Journal articles on the topic 'Calvary Hospital'

The need to facilitate healthy bereavement, resulting from both deaths from life-threatening illnesses as well as violent, sudden deaths, is great. For the past 9 summers, Bereavement Services at Calvary Hospital, Bronx, New York, has sponsored a week-long day camp for bereaved children and adolescents. Each year the program expands by adding new activities to meet the needs of grieving children in therapeutic ways congruent with current research and timely clinical interventions. This article reflects on our experience, which has evolved and become stronger over the past 9 years. It is believed that this program is replicable and can be initiated and developed by other hospitals and organizations interested in developing similar programs.

Background: The Australian Institute of Health and Welfare has reported an increased rate of hospital-treated intentional self-harm in young females (2000–2012) in Australia. These reported increases arise from institutional data that are acknowledged to underestimate the true rate, although the degree of underestimation is not known. Objective: To consider whether the reported increase in young females’ hospital-treated intentional self-harm is real or artefactual and specify the degree of institutional underestimation. Methods: Averages for age- and gender-standardised event rates for hospital-treated intentional self-harm (national: Australian Institute of Health and Welfare; state: New South Wales Ministry of Health) were compared with sentinel hospital event rates for intentional self-poisoning (Hunter Area Toxicology Service, Calvary Mater Newcastle) in young people (15–24 years) for the period 2000–2012. A time series analysis of the event rates for the sentinel hospital was conducted. Results: The sentinel hospital event rates for young females of 444 per 100,000 were higher than the state (378 per 100,000) and national (331 per 100,000) rates. There was little difference in young male event rates – sentinel unit: 166; state: 166 and national: 153 per 100,000. The sentinel hospital rates showed no change over time for either gender. Conclusion: There was no indication from the sentinel unit data of any increase in rates of intentional self-poisoning for young females. The sentinel and state rates were higher than the national rates, demonstrating the possible magnitude of underestimation of the national data. The reported increases in national rates of hospital-treated self-harm among young females might be due to artefactual factors, such as changes in clinical practice (greater proportion admitted), improved administrative coding of suicidal behaviours or possibly increased hospital presentations of community self-injury cases, but not intentional self-poisoning. A national system of sentinel units is needed for the accurate and timely monitoring of all hospital-treated self-harm.

Background: Hospital-treated deliberate self-poisoning is common, with a median patient age of around 33 years. Clinicians are less familiar with assessing older adults with self-poisoning and little is known about their specific clinical requirements. Objective: To identify clinically important factors in the older-age population by comparing older adults (65+ years) with middle-aged adults (45–64 years) during an index episode of hospital-treated deliberate self-poisoning. Methods: A prospective, longitudinal, cohort study of people presenting to a regional referral centre for deliberate self-poisoning (Calvary Mater Newcastle, Australia) over a 10-year period (2003–2013). We compared older-aged adults with middle-aged adults on demographic, toxicological and psychiatric variables and modelled independent predictors of referral for psychiatric hospitalisation on discharge with logistic regression. Results: There were ( n = 157) older-aged and ( n = 925) middle-aged adults. The older-aged group was similar to the middle-aged group in several ways: proportion living alone, reporting suicidal ideation/planning, prescribed antidepressant and antipsychotic drugs, and with a psychiatric diagnosis. However, the older-aged group were also different in several ways: greater proportion with cognitive impairment, higher medical morbidity, longer length of stay, and greater prescription and ingestion of benzodiazepines in the deliberate self-poisoning event. Older age was not a predictor of referral for psychiatric hospitalisation in the multivariate model. Conclusion: Older-aged patients treated for deliberate self-poisoning have a range of clinical needs including ones that are both similar to and different from middle-aged patients. Individual clinical assessment to identify these needs should be followed by targeted interventions, including reduced exposure to benzodiazepines.

IntroductionCardiac rehabilitation (CR) is recommended for secondary prevention of cardiovascular disease and reducing the risk of repeat cardiac events. Physical activity is a core component of CR; however, studies show that participants remain largely sedentary. Sedentary behaviour is an independent risk factor for all-cause mortality. Strategies to encourage sedentary behaviour change are needed. This study will explore the effectiveness and costs of a smartphone application (Vire) and an individualised online behaviour change program (ToDo-CR) in reducing sedentary behaviour, all-cause hospital admissions and emergency department visits over 12 months after commencing CR.Methods and analysisA multicentre, assessor-blind parallel randomised controlled trial will be conducted with 144 participants (18+ years). Participants will be recruited from three phase-II CR centres. They will be assessed on admission to CR and randomly assigned (1:1) to one of two groups: CR plus the ToDo-CR 6-month programme or usual care CR. Both groups will be re-assessed at 6 months and 12 months for the primary outcome of all-cause hospital admissions and presentations to the emergency department. Accelerometer-measured changes in sedentary behaviour and physical activity will also be assessed. Logistic regression models will be used for the primary outcome of hospital admissions and emergency department visits. Methods for repeated measures analysis will be used for all other outcomes. A cost-effectiveness analysis will be conducted to evaluate the effects of the intervention on the rates of hospital admissions and emergency department visits within the 12 months post commencing CR.Ethics and disseminationThis study received ethical approval from the Australian Capital Territory Health (2019.ETH.00162), Calvary Public Hospital Bruce (20–2019) and the University of Canberra (HREC-2325) Human Research Ethics Committees (HREC). Results will be disseminated through peer-reviewed academic journals. Results will be made available to participants on request.Trial registration numberACTRN12619001223123.

IntroductionAnti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is one of the more common forms of autoimmune encephalitis, predominantly affecting children and women of the child-bearing age. It is characterised by memory deficit, behavioural disturbance and seizures. Dysautonomia is recognised as a feature but rarely the first symptom of the condition.1 Here we present a case of severe dysautonomia preceding the diagnosis of NMDAR encephalitis.MethodsWe conducted a retrospective review of the admissions to the neurology ward at the Calvary Hospital, Canberra in 2018 to identify patients diagnosed with NMDAR encephalitis.ResultsOne patient was identified from the registry data. A 37-year-old woman presented with a week-long history of symptomatic orthostatic hypotension. Her supine systolic blood pressure was 110mmHg with a 46mmHg postural drop. Over the first week of hospitalisation, she became increasingly disoriented and erratic in behaviour with fluctuating levels of consciousness requiring intensive unit care. Her CSF demonstrated lymphocytic pleocytosis and NMDAR antibodies were detected in both CSF and serum. She was treated with IVIG, IV steroids and subsequently Rituximab. A pelvic teratoma was found and removed. Her symptomatology including dysautonomia improved substantially by the end of her six-week hospital admission. Her modified Rankin Scale was zero at three months.ConclusionAutonomic dysfunction is not a common feature of autoimmune encephalitides. Our case highlighted the possibility that dysautonomia can be the initiating symptom of this disease entity. Physician awareness is important in the early recognition and treatment of this condition.ReferenceTitulaer MJ, McCracken L, Gabilondo I, Armangue T, Glaser C, Iizuka T, Honig LS, Benseler SM, Kawachi I, Martinez-Hernandez E, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol 2013;12(2):157–165.

e14029 Background: A significant delay in oncology patient journey through emergency department (ED) due to various reasons such as multiple specialists involved, difficulty in accessing timely advice from extremely busy inpatient/outpatient oncology teams, etc. In order to streamline admissions and discharges for oncology patients, a new model of care was created with the introduction of oncology nurse practitioner (ONP) at Calvary Mater Newcastle ED. This model operated during business hours three days a week with an aim to improve continuity of care, to enhance patients’ experience and meet organisations key performance indicators (KPIs). Limited research into the impact of these services on patient care and patient experience, particularly from service users’ perspective. Methods: A retrospective audit (6 months) has been undertaken to determine the impact of this model of care on time to specialty transfer, number of admissions versus discharges and patients representations through ED when ONP was available versus standard care. Results: During the audit period, ONP reviewed 149 patients. Fifty-four (36%) patients were discharged and of those 6 (11%) returned (within 28 days) with same or related issues. There was an average reduction in time to disposition planning for ED oncology patients of approximately 83 (193 vs 110) minutes when ONP was present at ED (one month review). Using a raw bed day costing, this resulted in a significant financial saving. Further cost analysis of this model is underway. Conclusions: The introduction of ONP into an acute care hospital ED has proven to be effective in terms of continuity of patient care, financial savings and assisted ED in meeting KPIs. The perception within the senior emergency management team is that this new model of care has been an unqualified success. ONP has rapidly and effectively joined emergency team and has seamlessly adjusted practice to the new environment. ED remains highly supportive of this new model of care. This model of care is one that could be translated easily to other specialities. Further analysis will be presented at the time of ASCO meeting.

