Rituximab and Covid-19 Vaccines, Are They Fit for Purpose?

Background/Aims Since the COVID-19 outbreak the rheumatology community have been concerned about the risk of SARS-CoV-2 infection in patients prescribed immunosuppressing medications. Data suggests that patients receiving Rrtuximab are at increased risk of developing severe outcomes from COVID-19 (1). In our unit all patients receiving rituximab were selected to receive a targeted vaccination and booster programme with all patients receiving at least 2 vaccinations and up to 3 booster vaccinations. We studied the efficacy of the COVID-19 vaccines in rituximab patients, by checking the the Roche Elecsys Anti-SARS-CoV-2-S (Spike) IgG/IgM total antibody levels post vaccination. Our aim was to assess the vaccination response in patients receiving rituximab and to offer advice on continued shielding or alternatively passive immunization with tixagevimab/cilgavimab in those patients who did not mount a response. Methods Taking 39 patients currently on rituximab therapy, we measured Anti- SARS-CoV-2-S (Spike) antibody levels post vaccination. We recorded whether the test was positive or negative, and the numerical result. We recorded rituximab dates of administration and dates of vaccines. We also recorded diagnosis, co-prescribed DMARDs, immunoglobulin levels, white cell and lymphocyte counts. We took record of whether or not the patient subsequently contracted COVID-19, required a hospital admission, ICU or died. Results Of our 39 patients, 21 had Anti-SARS-CoV-2-S (Spike) antibody levels checked. Of these patients, 7 (33%) had a negative spike protein result. Of the patients with a positive result, 8 (38%) had an antibody level between 0-250U/ML, and only 6 (28.6%) had a level >250U/ML (The manufacturer advises that a level above 0.8U/ML is a positive result). Of patients with a negative result, 1 patient had received 3 vaccines, 5 patients had received 4, and 1 patient had 5. All of the patients had received a vaccine >4 weeks prior to receiving the drug. Two patients were co-prescribed Belimumab, 3 were co-prescribed low-dose methotrexate and 2 were not on additional disease modifying agents. The diagnoses of these patients were, 2 patients with SLE, 4 with SPRA, and 1 MPO Vasculitis. There were no significant findings in lymphocyte count, white cell count or immunoglobulin levels. Conclusion These findings suggest that our current COVID-19 vaccination and booster programme may not provide adequate response in patients receiving rituximab therapy. Despite this being a small cohort, these results show that 33% of patients have not mounted a vaccine response and this is concerning. We suggest that vaccine response should be checked in all patients receiving rituximab therapy and those patients who do not mount a vaccine response should be offered passive immunity and advised of possible additional risks regarding COVID-19 exposure.

Implantation from Short Term MCS to Durable VAD: Single Center Experience

The rising use of temporary mechanical circulatory support (tMCS) to stabilize patients with acute cardiogenic shock has resulted in an increased number of these patients being bridged to advanced therapies. While heart transplantation has become the favored path for these patients, durable VAD can be a safe option to recover these Intermacs I patients. All patients implanted with durable VAD at our center from 2017-2021 were reviewed retrospectively and included in this series. Thirty-three patients underwent VAD implantation during the study period. At the time of implant, 78.8% were INTERMACS 1 on tMCS (N=26) and 92.3% (N=24) were stabilized on an Impella (Abiomed, Danvers, MA), 3.8% (N=1) required Centrimag and 3.8% (N=1) required combined VA-ECMO and Impella. Mean age was 65.3 years, 88.4% were male and 39% (N=13) had nonischemic cardiomyopathy. Six patients were implanted with Heartmate II LVAD, while 27 received Heartmate 3 (Abbott, Abbott Park, IL). At the time of VAD implantation, 19% (n=5) of patients required RV mechanical support. Ninety-two percent of patients survived to discharge with a mean total length of stay of 56.23 days and mean post VAD length of stay 34.2 days. Sixty percent of these patients (N=15) survived at least 1-year, with 12 of the patients alive at 2 years. Of the early expirations, 80% died within the first 6 months post implant. Etiology of mortality included RV failure in 50% of patients, COVID-19 infection in 17% , and sepsis in 25%. Despite the high-risk of mortality in the cardiogenic shock population, those patients who can be stabilized with tMCS can have reasonable survival following durable VAD implantation. Following implant, the highest risk for mortality is within the first 6 months and is primarily related to worsening RV dysfunction. With recent data also showing that HM3 can extend life by 5 years, the concept of bridge to transplant LVAD should also be reconsidered for this very sick patient population. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Evaluating the psychosocial status of BC children and youth during the COVID-19 pandemic: A MyHEARTSMAP cross-sectional study.

