Protection against SARS-CoV-2 Omicron BA.4/5 variant following booster vaccination or breakthrough infection in the UK.

Following primary SARS-CoV-2 vaccination, whether boosters or breakthrough infections provide greater protection against SARS-CoV-2 infection is incompletely understood. Here we investigated SARS-CoV-2 antibody correlates of protection against new Omicron BA.4/5 (re-)infections and anti-spike IgG antibody trajectories after a third/booster vaccination or breakthrough infection following second vaccination in 154,149 adults ≥18 y from the United Kingdom general population. Higher antibody levels were associated with increased protection against Omicron BA.4/5 infection and breakthrough infections were associated with higher levels of protection at any given antibody level than boosters. Breakthrough infections generated similar antibody levels to boosters, and the subsequent antibody declines were slightly slower than after boosters. Together our findings show breakthrough infection provides longer-lasting protection against further infections than booster vaccinations. Our findings, considered alongside the risks of severe infection and long-term consequences of infection, have important implications for vaccine policy.

Impact of Integrative Therapies on Patients with Metastatic Breast Cancer

Background: Integrative therapies are shown to support cancer patients' treatment plans, help with side effect management, and improve patients' quality of life ([1-9]). In 2017, the American Society of Clinical Oncology endorsed the Association of Integrative Oncology's Clinical Practice Guidelines highlighting their importance in breast cancer care. Recent studies suggest that more evidence is needed to bring attention to the role of integrative therapies in advanced breast cancer care [4, 7, 8, 10]. This analysis explores participants' experiences with a wellness program implemented by Unite for HER (UFH), a non-profit organization that delivers integrative therapies and support services such as whole food nutrition services, medical acupuncture, oncology massage therapy, counseling, reiki, meditation, yoga, and fitness classes to patients with breast, metastatic breast, and ovarian cancer. As of April 2022, there were over 1,700 women diagnosed with metastatic breast cancer (MBC) participating in UFH locally and nationally. Method(s): UFH members completed a survey about the impact of the UFH Wellness Program on the overall quality of life, including measures on side-effect management, OTC/prescription drug utilization rate, stress reduction, changes to wellness habits, and the social and emotional challenges associated with living with MBC. In total, 119 unique UFH members with MBC answered online surveys distributed by email in 2020 and 2021. Survey questions were designed to evaluate the impact of the UFH Wellness Program. Descriptive analyses of survey questions and openended comments were conducted to assess program impact. Result(s): All respondents were MBC patients/survivors. No other demographic information was collected. While 2020 respondents received mostly in-person services for part of their program, all 2021 respondents received primarily virtual services due to the Covid-19 restrictions. Despite the inaccessibility of in-person services, the satisfaction levels with the wellness program did not drop significantly in 2021. More than two-thirds of respondents (80% in 2020, 67% in 2021) indicated that the therapies offered through UFH Wellness Program significantly improved the side effects of their treatment for MBC. Notably, more than a quarter of respondents (28% in 2020, 26% in 2021) specified that due to UFH integrative therapies they were able to reduce or eliminate one or more OTC/prescription drugs to manage side effects. At the same time, the majority reported experiencing reduced levels of stress after utilizing integrative therapies offered by UFH (93% in 2020, 81% in 2021), as well as improvements in their emotional wellbeing (95% in 2020, 83% in 2021), and quality of life during or after treatment for MBC (97% in 2020, 96% in 2021). Also, 86% of respondents in both years indicated that UFH services, such as nutrition counseling, cooking classes, and exercise classes, helped them adopt and maintain healthier habits in their life. Furthermore, a qualitative analysis of open-ended comments found that 1) respondents expressed deep gratitude and appreciation for UFH integrative therapies, 2) noted that they would otherwise not be able to access such therapies due to financial barriers, and 3) helped them feel better prepared to cope with the psychosocial aspects of their MBC experience. Discussion(s): These results suggest that integrative therapies such as those offered by UFH can play a significant role in improving patients' outcomes by reducing stress and drug utilization to manage side effects and improving patients' well-being and quality of life during metastatic breast cancer treatment. These findings highlight the importance of choosing integrative oncology programs to support MBC patients' needs in managing the psychosocial and physical side effects of the disease.

