The Potential of Artificial Intelligence for Achieving Healthy and Sustainable Societies

In this chapter we extend earlier work (Vinuesa et al., Nat Commun 11, 2020) on the potential of artificial intelligence (AI) to achieve the 17 Sustainable Development Goals (SDGs) proposed by the United Nations (UN) for the 2030 Agenda. The present contribution focuses on three SDGs related to healthy and sustainable societies, i.e., SDG 3 (on good health), SDG 11 (on sustainable cities), and SDG 13 (on climate action). This chapter extends the previous study within those three goals and goes beyond the 2030 targets. These SDGs are selected because they are closely related to the coronavirus disease 19 (COVID-19) pandemic and also to crises like climate change, which constitute important challenges to our society. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Social withdrawal and shyness

This chapter provides a conceptual overview of the construct of social withdrawal. It describes the developmental origins, with an emphasis on the contributions of biology and parents, and details the psychosocial costs of child and adolescent social withdrawal. Social withdrawal and shyness appear to develop from a biologically based temperamental predisposition toward heightened fear reactivity and ineffective fear regulation. From early childhood through adolescence, shyness is concurrently and predictively associated with a wide range of socioemotional difficulties. The chapter outlines the correlates and outcomes of shyness, with a focus on implications for social development. Numerous studies also indicate that many socially withdrawn youth experience peer victimization during childhood and early adolescence. The chapter suggests the potential impact of increased social isolation and solitude on socially withdrawn youth during Covid-19 global pandemic. The Covid-19 pandemic, however, may be particularly challenging for already vulnerable socially withdrawn youth. © 2022 John Wiley & Sons Ltd.

Reasons for Reduced Willingness to Participate in Clinical Trials During the COVID-19 Pandemic: The Translational Breast Cancer Research Consortium (TBCRC) 057 Survey

Background: Historically, less than 10% of adult patients with cancer enroll in clinical trials, however, enrollment dropped further at the onset of the COVID-19 pandemic. Barriers to trial participation during the pandemic have not been reported. As part of the TBCRC 057 survey on the impact of the pandemic on willingness to participate in breast cancer trials, we assessed reasons for reluctance to participate in trials during the pandemic. Method(s): US residents who self-reported a breast cancer diagnosis were eligible to complete the online survey 8/6/21-9/30/21. Respondents indicated whether they were current trial participants and, if not, their willingness to consider participating in a trial during the pandemic using a 5-point scale (0-not at all willing to 4-definitely willing). Respondents who were not current trial participants and who were not "definitely willing" to consider participation during the pandemic were characterized as "reluctant" and asked to select reasons for their reluctance from a checklist. Pandemic-related anxiety was assessed on an 11-point scale (0-no anxiety to 10-worst anxiety possible). Respondents indicated how the option to conduct trial activities online would affect their decision to participate in a trial (much less likely, somewhat less likely, would not affect my decision, somewhat more likely, or much more likely). In exploratory analyses, we evaluated whether pandemic-related anxiety and favorable reactions towards opportunities to conduct trial activities online were associated with reluctance to consider trial participation during the pandemic due to fear of SARS-CoV-2 exposure. Means were compared with two sample t-tests and proportions with Fisher's exact tests. Result(s): Of 385 survey respondents, 185 (48%) were characterized as reluctant to consider trial participation during the pandemic. Among these 185, median age was 55 (range 25-80), 85.7% were non-Hispanic White, 48.1% had metastatic disease and 44.2% received care at academic centers. Reasons for reluctance to consider trial participation during the pandemic cited by >=15% of the 185 reluctant respondents are shown in the Table. Respondents who selected fear of exposure to SARS-CoV-2 as a reason for their reluctance to consider participating in a trial during the pandemic had higher mean pandemic-related anxiety (7.0 vs 5.2, p< 0.001). These respondents were more likely to indicate telemedicine doctor visits (p=0.01), virtual consents (p=0.001) and online study questionnaires (p=0.001) would make them somewhat or much more likely to participate in trials than respondents who did not select fear of exposure to SARS-CoV-2 as a reason for their reluctance. Conclusion(s): Reasons for reluctance of patients with breast cancer to consider participation in clinical trials during the pandemic are multifactorial. Although concerns about safety and efficacy remain prominent, fear of exposure to SARS-CoV-2 drives unwillingness to participate in >25% of reluctant patients. Trial accrual may benefit from incorporation of electronic activities when possible.