BACKGROUND: Understanding the psychosocial status of children and adolescents during the COVID-19 pandemic is vital to the appropriate and adequate allocation of social supports and mental health resources. This study evaluates the burden of mental health concerns and the impact of demographic factors while tracking mental health service recommendations to inform community service needs. METHODS: MyHEARTSMAP is a digital self-assessment mental health evaluation completed by children and their guardian throughout British Columbia between August 2020 to July 2021. Severity of mental health concerns was evaluated across psychiatric, social, functioning, and youth health domains. Proportional odds modelling evaluated the impact of demographic factors on severity. Recommendations for support services were provided based on the evaluation. RESULTS: We recruited 541 families who completed 424 psychosocial assessments on individual children. Some degree of difficulty across the psychiatric, social, or functional domains was reported for more than half of children and adolescents. Older youth and those not attending any formal school or education program were more likely to report greater psychiatric difficulty. Girls experienced greater social concerns, and children attending full-time school at-home were more likely to identify difficulty within the youth health domain but were not more likely to have psychiatric difficulties. Considerations to access community mental health service were triggered in the majority (74%) of cases. CONCLUSIONS: Psychosocial concerns are highly prevalent amongst children and adolescents during the COVID-19 pandemic. Based on identified needs of this cohort, additional community health supports are required, particularly for higher risk groups.

The Presence of Non-pharmaceutical Interventions Correlates with Decreased Rates of Asthma Exacerbations and RSV infections in Arkansas

Rationale: To reduce transmission of SARS-CoV-2, non-pharmaceutical interventions (NPIs), including school closures, hand hygiene, mask mandates, and social distancing, were enforced in Arkansas from 3/2020-2/2021. We hypothesized that the presence of NPIs would correlate with a decrease in asthma exacerbations and viral infections. Methods: Demographic information was collected on subjects with asthma exacerbations or viral infections from 3/2018-5/2022, including age, race, ethnicity, and sex. To evaluate the effects of NPIs, three periods were considered: pre- (03/2018-02/2020), during (03/2020-02/2021), and post- (03/2021-05/2022) NPIs. ANOVA analysis and generalized linear models were performed to determine statistical significance. The stringency of NPIs was evaluated using publicly available data (Oxford Covid-19 Government Response Tracker), which allows for direct comparison of Arkansas NPI status to exacerbation data during the same time periods. Results: 5055 asthma exacerbations (3322 unique subjects) occurred between 3/2018-5/2022. Asthma exacerbations decreased from 3/2020-3/2021 and returned to pre-pandemic numbers by summer 2021 (p<0.0001). Similar downward trends occurred for respiratory syncytial virus (RSV) with out-of-season return in summer 2021 (p<0.0001). Rhinovirus was present throughout NPIs. The mean age of exacerbations decreased by 0.9 years when comparing the during NPIs and after NPIs periods (p = 0.0002). An increase in the proportion of exacerbations was noted for non-black and other/unknown ethnicity subjects during and after NPIs. Conclusions: Fewer asthma exacerbations occurred during the most significant NPI employment period (03/2020-02/2021), and an increase in exacerbations was seen as mitigation strategies were relaxed, which correlated with timing of increasing RSV infections.

Age-specific determinants of psychiatric outcomes after the first COVID-19 wave: baseline findings from a Canadian online cohort study.

