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Fintech is now defined by a long-term, global process of digitisation of finance, increasingly combined with datafication and new technologies including cloud computing, blockchain, Big Data and artificial intelligence. Cybersecurity and technological risks are thus evolving into major threats to financial stability and national security. This trend has been magnified by the COVID-19 crisis which has heightened dependence on digital technologies and seen substantial parts of the population working from home through systems of questionable security. Additionally, the entry of BigTech firms brings two new issues. The first arises with new forms of potentially systemically important infrastructure. The second arises because data-like finance-benefits from economies of scope and scale and from network effects and-even more than finance-tends towards monopolistic or oligopolistic outcomes. This leads to potential systematic risk from new forms of "Too Big to Fail" and "Too Connected to Fail" phenomena. We suggest some basic principles about how to address this entire range of risks.
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Academics in higher education around the world indicate high levels of stress from multiple sources. The COVID-19 pandemic has only served to intensify stress levels. Adaptation and resilience are needed if academics, particularly those focused on education and teaching, are to endure, learn, and bounce back during this era of stress and contribute to education quality and student learning. This review is organized to answer two key questions. First, what are the main forms of stress for academics, especially those focused on education and teaching? Second, what are the responses of academics to stress and is the concept of resilience relevant to understand the consequences for academic careers oriented toward education and education quality? To answer these questions, we first critically review the literature on the responses of academics to stress and the concept of resilience, which has been employed by multiple disciplines, including teacher education. We then broadly define the resilience of academics as their capacity to learn from and adapt to stress;our definition is perhaps less about individual personality characteristics and more associated with the relational aspect of the socioecological higher education ecosystem. There are, however, limits to resilience and its potential effects on education quality and student learning. Given higher education's adverse operating environment and the significant contributions of academics to the knowledge economy and graduate quality, understanding and building the resilience of academics to adapt and succeed has never been more critical. © 2023, The Author(s).
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Background: Trans-arterial chemoembolization (TACE) is the gold-standard for intermediate stage HCC. We hypothesised the ischemic and cytotoxic effect of TACE to boost anti-cancer immunity and to synergise with the anti PD-1 pembrolizumab (pembro). We designed a phase Ib study to test the safety and preliminary efficacy of pembro after TACE in intermediate HCC. Methods: PETAL study will enroll up to 32 patients with intermediate HCC to receive pembro 200 mg every 3 weeks for up to 1 year or until disease progression or unacceptable toxicity. The first safety-run-in phase includes 6 patients: if no dose limiting toxicities (DLTs) emerge over a 21-day window after first pembro, the others are enrolled in the expansion phase. Pembro is given within 30 days after 1 or 2 TACEs. The first phase includes 1 patient scoring Child-Pugh (CP)-B7 and the remaining have to be CP-A. Safety is the primary endpoint and is measured as the incidence of treatment-related adverse events (TRAEs), graded according to NCI CTCAEv4. Efficacy is the secondary endpoint and is evaluated as progression free survival (PFS) from first TACE, according to mRECIST criteria. Survival is estimated using Kaplan-Meier method. All the patients who have received at least one dose of pembro are evaluable for safety. Results: At the time of data cut-off, on the 14th of January 2022, 14 patients had received at least one dose of pembro. The median age was 72 (IQR: 63.3-74.6), 79% were male, 71% were cirrhotic, 29% had viral hepatis and 43% ECOG PS 1. One patient had Child-Pugh (CP) class B7 and 13 had A. The median number of nodules was 1.5 (IQR:1-2.8), and 4.1 cm (IQR: 3.7-4.5) the median diameter. Overall, 5 patients received 2 TACEs and 9 had 1. Patients received a median of 4.5 cycles (IQR: 2.3-6.5) of pembro. No DLTs emerged in the first phase. Treatment-related adverse events (TRAE) of any grade (G) were reported in 86% of participants, 21% of participants experienced G3 TRAEs, and there were no G4 or G5 TRAEs. Specific skin-related toxicity was the most frequently reported (35%) TRAE. No patients had treatment-related liver toxicity. Causes of treatment discontinuation were PD (n=7), TRAEs (n=1), clinical deterioration in the CP B patient (n=1), COVID pandemic (n=2) and withdrawal of consent (n=1);at the time of data cut-off, mPFS from first TACE was 10.8 months (95%CI: 6.63-14.97). Conclusions: Adjuvant pembro following TACE is manageable and tolerable with signs of activity. These results prompt the investigation in larger trials.
