The role of hospital antimicrobial and infectious diseases pharmacists in the UK: a theoretically underpinned exploration.

Objectives: We sought to characterise the role of hospital infection pharmacists in the UK and to understand the core challenges being faced, future role development desires and the required support to address these. Methods: We developed a questionnaire underpinned by the theoretical domains framework exploring the barriers and enablers to pharmacists fulfilling their perceived roles and responsibilities. Any pharmacist whose role included 'specialist antimicrobial' or 'infectious diseases' was invited to complete a questionnaire sent via national infection and pharmacy groups/networks. Descriptive statistics were used to report responses to each item, and a content analysis was undertaken to summarize the key messages from an extended response option. Results: Of the 102 respondents, 91 (89.2%) were from English hospitals. Fifty-three (52%) were from district general hospitals and 45 (45.1%) from teaching hospitals. Most (97, 95%) respondents were of a senior grade. The need for a comprehensive educational programme, recognition of research as core to the role and integration with infection/microbiology departments were key requirements along with protected time to engage with the activities. Highlights of the role were opportunities to teach, making a significant contribution to patient care and scope to contribute to strategy and vision. The COVID-19 pandemic negatively impacted on respondents' capacity to undertake their perceived roles and responsibilities. Conclusions: Our study delineates the need for UK infection and pharmacy policy makers to review hospital infection pharmacist developmental pathways and roles. Joint learning, and closer working, with infection/microbiology departments may be an efficient strategy to address the issues raised.

Navigating the Storm: Palliative Care Team Supportive Insights During the COVID-19 Pandemic (Sci242)

Outcomes: 1. Analyze protective and risk factors affecting registered nurses who provided end-of-life care to critically ill patients during the COVID pandemic. 2. Evaluate ways involvement of palliative care teams can improve the experience of registered nurses who provided care to critically ill patients during the COVID pandemic. Introduction: Minimal research documents the lived experience of intensive care unit (ICU) registered nurses (RNs) providing end-of-life care during the COVID-19 pandemic. The mixed-methods study aimed to understand the impact of end-of-life care and communication during the COVID-19 pandemic to identify protective and risk factors influencing the sample population. Method(s): Surveys were distributed in early summer 2021 following the initial wave of COVID patient influx. Responses for nurses in COVID-designated units were compared to non-COVID units. The survey included demographic questions, the ProQOL survey instrument (measuring burnout, compassion fatigue, and secondary traumatic stress), and open-ended questions to identify protective factors and unique challenges. Both quantitative and qualitative analyses were conducted. Result(s): A total of 311 registered nurses were eligible to complete the survey across five critical care settings between May 3, 2021, and June 15, 2021. A total of 107 participants responded to the survey;however, 17 were incomplete. 90 allowed for comparative analysis. The vast majority (n= 71;78.89%) had experience caring for COVID patients. The study population consisted of COVID-designated unit RNs (n=48;53.33%) and non-COVID designated units (n=42;46.67%). Two-group comparison indicated significant differences for compassion (p=0.041), burnout (p=0.014), and stress subscales (p=0.002). Analysis between both groups revealed significantly lower mean compassion scores and significantly higher burnout and stress scores among those working in the COVID-designated units. Nurses in both groups were able to identify protective factors and challenges. Conclusion(s): Despite higher levels of burnout and stress and lower levels of compassion, nurses readily identified various protective factors that helped them cope with challenges. Involvement of palliative care teams, who are uniquely equipped to deal with complicated symptom management needs, communication challenges, and difficult emotions, can further improve the experience of bedside nurses providing care to patients by helping navigate the challenges posed by the COVID-19 pandemic.Copyright © 2023

Low protection from breakthrough SARS-CoV-2 infection and mild disease course in ocrelizumab-treated patients with multiple sclerosis after three mRNA vaccine doses.

