The Evolution of the Covid-19 Pandemic in Pediatric Patients with Sickle Cell Disease: From Alpha to Omicron

Background: Approximately two years ago, COVID-19 was declared a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and through genomic surveillance, we have seen the emergence of variants of SARS-CoV-2. In the United States, over 78 million cases and >900,000 deaths attributable to COVID-19 have been reported. SCD was identified as a risk factor for severe COVID-19 disease in adults and pediatric patients. The emergence of novel SARs- CoV-2 variants has led to challenges in diagnosis, treatment, and prediction of long-term sequelae in individuals with SCD and COVID-19. Aim(s): We compare the overall seasonal variation of COVID-19 variants and patterns of healthcare utilization and clinical presentation over time in pediatric patients with SCD and COVID-19 at Children's National Hospital (CNH). Method(s): Our single-center, observational cohort study included 193 pediatric patients with SCD (0-21 years) with PCR-confirmed SARSCoV- 2 infection between March 31, 2020, and January 31, 2022. Per the SECURE SCD Registry definitions, clinical severity was classified as asymptomatic, mild, moderate, and severe. Result(s): A total of 193 unique patients with SCD and positive SARS-CoV-2 PCRs between March 2020-January 2022 were included in our registry. Most patients were female (51.8%), and the mean age was 11.2 years (SD 6.5 years). Most of the cohort resides in Maryland (N=135), and HbSS was the dominant genotype (69.4%). During the alpha dominant variant of the COVID-19 pandemic (March 2020- June 2021) there were 70 cases, followed by 40 cases during the Delta variant (July 2021- December 19, 2021), and 83 cases during the Omicron variant dominance (from December 20, 2021-January 31,2022). There were 149 patients (77%) that presented to the emergency department (ED) or were hospitalized. There were a total of 80 hospitalizations (41.5%), and a relative comparison showed that the percentage of hospitalizations was highest during the delta wave (47.5%) and lowest during the omicron wave (36.1%) (p= 0.407). ED-only utilization was highest in the era of omicron (43.4%, N=36), followed by delta (32.5%, N=13), and then alpha (30%, N=21)(p=0.197). The most common SCD-related complication was vaso-occlusive (VOC) pain (33%, N=64) which accounted for half of all hospital admissions (51%, N=41 of 80). Acute chest syndrome (ACS) was reported in 40% (N=32) of admitted patients and was highest in the alpha era (54.8%, N=17). The use of blood transfusion therapy was highest in the alpha (N=17) and delta (N=14) variants, while Remdesivir use was highest in omicron (N=15). A total of 6 patients received monoclonal antibodies (Delta, N=4;omicron, N=2). Throughout all the variants, there was a significant difference in COVID-19 clinical severity (p>0.005). Of the patients classified as asymptomatic (13%, N=25), seventy-two percent (n=18) were diagnosed during the alpha variant. Mild severity was the most prevalent (69%, N=134), with the omicron variant having the highest cases (51.5%, N=69). Severe cases were observed in all variants (6.7%, N=13) but were most prevalent during the alpha variant (46.2%, N=6). Summary - Conclusion(s): Interestingly, while the relative percentage of hospitalizations was lowest during the omicron wave, it saw the highest percentages of ER utilization. Overall, COVID-19 remains mild in pediatric patients with SCD, and notably, there was higher health care utilization in the omicron era.

Social Determinants of Health and Their Impact on Families of Children with Sickle Cell Disease during Covid-19 Pandemic

