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1.
Cogent Medicine ; 8, 2021.
Article in English | EMBASE | ID: covidwho-1617072

ABSTRACT

Introduction: The first wave of the COVID-19 pandemic required paediatric departments to quickly adapt to changing infection control policies, including altering physical space, pathway and rota restructuring, and adopting telemedicine platforms. As it emerged that COVID-19, as a disease entity, does not severely affect children, it became apparent the biggest challenges in delivering excellent care would be to overcome operational and organisational obstacles. Other challenges included delayed presentations of other conditions, waning staff morale and lack of paediatric specific infection control data and guidance. Methods: Our district general hospital's paediatric department established working groups comprising senior paediatricians, infection control leads and nursing managers. They regularly met during the first wave with the aim to optimise inpatient and outpatient paediatric care, agree on paediatric specific pathway changes and ensure staff morale was maintained. Actions: Paediatric doctors took over management of the paediatric emergency department (ED) to support adult services. Consultants became residents overnight to help manage ED and the requirements of a 'red' and 'yellow' admission pathway. We implemented a thrice-weekly multi-disciplinary resuscitation simulation to ensure all staff were aware of COVID adaptions to paediatric resuscitation algorithms. Weekly staff debriefs held to ensure the dissemination of pathway updates and to prioritise staff morale. Emergency funding led to the acquisition of new equipment to avoid cross-contamination with adult areas (e.g. blood gas analysers). Outpatient referrals were double-vetted by consultants and seen promptly. Over one year from January 2020, 8,104 children were seen in the clinic;4,619 (57%) were new referrals and seen face-to-face. We worked with adult services;the paediatric outpatient area was converted to an overflow adult ED. Paediatrics utilised an adult area with a larger footprint to continue face-to-face outpatient appointments. We extended our community nursing service to 7 days a week (from 5) to ensure more streamlined ambulatory care. Conclusions: Adaptability and flexibility were fundamental in implementing paediatric specific pathways. Schedule supportive team debriefs to promote staff wellbeing. Work with adult services to maintain excellent patient care throughout both specialities-we took over paediatric ED and utilised adult space to continue outpatient clinics. Anecdotally paediatricians preferred, and felt safer, undertaking face-to-face consultations for new outpatient appointments. Most children were not seen by their general practitioner prior to referral. We advocate ensuring all new outpatient referrals are seen face-to-face. Telemedicine was the preferred method for reviewing outpatient follow-ups. More research is required into the opportunities and barriers of paediatric telemedicine.

2.
J Hosp Med ; 16(3): 180-181, 2021 03.
Article in English | MEDLINE | ID: covidwho-1527022
3.
Archives of Disease in Childhood ; 106(SUPPL 1):A194, 2021.
Article in English | EMBASE | ID: covidwho-1495063

ABSTRACT

Background The COVID-19 pandemic required doctors to quickly adapt to new infection-control policies, rota restructuring and pathway changes. There was uncertainty on how the pandemic would affect paediatrics, as well as anxiety of the personal COVID-19 effects, frustration with media reporting and potential isolation with social-distancing measures. Our department recognised that both junior and senior doctors needed a platform to come together to address these feelings and reflect on them, ensuring a supportive team at work during this challenging period. Objectives To implement a supportive debrief session within the paediatric unit's teaching programme to improve team morale and reduce anxiety on the uncertainties of the pandemic. Methods During the first wave of the pandemic (April 2020- August 2020) we ran a weekly 'debrief hour' scheduled within the departmental teaching programme. Co-led by the college tutor, clinical director and trainee representatives, it was open to paediatric junior doctors and consultants. These sessions were held face-to-face and virtually. During the second wave (October 2020-February 2021) these sessions were held fortnightly and were focused on wellbeing. One week prior to each session questionnaires were completed anonymously by junior doctors to collate issues they wished to reflect on. Postdebrief surveys were completed by participants. Results We ran a total of 30 sessions. During the first wave 18 junior doctors and 5 consultants on average attended each debrief. Topics of discussion varied from difficult clinical cases and the emotional challenges of the pandemic to learning about individual approaches to mindfulness. Anecdotally junior doctors appreciated this dedicated time to 'offload' in a safe space. It helped forge bonds and personal connections within the team. Overall doctors were grateful their wellbeing was prioritised by these sessions. We took this initiative forward into the second wave where sessions became fortnightly. Our post-debrief surveys revealed that 96% (N=19) of junior doctors valued this time for team reflection and connection. 92% (N=19) found them useful. 94% (N=19) would like to see these sessions continue after the pandemic. Feedback included junior doctors 'feeling supported', 'paediatrics being the best team' and 'bonding during a worrying time'. From March 2021 these sessions will be led by the department's clinical psychologist. Conclusions • We advocate scheduling a supportive debrief session within departmental teaching programmes, especially in times of uncertainty and potential anxiety (such as global pandemics). This encourages team bonding. • Embedding debrief sessions within the teaching programme sends a clear message to junior doctors that the department prioritises and promotes the wellbeing of doctors, seeing it as an important part of their working lives. • Supportive debrief sessions allow doctors a safe space to 'offload' with their peers in a reflective, relaxed environment, thus helping create a sense of community at work and improving morale. • The department will continue to hold scheduled team debriefs, which will carry on after the pandemic. The Trust recognises the importance of championing wellbeing;moving forward time has been allocated for a clinical psychologist to lead these sessions. • We strongly recommend that budget planning includes provision for trainee wellbeing support services.