BACKGROUND: Our study investigated the rate of breakthrough SARS-CoV-2 infection and clinical outcomes in a cohort of multiple sclerosis (MS) patients who were treated with the anti-CD20 monoclonal antibody (Ab), ocrelizumab, before first, second and third BNT162b2 mRNA vaccinations. To correlate clinical outcomes with the humoral and cellular response. METHODS: The study was a prospective non-randomised controlled multicentre trial observational study. Participants with a diagnosis of MS who were treated for at least 12 months with ocrelizumab prior to the first BNT162b2 mRNA vaccination were prospectively followed up from January 2021 to June 2022. RESULTS: Out of 54 participants, 32 (59.3%) developed a positive SARS-CoV-2 PCR test in the study period. Mild infection was observed in all infected participants. After the third vaccination, the non-infected participants had higher mean Ab levels compared to the infected participants (54.3 binding antibody unit (BAU)/mL vs 26.5 BAU/mL, p=0.030). The difference in reactivity between spike-specific CD4+ and CD8+ T lymphocytes in the two groups was not significant. CONCLUSION AND RELEVANCE: The study results demonstrate rates of 59% in breakthrough infections after the third SARS-CoV-2 mRNA vaccination in ocrelizumab-treated patients with MS, without resulting in critical disease courses. These findings suggest the need for continuous development of prophylactic treatments when proved important in the protection of severe breakthrough infection.

MEDIA REPORTING OF LABOUR SHORTAGES IN UK HORTICULTURE DURING THE COVID-19 PANDEMIC: THE USE OF WARTIME METAPHORS IN THE SELECTIVE UNVEILING OF PRECARIOUS WORK/WORKERS

Over the 21st century almost all of the UK's harvest labour has been foreign-bom. The COVID-19 crisis (from March 2020) threatened UK food security by limiting this supply of low-wage foreign labour into the UK. In response a national campaign was launched to get a domestic 'Land Army' to 'Feed the Nation' and 'Pick for Britain' (the three main epithets used). The article profiles this campaign. We show that the COVID-19 crisis put low-wage harvest labour into the spotlight when this labour is usually hidden from public view. Potentially, such unveiling could have challenged the economics of the food production system. However, we argue that the rupture was stage-managed by invoking a wartime rhetoric and three key concomitant roles of the victim-hero farmer, the good migrant, and the reluctant British-based understudy. These emphasised the valiant nature of harvest work and framed migrant workers as (temporary) heroes helping to save the nation. In contrast, British-based workers' reluctance to embrace precarious work was framed as personal deficiency rather than a structural failure to create decent jobs. In all, the spotlight cast on the low-wage rural economy by the COVID-19 crisis was carefully targeted and stage-managed and did not challenge the persistence of precarious horticultural work. Copyright © 2022 CSIC.

Relapsing Encephalomyelitis After COVID-19 Infection and Vaccination: From the National MS Society Case Conference Proceedings.

Prior case studies suggest that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its vaccines may unmask CNS neuroinflammatory conditions. We present a case of relapsing steroid-responsive encephalomyelitis after SARS-CoV-2 infection and subsequent COVID-19 vaccination. We also characterize the frequency of CNS neuroinflammatory events reported in the literature after both SARS-CoV-2 infection and COVID-19 vaccination.

COVID-19 Vaccination Safety Profiles in Patients With Solid Tumour Cancers: A Systematic Review.

Vaccination has become an essential means of protection for solid tumour patients against coronavirus disease 2019 (COVID-19). In this systematic review, we sought to identify common safety profiles of the COVID-19 vaccine in patients with solid tumours. A search of Web of Science, PubMed, EMBASE and Cochrane was conducted for studies in English full-text that reported side-effect data experienced by patients with cancer who were at least 12 years old with solid tumours or a recent history of solid tumours after receiving either one or multiple doses of the COVID-19 vaccination. Study quality was assessed with the Newcastle Ottawa Scale criteria. Acceptable study types were retrospective and prospective cohorts, retrospective and prospective observational studies, observational analyses and case series; systematic reviews, meta-analyses and case reports were excluded. Among local/injection site symptoms, the most commonly reported were injection site pain and ipsilateral axillary/clavicular lymphadenopathy, whereas the most commonly reported systemic effects were fatigue/malaise, musculoskeletal symptoms and headache. Most side-effects reported were characterised as mild to moderate. A thorough evaluation of the randomised controlled trials for each featured vaccine led to the conclusion that in the USA and abroad, the safety profile seen in patients with solid tumours is comparable with that seen in the general public.

'How I'm feeling today, I probably won't be feeling tomorrow'. Using I-Poems to explore young people's changing emotions during the Covid-19 pandemic - A qualitative, longitudinal study.

