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The hypothesis of the fragile rural church was first advanced by Lawson (2018) and refined by Lawson (2019) using qualitative data from interviews with Church of England clergy with responsibility for three or more rural churches. Quantitative research by Francis, Village and Lawson (2020, 2021a, 2021b) confirmed the proposed five major marks of the fragile rural church, demonstrating that these marks were most prevalent in the rural situation. The current research, based on interviews with 17 rural Church of England clergy with responsibility for four or more churches, and focus groups involving 33 lay people from the same parishes, confirms the five major marks of the fragile rural church and proposes one further mark.
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Purpose: To identify cognitive impairments in patients (pts) with long COVID using the Cambridge Brain Sciences (CBS) computerized cognitive test (CCT) commonly used to evaluate cognitive function after concussions and traumatic brain injuries. Method(s): Retrospective review from May 2021-Sept 2022 of 16 (4 male, 12 female) patients with long COVID, ages 13- 66 (avg 46), with average of 10 months from COVID infection to time of evaluation. Cognitive (cog) performance and concussion profile symptom scores were assessed with CBS CCT and the Concussion Clinical Profiles screening tool (CP screen) respectively. Result(s): The total CP symptom score average was 34/89 (ranging 7-68) in the cohort. The predominant profile was cog fatigue scoring (1.8/3) on average. CBS CCT tested cog impairment (CI) and was divided into 5 categories (0-4): no CI, borderline (scores between the 21st-30th percentile), mild (1 test < / = 20th percentile), moderate (2-3 tests < / = 20th percentile), and severe CI (>3 tests,/520th percentile). Data showed 2/16 (13%) patients had no CI, 5/16 (31%) had borderline CI, 5/16 (31%) had mild CI, 3/16 (19%) had moderate CI, and 1/16 (6%) pts had severe CI. Although not significant, there was a positive correlation between CI and cog profile score (P = 0.3149) when performing a linear regression test. Deficits were most common in the CBS CTT composites of grammatical reasoning/verbal processing and attention, with 4/16 patients scoring < 20th percentile for each test. The lowest average percentile scores for the cohort were in visuospatial processing and verbal short-term memory. Conclusion(s): Most long COVID patients assessed with CCT demonstrated signs of CI, in particular in verbal processing and memory, followed by visual processing. In addition to the CCT results illustrating CI, the top CP profile of cognitive fatigue in this cohort suggests that the brain fog experienced by long COVID patients may be quantified. Significance: CCT may be a useful tool in assessing and quantifying those with Long COVID with chronic symptoms of cognitive fog, fatigue, or impairment. Targeted interventions aimed at specific deficits can aid in treatment and recovery.
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This paper sets out to explore the experience of discipleship in some of the fragile rural churches in two Church of England dioceses and to examine the challenges which clergy face as they seek to grow people as disciples of Jesus in the countryside. First the hypothesis of the fragile rural church is set out. The biblical background of discipleship is briefly considered, together with an assessment of what discipleship means in the twenty-first century Church. Next the experience of 17 clergy with responsibility for three or more multi-church rural parishes is explored, and the challenges they face are discussed. Finally, a conclusion is drawn that discipleship is an essential part of the Christian life, and ways and means of providing models of discipleship and discipleship learning which are appropriate for all rural Christians need to be found as a matter of urgency.
