Socially Vulnerable Patients with Inflammatory Bowel Disease Are at Increased Risk for Vaccine Preventable Illness

INTRODUCTION: Inflammatory bowel disease (IBD) affects patients across diverse ethnic, minority, cultural, and socioeconomic backgrounds;however, the relationship between these social determinants of health (SDOH) and IBD outcomes is not well-studied. SDOH have a known impact on disparities in vaccination, but these effects may be more salient in the IBD population where patients are at greater risk for vaccine-preventable illness from immunosuppressive therapies. The social vulnerability index (SVI) is a tool provided by Centers for Disease Control that can identify individuals at risk for health care disparities by estimating neighborhood-level social need on a 0-1 scale (higher scores indicating greater social vulnerability). Utilizing census tract-level SVI data, we aimed to identify the relationship between the SDOH and vaccination rates in patients with IBD. METHOD(S): We used a retrospective cohort design of patients seen at a single IBD center between 01/01/2015 and 08/31/2022. Using the current address listed in the electronic medical record, we geocoded patients to individual census tracts and linked them to corresponding SVI and subscales (Figure 1). Controlling a priori for age, gender, race, ethnicity, marital status, English proficiency, electoral district, and religious affiliation, we used multivariable linear regression to examine the relationship between SVI and vaccination against influenza, Covid-19, pneumococcal pneumonia (conjugate and polysaccharide), and Zoster. RESULT(S): 15,245 patients with IBD were included and the percent of unvaccinated individuals was high across all vaccine types: flu (42.8%), Covid-19 (50.9%), pneumonia (62.4%), and Zoster (89.6%). High total levels of social vulnerability were associated with lower vaccination rates across all vaccine groups: flu (B -1.3, 95% CI -1.5, -1.2, p<0.001), Covid-19 (B -0.99, 95% CI -1.1, -0.88), p<0.001), pneumonia (B -0.21, 95% CI -0.27, -0.14, p<0.001), Zoster (B -0.23, 95% CI -0.27, -0.19, p<0.001). On SVI sub-scales, high scores in Socioeconomic Status, Household Composition, and Housing/Transportation were important predictors of vaccine uptake while Minority Status/Language was non-significant (Table 1). CONCLUSION(S): Living in a socially vulnerable community is associated with lower vaccination rates across all vaccine types. Higher scores on neighborhood level Socioeconomic Status, Household Composition, and Housing/Transportation were also associated with lower vaccine uptake. Many factors may affect why socially vulnerable patients are under-vaccinated, including a lack of patient and provider knowledge of routine vaccines, lack of access to care, and poor trust in vaccines and healthcare system. Further research is needed improve IBD health maintenance in gastroenterology clinics and ensure equitable distribution of vaccines to socially vulnerable patients. [Formula presented] [Formula presented]Copyright © 2023

Socially Vulnerable Patients with Inflammatory Bowel Disease Are at Increased Risk for Vaccine Preventable Illness

INTRODUCTION: Inflammatory bowel disease (IBD) affects patients across diverse ethnic, minority, cultural, and socioeconomic backgrounds;however, the relationship between these social determinants of health (SDOH) and IBD outcomes is not well-studied. SDOH have a known impact on disparities in vaccination, but these effects may be more salient in the IBD population where patients are at greater risk for vaccine-preventable illness from immunosuppressive therapies. The social vulnerability index (SVI) is a tool provided by Centers for Disease Control that can identify individuals at risk for health care disparities by estimating neighborhood-level social need on a 0-1 scale (higher scores indicating greater social vulnerability). Utilizing census tract-level SVI data, we aimed to identify the relationship between the SDOH and vaccination rates in patients with IBD. METHOD(S): We used a retrospective cohort design of patients seen at a single IBD center between 01/01/2015 and 08/31/2022. Using the current address listed in the electronic medical record, we geocoded patients to individual census tracts and linked them to corresponding SVI and subscales (Figure 1). Controlling a priori for age, gender, race, ethnicity, marital status, English proficiency, electoral district, and religious affiliation, we used multivariable linear regression to examine the relationship between SVI and vaccination against influenza, Covid-19, pneumococcal pneumonia (conjugate and polysaccharide), and Zoster. RESULT(S): 15,245 patients with IBD were included and the percent of unvaccinated individuals was high across all vaccine types: flu (42.8%), Covid-19 (50.9%), pneumonia (62.4%), and Zoster (89.6%). High total levels of social vulnerability were associated with lower vaccination rates across all vaccine groups: flu (B -1.3, 95% CI -1.5, -1.2, p<0.001), Covid-19 (B -0.99, 95% CI -1.1, -0.88), p<0.001), pneumonia (B -0.21, 95% CI -0.27, -0.14, p<0.001), Zoster (B -0.23, 95% CI -0.27, -0.19, p<0.001). On SVI subscales, high scores in Socioeconomic Status, Household Composition, and Housing/ Transportation were important predictors of vaccine uptake while Minority Status/ Language was non-significant (Table 1). CONCLUSION(S): Living in a socially vulnerable community is associated with lower vaccination rates across all vaccine types. Higher scores on neighborhood level Socioeconomic Status, Household Composition, and Housing/Transportation were also associated with lower vaccine uptake. Many factors may affect why socially vulnerable patients are under-vaccinated, including a lack of patient and provider knowledge of routine vaccines, lack of access to care, and poor trust in vaccines and healthcare system. Further research is needed improve IBD health maintenance in gastroenterology clinics and ensure equitable distribution of vaccines to socially vulnerable patients. (Figure Presented).

