Prescription Opioid Use Among Cancer Patients before and after the Onset of COVID-19: Evidence from Real-World Data

Objectives: Opioids play a significant role in the effective management of cancer-related pain. The COVID-19 lock down may have reduced access to opioids and caused a decline in the use of prescription of opioids among cancer survivors. This study compared opioid prescription rates among cancer survivors before and after the onset of COVID-19 pandemic using real-world electronic health records (EHR). Method(s): Cohort analyses of cancer patients using data from EHR database from the TriNetX, a global federated health research network across 76 healthcare organizations. We analyzed changes in prescription opioid use before (March 1, 2018, through March 1, 2019) and after onset of COVID-19 (April 01, 2020, through March 2021) among cancer survivors. The key outcome variable was any opioid prescription within 1 year of cancer diagnosis. One-to-one propensity score matching was used to balance the characteristics (age, sex, race, diagnoses including diabetes, hypertensive diseases, overweight, mood disorders, and visual disturbances) of the two cohorts. Data were analyzed using the TriNetX platform. Result(s): There were 1,502,143 cancer survivors before COVID-19 and 1,412,599 cancer survivors after the onset of COVID-19. The one-to-one propensity-score match yielded 1,382,561 cancer patients, mean age 64 at cancer diagnosis, and 73% were white. Percentage of opioid use among cancer patients declined from 35.6% before the COVID-19 to 35.1% after the onset of the pandemic (OR=0.976, 95% CI 0.971-0.981). Average number of opioid prescriptions within 1 year of cancer diagnosis declined from 5.7 before to 5.3 after the COVID-19 onset (p<0.001). Conclusion(s): Among cancer survivors, a small decline in prescription opioid use was observed after the onset of COVID-19 pandemic. Future studies are needed to distinguish the impact of revised guidelines, opioid prescription policy changes, and COVID-19 lock down on lower rates of prescription opioid use among cancer survivors.Copyright © 2023

Depression Severity Among Patients with Psychiatric Disorders during the COVID-19 Pandemic

Objectives: The impact of the COVID-19 pandemic on mental health is not yet well-studied. This study's objective is to describe demographic characteristics of the population diagnosed with depression or anxiety, and to compare PHQ9 scores before and after the pandemic. Method(s): A retrospective cohort study was performed using Komodo Health's healthcare claims and EMR data, which included Patient Health Questionnaire-9 (PHQ9) survey responses. The study's baseline and follow-up periods were set as one year before and after 03/01/2020. Patients selected were >=18 years of age, had a MDD, GAD, or other psychiatric diagnosis in both periods, and had taken at least one PHQ9 survey in both periods, resulting in 10,433 patients. Demographic characteristics were described across age, gender, and race/ethnicity, and a subgroup analysis was performed on PHQ9 scores and depression categories using averages (mean, SD) and odds ratios. Result(s): Demographic analysis showed depression severity correlated with patients who were younger, female, and Black or Hispanic. Younger patients (<30) were more likely than older (>=30) to be in the moderately severe category or worse (PHQ9 score >=15) in both time periods (ORs 1.72 and 1.62, p<0.001). This was also true for female as compared to male (ORs 1.45 and 1.49, p<0.001), and Black or Hispanic as compared to White (ORs 1.87 and 1.47, p<0.001). However, mean PHQ9 scores tended to decrease in the follow-up period. The overall mean decreased slightly from 6.28 (SD 6.05) to 5.68 (SD 5.82), which was consistent in nearly all age, gender, and race/ethnicity subcategories. Conclusion(s): While the improvements in average PHQ9 scores were counterintuitive, given the harmful impacts of the pandemic, existing correlations between demographics and depression severity remained. One possible explanation is that this cohort definition selected for patients who received more consistent mental healthcare. Further study will investigate this and other possible factors.Copyright © 2023

Black Lives Experiencing Homelessness Matter: A Critical Conceptual Framework for Understanding How Policing Drives System Avoidance among Vulnerable Populations

