A Multi-Center, Randomized, Placebo-Controlled, Double-Blinded Trial of Efficacy and Safety of Riluzole in Acute Spinal Cord Injury Study (RISCIS)

INTRODUCTION: Riluzole, a sodium-glutamate antagonist which is FDA approved for ALS has shown promising pre-clinical results and is clinically safe in SCI patients. METHOD(S): The RISCIS trial is an international, multi-center, prospective, double-blinded, randomized, placebo-controlled Phase II/ III trial. Patients with ASIA A-C, C4-C8 SCI and <12 hours from injury were randomized between Riluzole, at an oral dose of 100mg BID for the first 24 hours followed by 50mg BID for the following 13 days, and placebo control. RESULT(S): Due to the impact of the global COVID-19 pandemic this trial was terminated prior to completion. 193 patients were randomized with a follow-up rate of 82.7% at 180-days. No statistical difference was noted in the demographics and baseline injury characteristics between the two groups. At 6 months there was a median gain in total motor scores (TOTM) of 30.0 in the Riluzole group compared to 20.0 for the Placebo group. The improved motor outcomes did not reach statistical significance. Given the decreased sample size, additional sensitivity analyses were conducted. In the ASIA-C population, Riluzole was a significant improver of total motor scores (coefficient estimate: 14.10, p = 0.020) and upper motor scores (CE: 7.68, p = 0.040) at 6 months. ASIA B patients had higher reported independence, as measured by the SCIM score (45.3 vs. 27.3;p = 0.071) and change in mental health scores as measured by the SF-36 mental health domain (2.01 vs. -11.58;p: 0.0205) at 180 days. CONCLUSION(S): Despite the premature termination of the RISCIS trial due to the COVID-19 pandemic, 193 subjects were recruited into this trial. Primary analysis showed a 10-motor point gain in riluzoletreated subjects which did not reach significance. However, on secondary analysis, incomplete cervical SCI subjects (AIS B and C) showed significant gains in functional recovery.

A COMPARISON OF HOW THE TRANSPORTATION AND LOGISTICS INDUSTRY AND THE AUTOMOTIVE INDUSTRY'S SUPPLY CHAIN PROCESSES HAVE BEEN AFFECTED BY COVID-19 AND HOW ENTREPRENEURIAL COMPETENCIES COULD BE USED TO ADDRESS THEM

Since it has been established that supply chain management has traditionally been a process-oriented field with not much focus on innovation, in a post-pandemic world, engineering managers have realized that research is needed to identify which aspects of global supply chain management have the greatest need for transformation and could benefit most through the application of entrepreneurial competencies. Along those lines, the authors of this paper have earlier proposed a research model, which includes a mapping between supply chain management process steps and entrepreneurial competencies along with proposed training and organizational changes to facilitate the implementation of a more entrepreneurial approach to supply chain management processes. Using a qualitative, grounded theory approach based on two case studies, the authors focus on two industries. The differences and similarities between the two industries will be compared in this paper;thus, showing engineering managers how the model could be applied to the two different industries considered in this paper. Copyright, American Society for Engineering Management, 2022.

Parkrun across the pond: examining location and event characteristics in Canada and the United States of America

Mass participation events, such as ‘parkrun', may be one option to encourage physical activity within communities. The purpose of the study was to describe the expansion of parkrun locations in Canada and the United States of America (USA) and identify and describe characteristics of parkrun locations. For each parkrun site, setting-level information was collected from selected websites. Findings revealed many parkrun events were started in 2019 with most locations offering a virtual option during the COVID-19 pandemic. Further, parkrun events appear to be supported in cities/towns that vary in demographics. Two-thirds of USA parkrun cities were above the national average for individuals being within a short walking distance to a park;however, most parkrun locations are car reliant. There is room to expand parkrun where no events currently exist and additional research is needed to determine the degree to which area-level characteristics are associated with actual parkrun participation. © 2023 Canadian Association for Leisure Studies / Association canadienne d'études en loisir.