BACKGROUND: Canadians endured unprecedented mental health (MH) and support access challenges during the first COVID-19 wave. Identifying groups of individuals who remain at risk beyond the acute pandemic phase is key to guiding systemic intervention efforts and policy. We hypothesized that determinants of three complementary, clinically actionable psychiatric outcomes would differ across Canadian age groups. METHODS: The Personal Impacts of COVID-19 Survey (PICS) was iteratively developed with stakeholder feedback, incorporating validated, age-appropriate measures. Baseline, cross-sectional online data collected between November 2020-July 2021 was used in analyses. Age group-specific determinants were sought for three key baseline MH outcomes: (1) current probable depression, generalized anxiety disorder, obsessive-compulsive disorder and/or suicide attempt during COVID-19, (2) increased severity of any lifetime psychiatric diagnosis, and (3) inadequate MH support access during COVID-19. Multivariable logistic regression models were constructed for children, youth (self- and parent-report), young adults (19-29 years) and adults over 29 years, using survey type as a covariate. Statistical significance was defined by 95% confidence interval excluding an odds ratio of one. RESULTS: Data from 3140 baseline surveys were analyzed. Late adolescence and early adulthood were identified as life phases with the worst MH outcomes. Poverty, limited education, home maker/caregiver roles, female and non-binary gender, LGBTQ2S + status and special educational, psychiatric and medical conditions were differentially identified as determinants across age groups. INTERPRETATION: Negative psychiatric impacts of COVID-19 on Canadians that include poor access to MH support clearly persisted beyond the first wave, widening pre-existing inequity gaps. This should guide policy makers and clinicians in current and future prioritization efforts.

Depressive Symptoms and Conflict Behaviors: A Test of the Stress Generation Hypothesis in Romantic Couples during the Covid-19 Pandemic

Introduction: In early 2020, North American jurisdictions required households (e.g., romantic couples) to isolate together to help mitigate the spread of COVID-19. This study provides a first look at the interplay of depressive symptoms and conflict behaviors among isolating couples, including tests of predictions of the stress generation hypothesis. Methods: Mixed-gender couples residing in Canada (N = 711) completed online measures across two waves. We used the actor-partner interdependence mediation model, with Wave 1 depressive symptoms as the predictor, Wave 1 conflict enactment as the mediator, and Wave 2 depressive symptoms as the outcome. Results: Depressive symptoms showed stability across Wave 1 and 2. Wave 1 depressive symptoms showed associations with Wave 1 conflict enactment. For men (but not women), Wave 1 conflict enactment was associated with their own and their partner's Wave 2 depressive symptoms. For both partners, Wave 1 conflict enacted by men mediated the association between Wave 1 depressive symptoms and Wave 2 depressive symptoms. Discussion: Our study confirms and extends the stress generation hypothesis to the pandemic context, showing that depressive symptoms may partially contribute to conflict for isolating couples and that conflict behaviors enacted by men toward their partner can exacerbate depressive symptoms in both partners.

Univenture: Feasibility of a developmentally-adapted, evidence-based drug and alcohol preventure program for university students

