The Impact of the Sars-Cov-2 Pandemic (COVID-19) on the Incidence of Newly Diagnosed Multiple Myeloma Patients Using a Federated Network of Real-World Evidence in US and Germany

Objectives: COVID-19 had an impact on health care, including diagnostics. Early diagnosis of MM is a critical factor for prognosis. We examined the impact of COVID-19 on incidence of NDMM patients and on characteristics in NDMM patients in US and in Germany. Method(s): 44,164 NDMM patients were identified in TriNetX federated network across 55 healthcare organizations in US between January 2018 and December 2021. A bivariate analysis examined changes in patient characteristics in two cohorts before (Cohort 1;n=25513) and after (Cohort 2;n=18.651) the start of the COVID-19 pandemic in March 2020. 4172 NDMM patients were identified in the German database in a sample of across >100 healthcare organizations in the same time period. Similarly, bivariate analysis examined changes in patient characteristics before (Cohort 1;n=2252) and after (Cohort 2;n=1920) the start of pandemic. Result(s): Analysis of US data showed a significant decrease in incidence of NDMM. Bivariate analysis revealed that NDMM patients in Cohort 2 have a significantly higher risk profile compared with patients in Cohort 1, higher incidence of renal failure (13.5% v. 15.43%), heart failure (10.3% v 11.26%), bone lesions (12.6% v. 13.05%) and anemia (26.8% v. 29.75%). The German data indicated an increased risk profile in Cohort 2, with higher reporting of renal impairment (12.3% v. 15.5%) and cardiac impairment (8.3% v. 10.9%). The higher risk profile was reflected in a significant increase of all SLiM-CRAB criteria, notably hypercalcemia (24.1 % v. 36.9%), bone marrow plasma cell infiltration (28.1% v. 36.8%) and free light chain involvement (27.3% v. 41.3%). Conclusion(s): The results provide real-world evidence of a change in risk profile for patients with NDMM during COVID-19. This higher risk profile is observed in both the US and Germany, and may negatively impact outcomes such as progression-free and five-year overall survival.Copyright © 2023

Discovery and Inquiry Pathways to Navigating the Routledge International Handbook of Failure

Our aim in this afterword is to take the position of an informed reader in the social sciences who seeks as we did to discover points of entry into critical failure studies as developed within the Routledge International Handbook of Failure. Because the book ranges across disciplines and subject matter, we find that the introduction provides an ample overview of the chapters and the goals of the work. We have chosen to ask the question: how might a reader navigate this volume and approach its many theories, definitions, and perspectives? To accomplish this, we offer a brief view of two current projects, distinct in their foci, which served as points of entry to this body of work. First, a project on failure narratives among women in the academy, and second, a project that revolves around the coronavirus pandemic and vaccine hesitancy across six nations. In so doing, we hope to show how particular chapters provide surprises, insights, and theoretical frameworks that inform and deepen our understanding of this nascent and rich inquiry into the nature of failure and how it is problematized and challenged. © 2023 selection and editorial matter, Adriana Mica, Mikolaj Pawlak, Anna Horolets and Pawel Kubicki;individual chapters, the contributors.

Prevalence and duration of anti-SARS-CoV-2 antibodies in healthcare workers

Introduction. Knowledge of the seroprevalence and duration of antibodies against SARS-CoV-2 was needed in the early phases of the COVID-19 pandemic and is still necessary for policy makers and healthcare professionals. This information allows us to better understand the risk of reinfection in previously infected individuals. Methods. We investigated the prevalence and duration of detectable antibodies against SARS-CoV-2 in sequentially collected samples from 379 healthcare professionals. Results. SARS-CoV-2 seroprevalence at inclusion was 5.3% (95% confidence interval (CI): 3.3-8.0%) and 25% of seropositive participants reverted during follow-up. At the end of follow-up, the calculated probability of having detectable antibodies among former seropositive participants was 72.2% (95% CI: 54.2-96.2%). Conclusion. Antibodies against SARS-CoV-2 were detectable in a subset of infected individuals for a minimum of 39 weeks.

