Initiating Home Parenteral Nutrition Therapy in a Patient at High Risk of Refeeding Syndrome After COVID-19 Infection

Background: An emerging finding about COVID-19 is its effect on nutrition and weight loss. The COVID-19 symptoms of fatigue, altered taste or smell, and lack of appetite are well known. But COVID-19 may have a more profound effect on clinical nutrition status. Two recent studies have identified that approximately one-third of ambulatory COVID-19 patients are at risk of experiencing weight loss >= 5% (Anker, et al;di Filippo, et al). The case study presented here discusses home start total parenteral nutrition (TPN) in a patient recently diagnosed with COVID-19 at high risk for refeeding syndrome. Method(s): N/A Results: Case Study: A 92-year-old patient was diagnosed with COVID-19 on June 8, 2022. Over the next week, she was hospitalized twice to manage symptoms of acute mental status changes, lethargy, aphasia, hypotension, and loss of appetite. The patient received nirmatrelvir/ritonavir, remdesivir, and bebtelovimab to treat COVID-19 at different times between June 9, 2022, and June 18, 2022. She remained COVID positive and continued to deteriorate clinically. On June 20, 2022, the patient began receiving 24/7 homecare, including intravenous (IV) fluids of dextrose 5% in normal saline (D5NS) 1000 mL daily for three days. She continued to experience loss of appetite and had no bowel movement for 3 days. On June 23, 2022, she was referred to this specialty infusion provider to initiate TPN therapy in the home setting. The patient's BMI was 18.2 kg/m2. Lab results revealed potassium 3.0 mmol/L, phosphate 1.6 mg/dL, and magnesium 1.6 mg/dL. High risk of refeeding syndrome was identified by the level of hypophosphatemia and hypokalemia. The specialty infusion provider's registered dietitian recommended to discontinue D5NS and begin NS with added potassium, phosphate, and magnesium. Thiamine 200mg daily was added to prevent Wernicke's encephalopathy. The patient's clinical status and lab values were monitored closely each day until her electrolyte levels stabilized (Table 1). Home TPN therapy was initiated on June 28, 2022, with <10% dextrose and 50% calorie requirement with 85% protein and 1.0 g/kg lipids. Three-day calorie count and nutrition education were performed four days post TPN initiation. Oral intake met only 25% of estimated needs. Over several days, theTPN formula was gradually increased to goal calories and the infusion cycle was slowly decreased. The following week, the patient's oral intake improved to 60%-75% of estimated needs. Her constipation resolved, and she showed improvement in functional status and mobility. Her appetite drastically improved when the TPN was cycled. Another three-day calorie count was performed when TPN calories reached goals. Oral intake demonstrated 100% estimated calorie and protein needs. TPN therapy was ultimately discontinued on July 14, 2022. As of September 30, 2022, the patient has stabilized at her pre-COVID weight of 45 kg with full recovery of appetite, function, and cognition. Discussion(s): The ASPEN Consensus Recommendations for Refeeding Syndrome (da Silva, et al) describe the repletion of electrolyte levels before introducing calories to prevent end-organ damage associated with refeeding syndrome (respiratory muscle dysfunction, decreased cardiac contractility, cardiac arrhythmias, and encephalopathy). Conclusion(s): This case study highlights the successful initiation of home TPN therapy in a patient at high risk of refeeding syndrome post COVID-19 infection. Although home start TPN and the risk of refeeding syndrome are not new concepts, they must be considered in the setting of COVID-19. Given the effects COVID-19 has on taste, smell, and appetite and the recent finding that one-third of patients with COVID infection may experience weight loss of >= 5%, nutrition support and patient education are vital components of overall patient care. (Figure Presented).

