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Trickle-down economics is a fallacious metaphor that hurts working people and the civic commons. In this paper, we discuss the role and impact metaphors have in economics education. We explore the stickiness of "truthy" but ultimately false metaphors and offer economics educators alternative metaphors to displace this problematic metaphorical language. In its place, we propose a restorying of this fiction to tell a more truthful story in economics classrooms using the dual metaphors of "evaporative economics" and "economic desertification." We end by identifying the limitations of metaphorical language in teaching complex economic concepts, even while we recognize the power of these tools to elicit engagement in and with economics content that has real and lasting impacts on individuals and communities.

The current assessment of the state of political division in the United States is foreboding. Americans are more divided than any time since the Civil War, leaving some to opine that these differences may be irreconcilable. This speculative analysis takes seriously as its point of departure the position of a growing number of American commentators and policy experts who argue that the United States exhibits many of the risk factors that could lead to another civil war. Some commentators have advocated breaking up the union to preempt this outcome. The critical analysis within this article draws upon historical analogies from states partitioned during the 20th century, such as the Soviet Union, Yugoslavia, Czechoslovakia, Palestine, and India. These comparisons are used to evaluate proposals for a geographical sundering of the United States into Red and Blue Americas. My analysis highlights how any kind of national dissolution, though appealing to some at first glance, would be more politically complex, demographically fraught, and possibly no less violent than the alternative of civil conflict.

Abstract Understanding interplay of breast cancer and microenvironment is critical. Here we identified two transcriptomic subtypes and five immune infiltration patterns from RNA-seq and multiplex immunohistochemistry from 21 ER + /HER2- ILCs. We found proliferative subtype associated with increased suppressive immune infiltration, and defined a signature associated with lower proliferative, pro-inflammatory TAM infiltration, and improved survival in ER+ breast cancer. Our work identified genes related to ILC immune microenvironment and prognosis.

Cancers rely on multiple, heterogeneous processes at different scales, pertaining to many biomedical fields. Therefore, understanding cancer is necessarily an interdisciplinary task that requires placing specialised experimental and clinical research into a broader conceptual, theoretical, and methodological framework. Without such a framework, oncology will collect piecemeal results, with scant dialogue between the different scientific communities studying cancer. We argue that one important way forward in service of a more successful dialogue is through greater integration of applied sciences (experimental and clinical) with conceptual and theoretical approaches, informed by philosophical methods. By way of illustration, we explore six central themes: (i) the role of mutations in cancer; (ii) the clonal evolution of cancer cells; (iii) the relationship between cancer and multicellularity; (iv) the tumour microenvironment; (v) the immune system; and (vi) stem cells. In each case, we examine open questions in the scientific literature through a philosophical methodology and show the benefit of such a synergy for the scientific and medical understanding of cancer.

Aims: Steroid injections are used for subacromial pain syndrome and can be administered via the anterolateral or posterior approach to the subacromial space. It is not currently known which approach is superior in terms of improving clinical symptoms and function. This is the protocol for a randomized controlled trial (RCT) to compare the clinical effectiveness of a steroid injection given via the anterolateral or the posterior approach to the subacromial space. Methods: The Subacromial Approach Injection Trial (SAInT) study is a single-centre, parallel, two-arm RCT. Participants will be allocated on a 1:1 basis to a subacromial steroid injection via either the anterolateral or the posterior approach to the subacromial space. Participants in both trial arms will then receive physiotherapy as standard of care for subacromial pain syndrome. The primary analysis will compare the change in Oxford Shoulder Score (OSS) at three months after injection. Secondary outcomes include the change in OSS at six and 12 months, as well as the Pain Numeric Rating Scale (0 = no pain, 10 = worst pain), Disabilities of Arm, Shoulder and Hand questionnaire (DASH), and 36-Item Short-Form Health Survey (SF-36) (RAND) at three months, six months, and one year after injection. Assessment of pain experienced during the injection will also be determined. A minimum of 86 patients will be recruited to obtain an 80% power to detect a minimally important difference of six points on the OSS change between the groups at three months after injection. Conclusion: The results of this trial will demonstrate if there is a difference in shoulder pain and function after a subacromial space steroid injection between the anterolateral versus posterior approach in patients with subacromial pain syndrome. This will help to guide treatment for patients with subacromial pain syndrome. Cite this article: Bone Jt Open 2024;5(9):729–735.

