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Liu, Z.; Le, K.; Zhou, X.; Alexander, J. L.; Lin, S.; Bewshea, C.; Chanchlani, N.; Nice, R.; McDonald, T. J.; Lamb, C. A.; Sebastian, S.; Kok, K.; Lees, C. W.; Hart, A. L.; Pollok, R. C.; Boyton, R. J.; Altmann, D. M.; Pollock, K. M.; Goodhand, J. R.; Kennedy, N. A.; Ahmad, T.; Powell, N.; Islam, M.; Croft, N.; Cipriano, B.; Francia, C.; Khalid, N.; Kingston, A.; Lee, I.; Lehmann, A.; Naik, K.; Samuels, K.; Plaatjies, N.; Khatun, H.; Bokth, F.; Pabriaga, E.; Saich, R.; Cousins, H.; Fraser, W.; Thomas, R.; Brown, M.; White, B.; Kirkineziadis, N.; Tilley, B.; Porter, P.; Bryant, R.; Robaczewska, N.; Muhammed, R.; Bi, R.; Cotter, C.; Grove, J.; Hong, K.; Howman, R.; Clayton, S.; Rogers, L.; Sultan, S.; Rooney, M.; Cottrill, C.; Singh, S.; Dawe, C.; Hull, R.; Silva, N.; Chadwick, J.; Robertson, L.; Manning, J.; Finlayson, L.; Roebuck, A.; Dawson, J.; Sonwalkar, S.; Chambers, N.; Robinson, M.; Haigh, A.; Matapure, L.; Raine, T.; Kapizioni, C.; Strongili, K.; Thompson, T.; Ahmed, M.; Kontos, C.; Dawson, C.; Bourges, C.; Barbutti, I.; Gozzard, M. E.; Hendy, P.; Bull, R.; Costa, P.; Davey, L.; Hannington, H.; Nundlall, K.; Martins, C.; Avanzi, L.; Carungcong, J.; Barr, S.; Appleby, R.; Johnson, E.; Shakweh, E.; Phillis, K.; Gascoyne, R.; Crowder, A.; Whileman, A.; London, I.; Grounds, J.; Martin, E.; Pajak, S.; Price, J.; Cawley, K.; Powell, S.; Kearsley, N.; Dhar, A.; Brown, E.; Cowton, A.; Warner, B.; Stuart, C.; Lacey, L.; de Silva, S.; Allcock, C.; Harvey, P.; Jones, L.; Cooke, E.; Slater, J.; King, D.; Brooks, J.; Baker, P.; Beadle, H.; Cruz, C.; Potter, D.; Collum, J.; Masters, F.; Kumar, A.; Coetzee, S.; Peiu, M.; Icke, B.; Raj, M.; Gaynor, E.; Chadokufa, S.; Huggett, B.; Meghari, H.; El-Khouly, S.; Kiparissi, F.; Girshab, W.; Russell-Walker, L.; Jackson, C.; Sidler, S.; Claridge, A.; Fowler, E.; McCafferty, L.; Haxton, L.; Irving, P.; Christodoulides, K.; Clifford, A.; Dawson, P.; Honap, S.; Lim, S.; Luber, R.; Mahiouz, K.; Meade, S.; Raymode, P.; Reynolds, R.; Stanton, A.; Tripoli, S.; Hare, N.; Odukwe, S.; Balachandran, S.; North, E.; North, J.; Browne, B.; Cordle, J.; Jameson, E.; Siaw, Y. H.; Manzano, L.; Segal, J.; Al-Bakir, I.; Khakoo, I.; Portukhay, S.; Thoua, N.; Davidson, K.; Miah, J.; Canclini, L.; Hall, A.; Furreed, H.; Mitchell-Inwang, C.; Hayes, M.; Myers, S.; Talbot, A.; Turnbull, J.; Whitehead, E.; Stamp, K.; Pattinson, A.; Mathew, V.; Sherris, L.; Wilcox, J.; Ramachandran, S.; Robertson, H.; Harvey, A.; Hicks, L.; Byrne, T. M.; Cabreros, L.; Downing-Wood, H.; Hunter, S.; Saifuddin, M. A.; Prabhudev, H.; Balarajah, S.; Krucznski, J.; Driva, K.; D'Mello, A.; Shah, P.; Castro-Seoane, R.; Ibraheim, H.; Constable, L. E.; Lo, J. W.; Torkizadeh, M.; Hermangild, S. K.; Sutherland, H.; Wilhelmsen, E.; Mackintosh, K.; Verma, A. M.; Sebastian, J.; Peerally, M. F.; Guerdette, A. M.; Coburn, S.; Novem