Background: According to national prevalence data, SCD has an estimated economic burden of $2.98 billion per year in the United States and caring for a child with sickle cell disease (SCD) carries its own financial burden, resulting in higher healthcare costs and unintended days lost from employment. Social experiences are known to impact health outcomes in the general pediatric population. These experiences can be examined through the construct of social determinants of health (SDOH), the "condition in which people are born, grow, work, live and age" that impact their health. Since the WHO has designated COVID-19 a pandemic in January 2020, many families in the US have suffered financially, and during the shutdowns, there was a record number of jobs lost. The objective of this study was to determine the impact of the COVID-19 pandemic on financial and employment status of SCD Families Methods: This study was part of the larger CNH Sickle Cell Disease Social Determinants of Health study that was IRB approved. Caregivers of children with SCD completed a 30-question survey reporting their experiences with SDOH that included Demographics, USDA Food Security Scale, the We Care housing screening tool, and the validated COVID-19 Employment Status/COVID-19 related household finances survey in RedCap during clinic visits and hospitalizations Results: 99 caregivers of SCD patients responded to our survey (82.5% Female, 17.5% Male) (N=97). 93.9% identified as African-American, 3% identified as Hispanic or Latinx, 1% identified as "other". Of respondents, 66% were insured through on Medicaid and 33% had private insurance. Twenty-six percent endorsed food insecurity and 2724% relied on low-cost food. Thirty-one percent lived in an apartment, 67.768% lived in a home, 1% lived in shelter or transitional housing. Sixteen percent lived in subsidized or public housing. Thirty-seven (36.8%) percent reported at least once they were being unable to pay the mortgage or rent on time at least once, 9% (8.5%) reported living with other people because of financial difficulties, 55.2% reported their home not being heated, 7.2% reported being evicted from their home and 3.1% lived in an emergency shelter or transitional housing. 6.1% had an educational level of high school graduation or less, 42.2% were college graduates or completed additional post-graduate education (N=98). Two weeks prior to the pandemic, 61.5% worked full time, 13.5% worked part time, 6.3% were unemployed with only 2.1% working from home of the 96 caregivers who responded to this question. 15.5% (N=12 of 77) reported losing their job or were furloughed during the pandemic;34.4% (N=33 of 96) reporting at least one household member losing a job or a significant amount of income. Twenty-five percent (N=21 of 83) reported it was difficult to get work/school done because of the home environment. 36.4 % (N=35 of 96) reported household income was significantly less since February 2020. 53% (N=52 of 97) worried their household income has been or will be negatively impacted by the COVID-19 pandemic. Additionally, 48.9% (N=47 of 96) worried the value of their assets (housing, savings, other financial assets) has been or will be negatively impacted by COVID-19 and its effects. Since February 2020, 9.8% (N= 9 of 97) received unemployment insurance, 30.9% (N=29 of 94) received SNAP or food stamps, 16.5% (N= 15 of 91) received from the food pantry, 6.6% (N=6 of 90) applied for temp ass.

Evaluation of the readability, understandability, and actionability of COVID-19 public health messaging in Atlantic Canada

IntroductionEffective communication of COVID-19 information involves clear messaging to ensure that readers comprehend and can easily apply behavioral recommendations. This study evaluated the readability, understandability, and actionability of public health resources produced by the four provincial governments in Atlantic Canada (New Brunswick, Newfoundland and Labrador, Nova Scotia, and Prince Edward Island). MethodsA total of 400 web-based resources were extracted in June 2022 and evaluated using the Flesch-Kincaid Grade Level, CDC Clear Communication Index, and the Patient and Education Materials Assessment Tool. Descriptive statistics and a comparison of mean scores were conducted across provinces and type of resources (e.g., text, video). ResultsOverall, readability of resources across the region exceeded recommendations, requiring an average Grade 11 reading level. Videos and short form communication resources, including infographics, were the most understandable and actionable. Mean scores across provinces differed significantly on each tool;Newfoundland and Labrador produced materials that were most readable, understandable, and actionable, followed by New Brunswick. DiscussionRecommendations on improving clarity of COVID-19 resources are described. Careful consideration in the development of publicly available resources is necessary in supporting COVID-19 knowledge uptake, while reducing the prevalence of misinformation.

Can we predict HoLEP surgery operating times for a given prostate volume to enhance theatre utilization?

Introduction & Objectives: Holmium laser enucleation of the prostate (HoLEP) has the strongest evidence base for bladder outlet surgery, despite its steep learning curve. Rapid enucleation rates can be achieved in established hands with day-case surgery being the norm in service delivery. We have previously shown the validity of such a model. With the post Covid surgical backlog we have developed a tool to support theatre utilization based on established surgeon specific operating room (OR) times for a given prostate volume in our unit based on almost 1100 cases. Material(s) and Method(s): Four HoLEP naive surgeons completed 1096 HoLEPs over 7.5 years using a 50 Watt (W) Holmium laser (Auriga XL, Boston Scientific Inc., Piranha morcellator, Richard Wolf). Pre and post-operative data including TRUS/MRI volume, flow rate, residual volume, international prostate symptom score, quality of life, stop-clock enucleation, morcellation and total operating room (OR) times, hospital stay, histology, haemoglobin, creatinine, sodium and catheter times were prospectively recorded. Mentorship was provided by a senior 100W HoLEP surgeon from an adjoining hospital. Result(s): The data was independently analysed by a bio-statistician (IN). Statistical regression analysis of unit and surgeon specific OR times vs prostate volume were used to produce predictive linear graphs of OR times (mins) for a given prostate volume for individual surgeons and the unit. [Figure presented] Conclusion(s): Use of surgeon-specific and unit specific OR times allows the opportunity to maximize theatre operating schedules to help tackle the post Covid surgical backlog. We encourage this process for index specialist procedures across units.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Analysis of National Surveillance Data to Support Case Definition Revisions for Multisystem Inflammatory Syndrome in Children (MIS-C), United States, February 2020-April 2022

