COVID-19 Period Research Articles

Frailty Explains Variation in Emergency Department Use for Older Veterans During the COVID-19 Pandemic.

Older adults were critically vulnerable to disruptions in health care during the COVID-19 pandemic, but it is not known if changes in ED utilization varied based on patient characteristics. Using a cohort of older Veterans, we examined changes in ED visit rates based on four characteristics of interest: age, race, area deprivation index, and frailty. Participants were aged ≥65, with ≥2 visits in primary or geriatric clinics between 02/02/2018-05/07/2019. An adjusted negative binomial regression model was constructed for each characteristic. We report mean counts of all ED visits by quarter for subgroups separately, and report rate ratios to compare ED visits in the first year of the COVID-19 pandemic to the year before. Patients with complete case data numbered 38,871. During the first two quarters, all subgroups had decreased ED visits, with more variation in the third and fourth quarters. The very highly frail, who had the highest mean estimated count of ED visits per person through both pre-COVID and COVID periods, also had a significant decrease in their ED visits during multiple quarters of the pandemic to a greater degree than other frailty subgroups. Stratifying older adults by frailty identified patient subgroups with the greatest variation in ED visits during COVID. Very highly frail patients warrant special attention to understand how variation in ED utilization affects patient outcomes.

Kontribusi perikanan pukat cincin yang berpangkalan di Pelabuhan Perikanan Pantai Tumumpa terhadap PDRB Kota Manado di masa Covid-19

Covid-19 brought their intensive effects in marine fishery subsector in Manado by the end of 2019. The research aimed at finding out how far the effect of purse seine fishery contribute on Gross Regional Domestic Product (GRDP) Manado between before and after Covid-19. Secondary data collected from of BPS Manado dan North Sulawesi in 2018 - 2022, while primary data i.e purse seiner’s catches and its value production from the annual reports of Tumumpa coastal fishing port by direct observation on board. Data was analyzed using Location Quotient (LQ) approach. The result of data analysis showed, there was a declining production during Covid-19 due to a lack of fishing operation activities, having a consequence in fish production value decreasing, because the fish distribution obstruction from the centres of producer to the centres of consumer. Before Covid-19 period, it gained the average catches of 10,7 million tons.yrs-1 (increasing 17,46% yrs-1), with production value of Rp. 159,6 billion yrs-1 (increase 23,23% yrs-1). During Covid-19, average cathes of purse seiner was 11,3 billion tons yrs-1 (decline 8,25% yrs-1) and production value of Rp. 204,3 billion yrs-1 in average (decline of 8,30% yrs-1). Purse seine fishery contribution on GRDP Manado decrease from 0,10% yrs-1 before Covid-19 (2017-2019) to - 0.42% yrs-1 during Covid-19 (2020-2012). During these two periods, (marine) fishery subsector had a LQ < 1, meant that this subsector was really not a basis of the subsector. To fulfill the Manado society consumption on fishes, it is required to supply fishes from other locations. The other side, the business of purse seiner fishery brought an agreeable advantage.

The impact of the COVID-19 public health response on service demand and patient perceptions in a tertiary Australian gynaecology oncology unit.

The public health response (PHR) to the COVID-19 pandemic significantly disrupted healthcare services worldwide. Our hospital, a major tertiary centre, is a unique two-state service across Queensland and New South Wales (NSW). The primary objective is to describe changes in service demand and delivery in our hospital resulting from the COVID-19 PHR. The secondary objective is to investigate patient perceptions of this impact. We performed a retrospective interrupted time series analysis and a population-based survey to examine patient perceptions of the impact of the COVID-19 PHR. The study periods were demarcated by the initiation of the COVID-19 PHR on 1 March 2020 with the 'pre' and 'during' COVID-19 periods defined as the 12 months before and after this date respectively. More patients were seen during the COVID-19 PHR period. The number or stage of cancer diagnoses was not different (P > 0.05). There was evidence (P = 0.03) of an increase in overall occasions of service and fewer failed attendances (P = 0.005). Fewer surgeries were performed on NSW patients (P = 0.005). The survey response rate was 19.3% (n = 185) with 48% stating that COVID-19 had negatively affected their emotional wellbeing. More participants from NSW than Queensland identified border closures as the most significant impact of the COVID-19 PHR. The COVID-19 PHR resulted in an unexpected increase in unit service demand and delivery. The necessary implementation of telephone appointments, while less preferred by patients, sustained service requirements. Cross-border tertiary healthcare services should consider the significant impact of border restrictions on patient wellbeing.

