The Impact of Inactivity During the COVID-19 Pandemic on the Physical Performance of High School Athletes (preprint)

Background/Objective This study was conducted during the 2019-2020 academic year to evaluate the impact of participation in school sports on students' Body Mass Index (BMI) and Assessing Levels of Physical Activity (ALPHA) test scores. Interrupted by the COVID-19 pandemic, which led to a suspension of in-person education, the study resumed in September 2021, refocusing on the effects of pandemic-induced inactivity on the physical fitness levels of the same cohort. Methods The study included twenty-nine male high school students, divided into thirteen athletes (participating in sports such as football, basketball, and track) and sixteen non-athletic counterparts. They underwent reassessment using the ALPHA test battery, evaluating cardiorespiratory, musculoskeletal, and motor skills fitness. Data were analyzed using independent and paired samples t-tests and a two-way repeated measures ANOVA to assess changes over time and between groups. Discriminant function analysis evaluated the ALPHA test's ability to classify students based on their athletic status pre- and post-pandemic. Results Initially, athlete students exhibited significantly better BMI, 20 m shuttle run, and 4 × 10 m speed run scores compared to their non-athlete peers. After the pandemic, only the 20 m shuttle run scores remained significantly higher for athletes, with diminished distinctions in other fitness areas. The classification accuracy of the ALPHA test battery decreased from 86.2% to 75.9% post-pandemic. Conclusion The enforced sedentary lifestyle due to the COVID-19 pandemic adversely affected all students, particularly diminishing health-related fitness parameters such as body composition, cardiorespiratory and musculoskeletal strength, and motor skills. Students previously engaged in regular physical activity, notably school athletes, experienced significant fitness declines. This highlights the urgent need for targeted interventions to encourage active lifestyles among youth in the post-pandemic phase, aiming to avert long-term adverse health outcomes.

Is Recovery Just the Beginning? Persistent Symptoms and Health and Performance Deterioration in Post-COVID-19, non-hospitalised University Students - A Cross-Sectional Study (preprint)

Many individuals experience persistent symptoms such as deteriorated physical and mental health, increased fatigue, and reduced cognitive performance months after recovering from COVID-19. Current data are limited on the long-term trajectory of these symptoms and their prevalence in milder cases. Our study aimed to assess the persistent effects of COVID-19 on physical and mental health, fatigue, and cognitive performance in a cohort of 214 students, averaging 21.8 years of age. Of these, 148 had contracted COVID-19 but were not hospitalized, with the time since infection ranging from 1 to 39 months. We utilized a comprehensive panel of cognitive tests to measure intelligence, memory, and psychomotor skills, and a detailed anamnestic questionnaire to evaluate physical and mental health. While contracting COVID-19 did not significantly impact overall health and performance, it was associated with increased reports of fatigue. However, the reported severity of the disease had a pronounced negative influence on physical health, mental well-being, fatigue, and reaction time. Trends of improvement in physical and mental health, as well as error rate, were observed within the first two years post-infection. However, fatigue and reaction time showed a trend of deterioration. Beyond the two-year mark, physical health and error rate continued to improve, while mental health began to deteriorate. Fatigue and reaction time continued to decline. Overall, our findings suggest that some effects of contracting COVID-19 can persist or even deteriorate over time, even in younger individuals who had mild cases that did not require hospitalization.

Building operations skills through a spaced learning and development approach in a corporate environment (preprint)

Corporate learning in general, and in particular now, faces the challenge of developing talent with the mix of skills needed to meet the demands of the future of work. The Covid-19 pandemic has been one of the biggest disruptions in the world of learning and has fundamentally changed the delivery modes in formal corporate learning. The current context continues to be highly uncertain, with inflation rising, geopolitical tensions, and a shortage of skilled labor in many countries. All of this drives changes affecting learners, related to the way of working, reduced travel, limited in-person training, apprenticeship, coaching, and work models in general (in-person presence vs. virtual remote working).Taking into account the limitations and circumstances described, the Operations Practice Learning team of a global strategy consultancy – together with corporate learning, learning professionals, and subject matter experts – was faced with the challenge to quickly adapt, define a skill-first approach for the expertise required, and to identify effective and efficient ways of formal learning for the core learning programs of the global Operations Practice and in particular for the cohort of a two-year Operations Excellence Program. In order to solve these challenges, three main aspects were considered: (1) high engagement in the learning process, (2) appropriate curriculum to build the right skills, and (3) integrating learning into the workflow.

