Advancing head and neck cancer following the coronavirus disease 2019 pandemic.

OBJECTIVE: Delay in the diagnosis of head and neck cancer can result in significant excess morbidity and mortality. How the pandemic has affected patient presentation in Scotland is unknown. METHOD: This retrospective cohort study compared all presentations of head and neck cancer between June and October of 2019 with the same period following the peak of the pandemic in 2020 in West Scotland, a region populated by 2.5 million people. RESULTS: A total of 528 patients met our inclusion criteria. Compared with 2019, patients in 2020 were more likely to present with a higher American Joint Committee on Cancer stage (odds ratio, 1.67 (95 per cent confidence interval = 1.20 to 2.31); p = 0.002), a longer preceding symptom duration (odds ratio, 2.03 (95 per cent confidence interval = 1.44 to 2.87; p < 0.001) and to have an emergency presentation (odds ratio, 2.53, (95 per cent confidence interval = 1.15 to 5.55; p = 0.017). CONCLUSION: Patients are presenting later with more advanced head and neck cancer following the coronavirus disease 2019 pandemic.

The impact of coronavirus disease 2019 on the head and neck cancer pathway in the West of Scotland.

OBJECTIVE: The coronavirus disease 2019 pandemic has greatly disrupted head and neck cancer services in the West of Scotland. This study aimed to assess the impact of the first wave of the pandemic on cancer waiting times. METHODS: A retrospective review of multidisciplinary team records was undertaken between March and May in 2019 and the same months in 2020. Time-to-diagnosis and time-to-treatment for new cancers treated with curative intent were compared between the study periods, and subclassified by referral pathway. RESULTS: A total of 236 new cancer patients were included. During the pandemic, pathways benefitted from reduced diagnostic and treatment times resulting from the restructuring of service provisions. A 75 per cent reduction in secondary care referrals and a 33 per cent increase in urgent suspicion of cancer referrals were observed in 2020. CONCLUSION: Head and neck cancer pathway times did not suffer because of the coronavirus pandemic. Innovations introduced to mitigate issues brought about by coronavirus benefitted patients, led to a more streamlined service, and improved diagnostic and treatment target compliance.

ISS Payload Operations Training Throughout the COVID-19 Pandemic: Impacts, Opportunities and Solutions

The onset of the COVID-19 pandemic brought a dramatic and rapid transformation to almost every aspect of humanity. The world’s space agencies and their missions were not immune to the wide-sweeping changes. One discipline principally affected was mission operations and the various groups supporting that function. Mission support teams, especially for complex and crewed missions like the International Space Station (ISS) were forced to rethink how and where control center staff performed their vital work. Operations training—an essential element to mission ops, had unique hurdles to overcome. Operations training is responsible for preparing astronaut crews for their missions, training and certifying flight controllers, as well as ensuring that new team members are ready to join their colleagues. Every element of training was impacted during the pandemic. From orientation and introductory classes for new controllers, simulations, and advanced lessons, On the Job Training (OJT) and final evaluations;all aspects faced challenges. Trainers at NASA’s Marshall Space Flight Center in Huntsville, Alabama were forced to become more efficient with trainees and resources to continue supporting ISS payload operations. The pandemic arrived in the USA in March 2020. Immediately, NASA mandated that the support for ISS real-time operations was critical. As a result, physical access to key facilities was restricted. Trainers and trainees had to quickly shift to 100% remote learning. In the short term, this was not a problem. However, instructors discovered lessons they were accustomed to delivering in a classroom environment often did not translate to remote teaching. Another hurdle to operations training was the mandate that all simulations could only be held remotely. The logistics of even small simulations proved to be challenging due to Information Technology (IT) restrictions and public internet limitations. With simulations essentially halted, as well as the restrictions on most OJT, trainees were essentially stopped in their advancement towards certification. Once limitations were identified, trainers prioritized new options. Transitioning to all electronic learning materials was a relatively easy fix. Teaching to large groups took additional shifts in the training paradigm. Methods for preparing astronauts for their missions were revised. Simulation supervisors found efficient techniques to provide realistic training experiences. Communication and coordination with management was essential. In every case, the payload operations instructors found novel solutions to all functions listed. This paper discusses the factors and solutions payloads operations trainers found to keep scientific research on the ISS flying forward to mission success. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

ISS Payload Operations Training During the COVID-19 Pandemic: Impacts and Solutions

