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1.
Journal of International Agricultural and Extension Education ; 29(1):22-39, 2022.
Article in English | CAB Abstracts | ID: covidwho-2100056

ABSTRACT

The COVID-19 pandemic precipitated profound disruptions across the higher education sector as institutions were forced to restructure entire systems and operate with significantly reduced resources. Most notably, many institutions were forced to transition to fully virtual instruction. The present study examined adult leadership development program participants' perceptions of online learning readiness during the transition to a fully virtual training environment precipitated by the COVID-19 pandemic. A census of the 2020 LEAD21 class was taken, and perceptions of online learning readiness were collected via a retrospective pre- and post-test. Descriptive and inferential statistics were used. Respondents had the highest levels of agreement with computer and Internet self-efficacy and the lowest levels of agreement with learner control in an online context. A paired t-test was conducted to analyze the difference in perceptions of online learning readiness post-training and retrospective pre-training. A statistically significant increase was observed for overall online learning readiness, as well as for computer and Internet self-efficacy, learner control, motivation for learning, Internet communication self-efficacy, and self-directed learning. An implication from this finding is that the transition to fully virtual training resulted in increased online learning readiness across all dimensions. With new strains of COVID-19 emerging and the potential for ongoing restrictions for social interaction, online learning will continue to be an important aspect of the educational process. It is vital that higher education leaders consider individuals' readiness to effectively engage in online training and instruction. Implications and recommendations for future research in practice in international contexts are provided.

2.
Anaesthesia ; 77(Supplement 4):33, 2022.
Article in English | EMBASE | ID: covidwho-2088122

ABSTRACT

The National Emergency Laparotomy Audit (NELA) year 7 data show Royal Derby Hospital (RDH) falls below regional Academic Health Services Network (AHSN) and national averages for admission to the critical care unit (CCU), where the predicted mortality is > 5% and > 10%. Data from years 2 to 7 show RDH met the > 10% target in years 2, 3 and 7, and the > 5% target only once in year 2. RDH is uniquely placed in having an anaesthetist-run step-down unit (SDU), but this is not considered part of the CCU within the NELA. The SDU at RDH has a daily anaesthetic consultant ward round and admits level 1 patients requiring single-organ support, including vasopressors. As such, it is possible that less severely unwell patients are admitted to the SDU, whereas in other hospitals, they are likely to go to the CCU. We investigated whether this 'shortfall' in CCU admissions compromises postoperative outcome. Methods Data from year 7 (1 December 2019 to 30 November 2020) was evaluated to see how the use of the SDU may affect the apparent 'underuse' of the CCU for patients with postoperative NELA-predicted mortality (POPM) of >= 5%. We looked at discharge destination alongside POPM and outcome to see if changes are required to improve patient care. There is no option for the SDU in the NELA database;RDH records SDU admissions as 'extended recovery'. Results Year 7 saw 234 laparotomies with POPM ranging from 0.1% to 77.7%. Table 1 shows the breakdown of discharge destination and POPM. Patients discharged to normal ward areas with POPM >= 5% (range 7-17%) were all discharged within 60 days. Seventy-five patients had POPM >= 5% with 73.3% admitted to the CCU (AHSN mean 88%). That rises to 94.7% if the SDU is included. Forty-three patients had POPM >= 10% with 79.1% admitted to the CCU (AHSN mean 90%) but 93% including the SDU. There were 17 deaths within 60 days of surgery, 15 on the CCU, one on the SDU (POPM 4.7%), and one on the ward (POPM 2.3%). Risk adjusted mortality was 8.3% (national mean 8.7%). [Table presented] Discussion The SDU reduces pressure on the CCU whilst providing anaesthetist-led care in a more intensive nursing environment than the ward. Sixty-day survival remains high, suggesting use of the SDU does not compromise patient care following emergency laparotomy. These data cover the first year of the COVID-19 pandemic, suggesting the use of the SDU may have eased capacity concerns for the CCU. Perhaps anaesthetist-led units should be considered a part of the critical care environment.

