QUASAR Induction Study 1 Cumulative Response to Guselkumab in Patients With Moderately to Severely Active Ulcerative Colitis

Introduction: Guselkumab (GUS), an IL-23p19 antagonist, had greater efficacy than placebo (PBO) in achieving clinical response and clinical remission atWeek (Wk) 12 in the randomized, controlled Phase 2b QUASAR Induction Study 1 (NCT04033445) in patients with moderately to severely active ulcerative colitis (UC).1 Patients who were not in clinical response at Wk 12 received GUS treatment through Wk 24. Here, we report GUS cumulative efficacy and safety results for Induction Study 1. Method(s): Eligible patients had moderately to severely active UC (modified Mayo score of 5 to 9 with a Mayo endoscopy subscore >=2) at baseline. Patients were randomized 1:1:1 to IV GUS 200mg, 400mg, or PBO at Wks 0, 4, and 8. Patients who were not in clinical response to IV induction at Wk 12 received GUS treatment (PBO IV->GUS 200mg IV;GUS 200mg IV->GUS 200mg SC;GUS 400mg IV->GUS 200mg SC) at Wks 12, 16, and 20 and were evaluated at Wk 24 (Figure). Matching IV or SC PBO was administered to maintain the blind. Result(s): Three hundred thirteen patients were randomized and treated at baseline. Demographic and disease characteristics at baseline were similar among the treatment groups, and approximately 50% had a prior inadequate response or intolerance to advanced UC therapy. AtWk 12, clinical response was achieved by 61.4% (62/101) and 60.7% (65/107) of patients randomized to GUS 200mg and GUS 400mg IV vs 27.6 % (29/105) of patients randomized to PBO IV (both p< 0.001). Of the patients in the GUS groups who were not in clinical response at Wk 12, 54.3% (19/35) in the GUS 200mg IV->200mg SC group and 50.0% (19/38) in the GUS 400mg IV->200mg SC group achieved clinical response at Wk 24. Clinical response atWk 12 or 24 was achieved by 80.2% of patients who were randomized to GUS 200mg IV and 78.5% of patients who were randomized to GUS 400mg IV. For patients who received PBO IV->GUS 200mg IV, clinical response at Wk 24 (65.2%) was similar toWk 12 clinical response following GUS 200mg IV induction (61.4%). The most frequent adverse events among all GUS-treated pts (n=274) were anemia (7.7%), headache (5.1%), worsening UC (4.4%), COVID-19 (3.6%), arthralgia (2.9%) and abdominal pain (2.6%) which are consistent with Wk 12 results. Conclusion(s): Overall, approximately 80% of patients randomized to receive GUS achieved clinical response at Wk 12 or 24. Continued treatment with SC GUS allowed 50-54.3% of IV GUS Wk 12 clinical nonresponders to achieve clinical response at Wk 24. No new safety concerns for GUS were identified. (Figure Presented).

The eXtraordinarY BABIES STUDY: EARLY SOCIAL COMMUNICATION SKILLS IN INFANTS WITH SEX CHROMOSOME TRISOMY (SCT)

