Tokyo 2020 Olympics sustainability: an elusive concept or reality?

The Olympic Games continue to be a creator of adverse environmental impacts for host communities. Given the role that the Olympic Games play in sustainability due to their size, the number of people attending, new construction and infrastructure, and the extensive exposure by the media, this study investigated the Tokyo 2020 Games by evaluating the efficacy of their ecological sustainability efforts. Methods for this study were framed by the conceptual model of Muller et al. Specifically, the model is grounded on the three general aspects of sustainability: ecological, social, and economic. Compared to all Olympic events from 1992 through 2020, results from the present research indicated that Tokyo 2020 Olympics may have been the most ecologically friendly Games. This ecological record is significant, but it may be an unrealistic benchmark, given that the lack of attendance due to the COVID-19 pandemic influenced much of the ecological sustainability scores.

A Practical Green Infrastructure Intervention to Mitigate Air Pollution in a UK School Playground

Air pollution severely compromises children's health and development, causing physical and mental implications. We have explored the use of site-specific green infrastructure (green barriers) in a school playground in Sheffield, UK, as an air-pollution-mitigation measure to improve children's environment. The study assessed air quality pre-post intervention and compared it with two control sites. Nitrogen dioxide (NO2) and particulate matter <2.5 µm in size (PM2.5) concentration change was assessed via three methods: (1) continuous monitoring with fixed devices (de-seasonalised);(2) monthly monitoring with diffusion tubes (spatial analysis);(3) intermittent monitoring with a mobile device at children's height (spatial analysis). De-seasonalised results indicate a reduction of 13% for NO2 and of 2% for PM2.5 in the school playground after two years of plant establishment. Further reductions in NO2 levels (25%) were observed during an exceptionally low mobility period (first COVID-19 lockdown);this is contrary to PM2.5 levels, which increased. Additionally, particles captured by a green barrier plant, Hedera helix 'Woerner', were observed and analysed using SEM/EDX techniques. Particle elemental analysis suggested natural and potential anthropogenic origins, potentially signalling vehicle traffic. Overall, green barriers are a valid complementary tool to improve school air quality, with quantifiable and significant air pollution changes even in our space-constrained site.

Transition to Universal Same Day Discharge (SDD) in Times of Corona Virus Disease-19 (COVID): A Success Story

Study Objective To evaluate success of universal SDD after minimally invasive hysterectomy. The COVID pandemic presented a unique scenario in which universal SDD was implemented abruptly across study institutions. This allowed for evaluation of patients with characteristics under-represented in SDD literature: large uteri due to leiomyoma, obesity defined as body mass index (BMI) ≥30, and later surgical end time. Design Retrospective chart review with before/after study design comparing pre-COVID to COVID cohorts. Setting High-volume, academic and academic-affiliated medical centers. Due to COVID, in the after-cohort, surgery could only be scheduled if SDD was planned. Patients or Participants Patients undergoing benign, laparoscopic or robotic-assisted hysterectomy during two 11-month periods: September 2018-July 2019 and May 2020-March 2021. Interventions Minimally invasive hysterectomy performed by three Minimally Invasive Gynecologic Surgeons. Measurements and Main Results 320 patients met inclusion criteria, 107 pre-COVID and 213 COVID. Mean age for both groups was 44.9. Patients were predominately non-Hispanic Black (40.2% pre- vs. 34.7% COVID) and non-Hispanic White (55.1% pre- vs. 63.4% COVID). Mean BMI was 33 for both groups. Pre-COVID, 2% of patients were discharged same day, whereas COVID 92% were discharged same day. Mean specimen weight was 478.2gm vs. 436.3gm for the two periods. In the COVID cohort, there was no difference in SDD success based on BMI (p 0.678), BMI <30 (49.5%), 30-39.9 (29.1%), 40-49.9 (15.3%), and ≥50 (6.1%). There was no difference in SDD success by specimen weight (p 0.077) stratified as <250gm (48.5%), 250-499gm (15.3%), or ≥500gm (36.2%). SDD success was not dependent on surgical end time (p 0.678) with end time stratified into ≤12:00 (45.4%), 12:01-14:59 (35.7%), and ≥15:00 (18.9%). There were no re-admissions in either cohort. Conclusion Abrupt transition to SDD is safe and feasible, including for patients with obese BMI and enlarged uterus. SDD success was not affected by later surgical end time.