A Multilingual Ai Talent Demand Analysis and Forecasting Using Semantic Analysis and Multivariant Deep Learning (preprint)

As artificial intelligence (AI) continues to revolutionize various industries, there is an increasing demand for skilled professionals in the field, leading to a significant talent gap and skill shortages. This study aims to understand and forecast the demand for AI professionals across 7 countries in North America, Europe, Australia, and South-East Asia. Using a semantic-based approach to identify relevant job postings, a multilingual analysis was conducted to assess country-specific demand. The US and Canada experienced a significant increase in demand, with a surge in 2020 due to the COVID-19 pandemic. In contrast, the UK and France showed a more gradual increase in demand, while Australia and Singapore demonstrated relatively flat trends. India exhibited a steady and consistent growth in AI demand over the years. Additionally, we analyze the skills that are missing in each country to fulfill AI demand, providing a comprehensive understanding of the talent gap and skill shortages. The US and France showed a shortage of skills in deep learning and artificial intelligence, while Singapore had a shortage in virtual reality skills, and India had a shortage in web-related technologies. Furthermore, we examined the correlation between job demand and factors such as tech industry growth and AI education program availability. The demand for AI jobs is highly correlated between the US and Canada (0.87), and moderately correlated between the US and the UK (0.81) and Canada and the UK(0.82), and low correlation between UK and France (0.30), and France and Singapore(0.08). This suggests a strong link between these countries in terms of AI job demand, which could be due to similar industry structures, language, and cultural ties. Finally, we utilized machine learning models to forecast future demand for AI jobs for each country, achieving and average MSE score of 1.162 using multi-variate LSTM model. Our findings underline the need to prepare the workforce for increasing demand and develop strategies to bridge the talent gap, including addressing skill deficiencies and shortages. This study provides policymakers, educators, and practitioners with valuable insights to shape the future of the AI industry.

Use of a digital application to enhance communication and triage between care homes and National Health Service community services in the United Kingdom: a qualitative evaluation (preprint)

Recent years have seen a rise in digital interventions to improve coordination between care homes and NHS services, supporting remote sharing of data on the health of care home residents. Such interventions were key components in the response to the COVID-19 pandemic. This paper presents findings from the qualitative component of an evaluation of an implementation of the HealthCall Digital Care Homes application, across sites in northern England. The implementation commenced prior to the pandemic and continued throughout. Semi-structured, qualitative interviews were held with stakeholders. Interviews were conducted remotely (October 2020 -June 2021). Data were analysed via a reflexive thematic analysis then mapped against Normalization Process Theory (NPT) constructs (coherence, collective action, cognitive participation, and reflexive monitoring) providing a framework to assess implementation success. Thirty-five participants were recruited: 16 care home staff, six NHS community nurses, five relatives of care home residents, four HealthCall team members, three care home residents, and one local authority commissioner. Despite facing challenges such as apprehension towards digital technology among care home staff, the application was viewed positively across stakeholder groups. The HealthCall team maintained formal and informal feedback loop with stakeholders. This resulted in revisions to the intervention and implementation. Appropriate training and problem solving from the HealthCall team and buy-in from care home and NHS staff were key to achieving success across NPT constructs. While this implementation appears broadly successful, establishing rapport and maintaining on-going support requires significant time, financial backing, and the right individuals in place across stakeholder groups to drive implementation and intervention evolution. The digital literacy of care home staff requires encouragement to enhance their readiness for digital interventions. The COVID-19 pandemic has pushed this agenda forward. Problems with stability across the workforce within care homes need to be addressed to avoid skill loss and support embeddedness of digital interventions.

Developing research skills in medical students online using an active research study (preprint)

Developing research skills and scholarship are key components of medical education. The COVID-19 pandemic necessitated that all teaching be delivered online. The purpose of our study was to use an online questionnaire to quantitatively evaluate medical student perspectives on development of their research and scholarship skills, teaching content and format, and tutor performance. In addition, we captured free text responses from both students and tutors on the positives and negatives of online teaching and suggested improvements. We also compared summative assessment marks for the online course with those obtained from previous in-person teaching sessions. Students were largely positive about most aspects of the online course utilising an active research study. Students agreed that they were able to acquire research skills, particularly related to data analysis, transferable skills, and giving scientific presentations. The assessment marks for the online course were comparable between the online course and the in-person laboratory teaching from previous years. Students enjoyed the convenience of online teaching and the availability of course resources, but least liked the lack of in-person interaction and laboratory training. Tutors enjoyed the collaborative aspects of online teaching, but least liked the lack of face-to-face interactions with students. Our study demonstrates that delivering online teaching, which involves students in active research, engages and motivates them to develop their research and scholarship skills. We recommend that educators consider incorporating a current research study in their undergraduate courses as this can enhance the student learning experience as well as the research project itself.