lam, C. Y.; Durrant, D.; Schaefer, B.; Serna, S.; Shahzad, M.; Kent, A.; Choong, L. M.; Pantaloni, B.; Ravdas, P.; Vadamalayan, B.; Foley, S.; Arnold, B.; Heeley, C.; Lovegrove, W.; Sowton, D.; Allsop, L.; Gregory, H.; Gill, M.; Holmes, M.; Balan, V.; Turner, S.; Smith, P. J.; Steel, A.; Bretland, G.; King, S.; Lofthouse, M.; Rigby, L.; Subramanian, S.; Tyrer, D.; Martin, K.; Probert, C.; Kamperidis, N.; Adedoyin, T.; Baden, M.; Chacko, F.; Young, L.; Cicchetti, M.; Saifuddin, M.; Yesupatham, P.; Gowda, R.; Williams, M.; Kemp, K.; Akhand, R.; Gray, G.; John, A.; John, M.; Mohammed, T.; Sathe, D.; Jones, N.; Soren, J.; Sprakes, M.; Burton, J.; Kane, P.; Lupton, S.; Bartholomew, J.; Denis, E.; Daniels, A.; MacFaul, G.; Scaletta, D.; Siamia, L.; Williams, F.; Green, C.; Ver, Z.; Lamb, C.; Doona, M.; Hogg, A.; Jeffrey, L.; King, A.; Speight, R. A.; Doyle, J.; Owen, R.; Haworth, J.; Patterson, L.; Varnaulasingam, V.; Mowat, C.; Rice, D.; MacFarlane, S.; MacLeod, A.; Mohammed, S.; Murray, S.; Elliott, A.; Anne Morris, M.; Coke, L.; Hindle, G.; Kolokouri, E.; Wright, C.; Lee, C.; Ward, N.; Dann, A.; Lockett, M.; Cranfield, C.; Jennings, L.; Srivastava, A.; Ward, L.; Jeynes, N.; Ranga, P.; Rajasekhar, P.; Gallagher, L.; Ward, J.; Basnett, R.; Murphy, J.; Parking, L.; Lawson, E.; Short, S.; Devadason, D.; Moran, G.; Khan, N.; Tarr, L.; Olivia, C.; Warbarton, S.; Kelly, S.; Limdi, J.; Goulden, K.; Javed, A.; McKenzie, L.; Melville, J.; Liu, E.; Sabine, J.; Jacob, P.; McSorland, D.; Schofield, N.; Cornwall, L.; Quirke, J.; Crook, E.; Turner, A.; Bhandari, P.; Baker-Moffatt, M.; Dash, J.; Le Poidevin, A.; Downe, H.; Bombeo, L.; Blackman, H.; Smith, R.; Wiles, A.; Bloxham, H.; Dias, J.; Nadar, E.; Curgenven, H.; Gilham, E.; Macdonald, J.; Finan, S.; McMeeken, F.; Mahmood, M.; Shields, S.; Seenan, J. P.; DeSilva, D.; Malkakorpi, S.; Carson, R.; Lawrence, H.; Boateng, O.; Kpodo, F.; Whiteoak, S.; Edger-Earley, K.; Vamplew, L.; Samways, J.; Roffe, S.; Ingram, S.; James, J.; Botfield, S.; Hammonds, F.; James, C.; Berry, Z.; Aspinall, G.; Hawkins, S.; Parkinson, M.; Gardner-Thorpe, H.; Marriott, S.; Redstone, C.; Windak, H.; Adam, A. M.; Mabb, H.; Stevenson, E.; Record, J.; Murray, C.; Diaba, C.; Joseph, F.; Pakou, G.; Gleeson, Y.; Nunag, A.; Berrill, J.; Stroud, N.; Pothecary, C.; Roche, L.; Turner, K.; Deering, L.; Israel, L.; Baker, E.; Nash, M.; Fagbemi, A.; Jennings, F.; Mayor, I.; Wilson, J.; Wheeler, A.; Phillips, N.; Gordon, J.; Levell, E.; Zagalo, S.; Hoad, I.; Anil, B.; Russell, R.; Henderson, P.; Millar, M.; Alexakis, C.; Michalak, N.; Marriott, C.; Stone, S.; Pristopan, V.; Saunders, J.; Burton, H.; Cambridge, V.; Clark, T.; Ekblad, C.; Hierons, S.; Katebe, J.; Saunsbury, E.; Perry, R.; Brookes, M.; Davies, K.; Green, M.; Plumbe, A.; Ormerod, C.; Christensen, H.; Howlett, H.; Keen, A.; Ogor, J.; Greenhaigh, M.; Knowles, K.; Yin, S.; Poulaka, M.; Anthony, A.; Newitt, E.; Trim, F.; Casey, R.; Seymour, K.; Reed, C.; Joy, L.; Fogden, E.; Russell, K.; Hussain, S.; Phillips, A.; Abdulla, M.; Butterworth, J.; Adams, C.; Carnahan, M.; Buckingham, E.; Childs, D.; Magness, A.; Stickley, J.; Motherwell, N.; Tonks, L.; Gibson, H.; Wistance, K.; Thomas, C.; Brinkworth, E.; Connor, L.; Cook, A.; Rees, T.; Harford, R.; Farley, S.; Jones, M.; Wesley, E.; Moss, A.; Lucas, J.; Lorimer, C.; Oleary, M.; Dixon, M.; Goodchild, F.; Twenlow, R.; Pawley, C.; Ramadas, A.; Tregonning, J.; Okeke, O.; Jackson, W.; Koumoutsos, I.; George, V.; Kunhunny, S.; Laverick, S.; Anderson, I.; Smith, S.; Joyce, J.; et al..
The Lancet Gastroenterology and Hepatology ; 8(2):145-156, 2023.
Article in English | EMBASE | ID: covidwho-2211788

