Online Learning During the Covid Crisis: Student Views

In the spring of 2020, students at all levels of education were suddenly thrown into online learning situations. Higher education institutions reacted without regard or exposure to known best practices for online learning. As a result, student satisfaction levels dropped dramatically. Before Covid, those participating in online courses chose that option. Occasionally, an individual course would only be offered online, but for the majority, students who did not like online courses could avoid them. With the Covid crisis, all students were thrust into an online educational environment with no alternatives and little notice. To examine the learning during this crisis, we developed a 22-item scale on student perspectives of online learning and administered the survey to a large regional university in the southwest US during the Covid crisis (n=1160). We found online students prefer non-quantitative courses, are motivated by many scheduling issues, believe they learn less online and feel online students must be self-motivated and more disciplined, among other findings. © 2023, North American Business Press. All rights reserved.

Humoral immune responses to COVID-19 vaccines are reduced in patients with severe asthma

Background: Patients with severe asthma (SA) may be at higher risk of severe COVID-19 (C-19) illness. C-19 vaccines aim to reduce number and severity of infections. Patients with SA are often treated with maintenance oral corticosteroids (mOCS) and/or biologics (mAb)- it is unknown if vaccines will generate the same protective responses in patients with SA on such therapies. Aim(s): To compare magnitude and range of post-vaccination (PV) antibody responses (IgG) in patients with SA on mAb, mOCS or high-dose inhaled corticosteroids (ICS) with healthy controls (HC) without asthma. Method(s): The Virtus finger-prick quantitative C-19 antibody test was used to detect IgG levels 16-24 weeks post second-dose of the C-19 vaccine (123 AstraZeneca, 56 Pfizer, 5 Moderna). IgG>0.2AU was considered positive with range: very high >1.25AU, high 0.751-1.25AU, medium 0.401-0.75AU and low 0.201-0.4AU. SA was defined as per ATS/ERS criteria. Result(s): PV IgG results were obtained from 127 patients with SA (84 mAb, 13 mOCS and 46 ICS) and 57 HC. After adjusting for age, significantly fewer people with SA compared to HC had a positive PV IgG result (81% vs 95% p=0.016). Lower median IgG levels were seen in patients on mOCS (0.40AU) compared to HC (1.24AU) (p=0.051). Patients on mAb had high or very high IgG levels (omalizumab n=25, 0.80AU;mepolizumab n=25, 1.07AU;benralizumab n=34, 1.11AU). Conclusion(s): Overall, a higher proportion of patients with SA had a negative PV IgG level after receiving 2 doses of a C-19 vaccine. This was mainly seen in patients on mOCS while mAb use was associated with high levels of humoral antibody response. These results reinforce the need for booster vaccines in SA, especially in those on mOCS.

Managing COVID-19 through collaboration: applying a novel patient care model in a rural Indian community

Background: Rural communities in India are vulnerable to the global pandemic of severe acute respiratory coronavirus 2 (SARS-CoV-2) due to a lack of resources and delayed access to information. To address the challenges faced by Primary Health Centers, the Karuna Trust-Lopamudra Medical Center COVID-19 High Dependency Unit (KLCHDU), a collaboration between a local hospital, a non-governmental organization, infectious disease physicians from an academic medical center in the United States, and a local citizens council, was established in May 2021. This collaboration implemented diagnostic and management COVID-19 protocols recommended by the Infectious Diseases Society of America, the National Institute of Health, and the U.S. Centers for Disease Control and provided basic training on recommended practices to Primary Health Center and other local healthcare workers.

