Paediatricians' awareness of Canadian screen time guidelines, perception of screen time use, and counselling during the COVID-19 pandemic

Objectives Paediatricians are essential in guiding families on screen time use as digital media becomes increasingly prevalent. While this has been highlighted through the COVID-19 pandemic there is no literature on paediatricians' awareness of Canadian screen time guidelines, or perception of these guidelines during this time. The aim of this study was to assess pediatricians' knowledge, attitudes, and comfort with the Canadian Paediatric Society's (CPS) screen time guidelines, specifically during the COVID-19 pandemic. Methods Our survey was developed by a paediatric resident and paediatric endocrinologist, reviewed by local experts, and sent electronically to members of the CPS Community and Developmental Paediatrics sections. Results All 53 respondents were aware of current CPS screen time guidelines, and the majority self-reported fair to excellent knowledge of guidelines for both age groups (<5 years and school-aged children/adolescents). Over 80% noticed increased screen use during the pandemic, and 98% were somewhat or very concerned about screen use and their patients' health and well-being. Pediatricians reported concerns about associations between increased screen time with worsening behaviour, mental health concerns, obesity, and sedentary lifestyle. The greatest barrier to reducing screen time was perceived insufficient motivation or support from caregivers/families. Conclusions Responding Canadian paediatricians are knowledgeable and comfortable with current screen time guidelines in Canada. Despite this, there is increasing concern with health outcomes associated with screen use. These results highlight paediatricians' important role in counselling patients and may encourage further local advocacy and public education around screen use and associated health risks in children.

Hiv and Chronic Comorbidities: Medication Adherence and Clinical Endpoint Covariation

Background: Evidence suggests negative monthly medication adherence trends during the COVID-19 era for patients with HIV (PWH) and multiple chronic conditions. However, it is unknown whether observed trends are associated with changes in outcomes of HIV care before and during the COVID-19 era. Method(s): Adult PWH with type 2 diabetes, hypertension, and/or hypercholesterolemia were identified in a US mid-Atlantic integrated health system. Multivariable population-averaged panel general estimating equations were used to assess the relationship between medication adherence [i.e., accepted dichotomous thresholds for optimal proportion of days covered (PDC)] for four medication groups: antiretrovirals [ART], diabetes medications [DMs], renin-angiotensin antagonists [RASMs], and statins [SMs] and their related clinical endpoints [i.e., viral load (VL;copies/mL), HbA1c, systolic and diastolic blood pressure (SBP, DBP;mmHg), and total cholesterol (TC;mg/dl)] during a 37-month longitudinal observation period [9/2018-9/2021]. Covariates included demographics, number of medication groups, COVID-19 era (starting 3/1/2020), and a COVID-19/PDC interaction term. Result(s): The cohort [n=543] was predominantly 51-64y [59.30%], Black [73.11%], male [69.24%], and privately insured [65.38%]. All patients were prescribed ART with 75.32% co-prescribed SMs;followed by RASMs [42.73%];and DMs [25.60%]. ART PDC>=0.9 was associated with decreased odds of VL>=200 copies/mL [aOR=0.77, 95% CI: 0.63-0.94]. For DMs, RASMs and SMS, PDC>=0.8 was not associated with the clinical endpoints of HbA1c>=7.0% [aOR=0.99, 95% CI: 0.94-1.04], SBP>=130 mmHg [aOR=1.03;95% CI: 0.93-1.14], DBP>=80 mmHg [aOR=1.05, 95% CI: 0.94-1.16] or TC>=200 mg/dl [aOR=1.00, 95% CI: 0.96-1.04], respectively. The COVID-19 era [3/2020 to 9/2021] was associated with increased odds of SBP>=130 [aOR=1.22, 95% CI: 1.01-1.48], but not for DBP>=80 mmHg [aOR=1.05, 95% CI: 0.85-1.28], VL>=200 copies/ mL [aOR=1.01, 95% CI: 0.67-1.52], HbA1c>=7.0% [aOR=0.99, 95% CI: 0.88-1.11], and TC>=200 mg/dl [aOR=0.95, 95% CI: 0.86-1.04]. No interactions between COVID-19 era and PDC on clinical endpoints were observed. Conclusion(s): ART adherence was associated with viral suppression in PWH, but there were no observed associations between DM, RASM, and SM adherence and their respective clinical endpoints. With the exception of a direct relationship between the COVID-19 start date and SBP, the COVID-19 era was not associated with variations in VL, HbA1c, DBP, and TC clinical endpoints.

