The Relationship and Effect Among Physical Literacy Attributes in University Physical Education During the Pandemic Quarantine Period

Purpose: This prospective cohort study investigated the impact of online and hybrid teaching of university-required physical education on students' physical literacy-related correlates. To avoid the widespread pandemic, the university decided to offer courses online through video conferencing or via a hybrid mode. When compared with face-to-face instruction, these formats may intensely affect students' physical literacy journey during early adulthood. Methods: A group of 1,738 students (42% males and 58% females) aged 18.52 (+/- 1.29) responded to a three-phase online survey in various courses. Results: The structural equation modeling determined that motivation and physical activity levels were negatively related to physical competence and knowledge and understanding. Further repeated-measure analyses recognized the interaction effect of amotivation. Results indicated that participants in the online teaching mode may experience a learning predicament over those in the hybrid one. Conclusion: Practically, the physical literacy teaching strategies in nurturing motivation and physical competence should be reinforced.

Critical role of diagnostic SARS-CoV-2 T cell assays for immunodeficient patients

After almost 3 years of intense study, the immunological basis of COVID-19 is better understood. Patients who suffer severe disease have a chaotic, destructive immune response. Many patients with severe COVID-19 produce high titres of non-neutralising antibodies, which are unable to sterilise the infection. In contrast, there is increasing evidence that a rapid, balanced cellular immune response is required to eliminate the virus and mitigate disease severity. In the longer term, memory T cell responses, following infection or vaccination, play a critical role in protection against SARS-CoV-2. Given the pivotal role of cellular immunity in the response to COVID-19, diagnostic T cell assays for SARS-CoV-2 may be of particular value for immunodeficient patients. A diagnostic SARS-CoV-2 T cell assay would be of utility for immunocompromised patients who are unable to produce antibodies or have passively acquired antibodies from subcutaneous or intravenous immunoglobulin (SCIG/IVIG) replacement. In many antibody-deficient patients, cellular responses are preserved. SARS-CoV-2 T cell assays may identify breakthrough infections if reverse transcriptase quantitative PCR (RT-qPCR) or rapid antigen tests (RATs) are not undertaken during the window of viral shedding. In addition to utility in patients with immunodeficiency, memory T cell responses could also identify chronically symptomatic patients with long COVID-19 who were infected early in the pandemic. These individuals may have been infected before the availability of reliable RT-qPCR and RAT tests and their antibodies may have waned. T cell responses to SARS-CoV-2 have greater durability than antibodies and can also distinguish patients with infection from vaccinated individuals.

Inhaled modified angiotensin converting enzyme 2 (ACE2) as a decoy to mitigate SARS-CoV-2 infection

COVID-19 is a new zoonotic disease caused by the SARS-CoV-2 virus. Since its emergence in Wuhan City, China, the virus has rapidly spread across the globe causing calamitous health, economic and societal consequences. It causes disproportionately severe disease in the elderly and those with co-morbidities, such as hypertension and diabetes. There is currently no proven treatment for COVID-19 and a safe and effective vaccine is at least a year away. The virus gains access to the respiratory epithelium through cell surface angiotensin converting enzyme 2 (ACE2). The receptor binding domain (RBD) of the virus is unlikely to mutate without loss of pathogenicity and thus represents an attractive target for antiviral treatment. Inhaled modified recombinant human ACE2, may bind SARS-CoV-2 and mitigate lung damage. This decoy strategy is unlikely to provoke an adverse immune response and may reduce morbidity and mortality in high-risk groups. Copyright © 2020 New Zealand Medical Association. All rights reserved.

