Plain language summaries: Enabling increased diversity, equity, inclusion and accessibility in scholarly publishing

circle Plain language summaries (PLS) are accessible, short, peerreviewed summaries of scholarly journal articles written in nontechnical language. circle The aim of PLS is to enable a broader audience of experts and non-experts to understand the original article. circle Here, we outline the evidence base for the value and impact of PLS and how they can enable diversity, equity, inclusion and accessibility in scholarly publishing. circle PLS can diversify readership and authorship, address information inequity, include typically under-represented stakeholders and provide an accessible route into scholarly literature.

Real-world response to dupilumab in patients with atopic dermatitis: a retrospective review of 100 patients

Dupilumab is a monoclonal antibody approved by the National Institute for Health and Care Excellence for the treatment of moderate-to-severe atopic dermatitis (AD) in 2018. It is indicated for patients who have not responded to at least one systemic medication or in whom these are contraindicated or not tolerated. Response criteria to allow continued treatment include at least a 50% reduction of Eczema Area and Severity Score (EASI) and/or at least a 4-point reduction in the Dermatology Life Quality Index (DLQI) score. Phase III clinical trials of dupilumab in AD reported a 75% reduction in EASI (EASI 75) of 51% in SOLO1 and 44% in SOLO2. Real clinic responses may differ from trials so we performed a retrospective review of 100 patients between June and August 2020 who had received dupilumab (44% female, 56% male;mean age 41 years). Fifty-eight per cent had a recorded diagnosis of asthma and 39% had a recorded diagnosis of allergic rhinitis. Seventy-six per cent of patients had received previous phototherapy. Ninety-seven per cent of patients received at least one systemic medication prior to commencing dupilumab. Thirty per cent (n = 29) received one, 33% (n = 32) received two, 33% (n = 32) received three and 4% (n = 4) received four prior to starting dupilumab. The most common were methotrexate (61%), followed by ciclosporin (22%) azathioprine (16%) and alitretinoin (1%). EASI scores were documented at baseline. The target time for EASI response assessment was 16 weeks, but we included outcome data recorded between 8 and 16 weeks, using the score nearest to 16 weeks where multiple scores were available. Seventy-five patients had response data recorded, 18 had stopped dupilumab and seven had missing data. Outcomes were 50% reduction in EASI [EASI 50;84% (n = 62)], EASI 75 [61% (n = 45)] and a 90% reduction in EASI [EASI 90;35% (n = 26)]. Mean (SE) EASI score pretreatment was 22 2 (1 2);at 16 weeks it was 5 8 (0 9). Sixty-five per cent of patients had a documented DLQI score at 8 and/or 16 weeks. Mean (SE) DLQI scores were 17 5 (0 7) predupilumab, 5 5 (1 1) at 8 weeks and 3 7 (0 8) at 16 weeks. Mean reduction was 13 8 (1 0). Eighty-six per cent (n = 56) had a reduction of four or more. Fifty-nine per cent of patients had Patient-Oriented Eczema Measure scores recorded. Mean (SE) values were 22 5 (0 5) predupilumab, 6 2 (1 2) at 8 weeks and 7 1 (1 1) at 16 weeks. Mean reduction was 15 4 (1 0). Compared with prospective clinical trials, real-world data have the limitations of missing data and slight scoring date variations, including the impact of the COVID-19 pandemic on missed appointments. Sixteen-week outcome data are not available for patients who withdrew from treatment. However, for the 75 patients with outcome data the proportion achieving EASI 75 and a 4-point reduction in DLQI is encouraging and similar to data from phase III trials.

