Pan-Respiratory Disease Surveillance in Southeast Asia: Past, Present and Future

The Global Influenza Surveillance and Response System (GISRS) was established by WHO in 1952 to conduct surveillance for influenza to inform strain selection for seasonal vaccines and to monitor for influenza pandemics. In 2016 WHO initiated a pilot project to add RSV to influenza surveillance platforms;this was disrupted by the SARS CoV-2 pandemic, and SARS CoV-2 was the first pathogen to be incorporated into influenza sentinel surveillance on a wide scale. This resulted in a "GISRS-plus" surveillance network for influenza and SARS CoV-2 that is now being standardized by WHO. In the wake of the SARS CoV-2 pandemic, there is global interest and funding to support pan-respiratory disease surveillance, which could result in expanding influenza/SARS CoV-2 surveillance platforms to include other pathogens and enhancing event- and indicator-based surveillance. Challenges with expanding sentinel surveillance include overburdening sentinel surveillance systems, reduced number of samples collected and loss of data quality for influenza and SARS CoV-2;thus, other types of surveillance for respiratory diseases might also be considered. This talk describes CDC-supported influenza surveillance platforms in Southeast Asia and recent successes and challenges in adding SARS CoV-2 to this surveillance. It discusses potential risks and benefits to GISRS-plus surveillance created by including other pathogens. Finally, it discusses decision-making steps on which methods to use for collecting data on respiratory viruses.Copyright © 2023

Impact of Covid-19 and Host Factors on the Humoral Immune Repertoire in Treated Hiv

Background: People with HIV (PWH) on antiretroviral therapy (ART) appear to be at higher risk for worse COVID-19 outcomes, but the underlying mechanisms-including effects of COVID-19 and host factors on the broader humoral immune repertoire-are poorly understood. Method(s): REPRIEVE enrolled a global cohort of ART-treated PWH ages 40-75. COVID+ was defined by positive receptor binding domain IgG or IgA from annual visits 5/2020-2/2021. Antibody isotype, subclass, and Fc receptor Luminex arrays to SARS-CoV-2, CMV, EBV, HSV, HIV, influenza, pneumococcus, and RSV were assessed. Report of COVID diagnosis (collected every 4 months) was defined as mild, moderate, or severe (asymptomatic if no clinical diagnosis but IgG/ IgA+). FDR-corrected regression was used to assess effects of 1) COVID+ on non- SARS-CoV-2 repertoire in full cohort and 2) host factors on non-SARS-CoV-2 and SARS-CoV-2 repertoire in COVID- and COVID+ cohorts, respectively, adjusted for age, sex, region, nadir CD4, and HIV VL at entry. Result(s): Of 2,464 unvaccinated participants, 283 (11%) were COVID+;260 (92%) were asymptomatic. Median age was 53, 35% were women, 50% had nadir CD4 < 200, median current CD4 was 649, and 97% had HIV VL < 400. In the full cohort, COVID+ was associated with higher CMV PP65 IgG3 and FcgammaRIIA (P< 0.05);COVID severity was not associated with the non-SARS-CoV-2 repertoire. Among COVID-, older age, female sex, and lower nadir CD4 were associated with higher EBV and CMV responses;IgG1 levels were higher in women for all non-SARS-CoV-2 antigens assessed (P< 0.05). Among COVID+, higher BMI was associated with amplified SARS-CoV-2 IgG, IgA, IgM, and FcgammaRIIA responses (P< 0.05). Lower nadir CD4 was associated with a SARSCoV- 2 repertoire shift toward IgM and FcgammaRIIB (P< 0.05). Age and sex were not associated with SARS-CoV-2-related repertoire changes in COVID+. Conclusion(s): Our analysis presents a comprehensive view of host factors associated with the humoral immune repertoire among a global cohort of ART-treated PWH. COVID's association with higher CMV responses may suggest increased susceptibility to or a consequence of persistent inflammation after infection. The striking amplification of SARS-CoV-2 responses with higher BMI suggests an excessive inflammatory response. Lower nadir CD4 was related to uncontrolled extra-follicular and inhibitory SARS-CoV-2 responses, which are unlikely to be protective. These findings may suggest mechanisms underlying factors associated with worse COVID-19 outcomes among PWH. (Figure Presented).

