Increased Use of Hyperosmolar Therapy for Suspected Clinically Apparent Brain Injury in Pediatric Patients with Diabetic Ketoacidosis during the Peak of the COVID-19 Pandemic

The incidence of pediatric diabetic ketoacidosis (DKA) increased during the peak of the COVID-19 pandemic. The objective of this study was to investigate whether rates of hyperosmolar therapy administration for suspected clinically apparent brain injury (CABI) complicating DKA also increased during this period as compared to the three years immediately preceding the pandemic and to compare the characteristics of patients with suspected CABI before the pandemic, patients with suspected CABI during the peak of the pandemic, and those with DKA but without suspected CABI during the pandemic. Patients aged <= 18 years presenting with DKA before (March 11, 2017-March 10, 2020) and during the peak of the pandemic (March 11, 2020-March 10, 2021) were identified through a rigorous search of two databases. Predefined criteria were used to diagnose suspected CABI. Biochemical, clinical, and sociodemographic data were collected from a comprehensive review of the electronic medical record. The proportion of patients with DKA who received hyperosmolar therapy was significantly higher (P = 0.014) during the pandemic compared to the prepandemic period;however, this was only significant among patients with newly diagnosed diabetes. Both groups with suspected CABI had more severe acidosis, lower Glasgow Coma Scale scores, and longer hospital admissions (P < 0.001 for all) than cases without suspected CABI. During the pandemic, the blood urea nitrogen concentration was significantly higher in patients with suspected CABI than those without suspected CABI, suggesting they were more severely dehydrated. The clinical, biochemical, and sociodemographic characteristics of patients with suspected CABI were indistinguishable before and during the pandemic. In conclusion, administration of hyperosmolar therapy for suspected CABI was more common during the peak of the COVID-19 pandemic, possibly a result of delayed presentation, highlighting the need for increased awareness and early recognition of the signs and symptoms of diabetes and DKA, especially during future surges of highly transmissible infections.

Risk-Variant APOL1 Expression in iPSC-Derived Macrophages Increases Cellular Stress and Inflammation

Background: DNA variants for the APOL1 gene have been linked to a higher risk of developing kidney and cardiovascular disease in individuals with recent African ancestry. APOL1 is expressed endogenously in not only kidney cells but also immune cells such as macrophages. Recent studies show that severe acute inflammatory illness such as COVID-19 increases the likelihood of individuals with the high-risk APOL1 genotype developing glomerulopathy, raising the question of the role of immune cells in APOL1-mediated disease. Therefore, we aim to understand the cellular stress and proinflammatory pathways increased by risk variant APOL1 expression in iPSC-derived macrophages (iPSDM). Method(s): Induced pluripotent stem cell (iPSC) expressing G0 and G1 variants of APOL1 were generated through CRISPR/Cas9. Macrophages (iPSDM) were differentiated from these iPSC lines. Expression of APOL1 in the cultured iPSDMs, was induced with IFNgamma (20 ng/mL). Cytokine expression in the cell culture supernatant was measured by ELISA. Metabolic respiration was measured by Seahorse Mito Stress Test (Agilent). Result(s): Upon stimulation with IFNgamma, we observed a 4.6-fold decrease in TGF-beta secretion (n=3, p<0.001) in G1 iPSDM compared to G0. When polarized to an M1-like phenotype with IFNgamma and LPS, IL-1beta secretion was 1.4-fold increased (n=3, p<0.005) in G1 iPSDM compared to G0. G1 macrophages also had decreased levels of basal respiration compared to G0 (n=3, p=0.04). However, there was no observed difference in mitochondrial reactive oxygen species as measured by MitoSOX Red staining. Additionally, we observe a decrease in protein levels of LC3-II, an indicator of active autophagy, and a 4.4-fold increase of autophagy substrate P62 levels in G1 macrophages compared to G0. Conclusion(s): The findings in our experiments show a significant increase in inflammatory cytokine expression in G1 macrophages and decreased levels of basal respiration and autophagy markers. These results suggest that APOL1 risk variant expression modulates macrophage functions which are relevant to kidney homeostasis and disease.