Purpose of Study: The eXtraordinarY Babies Study is a natural history study of health and neurodevelopment in infants with a prenatal diagnosis of SCT. Given the increased risk for social difficulties and autism in SCT in later childhood and beyond, the study explores trajectories of early social communication development to identify early predictors of outcomes, and relationship of social communication skills to developmental profiles. Methods Used: A subset of 56 participants (XXY=43, XYY=4, XXX=9) from the eXtraordinarY Babies Study completed the Autism Diagnostic Observation Schedule- 2nd edition (ADOS-2), Toddler Module as part of the 12-month visit and The Bayley-3 Scales of Infant and Toddler Development. The ADOS-2 provides ratings of 0 (typical development), 1 (mild atypicality), and 2 (atypical) for communication, social interaction, and other behavior items, and an algorithm classifies total score into categories of: Little-No Concern, Mild-Moderate Concern, Moderate-Severe Concern. Analyses were limited to those who completed the assessment prior to COVID19 mask/shield requirements. Summary of Results: High rates of delayed or atypical development of early social communication skills were identified, with >75% of the sample showing scores of 1 or 2 in frequency of babbling, spontaneous vocalizations, gesture use, and pointing. 58% of the sample showed unusual eye contact and vocalizations. Over 50% received atypical scores on items assessing the quality of eye contact. Participants showed few restricted and repetitive behaviors. Results of ADOS-2 total scores: Little-no concern 50%, Mild-Moderate concern 35.7%, Moderate-severe concern 14.3%. No one was assigned a clinical diagnosis of ASD. For this group, Bayley-3 results showed average Cognitive (scaled score 10.8 sd1.9) and Fine motor skills (9.3 sd2.3), followed by lower Receptive (8.2 sd2.4) and Expressive Language (8.9 sd3.0) and below average Gross Motor skills (7.9 sd2.6). Receptive language scores negatively correlated with ADOS-2 Social Affect (r= -.38, p = < .001) and Overall Total (r= -.41, p = < .001). Conclusion(s): Even at an early age, toddlers with SCT are at increased risk for language, communication, and social interaction delays. While no participants were diagnosed with ASD at 12 months of age, social communication deficits known to be "red flags" for later diagnosis of ASD were seen in a subset of young children with SCT. Prospective follow-up will allow us to determine the trajectory of these deficits and those that may predict higher risk for more significant clinical symptoms.

COVID-19 and Professional Sporting Leagues: European Football

In Chapter 5, the authors argue that the global pandemic helped unmask the fragile financial position of professional football in Europe. This chapter shows how some clubs have been pushed to the financial brink – following the lockout of match day crowds – for a great deal of the 2020–2021 season. Specifically, as leagues were shut down across Europe, the authors highlight that league and club revenue streams dried up extremely quickly, resulting in significant cash flow problems for these entities. © 2023 selection and editorial matter, Stephen Frawley and Nico Schulenkorf;individual chapters, the contributors.

QUASAR Induction Study 1 Cumulative Response to Guselkumab in Patients With Moderately to Severely Active Ulcerative Colitis

Background: Guselkumab (GUS), an IL-23p19 antagonist, had greater efficacy than placebo (PBO) in achieving clinical response and clinical remission at Week (Wk) 12 in the randomized, controlled Phase 2b QUASAR Induction Study 1 (NCT04033445) in patients with moderately to severely active ulcerative colitis (UC).1 Patients who were not in clinical response at Wk 12 received GUS treatment through Wk 24. Here, we report GUS cumulative efficacy and safety results for Induction Study 1. Method(s): Eligible patients had moderately to severely active UC (modified Mayo score of 5 to 9 with a Mayo endoscopy subscore >=2) at baseline. Patients were randomized 1:1:1 to IV GUS 200mg, 400mg, or PBO at Wks 0, 4, and 8. Patients who were not in clinical response to IV induction at Wk 12 received GUS treatment (PBO IVGUS 200mg IV;GUS 200mg IV->GUS 200mg SC;GUS 400mg IV->GUS 200mg SC) at Wks 12, 16, and 20 and were evaluated at Wk 24 (Figure 1). Matching IV or SC PBO was administered to maintain the blind. Result(s): Three hundred thirteen patients were randomized and treated at baseline. Demographic and disease characteristics at baseline were similar among the treatment groups, and approximately 50% had a prior inadequate response or intolerance to advanced UC therapy. At Wk 12, clinical response was achieved by 61.4% (62/101) and 60.7% (65/107) of patients randomized to GUS 200mg and GUS 400mg IV vs 27.6% (29/105) of patients randomized to PBO IV (both p<0.001). Of the patients in the GUS groups who were not in clinical response at Wk 12, 54.3% (19/35) in the GUS 200mg IV->200mg SC group and 50.0% (19/38) in the GUS 400mg IV->200mg SC group achieved clinical response at Wk 24. Clinical response at Wk 12 or 24 was achieved by 80.2% of patients who were randomized to GUS 200mg IV and 78.5% of patients who were randomized to GUS 400mg IV. For patients who received PBO IV->GUS 200mg IV, clinical response at Wk 24 (65.2%) was similar to Wk 12 clinical response following GUS 200mg IV induction (61.4%). The most frequent adverse events among all GUS-treated pts (n=274) were anemia (7.7%), headache (5.1%), worsening UC (4.4%), COVID-19 (3.6%), arthralgia (2.9%) and abdominal pain (2.6%) which are consistent with Wk 12 results. Conclusion(s): Overall, approximately 80% of patients randomized to receive GUS achieved clinical response at Wk 12 or 24. Continued treatment with SC GUS allowed 50-54.3% of IV GUS Wk 12 clinical nonresponders to achieve clinical response at Wk 24. No new safety concerns for GUS were identified.

