SeroNet Pooling Project of immunocompromised populations

Introduction: COVID-19 vaccination substantially reduces morbidity and mortality associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe illness. However, despite effective COVID-19 vaccines many questions remain about the efficacy of vaccines and the durability and robustness of immune responses, especially in immunocompromised persons. The NCI-funded Serological Sciences Network (SeroNet) is a coordinated effort including 11 sites to advance research on the immune response to SARS-CoV-2 infection and COVID-19 vaccination among diverse and vulnerable populations. The goals of the Pooling Project are: (1) to conduct real-world data (RWD) analyses using electronic medical records (EMR) data from four health care systems (Kaiser Permanente Northern California, Northwell Health, Veterans Affairs-Case Western, and Cedars-Sinai) to determine vaccine effectiveness in (a) cancer patients;(b) autoimmune diseases and (c) solid organ transplant recipients (SOTR);(2) to conduct meta-analyses of prospective cohort studies from eight SeroNet institutions (Cedars-Sinai, Johns Hopkins, Northwell Health, Emory University, University of Minnesota, Mount Sinai, Yale University) to determine post-vaccine immune responses in (a) lung cancer patients;(b) hematologic cancers/hematopoietic stem cell transplant (HSCT) recipients;(c) SOTR;(d) lupus. Method(s): For our RWD analyses, data is extracted from EMR using standardized algorithms using ICD-10 codes to identify immunocompromised persons (hematologic and solid organ malignancy;SOTR;autoimmune disease, including inflammatory bowel disease, rheumatoid arthritis, and SLE). We use common case definitions to extract data on demographic, laboratory values, clinical co morbidity, COVID-19 vaccination, SARS-CoV-2 infection and severe COVID-19, and diseasespecific variables. In addition, we pool individual-level data from prospective cohorts enrolling patients with cancer and other immunosuppressed conditions from across network. Surveys and biospecimens from serology and immune profiling are collected at pre-specified timepoints across longitudinal cohorts. Result(s): Currently, we have EMR data extracted from 4 health systems including >715,000 cancer patients, >9,500 SOTR and >180,000 with autoimmune conditions. Prospective cohorts across the network have longitudinal data on >450 patients with lung cancer, >1,200 patients with hematologic malignancies, >400 SOTR and >400 patients with lupus. We will report results examining vaccine effectiveness for prevention of SARS-CoV-2 infection, severe COVID-19 and post-acute sequelae of COVID-19 (PAS-C or long COVID) in cancer patients compared to other immunocompromised conditions. Conclusion(s): Our goal is to inform public health guidelines on COVID-19 vaccine and boosters to reduce SARS-CoV-2 infection and severe illness in immunocompromised populations.

Reflecting on Hybrid Events: Learning from a Year of Hybrid Experiences

The COVID-19 pandemic led to a sudden shift to virtual work and events, with the last two years enabling an appropriated and rather simulated togetherness - the hybrid mode. As we return to in-person events, it is important to reflect on not only what we learned about technologies and social justice, but about the types of events we desire, and how to re-design them accordingly. This SIG aims to reflect on hybrid events and their execution: scaling them across sectors, communities, and industries;considering trade-offs when choosing technologies;studying best practices and defining measures of "success"for hybrid events;and finally, identifying and charting the wider social, ethical, and legal implications of hybrid formats. This SIG will consolidate these topics by inviting participants to collaboratively reflect on previous hybrid experiences and what can be learned from them. © 2023 Owner/Author.

