Physical activity, low-grade inflammation, and psychological responses to the COVID-19 pandemic among older adults in England (preprint)

Mental health responses to the COVID-19 pandemic have been widely studied, but less is known about the potentially protective role of physical activity (PA) and the impact of low-grade inflammation. Using a sample of older adults from England, this study tested (1) if pre-pandemic PA and its changes during the pandemic were associated with mental health responses; (2) if older adults with low-grade inflammation experienced greater increases in depression and anxiety, compared to pre-pandemic levels; (3) if PA attenuated the association between inflammation and depression/anxiety. The study used data from the English Longitudinal Study of Ageing, a cohort study following a national sample aged 50+. Information on mental health and PA were collected before the pandemic (2016/17 and 2018/19) and during November and December 2020. Inflammation was ascertained using pre-pandemic C-reactive protein (CRP). Analyses were adjusted for sociodemographic and health-related factors and pre-pandemic mental health. Increasing PA from before to during the pandemic was linked to reduced odds of depression (OR = 0.955, 95%CI [0.937, 0.974]) and anxiety (OR = 0.954, 95%CI [0.927; 0.982]). Higher pre-pandemic PA was associated with reduced odds of depression (OR = 0.964, 95%CI [0.948, 0.981]) and anxiety (OR = 0.976, 95%CI [0.953, 1.000]), whereas elevated CRP was associated with 1.343 times higher odds of depression (95%CI [1.100, 1.641]). PA did not attenuate the inflammation-depression association. The findings suggest that PA may contribute to psychological resilience among older adults, independently of inflammation. Further research is needed to explore the psychobiological pathways underlying this protective mechanism.

Assessing the Cholinergic Anti-Inflammatory Response in Human Macrophages Exposed to the Spike Protein of the SARS-CoV-2 Strain from Wuhan, China

To date, the severe acute respiratory syndrome coronavirus 2 that causes the disease Coronavirus 2019, has infected 601 million people, claiming the lives of 6.4 million people worldwide. Of the patients who survive, 60% suffer from inflammatory problems leading to post-acute sequelae of COVID-19 (PASC). Inflammation in these patients is marked by an increase in pro-inflammatory cytokines which ultimately damage the body's organs, contributing to PASC. Understanding the main mechanism by which this cytokine storm occurs is of utmost importance in order to develop therapeutic strategies for counteracting inflammation in people suffering from COVID-19 and PASC. This project seeks to find out if an innate anti-inflammatory mechanism, the cholinergic anti-inflammatory response (CAR), works properly in patients suffering from COVID-19 and PASC by interrogating its functioning in its cellular substrate, macrophages.We hypothesized that disruption of the CAR in primary human monocytederived macrophages (MDMs) exposed to the SARS-CoV-2 spike protein trimer contributes to the chronic inflammation/ cytokine storm exhibited in these patients. To this end, we exposed MDMs to the SARS-CoV-2 spike protein in order to assess levels of the anti-inflammatory alpha-7 nicotinic acetylcholine receptor (alpha7-nAChR) by means of confocal imaging. Our results demonstrate a statistically significant reduction (P <= 0.01) of alpha7-nAChR expression in MDMs, in a time-dependent manner, after the addition of SARS-CoV-2 spike protein concentrations (30 nM and 100 nM), at different time points. Interestingly, when the receptor employed by the virus to infect, Angiotensin-converting enzyme 2 (ACE-2), was blocked, we detected a significant reduction in the levels of alpha7- nAChRs (P <= 0.001). Collectively, our results support the hypothesis of this work given that the SARS-CoV-2 spike protein is capable of compromising the functioning of the CAR by reducing the levels of alpha7-nAChRs available in macrophages to suppress inflammation. These results could position the alpha7- nAChR as a key target for the development of novel anti-inflammatory therapeutic strategies to counteract the inflammatory problem found in patients suffering from COVID-19 and PASC. We would like to acknowledge Dr. Negin Martin & Dr. Jerrel Yakel, for providing the Purified Spike Protein expressed by SARS-CoV-2 and Pseudotyped Virions in this collaborative study. Also, these experiments are being supported by the University of Puerto Rico - Rio Piedras NIH-RISE program. RISE Grant Number: 5R25GM061151-20.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.