Trauma 101: A virtual case-based trauma conference as an adjunct to medical education

Background: The COVID-19 pandemic has substantially affected medical school curriculum, limiting access to simulationbased trauma education and core surgical clerkship rotations. Virtual learning has been integrated into medical education as an alternative to live synchronous sessions. However, its effectiveness for teaching critical concepts in trauma resuscitation has not been validated. Moreover, while small-group sessions are an effective pedagogical model in-person, less is known about how they translate to online learning in clerkship. Method(s): Medical students were invited to attend a 2-day virtual trauma conference organized by student interest groups at McMaster University and promoted on social media. The event included 9 interactive presentations by physicians and residents in 5 specialties, followed by virtual small-group case discussions. A best-match algorithm assigned students to their preferred small-group sessions. Participants completed anonymous pre- and post-conference trauma knowledge tests and feedback questionnaires. Results were analyzed using paired t tests and descriptive content analysis. Result(s): A total of 360 students from over 17 medical schools in 5 countries registered to attend the conference. There was a peak of 167 simultaneous connections during presentations and 68 participants during small-group discussions. A total of 131 students (36%) completed the pretest, with a mean baseline score of 3.4 out of 10 (standard deviation [SD] 2.04). Eighty-six students (24%) completed the posttest, with a mean score of 6.3 out of 10 (SD 2.3, p < 0.001). Among students who completed both preand post-tests (20%, n = 73), paired t test analysis reveals a substantial improvement of the mean score of 2.7 out of 10 (SD 2.3, 95% confidence interval 2.17-3.23, p < 0.001). There were no significant correlations between years of education and school attended with pretest performance. Social media enhanced group engagement, resulting in a total of 147 posts, whereby 37.4% were participant generated. Live polling and a moderated chat box improved participation during presentations, with 74% of participants agreeing that the didactic sessions were interactive. The conference was well received. Overall, 95.2% of participants agreed that the online platform was effective and 78.3% agreed that the conference was helpful preparation for clerkship. The response rate for feedback forms for the small group sessions was 58.8% (40/68). Preliminary descriptive analysis revealed 42.5% (17/40) of participants reflected favourably on group interaction during small-group sessions. Overall, 92.7% of the participants rated the small-group discussions as effective. Conclusion(s): With high participant satisfaction and significantly improved posttest results, this virtual model for trauma education at the medical student level is an effective adjunct to the clerkship curriculum. Virtual small-group case-based discussions and social media were beneficial in enhancing participant engagement. This study has important implications for the future design and implementation of international virtual conferences..

A multi-centre national study of COVID-19 infection in cancer patients

Background & aims: COVID19 disproportionately affects the immunosuppressed, but its epidemiology over time is incompletely characterised. We describe Australian experiences of COVID19 in a national observational study of patients with malignancy. Methods: An ongoing multisite prospective cohort study of adult COVID19 patients with active cancer was conducted. Clinical and laboratory data over 28 months (1/3/20-22/7/22) was collated from 15 hospitals. Results: There were 491 patients included. Patients were a median of 63(IQR:50-71) years with majority male (254,52%). Solid organ malignancy was most common (296,60%), followed by haematological malignancy (180,37%), then both (15,4%). Most common solid tumour was breast cancer (74/296,25%);most common haematological cancer was lymphoma (102/180,57%). Majority (275,56%) were undergoing cancer treatment at COVID19 diagnosis. From 2020-2022, patients presented less with lower respiratory tract infections (57%,36%,5%) with increasing outpatient management (26%,50%,67%). Improved mortality was seen (27%,19%,11%). Median inpatient length of stay was 8(4-11) days. Intensive care admission was low (21,4%). For patients who had repeated respiratory PCR testing, median time from first to last positive test was 17(7-25, n = 123) days. Cancer treatment modification occurred in 18(4%) and delay in 74(15%). Conclusion: Despite improvements in outcomes, COVID19 still results in morbidity with impacts on cancer treatment. This preliminary data shows that cancer patients remain a vulnerable group and should be prioritised for public health interventions.