The Selah trial: A preference-based partially randomized waitlist control study of three stress management interventions (preprint)

Objective: Chronic stress can undermine psychological and physiological health. We sought to evaluate three stress management interventions among clergy, accounting for intervention preferences. Methods: United Methodist clergy in North Carolina enrolled in a partially randomized, preference-based waitlist control trial. The interventions were: mindfulness-based stress reduction (MBSR), Daily Examen prayer practice, and Stress Proofing (stress inoculation plus breathing skills). The intervention period spanned 12 weeks with a 12-week follow-up. Daily text message data were collected to assess practice across the 24 weeks. Co-primary outcomes were symptoms of stress using the Calgary Symptoms of Stress Inventory and 48-hour ambulatory heart rate variability (HRV) at 12-weeks post-intervention compared to waitlist control. Survey data were collected at 0, 12 and 24 weeks, with HRV collected at 0 and 12 weeks. Results: 255 participants (mean age=54 years old; 91% white; 48% female) were randomized and initiated an intervention (n=184) or waitlist control (n=71). Compared to waitlist control, lower stress symptoms were found for MBSR participants [Mean Difference (MD)=-0.30, 95% CI:-0.41,-0.20; p<.001] and Stress Proofing (MD=-0.27, 95% CI:-0.40,-0.14; p<.001) at 12 weeks, and Daily Examen participants not until 24 weeks (MD=-0.24, 95% CI:-0.41,-0.08). Only MBSR participants demonstrated improvement in HRV at 12 weeks (MD=+3.31 millisecond; 95% CI:0.20,6.43; p=.037). Conclusions: MBSR demonstrated robust improvement in self-reported and objective physical correlates of stress whereas Stress Proofing and Daily Examen resulted in improvements in self-reported correlates of stress only. These brief practices were sustainable and beneficial for an occupational sample during the COVID pandemic. Registration: ClinicalTrials.gov identifier: NCT04625777 (https://clinicaltrials.gov/ct2/show/ NCT04625777 )

Country Learning on Maintaining Quality Essential Health Services (EHS) during COVID-19 in Timor-Leste: A mixed methods qualitative analysis (preprint)

Objective: This research study examines the enabling factors, strengths, and challenges experienced by the Timor-Leste health system as it sought to maintain quality essential health services (EHS) during the COVID-19 pandemic. Design: A mixed methods qualitative analysis Setting: National, municipal, facility levels in Baucau, Dili and Ermera Municipalities in TLS Participants Key informant interviews (n=40) and focus group discussions (n=6) working to maintain quality EHS in TLS. Results: A reduction in people accessing general health services was observed in 2020, reportedly due to fears of contracting COVID-19 in healthcare settings, limited resources (eg. human resources, personal protective equipment, clinical facilities, etc) and closure of health services. However, improvements in maternal child health services simultaneously improved in the areas of skilled birth attendants, prenatal coverage, and vitamin A distribution, for example. Five themes emerged as enabling factors for maintaining quality EHS including 1) high level strategy for maintaining quality EHS, 2) implementation of quality activities across the three levels of the health system, 3) measurement for quality and factors affecting service utilization 4) the positive impact of quality improvement leadership in health facilities during COVID-19, and 5) learning from each other for maintaining quality EHS now and for the future. Other countries may benefit from the challenges, strengths and enablers found on planning for quality. Conclusion: The maintenance of quality essential health services (EHS) is critical to mitigate adverse health effects from the COVID-19 pandemic. When quality health services are delivered prior to and maintained during public health emergencies, they build trust within the health system and promote healthcare seeking behavior. Planning for quality as part of emergency preparedness can facilitate a high standard of care by ensuring health services continue to provide a safe environment, reduce harm, improve clinical care, and engage patients, facilities, and communities.