Hepatitis C epidemiology and treatment outcomes in Italy: Impact of the DAA era and the COVID-19 pandemic.

HCV infection poses a global health threat, with significant morbidity and mortality. This study examines HCV trends in a large Italian region from 2015 to 2022, considering demographic changes, evolving clinical profiles, treatment regimens and outcomes, including the impact of the COVID-19 pandemic. This multicentre retrospective study analysed demographics, clinical histories and risk factors in 6882 HCV patients. The study spanned before and after the direct-acting antiviral (DAA) era, and the COVID-19 period, focusing on treatment outcomes (SVR12, non-SVR12 and patients lost to follow-up). Statistical methods included ANOVA, multinomial logistic regression, Kruskal-Wallis test and chi-square analysis, and were conducted adhering to the intention-to-treat (ITT) principle. The cohort, mainly Italian males (average age 58.88), showed Genotype 1 dominance (56.6%) and a high SVR12 rate (97.5%). The pandemic increased follow-up losses, yet SVR12 rates remained stable, influenced by factors like age, gender, cirrhosis and comorbidities. Despite COVID-19 challenges, the region sustained high SVR12 rates in HCV care, emphasising the importance of sustained efforts in HCV care. Continuous screening and targeted interventions in high-risk populations are crucial for achieving WHO elimination targets. The study highlights the resilience of HCV care during the pandemic and provides insights for future public health strategies.

Changes in the incidence, clinical features and outcomes of tuberculosis during COVID-19 pandemic

BackgroundCOVID-19 pandemic has disrupted tuberculosis (TB) services in many countries, but the impacts on sites of involvement, drug susceptibility, smear positivity and clinical outcomes, and clinical outcomes of co-infection with influenza and COVID-19 remain unclear. MethodsDescriptive epidemiological study using episode-based and patient unique data of tuberculosis from Hospital Authority’s territory-wide electronic medical record database, comparing baseline (January 2015-December 2019) and COVID-19 period (January 2020-December 2022), followed by univariate and multivariate analyses. Effects of co-infection with influenza and COVID-19 were investigated. ResultsThe study included 10,473 episodes of laboratory-confirmed TB, with 6818 in baseline period and 3655 during COVID-19 period. During COVID-19 period, TB patients had a lower proportion of smear positivity (49.2 % vs 54.7 %, P < 0.001), and fewer cases of extrapulmonary TB (7.0 % vs 8.0 %, P = 0.078) and multidrug resistant TB (1.0 % vs 1.6 %, P = 0.020). Mortality was higher in TB patients with COVID-19 coinfection (OR 1.7, P = 0.003) and influenza coinfection (OR 2.6, P = 0.004). During COVID-19 period, there were higher rates of treatment delay (20.5 % vs 15.5 %, P < 0.001) and episodic death (15.1 % vs 13.3 %, P = 0.006). Factors associated with higher mortality included age ≥ 70 years (OR 7.24), treatment delay (OR 2.16), extrapulmonary TB (OR 2.13). smear positivity (OR 1.71) and Charlson comorbidity index score ≥ 3 (OR 1.37). Higher mortality was observed with co-infection by influenza (OR 1.18) and COVID-19 (OR 1.7). ConclusionsThe epidemiology and outcomes of TB were changed during COVID-19 period. Mortality was higher during COVID-19 period and with co-infection by influenza and COVID-19.

Decreased Positive Fecal Occult Blood Tests and Delayed Medical Presentation for Colorectal Cancer during the Initial COVID-19 Pandemic Period: A Single-center Experience.

