Male nurses' mental health and provision of emotional support during COVID-19: a thematic analysis

Background: COVID-19 has created mental health challenges for nurses. However, it is unknown if there is a gendered influence on nurses' experiences during the pandemic. Aim: The aim of this study was to explore the experiences of male nurses during COVID-19, including their mental health and experiences of providing emotional support. Methods: We conducted semi-structured interviews using Zoom with nine male nurses and analysed the interviews using thematic analysis. Findings: Male nurses experienced negative mental health outcomes from the pandemic, but participants attributed these outcomes to the context. Male nurses provided emotional support for patients, students, families and other staff and did not describe emotional support as a difficult part of their work. Participants identified their role as a ‘breadwinner' of being part of their concern during COVID-19. Participants used a variety of approaches to manage the stressors from the pandemic and cautioned against alcohol as a coping strategy. Discussion and Conclusions: Participants provided emotional support routinely as part of their work and went to great lengths to do so. This finding differs from most published literature that suggests male nurses struggle with emotional and interpersonal aspects of nursing. Male nurses require emotional support and employers can note that need for support may present differently by gender. © The Author(s) 2023.

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.

What Quality Control Mechanisms do We Need for High-Quality Crowd Work?

Crowd sourcing and human computation has slowly become a mainstay for many application areas that seek to leverage the crowd in the development of high quality datasets, annotations, and problem solving beyond the reach of current AI solutions. One of the major challenges to the domain is ensuring high-quality and diligent work. In response, the literature has seen a large number of quality control mechanisms each voicing (sometimes domain-specific) benefits and advantages when deployed in largescale human computation projects. This creates a complex design space for practitioners: it is not always clear which mechanism(s) to use for maximal quality control. In this article, we argue that this decision is perhaps overinflated and that provided there is "some kind" of quality control that this obviously known to crowd workers this is sufficient for "high-quality" solutions. To evidence this, and provide a basis for discussion, we undertake two experiments where we explore the relationship between task design, task complexity, quality control and solution quality. We do this with tasks from natural language processing, and image recognition of varying complexity. We illustrate that minimal quality control is enough to repel constantly underperforming contributors and that this is constant across tasks of varying complexity and formats. Our key takeaway: quality control is necessary, but seemingly not how it is implemented.

THE ASSOCIATION BETWEEN SLEEP HEALTH AND WORK- AND HEALTH-RELATED QUALITY OF LIFE IN DESK WORKERS AND DIFFERENCES IN ASSOCIATIONS PRE- AND POST-COVID-19 EMERGENCE

Introduction: COVID-19 resulted in many office workers switching to remote work. Emerging studies report working from home has negatively affected sleep health (SH) and psychological well-being. Our aim was to evaluate the relationship between SH and healthand work-related quality of life and explore whether these associations differed pre- and post-COVID-19 emergence. Methods: Baseline data from 125 adults enrolled pre- (n=59) and post-COVID-19 emergence (n=66) in a clinical trial with desk jobs were included in this analysis (86.4% White;49.6% female;43.9±10.7 y). Health-related quality of life (HRQoL) was assessed using the SF-36 questionnaire, which addresses eight health concepts (physical, social, and role functioning;mental health;health perceptions;energy or fatigue;pain;general health) and yields 2 summary scales (mental component summary, physical component summary). Workplace productivity and worker health was measured using the Health and Work Questionnaire (HWQ). Six SH dimensions were assessed using questionnaires (satisfaction, alertness) and 7 nights of actigraphy (regularity, timing, efficiency, duration). Each dimension was categorized as good or poor;a composite score was created based on the sum of good SH dimensions. Multiple linear regression models were adjusted for gender and age and stratified by enrollment pre- or post-COVID-19 emergence. Data are presented as standardized coefficients (β) and p-values (p). Results: Compared to participants enrolled prior to COVID-19, those enrolled post-COVID-19 had worse SF-36 emotional, social, and general health and greater HWQ-assessed impatience (all p<0.05);however, SH did not differ between those enrolled pre- and post-COVID. Prior to COVID-19, greater SH was associated with higher SF-36 physical component scores (β=.389, p=.003);however, no association was observed post-COVID (β=.137, p=.271). In contrast, no association was observed pre-COVID between SH and SF-36 mental component scores (β=.181, p=.160), but greater SH was associated with greater mental component scores post- COVID (β =.308, p=.004). Furthermore, better SH was associated with lower stress post-COVID (β =-.423, p<.001). Conclusion: SH was associated with HRQoL and workplace and worker health, though these associations sometimes differed between pre- and post-COVID emergence. Research should explore whether promoting SH in employees impacts their personal and workplace-related quality of life.