ABSTRACT

Background: Anti-TNF drugs, such as infliximab, are associated with attenuated antibody responses after SARS-CoV-2 vaccination. We aimed to determine how the anti-TNF drug infliximab and the anti-integrin drug vedolizumab affect vaccine-induced neutralising antibodies against highly transmissible omicron (B.1.1.529) BA.1, and BA.4 and BA.5 (hereafter BA.4/5) SARS-CoV-2 variants, which possess the ability to evade host immunity and, together with emerging sublineages, are now the dominating variants causing current waves of infection. Method(s): CLARITY IBD is a prospective, multicentre, observational cohort study investigating the effect of infliximab and vedolizumab on SARS-CoV-2 infection and vaccination in patients with inflammatory bowel disease (IBD). Patients aged 5 years and older with a diagnosis of IBD and being treated with infliximab or vedolizumab for 6 weeks or longer were recruited from infusion units at 92 hospitals in the UK. In this analysis, we included participants who had received uninterrupted biological therapy since recruitment and without a previous SARS-CoV-2 infection. The primary outcome was neutralising antibody responses against SARS-CoV-2 wild-type and omicron subvariants BA.1 and BA.4/5 after three doses of SARS-CoV-2 vaccine. We constructed Cox proportional hazards models to investigate the risk of breakthrough infection in relation to neutralising antibody titres. The study is registered with the ISRCTN registry, ISRCTN45176516, and is closed to accrual. Finding(s): Between Sept 22 and Dec 23, 2020, 7224 patients with IBD were recruited to the CLARITY IBD study, of whom 1288 had no previous SARS-CoV-2 infection after three doses of SARS-CoV-2 vaccine and were established on either infliximab (n=871) or vedolizumab (n=417) and included in this study (median age was 46.1 years [IQR 33.6-58.2], 610 [47.4%] were female, 671 [52.1%] were male, 1209 [93.9%] were White, and 46 [3.6%] were Asian). After three doses of SARS-CoV-2 vaccine, 50% neutralising titres (NT50s) were significantly lower in patients treated with infliximab than in those treated with vedolizumab, against wild-type (geometric mean 2062 [95% CI 1720-2473] vs 3440 [2939-4026];p<0.0001), BA.1 (107.3 [86.40-133.2] vs 648.9 [523.5-804.5];p<0.0001), and BA.4/5 (40.63 [31.99-51.60] vs 223.0 [183.1-271.4];p<0.0001) variants. Breakthrough infection was significantly more frequent in patients treated with infliximab (119 [13.7%;95% CI 11.5-16.2] of 871) than in those treated with vedolizumab (29 [7.0% [4.8-10.0] of 417;p=0.00040). Cox proportional hazards models of time to breakthrough infection after the third dose of vaccine showed infliximab treatment to be associated with a higher hazard risk than treatment with vedolizumab (hazard ratio [HR] 1.71 [95% CI 1.08-2.71];p=0.022). Among participants who had a breakthrough infection, we found that higher neutralising antibody titres against BA.4/5 were associated with a lower hazard risk and, hence, a longer time to breakthrough infection (HR 0.87 [0.79-0.95];p=0.0028). Interpretation(s): Our findings underline the importance of continued SARS-CoV-2 vaccination programmes, including second-generation bivalent vaccines, especially in patient subgroups where vaccine immunogenicity and efficacy might be reduced, such as those on anti-TNF therapies. Funding(s): Royal Devon University Healthcare NHS Foundation Trust;Hull University Teaching Hospital NHS Trust;NIHR Imperial Biomedical Research Centre;Crohn's and Colitis UK;Guts UK;National Core Studies Immunity Programme, UK Research and Innovation;and unrestricted educational grants from F Hoffmann-La Roche, Biogen, Celltrion Healthcare, Takeda, and Galapagos. Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