This study aimed to investigate the impact of the COVID-19 pandemic on the examination and treatment of colorectal cancer (CRC) and on the behaviors of patients and practitioners. This is a retrospective analysis of the CRC patients who presented to our department between April 2019 and March 2021 and underwent surgery. Clinical presentation of CRC and time from symptom onset to medical presentation were compared between the control (April 2019 to March 2020, n=124) and COVID-19 pandemic periods (April 2020 to March 2021, n=111). Two hundred and thirty-five patients were reviewed. The rate of positive fecal occult blood tests was significantly lower during the COVID-19 pandemic period (13.5 vs. 25.0%, P = 0.027). Among the symptomatic patients who had melena and abdominal symptoms, the time from symptom onset to medical presentation was significantly longer during the COVID-19 period (115 vs. 31 days, P < 0.001). In addition, the interval between presenting to a practitioner and being referred to our department was similar between the two periods (19 vs. 13 days, P = 0.092). There were no significant differences in the stage of cancer between the two periods. The rate of preoperative sub-obstruction was significantly higher during the COVID-19 period (41.4 vs 23.4%, P = 0.003). There was no significant difference in overall survival and recurrence-free survival between two periods. Hesitation to seek examination and treatment for CRC was observed in patients but not in practitioners during the COVID-19 pandemic period. The prognosis did not change.

Post-COVID-19 Era, 15th Minutes City New Urban Model Changing Housing Design and Models

This research centered on the transition from sustainability to the post-COVID-19 era, significantly altered and transformed cities, city plans, and housing models holistically approach. Although the academic world concentrating on sustainable urban and housing design since the 1990s, the pandemic has emerged as a critical paradigm shift in context since 2019. During the COVID-19 period the Paris city 15 minutes concept, first introduced by Paris Mayor A. Hidalgo initially sparked controversy as temporary now considered permanent in Paris recently, Oxford. In the post-pandemic era, sustainability has become significant on the global agenda, shaping cities, city models, and residences through profound and radical changes. Some efforts are supported by Climate-change conferences in the world and subsequently some determinations like the Paris Agreement and UN declarations that guide more livable environments and houses. Due to COVID-19 the newly emerged conditions and compulsory changes that have taken place in the cities the social isolation, distance living, and remote working led to radical changes in the living style, environment, city plans, housing models, and typologies holistically. Although many publications have been published in the last few years about the pandemic and the Paris City 15 minutes concept, they only address the city and urban scale solutions. There is no research with a holistic approach that relates the subject from the urban scale to the architectural scale, housing, and blocks. Within the 15-minute concept, searched, developed, innovative, and sustainable urban and housing-oriented suggestions for cities in the future are presented at the end of the research. In conclusion, it is revealed that the issue of sustainability has gained importance with an increasing momentum in the world agenda, witnessed the radical changes in cities and residences, in the post-COVID-19 period in the last 2-3 years.

End-Of-Life Cancer Patients' Dignity Perception Before and During COVID-19 Pandemic.

Background: The safety and restriction regulations implemented to contain the COVID-19 pandemic significantly impacted people's quality of life compromising the perception of dignity. Preserving dignity for end-of-life patients remains a paramount objective in palliative care. This study aimed to compare dignity levels in terminal cancer patients between pre- and during-pandemic periods. Methods: Dignity was assessed by the Italian version of the Patient Dignity Inventory (PDI-IT) in both pre- and during-pandemic groups of terminal cancer inpatients (hospitalized or admitted in hospice). The 2 groups were compared using non-parametric tests and a multivariate logistic regression analysis to estimate the association of the different dimensions of dignity with COVID-19 period, adjusting for other confounders. The study involved 2 groups of end-of-life cancer patients with a Karnofsky Performance Status (KPS) index less than 50. The first group included 506 patients before COVID-19, and the second group consisted of 156 patients enrolled during pandemic. Results: Existential Distress, Loss of Purpose and Meaning, Physical Symptoms and Dependency, Social Support PDI subscales and PDI Total score were higher in the during-pandemic group. The multivariate regression model partially supported the previous results as Loss of Purpose and Meaning, Social Support, and Existential Distress PDI subscales were associated with during-pandemic period, whereas PDI Physical Symptoms and Dependency and PDI Psychological Distress were not. Conclusion: Social isolation and other restrictions put in place to contain the COVID-19 pandemic may have had a negative impact on the perception of dignity in cancer patients at the end of life.

