Class Exercises Involving Ethical Issues Reinforce the Importance and Reach of Biomedical Engineering (and the Impact of the Coronavirus on Teaching Strategy and Measures of Assessment)

This paper builds on the ethical aspects of an introductory engineering course - BR200 - an Introduction to Biomedical and Rehabilitation Engineering. Various details of this course have been presented at ASEE Conferences in 2011, 2019 and here in 20211,2,3 and elsewhere.4 The course structure was described in 2011;one ethical innovation (story-writing) in 2019;and here in 2021 the didactic changes needed to adapt to a partial or full online presence as the result of the COVID pandemic. This present paper focuses on the impact of the COVID-19 on the teaching strategy used to introduce and discuss medical engineering ethical issues within the class as it abruptly transitioned from face-to-face instruction to completely remote in Spring 2020 (S20), and as it reappeared as a hybrid course in Fall 2020 (F20) and Spring 2021 (S21). The focus of this present paper is not on the instructional changes required by COVID (and discussed in our companion paper), but rather on how those in turn changed the approach to the handling of ethical questions and to the assessments of students' responses to those scenarios. One hypothesis is whether the content or style of the pre-post scenario answers and of the reflections changed between an answer handwritten under time-pressure and one electronically captured with little time constraint. Did the answers or reflections measurably change if more time were to be allowed for consideration? Another hypothesis was that the ethical dilemmas presented increased students' integration and appreciation of the biomedical engineering field regardless of comment modality. Biomedical engineering ethics can certainly be taught face-to-face, in a hybrid setting or completely online - but how well? Did ethics instruction suffer depending on modality? Our conclusion seemed clear - It didn't matter especially if each method employed a blended learning management system like Moodle or other similar platforms. An instructor receives qualitative feedback in the classroom (i.e., a sense of how students are responding). Data from off-line grading of responses can be assessed and quantified. In sum, the major consideration brought about by a switch among in-person, online and hybrid instruction was how to handle the interactive, immersive ethical vignettes that the students were required to respond to, sometimes as an in-class exercise and sometimes as a post-lecture submission. That is a major focus of this paper. Ethical vignette assignments used in BR200 were authentic assignments,5,6 a term used to describe assignments that often focused on messy, complex real-world situations and their accompanying constraints. The concepts of authentic assessment and authentic teaching are also explored in this paper, especially as they relate to ethical scenarios and the student's grasp of ethical principles. Our results indicate that applying authentic assignments, assessments and teaching strategies to the teaching of ethical principles and practices might prove to be a beneficial adjunct to packaged ethical case studies. © American Society for Engineering Education, 2021

Teaching an Immersive Experiential Introductory Biomedical Engineering Course in the Land of Covid (AKA: An Old Dog Has to Learn New Tricks)

