Research on the Relationship between Teacher Expectations and College Students' Online English Learning Engagement

As a critical influencing factor of learning engagement, teacher expectation plays a vital role in ensuring the quality of online teaching under COVID-19. This paper investigates the relationship between teacher expectations (three dimensions of teacher support, teaching interaction, and academic feedback) on students' online English learning engagement (three dimensions of cognitive engagement, behavioral engagement, and emotional engagement) in e-learning through a questionnaire survey of 513 college students. Pearson correlation analysis and multiple regression analysis were applied as research methods. The results manifest that college students' online English learning engagement was above average, but emotional engagement needs improvement. In addition, teacher expectations of teaching interaction positively and significantly predict English e-learning engagement. Based on this, the article puts forward suggestions on the future of online teaching from the aspects of online teaching design, feedback quality of teachers and students, innovative teaching practice of technology empowerment to effectively play the role of teachers as scaffolding and improve the effectiveness of online English teaching. © 2023 IEEE.

Investigating Factors That Influence College Students' Online Continuous Learning Intention during COVID-19 Epidemic

This study aims to explore university students' continuous intention toward online learning during COVID-19 pandemic. A total of 120 students enrolled in online learning were surveyed to collect their perception of an extended model by adding task value to the expectation-confirmation model. Structural equation modeling was employed to verify the hypotheses proposed in this study. The results indicated that task value and technology usefulness were significant predictors of students' continuous intention toward online learning. More specifically, technology usefulness had a direct impact on students' continuous intention, while students' perceived task value played an indirect role in the prediction of their continuous intention. However, the impacts of both confirmation and satisfaction were not statistically significant on students' continuous intention. The results suggest that practitioners and researchers should pay special attention to the technological usefulness of online learning environments and task value, especially task value, in order to enhance students' retention of online learning. This study would contribute to implications to better design and implement online learning. © 2023 IEEE.

Model Construction and Empirical Study on Unsustainable Usage Behavior of Paid Knowledge Users

Knowledge payment is a new method of electronic learning that has developed in the era of social media. With the impact of the COVID-19 pandemic, the market for knowledge payment is rapidly expanding. Exploring the factors that influence users' sustained willingness is beneficial for better communication between knowledge payment platforms and users, and for achieving a healthier and more sustainable development of the knowledge payment industry. The model of unsustainable usage behavior of knowledge payment users was constructed on the basis of expectation inconsistency theory, price equilibrium theory, and perceived value theory, using the 'cognitive-emotional-behavioral' model framework of cognitive emotion theory. The data were collected from 348 users through a web-based questionnaire and analyzed using structural equation modeling. Findings show that expectation inconsistency, price equilibrium, and quality value, emotional value, and social value have significant effects on discontinuous use intentions. Discontinuous use intentions also significantly affect discontinuous use behavior. © 2013 IEEE.

Patient Survey in Medical Practices on their Visit during the SARS-CoV-2 Pandemic.

Background: Since the beginning of the SARS-CoV2 pandemic medical practices have implemented diverse protective measures to contain the pandemic, practice organization and structures were adapted. In order to get information about patients' perception of their doctors' visit during the pandemic, we conducted a patient survey in medical practices. Method(s): Cross-sectional study of 58 patients, who were interviewed in four medical practices (family physicians and specialists) in the South West of Munich from 02.04.-17.04.2020 on the following topics: "personal risk assessment", "sense of security and perception of protection measures in the practice setting", "importance of the doctor's visit" and "change of medication, nicotine consumption". By means of a questionnaire with 24 items, data were collected anonymously. Results are presented descriptively and via ANOVA as well as via linear regression. Result(s): The personal risk assessments for COVID-19-disease and for a severe course of COVID-19 were rated low moderate, independent of sex or age. Around 8% of the surveyed patients discussed their personal risk with their doctors. The sense of security in the practice setting was rated high. The rating of the protection equipment was good as well, and closely met expectations. The personal importance of the visit varied. Only 6% had considered cancelling their visit beforehand. A change of medication due to SARS-CoV-2 pandemic was not observed. Conclusion(s): The patient survey provides a snapshot of the outpatient setting from the patient's perspective in a hyperdynamic pandemic situation. Yet, due to the small study population, the results have to be interpreted with caution.Copyright © 2021, Deutscher Arzteverlag.

