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Intro: The US CDC recommends that COVID-19 vaccines may be coadministered with other age-appropriate vaccines. There is limited data assessing outcomes, including reactogenicity, on such co-administration. For the first time, we present interim safety data of RZV administered concomitantly or sequentially with an mRNA-1273 booster vaccine. Method(s): In this phase 3, randomized, open-label, multi-center study (NCT05047770), adults aged >=50 years were randomized 1:1 to receive the first RZV dose with mRNA-1273 booster (50 mug) at day 1 and the second RZV dose at week (W)8 (Co-Administration group [Co-Ad]), or mRNA-1273 at day 1, the first RZV dose at W2 and the second RZV dose at W10 (Sequential group [Seq]). Descriptive analyses of solicited/unsolicited adverse events (AEs) with onset within 7/30 days post-mRNA-1273 or first RZV dose, and of serious AEs/potential immune-mediated diseases/AEs of special interest (SAEs/pIMDs/AESIs) reported until database freeze are reviewed. Finding(s): The exposed set comprised 267 (Co-Ad) and 272 (Seq) participants. In each group, most solicited AEs were mild/moderate in intensity and each with <=2.5 days median duration, the most frequent were injection site pain, myalgia, and fatigue. Unsolicited (vaccines-related) AEs were reported by 25.0% (2.9%) of participants post-mRNA-1273 in Seq, 25.2% (0.8%) post-RZV in Seq, and 37.1% (3.7%) in Co-Ad. SAEs/pIMDs/AESIs were reported for 6/1/2 participants in Co-Ad and 5/1/3 in Seq. In Seq, one SAE/AESI (pulmonary embolism) and one pIMD/AESI (cutaneous vasculitis) occurred 2 and 9 days postmRNA-1273 (before RZV administration), respectively, and were considered mRNA-1273-related by investigators. In Co-Ad, one AESI (chronic hepatitis) occurred 35 days post-second RZV dose, considered vaccines-related by Sponsor. No fatalities occurred. Conclusion(s): No safety concerns were identified. The frequency/severity/type of AEs were comparable between groups and consistent with the known safety profile of each vaccine, whether RZV and mRNA-1273 booster were administered concomitantly or sequentially. Co-administration may enhance vaccine coverage rates. Funding(s): GSKCopyright © 2023
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Les lésions de l'hypothalamus et l'altération de la signalisation de la voie du récepteur de type 4 aux mélanocortines (MC4R) résultant souvent d'une intervention chirurgicale ou de rayonnements reçus dans le cadre du traitement d'une tumeur bénigne, peuvent entraîner une obésité hypothalamique (OH). Suite à cette lésion, une prise de poids soudaine et des changements du comportement alimentaire ne répondant pas aux traitements existants apparaissent. Setmélanotide, un agoniste de MC4R, est approuvé pour le contrôle du poids et la régulation de la faim chez les patients présentant certains déficits génétiques associés à la voie de MC4R. Nous rapportons les résultats intermédiaires d'une étude de phase 2 évaluant setmélanotide dans le cadre du traitement de l'OH (NCT04725240). Des patients âgés de 6 à 40 ans ayant un indice de masse corporelle (IMC) ≥ 95e percentile (pour les enfants de 6 à < 18 ans) ou ≥ 35 kg/m2 (pour les adultes ≥ 18 ans) et une OH causée par une atteinte hypothalamique structurelle à la suite d'un crâniopharyngiome ou d'une autre tumeur cérébrale bénigne, d'une résection chirurgicale et/ou d'une chimiothérapie ont été inclus. La dose de setmélanotide a été déterminée en fonction de l'âge, avec 2 à 4 semaines d'escalade de doses, puis 12 à 14 semaines à la dose thérapeutique de 3 mg une fois par jour. Le critère d'évaluation principal était la proportion de patients obtenant une réduction ≥ 5 % de leur IMC à la semaine 16. L'un des critères d'évaluation secondaires clés était la proportion composite d'enfants présentant une réduction ≥ 0,2 point du score Z de l'IMC et d'adultes présentant une perte de poids ≥ 5 %. La faim a été évaluée quotidiennement à l'aide d'une échelle d'évaluation numérique, où 0 = aucune sensation de faim et 10 = sensation de faim la plus importante qui existe. Onze patients ont été inclus (âge moyen à l'inclusion [écart-type ;intervalle] : 14,6 [4,8 ;de 6 à 23] ans ;IMC moyen à l'inclusion [écart-type] : 38,7 [5,7] kg/m2). Tous les patients (IC à 90 % : [76,2 % ;100 %]) ont présenté une réduction ≥ 5 % de leur IMC (p < 0,0001) ;81,8 % (IC à 90 % : [53,0 % ;96,7 %]) ont présenté une réduction ≥ 10 % de leur IMC (p < 0,0001). La variation moyenne (intervalle) de l'IMC était de −17,2 % (de −37,2 % à −6,7 %). La variation moyenne (écart-type) de l'indice de faim était de −2,7 points (2,6). Les effets indésirables fréquents incluaient des nausées (63,6 %), des vomissements (45,5 %), des diarrhées (36,4 %) et la COVID-19 (36,4 %). Deux patients ont arrêté le traitement en raison d'événements indésirables. Ces premiers résultats justifient la poursuite de l'étude du setmélanotide dans cette population dont les besoins médicaux non satisfaits sont élevés et pour laquelle il n'existe aucun traitement approuvé. (French) [ FROM AUTHOR] Copyright of Nutrition Clinique et Métabolisme is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Background: The use of cryopreservation for stem cell grafts for both autologous stem cell and allogeneic cord blood transplant has been utilized for years. For other allogeneic stem cell transplant sources, the use of fresh collected grafts has been preferred due to concerns that cryopreservation may result in impaired graft function. With the onset of the COVID-19 pandemic a shift was made at our institution to exclusive use of cryopreservation Methods: In this retrospective single-center analysis a total of 133 patients undergoing allogeneic stem cell transplant at the University of Minnesota between 1/2018-6/2021 for a variety of malignancies were included, with 62 patients receiving fresh stem cell product and 71 patients receiving frozen stem cell product. Univariate statistical analysis was performed. Result(s): There was no significant difference between the two groups with regards to product type, sex, age, diagnosis (acute leukemia vs other), disease risk index, conditioning regimen, Karnofsky score, co-morbidity index, or cell dose (Table 1). Donor type was notably different between the two groups (p<0.01): matched sibling grafts were more commonly used for fresh products than frozen (85% vs. 35%), while matched unrelated donors were used more frequently for frozen than for fresh products (54% vs. 6%). Use of frozen product was associated with delayed neutrophil and platelet engraftment compared to fresh (median days to engraftment 15 vs 12 for neutrophils, 23 vs 17 for platelets, p<0.01 for both). Two-year relapse rates were significantly lower for frozen products (4%) than fresh (24%) (Table 2). This may be partially attributable to differences in follow up between the groups, as fresh products had a total of 910 days of follow up vs 432 for frozen products (P<0.0001). The difference in follow up remained statistically significant if the data was censored at 730 days (P<0.0001). Of note, the use of frozen products was associated with a lower rate of chronic graft-versus-host disease at one year post-transplant (p<0.01). There was no significant difference in the rates of acute GVHD between the groups. There were significant differences in GVHD prophylaxis regimens between the fresh and frozen groups (p<0.01). (Figure Presented)Two-year overall survival did not differ between groups (p=0.96). Conclusion(s): Use of cryopreserved stem cell products is associated with similar efficacy and outcomes as those seen with the use of fresh stem cell products. Although the data presented here suggest novel finding of decreased risk of relapse and chronic GVHD with the use of frozen stem cell products, additional follow up may abrogate these differences. Regardless, the logistical benefits of cryopreservation make this an attractive option for continued use in allogeneic transplants and our data presented here suggests that cryopreserved products remain an appropriate option for allogeneic stem cell transplant.Copyright © 2023 American Society for Transplantation and Cellular Therapy
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Ecological research, education, and community engagement were interrupted globally in the spring and summer of 2020 because of the COVID-19 pandemic. To allow for continued data collection and to provide opportunities for people to interact with nature, we developed a community science project focusing on pollinator visitation to gardens and lawns. To evaluate the accessibility of this project to volunteers, we conducted 28 semi-structured interviews with people who participated in the project training. Interviewees experienced a number of barriers to participation, the most common of which were difficulty with the data collection procedure (n = 22), challenges using technology (n = 11), and lack of access to technology (n = 9). However, components of the online training and data collection procedure helped overcome some of these barriers. Strategies such as using a hybrid training format, simplifying the use of technology during training, and incorporating active learning into online workshops could increase participation in community science projects, both in the context of the pandemic and moving forward. © 2023 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.