Clarkson University's BR200 is a highly interactive and well-subscribed (~50 students per term) face-to-face entry-level biomedical engineering class. Its title is Introduction to Biomedical and Rehabilitation Engineering. This long paper deals with the successes and pitfalls of taking this course abruptly online mid-course in the spring 2020 semester and as a hybrid but mainly remote fall 2020 course, both as the result of the COVID-19 pandemic. This class had been taught for over 25 semesters by the same instructor with the help of a few guest lectures. The 2020 Coronavirus pandemic profoundly altered the way any business or social interaction could be carried out. Universities were no exception. One day in mid-March 2020 undergraduate students were suddenly told to pack up and leave campus. All instruction was then to be remote. We describe and analyze 1) the incremental changes made in the approach to teaching this face-to-face class that were implemented from spring 2011 until fall 2019 based on feedback and assessment;2) the changes made to the in-person spring 2020 class at its start because of a fall 2019 two-day institutional Quality Matters2 (QM) class taken by the instructor;3) the rapid, fairly painless and sometimes clueless transition mid-spring 2020 to online instruction aided by the QM rubrics that were already in place for the class;and 4) the painful but necessary transition to a “proper” method of hybrid teaching (split in-class and online) that was greatly aided by the University's offering of a 4-week volunteer (i.e., no pay) intensive summer program for faculty entitled “RISE: Reframing Instruction for Success Everywhere.”3 Using abundant student assessment and reflective data, this paper takes a deep dive into lessons learned, work required, comparisons of didactic approaches, and how students' assessments changed. The first author relates how he, as an old dog and set in using his unlearned teaching methods, had to learn new tricks in order to survive as an effective instructor during a pandemic. The Quality Matters and the RISE courses prepared the instructor for better online course management, especially for the hybrid fall 2020 term. But the hours required for course management increased >10-fold for the fall term over the course as it was previously offered. BR200 used a highly effective interactive synchronous exercise to get naive students fired up about the biomedical engineering field. Translating this synchronous immersive exercise for remote learning was a challenge. The students really missed or found it hard to carry out interactive class assignments either with the professor or with each other. The majority of students surveyed in the COVID era said that they preferred face-to-face classes but tolerated remote learning because they needed to. Yet when given the chance to be face-to-face in a hybrid class, only 1 or 2 students did so. The 8am class time played a role, but COVID-avoidance might have been a bigger cause. Student vaccination only became available mid-April 2021. Module-based untimed open-source quizzes, although difficult, were preferred by the students over hand-written open notebook midterms and finals. Many commented that their stress was significantly reduced even if they struggled with the quizzes. The open-access online flipped finals yielded more complete answers than did an open-notebook in-class final. Flipped testing required the students to outline what they had learned from each module and provide a synopsis in the form of a summary essay for review. In addition to finding out what they knew, the instructor could determine what they didn't know or had misconceptions with. © American Society for Engineering Education, 2021

Incidence and Predictors of Sars-Cov-2 Antibody Responses Following COVID-19 Vaccination in Allogeneic Stem Cell Transplant Recipients