Background: Relatively little published qualitative research has explored children and young people's (CYP) prolonged or longitudinal experiences of the pandemic, and their emotional responses to such unreserved change to everyday life. As part of a broader, qualitative longitudinal study, this paper explores change and continuity in young people's emotions over time during the Covid-19 pandemic in North East England. Methods: I-Poems were curated for each of the 26 young people in this study from serial interview transcripts and diary entries, collected over the course of 16 months. Creation of I-Poems require researchers to focus on sentences made by the interviewee that include the word "I," and without changing the order of those sentences, to present them in poetic stanzas. Findings: Young people's voices and experiences became more poignant and powerful when their 'I' narrative was centralised, silencing the presence of the researcher. Further, presenting the data in this way allowed us to see how the following emotions shifted over time: grief, sadness, frustration, anger, anxiety, joy, pleasure, excitement. We contend that young people experienced significant rupture and change over the course of our 16 month project, with both positive and negative repercussions for their emotional wellbeing. Conclusions: Large scale (quantitative and qualitative) studies remain much needed to focus on the long-term impacts of the pandemic on young people's social, emotional and cultural lives. Longitudinal and creative qualitative approaches (such as I-Poems) have the potential to centralise participant voice, break down power dynamics, and allow exploration of shifting experiences and emotions over time.

Longitudinal adaptive immune responses following sequential SARS-CoV-2 vaccinations in MS patients on anti-CD20 therapies and sphingosine-1-phosphate receptor modulators.

BACKGROUND: Adequate response to the SARS-CoV-2 vaccine represents an important treatment goal in caring for patients with multiple sclerosis (MS) during the ongoing COVID-19 pandemic. Previous data so far have demonstrated lower spike-specific IgG responses following two SARS-CoV-2 vaccinations in MS patients treated with sphingosine-1-phosphate (S1P) receptor modulators and anti-CD20 monoclonal antibodies (mAb) compared to other disease modifying therapies (DMTs). It is unknown whether subsequent vaccinations can augment antibody responses in these patients. OBJECTIVES: The goal of this observational study was to determine the effects of a third SARS-CoV-2 vaccination on antibody and T cell responses in MS patients treated with anti-CD20 mAb or S1P receptor modulators. METHODS: Vaccine responses in patients treated with anti-CD20 antibodies (ocrelizumab and ofatumumab) or S1P receptor modulators (fingolimod and siponimod) were evaluated before and after third SARS-CoV-2 vaccination as part of an ongoing longitudinal study. Total spike protein and spike receptor binding domain (RBD)-specific IgG responses were measured by Luminex bead-based assay. Spike-specific CD4+ and CD8+ T cell responses were measured by activation-induced marker expression. RESULTS: MS patients and healthy controls were enrolled before and following SARS-CoV-2 vaccination. A total of 31 MS patients (n = 10 ofatumumab, n = 13 ocrelizumab, n = 8 S1P) and 10 healthy controls were evaluated through three SARS-CoV-2 vaccinations. Compared to healthy controls, total spike IgG was significantly lower in anti-CD20 mAb-treated patients and spike RBD IgG was significantly lower in anti-CD20 mAb and S1P-treated patients following a third vaccination. While seropositivity was 100% in healthy controls after a third vaccination, total spike IgG and spike RBD IgG seropositivity were lower in ofatumumab (60% and 60%, respectively), ocrelizumab (85% and 46%, respectively), and S1P-treated patients (100% and 75%, respectively). Longer treatment duration, including prior treatment history, appeared to negatively impact antibody responses. Spike-specific CD4+ and CD8+ T cell responses were well maintained across all groups following a third vaccination. Finally, immune responses were also compared in patients who were vaccinated prior to or following ofatumumab treatment. Antibody responses were significantly higher in those patients who received their primary SARS-CoV-2 vaccination prior to initiating ofatumumab treatment. CONCLUSIONS: This study adds to the evolving understanding of SARS-CoV-2 vaccine responses in people with MS treated with disease-modifying therapies (DMTs) known to suppress humoral immunity. Our findings provide important information for optimizing vaccine immunity in at-risk MS patient populations.

Decreased incidence of Hirschsprung-associated enterocolitis during COVID-19 across United States Children's hospitals.