The onset of the COVID-19 pandemic brought a dramatic and rapid transformation to almost every aspect of humanity in 2020. The world’s space agencies and their missions were not immune to the wide-sweeping changes. One discipline principally affected was mission operations and the various groups supporting that function. Mission support teams, especially for complex and crewed missions like the International Space Station were forced to rapidly rethink how and where control center staff performed their vital work. Operations training – an essential element to mission ops, had unique hurdles to overcome.Operations training is responsible for preparing astronaut crews for their missions, providing training to flight controllers, as well as ensuring that new team members are ready to join their colleagues. Every element of training was impacted by COVID restrictions. From orientation and introductory classes for new controllers, simulations and advanced lessons, On the Job Training and final evaluations;all aspects faced new challenges. Trainers at NASA’s Marshall Space Flight Center in Huntsville, Alabama, were forced to become more efficient with trainees and resources to continue supporting payload operations.The pandemic started in the USA in March 2020. Immediately, NASA mandated that the support for ISS real-time operations was critical. As a result, physical access to key facilities was restricted. Trainers and trainees had to quickly shift to 100 percent remote learning. In the short term, this was not a problem. However, instructors discovered lessons that they were accustomed to delivering in a classroom environment did not translate to remote teaching. Another hurdle to operations training was the mandate that all simulations could only be held remotely. The logistics of even small simulations proved to be challenging due to IT restrictions and public internet limitations. With simulations essentially stopped, as well as the restrictions on most OJT, trainees were essentially stopped in their advancement towards certification.Once limitations were identified, trainers prioritized new options. Transitioning to all electronic learning materials was a relatively easy fix. Teaching to large groups took additional shifts in the training paradigm. Methods for preparing astronauts for their missions were revised. Simulation supervisors found more efficient techniques to provide realistic training experience. Communication and approvals from management was essential. In every case, the payload operations instructors found novel solutions to all functions listed. This paper will discuss the factors and solutions payloads operations trainers found to keep scientific research on the ISS flying forward to mission success.

Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED): Updates from Year 2 of Multi-Site Trial

Despite nearly universal influenza vaccination for active duty military personnel, breakthrough influenza infections occur. We are reporting on the second year of the Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED), comparing three FDA-licensed influenza vaccine types (egg-based, cell -based, and recombinant) to assess differences in immunogenicity and effectiveness.

Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED): Updates from Year 3 of Multi-Site Trial

Background. The SARS-CoV-2 pandemic has spotlighted respiratory infections and the value of effective vaccines. The SARS-CoV-2 vaccine has been remarkably effective;however, influenza vaccine effectiveness has been reported to be lower among active duty military populations than in the general public (18% vs 36%). The Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED) study compares 3 FDA-licensed influenza vaccine types (egg-based, cell-based, and recombinant) to assess differences in immunogenicity and effectiveness in adults. Methods. Participants in the 3rd year of PAIVED (2020/21 influenza season) were enrolled from October 2020 through January 2021. Participants received weekly surveys about influenza-like-illnesses (ILI) experienced in the past week;if they reported an ILI, they were queried about symptom duration and severity, and asked to self-collect a nasal swab and dried blood sample. Four weeks later, more information about symptom duration and illness burden was obtained via telephone interview, and the participant collected a second blood sample. Results. PAIVED year 3 enrolled 3,269 participants (Table 1). 278 participants reported 1 ILI , while 60 reported 2 ILIs, and 18 reported 3 ILIs. No pathogen was identified for most processed ILI samples (78%);the most common viruses were SARS-CoV-2 (25, 12%), rhinovirus (24, 12%), and seasonal coronaviruses (4, 2%). No influenza has been identified thus far. Among those participants who had convalescent ILI visits (275), the median duration of the reported ILIs was 9 days (IQR 5, 15), with a median of 4 days (IQR 2, 7) of limited activity, and 2 days (IQR 0, 3) with fever. Three individuals were hospitalized. Conclusion. There have been relatively low rates of ILI identified in this study during this season, with only 11% of the participants reporting an ILI so far, consistent with low rates of non-COVID-19 ILI reported elsewhere during the current pandemic. We anticipate some influenza cases may be identified as more samples are processed. Planned analyses include calculating comparative influenza vaccine effectiveness to inform future vaccine purchasing decisions, as well as comparing serological response to the different vaccines.

Before and After: The Impact of the COVID-19 Pandemic on Influenza-Like Illness Trends in PAIVED