Remote Teaching of a Graduate-Level Instrument Repair and Maintenance Course Using Take-Home Kits and Laboratory Demonstrations

Because of the COVID-19 pandemic, most courses at universities in many countries transitioned to a remote format for the 2020-21 academic year. This presented additional challenges for courses taught with a hands-on component. Here we describe the implementation of a take-home activity kit and laboratory demonstrations to facilitate hands-on learning for a graduate-level instrument repair and maintenance course. Each student was provided with a take-home kit to enable hands-on activities at home, demonstrated by the course instructors during the synchronous lectures. Laboratory demonstrations were presented using short videos, photos, and instrument manufacturer instruction manuals. Student success was evaluated by means of a hands-on practical exam using the take-home kits and a student experience survey. All of the students who completed the survey indicated that they used the kit and felt that it improved their understanding of topics discussed in the synchronous lectures. The take-home kits and laboratory demonstrations enabled active remote learning that not only fulfilled the course learning objectives but also enhanced student experience and practical skills.

No Young Carer left Behind: A Two-Phased Study to Understand and Address the Needs of Young Carers from Rural and Urban Communities Before and During COVID-19

Canada has one of the largest cohorts of young carers aged 15 to 24 who provide unpaid care for a family member. Although the body of research on young carers is growing in Canada, knowledge on the experiences and needs of young carers living in remote and rural communities is almost absent. This study aimed to understand and address the needs of young carers in rural/remote communities to support our community partner's goal of expanding their resources and support of this underserved population. The study was conducted in two phases with the first phase being a needs assessment and the second phase addressed those needs. In Phase 1 (conducted pre-COVID-19), three focus groups were conducted with young carers from rural and urban communities with 20 young carers participating in total. Six themes were identified: Internet Usage in Daily Life;Finding and Filtering Information;Concerns Related to Internet Use;Social and Mental Support;What Makes Caregiving More Challenging;and Designing Something to Make Caring Easier. During Phase 2 (conducted mid-COVID-19), 2 focus groups were held via Zoom for Healthcare with a mix of rural and urban young carers in each group. One of the focus groups was held with those under 18 years old and the other included those between 18 to 25 years old. Four themes were identified: Responses to Emergencies;Awareness of Emergency Planning;Potential Impact on Planned Behaviour;and Considerations and Suggestions for Improvement.

Novel monitoring and dose adjustment of argatroban to maintain therapeutic anticoagulation

INTRODUCTION: In patients with unreliable activated partial thromboplastin time (aPTT) measurements who require anticoagulation with a direct thrombin inhibitor (DTI), the only reliable alternative measurement at present is a dilute thrombin time (dTT). However, this assay is not always readily available, which limits accurate real-time dose adjustments necessary to maintain therapeutic anticoagulation. DESCRIPTION: A 57 year-old woman with a history of antiphospholipid antibody syndrome, heparin-induced thrombocytopenia, and multiple prior deep venous thromboses and pulmonary emboli was admitted with COVID-19 pneumonia and intubated due to hypoxic respiratory failure. Argatroban was initiated in place of her home medication warfarin. This patient had a prolonged aPTT value at baseline and overnight dTT assay measurements were limited at our institution. To overcome this challenge, a multidisciplinary team of hematology and pharmacy clinicians created a modified aPTT algorithm. By measuring aPTT and dTT simultaneously from patient plasma samples, a patientspecific aPTT target range was derived and argatroban dosing was titrated accordingly. Subsequent aPTT values in the modified target range corresponded to therapeutic dTT values, indicating therapeutic anticoagulation was successfully achieved and maintained. Patient plasma samples were also evaluated retrospectively using a novel point-of-care (POC) coagulation test to detect and quantify the effect of argatroban. A Clotting Time Score (CTS) was derived for each sample tested. Comparison of CTS and dTT values demonstrated moderate positive correlation between test results. All CTS results accurately reflected if argatroban dosing achieved an appropriate level of anticoagulation. DISCUSSION: Therapeutic anticoagulation with a DTI in a patient with unreliable aPTT measurements is challenging but can be achieved with use of a modified aPTT scale, which in our case study was retrospectively confirmed by corresponding dTT measurements. Early validation of a novel test that could offer a rapid, POC alternative to dTT when dTT measurements are necessary but not readily available is promising. Such a technology could dramatically improve rapid accurate titration of DTIs to maintain therapeutic anticoagulation.

