Pause But Not Panic: Exploring COVID-19 as a Critical Incident for Nonprofit Workers

Critical incidents often have significant impacts on workers, sometimes causing disruptions to career pathways and a re-evaluation of past career decisions. This article seeks to explore the impact of the COVID-19 pandemic on nonprofit workers and their commitment to the sector using a critical incidents lens. In-depth interviews with nonprofit workers provided insights on the pandemic's impact on workers' personal and professional lives and how they made sense of these. Changes to work including flexibility and work-from-home options were often viewed positively, yet workers expressed a loss of connection with their colleagues, mental health and well-being challenges, as well as challenges to adapt to new ways of working. In making sense of these changes, commitment to the sector was mostly sustained;however, respondents also noted a shift in priorities and expressed a desire for better balance between their personal and professional lives. © The Author(s) 2023.

Utilization of Core Values and Branding to Recruit the Best Trainees for Your Program.

Branding is a tactic which has been well described in the business literature as a way to enhance a company's reputation, promote a sense of high quality and value, and influence an individual's perception and behavior. Branding has not traditionally been explicitly used by training programs for recruitment. However, it can be used as a powerful tool to help recruit and retain candidates who will thrive in your program. Branding has become even more important since the COVID-19 pandemic with the absence of in-person experiences for most applicants and a transition to virtual interview platforms. This article discusses how to develop and use your core values to understand your brand identity, create a clear and memorable message to your applicants, and ensure a brand experience that will allow applicants to understand the essence of your training program.

How Are Nonprofit Workers Doing? Exploring the Personal and Professional Impact of COVID-19

COVID-19 has presented unprecedented challenges to the nonprofit sector, and while evidence is accruing about its impact on nonprofit finances and operations, less is known about how nonprofit workers are faring. With so many organizations in the increasingly professionalized nonprofit sector reliant upon their paid staff, this study assesses how COVID-19 has changed the way nonprofit workers think about their current and future work. We use a survey of nonprofit workers who have a nonprofit graduate degree to describe pandemic-related work changes and to explore the impact of these changes on their commitment to the sector. Our findings reveal that nonprofit workers are nuanced in how they approach their work and commitment to the sector. We distill our findings considerate of how future research should endeavor to unpack the degree to which workers' personal and professional circumstances affect how they think about their work in the sector. © 2022 Canadian Journal of Nonprofit and Social Economy Research.

How Are Nonprofit Workers Doing? Exploring the Personal and Professional Impact of COVID-19

COVID-19 has presented unprecedented challenges to the nonprofit sector, and while evidence is accruing about its impact on nonprofit finances and operations, less is known about how nonprofit workers are faring. With so many organizations in the increasingly professionalized nonprofit sector reliant upon their paid staff, this study assesses how COVID-19 has changed the way nonprofit workers think about their current and future work. We use a survey of nonprofit workers who have a nonprofit graduate degree to describe pandemic-related work changes and to explore the impact of these changes on their commitment to the sector. Our findings reveal that nonprofit workers are nuanced in how they approach their work and commitment to the sector. We distill our findings considerate of how future research should endeavor to unpack the degree to which workers' personal and professional circumstances affect how they think about their work in the sector.

SEVERE ACUTE VULVAL ULCERATION ASSOCIATED WITH COVID-19 INFECTION IN A SEXUALLY ACTIVE DUAL COVID-VACCINATED YOUNG PERSON: A CASE REPORT

