Essential fatty acid and lipoprotein status in pediatric cystic fibrosis: Impact of cystic fibrosis transmembrane conductance regulator modulators

Background: Dyslipidemias and essential fatty acid deficiencies (EFADs) are well established complications of cystic fibrosis (CF). In the general population, a diet high in saturated fat is associated with hyperlipidemia and greater risk of cardiovascular disease and type 2 diabetes. Increasing life expectancy in CF brings concern about the risks of the "legacy" high-fat CF diet. The impact of CFTR modulators on CF-related dyslipidemia and EFAD is not known. Previous studies reported dyslipidemia in people with CF (PwCF) using traditional lipid measures. This study aimed to evaluate the lipoprotein and fatty acid profiles in children and adolescents with CF and to correlate biochemical results with clinical and molecular findings. Plasma and red blood cell (RBC) samples were studied to compare the ability of each method to identify EFAD markers. Method(s): Blood samples (n = 171) were obtained from 142 (78 female) children with CF aged 9.8 +/- 4.7 (range 4 months to 18 years) during routine laboratory draws at pediatric CF center clinic visits. Pancreatic insufficiency was present in 92% and glucose intolerance or diabetes in 14%. Body mass index percentile (BMI%ile) for age z-scorewas 0.23 +/- 0.89 (range -2.4-2.6). F508del mutation was homozygous for 56% and heterozygous for 41%. CFTR modulator therapy had been initiated 3 or more months before for 62% of samples. Sample collection began in September 2019, paused during the COVID-19 pandemic, and resumed in July 2021. An accredited, regional laboratory with expertise in fatty acid analysis processed all samples. Serum was separated and refrigerated for lipoprotein analysis, plasmawas separated and frozen, and RBCs were washed and frozen for fatty acid analysis. Nuclear magnetic resonance lipoprotein assayswere conducted to determine particle number and size of lipoprotein classes. Triglyceride, total cholesterol, and high-density lipoprotein cholesterol (HDL-C) were measured directly (Roche). Low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) were calculated. To correlate laboratory results with clinical findings, medical records were reviewed, and a CF clinic dietitian conducted 24-hour dietary recalls concurrent with study labs. Result(s): Of PwCF homozygous F508del/F508del, 43% tested positive for EFAD biomarkers (RBC linoleic acid, RBC mead acid, RBC triene/tetraene ratio), compared with 13% of PwCF heterozygous F508del ( p <=0.01) (Figure 1). There was no significant difference in concentrations of fatty acid and EFAD biomarkers between those who had or had not initiated CFTR modulator therapy. Lipoprotein abnormalities were identified in 69% of samples with low HDL-C and 39% with large HDL-C, 87% with large VLDL-C particle size and 52% with large VLDL-C particle number, and 5% with high LDL-C or small LDL-C particle numbers. High total cholesterol was found in 15% and high triglycerides in 17%. HDL-C was low in 24%, and 3% had high LDL-C. (Figure Presented) Figure 1. Differences in concentrations of red blood cell (RBC) linoleic and mead acids and triene/tetraene (T/T) ratio between F508del homozygous and F508del heterozygous individuals Conclusion(s): Despite clinical advances and use of CFTR modulator therapy, EFAD remains prevalent and underrecognized in the pediatric CF population. Of PwCF, those homozygous for f508del may have a higher risk of EFAD. Limitations of this study (four different CFTR modulator therapies and small sample sizes in each group) may have precluded significant findings for EFAD and lipid profiles, but PwCF receiving modulator therapy appear to have healthier lipid profiles than those not receiving therapy. Lipids and fatty acid are not routinely evaluated in PwCF, but evaluation should be included in the standard of care for timely dietary interventionsCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

Can White allyship contribute to tackling ethnic inequalities in health? Reflections on the experiences of diverse young adults in England