A Career in Biocatalysis: Kurt Faber

Kurt Faber, a synthetic organic chemist by training, strongly influenced the field of biocatalysis throughout the course of his four-decade career (from the late 1980s to the early 2020s). The evolution of his career has gone hand in hand with the development of biocatalysis into a mature and versatile discipline originally deep-rooted in organic chemistry that quickly integrated techniques from molecular biology. His work has provided numerous grounds for recognizing natural catalysts as essential tools in organic synthesis, complementing the more chemical approaches. An important aspect of Kurt Faber's career encompasses teaching, mentoring, and encouraging the development of younger scientists worldwide. His book, Biotransformations in Organic Chemistry, now in its seventh edition, has become a recognized tool for training generations of chemists and biotechnologists and remains a reference worldwide. At Biotrans 2021, the 15th International Symposium on Biocatalysis and Biotransformations (originally scheduled to be held in Graz, Austria, and eventually held online due to the COVID-19 pandemic), Kurt Faber received the Biotrans senior award in recognition of his innovative contributions to the field. In this Account, we would like to acknowledge his contributions to the field of biocatalysis, highlighting both the growing importance of this discipline in many (industrial) sectors and the profound changes that have occurred in recent decades, while reflecting on some of Kurt Faber's most important discoveries and his legacy to this field. © 2022 The Authors. Published by American Chemical Society.

COVID-19 Case and Contact Investigation in an Office Workspace

This investigation report describes a case of COVID-19 in a combined military and civilian office workspace and the contact investigation and mitigation efforts that followed. This office space included an embedded public health officer who was able to conduct the contact investigation and advise on the outbreak response. Over a 3-day period, the index case unintentionally exposed 150 coworkers to SARS-CoV-2 through participation in carpools, conferences, and small meetings. Of these exposures 37 were considered medium risk at the time and 113 were considered low risk. A total of 5 contacts reported COVID-like-symptoms at the time of the investigation and another 5 developed symptoms during the14-day quarantine period and all were directed to self-isolate. None of the contacts required hospitalization and all the symptomatic contacts tested negative for SARS-CoV-2. With the advice and aid of the embedded public health officer, the office authorized telework, conducted thorough cleaning of spaces, distributed informative messaging, conducted virtual question-and-answer forums, and evaluated outbreak policies. This report demonstrates that the close integration of public health and office management can lead to rapid identification of those at risk of infection and implementation of mitigation and control efforts to stop the spread of disease.

