Predicting the immediate impact of national lockdown on neovascular age-related macular degeneration and associated visual morbidity: an INSIGHT Health Data Research Hub for Eye Health report.

OBJECTIVE: Predicting the impact of neovascular age-related macular degeneration (nAMD) service disruption on visual outcomes following national lockdown in the UK to contain SARS-CoV-2. METHODS AND ANALYSIS: This retrospective cohort study includes deidentified data from 2229 UK patients from the INSIGHT Health Data Research digital hub. We forecasted the number of treatment-naïve nAMD patients requiring anti-vascular endothelial growth factor (anti-VEGF) initiation during UK lockdown (16 March 2020 through 31 July 2020) at Moorfields Eye Hospital (MEH) and University Hospitals Birmingham (UHB). Best-measured visual acuity (VA) changes without anti-VEGF therapy were predicted using post hoc analysis of Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular AMD trial sham-control arm data (n=238). RESULTS: At our centres, 376 patients were predicted to require anti-VEGF initiation during lockdown (MEH: 325; UHB: 51). Without treatment, mean VA was projected to decline after 12 months. The proportion of eyes in the MEH cohort predicted to maintain the key positive visual outcome of ≥70 ETDRS letters (Snellen equivalent 6/12) fell from 25.5% at baseline to 5.8% at 12 months (UHB: 9.8%-7.8%). Similarly, eyes with VA <25 ETDRS letters (6/96) were predicted to increase from 4.3% to 14.2% at MEH (UHB: 5.9%-7.8%) after 12 months without treatment. CONCLUSIONS: Here, we demonstrate how combining data from a recently founded national digital health data repository with historical industry-funded clinical trial data can enhance predictive modelling in nAMD. The demonstrated detrimental effects of prolonged treatment delay should incentivise healthcare providers to support nAMD patients accessing care in safe environments. TRIAL REGISTRATION NUMBER: NCT00056836.

The Working-from-Home Natural Experiment in Sydney, Australia: A Theory of Planned Behaviour Perspective

The rapid rise of working-from-home practices has led to a paradigm shift in the way many workers interact with cities, with major potential impacts on sustainability, health, and quality of life. Whilst the technology responsible for this shift is not new, the disruptive way that it is now interfacing with workplaces, homes, cities, and society is both novel and profound. To inform an understanding of the implications of this change, this article provides survey data from Sydney, Australia, on drivers, and patterns of behaviour linked with the change. Furthermore, we use of the Theory of Planned Behaviour to successfully interrogate what drives intentions, attitudes, norms, and competencies. We also provide data on the influence of job type and emerging employer attitudes. These data and analyses provide a unique contribution to the growing body of knowledge about working from home and builds potential for prediction of its prevalence across cities. This can inform updates of urban planning, infrastructure investment decisions, and to identify how this practice can be best supported, in a way that promotes sustainability outcomes.

Inequalities in Access to Care for the London Post Covid Syndrome Pathway for Children and Young People (Cyp)

Aims The London Post COVID Syndrome Pathway was set up in October in 2020 in order to meet the needs of children affected by persistent symptoms after SARS-CoV-2 infection. The UK CLoCk study (1), 11-17 years, showed high symptom prevalence, increasing from time of testing to 3 months (35.4% to 66.5% in SARS-CoV-2 positive cases and 8.3% to 53.3% in controls). ONS (2) data from a large, randomly selected population survey (April 2020 to August 2021) reported symptom prevalence 4-8 weeks after infection of 3.3% in primary aged children (vs 3.6% in negative controls) and 4.6% (vs 2.9%) in secondary aged. The Zoe Kings study (3) showed 1.8% of children had symptoms beyond 8 weeks after infection. The COVID pandemic has affected ethnic minorities and those in deprived communities the most. Here, we aimed to describe referral patterns and ascertain factors influencing inequalities in access to care. Methods We collected demographic and clinical data from our Post COVID clinics, from October 2020 to January 2022. Deprivation deciles were based on the Index of Multiple Deprivation (IMD 2019). Decile 1 represents the most deprived 10% (decile) in England and Decile 10 represents the least deprived 10%. Analyses were descriptive. Results A total of 86 patients were referred with persistent symptoms (median age 14, range 7-18). The female:male ratio was 1.5:1 (52:34). Ethnicity data was available for n=74. Of those 5% identified from Black backgrounds (expected 13.30%);9% Asian (vs 18.50%);12% Other Ethnic Groups (vs 3.40%), 7% Mixed Ethnic Groups (vs 5%) and 53% White (vs 59.80%). Median IMD score was 6, with mode =7 (London mean 3, mode =1). Conclusion Our data suggests children from more affluent (less deprived) areas are accessing the service, with an underrepresentation of males. A small number of patients were referred compared to those reporting persistent symptoms in national surveys. This may be due to a relatively lower number having impairment and/or a lack of awareness amongst professionals. Ethnicity data shows a lower number than expected Black (40% less) and Asian (50% less) backgrounds are accessing support. Since schools re-opened in September 2021 reduced school attendance has been reported for many children. Persistent symptoms are common post viral infection, and most children recover. However, for some these can be debilitating. If children have reduced school attendance due to persistent symptoms they need prompt access to care. Our study raises concern about access to Post COVID services for all children (particularly males and those from minority backgrounds), raising lack of awareness amongst GPs and schools as a possibility. Proactive case finding is needed, particularly in hardly-reached groups. NHS England has recommended a lead for supporting equality to help this and is in post. The numbers of children accessing care is smaller than the number reporting symptoms, an area that requires further study.