Smartwatch-based ecological momentary assessments for occupant wellness and privacy in buildings

This paper describes the adaptation of an open-source ecological momentary assessment smartwatch platform with three sets of micro-survey wellness-related questions focused on i) infectious disease (COVID-19) risk perception, ii) privacy and distraction in an office context, and iii) triggers of various movement-related behaviors in buildings. This platform was previously used to collect data for thermal comfort, and this work extends its use to other domains. Several research participants took part in a proof-of-concept experiment by wearing a smartwatch to collect their micro-survey question preferences and perception responses for two of the question sets. Participants were also asked to install an indoor localization app on their phone to detect where precisely in the building they completed the survey. The experiment identified occupant information such as the tendencies for the research participants to prefer privacy in certain spaces and the difference between infectious disease risk perception in naturally versus mechanically ventilated spaces. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.

Elastic buildings: Calibrated district-scale simulation of occupant-flexible campus operation for hybrid work optimization

Before 2020, the way occupants utilized the built environment had been changing slowly towards scenarios in which occupants have more choice and flexibility in where and how they work. The global COVID-19 pandemic accelerated this phenomenon rapidly through lockdowns and hybrid work arrangements. Many occupants and employers are considering keeping some of these flexibility-based strategies due to their benefits and cost impacts. This paper explores how demand-driven control strategies in the built environment might support the transition to increased workplace flexibility by simulating various scenarios related to the operational technologies and policies of a real-world campus using a district-scale City Energy Analyst (CEA) model that is calibrated with measured energy demand data and occupancy profiles extracted from WiFi data. These scenarios demonstrate the energy impact of ramping building operations up and down more rapidly and effectively to the flex-based work strategies that may solidify. The scenarios show a 5–15% decrease in space cooling demand due to occupant absenteeism of 25–75% if centralized building system operation is in place, but as high as 17–63% if occupancy-driven building controls are implemented. The paper discusses technologies and strategies that are important in this paradigm shift of operations. © 2023 The Author(s)

Methane emissions decline from reduced oil, natural gas, and refinery production during COVID-19d

In the summer of 2020, the AVIRIS-NG airborne imaging spectrometer surveyed California's Southern San Joaquin Valley and the South Bay (Los Angeles County) to identify anthropogenic methane (CH4) point source plumes, estimate emission rates, and attribute sources to both facilities and emission sectors. These flights were designed to revisit regions previously surveyed by the 2016-2017 California Methane Survey and to assess the socioeconomic responses of COVID-19 on emissions across multiple sectors. For regions flown by both the California Methane Survey and the California COVID campaigns, total CH4 point source emissions from the energy and oil & natural gas sectors were 34.8% lower during the summer 2020 flights, however, emission trends varied across sector. For the energy sector, there was a 28.2% decrease driven by reductions in refinery emissions consistent with a drop in production, which was offset in part with increases from powerplants. For the oil & natural gas sector, CH4 emissions declined 34.2% and significant variability was observed at the oilfield scale. Emissions declined for all but the Buena Vista and Cymric fields with an observed positive relationship between production and emissions. In addition to characterizing the short-term impact of COVID-19 on CH4 emissions, this study demonstrates the broader potential of remote sensing with sufficient sensitivity, spatial resolution, and spatio-temporal completeness to quantify changes in CH4 emissions at the scale of key sectors and facilities. © 2023 The Author(s). Published by IOP Publishing Ltd.

Evaluation of Tocilizumab on Clinical Outcomes in Critically Ill Patients with Covid-19