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Background: Primary cytomegalovirus (CMV) infection of the immunocompetent host usually produces little-to-no illness. Occasionally, the infection results in mononucleosis syndrome, protracted fever, hepatitis, tissue-invasive disease, or Guillain-Barré syndrome. Hemolytic anemia and hemophagocytic lymphohistiocytosis (HLH) are rare complications that have not been reported to co-occur. Having hemolytic anemia in conjunction with more common findings of fever and hepatitis complicates the diagnosis of HLH. Case Presentation. A 34-year-old male with previously good health presented with a prolonged febrile illness, jaundice, and anemia. An extensive work-up during hospitalization revealed intravascular hemolytic anemia, leukopenia, hepatosplenomegaly, and biopsy evidence of extensive lymphohistiocytic infiltration of the liver with microgranulomata and sinusoidal hemophagocytosis. Soluble CD25 level was mildly elevated at 1200.3 pg/mL and the HScore calculation (fever, bicytopenia, hepatosplenomegaly, aspartate aminotransaminase 99 IU/L, ferritin 1570 ng/mL, fibrinogen 488 mg/dL, and triglycerides 173 mg/dL) suggested a moderate probability of reactive HLH. Primary CMV infection was diagnosed based on CMV IgM positivity, low CMV IgG avidity index, and low-grade CMV DNAemia. The CMV antigen was not detected in the liver biopsy, and the bone marrow biopsy was unremarkable. The illness began to improve before he received oral valganciclovir for 5 days, and he was in good health 10 months later. Conclusion: Acute CMV illness in an immunocompetent adult can present with hemolytic anemia and clinicopathologic abnormalities consistent with a form fruste of HLH. The illness is likely due to an excessive or unbalanced immune response that may self-correct.
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Introduction: Cancer patients have been considered a high-risk population in the COVID-19 pandemic. We previously investigated risk of COVID-19 death in COVID-19 positive cancer patients during a median follow-up of 134 days, and identified the following risk factors: male sex, age >60 years, Asian ethnicity, hematological cancer type, cancer diagnosis for >2.5 years, patients presenting with fever or dyspnea, and high levels of ferritin and C-reactive protein (CRP). Here, we further investigate which factors are associated with a COVID-19 related death within 7 days of diagnosis. Methods: Using data from Guy's Cancer Centre and one of its partner trusts (King's College Hospital), we included 306 cancer patients with a confirmed COVID-19 diagnosis (February 29th-July 31st 2020). 72 patients had a COVID-19 related death (24%) of whom 35 died within 7 days (50%). Cox proportional hazards regression was used to identify which factors were associated with a COVID-19 related death <7 days of diagnosis. Results: Of the 72 cancer patients who had a COVID-19 related death, the mean age was 72 years (Standard Deviation (SD) 14). A total of 53 (74%) patients were men. 37 (52%) had a hematological cancer type, 47 (65%) had stage IV cancer, and 42 (58%) had been diagnosed with cancer more than 24 months before COVID-19 related death. In the group of patients who died within 7 days of diagnosis (n= 35), mean age was 73 years (SD 13.96), 24 (68%) were men, 20 (57%) had a hematological cancer type, 26 (74%) had stage IV cancer, and 24 (68%) had been diagnosed with cancer >24 months before COVID-19 diagnosis. Factors associated with COVID-19 related death <7 days of diagnosis were: hematological cancer (Hazard Ratio (HR): 2.74 (95% Confidence Interval (CI): 1.21-6.22)), 2-5 yrs since cancer diagnosis (HR: 4.81 (95%CI: 1.47-15.69)), and >5 yrs since cancer diagnosis (HR: 4.41 (95%CI: 1.38-14.06)). Additionally, patients who presented with dyspnea had increased risk of COVID-19 related death <7 days compared to asymptomatic patients (HR: 5.25 (95%CI 2.14-12.89)). CRP levels in the third tercile (146-528 mg/L) as compared to the first were also associated with increased risk of an early death due to COVID-19. Conclusion: From all the factors identified in our previous COVID-19 related death analysis, only hematological cancer type, a longer-established cancer diagnosis (2-5 years and more than 5 years), dyspnea at time of diagnosis and high levels of CRP were indicative of an early COVID-19 related death (within 7 days of diagnosis) in cancer patients.