ANTIBODIES TO SARS-CoV-2 VARY DUE TO ORDER AND FREQUENCY OF VACCINATION OR INFECTION

Background: Sero-studies of SARS-CoV-2 have used antibody (Ab) responses to spike (S) and nucleocapsid (N) antigens to differentiate mRNA vaccinated (S+/N-) from infected (S+/N+) individuals. We performed testing on wellcharacterized subjects to determine how repeated vaccination or infection, and time from those exposures, influence these Ab levels. Method(s): Samples from individuals with known infection status: prepandemic negative controls n=462;first-time infected n=237 (~45 days post);vaccinated after infection n= 34 (~40 days post-vaccination and ~180 days post-infection);fully vaccinated n=158 (~50 days post);boosted n=31 (~30 days post);breakthrough n=18 (~14 days post-infection);reinfected n=10 (varied). Longitudinal samples (n=51) from subjects with evidence of reinfection (symptoms and/or positive rapid antigen test), were tested to determine the impact of the order of infection and/or vaccination on the magnitude of the anti-S and anti-N IgG Ab detected in the blood. Testing was performed with MesoScale Diagnostics (Gaithersburg, MD) assay. Outcomes are presented in WHO International Binding Antibody Units (BAU/mL). The cutoff for a positive result was 18 BAU for S and 12 BAU for N. Result(s): The median amount of Ab (IQR) in BAU for each group (Figure A) was: pre-pandemic negative controls S 0.53(0.27,1.03), N 0.55(0.18,1.67);first-time infected S 114(51,328), N 70(29,229);vaccinated after infection S 4367(2479,4837), N 15(7,35);fully vaccinated S 998(586,1529), N 0.31(0.16,0.68);boosted S 2988(1768,3522), N 0.59(0.32,1.03);breakthrough S 2429(2032,3413), N 2.5(0.93,8.6);reinfected S 1533(486,4643), N 7.8(2.6,62). For the breakthrough and second infections 17% and 40% were seropositive to N, respectively. Longitudinal analysis (Figure B) of those with multiple infections showed that all those with a positive rapid antigen test for their second infection had an increase in N Ab. Conclusion(s): The prevalence of antibodies to nucleocapsid cannot be used to determine the proportion of individuals infected to SARS-CoV-2 in a vaccinated population. Booster, repeated, and breakthrough infections are associated with IgG Ab levels to S >400 BAU/mL. A majority of breakthrough infections did not elicit an Ab response to N. For those with repeated infection, a minority elicited antibody responses to N. This could be related to misdiagnosis or the burden of infection, as only those who were positive by rapid antigen assay (indicative of a high viral load) had an increase in N Ab.

Remote Work, Work Measurement and the State of Work Research in Human-Centred Computing

Over the past few decades, a small but growing group of people have worked remotely from their homes. With the arrival of the coronavirus pandemic, millions of people found themselves joining this group overnight. In this position paper, we examine the kinds of work that 'went remote' in response to the pandemic, and consider the ways in which this transition was influenced by (and in turn came to influence) contemporary trends in digital workplace measurement and evaluation. We see that employers appeared reluctant to let certain classes of employee work remotely. When the pandemic forced staff home, employers compensated by turning to digital surveillance tools, even though, as we argue, these tools seem unable to overcome the significant conceptual barriers to understanding how people are working. We also observed that, in the United Kingdom context, the pandemic didn't mean remote work for a significant proportion of the population. We assert that, to maximize its impact, 'future of work' research in human-centred computing must be more inclusive and representative of work, rather than focusing on the experiences of knowledge workers and those involved in new forms of work.

Comparative evaluation of Luminex based assays for detection of SARS-CoV-2 antibodies in a transplantation laboratory.

BACKGROUND: Detection of SARS-CoV-2 antibodies is essential in establishing the parameters of an individual's immune response to COVID-19, from both natural infection and vaccination. Despite this, there is currently limited clinical guidance or recommendations for serological methods for their measurement. Here, we evaluate and compare four Luminex-based assays for the multiplex detection of IgG SARS-CoV-2 antibodies. METHODS: The four assays tested were Magnetic Luminex Assay, MULTICOV-AB Assay, Luminex xMAP SARS-CoV-2 Multi-Antigen IgG Assay and LABScreen COVID Plus Assay. Each assay's ability to detect antibodies to SARS-CoV-2 Spike (S), Nucleocapsid (N) and Spike-Receptor Binding Domain (RBD) was evaluated using 50 test samples (25 positive, 25 negative), previously tested by a widely used ELISA technique. RESULTS: The MULTICOV-AB Assay had the highest clinical performance detecting antibodies to S trimer and RBD in 100% (n = 25) of known positive samples. Both the Magnetic Luminex Assay and LABScreen COVID Plus Assay showed significant diagnostic accuracy with sensitivities of 90% and 88% respectively. The Luminex xMAP SARS-CoV-2 Multi-Antigen IgG Assay demonstrated limited detection of antibodies to the S antigen resulting in a sensitivity of 68%. CONCLUSION: Luminex-based assays provide a suitable serological method for multiplex detection of SARS-CoV-2 specific antibodies, with each assay able to detect antibodies to a minimum of 3 different SARS-CoV-2 antigens. Assay comparison identified there is moderate performance variability between manufacturers and further inter-assay variation of antibodies detected to different SARS-CoV-2 antigens.