Visions of blended learning: identifying the challenges and opportunities in shaping institutional approaches to blended learning in higher education

Although higher education has engaged in blended learning since the early 1990s and its benefits are well catalogued, research often focuses on individual programmes and less on how institutions envision and engage with it to enhance learning and teaching. This article provides a pre-Covid 19 pandemic snapshot of cross-institutional UK policy and practice, through an interpretative, qualitative study of strategy documents and expert interviews. Findings show that while not prominent in pre-pandemic published institutional strategies, commitments to blended learning are expressed in terms of flexibility, inclusivity and accessibility, recognising the need for structures and support. Experts identify strategic leadership, governance structures, professional development and ongoing support as important requirements for large-scale adoption. The article concludes that blended learning, pre-pandemic, had not normalised. Post-pandemic, to normalise blended learning and support sustained widespread adoption, institutions should heed research literature recommendations and devise institutional visions that establish support, structure and shared strategy. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Changing characteristics of post-COVID-19 syndrome: Cross-sectional findings from 458 consultations using the Stanford Hall remote rehabilitation assessment tool.

BACKGROUND: In the UK, there have been multiple waves of COVID-19, with a five-tier alert system created to describe the transmission rate and appropriate restrictions. While acute mortality decreased, there continued to be a significant morbidity, with individuals suffering from persistent, life-restricting symptoms for months to years afterwards. A remote rehabilitation tool was created at the Defence Medical Rehabilitation Centre (DMRC) Stanford Hall to assess post-COVID-19 symptoms and their impact on the UK military.This study aims to understand changes in post-COVID-19 syndrome between wave 1 and wave 2, identify interactions between alert level and symptoms and investigate any predictive nature of acute symptoms for postacute symptomology in a young, physically active population. METHODS: Cross-sectional study of 458 consecutive remote rehabilitation assessments performed at DMRC Stanford Hall between 2 April 2020 and 29 July 2021. Consultations were coded, anonymised, and statistical analysis was performed to determine associations between acute and postacute symptoms, and between symptoms, alert levels and waves. RESULTS: 435 assessments were eligible; 174 in wave 1 and 261 in wave 2. Post-COVID-19 syndrome prevalence reduced from 43% to 2% between the waves. Acutely, widespread pain was more prevalent in wave 2 (p<0.001). Postacutely, there was increased anxiety (p=0.10) in wave 1 and increased sleep disturbance (p<0.001), memory/concentration issues (p<0.001) and shortness of breath/cough (p=0.017) in wave 2. Increasing alert level was associated with increased postacute symptom prevalence (p=0.046), with sleep disturbance increasing at higher alert level (p=0.016). Acute symptoms, including fatigue, sleep disturbance and myalgia, were associated with multiple postacute symptoms. CONCLUSIONS: This study reports the overall prevalence and symptom burden in the UK military in the first two waves of COVID-19. By reporting differences in COVID-19 in different waves and alert level, this study highlights the importance of careful assessment and contextual understanding of acute and postacute illnesses for individual management plans.

CLUSTER Trial An 82 U.S. Hospital Cluster Randomized Trial (CRT) to Assess the Impact of an Automated Statistical Outbreak Detection Tool and Response Protocol to Limit Hospital Transmission