SARS-CoV-2 E-PROTEIN VIROPORIN INHIBITOR BIT225 ACTIVE IN hACE2 TRANSGENIC MICE

Background: The CoV-2 envelope (E) protein plays an important role in virus assembly, budding, immunopathogenesis and disease severity. E protein has ion channel activity, is located in Golgi and ER membranes of infected cells and is associated with inflammasome activation and immune dysregulation. Here we report that BIT225, an investigational HIV clinical compound, inhibits E ion channel activity and prevents body weight loss and mortality and reduces inflammation in lethally infected K18-hACE2 transgenic mice. BIT225 efficacy was observed when dosing was initiated before or 24 h or 48 h after infection. Method(s): SARS-CoV-2 E protein ion channel activity and Xenopus TMEM16A were measured in Xenopus oocytes. K18-hACE2 transgenic mice were infected intranasally with 104 pfu SARS CoV 2 (US-WA1/2020) and dosed orally twice daily with BIT225 for up to 12 Days. Dosing was initiated 12 h pre-infection or 24 h or 48 h post-infection. Disease parameters measured were survival, body weight, viral RNA by qPCR and infectious virus titre (plaque assay) in lung tissue homogenates and serum. In addition, levels of pro-inflammatory cytokines (IL-6, IL-1alpha, IL-1beta, TNFalpha & TGFbeta, MCP-1) were measured in lung and serum samples. Result(s): BIT225 inhibited ion channel activity of E-protein, but not that of TMEM16A in Xenopus oocytes. BIT225 dosed at 300mg/kg BID for 12 days starting 12 h pre-infection completely prevented body weight loss and mortality in SARS-CoV-2 infected K18 mice (n=12), while all vehicle-dosed animals reached a mortality endpoint by day 9 across two studies (n=12). Figure 1 shows results from a time of addition study: When treatment with BIT225 started at 24 h post-infection, body weight loss and mortality was also prevented (100% survival, n=5). In the group of mice where treatment started at 48 h after infection, body weight loss and mortality were prevented in 4 of 5 mice. Treatment efficacy was associated with significant reduction in lung viral load (3.5 log10), virus titer (4000 pfu/ml) and lung and serum cytokine levels. Conclusion(s): BIT225 is an inhibitor of SARS-CoV-2 E-protein viroporin activity. In the K18 model BIT225 protected mice from weight loss and death, inhibited virus replication and reduced inflammation. These effects were noted when treatment with BIT225 was initiated before or 24-48 hours after infection and validate viroporin E as a viable antiviral target and support the clinical study of BIT225 in treatment of SARS-CoV-2.

The Impact of N-butyldeoxynojirimycin and 1-deoxymannojirimycin on SARS-CoV-2 S1 Subunit and Angiotensin-Converting Enzyme 2 Interaction in Intestinal Epithelial Cells

