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1.
Rheumatol Adv Pract ; 6(Suppl 1), 2022.
Article in English | PMC | ID: covidwho-2062968

ABSTRACT

Introduction/Background: During the COVID-19 (coronavirus) pandemic, some provision of healthcare shifted to remote, technology-assisted appointments (telemedicine). Whilst parents/carers of children and young people with rheumatic conditions have reported benefits of telemedicine, concerns remain.This patient and parent-led project sought to understand the views of parents/carers about telemedicine, identifying the benefits and limitations of remote technology-assisted appointments, and comparing views between Canadian and European cohorts. Description/Method: An online survey was developed, translated into multiple languages and shared via social media and patient organisations, targeted at parents of children and young people with rheumatic, autoimmune and autoinflammatory conditions. Fieldwork took place in April 2021 in Europe and May 2021 in Canada. Consent was provided during enrolment. Discussion/Results: A total of 290 responses were received (133 Europe;157 Canada;73% female, median age 12).Over half of respondents (53%) in Europe reported travelling over an hour to in-person appointments with their paediatric rheumatologist, compared to a significantly higher proportion of respondents in Canada (87%). Consequently, in-person appointments represent a greater time burden amongst Canadian caregivers, though both groups report appointments taking over three hours in total (51% Europe, 69% Canada).Prior to COVID-19, most had never had a telemedicine appointment (92% Europe, 95% Canada). Since March 2020, the majority (71% Europe, 82% Canada) had at least one telemedicine appointment.Table 1 shows the scores (1 worst, 5 best) given by parents about their telemedicine experience. Overall, most aspects scored positively (p<.05). However, parents felt telemedicine was not as good as in-person appointments.Table 1P65 Mean scores for a range of aspects of telemedicine (1-worst;5-best). EuropeCanadaPEasy to schedule3.50 (3.18, 3.82) *4.33 (4.14, 4.52) *†On time3.22 (2.89, 3.55)4.07 (3.85, 4.28) *†Enough time with doctor3.51 (3.19, 3.83) *4.24 (4.02, 4.45) *†As good as in-person visit2.21 (1.96, 2.46) **2.66 (2.42, 2.90) ** Easier to see doctor2.84 (2.55, 3.13)3.51 (3.25, 3.77) *†Easy to sign-in3.52 (3.22, 3.82) *4.25 (4.06, 4.43) *†Quality of video3.23 (2.93, 3.53)3.87 (3.66, 4.07) *†Quality of sound3.54 (3.26, 3.81) *3.94 (3.75, 4.14) * Able to speak freely3.61 (3.34, 3.88) *4.05 (3.85, 4.24) * Able to understand doctor3.61 (3.32, 3.90) *4.09 (3.90, 4.28) * Quality of care provided3.43 (3.12, 3.73) *3.78 (3.56, 4.00) * Overall telemedicine experience3.23 (2.91, 3.55)3.78 (3.57, 3.99) *†*Positive score (p<.05).**Negative score (p<.05).†Difference between Canadian and European cohorts is statistically significant (p<.05), chi-square. Key learning points/Conclusion: Overall respondents said they would prefer the next appointment to be in-person (82% Europe, 62% Canada, p<.05), although 31% from Canada were amenable to a combination of in-person and telemedicine-based care.There are advantages to telemedicine, notably saving time and making appointments accessible. Families from Canada tended to view telemedicine more favourably than those from Europe, although the majority from both cohorts reported concerns about the ability to assess their child. There may be value in providing training to parents to enhance the accuracy of home-based assessments, particularly when the disease is stable. However, parents continue to report the value of in-person appointments.

