ABSTRACT
IntroductionPulmonary rehabilitation (PR) is at the forefront of the NHS long term plan, due to its ability to improve quality of life, functional capacity, admission prevention, and self-efficacy in patients with long term respiratory conditions. Virtual PR (VPR) has been found to be feasible and has accelerated in use over the course of the covid-19 pandemic with face to face (F2F) PR capacity reducing due to loss of venues, shielding, and increasing demand. VPR can increase patient choice, accessibility, and reach patients groups that may not engage in traditional F2FPR.We looked at the feasibility and implementation of a centralised VPR service across an integrated care system (ICS), spanning a large geographical area, and multiple pulmonary rehab systems.Many boroughs within the ICS were running their own VPR service. It was decided that centralising the service would increase patient choice by offering a greater variety of class days and times, but also increase clinical capacity for services to restart F2F services.MethodsA host site was agreed, which then recruited one physiotherapist and two B4 therapy assistants to run VPR for the whole ICS. The referral process to the host site was agreed and a pilot trialled with one borough referring in, to identify any barriers prior to opening the referral pathway to the rest of the ICS. Barriers identified were information governance, reporting of outcome measures (including NACAP), and establishment of responsibility for the patient.ResultsHere we present preliminary data from the initial 3 months after service launch.At the time of writing, 35 referrals have been received from 4 out of the 6 boroughs. Of the 35 referrals;8 chose not to start the course, 3 enrolled but failed to complete the course, and 4 have completed. The remainder are in class or have their start date booked.ConclusionsWe have shown that operationally, a centralised VPR service is feasible to run across a large geographical area with multiple different PR services. Further analysis should target how the service has impacted staffing capacities and wait times across the network, and uptake amongst underrepresented groups.
ABSTRACT
The pedagogy of a first-year engineering course in manufacturing is presented. This course entitled Manufacturing and Society involves collaboration with social science, is based on industrial robots as the central theme to attract students’ interests and utilizes the flipped classroom approach for delivery. We hypothesize that, in one semester, recent high school graduates will be able to gain knowledge in manufacturing by learning the computer-aided engineering (CAD) software, applying CAD to design a penholder, fabricating the penholder using additive manufacturing and computer-aided manufacturing (CAM) software, programming the robot to create a toolpath for the pen, drawing using the pen on the penholder guided by a robot, and elaborating on impacts of robotic painting on society from a social science perspective. This course is designed to give students, regardless of their intended major in engineering, broad knowledge in manufacturing via 10 engineering, 3 social science, and 10 technical communication lectures;8 labs;and 4 projects. The social science lectures and discussions focus on how knowledge about society can be used to inform design and manufacturing decisions, social science research methods for understanding how engineers and technology can impact people's lives, and changing trends in work, the workplace, and the future workforce as it relates to manufacturing. This course aimed to give undergraduate first-year engineering students a positive view of advanced manufacturing and its impact on society. Student evaluations and comments were positive and affirmed the learning objective of teaching manufacturing to the first-year engineering students. The flipped classroom approach was demonstrated to be ideal during the COVID-19 pandemic with limited capacity for in-person lectures and labs. The use of flipped classrooms allowed students to learn at their own pace, review and reinforce knowledge, have a closer interaction with instructors, and reduce the number of technical errors using simulation tools. This course with the support of flipped classroom pedagogy can be successfully implemented in the post-pandemic era, devoting the time of the class to answer questions, expand upon the class content and have a closer in-person interaction with students. © 2022
ABSTRACT
Background: Infectious complications are a major cause of morbidity and mortality in Chronic Lymphocytic Leukaemia (CLL). Therapeutic approaches that deplete CLL cells also affect normal B-cells. Optimal treatment would result in eradication of CLL cells and recovery of normal immune function. FLAIR (ISRCTN01844152) is a phase III trial for previously untreated CLL comparing ibrutinib plus rituximab (IR) with fludarabine, cyclophosphamide and rituximab (FCR) and subsequently amended to also compare ibrutinib plus venetoclax (I+V) and ibrutinib alone (I) with FCR. Measurable residual disease (MRD) and normal B-cell levels were assessed at multiple timepoints. Aims: To assess the depletion of normal B-cells during treatment and recovery after end of treatment. Methods: Participants aged under 75 years with <20% TP53-deleted cells were initially randomised to FCR or IR and subsequently to FCR, IR, I+V or I with the IR arm closed after randomisation of 771 participants to FCR/IR. FCR was given for 6 cycles, while treatment in the IR, I and I+V arms continued for up to 6 years except in participants attaining <0.01% MRD who continued treatment for the time taken to achieved MRD <0.01% and then stopped if MRD remained <0.01%. Month (M) 24 was earliest permitted stopping point. MRD flow cytometry was performed according to ERIC guidelines (panel: CD19/5/20/43/79/81+ROR1, acquisition of 0.5-2.2 million cells, BD Biosciences Lyric). Additional analysis of normal B-cell subsets was performed in a cohort of >500 patients (panel: CD19 to identify B-cells, CD20/5/79b+ROR1 and CD3 to exclude CLL & contaminating cells, with CD27/ 38/IgD/IgM to characterise normal B-cell subsets using a Coulter Cytoflex LX). Results: Normal B-cells were undetectable during FCR treatment and only rarely detectable until 12 months after last FCR cycle. Circulating normal B-cells were reduced in number or undetectable in participants receiving ibrutinibcontaining regimens with greater depletion in the I+V and IR arms relative to I monotherapy. B-progenitors persist through FCR treatment but were depleted during I, I+R or I+V treatment. Normal B-cell levels at 24 and 36 months after randomisation, with time off-treatment if applicable, are shown in Figure 1. In the ibrutinib-containing arms (IR, I, and I+V), there was a trend towards fewer COVID-associated SAE at any time point for participants with detectable B-cells at 24M (4/181, 2.2%) compared to those with no detectable B-cells (14/344, 4.1%) and COVID-associated SAEs were not observed in FCR-treated participants who had recovered any level of normal B-cells by 24M (0/215). However, the data on COVID infections are limited and there was no apparent association between normal B-cell levels at 24M with the proportion of participants experiencing an infectious SAE overall. Assessment of normal B-cell subsets during ibrutinib-based treatment demonstrated a mix of naïve and memory B-cells. Serological response to COVID infection/vaccination in this cohort is currently being performed. Participants stopping I+V treatment at 24-30 months post-randomisation due to MRD eradication showed rapid recovery of normal naive B-cells within 6-12 months after end of treatment in the vast majority (>95%) of evaluable cases. Summary/Conclusion: Normal circulating B-cells are depleted during treatment with rituximab but can persist at a low level during I, IR or I+V treatment. Most patients in remission after treatment with FCR or I+V show recovery of normal B-cells at 12 months of stopping treatment.
ABSTRACT
Public sector administrative data has long been a powerful - if under-utilised - tool to help manage our society, economy and public services on the basis of lived experience. The Covid-19 pandemic only emphasises the need for timely access to the UK’s existing wealth of public sector data, to ensure the way we live and work, and our responses in times of crisis, are driven by the most comprehensive evidence available to us. For a thorough understanding of the impacts of Covid-19 on productivity, access to administrative data for research is nothing essential. © Philip McCann and Tim Vorley 2021.