Precision phenotyping of 'long COVID' through machine learning

Background. Characterizing, diagnosing, and caring for 'long COVID' patients has proven to be challenging due to heterogenous symptoms and broad definitions of these post-acute sequelae. Here, we take a machine learning approach to identify discrete clusters of long COVID symptoms which may define specific long COVID phenotypes. Figure 1: (A) Principal component analysis followed by K-means clustering identified three groups of participants. (B) Heatmap depicting three distinct clusters (high values are in red and low value are in blue);Cluster 1 exhibits sensory symptoms (e.g., loss of smell and/or taste), Cluster 2 exhibits fatigue and difficulty thinking (e.g., changes in ability to think) symptoms, and Cluster 3 exhibits difficulty breathing and exercise intolerance symptoms. (C) Clinical and demographic characteristics of 97 military health system beneficiaries by identified clusters Methods. The Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) study is a longitudinal COVID-19 cohort study with data and biospecimens collected from 10 military treatment facilities and online recruitment. Demographic and clinical characteristics were collected using case report forms and surveys completed at enrollment and at 1, 3, 6, 9, and 12 months. For this analysis, we identified those who reported any moderate to severe persistent symptoms on surveys collected 6-months post-COVID-19 symptom onset. Using the survey responses, we applied principal component analysis (PCA) followed by unsupervised machine learning clustering algorithm K-means to identify groups with distinct clusters of symptoms. Results. Of 1299 subjects with 6-month survey responses, 97 (7.47%) reported moderate to severe persistent symptoms. Among these subjects, three clusters were identified using PCA (Figure 1A). Cluster 1 is characterized by sensory symptoms (loss of taste and/or smell), Cluster 2 by fatigue and difficulty thinking, and Cluster 3 by difficulty breathing and exercise intolerance (Figure 1B). More than half of these subjects (57%) were female, 64% were 18-44 years old, and 64% had no comorbidities at enrollment (Figure 1C). Those in the sensory symptom cluster were all outpatients at the time of initial COVID-19 presentation (p < 0.01). The difficulty breathing and exercise intolerance symptom-clusters had a higher proportion of older participants (Age group >= 45-64) with more comorbidities (CCI >= 1-2). Conclusion. We identified three distinct 'long COVID' phenotypes among those with moderate to severe COVID-19 symptoms at 6-months post-symptom onset. With further validation and characterization, this framework may allow more precise classification of long COVID cases, and potentially improve the diagnosis, prognosis, and treatment of post- infectious sequelae.

Asymptomatic SARS-CoV-2 Infections, BNT162b2 mRNA COVID 19 Vaccine-Related Symptoms, and Correlates of Immunity in Post-Vaccination Breakthrough Infections in the Prospective Assessment of SARS-CoV-2 Seroconversion (PASS) Study

Background. We sought to determine the frequency of asymptomatic SARS-CoV-2 infections, the BNT162b2 mRNA COVID 19 vaccine-related symptoms, and the correlates of immunity in post-vaccination breakthrough infections in a prospective cohort of healthcare workers. Methods. We have been conducting a single-center, observational cohort study of healthcare workers. 271 participants were enrolled since August 25, 2020. Testing for SARS-CoV-2 spike (S)-specific IgG antibodies is conducted using a microspherebased multiplex immunoassay interpolated against an internal standard curve for binding antibody (bAb) units (BAU) and has been performed on serum samples collected at monthly visits between September 2020 to August of 2021, and quarterly since then. Neutralizing antibody titers against wild-type (WT) virus are determined by microneutralization assays and against Delta and Omicron variants by lentiviral pseudovirus neutralization assays. For the first 6 months, participants completed a symptoms questionnaire every day they had any symptoms. Results. 12 participants were diagnosed with SARS-CoV-2, with at least mild symptoms. Of 206 participants evaluated for adverse effects after 1st and 2nd vaccine doses, no relationship was observed between vaccine-associated symptom scores and antibody titers 1 month after the 2nd dose. Longitudinal studies demonstrate that anti-S IgG bAbs decrease from a geometric mean (GM) of 1929 BAU/mL at 1 month post-vaccination to a GM of 442 BAU/mL at 6 months post-vaccination ( P < 0.001, n =187), and that boosting increases S-specific IgG BAU. While only 5 of 39 participants had detectable anti-Omicron neutralizing activity 1 month after 2 vaccinations, booster vaccination resulted in detectable neutralizing activity for all participants. Conclusion. Asymptomatic infection is likely rare, that there is no relationship between vaccine-associated symptom severity and antibody titers 1 month after the 2nd vaccination, and that booster results in better protection against the Omicron variant. Ongoing studies are evaluating serological and cellular immune responses immediately prior to 38 breakthrough infections in an attempt to identify immune correlates of protection and will be reported at the conference.

