Risk and the Transformation of Everyday Places and Spaces: Emptiness and Meaning-Making in Daily Life Amid the COVID-19 Pandemic Hazardscape

During the COVID-19 pandemic, emergent geographies of empty space and its relationship to fears for one's health and wellbeing have replaced our traditional understanding of social space with a risk calculus. While quarantine is the ultimate form of the preoccupation of risk, it also provides a connotation of diseased space versus safe space and who can or cannot enter exclusive spaces designed to protect others. The risk society thesis posits the emergence of a risk ethos, the development of a collective risk identity, and the formation of communities united by an increased vulnerability to risk (Ekberg, Curr Sociol 55:344, 2007). Ultimately, Beck's (Risk society: toward a new modernity. SAGE Publications, Thousand Oaks, CA, 1992) thesis of a second modernity asserts that "… the ethos of wealth creation that characterized industrial modernity has been overshadowed by an ethos of risk avoidance, class consciousness has been displaced by a risk consciousness and the increased awareness of living in an environment of risk, uncertainty, and insecurity has become a major catalyst for social transformation” Ekberg (Curr Sociol 55:344, 2007). This chapter offers perspective on the symbolic understanding of once populated spaces and places that are now empty spaces and places as stark symbols of the ubiquity of risk and emergence of a collective risk consciousness in geographies of risk. It illuminates how the transformation of common places and spaces into empty spaces present as a geography of risks "hazardscapes” in our lives while showing how the "language of risk” is understood in our daily lives in the grocery stores, public parks, and spaces, and in shared spaces to help us make meaning of our current reality and other realities (post-pandemic) to come. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Extracorporeal Membrane Oxygenation Utilization in Pregnant and Post-Partum Patients During the Covid-19 Pandemic

The use of veno-venous extracorporporeal membrane oxygenation (ECMO) support quickly became instrumental in treating a wide-range of patients demographics, including peripartum, that became critically ill with COVID pneumonia. Despite the surge in VV ECMO support throughout the pandemic data remains limited on safety and efficacy as a treatment modality in peripartum patients. A systematic review of all peripartum patients that were placed on VV ECMO support for COVID-19 pneumonia at a single institution from March 2020 to April 2022. Patient demographics, peripartum status, length of ECMO run, survival to discharge rates and associated complications with ECMO support were extracted through EMR and analyzed. Ten patients in the peripartum phase were included in the study. Mean age 35(±5.8) with mean body mass index 37.2(±11.4). Prior to ECMO insertion eight patients had infant delivery with a mean gestational age of 29.6(±3.2) weeks. Two patients were placed on ECMO at 19 and 28 weeks gestational age. Pre-ECMO patient presentation;All patients were on mechanical ventilation at 100% FiO2 , 5 had neuromuscular blockade infusions, 7 required inhaled nitric oxide, and the mean PaO2/FiO2 ratio was 86.7(95% CI 73.9-99.5). Mean predicted mortality scores at ECMO insertion were RESP 3.8(95% CI 2.8-4.8) and Murray 3.72(95% CI 3.6-3.8) respectively. Overall maternal and infant survival to discharge was 100%. Mean VA ECMO run was 18.5 days (±10.3) with mean hospital length of stay of 28.2 days (±11.5). Based on our findings, the use of VV ECMO support within this previously understudied patient population has proven to be a safe and an effective intervention. We should encourage clinicians to consider using VV ECMO in any peripartum patients who develop refractory ARDS in order to increase chance at survival. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. 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.)

Improving Veno-Veno Extracorporeal Membrane Oxygenation (VV ECMO) Survival to Discharge by Implementing a Goal-Oriented Expected Progression Patient Management Guideline

Management of VV ECMO has substantially evolved over the past two decades. Plenty literature has been published regarding indications, management, and outcomes, however limited evidence of standardized goal-oriented management practices exists. The VV ECMO Expected Progression guideline, approved on March 1, 2021 by the institution's ECMO Steering Committee, consists of five goal-oriented phases with suggestive interventions. Patient characteristics and outcomes were collected retrospectively and compared between July 2019 to Feb 2021 ("pre-implementation group") and March 2021 to April 2022 ("post implementation group"). Chi Square tests were performed to analyze the primary outcomes. Patient characteristics and outcomes are shown in table 1. Out of 125 adult patients, 78 followed the VV ECMO expected progression guideline. There was no significant difference in patient age, sex, and body mas index between both groups. COVID ARDS was the primary ECMO indicator for both cohorts at 96% (75/78) and 68% (32/47) respectively. Pre-ECMO presentation characteristics were evenly distributed between both groups. ECMO duration, ICU length of stay (LOS), and hospital LOS were significantly longer in the post implementation group (p=<0.01). ICU survival and hospital discharge outcome measures demonstrated a statistically significant improvement of 23.3% (p=<0.01) in the post implementation group. The VV ECMO Expected Progression goal-oriented guideline demonstrated to be a useful tool that resulted in streamlined care and improved survival to discharge. Of note, the post implementation group did report an increased in ECMO run time, ICU and hospital LOS. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. 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 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 . (Copyright applies to all s.)

