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OBJECTIVES/GOALS: Methods for recruitment and retention of participants in research have been extensively discussed, but procedures to end studies in a way that is respectful to participants and keeps them engaged are seldom described. We relate the procedures to close a study focused on genomic DNA damage and DNA repair capacity in a longitudinal population sample. METHODS/STUDY POPULATION: Data collection, which included the provision of 30 ml blood sample along with a health status survey and anthropometric measurements, was discontinued earlier than anticipated during the fourth of a five-year Community Engaged Research (CEnR) study focused on residents of historically marginalized, low wealth communities. In collaboration with the project's Community Advisory Board, we devised a strategy to inform study participants of the study closure, which included: 1) attempts at one-on-one contact via phone, 2) provision of a study closure packet, 3) periodic mailing of study updates through study year five, 4) sustained interaction with participants through invitations to participate in additional research projects. RESULTS/ANTICIPATED RESULTS: Among 149 participants (65% female, 99% of African American descent), 106 (71%) have been reached by phone. The communication included: 1) expressions of gratitude for their participation;2) explanation of study findings to date;and 3) assurance that data analysis continued. Among those reached, 96% agreed to ongoing communication and 97% agreed to be contacted about future studies. We continue procedures to reach the remaining 43 participants. Over the study closure period, two qualitative studies offered opportunities for participants to join in focus groups (FG). The first one queried perceptions of community-based research. The response rate was 66% among 65 persons invited. The second study, focused on COVID-19 knowledge and invited 39 individuals with 24 scheduled to participate (62% response rate). DISCUSSION/SIGNIFICANCE: Translational research views the participant as an active partner. Study closure offers an opportunity to foster a long-lasting participant-research institution partnership, while also promoting participants' broad engagement and familiarity with research. Respectful research closure is an important step in CEnR.
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This paper discusses findings from a commissioned evaluation of an Australian government COVID-19 health campaign that utilised third-party influencers to increase the reach of health communication messages among culturally and linguistically diverse young people. Although the campaign was successful, interviews with select influencers and target audience members indicated that the ‘serious' tone of the health messaging was less effective and less likely to be shared and that messages should be more ‘entertaining'. Analyses of data indicated three themes providing insights into how future campaigns may benefit from a focus that draws together health information and entertainment using models already constructed in the entertainment–education field: (1) Entertaining health messages have a stronger fit with influencers who are known for their entertainment value;(2) Entertaining messages are more memorable and more likely to be shared;(3) A balance between entertainment and the signifiers of trust and credibility such as government health authority logos overcomes trust issues in the context of current health disinformation and misinformation. © The Author(s) 2023.
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SESSION TITLE: COVID-19 Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: The most reported fungal infections in patients with COVID-19 include aspergillosis, invasive candidiasis, and mucormycosis. We hereby present a case of a male who developed acute pulmonary histoplasmosis (APH) after COVID-19 infection. CASE PRESENTATION: 51-year-old male with PMHx of COVID-19 infection 3 weeks ago presenting with worsening shortness of breath. Patient had a complicated hospital course with COVID-19 treated with high doses of methylprednisolone. Patient was local to Arizona and lived on a ranch with livestock. CT chest suggestive of multilobar pneumonia and bilateral pleural effusions (Image 1). Coccidiomycosis serology came back negative. Urinary Histoplasma galactomannan antigen came back positive. The diagnosis of APH after COVID-19 infection was established. Patient was started on voriconazole. His symptoms significantly improved. Patient was discharged to skilled nursing facility with outpatient infectious disease follow-up. DISCUSSION: The current literature on APH in the setting of COVID-19 infection is limited. The few proposed mechanisms are: 1. Liberal use of high dose steroids in COVID-19 leading to reactivation of latent H. Capsulatum. 2. Systemic inflammation in COVID-19 causes interstitial lung damage permitting conidia to proliferate leading to acute infection. The Histoplasma urine antigen test is highly sensitive in the diagnosis of APH, especially in immunocompromised patients like our patient. With this case we would like to increase awareness of the possibility of rare fungal infections like APH in patients with COVID-19, as timely diagnosis and appropriate management can lead to improved outcomes. CONCLUSIONS: Rare fungal infections following COVID-19 have been documented and timely diagnosis and management are imperative to improve patient outcomes. Reference #1: Macedo, Priscila M, et al. APH following COVID-19. Case Report J.Fungi 2021 DISCLOSURES: No relevant relationships by Ali Raja no disclosure on file for Yamin Saddouk;No relevant relationships by Parita Soni No relevant relationships by Lyndie Wilkins Parker