INTRODUCTION: Markedly elevated pro-inflammatory cytokines, including interleukin-6 (IL-6), are associated with severe COVID-19. Blocking inflammation may prevent disease progression. Tocilizumab is a monoclonal antibody that reduces inflammation by blocking the IL-6 receptor, potentially having an impact on improving outcomes in patients with COVID-19. The objective of this study was to evaluate the use of tocilizumab in critically ill patients with COVID-19. METHOD(S): This multicenter, retrospective study included adults admitted to an intensive care unit (ICU) with severe COVID-19 from June 2020 to November 2021. Patients were placed into two groups: those who received one dose of tocilizumab in addition to dexamethasone, and those who received dexamethasone alone. Patients were matched on age, sex, C-reactive protein (CRP) level, and time from symptom onset to hospitalization. The primary endpoint was hospital length of stay (LOS). Secondary endpoints were ICU LOS, in-hospital all-cause mortality, number of mechanically ventilated days, and incidence of secondary infections. RESULT(S): 120 patients were included (60 patients per group). The mean age was 57 years old, 60% were male, and the median time from symptom onset to hospitalization was 7 days. The median CRP level in the tocilizumab + dexamethasone group vs the dexamethasone group was 140.6 and 143 mg/L, respectively. The median hospital LOS was 11 days (IQR 8-17) in the tocilizumab + dexamethasone group vs 13 days (IQR 8 - 22.8) in the dexamethasone group. In-hospital all-cause mortality occurred in 17 patients (28%) in the tocilizumab + dexamethasone group vs 16 patients (26%) in the dexamethasone group. Of the 26 patients in the tocilizumab + dexamethasone group and 24 patients in the dexamethasone group that were mechanically ventilated, the median number of mechanically ventilated days was 10 (IQR 5 - 18.3) vs 10.5 (5 - 18.8), respectively. Secondary infections were similar in both groups. CONCLUSION(S): In this retrospective study evaluating tocilizumab in addition to dexamethasone for severe COVID-19 treated in the ICU, tocilizumab did not show a benefit in clinical outcomes. Given the size of the study and its limitations, these findings should be interpreted with caution and require confirmation by larger studies.

"WORKSHOP ASSISTANTS: THE SECRET SAUCE OF VM WORKSHOPS”

In the advent of COVID, the value industry has found a new way of conducting value studies in the virtual environment which presents opportunities for developing innovative approaches, new skillsets, new tools, and consequently new and/or expanding roles and responsibilities for participants. As part of this adaptation, the role of Workshop Assistant has changed and taken on a more important role in value studies than ever before. The Workshop Assistant today serves several functions-administrative, technical and co-facilitation-to provide immense value (function/resources) during all stages of a value study. This paper focuses on the role of Workshop Assistant as featured through the lens of SAVE International's Core Competencies with the nuances for both in-person and virtual value studies highlighted. The Workshop Assistant supports a group to improve how it identifies and solves problems, supports the CVS Facilitator, and increases the group's effectiveness. © SAVE International 2022 Value Summit Proceedings: Turning Up the Heat on Value. All Rights Reserved.

Long COVID Awareness and COVID-19 Preventive Behaviors among Women

Background: ''Long COVID'' a condition that occurs when individuals with a confirmed COVID-19 infection experience long-term effects which cannot be explained by an alternative diagnosis, primarily affects women. Women are frequently the decision makers regarding health-related actions in their families;therefore, their intent to carry out health-related behaviors is likely to affect the adoption of health behaviors for their families as well. To date, only 51% of U.S. adults indicated that they were somewhat or very worried about Long COVID. Since the most likely way to prevent Long COVID is to prevent COVID-19 (re)infection, COVID-19 preventive measures may also help prevent the spread of Long COVID. Objective(s): In a sample of women, examine associations among demographics, COVID-19 diagnosis/COVID-19 vaccination status, Long COVID-related beliefs, and willingness to carry out preventive behaviors. Method(s): Panel survey firm Qualtrics was used to recruit a sample of N= 311 English-speaking U.S. women. The Health Belief Model (HBM) was used as a theoretical lens. Result(s): Black women were more likely to comply with COVID-19 protective measures of wearing masks (p < .001) and testing before attending an event (p = .049) than White women. Among this sample of women, HBM constructs added significantly to the regression models, especially susceptibility to Long COVID and self-efficacy to wear a mask and test for COVID-19. In addition, perceived benefits of mask-wearing (p < .001), testing before an event (p = .002), and getting a vaccine booster (p = .001) predicted intent to carry out these actions. Perceived severity of Long COVID did not significantly predict adherence to preventive behaviors. Conclusion(s): Further education is needed on the severity of Long COVID and its potential consequences. Public health messaging about Long COVID may be an effective means of increasing COVID-19 preventive behaviors that are effective against both COVID-19 and Long COVID.