Revisiting the economic growth in the shadow of financial stress in times of crisis: evidence from FIGARCH and wavelet coherence approach

PurposeThis study empirically investigates the interdependency of select Asian emerging economies along with the financial stress index during the times of the global financial crisis, the Euro crisis and the COVID-19 period. Moreover, it inspects the long-memory effects of the different crises during the study period.Design/methodology/approachTo address the objectives of the study, the authors apply different statistical tools, namely the adjusted correlation coefficient, fractionally integrated generalised autoregressive conditional heteroskedasticity (FIGARCH) model and wavelet coherence model, along with descriptive statistics.FindingsFinancial stress is having a prodigious effect on the economic growth of select economies. From the data analysis, it is found that the long-memory effect is noted in the gross domestic product (GDP) for India and Korea only, which implies that the volatility in the GDP series for these two nations demonstrates persistence and dependency on previous values over a lengthy period.Originality/valueThe study is unique of its kind to consider multi-segments within the period of the study to get a clear idea about the effects of the financial stress index on select Asian emerging economies by applying different econometric tools.

Covid-19 Döneminde Hemşirelerin Sosyo-Psikolojik Desteğe İlişkin Bakış Açıları

Within the scope of this research, the problematic of whether the health policies and contents of nurses as health workers are structured or not regarding the social-psychological support of nurses during the covid-19 period is emphasized. It is aimed to reveal the analysis of the functioning dynamics of the structures and mechanisms that produce the differences in nurses' perspectives through a grounded theoretical data analysis process based on a critical realist methodology. Accordingly, one of the basic assumptions of the research is based on the necessity of health policies and policies for health workers that will ensure that nurses are supported psycho-socially in accordance with changing conditions. On the axis of the research, it is aimed to examine the thoughts of nurses about receiving social-psychological support during the covid-19 period. In this context, nurses' opinions on whether they regularly participate in individual or group counseling during the epidemic and whether they consider the content of these supports sufficient were evaluated as a public health problem in terms of general health policies. The research was carried out within the framework of in-depth interviews as a data collection technique suitable for qualitative data analysis within the framework of the grounded theory design. The obtained data were analyzed in a critical realist methodological framework in accordance with the theory design based on the MAXQDA program. With a reasoning strategy based on the way individuals explain, the data were recontextualized and described, and health policies for the existing socio-cultural-economic-social structure components were associated with a reasoning strategy based on retroduction. Among the most important findings of the study, the emphasis of most of the participants on the need for psychological support draws attention. However, despite the participants' emphasis on the necessity of receiving social-psychological support, it was observed that they stated that they did not receive such support during the pandemic process. In addition, the participants emphasized the necessity of individual-group counseling. While receiving psycho-social support should be a normalized health parameter, it has been evaluated that even in terms of this normalization, there are significant gaps in terms of health policies, especially in terms of health workers, especially in extraordinary periods such as pandemics. Keywords: Psycho-Social Support, Nursing, Health Policies, Public Health.

The nexus of conventional, religious and ethical indexes during crisis

This study examines the interconnectedness between conventional and ethical indexes. Using a Bayesian graphical vector autoregressive model, we derive the contemporaneous and temporal interdependencies among these stock index returns before and during the Covid-19 pandemic. Our model specification strategy combines vector autoregressive models with networks. The findings provide empirical evidence of increased interconnectedness during the Covid-19 period across all networks. Notably, the religious and FTSE Islamic networks exhibited greater resilience during the pandemic. This could be attributed to the rigorous screening processes for religious portfolios, which focus on lower-leveraged equity stocks, contributing to their stability. Additionally, our results show that the Covid-19 crisis affected network density and the roles of key player shock transmitter entities, as indicated by changes in hub and authority scores, with new key players emerging during the crisis.