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Background/Aims Phalangeal microgeodic syndrome (PMS) is a rare condition with only a handful of published case reports. Most of these cases are recognised in childhood, typically in Japan. It presents with pain and dusky discolouration in the digits, distinct from Raynaud's phenomenon in that the colour change is fixed and pain constant. Symptom onset is related to cold exposure with first presentation usually occurring in winter. Features on magnetic resonance imaging (MRI) are striking and characteristic, with a distinct pattern of bone marrow oedema. Methods We report five cases of MRI-proven PMS all identified in the last 12 months, with symptom onset during the winter. The patients were all female, aged between 25 and 79. One patient was already under the care of rheumatology with an established diagnosis of systemic lupus erythematosus (SLE), but the remainder were De novo referrals presenting specifically with pain and discolouration of the digits. One patient developed symptoms 2 days after receiving the first dose of Pfizer/ Biontech RNA vaccine against COVID-19. One patient had to self-isolate following a COVID-19 contact and developed symptoms shortly thereafter, although there was no proven infection in the affected individual. Results Four out of five cases were managed conservatively, with advice on maintaining core and peripheral temperature and skin integrity. Without any specific therapy, these four cases improved spontaneously to coincide with increasing seasonal temperatures. The fifth case with existing SLE was treated with intravenous pamidronate and subsequently with a calcium channel blocker, with some improvement in symptoms. Conclusion In these authors' experience, it would seem PMS is increasing in incidence. It is unclear if this relates to wider availability and image quality of MRI, clinician bias due to personal experience of more cases or a genuine increase. The winter 2020/21 was particularly cold with sub-zero conditions lasting well into May, which may have impacted on this flurry of new cases. We have identified one prior case report which describes PMS in a patient with existing connective tissue disease. Our patient with SLE appeared to have a more severe clinical presentation requiring additional medical therapy to control the symptoms compared with the four cases where PMS was a standalone condition. Dermatological manifestations of acute COVID-19 infection are well documented in children and include chilblain-like lesions and acrocyanosis. Any association between COVID-19 and PMS is purely hypothetical and would require more study to identify any true relationship.
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Background/Aims We evaluated the RCN Competency Framework for Rheumatology Nurses published in March 2020. The competency aims to support personal development plans, continuing professional development (CPD) and career progression for rheumatology nurses to advanced practice acting as a benchmarking tool, providing a framework to support succession planning and service development, forming the base for a nationwide standard curriculum for training. This evaluation explores rheumatology nurses' views of the competency, and identify benefits, limitations, and recommendations. Methods We used a sequential research design utilising a questionnaire circulated from 13 March to 25 April 2021 followed by semi-structured interviews between May 2021 and August 2021. Results 106 people responded to the survey, 99 (93%) working as adult rheumatology nurses. There were 55 (52%) band 7 nurses and a wide range of job titles. Most nurses, 93 (87%) had academic qualification at degree or Master's level. Most respondents 77 (73%) were from England. 74 (70%) found out about the competency via the RCN Rheumatology Nursing Forum Facebook page, or via the BSR website (35%). Most (71%) respondents had their present role for five years or more and 103 (50%) nurses had been in their role for more than 10 years. When asked whether they had used the competency in their practice, 57 (54%) said they had. Reasons for using it were;to provide a framework for learning, to use as a benchmarking tool, for CPD, for teaching, to demonstrate skills and knowledge, when managing others, to show managers how their role can develop. Redeployment due to COVID-19 and workforce issues were the main reason why the competency was not implemented fully. However, using it with new staff was cited as beneficial. Free text comments described very good detail and identification of learning needs, giving good understanding of the underpinning knowledge. 15 nurses responded for interviews and 14 were conducted. The average was 12 minutes totalling 171 minutes. We asked why they used the competency, for any potential strengths or limitations, how much time it took to complete, would they use it again, improvement suggestions, if they would recommend it to others, and whether it was easy to locate. People said a paediatric rheumatology module and an accessible course focussed on leadership is needed. When asked to summarise the competency in five words, one said it was 'a reliable tool to improve quality care and set standards for education of nurses'. Conclusion The competency was well received as a strengthening resource for UK rheumatology nurses. We recommended that these competencies are universally adopted. Further dissemination is required and education needs must be addressed. A development framework is planned. Further analysis will be published in 2022. A review of the competency is due in 2023.