Background. The Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED) is a multicenter study assessing influenza vaccine effectiveness in active duty service members, retirees, and dependents. PAIVED recently completed its third year and offers a unique opportunity to examine influenza-like illness (ILI) trends prior to and during the COVID-19 pandemic in a prospective, well-defined cohort. Methods. During the 2018-19, 2019-20, and 2020-21 influenza seasons, PAIVED enrolled DoD beneficiaries presenting for annual influenza vaccination. After collecting baseline demographic data, participants were randomized to receive egg-based, cell-based, or recombinant-derived influenza vaccine. Weekly throughout the influenza season of enrollment, participants were surveyed electronically for ILI, defined as (1) having cough or sore throat, plus (2) feeling feverish/having chills or having body aches/fatigue. Participants with ILI completed a daily symptom diary for seven days and submitted a nasal swab for pathogen detection. Results. Over the three seasons, there were 10,656 PAIVED participants: 1514 (14.2%) in 2018-19, 5876 (55.1%) in 2019-20, and 3266 (30.6%) in 2020-21. The majority were male (68-73% per year) with a mean age of 34±14.8 years at enrollment. 2266 participants reported a total of 2673 unique ILIs. The highest percentage of participants with ILI was in 2019-20 (28.2%), versus 19.6% in 2018-19 and 9.6% in 2020-21. Figure 1 depicts the percent of individuals reporting ILI by week of the season for each of the PAIVED seasons. Notably, after March 21, 2020, the weekly incidence of participants reporting ILI never exceeded 1%. Figure 1. Percent of PAIVED participants reporting ILI by week of season. Conclusion. The low incidence of reported ILI in PAIVED participants during the COVID-19 pandemic is consistent with national influenza surveillance reports of influenza and outpatient ILI activity, suggesting that mitigation measures taken to reduce transmission of SARS-CoV-2 reduced the spread of other respiratory viruses.

Pragmatic assessment of influenza vaccine effectiveness in the dod (PAIVED): Updates from year 2 of multi-site trial

Background. Despite nearly universal influenza vaccination for active duty military personnel, breakthrough influenza infections occur. We are reporting on the second year of the Pragmatic Assessment of Influenza Vaccine Effectiveness in the DoD (PAIVED), comparing three FDA-licensed influenza vaccine types (eggbased, cell-based, and recombinant) to assess differences in immunogenicity and effectiveness. Methods. Participants in the second year of PAIVED were enrolled from Oct 2019 through Jan 2020 at 9 military facilities. Participants received weekly inquiries about influenza-like-illnesses (ILI) experienced in the past week, and if the participant reported having a cough or sore throat and a) muscle/body aches or fatigue and/or b) being feverish or having chills, they were scheduled for a clinic visit. During this visit, a blood sample and a nasal swab were collected, as well as information about symptom duration and severity. A second (convalescent) visit was conducted approximately 4 weeks later, which involved collecting additional information about the duration of symptoms and illness burden, as well as a second blood draw. Due to the COVID-19 pandemic, acute and convalescent visits were disrupted at most sites in March and April due to COVID-19 precautions. Results. PAIVED year 2 enrolled 5,892 participants who completed demographic forms (Table 1). Among those who reported any ILIs, most reported one ILI (1,345), while 264 reported two ILIs, and 42 reported three ILIs. Nasal swabs were processed from 273 ILIs at four sites (Fig 1), and 14 cases of influenza were identified thus far. The median duration of ILIs was ten days, with a median of three days of limited activity, and two days with fever. Nine individuals were hospitalized. Table 1. Demographic characteristics of individuals enrolled in PAIVED 2019/20 Figure 1. Lab results as of 5/15 (N=273 samples) Conclusion: Over 25% of participants reported an ILI, and 5% of the nasal swabs that have been tested thus far have been positive for influenza. While most samples have not yet been analyzed, we have identified some breakthrough cases of influenza among vaccinated participants. Planned analyses include comparative vaccine effectiveness in order to inform future vaccine purchasing decisions.

Assessing whether COVID-19 patients will benefit from critical care, and an objective approach to capacity challenges during a pandemic: An Intensive Care Society clinical guideline.

This national professional society guidance lays out operational and ethical principles for decision-making during a pandemic, in the immediate context of COVID-19 in the early 2020 surge iteration but with potential ongoing relevance. It identifies the different phases of a pandemic and the implications for capacity and mutual aid within a national healthcare system, and introduces a revised CRITCON-PANDEMIC framework for shared operational responsibilities and clinical decision-making. Usual legal and ethical frameworks should continue to apply while capacity and mutual aid are available (CRITCON-PANDEMIC levels 0-3); clinicians should focus on current clinical needs and should not treat patients differently because of anticipated future pressures. In conditions of resource limitation (CRITCON-PANDEMIC 4), a structured and equitable approach is necessary and an objective Decision Support Aid is proposed. In producing this guidance, we emphasise that all patients must be treated with respect and without discrimination, because everyone is of equal value. The guidance has been put together with input from patient and public groups and aims to provide standards that are fair to everyone. We acknowledge that COVID-19 is a new disease with a partial and evolving knowledge base, and aim to provide an objective clinical decision-making framework based on the best available information. It is recognised that a factual assessment of likely benefit may take into account age, frailty and comorbidities, but the guidance emphasises that every assessment must be individualised on a balanced, case by case, basis and may inform clinical judgement but not replace it. The effects of a comorbidity on someone's ability to benefit from critical care should be individually assessed. Measures of frailty should be used with care, and should not disadvantage those with stable disability.