Dialogic Learning in the Time of a Global Pandemic and Beyond

A book dedicated to dialogue at a time when formal and informal educational spaces are affected by COVID-19 would be incomplete without reflections on what this historic moment means for dialogue educators now and in the future. This chapter is a collection of reflections from diverse educators on the opportunities and challenges arising out of moving from mostly in-person, on-site learning to virtual learning. The first three essays focus on dialogic educators' insights on shifting course midstream, recalibrating previously planned courses, and conceiving entirely new offerings. The final essay weaves themes across the three essays and identifies underlying factors that inform pivoting to newer forms of learning and delivery of dialogic education. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021.

Convalescent Plasma as Adjunctive Therapy for Hospitalized Patients with COVID-19: The Co-CLARITY Trial

Background and Objective. Convalescent plasma therapy (CPT) may reduce the risk of disease progression among patients with COVID-19. This study was undertaken to evaluate the efficacy and safety of CPT in preventing ICU admission among hospitalized COVID-19 patients. Methods. In this open-label randomized controlled trial, we randomly assigned hospitalized adult patients with COVID-19 in a 1:1 ratio to receive convalescent plasma as an adjunct to standard of care or standard of care alone. The primary endpoint was ICU admission within first 28 days of enrolment. Primary safety endpoints include rapid deterioration of respiratory or clinical status within four hours of convalescent plasma transfusion and cumulative incidence of serious adverse events during the study period including transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), severe allergic reactions, and transfusion-related infections. Results. A total of 22 patients were assigned to receive convalescent plasma as an adjunct to standard of care and 22 to receive standard of care alone. The median time from onset of COVID-19 symptoms to study enrolment was eight days (IQR, 4 to 10). Two patients (9.1%) in the CPT group and one patient (4.5%) in the control group were admitted to the ICU. The primary outcome measure, ICU admission, was not different between the two groups (q-value >0.9). No patient who received convalescent plasma had rapid deterioration of respiratory/clinical status within four hours of transfusion and none developed TRALI, TACO, anaphylaxis, severe allergic reactions, or transfusion-related infections. There was also no significant difference in the secondary outcomes of 28-day mortality (two patients in the CPT group and none in the control group, q-value >0.90), dialysis-free days, vasopressor-free days, and ICU-free days. Conclusions. Among hospitalized COVID-19 patients, no significant differences were observed in the need for ICU admission between patients given CPT as adjunct to standard of care and those who received standard of care alone. Interpretation is limited by early termination of the trial which may have been underpowered to detect a clinically important difference. © 2023 University of the Philippines Manila. All rights reserved.

The Benefits That a Novel Antimicrobial Provides When Viewed From an Insurance Value Perspective

Objectives: Traditional health economic evaluations of antimicrobials and other therapeutics such as vaccines currently underestimate their value to wider society. It can be supplemented by additional value elements including insurance value, which captures the value of a novel antimicrobial in preventing or mitigating impacts of adverse risk events such as those related to Covid-19 and antimicrobial resistance (AMR). Despite being commonplace in other sectors, constituents of the impacts and approaches for estimating insurance value of therapeutics have not been investigated. Method(s): This study assessed the insurance value of a novel antimicrobial, from the operational healthcare costs and several wider population health and societal perspectives. This was done by: (1) identifying risk events pertaining to 4 relevant scenarios: ward closures, unavoidable shortage of conventional antimicrobials, viral respiratory pandemics and catastrophic AMR, through literature review and multidisciplinary expert workshops, (2) parameterising constituent mitigable costs and frequencies of the risk events, and (3) applying a Monte Carlo simulation model for extreme events, and a dynamic disease transmission model. Modelling was implemented in Excel and R. Result(s): The mean insurance value across all scenarios and perspectives was 718m over a 10-year period, should AMR levels remain unchanged, where only 134m related to operational healthcare costs. The viral respiratory pandemics and catastrophic AMR scenarios contributed most to this value (290m and 297m respectively). This overall value would be 50-70% higher if AMR levels steadily increased or if a more risk-averse view (1-in-10 year downside) of future events is taken. Conclusion(s): The insurance value of a novel antimicrobial can be systematically modelled, and substantially augments their traditional health economic value in normal circumstances. These approaches are generalisable to any health intervention, and form a framework for health systems and governments to recognise broader value in health technology assessments and increase resilience by planning for adverse scenarios. Copyright © 2022

