Of COVID-19 and Chickens: The Ethics of One Workplace Safety Policy Early in the Pandemic

The emergence of the COVID-19 pandemic created considerable challenges for the food supply chain. One of the industries hardest hit was the agricultural and agri-foods industry. This industry has long faced worker shortages and regularly relied on temporary foreign workers. In this case, Roosters, a chicken processing and production company in Vancouver, British Columbia, Canada, had just come off a very costly 12-day closure following a COVID-19 exposure risk in two of its processing plants. With the company back in operation a new safety policy has been implemented to limit future virus exposure and shutdown risks. The policy, however, targets a small group of temporary foreign workers, one of whom is challenging the lengths the company can go in the name of protecting employees from the virus and the company from losses due to closure. © 2022 Neilson Journals Publishing.

Antiretroviral (ART) Virologic Suppression (VS) and Patient Reported Outcomes (PROs) at 6 Months in the Clinical Opportunities and Management to Exploit Bictegravir/Emtricitabine/Tenofovir Alafenamide (B/F/TAF) an Asynchronous Connection Key (COMEBACK) Study

Background. Effectively interrupting the source of transmission is a critical step in ending the HIV epidemic. COMEBACK (NCT04519970) is a 48-week single-center study in Chicago implemented in September 2020, with its main objectives to reengage lost-to-care patients and rapidly reinitiate ART to promote VS and favorable PROs. Methods. Adults off ART >=2 weeks, without history of significant B/F/TAF resistance or renal impairment, were rapidly started on B/F/TAF upon reengagement after same day collection of baseline labs and PROs. A retention screening assessment was used to stratify participants into case management (CM) tiers: Minimal, Moderate, or Advanced. An acuity assessment tool was adapted to determine whether participants needed additional support based on retention and VS. Currently, 80 of the expected 100 subjects are enrolled and 55 have reached the 24-week timepoint. Baseline and 6-month endpoints were analyzed for these participants. Results. At baseline (N=55), median age was 34 years (range, 24-62), with 92.6% Black and 72.2% cisgender male. Median CD4+ was 338 cells/mm3, with a median viral load 7,402copies/mL, (range, < 40-333,350, 16.3% VS). Median time off ART was 2.6 months (range, 0.5-243). For CM, participants were stratified into Minimal (71%) and Moderate (29%) tiers;none were identified as Advanced. Table 1 reflects tier shifts through 24 weeks. Shifts inCMintensity differs from the HIV adherence self-efficacy PRO completed within 24 weeks, indicating that at least 50% underestimated their need to integrate and maintain adherence to ART treatment. Forty of 55 participants (72.7%) were retained-in-care at 6 months, with VS in 61.8% (N=34/55) by intention-to-treat and 85% (N=34/40) by observed analysis. No resistance to B/F/TAF was detected through 6 months. Note: The table reflects patients retained on study at their week 24 endpoint. Conclusion. VS was high for participants retained-in-care, but lapses in retention and shifts toward more intense CM were likely due to social determinants of health challenges, including incarceration, housing insecurity, and COVID-19-related disruptions in healthcare.

Safety and Activity of Anti-CD14 Antibody IC14 (Atibuclimab) in ALS: Experience with an Expanded Access Protocol