BACKGROUND: In 2021, four patients who had received solid organ transplants in the USA developed encephalitis beginning 2-6 weeks after transplantation from a common organ donor. We describe an investigation into the cause of encephalitis in these patients. METHODS: From Nov 7, 2021, to Feb 24, 2022, we conducted a public health investigation involving 15 agencies and medical centres in the USA. We tested various specimens (blood, cerebrospinal fluid, intraocular fluid, serum, and tissues) from the organ donor and recipients by serology, RT-PCR, immunohistochemistry, metagenomic next-generation sequencing, and host gene expression, and conducted a traceback of blood transfusions received by the organ donor. FINDINGS: We identified one read from yellow fever virus in cerebrospinal fluid from the recipient of a kidney using metagenomic next-generation sequencing. Recent infection with yellow fever virus was confirmed in all four organ recipients by identification of yellow fever virus RNA consistent with the 17D vaccine strain in brain tissue from one recipient and seroconversion after transplantation in three recipients. Two patients recovered and two patients had no neurological recovery and died. 3 days before organ procurement, the organ donor received a blood transfusion from a donor who had received a yellow fever vaccine 6 days before blood donation. INTERPRETATION: This investigation substantiates the use of metagenomic next-generation sequencing for the broad-based detection of rare or unexpected pathogens. Health-care workers providing vaccinations should inform patients of the need to defer blood donation for at least 2 weeks after receiving a yellow fever vaccine. Despite mitigation strategies and safety interventions, a low risk of transfusion-transmitted infections remains. FUNDING: US Centers for Disease Control and Prevention (CDC), the Biomedical Advanced Research and Development Authority, and the CDC Epidemiology and Laboratory Capacity Cooperative Agreement for Infectious Diseases.

Objectives: To describe how patients with Parkinson’s disease (PD) and care partners choose to share or withhold information from clinicians. Methods: This is a qualitative, descriptive study nested within a multisite, randomized clinical trial of outpatient palliative care compared to standard neurologic care for PD. Interviews with patients (n = 30) and care partners (n = 30) explored experiences communicating with neurology clinicians. Thematic analyses identified themes relevant to patient-care partner-clinician communication. Results: There were four themes relevant to sharing and/or withholding information from clinicians: (1) Suppressing Concerns During Visits, (2) Care Partner Awareness of Patients’ Communication Barriers due to Cognitive Impairment, (3) Limited Sharing of Sensitive or Intimate Issues by Patients and Care Partners, and (4) Patient and Care Partner Suggestions to Overcome ‘Holding Back’. Conclusion: Limitations to communication between patients, care partners, and clinicians should be acknowledged and recognized in routine Parkinson’s disease care to foster accurate disclosure of unmet palliative care and other needs. Triadic communication strategies may help patients and care partners talk about unmet palliative care needs. Innovation: By recognizing that cognitive impairment and sensitive topics can be barriers, clinicians can adjust or adopt targeted communication strategies for identifying and discussing care needs.