Real-world tocilizumab use in pediatric inpatients

INTRODUCTION: Tocilizumab (TCZ) is a recombinant monoclonal anti-interleukin-6 receptor antibody approved for use in children with juvenile idiopathic arthritis (JIA) and cytokine release syndrome (CRS) secondary to chimeric antigen receptor T-cell (CART) therapy. It is increasingly used off-label for other pediatric indications, though limited data exist describing safety and outcomes in these populations. This study describes TCZ use in JIA/CRS and other indications. Safety when administered during active infection and overall clinical outcomes were explored. METHODS: We performed a retrospective study of inpatients in a large children's hospital who received IV TCZ from 1/2016-5/2021 for any indication. Data included demographics, indication, dose amount, number of doses, safety events on days 0-7 after TCZ, use of extracorporeal support (ES), presence of concurrent infection, and survival to discharge. Exploratory analyses assessed characteristics associated with mortality. RESULTS: Data from 103 TCZ courses (n=87 pts) were analyzed. Median age was 14 yrs, and 66% had a primary oncologic diagnosis or had received myelosuppressive treatment (ONC/M). Indications for TCZ included CRS (56%), autoimmune disease (27%), GVHD (5%), and COVID-19 (4%). Median TCZ dose was 8 mg/kg. 18% of courses were administered during active infection, and ES was used in 15% of courses. New onset of ALT and AST >3x upper limit of normal occurred in 25% and 33% of courses, respectively. In patients without an ONC/M diagnosis (n=21), 10% of courses resulted in new onset neutropenia and 3% thrombocytopenia. Overall survival to discharge was 83%. Covariates associated with mortality by univariable analysis included an ONC/M diagnosis (OR 5.1 [95% CI 1.2-21], receipt of TCZ in an ICU (7 [1.8-41]), receipt of TCZ during active infection (3.8 [1-14), and use of ES (19 [4.6-91]). Only ES remained significant in multivariable analysis (OR 13 [3.1- 57]). CONCLUSIONS: TCZ is used for a range of pediatric inpatient indications, most commonly CRS. Risk factors for mortality are confounded by severity of illness, though administration during active infection was not independently associated with increased mortality. Prospective studies are needed to better understand the safety and efficacy of the off-label use of TCZ in children with inflammation.

Group-based multi-trajectory analysis of c-reactive protein and ferritin levels in pediatric sepsis

INTRODUCTION: Interest in using bedside C-reactive protein and ferritin levels to identify patients with hyperinflammatory sepsis who might benefit from anti-inflammatory therapies piqued with the COVID-19 pandemic experience. These widely available low-cost biomarkers might be similarly useful for assessing inflammatory profiles of all critically ill children with sepsis and septic shock and eventually guiding the use of precision anti-inflammatory therapies. We hypothesized groupbased trajectories of CRP and ferritin among critically ill children with sepsis would be associated with mortality and distinct inflammatory cytokine profiles. METHODS: Children with sepsis and organ failure from 9 pediatric intensive care units were enrolled in a prospective, observational cohort. Plasma CRP (mg/dL), ferritin (ng/mL), and 29 cytokine levels were measured at two samplings during sepsis (median Day 2 and Day 5). Group-based multi-trajectory models (GBMTM) identified groups of children with distinct patterns of CRP and ferritin. RESULTS: Two hundred and fifty-five children had at least 2 CRP and ferritin measurements. Five distinct clinical multitrajectory groups were identified with significantly different median maximum organ failures (MOF) and mortality. Group 1 had normal CRP and ferritin levels (n = 8;median MOF 2.0 [interquartile range 1.0, 2.0] and 0 % mortality);Group 2 had high CRP levels that became normal, with normal ferritin levels throughout (n = 80;median MOF 2.0 [1.0, 2.0] and 5% mortality);Group 3 had high ferritin levels alone (n=16;median MOF 2.5 [2.0, 3.0] and 6.3% mortality);Group 4 had very high CRP levels, and increased ferritin levels (n = 121;median MOF 2.0 [2.0, 4.0] and 10.7% mortality);and, Group 5 had very high CRP and very high ferritin levels (n = 30;median MOF 3.0 [2.0, 4.0] and 40% mortality). Cytokine responses differed across the 5 groups, with ferritin levels associated with macrophage inflammatory protein 1 a, and CRP levels reflective of many cytokines. CONCLUSIONS: Bedside CRP and ferritin levels can be used together to compute distinct groups of children with sepsis who have different systemic inflammation cytokine responses and mortality risks potentially targetable in clinical trials evaluating specific anti-inflammatory therapies.