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Introduction: The Inherited Cardiac Conditions (ICC) clinical nurse specialist (CNS) team host coffee mornings for parents and their children who are affected by cardiomyopathy. These were held in response to parents' requests to meet other families affected by the condition. Support groups for families of children with heart disease can identify positive coping strategies and the need for psychological support (Jackson et al., 2018). Since the COVID-19 outbreak in the UK, incoming calls to the nurse specialists from families were greatly increased, due to heightened anxieties surrounding COVID-19 and its potential effects on children with cardiomyopathy. Therefore, the CNS team responded by adapting the coffee morning forum to a virtual platform with questions and answers surrounding COVID-19 and cardiomyopathy. Methods: The first virtual cardiomyopathy coffee morning was held on the 23rd June 2020 via Microsoft teams, a secure and accessible platform. Parents of children with cardiomyopathy under the age of 5 years were invited. Parents were asked to submit anonymous questions prior to the morning if they wished. It aimed to be more accessible for families, rebuild a support network and help ease anxieties surrounding COVID-19 in the presence of the consultant and the clinical nurse specialists. Results: 6 families attended. Feedback from parents was collated in relation to their experience of the first virtual coffee morning via email and feedback forms. This assisted in identifying the benefits of the event and how this can be adapted for future practice i.e. more regular sessions with guest speakers. Results identified that all parents found it very reassuring, informative and it eased their anxiety in relation to COVID-19 and cardiomyopathy. Conclusions: Overall, the adaptation of the coffee morning to a virtual platform was deemed valuable as evidenced by feedback from staff and families that attended. Although the coffee morning was focused around COVID-19 for the event that took place during the pandemic, the team envisage that the focus can change in accordance with participants wishes. The virtual coffee morning is an initiative that will be incorporated into the future practice of the CNS team to further support families with children affected by cardiomyopathy.
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The current U.S. emission control requirements for on-road motor vehicles are driven by the ozone problem in the South Coast Air Basin (SoCAB) in southern California. Based on ozone modeling performed for Air Quality Management Plans (AQMPs), the SoCAB ozone attainment plan requires large (>80%) amounts of emission reductions in oxides of nitrogen (NOx) from current levels with more modest (similar to 40%) controls on Volatile Organic Compounds (VOC). The shelter in place orders in response to the 2020 COVID-19 pandemic resulted in an immediate reduction in emissions, but instead of ozone being reduced, in 2020 the SoCAB saw some of the highest observed ozone levels in decades. We used the abrupt emissions reductions from 2019 to 2020 caused by COVID-19 to conduct a dynamic model evaluation of the Community Multiscale Air Quality (CMAQ) model to evaluate whether the models used to develop ozone control plans can correctly simulate the ozone response to the emissions reductions. Ozone modeling was conducted for three scenarios: 2019 Base, 2020 business-as-usual (i.e., without COVID reductions), and 2020 COVID. We found that modeled ozone changes between 2019 and 2020 were generally consistent with the observed ozone changes. We determined that meteorology played the major role in the increases in ozone between 2019 and 2020;however, the reduction in NOX emissions also caused ozone increases in Los Angeles County and into western San Bernardino County, with more widespread ozone decreases further to the east.