Advancing the contributions of European stakeholders in farming systems to transitions to agroecology. (Special Issue: Insights into transitions to agroecological farming.)

The concept of a 'just transition' is gaining traction in international policy discourses. It has particular significance in relation to achieving net zero greenhouse gas emissions and the need for ensuring rights and responsibilities of all actors in transitions to agroecological farming systems. Research plays an important role in accompanying this transformation. It explores pathways for more sustainable and fair food systems, barriers to them being achieved, and where and what risks arise for communities of interest and of place. Researchers and practitioners across levels and sectors were brought together in H2020 projects LIFT and UNISECO using processes of stakeholder engagement. Both projects analysed the perceptions of actors towards agroecological farming, and their active involvement in the transitions required. This article summarises lessons learnt regarding multi-actor engagement in different participatory settings in both projects, including a Multi-Actor Platform approach, Q method, DELPHI and Hybrid forum workshops. The interactions involved several hundred actors from 18 countries across Europe. The article reflects on implications of the Covid-19 pandemic on the processes and effectiveness of multi-actor engagement, and assessments of the impacts on the empowerment of the actors. The findings are contextualised by contemporary European Union and national policy objectives of tackling climate change, the loss of biodiversity, and inequalities.

Advancing the Contributions of European Stakeholders in Farming Systems to Transitions to Agroecology

The concept of a ‘just transition' is gaining traction in international policy discourses. It has particular significance in relation to achieving net zero greenhouse gas emissions and the need for ensuring rights and responsibilities of all actors in transitions to agroecological farming systems. Research plays an important role in accompanying this transformation. It explores pathways for more sustainable and fair food systems, barriers to them being achieved, and where and what risks arise for communities of interest and of place. Researchers and practitioners across levels and sectors were brought together in H2020 projects LIFT and UNISECO using processes of stakeholder engagement. Both projects analysed the perceptions of actors towards agroecological farming, and their active involvement in the transitions required. This article summarises lessons learnt regarding multi-actor engagement in different participatory settings in both projects, including a Multi-Actor Platform approach, Q method, DELPHI and Hybrid forum workshops. The interactions involved several hundred actors from 18 countries across Europe. The article reflects on implications of the Covid-19 pandemic on the processes and effectiveness of multi-actor engagement, and assessments of the impacts on the empowerment of the actors. The findings are contextualised by contemporary European Union and national policy objectives of tackling climate change, the loss of biodiversity, and inequalities. © 2022 The Authors. EuroChoices published by John Wiley & Sons Ltd on behalf of Agricultural Economics Society and European Association of Agricultural Economists.

Advancing the Contributions of European Stakeholders in Farming Systems to Transitions to AgroecologyForderung der Beitrage von europaischen Beteiligten der landwirtschaftlichen Systeme zum ubergang zur Agrarokologie

The concept of a 'just transition' is gaining traction in international policy discourses. It has particular significance in relation to achieving net zero greenhouse gas emissions and the need for ensuring rights and responsibilities of all actors in transitions to agroecological farming systems. Research plays an important role in accompanying this transformation. It explores pathways for more sustainable and fair food systems, barriers to them being achieved, and where and what risks arise for communities of interest and of place. Researchers and practitioners across levels and sectors were brought together in H2020 projects LIFT and UNISECO using processes of stakeholder engagement. Both projects analysed the perceptions of actors towards agroecological farming, and their active involvement in the transitions required. This article summarises lessons learnt regarding multi-actor engagement in different participatory settings in both projects, including a Multi-Actor Platform approach, Q method, DELPHI and Hybrid forum workshops. The interactions involved several hundred actors from 18 countries across Europe. The article reflects on implications of the Covid-19 pandemic on the processes and effectiveness of multi-actor engagement, and assessments of the impacts on the empowerment of the actors. The findings are contextualised by contemporary European Union and national policy objectives of tackling climate change, the loss of biodiversity, and inequalities.