IntroductionSub-clinoid proximal occlusion is defined by internal carotid artery (ICA) occlusion with intact Circle of Willis flow. We hypothesise that such cases of large vessel occlusion provide collateral blood flow to preserve the ischaemic penumbra and may benefit from endovascular clot retrieval (ECR) beyond 24 hours.MethodWe retrospectively searched the stroke database from 2018 at Calvary Hospital, Canberra, Australia for ECR cases performed beyond 24 hours from symptom onset.ResultsTwo patients were identified from the registry data.64-year-old man awoke with left hemiparesis and was last seen well 9.5 hours prior. ECR for ICA occlusion was not initially performed due to rapidly improving National Institute of Health Stroke Scale (NIHSS) of three to zero. ECR was later performed at 38.5 hours for clinical deterioration. Stroke aetiology was atrial fibrillation. At 90-day NIHSS and modified Rankin Scale (mRS) were three.75-year-old man awoke with left hemiparesis and was last seen well 10 hours prior. Baseline NIHSS was four. Off-label thrombolysis was administered based on salvageable penumbra on CTP, however ECR for ICA occlusion was not performed as neurointervention was unavailable. After 24 hours his NIHSS score improved to one but hemispheric hypoperfusion persisted on CTP. At 36 hours he underwent ECR with carotid stenting. Stroke aetiology was large-vessel atherosclerosis. At 90 days his NIHSS and mRS were zero.ConclusionAcute sub-clinoid proximal carotid occlusion requires tissue viability assessment with imaging to guide decision of ECR beyond 24 hours and may be of benefit.

IntroductionThe association between intracranial stenosis (ICS) and extracranial stenosis (ECS) using CT angiography (CTA) and the occurrence of ischaemic stroke and TIA has not yet been fully investigated.This study aimed to investigate if there is a clinically significant relationship between ICS and ECS with stroke and its risk factors, including diabetes, hypertension, hypercholesterolemia, atrial fibrillation (AF) and ischaemic heart disease (IHD).MethodsFour hundred and fifteen consecutive patients that presented to Calvary Public Hospital, Bruce were retrospectively analysed, with 158 excluded for incomplete CTA and MRA results. ICS and ECS severity was based on grading used in the WASID and SAMPRISS trials, while the Fazekas scale was used to grade periventricular white matter disease. CTA findings were used to base the presence and absence of stenosis.ResultsICS and/or ECS was present in 80% with ischaemic stroke, 78% with TIAs but comparatively only in 56% of those diagnosed as ‘mimics’ (p<0.05). Univariate analysis demonstrated an association between presence of ICS and AF, hypertension, IHD and diabetes (82%, 73%, 84%, 78%; p<0.001) respectively, while for ECS only with AF, hypertension and IHD (77%, 67%, 81%; p<0.001) respectively. Diabetes was independently associated as single biggest risk factor for ICS. Most steno-occlusive lesions were bilateral for ICS and ECS at 80% and 61%, respectively. There also seems to be an association between the presence of ECS and the presence of ICS, with ECS particularly demonstrating predictive value for ICS (ECS PPV for ICS=0.85, chi-square p-value<0.001).ConclusionThese findings suggest a significant association between the presence of ICS and ECS with the occurrence of ischaemic stroke and TIAs as well as with well-known stroke risk factors. This also indicates that perhaps the underlying pathophysiology for steno-occlusive lesions plays a role in ischaemic stroke and warrants further investigating.

IntroductionThere is evidence to support both clinically and economically that stroke units improve stroke outcomes, but this is offset by high stroke mimics rates, which account for up to quarter of stroke unit admissions. There is no Australian data looking at stroke mimic rates and the time of day when they are admitted.MethodsWe conducted a retrospective cross-sectional study at Calvary Public Hospital, Bruce from May 2014 to May 2017 looking at stroke unit admission rates and mimic types. We collected data on the times of stroke unit admission, business hours Monday to Friday 0800–1630 hours and after-hours Monday to Friday 1630–0800 hours, weekends 0800–0800 hours. Stroke mimics length of stay (LOS) was compared with TIA mild strokes (NIHSS <5) LOS.ResultsOut of 1017 stoke unit admissions, 257 (25.3%) were stroke mimics. The most common mimic diagnoses were migraine and headaches (18.3%), peripheral vestibulopathy (14.0%), and functional neurology (13.2%). Data on admission times were available for 240 of 257 (93.4%) mimics of which more than 2/3 s of mimics were admitted after-hours; Bayes factor 0.912 demonstrating this is unlikely to be a significant difference. 3.5% of stroke mimics were thrombolysed with 2/3 s occurring after-hours. The average LOS was 2.3 days for mimics, compared to 4.0 days for TIA and minor strokes (p=0.00017).ConclusionOur study shows similar stroke mimic rates as previously described in literature with a higher proportion of these patients were admitted after-hours. However, there is little evidence that this difference is significant. The LOS for stroke mimics was less than TIAs and minor strokes. Our study highlights the need for better recognition of stroke mimics in order to prevent unnecessary utilisation of a valuable resource such as the stroke unit.

6600 Background: Cancer treatment has evolved rapidly since the advent of immunotherapy (checkpoint inhibitors). As compared to chemotherapy, immunotherapy is associated with a more favourable but distinct side effect profile. Mortality within 30 days of chemotherapy in cancer patients has been accepted as a clinical indicator of preventable harm and used as an auditing tool for clinical practice and improving quality of life. This should be investigated in the current era of immunotherapy, as it has been the standard treatment for advanced melanoma, lung cancer, renal cell cancer and others. Methods: We conducted a retrospective study on patients with advanced cancer treated with immunotherapy and died within 30 days of treatment. Clinical data on patients treated with immunotherapy at Calvary Mater Newcastle between 2006 and 2018 was collected. Data were compared with 30-day mortality statistics of chemotherapy. Results: A total of 601 metastatic cancer patients received immunotherapy agents (Pembrolizumab, Nivolumab, Ipilimumab, Atezolizumab, Tislelizumab and MSB0011359C) on 5022 occasions. Seventy-six (12.6%) patients died within 30 days of receiving immunotherapy. Median age was 68 years (35-90). Melanoma was the most prevalent cancer type (63%) followed by lung (20%). Forty-seven (47%) of patients received immunotherapy as first-line treatment and 39% as second-line. Patients died within 30 days received an average 2 (1-16) immunotherapy doses. A quarter of patients had ECOG 3 and ECOG 4 before last dose. Majority of deaths were related to disease (86%). Nearly 80% of patients died in hospital. One patient died due to treatment-related pneumonitis. In univariate analysis, there was no association between mortality and patients’ demographic variables such as age, sex, BMI, cancer type, ECOG performance status, immunotherapy agent and prior treatment. Conclusions: To our knowledge, this is the first ever real-world data on 30-day mortality after immunotherapy in advanced cancer. Thirty-day mortality rates were comparable to published data on patients treated with chemotherapy. Results emphasise significance of careful selection of advanced cancer patient for immunotherapy. Due to small sample size, the power to detect a significant association between patients demographics and survival is reduced.