Longitudinal Alpha-gal IgE Levels in a University of Virginia Employee Cohort

Rationale: The alpha-gal syndrome (AGS) is caused by IgE to galactose-α-1,3-galactose (α-Gal) and is strongly linked to tick bites. To date there have been limited studies on the natural history of AGS and α-Gal sensitization. Here we monitored α-Gal IgE levels over time among sensitized individuals in an employee vaccine cohort unselected for allergic disease. Methods: University of Virginia employees were recruited for an IRB-approved COVID-19 vaccine study. Study subjects provided blood samples and answered a questionnaire capturing medical history including diet and allergy history. α-Gal IgE (cut-off 0.1 kU/L) and total IgE were assayed in banked serum by ImmunoCAP and slopes calculated by linear regression. Results: Of the 266 subjects in the study, 46 (17%) were sensitized to alpha-gal. 38 sensitized subjects had two or more samples separated by at least 100 days. Of these, 68% were female, median age was 55.6 and α-Gal IgE levels dropped over time in 25 (66%). Median rate of decay among subjects with decreasing titers was 53%/year (IQR 46-61). Of the 38 sensitized subjects, 12 (32%) reported interval tick bites over the course of the study. The correlation between α-Gal IgE slopes and total IgE slopes was moderately strong (Pearson's R = 0.60, P<0.001). Conclusions: α-Gal IgE levels decrease over time in many subjects, with a median decay rate of 53%/year. Although α-Gal specific IgE is often only a small fraction of total IgE, both track closely with each other over time, likely a reflection of changes in IgE relating to tick bites.

MBA futures: Images from Principles for Responsible Management Education (PRME) signatories during the COVID-19 pandemic

This paper presents key ideas from a Futures study relating to part-time (PT) Master of Business Administration (MBA) degree programmes. The objective of the study was to determine the likely nature of PT MBA programmes approximately 30 years in the future, i.e., 2050, and to do so in the context of an assessment of possible long-term impact of disruptions caused or accelerated by the COVID-19 pandemic. The research involved strategic conversations with ten PT MBA Programme Directors or equivalent across seven countries and each of whom was based in Principles for Responsible Management Education (PRME)-signatory institutions. The findings suggest that MBA programmes of the future are likely to be significantly different to current PT MBAs. To close the learning loop associated with the original term of strategic conversations, higher education institutions (HEIs) are invited to consider the findings to inform strategic conversations within their own institutions in respect of future PT MBA design and provision. © 2022 Elsevier Ltd

What makes a balanced leader?: An islamic perspective

Despite continuous public interest in leadership studies as well as the abundance of extant literature, the world continues to face leadership predicaments. Given the global crises mankind has been recently exposed to, which include the financial crisis of 2008 as well as the COVID-19 pandemic, further exploration of leadership concepts seems warranted. © 2023 Walter de Gruyter GmbH, Berlin/Boston. All rights reserved.

The role of pandemic planning in the management of COVID-19 in England from an infection prevention and control perspective: results of a national survey.

OBJECTIVES: This national survey aimed to explore how existing pandemic preparedness plans (PPP) accounted for the demands placed on infection prevention and control (IPC) services in acute and community settings in England during the first wave of the COVID-19 pandemic. STUDY DESIGN: This was a cross-sectional survey of IPC leaders working within National Health Service Trusts or clinical commissioning groups/integrated care systems in England. METHODS: The survey questions related to organisational COVID-19 preparedness pre-pandemic and the response provided during the first wave of the pandemic (January to July 2020). The survey ran from September to November 2021, and participation was voluntary. RESULTS: In total, 50 organisations responded. Seventy-one percent (n = 34/48) reported having a current PPP in December 2019, with 81% (n = 21/26) indicating their plan was updated within the previous 3 years. Around half of IPC teams were involved in previous testing of these plans via internal and multi-agency tabletop exercises. Successful aspects of pandemic planning were identified as command structures, clear channels of communication, COVID-19 testing, and patient pathways. Key deficiencies were lack of personal protective equipment, difficulties with fit testing, keeping up to date with guidance, and insufficient staffing. CONCLUSIONS: Pandemic plans need to consider the capability and capacity of IPC services to ensure they can contribute their critical knowledge and expertise to the pandemic response. This survey provides a detailed evaluation of how IPC services were impacted during the first wave of the pandemic and identifies key areas, which need to be included in future PPP to better manage the impact on IPC services.

