Disruptions in Health Care among Mwccs Participants during the Covid-19 Pandemic

Background: The COVID-19 pandemic resulted in disruptions to health care services. Vulnerable populations, including people living with HIV (PLHIV), may have experienced unique challenges when accessing medical care. The objective of this study was to evaluate the impact of social disruptions on health care visits among Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (MWCCS) participants. Method(s): A survey collecting data on missed health care visits and social disruptions (i.e., disruptions in employment, childcare, financial support, housing, and health insurance) during the pandemic was administered via telephone to MWCCS participants 1-3 times from March and September 2020. Logistic regression models adjusted for sociodemographics and HIV-status were used to test the association between social disruptions and three medical care interruption outcomes (i.e., missed healthcare appointment, interruption of mental health care, and interruption of substance use care). Result(s): Surveys (n=10,076) were conducted among 2238 PLHIV (61% women) and 1427 people living without HIV (PLWoH) (41% women). Overall, 42% of participants reported disruptions in health care with no significant difference by HIV status. Among participants receiving mental health care services and substance use treatment, 52% and 36% reported interruptions of care, respectively. Participants reporting >= 2 social disruptions were more likely to report missed health care appointments (adjusted odds ratio [aOR]: 1.81, 95% confidence interval [CI]: 1.54-2.13), and interruptions in mental health care [aOR: 2.42, 95%CI: 1.85-3.17) or substance use treatment (aOR: 1.97, 95%CI: 1.26-3.09), compared to those reporting no disruptions. Participants who were unemployed were more likely to miss health care appointments (aOR:1.46, 95% CI: 1.25-1.71) and report disruptions in mental health care (aOR: 2.02, 95% CI: 1.54-2.66) compared to those who were employed. PLHIV reporting >= 2 social disruptions were at increased risk for missed health care appointments (aOR 1.92, 95%CI: 1.56-2.36) and disruptions in mental health care (aOR: 2.54, 95%CI: 1.83-3.53 (Table 1). Conclusion(s): Social disruptions as a result of the COVID-19 pandemic have adversely impacted the receipt of health care among PLHIV and PLWoH, including the receipt of treatment for mental health and substance abuse. Providing childcare, financial support, housing, and health insurance may reduce disruptions in care and improve health outcomes.

Acute Coronary Syndrome during the Era of Covid-19: Perspective and Implications Using Google Trends

Background Acute coronary syndrome (ACS) hospital admissions decreased during the start of the COVID-19 outbreak. There is limited information on how Google searches related to patients behavior during this time. Methods We examined de-identified data from 2019 through 2020 regarding monthly: 1) admissions for ACS from the Veterans Affairs Healthcare System;2) out of hospital cardiac arrest (OHCA) from NEMSIS public dataset;and 3) Google searches for "chest pain", "coronavirus", "chest pressure", and "hospital safe" from Google Trends. We analyzed the trends for ACS admissions, OHCA, and Google searches. Results During the early months of the first COVID-19 outbreak: 1)Veterans Affairs data showed a significant reduction in ACS admissions at a national and regional (Florida) level (Figure 1);2) NEMSIS database showed a marked increase in OHCA at a national level;and 3) Google Trends showed a significant increase in the before mentioned Google searches at a national and regional level. Conclusion ACS hospital admissions decreased during the beginning of the pandemic likely due to delayed healthcare utilization secondary to patients fear of acquiring COVID-19 infection. Concordantly, Google searches for hospital safety and ACS symptoms increased along with OHCA events during this time. Our results suggest that Google Trends may be a useful tool to predict patients behavior and increase preparedness for future events, however, statistical strategies to establish association are needed. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Ambroxol therapy for patients with Gaucher disease type 1, either poor responders to enzyme replacement therapy/substrate reduction therapy (ERT/SRT) or untreated