4.
Nat Prod Rep ; 38(7): 1251-1281, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1324434

ABSTRACT

Covering: July 2012 to December 2019Over the last seven years, expanding research efforts focused on sesterterpenoids has led to the isolation, identification, and characterization of numerous structurally novel and biologically active sesterterpenoids. These newly reported sesterterpenoids provide diverse structures that often incorporate unprecedented ring systems and new carbon skeletons, as well as unusual functional group arrays. Biological activities of potential biomedical importance including suppression of cancer cell growth, inhibition of enzymatic activity, and modulation of receptor signaling, as well as ecologically important functions such as antimicrobial effects and deterrence of herbivorous insects have been associated with a variety of sesterterpenoids. There has also been a rapid growth in our knowledge of the genomics, enzymology, and specific pathways associated with sesterterpene biosynthesis. This has opened up new opportunities for future sesterterpene discovery and diversification through the expression of new cryptic metabolites and the engineered manipulation of associated biosynthetic machinery and processes. In this paper we reviewed 498 new sesterterpenoids, including their structures, source organisms, country of origin, relevant bioactivities, and biosynthesis.

5.
Nat Hum Behav ; 5(2): 239-246, 2021 02.
Article in English | MEDLINE | ID: covidwho-1007623

ABSTRACT

The COVID-19 quarantine in China is thought to have reduced ambient air pollution. The overall exposure of the population also depends, however, on indoor air quality and human mobility and activities. Here, by integrating real-time mobility data and a questionnaire survey on time-activity patterns during the pandemic, we show that despite a decrease in ambient PM2.5 during the quarantine, the total population-weighted exposure to PM2.5 considering both indoor and outdoor environments increased by 5.7 µg m-3 (95% confidence interval, 1.2-11.0 µg m-3). The increase in population-weighted exposure was mainly driven by a nationwide urban-to-rural population migration before the Spring Festival coupled with the freezing of the migration backward due to the quarantine, which increased household energy consumption and the fraction of people exposed to rural household air pollution indoors. Our analysis reveals an increased inequality of air pollution exposure during the quarantine and highlights the importance of household air pollution for population health in China.


Subject(s)
Air Pollution, Indoor/statistics & numerical data , Air Pollution/statistics & numerical data , COVID-19 , Environmental Exposure/statistics & numerical data , Quarantine , Travel/trends , China , Humans , Particulate Matter , SARS-CoV-2 , Time Factors
6.
J Clin Immunol ; 40(2): 267-276, 2020 02.
Article in English | MEDLINE | ID: covidwho-829366

ABSTRACT

We report three new cases of a germline heterozygous gain-of-function missense (p.(Met1141Lys)) mutation in the C2 domain of phospholipase C gamma 2 (PLCG2) associated with symptoms consistent with previously described auto-inflammation and phospholipase Cγ2 (PLCγ2)-associated antibody deficiency and immune dysregulation (APLAID) syndrome and pediatric common variable immunodeficiency (CVID). Functional evaluation showed platelet hyper-reactivity, increased B cell receptor-triggered calcium influx and ERK phosphorylation. Expression of the altered p.(Met1141Lys) variant in a PLCγ2-knockout DT40 cell line showed clearly enhanced BCR-triggered influx of external calcium when compared to control-transfected cells. Our results further expand the molecular basis of pediatric CVID and phenotypic spectrum of PLCγ2-related defects.


Subject(s)
B-Lymphocytes/immunology , Common Variable Immunodeficiency/diagnosis , Germ-Line Mutation/genetics , Immunologic Deficiency Syndromes/diagnosis , Mutation, Missense/genetics , Phospholipase C gamma/genetics , Autoimmunity/genetics , Calcium Signaling , Cell Line , Child , Child, Preschool , Female , Humans , Infant , Male , Phenotype , Protein Domains/genetics
7.
Preprint in English | bioRxiv | ID: ppbiorxiv-233064

ABSTRACT

Development of accurate disease models and discovery of immune-modulating drugs is challenged by the immune systems highly interconnected and context-dependent nature. Here we apply deep-learning-driven analysis of cellular morphology to develop a scalable "phenomics" platform and demonstrate its ability to identify dose-dependent, high-dimensional relationships among and between immunomodulators, toxins, pathogens, genetic perturbations, and small and large molecules at scale. High-throughput screening on this platform demonstrates rapid identification and triage of hits for TGF-{beta}- and TNF--driven phenotypes. We deploy the platform to develop phenotypic models of active SARS-CoV-2 infection and of COVID-19-associated cytokine storm, surfacing compounds with demonstrated clinical benefit and identifying several new candidates for drug repurposing. The presented library of images, deep learning features, and compound screening data from immune profiling and COVID-19 screens serves as a deep resource for immune biology and cellular-model drug discovery with immediate impact on the COVID-19 pandemic.

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