A quality improvement project regarding family communication within critical care

Introduction: Communication is central to high quality critical care (CC)1 and caring for family members is integral to the care of critically ill patients. Communication within the CC frequently does not meet families' needs,2 impacts informed decisions making3 and can result in psychological morbidity for patients and their families.4 During the COVID-19 pandemic communication was challenging with restricted family visiting. As part of our recovery strategy we aim to ensure that frequent, high quality communication remains a key aspect of critical care. There is currently no guidance relating to the frequency of family communication within critical care. Objective(s): Our aim was to review the frequency of family communication during CC admissions admission and to develop our own internal standards. Method(s): A retrospective audit was conducted of 110 admissions to Guys and St Thomas' CC from November 2021 - February 202. We reviewed all routine family discussions documented in the medical notes. Data regarding the patient's length of stay, time to first communication from admission, frequency of communication throughout admission and grade of clinician leading the communication was collected. Family discussion regarding adverse incidents and admissions less than 24hrs were excluded. If multiple communications occurred on the same day, the most senior communication was included. To complement the audit a short survey of the consultants, regarding expectations and standards of practice of family communication was completed. Result(s): 99 patients were included within the audit and 13 responses to the survey (34% response). The mean length of stay for all patients was 14 days for survivors and 16.5 days for those who died. 32% of patients received a document family communication within 24hrs of admission, 34% did not have a documented communication within 72 hours of admission. 58.3% of consultants felt a family update should happen within 24hrs of admission and 84.7% of consultants reported that families should be updated once every 3 days. On average families received a documented family communication every 5.5 days of a CC admission. When focusing just on patients who died there was an increase in the frequency of communication to once every 3 days. 23% of all documented family discussions were consultant led with the number rising to 44% in non-survivors. The audit also showed that the longer a patient stayed within critical care the less frequently a family communication became. The survey indicated that the two biggest barriers to family communication is time pressures and appropriate space. Conclusion(s): We demonstrated that documented family communication was less frequent than expected. To ensure that family commination remains a key component of CC within our department we have adopted or own internal standard of providing families with an update once every 3 days. We are exploring the role of communication facilitators5 and seeking patient/family feedback also to improve family communication further.

Online adaptation of a compassion-focused intervention to treat comorbid eating disorders and posttraumatic stress disorder during the COVID-19 pandemic

Aims: To provide psychological support for individuals recovering from comorbid eating disorders (EDs) and posttraumatic stress disorder (PTSD) during the COVID-19 pandemic, we adapted a 10-session compassion-focused group-based intervention for delivery online using video conferencing technology. This study describes how the group content and resources were adapted and synthesizes qualitative feedback from participants and facilitators. Method(s): Content and format were modified and a new website to host supporting material was developed. Clear guidelines regarding recruitment and acceptance into the group, boundaries within the group, and risk management were implemented. Structured qualitative interviews regarding participants' online group experiences were conducted with 17 women following the group completion. Result(s): In-depth communication concerning group expectations and activities was important during assessment to ensure the intervention was well-suited to prospective participants. Consistent implementation of group guidelines by facilitators was critical in maintaining a safe online environment. Participants indicated online delivery increased logistical accessibility, as many reported they would have been unable to attend otherwise (e.g., time, geographical location), and reduced fear of judgement and anxiety about in-person attendance. Favourable online adaptations reported by participants included inclusion of all group members, opportunities to share in smaller groups/pairs and online resources. Conclusion(s): Delivery of group-based compassion-focused interventions for individuals with comorbid EDs and PTSD are appropriate for overcoming barriers that may otherwise prevent participation. Online resources could potentially increase intervention uptake among individuals in the early stages of recovery from these disorders.