Faculty Driven Virtual Reality (VR) Scenarios and Students Perception of Immersive VR in Nursing Education: A Pilot Study

Innovative nursing education methods became essential due to the COVID-19 pandemic. Immersive Virtual Reality (VR) education offers nursing students authentic patient encounters in a realistic simulated environment. A pilot study was conducted to identify nursing education clinical scenarios that should be developed for immersive VR and to assess students' perception of immersive VR in education. We formed a focus group composed of nursing faculty (N=10) with expertise in the clinical setting and simulation. Faculty participants identified important topics and aspects of immersive VR scenarios during focus group discussions. We assessed nursing student participants' (N=11) perception of immersive VR in nursing education using a VR game (Anatomy Explorer 2020). Most student participants indicated that a VR game was immersive and realistic and recommended using immersive VR to learn clinical nursing skills. Realistic immersive VR clinical education scenarios could result in effective clinical nursing education.

Ties that bind: Young people, community and social capital in the wake of the pandemic

The connection that young people have to their local neighbourhood and community has been shown to impact on health and wellbeing, particularly for those living in the most deprived areas. We report on a qualitative participatory study using photo elicitation methods undertaken in three deprived neighbourhoods across London exploring concepts of community and social connection, with young people aged 13-24 years, against the backdrop of the COVID-19 pandemic. The construct of social capital, referring to the extent of solidarity and connection between groups, has been shown to impact on pandemic related outcomes, and is used in this study as a lens to enhance understanding of young people's experience of the pandemic. Young people created heterogenous physical social ties across class, ethnicity, and geographical area which were important during the pandemic, although these may be jeopardised by a range of factors including fear of violence, mistrust of those in power, parental control and place-based inequity. The isolation and localism enforced by the pandemic encouraged young people to pay more attention to the value of local connections they built up both with people and place. Place-based research needs to continue a dialogue with young people, acknowledging and drawing on existing networks, community assets and cultural beliefs. The impact of COVID-19 on accentuating existing inequalities means that the need for place-based action, addressing the social determinants of health and involving the experiences and input of the young, is more vital than ever.Copyright © 2022 London School of Hygiene and Tropical Medicine

Insights into a Community of Inquiry that emerged during academics' emergency remote university teaching of chemistry in response to concern for students

Background: Effective teaching of university chemistry in an online environment not only requires teachers to have specific discipline content knowledge;it also requires them to have knowledge and skills in technology-enhanced teaching practices. When transitioning from traditional face-to-face teaching into online contexts, teachers must learn new strategies and methods, along with a shift in their beliefs. Whilst online learning of chemistry is commonplace in many higher education institutions globally, the integration of computer and digital technologies in teaching chemistry in developing countries had been limited prior to the 2020 pandemic. Purpose: In this study, the experiences, perceptions, and teaching strategies of university chemistry teachers in the Philippines have been explored during the transition of their instruction to emergency remote teaching at two timepoints during the COVID-19 pandemic. Sample: Data were collected in the form of survey responses from 139 participants representing 35 universities and colleges across the nation. Results: No strong relationships were found between participants' experiences and their academic rank, length of service, or institution type, suggesting university chemistry teachers took similar approaches to quickly adopt and adapt available technologies to deliver the required curriculum. Since the Philippines continues to struggle to establish a robust infrastructure to promote online and technology-enhanced learning, participants had to devise pedagogies and practices that would allow accessible learning experiences for their students by curating online tools that would require minimal bandwidth and low internet data consumption. Using abductive methodology, the Community of Inquiry (CoI) framework was employed as a guide in interpreting university chemistry teachers' experiences and perceptions about their implementation of emergency remote teaching using online technologies. Whilst participants had limited prior experiences in employing online learning pedagogies, key elements of the CoI framework became apparent through the new technologies and practices implemented by university chemistry teachers which fostered teaching presence, cognitive presence, and social presence. © 2023 Crown Copyright.

