RSTNCOVID Burns: A multi-centre service evaluation and stakeholder survey of the impact of COVID-19 on burns care in England, Wales and Northern Ireland

As the UK entered the first wave of the COVID-19 pandemic, the National Health Service published consensus guidance to the UK burns services advising changes to the acute management of burns to allow the continuation of safe care while protecting limited hospital resources. We aimed to describe the demographics of burns service users, changes to clinical pathways and experiences of the burns team during the first wave of the COVID-19 pandemic. All burns services in the UK were invited to participate in a national collaborative, trainee-led study supported by the Reconstructive Surgery Trials Network. The study consisted of (1) a service evaluation of patients receiving burns treatment during the COVID-19 pandemic; (2) a multidisciplinary team survey. Analyses were descriptive and narrative depending on data types. Collaborators from 18 sites contributed data from burns MDT surveys and 512 patients. Patient demographics were consistent with typical burns patterns in the UK. The delayed presentation occurred in 20% of cases, with 24 patients developing complications. MDT surveys indicated substantial adaptations and challenges as a result of the pandemic. Access to theatres and critical care were limited, yet a comprehensive acute burns service was maintained. Telemedicine was utilised heavily to reduce patient footfall. Adaptations in the provision of burns care, including greater outpatient care and telemedicine, have emerged out of necessity with reported success. The impact of reduced scar therapy and psychological interventions for burns patients during the pandemic requires longer-term follow-up. Lessons from the UK experience can be used to strategise for future pandemics

Australian protected areas and adaptive management: contributions by visitor planning frameworks and management effectiveness assessments

Protected areas are recognised as crucial for conserving biodiversity and supporting the ecological processes that benefit humans, as well as providing recreational and wellbeing benefits. The complexities and uncertainties associated with their management make adaptive management an appealing ideal. This paper examines how two well-developed management methodologies - visitor planning frameworks (e.g. limits of acceptable change) and management effectiveness assessments - contribute to the adaptive management of visitor use of protected areas. A set of principles was developed from the literature by the authors and used to analyse the performance of these methodologies in facilitating adaptive management of visitor use in such areas in Australia. The analysis revealed both methodologies as contributing to institutionalising monitoring and the development of shared understandings. Effectiveness assessments are facilitating adaptation, with systematic evaluation and feedback of results into management evident. Performance of the visitor frameworks was impeded by a lack of commitment to implementation. Identifying and evaluating future options was a weakness of both frameworks. In sum, however, both provide practical, much-needed means for progressing the institutionalisation of adaptive management and hence contributing to innovative solutions to the complex problems facing protected areas

Division of data according to CSF HIV RNA detectability reveals distinct CD8 T-cell and monocyte inflammatory responses correlations with NC impairment in the HIV RNA detectable and HIV RNA undetectable conditions.

<p>*values were square root transformed</p><p>** P value from ANOVA</p><p>Division of data according to CSF HIV RNA detectability reveals distinct CD8 T-cell and monocyte inflammatory responses correlations with NC impairment in the HIV RNA detectable and HIV RNA undetectable conditions.</p