Incidence of Long Covid Symptoms in Patients Previously Hospitalized for Covid-19

Background: Long COVID, also known as post-acute sequelae of COVID (PASC), affects more than 144 million people globally. While there is no broadly accepted consensus on a definition for the term "long COVID," studies have found symptoms persist or begin weeks or months after the end of SARS-CoV-2 infection. This study assessed the incidence of codes found in medical claims and hospital chargemasters that were consistent with long COVID symptoms commonly found in the literature. Method(s): Using the HealthVerity database, which provides closed claims and linked hospital chargemaster data on more than 25 million US patients, we examined patients aged 12 and above hospitalized between May 1, 2020 and September 30, 2021 with a diagnosis of COVID-19 who had at least 365 days of closed medical claims enrollment prior to index hospitalization admission and 90 days after admission, and did not have a long COVID diagnosis (ICD-10- CM U09.9) prior to the index hospitalization. Patients were allowed to have symptoms prior to hospitalization. The assessment period for the outcomes, which included 10 symptoms, was 90 days to 270 days after the date of hospitalization. Incidence rate per 100 person-years was calculated as the number of patients with the outcome divided by total person-time contributed (90 days after admission to the minimum of the following: outcome, inpatient death, disenrollment, end of data (April 30, 2022), or 270 days after admission). Result(s): The dataset included 3,661,303 patients with an inpatient hospitalization during the study period. The final study cohort included 44,922 patients hospitalized with COVID-19, 20,627 of whom experienced at least one of the long COVID symptoms. Anosmia and dysgeusia were the rarest events captured in medical claims. More commonly found symptoms were joint pain, fatigue and breathlessness (see table). Conclusion(s): This study examined diagnosed symptoms commonly found posthospitalization among COVID-19 patients and reported the incidence of these symptoms in a representative population. The start period of long COVID used in this study (90 days post hospitalization) is consistent with the WHO definition of long COVID. In the absence of an understanding of the pathophysiology of long COVID, the use of diagnosed symptoms to define long COVID has the advantage of ease of use and availability of data. Further studies of additional symptoms and predictors of long COVID are needed. (Figure Presented).

If You Believe, You Will Receive: VR Interview Training for Pre-employment

Covid-19 pandemic accelerates the growing use of augmented and virtual reality in various industries, especially in education sector. It is worthy to study whether VR training would apply to technology-accepted learners, i.e., does "If you believe, you will receive” apply to VR training. In this work, the researchers developed an immersive VR interview room system that allows pre-employment learners to try on a simulated environment. Pre-captured interviewer questions are played for the learners get a taste into a real-liked interview. The investigation is the relationship between learners' perceived usefulness and interview self-efficacy in VR training in human resources management. The experiment results show they are positively correlated. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Understanding MOOC Learners from Different Levels of Study: An Investigation of Hospitality and Tourism

Despite the increasingly severe manpower shortage in the hospitality industry and the emergence of the Covid-19 pandemic, different levels of learners of Massive Online Open Courses (MOOCs) in hospitality and tourism education have been largely neglected in literature. This study explores different levels of hospitality and tourism education learners' perceptions, motivations, obstacles, and perceived outcomes of MOOCs in Hong Kong. Data were collected from five focus group interviews. The findings show that MOOC learners could be categorised into 3 groups: i) Sub-degree and undergraduate learners who lack self-motivation, prefer flexible timing and with English as the main barrier to learn via MOOCs. ii) Postgraduate learners who have moderate motivation to learn via MOOCs, with the key determinants of knowledge acquisition, flexible learning, and electronic communication. They are capable and can self-regulate their learning paces. Lastly, iii) hospitality and tourism in-service learners have high motivation to learn via MOOCs, which provides a shortcut and flexibility for satisfying both employee and employer's requirements. © 2022 IEEE.

