Supporting victims of domestic violence in rural and island communities during COVID-19: the impact of the pandemic on service providers in North East Scotland and Orkney

We investigate the impact of the COVID-19 pandemic on domestic violence service providers in rural and island communities in North East Scotland and Orkney. Domestic abuse and violence in rural areas is typically underestimated and might be more hidden due to stigma, a surveillance culture, and the practical difficulties of accessing services. The geographical challenges of rural and remote areas in relation to domestic violence are, to some extent, further amplified in small island locations, given population sizes, terrain and separation by sea. In such communities, visits to a service organisation's offices, or a visit by one of their staff, might publicly mark a service user out as a domestic abuse survivor. This article focuses on the move to digital and telephone provision of support in areas where broadband internet access is inconsistent and service users may live many miles from sources of support. At the same time, the move to online modes of communication was welcomed by staff in relation to offering opportunities for training and networking. There was also use of social and local media to raise awareness of the prevalence of domestic violence in these locations and to counter the myth of idyllic and abuse-free rural and island communities.

Highly synergistic combinations of nanobodies that target SARS-CoV-2 reduce viral load in hACE2 transgenic mice

The ongoing emergence of SARS-CoV-2 variants threatens current vaccines and renders current therapeutic antibodies obsolete, demanding powerful new treatments that can resist viral escape. We therefore generated a large nanobody repertoire to saturate the distinct and highly conserved available epitope space of SARS-CoV-2 spike, including the S1 receptor binding domain, N-terminal domain, and the S2 subunit, to identify new nanobody binding sites that may reflect novel mechanisms of viral neutralization. Structural mapping and functional assays show that these highly stable monovalent nanobodies potently inhibit SARS-CoV-2 infection, display numerous neutralization mechanisms, are effective against past and present emerging variants of concern, and are resistant to mutational escape. Rational combinations of these nanobodies that bind dissimilar sites within and between spike subunits exhibit extraordinary synergy and suggest multiple tailored therapeutic and prophylactic strategies. All mouse involved experiments were performed in compliance with the Institutional Animal Care and Use Committee and mice were housed and maintained in a specific pathogen-free conditions at Seattle Children's Research Institute. Infected mice with SARSCoV- 2 were housed in a Biosafety Level 3 facility in an Animal Biohazard Containment Suite. Prophylactic intranasal application of a synergistic pair of unmodified nanobodies in 10-12 week-old female K18-hACE2 transgenic mice, a mouse model of SARS-CoV-2 infection, showed significant reduction in viral load after 3 days post-challenge with SARS-CoV-2, the first demonstration of synergy in vivo. In summary, our results show that our diverse repertoire of nanobodies can neutralize current variants of live SARS-CoV-2, pairs of nanobodies that bind distinct sites on spike show tremendous synergy in neutralizing efficacy in vitro, and the application of synergizing pair of nanobodies translates to an in vivo mouse model of SARSCoV- 2. Research funded by the Mathers Foundation, Robertson Foundation, NIH P41GM109824.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.

What is the relationship between fatigue, pain and urgency in people with inflammatory bowel disease? Results of the IBD-BOOST survey in 8486 participants

