Global Virtual Team Working during the Covid-19 Pandemic

RESEARCH HIGHLIGHTS: center dot A qualitative study of Global Virtual Teams (GVTs) and their challenges during the Covid-19 Pandemic. center dot GVT members became proactive in dealing with the challenges of 100% remote working. center dot GVTs adapt their methods of working and the tools available to them. center dot Communication failures, building trust and relationships, and resolving conflict are significant challenges. center dot Lack of informal communication opportunities adversely affects relationships in GVTs. center dot Further investigation of gender differences in attitudes and practices are prompted;and the associations between trust and conflict resolution in virtual relationships. Virtual work introduces distinct challenges when compared to face-to-face or on-site work. Communication and collaboration are key factors in team development and in team performance. When teamwork is of a global nature, imposed because of a pandemic, then additional variables are introduced into the equation. The challenges that global virtual teams (GVTs) encounter when communicating and developing in the context of the Covid-19 pandemic impacts how work is structured and teams develop. This qualitative study was conducted just over 1 year after the start of the Covid-19 pandemic when working from home became mandatory and particular challenges for GVTs became apparent. Data are gathered through an online anonymous survey and followed by semi-structured video-mediated interviews with staff in a large multinational software development company. Findings show that GVTs encounter a number of distinct challenges than face-to-face teams. However, individuals are actively adapting to the situation in which they find themselves and are learning to deal with the challenges by being proactive. Even though the tools used previously may not be entirely suitable for virtual work, GVTs learn to change how tools are used to be more productive and collaborative. Challenges continue to exist in areas, such as knowledge gathering and knowledge sharing. Communication failures can lead to delays and confusion. The findings also indicate that even though GVTs are not communicating as much informally or socially with their colleagues because of remote working in the pandemic, being remote is not having a negative effect on the ability to get work done. Some aspects of team development can be negatively affected when working in GVTs. Impacts are identified relating to trust and relationship building, as well as being able to identify and resolve conflict. These results prompt further research opportunities as organizations and individuals continue to adapt and embrace global virtual teamwork.

Arsenic in medicine: past, present and future.

Arsenicals are one of the oldest treatments for a variety of human disorders. Although infamous for its toxicity, arsenic is paradoxically a therapeutic agent that has been used since ancient times for the treatment of multiple diseases. The use of most arsenic-based drugs was abandoned with the discovery of antibiotics in the 1940s, but a few remained in use such as those for the treatment of trypanosomiasis. In the 1970s, arsenic trioxide, the active ingredient in a traditional Chinese medicine, was shown to produce dramatic remission of acute promyelocytic leukemia similar to the effect of all-trans retinoic acid. Since then, there has been a renewed interest in the clinical use of arsenicals. Here the ancient and modern medicinal uses of inorganic and organic arsenicals are reviewed. Included are antimicrobial, antiviral, antiparasitic and anticancer applications. In the face of increasing antibiotic resistance and the emergence of deadly pathogens such as the severe acute respiratory syndrome coronavirus 2, we propose revisiting arsenicals with proven efficacy to combat emerging pathogens. Current advances in science and technology can be employed to design newer arsenical drugs with high therapeutic index. These novel arsenicals can be used in combination with existing drugs or serve as valuable alternatives in the fight against cancer and emerging pathogens. The discovery of the pentavalent arsenic-containing antibiotic arsinothricin, which is effective against multidrug-resistant pathogens, illustrates the future potential of this new class of organoarsenical antibiotics.

Immunological response to airway Aspergillus in CF is reduced following treatment with the CFTR modulator elexacafor-tezacaftor-ivacaftor