THE ONLINE GAMING BEHAVIOUR OF UNIVERSITY STUDENTS UNDERGOING SELF-QUARANTINE

Self-quarantining is one of the coping mechanisms used during the pandemic. However, it can negatively affect the sufferer. Self-quarantine causes many students to play online games excessively. Understanding students' online game behavior during self-quarantine can help to prevent online game addiction and encourage positive self-quarantine activities. This study aims to investigate the online gaming experience during self-quarantine for university students who tested positive for COVID-19 during the pandemic. Phenomenological qualitative research was used. The study's sample consists of ten university students from Yogyakarta who tested positive for COVID-19 and played online games during self-quarantine. Purposeful sampling was utilized, and data were collected through semi-structured in-depth interviews. The Colaizi method was then used to analyze the data. The results indicated four themes: (1) the changes in online gaming behaviors before and after being tested positive for COVID-19;(2) the influencing factors on online gaming behavior before and during self-quarantine, (3) the impacts of parenting styles on online gaming behaviors, and (4) the impacts/consequences of online gaming behaviors. Overall, during self-quarantine, the students changed their behavior during online gaming, which was influenced by internal and external factors. They also became aware of the consequences of excessive online gaming. © 2023, Universitas Jenderal Soedirman. All rights reserved.

Interactions detected with the use of nirmatrelvir/ritonavir in a tertiary hospital

Background and ImportanceThe incorporation of nirmatrelvir/ritonavir into the therapeutic arsenal for the treatment of SARS-CoV2 infection has made it necessary for Pharmacy departments to activate circuits and tools that allow us to adequately review the potential multiple interactions that ritonavir can produce.Aim and ObjectivesTo describe the interactions detected since the beginning of the use of nirmatrelvir/ritonavir in a tertiary hospital.Material and MethodsAll patients who received nirmatrelvir/ritonavir from April to the end of August 2022 were included. The patient‘s usual treatment was consulted in the electronic prescription system of the region of Madrid, as well as an interview with the patient, and the medical history was consulted when deemed necessary. For the detection of interactions, the ‘COVID-19 Drug Interactions' platform of the University of Liverpool was used and Farmaweb, an application of the Madrid Health Service, was used to validate the dispensing of medication. If there are any interacciones the pharmacist notifies the prescribing physician, as well as the necessary adjustments, these treatment modifications are also explained to the patient when the medication is given to them. An Excel table was used to record whether the patient had any interaction and, if there were any, the drugs were recorded.ResultsDuring the study period, these drugs were dispensed to a total of 81 patients, and interactions with the patient‘s usual medication were detected in 61.73% (50 patients). 18 patients had one interaction, 21 patients had 2 interactions, 6 patients had 3, 4 patients had 4 and one patient had 5 potential interactions. The most commonly detected interaction was with atorvastatin (19) followed by metamizole (11), simvastatin (7), amlodipine (6) and tramadol (4).Conclusion and RelevanceThe percentage of patients with interactions is very high, and it is very important to review the usual treatment as well as an interview with the patient to identify whether the patient is taking other unregistered medication that could interact.This has highlighted the importance of interdisciplinary collaboration between the medical team (mainly in the emergency department, where most of these drugs have been prescribed) and the pharmacy team to ensure the correct use of this drug.References and/or AcknowledgementsConflict of InterestNo conflict of interest

Challenges, strategies and consequences from the perspective of German nursing home managers during the first wave of the COVID-19 pandemic - a qualitative interview study.