ONLINE CO-DESIGN OF A UNIVERSITY WORK-BASED LEARNING DEGREE PROGRAMME: LESSONS LEARNED FROM COMPARING CASES IN UNITED KINGDOM AND ESWATINI

Greater collaboration is required between universities, industry and society to provide the engineering education that will tackle society's challenges. Work-based learning (WBL) programmes offer an industry-aligned, academically-informed education to support such socio-economic development. Co-design of such programmes is vital with responses to the COVID-19 pandemic innovating alternative ways to design programmes. Knowles et al (2021) [1] outlined an approach to online programme co-design in the UK university context, framed using Signature Pedagogy and through online conferencing and Miro (online whiteboard). Subsequently, the approach has been utilised to co-design a WBL degree programme in Electrical Engineering in Eswatini, supported by Knowles and other UK and Eswatini colleagues. This paper compares and contrasts cases from UK and Eswatini, and from this address the research question, "What considerations are required to support an effective online process to co-design a work-based learning programme in Engineering?” A collaborative autoethnographic methodology based around field notes, observations and reflections is used to allow exploration across pedagogy, technology, work practices, expectations and challenges. Many aspects of the approach worked well in both cases (for example, effectiveness of Signature Pedagogy, Miro as shared space), whereas differences arose related to limitations in the synchronous use of technologies, and readiness to adopt an outcome-focused approach. Addressing these differences, along with balancing progress against full participation and having clear expectations of participants, are key considerations in online co-design of WBL programmes. Moreover, the approach of Knowles (ibid) has shown to be adaptable with potential for broader adoption. © 2022 SEFI 2022 - 50th Annual Conference of the European Society for Engineering Education, Proceedings. All rights reserved.

Multi-centre review of systemic anti-cancer prescribing patterns and treatment drop off rates in the United Kingdom 2018-2021

Background: The treatment landscape of metastatic renal cell carcinoma (mRCC) has evolved over recent years with several systemic anti-cancer therapies (SACT) licensed across different lines of treatment. There is ongoing discussion amongst oncology professionals about how best to optimise treatments in terms of sequencing to maximise the potential number of lines or to give the best treatments first. A previous south-west UK audit was completed in 2021 reviewing the drop off rates across 5 UK sites identifying that 69% of patients were able to receive second line therapy and 34% were able to receive third line therapy. Method(s): In this study we conducted retrospective analysis of all patients who commenced treatment with SACT for mRCC between 1st January 2018 and 30th June 2021 in 18 centres across the 4 nations of the United Kingdom. All NHS reimbursed treatment options including the COVID interim treatment guideline options were included. Patients who received SACT as part of a clinical trial were also included. Patients who continued on their respective lines of treatment were censored. We also identified patients who had been on a period of active surveillance before staring SACT in this cohort. Result(s): 1549 patients (71% male: 29% female) were included. IMDC subgroup patients included 21.6%favourable, 52.3% intermediate, 25.1%poor and 1% unavailable. 9.1% of patients had been on active surveillance before starting SACT - defined as a period of longer than 3 months from mRCC diagnosis to starting SACT. Of those patients that started SACT 60.5% of eligible patients had 2nd line therapy, 25.3% had 3rd line, 7.2% received 4th line therapy and only 1% had 5th line therapy. In the 1st line setting 58.9% received single agent VEGF TKI, 24.5% received combination ipilimumab and nivolumab (IO-IO) immunotherapy, 14 % received IO/ VEGF TKI combination and 2.6% received other/trial treatment. The single agent VEGF TKI ratio for 1st line SACT declined year by year with rising IO-IO and IO/VEGF TKI combination ratios seen. In the secondand third-line settings cabozantinib (33.2% 2nd line and 44.4% 3rd line) and nivolumab (32.8% 2nd line and 22.6% 3rd line) were the most common options. Disease progression or death was the most common cause of SACT discontinuation amounting to 57.4%, 62.5% and 79% of SACT cessation in the 1st, 2nd and 3rd lines respectively. Treatment toxicity SACT discontinuation rates were 22.8%, 21.4% and 10.9% for 1st, 2nd and 3rd lines respectively. Conclusion(s): These results suggest that with more treatment options available, including combination/immunotherapy therapies, more patients are able to receive second- and third-line therapies. That said there remains significant drop off rates mostly driven by disease progression that would support the use of our most effective therapies in the upfront setting.

