Incentivising public transport use for physical activity gain: process evaluation of the COVID-19 disrupted trips4health randomised controlled trial.

BACKGROUND: Partnering with a public transport (PT) provider, state government, and local government, the single-blinded randomised controlled trial, trips4health, investigated the impact of PT use incentives on transport-related physical activity (PA) in Tasmania, Australia. The intervention involved 16-weeks of incentives (bus trip credits) for achieving weekly PT use targets, supported by weekly text messages. This study objective was to conduct a process evaluation of the COVID-19 disrupted trips4health study. METHODS: The Medical Research Council UK's framework for complex public health interventions guided the process evaluation. Participant reach, acceptability, fidelity and feasibility were evaluated. Administrative and post-intervention survey data were analysed descriptively. Semi-structured interviews with intervention participants (n = 7) and PT provider staff (n = 4) were analysed thematically. RESULTS: Due to COVID-19, trips4health was placed on hold (March 2020) then stopped (May 2020) as social restrictions impacted PT use. At study cessation, 116 participants (approximately one third of target sample) had completed baseline measures, 110 were randomised, and 64 (n = 29 in the intervention group; n = 35 in the control group) completed post-intervention measures. Participants were 18 - 80 years (average 44.5 years) with females (69%) and those with tertiary education (55%) over-represented. The intervention was delivered with high fidelity with 96% of bus trip credits and 99% of behavioural text messages sent as intended. Interviewed PT staff said implementation was highly feasible. Intervention participant acceptability was high with 90% reporting bus trip incentives were helpful and 59% reporting the incentives motivated them to use PT more. From a total of 666 possible bus trip targets, 56% were met with 38% of intervention participants agreeing and 41% disagreeing that 'Meeting the bus trip targets was easy'. Interviews and open-ended survey responses from intervention participants revealed incentives motivated bus use but social (e.g., household member commitments) and systemic (e.g., bus availability) factors made meeting bus trip targets challenging. CONCLUSIONS: trips4health demonstrated good acceptability and strong fidelity and feasibility. Future intervention studies incentivising PT use will need to ensure a broader demographic is reached and include more supports to meet PT targets. TRIAL REGISTRATION: ACTRN12619001136190 .

Redesigning our follow up pathway for post critical care discharges

Introduction: During theCOVID-19 pandemic we were faced with a large number of critical care discharges recovering from prolonged intensive care admission and severe lung injury at our 500 bed hospital in the South East of England. These patients often had complex rehabilitation needs and rehabilitation of these patients had been challenged by social distancing and the reconfiguration of many outpatient departments. Prior to the covid pandemic our rehabilitation pathway consisted of a nurse led follow up that focussed on psychological recovery and, following initial assessment, physiotherapy that included musculoskeletal therapy, 1:1 or small group exercises and respiratory physiotherapy. We developed a new pathway during the COVID-19 pandemic that united these above services into a one-stop multidisciplinary service that included clinician follow up and utilised smart watch technology from Fitbit watches to aid recovery of our ICU discharges. Method: Prior to discharge patients had a comprehensive set of assessments to identify physical and psychological needs. This included an incremental shuttlewalk test, oneminute sit-to-stand test, patient health questionnaire-9 (PHQ-9), generalized anxiety depression questionnaire -7 and Chelsea critical care physical assessment (CPAX). Patients were offered an exercise programme, depending on level of function, and referred to appropriate community services as required. Patients received Fitbit charge 3watches and were asked towear these as often as they felt able. At three months following discharge patients attended a multidisciplinary clinic consisting of an intensive care clinician, physiotherapist, and nursing staff. Outcome measures were re-assessed, and the patient had access to ongoing physio, nursing and medical input to support their recovery. Fitbit data was reviewed and incorporated into future goal setting. In addition, patients were invited to a relative and patient support group as an opportunity to meet other critical care survivors and for their relatives to share their experiences of recovery. They were also offered the chance to visit the ICU to aid physiological recovery. Results: The one-stop nature of the clinic allowed a resource efficient means for multi disciplinary care to be delivered to patients. The majority of patients found the support group extremely beneficial. Patients reported they found it helpful being able to share experiences, listen to others and see people at different stages in their recovery. Relatives also found the experience useful to deal with the traumatic experience of a critically ill loved one. Smart watches were well received by patients and over 80% of patients felt the watch aided their recovery. The watches also added a unique dimension to the MDT meeting, able to pick up changes in daily activity levels, rapidly alerting the clinician to a potential problem in that patient. Conclusion: The service is continually evolving. Future plans aim;to use smart watches for all ICU discharges with an integrated app to promote recovery and allow remote feedback, to use a Post-ICU Presentation Screen (PICUPS) and rehabilitation prescription to inform rehabilitation needs and to include a psychologist into the clinic to improve patient recovery after ICU admission.