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Cooperative learning (CL) has the potential to increase students' college and career readiness with benefits including higher student achievement, higher critical thinking, and greater psychological health (Johnson & Johnson, 1983, 1989;Kramarski & Mevarech, 2003;Natasi & Clements, 1991;Webb & Mastergeorge, 2003). This study explores student attitudes toward cooperative learning in two virtual high school English language arts (ELA) courses which occurred as a direct result of the COVID-19 pandemic. Employing action research methodology, the authors gained valuable insights about structuring cooperative learning in an online learning environment effectively. The study took place during the first eight weeks of two tenth grade ELA courses, one standard and one honors. Findings suggest many factors influence the implementation of effective cooperative learning within the virtual ELA classroom, including student attitudes and relationships, instructional time, class size, interdependence and group accountability, task completion, and modeling and practice. © 2023, IGI Global.
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The COVID-19 pandemic has presented huge challenges to health care systems, the research community, and regulatory authorities worldwide. In recognition of the urgent need for safe and effective vaccines against this new coronavirus, the National Institutes of Health (NIH) worked with 5 manufacturers of promising vaccine candidates to mount the studies required to evaluate these vaccines and potentially support their deployment. The outcomes of the studies reported thus far have been far more successful than anyone would have imagined. In this session, perspectives on the issues raised in the COVID-19 vaccine development process under Operation Warp Speed will be shared by individuals playing a major role in the design, conduct, and analysis of these studies. We will hear from the lead company investigator of the Moderna trial, the first Operation Warp Speed trial to receive Emergency Use Authorization from the US Food and Drug Administration (FDA);from the NIH coordinator of the Data and Safety Monitoring Board (DSMB) convened to oversee all 5 trials;and from a member of that DSMB. SPEAKERS: Dr. Jacqueline Miller, Moderna, Inc., Lead company investigator for Moderna COVID-19 vaccine trial. Working title: Managing the evaluation of the data of a COVID-19 clinical trial: the manufacturer's perspective Dr. Sally Hunsberger, National Institute of Allergy & Infectious Diseases, NIH Coordinator of Data and Safety Monitoring Board for NIAO-sponsored trials of COVID-19 vaccines. Working title: Managing the evaluation of the data of a COVID-19 clinical trial: the NIH perspective Dr. Steven Joffe Department of Medical Ethics and Health Policy Perelman School of Medicine, University of Pennsylvania Member, NIAID COVID-19 vaccine trials Data and Safety Monitoring Board. Working title: Managing the evaluation of the data of a COVID- 19 clinical trial: a DSMB member's perspective.
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How do citizens in a polarized political system react to an unexpected emergency like the COVID-19 pandemic and how do citizens process conflicting polarized narratives to for-mulate a public policy view of the threat of the pandemic? The emergence of the COVID-19 pandemic is a health emergency unlike anything in the United States since the polio epidemic 70 years ago, but the political climate of the U.S. in the 1950's was far more centrist and consensual than the deep divisions observed today. This paper will utilize data from a 35-year longitudinal study of Generation X young adults (now in their mid-40's) and a three-decade time series of national U.S. surveys to examine information acquisition behaviors to understand the new threat. Our analysis of the last 35 years of Generation X finds that polarized ideological partisanship was the strongest single predictor of individual votes in the 2020 election, but that individuals with a higher level of understanding of the corona-virus were more critical of the Trump Administration's handling of the COVID-19 pandemic and were more likely to vote for Bid-en than Trump. A parallel analysis of a national probability sample of U.S. adults in 2020 found the same pattern of influence from ideological partisanship, coronavirus understanding, and assessment of the Trump Administration's handling of the pan-demic. The results indicate that knowledge and understanding can provide a critical balancing effect in an evenly divided polarized political system. © 2022, CSIC Consejo Superior de Investigaciones Cientificas. All rights reserved.