Impact of the COVID-19 Pandemic on Surgical Residency Training: Time to digitalization (preprint)

Background The COVID-19 pandemic has negatively impacted surgical residency training worldwide. This study aims to evaluate the impact of the COVID-19 pandemic on surgical residency training and psychological well-being in a Tunisian residents cohort, and to emphasize on the importance of digital simulation-based training through a review of different tools reported in the literature.Methods A cross-sectional survey of surgical residents was conducted at our surgical division of the teaching hospital, between 1st and 30 December 2020. A study-specific electronic questionnaire designed using the free software Google Forms was distributed to 36 residents via emails and Whatsapp.Results At the end of the study period, only 26 participants (72%) completed and submitted the questionnaire. Most respondents reported the negative impact of the pandemic on clinical and surgical training. Anxiety was noticed in all participants; more than half presented depression. During the pandemic, clinical activity was mainly based on "patient bedside" learning (50%) and college courses via webinars (38.4%). Surgical training was mainly based on the medico-surgical encyclopedia (65.4%), surgical videos on YouTube® (61.5%) and emergent surgeries attendance (53.8%). There was a lack of didactic teaching programs implementation during the pandemic.Conclusions There is a pressing need to improve surgical training during residency. Simulation-based training using digital tools is the best way to improve psychomotor skills outside of the operating theatre.

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Post-COVID Syndrome: A Common Neuroimmune Ground? (preprint)

A Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating chronic disease of unknown aetiology under growing interest now in view of the increasingly recognized post-COVID syndrome as a new entity with similar clinical presentation. We performed the first cross-sectional study of ME/CFS in community population in Russia and then described and compared some clinical and pathophysiological characteristics of ME/CFS and post-COVID syndrome as neuroimmune disorders. Of the cohort of 76 individuals who suggested themselves suffering from ME/CFS 56 subsequently were confirmed as having CFS/ME according to ≥1 of the 4 most commonly used case definition. Of the cohort of 14 individuals with post-COVID-19 syndrome 14 met diagnostic criteria for ME/CFS. The prevalence of clinically expressed and subclinical anxiety and depression in ME / CFS and post-COVID ME/CFS did not differ significantly from that in healthy individuals. Severity of anxiety / depressive symptoms did not correlate with the severity of fatigue neigther in ME / CFS nor in post-COVID ME/CFS, but the positive correlation was found between the severity of fatigue and 20 other symptoms of ME / CFS related to the domains of “post-exertional exhaustion”, “immune dysfunction”, “sleep disturbances”, "dysfunction of the autonomic nervous system", "neurological sensory / motor disorders" and "pain syndromes". Immunological abnormalities were identified in 12/12 patients with ME / CFS according to the results of laboratory testing. The prevalence of postural orthostatic tachycardia assessed by the active standing test was 37.5% in ME / CFS and 75.0% in post-COVID ME/CFS (the latter was higher than in healthy controls, p = 0.02) There was a more pronounced increase in heart rate starting from the 6th minute of the test in post-COVID ME/CFS compared with the control group. Assessment of the functional characteristics of microcirculation by laser doppler flowmetry revealed obvious and very similar changes in ME/CFS and post-COVID ME/CFS compared to the healthy controls. The identified pattern corresponded to the hyperemic form of microcirculation disorders, usually observed in acute inflammatory processes or in deficiency of systemic vasoconstriction influences.

Digital Skills as A Significant Factor of Human Resources Development (preprint)

Digital technologies play a key role in reviving the world economy. The EU has pledged to combine recovery support with resilient digital transformation. The COVID-19 pandemic highlighted the lack of digitization in Slovakia and the shortcomings of digital skills in citizens and communication with institutions. Digital skills are important and should form part of educational policy. ICT skills can help people succeed in the labour market and improve communication with public administration. Digitization and globalization increase the importance to communicate through the Internet, applications and other e-based gadgets. Digital skills are one of the essential parts of e-Government, so people can use e-Government services in communication with public administration. The current crisis citizens' use of online services. In-dices concerning the digital economy are analysed, such as the digital economy and society index DESI and e-government digital skills (EGDI) from 2018 to 2021 revealed a stagnant state in 2018 and 2019 and 2020, there was a decrease in basic digital skills". The next index is E-Government Digital Index It focuses on human capital and digital skills in these indices. The paper analyses and identifies the digital skills of citizens in the context of e-Government development and describes the use of e-Government services by EU citizens with a focus on the Slovak republic. The data were collected through a questionnaire survey with citizens in Slovak republic's digital skills according to selected categories, the use of e-Government services as well as awareness of e-Government services. Solutions that improve e-government in the Slovak Republic are gradually being implemented. Improving digital skills according to National Coalition for Digital Skills and professions in the Slovak republic and is one of the priorities of The Ministry of Education, Science, Research and Sport of the Slovak Republic which has adopted an action plan for 2019 – 2022 to improve the results in the DESI index by 2025 and focus on the digital skills required by employers. The survey revealed that in Slovakia, the majority of schools offer only weak support for digital education (about the EU-27 average of 68% and 45%, respectively). The research revealed also decreased level of digital literacy among young people. These competencies are very important to gain a position in the labour market in the digital society. The projects aim to support the development of digital skills of primary and secondary school students, and the integration of new technologies into teaching.