Determining the feasibility and acceptability of delivering HEADS: UP, a psychoeducational intervention for self-management of depression and anxiety symptoms post-stroke, face-to-face and online

Introduction: Depression and anxiety are prevalent after stroke, persist long-term, and are associated with poor outcomes, including lack of engagement with rehabilitation. Long-term psychological support is a recognised unmet need and a research priority. In previous work with people affected by stroke we co-developed a stroke-specific psychoeducational self-management intervention HEADS: UP, an adaptation of a Mindfulness Based Stress Reduction course. The work reported here aimed to test feasibility and acceptability of HEADS: UP (NCT03956693). Method(s): We recruited stroke survivors (SS) >=3 months post-stroke, with symptoms of mood disorder (Hospital Anxiety and Depression Scale >=8), to participate in one of two non-randomised feasibility studies. Participants could 'enrol' a family member/'other', if desired. Study 1 tested face-to-face delivery of HEADS: UP;data informed optimisation and adaptation of research processes and the intervention. In response to COVID 19, Study 2 tested HEADS: UP Online. Quantitative data (demographics;mood and quality of life outcomes measures (OMs)) and qualitative data were collected pre-/post-intervention. Both studies received ethical approval. Result(s): STUDY 1: SS n=13;aged 63.3 (mean). Feasibility: Completion of paper-based OMs post-intervention n=6 (46.2%);intervention attendance 6.2/9 (median). Acceptability: I find myself . . . on the bus doing [mindfulness]! I realise I am actually doing it! STUDY 2: SS n=9;aged 54.2 (mean). Feasibility: Completion of online OMs: n=9 (100%) post-intervention;intervention attendance: 8.6/9 sessions. Acceptability: I was apprehensive . . . I wasn't sure you could do mindfulness over Zoom . . . but it has worked really, really well Conclusion(s): Stroke survivors found a stroke-specific psychoeducational self-management intervention, HEADS: UP, feasible and acceptable.

Enhancing accessibility for participants in HEADS: UP Online RCT research: the essential role of a Patient and Public Involvement and Engagement group

Introduction: HEADS: UP is a psychoeducational self-management intervention to help stroke survivors cope with symptoms of anxiety and depression. During COVID 19 the HEADS: UP (Helping Ease Anxiety and Depression after Stroke) pilot randomised controlled trial (protocol: NCT04985838) was adapted at short notice for online delivery. The Project Advisory Group (PAG) or Patient and Public Involvement and Engagement group comprising 5 stroke survivors, a family member, and 2 stroke health professionals provided first-hand experience and advice to help develop resources required to enable stroke survivors negotiate the technology and 'get online'. Method(s): The PAG met 4-6 weekly online with HEADS: UP researchers;interim contact was by phone and email. They tested, advised, and offered personal reflections on/experiences of i) research processes e.g. online screening/recruitment, data collection and ii) intervention delivery e.g. suitability of Zoom for weekly HEADS: UP sessions, and accessibility of an online community platform, Padlet. Result(s): The PAG helped improve accessibility of pre-existing HEADS: UP research and intervention materials e.g. study Welcome Packs. Their 'hands-on' experiential approach also informed development of novel resources e.g. How to use Padlet. PAG members reported benefiting from their reciprocal relationship with researchers: "Everything changed after COVID . . . working online with HEADS: UP made me feel . . . important!" Their input enabled participants to successfully navigate online screening/ recruitment, complete research questionnaires online, and take part in the online course (if randomised to the intervention). Conclusion(s): The PAG's first-hand experience and advice enhanced HEADS: UP online research processes and intervention delivery for stroke survivor participants.

Using social media to recruit stroke survivors to the HEADS: UP Online randomised control trial, a stroke-specific psychological self-management intervention: reflections and lessons learned

Introduction: Social media has emerged as a useful and potentially costeffective recruitment route for clinical trials particularly during the COVID-19 pandemic. This paper presents recruitment results and lessons learned from using social media for recruitment to the HEADS: UP Helping Ease Anxiety and Depression after Stroke Online randomised control trial. Method(s): We recruited UK-based community-dwelling stroke survivors with self-reported anxiety and depression. Our recruitment strategy included community networks and social media platforms. Result(s): Recruitment over 22 weeks resulted in 120 leads (5.5/week), with social media, primarily Facebook and Twitter, contributing 38 leads (31.7%;1.7/week). We enrolled 64 participants (female n=36 (56.3%), mean age 56.3 yrs, SD=11.2 ), with 28 (43.8%;female n=15 (53.6%), mean age 53.0 yrs, SD=11.3) recruited through social media. Facebook generated 21 (75%) of 28 social media participants, with Twitter contributing 8 (28.6%), including one participant from both Facebook and Twitter (3.6%). Facebook allowed for recruitment from stroke community groups and contact with key group members who posted regularly on our behalf, aiding credibility. Twitter provided the opportunity to recruit without gatekeepers, but required considerable researcher time and effort spent networking (i.e. Following, Liking, requesting Retweets) and developing new content to post, which stretched our limited resources. Conclusion(s): Social media was an effective, integral strategy for recruitment. However, substantial resources were required to develop content and manage our online presence. Future research could benefit from costing researcher time into funding applications and investing time in identifying and making contacts within population-specific pages or groups.