Exploring older adults' experiences using technology during a viral pandemic

BACKGROUND: Older adults are at greater risk for morbidity and mortality associated with COVID-19. Spatial distancing and sequestering practices are recommended to limit viral exposure. Older adults adopting these practices are at increased risk of social isolation and adverse health outcomes. Remote technologies offer various platforms for satisfying socialization and healthcare needs while sequestering. Understanding how older adults are using technology has implications for wellbeing during a pandemic. METHOD: Researchers attempted to contact all participants enrolled in the University of Kentucky Alzheimer's Disease Research Center longitudinal study via telephone to survey technology use (n = 706). Participants were contacted directly, except for demented participants, whose primary caregivers were contacted to respond on their behalf, when possible. Participants and caregivers gave their assent verbally to complete the voluntary survey, the procedures of which were approved by the IRB. The surveys consisted of validated instruments to gauge the extent of use of and comfort with technology. Spearman correlations, chi-square tests, and t-tests were used to explore data. RESULT: Ultimately, 384 participants were reached and 332 consented to participate. Most reported reliable home internet access (91.5%) and some internet use (90.6%). Recent feelings of loneliness were not related to any technology-related variables (all ps > 0.29) other than decreasing with greater willingness to use telehealth (Rho = -0.11, p = 0.06). Those who reported a lack of comfort with technology (n = 76) were less likely to text messaging (67% vs 78%) and social media (56% vs 69%), ps ≤ 0.06, but felt socially connected using technology at similar levels (82% vs 75%), p = 0.22. Nearly 70% of this group reported they would use technology more with training. Across all participants, willingness to use telehealth was not related to frequency of frustration with tech (Rho = 0, p = 0.99). CONCLUSION: The results suggest that some older adults' use of technology is limited by familiarity. Lack of familiarity does not appear to create a barrier to using telehealth nor does frustration with technology appear to limit telehealth use. The findings have implications for supporting older adults sequestered during a pandemic but potentially more broadly. © 2021 the Alzheimer's Association.

Identifying Early Opinion Leaders on COVID-19 on Twitter

This study aims to empirically identify opinion leaders on Twitter from the lens of Innovation Diffusion theory. We analyzed pandemic-specific tweets from casual users as well as from the US President to map their conversation for the purpose of finding opinion leaders over a three month period at the onset of the pandemic. By applying network analysis following with cluster enrichment as well as sentiment analysis, we recognize potential thought leaders, but we could not find strong evidence for opinion leaders according to the Innovation Diffusion theory. We interpret that users tweet for two different purposes - tweets to elicit agreement and tweets to elicit debate. © 2021, Springer Nature Switzerland AG.

A prospective multidisciplinary review of radiotherapy processes during the telemedicine era

Background: The COVID-19 pandemic resulted in the use of telemedicine for evaluation and management visits in radiation oncology departments to decrease in-person interactions. The primary objective of this study is to evaluate the utility of telemedicine for patient consultation and its effect on radiotherapy simulation and treatment processes. Methods: A standardized simulation requisition directive was used for all consults (telemedicine and inperson) undergoing simulation for external beam radiation therapy at a single tertiary care institution from January to December 2020. These directives were reviewed at daily multidisciplinary peer review meetings;modifications occurring as a result of this review were prospectively recorded in a departmental quality database. Descriptive statistics were used to identify characteristics associated with consultation type. Mann Whitney and Chisquare tests were used to compare continuous and categorical variables. Results: 1500 consecutive patients were reviewed in this prospective peer review process;444 (29.6%) had telemedicine visits preceding simulation and 1056 (70.4%) had in-person consults. The median time between physician simulation order and date of simulation was 5 days (IQR: 2-11 days) for telemedicine visits and 4 days (IQR: 1-8 days) for in-person consults (p<0.05). Significant differences were observed in telemedicine usage across months (p<0.05) with the highest percentage in July, September, and August (50%, 45.9% and 45%, respectively). As a result of prospective multidisciplinary peer review, 397 modifications in 290 simulations were recorded in total;101/444 (22.7%) telemedicine simulations had modifications compared to 189/1056 (17.9%) following inperson consultation (p<0.05). The most common modifications for telemedicine visits resulted from immobilization device changes (n=32, 23.5%), arm positioning (n=19, 14.0%), and changes in the radiotherapy care path (n=17, 12.5%). For telemedicine consults, the median radiotherapy fraction dose was 2.66 Gy (2-4 Gy) and median fraction number was 16 (5-28). There was no difference for fractionation preference between telemedicine and in person consults (p=0.084). Seven (1.6%) telemedicine visits and 7 (0.7%) in-person consults needed resimulation during the entire study period (p=0.136). Conclusions: Telemedicine is a powerful tool with the potential to revolutionize the radiation oncology daily practice. In the initial learning phase, it appears that there is a higher frequency of simulation modifications for patients evaluated by telemedicine. Therefore, as departmental processes incorporate telemedicine in the future, thorough attention is needed to encourage review of common modifications as well as identify patients at high risk of error at time of simulation who may also benefit from in-person evaluation prior to simulation.