Oncogene amplification on extrachromosomal DNA (ecDNA) drives the evolution of tumours and their resistance to treatment, and is associated with poor outcomes for patients with cancer1-6. At present, it is unclear whether ecDNA is a later manifestation of genomic instability, or whether it can be an early event in the transition from dysplasia to cancer. Here, to better understand the development of ecDNA, we analysed whole-genome sequencing (WGS) data from patients with oesophageal adenocarcinoma (EAC) or Barrett's oesophagus. These data included 206 biopsies in Barrett's oesophagus surveillance and EAC cohorts from Cambridge University. We also analysed WGS and histology data from biopsies that were collected across multiple regions at 2 time points from 80 patients in a case-control study at the Fred Hutchinson Cancer Center. In the Cambridge cohorts, the frequency of ecDNA increased between Barrett's-oesophagus-associated early-stage (24%) and late-stage (43%) EAC, suggesting that ecDNA is formed during cancer progression. In the cohort from the Fred Hutchinson Cancer Center, 33% of patients who developed EAC had at least one oesophageal biopsy with ecDNA before or at the diagnosis of EAC. In biopsies that were collected before cancer diagnosis, higher levels of ecDNA were present in samples from patients who later developed EAC than in samples from those who did not. We found that ecDNAs contained diverse collections of oncogenes and immunomodulatory genes. Furthermore, ecDNAs showed increases in copy number and structural complexity at more advanced stages of disease. Our findings show that ecDNA can develop early in the transition from high-grade dysplasia to cancer, and that ecDNAs progressively form and evolve under positive selection.

Abstract Soft bioelectronic devices exhibit motion-adaptive properties for neural interfaces to investigate complex neural circuits. Here, we develop a fabrication approach through the control of metamorphic polymers’ amorphous-crystalline transition to miniaturize and integrate multiple components into hydrogel bioelectronics. We attain an about 80% diameter reduction in chemically cross-linked polyvinyl alcohol hydrogel fibers in a fully hydrated state. This strategy allows regulation of hydrogel properties, including refractive index (1.37-1.40 at 480 nm), light transmission (>96%), stretchability (139-169%), bending stiffness (4.6 ± 1.4 N/m), and elastic modulus (2.8-9.3 MPa). To exploit the applications, we apply step-index hydrogel optical probes in the mouse ventral tegmental area, coupled with fiber photometry recordings and social behavioral assays. Additionally, we fabricate carbon nanotubes-PVA hydrogel microelectrodes by incorporating conductive nanomaterials in hydrogel for spontaneous neural activities recording. We enable simultaneous optogenetic stimulation and electrophysiological recordings of light-triggered neural activities in Channelrhodopsin-2 transgenic mice.

Abstract Background We previously reported our phase Ib trial, testing the safety, tolerability, and efficacy of T-DM1 + neratinib in HER2-positive metastatic breast cancer patients. Patients with ERBB2 amplification in ctDNA had deeper and more durable responses. This study extends these observations with in-depth analysis of molecular markers and mechanisms of resistance in additional patients. Methods Forty-nine HER2-positive patients (determined locally) who progressed on-treatment with trastuzumab + pertuzumab were enrolled in this phase Ib/II study. Mutations and HER2 amplifications were assessed in ctDNA before (C1D1) and on-treatment (C2D1) with the Guardant360 assay. Archived tissue (TP0) and study entry biopsies (TP1) were assayed for whole transcriptome, HER2 copy number, and mutations, with Ampli-Seq, and centrally for HER2 with CLIA assays. Patient responses were assessed with RECIST v1.1, and Molecular Response with the Guardant360 Response algorithm. Results The ORR in phase II was 7/22 (32%), which included all patients who had at least one dose of study therapy. In phase I, the ORR was 12/19 (63%), which included only patients who were considered evaluable, having received their first scan at 6 weeks. Central confirmation of HER2-positivity was found in 83% (30/36) of the TP0 samples. HER2-amplified ctDNA was found at C1D1 in 48% (20/42) of samples. Patients with ctHER2-amp versus non-amplified HER2 ctDNA determined in C1D1 ctDNA had a longer median progression-free survival (PFS): 480 days versus 60 days (P = 0.015). Molecular Response scores were significantly associated with both PFS (HR 0.28, 95% CI 0.09–0.90, P = 0.033) and best response (P = 0.037). All five of the patients with ctHER2-amp at C1D1 who had undetectable ctDNA after study therapy had an objective response. Patients whose ctHER2-amp decreased on-treatment had better outcomes than patients whose ctHER2-amp remained unchanged. HER2 RNA levels show a correlation to HER2 CLIA IHC status and were significantly higher in patients with clinically documented responses compared to patients with progressive disease (P = 0.03). Conclusions The following biomarkers were associated with better outcomes for patients treated with T-DM1 + neratinib: (1) ctHER2-amp (C1D1) or in TP1; (2) Molecular Response scores; (3) loss of detectable ctDNA; (4) RNA levels of HER2; and (5) on-treatment loss of detectable ctHER2-amp. HER2 transcriptional and IHC/FISH status identify HER2-low cases (IHC 1+ or IHC 2+ and FISH negative) in these heavily anti-HER2 treated patients. Due to the small number of patients and samples in this study, the associations we have shown are for hypothesis generation only and remain to be validated in future studies. Clinical Trials registration NCT02236000