Background Pharmacologic immunosuppression and incomplete immune reconstitution after allogeneic stem cell transplant (alloSCT) may impair a patient's ability to mount an immune response to vaccines, including currently available COVID-19 vaccines. Since immunocompromised patients are susceptible to severe COVID-19 and likely to respond poorly to vaccination, we sought to characterize SARS-CoV-2 antibody responses after vaccination in alloSCT patients to determine predictors of serologic response, which may inform timing of vaccine administration. Methods This retrospective analysis included adult patients who underwent alloSCT at the University of Pennsylvania between 1/1/2019 and 1/1/2021. Chart review identified patients who had received COVID-19 vaccines and had post-vaccination antibody titers drawn by July 2021 as part of routine care (n=63). Antibodies to SARS-CoV-2 spike protein receptor binding domain were detected using an assay developed at the Hospital of the University of Pennsylvania. Variables analyzed include interval between transplant date and initial vaccination, active GVHD, concurrent immunosuppressive therapy, absolute CD4 count greater than or equal to 200 cells/mm3 peri-vaccination, and total IgG greater than or equal to 400 mg/dL peri-vaccination. Immunosuppressive therapy was defined as tacrolimus, rituximab, ruxolitinib, prednisone 10 mg daily or greater, or extracorporeal photopheresis. Predictors of positive antibody response were assessed using a multivariate, binary logistic regression. Results Median transplant to vaccine interval was 458 days (range 125 to 813) for the 63 vaccinated patients with serologies available. GVHD was present in 23/63 (37%), and 19/63 (30%) were receiving immunosuppressive therapies at the time of vaccination. CD4 count greater than 200 cells/mm3 was observed in 49 patients (78%), and total IgG greater than 400 mg/dL was observed in 51 patients (81%). In total, 50/63 patients (79%) were positive for SARS-CoV-2 IgG antibodies. Positive serologies were observed in 41/49 (84%) with CD4 counts greater than 200 cells/mm3, compared to 9/14 (64%) with CD4 less than 200 cells/mm3. Our model found that peri-vaccination CD4 count greater than 200 cells/mm3 was a significant predictor of positive SARS-CoV-2 IgG serologies in this population (OR 2.14, 97.5% CI = 0.7 to 3.8, p= 0.005). Transplant to vaccine interval, total IgG levels, GVHD status, and immunosuppressive therapies were not significant predictors of serologic response. As of July 2021 no patients had developed COVID-19 after vaccination, regardless of serologic response. Conclusions This retrospective observational study demonstrates that the majority of alloSCT patients vaccinated against COVID-19 within 2 years of transplant, including those with active GVHD and on immunosuppressive therapies, can mount serologic responses. CD4 count greater than 200 cells/mm3 is a significant predictor of positive serologic response, though even among patients with CD4 counts under 200 cells/mm3 over 60% developed SARS-CoV-2 IgG antibodies. Disclosures: Perry: Incyte: Consultancy, Speakers Bureau;Abbvie,: Speakers Bureau;Kadmon: Consultancy. Pratz: University of Pennsylvania: Current Employment;Abbvie: Consultancy, Honoraria, Research Funding;Astellas: Consultancy, Honoraria, Research Funding;Cellgene: Consultancy, Honoraria;Novartis: Consultancy;BMS: Consultancy, Honoraria;Agios: Consultancy;Millenium: Research Funding. Luger: Syros: Honoraria;Agios: Honoraria;Daiichi Sankyo: Honoraria;Jazz Pharmaceuticals: Honoraria;Brystol Myers Squibb: Honoraria;Acceleron: Honoraria;Astellas: Honoraria;Pfizer: Honoraria;Onconova: Research Funding;Celgene: Research Funding;Biosight: Research Funding;Hoffman LaRoche: Research Funding;Kura: Research Funding. Perl: Astellas: Consultancy, Research Funding;Loxo: Consultancy;AbbVie: Consultancy, Research Funding;Syndax: Consultancy;BMS/Celgene: Consultancy;Roche: Consultancy;Fujifilm: Research Funding;Daiichi Sankyo: Consultancy, Research Funding;Forma: Consult ncy;Arog: Research Funding;Genentech: Consultancy;Actinium: Consultancy;Onconova: Consultancy;Sumitomo Dainippon: Consultancy. Porter: ASH: Membership on an entity's Board of Directors or advisory committees;Incyte: Membership on an entity's Board of Directors or advisory committees;DeCart: Membership on an entity's Board of Directors or advisory committees;Genentech: Current equity holder in publicly-traded company, Ended employment in the past 24 months;American Society for Transplantation and Cellular Therapy: Honoraria;Kite/Gilead: Membership on an entity's Board of Directors or advisory committees;Janssen: Membership on an entity's Board of Directors or advisory committees;National Marrow Donor Program: Membership on an entity's Board of Directors or advisory committees;Novartis: Membership on an entity's Board of Directors or advisory committees, Patents & Royalties, Research Funding;Tmunity: Patents & Royalties;Wiley and Sons Publishing: Honoraria. Hexner: Blueprint medicines: Membership on an entity's Board of Directors or advisory committees, Research Funding;PharmaEssentia: Membership on an entity's Board of Directors or advisory committees;Tmunity Therapeutics: Research Funding. Frey: Sana Biotechnology: Consultancy;Kite Pharma: Consultancy;Syndax Pharmaceuticals: Consultancy;Novartis: Research Funding.