Case A 20-year old was seen at the height of the Omicron wave of the COVID-19 pandemic with a two day history of a first episode of painful genital ulceration. Her last sexual contact was one week previously. She had no other symptoms and no medical or drug history. There was bilateral inguinal lymphadenopathy and a unilateral 1cm slightly indurated shallow vulval ulcer with slough. She was treated empirically for secondarily infected primary herpes. Three days later she presented with increased pain and negative HSV PCR and STI/ BBV tests. She had large bilateral genital ulcers (figure 1) and was admitted. Repeat swabs for HSV, VZV and syphilis were negative. She had a neutrophilia, raised CRP and negative EBV and CMV IgM. A routine nasopharyngeal swab identified SARS-CoV-2 and a full respiratory virus PCR panel was otherwise negative. She disclosed a sore throat and fevers the week before the onset of her vulval symptoms but was reassured by negative home antigen tests. She had received the second dose of an mRNA COVID-19 vaccine four months previously but no booster. She was discharged after five days and treated with a reducing course of oral steroids. At four weeks her ulcers were healing well. Discussion There are few published cases of Lipschütz ulcers associated with COVID-19 and this case adds to the burgeoning evidence of the possible dermatological manifestations of the disease and crucially it illustrates the value of prompt access to sexual health services during the pandemic. (Figure Presented).

JOB LOSS, FINANCIAL HARDSHIP, AND SLEEP DURING THE COVID-19 PANDEMIC: DIFFERENCES BY SEX/ GENDER AND RACE/ETHNICITY

Introduction: In the United States (US), health and financial consequences of COVID-19 have disproportionately impacted minoritized groups. Yet, few US studies have investigated COVIDrelated financial loss/consequences and sleep health disparities. Methods: To investigate differences by sex/gender and race/ethnicity in cross-sectional associations between both job/business loss and substantial financial hardship (SFH) with sleep health, we used data collected from 12/2020 to 2/2021 among 4,726 men and women in the nationally representative COVID-19 Unequal Racial Burden (CURB) Study (N=5,500 American Indian/Alaska Native (AI/AN), Asian, Black, Hispanic/Latino, Multiracial, Native Hawaiian/Pacific Islander (NH/PI), and non-Hispanic (NH)-White adults). Participants reported job/business loss since the start of the pandemic (yes, no) and SFH (e.g., unable to pay for housing costs). Poor sleep health was defined as concurrence of self-reported fair/poor sleep quality, non-restorative sleep, sleep problems, and difficulty falling asleep in the past week. Adjusting for sociodemographic and health characteristics and receipt of financial assistance, weighted Poisson regression with robust variance estimated prevalence ratios (PRs) for poor sleep overall, by sex/gender, and by race/ethnicity. Results: Men and women equally reported both job/business loss (20%) and SFH (11% men and 12% women). Minoritized racial/ ethnic groups except Asians most frequently reported job/business loss (20%-25% vs. 16% Asian, 13% NH-White) and SFH (11%-15% vs. 9% NH-White, 5% Asian). Poor sleep health was more prevalent among women (21%) than men (14%) and among AI/AN, NH/PI, and Multiracial adults (each 22% vs. 11%-19% remaining racial/ethnic groups). Both job/business loss and SFH were associated with a higher prevalence of poor sleep health, overall. Compared to women, men had stronger associations for both job/ business loss (PRmen=1.80 [95% CI:1.39,2.33], PRwomen=1.23 [1.01,1.50];pinteraction=0.01) and SFH (PRmen=4.46 [3.18,6.26]), PRwomen= 1.82 [1.45,2.30];pinteraction=0.01). For job/business loss, associations were strongest among Asians (PR=2.07 [1.32,3.23] vs. PR range=0.88-1.89;pinteraction=0.09). Conclusion: COVID-19 related job/business loss and financial hardship were both associated with poorer sleep health, and associations for job/business loss were strongest among men and Asian adults.

Internships: A policy and regulatory challenge

The purpose of this book is to bring together experts from around the world in labour law, employment relations and labour economics to explain what we know about the use and value of internships (or traineeships as they are sometimes called), and to discuss how they are or should be regulated. This introduction offers some preliminary explanations for the growth of internships, and highlights some of the ways in which both scholars and policy makers have sought to analyse and respond to that development. It explains how the rest of the book is structured and briefly summarises the contributions in it. The introduction concludes by saying something about the impact that the COVID-19 pandemic has had so far on internships and what it might mean for their use in the future. © International Labour Organization 2021.