Individual characteristics and demographics associated with mask wearing during the COVID-19 pandemic in the United States

Introduction: Many scientific studies provide evidence of mask wearing as an effective strategy to reduce the spread of the COVID-19 virus. However, US citizens do not adhere to this prevention practice universally. Although past studies have shown disparities in mask wearing by age, gender, ethnicity, and location, the literature lacks a work that uses large-scale national survey data to understand the mask-wearing resistors' characteristics and demographics. This study's purpose is to fill this gap. Methods: We obtained this study's data from the COVID-19 Impact Survey, a nationally representative survey conducted by NORC at the University of Chicago. This survey aims at generating national and regional statistics by surveying representative regional and national samples in three time periods: April 20-26, 2020, May 4-10, 2020, and June 1-8, 2020. Data for our analysis are from the public-use files of these three waves. We performed logistic regressions to estimate the adjusted risk ratio (ARR) of not wearing masks for several personal characteristics and demographics. Results: Our results suggest that younger (average ARR = 1.66) and lower-income (average ARR = 1.51) adults are more likely not to wear a face mask to prevent the coronavirus spread. On the other hand, unhealthy (average ARR = 0.81), female (average ARR = 0.68), and minority (average ARR = 0.65) adults are less likely not to wear a mask. Furthermore, residents in the Northeast region (average ARR = 0.34) and urban residents (average ARR = 0.54) are less likely not to wear a face mask. Conclusion: Mask-wearing behavior differs by age, income, health status, gender, race, region, and geographical residence in the US. © 2022 Medknow. All rights reserved.

Multiple Myeloma, Clinical Characteristics, and Increased COVID-19 Risk Using Real-World Data

Background: A question that was commonly investigated during the COVID-19 pandemic was which clinical characteristics would make one more susceptible to contracting COVID-19? This was especially a concern for those who were considered “high risk” as they would be more prone to suffering from more severe COVID-19 symptoms and at times even death. In this , we investigated which clinical characteristics of multiple myeloma (MM) cancer patients could make them more prone to contracting COVID-19. We also investigated which of these conditions make patients more at risk for experiencing more severe COVID-19 symptoms (PMID: 32950467, PMID: 32353254). Knowing what medical conditions that would make a patient more at risk for contracting or experiencing a more severe case of COVID-19 has been a concern for many, especially for those who suffer from more severe health conditions such as cancer. Methods: MM patient data and demographics were collected through HealthTree ® Cure Hub for Multiple Myeloma. We analyzed medical conditions including hypertension, heart condition, neuropathy condition, and BMI. We also looked into lung condition, kidney condition, diabetes, stroke, smoking history, drug use history, HIV, and Mediterranean descent but did not include in the figure due to small population sizes. We determined whether a patient had to be hospitalized, admitted to the ICU, needed oxygen therapy, or needed a D-dimer test as a severe COVID-19 case. Multivariable logistic regressions were performed to quantify the risk for contracting COVID-19 for patients with specific medical conditions and which medical conditions made COVID-19 positive patients more at risk for experiencing a more severe case of COVID-19. Results: Out of the 962 patients that were involved in this study, we found that patients who were overweight were 2% more likely to contract COVID-19 than those who were not overweight. Other medical conditions did not increase the risk of contracting COVID-19. Furthermore, there were 35 patients that were involved in investigating how certain medical conditions may affect the severity of COVID-19 symptoms. We found that overweight patients were 12% more likely to suffer from more severe COVID-19 than those not overweight. Patients who suffered from neuropathy conditions were 3% more likely to experience a more severe COVID-19 case than those who do not have that condition. It is important to note that these results were not statistically significant, although are still informative. Conclusion: Our results show that MM patients who are overweight have a greater tendency to not only contract COVID-19 but experience a more severe case of COVID-19. Somewhat surprisingly, we found that patients who experience neuropathy, common among MM patients, had a higher tendency to experience a more severe case of COVID-19. We speculate whether MM patients, a high-risk group due to their immunocompromised state, took extra care to follow safety recommendations and caution to avoid contracting COVID-19. A logical next step would be to compare medical condition interactions to examine whether patients with more than one condition experience additive or synergistic risk, as well as comparing out results to other high-risk groups. These findings, although not statistically significant, may help MM patients identify which of their own medical conditions may put them more at risk for contracting COVID-19 and thus take precautionary measures. [Formula presented] Disclosures: Ahlstrom: Takeda: Other: Patient Advisory;Pfizer: Other: Patient Advisory;Janssen: Other: Patient Advisory;Bristol Myers Squibb: Other: Patient Advisory.