This paper examines racialized encounters with the police from the perspectives of people experiencing homelessness in San Diego, California in 2020. By some estimates, homelessness doubled in San Diego during the first year of the COVID-19 pandemic. We conducted a survey of (n = 244) and interviews with (n = 57) homeless San Diegans during initial shelter-in-place orders, oversampling for Black respondents, whose voices are often under-represented despite high rates of homelessness nationally. Our respondents reported high rates of police contact, frequent lack of respect;overt racism, sexism, and homophobia;and a failure to offer basic services during these encounters. Centering our Black respondents' experiences of criminalization and racism in what Clair calls "criminalized subjectivity," we develop a conceptual framework that brings together critical theoretical perspectives on the role of race in the governance of poverty and crime. When people experiencing extreme poverty face apathy, disrespect, and discrimination from police—as our data show—the result is a reluctance to seek services and to engage with outreach when offered. This reinforces stereotypes of unhoused people as not "wanting" help or "choosing" to be homeless. We reflect on these findings and our framework for envisioning a system of public safety that supports and cares for—rather than punishes—the most vulnerable members of our society. [ FROM AUTHOR] Copyright of Public Integrity is the property of Taylor & Francis Ltd 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.)

Educational attainment, race, and employability post COVID-19: insights from data visualization

The COVID-19 pandemic caused unemployment rates to reach record highs, adding to an already unequally divided system (Kawohl & Nordt, 2020). Minorities' unemployment rates in the United States were significantly higher in 2020 than the white unemployment rate, regardless of educational attainment. This study draws upon U.S. census data after the onset of the pandemic to investigate the relationship between educational attainment, race, and employment rates in the United States. Logistic regression revealed that the probability of being employed in 2020 was higher for whites than minorities and significantly higher for those with higher levels of education. Based on these preliminary results, we discuss the relationships among race, educational attainment, and employment, and suggest routes for further inquiry. © Issues in Information Systems.

Innovative Methods for Integrating Social Determinants of Health Data with Administrative Claims to Facilitate Health Equity Research

Objectives: The Covid-19 pandemic highlighted the importance of considering Social Determinants of Health (SDoH) in healthcare research. Administrative claims databases are widely used for research, but often lack SDoH data or sufficient transparency in how these data were obtained. This study describes innovative methods for integrating SDoH data with administrative claims to facilitate health equity research. Method(s): The HealthCore Integrated Research Database (HIRD) contains medical and pharmacy claims from a large, national US payer starting in 2006 and includes commercial (Comm), Medicare Advantage (MCare), and Medicaid (MCaid) populations. The HIRD includes individually identifiable information, which was used for linking with SDoH data from the following sources: national neighborhood-level data from the American Community Survey, the Food Access Research Atlas, and the National Center for Health Statistics' urbanicity classification;and member-level data on race/ethnicity from enrollment files, medical records, self-attestation, and imputation algorithms. We examined SDoH metrics for members enrolled as of 05-July-2022 and compared them to the respective US national data using descriptive statistics. We also examined telehealth utilization in 2022. Result(s): SDoH data were available for ~95% of currently active members in the HIRD (Comm/MCare/MCaid 12.5m/1m/7.6m). Socioeconomic characteristics at the neighborhood-level differed by membership type and vs. national data: % of members with at least a high-school education (90/88/84 vs. 87);median family income ($98k/$76k/$70k vs. $82k);% of members living in low-income low-food-access tracts (9/14/18 vs. 13);urban (57/52/47 vs. 61). At the member-level, the % of White Non-Hispanics, Black Non-Hispanics, Asian Non-Hispanics, and Hispanics were 61/6/5/6 (Comm), 76/12/2/2 (MCare), and 45/26/5/19 (MCaid). Imputation contributed 15-60% of race/ethnicity values across membership types. Telehealth utilization increased with socioeconomic status. Conclusion(s): We successfully integrated SDoH data from a variety of sources with administrative claims. SDoH characteristics differed by type of insurance coverage and were associated with differences in telehealth utilization.Copyright © 2023