Training needs for ECMO nurses: Analysis, results and what,s beyond

Objectives: Nurses attending ECMO patients must have specialized knowledge and skills. At Careggi Teaching Hospital and ECMO center, as well as in other hospitals worldwide, new personnel have been summoned to face the increased number of critical patients due to the COVID pandemic. Therefore, the number of nurses with poor ECMO experience has recently skyrocketed. During the work shifts inexperienced nurses have been coached by experienced ones. This organization has permitted to manage a volume of fifty-nine ECMO patients during the pandemic without significant adverse events. Method(s): We led a survey among the nurses of the ICU and ECMO unit to assess their perceived training status and educational needs. In November 2022 seventy-two nurses received an anonymous questionnaire made of 21 items based on Likert scale. The questionnaire consisted of three parts investigating the general knowledge of ECMO support and maintenance, their perceived level of competency in several conditions and, finally, their expectations for future training. Result(s): The most relevant results are presented in figure 1. From the analysis of the survey we have assessed that in our institution, an educational programme for nurses actually involved in managing ECMO patients is an urgent need and should cover both ordinary management and emergency situations. Real life scenarios and crisis resource management events should be the focus of the programme. Conclusion(s): Training in ECMO is crucial for patient safety. After COVID pandemic, in our ECMO center, capabilities and knowledge of newly recruited nurses treating ECMO patients are suboptimal/unsatisfactory. A questionnaire to analyze the actual level of competence of the personnel involved can help to tailor a more effective educational programme to meet their real needs and to select the appropriate improvement actions. (Figure Presented). (Figure Presented).

Remote care for chronic pain: A qualitative evaluation with managers, practitioners, and patients

The Covid-19 pandemic obliged many healthcare providers to transition rapidly to a remote-only model of care. Concerns have been expressed about patient access to remote services, their appropriateness for sensitive consultations and physical examinations. Pre-pandemic research into telemedicine showed evidence of its effectiveness, but patient, staff and service user perspectives on remote care approaches remain unclear. This study explored the experiences and perceptions of care among patients, practitioners and managers in a single United Kingdom chronic pain organisation whose services were delivered remotely (telephone and online) during the pandemic. Nineteen participants (seven patients, seven practitioners, five managers) took part in in-depth qualitative interviews, conducted via telephone or online. Transcripts were analysed thematically. Five service provider and four service user themes were generated. Service provider themes comprised "The change process," "Accessibility and efficiency," "Effective when remote: Contact, support and education," "Concerns about communication, connection and disembodied work," and "Supporting and sustaining the team." Patients' themes comprised "Preferences, expectations and acceptance of remote care," "Convenience and accessibility," "Sense of support" and "Delivery modality matters." The study provides evidence from the qualitative evaluation of a single remote only service of its benefits and limitations as perceived by stakeholders. Findings suggest that service providers could address limitations, and progress to a blended care package, based on for patient need and choice. Further attention could be paid to services delivered by telephone, and to staff communication skills, resources, time management and wellbeing needs.Copyright © Nova Science Publishers, Inc.

Risk factors for worsening of somatic symptom burden in a prospective cohort during the COVID-19 pandemic

Aims: Little is known about risk factors for both Long COVID and somatic symptoms that develop in individuals without a history of COVID-19 in response to the pandemic. There is reason to assume an interplay between pathophysiological mechanisms and psychosocial factors in the etiology of symptom persistence. This study investigates specific risk factors for somatic symptom deterioration in a cohort of German adults with and without prior SARS-CoV-2 infection. Method(s): German healthcare professionals underwent SARS-CoV-2 IgG antibody testing and completed self-rating questionnaires at baseline and 21 months later between April 2020 and February 2022. Differences in variables between the time points were analyzed and a regression analysis was performed to predict somatic symptom deterioration at follow-up. Result(s): Seven hundred fifty-one adults completed both assessments. Until follow-up, n = 58 had contracted SARS-CoV-2 confirmed by serology. Between baseline and follow-up, signs of mental and physical strain increased significantly in the sample. Symptom expectations associated with COVID-19 and a self-reported history of COVID-19, but not serologically confirmed SARS-CoV-2 infection, significantly predicted somatic symptom deterioration at follow-up. A further predictor was baseline psychological symptom burden. Conclusion(s): This study supports a disease-overarching biopsychosocial model for the development of burdensome somatic symptoms during the COVID-19 pandemic and supports research findings that symptom burden may be more related to the psychosocial effects of the pandemic than to infection itself. Future studies on Long COVID should include SARS-CoV-2 negative control groups and consider symptom burden prior to infection in order to avoid an overestimation of prevalence rates.Copyright © 2023