GrazingFutures: learnings from a contemporary collaborative extension program in rangeland communities of western Queensland, Australia

Producer reliance on drought subsidies instead of proactive planning and timely destocking in low rainfall years has prompted Queensland government investment in promoting business and drought resilience. GrazingFutures (AU$6 million budget, 2016-2022) is an extension project focussed on enhancing business management skills of extensive livestock producers in western Queensland, Australia. The region's rangelands are in productivity decline, span 1 million km2 and are managed by graziers operating more than 2400 livestock businesses (beef, sheep and goats). The Queensland Department of Agriculture and Fisheries delivers GrazingFutures as a component of the Drought and Climate Adaptation Program, in partnership with regional natural resource management groups and other public and private organisations. Project delivery emphasised upskilling multi-agency staff and livestock producers to promote practice change within three whole of business themes: (1) grazing land management;(2) animal production;and (3) peoplebusiness. Three independent surveys (2018, 2019, 2020) indicated positive practice change was occurring in grazing businesses as a consequence of the project. Graziers instigated management changes even under major environmental challenges including extended drought (2013-2020), an extreme flood event in 2019 and the COVID-19 pandemic in 2020. This paper details the rationale, progress against the objectives, challenges and future direction of the GrazingFutures extension project.

Improving hematology/oncology clinical research recruitment via universal prescreening: The VA Connecticut (VACT) Cancer Center experience

Background: Patient-trial matching is a critical step in clinical research recruitment that requires extensive review of clinical data and trial requirements. Prescreening, defined as identifying potentially eligible patients using select eligibility criteria, may streamline the process and increase study enrollment. We describe the real-world experience of implementing a standardized, universal clinical research prescreening protocol within a VA cancer center and its impact on research enrollment. Methods: An IRB approved prescreening protocol was implemented at the VACT Cancer Center in March 2017. All patients with a suspected or confirmed diagnosis of cancer are identified through tumor boards, oncology consults, and clinic lists. Research coordinators perform chart review and manually enter patient demographics, cancer type and stage, and treatment history into a REDCap (Research Electronic Data Capture) database. All clinical trials and their eligibility criteria are also entered into REDCap and updated regularly. REDCap generates real time lists of potential research studies for each patient based on his/her recorded data. The primary oncologist is alerted to a patient's potential eligibility prior to upcoming clinic visits and thus can plan to discuss clinical research enrollment as appropriate. Results: From March 2017 to December 2020, a total of 2548 unique patients were prescreened into REDCAP. The mean age was 71.5 years, 97.5% were male, and 15.5% were African American. 32.57 % patients had genitourinary cancer, 17.15% had lung cancer, and 46.15% were undergoing malignancy workup. 1412 patients were potentially eligible after prescreening and 556 patients were ultimately enrolled in studies. The number of patients enrolled on therapeutic clinical trials increased after the implementation of the prescreening protocol (35 in 2017, 64 in 2018, 78 in 2019, and 55 in 2020 despite the COVID19 pandemic). Biorepository study enrollment increased from 8 in 2019 to 15 in 2020. The prescreening protocol also enabled 200 patients to be enrolled onto a lung nodule liquid biopsy study from 2017 to 2019. Our prescreening process captured 98.57% of lung cancer patients entered into the cancer registry during the same time period. Conclusions: Universal prescreening streamlined research recruitment operations and was associated with yearly increases in clinical research enrollment at a VA cancer center. Our protocol identified most new lung cancer patients, suggesting that, at least for this malignancy, potential study patients were not missed. The protocol was integral in our program becoming the top accruing VA site for NCI's National Clinical Trial Network (NCTN) studies since 2019.

A Phase I Study of the IDH2 Inhibitor Enasidenib As Maintenance Therapy for IDH2-Mutant Myeloid Neoplasms Following Hematopoietic Cell Transplantation