BACKGROUND: The first wave of the COVID-19 pandemic reached Germany between March and May 2020. In order to contain the spread of the virus and particularly protect vulnerable people, the government imposed a lockdown in March 2020. In addition to infection control measures, such as hygiene and social distancing requirements, a general ban on access to nursing homes for relatives and external service providers was issued. METHODS: To investigate the challenges and consequences of the enacted infection prevention measures and specific strategies for nursing homes in Germany, a multicentre cross-sectional qualitative interview study with nursing home managers and ward managers was conducted. Recorded audio data were transcribed, analysed using thematic framework analysis and reflected in peer debriefings. RESULTS: Seventy-eight interviews with 40 nursing home managers and 38 ward managers from 43 German nursing homes were conducted. At organisational level, the following six themes were identified: Appointing a multi-professional crisis task force, reorganizing the use of building and spatial structures, continuous adaption and implementation of hygiene plans, adapting staff deployment to dynamically changing demands, managing additional communicative demands and relying on and resorting to informal networks. To deal with the pandemic challenges also six themes can be described for the direct care level: Changed routines, taking over non-nursing tasks, increased medical responsibility, increased documentation demands, promoting social participation and increased communication demands. Also various negative consequences were identified (four themes): Psychological stress, negative emotional consequences, permanent feeling of responsibility and increased potential for conflicts. Positive emotional consequences were also reported (two themes): resources for the challenges and positive emotional consequences for home managers and staff. CONCLUSIONS: The results of the described challenges, strategies and consequences allow recommendations as basis for possible approaches and successful adaptation processes in nursing home care in the future. In particular, there is a need for local networks to act in a coordinated way and a need for quantitative and qualitative support for nurses, such as staff support as well as advanced nursing practice, to cope with the challenges of the pandemic.

Analysis of methods to improve engagement of under-represented and socioeconomically deprived patients in clinical research

The current under-representation of racial and ethnic minorities and socio-economically disadvantaged participants in clinical trials represents an important problem, because it reduces generalizability of trial results and should urgently be addressed in all diseases. Decentralized trials may improve engagement of under-represented populations with long-standing health disparities and may be relevant to patients with pancreatic cancer who would benefit from at home trial participation. We completed a fully decentralized randomized double-blind phase II clinical trial in New York State for participants with mild-to-moderate COVID-19. Electronic data were collected for 28 days (5 vital readings and 1 survey with 20 questions per day) from 55 non-hospitalized participants. Home monitoring devices, HIPAA compliant data submission technology, and internet access were provided free-of-charge. We enrolled 40% White, 33% Black or African American and 27% Other/Mixed/Unknown participants. Of these, 25% self-identified as Hispanic or Latino. This exceeded national and New York state averages of minority populations, in contrast with the current clinical trial landscape. We found that the local area within a 30-minute return car journey from our main research hospital disproportionately over-represented socio-economically advantaged white inhabitants. We found that decentralization enabled the inclusion of participants living up to a 2-hour journey from this hospital in socio-economically deprived geographies with higher minority race representation. We excluded selection bias, by demonstrating that our trial population represented the differences of social deprivation observed between races at the national and state level (p = 0.003). In addition to trial enrollment, completeness of trial data has an important impact on the veracity of trial results. Half our participants were assigned a dedicated team member to make telephone call reminders if participants had not submitted data by mid-day despite of a pre-ceding automated notification to the supplied electronic device. Daily telephone follow-up significantly reduced missing electronic data in participants living above the median deprivation index (submitted data per day 4 out of 6 vs 6 out of 6: p = 0.03), thereby aiding equitable data collection from traditionally under-represented participant groups. Our findings require further validation and refinement from multiple centers and expansion to patients with reduced mobility and cachexia due to progressing pancreatic cancer. Also, other factors such as language assistance and recruitment methods, need to be addressed in clinical trials to mitigate against their negative impact on equitable recruitment. Nevertheless, for now we identify decentralization combined with engagement telephone calls as readily actionable methods to improve inclusion of under-represented participants in clinical trials.

The impact of maternal SARS-COV-2 infection in early stages of newborn neurodevelopment: preliminary results in a multicenter Spanish study

Introduction: The consequences for the COVID-19 pandemic in the newborns of affected mothers remains unknown. Previous clinical experiences with other infections during pregnancy lead to considered pregnant women and their offspring especially vulnerable for SARS-COV-2. That is, the underlying physiopathological changes caused by the infection (e.g. storm of cytokines, micro-coagulation in placenta or vertical transmission) could clearly compromise fetal neurodevelopment. Objective(s): To analyze the impact of maternal SARS-COV-2 infection during pregnancy in early neurodevelopment of infants gestated during the COVID-19 pandemic period compared to those gestated immediately prior (2017-2021). Method(s): 212 pregnant women (14% infected) were followed throughout their pregnancy and postpartum, including newborn development. SARS-COV-2 infection was serologically confirmed during pregnancy. The Brazelton Neonatal Assessment Scale (NBAS) was administered at 6 weeks old by a trained neonatologist to evaluate neurological, social and behavioral aspects of newborn's functioning. Differences in NBAS scores between cases and controls were tested by ANOVAs. All the analysis were adjusted for maternal age, sociodemographic status, anxious-depressive symptomatology, infant's sex and gestational age at birth and NBAS, and for the period of gestation (previous or during COVID-19 pandemic). Result(s): NBAS social interactive dimension was significantly decreased in those infants exposed to prenatal SARS-COV-2 (F= 4.248, p=.043), particularly when the infection occurred before the week 20 of gestation. Gestation during COVID-19 pandemic did not alter NBAS subscales. Conclusion(s): SARS-COV-2 infection during pregnancy seems to be associated with lower NBAS scores on social dimension in 6 weeks old exposed newborns.