Starting anew: ecotourism and resilience principles as a framework for building wildlife destination sustainability in a post-COVID-19 pandemic world

The wildlife tourism industry faces increasing threats of climate change and human demand, both of which have been exacerbated by the COVID-19 pandemic. The decrease in human activity resulting from the pandemic has created disruptions for wildlife tourism destinations that are being felt by the local communities, the wildlife, and the surrounding environment. This paper examines the impacts of these disruptions and highlights the opportunity for wildlife destinations to start building back towards the goal of sustainability with increased resilience. The principles of resilience and ecotourism are examined, with the intersecting and applicable fundamentals further explained. A framework for wildlife destination sustainability is then presented alongside a conceptual model for policymakers, tourism operators, and community leaders to consider. This study argues that wildlife tourism destinations should apply and promote sound ecotourism principles to better prepare for and recover from disruptions, promote biodiversity conservation, and support socio-economic stability. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Global food systems in the wake of COVID-19

Research by the International Food Policy Research Institute (IFPRI) on the impacts of Covid-19 regarding global food security suggests that the poor are disproportionately affected. Furthermore, the pandemic appears to have pushed more people into poverty in rural than in urban areas. Analyses also address impacts which Covid-19 has had on supply chains. This article looks at some of the findings and emphasises the role of policies in making food systems sustainable, resilient and inclusive.

Understanding educators' perspectives and experiences of COVID-19 in schools serving children with intellectual/developmental disabilities

The COVID-19 pandemic has significantly impacted educators, both personally and professionally. However, very little is known about the extent of these impacts among educators' serving children with intellectual and developmental disabilities (IDD). The present study surveyed 230 educators (teachers, staff, and administrators) to assess their wellbeing, concerns during the pandemic, and perceived importance of various COVID-19 school mitigation strategies. Data were gathered May/June of 2021 from two separate school districts, one in the Midwest and the other in the Mid-Atlantic, serving children with IDD. Nearly half of all survey respondents reported poor wellbeing. Almost all educators reported health of themselves, students, and family members was their greatest concern when compared to pandemic-related disruption of their duties or benefits (e.g., not having enough sick time). Most educators felt disinfecting routines, vaccinations, and daily health checks were the most helpful in preventing the spread of COVID-19 in schools, while in-school mask mandates and weekly testing of students and staff were perceived as less helpful. Our findings suggest that efforts are needed to support the wellbeing of educators during these challenging times. When pandemic-related policies and procedures are decided by administrators, our data suggest educators will review decisions within the framework of health and safety of themselves, their students, and families. Understanding this framework may be particularly valuable when considering implementation of COVID-19 policies, like masking and COVID-19 testing, that are less preferred.