Remote longitudinal monitoring of glaucoma using virtual reality-based oculokinetic perimetry

Purpose : Virtual reality-based oculokinetic perimetry (VR-OKP) is a mobile, short, screening visual field test. The purpose of this study is to examine whether VR-OKP could be implemented in a remote fashion and used to assess the stability of the visual field. Methods : Glaucoma subjects with known glaucomatous defects who had taken an inperson VR-OKP test in 2019 were re-enrolled and underwent the same test remotely in 2020. An exit survey comparing patients' preferences for visual field testing was also conducted remotely. Subjects underwent Humphrey visual field 24-2 (HVF) testing within 3 months of VR-OKP both in 2019 and 2020. For unadjusted comparisons between HVF and VR-OKP, we compared mean sensitivities and fraction of points. A non-parametric bootstrap analysis that resampled eyes with replacement was done to calculate the 95% confidence interval of the Spearman correlation coefficient between HVF sensitivity versus VR-OKP fraction seen at each point of the 54 test locations. Results : The cohort consisted of 19 eyes of 11 patients (55% female, 73% Caucasian, 27% Asian, mean age 61.4 ± 12.6 yrs) with moderate to advanced glaucoma (2020 average HVF mean deviation -4.23 dB ± 5.12). VR-OKP from 2019 to 2020 had a decreased mean percent change of -6.31% ± 17.22 (p=0.13) compared to HVF testing from 2019 to 2020 which had an increased mean change of mean deviation of +2.41 dB ± 1.35 (p<.00005). The Pearson's Correlation Coefficient between 2019 VR-OKP fraction seen and 2019 HVF mean sensitivity was 0.74, while it was 0.56 in 2020. Spearman correlation coefficients of HVF sensitivity vs VR-OKP fraction seen at each point ranged from -0.01-0.86 (median = 0.33). Subjects found VR-OKP to be as comfortable as HVF (p=0.8) and less fatiguing (p=0.03). Conclusions : This study highlights the feasibility of a remote option for visual field assessment. The correlation between VR-OKP and HVF in 2019 was higher than in 2020. One explanation is that the 2019 test was taken with in-person instruction, whereas the 2020 test was administered remotely. While the mean percentage change in VR-OKP was non-significant, the 2019 to 2020 change in HVF was statistically significant and showed improvement, which may be due to long term fluctuation. This short VR-OKP test is less fatiguing to patients, can detect non-progression even when taken at home, and could potentially be deployed to decrease patients' risk of COVID-19.

Remote training and administration of a portable virtual reality-based visual field test for home testing during COVID-19

Purpose : To 1) determine the feasibility of remotely administering and training subjects at home on how to use Vivid Vision Perimetry (VVP-10), a portable virtual reality-based visual field test during COVID-19 shelter-in-place;2) assess the correlation between VVP-10 and standard automated perimetry (SAP) and the test-retest variability of VVP-10. Methods : Inclusion criteria included subjects 21 or older with glaucomatous visual field defects, and exclusion criteria included those with retinal diseases or significant cataracts. Virtual reality devices were given to subjects during clinic visits or mailed to them. Subjects were remotely trained using training software and coaching via Zoom and proceeded to take 10 tests at home over 14 days. Subject age and sex, test duration, response rate at each of the test points (fraction correct), and SAP results including mean deviation and individual test point sensitivities were recorded. The Pearson correlation coefficients of SAP mean sensitivity versus VVP-10 fraction correct for all eyes together and fraction correct of tests 6-10 versus tests 1-5 for individual eyes were calculated. A bootstrap analysis that resampled eyes with replacement was done to calculate the 95% confidence interval of the Spearman correlation coefficient between SAP sensitivity versus VVP-10 fraction correct for each point of the 54 test locations. Results : Of the 20 subjects enrolled, 11 (55%) were male and the average (SD) age was 62.9 (10.5) years. Eight (40%) subjects were Asian and 12 (60%) were Caucasian. In total, 37 glaucomatous eyes with an average (SD) mean deviation of-6.1 (6.1) dB were analyzed. The Pearson correlation coefficient of SAP mean sensitivity versus VVP-10 fraction correct for 37 eyes was 0.68. The Pearson correlation coefficient between fraction correct in tests 6-10 versus tests 1-5 for individual eyes ranged from 0.78-0.99 (median = 0.94). Spearman correlation coefficients of SAP sensitivity versus VVP-10 fraction correct at each point ranged from 0.008-0.85 (median = 0.58). Conclusions : We demonstrate good test-retest variability of VVP-10 and a strong correlation with SAP, both globally and in a pointwise manner. VVP-10 is portable, inexpensive, and can be used entirely remotely while producing results that are similar to the current gold standard for assessing glaucomatous visual fields.

