Effectiveness of Bosa (Brief Observation of Symptoms of Autism) as an Alternative Diagnostic Tool for Asd (Autistic Spectrum Disorder) during the Coronavirus Pandemic - a Retrospective Audit

Aims By necessity, our trust was unable to complete gold standard ADOS (Autism Diagnostic Observation Schedule) assessments as part of the ASD diagnostic pathway during the Coronavirus pandemic. We, therefore, implemented the BOSA as a stop-gap. This retrospective audit compares the need for further assessments and the outcomes from BOSA assessments against those achieved by our unit when the 'gold standard' ADOS was in use. Our audit standard was to achieve equivalent results pre- and during the pandemic. Methods Data from a random sample of 120 children who completed an ADOS assessment August - December 2019 was compared with data from a random sample of 118 children who completed a BOSA August 2020 - January 2021. Statistical analysis was performed using the 2 tailed Fisher's exact test. Results In school age children, further assessment was significantly more likely to be required when a BOSA assessment was used (25.6% vs. 8.9%, p=0.01). There was a less significant difference between the need for further assessment in the pre-school age group between the ADSO and BOSA groups (14.3% vs. 0%, p=0.048). In this audit, the wait time for a BOSA assessment was 372 days vs. for an ADOS assessment 278 days. However, due to the complex disruption caused by the pandemic, any difference in pathway duration could not meaningfully be evaluated by this audit. An additional ADOS was needed in 14.3% of cases undergoing the BOSA assessment. This will have affected the duration of the assessment process due to delays in arranging and completing further assessments. Children were slightly more likely to receive a positive autism diagnosis using the BOSA. However, this was not statistically significant (p=0.31 for school age, p= 1.0 for preschool age). Conclusion The BOSA assessment seems to be effective when used with pre-school children, with a minimally significant difference in rates of children requiring further assessment and no significant difference in final diagnosis rates. BOSA assessment appears to be less useful in school age children - with a greater proportion then requiring a subsequent ADOS assessment, but, again, with no significant difference in final diagnosis rates. This audit supports the recommendation that the BOSA assessment is not intended to be used long-term or to replace the ADOS, which remains the gold standard assessment. However, in the context of a pandemic, where ADOS assessments were not possible, the BOSA assessment allowed 86% of preschool age and 74% of school age children to receive a confirmed diagnosis (positive or negative), using an assessment method whose diagnosis rates were similar to the ADOS assessment.

LONGITUDINAL STUDY ASSESSING THE EFFECTS OF METHENAMINE HIPPURATE ON THE URINARY MICROBIOME OF POSTMENOPAUSALWOMEN WITH RECURRENT UTI

Introduction: Postmenopausal women with recurrent urinary tract infections (RUTI) are repeatedly exposed to antibiotics and therefore at risk for colonization by multi-drug resistant organisms. Methenamine hippurate (MH) is FDAapproved for the prevention of RUTI;however, the mechanism of action of MH or, more specifically, the role of MH in the alteration of the urobiome is not known. Since preliminary data has shown that MH may be effective against some bacteria (e.g., Escherichia coli), but not others (e.g., Enterococcus faecalis), we hypothesize that resident bladder microbiota will be altered by administration of MH. Objective: Our objective is to determine the longitudinal effect of MH on the urobiome of postmenopausal women with RUTI. Methods: A longitudinal study with a convenient sample of 10 postmenopausal women with a clinical history of RUTI was conducted (Figure 1). UDI6 questionnaires, voided urine, catheterized urine, and peri-urethral swabs were obtained at baseline and three months after daily MH use. Expanded quantitative urine culture (EQUC) was performed on these specimens. In addition, during the 3-month timeframe, four self-collection windows were completed (windows A-D): (A) prior to initiating MH (baseline urobiome), (B) one week after starting MH, (C) two weeks before the 3-month follow-up, and (D) one week before the 3-month follow-up. Voided urine and peri-urethral swabs were collected daily for one week during windows A-D to determine how the urobiome changed. Sequencing of samples from these collection windows is pending. Results: Ten participants enrolled;however, three participants were not able to complete the study due to allergic reaction, improper handling of samples, and COVID infection. Six participants have completed the study;microbiological studies for one participant are still in process. There were no episodes of acute cystitis for any participant during the length of the study. UDI6 results suggested a trend towards a decrease in frequency, leakage with urgency, and abdominal pain;however, none of these were statistically significant (Table 1). Of the six remaining participants, the average baseline urine pH was 5.8 ± 0.8. For the completed participants, an initial microbiological comparison of EQUC results at baseline and 3-month visits show differences in sample diversity. Specifically, the number of species detected (richness) in catheterized urine increased for all but one participant (Figures 2A and 2B) though there was little or no changes in overall diversity (Shannon Index, Figure 2B) or evenness (Pielou's Index, Figure 2C) for any sample type. Exposure to MH did not result in the loss of uropathogenic species present in catheterized urine at baseline;instead, additional uropathogenic and commensal microbiota were detected at the 3-month visit. Conclusions: UDI6 trended towards symptom improvement in frequency, urge incontinence, and pain, consistent with RUTI prevention and symptoms control. Microbiological results suggest that MH increases the richness of the bladder urobiome. This consistent trend suggests MH may reduce RUTI events by altering the urobiome community richness instead of eliminating uropathogenic microbiota from the bladder. Further studies are needed to understand the interaction between MH and a host that is susceptible to uropathogen overgrowth (Table Presented).