Outcomes of Gynaecological Cancer Surgery during the Covid-19 Pandemic: Results from the International, Multicenter, Prospective Covidsurggynaecological Cancer Study

Objectives The magnitude of adverse outcomes caused by the disrupted surgical cancer care during the COVID-19 pandemic is unclear. Our aim was to evaluate the changes in care and short-term outcomes of surgical patients with gynecological cancers during the initial phase of the COVID-19 pandemic internationally. Methods A multicenter, international prospective cohort study including consecutive patients with gynecological cancers who were initially planned for non-palliative surgery. Primary Outcome: 30-day postoperative SARS-CoV-2 infection rate. Secondary Outcomes: 30-day perioperative mortality and morbidity, COVID-19-related treatment modifications. Results We included 3973 patients (52 countries;7 world regions). Lower-than-reported rate (22/3778;0.6%) of perioperative SARS-CoV-2 infections was observed. This group had higher morbidity (63.6% vs 19.1%;p<0.0001) and mortality (18.2% vs 0.7%;p<0.0001), compared to the uninfected cohort. In 20.7% (823/3973), standard of care was adjusted. Significant delay (>8 weeks) was observed in 11.2% (424/ 3784), particularly in those with ovarian cancer (213/1355;15.7%). This delay was associated with a composite of adverse outcomes including disease progression and death (95/ 424;22.4% versus 601/3360;17.9%, p=0.024), compared to those who had operations within 8 weeks of their MDT decisions. One in thirteen did not receive their planned operations (189/2430;7.9%), in whom 1 in 20 (5/189;2.7%) died and 1 in 5 (34/189;18%) experienced disease progression or death within 3 months of decisions for surgery. Conclusions One in five surgical patients with gynecological cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operationscoordinated mitigating strategies are urgently needed.

Outcomes of Gynaecological Cancer Surgery during the Covid-19 Pandemic: Results from the International, Multicenter, Prospective Covidsurggynaecological Cancer Study

Introduction/Background The magnitude of adverse outcomes caused by the disrupted surgical cancer care during the COVID-19 pandemic is unclear. The aim of CovidSurg-Gynaecological Cancer study was to evaluate the changes in care and short-term outcomes of surgical patients with gynecological cancers during the initial phase of the COVID-19 pandemic internationally. Methodology A multicenter, international prospective cohort study including consecutive patients with gynecological cancers who were initially planned for non-palliative surgery. Primary outcome The incidence of pandemic-related changes in care Secondary outcomes 30-day postoperative morbidity and mortality rates A composite outcome of unresectable disease or disease progression, emergency surgery and death Results We included 3973 patients (52 countries;7 world regions;27% from low-and-middle-income countries). Lower-than-reported rate (22/3778;0.6%) of perioperative SARS-CoV-2 infections was observed. This group had higher morbidity (63.6% vs 19.1%;p<0.0001) and mortality (18.2% vs 0.7%;p<0.0001) rates, compared to the uninfected cohort. In 20.7% (823/3973), standard of care was adjusted. Significant delay (>8 weeks) was observed in 11.2% (424/3784), particularly in those with ovarian cancer (213/1355;15.7%). This delay was associated with the use of neoadjuvant chemotherapy (p<0.0001), a composite of adverse outcomes including disease progression and death (95/424;22.4% versus 601/ 3360;17.9%, p=0.024), compared to those who had operations within 8 weeks of their MDT decisions. One in thirteen did not receive their planned operations (189/2430;7.9%), in whom 1 in 20 (5/189;2.7%) died and 1 in 5 (34/189;18%) experienced disease progression or death within 3 months of MDT decisions for surgery Conclusion One in five surgical patients with gynecological cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operations. This global data on the magnitude of care changes and their consequences could be used to leverage resources for the ongoing mitigating strategies worldwide.