SARS-CoV-2 infection is associated with decreased reported physical fitness in a US military longitudinal cohort

Background. COVID-19 may have deleterious effects on the fitness of active duty US military service members. We seek to understand the long-term functional consequences of SARS-CoV-2 infection in this critical population, and in other military healthcare beneficiaries. Methods. The Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) study is a longitudinal cohort study to describe the outcomes of SARS-CoV-2 infection in US Military Health System beneficiaries. Subjects provided information about difficulties experienced with daily activities, exercise, and physical fitness performance via electronic surveys. Subjects completed surveys at enrollment and at 1, 3, 6, 9, and 12 months. Results. 5,910 subjects completed survey fitness questions, 3,244 (55%) of whom tested SARS-CoV-2 positive at least once during the period of observation. Over 75% of subjects were young adults and over half were male (Table 1). 1,093 (34.3%) of SARS-CoV-2-positive subjects reported new or increased difficulty exercising compared to 393 (14.8%) SARS-CoV-2 negative subjects (p < 0.01) (Table 2). The most commonly reported symptoms related to problems with exercise and activities were dyspnea and fatigue.Among the active-duty members who answered the question about their service-mandated physical fitness test scores, 43.2% of SARS-CoV-2-positive participants reported that their scores had worsened in the study period, compared with 24.3%of SARS-CoV-2 negative participants.Among SARS-CoV-2-positive subjects, reports of difficulty exercising and performing daily activities were highest within one month of the first positive test, decreasing in prevalence among the cohort only slightly to 24% and 18%, respectively, at 12 months (Figure 1). Conclusion. A substantial proportion of military service-members in this cohort have reported impairment of their service-mandated physical fitness scores after COVID-19;this proportion is significantly higher than those who are SARS-CoV-2 negative and persists to 12 months in many;similar complaints were reported among non-active duty. Further objective evaluation of post-COVID fitness impairment in this population is warranted. (Figure Presented).

Humoral immune responses to COVID-19 vaccines are reduced in patients with severe asthma

BackgroundPatients with severe asthma (SA) may be at higher risk of severe COVID-19 (C-19) illness. C-19 vaccines aim to reduce number and severity of infections. Patients with SA are often treated with maintenance oral corticosteroids (mOCS) and/or biologics- it is unknown if vaccines will generate the same protective responses in patients with SA on such therapies.AimsTo compare magnitude and range of post-vaccination (PV) antibody responses (IgG) in patients with SA on biologics, mOCS or high-dose inhaled corticosteroids (ICS) with healthy controls (HC) without asthma.To review temporal trends in PV IgG in patients with SAMethodsThe Virtus finger-prick quantitative C-19 antibody test was used to detect IgG levels 16–24 weeks post second-dose of the C-19 vaccine (123 AstraZeneca, 56 Pfizer, 5 Moderna). PV IgG levels were also measured in a subset of patients 6 weeks PV. IgG>0.2 AU was considered positive with range: very high >1.25 AU, high 0.751–1.25 AU, medium 0.401–0.75 AU and low 0.201–0.4 AU. SA was defined as per ATS/ERS criteria.ResultsPV IgG results were obtained from 127 patients with SA (84 on biologics, 13 mOCS and 46 ICS) and 57 HC. After adjusting for age, significantly fewer people with SA compared to HC had a positive PV IgG result (81% vs 95% p=0.016). Compared to HC (1.24 AU), lower median IgG levels were seen in patients on high dose ICS (1.02 AU, p=0.033) and mOCS (0.40 AU, p=0.017).Patients on biologics had high or very high IgG levels (omalizumab n=25, 0.80 AU;mepolizumab n=25, 1.07 AU;benralizumab n=34, 1.11 AU).Paired temporal measurements in 37 SA patients showed regression coefficient -0.005 (95%CI -0.006,-0.003) and can be interpreted as IgG decreases, on average, by 0.15 AU per month.ConclusionOverall, a higher proportion of patients with SA had a negative PV IgG level after receiving 2 doses of a C-19 vaccine. This was mainly seen in patients on mOCS while biologic use was not associated with reduced humoral antibody response. These results reinforce the need for booster vaccines in SA, especially in those on mOCS.