Assessment of Herpes Zoster Risk Among Recipients of COVID-19 Vaccine.

Importance: Herpes zoster infection after COVID-19 vaccination has been reported in numerous case studies. It is not known whether these cases represent increased reporting or a true increase in risk. Objective: To assess whether COVID-19 vaccination is associated with an increased risk of herpes zoster infection. Design, Setting, and Participants: This cohort study used a self-controlled risk interval (SCRI) design to compare the risk of herpes zoster in a risk interval of 30 days after COVID-19 vaccination or up to the date of the second vaccine dose with a control interval remote from COVID-19 vaccination (defined as 60-90 days after the last recorded vaccination date for each individual, allowing for a 30-day washout period between control and risk intervals). A supplemental cohort analysis was used to compare the risk of herpes zoster after COVID-19 vaccination with the risk of herpes zoster after influenza vaccination among 2 historical cohorts who received an influenza vaccine in the prepandemic period (January 1, 2018, to December 31, 2019) or the early pandemic period (March 1, 2020, to November 30, 2020). Data were obtained from Optum Labs Data Warehouse, a US national deidentified claims-based database. A total of 2 039 854 individuals who received any dose of a COVID-19 vaccine with emergency use authorization (BNT162b2 [Pfizer-BioNTech], mRNA-1273 [Moderna], or Ad26.COV2.S [Johnson & Johnson]) from December 11, 2020, through June 30, 2021, were eligible for inclusion. Individuals included in the SCRI analysis were a subset of the COVID-19-vaccinated cohort who had herpes zoster during either a risk or control interval. Exposures: Any dose of a COVID-19 vaccine. Main Outcomes and Measures: Incident herpes zoster, defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes and a prescription of a new antiviral medication or a dose increase in antiviral medication within 5 days of diagnosis. Results: Among 2 039 854 individuals who received any dose of a COVID-19 vaccine during the study period, the mean (SD) age was 43.2 (16.3) years; 1 031 149 individuals (50.6%) were female, and 1 344 318 (65.9%) were White. Of those, 1451 patients (mean [SD] age, 51.6 [12.6] years; 845 [58.2%] female) with a herpes zoster diagnosis were included in the primary SCRI analysis. In the SCRI analysis, COVID-19 vaccination was not associated with an increased risk of herpes zoster after adjustment (incidence rate ratio, 0.91; 95% CI, 0.82-1.01; P = .08). In the supplementary cohort analysis, COVID-19 vaccination was not associated with a higher risk of herpes zoster compared with influenza vaccination in the prepandemic period (first dose of COVID-19 vaccine: hazard ratio [HR], 0.78 [95% CI, 0.70-0.86; P < .001]; second dose of COVID-19 vaccine: HR, 0.79 [95% CI, 0.71-0.88; P < .001]) or the early pandemic period (first dose of COVID-19 vaccine: HR, 0.89 [95% CI, 0.80-1.00; P = .05]; second dose: HR, 0.91 [95% CI, 0.81-1.02; P = .09]). Conclusions and Relevance: In this study, there was no association found between COVID-19 vaccination and an increased risk of herpes zoster infection, which may help to address concerns about the safety profile of the COVID-19 vaccines among patients and clinicians.

Risk of herpes zoster ophthalmicus following COVID-19 vaccination in a large US claims database