Empirically Derived Psychological Profiles of College Students: Differential Associations With COVID-19 Impact and Social Adjustment

Using latent profile analysis, we derived psychological profiles of undergraduates during the pandemic and investigated profiles’ differential associations with COVID-19 impact and social adjustment. Participants (N = 517) completed measures of depression, loneliness, and anxiety, and two indices of social adjustment: friendship support and social connectedness. We identified Severe, Moderate, and Mild symptom profiles. Higher COVID-19 impact was associated with increased odds of belonging to the Severe versus Moderate and Mild profiles, and the Moderate versus Mild profile. On social adjustment, the Mild profile outscored the Moderate profile, which outscored the Severe profile. Overall, findings imply that individuals who perceive high levels of COVID-19 impact are especially likely to belong to a profile characterized by severe psychological symptoms and that membership in this profile is associated with social maladjustment.

A retrospective analysis of Klebsiella bloodstream infections in critically ill patients over a five-year period

Introduction: This study aimed to identify Klebsiella spp. bloodstream infections (KBSIs) in critically ill patients, characterising potential risk factors and targets for intervention. Methods: A retrospective analysis of blood cultures submitted to the Clinical Microbiology and Public Health Laboratory between 2015 and 2020, together with data from the Public Health England Data Capture System, was performed to identify KBSIs. Electronic patient records were reviewed for potential sources and risk factors. Results: Klebsiella spp. were the second leading cause of Gram-negative BSIs in critically ill patients, after E. coli (82 KBSIs over five years). Almost two-thirds (62.2%) were nosocomial. Median age was 64.3 years (IQR: 50.2–71.2), 62.2% were male and case fatality rate was 22%. Comorbidities included ‘Cardiovascular’ (48.8%), ‘Respiratory’ (37.8%), ‘Gastrointestinal’ (37.8%), ‘Endocrine’ (35.4%) and ‘Surgery’ (35.4%). Common sources were ‘Line’ (36.6%), ‘Urinary Tract’ (25.6%) and ‘Gastrointestinal’ (11.0%). 54.3% of sputum/BAL, 33.3% of line and 14.9% of urine cultures grew Klebsiella within 2 weeks of a KBSI. Ventilator use (76.5%) and pneumonia (51.0%) were common prior to hospital-onset KBSIs. KBSIs numbers peaked in April-June 2020, coinciding with the first wave of COVID-19. Discussion: This study presents a current overview of characteristics of KBSIs in critically ill patients. We speculate that the high rates of positive sputum/BAL and line cultures associated with nosocomial infections, signify pneumonia and subsequent line contamination as a potential cause of KBSIs. This could have important consequences in context of the COVID-19 pandemic and highlights the importance of intravascular catheter care in the prevention of KBSIs.

My stress led me to procrastinate: Temporal relations between perceived stress and academic procrastination

Academic procrastination is widespread among college students, leads to poorer academic performance and has been related to concurrent stress. Because the direction of effects between procrastination and stress is unclear, two longitudinal studies were conducted. Study 1 (n = 454) showed that mid-semester levels of stress were related to end of semester procrastination controlling for mid-semester procrastination but not vice versa. Study 2 (n = 326) examined procrastination and stress both before and during a quarantine occasioned by the coronavirus pandemic. Although procrastination increased during the quarantine, this study replicated the Study 1 finding that earlier stress is associated with later procrastination rather than vice versa. The importance of these findings is emphasized by the need for empirically based interventions for academic procrastination in tertiary education. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Amyloid processing in COVID-19-associated neurological syndromes.