Ethnic diversity and racism have not featured strongly in English research, policy or practice centred on understanding and addressing health inequalities. However, the COVID-19 pandemic and the Black Lives Matter movement have shone fresh light on deep-rooted ethnic inequalities and mobilised large segments of the population into anti-racist demonstration. These recent developments suggest that, despite strong counterforces within national government and the mainstream media, there could be a shift towards greater public awareness of racism and potentially a willingness to take individual and collective action. This paper addresses these developments, and specifically engages with the contested notion of 'allyship'. We bring together the experiences of 25 young adults living across England and prior literature to raise questions about whether and how racialized White individuals can play a role in dismantling systemic racism and reducing ethnic inequalities in health. Our analysis reveals a variety of complexities and obstacles to effective and widespread allyship. Findings suggest the need to nurture contingent, responsive and reflexive forms of allyship that can attend to the harms inflicted upon racially minoritized people as well as push for systemic transformation. White allyship will need to take a variety of forms, but it must be underpinned by an understanding of racism as institutional and systemic and a commitment to tackling interlocking systems of oppression through solidarity. The issues addressed are relevant to those occupying public health research, policy and practice roles, as well as members of the public, in England and other multi-racial settings.Copyright © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Is daily home spirometry feasible in remote monitoring of interstitial lung disease?

Introduction: Access to in-clinic spirometry for patients with interstitial lung disease (ILD) has been restricted by the COVID19 pandemic. Remote monitoring of patient-recorded at-home spirometry & pulse oximetry offers an alternative approach to traditional hospital-based monitoring. Objective(s): To assess the feasibility of a remote monitoring programme (with spirometry & pulse oximetry) delivered within ILD clinical care settings for a 3-month period through assessment of adherence to study measurements. Method(s): In this prospective, single-arm, observational study (NCT04850521), patients were asked to record 1 spirometry and pulse oximetry measurement per day for 91 days, using a digital health application (patientMpowerTM) & Bluetooth-linked devices. Patient-recorded data could be viewed in real time by their clinical teams via a secure, password-restricted web-based portal. Health-related quality of life and patient experience were also assessed. Result(s): 51 ILD patients enrolled and provided >=1 spirometry reading. Baseline demographics: 35M/16F;29 idiopathic pulmonary fibrosis (IPF)/22 non-IPF ILD;age: 67+/-12Y;in-clinic FVC: 84+/-20% predicted;TLCO 54+/-19% predicted (mean+/-SD);median modified ILD GAP score: 3. Patients recorded spirometry on median 92% of days & pulse oximetry on median 93% of days. To date, 30 patients have completed follow-up. 26/30 patients recorded spirometry and pulse oximetry >=3 days/week & >=70% of days. Conclusion(s): In this study, daily recording of home spirometry & pulse oximetry over 3 months appeared feasible. Further research is needed to understand how remote monitoring is best used within ILD clinical services. .

Managing through a crisis: emotional leadership strategies of high-growth entrepreneurs during the COVID-19 pandemic

This study explores how high-growth entrepreneurs use well-being and emotional labour as tools to respond to crises. Drawing on 173 longitudinal interviews with 57 high-growth entrepreneurs during the Covid-19 crisis, we explore internal crisis response strategies. The data show that entrepreneurs employ a variety of emotional labour practices which produce organizational resilience. However, these practices are in tension with the strategic practices required for economic resilience. We show how the emotional of entrepreneurs serves as part of their crisis leadership strategy. This adds a new perspective to the literature on entrepreneurial crisis and resilience by showing the complexity of internal reactions to sudden and prolonged shocks. © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Variations in classroom ventilation during the COVID-19 pandemic: Insights from monitoring 36 naturally ventilated classrooms in the UK during 2021

