Dealing with fear of cancer recurrence - evaluation of a psychooncological group therapy program

Background: Fear of cancer recurrence (FCR) is a common burden for cancer patients. However, it is often challenging to find outpatient psychological support. Therefore, for the following study, an outpatient group adapted from Waadt et al.'s manual (2011)1 was developed to focus on specific needs of oncological patients experiencing FCR. Method(s): The group program consisted of 8 treatment sessions in smallsized closed groups with 6-8 patients and 2 therapists. The content was standardized and included behavioral strategies (psychoeducation, cognitive exposure, coping strategies and resources) as well as mindfulness. The intervention was evaluated by comparing FCR, anxiety and depression before and after the group using Wilcoxon-signed-rank-tests. Result(s): In total, N = 33 patients with varying oncological diagnoses participated in the group intervention. Out of these, 26 were female (76.5 %) and 7 were male (20.6 %). The mean age was 57.6 years, ranging from 42 to 77 years. A significant decrease in depression (z =-3.09, p = .002, n = 18), anxiety (z =-3.00, p = .003, n = 19) and FCR (z =-2.47, p = .013, n = 13) was found after finishing the group intervention. Moreover, our patients rated the techniques covered in the intervention as helpful for dealing with FCR and feasible in everyday life. Discussion(s): Despite limitations in implementation and recruitment of patients due to the Corona pandemic, results show positive changes in the group intervention with respect to FCR, anxiety, and depression. Conclusion(s): The results indicate that a structured group therapy program with a focus on FCR for oncological patients can be an effective and feasible intervention improving outpatient psychooncological care.

Von Willebrand factor (vWF) is involved in thrombophilia of severe COVID-19: in situ evidence from autopsies

Introduction: Coronavirus disease 2019 (COVID-19) is accompanied by a hypercoagulable state with micro- and macrovascular thrombotic complications. In plasma samples from COVID-19 patients, von Willebrand factor (vWF) levels were shown to be highly elevated and, like the relative lack of its counterpart, ADATMS13 (a disintegrin-like and metalloprotease with thrombospondin repeats 13), predictive of adverse outcomes, especially mortality. However, vWF is usually not included in routine coagulation analyses, and histologic evidence of its involvement in thrombus formation in COVID-19 is lacking. Moreover, since vWF is also an acute phase protein it needs to be determined whether it is a bystander, i.e. a biomarker reflective of endothelial dysfunction, or a causal factor in the pathogenesis of COVID-19. Method(s): We compared lung, lymph node and heart autopsy samples from 28 patients with lethal COVID-19 (B.1 virus-lineage) to controls, and systematically assessed for vWF and platelets (CD42b) by immunohistochemistry. Controls comprised of 24 lungs, 23 lymph nodes, and 9 hearts, and did not differ significantly from the COVID-19 group respecting age, sex, BMI, blood group, or anticoagulant use. Result(s): Compact platelet-rich microthrombi were more frequent in patients, who died of COVID-19 (36% vs. 8%, p = 0.02;staining for CD42b). This difference was more pronounced when lungs were analyzed for vWF: in normal lungs, vWF is physiologically present in vascular endothelial cells (Figure 1A). A completely normal pattern of vWF was rare in both groups (controls vs. COVID-19: 25% vs. 7%;p = 0.081), but vWF-rich thrombi were exclusive to COVID-19 (39% vs. 0%, p <0.01), as were NETosis thrombi enriched for vWF (25% vs. 0%, p <0.01). 46% of COVID-19 patients had either vWF-rich thrombi, NETosis thrombi, or both (Figures 1B&C). Such trends were also seen in pulmonary draining lymph nodes (35% vs. 17%, p = 0.147), where the overall presence of vWF was very high (Figure 1C). Conclusion(s): We bring in situ evidence of vWF-rich thrombi that we context as likely attributable to COVID-19. In line with the growing evidence that increased plasma vWF correlates with adverse outcomes, this supports the hypothesis that high levels of vWF and a dysregulation of the vWF/ADAMTS13 ratio contribute to COVID-19 morbidity and mortality. Hence, vWF may be a therapeutic target in severe COVID-19, warranting further studies.

Inflammatory responses in SARS-CoV-2 associated Multisystem Inflammatory Syndrome and Kawasaki Disease in children: An observational study.

Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe inflammatory disease in children related to SARS-CoV-2 with multisystem involvement including marked cardiac dysfunction and clinical symptoms that can resemble Kawasaki Disease (KD). We hypothesized that MIS-C and KD might have commonalities as well as unique inflammatory responses and studied these responses in both diseases. In total, fourteen children with MIS-C (n=8) and KD (n=6) were included in the period of March-June 2020. Clinical and routine blood parameters, cardiac follow-up, SARS-CoV-2-specific antibodies and CD4+ T-cell responses, and cytokine-profiles were determined in both groups. In contrast to KD patients, all MIS-C patients had positive Spike protein-specific CD3+CD4+ T-cell responses. MIS-C and KD patients displayed marked hyper-inflammation with high expression of serum cytokines, including the drug-targetable interleukin (IL)-6 and IFN-γ associated chemokines CXCL9, 10 and 11, which decreased at follow-up. No statistical differences were observed between groups. Clinical outcomes were all favourable without cardiac sequelae at 6 months follow-up. In conclusion, MIS-C and KD-patients both displayed cytokine-associated hyper-inflammation with several high levels of drug-targetable cytokines.

Challenges and opportunities for public participation in urban and regional planning during the COVID-19 pandemic—lessons learned for the future

The COVID-19 pandemic has spurred significant changes in the fields of economic develop-ment, social issues, everyday life, etc. Activities that used to depend on face-to-face communication were firstly suspended and then shifted to new forms of communication. This includes the public participation process in urban and spatial planning. Therefore, this study explores the new domain developed in urban and spatial planning with regard to public participation and surmises future realms in the post-pandemic era. On the occasion of the virtual collaboration platform Cyber Agora organized by the ISOCARP (International Society of City and Regional Planners), chosen participants got together virtually to share, discuss, and compare their practical knowledge in public participation before and during COVID-19. In addition, they addressed the potential benefits of shifting from traditional to virtual participation and potential benefits in the post-COVID-19 era. Considering the collected data and understanding them in the light of the available literature, this study concludes that the application of a combined approach (using both traditional and virtual modes of participa-tion) is recommended because it would enable a larger number and higher diversity of participants. The study also elaborates particular modes of virtual participation with the pros and cons of their use in a particular context. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Extended dosage interval of B-cell therapy in multiple sclerosis

Introduction: Ocrelizumab is an anti-CD20 monoclonal antibody used in the treatment of multiple sclerosis (MS). Anti-CD20 therapy causes lysis of B-cells thereby immunosuppression. Safety concerns during the COVID-19 pandemic resulted in paused treatment, thereby prolonged treatment interval. Aims: The study aims are to investigate differences in disease activity, levels of neurofilament light chain (NFL), glial fibrillary acidic protein (GFAP), T-,B- and NK-cells, and their relation in patients treated with a regular six-month interval or extended dosage interval. Methods: We included patients with MS that were treated ≥12 months with ocrelizumab and with a regular (24 weeks) or delayed (>4 weeks) time interval. NFL and GFAP were measured with SIMOA™ (ng/L) prior to infusion with ocrelizumab. B-, T- and NK-cells were measured on a national validated flowcytometry (10-9/L). Confirmed progression of disability (CPD) was determined by worsening in neurostatus at 6-12 months after infusion. MRI progression was defined as new or enlarged T2-weighted or T1-weighted gadolinium-enhancing lesions. Results: We included 187 patients. 99 patients were treated with extended dosage interval and the average delay was 11.4 weeks (SD:6.2, range: 4-53 weeks). 88 patients were treated with regular dosage interval. NFL-levels were 10.0 (SD:8.2) and 7.6 (SD:3.3) in extended patients and regular scheduled patients, respectively (ns). GFAP-levels were 77.2 (SD:40.0) and 71.5 (SD:29.8) in extended patients and regular scheduled patients, respectively (ns). No correlations were found between NFL/GFAP and length of extended dosage interval. B-cell levels were 0.033 (SD:0.049) and 0.0037 (SD: 0.0072) in extended patients and regular scheduled patients, respectively (p<0.0001). No correlations were found between B-cells and levels of GFAP/NFL (ns). No differences were found when comparing levels of T- and NK-cells in the two groups. Conclusions: We found similar levels of NFL and GFAP in both groups. Levels of B-cells were higher in delayed patients but not related to levels of NFL and GFAP, suggesting early rise of B-cells, but similar levels of neuroaxonal damage despite extended dosage interval in MS patients treated with ocrelizumab. Clinical and MRI results are currently being collected and will also be presented at the conference. Extending dosage interval could be relevant in selected patients or on an individualized basis in the treatment of MS.