Assessing mental health presentations to the paediatric emergency Department : An inconsistent process. evaluating staff agreement using video vignettes

Background The rise in mental health presentations to Paediatric Emergency Departments (PED) during the Covid pandemic has been well documented. Whilst it has never been more important to accurately assess the mental health risk posed to young people on their arrival in PED, staff undertaking these assessments often have little formal training or oversight. Whilst physical presentations can be quantified by clinical parameters and evidenced investigations, the accurate assessment of mental health cases is inherently subjective, yet just as crucial. Objectives To assess the level of agreement between professionals routinely assessing undifferentiated mental health presentations in PED using video vignettes. Methods We identified mental health-related presentations to a tertiary PED over a one-month period. We selected six cases by random number generation, carefully altered/anonymised the details and engaged actors to re-create the presentations. Using an existing assessment matrix, participating PED and CAMHS (child and adolescent mental health service) staff watched the video vignettes and allocated presentations to 'green', 'amber' or 'red' risk categories. A free marginal multi-rater Kappa was used to assess the level of agreement between responses (0 indicating no agreement and 1 perfect agreement). Staff were asked to rate their confidence in assessing the vignettes on a modified likert scale numbered 1-5 (5 = very confident). This was undertaken as a service evaluation project after discussion with relevant Trust R&D teams. Results The Kappa for all responses was Kfree=0.21 (95%CI 0.04-0.38). Table 1 outlines Kappa values and self-reported confidence within each staff category. Conclusions When assessing the severity of mental health presentations on a simple traffic-light system, the agreement between PED staff was very low. This was lowest amongst nursing staff, who may be less familiar with the assessment matrix. Concordance was high amongst CAMHS staff, admittedly with few participants. This likely reflects their greater exposure and training. Despite the wide variation in responses, each staff group reported their collective confidence in assessing the cases similarly. This may point to a lack of standardised training and staff awareness. In order to best support young people during mental health difficulties, an accurate, objective and standardised assessment is key. This keeps young people safe, informs the level of support/ supervision they require and is crucial to de-escalate crises. This process starts in PED but practice is widely variable in our single-centre study - a level of inconsistency we would not tolerate in the assessment of physical symptoms. We plan to undertake regular multi-disciplinary training led by CAMHS to encourage standardised and robust assessments. We hope to improve the productivity and accuracy of discussions between PED and CAMHS and improve the patient journey for young people. We plan to repeat the vignettes following this intervention.

Patterns of Care in Stereotactic Body Radiation Therapy Fractionation Schedules in Non-Small Cell Lung Cancer in the United States From 2004-2016