Background: There is growing concern surrounding high rates of binge drinking and illicit drug use on Canadian university campuses. Furthermore.Univ. Students Face A Range of Barriers to Accessing Evidence-based Substance Use and Mental Hlth. Serv.. Both of These Issues Are of Increased Relevance in the Context of the COVID-19 Pandemic. the SSHRC UniVenture Consortium Represents A Partnership Across Five Can. Universities Whose Aim Is to Address the Need for Accessible and Evidence-based Substance Use and Mental Hlth. Prev. Serv. on Campuses. to That End, the Consortium Adapted the PreVenture Prog., A Brief Personality-targeted Preventative Intervention Which Has Proven to Be Effective in Reducing Substance Use and Mental Hlth. Prob. among High Sch. Students, Such That It Be: (1) Developmentally Appropriate for First- and Second-Yr. Undergraduate Students and (2) Delivered Virtually. Method(s): the Adapted uniVenture Prog. Was Piloted Across All Five Partner Universities. after Screening for Eligibility Based on Age, Enrolment Status and Elevation on One of Four Personality Dimensions, 604 Students Were Invited to Participate in the Intervention Sessions. Result(s): Low Intervention Uptake (N = 90;14.90%) Suggests Mild-to-moderate Demand for Virtual Interventions, However, High Treatm. Completion Rates (N = 83;92.22%) Suggest High Practicality for Those Who Did Enroll. High Mean Ratings for Satisfaction, (M = 4.87, SD = 1.48), Usefulness (M = 4.97, SD = 1.30), Useability (M = 5.32, SD = 1.19) and Ease of Lrng. (M = 5.57, SD = 1.23) Indicate High Acceptability among Participants. Qualitative Student Responses Indicate Short-term Prom. of Cogn.-Behav. Skills and 1-month Follow-up Outcomes Showed Depressive Symptoms to Decrease Significantly (P 0.001) for All Students from Pre to Post Intervention. Both of These Outcomes Have Been Shown to Predict Longer-term Alcohol Outcomes in Previous Studs.. Conclusion : the Adapted UniVenture Intervention Is Feasible and Acceptable for Undergraduate Students Across Canada, but Strategies to Address Low Intervention Uptake Should Be Considered in the Fut..

COVID-19: Understanding Novel Pathogens in Coupled Social–Ecological Systems

The emergence of SARS-CoV-2 and the spread of COVID-19 is explored using a social-ecological systems (SES) framework. From an SES perspective, the pandemic is the outcome of feedback loops and cascading interactions within an anthropologically disturbed system. However, the SES framework tends to overemphasize human agency as drivers of system disequilibrium. Drawing on posthumanism theory in social science, the agency of the non-human world also plays a critical role in disturbances in SES. Non-human agency is incorporated into the SES framework, applying it to the emergence of SARS-CoV-2 and the spread of COVID-19, and public health responses. The paper is interdisciplinary, and a non-systematic literature review was combined with Socratic dialogue to examine how human-induced changes trigger feedbacks in SES, such as SARS-CoV-2. The non-human world, embedded within a coupled system of material relations;the natural/biological element, that finds expression in the emergence of SARS-CoV-2 and in generating the genome novel recombinant, which aligns with the conceptualization of the non-human as “vibrant”, all play a role in shaping systems dynamics. This calls into question the anthropocentric view that human agency has the capacity to drive ecosystem dynamics. The implications for SES theory are discussed and we conclude with a case for a new ethics of interdependency to better serve SES analysis. The implications for practice, particularly considering projected future novel virus outbreaks, are discussed. © 2022 by the authors.

Feasibility of online mindfulness-based interventions for families affected with postpartum depression and anxiety: study protocol.

INTRODUCTION: Postpartum depression and anxiety (PPDA) is experienced by up to 20% of families in the first year. The condition impacts not only parents but also their developing child. While mindfulness-based interventions (MBI) have shown to be beneficial for this population, many parents do not have access to treatment or find it challenging to commit or complete the treatment. The COVID-19 pandemic has heightened some of the challenges that parents face. The ability to find time for needed self-care and health interventions is also affected by limited childcare support. The opportunity to attend a group online may significantly improve the accessibility to group MBI but may also bring challenges. This study aims to examine the feasibility and acceptability of online MBI groups for parents in families affected with PPDA. METHODS AND ANALYSIS: In this feasibility study, participants will include mothers diagnosed with PPDA and their partners. Two online MBI groups will run simultaneously for 8 weeks: one for mothers with PPDA and another one for their partners. The primary outcome will be feasibility of conducting the online groups, assessed from the facilitators' perspective, participants' perspective and attrition throughout the study. The participants' perspectives on feasibility will be assessed by questions including how difficult it was for them to make it to the sessions, specific obstacles encountered and their scheduling preferences. The facilitators' perspective will be assessed by frequency of technical difficulties encountered, of disruptions in the online sessions and of episodes where parents leave the screen (eg, to calm their child). Secondary outcomes will include mental health, couple relationship, satisfaction and acceptability which will also be evaluated through participant questionnaires. ETHICS AND DISSEMINATION: The study has received ethics approval from the University of British Columbia Children's and Women's Research Ethics Board. Study results will be disseminated through peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER: NCT04617132.