Ethnic, racial and migrant inequalities in respiratory health

Disparities in the incidence, prevalence, and morbidity and mortality rates of many respiratory diseases are evident among ethnic groups. Biological, cultural and environmental factors related to ethnicity can all contribute to the differences in respiratory health observed among ethnic minority groups, but the inequalities observed are most commonly due to lower socioeconomic position. People who migrate within a country or across an international border may experience an improvement in respiratory health associated with improvements in socioeconomic position. However, migrants may also experience worse health outcomes in destination countries, as they are faced by barriers in language and culture, discrimination, exclusion and limited access to health services. While some high-quality studies investigating ethnicity and respiratory health are available, further research into ethnic differences is needed. Improving the recording of ethnicity in health records, addressing barriers to accessing respiratory healthcare and improving cultural literacy more generally are some of the ways that inequalities can be tackled.Copyright © ERS 2023.

The Impact of Stay-at-Home Orders on Binge Drinking Patterns in the US

Objectives: This study aims to evaluate the impact of the stay-at-home orders, especially closing and reopening bars and other drinking establishments, on binge drinking patterns in US populations in Metropolitan Statistical Areas (MSAs). Method(s): Data on binge drinking and heavy binge drinking for this study was extracted from the 2018-2021 Behavioral Risk Factor Surveillance System (BRFSS). Data on regulations were collected by National Academy for State Health Policy. We used two staggered differences-in-differences strategies to account for monthly variations in bar regulations. We implemented a strategy that used never treated states as controls via the Stata package CSDID and a strategy that directly imputed counterfactuals for treated states via the Stata package FECT. The outcomes were measured by the number of binge drinkers or heavy binge drinkers per 1000 population. The treatment effect was estimated while controlling for age, income level, race, chronic conditions, gender, MSA fixed effects, and month fixed effects. Stay-at-home orders were coded as 1 in the first full month of implementation and were assumed to impact the entire state equally. Bars were assumed to reopen if the indoor service has been reactivated at any capacity. Result(s): For heavy binge drinking, the average treatment effect on the treated group was 4.86 per 1000 population (p=0.027) using FECT package and 6.74 per 1000 population (p = 0.025) using CSDID package. No significant effect was found for binge drinking. Conclusion(s): We provide suggestive evidence that stay-at-home orders may have increased heavy binge drinking in metropolitan areas. We estimated this led to a 3.38% (FECT) or 4.68% (CSDID) increase in heavy binge drinking during the pandemic. Future work will assess the characteristics of areas that saw the greatest increase in heavy binge drinking, and explore why heavy binge drinkers were more vulnerable than binge drinkers during the Covid.Copyright © 2023

Economic Inequality during Covid-19 as a Pathway to Food Insecurity for People who are Disabled and Racialized as Non-White

Covid-19 heightened economic inequality across the U.S., especially for people who are disabled and non-white. These intersecting economic vulnerabilities open pathways to hunger. Using a survey from July 2020 (n = 2,043) in the Intermountain West, we find that economic inequality explained a substantial portion of food insecurity for people with disabilities. Racially stratified models show that people who were also non-white were more likely to be food insecure and receive differential protection from economic resources. Stronger social support will help mitigate food insecurity, yet such programs must grapple with the ways that ableism and racism intersect, especially during economic shock.Copyright © 2022 Taylor & Francis Group, LLC.

Women and Alzheimer's disease risk: a focus on gender

A previous chapter highlighted the biological mechanisms by which female sex contributes to Alzheimer's disease (AD) risk and outcomes. However, discussion of AD in women is incomplete without considering the impact of female gender on AD risk, as gender encompasses psychosocial and cultural differences between women and men that also modulate risk for cognitive decline. The current chapter discusses several main social determinants of health and explains how women, as a historically oppressed population, may be particularly vulnerable to the effect of each on cognition. This chapter also considers the disproportionate female burden of dementia caregiving, how associated stresses augment risk for later cognitive decline among caregivers themselves, and how the COVID-19 pandemic may add to this risk. Understanding the gender-specific factors that affect AD risk and disease progression is essential for developing targeted preventative interventions and treatments. Future research is necessary to better characterize how social determinants of health uniquely impact female cognition compared to males. Moreover, future studies focused on gender identities outside of the male–female binary are critical to developing a holistic understanding of how gender may impact late-life cognition. © 2023 Elsevier Inc. All rights reserved.