A Health Inequalities Impact Assessment of the surveillance of COVID-19 in asymptomatic patients attending dental settings in Scotland.

INTRODUCTION: A key aspect of the public health response to COVID-19 in Scotland was enhanced community surveillance, including testing in dental settings. Across Scotland, dental settings offered patients over 5-years-old the opportunity to participate in community surveillance of COVID-19. METHODS: A Health Inequalities Impact Assessment (HIIA) was conducted to understand the differential impacts the programme would have on the population and to improve the accessibility of the programme. HIIA is a tool to allow the assessment, understanding, and mitigation of impacts on people of a proposed policy or practice. It fulfils an organisational duty to meet the requirements of the Equality Act and Fairer Scotland Duty. The HIIA was conducted rapidly in parallel with the programme development. An action research approach included an online workshop, consultation, review of population data and a literature search. RESULTS: Adjustments were required to improve the programme's accessibility. Stakeholders, including dental teams from across Scotland were involved in the consultation and brought their front-line experience in different settings. Common issues identified included digital literacy and access, language and cultural barriers to participation, and issues relating to the implications of a positive COVID-19 result. Literature indicated limited evidence on the acceptability, accessibility, and equity of asymptomatic COVID-19 surveillance. CONCLUSION: This HIIA was conducted during the COVID-19 pandemic. As an example of good practice in tackling inequalities in access to programmes it should represent the benchmark for other similar initiatives.

IMPACT OF EDUCATIONAL ACTIVITIES, DEDICATED RAPID RESPONSE TEAMS, AND QUALITY CASE REVIEWS ON IN-HOSPITAL CARDIAC ARREST

SESSION TITLE: Lifelong Learning in Critical Care SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Physiological instability occurs several hours prior to in-hospital cardiac arrest. Delays in early intervention is associated with an increase in morbidity, mortality and the incidence of in-hospital cardiac arrest [1]. Improving health care quality through the deployment of a rapid response team was recommended in 2004 by the Institute for Healthcare Improvement through the ‘100,000 Lives Campaign’ [2]. METHODS: Cleveland Clinic Fairview Hospital, one of the largest academic centers of the Cleveland Clinic Health Care System, appointed a dedicated daytime Rapid Response Registered Nurse in 2016, and in 2017 the above coverage was expanded to the night and week-end shifts. In 2019 a dedicated Internal Medicine Residents team took the lead of the Rapid Response and Code Blue team. Starting in 2017 monthly unannounced Rapid Response and Code Blue educational simulation cases were implemented, and in 2020 a dedicated simulation Lab provided immersive leaning experience to healthcare practitioners. In 2018 a centralized Code Blue event ion by the Quality Data Registry begun and in 2020 monthly events review helped improve the quality of cardiopulmonary resuscitation with valuable feedback provided to caregivers. Also, in 2020 the Cleveland Clinic Health Care System Resuscitation Operations Council was formed, where representatives from each hospital shared experience and quality initiatives. The above helped with the standardization of care across the 21 hospitals of the Cleveland Clinic Enterprise. RESULTS: Across five years of quality initiatives and consolidation of our rapid response response team from 2016 to 2021, the number of Rapid Responses increased by 104 % from 704 events in 2015 to 1438 in 2021. At the same time, the number of Code Blue events decreased by 56.5% from 283 in 2015 to 123 in 2021 and the number on non-critical care medical and surgical units decreased by 48.9% from 45 to 23 cases per year. The above was seen despite a significant increase in the hospital patient census, and the Coronavirus Infectious Disease 19 Pandemic where Fairview Hospital served as a tertiary referral center for all North Central and North Western Ohio. These results confirm prior published data on the subject where not only a focused rapid response team but also educational, simulation and case review activities are all associated with a reduced incidence of unexpected cardiac arrest [3-9]. CONCLUSIONS: A dedicated Rapid Response and Code Blue team, Simulation in education, and frequent quality review of cardiac arrest cases are all strategies that reduce the incidence of in hospital cardiac arrest. Future research is needed to highlight the impact of each of those quality and educational initiatives on outcomes and performance. CLINICAL IMPLICATIONS: Educational Activities, Dedicated Rapid Response Team and Quality Case Reviews decreases the incidence of In-Hospital Cardiac Arrest. DISCLOSURES: No relevant relationships by Francois Abi Fadel No relevant relationships by Lauren Crosby no disclosure on file for Megan Edwards;no disclosure on file for June McMahan;no disclosure on file for Patrick Murphy;No relevant relationships by Kelly Orlosky No relevant relationships by Anoosha Tauquir