Characterization of molecular alterations in acute myeloid leukemia (AML) has led to development of targeted therapies, including FLT3 and IDH1/2 inhibitors. Maintenance therapy following hematopoietic cell transplantation (HCT) has shown substantial promise. Enasidenib (ENA), a selective IDH2 inhibitor, was associated with impressive rates of response in relapsed/refractory (R/R) AML and is now FDA-approved for this indication. We sought to assess the tolerability and define the maximum tolerated dose (MTD) of ENA as maintenance following HCT for IDH2-mutated myeloid malignancy. HCT-eligible patients (pts) ≥ 18 years with AML in remission, or myelodysplastic syndrome (MDS) with <5% marrow blasts, were enrolled. There were no restrictions on conditioning or donor type. A 2-step registration process was utilized;1 before HCT and 1 before ENA initiation. Before HCT, pts were required to have normal organ and recovered marrow function (neutrophils > 1000/µL and platelets > 50000/µL). Those with prior HCT, active disease, QTc ≥450ms, and active infections were excluded. ENA was initiated between day 30 and 90 after HCT, at which time the following were required: chimerism ≥70% of donor origin among blood/marrow cells, no acute graft versus host disease (aGVHD) requiring ≥0.5mg/kg/day prednisone or equivalent, and no relapse. ENA was taken orally (po) daily (qd) in 28-day cycles. The period for dose-limiting toxicity (DLT) evaluation was the first cycle, escalation to successive levels was guided by DLT incidence, and 2 levels (50mg,100mg) were studied. Following establishment of MTD or recommended phase 2 dose (RP2D), 10 pts would be enrolled in an expansion cohort. Pts were monitored for relapse and toxicity and continued until disease progression, intolerable toxicity, or receipt of 12 cycles. Nineteen pts have been registered prior to HCT at 3 sites, Massachusetts General Hospital, Dana Farber Cancer Institute, and Johns Hopkins Hospital. Three pts could not initiate ENA following HCT;2 due to logistic challenges of the COVID pandemic and 1 due to relapse. The remaining 16 pts initiated ENA treatment. The median age was 61 years (range 31-76);12 (75%) were male, and 13 (81%) were Caucasian. Fourteen (88%) had AML, of which 6 were AML with MDS related changes and 2 had antecedent myeloproliferative neoplasm. Two pts (13%) had MDS. Among these 16 pts, 9 (56%) had IDH2 R140, and 5 (25%) had IDH2 R172 mutations. IDH2 subtype data was unavailable for 2 pts. Of 15 pts with available data from time of diagnosis, 11 (73%) had intermediate-risk and 4 (27%) had adverse-risk cytogenetics. Among these 15 pts, common concurrent mutations were DNMT3A (47%), SRSF2 (33%), and RUNX1 (33%). Eleven AML pts (85%) received intensive versus non-intensive therapies (15%) prior to HCT, and among all pts, 7 (44%) had received ENA prior to HCT. HCT data was available for all 16 pts;4 pts (25%) received myeloablative, and 12 (75%) received reduced-intensity conditioning. Nine pts (56%) had a matched unrelated, 6 (38%) had haploidentical, and 1 (6%) had a matched related donor HCT. Three pts were enrolled at the 50mg dose level, 6 pts at 100mg, and after no DLTs were detected, the remaining were enrolled in an expansion cohort at 100mg qd. Median follow-up (F/U) for surviving patients is currently 11.7 months (range 1.5-18.9). 2 pts (13%) have relapsed during F/U, at 96 and 364 days post HCT. Additional ≥grade (G) 3 toxicities detected during treatment, possibly or probably related to ENA, included neutropenia, anemia, and bilirubinemia. Six pts (38%) required dose interruptions lasting a median 19 days (range 7-25), 4 required a dose reduction to 50mg, and 1 stopped treatment due to G3 bilirubinemia. In total, 3 pts (18%) discontinued study treatment, 1 for aforementioned G3 bilirubinemia, 1 to pursue a GVHD trial, and 1 for relapse. Six pts have completed the 12-month f/u without relapse, and 7 remain on study. 