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Background: The COVID-19 pandemic has had a significant effect on healthcare services, particularly affecting patients who suffer from chronic conditions. However, the pandemic's effect on endometriosis surgery is not yet known. Objectives: To determine the impact of the COVID-19 pandemic on surgery for severe endometriosis in the UK at a national, regional and centre-level. Materials and Methods: The British Society for Gynaecological Endoscopy (BSGE) collects data nationally on all operations for severe endometriosis which involve dissection of the pararectal space. Annual audits of this database were obtained from the BSGE. Publicly available data on COVID-19 cases and population were obtained from the UK Office for National Statistics. Main outcome measures: Numbers of annual BSGE-registered endometriosis operations. Results: A total of 8204 operations were performed. The number of operations decreased by 49.4% between 2019 and 2020 and then increased in 2021, but remained 10.5% below average pre-pandemic levels, indicating at least 980 missed operations between 2019-2020. Median operations per centre decreased by 51.0% in 2020 (IQR 29.4% - 75.0%) and increased in 2021 but remained 33% below pre-pandemic levels. There was no change in the type of surgery performed. All 11 administrative regions of Great Britain had reduced numbers of operations in 2020 compared with the average for 2017-2019, with a median 44.2% decrease (range 13.3% - 67.5%). Regional reduction in operations was correlated with COVID-19 infection rates (r=0.54, 95% CI of r 0.022 - 1.00, p=0.043). Conclusion: The number of operations performed annually in the UK for severe endometriosis fell dramatically during the COVID-19 pandemic and is yet to normalise. What's new?: This study shows the dramatic effect that the COVID-19 pandemic has had on UK services for endometriosis surgery, which may continue to affect patients and clinicians for a considerable time to come.
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Context: Patients with hematologic malignancies have an increased risk of SARS-CoV-2 infection, severe COVID-19, and higher mortality rates. Objective(s): We investigated the immunological response to SARS-CoV-2 after infection and/or vaccination and explored the impact of treatment response on antibody levels. Design(s): We added a cohort of CML patients to the ongoing study SPARTA. We collected saliva and peripheral blood to measure levels of SARS-CoV-2 antigen and antibodies. Result(s): From 10-1-2021 to 3-31-2022, we prospectively enrolled 69 participants (32 with CML, 37 non-cancer) with similar sociodemographic characteristics. There was a significant difference in the frequency of previous SARS-CoV-2 infections, where the control group had a higher percentage of patients previously diagnosed with COVID-19 (18.8% vs. 84%). Nevertheless, there was no difference in the detection of SARS-CoV-2 at the time of enrollment (0% vs. 5.6%). SARS-CoV-2 antibodies, either IgG or neutralizing (nAB), were detected in most of the participants regardless of cancer status (IgG, 84.4% in the CML cohort and 91.7% in the non-cancer cohort;nAB, 84.4% vs. 88.9%). The two groups had comparable IgG (mean 160.8 vs. 157.5 Ru/mL) and nAB (mean 1,473 vs. 1,509 ng/ml) levels. Overall, IgG and nAB levels were significantly higher in subjects who received the last vaccine dose within 6 months compared to those who received it >=6 months previously (IgG, CML, mean 177.7 vs. 113.2, control 190.5 vs. 134.4;nAB, CML 1,784 vs. 951.9, control 2,066 vs. 1,335). Both groups had comparable mean antibody levels according to the time since the last dose (IgG, <=6 months, 177.7 vs. 190.5, >=6 months, 113.2 vs. 134.4;nAB, <=6 months, 1,784 vs. 2,066, >=6 months 951.9 vs. 1,335). There was no difference in the detection and levels of antibodies according to therapy with TKIs (IgG, mean 158.8 vs. 185.2;nAB, 1,515 vs. 1,883) or achieving MMR (IgG, mean 152.4 vs. 177.5;nAB, 1,447 vs. 1,686). Conclusion(s): The immunological response to SARS-CoV-2 among CML patients is comparable to that in non-CML subjects. TKI therapy and the response to treatment did not impact the development of antibodies. Moreover, antibody levels decreased over time, with the most significant drop after 6 months since the last immunization dose. Copyright © 2022 Elsevier Inc.
