Identifying and Responding to Students? Social-emotional Learning Needs related to COVID-19

In this practice-oriented article, the authors aim to provide teachers with tools to identify and respond to students' social-emotional learning (SEL) during COVID-19 and beyond. Related to the principles of whole schooling, this content connects with Principle 1: Creating Learning Spaces for All, Principle 4: Build a Caring Community, and Principle 6: Partner with Families and the Community. In this article, the authors provide an overview of SEL literature and research-based related strategies, then introduce two vignettes, one pre-COVID-19 and one peri-COVID-19 (i.e., during COVID-19), and conclude with a discussion connecting SEL literature and strategies to the data they received from surveying students' SEL needs at their school. The authors hope that by sharing how they surveyed students to identify their SEL needs because of the pandemic, that administrators and teachers can recreate a similar "SEL roadmap" that they used to navigate students' emotional support needs resulting from excessive stress, anxiety, and isolation connected to remote learning and the pandemic at large.

CROI 2022: Summary of Basic Science Research in HIV and SARS-CoV-2

The Conference on Retroviruses and Opportunistic Infections (CROI) 2022, which was held as a virtual conference, continues to serve as the preeminent forum that features research advances in HIV-1 and its associated coinfections. The conference has extended its area of coverage to include research advances in SARS-CoV-2. As pointed out in the presentation from Hatziioannou in the New Investigators workshop, there has been an explosion in research activity on SARS-CoV-2 that has eclipsed that for HIV-1. In the past 12 months, there were approximately 6600 publications on HIV-1 and approximately 64, 000 on SARS-CoV-2. Although these numbers include review articles, they reveal the tremendous response by researchers to the existential threats posed by lentiviruses and coronaviruses. This poses challenges for any conference committee tasked with selecting abstracts for presentation from the large number submitted for consideration. CROI organizers have consistently been able to assemble a program that, through invited presentations, abstract-driven talks, posters, interactive sessions, workshops, and symposia, showcases the most recent research advances.Copyright © 2022, IAS-USA. All rights reserved.

CROI 2021: Summary of Basic Science Research in HIV and SARS-CoV-2

The Conference on Retroviruses and Opportunistic Infections (CROI) serves as one of the most highly visible platforms upon which researchers gather to share the most recent findings on HIV/AIDS and, recently, on SARS-CoV-2 research. Research presentations on the novel coronavirus SARS-CoV-2 have become an increasing fixture at the conference since it was first covered at last year's conference. Although CROI 2021 was virtual, the organizers coordinated a seamless platform for presentations and poster sessions that effectively engaged the audience. CROI 2021 had a strong showing in terms of basic science presentations on HIV-1 and on SARS-CoV-2. Highlights included new insights into some of the more elusive steps in the viral replication cycle as well as new findings on immune escape strategies employed by SARS-CoV-2. The new investigator workshop has become a valuable resource that can be used by early stage and established investigators alike to receive state-of-the-art updates on research areas that might be outside their immediate areas of research. The new investigator workshop featured engaging presentations on novel aspects of HIV-1 and SARS-CoV-2 replication, impact of host immunity on HIV-1 and SARS-CoV-2, and approaches to assessing viral reservoir dynamics and strategies for viral reservoir elimination.Copyright © 2021, IAS-USA. All rights reserved.

Economic Euthanasia in Dogs Requiring Emergency Surgery Increased during the Covid-19 Pandemic