IMPACT OF COVID-19 ON PRESENTATION AND TREATMENT OF PANCREATIC CANCER

Purpose During the first peak of the COVID-19 pandemic in spring 2020, the American College of Surgeons released triage recommendations for cancer care to assist with resource allocation during a global healthcare crisis.1 Our study investigates the relationship between pandemic restrictions and pancreatic cancer diagnosis and care at a single institution. Methods Our paper reports a retrospective single-center analysis of newly diagnosed pancreatic cancer from 2016-2020. Patient data was collected from our institutional cancer registry. Data was stratified into pre-pandemic years (2016-2019) and the pandemic year (2020) with further separation into fiscal quarters (Q1-Q4). Comparison of case numbers, staging, type of treatment and time to treatment was performed. Time-to-treatment was defined as the time from the date of initial diagnosis to date of treatment, for both any treatment overall and for each specific treatment type. Statistical analysis was performed using Chi-square and independent t-tests Results No changes were seen in the number of patients diagnosed with pancreatic cancer from 2016-2019 (mean=117.5 cases/year) versus 2020 (104 cases, p=0.475). There was no change in clinical overall staging comparing pre-pandemic (stage 1, n=81;stage 2, n=45;stage 3, n=55, stage4, n=184) to pandemic years (stage 1, n=28;stage 2;n=10;stage 3, n=11;stage 4, n=43;p=0.145). There were 220 patients treated by surgery, 306 by chemotherapy, 67 by radiation and 3 by immunotherapy. There were 46 patients (18.78%) who received chemotherapy during Q3 in the pre-pandemic years compared to 19 patients (31.14%) in Q3 of 2020 (p<0.001, Table 1). No difference was seen between pre-pandemic and pandemic years for both neoadjuvant (p=0.347) or adjuvant chemotherapy (p=0.217). There was no difference between pre-pandemic versus pandemic years for the other treatment modalities, including neoadjuvant or adjuvant radiation. The average time-to-first-treatment in pre-pandemic years was 36.71 days compared to 41.46 days in 2020 (p=0.31). Conclusion The number of patients receiving chemotherapy treatment increased immediately after the peak pandemic months without any change in neoadjuvant or adjuvant treatment. No change was seen in case numbers, disease stage, time-to-treatment overall and all specific modalities during peak of the pandemic. This lack of change shows the diligence of both healthcare workers and the patients involved in treating pancreatic cancer. References 1. Kato H, Asano Y, Arakawa S, et al. Surgery for pancreatic tumors in the midst of COVID-19 pandemic. World J Clin Cases. 2021;9(18):4460-4466. doi:10.12998/wjcc.v9.i18.4460 (Table Presented)

PIMS-TS: Neurological, quality of life and adaptive functioning outcomes and associated factors

Background: Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS) causes prolonged hospitalisation and morbidity. The longer term neurological and health outcomes in children following PIMS-TS are largely unknown. Methods: In this single-institution study, we evaluated the domains of daily living, physical, emotional, and quality of life outcomes at 6 months following PIMS-TS. Data were collected by telephone questionnaire interviews with parents and children and also using standardized assessment tools -PedsQL-Multidimensional Fatigue Scale, and Paediatric Symptom Checklist (PSC). Results: Data were obtained from 81 children admitted with PIMS-TS between April and August 2020. 49 were males (60%) and 52 (63%) non-white. Median age was 9 years (8-17 years) with length of stay of 6 days (range 1-22 days). Prior to discharge, 34 children (42%) had difficulties with activities of daily living whereas only 5 (6%) persisted on 6 months follow up. Exercise intolerance/mobility difficulty was observed in 40 children (9%) at discharge compared to 20 (25%) 6 months later. Predictors associated with difficulty in exercise tolerance/mobility were obesity (OR=4.0;95% CI: 1.1-13.7;p=0.03) and older age (OR=1.1;95% CI: 0.99-1.3;p=0.086). Inflammatory markers on admission (CRP, fibrinogen, D-dimer and ferritin) did not correlate with worse outcome at follow-up nor did sex and length of stay. The PedsQL-Multidimensional Fatigue Scale revealed a median score of 94 (IQR: 83-100) indicating an overall average range quality of life. The PSC were in line with population prevalence of behavioural/emotional difficulties: 10% had difficulties with attention;7% and 4% of patients had internalizing and externalizing difficulties, respectively Conclusion: Overall, patients with PIMS-TS have good short-term outcomes at 6 months with respect to daily functioning, quality of life, and behaviour. One in four had some difficulty with mobility/pain requiring rehabilitation, with main risk factors being obesity and older age. Further studies are required to evaluate long-term sequelae.