ObjectivesAspergillus fumigatus is the most frequently cultured fungal pathogen in sputum from cystic fibrosis (CF) patients. Elexacaftor-tezacaftor-ivacaftor (ETI) is a CFTR modulator which results in significant improvements in lung function. We aimed to investigate the effect of ETI therapy on the serological response to Aspergillus in adult CF patients prescribed ETI.MethodsData from 275 patients with at least one Phe508del mutation were included. Aspergillus IgG, Aspergillus IgE, total IgE and blood eosinophil count were collected annually 3 years prior to ETI initiation, at baseline (initiation of therapy) and at 3-monthly intervals for the first 12 months of ETI treatment. FEV1 was compared at baseline and at 3 months as a marker of treatment response.ResultsThere was a significant relative increase in median FEV1 values of 22% at 3 months following ETI initiation (p<0.0001). In the year prior to ETI initiation, there was a significant decrease in total IgE (from 59.3 to 57.5, median change -1.8, p=0.007) and Asp-IgE (from 0.39 to 0.30, median change -0.09, p<0.0001) but not Asp-IgG. In the first 3 months following ETI, there was a significant reduction in all markers (median total IgE 53.6 to 32.9 p<0.001, median Asp-IgE 0.27 to 0.17, p<0.001 and Asp-IgG from 60.0 to 50.5, p<0.001). Asp-IgG continued to decline over the 12 month period post ETI. Asp-IgE however did not change from 3 to 6 months and appeared to increase between 3 and 9 months post ETI. Similarly, total IgE displayed an acute drop but appeared to plateau thereafter. Using suggested clinical ULN for CF, the proportion of patients with significant rises in Asp-IgE declined by 19.1% and Asp-IgG declined by 45%.ConclusionsETI therapy resulted in an acute, clinically relevant increase in lung function. In the same time frame, we noted an acute reduction in markers of immunological response to Aspergillus fumigatus. This may be due to reduced airway fungal burden, direct effects on immunological response or potentially reduced pathogen exposure as many patients were shielding during the COVID pandemic. Further longitudinal data is required to establish if these changes will be maintained.

Increasing Ventilation In 1980s High-Rise Commercial Office Buildings

The COVID-19 pandemic has driven public interest in building ventilation rates. The ASHRAE Epidemic Task Force's recommendation that buildings "provide and maintain at least the minimum outdoor airflow rates for ventilation as specified by applicable codes and standards" put quantitative ventilation system assessments in high demand. Throughout the pandemic, many building owners conducted assessments of building systems, including ventilation, to reduce risk of COVID-19 transmission. A recent study of assessments at 95 commercial office buildings found that 77% provided minimum ventilation rates or could make minor adjustments to do so. However, 23% of buildings were underventilated and would require significant capital investment to meet current standards. All but one of these buildings were designed between 1981 and 1992, with ventilation rates as low as 9 cfm/person (4 L/s person) (assuming default occupant density).

Evolution of dry powder inhaled colistimethate sodium (Colobreathe®) in a large adult cystic fibrosis centre

Objectives: Colobreathe® is a dry powder formulation of colistimethate sodium developed to reduce treatment burden for people with cystic fibrosis. In our centre initial experience revealed 45% discontinued this therapy within 12 months, of which 83% were due to tolerance or device issues. Capsuleswere reformulated in 2017 to address some of these issues. We aimed to assess the prescription rates of Colobreathe® over 3 time periods to assess whether prescription practices and tolerance changed. Methods: A retrospective review of antibiotic challenges in the one-year periods from Dec 2013, 2016 and 2020 was conducted. Key end points included tolerance of test dose and continued use at 1 and 3 months. The proportion of antibiotic challenges that were Colobreathe® at each time point was compared. Results: Therewas a significant difference in the proportion of all antibiotic challenges whichwere for Colobreathe® across the 3 periods (2013–65/186 (35%), 2016–8/136 (6%), 2020–22/55 (40%), p < 0.001). The majority of patients at all 3 time points had previously nebulised colistimethate sodium (98%, 88% and 100%, respectively). All patients had a successful test dose during each time period. Therewas no difference in the proportion of patients who commenced long-term prescription following a 1-month review at the 3 time periods (75%, 75% and 73% respectively, p = 0.97). Of those who received a long-term prescription, continuation rates were similar at 3 months (82%, 100% and 93%, respectively). Conclusions: There was a marked reduction in inhaled antibiotic challenges in 2020, likely due to COVID. There was a significant change in prescription of Colobreathe® over the 3 time frames. Colobreathe®waswell tolerated at initial challenge and continuation rates after a month appear to be consistent. A number of factors likely influenced prescription practices, including early experience and potentially changing airway physiology following CFTR modulation introduction.