A follow-up on quantitative and qualitative olfactory dysfunction and other symptoms in patients recovering from COVID-19 smell loss.

BACKGROUND: Sudden smell loss is a specific early symptom of COVID-19, which, prior to the emergence of Omicron, had estimated prevalence of ~40% to 75%. Chemosensory impairments affect physical and mental health, and dietary behavior. Thus, it is critical to understand the rate and time course of smell recovery. The aim of this cohort study was to characterize smell function and recovery up to 11 months post COVID-19 infection. METHODS: This longitudinal survey of individuals suffering COVID-19-related smell loss assessed disease symptoms and gustatory and olfactory function. Participants (n=12,313) who completed an initial survey (S1) about respiratory symptoms, chemosensory function and COVID-19 diagnosis between April and September 2020, were invited to complete a follow-up survey (S2). Between September 2020 and February 2021, 27.5% participants responded (n=3,386), with 1,468 being diagnosed with COVID-19 and suffering co-occurring smell and taste loss at the beginning of their illness. RESULTS: At follow-up (median time since COVID-19 onset ~200 days), ~60% of women and ~48% of men reported less than 80% of their pre-illness smell ability. Taste typically recovered faster than smell, and taste loss rarely persisted if smell recovered. Prevalence of parosmia and phantosmia was ~10% of participants in S1 and increased substantially in S2: ~47% for parosmia and ~25% for phantosmia. Persistent smell impairment was associated with more symptoms overall, suggesting it may be a key marker of long-COVID illness. The ability to smell during COVID-19 was rated slightly lower by those who did not eventually recover their pre-illness ability to smell at S2. CONCLUSIONS: While smell ability improves for many individuals who lost it during acute COVID-19, the prevalence of parosmia and phantosmia increases substantially over time. Olfactory dysfunction is associated with broader persistent symptoms of COVID-19, and may last for many months following acute COVID-19. Taste loss in the absence of smell loss is rare. Persistent qualitative smell symptoms are emerging as common long-term sequelae; more research into treatment options is strongly warranted given that even conservative estimates suggest millions of individuals may experience parosmia following COVID-19. Healthcare providers worldwide need to be prepared to treat post COVID-19 secondary effects on physical and mental health.

Undergraduate Biology Students Received Higher Grades During COVID-19 but Perceived Negative Effects on Learning

Institutions across the world transitioned abruptly to remote learning in 2020 due to the COVID-19 pandemic. This rapid transition to remote learning has generally been predicted to negatively affect students, particularly those marginalized due to their race, socioeconomic class, or gender identity. In this study, we examined the impact of this transition in the Spring 2020 semester on the grades of students enrolled in the in-person biology program at a large university in Southwestern United States as compared to the grades earned by students in the fully online biology program at the same institution. We also surveyed in-person instructors to understand changes in assessment practices as a result of the transition to remote learning during the pandemic. Finally, we surveyed students in the in-person program to learn about their perceptions of the impacts of this transition. We found that both online and in-person students received a similar small increase in grades in Spring 2020 compared to Spring 2018 and 2019. We also found no evidence of disproportionately negative impacts on grades received by students marginalized due to their race, socioeconomic class, or gender in either modality. Focusing on in-person courses, we documented that instructors made changes to their courses when they transitioned to remote learning, which may have offset some of the potential negative impacts on course grades. However, despite receiving higher grades, in-person students reported negative impacts on their learning, interactions with peers and instructors, feeling part of the campus community, and career preparation. Women reported a more negative impact on their learning and career preparation compared to men. This work provides insights into students’ perceptions of how they were disadvantaged as a result of the transition to remote instruction and illuminates potential actions that instructors can take to create more inclusive education moving forward. © Copyright © 2021 Supriya, Mead, Anbar, Caulkins, Collins, Cooper, LePore, Lewis, Pate, Scott and Brownell.