Background. The CLUSTER trial assessed the impact of prospective identification of clusters coupled with a response protocol on the containment of hospital clusters. Methods. This 82-hospital CRT in 16 states compared clusters of bacterial and fungal healthcare pathogens using a statistical outbreak detection tool (WHONET-SaTScan) coupled with a standardized response protocol (automated cluster detection arm) compared to routine surveillance with the response protocol (control arm). Trial periods: 24 mo Baseline (2/17-1/19);5 mo Phase-in (2/19-6/ 19);30 mo Intervention (7/19-1/22). The primary outcome was the number of additional cases occurring after initial cluster detection. Analyses used generalized linear mixed models to assess differences in additional cases between the intervention vs baseline periods across arms, clustering by hospital. Results were assessed overall and, to account for the effect of COVID-19 on hospital operations, stratified into pre-COVID-19 (7/19-6/20) and during COVID-19 (7/20-1/22) intervention periods. We also assessed the probability that a patient was in a cluster. Results. In the baseline period, the automated cluster detection and control arms had 0.09 and 0.07 additional cluster cases/1000 admissions, respectively. The automated cluster detection arm had a 22% greater relative reduction in additional cluster cases in the intervention vs baseline period compared to control (P=0.5). Within the intervention period, the automated cluster detection arm had a significant 64% relative reduction pre-COVID-19 (P< 0.05) and a non-significant 6% relative reduction during COVID-19 (P=0.9) compared to control (Figure). When evaluating patient risk of being part of a cluster across the entire intervention period, the automated cluster detection arm had a significant 35% relative reduction vs control (P< 0.01). Conclusion. A statistical automated tool coupled with a response protocol improved cluster containment by 64% pre-COVID-19 but not during COVID-19;there were no significant differences between the arms when using the entire intervention period. Automated cluster detection may substantially improve outbreak containment in non-pandemic periods when infection prevention programs are able to optimize containment protocols. (Figure Presented).

OLDER AGE IS (STILL) ASSOCIATED WITH MENTAL HEALTH BENEFITS IN JUNE–JULY 2021 OF THE COVID-19 PANDEMIC

In the early months of the COVID-19 pandemic, older age was associated with less anxiety and depression (Bruin de Bruin, 2021). Similar results were found for data collected during the June-July 2020 spike in cases (Smith et al., 2021). Theorists have suggested that benefits of age for well-being may be reduced when stressors are prolonged and unavoidable (Charles, 2010). Here, we investigated whether older age continued to be protective in June-July 2021, when vaccines had become widely available, but the pandemic persisted. Secondary data analysis was conducted from the Understanding America Study, based on n=5,535 (M=52.69 yrs., SD=16.04) participants who responded to online self-report surveys. Participants reported symptoms of anxiety and depression (assessed by the Patient Health Questionnaire, PHQ-4), engagement in protective behaviors (e.g., wearing a mask), and coping strategies (e.g., getting extra exercise). Multiple regression analyses predicted anxiety and depression from age, coping strategies, and protective behaviors, controlling for marital status, gender, and income. Coping through exercise and calling family/friends were significantly associated with less anxiety and depression, whereas coping by using social media and engaging in protective behaviors was significantly associated with more anxiety and depression. The harmful effects of protective behaviors may reflect the people engaging in these strategies most often are also those most worried about COVID-19. Even after accounting for coping strategies and protective behaviors, older age was still associated with fewer symptoms of anxiety and depression. Implications of older adults' resilience in the face of a prolonged stressor for promoting mental health are discussed.

The effect of modifications to clinical trial activities implemented during the COVID-19 pandemic on willingness to participate in clinical trials: The TBCRC 057 survey