Ambroxol hydrochloride is an oral mucolytic drug, available over-the-counter for many years as cough medicine, which was found to also act as a pharmacological chaperone for mutant glucocerebrosidase, albeit in a several-fold higher dose. Proof-of-concept reports have been published over the past decade in all three forms of Gaucher disease (GD). The current study aimed to assess the safety and efficacy of 12-months ambroxol 600 mg/day in 3 groups of type 1 GD patients with sub-optimal response, after a minimum of 3 years, to enzyme replacement therapy (ERT)/substrate reduction therapy (SRT) defined as lumbar spine bone density <−2.0 t-score, or platelet count<100 × 10−3/L, or LysoGb1 > 200 ng/ml, and for a group of naïve patients, i.e., never treated or stopped therapy >12 months prior to enrollment, who had abnormal values in 2 of the 3 above-mentioned parameters. Forty patients were enrolled: 28 ERT/SRT treated and 12 naïve;21 (52%) males, mean age 52 years (range 24–84). Safety aspects included several adverse effects (mainly gastrointestinal, excessive saliva, and vertigo) all mild and transient in nature, but led to drug discontinuation in 14 patients, additional dropouts were 7 patients due to COVID19 pandemic and 3 due to personal reasons. Of the remaining 16 patients, 14 have completed 12 months, and 2 are ongoing. Of the 14 completers, 5 (~36%) achieved significant improvement in at least one of the three parameters, and nine did not demonstrate any improvement nor deterioration. The interpretation of the results must take into account the fact that most of the enrolled patients have had poor response to ERT/SRT (including 10 of the 12 naïve patients) and therefore may not represent the majority of the patients. Further studies are needed in never-treated patients as well as an oral, less expensive, alternative to unselected stable patients currently treated with ERT/SRT with a favorable response.

Functional Improvements Observed in Long-Covid Patients Following Participation in Pulmonary Rehabilitation

PURPOSE/HYPOTHESIS: Some patients with COVID-19 have physical impairments that last well beyond the acute infection, termed long-COVID. An increasing number of patients experiencing ongoing symptoms are being referred to outpatient Pulmonary Rehabilitation (PR) with a growing understanding of their key limitations and the benefits of PR. Patients with long- COVID often present with significant inspiratory muscle weakness and functional limitations even months after infection and benefit from PR and IMT. The purpose of this study was to examine the impact of PR on inspiratory muscle performance (IMP) and several functional performance measures (FPM), as well as COPD Assessment Tool (CAT), quality of life (QOL) and depression (D) screening. NUMBER OF SUBJECTS: Eight patients (3 male and 5 female, age 51 +/- 15, BMI 32 +/- 6) diagnosed with long- COVID-19. MATERIALS AND METHODS: Twenty-two patients with long-COVID entered PR but only 8 patients successfully completed the program. The PR program included aerobic exercise, strength training, IMT, and education. Of the 22 patients who started PR, 64% dropped out due to a variety of reasons. IMP was examined via the PrO2 from residual volume providing the maximal inspiratory pressure (MIP) at 1 to 2 seconds of inspiration and the sustained maximal inspiratory pressure (SMIP) from MIP to total lung capacity. The 6-minute walk test (6MWT), timed-up-and-go (TUG), BERG balance test (BERG), 5x-sit-to-stand (5xSS), Patient Health Questionnaire (PHQ9), Ferrans & Powers QOL, and CAT were measured using standardized methods. Wilcoxon Signed Rank Tests were computed before and after PR with statistical significance set at P< 05. RESULT(S): No significant difference in any outcome measure was found when comparing completers to non-completers of PR. Significant (P< 05) improvements in the SMIP (198.1 +/- 61.5-286.8 +/- 130.7 PTU), 6MWT (313 +/- 103-451 +/- 101 m), TUG (7.7 +/- 2.3-6.2 +/- 1.1 s), 5xSS (13.0 +/- 3.2-10.5 +/- 1.5 s) and QOL (21.2 +/- 3.6-24.8 +/- 2.4) were observed, while non-significant changes were observed in PHQ9 (7.3 +/- 5.6-6.5 +/- 5.1), BERG (52.7 +/- 6.7-55.8 +/- 0.4), MIP (69.9 +/- 17.2-84.8 +/- 27.7 cmH2O), and CAT (22.2 +/- 7.7-19.8 +/- 7.9) following PR. At baseline, SMIP but not MIP was significantly (P< 05) lower than predicted values (41 +/- 11% and 76 +/- 20%) but following PR the difference from predicted was no longer significant. CONCLUSION(S): Only 36% of patients with long-COVID who were referred to and initiated PR successfully completed the program. Following PR, patients demonstrated significant improvements in inspiratory muscle endurance, functional performance, and self-reported QOL, with non-significant improvements in balance and self-reported symptoms, confidence with activity, and depression. CLINICAL RELEVANCE: IMP and FPM are significantly impaired in patients with long-COVID. PR has been shown to significantly improve many respiratory, functional performance, and psychosocial outcome measures and should be considered as part of the plan of care for these patients. Furthermore, methods to improve adherence to PR in patients with long-COVID are needed.