EXPLORING THE GENOME-WIDE GENETIC OVERLAP BETWEEN ANXIETY AND FEAR DISORDERS

: Background: Twin studies have consistently shown a high genetic overlap amongst anxiety disorders and depression. Some research has also identified modest genetic specificity to fear-based anxiety disorders not shared with general anxiety. Identifying the genetic variants shared amongst all anxiety disorders or specific to one or more requires large sample sizes. Measuring anxiety disorders in large cohorts typically involves in-depth symptom-based diagnoses or minimally phenotyped single-item self-report diagnoses. A trade-off exists between maximising sample size and the level of detail in the phenotyping. Aims: First, to explore genetic correlations between generalised anxiety disorder (GAD) and the fear disorders (panic disorder, agoraphobia, specific phobia and social phobia) using a combination of in-depth and minimal phenotyping. Second, to compare the results from using minimal phenotyping of the anxiety disorders to that of in-depth phenotyping. Methods: We will use two case-only samples for analyses: the Genetic Links to Anxiety and Depression (GLAD) Study (∼N = 18,000) and the Australian Genetics of Depression Study (AGDS) (∼18,000). In addition, we will use three studies that provide both cases and controls: the COVID-19 Psychiatric and Neurological Genetics (COPING) study (N = ∼10,000), the QSkin study (N = ∼18,000) and the UK Biobank (N = ∼157,366). We will conduct three independent sets of case-control anxiety disorder genome-wide association studies (GWAS) before meta-analysing all five samples together (expected N cases ∼53,000, N controls ∼160,000). Results from GWAS meta-analyses of lifetime anxiety disorder, GAD, and fear-based disorders will be used to explore genetic correlations across anxiety disorders and depression and a wide range of complex traits. As sensitivity analyses, we will explore genetic correlations between anxiety phenotypes assessed using minimally phenotyped single-item diagnoses versus in-depth symptom-based diagnoses. Results: We hypothesise that the anxiety disorders will have a SNP-based heritability of approximately 15%. We also hypothesise that GAD and fear-based disorders will be moderately to highly genetically correlated, with some genetic variants that are specific to the fear disorders [1]. Disclosure: Nothing to disclose.

Sharing Lessons From Successes: Long-term Care Facilities That Weathered the Storm of COVID-19 and Staffing Crises

PURPOSE: To identify leadership styles and staffing strategies in Missouri long-term care (LTC) facilities that stood out among their peers as "positive deviants" with regard to COVID-19 infections and staffing shortages. METHODS: Statewide survey of all LTC facilities to identify exemplar facilities with stable staffing and low rates of COVID-19. Interviews with senior leaders were conducted in 10 facilities in the state to understand the strategies employed that led to these "positive outliers." A result-based educational program was designed to describe their actions and staff reactions. RESULTS: Exemplar leaders used transformational leadership style. Top reasons for their success were as follows: (1) trusting and supportive staff relationships;(2) positive presence and communication;and (3) use of consistent staffing assignments. Strong statewide participation was noted in the educational programs.