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This article examines how the digital financial infrastructure that emerged in the wake of the 2008 Global Financial Crisis is being tested and leveraged to meet some of the financial, economic and health challenges presented by the COVID-19 pandemic. The origins of the 2008 crisis and the current crisis are different: the 2008 crisis was a financial crisis that spilt over into the real economy, whileCOVID-19is a health and geopolitical crisisspilling over into the real economy. As such,COVID-19 - a pandemic and an existential sustainability crisis - requires different approaches. This article explores the role of digital finance in this context on two levels. At the macro level, it identifies how digital finance has been used to address areas of systemic risk and underpin wider financial stability. At the micro level, it illustrate show digital financial tools can be used to address a range of emerging challenges particularly relating to recovery. Looking forward, it argues that digitisation generally and of finance in particular driven by the COVID-19 crisis - while providing effective tools to support the response - has also raised new challenges, particularly around new forms of Tech-Riskarising from concentration and data. Looking forward, these are among the most significant challenges for policy, law and regulation in the 2020s.
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INTRODUCTION: The COVID-19 pandemic has caused oncological services worldwide to face unprecedented challenges resulting in treatment disruption for surgical patients. Hepatopancreatico-biliary (HPB) cancers are characterised by rapid disease progression. This study aims to assess delays in receiving surgery for this patient cohort during the first COVID-19 wave. METHODS: Patients undergoing surgery between April and July 2020 (COVID period) were compared with a control group from the preceding year. Delay in receiving surgery was defined as more than 50 days between referral and surgery date. Statistical analysis was carried out to evaluate predictors of delay and short-term outcomes. RESULTS: During the COVID-19 and pre-COVID-19 periods, 94 and 115 patients underwent surgery, respectively. No patients contracted COVID-19 postoperatively. Some 118 patients waited more than 50 days for surgery versus 91 who received surgery within 50 days from referral. Independent predictors for surgical delay were undergoing surgery in the COVID-19 era (odds ratio (OR) 2.2, 95% confidence interval (CI) 1.2-4.1; p=0.015), referral pathway (OR 35.1, 95% CI 4.2-296; p=0.001) and presenting pathology (OR 8.3, 95% CI 1.2-56.1; p=0.03). Short-term outcomes were comparable between groups. CONCLUSIONS: Patient referral pathway and presenting pathology may contribute to delays in undergoing HPB cancer surgery during COVID-19 outbreaks. It is hoped that a better understanding of these factors will aid in designing shifts in healthcare policy during future pandemic outbreaks.
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OBJECTIVES: Although a known association exists between stress and alcohol consumption among health care workers (HCWs), it is not known how the COVID-19 pandemic has affected this association. We assessed pandemic work-related stress and alcohol consumption of HCWs. METHODS: We emailed a cross-sectional, anonymous survey in June 2020 to approximately 550 HCWs at an academic hospital in New Orleans, Louisiana. HCWs from all departments were eligible to complete the survey. Questions measured work-related stress and emotional reactions to the pandemic (using the Middle East Respiratory Syndrome [MERS-CoV] Staff Questionnaire), depressive symptoms (using the Patient Health Questionnaire-9 [PHQ-9]), coping habits (using the Brief COPE scale), and pre-COVID-19 (March 2020) and current (June 2020) alcohol consumption. We measured alcohol consumption using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), with scores >3 considered positive. We asked 4 open-ended questions for in-depth analysis. RESULTS: One-hundred two HCWs participated in the survey. The average AUDIT-C scores for current and pre-COVID-19 alcohol consumption were 3.1 and 2.8, respectively. The level of current alcohol consumption was associated with avoidant coping (r = 0.46, P < .001). Relative increases in alcohol consumption from March to June 2020 were positively associated with PHQ-9 score and greater emotional reactions to the pandemic. Availability of mental health services was ranked second to last among desired supports. Qualitative data demonstrated high levels of work-related stress from potential exposure to COVID-19 and job instability, as well as social isolation and negative effects of the pandemic on their work environment. CONCLUSIONS: Ongoing prevention-based interventions that emphasize stress management rather than mental or behavioral health conditions are needed.