Introducing a model of business sustainability in English professional rugby union

Research question: The transition of rugby union as the last major team sport to go professional in 1995, has remained problematic. With ongoing challenges with financial health, the impact of COVID-19 and the need for more effective governance, the game has reached a pivotal moment in its history, if it is to become a sustainable sports business. The purpose of this paper is to introduce a model that identifies key characteristics of business sustainability in English professional rugby. Research methods: This paper is designed to position a case for change, by examining a range of issues that can deliver a theoretical method to support the achievement of sustainability of professional rugby union, and specifically the Gallagher Premiership. The development of the model is considered a starting point for further research based on the theoretical application of the economics of team sports and sports business modelling. Research findings: The development of a sustainable business model in professional rugby union has led to the identification of four key characteristics related to cost control, profit maximisation, business model innovation and governance. Practical implications: The authors argue that unless the custodians of the game take note of the need for reform relating to the extant models of business practice being operated in the Gallagher Premiership, there is the acute possibility that the growth of the game may be stifled or even cease to exist when the game is at its most popular. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Systemic Amyloid Light Chain (AL) Amyloidosis Patient Experience Research

Background: There is limited empirical evidence exploring the patient experience and treatment needs in AL-amyloidosis. Many patients experience delays in receiving a diagnosis and research suggests they suffer from a lack of support and information about the condition, worsening the impact of the disease on their quality-of-life. In June 2021 the EMA granted marketing authorisation for daratumumab in combination with bortezomib, cyclophosphamide and dexamethasone (DBCd) to treat adults with newly diagnosed AL-amyloidosis. Previously, patients have been treated with off-label therapies for multiple myeloma. Objective(s): To develop greater understanding of the diagnosis, management of the disease, and impact on patients and carers, in the UK. Method(s): A literature review and focus groups with adults living with AL-amyloidosis and a carer. Group 1 consisted of 3 adults, group 2 of 3 adults plus 1 carer. Groups were semi-structured;discussion topics included the patient journey, impact of disease, and COVID-19. Result(s): Despite delays to diagnosis, ongoing relationships with consultants fostered good communication with patients. In the treatment pathway, patients prioritised extension of life and quality-of-life, even if side-effects from treatment impaired quality-of-life. Participants spoke highly of their healthcare teams and experiences with the National Amyloidosis Centre. Impacts on daily life and emotional well-being tended to be more prominent among patients with a more complex disease pathway. For patients, time to diagnosis, ongoing communication with a trustworthy consultant, treatment outcomes and support was important. Although generally satisfied, suggestions for change across the diagnostic and treatment pathway were recommended. Striving for consistency of care and communication was paramount, and treatment impacts on day-to-day life (e.g., through minimising side-effects and convenient administration) should be prioritised. Conclusion(s): Results have the power to better inform healthcare decisions and the development of specific treatments, prioritising interventions that align with the unmet needs and preferences of people living with AL-amyloidosis. Copyright © 2022

Affective Responses of Older Adults to the Anthropomorphic GenieConnect Companion Robot During Lockdown of the COVID19 Pandemic

Anthropomorphic robots may reduce loneliness in older people, however, acceptance is requisite for adoption. We collected the experiences of 10 people aged 80-92 who used a pre-market social robot, GenieConnect, for between 2 to 35 days during the COVID19 pandemic restrictions. GenieConnect is a table-top robot with a large face and animated eyes, designed for support and companionship. The robot asked 'how are you feeling, Name' each day and delivered lifestyle prompts such as medication reminders. We observed conflicting responses from participants - five expressed positive responses, three negative (two of these withdrew) and two neutral. Positive comments included 'feeling not alone';'having someone to talk to';and enjoying being asked 'how are you feeling'. Negative comments were mainly related to not liking the eyes. Design adaptations were made to increase acceptance. We conclude that robots like GenieConnect could reduce loneliness when a user-centred design approach is taken. © 2022 IEEE.