Purpose : To determine whether there is an increased risk of herpes zoster ophthalmicus (HZO) following COVID-19 vaccination. Methods : Retrospective observational study utilizing OptumLabs® Data Warehouse, a longitudinal, real-world data asset with de- identified administrative claims and electronic health record data. A cohort study design and a self-controlled design were both utilized to investigate HZO following vaccination, defined by an ICD-10 diagnosis code within 30 days after vaccine administration (or up to the second dose if a second dose was administered), plus a new prescription or dose escalation of antivirals within 5 days of HZO diagnosis. Using a cohort design, COVID-19 vaccinated individuals from 12/11/2020- 6/30/2021 were compared to two influenza-vaccinated cohorts: a pre-pandemic group (1/1/2018-12/13/2019) and an early pandemic group (3/1/2020-11/1/2020). Cox proportional hazard models were used to identify unadjusted and adjusted hazard ratios for HZO. Using a self-controlled design, the incidence rate ratio comparing the risk of HZO in the risk intervals following COVID-19 vaccination to a control interval 60 to 90 days prior to the first dose was estimated using conditional Poisson regression. Results : Among 3,567,715 patients in the COVID-19 vaccinated cohort, there were 60 post-vaccine HZO cases. Patients vaccinated against COVID-19 were not at increased risk of HZO compared to pre-pandemic influenza vaccinated patients (N= 5,101,709;HR= 0.84;95% CI: 0.61-1.16;p= 0.29) and early pandemic influenza vaccinated patients (N= 4,060,412;HR= 0.93;95% CI: 0.64-1.34;p= 0.69) after adjustment for demographics, comorbidities, zoster vaccine, and medication use. Additionally, HZO cases post-COVID-19 vaccination were less likely to be prescribed ophthalmic steroids compared to cases following pre-pandemic and early pandemic influenza vaccination (18.3% vs 29.6% vs 41.4%, respectively). In the self-controlled design, patients were not at increased risk of HZO after COVID-19 vaccination compared to their control interval (IRR= 0.74;95% CI: 0.49-1.12;p= 0.15). Conclusions : There is not an increased risk of HZO following COVID-19 vaccination. These results provide reassurance for the safety of the COVID-19 vaccine from an ophthalmic standpoint.

Neoadjuvant cemiplimab in patients (pts) with stage II–IV (M0) cutaneous squamous cell carcinoma (CSCC): Primary analysis of a phase II study

