Balancing Privacy and Serendipity in Cyberspace

Unplanned encounters or casual collisions between colleagues have long been recognized as catalysts for creativity and innovation. The absence of such encounters has been a negative side effect of COVID-enforced remote work. However, there have also been positive side effects such as less time lost to commutes, lower carbon footprints, and improved work-life balance. This vision paper explores how serendipity for remote workers can be created by leveraging IoT technologies, edge computing, high-resolution video, network protocols for live interaction, and video/audio denaturing. We reflect on the privacy issues that technology-mediated serendipity raises and sketch a path towards honoring diverse privacy preferences.

‘Why would you swap your nice warm van, where you can eat your butties and listen to the radio?' Mainstreaming a niche of cycle logistics in the United Kingdom

Due to a high level of dependency on fossil fuels, transport is not only a priority for decarbonsation but also a particularly challenging sector to decarbonise. Significant low-carbon energy transitions in mobility will require changes in practices, technologies, infrastructure and policy. Cycle logistics is a growing economic sector. E-cargo bikes have the potential to replace some delivery and service journeys and to be used in combination with other transport modes to form a network of low-carbon deliveries. In comparison with conventional cargo bikes, e-cargo bikes are adapted with electric assist motors, thereby enabling the carriage of heavier loads over longer distances with lower physical strain on the rider. This study positions e-cargo bikes as an emerging technology within the Multilevel Perspective (MLP), a framework for understanding sustainable transitions that is structured around three levels: niche, regime and landscape. The Covid-19 pandemic has caused a landscape-level shock that has prompted an interest in increasing active travel and local deliveries. E-cargo bikes are a niche technology, and, although they respond to landscape-level trends, such as decarbonisation and air pollution reduction, the development of cycle logistics faces challenges stemming from the dominant automobility regime. There are limitations with e-cargo bikes themselves, although the technology and practice of e-cargo bike use are developing rapidly;there are factors that relate to the ability of the regime to accommodate and support the niche;there are considerations relating to practices and perceptions;and, finally, there are policy choices that reflect a lack of proactivity in encouraging and enabling e-cargo bike use. The paper explores experiences and perceptions of actual and potential e-cargo bike use and configures the MLP and the relationship between niche, regime(s) and landscape in relation to mobility transitions. © 2023 The Authors

Factors Associated with Mortality in Patients with COVID-19 from a Hospital in Northern Peru

We aimed to identify the factors associated with mortality in patients with COVID-19 from the hospitalization service of the Cayetano Heredia Hospital, Piura, Peru, from May to June 2020. A prospective study was conducted in hospitalized patients with a confirmed diagnosis of COVID-19 through serological and/or molecular reactive testing. The dependent variable was death due to COVID-19, and the independent variables were the epidemiological, clinical and laboratory characteristics of the patient. The chi-square test and the non-parametric Mann–Whitney U test were used, with a significance level of 5%. Of 301 patients with COVID-19, the majority of them were male (66.1%), and the mean age was 58.63 years. Of the patients analyzed, 41.3% of them died, 40.2% of them were obese and 59.8% of them had hepatic steatosis. The three most frequent signs/symptoms were dyspnea (90.03%), fatigue (90.03%) and a cough (84.72%). Being an older adult (p = 0.011), being hospitalized in the ICU (p = 0.001), overweight (p = 0.016), obese (p = 0.021) and having compromised consciousness (p = 0.039) and thrombocytopenia (p = 0.024) were associated with mortality due to COVID-19. Overall, the mortality rate due to COVID-19 was 41.3%. Having an older age, being hospitalized in the ICU, overweight, obese and having compromised consciousness and thrombocytopenia were positively associated with mortality in patients with COVID-19. These findings highlight the need to establish an adequate system of surveillance and epidemiological education in hospitals and communities in the event of new outbreaks, especially in rural and northern Peru. © 2023 by the authors.