Vulnerabilidades das travestis e das mulheres trans no contexto pandêmico

Este artigo objetiva analisar os impactos da pandemia de Covid-19 na comunidade LGBTQIA+, em específico a situação das travestis e mulheres trans. Nessa direção, este texto privilegia a análise secundária em uma pesquisa direcionada à população nacional LGBTQIA+ e outra pesquisa direcionada às travestis e mulheres trans da cidade de São Paulo, bem como a revisão bibliográfica do tema proposto. Para tanto, nos apropriamos das categorias que perpassam e vão além da questão de gênero e incorporam a diversidade humana, contemplando as relações sociais de sexo, raça e classe social, bem como aquelas que determinam as mutações do mundo do trabalho no contexto do "capitalismo pandêmico”.Alternate :This article aims to analyze the impact of pandemic the new coronavirus of Covid-19 on the LGBTQIA+ community, particularly the situation of transvestites and transgender women. With this in mind, this text advocates a secondary analysis in one research aimed at the national LGBTQIA+ population and another research aimed at transvestites and transgender women in the city of São Paulo, as well as the bibliographical review of the proposed. To this end, we use the categories that permeate and go beyond gender and include human diversity, taking into account the social relationships of gender, race and social class, as well as those that determine the changes in the world of work in the context of "pandemic capitalism”.

Multisystem Inflammatory Syndrome in Children: Characteristics and Epidemiology

Shortly after the novel coronavirus (now known as SARSCoV- 2) was recognized, data began to accumulate on the virus's effects on children. Initial data showed that children were more likely to be mildly affected, compared to adults, with lower risks of hospitalization and death. However, in April of 2020, reports appeared of a severe disease in children occurring about two-six weeks after infection with SARS-CoV-2. The features were similar to those seen in a rare vasculitis condition called Kawasaki disease. On May 14, 2020, the Centers for Disease Control and Prevention (CDC) issued a national health advisory regarding this new condition, which was called multisystem inflammatory syndrome in children (MIS-C). The current case definition for MIS-C includes six criteria: (1) serious illness leading to hospitalization or resulting in death;(2) age less than 21 years;(3) measured fever over 38 degrees Celsius or report of subjective fever;(4) laboratory evidence of inflammation;(5) new onset involvement in at least two of the following (cardiac involvement, mucocutaneous involvement, shock, gastrointestinal involvement, and hematologic involvement);and (6) laboratory-confirmed SARS-CoV-2 infection or an epidemiologic link to a person with COVID-19. According to CDC, as of January 3, 2023, there have been 9,333 patients in the United States meeting the case definition of MIS-C, with 76 deaths. The median age of patients was nine years, with half of those affected between the ages of five and 13 years. More than half of the reported patients on whom race-ethnicity information was available were in children who are Hispanic/Latino or Black, non-Hispanic. Over 60% of reported patients were male. Most affected children had previously been healthy. A better understanding of the pathogenesis of this serious illness is needed to provide better treatment options for children with MIS-C. Prevention of MIS-C is focused on the prevention of SARS-CoV-2 infection through staying up to date with COVID-19 vaccination, masking, and other prevention strategies.

Developments in American politics 9

This textbook provides students of US Politics with an informed scholarly analysis of recent developments in the American political environment, using historical background to contextualize contemporary issues. As the ninth edition, this book reviews a time of political controversy in the United States, touching on topics such as gender, economic policy, gun control, immigration, the media, healthcare, the COVID-19 pandemic, and the widespread social protests against police brutality. The book looks both backwards to Trump's presidency and forward to Biden's. Ultimately, the editors and contributors evaluate the significance of these events on the future of American politics, providing a perspective that is at once broad and meticulous. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.