Subject(s)
Alcohol Drinking , COVID-19/psychology , Health Personnel/psychology , Occupational Stress , Personnel, Hospital/psychology , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , New Orleans , Young AdultABSTRACT
The consumer acceptance of alternative plant-focused ingredients within the meat industry is growing globally. Oat protein is insoluble and used to increase product yield and fat retention. Furthermore, inclusion of oat protein can provide manufacturers another option for extending beef supplies. As the consumer diet shifts for improvements in nutritional density, oat protein is an alternative ingredient that lacks information on inclusion in a ground beef formulation. Coarse ground beef was allocated to one of four treatments, mixed with oat protein (0%, 1.5%, 3.5% and 4.5%), water, salt, pepper, textured vegetable protein, soy protein concentrate, and sodium tripolyphosphate. Meat blocks (n = 3 batches) were finely ground and formed into patties (N = 65/treatment). Patties were placed onto an expanded polystyrene tray, overwrapped with polyvinyl chloride film and displayed for 7 days. Instrumental color (L*, a*, and b*) decreased throughout simulated display (p = 0.0001). Increased usage rates of oat protein in patties resulted in greater cook yields (p = 0.0001). Objective measures of Allo-Kramer shear force values increased as oat protein inclusion rates increased (p = 0.0001). Oat protein can be incorporated in ground beef patties with positive effects on cook yield, but inclusion rate may have a deleterious impact on color and instrumental tenderness.
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Background: The COVID 19 Pandemic has been an unprecedented global health crisis. We undertook a retrospective observational study to evaluate its impact on the management of hepatocellular cancer (HCC) in a large tertiary referral service in the UK offering all treatment modalities: liver transplantation and resection through to locoregional, systemic therapy and specialist palliative care. HCC in adults is often diagnosed in advanced stages as symptoms are only apparent later in the disease, and recent reviews have highlighted more patients presenting later with decompensation and a backlog of deferred care1. This study reviews outcomes pre and post the first wave of the Pandemic, including disease presentation, time to treatment and loss to follow up. Methods: Retrospective study of consecutive new referrals to a tertiary treatment centre. These included patients discussed between Dec 2019-Feb 2020 ('pre-COVID';total referrals n=98 with 66 newly diagnosed HCC), and July-Sept 2020 ('post 1st wave COVID';total referrals n=81 with 51 newly diagnosed HCC). NHS Providers had been asked to maintain access to essential cancer treatment throughout the Pandemic with easing of lockdown on 11 May 2020. Patients were longitudinally followed up and analysed using electronic medical records. Descriptive results were expressed as median with IQR for continuous data and as frequency (%) for categorical data. Baseline characteristics of patients were compared between the two cohorts using the Mann-Whitney U test for continuous data, and χ2 test for qualitative data. Results: As shown in Table 1, post 1st wave there has been a reduction in total number of referrals. Median age, sex and aetiology were similar between groups. Differences were noted in patient characteristics of the 'post 1st wave' cohort with a greater proportion presenting with Child Pugh C (19% vs 4%, p=0.037) and BCLC stage D (25.5% vs 12% p=0.019). Among the group of patients presenting during the Pandemic none had a diagnosis of COVID 19 infection. While there were no significant differences in loss to follow up or the decision to treatment time interval (excluding transplant) between 2019 & 2020 (p=0.672), 3 patients in 2020 had treatment cancellations due to capacity. Conclusion: After the 1st wave there has been a reduction in external referrals and an increase in number of patients presenting with advanced chronic liver disease and untreatable HCC. Whilst these are likely to represent the effects of major service reconfiguration during the Pandemic at both a 1° and 2° care level our study suggests we need to better understand medium to longterm impact. We note local efforts to preserve cancer care avoided treatment delays post 1st wave but further analysis is underway to assess impact of the second wave on quality of care received and mortality.
