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Background/Aims It is recognised that immunosuppressive medications, often relied upon in the management of autoimmune rheumatic disease, inhibit vaccine-induced immunity against the SARS-CoV-2 virus. A key challenge for rheumatologists is maximising immunity provided by the vaccine in their patients. Recent data has implicated methotrexate (MXT), a commonly used disease modifying anti-rheumatic drug (DMARD), in reducing patients' vaccine-induced immunity against the virus and studies have demonstrated the effectiveness of pausing MXT medication for 2-weeks after receiving the vaccine in boosting patients' immunity. There is a lack of data exploring the impact of concurrent biologic-DMARD (b-DMARD) use with MXT on COVID-19 infection rates in vaccinated individuals. This analysis forms part of a larger programme of research (clinicaltrials.gov NCT04542031) exploring COVID-19 in patients with rheumatic disease. Here we provide a comparative analysis of COVID-19 infection rates between patients taking MXT either with or without b-DMARD therapy and those on no immunosuppression. Methods We distributed two web-based questionnaires via SMS-messaging in April 2020 and December 2021 and two interim monitoring questionnaires in December 2020 and June 2021. All rheumatology patients with a valid mobile telephone number under follow up at the Royal Wolverhampton Trust were invited to participate in the study;those that consented received follow up questionnaires. We collected information on demographics, rheumatology diagnosis and treatment, vaccination status, and COVID-19 infection rates. Data were collected 7-days following questionnaire distribution. Results Initial questionnaires were sent to 7911 active follow up patients, 1636/ 7911 (21%) responded and consented to further follow up;906/1636 (55.4%) provided a complete response to the final survey which was subsequently linked to survey one enabling analysis. Responders were female (622/906, 68.7%), white (865, 95.5%), 60 years or above (519, 57.3%), and vaccinated (898/906;99.1%). Of those vaccinated significantly more patients that were on any immunosuppressive therapy compared to those on no immunosuppression (92/530 (17.4%) vs. 26/368 (7.1%);p<0.001), and more in the MXT monotherapy group compared to no immunosuppression (33/222 (14.9%) vs. 26/368 (7.1%);p=0.001) contracted COVID-19. Similar numbers in the MTX and b-DMARD and b-DMARD without MXT groups (23/140 (16.4%) vs. 36/168 (21.4%);p=0.23) contracted COVID-19. Conclusion Recent trial data from the VROOM study has demonstrated that omitting a patients MXT therapy for a 2-week period following administration of the COVID-19 vaccine doubles their antibody response. This data highlights that the risk of COVID-19 infection in vaccinated rheumatology patients is doubled in patients on any immunosuppressive medication compared to those on no immunosuppression, while there is no significant difference in infection rates between patients on MXT and a b-DMARD and b-DMARD therapy without MXT. Further work exploring the impact of different types of immunosuppression on COVID-19 vaccine-induced immunity and simple interventions to maximise this immunity in immunosuppressed individuals is required.
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Introduction: COVID-19 pandemic has driven an abrupt shift from centre-based pulmonary rehabilitation to home-based or telerehabilitation models in order to safely deliver this important treatment. However, functional capacity assessment is still carried out with in-person supervision. Aim(s): To compare remote and in-person assessment of four field tests for patients with chronic lung diseases. Method(s): People with chronic respiratory diseases underwent timed up and go test (TUG), 5-repetitions sit-to-stand test (5-repStS), 1-minute STS (1-minStS), and modified incremental step test (MIST). Tests were carried out at participants' home with in-person or remote (Skype or WhatsApp) assessment, in random order. During the remote assessment, the physiotherapist was at the pulmonary rehabilitation centre. The order of the tests was also randomized and was the same for in-person and remote supervision. Each test was performed twice and the test with best performance was used for comparison between remote and in-person supervision. A kit containing a finger pulse oximeter, tape measure, and a step was provided. Pair t -test expressed as mean difference (95% CI), intraclass correlation coefficient (ICC 2:1), and Bland-Altman method were used for analysis. Result(s): Forty-four participants (23 COPD, 18 bronchiectasis, three cystic fibrosis, FEV 1 47 +/- 19%, 56 +/- 15 years old) were assessed. There was no difference between in-person and remote supervision for all tests (TUG 0.04(-0.2-0.2) s, 5-repStS: 0.3(-0.1-0.7) s, 1-minStS: -0.9 (-1.9-0.1) repetitions, and MIST: -3.1 (-9.9-3.7) steps). High reproducibility was observed by ICC (95% CI) (TUG: 0.94 (0.89-0.97), 5-repStS: 0.96 (0.92-0.98), 1-minStS: 0.87 (0.77-0.93), and MIST: 0.94 (0.88-0.96). Limits of agreement were narrow for TUG (-0.8-1.7), 5-repStS (-2.3-2.9), and 1-minStS (-7.4-5.5), but wide for MIST (-46-40). Conclusion(s): Remote assessment provides similar results to in-person assessment for four field tests commonly used in people with chronic lung diseases.
