Inflammatory profiles across the spectrum of disease reveal a distinct role for GM-CSF in severe COVID-19

While it is now widely accepted that host inflammatory responses contribute to lung injury, the pathways that drive severity and distinguish coronavirus disease 2019 (COVID-19) from other viral lung diseases remain poorly characterized. We analyzed plasma samples from 471 hospitalized patients recruited through the prospective multicenter ISARIC4C study and 39 outpatients with mild disease, enabling extensive characterization of responses across a full spectrum of COVID-19 severity. Progressive elevation of levels of numerous inflammatory cytokines and chemokines (including IL-6, CXCL10, and GM-CSF) were associated with severity and accompanied by elevated markers of endothelial injury and thrombosis. Principal component and network analyses demonstrated central roles for IL-6 and GM-CSF in COVID-19 pathogenesis. Comparing these profiles to archived samples from patients with fatal influenza, IL-6 was equally elevated in both conditions whereas GM-CSF was prominent only in COVID-19. These findings further identify the key inflammatory, thrombotic, and vascular factors that characterize and distinguish severe and fatal COVID-19

Procalcitonin Is Not a Reliable Biomarker of Bacterial Coinfection in People With Coronavirus Disease 2019 Undergoing Microbiological Investigation at the Time of Hospital Admission

Abstract Admission procalcitonin measurements and microbiology results were available for 1040 hospitalized adults with coronavirus disease 2019 (from 48 902 included in the International Severe Acute Respiratory and Emerging Infections Consortium World Health Organization Clinical Characterisation Protocol UK study). Although procalcitonin was higher in bacterial coinfection, this was neither clinically significant (median [IQR], 0.33 [0.11–1.70] ng/mL vs 0.24 [0.10–0.90] ng/mL) nor diagnostically useful (area under the receiver operating characteristic curve, 0.56 [95% confidence interval, .51–.60]).</jats:p

Chaired by ...

Autorthnographic examination involving drawing, painting and sculptural installation. A solo exhibition of artistic investigation at the Platform Gallery, Kingston University, London as part of professional doctorate study

Loss

Make Create: A group exhibition as part of London Craft Week 2015 bringing together contemporary artists to work in collaboration with craft practitioners. I collaborated with a textile weaver Margaret Jones creating woven and plasma cut ‘figures’

Books to help alleviate procedural anxiety for children facing serious illness or surgery in conjunction with Great Ormond Street Hospital

1. MISSION ‘To make kids who are really poorly feel better’. Our Purpose To provide witty and playful designs to help patients understand their treatment and get better. We are a nascent not-for-profit company using design skills to help patients feel less anxious and more empowered through their treatment journey. We help the NHS save money by minimising delays and cancellations. ‘the book is incredible – absolutely great in everything – information, fun, lovely graphics, exactly what is needed’ Jacqueline Wilson WHY? We exist to support patients through their clinical experience and make them feel less anxious and empowered. Currently there is a paucity of this sort of support and patients can feel overwhelmed and uninformed. There is compelling evidence that our interventions are really cost effective and save the NHS valuable time and resources. HOW? We create clear and witty communication design that explains the treatment journey in simple, step-by- step ways that everyone can understand. Beautifully designed, simple to use and absolutely user-friendly. WHAT? We create interactive designs that are really effective! From interactive books, through to apps, animations and plenty more too. Eminently silly, funny but underneath all this: utterly focused and serious. Our desired impact is simple. We want to support more and more patients and, to do this, we have ambitious plans to make a real difference in an ever-widening sphere. We have worked closely with the teams at Great Ormond Street Hospital in London to pilot our products and now want to expand across healthcare in the UK and internationally. The innovation is eminently transferable and can work anywhere. We have already helped over 3750 children and have amassed fantastic feedback and plaudits. We will measure our impact by: • having a sustainable not-for-profit business that continues to grow and support more patients. • validating our work through research into the effectiveness of our interventions (we are currently doing this in conjunction with academics at GOSH). • continuing to receive positive feedback and endorsements. • receiving new commissions for new projects. • receiving repeat orders (this is already happening in the arenas we are working in). Our products are becoming part of the everyday dialogue between clinicians and patients. • expanding into new hospitals and healthcare environments. • expanding to work on a widening range of conditions. 2. SERVICE SUMMARY What market needs or problems are we addressing: • Poor patient experience. • Patients (and parents!) do not understand their condition and the required treatments. • Patient anxiety can cause expensive delays. • Time costs money in clinical environments. • Increased need for expensive human resources (anxious patients require Increased support). • There can be long term negative consequences of anxiety. • An anxious patient can create anxiety for all involved. • Lack of compliance with medical processes can necessitate additional or duplicate treatments. Up to 80% of children admitted to hospital with chronic illness experience anxiety from hospitalisation alone. Between 50% and 75% of children having surgery experience anxiety in the anaesthetic room. Between 24% and 60% of children will display dysfunctional behaviour within the 3 weeks following surgery. This takes the form of eating disorders, problems sleeping, nightmares, temper tantrums, bed- wetting and problems with authority. P.O.E.M.S for Children Charity (poemsforchildren.co.uk/about-us/) Compliance with medication is a key factor in successful kidney transplantation. Immunosuppressive medications are crucial to the transplanted kidney as these prevent the rejection of the organ by the host immune system. Consequently, poor compliance with these medications is considered a serious healthcare problem. Despite its severe complications poor adherence to medication can be found in 20% of kidney recipients. Dr M. Harber, Consultant Nephrologist, Royal Free Hospital, London How are we solving these problems: Our interventions are designed to help mitigate procedural and hospital anxiety, optimise the patient experience and disseminate knowledge and understanding of the complex steps involved in the patient’s treatment, recovery and ongoing care. By helping do these things, hospitals help themselves by speeding up procedures and saving money. We work in close collaboration with specialist teams to understand the patient journey so that we can translate this information into witty and engaging communication design. What we do: • Interactive books. • Books for older children. • Books for adults. • Books for patients with Learning difficulties, autism and additional needs. • App Designs • Graphic Designs for use throughout hospitals. • Animated Training Materials • Animations to explain health conditions to children • 'This phenomenal book is a wonderful resource for children. It allows them to access images and discuss areas of concern with family, friends and staff to smooth the pathway for children on this long journey' . Dr Stephen Marks Consultant Nephrologist Great Ormond Street Hospital, London

