Genetic associations from the Long COVID-19 Host Genetics Initiative contribute to understanding of the genetics of prolonged symptoms in COVID-19

Background/Objectives: One of the most remarkable features of SARS-CoV-2 infection is that a large proportion of individuals are asymptomatic while others experience progressive, even lifethreatening acute respiratory distress syndrome, and some suffer from prolonged symptoms (long COVID). The contribution of host genetics to susceptibility and severity of infectious disease is well-documented, and include rare monogenic inborn errors of immunity as well as common genetic variation. Studies on genetic risk factors for long COVID have not yet been published. Method(s): We compared long COVID (1534) to COVID-19 patients (96,692) and population controls (800,353) using both questionnaire and EHR- based studies. First meta-analysis of 11 GWAS studies from 8 countries did not show genome-wide significant associations. Result(s): Testing 24 variants earlier associated to COVID-19 susceptibility or severity by COVID-19 Host Genetics Initiative showed genetic variation in rs505922, an intronic variant in ABO blood group gene, to be associated with long COVID compared to population controls (OR = 1.16, 95% CI: 1.07-1.27, p = 0.033). (Within-COVID analysis gave similar OR, but was not significant after conservative Bonferroni correction (OR = 1.17, 95% CI: 1.06-1.30, p = 092)). Conclusion(s): The first data freeze of the Long COVID Host Genetics Initiative suggests that the O blood group is associated with a 14% reduced risk for long COVID. The following data freezes with growing sample sizes will possibly elucidate long COVID pathophysiology and pave the way for possible treatments for long lasting COVID symptoms.

The great Canadian recovery: The impact of COVID-19 on Canada's labour market

The Canadian labour market experienced a period of unprecedented turmoil following the onset of the COVID-19 pandemic. We analyze the main changes using standard labour force statistics and new data on job postings. Envisaging a phase of temporary severing of employment relationships followed by a phase of more standard labour market search and matching, we use stock and flow data to understand key developments. We find dramatic changes in employment, unemployment and labour market attachment in the first few months of the pandemic and a broad though gradual recovery through to the end of 2021.

Trends in Mood Disorders in Incoming Freshman Division One Collegiate Cross Country and Track And Field Athletes

Purpose: This study's purpose was to evaluate trends in mood disorders in incoming collegiate cross-country and track and field athletes to appropriately allocate resources. The prevalence of mood disorders surrounding the COVID- 19 pandemic was of interest. Method(s): Preparticipation questionnaires of incoming firstyear cross country and track and field athletes at The Ohio State University were reviewed between the years 2018-2022 (n = 138). Data regarding psychiatric history were collected and evaluated for trends based on year of matriculation, reported gender, family history of mood disorders, and specific sporting event. Result(s): The prevalence of history of mood disorder or counseling in incoming first-year cross country and track and field athletes was not statistically different across the five years from 2018 to 2022. Female athletes were 2.6 times more likely to report a history of mood disorder or counseling compared with male athletes (P = 0.02, CI 1.17-5.96). Prevalence of history of mood disorder or counseling was highest in distance runners, lower in field athletes, and least in sprinters, but this difference was not significant (P = 0.322). Athletes who reported a personal history of mood disorder or counseling were 42.9 times more likely to also report family history of a mood disorder (P < 0.001, CI 5.2-351.5). Conclusion(s): The prevalence of mood disorders in first-year cross country and track and field athletes have remained stable over the past five years despite the COVID-19 pandemic and increased normalization of mental health problems. Female cross country and track and field athletes are more than twice as likely as males to start college with a history of a mood problem. There is a strong association between personal and family history of mood disorders. Significance: More psychological resources may need to be allotted to female cross country and track and field athletes compared with males. It may not be necessary to increase mood resources overall, because prevalence remains stable over the years.

Telemedicine physical examination for spine

Telemedicine has become widespread during the covid 19 pandemic. This chapter discusses the use of telemedicine for spine care and emphasizes physical examination capabilities using telemedicine. © The Author(s), 2022. All rights reserved.