Utility of Virtual New-Patient Clinics in Women Under 30

Aim: Virtual consultations (VC) in breast surgery have been successfully utilised during the COVID pandemic and have potential to reduce the costs of outpatient clinics as well as increase patient satisfaction. We aimed to assess the utility and safety of VC in new patient clinics in women under 30, which are considered a low-risk subgroup. Method: Data was prospectively collected on 118 women aged under 30 who were referred from primary care to the breast clinic between December 2020 and April 2021. Clinicopathological data was collected on referrals, imaging and follow up. Results: Median age was 24 years (range 17-30). The commonest presenting symptoms were a lump (69%), breast pain (16%) and nipple symptoms (14%). The VC was performed via video in 63 (53%) patients and via telephone alone in 55 (47%). Nineteen patients (16%) were reassured and discharged directly from VC. Ninety-four patients (80%) underwent an outpatient ultrasound with a sonographer trained in clinical palpation. Twenty-six (27%) ultrasounds showed benign pathology with the remainder being normal. Six biopsies were performed, all of which were benign. Seventeen (14%) patients required a face-to-face appointment with a breast surgeon after ultrasound or biopsy. Ninety-four (79%) patients were discharged after VC + ultrasound alone. No patients required surgery. Conclusions: Utilising VC, the majority of new referrals in women under 30 did not require face-to-face appointments. VC have potential to reduce burden on new patient clinics whilst improving patient convenience. Early data suggest a low risk of compromising safety in this subgroup.

Too Harsh for Me but Not for Thee? Threat Control, Personal Freedom, and Perception of Pandemic Policy

Policies implemented to control the COVID-19 (C19) pandemic have faced public resistance. We examined this issue via an experimental vignette study embedded in a May 2020 national (U.S.) survey conducted by YouGov. Specifically, we explore how the public perceived a local policymaker proposing a C19-related isolation policy, based on the policy’s invasiveness or its punitivity. We find that more intrusive and more punitive policies generally resulted in colder feelings towards, and harsher perceptions of, the policymaker. However, our results suggest that the main driver of public sentiment towards the policymaker was the invasiveness of the proposed policy, with the policy's punitivity being less impactful. We discuss these findings in relation to policymaking, policy support and compliance, and tradeoffs between informal/formal controls, and intrusive/punitive policies. [ FROM AUTHOR] Copyright of JQ: Justice Quarterly is the property of Routledge 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.)

IS TELEHEALTH EFFECTIVE FOR DIABETES CARE FOR THE UNDERSERVED, MINORITY AND COMPLEX PATIENTS

BACKGROUND: The rapid conversion to telehealth services as an alternative to in-person ambulatory care in response to COVID-19 required abrupt adaptations by patients with diabetes and their providers, that may have resulted in poorer outcomes for subgroups of the population. METHODS: We conducted a longitudinal population study from a diabetes registry with clinical and administrative data maintained for all patients with diabetes seen at an academic medical center. From this registry, we identified all patients seen at least once in the year before and after 03/20/20 at any of the 16 ambulatory care clinics at this site (n=9760) who also had ≧ 1 HbA1c value in both periods (n=4710), and those with ≧ 2 visits and ≧ 2 HbA1c values in the same periods (n=1553). We compared patient characteristics (age, gender, race/ethnicity, Charlson comorbidity score), clinic site [Federally Qualified Health Centers (FQHCs) vs. other ambulatory care sites], total number of ambulatory visits and number of telehealth visits, mean HbA1c mean value and % in poor control (HbA1c ≧ 9%) for both groups of patients. We used odds ratios for bivariate comparisons and logistic regression for multivariable analyses. RESULTS: The mean age of patients with ≧ 1 visit in the pre-post periods was 62.5 [SD 14.0], 47% were female, 40% were Hispanic, 28% had a Charlson score greater than the median, 37% were seen at an FQHC, and 18.9% had poor glycemic control (HbA1c ≧9%). Characteristics for patients with ≧ 2 visits were comparable. Poor control was more likely among those seen at FQHC sites (OR=3.17, p<.0002), those ≧65 years (OR=3.53, p<.0001), those with substantial comorbidity (Charlson ≧ median value, OR=1.40, p=.0011), Hispanic patients (OR=3.08, p<.0001) and those seen by telehealth (OR=1.59, p<.0001). Results for patients with ≧ 2 visits and corresponding HbA1c values were comparable. Parameter estimates from the logistic regression model predicting HbA1c ≧ 9% were all statistically significant and in the expected direction for the variables considered. CONCLUSIONS: Telemedicine is currently being considered for continuation as an accepted, efficient and safe mode of healthcare delivery. However, it may not be effective for specific subgroups of patients with chronic diseases such as diabetes in which patient partnership and the provider patient relationship are key to optimizing outcomes. Further, advances in the delivery of telehealth care, including easily accessed high quality technologies are needed to ensure that remote healthcare delivery does not further increase disparities in health outcomes, particularly for the poor, underserved, minorities, elderly and those with complex diseases.