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Purpose: In the Covid-19 pandemic era, corporate responsibility and accountability for maintaining employee health and safety, particularly from this pernicious virus, have become a matter of major social and economic importance. From an accountability through action perspective, this study aims to set out to evaluate the potential occupational health and safety accountability consequences of the Covid-19 pandemic. Design/methodology/approach: This paper is based upon purposive sampling of several sets of publicly available data including published research literature addressing corporate social responsibility and accountability, and the literature more specifically addressing occupational health and safety (OHS) and its reporting. Also included are recent Web-based reports and articles concerning Covid-19-related OHS government and industry sponsored guidelines for employers and their workplaces across the UK and Australia. Findings: The findings of this research highlight that firstly, the extant literature on OHS has been predominantly functionalist in its approach and that accountability through action provides an opportunity to make employers more visibly accountable for their response to Covid-19. Secondly, the paper highlights that despite recent progress on OHS issues significant concerns remained in the pre-Covid-19 era and that emerging regulations and legal obligations on employees have the potential to make OHS issues a prominent part of corporate social responsibility research. Originality/value: Disease and mental health statistics reveal the potential significance of their expansion in the Covid-19 environment, and regulatory and legal liability concerns emerge as potential drivers of renewed corporate as well as researcher attention to OHS issues. Implications for the emergence of a broader range of accountability forms and visibilities are also canvassed. © 2020, Emerald Publishing Limited.
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This paper explores the impact of neoliberalism on Australia's public higher education system. It examines flaws in the university system revealed by the COVID-19 pandemic and identifies how the conditions created by neoliberal policies have limited universities' capacity to respond to a crisis. The paper reviews the previous literature on universities, neoliberalism policies, and new public management practices. It uses data from the literature, newspapers, and contemporary documents to shape an overview of the Australian public sector university system up to 2021 and its transformation by stealth. The impact of this transformation has been a heavy reliance on international onshore student fees to fund operations, infrastructure, and research activities. COVID-19-related public health measures have caused a significant downturn in the number of international students studying in Australia, in turn, creating a financial crisis that has seen many tens of thousands of university staff losing their jobs and courses being cut. The transformation has also seen accountingization of both individual academic and university performance to become the norm. The quantified performance metrics associated with accountingization have become universities' new language, and their goal displaced ends. Revenue generation and expenditure has been privileged over making a contribution to the nation and society. We call for a radical rethinking of the public sector university mission for the ultimate benefit of the Australian community.
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Background: The Covid-19 pandemic has resulted in a rapid adoption of remote consultations in order to limit face to face clinical contact wherever appropriate, as recommended by the British Society for Rheumatology. The same clinic templates which existed for face-to-face encounters have been retrospectively adapted, without consideration of any potential difference in duration of consultations. Rheumatology practitioners from a variety of clinical backgrounds work alongside the rheumatology consultants, providing clinical care to patients with both inflammatory arthritis and connective tissue disease. Objectives: To record the duration of all scheduled telephone consultations carried out by advances rheumatology practitioners in a 4-week period. Methods: All scheduled telephone clinic encounters over a 4-week period were timed and the duration recorded in a spreadsheet. Data was collected in real time by all 8 rheumatology advanced practitioners working within the rheumatology department of a district general hospital, following each clinic episode. Results: Data was recorded from a total of 337 clinic appointments. Of these, 317 (94%) were booked as routine, 3 (0.9%) as urgent, 4 (1.2%) were expedited following an advice line contact, and 13 (3.9%) no data was recorded. 28 (8%) of the patients did not answer when contacted. 80 (24%) clinic appointments lasted 15 minutes or less, 186 (55%) lasted 16 -30 minutes, 37 (11%) lasted 31 -45 minutes, and 6 (2%) lasted 46 -60 minutes. The average duration was 22 minutes. Conclusion: Within this department, remote consultations appear to have a similar duration when compared against the traditional clinic template for a fully faceto-face clinic, with some encounters lasting significantly longer than the planned duration. This would appear to differ to telephone consultations used in other settings, such as general practice where the duration is reportedly shorter1. This may be representative of the additional complexity and co-morbidity of a typical rheumatology patient, or due to the multi-faceted nature of a rheumatology follow-up appointment2. Although remote consultations are effective in limiting risk of exposure to Covid-19, they may not offer a quicker or more efficient service compared with the face-to-face model. Further study in this field is required to evaluate this widely adopted new pattern of working.