PUBLIC PERCEPTIONS OF TEST TRACE PROTECT WALES: UNDERSTANDING AND IMPROVING SELF-ISOLATION ADHERENCE

Introduction: Despite the ongoing roll-out of the vaccination programme in Wales, self-isolation remains a crucial strategy to reduce transmission of COVID-19, especially as cases remain high. Test, Trace, Protect (TTP) is Wales' contact tracing programme where people are asked to isolate and provided with information and resources. Public Health Wales ran a real-time text message survey of contacts of cases of COVID-19 to provide insight as people were starting a period of self-isolation after notification from NHS Wales Test Trace Protect (Adherence Confidence Text Survey (ACTS)). This research study was designed to investigate what those being asked to self-isolate felt was good about their experience with TTP and what do they feel could be done better based on their text responses. Method: Text responses between 15th November 2020 and 2nd May 2021 (N = 12,092) were analysed using an automated content analysis (ACA) and sentiment analysis using the software Leximancer. Next, we conducted a qualitative thematic analysis using the software NVivo to explore further the findings of the ACA, as well as to look more deeply into some of the reasons behind people's views of TTP at two time periods for comparison, T1: 15th November- 5th December 2020 (n=2956) and T2: 1st March - 31st 2021 (n = 515). Results: ACA revealed that there were substantially more (roughly ten times as many) instances of favorable (positive affective) (n=4,963) terms within the data than unfavorable (negative affective) (n=425). NVivo analysis were in keeping with this finding as the majority reported a positive experience with TTP (T1 N = 1717, 58%;T2 N = 355, 69%). One of the sources of confusion was the date of the end of required isolation (T1 N= 101, 3.4%;T2 N = 11, 2.1%) though clarity improved from T1 to T2. Another concern was the time it took to be contacted following a positive test (T1 N = 205, 6.9%, T2 N = 14, 2.7%) again improving with time. Less than 1% reported financial concerns at both time periods. Conclusions: The Welsh population responding to the text sent by PHW had a positive experience with TTP. Automated content analysis is a viable method to process large datasets of qualitative content such as text responses.

Remote Microwave Sterilization Applicable to Coronaviruses Using a Van-Atta Retrodirective Antenna Array with 2-D Tracking Capability

We propose a method for remote sterilization of surfaces which follows wireless power transmission principles. Using the self-steering tracking capability of retro-directive arrays (RDAs), an infected area of interest can be sterilized by radiating microwave power in a controlled and efficient manner, thus producing heat for pathogen deactivation. The employed antenna array system offers dual-circular polarization with isolation values of 55 dB which supports the co-location of the transmit and receive parts of the RDA. In particular, the paper reports the use of a 2 x 2 circularly polarized RDA system operating in the S-band, which is used to investigate the possible heat change of a water covered sample for sterilization, placed at different ranges from the transmitting point and rotated in the plane normal to the illumination. The time required to heat the area of interest up 60°C is numerically studied and the capabilities of inducing the needed temperature gradient over the samples is examined. In addition, measurements have been performed using biological samples of the coronavirus (strain Cov-229E-GFP) to demonstrate virus deactivation. The proposed methodology can also be made completely automated and with little operator interaction, representing a new and attractive option for microwave sterilization of pathogens such as those related to the severe acute respiratory syndrome coronavirus (SARS COVID-19). © 2022 European Microwave Association.

Telerobotic interventions from a distance: An initial experience in 3D phantom mapping

Introduction: The current COVID-19 pandemic has fostered several accelerations in remote patient care such as video and telephone clinics, as well as multidisciplinary collaborations using online platforms with experts consulting the local teams from a distance. The next logical step would be to also offer remote-controlled interventions which the expert operator not on site, but in support of the local team. This is especially valuable for complex interventions when either patient or expert operator can not be present at the same place. Purpose: We aimed to demonstrate that an expert operator located at far distance (Austria) could directly interact with the remote magnetic navigation system in London (UK) whilst mapping a 3D phantom using an electroanatomical mapping system. Method: Two experienced operators of the magnetic navigation system were tasked with creating fast anatomic maps (FAM) of the atrial and ventricular chambers of a 3D phantom using remote magnetic navigation in combination with 3D electroanatomical mapping. One was located in the control room of the magnetic catheter lab (UK) and the second one was in Tirol, Austria and connected through a secure remote desktop connection (via high speed fibre optic cable). Using a solid tip magnetic catheter connected to a mechanical drive, all interactions with the system were carried out via the Odyssey platform. Acquisitions for right and left atrium, as well as right and left ventricles plus aorta was compared with regards to mapping duration, map completeness (as judged by the average distance of surface points from 3D CT scan reconstruction), total 3D map volume and need for additional radiation exposure during the mapping process. Results: Mapping time and map completeness when performed by the distant operator was not inferior to the local operator and both did not require any additional radiation exposure during the mapping process. Table 1 demonstrates the mean parameters for each chamber, respectively. Figure 1 depicts the matched data for chamber completeness as compared for the LA (green= local operator, pink= distant operator) using a contrast CT scan as the gold standard. Conclusion: Telerobotic 3D mapping of a 3D phantom from a distance was equally fast delivered from the control room as compared to an operator located 1200 km away without compromising on map completeness. This demonstrates the feasibility of telerobotic interventions and stress the need for remote collaboration which is especially valuable when travel of patients and/or physician experts is restricted.