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Background: Early reports in the COVID-19 pandemic suggested higher mortality for cancer patients. The impact of potentially immunosuppressive systemic anti-cancer treatments (SACT) was unknown. This study analysed the delivery of SACT for patients with solid malignancies during the COVID-19 outbreak in 2020 compared to the same period in 2019 to inform future clinical decision-making. Methods: All patients receiving at least one SACT at Guy's comprehensive Cancer Centre during the COVID-19 outbreak for solid tumours (1st March- 31st May 2020) were compared to the same period in 2019. SARS-CoV2 infection was by positive RT-PCR test. Data collected: demographics, tumour type/stage and treatment (chemotherapy, immunotherapy (IO), biological-targeted (BT)). Results: 2125 patients received SACT in 2020, compared to 2450 in 2019 (13% decrease). Demographics were comparable with mean age of 62. 56% females in 2020 vs 54% in 2019, 85% vs 83% in the low socio-economic category, 63% vs 73% PS 0-1;30% vs 29% uro-gynaecological, 27% vs 24% breast and 20% vs 23% GI tumours. In 2020 compared to 2019, there was an increase in metastatic disease (71% vs 62%), decrease in CT (34% vs 42%), increase in IO (10% vs 6%), but similar rates of BT treatments (38% vs 37%). Treatment paradigms were similar in 2020 and 2019: neo/adjuvant (28% vs 29%), radical (4% vs 5%) and palliative (69% vs 67%). Earlier palliative treatments were prioritised in 2020 with significant increase in treatments in 1st-2nd line (72% vs 67%;p=0.02) and reduction in > 3rd line (12% vs 27%;p<0.05). 42 of 2125 patients (2%) developed SARS-CoV2 infections;38% GI, 26% breast with 69% on CT. Of 42 patients with COVID-19, 24 (57%) had severe infections and 6 (14%) resulted in COVID-related death. Conclusions: These data suggest that SACT does not put solid tumour patients at much a higher additional risk from COVID-19. Despite a 13% decline in treatment rates, radical and early palliative treatment were prioritised. There was a low frequency (2%) of SARS-CoV-2 infection;comparable to the 1.4% point prevalence rate in our cancer population. However, this was during national lockdown with limited COVID-19 testing. The next steps are to evaluate the impact of new variant strains and COVID vaccination programme. Legal entity responsible for the study: Guy's Real-World Evidence. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
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Background: The Covid-19 pandemic is a healthcare emergency with a significant impact on cancer services provision. In March 2020, our institution adopted the ESMO expert consensus guidelines for radiotherapy management of rectal cancer during the pandemic. Here we present short-term oncological outcomes of this approach compared to the same period in 2018. Methods: Patients who underwent neoadjuvant (chemo) radiotherapy for rectal cancer between 1st March 2020 and 31 May 2020 were identified from a research ethics committee (REC)-approved research database for cancer patients (Guy’s Cancer Cohort). Patient demographics and treatment characteristics were extracted and compared with a control cohort treated in the same period in 2018. The definition of local response was based on identification of downstaging on re-staging Magnetic Resonance Imaging (MRI) post neoadjuvant treatment (mrT3c/d-4 to mrT0-2 and mrT2 to mrT0-1) and classified in a binary format (response vs no response). In addition, in patients who underwent total mesorectal excision (TME), neoadjuvant rectal (NAR) score was calculated, as described previously, and classified into low (<8), intermediate (>=8<=16) and high (>16). The frequency of MRI and pathological response was compared using non-parametric Fisher exact test. Results: Thirty patients were treated in the three-month period in 2020 as compared with 21 in 2018 (43% increase). No statistically significant differences were observed in baseline tumour characteristics. The use of neoadjuvant short-course radiotherapy (SCRT) treatment increased significantly from 19% of cases in 2018 to 50% during the pandemic, which was reflected in reduced radiotherapy-related hospital footfall (median 15 appointments in 2020 vs 25 appointments in 2018). While