Factors Influencing Patient Reporting of Adverse Reactions to Covid-19 Vaccines

Introduction: The Covid-19 pandemic and the resultant vaccination programme has seen greatly increased discussion of adverse drug reactions (ADR) and how to report them, and non-healthcare professions have submitted many more ADR reports. Various barriers have been proposed to influence the reporting by patients [1, 2] and patients' motives to report have also been discussed [3]. We investigated differences in COVID-19 vaccine ADR reporting rates within this region to identify factors that may influence the number of reports received from patients. Objective(s): To identify factors which may influence the number of reports received from patients Methods: The West Midands Centre for ADRs receives data from Yellow Card reports that are generated in the Midlands NHS region (population 6.6 million) in the UK. We compared the rates of ADR reporting by patients with COVID-19 vaccination rates and indices of deprivation [4] in the 12 clinical commissioning groups (CCGs)- areas with populations ranging from 0.13 to 1.38 million. We ranked CCGs by number of patient reports to COVID-19 vaccines and compared these with the rankings of the number of vaccines received and each of the domains of deprivation using Spearman's rank correlation. Result(s): In the period 9/12/20 to 31/12/21 there were 30,874 patient reports from the region (83% of all COVID-19 vaccine reports). Reporting rates per CCG ranged from 167 to 307 (mean 240) per 100,000 vaccinations administered, with a mean of 2.00 (range 1.69 to 2.14) vaccines per person-the UK at this stage was part way through the booster campaign with only adults routinely vaccinated. Table 1 shows the correlation between ADR reporting and the listed factors Conclusion(s): ADR reporting rates had, perhaps unsurprisingly, a strong correlation with high vaccination rates. However, higher deprivation, lower education levels, and more unemployment were all negatively correlated with patient ADR reporting to COVID-19 vaccinations, echoing similar findings in professionals ADR reports from deprived areas. [5] The experiences of adverse effects that patients from lower socio-economic groups have are likely to have been less well recorded than those of more wealthy and educated groups. This may have implications for the design and availability of ADR reporting forms and for the assessment of ADRs more generally.

Higher Proinflammatory Cytokines Are Associated with Increased Antibody Titer After a Third Dose of SARS-CoV-2 Vaccine in Solid Organ Transplant Recipients

Purpose: Solid organ transplant recipients (SOTRs) are at increased risk for severe COVID-19 and exhibit lower antibody responses to SARS-CoV-2 vaccines. This study aimed to determine if pre-vaccination cytokine levels are associated with antibody response to SARS-CoV-2 vaccination. Method(s): A cross-sectional study was performed among 58 SOTRs before and after two-dose mRNA vaccine series, 35 additional SOTRs before and after a third vaccine dose, with comparison to 16 healthy controls (HCs). Anti-spike antibody was assessed using the IgG Euroimmun ELISA. Electrochemiluminescence detectionbased multiplexed sandwich immunoassays were used to quantify plasma cytokine and chemokine concentrations (n=20 analytes). Concentrations between SOTRs and HCs, stratified by ultimate antibody response to the vaccine, were compared using Wilcoxon-rank-sum test with false discovery rates (FDR) computed to correct for multiple comparisons. Result(s): In the study population, 100% of HCs, 59% of SOTRs after two doses and 63% of SOTRs after three doses had a detectable antibody response. Multiple baseline cytokines were elevated in SOTRs versus HCs. There was no significant difference in cytokine levels between SOTRs with high vs low-titer antibodies after two doses of vaccine. However, as compared to poor antibody responders, SOTRs who went on to develop a high-titer antibody response to a third dose of vaccine had significantly higher pre-third dose levels of several innate immune cytokines including IL-17, IL-2Ra, IL-6, IP-10, MIP-1alpha, and TNF-alpha (FDR <0.05). Conclusion(s): A specific inflammatory profile or immune state may identify which SOTRs are likely to develop stronger sero-response and possible protection after a third dose of SARS-CoV-2 vaccine.

