An evaluation of the early impact of the COVID-19 pandemic on Zambia's routine immunization program.

Implications of the COVID-19 pandemic for both populations and healthcare systems are vast. In addition to morbidity and mortality from COVID-19, the pandemic also disrupted local health systems, including reductions or delays in routine vaccination services and catch-up vaccination campaigns. These disruptions could lead to outbreaks of other infectious diseases that result in an additional burden of disease and strain on the healthcare system. We evaluated the impact of the COVID-19 pandemic on Zambia's routine childhood immunization program in 2020 using multiple sources of data. We relied on administrative vaccination data and Zambia's 2018 Demographic and Health Survey to project national disruptions to district-specific routine childhood vaccination coverage within the pandemic year 2020. Next, we leveraged a 2016 population-based serological survey to predict age-specific measles seroprevalence and assessed the impact of changes in vaccination coverage on measles outbreak risk in each district. We found minor disruptions to routine administration of measles-rubella and pentavalent vaccines in 2020. This was in part due to Zambia's Child Health Week held in June of 2020 which helped to reach children missed during the first six months of the year. We estimated that the two-month delay in a measles-rubella vaccination campaign, originally planned for September of 2020 but conducted in November of 2020 as a result of the pandemic, had little impact on modeled district-specific measles outbreak risks. This study estimated minimal increases in the number of children missed by vaccination services in Zambia during 2020. However, the ongoing SARS-CoV-2 transmission since our analysis concluded means efforts to maintain routine immunization services and minimize the risk of measles outbreaks will continue to be critical. The methodological framework developed in this analysis relied on routinely collected data to estimate disruptions of the COVID-19 pandemic to national routine vaccination program performance and its impact on children missed at the subnational level can be deployed in other countries or for other vaccines.

The impact of COVID-19 public health restrictions on particulate matter pollution measured by a validated low-cost sensor network in Oxford, UK

Emergency responses to the COVID-19 pandemic led to major changes in travel behaviours and economic activities with arising impacts upon urban air quality. To date, these air quality changes associated with lockdown measures have typically been assessed using limited city-level regulatory monitoring data, however, low-cost air quality sensors provide capabilities to assess changes across multiple locations at higher spatial-temporal resolution, thereby generating insights relevant for future air quality interventions. The aim of this study was to utilise high-spatial resolution air quality information utilising data arising from a validated (using a random forest field calibration) network of 15 low-cost air quality sensors within Oxford, UK to monitor the impacts of multiple COVID-19 public heath restrictions upon particulate matter concentrations (PM10, PM2.5) from January 2020 to September 2021. Measurements of PM10 and PM2.5 particle size fractions both within and between site locations are compared to a pre-pandemic related public health restrictions baseline. While average peak concentrations of PM10 and PM2.5 were reduced by 9–10 μg/m3 below typical peak levels experienced in recent years, mean daily PM10 and PM2.5 concentrations were only ∼1 μg/m3 lower and there was marked temporal (as restrictions were added and removed) and spatial variability (across the 15-sensor network) in these observations. Across the 15-sensor network we observed a small local impact from traffic related emission sources upon particle concentrations near traffic-oriented sensors with higher average and peak concentrations as well as greater dynamic range, compared to more intermediate and background orientated sensor locations. The greater dynamic range in concentrations is indicative of exposure to more variable emission sources, such as road transport emissions. Our findings highlight the great potential for low-cost sensor technology to identify highly localised changes in pollutant concentrations as a consequence of changes in behaviour (in this case influenced by COVID-19 restrictions), generating insights into non-traffic contributions to PM emissions in this setting. It is evident that additional non-traffic related measures would be required in Oxford to reduce the PM10 and PM2.5 levels to within WHO health-based guidelines and to achieve compliance with PM2.5 targets developed under the Environment Act 2021.

Training the next generation of learning health system scientists.