Leading through crisis

The COVID-19 pandemic, societal racial reckonings, and pressure from parents and the media have put education leaders in a crisis. Carole Learned-Miller of the Leadership Academy in New York spoke with school and education organization leaders who saw their organizations through a variety of challenges, including the pandemic, racial inequities, a teacher strike, and a financial crisis. These leaders shared some of the principles that helped them through. These include building relationships, communicating clearly, listening to other views, having trusted advisers, being true to their values, and staying hopeful. Leaders describe how these principles helped them weather difficult times.

Reducing harm from Covid-ICU proning related peripheral neuropathies - Comparing patient outcomes for 2020 and 2021 surges and recommendations for future care

Introduction: Prone positioning is commonly used when treating ventilated Covid-19 patients. Whilst there have been some reports of ICU proning-related injuries to the brachial plexus well before the pandemic (Goettler et al. 2002), it is usually a very uncommon complication. Despite guidance from the Faculty of Intensive Care Medicine on the care of the proned patient, cases of peripheral neuropathies following ICU admission have significantly increased during the Covid-19 pandemic at our centre (Miller et al. 2021). Nerve injury is associated with reduced quality of life, impaired activity participation and persistent pain (Bailey et al. 2009). Objectives: The aim of this quality improvement project was to identify the effect that new guideline development and related healthcare professional education had on the number and severity of peripheral neuropathies identified following Covid-19 ICU admission. Methods: Between March 2020 and May 2021, we collected clinical data from patients who sustained peripheral neuropathies during their inpatient stay for Covid-19. Data were collected via face-to-face patient assessments within acute nerve clinics or post-ICU rehabilitation wards. A grading system was used to categorise the peripheral nerve injuries into severe, intermediate and mild (Power et al. 2020). Electronic ICU clinical noting was examined to identify the frequency and duration of each proning episode for each patient who presented with nerve injury. Following the first surge in 2020 updated proning guidelines were developed with ICU team leaders and disseminated. This involved face-to-face education of frontline staff. Results: At our centre 93 patients survived Covid ICU between March -June 2020 (surge 1) and 21 of those sustained nerve injury (22.58%). 309 patients survived Covid ICU between September 2020 -May 2021 (surge 2) and 12 of those sustained nerve injury (3.88%). For patients who sustained nerve injury, the average number of prones changed between surges from 6 to 13. The average duration of each episode of proning changed from 17.8hrs to 18.6hrs. Despite the increase in prone frequency, nerve injury occurrence reduced (proportionate to the number of patients who survived Covid ICU) by 82%. 14/21 (66%) injuries acquired in the first surge were of high grade and 4/ 12 (33%) were of high grade during the second surge. Conclusion: Optimising positioning of the proned ventilated patient may reduce the incidence of nerve injury. However, we must also acknowledge that changes in medical management between surges (i.e. use of dexamethasone, remdesivir) may have contributed to this. Individuals still developed severe injury despite this change in practice. Further research looking into risk factors and further methods of optimising the prone positioning on ICU is warranted to reduce the occurrence of this potentially life-changing injury.

Marathon not a Sprint: ECMO as a Bridge in COVID-19 associated ARDS, A Single Center Experience

Background: The COVID-19 pandemic has led to a significant increase in the use of Veno-venous extracorporeal membrane oxygenation (VV ECMO) as a bridge to various outcomes including transplantation or recovery. Unlike other etiologies of acute respiratory distress syndrome (ARDS), utilization of VV ECMO in COVID-19 has been associated with longer duration of ECMO support requirements. Our team sought to evaluate outcomes associated with prolonged duration of ECMO support in this patient population. Methods: Single-center retrospective review of patients who were placed on ECMO due to COVID-19 associated ARDS. Specifically examining outcomes-mortality, transplantation and discharge rates-of patients requiring VV ECMO support more than 50 days in duration. Data collected between February 15,2020 to February 15, 2022. Results: Reviewed outcomes in 18 patients who required VV support for >50 days. Twenty three percent (n=4) mortality rate within cohort. Three patients (16%) continue to require ECMO support at time of submission. Sixty-one percent (n=11) patients were discharged, of which sixteen percent (n=3) required a lung transplant (Table). Summary: Prolonged VV ECMO at our center was associated with comparable outcomes to the national ELSO pulmonary ECMO cohort. With availability of device and staffing, prolonged ECMO runs can potentially be justified in a highly selected patient population (Table Presented).