3.
International Journal of Radiation Oncology, Biology, Physics ; 114(3):e345-e345, 2022.
Article in English | Academic Search Complete | ID: covidwho-2036106

ABSTRACT

The COVID-19 pandemic disrupted medical care and reduced access to elective procedures. While prior claims-based research has shown that patients received more conservative care, little is known about how radiation therapy (RT) ordering behavior changed during the pandemic. This study examines whether the rate at which orders for lumpectomy were followed by orders for RT changed from 2019 to 2020, and whether there were changes in the percentage of RT orders that were for hypofractionated (HF) RT, rather than conventional (CF) RT. Prior authorization order data pertaining to patients from one national organization's commercial and Medicare Advantage health plans were used to perform the analysis. Included patients were females, aged 18 to 89, who had an order for a lumpectomy in 2019 or 2020. Patients were excluded if they were not continuously enrolled in their health plan for 90 days following lumpectomy. Orders were reviewed to determine whether patients had an order for RT in the 90 days following lumpectomy. Orders were classified as HF if they were for 5 to 21 fractions, CF if they were for 28 or more fractions, and as neither if they were for other numbers of fractions. Univariate analyses were conducted using Chi-square tests, and adjusted analyses were conducted using multivariate logistic regression, controlling for patient age, urbanicity, local median income (<$40,000, $40,000-$80,000, or >$80,000), region (top four CMS regions by enrollment versus all other regions), if the designated lumpectomy facility's name implied an academic affiliation, and if the designated lumpectomy facility was a hospital. There were 4,689 patients meeting inclusion criteria in 2019 and 4,383 in 2020, for a total of 9,072. In 2019, 47.1% (2,208/4,689) of patients had an RT order following lumpectomy, versus 44.6% (1,953/4,383) in 2020, a significant difference (P=0.02). Of the patients receiving RT orders meeting the definition of HF or CF, 76.3% (1,475/1,933) of orders in 2019 were for HF, and 80.5% (1,383/1,719) of orders in 2020 were for HF, a significant difference (P<0.01). Adjusted analysis found that patients in 2020 were at significantly reduced odds (OR: 0.91;95% CI: 0.83-0.99) of receiving an order for RT following lumpectomy, and among orders meeting the definition of HF or CF, there were significantly increased odds that the order was for HF (OR: 1.29;95% CI: 1.10-1.52). Patient age, region, and receipt of an order for treatment at an academic facility were significantly associated with receipt of an order for RT. Patient age, local median income, and region were all significantly associated with whether CF versus HF RT was ordered. In the population examined, physicians were less likely to order RT following lumpectomy in 2020 than in 2019, and if they did, were more likely to order HF in 2020 than in 2019. This suggests that physician ordering became more conservative in response to the pandemic. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science 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.)

4.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009590

ABSTRACT

Background: In the 1990s, it was demonstrated that Black patients were less likely to receive timely treatment for Stage 3 lung cancer than White patients. While contemporary work has found racial disparities in accessing insurance, diagnostics, and treatments, we wished to explore whether patients faced disparities once in treatment. To do this, we examined whether racial disparities were observable in a 2019 cohort of Medicare Advantage beneficiaries receiving treatment for lung cancer. Methods: This retrospective, observational study used health plan claims data to identify Black and White patients aged 18 to 89 years with a Medicare Advantage health plan in calendar year 2019 who received diagnostic imaging (computed tomography or positron emission tomography) followed by lung cancer treatment (radiation therapy [RT] or surgery claims mentioning a diagnosis of lung cancer) within 90 days. Only patients treated in 2019 were considered so that the findings would reflect the state of care immediately preceding the COVID-19 pandemic. Patients were excluded if they had a history of RT or lung surgery in the year prior to the diagnostic imaging date. Other databases were used to determine cancer stage, patient demographics, comorbidities, the urbanicity and median income of patients' home ZIP code, and whether treatment was ordered by a hospital-based physician. A multivariate logistic model was used to examine the association between race and surgery, and a multivariate negative binomial model was used to examine the association between race and days to treatment (surgery or RT). Results: We identified 823 patients, 83.8% White (690), and 16.2% (133) Black. Surgery was received by 3.1% [4/133] of Black patients and 9.7% [61/690]) of White patients. Black patients received treatment on average 36.9 days after diagnosis, versus 35.1 days for White patients. Adjusted analysis did not find a significant association between race and receipt of surgery (P = 0.07) or race and days to treatment (P = 0.77). No covariate was significantly associated with receipt of surgery. Residence in a state with a higher obesity rate was associated with fewer days to treatment (P = 0.02). Conclusions: In a uniformly insured population that successfully received treatment, adjusted analysis found no evidence of a Black / White racial disparity in use of lung surgery for Stage 3 lung cancer or in timeliness of treatment. Given the directionality of the findings, they could potentially have been significant if the sample size had been increased by extending the enrollment period. The implication of these findings is that it may be most fruitful to address racial disparities at the frontend of the care process;working to ensure that patients have access to insurance, diagnostics, and treatments, as disparities were not observed in a population that had accessed treatment. Further research is needed to assess whether racial disparities in lung cancer treatment have dissipated over time.