Mental health care using video during COVID-19: service user and clinician experiences, including future preferences

Purpose: This paper aims to evaluate service user (SU) and clinician acceptability of video care, including future preferences to inform mental health practice during COVID-19, and beyond. Design/methodology/approach: Structured questionnaires were co-developed with SUs and clinicians. The SU online experience questionnaire was built into video consultations (VCs) via the Attend Anywhere platform, completed between July 2020 and March 2021. A Trust-wide clinician experience survey was conducted between July and October 2020. Chi-squared test was performed for any differences in clinician VC rating by mental health difficulties, with the content analysis used for free-text data. Findings: Of 1,275 SUs completing the questionnaire following VC, most felt supported (93.4%), and their needs were met (90%). For future appointments, 51.8% of SUs preferred video, followed by face-to-face (33%), with COVID-related and practical reasons given. Of 249 clinicians, 161 (64.7%) had used VCs. Most felt the therapeutic relationship (76.4%) and privacy (78.7%) were maintained. Clinicians felt confident about clinical assessment and management using video. However, they were less confident in assessing psychotic symptoms and initiating psychotropic medications. There were no significant differences in clinician VC rating by mental health difficulties. For future, more SUs preferred using video, with a quarter providing practical reasons. Originality/value: The study provides a real-world example of video care implementation. In addition to highlighting clinician needs, support at the wider system/policy level, with a focus on addressing inequalities, can inform mental health care beyond COVID-19. © 2022, Emerald Publishing Limited.

UNDERSTANDING THE ROLE OF SOCIAL INFRASTRUCTURE FOR OLDER ADULT ENGAGEMENT ACROSS GEOGRAPHIC CONTEXTS

Using semi-structured interviews of older adults, living alone or with a partner in the community, this research explores themes related to aging in place, social infrastructure, and community engagement across geographic contexts in Indiana. In particular, we are interested in understanding how older adults experience and use the existing social infrastructure in their communities and how these experiences vary across the rural-suburban-urban continuum. Additionally, we examine how social interactions supported by social infrastructure influence the maintenance of social relationships including weak social ties. Because COVID-19 has significantly changed patterns of community engagement among older adults, respondents were asked to discuss their behavior pre- and post-COVID-19. Applying a thematic analysis approach to the data, we explore the interconnections among social infrastructure, community engagement, social relationships, and geographic settings with an emphasis on older adults' experiences and perceptions.

What makes a balanced leader?: An islamic perspective

Despite continuous public interest in leadership studies as well as the abundance of extant literature, the world continues to face leadership predicaments. Given the global crises mankind has been recently exposed to, which include the financial crisis of 2008 as well as the COVID-19 pandemic, further exploration of leadership concepts seems warranted. © 2023 Walter de Gruyter GmbH, Berlin/Boston. All rights reserved.

Family and Next of Kin (NoK) Communication-Time for a new NELA standard?