BACKGROUND: The Coronavirus Disease 2019 pandemic provided a natural experiment to study the effect of social distancing on the risk of developing Hirschsprung's Associated Enterocolitis (HAEC). METHODS: Using the Pediatric Health Information System (PHIS), a retrospective cohort study of children (<18 years) with Hirschsprung's Disease (HSCR) across 47 United States children's hospitals was performed. The primary outcome was HAEC admissions per 10,000 patient-days. The exposure (COVID-19) was defined as April 2020-December 2021. The unexposed (historical control) period was April 2018-December 2019. Secondary outcomes included sepsis, bowel perforation, intensive care unit (ICU) admission, mortality, and length of stay. RESULTS: Overall, we included 5707 patients with HSCR during the study period. There were 984 and 834 HAEC admissions during the pre-pandemic and pandemic periods, respectively (2.6 vs. 1.9 HAEC admissions per 10,000 patient-days, incident rate ratio [95% confidence interval]: 0.74 [0.67, 0.81], p < 0.001). Compared to pre-pandemic, those with HAEC during the pandemic were younger (median [IQR]: 566 [162, 1430] days pandemic vs. 746 [259, 1609] days pre-pandemic, p < 0.001) and more likely to live in the lowest quartile of median household income zip codes (24% pandemic vs. 19% pre-pandemic, p = 0.02). There were no significant differences in rates of sepsis (6.1% pandemic vs. 6.1% pre-pandemic, p > 0.9), bowel perforation (1.3% pandemic vs. 1.2% pre-pandemic, p = 0.8), ICU admissions (9.6% pandemic vs. 12% pre-pandemic, p = 0.2), mortality (0.5% pandemic vs. 0.6% pre-pandemic, p = 0.8), or length of stay (median [interquartile range]: 4 [(Pastor et al., 2009; Gosain and Brinkman, 2015) 2,112,11 days pandemic vs. 5 [(Pastor et al., 2009; Tang et al., 2020) 2,102,10 days pre-pandemic, p = 0.4). CONCLUSIONS: The COVID-19 pandemic was associated with significantly decreased incidence of HAEC admissions across US children's hospitals. Possible etiologies such as social distancing should be explored. LEVEL OF EVIDENCE: II.

Reduction in Long-term Mortality after Sleeve Gastrectomy and Gastric Bypass Compared to Non-surgical Patients with Severe Obesity.

OBJECTIVE: To separately compare the long-term risk of mortality among bariatric surgical patients undergoing either RYGB or SG to large, matched, population-based cohorts of patients with severe obesity who did not undergo surgery. BACKGROUND: Bariatric surgery has been associated with reduced long-term mortality compared to usual care for severe obesity which is particularly relevant in the COVID-19 era. Most prior studies involved the Roux-en-Y gastric bypass (RYGB) operation and there is less long-term data on the sleeve gastrectomy (SG). METHODS: In this retrospective, matched cohort study, patients with a body mass index ≥35 kg/m2 who underwent bariatric surgery from January 2005 to September 2015 in three integrated health systems in the United States were matched to nonsurgical patients on site, age, sex, body mass index, diabetes status, insulin use, race/ethnicity, combined Charlson/Elixhauser comorbidity score, and prior health care utilization, with follow-up through September 2015. Each procedure (RYGB, SG) was compared to its own control group and the two surgical procedures were not directly compared to each other. Multivariable-adjusted Cox regression analysis investigated time to all-cause mortality (primary outcome) comparing each of the bariatric procedures to usual care. Secondary outcomes separately examined the incidence of cardiovascular-related death, cancer related-death, and diabetes related-death. RESULTS: Among 13,900 SG, 17,258 RYGB, and 87,965 nonsurgical patients, the 5-year follow-up rate was 70.9%, 72.0%, and 64.5%, respectively. RYGB and SG were each associated with a significantly lower risk of all-cause mortality compared to nonsurgical patients at 5-years of follow-up (RYGB: HR = 0.43; 95% CI: 0.35,0.54; SG: HR = 0.28; 95% CI: 0.13,0.57) Similarly, RYGB was associated with a significantly lower 5-year risk of cardiovascular- (HR = 0.27; 95% CI: 0.20, 0.37), cancer- (HR = 0.54; 95% CI: 0.39, 0.76), and diabetes-related mortality (HR = 0.23; 95% CI:0.15, 0.36). There was not enough follow-up time to assess 5-year cause-specific mortality in SG patients, but at 3-years follow up, there was significantly lower risk of cardiovascular- (HR = 0.33; 95% CI:0.19, 0.58), cancer- (HR = 0.26; 95% CI:0.11, 0.59), and diabetes-related (HR = 0.15; 95% CI:0.04, 0.53) mortality for SG patients. CONCLUSION: This study confirms and extends prior findings of an association with better survival following bariatric surgery in RYGB patients compared to controls and separately demonstrates that the SG operation also appears to be associated with lower mortality compared to matched control patients with severe obesity that received usual care. These results help to inform the trade-offs between long-term benefits and risks of bariatric surgery.