Introduction: The learning health system (LHS) aligns science, informatics, incentives, stakeholders, and culture for continuous improvement and innovation. The Agency for Healthcare Research and Quality and the Patient-Centered Outcomes Research Institute designed a K12 initiative to grow the number of LHS scientists. We describe approaches developed by 11 funded centers of excellence (COEs) to promote partnerships between scholars and health system leaders and to provide mentored research training. Methods: Since 2018, the COEs have enlisted faculty, secured institutional resources, partnered with health systems, developed and implemented curricula, recruited scholars, and provided mentored training. Program directors for each COE provided descriptive data on program context, scholar characteristics, stakeholder engagement, scholar experiences with health system partnerships, roles following program completion, and key training challenges. Results: To date, the 11 COEs have partnered with health systems to train 110 scholars. Nine (82%) programs partner with a Veterans Affairs health system and 9 (82%) partner with safety net providers. Clinically trained scholars (n = 87; 79%) include 70 physicians and 17 scholars in other clinical disciplines. Non-clinicians (n = 29; 26%) represent diverse fields, dominated by population health sciences. Stakeholder engagement helps scholars understand health system and patient/family needs and priorities, enabling opportunities to conduct embedded research, improve outcomes, and grow skills in translating research methods and findings into practice. Challenges include supporting scholars through roadblocks that threaten to derail projects during their limited program time, ranging from delays in access to data to COVID-19-related impediments and shifts in organizational priorities. Conclusions: Four years into this novel training program, there is evidence of scholars' accomplishments, both in traditional academic terms and in terms of moving along career trajectories that hold the potential to lead and accelerate transformational health system change. Future LHS training efforts should focus on sustainability, including organizational support for scholar activities.

Using Real World Evidence (Rwe) to Assess Drug-Drug Interaction (Ddi) between Paxlovid and the Top 100 Prescribed Drugs in the Us

BACKGROUND: Paxlovid (nirmatrelvir/ritonavir) has received a US Emergency Use Authorization for patients >=12 years with mild-to- moderate COVID-19 at high-risk of progression to severe disease. DDI studies conducted with Paxlovid implicate the PK enhancer ritonavir as the main perpetrator of DDIs. Ritonavir is a potent inhibitor of CYP3A4, CYP2D6, and P-gp. The Paxlovid Fact Sheet1 identifies contraindicated drugs and those with a potentially important interaction. METHOD(S): A retrospective analysis was conducted using RWE from the Optum Clinformatics Data Mart. Patients were identified based on CDC criteria for high-risk COVID-19 and confirmed continuous insurance enrollment from Jan 1 to Dec 31, 2019 with >=1 prescription claim. Excluding non-drug claims (e.g., vaccines), the top 100 drugs were selected and ranked based on total patient counts. DDI potential with Paxlovid was evaluated using US Prescribing and DailyMed Information or relevant literature for each drug. RESULT(S): Of the top 100, 70 drugs are not expected to have a DDI with Paxlovid. These drugs are eliminated unchanged in urine, cleared by enzymes other than CYP3A4 or CYP2D6, are not P-gp substrates, or are cleared by multiple pathways. The remaining 30 drugs expected to have a DDI are represented in the Paxlovid Fact Sheet. The top four drug classes expected to interact with Paxlovid include corticosteroids, narcotic analgesics, anticoagulants, and statins. One drug, simvastatin, is contraindicated. The mechanism of interaction with Paxlovid, or lack thereof, will be presented in detail for each drug. CONCLUSION(S): Paxlovid DDI management is important to ensure the right patients receive this antiviral. This analysis provides an understanding of Paxlovid interactions with the top 100 drugs likely to be used in high-risk COVID-19 patients and serves as an additional DDI management resource.

The Society of Thoracic Surgeons Intermacs 2022 Annual Report: Focus on 2018 Heart Transplant Allocation System.