SUCCESSFUL IMPLEMENTATION OF CASE FINDING FOR HEPATITIS C IN PEOPLE DETAINED IN POLICE CUSTODY

Introduction As part of the national Hepatitis C (HCV) elimination strategy, NHS England aims to eliminate HCV by 2025. As part of this programme, identifying undiagnosed cases through HCV testing is critical. Unfortunately, the global COVID 19 pandemic led to a reduction in HCV testing in England, potentially slowing progress towards elimination. To mitigate the impact of this, innovative ways of increasing HCV testing are required. Individuals detained in police custody have higher rates of injecting drug use than the general population and may therefore be at risk of HCV transmission. Police custody suites may therefore provide an opportunity to offer HCV testing to 'at risk' individuals. In collaboration with local police custody healthcare staff, we developed a pilot of HCV testing for individuals in police custody. Here we describe the outcomes of this pilot Methods Since 01/07/2021, all individuals presenting to Northumbria police custody suites who were reviewed by a healthcare professional were offered Dried Blood Spot test (DBS) for HCV Antibody/RNA, HIV and HBsAg. Individuals were excluded if they were <16 years of age or alleged perpetrators of sexual violence. The Newcastle HCV team were responsible for informing people of their results and establishing those with a positive HCV result on a treatment pathway. Results Of the 3116 people in police custody identified as eligible to be offered BBV testing (See figure 1), 193 accepted (6%). A total of 19 were HCV Ab positive (10% of total individuals tested) and of these 12 were HCV RNA detected (63.0% of HCV Ab positive and 6% of total individuals tested). No cases of HIV or hepatitis B were identified. 137 (71.0%) individuals were negative for all BBV's. Unfortunately, 37 (19%) samples could not be processed by the lab due to insufficient samples (19.0%). This was identified as a training issue and addressed by senior custody suite staff. of the 12 cases of active HCV identified, 5 have commenced HCV antiviral treatment, 6 are awaiting treatment and 1 person is awaiting retesting as the result was 'weak positive'. of the 7 individuals who were HCV Antibody positive but RNA negative, 3 had self-cleared, 3 were known to have received antiviral treatment and achieved a sustained virological response and 1 patient was currently on treatment. Conclusions The pilot demonstrated that HCV screening can successfully be implemented into the police custody suites, leading to a diagnosis of active HCV in 6%. Wider implementation of this strategy could help progress towards HCV elimination.

Traveling tunable laser projector for UV-blue disinfection dose determinations.

As the COVID-19 pandemic was overtaking the world in the spring of 2020, the National Institute of Standards and Technology (NIST) began collaborating with the National Biodefense Analysis and Countermeasures Center to study the inactivation of SARS-CoV-2 after exposure to different ultraviolet (UV) and blue light wavelengths. This paper describes a 1 kHz pulsed laser and projection system used to study the doses required to inactive SARS-CoV-2 over the wavelength range of 222 to 488 nm. This paper builds on NIST's previous work for water pathogen inactivation using UV laser irradiation. The design of the laser and projection system and its performance in a Biosafety Level 3 (BSL-3) laboratory are given. The SARS-CoV-2 inactivation results (published elsewhere by Schuit, M.A., et al., expected 2022) demonstrate that a tunable laser projection system is an invaluable tool for this research.