P.25 Improving antenatal anaesthetic assessment and dissemination of information to parturients with a high body mass index

Introduction: Parturients with a body mass index (BMI) greater than 40 kg/m2 should be referred to the anaesthetic clinic for antenatal assessment.1We assessed parturients’ understanding of high BMI and the additional risks posed to them in order to improve their anaesthetic assessment. This has particular importance due to COVID-19 when most assessments have taken place over the telephone. Methods: All patients were sent the Obstetric Anaesthetists’ Association (OAA) high BMI leaflet2 by text message one week before their clinic appointment. The aim was to increase patients’ knowledge base prior to the appointment. A survey was conducted to assess patients’ understanding of high BMI, the reason for their referral to the anaesthetic clinic and additional intrapartum risks posed to them. Data including timing of referral and anaesthetic clinic, specialty of referrer and patients’ BMI were collected as well as patient preferences for information dissemination. Results: 21 patients were surveyed over a nine-week period. The mean BMI was 42 kg/m2. 71% patients understood the meaning of high BMI but only 29% understood why they had been referred to the anaesthetic clinic. 48% patients claimed that they understood the additional risks but only 60% of those could actually comment on what those risks were. 62% of patients were referred to the anaesthetic clinic by a midwife but only 23% of those were at the booking appointment. The mean timing of referral was 21 weeks gestation with mean timing of the anaesthetic clinic at 28 weeks (maximum gestation was 38 weeks). 86% patients had the maternity app for online notes and would like information leaflets to be uploaded there. Discussion: Despite a limitation in case numbers, this survey shows that patients’ understanding of their reason for referra l to anaesthetic high-risk clinic and additional risks posed to them due to high BMI is generally poor. Referral to the anaesthetic clinic is not systematic resulting in some patients reviewed late in their gestation. In order to improve the antenatal anaesthetic clinic service, we have introduced several measures. These include a new electronic referral form, education of antenatal midwives to refer women at their booking appointment once height and weight have been checked and to aim for an anaesthetic clinic appointment at 24–30 weeks gestation. At the time of referral, patients are informed of the reason and directed towards information leaflets which will be uploaded onto their maternity app. We hope these measures will increase patients’ understanding and engagement with the service and we will re-evaluate them once they have been established.

Responding to COVID-19: a device clinic perspective

Introduction: Coronavirus disease 2019 (COVID-19) has presented unparalled challenges to the management of patients with cardiac implantable electronic devices (CIED). The need to limit exposure to healthcare staff and patients has increased reliance on remote monitoring (RM). This study summarises the change in workload of a device clinic in a Tertiary centre required to completely eliminate all outpatient activity in response to COVID-19. Methods: In person (IP) follow-ups, RM follow-ups and remote transmissions (RT) received per-month to our device clinic were reviewed from institutional databases and manufacturer remote transmission data. Data was reviewed for the six months before the cessation of outpatient activity in response to COVID-19 (Sept 2019-Feb 2020;pre COVID) and the two months afterwards (April-May 2019;during COVID). Data from March was excluded due to COVID-19 restrictions beginning mid-way through the month. Referrals for procedures from our clinic to other hospitals during COVID were reviewed. Data are expressed as median (range). Results: Of the 3562 patients (PPM 1828 patients, CRT-P 326, ICD/CRT-D 1408) reviewed annually at our centre, enrolment on RM increased from 97.4% to 97.8% ICD/CRT-D, 16.0% to 19.6% CRT-P and 1.6% to 6.5% PPM pre COVID to during COVID. RM was provided to all patients who required review following CIED procedures or those with hardware or clinical issues. There was a 26.9% reduction in total CIED follow ups (1813 per month (1293-2000) pre COVID to 1326 (1299-1353) during COVID) with a 98.7% reduction in IP follow ups (1335 per month (865-1565) to 15 (13-17)) offset by a 63.9% increase in RM follow ups (800 per month (650-920) vs 1311 (1282-1340)). IP follow ups were only performed for urgent MRIs in patients with CIEDs. PPM follow ups decreased by 77% (661 per month (495-759) to 150 (123-177)) and CRT-P by 53% (105 per month (85-144) to 50 (49-50)) whereas ICD/CRT-D follow ups remained similar to pre COVID levels (922 per month (629-1034) vs 917 (912-922), 0.5% decrease). Remote transmissions increased by 55% (969 per month (586-1010) pre COVID to 1505 (1488-1522) during COVID) with substantial increases for PPMs (19 per month (9-27) to 172 (168-175), 803% increase) and CRT-Ps (10 per month (6-25) to 58 (57-58), 475% increase). ICD/CRT-D transmissions increased by 55.3% (495 per month (586-1010) to 760 (145-536). Twenty patients were referred from our clinic for CIED related procedures at other hospitals (17 generator replacements, two right ventricular lead replacements and 1 right ventricular lead repositioning). Conclusions: COVID-19 resulted in an immediate increase in CIED follow ups performed via remote monitoring due to the rapid provision of transmitters and the inability to perform IP follow ups. Significant changes to device clinics will be required in the post COVID-19 era including the re-establishment of reduced IP follow ups and an increased utilisation of RM.