The thirteenth annual report from The Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) highlights outcomes for 27,314 patients receiving continuous flow durable left ventricular assist devices (LVAD) over the last decade (2012-2021). In 2021, 2,464 primary LVADs were implanted, representing a 23.5% reduction in the annual volume compared to peak implantation in 2019 and an ongoing trend from the prior year. This decline is likely a reflection of the untoward effects of the COVID-19 pandemic and the change in the US heart transplant allocation system in 2018. The last several years have been characterized by a shift in device indication and type with 81.1% of patients now implanted as destination therapy and 92.7% receiving an LVAD with full magnetic levitation in 2021. However, despite an older, more ill population being increasingly supported pre-implant with temporary circulatory devices in the recent (2017-2021) vs prior (2012-2016) eras, the 1- and 5-year survival continues to improve at 83.0% and 51.9%, respectively. The adverse events profile has also improved, with significant reduction in stroke, gastrointestinal bleeding, and hospital readmissions. Finally, we examined the impact of the change in heart transplant allocation system in 2018 on LVAD candidacy, implant strategy, and outcomes. In the competing outcomes analysis, the proportion of transplant eligible patients receiving a transplant has declined from 56.5% to 46.0% at 3 years, while the proportion remaining alive with ongoing support has improved from 24.1% to 38.1% at 3 years, underscoring the durability of the currently available technology.

A Randomized Trial of Mesenchymal Stromal Cells for Moderate to Severe ARDS From COVID-19.

RATIONALE: There are limited therapeutic options for patients with COVID-19-related acute respiratory distress syndrome (ARDS) with inflammation-mediated lung injury. Mesenchymal stromal cells offer promise as immunomodulatory agents. OBJECTIVES: Evaluation of efficacy and safety of allogeneic mesenchymal cells in mechanically-ventilated patients with moderate or severe COVID-induced respiratory failure. METHODS: Patients were randomized to two infusions of 2 million cells/kg or sham infusions, in addition to standard of care. We hypothesized that cell therapy would be superior to sham-control for the primary endpoint of 30-day mortality. The key secondary endpoint was ventilator-free survival within 60 days, accounting for deaths and withdrawals in a ranked analysis. MEASUREMENTS AND MAIN RESULTS: At the third interim analysis, the Data and Safety Monitoring Board recommended that the trial halt enrollment as the pre-specified mortality reduction from 40% to 23% was unlikely to be achieved (n=222 out of planned 300). Thirty-day mortality was 37.5% (42/112) in cell recipients versus 42.7% (47/110) in control patients (RR 0.88;95% CI 0.64,1.21;p=0.43). There were no significant differences in days alive off ventilation within 60 days (median rank 117.3 [IQR:60.0,169.5] in cell patients and 102.0 [IQR:54.0,162.5] in controls; higher is better). Resolution or improvement of ARDS at 30-days was observed in 51/104 (49.0%) cell recipients and 46/106 (43.4%) of control patients (OR 1.36;95% CI 0.57, 3.21). There were no infusion-related toxicities and overall serious adverse events over 30 days were similar. CONCLUSIONS: Mesenchymal cells, while safe, did not improve 30-day survival or 60-day ventilator-free days in patients with moderate/severe COVID-related acute respiratory distress syndrome. Clinical trial registration available at www. CLINICALTRIALS: gov, ID:NCT04371393. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Impacts of COVID-19 Lockdown on Traffic Flow, Active Travel and Gaseous Pollutant Concentrations. Implications for Future Emissions Control Measures in Oxford, UK

The COVID-19 lockdown provided a unique opportunity to test the impacts of changes in travel patterns on air quality and the environment. Therefore, this study provides insights into the impacts of COVID-19 emergency public health "lockdown" measures upon traffic flow, active travel and gaseous pollutant concentrations (NO, NO2 and O3) in Oxford city centre during 2020 using time-series analysis and linear regression methods. Comparisons of traffic counts indicated pronounced changes in traffic volume associated with national lockdown periods. Car volume reduced by 77.5% (statistically significant) during the first national lockdown, with lesser changes in goods vehicles and public transport (bus) activity during the second lockdown. Cycle flow reduced substantively during the first lockdown only. These changes resulted in a reduction in nitric oxide (NO) and nitrogen dioxide (NO2) concentrations of 75.1% and 47.4%, respectively, at roadside, and 71.8% and 34.1% at urban background during the first lockdown period. In contrast ozone (O3) concentrations increased at the urban background site by 22.3% during the first lockdown period, with no significant changes in gaseous concentrations during the second lockdown at either roadside or urban background location. The diurnal pattern of peak mean NO and NO2 concentrations reduced in magnitude and was shifted approximately 2 h earlier in the morning and 2 h later in the evening (roadside) and 3 h earlier in the morning and 3 h later in the evening (urban background). Our findings provide an example of how gaseous air quality in urban environments could respond to future urban traffic restrictions, suggesting benefits from reductions in peak and daily NO2 exposures may be offset by health harms arising from increases in ground level O3 concentrations in the summer months.