SARS-CoV-2 infection can damage the nervous system with multiple neurological manifestations described. However, there is limited understanding of the mechanisms underlying COVID-19 neurological injury. This is a cross-sectional exploratory prospective biomarker cohort study of 21 patients with COVID-19 neurological syndromes (Guillain-Barre Syndrome [GBS], encephalitis, encephalopathy, acute disseminated encephalomyelitis [ADEM], intracranial hypertension, and central pain syndrome) and 23 healthy COVID-19 negative controls. We measured cerebrospinal fluid (CSF) and serum biomarkers of amyloid processing, neuronal injury (neurofilament light), astrocyte activation (GFAp), and neuroinflammation (tissue necrosis factor [TNF] ɑ, interleukin [IL]-6, IL-1ß, IL-8). Patients with COVID-19 neurological syndromes had significantly reduced CSF soluble amyloid precursor protein (sAPP)-ɑ (p = 0.004) and sAPPß (p = 0.03) as well as amyloid ß (Aß) 40 (p = 5.2 × 10-8 ), Aß42 (p = 3.5 × 10-7 ), and Aß42/Aß40 ratio (p = 0.005) compared to controls. Patients with COVID-19 neurological syndromes showed significantly increased neurofilament light (NfL, p = 0.001) and this negatively correlated with sAPPɑ and sAPPß. Conversely, GFAp was significantly reduced in COVID-19 neurological syndromes (p = 0.0001) and this positively correlated with sAPPɑ and sAPPß. COVID-19 neurological patients also displayed significantly increased CSF proinflammatory cytokines and these negatively correlated with sAPPɑ and sAPPß. A sensitivity analysis of COVID-19-associated GBS revealed a non-significant trend toward greater impairment of amyloid processing in COVID-19 central than peripheral neurological syndromes. This pilot study raises the possibility that patients with COVID-19-associated neurological syndromes exhibit impaired amyloid processing. Altered amyloid processing was linked to neuronal injury and neuroinflammation but reduced astrocyte activation.

Health Care Providers' Perspectives on COVID-19 and Medical Neglect in Children with Life-Threatening Complex Chronic Conditions.

Purpose: Little is known regarding medical neglect in children with Life-Threatening Complex Chronic Conditions (LT-CCCs). We examined the impact of COVID-19 on concern for medical neglect in this population. Methods: Qualitative interview study of multi-disciplinary health care providers (HCPs) from critical care, palliative care, and complex care services on the topic of medical neglect in children with LT-CCCs. We used inductive thematic analysis to generate themes. Findings presented herein are derived from a sub-analysis of the larger study that focused specifically on discussion of COVID-19 by HCPs. Results: 9 of the 20 HCPs interviewed mentioned COVID-19 as influencing situations of potential medical neglect. These 9 represent all disciplines and teams. Interviewees reported COVID-19 increased burden on parents and likelihood of medical neglect due to: 1) Familial distancing from medical and social support and, 2) Changes to medical care delivery that impaired the medical community's ability to engage and support families. Conclusions: The COVID-19 pandemic has exposed the fragility of the medical and social systems that supports families of children with LT-CCCs. These findings are consistent with previous literature that suggest that the COVID-19 pandemic has increased the risk for child maltreatment. It additionally highlights the vulnerability of this patient population.

The impact of the COVID-19 pandemic on endoscopy procedure volume and cancer detection rate at a large academic cancer center

Introduction: The COVID-19 pandemic greatly affected the capacity to perform standard endoscopic procedures. Due to government mandate, practice shifted to performing only urgent procedures at the beginning of the pandemic followed by gradual resumption of elective procedures. We evaluated the impact of deferred colorectal cancer screening from March to December 2020 at a large academic cancer center. Methods: We performed a retrospective cohort study among adults aged 18 years and older who had an endoscopy procedure performed between January 2019 to December 2020 at the University of Texas MD Anderson Cancer Center. In March 2020, elective procedures were suspended, then resumed in June 2020, with close to full capacity achieved by September 2020. There was no suspension during the 2020 winter COVID-19 surge. Clinical data were obtained via extraction of electronic health records. Data were aggregated and analyzed by the Syntropy platform: Palantir Foundry (Foundry). Basic statistics were performed, including student's t-test and Chi-squared analysis. Results: We identified 12444 endoscopy procedures performed on 9993 patients in 2019 and 9993 endoscopy procedures on 8138 patients in 2020 (Table 1). Between March and December 2020, 8756 COVID tests were performed pre-endoscopy, with an average positivity rate of 4.8%. In Texas, the average COVID positivity rate was 8.9%. Total endoscopy volume declined by 19.7% in 2020 compared to 2019 (P-value = 0.02). The sharpest declines in endoscopy were in April 2020, with EGD volume falling by 76%, colonoscopy volume by 78%, and ERCP volume by 16% compared to respective averages in April 2019. By the end of 2020, case volume returned to 2019 levels. From March 2020 to December 2020, 850 colonoscopies were cancelled;average adenoma detection rates (ADR) were 27.0 and average carcinoma detection rates (CDR) were 10.7, compared to ADR of 34.5 (P-value = 0.004) and CDR of 12.6 (P=0.71) for the same time period in 2019. See Figure 1. Conclusion: Total endoscopy volume declined by 19.7% in 2020 due to the impact of COVID-19 related changes in endoscopy practice. This impacted elective procedures such as screening colonoscopy procedures. The ADR was significantly lower in 2020 compared to 2019. There was not a significant change in CDR. These findings highlight the importance of increased routine endoscopic procedures, as the burden of COVID-19 diminishes. (Table Presented).