A Feasibility Study of LORETA Z-Score Neurofeedback Training in Adults with Schizophrenia-Spectrum Disorder Experiencing Treatment-Resistant Auditory Verbal Hallucinations

Introduction: The incomplete effectiveness of interventions demands new ways to help people diagnosed with schizophrenia who experience auditory verbal hallucinations (SZ-AVH). We aimed to perform a feasibility study of low-resolution electromagnetic tomography analysis (LORETA) neurofeedback with people exhibiting treatment-resistant SZ-AVH. Method(s): We examined changes in resting-state quantitative electroencephalogram (qEEG) in four people with SZ-AVH (three male, one female) after LORETA Z-score neurofeedback training. Result(s): The study design had to be amended due to a national COVID-19 lockdown. Neurofeedback was well tolerated and no participants dropped out. Recruitment was the main feasibility issue. Barriers included a lack of knowledge of neurofeedback by patients and mental health teams, as well as the travel and time commitment involved. For the only patient who completed all 20 sessions, elevated frontal, central, and temporal theta absolute power measured at baseline normalized after treatment, but decreased temporal delta and an increase in coherence for all frequency bands were also found. Conclusion(s): Two key lessons were drawn for the feasibility of trials of EEG neurofeedback in this population. First, significant effort is needed to educate mental health professionals and patients about neurofeedback. Second, the equipment employed for neurofeedback training needs to be physically based at a site where patients routinely attend.Copyright © 2022. Amico et al.

Racism-related stress: Manifestations, moderators, and additional considerations

On March 11, 2020, the World Health Organization (WHO) declared the COVID-19 outbreak to be a global pandemic (Cucinotta and Vanelli, 2020). While rates of psychological stress surged for all Americans in the weeks following this declaration, Census Bureau data suggested significant increases in endorsement of depressive and anxiety symptoms for Black 11 In this entry, Black and African American are utilized interchangeably, or if dictated by the citation source. and Asian Americans in the week following the public release of the death of George Floyd, a Black man whose neck was kneeled upon by a police officer. Data from the Pew Research Center indicated that 31% of Asian Americans experienced racial slurs of jokes in the 4 months after the start of the COVID-19 pandemic. Given both concerns of antagonistic attitudes and differential treatment occupy the realities of many Black People, Indigenous People, and People of Color (BIPOC) and health concerns amid a public health crisis has led some to refer to this moment of history as a "double pandemic.” The second "pandemic” to which scholars, clinicians, and clergy refer is the indelible legacy of racism, a pernicious system of prejudice, discrimination, and oppression that has operated for centuries. Indeed, though over two decades have passed since Dr. Shelly Harrell's treatise on the impact of racism on the lives of people of color, her admonition that racism is "alive and sick” is sagacious, even if unnerving (Harrell, 2000, p. 42). As a system, racism can exert stress that threatens the health and wellbeing of BIPOC individuals. Consistent with the biopsychosocial framing of this volume, the impairment of racism-related stress can manifest physically and psychologically. Moreover, given the socio-cognitive development of children and adolescents, the sequelae of racism-related stress can be particularly damaging, with differential exposure and impact depending on the intersections of various social identities (e.g., race, ethnicity, gender identity, socioeconomic standing). Despite the deleterious nature of racism-related stress, research also has elucidated a number of protective factors that moderate and mediate the pathway between racism-related stress and health for children and adolescents. In this entry, we (a) outline racism-related stress (RRS) in its multiple forms;(b) elucidate the most common health outcomes associated with RRS for BIPOC youth;(c) briefly introduce several moderators in the RRS to youth health pathway;and (d) discuss a number of developmental and intersectional considerations that influence the qualitative experiences of this pathway. Throughout the entry, we pay special attention to the ways in which these various factors operate at the neighborhood and community levels. Lastly, this entry concludes with a critical commentary. © 2023 Elsevier Inc. All rights reserved

Development, implementation and evaluation of a seven-day clinical pharmacy service in a tertiary referral teaching hospital during surge-2 of the COVID-19 pandemic.