Abstract Background It is known that COVID-19 disproportionally adversely affects the immunocompromised, including kidney transplant recipients (KTR), as compared to the general population. Risk factors for adverse outcomes and vaccine seroconversion patterns are not fully understood. Australia was uniquely positioned to reduce initial case numbers during the 2021–2022 pandemic period due to its relative isolation and several significant public health interventions. South-Western Sydney Local Heath District was one of the predominant regions affected. Methods A single centre, prospective cohort study of prevalent renal transplant recipients was conducted between 25th July 2021 and 1st May 2022. Baseline characteristics, COVID-19 vaccination status, COVID-19 diagnosis and outcomes were determined from the electronic medical record, Australian vaccination register and Australian and New Zealand Dialysis and Transplant Registry. Assessment of vaccine-induced seroconversion was assessed with ELISA in a subpopulation. Analysis was performed using SPSS v.28. Results We identified 444 prevalent transplant recipients (60% male, 50% diabetic, median age 58 years (Interquartile range (IQR)21.0) and eGFR 56 ml/min/1.73m2 (IQR 21.9). COVID-19 was identified in 32% (n = 142) of patients, of which 38% (n = 54) required hospitalisation and 7% (n = 10) died. At least one COVID-19 vaccination was received by 95% (n = 423) with 17 (4%) patients remaining unvaccinated throughout the study period. Seroconversion after 2 and 3 doses of vaccine was 22% and 48% respectively. Increased COVID-19 related deaths were associated with older age (aOR 1.1, 95% CI 1.004–1.192, p = 0.040), smoking exposure (aOR 8.2, 05% CI 1.020-65.649, p = 0.048) and respiratory disease (aOR 14.2, 95%CI:1.825–110.930, p = 0.011) on multi-variable regression analysis. Receipt of three doses of vaccination was protective against acquiring COVID-19 (aOR 0.48, 95% CI 0.287–0.796, p = 0.005) and death (aOR 0.6, 95% CI: 0.007–0.523, p = 0.011), but not against hospitalisation (p = 0.32). Seroconversion was protective for acquiring COVID-19 on multi-variable regression independent of vaccination dose (aOR 0.1, 95%CI: 0.0025–0.523, p = 0.011). Conclusions COVID-19 was associated with a high mortality rate. Older age, respiratory disease and prior smoking exposure may be risk factors for increased mortality. Vaccination of 3 doses is protective against acquiring COVID-19 and death, however not hospitalisation. Antibody response is protective for acquiring COVID-19, however seroconversion rates are low.