Introduction: The COVID-19 pandemic highlighted The importance of communication between patients, families, and The surgical team. COVID left many patients bereft of personal contact with loved ones and NoK were of ten left without information due to overwhelming, challenging situations for surgical teams. These challenges may not be unique to COVID-e.g team shift-working, late-night operating are ongoing barriers to NoK communication following Emergency laparotomy (EmLap). Method(s): Twenty random EmLap patients during The pandemic were identified. Qualitative data on NoK discussion were obtained including telephone follow-up to confirm whether discussions took place. Result(s): only 50% of patients had documented NoK discussion-of these seven were held prior to surgery, 4 post-operatively and 5 during admission. Communication with families was mainly carried out by nurses while consultant/registrar discussions were documented on 7 occasions only. Conclusion(s): Communication with The NoK of patients undergoing Emergency laparotomy needs improving. Patient-centred care must involve The NoK. We would suggest that NoK should be informed of surgical outcomes and prognosis by a senior surgical team member. Notwithstanding The usual caveats of confidentiality and patient wishes-The importance of this facet of surgical care to many patients and their relatives cannot be understated and could be considered as a potential NELA standard of care.

Accelerated Partial Breast Irradiation (APBI) Using Five Daily Fractions: A Prospective, Phase II, Multi-Centre Trial of Cosmetic Outcomes and Toxicity (The Accel Trial): Final Results

Purpose: To report final results of a clinical trial of APBI using intensity modulated radiotherapy (IMRT) to deliver 27 Gy in 5 daily fractions following breast conserving surgery (BCS) prospectively designed to assess the efficacy and cosmetic outcomes of a oneweek, APBI regimen among women with early breast cancer. Material(s) and Method(s): Women >= 50 years, with lymph nodenegative, ER positive, HER-2 negative breast cancer or ductal carcinoma in situ (DCIS), <= 3cm diameter, following BCS with margins >= 2mm, and excellent or good baseline cosmesis received 27 Gy in 5 daily fractions to the seroma plus 1 cm CTV and 0.7 cm PTV margins. Clinical photographs, patient and provider cosmetic scores, breast fibrosis, telangiectasia and pain were collected prospectively, prior to RT and at 6 weeks, 1 and 2 years after RT. The primary endpoint was the proportion of women who retained Excellent or Good cosmesis at 2 years using the EORTC Cosmetic Rating System. Cosmetic failure was deterioration from Excellent or Good to Fair or Poor. A panel of 5 radiation oncologists independently assessed the cosmetic photographs. Secondary endpoints were rates and grades of breast fibrosis, telangiectasia, breast pain, ipsilateral breast tumour recurrence (IBRT), overall (OS), breast cancer-specific survival (BCSS) and subsequent mastectomy. Efficacy outcomes were assessed at clinic visits and by review of charts. ClinicalTrials.gov registration: NCT02681107. Result(s): A total of 298 patients were treated between April 25, 2016, and October 31, 2019. At a median follow-up of 48 months, the four-year OS was 98.5% (95% CI 96.1% - 99.5%) and BCSS was 99.7% (95% CI 97.6% - 99.9%). The four-year IBRT rate was 3.3% (95% CI 1.1% - 6.4%). There were 10 contralateral breast events for a four-year rate of 3.9% (95% CI 2.2% - 6.9%). There were 10 ipsilateral and six contralateral mastectomies. Two patients died of unrelated causes prior to two years;79 patients declined inclinic attendance due to COVID or competing comorbidities and 217 women had two-year cosmetic photographs and clinical assessments performed. Consensus of the photo-panel cosmesis at baseline was: Excellent: n=116 (53%), Good: n=102 (47%), Fair: n=1 (0.5%) and Poor: n=0. Consensus overall cosmesis at two years was: Excellent: n= 141 (65%), Good: n=78 (35%), Fair: n=0 and Poor: n=0. Most patients had either improved (n=168;77%) or no change (n=43;20%) in cosmesis at two years. No patient had cosmetic failure but 6 (3%) had a change from Excellent to Good at two years. Most patients reported either no (79%) or mild (21%) pain, with no moderate or severe pain. Two patients (0.9%) had Grade 2 fibrosis and five patients (2%) had visible telangiectasia that did not detract from overall cosmesis. Conclusion(s): APBI using 27 Gy in 5 fractions using a conformal IMRT technique, achieved excellent two-year cosmesis with minimal toxicity. The IBRT risk was comparable to the contralateral new breast cancer risk and to local recurrence rates of recently published early breast cancer trials. Copyright © 2022 Elsevier Ireland Ltd. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