Framing of economic news and policy support during a pandemic: Evidence from a survey experiment

We examine how news outlets' communication of macroeconomic information affects policy support during the COVID-19 crisis. In our survey experiment based on a representative sample from Germany, respondents are exposed to an expert forecast of GDP growth. Individuals either receive no information, the baseline forecast, or real-world media frames of the same forecast. We find that positive framing of economic growth increases policy support. This effect is stronger for respondents with more pessimistic macroeconomic expectations. Negatively framed economic news are perceived as more credible and hence less surprising in times of recession, not translating into political opinion.

The Importance of the Treatment Rationale for Pain in Animal-Assisted Interventions: A Randomized Controlled Trial in Healthy Participants.

Animal-assisted interventions (AAIs) is a promising treatment approach for pain, but possible mechanisms still need to be elucidated. This study set out to investigate the analgesic effects of an animal provided with a treatment rationale in a randomized controlled trial employing a standardized experimental heat-pain paradigm. We randomly assigned 128 healthy participants to: dog treatment (DT), placebo treatment (PT), dog and placebo treatment (DPT), and no treatment (NT). Primary outcomes were heat-pain tolerance and the corresponding self-reported ratings of pain unpleasantness and intensity. Results revealed no differences in heat-pain tolerance between the conditions. However, participants in the DT condition experienced heat-pain as significantly less unpleasant at the limit of their tolerance compared to participants in the NT condition (estimate = -0.96, CI = -1.58 to 0.34, P = .010). Participants in the DT condition also showed lower ratings of pain intensity at the limit of their tolerance compared to participants in the NT condition (estimate = -0.44, CI = -0.89 to 0.02, P = .060). This study indicates that a dog has analgesic effects on pain perception when integrated into the treatment rationale. We assume that providing a treatment rationale regarding the animal is important in AAIs for pain. PERSPECTIVE: This study shows that the presence of an animal is not sufficient for animal-assisted interventions (AAIs) to have an analgesic effect on pain unless they are provided with a treatment rationale. This could imply that not only the animal but also contextual factors are important in AAIs. TRIAL REGISTRATION: Clinical Trials NCT04361968.

Factors influencing loyalty to online health consultation platform: a cross-strait cultural perspective.

BACKGROUND: The geographical, cultural, and linguistic proximity between Taiwan and Mainland China has facilitated rapid growth of cross-strait interactions. Both countries have developed online health consultation platforms on the Internet for the public to access healthcare related information. This study examines factors that influence loyalty to a specific online health consultation platform (OHCP) from a cross-strait perspective. METHODS: Based on the Expectation Confirmation Theory and the combined Trust, Perceived Health Risks and Culture, we examine factors that influence loyalty to OHCPs among cross-strait users by investigating the roles of trust, perceived health risks, and culture. Data was collected through a questionnaire survey. RESULTS: The research models used provide a high-power explanation of loyalty to OHCPs. Results generally align with those of previous studies, with the exception of the relationships between Perceived Health Risks and Perceived Usefulness, Perceived Usefulness and Loyalty, Confirmation and Satisfaction, and Trust and Loyalty. In other words, culture may have moderated these relationships. CONCLUSIONS: Findings can help promote OHCPs among cross-strait users to make things easier for patients, and further reduce the load on the emergency department, especially in view of the still ongoing issues related to global outbreak of Coronavirus disease by facilitating early detection of potential cases.