Introduction Skull has cranial vault and base. The cranial vault is called as calvarium which roofs the cranial cavity (brain box).Cranial vault consists of frontal, parietal and occipital bones. Total thickness of calvarial bones includes outer table, diploe and inner table. Diploe is made up of spongy bone whereas outer and inner table made up of compact bone. Objective To measure the thickness of Nepalese calvarial bones i.e. Frontal, Parietal and Occipital. Methods It is a hospital base cross-sectional study. CT records of one hundred and fifty adult people were studied. Nine various points on frontal bone, seven on parietal and six on occipital were located and their thickness were measured bilaterally with help of CT scan. Results The present study showed that Mean thickness+_SD of frontal bone were 6.1+_1.8mm; parietal 4.6+_2.2 and occipital 9.5+_3.4. The study also showed that frontal bone had 2.4+_0.8 mm thick outer table; 1.4+_0.6mm inner table and 3.5+_1.3mm diploe. Similarly parietal bone had 1.9+_0.6 mm thick outer table; 1.1+_0.4mm inner table and 0.8+_0.5mm diploe. The occipital bone had 3.5+_1.5 mm thick outer table; 2.2+_0.8mm inner table and 4.3+_1.8mm diploe. Similarly this present study also calculated the mean thickness+_SD of outer table in the calvarium as 2.7+_1.3mm and that of inner table 1.5+_0.9 mm. Thus it concluded that outer table was thicker than inner table. Journal of Nobel Medical College Vol. 2, No.1 Issue 3 Nov.-April 2013 Page 31-35 DOI: http://dx.doi.org/10.3126/jonmc.v2i1.7670

Objective To describe and analyze the variability in carboplatin dosing strategies in Spanish hospitals. Methods We designed a questionnaire consisting of 19 multiple-choice items structured in two sections (hospital characteristics and carboplatin dosing data). The questionnaire was sent by e-mail to all the oncology pharmacists included in the register of the Spanish Oncology Pharmacy Group (GEDEFO), and we analyzed the completed questionnaires. Results Response rate was 33.5% from a total of 185 pharmacy services invited to take part in the survey. All hospitals used the Calvert formula to calculate carboplatin dose with glomerular filtration rate estimated by a formula, most commonly the Cockcroft-Gault equation (80.7%). Carboplatin doses were capped in most hospitals (91.9%): 54.8% capped creatinine clearance at 125 mL/min, 11.3% capped serum creatinine, and 19.3% capped both creatinine clearance and serum creatinine. Serum creatinine cut-off values ranged from 0.36 mg/dL to 1 mg/dL. The most commonly used body weight was actual body weight for underweight, normal weight, and overweight patients. The use of adjusted ideal body weight increased in obese and especially in morbidly obese patients. Conclusion The results from this survey show the variability that exists in carboplatin dose calculation methods among Spanish hospitals and the need to continue investigating to find the optimum dose calculation method and unify criteria to avoid differences between sites that can affect effectiveness and toxicity of carboplatin-containing treatments.

A girl named Tania, aged 5yrs was brought to Shaheed Ziaur Rahman Medical College Hospital, Bogra with the complains of swelling of both legs for 5days & low grade intermittent fever for 1month & she also had severe mental retardation, facial dysmorphism, hepatosplenomegaly, umbilical hernia, corneal clouding, large calvaria & features of dysostosis multiplex. Her clinical as well as radiological features arouse strong suspicion suffering from a rare genetic disease (autosomal recessive) hurler’s syndrome though it wasn’t confirmed by deficiency of specific enzyme or urinary excretion of GAG (glycosaminoglycan).TAJ 2011; 24(2): 148-151

Hace una década era necesario e inminente que el Hospital del IESS de Machala de Nivel II referente se la Seguridad Social en la Provincia de El Oro, pueda contar con equipamiento médico para implementar la primera Unidad de Cuidados Intensivos en sus instalaciones. Las altas cifras por derivaciones de los pacientes a clínicas particulares trasladándolos dentro de la ciudad de Machala y a otros Hospitales de Nivel III de mayor complejidad de otras provincias como Guayaquil el Hospital Teodoro Maldonado Carbo y en Cuenca el Hospital José Carrasco Arteaga, eran una constante que hacían un calvario y provocaban demoras en que la vida de un paciente es crucial. Posteriormente, estas casas de salud tampoco atendían a los pacientes por no tener espacio y camas para albergarlos, derivándolos a clínicas particulares quienes mantenían convenios particulares con el IESS. El presente trabajo muestra el gran desafío de adquirir el equipamiento médico a través del portal de compras públicas y sus modalidades de contratación según la LOSNCP promulgada en el año 2008 y de manera eficiente se logró conformar la primera UCI en el IESS Hospital Machala capital de la provincia de El Oro en el año 2010 para dotar de este importante servicio con “calidad y calidez” y su incidencia, actual para beneficio y aporte a los pacientes de la seguridad social y del Ministerio de Salud Pública y su grado de importancia ante la emergencia sanitaria por Covid.19 a nivel nacional.

A 10-year-old, female spayed Chihuahua dog was presented to the Veterinary Teaching Hospital at the University of Georgia for evaluation of seizures, abnormal mentation, and cervical pain of 2 months duration. On magnetic resonance imaging, there was generalized thickening of the meninges overlying the left cerebral hemisphere and along the falx cerebri. Despite symptomatic treatment, the dog remained neurologically affected. Consequently, the owners elected euthanasia. On gross examination, the meninges covering the left cerebral hemisphere were severely thickened and firmly adhered to the calvaria. On transverse section, the white matter of the left cerebral hemisphere was swollen, enlarged, and extended across the midline with resultant compression of the right cerebral hemisphere. Cytologic evaluation of an impression smear of the thickened meninges showed numerous large, spindloid to polygonal cells with abundant, amphophilic, vacuolated cytoplasm, present either in clusters or in individual cells. Histopathologic evaluation of the meninges revealed a poorly circumscribed and infiltrative, moderately cellular neoplasm, composed of vacuolated, spindloid to polygonal cells with marked anisocytosis and anisokaryosis, arranged in sheets, and occasionally separated by thick bands of connective tissue. Immunohistochemistry for vimentin revealed diffuse cytoplasmic staining of the neoplastic cells. Although the periodic acid–Schiff reaction was negative, ultrastructural findings showed numerous vesicles that were empty or that contained membranous or electron-dense material. Based on gross, microscopic, immunohistochemical, and ultrastructural changes, the meningeal neoplasm was diagnosed as an atypical granular cell tumor.