Federated networks in England and Australia cricket: a model of economic dependency and financial insecurity

Purpose The purpose of this study is to critically examine the financial health and performance of the English and Australian cricket networks. This includes the county cricket clubs (CCC) and state and territory cricket associations (STCA) affiliated to the England and Wales Cricket Board (ECB) and Cricket Australia (CA) respectively, as well as the ECB and CA themselves. The authors apply resource dependency theory to understand if there are any financial dependencies within the networks of cricket in England and Australia. Design/methodology/approach The data for this research was obtained from the financial statements of the ECB, the 18 affiliated CCCs, CA and the six affiliated STCAs. This sample covers the last 5 years of financial information (2014-2019) for all the organisations at the time of writing. Ratio analysis was conducted on all organisations within the sample to assess financial health and performance. Findings Both CCCs and STCAs show signs of poor financial health. There is a clear dependence on the financial support they receive from the ECB and CA respectively and this dependence appears more prominent in Australia. The ECB and CA have better financial health which ultimately allows them to financially support the CCCs and STCAs. Originality/value The ECB and CA are facing difficult financial decisions to remain financially secure themselves due to the impact of COVID-19 but also to support their affiliated clubs. The affiliated clubs do not generate sufficient revenues and must diversity their revenue streams if they are to become financially self-sustaining. This financial structure and distribution mechanism will be vital in safeguarding the future of some of England's and Australia's most important cricket organisations.

Belonging as a responsive strategy in times of supercomplexity and change

Since 2011 the School of Media and Communication at RMIT University has been actively supporting an ethos of belonging throughout their learning and teaching. In 2017 ‘belonging’ became a formal university priority, embedded in the institution’s strategy and dispersed across Colleges and Schools through a range of activities and interventions. However, in the supercomplex COVID-19 landscape, practices of belonging are being reconsidered and reimagined for online learning environments. This paper outlines some of the reasons why belonging should be prioritised during times of intense change and complexity. We outline a range of responsive initiatives that have assisted staff and students as they rapidly shifted to a learning and teaching environment. Indeed, given our grounding in the field of media and communication, we seek to demonstrate that embracing supercomplexity through a disciplinary focus can in fact be productive for staff and students alike. Through this discussion we demonstrate how a belonging strategy at the institutional level can be translated as embedded practice at the level of the discipline and within micro-level classroom interventions. © 2022, University of Wollongong. All rights reserved.