Association of Long COVID with Seeing Difficulties Among Adults in the United States

Objectives: Many patients with long COVID experience at least one vision problem. This study determines the association of long COVID with seeing difficulties. Method(s): We conducted a cross-sectional analysis with the Census Household Pulse Survey data (N = 51,288). We excluded adults who reported contracting COVID within the past four weeks, those with missing data on seeing difficulty when infected with COVID, and long COVID. Long COVID was defined as having symptoms lasting three months or longer that the adults did not have prior to having COVID. Adults self-reporting to a question on seeing with "some difficulty," "a lot of difficulty," or "unable to do" were classified as having "seeing difficulties." We conducted Chi-square tests and logistic regressions with replicate weights. Logistic regressions adjusted for long COVID, sex, age, race and ethnicity, marital status, income, education, food sufficiency, health insurance, remote work, vaccine doses, region, depression, and anxiety. Result(s): During the survey period (November 2 - November 14, 2022), 37.3% reported seeing difficulties, and 14.4% reported long COVID. A higher percentage of adults with long COVID reported seeing difficulties than those without long COVID (47.6% vs. 31.9%). In the fully adjusted logistic regression model, compared to adults with no COVID or without long COVID, those with long COVID had greater odds of seeing difficulties (AOR = 1.50, 95%CI = 1.32, 1.70). We did not observe a statistically significant difference between adults without long COVID and no COVID (AOR = 1.01, 95%CI = 0.93, 1.10 p = 0.7888). Conclusion(s): One in eight adults had long COVID. Adults with long COVID had significantly higher odds of seeing difficulties than those without long COVID. Therefore, a follow-up of patients with long COVID needs to include screening for seeing difficulties. More research is needed on the links between long Covid and vision care.Copyright © 2023

Tracking the Transit Divide: A Multilevel Modelling Approach of Urban Inequalities and Train Ridership Disparities in Chicago

Using a multilevel modelling approach, this study investigates the impact of urban inequalities on changes to rail ridership across Chicago's "L” stations during the pandemic, the mass vaccination rollout, and the full reopening of the city. Initially believed to have an equal impact, COVID-19 disproportionally impacted the ability of lower socioeconomic status (SES) neighbourhoods' to adhere to non-pharmaceutical interventions: working-from-home and social distancing. We find that "L” stations in predominately Black or African American and Hispanic or Latino neighbourhoods with high industrial land-use recorded the smallest behavioural change. The maintenance of higher public transport use at these stations is likely to have exacerbated existing health inequalities, worsening disparities in users' risk of exposure, infection rates, and mortality rates. This study also finds that the vaccination rollout and city reopening did not significantly increase the number of users at stations in higher vaccinated, higher private vehicle ownership neighbourhoods, even after a year into the pandemic. A better understanding of the spatial and socioeconomic determinants of changes in ridership behaviour is crucial for policymakers in adjusting service routes and frequencies that will sustain reliant neighbourhoods' access to essential services, and to encourage trips at stations which are the most impacted to revert the trend of declining public transport use.

Age, race/Hispanic origin, and COVID-19 mortality among sickle cell disease patients in the United States

The COVID-19 pandemic remains a global health challenge, with 6.7 million deaths worldwide as of January 2023. It has illuminated the health iniquities in underserved communities and populations like those with sickle cell disease (SCD). Researchers have associated the COVID-19 outcome among SCD patients in other regions of the globe. The purpose of this retrospective cross-sectional observational study was to investigate the relationship between age, race/Hispanic origin, and COVID-19 mortality among persons with SCD in the United States from January 2020 to March 2021. The Krieger ecosocial theory of disease distribution framed the study. Data were drawn from an existing Centers for Disease Control and Prevention provisional SCD death data set (N = 140). The binary logistic regression analysis result showed a statistically significant relationship between age and race/Hispanic origin and COVID-19 mortality. The variability between ages was 42.9%;race/Hispanic origin was 29.9%;and age and race/Hispanic origin were the highest, with 62.4% dying from COVID-19. Non-Hispanic Black patients were 9.6 times more likely to die overall but those aged 60+ were 17.5 times more likely to die from COVID-19 than the reference groups (0-19-year-old and other race). This study can benefit the research community, public health workers, medical professionals, and policymakers to understand better and influence policy on developing and prioritizing age- and race-tailored preventive protocols and medical care. They may minimize pain and suffering while mitigating mortality from COVID-19 and other unforeseen future pandemics within the SCD community at home and abroad and positively effect social change. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Students' sense of belonging at a South African university during COVID-19

