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Introduction: The need for standardised education on tracheostomy care is well recognised.1 Staff frequently report a lack of confidence in caring for those with tracheostomies, as well as the management of adverse events as they occur.2 Over the past decade, healthcare providers have developed strategies to educate staff, however, the covid-19 pandemic has severely hampered the ability to provide this necessary training due to restrictions on access to training rooms, the need for social distancing and the significant clinical demands placed on both trainers and trainees.3 The potential for immersive technologies to augment healthcare training is gaining interest exponentially.4 However, its effectiveness is yet to be clearly understood and as such it is not yet common within healthcare education.5 Based on the above, we aimed to explore the potential of these immersive technologies to overcome the current challenges of tracheostomy education, and to develop future strategies to use immersive technology in healthcare education. Method(s): We received a 400,000 grant from Cardiff Capital Region (CCR) to undertake a rapid innovation project overseen by the SBRI centre of excellence. The project consisted of 3 main phases: 1) feasibility;2) development;and 3) testing. The project was officially launched in April 2021 and lasted 12 months. Project governance was provided via the SBRI for clinical excellence, a project board with representation from Welsh Government, Cardiff University and Cardiff and Vale UHB, and a project team with clinical expertise in both the delivery of tracheostomy education and the provision of simulation training in healthcare. Result(s): Phase 1: During phase one 4 industries were successful and received up to 30,000 to explore the feasibility of immersive technology to support tracheostomy education. The industries were Rescape, TruCorp, Aspire2Be and Nudge Reality. During the feasibility phase all industries focused on the emergency management process utilising existing NHS Wales tracheostomy education resources and the national tracheostomy safety programme. Phase 2: For phase 2, Rescape and Nudge Reality were chosen to develop the technology. These industries continued to work in conjunction with the project team to capture the core elements of tracheostomy care, including multi-user emergency management scenarios. Additional content was also added for bronchoscopy and insertion of intercostal drains. Phase 3: Testing of both solutions was undertaken over an 8-week period, across 6 Health Boards in NHS Wales. The results of the testing will be analysed and available for presentation in due course. Provision findings demonstrate good face and content validity with high levels of user satisfaction. Discussion / Conclusion(s): The provision of essential tracheostomy education has been severely affected by the covid-19 pandemic. Evolving immersive technologies have the potential to overcome these challenges and improve the effectiveness and efficiency of education packages in tracheostomy care and wider. Through this CCR grant, in conjunction with industry, we have developed two solutions with the potential for widescale procurement and future research on the use of immersive technologies within healthcare.
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We present three cases of patients who devel-oped acute, non-severe myocarditis following messenger RNA-1273 vaccine from Moderna (Moderna Inc.) against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A brief review of the literature, diagnostic modalities, work-up and treatment are discussed.Copyright © 2021 Authors. All rights reserved.
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Background. We developed a COVID-Influenza Combination (CIC) vaccine, comprising recombinant SARS-CoV-2 Spike (rS) and quadrivalent influenza hemagglutinin (HA) protein nanoparticles (qNIV), and Matrix-MTM adjuvant. rS/Matrix-M previously demonstrated efficacy against COVID-19 in Phase 3 trials, while qNIV/ Matrix-M previously demonstrated induction of broadly cross-reactive antibodies. Here we report preliminary safety and immunogenicity results of a first-ever Phase 1/2 CIC dose-finding trial. Methods. Seropositive (COVID-19 vaccinated >= 8 weeks prior) participants (N=642) aged 50-70 years were randomized equally, to receive two intramuscular doses, 56 days apart, to 1 of 14 different dose/formulations of CIC using a design of experiments approach (dose range: rS 2.5-22.5ug, HA5-60ug;and 50ug Matrix-M), or to 1 of 2 reference formulations of either standalone rS with Matrix-M [2 doses] or qNIV with Matrix-M [1 dose only]. Pre- and post-vaccination (Days 0, 28, 56, 70, 84, 182) immunogenicity assessments including SARS-CoV-2 anti-S IgG and influenza HAI antibodies to vaccine-homologous strains. Reactogenicity was assessed 7 days following each dose, and safety outcomes assessed through Day 70. Multiple regression was used to create predictive models to assess antibody response surfaces and for dose optimization. Results. All CIC formulations were well tolerated, with a reactogenicity and safety profile generally comparable to standalone rS or qNIV. Regression modelling of post-first dose responses revealed that both rS and HA antigens in a CIC formulation modestly interfered with each other, however, interference was overcome with dose adjustment across a range of rS/HA doses. Specifically, higher rS dose ( >20ug), in a dose dependent fashion, overcame HA interference, closely matching standalone rS IgG reference responses (GMEU 16,818), whereas lower, intermediate HA dose overcame rS interference, closely matching standalone HA reference HAI responses for H3N2 (GMT 145), H1N1 (GMT 134), and B-Victoria (GMT 66);while modestly (at least 34%) lower than the reference B-Yamagata response (GMT 101). Conclusion. CIC formulations were well tolerated and immunogenic, with various dose combinations achieving response comparable to standalone vaccines.
