Graduating in uncertain times: The impact of COVID-19 on recent graduate career prospects, trajectories and outcomes

This article examines the impacts of the COVID-19 pandemic on recent UK graduates' initial employment outcomes and how they experience the transition into a challenging labour market context. We draw on longitudinal survey and interview data, collected from recent graduates who had mainly graduated during the onset of the COVID-19 pandemic in summer 2020 that examines graduate perception of the labour market, impacts on labour market entry impacts and early career progression and effects of periods of unemployment or under-employment. The article shows some of the main impacts of the recent pandemic-affected labour market, including: widespread concerns about job opportunities and employer support, the perceived employment impacts of the pandemic and early signs of scarring and labour market disorientation amongst those who were struggling to find employment of their choice. Such experiences are clearly intensified during the specific COVID-19 context, but the policy implications they raise have wider relevance for supporting graduates during future periods of labour market volatility.

Honorable Mention: Associated Professional Comparing In-Person and Remote Substance Use Treatment Outcomes Before and During COVID-19

Introduction: Individuals with substance use disorders (SUDs) have borne a disproportionate burden of the physical and psychosocial consequences of the Covid-19 pandemic (1,2). Amid repeated lockdowns and mandates for reduced in-person contact, substance use services across the United States have responded to the rising need for treatment by providing services remotely (3). This transition to telehealth services has presented an unprecedented opportunity to evaluate the effectiveness of hybrid (largely remote) services on patient outcomes (3), such as quality of life (4). To date, research on the provision of remote services for SUDs has been preliminary and limited (3). Objective(s): To compare changes in multiple domains of quality of life (QOL) between new admissions before the Covid-19 Pandemic (2019), who received only in-person services, versus new admissions during the Pandemic (2020), who received predominately remote services. These comparisons will help assess whether patient outcomes were comparable across treatment modalities. Method(s): To compare baseline and 3-month Quality of Life Enjoyment and Satisfaction5 (Q-LES-Q-SF) data during in-person (prepandemic, n = 298) and largely remote (pandemic, n = 316) services using a mixed repeated measures ANOVA. The present sample was drawn from four substance use clinics and one methadone clinic in New York state. All clinics transitioned from exclusively in-person to remote services. The methadone clinic continued to administer methadone in person (although patients did not attend in-person often), and all other services for all five clinics (e.g., individual and group therapy, psychiatric services) transitioned to being provided on telehealth platforms (e.g., Zoom) in the Spring of 2020. Result(s): Both modalities were associated with similar QOL improvements. Analysis of the effect of condition (remote/in-person) on changes in QOL from admission to 3 months revealed a significant main effect of time (admission vs. 3-month follow-up), F(1, 612) = 90.82, P < 0.001. From admission, M = 50.10, 95% CI [49.33-50.96], to 3 months later, M = 53.58, 95% CI [52.85-54.31], Total self-reported QOL significantly improved. There was no main effect of condition (remote vs. in-person), F(1, 612) = 0.433, P = 0.51. There was no interaction effect F(1, 612) = 0.213, P = 0.65. Given that no differences emerged between the in-person and remote groups, the groups were collapsed and the individual items that comprised the Q-LES-Q-SF total score were evaluated utilizing paired samples t-tests to assess changes in sub-types of QOL. All domains of QOL (e.g., satisfaction with family functioning, mood) significantly improved at the P < 0.0001 level. Conclusion(s): Both modalities appear equally effective in improving overall quality of life, as well as the individual domains that comprise this total score. Scientific significance: Remote substance use treatment that includes evidence-based individual and group therapy delivered via telehealth platforms and limited, as-needed, in-person treatment (e.g., methadone administration) appears to be an effective and accessible option for this vulnerable, high needs, population.

CURRENT BARRIERS TO PATIENTS PROCEEDING WITH DIAGNOSTIC TESTS IN THE ENGLISH BOWEL CANCER SCREENING PROGRAMME

Introduction Uptake rates and pathology detection has increased significantly with integration of faecal immunochemical testing (FIT) in the English Bowel Cancer Screening Programme (BCSP). However a proportion of patients do not uptake diagnostic tests after positive FIT tests. We compared pre and peri-COVID cohorts to identify current barriers to uptake of diagnostic tests within a single, large BCSP centre. Methods Two patient cohorts were analysed from the Wolverhampton BCSP Centre (September 2019-February 2020 (Group A, pre-Covid) and April-July 2021 (Group B, peri- Covid)). Patients with a positive FIT were assessed by either a face-to-face (F2F) consultation (Group A) or a telephone consultation (TC) (Group B) by a specialist screening practitioner (SSP) and offered information and diagnostic tests. Total overall numbers were recorded and cases not proceeding with diagnostic tests reviewed. Statistical analysis utilised Fisher's exact test where appropriate. Results In group A, 26293/42545 (61.8%) patients returned a FIT test compared with, 30214/45538 (66.3%) in group B (p<0.00001) with similar positivity rates (2.1% (A) vs. 2.2% (B), p=NS). The peri-COVID era shows an increase in patients not proceeding with diagnostic tests after positive FIT tests (Group A 90/633 (14.2%) Vs. Group B 144/655 (22%), p=0.0003). Table 1 expands the reasons for this. Conclusion FIT sample return rates have increased in the peri- COVID era but proportions of patients not proceeding with diagnostic investigations following positive FIT testing have risen. Patient choice is a notable barrier to uptake and other barriers which have significantly increased during this current period are patients being assessed as clinically unsuitable due to health reasons, declining initial telephone appointments and DNA tests. Whilst informed patient choice is key in national screening programmes, cancer and polyp detection in FIT positive patients in BCSP are notable. Understanding patient's perspectives on tests, preferences over TC or F2F and SSP education on health assessment for colonoscopy may improve uptake of diagnostic tests within the BCSP.

