Moral Judgments Impact Perceived Risks From COVID-19 Exposure

The COVID-19 pandemic created enormously difficult decisions for individuals trying to navigate both the risks of the pandemic and the demands of everyday life. Good decision making in such scenarios can have life and death consequences. For this reason, it is important to understand what drives risk assessments during a pandemic, and to investigate the ways that these assessments might deviate from ideal risk assessments. In a preregistered online study of U.S. residents (N = 841) using two blocks of vignettes about potential COVID exposure scenarios, we investigated the effects of moral judgment, importance, and intentionality on COVID infection risk assessments. Results demonstrate that risk judgments are sensitive to factors unrelated to the objective risks of infection. Specifically, activities that are morally justified are perceived as safer while those that might subject people to blame or culpability, are seen as riskier, even when holding objective risk fixed. Similarly, unintentional COVID exposures are judged as safer than intentional COVID exposures. While the effect sizes are small, these findings may have implications for public health and risk communications, particularly if public health officials are themselves subject to these biases.

Comparison of photographic photonic assessment and conventional clinical assessment in diagnosis of contact allergy with patch testing: a pilot study

The SARS-CoV-2 (COVID-19) pandemic has led to the rapid implementation of virtual clinics across the healthcare sector. Alternatives to the conventional face-to-face patient assessment have been sought and piloted within dermatology departments. Cutaneous patch testing is traditionally assessed on days 2 and 4, and often delayed readings are required. Strategies to minimize physical attendance and the potential risk of COVID-19 transmission were required in order to maintain access to services. Photographic assessment of patch testing was introduced in our department. In addition, we employed photographic phototonics to augment the patch-test result image. Phototonics is the technology of generating, detecting and manipulating physical light, whose quantum unit is the photon. Photonics can be used to assess levels of blood flow in a clinical photograph of skin acting as a surrogate marker for cutaneous inflammation. Our aim was to assess if clinical photography and photonic image analysis can improve the detection of positive reactions in the virtual interpretation of patchtest results. Consecutive patients attending for patch testing were recruited and written consent was obtained. Photographs of patch-test results were taken using a 40-megapixel colour camera, on day 5, contemporaneous to patch-test assessment by the study investigators. The photographs were then analysed using spectral imaging technology software (HyperCube). The analysis employed principal component analysis, a technique used to reduce the dimensionality of datasets. The phototonic images were then examined to determine a combination of variables or colour patterns (red-green-blue) that would indicate a positive result and a surrogate marker for cutaneous inflammation. Thirty patients were recruited from September to November 2020. Two blinded investigators determined whether the results were positive, ?positive, irritant or other. Phototonic, photographic and clinical results were then compared. Photonic evaluation captured 59% of positive patch-test readings, while photographic assessment captured 50%. Interpretation of the results was almost identical between both investigators. This pilot study outlines the potential application of phototonic technology in the interpretation of virtual patch-test results. It is evident that physical attendance for patch-test reading is superior to both photographic phototonic assessment and photographic assessment. However, there may be role for the use of phototonics in order to augment the evaluation of virtual patch-test results. Interpretation of phototonics can be difficult and is generally modelled to validated results. Analysis using a multispectral camera to include specific wavelengths to monitor increased blood flow may have a role.