The Impact of COVID-19 on People with Parkinson's: Insights from Wearable Sensors

Objective: To describe changes in daily activity measured by wearable sensors in participants with Parkinson's disease (PD) following the COVID-19 pandemic. Background: Digital tools provide objective, frequent and sensitive data collection in real-world settings. In a natural history study of PD, participants used wearable sensors before and after COVID-19 shutdowns. Design/Methods: At research visits throughout this two-year study at the University of Rochester Medical Center, participants wore sensors with accelerometer and gyroscopic capabilities and completed questionnaires. Following each visit, participants wore sensors remotely for 7 days during waking hours. Participant position and activity from days 1-6 of wear was classified from sensor data. Results: Prior to March 14 2020, when COVID-19 shutdowns began in Monroe County, NY, 17 participants with PD (70.4 (6.3) years) and 13 controls (61.1 (13.5) years) completed a baseline visit. All 30 later completed a month 12 visit after COVID-19 shutdowns. Sensor wear was comparable at baseline (13.9 (1.4) hours/day) and month 12 (13.74 (2.1) hours/day). At month 12, PD participants walked an average of 1709 (1457) steps/day, approximately 17% less than at baseline (2048 (1416) steps/day), with considerable individual variation. PD participants spent approximately 20% more time lying while awake at month 12 (112.7 (149.9) min) than at baseline (93.6 (103.1) min). Daytime sleep did not increase from baseline (39.6 (39.3) min) to month 12 (39.2 (32.8) min). PD and control participants reported greater anxiety and depression at month 12. From baseline to month 12, controls had similar activity trends as participants with PD, but walked more, spent less time lying, had less daytime sleep, and reported less depression and anxiety at both time points. Conclusions: Following the emergence of COVID-19, participants with PD walked less and spent more time resting. These data provide an objective measure of the pandemic's impact on a small cohort of individuals with PD.

COVID-Long Haulers Can Develop POTS (Postural Orthostatic Tachycardia Syndrome) with Small Fiber Neuropathy and Abnormal Autonomic Testing

Objective: A substantial number of COVID long-haulers have developed POTS, which warrants further investigation. This study is intended as a first look at a new and growing patient population that is bringing greater attention to the prevalent autonomic disease of POTS. Background: POTS (Postural Orthostatic Tachycardia Syndrome) is a disorder of autonomic dysregulation involving overactive compensation for postural blood pressure changes. This debilitating syndrome can be associated with small fiber neuropathy and a broad spectrum of autonomic symptoms including palpitations, changes in sweating, and gastrointestinal problems like constipation. Respiratory and gastrointestinal viruses have been known to cause onset of POTS pathophysiology. In approximately 10% of COVID cases, patients experience long-term health effects after the conclusion of their COVID infection. These patients are called COVID “long-haulers.” Design/Methods: We conducted a chart review of 25 Cleveland Clinic post-COVID POTS patients who are mostly female (84%) to learn about this patient population's distribution of top symptoms, comorbidities, autonomic testing, and autonomic questionnaire scores. Top three symptoms were determined based on the physician's note from the patients' initial visit to the Cleveland Clinic Neurology Department. Results: Our chart review revealed a high occurrence of excitatory comorbidities such as chronic migraine (44%) and irritable bowel syndrome (24%). In addition, when assessing patients' top three POTS symptoms, we found that palpitations, fatigue, and dyspnea were affecting patients most. As with POTS in general, autonomic testing outside of tilt table testing (85.7%) shows variable results with QSART (50%), skin punch biopsy (37.5%), deep breathing (14.3%), and Valsalva testing (0%) all showing positivity rates of 50% or less for our patient sample. Conclusions: Post-COVID POTS could be an excitatory process with hyperadrenergic signaling based on the symptoms and comorbidities. We hope that this chart review will be the launching point for future studies aimed at achieving greater understanding of the post-COVID POTS phenomenon.

Breathing Curriculum for Stress Reduction in High School Students: A Feasibility Randomized Controlled Trial