C2CL: Contact to Contactless Fingerprint Matching

Matching contactless fingerprints or finger photos to contact-based fingerprint impressions has received increased attention in the wake of COVID-19 due to the superior hygiene of the contactless acquisition and the widespread availability of low cost mobile phones capable of capturing photos of fingerprints with sufficient resolution for verification purposes. This paper presents an end-to-end automated system, called C2CL, comprised of a mobile finger photo capture app, preprocessing, and matching algorithms to handle the challenges inhibiting previous cross-matching methods;namely i) low ridge-valley contrast of contactless fingerprints, ii) varying roll, pitch, yaw, and distance of the finger to the camera, iii) non-linear distortion of contact-based fingerprints, and vi) different image qualities of smartphone cameras. Our preprocessing algorithm segments, enhances, scales, and unwarps contactless fingerprints, while our matching algorithm extracts both minutiae and texture representations. A sequestered dataset of 9, 888 contactless 2D fingerprints and corresponding contact-based fingerprints from 206 subjects (2 thumbs and 2 index fingers for each subject) acquired using our mobile capture app is used to evaluate the cross-database performance of our proposed algorithm. Furthermore, additional experimental results on 3 publicly available datasets show substantial improvement in the state-of-the-art for contact to contactless fingerprint matching (TAR in the range of 96.67% to 98.30% at FAR=0.01%). IEEE

Developing an e-consent system

With the COVID-19 pandemic, the ability to coordinate and manage research studies remotely has become increasingly important. Most systems offer a variation of a mobile interface for study participants to complete self-administered questionnaires outside of the clinical setting. However, there was a need for functionality to allow a potential participant to virtually and electronically complete a screening questionnaire and provide consent. The web development team and research staff at the George Washington University Biostatistics Center collaborated to create a web-based public form and electronic informed consent system. This system allows potential participants to be screened and join studies without the need to be physically present to sign regulatory documents. The e-consent system is based on the Biostatistics Center's existing electronic patient report outcome system. Users are able to access the system on a variety of devices, as the display is tailored to the size of the screen. To assure data quality and security, the system incorporates reCAPTCHA verification, email verification, tailored in-system messaging, personal links and codes, link expiration, electronic signature, and encryption. Existing features from the electronically patient report outcome system-such as skip patterns, range checks, lookup tables, and partial saving-were utilized to minimize data quality issues. In describing the design, implementation, successes, and challenges of this system, the Biostatistics Center team hopes to inform other coordinating centers and research studies interested in utilizing virtual enrollment systems for remote research.

Online Patient-Reported Platform Detects Trend of Increased COVID-19 Risk and Severity for Multiple Myeloma Patients on Active Lenalidomide-Based Therapy