Background. Classification of MIS-C, COVID-19, and other pediatric inflammatory conditions is challenged by phenotypic overlap and absence of diagnostic laboratory evidence. Due to public health need and based on limited data from early cases, CDC developed a necessarily broad MIS-C surveillance case definition in May 2020. Studies have since shown that some criteria do not distinguish between MIS-C and other conditions and may contribute to misclassification. To inform planned revision to the CDC definition, we evaluated the impact of narrowing these criteria on case inclusion in national MIS-C surveillance. Methods. Of state and local health-department reported cases meeting the current MIS-C case definition as of 04/14/2022, we describe the proportion that met revised criteria under consideration including fever duration, C-reactive protein (CRP) elevation using a defined cutoff, and organ involvement represented by specific criteria. We also evaluated cases identified using potential combinations of revised criteria. Results. Of 8,096 MIS-C cases fulfilling the original case definition, 6,332 (78%) had sufficient data for evaluation of criteria. Of these, 96% had fever for >=2 days and 94% had a CRP >= 3.0 mg/dL (Table 1). Cardiac involvement defined by key features of MIS-C was present in 84% of cases (62% if BNP/proBNP elevation was excluded);43% had shock. Dermatologic, gastrointestinal (GI) and hematologic involvement were present in 75%, 89% and 37% of cases, respectively. Neurologic (excluding headache), renal, and respiratory involvement were present in 16%, 20%, and 63% of cases, respectively. The number of cases with >= 2 of cardiac (without BNP/proBNP elevation), shock, dermatologic, GI, or hematologic involvement was 5,733 (91%). SARS-CoV-2 testing results are shown in Table 2. Conclusion. The CDC MIS-C case definition is intentionally broad. Using national surveillance data, we evaluated case inclusion under narrower criteria, prioritizing features of MIS-C that distinguish it from similar pediatric inflammatory conditions. A surveillance case definition may not capture all cases and is not intended to replace clinical judgment. We plan to assess additional criteria combinations, describe potentially excluded cases, and incorporate findings into a revised definition.

Multisystem Inflammatory Syndrome in Children (MIS-C) in Persons Fully Vaccinated with Two Doses of mRNA COVID-19 Vaccine Compared with Persons with Partial or No Vaccination Reported, U.S. National MIS-C Surveillance

Background. CDC began collecting COVID-19 vaccination status of persons with MIS-C as part of national surveillance inMay, 2021. We describe and compare MIS-C in fully vaccinated persons withMIS-C in persons with partial or no vaccination reported. Methods. We identified COVID-19 vaccine age-eligible persons meeting the CDC MIS-C case definition reported by health departments as of March 28, 2022 and divided theminto 3 groups for this analysis: 1) fully vaccinated (receipt of a 2-dosemRNAprimary vaccine series with MIS-C onset >=28 days after vaccine dose 2 to account for the delay between infection and MIS-C), 2) partially vaccinated (MIS-C onset after dose 1 or < 28 days from dose 2 or receipt of Janssen [Johnson & Johnson] vaccine and 3) no vaccination reported. We compared characteristics between the groups. Results. Of 7,880 MIS-C cases reported, 1,085 were vaccine eligible: 45 were fully vaccinated, 64 partially vaccinated, and 976 had no vaccine reported. Demographic characteristics were similar, although the Northeast had the lowest percentage of persons with vaccination not reported (Table). Though not statistically significant, fully vaccinated persons less frequently had severe cardiac involvement (67% vs 74%), shock (33% vs 44%), severe hematologic involvement (47% vs 54%), and mucocutaneous involvement (53% vs 63%) compared with those with no vaccine reported (Table). Forty-four percent of those fully vaccinated required ICU-level care vs 59% with no vaccine reported (p=0.053). Nineteen (2%) of those without vaccine reported died;no fully or partially vaccinated persons died. (Table Presented) Conclusion. Persons who acquire SARS-CoV-2 infection after being fully vaccinated can develop MIS-C, with similar clinical characteristics to those with no vaccination reported. A lower but not statistically significant percentage of fully vaccinated persons required ICU-level care compared with those without vaccination, and there were no deaths in the fully vaccinated group. These data do not account for trends in MIS-C over time, including the influence of circulating SARS-CoV-2 variants on MIS-C clinical manifestations. We will continue to evaluate these comparisons as the sample size of reported MIS-C cases increases.