Estimating the Distributional Impacts of the COVID-19 Pandemic and the Remedial Tax and Benefit Policies in Indonesia

The Government of Indonesia acted quickly to protect people from the financial impact of the COVID-19 pandemic and associated lockdown measures in 2020. Using a static tax and microsimulation model for Indonesia with adjusted datasets to reflect the economic shock throughout 2020, we explore how the pandemic affected people’s earnings in Indonesia, the extent to which the automatic stabilisers that were already built into the tax and benefit system cushioned the economic shock, and how the augmented or new benefit policies served to further cushion the shock. We estimate that in 2020 the additional policies meant that poverty rose from 6.8 percent to a maximum of 8.3 percent rather than to 10.7 percent if they had not been introduced. We discuss reasons why the official poverty estimates for 2020 are higher than those generated in this study. © 2021, Wright et al.

Analysis of the Distributional Effects of COVID-19 and State-led Remedial Measures in South Africa

This paper explores the impact of the first wave of the COVID-19 pandemic in South Africa on income poverty and inequality in South Africa. Using a static tax-benefit microsimulation model with input datasets that were adjusted to reflect people’s earned incomes just before the pandemic (March 2020) and during the first national lockdown (April 2020), we investigate how well the social protection system in South Africa was able to mitigate the economic losses to the public. We take into account both the existing benefit system that was in place before the crisis and the role of the new policy measures that were introduced in April, May, and June 2020. © 2021, Barnes et al

Worse discharge outcomes of stroke patients during the COVID-19 pandemic: A dual-network experience

Background and Purpose: The novel coronavirus of 2019 (COVID-19) has been associated with worse outcomes for hospitalized patients across the US and worldwide. Our study investigates the effect of the pandemic on functional outcomes for patients presenting with stroke-like symptoms in two high-volume Tele-Stroke networks. Methods: We performed retrospective chart review of 7689 consecutive patients seen through two Tele-Stroke networks (Medical University of South Carolina and Augusta University) from July 2019 through May 2020. Discharge outcomes were assessed using modified Rankin scale (mRS). We dichotomized patients to preCOVID-19 pandemic (July 2019 to February 2020) and during COVID- 19 pandemic (March to May 2020). Results: During COVID, a higher percentage of patients received intravenous tissue plasminogen activator (tPA) (14.2% vs 11.3% before, p=0.001), despite a similar baseline NIHSS. Also, patients during the pandemic had a shorter symptom-onset to hospital door time (288 vs 353, P=0.012). Demographics were similar between groups, other than older age in patients presenting during COVID (66.02 vs 65.15 before, p=0.04) (table 1). During the pandemic, a higher percentage of patients had a poor functional outcome, as defined by mRS 3-6 (35.7% vs 30% before, p=0.012), and a higher percentage died or were discharged to hospice (7.0% vs 5.1%, p=0.000). Conclusions: Despite earlier ED presentation and increased tPA administration, our results demonstrate worse discharge outcomes during the pandemic in two large telestroke networks. Changes in workflow and resulting delays during COVID-19 may explain these findings.

Same inequities or engaged te tiriti partnership?

As the government shifts its focus from COVID-19 elimination to addressing the longer-term social and economic repercussions of the pandemic, it is critical that Mäori are able to partner and lead in decision-making. In the new normal of a post-COVID Aotearoa, the transformational vision of just relationships set out by Matike Mai is more relevant than ever. Responses that do not locate Mäori at their centre will maintain, or deepen, the inequities that existed prior to the pandemic. To meet the chal-lenges ahead, we need to draw on Aotearoa’s dual knowledge systems and the richness of mätauranga Mäori. Rather than a centralised, top-down approach, we need diverse sources of expertise, experience and leadership, with communities as the locus of decision-making, orientation and direction of recovery. © 2020, Nga Pae o te Maramatanga. All rights reserved.