Telework, Hybrid Work and the United Nation's Sustainable Development Goals: Towards Policy Coherence

With increased participation in telework expected to continue, in the aftermath of COVID, it will be important to consider what long-term impact this practice could have on sustainability outcomes. This paper describes a scoping review and identifies connections between telework and sustainability outcomes from previous academic studies. These connections were categorised, and are discussed, based on their contributions to different United Nations Sustainable Development Goals. Most research was found to focus on countries classified as having a very high human development index status. The SWOT matrix technique was used to illustrate the strengths and weaknesses identified in the existing literature, and the threats and opportunities for future work. This aims to ensure policy coherence so that strategies to promote one outcome, such as economic productivity improvements, do not undermine another, such as improved health. Practical implications and research opportunities were identified across a range of SDG impact areas, including good health and well-being, gender equality, reduced inequality, climate mitigation, sustainable cities, and resilient communities. Overall, our impression is that increased rates of telework present an important opportunity to improve sustainability outcomes. However, it will be important that integrated and holistic policy is developed that mitigates key risks.

Using a Novel Research Methodology to Study and Respond to Faculty and Student Experiences with COVID-19 in Real Time

This paper describes the use of a novel research platform called SenseMaker® to collect and analyze real-time data in the form of participants’ qualitative accounts of COVID-19 along with online learning experiences and participants’ own quantitative assessments of those experiences. Participants were faculty, students, and staff in the College of Engineering at the University of Georgia during Spring 2020. Results from two waves of data collection informed real-time recommendations to College faculty and administration to address COVID-19-related challenges. Results also facilitated faculty development programming to build instructor communities of learning and support in response to the University’s transition to online learning. © 2020

Molecular SARS-CoV-2 testing during the COVID-19 outbreak: Experiences of a hospital in Southeast Michigan, USA

Background: The novel Coronavirus SARS CoV-2 (COVID-19) outbreak was complicated by the lack of diagnostic testing kits. In early March 2020, leadership at Beaumont Hospital, Royal Oak Michigan (Beaumont) identified the need to develop high capacity testing modalities with appropriate sensitivity and specificity and rapid turnaround time. We describe the molecular diagnostic testing experience since initial rollout on March 16, 2020 at Beaumont, and results of repeat testing during the peak of the COVID-19 pandemic in MI. Methods: Beaumont is an 1100 bed hospital in Southeast MI. In March, testing was initially performed with the EUA Luminex NxTAG CoV Extended Panel until March 28, 2020 when testing was converted to the EUA Cepheid Xpert Xpress SARSCoV- 2 for quicker turnaround times. Each assay was validated with a combination of patient samples and contrived specimens. Results: During the initial week of testing there was > 20 % specimen positivity. As the prevalence grew the positivity rate reached 68% by the end of March (Figure 1). Many state and hospital initiatives were implemented during the outbreak, including social distancing and screening of asymptomatic patients to increase case-finding and prevent transmission. We also adopted a process for clinical review of symptomatic patients who initially tested negative for SARS-CoV-2 by a group of infectious disease physicians (Figure 2). This process was expanded to include other trained clinicians who were redeployed from other departments in the hospital. Repeat testing was performed to allow consideration of discontinuation of isolation precautions. During the surge of community cases from March 16 to April 30, 2020, we identified patients with negative PCR tests who subsequently had repeat testing based on clinical evaluation, with 7.1% (39/551) returning positive for SARS- CoV2. Of the patients who expired due to COVID-19 during this period, 4.3% (9/206) initially tested negative before ultimately testing positive. Conclusion: Many state and hospital initiatives helped us flatten the curve for COVID-19. Our hospital testing experience indicate that repeat testing may be warranted for those patients with clinical features suggestive of COVID-19. We will further analyze these cases and clinical features that prompted repeat testing. (Figure Presented).