Designing Predictive Models for Customer Recommendations During COVID-19 in the Airline Industry

Although travel restrictions imposed by countries are gradually lifted, the airline industry rebounds only when customers’confidence in air travel is restored. Airlines that generate positive customer recommendations during the pandemic can have a competitive advantage in the post-pandemic environment. This article focuses on the prediction of customer recommendations of airlines during the pandemic. The results show that airline ratings established before the pandemic have weak performance, implying that customer recommendations could be based on other factors that are unique to the pandemic. In addition, COVID-19 travel safety of airlines and sentiments hidden in customer reviews are valuable for predicting customer recommendations. The results also confirm that flight duration affects the predictive powers of airline rating established before the pandemic and COVID-19 travel safety rating of airlines. There are important implications for the airline industry. First, airline ratings established before pandemic is not valuable to predict customer recommendations during COVID-19, underpinning the importance of including COVID-19 travel safety measures as part of the airline evaluation criteria in the future. Besides, COVID-19 travel safety is more relevant to customer recommendations in the long-haul markets. When selecting airlines for evaluation, airline rating organizations can give priorities to airlines that offer long-haul flights. IEEE

Can Everyone See My Screen? Successfully Engaging Community Virtually during a Pandemic

BACKGROUND: Community engagement is widely regarded as a necessary strategy to address health disparities;however, connecting with the most marginalized communities can be difficult. Early in the COVID 19 pandemic (January 2020-March 2021) it became nearly impossible. Cicatelli Associates Inc. was funded to build the capacity of Black/African American identifying young adults, age 21-27, in developing and implementing an intervention to address social determinants of health that lead to STI disparities in Jackson, MS. Partnering with My Brother's Keeper, Inc. from October 2020 to December 2021, we implemented an authentic community engagement model to recruit 12 community members to form a Community Advisory Board (CAB). METHOD(S): We utilized the Creative Problem Solving (CPS) process with the CAB to train, conduct and implement a needs assessment, and make meaning of its results. We hosted meticulously designed bi-weekly meetings that accounted for the virtual platform, provided technology and software, while using surveys to address any challenges experienced by the CAB and staff. Between meetings we kept lines of communication open utilizing group chat messaging and telephone calls. RESULT(S): During the 14-month period, we held 20 meetings with an attendance rate of 74%. We conducted 15 trainings with attendance rate of 76%. We assessed the CAB's experience and satisfaction via 25 statements (scale: 1 = strongly disagree to 4= strongly agree);on average, the CAB reported high satisfaction (score = 3.98), with special attention being given to staff treating them as equal partners (4), Zoom as an effective meeting platform (3.98), and meetings were a good use of their time (3.99). CONCLUSION(S): Employing authentic community engagement principles and strategies, making technology available and creating space and time for communities to discuss effects of the pandemic on their lives beyond the scope of the work, organizations can successfully engage and collaborate with communities within an authentic manner.

Using a Hyflex Learning Format in a Second-year Mechatronics Course

This evidence-based practice paper details a Hyflex learning format used in a second-year Mechatronics course for Mechanical Engineering majors. At York College of Pennsylvania, Mechatronics introduces second-year Mechanical Engineering students to essential aspects of electronics and instrumentation through experiential hands-on learning. Students regularly conduct laboratory exercises and work on short projects as they learn about common electronic components, basic circuit analysis and sensors, and how these components can be used to create electro-mechanical devices. The course was modified in Spring 2021 to incorporate aspects of the Hyflex course format necessary to accommodate the ongoing COVID-19 pandemic. The course format enabled students to attend in person or remotely through Zoom video conferencing. The format expanded the use and support of asynchronous learning activities to better enable students quarantined, due to close contacts or positive Covid tests, to keep up or catch up on the course instruction. The goal of the instructors was to enable the same learning outcomes for all students, independent of personal circumstances. Online software tools (Canvas learning management system, Tinkercad and Nearpod) were used to deliver content and engage students. Conceptual topics were introduced followed by hands-on activities from Make: Electronics 2nd edition. Each student was also given a kit of electronic components, wire, a breadboard and a multimeter. Students completed and submitted assignments in a variety of digital formats, such as video reports. This paper details the Hyflex modifications made to Mechatronics. It also includes student feedback and instructor reflections. Although the Hyflex format required significant new planning and experimentation it provided a means of accommodating a mix of face-to-face and online students and also provided an opportunity to increase the long term effectiveness of the course. © American Society for Engineering Education, 2022.