BACKGROUND: Seven-day clinical pharmacy services in the acute sector of the National Health Service are limited. There is a paucity of evidential patient benefit. This limits investment and infrastructure, despite United Kingdom wide calls. AIM: To optimise medicines seven-days a week during surge-2 of the COVID-19 pandemic through implementation of a seven-day clinical pharmacy service. This paper describes service development, evaluation and sustainability. SETTING: A tertiary-referral teaching hospital, London, United Kingdom. DEVELOPMENT: The seven-day clinical pharmacy service was developed to critical care, acute and general medical patients. Clinical leads developed the service specification and defined priorities, targeting complex patients and transfer of care. Contributing staff were briefed and training materials developed. IMPLEMENTATION: The service was implemented in January 2021 for 11 weeks. Multidisciplinary team communication brought challenges; strategies were employed to overcome these. EVALUATION: A prospective observational study was conducted in intervention wards over two weekends in February 2021. 1584 beds were occupied and 602 patients included. 346 interventions were reported and rated; 85.6% had high or moderate impact; 56.7% were time-critical. The proportion of medicines reconciliation within 24-h of admission was analysed across the hospital between November 2020 and May 2021. During implementation, patients admitted Friday-Sunday were more likely to receive medicines reconciliation within 24-h (RR 1.41 (95% CI 1.34-1.47), p < 0.001). Rostered services were delivered sustainably in terms of shift-fill rate and medicines reconciliation outcome. CONCLUSION: Seven-day clinical pharmacy services benefit patient outcome through early medicines reconciliation and intervention. Investment to permanently embed the service was sustained.

Mind the Gap: Providing Transferrable Skills Training for Nhs Pathology Apprentices

Apprenticeship programmes allow employers to grow their own talent and support progression for their employees. In NHS pathology services, healthcare science apprenticeships give staff the opportunity to complete BTECs in healthcare science, a BSc in biomedical science and gain HCPC registration. The education and technical components of apprenticeships are covered by the education provider and employer respectively, however, some transferrable skills are not easily supported in the workplace. This has been exacerbated during the COVID-19 pandemic when pathology laboratories have experienced a significantly higher workload. A funding proposal was successfully submitted to NHS England - London for a 19,000 grant to run three free training days for pathology apprentices in London. These sessions were mapped to the healthcare science apprentice standards and focussed on providing apprentices with evidence for their portfolios and networking opportunities with other apprentices from different Trusts. The three training days were*Science Communication: covering the science of storytelling and patient experience.*Leadership: covering leadership pathways and inclusive NHS healthcare.*Professional Practice/Research & Innovation: covering constructive feedback, research questions and duty of candour. Training days were well attended by level 2, 4 and 6 apprentices, with two of the three fully booked. In the evaluation 89% of respondents were happy with the structure of the day and all reported that the sessions fulfilled their expectations. Attendees left positive comments about the ability to network with other apprentices. Strong themes throughout the feedback were the commitments of attendees to apply the skills they'd learned in their workplace, but also a lack of prior awareness of these skills. This shows the vital importance of courses like these and providing leadership and communication training to healthcare scientists at all stages of their career.