2.
Rheumatol Adv Pract ; 6(Suppl 1), 2022.
Article in English | PMC | ID: covidwho-2062967

ABSTRACT

Introduction/Background: Vaccination of children and young people (CYP) with rheumatic and auto-inflammatory diseases is reported to be lower than amongst healthy peers. Whilst vaccination to confer protection against COVID-19 is now underway amongst adults and adolescents, vaccination of CYP under 16 years was not available at the time of this study. This study sought to understand the views of parents/carers regarding vaccination against COVID-19 for CYP with rheumatic and autoinflammatory diseases. Description/Method: An online survey was developed and shared via social media and direct contacts, targeted at parents of children with rheumatic and autoinflammatory conditions in Canada. Fieldwork took place during May 2021. Consent was provided during enrolment. Discussion/Results: A total of 157 responses were received (78% female, median age 12). The primary diagnosis for the majority was Juvenile Idiopathic Arthritis (JIA;39% polyarticular, 15% oligoarticular, 8% enthesitis-related JIA, 6% psoriatic, and 9% systemic). At the time of completing the survey, the majority of CYP had received no vaccination against COVID-19 (83%), although 17% had received one dose;none had received both doses. The majority of parents/carers (55%) would agree for their child to be vaccinated to prevent COVID-19 if the vaccine was approved and available at no cost, with only 10% saying they would not agree, and 18% unsure. Overall, 40% would allow their child to have the vaccine as soon as it was available, with a further 22% who would prefer to wait, and 10% who will allow their child to have the vaccine only when required to. Reasons given by parents choosing not to vaccinate their child against COVID-19 focussed on perceived safety, apparent lack of testing, and alleged potential damage caused by vaccines. In addition, some respondents advised that they had seen anti-vaccine videos on social media targeted at young people, but would still have their child vaccinated when it was available. The majority (92%) cited their doctor or health professionals would be a key source of information when deciding whether to vaccinate their child;however, this varied significantly (p=.0017, chisquare) based on whether they currently would agree to have their child vaccinated, with only 69% of parents who would not vaccinate their child saying their healthcare professional would influence their decision. Around 38% of parents would be influenced by information from their patient organisation. Parents who indicated they would not be vaccinated themselves were less likely to agree for their child to be vaccinated (p<.001, chi-square). Key learning points/Conclusion: Healthcare professionals play a vital role in supporting, advising and influencing parental decision-making with regards to COVID-19 vaccination amongst CYP with rheumatic and autoinflammatory conditions, particularly amongst parents/carers who are currently undecided. Working collaboratively with patient organisations to deliver simple, clear advice may help reduce vaccine hesitancy.

3.
Rheumatol Adv Pract ; 6(Suppl 1), 2022.
Article in English | PMC | ID: covidwho-2062966

ABSTRACT

Introduction/Background: During the COVID-19 (coronavirus) pandemic, some healthcare provision shifted to remote, technology-assisted appointments (telemedicine). This study sought the views of parents/carers about telemedicine, identifying the benefits and limitations, to assist in improvement to future service provision. Description/Method: An online survey was developed and shared via social media and direct contacts, targeted at parents of children with rheumatic and autoinflammatory conditions in Canada. Fieldwork took place during May 2021. Consent was provided during enrolment. Discussion/Results: A total of 157 responses were received (78% female, median age 12). The primary diagnosis for the majority was Juvenile Idiopathic Arthritis (JIA;39% polyarticular, 15% oligoarticular, 8% enthesitis-related JIA, 6% psoriatic, and 9% systemic). Respondents reported in-person appointments represent a considerable time burden (87% travel more than an hour to attend;40% take a full day (or more) out of school to attend;38% of parents take a full day off work). During the pandemic, the proportion having a telemedicine appointment increased from 5% to 82%. Table 1 shows the scores (1 worst, 5 best) given by parents about their telemedicine experience. Overall, most aspects scored positively (p<.05). However, parents felt telemedicine was not as good as in-person appointments (mean 2.66, 95% CI 2.42-2.90).Overall 61% said they would prefer the next appointment to be in-person, while 31% were amenable to some combination of in-person and virtual care.P62 Table 1Mean scores for a range of aspects of telemedicine (1-worst;5-best).AspectMean (95% CI)Easy to schedule4.33 (4.14, 4.52) *On time4.07 (3.85, 4.28) *Enough time with doctor4.24 (4.02, 4.45) *As good as in-person visit2.66 (2.42, 2.90) **Easier to see doctor3.51 (3.25, 3.77) *Easy to sign-in4.25 (4.06, 4.43) *Quality of video3.87 (3.66, 4.07) *Quality of sound3.94 (3.75, 4.14) *Able to speak freely4.05 (3.85, 4.24) *Able to understand doctor4.09 (3.90, 4.28) *Quality of care provided3.78 (3.56, 4.00) *Overall telemedicine experience3.78 (3.57, 3.99) **Positive score (p<.05)**Negative score (p<.05). Key learning points/Conclusion: There are advantages to telemedicine, notably saving time and making appointments accessible, and overall parents reported satisfaction with remote appointments. However, parents continue to report the value of in-person appointments.