Community logistics: a dynamic strategy for facilitating immediate parcel delivery to smart lockers

The COVID Pandemic since early 2019 has imposed significant effects on our life. In the retail and logistics sector, the large-scale national lockdown has drastically driven e-commerce sales because the e-marketplace has become the only sales channel. Whilst the pandemic has accelerated the shift towards a more digital world and led to an irreversible dependence on e-commerce retailing, the pressure is on retailers and logistics service providers to respond to the growing demand for immediate delivery in the e-commerce era. Given the integration of smart lockers into developing a more favourable environment which potentially makes immediate delivery more feasible, this paper introduces a novel, dynamic delivery strategy, namely Community Logistics Strategy (CLS), for formulating and updating the new delivery plan in real time as new delivery requests to smart lockers arrive. To shed light on the effect of dynamic order arrival towards delivery planning, the CLS attempts to update the delivery plan by taking new requests into account in real time. Simulation results reveal the superiority of the proposed strategy in managing e-commerce delivery requests, especially within megacities where consumers are highly dense in a compact geographical area. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

IS REMOTE LEARNING AS EFFECTIVE AS IN-PERSON LEARNING FOR CONTOURING EDUCATION? A COMPARISON OF FACETO-FACE VERSUS ONLINE DELIVERY OF THE ANATOMY AND RADIOLOGY CONTOURING BOOTCAMP

Purpose: The Anatomy and Radiology Contouring (ARC) Bootcamp was a three-day in-person intervention providing integrated radiology, anatomy, and contouring education for radiation oncology (RO) residents and medical physicists. The course consisted of didactic radiology and contouring lectures, small group anatomy sessions using cadaveric prosections, and realtime contouring using commercial software. Acknowledging the importance of increasing access to the Bootcamp, we launched an online version of the ARC Bootcamp in November 2019. We evaluated the online (ONL) course's impact on participants' knowledge acquisition, contouring skills, and self-confidence by comparing it to the face-to-face (F2F) course. Materials and Methods: The F2F Bootcamp was adapted into an ONL version using the Teachable platform (teachable.com). The ONL course was structured in a linear progression of locked modules to offer similar content to the F2F comparator. Participants from the 2019 F2F and the 2019-2020 ONL Bootcamp provided consent for the study and completed pre-and post-intervention evaluations, which assessed anatomy/radiology knowledge, contouring skills, anatomy/radiology knowledge and contouring self-confidence, and course satisfaction. Results: Fifty-seven (F2F: n=30;ONL: n=27) participants completed both evaluations. The ONL course had a substantially wider geographic participation, with participants from 19 countries (versus four countries in the F2F course) completing the preevaluation. F2F had primarily RO resident participation (80%) compared to ONL (41%). In the ONL course, most were from a different field (52%), including medical physics residents or medical students. Compared to baseline self-assessments, both cohorts demonstrated similar self-confidence improvements with their anatomy/radiology knowledge, contouring skills, and in interpreting radiology p<0.001). In the anatomy/radiology knowledge testing, the ONL group showed improvement (mean improvement ± SD: 4.6 ± 6.3 on a 40-point scale;p<0.001) but the F2F group did not (1.6 ± 5.6;p=0.159). The F2F group demonstrated improvement with the contouring assessment (mean ± SD: 0.10 ± 0.17 on a 1-point Dice scale;p=0.004), whereas only a trend was found for the ONL group (0.07 ± 0.16;p=0.076). Both cohorts perceived the course as a positive learning experience (F2F: 4.8 ± 0.4 on a 5-point scale;ONL: 4.5 ± 0.6) and stated it will improve their professional practice (F2F: 4.6 ± 0.5 on a 5-point scale;ONL: 4.2 ± 0.8). Both groups would recommend the course to others (F2F: 4.8 ± 0.4 on a 5-point scale;ONL: 4.4 ± 0.6). Conclusions: The ONL ARC Bootcamp achieved similar results as the F2F version, with improved self-confidence, knowledge scores, and high satisfaction levels among participants. The ONL course is more accessible to diverse geographic regions and disciplines, allows for ongoing education during the COVID-19 pandemic, and can be used as a framework to develop other online educational interventions in radiation oncology.