Methods: This cluster-randomized pilot compared 5-minute slow DB with treatment-as-usual among four 12th-grade public high school classes. Students individually participated in the curriculum after school during COVID-19-related hybrid teaching, with DB 3 times/week and breath science education once/week. Feasibility was based on overall compliance and qualitative assessments. Preliminary effectiveness was measured with the State-Trait Anxiety Inventory (STAI) and a timed-exhale carbon dioxide tolerance test (CO2TT). Descriptive statistics and repeated analysis of variance were performed to quantify and compare cross-sectional and temporal outcomes between classes and time periods. Human subjects research approval was granted through WCG-IRB. Results: Forty-two students consented to participate. Intervention and effectiveness assessments' compliance varied from 29-91% across classes and weeks, and decreased on average 40% from baseline to follow-up. Compliance of ease/ tolerability assessments ranged from 41% to 86%, and averaged 55% for open-ended assessments. Usefulness, ease and tolerability ratings for the DB ranged from 1.63±0.74 to 2.88±0.35 on scales of 0-3 (“not at all” - “very much”);and from 2.24±0.84 to 2.60±0.55 for effectiveness assessments. Students reported enjoying the DB, CO2TT, and breath science;some found the extended exhales challenging and the curriculum and assessments time-consuming. Outcome measures demonstrated trends towards improvements (e.g., improved STAI and CO2TT before-to-after breathing exercises), but were not statistically significant. Background: Nearly 1 in 3 US adolescents meet the criteria for anxiety, an issue that has worsened with the COVID-19 pandemic. We developed a video-based, 5-week, slow diaphragmatic breathing (DB) stress-reduction curriculum for high school students and evaluated its feasibility and preliminary effectiveness. Conclusion: Implementation of this 5-week slow breathing curriculum was feasible and tolerable to this cohort. Compliance, tolerability, and effectiveness may be improved with in-class participation. Future research on simple and accessible slow-breathing exercises is warranted to address today's adolescent stress-management crisis.

Utility of virtual new-patient clinics in women under 30

Aim: Virtual consultations (VC) in breast surgery have been successfully utilised during the COVID pandemic and have potential to reduce the costs of outpatient clinics as well as increase patient satisfaction. We aimed to assess the utility and safety of VC in new patient clinics in women under 30, which is considered a low-risk subgroup. Methods: Data was prospectively collected on 118 women aged under 30 who were referred from primary care to the breast clinic between December 2020 and April 2021. Clinicopathological data was collected on referrals, imaging and follow up. Results: Median age was 24 years (range 17-30). The commonest presenting symptoms were a lump (69%), breast pain (16%) and nipple symptoms (14%). The VC was performed via video in 63 (53%) patients and via telephone alone in 55 (47%). Nineteen patients (16%) were reassured and discharged directly from VC. Ninety-four patients (80%) underwent an outpatient ultrasound with a sonographer trained in clinical palpation. Twenty-six (27%) ultrasounds showed benign pathology with the remainder being normal. Six biopsies were performed, all of which were benign. Seventeen (14%) patients required a face-to-face appointment with a breast surgeon after ultrasound or biopsy. Ninety-four (79%) patients were discharged after VC + ultrasound alone. No patients required surgery. Conclusion: Utilising VC, the majority of new referrals in women under 30 did not require face-to-face appointments. VC have potential to reduce burden on new patient clinics whilst improving patient convenience. Early data suggest a low risk of compromising safety in this subgroup.

COVID-19, networks and sport. (Special Issue: Managing sport and leisure in the era of Covid-19.)

This commentary serves to provide a rapid analysis of the impact of coronavirus disease 2019 (COVID-19) on sporting mass gatherings. The focus of this commentary surrounds sporting mass gatherings and strategies to mitigate the spread of COVID-19, with a particular focus on the UEFA EURO 2020 competition. Further references to the 2020 Olympic Games, and community recreational football are made. The intention is to stimulate discussion, analysis, interest and research on what the initial impact of COVID-19 has on sport. COVID-19 could fundamentally change the way sport operates in the future and requires further analysis. We hope this commentary provides an interesting record and reference point for future research and practice of those operating in sporting organisations. Learning lesson from this crisis, must ensure sport managers and practitioners are better prepared in sport and society for similar events in the future.

COVID-19: the return of football fans. (Special Issue: Managing sport and leisure in the era of Covid-19.)

COVID-19 has sent a shockwave into society and sport. As result of this, sport and football resuming without spectators - fans or supporters, has brought a number of financial issues that has threatened the sustainability and future of many clubs. This commentary unpicks what has happened and some of the tensions, decision-making and consequences surrounding the return of spectators. The commentary presents the case that spectators are key to the survival of football clubs and that the United Kingdom Government must reverse their decision to not let spectators return. Now more than ever, these words hold substance, meaning and truly matter to clubs and their networked communities, "Football without fans is nothing".