Background: Fatigue, pain and faecal incontinence are common in people with IBD. However, little is known about co-existence of these multiple symptoms, how they inter-relate and whether people want help for these symptoms. In qualitative interviews, patients have reported that these symptoms are often ignored in clinical consultations where the focus is on inflammation, but that they are very bothered by these symptoms, even when disease is apparently in remission The aim of this study was to determine the presence and relationship between fatigue, pain and incontinence in people with inflammatory bowel disease, and desire for intervention for these symptoms Methods: A purpose-designed survey (online or postal), incorporating validated tools and demographic details, was sent to unselected UK clinic and UK IBD-BioResource adult patients. When the covid-19 pandemic halted clinic recruitment, additional self-selected UK recruits were solicited via social media. Using the validated PROMIS tools the following definitions were used for presence of symptoms: Fatigue: PROMIS fatigue T-score of 60 or more;pain: PROMIS pain intensity T-score of 60 or more;PROMIS bowel incontinence: Raw score of 50 or more. Participants also reported disease activity using the relevant PRO-2 score, IBD-Control, anxiety (GAD-7), depression (PHQ-9) and quality of life (EQ-5D-5L) which will all be reported elsewhere Results: A total of 8486 useable responses were received (7716 online 770 postal). 4176 reported Crohn's disease, 4255 had ulcerative colitis or other form of IBD. There were 3281 men and 4883 women. Median age was 51 years (range 18 - 92). 2550 (30%) reported fatigue 1766 (21%) pain and 4565 (54%) faecal incontinence according to the above definitions;925 (10.9%) reported having all three symptoms Demographics by symptom are shown in Table 1. Table 2 reports those participants indicating the presence of each symptom and each combination of symptoms. Table 3 shows a summary of self-defined severity and impact of symptoms (scoring scale 0-10 for both severity and impact of each symptom). Participants scored severity and impact a mean between 3.3 and 4.8, with a wide variation. 56% of all respondents (not just those with symptoms) "definitely" wanted help for fatigue;42% wanted help for pain;53% wanted help for incontinence. 29% reported "definitely" wanting help for all three symptoms (Table 4) Conclusion(s): This study confirms that fatigue, pain and urgency are common in IBD and for the first time reports the co-existence and unmet need for help with these symptoms.

Exercise, diet, and sleep habits of nurses working full-time during the COVID-19 pandemic: An observational study.

BACKGROUND: Healthy diet, exercise, and sleep practices may mitigate stress and prevent illness. However, lifestyle behaviors of acute care nurses working during stressful COVID-19 surges are unclear. PURPOSE: To quantify sleep, diet, and exercise practices of 12-hour acute care nurses working day or night shift during COVID-19-related surges. METHODS: Nurses across 10 hospitals in the United States wore wrist actigraphs and pedometers to quantify sleep and steps and completed electronic diaries documenting diet over 7-days. FINDINGS: Participant average sleep quantity did not meet national recommendations; night shift nurses (n = 23) slept significantly less before on-duty days when compared to day shift nurses (n = 34). Proportionally more night shift nurses did not meet daily step recommendations. Diet quality was low on average among participants. DISCUSSION: Nurses, especially those on night shift, may require resources to support healthy sleep hygiene, physical activity practices, and diet quality to mitigate stressful work environments.

Reacting, Re-learning and Reflecting on Sudden Pedagogical Adaptations

In the COVID-19 period, teachers and learners across the globe face great challenges, not only physically, mentally, but also pedagogically. The pandemic forced most teachers to move from classroom-based to online teaching within a matter of weeks. That is, the sudden revaluation of pedagogy pushed teachers to make quick adaptations to online teaching, willingly or not. Against this backdrop, this chapter unpacks the challenges of two language teachers at a university in Hong Kong. We adopt a narrative inquiry approach to investigate the lived experience of the teachers who went through this unprecedented period of time. Teacher A is a highly experienced classroom teacher yet a non-digital native while Teacher B is a digital native but with limited teaching experience. Teacher A taught a language skills and strategies course to BA English majors, while Teacher B taught a Business English course to non-English majors. Drawing on Bronfenbrenner's (The ecology of human development: experiments by nature and design. Harvard University Press, Cambridge, 1979) ecosystem model, we examine the teachers' needs and challenges in order to understand their experiences from the micro-, meso- and exo-systems perspectives. The study provides implications on what universities and teacher educators can do in order to better offer in-service teacher training and support to teachers for future online teaching scenarios. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Acute Thromboembolism in Non-ICU Hospitalized Patients with COVID-19 infection: Examining the Impact of Prior COVID Vaccination

