Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov , NCT04384926 . Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include...

Background: The colonial origins of schooling and the implications these origins have on leadership is missing from educational leadership literature. Indeed little has been published on decolonizing and indigenous ways of leading schools. Purpose: In this article, we synthesize the literature on indigenous, decolonizing education leadership values and practices across national and international spaces that have been informed to various degrees by colonial models of schooling. Methodology: Through a review of the research and keywords including colonialism, educational leadership, indigenous communities, and decolonization, we identify two overarching themes. Findings: First, we found that the literature revealed a critique of the way in which Westernized Eurocentric schooling serves as a tool of imperialism, colonization, and control in the education of Indigenous peoples. Second, we discovered that the literature provided unique, but overlapping worldviews that situate the values and approaches enacted by Indigenous leaders throughout the globe. Within this second theme, we identify five strands of an Indigenous, Decolonizing School Leadership (IDSL) framework that can contribute to the development and reflection of school leadership scholars and practitioners. Specifically, we found that the five consistent and identifiable strands across IDSL include prioritizing Indigenous ancestral knowledge, enacting self-reflection and self-determination, connecting with and empowering the community, altruism, and spirituality as expressed through servant leadership, and inclusive communication practices. Conclusion: Based on the identified worldviews and values, we conclude by offering insights on the structure and policy of post-colonial schooling, as well as implications for the theory, research and practice needed to reclaim the co-opted contributions of Indigenous leaders in ways that decenter Western colonial approaches to leadership.

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On June 29, 2021, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).In response to the COVID-19 pandemic, schools across the United States began transitioning to virtual learning during spring 2020. However, schools' learning modes varied during the 2020-21 school year across states as schools transitioned at differing times back to in-person learning, in part reflecting updated CDC guidance. Reduced access to in-person learning is associated with poorer learning outcomes and adverse mental health and behavioral effects in children (1-3). Data on the learning modes available in 1,200 U.S. public school districts (representing 46% of kindergarten through grade 12 [K-12] public school enrollment) from all 50 states and the District of Columbia during September 2020-April 2021 were matched with National Center for Education Statistics (NCES) demographic data. Learning mode access was assessed for K-12 students during the COVID-19 pandemic, over time and by student race/ethnicity, geography, and grade level group. Across all assessed racial/ethnic groups, prevalence of virtual-only learning showed more variability during September-December 2020 but declined steadily from January to April 2021. During January-April 2021, access to full-time in-person learning for non-Hispanic White students increased by 36.6 percentage points (from 38.0% to 74.6%), compared with 31.1 percentage points for non-Hispanic Black students (from 32.3% to 63.4%), 23.0 percentage points for Hispanic students (from 35.9% to 58.9%) and 30.6 percentage points for students of other races/ethnicities (from 26.3% to 56.9%). In January 2021, 39% of students in grades K-5 had access to full-time in-person learning compared with 33% of students in grades 6-8 and 30% of students in grades 9-12. Disparities in full-time in-person learning by race/ethnicity existed across school levels and by geographic region and state. These disparities underscore the importance of prioritizing equitable access to this learning mode for the 2021-22 school year. To increase equitable access to full-time in-person learning for the 2021-22 school year, school leaders should focus on providing safetyoptimized in-person learning options across grade levels. CDC's K-12 operational strategy presents a pathway for schools to safely provide in-person learning through implementing recommended prevention strategies, increasing vaccination rates for teachers and older students with a focus on vaccine equity, and reducing community transmission (4).All data for the analyses were publicly available. Data were collected on learning modes used across 1,200 school districts from all 50 states and the District of Columbia, representing 46% of U.S. K-12 public school enrollment and 90% of students in the 232 most populous U.S. counties.* Information on learning mode was collected through weekly Internet searches of school district webpages, Facebook, and other public sources for each school district, by grade level group (K-5, 6-8, 9-12) or in...

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