Abstract Background Prospectively identifying patients at highest risk for hospital-acquired and ventilator-associated bacterial pneumonia (HABP/VABP) by implementing a risk assessment scoring tool may help focus prevention efforts, optimize the screening process to improve clinical trial feasibility, and enhance development of new antibacterial agents. Methods Within the intensive care units (ICU) of 28 US hospitals, between February 6, 2016 and October 7, 2016, patients hospitalized &gt;48 hours and receiving high levels of respiratory support were prospectively followed for meeting the definition of HABP/VABP recommended in US FDA draft guidance. Patient demographics, medical comorbidities, and treatment exposures were recorded. The association between candidate risk factors and odds of developing HABP/VABP was evaluated with a multivariable logistic regression model. Risk factors were selected using backward selection with α = 0.1 for model inclusion. A web-based scoring system was developed to estimate the risk of HABP/VABP from the risk factors identified. Results A total of 5,101 patients were enrolled, of whom 1,005 (20%) developed HABP/VABp. 4,613 patients were included in the model, excluding 488 (10%) with HABP/VABP at or before enrollment. There are 15 variables included in the model. APACHE II admission score &gt;20 (P &lt; 0.001, OR 2.14, 95% CI 2.00–2.29), admission diagnosis of trauma (P &lt; 0.001, OR 3.31, 95% CI 1.90–5.74), frequent oral or lower respiratory tract suctioning (P &lt; 0.001, OR 2.33, 95% CI 1.81–2.99), and receipt of enteral nutrition (P &lt; 0.001, OR 2.31, 95% CI 1.69–3.16) were the key drivers of increased pneumonia risk. The model demonstrated excellent discrimination (bias-corrected C-statistic 0.861, 95% CI 0.843–0.880). The web-based scoring system can be accessed via this link: https://ctti-habpvabp.shinyapps.io/web_based_tool/. Conclusion Using a web-based scoring system, ICU patients at highest risk for developing HABP/VABP can be accurately identified. Prospective implementation of this tool may assist in focusing additional prevention efforts on the highest risk patients and enhance new drug development for HABP/VABP. Disclosures S. P. Bergin, CTTI: Investigator and Scientific Advisor, Research support and Travel to study related meetings. A. Coles, CTTI: Investigator and Scientific Advisor, Salary. S. B. Calvert, CTTI: Employee, Salary. M. J. Zervos, CTTI: Investigator, Research support. A. C. Bardossy, CTTI: Investigator, Research support. M. Kollef, CTTI: Investigator, Research support. M. J. Durkin, CTTI: Investigator, Research support. M. Sims, CTTI: Investigator, Research support. C. Greenshields, CTTI: Investigator, Research support. B. A. Kabchi, CTTI: Investigator, Research support. H. K. Donnelly, CTTI: Collaborator and Scientific Advisor, Research support and Salary. P. Tenaerts, CTTI: Employee, Salary. P. Gu, CTTI: Collaborator, Research support and Salary. V. G. Fowler Jr., CTTI: Investigator and Scientific Advisor, Research support and Salary. Merck: Consultant, Grant Investigator and Scientific Advisor, Consulting fee, Grant recipient and Research support. Cerexa/Actavis/Allegan: Grant Investigator, Grant recipient. Pfizer: Consultant and Grant Investigator, Consulting fee and Grant recipient. Advanced Liquid Logics: Grant Investigator, Grant recipient. NIH: Investigator, Grant recipient, Research support and Salary. MedImmune: Consultant and Grant Investigator, Consulting fee and Grant recipient. Basilea: Consultant and Grant Investigator, Consulting fee and Grant recipient. Karius: Grant Investigator, Grant recipient. Contrafect: Consultant and Grant Investigator, Consulting fee and Grant recipient. Regeneron: Grant Investigator, Grant recipient. Genentech: Consultant and Grant Investigator, Consulting fee and Grant recipient. Achaogen: Consultant, Consulting fee. Astellas: Consultant, Consulting fee. Arsanis: Consultant, Consulting fee. Affinergy: Consultant, Consulting fee. Bayer: Consultant, Consulting fee. Cerexa: Consultant, Consulting fee. Cubist: Consultant, Consulting fee. Debiopharm: Consultant, Consulting fee. Durata: Consultant, Consulting fee. Grifols: Consultant, Consulting fee. Medicines Co.: Consultant, Consulting fee. Novartis: Consultant, Consulting fee. Novadigm: Consultant, Consulting fee. Theravance: Consultant, Consulting fee and Speaker honorarium. xBiotech: Consultant, Consulting fee. Green Cross: Consultant, Speaker honorarium. T. L. Holland, CTTI: Investigator and Scientific Advisor, Research support and Salary.

Abstract Introduction: Osteitis fibrosa cystica (OFC) is the most serious bone involvement of primary hyperparathyroidism (PHPT), it is characterized by subperiosteal resorption, lytic lesions and the appearance of brown tumors; this is why, in some cases, this condition can easily be mistaken for a malignant neoplasm. Its prevalence in developed countries is only 5%. Clinical Case: We present a 58-year-old woman, with no relevant personal history, who came to the emergency room with pain in her right shoulder after an accidental fall on the bus. The humerus radiograph shows a pathological fracture of the right humerus, with significant osteopenia. In the emergency analysis, serum Calcium 13.3 mg / d), Ionic Calcium 7.03 mg / dL, Phosphorus 2.4 mg / dL, Alkaline Phosphatase 248 U / L and normal kidney function stand out. With a diagnosis of severe hypercalcemia, treatment was started in the emergency room with serum therapy (1000 ml of 0.9% physiological saline in 4 hours) and intravenous diuretic treatment (furosemide 40mg) with a decrease in calcemia to 12.8mg / dL. Later, she was admitted to the Internal Medicine hospital ward to perform a differential diagnosis of hypercalcemia secondary to a primary tumor, Multiple Myeloma or Primary Hyperparathyroidism. The study findings are: Calcium metabolism: PTH 660 pg / ml (12 - 65), 25 Hydroxyvitamin D: 14.00. Thyroid ultrasound: Posterocaudal to right thyroid lobe, an area of ​​echogenicity slightly lower than the thyroid is identified, of dimensions not estimated by endothoracic component, which could correspond to a parathyroid adenoma. Body CT: Neck: Heterogeneous nodule dependent on the posterior region of the right thyroid nodule with endothoracic extension. Skeleton: Lytic lesions with a tumor aspect in the humerus, right scapula and bilateral seventh rib and right pubic branch. Skull: Diffuse increase in bone density of the calvaria, showing multiple punctate lytic lesions with a permeative appearance. Bone densitometry: Femur neck: - &lt;1.5, Lumbar spine: - &lt;3.0 With the diagnosis of PHPT causing osteitis fibrosa cystica, surgical intervention was decided. Under general anesthesia, a selective right approach was performed, finding a large parathyroid adenoma weighing 17 grams. PTH fell to 36 pg / ml after surgery. At 9 months after surgery, the patient presented calcium levels of 9 mg / dl and PTH 146 pg / ml with clear radiological improvement. Discussion: Osteitis fibrosa cystica is rare in our environment, it is often confused with other neoplasms. After parathyroidectomy, patients with PHPT have a marked and sustained recovery from OFC, although in some cases this recovery can only be achieved after several years. We consider this case of interest, since it illustrates the importance of evaluating the study of phospho-calcium metabolism and parathyroid function in all patients with bone lesions to rule out Primary Hyperparathyroidism with OFC.

Summary We present the first case of pigeon allergy causing severe haemolytic anaemia. Serology demonstrated very high titres of antibodies to avian proteins; in excess of those seen in the majority of cases of allergic lung disease1. Observation, immunosuppressive therapy and attempts at reducing antigen exposure were ineffective in controlling the disease. The only effective measure was culling the birds which resulted in a swift remission in the patient’s illness. Background Avian allergic diseases are well documented including extrinsic allergic alveolitis and asthma. However, from a review of the literature, haemolytic anaemia has not yet been described. Case Presentation An eight year old boy presented to accident and emergency with malaise, pallor and a sore throat. Haemoglobin was 53g/L. Further clinical examination revealed splenomegaly of 3.5cm below the costal margin. Investigations Full blood count demonstrated marked anaemia and a reticulocytosis (Hb 53g/L, WBC 2.2 x109/L, Neuts 1.3 x109/L, Lymphs 0.6 x109/L, Platelets 186 x109/L, Reticulocytes 375 x109/L). Blood film demonstrated increased polychromasia and microspherocytes. Direct coombes test was negative. Differential Diagnosis The patient’s haemoglobin stabilised following a short period of time in hospital. Red blood cell transfusion and immunosuppressive therapy were not required at this stage. Despite stable haemoglobin concentrations there continued to be evidence of haemolysis throughout the first year of follow-up. This was complicated by gallstone disease which required open cholecystectomy. School attendance was adversely affected. In view of the prolonged duration of the illness the patient was screened for congenital and acquired causes of haemolysis. No cause was found for the condition. Three years later the patient experienced decompensated haemolysis with a fall in his haemoglobin to 66g/L and symptoms of lethargy and malaise. His splenomegaly was more marked at 5.0cm. He was commenced on prednisolone (1mg/kg) which stabilised his blood count but was complicated by psychiatric disturbances. During a routine follow-up appointment the patient disclosed that he kept over 100 racing pigeons at his home. He was involved in their care on a daily basis and would regularly race the birds in competitions. Serological testing demonstrated high titres of antibodies to avian proteins (pigeon and budgie serum, feather and droppings >200x103 mg/L). These levels are in excess of those seen in the majority of cases of allergic lung disease1. Treatment Initial attempts to reduce exposure were ineffective. Following discussions with the family the birds were culled. There was an immediate and dramatic effect on reticulocytes and within a month it was possible to begin reducing the steroid dose. Over the following year there was a progressive rise in his haemoglobin associated with a continued fall in the reticulocytosis. Steroids were discontinued at four months. Three years following the removal of the causative agent the patient remains well and off treatment. Discussion Avian proteins are commonly cited as a cause for immune conditions, predominantly those affecting the respiratory system. This is the first case of avian allergic haemolytic anaemia. This case highlights the importance of consideration of unusual pathologies. Competing interests None Patient consent Not obtained. References 1) C I Baldwin, A Todd, J E Calvert. Pigeon fanciers' lung: effects of smoking on serum and salivary antibody responses to pigeon antigens. Clin Exp Immunol. 1998 Aug;113(2):166-72. Disclosures: No relevant conflicts of interest to declare.