Background. Patients hospitalized with severe COVID-19 infections are at risk for acute thromboembolism. There are few data on the impact of vaccines on COVID-associated acute thromboembolism (CA-ATE) in patients hospitalized with COVID-19 infection. Methods. Retrospective cohort of CA-ATE between March 2020 and March 2022 (Torrance Memorial Medical Center, pre-pandemic ATE incidence < 1%). Inclusion criteria were confirmed COVID infection, > 18 years, not admitted to ICU, and standard-dose thromboprophylaxis. Exclusion criteria were pregnancy, partial vaccination, and therapeutic dose anticoagulation. Primary outcome was CA-ATE incidence identified by routine clinical testing. We performed a multiple logistic regression for CA-ATE risk factors. Results. Of 3,218 hospitalized COVID-19 patients, 1,428 patients were included;185 were vaccinated (13%) and 1,243 unvaccinated (87%). Vaccinated status was associated with older age, diabetes, heart failure, and chronic kidney disease (p< 0.01). CA-ATE was noted in 7.0% (2.2% deep vein thrombosis (DVT), 0.5% pulmonary embolism (PE), 2.7% myocardial infarction (MI), 1.6% Ischemic stroke (IS)) in the vaccinated and 3.9% (2.7% DVT, 1.5% PE, 1.0% MI, 0.8% IS) in the unvaccinated. In our multivariate model, we found no significant difference in incident CA-ATE between vaccinated and unvaccinated (7.0% vs 3.9%, adj OR=1.35, [95% CI 0.67-2.58], p=0.38). CA-ATE was associated with older age (68 vs 61 years, OR=1.03, [95% CI 1.01-1.05], p=0.01) and heart failure (24% vs 7%, OR=2.84, [95% CI 1.35-6.00], p=0.006). No significant difference was seen in mortality (3.8% vs 4.8%, OR=0.79, [95% CI 0.35-1.69], p=0.56), CRP AUC24hr (5.7 vs 4.7, p=0.18), or D-dimer AUC24hr (596 vs 653, p=0.77) between vaccinated and unvaccinated patients. Conclusion. Adult, non-ICU, hospitalized, COVID-19 patients are at high risk for ATE. We found no association between vaccination status and ATE, but older age and congestive heart failure were predictive in this population. Decisions to anticoagulate non-ICU patients hospitalized with acute COVID-19 infections may not need to consider COVID vaccination status in as part of medical decision making, but may instead need to focus on underlying, high-risk, co-morbidities.

Exercise, diet, and sleep habits of nurses working full-time during the COVID-19 pandemic: An observational study☆

Background Healthy diet, exercise, and sleep practices may mitigate stress and prevent illness. However, lifestyle behaviors of acute care nurses working during stressful COVID-19 surges are unclear. Purpose To quantify sleep, diet, and exercise practices of 12-hour acute care nurses working day or night shift during COVID-19-related surges. Methods Nurses across 10 hospitals in the United States wore wrist actigraphs and pedometers to quantify sleep and steps and completed electronic diaries documenting diet over 7-days. Findings Participant average sleep quantity did not meet national recommendations;night shift nurses (n = 23) slept significantly less before on-duty days when compared to day shift nurses (n = 34). Proportionally more night shift nurses did not meet daily step recommendations. Diet quality was low on average among participants. Discussion Nurses, especially those on night shift, may require resources to support healthy sleep hygiene, physical activity practices, and diet quality to mitigate stressful work environments.

Adapting to the Times: Evaluating the Efficacy of Telehealth on Hcv Outcomes in a Safety-Net Population

Background: The Grady Liver Clinic (GLC) is a primary care-based hepatitis C (HCV) clinic that provides comprehensive care for an urban, primarily African American, underserved patient population at Grady Health System. At the onset of the COVID-19 pandemic, GLC pivoted to using a telehealth model for HCV treatment. With telehealth, treatment visits were conducted via telephone or video and HCV medications could be couriered to patients' residences. We aim to compare outcomes of the HCV telehealth treatment model to traditional, in-person treatment. Method(s): We performed a retrospective chart review of all patients who initiated HCV treatment at GLC from 03/2019-02/ 2020 (Pre-Pandemic) and 03/2020-02/ 2021 (Pandemic). The latter cohort was stratified into three types of visits: in-person only, telehealth only, and hybrid (mixture of in-person and telehealth). We compared demographic data and HCV treatment outcomes between groups. Result(s): Patients in pre-pandemic and pandemic cohorts were similar genders, ages, ethnicities, and used similar payor sources. The average number of days from referral to treatment initiation differed between cohorts (52 days vs 92 days) as did the treatment duration (84 vs 56 days). The rate of sustained virologic response (SVR12) was similar between cohorts, with SVR12 obtained in 59% of the pre-pandemic cohort that started treatment (96% of those who completed testing for SVR12) vs 61% of the pandemic cohort that started treatment (95% of those who completed testing for SVR12). A substantial proportion of patients in both groups did not follow-up for SVR12 testing. Importantly, there were similar rates of SVR12 in the pandemic in-person, telehealth, and hybrid subgroups (Figure 1, attached). Conclusion(s): Our results show that virtual delivery of healthcare is as effective as traditional in-person clinic visits for HCV treatment. Our data supports continued use of telehealth to improve access to HCV treatment for a vulnerable patient population who face chronic barriers to healthcare access. (Figure Presented).