A Case-Control Study Investigating Household, Community, and Clinical Risk Factors Associated with Multisystem Inflammatory Syndrome in Children (MIS-C) after SARS-CoV-2 Infection

Background. Risk factors for MIS-C, a rare but serious hyperinflammatory syndrome associated with SARS-CoV-2 infection, remain unclear. We evaluated household, clinical, and environmental risk factors potentially associated with MIS-C. Methods. This investigation included MIS-C cases hospitalized in 14 US pediatric hospitals in 2021. Outpatient controls were frequency-matched to case-patients by age group and site and had a positive SARS-CoV-2 viral test within 3 months of the admission of their matched MIS-C case (Figure 1). We conducted telephone surveys with caregivers and evaluated potential risk factors using mixed effects multivariable logistic regression, including site as a random effect. We queried regarding exposures within the month before hospitalization for MIS-C cases or the month after a positive COVID-19 test for controls. Enrollment scheme for MIS-C case-patients and SARS-CoV-2-positive outpatient controls. MIS-C case-patients were identified through hospital electronic medical records, while two outpatient controls per case were identified through registries of outpatient SARS-CoV-2 testing logs at facilities affiliated with that medical center. Caregivers of outpatient controls were interviewed at least four weeks after their positive test to ensure they did not develop MIS-C after their infection. Results. We compared 275 MIS-C case-patients with 494 outpatient SARS-CoV-2-positive controls. Race, ethnicity and social vulnerability indices were similar. MIS-C was more likely among persons who resided in households with >1 resident per room (aOR=1.6, 95% CI: 1.1-2.2), attended a large (>=10 people) event with little to no mask-wearing (aOR=2.2, 95% CI: 1.4-3.5), used public transportation (aOR=1.6, 95% CI: 1.2-2.1), attended school >2 days per week with little to no mask wearing (aOR=2.1, 95% CI: 1.0-4.4), or had a household member test positive for COVID-19 (aOR=2.1, 95% CI: 1.3-3.3). MIS-C was less likely among children with comorbidities (aOR=0.5, 95% CI: 0.3-0.9) and in those who had >1 positive SARS-CoV-2 test at least 1 month apart (aOR=0.4, 95% CI: 0.2-0.6). MIS-C was not associated with a medical history of recurrent infections or family history of underlying rheumatologic disease. Conclusion. Household crowding, limited masking at large indoor events or schools and use of public transportation were associated with increased likelihood of developing MIS-C after SARS-CoV-2 infection. In contrast, decreased likelihood of MIS-C was associated with having >1 SARS-CoV-2 positive test separated by at least a month. Our data suggest that additional studies are needed to determine if viral load, and/or recurrent infections in the month prior to MIS-C contribute to MIS-C risk. Medical and family history were not associated with MIS-C in our analysis.

SSISI Public Policy Brief: International Trade and Investment Agreements: Fit for Future Purpose The Comprehensive Economic and Trade Agreement (CETA) - A Gold Standard Agreement for Canada and Ireland

I have been looking forward to this discussion to take stock of how FTAs can help expand trade and investment, and especially how modern Agreements such the Canada-EU Comprehensive Economic and Trade Agreement (CETA) are fit for future purpose, designed to help economies thrive in the 21st century. I will focus my remarks today on CETA. I believe that CETA is a modern and progressive trade agreement for Canada, Ireland and the EU. For over 3 and half years now, CETA has built a track record of inclusive, sustainable and durable wealth creation on both sides of the Atlantic. In 2020, CETA has also cushioned our economies against a bigger dip to our trade sectors. COVID-19 has highlighted the interconnected nature of our economies and, by extension, the importance of strong ties. That is why the CETA will be more important than ever in advancing our shared - if not global - economic recovery from COVID-19.

