Continuity of cancer care: The surgical experience of two large Cancer Hubs in London and Milan

Introduction: A better understanding of the reality for cancer patients during COVID-19 will help us readapt current predication models. To further inform future clinical guidelines, we need a deep dive into rich data sources from apex Cancer Centres. We report on the outcomes of cancer patients receiving radical surgery between March-September 2020 (as well as 2019) in the European Institute of Oncology (EIO) in Milan and the South East London Cancer Alliance (SELCA). Methods: IEO is one of the largest cancer hospitals in Italy. SELCA includes 3 major hospital trust, treating about 8,000 new cancer patients per annum. Both institutions implemented a COVID-19 minimal pathway, whereby patients were required to shield for 14 days prior to admission and were swabbed for COVID-19 within 3 days of surgery. Positive patients had surgery deferred until a negative swab. Surgical outcomes assessed were: ASA grade, surgery time, theatre time, ICU stay>24h, pneumonia, length of stay (LOS), and admissions. For COVID-19, we focused on infection rate and mortality. Results: At IEO the number of radical surgeries (270 for gynaecological, 339 for head and neck, 377 for thoracic, and 491 for urological cancers) declined by 6% as compared to the same period in 2019 (n=1477 vs 1560). The main decline was observed for thoracic surgery (377 vs 460, i.e. -18%). Age, sex, SES, ethnicity, comorbidities, and performance status were all comparable between both periods (e.g. 58% male, 38% aged 70+, 48% high SES, 15% with existing cardiovascular diseases). Readmissions were required for 39%, and <1% (n=9) developed COVID-19, of which only 1 had severe disease and died. 11 died of other causes during follow-up (1%). At SELCA, the number of radical surgeries (321 for breast, 129 for colorectal, 114 for gynaecological, 152 for head and neck, 92 for liver, 56 for plastics/skin, 305 for thoracic, 72 for upper gastrointestinal, and 312 for urology) declined by 29% (n=1553 vs 2182). Even though a different geographical setting, characteristics were fairly comparable with the IEO: 58% males, 30% aged 70+, 34% high SES, 16% with existing cardiovascular diseases. Readmissions were required for 22%, <1% (n=7) developed COVID-19, and none died from it. 19 died of other causes within 30 days (1%). Conclusion: Milan and London were both at the epicentre of the first COVID-19 wave. Whilst a decline in number of surgeries was observed, the implemented COVID-19 minimal pathways have shown to be safe for cancer patients requiring radical treatment, with limited complications and almost no COVID-19 infections.

Schooling, Interrupted: A Critical Account of Motivation and Education During the First Wave of the COVID-19 Pandemic in Quebec

Among the concerns about youth wellbeing during the COVID-19 pandemic, one well-documented impact is youth motivation, particularly in relation to schooling. Yet many questions remain: How are youth experiencing motivation? What factors affect their motivation? How are youth differentially experiencing motivation? This article addresses young people’s experiences of motivation during the first wave of the pandemic as explored through participatory visual research. In Spring 2020, the Quebec private and public secondary school systems responded very differently to school closures. Private schools pivoted to distance learning within about two weeks, whereas public schools took almost two months to provide formal instruction. Bringing youth’s accounts of motivation into conversation with youth’s concerns about the inequities across the private and public school systems offers a rich opportunity to revisit Self-Determination Theory as an established theory of motivation. Youth’s analyses urge us to revisit the conceptualization of “structure”within this theory and how structure might offer a junction for accounting for more macrostructural inequalities within motivation research. © 2021. Journal of Teaching and Learning. All Rights Reserved.

The Future of Software Engineering: Where Will Machine Learning, Agile, and Virtualization Take Us Next?

Software has become the lifeblood of the 21st century, enabling a broad range of commercial, medical, educational, agricultural, and government applications. These applications are designed and deployed through a variety of software best practices. With the onset of the COVID-19 pandemic, developers have embraced virtualization (remote working) and a variety of strategies to manage the complexity of global development on multiple platforms. However, evolving hazards such as network security, algorithm bias, and the combination of careless developers and deliberate attacks continue to be a challenge. An XP2021 panel organized and chaired by Steven Fraser debated the future of software engineering and related topics such education, ethics, and tools. The panel featured Anita Carleton (CMU’s SEI), Priya Marsonia (Cognizant), Bertrand Meyer (SIT, Eiffel Software), Landon Noll (Independent Consultant), and Kati Vilkki (Reaktor). © 2021, The Author(s).

