings. Live oral vaccines have the potential to address some of these limitations;however no studies have yet been conducted to assess the immunogenicity and protective efficacy of a live oral vaccine against SARS-CoV-2. Thus far, we assessed whether oral administration of live SARS-CoV-2 in non-human primates might offer prophylactic benefits. Methods: In this study, we assessed the immunogenicity of gastrointestinal (GI) delivery of SARS-CoV-2 and the protective efficacy against intranasal and intratracheal SARS-CoV-2 challenge in rhesus macaques. Esophagogastroduodenoscopy (EGD) administration of 106 50% Tissue Culture Infectious Dose (TCID50) of SARS-CoV-2 elicited low levels of serum neutralizing antibodies (NAb), which correlated with modestly diminished viral loads in nasal swabs (NS) and Bronchoalveolar Lavage (BAL) post-challenge. In addition, mucosal NAb titers from the rectal swabs (RS), NS, and BAL and Spike-specific T-cell responses appear to be below the limit of detection post-vaccination. Replicating virus was only observed in 44% of macaques and on limited number of dates post vaccination, suggesting limited, if any, productive infection in the GI tract. Results: We demonstrate that GI delivery of live 1x106 TCID50 SARS-CoV-2 elicited modest immune responses and provided partial protection against intranasal and intratracheal challenge with SARS-CoV-2. Moreover, serum neutralizing antibody titers correlated with protective efficacy. Conclusion: These data provide proof-of-concept that an orally administered vaccine can protect against respiratory SARS-CoV-2 challenge, but the limited immunogenicity and protective efficacy observed here suggests that the oral vaccine approach will require optimization.
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Background and Aims: Hypolipidaemia is a known consequence of sepsis, predominantly from HDL-C (HDL-cholesterol) lowering. The dynamic of lipoprotein responses is in COVID-19 is not yet elucidated. We aim to describe a lipoprotein response pattern in patients with severe COVID-19 admitted to Intensive Care Department (ICU) at TUH during the first wave of the pandemic in Ireland. Methods: A multidisciplinary team extracted the clinical data and laboratory results of all patients diagnosed with COVID-19 by RT-PCR and admitted to the ICU department in March and April 2020. Data are presented as means, apart from laboratory data where patients had more than one set of results in 24 hours, when median results were calculated for each 24-h period. Results: Twenty-five patients were admitted to ICU (table 1). Presenting comorbidities included hypertension in 10, cardiovascular disease in 5 and diabetes mellitus in 8 patients. Lipoprotein median concentrations demonstrated initial reduction at admission to ICU, followed by rise in concentration during ICU stay (table 1 and figure 1). A significant negative correlation was observed between ICU outcome and HDL-C area under the curve (AUC) (R=-0.506, p=0.004) and LDL-AUC (R=-0.575, p=0.003). Delta LDL-AUC had the strongest correlation with ICU length of stay (LOS) (R=0.455, p=0.02), hospital LOS (R=0.484, p=0.02) and ICU outcomes (R=-0.454, p=0.02). Individual lipoprotein parameters did not demonstrate significant correlation. [Formula presented] [Formula presented] Conclusions: Lipoprotein concentrations (HDL-C and LDL-C) upon ICU admission are low in severe COVID-19 pneumonia patients and subsequent changes in concentrations may be associated with patient outcomes.
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Emergencies can cause disruption to education. This study is unique in providing the first empirical systematic review on teacher support for Emergency Remote Education (ERE) from 2010 to 2020. A total of 57 studies emerged from the PRISMA search. This mixed-method study used deductive and inductive iterative methods to examine the data. The data reveal teacher support strategies from across 50 different high and low-income countries. Few studies focused on a teacher’s subject and the age range taught. In the examination of professional development provided to prepare K-12 teachers to conduct ERE, eight codes emerged from the grounded coding as;1) prior preparation, 2) understanding ERE, 3) needs analysis, 4) digital pedagogical strategies, 5) technology tools, 6) frameworks, 7) digital equity, and 8) mental wellness. © 2021 ISTE.
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Purpose Forewarned by the early COVID-19 experience elsewhere, and the need to create a COVID-safe environment for lung transplant (LTx) patients and their attendant health care workers (HCW), we radically re-structured our ambulatory out-patient model. We replaced our hospital-centric approach, with an entirely home-based telehealth service, that involved the majority of the LTx staff also working remotely from home. Methods Our hospital's LTx service manages over 800 post-LTx patients. From March 2020, LTx staff were instructed to work from home. Exceptions included the in-patient care team, the LTx pharmacist and one LTx physician;both of whom provided liaison between the home-based team and the hospital. The hospital's telehealth portal was used for patient consults, and daily clinics were established. Administrative, nursing, allied health, and physician staff were provided with computers, as well as remote access to the hospital's electronic medical record. Microsoft Teams facilitated communication between team members during clinic. LTx drugs were remotely e-ordered and then posted from the hospital. Pathology slips were emailed to patients and requested bloods were collected locally. Patients received weekly service updates via the Mailchimp email platform. The in-patient LTx team were available for critical in-person assessments, specifically for patients early post-LTx. Results Our LTx service remained operational despite two COVID-19 waves in 2020. To date, 66 LTx have been performed;an 11% drop in activity compared to 2019. The LTx team have remotely provided >175 medical and allied health reviews/wk. In-person reviews were limited to <10/wk. Over 20,000 separate LTx drugs were posted out providing uninterrupted access to LTx-critical medications. Access to spirometry and bronchoscopy remains suboptimal. Despite widespread community transmission, there was no COVID-19 infection in our LTx team, and only a single episode of self-limiting community-acquired COVID-19 infection in our wider LTx patient population. Conclusion Reflecting the need to also provide a COVID-safe environment for HCW, we established a completely remote ambulatory service that maintained both LTx patients and LTx HCW at home. Whilst COVID-19 infections have been avoided, future studies will need to assess whether remote access to LTx has impacted on non-COVID morbidity and mortality in our LTx population.
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BACKGROUND: The COVID-19 pandemic has resulted in many changes to clinical practice, including the introduction of remote clinics. Those familiar with remote clinics have reported benefits to their use, such as patient satisfaction and cost benefits; however, ongoing challenges exist, including delivering optimal patient-centred care. As a tertiary paediatric surgery unit in the UK, completing remote clinics was a new experience for most of our surgical team. We completed a service evaluation early into the COVID-19 pandemic aiming to define and address issues when delivering remote clinics in paediatric surgery. Remote clinics were observed (telephone and video), with follow-up calls to families following the consultations. RESULTS: Eight paediatric surgeons were observed during their remote clinics (telephone n = 6, video n = 2). Surgeons new to remote clinics felt their consultations took longer and were reluctant to discharge patients. The calls did not always occur at the appointed time, causing some upset by parents. Prescription provision and outpatient investigations led to some uncertainty within the surgical team. Families (n = 11) were called following their child's appointment to determine how our remote clinics could be optimised. The parents all liked remote clinics, either as an intermediate until a face-to-face consultation or for continued care if appropriate.Our findings, combined by discussions with relevant managers and departments, led to the introduction of recommendations for the surgical team. An information sheet was introduced for the families attending remote clinics, which encouraged them to take notes before and during their consultations. CONCLUSIONS: There must be strong support from management and appropriate departments for successful integration of remote clinics. Surgical trainees and their training should be considered when implementing remote clinics. Our learning from the pandemic may support those considering integrating remote clinics in the future.