15 of 16 pts remain alive. Thus far, 3 pts have experienced ≥ G2 aGVHD, and 4 had moderate chronic GVHD. Serial me surement of 2HG is being conducted on samples, and these will be reported. Enasidenib is well-tolerated as post-HCT maintenance therapy for myeloid malignancy at the RP2D of 100mg qd. No DLTs have been detected, and a low rate of post-HCT relapse has been identified to date, although longer f/u is needed. Larger, randomized studies of ENA in the post-SCT setting would determine the true efficacy of this agent as maintenance therapy. Disclosures: Fathi: Blueprint: Consultancy;Jazz: Consultancy;Amgen: Consultancy;Newlink Genetics: Consultancy;Pfizer: Consultancy;Abbvie: Consultancy;Seattle Genetics: Consultancy, Research Funding;Agios: Consultancy, Research Funding;PTC Therapeutics: Consultancy;Takeda: Consultancy, Research Funding;Boston Biomedical: Consultancy;Amphivena: Consultancy;BMS/Celgene: Consultancy, Research Funding;Kite: Consultancy;Trovagene: Consultancy;Forty Seven: Consultancy;Novartis: Consultancy;Daiichi Sankyo: Consultancy;Astellas: Consultancy;Trillium: Consultancy;Kura Oncology: Consultancy. Soiffer: Gilead: Consultancy;Novartis: Consultancy;Juno: Membership on an entity's Board of Directors or advisory committees;Celgene: Membership on an entity's Board of Directors or advisory committees;VOR Biopharma: Consultancy;alexion: Consultancy;Rheos Therapeutics: Consultancy;Cugene: Consultancy;Precision Bioscience: Consultancy;Be the Match/ National Marrow Donor Program: Membership on an entity's Board of Directors or advisory committees;Kiadis: Membership on an entity's Board of Directors or advisory committees;Mana Therapeutics: Consultancy. Levis: Menarini: Honoraria;Amgen: Honoraria;FujiFilm: Honoraria, Research Funding;Astellas: Honoraria, Research Funding;Daiichi-Sankyo: Honoraria. Mims: Novartis: Speakers Bureau;Kura Oncology: Membership on an entity's Board of Directors or advisory committees;Leukemia and Lymphoma Society: Other: Senior Medical Director for Beat AML Study;Agios: Consultancy;Syndax Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees;Jazz Pharmaceuticals: Other: Data Safety Monitoring Board;Abbvie: Membership on an entity's Board of Directors or advisory committees. Devine: Magenta Therapeutics: Consultancy. Defilipp: Incyte: Research Funding;Regimmune: Research Funding;Syndax Pharmaceuticals: Consultancy. Spitzer: Jazz Pharmaceuticals, Inc.: Membership on an entity's Board of Directors or advisory committees;Bluebird Bio: Membership on an entity's Board of Directors or advisory committees. Frigault: Celgene: Consultancy;Arcellx: Consultancy;Novartis: Consultancy, Research Funding;Gilead/Kite: Consultancy, Research Funding. Amrein: Amgen: Research Funding;AstraZeneca: Consultancy, Research Funding;Takeda: Research Funding. Hobbs: Incyte: Research Funding;Merck: Research Funding;Bayer: Research Funding;Constellation: Honoraria, Research Funding;Jazz: Honoraria;Celgene/BMS: Honoraria;Novartis: Honoraria. Brunner: Janssen: Research Funding;Acceleron Pharma Inc.: Consultancy;GSK: Research Funding;Xcenda: Consultancy;Takeda: Consultancy, Research Funding;Novartis: Consultancy, Research Funding;Jazz Pharma: Consultancy;Forty Seven, Inc: Consultancy;Celgene/BMS: Consultancy, Research Funding;Biogen: Consultancy;Astra Zeneca: Research Funding. Narayan: Genentech: Other: Prior Spouse employment within 24 months and prior spouse equity divested within past 24 months;Takeda: Other: Prior Spouse employment within 24 months;Sanofi-Genzyme: Other: Current Spouse employment. Chen: AbbVie: Other: Data and Safety Monitoring Board Member;Incyte Corporation: Consultancy;Takeda: Consultancy;Actinium: Other: Data and Safety Monitoring Board Member;Equillium: Other: Data and Safety Monitoring Board Member;Magenta: Consultancy;Kiadis: Consultancy. OffLabel Disclosure: Enasidenib as post-transplant maintenance therapy