Statistical and Health Economic Analysis Plan Including COVID-19 Mitigation Strategy for the Physio4FMD Trial (preprint)

Background: Functional motor disorder (FMD) is a common cause of disabling neurological symptoms such as weakness and tremor. We are carrying out a pragmatic, multicentre single blind randomised controlled trial to evaluate effectiveness and cost effectiveness of specialist physiotherapy versus treatment as usual to improve physical functioning at 12 months. Like many other studies, this trial was affected by the COVID-19 pandemic, which interrupted the trial towards the end of planned recruitment. In this paper, we discuss (i) the impact of COVID-19 on the trial; (ii) the impact mitigation strategies implemented; and (iii) the planned statistical and health economic analysis methods and sensitivity analyses aimed at assessing the disrupting influence of COVID-19 on the trial. Methods The planned statistical and health economics analyses for this trial are described, as well as the sensitivity analyses designed to assess the disruption caused by COVID-19. The trial treatment of at least 89 participants (33%) was disrupted due to the pandemic response. To account for this, we have extended the trial to increase the sample size. We have identified four groups based on how participants’ involvement in Physio4FMD was affected; A: 24 were unaffected; B: 131 received their trial-treatment before the start of the COVID-19 pandemic and were followed up during the pandemic; C: 89 were recruited in early 2020 and had not received any randomised treatment before clinical services closed because of COVID-19; D: participants recruited after the trial was restarted in July 2021 (target 90 to 120). The primary analysis will involve groups A, B and D. Regression analysis will be used to assess treatment effectiveness. We will conduct descriptive statistics for each of the groups identified and sensitivity regression analyses with participants from all groups, including group C, separately. Discussion The COVID-19 mitigation strategy and analysis plans are designed to maintain the integrity of the trial while providing meaningful results. By publishing our analysis plans ahead of database lock, analysis and unblinding, we aim to avoid bias due to data-driven analysis. Trial registration : The trial was registered with the ISRCTN register on 27/03/2018, number ISRCTN56136713.

Men and loneliness in the Covid-19 pandemic: insights from an interview study with UK-based men (preprint)

As the SARS-COV-2 pandemic hit, the UK, like many countries, introduced severe restrictions on social contact, and injunctions of 'social distancing', to reduce transmission. This led to a concern that loneliness may increase, facilitating poorer mental and physical health. Twenty qualitative interviews were conducted, with a diverse group of UK-based men, between January and March 2021, during severe restrictions. Our aim was to generate new insights into men's experience of loneliness during the pandemic, and consider the ramifications of these for continued/future restrictions, the easing of restrictions, and the future beyond the pandemic. Thematic analysis, focused on semantic themes, was employed as part of a 'grounded' epistemology whereby the stated perspectives of the interviewees drove the content of the study. Six themes were constructed: i) people to see and things to do (broken, changed, and new); ii) rethought and renewed recognition of what is important; iii) loneliness with a purpose; iv) loneliness as normal; v) anxiety of social contact; and vi) easier for some than others. The restrictions did cause some loneliness, particularly because of lost routines and opportunities, and the reduction in face-to-face interaction. However, a need to reduce transmission of SARS-COV-2, and a fear of catching it, became important features of participants lives that also affected loneliness and its causes. Remote forms of interaction were often utilised, and though they were imperfect, those that were dependable, were smaller than might be desired in person, and ensured a chance to speak, were constructed as more positive. The fear of Covid-19, and a loss of social skills, may mean that reducing restrictions alone will not return everyone to pre-pandemic levels of loneliness. Some believed the building of supportive local communities, and a destigmatisation of loneliness, may allow for the building of a more compassionate and less lonely society.