Os trotes vêm passando por um processo de mudança nas universidades brasileiras, visando preservar a integridade moral e física do calouro. Por outro lado, é percebido um declínio progressivo da empatia dos estudantes durante os anos de graduação. Nesse panorama, a Liga do Câncer da Universidade Federal de Ciências da Saúde de Porto Alegre – UFCSPA – organizou a atividade de extensão chamada “Careca Amiga”, um evento em que os calouros têm seus cabelos raspados por pacientes oncológicos pediátricos do Hospital da Criança Santo Antônio (Irmandade Santa Casa da Misericórdia de Porto Alegre) e realizam a doação de seus cabelos para confecção de perucas. Participam do evento o Centro Acadêmico XXII de Março da Medicina da UFCSPA (organização), a ONG Doutorzinhos (que utiliza a figura do palhaço e da arte cênica para animar os pacientes), a ONG Cabelaço (na coleta e distribuição dos cabelos dos estudantes) e cabelereiros voluntários (para auxiliar as crianças no corte dos cabelos). Em 2017, o evento alcançou sua 3ª edição e contou com 14 calouros. Ao todo, já foram mais de 39 estudantes que participaram ativamente do evento e várias mechas de cabelo cedidas para a confecção de perucas. Mais do que os números, esse encontro visa desmistificar o estigma da careca e ser um momento de transição de etapas: passar no vestibular e lutar contra um câncer. Além disso, a conexão criada entre estudantes e pacientes permite cultivar a empatia e fortalece a mudança no estilo do trote nas universidades brasileiras. Palavras-chave: Trote Solidário, Corte de Cabelos, Perucas, Empatia, Extensão Universitária “Careca Amiga”: a new perspective in the university trot Abstract: Freshman pranks are undergoing a process of change in Brazilian universities, aimed at preserving the moral and physical integrity of the freshman student. On the other hand, is perceived decline in student empathy during undergraduate years. In this scenario, the academic society of cancer (Liga do Câncer) of the Federal University of Health Sciences of Porto Alegre – UFCSPA (Porto Alegre, Rio Grande do Sul State, Brazil) organize an extension activity called “Careca Amiga”, an event which freshmen have their hair shaved by oncology pediatric patients of Hospital of Children Santo Antônio (Irmandade Santa Casa da Misericórdia of Porto Alegre) and perform the donation of their hair for the creation of wigs. Attending the event are the Academic Center of Medicine of the University, the Doutorzinhos NGO (with uses the clown figure and scenic art to animate patients), the Cabelaço NGO (in the collection and distribution of student’s hair) and volunteer hairdressers (to help children cut the hair). In 2017, the event reached your third edition and count with 14 freshmen. In all, 39 students have attended the event and several strands of hair were donated to make wigs. More than a number, this meeting aims to desmystify the stigma of bald and being a moment of step transition: pass in the entrance exam and fight against a cancer. Also, the connection between students and patient lets cultivate empathy and reiterates the chance the style of pranks in Brazilian universities. Keywords: Solidary Trot, Haircut, Wig, Empathy, University Extension Careca Amiga”: una nueva perspectiva del trote en la universidad Resumen: Las bromas de estudiante del primer año vienen atravesando un proceso de cambio en las universidades brasileñas, con el intuito de preservar la integridad moral y física del estudiante. Sin embargo, es percibida una disminución progresiva de la empatía de los estudiantes durante los años de la graduación. En este panorama, a sociedad académica del cáncer de la Universidad Federal de Ciencias de la Salud de Porto Alegre – UFCSPA (Porto Alegre, Rio Grande do Sul, Brasil) organizó la actividad de extensión llamada “Careca Amiga”, evento en el que estudiantes del primer año tiene su cabello raspado por pacientes oncológicos pediátricos del Hospital de los niños Santo Antonio (Irmandade Santa Casa de Misericordia de Porto Alegre) y realizan la donación de su cabello para la confección de pelucas. Participan del evento Centro Académico de Medicina, ONG Doutorzinhos (utilizan la figura del payazo y artes escénicas para alegrar a los pacientes), ONG Cabelaço (en la colecta y distribución del cabello) y peluqueros voluntarios (para auxiliar los niños en los cortes de cabello). En 2017, el evento alcanzó su tercera edición y conto con 14 estudiantes del primer año. En el total, ya fueron más de 39 estudiantes que participaron activamente del evento. Más que números, ese encuentro visa desmitificar el estigma de la calva y ser un momento de transición de etapas: ingresar en la universidad y luchar contra un cáncer. Más allá de eso, la conexión creada entre estudiante y paciente permite cultivar la empatía y fortalece el cambio en el estilo de la broma en las universidades brasileñas. Palabras-clave: Broma solidaria, Corte de Cabello, Pelucas, Empatía, Extensión Universitaria

This study was designed to promote enhanced self-efficacy and decreased stress levels for family caregivers at a hospice care hospital, thus increasing their quality of life. This is achieved through group flower arranging sessions. The objectives are to (a) enhance self-efficacy scores for family caregivers of Calvary patients, (b) decrease stress levels for family caregivers of Calvary patients, and (c) disseminate results to other hospices. The results show that the flower arranging sessions resulted in significantly increased self-efficacy and decreased stress and associated problems for the caregiver participants. Implications and suggestions for future research are discussed.

Background: The Accredited Persons Programme was introduced in 2003. The relevant Mental Health Acts (NSW) authorised reviews by appropriately credentialed non-medical health professionals as part of the process of detaining and treating a person without consent: an authority previously held by medical officers. Evaluations of the Programme are needed. Objective: To compare discharge decisions for hospital-treated deliberate self-poisoning patients made by an Accredited Person and Medical Officers. Methods: For a 10-year cohort (2003–2012) of index hospital-treated deliberate self-poisoning admissions at the Calvary Mater Newcastle, we compared Accredited Person and Medical Officer discharge decisions from the general hospital. We specifically examined discharges to the psychiatric hospital under a Mental Health Act certificate (used as an index of the Accredited Person’s use of the authority under the Accredited Persons Programme) compared to any other discharge destination. Unadjusted and adjusted logistic regression models and a propensity score analysis were used to explore the relationship between clinician type and discharge destination. Results: There were 2237 index assessments (Accredited Person = 884; Medical Officer = 1443). One-quarter (27%) were referred for assessment under the Act at the psychiatric hospital, with the Accredited Person significantly more likely (32%) to require this compared to the Medical Officers (24%); Risk Difference: 8.3% (4.5 to 12.1). However, after adjusting for patient characteristics; Risk Difference: −3.0% (−5.9 to −0.1) and for propensity score, Risk Difference: −3.3% (−6.7 to 0.1), the Accredited Person and Medical Officer likelihood of discharging for an assessment under the Act was similar. Conclusions: The Accredited Person assessed more clinically complex patients than the Medical Officers. After adjusting for clinical complexity and propensity score, the likelihood of referral for involuntary psychiatric hospital care was similar for Accredited Person and Medical Officers. Our evaluation of the Accredited Person programme in the general hospital was favourable, and wider implementation and evaluation is warranted.