Background: In order to maintain safety, clinical trial activities have been modified during the COVID- 19 pandemic. As part of the TBCRC 057 survey, we assessed how pandemic-related modifications to trial activities affect breast cancer patients' willingness to participate in clinical trials. Method(s): US residents with breast cancer were eligible to complete the online survey 8/6/21 - 9/30/21. Respondents rated whether each of 11 modifications to clinical trial activities would affect their decision to participate in a trial during or after the pandemic. Items evaluated modifications that involved changing the location of trial activities to closer to home, switching trial activities to telemedicine and making the trial schedule more flexible and convenient. Response options were much less likely to participate, somewhat less likely to participate, would not affect my decision whether or not to participate, somewhat more likely to participate and much more likely to participate. Current trial participants were asked to consider how modifications would affect their decision to participate in another trial. Results are reported descriptively. Result(s): Among 385 respondents, median age was 52 (range 25-85), 88.6% were non-Hispanic White, 52.5% had metastatic disease, 93% were receiving active treatment, 48.6% received care at an academic center and 9.6% were current trial participants. Changing location of trial activities was viewed favorably, with 70.2%, 64.6% and 54.1% of respondents indicating they would be much or somewhat more likely to participate if they could complete trial blood tests, x-ray tests or doctor visits closer to home, respectively. Similarly, the option to complete trial activities electronically was viewed favorably, with 59.6%, 58.6% and 60.9% of respondents indicating they would be much or somewhat more likely to participate if they could complete trial doctor visits, consent and questionnaires via telemedicine, respectively. With regard to modifications to make the trial schedule more flexible and convenient, respondent feedback was also favorable. 71.4%, 67.7% and 82.4% of respondents indicated that requiring study site visits no more than once per 3 weeks, widening windows for trial activities and offering home delivery of oral study medications, respectively, would make them much or somewhat more likely to participate. Finally, 30.4% and 51.7% indicated that the flexibility to opt-out of research-only blood tests and biopsies, respectively, would make them much or somewhat more likely to participate. Conclusion(s): Patients view modifications to trial activities implemented during the pandemic favorably. Trials should be flexible and the option to conduct study activities close to home or electronically when possible should be maintained during the pandemic and beyond.

Evaluating Information and Misinformation during the COVID-19 Pandemic: Evidence for Epistemic Vigilance

There are many ways to go wrong when evaluating new information, e.g. by putting unwarranted trust in non-experts, or failing to scrutinize information about threats. We examined how effective people were at evaluating information about the COVID-19 pandemic. Early in the course of the pandemic, we recruited 1791 participants from six countries with varying levels of pandemic severity, and asked them to evaluate true and false pandemic-related statements (assertions and prescriptions) sampled from the media. We experimentally manipulated the source of each statement (a doctor, a political/religious leader, social media, etc.). Overall, people proved to be epistemically vigilant: they distinguished between true and false statements, especially prescriptions, and they trusted doctors more than other sources. These effects were moderated by feeling threatened by the pandemic, and by strong identification with some sources (political/religious leaders). These findings provide optimism in the fight against misinformation, while highlighting challenges posed by politics and ideology. © Cognitive Science Society: Comparative Cognition: Animal Minds, CogSci 2021.All rights reserved.

Choose Paediatrics: Engaging Medical Students and Foundation Doctors in a Career in Paediatrics during the Covid-19 Pandemic Via an Online Paediatric Careers Conference

Aims The Covid-19 pandemic had a significant impact on the shape of undergraduate and postgraduate medical training, with medical students unable to spend time on the wards and post rotations for junior doctors paused. We recognised that the opportunity to gain insight into a career in paediatrics was significantly limited as a result. In conjunction with our local children's hospital charity, we arranged an online paediatrics careers conference for foundation year doctors and medical students in June 2021. Objectives * Introduce attendees to paediatrics as a speciality, including different career paths within paediatrics. * Increase knowledge about building a paediatric-orientated CV, and the process of applying for paediatric training. * Provide a platform for medical students and foundation doctors to present their own research in the field of paediatrics. * Assess the impact of the conference on attendees via a post-conference survey with regards to knowledge of paediatric training, intention to apply to paediatrics and experience of an online learning platform for conference delivery Methods * * Pre-conference survey sent to medical students and foundation doctors locally to assess interest and availability. * One day online conference organised on the communication platform Zoom and advertised through university and postgraduate channels. * Live and pre-recorded talks on various paediatric subspecialties, CV building, opportunities throughout undergraduate training and practical aspects of applying for training. * Poster and oral presentations from conference attendees. * Post-conference survey to assess change in perceived knowledge about paediatric careers and likelihood to apply for training. Results There were 48 conference attendees from across the United Kindgom. Forty-two post-conference surveys were received;with the following feedback collated: A key finding was that 69% of attendees had received no information about paediatric careers at medical school, and 84% received none during foundation training prior to this conference. Knowledge about paediatric careers * 85% rated their knowledge about paediatric careers as 'good' or 'excellent' (14% pre-conference) * 83% rated their knowledge about building a CV as 'good' or 'excellent' (19% pre-conference, 'good' only) * 83% rated their knowledge about applying for paediatrics as 'good' or 'excellent' (12% pre-conference, 'good' only) Intention to apply to paediatrics: * 83% would 'probably' or 'definitely' apply for a foundation programme with a paediatrics post (60% pre-conference) * 64% would 'probably' or 'definitely' apply for paediatrics speciality training (47% pre-conference) Suitability of Zoom platform: * 100% found the platform appropriate for their learning needs. * 86% felt it was easy to engage with speakers. * 95% would attend another online conference in the future, although 65% would prefer a face-to-face conference. The most useful topics covered (as reported by attendees) included information regarding application for paediatric speciality training, how to build a paediatric-specific CV, and discussion of the variety of careers paths and subspecialties available within paediatrics. Conclusion Attendees found the online platform accessible and appropriate for their learning needs, and following the conference had increased self-reported knowledge of building a paediatric-specific CV, applying to paediatric training, and career paths within paediatrics. Furthermore an online paediatrics careers conference can increase the self-reported likelihood of applying for paediatric posts during foundation years and speciality training.