Herd Behaviour and COVID-19 Intervention

The paper attempted to confirm the rational assets pricing model by examining the herd behaviour in extreme market returns and examining the COVID-19 intervention by comparing before COVID-19, during COVID-19 and after COVID-19 period. Cross Sectional Standard Deviation (CSSD) calculated as the index and further regressed by using dummy variables (Extreme upper tail market returns =1, otherwise = 0). For the better inferences stationarity of time series data were checked by both graphically and Augmented Dickey –Fuller test in all three states of COVID-19. Finally, the Cumulative-Sum (CUSUM) test was conducted to check the parameter stability of the regression model. The finding of the study supports the rational asset pricing models, meaning that there is no presence of herding in NEPSE in extreme upper tail returns. But it rejects the rational asset pricing models in case of extreme lower market returns and in COVID-19 period. For better affirmation of rational assets pricing models, future research can extend the work by addressing the market characteristics, such as: trading volume, volatility, and liquidity.

Factors influencing academic resilience of master students in China

ABSTRACT This study conducted a survey using the Academic Resilience Scale and the Factors Influencing Academic Resilience Scale among 558 master’s students during the COVID-19 period. The findings reveal that master’s students’ academic resilience is at a moderately high level. Factors such as research self-efficacy, research involvement, academic guidance from supervisors, support from the university, and family support are at moderate levels and significantly influence master’s students’ academic resilience. Additionally, the study found that students with a higher frequency of communication with supervisors and those involved in supervisors’ research projects or leading their own research projects demonstrate higher levels of academic resilience and validated the applicability of an input-process-output model to contemporary master’s students. Given the above findings, it is important to enhance master students’ research investment, effectively provide them with tutor guidance and family support, and concentrate on their negative influence and emotional response to improve their academic resilience.

Corporate Cash Holdings and Investment Efficiency: Do Women Directors and Financial Crisis Matter?

This study investigates the relationship between corporate cash holdings and investment efficiency, with a focus on how COVID-19 and the presence of women directors may influence this relationship. Using data from Indonesian public companies during the COVID-19 period, comprising 2350 firm-year observations, we employ fixed-effect regression models with industry and year controls to test our hypotheses. Robustness and endogeneity tests are conducted to ensure the reliability of our findings. Our research reveals that companies with larger cash reserves tend to experience decreased investment efficiency during the COVID-19 crisis. Moreover, the negative impact of substantial cash reserves on investment efficiency is exacerbated by the presence of female directors on the board. However, our findings also suggest that female directors can mitigate the adverse effects of excessive cash reserves on a company’s investment efficiency, particularly during unforeseen economic challenges such as the pandemic.

Cash is queen? Impact of gender-diverse boards on firms' cash holdings during COVID-19

This study examines the role of gender-diverse boards in preserving cash holdings during crises. Using a sample of UK firms during the COVID-19 period, we find that firms with more female directors had higher cash holdings. This increase in cash reserves is primarily driven by reduced board compensation, reflecting the careful stewardship associated with gender-diverse boards. Interestingly, we find no evidence of female directors reducing acquisition activity or capital expenditures, suggesting that these firms did not compromise on growth prospects while building their cash buffer. Our study underscores the value of gender-diverse boards in navigating firms through crises without sacrificing shareholder value. Our results remain robust even after controlling for endogeneity and alternative estimation techniques. The findings hold significant implications for investors, policymakers, and advocates of gender diversity in boardrooms, emphasizing the financial prudence that gender diversity can bring in crisis management.