Antecedents of students' e-learning continuance intention during COVID-19: An empirical study

This study aims at exploring the underlying determinants influencing students' continuance intention to use an e-Learning platform during the COVID-19 pandemic. Based on the technology acceptance model and expectation-confirmation model, the study investigated the role of contextual (i.e., social isolation), psychological (academic year loss and cyberchondria), and student support-related (government and institutional supports) determinants on students' continuance intention to use an e-Learning platform during the pandemic. The study collected data from 440 respondents and analyzed those with Structural Equation Modeling. The findings showed that an e-Learning continuance intention during the pandemic is affected by usefulness, ease of use, attitudes, and intention to use the e-Learning platform;while the behavioral intention is influenced by usefulness, ease of use, attitudes, contextual, psychological, and student support-related determinants;and attitudes are impacted by usefulness and ease of use. Moreover, usefulness is predicted by confirmation of expectation;e-satisfaction is forecasted by usefulness and confirmation of expectation;whereas, cyberchondria is influenced by social isolation;fear of academic year loss is influenced by cyberchondria. Finally, intention to use mediated the impact of usefulness, ease of use, attitudes, contextual, psychological, and student support-related determinants on continuance intention. The study contributes to e-Learning literature incorporating contextual, psychological, and student support-related determinants into the technology acceptance model and expectation-confirmation model, which guide policymakers to understand how all levels of students can be brought into the e-Learning platforms that eventually help to eliminate digital discrimination barrier in the academia during any emergency. The policymakers must be careful in designing eLearning platforms since students' e-learning continuance intention may vary due to unprecedented crises, such as COVID-19.

The Role of Perceived Usefulness and Confirmation in Influencing Student's Satisfaction on Online Distance Learning

Today's learning opportunities are immense in scale and bolstered by the support of technological advancements. Many universities in Malaysia have contributed to the trend of advancements in education and technology. It was recommended that online distance learning (ODL) and online teaching processes should be used at all levels of education during the COVID-19 pandemic. However, the use of these technological advancements has encountered challenges, which were recognized during the initial application of ODL. Both students and academics faced many obstacles as first-time users of online education. This study explores students' expectations of ODL based on Expectation-confirmation theory (ECT). A survey was conducted with 579 university students to test the hypotheses of this study. The results of this questionnaire were tested using structural equation modeling (SEM) AMOS mediation analysis. The results showed partial mediating effects between perceived usefulness, confirmation, and satisfaction with online distance learning. Furthermore, it was found that perceived usefulness has a significant influence on student satisfaction with and confirmation of ODL. To ensure that students of higher learning institutions are satisfied with ODL, it is vital for universities and colleges to make these students believe that the application of ODL is useful and can create significant value for them © 2023, Asian Journal of University Education.All Rights Reserved.

VentConnect: telemetry system that enables remote live transmission of ventilator screen: qualitative study of clinicians' expectations and experience

Introduction: To maximise the input of intensivists onto the management of ventilated patients during the COVID pandemic, we have developed and implemented telemetry system VentConnect [1]. The aim of this study is to identify stakeholder's expectations and experience from this technology. Method(s): The telemetry device VentConnect (scheme at Fig. 1) enabled transmission of HDMI signal from mechanical ventilators to a password protected interface on any web browser. We implemented it between December 2020 and March 2021 on a total of 31 beds where patients were treated during COVID Pandemic. Afterwards, we performed Structured User Interviews with ICU doctors. Questionnaire responses we clustered and calculated. Result(s): Eight doctors were interviewed, 4 fully qualified intensivists, and 4 in training. By far the most demanded was the ability to see flow curve or flow pattern (100%), followed by inspiratory pressures (75%) and check tidal volume (63%). Other parameters were mentioned less frequently such as driving pressure (25%) and interferences (38%). With regards users experience, answers were overwhelmingly positive, highlighting mostly the ability to continuously monitor the progress of patients without the need to donning personal protective equipment. In some, however, curiosity was the only motivator for use. Three juniors expressed apprehension that their supervisors might criticise their ventilator setting which would otherwise had gone unnoticed. Two participants thought that the temptation to check patient 24/7 would impair their ability to rest and relax during their off time. Conclusion(s): Telemetry system that enabled clinicians to remotely check ventilator screen met the expectation of clinicians, who mainly demanded to check flow patterns, tidal volumes and pressures. Concerns were mainly about psychological impact of using this technology. These need to be addressed.