Using what we know about threat reactivity models to understand mental health during the COVID-19 pandemic.

The COVID-19 pandemic has been accompanied by unprecedented levels of stress and threats in a variety of domains (e.g., health, livelihood). Individual differences in threat reactivity may explain why some individuals are at elevated risk for the development or maintenance of psychopathology during the COVID-19 pandemic. This article describes several prominent models, mechanisms, and components of threat reactivity (e.g., appraisals, intolerance of uncertainty, avoidance) and discusses how they might help improve understanding of changes in psychopathology during and following the COVID-19 pandemic.

Successful introduction of the methoxyflurane inhaler, Penthrox®, to brachytherapy for post-irradiation implant removal analgesia during the COVID-19 pandemic

Methods We planned to introduce the Penthrox® methoxyflurane inhaler device into brachytherapy and started prospectively collecting peri-procedure pain scores (using the 10-point visual analogue scale) whilst the processes of training and drug approval were completed. After which, peri-procedure pain scores were collected prospectively. We also recorded drug idiosyncrasies and patient feedback. Results Data were collected before introducing Penthrox from 10 patients and from 16 patients after introduction. Pre-Penthrox pain scores during needle removal demonstrated a mean score of 8/10, despite pre-procedure administration of intravenous analgesia including morphine. The mean pain score with Penthrox and without any other analgesia was 0.6/10. Penthrox has been well tolerated with patients reporting few adverse side effects. Discussion Pre-COVID-19, patients attending our brachytherapy suite for gynaecological malignancy would have sufficient analgesia for needle insertion and removal with a single-shot intrathecal anaesthetic. The pandemic necessitated the decision to administer two treatments within 1 day, reducing the need to attend hospital on multiple separate visits. This meant the intrathecal analgesia would be less effective by the time of needle removal, thus necessitating other methods of analgesia for the procedure. This included intravenous morphine, Entonox® and, at times, midazolam. Using Penthrox to reduce pain during needle removal was discussed and, following local approval, was introduced to brachytherapy. Penthrox (methroxyflurane) is a halogenated ether with a UK license for emergency relief of moderate to severe pain in adult patients with trauma. It provides generally well-tolerated analgesia, which may negate the need for procedural sedation. Associated potential risks are nephrotoxicity, hepatotoxicity and it is an enzyme inducer. It is well tolerated in suitable patients [1]. The introduction of Penthrox to the brachytherapy service has been successful in significantly reducing the reported pain scores during removal of needles. This has in turn improved procedural conditions through providing a calmer atmosphere in theatre and better operating conditions for the oncologists. Patient satisfaction was also high. To our knowledge, this is the first time Penthrox has been used for this indication outside Australasia.

The effects of the pandemic on mental health in persons with and without a psychiatric history.

BACKGROUND: Prospective studies are needed to assess the influence of pre-pandemic risk factors on mental health outcomes following the COVID-19 pandemic. From direct interviews prior to (T1), and then in the same individuals after the pandemic onset (T2), we assessed the influence of personal psychiatric history on changes in symptoms and wellbeing. METHODS: Two hundred and four (19-69 years/117 female) individuals from a multigenerational family study were followed clinically up to T1. Psychiatric symptom changes (T1-to-T2), their association with lifetime psychiatric history (no, only-past, and recent psychiatric history), and pandemic-specific worries were investigated. RESULTS: At T2 relative to T1, participants with recent psychopathology (in the last 2 years) had significantly fewer depressive (mean, M = 41.7 v. 47.6) and traumatic symptoms (M = 6.6 v. 8.1, p < 0.001), while those with no and only-past psychiatric history had decreased wellbeing (M = 22.6 v. 25.0, p < 0.01). Three pandemic-related worry factors were identified: Illness/death, Financial, and Social isolation. Individuals with recent psychiatric history had greater Illness/death and Financial worries than the no/only-past groups, but these worries were unrelated to depression at T2. Among individuals with no/only-past history, Illness/death worries predicted increased T2 depression [B = 0.6(0.3), p < 0.05]. CONCLUSIONS: As recent psychiatric history was not associated with increased depression or anxiety during the pandemic, new groups of previously unaffected persons might contribute to the increased pandemic-related depression and anxiety rates reported. These individuals likely represent incident cases that are first detected in primary care and other non-specialty clinical settings. Such settings may be useful for monitoring future illness among newly at-risk individuals.