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Introduction: Pulmonary rehabilitation (PR) is an effective treatment for people with chronic respiratory disease but is delivered to <5% of eligible individuals. Home-based telerehabilitation achieves similar clinical outcomes to centre-based PR in clinical trials. We aimed to evaluate the clinical implementation of telerehabilitation. Method(s): Suitable individuals with respiratory disease referred for PR at Alfred Health have been offered the option of an 8-week home-based telerehabilitation program (one home visit followed by twice-weekly exercise training sessions, with real time supervision, for 8-weeks). Equipment was provided to patients, as necessary. Standard PR assessments were conducted pre and post program. Program completion was defined as undertaking >=70% of prescribed sessions. Real-world implementation was evaluated against the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Result(s): Reach: Across 2-years (Sept 2020-22), 269 people were referred with 55 (21%) undertaking telerehabilitation (25 female, mean (SD) age 61 (11) years, 6-min walk distance (6MWD) 430 (120) metres, Chronic Respiratory Questionnaire Dyspnoea (CRQD) domain 16 (6)). Participant diagnoses included COPD (n = 11), ILD (n = 15), bronchiectasis (n = 5), asthma (n = 2), post COVID-19 (n = 9), and pulmonary hypertension (n = 4). Forty participants (73%) completed >=70% of prescribed sessions. Effectiveness: Significant and clinically meaningful improvements were demonstrated (CRQD MD 4 (95% CI 1, 6);6MWD MD 24 m (95% CI 8, 41)). Adoption: Training to deliver telerehabilitation and perform home visits was completed by PR clinicians (n = 7 and n = 4 respectively). Implementation: All participants independently supplied Wi-Fi, and 40% used their own exercise equipment or internet-enabled device. Most participants had an in-person home visit (n = 45), and undertook cycle-based training (n = 46). Fifteen participants required additional support for iPad or videoconferencing navigation. There were no serious adverse advents. Maintenance will be evaluated following this pilot period. Conclusion(s): 'Real-world' telerehabilitation achieves clinically meaningful outcomes for patients and provided access to an effective model of PR particularly when centre-based programs were unavailable due to COVID-19 restrictions.
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Background/Aims The UK coronavirus vaccination programme has been successful;by 8.10.21, 85% of those over 12 years had received the first dose of the vaccine and approximately 78% had received both doses. National guidance from British Society for Rheumatology recommends that all patients with rheumatic disease should receive a SARS-CoV-2 vaccine regardless of underlying diagnosis and treatment regime. Data highlight that in this group vaccine uptake can be significantly improved with physician recommendations and timely intervention. At the Royal Wolverhampton Trust (RWT, UK), we have previously described an innovative 8-minute web-based multimedia educational video sent via SMS-text messaging 21.12.20 to increase awareness of the recommendations and safety profile of the COVID vaccine in our cohort. A single-centre longitudinal study assessing the impact of COVID-19 on health-related quality of life (HRQOL) in our rheumatology patients is ongoing (NCT04542031), which we used to explore the impact of our intervention. Methods Existing study participants were sent a 6-monthly SMS text message containing a linked web-based survey. This collects demographic profiles, including gender, ethnicity, underlying rheumatological conditions;vulnerability, vaccination status, and HRQOL scores. Patients were asked to rate the impact of the video: more likely to be vaccinated;less likely;no impact. Responses were collected 7-days following distribution. Results Surveys were sent 9.06.21 to 1636 patients;there were 628/1636 (38.3%) complete responses. Responders were mostly female (69%), Caucasian (96%), mean age 63years, most had an autoimmune rheumatic disease (75%) and half were clinically extremely vulnerable (47%);623/628 (99%) were vaccinated and 45/628 (7%) had contracted COVID since the beginning of the pandemic. In total 424/ 628 (68%) reported watching the educational video;422/468 (99%) reported receiving the vaccination. Of these 138/424 (32%) reported they were more likely to get the vaccine as a result, 285/424 (67%) reported it made no difference, and one patient (1%) reported that the video made them less likely to have the vaccine. Of the 5/628 (1%) non-vaccinated patients, reasons for not having the vaccine were concerns over vaccine side effects (2/5), and personal reasons including awaiting further vaccine data and awaiting home visit (3/5);2/5 had watched the video, both reported the video made no difference to their decision and none had contracted COVID. Conclusion In a research cohort of patients with rheumatic disease, following a targeted COVID-19 vaccine education video 32% were more likely to get the COVID vaccine, and the vast majority went on to be vaccinated. Within the limitations of a research study, these data contribute to evidence supporting the use of SMS technology to communicate key healthcare messages and targeted educational materials. Further research exploring the use of targeted educational materials and communications via SMS-text messaging could support in tackling vaccine hesitancy in this population.