Cystic Fibrosis Learning Network Learning Structure for Multicenter Spread of Co-Production and Timely Patient Registry Data Entry Practices

Background: The Cystic Fibrosis Learning Network (CFLN) is a group of 34 programs that work and learn together with shared measures and processes to improve patient outcomes. Interventions are organized into change packages (collected, actionable concepts to share tested, refined ideas across multiple care centers). Since 2016, these change packages have helped advance team level co-production and improve timely data entry (TDE) and quality and use of Cystic Fibrosis Foundation Patient Registry (CFFPR) data. In the context of the COVID-19 pandemic, in-person meetings were curtailed, and team membership changed often. New learning structures to promote peer-to-peer learning were needed to spread and sustain these interventions. The objective was to describe the shared multicenter learning method used to spread practices in two series: co-production (recruitment and onboarding of patient and family partners (PFPs)) and TDE entry into the CFFPR. Method(s): In the design phase of the learning structure, we developed objectives specific to each series. Community content experts refined the curriculum from the established change package concepts. Teams were recruited through an open invitation to all CFLN sites. and met virtually biweekly for 30-minute sessions for 10 to 12 weeks. CFLN content experts used the change packages to coach teams and share their experiences during learning structure huddles. These sessionswere followed by 2-week action periods to review and test change package ideas. Teams shared progress at each meeting in round-robin format. Progress toward smart aims, team experience, and participation were assessed using descriptive surveys before, during, at the end of the series, and 6 months after it closed. Result(s): In initial surveys, teams self-reported awide range of experiences with co-production and TDE into the CFFPR. Participating teamswere from pediatric and adult programs that varied in number of patients and geographic location. Four teams participated in the co-production series to recruit and onboard PFPs within 6 months of completion. In the 6-month follow-up survey, two of the four teams met their goal of recruiting and onboarding a new PFP. The remaining teams reported barriers related to institutional policies that limited training for volunteers. In the TDE series, five teams joined and aimed to improve TDE into the CFFPR within 8 months. All five teams are on target to meet this goal. For both series, action-period surveys revealed completion of tasks assigned (e.g., reviewof change package concepts, testing tools, process maps, barriers, facilitators). Feedback surveys collected during the final sessions of each series indicated that the learning structure helped teams meet expectations, learn something new, and increase confidence in the interventions. Conclusion(s): This learning structure for spreading standard interventions helped teams meet series' aims. The small-group structure allowed teams to learn and adapt coproduction and timely data change package ideas and sustain practices for at least 6 months. In future iterations, this learning structure could be used as a model to spread standard interventions to other programs in the CFLN and the larger care center network.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

'Forgotten issue': Living and caring for people with chronic breathlessness

Introduction: Breathlessness is a common symptom in clinical practice and in many prevalent diseases including chronic obstructive lung disease (COPD), asthma, heart failure, lung cancers and post COVID-19 syndrome. Understanding patients' experience of living with breathlessness, their expectations of care and self-management needs is essential to support development of health services and resources that meet their needs. Aim(s): To explore the perspectives of patients and their careers, on living with chronic breathlessness, provision and quality of medical care, and accessing information and resources to assist self-management. The study also explored their views on three evidence-based breathlessness patient education materials (PEMs). Method(s): Qualitative study involving in-depth semi-structured interviews with 16 patients living with chronic breathlessness (>=2 weeks) and their careers. Topics explored included: (1) experience living with breathlessness;(2) current medical care experience and their expectations;and (3) self-management resources, needs and views on some current publicly available PEMs. Result(s): Fourteen patients (cardiac, respiratory, and non-cardiorespiratory) and two carers (50% female) were interviewed (mean age 57 years). Twelve main themes were identified - (1) Breathlessness controls their lives, (2) Breathlessness avoidance and the vicious cycle, (3) Coping vs Fatalism, (4) Feeling misunderstood by their surroundings and health providers, (5) Diagnostic delays, misdiagnosis, and knowledge gaps, (6) Discontinuity of care, (7) Focus on pharmacologic management of breathlessness, (8) Demand for choice, non-pharmacologic options and support, (9) Beyond curing disease: symptom relief and improving quality of life as a goal, (10) Being more aware and in control of their disease, (11) Self-management and limited support for it, and (12) Resources they would value. Conclusion(s): Breathlessness remains a neglected condition in Australia. Patients suffer from lack of clinician and community awareness, discontinuity of care, and too few clinical and self-management options.