2021 Strategies for "Socially Distant" University-Company Collaborations

In the early months of 2020, the COVID-19 pandemic suddenly transformed the way the world works and collaborates. With all work-related travel abruptly curtailed and most company professionals and academics working from home, the daily work environment shifted to an ecosystem enabled by online communication and collaboration tools. In 2021, workflows continue to evolve for both universities and corporations - to better support R&D, education, and ideation. This panel will discuss how COVID-19-inspired innovation ecosystems have changed - for better or worse - university-company collaborations. Panelists will share personal observations, challenges, results, and ideas for the future.

OA08.04 Providing Thoracic Prehabilitation during COVID-19: Review of a Virtual Model

Introduction: Prehabilitation in lung cancer surgery has shown to improve exercise capacity and reduce post-operative complication rates, morbidity and hospital length of stay (Rosero et al, 2019;Boujibar et al, 2018;Steffens et al, 2018). Prehabilitation is predominantly delivered via supervised exercise programmes, however since the COVID-19 pandemic, capacity to deliver face-to-face hospital appointments has significantly reduced. Therefore, we present preliminary data from a new, virtual prehabilitation service for patients undergoing lung surgery at a busy National Health Service Trust in London. Methods: 20 patients were prospectively recruited from surgical lists over six weeks (15th June-30th July 2020). Each patient was offered a virtual prehabilitation assessment over video or phone. Assessment included outcomes that could be completed virtually: MRC Dyspnoea scale, physical activity levels (Godwin Leisure Time Exercise Questionnaire (GLTEQ), dietary needs, mood (Hospital Anxiety and Depression Scale (HADS) and fatigue (FACIT-fatigue). Exercise capacity was measured using the one minute sit to stand (STS) test. Following assessment, each patient received a personalised home-based exercise programme and a diary to monitor compliance. Written advice and counselling for specific symptom management was also provided. Virtual follow-up occurred weekly or fortnightly. An ‘end of prehabilitation’ (EOP) assessment was completed approximately three days before surgery to repeat outcome measures. Due to local policy changes during this pilot, some patients were permitted a one-off, face-to-face prehabilitation assessment, however intervention and follow-up continued virtually. Results: Baseline characteristics: 65% of the cohort were female, with an average: age 68 years;MRC Dyspnoea scale: 2;FEV1 %predicted: 87.9 and performance status: 1. 45% had ≥5 comorbidities, 70% had a smoking history and 15% were classified as ‘vulnerable-mildly frail’ using the Rockwood Clinical Frailty Score. A walking exercise tolerance ≥500m was present in 80% of the cohort, yet only 40% were classified as ‘sufficiently active’ on the GLTEQ. Uptake and technology: 35% of participants received a virtual prehabilitation assessment, whilst 65% had this delivered face-to-face. The uptake rates for patients approached for virtual or face-to-face assessments were 64% and 100% respectively. 75% of participants had access to email and video technology, whilst 25% could only receive telephone calls and written handouts. Inability to access emails and video was noted in all patients ≥80 years of age, yet there was no association between lack of technology and higher comorbidities or frailty. At EOP there was no change in average MRC-Dyspnoea scale, HADS or fatigue levels. However, GLTEQ scores changed by an average of +45.9 points, with 100% of the cohort meeting recommended levels of physical activity. We observed an average change in one minute STS test scores of +5.1, exceeding the minimum clinically important difference of +3 (Vaidya et al, 2016). Conclusion: Our findings demonstrate that virtual, home-based prehabilitation is feasible and may improve patients’ pre-surgical physical activity levels and exercise capacity. This is pertinent given ongoing uncertainty surrounding COVID-19 and its impact on face-to-face healthcare delivery. Further consideration regarding the delivery of safe and effective virtual prehabilitation to more elderly or vulnerable patients may be required. Keywords: Prehabilitation, lung cancer, COVID-19