INTRODUCTION: 'Economic euthanasia', defined as euthanasia of pets due to financial constraints despite treatable illness, is common in veterinary emergency medicine. Gastric dilatation-volvulus (GDV) in dogs is inexpensive to diagnose and has a high survival rate with corrective, but costly, surgery. Without surgery, GDV is lethal. The proportion of dogs with GDV euthanized pre-surgery emerged as a reliable metric of economic euthanasia. If the COVID-19 pandemic aggravated economic distress in dog owners compromising their ability to afford pet healthcare, an increase in pre-surgical euthanasia in dogs with GDV would be expected. We hypothesized that in dogs with GDV, the risk of pre-surgical euthanasia during the COVID-19 pandemic increased compared to such risk before the pandemic. METHOD(S): In this case-control study, we included nonreferred dogs with GDV that presented to 11 US veterinary hospitals. Dogs were cases if they were euthanized presurgery, and controls if they underwent surgical treatment. Exposure positive dogs were those presenting during the initial surge of unemployment due to COVID-19 (March 16 - July 5 2020), exposure negative dogs were those during the same period in 2019. Univariate analyses and binary logistic regression models were developed to quantify the association between COVID-19 status (present, absent) and euthanasia risk, adjusting for the effect of known confounders. The significance level was set at p < 0.05. RESULT(S): We recorded 118 dogs with GDV over the 2 time periods, with 30% of non-exposed and 52% of exposed pets being euthanized pre-surgery (OR, 2.6;95% CI, 1.2-5.4). After adjusting for age, breed, comorbidities and recumbency, the odds of euthanasia for dogs presenting during COVID-19 were 2.7 (95% CI 1.1 to 6.3) times those of dogs presented in 2019. Old age (OR, 2.6;95% CI, 1.1 to 6.1), but no other explanatory variables, were associated with pre-surgical euthanasia. CONCLUSION(S): Our findings show that in this study population, dogs with GDV presented in the period March 16 to July 5 2020 had a greater risk of euthanasia compared with dogs presented in the same period the year before. It is our inference that economic consequences arising from the COVID-19 pandemic directly impacted on the level of veterinary care owners were able to provide for their pets.

State Legislation Engagement to Increase Community Partnership: A Blood Center Experience

Background/Case Studies: Oklahoma (OK), the 20th largest state in the United States, is served by a regional blood center. At this blood center (BC), red blood cell (RBC) collections from OK business donor groups consistently contributed 40% of the total RBC units collected in the state. Given the declining donor population, general decrease in blood donations, and the COVID-19 pandemic, a 32% decrease in RBC donations from businesses between 2018 through 2020 was noted by the BC (see Table 1). Given the decline, the BC initiated legislation in OK known as Senate Bill 905 in the summer of 2019. Study Design/Methods: In order to mobilize existing and develop new community partnerships, especially businesses, Senate Bill 905 was introduced in OK through the BC's advocacy efforts. The purpose of the bill was to offer a tax credit to employers that provide on-site space to conduct blood drives and time allocation to their employees to donate blood during work hours. The employee tax incentive credits businesses for lost wages and productivity experienced by them for hosting blood drives with a not-for-profit BC. Results/Findings: The passing of the legislative bill, known as the Oklahoma Blood Drive Tax Credit Program, was signed into law on May 25, 2021. This law allowed businesses to receive a $20 income tax credit per employee for each volunteer blood donation at their business-sponsored blood drive. The COVID-19 pandemic slowed the passage of the bill in the Senate. Despite the challenges imposed by the pandemic, the number of RBC donations from businesses has remained steady since the program's signage into law in 2021. In the initial two months of the program, 993 business donations resulted in a total tax incentive of $19,860 for businesses. This incentive program has also been adopted by other states, including the upper Midwest. Conclusion(s): The OK employee tax incentive program for blood donation is an example of engagement between a local BC and a state government to enact legislation and mobilize local business participation. By reducing burdens faced by employers hosting a blood drive, this program fosters not only community partnerships but also safeguards a reliable and sufficient blood supply that is essential for many hospitalized patients.