Return to University Classrooms With Blended Learning: A Possible Post-pandemic COVID-19 Scenario

After more than 2 years of the pandemic caused by COVID-19, a gradual return to face-to-face teaching has been taking place. Therefore, administrators need to establish procedures to facilitate and ensure the quality of teaching during this process. The purpose of this article is to describe the strengths and challenges of implementing Blended Learning (BL). The design used is consistent with a secondary investigation of a narrative review. As a result, several recommendations are presented for building institutional frameworks that enable the implementation of high-quality BL models in the context of a gradual return to face-to-face courses in higher education. From a theoretical and contextual perspective, considerations for transitioning to this model are discussed, based on lessons learned from emergency remote education. We conclude that the present post-pandemic scenario constitutes a pivotal moment for determining the way education is delivered in higher education.

Measuring College Students' Experiences with Virtual Education During the Pandemic by COVID-19

Due to the COVID-19 pandemic, young university students had to adjust to the emergency remote education provided by the online education modality. To know about the impact of this situation, the objective of this work was to validate the Scale of Experiences of University Students in Virtual Education (EEEV). A total of 2841 Chilean university students participated, with a mean age of 23.42 years (SD=7.72), of which 20% were engineering students. The EEEV arose from the adaptation of the questionnaire of expectations towards virtual education in university students during the COVID-19 pandemic, composed of six dimensions (Relationship with peers, Online learning, Online teaching, Self-efficacy for online learning, Online evaluation, and Comparison with face-to-face education). The psychometric properties of the EEEV version were verified. Validity estimations were performed using confirmatory factor analysis, finding a good fit, and maintaining the original version's factors. As for the dimensions, the internal consistency coefficient for the total scale was adequate. Therefore, it is concluded that the EEEV is a valid and reliable scale for measuring the experiences of university students in the context of emergency remote education.

Challenges, strategies and consequences for German nursing homes during the first wave of the COVID-19 pandemic. A qualitative interview study. (preprint)

Background The first wave of the COVID-19 pandemic reached Germany between March and May 2020. In order to contain the spread of the virus and particularly protect vulnerable people, the government imposed a lockdown in March 2020. In addition to infection control measures, such as hygiene and social distancing requirements, a general ban on access to nursing homes for relatives and external service providers was issued.Methods To investigate the challenges and consequences of the enacted infection prevention measures and specific strategies for nursing homes in Germany, a multicentre cross-sectional qualitative interview study with nursing home managers and ward managers was conducted. Recorded audio data were transcribed, analysed using thematic framework analysis and reflected in peer debriefings.Results 78 interviews with 40 nursing home managers and 38 ward managers from 43 German nursing homes were conducted. At organisational level, appointing a multi-professional crisis task force, reorganizing the use of building and spatial structures, continuous adaption and implementation of hygiene plans, adapting staff deployment to dynamically changing demands, managing additional communicative demands and relying on and resorting to informal networks were topics identified in response to the challenges posed by the pandemic. At direct care level, changed routines, taking over non-nursing tasks, increased medical responsibility, increased documentation demands, promoting social participation and increased communication demands were identified as topics in dealing with the challenges of the COVID-19 pandemic. Also various negative consequences were identified, such as psychological stress and negative emotional consequences. Positive emotional consequences such as a newly established team cohesion, the feeling of a calm atmosphere and a stronger sense of connection between nursing staff and residents were also reported.Conclusions The results of the described challenges, strategies and consequences allow recommendations as basis for possible approaches and successful adaptation processes in nursing home care in the future. There is also a need for local networks to act in a coordinated way and a need for quantitative and qualitative support for nurses, such as staff support as well as advanced nursing practice, to cope with the challenges of the pandemic.