Girls and Young Women Negotiate Wellbeing during COVID-19 in Quebec

In this article, we feature photographs and cellphilms produced by 13 girls and young women (aged 13 to 19) from urban, rural, and Indigenous areas of Quebec, Canada during the COVID-19 pandemic. Framed within girls' studies, we present girls' and young women's creations and co-analysis about wellbeing during a period of lockdown. We explore how girls and young women restructured their routines at home as well as negotiated motivation and the pressure to be productive. We note that girls had more time than usual for creative activities and self-discovery and that they engaged with the politics of the pandemic and advocated for collective forms of wellbeing. Importantly, girls reported that participating in this research improved their wellbeing during this lockdown.

COVID-19 AKI: Risk factors and markers of disease from a large UK cohort

Background: Acute kidney injury (AKI) is a significant complication of COVID-19 infection. UK NICE guidelines have been developed. Aim: to examine our local patientlevel COVID-19 Hospitalisation in England Surveillance System (CHESS) database to elucidate potential risk factors for AKI vs guidelines. Methods: 564 COVID positive admissions between 7 March-24 May 2020 at University Hospital Southampton were examined using Python (Anacondas distribution) and SPSSTM. AKI was staged by RIFLE and AKIN criteria consistent with NICE guidance. X2, t-test, Mann-Whitney U test and logistic regression were used to analyse the data. Results: AKI was present in 177 patients (31%). At peak, 108 (61%) stage 1;42 (24%) stage 2;27 (15%) stage 3. There were no significant differences in cohorts with respect to white vs non-white ethnicity, gender, obesity or anti-COVID-19 treatment. 44% of patients with AKI died vs 19% in the non-AKI group (p<0.001). AKI was associated with ICU admission (27% vs 10% p<0.001), requirement of non-invasive (13% vs 4%) and invasive ventilation (14% vs 4%) (both p<0.001). Prior diabetes (18% vs 8%), hypertension (47% vs 34%), chronic respiratory and cardiac disease (both 25% vs 15%) were more common in the AKI group (p<0.004). Increased age was associated with AKI (p=0.02) and length of stay (LOS) positively correlated to AKI stage(p<0.001). Peak levels of biomarkers: ferritin, D-dimer, C-reactive protein, high sensitivity troponin-I, neutrophil count and total white cell count, were all significantly raised (p<0.001) in the AKI group, increasing with stage of AKI (p<0.001). However, in multivariable analysis first clinical observations, neutrophil count, haemoglobin, D-Dimer and albumin came out as the most significant predictors of AKI: Specificity 88.7%, Sensitivity 43.6%. Conclusions: AKI is a frequent complication of COVID-19 and we identified similar risk factors to those in the NICE guidelines. In addition, we found hypertension and chronic respiratory disease to increase risk of AKI whilst ethnicity, gender, obesity and COVID-19 treatments did not. Furthermore, AKI was associated with increased mortality, ICU admissions and LOS, concordant with previous studies. This data also points to several biomarkers as possible predictors of AKI development and severity. Further analysis of this data is ongoing.

Covid-19’s influence on the future of agile

As a result of the global COVID-19 pandemic, the way the world works, collaborates, and plays has changed. Commerce has stalled with travel, hospitality, education, retail, and health sectors particularly affected. This paper is based on an XP 2020 panel organized by Steven Fraser and featuring Aino Corry, Steve McConnell, and Rachel Reinitz. The panel discussed the impact of COVID-19 on knowledge workers, the acceleration of digital workplace transformation, and anticipated long term effects from the pandemic in the context of agile practices. Four key observations emerged from the discussion: First, virtual collaboration between those working from home is enabled by a variety of communication tools – substituting for face-to-face interactions. Second, agile work practices are harder to perform given the virtual nature of meetings and interactions. Third, communication tools are not always adequate for high-bandwidth or informal interactions, such as brainstorming, side discussions, or hallway conversations. Fourth, forming new teams and onboarding staff is challenging in a virtual work environment. © The Author(s) 2020.