Comparison of three methods of semen analysis: A novel at-home sperm test kit, a computer-assisted assessment and an embryologist

Study question How does computer-assisted semen analysis (CASA) (Lenshooke, LOGIXX) and at-home sperm testing (ExSeed) compare with manual methodology assessment of male fertility based on WHO criteria (5thEdition);a three-method comparison study. Summary answer All methods showed good agreement for concentration and limited agreement for motility highlighting the need for further development of alternatives to manual assessment. What is known already Several studies have shown good correlation between CASA systems and laboratory-based manual semen analysis, but only a few have carried out a three-way comparison study. One of which showed positive correlation with motility and concentration between a smartphone-based semen analysis and laboratory-based CASA system and positive correlation between concentration and motility between the smartphone-based CASA system and microscopic-based results. The at-home sperm test kit may play a role in motivating infertile males to visit clinics for early diagnosis and also reducing the need for multiple visits to the fertility clinic for repeat semen analyses. Study design, size, duration Fifty patients (between 29 and 56 years) attending a fertility clinic were included in the study between September 2021 to December 2021. Semen samples were split into 3 aliquots and evaluated using manual semen assessment (MSA) according to the WHO 5th Edition (2010) guidelines, the ExSeed Home Sperm Test (HST) and the LensHooke® X1 PRO Semen Quality Analyzer (CASA). Participants/materials, setting, methods The semen samples were collected from fifty participants at CARE Fertility Tunbridge Wells. The samples were placed in an incubator at 37°C for 30 minutes to liquefy. After liquefaction, sperm concentration, total motility, total motile sperm count (TMSC) and normal morphology were evaluated. Spearman’s Rank correlations (>0.7) and Chi-squared tests were used and the p-value < 0.05 was considered as statistically significant. Main results and the role of chance All variables were highly significantly (p < 0.0002) positively correlated between all 3 methods. The greatest correlations were obtained for sperm concentration (CASA/HST: r = 0.826;MSA/HST: r = 0.870;MSA/CASA: r = 0.871) and TMSC (MSA/CASA: p = 0.792;CASA/HST: r = 0.800;MSA/HST: r = 0.854). Correlations for motility were markedly lower (MSA/HST: r = 0.611;CASA/HST: r = 0.717;MSA/LCASA: r = 0.750). The lowest correlation was found for morphology (MSA/CASA: r = 0.500). The HST device does not determine morphology. As compared to MSA, using the HST device agreement for normal or low sperm concentration (≥15 × 106/mL or < 15 × 106/mL respectively) was identified in 84.3% of the cases, whereas 94.0% with CASA. The agreement between CASA and HST was 82.0%. For total motility ≥ or < 40%, the agreements were 68.0% (CASA/HST), 56.9% (MSA/HST) and 82.0% (MSA/CASA), respectively. For the identification of patients with normal morphology >4%, the agreement between MSA and CASA was 30%. Limitations, reasons for caution The small sample size was 50 cases. The home testing device does not assess morphology. Furthermore, it is difficult to ascertain whether a consumer would carry out the analysis with this device with the same accuracy as an embryologist. Wider implications of the findings The need for repeated semen analyses, the effect of the COVID-19 pandemic and the discomfort some patients feel in a clinical setting, necessitate the need for evaluation of novel semen analysis approaches. These emerging technologies have potential to be more patient friendly, convenient and efficient than standard semen assessment methods. Trial registration number not applicable