Domestic fuel affordability and accessibility in urban Rwanda' policy lessons in a time of crisis?

Background Cooking fuel choice and fuel switching behaviours can be influenced by both social and economic contextual factors;with implications for household air pollution exposure. The Rwandan Government have recently proposed a charcoal sale ban to reduce domestic reliance upon charcoal fuels and reduce associated respiratory health harms. Methods A semi-structured mobile telephone survey administered to 85 participants in an informal settlement in Kigali, Rwanda to identify (i) fuel switching as a result of COVID-19 emergency health protection ‘lockdown’ measures (ii) awareness of proposed charcoal sale restrictions and willingness to pay for alternative domestic cooking fuels. Results Of the 85 interviewed participants, 15 (17.6 %) reported a change in primary cooking fuel since the first national COVID-19 emergency ‘lockdown’ period (March – May), with Liquid Petroleum Gas (LPG) users moving to charcoal (n = 3;20 %), and charcoal users to firewood (n = 7;46.7 %) or LPG (n = 4;26.7 %) and one firewood user to charcoal (n = 1;6.6 %). Awareness of the forthcoming LPG subsidy (81.5 %) and charcoal ban policy proposals was high among all participants (81.5 %), with 90.7 % indicating they would change their cooking fuel as a consequence. LPG was the preferred alternative fuel of choice (89.8 %), with cost, ease of use and cleanliness reported as rationale. Forty-four percent of participants reported a willingness to pay less, 38 % to pay the same and 25 % to pay more than their current cooking fuel expenditure for a cleaner alternative fuel. Conclusion Domestic fuel switching as a result of economic and energy market volatility, was observed in an informal settlement in urban Rwanda as a consequence of COVID-19 emergency measures, most notably by substitution of firewood for charcoal, reflecting a regressive step in the energy ladder. Our findings demonstrate a high level of awareness and engagement with forthcoming domestic fuel policy changes in Kigali, and a large proportion of those interviewed would consider transition to cleaner domestic energy sources. This novel primary research has implications for developing domestic energy resilience to disruptive economic impacts and ensuring effective clean fuel policy implementation in East Africa.

Missing Care: the Initial Impact of the COVID-19 Pandemic on CKD Care Delivery.

BACKGROUND: Chronic kidney disease (CKD) is a common condition with adverse health outcomes addressable by early disease management. The impact of the COVID-19 pandemic on care utilization for the CKD population is unknown. OBJECTIVE: To examine pandemic CKD care and identify factors associated with a high care deficit. DESIGN: Retrospective observational study PARTICIPANTS: 248,898 insured individuals (95% Medicare Advantage, 5% commercial) with stage G3-G4 CKD in 2018 MAIN MEASURES: Predicted (based on the pre-pandemic period of January 1, 2019-February 28, 2020) to observed per-member monthly face-to-face and telehealth encounters, laboratory testing, and proportion of days covered (PDC) for medications, evaluated during the early (March 1, 2020-June 30, 2020), pre-vaccine (July 1, 2020-December 31, 2020), and late (January 2021-August 2021) periods and overall. KEY RESULTS: In-person encounters fell by 24.1% during the pandemic overall; this was mitigated by a 14.2% increase in telehealth encounters, resulting in a cumulative observed utilization deficit of 10% relative to predicted. These reductions were greatest in the early pandemic period, with a 19.8% cumulative deficit. PDC progressively decreased during the pandemic (range 9-20% overall reduction), with the greatest reductions in hypertension and diabetes medicines. CKD laboratory monitoring was also reduced (range 11.8-43.3%). Individuals of younger age (OR 1.63, 95% CI 1.16, 2.28), with commercial insurance (1.43, 95% CI 1.25, 1.63), residing in the Southern US (OR 1.17, 95% CI 1.14, 1.21), and with stage G4 CKD (OR 1.21, 95% CI 1.17, 1.26) had greater odds of a higher care deficit overall. CONCLUSIONS: The early COVID-19 pandemic resulted in a marked decline of healthcare services for individuals with CKD, with an incomplete recovery during the later pandemic. Increased telehealth use partially compensated for this deficit. The downstream impact of CKD care reduction on health outcomes requires further study, as does evaluation of effective care delivery models for this population.