Donor Return Rates after Abnormal Health Screenings: Follow-up Opportunity

Background/Case Studies: To help recruit and retain donors, blood collectors often offer health screening tests, such as cholesterol and COVID-19 antibodies. Because most blood donors return to give, the opportunity to provide follow-up screening, education, or engagement for an abnormal result adds a longitudinal dimension to the role a blood center can play as a community health resource. Quantifying this value is important to help attract stronger public health partnerships and funding. Study Design/Methods: From August 1 to October 31, 2021, a total of 70,248 individual, allogeneic donors were screened for a panel of cardiovascular risks: hemoglobin A1c (a marker for glucose control/diabetes risk), blood pressure, and total cholesterol. Abnormal findings were defined as Hb A1c >= 5.7% (prediabetes);BP >= 130/80 (stage 1 hypertension);and total cholesterol > 200 mg/dL (borderline high). Donors were monitored for return rates at 3, 4, 5, and 6 months after the midpoint of the accrual period (Sept. 16, 2021). Individual donor demographics were associated with these screening results. Results/Findings: Overall, 47.3% of the donors returned after an averaged 6-month interval. Table 1 shows that for all screening measures, donors with elevated results returned in a higher proportion than those in the comparison group with reference range findings ("WNL"). Stratification by gender showed overall male returns were higher than female returns (51.7% vs. 43.2%). For both these subsets, return percentages rose for donors with elevated results in each screening measure (see Table 2). Conclusion(s): Blood donors with abnormal results on a battery of cardiovascular health screenings return to give at a high rate, with 49.6-54.6% drawn again during an averaged 6-month span. Gender cohort analyses widened this range to 44.2-59.7%. For all subsets, returns were much higher than for "control" donors without abnormalities. These findings show a significant opportunity for in-person, follow-up interventions subsequent to blood donor wellness screenings. This longitudinal, recontacting strength should be considered in designing donor-based community health studies.

Parental Intent and Willingness to Vaccinate Children Against COVID-19 in the Pediatric Emergency Department

Background: Limited data exist regarding parental acceptance of COVID-19 vaccines for children or likelihood of acceptance in a pediatric emergency department (PED). We sought to determine rates of COVID-19 immunization among eligible children with a minor illness or injury treated in a pediatric emergency department (PED), to ascertain parent willingness for their child to receive COVID-19 vaccine (CV) in general and during future PED visits, and to describe factors associated with vaccine acceptance. Methods: Structured interviews were conducted with caregivers of children aged 6+ months evaluated in a large, urban PED in the summer of 2021 using questions derived from the literature and prior surveys. Exclusion criteria included temperature 103+F, communication barrier, Emergency Services Index (ESI) triage score of 1 or 2, or evaluation for non-accidental trauma or psychiatric complaints. Demographic and visit data, contact information, patient and parent vaccination history, and intent and willingness to receive CV were recorded, along with responses regarding parental concerns about COVID-19 illness or vaccination. Data were analyzed using standard descriptive statistics. Participants will be contacted by phone 6 months after vaccines become available for their age group to assess vaccination status. Results: Of 205 families approached, 17 declined participation, 7 were ineligible, and 181 have been enrolled. The mean patient age was 6.15 (+/- 5) years;43.6% were black. 33 (18.2%) had asthma and 16 (8.8%) had another high-risk condition. 17 (9.4%) had been previously diagnosed with COVID. Only 8/36 eligible patients (22.2%) were vaccinated. Among those previously unvaccinated, 55/173 (31.7%) definitely/probably would vaccinate their child when CV becomes available. 59/181 (32.6%) would definitely/probably accept CV in the PED at a similar future visit. Factors associated with increased overall CV acceptance included caregiver flu vaccine receipt (52.3% vs. 26.5%, p = 0.002), caregiver CV receipt (43.2% vs. 21.2%, p = 0.022), and concern that the child currently has COVID (77.8% vs. 35.6%, p = 0.012). Factors associated with acceptance in the PED included intent to vaccinate against CV (81.8% vs. 17.2%, p < 0.001), caregiver flu vaccine receipt (46.1% vs. 25.2%, p = 0.004), caregiver CV status (40.7% vs. 11.1% %, p < 0.001) and caregiver concern the child has COVID (87.5% vs. 31.9%, p = 0.001). Caregivers who were very/somewhat concerned that the child would become ill from CV were less likely to accept (overall (32.6% vs. 51.4%) and significantly less likely to accept in the PED (26.2% vs. 51.4% accepting, p < 0.001). Conclusion: Caregiver intent to immunize children against COVID is concerningly low, but is associated with caregiver vaccination status and concern for current COVID-19 illness. Those who intend to vaccinate are willing to receive CV while in the PED, indicating potential viability for future COVID-19 vaccine programs in the PED.