Stereotactic Body Radiation Therapy (SBRT) is considered standard of care for inoperable early stage non-small cell lung cancer (NSCLC) and is commonly delivered in 1-5 fractions. Single fraction SBRT is supported by randomized data demonstrating equivalent safety compared to fractionated approaches. The purpose of this study is to measure trends in the utilization of SBRT fractionation in NSCLC patients in the National Cancer Database (NCDB) from 2004-2016. The NCDB was queried for patients with cT1-T3N0M0 NSCLC who were treated with a known SBRT dosing schema during the study period (including 30-34 Gy/1 fraction, 54-60 Gy/3 fractions, 48-50 Gy/4 fractions, and 50-60 Gy/5 fractions). Adjusted logistic regression was used to assess the association of treatment year with the annual percentage of patients who received SBRT using 1, 3, 4, and 5 fractions. Average annual percentage changes (AAPC) were computed and compared to determine if a significant change (defined a priori as P < 0.01) occurred in the use of different fractionation schemes over time. Multivariable analysis was used to evaluate factors associated with receipt of single fraction SBRT. The analytic cohort consisted of 39,536 patients. Use of 3 fraction SBRT decreased from 72.6% in 2004 to 20.3% in 2016 (AAPC -10.6% per year, 95% CI: [-12.1%, -9.1%], P < 0.001). During this interval, a corresponding increase in the use of 5 fraction SBRT also occurred, from 6.5% in 2004 to 53.7% in 2016 (AAPC +18.3% per year, 95% CI: [+13.3%, +23.4%], P < 0.001). No significant change was observed in single fraction and 4 fraction SBRT utilization;< 1% of patients per year received single fraction SBRT in all but three years of the study with a 1.1% percent utilization rate in 2016. On logistic regression, cT2 patients were less likely to receive single fraction SBRT (Odds Ratio 0.592, 95% CI: 0.414-0.846) while academic facility (Odds Ratio 5.821, 95% CI: 4.331-7.823) and Charlson Deyo Score > 2 (Odds Ratio 1.447, 95% CI: 1.038-2.017) were significantly associated with receipt of single fraction SBRT. Age, insurance, distance to treatment facility, and treatment year were not significantly associated with single fraction SBRT. Single fraction SBRT use remained scarce in the United States during 2004-2016, with no clear indication of increased utilization after 2014 when RTOG0915 was first reported. With prospective evidence that long-term toxicity, local control, and survival are similar to 3-4 fraction regimens, the application of single fraction SBRT in the clinic may warrant further interest in light of the recent COVID-19 pandemic and the implementation of the alternative payment model. [ABSTRACT FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Evaluation of a Prospective Radiation Oncology Departmental Peer Review Process using Standardized Simulation Directives

The primary objective of this study is to evaluate the utility and value of an institutional, multi-disciplinary peer review process prior to radiotherapy simulation. Over a period of 3 months and through an iterative process, a standardized simulation requisition directive (SSRD) was developed, piloted, modified, and subsequently implemented for all patients treated with external beam radiotherapy at a single tertiary care institution from January to December 2020. The SSRDs were reviewed at a daily multi-disciplinary peer review conference ("morning huddle");modifications in the simulation process consequential to the review were prospectively recorded in a quality database. Descriptive statistics were used to identify characteristics associated with modifications. Independent sample t test and Chi-square test were used to compare continuous and categorical variables. A total of 1500 consecutive SSRDs were prospectively reviewed and met inclusion criteria for this study. The median time between the physician SSRD order and date of simulation was 4 days (Range: 0-97 days), and the majority of patients were treated with curative intent (n = 872, 58%). A total of 369 modifications on 269 (17.9%) simulation directives were recorded and parsed into 17 categories. The most common modifications resulted from omission of pregnancy testing orders (n = 92, 24.9%), immobilization device changes (n = 88, 23.8%), changes in the radiotherapy care path (n = 56, 15.1%), and arm positioning (n = 43, 11.6%). Modifications were less likely to occur if the directives were entered within 1 week of simulation (15.6% vs. 21.7%, P = 0.0028). Significant differences were also observed across tumor sites (P = 0.0091) with the highest modification rates observed for stomach, esophagus, and pelvis sites (40%, 30%, and 26.9% modified, respectively). A significant change in department workflow and clinic visits occurred in March 2020 as a result of COVID-19, with transition to virtual platforms. An increased rate of simulation directive modifications was also observed for patients simulated after these changes were implemented (April – December 2020 19.3% vs. Jan – March 2020 13.5%, P = 0.013). No differences in modification rates were observed by modality, i.e., photon or proton therapy (P = 0.20). Overall, with this prospective peer review process, only 14 patients (0.9%) needed re-simulation during the entire study period. Prospective peer review prior to simulation in radiotherapy identifies actionable change in approximately 18% of procedures, and results in an extremely low, < 1% rate of re-simulation. SSRDs ordered > 1 week before from simulation and gastrointestinal and pelvic sites were at higher risk of requiring modifications during peer review. As departmental processes transition to virtual meeting platforms, more thorough attention is needed to identify patients at higher risk of simulation modifications. [ABSTRACT FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Coping strategies moderate the effect of perceived stress on sleep and health in older adults during the COVID-19 pandemic