Pushing Geographical Boundaries: Interfacility Transport and Remote ECMO Cannulation of Patients during COVID Pandemic

Purpose of study: Due to the high incidence of ARDS in those with COVID-19, ECMO centers began utilizing this therapy in early phases of the pandemic. Although receiving care at a high volume ECMO center has been associated with improved mortality amongst this patient population, there are significant obstacles associated with providing this service to those residing far from such centers. Amidst a pandemic, these challenges are compounded. Our urban, academic medical center serves as one of the highest volume ECMO referral centers in the Southeastern United States;amidst the pandemic we expanded our geographical boundaries to provide aid to those in need. Authors sought to describe characteristics of patients transported, evaluate for potential predictors of treatment success and to review our remote cannulation training and process. Additionally to identify transport associated challenges and lessons learned. Methods: Retrospective case series of critically ill, adult patients (≥18 years of age) with laboratory-confirmed COVID-19 transported to our medical center by our ECMO transport team from March 24, 2020 through June 8, 2021. Our team examined: age, gender, body mass index, ratio of arterial partial pressure to fractional inspired oxygen (P/F ratio);duration of mechanical ventilation, ECMO support and ICU admission. Descriptive statistics including mean, standard deviation, ranges, median, percentages and associated interquartile ranges (IQR) were used. Summary of results: 63 adult patients admitted to the Intensive Care Unit (ICU) with COVID associated ARDS requiring ECMO support were admitted to our ECMO center. The mean age of those transferred was 44 years old [SD 12;IQR 36-56] (Table 1). Fifty nine percent [n=37] of patients were male, fifty two percent [n=33] were African American, and the average body mass index (BMI) of our cohort was 39.7 [SD 11.3;IQR 31-48.5]. Medical history of hypertension and diabetes were commonly noted in forty six and twenty four percent of patients respectively (Table 1). All but one patient [n=62] required mechanical ventilation during their hospitalization. The majority of patients [77.8%;n=35] had severe ARDS -defined as P/F ratio less than 100-on transfer. Median days of admission and mechanical ventilation at the time of ECMO initiation were 8 days [IQR 5-12] and 4 days [IQR 2-6] respectively. Majority of patients [92% n=58] were transferred from facilities outside of our healthcare system and via ambulance [98.3% n=57]. Amidst those, eighty seven percent [n=55] were remotely cannulated (Table 2). Transport distances ranged from 2.2 to 236 miles [median 22.5 miles;IQR 8.3-79] and round trip transport times-not including time for pre cannulation preparation, cannulation, initiation of ECMO support and preparing patients for transport-ranged from 18 to 476 minutes [median 83 min;IQR 44-194]. Median duration of ECMO support was 17 days [IQR 9.5-34.5]. Duration of mechanical ventilator support was a median of 24 days [IQR 14-34]. Length of stay in the intensive care unit (ICU) [median 36 days;IQR 17-49] and hospital [median 39 days;IQR 25-57] varied. Amongst those discharged thus far, sixty percent survived [n=31]. Twenty nine percent percent [n=10] were discharged to their homes, fifty three percent [n=18] to rehabilitation facilities and nine percent [n=3] were back to the referral medical centers for continuation of care once they were determined to no longer have need for ECMO or transplantation. The majority of factors evaluated were not found to be statistically significant predictors of treatment success. Although ICU and hospital duration were noted to have p-values of significance, the associated odds ratios and small sample size make true clinical significance difficult to interpret.

SARS-CoV-2 inactivation by ultraviolet radiation and visible light is dependent on wavelength and sample matrix.

Numerous studies have demonstrated that SARS-CoV-2 can be inactivated by ultraviolet (UV) radiation. However, there are few data available on the relative efficacy of different wavelengths of UV radiation and visible light, which complicates assessments of UV decontamination interventions. The present study evaluated the effects of monochromatic radiation at 16 wavelengths from 222 nm through 488 nm on SARS-CoV-2 in liquid aliquots and dried droplets of water and simulated saliva. The data were used to generate a set of action spectra which quantify the susceptibility of SARS-CoV-2 to genome damage and inactivation across the tested wavelengths. UVC wavelengths (≤280 nm) were most effective for inactivating SARS-CoV-2, although inactivation rates were dependent on sample type. Results from this study suggest that UV radiation can effectively inactivate SARS-CoV-2 in liquids and dried droplets, and provide a foundation for understanding the factors which affect the efficacy of different wavelengths in real-world settings.