Pre-Vaccine Antibodies Against Seasonal Betacoronaviruses Are Associated with Decreased Antibody Response to SARS-CoV-2 mRNA Vaccination in Solid Organ Transplant Recipients

Purpose: The impact of antigenic imprinting, when immune memory of one antigen influences the response to subsequent similar antigens, on the antibody response in solid organ transplant recipients (SOTRs) after SARS-CoV-2 vaccination is currently unknown. This study examines the relationship between seasonal coronaviruses (sCoV) and SARS-CoV-2 antibody levels pre- and post-vaccination in SOTRs. Method(s): Plasma from 52 SOTRs pre- and post-SARS-CoV-2 vaccination (2 doses, mRNA) was analyzed using the Meso Scale Diagnostic Coronavirus Panel 3 (an electrochemiluminescence detection-based multiplexed sandwich immunoassay) for IgG antibodies against alpha sCoVs (229E, NL63), beta sCoVs (HKU1, OC43), and SARS-CoV-2 spike proteins. Changes in IgG titers were determined by paired Wilcoxon rank-sum tests. Spearman correlation analysis was used to determine associations between pre-vaccination anti-sCoVs and post-vaccination anti-SARS-CoV-2 IgG. Result(s): Vaccination increased both anti-SARS-CoV-2 (fold change (FC) 1.9, p<0.001) and anti-beta sCoV (HKU1 [FC 0.05, p<0.001], OC43 [FC 0.8, p<0.001]) IgG titers in SOTRs, but did not increase anti-alpha sCoV IgG. Furthermore, prevaccination anti-beta sCoV (HKU1 [rho= -0.3, p=0.03], OC43 [rho= -0.3, p<0.03]) IgG titers were negatively correlated with post-vaccination anti-SARS-CoV-2 IgG. Conclusion(s): These exploratory findings suggest that prior exposure to seasonal betacoronaviruses may lead to antigenic imprinting in SOTRs that negatively impacts the antibody response to vaccination against the novel pandemic betacoronavirus, SARS-CoV-2.

Effect of a Fourth COVID-19 Vaccine Dose on Omicron Variant Neutralization in Solid Organ Transplant Recipients

Purpose: Humoral response to COVID-19 vaccines is attenuated in many solid organ transplant recipients (SOTRs), necessitating additional primary and booster vaccinations. The omicron variant demonstrates substantial immune evasion, and it is not known if boosters increase neutralizing capacity versus omicron among SOTRs. We therefore investigated SOTR antibody response and neutralization versus variants of concern (VOC) including omicron to a 4th vaccine dose (D4). Method(s): Within a national, prospective observational cohort, 25 SOTRs underwent anti-SARS-CoV-2 spike and receptor binding domain (RBD) IgG testing using the Meso Scale Discovery platform before and 2-4 weeks after D4. Surrogate neutralization (%ACE2 inhibition [%ACE2i], range 0-100% with >20% correlating with live virus neutralization), was measured versus full spike proteins of the ancestral ("vaccine") strain and 5 VOCs including delta and omicron. Change in IgG level and %ACE2i were compared using paired Wilcoxon rank-sum testing. Result(s): Demographics are outlined in Table 1, including median (IQR) age 59 (45- 55) years, 64% kidney recipients, and D4 receipt (60% Moderna, 40% Pfizer) median (IQR) 93 days (28-134) post D3. Two participants had SARS-CoV-2 exposure per anti-nucleocapsid testing, including one incident infection. Overall, anti-RBD (92%- >100%) and anti-spike (84%->92%) seropositivity increased after D4, as did median (IQR) anti-spike IgG 42.3 (4.9-134.2)->228.9 (115.4-655.8) WHO binding antibody units (p<0.05). Median (IQR) %ACE2i significantly increased after D4 vs the vaccine strain 5.8% (0-16.8)->20.6% (5.8-45.9) and delta variant 9.1% (4.9-12.8)->17.1% (10.3-31.7) (both p<0.001). In contrast, no SOTR showed neutralization vs omicron before or after D4: median (IQR) %ACE2i 4.1% (0-6.9)->0.5% (0-5.7) (p=0.11). Conclusion(s): Although a 4th vaccine dose increased anti-spike IgG and neutralizing capacity vs some VOC, there was no omicron variant neutralization among SOTRs. SOTRs may remain at high risk for SARS-CoV-2 infection despite boosting, thus additional protective interventions should be urgently explored. (Figure Presented).