Risk factors for persistent abnormality on chest radiographs at 12-weeks post hospitalisation with PCR confirmed COVID-19.

BACKGROUND: The long-term consequences of COVID-19 remain unclear. There is concern a proportion of patients will progress to develop pulmonary fibrosis. We aimed to assess the temporal change in CXR infiltrates in a cohort of patients following hospitalisation for COVID-19. METHODS: We conducted a single-centre prospective cohort study of patients admitted to University Hospital Southampton with confirmed SARS-CoV2 infection between 20th March and 3rd June 2020. Patients were approached for standard-of-care follow-up 12-weeks after hospitalisation. Inpatient and follow-up CXRs were scored by the assessing clinician for extent of pulmonary infiltrates; 0-4 per lung (Nil = 0, < 25% = 1, 25-50% = 2, 51-75% = 3, > 75% = 4). RESULTS: 101 patients with paired CXRs were included. Demographics: 53% male with a median (IQR) age 53.0 (45-63) years and length of stay 9 (5-17.5) days. The median CXR follow-up interval was 82 (77-86) days with median baseline and follow-up CXR scores of 4.0 (3-5) and 0.0 (0-1) respectively. 32% of patients had persistent CXR abnormality at 12-weeks. In multivariate analysis length of stay (LOS), smoking-status and obesity were identified as independent risk factors for persistent CXR abnormality. Serum LDH was significantly higher at baseline and at follow-up in patients with CXR abnormalities compared to those with resolution. A 5-point composite risk score (1-point each; LOS ≥ 15 days, Level 2/3 admission, LDH > 750 U/L, obesity and smoking-status) strongly predicted risk of persistent radiograph abnormality (0.81). CONCLUSION: Persistent CXR abnormality 12-weeks post COVID-19 was common in this cohort. LOS, obesity, increased serum LDH, and smoking-status were risk factors for radiograph abnormality. These findings require further prospective validation.

Impact of COVID-19 on college seniors' learning and performance in communication sciences and disorders: Students' self-reflections

Purpose: A recent summary of ASHA surveys (fielded in March and April 2020) has delineated the pandemic-related challenges in education of communication sciences and disorders (CSD). This paper aimed to estimate how COVID-19 affected college seniors' learning and course performance, and discuss how a threat is posed to workforce entering. Methods: Ninety-eight written reflections were analyzed using a descriptive analysis to determine how sudden termination of face-to-face instruction affected learning, and subsequently impacted seniors' completion of course assignments and test performance. Results: It was found that students' loss of motivation, concentration, and/or self-discipline when adjusting and adapting to the pandemic posed the greatest challenge to knowledge acquisition and studying. Losing class engagement and face-to-face clinical exposure greatly hindered skill application;both elements lowered preparedness and satisfaction of college experience, and might reduce seniors' competitiveness and readiness to launch a new job. Conclusions: As the coronavirus era is evolving, student comments and reflections become particularly valuable for gaining insights into improving online teaching and learning for future career. © 2020 The Korean Association of Speech-Language Pathologists

EACH: A phase II study evaluating the safety and anti-tumour activity of avelumab and cetuximab in recurrent/metastatic squamous cell carcinomas