Sustained 97% hiv testing rate in the emergency department: the new gold standard

Background: UK 2020 HIV guidelines recommend opt-out HIV testing in Emergency Departments (ED) in areas of high prevalence (>2/1000). Our area has a very high HIV prevalence (>5/1000) with a 46% late diagnosis rate. We implemented opt-out testing in our ED in May 2020, sustaining testing rates of 97%. Methods: All patients aged ≥16 undergoing venesection in ED have an HIV test automatically added. A separate blood sample is tested using Roche 4th generation HIV 1/2 antigen-antibody combination test. Posters and leaflets are prominently displayed in ED, signposting how to opt-out. IT blocks duplicate testing and those opted-out within the past 6 months. The HIV team receives an automated daily report of all non-negative HIV results. Patients not engaged in care are contacted. Those with new reactive tests are invited to attend for full sexual health screening including point of care test (POCT);if positive, patients are counselled pending confirmatory results and linked to HIV care that day with baseline bloods taken. Results: 24,621/25,336 (97%) eligible patients were tested. This data excludes 21 days when Covid-19 reagent shortages halted testing. 244 patients had nonnegative results. 161 were already engaged in care. 14 had defaulted care;nine have now re-engaged. 15 patients were confirmed new HIV diagnoses;13 are now engaged in care and receiving antiretrovirals and two have declined care. 8/14 (57%) new patients and 5/9 (56%) defaulters had a CD4 count <200. 9/13 (69%) new patients had missed diagnostic opportunities. 42/244 (17%) patients with reactive tests were verified as false positives. 12 patients are awaiting repeat testing. Seven regular partners of newly diagnosed patients were verified HIV negative and managed with post- or pre-exposure prophylaxis, condoms and/or treatment as prevention. In the same period, ED diagnosed 15 patients compared to 12 non-ED (eight sexual health, one antenatal, two haematology, one medical). Our tested ED HIV prevalence is 7.72/1000 compared to a local recorded prevalence of 5.84/1000 (p<0.0002). Conclusion: Collaborative working between ED, pathology, IT and HIV can sustain 97% testing rates using opt-out testing. The prevalence of HIV in ED attendees is statistically significantly higher than the local prevalence underlining the importance of HIV testing in ED. Wider benefits include earlier HIV diagnosis, reduced morbidity, mortality, investigations and healthcare costs, reduced length of stay, and reduced onward transmission.

Clinical outreach to older adults in the community during COVID: A description of unmet health-related needs

Background: Shelter-in-place orders and service disruptions due to the COVID-19 pandemic created a risk of unmet healthrelated needs among older adults and those with disabilities, such as the ability to obtain medications or receive healthcare. To mitigate these risks, primary care clinics performed outreach calls to identify and address unmet needs. We examined the association with unmet needs and healthcare utilization. Methods: Four primary care clinics completed outreach calls, each with differing with at-risk populations: home-based, safety-net adult, academic geriatrics and safety-net HIV. Examined needs included medication refills, medical supplies, food insecurity, and telehealth capability. Utilization included urgent care, ER visits and hospitalizations, measured 3 months prior and 3 months after the call. We also report on COVID diagnosis and death in the 3 months after the outreach call. We show descriptive statistics and will use Poisson regression models to examine associations. Results: Thus far, we analyzed 165 of 500 total outreach calls. Mean age was 84.1, with 18% of patients >95, 71% female, 40% white, 33% Asian, 12% Black, and 15% Latinx. Forty five percent had both Medicare and Medi-Cal, 33% had Medicare and supplemental insurance, and 17% had Medicare only. Comorbid conditions were frequent: 69% had hypertension, 37% had dementia, 30% had depression. Unmet needs and care utilization are presented in Table 1. Conclusion: The pandemic has disrupted health and social care among older adults. Evaluation of associations between unmet needs and use of urgent healthcare services can inform future planning during crises to better meet the needs of community dwelling older adults.