5.
Science ; 375(6583):864-+, 2022.
Article in English | Web of Science | ID: covidwho-1769817

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant of concern evades antibody-mediated immunity that comes from vaccination or infection with earlier variants due to accumulation of numerous spike mutations. To understand the Omicron antigenic shift, we determined cryo-electron microscopy and x-ray crystal structures of the spike protein and the receptor-binding domain bound to the broadly neutralizing sarbecovirus monoclonal antibody (mAb) S309 (the parent mAb of sotrovimab) and to the human ACE2 receptor. We provide a blueprint for understanding the marked reduction of binding of other therapeutic mAbs that leads to dampened neutralizing activity. Remodeling of interactions between the Omicron receptor-binding domain and human ACE2 likely explains the enhanced affinity for the host receptor relative to the ancestral virus.

7.
Acta Crystallographica a-Foundation and Advances ; 77:C196-C196, 2021.
Article in English | Web of Science | ID: covidwho-1762255
8.
Mmwr-Morbidity and Mortality Weekly Report ; 71(8):313-318, 2022.
Article in English | Web of Science | ID: covidwho-1756001

ABSTRACT

What is already known about this topic? Health seeking behavior has changed during the COVID-19 pandemic. What is added by this report? Compared with 2019, overall pediatric emergency department visits decreased by 51%, 22%, and 23% during 2020, 2021, and January 2022, respectively. COVID-19 visits predominated across all pediatric ages;visits for other respiratory illnesses mostly declined. Number and proportion of visits increased for certain injuries (e.g., firearm injuries, self-harm, and drug poisonings), some chronic diseases, and behavioral health concerns, with variations by age group. What are the implications for public health practice? Health care providers and families should remain vigilant for potential indirect impacts of the COVID-19 pandemic, including health conditions resulting from delayed care, and increasing emotional distress and behavioral health concerns among children and adolescents.

10.
Circulation ; 144(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1638041

ABSTRACT

Introduction: Although home health aides (HHAs) often care for adults with heart failure (HF), studies have found that the majority have not received HF training and lack confidence with HF caregiving. To address this, we tested the feasibility, acceptability, and effectiveness of a virtual HF training course for HHAs. Methods: We partnered with the Education Fund of the 1199SEIU United Health Care Workers East, the largest healthcare union in the US, which provides training to 55,000 HHAs in NYC. HHAs typically receive in-person training, but due to COVID-19, we conducted this course virtually. The 2- hour course, taught in English and Spanish, utilized case-based learning and motivational interviewing to engage HHAs in interactive discussions on HF signs, symptoms, and HF self-care. HHAs with access to Zoom (via smartphone, computer, or tablet) were eligible. We conducted pre/post surveys and semi-structured interviews. Measures included: a) feasibility (attendance, retention), b) acceptability (modality, technological ease, satisfaction);and c) effectiveness (change in knowledge [Dutch Heart Failure Knowledge Scale, range 0-15] and caregiving self-efficacy [HF Caregiver Self-efficacy Scale, range 0-100]). Results: 48 HHAs employed by 15 distinct home care agencies enrolled and completed the course;course size ranged from 4-9 participants. The majority were middle-age women (60% Hispanic, 10% non-Hispanic Black). To participate, 59% used a smartphone, 32% a computer, and 10% a tablet. Compared to prior in-person courses, 83% participants reported that the course ran more smoothly and was more convenient;only 7% reported technical problems. Participants and course instructors reported high levels of satisfaction and engagement. Post-course data showed significant and clinically meaningful improvements in HF knowledge (11.21 [1.90] v. 12.21 [1.85];p = 0.0000) and HF caregiving self-efficacy (75.21 [16.57] v. 82.29 [16.49];p = 0.0017). Conclusions: A virtual HF training course was feasible and acceptable among HHAs and improved their HF knowledge and caregiving confidence. Efforts to scale and disseminate the course may be warranted. Future studies are needed to test the effect of the course among HHAs and their patients.