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Adolescence is a time when developmental and contextual transitions converge, increasing the risk for adverse outcomes across the life course. It is during this period that self-concept declines, mental health problems increase and when young people make educational and occupational plans for their future. Considerable research has shown that parent engagement in their child’s learning has positive effects on academic and wellbeing outcomes and may be a protective factor in adolescence. However, it is during adolescence that parent engagement typically declines. Most studies focus on early childhood or use cross-sectional designs that do not account for the high variability in both the child’s development and the parent-child relationship over time. In this chapter, we examine the association between parent engagement and students’ outcomes—self-concept, mental health, and educational aspirations—drawing on national data from the Longitudinal Study of Australian Children, while accounting for the school context—school belonging, peer connection problems, and bullying—and parenting styles using panel fixed effects models. We then explore perceptions of parental engagement and educational aspirations among a sample of adolescent students from highly disadvantaged backgrounds using interviews from the Learning through COVID-19 study. Findings show that parent engagement is important for students’ outcomes such as self-concept, mental health and aspirations in early and middle adolescence, even when accounting for family and school context factors. Further, parent engagement in late adolescence, with students from highly disadvantaged backgrounds, continues to be important for positive student outcomes. © 2022, The Author(s).
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In response to the growing interest in the health of natural resource-dependent communities, numerous methods have been used to monitor community well-being. However, many existing approaches lack the ability to compare well-being metrics across space and over time while maintaining community voices and perspectives in their own well-being assessment. This manuscript describes the development and implementation of a virtual methodological approach to gathering both quantitative and qualitative data about community well-being in natural resource contexts. We demonstrate application of the approach with commercial fishing communities in relation to long-term socioeconomic monitoring of the California marine protected area network. The approach involved conducting focus groups with commercial fishing “community-experts” in eighteen major California ports. Due to pandemic conditions at the time of data collection, focus groups were held online over Zoom, but the method could also be conducted in-person when health and safety protocols allow. The focus groups were guided by a well-being assessment tool, which included quantitative questions where fishing community-experts were asked to rate their port along environmental, economic, and social aspects of community well-being. An open-ended qualitative discussion followed the rating exercise for each question, after which participants were asked to re-rate the question to produce deliberative, consensus-based ratings. We describe considerations of and insights from the implementation of this approach. Future researchers and practitioners may want to consider the benefits of this approach based on two factors: (1) the mixed-methods focus groups provided a means to develop quantitative well-being metrics comparable across communities and time and introduced rich qualitative information about the context of and conditions in communities across a large spatial area;and (2) the virtual format of the focus group led to lower research costs, offered greater flexibility in scheduling, and received positive feedback from participants who communicated the benefits of being able to participate in the research experience from the comfort and convenience of their own homes. Even as COVID-19 restrictions are lifted, researchers and practitioners may want to consider keeping virtual engagement approaches as a tool in their methodological toolbox, which can open up new avenues for connection and understanding. © 2022 by the Society for Applied Anthropology.