Background: Since the start of the COVID-19 pandemic, “high-risk” patients, such as cancer patients, have had to reconsider their current medical treatments and other treatment alternatives to best minimize their risk for contracting COVID-19. Lenalidomide has immunomodulatory properties that stimulate the production of T-cells which help combat against infections which may include diseases such as COVID-19. In this , we investigate whether lenalidomide protects multiple myeloma (MM) patients from contracting COVID-19 and whether lenalidomide decreases the severity of COVID-19 events (including hospital or intensive care unit [ICU] admissions, and need of assisted ventilation) for patients that contract the virus (PMID: 32950467, PMID: 32353254). Methods: MM patient data was collected through HealthTree ® Cure Hub for Multiple Myeloma (healthtree.org) and the relative risk was calculated to compare the risk of contracting COVID-19 between patients taking lenalidomide and those who were not at the time of contracting COVID-19. The odds ratio was calculated to measure lenalidomide's effect on the severity of COVID-19 if contracted. These events include whether a patient was hospitalized, had to go to the ICU, or required oxygen therapy. Results: There were 1,123 patients involved in comparing lenalidomide with the risk of contracting COVID-19, including patients that never tested positive for COVID-19. Surprisingly, our results showed that patients who are taking lenalidomide have a 10% higher risk for contracting COVID-19 than those who are not;however, these findings were insignificant. Furthermore, 40 patients were involved in investigating lenalidomide's effect on decreasing severe COVID-19 symptoms for MM patients. Our results showed that the odds of patients experiencing severe COVID-19 were 1.95 times more for those on lenalidomide than those who were not. Conclusions: Despite the insignificance of lenalidomide during COVID-19, our results indicated that taking lenalidomide may not be beneficial in lowering the risk for MM patients in contracting COVID-19. Furthermore, lenalidomide may also not decrease the severity of COVID-19 symptoms for MM patients that did contract COVID-19. Our results may help MM patients and their providers decide whether to continue their use of lenalidomide or to seek alternative treatment options. Disclosures: Ahlstrom: Pfizer: Other: Patient Advisory;Janssen: Other: Patient Advisory;Takeda: Other: Patient Advisory;Bristol Myers Squibb: Other: Patient Advisory.

An analysis of a third-party food delivery app during the COVID-19 pandemic

Purpose: The study aims to analyze guest comments on the Uber Eats food delivery app (FDA) in the USA during the April–June 2020 COVID-19 pandemic lockdown period. Three aspects influencing customer satisfaction with the FDA were evaluated in this study: (1) performance on the app, (2) product quality and (3) service quality. Design/methodology/approach: One thousand customer comments posted on the Uber Eats Google Play app from April 1 to June 30, 2020 were analyzed in this study. The text mining technique was applied to discover the hidden, but meaningful patterns from the unstructured text. Content analysis was applied to systematically analyze the text into organized categories and themes. Findings: Among the three dimensions evaluated in this study, the most important dimension regarding customers' perceptions toward the FDA was the service quality dimension (40.02%), followed by the FDA's performance dimension (39.43%) and the product quality dimension (20.54%) was least important. Additionally, customers' perceptions towards the three dimensions were all unfavorable and there were more negative comments than the positive comments: FDAs (P/N = 0.728), product quality (P/N = 0.60) and service quality (P/N = 0.865). Originality/value: Previous studies investigating FDAs assessed solely the performance of the app. However, customers' experience of a food delivery service is comprised of multiple components including the app, the restaurant and the delivery driver. To fill the void, this study evaluated a third-party app performance, product quality and service quality to capture the totality of customers' food delivery service experience. © 2021, Emerald Publishing Limited.

Kidney transplant recipients who had COVID-19 prior to transplant: A single-center experience

Purpose: In the early recovery phase after the initial surge of the COVID-19 pandemic, a question emerged in the context of resuming transplant activity: should a patient who had recovered from COVID-19 be eligible for transplant, and under what conditions? Here we report our early experience of patients who had recovered from COVID-19 and then subsequently underwent kidney transplantation. Methods: Patients who were known to have COVID-19 were required to be fully asymptomatic and to have a negative PCR test prior to being eligible to undergo transplant, but no specific waiting period was required. A retrospective chart review was performed on patients who underwent transplant between 6/3/2020 and 7/30/2020, allowing for at least 3 months of post-transplant follow-up. During this period we adjusted our protocol to reduce the total dose of anti-thymocyte globulin for induction, from a historical dose of 6 mg/kg, now to 4.5mg/kg in three divided doses, while the maintenance immunosuppression was unchanged. Results: In the study period, there were 10 patients who were known to have had COVID-19, by a PCR test, who then underwent kidney transplant. The average duration between the first COVID test and the date of transplant was 97 days (range 47 - 137). All patients demonstrated the presence of antibodies, at a mean duration of 96 days (range 32 - 164) after the PCR test. There were 8 males and 2 females. The average age at the time of transplant was 51.3 years (range 31.0 - 68.7). There were 7 living donors and 3 deceased donors. There were no episodes of respiratory failure and no deaths. There were no cases of biopsy-proven acute rejection, or graft thrombosis. There was 1 case of recurrent FSGS, which was treated. There was 1 graft loss relating to a severe neurologic decompensation of unclear etiology and the resulting inability to tolerate immunosuppression. This patient had a positive PCR test 42 days post-transplant, but other PCR tests before and after that point were negative. In the remaining 9 cases with functioning grafts, the average Cr at 3 months of follow-up was 1.71 mg/dL (range 1.1 - 3.89). Conclusions: In this small series with short-term follow-up, outcomes of patients who previously had COVID-19 and then underwent kidney transplant were generally good. However, caution is still advised until larger experiences and longer-term data are published.