Increasing Underrepresented Minority Undergraduate Student Exposure to Pediatrics via a Longitudinal Mentorship Program

Background: The United States is increasingly diverse, but representation of minorities (specifically Black/African-American) in medicine has not followed this trend. Lack of mentorship is identified as a barrier at multiple levels. We developed and piloted a mentorship program between pediatric emergency medicine (PEM) physicians and underrepresented minority (URM) undergraduate students in the Porter Scholars program (the largest African American student organization at the University of Louisville), known as the Porter Scholars in Medicine Program (PSMP). By providing robust mentorship and educational activities, our goal is to encourage students in this program to matriculate to medical school. Methods: The pilot program included clinical experiences (simulation and ultrasound), direct mentorship, connections with medical school admissions agents, and personal development programming including a book club. Students selected for the PSMP completed a survey upon entry into the program including demographic questions, as well as 5-point Likert scale questions regarding familiarity with the medical school application process, comfort with being a physician, and barriers to becoming a physician. Additionally, they received a survey after specific experiences and at the end of the year. A final survey will be sent following graduation. Data were analyzed using descriptive statistics, and Wilcoxon-Signed Rank tests were used to compare entry to end of year results. Results: Twenty-three PEM faculty, fellows and clinicians volunteered as mentors or led clinical programs in the PSMP program. Twenty-five undergraduate students were accepted into the program in fall of 2020;22(88%) completed the initial survey. Mean age was 18.6 (+/- 0.8) years, 19 (86.4%) were female. On initial surveys, the median Likert scores were: awareness of available resources to assist with medical school application 2, understanding of the medical school application process 2.5, confidence in acceptance to medical school 3, and mentor support 4. Eight (36.3%) students completed the end of year survey. For these 8 students, significant increases in median Likert scores were noted for the following categories: awareness of available resources to assist with medical school application median 3.5 (p = 0.03) and understanding of the medical school application process median 4 (p = 0.03). While not statistically significant, increases were also noted in confidence in acceptance to medical school median 4 (p = 0.10), and mentor support median 5 (p = 0.06). Student comments were generally positive though experiences were limited by the COVID 19 pandemic, see table 2. Conclusion: This pilot program demonstrates feasibility of a longitudinal mentorship program for URM premedical students which was generally well-received by students and physicians. The pandemic was a limitation, with few opportunities for in-person activities, but we look forward to more robust programing this year.

Socially responsible operations in the Industry 4.0 era: post-COVID-19 technology adoption and perspectives on future research

Purpose As focal firms in supply networks reflect on their experiences of the pandemic and begin to rethink their operations and supply chains, there is a significant opportunity to leverage digital technological advances to enhance socially responsible operations performance (SROP). This paper develops a novel framework for exploring the adoption of Industry 4.0 technologies for improving SROP. It highlights current best-practice examples and presents future research pathways. Design/methodology/approach This viewpoint paper argues how Industry 4.0 technology adoption can enable effective SROP in the post-COVID-19 era. Academic articles, relevant grey literature, and insights from industry experts are used to support the development of the framework. Findings Seven technologies are identified that bring transformational capabilities to SROP, i.e. big data analytics, digital twins, augmented reality, blockchain, 3D printing, artificial intelligence, and the Internet of Things. It is demonstrated how these technologies can help to improve three sub-themes of organisational social performance (employment practices, health and safety, and business practices) and three sub-themes of community social performance (quality of life and social welfare, social governance, and economic welfare and growth). Research limitations/implications A research agenda is outlined at the intersection of Industry 4.0 and SROP through the six sub-themes of organisational and community social performance. Further, these are connected through three overarching research agendas: "Trust through Technology", "Responsible Relationships" and "Freedom through Flexibility". Practical implications Organisational agendas for Industry 4.0 and social responsibility can be complementary. The framework provides insights into how Industry 4.0 technologies can help firms achieve long-term post-COVID-19 recovery, with an emphasis on SROP. This can offer firms competitive advantage in the "new normal" by helping them build back better. Social implications People and communities should be at the heart of decisions about rethinking operations and supply chains. This paper expresses a view on what it entails for organisations to be responsible for the supply chain-wide social wellbeing of employees and the wider community they operate in, and how they can use technology to embed social responsibility in their operations and supply chains. Originality/value Contributes to the limited understanding of how Industry 4.0 technologies can lead to socially responsible transformations. A novel framework integrating SROP and Industry 4.0 is presented.