2.
Int J Environ Res Public Health ; 20(1), 2022.
Article in English | PubMed | ID: covidwho-2200056

ABSTRACT

The increasing burden of non-communicable diseases (NCDs), particularly cardiovascular diseases (CVD) in low- and middle-income countries (LMICs) poses a considerable threat to public health. Community-driven CVD risk screening, referral and follow-up of those at high CVDs risk is essential to supporting early identification, treatment and secondary prevention of cardiovascular events such as stroke and myocardial infarction. This protocol describes a multi-country study that aims to implement and evaluate a community health worker (CHW)-led CVD risk screening programme to enhance referral linkages within the local primary care systems in sub-Saharan Africa (SSA), using a participatory implementation science approach. The study builds upon a prior community-driven multicentre study conducted by the Collaboration for Evidence-based Health Care and Public Health in Africa (CEBHA+). This is a participatory implementation research. The study will leverage on the CVD risk citizen science pilot studies conducted in the four selected CEBHA+ project countries (viz. Ethiopia, Rwanda, Malawi, and South Africa). Through planned engagements with communities and health system stakeholders, CHWs and lay health worker volunteers will be recruited and trained to screen and identify persons that are at high risk of CVD, provide referral services, and follow-up at designated community health clinics. In each country, we will use a multi-stage random sampling to select and then screen 1000 study participants aged 35-70 years from two communities (one rural and one urban). Screening will be done using a simple validated non-laboratory-based CVD risk assessment mobile application. The RE-AIM model will be used in evaluating the project implementation outcomes, including reach, fidelity, adoption and perceived effectiveness. Developing the capacities of CHWs and lay health worker volunteers in SSA to support population-based, non-invasive population-based CVD risk prevention has the potential to impact on early identification, treatment and secondary prevention of CVDs in often under-resourced communities. Using a participatory research approach to implementing mobile phone-based CHW-led CVD risk screening, referral and follow-up in SSA will provide the evidence needed to determine the effectiveness of CVD risk screening and the potential for scaling up in the wider region.

3.
Neuropsychopharmacology ; 47(Supplement 1):92-93, 2022.
Article in English | EMBASE | ID: covidwho-2185747

ABSTRACT

Background: Posttraumatic stress disorder (PTSD) is common, can be chronic and debilitating, and has high human and economic costs to individuals, families, and society. While existing trauma exposure-based psychotherapies show high efficacy, many PTSD patients decline trauma-focused therapy, and meta-analyses report 30-50% of PTSD patients treated with trauma-focused therapy do not show clinically meaningful improvement, suggesting "one size may not fit all". Accumulating evidence finds clinically significant efficacy of 8 wk group mindfulness-based approaches like Mindfulness-based Cognitive Therapy (MBCT) for acute depression, anxiety, and PTSD, in addition to original target of relapse prevention for depression and substance use disorders, warranting more research on efficacy for PTSD and potential neural mechanisms. We reported in 2016 that a mindfulnessbased intervention for PTSD led to increased resting state functional connectivity (rsFC) between posterior cingulate cortex (PCC, key node of Default Mode Network, DMN) and dorsolaterasl prefrontal cortex (dlPFC, key node of frontoparietal network, FPN);and mindfulness-associated increased PCC-dlPFC rsFC has since been independently replicated by 3 laboratories. In 2017 we registered hypotheses with NCCIH (R61 "Go-criteria") that MBCT - compared to an active Mind-body comparator, progressive muscular relaxation (PMR) - would lead to increased PCC-dlPFC rsFC, and both MBCT and PMR would lead to decreased PCC-insula rsFC (which is increased in PTSD). Method(s): We conducted a randomized controlled trial (RCT) with PTSD patients comparing MBCT to an active mind-body control (PMR, designed to be structurally similar to MBCT but no mindfulness instruction) using cluster randomization (blinded to assignment during recruitment). Functional MRI (3T GE scanner) scans were collected at intake and within 3 weeks post-treatment. We consented 161 persons from the community, and enrolled 77 with PTSD diagnosis by CAPS-5 and intake fMRI scan. Due to COVID pandemic, 22 patients were lost to follow-up, and interventions were shifted to remote delivery ("Zoom"), and 41 participants completed the RCT with both pre- and post-therapy fMRI scans. Assessments (CAPS-5 and HAM-D) were conducted by blinded assessors, and CGIs obtained by consensus of clinical team, and the PI and analysts were blinded. Self-report measures (PCL-5, decentering, PTSD cognitions, rumination, etc) were conducted using web-based REDCap. fMRI paradigms including resting state (8 min), a previously validated self-referential task, and a contextual processing task. We assessed rsFC using a PCC seed in CONN toolbox, and used a flexible ANOVA in SPM12 testing a time (pre- vs post-therapy) by treatment (MBCT vs PMR) interaction term. Result(s): We report results from our rsFC data testing our registered hypotheses that MBCT leads to increased PCC-dlPFC and decreased PCC-insula rsFC. Both MBCT and PMR led to clinically meaningful improvements in PTSD (MBCT mean 8.9 point CAPS-5 reduction, Hedge's g = 1.0, p < .001, PMR 10.1 point CAPS- 5 reduction, g = 1.0, p < .001), no significant between treatment effect. Both interventions were well-tolerated and had completion rates (5+ sessions) >80%, Rates of "responders" (CGI-I 1-very much or 2-much improved) were 48% MBCT and 50% PMR. In the PCC-seed rsFC ANOVA interaction Z-map we found a cluster in right dlPFC/ BA 10 MINI:(30, 48, 12), F = 20.91, Z = 3.90, k = 94 voxels, SVC pFWE=0.021. Test of the change score (pre- vs post delta) in the extracted dlPFC (5 mm sphere) beta values found significantly greater (p = .002) increase in rsFC in the MBCT group compared to the PMR group (Hedges g = 1.03). Furthermore, change in PCC-dlPFC rsFC was greater in MBCT responders vs nonresponders (p < .05, g = 0.57). Both MBCT and PMR led to decreased PCC-insula rsFC (pre vs post extracted aal insula g = - 0.35 in MBCT, g = -0.53 in PMR, p < .05). Conclusion(s): We found evidence supporting our registered hypothesis (R61 "Go-criteria") that MBCT but not PMR lead to an increase in PCC- lPFC rsFC (altered DMN-FPN cross-network connectivity). This is also consistent with recently reported findings from independent research groups. Furthermore, the increase in PCC-dlPFC rsFC was significantly related to clinical improvement (blinded CGI-I scores for PTSD) in the MBCT group only. These data further support PCC-dlPFC FC as a potential treatment target mechanism of mindfulness interventions, potentially related to increased volitional meta-cognitive attention and emotional regulation of spontaneous distressing thoughts. Both MBCT and PMR decreased PCC-insula rsFC, suggesting a general mechanism related to improvement of PTSD symptoms.