A Distance-Learning Approach to Point-of-Care Ultrasound Training (ADAPT): A Multi-Institutional Educational Response During the COVID-19 Pandemic.

PROBLEM: The COVID-19 pandemic significantly disrupted point-of-care ultrasound (POCUS) education. Medical schools and residency programs placed restrictions on bedside teaching and clinical scanning as part of risk mitigation. In response, POCUS faculty from 15 institutions nationwide collaborated on an alternative model of ultrasound education, A Distance-learning Approach to POCUS Training (ADAPT). APPROACH: ADAPT was repeated monthly from April 1 through June 30, 2020. It accommodated 70 learners, who included 1- to 4-week rotators and asynchronous learners. The curriculum included assigned prework and learning objectives covering 20 core POCUS topics. A rotating group of 30 faculty and fellows delivered daily virtual teaching sessions that included gamification to increase learner engagement and hands-on instruction through teleguidance. After participation, faculty and learners completed anonymous surveys. OUTCOMES: Educators reported a significant decrease in preparatory time (6.2 vs 3.1 hours per week, P < .001) dedicated to ultrasound education after implementing ADAPT. The majority of 29 learners who completed surveys felt "somewhat confident" or "very confident" in their ability to acquire (n = 25, 86.2%) and interpret (n = 27, 93.1%) ultrasound images after the intervention; the majority of 22 educators completing surveys rated the program "somewhat effective" or "very effective" at contributing to learner's ability to acquire (n = 13, 59.1%) and interpret (n = 20, 90.9%) images. Most learners (n = 28, 96.6%) and all educators (n = 22, 100%) were "satisfied" or "very satisfied" with ADAPT as a whole, and the large majority of educators were "very likely" (n = 18, 81.8%) to recommend continued use of this program. NEXT STEPS: A virtual curriculum that pools the efforts of multiple institutions nationwide was implemented rapidly and effectively while satisfying educational expectations of both learners and faculty. This collaborative framework can be replicated and may be generalizable to other educational objectives.

Sustaining Healthy Staying Communities in University Residential Halls amid Unprecedented Pandemic

Because of the COVID-19 pandemic, most teaching and learning or student services in the higher education setting have moved to the digital world. However, university residential halls have continued to provide services as there are students who are unable to go back to their homes/countries because of travel bans or family reasons. This study investigates the perceptions of residents who stayed at university residential halls during the pandemic. In-depth interviews were conducted with 77 staying residents from four public universities in Hong Kong. Through the sharing of their residential experience, it was found that these stayers were impacted greatly by the changes in the residential hall environment, particularly in terms of reduced interaction and emerging disciplinary concerns. Results reveal that stayers had undergone different negative mental states, namely stress, paranoia, loneliness and boredom. After identifying their conditions, some sustainable residential practices were proposed, such as maintaining minimum face-to-face contact for stayers, practicing transparent communication and arranging bulk purchases of living supplies. It is hoped that the results of this study can help to inform readers regarding the possible impacts on the stayers during a partial lockdown environment in university residential halls and how they can be better supported by universities.