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Background/Aims COVID-19 has had severe consequences across the globe and the detrimental impacts are continually emerging. Recently it has been recognised that some patients develop persisting symptoms past the initial infection, termed 'long-COVID'. The prevalence of long-COVID in the general population is estimated to range from 2.3% to 37.7% and while risk factors in this group have been explored, there is a lack of data reporting prevalence and risk factors of long-COVID in patients with rheumatic disease (RD). This is an interim report of an ongoing study (clinicaltrials.gov NCT04542031) exploring COVID19 in patients with RD;we report risk factors for the development and impacts on health-related quality of life (HRQoL) of long-COVID in patients with RD to inform guidelines and target service provision as the pandemic continues. Methods We distributed three web-based surveys spanning 14 months, April 2020 to June 2021. Surveys were communicated via a linked SMS-text message;all patients with a validated mobile-number under rheumatology follow-up at the Royal Wolverhampton Trust were invited to participate in survey-1, those that consented were invited to participate in follow-up surveys. Patients reported a range of metrics including demographics, and self-reported COVID-status;on completion patients were asked to complete a validated HRQoL survey, the short-Form 12 encompassing physical (PCS), and mental component (MCS) scores. Data were collected 7-days following survey distribution. SPSS version-27 was used for comparative data analysis. Results Initial surveys were sent to 7911 active follow-up patients, 1636/7911 (21%) responded and consented to further follow-up;628/1636 (38%) responded to all surveys. 45/628 (7%) reported contracting COVID at any time (59years, female-80%, BAME-9%). 26/45 (58%) suffered acute-COVID (symptoms <4weeks), and 19 (42%) suffered long- COVID (symptoms 4 weeks or more);10/19 (53%) had post-COVID syndrome (symptoms 12 weeks or more). Compared to the acute- COVID group more in the post-COVID syndrome group were female (69% vs 100%), BAME (4% vs 20%), housebound due to prepandemic ill-health (5% vs 60%), and needed regular assistance (7% vs 60%). While baseline MCS did not differ, after 14months, compared to the acute-COVID group MCS was significantly worse in those that developed post-COVID syndrome (43.2 vs 35.8) and more in this group reported visiting their GP due to mental health concerns (7% vs 30%). Age, diagnosis, and PCS were similar across groups. Conclusion These data highlight that in RD patients those at risk of developing post-COVID syndrome are females, those with worse pre-pandemic health, and BAME-groups. While physical health remained stable, following infection the mental health of patients that developed post- COVID syndrome was significantly worse than those that suffered COVID acute-COVID. These data can be used to identify COVIDpositive patients at greater risk of developing post-COVID syndrome and suggest services need to adapt to support psychological wellbeing in these groups.