Selpercatinib in Patients With RET Fusion-Positive Non-Small-Cell Lung Cancer: Updated Safety and Efficacy From the Registrational LIBRETTO-001 Phase I/II Trial.

PURPOSE: Selpercatinib, a first-in-class, highly selective, and potent CNS-active RET kinase inhibitor, is currently approved for the treatment of patients with RET fusion-positive non-small-cell lung cancer (NSCLC). We provide a registrational data set update in more than double (n = 316) of the original reported population (n = 144) and better characterization of long-term efficacy and safety. METHODS: Patients were enrolled to LIBRETTO-001, a phase I/II, single-arm, open-label study of selpercatinib in patients with RET-altered cancers. An analysis of patients with RET fusion-positive NSCLC, including 69 treatment-naive and 247 with prior platinum-based chemotherapy, was performed. The primary end point was objective response rate (ORR; RECIST v1.1, independent review committee). Secondary end points included duration of response (DoR), progression-free survival (PFS), overall survival, and safety. RESULTS: In treatment-naive patients, the ORR was 84% (95% CI, 73 to 92); 6% achieved complete responses (CRs). The median DoR was 20.2 months (95% CI, 13.0 to could not be evaluated); 40% of responses were ongoing at the data cutoff (median follow-up of 20.3 months). The median PFS was 22.0 months; 35% of patients were alive and progression-free at the data cutoff (median follow-up of 21.9 months). In platinum-based chemotherapy pretreated patients, the ORR was 61% (95% CI, 55 to 67); 7% achieved CRs. The median DoR was 28.6 months (95% CI, 20.4 to could not be evaluated); 49% of responses were ongoing (median follow-up of 21.2 months). The median PFS was 24.9 months; 38% of patients were alive and progression-free (median follow-up of 24.7 months). Of 26 patients with measurable baseline CNS metastasis by the independent review committee, the intracranial ORR was 85% (95% CI, 65 to 96); 27% were CRs. In the full safety population (n = 796), the median treatment duration was 36.1 months. The safety profile of selpercatinib was consistent with previous reports. CONCLUSION: In a large cohort with extended follow-up, selpercatinib continued to demonstrate durable and robust responses, including intracranial activity, in previously treated and treatment-naive patients with RET fusion-positive NSCLC.

Design principles for dual mode readiness in an uncertain future

This paper proposes four principles for managers and higher education educators who are designing units and programmes so as to be dual mode ready. `Dual mode’ design and delivery enables students to equitably complete their studies fully online, while also offering on-campus experiences where possible. The four principles are: (1) All learning outcomes can be met irrespective of participation mode;(2) Teaching-learning activities are equitable across participation modes;(3) All students have equivalent opportunity to demonstrate achievement of learning outcomes;and (4) ‘Online ready’ design. Being dual mode ready will likely remain important as on-campus delivery may not be possible for all students. Further, universities may need to pivot rapidly to fully online delivery for a range of reasons, including pandemic-related circumstances. The four principles provide guidance on how best to ensure equity and fairness for students and teachers in a dual mode context. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

"They're Coming in Pretty Defeated:" Mental Health During the COVID-19 Pandemic( Practice Brief)

Limited research explores postsecondary disability resource professionals' (DRPs) perceptions and experiences supporting students during the COVID-19 pandemic. As part of a larger study utilizing national survey and interview data, this paper explores DRPs' experiences and observations related to student mental health during the pandemic-related lockdowns and subsequent transitions back to in- person campus settings. The findings of this study reveal DRPs are grappling with increasing student numbers, continuing need for expanded mental health accommodations and supports, and a persisting urgency to re-examine the role of the disability resource office (DRO) on campus related to student mental health. Implications and strategies for practice.