The severe acute respiratory syndrome coronavirus 2 (SARSCoV- 2) targets mainly the respiratory tract. In addition to respiratory symptoms, many extrapulmonary manifestations were observed in the gastrointestinal tract and reported by SARS-CoV-2 patients, including abdominal pain, nausea, and diarrhea. SARS-CoV-2 binds initially to angiotensin-converting enzyme 2 (ACE2) on the host cell surface via its spike (S) protein before it undergoes endocytosis and fusion with the lysosomal membrane. The spike protein of SARS-CoV-2 is a heavily N- and O-glycosylated trimer. Glycosylation is an essential posttranslational modification in the life cycle of membrane and secretory proteins that affects their structural and functional characteristics as well as their trafficking and sorting patterns. This study aimed at elucidating the impact of glycosylation modulation on the trafficking of both S1 subunit and ACE2 as well as their interaction at the cell surface of intestinal epithelial cells. For this purpose, the S1 protein was expressed in COS-1 cells and its glycosylation modified using N-butyldeoxynojirimycin (NB-DNJ), an inhibitor of ER-located alpha-glucosidases I and II, and or 1-deoxymannojirimycin (dMM), an inhibitor of the Golgi-located alpha-mannosidase I. The intracellular and secreted S1 proteins were analyzed by endoglycosidase H treatment. Similarly, ACE2 trafficking to the brush border membrane of intestinal Caco-2 cells was also assessed in the presence or absence of the inhibitors. Finally, the interaction between the S1 protein and ACE2 was investigated at the surface of Caco-2 cells by co-immunoprecipitation. Our data show that NB-DNJ significantly reduced the secretion of S1 proteins in COS-1 cells, while dMM affected S1 secretion to a lesser extent. Moreover, NB-DNJ and dMM differentially affected ACE2 trafficking and sorting to the brush border membrane of intestinal Caco-2 cells. Strikingly, the interaction between S1 and ACE2 was significantly reduced when both proteins were processed by the glycosylation inhibitors, rendering glycosylation and its inhibitors potential candidates for SARS-CoV-2 treatment. This work has been supported by a grant from the German Research Foundation (DFG) grant NA331/15-1 to HYN. M.K. was supported by a scholarship from the Hannover Graduate School for Veterinary Pathobiology, Neuroinfectiology, and Translational Medicine (HGNI) and by the DFG grant NA331/15-1.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.

Pandemic Produce: Impacts of COVID-19 on Florida's Fruit and Vegetable Industries

Florida has one of the most diverse agricultural economies in the United States, producing several dozen types of fruits and vegetables that are consumed within the state, across the country, and around the world. The COVID-19 pandemic and resulting policy responses occurred during the peak of spring harvest season for many crops in Florida, abruptly removing market demand from the food service industry and shifting consumer purchasing habits, which enabled insights into several aspects of the fruit and vegetable supply chain. This article examines how the COVID-19 pandemic impacted fruit and vegetable industries in Florida, how these industries responded to COVID-19 impacts, and how Florida's experience compared to that of other states. Data are derived from several sources including a statewide survey that measured agricultural production losses in Florida resulting from COVID-19 in early 2020, interviews with Florida operations that provided insights into how the pandemic induced change across the food supply chain, and a survey of food supply chain operations in three regions of the United States conducted in 2021. © 2022 Walter de Gruyter GmbH, Berlin/Boston.

Detection of SARS-CoV-2 RNA in wastewater and comparison to COVID-19 cases in two sewersheds, North Carolina, USA

Wastewater surveillance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be useful for monitoring population-wide coronavirus disease 2019 (COVID-19) infections, especially given asymptomatic infections and limitations in diagnostic testing. We aimed to detect SARS-CoV-2 RNA in wastewater and compare viral concentrations to COVID-19 case numbers in the respective counties and sewersheds. Influent 24-hour composite wastewater samples were collected from July to December 2020 from two municipal wastewater treatment plants serving different population sizes in Orange and Chatham Counties in North Carolina. After a concentration step via HA filtration, SARS-CoV-2 RNA was detected and quantified by reverse transcription droplet digital polymerise chain reaction (RT-ddPCR) and quantitative PCR (RT-qPCR), targeting the N1 and N2 nucleocapsid genes. SARS-CoV-2 RNA was detected by RT-ddPCR in 100 % (24/24) and 79 % (19/24) of influent wastewater samples from the larger and smaller plants, respectively. In comparison, viral RNA was detected by RT-qPCR in 41.7 % (10/24) and 8.3 % (2/24) of samples from the larger and smaller plants, respectively. Positivity rates and method agreement further increased for the RT-qPCR assay when samples with positive signals below the limit of detection were counted as positive. The wastewater data from the larger plant generally correlated (square similar to 0.5, p < 0.05) with, and even anticipated, the trends in reported COVID-19 cases, with a notable spike in measured viral RNA preceding a spike in cases when students returned to a college campus in the Orange County sewershed. Correlations were generally higher when using estimates of sewershed-level case data rather than county-level data. This work supports use of wastewater surveillance for tracking COVID-19 disease trends, especially in identifying spikes in cases. Wastewater-based epidemiology can be a valuable resource for tracking disease trends, allocating resources, and evaluating policy in the fight against current and future pandemics.