MitoScape: A big-data, machine-learning platform for obtaining mitochondrial DNA from next-generation sequencing data.

The growing number of next-generation sequencing (NGS) data presents a unique opportunity to study the combined impact of mitochondrial and nuclear-encoded genetic variation in complex disease. Mitochondrial DNA variants and in particular, heteroplasmic variants, are critical for determining human disease severity. While there are approaches for obtaining mitochondrial DNA variants from NGS data, these software do not account for the unique characteristics of mitochondrial genetics and can be inaccurate even for homoplasmic variants. We introduce MitoScape, a novel, big-data, software for extracting mitochondrial DNA sequences from NGS. MitoScape adopts a novel departure from other algorithms by using machine learning to model the unique characteristics of mitochondrial genetics. We also employ a novel approach of using rho-zero (mitochondrial DNA-depleted) data to model nuclear-encoded mitochondrial sequences. We showed that MitoScape produces accurate heteroplasmy estimates using gold-standard mitochondrial DNA data. We provide a comprehensive comparison of the most common tools for obtaining mtDNA variants from NGS and showed that MitoScape had superior performance to compared tools in every statistically category we compared, including false positives and false negatives. By applying MitoScape to common disease examples, we illustrate how MitoScape facilitates important heteroplasmy-disease association discoveries by expanding upon a reported association between hypertrophic cardiomyopathy and mitochondrial haplogroup T in men (adjusted p-value = 0.003). The improved accuracy of mitochondrial DNA variants produced by MitoScape will be instrumental in diagnosing disease in the context of personalized medicine and clinical diagnostics.

Exploring human-genome gut-microbiome interaction in Parkinson's disease.

The causes of complex diseases remain an enigma despite decades of epidemiologic research on environmental risks and genome-wide studies that have uncovered tens or hundreds of susceptibility loci for each disease. We hypothesize that the microbiome is the missing link. Genetic studies have shown that overexpression of alpha-synuclein, a key pathological protein in Parkinson's disease (PD), can cause familial PD and variants at alpha-synuclein locus confer risk of idiopathic PD. Recently, dysbiosis of gut microbiome in PD was identified: altered abundances of three microbial clusters were found, one of which was composed of opportunistic pathogens. Using two large datasets, we found evidence that the overabundance of opportunistic pathogens in PD gut is influenced by the host genotype at the alpha-synuclein locus, and that the variants responsible modulate alpha-synuclein expression. Results put forth testable hypotheses on the role of gut microbiome in the pathogenesis of PD, the incomplete penetrance of PD susceptibility genes, and potential triggers of pathology in the gut.