An evaluation of the early impact of the COVID-19 pandemic on Zambia's routine immunization program (preprint)

Implications of the COVID-19 pandemic for both populations and healthcare systems are vast. In addition to morbidity and mortality from COVID-19, the pandemic also has disrupted local health systems, including reductions or delays in routine vaccination services and catch-up vaccination campaigns that could lead to outbreaks of other infectious diseases that result in an additional burden of disease and strain on the healthcare system. We evaluated the impact of the COVID-19 pandemic on Zambia's routine childhood immunization program in 2020 using multiple sources of data. We relied on district-level administrative vaccination coverage data and Zambia's 2018 Demographic and Health Survey to project disruptions to routine childhood vaccination within the pandemic year 2020 (N=5,670). Next, we leveraged serological data to predict age-specific measles seroprevalence and assessed the impact of changes in vaccination coverage on measles outbreak risk in each district. We found minor disruptions to routine administration of measles-rubella and pentavalent vaccines in 2020. This was in part due to Zambia's Child Health Week held in June of 2020 which helped to reach children missed during the first six months of the year. We estimated that the two-month delay in a measles-rubella vaccination campaign, originally planned for September of 2020 but conducted in November of 2020 as a result of the pandemic, had little impact on modeled district-specific measles outbreak risks. The pandemic only minimally increased the number of children missed by measles-rubella and pentavalent vaccines in 2020. However, the ongoing SARS-CoV-2 transmission since our analysis concluded means efforts to maintain routine immunization services and minimize the risk of measles outbreaks will continue to be critical. Fortunately, the methodological framework developed in this analysis relied on routinely collected data and can be used to evaluate COVID-19 pandemic disruptions in Zambia following 2020 and in other countries or for other vaccines at a sub-national level.

Impacts of COVID-19 lockdown on traffic flow, active travel and gaseous pollutant concentrations; implications for future emissions control measures in Oxford, UK (preprint)

This study provides valuable insight into impacts of COVID-19 emergency public health “lockdown” measures upon traffic flow, active travel and gaseous pollutant concentrations (NO, NO2, and O3) in Oxford city centre during 2020. Comparisons of traffic counts indicated pronounced changes in traffic volume associated with national lockdown periods. Car volume reduced by 77.5% (statistically significant) during the first national lockdown, with lesser changes in goods vehicles and public transport (bus) activity during the second lockdown. Cycle flow reduced substantively during the first lockdown only. These changes resulted in a reduction in nitric oxide (NO) and nitrogen dioxide (NO2) concentrations of 75.1% and 47.4%, respectively at roadside, and 71.8% and 34.1% at urban background during the first lockdown period. In contrast ozone (O3) concentrations increased at the urban background site by 22.3% during the first lockdown period, with no significant changes in gaseous concentrations during the second lockdown at either roadside or urban background location. The diurnal pattern of peak mean NO and NO2 concentrations reduced in magnitude and was shifted approximately 2 hours earlier in the morning and 2 hours later in the evening (roadside) and 3 hours earlier in the morning and 3 hours later in the evening (urban background). Our findings provide an example of how gaseous air quality in urban environments could respond to future urban traffic restrictions, suggesting benefits from reductions in peak and daily NO2 exposures may be offset by health harms arising from increases in ground level O3 concentrations in the summer months.