Background: Patients with R/M SCC have low response rates to second line therapies, including PD-1 inhibitors nivolumab and pembrolizumab, representing an area of unmet clinical need. Cetuximab has modest activity as a single agent but potentiates the activity of radiotherapy in locally advanced head & neck SCC (HNSCC) and chemotherapy in R/M HNSCC. Cetuximab initiates Natural Killer cell antibody-dependent cell-mediated cytotoxicity, resulting in an anti-tumour immune response and the potential to augment the activity of PD-1/PD-L1 inhibition. Methods: Trial entry required histologically confirmed R/M SCC of any site, unselected by PD-L1 expression, considered incurable by local therapies and no previous treatment with cetuximab for recurrent/metastatic disease. Prior therapy with anti-PD-1, anti-PD-L1 or anti-PD-L2 was excluded. Patients had avelumab 10 mg/kg + cetuximab 500 mg/m2 intravenously every 2 weeks, for up to 1 year. Primary endpoint was occurrence of dose-limiting toxicity within 42 days of treatment starting, graded using CTCAE v5. Secondary endpoints were objective response (ORR) and disease control rate (DCR) at 6 and 12 months using iRECIST. Results: 16 patients, median age 58 years (range 34 – 88), were enrolled from 2 UK hospitals between July 2018 and October 2019. The trial stopped after completing the safety run-in. 5 patients remain on treatment, 9 stopped treatment early (7 disease progression, 1 patient choice, 1 due to risk of COVID-19). 2 patients died whilst on treatment (both unrelated to trial treatment). Grade 3 AEs were seen in 4 patients and grade 5 in 1 patient. None were related to trial treatment. No patients experienced dose-limiting toxicity. Of 10 patients evaluable for response by iRECIST 2 (20%) had complete response, 3 (30%) had partial response and 4 (40%) had stable disease as their best response, representing an ORR of 50%. One patient had confirmed disease progression. In 6 patients who remained on trial for >6 months, all 6 had disease control at 6 months (2 CR, 1 PR, 3 SD). Conclusions: Avelumab + cetuximab is safe and tolerable, and demonstrates promising efficacy in R/M SCC patients. Clinical trial identification: NCT03494322;20/03/2018;Sponsor reference: UCL/17/0560. Legal entity responsible for the study: University College London. Funding: Merck KGaA. Disclosure: M. Forster: Advisory/Consultancy, Travel/Accommodation/Expenses: BMS;Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: Merck;Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: MSD;Advisory/Consultancy: Novartis;Advisory/Consultancy: PharmaMar;Advisory/Consultancy, Travel/Accommodation/Expenses: Roche;Advisory/Consultancy: Nanobiotix;Advisory/Consultancy, Travel/Accommodation/Expenses: Guardant Health;Advisory/Consultancy: Oxford VacMedix;Advisory/Consultancy, Research grant/Funding (institution), Travel/Accommodation/Expenses: AstraZeneca;Advisory/Consultancy: Takeda;Research grant/Funding (institution): Boehringer Ingelheim;Travel/Accommodation/Expenses: Celgene. J. Sacco: Honoraria (self), Research grant/Funding (institution), Travel/Accommodation/Expenses: BMS;Honoraria (self), Advisory/Consultancy, Travel/Accommodation/Expenses: MSD;Honoraria (self), Advisory/Consultancy: Amgen;Honoraria (self), Advisory/Consultancy, Research grant/Funding (institution): Immunocore;Honoraria (self), Advisory/Consultancy: Delcath;Honoraria (self): Pierre Fabre;Research grant/Funding (institution): AstraZeneca. A. Kong: Honoraria (self), Advisory/Consultancy, Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: Merck;Honoraria (self), Speaker Bureau/Expert testimony: BMS;Advisory/Consultancy: Centauri Therapeutics;Advisory/Consultancy: Amgen;Advisory/Consultancy, Research grant/Funding (institution): Puma Biotechnology;Speaker Bureau/Expert testimony, Travel/Accommodation/Expenses: MSD;Research grant/Funding (institution): AstraZeneca. G. Wheeler: Honoraria (self): AstraZeneca. J. Hartley: Full/Part-t me employment: AstraZeneca;Advisory/Consultancy, Shareholder/Stockholder/Stock options: ADC Therapeutics. All other authors have declared no conflicts of interest.