First-in-human CAR T targets MUC1 transmembrane cleavage product

Purpose: To develop a MUC1-targeted CAR T that recognizes the growth factor receptor form, MUC1∗, does not bind full-length MUC1, hits a wide range of solid tumor cancers, binds to little or no normal tissues, and effectively kills tumor cells. Methods: Because MUC1 is expressed on normal epithelial tissues, we needed to develop an antibody that would only bind to the aberrant, cancerous form - MUC1∗. MUC1∗ (muk1 star) is the transmembrane portion that remains after MUC1 is enzymatically cleaved and the bulky tandem repeat domain is shed from the cell surface. MUC1∗ is a growth factor receptor that is activated by ligand-induced dimerization of its truncated extracellular domain. Via a novel screen we identified antibodies that bind to a specific conformation within the ectopic epitope that is created when MUC1 is cleaved to MUC1∗ by enzymes secreted by the tumor microenvironment. This set of antibodies competitively inhibit the binding of onco-embryonic growth factor NME7AB to the cancerous form of MUC1∗. We incorporated one of these cancer-specific antibodies into a CAR T. Results: huMNC2-CAR44 is in a 1st-in-human clinical trial [NCT04020575] for metastatic breast cancers, currently being performed at the Fred Hutchinson Cancer Research Center. Our IND-enabling studies showed that huMNC2-scFv bound robustly to 95% of breast cancer tissues, 83% ovarian cancers, 78% pancreatic cancers and 71% of lung cancer tissues, but showed little to no binding to normal tissues. In co-culture experiments, huMNC2-CAR44 T cells did not kill MUC1∗ negative cells, even if they expressed full-length MUC1, and the presence of MUC1∗ negative cells did not elicit a cytokine response from the CAR T cells. In vivo, huMNC2-CAR44 T cells inhibited or completely obliterated a variety of MUC1∗ positive solid tumors in NSG mice (n≥400). The human CD8+ huMNC2-CAR44 T cells expanded in animals as tumors shrunk, whereas the untransduced T cells did not. Clinical trial was slowed by COVID-19, as Seattle was the first hotbed of the virus. Thus far, there have been no serious adverse events attributed to the CAR T therapy. Even at the lowest dosage, patients have had robust CAR T cell expansion and have also had measurable signs of efficacy. Conclusions: MUC1∗ is the predominant form of MUC1 on cancerous tissues. Antibodies that bind to a specific conformation within the ectopic growth factor binding site in the MUC1∗ extra cellular domain are tumor selective. CAR T cells incorporating these antibodies are highly effective against solid tumors in animals. Robust staining of cancerous tissues and minimal to no staining of normal tissues predicts a large therapeutic window for huMNC2-CAR44 T cell dosing. Early patient responses appear to fulfill the predictions of the IND-enabling studies. We have now developed a cryopreservation formulation which enables shipping frozen product to additional clinical sites for bedside thaw and infusion. The trial is currently enrolling patients.

Widespread implementation of telehealth in the delivery of antenatal care during the COVID-19 pandemic: An observational cohort study

Introduction: Driven by the COVID-19 pandemic, our maternity service developed and implemented a new antenatal care schedule integrating telehealth across all models of pregnancy care. Given limited evidence to inform this clinical initiative we evaluated the safety of telehealth in antenatal care. Methods: We undertook a population-based cohort study using interrupted time series analysis to evaluate the impact of telehealth integration into antenatal care from 23rd March 2020. Allowing a one-month implementation period, we compared the first three months of telehealth integrated care (20th April to 2nd August 2020) to previously delivered conventional care (1st January 2018 to 22nd March 2020). Main pregnancy outcomes measured were detection and outcomes of fetal growth restriction, pre-eclampsia and gestational diabetes, as well as stillbirth. Results: The outcomes of 2,977 births during the telehealth integrated period were compared to 20,031 births prior to its implementation. Following telehealth integration, 10,928 of the 20,517 (53.3%) antenatal consultations provided were delivered via telehealth. No significant change during integrated compared to conventional care periods in the rate of fetal growth restriction <3rd centile (2.9% vs 2.6%), stillbirth (1% vs 1%), or pregnancies complicated by pre-eclampsia (4.2% vs 3.9%) or gestational diabetes (23.6% vs 22.9%) was seen. A reduction in preterm birth among women in high-risk models (ITS-0.71 (-1.4 to-0.036);p = 0.04), but no change in other outcome measures were observed for low or high-risk care models. Discussion: Telehealth integrated into antenatal care was able to reduce in-person consultations by 50% without compromising pregnancy outcomes.