The impact of the novel Coronavirus on migrant workers in the GCC countries

This research tracks the evolution of GCC government policies address-ing SARS-CoV-2 in the region and the impact of those policies on migrant workers. Several broad conclusions are drawn. First, is to note a serious failure of all government and international agencies (countries of origin, countries of residence, and relevant UN agencies) to protect the rights of migrant workers in the GCC. Secondly, although some GCC countries (e.g., Qatar) attempted to guarantee at least partially the rights of migrant workers, the implementation relied on employers/sponsors. Thus, these attempts largely failed, leaving many migrants without wag-es, without food, and even without accommodation. The third conclusion is that national policies for workers’ paid leave (if unwell or with symp-toms) were openly discriminatory – usually excluding foreign workers. © 2022, Fondazione Centro Studi Emigrazione. All rights reserved.

DIFFERENCES IN ACUTE ALCOHOL-RELATED HEALTHCARE UTILIZATION COMPARING BEFORE AND DURING THE COVID-19 PANDEMIC

Background: Data have shown an increase in alcohol use during the COVID-19 pandemic in North America. While the total number of emergency department (ED) visits decreased during the early pandemic, some studies show that the proportion of alcohol-associated visits increased during this time. There is otherwise a paucity of data on how potentially increased alcohol use during the pandemic has affected healthcare utilization and patient outcomes, especially in patients with liver disease. Methods: Clinical records from a tertiary hospital in Ontario, Canada were reviewed for all adult patients encounters in the ED, urgent care, or inpatient setting for alcohol-associated reasons between April 2019 and October 2019 (pre-pandemic cohort) and between April 2020 and October 2020 (pandemic cohort). Data collected included: age, sex, marital status, rurality and socioeconomic status (by postal code-linked national census data), medical history, alcohol consumption habits, use of medications for alcohol use disorder, alcohol-associated diagnosis (based on ICD-10 code), need for intensive care unit admission, consultations made, discharge disposition, and laboratory results. Bivariate chi-squared analysis was performed to compare data from the pre-pandemic and pandemic cohorts. Results: 528 records in the pre-pandemic cohort and 490 records in the pandemic cohort were ed and summarized (Tables 1 and 2). As compared with the pre-pandemic cohort, patients during the pandemic presenting with alcohol-associated diagnoses were older (43 years, IQR 31-57 vs. 38 years, IQR 24-55;p<.001), more likely to be male (66% vs. 55%;p=.001), have a prior history of habitual heavy alcohol use or alcohol use disorder (77% vs. 63%;p<.001), have a history of a psychiatric disorder (56% vs 46%;p=.003), and to have been previously prescribed medication for alcohol use disorder (18% vs. 5%;p<.001). In the pandemic cohort, there was a greater proportion of encounters for alcohol withdrawal (32% vs. 22%;p=.001), a lower proportion of encounters for alcohol intoxication (46% vs. 56%;p<.001), and a similar proportion of encounters for alcohol-associated liver disease (8% vs. 7%;p=.651) compared to the pre-pandemic cohort. Conclusion: Our data show differences in patient characteristics for patients presenting to hospital for alcohol-associated reasons during the COVID-19 pandemic. As compared with the year before the pandemic, patients were older, more often male, and more likely to have history of psychiatric disorders or heavy alcohol use. One concerning finding was a significant rise in alcohol withdrawal, which could potentially be due to increased consumption of alcohol during the pandemic. These data raise concern for an increase in prevalence of alcohol-associated liver disease in the future, highlighting the need for enhanced alcohol addiction services. (Table Presented)