The Cat Is Significantly Correlated to Dlco and 6-Minute Walk Test in Patients with Long-Covid

PURPOSE/HYPOTHESIS: Literature has reported some patients experience long-term impairments in pulmonary function following COVID-19 infection, with the most common abnormality being diffusing capacity for carbon monoxide (DLCO). Research on DLCO's association with other measures has been varied, with some studies demonstrating a significant association with older age, female gender, and disease severity, however these results are not consistent. In pulmonary patients, a DLCO of<40% or a drop in DLCO of >4 units is associated with increased morbidity and mortality, is an independent predictor of decreased exercise capacity, and predicts a more rapid decline in pulmonary function. In COPD patients, every 10% decrease in DLCO was associated with worsening quality of life (QOL), 6MWT, severe exacerbations, symptoms, and COPD assessment test (CAT) scores. CAT scores represent the general health status and include cough, sputum, energy, and ability to perform physical work. Daynes et al found an average of 52% of COVID-19 patients had high CAT scores (>10), which the GOLD guidelines suggest using as a cutoff to indicate symptomatic COPD. They found no significant association between CAT score and hospital length of stay or days on mechanical ventilation, but did find a moderately significant association to anxiety, depression, and self-reported physical activity levels.While a patient's pulmonary function test (PFT) may not be available to a clinician, the CAT is a quick and easy screening tool that can be performed in the clinic. The purpose of this study was to assess possible relationships between PFT measures and outcome assessments that can be performed in the clinic by a physical therapist (PT), which may aid in prognosis. NUMBER OF SUBJECTS: Sixteen subjects (8 male and 8 female with a mean age and BMI of 52 +/- 16 and 32 +/- 5, respectively) diagnosed with long-COVID and referred to pulmonary rehabilitation (PR). MATERIALS AND METHODS: Baseline PFT and CAT scores were obtained during the initial evaluation. Spearman's rho correlation analyses were performed. The 6MWT and DLCO were performed using standardized methods. RESULT(S): The baseline CAT, DLCO, and 6MWT were 22.2 +/- 6.7, 14.1 +/- 7.3 and 292 +/- 144 m, respectively. The CAT was significantly correlated to the DLCO (r-value of -0.63;P = .009) and 6MWT (r-value of -0.52;P = .04). CONCLUSION(S): Self-reported CAT scores were significantly correlated with DLCO and 6MWT in patients with long-COVID. CLINICAL RELEVANCE: DLCO is the most common PFT abnormality observed in patients with long- COVID and can provide useful information to the clinician regarding prognosis and possibly disease severity. However, PTs may not have access to a patient's PFT report. Alternatively, a CAT assessment is free and quick and can be easily performed in the clinic.We found CAT scores were significantly correlated to DLCO and 6MWT, which may allow clinicians to use CAT scores as a surrogate measure to aid in establishing a prognosis and/or understanding of disease severity in patients with long-COVID.