Antibody responses to SARS-CoV-2 vaccination outperform responses induced by natural infection in patients with IBD receiving immunosuppressive medications: A report from the ICARUS-IBD consortium

Background: The effects of immunosuppressive medications on immune responses to COVID-19 vaccination in patients with inflammatory bowel diseases (IBD) have been reported. However there is little data on immune responses in naturally infected SARS-CoV-2 patients compared with vaccination. We compared in a longitudinal study SARS-CoV-2 antibody and T cell responses in naturally-infected vs. vaccinated IBD patients Methods: 110 IBD patients enrolled at the Icahn School of Medicine at Mount Sinai were prospectively followed with serial blood collection between May 2020, and February 2022. Samples were screened by ELISA to determine seropositivity, and stratified by infection, vaccination status, and IBD medications. Subsequently, ELISA-based inhibition assay and pseudotyped SARS-CoV-2 microneutralization assays were used to determine the inhibition and neutralization capacity of the seropositive individuals for wild type (WT) delta variant (Dv) and Omicron. Cellular responses were measured by IFN-gamma ELIspot using nucleocapsid and spike peptide libraries Results: Overall, 64 patients had Crohn's Disease and 46 had Ulcerative Colitis (UC), 69 were naturally infected. Only Anti-TNF (N=52), Ustekinumab (N=16), and Vedolizumab (VDZ) (N=33) treatment groups were considered. Only US-available vaccinations were included. Double-vaccinated IBD patients showed greater neutralizing responses to SARS-CoV-2 WT and Dv than naturally-infected individuals (p=0.0003, p=0.0025). Moreover, double-vaccinated individuals had greater neutralizing reactions against WT than DV (p 0.017) and Omicron (p 0.001) variants. Following natural infection, there were no differences between treatment groups in neutralization response, however those double-vaccinated on anti-TNF had lower neutralization than VDZ (p=0.008). Neutralization responses were maintained for a period of 8 months following natural infection and double vaccination SARS-CoV-2 spike T cell responses were significantly higher in naturally infected (p=0.009) and double vaccinated individuals (p=0.005) with no significant differences between treatment groups (p<0.999) Conclusion(s): After a second vaccine dose, IBD patients showed stronger neutralizing antibody titers than naturally infected patients. Those on anti-TNF exhibited lower neutralizing responses than VDZ. T-cell responses were similar in infected and double-vaccinated subjects after vaccination or infection. These data imply COVID-19 immunization provides additional serological protection over natural infection.

A Case of SARS-CoV-19-Associated Encephalitis in a Neonate

Objective: To describe a case of SARS-CoV-19-associated encephalitis in a neonate. Method(s): Case report. Report: A 9-day-old term neonate presented with two focal motor seizures (right upper limb jerking and facial twitching). He had a 1-day history of coryzal illness with reduced feeding, but was afebrile. Antenatal course was uneventful. He was born at term via vaginal delivery. He did not require resuscitation or admission to SCBU. Maternal history was notable for symptomatic SARS-CoV-19 infection at time of delivery. Two siblings subsequently tested positive for SARS-CoV-19. He had further seizures in the emergency department and was loaded with phenobarbitone. The infant was stabilised locally and transferred to a tertiary paediatric hospital for the management of neonatal sepsis. He never required respiratory support. However, he was diffusely hypotonic with poor suck, necessitating nasogastric feeding. Nasopharyngeal PCR was positive for SARS-CoV-19. Lumbar puncture microscopy was negative (WCC 6). All CSF bacterial and viral investigations were negative. CSF testing of SARS-CoV-19 was not available. Brain MRI revealed bilateral asymmetric areas of reduced diffusivity involving the subcortical white matter, medulla and the corpus callosum with frontal lobe predominance. He made a full neurologic recovery with supportive therapies and was discharged following a 9-day admission. He had no further clinical seizures and phenobarbitone was successfully weaned pre-discharge. Conclusion(s): In the absence of another aetiology or antenatal risk factor, SARS-CoV-19 infection was presumed causative in this case of focal seizures and white matter changes in this term neonate. White matter abnormalities on MRI imaging are reported in neonates with seizures in the context of other viral infections. Single case reports have been published of SARS-CoV-19 infection with associated abnormal MRI brain findings, particularly diffusion abnormalities of the corpus callosum, as seen in our case.

Engineering for Equity: Asking the Right Questions

Equity is becoming a higher priority for transportation agencies and organizations, particularly as the COVID-19 pandemic has highlighted gaps in access and as racial injustice has inspired new commitments to antiracist practices. Still, while questions of diversity, access, and bias have come into focus within our industry and have even, at times, led to more equitable public engagement during the planning stages of a project, centering equity should not stop there. Here, Thompson et al encourage transportation practitioners to remember that our work does not have an unspecified end--it impacts actual people whose lived experiences matter and who should be treated equitably. © 2022, Institute of Transportation Engineers. All rights reserved.