PRONE POSITIONING IN COVID-19 VS NON-COVID-19 ARDS IN THE EARLY COVID-19 PANDEMIC

SESSION TITLE: Critical Care Management of COVID-19 SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm PURPOSE: Acute respiratory distress syndrome (ARDS) is a major cause of hypoxemic respiratory failure in the intensive care unit (ICU), with a mortality rate approaching 40%. Early prone positioning (PP) in ARDS improves oxygenation and mortality;however, observational studies have previously shown low uptake of this life-saving treatment. The COVID-19 pandemic resulted in high volumes of patients with easily recognized ARDS, potentially overcoming an important implementation barrier of PP. This study aimed to test the hypothesis that patients with ARDS with COVID-19 would be more likely to undergo PP compared to patients without COVID-19. METHODS: We conducted a retrospective cohort study of patients admitted to ICUs in 5 University of Pennsylvania Health System hospitals between March 16 and July 14, 2020. Patients with a PaO2:FiO2 (P:F) ratio ≤ 150 on first blood gas after intubation or at 24h were identified using an automated EHR-based algorithm and verified by chart review. PP was identified by chart review. We compared patient characteristics of patients with and without COVID-19 in unadjusted analyses using chi-square and rank sum tests. We estimated the odds of PP using multivariable logistic regression adjusted for patient age, gender, Sequential Organ Failure Assessment (SOFA) score, and body mass index (BMI). RESULTS: The cohort included 197 patients, 158 with COVID-19 and 39 without COVID-19. Median initial P:F ratio in all patients was 99 (IQR 76-130;COVID-19 ARDS median 99, IQR 76-129;non-COVID-19 ARDS median 100, IQR 76-138 p=0.81). Patients with COVID-19 ARDS were older (median age 65 vs 60 years, p=0.01), more predominantly male (57% vs 38%, p=0.04), had longer hospital length of stay (median 23 vs 15 days, p=0.001), and had lower SOFA scores (worst score on first day 10 vs 12, p=0.02) than non-COVID-19 ARDS patients. There were no significant differences between the COVID-19 and non-COVID-19 ARDS groups in BMI (p=0.2) or unadjusted in-hospital mortality (p=0.4). 87 (55%) COVID-19 ARDS patients and 6 (15%) non-COVID-19 ARDS patients underwent PP (chi-square=19.76, p<0.001). After adjustment for patient characteristics, patients with COVID-19 ARDS were significantly more likely to undergo PP than non-COVID-19 ARDS patients (OR 7.7, 95% CI 2.7-22.0, p=0.9). CONCLUSIONS: Patients with COVID-19-associated ARDS were significantly more likely to undergo PP than those with non-COVID-19 ARDS during the early months of the COVID-19 pandemic. This may be due to the fact that PP was one of the few interventions consistently identified to improve outcomes in a time of great uncertainty and high mortality from COVID-19. In non-COVID-19 ARDS, the diagnosis may not be made as frequently, and when it is, PP is often incorrectly thought of as a “last resort” for refractory hypoxemia. CLINICAL IMPLICATIONS: Further efforts should be made to identify ARDS and offer PP to non-COVID-19 ARDS patients. DISCLOSURES: No relevant relationships by Barry Fuchs No relevant relationships by Lilian Iglesias No relevant relationships by Meeta Kerlin No relevant relationships by Rachel Kohn No relevant relationships by Allyson Lieberman No relevant relationships by Stefania Scott No relevant relationships by Gary Weissman