Deuterium Dilution Accuracy & Precision of Total Body Water in Multiple Laboratories and Techniques

Background: Deuterium dilution is the criterion method to quantify total body water (TBW) in humans and to estimate body composition and hydration. Dilution of deuterated water in the body can be estimated from saliva, urine, or blood samples. The gold standard for quantifying isotope fractions is isotope ratio mass spectroscopy (IRMS);Fourier Transfer Infrared Spectroscopy (FTIR) is another less validated method that is more accessible. Few studies compare the precision and accuracy of TBW where samples are analyzed at different laboratories using different techniques and/or types of samples. In this study, we compare results from three laboratories using blinded duplicate samples of either saliva or urine measured using either FTIR or IRMS. Methods: The DaKine study recruited 80 athletes for multiple body composition measures. Each participant had 9 ml of both urine and saliva collected at baseline, 3 and 4-hour time points following the International Atomic Energy Agency protocol. The samples were aliquoted into 30 divisions providing blindedduplicate samples to three laboratories for both urine and saliva. Lab1 used IRMS for urine. Lab2 used IRMS to process saliva and urine, while Lab3 used FTIR to process saliva and urine. Results: Because of the temporary closure of the laboratories due to Covid-19, urine samples from only 24 of the 80 subjects have been processed by the laboratories so far. The test-retest RMSE (%CV) for urine was as follows: Lab1=0.25 L (0.55%);Lab2=0.24 L (0.60%);Lab3=pending. For saliva, the precision was: Lab1=unavailable;Lab2=0.26 L (0.63%);Lab3=pending. The accuracy between laboratories for urine measures was Lab2=0.98Lab1 -.024, R2=0.98, RMSE=1.31. Intra-laboratory comparison of urine and saliva was Lab2(urine)=1.01Lab2-.08, R2=0.98, RMSE=1.2. Conclusions: We conclude that inter-lab urine samples using IRMS are highly accurate (R2 = 0.98) to one another with precisions less than 1%. Intralab lab saliva and urine comparisons had similar accuracy and precision.

Global impact of COVID-19 on non-communicable disease management: descriptive analysis of access to FRAX fracture risk online tool for prevention of osteoporotic fractures.

The COVID-19 pandemic, and its management, is markedly impacting the management of osteoporosis as judged by access to online FRAX fracture risk assessments. Globally, access was 58% lower in April than in February 2020. Strategies to improve osteoporosis care, with greater use of fracture risk assessments, offer a partial solution. INTRODUCTION: The COVID-19 pandemic is having a significant detrimental impact on the management of chronic diseases including osteoporosis. We have quantified the global impact by examining changes in the usage of online FRAX fracture risk assessments before and after the declaration of the pandemic (11 March 2020). METHODS: The study comprised a retrospective analysis using GoogleAnalytics data on daily sessions on the FRAX® website ( www.sheffield.ac.uk/FRAX ) from November 2019 to April 2020 (main analysis period February-April 2020), and the geographical source of that activity. RESULTS: Over February-April 2020, the FRAX website recorded 460,495 sessions from 184 countries, with 210,656 sessions in February alone. In March and April, the number of sessions fell by 23.1% and 58.3% respectively, a pattern not observed over the same period in 2019. There were smaller reductions in Asia than elsewhere, partly related to earlier and less-marked nadirs in some countries (China, Taiwan, Hong Kong, South Korea and Vietnam). In Europe, the majority of countries (24/31, 77.4%) reduced usage by at least 50% in April. Seven countries showed smaller reductions (range - 2.85 to - 44.1%) including Poland, Slovakia, Czech Republic, Germany, Norway, Sweden and Finland. There was no significant relationship between the reduction in FRAX usage and measures of disease burden such as COVID-attributed deaths per million of the population. CONCLUSION: This study documents a marked global impact of the COVID-19 pandemic on the management of osteoporosis as reflected by FRAX online fracture risk assessments. The analysis suggests that impact may relate to the societal and healthcare measures taken to ameliorate the pandemic.