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Introduction: As of March 2020, COVID-19 pneumonia was declared a global pandemic by the World Health Organisation (WHO).1 COVID19 pneumonia typically presents with systematic and/or respiratory manifestations, with a large percentage requiring advanced respiratory support.2 In severe cases COVID-19 pneumonia can induce acute respiratory distress syndrome leading to refractory hypoxaemia and the use of extra-corporeal life support (ECLS) may be appropriate as a rescue therapy.3 The functional outcomes of patients receiving extra-corporeal membrane oxygenation (ECMO) for COVID are unknown and this observational study will present data from the first and second wave of the pandemic. Objectives: To describe the demographics, functional outcomes and discharge needs of patients receiving ECMO for COVID-19. Methods: Adults admitted to ICU for ECMO with a confirmed diagnosis of COVID19 were included. Functional outcomes were measured using the Chelsea Physical Assessment Scale (CPAx)4 and ICU mobility score.5 Measurements were taken once patients were deemed appropriate for rehabilitation up to discharge from the hospital. Data collection and analysis was performed by two independent unblinded reviewers. Results: A total number of n34 patients were included in the review, n21 survived to hospital discharge and were included in the analysis. 71% of patients were male with an average age of 46 (±9.9) The predominant method of ECMO was veno-venous (90%). Mean duration of ECMO was 25.1 days (±19.6) The average time to mobilise post decannulation from ECMO was 10.86 days (±6.61), with an average CPAx score of 30.10 (±8.94) and ICU mobility score of 6.14 (±2.33) on ICU discharge. Functional milestones included on average achieving independent sitting balance at ∼4 weeks and mobilising +/-an aid at ∼6 weeks. There were no significant differences between patients who were mobilised within 7 days of decannulation of ECMO (P= 0.9) Patients who did not require a tracheostomy had reduced ICU length of stay (P= 0.006). There was nil significant difference between patients who received steroids for ICU length of stay (P = 0.143), CPAx (P= 0.357) or ICU mobility scores (P= 0.414) on discharge from ICU. On discharge from hospital 95% of patients required ongoing support which included the following-discharge home with community therapy, in-hospital transfer and referral to a rehabilitation centre. Conclusions: This data is the first of its kind to present the functional outcomes of patients receiving ECMO during the COVID19 pandemic. Patients receiving ECMO for COVID19 present with high acuity of illness with prolonged mechanical ventilation and ongoing rehabilitation needs at discharge from hospital. Despite a surge in ECMO bed occupancy and redeployment of staff, the therapy team were able to provide high level rehabilitation to patients and a follow up clinic was established to support ongoing needs post hospital care.
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BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic has affected over 61 million U.S. citizens, and up to 30-80% of COVID-19 survivors may go on to develop post-acute sequelae of SARS-CoV-2 (PASC). These sequelae can be debilitating and often impair quality of life and daily function. Although it has been suggested that severity of acute COVID-19 infection is directly related to PASC development, this association remains unclear. METHODS: This prospective cohort study was conducted through consecutive recruitment of confirmed and probable COVID-19 patients with persistent symptoms lasting ≥3 weeks from disease onset or positive SARS-CoV-2 test from academic PASC clinics at Emory University and Grady Memorial Hospital in Atlanta, GA during January-December 2021. Sociodemographic, comorbidity, and acute COVID-19 data were collected. Severe acute COVID- 19 was defined as requiring hospitalization, and critical acute COVID-19 required intensive care. New or worsening symptoms persisting ≥3 weeks from COVID-19 onset were collected using a standardized review of systems, and confirmed by clinician interview. Differences in PASC symptom type were assessed by calculating risk ratios (RR) and 95% confidence intervals (CI) using the Taylor series, and difference in PASC duration was assessed using student's t-test. Two-tailed p-values ≤0.05 were considered significant. RESULTS: Of 269 enrollees, median age was 52 years (range 18-93) and there were more women (74%) than men (26%). There were 152 (57%) African American, 76 (28%) White, and 21 (8%) Hispanic. Among PASC patients, the most common symptoms were dyspnea (68%), fatigue (63%), brain fog (48%), dizziness (27%), chest pain (25%), cough (23%) and headache (23%) with a median PASC duration of 132 days (range 21-523). Acute COVID-19 severity was asymptomatic in one participant, mild in 149 (55%), severe in 95 (35%), and critical in 23 (9%). Asymptomatic- mild acute COVID-19 patients had more persistent dyspnea (RR: 1.33, 95%, CI: 1.09- 1.61), fatigue (RR: 1.53, 95%CI: 1.22-1.91), brain fog (RR: 2.00, 95%CI: 1.44-2.67), dizziness (RR: 2.03, 95%CI: 1.27-3.25), and headache (RR: 2.07, 95%CI: 1.22-3.48) compared with severe-critical acute disease, who had a non-significant trend towards more cough and chest pain. Asymptomatic-mild participants were further from incident infection (153 days) compared to severe-critical participants (110 days) (p=0.04). CONCLUSIONS: Contrary to previous observations, COVID-19 survivors who experienced asymptomatic-mild infections may develop higher rates of prevalent PASC symptoms compared to those with severe- critical antecedent infections. These findings are not attributable to PASC duration, as longer PASC duration has been previously associated with fewer symptoms. To ensure early identification and linkage to specialized care, clinicians should be aware of PASC in patients with antecedent asymptomatic-mild acute COVID-19 infections.