The research on students' sense of belonging in higher education has evolved into a prominent theme worldwide. Institutional research focuses on the institution understanding itself and helps leaders to rethink improvement initiatives. Moreover, the COVID-19 pandemic has required of institutions to revise student support programmes and approaches to maintain a strong sense of belonging. The theories of belonging by Strayhorn (2012) and Dumford et al. (2019) were adopted to analyse student responses. The aim of the study was to understand students' sense of belonging and how the university responded to the challenges presented by the COVID-19 pandemic to ensure a strong sense of belonging. Data were generated through in-depth interviews with 45 undergraduate students from all seven faculties. The findings highlight notable prevention measures intended to limit the spread of the virus on campus and student support in the form of study devices and data. The post-lockdown changes included a return to face-to-face mental health support, drafting COVID-19 catchup plans for first year orientation of 2020 and 2021 cohorts, improving the student voice. Finally, notable principles for responding to a future higher education crisis are highlighted. These initiatives contributed towards establishing and maintaining a strong students' sense of belonging.

Mitochondrial Neurogastrointestinal Encephalopathy (MNGIE) Disease

Does mens rea matter to the criminal legal system? Our study addresses this question by performing the first-ever empirical analysis of a culpable mental state's impact on administration of a criminal statute. We focus on the U.S. Supreme Court's 2019 decision in Rehaif v. United States, which applied a culpable knowledge requirement to the federal felon-in-possession statute, 18 U.S.C. 922(g). Prior to Rehaif, federal courts viewed 922(g)'s critical legal status element-whether a firearm or ammunition possessor meets the conditions for one of nine prohibited categories-as being subject to strict liability. After Rehaif, the government must now prove that the target of a 922(g) prosecution was aware of their prohibited legal status to secure a conviction. Our study provides reason to believe that this new mens rea requirement significantly reduced the number of defendants charged with 922(g) per month, the number of 922(g) charges filed each month, the number of 922(g) charges per defendant, and the likelihood that any individual charge of 922(g) would be adjudicated guilty. We estimate these charging reductions prevented 2,365.32 convictions and eliminated 8,419.06 years of prison sentences for 922(g) violations during the eight-month period between the issuance of the Rehaifopinion and the start of the COVID-19 pandemic, which severely disrupted federal criminal prosecutions. At the same time, we also find that the government's 922(g) conviction rate-the likelihood that someone charged by federal prosecutors with violating 922(g) will ultimately be found guilty-did not change after Rehaif. All told, our study indicates that mens rea can constrain prosecutorial discretion, lower convictions, and reduce punishment without bringing criminal administration to a halt.

Citizenship Wanted, but Denied: The Racial Prerequisite Cases and Their Role in Institutionalizing Racism Against Asians: a Journal for Readers, Students and Teachers of History

This article explores the racial prerequisite cases, which were dubious court decisions that attempted to rationalize pseudo-scientific evidence and common knowledge as reasons for who could and could not be considered for, and who was ultimately denied, U.S. citizenship. These cases are historical antecedents of the current anti-Asian racism that has become even more pronounced as a result of COVID-19. Social studies educators can leverage these court cases to teach about controversial and relevant issues that connect to current immigration and citizenship policies, as well as provide historical context for contemporary discussions about race and racism.