A sustainable outpatient transformation project for metabolic stone assessment: A specialist stone nurse led non-face-to-face (F2F) clinic

Introduction: Recent NHSEI policy and the COVID-19 pandemic are increasing the proportions of consultations occurring non-face-to-face (F2F). Here we describe a nurse-led non-F2F clinic for the metabolic assessment of kidney stone patients. Method: A metabolic assessment may be indicated in patients forming urate stones, CaPO4 stones, or recurrent stones or with clinical features suggesting a metabolic cause. In otherwise uncomplicated clinical scenarios, these patients are reviewed in a non-F2F clinic run by an endo-urological specialist nurse. A stone history is taken by telephone. Blood tests are arranged in primary care. A collapsible 24-hour urine collection container is posted to the patient and returned via the primary care sample collection service. The cases are reviewed at the Metabolic Stone MDT by the nurse, nephrologist and urologist. Results: A total of 145 patients were eligible with six DNAs, leaving 139 patients reviewed through the non-F2F clinic between March 2020 and June 2021. Demographics were 81 males: 58 females, age range 17-83. About 126 of 139 (91%) patients completed the tests, which is a significantly higher rate than completion rates typically reported. Stone analysis was also available in 97 patients (28 CaOx;54 CaPO4;15 urate). Around 102 patients (81%) were discharged with dietary advice, while 24 patients (19%) were referred for consultant review. Two patients had primary hyperparathyroidism. Nineteen patients had hypercalciuria, all requiring consultant review. Conclusion: Nurse-led non-F2F review streamlines the metabolic assessment of stone-formers, reducing the need for hospital attendances and reducing consultant workload.

INFANTS WITH HYPERBILIRUBINEMIA PRESENTING TO THE EMERGENCY DEPARTMENT IN THE COVID-19 ERA

Purpose of Study Amidst the COVID 19 pandemic, hospitals implemented changes in labor and delivery practice, including limiting maternal and neonatal length of stay. A key aspect of neonatal care during the first few days of life is trending bilirubin. Modifications in newborn length of stay may lead to premature infant discharge before bilirubin rises enough to require phototherapy. The purpose of this study is to determine if there was a significant increase in the number of neonates presenting to our Emergency Department and admitted for hyperbilirubinemia in the COVID 19 era. Methods Used A retrospective chart review of infants 0-7 days old presenting to the Emergency Department (ED) with jaundice from March 01-November 01 of 2017, 2018, 2019 and 2020 was completed. Data collected included gestational age, day of life (DOL) at presentation, peak serum bilirubin level, presence of hyperbilirubinemia and neurotoxic risk factors, and length of stay (LOS). Chi square and t-tests determined differences between the study periods. Logistic regression was used to describe associations between COVID era and management of hyperbilirubinemia after adjusting for gestational age and peak serum bilirubin. Summary of Results Our analysis included 209 infants, 144 from the pre-pandemic period (48/year) and 65 after the onset of the pandemic. There was a statistically significant increase in the number of infants presenting to the ED with hyperbilirubinemia in the COVID era (p=0.04, table 1). A larger proportion of infants presenting with hyperbilirubinemia were admitted in the COVID era (41% vs 20%, p=0.001). A higher percentage of patients had a LOS of 2 or more days in the COVID era as compared to pre-pandemic (21.5% vs 6.3%, p=0.001). After adjusting for gestational age or peak serum bilirubin, infants presenting to the ED with hyperbilirubinemia had higher odds of being admitted (OR 2.8, 95% CI 1.5-5.2) and having a LOS of 2 or more days (OR 3.5, 95% CI 1.5-9.9). Conclusions Our study indicates that the number of patients presenting to the emergency department with hyperbilirubinemia in the first week of life increased following the onset of the pandemic. These patients had a higher likelihood of admission and longer length of stay compared to pre-pandemic visits. While some of these results may be attributable to earlier post-partum discharge, this was not due to variations in gestational age or peak bilirubin levels. Further studies show examine causes for these changes, particularly around decisions to admit infants with hyperbilirubinemia and the inability to perform home nursing visits during the early days of the pandemic. (Table Presented).