11.
Journal of Childhood Studies ; 46(3):3-15, 2021.
Article in English | Web of Science | ID: covidwho-1507484

ABSTRACT

The COVID-19 pandemic has exposed the chronically inadequate childcare infrastructure in Canada and across much of the world. Government responses have been many and varied within and between countries, provinces, municipalities, and local communities. Embracing a feminist ethics of care lens, this paper examines how the needs of mothers, children, and early childhood educators were recognized as interconnected (or not) in Ontario's childcare policy discourse and action throughout the pandemic. Findings indicate that children were rarely discussed beyond being a "burden" to their parents (and therefore the economy) while children's and early childhood educators' childcare experiences and needs were largely absent in any policy discussion or action. The only group to receive widespread media and political attention were mothers, whose ongoing struggle to "balance" paid and unpaid (care) work became heightened and visible en masse throughout the pandemic. We offer overarching observations and recommendations for childcare policy stakeholders and actors as we look to build new possibilities for Canadian childcare beyond the pandemic.

12.
Architectural Design ; 91(6):38-45, 2021.
Article in English | Scopus | ID: covidwho-1499206

ABSTRACT

Aubrey Powell started his creative life as the photographer and graphic designer for Hipgnosis, the acclaimed design studio he co-founded in 1967 with Storm Thorgerson. They were instrumental in defining Pink Floyd's graphic identity. Powell and Hipgnosis began working with Mark Fisher on the Pink Floyd ‘Animals’ world tour and album cover. It was a natural progression for Powell to move into filmmaking some 15 years later, when music video started. Here he describes some of his design collaborations with STUFISH. Copyright © 2021 John Wiley & Sons, Ltd.

13.
Health Syst (Basingstoke) ; 10(4): 337-347, 2021.
Article in English | MEDLINE | ID: covidwho-1390343

ABSTRACT

Without timely assessments of the number of COVID-19 cases requiring hospitalisation, healthcare providers will struggle to ensure an appropriate number of beds are made available. Too few could cause excess deaths while too many could result in additional waits for elective treatment. As well as supporting capacity considerations, reliably projecting future "waves" is important to inform the nature, timing and magnitude of any localised restrictions to reduce transmission. In making the case for locally owned and locally configurable models, this paper details the approach taken by one major healthcare system in founding a multi-disciplinary "Scenario Review Working Group", comprising commissioners, public health officials and academic epidemiologists. The role of this group, which met weekly during the pandemic, was to define and maintain an evolving library of plausible scenarios to underpin projections obtained through an SEIR-based compartmental model. Outputs have informed decision-making at the system's major incident Bronze, Silver and Gold Commands. This paper presents illustrated examples of use and offers practical considerations for other healthcare systems that may benefit from such a framework.

14.
Journal of Global Responsibility ; ahead-of-print(ahead-of-print):14, 2021.
Article in English | Web of Science | ID: covidwho-1358543

ABSTRACT

Purpose The purpose of this paper is to enrich the discussion at the intersection of responsible management education (RME) and the pandemic with new views that explore together the inhibitors of and drivers for a strengthening of RME in the emerging context. On the one hand, the pandemic crisis fosters the social role business schools play by supporting the enhancement of the RME rationale as an idealist foundational pillar of responsible business schools. On the other hand, it invites negative pragmatic responses in the light of financial and competitive disturbances that seem to enlarge the opportunity cost of moving RME forward. Design/methodology/approach The essay puts forward arguments that help dissect the inherent contradictions and synergies between idealistic and pragmatic business school strategies, as they are impacted by the dynamics of COVID-19. The analysis serves to frame a discourse over the extent to which the pandemic crisis is acting as an accelerator of the RME agenda or instead brings the risk of demolishing what has been achieved so far. Findings The authors form an opinion of the emerging factors that promote and inhibit RME in business schools as they grapple with the challenges of the pandemic whilst recognizing the inherent contradictions faced in their strategic choices and resourcing. Originality/value In light of the growing emphasis on RME in the literature, this study challenges the degree to which the agenda has already become firmly rooted as a core organizational and educational theme in business schools. By doing so, it delivers an assessment of RME progress as a relevant strategic lever for business schools, whilst nonetheless being at risk of back-sliding.

