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1.
Gut ; 71(Suppl 3):A24, 2022.
Article in English | ProQuest Central | ID: covidwho-2064222

ABSTRACT

The COVID-19 pandemic has presented unique challenges. Beyond the direct COVID-related mortality in those with liver disease, we sought to determine the effect of lockdown on people with liver disease in Scotland. The effect of lockdown on those with alcohol-related disease is of interest;and whether there were associated implications for a change in alcohol intake and consequent presentations with decompensated disease.We performed a retrospective analysis of patients admitted to seven Scottish hospitals with a history of liver disease between 1 April and 30 April 2020 (n=111) and compared across the same time in 2017, 2018 and 2019 (n=348). We also repeated an intermediate assessment based on a single centre to examine for delayed effects between 1 April and 31 July 2020 (n=89) compared to the same time period in 2017–2019 (n=284). Information was collected on patient demographics, disease characteristics, length of stay and inpatient mortality.We found that results and outcomes for patients admitted in 2020 were similar to those in previous years in terms of morbidity, mortality, and length of stay. In the Scotland-wide cohort: admission UKELD (United Kingdom Model for End-Stage Liver Disease) (56 (52–60) vs 54 (50–60);p<0.01), inpatient mortality ((10.9% vs 8.6%);p=0.499) and length of stay (8 days (4–15) vs 7 days (4–13);p=0.140). In the single centre cohort: admission UKELD (57 (53–62) vs 57 (53–60);p=0.246), inpatient mortality ((13.7% vs 10.1%;p=0.373) and length of stay (7 days (4–14) vs 7 days (3.5–14);p=0.525)).In the Scotland wide cohort, patients admitted in 2020 had a significantly higher serum sodium at presentation (137 (132–140) vs 135 (130–138) p<0.01)This group also had lower rates of HCC (1.8% vs 7.2%;p=0.04)In the single centre cohort, patients admitted in 2020 had lower rates of hepatic encephalopathy (21.3% vs 35.9%;p=0.01) and were less likely to be admitted due to decompensation (70.8% vs 82.7%;p=0.01). This assessment of immediate and medium-term lockdown impacts on those with chronic liver disease suggested a minimal effect on the presentation of decompensated liver disease to secondary care in terms of patient outcomes.

2.
Public Administration and Policy ; 25(2):109-123, 2022.
Article in English | ProQuest Central | ID: covidwho-1992554

ABSTRACT

Purpose>To show that establishing an anti-corruption agency (ACA), by itself, is not likely to be a successful anti-corruption strategy. Instead, a solid base of social trust, participation, and support is just as essential as creating an ACA with significant powers and resources.Design/methodology/approach>This is a historical review of the origins and development of the Independent Commission Against Corruption (ICAC) of Hong Kong, and an assessment of its three-pronged approach strategy at both strategic and tactical levels.Findings>An ACA requires broad and deep social support and participation if it is to succeed. That the ICAC remains nearly unique in developing such a base of support provides important lessons for those countries with ineffective ACAs.Originality/value>A reassessment of the ICAC after a half-century shows that the Hong Kong case, despite its familiarity, has much to teach us if we understand it in its broadest implications.

3.
Front Immunol ; 12: 785349, 2021.
Article in English | MEDLINE | ID: covidwho-1911033

ABSTRACT

SARS-CoV-2 infections present a tremendous threat to public health. Safe and efficacious vaccines are the most effective means in preventing the infections. A variety of vaccines have demonstrated excellent efficacy and safety around the globe. Yet, development of alternative forms of vaccines remains beneficial, particularly those with simpler production processes, less stringent storage conditions, and the capability of being used in heterologous prime/boost regimens which have shown improved efficacy against many diseases. Here we reported a novel DNA vaccine comprised of the SARS-CoV-2 spike protein fused with CD40 ligand (CD40L) serving as both a targeting ligand and molecular adjuvant. A single intramuscular injection in Syrian hamsters induced significant neutralizing antibodies 3-weeks after vaccination, with a boost substantially improving immune responses. Moreover, the vaccine also reduced weight loss and suppressed viral replication in the lungs and nasal turbinates of challenged animals. Finally, the incorporation of CD40L into the DNA vaccine was shown to reduce lung pathology more effectively than the DNA vaccine devoid of CD40L. These results collectively indicate that this DNA vaccine candidate could be further explored because of its efficacy and known safety profile.


Subject(s)
CD40 Ligand/immunology , COVID-19/immunology , Mesocricetus/immunology , SARS-CoV-2/immunology , Spike Glycoprotein, Coronavirus/immunology , Vaccines, DNA/immunology , Adjuvants, Immunologic/pharmacology , Animals , Antibodies, Neutralizing/immunology , Antibodies, Viral/immunology , COVID-19/virology , Cell Line , Female , HEK293 Cells , Humans , Lung/immunology , Lung/virology , Mesocricetus/virology , Models, Animal , Vaccination/methods , Vaccines, Inactivated/immunology
4.
Frontiers in immunology ; 12, 2021.
Article in English | EuropePMC | ID: covidwho-1652330

ABSTRACT

SARS-CoV-2 infections present a tremendous threat to public health. Safe and efficacious vaccines are the most effective means in preventing the infections. A variety of vaccines have demonstrated excellent efficacy and safety around the globe. Yet, development of alternative forms of vaccines remains beneficial, particularly those with simpler production processes, less stringent storage conditions, and the capability of being used in heterologous prime/boost regimens which have shown improved efficacy against many diseases. Here we reported a novel DNA vaccine comprised of the SARS-CoV-2 spike protein fused with CD40 ligand (CD40L) serving as both a targeting ligand and molecular adjuvant. A single intramuscular injection in Syrian hamsters induced significant neutralizing antibodies 3-weeks after vaccination, with a boost substantially improving immune responses. Moreover, the vaccine also reduced weight loss and suppressed viral replication in the lungs and nasal turbinates of challenged animals. Finally, the incorporation of CD40L into the DNA vaccine was shown to reduce lung pathology more effectively than the DNA vaccine devoid of CD40L. These results collectively indicate that this DNA vaccine candidate could be further explored because of its efficacy and known safety profile.