A five-year review of chemoradiotherapy in anal cancer: Audit results from a cancer centre in Wales, UK

Category: Chemoradiotherapy Background to the audit: We aimed to review a five-year clinical practice of radical chemoradiotherapy (CRT) in anal cancers at our centre. Standard: Seven key quality indicators were tested against the referenced standards from RTOG 8704/RTOG 8911, ACT II, RCR guidance and departmental protocols.3,4,5 1. 75% and 100% acquisition of computed tomography simulation (CT SIM) within seven and 14 days of consent taking. 2. 100% commencement of CRT within 28 days of CT SIM. 3. 100% start of CRT within 28 days of CT SIM. 4. Overall CRT duration of 38 days in 100% cases, with radiotherapy (RT) interruptions for >2 days in <2%. 5. Completion of concurrent chemotherapy in 75% of cases. 6. Colostomy rate for CRT morbidity <2%. 7. 30-days mortality rate <2%. Indicator: AA. Target: Primary anal cancers received curative CRT between 2016 and 2021. The audit took place from October to December of 2021. Methodology: The data source consisted of electronic medical records using the Welsh Clinical Portal (WCP), MOSAIQ radiation oncology and chemocare CIS oncology. Results of first audit round: A total of 80 anal cancers received CRT. 75% of CT SIM was acquired within seven days, and in 95% of patients within 14 days of consent. The observed slight deviation was related to the COVID pandemic in 2020. About 96.3% started CRT within 28 days of CT SIM. The mean duration of CRT was 37.9 days. RT interruptions >2 days were about 5%, and 67.5% started CRT within 28 days of consent. 92.5% and 76.2% completed mitomycin and capecitabine without breaks. The colostomy rate was 1.2%, and the 30-day mortality was 1.2%. First action plan: A sustained plan execution to ensure 100% acquisition of CT SIM within seven days of consent. New referrals are seen same day after the multidisciplinary team decision. A 14-day deadline from CT SIM to CRT delivery has been introduced for physicists and oncologists for target and organs at risk (OAR) delineation, peer review, planning/approval. An additional CT simulator has been requested. References: 1. Kang YJ, Smith M, Canfell K. Anal cancer in high-income countries: increasing burden of disease. PLoS One 2018, 13(10): e0205105. 2. Glynne-Jones R, Meadows H, Wan S et al. National Cancer Research Institute Anal Sub Group and Colorectal Clinical Oncology Group. EXTRA - a multicenter phase II study of chemoradiation using a 5 day per week oral regimen of capecitabine and intravenous mitomycin C in anal cancer. Int J Radiat Oncol Biol Phys 2008, 72: 119-26. 3. Edgar B-J, Moughan J, Ajani JA et al. Impact of overall treatment time on survival and local control in patients with anal cancer: a pooled data analysis of Radiation Therapy Oncology Group trials 87-04 and 98-11. J Clin Oncol 2010, 28: 5061-6. 4. James RD, Glynne-Jones R, Meadows HM et al. Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomised, phase 3, open-label, 2 x 2 factorial trial. Lancet Oncol 2013, 14(6): 516-24. 5. The Royal College of Radiologists. The timely delivery of radical radiotherapy: guidelines for the management of unscheduled treatment interruptions, fourth edition. London: The Royal College of Radiologists, 2019. Copyright © 2022

Using GastroPlus to teach complex biopharmaceutical concepts

Context: In response to the COVID-19 pandemic, many educational adjustments had to be made to move in-person teaching to online classrooms. This report showcases the use of the software GastroPlus at an undergraduate level pharmacy course. Programme description: This course aimed for the students to learn how to perform mechanistically based simulation to predict the oral absorption pattern, pharmacokinetics and biopharmaceutics properties of compounds in humans. The computer simulation offered the opportunity to teach concepts about bioavailability providing all kinds of experience with major biopharmaceutic determinants that affect systemic drug exposure. Evaluation: The advantage of this approach was seen by the enhanced performance on the biopharmaceutics questions on the final exam compared with the previous year where the laboratory was not implemented: An increase from 2019 (where no laboratory was implemented) through 2021 in correct scores from 52, 76 to 75%, respectively. Conclusion: There is great benefit in using computer programs and simulations as a technique to enhance active learning and to educate pharmacy students in salient aspects of biopharmaceutics.

Balancing Privacy and Serendipity in Cyberspace

Unplanned encounters or casual collisions between colleagues have long been recognized as catalysts for creativity and innovation. The absence of such encounters has been a negative side effect of COVID-enforced remote work. However, there have also been positive side effects such as less time lost to commutes, lower carbon footprints, and improved work-life balance. This vision paper explores how serendipity for remote workers can be created by leveraging IoT technologies, edge computing, high-resolution video, network protocols for live interaction, and video/audio denaturing. We reflect on the privacy issues that technology-mediated serendipity raises and sketch a path towards honoring diverse privacy preferences. © 2022 Owner/Author.