Teledermatology visits favor specific diagnosis codes

Background: The COVID-19 pandemic sparked increased utilization of telemedicine services, as telemedicine offers care at a safe distance. Dermatology is well-suited for telemedicine due to its visual nature;however, concerns regarding diagnostic accuracy limit its widespread use. Visits for certain types of concerns may be more conducive to virtual visits than others. Further study of teledermatology may reveal trends in visit types and influence future integration into practice. Methods: Thomas Jefferson University analyzed aggregated, de-identified data from FAIR Health’s FH NPIC repository of privately insured medical claims, for telehealth services performed by dermatologists between 2019 and 2020 at urban and rural levels. Calculations were performed to determine the percentage of teledermatology visits that used specific diagnosis codes relative to all teledermatology visits. Visits were also assessed for the following parameters: demographics, diagnosis codes, and procedure codes. Results: Diagnosis codes L70.0 and L71.0, which primarily pertain to acne and rosacea, comprised 61% and 75% of Disorders of Skin Appendages teledermatology claims in 2019 and 2020 respectively. In 2019, teledermatology visits most often used diagnosis codes L60-75 in both urban and rural locations (33.7% and 31.9%, respectively). Moreover, from 2019 to 2020, the percentage of teledermatology visits that used codes L60-75 was 1.35 times greater in urban locations and 1.48 times greater in rural locations. Conclusions: Teledermatology visits favored specific diagnoses, specifically pertaining to acne and rosacea. This suggests that these diagnoses may be more conducive to virtual visits relative to other diagnoses such as skin neoplasms or papulosquamous disorders, including psoriasis.

Investing in Canada?s nursing workforce post-pandemic: A call to action br

Nurses represent the highest proportion of healthcare workers globally and have played a vital role during the COVID-19 pandemic. The pandemic has shed light on multiple vulnerabilities that have impacted the nursing workforce including critical levels of staffing shortages in Canada. A review sponsored by the Royal Society of Canada investigated the impact of the pandemic on the nursing workforce in Canada to inform planning and implementation of sustainable nursing workforce strat-egies. The review methods included a trend analysis of peer-reviewed articles, a jurisdictional scan of policies and strategies, analyses of published surveys and interviews of nurses in Canada, and a targeted case study from Nova Scotia and Saskatchewan. Findings from the review have identified longstanding and COVID-specific impacts, gaps, and opportunities to strengthen the nursing workforce. These findings were integrated with expert perspectives from national nursing leaders involved in guiding the review to arrive at recommendations and actions that are presented in this policy brief. The findings and recommendations from this policy brief are meant to inform a national and sustained focus on retention and recruitment efforts in Canada.

NOBODY SHOULD DIE IN HANDCUFFS: A CASE FOR ENDING SHACKLING AT THE END OF LIFE

CASE: A 75-year-old incarcerated man presented to the ED with one week of chills, body aches, dry cough, and dyspnea. His past medical history was significant for hypertension, type II diabetes, and obesity. He had been incarcerated for 18 years and was looking forward to his release in five months. He was identified as African-American in his chart. On initial evaluation, his oxygen saturation was 87% on room air with otherwise normal vitals. His breathing was labored with crackles in the lung bases. His chest x-ray showed multifocal opacities. He tested positive for SARS-CoV- 19 and was admitted on high-flow nasal cannula. In the following week, his oxygen needs escalated and he was transferred to the Medical ICU. Multiple requests for medical clearance to contact family were declined by the correctional facility. On day 8, he was intubated, paralyzed, and proned. He remained shackled to his bed with two correctional officers posted outside his door. On day 14, he suffered a PEA arrest with return of spontaneous circulation following ACLS. Attempts to contact family are approved and his care plan is changed to comfort measures only. He was terminally extubated and passed away soon after. Throughout the hospitalization, including during his cardiac arrest, the patient remained shackled to his hospital bed by the left ankle. Two correctional officers were stationed outside his hospital room 24 hours per day. The medical team had been unable to contact the patient's next of kin until the day he arrested, at which time they opted to pursue comfort measures. Months later, a medical resident who had cared for him shared the following words during a reflective writing session: “Nobody should die in handcuffs.” IMPACT/DISCUSSION: End-of-life care for incarcerated people is a pressing issue in the United States, where approximately 2.4 million individuals are held within the prison system. Due to an aging prison population, more incarcerated patients are dying than ever before. It is predicted that by 2030, the number of elderly prisoners is expected to reach 400,000 - an increase of 4,400% since 1981, according to a 2012 report from the ACLU. Most jurisdictions in the United States require shackling of the hands or feet when inmates are transported outside the prison setting. For patients with debilitating illness, shackling in the medical setting violates the principles of beneficence, non-maleficence, and autonomy essential to the practice of medicine. The COVID-19 pandemic has further underscored the ethical, legal, and moral dilemmas which clinicians face in preserving the dignity of the dying patient. CONCLUSION: Given the expected changes in demographics within the US correctional system, clinicians must advocate for compassionate policies such as the removal of shackles at the end of life. Potential avenues for change in practice can involve increased medical-legal dialogue and partnerships with correctional officers and other stakeholders within medical and correctional institutions.