Engineering for Equity: Asking the Right Questions

Equity is becoming a higher priority for transportation agencies and organizations, particularly as the COVID-19 pandemic has highlighted gaps in access and as racial injustice has inspired new commitments to antiracist practices. Still, while questions of diversity, access, and bias have come into focus within our industry and have even, at times, led to more equitable public engagement during the planning stages of a project, centering equity should not stop there. Here, Thompson et al encourage transportation practitioners to remember that our work does not have an unspecified end--it impacts actual people whose lived experiences matter and who should be treated equitably. © 2022, Institute of Transportation Engineers. All rights reserved.

Potential cost of not vaccinating against COVID19 in the United States

Introduction: As of April 2022, the COVID19 global pandemic has resulted in over six million deaths globally, and over 81 million cases of COVID19 in the United States. Objective(s): The objective of the presentation is to share estimated direct and indirect costs due to COVID19 infection juxtaposed with the costs of COVID19 vaccine administration in the United States. Method(s): A literature review was conducted to identify potential cost savings from being immunized against COVID19. The costs of COVID19 vaccinations, direct costs related to healthcare and types of indirect costs were noted. Result(s): After reviewing over 40 resources, several costs were identified. The cost of COVID19 vaccine series, as defined by the Centers of Medicare and Medicaid Services (CMS), is currently USD40 for single-dose and USD40 per dose in a multiple-dose series. It is estimated that the average hospitalisation stay of an uninsured inpatient was ~USD7000-USD10,000 per day. The average cost of 12 major metropolitan cities in the United States were estimated for primary care facilities, urgent care facilities, and emergency room visits at USD195, USD239, USD1,425, respectively. As of April 2, 2022, 77% of the US have received at least one dose of COVID19 vaccine and 66% are considered to be fully vaccinated against COVID19 primary series. Conclusion(s): According to the data, the cost reduction in healthcare is consequential and cost-effective in vaccinating the population. This analysis contributes to the limited reports of a national cost-benefit analysis.

The Effects of COVID-19 on Australian Family Caregivers of People with Dementia: Caregiver COVID-19 Limitations Scale

Background: There is limited research on the effects of COVID-19 and accompanying psychological and health related outcomes among Australian family caregivers. The aim of this research was to examine caregiver limitations as a result of COVID-19, and measure this perceived impact on caregiving using the newly developed Caregiver COVID-19 Limitations Scale (CCLS-9). Psychometric properties of the CCLS-9 were also examined. Method(s): Forty-four Australian family caregivers of individuals living with dementia completed a cross-sectional online survey between May and September 2021. Outcome measures included psychological distress, caregiver burden, caregiver self-efficacy, social support, quality of life, and COVID-19 related caregiver limitations. Result(s): Psychological distress and social support significantly predicted caregiver limitations. Australian family caregivers reported high levels of psychological distress and caregiver burden, low levels of self-efficacy, moderate levels of perceived social support and quality of life. Overall COVID-19 had a moderate impact on Australian family caregivers. The CCLS-9 demonstrated good internal consistency and test-retest reliability, poor concurrent validity, and results provided support for a two-factor model of the CCLS-9. Conclusion(s): Findings from this study offer preliminary insight into the negative effects of COVID-19 on Australian family caregivers. Distinctly, the pandemic continues to pose a significant threat to the health and psychological wellbeing of Australian family caregivers of individuals living with dementia. Therefore, Australian family caregivers should receive increased and ongoing support during these unprecedented times. Copyright © 2022 the Alzheimer's Association.

Discriminating narcolepsy type-2, idiopathic hypersomnia, depression and hypersomnolence in post-acute COVID-19 syndrome