B Cells Fit for Germinal Center Activity Predict Response to a Third Dose of SARS-CoV-2 Vaccine in Solid Organ Transplant Recipients

Purpose: While SARS-CoV-2 vaccination has dramatically reduced COVID-19 severity in the general population, fully vaccinated solid organ transplant recipients (SOTRs) demonstrate reduced seroconversion and increased breakthrough infection rates. Furthermore, a third vaccine dose only increases antibody and T cell responses in a proportion of SOTRs. We sought to investigate the underlying mechanisms resulting in varied humoral responses in SOTRs. Method(s): Within a longitudinal prospective cohort of SOTRs, anti-spike IgG, total and spike-specific B cells were evaluated in 44 SOTR participants before and after a third vaccine dose using high dimensional flow cytometry to assess immunologic and metabolic phenotypes. B cell phenotypes were compared to those of 10 healthy controls who received a standard two-dose mRNA series. Result(s): Notably, even in the absence anti-spike antibody after two doses, spikespecific B cells were detectable in most SOTRs (76%). While 15% of participants were seropositive before the third dose, 72% were seropositive afterward. B cells, however, were differentially skewed towards non-class switched B cells in SOTRs as compared to healthy control B cells. Expansion of spike-specific class-switched B cells in SOTRs following a third vaccine dose correlated with increased classswitched (IgG) antibody titers. Antibody response to a third vaccine dose was associated with expanded populations of germinal center-like (CD10+CD27+) B cells, as well as CD11c+ alternative lineage B cells with specific upregulation of CPT1a, the rate limiting enzyme of fatty acid oxidation and a preferred energy source of germinal center B cells. Conclusion(s): This analysis defines a distinct B cell phenotype in SOTRs who respond to a third SARS-CoV-2 vaccine dose, specifically identifying fatty acid oxidation as pathway that could be targeted to improve vaccine response such as through targeted immunosuppressive modulation. (Figure Presented).

HERPES SIMPLEX VIRUS PNEUMONITIS IN A CRITICALLY ILL PATIENT WITH SARS-COV-2

SESSION TITLE: COVID-19 Co-Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Herpes simplex type 1 (HSV-1) related respiratory tract infections have been described in critically ill or immunocompromised patients. We present a case of HSV-1 pneumonia in a mechanically ventilated and immunocompromised patient in the setting of SARS CoV-2 infection. CASE PRESENTATION: A 54-year-old female on Rituximab for Rheumatoid arthritis presented with shortness of breath and cough. She was afebrile, tachypneic and hypoxic. She was discharged 1 week prior after a 3 weeklong treatment for COVID-19 pneumonia. CT Angiogram showed extensive bilateral patchy consolidations with ground-glass infiltrates and subsegmental pulmonary emboli. Patient was initiated on heparin and broad-spectrum IV antibiotics with steroids for presumed ARDS with superimposed bacterial pneumonia. Her respiratory failure worsened requiring invasive mechanical ventilation. Failing oxygenation despite aggressive therapy prompted further workup that showed a normal echo and negative blood cultures. Sputum was negative for Pneumocystis pneumonia and Tuberculosis. Cytology from tracheal aspirate showed bronchial cells with inclusions and multinucleations consistent with HSV-associated cytopathic changes. A positive serum HSV-1 IgG and serum quantitative PCR of HSV-1 DNA solidified the diagnosis. Ganciclovir therapy was initiated to cover for HSV and Cytomegalovirus (CMV), however, a serum CMV PCR was negative. Within a day, her clinical course took a downward spiral. CT chest was repeated which showed worsening airspace disease. Despite ganciclovir therapy, the severity of lung disease led to eventual failure of oxygenation and patient demise. DISCUSSION: Prolonged mechanical ventilation due to ARDS is a risk factor for HSV bronchopneumonia in patients with COVID-19 and has shown an increased mortality 1,2. Diagnosis can be achieved by viral culture or observing cytopathic effects of HSV on cells in tracheobronchial aspirates, bronchoalveolar lavage, or biopsy3. In critically ill patients early treatment has been shown to prolong the ICU time to death and improved oxygenation4. It is important to test for co-infections as about 65% of HSV pneumonia cases are associated with pathogens like CMV and Pneumocystis5. CONCLUSIONS: Worsening respiratory disease in mechanically ventilated COVID-19 patients despite antibiotic therapy for suspected superimposed bacterial infection warrants a workup for secondary viral infections like HSV. Increased mortality is seen if not promptly treated. Reference #1: 1. Meyer A, Buetti N, Houhou-Fidouh N, et al. HSV-1 reactivation is associated with an increased risk of mortality and pneumonia in critically ill COVID-19 patients. Critical Care. 2021/12/06 2021;25(1):417. doi:10.1186/s13054-021-03843-8 Reference #2: Le Balc'h P, Pinceaux K, Pronier C, Seguin P, Tadié J-M, Reizine F. Herpes simplex virus and cytomegalovirus reactivations among severe COVID-19 patients. Critical Care. 2020/08/28 2020;24(1):530. doi:10.1186/s13054-020-03252-3 Reference #3: Shah JN, Chemaly RF. Herpes Simplex Virus Pneumonia in Patients with Hematologic Malignancies. Pulmonary Involvement in Patients with Hematological Malignancies. 2010:301-311. doi:10.1007/978-3-642-15742-4_24 DISCLOSURES: No relevant relationships by Andrew Cox No relevant relationships by Syeda Hassan No relevant relationships by Maria Khan No relevant relationships by Malik Muhammad Uzair Khan No relevant relationships by Rameesha Mehreen No relevant relationships by Rahat Ahmed Memon No relevant relationships by Ifrah Naeem No relevant relationships by Laura Walters