Denali, a phase 3B multicenter, open-label single-arm study of roxadustat: Operational learnings within us dialysis organizations

Background: Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitor that promotes erythropoiesis and improves iron availability in patients with anemia of chronic kidney disease (CKD). This trial aims to provide practical data on roxadustat use in dialysis patients with anemia via a semi-pragmatic evaluation of introduction into providers' practices (Fresenius Medical Care). Methods: This open-label, single-arm study assesses the efficacy and safety of roxadustat in correcting/maintaining hemoglobin (Hb) in patients with CKD-related anemia receiving in-center/home dialysis at nine US sites (NCT04410198). Initial roxadustat dose is weight-based (erythropoiesis-stimulating agent [ESA]-naïve patients) or guided by an ESA dose-conversion algorithm (ESA patients), in this trial targeting Hb=11±1 g/dL. Roxadustat dose is titrated every 4 weeks based on Hb level or rate of change, with 24-week treatment duration and up to 1-year extension. Efficacy is assessed by change from baseline in Hb and proportion of patients achieving mean Hb ≥10 g/dL averaged over weeks 16-24. Exploratory endpoints include time to first red blood cell transfusion, proportion of patients achieving mean Hb ≥10 g/dL in first 8 weeks, intravenous iron use, and dosing adherence. Safety endpoints include treatment-emergent adverse events (AE), with COVID-19 positivity an AE of special interest. Results: This ongoing trial was successfully initiated and enrolled (n=203) during the COVID-19 pandemic, with modifications for home dialysis. Baseline characteristics appear representative of the US dialysis population (Table). Conclusions: This trial adds to phase 3 studies of roxadustat by evaluating its use in treating anemia of CKD in home/in-center dialysis patients during the COVID-19 pandemic, while providing a view into operationalization and ease of real-world use. Full study results will be presented. (Table Presented) .

Understanding the impact of the pandemic on cancer services in Australia

Background: Health professionals have reported significant reductions in cancer referrals during the COVID-19 pandemic. As national real-time cancer incidence data were not available, Cancer Australia designed an approach to analysing Medicare Benefits Schedule (MBS) data to provide evidence on the impact of the pandemic on cancerrelated services in Australia. Methods: Over 500 MBS items for diagnostic and treatment procedures for the five highest incidence cancers were identified and categorised into analysis groups based on cancer type and/or similarities in type of service. Data for January to December 2020 were examined at national and jurisdictional levels, and compared to 2019 to account for normal seasonal variation. Analysis of expanded data to March 2021 for additional cancer types, age, sex, remoteness and socioeconomic status, is being undertaken. Results: There were notable reductions in services across all diagnostic and surgical procedure groups. Initial reductions were observed between March and April for diagnostic procedures and between April and May for surgical procedures. Some services showed an initial recovery in May, and some showed partial or full recovery by June and further recovery by September. For some procedure groups, analyses showed sustained reductions over the 12 months to December 2020. Similar patterns of change were observed across all Australian states and territories, with some variation by jurisdiction. While the number of cases of COVID-19 were greater during Victoria's second wave of the pandemic (July-September), the impact on service numbers was less significant, likely owing to more refined policy approaches to managing health system and workforce capacity. Conclusion: Reductions in cancer-related services may impact patient outcomes, including recurrence and survival. Understanding Editorialmaterial and organization ©2021 John Wiley & Sons Australia. Copyright of individual abstracts remains with the authors. the nature and extent of this impact, including data disaggregated by population groups, will help to determine an approach moving forward to address any poorer cancer outcomes resulting from the pandemic.