Background: CSCC is highly immune-responsive;a prior pilot study demonstrated a high rate of pathologic complete response (pCR) or major pathologic response (MPR, ≤10% viable tumor), using cemiplimab anti-programmed death 1 (PD-1) therapy in the neoadjuvant setting. Here, we present the primary analysis of a confirmatory, open-label, multicenter, Phase 2, single-arm trial of neoadjuvant cemiplimab in pts with resectable Stage II–IV (M0) CSCC. Methods: Pts received cemiplimab 350 mg IV q3W for up to 4 doses before surgery. The primary endpoint was pCR rate per independent central pathologic review (ICPR). Key secondary endpoints included MPR rate per ICPR, objective response rate (ORR;complete response [CR] + partial response [PR]) per RECIST v1.1, investigator-assessed pCR and MPR, safety and tolerability. Results: At data cutoff date of 01 Dec 2021, 79 pts were enrolled (67 male;median age 73.0 yrs [range, 66.0–81.0];ECOG performance status 0 (n=60) and 1 (n=19) with stage II (n=5), III (n=38), or IV(M0) (n =36) disease;62 pts received all 4 doses (median number of doses given (Q1:Q3), 4 (4:4);70 pts underwent surgery. The study met its primary endpoint: pCR was observed in 40 (50.6%) pts (95% confidence interval [CI], 39.1–62.1%). MPR was observed in an additional 10 (12.7%) pts (95% CI, 6.2–22.0%). ORR was 68.4% (95% CI, 56.9–78.4) (5 CR, 49 PR, 16 stable disease, 8 progressive disease (PD), 1 non evaluable. Reasons 9 pts did not have surgery: 3 responders declined surgery, 2 lost to follow-up or noncompliance, 2 had inoperable PD, 2 due to AE. Fourteen (17.7%) pts experienced Grade ≥3 AE. Four pts died due to AEs: 1 exacerbation of cardiac failure, 2 myocardial infarctions, and 1 COVID-19 pneumonia. The most common AEs regardless of attribution (all grades) were fatigue (30.4%), rash maculo-papular (13.9%), diarrhea (13.9%) and nausea (13.9%). Conclusions: The pCR + MPR of 63.3% by ICPR in pts with Stage II–IV (M0) CSCC is the highest observed in a multicenter anti-PD-1 neoadjuvant monotherapy study for any solid tumor type. The safety profile of neoadjuvant cemiplimab is consistent with previous anti-PD-1 monotherapy experience. Ongoing follow-up will describe disease-free survival. Clinical trial identification: NCT04154943. Editorial acknowledgement: Medical writing support was provided by John G Facciponte, PhD, of Prime, Knutsford, UK, funded by Regeneron Pharmaceuticals, Inc., and Sanofi. Legal entity responsible for the study: Regeneron Pharmaceuticals, Inc., and Sanofi. Funding: Regeneron Pharmaceuticals, Inc., and Sanofi. Disclosure: N. Gross: Financial Interests, Personal, Research Grant: Regeneron Pharmaceuticals, Inc.;Financial Interests, Personal, Advisory Board: PDS Biotechnology, Shattuck Labs and Genzyme;Financial Interests, Personal, Advisory Role: PDS Biotechnology, Shattuck Labs and Genzyme. D.M. Miller: Financial Interests, Personal, Advisory Role: Castle Biosciences, EMD Serono, Merck KGaA, Merck Sharpe & Dome, Pfizer, Regeneron, Sanofi Genzyme;Financial Interests, Personal, Ownership Interest: Checkpoint Therapeutics;Financial Interests, Personal, Research Grant: Kartos Therapeutics, NeoImmune Tech, Inc., Regeneron Pharmaceuticals, Inc. N. Khushanlani: Financial Interests, Personal, Research Grant: Regeneron Pharmaceuticals, Inc., Bristol Myers Squibb, HUYA Bioscience International, Merck, Novartis, GlaxoSmithKline, Celgene, Amgen;Financial Interests, Personal, Advisory Board: EMD Serono, Regeneron Pharmaceuticals, Inc., Genentech, AstraZeneca (data safety monitoring committee), Merck, Array Biopharma, Jounce Therapeutics, Immunocore, Bristol Myers Squibb, HUYA Bioscience International;Financial Interests, Personal, Other, honoraria: Sanofi;Financial Interests, Personal, Stocks/Shares: Bellicum Pharmaceuticals, Mazor Robotics, Amarin, Transenetrix. V. Divi: Financial Interests, Institutional, Research Grant: Genentech. E.S. Ruiz: Financial Interests, Personal, Advisory Board: Genentech, Leo Pharmaceuticals, Regeneron Pharmaceuticals, Inc., Sanofi;Financial Int rests, Personal, Advisory Role, consulting fees: Genentech, Leo Pharmaceuticals, Regeneron Pharmaceuticals, Inc., Sanofi;Financial Interests, Personal, Member of the Board of Directors: Checkpoint Therapeutics. E.J. Lipson: Financial Interests, Personal, Other, Advisory board and consulting fees: Bristol Myers-Squibb, Eisai, Genentech, Immunocore, Instil Bio, MacroGenics, Merck, Natera, Nektar Therapeutics, Odonate Therapeutics, OncoSec, Pfizer, Rain Therapeutics, Regeneron, Sanofi;Financial Interests, Institutional, Research Grant: Bristol Myers Squibb, Merck, Regeneron. F. Meier: Financial Interests, Personal, Other, Travel support, speaker’s fees or advisor’s honoraria: Bristol Myers Squibb, Merck Sharp & Dohme, Novartis, Pierre Fabre, Roche and Sanofi;Financial Interests, Personal, Research Grant: Novartis and Roche. P.L. Swiecicki: Financial Interests, Institutional, Research Grant: Ascentage Pharma, Pfizer;Financial Interests, Personal, Advisory Board: Prelude Therapeutics, Elevar Therapeutics, Regeneron Pharmaceuticals. J.L. Atlas: Financial Interests, Personal, Advisory Role: Regeneron Pharmaceuticals, Inc., Sanofi, and Bristol Myers Squibb. J.L. Geiger: Financial Interests, Institutional, Research Grant: Alkermes, Debio, Merck, Regeneron Pharmaceuticals, Inc., and Roche/Genentech;Financial Interests, Personal, Advisory Role: Exelixis, Merck and Regeneron Pharmaceuticals, Inc. A. Hauschild: Financial Interests, Personal and Institutional, Other, Institutional grants, speaker’s honoraria and consultancy fees: Amgen, Bristol Myers Squibb, Merck Sharp & Dohme, Novartis, Pierre Fabre, Provectus and Roche;Financial Interests, Institutional, Other, Institutional grants and consultancy fees: EMD Serono, Philogen and Regeneron Pharmaceuticals, Inc.;Financial Interests, Personal, Advisory Role: OncoSec Medical. J.H. Choe: Financial Interests, Personal, Advisory Role: Exelixis, Coherus Biosciences, Regeneron Pharmaceuticals, Inc. B.G.M. Hughes: Financial Interests, Personal, Advisory Role: AstraZeneca, Bristol Myers Squibb, Eisai, Merck Sharp & Dohme, Pfizer and Roche;Financial Interests, Institutional, Research Grant: Amgen. S. Yoo: Financial Interests, Personal, Full or part-time Employment: Regeneron Pharmaceuticals, Inc.;Financial Interests, Personal, Stocks/Shares: Regeneron Pharmaceuticals, Inc. K. Fenech: Financial Interests, Personal, Full or part-time Employment: Regeneron Pharmaceuticals, Inc.;Financial Interests, Personal, Stocks/Shares: Regeneron Pharmaceuticals, Inc. M.D. Mathias: Financial Interests, Personal, Full or part-time Employment: Regeneron Pharmaceuticals, Inc.;Financial Interests, Personal, Stocks/Shares: Regeneron Pharmaceuticals, Inc. H. Han: Financial Interests, Personal, Full or part-time Employment: Regeneron Pharmaceuticals, Inc.;Financial Interests, Personal, Stocks/Shares: Regeneron Pharmaceuticals, Inc. M.G. Fury: Financial Interests, Personal, Full or part-time Employment: Regeneron Pharmaceuticals, Inc.;Financial Interests, Personal, Stocks/Shares: Regeneron Pharmaceuticals, Inc. D. Rischin: Financial Interests, Institutional, Research Grant: Regeneron Pharmaceuticals, Inc., Genentech, Sanofi, Kura Oncology, Roche, Merck Sharp & Dohme, Merck KGaA, Bristol Myers Squibb, GlaxoSmithKline, ALX Oncology;Financial Interests, Personal, Advisory Role: Merck Sharp & Dohme, Regeneron Pharmaceuticals, Inc., Sanofi, GlaxoSmithKline, Bristol Myers Squibb;Financial Interests, Personal, Advisory Board: Merck Sharp & Dohme, Regeneron Pharmaceuticals, Inc., Sanofi, GlaxoSmithKline, Bristol Myers Squibb. All other authors have declared no conflicts of interest.