A Pilot Study Delivering Physiotherapy Support for Rett Syndrome Using a Telehealth Framework Suitable for COVID-19 Lockdown.

Background: Rett syndrome (RTT) is a genetically caused neurodevelopmental disorder associated with severe disability. We assessed the feasibility of a telehealth program supporting gross motor skills in RTT.Methods: Five girls with RTT were assessed and a home-based exercise program developed in response to functional goals. Families then participated in monthly Skype sessions for 6 months, guided by a physiotherapist to monitor progress and adjust the program as necessary. Goal Attainment Scaling was used to evaluate progress and a parental satisfaction questionnaire was administered.Results: Four goals were established for each participant and progress was greater than would be expected in 16 of 20 goals. Parents evaluated the program as feasible and useful for their daughters.Discussion: A telehealth model of home-based intervention supported individuals with RTT to achieve gross motor skills and was found to be feasible. This model is important at present times during COVID-19 outbreak and lockdown.

Well-Being Perception During COVID-19 Pandemic in Healthy Adolescents: Evidence From the Avatar Study (preprint)

Background COVID-19 pandemic provided an extraordinary and naturalistic context to observe young people’s psychosocial profile and to study how a condition of environmental deprivation and lack of direct social contact, affect the well-being and health status of adolescents. The current study explored whether the COVID-19 outbreak changes, in the short term, the acute well-being perception in adolescents, as measured by a Personalised Well-being Index (PWBI) and the four components affecting health (i.e. lifestyle habits, social context, emotional status, mental skills), in a sample of early adolescent students.Methods Data were collected in 1019 adolescents (boys 48.3%, mean age 12.53 ± 1.25), at the beginning of school year (Baseline Condition, BC) as part of the AVATAR project and during the Italian lockdown phase (LP) using online questionnaire.Results During COVID-19 quarantine, adolescents showed a lower PWBI (p = 0.000) as compared to the baseline conditions. Considering the four health-related well-being components, lifestyle habits (p = 0.000), social context (p = 0.000), and emotional status (p = 0.000), showed significantly lower values during lockdown phase than baseline ones. However, mental skills, in LP, displayed a significant increase as compared to pre-COVID conditions (p = 0.000).Conclusions In this study, we have provided data on the personalised well-being index and the different components affecting health in adolescents during the COVID-19 lockdown, showing a general decreased in well-being perception, expressed in the lifestyle habits, social, and emotional components, demonstrating detrimental effects in the first phase of quarantine on adolescents’psychosocial profile. Our result shed new light on adolescence as a crucial period of risk behaviour, especially when social support is lacking.

Clinical Outcomes of Patients With and Without HIV Hospitalised with COVID-19 in England During the Early Stages of the Pandemic: A Matched Retrospective Multicentre Analysis (RECEDE-C19 Study) (preprint)