DOES EVIDENCE-BASED CARE FOR INDIVIDUALS WITH ARDS DIFFER BY RACE? A RETROSPECTIVE COHORT STUDY

SESSION TITLE: Impact of Health Disparities and Differences SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Previous studies have demonstrated that Black patients with acute respiratory distress syndrome (ARDS) have significantly higher mortality than white patients. However, the mechanisms underlying these differences are unknown. We sought to determine if there are racial differences in the delivery of prone positioning (PP) and low tidal volume ventilation (LTVV). We hypothesized that compared to white patients, Black patients would have similar rates of LTTV but lower rates of PP, because of racial differences in family communication and that PP is more likely to be discussed with families than LTTV. METHODS: We performed a retrospective cohort study of Black and white patients with ARDS with and without COVID-19 who underwent mechanical ventilation (MV) in any of five hospitals of one health system from March 2020 to July 2020. We included patients with P:F < 150 at the time of or within 24 hours of intubation. The primary exposure was self-reported race. The primary outcome variables were (1) PP at any time during hospitalization and (2) percentage of time of the first 72 hours of MV with tidal volumes (Vt) < 6.5 ml/kg ideal body weight. We performed unadjusted analyses comparing patient characteristics and outcomes between black and white patients, and adjusted analyses of outcomes using multivariable regression including age, sex, Sequential Organ Failure Assessment (SOFA score), COVID status, height, and weight as covariates. RESULTS: The cohort included 71 (43%) white patients and 94 (57%) Black patients. Patients had a median age of 63 (IQR 53 to 72), 82 (50%) were male, and median SOFA score at the start of MV was 11 (IQR 8 to 13). Among all patients, 38/71 (54%) of white patients vs 39/94 (41%) of Black patients received PP (p=0.125). Black patients received Vt < 6.5 ml/kg ideal body weight for a median of 96% of the first 72 hours of MV, compared to 82% in white patients (p=0.08). After adjusting for COVID, BMI, sofa, age, gender, Black race was not significantly associated with lower likelihood of PP (OR 0.69, 95% CI 0.33-1.43, p 0.32), but was associated with increased adherence to LTVV (mean difference 12.9%, p-value 0.039). CONCLUSIONS: In this retrospective study of patients with ARDS, we found that Black race was not associated with receipt of PP but was associated with higher adherence to LTVV, contrary to our hypotheses. However, our study is limited by a small sample size in a single health system and a predominance of patients with COVID-19 with higher rates of adherence to evidence-based care for ARDS. Delivery of PP and LTVV may not explain racial differences in outcomes for COVID-19 ARDS;however, further research is required to understand the mechanisms underlying worse outcomes among black patients with ARDS. CLINICAL IMPLICATIONS: Further research is required to better understand the causes of worse outcomes in Black patients with ARDS. DISCLOSURES: No relevant relationships by Barry Fuchs No relevant relationships by Lilian Iglesias No relevant relationships by Meeta Kerlin No relevant relationships by Rachel Kohn No relevant relationships by Allyson Lieberman No relevant relationships by Stefania Scott No relevant relationships by Gary Weissman

Evaluating group-sequential non-inferiority clinical trials following interim stopping: The HIV Prevention Trials Network 083 trial.

BACKGROUND/AIMS: The HIV Prevention Trials Network 083 trial was a group-sequential non-inferiority trial designed to compare HIV incidence under a novel experimental regimen for HIV prevention, long-acting injectable cabotegravir, with an active-control regimen of daily oral tenofovir disoproxil fumarate/emtricitabine (brand name Truvada). In March of 2020, just as the trial had completed enrollment, the COVID-19 pandemic threatened to prevent trial participants from attending study visits and obtaining study medication, motivating the study team to update the interim monitoring plan. The Data and Safety Monitoring Board subsequently stopped the trial at the first interim review due to strong early evidence of efficacy. METHODS: Here we describe some unique aspects of the trial's design, monitoring, analysis, and interpretation. We illustrate the importance of computing point estimates, confidence intervals, and p values based on the sampling distribution induced by sequential monitoring. RESULTS: Accurate analysis, decision-making and interpretation of trial results rely on pre-specification of a stopping boundary, including the scale on which the stopping rule will be implemented, the specific test statistics to be calculated, and how the boundary will be adjusted if the available information fraction at interim review is different from planned. After appropriate adjustment for the sampling distribution and overrun, the HIV Prevention Trials Network 083 trial provided strong evidence that the experimental regimen was superior to the active control. CONCLUSIONS: For the HIV Prevention Trials Network 083 trial, the difference between corrected inferential statistics and naive results was quite small-as will often be the case-nevertheless, it is appropriate to report and publish the most accurate and unbiased statistical results.