Extracellular vesicles as delivery vectors to enhance killing of bacteria and viruses by airway-recruited human neutrophils

Background: Polymorphonuclear neutrophils (PMNs) recruited to the airway lumen in cystic fibrosis (CF) undergo a rapid transcriptional program, resulting in exocytosis of granules and inhibition of bacterial killing. As a result, chronic infection, feed-forward inflammation, and structural tissue damage occur. Because CF airway PMNs are also highly pinocytic, we hypothesized that we could deliver protein- and ribonucleic acid (RNA)-based therapies to modulate their function to benefit patients. We elected to use extracellular vesicles (EVs) as a delivery vector because they are highly customizable, and airway PMNs have previously been shown by our group to process and use their cargo efficiently [1]. Furthermore, our prior work on CF airway PMNs [2] led to identification of the long noncoding RNA MALAT1, the transcription factor Ehf, and the histone deacetylase/long-chain fatty deacylase HDAC11 as potential targets to modulate CF airway PMN dysfunction. Method(s): H441 human club epithelial cells were chosen for EV production because they efficiently communicate with lung-recruited primary human PMNs [1]. Relevant constructs were cloned into an expression plasmid downstream of a constitutive cytomegalovirus or U6 promoter with an additional puromycin selection cassette. EVs were generated in serumdepleted media and purified by differential centrifugation. Quality and concentration of EVs was determined by electron microscopy and nanoparticle tracking analysis and cargo content by western blot (protein) or qualitative reverse transcription polymerase chain reaction (RNA). Enhanced green fluorescent protein and messenger ribonucleic acid (mRNA) were used as controls. To test delivery to primary human PMNs, generated EVs were applied in the apical fluid of an airway transmigration model [2]. PMN activation was assessed by flow cytometry, and bacterial (PA01 and Staphylococcus aureus 8325-4) killing and viral (influenza Avirus [IAV] H1N1/PR/8/34;SARS-CoV-2/Washington) clearance assays were conducted. Result(s): To package protein, we used EV-loading motifs such as the tetraspanin CD63, Basp1 amino acids 1-9, and the palmitoylation signal of Lyn kinase. To load mRNA, a C'D box motif recognized by the RNA-binding protein L7Ae was included in the 3' untranslated region of the expressed RNA, and CD63-L7Ae was co-expressed. Airway-recruited PMNs treated with EVs containing small interfering RNAs against MALAT1 or HDAC11 showed greater ability to clear bacteria. Conversely, PMNs treated with constructs encasing MALAT1 or HDAC11 efficiently cleared IAV and SARSCoV- 2. PMNs expressing Ehf showed greater clearance of bacteria and viruses. Conclusion(s): Our findings suggest mutually exclusive roles of MALAT-1 and HDAC11 in regulating bacterial and viral clearance by airway-recruited PMNs. Expression of Ehf in airway PMNs may be a pathogen-agnostic approach to enhancing clearance by airway-recruited PMNs. Overall, our study brings proof-of-concept data for therapeutic RNA/protein transfer to airway-recruited PMNs in CF and other lung diseases and for use of EVs as a promising method for cargo delivery to these cells. It is our expectation that, by treating the immune compartment of CF airway disease, pathogentherapies, such as antibiotics will be more effective, and epithelial-targeted therapies, such as CFTR modulators, will have greater penetrance into the cell types of interest.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Impact of the pandemic on critical care staff safety climate assessed using safety attitudes questionnaire (SAQ) in all hospitals within the East of England