5.
BMJ Open Gastroenterol ; 9(1)2022 01.
Article in English | MEDLINE | ID: covidwho-1612991

ABSTRACT

BACKGROUND AND AIMS: SARS-CoV-2 and consequent pandemic has presented unique challenges. Beyond the direct COVID-related mortality in those with liver disease, we sought to determine the effect of lockdown on people with liver disease in Scotland. The effect of lockdown on those with alcohol-related disease is of interest; and whether there were associated implications for a change in alcohol intake and consequent presentations with decompensated disease. METHODS: We performed a retrospective analysis of patients admitted to seven Scottish hospitals with a history of liver disease between 1 April and 30 April 2020 and compared across the same time in 2017, 2018 and 2019. We also repeated an intermediate assessment based on a single centre to examine for delayed effects between 1 April and 31 July 2020. RESULTS: We found that results and outcomes for patients admitted in 2020 were similar to those in previous years in terms of morbidity, mortality, and length of stay. In the Scotland-wide cohort: admission MELD (Model for End-stage Liver Disease) (16 (12-22) vs 15 (12-19); p=0.141), inpatient mortality ((10.9% vs 8.6%); p=0.499) and length of stay (8 days (4-15) vs 7 days (4-13); p=0.140). In the Edinburgh cohort: admission MELD (17 (12-23) vs 17 (13-21); p=0.805), inpatient mortality ((13.7% vs 10.1%; p=0.373) and length of stay (7 days (4-14) vs 7 days (3.5-14); p=0.525)). CONCLUSION: This assessment of immediate and medium-term lockdown impacts on those with chronic liver disease suggested a minimal effect on the presentation of decompensated liver disease to secondary care.


Subject(s)
COVID-19 , End Stage Liver Disease , Communicable Disease Control , Humans , Retrospective Studies , SARS-CoV-2 , Scotland/epidemiology , Severity of Illness Index
6.
Trends in Anaesthesia and Critical Care ; 2021.
Article in English | ScienceDirect | ID: covidwho-1180040

ABSTRACT

Background COVID-19 is a global pandemic with many patients requiring prolonged mechanical ventilation. COVID-19 is associated with laryngeal oedema and a high rate of reintubation and difficult airway. Tracheostomy insertion is an aerosol generating procedure, so we strived to make our novel technique safe for operator and patient. Aim To share our experience of a novel percutaneous tracheostomy technique, based on a case series of 18 patients with COVID-19 pneumonitis. Method Our novel percutaneous tracheostomy technique is a landmark-based approach without bronchoscopic confirmation of the correct needle placement. Blunt dissection using tracheal dilators onto the tracheal rings facilitates first pass needle insertion into the trachea. The tracheal tube is retracted into the supraglottic airway, the cuff overinflated, and a wet throat pack inserted to reduce aerosolisation. Results From March 2020 to May 2020, 38 patients with suspected or confirmed COVID-19 presented to Royal Bolton Hospital requiring invasive ventilation. 18 patients underwent percutaneous tracheostomy. 6 patients have been decannulated, 12 patients died. Mean time from intubation to tracheostomy was 6.1 days and from tracheostomy to decannulation 20.6 days. No operator developed COVID-19 symptoms. Conclusions Despite the low numbers our novel technique appears to be safe, but confirmation requires a larger controlled trial. As an institution we have avoided difficulties with reintubation and reduced our drug usage.

7.
Mil Med ; 186(9-10): e873-e878, 2021 08 28.
Article in English | MEDLINE | ID: covidwho-1007397

ABSTRACT

INTRODUCTION: Navy Medicine's Role 2 Light Maneuver (R2LM) Emergency Resuscitative Surgical Systems (ERSS) are austere surgical teams manned, trained, and equipped to provide life-saving damage control resuscitation and surgery in any environment on land or sea. Given the restrictions related to the COVID-19 pandemic, the previously established pre-deployment training pipeline for was modified to prepare a new R2LM team augmenting a Role 1 shipboard medical department. METHODS: The modified curriculum created in response to COVID-19 related restriction is compared and contrasted to the established pre-deployment R2LM ERSS curriculum. Subject Matter Experts and currently deployed R2LM members critically evaluate the two curricula. RESULTS: Both curricula included the team R2LM platform training and exposure to cadaver based team trauma skills training. The modified curriculum included didactics on shipboard resuscitation, anesthesia and surgery, shipboard COVID-19 management, and prolonged field care in austere maritime environments. CONCLUSIONS: We describe Navy Medicines R2LM ERSS capability and compare and contrast the standard R2LM pre-COVID-19 curriculum to the modified curriculum. Central to both curricula, the standard R2LM platform training is important for developing and honing team dynamics, communication skills and fluid leadership; important for the successful function austere surgical teams. Several opportunities for improvement in the pre-deployment training were identified for R2LM teams augmenting shipboard Role 1 medical departments.


Subject(s)
COVID-19 , Pandemics , Curriculum , Humans , Patient Care Team , Patient Simulation , SARS-CoV-2
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