EVALUATING VIRTUAL GROUP VISITS FOR DIABETES CARE DURING THE COVID-19 PANDEMIC

BACKGROUND: One strategy to aid patients in managing their diabetes is group visits (GVs) that include group education and individual medical visits with a provider. Though in-person GVs have been shown to benefit patients, few studies have evaluated virtual diabetes GVs. METHODS: In this single-arm trial, adult patients with A1c ≥ 8% from six community health centers were recruited to participate in monthly virtual GVs for 6 months. Patients completed surveys about diabetes self-care, support, distress, and the group visit concept before and after they participated in GVs. Health center staff trained to lead the GVs completed surveys pre and post virtual GVs. Linear mixed effects models were used to adjust cohort-based association and model the survey data over time for the time trend effect. RESULTS: Forty-five patients enrolled in the study and thirty-eight patients completed the baseline survey. The average age was 55 (range of 36-83) and 65% of enrollees were female. 63% were black/African American, 32% were white/Caucasian, and 8% were Hispanic/Latino. Thirty-four patients attended one or more GVs and twenty-one patients completed the post GV survey. Overall satisfaction with the virtual GVs was high with 18/20 (90%) of participants being very satisfied and 20/21 (95%) saying they would attend GVs in the future. Most participants agreed that GVs helped improve diabetes self-management skills (78%), motivated them to achieve health goals (89%), and introduced them to others living with diabetes (78%). Barriers to participation were the timing of the GVs and access to a computer, tablet, phone, and internet. Patients had an increase in their diabetes knowledge (mean (SD): 3.2/ 5 (0.9) to 3.6/5 (0.7), p= 0.02) and diabetes support (3.5/5 (0.64) to 4.1/5 (0.7), p <0.001) as well as decreased diabetes distress (2.9/6 (1.5) to 1.2/6 (0.5), p=0.03) from baseline to 6 months. Thirty-five staff enrolled in the study and seventeen completed a post GV survey. Most staff agreed that GVs provided patients with social support and more frequent contact with medical providers. Staff largely agreed that virtual GVs increased opportunity for teamwork and collaboration (94%), care coordination (82%), and understanding of patients (94%). However, only 5/17 (29%) and 3/17 (18%) staff members agreed that virtual GVs increased provider productivity or led to higher reimbursement, respectively. Staff cited other priorities at the health center, difficulty recruiting patients, and concerns about access to technology as the biggest barriers to implementing virtual GVs. CONCLUSIONS: Virtual GVs show promise as evidenced by high patient satisfaction and improvements in support, distress, and diabetes knowledge in patients. Staff also perceived virtual GV benefits to patients, staff, and health centers despite concerns about logistics such as productivity, reimbursement, and the health center's ability to continue visits virtually.

IMPACT OF VIRTUAL DIABETES GROUP VISITS ON PATIENT OUTCOMES DURING THE COVID-19 PANDEMIC IN MIDWESTERN HEALTH CENTERS

BACKGROUND: Diabetes group visits (GVs) or shared medical appointments have been shown to improve clinical outcomes, but few have reported results from virtual diabetes GVs. No studies have evaluated virtual GVs among community health center patients across a region of the U.S. METHODS: Six health center sites across five states conducted six monthly virtual GVs with up to 12 adult patients with type 2 diabetes and suboptimal glycemic control (glycosylated hemoglobin (A1C) ≥8%). Virtual group visits consisted of six monthly 60 to 90 minute-long diabetes education sessions led by health center staff via a videoconferencing platform. GV patients enrolled at the site also had an appointment with their primary care physician within two weeks of each monthly virtual group visit. Primary outcome was change in patients' A1C from baseline to 6- months. Secondary outcomes were changes in patients' blood pressure, low density lipoproteins (LDL) and weight. Patients also completed surveys at baseline and 6-months describing their diabetes self-care behaviors and satisfaction with the virtual GVs. Generalized linear mixed models and linear mixed models were used to test the effects of GVs, time points and their interaction. RESULTS: Forty eight patients were enrolled (mean age 55 ± 12 years, 67% female, 63% black/African American, 32% white/Caucasian, and 8% Hispanic/Latino, 88% had public health insurance, mean baseline A1C of 9.84% ± 1.78%, 35% with A1c <9%). 34 patients completed one or more virtual GVs;14 patients attended no virtual group visits. At 6-months, average A1C was 8.96 ±1.82;A1C decreased by -0.56% ± 0.31 compared to baseline which was borderline significant (p=0.08). At 6-months, 58% of patients had an A1C < 9% which was borderline significantly decreased (p=0.055) compared to baseline. For patients with an A1C at baseline >9%, there was a significant decrease in A1C at 6 months (-1.06 ±0.45, p=0.03). There was no significant difference in blood pressure, LDL or weight from baseline to 6- months or association of number of visits attended and change in A1C. There were no significant changes in foot self-exams, blood sugar testing, nor exercise, but patients did report more days of healthy eating in the past week at 6-months compared to baseline (4.5 ±2.3 vs. 3.2 +2.7 days, p=0.02). Overall satisfaction with the virtual GVs was high with 90%of participants being very satisfied and 95% saying they would attend GVs in the future. CONCLUSIONS: Virtual GVs show high patient satisfaction and promise for improving A1C among patients with poor glycemic control who receive care in community health centers. Future studies are needed with a larger patient sample size and a control comparison group to determine which patients and health centers are best suited for virtual GVs.