Bulletin Report – GIS Days 2022 The culmination of 3 years of virtual, collaborative, GIS Days

GIS Day was a small, local offering dependent on individual institutions, until the COVID-19 pandemic prompted a wealth of online events. After 3 years of successive development, 2022 saw this event span multiple days and reach beyond Western University to institutions across Canada. The planning process, events, and outcome are here described as inspiration for future events by interested parties, and to acknowledge the work of those involved while simultaneously promoting the current work in GIS being undertaken and potential future directions for event organizers. © 2023 Association of Canadian Map Libraries and Archives. All rights reserved.

Parkrun across the pond: examining location and event characteristics in Canada and the United States of America

Mass participation events, such as ‘parkrun', may be one option to encourage physical activity within communities. The purpose of the study was to describe the expansion of parkrun locations in Canada and the United States of America (USA) and identify and describe characteristics of parkrun locations. For each parkrun site, setting-level information was collected from selected websites. Findings revealed many parkrun events were started in 2019 with most locations offering a virtual option during the COVID-19 pandemic. Further, parkrun events appear to be supported in cities/towns that vary in demographics. Two-thirds of USA parkrun cities were above the national average for individuals being within a short walking distance to a park;however, most parkrun locations are car reliant. There is room to expand parkrun where no events currently exist and additional research is needed to determine the degree to which area-level characteristics are associated with actual parkrun participation. © 2023 Canadian Association for Leisure Studies / Association canadienne d'études en loisir.

The Impact of the COVID-19 Pandemic on Women's Adjustment Following Pregnancy Loss

There are a variety of constraints to accessing social support following pregnancy loss that can negatively impact women. Being able to seek and receive needed social support following pregnancy loss may be further complicated by the ongoing COVID-19 pandemic. The current study explored the experiences and impact of the COVID-19 pandemic on women who have experienced miscarriage or stillbirth. Results showed that the pandemic exacerbated women's feelings of grief, trauma, depression and anxiety. These findings indicate that addressing the mental health needs of women who have experienced pregnancy loss during the pandemic should be evaluated and addressed. © 2022 Taylor & Francis Group, LLC.

50. Creating Adolescent-centered Sexual and Reproductive Care for a Mobile Health Unit

Purpose: Exacerbated by the COVID-19 pandemic, adolescents from structurally marginalized communities face barriers to accessing sexual and reproductive health (SRH) care. Mobile health units (MHUs) may be effective in reaching these adolescents but few studies have assessed their feasibility in this population. Methods: We assessed the feasibility of an MHU to provide SRH care to adolescents in community settings. Adolescents were invited to community demonstrations of hypothetical MHU care ("Demonstration events”). Adolescents completed surveys (demographics, likelihood of future MHU-based care, and access to health care) and staff documented field notes. We then partnered with adolescents, health care providers, and community leaders to create adolescent-centered SRH care for MHU delivery ("Clinical events”). Free and confidential services provided on the MHU included contraceptive care, condoms, testing for pregnancy, Neisseria gonorrhea (GC), Chlamydia trachomatis (CT), Syphilis, and Human Immunodeficiency virus (HIV). Initially, we provided electronic prescriptions for contraception during MHU visits. We later designed a system to dispense contraception [I.e., emergency contraception (EC) for future use, combined hormonal oral contraceptives (CHOCs), patches and Medroxyprogesterone] in the MHU. After MHU care, adolescents completed surveys to report satisfaction while staff documented feedback through field notes. Results: At 8 community "Demonstration events”, 98 teens (mean age 15.8 years, 67% female at birth, 17% Genderfluid/Non-Binary/Trans, 49% heterosexual, 24% Hispanic, 49% Black, 40% White) were enrolled. Most (70%) reported no previous vaginal/penile sex. Many (46%) had forgone needed health care in the previous year. Most (77%) said they were very/somewhat likely to get care on the MHU if available in the future and 82% would recommend it to friends. Most thought the MHU would be a great way to increase access to SRH care because it eliminated transportation obstacles and appointment delays. Many felt the MHU would provide adequate privacy and advised bringing the MHU to school or community events. Teens recommended collecting urine specimens in nearby restrooms and using a brown bag to transport them to the MHU. Utilizing their feedback, we partnered with teen-serving community organizations and schools to host the MHU. At two "Clinical events”, we provided care for five patients (4 biologic females, 1 biologic male). Accepted health services included condom provision (n=5) and, pregnancy (n=3), GC/CT (n=4), and Syphilis/HIV (n=2) testing. Two MHU patients received contraceptive prescriptions, one received contraception onsite (EC and CHOCs), and one with a positive CT test was contacted and treated. Four adolescents completed a post-care survey. All (100%) were very satisfied with MHU care and said they would recommend it to a friend. All (100%) agreed/strongly agreed they learned something new about SRH and reported the information was helpful. Field notes revealed patients communicated appreciation for the care, felt comfortable on the MHU, and found school-based SRH care acceptable. We plan to host five additional MHU "Clinical events” (Fall 2022). Conclusions: As COVID-19 continues to negatively impact adolescent SRH care-seeking, our work offers key insights to customizing MHU-based SRH care to meet the unique needs of adolescents from structurally marginalized communities. Sources of Support: Institutional expansion of NIH-funded KL2 program (RB), 3R21HD098086-02S1 (MM), K23HD098299 (KM).