Neuroscience emergencies simulation teaching

Objectives: Simulation sessions were designed and introduced into the Cardiff University Clinical Neurosciences placement for 4th-year medical students. We present our approach to delivering these simulation sessions, student feedback and our recent experience in the context of the COVID19 pandemic. Design: Three emergency clinical neuroscience simulation scenarios were designed, aimed at final phase (Year 4-5) medical students. Subjects: Final phase (Year 4-5) medical students. Methods: The sessions are delivered weekly during the academic year by the Clinical Neurosciences teaching fellows at The University Hospital of Wales, (UHW) to groups of sixeight students. Student pairs work through each scenario in a high-fidelity simulation suite under the guidance of the tutor. Observing students remain engaged through participation as patient relatives or medical colleagues. Upon completion, learners are debriefed using the Pendleton Model for feedback/reflection, and anonymised feedback is then collected. Results: One year of collated feedback revealed that 90% (109/122) of respondents strongly stated that the sessions were enjoyable, achieved the desired learning outcomes, and advanced their clinical knowledge. One hundred percent of respondents (122/122) agreed that the sessions improved their confidence at managing medical emergencies. Due to the COVID19 pandemic, session modifications included: a larger simulation suite to facilitate social distancing;procurement of appropriate personal-protective-equipment, and a reduction in session size, (<6 students) offset by higher session frequency. Conclusions: Simulation sessions provide a safe, structured environment in which learners can gain confidence managing emergencies. Feedback confirms that our sessions achieve these goals for most students. The possibility of further restrictions on students' exposure to patients remains high due to rising medical student numbers and potential COVID19 resurgences. There may thus be a need to expand the volume and scope of these simulations to cover more scenarios and broader learning outcomes, to ensure future students gain necessary skills and confidence to manage neurological emergencies.

Echinacea purpurea for the Prevention and Treatment of Viral Respiratory Tract Infections including SARS-CoV-2: an Openlabel RCT

Methods: Open-label randomized clinical trial to investigate preventive and therapeutic effects of EF extract. Healthy volunteers (18 - 75 years) were to take either 2400mg/d over 5 months or received no treatment. Nasal and oropharyngeal swabs as well as blood samples were collected routinely for detection of a broad spectrum of viruses, including SARS-CoV-2. Additional swabs were taken during acute respiratory episodes, when EF dosing was increased to 4000mg/d for up to 10 days. Results: N=120 adults were randomized and treated in Sofia, Bulgaria between November 2020 and May 2021. Over 5months, 21 and 29 samples tested positive for any virus in the EF and control group (difference n.s.), of which 5 and 14 samples were SARS-CoV-2 positive (RR=0.37, Chi-square test, p=0.03). Overall, 10 symptomatic episodes occurred with EF, resp. 14 in the control group (difference n.s.) of which 5 and 8 were COVID-19 (RR=0.70, p>0.05). Treatment with EF during acute episodes reduced the overall virus load by at least 2.12 log10 or approx. 99% (p<0.05, t-test), as well as the time to virus clearance by 8.0 days for all viruses (p=0.02,Wilcoxon test) resp. by 4.8 days for SARS-CoV-2 (p>0.05) in comparison between groups. EF significantly reduced fever days (1 vs. 11 days, p=0.003, chi square test). Background: Although quite a few plants claim preventive and/ or therapeutic effects against SARS-CoV-2, only few [RS1] have been investigated in clinical trials. A 65% ethanolic extract from fresh Echinacea purpurea (95% aerial parts and 5% root, Echinaforce® [EF]) licensed as drug in Switzerland, has documented anti-viral effects in former clinical trials, i.a. against various coronavirus strains. Conclusion: EF extract reduced the risk of viral RTIs, including those caused by SARS-CoV-2 and substantially decreased virus loads in infected subjects. It might offer a supportive option to existing preventive and therapeutic measures.