Introduction: IC14 (atibuclimab) is a monoclonal anti-CD14 antibody that may target T-regulatory (T-reg) cell function. A previous phase 1 trial of 10 participants with amyotrophic lateral sclerosis (ALS) demonstrated initial safety of IC14 for a single cycle of treatment. We provided longterm treatment with IC14 to 17 individuals with ALS via an expanded access protocol (EAP) and documented target engagement, safety, and disease endpoints. Method(s): Participants received intravenous IC14 every two weeks. Consistent with FDA guidelines, participants were ineligible for clinical trials and the EAP was inclusive of a broad population. Participants unable to travel to MGH due to the COVID-19 pandemic or disease progression, were transitioned to infusions in-home or local clinics. Blood samples for hematology, chemistry, and coagulation were collected to monitor safety. The Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) was administered monthly to track disease progression. Respiratory function was measured through slow vital capacity tests -data for this is limited due to the COVID-19 pandemic. Whole blood and serum were collected to determine monocyte CD14 receptor occupancy (RO), soluble CD14, and antidrug antibodies (ADA). Ex vivo T regulatory functional assays were performed with five participants. Result(s): Participants received IC14 for up to 103 weeks (average: 30.1 weeks, range: 1-103 weeks). Treatmentemergent adverse events were uncommon, mild, and self-limited. There were 18 serious adverse events (SAEs) which were related to disease progression and unrelated (17) or likely unrelated (1) to IC14. Three participants died due to disease progression. Most participants achieved >80% monocyte mCD14 RO on a 14-day dosing schedule, although one individual required more frequent dosing (every 10 days) to achieve >80% RO. ADA were detected in only one participant and were transient, low titer, and non-neutralizing. Tregs were isolated from the available longitudinal samples and assayed for suppression of CD4 T cell proliferation and cytokine production versus baseline T-reg activity. Conclusion(s): IC14 administration to ALS patients was safe and well tolerated in this EAP, with no significant changes in laboratory tests and no drug-related SAEs. Measuring RO guided dosing frequency. Preliminary data suggest IC14 enhanced T-reg activity. Additional placebo-controlled trials are required to determine the efficacy of IC14 in ALS.

Results of a nationwide survey on the use of non-invasive respiratory support in patients with respiratory failure due to COVID-19 infection

Introduction: Currently patients with COVID-19 related acute respiratory failure (ARF) may receive respiratory support with conventional oxygen therapy, high-flow nasal oxygen (HFNO) or continuous positive airway pressure (CPAP). A proportion of patients will subsequently require invasive ventilation. However, there is insufficient evidence on the relative effectiveness of different modes of noninvasive respiratory support (NIRS). In the absence of robust evidence to guide clinical decisions, there is likely significant variation in their use in UK practice. The RECOVERY-RS trial sought to address this knowledge gap, aiming to identify the most effective method of non-invasive respiratory support in COVID-19. This survey, conducted whilst RECOVERY-RS was in progress, sought to characterise the current use of NIRS in COVID-19 patients across the UK. Methods: An anonymous, online survey (10 questions) was distributed via national networks and professional societies. Healthcare professionals involved in managing COVID-19 patients were invited to participate with responses collected over two months from September to October 2020. Results: Of 145 respondents, the majority were critical care (60%) or respiratory (27%) clinicians. Prior to the COVID-19 pandemic, most reported having commonly used HFNO (89%) or CPAP (70%) for infection-related ARF. A small minority (3% HFNO vs 9% CPAP) reported no previous experience of their use. In COVID-19 patients suitable for intubation and ventilation, 92% of respondents had used CPAP and 61% HFNO to bridge to or prevent intubation. Conversely, 5% reported they would never use CPAP and 8% would never use HFNO as a bridge to intubation. 68% of clinicians chose CPAP as their personal preferred method of NIRS vs 26% HFNO when treating COVID-19 patients. In patients not suitable for invasive ventilation, CPAP was also more frequently used than HFNO (92% vs 61%). 37% worked in trusts enrolled in the RECOVERY-RS trial and the majority (59%) felt that RECOVERY-RS was an important study, addressing a key unanswered research question. Conclusion: This survey identified that a variety of methods of NIRS are being used for COVID-19 patients in the UK. CPAP predominates as both a ceiling of care treatment and as a bridge to intubation. This appears to represent a change in practice compared to the management of infection-related ARF prior to the COVID-19 pandemic, despite a lack of evidence at that time to suggest superior efficacy of CPAP. The heterogeneous survey results support the need for evidence of the most effective NIRS in COVID-19 in order to deliver optimal and standardised treatment.