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Situated expectancy-value theorists propose that students' domain-specific expectancies and subjective task values are critical predictors of their achievement and academic choices in those domains. The theory also posits that subjective task values are multidimensional and can be separated into four subcomponents: intrinsic value, attainment value, utility value, and perceived cost. Recently, there have been debates regarding whether perceived cost should be conceptualized and operationalized as part of subjective task value (i.e., the classic expectancy-value perspective), or as a separate construct from subjective task value (i.e., the expectancy-value-cost perspective). In the present study, we explore different structural associations among expectancies, values, and costs using a hierarchical structural equation modeling approach in a high-stakes undergraduate biochemistry course. We use two different measures of perceived cost: one that measured cost as a unidimensional construct and one that measured cost as a multidimensional construct. We also report on data collected both before and after the COVID-19 lockdowns in the United States. Overall, our results suggested that models that supported the expectancy-value perspective and models that supported the expectancy-value-cost perspective both fit the data reasonably well. However, in line with situated expectancy-value theory, we discuss how aspects of the educational context (a high-stakes undergraduate context), the historical context (COVID-19), and measurement of cost (unidimensional vs. multidimensional) may have impacted our findings. Implications for SEVT and future research in this area are discussed. © 2023 Elsevier Inc.
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Early into the COVID-19 pandemic, Miller & Blumstein (2020) outlined a theoretical research program (TRP) oriented around themes of contagion control and containment, legal amnesty, system leniency, nonenforcement, and tele-justice. Here, two and a half years later, these lingering themes are revisited to advocate for empirical research informing criminal justice system reform. The pandemic created rare natural experiment research conditions that enable unique and potentially valuable insights on necessitated innovations that may indicate future justice practices and policies. Given the sweeping effects of the shutdown, examples are numerous ranging from staffing analyses to estimate agencies' personnel needs to ensure that basic public safety functions can be met after early retirements and resignations from virus risk and anti-police sentiment, the use of virtual communication in various legal proceedings at arrest, incarceration, and release junctures, and, especially, the risks versus benefits of early release. In addition to better identifying who should be jailed pre-trial, prioritization of calls for service, triaging of court cases, and hygiene and sanitation issues within facilities are other important examples central to a COVID and crime TRP. Attending research could demonstrate the utility of normative operations and identify shortfalls to be addressed during anomic conditions prior to another shutdown or similar event and present, through comparison of innovative and traditional derived outcomes, system reform and improvement opportunities. By seizing upon rare data made possible by natural experimental COVID generated conditions, researchers can meaningfully investigate the ongoing applicability of justice system adaptations mandated by the pandemic in terms of effectiveness and efficiency toward the interrelated goals of evidence-based practice discovery and justice reform.