Learning, Growing, Embracing, Transitioning, and Changing: Exploring Resilient Teaching and Learning during the Covid-19 Shutdown

This paper presents a collective self-study that examines what student teachers and a teacher educator learned from our collective work during the initial Covid-19 shutdown. Using a theory of collaborative inquiry grounded in Brené Brown's work on resiliency and vulnerability, we examined our work during this time of great struggle. We learned how severe challenges prompted us to enhance our practices and reimagine typical roles while thinking critically and creatively about teaching and learning. © 2023 Kappa Delta Pi.

Pivoting an international experience preparation course during the COVID-19 pandemic

This case study describes the adaptation of a small group interactive course, originally designed to prepare student pharmacists for an international Advanced Pharmacy Practice Experience (APPE), to a hybrid virtual course designed to prepare students to work across cultures and in many different professional environments. As the uncertainty of the COVID-19 pandemic impacted planned international experiences, a strategic pivot in delivery and content was necessary. The course content was changed to enhance student skills in cross cultural communication and humility, working through conflict, personal emotion regulation, and appropriately engaging with other cultures. Copyright © 2020, International Pharmaceutical Federation. All rights reserved.

The Effect of Decreased Physical Activity on Physical and Mental Health of School-Aged Children during the Covid-19 Pandemic

BACKGROUND: School-aged children are recommended to complete at least one hour of moderate to vigorous intensity physical activity per day. North American data has shown that due to COVID-19 restrictions placed on in person schooling and extracurricular activities, children were not meeting recommended levels of physical activity. Additional barriers to activity during the first wave of the COVID-19 pandemic included lack of access to public facilities including community centers, parks, and outdoor recreation. Decreased physical activity in children has been shown to have a negative impact on both physical and mental health, and childhood development. However, there is a paucity of literature on parents' perceptions of the association between physical activity and physical and mental health. OBJECTIVE(S): The objective of this study was to gain a better understanding of the implications of the COVID-19 pandemic on levels of physical activity and parents' perceptions surrounding physical activity and physical and mental health. DESIGN/METHODS: An online survey was distributed to parents of school-aged children aged 4-13 in Ontario. The survey included questions regarding demographics, children's physical activity prior to and during the first wave of the COVID-19 pandemic, and parental perceptions regarding the pandemic's impact on mental and physical health. This study received ethics approval, was hosted on the REDCapTM platform, and distributed from February-June 2021 through a local school board, the Pediatrics section of the Ontario Medical Association, and through social media. RESULT(S): Of 361 participants, 90.4% strongly agreed that physical activity was important for mental health, and 92.2% strongly agreed that physical activity was important for physical health. There was a statistically significant decrease in the overall mean number of hours of physical activity per week between pre-COVID and the first wave of COVID (mean difference = 9.34 hours, SD = 10.06, p<0.001). Additionally, parents of children with decreased physical activity reported a statistically significant negative impact on physical and mental health as compared to parents whose children had no change in amount of physical activity. Decreased energy, poor sleep, increased anxiety, mood disturbances, and disruptive behaviour were noted by over 50% of respondents. CONCLUSION(S): This survey highlights that parents themselves perceived a significant negative impact on children's mental and physical well-being with decreased physical activity during the COVID-19 pandemic. This emphasizes the importance of retaining access to recreational facilities and extracurricular activities. Future research includes identifying ways to re-engage parents and children with physical activity during times of decreased access.