4.
Clinical Practice and Epidemiology in Mental Health ; 18(1), 2022.
Article in English | Scopus | ID: covidwho-2141196

ABSTRACT

Background: Social distancing as a preventive measure to contain the spread of the COVID-19 pandemic has resulted in many people working from home, using online digital resources. Staying at home has led to the adaptation of many work activities to allow continuity of people´s jobs. It can also affect home routines and ways of working, thereby leading to changes in behavior, as the main interest of this study. Objective: The study aimed to assess the impact on human behavior of working conditions in home office format due to social distancing. Methods: Data collection was done online, using a specific computational tool (Google Forms) for this type of research, using the Home Office Work Scale (HOWS) validated and published in Mental Health and Addiction Research in 2021, with a total sample of 1,056 valid questionnaires. After the data collection, a database was created for statistical analysis of the results. Results: More women than men volunteered to answer the questionnaire, although the results were similar between women and men. Home office work has impacts on human behavior and results in changes in routines and adaptations in people´s personal and professional lives. Conclusion: Proportionally, more women participated, and there was low participation by young and elderly people. In general, people accepted home office work and the possibility of continuing to work in this format. Changes to routines and restrictive adaptations were necessary. The limitations reported for applying the scale did not compromise the results. © 2022 Gonçalves et al.

7.
Chest ; 162(4):A2176, 2022.
Article in English | EMBASE | ID: covidwho-2060906

ABSTRACT

SESSION TITLE: Critical Systemic Disease Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Granulomatosis with polyangiitis (GPA) is a necrotizing granulomatous vasculitis affecting small-to-medium sized blood vessels. GPA is highly associated with antineutrophil cytoplasmic antibodies (ANCAs) and often triggered by environmental factors such as medications and infectious agents. Tracheobronchial stenosis and diffuse alveolar hemorrhage are serious complications of GPA. CASE PRESENTATION: A 35-year-old Caucasian male with a history of chronic sinusitis requiring balloon sinuplasty and recent tympanostomy had presented multiple times to the emergency room due to dyspnea and cough with pinkish sputum production. This was associated with sore throat and fever, which were attributed to his COVID-19 infection and treated with supportive care. Due to persistent drainage through his tympanostomy he was prescribed levofloxacin by his ENT specialist. After the second dose of levofloxacin, he developed Raynaud's phenomenon, diffuse purpuric lesions and swelling over his lower extremity, eyelids, and elbows. Four days later he developed worsening hemoptysis and dyspnea for which he was admitted for further evaluation. Laboratory findings were remarkable for peripheral eosinophilia, elevated ESR 19mm/hr, CRP 9.2mg/dl, c-ANCA 1:320 titer, positive proteinase-3 antibodies and normal p-ANCA titers. Urinalysis with microscopic hematuria. Chest CT scan showed ground glass opacity, consolidative infiltrate with subpleural sparing and minimal left bronchial stenosis. Bronchoscopy suggestive of diffuse alveolar hemorrhage. Limited lung biopsy showed ulcer and granulation tissue with abundant eosinophils, but no granulomatous inflammation noted. Pulse dose steroids and Rituximab were initiated, and rapid clinical improvement was noted. Patient was discharged on prednisone taper and Pneumocystis jiroveci prophylaxis. DISCUSSION: We believe that GPA may have been triggered by recent COVID-19 infection and levofloxacin use. Mild peripheral blood and tissue eosinophilia (<12%) has been described in GPA, however it is a rare finding. GPA and eosinophilic granulomatosis with polyangiitis (EGPA) are both ANCA vasculitis that involve lungs and kidneys. GPA presents with sinusitis, alveolar hemorrhage and high titers of PR-3 antibodies. EGPA presents with a history of atopic, asthma and high titers of myeloperoxidase-ANCA along with abundant peripheral eosinophils. Our patient best fits the diagnostic criteria for GPA with eosinophilia variant rather than EGPA. Our patient had no history of asthma or atopic disease and p-ANCA was normal, which also points away from EGPA. CONCLUSIONS: Clinicians should recognize the differential diagnosis for eosinophils in ANCA vasculitis. Early diagnosis of ANCA vasculitis and initiation of appropriate treatment is important to decrease morbidity and mortality. Reference #1: Potter MB, Fincher RK, Finger DR. Eosinophilia in Wegener's Granulomatosis. Chest 116: 1480-1483, 1999 Reference #2: Krupsky, Meir et al. Wegener's Granulomatosis With Peripheral Eosinophilia. CHEST, Volume 104, Issue 4, 1290 - 1292 Reference #3: Kitching AR, Anders HJ, et al. ANCA-associated vasculitis. Nat Rev Dis Primers. 2020 Aug 27;6(1):71. doi: 10.1038/s41572-020-0204-y. PMID: 32855422. DISCLOSURES: No relevant relationships by Afoma King No relevant relationships by Joshuam Ruiz Vega No relevant relationships by Krishna Shah no disclosure on file for Milos Tucakovic;