Coronaviruses and the chemical senses: past, present, and future

A wealth of rapidly evolving reports suggests that olfaction and taste disturbances may be manifestations of the novel COVID-19 pandemic. While otolaryngological societies worldwide have started to consider chemosensory evaluation as a screening tool for COVID-19 infection, the true nature of the relationship between the changes in chemosensory ability and COVID-19 is unclear. Our goal with this review is to provide a brief overview of published and archived literature, as well as the anecdotal reports and social trends related to this topic up to April 29, 2020. We also aim to draw parallels between the clinical/chemosensory symptomology reported in association to past coronavirus pandemics (such as SARS and MERS) and the novel COVID-19. This review also highlights current evidence on persistent chemosensory disturbances after the infection has resolved. Overall, our analysis pinpoints the need for further studies: (1) to better quantify olfaction and taste disturbances associated with SARS-CoV-2 infection, compared to those of other viral and respiratory infections, (2) to understand the relation between smell, taste, and chemesthesis disturbances in COVID-19, and (3) to understand how persistent are these disturbances after the infection has resolved.

The COVID-19 pandemic led to a reduction in cancer services in Australia

Background: Australian oncologists reported dramatic decreases in cancer referrals during the pandemic. As real time data were difficult to acquire, Cancer Australia used surrogate measures to infer where reductions in medical services occurred. We analysed data available through the Medicare Benefits Schedule (MBS), a list of the medical services and professional attendances subsidised by the Australian Government, for the five highest incidence cancers: breast, colorectal, lung, prostate, and skin cancers. Methods: We identified over 500 MBS item codes for diagnostic and treatment procedures for malignancies and pre-cancerous conditions. Item codes were categorised into analysis groups based on cancer type and/or similarities in type of service. Data were examined at national and jurisdictional levels for 2020 to determine reductions during the initial COVID-19 period and to monitor subsequent recovery. Data were compared to 2019 to account for normal seasonal variation. Results: Australia's first wave of the pandemic ran from March to May, and a second wave in the state of Victoria alone ran from July to September 2020. We observed notable reductions across all diagnostic and surgical procedure groups examined, with initial reductions observed between March and April for diagnostic procedures, and a one-month delay for surgical procedures, between April and May. Some services showed an initial recovery in May, with many showing partial or full recovery by June. For some groups, analyses showed sustained reductions over the 12- month period. While COVID-19 case numbers were greater during the second wave, the impact on services was less pronounced, likely owing to more refined policy approaches to managing health system and workforce capacity. There was further recovery by September for some but not all services. Similar patterns of change were observed across all Australian states and territories, with some variation by jurisdiction. Conclusions: The pandemic has impacted the delivery of cancer care. Any potential delays in diagnoses and treatment due to these reductions in services may lead to more advanced cancer stage at diagnosis and poorer patient outcomes including recurrence and survival. Impact of COVID-19 on selected cancer services in Australia in 2020.

Practitioner review: health anxiety in children and young people in the context of the COVID-19 pandemic.

Health-related fear is a normal and common response in the face of the global pandemic of COVID-19. Children and young people are frequently being exposed to messages about the threat to health, including from the media and authorities. Whilst for most, their anxiety will be proportionate to the threat, for some, existing pre-occupation with physical symptoms and illness will become more problematic. There is a growing body of evidence that health anxiety may occur in childhood, however much of the literature is taken from research using adult samples. This practitioner review aims to give an overview of the assessment and treatment of health-related worries in children and young people in the context of the COVID-19 pandemic. This review is based on the limited existing evidence in this population and the more substantial evidence base for treating health anxiety in adults. We consider the adaptations needed to ensure such interventions are developmentally appropriate.