Aplasia cutis congenita in dizygotic twin infants

Aplasia cutis congenita (ACC) is often sporadic, but familial cases have been reported. We report a case of a dichorionic diamniotic twin pregnancy in which both the male and female twins had matching areas of aplasia cutis on their scalps. An Irish couple sought fertility treatment using a donor egg and paternal sperm. Successful in vitro fertilization (IVF) and the transfer of two embryos resulted in a diamniotic dichorionic twin pregnancy. Two fetal poles were noted at the 12-week ultrasound (US) scans. The mother suffered from a minor urinary tract infection during the first trimester but had no other history of infection, including herpes simplex virus or COVID- 19. She was known to be varicella immune prior to pregnancy. The twins were born by elective caesarean section owing to breech presentation. Twin one was female and twin two was male. Both infants were born with scarring on the crown of their head, which was consistent with ACC. Cranial US showed no underlying bony abnormality. The rest of the cutaneous examination was normal and there were no other congenital anomalies. ACC is a rare, heterogeneous group of disorders characterized by the congenital absence of skin, which can be focal or widespread. It is thought to affect 1-3 per 10 000 live births. The exact cause of ACC is unclear. Various hypotheses have been suggested, including defective closure of the neural tube or embryonic fusion lines, intrauterine trauma, placental insufficiency, fetus papyraceus, amniotic membrane adhesions, intrauterine infections, teratogens and genetic mutations. The classification of ACC is based on the area affected, type of skin irregularity, associated congenital defects and mode of inheritance. Scalp ACC without multiple anomalies (category 1) is generally associated with an autosomal dominant or sporadic pattern of inheritance. These twins may have an autosomal dominant mutation that led to this phenotype. ACC can also be associated with fetus papyraceus or placental infarct. This is less likely in this case as only two embryos were transferred, and the pregnancy was dichorionic. Most cases of ACC associated with fetus papyraceus occur in monozygotic pregnancies. ACC lesions often heal spontaneously by re-epithelialization resulting in a hairless superficial scar. Twin one had a slightly smaller area affected by ACC and overlying eschar resolved several weeks after birth. Twin two has had no hair growth in the area. This case highlights the difficulties in ascertaining the aetiology of this rare condition in twin pregnancies.

Troubled times: Canadian social workers' early adversities, mental health, and resilience during the COVID-19 pandemic

Canadian social workers were surveyed about early adversities, mental health, and resilience. Bivariate analysis (n = 236) was conducted to understand relationships between predictor and outcome variables;and logistic regression analyses were conducted for depression, post-traumatic stress disorder, anxiety, and resilience. The impact of pandemic-related factors was also investigated. The results indicate that social workers are experiencing concerning levels of mental health issues, with significantly lower levels of resilience in younger social workers. A trauma and resilience informed approach to workplace policies and practices is urgently required to support social workers' mental health needs.

Remdesivir in the treatment of children 28 days to < 18 years of age hospitalised with COVID-19 in the CARAVAN study

P168 Table 1Overall safety showing proportion of participants with AEsParticipants, n (%) Cohort 1n=12 Cohort 2n=12 Cohort 3n=12 Cohort 4n=12 Cohort 8n=5 TotalN=53 Any AE 11 (92) 7 (58) 9 (75) 7 (58) 4 (80) 38 (72) Grade ≥3 AE 6 (50) 2 (17) 1 (8) 4 (33) 2 (40) 15 (28) SAE 5 (42) 2 (17) 0 3 (25) 1 (20) 11 (21) Treatment discontinuation due to AE 2 (17) 0 0 0 0 2 (4) Treatment-emergent death 1 (8) 1 (8) 0 0 1 (20) 3 (6) Grade 3–4 laboratory abnormalities 9 (75) 2 (17) 4 (33) 4 (36) 3 (60) 22 (42) ConclusionsRDV was generally well tolerated in children hospitalised for COVID-19 who were 28 days and older, weighing at least 3 kg. No new safety trends for RDV were identified and a high proportion of participants had clinical improvement. CARAVAN is ongoing for enrolment of full term and preterm neonates.

Piloting Photographic Photonic Patch Testing: Pioneering Equitable Diagnosis of Contact Dermatitis

Objectives: Due to restricted access to cutaneous patch testing (PT) during the SARS-CoV-2 pandemic innovative strategies were necessary to promote equitable healthcare. Photonics generates, detects and manipulates physical light (photons) which can assess blood-flow in a clinical photograph and potentially act as a surrogate marker for cutaneous inflammation. We wished to assess if clinical photography and photonic image analysis could improve the virtual interpretation of PT results. Methods: PT photographs of 30 consecutive patients were taken using a 40- megapixel colour camera contemporaneous to PT assessment by study investigators. Photographs were then analysed using HyperCube using Principal Component Analysis (PCA), a technique used to reduce the dimensionality of datasets. Photonic images were then examined to determine a combination of variables or colour patterns indicating a positive result. Results: Thirty patients were recruited from September-November 2020. Two blinded investigators determined whether the results were positive, ?positive, irritant or other. Photonic, photographic and clinical results were compared. Initial blinded photonic evaluation captured 40% of positive PT while photographic assessment captured 51%. Unblinded evaluation captured 90% of both PCA and clinically positive results. Conclusions: The SARS-CoV-2 pandemic catalysed many changes in healthcare delivery and introduced opportunities to produce patient centred care. This pilot study employs innovative technology to improve rural accessibility to PT, promote inclusivity and reduce carbon emissions by reducing patient travel. Further development is necessary as while PCAanalysis of digital images improves pick-up of positive PTvirtually it remains inferior to face-to-face assessment. Multispectral imaging has the potential to expand the range of wavelengths further.