Experiences of delivering virtual therapy groups for children with osteogenesis imperfecta during the Covid-19 pandemic

OBJECTIVE: To explore the experiences of a virtual group therapy programme for children with Osteogenesis Imperfecta (OI) who were unable to access face to face therapy due to a global pandemic. In a regional OI service up to 3 face to face 6-week therapy groups are offered for children during summer school holidays. Throughout the Covid-19 pandemic, OI children were at risk of deconditioning due to government restrictions in school attendance, exercise and socialisation. An alternative means of delivering therapy was required. METHOD(S): 30 families with school age children were invited to attend a virtual therapy group. Following initial interest from 21 children, 14 (age range 4-14 years) participated in a 5 week therapy group. Children were split into 3 age groups (4-7/8-12/13-14). Weekly 75 minute sessions comprised functional gross and fine motor activities. Educational elements with opportunities to explore thoughts and feelings were included. Each group were set a challenge to compete a virtual race from Bristol to Lands' End, recording their distance (walking, wheeling, cycling) throughout the week. Feedback was collected from participants and parents. RESULT(S): Feedback was received from 12/14 of attendees and parents and 4/7 who did not attend. Reasons for non-attendance included anxiety around video calls, other commitments and injuries. Of those that attended 100% (n=12) enjoyed the group and reported increased activity levels. Scavenger Hunt was cited as the favourite activity. 16.6% (n=2) children reported discussion on personal feelings uncomfortable. 16.6% (n=2) reported exercises were hard. 100% (n=9) of parents reported no significant difficulties with IT. Parent reported benefits included positive social interaction with other children with OI (66%, n=6), improving routine in preparation for school return (55%, n=5). Challenges for therapy team included identifying appropriate IT platform, choosing activities appropriate for various abilities and virtual instruction. Successes included time efficiency, full inclusion regardless of geographic location, increased activity levels of children with OI in preparation for school return. CONCLUSION(S): A safe, socially distanced method of delivering group therapy during a pandemic was achieved. Virtual therapy can be a useful adjunct, however this should not replace face to face therapy where possible.

A breath of fresh air

Submission content Introduction: This is a story about the day I wheeled a patient outside. I know, it sounds somewhat underwhelming. But little did I know that this short trip down a hospital corridor and beyond the entrance foyer would mark a profound shift in perspective both for me and my patient, which I hope will influence me for the rest of my career. Main Body: "Paul" was in his 50s and severely afflicted by COVID-19, resulting in a protracted ICU admission with a slow and arduous ventilator wean. Throughout his time on the unit, Paul had seen no daylight;no view of the outside world. He was struggling to make progress and was becoming exasperated. His deteriorating mood in turn affected his sleep, which further undermined his progress. Due to COVID-19, visiting was not permitted and Paul's cuffed tracheostomy meant that he couldn't speak to his family. One day, witnessing Paul's psychological decline, I asked him if he fancied a trip outside. Despite initial reluctance, he eventually gave in to some gentle persuasion from the staff nurse, with whom he had developed a close bond. So there we went;Paul, his nurse and me. And as we wheeled his bed through the door into open air, Paul's whole demeanour suddenly changed. He appeared as though the weight of the world had been lifted from his shoulders and his face lit up with awe, a tear emerging in the corner of his eye. In that moment he rediscovered life. Not as a hospital patient, but as a person. Watching the world go by, he remembered what it was like to be a member of the human race, not the subject of endless tests and treatments. He tasted freedom. Conclusion(s): Awakened by his experience of the forgotten outside world, when we eventually returned to the ICU Paul was an entirely different man. To Paul, the trip outside symbolised progress. After weeks of frustration and despair, he finally had a purpose;a motivation to get better. Meanwhile, I was having my own quiet realisation. I now understood what it truly meant to deliver holistic care. It can become all too easy to focus on the clinical aspects;to obsess about the numbers. But in fact, often what matter most to patients are the 'little things', to which no amount of medication is the solution. I now try to consider during my daily review: what matters to this patient? How are they feeling? What are they thinking? What else can I do to help their psychological recovery? And as for me personally? Having witnessed Paul's reaction to the outside world, I suddenly became aware of how little attention I normally pay to the world around me. How little I appreciate the simple ability to walk outside, and the fundamental things we take for granted. Now, when I'm feeling annoyed or frustrated about something trivial, I stop and think of Paul. I then thank my lucky stars for what I have to be grateful for. Ultrasound Ninja.