Cancers occur across species. Understanding what is consistent and varies across species can provide new insights into cancer initiation and evolution, with significant implications for animal welfare and wildlife conservation. We build a pan-species cancer digital pathology atlas (panspecies.ai) and conduct a pan-species study of computational comparative pathology using a supervised convolutional neural network algorithm trained on human samples. The artificial intelligence algorithm achieves high accuracy in measuring immune response through single-cell classification for two transmissible cancers (canine transmissible venereal tumour, 0.94; Tasmanian devil facial tumour disease, 0.88). In 18 other vertebrate species (mammalia = 11, reptilia = 4, aves = 2, and amphibia = 1), accuracy (range 0.57-0.94) is influenced by cell morphological similarity preserved across different taxonomic groups, tumour sites, and variations in the immune compartment. Furthermore, a spatial immune score based on artificial intelligence and spatial statistics is associated with prognosis in canine melanoma and prostate tumours. A metric, named morphospace overlap, is developed to guide veterinary pathologists towards rational deployment of this technology on new samples. This study provides the foundation and guidelines for transferring artificial intelligence technologies to veterinary pathology based on understanding of morphological conservation, which could vastly accelerate developments in veterinary medicine and comparative oncology.

Student-generated questions can be an effective study technique to improve active learning, metacognitive skills, and performance on examinations. Students have shown greater success when assessed using peer-made study questions than when studying without questions. In three semesters of a kinesiology research methods course students were taught how to write high-quality multiple-choice questions that addressed course objectives and Bloom’s Taxonomy. Students were given a graded assignment to write three multiple-choice questions using Makequiz, a Java and web-based tool for helping students generate multiple choice questions. Student- generated questions that were rated as good quality (n = 169-245) were provided to the students as a study resource prior to the final exam. Of those study questions, 40 were selected each semester to be on the final exam. Students performed significantly better on student-written questions than instructor-written questions on the final exam in Class A (p < .05) and in Class C (p < .05). A majority of students felt this assignment was a worthwhile component of the course, voting to keep Makequiz in the curriculum (Class A: 52.6%, Class B: 62.3%, Class C: 58.3%) or to modify Makequiz (Class A: 25.3%, Class B: 14.5%, Class C: 18.1%). Many of the students stated it was the most valuable assignment of the course (32% Class B and Class C). Makequiz is, therefore, a recommended study tool for students. Comparisons are also made with PeerWise, an online platform for creating and sharing MCQ and feedback. Further investigation is required to measure the impact Makequiz has on learning, metacognitive skills, and anxiety levels before test-taking.

Abstract Cells in obligately multicellular organisms by definition have aligned fitness interests, minimum conflict, and cannot reproduce independently. However, some cells eat other cells within the same body, sometimes called cell cannibalism. Such cell-in-cell events have not been thoroughly discussed in the framework of major transitions to multicellularity. We performed a systematic screening of 508 articles, from which we chose 115 relevant articles in a search for cell-in-cell events across the tree of life, the age of cell-in-cell-related genes, and whether cell-in-cell events are associated with normal multicellular development or cancer. Cell-in-cell events are found across the tree of life, from some unicellular to many multicellular organisms, including non-neoplastic and neoplastic tissue. Additionally, out of the 38 cell-in-cell-related genes found in the literature, 14 genes were over 2.2 billion years old, i.e., older than the common ancestor of some facultatively multicellular taxa. All of this suggests that cell-in-cell events may have originated before the origins of obligate multicellularity. Thus, our results show that cell-in-cell events exist in obligate multicellular organisms, but are not a defining feature of them. The idea of eradicating cell-in-cell events from obligate multicellular organisms as a way of treating cancer, without considering that cell-in-cell events are also part of normal development, should be abandoned.

Abstract Background Viruses within the γ-herpesviruses subfamily include the causative agents of Malignant Catarrhal Fever (MCF) in several species of the order Artiodactyla. MCF is a usually fatal lymphoproliferative disease affecting non-adapted host species. In adapted host species these viruses become latent and recrudesce and transmit during times of stress or immunosuppression. The undetected presence of MCF-causing viruses (MCFVs) is a risk to non-adapted hosts, especially within non-sympatric zoological collections. This study investigated the presence of MCFVs in six different zoological collections in the UK, to evaluate the presence of subclinical/latent MCFVs in carrier animals. Methods One-hundred and thirty eight samples belonging to 54 different species of Artiodactyla were tested by Consensus Pan-herpes PCR. The positive samples were sequenced and subjected to phylogenetic analyses to understand their own evolutionary relationships and those with their hosts. Results Twenty-five samples from 18 different species tested positive. All viruses but one clustered in the γ-herpesvirus family and within the Macavirus as well as the non-Macavirus groups (caprinae and alcelaphinae/hippotraginae clusters, respectively). A strong association between virus and host species was evident in the Macavirus group and clustering within the caprinae group indicated potential pathogenicity. Conclusion This study shows the presence of pathogenic and non-pathogenic MCFVs, as well as other γ-herpesviruses, in Artiodactyla species of conservation importance and allowed the identification of new herpesviruses in some non-adapted species.