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Firefighters are on the front lines of the COVID-19 pandemic, working to transport and treat sick patients. Fear of contracting the virus and constant vigilance of not infecting family members is a significant source of stress and impacts their well-being and physiological functioning. Aimed at addressing this stress, we implemented a 10-day app-based meditation intervention designed to reduce stressful thoughts by promoting mindfulness. Participants (N = 35) were active-duty firefighters from a large metropolitan area in the Southwest. Firefighters completed 10-minute sessions each day with the mobile app created by Healthy Minds Innovations (Madison, WI) and reported daily COVID-19-related stress and well-being. Saliva samples were taken before and after the intervention. After the intervention, firefighters reported lower anxiety symptoms, (t(32)=2.70, p=.01), lower burnout, (t(32)=2.03, p=.05), and lower negative affect, (t(25)=2.50, p=.02), lower waking cortisol (t(18) = 2.61, p =.02), and lower cortisol output across the day, (t(15) = 2.127, p =.05). Results suggest the meditation app reduced psychological/physiological distress and could be a fast, low-cost, and scalable intervention to promote well-being among firefighters.
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In the post-pandemic era, we must value our cities as cultural and economic centres, that are socially and environmentally diverse. This requires a transformation in the way we plan and govern our cities, but what can be learnt from the current crisis about how cities should be managed? In this article, we report on a scoping review to help identify seven lessons learnt for cities from the COVID-19 pandemic. We build on these lessons through a synthesis, outlining three urban missions that will chart a green urban recovery. The missions are to accelerate the urban mobility transition;to attain regenerative urban development;and create resilient urban infrastructure. We expand on what these missions entail, by defining six pathways that supports transition of urban mobility, energy, food, housing, health and nature. These pathways, when implemented in an integrated manner, provides a roadmap for green recovery in cities, that also builds resilience.