Perceptions of Fake News, Misinformation, and Disinformation Amid the COVID-19 Pandemic: A Qualitative Exploration

Fake news and misinformation spread quickly and virulently during the height of the COVID-19 pandemic, potentially outpacing the spread of the virus itself across the globe. This study aimed to develop a greater understanding of how individuals make sense of and interact with information they suspect to be fake by exploring perceptions of information sharing on social media during the COVID-19 pandemic. A total of 24 participants (N-female = 14, N-male = 10) took part in semistructured telephone interviews from March to June 2020. Thematic analysis was guided by principles of social constructionism. A total of 3 themes were developed from the data. First, participant interactions with information on social media were directed by the intention "Staying Social." Second, the role of social media and the uncertainty of the pandemic was framed as "A Perfect Storm for Fake News." Third, participants framed interactions in terms of "Fact-Checking" with differing rigor in this process. The data demonstrated the complexities involved when it came to participants' experiences related to fake news and misinformation surrounding the COVID-19 pandemic. The results also highlight some of the key challenges faced when it comes to preventing the spread of fake news and misinformation, particularly from the online to the offline environment. The results are discussed in the context of strategies and frameworks that can aid in educating individuals about the dangers of misinformation. Public Policy Relevance Statement An understanding of individual interactions with misinformation on social media during a global crisis provides critical insight into reasons related to proliferation, understanding, and acceptance of fake news. This article presents a qualitative exploration of individual interactions with misinformation on social media during the early weeks of the COVID-19 pandemic. The results are presented alongside a discussion of potential approaches that could help prevent the further spread of misinformation in future crises.

Safety and tolerability demonstrated with inhaled αenac antisense oligonucleotide (ION-827359) in patients with cystic fibrosis

Background: Epithelial sodium channels (ENaC) have been demonstrated to be hyperactive in patients with Cystic Fibrosis (CF) and to contribute to reduced airway surface liquid, mucus dehydration and airway mucus accumulation. An antisense oligonucleotide (ASO) which inhibits murine αENaC expression was demonstrated to be efficacious in two different mouse models of CF. ION-827359 is a chemically modified ASO, 16 nucleotides in length with a phosphorothioate backbone and constrained ethyl (cEt) modifications. In healthy volunteers the ASO was found to decrease ENaC mRNA expression in bronchial brushings by a mean of 56%.Methods: This ascending dose trial was conducted in three parts, the first two of which were in healthy volunteers. The third part of this trial was a randomized, double-blind, placebo-controlled multiple ascending dose (MAD) study in patients with CF. Patients were allowed to stay on their usual CF medications throughout the trial. The primary objective was the evaluation of safety and pharmacokinetics of ION-827359 delivered via a Pari eFlow © mesh nebulizer. A total of 33 subjects in 4 cohorts received doses of 10, 37.5, 75, or 100 mg once weekly for 4 doses, with an additional dose administered during the first week. Subjects were followed for 13 weeks after dosing. Results: ION-827359 was well-tolerated with an acceptable safety profile after multiple inhalations. The rate of adverse events was similar between ION-827359 and placebo treated groups. There were no clinically relevant changes in chemistry, hematology, urinalysis, ECG, or vital signs. There were no drug related serious adverse events or discontinuations due to adverse events although three subjects discontinued early due to concerns about COVID-19. Pharmacokinetics demonstrated low systemic exposure with a plasma half-life of approximately 2 weeks. Spirometry showed a numerical dose dependent increase in FEV1 at the end of the 4-week treatment period (4.5% difference for 100mg group from placebo). Conclusions: These results demonstrate strong evidence of tolerability and safety at the doses and regimens tested and supports further investigation of ENaC ASO ION-827359 in patients with cystic fibrosis.