COVID-19 vaccine uptake and hesitancy amongst Australian patients with breast cancer

Aims: Vaccination uptake is the principal focus of the world-wide response to the COVID-19 pandemic. Vaccine hesitancy remains a critical issue. Our aim was to ascertain rates and reasons for vaccine hesitancy in people with breast cancer (BC) in Australia. Method(s): Between June and October 2021, an anonymous online survey was conducted among people with solid organ cancer treated at nine Australian treatment centres. Data collected included demographics and clinical characteristics. Vaccine hesitancy and related beliefs were assessed using the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale (OCVCCS), and the Disease Influenced Vaccine Acceptance Scale-Six. Descriptive statistics, chi-squared and linear regression were used. Results for the BC subgroup are reported. Result(s): The BC subgroup (N = 986, mean age 58.4 years, 99% female) comprised 36.6% of the responses in the solid cancer population (N = 2691). Most (76%) were treated at metropolitan centres and 64% were receiving ongoing treatment. Early BC was more commonly reported than metastatic BC (77% vs. 23%). Overall, 82% self-reported at least one COVID-19 vaccine dose. Unvaccinated participants were more likely to diagnosed with BC for a shorter time (<2 years (22.1%) vs >=2 years (14.5%), p = 0.003). Participants with metastatic BC were more likely to be unvaccinated and report greater disease-related vaccine concerns and hesitancy, when compared with participants with early BC (all p < 0.05). When compared with participants with all other solid cancers, participants with BC reported more negative attitudes towards COVID-19 vaccine side-effects (OCVCCS Side-Effects subscale mean scores: 5.19 (SD 1.91) vs. 5.46 (SD 1.82), p < 0.001). Conclusion(s):Despite a relatively high rate of self-reported vaccination, people with BC reported lower vaccine confidence when compared with all other solid cancers. A better understanding of these inequalities, and strategies to address vaccine confidence in people with BC, particularly those with metastatic BC, should be developed.

A single intranasal administration of AdCOVID protects against SARS-CoV-2 infection in the upper and lower respiratory tracts.

The coronavirus disease 2019 (COVID-19) pandemic has illustrated the critical need for effective prophylactic vaccination to prevent the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Intranasal vaccination is an attractive approach for preventing COVID-19 as the nasal mucosa is the site of initial SARS-CoV-2 entry and viral replication prior to aspiration into the lungs. We previously demonstrated that a single intranasal administration of a candidate adenovirus type 5-vectored vaccine encoding the receptor-binding domain of the SARS-CoV-2 spike protein (AdCOVID) induced robust immunity in both the airway mucosa and periphery, and completely protected K18-hACE2 mice from lethal SARS-CoV-2 challenge. Here we show that a single intranasal administration of AdCOVID limits viral replication in the nasal cavity of K18-hACE2 mice. AdCOVID also induces sterilizing immunity in the lungs of mice as reflected by the absence of infectious virus. Finally, AdCOVID prevents SARS-CoV-2 induced pathological damage in the lungs of mice. These data show that AdCOVID not only limits viral replication in the respiratory tract, but it also prevents virus-induced inflammation and immunopathology following SARS-CoV-2 infection.