Microbiological surveillance in cystic fibrosis – an emerging multifactorial challenge

Objectives: Accurate identification of airway pathogens with appropriate eradication and suppressive therapies is associated with improved health outcomes in cystic fibrosis (CF). From 2020, 2 key factors may have influenced the ability to carry out this monitoring effectively;1. the COVID- 19 pandemic accelerated a transition to ‘virtual’ clinic visits and 2. the introduction of ELX/TEZ/IVA. Methods:We retrospectively analysed out-patient clinic attendance in the month of November for the years 2017–2021 and microbiological samples received from adults with CF in the regional microbiology department. Results: The total number of microbiological samples reduced in 2020 and 2021 (Table 1). In 2017, 211 samples were generated from 261 clinic visits (80.8%). For subsequent years this was 80.0%, 71.0%, 51.2% and 72.2%, respectively. The proportion of cough swabs significantly increased in 2021, (p < 0.001). In 20216 postal sampleswere provided, indicating that yield of a sample from a virtual appointment was at most 8.3%. Table 1. Overview of microbiological samples and clinic visits November 2017–2021 (Table Presented)Conclusions: There has been a marked reduction in microbiological samples in the years 2020 and 2021 despite relative preservation of total clinic appointments. This appears to be partly due to an increase in virtual clinic attendance without adequate remote sampling. The disproportionate increase in cough swabs in 2021 can be attributed to ELX/TEZ/IVA availability resulting in decreased sputum burden. This work identifies challenges in monitoring patients established on highly effective modulator therapy in new clinic models

From Guidance to Implementation: Applying ASHRAE Epidemic Task Force Building Readiness Strategies in 95 Commercial Office Buildings

During the COVID-19 pandemic, building owners and operators sought to protect their occupants by following ASHRAE and CDC guidance for HVAC and water system risk mitigation. This paper presents the results of building readiness assessments conducted for 95 commercial office buildings across the United States. In these assessments, the authors evaluated buildings for initial alignment with ASHRAE Epidemic Task Force (ETF) guidance and recommended action where additional risk mitigation measures were warranted. The engineering assessments focused on outdoor air ventilation rates, filtration efficiency levels, flushing spaces during unoccupied periods, and Eegonella water management practices. Primary challenges to implementing ETF guidance included resistance to operational changes with potential adverse energy impacts, concerns regarding existing system limitations, and in a limited number of cases, ventilation system design constraints. The assessments showed that most of the office buildings could modify their HVAC and water system operatingpractices to minimize the spread of harmful pathogens without major upgrades to equipment or significant increases in energy use. Almost all subject buildings had the capacity to meet or exceed minimum ventilation rates, upgrade to at least MERV-13 filters, implement appropriate flushing periods to achieve target clean air changes, and manage their water systems to minimize Legionella risk.

PULMONARY CMV REACTIVATION FOLLOWING SARS-CoV-2: IMPLICATIONS for IMMUNOPATHOLOGY

Background: SARS-CoV-2 infection results in a spectrum of disease severity attributable to the magnitude of the underlying inflammatory response. Aged individuals with co-morbidities are most vulnerable and severely affected, but the mechanisms driving aberrant immune responses fueling SARS-CoV-2 immunopathology in this high-risk population are not fully elucidated. We hypothesized that asymptomatic CMV infection might exacerbate SARS-CoV-2 pathogenesis since its replication is both a cause and consequence of inflammation and appears to worsen oxygenation in critically ill patients (Limaye, JAMA, 2017). CMV-seropositivity was associated with increased hospitalization among people with SARS-CoV-2 infection (Shrock, Science, 2020). To begin to address this hypothesis, we utilized the rhesus macaque model of natural rhesus (Rh)CMV infection to investigate the extent to which SARS-CoV-2 induces CMV reactivation in the anatomic sites of SARS-CoV-2 pathology. Methods: To assess CMV reactivation, eight aged, type 2 diabetic RhCMV-seropositive rhesus macaques (sera anti-CMV IgG: 300-1400 ng/ml) were infected with high-dose SARS-CoV-2 (2.5x10 6 PFU) and monitored for 7 days prior to euthanasia. Samples from the respiratory tract, intestinal tract, and blood were collected to assess viral and inflammatory dynamics in distinct tissue compartments. Results: Following infection, SARS-CoV-2 replication was observed throughout the respiratory tract, which was associated with local and systemic inflammation and immune activation. Lung histopathological assessments revealed development of interstitial pneumonia with colocalization of SARS nucleocapsid protein within pneumocytes. qPCR assays targeting RhCMV gB showed CMV DNA within the caudal lung lobe (up to 103 CMV DNA copies/mg of tissue) in all animals at day 7, and the animal with the highest CMV DNA presented with the most profound clinical symptoms. Strikingly, CMV DNA copies strongly correlated with CD4 and CD8 T cell activation indices in blood and spleen (r = 0.96, p< 0.001). Additionally, we found RhCMV reactivation in the ileum, where high levels of ACE2 are reported. Conclusion: SARS-CoV-2 infection of RhCMV-seropositive macaques results in CMV reactivation in the anatomic sites where SARS-CoV-2 causes pathology. Future experimental studies should address whether CMV reactivation exacerbates SARS-CoV-2 pathogenesis.