Hydrocele aspiration and injection sclerotherapy under local anaesthetic: a viable alternative to open surgical repair

Introduction: Hydroceles could cause discomfort, scrotal heaviness, cosmetic problems or adversely impact quality of life. Conventional treatment involves open surgical repair under general anaesthetic. Aspiration and injection sclerotherapy is however an attractive alternative since literature suggests it has comparable outcomes, lower complication rates and can be performed under local anaesthetic (LA) in timely manner. Patients and Methods: Consenting patients were prospectively recruited following necessary approvals. The procedure was carried out under LA and ultrasound guidance at our urology clinic. The hydrocele was drained and sclerosant (3% sodium tetradecyl sulphate) immediately injected into the tunica vaginalis. Post-procedure followup ranged from 3-12months. Results: Thirty-two patients with 35 procedures (2 re-do, 1 bilateral) were studied. Average volume drained was 283ml (18-1000ml). Overall success rate was 77.1% (complete resolution- 21 [60.0%], mild re-accumulation without need for re-intervention- 4 [11.4%], moderate re-accumulation successfully treated with re-do sclerotherapy- 2 [5.7%]). Large/significant recurrence was noted in 8 (22.9%) patients- they all had large (>200ml) hydroceles ab-initio and went on to have straightforward open surgical repair. One procedure was abandoned due to traumatic aspiration and was excluded. Conclusions: Hydrocele aspiration and injection sclerotherapy under LA is safe, easy to set-up and effective, with trend towards better outcomes for smaller hydroceles. This treatment could ease waiting-list pressures occasioned by the COVID-19 pandemic and should be considered as part of informed consent process for all men with hydroceles. Further data is required to define most suitable patients and also to fully assess ease of hydrocele repair after failed sclerotherapy.

COVID Student Study: A Year in the Life of College Students during the COVID-19 Pandemic Through the Lens of Mobile Phone Sensing

The COVID-19 pandemic continues to affect the daily life of college students, impacting their social life, education, stress levels and overall mental well-being. We study and assess behavioral changes of N=180 undergraduate college students one year prior to the pandemic as a baseline and then during the first year of the pandemic using mobile phone sensing and behavioral inference. We observe that certain groups of students experience the pandemic very differently. Furthermore, we explore the association of self-reported COVID-19 concern with students' behavior and mental health. We find that heightened COVID-19 concern is correlated with increased depression, anxiety and stress. We evaluate the performance of different deep learning models to classify student COVID-19 concerns with an AUROC and F1 score of 0.70 and 0.71, respectively. Our study spans a two-year period and provides a number of important insights into the life of college students during this period. © 2022 Owner/Author.

Estimating SARS-CoV-2 Seroprevalence from Spent Blood Samples, January-March 2021

Background. Measuring SARS-CoV-2 antibody prevalence in spent samples at serial time points can determine seropositivity in a diverse pool of individuals to inform understanding of trends as vaccinations are implemented. Methods. Blood samples collected for clinical testing and then discarded ("spent samples") were obtained from the clinical laboratory of a medical center in Atlanta. A convenience sample of spent samples from both inpatients (medical/surgical floors, intensive care, obstetrics) and outpatients (clinics and ambulatory surgery) were collected one day per week from January-March 2021. Samples were matched to clinical data from the electronic medical record. In-house single dilution serological assays for SARSCoV-2 receptor binding domain (RBD) and nucleocapsid (N) antibodies were developed and validated using pre-pandemic and PCR-confirmed COVID-19 patient serum and plasma samples (Figure 1). ELISA optical density (OD) cutoffs for seroconversion were chosen using receiver operating characteristic analysis with areas under the curve for all four assays greater than 0.95 after 14 days post symptom onset. IgG profiles were defined as natural infection (RBD and N positive) or vaccinated (RBD positive, N negative). Single dilution serological assays for SARS-CoV-2 nucleocapsid antibodies were validated using pre-pandemic and PCR-confirmed COVID-19 patient serum and plasma samples. ELISA optical density (OD) cutoffs for seroconversion were chosen using receiver operating characteristic (ROC) analysis with areas under the curve (AUC) for all four assays greater than 0.95 after 14 days post symptom onset. Results. A total of 2406 samples were collected from 2132 unique patients. Median age was 58 years (IQR 40-70), with 766 (36%) ≥ 65 years. The majority were female (1173, 55%), and 1341 (63%) were Black. Median Elixhauser comorbidity index was 5 (IQR 2-9). 210 (9.9%) patients ever had SARS-CoV-2 detected by PCR, and 191 (9.0%) received a COVID-19 vaccine within the health system. Nearly half (1186/2406, 49.3%) of samples were collected from inpatient units, 586 (24.4%) from outpatient labs, 403 (16.8%) from the emergency department, and 231 (9.6%) from infusion centers. Overall, 17.0% had the IgG natural infection profile, while 16.2% had a vaccination profile. Prevalence estimates for IgG due to natural infection ranged from 24.0% in week 2 to 9.7% in week 5, and for IgG due to vaccine from 4.4% in week 2 to 32.0% in week 6 (Table, Figure 2). Conclusion. Estimated SARS-CoV-2 IgG seroprevalence among patients at a medical center from January-March 2021 was 17% by natural infection, and 16% by vaccination. Weekly trends likely reflect community spread and vaccine uptake.