Seasonal changes in the measured CO2 levels at four schools are herein presented through a set of indoor air quality metrics that were gathered during the height of the COVID-19 pandemic in the UK. Data from non-intrusive environmental monitoring units were remotely collected throughout 2021 from 36 naturally ventilated classrooms at two primary schools and two secondary schools in England. Measurements were analysed to assess the indoor CO2 concentration and temperature. Relative to UK school air quality guidance, the CO2 levels within classrooms remained relatively low during periods of warmer weather, with elevated CO2 levels being evident during the colder seasons, indicating lower levels of per person ventilation during these colder periods. However, CO2 data from the cold period during the latter part of 2021, imply that the per person classroom ventilation levels were significantly lower than those achieved during a similarly cold weather period during the early part of the year. Given that the classroom architecture and usage remained unchanged, this finding suggests that changes in the ventilation behaviours within the classrooms may have altered, and raises questions as to what may have given rise to such change, in a year when, messaging and public concerns regarding COVID-19 varied within the UK. Significant variations were observed when contrasting data, both between schools, and between classrooms within the same school building;suggesting that work is required to understand and catalogue the existing ventilation provisions and architecture within UK classrooms, and that more work is required to ascertain the effects of classroom ventilation behaviours. © 2022 The Author(s)

Applied Regional Economic Research Can Improve Development Strategies and Drive Better Outcomes

The COVID-19 pandemic brought about an unimagined level of federal investment in regional economic development and much greater political attention to its priorities. Economic development researchers have an opportunity to contribute to an array of federally funded and pandemic-inspired regional experiments, many of which reflect shifting concerns about economic development and what constitutes success. Among these include the importance of addressing historical racial, ethnic, and gender inequalities;the value of research and development as a solution to major human problems;the severity of impending workforce shortages in key sectors;the fragility of many highly efficient global supply chains;and the inadequacy of our underinvested economic data infrastructure to help understand these issues. Researchers have a unique opportunity to examine the regional impacts of national issues by improving public investment logic models, advocating for an improved data infrastructure, and providing evidence to address the long-standing tension between growth and equity as competing economic development priorities.

Centralisation and decentralisation in a crisis: how credit and blame shape governance. (Special Issue: COVID-19 health system governance.)

The COVID-19 pandemic led to unprecedented challenges and political creativity worldwide. In governance, this often led to unexpected centralisation and decentralisation in response to case surges. Changes in the distribution of power and responsibility throughout governments changed quickly as the pandemic progressed. Centralisation and decentralisation occurred within governments and between governments, as power shifted. The main explanation for the patterns of centralisation and decentralisation is the politics of credit and blame. Politicians at all levels seek to centralise when there is credit to be had from forceful action and decentralise when there are unpopular policies or bad news coming.

Use of the National Consultant Information Programme to assess the impact of the COVID-19 pandemic on volumes and admission route of colectomies for ulcerative colitis for NHS procedures in England

Introduction: The National Consultant Information Programme (NCIP) aims to support National Health Service (NHS) consultants in England with learning and continuous self-development via an online portal which compares their individual and patient outcomes against local and national benchmarks. The aim of this study is to confirm the idea that the COVID-19 pandemic has changed surgical practice for Ulcerative Colitis (UC) patients. Method(s): Hospital Episode Statistics data was extracted from NCIP using the International Classification of Diseases-10 code K51 (ulcerative colitis) and cross referencing them with procedures performed for UC. The financial year (April-March) was chosen as it corresponded to the start of the pandemic. Result(s): The table highlights a stepwise decrease in colectomies for UC during the pandemic. Proportionally the number of emergency colectomies was higher during the pandemic in 2020-21 when compared to pre-pandemic levels in 2018-2020 (p = 0.01). A simultaneous decrease was illustrated in the proportion of elective colectomies. Conclusion(s): This large national healthcare data set has provided evidence that the pandemic has had a profound impact on surgery for UC. The proportion of cases performed electively decreased, with a corresponding rise in emergency procedures. An overall decrease in operations for UC as a whole was seen;raising the concern that patients may be waiting excessively long for their surgery.