Patterns in Attending and Resident Remote Work Policies in Academic Radiation Oncology Departments

Purpose/Objective(s): Historically, work from home (WFH) policies were not common in radiation oncology (RO). With the onset of the COVID-19 pandemic and without oversight from professional organizations, many departments individually generated WFH policies. This study reports WFH policies and perceived impact on workflow and work-life balance within United States (US) academic RO departments for both residents and faculty. Materials/Methods: An IRB-approved questionnaire was developed and sent to one resident and one faculty member at each of the 92 US academic RO departments. Purposive sampling for residents and faculty was utilized. For residents, this consisted of the most senior resident and for faculty, a senior faculty member or the program director. If no reply was obtained after 3 weeks, an alternate member was selected. The survey remained open for 75 days. Categorical and continuous variables, along with free-responses were aggregated and reported. Results: 135 responses (residents n = 65, faculty n = 70) were received, representing 70.7% and 77.2% of the 92 programs respectively. A new WFH policy was reported by 83% faculty (58/70) and 92% residents (60/65), predominantly initiated within 2 months of the pandemic (60% faculty and 79% residents respectively). The initial WFH policy allowed moderate WFH for 40% faculty and 46% residents, while minimal WFH was offered for 30% faculty and 32% residents. Full WFH was reported by 14% of respondents in both categories. Policies have since contracted for 39% faculty and 62% of residents, being revoked for 11% of faculty and 22% of residents. 15/70 (21.4%) faculty and 12/65 (18.5%) residents report dissatisfaction with their current WFH policy. 18/70 (25.7%) faculty and 14/65 (21.5%) residents perceived negative sentiments from others regarding utilization of WFH. On a 4-point scale, residents and faculty reported personal/family life, research, and day-to-day productivity were positively impacted by WFH policy, while patient care was perceived as negatively impacted. No difference was reported for leadership or education. Conclusion: A variety of WFH policies have been adopted in RO. Understanding perceptions of the impact of different approaches can help to inform future policy and practice.

Has the COVID-19 pandemic affected medication adherence to inhaled nebulised therapy for patients at a large adult cystic fibrosis centre?

Objectives: The COVID-19 pandemic has led to immense challenges for healthcare systems worldwide. People with cystic fibrosis (CF) were included in the clinically extremely vulnerable group for complications of coronavirus by the UK government and advised to shield during a national lockdown. Data suggests that pandemic-related restrictions have been linked to a reduction in pulmonary exacerbation events (PEx). We sought to explore whether an increase in medicine possession ratio and potentially adherence may be a factor in this finding. Methods: 50 patients who received medication through a homecare delivery system at a single large adult centre were randomly selected. Data from 12 months ‘pre-lockdown’ was compared to data for 9 months following start of shielding in March 2020. MPR was calculated and capped at 100%. Medications that were started or stopped during the pandemic were not included. Wilcoxon signed rank test was used to compare pre- and post-values. Results: 91 prescription medications were valid for analysis (45 nebulised antibiotics, 34 mucolytics and 12 CFTR modulators). MPR increased for 41 prescriptions (45.1%), decreased for 21 medications (23.1%) and remained unchanged for 29 medications (31.9%). Median MPR increased from 83% [57–100%] to 89% [66–100%], p = 0.037. MPR for nebulised antibiotics significantly increased (median 75% [54–100%] vs 89% [61–100%], p = 0.027). Median MPR for CFTR modulators was 100% throughout and did not change for mucolytics (75% [42–100%] vs 78% [53–100%], p = 0.419). Conclusion: We report a significant change in medication possession in adults with CF during the coronavirus pandemic in the UK. It is unclear whether this change translated to an increase in adherence but may be one factor in the reported decrease in PEx events described during this time. It is notable that increases were largely driven by inhaled antibiotics and this may represent a concerted effort to achieve maximal protection from infection.