Mid-semester Pandemic-driven Course Rescheduling with Integer Programming

As universities begin the return to in-person course work, uncertainty remains about the future of SARS-CoV-2 virus and its variants. In the years to come, other novel pathogens may emerge. Pandemic-driven social distancing requirements reduce the number of students in classrooms, and when these requirements are instituted mid-semester, universities must make quick changes to classroom assignments and course delivery mode. In this work, we introduce two integer programs to optimize mid-semester changes: (i) a conflict-matrix-based model that determines new classroom capacities and designs the corresponding seat map, and (ii) a hierarchical model that optimizes room assignment and course delivery mode according to prioritized objectives. We test our methods with University of Michigan's engineering course schedule for Fall 2021, under a hypothetical 3-foot social distancing requirement. We compare the performance of the models under different hierarchical objectives and room assignment assumptions and discuss the managerial implications of our results. © 2022 IISE Annual Conference and Expo 2022. All rights reserved.

TBCRC 057: An online survey about anxiety and willingness to participate in breast cancer clinical trials during the COVID-19 pandemic

Background: Enrollment in clinical trials has declined during the COVID-19 pandemic. Simultaneously, breast cancer patients have reported heightened anxiety. We assessed whether breast cancer patients' anxiety about the pandemic affects their willingness to participate in trials. Methods: English or Spanish- speaking US residents with breast cancer were eligible to complete the online REDCap survey 8/6/ 21 - 9/30/21. Respondents rated their anxiety about the pandemic on an 11-point scale from 0 (no anxiety) to 10 (worst anxiety possible). Anxiety scores were categorized as no/mild (0-3), moderate (4- 6) or severe (7-10). Knowledge about trials was assessed with 11 true/false items and attitudes toward trials with the Attitudes Toward Cancer Trials Scales - Cancer Treatment Subscale (ATCTS-CTS). Respondents rated their willingness to participate in a breast cancer clinical trial before and during the pandemic on 5-point scales from 0 (not at all willing) to 4 (definitely willing). Trial participants were considered “definitely willing.” Change in willingness to participate in trials during the pandemic compared to prior was defined as a binary outcome, “less willing” vs “no less willing.” Means were compared via t-test and mean difference was tested via paired t-test. Multivariable logistic regression was used to model the association of anxiety and other factors with being less willing to participate in trials during compared to prior to the pandemic. Results: Among 385 respondents, median age was 52 (range 25-85), 271 (70%) were non-Hispanic White and 202 (53%) had metastatic disease. 154 (40%) received care at academic centers and 37 (10%) were current trial participants. Most rated their anxiety as moderate (43%) or severe (38%). Mean willingness to participate in a trial was lower during compared to prior to the pandemic (2.97 vs 3.10;p < 0.0001). Fifty (13%) respondents were less willing to participate in a trial during the pandemic compared to prior. After controlling for covariates, those with severe anxiety had 5.07 times odds of being less willing to participate during the pandemic compared to prior than those with no/mild anxiety (p = 0.01). For every 1-point increase in ATCTS-CTS score (indicating better attitude toward trials) there was a 3% decrease in the odds of being less willing to participate during the pandemic (p = 0.006). For every 1-point increase in the clinical trials knowledge score (indicating more knowledge) there was a 15% decrease in the odds of being less willing to participate during the pandemic (p = 0.02). Conclusions: Pandemic-related anxiety is common in breast cancer patients and is associated with being less willing to participate in trials during the pandemic compared to prior. Education about trials, including safety modifications implemented during the pandemic, may mitigate anxiety and improve willingness to participate.