Does Physical Activity Vary by Virtual or in-Person School Models in School-Aged Children?

BACKGROUND: Current recommendations for school-aged children's physical activity include at least one hour of moderate to vigorous intensity physical activity per day. Schools play an essential role in providing access to physical activity, through both structured and unstructured activity such as physical education and recess. North American data has shown that due to restrictions placed on in-person schooling, children were not meeting recommended levels of physical activity during the first wave of the COVID-19 pandemic. OBJECTIVE(S): The objective of this study was to understand the effect schooling models have on access to physical activity and subsequent reported changes in mental and physical health. DESIGN/METHODS: An online survey was distributed to parents of school-aged children aged 4-13 in Ontario. The survey included questions regarding demographics, children's physical activity prior to and during the first wave of the COVID-19 pandemic, and parental perceptions regarding the pandemic's impact on mental and physical health. This study received ethics approval, was hosted on the REDCapTM platform, and distributed from February-June 2021 through a local school board, the Pediatrics section of the Ontario Medical Association, and through social media. RESULT(S): A total of 361 survey participants responded. Although there was a statistically significant decrease in the overall mean number of hours of physical activity per week from prior to the COVID-19 pandemic and the first wave of the COVID-19 pandemic (mean difference = 9.34 hours, SD = 10.06, p<0.001), there was no significant difference in hours of physical activity when comparing in-person and virtual school models (p=0.892 pre-COVID-19 pandemic and p=0.146 during the first wave of the COVID- 19 pandemic). There was no significant difference in parent-reported impact of either physical (p=0.724) or mental (p=0.822) health between those that were enrolled in virtual or in-person school models, and no significant difference between school model and restarting activities (p=0.078). CONCLUSION(S): This survey highlights not only that parents identified a significant decrease in children's physical activity during the pandemic but also that there was no correlation between school model and physical activity. This may be due to several organized physical activities not being re-started despite schools reopening, thus contributing to similar outcomes for children in both school models. Future research may include exploring why virtual and in-person models demonstrated no significant difference in physical activity and to conduct a qualitative analysis on methods used by parents to engage children in activity.

Ambulatory Care Visits and Admissions for Suicidal Ideation and Self-Harm in Canadian Adolescents during the Covid-19 Pandemic: A Population-Based Analysis

Database, and Hospital Morbidity Database. The primary outcome was ambulatory care visits for a composite of suicidal ideation, intentional self-poisoning, and intentional self-harm. Results were stratified by age and sex and expressed as a rate (proportion of encounters with an outcome per 100 encounters). We compared the differences (delta) in slopes (average increase in outcomes) between April 1, 2015, to March 31, 2020, and April 1, 2020 to March 31, 2021 to determine if the expected rate (pre-pandemic) differed significantly from the observed rate (pandemic). RESULT(S): From April 1, 2020, to March 31, 2021, compared to April 1, 2015, to March 31, 2020, the rate of ambulatory care visits and admissions for all conditions decreased. The average quarterly rate of ambulatory care visits for the composite among males 10-14 years, increased by 40.3%, from 0.57 to 0.8 (slope delta=0.1;95% CI: 0.02, 0.18;p=0.012). Among females 10-14 years, the rate increased by 85.1%, from 1.81 to 3.35 (slope delta=0.7;95% CI: 0.43, 0.97;p<0.001). Among males 15-18 years, the rate increased by 29.5%, from 1.56 to 2.02 (slope delta=0.13;95% CI: -0.02, 0.28;p=0.078). Among females 15-18 years, the rate increased by 33.6%, from 3.18 to 4.25 (slope delta=0.26;95% CI: -0.16, 0.68;p=0.192). The average quarterly rate of admissions was significant for females 10-14 years and increased by 27.7%, from 8.59 to 10.97 (slope delta=1.99;95% CI: 0.57, 3.41;p=0.017). CONCLUSION(S): The proportion of ambulatory care visits and admissions for emotional symptoms, suicidal ideation, and self-harm during the first year of the COVID-19 pandemic increased compared to pre-pandemic rates among adolescents 10-14 years in Canada. Our findings underscore the importance of promoting public health policies that mitigate the impact of pandemics on adolescent mental health.