Appropriateness of Antibiotic Prescribing Through the COVID-19 Pandemic and Associated Telehealth Visits

Background. The COVID-19 pandemic and resulting mitigation strategies have impacted rates of outpatient infections and delivery of care to pediatric patients. Virtual healthcare was rapidly implemented but much is unknown about the quality of care provided in telehealth visits. We sought to describe changes in visits throughout the pandemic and evaluate the appropriateness of antibiotic prescribing. Methods. We utilized EHR data from a large health care system that provides primary care via pediatric, family medicine, and urgent care clinics. We included outpatient visits from 1/1/19 - 4/30/21 for children < 20 years. The COVID-19 era was defined as after March 2020. Visits were labeled as virtual according to coded encounter or visit type variables. The appropriateness of antibiotic prescriptions was assigned using a previously published ICD-10 classification scheme that defines each prescription as appropriate, potentially appropriate, or inappropriate (Chua, et al. BMJ, 2019). Results. There were 805,130 outpatient visits during the study period. The mean rate of antibiotic prescriptions in the pre-pandemic period was 23% (range 17-26% per month) and 11% (range 9-15%) in the COVID-19 era. Mean rates of inappropriate prescribing were 17% (range 14-20% per month) and 20% (range 19-22%), respectively (Figure 1). Coded virtual visits during the COVID-19 era were uncommon (1-2%) with the exception of April and May 2020 (11% and 5%, respectively). During the COVID-19 era, approximately 9% of telehealth visits resulted in antibiotics, compared to 11% of in-person visits (Table 1). Virtual visits had lower rates of inappropriate and appropriate prescribing, but higher rates of potentially appropriate prescribing (Table 1). Visits and associated antibiotic prescribing in the pre-pandemic and COVID-19 era Appropriateness of antibiotic prescribing in the COVID-19 era, by visit type Conclusion. Rates and volume of antibiotic prescribing in outpatient pediatric visits have declined in the COVID-19 era, while rates of inappropriate prescribing have increased slightly. Our study suggests use of telehealth for pediatric visits was minimal and led to higher prescribing rates for "potentially appropriate" indications. This could be explained by a lack of clinical certainty in conditions such as otitis media and pharyngitis in virtual visits.

Emerging and endemic zoonotic diseases: surveillance and diagnostics.

In this paper, the authors: (a) list methods used to diagnose zoonotic diseases in humans and animals; (b) identify between-species differences in diagnostic approaches, providing commentary on the benefits that might arise from simultaneous interpretation of data from human and animal health surveillance systems; and (c) reiterate the importance of using species-specific, validated diagnostic tests for surveillance and disease outbreak investigations. Emerging and endemic zoonotic diseases are likely to provide a continued threat to global health in the short- to medium-term future. A good deal of knowledge about the drivers of infectious disease emergence has been developed based on numerous examples from the recent past. Sharing of diagnostic resources across human and animal health sectors, sharing of human and animal health surveillance data, development of skills in the interpretation of that data and awareness of issues related to the validation and interpretation of diagnostic test data are necessary prerequisites for an effective endemic disease surveillance system. A good understanding of the epidemiological patterns of endemic disease will allow human and animal health professionals be able to more quickly detect the presence of emerging disease threats.

Après avoir répertorié les méthodes utilisées pour diagnostiquer les maladies zoonotiques chez l'homme comme chez les animaux, les auteurs définissent les différentes approches diagnostiques suivant les espèces considérées et commentent les avantages qui pourraient découler d'une interprétation simultanée des données par les systèmes de surveillance en santé animale et en santé publique ; il réitèrent ensuite l'importance de recourir à des tests diagnostiques validés et spécifiques de l'espèce considérée dans le cadre de la surveillance et des enquêtes suite à l'apparition d'un foyer. Les maladies zoonotiques émergentes et endémiques représentent potentiellement une menace continue pour la santé mondiale à court et à moyen terme. Les facteurs favorisant l'émergence des maladies infectieuses sont désormais beaucoup mieux connus grâce aux enseignements tirés de nombreux exemples récents. Le partage des ressources diagnostiques entre les secteurs de la santé humaine et animale, les échanges des données de la surveillance sanitaire réunies par les deux secteurs, le renforcement des compétences en matière d'interprétation des données et la sensibilisation aux problématiques de la validation et de l'interprétation des données générées par les tests de diagnostic sont des conditions préalables à la mise en place d'un système efficace de surveillance des maladies endémiques. Une bonne compréhension des profils épidémiologiques des maladies endémiques permettra aux professionnels de la santé humaine et animale de détecter plus rapidement la présence de menaces émergentes.