THE IMPACT of COVID-19 on HCV MICRO-ELIMINATION in MSM in GERMANY

Background: Men who have sex with men (MSM) have been identified as one subgroup with continuous HCV transmission and as a target for HCV micro-elimination efforts. We assess newly acquired HCV among MSM in Germany since the introduction of directly-acting antiviral agents (DAAs). Methods: The German NoCo cohort consists of patients from six German HIV and hepatitis treatment sites providing care for more than 8000 HIV-positive MSM, and serving as primary care providers and HIV pre-exposure prophylaxis (PrEP) sites. Patients who were diagnosed with recently acquired HCV infection since 2014 were enrolled and are followed-up. Virologic data, HIV and HCV treatment data, risk factors and behavior as well as liver disease assessment is acquired regularly. Results: Between January 2014, and October 2021, 237 MSM with recently acquired HCV infection were included. A majority were Caucasian (95%), and mean age was 45.3 years (standard deviation, SD, 9.57). At HCV diagnosis, median ALT level was 224 U/L (interquartile range, IQR, 86-521), and median HCV viral load was 475,000 IU/mL (IQR 66,955-3,005,882). The most prevalent HCV genotype were 1a (58.7%), and 4d (16%). The risk factors for HCV acquisition were as follows: MSM: 92.4%, intravenous drug use: 2.95%, intranasal drug use: 0.8%, other: 0.4%, unknown: 7.2%. A subgroup of 21 (8.9%) MSM were not co-infected with HIV, of whom 15 (71.4%) were using PrEP. Anti-HCV treatment with DAAs was documented in 165 patients (71.7%), 18 (7.8%) had a spontaneous clearance, and in 47 patients (20.4%) treatment was not started. DAAs were initiated a median 6.6 months (IQR 4 to 9.3) after diagnosis;all treated patients achieved a sustained virologic response (SVR), or treatment was still ongoing (16%). Between 2014-2019 27-36 patients were diagnosed with recently acquired HCV annually. In relation to all HIV-positive MSM under care, the incidence was 0.33-0.39% per year with no significant change over time. In 2020, a decline in HCV incidence to 0.28% was observed. In 2021 HCV incidence dropped to 0.02%. In the same period, the number of patients seen in the centers remained stable, and routine HCV testing returned to pre-pandemic levels by the end of 2020. Conclusion: The German NoCo cohort demonstrated stable HCV incidence rates despite a broad use of DAAs. In 2021, however, micro-elimination goals were met, possibly due to behaviour changes related to the SARS-CoV-2 pandemic and associated containment measures.

MODELING IMPACT of the COVID-19 PANDEMIC on HEPATITIS C VIRUS ELIMINATION in the US

Background: Due to the COVID-19 pandemic, hepatitis C virus (HCV) treatment in the U.S. reduced by 30% in March 2020 and remained low throughout the end of 2020, but the impact on HCV elimination is unknown. We use modeling to estimate the impact of the COVID-19 pandemic on the likelihood of reaching the World Health Organization (WHO) and U.S. National Academies of Sciences and Engineering (NASEM) HCV elimination targets by 2030 (80% reduction in HCV incidence, 65% reduction in HCV mortality from a 2015 baseline). Methods: We developed a general population model that simulates HCV transmission and progression in the U.S. The model is stratified by age and risk (young adult (20-30 years) non PWID, young adult (20-30 years) PWID, adults (31-51 years), and older adults (≥ 52 years)), HCV disease stage, diagnosis, and treatment status. The model was calibrated to data from the literature on number of chronic infections in 2011 and 2018, number aware of their infection and number cured in 2018. The model was validated against U.S. Centers for Diseases Control estimates of new HCV infections in 2019. We used the calibrated model to simulate the impact on HCV incidence and HCV-related mortality from 2015-2030 with: (1) no disruption to treatment uptake from 2020 onwards;(2) 1-year reduction in treatment (by 30%) from 2020 (as observed in national data), and (3) 2-year reduction in treatment (by 30%) followed by return to status quo. Results: We estimated there were 67,267 (95%CI 23,433-114,471) new HCV infections in 2015. Under all scenarios the 80% incidence reduction target is missed (29.7% reduction by 2030 even with no disruption to treatment, even less impact with COVID disruptions). There are overall 990 (95% 417-1,330) additional new infections from 2015-2030 for the 1 year disruption, and 1,933 (95% 800-2,599) additional new infections for the 2 year disruption. Similarly, all projections fail to meet the mortality target by 2030, with an anticipated relative reduction in mortality of 30.6% (95% 21.7-38.4%) with a 1 year disruption. Conclusion: The U.S. was not on track to achieve the WHO and U.S. NASEM elimination targets pre-pandemic and has fallen further behind during the COVID-19 pandemic. Urgent scale-up of HCV diagnosis, treatment, and prevention is required.

Platelet Distribution Width and Increased D-Dimer at Admission Predicts Subsequent Development of ARDS in COVID-19 Patients.