6.
International Journal of Radiation Oncology, Biology, Physics ; 114(3):S6-S6, 2022.
Article in English | Academic Search Complete | ID: covidwho-2036083

ABSTRACT

To report final results of a clinical trial of APBI using intensity modulated radiotherapy (IMRT) to deliver 27 Gy in 5 daily fractions following breast conserving surgery (BCS) prospectively designed to assess the efficacy and cosmetic outcomes of a 1-week, APBI regimen among women with early breast cancer. Women ≥ 50 years, with lymph node-negative, ER positive, HER-2 negative breast cancer or ductal carcinoma in situ (DCIS), ≤ 3cm diameter, following BCS with margins ≥ 2mm, and excellent or good baseline cosmesis received 27 Gy in 5 daily fractions to the seroma plus 1 cm CTV and 0.7 cm PTV margins. Clinical photographs, patient and provider cosmetic scores, breast fibrosis, telangiectasia and pain were collected prospectively, prior to RT and at 6 weeks, 1 and 2 years after RT. The primary endpoint was the proportion of women who retained Excellent or Good cosmesis at 2 years using the EORTC Cosmetic Rating System. Cosmetic failure was deterioration from Excellent or Good to Fair or Poor. A panel of 5 radiation oncologists independently assessed the cosmetic photographs. Secondary endpoints were rates and grades of breast fibrosis, telangiectasia, breast pain, ipsilateral breast tumor recurrence (IBRT), overall (OS), breast cancer-specific survival (BCSS) and subsequent mastectomy. Efficacy outcomes were assessed at clinic visits and by review of charts. ClinicalTrials.gov registration: NCT02681107. A total of 298 patients were treated between April 25, 2016, and October 31, 2019. At a median follow up of 48 months, the 4-year OS was 98.5% (95% CI 96.1% - 99.5%) and BCSS was 99.7% (95% CI 97.6% - 99.9%). The 4-year IBRT rate was 3.3% (95% CI 1.1% - 6.4%). There were 10 contralateral breast events for a 4-year rate of 3.9% (95% CI 2.2% - 6.9%). There were 10 ipsilateral and 6 contralateral mastectomies. Two patients died of unrelated causes prior to 2 years;79 patients declined in-clinic attendance due to COVID or competing comorbidities and 217 women had 2-year cosmetic photographs and clinical assessments performed. Consensus of the photo-panel cosmesis at baseline was: Excellent: n=116 (53%), Good: n=102 (47%), Fair: n=1 (0.5%) and Poor: n=0. Consensus overall cosmesis at 2 years was: Excellent: n= 141 (65%), Good: n=78 (35%), Fair: n=0 and Poor: n=0. Most patients had either improved (n=168;77%) or no change (n=43;20%) in cosmesis at 2-years. No patient had cosmetic failure but 6 (3%) had a change from Excellent to Good at 2 years. Most patients reported either no (79%) or mild (21%) pain, with no moderate or severe pain. Two patients (0.9%) had grade 2 fibrosis and 5 patients (2%) had visible telangiectasia that did not detract from overall cosmesis. APBI using 27 Gy in 5 fractions using a conformal IMRT technique, achieved excellent 2-year cosmesis with minimal toxicity. The IBRT risk was comparable to the contralateral new breast cancer risk and to local recurrence rates of recently published early breast cancer trials. [ 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.)