Abstract Background Breastfeeding has positive impacts on the health, environment, and economic wealth of families and countries. The World Health Organization (WHO) launched the Baby Friendly Hospital Initiative (BFHI) in 1991 as a global program to incentivize maternity services to implement the Ten Steps to Successful Breastfeeding (Ten Steps). These were developed to ensure that maternity services remove barriers for mothers and families to successfully initiate breastfeeding and to continue breastfeeding through referral to community support after hospital discharge. While more than three in four births in Australia take place in public hospitals, in 2020 only 26% of Australian hospitals were BFHI-accredited. So what is the social return to investing in BFHI accreditation in Australia, and does it incentivize BFHI accreditation? This study aimed to examine the social value of maintaining the BFHI accreditation in one public maternity unit in Australia using the Social Return on Investment (SROI) framework. This novel method was developed in 2000 and measures social, environmental and economic outcomes of change using monetary values. Method The study was non-experimental and was conducted in the maternity unit of Calvary Public Hospital, Canberra, an Australian BFHI-accredited public hospital with around 1000 births annually. This facility provided an opportunity to illustrate costs for maintaining BFHI accreditation in a relatively affluent urban population. Stakeholders considered within scope of the study were the mother-baby dyad and the maternity facility. We interviewed the hospital’s Director of Maternity Services and the Clinical Midwifery Educator, guided by a structured questionnaire, which examined the cost (financial, time and other resources) and benefits of each of the Ten Steps. Analysis was informed by the Social Return on Investment (SROI) framework, which consists of mapping the stakeholders, identifying and valuing outcomes, establishing impact, calculating the ratio and conducting sensitivity analysis. This information was supplemented with micro costing studies from the literature that measure the benefits of the BFHI. Results The social return from the BFHI in this facility was calculated to be AU$ 1,375,050. The total investment required was AU$ 24,433 per year. Therefore, the SROI ratio was approximately AU$ 55:1 (sensitivity analysis: AU$ 16–112), which meant that every AU$1 invested in maintaining BFHI accreditation by this maternal and newborn care facility generated approximately AU$55 of benefit. Conclusions Scaled up nationally, the BFHI could provide important benefits to the Australian health system and national economy. In this public hospital, the BFHI produced social value greater than the cost of investment, providing new evidence of its effectiveness and economic gains as a public health intervention. Our findings using a novel tool to calculate the social rate of return, indicate that the BHFI accreditation is an investment in the health and wellbeing of families, communities and the Australian economy, as well as in health equity.

INTRODUCTION This is an Am bidirectional observational study. Study population is the patients who have undergone craniotomy for any indication in the department of neurosurgery of CH (EC) from September 2016 to Aug 2019. A list of patients who have undergone NCCT/CECT head during their follow up period, due to any clinical indication, drawn. All such patients interviewed and clinically examined for pain at the craniotomy site. AIMS AND OBJECTIVES The incidence of non-union was Correlation between non-union and predisposing factors via primary pathology, fixation technique, age, sex, comorbidities such as DM, TB and radiotherapy. Correlation with postoperative headache MATERIALS AND METHODS Study area Command Hospital Eastern Command. Study population- Patients who have undergone craniotomy for any indication in the department of neurosurgery of CH (EC) from September 2016 to Aug 2019. Sample size is the number of patients who have undergone CT Scan evaluation based on clinical indications in the post operative period. Am bidirectional observational study RESULT AND ANALYSIS We showed that in ICSOL was significantly in higher non union and bad union patients; Head Injury was significantly higher in good union patients. It was found that carcinoma patients were higher in non union and bad union which was statistically significant. Radiation patients were higher in good union which was statistically significant. Present study found that Post-Op Headache was significantly higher in non union and bad union and mean Rate of union was higher in good union. Association of Fixation Technique with Non Union, Good Union and Bad Union was statistically significant. CONCLUSION We can conclude that patients are more likely to have their craniotomy fuse if they did not undergo radiation treatment or have sutures secure the free flap. Craniotomy fusion rates after free flap increases steadily over time, as expected. We were not able to demonstrate that clinical factors such as age, sex, BMI, diagnosis, fixation material, and radiation have an impact on fusion rate when time to fusion was considered.

The coronavirus SARS-CoV-2 epitomises the perfect example of a storm, a nightmare pandemic scenario that requires rescue plans for the infected populations. This is of particular relevance as newer fast spreading variants appearing with almost 10 times faster, despite numerous precautionary measures and restriction being in place to reduce this happen. An armamentarium of anti-viral, anti-inflammatory, and antithrombotic drugs are being recruited, through artificial intelligence tools in big data, patterns and procedures to survive the problem; research in plasmapheresis-based exchange technologies to decrease inflammatory mediators; in-line affinity column absorption to prepare neutralizing antibody concentrate against the variants strains of this virus, as the most useful direct intervention and more recently novel developments in vaccines with reported efficacies in the range 62% to 95%, ie. to simian adenovirus-vectored and the mRNA vaccines all with partial success with the implementation of personal protective equipment and physical distancing. A preliminary analysis of published data on the relationship between T cell lymphopenia and the outcomes of coronavirus infections, that have been stratified in various ways to measure cumulative [CD4+CD8] counts: (1) mild to moderate v. severe disease; (2) survivors v. non-survivors; (3) non-severe v. severe cases; and (4) infected patients v. healthy controls suggest: Firstly, the severity of T-cell depletion correlates with a worse patient outcome for SARS. Secondly, the degree of lymphopenia appears to associate with a cytokine driven hyperinflammatory cascade triggered by coronaviruses. Thirdly, quantitative T-cell lymphodepletion may be a surrogate marker of hyper- inflammation and has a potential role to identify the timing of when resource intensive clinical treatments should be applied and be effective. Fourthly, recognition of elevated regulatory T-cells (Tregs) as an important T-cell subset to modulate immune responses and may lower the risk of respiratory viral infections in the elderly. Moreover, evidence is accumulating that the onset of SARS becomes highly critical in a smaller percentage of patients (estimated 1.4% infection mortality rate) who are susceptible innately to an intense cytokine/chemokine inflammatory response; and with multiple risk factors. The notion thought to be driven by the virus in the lungs causing massive pulmonary edema and requiring mechanical support by ventilator or even Extracorporeal Membrane Oxygenation (ECMO). Given the large number of infections in the population encompassed by SARS CoV-2, this percentage of patients with intense inflammation although small translates to a major stressor on the limited availability of hospital medical ICU beds and intensivists. Therapeutically, a miscellany of monoclonal antibodies, recombinant protein and antiviral drugs are being tried to attenuate the adverse effects of the hyperinflammatory cascade. These include both tocilizumab, a monoclonal antibody and inhibitor of the interleukin-6 receptor and the recombinant protein anakinra, an interleukin-1 receptor antagonist of the cytokine inflammatory cascade. Remdesivir is an anti-viral prodrug, an adenosine nucleotide inhibitor of the SARS-CoV-2 RNA dependent RNA Polymerase (RdRp) essential for viral replication. The drug has reported modest therapeutic effects, shortening the average duration of hospitalisation by four days. Moreover, to attenuate the host inflammatory factors of SARS, future R&D are already progressing well with specialised immunosorbent devices incorporated into extracorporeal circuits for hemopurification. One such product of potential utility is a biocompatible porous polymer adsorbent micro bead. Undoubtedly, as is in practice with such an advanced technologies established for many decades the manufacturers do take the responsibly to ensure such hemopurification devices in development are secured in the most effective standardised way under strict GMP regulatory adherence. Another matter of pharmacological concern is the use of painkillers to dampen the side effect of vaccination. For most people, the side effects of the vaccine are mild or moderate and last only a day or two, though in a limited cases in some people the side effects might them feel like they have the flu, affecting their ability to perform daily activities; These side effects are the signs of an appropriate recognition and immune reactions to the active principle of vaccine, is teaching the recipient immune system how to recognize and attack SARSCoV- 2, the coronavirus that causes COVID-19, when encountered. In the context of the use of painkiller when faced with a couple of days of flu-like discomfort, such as using ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) to relieve their fever and pain to reduce the side effects of the vaccine, is not warranted as there a chance that they’ll also depress the immune system’s beneficial response to vaccination. Moreover using a pain reliever before the vaccine injection to head off the discomfort that the drugs may dampen the inflammatory response, fever and aches with reduced inflammation, unwarranted as it may also be a lower immune response to the vaccine. Moreover, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), which include ibuprofen, reduced the production of antibodies and other aspects of the immune response to SARS-CoV-2. Basically antibodies are proteins made by the immune system to fight viruses like CoV-2. The COVID-19 vaccines stimulate the body to produce antibodies that specifically target the coronavirus without causing disease. While some fever-reducing pain medications may blunt the antibody response to vaccination, but it’s not clear what this means in the real world. While more research is needed but based on the existing data on the COVID-19 vaccine studies that have already been done it is clear that taking a pain reliever after injection, if needed, may not cause that much of a problem. To conclude in short as of 10 January 2021, over 1,941,757 people have died so far from the coronavirus COVID-19 outbreak, all from a miniscule RNA virus 0.125 um in diameter. The virus has truly challenged mankind, which despite our ingenuity, the infections and deaths are continuing to rise exponentially in the colder months, facilitated by cohabitation and travel. Despite these rising numbers, we should be sanguine about the prospects for a better future. The Calvary has arrived with the ongoing mass distribution of multiple vaccines and warmer weather only several months away. With encouragement, we should be cautiously optimistic about the longer-term actions of the public for responsibly enhancing the use of personal protective equipment, physical distancing and hygienic practices. Add on the targeted use of pharmaceuticals and plasmapheresis technologies to mitigate infections and prevent deaths. SARS-CoV-2 is only an awakening with numerous forewarnings, infection disease, Yet not to underestimate our resourcefulness. With advancing developmental technologies, we should improve in the future.

