ABSTRACT
Optimum management of patients with cancer during the COVID-19 pandemic has proved extremely challenging. Patients, clinicians and hospital authorities have had to balance the risks to patients of attending hospital, many of whom are especially vulnerable, with the risks of delaying or modifying cancer treatment. Those whose care has been significantly impacted include patients suffering from the effects of cancer on bone, where delivering the usual standard of care for bone support has often not been possible and clinicians have been forced to seek alternative options for adequate management. At a virtual meeting of the Cancer and Bone Society in July 2020, an expert group shared experiences and solutions to this challenge, following which a questionnaire was sent internationally to the symposium's participants, to explore the issues faced and solutions offered. 70 respondents, from 9 countries (majority USA, 39%, followed by UK, 19%) included 50 clinicians, spread across a diverse range of specialties (but with a high proportion, 64%, of medical oncologists) and 20 who classified themselves as non-clinical (solely lab-based). Spread of clinician specialty across tumour types was breast (65%), prostate (27%), followed by renal, myeloma and melanoma. Analysis showed that management of metastatic bone disease in all solid tumour types and myeloma, adjuvant bisphosphonate breast cancer therapy and cancer treatment induced bone loss, was substantially impacted. Respondents reported delays to routine CT scans (58%), standard bone scans (48%) and MRI scans (46%), though emergency scans were less affected. Delays in palliative radiotherapy for bone pain were reported by 31% of respondents with treatments often involving only a single dose without fractionation. Delays to, or cancellation of, prophylactic surgery for bone pain were reported by 35% of respondents. Access to treatments with intravenous bisphosphonates and subcutaneous denosumab was a major problem, mitigated by provision of drug administration at home or in a local clinic, reduced frequency of administration or switching to oral bisphosphonates taken at home. The questionnaire also revealed damaging delays or complete stopping of both clinical and laboratory research. In addition to an analysis of the questionnaire, this paper presents a rationale and recommendations for adaptation of the normal guidelines for protection of bone health during the pandemic.
ABSTRACT
When it comes to the COVID-19 pandemic [1], various issues and problems arise for institutions and critical infrastructures. Institutions such as first responders can be affected by COVID-19 by temporary or permanent loss of their essential staff and resources and therefore loss of their carrying capacity. The gradual and partial loss of carrying capacity in combination with increased demand on first responder systems can potentially push these system towards their tipping point, and thus cause even more loss of capacity to respond to emergency situations. In addition to the increased mental and emotional pressure burdened on first responders due to the presence and dangers of the virus, emergency personnel such as police officers can experience increased workload and stress during the pandemic as well as exposure to symptomatic or asymptomatic individuals affected by COVID-19. By assessing the dynamic carrying capacity of the first responder systems and their interaction with the general population they provide service to, the resiliency of first responder systems can be assessed in face of various scenarios. The resiliency of first responder systems can be increased by designing extra capacity and preventing the system from coming into the proximity of its tipping point, which could result in partial or major collapse in performance of the system. Therefore, protecting the emergency personnel and these indispensable institutions as well as maintaining the capacity to respond to the majority of the emergency calls is paramount. Since the police force, hospitals, fire departments, and other care institutions are structures consisting of a wide range of individuals and operate in an ever-changing environment, this paper attempts to assess the resilience and capacity of such institutions via simulations to find and localize their tipping points. To enable such simulations, the model developed by Vierlboeck, Nilchiani, and Edwards [2] was extended with further branches to allow for simulations of sub-systems and loads thereof. For this paper, the police force of New York City (NYC) was chosen as a case study. To assess the police force performance, the capabilities and capacities of the sub-system were evaluated by testing its function under different circumstances and with different influencing factors such as fatigue [3] and the influence of the Yerkes-Dodsen Law [4]. This way, it was possible to assess the performance of the emergency personnel and provide information that could potentially be used for regulatory measures and decisions. The conducted evaluations and simulations studied the existing system's resiliency and its proximity to the system tipping point as the reduction of a number of emergency personnel is inevitable due to sickness caused by COVID-19. The baseline simulations showed performance drops under high loads which leaves the system in a more delicate state and vulnerable, with a higher tendency to collapse. Testing different scenarios, it was found that overall the system can tolerate a certain degree of changes in temporary demand. However, extended stress and increased demand on the emergency infrastructure systems can push them towards their tipping point and therefore cause irreversible damage.
ABSTRACT
Non-technical summary We summarize some of the past year's most important findings within climate change-related research. New research has improved our understanding of Earth's sensitivity to carbon dioxide, finds that permafrost thaw could release more carbon emissions than expected and that the uptake of carbon in tropical ecosystems is weakening. Adverse impacts on human society include increasing water shortages and impacts on mental health. Options for solutions emerge from rethinking economic models, rights-based litigation, strengthened governance systems and a new social contract. The disruption caused by COVID-19 could be seized as an opportunity for positive change, directing economic stimulus towards sustainable investments. Technical summary A synthesis is made of ten fields within climate science where there have been significant advances since mid-2019, through an expert elicitation process with broad disciplinary scope. Findings include: (1) a better understanding of equilibrium climate sensitivity;(2) abrupt thaw as an accelerator of carbon release from permafrost;(3) changes to global and regional land carbon sinks;(4) impacts of climate change on water crises, including equity perspectives;(5) adverse effects on mental health from climate change;(6) immediate effects on climate of the COVID-19 pandemic and requirements for recovery packages to deliver on the Paris Agreement;(7) suggested long-term changes to governance and a social contract to address climate change, learning from the current pandemic, (8) updated positive cost-benefit ratio and new perspectives on the potential for green growth in the short- A nd long-term perspective;(9) urban electrification as a strategy to move towards low-carbon energy systems and (10) rights-based litigation as an increasingly important method to address climate change, with recent clarifications on the legal standing and representation of future generations. Social media summary Stronger permafrost thaw, COVID-19 effects and growing mental health impacts among highlights of latest climate science. Copyright © The Author(s), 2021. Published by Cambridge University Press.