SETTLE DOWN: Preliminary investigations and development of an online toolkit to support student self-regulation in higher education

The impact of stressors on student wellbeing and academic performance is widely documented within the Higher Education (HE) sector, with student drop-out rates linked to poor wellbeing. Identified connections between attrition rates and the levels of support offered to students has led to concerted efforts to better support student wellbeing-particularly for those in the first year of study. The COVID-19 pandemic and the rapid and abrupt shift toward online learning has complicated how students manage stress by reducing students' access to the very resources that might otherwise buffer them (e.g., social connection) exposing them to risk factors (e.g., isolation and greater uncertainty). Accordingly, empowering students to better self-regulate during stressful times is, more than ever, essential to supporting the transition to the adult learning environment. The development of students' self-awareness and self-knowledge of the influences of being stressed on their engagement in study is an important adjunct to self-regulated learning. This nexus between psychology and education is a point for an interventive program that meets a gap in current support efforts, and that recognises the need for such endeavours that situate within the digital landscape of HE. In this paper we describe the groundwork of a single cohort case study that outlines a novel approach to student wellbeing. We discuss the design and development process of the SETTLE DOWN program;an evidence-based and clinically informed series of self-regulation workshops for undergraduate students, which aimed to foster student self-awareness about personal stress responses, facilitate a guided self-discovery of self-regulation techniques, and embed self-knowledge through reflection and practice. Preliminary pilot data is presented with respect to the intended purpose of assessing the suitability of the program material to achieve desired outcomes. The translation of these workshops into an online format to maximise accessibility for students and teachers is extrapolated in discussion of future-directions and next steps for the SETTLE DOWN program. The case study offers an example of the development of an evidence-based approach to ultimately support students with online availability of the necessary knowledge and skills to foster self-awareness and self-knowledge in the context of engaging in study under stress.

Assessing infection prevention and control during COVID-19 in 22 humanitarian contexts

Building a robust healthcare system is dependent on infection prevention and control (IPC), which is also essential during pandemics. In late 2020, a multi-country assessment was conducted, and it revealed serious issues that need to be fixed. Poor infection prevention and control (IPC) infrastructure and practices during the Ebola outbreaks in West Africa in 2014 to 2015 and the Democratic Republic of the Congo in 2019 resulted in high numbers of health-care worker infections and decreased use of health services because of people's fear of transmission. The International Rescue Committee (IRC) created a baseline set of IPC criteria for COVID-19 based on their experience with Ebola in an effort to facilitate quick IPC advancements at healthcare facilities serving people impacted by violence and displacement. The main tenets of this basic package for IPC are on personnel and responsibility, expertise and application, and resources and infrastructure. The administered facilities by IRC perform better generally than those by MOH and other partners, it is crucial to mention. The reason for this discrepancy is that IRC can more readily make modifications in facilities that it directly maintains than in facilities that it merely supports. This should show that even under the most challenging situations, it is possible to put appropriate IPC procedures in place. Members of the World Health Assembly (WHA) decided to enhance WASH services in healthcare facilities in four resolutions that were enacted in 2019. 2 Member states likewise urged nations to improve IPC, particularly in the WASH industry, in order to guarantee the greatest standards of universal healthcare. IPC is still given too little priority despite these international agreements.