Coping with COVID-19: An exploratory mixed-methods investigation of the impact of John Henryism on urban college students' engagement in schoolwork

The current study examined how COVID-19 impacted urban college students' engagement in their schoolwork and whether John Henryism mediated the relationship among demographic variables and engagement. Results demonstrated that John Henryism is a significant predictor of all three engagement outcomes (absorption, dedication, and vigor) and mediated the relationship between historically underrepresented students (Black and Latinx) and their vigor for engaging in schoolwork. Three themes emerged from the qualitative analysis: intrapersonal, interpersonal, and contextual challenges. This study adds another dimension to the coping strategies urban college students are using to stay engaged in their schoolwork during the pandemic. Practitioner Notes 1. Results demonstrated that John Henryism is a significant predictor of all three engagement outcomes (absorption, dedication, and vigor) 2. John Henryism mediated the relationship between historically underrepresented students (Black and Latinx) and their vigor for engaging in schoolwork 3. Three themes emerged from the qualitative analysis: intrapersonal, interpersonal, and contextual challenges 4. This study adds another dimension to the coping strategies urban college students are using to stay engaged in their schoolwork during the pandemic. 5. Colleges and universities need to be aware of John Henryism as a coping strategy for students.

Investigational immunomodulatory therapies for COVID-19

A large number of candidate drugs are undergoing evaluation for their potential to modulate the pathologic host immune response to SARS-CoV-2 infection. Clinical trial efficacy and safety data are slowly emerging for several of these agents. We provide a summary of candidate immunomodulatory agents, which are registered in ClinicalTrials.gov, and for which clinical data are available. We provide the rationale for their consideration for the treatment of COVID-19, as well as report on data available from the various clinical investigations of their efficacy and safety. © 2021 Prous Science. All rights reserved.

Investigational antiviral drugs for the treatment of COVID-19

A large number of candidate drugs are undergoing evaluation for their potential to limit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication. Clinical trial data are slowly emerging for several of these agents. We provide a review of candidate antiviral agents registered in ClinicalTrials.gov, which have clinical efficacy data, provide the rationale for their consideration for this purpose, and summarize available data on their efficacy and safety. © 2021 Clarivate Analytics

Virtual psychosocial services for the adult population in a large community oncology practice

Background: Psychological and social supports are essential to address the emotional impact of cancer. The Covid-19 pandemic exacerbated emotional distress for patients with cancer and impeded many of the traditional service delivery models for supportive services. An increase in patient reported distress from routine distress screenings highlighted the need to transition to virtual Social Work (SW) services. Methods: Patients were referred to virtual SW services three ways: Self-referral, distress screenings, and clinic staff. A virtual support group registration site was created to increase awareness which was promoted by our marketing team. Three different SW facilitated virtual support groups were offered: Stronger Together, Empower Your Recovery: A Program for Healing and Growth for Living Beyond Cancer ©∗, and Paving the Way for Your Journey: A Cancer Support Program (PTW). Of note, the PTW six-week psychoeducation support group curriculum was developed by six employed SW facilitators. Groups included closed and open formats with scheduled frequencies. In addition to virtual support groups, standard social support including, psychosocial assessments, Advance Care Planning, virtual counseling visits were offered virtually with patients via the VSee telemedicine platform. Results: Social Work referrals increased by 154% from 949 in 2019 to 2413 in 2020 due to positive distress screening. From March 2020-21, 14,948 patients received SW services which was an increase from 10,208 seen from March 2019-20. Of these, 372 received virtual psychosocial telemedicine services from March 2020-21. There were 4092 unique webpage views to the support group information and registration website. Total number of all virtual registrants in the 3 groups from May 2020 to February 2021 was 326. Conclusions: The COVID19 pandemic required us to use, technology and virtual tools to ensure continued patient access to psychosocial services and expand access to support groups, in addition to the in-person SW services that remained. Limitations of virtual support groups and telemedicine included lack of internet access felt to be from socioeconomic barriers. Further research is needed to evaluate the benefits of providing structured psychoeducational virtual support groups to patients with cancer. Virtual counseling and support groups may continue to benefit patients with cancer.