Conceptualizing anti-Asian racism in Cnada during the COVID-19 pandemic: A call for action to social workers

Anti-Asian racism in Canada has emerged from the COVID-19 pandemic and become more rampant. This article integrates Canadian postcolonialism, a critique of Canadian multiculturalism, and a framework of intergroup prejudice to conceptualize the covert anti-Asian racism that is entrenched in Canadian society. How COVID-19 exposes and "legitimizes" anti-Asian racism is further analyzed and included in this conceptualization. This conceptualization also includes social workers' leading roles in combating anti-Asian racism through reforming and integrating client interventions, cultural policy, social context, and offers directions that can guide future social work research and practice in improving social justice during this crisis.

A qualitative analysis of online misinformation and conspiracy theories in psoriasis.

Psoriasis is a chronic, hereditary disease with a complex immunopathogenesis, rendering it susceptible to misinformation. Misinformation related to psoriasis can have negative effects both on the public perception of psoriasis and on patients' knowledge of psoriasis. To characterize misinformation related to psoriasis available online, we performed a formal literature review via PubMed and a thematic review via Google. Key themes of misinformation included 'victim-blaming' (hygiene), 'vector' (contagion), 'vaccination', 'vilification' of conventional therapy, 'validation' of natural treatment and diet, 'veneration' of cures and 'vocalization' from celebrities. Misinformation related to psoriasis is pervasive on social media and other websites. Dermatologists, as patient advocates, should be aware of the content of misinformation available online and combat misleading health information to optimize health outcomes for patients with psoriasis.

Reducing broad-spectrum antibiotic use in intensive care unit between first and second waves of COVID-19 did not adversely affect mortality.

BACKGROUND: The COVID-19 pandemic increased the use of broad-spectrum antibiotics due to diagnostic uncertainty, particularly in critical care. Multi-professional communication became more difficult, weakening stewardship activities. AIM: To determine changes in bacterial co-/secondary infections and antibiotics used in COVID-19 patients in critical care, and mortality rates, between the first and second waves. METHODS: Prospective audit comparing bacterial co-/secondary infections and their treatment during the first two waves of the pandemic in a single-centre teaching hospital intensive care unit. Data on demographics, daily antibiotic use, clinical outcomes, and culture results in patients diagnosed with COVID-19 infection were collected over 11 months. FINDINGS: From March 9th, 2020 to September 2nd, 2020 (Wave 1), there were 156 patients and between September 3rd, 2020 and February 1st, 2021 (Wave 2) there were 235 patients with COVID-19 infection admitted to intensive care. No significant difference was seen in mortality or positive blood culture rates between the two waves. The proportion of patients receiving antimicrobial therapy (93.0% vs 81.7%; P < 0.01) and the duration of meropenem use (median (interquartile range): 5 (2-7) vs 3 (2-5) days; P = 0.01) was lower in Wave 2. However, the number of patients with respiratory isolates of Pseudomonas aeruginosa (4/156 vs 21/235; P < 0.01) and bacteraemia from a respiratory source (3/156 vs 20/235; P < 0.01) increased in Wave 2, associated with an outbreak of infection. There was no significant difference between waves with respect to isolation of other pathogens. CONCLUSION: Reduced broad-spectrum antimicrobial use in the second wave of COVID-19 compared with the first wave was not associated with significant change in mortality.