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Background. Vaccination strategies that provide enhanced immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants are needed. We evaluated the safety and immunogenicity of a bivalent omicron containing vaccine, mRNA-1273.214 (50 mug), administered as a second booster dose in adult participants. Methods. In this ongoing phase 2/3 trial, 50 mug of the bivalent vaccine mRNA-1273.214 (25 mug each ancestral Wuhan-Hu-1 and omicron BA.1 spike mRNAs) or 50 mug of the authorized mRNA-1273 were administered as second boosters in adults who previously received a 2 dose (100 mug) primary series and a first booster (50 mug) dose of mRNA-1273 (>= 3 months prior). Primary objectives were safety and reactogenicity and immunogenicity 28 days post-booster dose. Results. In participants with no prior SARS-CoV-2 infection who received booster doses of mRNA-1273.214 (n=334) or mRNA-1273 (n=260), neutralizing antibody (nAb) geometric mean titers (GMTs [95% confidence interval (CI)]) against omicron BA.1 were 2372.4 (2070.6-2718.2) and 1473.5 (1270.8-1708.4), respectively. The model-based GMT ratio (GMR [97.5% CI]) of mRNA-1273.214 compared to mRNA-1273 was 1.75 (1.49-2.04), meeting the pre-specified superiority criterion against omicron BA.1. The pre-specified criterion for non-inferiority against the ancestral SARS-CoV-2 strain was also met. Additionally, mRNA-1273.214 elicited higher GMTs (727.4 [632.8-836.1]) than mRNA-1273 (492.1 [431.1-561.9]) against omicron subvariants BA.4/BA.5 [GMR (95% CI) 1.69 [1.51-1.90])]. Binding antibody responses against alpha, beta, gamma, delta, and omicron were numerically higher in the mRNA-1273.214 group compared to mRNA-1273. mRNA-1273.214 GMTs were consistently higher across age (18-< 65 and >= 65 years) and pre-booster SARS-CoV-2 infection subgroups (Figure). Safety and reactogenicity were similar for both vaccine groups. Conclusion. The bivalent omicron containing mRNA-1273.214 elicited superior nAb responses against omicron 28 days post-immunization compared to mRNA-1273 regardless of age and prior SARS-CoV-2 infection;no new safety concerns were identified. (Figure Presented).
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Study Objectives: Overdoses are now the leading cause of injury-related death in the United States with recent increases influenced by multiple factors including the COVID-19 pandemic. Among the most recent overdose deaths, about 75% involved a prescription or illicit opioid. Naloxone can rapidly reverse fatal overdose and evidence shows reduced mortality when naloxone is available in the community. Although emergency physicians are generally willing to prescribe naloxone to patients at risk of opioid overdoses, prescriptions remain uncommon. We hypothesize that the implementation of a Best Practice Advisory (BPA) alert within the electronic medical record (EMR) can increase the number of naloxone prescriptions given to high risk patients within the emergency department (ED). Study Design/Methods: In this retrospective chart review, we measured the number of naloxone prescriptions in a 5-month period prior to the initiation of the BPA and compared that to the number of naloxone prescriptions in the 5-month period after the initiation of the BPA. The chart review was inclusive of 9 EDs across a health system with a total annual volume of 450,000 visits per year. We also quantified the total number of BPA triggers and the action taken by the type of ED clinician including physician, resident, physician assistant and nurse practitioner. The BPA was designed to prompt a prescription for naloxone for patients at-risk for opioid overdose that meet criteria including: patients prescribed opioids with comorbidities including chronic lung or heart disease, opioid use disorder, history of opioid overdose, and those with an opioid prescription greater than 50 morphine milligram equivalents per day. Results/Findings: In the 5-month period after naloxone BPA initiation, there were 740 naloxone prescriptions. This compares to 180 naloxone prescriptions in the 5-month period prior to initiation of the BPA, a 311% increase in naloxone prescriptions after BPA initiation. The BPA fired 2,450 times after initiation and the clinician clicked to "accept" the BPA 1,428, a 58.3% acceptance rate. The rates of ED clinicians clicking "accept" who encountered the naloxone BPA by the type of ED clinician were as follows: physicians (56.5%), residents (67.2%), physician assistants (54.8%), nurse practitioners (42.5%). Conclusion(s): Increasing naloxone availability should be considered an important part of a multi-pronged approach to combatting our current opioid epidemic. BPAs within the EMR could be a low-cost, effective intervention to increase naloxone prescription rates for patients at-risk of opioid overdose in the ED. Further investigation is needed to determine pharmacy fill rates of naloxone prescriptions and understand clinician perspectives toward naloxone prescription in order to characterize the most effective model for naloxone distribution. No, authors do not have interests to disclose Copyright © 2022
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In 2021, both social and economic activities began to return towards the levels preceding the COVID-19 pandemic for some parts of the globe, with others still experiencing restrictions. Meanwhile, the climate has continued to respond to the ongoing increase in greenhouse gases and resulting warming. La Nia, a phenomenon which tends to depress global temperatures while changing rainfall patterns in many regions, prevailed for all but two months of the year. Despite this, 2021 was one of the six-warmest years on record as measured by global mean surface temperature with an anomaly of between +0.21 and +0.28C above the 19912020 climatology. © 2022 American Meteorological Society.