A partnership approach to supporting the health and wellbeing of the Charedi (Orthodox Jewish) community in London

BACKGROUND: There is a need for a specific programme of engagement around COVID-19 vaccination with the Charedi Orthodox Jewish community in Stamford Hill, London, UK. We co-produced a live event for women on COVID-19 safety and vaccination and wider health topics to support vaccine uptake and improve awareness of health and wellbeing issues. METHODS: For this qualitative analysis, we organised an event that was designed and delivered by a local community organisation in partnership with regional and local health partners and community groups. The event was for Charedi women aged 16 years and older, and provided information on COVID-19, childhood immunisations, oral health and dental hygiene, childhood respiratory infections, and mental health. The event included health stalls, a panel session, co-designed culturally competent physical information, and the opportunity to speak with health professionals. We evaluated the event using attendees' feedback forms, collected in person at the end of the event, and a thematic analysis of semi-structured interviews with organisers from community and statutory organisations. The evaluation was informed by a co-produced logic model and outcomes framework. FINDINGS: More than 100 women attended the event on March 28, 2022. Feedback suggested the focus on wider health issues was valued, and a greater number of more targeted events (eg on health for women older than 40) would be beneficial. Dental health, COVID-19 vaccination, and childhood immunisations were identified as the most important topics by participants. 16 (55%) of 29 respondents stated they would attend a similar event again, 12 (41%) stated they were unsure, and one (3%) said they would not attend again. Informal feedback from the community highlighted that the event was useful and acted as a basis for further engagement and collaboration with the community. INTERPRETATION: Our findings emphasised the need to work in partnership with a lead community organisation to identify and address principal health challenges within communities, to share community-specific insights, and to promote community events through community communication channels. Statutory institutions should engage with local community organisations to support and facilitate public health interventions to increase relevant vaccine uptake and to improve awareness around wider health and wellbeing issues and services. FUNDING: None.

Acute Onset Diabetes and GAD Antibody Positivity After COVID-19

Background: Viral infections can trigger the development of auto-antibodies including against the pancreas (1). The Sars-CoV2 virus can infect the pancreas (2). Limited data exist linking COVID-19 infection and the development of islet related auto-antibodies and diabetes in adults. Case: A 46-year-old healthy man (BMI 24.7kg/m2) developed upper respiratory symptoms in mid-July 2021. He did not have a family or personal history of autoimmune diseases. His mother has mild type 2 diabetes mellitus. He underwent Sars-CoV-2 testing in July which was positive. In August, upper respiratory symptoms resolved, however, he developed acute onset polyuria, polydipsia, fatigue, and weight loss. He lost 12.7kg within one month. On his own, he noticed that he felt worse after eating carbohydrates and modified his eating (limiting to 20g of carbohydrates per meal), which reduced his polyuria, polydipsia, and weight loss. In September, he presented to his primary care physician who diagnosed him with hyperglycemia and diabetes. Fasting blood glucose was 331mg/dL (18.4mmol/L) and hemoglobin A1C was 11.3%. He presented to endocrinology clinic in October for evaluation and was started on insulin therapy for diabetes. Laboratory studies included: glucose 194mg/dL (10.8mmol/L), repeat hemoglobin A1C 10.1%. Autoantibody testing was positive for GAD65 (glutamic acid decarboxylase 65 antibody 34.4nmol/L, reference <0.02nmol/L). Other type 1 diabetes related autoantibodies were negative. Blood glucose normalized on insulin therapy (average 115mg/dL (6.4mmol/L) on continuous glucose monitor).Op de Beeck, Anne and Decio L. Eizirik, Nature Reviews, May 2016.Muller, J, et al. Nature Metabolism, Feb 2021.Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

A patient-led survey into the benefits and limitations of telemedicine appointments for assessing children and young people with rheumatic conditions: Comparing European and Canadian cohorts