Change in breast cancer risk perception related to perceived COVID-19 risk: A WISDOM sub-population analysis

Background: Obstacles to access to care due to the perceptions of the risk posed by COVID-19 have led to unprecedented disruptions in cancer care. Yet, little is understood about whether perceived COVID- 19 risk influences perceptions of cancer risk. We examined how COVID-19 risk perception was associated with perceptions of breast cancer risk over one year of the pandemic among women enrolled in the WISDOM study, a PCORI-funded pragmatic trial testing risk-based cancer screening that began before the pandemic. Methods: We conducted four longitudinal surveys among the 13,002 women enrolled in the WISDOM study from May - December 2020. Responses from 8,285 women are eligible for inclusion in this analysis leading to a total sample size of 16,859 survey responses. Surveys were conducted online and asked women's perceived lifetime chance of developing breast cancer (0- 100%). COVID-19 risk perception was reported on a 5-point scale from Very Low to Very High. We computed the difference between breast cancer risk perception at each COVID-19 survey to pre-COVID breast cancer risk perception, measured as a secondary aim of the WISDOM study, and compared that to COVID-19 risk perception at each time point. Results: Across the four survey waves, most women perceived low COVID risk: 29% very low, 42% moderately low, 23% neither high nor low and 6% high or very high. Overall, breast cancer risk perception declined for those with very low COVID-19 risk perception and rose for women in the highest levels of COVID-19 risk perception. However, changes in breast cancer risk perception associated with COVID risk perception were small. For example, in survey wave 4, breast cancer risk change was -2.4% very low, -1.4% low, 2.5% not high or low and 3.1% high or very high. (Table). Conclusions: Among women participating in a pragmatic trial testing riskbased cancer screening, COVID risk perception had a small relationship with change in breast cancer risk perception. Change in breast cancer risk perception paralleled COVID-19 risk perception. This calls for exploration of the underpinnings of these risk changes and may have implications for changes in cancer screening behavior related to COVID-19.

Convening the International Drama in Education Research Institute (IDIERI) Conference: Past, present and futures

Since its inaugural conference in 1995, the International Drama in Education Research Institute (IDIERI) Conference has become one of the prominent research meetings in the field of drama education and applied theatre. Held triennially, the IDIERI Conference has brought together leading academics and practitioners to share practices and deepen their critical engagement with research. Recently, though, the impact of the COVID-19 pandemic on public health and international travel, as well as growing concerns around lowering carbon emissions, has thrown the purpose of academic conferences into existential uncertainty. In July 2022, the University of Warwick is set to host the tenth IDIERI Conference as a ‘hybrid’ live in-person and virtual conference with accompanying ‘local’ modes of workshop facilitation. This article offers a timely retrospective informed by reflections from past convenors and related literature. We analyse IDIERI’s role in the research community, focusing on its scope, its shifting boundaries and intersections, its internationalism and diversity, as well as its significance in the future sustainability of our evolving discipline. © 2022. Intellect Ltd Article. English language. https://doi.org/10.1386/atr_00059_1

Preparing Engineers for 2035: Transforming Australia’s Engineering Education for Emerging Roles and Expectations

The Australian Council of Engineering Deans (ACED) recently concluded a project (‘Engineering 2035’) to reshape Australian engineering education for future professional engineering graduates. Consultations with industry leaders and others identified the need to strengthen graduate engineers’ capacity for multi-disciplinary and cross-functional teamwork, with greater public accountability. Focus groups of prospective students revealed weak understanding of the growing range of opportunities offered by an engineering qualification of this nature. The corresponding curriculum transformation must ensure greater focus on transferable skills and contexts are delivered alongside technical content. We envisage more industry-based, problem and project-based pedagogies. We found that the engineering academic workforce is positive to such changes. Its recent adaptation of teaching methods to accommodate COVID-19 restrictions gives confidence of a good response to the emerging needs. The project identified 22 Calls for Action to the schools of engineering and ACED, and to industry, government and the professional accrediting body, Engineers Australia. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

What trends can we see with consumer-initiated testing orders and telehealth genetic counseling pre- and post-COVID?