8.
British Journal of Social Work ; 52(6):3559-3577, 2022.
Article in English | Web of Science | ID: covidwho-2042570

ABSTRACT

The global coronavirus SARS-CoV2 (COVID-19) pandemic outbreak caused immediate, far-reaching social schisms and created unprecedented challenges for hospital social work services worldwide. Existing hospital disaster plans were inadequately equipped for pandemics and organisational plans needed to quickly adapt to respond to the increased clinical demands and unique logistical considerations triggered by the virus. Literature reviews provided little in the way of precise guidance for practitioners. Hospital social workers responded not only to a new cohort of patients, but also to all patients affected by the societal repercussions of the pandemic and by governments' attempts to mitigate the impacts of the virus. Psychosocial assessments, the bedrock of social work intervention, needed to adapt and evolve to encompass and address the exacerbation of existing social risks in new ways. This article originated from the authors' interest in identifying practice implications for hospital social work during the COVID-19 pandemic. The authors briefly outline the distinct impact of COVID-19 on psychosocial issues such as domestic and family violence, elder abuse, child protection, financial stress and social isolation. They create a forum of international hospital social work centres to develop a consensus approach for addressing these issues in the context of a social work psychosocial assessment. The global COVID-19 pandemic stretched hospital resources across the globe and presented unique challenges to social work services. Disaster response plans were not adequately applicable given their time-limited nature. The broader social repercussions of the pandemic and governments' approaches to mitigating it meant that the cornerstone of social work intervention in hospitals-psychosocial assessments-needed to consider the aggravation of social risks in entirely new ways. The authors briefly outline the impacts of the pandemic and response on psychosocial issues such as domestic and family violence, elder abuse, child protection, financial stress and social isolation. They consult international hospital social work centres and develop an agreed approach for addressing these issues in the context of a social work psychosocial assessment.

10.
Meteoritics & Planetary Science ; 57:6299-6299, 2022.
Article in English | Academic Search Complete | ID: covidwho-2012182

ABSTRACT

Introduction: The UK currently has six meteor camera networks that are coordinated through the UK Fireball Alliance (UKFAll) [1]. Together, these networks currently image much of the UK's night sky. Since its formal establishment in 2020, the UKFAll has organised field searches following two detected fireball events that dropped meteorites in the UK: one at 21:54 (UTC) 28th February 2021 in Gloucestershire, England, and another at 23:45 (UTC) 14th April 2022 in Shropshire, England. The former fireball detection led to the recovery of the Winchcombe CM chondrite, the first UK meteorite in 30 years [2-4], whilst our search for the Shropshire meteorite have not yet located any stones. Here, we report some lessons learned as a citizen-science and academic collaboration, and from engaging with both local and national communities in searching for meteorites in Gloucestershire and Shropshire, UK. Camera Networks: UKFAll includes the UK Meteor Network (UKMON), Network for Meteor Triangulation and Orbit Determination (NEMETODE), the UK Fireball Network (UKFN), the Fireball Recovery and InterPlanetary Observation Network (FRIPON), the Global Meteor Network (GMN), and the AllSky7 network. Orbital calculations and dark flight modelling are a collaborative effort by researchers from the Global Fireball Observatory based at Curtin University, Australia, as well as the University of Western Ontario, Canada, and FRIPON, France. Winchcombe: Since the Winchcombe meteorite fell during a national lockdown, we issued a press release asking residents in Gloucestershire to report possible meteorite finds following the fireball, as opposed to sending a search party immediately. This approach was successful, with the Wilcock family waking to find a pile of dark rocks and powder on their driveway, and having seen the news, collecting the material and contacting the UKMON. Following verification of the meteorite fall, and additional refinement of the strewn field, a small (~15 scientists) search party assembled in Gloucestershire on 4th March 2021. This led to the recovery of the largest 152 g stone at Rushbury House farm on 6th March 2021. Field Experience: Members of UKFAll with meteorite searching experience led small teams of 4 - 8 people. The search was conducted in a unique situation due to COVID. Care was taken to remain socially distanced at all times, which made coordination of the search efforts challenging. Positive engagement with the local community was prioritised from the outset, with team leaders contacting landowners for permission to search and emphasising our safety precautions and risk assessments. News of the meteorite fall spread quickly, and residents were very hospitable and enthusiastic about our activities. The UK countryside is full of "meteorwrongs", and the rural terrain was difficult to search due to long grass, bushes etc. A game was devised to help boost morale - and to see if a meteorite would be found in that field - where a convincing meteorwrong was thrown into each new area by one team member to be found by the search team. During the field search, we also received many enquiries. These were managed by dedicated UKFAll team members, who replied to emails and visited potential meteorite finds in the area. The press interest in the story following the announcement that the meteorite had been found was significant, with journalists soon arriving in Winchcombe. This press release came after the main UKFAll search had ended, and there were many requests from the the media for interviews. Following several busy days, a key lesson learned was to the need to have a designated media liaison for any future press releases. Shropshire: This meteorite search was carried out over six days by ~20 scientists in an agricultural area south of Shrewsbury that included grazing land for sheep, wheat and rapeseed fields, and woodland. Searching in mid-April proved more challenging due to the increased vegetation cover. In order to train more people in meteorite hunting strategy, search line leaders were alternated each day. An initial small team arrived for the first two days to engage with the community. This "recon" was used to assess the terrain, identify key areas, and obtain permissions, and to avoid inundating small communities with search teams without advance notice. Early on, we engaged with a business owner, who helped to spread the word using local social media groups. Within 24 hours, most residents in the strewn field were aware of the meteorite fall and our presence, with many families conducting their own searches of public land. On 18th April 2022, a press release with an approximate strewn field was issued to local journalists. As with Winchcombe, there was significant national media interest, despite no stone being found to date. This helped us to gain access to search areas, as several landowers were aware of the meteorite before we contacted them. [ FROM AUTHOR] Copyright of Meteoritics & Planetary Science is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