Melville’s Anatomies Two Decades Later: A Forum

Melville scholars gathered virtually as part of the 2021 American Literature Association Conference to celebrate and re-assess the contribution made by a landmark volume in late twentieth-century scholarship on Melville, Samuel Otter’s Melville’s Anatomies (1999). The roundtable had initially been planned as a face-to-face contribution to the 2020 ALA Conference, which was cancelled due to COVID, and so the scholars who had initially meant to discuss Otter’s book near the occasion of the twentieth anniversary of its publication found that their conversations had to be delayed by a year. We offer the full reflections of the six scholars who discussed the volume in hopes that this can serve as a model for future reflections on landmarks of Melville scholarship and major new contributions to the field that can appear in this venue. © 2022 The Melville Society and Johns Hopkins University Press

Biomarker testing in patients (pts) with metastatic colorectal cancer (mCRC): Perspectives from U.S. oncologists (ONC) in rural areas and urban clusters

Background: In the US, pts living in rural areas have higher CRC mortality rates than urban areas. Clinical guidelines recommend testing for BRAF and RAS mutations and deficient mismatch repair/microsatellite instability in pts with mCRC. However, data on biomarker testing rates in rural communities compared with urban areas are limited. We surveyed ONC in the US who practice in rural areas or urban clusters to identify biomarker testing patterns and barriers (data previously reported) and conducted interviews with a select group of respondents to further understand key differences that may contribute to substandard biomarker testing rates in rural areas. Methods: A 2-part (quantitative and qualitative) survey was conducted with ONC who spend > 40% of their time providing direct care to pts in rural areas or urban clusters and who had treated ≥2 pts with stage IV mCRC in the month prior to the survey. After screening, a subset of those who completed the quantitative survey participated in the qualitative survey (a 30- minute, web-assisted, telephone interview). The interview questions targeted 6 areas: clinical practice description, biomarker and genomic testing patterns, pathology and molecular tumor board, tumor tissue journey, electronic health records, and training/educational opportunities. Results: Of the 99 ONC who responded to the quantitative survey, 17 were interviewed for the qualitative survey from June 16-29, 2021. A key finding of the quantitative survey was that although ONC reported being familiar with biomarkers relevant to mCRC, the reported rate of biomarker testing was suboptimal. The interviews probed reasons why testing does not align with current guidelines and found that challenges exist throughout the tumor tissue journey including insufficient tumor tissue available for testing (especially in the relapsed/refractory setting);lack of or limited protocols, clinical decision support systems, reflexive testing, and molecular tumor boards;lengthy and difficult-to-navigate next-generation sequencing reports;and financial toxicity surrounding biomarker tests (especially for underinsured pts), among other barriers. Despite these challenges, ONC reported easy access to third-party reference labs and electronic references, such as NCCN and UpToDate. Although telehealth visits have nearly quadrupled during the COVID pandemic, access to telehealth may be limited for pts living in rural areas or urban clusters. Conclusions: The ONC surveyed reported that practicing in rural/urban clusters poses unique challenges related to tissue acquisition, practice resources, pts' ability to pay, and clinical knowledge gaps that may affect biomarker testing rates in pts with mCRC. Addressing these gaps is warranted if optimal utilization of precision medicine tools is to be realized.

Parental perceptions of the impact of COVID-19 and returning to play based on level of sport

This study examined the impact of COVID-19 on youth sport parents based on competition level to understand how the pandemic affected youth sport and factors associated with youth returning to sport. Survey data were collected from samples of US sport parents in two waves - early in the pandemic (N = 751) and as programs began to resume (N = 707). Data showed elite sport parents were more willing to return. Although most participants returned to play, significant numbers had not resumed participation. Parent comfort was the most important factor associated with resuming. However, parents allowed children to resume play due to perceived external pressure, potentially creating stress among parents regarding sport participation decisions. Attending school in person and household income were associated with the ability to resume sport suggesting the need to provide school sport environments and consider the financial impacts of COVID-19 on sport families.