7.
HemaSphere ; 6:1985-1987, 2022.
Article in English | EMBASE | ID: covidwho-2032163

ABSTRACT

Background: Ibrutinib (IBR) is an oral covalent Bruton tyrosine kinase inhibitor (BTKi), licensed for treatment of relapsed or refractory mantle cell lymphoma (MCL). Under NHS interim Covid-19 agreements in England, IBR with or without rituximab (R) was approved for the frontline treatment for MCL patients (pts) as a safer alternative to conventional immunochemotherapy. Although recent phase 2 studies have reported high response rates in low-risk patients for this combination in the frontline setting, randomised phase 3 and real-world data are currently lacking. Aims: To describe the real-world response rates (overall response rate (ORR), complete response (CR) rate) and toxicity profile of IBR +/-R in adult patients with previously untreated MCL. Methods: Following institutional approval, adults commencing IBR +/-R for untreated MCL under interim Covid-19 arrangements were prospectively identified by contributing centres. Hospital records were interrogated for demographic, pathology, response, toxicity and survival data. ORR/CR were assessed per local investigator according to the Lugano criteria using CT and/or PET-CT. Results: Data were available for 66 pts (72.7% male, median age 71 years, range 41-89). Baseline demographic and clinical features are summarised in Table 1. 23/66 pts (34.8%) had high-risk disease (defined as presence of TP53 mutation/deletion, blastoid or pleomorphic variant MCL, or Ki67%/MiB-1 ≥30%). IBR starting dose was 560mg in 56/62 pts (90%) and was given with R in 22/64 pts (34%). At a median follow up of 8.7 months (m) (range 0-18.6), pts had received a median of 7 cycles of IBR. 19/60 pts (32%) required a dose reduction or delay in IBR treatment. New atrial fibrillation and grade ≥3 any-cause toxicity occurred in 3/59 pts (5.8%) and 8/57 (14.0%) respectively. For the whole population and high-risk pts only, ORR was 74.4% and 64.7% respectively (p=0.2379), with a median time to response of 3.8m, coinciding with the first response assessment scan. Seven pts (16.7%), of whom 2 had highrisk disease, attained CR at a median of 6.0m. ORR for pts receiving vs not receiving R were 84.2% and 66.7% respectively (p=0.1904). IBR was discontinued in 20/61 pts (32.8%) at a median time to discontinuation of 4.1m, due to progressive disease (PD, 19.7%), toxicity (4.9%), death (3.3%;1 pt each of Covid-19 and E. coli infection), pt choice (3.3%) and other unspecified reasons (1.6%). 15/66 pts (22.7%) overall and 7/23 (30.4%) with high-risk disease progressed on IBR at a median time to PD of 4.0m. No pts underwent autologous stem cell transplantation consolidation during the study period. 12/57 pts (21.1%) received second line treatment (R-chemotherapy n=7, Nordic MCL protocol n=2, VR-CAP n=2, pirtobrutinib n=1). Response to second line treatment was CR in 4/11 pts, PD in 7/11. Of the 2 Nordic-treated patients, 1 had CR after cycle 2 and 1 PD. Fourteen pts (21.2%) died during the follow up period, due to MCL (n=11), Covid-19 (n=2) and congestive cardiac failure (n=1). Overall survival was lower for patients with high-risk disease (HR 0.55, p=0.038). Image: Summary/Conclusion: In this real-world UK cohort of pts receiving first-line IBR +/-R for MCL, including older and high-risk pts, we report high ORR rates in a similar range to the phase II Geltamo IMCL-2015 study of combination IBR-R in an exclusively low-risk population. Documented CR rates were lower, possibly reflecting a low usage of rituximab in the Covid-19 pandemic as well as CT assessment of response. Treatment was generally well tolerated, with low rates of toxicityrelated treatment discontinuation. The study is ongoing.

8.
Open Forum Infect Dis ; 9(8): ofac400, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-2018038

ABSTRACT

During the coronavirus disease 2019 (COVID-19) pandemic, we also experienced a worsening opioid overdose epidemic. Untreated opioid use disorder (OUD) in persons with human immunodeficiency virus (HIV) is associated with worse HIV-related outcomes. Buprenorphine is a safe, evidence-based medication for OUD and is effective in reducing opioid craving and overdose and improving outcomes along the HIV care continuum. Despite the longstanding evidence supporting the benefits of buprenorphine, there remains an implementation gap in the uptake of buprenorphine prescribing in HIV care settings. To improve integration of OUD care and HIV primary care, we recommend (1) all HIV clinicians obtain a buprenorphine waiver, (2) teaching on OUD should be integrated into infectious diseases and HIV continuing medical education, and (3) previously validated models of integrated care should be leveraged to urgently expand access to buprenorphine for persons with HIV and OUD.