The Impact of the Covid19 Pandemic on Patients with Peripheral Artery Disease

Background The impact of COVID-19 on major adverse lower extremity (MALE) and cardiovascular events (MACE) in patients with peripheral artery disease (PAD) is unknown. Methods Using the VA Corporate Data Warehouse, Veterans with PAD were identified. Rates of MALE (amputation or lower extremity revascularization [LER]), and MACE (death, MI, or coronary revascularization) were assessed in pre-pandemic (3/11/2019-3/10/2020), early-pandemic (3/11/2020-3/10/2021), and late-pandemic (3/11/2021-3/10/2022) periods. Outcomes were compared using Kaplan-Meier method. Results Of 418,042 Veterans (mean age 72 yrs) with PAD, 76.7% were white and 96.8% male. Furthermore, 89.2% had HTN, 60.4% diabetes, 49.3% CAD, 21.6% heart failure, and 20.5% atrial fibrillation. From 3/11/2019 to 3/10/2022, 3,100 had amputation, 8,187 had LER, & 2,229 had MACE. Amputation rates declined and continued to decline in early- and late-pandemic period (306 to 268 to 235;p<0.001;rates per 100k). Rates of LER declined initially and stabilized in late-pandemic period (951 to 587 to 609;p < 0.001;rates per 100k). MACE did not change significantly. (215 to 168 to 202;p<0.001;rates per 100k). Conclusion Amputation rates in Veterans with PAD did not increase despite a clinically significant decline in LER. Given the known efficacy of noninvasive therapies in PAD, these data suggest that there is a need to re-evaluate appropriate indications for LER and amputation. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Challenges and strategies with international recruitment in early phase gene therapy trials

The Children's NIHR Clinical Research Facility at Royal Manchester Children's Hospital has been involved in numerous early phase gene therapy trials for diseases such as GM1 gangliosidosis, Gaucher disease, MPSIIIA and MPSII. These trials have necessitated international recruitment which brings challenges for both site and families. In addition, we also actively recruited participants during the Covid-19 global pandemic, amplifying these challenges. A typical patient journey on one of these trials would involve being approached soon after diagnosis due to the rapid progression of these diseases and the need for early intervention. The family would then relocate to the UK with relatively short notice and commence an intensive period of screening involving a lot of extensive information for them to retain and invasive procedures for the patient. Some of these families will speak no English at all which is an additional barrier to managing the parental anxiety and expectations of the trial and its outcome. Once eligibility is confirmed the families are then faced with an extended stay in the UK without the support of their extended family/community. This impacts parent's employment and other siblings who may or may not be with them and who may also be affected by the same disease. Following administration of the gene therapy, participants then commence intensive follow up often associated with immunosuppressants. Close working with the local clinicians is essential for patient safety and trial integrity. Good engagement with families once they have returned to their home country is vital in obtaining continuing trial data and ensuring retention and compliance with attending future visits. Follow up visits are essential for safety and efficacy data for the progression of gene therapy trials. Travel restrictions brought about by the covid 19 pandemic exacerbated these challenges but with good communication and engagement we have mostly overcome them.

Africa's lockdown dilemma: High poverty and low trust

As the COVID-19 pandemic unfolded, sub-Saharan African countries faced the dilemma of how to minimize viral transmission without adversely affecting the poor. This study proposes an index of lockdown readiness, taking into account housing conditions and income security, and analyses how this predicts the pandemic responses of governments. Drawing on Afrobarometer data, we document that less than two in 10 urban households were fully ready for a lockdown and that neither institutional nor community trust levels offset this challenge. We find that the prior degree of lockdown readiness was predictive of the stringency of restrictions adopted but not of social unrest. © 2023 John Wiley & Sons, Ltd.

Pandemic experimentalism: decentering studio art education in an ongoing global emergency