Introduction: Americans have made a myriad of changes in theirhealth choices and lifestyle habits as a result of the COVID-19pandemic. Concern over infection has led to increased stress andanxiety (Bhattacharjee B, Acharya T. Psychiatr Q. 2020) as well as anincreased focus on physical and mental wellness to cope with thosestressors. Due to fear of viral exposure in an in-clinic setting, manyhave opted to schedule telehealth appointments with their healthcareproviders (Betancourt JA, et al. Healthcare (Basel). 2020;8(4):380).However, there is very little literature describing how the pandemicimpacted the consumer-initiated testing (CIT) market and interest intelehealth genetic counseling. In this study, we sought to determinewhether the public’s demonstrated increased interest in personalhealth and wellness and adoption of telehealth extended to uptake ingenetic CIT and telehealth genetic counseling consultations.Methods: We conducted a chart review of all genetic CIT ordersreceived and genetic counseling consults scheduled with PWNHealthin the 9 months prior to the COVID pandemic being declared a nationalemergency on 3/13/20 (“pre-COVID,” 6/13/19–3/12/20) and 9 monthsafter that date (“post-COVID,” 3/13/20–12/13/20). The reviewincludedthe number of test requests received, consumers’ primary motivationfor pursuing testing from a drop-down selection of options, uptake ofpost-test genetic counseling consults and mode of consultationchosen (phone vs video).Results: There was a significant decrease (20%, p < 0.0001) in thenumber of genetic CIT orders received between the pre-COVID andpost-COVID time period (135,640 to 90,675). We found significantdifferences in chosen motivations for testing after the COVIDpandemic began in the US for all studied options (p < 0.0001). Seechart for which motivations were more likely to be chosen pre- vs.post-COVID. Consumers were 3 times more likely after the pandemicbegan to answer the motivation question rather than leave itunanswered. Post-COVID, they were 60% less likely to choose theirprimary motivation of testing as “I’m interested in the latest scientificbreakthroughs,” 35% more likely to choose “I’m interested in mygenetic risk for disease” and 61% more likely to choose “I have apersonal history.”There was a slight, but statistically insignificant, decrease in thenumber of genetic counseling consults scheduled after the start of theUS COVID pandemic (967 vs 886, P = 0.0582). Post-COVID, consumerswere significantly more likely to schedule their consults at a soonerdate (3.3 vs 3.6 pre-COVID, p < 0.0001) and twice as likely to choosevideo than phone (27.9% vs 12.5% pre-COVID) (P < 0.001). We can seethat this trend has continued to increase by month since the start ofthe pandemic (see graph). In addition, individuals were significantly more likely to complete their scheduled consult post-COVID (77.1% vs73.5% pre-COVID) (P < 0.001). Pre-COVID, individuals who scheduledvideo consultswere significantly less likely to complete the consult (i.e. they canceled or no-showed) as compared to those who hadscheduled phone consults (70.2% vs 74.0%, respectively;P < 0.0001).However, post-COVID, those individuals who scheduled video consultswere significantly more likely to go through with thatconsultation (83.8% vs 70.2% pre-COVID) and as compared to thosewho scheduled phone consults (74.5% completed, P < 0.0001). (Table Presented) Table 1Discussion: The increased willingness to answer the motivationquestion post-COVID could explain the increased likelihood ofconsumers reporting 7 out of the 9 motivations. However, theresults indicate that, post-pandemic, more individuals are seekinggenetic CIT because they are concerned about learning more abouttheir genetic risk for disease out of general interest or due to a personalor family history. The increased uptake of video genetic counselingconsults rather than phone only and the increased completion rate ofboth types of telehealth consults reflects the national trend towardsacceptance of medical appointments via telehe lth. Limitations of thisstudy include the restriction of consumers to select their motivationfrom a pre-selected dropdown menu which may not fully describetheir motivation for testing. In addition, this is a snapshot ofindividuals seeking services with one company’s clinical oversight. (Figure Presented) Conclusion: This review indicates that individuals have become moreengaged with their genetic health since the onset of the COVID-19pandemic in the US and are more accepting of medical consultationsvia video. Additional studies need to be done to determine if thesetrends continue on a broader healthcare scale.