Exploring Temporal Evaluations of Interpersonal Social Media Surveillance During the COVID-19 Lockdown

The occurrence of the novel coronavirus necessitates a better understanding of how romantic partners use social technology to cope with health stressors. This exploratory study, therefore, examined whether COVID-related health concerns regarding oneself or one?s romantic partner before/during quarantine predict, or are predicted by, emerging adults? engagement in social media surveillance of their romantic partner. Participants (N = 181 emerging adults in a romantic relationship) responded to online surveys at two points during spring 2020. Findings from a cross-lagged analysis indicate that COVID-related health concerns for oneself before stay-at-home orders predicted emerging adult?s participation in social media surveillance of a romantic partner during COVID quarantine. This study serves as an initial inquiry into how health-related concerns impact technology use in romantic relationships and how they serve to modify digital participation during a global crisis (i.e., the COVID-19 pandemic). Limitations, future research directions, and implications of the study are discussed.

Serum and cerebrospinal fluid biomarker profiles in acute SARS-CoV-2-associated neurological syndromes.

Preliminary pathological and biomarker data suggest that SARS-CoV-2 infection can damage the nervous system. To understand what, where and how damage occurs, we collected serum and CSF from patients with COVID-19 and characterized neurological syndromes involving the PNS and CNS (n = 34). We measured biomarkers of neuronal damage and neuroinflammation, and compared these with non-neurological control groups, which included patients with (n = 94) and without (n = 24) COVID-19. We detected increased concentrations of neurofilament light, a dynamic biomarker of neuronal damage, in the CSF of those with CNS inflammation (encephalitis and acute disseminated encephalomyelitis) [14 800 pg/ml (400, 32 400)], compared to those with encephalopathy [1410 pg/ml (756, 1446)], peripheral syndromes (Guillain-Barré syndrome) [740 pg/ml (507, 881)] and controls [872 pg/ml (654, 1200)]. Serum neurofilament light levels were elevated across patients hospitalized with COVID-19, irrespective of neurological manifestations. There was not the usual close correlation between CSF and serum neurofilament light, suggesting serum neurofilament light elevation in the non-neurological patients may reflect peripheral nerve damage in response to severe illness. We did not find significantly elevated levels of serum neurofilament light in community cases of COVID-19 arguing against significant neurological damage. Glial fibrillary acidic protein, a marker of astrocytic activation, was not elevated in the CSF or serum of any group, suggesting astrocytic activation is not a major mediator of neuronal damage in COVID-19.

Antiphospholipid antibodies and neurological manifestations in acute COVID-19: A single-centre cross-sectional study.