Development of a point-of-care mortality risk score for hospitalized COVID-19 patients

Rationale: While several COVID-19-specific mortality risk scores exist, they lack the ease of use given their dependence on online calculators and algorithms. Objectives: The objectives of this study were (1) to design, validate, and calibrate a simple, easy-to-use mortality risk score in a hospitalized COVID-19 population. Methods: Multi-hospital health system in New York City. Patients (n=4840) with laboratory-confirmed SARS-CoV2 infection who were admitted between March 1 and April 28, 2020. Gray's K-sample test for the cumulative incidence of a competing risk was used to assess and rank 48 different variables' associations with mortality. Candidate variables were added to the composite score using DeLong's test to evaluate their effect on predictive performance (AUC) of in-hospital mortality. Final AUCs for the new score, SOFA, qSOFA, and CURB-65 were assessed on an independent test set. Results: Of 48 variables investigated, 36 (75%) displayed significant (p<0.05 by Gray's test) associations with mortality. The variables selected for the final score were (1) oxygen support level, (2) troponin, (3) blood urea nitrogen, (4) lymphocyte percentage, (5) Glasgow Coma Score, and (6) age. The new score, COBALT, outperforms SOFA, qSOFA, and CURB-65 at predicting mortality in this COVID-19 population: AUCs for initial, maximum, and mean COBALT scores were 0.81, 0.91, and 0.92, compared to 0.77, 0.87, and 0.87 for SOFA. Conclusions: The COBALT score provides a point-of-care tool to estimate mortality in hospitalized COVID-19 patients with superior performance to SOFA and other scores currently in widespread use.

Cardiovascular disease and severe hypoxemia are associated with higher rates of non-invasive respiratory support failure in COVID-19 pneumonia

RATIONALE Acute hypoxemic respiratory failure (AHRF) is the major complication of coronavirus disease 2019 (COVID-19), yet optimal respiratory support strategies are uncertain. We aimed to describe outcomes with highflow oxygen delivered through nasal cannula (HFNC) and non-invasive positive pressure ventilation (NIPPV) in COVID-19 AHRF and identify individual factors associated with non-invasive respiratory support failure. METHODS We conducted a retrospective cohort study of hospitalized adults with COVID-19 within a large academic health system in New York City early in the pandemic to describe outcomes with HFNC and NIPPV. Patients were categorized into the HFNC cohort if they received HFNC but not NIPPV, whereas the NIPPV cohort included patients who received NIPPV with or without HFNC. We described rates of HFNC and NIPPV success, defined as live discharge without endotracheal intubation (ETI). Further, using Fine-Gray sub-distribution hazard models, we identified demographic and patient characteristics associated with HFNC and NIPPV failure, defined as the need for ETI and/or in-hospital mortality. RESULTS Of the 331 patients in the HFNC cohort, 154 (46.5%) patients were successfully discharged without requiring ETI. Of the 177 (53.5%) who experienced HFNC failure, 100 (56.5%) required ETI and 135 (76.3%) patients ultimately died. Among the 747 patients in the NIPPV cohort, 167 (22.4%) patients were successfully discharged without requiring ETI, and 8 (1.1%) were censored. Of the 572 (76.6%) patients who failed NIPPV, 338 (59.1%) required ETI and 497 (86.9%) ultimately died. In adjusted models, significantly increased risk of HFNC and NIPPV failure was observed among patients with co-morbid cardiovascular disease (sub-distribution hazard ratio (sHR) 1.82;95% confidence interval (CI), 1.17-2.83 and sHR 1.40;95% CI 1.06-1.84, respectively). Conversely, a higher oxygen saturation to fraction of inspired oxygen ratio (SpO2/FiO2) at HFNC and NIPPV initiation was associated with reduced risk of failure (sHR, 0.32;95% CI 0.19-0.54, and sHR 0.34;95% CI 0.21-0.55, respectively). CONCLUSIONS A subset of patients with COVID-19 AHRF was effectively managed with non-invasive respiratory modalities and achieved successful hospital discharge without requiring ETI. Notably, patients with co-morbid cardiovascular disease and more severe hypoxemia experienced lower success rates with both HFNC and NIPPV. Identification of specific patient factors may help inform more selective use of non-invasive respiratory strategies, and allow for a more personalized approach to the management of COVID-19 AHRF in pandemic settings.