Comparison of Four Flipped Classroom Implementations in a Civil Engineering Curriculum during the COVID-19 Pandemic

Due to the public health policies put into place by institutions in response to the international COVID-19 pandemic, many engineering educators were required to implement alternative pedagogies into their courses. The flipped classroom was viewed by many educators as a method to continue to teach within the constraints created by the pandemic. At its most fundamental form, a flipped class moves activities, which commonly take place in-person, outside of the classroom by providing students with alternative educational resources. Students are expected to engage in these activities prior to attending class which allows students to use the valuable in-person class periods to complete example problems and study advanced topics in a collaborative and creative learning environment. In the 2021 academic year, the Department of Civil and Mechanical Engineering at the U.S. Military Academy implemented the flipped classroom into four undergraduate civil engineering courses: Mechanics of Materials, Hydrology and Hydraulic Design, Soil Mechanics and Foundation Engineering, and Design of Reinforced Concrete Structures. The objective of this study is to evaluate the approach taken by each individual course to implement the flipped classroom pedagogy. The design of the four courses varied based on the execution of asynchronous content out-of-class, schedule for in-person learning, and delivery of graded assessments. The impact of each flipped course design was determined by comparing the results to historical student performance, the time spent by the students on out-of-class activities, and anecdotical feedback from both the instructors and students. The results of the study confirmed a more deliberate design approach is required than simply rearranging the order of learning activities to effectively execute a flipped course. © American Society for Engineering Education, 2022.

ASSESSING THE BENEFIT, ACCEPTABILITY AND FEASIBILITY OF A STROKE-SPECIFIC PSYCHOLOGICAL SELF-MANAGEMENT INTERVENTION, HEADS:UP

Introduction: Mood disorder is a significant problem following stroke, affecting survivors (approximately 33%) up to 5 years post-stroke. Mindfulness Based Stress Reduction (MBSR) group-based courses are effective in helping people self-manage symptoms of anxiety and depression. In earlier co-creation work we developed HEADS: UP (Helping Ease Anxiety and Depression after Stroke), a 9-week stroke-specific MBSR course designed to mitigate effects of stroke which make mastery of MBSR skills challenging. Methods: In two non-randomised mixed-methods feasibility studies we further adapted HEADS: UP: face-to-face (study 1);online, in response to COVID-19 restrictions (study 2). We used community networks and social media to recruit stroke survivors (SS) with self-reported anxiety and depression. Quantitative and qualitative data were collected pre-/ post-intervention. Both studies received ethical approval. Results: We enrolled 21 community-dwelling participants. Study 1: 13 SS (female n=4, 30.8%;mean age 63.3 years). Study 2: 9 SS (female n=5, 55.6%;mean age 54.2 years). Qualitative data informed changes to research processes and HEADS: UP course materials. Participants found the course accessible and beneficial, “It's helped dramatically;I can't explain how much.” Conclusions: Stroke survivors found a stroke-specific psychological self-management intervention, HEADS: UP (face-to-face, online) acceptable, feasible and beneficial. (Table Presented).

HASHTAG RESEARCH: UTILISING SOCIAL MEDIA FOR RECRUITMENT OF STROKE SURVIVORS TO THE HEADS: UP ONLINE RANDOMISED CONTROLLED TRIAL, A STROKE-SPECIFIC PSYCHOLOGICAL SELFMANAGEMENT INTERVENTION

Background: Social media can be a useful tool in clinical trial recruitment strategy and could become increasingly important as established recruitment methods may be impaired by the COVID-19 pandemic, i.e. flyers, posters. The HEADS: UP randomized control trial utilised multiple social media platforms to access and recruit stroke survivors alongside additional, non-social media routes in response to COVID-19 pandemic restrictions. Aim: To assess the effectiveness of recruitment to the HEADS: UP clinical trial through social media. Methods: We recruited community-dwelling stroke survivors (SS) with self-reported anxiety and depression using community networks and social media. Social media recruitment allowed for direct communication with potential participants through the development of Twitter (@ HeadsUpStroke), YouTube and Reddit accounts. Facebook posts were shared on the researchers' personal accounts and UK-based stroke organization Facebook pages and groups. Results: Recruitment lasted 16 weeks and resulted in 120 leads (7.5/ week). Where recruitment source was known, social media contributed 36 leads (2.3/week). We enrolled 64 participants (female n=36, mean age 56.3 years) of which 28 were recruited through social media (43.8%;female n=15;mean age 53.0 years). Facebook was the most effective route (n=21, 75%). The least effective route was Reddit. One lead contacted the primary investigator using LinkedIn, a platform we had not included in our strategy. Costs totaled £50 (£1.79/enrolled social media participant). Conclusions: The use of social media for recruitment of stroke survivors to a psychological self-management intervention trial was both effective and low-cost, significantly contributing to overall recruitment and supplementing established research methods.