After eighteen months of online art education during the COVID-19 pandemic, the authors consider Form and Time, a required first-year studio art course at OCAD University in Toronto, as a case study within global practices of reconfiguration and experimentalism in art and design pedagogy during the crisis. Form and Time was scheduled to launch as a required first-year course on campus at OCADU in Fall 2020, but quarantine prompted the pivot to fully remote. Critiques of the traditional art school's situated format were launched before COVID-19 by anti-ableist, Indige-nous and feminist scholars, addressing access barriers and stressing resilience in the face of crisis and oppression. The pandemic disrupted the centrality of in-person studios and critique methods in post-secondary art education;this accelerated and took unexpected turns during the online pedagogical experiments of the early pandemic. In this context, Form and Time foreshadows new modes of art school studio delivery, decentering and critically intersecting with studio precedents suddenly disrupted by remote learning during COVID-19. Form and Time's weekly asynchronous video lectures and online meetings probed themes of Space, Form and Time. Students posted weekly studio experiments on discussion boards, using materials close at hand. As with other art and design courses, everyday objects and materials provided a platform for discussing material conditions and encounters during the pandemic. Students depicted their unique surroundings using strategies of observation and wal-king. They accessed faculty-made online micro-workshops recorded by the various course instructors on home studio material techniques. These comprise a growing online archive shared by faculty teaching the multi-section course. Looking forward, we anticipate further crises. Greater interplay between online, blended and hands-on art studio education will prioritize flexibility that can better adapt to life pressures and emergencies, opening access for a diverse range of learners in decentered locations. © 2023, Judith Doyle, Simone Jones, Elizabeth Lopez.

Evaluating the transmission risk of SARS-CoV-2 from sewage pollution.

The presence of SARS-CoV-2 in untreated sewage has been confirmed in many countries but its incidence and infection risk in contaminated waters is poorly understood. The River Thames in the UK receives untreated sewage from 57 Combined Sewer Overflows (CSOs), with many discharging dozens of times per year. This study investigated if such discharges provide a pathway for environmental transmission of SARS-CoV-2. Samples of wastewater, surface water, and sediment collected close to six CSOs on the River Thames were assayed over eight months for SARS-CoV-2 RNA and infectious virus. Bivalves were also sampled as an indicator species of viral bioaccumulation. Sediment and water samples from the Danube and Sava rivers in Serbia, where raw sewage is also discharged in high volumes, were assayed as a positive control. No evidence of SARS-CoV-2 RNA or infectious virus was found in UK samples, in contrast to RNA positive samples from Serbia. Furthermore, this study shows that infectious SARS-CoV-2 inoculum is stable in Thames water and sediment for <3 days, while SARS-CoV-2 RNA is detectable for at least seven days. This indicates that dilution of wastewater likely limits environmental transmission, and that detection of viral RNA alone is not an indication of pathogen spillover.

Interprofessional collaboration (IPC): A comparative analysis of global standards for pharmacy practice

Introduction: Globally, disparities exist in healthcare quality, accessibility and regulation (Das, & Gertler, 2007). Consequently, few countries have governing bodies overlooking healthcare-professional (HCP) practice (Epstein, & Bing, 2011). Research has suggested that HCP regulation depended on nations' human development index (HDI), gross domestic product (GDP), and safety (Ozturk, & Topcu, 2014). IPC enables partnership working between HCPs to ensure patient-centred care (Gregory, & Austin, 2016). This study thematically analysed pharmacy professional standards' documents of various countries and investigated whether nations' developmental parameters influenced pharmacy regulation. Objectives * To compare global pharmacy professional standards on IPC. * To synthesise a thematic framework to evaluate literature on IPC. * To iInvestigate the relationship between HDI, GDP, global peace index (GPI), and pharmacy regulation. Method(s): A group (N = 8) of countries were studied based on 2018 HDI classification;(N = 4) 'very high' (Australia, Hong Kong, Canada, United Kingdom) and (N = 4) 'low' (Solomon Islands, Haiti, Yemen, South Sudan). Pharmacy professional standards' documents were screened to extract IPC-related themes via a constant comparative method. This facilitated thematic framework synthesis;'pharmacists' attitudes' and 'patient outcomes' were measures of IPC. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), (N = 17) peer-reviewed journal articles from 2010-2019 studying pharmacists in sample countries were selected. Key terms searched on Medline/PubMed databases were: 'IPC', 'pharmacist' and 'professional standards'. Literature was then reviewed with reference to the thematic framework and development metrics (HDI/GDP/GPI). This study did not require ethics approval. Result(s): Of the countries (N = 8) studied, only HDI-classified 'very high' had professional standards' documents, frequently incorporating IPC. Key themes were: 'shared decision-making', 'continuity-of-care', and 'effective communication'. Seven studies referred to these themes and confirmed IPC benefits: fewer medication-related errors4. The number of IPC standards and HDI-rank for 'very high' countries, except Hong Kong, were positively correlated, suggesting possible economic impact on pharmacy sector progress. Two studies found cultural influences on Hong Kong pharmacists' attitudes as contributory to a hierarchical than IPC-approach to healthcare provision5. HDI and GPI had a strong negative correlation (r = -0.83), potentially explaining low pharmacist density and GDP healthcare expenditure in HDI-classified low. Conclusion(s): Results denote that IPC improved patient safety (Gregory, & Austin, 2016). Global differences existed in pharmacists' attitudes and IPC training. These correlated with growing gaps in HDI and GPI between HDI-classified 'very high' and 'low' countries. Qualitative analysis highlighted the need for elaboration of 'continuity-of-care' and inclusion of 'understanding roles/responsibilities of team members' in the United Kingdom's professional standards set by the General Pharmaceutical Council. Future work could study 2021/inequality-adjusted HDI data, 'high'/'medium' HDI countries to improve validity alongside COVID19 impact on GDP and pharmacy practice.