Los autores proceden aquí a: a) relacionar los métodos empleados para diagnosticar enfermedades zoonóticas en personas y animales; b) señalar las diferencias que existen entre los distintos planteamientos de diagnóstico según la especie de que se trate, comentando asimismo las ventajas que podrían derivarse de la interpretación simultánea de los datos de los sistemas de vigilancia sanitaria y de los de vigilancia zoosanitaria; y c) reiterar la importancia que reviste el uso de pruebas de diagnóstico no solo validadas, sino también adaptadas específicamente a cada especie, para las labores de vigilancia y estudio de brotes. Lo más probable es que a corto y medio plazo las enfermedades zoonóticas, ya sean emergentes o endémicas, sigan constituyendo una amenaza para la salud mundial. Gracias a numerosos ejemplos del pasado reciente se ha ido constituyendo un buen conocimiento de los factores que propician la aparición de enfermedades infecciosas. Para disponer de un eficaz sistema de vigilancia de enfermedades endémicas hay una serie de requisitos previos indispensables: utilización compartida de los recursos de diagnóstico entre los sectores de la salud humana y la sanidad animal; intercambio de los datos de vigilancia sanitaria y de vigilancia zoosanitaria; adquisición de competencias para interpretar esos datos; y buen conocimiento de las cuestiones ligadas a la validación de pruebas de diagnóstico y a la interpretación de los datos que arrojan. Si los profesionales de la salud humana y la sanidad animal conocen debidamente los patrones epidemiológicos de las enfermedades endémicas, estarán en condiciones de detectar con más celeridad la presencia de enfermedades emergentes que constituyan una amenaza.

Breaking the mould: achieving high-volume production output with additive manufacturing

Purpose: The study aims to examine a discrepant industrial case that demonstrates how to achieve economies of scale with additive manufacturing (AM), thereby expanding the scope of AM beyond high-variety, customised production contexts. Design/methodology/approach: Abductive reasoning is applied to analyse a case of using AM to compete with conventional production, winning a contract to supply 7,700,000 products. Comparing this case to existing theories and contemporary practices reveals new research directions and practical insights. Findings: Economies of scale were realised through a combination of technological innovation and the adoption of operations management practices atypical of AM shops (e.g. design for volume, low-cost resource deployment and material flow optimisation). The former improved AM process parameters in terms of time, cost and dependability;the latter improved the entire manufacturing system, including non-AM operations/resources. This system-wide improvement has been largely overlooked in the literature, where AM is typically viewed as a disruptive technology that simplifies manufacturing processes and shortens supply chains. Originality/value: It is empirically shown that an AM shop can achieve economies of scale and compete with conventional manufacturing in high-volume, standardised production contexts. © 2021, Emerald Publishing Limited.

Display technology responds to covid-19 challenges

We demonstrate the use of Nitride semiconductors as the light emitting layer in a series of devices, from Visible emitting LEDs, to far-UVC LEDs and novel light emitting devices. © 2021 SID.