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Purpose: The SRTR January 2022 program evaluations (Jan 2022 program-specific reports [PSRs]) applied a COVID-19 carve-out where follow-up for transplants performed before March 13, 2020, ends on March 12, 2020;transplants performed from March 13, 2020, through June 12, 2020, are excluded;and transplants performed after June 12, 2020, are followed as usual. This study quantified the impact of the carve-out and investigated the effect of censoring COVID-19 deaths (in addition to the carve-out) on first-year posttransplant outcomes metrics in the Jan 2022 PSRs, with particular attention to investigating variation among OPTN regions. Method(s): The program-specific hazard ratios (HRs) for graft failure and patient death were estimated under 2 alternative scenarios and compared with the published HRs. In the first scenario, the COVID-19 carve-out was removed. In the second scenario, the COVID-19 carve-out was retained, but deaths due to COVID-19 infection that were not already carved out were censored. Result(s): Compared to the HRs from the Jan 22 PSRs as published with the COVID- 19 carve-out, adding censoring for the COVID-19 deaths that are not already removed by the carve-out results in very little change on average in the HRs (beta=1.0, r2=0.96). Removing the COVID-19 carve-out has a relatively larger impact on the estimated HRs (beta=0.89, r2=0.82) By geography, there were 2 slight yet statistically significant differences. When removing the carve-out, the average HR in the Northwest (OPTN Region 6) was 0.049 lower (95% CI: -0.087 to -0.011) than under the program evaluations with the carve-out. When censoring COVID-19 deaths in addition to the carve-out, the average HR in the Midwest (OPTN Regions 7, 8, and 10) was 0.009 lower (95% CI: -0.015 to -0.003) than under the program evaluations as published with only the COVID-19 carve-out. Conclusion(s): The HRs estimated by censoring COVID-19 deaths are highly correlated with those estimated with the carve-out alone. Removal of the carve-out resulted in greater variation in estimated HRs than the censoring scenario. Little variation by OPTN Region was observed, with the carve-out resulting in slightly higher HRs on average in OPTN Region 6. Censoring COVID-19 deaths imparted little regional variation, with HRs in the Midwest reduced on average by 0.009. The impact of the carve-out on program-specific evaluations will continue to be evaluated.
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Purpose: Lung transplant may be a viable treatment option for select patients with non-recoverable COVID-19-associated acute respiratory distress syndrome (ARDS) and COVID-19-associated pulmonary fibrosis. This study aims to characterize the utilization and outcomes of lung transplant among patients with COVID-19- associated ARDS and pulmonary fibrosis. Method(s): We analyzed the Organ Procurement Transplant Network database to characterize the prevalence and characteristics of patients with COVID-19-associated ARDS and pulmonary fibrosis who were added to the waiting list and/or received a lung transplant between March 13, 2020 and July 31, 2021. Result(s): We found that 207 lung candidate registrations were added to the waiting list and 182 lung transplants were conducted for patients with COVID-19-associated ARDS or pulmonary fibrosis. The majority of lung candidates and lung transplant recipients with COVID-19-associated diagnoses were male, had private insurance, were disproportionately Hispanic and had a higher lung allocation scores (LAS) compared to patients with non-COVID-19 diagnoses. There was no significant difference in 30-day post-transplant survival among recipients with COVID-19- associated diagnoses compared to non-COVID-19 diagnoses. Conclusion(s): Future research on post-transplant outcomes among lung transplant recipients with COVID-19-associated diagnoses is warranted. Further study of outcomes may assist in refining the appropriate LAS waitlist mortality and posttransplant survival scoring for these patients. (Figure Presented).