Police emergency: career survivability navigating trauma, the impacts of COVID-19 and mental illness for police

Purpose - This study aims to view police mental and physical health and overall well-being through a victimological lens so as to attempt to prevent problems from starting or protecting them by informing them of what may occur within their career. Design/methodology/approach - Knowledge production within the field of police health and career implications is exponentially increasing as officers all over the world try and sometimes fail to navigate the difficulties of their complex career choice. Many of the disciplines that deal with this research are acting as silos, so there is not a lot of crossover in Australian literature. This study creates a contemporary collective of literary evidence in relation to police well-being as well as the impact of COVID on them. Creating this collective is why the literature review as a research method is critical. Traditional literature reviews can lack clear process. By using a literature review as a specific methodology, the outcome is a meticulous record of all relevant materials. Findings - The results of this literature review identified, without bias or interpretation, many officers became disillusioned, mentally unwell and took time away from work for two main reasons: (1) for many police officers, the substantial distress from cumulative exposure to bureaucratic administration and management styles, erratic work hours and long hours of repetitive work and (2) the dangers of day-to-day policing with the presence at fatal accidents, suicides, receiving threats to life, being assaulted and gaining poor eating and drinking habits creating issues for sleep and physical health. Research limitations/implications - For the purposes of creating a contemporary paper, the authors restricted the sample of literature to 22 years (accessing from 2,000 onward). By only selecting journals from Google Scholar, relating to specific years and drawing on search terms to limit our search, it may be perceived to have skewed the sample and the outcomes. Further work will be completed in the future to correct this. Practical implications - Police organisations may consider altering their bureaucratic procedures and make an effort to allow officers to better self-manage minor issues. From a victimological perspective, given that police officers are more than likely to be affected by cumulative experience of traumatic events over their career, they should be taught how to lower their individual levels of stress, to practice self-care and to be able to trust that the care they seek will be readily available without judgement. Social implications - Knowing the triggers related to police breakdown, both physically and mentally, may help intervene in the early years to prevent The extremes of policing range from being faced with overwhelming paperwork and administration to acute trauma events and can leave the officer dealing with cumulative stress in all its guises. Allowing a judgment free public debate into this issue will assist police (and other emergency service works) in the future. Originality/value - Viewing police officers as victims of their career choice is not common and reviewing the factors that impact them on a daily basis and throughout their career is critical for both prevention and understanding. This paper has value to numerous disciplines.