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Introduction COVID-19 is usually a mild disease in immunocompetent children, with ~1% requiring intensive care unit (ICU) admission and <0.1% mortality. Data on its course in children following hematopoietic cell transplantation (HCT) is limited. Methods Data on children following HCT who developed COVID-19 (diagnosed by positive SARS-CoV-2 PCR on respiratory tract samples) during 3.2020-4.2021 were prospectively collected by EBMT and GETH, including demography, HCT data, COVID-related manifestations, ICU admission and mortality. Factors associated with worse outcomes (ICU admission or mortality) were characterized. Results Sixty-two children (34 boys;median age 9;min-max;0.7-17 years) were reported from 27 centers, 16 countries;57 (92%) following allogeneic and 5 (8%) following autologous HCT. Underlying diseases were acute leukemia (23;37%), inherited disorders (9;15%), hemoglobinopathies (7;11%), solid tumor (6;10%), bone marrow failure (5;8%), other malignant (8;13%) and non-malignant (4;6%) diseases. Five (8%) children had high blood pressure;6 (10%) had underlying lung pathology. The median time from the most recent HCT to COVID was 5 months (min-max;0-169). The stem cell source was bone marrow (33);peripheral (22) or cord blood (1). Among the patients with information available, 34 (62%) underwent in-vivo T cell depletion, 20 (33%) received corticosteroids, and 36 (60%) other immunosuppressant drugs(s) within two months prior to and after the COVID-19 episode. The presence of acute grade 2-4 or chronic graft versus host disease (GVHD) was reported in 12/54 (23%) and 8/51 (16%) children, respectively. Clinical presentation (n=57) included fever (28;49%), cough (18;32%), diarrhea (8;14%), upper respiratory tract disease (as rhinorrhea, sinusitis, otitis, or pharyngitis;12;21%);six (10%) required oxygen to maintain oxygen saturation above 92%;20 children (35%) were asymptomatic. The median time from symptoms onset to COVID diagnosis was 1 day (-43-40). Sixty-three percent of patients were hospitalized;43% due to COVID. The proportion of children with neutropenia or lymphocytopenia (<500 cells/mm 3) was 75% and 73%, respectively. Sixteen children (26%) had evidence of viral (n=10), bacterial (n=6) or fungal (n=2) coinfections. The median time from COVID diagnosis to the last follow-up in alive patients was 69 days (min-max;2 - 294). Six (10%) children who developed COVID at a median 6.5 (min-max;2- 16) months following allo-HCT (median age 6 years;5 boys) required ICU care within a median 6 (min-max;-5-15) days after diagnosis. All of them were neutropenic, received steroids, and other immunosuppressive drugs at COVID diagnosis;5 had undergone in-vivo T cell depletion;5 were lymphocytopenic, 5 had GVHD (2 acute and 3 chronic);3 received non-invasive and 2 invasive ventilation. Three children had viral or bacterial coinfections. Three children died. Six (10%) children (5 boys, median age 10.5 years;min-max;4-13) who developed COVID at median 2 (min-max;0-147) months following allo-HCT died within median 35 days (min-max;5-54) after diagnosis. One had high blood pressure, and none suffered from underlying lung pathology. At the time of COVID, 3 were neutropenic, 2 lymphocytopenic;4 had GVHD (2 acute, 2 chronic);3 received steroids and 4 immunosuppressive drugs. Two had viral or bacterial coinfections. Five had positive SARS-CoV-2 PCR at the time of death. In 3, COVID was the primary cause of death. We compared nine children with the worse outcomes to 53 children with benign course. Among patients alive at 100-day post HCT, the probability of worse outcomes was higher in patients with vs. without chronic GVHD (Figure). No other significant differences were observed in demographic, underlying disease, and HCT-related characteristics. Compared to adults following HCT (Ljungman, Leukemia 2021), children had: - Shorter median time from HCT to COVID diagnosis, 5 vs 18 months;- Higher proportion of asymptomatic infections, 35% vs 9%;- Lower proportion of those who required oxygen, 10% vs 35%;- Lower all-cause mortality, 10% vs 29%. Conclusions Children following HCT with COVID-19 have a higher risk of ICU admission and mortality compared to immune competent children. The presence of chronic GVHD at COVID diagnosis was associated with worse outcomes. COVID course following HCT is milder in children compared to adults. [Formula presented] Disclosures: Averbuch: Takeda: Consultancy;Pfizer: Consultancy;GSK: Speakers Bureau. De La Camara: Roche: Consultancy;IQONE: Consultancy. Corbacioglu: Gentium/Jazz Pharmaceuticals: Consultancy, Honoraria. Mikulska: Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Gilead: Speakers Bureau;MSD: Speakers Bureau;Janssen: Speakers Bureau;Biotest: Speakers Bureau. Kulagin: Roche: Speakers Bureau;Sanofi: Speakers Bureau;Generium: Speakers Bureau;Biocad: Research Funding;Apellis: Research Funding;Alexion: Research Funding;X4 Pharmaceuticals: Research Funding;Novartis: Speakers Bureau;Johnson & Johnson: Speakers Bureau;Pfizer: Speakers Bureau. Cesaro: Sobi: Membership on an entity's Board of Directors or advisory committees;Gilead: Speakers Bureau. Lawson: Alexion: Honoraria. Kroeger: Neovii: Honoraria, Research Funding;Sanofi: Honoraria;Jazz: Honoraria, Research Funding;Celgene: Honoraria, Research Funding;Riemser: Honoraria, Research Funding;Gilead/Kite: Honoraria;AOP Pharma: Honoraria;Novartis: Honoraria. Styczynski: MSD, Pfizer, Giled, TEVA, Jazz, Novartis: Honoraria, Speakers Bureau. Ljungman: Takeda: Consultancy, Other: Endpoint committee, speaker;Enanta: Other: DSMB;Janssen: Other: Investigator;OctaPharma: Other: DSMB;Merck: Other: Investigator, speaker;AiCuris: Consultancy.