Lancashire and South Cumbria Critical Care Network Follow Up Clinic Evaluation Project

Introduction: Admission and survival from critical care is not without its far-reaching consequences to both the patient and their families. Follow-up clinic for critical care patients is something that has been established to try to 'mop up' some of these consequences. However, resource allocation to this vital line for many patients is patchy and often inadequate. Within the LSCCC Network there are Four Trusts with critical care follow up services. Three sites agreed to participate in the project to evaluate the issues patients report at clinics and the provision of services for ongoing support for these patients. Objectives: To evaluate the physical, functional, psychological and cognitive issues patient identify at follow up clinic reviews and the service provision for ongoing support for these patients. Methods: From the period of July 2020 -July 2021 we collected data on patients attending follow up clinics at three sites. We collected basic demographic data, level of care, type of ventilatory support, length of ventilation, length of critical care and hospital stay and COVID-19 status. We used the EQ-5D Health Related Quality of Life score (HRQoL) questionnaire, Health Score and Trauma Screening Questionnaire to assess how respondents rated their own health. We identified physical/ functional and psychological issues patients reported at the clinic appointments. We identified onward referrals to other specialities and if these services were available. We identified if patients had returned to work after their admission to critical care and whether patients would benefit from further Follow Up appointments. Results: We collected data on 249 patients. 58% of these were male and 42% of these patients were admitted due to COVID-19. The median age of our patients was 59 (16-86), with 53% of patients requiring Level 3 care. The median length of invasive ventilation was nine days (0-88 days), noninvasive ventilation was 2 days (0-16 days) and median total ventilation was 11 days (0-100 days). The median length of Critical Care stay was 15 days (3-108 days), and the median hospital length of stay was 28 days (4-280 days). The HRQoL data identified issues in all the dimensions of quality of life and highlighted the problems patients face in their recovery from critical illness. The health score also identified that most patients felt their illness has impacted on the overall health status with some patients reporting significant reductions. The most common physical issues reported were fatigue and muscle weakness, however there was a range of physical issues identified showing the complexity of issues patients have during their recovery. The psychological issues highlighted high levels of anxiety in patients and sleep disturbance, as well as delusional memories and cognitive issues. The Trauma Screening questionnaire also identified self-reported psychological issues with the median score 3 but some patients reporting scores of 10 indicating severe psychological distress. The data identified patients requiring a high number of onward referrals to Medical and Allied Health Professional services to support their recovery. This is due to their being limited clinicians present in the Follow Up Clinics at the different sites. Most clinics had services available for onward referral except Psychology which was only available in one site. In the patients who were working prior to the period of hospitalisation only a limited number had been able to return to work by the time of the clinic appointment. Nearly a quarter of patients were identified as potentially benefitting from further appointments. Conclusion: We identified that patients in the LSSCC Network who are admitted to Critical care, have significant impairments following a stay in critical care. They often require referral to further specialty services which are not always available within the follow up clinic that they attend. However, what is clear from our data is that our patients they need access to a range of Health and Social Care Professionals when they atte d Follow Up Clinics and ability to access further ongoing health and support services.

Trust disruption and preservation in the Covid-19 work from home context

Purpose The paper posits that the enforced work from home (WFH) arrangement due to Covid-19 provides a unique setting for the study of trust in changing contexts. The purpose of this study, therefore, is to examine to what extent Covid-19 WFH changed trust relationships among remote employees, their managers and organisations and how this has taken place. Design/methodology/approach The study used semi-structured interviews with employees and managers from different organisations across different sectors. Interviews were supported with image prompts as suggested by the storyboarding method, and took place between November 2020 and February 2021. Thematic analysis was used to analyse the data. Findings The findings identified factors that contribute to trust disruption and factors that led to trust preservation within the changing workspace landscape enforced by WFH environment. Employees reported trust in their organisations, feeling as though their organisations proven resilient at the time of the crisis caused by the pandemic. Interestingly, managers reported trust in employees to remain productive but also anxieties due to the possible presence of others in the household. Originality/value The study identified factors that affect intra-organisational trust that have not been previously recognised, exposing tensions and challenges that may disrupt trust relations between managers and employees whilst also identifying evidence of trust preservation in the Covid-19 WFH context. The study has implications for workplace learning within the remote, WFH context, which are discussed.

Establishment of a clinical nurse specialist-led, virtual aneurysm surveillance clinic.