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Purpose: We sought to evaluate racial disparities in access to deceased donor kidney transplant (DDKT) following changes to kidney allocation system (KAS) implemented in 2014. We also aimed to identify candidate factors that were responsible for reducing African American (AA) access to transplant. Method(s): This study used Scientific Registry of Transplant Recipient Data, and included all adult candidates for DDKT on the waitlist between Jan. 1, 2015 and Mar. 12, 2020 (n=233,033). Candidates were classified as African American (AA) or non-African American (non-AA) and categorical differences in waitlist activity and clinical factors were evaluated by chi-square tests. Univariable (e.g. AA race only) and multivariable (e.g. race and combinations of clinical factors) Cox models with the outcome of time to transplant were constructed to evaluate the impact of AA race on access to transplant. Sub-analysis were performed to account for potential confounding from inactive time and the COVID-19 era. Result(s): Of the 233,033 waitlisted candidates during the study period, 76,576 (32.9%) were AA. There were differences in the clinical profiles of AA and non-AA candidates. For instance, AA were more likely to have the following characteristics: higher BMI, blood type B, female, and have higher cPRA (all with p < 0.0001). AA had longer wait times and slower access to the waitlist after initiating dialysis (p < 0.0001). Our most complete multivariable model showed that AA were 16.3% less likely to receive DDKT, [HR: 0.837, (95% CI: 0.821, 0.852)] (Figure 1). Adjusting for dialysis time prior to listing [HR: 0.863 (95% CI: 0.849, 0.877)] and the combination of dialysis time prior to listing and ethnicity [HR: 0.807 (95% CI: 0.793, 0.822)] resulted in the biggest change in HR from the unadjusted model. Conclusion(s): AA have reduced access to DDKT when compared to non-AA in adjusted analyses. Dialysis time prior to listing and ethnicity are the biggest contributors to the disparity in access. The KAS provides increased access for patients with longer time on the waiting list, therefore, the unadjusted model has closer parity between AA and non-AA. However, even the unadjusted model still shows some disparity meaning that changes may still be necessary in the system by with DDK are allocated to candidates. (Figure Presented).
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Purpose : The effects of COVID-19 on the retina have been debated since the start of the pandemic. This study aims to assess how COVID-19 may alter retinal microvasculature using wide-field swept-source optical coherence tomography angiography (WF SS-OCTA). Methods : This prospective, cross-sectional, observational study included patients with a positive COVID-19 polymerase chain reaction (PCR) test who underwent WF SS-OCTA imaging from August 2020 to November 2021. The mean days from PCR diagnosis to imaging was 175.6. Age-matched controls included healthy eyes and fellow eyes of retinal detachment, retinal tears, retinal artery occlusion, and retinal vein occlusion. Patients with diabetes, uncontrolled hypertension, retinal disease, prior retinal surgery, and a positive COVID-19 test >365 days before imaging were excluded. Vessel density (VD) and vessel skeletonized density (VSD) were calculated (Macular Density Algorithm v0.7.3.3, ARI Network) for the superficial capillary plexus (SCP), deep capillary plexus (DCP), and whole retina using 3x3, 6x6, and 12x12 mmscans centered on the fovea. A mixed-effect multivariate multilevel linear regression model was used to identify any difference between controls and COVID-19 groups. Results : 34 eyes of 29 patients with COVID-19 and 54 eyes of 45 controls were included. Generalized reductions in VD and VSD were seen in COVID-19 eyes compared to controls (Fig 1). Controlling for age, COVID-19 was associated with a statistically significant overall reduction in VD in the SCP and whole retina in 3x3 mmand DCP of 6x6 mm scans as well as decreased VSD in the DCP in 6x6 mm scans(Table 1). Looking at changes by region, COVID-19 eyes had significant reductions in superior sectors in VD across all scan sizes and layers except the whole retina in 6x6 mm scans, and in VSD across all scan sizes and layers except the SCP in 3x3 and 6x6 mm scans and whole retina in 6x6 mm scans. Additional region-specific reductions in VD and VSD were seen in the DCP in 6x6 and 12x12 mm scans, whole retina in 12x12 mmscans, and SCP in 12x12 mmscans. Conclusions : Patients with COVID-19 showed reduced VD and VSD compared to controls. This may indicate that there are some retinal microvasculature changes in patients with prior COVID-19 infection. (Figure Presented).