11.
Canadian Liver Journal ; 2022.
Article in English | Web of Science | ID: covidwho-2005842

ABSTRACT

BACKGROUND: Infection with chronic hepatitis C virus is a global public health concern. A recent study concluded that Canada is on track to achieve hepatitis C elimination goals set by the World Health Organization if treatment levels are maintained. However, recently a falling temporal trend in treatments in Canada was observed, with most provinces seeing a decrease before the global coronavirus pandemic. This study assesses the timing of elimination of hepatitis C in the 10 provinces of Canada. METHODS: Previously published disease and economic burden model of hepatitis C infection was populated with the latest epidemiological and cost data for each Canadian province. Five scenarios were modelled: maintaining the status quo, decreasing diagnosis and treatment levels by 10% annually, decreasing diagnosis and treatment levels by 20% annually, increasing them by 10% annually, and assuming a scenario with no post-coronavirus pandemic recovery in treatment levels. Year of achieving hepatitis C elimination, necessary annual treatments for elimination, and associated disease and economic burden were determined for each province. RESULTS: If status quo is maintained, Manitoba, Ontario, and Quebec are off track to achieve hepatitis C elimination by 2030 and would require 540, 7,700, and 2,800 annual treatments, respectively, to get on track. Timely elimination would save 170 lives and CAD$122.6 million in direct medical costs in these three provinces. CONCLUSIONS: Three of Canada's provinces-two of them most populous in the country-are off track to achieve the hepatitis C elimination goal. Building frameworks and innovative approaches to prevention, testing, and treatment will be necessary to achieve this goal.

12.
Journal of Neurology Neurosurgery and Psychiatry ; 93(9), 2022.
Article in English | Web of Science | ID: covidwho-2005429
13.
Gut ; 71:A53-A54, 2022.
Article in English | EMBASE | ID: covidwho-2005351

ABSTRACT

Introduction Good paediatric to adult transition of IBD care is important to prevent disengagement and poor disease outcomes. 1 The aim of this study was to qualitatively measure what is important to patients before they attended a new transitional service. There may be a dichotomy between the treating healthcare workers' priorities and teenagers' priorities that form a barrier to effective communication. Unprepared services can result in negative consequences for those involved2 and a greater understanding of what matters to teenagers and young adults may improve the clinicians' ability to facilitate the transition process Methods We asked 75 teenagers and young adults, aged between 14 and 21, who attended a new transitional service at a tertiary IBD unit in the North of England, to complete a survey prior to their clinic review. This 'what matters to you' survey included 12 suggestions they could circle, with no limitations on how many they selected, but a suggestion to choose up to 3 topics. The survey was conducted during the COVID- 19 pandemic and UK national lockdown, between September 2020 and September 2021 Conclusion Inflammatory bowel disease is a condition with potentially a high morbidity from physical symptoms, and it is important not to forget this as a focus of a consultation. Medical therapies and their effects on the patient were important to 48% of responders, and the transition process should include further education on treatment options with discussions of compliance. The impact on education and schooling feature as a significant topic and should be discussed during transition. Minimising the impact on education and employment should be considered when developing transitional services. Mental health wellbeing and body image were highly significant to a smaller number of patients and remain an important consideration. Interestingly not a single responder including the COVID-19 outbreak as a concern despite universally being on biological therapy or immunomodulators. It is important to note that whilst no patients reported 'smoking, drugs and alcohol' as important, risk-taking behaviours are increased in this patient population [3], they need to be sensitively discussed to become apparent and may be under-represented with the methodology used.