Lessons Learned: A Process Evaluation of the Rural Elder Awareness of Medication Safety (REAMS) Program.

This process evaluation of the Rural Elder Awareness of Medication Safety (REAMS) program provided identification of successful and unsuccessful elements along with barriers to and facilitators of this home-based pilot program. The REAMS program was developed to assist rural older adults aged >65 years and community health care organizations with strategies to improve health literacy related to medications. Recruitment of older adults, rurality of the program's setting, time constraints, and the onset of the COVID-19 pandemic were the greatest barriers. The collaborative relationship developed with community health care partners was the greatest facilitator. This relationship promoted shared ideas and adjustments in program design to achieve the outcome goals. The lessons learned from process evaluation may benefit future researchers or community health promotion planners with designing community-based programs for older adults in rural areas. Future research should focus on expanding recruitment opportunities in acute care, primary care, and home health with the inclusion of all established health care providers in the community. [Journal of Gerontological Nursing, 47(4), 7-12.].

Long-term Overall Survival Outcomes in Patients with Early Stage, Peripherally Located, Non-small Cell Lung Cancer Treated with Stereotactic Ablative Radiotherapy in a Non-academic Cancer Centre.

AIMS: To report long-term outcomes of patients treated with stereotactic ablative radiotherapy (SABR) for early stage, peripherally located non-small cell lung cancer. MATERIALS AND METHODS: Data were collected retrospectively between September 2009 and May 2019. Electronic medical records were reviewed for baseline characteristics, treatment details and outcomes. All patients were treated according to local protocol based on the national UK SABR Consortium guidelines. Risk-adapted treatment schedules were used depending on the size and the location of the tumour (54 Gy in three fractions, 55 Gy in five fractions, 60 Gy in eight fractions or 50 Gy in 10 fractions). Overall survival outcomes were evaluated using the Kaplan-Meier method. RESULTS: In total, 412 patients were included in the analysis. The median age was 76 years (range 48-93 years). Histological confirmation was obtained in 233 cases (56.6%). The median overall survival for all patients was 42.3 months (95% confidence interval 37.3-47.3 months), with 3- and 5-year overall survival of 52.8% and 37.3%, respectively. For biopsy-proven patients (56.6%), 3- and 5-year overall survival was 57.3% and 40.1%, respectively. With respect to overall survival, univariate and multivariate analysis revealed no significant difference in survival by technique (volume-modulated arc therapy versus conformal; three-dimensional computed tomography versus four-dimensional computed tomography), tumour location, smoking status at first contact, pre-treatment tumour stage or pre-treatment standardised uptake value. Survival was poorer for patients who received the 50 Gy in 10 fractions schedule. Treatment was very well tolerated with very low rates of grade 3-4 toxicity (1%). CONCLUSIONS: SABR for peripherally located, medically inoperable non-small cell lung cancer can be safely and effectively implemented in a non-academic institution with appropriate equipment and training. Overall survival outcomes and toxicity rates are comparable with internationally published studies. Patients treated with 50 Gy in 10 fractions had a poorer survival outcome.

How the COVID-19 Pandemic Changed Chemistry Instruction at a Large Public University in the Midwest: Challenges Met, (Some) Obstacles Overcome, and Lessons Learned

This communication presents a partial historical summary of some of Iowa State Universitys Chemistry Department teaching response to the shift to online course delivery caused by the COVID-19 pandemic. The observations reflect discussions between and informal surveys of an instructor cohort that impacted roughly 1200 undergraduate students. These students were enrolled in general chemistry I, organic chemistry II, inorganic chemistry, quantum mechanics, and chemistry for non-physical-science majors. The paper highlights the challenges faced and describes how faculty and students met them.