COVID-19 vaccine-induced antibody responses are impaired in Inflammatory Bowel Disease patients treated with infliximab, ustekinumab or tofacitinib, but not thiopurines or vedolizumab

Background: Robust COVID-19 vaccine-induced antibody (Ab) responses are important for protective anti-viral immunity. Data are urgently needed to determine whether vaccine-induced immunity is impacted by commonly used immunosuppressive drug regimens in IBD. Methods: We prospectively recruited 447 adults (90 healthy controls and 357 IBD) at nine UK centres. The IBD study population was established (>12 weeks therapy) on either thiopurine monotherapy (n=78), infliximab (IFX) monotherapy (n=61), thiopurine & IFX combination therapy (n=70), ustekinumab (uste) monotherapy (n=56), vedolizumab (vedo) monotherapy (n=62) or tofacitinib (tofa) monotherapy (n=30). Participants had two doses of either ChAdOx1 nCoV-19, BNT162b2 or mRNA1273 vaccines. The primary outcome was anti-SARS-CoV-2 spike (S1 RBD) Ab concentrations, measured using the Elecsys anti- SARS-CoV-2 spike (S) Ab assay, 53-92 days after second vaccine dose, in participants without prior infection, adjusted by age & vaccine type. Secondary outcomes included proportions failing to generate protective Ab responses (defined cut-off anti-S concentration 15 U/mL, which correlated with 20% viral neutralization). Results: Geometric mean S Ab concentrations (figure 1) were lower in patients treated with IFX (153U/mL;p<0.0001), IFX and thiopurine combination (109U/mL;p<0.0001), tofa (430U/mL;p<0.0001) and uste (561U/mL;p=0.013) compared to controls (1596U/ml). No differences in S Ab concentrations were found between controls and thiopurine monotherapy- treated patients (1020U/mL;p=0.62), nor between controls and vedo-treated patients (944 U/mL;p=0.69). In multivariable modelling (figure 2), lower S Ab concentrations were independently associated with IFX (FC 0.10 [95% CI 0.07-0.14], p<0.0001), tofa (0.36 [95% CI 0.19-0.69], p=0.002) and uste (0.56 [95% CI 0.31-1.00], p=0.049), but not with thiopurine (0.77 [95% CI 0.54-1.11], p=0.17) or vedo (1.01 [95% CI 0.61-1.68], p=0.96). mRNA vaccines (3.67 [95% CI 2.72- 4.96], p<0.0001) and older age (0.82 [95% CI 0.73-0.91], p=0.0003) were independently associated with higher & lower S Ab concentrations respectively. Protective Ab responses were generated by all thiopurine monotherapy, vedo, tofa and healthy control participants, but not by 11% of patients on IFX monotherapy, 13% on thiopurine & IFX combination therapy and 4% on uste. Conclusion: COVID-19 vaccine-induced Ab responses are significantly reduced in patients treated with IFX, or tofa, and to a lesser extent with uste. No significant reduction was seen in vedo or thiopurine monotherapy-treated patients. Our data suggest that 3rd primary or booster vaccine doses for IBD patients might be tailored to an individual's immunosuppressive treatment.

Autoimmune encephalitis following recovery of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection

Objective: The novel SARS-CoV-2 predominantly presents with respiratory symptoms. Neurological complications of coronavirus disease 2019 (COVID-19) have been reported including but not limited to encephalopathy, stroke, seizures, meningoencephalitis, GBS, ADEM and myalgias. However, post-infectious COVID-19 autoimmune encephalitis has not been reported. Here, we report a case of post-COVID-19 autoimmune encephalitis. Background: A 60-year-old male physician with a history of recent recovered COVID-19 infection presented with neuropsychiatric complaints including altered mental status, perseveration, disinhibition, word finding difficulty and worsening paranoia. Exam consistent with constructional apraxia, akinetic mutism, bradykinesia, severely impaired delayed recall, and difficulty with complex tasks and multistep commands. Other neurological exam was normal. Cerebrospinal fluid analysis (CSF) demonstrated a glucose of 58, protein of 54, nucleated cell count of 0, RBC 0. SARS-CoV-2 RT-PCR in CSF was inconclusive. Autoimmune encephalitis and paraneoplastic panel in CSF were negative. Positron emission tomography (PET) scan was consistent with abnormal mixed brain hypometabolism and hypermetabolism suggesting an early pattern of autoimmune encephalitis. Detailed neurocognitive testing consistent with severe executive dysfunction. 48 hours of video EEG was suggestive of severe diffuse encephalopathy, no seizures or epileptiform discharges. Patient received treatment with 5 days of intravenous immunoglobulin (IVIg) with marked improvement noted clinically and as well as on repeat PET imaging and neurocognitive testing. Design/Methods: NA Results: NA Conclusions: SARS-CoV-2 infection is associated with respiratory symptoms and complications. There should be high suspicion of autoimmune encephalitis following COVID-19 infection in patients presenting with combination of neurological and neuropsychiatric symptoms following recovery of acute infection. PET scan can be abnormal initially in the autoimmune encephalitis, when EEG, MRI, and CSF studies are in-conclusive. Treatment with IVIg is warranted and clinical improvement can be monitored with pre and post treatment repeat imaging and neurocognitive testing. Future studies to understand post COVID autoimmune encephalitis are warranted.

Single-Dose Intranasal Administration of AdCOVID Elicits Systemic and Mucosal Immunity against SARS-CoV-2 and Fully Protects Mice from Lethal Challenge.

The coronavirus disease 2019 (COVID-19) pandemic has highlighted the urgent need for effective prophylactic vaccination to prevent the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Intranasal vaccination is an attractive strategy to prevent COVID-19 as the nasal mucosa represents the first-line barrier to SARS-CoV-2 entry. The current intramuscular vaccines elicit systemic immunity but not necessarily high-level mucosal immunity. Here, we tested a single intranasal dose of our candidate adenovirus type 5-vectored vaccine encoding the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein (AdCOVID) in inbred, outbred, and transgenic mice. A single intranasal vaccination with AdCOVID elicited a strong and focused immune response against RBD through the induction of mucosal IgA in the respiratory tract, serum neutralizing antibodies, and CD4+ and CD8+ T cells with a Th1-like cytokine expression profile. A single AdCOVID dose resulted in immunity that was sustained for over six months. Moreover, a single intranasal dose completely protected K18-hACE2 mice from lethal SARS-CoV-2 challenge, preventing weight loss and mortality. These data show that AdCOVID promotes concomitant systemic and mucosal immunity and represents a promising vaccine candidate.

The urgent need for diagnostic criteria and further understanding of burnout syndrome

The term burnout is widely used and accepted worldwide, but its existence as a distinct clinical entity remains poorly understood and is the source of controversy within academic circles. The existence or nonexistence of burnout has significant implications for individuals, families, organizations, communities, and societies. There is an urgent need for further descriptive research to determine consensus-driven diagnostic criteria that will aid in high-quality research to guide nonpharmacologic and pharmacologic treatment and to aid in the development of individual, organizational, and societal prevention strategies. This urgency is driven by recent changes in the occupational-social contract and highlighted by the ongoing COVID-19 pandemic. To address this need, the authors performed a narrative, nonsystematic review to obtain an overview of the current body of literature regarding the symptoms, diagnosis, and treatment of burnout symptoms. A literature search was conducted in PubMed for relevant articles in English since 1974 with the following search terms: "occupational burnout," "professional burnout," "career burnout," "assessment," "inventory," "measure," "instrument," "diagnosis," "treatment," "guideline" in different combinations. Hand searching was also performed. Retrieved records were reviewed, and the relevant studies were summarized. Burnout, whether a distinct clinical entity or an occupationally triggered manifestation of an already defined mental health condition, is an urgent public health priority. There is peril in waiting for a follow-on epidemic of its manifestations before embarking on high-quality research into diagnostic criteria, treatment, and prevention, as this takes time. However, this information is vital for individual practitioners, health-care systems, governments, and societies to meet this pressing need.