ABSTRACT
The fragile church thesis was originally shaped by Lawson on the basis of qualitative research among rural clergy. A subsequent quantitative study demonstrated that, although the fragile church thesis was more strongly endorsed by rural clergy it was also endorsed by clergy serving in other areas. The present study conducted among 2,496 Church of England laity confirms that the thesis is not just in the mind of the clergy, but to a lesser extent in the mind of the laity as well. Once again the thesis is more strongly endorsed by laity living in rural areas than by laity living elsewhere. The current study points to serious investment in discipleship learning as a strategy for addressing the malaise underpinning the fragile church thesis and invites the rural church to rise to this challenge. [ABSTRACT FROM AUTHOR] Copyright of Rural Theology is the property of Taylor & Francis Ltd 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 abstract 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 abstract. (Copyright applies to all Abstracts.)
ABSTRACT
INTRODUCTION: Coagulopathies have been frequently observed in hospitalized patients with COVID-19, particularly in the critically ill. Thrombotic events such as venous and arterial thromboembolism, and clotting of the extracorporeal circuit during continuous renal replacement therapy (CRRT) can significantly contribute to morbidity and mortality. Due to the novelty of this disease, clinicians have no standardized approach for management of this complication. This review was conducted to characterize the incidence of COVIDrelated coagulopathies during treatment with CRRT and associated clinical outcomes. METHODS: Single center, retrospective review of patients admitted to Grady Memorial Hospital with a diagnosis of COVID-19 from March to July 2020 who received CRRT. Level of anticoagulation was determined by a COVID-specific anticoagulation protocol, predicated on thrombotic risk and/ or d-dimer levels. The primary objective was to determine the incidence of thrombosis. Secondary objectives included rate of bleeding and mortality. Demographics, laboratory results, length of stay, and clinical diagnoses were collected from the electronic medical record. RESULTS: 30 patients were included in the analysis;demographics included a mean age of 55.8 (24-77), weight of 97 kg (47.7-248.2), and 43.3% of patients with a preexisting risk for coagulopathy. For anticoagulation on admission, 18 (60%) were initiated on prophylactic dose, 9 (30%) received intermediate dose, and 3 (10%) received therapeutic dose;unfractionated heparin was the most common agent (53.3%) followed by enoxaparin (46.7%). 9 (30%) patients received a direct thrombin inhibitor for refractory management of thrombosis. The rates of thrombosis, major bleeding, and in-hospital mortality were 80%, 30%, and 46.7%, respectively. Sources of thrombosis included pulmonary embolism, deep vein thrombosis, myocardial infarction, stroke, and CRRT circuit clotting. CONCLUSIONS: There is significant morbidity associated with the coagulopathic complications in critically ill COVID-19 patients. Despite what is currently observed as adequate anticoagulation, thrombosis occurs with a high incidence in this patient population. The optimal strategy for management of anticoagulation in the COVID-19 patient population undergoing CRRT remains under investigation.
ABSTRACT
In a series of earlier papers in Rural Theology, drawing on qualitative research, Anne Lawson has advanced and documented the fragile rural church thesis. The present study draws on data from 745 full-time parochial clergy serving in the Church of England who responded to the Coronavirus, Church & You Survey to test two objections to Lawson's thesis. The first objection is that the qualitative research has not demonstrated the extent of the fragile church thesis among rural clergy. The new data show that one in three rural clergy endorse the thesis. The second objection is that the qualitative research has not demonstrated that the thesis is specific to rural ministry. The new data show that, although the fragile church thesis is not limited to rural ministry, it is more in evidence within rural areas. [ABSTRACT FROM AUTHOR] Copyright of Rural Theology is the property of Taylor & Francis Ltd 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 abstract 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 abstract. (Copyright applies to all Abstracts.)