Central disorders of hypersomnolence, including narcolepsy type-1 and type-2 as well as idiopathic hypersomnia, depression and a subtype of post-acute COVID-19 syndrome might be confused when establishing a diagnosis. This diagnostic challenge can be explained by the presence of excessive daytime sleepiness, a clinical symptom that is observed in all four conditions, an overlap in the phenotypic traits of narcolepsy type-2 and idiopathic hypersomnia, as well as the presence of depressive symptoms observed in central disorders of hypersomnolence and post-acute COVID-19 syndrome subtypes. Considering the importance of a valid diagnostic on treatment's efficacy and future interventions, it is essential to define those conditions with precision. In this review, we will discuss the diagnostic criteria, clinical presentation and current state of knowledge with regards to the pathophysiology of central disorders of hypersomnolence and post-acute COVID-19 syndrome. We will pay particular attention to the characteristics specific to narcolepsy type-2, idiopathic hypersomnia, depressive episodes with hypersomnolence, and post-acute COVID-19 syndrome with drowsiness. While many studies have assessed the ability of different tools used to diagnose central disorders of hypersomnolence, very few have focused on physiological markers. A better understanding and identification of biomarkers specific to narcolepsy type-1 and type-2, idiopathic hypersomnia and post-acute COVID-19 syndrome will reduce the possibility of misdiagnoses and allow the development of optimal treatment plans. Copyright © 2022 Elsevier Masson SAS

Distinguer la narcolepsie de type 2, l’hypersomnie idiopathique, la dépression et la somnolence dans le syndrome post-COVID-19

Résumé Les syndromes d’hypersomnolence d’origine centrale (c.-à-d. narcolepsie de type-1, narcolepsie de type-2 et hypersomnie idiopathique), la dépression ainsi qu’un sous-type du syndrome post-COVID-19 peuvent être confondus lors de l’établissement d’un diagnostic. Ce défi diagnostique s’explique par un symptôme clinique caractéristique retrouvé dans les quatre conditions, la somnolence diurne excessive, un chevauchement phénotypique considérable entre la narcolepsie de type-2 et l’hypersomnie idiopathique ainsi qu’une symptomatologie dysphorique pouvant être présente autant dans les hypersomnolences centrales que dans un sous-type du syndrome post-COVID-19. Considérant l’importance d’un diagnostic valide sur l’efficacité des traitements et des interventions futures, il est essentiel de définir précisément ces quatre conditions. Dans cette revue, nous reprendrons les critères diagnostiques, les présentations cliniques et les connaissances actuelles en ce qui a trait à la pathophysiologie de ces troubles en portant une attention particulière aux éléments distinctifs de la narcolepsie de type-2, de l’hypersomnie idiopathique, des épisodes dépressifs avec hypersomnolence et du syndrome post-COVID-19 avec somnolence. Bien que de nombreuses études se soient penchées sur les valeurs diagnostiques des différents outils employés dans l’identification des hypersomnolences centrales, très peu de marqueurs physiologiques ont été identifiés. Une meilleure compréhension de ces conditions cliniques pourrait permettre l’identification de marqueurs objectifs spécifiques à chaque condition réduisant ainsi la possibilité d’une erreur diagnostique et optimisant les plans de traitement. Summary Central disorders of hypersomnolence, including narcolepsy type-1 and type-2 as well as idiopathic hypersomnia, depression and a subtype of post-acute COVID-19 syndrome might be confused when establishing a diagnosis. This diagnostic challenge can be explained by the presence of excessive daytime sleepiness, a clinical symptom that is observed in all four conditions, an overlap in the phenotypic traits of narcolepsy type-2 and idiopathic hypersomnia, as well as the presence of depressive symptoms observed in central disorders of hypersomnolence and post-acute COVID-19 syndrome subtypes. Considering the importance of a valid diagnostic on treatment's efficacy and future interventions, it is essential to define those conditions with precision. In this review, we will discuss the diagnostic criteria, clinical presentation and current state of knowledge with regards to the pathophysiology of central disorders of hypersomnolence and post-acute COVID-19 syndrome. We will pay particular attention to the characteristics specific to narcolepsy type-2, idiopathic hypersomnia, depressive episodes with hypersomnolence, and post-acute COVID-19 syndrome with drowsiness. While many studies have assessed the ability of different tools used to diagnose central disorders of hypersomnolence, very few have focused on physiological markers. A better understanding and identification of biomarkers specific to narcolepsy type-1 and type-2, idiopathic hypersomnia and post-acute COVID-19 syndrome will reduce the possibility of misdiagnoses and allow the development of optimal treatment plans.