BACKGROUND: The COVID-19 pandemic has necessitated significant changes to the manner in which healthcare is delivered. Chief among these has been the need to rapidly adopt virtual, or telephone clinics as a means of reducing unnecessary patient exposure to hospitals and clinical care settings. We were greatly aided in our adoption of virtual clinics by our experience in the establishment and maintenance of a Clinical Nurse Specialist-led, virtual clinic for both abdominal aortic (AAA) and extra-aortic aneurysm (EAA) surveillance within our department since 2016. Patients undergoing surveillance for abdominal aortic aneurysm (AAA) require frequent and lifelong clinical review. Previous studies have shown that post-operative surveillance in particular is critical in prolonging survival in AAA patients and in the early detection of late complications particularly following endovascular repair (EVAR). Poor compliance with EVAR surveillance has been shown to result in worse outcomes. AIM: The aim of this study was to evaluate the success of a nurse-led virtual clinic programme in terms of the safe management of patients undergoing AAA surveillance in a nurse-led virtual clinic. RESULTS: Over the course of the 4-year period from 2016 to 2019, 1352 patients were enrolled in the virtual aneurysm surveillance clinic. The majority of patients each year were male, ranging from 78.2% in 2016 to 85.2% in 2017. The majority of patients encountered the service owing to pre-operative surveillance of an AAA, with this group comprising at least 65% of the total cohort of patients each year.Over the course of the 4-year period of the virtual clinic there were 1466 patient encounters. Each ambulatory day care centre (ADCC) attendance normally costs the hospital €149. Therefore, a total saving of €218,434 resulted from this initiative alone. No patient presented as an emergency with a ruptured aneurysm during the time period studied. CONCLUSION: Patients with AAA can be safely kept under surveillance in a nurse-led virtual clinic. Our experience with this model of care proved to be particularly advantageous during the period of the early COVID-19 pandemic.

NeuroSAFE PROOF. Update on a multi-centre, pragmatic, RCT for men undergoing robot-assisted radical prostatectomy: Trial in progress

Introduction & Objectives: Robot-assisted Radical Prostatectomy (RARP) is an effective cure for organ confined prostate cancer but is associated with considerable post-operative functional toxicity. The NeuroSAFE technique (intra-operative frozen section analysis of the neurovascular structure adjacent margin) may help improve functional outcomes by promoting optimal nerve-sparing (NS) RARP without compromising on oncological outcomes. NeuroSAFE technique has reported favourably in retrospective, single-centre studies but has never been evaluated prospectively by a randomised study. The NeuroSAFE PROOF Feasibility Study has succeeded in demonstrating feasibility and has been succeeded by the fully powered, definitive NeuroSAFE PROOF Randomized Controlled Trial (RCT) (NCT03317990). Materials & Methods: Potent men (IIEF-5>21) with localised prostate cancer at 4 regional uro-oncology centres in the UK (UCLH, Bristol, Sheffield and Glasgow) are eligible. Participants are randomised 1:1 to RARP with NS decision guided by standard of care (clinical information, DRE and pre-operative mpMRI surgical plan) vs. RARP with NS decision guided by standard of care information and the NeuroSAFE technique. The primary outcome is erectile function (EF) recovery assessed by IIEF-5 score at 12-months. Important secondary outcomes include detailed peri-operative outcomes, histological outcomes, post-operative complications, biochemical recurrence rates, urinary continence (assessed by ICIQ), health related quality of life (assessed by Rand-36 and EQ-5D-5L), and health economics. In order to demonstrate a difference of 15% in EF recovery rates between the arms, a total of 404 men will be randomised and treated. Patient follow-up will continue for 5 years after RARP. Results: At the time of writing, 160 men have been recruited and treated with RARP as per random allocation at 4 participating sites. The independent DMC has met twice to ensure the oncological safety of the trial and will continue to review the data at intervals. Covid-19 has led to significant challenges, including suspension of recruitment and difficulties performing follow-up. The trial team have developed new methods of recruitment, consent and follow-up to ensure conduct of the study remains in line with the highest standards of trial conduct, including electronic remote consent processes and remote collection of PROMs. Conclusions: The NeuroSAFE technique has been reported as a method to optimise outcomes for men undergoing RARP for over a decade, but, in the absence of Level 1 evidence, equipoise remains. Despite the Covid-19 pandemic recruitment continues to be favourable. We hope that our