BACKGROUND: A high prevalence of antiphospholipid antibodies has been reported in case series of patients with neurological manifestations and COVID-19; however, the pathogenicity of antiphospholipid antibodies in COVID-19 neurology remains unclear. METHODS: This single-centre cross-sectional study included 106 adult patients: 30 hospitalised COVID-neurological cases, 47 non-neurological COVID-hospitalised controls, and 29 COVID-non-hospitalised controls, recruited between March and July 2020. We evaluated nine antiphospholipid antibodies: anticardiolipin antibodies [aCL] IgA, IgM, IgG; anti-beta-2 glycoprotein-1 [aß2GPI] IgA, IgM, IgG; anti-phosphatidylserine/prothrombin [aPS/PT] IgM, IgG; and anti-domain I ß2GPI (aD1ß2GPI) IgG. FINDINGS: There was a high prevalence of antiphospholipid antibodies in the COVID-neurological (73.3%) and non-neurological COVID-hospitalised controls (76.6%) in contrast to the COVID-non-hospitalised controls (48.2%). aPS/PT IgG titres were significantly higher in the COVID-neurological group compared to both control groups (p < 0.001). Moderate-high titre of aPS/PT IgG was found in 2 out of 3 (67%) patients with acute disseminated encephalomyelitis [ADEM]. aPS/PT IgG titres negatively correlated with oxygen requirement (FiO2 R=-0.15 p = 0.040) and was associated with venous thromboembolism (p = 0.043). In contrast, aCL IgA (p < 0.001) and IgG (p < 0.001) was associated with non-neurological COVID-hospitalised controls compared to the other groups and correlated positively with d-dimer and creatinine but negatively with FiO2. INTERPRETATION: Our findings show that aPS/PT IgG is associated with COVID-19-associated ADEM. In contrast, aCL IgA and IgG are seen much more frequently in non-neurological hospitalised patients with COVID-19. Characterisation of antiphospholipid antibody persistence and potential longitudinal clinical impact are required to guide appropriate management. FUNDING: This work is supported by UCL Queen Square Biomedical Research Centre (BRC) and Moorfields BRC grants (#560441 and #557595). LB is supported by a Wellcome Trust Fellowship (222102/Z/20/Z). RWP is supported by an Alzheimer's Association Clinician Scientist Fellowship (AACSF-20-685780) and the UK Dementia Research Institute. KB is supported by the Swedish Research Council (#2017-00915) and the Swedish state under the agreement between the Swedish government and the County Councils, the ALF-agreement (#ALFGBG-715986). HZ is a Wallenberg Scholar supported by grants from the Swedish Research Council (#2018-02532), the European Research Council (#681712), Swedish State Support for Clinical Research (#ALFGBG-720931), the Alzheimer Drug Discovery Foundation (ADDF), USA (#201809-2016862), and theUK Dementia Research Institute at UCL. BDM is supported by grants from the MRC/UKRI (MR/V007181/1), MRC (MR/T028750/1) and Wellcome (ISSF201902/3). MSZ, MH and RS are supported by the UCL/UCLH NIHR Biomedical Research Centre and MSZ is supported by Queen Square National Brain Appeal.

Mucosal vaccines - fortifying the frontiers.

Mucosal vaccines offer the potential to trigger robust protective immune responses at the predominant sites of pathogen infection. In principle, the induction of adaptive immunity at mucosal sites, involving secretory antibody responses and tissue-resident T cells, has the capacity to prevent an infection from becoming established in the first place, rather than only curtailing infection and protecting against the development of disease symptoms. Although numerous effective mucosal vaccines are in use, the major advances seen with injectable vaccines (including adjuvanted subunit antigens, RNA and DNA vaccines) have not yet been translated into licensed mucosal vaccines, which currently comprise solely live attenuated and inactivated whole-cell preparations. The identification of safe and effective mucosal adjuvants allied to innovative antigen discovery and delivery strategies is key to advancing mucosal vaccines. Significant progress has been made in resolving the mechanisms that regulate innate and adaptive mucosal immunity and in understanding the crosstalk between mucosal sites, and this provides valuable pointers to inform mucosal adjuvant design. In particular, increased knowledge on mucosal antigen-presenting cells, innate lymphoid cell populations and resident memory cells at mucosal sites highlights attractive targets for vaccine design. Exploiting these insights will allow new vaccine technologies to be leveraged to facilitate rational mucosal vaccine design for pathogens including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and for cancer.

Thinking outside the 'box': a discussion of sports fans, teams, and the environment in the context of COVID-19. (Special Issue: SportsWorld V: the evolving SportsWorld: sports and physical activities in the time of COVID-19.)

In this paper, we examine the implications of sport stadiums closures during the COVID-19 global pandemic. The paper looks at the impact of sport stadium closures from three perspectives: The individual fan, the sport organization, and societal implications, with specific consideration to the environment. Previous literature was reviewed in order to highlight the areas in which the sport industry will need to focus their attention to in the coming months and provide theoretical background for academics looking to identify unique research opportunities. With an understanding of the implications of sport stadium closures to the sport world and beyond, academics and practitioners can work to solve the problems that lie ahead during and after the COVID-19 crisis.

Dementia wellbeing and COVID-19: Review and expert consensus on current research and knowledge gaps.