Digital Preservation of Experiences in Virtual Worlds: Extending Digital Rights to Include Right to Replay

Experiences within Virtual Worlds spaces are increasingly becoming normalised as the standard form of human interaction, not only for play but also for work and education. The COVID pandemic did not cause this, but because of this existential crisis and Climate change, the development of virtual worlds is speeding up. Their role in society is changing, and they are becoming just as important as real-world spaces. Still, due to their digital nature, they are inherently ephemeral, they only exist for a short time in software and hardware. Then, they are simply lost to the ether. These worlds and the experiences of the users within them needs to be preserved. For digital preservation of these virtual worlds to succeed, a new approach is necessary, based not on preserving the world’s data but on the players’ experiences within. A user-centric approach to the digital preservation of our experiences in Virtual Worlds virtual reality experiences is required. This can be achieved by extending our digital rights to include our right to replay. When codifying the right to allow for replaying experiences within virtual worlds, it can be argued that this action is burdening the companies who create those virtual worlds with undue responsibilities. This paper outlines how such a burden is trivial given modern-day game engines. To demonstrate this fact, an open-source library was developed to record generic objects within a Virtual World. This approach differs from others that approach treating the virtual world as a deterministic environment. The system in this paper records an object position and interactions within a world instead of just the raw inputs that most replay systems use. This article aims to discuss how future technology generating these worlds should target replays systems as a digital preservation method. Other more laborious processes will not be achieved even if they are enshrined into law. This approach hopes to offer to balance the burden between user and producer of virtual worlds. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Treatment with monoclonal antibodies minimize severity of covid-19 illness among kidney transplant recipients

Background: The mortality rate of kidney transplant recipients with COVID-19 is significantly higher than the general population, indicating a need for effective treatment to minimize potential severe symptoms in this population. We sought to evaluate the efficacy of monoclonal antibody therapy in decreasing the severity of COVID-19 symptoms among our kidney transplant recipients. Methods: We reviewed 17 kidney transplant recipients who were infected with SARS-CoV2 and received treatment with monoclonal antibody therapy. All patients were on standard immunosuppression with Tacrolimus and Prednisone, and 88% were on Mycophenolate prior to COVID diagnosis, which was subsequently reduced or held for at least 2 weeks. Results: Of the 17 patients reviewed, median age was 61 years (range 42 to 77 years), 47% were male, 59% were Hispanic, and 29% were African American. Additionally 94% had history of hypertension, 47% diabetes mellitus, 18% coronary artery disease, and median BMI was 28.8 (range 23.4 to 41.9). Eighteen percent were transplanted <1 year, 29% between 1-5 years, 24% 6-10 years, and the remaining >10 years. All patients had mild symptoms without evidence of hypoxia, and 94% received monoclonal antibody therapy within 7 days of diagnosis. Bamlanivimab 700mg was the most commonly administered agent at 59%, while 18% received Bamlanivimab 700mg and Etesevimab 1400mg. Casirivimab 1200 mg and imdevimab 1200 mg was used in 24%. Only 2 out of the 17 patients (11.8%) required hospitalization, and both were non-COVID-19 related reasons. Five out of 17 patients (29.4%) were evaluated in the Emergency Department but not admitted. All 17 patients (100%) recovered from their COVID-19 illness. There were no episodes of graft failure. Conclusions: Our experience suggests that monoclonal antibody therapies may be beneficial in preventing severe COVID-19 in renal transplant recipients and possibly reduce the need for COVID-19 related hospitalization in this high risk population. However, larger studies are needed to confirm these findings.