9.
Monthly Labor Review ; : 1-29, 2022.
Article in English | Web of Science | ID: covidwho-2011567

ABSTRACT

The U.S. Bureau of Labor Statistics publishes seasonally adjusted Consumer Price Index (CPI) and Producer Price Index (PPI) data monthly. Seasonal adjustment removes within-year seasonal patterns from data. To seasonally adjust data and estimate seasonal patterns of time series, the CPI and PPI use a filter-based approach that employs moving averages of historical data. In 2020, many PPIs and CPIs experienced extreme movements because of the coronavirus disease 2019 (COVID-19) pandemic. For example, the PPI and CPI for gasoline decreased 53.0 percent and 16.5 percent in April 2020, respectively. Because the CPI and PPI use historical data to estimate seasonal patterns, the extreme price movements in 2020 could have adversely affected the capability of the two price programs to accurately estimate seasonally adjusted data. This article explains how the CPI and PPI mitigated the effects of the COVID-19 pandemic on their seasonally adjusted price indexes. Mitigation steps included identifying price indexes whose movements were affected by the pandemic, estimating time series models to quantify these effects, and removing pandemic-related price movements from the data before estimating seasonal patterns.

10.
Innovation in Aging ; 5:720-720, 2021.
Article in English | Web of Science | ID: covidwho-2012588
11.
Annals of the Rheumatic Diseases ; 81:1131, 2022.
Article in English | EMBASE | ID: covidwho-2008798

ABSTRACT

Background: During the COVID-19 (coronavirus) pandemic, some provision of healthcare shifted to remote, technology-assisted appointments (telemedicine). Whilst parents/carers of children and young people with rheumatic conditions have reported benefts of telemedicine, concerns remain. Objectives: This patient and parent-led project sought to understand the views of parents/carers about telemedicine, identifying the benefts and limitations of remote technology-assisted appointments, and comparing views between Canadian and European cohorts. Methods: An online survey was developed, translated into multiple languages and shared via social media and patient organisations, targeted at parents of children and young people with rheumatic, autoimmune and autoinfammatory conditions. Fieldwork took place in April 2021 in Europe and May 2021 in Canada. Consent was provided during enrollment. Results: A total of 290 responses were received (133 Europe;157 Canada). Of these, 73% were female, median age 12. Over half of respondents (53%) in Europe reported travelling over an hour to in-person appointments with their paediatric rheumatologist, compared to a signifcantly higher proportion of respondents in Canada (87%). Consequently, in-person appointments represent a greater time burden amongst Canadian car-egivers, though both groups report appointments taking over three hours in total (51% Europe, 69% Canada). Prior to COVID-19, most had never had a telemedicine appointment (92% Europe, 95% Canada). Since March 2020, the majority (71% Europe, 82% Canada) had at least one telemedicine appointment. When asked about aspects of telemedicine, a greater proportion of respondents from Canada answered favourably compared to those from Europe with the majority reporting telemedicine appointments had saved them time, enabled them to have an appointment and that it made the appointment safer. However, most felt that their consultant could not properly assess their child (72% Europe, 78% Canada, P<.05). Overall respondents said they would prefer the next appointment to be in-person (82% Europe, 62% Canada, p<.05), although 31% from Canada were amenable to a combination of in-person and telemedicine-based care. Conclusion: There are advantages to telemedicine, notably saving time and making appointments accessible. Families from Canada tended to view telemed-icine more favourably than those from Europe, although the majority from both cohorts reported concerns about the ability to assess their child. There may be value in providing training to parents to enhance the accuracy of home-based assessments, particularly when the disease is stable. However, parents continue to report the value of in-person appointments.