STEREOTACTIC PELVIC ADJUVANT RADIATION THERAPY IN CANCERS OF THE UTERUS (SPARTACUS): A MULTI-CENTRE PROSPECTIVE TRIAL EVALUATING ACUTE TOXICITIES AND PATIENT REPORTED OUTCOMES

Purpose: Adjuvant radiation plays a significant role in reducing loco-regional recurrences in uterine cancers. Standard treatment consists of daily radiation for five weeks which can be challenging for patients and the healthcare system, especially during the COVID-19 pandemic. Hypofractionated radiotherapy has been evaluated and established in other pelvic malignancies. This study aims to evaluate the acute urinary and bowel toxicities, and patient reported outcomes following stereotactic hypofractionated adjuvant radiation for endometrial cancer. Materials and Methods: This is a prospective phase I/II trial in which patients with endometrial cancer planned for adjuvant radiation received 30Gy in 5 fractions, every other day or once weekly. Treatment was delivered at two centres with volumetric arc radiation therapy with a body-vacuum immobilization, bowel enema and 3D image-guidance. Toxicity assessment, outcomes and patient reported quality of life (QOL, EORTC core QLQ-C30 and endometrial EN24) were collected at baseline, fractions (F) 3 and 5, and at regular follow-up intervals. Higher scores represent better global QOL/health status or worse symptoms (scale 0 -100). Changes in QOL over time were investigated with linear mixed-effects models. A p-value threshold of 0.05 was used for statistical significance. A change in QOL score of > 10 points was considered clinically significant. Results: The median age of the 41 enrolled patients is 66 (range: 51 - 88). Histologies included 29 endometrioid adenocarcinoma, eight serous/clear cell, one carcinosarcoma, and three dedifferentiated. Thirty patients had Stage I disease while three had Stage 2 and eight Stage 3. Seven patients received sequential chemotherapy and 3 had additional vault brachytherapy. Median follow-up is nine months, with worst toxicity (GI or GU) of Grade 1 and 2 in 63% and 24% respectively. No patients have experienced a Grade 3 or higher toxicity. Patient-reported diarrhea and gastrointestinal domain scores were statistically significantly worse than baseline at F5 (mean paired difference = 27.2;8.7, p<.005) and six weeks (mean paired difference = 7.9;5.1, p<0.05), and returned to baseline levels at 12 weeks. The only clinically significant change (>10) from baseline was in diarrhea at F5. There were no significant changes in urinary domain, overall health and quality of life scores. No loco-regional recurrences have been found;three patients recurred distantly, of which two died of metastatic disease. Conclusions: Stereotactic hypofractionated radiation is feasible and well-tolerated with short-term follow-up. Longer follow-up and future randomized studies are needed to further evaluate this treatment.

Is Remote Learning as Effective as In-Person Learning for Contouring Education? A Comparison of Face-to-Face vs. Online Delivery of the Anatomy and Radiology Contouring Bootcamp