SARS-CoV-2 antibody trajectories after a single COVID-19 vaccination with and without prior infection.

Given high SARS-CoV-2 incidence, coupled with slow and inequitable vaccine roll-out in many settings, there is a need for evidence to underpin optimum vaccine deployment, aiming to maximise global population immunity. We evaluate whether a single vaccination in individuals who have already been infected with SARS-CoV-2 generates similar initial and subsequent antibody responses to two vaccinations in those without prior infection. We compared anti-spike IgG antibody responses after a single vaccination with ChAdOx1, BNT162b2, or mRNA-1273 SARS-CoV-2 vaccines in the COVID-19 Infection Survey in the UK general population. In 100,849 adults median (50 (IQR: 37-63) years) receiving at least one vaccination, 13,404 (13.3%) had serological/PCR evidence of prior infection. Prior infection significantly boosted antibody responses, producing higher peak levels and/or longer half-lives after one dose of all three vaccines than those without prior infection receiving one or two vaccinations. In those with prior infection, the median time above the positivity threshold was >1 year after the first vaccination. Single-dose vaccination targeted to those previously infected may provide at least as good protection to two-dose vaccination among those without previous infection.

A New View of Internationalization: From a Western, Competitive Paradigm to a Global Cooperative Strategy

Internationalization as a concept and strategy for, and in, higher education has evolved over the past four decades. Currently, discussion is increasing over whether internationalization is yet taking more distinctive forms in different parts of the world which better reflect local needs and priorities. We first consider several important moments in the development of international dimensions of higher education over the past hundred years which reflect the multidimensional and progressive development of internationalization: from an isolated to a process approach. Then we address the call for rethinking internationalization around the turn of the century, with initiatives such as internationalization of the curriculum in Australia and the UK and, across Europe, ‘Internationalization at Home’. The Covid-19 pandemic brought to the forefront a further rethinking: ‘internationalization of higher education for society’ and virtualization. But, internationalization continues to both reflect and exacerbate the inequalities in global societies. Moving our understanding of internationalization from a western, competitive paradigm to a global cooperative strategy is now an imperative for the coming years. © 2022 Journal of Higher Education Policy and Leadership Studies. All rights reserved.

Service improvement project: Gestational diabetes, nutrition & lifestyle

Aims: Gestational diabetes group education was delivered face to face prior to the covid-19 pandemic. An online workshop was set up in September 2020 to deliver remote group training on diet and lifestyle for blood glucose management in pregnancy. This created a safe, supportive environment to deliver education to patients and allowed efficient use of staffing during the pandemic response. Methods: An Eventbrite page for gestational diabetes workshop was set up and a presentation with additional resources created. A midwife referral system was created from two hospital sites and participants recruited weekly. Sessions were delivered online via Microsoft Teams and emails with resources sent to patients after the workshop. Data was collected on Excel regarding attendance and a follow up questionnaire via Survey Monkey. Results: Twenty six online workshops over eight months (November 2020-June 2021) had a total of 166 patient bookings. There was equal distribution across the two sites and an attendance rate of 59%. Forty patients completed the Survey Monkey questionnaire where it was found that 100% enjoyed and would recommend the session;47.5% strongly agree and 52.5% agree that they have a good understanding of Gestational Diabetes and how to manage it and 40% strongly agree, 57.5% agree and 2.5% neither agree/disagree with being confident to manage Gestational diabetes with diet and exercise. Conclusion: Virtual group workshops are an effective way to educate gestational diabetes patients on their diet and lifestyle to manage their blood glucose.