Heritage questing with Virginia Woolf: UCL Institute of Archaeology's 'spirit of place' and new pedagogies of the pandemic

This article charts a particular journey of discovery - that of 'heritage questing with Virginia Woolf. We explore how, against the backdrop of COVID-19, the Master's in Cultural Heritage Studies (MACHS) adopted and adapted Virginia Woolf as an efficacious 'ancestor figure' around which staff and students were able to grasp, engage with, articulate and try to understand the extraordinary experiences and challenges faced throughout the academic year. Woolf emerged as the shared conduit and portal by which MACHS in 'diaspora' could imaginatively connect with, collectively tap into and add new layers to the Institute of Archaeology (IoA)'s 'spirit of place' in Bloomsbury. In what follows, our article draws on a co-ethnography of these experiences which, in turn, we juxtapose alongside Virginia Woolf s own literary insights. Writ large, our journey sees us critically reflect upon attempts to navigate the unknown currents and trajectories of living, teaching and learning in times of coronavirus within which Woolf emerged as a lighthouse of sorts. Writ larger still, we see our quest as a means to grasp the 'new pedagogies of the pandemic' that materialised as an outcome of the impacts and experiences of coronavirus. Ultimately these were also seized upon as a means of taking forward the shared promise of fulfilment, in terms of shaping such quests into liveable presents and better futures as well as adding new layers to the IoA's stratigraphy.

Women’s Perceptions and Attitudes to Household Air Pollution Exposure and Capability to Change Cooking Behaviours in Urban Rwanda

Household air pollution (HAP) from cooking on biomass fuel presents significant health, environmental and socioeconomic consequences worldwide. However, there is a lack of understanding of the factors influencing cooking behaviours that affect HAP exposure in Rwanda (e.g., cooking location, removing children from the cooking area). Sixteen qualitative in-depth interviews were undertaken with women living in an underprivileged neighbourhood in Kigali, Rwanda. Deductive thematic analysis was carried out using the Behaviour Change Wheel (Capability—ability to engage with chosen activity, Opportunity—factors which are beyond the individual’s control and Motivation—brain processes which direct behaviour: COM-B) to determine the thoughts and perceptions around cooking location and removing children from the cooking area. Facilitators and barriers were subsequently identified within the COM-B framework for the following HAP mitigation interventions: outdoor cooking, removing children from the cooking area and Liquid Petroleum Gas (LPG) use. Of the 16 interviewed, 12 cooked outdoors (75%), two (12.5%) cooked indoors (in the main home) and two (12.5%) in a separate kitchen. Despite the majority cooking outdoors, this was reported not to be a favourable cooking location. Levels of awareness of HAP sources and knowledge of the health effects of air pollution were observed to be limited, reducing women’s capability to change, along with stated barriers of cost, housing constraints and safety. Factors out of the individuals’ control (opportunities) included weather, socio-economic and educational factors. Preconceived beliefs, experiencing smoke reduction and the briefly described short-term health effects, directed motivation. Furthermore, participants identified a need for community-based education as a facilitator to changing their behaviour. Despite a high level of observed motivation towards reducing HAP exposure, many women lacked the capability and opportunity to change their behaviour. There are research and policy implications concerning development of community-based interventions which involved end-users and relevant stakeholders in the development process.

Twelfth Interagency Registry for Mechanically Assisted Circulatory Support Report: Readmissions After Left Ventricular Assist Device.

The twelfth annual report from The Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) highlights outcomes for 26 688 continuous-flow left ventricular assist device (LVAD) patients over the past decade (2011-2020). In 2020, we observed the largest drop in yearly LVAD implant volumes since the registry's inception, which reflects the effects of the COVID-19 pandemic on cardiac surgical volumes in the United States. The 2018 heart transplant allocation policy change in the United States continues to affect LVAD implantation volumes and device strategy, with 78.1% of patients now receiving LVAD implants as destination therapy. Despite an older and sicker patient cohort, survival in the recent era (2016-2020) at 1 and 2 years continues to improve at 82.8% and 74.1%. Patient adverse event profile has also improved in the recent era, with significant reductions in stroke, gastrointestinal bleeding, infection, and device malfunction/pump thrombosis. Finally, we review the burden of readmissions after LVAD implant and highlight an opportunity to improve patient outcomes by reducing this frequent and vexing problem.

Impacts of emergency health protection measures upon air quality, traffic and public health: evidence from Oxford, UK.