A Coping Motives Mediational Model Explaining Links of Romantic Conflict to Addictive Behaviors

Motivational models of addiction posit that individuals engage in addictive behaviors for a variety of different reasons or motives some of which are riskier than others in terms of links with heavy and problematic involvement. Coping motives (i.e., addictive behavior to reduce or avoid unpleasant emotional states) have consistently been linked with both greater intensity and more problematic involvement in a variety of addictive behaviors. Romantic conflict is one interpersonal contextual factor that theoretically can trigger coping motives for various addictive behaviors. In this talk, Dr. Stewart will outline a model that considers motivational theory from an interpersonal lens to explain links between romantic conflict and adverse addictive behavior outcomes. Next, she will present a set of studies from her lab that test links between conflict and addictive behaviors/problems as mediated though risky coping motives. These studies span addictive behaviors (e.g., alcohol, gambling) and make use of a variety of methodologies (e.g., dyadic studies of couples, longitudinal assessment), settings (e.g., the COVID-19 pandemic context), and analyses (e.g., chained mediation). Implications of the results for motivational theory and for intervention will be discussed.

Provoking Reflection: A Photovoice Exploration of Non-Traditional Adult Learners' Challenges in a Jamaican Higher Education Context

The demand for higher education has been increasing in Jamaica as in many other Caribbean countries. Those who respond to such demands, pursuing further studies in higher education, will need to navigate many obligations and challenges. Additionally, some individuals may be First Generation (FG) adult learners and may lack the tacit knowledge and emotional sustenance to help them succeed. Consequently, adult learners pursuing postgraduate studies will need support in understanding themselves as learners and how to succeed. This study reports findings on challenges that non-traditional adult learners in a Jamaican higher education context face in pursuing postgraduate studies. Using the photovoice research method, qualitative data were collected from 10 adult learners through photographed representations of prompts, photovoice focus group discussions, and participants' reflections. The main findings revealed that the adult learners experienced multiple conflicting emotions as they engaged in their postgraduate programmes of study;experienced challenges balancing their multiple roles and responsibilities, some of which were linked to their status as FG adult learners;and characterised the COVID-19 pandemic as having a dualistic nature, one that exacerbated challenges whilst also offering them opportunities to focus on their studies as well as themselves. The article makes recommendations for supporting these adult learners at the institutional and personal levels as they pursue their studies.

The Impact of COVID-19 on the Clinical Experience and Training of Undergraduate Student Radiographers internationally: The Clinical Tutors' perspective.

INTRODUCTION: The impact on the clinical training and education of healthcare students by COVID-19 has been documented. However, the thoughts and experiences of clinical tutors (CTs) about radiography students attending for clinical training and education during this now elongated period beyond first recognition of the virus has not been explored. This paper will discuss data collected from CTs in the UK Devolved Nations (UKDN) and the United Arab Emirates (UAE) who were compared because of their similarities in delivery based on individual 'rules of engagement' devised by their various health departments. AIM: The purpose of this study was to examine the clinical tutors' thoughts and experiences of supervising radiography students attending clinical placement during the COVID-19 pandemic. METHODS: The UK Devolved Nations (UKDN) and the United Arab Emirates (UAE) were selected for comparison on an international level as they are geographically distinct with a comparable population and education accredited/acknowledged by the Society and College of Radiographers (SCoR). Data was collected data from CTs across the UKDN and the UAE. The study used an online questionnaire (Google Forms) with closed questions in four themes including: students' experiences, impact on students' clinical placement, attitude of the clinical staff and the potential effects of COVID-19 on future graduates' skills and competencies. Further data was gathered on the experience of CTs mentoring students during the COVID-19 pandemic. RESULTS: Data were collected from 59 CTs (81%, n = 48) from UKDN and (19%, n = 11) UAE. Twenty-seven (46%) respondents reported that COVID-19 had a negative impact on clinical practical experience. However, 32 (54%) identified that COVID-19 had no impact on student supervision/feedback or on clinical achievements. Eleven (19%) respondents thought that students should not have been on clinical placement during the pandemic but a further 51% (n = 30) were happy with the students on placement and expressed willingness to delegate work to students. Interestingly, 58% (n = 34) of CTs suggested that future graduates may need a longer preceptorship after they graduate due to receiving decreased clinical experience during the pandemic. Overall, 78% (n = 46) of respondents thought that students improved their clinical confidence by working directly with COVID-19 positive patients. CONCLUSION: The current study has identified conflicting opinions across CTs in different clinical departments. Whilst some felt that students should not be in the hospital during the pandemic, others reported that working directly with COVID-19 patients had a positive impact on students as it improved their clinical confidence. Despite the challenges presented by COVID-19, CTs were able to provide direct clinical supervision and feedback to students on clinical placement throughout the pandemic. Nevertheless, future graduates may need a longer preceptorship period due to decreased clinical experience during the pandemic. IMPLICATIONS FOR PRACTICE: Clinical placements should continue during subsequent COVID-19 waves of infection or future pandemics to ensure development of skills in resilience and adaptability. Underdeveloped skills due to a decreased range of examinations can be rectified when any wave of the infection subsides by providing tailored training based on individual student's needs.