Background: It is unclear from epidemiological data for COVID-19 infections, whether people living with HIV (PLWH) have a different outcomes compared to the general population. We conducted a multi-centre, retrospective matched cohort study of SARS-CoV-2 PCR-positive hospital inpatients analysed by HIV-status.Methods: HIV-negative patients were matched to PLWH admitted to hospital before 31 st May 2020, with a 3:1 ratio by: hospital site, SARS-CoV-2 test date +/- 7 days, age +/- 5 years, gender, and index of multiple deprivation decile (IMDD) +/- 1. The primary objective was clinical improvement (≥2-point improvement on a 7-point ordinal scale) or hospital discharge by day 28, whichever was earlier.Results: 68 PLWH and 181 HIV-negative comparators were included. After adjustment for ethnicity, frailty, baseline hypoxia, duration of symptoms prior to baseline, body mass index categories, and comorbidities (hypertension, chronic cardiac disease, chronic lung disease, active malignancy, diabetes, and chronic renal disease), the effect size of HIV status was not associated with time to clinical improvement or discharge from hospital (aHR 0.70, 95%CI 0.43, 1.17; p=0.18), despite unadjusted hazards of PLWH achieving the primary outcome being 43% lower (p=0.005). Baseline frailty (aHR=0.79; 95%CI 0.65, 0.95; p=0.011), malignancy (aHR=0.37; 95%CI 0.17, 0.82; p=0.014) remained associated with poorer outcomes. PLWH were more likely of black and minority ethnicities (75.0% vs 48.6%, p=0.0002), higher median clinical frailty score (3 IQR 2-5 vs 2 IQR 1-4, p=0.0069), higher proportion of active malignancy (14.4% vs 9.9%, p=0.29). Median body mass index (BMI) was lower amongst PLWH (27.7 IQR 23.9-32.3 vs 29.4 IQR 24.7-34.3, p=0.19). Median CD4 count of PLWH was 352cells/µL (IQR 235-619) and 95.7% had suppressed viral loads <200copies/mL, 63/68 (92.3%) were taking antiretroviral therapy.Conclusions: Differences in clinical outcomes of COVID-19 hospitalisations in PLWH may be due to other important factors including increased frailty and comorbidities such as malignancies, rather than HIV-status alone.Funding Statement: This study has not received any funding sources.Declaration of Interests: MJL has received grants and honoraria from Gilead Sciences and Viiv Healthcare not related to this work. SF has received research grants to her institution from NIH, MRC, BMGF. JT has received support for virtual conference registration from ViiV Healthcare and research grants from the Medical Research Council and the British HIV Association not related to this work. CvH has received educational grants, conference support and advisory board fees from ViiV Healthcare, Gilead Sciences, MSC not related to this work. MP reports grants and personal fees from Gilead Sciences and personal fees from QIAGEN, outside the submitted work. MP is supported by a NIHR Development and Skills Enhancement Award (NIHR301192) and in receipt of funding from UKRI / MRC (MR/V027549/1). He acknowledges the support from UKRI, the NIHR Leicester BRC and NIHR ARC East Midlands. No other competing interests, financial relationships with any organisations that might have an interest in the submitted work, or other relationships or activities that could appear to have influenced the submitted work have been reported by other authors.Ethics Approval Statement: Ethical approval was granted by the UK Health Research Authority (REC reference 20/HRA/2278).

Development and Pilot-testing of a Hepatitis C Reinfection Prevention Intervention for Patients in Treatment for Hepatitis C Infection (preprint)

Background: With annual rates of hepatitis C virus (HCV) reinfection among persons who inject drugs ranging from 5% to 22%, the need for behavioral interventions to prevent reinfection following successful treatment is clear. Methods: This report aims to describe the conception and development of an intervention to prevent HCV reinfection and present preliminary results from its pilot testing at an opioid treatment program offering on-site primary medical care, including treatment for HCV infection. We developed a two-session intervention combining a teachable moment followed by a session based on the Information-Motivation-Behavioral Skills (IMB) Model to reinforce learning. The teachable moment occurs in less than ten minutes during the routine blood draw to measure viral load during HCV treatment. The reinforcing IMB session builds knowledge, motivation, and self-efficacy in practicing safer injection skills. Formative exploratory work for the intervention involved a literature review, planning meetings with implementation staff, and development of study materials. Intervention staff were trained and the intervention was pilot tested. Measured outcomes included feasibility and acceptability of the intervention to patients and implementers, study recruitment and retention, and preliminary changes in knowledge, motivation, self-efficacy, and HCV reinfection risk behaviors over the study time period. Results: The study protocol and intervention content are both described, along with the preliminary results of implementation and psychosocial outcomes among 17 patients undergoing direct-acting antiviral treatment for HCV. Baseline data revealed gaps in HCV prevention knowledge that could lead to reinfection. We also report lessons learned related to implementation of such an intervention with this population in integrated care settings. After some minor adjustments, we found high levels of feasibility and acceptability for the intervention at the implementing organization. Intervention implementation was interrupted due to COVID-19 restrictions. Conclusions: It is possible to implement an intervention in an opioid treatment program to improve HCV prevention knowledge with the potential to prevent reinfection. Intervention staff must be attentive to participant needs regarding time and monetary constraints to maximize acceptability. Given the impact of the COVID-19 pandemic, future research should explore the possibility of offering the intervention via phone or video chat.