BE PROACTIVE

Creation of animated films to help clinicians understand how best to work with young patients with learning difficulties, autism or additional needs. Working in close conjunction with Dr. Kate Oulton ( Senior Research Fellow and Clinical Academic Programme Lead for Nursing and Allied Health Professional (AHP) Research, Great Ormond Street Hospital, London) we have devised a series of 10 films each dealing with particular emphasis within paediatric care: 1.P. Parents and Partnerships 2.R. Resources 3.O. Organisation 4.A. Ask and Advocate 5.C. Communication 6.T. Time and Timing. 7.I Information 8.V. Values 9.E. Environment 10. Concise version of the above. Gifs and lead ins. In busy hospital environments children with additional needs can be sometimes overlooked and these interventions aim to help clinicians understand their sometimes complex needs and put a series of support structures in place. Regulatory frameworks also have to be adhered to and these too are emphasised

Should Men and Women be Managed Differently in Glaucoma?

INTRODUCTION: To assess differences in associations of ocular perfusion pressure (OPP) as well as retinal and retrobulbar blood flow between men and women with primary open angle glaucoma (OAG). METHODS: A total of 116 patients with OAG (age 66.9 ± 10.9 years, 70 females) participating in the Indianapolis Glaucoma Progression Study were assessed for OPP, retinal microcirculation, and retrobulbar blood flow. Confocal scanning laser Doppler flowmetry measured peripapillary retinal capillary blood flow. Color Doppler imaging measured peak systolic (PSV) and diastolic blood flow velocities and vascular resistance in the ophthalmic (OA), central retinal (CRA), and nasal and temporal short posterior ciliary arteries (N/T PCA). Bivariate Spearman correlation and multivariate linear regression analyses were performed. RESULTS: In female patients with OAG, inferior retinal capillary flow was associated with OPP (r = 0.246, P = 0.044). In men, superior and inferior sector retinal blood flow was associated with OPP (r = −0.402, P = 0.006 and r = −0.357, P = 0.016, respectively). There was no statistically significant association between OPP and retrobulbar blood vessel flow velocities in male patients with OAG but there was an association between OA and TPCA PSV and OPP in female patients with OAG (r = 0.290, P = 0.015 and r = 0.357, P = 0.002, respectively). In female patients with OAG, multivariate regression showed no statistically significant effect of any variable on the superior retinal capillary blood flow, with CRA PSV as a sole predictor to the inferior retinal sector (partial rho = 0.302, P = 0.015) and in male patients with OAG, superior sector retinal capillary blood flow was independently associated with intraocular pressure (partial rho = −0.371, P = 0.016) and OPP (partial rho = −0.456, P = 0.002) with a trend of association with OPP in the inferior retina (partial rho = −0.301, P = 0.053). CONCLUSIONS: There was a positive linear association between retinal microcirculation and OPP in females and a negative association in males. Male and female patients with OAG may differ in their vascular autoregulation in response to changes in OPP