Emergency responses to the COVID-19 pandemic led to major changes in travel behaviours and economic activities in 2020. Machine learning provides a reliable approach for assessing the contribution of these changes to air quality. This study investigates impacts of health protection measures upon air pollution and traffic emissions and estimates health and economic impacts arising from these changes during two national 'lockdown' periods in Oxford, UK. Air quality improvements were most marked during the first lockdown with reductions in observed NO2 concentrations of 38% (SD ± 24.0%) at roadside and 17% (SD ± 5.4%) at urban background locations. Observed changes in PM2.5, PM10 and O3 concentrations were not significant during first or second lockdown. Deweathering and detrending analyses revealed a 22% (SD ± 4.4%) reduction in roadside NO2 and 2% (SD ± 7.1%) at urban background with no significant changes in the second lockdown. Deweathered-detrended PM2.5 and O3 concentration changes were not significant, but PM10 increased in the second lockdown only. City centre traffic volume reduced by 69% and 38% in the first and second lockdown periods. Buses and passenger cars were the major contributors to NO2 emissions, with relative reductions of 56% and 77% respectively during the first lockdown, and less pronounced changes in the second lockdown. While car and bus NO2 emissions decreased during both lockdown periods, the overall contribution from buses increased relative to cars in the second lockdown. Sustained NO2 emissions reduction consistent with the first lockdown could prevent 48 lost life-years among the city population, with economic benefits of up to £2.5 million. Our findings highlight the critical importance of decoupling emissions changes from meteorological influences to avoid overestimation of lockdown impacts and indicate targeted emissions control measures will be the most effective strategy for achieving air quality and public health benefits in this setting.

Iron deficiency anaemia in inflammatory bowel disease: Diagnosis, quality of life and iron treatment preferences among european patients

Introduction: Iron-deficiency anaemia (IDA) is a major complication in inflammatory bowel disease (IBD). Aims & Methods: A European patient survey was conducted to analyse the IDA diagnostic journey and the impact of IDA on patients' quality of life (QoL). This quantitative survey was conducted in the UK, Spain, Italy and Germany between 28 May and 24 August 2020. The questions had been pre-validated by patients in an initial qualitative research phase. Adult patients with IDA associated with IBD and current or last haemoglobin level(s) greater than 8 g/dl, or IDA perceived to be mild or moderate were included. Patients on ferric maltol were excluded due to focus on traditional iron therapies. Selected Short Form-36 measures were used to assess the QoL. Results are presented as the percentage of respondents. Results: A total of 173 patients were included (54% female;98% aged ≤67 years). For months before their IDA diagnosis, most patients experienced IDA symptoms such as extreme fatigue 57%, weakness 45%, headache/ dizziness 38% and sleeping difficulty 36%. IDA was typically diagnosed during either regular IBD check-ups or when the patient asked about their symptoms (37% each). Patients felt limited in carrying out daily activities such as running (77%), climbing stairs (65%), or walking more than a mile (64%). As a result of being fatigued, most patients (58%) also felt limited in their ability to complete work or college/university activities. Initially most patients (66%) received oral iron, and 34% received intravenous iron (IV). At the time of the survey, 71% were receiving oral iron and 28% IV iron. In 27% patients, side-effects with both oral and IV irons were the main challenge with IDA treatment. The three most frequently experienced side-effects were, with oral iron: black faeces 42%, stomach pain 37% or constipation 30%;and with IV iron: diarrhoea 23% or headache 21%. One in two patients had to wait 2 or more weeks to start their IV treatment. Once given, 57% patients had to return at least every 1-2 months for new IV iron injections. The majority patients who experienced both oral and IV therapies preferred oral treatments over IV (59% versus 41%). Homebased administration was the predominant reason (by 50%) for oral treatment preference. Most patients (64%) who preferred IV treatment valued fewer side-effects versus oral iron. Conclusion: Patients with IBD and IDA are limited in their daily activities. Enduring IDA symptoms such as extreme fatigue often precede and trigger the IDA diagnosis. While challenges remain with both oral and IV irons, oral iron tablets are preferred due to home-based administration. The ongoing COVID pandemic may thus increase the demand for better oral iron treatments of IDA in patients with IBD.