Introduction: As part of the last two peer review processes the East of England Critical Care Network have undertaken SAQ [1] involving staff in the 18 hospitals in the region. The questionnaire is divided into 7 scales and allows a wide assessment of safety culture which has been associated with improved outcomes and reduced adverse incidents [2]. The two surveys straddle the Covid-19 pandemic which has had a recognised impact on staff welfare. We postulated that this is likely to be identifiable within the survey and wished to understand the effect on different staff groups and levels of experience. Method(s): The survey was distributed using an online platform and analysed in R. Result(s): 1647 questionnaires were completed in 2019 (753) and 2022 (894). Demographic data was collected for role (nursing, medical, AHP, support) and critical care experience (short: < 4 years medium: 4-10 years, long: > 10 years). For all staff Climate scores fell significantly in all scales except stress recognition, most noticeably in job satisfaction and working conditions. This was also the case within the nursing subgroup;however, it was not seen in medical staff (though there was a less pronounced trend). AHPs reported a marked reduction in job satisfaction. Support staff also demonstrated big reductions in all scales including teamworking and safety climate. The fall in job satisfaction and working condition scales were also most profound in staff with 4-10 year's critical care experience. Conclusion(s): The pressures of the pandemic have had a lasting effect on most staff groups, particularly in job satisfaction and working conditions. This appears to have particularly impacted nursing and support staff. Those of moderate experience may have been the staff most directly involved with increased patient care and expectations to undertake managerial roles with reduced training. The impact of this appears to be ongoing despite efforts to support staff well-being.

Prescribing of oral antibacterial drugs in primary care out-of-hours services: a scoping review

Introduction: The rapid spread of antimicrobial resistance (AMR), which causes a serious threat to both human health and the global economy, is primarily linked to the overuse and misuse of antibacterial drugs. The AMR crisis is significantly impacted by the use of antibacterial drugs in primary care (1). Within these settings, oral antibacterial drugs are considered one of the most frequently prescribed group of medicines. It has been claimed that within primary care, the proportion of antibacterial drug prescribing is higher outside the regular working hours (out-of-hours (OOH) services) compared to in-hours (IH) services (2). Aim(s): To identify the existing body of literature around oral antibacterial drug prescribing within primary care OOH services. Method(s): The scoping review was guided by the Joanna Briggs Institute manual and reported in accordance with the PRISMA-ScR. Seven electronic databases (Medline, Embase, Emcare, CINAHL, Scopus, Web of Science, and Cochrane Library) were systematically searched, and the results were screened against pre-defined eligibility criteria. Original and secondary analysis studies that addressed oral antibacterial prescribing in OOH primary care and were published in English were included. Titles and s were independently screened by three reviewers. A pre-piloted extraction form was used to extract relevant data. A narrative synthesis approach was used to summarise the results. Result(s): The initial search yielded 834 records. Upon screening, 28 publications fulfilled the eligibility criteria. Included studies originated from nine high-income countries, with the most frequent being the United Kingdom (six studies, 21.4%) followed by Belgium (five studies, 17.9%). Literature on antibacterial prescribing in OOH services was mostly from quantitative studies (23 studies, 82.14%), with only a few employing a qualitative design (five studies, 17.86%). Different themes and sub-themes were identified across these studies. The majority discussed antibacterial prescribing data in terms of the commonly prescribed medications and/or associated conditions. Eleven studies provided a comparison between IH and OOH settings. Seven studies reported the trends of prescribing over time;of these, three explored prescribing trends before and during COVID-19. The impact of intervention implementation on prescribing was investigated in two studies, an educational intervention in one study and the use of an interactive booklet in the other study. Four studies assessed the quality/appropriateness of prescribing either by adherence to guidelines or antibiotic prescribing quality indicators. Limited studies explored prescribing predictors and patients' expectations and satisfaction with OOH services. In contrast, qualitative studies focussed more on exploring prescribers' experiences, perspectives, behaviours, and the challenges they face during consultations within OOH settings which may influence their decision-making process. Of these, one study explored why patients consult OOH services and how they communicate their problems. Conclusion(s): This review shows the key areas around oral antibacterial prescribing in primary care OOH services. While there is a satisfactory number of published articles covering various areas within OOH, the use of different approaches to OOH across countries may confound the comparison of practice. A strength of this work is using three reviewers to screen identified records independently. Further research is needed to provide a better understanding of current practice in these settings and how it may be contributing to AMR.