Introduction/Background: During the COVID-19 (coronavirus) pandemic, some provision of healthcare shifted to remote, technology-assisted appointments (telemedicine). Whilst parents/carers of children and young people with rheumatic conditions have reported benefits of telemedicine, concerns remain.This patient and parent-led project sought to understand the views of parents/carers about telemedicine, identifying the benefits and limitations of remote technology-assisted appointments, and comparing views between Canadian and European cohorts. Description/Method: An online survey was developed, translated into multiple languages and shared via social media and patient organisations, targeted at parents of children and young people with rheumatic, autoimmune and autoinflammatory conditions. Fieldwork took place in April 2021 in Europe and May 2021 in Canada. Consent was provided during enrolment. Discussion/Results: A total of 290 responses were received (133 Europe;157 Canada;73% female, median age 12).Over half of respondents (53%) in Europe reported travelling over an hour to in-person appointments with their paediatric rheumatologist, compared to a significantly higher proportion of respondents in Canada (87%). Consequently, in-person appointments represent a greater time burden amongst Canadian caregivers, though both groups report appointments taking over three hours in total (51% Europe, 69% Canada).Prior to COVID-19, most had never had a telemedicine appointment (92% Europe, 95% Canada). Since March 2020, the majority (71% Europe, 82% Canada) had at least one telemedicine appointment.Table 1 shows the scores (1 worst, 5 best) given by parents about their telemedicine experience. Overall, most aspects scored positively (p<.05). However, parents felt telemedicine was not as good as in-person appointments.Table 1P65 Mean scores for a range of aspects of telemedicine (1-worst;5-best). EuropeCanadaPEasy to schedule3.50 (3.18, 3.82) *4.33 (4.14, 4.52) *†On time3.22 (2.89, 3.55)4.07 (3.85, 4.28) *†Enough time with doctor3.51 (3.19, 3.83) *4.24 (4.02, 4.45) *†As good as in-person visit2.21 (1.96, 2.46) **2.66 (2.42, 2.90) ** Easier to see doctor2.84 (2.55, 3.13)3.51 (3.25, 3.77) *†Easy to sign-in3.52 (3.22, 3.82) *4.25 (4.06, 4.43) *†Quality of video3.23 (2.93, 3.53)3.87 (3.66, 4.07) *†Quality of sound3.54 (3.26, 3.81) *3.94 (3.75, 4.14) * Able to speak freely3.61 (3.34, 3.88) *4.05 (3.85, 4.24) * Able to understand doctor3.61 (3.32, 3.90) *4.09 (3.90, 4.28) * Quality of care provided3.43 (3.12, 3.73) *3.78 (3.56, 4.00) * Overall telemedicine experience3.23 (2.91, 3.55)3.78 (3.57, 3.99) *†*Positive score (p<.05).**Negative score (p<.05).†Difference between Canadian and European cohorts is statistically significant (p<.05), chi-square. Key learning points/Conclusion: Overall respondents said they would prefer the next appointment to be in-person (82% Europe, 62% Canada, p<.05), although 31% from Canada were amenable to a combination of in-person and telemedicine-based care.There are advantages to telemedicine, notably saving time and making appointments accessible. Families from Canada tended to view telemedicine more favourably than those from Europe, although the majority from both cohorts reported concerns about the ability to assess their child. There may be value in providing training to parents to enhance the accuracy of home-based assessments, particularly when the disease is stable. However, parents continue to report the value of in-person appointments.