Mental health and coping during COVID-19 among cancer patients and survivors

Background and Purpose: Until a vaccine is widely available, adherence to COVID-19 preventive behaviors is the most effective way to prevent the spread of the COVID-19 pandemic. While there is a general paucity of information on COVID-19 infection and its impact on cancer patients, immunocompromised individuals, such as cancer patients, are likely at greater risk for both COVID-19 morbidity and mortality. In addition, a cancer diagnosis can cause stress, anxiety, depression, psychological distress, and poor quality of life. While the recommendations for COVID-19 parallel the common recommendations for managing infection risk, the enhanced social isolation and limited social distancing can be even more difficult for patients resulting in increased risk for psychological distress and deteriorations in health outcomes. Depressive disorders frequently result in substantial functional impairment, as well as increased emotional, economic, and productivity costs. It is important to understand how the COVID-19 pandemic impacts psychological and psychosocial factors, as well as health behaviors of cancer patients and survivors, and how various contextual factors may play risk and protective roles. The purpose of this study, therefore, is to determine differences in stress, mental health and coping behaviors, and adherence to COVID-19 preventive behaviors during the COVID-19 pandemic among three groups of adults (in active cancer treatment, cancer survivors, and those without a history of cancer). This study focuses on determining how sociodemographic characteristics and cancer status influence COVID-19 mental health/coping mechanisms, as well as how mental health/coping mechanisms and cancer status may predict adherence to preventive COVID-19 behaviors. Methods: Panel survey firm Qualtrics was used to administer an online survey among 897 U.S. adults in May of 2020. Quota sampling was utilized to ensure a sample consisting of approximately one-third: cancer patients currently in treatment (32.0%, n = 287), cancer survivors not currently in treatment (33.6%, n=301), and respondents with no cancer history (34.4%, n = 309). Survey items assessed demographic variables, depression, coping, and adherence to COVID-19 preventive behaviors. Results and Discussion: Preliminary analyses show that cancer patients report higher levels of depressive symptoms than survivors and the control group. In addition, cancer patients in active treatment use both avoidance and approach-focused coping more frequently than both survivors and the control group. Regression analyses show that avoidance coping predicts lower adherence to COVID-19 preventive behaviors, while approach-focused coping predicts higher adherence. Analyses are ongoing.

An examination of COVID-19-related preventive behaviors by cancer status

Purpose: To determine patterns of and factors associated with COVID-19-related preventive behaviors practiced by cancer survivors. Methods: Participants (N=897) were recruited through a commercial survey administration and sampling company, Qualtrics, in June 2020. Quota sampling was utilized to ensure the sample would consist of approximately one-third of cancer patients currently in treatment, one-third of cancer survivors not currently in treatment, and one-third of individuals without a history of cancer. Survey items collected information on socio-demographic characteristics (age, gender, race, and education attainment) and COVID-19-related preventive behaviors in the past week. Eight items focused on handwashing, avoiding contact with sick people, staying home when feeling sick, respiratory hygiene, avoiding touching face, social distancing, avoiding large gatherings, and wearing a mask were reported on a 4-point Likert scale (never to frequently). Differences between groups were assessed using one-way ANOVAs with Tukey post hoc tests. Results: Respondents were 49.6 years (SD=17.3) on average, 51.6% female, and 48.9% had a Bachelor's degree or higher education attainment. Most respondents were White (66.7%), with 16.8% Black and 16.5% Hispanic participants. Those with no history of cancer were more likely to avoid someone ill (p<.01) and stay home when sick (p<.001) than cancer survivors not currently in treatment. However, survivors were less likely to stay home when sick than cancer patients in treatment (p=001) and less likely to avoid touching their face (p<.05) than those with no cancer history. Analyses are ongoing and will explore factors related to COVID-19 preventive behaviors within each group. Conclusions: There are differences in COVID-19-related preventive behaviors by cancer status. Future research should examine the factors underlying these differences and adapt prevention efforts using this information.