Comparison of Antibiotic Use between the First Two Waves of COVID-19 in an Intensive Care Unit at a London Tertiary Centre: reducing broad-spectrum antimicrobial use did not adversely affect mortality

Background The COVID-19 pandemic increased the use of broad-spectrum antibiotics due to diagnostic uncertainty, particularly in critical care. Multiprofessional communication became more difficult, weakening stewardship activities. Aim To determine changes in bacterial co-/secondary infections and antibiotics used in COVID-19 patients in critical care, and mortality rates, between the first and second waves. Methods Prospective audit comparing bacterial co-/secondary infections and their treatment during the first two waves of the pandemic in a single centre teaching hospital ICU. Data on demographics, daily antibiotic use, clinical outcomes, and culture results in patients diagnosed with COVID-19 infection were collected over 11 months. Findings From 9/3/20 to 2/9/20 (Wave 1), there were 156 patients and between 3/9/20 and 1/2/21 (Wave 2) there were 235 patients with COVID-19 infection admitted to intensive care. No significant difference was seen in mortality or positive blood culture rates between the two waves. The proportion of patients receiving antimicrobial therapy (93.0% vs 81.7%;p<0.01), and the duration of meropenem use (median (interquartile range): 5 (2-7) vs 3 (2-5) days;p=0.01) was lower in Wave 2. However, the number of patients with respiratory isolates of Pseudomonas aeruginosa (4/156 vs 21/235;p<0.01) and bacteraemia from a respiratory source (3/156 vs 20/235 p<0.01) increased in Wave 2, associated with an outbreak of infection. There was no significant difference between waves with respect to isolation of other pathogens. Conclusions Reduced broad spectrum antimicrobial use in the second wave of COVID-19 compared with the first wave was not associated with significant change in mortality.

IDENTIFYING THE TOP 10 RESEARCH PRIORITIES FOR FAMILY CARERS: THE INTERFACE PROJECT

Background In assessing the global impact of the COVID-19 pandemic on society, it is important to understand the communities most affected and develop methods of support. Family carers provide a vital, yet often invisible role in our society and healthcare system. Identifying research priorities for carers helps establish overall gaps in the research agenda and increases awareness of the role of carers in the community. Methods A priority setting partnership methodology was engaged and through collaboration with carers, healthcare professionals and researchers, a participatory process was conducted to identify gaps in the current literature and prioritise research questions and uncertainties. Focus group discussions followed, the first consisted of family carers (n = 5). The second (n = 3) interviewed stakeholders namely healthcare professionals, researchers and policy makers. After collating the data, researchable questions were developed through an iterative process with a Multi Stakeholder Advisory Committee to identify the top 10 research priorities for Family Carers Ireland. Results The top 10 researchable questions were distilled from a list of 16 and fit into 7 broad categories. 1) economic impact and financial strain 2) Systemic issues, education, resources and policy 3) technology 4) support services and infrastructure 5) mental health and wellbeing of the carer 6) carers in society 7) Recognition and acknowledgment of the family carer. Conclusion The partnership focus of this project allowed the ‘ground-up’ development of research priorities for carers by carers. The COVID-19 pandemic served to magnify systemic issues already present in society, as well as highlight new burdens. As a result, the subsequent development of 10 researchable questions will guide further investigation to improve the support and wellbeing of family carers.

114 The use of video consultations in the lung cancer fast track clinic: patients' feedback

Introduction: The use of virtual communications has evolved rapidly during the Covid-19 pandemic. Video consultations are now widely used to minimise hospital attendance and promote patient safety, including in the lung cancer fast track clinic where new cancer diagnoses are delivered. The aim of this study was to obtain patient feedback and assess the quality of video calls from the patient's perspective. Methods: Video consultations were performed using NHS England Attend Anywhere platform. Questionnaires were communicated to patients from the fast track clinic following a completed video call between July and August 2020. Results: Feedback was obtained from 20 patients, 15 had subsequent investigations for likely lung cancer. Out of the 20 patients, 15 (75%) rated the quality of the video call as good, 3 (15%) as satisfactory and 2 (10%) as poor. Regarding the choice between a video or face-to-face consultation, five (25%) patients preferred a video consultation, 5 (25%) preferred face-to-face while 10 (50%) had no specific preference. In comparison with telephone consultations, 11 (55%) preferred video, 4 (20%) preferred telephone and 5 (25%) had no preference. Regarding additional comments, some described the video consultations as an excellent or positive experience. For example, one patient preferred receiving the diagnosis in the comfort of their own home, instead of in hospital and having to make the journey home. Less positive comments included poor connection quality and less personal interactions. None of the 20 patients required a further face-to-face attendance prior to the next step in their management pathway. Conclusion: Video consultations for the lung cancer fast track clinic is a new virtual tool that appears effective and preferred or equally accepted in 75% of patients compared to face-to-face attendance. Patient preference needs to be taken into consideration when planning video clinics. Disclosure: No significant relationships.