The radiography students' perspective of the impact of COVID-19 on education and training internationally: a across sectional survey of the UK Devolved Nations (UKDN) and the United Arab Emirates (UAE).

INTRODUCTION: The overnight change in hospital practice and service delivery during the COVID-19 pandemic raises the question whether undergraduate radiography students received an adequate clinical experience. Many students had their clinical placements cancelled, deferred or replaced with simulated learning. As a way of dealing with the pandemic some hospitals were dedicated to COVID-19 patients only resulting in many elective procedures being cancelled. Many patients also chose to stay away from the hospital out of fear of infection or the desire to reduce the burden on staff. This resulted in a limited range of examinations and clinical experience for those students who were able to complete their clinical placement. AIM: This study aims to investigate the impact of COVID-19 on the education and training of radiography students internationally in the United Kingdom Devolved Nations (UKDN) and the United Arab Emirates (UAE), to determine any possible impact on their future careers. METHOD: Ethical permission was sought and granted from the Research Ethics Committees (ID: 21-04-12-02 and ID:21/0032). An online survey was developed using Google Forms and link was shared with students via email. RESULTS: 262 students participated in the study [UAE (n = 60, 23%) and UKDN (n = 202, 77%)]. 72% stated that their clinical skills have improved and 82% were confident in the choice of radiography as a career. Participants from UAE displayed a higher tendency towards anxiety (p = 0.009). Students who were on clinical placements during the COVID-19 pandemic and worked with COVID-19 positive patients displayed less ongoing concern relating to COVID-19 (p = 0.004). 78% of the participants did not require wellbeing advice or request any type of wellbeing support from the higher education institutions (HEIs). Nevertheless, the study found that wellbeing of students was found to be negatively affected during the pandemic. CONCLUSION: Completing clinical placement during the COVID-19 pandemic allowed the continuation of education as students were allowed to improve their skills, confidence and resilience in coping with uncertainties and challenges. Undergraduate students should not be excluded from the clinical department during subsequent waves of COVID-19 or future pandemics to ensure continued workforce planning is possible. IMPLICATIONS FOR PRACTICE: HEIs should find solutions to compensate students for the loss of practical experience and skills due to the decreased number of patients in some areas of radiography practice. Providing academic and career counselling can assist students achieve their professional objectives and decrease the risk of attrition and problems upon qualification.