Coping with COVID impact on Self-Employment: Does Gender and Academic Education Matters? (preprint)

In this modern age of competitiveness and the quest for sustainable income source through the adoption of innovative approaches, the preference towards self-employment is ever-increasing among individuals in the global scenario. In Nepali scenario, as the rate of employment opportunities are comparatively low in comparison to the rate of individual obtaining higher degree (above high school), the rate of self-employed individuals has increased in a significant manner. As financial security is not as strong as that of developed countries, the self-employment sector gets affected during any unwanted circumstances which were evident during COVID-19 period as well. This paper used Human Capital Theory and Need for Achievement Theory to discuss the role of gender and academic knowledge as contributing factors towards identification and adoption of coping strategies during COVID-19. With desk review and interviews with self-employed individuals, this paper strongly argues, the strategies adopted to cope with COVID-19 is more guided by enterprise type and financial backing instead of academic skill and gender.

Future Proofing Applied Epidemiology Workforce Training for Emergency Response. A Global Survey of Applied Epidemiologists, 2019-2020 (preprint)

BackgroundRapid and effective emergency response to address health security relies heavily on a competent and suitably trained local and international workforce. The COVID-19 pandemic has highlighted the need to ensure that the health security workforce is well equipped to tackle current and future challenges. We conducted a survey to understand whether applied epidemiology training was meeting the needs of the field epidemiological workforce.MethodWe conducted a cross sectional online survey. Purposive sampling and snowballing techniques were used to identify survey respondents. Inclusion criterion was any person who self-identified as working in an applied epidemiology role. We recruited survey respondents through an online social media campaign and partnered with the Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) to directly reach field epidemiology training programme (FETP) alumni networks. Survey topics included participant demographics, technical background, formal education level, year of epidemiology training, topics studied during epidemiology training, years of experience as an epidemiologist, and their public health/epidemiology learning. The survey was available in English and French. ResultsWe received 282 responses from people with a range of formal public health and epidemiology training backgrounds. Applied epidemiology work experience of respondents spanned almost 30 years from across 64 countries. FETP alumni made up 74% (n=210) of the total. Basic outbreak and surveillance training was well reported by the respondents, however training in specialised techniques related to emergency response was not as common. Less than 50% of respondents reported receiving training in leadership and management. Training in emergency response and communications scored low across most categories. Fifty-six per cent of respondents reported learning evidence-based decision-making. FETP graduates reported higher levels of formal training in all survey topics. ConclusionA specific aim of our survey was to identify the training needs of the applied epidemiology workforce. Training gaps identified included leadership, communication and social skills, as well as emergency response capacity. Our survey showed that applied epidemiology workforce training must evolve to remain relevant to current and future public health challenges. 

A Near-Peer Surgical Teaching Programme for Junior Doctors (preprint)

Background: Surgical departments across the UK are having to mitigate increasing service demands, budget constraints and changes to work patterns, with their statutory duty to provide high-quality training and education. In an overstretched NHS, securing consultant-led teaching for junior doctors has become increasingly difficult leading to the rise of near-peer teaching. We evaluate the long-term effectiveness of a near-peer surgical teaching programme for junior doctors. Methods: We developed a rolling 12-week trainee-led, didactic surgical education programme for junior doctors and incorporated a three-tiered leadership and handover mechanism involving lead junior doctors, registrars and a lead consultant to ensure consistency and programme continuity. Junior doctors delivered presentations to their peers with close supervision and input from registrars. Participants provided session and supervision feedback using 5-point scales and free-text responses. Data was collected using Google Forms™ and analysed using student’s t-test on Microsoft Excel®. Results: 42 junior doctors responded to our end-of-programme feedback surveys covering December 2018 to April 2020. The overall programme (8.83±1.08/10), topic relevance (4.62±0.58/5), presentation quality (4.60±0.50/5) and supervisor knowledge (4.81±0.40/5) were rated highly by respondents. 95.2% (n=40) of respondents had attended more than 3 sessions and 71.4 % (n=30) had delivered teaching. Respondents also reported significant improvements in subject knowledge (3.72±0.92/5 to 4.50±0.56/5, P<0.0001), clinical confidence, presentation and teaching skills following each session. Conclusions: This long-term near-peer teaching programme addressed the educational needs of junior doctors and developed their presentation and organisational skills. Supervision and input from registrars facilitated discussion and reinforced key concepts. Our strategy also facilitated workplace-based assessments and familiarisation with local management protocols for new cohorts of doctors rotating in Surgery at Basildon University Hospital. We also recently adapted this into a virtual programme in response to the COVID-19 pandemic, maintaining clinical education and expanding our audience. The success of this programme highlights the role that trainees can play in designing, developing and coordinating an effective surgical teaching programme.