P292 Online HIV/STI-Clinical Training for Eleven Pacific Island Countries Provided by the UNDP Multi-Country Western Pacific Integrated HIV/TB Programme

BackgroundThe Pacific Islands have a low HIV prevalence, but high rates of STI’s and large high-risk populations. The UNDP Programme supports 11 Pacific Island Countries (PICs). In-country clinical training are provided as well as HIV/TB diagnostics, treatments, and specialist HIV clinical advice. In 2020, in-country support was not possible because of the COVID19 pandemic.ApproachAfter discussion with UNDP partners and PICs HIV/STI-healthcare workers, we presented the following online education:Monthly webinars. Eight one-hour webinars on Zoom, each repeated 4 hours later as the PICs span 7 time-zones. These case-based educational webinars covered HIV/STI clinical care related topics. Guest speakers were invited for specialist topics.In-country HIV/STI-online education workshops run over one-day for nine PICs and over half-day for Niue and Tuvalu, the two smallest PICs. The workshops ran in late 2020 to build on the webinar knowledge and were tailored to in-country needs. Training was mainly case based, co-facilitated by a worker from the Fijian HIV-positive peoples NGO, FJN+, with guest speakers invited for specialist topics.OutcomesMonthly webinars: 323 individual attendances for the 8 webinars. 114 evaluations were returned;95% found the HIV webinars very helpful and 92% would recommend them to other clinical staff. As poor internet was a problem, the presentation slides and the recorded webinars were sent to the PIC attendees.In-country online HIV/STI-education workshops: 241 participants across the PICs. A planning meeting was conducted with each PIC. The average scores in questionnaires pre– and post-training doubled from 40% to 80%. Participants found the case-based training useful and requested follow-up training.Innovation/SignificanceThis is first time in the HIV/STI clinical support to the Pacific has been provided on-line and despite internet challenges, it is an economical and efficient way to provide ongoing HIV/STI clinical education in this remote setting.

Examining the associations among moral injury, difficulties with emotion regulation, and symptoms of PTSD, depression, anxiety, and stress among Canadian military members and Veterans: A preliminary study

Introduction: Moral injury (MI) refers to the psychological distress associated with perceived betrayals or perceived transgressions of one’s moral values. It has been studied primarily among military personnel and Veterans and has been found to be associated with posttraumatic stress disorder (PTSD), depression, anxiety, and other psychiatric symptoms. Recently, research has begun to investigate MI and its potential risk factors. Difficulties with emotion regulation (ER), which refers to difficulties with managing and moderating emotions, is a transdiagnostic factor associated with several psychiatric conditions, including PTSD, depression, and anxiety. The objective of the current study was to investigate the relations among MI;symptoms of PTSD, depression, anxiety, and stress;and difficulties with ER in a sample of Canadian military personnel and Veterans. A secondary aim was to discuss the potential relevance of these relations for military personnel, Veterans, and front-line health care workers during the COVID-19 pandemic. Methods: Assessments of MI, PTSD, depression, anxiety, stress, and difficulties with ER were administered to Canadian military personnel and Veterans. Correlational analyses were used to assess the relation of MI to these symptoms. Results: Increased levels of MI were associated with avoidance and alterations in mood and cognition symptom clusters of PTSD. Perceived betrayals were also significantly correlated with PTSD-related alterations in mood and cognition symptoms. Symptoms of PTSD were significantly associated with depression, anxiety, and stress. Difficulties with ER were significantly correlated with symptoms of PTSD, depression, anxiety, and stress, but not with MI (p = 0.07). Discussion: These results reveal an association between MI and specific symptom clusters of PTSD, and they highlight the association between difficulties with ER and symptoms of psychiatric illness among Canadian military personnel and Veterans. The potential implications of these findings and future work examining MI in military personnel, Veterans, and front-line health care workers during the COVID-19 pandemic are discussed. © Her Majesty the Queen in Right of Canada, as represented by the Minister of Defence, (2020).