STRUCTURAL COMPETENCY: A FACULTY DEVELOPMENT CURRICULUM FOR ANTI-RACISM IN MEDICAL EDUCATION

SETTING AND PARTICIPANTS: Structural racism is defined as the cumulative effects of policies, institutional practices, cultural representations, and other norms that work together to perpetuate racial inequity. This phenomenon extends to academic medicine and is exposed through how we teach, learn, and evaluate patients, students, trainees, and faculty physicians. Thus, the authors created a faculty development series to establish a knowledge of structural competency as a framework for teaching and to change participants' attitudes and confidence. Our participants consisted of clinician-educators (N=122) including internal medicine (generalists and subspecialists), pediatrics, psychiatry, and surgery who participated in sessions rooted in structural competency. The authors developed and facilitated the sessions over Zoom. DESCRIPTION: In the wake of Black Lives Matter protests following the killing of George Floyd, and in light of alarming health disparities uncovered in the COVID-19 pandemic, our institution, like many across the country, realized the importance of actively training providers to address racism and its downstream effects. Despite this, there are few examples of curricula for clinician-educators. Structural competency offers a framework for practicing anti-racism in medical education. We developed a faculty development workshop series consisting of four 90-minute workshops administered in the spring and summer of 2021 and developed or adapted associated tools that could be directly applied to teaching. Session Developed Tools Introduction to Structural Competency & Revising Existing Curricula Structurally competent and anti-racist rubric for revising existing didactics Transforming Resident Report and Case-Based Presentations Using the Structural Differential Step by step guide for building a structural differential with learners Ambulatory Teaching: The Structurally Competent Preceptor Structurally competent adaptations of the One Minute Preceptor and SNAPPS precepting models Inpatient Teaching: Structurally Competent Hospital-Based Medicine Structurally competent inpatient discharge checklist EVALUATION: Preliminary results showed significant improvements in overall faculty attitudes and confidence on pre-and post-intervention surveys (M=1.92, SD=2.29, p= 0.01;M=4.36, SD=3.32, p=.0.00) respectively. Additional results will evaluate whether there are improvements in faculty knowledge and behavior by tracking faculty use of the structural competency rubric and comparing faculty clinical documentation practices before and after the curriculum. DISCUSSION / REFLECTION / LESSONS LEARNED: The potential next step is to integrate into a faculty development program aimed to bolster structurally competent communication with diverse patients, strengthen efficiencies in clinical data gathering, and deepen patient trust in treatment plans. Future investigations will center on the validation of a survey tool to assess anti-racism within an institution's teaching faculty and apply the workshop to various institutional settings.

Stressed? Focus on Resources and Perceptions

Some individuals and families have the psychological, social, emotional, and physical resources available to respond to the stressor in a way that causes little, if any, strain and results in maintained stability or growth. Though not the norm, some of the students in my research indicated growth in family relationships (taking advantage of the time and proximity together);others, as individuals, took advantage of the time to focus on nurturing interests and abilities. If you have the opportunity to influence people dealing with extra stress, consider helping them take inventory of their resources (including personality, emotional, and intellectual strengths) and to analyze and even challenge their own interpretations and assumptions about the circumstances and about their resources.

A Granular Examination of the Impact of the Health Crisis and the Public Support Measures on French Companies’ Financial Situation

– We develop a microsimulation model fed by a particularly rich set of individual data in order to assess the impact of the health crisis on the financial situation of more than 645,000 French companies in 2020. We show that the relative stability in net debt at the macroeconomic level is concealing major disparities on an individual level. Heterogeneity is particularly significant between sectors (before and after public support measures) but is also present within each sector. Our simulations confirm the need for public intervention during the crisis: a mere adjustment in company behaviour is insufficient to absorb the shock. These support measures brought the share of firms with a negative cash flow shock in line with normal years, although “extrem” cash flow shocks occur more frequently than usual. One important lesson learned from this exercise is that sector and size cannot be the only criteria taken into account when drawing up crisis recovery policies. © 2022, Institut National de la Statistique et des Etudes Economiques. All rights reserved.

Disability Resource Professionals' Perceived Challenges in Minority-Serving Institutions During COVID-19: Recommendations for Supporting Students With Disabilities

The COVID-19 pandemic impacted all components of higher education, with current inequities within the campus setting exacerbated, creating larger disparities between individuals with and without readily available access to needed resources. Utilizing data collected from a national survey, this article highlights the perceptions and experiences of disability resource professionals (DRPs) employed at minority-serving institutions (MSIs) on how students with disabilities fared during the COVID-19 pandemic, as well as potential recommendations for supporting students with disabilities at MSIs for the future. The experiences of DRPs working at MSIs during the COVID-19 pandemic reveal challenges for students with disabilities that may complicate or significantly impact their academic experience within the MSI setting.