Rerouting of the parotid ducts posteriorly to drain into the tonsillar fossae (Wilkie procedure) was initially designed to address drooling in patients with cerebral palsy. This procedure was subsequently modified to include bilateral submandibular gland excision and extended to apply to other etiologies of sialorrhea. Our literature review failed to identify report of long-term follow-up beyond 2 decades following this procedure. We describe a 33-year-old female with spastic cerebral palsy who underwent the Wilkie procedure to treat sialorrhea and, 25 years later, developed right-sided facial swelling and dental infections in association with xerostomia. CT imaging showed symmetric atrophy of the parotid glands with fat replacement interspersed with fibrosis. Ultrasound analysis with shear wave elastography offered the additional interpretation of a greater degree of gland stiffness involving the tail of the recently inflamed right parotid gland compared to the left. This case report identifies long-term complications associated with xerostomia following initial success employing the Wilkie procedure to address sialorrhea. The radiographic evaluation supports the contention that rerouting of Stensen's duct may be associated with chronic obstructive changes to the parotid gland. Ultrasound shear wave elastography supplemented CT imaging by identifying asymmetric stiffness of the parotid glands as was consistent with the more recent right parotid inflammation.

International mobility is an integral part of higher education strategy in Europe. This action has triggered the development of the Erasmus program, the most popular scheme for student credit mobility at the European level. Although the program has generally been a success, it also endures several weaknesses, among them, the financial and social selectivity that prevents many students from participating. International credit virtual mobility (ICVM) is an alternative that facilitates mobility to a broader range of students. However, there is a lack of research that analyses students' perspectives and attitudes to ICVM programs. This study aims to explore the students' profiles, needs and expectations related to these mobility programs. The empirical analysis relies on a sample of over 1000 Spanish students involved in international physical and virtual credit mobility programs from 2018 to 2021.

While the idea of a gender-sensitive parliament is over 20 years old (Childs & Palmieri, 2023), institutional reforms in the name of gender equality have been slow to materialise around the world. Where change has occurred, it appears to have been catalysed by a limited range of—sometimes confluent—factors including the public airing of allegations of sexual misconduct in the #MeToo era, the increasing salience of gender-sensitive parliament international norms, and the role of feminists in the academy. Celis and Childs (2020) identify feminist academic critical actors as those who rather than simply researching parliamentary change, explicitly undertake institutional (re)design and (re)building work (see also Childs, 2024). In this article, we uncover the work undertaken by feminists in an Australian academic institution to support the 2021 independent inquiry of the Australian Human Rights Commission into Commonwealth parliamentary workplaces. This work—undertaken by the authors as both insiders and outsiders—informed the analysis and recommendations in the Australian Human Rights Commission’s report, and since its launch, has also kept pressure on the various bodies entrusted with implementing gender-sensitive changes. We argue that feminists in the academy are uniquely positioned to navigate insider and outsider roles in support of gender-sensitive parliamentary reform.