IMMUNE RESPONSES TO MODERNA COVID-19 MRNA VACCINE IN FRAIL NURSING HOME PATIENTS

Prior COVID-19 mRNA vaccine trials included healthy older adults, but mRNA vaccine responses were not studied in frail older adults. We postulated that frailty was associated with immune responses of reduced quality and quantity following mRNA vaccination. A cohort of 15 older adults in a retirement facility were followed from the first Moderna mRNA-1273 vaccine dose in February 2021 with blood collections at baseline and weeks 4 (boost), 6, 18 and 28. Outcomes were IgG titers to SARS-CoV-2 Spike protein with secondary outcomes of T cell responses. Statistical analysis used log transformed geometric mean antibody titers in multivariable regression models with clinical predictors including, age, sex, prior infection status, and clinical frailty scale (CFS) score. Cellular immune response analysis used multivariable regression for function and phenotyping of T cell subsets. All participants with median (IQR) age: 90 years (84, 96) and CFS score: moderately frail 6 (5, 7) generated robust antibody responses with mean peak titer levels 10-fold higher than baseline. In the adjusted model, individuals with severely frail scores CFS=7 had lower antibody levels compared to mildly frail CFS=5, OR: 0.55 (0.35, 0.87) p=0.017. Both chronological age and sex had non-significant relationships with antibody titers. Spike peptide specific CD4 cells and T follicular helper cells were significantly decreased in more frail individuals (p=0.011 and p=0.008 respectively), though the relationship with antibody titers was non-significant. Frailty scores were a better predictor than age for serologic and cellular immune responses to COVID-19 mRNA vaccination in very old adults.

The Impact of COVID-19 on Teachers’ Integration of Digital Technology

The coronavirus pandemic impacted all aspects of society, causing countries and local communities to close workplaces, move schools to remote instruction, limit in-person contact, cancel public gatherings, and restrict travel. Attempts to mitigate COVID-19 through remote instruction provided unique opportunities for researchers to examine the resources teachers utilize to drive their practices. We examine the impacts of the pandemic on grades 6-12 mathematics teachers and math interventionists, with particular attention to teachers’ integration of digital resources. Using purposive sampling, we surveyed 50 participants—across urban, suburban, and rural districts—throughout the United States. The descriptive survey focused on six aspects of teachers’ practices with digital resources. Results indicate that challenges encountered and lessons learned included a lack of student engagement and motivation, increased distractions, and varied access to technology. Integration of technology did not positively impact students’ mathematical proficiency across all teachers. Common resources used across planning of lessons, implementation of instruction, and assessment included the Google platform, Desmos, and GeoGebra. Where appropriate, we situate our results within the larger context of recent international research. These findings support teacher practices that constantly attempt to optimize students’ mathematics and social emotional learning, regardless of the environment or situation. © 2022 by authors.

Barriers and Facilitators in Clinical Trial Enrollment and Assessments of Infants Born Extremely Preterm During the COVID-19 Pandemic