Impact of COVID 19 vaccination or infection on disease activity in radiologically isolated syndrome cohort: the VaxiRIS study

Introduction: Nowadays, mandatory vaccination in patients with multiple sclerosis (MS) is widely recommended. Regarding COVID19, the absence of specific warnings led to the proposal of vaccination in patients with inflammatory diseases of the central nervous system. However global vaccination hesitancy remains and potential effect of COVID19 vaccination on disease activity needs to be assessed. Objective(s): We aimed to evaluate if COVID19 vaccination or infection increased the risk of clinical conversion to multiple sclerosis or evidence of disease activity (EDA) in a cohort of RIS subjects. Method(s): This multicentric observational study is based on the RISC cohort. Data regarding COVID19 infection and vaccination has been collected between January 2020 and December 2021. We compared the occurrence of clinical conversion to MS and EDA in patients according to their vaccination status. The same analysis was conducted by comparing patients according to their history of COVID19 infection. Result(s): 217 subjects with known vaccination status were included (Mean age: 44yrs, F/M sex ratio 2.7). 80% of subjects had a complete vaccination and 20% were incompletely or not vaccinated. Both groups did not differ regarding the main demographical data and known risk factors of conversion to MS. No difference was found concerning clinical conversion to MS in the vaccinated versus unvaccinated group (2.4% versus 2.5%, p = 0.9747). We did not observe any statistical difference regarding the rate of EDA in both groups. 20% of subjects had a history of COVID-19 infection. The rate of clinical conversion to MS in the infected compared to the noninfected group did not show any difference The global conversion rate to MS in the whole RISC cohort in 2021 was 2.64%, which is comparable with the observed rates during the four previous years (5.75%, 2.55%, 4.79%, and 4.85% per year respectively). Conclusion(s): Our study suggests that COVID19 vaccination does not increase the risk of clinical conversion to MS in RIS subjects and supports that immunization can be safely proposed for these patients.

Vaccination rates in Europe are not associated with online media intensity

To map the public information about COVID-19 vaccines and vaccine trials in Europe, we have compiled an inventory of online communication materials from official sources (e.g., governments, public agencies, and NGOs) via directed online research. While information for the general public was abundant across Europe, we found a large variation in number, type and target audiences among countries. Little or no information was found for population groups that are typically underrepresented in vaccine clinical trials. Materials about clinical trials and trial participation were also limited.Interestingly, higher number of media materials was not reflected in higher national vaccination rates.

Financial Uncertainty and Anxiety During the COVID-19 Pandemic The Mediating Role of Future Orientation

Background: The COVID-19 pandemic involved many uncertainties, including financial uncertainty due to the global financial crisis. Previous research indicates that financial uncertainty is negatively related to mental health and wellbeing. Aims: We tested a model suggesting that the negative impact of financial uncertainty is explained by a restriction of individuals' view of their future possibilities. Specifically, this longitudinal study explored the relationship of financial uncertainty and anxiety, considering the mediating role of future orientation. Method: Data were collected with questionnaires administered to Israeli citizens in April, June and August 2020. Data analysis comprised 379 respondents who participated in all three times. Results: Future orientation mediated the relationship of financial uncertainty and anxiety over time. Tests of changes across time show that changes in financial uncertainty were related to changes in anxiety levels over time. Limitations: Our sample was biased toward younger ages and the measurement of future orientation referred to a general view of the future rather than specific areas. Conclusion: The results suggest that the stressor of financial uncertainty is generalized to a negative view of future possibilities, thereby increasing anxiety.

AN INTERPROFESSIONAL STUDENT-FACULTY COLLABORATIVE TELEHEALTH PROGRAM TO ADDRESS POORLY CONTROLLED DIABETES AND SOCIAL DETERMINANTS OF HEALTH EXACERBATED BY THE COVID-19 PANDEMIC