In February 2021, during the third COVID-19 lockdown in the state of Victoria, Australia, artist Shaun Wilson used the teleconferencing platforms Teams and Skype to create a slow cinema feature length artwork titled Fading Light to demonstrate how innovative creative practice can overcome barriers of distance experienced by creative practitioners from the limitations sustained during the COVID-19 pandemic. While these production techniques offer free access to develop new methodologies through practice, the wider scope of pandemic lockdowns mediated artists with teleconferencing as a tool to interrogate the nature of life during our various global lockdowns. It thus afforded a pioneering ability for artists to manufacture artwork about lockdowns whilst in lockdown, made from the tools commonly used for virtual communication. The significance of such opportunities, as this article will argue, demonstrates a novel approach to making artwork about COVID-19 in ways that were limited prior to the start of 2020 in terms of commonality, that now are “turning us all into broadcasters, streamers and filmmakers” (Sullivan). However, as we are only just becoming familiar with the cultural innovation pioneered from the limitations brought about by the pandemic, new aesthetics are emerging that challenge normative traditions of manufacturing and thinking about creative artefacts. Teleconferencing platforms were used differently prior to 2020 when compared to the current pandemic era. Throughout the 2000s and 2010s, there were no global gigascale movement restrictions or medical dangers to warrant a global shutdown that would ultimately determine how a person interacts with public places. In a pre-pandemic context, the daily use of teleconferencing was a luxury. Its subsequent use in the COVID-19 era became a necessity in many parts of day-to-day life. As artists have historically been able to comment through their work on global health crises, how has contemporary art responded since 2020 in using teleconferencing within critical studio practice? To explore such an idea, this article will probe examples of practice from artists making artworks with teleconferencing about pandemics during the COVID-19 pandemic. Discussion will purposely not consider a wider historical scope of teleconferencing in art and scholarship as the context in this article explicitly addresses art made in and commenting on the COVID-19 pandemic using the tools of lockdown readily available through teleconferencing platforms. It will instead concentrate on three artists addressing the pandemic during 2020 and 2021. The first example will be There Is No Such Thing as Internet from Polish artists Maria Magdalena Kozlowska and Maria Tobola, “performers who identify as one artist, Maria Małpecki” (“Pogo”). The second example is New York artist Michael Mandiberg’s Uncle Bob 85th Birthday via Zoom 3:00-4:00PM, August 16, 2020 (#24), from the series Zoom Paintings. The third example is Australian artist Shaun Wilson’s Fading Light. These works will be discussed as a means of considering teleconferencing as a contemporary art medium used in response to COVID-19 and art made as pandemic commentary through the technology that has defined its global social integration. Figure 1: Maria Małpecki, There Is No Such Thing as Internet, used with permission. There Is No Such Thing as Internet was presented as a live stream on 7 May 2020 and as an online video between 7-31 May 2020 in the “Online Cocktail Party with Maria Małpecki” at Pogo Bar, KW Institute for Contemporary Art, Berlin by Maria Małpecki and curator Tomek Pawlowski Jarmolajew (“Pogo”). The work represents a twenty-minute livestream essay created in part by a teleconferencing video call performance and appropriated video streams. This includes video chat examples from Chomsky and Žižek, compiled together through intertextual video collages which The Calvert Journal described as a work “that explore[s] identity and different modes of communication in times of isolation” (De La Torre). One of the key strengths of this work in terms of teleconferencing is how it embraces the medium as an integral part of the performative methodology. To such an extent, one might argue that if it was removed and replaced by traditional video camera shots, which do feature in the video but are not the main aesthetic driver, the Metamodernist troupe of Małpecki’s videos would not perform the same critique of the pandemic. So, for Małpecki to comment on isolation through the Internet requires video calls to be central in the artwork in order for it to hold the cultural value it embeds through the subject. The conceptual framework relies on short segments to create episodic moments reliant on philosophical laments relating to each part of the work. For example, the first act unfolds with a montage of short video clip collages reminiscent of the quick-clip YouTube browsing habit culture from the pandemic to expedite an argument that indeed, there really is no singular internet. Rather, from this, what we are experiencing is arguably something else entirely. From here we move to the second act titled “We wake up in a different room every morning. We wander in a labyrinth where most doors are already open” (Małpecki); but as Małpecki comments, “sometimes our job is to shut them”. The sequence evolves into a disorientating dual screen sequence of the artists panicking to what they are viewing on screen. What this is exactly remains unclear. It may be us as the audience or something else as Malpecki holds their webcam devices upside down to provide an unnerving menage amidst the screams and exacerbations that invites spatial disorientation as a point of engagement for the viewer. As we recognise that video call protocols during the pandemic are visually static and that normative ‘rules’ of video calls require stabilised video and clean sound, Małpecki subverts these protocols to that of an uncomfortable, anarchic performance. It's at odds with the gentility of video call aesthetics which, in the case of this artwork, is more like watching a continuous point of view shot from a participant on a roller coaster or an extreme fairground ride. As the audience moves through each of the eclectic acts, this randomness laments a continuity that, sometimes satirical and at other times sublime, infuses the silliness and obliqueness of habitual lockdown video viewing. Even the most mundane of videos we watch to pass the time have become anthems of the COVID-19 era as a mixture of boredom, stupidity, and collective grief. Małpecki’s work in this regard becomes a complex observation for a society in crisis. It eloquently uses video calls as a way to comment on what this article argues to be an important cultural artefact in contemporary art’s response to COVID-19. Just as Goya subverted the Venetian pandemic in the grim Plague Hospital, Małpecki reflects our era in the same disruptive way by using frailty as a mirror to reveal an uneasy reflection masked in satirical obscurity, layered with fragments of the Internet and its subjective “other”. Figure 2: Michael Mandiberg, Uncle Bob 85th Birthday via Zoom 3:00-4:00PM, August 16, 2020 (#24), used with permission. Conversely, the work of New York artist Michael Mandiberg uses teleconferencing in a different way by painting the background of video calls onto stretched canvases mostly over the duration of the actual call time. Yet in doing so, the removal of people from inside the frame highlights aspects of isolation and absence in lockdown. At the Denny Dinin Gallery exhibition in New York, The Zoom Paintings “presented in the digital sphere where they were born” (Defoe). Zoom provided both the frame and the exhibition space for these works, with “one painting … on view each day [on Zoom], for a total of ten paintings” (“Zoom”). Describing the works, Mandiberg states that they are “about the interchangeability of people and places. It’s not memorializing a particular event; it’s memorializing how unmemorable it is” (Mandiberg; Defoe). This defines an innovative approach to teleconferencing that engages with place in times when the same kinds of absence experienced in the images of peopleless Zoom video calls mirror the external absence of people in public places during lockdown. Uncle Bob 85th Birthday via Zoom 3:00-4:00PM, August 16, 2020 (#24) is time stamped with the diaristic nature of the Zoom Paintings series. These works are not just a set of painting subjects interlinked through a common theme of paintings ‘about Zoom backgrounds’. They, rather, operate as a complex depiction of absence located in the pandemic, evidently capturing a powerful social commentary about what the artist experienced during these times. In doing so, it immediately prompts the viewer into tensions that conceptually frame COVID-19, whether that be the isolation of waiting out the pandemic in lockdown, the removal of characters through illness from the virus, or even a sudden death from the virus itself. The camera’s point of view illustrates an empty space where we know something is missing. At the very least the artist suggests that someone nearby once