Impact of COVID-19 on a real-world treat-and-extend regimen with aflibercept for neovascular age-related macular degeneration

ObjectiveTo assess the effect of the COVID-19 pandemic on injection intervals among patients treated for neovascular age-related macular degeneration. DesignRetrospective cohort study. ParticipantsPatients treated at a single practice using a treat-and-extend regimen with intravitreal aflibercept between December 2018 and April 2021. MethodsThe primary outcome was the change in injection intervals. Secondary outcomes included differences in best-recorded visual acuity (BRVA) and central subfield thickness (CST). Associations were evaluated with linear mixed-effects modelling. ResultsThis study included 1839 injections from 185 eyes (141 patients). The median (interquartile range) injection intervals in the pre-COVID-19 and COVID-19 periods were 60 (42–70) and 70 (49–90) days, respectively. The pandemic was associated with a mean injection interval lengthening of 7.2 days (P < 0.001), a decrease in BRVA of 3.1 Early Treatment Diabetic Retinopathy Study letters (P < 0.001), and a reduction in CST of 14.7 μm (P = 0.003). The presence of exudative intraretinal fluid was associated with a reduction in treatment intervals of 11.1 days (P < 0.001), a reduction in BRVA of 1.9 Early Treatment Diabetic Retinopathy Study letters (P < 0.001), and an increase in CST of 52.4 μm (P < 0.001). The presence of subretinal fluid was associated with a reduction in treatment intervals of 8.5 days (P < 0.001) and an increase in CST of 21.6 μm (P < 0.001). ConclusionsThis real-world study estimated that the severe acute respiratory syndrome coronavirus 2 pandemic resulted in an injection extension of 7.2 days with associated decreases in BRVA and CST that are unlikely clinically significant on a population basis. This builds on evidence suggesting that long-term vascular endothelial growth factor suppression can facilitate meaningful interval extensions while maintaining visual acuity.

Real-World Treatment Patterns and Timeliness of Clinical Care Pathway for Non-Small Cell Lung Cancer Patients in Austria: The PRATER Retrospective Study.

This was a retrospective study of the profile and initial treatments of adults diagnosed with early-stage (ES) non-small cell lung cancer (NSCLC) during January 2018-December 2021 at 16 leading hospital institutions in Austria, excluding patients enrolled in clinical trials. In total, 319 patients were enrolled at a planned ~1:1:1 ratio across StI:II:III. Most tested biomarkers were programmed death ligand 1 (PD-L1; 58% expressing), Kirsten rat sarcoma virus (KRAS; 22% positive), and epidermal growth factor receptor (EGFR; 18% positive). Of 115/98/106 StI/II/III patients, 82%/85%/36% underwent surgery, followed by systemic therapy in 9%/45%/47% of those [mostly chemotherapy (ChT)]. Unresected treated StIII patients received ChT + radiotherapy [43%; followed by immune checkpoint inhibitors (ICIs) in 39% of those], ICI ± ChT (35%), and ChT-alone/radiotherapy-alone (22%). Treatment was initiated a median (interquartile range) of 24 (7-39) days after histological confirmation, and 55 (38-81) days after first medical visit. Based on exploratory analyses of all patients newly diagnosed with any stage NSCLC during 2018-2021 at 14 of the sites (N = 7846), 22%/10%/25%/43% had StI/II/III/IV. The total number was not significantly different between pre-COVID-19 (2018-2019) and study-specific COVID-19 (2020-2021) periods, while StI proportion increased (21% vs. 23%; p = 0.012). Small differences were noted in treatments. In conclusion, treatments were aligned with guideline recommendations at a time which preceded the era of ICIs and targeted therapies in the (neo)adjuvant setting.

Changes in Time to Initial Physician Contact and Cancer Stage Distribution during the COVID-19 Pandemic in Patients with Head and Neck Squamous Cell Carcinoma at a Large Hungarian Cancer Center.