Food deserts and food insecurity in the UK: Exploring social inequality

Access to food in the UK, and especially access to healthy food, is a constant source of worry for many in this wealthy country. Crises, such as the COVID-19 pandemic, have coincided with a steep rise in the cost of living, meaning household food insecurity has become a reality for many more households. This book introduces a new framework to examine the many influences on local-level food inequalities, whether they result from individual circumstances or where a person lives. The framework will allow researchers new to the field to consider the many influences on food security, and to support emerging research around different sub-topics of food access and food security. Providing a thorough background to two key concepts, food deserts and food insecurity, the book documents the transition from area-based framing of food resources, to approaches which focus on household food poverty and the rise of food banks. The book invites researchers to acknowledge and explore the ever changing range of place-based factors that shape experiences of food insecurity: from transport and employment to rural isolation and local politics. By proposing a new framework for food insecurity research and by drawing on real-world examples, this book will support academic and applied researchers as they work to understand and mitigate the impacts of food insecurity in local communities. © 2023 Dianna Smith and Claire Thompson. All rights reserved.

Prevalence and duration of anti-SARS-CoV-2 antibodies in healthcare workers

Introduction. Knowledge of the seroprevalence and duration of antibodies against SARS-CoV-2 was needed in the early phases of the COVID-19 pandemic and is still necessary for policy makers and healthcare professionals. This information allows us to better understand the risk of reinfection in previously infected individuals. Methods. We investigated the prevalence and duration of detectable antibodies against SARS-CoV-2 in sequentially collected samples from 379 healthcare professionals. Results. SARS-CoV-2 seroprevalence at inclusion was 5.3% (95% confidence interval (CI): 3.3-8.0%) and 25% of seropositive participants reverted during follow-up. At the end of follow-up, the calculated probability of having detectable antibodies among former seropositive participants was 72.2% (95% CI: 54.2-96.2%). Conclusion. Antibodies against SARS-CoV-2 were detectable in a subset of infected individuals for a minimum of 39 weeks.

SAWBRID: SmArt WhiteBoard Replacement Interactive Device

The idea of attending a professor's office hours seems very basic to the average college student. The beginning of each semester brings about a wave of invitations to visit each professor in their office, at the allotted time for the section of their class. Recent developments such as the growing prevalence of texting and email, as well as specific events such as the Covid-19 pandemic have brought the norm away from these in person meetings between students and professors, to the detriment of the students' education. The SmArt WhiteBoard Replacement Interactive Device (SAWBRID) is an innovative solution composed of an interactive device with a Low-power screen that, through a user friendly mobile application, makes the facilitation of office hours and the student/professor interactions outside of the classroom far more flexible and simple. In whole, the project is centered around the individual professor, their schedule, and how that schedule is communicated. The SAWBRID sits in an accessible casing outside of the professor's office, relaying information about their schedule, available time slots to be scheduled through the mobile application, and personalized messages. The device is self-updating whenever a change is detected in the professor's schedule, or when they decide to update their personalized message. The student can access a professor's schedule through the mobile application and schedule an appointment, which will place their initials in the selected time slot on both the mobile application and the SAWBRID. The professor has a different interface to interact with their SAWBRID from the mobile application giving them more control over their schedule, the personalized messages they want to display and other features. We use security services such as confidentiality and authentication throughout the system to protect user credentials, user data, and to ensure the privacy of the users. Our solution effectiveness and performance are evaluated through power measurements to determine the device's ability to self-sustain for long periods of time and the ease of use.

BOTH VEDOLIZUMAB AND ANTI-TNF THERAPY ARE ASSOCIATED WITH ATTENUATION OF SEROLOGICAL AND NEUTRALIZING RESPONSES TO SARS-COV-2 INFECTION IN INFLAMMATORY BOWEL DISEASE