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Introduction: Racial and ethnic minorities have accounted for the majority of intensive care unit (ICU) hospitalizations for COVID-19. At the same time, ICUs were forced to deviate from long-established care processes in response to a steep increase in admissions and to prevent healthcare worker infections. These shifts may have resulted in changes to sedation practices, such as level of sedation or sedation holidays, that differed by patient race or ethnicity. We aimed to examine associations among patient race and ethnicity, sedation practices, and mortality in a large, national sample of patients receiving mechanical ventilation for COVID-19. Methods: We analyzed granular daily data from the Viral Infection and Respiratory Illness Universal Study (VIRUS) Registry for COVID-19 patients admitted to ICUs between February and November 2020. We included patients over 18 years of age, who were mechanically ventilated following clinical or PCR-confirmed COVID-19 diagnosis. We will calculate descriptive statistics for mortality at discharge and 28 days by patient race/ethnicity, sex, and two care processes associated with mechanical ventilation: sedation level and sedation holidays. We will estimate risk-adjusted, hospital-level mortality differentials by race. We will use mixed effects logistic regression and causal mediation analysis to test associations among patient race/ethnicity, sedation practices for mechanical ventilation, and mortality at 28 days, controlling for comorbidities, markers of severity, and time to admission, and adjusting for clustering by ICU. Results: Among 19,626 patients hospitalized for COVID-19, 8,668 (14.6%) received mechanical ventilation at 238 hospitals. The median age was 62 (IQR 40-72) and 45.1% were female. Among hospitalized patients, 23.3% self-identified as Hispanic, 26.6% as non-Hispanic Black, 35.6% as non-Hispanic White, and 14.5% as non-Hispanic and another racial group. Approximately 1% (n=236) of patients were missing race/ethnicity. At 28 days, 20.7% (n=4,076) of hospitalized patients were deceased. Use of benzodiazepines was highly clustered by hospital (intraclass correlation coefficient of 0.63). In cluster-adjusted analyses, Hispanic patients were more likely to receive benzodiazepines at least once during hospitalization than either non-Hispanic White (Odds Ratio (OR) 0.76, p=0.013) or non-Hispanic Black (OR 0.70, p=0.003) patients. Multivariable mixed effects and causal mediation analyses are ongoing. Conclusions: Sedation practices, such as level of sedation and sedation holidays, are associated with mortality;yet these practices may differ based on a patient's race or ethnicity. We will leverage a unique, multi-center database with granular clinical information to understand how these differences may influence racial and ethnic disparities in respiratory failure.
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Background: In response to the pandemic, our facility recognized the need to safely decompress ICUs to create space for critically ill COVID-19 patients. Stroke leadership identified select recipients of Alteplase to have care safely de-escalated from ICU to stepdown status earlier than the traditional protocol allowed. Per previous protocol, all stroke patients recovered in ICU for 24 hours post- Alteplase with 36 neurological and vital sign assessments completed. Acting upon the need to ensure patient safety and create inpatient ICU bed availability, the multidisciplinary stroke leadership team created the Fast Track Alteplase Protocol. Goals: Project goals included decreasing ICU utilization and minimizing nursing encounters at the patient bedside to decrease potential COVID-19 exposures. Methods: Protocol qualifications include both pre-Alteplase NIH Stroke Scale scores less than 10 and no large vessel occlusions or flow limiting stenosis present on imaging. Once in the protocol, to qualify for transfer out of ICU, an NIH Stroke Scale score less than 10 throughout ICU stay, noncontrast head CT or MRI to evaluate infarct burden, not require continuous anti-hypertensive medications to maintain systolic blood pressure cap, and not demonstrate hemodynamic or respiratory concerns must be achieved and completed. We developed education for nurses and physicians in ED, ICU, and stepdown patient care areas and tip sheets to guide nursing care and documentation associated with the new protocol. Electronic orders were quickly developed and integrated as a new subphase specific to the Fast Track Alteplase Protocol within an existing stroke order set. Results: The protocol decreased the number of encounters between nursing and patients from 36 to 12 interactions (66.7%) and planned time in the ICU from 24 to 12 hours (50%). The median time comparison of ICU length of stay for Fast Track vs. traditional protocol was 12 hours and 26 min vs35 hours and 15 minutes respectively. Conclusion: The protocol achieved both goals of decreasing the amount of time stroke patients arein the ICU and number of nursing encounters reducing the possibility of patient and staff exposure toCOVID-19.
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Background: Although extracorporeal therapies (ECTs) are commonly used in human medicine, they are still in their infancy in veterinary medicine and are currently only offered in referral or experimental settings. This is expected to change in coming years, with ECTs becoming more widely available throughout the profession, although we acknowledge that while the Covid-19 pandemic is ongoing the provision of some of these therapies might be reduced/altered. Aim of the article: This article provides practitioners with an introduction to the three ECTs currently offered to veterinary patients - haemodialysis, therapeutic plasma exchange and cardiopulmonary bypass.
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SARS-CoV-2 affects the cardiovascular system triggering a proinflammatory response which results in direct and indirect myocardial injury. The objective of this article is to describe the underlying mechanisms and clinical implications.