Parents report that healthcare professionals play an influential role in deciding whether to vaccinate against COVID-19: Results of a patient-led survey in Canada

Introduction/Background: Vaccination of children and young people (CYP) with rheumatic and auto-inflammatory diseases is reported to be lower than amongst healthy peers. Whilst vaccination to confer protection against COVID-19 is now underway amongst adults and adolescents, vaccination of CYP under 16 years was not available at the time of this study. This study sought to understand the views of parents/carers regarding vaccination against COVID-19 for CYP with rheumatic and autoinflammatory diseases. Description/Method: An online survey was developed and shared via social media and direct contacts, targeted at parents of children with rheumatic and autoinflammatory conditions in Canada. Fieldwork took place during May 2021. Consent was provided during enrolment. Discussion/Results: A total of 157 responses were received (78% female, median age 12). The primary diagnosis for the majority was Juvenile Idiopathic Arthritis (JIA;39% polyarticular, 15% oligoarticular, 8% enthesitis-related JIA, 6% psoriatic, and 9% systemic). At the time of completing the survey, the majority of CYP had received no vaccination against COVID-19 (83%), although 17% had received one dose;none had received both doses. The majority of parents/carers (55%) would agree for their child to be vaccinated to prevent COVID-19 if the vaccine was approved and available at no cost, with only 10% saying they would not agree, and 18% unsure. Overall, 40% would allow their child to have the vaccine as soon as it was available, with a further 22% who would prefer to wait, and 10% who will allow their child to have the vaccine only when required to. Reasons given by parents choosing not to vaccinate their child against COVID-19 focussed on perceived safety, apparent lack of testing, and alleged potential damage caused by vaccines. In addition, some respondents advised that they had seen anti-vaccine videos on social media targeted at young people, but would still have their child vaccinated when it was available. The majority (92%) cited their doctor or health professionals would be a key source of information when deciding whether to vaccinate their child;however, this varied significantly (p=.0017, chisquare) based on whether they currently would agree to have their child vaccinated, with only 69% of parents who would not vaccinate their child saying their healthcare professional would influence their decision. Around 38% of parents would be influenced by information from their patient organisation. Parents who indicated they would not be vaccinated themselves were less likely to agree for their child to be vaccinated (p<.001, chi-square). Key learning points/Conclusion: Healthcare professionals play a vital role in supporting, advising and influencing parental decision-making with regards to COVID-19 vaccination amongst CYP with rheumatic and autoinflammatory conditions, particularly amongst parents/carers who are currently undecided. Working collaboratively with patient organisations to deliver simple, clear advice may help reduce vaccine hesitancy.

The benefits and limitations of telemedicine appointments for assessing children and young people with rheumatic conditions in Canada: A patient-led survey

Introduction/Background: During the COVID-19 (coronavirus) pandemic, some healthcare provision shifted to remote, technology-assisted appointments (telemedicine). This study sought the views of parents/carers about telemedicine, identifying the benefits and limitations, to assist in improvement to future service provision. Description/Method: An online survey was developed and shared via social media and direct contacts, targeted at parents of children with rheumatic and autoinflammatory conditions in Canada. Fieldwork took place during May 2021. Consent was provided during enrolment. Discussion/Results: A total of 157 responses were received (78% female, median age 12). The primary diagnosis for the majority was Juvenile Idiopathic Arthritis (JIA;39% polyarticular, 15% oligoarticular, 8% enthesitis-related JIA, 6% psoriatic, and 9% systemic). Respondents reported in-person appointments represent a considerable time burden (87% travel more than an hour to attend;40% take a full day (or more) out of school to attend;38% of parents take a full day off work). During the pandemic, the proportion having a telemedicine appointment increased from 5% to 82%. Table 1 shows the scores (1 worst, 5 best) given by parents about their telemedicine experience. Overall, most aspects scored positively (p<.05). However, parents felt telemedicine was not as good as in-person appointments (mean 2.66, 95% CI 2.42-2.90).Overall 61% said they would prefer the next appointment to be in-person, while 31% were amenable to some combination of in-person and virtual care.P62 Table 1Mean scores for a range of aspects of telemedicine (1-worst;5-best).AspectMean (95% CI)Easy to schedule4.33 (4.14, 4.52) *On time4.07 (3.85, 4.28) *Enough time with doctor4.24 (4.02, 4.45) *As good as in-person visit2.66 (2.42, 2.90) **Easier to see doctor3.51 (3.25, 3.77) *Easy to sign-in4.25 (4.06, 4.43) *Quality of video3.87 (3.66, 4.07) *Quality of sound3.94 (3.75, 4.14) *Able to speak freely4.05 (3.85, 4.24) *Able to understand doctor4.09 (3.90, 4.28) *Quality of care provided3.78 (3.56, 4.00) *Overall telemedicine experience3.78 (3.57, 3.99) **Positive score (p<.05)**Negative score (p<.05). Key learning points/Conclusion: There are advantages to telemedicine, notably saving time and making appointments accessible, and overall parents reported satisfaction with remote appointments. However, parents continue to report the value of in-person appointments.