Improving wellbeing among UK doctors redeployed during thecovid-19 pandemic

Background: In response to the COVID-19, the NHS has implemented significant workforce changes to manage the increased and changing demand on healthcare services. We aimed to investigate the impact of such changes on the wellbeing of redeployed doctors. Method: We conducted a survey at three NHS trusts over 2 weeks during the peak of the pandemic, asking redeployed doctors to rate their morale, work-life balance, perceived support and safety, and to voice concerns. Results: 172 redeployed doctors responded to the survey. On exploring morale, 114 (66.3%) respondents felt confident in their new role, 113 (65.7%) felt satisfied or neutral with their new role and only 54 (31.4%) felt stressed at work. 114 (66.3%) doctors felt valued by their team and 136 (79%) felt valued by the general public. 111 (64.5%) had noticed an increase in the length of breaks and 153 (89%) felt that their rotas provided sufficient respite. 95 respondents (55.2%) did not feel confident in the Public Health personal protective equipment (PPE) guidance and similarly 94 (54.7%) did not feel safe while wearing PPE. The three most common concerns were training opportunities-105 (61%), PPE-99 (57.6%) and family health-95 (55.2%). Conclusions: Our findings suggest that, among the doctors surveyed, morale is higher than might be expected, with doctors feeling valued, confident, and well rested in their new role. Concerns about training opportunities/career progression, PPE and family safety need to be addressed to minimise the adverse effects on doctor's wellbeing due to redeployment.

Engineering Calculus: Fostering Engagement and Understanding in a Virtual Setting

In this paper, we focus on resolving three key challenges during COVID-19 distance learning: engagement, understanding, and assessment. In particular, as a case study for an undergraduate Engineering calculus course, we develop the Desmos activities and the Think Alouds to provide effective solutions for these challenges. © 2020

Rapid Implementation of a Statewide Observational Surveillance System to Monitor Wearing of Face Masks in Public Spaces

This report describes the rapid implementation of a statewide observational surveillance program to monitor the public's wearing of face masks in public spaces during community spread of Coronavirus disease 2019 (COVID-19). It describes how the Hawai'i State Department of Health partnered with University of Hawai'i faculty to develop and implement the surveillance program. The surveillance program involved organizing volunteers to conduct weekly direct observations in designated locations. A smartphone application (app) was created to record real-time observational surveillance data. From September 5, 2020, to March 13, 2021, a total of 84 577 observations were conducted across the state. Eighty-three percent of those observed were correctly wearing a face mask, 7% were wearing a face mask incorrectly, and 10% were not wearing a mask. Following the 2-week pilot phase of the project, volunteers were surveyed regarding facilitators and barriers for conducting observations and motivations for volunteering. Feedback was used to refine project procedures. With few states having implemented such a surveillance program, the information reported in this article may inform communities interested in tracking mask-wearing behaviors in the context of the COVID-19 pandemic.

Utilising the international human rights framework to access the benefits of paediatric research in the covid era: A Wales case study

This article uses Wales as a case study to discuss the challenges to accessing the benefits of paediatric research before and during the Covid-19 pandemic. Due to the rapidly changing political and legislative landscape, it is critical that health professionals working for the benefit of children can utilise international human rights treaties and the most relevant General Comments that offer a bridge between legalistic provisions and practice. Additionally, it is vital for health professionals to interpret and understand domestic children’s rights legislation, including tools for implementation for realising children’s rights. This article shares learning from the Children’s Hospital for Wales, Children and Young Adult Research Unit’s endeavour to challenge the Welsh Government to pay due regard to the rights of the child in ensuring children can access the benefits of paediatric research;including research concerning children’s role in infection and transmission, during the pandemic. © koninklijke brill nv, leiden, 2021