Factors Influencing Patient Reporting of Adverse Reactions to Covid-19 Vaccines: An International Journal of Medical Toxicology and Drug Experience

Introduction: The Covid-19 pandemic and the resultant vaccination programme has seen greatly increased discussion of adverse drug reactions (ADR) and how to report them, and non-healthcare professions have submitted many more ADR reports. Various barriers have been proposed to influence the reporting by patients [1, 2] and patients motives to report have also been discussed [3]. We investigated differences in COVID-19 vaccine ADR reporting rates within this region to identify factors that may influence the number of reports received from patients. Objective: To identify factors which may influence the number of reports received from patients Methods: The West Midands Centre for ADRs receives data from Yellow Card reports that are generated in the Midlands NHS region (population 6.6 million) in the UK. We compared the rates of ADR reporting by patients with COVID-19 vaccination rates and indices of deprivation [4] in the 12 clinical commissioning groups (CCGs)- areas with populations ranging from 0.13 to 1.38 million. We ranked CCGs by number of patient reports to COVID-19 vaccines and Conclusion: ADR reporting rates had, perhaps unsurprisingly, a strong correlation with high vaccination rates. However, higher deprivation, lower education levels, and more unemployment were all negatively correlated with patient ADR reporting to COVID-19 vaccinations, echoing similar findings in professionals ADR reports from deprived areas. [5] The experiences of adverse effects that patients from lower socio-economic groups have are likely to have been less well recorded than those of more wealthy and educated groups. This may have implications for the design and availability of ADR reporting forms and for the assessment of ADRs more generally.

Enteral feed delivery in patients with COVID-19 admitted to a Nightingale intensive care unit (ICU)

Introduction: Optimal calorie delivery is around 80% of predicted energy requirements.1 Underfeeding critical care patients may cause harm in some long stay patients.2 ESPEN guidelines state if oral intake is not possible, enteral nutrition should commence within 48 hours. Calorie delivery can be increased to 80-100% after day three of admission to ICU.3 The Nightingale ICU was situated on an acute ward which was modified to function as an ICU. This was to facilitate increased admissions of COVID-19. The Nightingale dietetic team were redeployed from acute and community settings in from within the trust, with various levels of ICU experience. The team provided seven day dietetic cover based on a rota, including bank holidays. Objectives: The aim of this audit was to evaluate enteral feed delivery and the number of days taken to reach target rate of feed compared to the regimen set by the dietitian, in patients with COVID-19 admitted to Nightingale ICU. Methods: At each review, dietitians calculated enteral feed delivery over the preceding 24 hours as a percentage of the target regimen, from the input recorded on the fluid balance chart. The number of days to reach enteral feed delivery targets were calculated relative to dietetic plans. All patients who required enteral nutrition from 15/10/ 2020 until 11/03/2021 were eligible for inclusion. Days where enteral feed was not required, target rate of enteral feed was not yet due to be achieved, parenteral nutrition was required, or following ICU discharge and end of life care were excluded. Days where enteral nutrition delivery information was unavailable were also excluded from the analysis. No imputation was used to estimate missing data. Results: The data consisted of a total of 116 patients. Following exclusions, the total number of patients included in the analysis was 107. Mean age was 63.6 ± 9.4 years.Mean body mass index (BMI) was 32.7 ± 7.4kg/m2. Number of enteral feed days per patient was 11. Patients with COVID-19 admitted to Nightingale ICU received a median of 84% of their enteral feeding regimen. The feeding regimen set by the dietitian aimed to achieve target rate of feed by 3.1 days. The data analysis showed the mean number of days until the target was achieved was 3.5 days. Conclusion: Results are based on a homogenous COVID-19 ICU cohort. Dietetic staffing levels were increased, and seven-day working was provided in response to the COVID-19 pandemic compared to a standard ICU. Quantifying common reasons for feed interruptions could be explored further. Despite suboptimal COVID-19 Nightingale ICU conditions, enteral feed delivery and time taken to reach target rate of feed was in keeping with ESPEN guidelines.