15.
BJS Open ; 5(4)2021 07 06.
Article in English | MEDLINE | ID: covidwho-1331540

ABSTRACT

INTRODUCTION: Core surgical training programmes are associated with a high risk of burnout. This study aimed to assess the influence of a novel enhanced stress-resilience training (ESRT) course delivered at the start of core surgical training in a single UK statutory education body. METHOD: All newly appointed core surgical trainees (CSTs) were invited to participate in a 5-week ESRT course teaching mindfulness-based exercises to develop tools to deal with stress at work and burnout. The primary aim was to assess the feasibility of this course; secondary outcomes were to assess degree of burnout measured using Maslach Burnout Inventory (MBI) scoring. RESULTS: Of 43 boot camp attendees, 38 trainees completed questionnaires, with 24 choosing to participate in ESRT (63.2 per cent; male 13, female 11, median age 28 years). Qualitative data reflected challenges delivering ESRT because of arduous and inflexible clinical on-call rotas, time pressures related to academic curriculum demands and the concurrent COVID-19 pandemic (10 of 24 drop-out). Despite these challenges, 22 (91.7 per cent) considered the course valuable and there was unanimous support for programme development. Of the 14 trainees who completed the ESRT course, nine (64.3 per cent) continued to use the techniques in daily clinical work. Burnout was identified in 23 trainees (60.5 per cent) with no evident difference in baseline MBI scores between participants (median 4 (range 0-11) versus 5 (1-11), P = 0.770). High stress states were significantly less likely, and mindfulness significantly higher in the intervention group (P < 0.010); MBI scores were comparable before and after ESRT in the intervention cohort (P = 0.630, median 4 (range 0-11) versus 4 (1-10)). DISCUSSION: Despite arduous emergency COVID rotas ESRT was feasible and, combined with protected time for trainees to engage, deserves further research to determine medium-term efficacy.


Subject(s)
Burnout, Professional/prevention & control , Curriculum , General Surgery/education , Resilience, Psychological , Stress, Psychological/prevention & control , Surgeons/psychology , Adult , Anxiety/prevention & control , COVID-19/epidemiology , Depression/prevention & control , Feasibility Studies , Female , Humans , Male , Mindfulness , Pandemics , Surveys and Questionnaires , United Kingdom , Work Schedule Tolerance
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18.
Critical Care Medicine ; 49(1 SUPPL 1):132, 2021.
Article in English | EMBASE | ID: covidwho-1193977

ABSTRACT

INTRODUCTION: As the COVID-19 pandemic continues, respiratory management strategies emerged as a primary concern. The mortality rate for patients with COVID19 who require intubation, and the predictors of mortality for this specific population are poorly characterized with only a few case series and retrospective studies. Published mortality rates of patients requiring intubation have ranged from as low as 35% to as high as 80%. Given the overall high mortality rate associate with intubation, growing literature calls for further efforts to characterize this critical population. METHODS: Analysis of a single urban academic center prospective database of intubated patients with COVID-19, including transferred patients. Descriptive statistics were used to characterize the intubated patients. Logistic regression was performed to account for age, gender, BMI, race, history of diabetes, COPD, and asthma. RESULTS: From March 2020 to July 2020, 369 COVID-19 patients were included in the registry 93 of whom were intubated. Of those intubated, mean age was 57.3 years, with an average BMI of 32.5. 63.7% of the intubated patients were males, with 62.6% Black, 24.2% Hispanic, and 13.2% Caucasian. We report an overall mortality of 80%, with a crude odds ratio of 28.5 (95% CI: 14.5 - 55.8) for death associated with intubation. Logistic modeling revealed that age and gender are significantly associated with mortality, with mortality odds increasing approximately 9% for each year of age, and 2.8 times higher for males. BMI, race, and history of diabetes, COPD, and asthma did not meet statistical significance for association with mortality, nor were there any significant interaction effects. Holding age and gender constant, the odds ratio for death associated with intubation increases to 105.3 (95% CI: 38.5-287.8). CONCLUSIONS: We report a high mortality rate of intubated patients, which may be multifactorial from being a referral center accepts critically ill patients, including evaluation for ECMO. Furthermore, our institution was an early adopter of noninvasive ventilation methods in an attempt to avoid intubation whenever possible. Ultimately, further studies are needed to better characterize those COVID-19 patients that require intubation and what variables are more closely associated with morbidity and mortality.

20.
Journal of 3D Printing in Medicine ; 4(3):127-129, 2020.
Article in English | EMBASE | ID: covidwho-993118
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