Atovaquone for Treatment of COVID-19 (Ataq COVID-19) Trial

Background. Our group performed an in-silico screen to identify FDA approved drugs that inhibit SARS-C0V-2 main protease (Mpro), followed by in vitro viral replication assays, and in vivo pharmacokinetic studies in mice. These studies identified atovaquone as a promising candidate for inhibiting viral replication. Methods. Enrolled patients were randomized in a 2:1 fashion to atovaquone 1500 mg twice daily versus matched placebo. Patients received standard of care treatment including remdesivir, dexamethasone, or convalescent plasma as deemed necessary by the treating team. Patients agreed to allow collection of saliva at baseline and twice a day while hospitalized or up to 10 days. Saliva was collected and RNA extracted for viral load (VL) measurement by Real-time PCR. Our primary outcome was to examine the between group differences in log transformed VL(copies/mL) using generalized linear mixed-effect models of repeated measures from all samples. Additional analysis of Atovquone plasma concentrations were examined and correlated with viral load and body mass index (BMI). Results. Of the 61 patients enrolled;41 were received atovaquone and 19 placebo. Overall the population was predominately male Hispanic with a mean age of 51 years. The two groups were balanced (Table 1) with regard to age, gender, race, co-morbidities, days from onset of symptoms, baseline oxygen requirements, and receipt of COVID-19 specific standard of care treatment. A higher proportion with diabetes was noted in the Atovaquone arm. The log10 VL was 5.25 copies/mL vs. 4.79 copies/mL at baseline in the atovaquone vs. placebo group. Although there was a decrease in VL over time, there was no differences between the atovaquone plus standard of care arm versus the standard of care arm (Figure 1). Additional analysis of atovaquone plasma concentration demonstrated a wide variation in atovaquone levels, inverse association between atovaquone levels and BMI (rho -0.44, p=0.03), and Day 5 concentrations and VL (rho -0.54, p=0.005). Conclusion. Although atovaquone showed promising in vitro antiviral properties for COVID-19, in this pilot study we did not detect a change in VL in patients who received atovaquone compared to placebo, possibly due to failure of patients achieve adequate drug levels.

What trends can we see with consumer-initiated testing orders and telehealth genetic counseling pre- and post-COVID?