OBJECTIVES: In response to a commissioned research update on dementia during the COVID-19 pandemic, a UK-based working group, comprising dementia researchers from a range of fields and disciplines, aimed to describe the impact of the pandemic on dementia wellbeing and identify priorities for future research. METHODS: We supplemented a rapid literature search (including unpublished, non-peer reviewed and ongoing studies/reports) on dementia wellbeing in the context of COVID-19 with expert group members' consensus about future research needs. From this we generated potential research questions the group judged to be relevant that were not covered by the existing literature. RESULTS: Themes emerged from 141 studies within the six domains of the NHS England COVID-19 Dementia Wellbeing Pathway: Preventing Well, Diagnosing Well, Treating Well, Supporting Well, Living Well and Dying Well. We describe current research findings and knowledge gaps relating to the impact on people affected by dementia (individuals with a diagnosis, their carers and social contacts, health and social care practitioners and volunteers), services, research activities and organisations. Broad themes included the potential benefits and risks of new models of working including remote healthcare, the need for population-representative longitudinal studies to monitor longer-term impacts, and the importance of reporting dementia-related findings within broader health and care studies. CONCLUSIONS: The COVID-19 pandemic has had a disproportionately negative impact on people affected by dementia. Researchers and funding organisations have responded rapidly to try to understand the impacts. Future research should highlight and resolve outstanding questions to develop evidence-based measures to improve the quality of life of people affected by dementia.

The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings.

Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological and neuropsychiatric illness. Responding to this, a weekly virtual coronavirus disease 19 (COVID-19) neurology multi-disciplinary meeting was established at the National Hospital, Queen Square, in early March 2020 in order to discuss and begin to understand neurological presentations in patients with suspected COVID-19-related neurological disorders. Detailed clinical and paraclinical data were collected from cases where the diagnosis of COVID-19 was confirmed through RNA PCR, or where the diagnosis was probable/possible according to World Health Organization criteria. Of 43 patients, 29 were SARS-CoV-2 PCR positive and definite, eight probable and six possible. Five major categories emerged: (i) encephalopathies (n = 10) with delirium/psychosis and no distinct MRI or CSF abnormalities, and with 9/10 making a full or partial recovery with supportive care only; (ii) inflammatory CNS syndromes (n = 12) including encephalitis (n = 2, para- or post-infectious), acute disseminated encephalomyelitis (n = 9), with haemorrhage in five, necrosis in one, and myelitis in two, and isolated myelitis (n = 1). Of these, 10 were treated with corticosteroids, and three of these patients also received intravenous immunoglobulin; one made a full recovery, 10 of 12 made a partial recovery, and one patient died; (iii) ischaemic strokes (n = 8) associated with a pro-thrombotic state (four with pulmonary thromboembolism), one of whom died; (iv) peripheral neurological disorders (n = 8), seven with Guillain-Barré syndrome, one with brachial plexopathy, six of eight making a partial and ongoing recovery; and (v) five patients with miscellaneous central disorders who did not fit these categories. SARS-CoV-2 infection is associated with a wide spectrum of neurological syndromes affecting the whole neuraxis, including the cerebral vasculature and, in some cases, responding to immunotherapies. The high incidence of acute disseminated encephalomyelitis, particularly with haemorrhagic change, is striking. This complication was not related to the severity of the respiratory COVID-19 disease. Early recognition, investigation and management of COVID-19-related neurological disease is challenging. Further clinical, neuroradiological, biomarker and neuropathological studies are essential to determine the underlying pathobiological mechanisms that will guide treatment. Longitudinal follow-up studies will be necessary to ascertain the long-term neurological and neuropsychological consequences of this pandemic.

Improving the online presence of residency programs to ameliorate COVID-19's impact on residency applications.

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has created several challenges for residency programs and prospective interns alike during the upcoming application cycle, including the cancellation of away sub-internships and in-person interviews. Given prior research documenting that applicants' application and ranking decisions are significantly influenced by residency webpages, a potential solution to the loss of in-person experiences during the pandemic is the expansion of residency programs' online presence through their program websites, provision of virtual grand rounds and pseudo-away rotations, and enhancement of virtual interviews. This study seeks to summarize the existing literature on these areas and provide concrete suggestions for improving programs' virtual presence.Methods: The authors summarize earlier literature querying the content of program websites across 14 medical specialties, which documented significant gaps in the content of interest to applicants.Results: Among 14 analyzed specialties, the majority of programs had a functional website (>90%), with the exception of interventional radiology (73.9%). However, significant gaps in content were documented, with the percentage of content variables contained on websites ranging from 33.3% to 70.5% (median = 47.0%, interquartile range = 37.8-52.6%). Program websites were also limited by underrepresentation of content most valued by applicants as well as potential areas of inaccurate or outdated information.Conclusions: There are several interventions programs can undertake to address existing gaps in online presence. During an application cycle facing unprecedented resource strain, bolstering the online presence of programs may facilitate an improved fit between programs and future residents.