In the current pandemic of coronavirus disease (COVID-19), the identification of the patients admitted with severe infection-who are disposed to a high risk of acute respiratory distress syndrome (ARDS) development, is of a major significance for the determination of the appropriate therapeutic strategy. Laboratory records in admission were retrospectively reviewed from 493 cases of severe COVID-19 divided into two groups: Group 1 with ARDS and Group 2 without ARDS. The platelet distribution width (PDW) difference between Group 1 and Group 2 is significant-15.10 ± 2.08 fl for those who developed ARDS versus 12.94 ± 2.12 fl for those without ARDS. The sensitivity and the specificity of this parameter is lower than that of D-dimer. After grouping of the PDW values into intervals and combining them with the rate of increase in D-dimer (D-PDWf index) to form a forecasting index, a significant increase in the specificity and sensitivity of the two parameters is identified-area under the ROC curve (AUC) is 0.874 for D-PDWf index, with respective AUC for PDW 0.768 and AUC for D-dimer 0.777. Conclusion: PDW is a significant predictive parameter at admission for subsequent development of ARDS in patients, with increased significance in combination with the degree of increase in D-dimer.

DEVELOPMENT OF A NATIONAL ACROSS SPECIALTY MULTI-DISCIPLINARY TEAM FOR MANAGEMENT OF HYPERINFLAMMATORY CONDITIONS DURING THE SARS-COV-2 PANDEMIC

Background/Aims Effective multi-specialty team working is extremely beneficial in management of children with hyper-inflammatory conditions. With the recognition of paediatric inflammatory multisystem syndrome (PIMS) it became apparent a standardised process for discussion of patients would be beneficial. This includes urgent discussion, with access to multiple specialties, and sharing knowledge and experience in a novel condition. Delivering equitable healthcare including access to expertise, specific treatments and research is challenging in Scotland due to its geography. This is facilitated by successful clinical networks (Scottish Paediatric & Adolescent Rheumatology Network [SPARN] and Scottish Paediatric& Adolescent Infection & Immunology National Managed Clinical Network [SPAIIN]) and a well-established paediatric transport service (ScotSTAR). Our aim was to develop a multi-specialty multi-disciplinary team (MDT) for management of patients with hyper-inflammatory conditions. Methods Narrative account of MDT and service development Results We identified a core group of individuals with an interest in inflammatory disorders from different centres and specialties across Scotland including Rheumatology, Infectious Diseases, Cardiology, Intensive Care, Academic Paediatrics, Pharmacists and Clinical Nurse Specialists. Three priorities emerged from initial planning stages: urgent discussions around patient management, peer-to-peer learning and information sharing, and effective prioritisation of research. We designed a written framework and referral pathway, including criteria for acute cardiology involvement, ScotSTAR transfer and intensive care. An electronic proforma was designed to guide MDT discussion, medicolegal documentation and audit purposes. Table 1 describes characteristics of the first nine patients discussed. A particular strength was in diagnostics and consideration of differentials;among patients referred we identified those with haematological malignancy, systemic lupus erythematosus and non-accidental injury. Regular peer-review sessions were held, for reflection on cases and their management in both secondary and tertiary care settings. Clinicians throughout Scotland were encouraged to join via SPARN and SPAIIN networks. Conclusion This multi-specialty MDT has been and continues to be beneficial for management of hyper-inflammatory patients. We will review the process but hope the MDT will prove to continue to be beneficial for future patients. The authors would like to acknowledge all members of the MDT. (Table Presented).

Discrimination of residents during neurosurgical training in Mexico: Results of a survey prior to SARS-CoV-2.

BACKGROUND: Recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic represents an important negative impact on global training of neurosurgery residents. Even before the pandemic, discrimination is a challenge that neurosurgical residents have consistently faced. In the present study, we evaluated discriminatory conditions experienced by residents during their neurosurgical training in Mexico before the SARS-CoV-2 pandemic. METHODS: An electronic survey of 18 questions was sent among residents registered in the Mexican Society of Neurological Surgery (MSNS), between October 2019 and July 2020. Statistical analysis was made in IBM SPSS Statistics 25. The survey focused on demographic characteristics, discrimination, personal satisfaction, and expectations of residents. RESULTS: A response rate of 50% (132 of 264 residents' members of MSNS) was obtained and considered for analysis. Median age was 30.06 ± 2.48 years, 5.3% (n = 7) were female and 16.7% (n = 22) were foreigners undergoing neurosurgical training in Mexico. Approximately 27% of respondents suffered any form of discrimination, mainly by place of origin (9.1%), by gender (8.3%) or by physical appearance (6.1%). About 42.9% (n = 3) of female residents were discriminated by gender versus 6.4% (n = 8) of male residents (P = 0.001); while foreign residents mentioned having suffered 10 times more an event of discrimination by place of origin compared to native Mexican residents (36.4% vs. 3.6%, P < 0.001). CONCLUSION: This manuscript represents the first approximation to determine the impact of discrimination suffered by residents undergoing neurosurgical training in Mexico before the SARS-CoV-2 pandemic.