Purpose/Objective(s): The Anatomy and Radiology Contouring (ARC) Bootcamp was a three-day in-person course providing integrated radiology, anatomy, and contouring education for radiation oncology (RO) residents and medical physicists. The course consisted of didactic radiology and contouring lectures, small group anatomy sessions using cadaveric prosections, and real-time contouring using commercial software. Acknowledging the importance of increasing access to the Bootcamp, we launched an online (ONL) version of the ARC Bootcamp in November 2019. We evaluated the ONL course's impact on participants' knowledge acquisition, contouring skills, and self-confidence by comparing it to the face-to-face (F2F) course. Materials/Methods: The F2F Bootcamp was adapted into an ONL version using the Teachable platform (teachable.com). The ONL course was structured in a linear progression of locked modules to offer similar content to the F2F comparator. Participants from the 2019 F2F and the 2019–2020 ONL Bootcamp provided consent for the study and completed pre-and post-intervention evaluations, which assessed anatomy/radiology knowledge, contouring skills, anatomy/radiology knowledge and contouring self-confidence, and course satisfaction. Results: Fifty-seven (F2F: n = 30;ONL: n = 27) participants completed both evaluations. The ONL course had a substantially wider geographic participation, with participants from 19 countries (vs. 4 countries in the F2F course) completing the pre-evaluation. F2F had primarily RO resident participation (80%) compared to ONL (41%). In the ONL course, most were from a different field (52%), including medical physics residents or medical students. Compared to baseline self-assessments, both cohorts demonstrated similar self-confidence improvements with their anatomy knowledge, contouring skills, and in interpreting radiology images (all P < 0.001). In the anatomy/radiology knowledge testing, the ONL group showed improvement (mean improvement ± SD: 4.6 ± 6.3 on a 40-point scale;P < 0.001) but the F2F group did not (1.6 ± 5.6;P = 0.159). The F2F group demonstrated improvement with the contouring assessment (mean ± SD: 0.10 ± 0.17 on a 1-point Dice scale;P = 0.004), whereas only a trend was found for the ONL group (0.07 ± 0.16;P = 0.076). Both cohorts perceived the course as a positive learning experience (F2F: 4.8 ± 0.4 on a 5-point scale;ONL: 4.5 ± 0.6) and stated it will improve their professional practice (F2F: 4.6 ± 0.5 on a 5-point scale;ONL: 4.2 ± 0.8). Both groups would recommend the course to others (F2F: 4.8 ± 0.4 on a 5-point scale;ONL: 4.4 ± 0.6). Conclusion: The ONL ARC Bootcamp achieved similar results as the F2F version, with improved self-confidence, knowledge scores, and high satisfaction levels among participants. The ONL course is more accessible to diverse geographic regions and disciplines, allows for ongoing education during the COVID-19 pandemic, and can be used as a framework to develop other online educational interventions in radiation oncology.

Stereotactic Pelvic Adjuvant Radiation Therapy in Cancers of the Uterus (SPARTACUS): A Multicenter Prospective Trial Evaluating Acute Toxicities and Patient Reported Outcomes

Adjuvant radiation plays a significant role in reducing locoregional recurrences in uterine cancers. Standard treatment consists of daily radiation for 5 weeks which can be challenging for patients and the healthcare system, especially during the COVID pandemic. Hypofractionated radiotherapy has been evaluated and established in other pelvic malignancies. This study aims to evaluate the acute urinary and bowel toxicities, and patient reported outcomes following stereotactic hypofractionated adjuvant radiation for endometrial cancer. This is a prospective phase I/II trial in which patients with endometrial cancer planned for adjuvant radiation received 30 Gy in 5 fractions, every other day or once weekly. Treatment was delivered at two centers with volumetric arc radiation therapy with a body-vacuum immobilization, bowel enema and 3D image-guidance. Toxicity assessment, outcomes and patient reported quality of life (QOL, EORTC core QLQ-C30 and endometrial EN24) were collected at baseline, fractions (F) 3 and 5, and at regular follow-up intervals. Higher scores represent better global QOL/health status or worse symptoms (scale 0 – 100). Changes in QOL over time were investigated with linear mixed-effects models. A P -value threshold of 0.05 was used for statistical significance. A change in QOL score of ≥ 10 points was considered clinically significant. The median age of the 41 enrolled patients is 66 (range: 51 – 88). Histologies included 29 endometrioid adenocarcinoma, 8 serous/clear cell, 1 carcinosarcoma, and 3 dedifferentiated. Thirty patients had stage 1 disease while 3 had stage 2 and 8 stage 3. Seven patients received sequential chemotherapy and 3 had additional vault brachytherapy. Median follow-up is 9 months, with worst toxicity (GI or GU) of grade 1 and 2 in 63% and 24% respectively. No patients have experienced a grade 3 or higher toxicity. Patient-reported diarrhea and gastrointestinal domain scores were statistically significantly worse than baseline at F5 (mean paired difference = 27.2;8.7, P <.005) and 6 weeks (mean paired difference = 7.9;5.1, P < 0.05), and returned to baseline levels at 12 weeks (Table 1). The only clinically significant change (≥ 10) from baseline was in diarrhea at F5. There were no significant changes in urinary domain, overall health and quality of life scores. No locoregional recurrences have been found;3 patients recurred distantly, of which 2 died of metastatic disease. Stereotactic hypofractionated radiation for uterine cancers is feasible and well-tolerated with short-term follow-up. Longer follow-up and future randomized studies are needed to further evaluate this treatment. [ABSTRACT FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Impact of the COVID pandemic on gynaecological cancer surgery - COVIDSurg gynaecological-cancer results