EVALUATION of the COVID-19 CONTACT TRACING PROGRAM in KING COUNTY, WA, USA

Background: Case investigation and contact tracing (CI/CT) is a key component of the response to COVID-19. CI/CT seeks to ensure that people exposed to SARS-CoV2 learn of their exposure and that infected persons and their contacts adhere to isolation and quarantine (I/Q) guidance. CI/CT programs also have the potential to address pandemic-related health inequities through the provision of support services. We evaluated the Public Health-Seattle & King County (PHSKC) CI/CT program, including its reach, timeliness, and case-reported impact on I&Q adherence. Methods: The PHSKC CI/CT case interview assessed case demographics, recently visited places, contacts, and service needs. In March 2021, a random sample of cases completed an End of I&Q Survey to assess their adherence to I&Q guidance and opinions of CI/CT. We calculated descriptive statistics to evaluate survey and programmatic data collected between July 2020 and June 2021. Results: The PHSKC CI/CT team interviewed 42,018 cases (81% of cases contacted) a mean of 6.1 days after symptom onset, and 3.4 days after SARS-CoV2 testing. Cases disclosed the names and addresses of 10,650 worksites (mean= 0.8/interview) and 11,269 other recently visited locations (mean= 0.5/interview), and provided contact information for 61,969 household members (mean=2.7/interview) and 8,753 non-household contacts (mean= 0.3/interview). The CI/CT team helped arrange COVID-19 testing for 5,660 contacts from 3,104 households, facilitated grocery delivery for 7,257 households, and referred 9,127 households for financial assistance. End of I&Q Survey participants (n=304, 54% of sampled) reported self-notifying an average of 4 non-household contacts and 69% agreed that the information and referrals provided by the CI/CT team helped them stay in isolation. Conclusion: CI/CT reached many persons with COVID-19 and their household contacts and identified thousands of possible exposure venues. The intervention's effectiveness was likely limited by the inability to interview cases during their period of peak infectiousness and cases' reluctance to name non-household contacts, though cases notified many non-household contacts themselves. CI/CT was effective in linking people to testing, food, and financial assistance, and most cases reported that the intervention helped them isolate. These findings provide evidence that CI/CT can help mitigate the impact of COVID-19 on disproportionately impacted communities through the promotion of I&Q guidance and provision of support services.

HIGH-RISK MARKERS AND INFECTION RATES IN FEBRILE INFANTS AGED 29-60 DAYS PRESENTING TO THE EMERGENCY DEPARTMENT DURING THE COVID-19 PANDEMIC COMPARED WITH PREVIOUS YEARS

Purpose of Study During the COVID-19 pandemic there was a change in the utilization of the emergency department (ED) for many reasons, including a decrease in transmission of communicable childhood infections and avoidance of situations that could result in exposure. Caregivers are educated on the importance of bringing neonates to the ED if febrile, however for infants aged 29-60 days, there may not be the same urgency especially during a pandemic. In this population there may have been a delay in ED presentation, leading to patients presenting with increased clinical and laboratory markers associated with a higher risk of serious bacterial infection. The objective was to evaluate how the COVID-19 pandemic affected the clinical and laboratory high-risk markers as well as infection rate in infants aged 29-60 days presenting to the ED with fever. Methods Used Retrospective chart review of infants evaluated in the ED from March 11-December 31, 2017-2020 at a freestanding children's hospital. Patients were identified using a dataset derived from the hospital's clinical pathway for febrile infants aged 29-60 days. Inclusion, exclusion and high-risk criteria are included in table 1. Data was reviewed by quality data specialists and then reviewed by a physician to ensure proper categorization and infectious diagnosis. Patient demographics, categorization as high-risk, and type of infection were collected (table 2). Data was analyzed using chisquare and Fisher exact tests. A p-value < 0.05 was considered significant. Summary of Results 251 patients over the 4 years met inclusion criteria. The ED visits for this patient population decreased in 2020 compared to prior years. However, the proportion of visits for this patient population to all ED visits remained similar across all 4 years (p = 0.66). There was no significant difference in patient demographics as seen in Table 2. Year 2020 had the highest rate of urinary tract infection (26%) and bacteremia (11%). The rate of the high-risk criteria of ill-appearance, white blood cell count (WBC), and urinalysis (UA) were highest in 2020. Comparison of the cumulative data from 2017 through 2019 to 2020 data showed a significant difference in the proportion of patients presenting with high-risk WBC (p = 0.028) and UA (p = 0.034), but no significant difference in high-risk ill-appearance (p = 0.208). Conclusions In 2020 there was a higher rate of urinary tract infections and bacteremia as well as a significantly greater proportion of patients presenting with high-risk WBC and UA in this patient population. This suggests that during the COVID-19 pandemic, a lower rate of community viral infection due to pandemic mitigation strategies and possibly later presentation of febrile infants to the ED led to these results. (Table Presented).