Rapid Implementation of Remote Online Patient Portal Activation in a Children's Hospital During the COVID-19 Pandemic

Purpose/Objectives: To describe the rapid implementation of remote patient portal activation in a pediatric integrated delivery network during the initial phase of the COVID-19 pandemic. We sought to increase the percentage of patients with active portal status upon discharge by 15% (absolute change) across inpatient units within 3 months. Design/Methods: A multidisciplinary taskforce utilized QI tools (fishbone diagram, process map) to identify barriers to successful inpatient patient portal activation. PDSA cycles included rapid cycle training of the remote MyChart enrollment workflow for hospital unit clerks (HUCs), increased patient education about portal functionality, standardized portal enrollment workflow across all inpatient units, and improved visibility of portal status for clinical staff and HUCs. The primary measure was the percentage of admitted patients with active MyChart status upon discharge. Baseline data was collected retrospectively via Epic Reporting Workbench. A patient portal activation dashboard was used to monitor progress on a weekly basis. We used statistical process control charts to examine the impact. Results: We completed training and clinical decision support tools (Unit Manager view and MyChart® status Epic column) creation within 2 weeks from the start of the initiative. Active online patient portal status upon hospital discharge increased from 44% to 66% (a 22% absolute increase) within 12 weeks. The process demonstrated a consecutive upward trend of 5 or more data points, consistent with special cause variation at the end of April 2020. During the same time period, the percentage of online patient portal activation within 7 days after hospital discharge increased from 6.0% to 24%, and the patient portal offer rate increased from 73% to 85% across all inpatient units. Conclusion/Discussion: We rapidly and effectively implemented a remote proxy portal activation process in the inpatient setting. Remote activation, training, clinical decision support, multidisciplinary involvement, and emphasis on the portal as integral to ongoing care allowed us to dramatically increase activation.

NEPHROLOGY E-CONSULTS: A NOVEL APPROACH TO KIDNEY CARE IN A SAFETY-NET HOSPITAL

STATEMENT OF PROBLEM/QUESTION: With Chronic Kidney Disease (CKD) on the rise, Grady Health System (GHS) implemented a novel Electronic-Consultation (E-Consult) Service for outpatient Nephrology and we sought to determine the characteristics and outcomes of these patients to better recognize the utility in our new approach to kidney care. DESCRIPTION OF PROGRAM/INTERVENTION: The Nephrology EConsult service was launched in September 2020 across all primary care clinics at GHS, which is located in downtown Atlanta, GA, and serves a population of mainly Medicare/Medicaid and uninsured patients. With this service, Primary Care Providers (PCPs) submit an E- Consult and a single Nephrologist reviews the chart to communicate closed-loop recommendations via the patient's Electronic Health Record (EHR). If high-complexity factors are discovered (including nephrotic-range proteinuria, acute kidney injury (AKI), or CKD 4/5), the patient is scheduled for an in-person clinic visit with Nephrology. MEASURES OF SUCCESS: We retrospectively analyzed the charts of 200 randomly-selected E-Consults placed 09/2020-12/2021 to determine disease complexity, A1c and albuminuria screening rates, DM2 control, common comorbidities, renoprotective medication use, as well as the percentage of PCPs who completed the consultation recommendations. We identified the number of in-person Nephrology clinic visits that were prevented with this virtual service and compared waitlist times against a traditional referral to outpatient Nephrology. FINDINGS TO DATE: The majority of patients (55%) have low-complexity kidney disease, and nearly half of all E- Consults are managed entirely virtually, avoiding an in-person visit to Nephrology. Fewer E-Consults have high- complexity disease (45%), most of which involve AKI (60%) and/or CKD4 (35%), warranting an in-person Nephrology evaluation, and with this service an in-person visit occurs in 1/3 the time of traditionally-placed referrals. The most common comorbidities are hypertension (80%) and DM2 (51%), and interestingly, the majority of patients with DM2 have relative control of their disease with an A1c <7% (63%). However, the rate of screening A1c differs from albuminuria: most patients have a recent A1c (70%) while less than half of patients have a recent urine albumin. Very few patients are prescribed an SGLT2-inhibitor (5%) and more than a quarter of eligible patients are not on any renoprotective medications. Nearly a quarter of PCPs do not complete the e-consult recommendations, representing an area where EMR automatization may be useful. KEY LESSONS FOR DISSEMINATION: Our Nephrology E-Consult Service improves access to kidney care for all patients, reduces clinic wait times for those with high-complexity disease, and may play an important role during the Covid-19 pandemic by reducing healthcare-associated exposures. By providing a closed-loop method of communication between PCP and Nephrologist, guideline-based recommendations for routine screening and renoprotective strategies can be exchanged for the patient's benefit.