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The pandemic caused by the spread of the virus SARS-CoV-2 threatened to severely disrupt the activities of student-athletes. In order to provide a safe environment for athletic competition, the National Collegiate Athletic Association (NCAA) mandated testing of student-athletes. The goal was to rapidly identify student-athletes and the athletic staff member who either tested positive for SARS-CoV-2 or were in contact with individuals who tested positive. Rapid identification of infected individuals and their contacts allowed the University to implement quarantine standards and quarantine facilities quickly as needed. The University of Texas at Arlington (UTA) developed an in-house testing program and was quickly able to meet the NCAA requirements, allowing UTA to continue its athletic participation with minimal forfeiture of scheduled games. The purpose of this paper is to report the implementation UTRs COVID prevention program for the university's athletic program. This program may provide valuable information to other universities' planning for the management of COVID prevention in their athletic programs. Challenges and solutions are identified.
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The Mars Science Laboratory team had been putting in effort to make a Training Venue to allow for parallel shadow tactical operations for trainees to actively work alongside the prime tactical operations personnel without affecting operations, since staffing constraints and shortened operations timelines were straining the tactical process in supporting operations trainees in the traditional way. The COVID- 19 Pandemic presented further challenges in continuing on-console training for MSL operations trainees. The MSL operations team switched to fully remote operations, thus hampering the direct mentorship a trainee would normally receive while on site at JPL. The Mars 2020 training team had developed a concept for rover operations training simulations based on Johnson Space Center's extensive simulations training program for astronauts and flight controllers. The MSL team borrowed this idea, and implemented these training simulations which are called Practical Operational Readiness Gambits (PORGs). The PORGs so far have focused on the Science Planner and Rover Planner roles, which are two crucial roles in tactical operations that engage in key interactions throughout a shift. PORGs are based on actual sol scenarios that have occurred on Mars and follow the tactical operations process and timeline as closely as possible. However, unlike an operations shift, PORGs can slow down or pause to allow for more mentoring time. PORGs can focus on particular skills to test the trainees on their understanding of a concept. PORGs increase in complexity with each scenario to ease the trainees into more typical tactical operations workloads. As more trainees join the MSL operations team, more roles are being incorporated into PORGs. There are plans to incorporate certified operations personnel into PORGs to practice anomaly response situations. PORGs have become an essential part of the MSL operations training program and will continue even after the return to on-site operations at JPL.
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Founded in 2019, Lettuce Harvest Foundation (LHF) is a grassroots urban agriculture nonprofit organization based in Vancouver, Canada. As an organization just launching as COVID-19 took hold, LHF's programming has been designed to enable urban agriculture in light of the pandemic's challenges. This article presents observations and suggestions gained from LHF operations as an organization with limited resources. When COVID-19 put stress on the global food system, it revealed that short-term emergency food relief is insufficient, indicating an urgent need for redesigning our food system. Harnessing pre-existing industry elements for accessible resources is one proposed method that grassroots organizations can adopt to mitigate strains on our food system inflicted by COVID-19 and other future crises.
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Background: Pulmonary rehabilitation is an effective treatment for people with chronic respiratory disease, but is delivered to <5% of eligible individuals. Due to COVID-19 remote rehabilitation models may be critical for future delivery of services. Aims: To compare the efficacy of home-based telerehabilitation (TR) and centre-based pulmonary rehabilitation (PR) in people with chronic respiratory disease. Methods: Assessor blinded, multi-centre RCT, powered for equivalence. Participants were randomised to centre-based PR or home-based TR. Both programs were 2 sessions/week for 8 weeks. Telerehabilitation used a stationary cycle and group videoconferencing to enable social interaction and real time monitoring. The primary outcome was change in chronic respiratory disease questionnaire dyspnea domain (CRQ-D) at end rehabilitation, with a pre-specified equivalence margin of 2.5 points. Results: We randomised 142 participants to PR (n=72) orTR (n=72). Both groups had clinically important improvements in CRQ-D following rehabilitation (TR mean (95%CI) 4 (2 to 5) vs PR 5 (3 to 7)), however equivalence of TR was not confirmed (mean difference between groups (MD) -1 point (-3 to 1)), with similar findings at 12 month followup (MD -1 point (-4 to 1)). The 6-minute walk distance (6MWD) was equivalent at end rehabilitation (MD -6 metres (-26 to 15) and at 12 months superiority of TR could not be excluded (MD 14 metres (-10 to 38). The proportion of participants who completed >70% of prescribed sessions was high (84% TR vs 79% PR). Conclusions: Home-based TR achieved clinically important gains in health-related quality of life, but equivalence to centre-based PR was not confirmed.