Uniting Global Efforts on Pediatric Long-COVID: Results of the International Post- COVID Condition in Children Collaboration (IP4C)

RATIONALE4,4-44,4% of children suffer from post-COVID syndrome, commonly known as long- COVID, after an acute SARS-CoV-2 infection. However, an uniform clinical definition, and guidelines to diagnose or treat children suspected of long-COVID are lacking. Multiple careprograms have been initiated worldwide. In this study, we aimed to assess the currently available pediatric international long-COVID care programs and explore the characteristics of their patient cohorts.METHODSWe established an international network (IP4C) and performed a crosssectional analysis from aggregated data collected by its members using a survey. Topics included: the used definition for long-covid in children, the organization of pediatric long-COVID clinics and long-COVID patients characteristics. Descriptive analysis of the aggregated data was used to summarize and compare each of these categories across countries. RESULTSWe included data concerning organization of care from 17 cohorts based in 13 different countries. A wide range of definitions for long COVID was used, which differed mostly in duration of symptoms and the necessity of microbiologically proven SARS-COV-2 infection. 66,6-100% of patients in the long- COVID cohorts suffered from complaints for more than twelve weeks, and 49,5-97,3% of patients had a positive RT-PCR or serology for SARS-CoV-2. Most long-COVID care programs consisted of real-life visits with multidisciplinary teams, consisting of general pediatricians, pediatric lung specialists, cardiologists and infectiologist, a physiotherapist and psychologist. The type of investigations performed at the long-COVID clinics ranged from assessment of medical history (100%) and standardized questionnaires (91%) to in depth evaluation of organ functioning (e.g. spirometry performed in 0-100% of patients). Aggregated data of 431 long-COVID patients from 11 dedicated long-COVID care programs were analyzed. Mean age of patients ranged from 6,5-16,4 years old. Girls were overrepresented in most cohorts (20-65%). 28-81,8% of patient had a positive medical history, most commonly atopic syndrome, asthma and prematurity. Most patients (90- 100%) suffered from asymptomatic or mild acute COVID-19. Frequent long-COVID symptoms were fatigue, headaches, concentration difficulties, dyspnea and sleep disturbances. 5-37% of patients had severe limitations in daily life. CONCLUSIONSThis is the first study to describe the organization of pediatric long-COVID care. It demonstrates that pediatric long-COVID is recognized worldwide as a multisystemic disease, but its definition and care programs for pediatric long- COVID patients differ between cohorts. A clear definition of pediatric long-COVID is needed to improve international scientific collaboration and patient care. Our international network will facilitate further collaboration in investigation pathophysiology and therapeutic interventions in order to provide evidence based medical care for these patients.