12.
Open forum infectious diseases ; 2022.
Article in English | EuropePMC | ID: covidwho-1998751

ABSTRACT

During the COVID-19 pandemic, we also experienced a worsening opioid overdose epidemic. Untreated opioid use disorder (OUD) in persons with HIV is associated with worse HIV-related outcomes. Buprenorphine is a safe, evidence-based medication for OUD and is effective in reducing opioid craving and overdose and improving outcomes along the HIV care continuum. Despite the longstanding evidence supporting the benefits of buprenorphine, there remains an implementation gap in the uptake of buprenorphine prescribing in HIV care settings. To improve integration of OUD care and HIV primary care, we recommend 1) all HIV clinicians obtain a buprenorphine waiver, 2) teaching on OUD should be integrated into infectious diseases and HIV continuing medical education, and 3) previously validated models of integrated care should be leveraged to urgently expand access to buprenorphine for persons with HIV and OUD.

13.
Journal of the Intensive Care Society ; 2022.
Article in English | EMBASE | ID: covidwho-1997280

ABSTRACT

Background: Current personal protective equipment (PPE) practices in UK intensive care units involve “sessional” use of long-sleeved gowns, risking nosocomial infection transmitted via gown sleeves. Data from the first wave of the COVID19 pandemic demonstrated that these changes in infection prevention and control protocols were associated with an increase in healthcare associated bloodstream infections. We therefore explored the use of a protocol using short-sleeved gowns with hand and arm hygiene to reduce this risk. Methods: ICU staff were trained in wearing short-sleeved gowns and using a specific hand and arm washing technique between patients (experimental protocol). They then underwent simulation training, performing COVID-19 intubation and proning tasks using either experimental protocol or the standard (long-sleeved) control protocol. Fluorescent powder was used to simulate microbial contamination, detected using photographs under ultraviolet light. Teams were randomised to use control or experimental PPE first. During the simulation, staff were questioned on their feelings about personal safety, comfort and patient safety. Results: Sixty-eight staff and 17 proning volunteers were studied. Experimental PPE completely prevented staff contamination during COVID-19 intubation, whereas this occurred in 30/67 staff wearing control PPE (p =.003, McNemar). Proning volunteers were contaminated by staff in 15/17 control sessions and in 1/17 with experimental PPE (p =.023 McNemar). Staff comfort was superior with experimental PPE (p<.001, Wilcoxon). Their personal safety perception was initially higher with control PPE, but changed towards neutrality during sessions (p <.001 start, 0.068 end). Their impressions of patient safety were initially similar (p =.87), but finished strongly in favour of experimental PPE (p <.001). Conclusions: Short-sleeved gowns with hand and forearm cleansing appear superior to sessional long-sleeved gowns in preventing cross-contamination between staff and patients.

15.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927857

ABSTRACT

Background: Latent class analyses in patients with acute respiratory distress syndrome (ARDS) have identified “hyper-inflammatory” and “hypo-inflammatory” phenotypes with divergent clinical outcomes and treatment responses. ARDS phenotypes are defined using plasma biomarkers and clinical variables. It is currently unknown if these phenotypes have distinct pulmonary biology and if pre-clinical models of disease replicate the biology of either phenotype. Methods: 45 subjects with ARDS (Berlin Definition) and 5 mechanically ventilated controls were selected from cohorts of mechanically ventilated patients at UCSF and ZSFG. Patients with COVID-19 were excluded from this analysis. A 3-variable classifier model (plasma IL-8, protein C, and bicarbonate;Sinha 2020) was used to assign ARDS phenotypes. Tracheal aspirate (TA) RNA was analyzed using established bulk and single-cell sequencing pipelines (Langelier 2018, Sarma 2021). Differentially expressed (DE) genes were analyzed using Ingenuity Pathway Analysis (IPA). Microbial community composition was analyzed with vegan. Fgsea was used to test for enrichment of gene sets from experimental ARDS models in genes that were differentially expressed between each phenotype and mechanically ventilated controls. Results: Bulk RNA sequencing (RNAseq) was available from 29 subjects with hypoinflammatory ARDS and 10 subjects with hyperinflammatory ARDS. 2,777 genes were differentially expressed between ARDS phenotypes. IPA identified several candidate upstream regulators of gene expression in hyperinflammatory ARDS including IL6, TNF, IL17C, and interferons (Figure 1A). 2,953 genes were differentially expressed between hyperinflammatory ARDS and 5 ventilated controls;in contrast, only 243 genes were differentially expressed between hypoinflammatory ARDS and controls, suggesting gene expression in the hypoinflammatory phenotype was more heterogeneous. Gene sets from experimental models of acute lung injury were enriched in hyperinflammatory ARDS but not in hypoinflammatory ARDS (Figure 1B). Single cell RNA sequencing (scRNAseq) was available from 6 additional subjects with ARDS, of whom 3 had hyperinflammatory ARDS. 14,843 cells passed quality control filters. Hyperinflammatory ARDS subjects had a markedly higher burden of neutrophils (Figure 1C), including a cluster of stressed neutrophils expressing heat shock protein RNA that was not present in hypoinflammatory ARDS. Expression of a Th1 signature was higher in T cells from hyperinflammatory ARDS. Differential expression analysis in macrophages identified increased expression of genes associated with mortality in a previous study of ARDS patients (Morell 2019). Conclusions: The respiratory tract biology of ARDS phenotypes is distinct. Hyperinflammatory ARDS is characterized by neutrophilic inflammation with distinct immune cell polarization. Transcriptomic profiling identifies candidate preclinical disease models that replicate gene expression observed in hyperinflammatory ARDS.