Health maintenance and breast cancer screening during the COVID-19 pandemic

Background: WISDOM is a large (target enrollment>40,000) healthy women preference-tolerant, pragmatic study comparing traditional annual screening to personalized risk-based breast screening. Cancer screening, routine health care, and elective procedures were disrupted due to attempts to manage resources during the COVID-19 pandemic. Understanding of the impact on COVID-19 on trial participants is important to gain a broader understanding of the effect of the pandemic on healthcare activities. Methods: Women aged 40-74 years with no history of breast cancer or DCIS, and no previous double mastectomy can join the WISDOM (NCT02620852) study online at wisdomstudy.org. A total of 28,600 women have consented to participate. As part of the trial, each patient completes a baseline and interval surveys through a Salesforce platform. In May, the study IRB was amended to add a COVID specific survey with questions related to participants COVID risk perceptions, coexisting conditions, and receipt of healthcare services in the 2 months prior to the survey. An initial survey was sent May 2020, with follow-up surveys planned every 2 months. In addition, national surveys on a population-based cross section of individuals across the nation will be performed in parallel. Data was collected, de-identified, and then analyzed using basic descriptive analysis, chi-2 analysis, and logit regression. Results: A total of 7,523 individuals in WISDOM responded to the survey (response rate 27%). Of those that responded, the average age at the time of the survey was 59 (range 40-79). The population was 87% Caucasian, 6% Hispanic, and 4% African-American. Only 3.6% of the sample felt they had COVID-19 either by symptoms or through testing. However, 10.0% felt they were at higher risk compared to similar individuals their age to get COVID-19. Of the sample, 29% had some form of high-riskcoexisting condition that put them at higher risk for COVID-19. In terms of healthcare utilization in the prior 2months, 43% had a routine medical visit cancelled by their primary care provider or health system, whereas 26%cancelled an appointment themselves. In terms of breast cancer screening, 16% had their screening visit eithercancelled or delayed. Individuals who believed they were at higher risk (and more likely to have shorter intervalscreening recommendations on this trial) had a higher Odds Ratio (1.66) for a screening cancellation (p<0.001).Those individuals who held the belief that COVID-19 was no more dangerous than the seasonal flu were more likelyto have medical visits and routine care in the preceding 2 months than those that did not share that belief. (OR 1.18,p=0.032). Individuals were significantly more worried about COVID-19 than developing breast cancer (43%moderate to severely worried about COVID compared to 8.2% for breast cancer). Those worried about COVID weremore likely to have screening cancellation (OR 1.18, P<0.001) and those more worried about breast cancer wereless likely to have a screening cancellation (OR. 0.83, P<0.001). Conclusions: Health maintenance, prevention,and specifically breast cancer screening are important, but these health activities have been significantly disrupteddue to the COVID-19 pandemic. Given that the pandemic will likely continue for many months until there is either avaccine, treatment, or herd immunity, it will be important to define the drivers and messages (healthcare andscreening) to ensure patients receive proper health maintenance and prevention to reduce the risks associated withother diseases that are not COVID-19. The preliminary data presented as part of this Abstract submission are theearly results of an effort to develop a predictive model and targeted strategies for communication and interventionfor cancer screening during the course of the COVID-19 pandemic.

UK food and nutrition security during and after the COVID-19 pandemic.

The COVID-19 pandemic is a major shock to society in terms of health and economy that is affecting both UK and global food and nutrition security. It is adding to the 'perfect storm' of threats to society from climate change, biodiversity loss and ecosystem degradation, at a time of considerable change, rising nationalism and breakdown in international collaboration. In the UK, the situation is further complicated due to Brexit. The UK COVID-19 F ood and N utrition S ecurity project, lasting one year, is funded by the Economic and Social Research Council and is assessing the ongoing impact of COVID-19 on the four pillars of food and nutrition security: access, availability, utilisation and stability. It examines the food system, how it is responding, and potential knock on effects on the UK's food and nutrition security, both in terms of the cascading risks from the pandemic and other threats. The study provides an opportunity to place the initial lessons being learnt from the on-going responses to the pandemic in respect of food and nutrition security in the context of other long-term challenges such as climate change and biodiversity loss.