Validation of dried blood spot sampling for detecting SARS-CoV-2 antibodies and total immunoglobulins in a large cohort of asymptomatic young adults.

BACKGROUND: Detecting antibody responses following infection with SARS-CoV-2 is necessary for sero-epidemiological studies and assessing the role of specific antibodies in disease, but serum or plasma sampling is not always viable due to logistical challenges. Dried blood spot sampling (DBS) is a cheaper, simpler alternative and samples can be self-collected and returned by post, reducing risk for SARS-CoV-2 exposure from direct patient contact. The value of large-scale DBS sampling for the assessment of serological responses to SARS-CoV-2 has not been assessed in depth and provides a model for examining the logistics of using this approach to other infectious diseases. The ability to measure specific antigens is attractive for remote outbreak situations where testing may be limited or for patients who require sampling after remote consultation. METHODS: We compared the performance of SARS-CoV-2 anti-spike and anti-nucleocapsid antibody detection from DBS samples with matched serum collected by venepuncture in a large population of asymptomatic young adults (N = 1070) living and working in congregate settings (military recruits, N = 625); university students, N = 445). We also compared the effect of self-sampling (ssDBS) with investigator-collected samples (labDBS) on assay performance, and the quantitative measurement of total IgA, IgG and IgM between DBS eluates and serum. RESULTS: Baseline seropositivity for anti-spike IgGAM antibody was significantly higher among university students than military recruits. Strong correlations were observed between matched DBS and serum samples in both university students and recruits for the anti-spike IgGAM assay. Minimal differences were found in results by ssDBS and labDBS and serum by Bland Altman and Cohen kappa analyses. LabDBS achieved 82.0% sensitivity and 98.2% specificity and ssDBS samples 86.1% sensitivity and 96.7% specificity for detecting anti-spike IgGAM antibodies relative to serum samples. For anti-SARS-CoV-2 nucleocapsid IgG there was qualitatively 100% agreement between serum and DBS samples and weak correlation in ratio measurements. Strong correlations were observed between serum and DBS-derived total IgG, IgA, and IgM. CONCLUSIONS: This is the largest validation of DBS against paired serum for SARS-CoV-2 specific antibody measurement and we have shown that DBS retains performance from prior smaller studies. There were no significant differences regarding DBS collection methods, suggesting that self-collected samples are a viable sampling collection method. These data offer confidence that DBS can be employed more widely as an alternative to classical serology.

Reducing time to antibiotics in patients with neutropenic fever on a bone marrow transplant unit

Background: Timely administration of antibiotics in patients with neutropenic fever (NF) is essential for reducing morbidity and mortality among oncology patients. Due to their immunocompromised state, neutropenic patients are at particularly high risk of developing severe complications from infection. The optimal time to antibiotics (TTA) for patients with NF is unclear, but IDSA/ASCO guidelines recommend a median TTA within one hour of documented fever. This study focused on identifying barriers at a single academic institution to timely antibiotic administration for patients admitted to the inpatient Bone Marrow Transplant (BMT) unit, and implemented new processes to reduce median TTA to less than 60 minutes. Method(s): Patients who developed NF during their hospital admission were included in the study. Individuals who were transferred from another facility or presented to the Emergency Department with NF were excluded. Chart reviews were performed to identify root causes for delays in antibiotics (abx). Data was collected for the following time points: time from fever to notification of provider, time from notification to abx order, time from order to release, and time from release to administration. The research team also met with key stakeholders from nursing, pharmacy, advance practice providers, and physicians to better understand the process. Result(s): Based on the root cause analysis, 4 interventions were implemented: cefepime was stocked in the pyxis (Int 1 - August 2018), NF guidelines were updated (Int 2 - October 2019), Educational videos were created for just in time learning for house staff rotating on the oncology services and an education campaign for the nursing staff (Int 3 - June 2020), a nurse driven protocol to release and administer abx was piloted on the BMT (Int 4 - December 2021). Baseline TTA was 128 minutes. After Int 1, median TTA decreased to 77.2 minutes. Int 2 and Int 3 did not improve median TTA. In October 2020, median TTA had increased to 98 minutes. After Int-4, on the BMT unit, median TTA decreased to 40 minutes. Conclusion(s): Through iterative changes and process improvement methodology, we were able to improve our median TTA from 128 minutes to 40 minutes. The most impactful changes simplified the process to administer abx. Educational initiatives were less impactful, which is consistent with human factor re-engineering science and change management strategies. This improvement initiative spanned over an extended time period largely because of interruptions due to the COVID pandemic. As a result, the project demonstrated that the goal to implementing and sustaining change requires workflow redesign, culture shifts, and engagement by all key stakeholders.

Evaluation in Education and Guidance: Contributions from TEEM 21

The eighth edition of TEEM held last year in Salamanca was marked by the effects of COVID-19. This situation meant that the edition was held entirely online, and also focused the theme of most of the papers presented. The improvement of the situation has allowed this year's edition to be held in a hybrid manner, allowing authors to present their contributions both virtually and in person. This gradual normalization of the situation has also been reflected in the content of the papers presented, in which the effects of the pandemic on the evaluation process occupy a marginal place. The national and international contributions received this year address different assessment-related topics such as the effects of game-based learning, the use of expert judgement as an assessment tool or the impact of COVID-19 on teachers' wellbeing. This paper presents an overview of the papers submitted to the track. © 2021 Owner/Author.

Challenges in Evaluation in Education and Guidance: A Perspective from 2020

Last year, the "Evaluation in Education and Guidance"track was celebrated in León during the seventh edition of TEEM. This year, the conference returns to Salamanca with a new format;an online conference consisting of different activities such as keynote speakers, round tables and debates. As in previous editions, the papers presented to the Evaluation in Education and Guidance track have reflected on the current challenges of educational assessment, revolving mainly around two topics: student assessment during the COVID-19 pandemic and competence assessment in higher education. The authors explained the main findings and conclusions of their papers through publicly available video presentations, and the Chairs organized a Delphi-based debate activity in order to collectively reflect on the two aforementioned topics. To that end, the Chairs prepared an open-ended questionnaire consisting of nine questions so that the authors could express their opinions. Then, a live session ensued in which the Chairs explained the different points of view on each issue and the authors debated them. This paper presents an overview of the papers submitted to the track, as well as a summary of the main conclusions that emerged from the questionnaire and the live session. © 2020 ACM.