16.
Orthopaedic Journal of Sports Medicine ; 10(5 SUPPL 2), 2022.
Article in English | EMBASE | ID: covidwho-1916584

ABSTRACT

Background: Post-concussion sequelae in adolescents include physical, cognitive, and psychosocial effects that may result in reduced quality of life (QOL) and academic challenges when returning to school. The COVID-19 pandemic resulted in altered teaching and learning models outside the traditional in-person classroom, and elevated psychosocial stress and isolation among adolescents. It is unknown whether these changes affected QOL or academic challenges postconcussion. Hypothesis/Purpose: To compare self-reported QOL and academic challenges among concussed adolescents prior to and during the COVID-19 pandemic. Methods: Concussed adolescents were enrolled from secondary schools and children's medical centers across seven sites into the Sport Concussion Outcomes in Pediatrics (SCOPE) study (PRiSM Concussion RIG). Participants completed demographics, medical history, symptom report, the Concussion Learning Assessment and School Survey (CLASS) and QOL via PROMIS Pediatric Global 25 during their first evaluation visit. Participants were grouped by date ranges: September 2018-January 2020 (Pre-COVID-19) and September 2020-May 2021 (COVID-19). No participants were enrolled between February-August 2020 (cessation of clinical research activities during this time.) Results: A total of 141 patients were enrolled. Mean age=14.9±2.4 years, 61% self-reported as male, 82% white and 85% not Hispanic or Latino, 5.2+3.1 days post-injury (range=1-14 days). Seventy-four patients were enrolled prior to COVID, and 67 were enrolled during COVID (Table 1). No significant differences were found between the 'Pre-COVID-19' group versus 'During COVID-19' group in symptom resolution, symptom severity score, QOL, or academic concerns (Table 2). The only difference was the 'person at school who is best to coordinate support.' A significantly lower proportion of participants who sustained their concussion during COVID-19 reported their principal/assistant principal would be the best person to coordinate support compared to those who sustained their concussion before the COVID-19 pandemic. In contrast, a significantly higher proportion of those who sustained their concussion during the COVID-19 pandemic reported their coach would be the best person to coordinate support. Conclusion: In this convenience yet nationally representative sample, students who sustained a concussion during the pandemic did not report increased academic concerns or reduced QOL compared to those whose injury was prior to the pandemic. Median symptom severity was lower during the pandemic, though not statistically significant. These findings could represent shifted priorities of the principal/assistant principal but still adequate support from medical and schoolbased staff;less academic stress and greater flexibility during the COVID-19 pandemic;or may represent limitations in the CLASS instrument to detect differences that occurred during the pandemic.