Does health literacy impact technological comfort in cancer patients?

INTRODUCTION: As healthcare systems are adapting due to COVID-19, there has been an increased need for telehealth in the outpatient setting. Not all patients have been comfortable with this transition. We sought to determine the relationship between health literacy and technological comfort in our cancer patients. METHODS: We conducted a survey of patients that presented to the oncology clinics at a single-center over a 2-month period. Patients were given a voluntary, anonymous, survey during their visit containing questions regarding demographics, health literacy and technological comfort. RESULTS: 344 surveys were returned (response-rate 64.3%). The median patient age was 61 years, 70% of responders were female and the most common race was White (67.3%). Increasing patient age, male gender, Black and Native-American race, decreased health literacy and lack of home broadband were associated with lower technological comfort score. CONCLUSION: In our cohort, patients with lower health literacy scores, older and male patients, or who have poor internet access showed a lower level of technological comfort. At risk patients can be identified and provided additional support in their use of telehealth services.

Performance and Deployment Status of MUSCAT: a 1500-Pixel LEKID-Based mm-Wave Camera for the Large Millimeter Telescope

The Mexico-UK Sub-Millimetre Camera for AsTronomy (MUSCAT) is a 1.1-mm band receiver consisting of 1,500 single-colour lumped-element kinetic inductance detectors and is scheduled for deployment to the Large Millimeter Telescope (LMT) after the ongoing COVID-19 pandemic. MUSCAT is designed to utilise the full field of view of the LMT's upgraded 50-m primary mirror (approximately 4'). Here we will present the as-measured performance of MUSCAT from the final lab-verification testing prior to shipping to the LMT. We will also explain the overall design of MUSCAT including the novel technologies utilised-such as continuous cooling using sorption coolers and a miniature dilutor, and horn-coupled LEKIDs-for which MUSCAT will provide a first on-sky demonstration.

Covid-19 crisis promotes innovation: The extended indications for pedicled perforator flaps in breast cancer surgery

Background: During the height of the Covid-19 pandemic in the United Kingdom (March-May 2020) the use of implants and DIEP flaps was prohibited to avoid extended patient in-hospital stay and exposure to risk. Due to a requirement to innovate, we increased our use of local pedicled perforator flaps (PPF) to optimise wide excision allowing for clear margins and replacing tissue to maintain cosmesis and also to provide whole breast reconstruction whilst minimising length of hospital stay (LOS) and risk of complications requiring readmission. We report the early outcomes from these cases. Materials and Methods: We audited a prospective database of patients who had a single-stage local pedicled perforator flap (PPF) as part of their breast cancer surgery at The Royal Marsden Breast Unit during the peak incidence period for London of the Covid-19 pandemic. Results: Seventeen female patients (median age (IQR) = 56years (53-63), BMI 26.3 kg/m2 (23.5-28.6) and 3 were current smokers) had a PPF for the following indications: resurfacing for locally-advanced breast cancer (LABC) without muscle, (n=2), small local recurrence after previous BCS and radiotherapy (n=2), whole breast autologous reconstruction (n=3) and volume replacement as part of BCS (n=10). Median resection specimen weight was 167g (IQR 51-208). LOS for 16 of the 17 was less than 36 hours and only 1 patient had unplanned return to surgery for ischaemia of a small area of the distal flap (debridement and closure, day surgery) 8 days after initial surgery. The median tumour extent was 57mm (IQR 41-71mm) and no BCS patients had involved margins and all patients made uneventful recovery. Median follow-up is 12.7 weeks (minimum 30 days) and 12 patients have undergone adjuvant radiotherapy with 6 having adjuvant chemotherapy. Longer-term follow-up will be undertaken for oncological and patient-reported outcomes. (914) Ten out of 17 had pre-operative Covid-19 swab tests which were all negative and no patient had acquired Covid-19 at 28 days post-surgical follow-up. Conclusions: Short-term follow-up demonstrated feasibility and safety of extending the indications for single-stage PPF surgery in selected breast cancer patients including whole breast autologous reconstruction and resurfacing for LABC whilst safely minimising LOS. Times of heightened risk such as the Covid-19 pandemic can provide opportunities for innovation for patient benefit.