Breath-taking Pedagogy: Self-care & Ethical Pedagogy in the Climate of Anti-Blackness and COVID-19

As a Black literary scholar working and living at the intersection of the urgent matters of the COVID-19 pandemic and national racial unrest, I felt a sense of despondency and disillusionment about the kind of work I could and should be doing and what its impact would be. Racial fatigue weighed heavily on my mind and spirit. I questioned, how does literature help us to better understand the concerns of our moment and imagine a more equitable future? What does ethical and engaged pedagogy look like in this moment? "Breath-taking Pedagogy” examines my concerns and anxieties while navigating these coinciding threats to Black breath and the ways this experience informed a radical shift in my approach to teaching and public scholarship. Specifically, I detail how I have tried to reconcile my role and contribution through community engaged scholarship that demonstrates the transformative potential of literature and through an ethical teaching practice that privileges equity, empathy, and self-care. © 2022, University Library System, University of Pittsburgh. All rights reserved.

A case study into technical eLearning: Upskilling Excelitas' workforce with SPIE Partnership

Electronic learning, or e-learning, is a vital educational format for the upskilling of the workforce, with promises to sustain accessibility to training in spite of travel restrictions brought by the Covid-19 pandemic. In addition, specialized online photonics courses are becoming increasingly available on the market, responding to needs of business employees to access on-demand technical teaching material to maintain competitive business advantages. It is in this context that Excelitas Technologies Inc. and the International Society for Optics and Photonics, SPIE, formed a partnership to deploy a platform to upskill scientists, engineers and project managers. Since June 2021, 60 employees across seven Excelitas sites worldwide have gained access to a library of technical courses offered by SPIE. The paper will present a case study into the instructional design, implementation strategies, and evaluation methods for this program. An evaluation framework based on the Kirkpatrick model is used to provide qualitative data to assess the quality of the learning delivery, the performance of the learners, and benefits to the organization. Preliminary evaluation results based on the analysis of pre-training and post-training surveys will be presented, along with lessons learned in organizational and learning development.

Incorporation of Online Modules in an Immunohematology Reference Laboratory Rotation for Medical Laboratory Science Students

Background/Case Studies: An immunohematology reference laboratory (IRL) at a regional blood center provides education for medical laboratory science (MLS) students, covering methods infrequently performed in hospitals (elution, adsorption, etc.). Rotations include wet lab benchwork, background instruction, a handbook of educational material, and conclude with a post-test. Students provide feedback by evaluation form. In response to the COVID-19 pandemic, and to cover required material while minimizing in-person time with students, online modules were created and incorporated into the rotation. In this hybrid model, the interactive modules provided background instruction, while inperson learning focused on performing methods. This study compared length of in-person experience, post-test scores, and student evaluation data before and after incorporating online modules into MLS rotations. Study Design/Methods: Online modules, created with Articulate 360 eLearning software, and incorporating voiceover instruction, interactive quizzes, and how-to videos, were uploaded onto the blood center website. Students completed online modules, ranging from 24- 34 min in length, along with accompanying worksheets, prior to in-person IRL learning. The study period prior to online module implementation (in-person only) was September 2017- October 2020. The post-implementation study period (online modules and abbreviated in-person experience) was November 2020- January 2022. Average length of in-person learning and post-test scores were compared for the two study periods. Average evaluation scores were also compared, calculated from student evaluations containing 5-6 questions utilizing a 5-point Likert scale. The IRL hosted 80 MLS students during the study periods, 61 prior to online module implementation and 19 after. The IRL rotation is a routine part of MLS programs, and only the hybrid model was offered postimplementation. Results/Findings: Average length of in-person experience prior to implementation was 8.48 h compared to 5.28 h for the hybrid model (p < 0.001, two-tailed t test). Average post-test score prior to implementation was 81% compared to 87% after, while student evaluation feedback scores averaged 4.70 out of 5 prior to use of the online modules and 4.76 out of 5 with the hybrid model. Conclusion(s): The incorporation of online modules into an IRL rotation for MLS students resulted in students spending significantly less time in the IRL, while attaining similar post-test scores. There was no significant difference in student evaluations. Based on these results, this hybrid strategy will continue to be used and applied to other educational programs.