the use of concomitant fluoropyrimidines was lower (47 vs 71%), the use of induction chemotherapy was higher (30 vs 19%) in 2020 compared to 2018, which may reflect more prevalent use of total neoadjuvant treatment. There was no difference in the proportion of MRI responders between cohorts (52% in 2020 vs 38% in 2018). In patients who underwent TME, there was no difference in the proportion of R1 resection (0 in 2020 vs 9% in 2018), median NAR scores (8 (1-30) in 2020 v 15 (range 4-50) in 2018) or NAR score categories (22% good responders, 64% intermediate and 14% non-responders during Covid-19 vs 9% good responders, 55% intermediate and 36% non-responders in 2018). Conclusions: Changes in radiotherapy treatment of rectal cancer during Covid-19 pandemic, including more frequent use of SCRT (often in combination with neoadjuvant chemotherapy), did not seem to have negatively impacted short-term oncological outcomes, as measured by MRI downstaging rates and NAR scores following TME. The effect of the pandemic on medium and long-term oncological outcomes is still awaited. Legal entity responsible for the study: The author. Funding: We acknowledge funding support from King’s Health Partners Research and Development Challenge Fund and Biomedical Research Centres (BRC) at Guy's and St Thomas' NHS Foundation Trust. Disclosure: All authors have declared no conflicts of interest.
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The first miser I met was the supremely joyful Scrooge McDuck diving in and out of pools of cash. The pandemic has shaken my miser, but finally he can’t not be gleefully optimistic that rentierismo will return in triumph, re-establishing the old order of inequality, exploitation, class relations and bins of moola for the few. © 2021 by the author(s).
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Background: Current precautionary management decisions being made for cancer patients are based onassumptions supported by limited evidence, based on small case series from China and Italy and larger series fromNew York and a recent consortium of 900 patients from over 85 hospitals in the USA, Canada, and Spain. Hence, there is insufficient evidence to support clinical decision-making for cancer patients diagnosed with COVID-19 dueto the lack of large studies. Methods: We used data from a single large UK Cancer Centre to assess demographic/clinical characteristics of 156cancer patients with a confirmed COVID-19 diagnosis between 29 February-12 May 2020. Logistic/Cox proportionalhazards models were used to identify which demographic and/or clinical characteristics were associated withCOVID-19 severity/death. Results: 128 (82%) presented with mild/moderate COVID-19 and 28 (18%) with severe disease. Initial diagnosis ofcancer >24m before COVID-19 (OR:1.74 (95%CI: 0.71-4.26)), presenting with fever (6.21 (1.76-21.99)), dyspnea(2.60 (1.00-6.76)), gastrointestinal symptoms (7.38 (2.71-20.16)), or higher levels of CRP (9.43 (0.73-121.12)) werelinked with greater COVID-19 severity. During median follow-up of 47d, 34 patients had died of COVID-19 (22%).Asian ethnicity (3.73 (1.28-10.91), palliative treatment (5.74 (1.15-28.79), initial diagnosis of cancer >24m before(2.14 (1.04-4.44), dyspnea (4.94 (1.99-12.25), and increased CRP levels (10.35 (1.05-52.21)) were positivelyassociated with COVID-19 death. An inverse association was observed with increased levels of albumin (0.04 (0.01-0.04). Conclusions: Our analysis of one of the largest single-center series of COVID-19-positive cancer patients to dateconfirms a similar distribution of age, sex, and comorbidities as reported for other populations. With respect tocancer-specific observations, patients who have lived longer with their cancer were found to be more susceptible toa greater infection severity, possibly reflecting the effect of more advanced malignant disease, as almost half of thesevere cohort were on third-line metastatic treatment, or the impact of this infection. The latter was also found to beassociated with COVID-19 death in cancer patients, as were Asian ethnicity and palliative treatment. Furthervalidation will be provided from other large case series, as well as from those including longer follow-up, to providemore definite guidance for oncologic care.