Immune thrombocytopenic purpura: an early cutaneous manifestation of a dangerous and not yet fully understood complication of COVID-19 infection

COVID-19 has created a series of clinical conundrums since its emergence. We report a case of severe immune thrombocytopenic purpura (ITP) in a 67-year-old gentleman in April 2020. He presented to hospital with a rapidly evolving rash, 3 weeks following infection with COVID-19. Clinically he had a widespread non palpable petechial rash, haemorrhagic blisters across his oral mucosa and severe epistaxis. His platelet count was 2 × 109 L-1 (150-450 × 109 L-1). Full blood count and clotting studies were otherwise normal. With ITP not yet well reported as a complication of COVID-19, there was a treatment dilemma. ITP is an acquired autoimmune-mediated disorder (often with a viral or vaccine precipitant) and first-line treatment is immunosuppression. However, due to concurrent infection with the novel COVID-19 virus, a thrombopoietin receptor agonist (TPO-RA) (eltrombopag 50 mg once daily) was instead commenced. Persistent epistaxis, oral bleeding and a platelet count < × 109 L-1 required intravenous immunoglobulin (1 g kg-1) to be administered on day 7 of TPO-RA treatment. By day 12 of TPO-RA treatment the platelet count had successfully normalized. The patient remains in remission 18 months on. Since this case, ITP has become a recognized phenomenon of both COVID-19 infection and COVID-19 vaccination (Pishko AM, Bussel JB, Cines DB. COVID-19 vaccination and immune thrombocytopenia. Nat Med 2021;27: 1145-6). Moreover, corticosteroid therapy has become the first evidence-based therapy for severe COVID-19 infection (Horby P, Lim WS, Emberson J et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med 2021;384: 693-704), although their use in COVID-19- related ITP remains unclear. This case demonstrates an important cutaneous manifestation of the COVID-19-provoked disrupted haemostasis pathways, which results in significant morbidity and mortality. Additionally, this case describes practical real-life multidisciplinary team decision-making to emerging complications of a uniquely studied virus.

The role of NGO administrative data in understanding the impact of COVID-19 on survivors of domestic abuse

COVID-19 quickly changed the context of domestic abuse in England. Within weeks of the first COVID-19 related death, the country was in lockdown. A quick response was essential for understanding the needs of survivors. With limited time to establish new data collection mechanisms, the role of administrative data was central in shaping the response by the Women’s Aid Federation of England. This article explores the opportunities and challenges of using administrative data to understand and respond to the impact of COVID-19 on survivors of domestic abuse in England, using analysis by Women’s Aid of administrative data as a case study. The article discusses the challenges, such as the complexity of analysing a longitudinal administrative dataset, and the need for increased skills and capacity within the NGO research environment. We also reflect on ethical considerations in light of the context of frontline workers responding to the pandemic, the opportunities for collaboration with other sector partners and academics and the benefits of being able to undertake reactive analysis to inform policy. The article concludes that our access to administrative data bolstered our ability to respond expediently to the pandemic, and achieve the long-term benefits of the partnerships that we built during this time. © Centre for Gender and Violence Research.