14.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927872

ABSTRACT

Introduction Reportedly, teaching at the bedside is declining over time. This purported decline has not been quantified. Quantifying bedside teaching is challenging, and we found only one study quantifying bedside teaching on a hospitalist service. We conducted a study to understand the prevalence of bedside teaching in our medical intensive care unit. Methods We conducted a single-center single-unit study in the medical intensive care unit of an academic tertiary care institution. We utilized a survey tool to assess perceived time spent on bedside teaching, quality of teaching, and total rounding time. In parallel, independent observers objectively measured time spent on rounds and on bedside teaching. Residents were asked to complete the survey once a week. Independent observers collected data daily and weekly averages were obtained. Results A total of 43 responses were collected over a 4-month period. Most respondents (73%) reported a total rounding time of either 90-120 min or greater than 120 min. Median reported bedside teaching time was 16-20 min with 16 respondents (37%) reporting less than 15 min and 27 respondents (63%) reporting 16 min or more. The amount of time spent on bedside teaching was reported as adequate or more than adequate by 77% (33) of respondents with 58% (25) reporting that bedside teaching was very or extremely effective in helping them learn. The mean census reported by the independent observers was 12.75 patients per team. Bedside teaching represented an average of 12% of total rounding time, 16.85 minutes per day. There was no correlation between the team census and the amount of bedside teaching. While total rounding time increased with increasing census, there was no decline in bedside teaching time. Discussion/Conclusion Medical education has evolved over time and has gradually incorporated informal teaching sessions, simulations, and mini lectures in addition to traditional bedside teaching. Despite the evolution in medical education, bedside teaching remains an integral component of post graduate medical education. Even though bedside teaching represented only 12% of total rounding time, medical residents perceived the time and quality of bedside teaching to be adequate. Strengths: Bedside teaching time was corroborated by independent observers and not limited to subjective perception of trainees. Limitations: This study was limited to one medical intensive care unit in an academic tertiary care hospital. This study was conducted during the COVID-19 pandemic which may have affected results. A small number of surveys were collected over a 4-month period. (Figure Presented).

15.
Chemistry World ; 18(11):18, 2021.
Article in English | Scopus | ID: covidwho-1887919
16.
Chemistry World ; 18(9):18-19, 2021.
Article in English | Scopus | ID: covidwho-1871188
17.
British Journal of Haematology ; 197(SUPPL 1):89-90, 2022.
Article in English | EMBASE | ID: covidwho-1861229

ABSTRACT

Restrictive transfusion thresholds are accepted as optimal blood management for patients receiving transfusions. 1 Unnecessary blood transfusions result in increased blood product shortages (exacerbated by the COVID-19 pandemic), 2 adverse patient outcomes and significant costs to health systems. 3 To improve transfusion practice, we aimed to minimise inappropriate transfusions through exploring and targeting areas of noncompliance with locally agreed red blood cell (RBC) and platelet transfusion thresholds of 80 g/l and 10∗109/l respectively. We conducted a retrospective multicycle audit over 4 months (Aug 2020, Feb 2021, May 2021 and Jun 2021) for all patients on the Haematology-Oncology ward. Standards were set at 100% compliance with local hospital guidelines. We analysed the number of RBC and platelet transfusions, pre-and post-transfusion haemoglobin and platelet counts, and clinical indications for transfusion. Actions implemented following each cycle composed of departmental meetings, teaching for foundation doctors and trainees, trust guideline updates and creation of a RBC transfusion checklist on our electronic 'EPIC' prescribing system. 4 Percentage compliance for RBC transfusions improved from 89% to 95% following actions implemented per audit cycle. Inappropriate RBC transfusions associated with discharge decreased from 10% to 1% and transfusion of two RBC units without appropriate increment decreased from 10% to 3%. Although percentage compliance of platelet transfusions did not improve from Aug 2020 to Jun 2021, they were consistently higher (97%) compared to RBC transfusions. This may be secondary to differing causes for inappropriate platelet transfusions detected each cycle. Despite inappropriate HLA-platelet use detected in the latest cycle, there are improvements in documentation to justify platelet transfusions outside normal threshold (100% in latest cycle), total number of platelets transfused and transfusion associated with discharge. Our audit has been successful in improving overall transfusion practice on the Haematology-Oncology ward. Ongoing education and re-audit will ensure this is maintained. (Table Presented).

18.
Chemistry World ; 18(12):20, 2021.
Article in English | Scopus | ID: covidwho-1857357
20.
Journal of the American College of Cardiology ; 79(9):2337-2337, 2022.
Article in English | Web of Science | ID: covidwho-1848394
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