Targeting Vulnerability to Seasonal and Acute Weather Changes to Keep Australians With Cardiovascular Disease Out of Hospital - The RESILIENCE Trial

Background: Australia is experiencing ever more frequent weather/environmental challenges, including extreme heatwaves and bushfires. There are no proven interventions to reduce seasonal challenges to the cardiovascular health of vulnerable individuals. The REsilience to Seasonal ILlness and Increased Emergency admissioNs CarE (RESILIENCE) Trial will test the hypothesis that an individually-tailored intervention program will reduce re-hospitalisation risk and mortality in vulnerable individuals. Methods: We will recruit 300 medical patients admitted to the Austin Hospital (Melbourne, Australia), with chronic heart disease and multimorbidity and randomise (1:1) to standard care or the RESILIENCE program (RP). Applying a COVID-19 adapted protocol, the RP group will have their bio-behavioural profile and home environment assessed to determine their vulnerability to seasonal events. An individualised case-management program, including virtual clinic review with a nurse and physician, will be applied to promote seasonal resilience. The primary endpoint is all-cause days alive out of hospital during 12-month follow-up. Trial registered at ClinicalTrials.gov NCT04614428. Results: To date, 27 patients have been recruited and randomised. The mean age was 76±9 years and 11 (40%) were female. The most common comorbidities were hypertension (76 %), coronary artery disease (52 %), heart failure (52 %) and chronic kidney disease (52 %). Ten patients (37 %) have had a post-discharge home visit by the RP nurse and 5 (18 %) have attended the clinic. Conclusion: Recruitment is ongoing, and in the absence of further COVID-19 related lockdowns, all patients will be recruited over the next 12 months. Funding: MRFF-Keeping Australians Out of Hospital Grant

Development of IMPAACT (Impairment Measure for Parental Food Allergy-Associated Anxiety and Coping Tool), a validated tool to screen for food allergy-associated parental anxiety.

BACKGROUND: Parents commonly experience anxiety owing to their children's food allergies (FAs). Although FA-specific anxiety screening tools for adult and pediatric patients exist, a tool for parents with children with food allergy is lacking. OBJECTIVE: To develop and validate a tool that measures parental anxiety related to their child's FA. METHODS: To construct the instrument, items were developed based on consultations with stakeholders and review of existing literature. The instrument was then pilot tested, and items were modified based on relevance, importance, item-total correlations, and fit with the instrument's overall factor structure. The modified instrument was validated through assessing internal validity (reliability), convergent and discriminant validity, concurrent validity, and practical usefulness at 2 time points (precoronavirus disease 2019 and current). RESULTS: The scale showed excellent reliability (Cronbach's α = 0.95). It had a 4-factor structure that was replicated at the 2 time points. The 4 subscales were moderately correlated (between r = 0.438 and 0.744). The scale showed excellent convergent and discriminatory validity, correlating moderately with State Trait Anxiety Inventory and Generalized Anxiety Disorder, and highly with Food Allergy Quality of Life-Parental Burden. It also showed excellent concurrent validity, differentiating among many external variables. Most importantly, it successfully differentiated parents in need of psychological support for problems related to their child's FA. CONCLUSION: The Impairment Measure for Parental Food Allergy-associated Anxiety and Coping Tool fills a gap in the existing literature as a validated screening tool for parental anxiety associated with a child's FA, employing a multi-factor structure addressing multiple dimensions of anxiety and its functional impacts. It has excellent internal and external validity and is well-suited for use in both research and clinical settings to quickly determine which parents of children with FA are in need of further psychological support.