CROI 2021: Summary of Basic Science Research in HIV and SARS-CoV-2

The Conference on Retroviruses and Opportunistic Infections (CROI) serves as one of the most highly visible platforms upon which researchers gather to share the most recent findings on HIV/AIDS and, recently, on SARS-CoV-2 research. Research presentations on the novel coronavirus SARS-CoV-2 have become an increasing fixture at the conference since it was first covered at last year's conference. Although CROI 2021 was virtual, the organizers coordinated a seamless platform for presentations and poster sessions that effectively engaged the audience. CROI 2021 had a strong showing in terms of basic science presentations on HIV-1 and on SARS-CoV-2. Highlights included new insights into some of the more elusive steps in the viral replication cycle as well as new findings on immune escape strategies employed by SARS-CoV-2. The new investigator workshop has become a valuable resource that can be used by early stage and established investigators alike to receive state-of-the-art updates on research areas that might be outside their immediate areas of research. The new investigator workshop featured engaging presentations on novel aspects of HIV-1 and SARS-CoV-2 replication, impact of host immunity on HIV-1 and SARS-CoV-2, and approaches to assessing viral reservoir dynamics and strategies for viral reservoir elimination.

Modified operations to permit safe and timely delivery of essential surgical care for high-risk skin cancer during a pandemic

Background: Many surgical practices closed at the onset of the COVID-19 pandemic raising concerns that delayed cancer care might impact patient outcomes. We implemented operational changes to safely remain open and treat tumors with potential to threaten life or function. We studied the impact of these changes on safety, access, and treatment. Methods: A single-center retrospective study was conducted in an academic office-based dermatologic surgery practice. All patients consented to research. 'Pre-pandemic' (Nov. 2019 - March 21, 2020) consultations served as controls. Consultations during the 'pause' (March 22 - June 8, 2020) and 'reopening' (June 9 - Sept. 30, 2020) were evaluated for time to treatment, tumor area, and upstaging. One-way ANOVA or Fisher Exact analyses were performed with P < 0.05 significant. Operational changes included (1) modified scheduling, staffing, and rooming;(2) COVID-19 symptom screening;(3) N95 masks and shields for patient contact;(4) triage by tumor acuity;(5) same day or video consultation;and (6) increased utilization of same day biopsy and surgery for suspicious lesions. Results: Data from 698 patients (23-103 yrs of age, avg 71 yrs) yielded 876 tumors treated by Mohs surgery (n = 776), standard excision (n = 73), staged excision (n = 14) or electrodessication and curettage (n = 13). The average time from biopsy or consultation to treatment was faster during the pause and reopening relative to prepandemic (Table). More frozen section diagnostic biopsies were performed in the pause (n = 6) and reopening (n = 4) compared to pre-pandemic (n = 0). Post-operative defects were similar to prepandemic sizes (3.2 cm2 ) during the pause (3.9 cm2 ) and reopening (3.2 cm2 ) (p = 0.72). A reduction in treatment of basal cell carcinoma (BCC, X2 = 0.04) and shift toward treatment of higher risk tumors such as cutaneous squamous cell carcinoma (SCC, 49% of tumors during pause vs 37% pre-pandemic) and melanoma (11% pause vs 4.7% pre-pandemic) was noted. The percentage of SCC upstaged after treatment increased during the pause (42%, X2 = 0.02) vs pre-pandemic (18.5%) or reopening (17.4%). Conclusions: Time to treatment, tumor size, and SCC upstaging prepandemic and during the reopening fail to identify any significant access interruptions. This likely reflects practice modifications of increased same day surgery, frozen section diagnostic biopsy, and tumor triage. Lack of COVID-19 transmission attributable to maintained operations suggests that essential surgical care can be delivered safely to patients with high-risk skin cancers during a pandemic.

Phase 1 trial of anti-CD22 recombinant immunotoxin moxetumomab pasudotox combined with rituximab for relapsed/refractory hairy cell leukemia