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Purpose : To offer early ophthalmology exposure to underrepresented minority (URM) premedical undergraduate students through clinical, research, and mentorship opportunities in an effort to increase URM trainees in the ophthalmology pipeline. Methods : An ophthalmology mentorship program for URM undergraduate students was launched in the spring 2021 semester and continued through the fall 2021 semester. The program offered clinical experience through virtual shadowing sessions, research opportunities, and mentorship for applying to medical school and supporting career development. Twenty-two undergraduate students (including 13 returning students from the first session) were paired with 13 mentors composed of medical students, residents, and post-doctoral fellows. As part of the Virtual Shadowing Series, 8 ophthalmology faculty hosted 1-hour sessions during which they presented patient cases and surgical videos and shared their career paths. Results : In a survey, respondents reported increased interest in ophthalmology (17/19, 90%), medicine (15/19, 83%), and research (13/19, 68%). Students attended an average of 3.5 (median 3) of the 8 virtual shadowing sessions offered. All respondents met with their mentor or attended a virtual shadowing session at least once, and all respondents indicated an interest in continuing to participate in the program. In addition to virtual shadowing, 3 students shadowed in the operating room for a half day, observing vitreoretinal surgery through a heads-up 3D surgery platform. Conclusions : A program offering mentorship, research opportunities, and virtual shadowing experiences for URM undergraduate students increased interest in ophthalmology, medicine, and research for the majority of students, and may serve as a model for other institutions.
ABSTRACT
Purpose : During the COVID-19 pandemic, regulatory changes in the United States allowed physicians to practice telemedicine across state lines. Data on the use of interstate ophthalmic telemedicine during the pandemic are limited. We aimed to evaluate the geographic characteristics and interstate utilization of telemedical care as compared to in-person care at a tertiary eye care center during the pandemic. Methods : In this single-center, retrospective, cross-sectional study at Massachusetts Eye and Ear (MEE) from January 1 to December 31, 2020, clinical encounters were reviewed to extract patient and visit characteristics. In-person versus telemedical visit types were identified based on institutional categories and billing codes. Residential zip codes were used to estimate geographic characteristics of patients including distance from MEE and in-state versus out-of-state status. Pearson chi-squared tests were used to compare telemedical and in-person care groups. Results : A total of 1911 telemedical patients (2262 encounters) and 65763 in-person patients (147211 encounters) were included. The median (interquartile range;IQR) age of telemedicine patients was 61 (43-72) years, 62% of which were female. The median (IQR) age of in-person patients was 63 (49-72) years, 58% of which were female. Telemedicine patients included 14.7% (n=281) out-of-state patients, as compared to 12.0% (n=7876) out-of-state in-person patients (p<0.001). Regarding distance, 42.5% of telemedicine patients and 47.5% of in-person patients lived <10 miles (p<0.001), 41.9% and 41.3% lived 10-50 miles (p=0.611), 8.8% and 7.0% lived 51-100 miles (p=0.002), 3.9% and 2.5% lived 101- 250 miles (p<0.001), and 3.0% and 1.8% lived >250 miles (p<0.001) away from MEE, respectively. Conclusions : A significantly greater proportion of telemedical care, as compared to in-person care, was provided to out-of-state patients at a large eye care center during the pandemic. Moreover, a significantly greater proportion of telemedical care was utilized by patients living further away from the eye center. Proposals to revert to pre-pandemic policies requiring in-state telemedicine could set back forward progress made during the pandemic, including negative impacts on access to care and continuity of care for established patients. Expanded telemedicine licensure and scope could help advance the efficiency and deployment gains seen during the pandemic.