Association between Immunosuppressive Drugs and Coronavirus Disease 2019 Outcomes in Patients with Noninfectious Uveitis in a Large US Claims Database.

PURPOSE: To determine the dose-dependent risk of systemic corticosteroids (SCs) and the risk of other immunosuppressive therapies on coronavirus disease 2019 (COVID-19) infection, hospitalization, and death in patients with noninfectious uveitis (NIU). DESIGN: A retrospective cohort study from January 20, 2020, to December 31, 2020 (an era before widespread COVID-19 vaccination), using the Optum Labs Data Warehouse, a US national de-identified claims database. PARTICIPANTS: Patients who had at least 1 NIU diagnosis from January 1, 2017. METHODS: Unadjusted and adjusted hazard ratios (HRs) were estimated for each variable and COVID-19 outcome using Cox proportional hazards models, with time-updated dichotomous indicators for outpatient immunosuppressive medication exposure. To assess the dose-dependent effect of SC exposure, the average daily dose of prednisone over the exposed interval was included in the adjusted models as a continuous variable, in addition to the dichotomous variable. MAIN OUTCOME MEASURES: Incidence rates of COVID-19 infection, COVID-19-related hospitalization, and COVID-19-related in-hospital death. RESULTS: This study included 52 286 NIU patients of whom 12 000 (23.0%) were exposed to immunosuppressive medications during the risk period. In adjusted models, exposure to SCs was associated with increased risk of COVID-19 infection (HR, 2.66; 95% confidence interval [CI], 2.19-3.24; P < 0.001), hospitalization (HR, 3.26; 95% CI, 2.46-4.33; P < 0.001), and in-hospital death (HR, 1.99; 95% CI, 0.93-4.27; P = 0.08). Furthermore, incremental increases in the dosage of SCs were associated with a greater risk for these outcomes. Although tumor necrosis factor-α (TNF-α) inhibitors were associated with an increased risk of infection (HR, 1.48; 95% CI, 1.08-2.04; P = 0.02), other immunosuppressive treatments did not increase the risk of COVID-19 infection, hospitalization, or death. CONCLUSIONS: This study from an era before widespread COVID-19 vaccination demonstrates that outpatient SC exposure is associated with greater risk of COVID-19 infection and severe outcomes in patients with NIU. Future studies should evaluate the impact of immunosuppression in vaccinated NIU patients. Limiting exposure to SCs and use of alternative therapies may be warranted.

Getting the most out of digital healthcare systems: Data repurposing to improve inpatient diabetes care

Aims: At a North London hospital which lacked remote blood glucose monitoring, we sought to introduce a system that automatically alerted the Diabetes Team of inpatients with deranged blood glucose (BG) measurements. We hypothesised that this would streamline the team's workflow, and improve glycaemic control in inpatients. Methods: We developed a feature that used data from recently deployed e-vitals software to generate daily reports containing lists of inpatients who had experienced hypo-or substantial hyper-glycaemia ( < 4 or >20mmol/L) within the previous 24h. These reports were automatically sent each morning to the Diabetes Team. Results: Feedback from specialist nurses suggested improvement in the efficiency of their patient identification workflow, which previously had principally involved taking phone referrals and manually searching ward lists. Initial post-intervention data did not suggest improvement in hospital-wide deranged BG rates, however this was confounded by a sharp rise in covid-19 admissions shortly after deployment, with the majority receiving corticosteroids. After several months of use, the feature unexpectedly failed for approximately six weeks, during which time on average significantly more daily hypoglycaemic episodes occurred vs the preceding six-week period (two-sided rank sum, p < 0.001), with rates returning to baseline after it was reintroduced. Conclusions: Our intervention aided staff workflows and possibly improved inpatient glycaemic control, although worsening glycaemic control outcomes upon intervention withdrawal cannot reliably be extrapolated to infer overall benefit of the feature vs pre-intervention standard-of- care. Financial barriers often preclude deployment of gold-standard digital systems in healthcare;innovative exploitation of data generated by more affordable systems can improve productivity and patient care without additional cost.