Background: Anti-CD22 recombinant immunotoxin moxetumomab pasudotox (Moxe) is FDA-approved for hairy cell leukemia (HCL) patients who have received at least two prior systemic therapies including a purine nucleoside analog. In phase 3 testing the complete remission (CR) rate was 41%, and response was higher in patients with lower tumor burden and lower titers of antidrug antibodies (ADA). Phase 1 testing indicated that most CRs were without minimal residual disease (MRD) and eradication of MRD was associated with prolonged CR duration. Monoclonal antibody (Mab) rituximab binds to CD20 on HCL cells and induces apoptosis or immune-mediated killing, but as a single-agent achieved only 13% CRs in relapsed HCL requiring therapy. In a phase 1 trial to determine safety, rituximab was combined with Moxe, with the goal to help reduce tumor burden and to prevent or delay ADA by killing normal B-cells. Methods: To allow rituximab sufficient time to accomplish both goals, it was infused 3 days before day 1 of cycle 1 at 375 mg/m2 , and Moxe was given by 30-minute infusion on days 1, 3 and 5. On repeat cycles of Moxe days 1, 3 and 5, rituximab was given on day 1. Cycles were generally spaced 4 weeks apart. Moxe was begun at a lower dose, 30 rather than the 40 mcg/kg dose used in phase 3 in case the rituximab would increase its toxicity. Bone marrow aspirate flow cytometry, which can detect 0.002% HCL cells, was the most sensitive test used for MRD detection, much more sensitive than BRAF V600E digital droplet PCR (ddPCR) or bone marrow biopsy immunohistochemistry (IHC). Patients could receive 4 cycles past MRD-free CR, but not more than 8 cycles. Results: Three patients received Moxe at 30 mcg/Kg/dose and 6 received 40 mcg/Kg/dose, all without dose limiting toxicity (DLT). There was no evidence of hemolytic uremic syndrome or capillary leak syndrome. To prevent intravascular hypovolemia due to expected third spacing, patients were encouraged to drink one cup per hour of water or other fluid from days 1 to 8 and take dexamethasone 4 mg orally if headache or nausea prevented good oral hydration. Of the 9 patients, 7 (78%) achieved CR after 2 (n = 6) or 3 (n = 1) cycles, and achieved MRD-free CR after 2 (n = 3), 4 (n = 3) or 6 (n = 1) cycles. No patients became infected with COVID-19. Conclusions: This phase 1 trial met its primary endpoint of determining whether rituximab could be safely combined with Moxe and will enroll 4 additional patients to further access clinical activity. Further testing will determine whether addition of a CD20 Mab to Moxe significantly improves clinical outcome compared to Moxe alone, particularly long-term MRD-free CR rate.

Hidden in plain sight: the bystander effect and the mobilisation of modern slavery whistleblowing

Purpose: The purpose of this study is to provide new insight into the modern slavery threat and to enhance its detection in supply chains by understanding and addressing barriers to whistleblowing. A broad definition of a whistle-blower is adopted, which includes any witness internal or external to an organisation. Design/methodology/approach: This is a viewpoint paper that includes using news reports and other secondary data sources on a recent modern slavery scandal in garment factories in Leicester, UK and the lens of the bystander effect from the social psychology literature. The core focus is on whistleblowing by members of the local community in which an operation or supply chain is embedded. Findings: The phenomenon of modern slavery being an “open secret” within the local community is highlighted. But rather than the case being characterised by widespread whistleblowing, the problem only came into full focus when poor working conditions and forced labour during COVID-19 lockdown restrictions contributed to the spread of the virus. It is argued that overcoming this “bystander effect” can lead to the greater mobilisation of modern slavery whistleblowing. Research limitations/implications: Two sets of propositions and a conceptual model are provided and seven future research suggestions are outlined, including extending the present study to whistleblowing by victims and other internal members of an organisation or supply chain. Practical implications: If it can be mobilised, then whistleblowing has the potential to be an important part of detecting modern slavery, either temporarily replacing audits where they are not possible due to social distancing restrictions or directing the use of limited auditing resources to high-risk factories. In this way, combinations of practices can be effectively used to tackle the threat. Social implications: This contributes to addressing an important societal problem and one of the grandest challenges facing modern-day supply chains. This, it has been argued, is an even bigger problem now than ever before given the economic and market conditions created by the COVID-19 global pandemic. Originality/value: This is the first paper to focus on operationalising the practice of whistleblowing as a source of greater supply chain intelligence to aid modern slavery detection. Causes of the bystander effect include the perceived low-emergency threat of modern slavery, the high-ambiguity environment, a low bystander responsibility and low assistance/intervention incentive. Countermeasures include elevating the emergency status of modern slavery, creating a shared sense of responsibility for tackling the problem, having clear reporting channels and taking swift and consistent action when instances of modern slavery are detected. © 2021, Emerald Publishing Limited.