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Case Report Wiskott-Aldrich Syndrome (WAS) is a recessive Xlinked syndrome characterized by atopic dermatitis, impaired humoral immunity, thrombocytopenia, and autoimmune disease. We present a case of diffuse alveolar hemorrhage initially thought to be bronchiolitis. A 4-month-old late preterm male with history of congenital thrombocytopenia and eczema presented with respiratory distress, hypoxia, cough, petechiae, and painful rash on day of illness (DOI) 5. He had no fever, congestion, or rhinorrhea. Rapid RSV was positive, but viral PCR including RSV and SARS-CoV-2 was negative. Admission labs were notable for thrombocytopenia (54 K/mm3), and otherwise normal leukocytes (9.8 K/mm3), hemoglobin (11.4 g/dL), and CRP (4.9 mg/L). Chest radiograph showed interstitial changes suggesting chronic lung disease. Hypoxia worsened on DOI 6 requiring critical care admission and escalation of oxygen to high flow nasal cannula. Dermatology diagnosed his rash as eczema with viral exanthem. His clinical course and radiographic finding of interstitial changes were not consistent with bronchiolitis and prompted a chest CT on DOI 8 that demonstrated extensive patchy bilateral ground glass opacities consistent with diffuse alveolar hemorrhage. PT, PTT, D-dimer, and Factor VIII activity were normal. Peripheral smear showed small scant platelets. Immunoglobulins were mildly elevated. Oxygen was weaned off by DOI 23. PJP prophylaxis was started due to mild neutropenia with presumed WAS diagnosis. Genetic testing confirmed the diagnosis of WAS. The WAS gene mutation results in a spectrum of syndromes including Wiskott-Aldrich syndrome, X-linked thrombocytopenia and X-linked neutropenia. WAS includes thrombocytopenia, atopic dermatitis, recurrent infections, and autoimmune diseases which rarely can include pulmonary capillaritis leading to diffuse alveolar hemorrhage. Here the initial diagnosis of RSV bronchiolitis was misleading, but a high index of suspicion with an atypical course lead to diagnosis and appropriate treatment and follow-up for WAS.
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Purpose: The purpose of this paper is to critique the accounting and financial orientation of Australian universities’ business model to identify the future university financial management and accounting role in universities’ strategic trajectory responding to COVID-19. Design/methodology/approach: Informed by Habermasian perspectives on change, it uses published research into university commercialisation and media commentaries on COVID-19 impacts. Findings: Australian universities have aggressively pursued an accounting-based private sector business model. Their revenue generating reliance on international student revenues has been undermined by the COVIS-19 crisis. Nonetheless, university management clings to their commercialised university identity and role colonised by the accounting structures. Fundamental change requires a reversal of this relationship. Research limitations/implications: Future research must observe and evaluate university strategic crisis reactions and their impacts on national and societal well-being with a view to identifying alternative futures. Practical implications: Universities face decisions concerning their ongoing role in society and their future approach to balancing operational strategies and the accounting influence. Social implications: This study raises the issue of whether universities should continue being seen as an export industry supporting the national economy or as knowledge, educational and social resource for their national and regional communities. Originality/value: This paper integrates research into universities over several decades into a strategic critique of their current reaction to an unprecedented global pandemic. © 2020, Emerald Publishing Limited.