IBRUTINIB AND RITUXIMAB AS FIRST LINE THERAPY FOR MANTLE CELL LYMPHOMA: A MULTICENTRE, REAL-WORLD UK STUDY

Background: Ibrutinib (IBR) is an oral covalent Bruton tyrosine kinase inhibitor (BTKi), licensed for treatment of relapsed or refractory mantle cell lymphoma (MCL). Under NHS interim Covid-19 agreements in England, IBR with or without rituximab (R) was approved for the frontline treatment for MCL patients (pts) as a safer alternative to conventional immunochemotherapy. Although recent phase 2 studies have reported high response rates in low-risk patients for this combination in the frontline setting, randomised phase 3 and real-world data are currently lacking. Aims: To describe the real-world response rates (overall response rate (ORR), complete response (CR) rate) and toxicity profile of IBR +/-R in adult patients with previously untreated MCL. Methods: Following institutional approval, adults commencing IBR +/-R for untreated MCL under interim Covid-19 arrangements were prospectively identified by contributing centres. Hospital records were interrogated for demographic, pathology, response, toxicity and survival data. ORR/CR were assessed per local investigator according to the Lugano criteria using CT and/or PET-CT. Results: Data were available for 66 pts (72.7% male, median age 71 years, range 41-89). Baseline demographic and clinical features are summarised in Table 1. 23/66 pts (34.8%) had high-risk disease (defined as presence of TP53 mutation/deletion, blastoid or pleomorphic variant MCL, or Ki67%/MiB-1 ≥30%). IBR starting dose was 560mg in 56/62 pts (90%) and was given with R in 22/64 pts (34%). At a median follow up of 8.7 months (m) (range 0-18.6), pts had received a median of 7 cycles of IBR. 19/60 pts (32%) required a dose reduction or delay in IBR treatment. New atrial fibrillation and grade ≥3 any-cause toxicity occurred in 3/59 pts (5.8%) and 8/57 (14.0%) respectively. For the whole population and high-risk pts only, ORR was 74.4% and 64.7% respectively (p=0.2379), with a median time to response of 3.8m, coinciding with the first response assessment scan. Seven pts (16.7%), of whom 2 had highrisk disease, attained CR at a median of 6.0m. ORR for pts receiving vs not receiving R were 84.2% and 66.7% respectively (p=0.1904). IBR was discontinued in 20/61 pts (32.8%) at a median time to discontinuation of 4.1m, due to progressive disease (PD, 19.7%), toxicity (4.9%), death (3.3%;1 pt each of Covid-19 and E. coli infection), pt choice (3.3%) and other unspecified reasons (1.6%). 15/66 pts (22.7%) overall and 7/23 (30.4%) with high-risk disease progressed on IBR at a median time to PD of 4.0m. No pts underwent autologous stem cell transplantation consolidation during the study period. 12/57 pts (21.1%) received second line treatment (R-chemotherapy n=7, Nordic MCL protocol n=2, VR-CAP n=2, pirtobrutinib n=1). Response to second line treatment was CR in 4/11 pts, PD in 7/11. Of the 2 Nordic-treated patients, 1 had CR after cycle 2 and 1 PD. Fourteen pts (21.2%) died during the follow up period, due to MCL (n=11), Covid-19 (n=2) and congestive cardiac failure (n=1). Overall survival was lower for patients with high-risk disease (HR 0.55, p=0.038). Image: Summary/Conclusion: In this real-world UK cohort of pts receiving first-line IBR +/-R for MCL, including older and high-risk pts, we report high ORR rates in a similar range to the phase II Geltamo IMCL-2015 study of combination IBR-R in an exclusively low-risk population. Documented CR rates were lower, possibly reflecting a low usage of rituximab in the Covid-19 pandemic as well as CT assessment of response. Treatment was generally well tolerated, with low rates of toxicityrelated treatment discontinuation. The study is ongoing.