17.
Adv Radiat Oncol ; 7(5): 100667, 2022.
Article in English | MEDLINE | ID: covidwho-1899443

ABSTRACT

Purpose: The COVID-19 pandemic brought several challenges to cancer practice, especially in ensuring continuity of treatment during this period while minimizing the risks of transmission to a vulnerable population. For radiation oncology departments in Brazil, this contingency has become even more complex owing to the significant effect observed in different sectors of society and the large number of COVID-19 cases and deaths. This study estimated the effect of the COVID-19 pandemic on Brazilian radiation oncology departments and the coping measures used in the country. Methods and Materials: The Brazilian Radiotherapy Society developed a questionnaire, with 14 questions, that were sent to all heads of radiation oncology departments in the country between May and June 2020. These data were evaluated regarding cases confirmed and deaths by COVID-19 in epidemiologic week 28, on July 11, 2020. Results: One hundred twenty-six questionnaires from different regions were answered, representing 44% of the country's services. A drop in the number of patients was observed in 61% of services. This drop was observed both in patients from the public and supplementary private health insurance systems. Regarding patients and employees with COVID-19, we observed that services that primarily treat Unified Health System patients reported significantly fewer cases of the disease. About half of the services had collaborators and patients during radiation therapy with a positive diagnosis of COVID-19. Among the coping measures, the services used intensified hygiene and cleanliness practices, interpersonal distancing, restrictions on access to companions, and other changes in daily practice. Conclusions: Thus, there was an important drop in the number of radiation therapy patients in the country during the pandemic, and this effect was similar among the services, regardless of the characteristics of the patients and the departments' coping measures adopted during the pandemic.

18.
Lecture Notes in Educational Technology ; : 29-52, 2022.
Article in English | Scopus | ID: covidwho-1899063

ABSTRACT

The Australian Council of Engineering Deans (ACED) recently concluded a project (‘Engineering 2035’) to reshape Australian engineering education for future professional engineering graduates. Consultations with industry leaders and others identified the need to strengthen graduate engineers’ capacity for multi-disciplinary and cross-functional teamwork, with greater public accountability. Focus groups of prospective students revealed weak understanding of the growing range of opportunities offered by an engineering qualification of this nature. The corresponding curriculum transformation must ensure greater focus on transferable skills and contexts are delivered alongside technical content. We envisage more industry-based, problem and project-based pedagogies. We found that the engineering academic workforce is positive to such changes. Its recent adaptation of teaching methods to accommodate COVID-19 restrictions gives confidence of a good response to the emerging needs. The project identified 22 Calls for Action to the schools of engineering and ACED, and to industry, government and the professional accrediting body, Engineers Australia. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

19.
Journal of the Practice of Cardiovascular Sciences ; 8(1):22-29, 2022.
Article in English | English Web of Science | ID: covidwho-1884554

ABSTRACT

Objective: The aim of this study is to investigate the postoperative outcomes in post COVID versus non-COVID patients undergone cardiac surgery. Materials and Methods: A retrospective cohort study to analyze the impact of COVID-19 in patients undergoing elective or emergency cardiac surgeries. A total of 512 patients were included in the study over a period of 6 months. The study consists of 35 post-COVID patients and 477 non-COVID patients. All data were collected from previous medical records and hospital database. The clinical outcomes and mortality of post-COVID patients were compared with a cohort of non-COVID patients. The endpoints were compared using t-test or Chi-squared test. Results: Among the post-COVID patients, 54.3% (19) of the post-COVID patients were under COVID category A followed by category B 28.6% (10) and category C 17.1% (6). About 50% of post-COVID patients had complications, especially pneumonia and myocardial infarction following COVID-19. Around 43% of patients showed fibrotic changes in computed tomography (CT) Thorax at the time of admission for surgery. 63% showed CT score in between 1 and 5. The mean COVID antibody titer was 158 U/ml. Majority of the surgeries were coronary artery bypass graft and significant difference was observed in the requirement of intra-aortic balloon pump in post-COVID patients (P < 0.0001). No postoperative mortality reported in post-COVID patients. The postoperative outcomes and survival rates were almost similar in both groups. Conclusion: In our study, the post-COVID patients were recover in a similar way as non-COVID patients after cardiac surgery.

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