Policy mixes to achieve sustainable mobility after the COVID-19 crisis.

The COVID-19 pandemic has the potential to have lasting impacts on energy and the environment at the global scale. Shelter-in-place measures implemented to mitigate the spread of COVID-19 have resulted in expectations for 2020 global energy demand to contract by nearly 5% with related global CO2 emissions declining by as much as 7%. Exactly how long and to what extent we will see continue to see energy demand, CO2 and related greenhouse gas (GHG) emission destruction resulting from COVID-19 is uncertain but dependent on global policy responses to the pandemic. Policy responses targeting the transportation sector, particularly ground-based transportation, can stimulate a sustainable mobility transition that mitigates the potential for long-term environmental damage. This paper reviews and examines social and cultural dynamics of transportation and extends state-of-the-art knowledge to consider how events surrounding the COVID-19 crisis may have created a sustainable mobility opportunity though (1) avoiding unnecessary transportation volume, (2) shifting transportation norms and practices and/or (3) improving the carbon-efficiency of transportation systems. Relevant policies for a low-carbon transportation transition are considered and those most appropriate to the current context are proposed with consideration of key factors that may help or hinder their implementation success.

“You guys are good at swabs!” Setting up a staff and patient coronavirus testing service using existing sexual health service infrastructure in a large regional teaching hospital

Introduction: Early in the response to the coronavirus pandemic, our large Teaching Hospital asked our Sexual Health Service (SHS) team to set up a facility to test symptomatic staff and their contacts, for the 16000+ staff in the Trust. Here we describe the process and results. Methods: The SHS team used existing staff, IT facilities and estates to set up a testing service within 24hrs of being approached. We used our existing Inform EPR, which we altered with permission. Hospital Staff, or their household (including children), who were symptomatic of covid-19 were booked electronically for a test by SHS admin team. SHS nursing staff performed testing using a specially set up drive-through facility in the car park of our existing building. The service ran in the afternoon/evening, allowing ongoing emergency SHS work to continue in the mornings. Tests were ordered and returned electronically. SHS staff used text messaging to deliver results and appropriate actions within 24hrs of swab being taken. From June 2020, we began contact tracing for positive staff and their contacts, using established Partner Notification skills in our health advising team. The service also took on testing of self-isolating pre-oper-ative patients. Results/discussion: From 1st April to 20th July 2020 we performed 6025 tests, of which 4022 were in staff or their household contacts. The overall positivity rate in staff was 9.6% (with a peak of 24% in mid April). Patient testing positivity rate was extremely low at 0.1%. Where staff or their contacts were coronavirus negative and able to attend work again, we estimate that we saved the Trust around 13 500 work days, a significant consideration both financially and operationally. Feedback from staff was universally positive. We were able to demonstrate that SHS staff and facilities have important transferable skills/resource in response to the unprecedented challenge of Covid-19.