STATEMENT OF PROBLEM/QUESTION: Will a telehealth initiative improve poorly controlled type 2 diabetes mellitus (DM) and unmet social determinants of health (SDOH) needs exacerbated by the COVID-19 pandemic? DESCRIPTION OF PROGRAM/INTERVENTION: Due to COVID-19, many patients with DM faced challenges accessing healthcare, as well as exacerbations of socioeconomic disparities regarding access to food, affordable housing, and safe places to exercise. To address these challenges, we adapted an existing student-faculty collaborative practice at Beth Israel Deaconess Medical Center, Boston, MA, to a telehealth platform to provide targeted DM management, and referrals to dietitians and community resource specialists. MEASURES OF SUCCESS: We assessed clinical outcomes, such as changes in hemoglobin A1c (HbA1c), LDL, and number of medication adjustments. Measured quality indicators included frequency of HbA1c, LDL, and microalbuminuria measurements, as well as prescription of cardiovascular/diabetic medications such as ACE inhibitors, statins, and aspirin within the year prior to enrollment and within 6 months after the final visit. To measure the role and intervenability of SDOH needs, we tracked the results of SDOH screens to identify key needs, as well as the number of dietitian and community resource specialist (CRS) referrals placed. FINDINGS TO DATE: Of 998 patients with non-insulin-dependent type 2 DM, 60 were enrolled in the program, of whom 42% were white and had a median BMI of 32.0 kg/m2 (IQR 28.3-36.1). Patients endorsed high motivation (8/10) and confidence (7/10) in managing their diabetes, but reported inadequate nutrition education (56.7% of cohort), as well as difficulty maintaining a healthy diet (76.7%) and exercising (78.3%). Analysis of baseline data and for those who completed the program thus far (n = 22, >6 months since last clinic visit), showed a significant decrease in mean HbA1c (mean ±SEM) from 8.72±0.15 to 8.09±0.22 (p = 0.03). LDL levels were not significantly different before and after the program, 90.3±5.4 vs 100.9±10.6 (p = 0.42). Lab draw frequency (HbA1c, LDL) and medication prescription (ACE inhibitors, statin, aspirin) and were not significantly different. Of patients who completed the program, 8 (36.4%) had their diabetes medications adjusted. 2 (9.1%) were referred to a CRS, and 2 (9.1%) were referred to a dietitian. KEY LESSONS FOR DISSEMINATION: Our ongoing study showed that the implementation of a telehealth diabetes program with SDOH screening can be an effective way to assist patients with uncontrolled diabetes. We identified significant patient needs for additional support and clinical care. Assessing socioeconomic burdens faced by patients and understanding the impact and key features of such a collaborative telehealth program can pave the way for the implementation of a similar model of care for other chronic conditions.

HIV-1 DIAGNOSES in NORTH CAROLINA, 2018-21: INCIDENT INFECTIONS and DRUG RESISTANCE

Background: Knowing the true incidence of HIV-1 infections (recent infections) among people newly diagnosed is pivotal to monitoring the course of the epidemic. We have developed a Primer ID Next Gen Sequencing (PID-NGS) assay to identify recent infection by measuring within-host viral diversity over multiple regions of the HIV-1 genome. We implemented a state-wide project to identify recent infections and transmitted drug resistance mutations (DRMs) in diagnostic samples in near real time. Methods: Serum samples from individuals with newly HIV-1 diagnoses (diagnostic sample collected within 30 days of diagnosis) were sequenced. PID-NGS libraries were constructed covering the coding regions for protease, a portion of reverse transcriptase, integrase, and the env gene. The use of the PID-NGS strategy allows for significant error correction and also a definition of the sampling depth of the viral population. Recent infection was defined as within 9-month of infection. DRMs were summarized at detection sensitivities of 30%, 10% and 1% based on viral population sampling depth. Results: From Jan 2018 to Jun 2021, we successfully sequenced partial genomes from 743 individuals with new diagnoses. Year 2020 had the lowest number of new diagnoses (Fig 1a, red bar). Overall, 39.2% of samples were inferred to have represented infection within the previous 9 months. Percent of recent infection varied significantly over the years, increasing from 29.6% in late 2018 to 50.9% in early 2020, but decreasing significantly to 32.7% in 2021 (Fig 1a, blue lines). Individuals younger than 30 y/o were more likely to be identified with recent infection (p<0.01). NNRTI DRMs, especially K103N, were the most abundant DRMs. Fig 1b shows the trend of DRMs over the four years. We observed a trend of decrease in the overall NNRTI DRMs and an increase in the NRTI DRMs in the population. Further analysis suggests that the increase in NRTI DRMs were from TAMs and their revertants, while clinically important NRTI DRMs (K65R and M184) were low (<1%). Conclusion: We have demonstrated a state-wide, all-in-one platform to monitor HIV-1 recency and DRMs in new diagnoses. The number of new diagnoses decreased significantly in 2020 in concert with the COVID-19 pandemic which suggests a decrease in overall HIV testing. The decline in the percentage of recent infections in early 2021 signals a return to broader HIV-1 testing and diagnosis. The increase of other NRTI DRMs suggests ongoing evolution at these sites within the viral population.