Introduction: Americans have made a myriad of changes in theirhealth choices and lifestyle habits as a result of the COVID-19pandemic. Concern over infection has led to increased stress andanxiety (Bhattacharjee B, Acharya T. Psychiatr Q. 2020) as well as anincreased focus on physical and mental wellness to cope with thosestressors. Due to fear of viral exposure in an in-clinic setting, manyhave opted to schedule telehealth appointments with their healthcareproviders (Betancourt JA, et al. Healthcare (Basel). 2020;8(4):380).However, there is very little literature describing how the pandemicimpacted the consumer-initiated testing (CIT) market and interest intelehealth genetic counseling. In this study, we sought to determinewhether the public’s demonstrated increased interest in personalhealth and wellness and adoption of telehealth extended to uptake ingenetic CIT and telehealth genetic counseling consultations.Methods: We conducted a chart review of all genetic CIT ordersreceived and genetic counseling consults scheduled with PWNHealthin the 9 months prior to the COVID pandemic being declared a nationalemergency on 3/13/20 (“pre-COVID,” 6/13/19–3/12/20) and 9 monthsafter that date (“post-COVID,” 3/13/20–12/13/20). The reviewincludedthe number of test requests received, consumers’ primary motivationfor pursuing testing from a drop-down selection of options, uptake ofpost-test genetic counseling consults and mode of consultationchosen (phone vs video).Results: There was a significant decrease (20%, p < 0.0001) in thenumber of genetic CIT orders received between the pre-COVID andpost-COVID time period (135,640 to 90,675). We found significantdifferences in chosen motivations for testing after the COVIDpandemic began in the US for all studied options (p < 0.0001). Seechart for which motivations were more likely to be chosen pre- vs.post-COVID. Consumers were 3 times more likely after the pandemicbegan to answer the motivation question rather than leave itunanswered. Post-COVID, they were 60% less likely to choose theirprimary motivation of testing as “I’m interested in the latest scientificbreakthroughs,” 35% more likely to choose “I’m interested in mygenetic risk for disease” and 61% more likely to choose “I have apersonal history.”There was a slight, but statistically insignificant, decrease in thenumber of genetic counseling consults scheduled after the start of theUS COVID pandemic (967 vs 886, P = 0.0582). Post-COVID, consumerswere significantly more likely to schedule their consults at a soonerdate (3.3 vs 3.6 pre-COVID, p < 0.0001) and twice as likely to choosevideo than phone (27.9% vs 12.5% pre-COVID) (P < 0.001). We can seethat this trend has continued to increase by month since the start ofthe pandemic (see graph). In addition, individuals were significantly more likely to complete their scheduled consult post-COVID (77.1% vs73.5% pre-COVID) (P < 0.001). Pre-COVID, individuals who scheduledvideo consultswere significantly less likely to complete the consult (i.e. they canceled or no-showed) as compared to those who hadscheduled phone consults (70.2% vs 74.0%, respectively;P < 0.0001).However, post-COVID, those individuals who scheduled video consultswere significantly more likely to go through with thatconsultation (83.8% vs 70.2% pre-COVID) and as compared to thosewho scheduled phone consults (74.5% completed, P < 0.0001). (Table Presented) Table 1Discussion: The increased willingness to answer the motivationquestion post-COVID could explain the increased likelihood ofconsumers reporting 7 out of the 9 motivations. However, theresults indicate that, post-pandemic, more individuals are seekinggenetic CIT because they are concerned about learning more abouttheir genetic risk for disease out of general interest or due to a personalor family history. The increased uptake of video genetic counselingconsults rather than phone only and the increased completion rate ofboth types of telehealth consults reflects the national trend towardsacceptance of medical appointments via telehe lth. Limitations of thisstudy include the restriction of consumers to select their motivationfrom a pre-selected dropdown menu which may not fully describetheir motivation for testing. In addition, this is a snapshot ofindividuals seeking services with one company’s clinical oversight. (Figure Presented) Conclusion: This review indicates that individuals have become moreengaged with their genetic health since the onset of the COVID-19pandemic in the US and are more accepting of medical consultationsvia video. Additional studies need to be done to determine if thesetrends continue on a broader healthcare scale.

COVID-19 vaccine confidence and tourism at the early stage of a voluntary mass vaccination campaign: a PMT segmentation analysis. (Special Issue: COVID-19 and tourism.)

Restarting the mass tourism industry relies on the success of the COVID-19 vaccination campaign which requires individuals' voluntary participation to reduce health risks to hosts and visitors. This study identifies segments of Italian residents based on vaccine confidence at the early stage of a voluntary mass vaccination programme. Using a survey held with 3893 Italian residents, two COVID-19 vaccine confidence clusters were identified. These clusters were compared and revealed significant differences in response and self-efficacy, vaccine adoption, travel behaviour and involvement in the tourism industry.

Investigating Meaningful Learning in Virtual Reality Organic Chemistry Laboratories

Virtual reality (VR) lab experiences for organic chemistry were developed at NC State University as an accessibility tool for students who are unable to attend in-person laboratories due to disabilities, attendance challenges such as pregnancy or military deployment, or safety concerns. The resulting first-person VR experiences are immersive and realistic, with a virtual teaching assistant guiding the user along the steps required to complete the experiment, including feedback as needed. During the COVID pandemic, these laboratories replaced traditional face-to-face laboratories at NC State and several other universities. During the summer of 2020, we used the Meaningful Learning in the Laboratory Instrument (MLLI) to measure both the cognitive and affective dimensions of students' expectations of the virtual lab before the course and their experiences with virtual reality after completing the course. Students who completed virtual reality laboratories reported more positive affective experiences than they anticipated, including little frustration or confusion in the laboratory. © 2021 American Chemical Society and Division of Chemical Education, Inc.