Objective Covid-19 has resulted in significant number of elective surgeries being delayed or cancelled worldwide with an estimated 28 million patients being affected. Previous studies suggest that perioperative Covid-19 infection has significant implications on surgical morbidity with perioperative mortality rates as high as 23.8%. Complication profiles increase with any additional treatment burden such as cytotoxic chemotherapy, radiotherapy or immunotherapy. Design We investigated the impact of the Covid-19 pandemic on gynaecological-cancer surgery in an international prospective multi-centre study. Participating centres entered consecutive patient's data into a customized electronic database for 12 weeks from the first COVID positive patient managed in their hospital between March and June 2020. Patients were eligible for enrolment into the present study if they were planned to undergo surgery for gynaecological cancer during the study duration, regardless of their COVID-19 status and whether they underwent surgery as recommended or not. Those patients who did not undergo their planned surgery were followed up for 12-weeks to observe outcomes. Method 4722 patients with gynecological cancer were recruited across 56 countries from 4 continents. The distribution of sites of origin was: 42% (n = 2024) uterine, 39% (n = 1872) ovarian, 11% (n = 538) cervical and 5.93% (n = 275) vulva-vagina cancer. The majority of the patients entered 73% (n = 3465) were from high-income countries, 26% (n = 1255) from middle income countries and 0.04% (n = 2) from low income countries. 4490 patients underwent surgery with a significant proportion of the patients experiencing change or adaptation of their treatment due to the COVID-19 pandemic. Results The main impact was on surgical timing;1.1% (n = 50) of patients experienced > 12-week delay in surgery, 2% (n = 119) a change in choice of operation, 0.02% (n = 50) change in neo-adjuvant chemotherapy, 2.7% (n = 452) received surgery in alternative hospital. Patients in this study had confirmed resolved COVID-19 prior to surgery in 0.95% (n = 45) of patients with an additional 0.34% (n = 16) with probable resolved COVID-19 infection. Furthermore, a post-operative COVID-19 rate of 2.27% (n = 25) and pulmonary complication rate of 1.8% (n = 20) was found in the initial analysis of the Covidsurg cancer data, analysing outcomes for 1102 gynaecological cancer patients. The overall 30-day mortality rate in this cohort was 1.18% (n = 13) (5). Discussion The largest multi-centre analysis of gynaecological cancer surgery during the Covid-19 pandemic has demonstrated worldwide significant adjustments of timing, indications and radicality of surgery in an effort to reduce COVID-19 related complications and has exposed constraints of the system, even in high income countries.

Healthcare workers acquired COVID-19 disease from patients? An investigation by phylogenomics.

The increasing number of coronavirus disease 2019 (COVID-19) cases in the community has posed a significant epidemic pressure on healthcare settings. When healthcare workers (HCWs) acquire COVID-19, contact tracing and epidemiological investigation might not be adequate for determining the source of transmission. Here, we report a phylogenetic investigation involving two infected HCWs and nine patients to determine whether patient-to-HCW transmission had occurred in a hospital without a previous COVID-19 outbreak. This is the first study to apply phylogenomics to investigate suspected nosocomial transmission in a region with low prevalence of COVID-19. Our results do not support the occurrence of direct patient-to-HCW transmission.