Organizations increasingly recognize the importance of work engagement and career commitment. Yet, how these factors operate within teams remains unexplored in the current literature. This study aims to uncover how conflict and innovation influence engagement and career commitment in teams. We conducted a two-wave survey involving 196 managers and 873 subordinates from Sri Lankan manufacturing firms. As expected, higher work engagement is linked to greater career commitment and role innovation. Interestingly, role innovation was more pronounced during elevated task conflict. While task conflict enhanced the connection between work engagement and role innovation, it also positively impacted career commitment. Thus, the findings confirm role innovation's mediating role between employee engagement and career commitment and reveal task and relationship conflict as moderators in this relationship. This research expands on the Broaden and Build theory by emphasizing the greater importance of task conflict intensity in teams than previously recognized. Additionally, the study highlights that low conflict levels detrimentally affect teams, offering fresh insights for managerial considerations. By enhancing our understanding of team dynamics, this study contributes to improved organizational efficiency and positive outcomes.

Abstract Objectives To assess the adequacy of gadolinium in sialography as an alternative contrast agent for patients with iodine allergies. To directly compare images taken with gadolinium versus iodine‐based contrast agents using the Iowa Sialography Classification System. Methods Retrospective chart review was performed on patients undergoing sialography between February 2008 and July 2022. Patients with sialograms obtained with gadolinium were identified and matched to similar sialograms obtained with iodine‐based contrast agent. Patients were matched based on duct location, duct side, and initial radiology findings. Blinded reevaluation of sialograms was performed first independently and then by consensus by two head and neck radiologists to evaluate overall image adequacy and grade using the Iowa Sialography Classification System. Results Four patients with six sialograms (one bilateral parotid and one parotid + submandibular) obtained with gadolinium were identified and reevaluated. Five patients with six sialograms (one bilateral parotid) obtained with iodine‐based were matched to the gadolinium sialograms. The overall adequacy of images for gadolinium sialograms was graded at an average of 4.25 (4 = good and 5 = excellent); whereas, the overall adequacy of iodine‐based sialograms was graded at an average of 5. Inter‐observer variability was observed in three sialograms obtained with gadolinium (50%), while no interobserver variability was observed in sialograms obtained with iodine‐based contrast agent. Conclusion Gadolinium is an adequate alternative to use in sialography for patients with iodine allergies undergoing contemporary digital infusion sialography. Adverse reactions to iodine contrast agents are rare in sialography; however, the precautionary use of gadolinium is acceptable for the diagnostic and therapeutic benefits in sialography. Level of Evidence: IV

The multifaceted long-term impairments resulting from critical illness and COVID-19 require interdisciplinary management approaches in the recovery phase of illness. Operational insights into the structure and process of recovery clinics (RCs) from heterogeneous health systems are needed. This study describes the structure and process characteristics of existing and newly implemented ICU-RCs and COVID-RCs in a subset of large health systems in the United States.DesignCross-sectional survey.SettingThirty-nine RCs, representing a combined 156 hospitals within 29 health systems participated.PatientsNone.InterventionsNone.Measurement and main resultsRC demographics, referral criteria, and operating characteristics were collected, including measures used to assess physical, psychologic, and cognitive recoveries. Thirty-nine RC surveys were completed (94% response rate). ICU-RC teams included physicians, pharmacists, social workers, physical therapists, and advanced practice providers. Funding sources for ICU-RCs included clinical billing (n = 20, 77%), volunteer staff support (n = 15, 58%), institutional staff/space support (n = 13, 46%), and grant or foundation funding (n = 3, 12%). Forty-six percent of RCs report patient visit durations of 1 hour or longer. ICU-RC teams reported use of validated scales to assess psychologic recovery (93%), physical recovery (89%), and cognitive recovery (86%) more often in standard visits compared with COVID-RC teams (psychologic, 54%; physical, 69%; and cognitive, 46%).ConclusionsOperating structures of RCs vary, though almost all describe modest capacity and reliance on volunteerism and discretionary institutional support. ICU- and COVID-RCs in the United States employ varied funding sources and endorse different assessment measures during visits to guide care coordination. Common features include integration of ICU clinicians, interdisciplinary approach, and focus on severe critical illness. The heterogeneity in RC structures and processes contributes to future research on the optimal structure and process to achieve the best postintensive care syndrome and postacute sequelae of COVID outcomes.