The end of the active work break? Remote work, sedentariness and the role of technology in creating active break-taking norms

Excessive sedentariness can impair workers' health and productivity. The move to working from home as a result of the Covid-19 pandemic eliminated many workday opportunities for physical activity. This, coupled with a blurring of boundaries between work and non-work periods, put many at risk of overwork and musculoskeletal issues. We examined how the sudden transition to working from home influenced people's ability to take physically active work breaks. We found that the absence of social norms associated with the presence of colleagues in the work environment left workers uncertain about whether and when it is appropriate to take breaks. The pressure to demonstrate productivity while working asynchronously led to increased sedentariness and decreased break-taking. We propose that online tools that promote flexible social norms around break-taking could empower remote workers to incorporate regular physical activity into their days, without compromising the beneficial aspects of asynchronous working. © 2022 ACM.

Virtual staff teas: Connecting and growing

With the quick shift to remote work in spring 2020 due to COVID-19, we experienced a lot of change in a short period of time that disrupted many aspects of our lives, including our working way of life. To adapt to the unexpected shift, we quickly repositioned our service models at the University of Northern Iowa Rod Library to 100% online or asynchronous. We found creative ways to increase access to our physical collections while upping the marketing of our online resources. We put our patrons’ needs before our own. © 2019 Association of College and Research Libraries, a division of the American Library Association.

Aligned but not integrated: UK academic library support to mental health and well-being during COVID-19

Purpose: To discover how UK academic libraries sought to support student mental health and well-being during the COVID-19 pandemic. Design/methodology/approach: The data was from a 24-question survey of UK universities distributed in May 2021 which received 56 responses from 47 different Higher Education Institution libraries. Descriptive statistics are combined with thematic analysis of open text comments. Findings: Libraries were undertaking a wide range of activities, targeted chiefly at students and broadcast via Twitter, other social media and library web sites. The problem being addressed was the stresses of studying in the context of the pivot online and isolation caused by social distancing. Digital well-being seemed also to be an increased concern. COVID-19 had proved the value of digital support but created a number of challenges such as loss of physical space, communication barriers and lack of extra resource. The role had a somewhat informal place in the organisation. Overall library activities were aligned but not strongly integrated into institutional efforts. Research limitations/implications: This was a study in one specific national context with a relatively limited number of total responses. There could be a non-response bias where respondents were doing more than was typical in the sector. Originality/value: The paper is one of the first papers to gather sector wide data and move beyond case studies of what individual libraries due to support to mental health and well-being. It also offers a case study of the impacts of COVID-19 on management pointing to its catalysing the digital shift, creating constraints on resources and communication and prompting the emergence of staff well-being as a consideration in management decision making. © 2021, Emerald Publishing Limited.

Disengaged From Planning During the Lockdown? An Interview Study in an Academic Setting

This article reports the results of a repeated interview study with 15 knowledge workers in academia during the first COVID-19 lockdown (April–July 2020). The focus of these interviews was to understand how people adjusted to working from home and the impact this had on their planning routines, strategies, and use of tools. Common themes reveal that work was chaotic, participants lost focus, and felt overworked and tired. Many disengaged from their planning routines and were reluctant to plan work in detail. However, those who reflected on how efficiently they were spending their time, found two planning strategies—breaking down tasks and manual time tracking—effective at improving accuracy of plans and productivity. Participants did not start using any new planning tools instead they adapted their existing ones. Design implications for planning tools in the context of the future of work and prevention of planning disengagement are discussed. IEEE