CASIRIVIMAB and IMDEVIMAB COMBINATION PROVIDES LONG-TERM PROTECTION AGAINST COVID-19

Background:A previous report showed that a single 1200 mg subcutaneous (SC) dose of casirivimab and imdevimab (cas/imd) prevented symptomatic COVID-19 by 81.4% and reduced all SARS-CoV-2 infections (symptomatic and asymptomatic) by 66.4% in household contacts living with recently infected individuals over a 28-day period. While highly effective vaccines now exist for the prevention of COVID-19, a significant unmet need remains in patients who are unable to mount or maintain an adequate immune response to vaccination. Here we present additional results from 7-month follow-up period of the aforementioned study. Methods: In this randomized, double-blind, placebo-controlled Phase III trial, asymptomatic participants exposed to a SARS-CoV-2-infected household member were randomized 1:1 to a single SC dose of placebo or 1200 mg cas/imd (600 mg of each monoclonal antibody). Efficacy analyses include participants who were RT-qPCR negative for SARS-CoV-2 (no current infection) and seronegative for SARS-CoV-2 (no prior infection) at baseline. The trial consisted of a primary efficacy assessment period of 28 days (Month 1) and a 7-month follow-up period (Months 2-8). Results: Results from 842 placebo and 841 cas/imd RT-qPCR negative/seronegative enrolled participants (data through 04Oct2021, prior to emergence of Omicron) are presented. During the entirety of the 8-month study, cas/imd reduced the risk of symptomatic SARS-CoV-2 infections by 81.2% versus placebo (nominal P<0.0001;Table) and all SARS-CoV-2 infections (symptomatic and asymptomatic) by 68.2% versus placebo (nominal P<0.0001;Table). During Months 2-5, the risk of symptomatic and all infections were reduced by 100% and 89.5%, respectively (nominal P<0.0001). During Months 6-8 there was a resumption of symptomatic and all SARS-CoV-2 infections in the cas/imd group (19.9%;nominal P=0.6411 and 30.7%;nominal P=0.3967 risk reduction, respectively). Fewer cas/imd participants had a medically-attended visit versus placebo during the 8-months (1/841 [0.1%] vs 16/842 [1.9%], respectively). No new safety signals were identified for cas/imd during the follow-up period. Conclusion: During the 8-month study period, a 1200 mg SC dose of cas/imd prevented SARS-CoV-2 infections, with maximal protection through Month 5. The prolonged protection supports the use of cas/imd for the long-term prevention of COVID-19 against susceptible variants, offering a pre-exposure prophylaxis strategy for individuals who are unlikely to respond or be protected by vaccination.