Positive provider experience with telehealth during COVID-19 pandemic

Introduction: There has been a rapid increase in the usage of telehealth since the onset of COVID. We examine providers' perceptions of their ability to perform clinical assessments, physical exams, and connect with patients over a digital platform and identify which types of patients may be best suited to telehealth. Since the onset of the COVID-19 pandemic, there has been rapid expansion in the use of telehealth, but very few studies examining provider experience and perceptions of this technology. This research was conceptualized and conducted after the onset of COVID-19. Discussing the results of the survey at the 2021 meeting will be both relevant and timely to private groups and hospital systems that seek to better understand providers' perceptions of their ability to perform clinical assessments, physical exams, and connect with patients over a digital platform, along with discerning what type of patients may be best suited to telehealth. Methods: Survey invitations were sent via email to 944 physicians and advanced practice providers at a large midwestern academic system over a 2-week period in October 2020. The survey included demographics questions and a combination of open- and closed-ended questions. Data were collected using REDCAP. Descriptive statistics were conducted using SPSS. Results: A total of 178 surveys were completed and analyzed. In most telehealth visits, 86.8% of providers felt they adequately addressed the chief complaint, 86.6% felt confident in their clinical assessment, and 86.1% felt they formed an adequate personal connection with the patient. Of the providers, 58.5% felt telehealth was not effective for new patients, but 83% of providers felt it was effective for providing care to established patients. Conclusion: This survey demonstrates that providers had positive experiences with telehealth, and they wish to continue using telehealth in a postpandemic setting. While this method may not be appropriate for some new patients, providers did feel that telehealth was an effective means of providing care for established patients.

Confessions of a YouTube preacher: Prelimaniry autoetnographical reflections on the recording and conducting of a digital worship service

Digitalisation as part of a ministry strategy was already high on the agenda of communities of faith prior to the COVID-19 pandemic. When considering possible ministry strategies, references to, among others, the Fourth Industrial Revolution and its potential systemic influence were evaluated in reflections on the nature of future congregations. The COVID-19 pandemic, however, considerably complicated and accelerated these trajectories, as the digitalisation of congregations took place, as it were, overnight. An autoetnographical exploration presents a personal, intimate and subjective reflection of this dynamics as well as the significance of digitalisation for communities of faith as can be seen in die conducting and recording of a digital worship service. Contribution: In these critical-evaluative autoetnographical reflections, the author sensitively considers, from a practical theology perspective, the possible significance of perspectives for future worship practices of communities of faith.

O12.6 Minority HIV/AIDS Research Initiative: Advancing HIV Prevention and Treatment Through Data-Informed Research, Community-Informed Practices and Innovative Intervention Strategies

Black/African American (Black thereafter) and Hispanic/Latino (Latinx thereafter) communities bear disproportionate burden of HIV infections in the U.S. These communities also tend to be disproportionately affected by social and structural determinants of health that hamper access to and engagement in HIV prevention and care services. Public health research efforts must advance HIV prevention and care through biomedical and structural interventions tailored to the needs of and culturally acceptable for the affected communities.The CDC Minority HIV Research Initiative (MARI) was established in 2003 to build capacity for HIV epidemiologic and prevention research in mostly Black and Latinx communities and among historically underrepresented early-career scientists working in highly affected communities. The MARI program supports the goal of promoting health equity and reducing HIV-related health disparities.From 2007–2020, 11 MARI investigators have developed HIV prevention interventions in highly affected communities. The interventions developed by seven MARI investigators will be discussed. Best practices about the recruitment and engagement of communities of color using evidence-based online recruitment campaigns, establishing community and scientific advisory boards, engaging community members in all stages of HIV research, and integration of mobile technologies to sustain HIV prevention and care interventions during the COVID-19 pandemic will be illustrated. We will also highlight the accomplishments of MARI investigators building successful partnerships with local health departments and community-based organizations to promote disseminations of findings and sustainability of interventions tailored to their communities. Lastly, we describe why initiatives like MARI that support the development of innovative and effective interventions to reduce HIV disparities in communities of color are essential to ending the HIV epidemic in the U.S.Ensuring the communities’ engagement in HIV policy changes and intervention development are crucial to intervention uptake and sustainability. As such, MARI research initiative is filling gaps in how we address HIV in racial/ethnic and sexual minority communities.