Single, daily multiple-choice-question: A microlearning tool for a core emergency medicine clerkship

Learning Objectives: We sought to deliver interspersed, concise teaching points on core content while providing direction for additional reading. Using pre-scheduled learning sets messaged to students each morning, we also hoped to create a more cohesive and dedicated learning experience. : The breadth and depth of Emergency Medicine (EM) can be both attractive and daunting for medical students exposed to the specialty on clinical rotations. For clerkship directors and education faculty, it can be difficult to review a representative amount of content in the short duration of a clerkship. For students, it can be challenging to know where and what to read for end-of-clerkship exams. Furthermore, social-distancing policies during the COVID-19 pandemic limited in-person instruction, potentially contributing to perceptions of decreased formal teaching. Creative use of interspersed learning sets can provide direction for and supplement the clerkship curriculum. EMED Daily was created as part of a required EM clerkship at Stanford. Each EMED Daily is a single, multiplechoice-question (MCQ) bundled with relevant medical and procedural knowledge, as well as testing strategy for core EM content. Online survey software is used to automate the delivery of the next EMED Daily each morning. Building on concepts of “pushed” delivery from eLearning and digestible teaching moments from Microlearning, the EMED Daily allows students to engage in retrieval practice and review curated material while eating breakfast, brushing their teeth, or walking to shift. Learning sets reflect core topics from the Clerkship Directors in EM (CDEM) medical student curriculum and include links to free open access medical education (FOAMEd) resources. MCQs are not graded individually, but a completion rate of 75% is required for credit towards a final grade. The EMED Daily has been well received by students. In 6 months, the average completion rate was 96%, well above the required amount. Students commented that the EMED Daily sets “were simple and good for framing,” and “a great way to review a small amount of info every day.” Additionally, as COVID policies affected the type of patients students could see, question sets were adjusted to supplement learning as needed.

A survey of patients' preferences on treatment effects among head and neck cancer patients receiving radiotherapy

Introduction: Head and neck cancer (HNC) is a heterogeneous group of subsites, with differing natural histories. Its management is complex and it may have a long-term effect on patients’ quality of life (QOL). The purpose of this survey was to assess patients’ preferences using a validated 12 point ‘Priority Assessment Tool’ developed by Sharp et al [1]. Materials and Methods: Sixty consecutive HNC patients being treated with radiotherapy at our centre were approached. Patients were asked to rank their priorities from 1 to 12 (1 = very important, 12 = least important). Results: 45 patients (75%) completed the survey. The most important, overwhelming priority for the cohort as a whole, was ‘being cured of my cancer’ which was first priority in 73% patients and within first three priorities for 96% of patients. Similarly, ‘living as long as possible’ was within the first three priorities for 67% of patients although for 13% patients, living longer was, surprisingly the least priority. For more than two third of patients (69%), ‘having no pain’ was within the first four important priorities. There is next, a group of six QOL priorities (voice, speech, chewing, swallowing, taste/smell, moist mouth), which have a much wider range and vary considerably in importance to individual patients, being very important to some and much less important to others. There then remains a group of three priorities that have a relatively low importance to patients, not absolutely, but in relation to their other priorities, with ‘keeping appearance unchanged’, being the lowest priority chosen by 40% patients. The other two least priorities were ‘returning to activities as soon as possible’ and ‘having a normal amount of energy’. Conclusions: Our survey has shown that most HNC patients markedly prioritise survival over function and other QOL measures. Having such information is crucial, to being able to make a valid decision with regard to the treatment options and the trade-offs between increased probability of cure or extending survival and loss of function, and late morbidity. This makes shared decision-making even more important in the present COVID-19 era, so that added information about the risks of infection and potential changes in risk benefit ratio may alter patients’ priorities and preferred outcomes.

Abrupt new realities amid the disaster landscape as one crisis gives way to crises. (Special Issue: Tourism and hospitality post-disaster and crisis: how can global resilience be enhanced?)

Purpose: This paper aims to highlight the roles of sudden change and social disruption in the disaster landscape that shapes the environment of tourism destinations when hazards intersect with human systems. Design/methodology/approach This paper draws on the social science literature on disasters and crises. To this end, this paper provides an overview of the role abrupt changes have in transforming the tourism and hospitality industries. Findings This paper serves as a call to seek bold solutions that bring about industry best practices while fostering local community stakeholders in a more integrated way to build a more resilient future. Originality/value The disaster landscape provides opportunities to advance new structures, norms, cultural beliefs and collaborations that can foster resilience. This paper highlights the need to integrate resilience in the form of disaster management, recovery and organizational continuity strategies in the post-COVID-19 hospitality and tourism industries.