An Observational Cohort Study on the Incidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection and B.1.1.7 Variant Infection in Healthcare Workers by Antibody and Vaccination Status.

BACKGROUND: Natural and vaccine-induced immunity will play a key role in controlling the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. SARS-CoV-2 variants have the potential to evade natural and vaccine-induced immunity. METHODS: In a longitudinal cohort study of healthcare workers (HCWs) in Oxfordshire, United Kingdom, we investigated the protection from symptomatic and asymptomatic polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection conferred by vaccination (Pfizer-BioNTech BNT162b2, Oxford-AstraZeneca ChAdOx1 nCOV-19) and prior infection (determined using anti-spike antibody status), using Poisson regression adjusted for age, sex, temporal changes in incidence and role. We estimated protection conferred after 1 versus 2 vaccinations and from infections with the B.1.1.7 variant identified using whole genome sequencing. RESULTS: In total, 13 109 HCWs participated; 8285 received the Pfizer-BioNTech vaccine (1407 two doses), and 2738 the Oxford-AstraZeneca vaccine (49 two doses). Compared to unvaccinated seronegative HCWs, natural immunity and 2 vaccination doses provided similar protection against symptomatic infection: no HCW vaccinated twice had symptomatic infection, and incidence was 98% lower in seropositive HCWs (adjusted incidence rate ratio 0.02 [95% confidence interval {CI} < .01-.18]). Two vaccine doses or seropositivity reduced the incidence of any PCR-positive result with or without symptoms by 90% (0.10 [95% CI .02-.38]) and 85% (0.15 [95% CI .08-.26]), respectively. Single-dose vaccination reduced the incidence of symptomatic infection by 67% (0.33 [95% CI .21-.52]) and any PCR-positive result by 64% (0.36 [95% CI .26-.50]). There was no evidence of differences in immunity induced by natural infection and vaccination for infections with S-gene target failure and B.1.1.7. CONCLUSIONS: Natural infection resulting in detectable anti-spike antibodies and 2 vaccine doses both provide robust protection against SARS-CoV-2 infection, including against the B.1.1.7 variant.

Antibody responses and correlates of protection in the general population after two doses of the ChAdOx1 or BNT162b2 vaccines.

Antibody responses are an important part of immunity after Coronavirus Disease 2019 (COVID-19) vaccination. However, antibody trajectories and the associated duration of protection after a second vaccine dose remain unclear. In this study, we investigated anti-spike IgG antibody responses and correlates of protection after second doses of ChAdOx1 or BNT162b2 vaccines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United Kingdom general population. In 222,493 individuals, we found significant boosting of anti-spike IgG by the second doses of both vaccines in all ages and using different dosing intervals, including the 3-week interval for BNT162b2. After second vaccination, BNT162b2 generated higher peak levels than ChAdOX1. Older individuals and males had lower peak levels with BNT162b2 but not ChAdOx1, whereas declines were similar across ages and sexes with ChAdOX1 or BNT162b2. Prior infection significantly increased antibody peak level and half-life with both vaccines. Anti-spike IgG levels were associated with protection from infection after vaccination and, to an even greater degree, after prior infection. At least 67% protection against infection was estimated to last for 2-3 months after two ChAdOx1 doses, for 5-8 months after two BNT162b2 doses in those without prior infection and for 1-2 years for those unvaccinated after natural infection. A third booster dose might be needed, prioritized to ChAdOx1 recipients and those more clinically vulnerable.