Introduction: More adverse clinical outcomes following SARS-CoV-2 infection are reported in patients treated with infliximab/thiopurines (IFX/THIO), compared with biological monotherapy with anti-TNF or vedolizumab (VDZ). VDZ has been associated with a heightened and more durable serological response after infection and vaccination, compared to IFX. However, whether IBD patients on VDZ have a fully intact systemic response to SARS- CoV2 remains unknown. We explored the serological and functional neutralizing response after SARS-CoV-2 infection in IBD patients treated with VDZ, IFX or IFX/THIO compared to true healthy controls to guide treatment decisions and vaccination strategies. Methods: Serum from 640 IBD patients attending routine infusions in Oxford and London (May to December 2020) was screened by the Abbott assay for SARS-CoV-2 nucleocapsid (N) antibodies. Serum from seropositive patients was compared to seropositive health care workers (Table 1). Antibody reactivity to the SARS-CoV-2 wild type (WT) strain receptor-binding domain (RBD), full-length spike, and N was assayed by IgG/IgA ELISA over time as well as by IgG MSD V-PLEX ELISA at the time of seropositivity. A pseudotyped SARS-CoV-2 virus microneutralization assay was used to detect neutralizing antibodies to the WT, and an ELISA-based inhibition assay to compare differential inhibition of the WT vs. delta variant (DV) SARS-CoV-2 RBD-ACE2 interaction. Results: All IBD patients showed significantly reduced IgG antibody responses compared to healthy controls to all SARS-CoV-2 antigens, using MSD V-PLEX (Figure 1A-C). The greatest reduction in IgG response by ELISA was observed in patients treated with IFX/THIO (p=0.00019), whereas IgG response over time declined significantly faster in the IFX treated group (p=0.019). IgA responses were significantly reduced in the IFX/THIO group compared to healthy controls (p=0.009), but not in the IFX or VDZ group. The rate of decline in these monotherapy groups was not significantly different to healthy controls. Compared to healthy controls, functional SARS-CoV-2 neutralization was reduced in each treatment group (Figure 1D), with the greatest effect in patients receiving IFX/THIO (p=0.00000091). Neutralizing capacity to the DV was significantly reduced in 68.1% of IBD patients (30/44, p=0.0005). Conclusion: Both IFX and VDZ are associated with significantly reduced IgG responses to multiple SARS-CoV-2 antigens, and with impaired functional SARS-CoV-2 neutralizing antibody capacity, compared to healthy individuals. However, whilst IgG and neutralization responses are reduced in IBD patients on biological monotherapy, these findings were most pronounced in the combination treatment group. As neutralizing antibody responses are associated with protection, these observations may impact on decision-making regarding treatment and vaccination strategies.(Table Presented)(Figure Presented)

Gynaecological surgical training: the Irish trainee's perspective & potential solutions

Objective: This survey is the first part of a regional improvement project for Gynaecological surgical training in Ireland. Initial step to ascertain current opinions and confidence levels of trainees in gynaecological surgery and develop an understanding of their career goals. Design: Many surveys have been conducted on training within Obstetrics & Gynaecology. However, with the devastating impact on gynaecological surgical training from the COVID-19 Pandemic, a new vigour has emerged to assess this area, enhanced via the publication of the RCOG Gynaecological Surgery Recovery Plan. Ireland equally has felt the impact to surgical training and our project hopes to start to address this. This survey was designed with specific focus on gynaecological surgical training and to identify the key areas to focus the recovery process on. Designed using the SurveyMonkeyR platform and distributed via email. Methods: The survey was circulated to all O&G trainees in Ireland. The 34 questions focused on the number of procedures performed over last 12 months, confidence levels on performing these procedures alongside management of complications. Questions also assessed future career aspirations. The returned results were anonymised and analysis performed using a password protected ExcelR database. Results: We received 76 respondents, with 46% (n = 35) having worked in O&G for more than 5 years. A concerning 51% of trainees had contemplated leaving the specialty in the last 12 months. Only 20% (n = 16) of trainees had access to a Laparoscopic box trainer in their hospital and of these, only 38% (n = 29) received dedicated teaching on the trainer. The only laparoscopic procedure in which >50% of trainees felt comfortable performing was Veres entry at laparoscopy. Two thirds of respondents (n = 51) believed that the lack of gynaecological surgery training has impacted decisions on future career choices. 43% of SpR (ST4-8) trainees experienced difficulty in annual training progression due to a lack of surgical numbers. 95% felt a forum for surgical education and career guidance was needed. Conclusions: Trainees are significantly impacted by a lack of surgical exposure and training. This has understandably affected their confidence but also career planning, which may in turn affect national workforce structure and patient care. Our project design has moved forward using this survey information to develop a regional laparoscopic simulation hub in Dublin following the award of funding from the Mater Hospital Foundation and SPARK initiative. A pilot programme for trainees will be offered from January 2022.