Micro-elimination of hepatitis C in people who use injectable drugs along the USA-Mexico border: a modelling study

BACKGROUND: The prevalence of hepatitis C in people who use injectable drugs along the USA-Mexico border is very high (>90%). In 2019, the Mexican government committed to providing hepatitis C treatment with priority for people who use injectable drugs, people living with HIV, and people living in prison or jail, yet the immediate plan for prioritized treatment allocation and rollout remained unclear prior to the COVID-19 pandemic. Understanding which prevention and intervention strategies and at what level of scale-up can achieve the WHO goal of 80% incidence reduction by 2030 along the border is needed. METHODS: We adapted our previously published dynamic, deterministic model of hepatitis C transmission among people who use injectable drugs to determine the direct-acting antiviral treatment allocations in combination with harm-reduction interventions (opiate agonist therapy and needle and syringe programmes) needed to achieve the WHO elimination goal between 2021 and 2030. Our model is calibrated and parameterised to epidemiological data from Ciudad Juarez (where approximately 10 000 people who use injectable drugs reside and the seroprevalence of hepatitis C among people who use injectable drugs is 92%) and minimal harm reduction. FINDINGS: To reduce hepatitis C incidence by 80% between 2021 and 2030, 910 direct-acting antiviral treatments per 10 000 people who use injectable drugs in Ciudad Juarez per year are needed. Overall, fewer treatments are required if combined with harm reduction. If opiate agonist therapy and needle and syringe programmes are scaled-up to 50%, approximately 30-40% fewer people who use injectable drugs would need to be treated each year (650 direct-acting antiviral treatments per 10 000 people who use injectable drugs per year). Between 2021 and 2030, using direct-acting antivirals alone, an estimated total of 8190 people who use injectable drugs in Ciudad Juarez would need to be treated, compared with 6255 (nearly 25%) fewer people who use injectable drugs overall if treatment is scaled-up alongside 50% of opiate agonist therapy and needle and syringe programmes combination intervention coverage. INTERPRETATION: Hepatitis C treatment with direct-acting antivirals should be prioritised for people who use injectable drugs along the USA-Mexico border and progress towards hepatitis C elimination should be monitored. Regional hepatitis C micro-elimination among people who use injectable drugs could be possible if national treatment allocations are prioritised and distributed to people who use injectable drugs as planned and in the presence of essential harm-reduction programmes. FUNDING: National Institutes of Health;Fogarty International Center grant D43TW009343;and National Institute of Allergy and Infectious Diseases and National Institute on Drug Abuse grant R01AI147490.

A national open-access research registry to improve recruitment to clinical studies.

INTRODUCTION: Barriers to recruitment for dementia studies are well documented. As part of the UK government's Dementia 2020 strategy, a nationally consistent system to increase public engagement and participation in research was launched in February 2015. METHODS: We describe the development of the "Join Dementia Research" registry, including evolution of policy, involvement of people with dementia in co-production, data requirements, governance, technology, and the impact on study recruitment and what factors may have contributed to the services success. RESULTS: The UK-wide online, telephone, and postal service has registered 47,071 volunteers, with 33,139 people (67.9% of all volunteers) taking part in 378 studies, with 49,954 total study enrolments. This has taken place across 295 research sites, involved 1522 researchers, and resulted in 134 peer-reviewed publications. DISCUSSION: Public registries of individuals interested in research, with user-provided data enabling basic phenotyping, are effective at increasing public engagement with research and removing barriers to study recruitment. Deeper pheno/genotyping could be undertaken to improve matching, but how and when that information is collected will be a key factor.