Accelerated Partial Breast Irradiation (APBI) Using Five Daily Fractions: A Prospective, Phase II, Multi-Center Trial of Cosmetic Outcomes and Toxicity: Final Results

To report final results of a clinical trial of APBI using intensity modulated radiotherapy (IMRT) to deliver 27 Gy in 5 daily fractions following breast conserving surgery (BCS) prospectively designed to assess the efficacy and cosmetic outcomes of a 1-week, APBI regimen among women with early breast cancer. Women ≥ 50 years, with lymph node-negative, ER positive, HER-2 negative breast cancer or ductal carcinoma in situ (DCIS), ≤ 3cm diameter, following BCS with margins ≥ 2mm, and excellent or good baseline cosmesis received 27 Gy in 5 daily fractions to the seroma plus 1 cm CTV and 0.7 cm PTV margins. Clinical photographs, patient and provider cosmetic scores, breast fibrosis, telangiectasia and pain were collected prospectively, prior to RT and at 6 weeks, 1 and 2 years after RT. The primary endpoint was the proportion of women who retained Excellent or Good cosmesis at 2 years using the EORTC Cosmetic Rating System. Cosmetic failure was deterioration from Excellent or Good to Fair or Poor. A panel of 5 radiation oncologists independently assessed the cosmetic photographs. Secondary endpoints were rates and grades of breast fibrosis, telangiectasia, breast pain, ipsilateral breast tumor recurrence (IBRT), overall (OS), breast cancer-specific survival (BCSS) and subsequent mastectomy. Efficacy outcomes were assessed at clinic visits and by review of charts. ClinicalTrials.gov registration: NCT02681107. A total of 298 patients were treated between April 25, 2016, and October 31, 2019. At a median follow up of 48 months, the 4-year OS was 98.5% (95% CI 96.1% - 99.5%) and BCSS was 99.7% (95% CI 97.6% - 99.9%). The 4-year IBRT rate was 3.3% (95% CI 1.1% - 6.4%). There were 10 contralateral breast events for a 4-year rate of 3.9% (95% CI 2.2% - 6.9%). There were 10 ipsilateral and 6 contralateral mastectomies. Two patients died of unrelated causes prior to 2 years;79 patients declined in-clinic attendance due to COVID or competing comorbidities and 217 women had 2-year cosmetic photographs and clinical assessments performed. Consensus of the photo-panel cosmesis at baseline was: Excellent: n=116 (53%), Good: n=102 (47%), Fair: n=1 (0.5%) and Poor: n=0. Consensus overall cosmesis at 2 years was: Excellent: n= 141 (65%), Good: n=78 (35%), Fair: n=0 and Poor: n=0. Most patients had either improved (n=168;77%) or no change (n=43;20%) in cosmesis at 2-years. No patient had cosmetic failure but 6 (3%) had a change from Excellent to Good at 2 years. Most patients reported either no (79%) or mild (21%) pain, with no moderate or severe pain. Two patients (0.9%) had grade 2 fibrosis and 5 patients (2%) had visible telangiectasia that did not detract from overall cosmesis. APBI using 27 Gy in 5 fractions using a conformal IMRT technique, achieved excellent 2-year cosmesis with minimal toxicity. The IBRT risk was comparable to the contralateral new breast cancer risk and to local recurrence rates of recently published early breast cancer trials. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)