Background and Objective(s): Although the overall rates of preterm birth decreased, the proportion of infants born preterm was high among Black, Indigenous, and other People of Color (BIPOC) during the COVID pandemic. This study aims to identify barriers/facilitators to study enrollment and assessment completion. Study Design: Cohort study. Study Participants & Setting: Fifty-seven very preterm infants (<29 weeks gestation) enrolled in the Supporting Play, Exploration, and Early Development Intervention trial while in a participating Neonatal Intensive Care Unit (NICU). Comparisons of two time periods for enrollment and 2 for assessments were compared;pre-COVID (Before 03/12/20), COVID (03/13/20 -03/ 12/21), and late-COVID (after 03/12/21). Materials/Methods: The proportion of eligible infants that enrolled and completed planned assessment visit was extracted from detailed enrollment and visit completion notes. A combination of assessments including the General Movement Assessment, Test of Infant Motor Performance (TIMP), Bayley Scales of Infant and Toddler Development 3rd edition (BSID), Gross Motor Function Measure (GMFM), Hammersmith Infant Neurological Exam (HINE), 5-minute observation of Parent-child interaction, and Assessment of Problem Solving in Play (APSP) were completed based on age at 5 visits over 24 months. The GMFM, APSP, and the parent child observations were completed via telemedicine (after contactless drop off of manipulatives to the family). The assessment protocols were modified to facilitate completion of as much of the assessment as possible via telemedicine. During the end of the COVID period hybrid visits, with only the BSID completed in person were included if the in-person contact was less than 60 minutes. All analysis are descriptive due to small samples. Result(s): Eligibility and enrollment was impacted by COVID with 48% and 60% of eligible infants enrolling pre-COVID decreasing to 33% and 46% during COVID. The proportion of infant that enrolled who were non-White changed, decreasing from 70 to 60% in an urban hospital and increasing from 12 to 20% in a rural hospital. The rate of in-person assessments during COVID (59%) was lower than pre-COVID (100%) or late-COVID (96%) period. Conclusions/Significance: Caregiver engagement while in the NICU and persistent study coordinators making multiple phone calls to provide ample opportunities for enrollment helps to maintain a high level of enrollment during the COVID periods. NICU visitation restrictions, children at home, and role of essential workers, who are more likely to be BIPOC, may have impacted enrollment. Quick adaptation of assessors to telehealth via training sessions and standardized protocols were identified as facilitators to enrollment and assessment completion. The GMA, APSP, Parent child observation and GMFM were performed in person as well as through telehealth with additional planning and parent engagement required. Whereas BSID, TIMP, and HINE could be performed only in-person resulting in missing data. The impact of the pandemic on research is important to understand.

Barriers and Facilitators to Participation in Intervention for High-risk Infants Enrolled in a Clinical Trial During the COVID-19 Pandemic

Background and Objective(s): Preterm birth is associated with a significant health, emotional, and financial burden on families. Racial, ethnic, and social inequities in the United States during COVID-19 did not spare infants born preterm and their families. While the rates of preterm birth declined during the lockdown, the highest proportions of preterm births continued to be in the Black, Indigenous, and other People of Color (BIPOC) groups. Limited data exists on factors influencing access to rehabilitation services for high-risk infants during COVID-19. We aim to identify barriers and facilitators impacting access to intervention in parents of preterm infants as measured by enrollment and retention in an intervention arm of a multisite rehabilitation clinical trial. Study Design: RCT. Study Participants & Setting: Fifty-seven extremely to very preterm infants (<29 weeks gestation) participating in an ongoing Supporting Play, Exploration, and Early Development (SPEEDI) trial. Intervention was conducted in the neonatal intensive care unit (NICU), home, and/or via telehealth. Materials/Methods: All infants were recruited in the NICU and randomized into SPEEDI intervention or usual care group. The intervention group received 10 sessions of therapist-guided, parent-provided intervention, delivered in two phases (5 sessions per Phase) across 4 months. Both groups continued to receive early intervention services in the community. The intervention was adapted to telehealth in response to COVID-19 and an online platform with videos and activities was created for parents. Enrollment and retention were descriptively analyzed in two time periods;pre-COVID (Before 03/12/20), and COVID (03/13/20 -03/ 12/21) with emphasis on distinctions between in-person vs telehealth participation. Result(s): Enrollment during the COVID period was reduced by 41.18% compared to pre-COVID. Thirty-five preterm infants participated in the intervention during both periods, of which 54% were white and 46% belonged to BIPOC groups. The overall completion rate (i.e.10/10 intervention sessions completed) was 65%, 11% missed >=1 visit, and 26% either withdrew from intervention or were lost to follow-up. The completion rates did not differ for pre-COVID (99%) and COVID (98%) periods. For withdrawals, 55% occurred during COVID, 66% of participants who withdrew self-identified as Black, and 77% had a sibling at home. Of the 63 sessions scheduled during COVID, 31.7% were in-person and 68.2% via telehealth. There was a 68% decline in in-person sessions during COVID compared to pre-COVID. The completion rate for telehealth during COVID was 97% (42/43). Conclusions/Significance: Caregiver engagement in intervention, provision of intervention materials online, and quick adaptation of interventionists to telehealth via training sessions and standardized protocols were identified as facilitators to retention. Navigating siblings at home and the burden of COVID were the primary barriers to retention. The impact of race on retention and participation in intervention and research for high-risk infants should be monitored.