Trust in older black, Asian and minority ethics persons with dementia and caregivers: The effects of COVID-19

Introduction: Members of Black, Asian and minority ethnic (BAME) communities in the UK have faced significant burden due to COVID-19. This population has had higher incidence rates of COVID-19, and also higher death rates. The pandemic has also disproportionately affected older adults, including those with dementia and as a result their caregivers. This study aims to explore culturally specific experiences of trust surrounding government policies, guidelines and services in BAME populations in the UK. Methods: Semi-structured interviews with 11 caregivers and 7 older adults with dementia were performed as part of a wider study on BAME experiences under COVID-19. Participants were recruited from national registries, such as Join Dementia Research, social media and word-ofmouth. Data was then analysed using thematic analysis methods with a specific focus on experiences around trust in guidelines, services and policy. Results: The concept of trust featured heavily in respondent interviews. Trust was seen as both a personal and a wider community issue. When stratified by ethnicity (within BAME communities) and other demographic factors, differences in level of trust and perception of guidelines and policies were found between groups - such as how much trust was put into government messaging. Conclusions: This paper looks at groups highly vulnerable to COVID-19 and their experiences of health and social policy. It is clear that attention must be paid to differences between different groups' cultural norms and structures in formulating and providing health and social care interventions. A move away from 'one-size-fits-all' policies may improve both the experience of health and social care interventions and promote feelings of inclusion and trust towards providers.

Rapid review of decision-making for place of care and death in older people: Lessons for COVID-19

IntroductionThe coronavirus pandemic (COVID-19) has affected the functioning and capacity of healthcare systems worldwide. COVID-19 has also disproportionately affected older adults, including those living with dementia. In the context of COVID-19, decision-making surrounding place of care and place of death in this population involves significant new challenges.ObjectivesTo explore key factors that influence place of care and place of death decisions in older adults. A secondary aim was to investigate key factors that influence the process and outcome of these decisions in older adults. To apply findings from current evidence to the context of COVID-19.MethodsRapid review of reviews, undertaken using WHO guidance for rapid reviews. Ten papers were included for full data extraction. These papers were published between 2005-2020. Data extracted was synthesised using narrative synthesis, with thematic analysis and tabulation.ResultsPapers included discussed actual place of death, as well as preferred. Results were divided into papers that explored the process of decision-making, and those that explored decision-making outcomes. Factors such as caregiver capacity, the availability of multidisciplinary teams, cultural appropriateness of care packages and advanced care planning were found to be key.ConclusionsThe process and outcomes of decision-making for older people are affected by many factors – all of which have the potential to influence both patients and caregivers experience of illness and dying. Within the context of COVID-19, such decisions may have to be made rapidly and be reflexive to changing needs of systems and of families and patients.

Rapid development of a decision-aid for people with dementia and their families during COVID-19

IntroductionCOVID-19 as a pandemic has disproportionately affected older adults, including those with dementia. The effects on health and social care systems has necessitated a rapid-response approach to care planning and decision-making in this population, with reflexivity and responsiveness to changing individual and system needs at its core. In light of this, a decision-making tool to help families of persons with dementia was developed using a combination of qualitative data and evidence synthesis.ObjectivesTo develop a decision-aid using a combination of assessment and evidence-gathering methods for families of persons with dementia.MethodsSemi-structured interviews with helpline staff from national end-of-life and supportive care organisations formed the basis of the tool design. Co-design with people living with dementia, current and former carers and experts in general practice and social care shaped the next stage. Simultaneously, a rapid review of current evidence on making decisions with older people at the end of life was undertaken.ResultsOutput from interviews covered many topics, including trust, agency and confusion in making decisions in the context of COVID-19. The rapid review of existing evidence highlighted the need to consider both process and outcome elements of decision-making.ConclusionsCombining different sources and forms of evidence was efficient and valuable in creating a novel decision-making tool for persons with dementia and their families within the context of COVID-19. The decision-aid covered care planning, caregiver support systems, access to information and contingency considerations. Upon publication, the tool was adopted by NHS England and other leading healthcare organisations.DisclosureNo significant relationships.