inhabited these empty spaces but they are, at present, removed from the scene or have vanished altogether. On 16 August 2020, the day that the painting was made, the New York Times estimated that 514 people in the United States died from COVID-19 (“Coronavirus”). When measured against a further death rate peaking at 5,463 people in the United States who died on 11 February 2021, the catastrophic mortality data in the United States alone statistically supports Mandiberg’s lament as to the severity of the pandemic, which serves as the context of his work. Based on this data alone, the absence in Mandiberg’s paintings intensifies a sense of isolation and loss insofar as the subjectivity embedded within the video call frame speaks to a powerful way that contemporary art is providing commentary during the pandemic (“Coronavirus”). Art in this context becomes a silent observer using teleconferencing to address both what is taken away from us and what visually remains behind. This article acknowledges the absence in Mandiberg’s paintings as a timely reminder of the socio-devastation experienced in the pandemic’s wake. Therein lies a three-folded image within an image within an image, not unlike what we see in Blade Runner when Deckard’s Esper Machine investigates the reflection in a mirror of someone else, and no more vivid than in Van Eyck’s Arnolfini Portrait. From a structural point of view, we witness Mandiberg’s images during its exhibition on Zoom in much the same conceptual way. In this case though, it is a mirrored online image of an image painted from a video call interpreted online from a recorded image transmitted online through teleconferencing. Through similar transactions, Shaun Wilson’s utilisation of video calls is represented in Fading Light as a way to comment on COVID-19 through the lens of Teams and Skype. The similarities of Fading Light to There Is No Such Thing as Internet stem obviously from the study of figuration used as the driver of the works but at the same time, it also draws comparison with Mandiberg’s stillness as represented in the frozen poses of each figure. At a more complex level, there is, though, a polar opposite in the mechanics that, for Mandiberg, uses video to translate into painted subjects. Fading Light does the opposite, with paintings recontextualised into video subjects. Such an analysis of both works brings about a sense of trepidation. For Mandiberg, it is the unsettling stillness through absence. In Fading Light it is the oppressive state of the motionlessness in frame that offers the same sense of awkwardness found in Mandiberg’s distorted painted laptop angles, and that makes the same kind of uncomfortableness bearable. It is only as much as an audience affords the time to allow before the loneliness of the subject renders the Zoom paintings a memorial to what is lost. Of note in Fading Light are the characteristically uncomfortable traits of what we detect should be in the frame of the subject but isn’t, which lends a tension to the viewer who has involuntarily been deprived of what is to be expected. For a modern Internet audience, a video without movement invites a combination of tension, boredom, and annoyance, drawing parallels to Hitchcock’s premise that something has just happened but we’re not entirely sure exactly what it was or is. Likewise, Małpecki’s same juxtaposition of tension with glimpses of Chomsky and Žižek videos talking over each other is joined by the artists’ breaking the fourth wall of cinema theory. Observing the artists lose concentration while watching the other videos in the video call scenario enact the mundane activities we encounter in the same kinds of situations of watching someone else on Zoom. However, in this context, we are watching them watching someone else whom we are also watching, while watching ourselves at the same time. Figure 3: Shaun Wilson, Fading Light, used with permission. The poses in Fading Light are reconfigured from characters in German medieval paintings and low relief religious iconography created during the Black Death era. Such works hang in the Gothic St. Michael’s Church in Schwäbisch Hall in Germany originally used by Martin Luther as his Southern Germany outpost during the Reformation. Wilson documented these paintings in October 2006, which then became the ongoing source images used in the 51 Paintings Suite films. The church itself has a strong connection to pandemics where a large glass floor plate behind the altar reveals an open ossuary of people who died of plague during the Black Death. This association brings an empirical linkage to the agency in Fading Light that mediates the second handed nature of the image, initially painted during a medieval pandemic, and now juxtaposed into the video frame captured in a current pandemic. From a conceptual standpoint, the critical analysis reflected in such a framework allows the artwork to reveal itself at a multi-level perspective, operating within a Metamodernist methodology. Two separate elements oscillate in tandem with one another, yet completely independent, or in this case, impervious to each other’s affect. Fading Light’s key affordance from this oscillation consolidate Wilson’s methodology in the artwork in as much detail as what Małpecki and Mandiberg construct in their respective works, yet obviously for very different motivations. If the basis of making video art in the pandemic using teleconferencing changes the way we might think about using these platforms, which otherwise may not have previously been taken serious by the academy as a valid medium in art, then the quiet meaningfulness throughout the film transcends a structured method to ascertain a pictorial presence of the image in its facsimile state. This pays respect to the source images but also embraces and overlays the narrative of the current pandemic intertwined within the subject. Given that Fading Light allows a ubiquitous dialogue to grow from the framed image, a subjective commonality in these mentioned works provide insight into how artists have engaged innovation strategies with teleconferencing to develop artwork made and commenting about the current pandemic. Whether it be Małpecki’s subversive pandemic variety show, the loneliness of Mandiberg’s Zoom call paintings or Wilson’s refilming of Black Death era paintings, all three artists use video call platforms as a contemporary art medium capable of social commentary during histo-trauma. These works also raise the possibility of interdisciplinary Metamodernist approaches to consider the implications of non-traditional mediums in offering socio-commentary during profoundly impactful times. It remains to be seen if contemporary video call platforms will become a frequented tool in contemporary art long after the COVID-19 pandemic is over. However, by these works and indeed, from the others to follow and not yet revealed, the current ossuary provides an opportunity for artists to respond to their own immediate surroundings to redefine existing boundaries in art and look to innovation in the methods they use. We are in a new era of art making, only now beginning to reveal itself. It may take years or even decades to better understand the magnitude of the significance that artists have contributed towards their own practices since the beginnings of the pandemic. This time of profound change only strengthens the need for contemporary art to preserve and enlighten humanity through the journey from crisis to hope. References Blade Runner. Dir. by Ridley Scott, Warner Brothers, 1982. “Coronavirus US Cases.” New York Times, 27 Mar. 2021. 28 Mar. 2021 <http://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html>. Defoe, Taylor. “‘It's Memorializing How Unmemorable It Is’: Artist Michael Mandiberg on Painting Melancholy Portraits on Zoom.” Artnet News 10 Nov. 2020. 19 Mar. 2021 <http://news.artnet.com/exhibitions/mandiberg-zoom-paintings-1922159>. De La Torre, Lucia. “Art in the Age of Zoom: Explore the Video Art Collage Unraveling the Complexities of the Digital Age.” The Culvert Journal, 5 May 2020. 19 Mar. 2021 <https://www.calvertjournal.com/articles/show/11788/online-performance-art-polish-artist-maria-malpecki-digital-age>. Goya, Francisco. Plaga Hospital. Private Collection. 1800. Małpecki, Maria. There Is No Such Thing as Internet. Vimeo, 2020. <http://vimeo.com/415998383>. Mandiberg, Michael. Uncle Bob 85th Birthday via Zoom 3:00-4:00PM, August 16, 2020 (#24). New York: Denny Dinin Gallery, 2020. “Pogo Bar: Maria Małpecki & Tomek Pawłowski Jarmołajew.” KW Institute for Contemporary Art, 7 May 2020. 19 Mar. 2021 <http://www.kw-berlin.de/en/maria-malpecki-tomek-pawlowski-jarmolajew/>. Sullivan, Eve. “Video Art during and after the Pandemic: 2020 Limestone Coast Video Art Festival.” Artlink, 2020. 19 Mar. 2021 <http://www.artlink.com.au/articles/4885/video-art-during-and-after-the-pandemic-2020-limes/>. Van Eyck, Jan. Arnolfini Portrait. Canberra: National Gallery, 1434. Wilson, Shaun. Fading Light. Bakers Road Entertainment, 2021. “The Zoom Paintings.” Denny Dimin Gallery, 12 Nov. 2020. <http://dennydimingallery.com/news/virtual_exhibition/zoom-paintings/>.