Mucosal Cytokine Profiles in Children with COVID-19

Background. The mechanisms associated with COVID-19 in children are not well understood. We sought to define the differences in nasopharyngeal (NP) cytokine profiles according to clinical presentation in children with COVID-19. Methods. Single-center, prospective study in 137 children and adolescents < 21 years of age hospitalized with COVID-19, and 35 age, sex and race matched pre-pandemic (2016-2019) healthy controls. Children with COVID-19 were categorized according to their clinical presentation in: COVID-19-symptomatic;COVID-19-screening, and multisystem inflammatory syndrome (MIS-C). NP swabs were obtained within 24 hours of admission to measure SARS-CoV-2 loads by rt-PCR, and a 92-cytokine panel. Unsupervised and supervised analysis adjusted for multiple comparisons were performed. Results. From 3/2020 to 1/2021, we enrolled 76 COVID-19-symptomatic children (3.5 [0.2-15.75] years);45 COVID-19-screening (11.1 [4.2-16.1] years), and 16 MIS-C (11.2 [5.9-14.6] years). Median NP SARS-CoV-2 loads were higher in COVID-19-symptomatic versus screening and MIS-C (6.8 vs 3.5 vs 2.82 log10 copies/mL;p< 0.001). Statistical group comparisons identified 15 cytokines that consistently differed between groups and were clustered in three functional categories: (1) antiviral/regulatory, (2) pro-inflammatory/chemotactic, and (3) a combination of (1) and (2);(Fig 1). All 15 cytokines were higher in COVID-19-symptomatic versus controls (p< 0.05). Similarly, and except for TNF, CCL3, CCL4 and CCL23, which were comparable in COVID-19-symptomatic and screening patients, the remaining cytokines were higher in symptomatic children (p< 0.05). PDL-1 (p=0.01) and CCL3 (p=0.03) were the only cytokines significantly decreased in children with MIS-C versus symptomatic COVID-19 children. The 15 cytokines identified by multiple comparisons were correlated using Person's in R software. Red reflects a positive correlation and blue a negative correlation with the intensity of the color indicating the strength of the association. Conclusion. Children with symptomatic COVID-19 demonstrated higher viral loads and greater mucosal cytokines concentrations than those identified via screening, whereas in MIS-C concentrations of regulatory cytokines were decreased. Simultaneous evaluation of viral loads and mucosal immune responses using non-invasive sampling could aid with the stratification of children and adolescents with COVID-19 in the clinical setting.

SARS-CoV-2 RNAemia and Disease Severity in Pediatric Coronavirus Disease 2019 (COVID-19)