Carer perspectives of trust and authority during COVID-19

The COVID-19 global pandemic has had a significant impact in the way services are accessed and perceived by patients and their carers. Trust in services has shifted, and relationships with healthcare professionals have been affected, with carers now seeking alternative and more accessible sources of support. The aim of this paper is to explore the challenges and concerns including issues around trust that carers of people living with dementia and terminal illness have brought to support helplines, the decisions they are having to make, and the impact that the pandemic has had on end of life care. Eight helpline support workers were recruited from the Dementia UK and Marie Curie organisations, and semi-structured qualitative interviews were conducted through video calls on Microsoft Teams. Interviews were recorded with participants' consent and transcribed and checked via the Microsoft Stream automated system. The data was analysed by means of thematic analysis on NVIVO 11. Interview data was coded according to the point of time in the pandemic;early, later, or general. It was found that issues of trust, perceived loss of agency and confusion regarding government guidelines were expressed from the beginning of the pandemic to the current day. These stemmed from situations including care within hospitals and care homes, particularly due to a lack of communication from the aforementioned about the welfare of their relatives, and choices being removed from carers about their relatives' discharge pathways. There were also concerns raised about the rapidly and constantly changing guidelines for vulnerable people during the pandemic, with carers seeking information and reassurance from charity helplines rather than authority figures and the government.

1 Carer perspectives of trust and authority during COVID-19

The COVID-19 global pandemic has had a significant impact in the way services are accessed and perceived by patients and their carers. Trust in services has shifted, and relationships with healthcare professionals have been affected, with carers now seeking alternative and more accessible sources of support. The aim of this paper is to explore the challenges and concerns including issues around trust that carers of people living with dementia and terminal illness have brought to support helplines, the decisions they are having to make, and the impact that the pandemic has had on end of life care. Eight helpline support workers were recruited from the Dementia UK and Marie Curie organisations, and semi-structured qualitative interviews were conducted through video calls on Microsoft Teams. Interviews were recorded with participants’ consent and transcribed and checked via the Microsoft Stream automated system. The data was analysed by means of thematic analysis on NVIVO 11. Interview data was coded according to the point of time in the pandemic;early, later, or general. It was found that issues of trust, perceived loss of agency and confusion regarding government guidelines were expressed from the beginning of the pandemic to the current day. These stemmed from situations including care within hospitals and care homes, particularly due to a lack of communication from the aforementioned about the welfare of their relatives, and choices being removed from carers about their relatives’ discharge pathways. There were also concerns raised about the rapidly and constantly changing guidelines for vulnerable people during the pandemic, with carers seeking information and reassurance from charity helplines rather than authority figures and the government.

The effectiveness of social bubbles as part of a Covid-19 lockdown exit strategy, a modelling study

Background: ​ During the coronavirus disease 2019 (COVID-19) lockdown, contact clustering in social bubbles may allow extending contacts beyond the household at minimal additional risk and hence has been considered as part of modified lockdown policy or a gradual lockdown exit strategy. We estimated the impact of such strategies on epidemic and mortality risk using the UK as a case study. Methods: ​ We used an individual based model for a synthetic population similar to the UK, stratified into transmission risks from the community, within the household and from other households in the same social bubble. The base case considers a situation where non-essential shops and schools are closed, the secondary household attack rate is 20% and the initial reproduction number is 0.8. We simulate social bubble strategies (where two households form an exclusive pair) for households including children, for single occupancy households, and for all households. We test the sensitivity of results to a range of alternative model assumptions and parameters. Results:  Clustering contacts outside the household into exclusive bubbles is an effective strategy of increasing contacts while limiting the associated increase in epidemic risk. In the base case, social bubbles reduced fatalities by 42% compared to an unclustered increase of contacts. We find that if all households were to form social bubbles the reproduction number would likely increase to above the epidemic threshold of R=1. Strategies allowing households with young children or single occupancy households to form social bubbles increased the reproduction number by less than 11%. The corresponding increase in mortality is proportional to the increase in the epidemic risk but is focussed in older adults irrespective of inclusion in social bubbles. Conclusions: ​ If managed appropriately, social bubbles can be an effective way of extending contacts beyond the household while limiting the increase in epidemic risk.