Introduction: The COVID-19 pandemic is an enormous stressor that can impact various dimensions of health, including sleep health. Older adults may be particularly vulnerable. Coping strategies to manage stress can also impact health outcomes by modifying the relationships between perceived stress and health outcomes. This study examined concurrent and longitudinal associations between perceived stress and sleep health, mental health, physical health, and overall perceived health outcomes among older adults. We also examined whether coping strategies moderate these associations. Methods: Older adults (n = 115;Mage = 68.62, 58.3% female) reported perceived stress (PSS), coping strategies (Brief COPE), global sleep quality (PSQI global sleep quality score and dichotomous good/ poor sleep quality), depressive symptoms (CES-D), and perceived mental, physical, and overall health (RAND-12) before and during the COVID-19 pandemic. Results: The number of individuals with poor sleep quality was greater during the COVID-19 pandemic than before (50% vs. 36.5%). Participants also reported poorer physical health during the COVID-19 pandemic than before. Hierarchical linear regression and hierarchical logistic regression revealed that higher perceived stress was crosssectionally associated with poorer sleep (e.g., higher total PSQI score and dichotomous sleep quality category). Higher perceived stress was associated with worse depressive symptoms and global mental health concurrently and longitudinally. Coping strategies moderated the relationships between perceived stress and physical health and overall perceived health. For example, higher perceived stress was associated with poorer overall perceived health for those who have lower problem-focused coping-but not for those with higher problemfocused coping-both concurrently and longitudinally. Conclusion: Perceived stress influences cross-sectional and longitudinal measures of sleep health and general health among older adults during the COVID-19 pandemic. Coping strategies can moderate the effects of perceived stress on health outcomes. Older adults may benefit from prevention and intervention strategies targeting stress management and problem-focused coping strategies.

Social integration and sleep quality during the COVID-19 pandemic: Prospective evidence from a study of retired older adults

Introduction: Growing evidence has documented the adverse impact of the global coronavirus pandemic on sleep quality. Older adults may be especially susceptible to declines in sleep quality for multiple reasons, including their elevated risk of social isolation and loneliness during the pandemic. Given the adverse health consequences of poor sleep, there is a need to identify resilience factors that help protect older adults against decreased sleep quality. Social integration is a plausible resilience factor because involvement in a broad range of social relationships is thought to promote psychological well-being (e.g., meaning, purpose in life), as well as reduce the intensity and duration of negative psychological states. Social integration may also assume increased importance during the coronavirus pandemic because of normative declines in overall social contact. This prospective study assessed the impact of the coronavirus pandemic on older adults' sleep quality and tested whether social integration moderated the impact of the pandemic on sleep quality. Methods: A sample of 115 retired older adults (mean age = 68.6, 58% female, 89% white) completed self-report assessments of their social integration (number of roles on Cohen's Social Network Index) and sleep quality (global score on Pittsburgh Sleep Quality Index) before and after the onset of the coronavirus pandemic (mean duration of follow-up = 2.3 years). Results: Multilevel analyses indicated that social integration moderated the impact of the coronavirus pandemic on sleep quality;there was no main effect of time. Older adults with low social integration had reduced sleep quality from Time 1 to Time 2 (b=.94, p=.02), whereas older adults with high social integration showed no changes in sleep quality over time (b=-.38, p=.37). Conclusion: Broader social networks confer resilience against pandemic-related declines in sleep quality among older adults. The level of social integration should be addressed when studying or treating sleep complaints during the coronavirus pandemic. Additional research is warranted to determine whether psychosocial interventions targeted towards older adults with low social integration can reduce observed differences in sleep quality.