Primary Adrenal Insufficiency after COVID-19 Infection

Introduction: The clinical presentation of SARS-CoV-2 ranges greatly from asymptomatic disease to critical illness. The multisystemic effect of COVID-19 is becoming increasingly apparent, but its impact on the endocrine system, in particular, the hypothalamic adrenal axis has yet to be defined. Case Description: A 64-year-old woman with hypothyroidism and type 2 diabetes mellitus presented to the emergency room with a 1-week history of abdominal pain, nausea, and vomiting. The patient experienced an asymptomatic COVID-19 infection 5 months prior and reported an unintentional 30-lb weight loss since. She had been admitted several times at an outside hospital for hyponatremia where she never received exogenous steroids. Physical exam was notable for hypotension, epigastric tenderness, and hyperpigmentation of oral mucosa. Chemistry was significant for hyponatremia 117 mmol/L (135-145). Hyponatremia workup revealed a TSH of 0.33 mcIU/ml (0.35-4.00), free T4 1.4 ng/dl (0.6-1.7), serum osmoles 253 mOsm/kg (279-300), urine osmoles 324 mOsm/kg (300-900) and urine sodium 104 mmol/l consistent with hypotonic hyponatremia. Fluid restriction and salt tablets were initiated. Morning 8 AM cortisol returned low (2.6 μg/dl (ref: >18). A high-dose 250 mcg ACTH stimulation test followed;cortisol levels returned 2.3, 2.9, and 2.6 μg/dl (ref: >18) at baseline, 30, and 60 minutes, respectively. ACTH level was elevated to 1944 pg/ml (7.2-63.3), aldosterone was undetectable < 3.0 ng/dl (upright: 4.0-31.0), anti-21-hydroxylase antibody were positive (ref: neg). CT scan of the abdomen returned unremarkable for any adrenal pathologies. Fluid restriction and salt tablets were discontinued. Hypotension and hyponatremia resolved after initiation of Hydrocortisone IV 25 mg q8h. She was discharged on Hydrocortisone 30 mg daily and Fludrocortisone 0.05 mg daily. Discussion: This patient presented with hyponatremia and biochemical evidence of adrenal insufficiency confirmed by an abnormal stress cortisol response to a high-dose ACTH stimulation test. The markedly elevated ACTH level, inappropriately low aldosterone level, and the presence of anti-21-hydroxylase antibodies support the diagnosis of Addison's disease. Primary adrenal insufficiency (AI) after COVID-19 due to adrenal infarcts and hemorrhage have been documented, but the normal CT suggested that the etiology of AI, in this case, was not due to the aforementioned. This case is the first to suggest the onset of Addison’s disease in the COVID-19 sequelae.

Library Resilience and Leadership in a Global Crisis

Research Libraries, like other organisations during the COVID-19 pandemic, have been facing difficult choices concerning which services to offer, whilst minimising risk to their staff, communities, and users. As the post COVID-19 era beckons, library leaders are urged to adapt flexible strategic plans that apply to every facet of library operation to ensure the organisations remain both safe and resilient in the future. This paper discusses leadership skills and practical techniques that can be applied to help build resilient libraries and deliver positive new change in the post-COVID-19 recovery period. Our findings indicate that leaders need to find ways to realign library ambitions to this uncertain new operating environment. The focus should be directed to digitisation and supporting systems, as well as on sustainability and transformative services. These are a must for the future of libraries. © 2022, Igitur, Utrecht Publishing and Archiving Services. All rights reserved.

Changes in Surgical Pathology Case Volume and Amendment Rates During the COVID-19 Pandemic.

OBJECTIVES: Surgical pathology volume decreased during the peak of the coronavirus disease 2019 (COVID-19) pandemic. We looked at the 4 months with the greatest reduction in surgical pathology volume during the COVID-19 pandemic and compared them with those same months in 2019 to determine changes in specimen volume. We compared the amendment rates during those periods and types of amendments issued (identification [ID], report defect [RD], diagnostic information [DI]). METHODS: All pathology reports between March to June 2019 and March to June 2020 were extracted from the pathology information system. All amendments issued were extracted over the same period and then subclassified by two pathologists. RESULTS: There was a 52.1% reduction in surgical pathology volume between the 4-month periods in 2019 and 2020 (P = .04). The amendment rate was 0.9% in 2019 compared with 1.4% in 2020, representing a 65.5% increase in amendments overall. There was a 53.3% reduction in amendments issued for ID, a 3.8% reduction in RD, and a 23.2% increase in amendments issued for DI. The change in amendments was not statistically significant. CONCLUSIONS: These findings suggest that a reduction in workload would not improve error rates. The circumstances of the pandemic highlight the many factors contributing to error rates in surgical pathology.