ABSTRACT
Background: The rapid spread of SARS-CoV-2 has elicited an equally rapid development of effective vaccines, leading to a reduction of COVID-19 severity and deaths. There is limited data on COVID-19- related immunity in chronic myeloid leukemia (CML) patients. Methods: SPARTA (SARS2 SeroPrevalence And Respiratory Tract Assessment) is an ongoing observational study for participants age ≥18 years to investigate immunity to SARS-CoV-2 after infection and/or vaccination. We included patients with CML and compared them with a non-cancer group. We collected saliva and peripheral blood to measure antigen levels by RT-PCR and antibodies (secretory IgG antibodies and neutralizing antibodies). Results: From October 1, 2021, to February 4, 2022, we prospectively enrolled 49 participants (23 CML, 26 non-cancer). Most were male (56.5%) in the CML group and female in the control group (61.5%), mean age 56.39 y vs. 51.96 y, respectively, and self-identified as white (87% vs. 76.9%). In the CML group, 11 (47.8%) had ≥1 comorbidities, vs 13 (50%) in the control group. Twenty-one (91.3%) CML patients were receiving tyrosine-kinase inhibitors;4 (18.2%) non-cancer subjects reported taking any medication. Most participants in both groups had received at least one dose of COVID- 19 vaccine (73.9% vs. 73.1%);100% of CML patients received two doses vs. 84.2% of controls;the CML group had a higher percentage of subjects fully vaccinated (66.7% vs. 25%). The CML group had a lower percentage of patients previously diagnosed with COVID-19 (8.8% vs. 57.7%). However, there was no difference in the detection of SARS-CoV-2 antigen at the time of enrollment (0% vs. 4%). SARS-CoV-2 IgG antibodies were detected in most of the participants regardless of cancer status (78.3% in the CML cohort and 88% in the non-cancer cohort), and neutralizing antibodies were detected in 82.6% and 95.6%, respectively. The two groups had comparable IgG (mean 146.3 Ru/ml vs. 148.9 Ru/ml) and neutralizing (mean 1329.1 ng/ml vs. 1112 ng/ml) antibody levels. Conclusions: Our preliminary data comparing concomitant cohorts with similar socio-demographic characteristics and medical history indicate that a diagnosis of CML did not impact the development of antibodies against SARS-CoV-2. We are conducting continuous analysis of antibodies levels over time to assess the evolution of antibody immunity and functional studies including cellular immunity assessments.
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Purpose: The study aims to investigate the consumers' behavioral intention toward green hotels. The tendency of individuals to afford green hotels is further escalating with progressing coronavirus disease-2019 (COVID-19) pandemic recurring waves. The increased worry of consumers toward health, hygiene and the climate is acquiring momentum and transforming how consumers traditionally perceive green hotels. Design/methodology/approach: The study has recommended an integrated framework incorporating various research fields as attitude-behavior-context theory, theory of planned behavior (TPB) and moderating influences to study the associations among the antecedents of consumers' behavioral intention toward green hotels. The study comprised the participation of 536 respondents residing in the Delhi and National Capital Region (NCR) of India. The data analysis strategy involved the use of structural equation modeling (SEM) analysis to test the proposed research framework. Findings: The results and findings of the study indicated a significant influence of fear and uncertainty of the COVID-19 pandemic and environmental concern on green trust. The results also revealed the considerable impact of green trust on willingness to pay premium, attitude and subjective norms, which significantly influenced behavioral intention. The analysis also revealed the moderating influence of environmental concern in the relationship of green trust and behavioral intention. Research limitations/implications: The study has recommended significant theoretical. The theorists may use this research framework to analyze better the transforming consumer behavior trends toward green hotels in the ongoing fearful and uncertain COVID-19 pandemic scenario. Practical implications: The study has recommended significant managerial implications. The industry practitioners may also utilize the framework to sustain the hotel business and bring new strategic insights into practice to combat the impact of the pandemic and simultaneously win consumers' trust in green hotels. Originality/value: Although the researchers have previously emphasized consumers' intention toward green practices embraced by hotels, the impact of the COVID-19 pandemic on the green hotel industry gained noticeable attention from researchers. Furthermore, there is a scarcity of literature providing insights on the behavioral dynamism of hotel customers' trust, attitude and willingness to pay for green hotels during the repetitive waves of the COVID-19 pandemic. The study will support the existing literature gap by enlightening the associations among the various antecedents of green hotels' behavioral intention, COVID-19 and environmental concern. © 2022, Rajiv Kumar Dwivedi, Manoj Pandey, Anil Vashisht, Devendra Kumar Pandey and Dharmendra Kumar.
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Objectives: The SARS-Cov-2 pandemic has resulted in more than 130,000 deaths. Factors like old age and presence of comorbid conditions have been hypothesized to increase likelihood of mortality. In this study, the Apriori data mining technique was used to identify combinations of patient variables associated with either mortality or survival. Understanding combinations of key risk factors may help practitioners classify patients as high or low risk for mortality. Methods: This is a retrospective data analysis using records of patients with COVID-19 diagnoses in the Premier Healthcare Database, from September 2019 to May 2020. Patients were characterized by comorbidities (Elixhauser and Charlson), demographics, provider characteristics, diagnoses and symptoms at time of admission and treatments during admission. Association rules were generated using Apriori algorithm keeping minimum support and minimum confidence as 0.004 and 0.65 respectively for outcome of mortality, and 0.10 and 0.95 for outcome of survival. Results: A total of 39 rules of factors predicted an increase in mortality by 5.87 times (average lift). Elderly patients (age greater than 65 years) who had a ventilator usage of more than 96 hours had the greatest mortality risk. Along with a COVID-19 diagnosis, they were also observed to have hypertension, fluid and electrolyte disorders, renal and congestive heart failure as comorbid conditions, with mostly Elixhauser Index of 5 or above. For survival, 132 rules were generated, all rules had a lift > 1 with an average of 1.08. Age groups less than 64 years, female and Elixhauser less than 3 were included in the algorithm. Diagnoses of “fever” and “cough” were also observed in the survival cohort. Conclusions: The Apriori algorithm, first developed to evaluate association rules in retail and other industry, may have significant applications in understanding concurrent risks for COVID-19 and tailor preventive measures and care specifically to patients with greater risk factors.