The aim of our study was to compare the characteristics and time to initial physician contact in patients with head and neck squamous cell carcinoma (HNSCC) before and during the COVID-19 pandemic at a large Hungarian cancer center. This was a retrospective study of patients 18 years or older presenting at the regional cancer center of Pécs Clinical Center with HNSCC between 1 January 2017, and 15 March 2020 (the pre-COVID-19 period) and between 16 March 2020, and 13 May 2021 (the COVID-19 period). Demographic and clinical data were collected, and the time between initial symptom onset and initial physician contact (TTP) was determined. Descriptive and exploratory statistical analyses were performed. On average, the number of patients diagnosed with HNSCC per month during the pandemic decreased by 12.4% compared with the pre-COVID-19 period. There was a significant increase in stage I and stage II cancers (from 15.9% to 20.3% and from 12.2% to 13.8%, respectively; p < 0.001); a decrease in stage III and IVa,c cancers; and a significant increase in stage IVb cancers (from 6% to 19.9%; p < 0.001) during the pandemic. The median TTP increased during the pandemic from 43 to 61 days (p = 0.032). To our knowledge, this is the first study investigating the effect of COVID-19 on patients with HNSCC in the Central-Eastern European region. We found a bidirectional shift in cancer stages and increased TTP during the pandemic. Our findings highlight the necessity for more nuanced analyses of the effects of COVID-19.

Exploring Factors Influencing e-Learning Dropout Rates in the Post-COVID-19 Era

The COVID-19 period ushered in a paradigmatic shift towards exponential growth of ubiquitous e-learning. Despite the well-documented benefits of e-learning, which received unprecedented attention during the COVID-19 pandemic, little has been reported on factors influencing student dropout rates in courses delivered via e-learning. In this paper, the authors explore the factors contributing to student discontinuations in nonvolitional postpandemic conditions. Adopting a multimethod qualitative research design, the authors investigated the factors leading to increased student dropout rates from e-learning programs. The researchers used thematic analysis to interpret the data, resulting in the emergence of five themes. The findings reveal several factors contributing to failure to complete studies on programs delivered via e-learning. Although not exclusively conclusive, the study's findings indicate skills gap solutions and resource concerns which need to be addressed to convert market demand and enrolment into optimum completion rates, thereby increasing e-learning's success.

Building resilience of street-connected children during COVID-19: turning rights into practices through CINI method.

This article examines the methods and opportunities for SCC's meaningful participation that recognize their agency and are aligned with General Comment No. 21 (GC21) to the United Nations Convention on the Rights of the Child (UNCRC) on Children in Street Situations (UNCRC, 1989). This article explains the application of CINI's core practice models which explains the child centrality in development practices for "turning rights into practice for children" derived from the Sustainable Development Goals, principles of Human Rights, UNCRC, and General Comment No. 20 (2016). The Institutional knowledge was practiced through child-led action research with street- connected children which resulted in the development of agency among SCC, peer researchers, and child advocates for resilience building within their community during COVID-19. Child in Need Institute (CINI) has been working with SCC since 1989 and has derived a rich body of experience from the interventions. CINI applied participatory approaches to practice, research, decision-making, and policy development; thus, facilitating children in the process of systematically gathering information with their peers, identifying key issues and problems faced by SCC, and securing support from duty bearers that were required for the survival within their situations. Drawing on the approach undertaken and the tools used in the participatory research and advocacy, this article reflects upon the processes and strategies that worked out in facilitating SCC's ability to exercise agency and resilience through evidence generation and advocacy during COVID-19 and the associated lockdown and beyond. Through capacity building on research tools, leadership and communication skills, SCC can build concrete evidence of their vulnerabilities and the gaps that pose as barriers to their access to existing support mechanisms. This evidence helps them to prioritize the solutions that are required to bring changes in their lives and that of their peers, with which they can advocate at different platforms that promote dialogs and negotiations between children and duty-bearers. A participatory research project funded by Wellcome Trust focused on the vulnerabilities faced by street-connected young people and the access to services available to them. It revealed the lack of understanding regarding SCC and their invisibility in data and planning of support services, the gaps in access to healthcare services, the social determinants of health including safety, and their exclusion in platforms for dialogs with duty bearers. They took these issues to local government leaders, service providers, and national and international advocacy platforms; and suggested solutions to local and world leaders to bring changes in their situations. This resulted in a marked increase in the responsiveness of service providers toward SCC during the period of COVID-19, and the increased agency and negotiation skills of peer leaders to support their communities and demand solutions during the period of COVID-19 and associated lockdown.