Background. Children with COVID-19 may develop severe disease. In hospitalized adults, detection of plasma SARS-CoV-2 RNAemia ranges from 19% to 42% and has been associated with worse clinical outcomes. A similar association in children remains unexplored. We determined the frequency of SARS-CoV-2 RNAemia in children hospitalized with COVID-19 and evaluated its potential association with severe disease. Methods. Single center prospective study that enrolled hospitalized children and adolescents ≤21 years old with COVID-19 from March 2020-April 2021 at Nationwide Children's Hospital, Columbus, OH. Nasopharyngeal (NP) and blood samples were obtained and SARS-CoV-2 RNA was quantified using a real time PCR assay targeting the N1 gene. Pertinent demographic, clinical, laboratory, and outcome data were evaluated. Results. We enrolled a convenience sample of 103 hospitalized children (median age, 9 years;range, 3 days-21 years) who had confirmed SARS-CoV-2 infection and both NP and blood samples obtained (Table 1). Overall, 27 (26%) patients with COVID-19 had SARS-CoV-2 RNAemia. Compared with patients who had undetectable RNAemia, those with SARS-CoV-2 RNAemia had significantly higher nasopharyngeal RNA loads (8.1 vs. 4.9 log10 copies/mL;p=0.0006), fever (78 vs 54%;p=0.02), receipt of supplemental oxygen (37% vs 14%;p=0.02), and treatment with anti-COVID-19 medications (30% vs 12%;p=0.04). In addition, patients with SARSCoV-2 RNAemia were more likely to require intensive care (40%% vs. 20%, p= 0.04) and had longer hospitalization (2.56 vs 2.15 days;p=0.03). There were no COVID-19 related deaths. Table 1. Demographic, clinical, laboratory and virology characteristics of study patients Conclusion. The frequency of SARS-CoV-2 RNAemia in pediatric patients was 26% and its finding was associated with worse clinical in-hospital outcomes, similar to that reported in adults. Testing for SARS-CoV-2 RNAemia in children may help identify those who could benefit from more intensive supportive care as well as antiviral and anti-inflammatory medications.

Predictors of Seropositivity to SARS-CoV-2 among Workforce Members at a Large Urban Medical Center

Background. Prior to SARS-CoV-2 vaccination availability, medical centers workers were at significant COVID-19 (COVID) infection risk. As part of a program offering free SARS-CoV-2 serology tests to medical center employees, we examined risk factors for prior COVID infection. Methods. From Sept. to Dec. 2020, we advertised free IgG antibody testing to all Los Angeles County-Univ. of Southern California Medical Center (LAC+USC) workforce members (clinical and non-clinical) via repeated email blasts. Antibody was determined using the Abbott SARS-Cov-2 IgG test against SARS-CoV-2 nucleocapsid protein. Program participants were asked to fill out a detailed epidemiologic questionnaire about work and non-work COVID risks on their cell phone or on paper at the time of phlebotomy. All testing was done prior to COVID vaccine availability. Results. Among approximately 10,500 workforce members, 1327 had serologies done. Among those 1273 (96%) completed the questionnaire and were included in the analysis. SARS-CoV-2 IgG antibodies were found in 60 (4.7%). In bivariate analysis, we found associations between SARS-CoV-2 seropositivity and persons who previously tested positive for COVID (OR 175.8 [95% CI 77.6 - 398.6]), persons who thought they had prior COVID but tested negative (OR 3.9 [95% CI 1.3 - 11.4]), and persons who thought they had prior COVID but did not get a COVID test (OR 4.2 [95% CI 1.4 - 12.5]). In a multivariate model of SARS-CoV-2 seropositivity examining work- and non-work-related COVID exposures (Table), seropositivity was associated with work-related COVID exposure without adequate personal protective equipment (PPE) (OR 5.1 [95% CI 2.1 - 12.2]), work-related COVID exposure with adequate PPE (OR 3.5 [95% CI 1.5 - 8.0]), never wearing a mask outside of work (OR 7.1 [95% CI 1.3 - 38.4]), and Native Hawaiian/Pacific Islander race (OR 6.6 [95% CI 1.7 - 23.4]). Seropositivity was inversely associated with living at home with multiple age groups (OR 0.4 [95% CI 0.2 - 0.8]). Multivariate Model of Exposures Associated with Positive COVID Serology Among LAC+USC Workforce Members Conclusion. Among workers in a large urban medical center prior to COVID vaccine availability, SARS-CoV-2 seropositivity was associated with work-related COVID exposures and low mask use outside of work, suggesting that COVID transmission in workforce members occurs both via occupational and non-occupational routes.