An 18-month report on the safety and efficacy of rapid intravenous velaglucerase alfa infusions in naïve patients with Gaucher disease

The introduction of enzyme replacement therapy (ERT) has revolutionized the management of patients with Gaucher disease (GD). To improve the patients' quality of life, we have studied and published the safety and efficacy of a rapid 10-min infusion of high-dose velaglucerase-alfa, instead of one hour as labeled, in 15 previously treated patients. We herein present the 18-month results of the investigator-initiated research in naïve patients with GD (defined by at least one year off ERT or SRT). All patients received bi-weekly infusions of 60 unit/kgBW velaglucerase-alfa;the infusion rate was gradually reduced from 60 to 10 min over six infusions in the hospital setup, followed by home infusions. Each infusion was followed for safety, and efficacy parameters were assessed every 3 months. We enrolled 15 patients (77% males) at a median age (range) of 40 (10–72) years. Thirteen patients were never treated, and two patients were off-ERT for over one year. Ten-minute rapid infusions were well tolerated with no reported related severe or non-severe adverse events (AEs). Two patients reported a non-related SAE and another a non-related AE. Two patients dropped out due to unwillingness to attend follow-up visits during the COVID-19 pandemic. In addition, in 3 patients the infusion rate was increased back to 30 or 60 min due to different causes (2 due to sub-optimal response and one due to AE). All 13 remaining patients reached the 18-month time-point. The platelet counts increased by a median (range) of 75.1% [15.6%–206.9%] and the lyso-GB1 levels decreased by 60.15% [25.7%–85.6%]. Shortening the infusion time has shown to be safe and effective in both previously treated (Zimran et al., AJH2018) and in treatment-naïve patients (this report) and could therefore improve the quality-of-life of patients with GD who have a long-life commitment to this therapy.

Challenges of data collection on mturk: A human-AI joint face-matching task

During the COVID-19 pandemic, many human-subject studies have stopped in-person data collection and shifted to virtual platforms like Amazon Mechanical Turk (MTurk). This shift involves important considerations for study design and data analysis, particularly for studies involving behavioral assessment and performance with technology. We report on lessons learned from a recent study that used MTurk for a face-matching task with an open-source AI. Participants received $5 compensation for completing a 45-minute session that included questionnaires. To help address data validity issues, Qualtrics fraud-detection features (i.e., reCAPTCHA, ID-Fraud), trap-items (e.g., Respond with Often), and a modified-batch-randomization-process were employed. Participants' accumulative accuracy and response rates were also assessed. Out of 272 participants, 121 passed the data inclusion criteria. The questionnaires' reliability was within range (average 0.78) for the healthy dataset. Accumulative accuracy in the face-matching task decreased approximately halfway through the task. Subsequent data inspection revealed that almost half of the participants spent longer than 20 seconds and up to 12 minutes on a random image pair. It is possible that participants were interrupted during the study or they elected to take unscheduled breaks. Environmental factors that were easier to control during in-person laboratory studies now require built-in controls for virtual study environments. We learned that: (1) it is imperative to monitor performance measures over time for each participant;(2) the study duration may need to be kept shorter on virtual platforms compared to in-person studies;(3) an optional, planned break during the task might help prevent other unplanned breaks. © 2021 IISE Annual Conference and Expo 2021. All rights reserved.

A computer aided medical classification system of COVID-19 CT lung scans using convolution neural networks

The CT scan is an important diagnostic procedure for COVID-19. CT images tend to reveal similar features in most COVID-19 cases, including ground-glass opacity in the early stages and pulmonary consolidation in the later stages. The work presented here demonstrates the feasibility of developing a classification system for Covid-19 CT lung scans, which would assist doctors in distinguishing COVID-19 from healthy cases. Three architec-tures, ResN50, Inception-V3, and Xception, were trained, validated, and tested to achieve the highest accuracy. Furthermore, the influence of hyper-parameters on the accuracy of each model was evaluated, searching for minimal loss values. With this system, classification of CT scans can be performed. © 2022 CAD Solutions, LLC.