Cytokine profile using plasma mRNA to mark onset of ARDS in a pediatric swine model

INTRODUCTION/HYPOTHESIS: Acute Respiratory Distress Syndrome (ARDS) is a proinflammatory acute lung injury (ALI) that leads to noncardiac pulmonary edema. In humans, ARDS can be caused directly through damage of the epithelial tissue or indirectly through damage of the endothelial tissue. Different animal models to induce ALI have been developed to mimic the complex pathophysiology of ARDS, including the use of oleic acid injections. Oleic acid induces clinical ARDS by inducing an extensive immune response, including having direct effects on innate immune cells in the lungs triggering direct inflammatory mediator production, damaging the alveoli-capillary unit with increase of alveolar leakage and impairment of gas exchange. There is a paucity of data available to characterize the use of cytokine markers in pediatric ARDS swine models. We hypothesize that in a pediatric swine model of oleic acid ARDS, pro and anti-inflammatory cytokine mRNA in plasma will display at differing concentrations than the baseline at ARDS. METHODS: Seven juvenile swine were sedated, intubated, and mechanically ventilated. ARDS was established using continuous oleic acid infusion at 0.05-0.6 mL/kg. Blood samples were taken from the femoral artery before oleic acid infusion was initiated, an hour after and at the start of ARDS. Plasma was collected and mRNA was extracted from blood mononuclear cells (MNC). Quantitative polymerase chain reaction (qPCR) was performed on samples testing for the presence of mRNA for IFN-γ, TNF-α, IL-17, IL-10, and IL-6. RESULTS: 4-5 10 mL blood samples were collected from each animal and analyzed. When compared to baseline, IFN-γ collected at ARDS onset significantly decreased by a foldchange of 0.53±0.4 at ARDS (p=0.028). IL-6 trended down at ARDS onset, although this was not significant (p=0.087). Changes of TNF-α, IL-17 and IL-10 levels at ARDS onset were not significant (p=0.740, p=0.262, and p=0.342) respectively. CONCLUSIONS: In an oleic acid swine model, ARDS is characterized by decreasing IFN-γ levels. This data does correlate with severe ARDS caused by COVID in human patients. Future studies are warranted to better characterize the role of pro-and anti-inflammatory cytokine in developing ARDS and confirm our model.

Successful implementation of universal hcv screening at a safety-net hospital's emergency department during the COVID-19 pandemic

Background: In 2020, the USPSTF revised its hepatitis C (HCV) screening recommendations to include universal screening for persons aged 18-79. Grady Health System (GHS), a safety-net health system in Atlanta, GA has had an active HCV screening program for baby boomers since 2012, with a high prevalence of HCV antibody positivity (9%) as well as chronic infection (5%). The program expanded from ambulatory settings to the inpatient wards and finally to the Emergency Department (ED) in 2019. In May 2020, despite the COVID-19 pandemic, we pivoted from baby boomer (born 1945-1965) to universal HCV screening in the GHS ED. We compare HCV prevalence and linkage to care between baby boomers (BB) and non-baby boomers (non-BB) during the first year of universal ED screening. Methods: We updated the existing electronic health record algorithm, which previously flagged only baby boomers, to flag all patients aged 18-79 with no prior HCV test or diagnosis for screening. ED triage nurses offered opt-out testing to patients whose charts were flagged by the algorithm. This triggered an order for HCV antibody with reflex to HCV RNA for the medical provider to sign. We analyzed data from May 2020 to May 2021 for outcomes including HCV Ab and RNA prevalence and linkage to care, comparing BB and non-BB. Results: 2,388 HCV Ab tests were performed in the ED, 78% among non-BB. The overall HCV Ab prevalence was 6%, with a 13% prevalence in BB and only a 4% prevalence among non-BB. 77% of all positive HCV Ab tests were followed by a reflex HCV RNA test, and 41% of BB and 62% of non-BB were RNA positive. The overall prevalence of chronic infection among all tested was 2.5%. Linkage to care occurred in 25% of ED patients and was double for BB (38%) compared to non-BB (16%). Conclusion: The launch of universal HCV testing in the GHS ED showed a high prevalence of both HCV exposure and chronic infection in this safety-net health system population. Interestingly, HCV Ab prevalence was higher among BB, while HCV RNA prevalence was higher among non-BB, likely reflecting more cleared or cured infection among BB patients. Overall, linkage to care rates were suboptimal, and higher in BB. Low linkage rates were likely due to lack of inperson navigation and care access barriers associated with the COVID-19 pandemic, which affected the entire reporting period. We suspect linkage rates were higher in BB as more of this population uses GMH as their medical home than the non-BB population.