Impact of Modality on Workload among Engineering Undergraduates during the COVID-19 Pandemic

The COVID-19 pandemic created unprecedented disruptions in models for engineering student training. At The Citadel, an undergraduate-focused college in the Southeastern United States, a variety of modalities were implemented following the onset of the pandemic, including emergency online and Hyflex learning. We conducted a longitudinal study to analyze the cognitive load among our undergraduate engineering students throughout changing modalities. Using data from the NASA Task Load Index (TLX) and open-ended reflections on student challenges, we found that total workload (a surrogate for cognitive load) was generally highest during emergency online learning in the second half of Spring 2020 semester, with experiences possibly varying across different demographic and academic groups. Emergency online challenges were often related to time management, personal organization, and responsibility for learning. In contrast, HyFlex challenges were often related to technology and communication challenges. While emergency online learning was a cognitive load disruption, that disruption was often associated with personal and/or academic development. HyFlex learning mediated cognitive load disruption;although, student challenges may have been simple nuisances rather than mediators of developmental change. © 2023 American Society of Civil Engineers.

Exploring the authentication of COVID-19 vaccines using Surface-enhanced handheld Raman spectroscopy (SERS) equipped with orbital Raster scattering and machine learning

COVID-19 is a novel coronavirus first emerging in Wuhan, China in December 2019 and has since spread rapidly across the globe escalating into a worldwide pandemic causing millions of fatalities. Emergency response to the pandemic included social distancing and isolation measures as well as the escalation of vaccination programmes. The most popular COVID-19 vaccines are nucleic acid-based. The vast spread and struggles in containment of the virus has allowed a gap in the market to emerge for counterfeit vaccines. This study investigates the use of handheld Raman spectroscopy as a method for nucleic acid-based vaccine authentication and utilises machine learning analytics to assess the efficacy of the method. Conventional Raman spectroscopy requires a large workspace, is cumbersome and energy consuming, and handheld Raman systems show limitations with regards to sensitivity and sample detection. Surface Enhanced Raman spectroscopy (SERS) however, shows potential as an authentication technique for vaccines, allowing identification of characteristic nucleic acid bands in spectra. SERS showed strong identification potential through Correlation in Wavelength Space (CWS) with all vaccine samples obtaining an r value of approximately 1 when plotted against themselves. Variance was observed between some excipients and a selected number of DNA-based vaccines, possibly attributed to the stability of the SERS colloid where the colloid-vaccine complex had been measured over different time intervals. Further development of the technique would include optimisation of the SERS method, stability studies and more comprehensive analysis and interpretation of a greater sample size. © 2023 IEEE.

Impacts of Emergency Online Instruction on Engineering Students' Perceived Cognitive Load during Learning Assessments

CONTEXT A primarily undergraduate military college shifted from face-to-face instruction to emergency online instruction in Spring 2020 due to the COVID-19 pandemic. We are examining student experiences with the shift using Cognitive Load Theory (CLT), which asserts that learning is hindered when cognitive load overwhelms finite working memory capacity. At the onset of the pandemic, we hypothesized that the need to manage learning in new and changing modalities may increase students' cognitive load and development. PURPOSE OR GOAL We seek to triangulate a previous finding that middle-years students experienced more cognitive load demands than either freshmen or seniors during the Spring 2020 semester. In this study, we examine cognitive load experienced by students in sophomore-, junior-, and senior-level civil engineering courses when engaging in various types of summative assessments. Our goal was to understand how academic course level and assessment type (closed-ended vs. open-ended) may have impacted cognitive load among students. APPROACH OR METHODOLOGY/METHODS We are engaged in a longitudinal mixed-methods study to explore the impacts of changing modalities on cognitive load and student development during the pandemic. For this study, we measured cognitive load experienced during five assessments administered across civil engineering courses of different academic levels using the NASA Task Load Index (TLX). The TLX is a rigorously-developed instrument that quantifies workload (a surrogate for cognitive load) across six dimensions: mental demand, physical demand, temporal demand, performance, effort, and frustration. We used non-parametric analysis to identify differences in cognitive workload by course level and assessment type. We supplemented interpretation of findings through analysis of open-ended questions and focus group transcripts. ACTUAL OR ANTICIPATED OUTCOMES Sophomores and juniors experienced summative assessments differently than seniors, a finding that is consistent with our previous publications suggesting that modality changes may have disproportionately impacted middle-years students. Analysis of TLX data showed that sophomores and juniors reported highest time-demand and frustration, respectively, during closed-ended assessments. Open-ended assessments elicited significant frustration among juniors, a trend that was not observed for seniors. Qualitatively, both sophomores and juniors discussed workload-associated aspects of the modality shift more than seniors. CONCLUSIONS/RECOMMENDATIONS/SUMMARY We seek to further understand the unique experiences of middle-years students as a means for developing recommendations for managing cognitive load during online engineering courses - whether planned or unplanned. Copyright © Mary K. Watson, Elise Barrella, Kevin Skenes, Benjamin Kicklighter and Aidan Puzzio, 2021.

Novel recombinant measles virus vaccine prevents measles virus disease in rhesus macaques

Background: Measles-Mumps-Rubella (MMR) is an effective live-virus vaccine against measles virus (MeV). However, use of MMR is limited by its inability to boost MeV immunity, lack of immunogenicity in infants, and contraindication in pregnant and immunocompromised persons. Methods: We evaluated a novel recombinant dimeric MeV hemagglutinin protein vaccine (rMeV) in a rhesus macaque model. Sixteen macaques were primed at day 0 and boosted at day 42 by experimental group: 1) MMR x2;2) rMeV x2;3) MMR prime/rMeV boost;4) control;n=4. Macaques were challenged intratracheally with Bilthoven strain wild type MeV 8 months later. Blood, bone marrow (BM), and lymph node (LN) samples were collected over 3–28 days after challenge. Replication-competent MeV was measured in peripheral blood mononuclear cells (PBMC), BM cells, and LN cells by infectious assay;MeV RNA in PBMC and BM cells was determined by quantitative reverse transcriptase polymerase chain reaction. Plasma was evaluated for MeV-specific IgG and plaque reduction neutralization titer (PRNT). Results: Six months after vaccination, mean PRNT was 2,432 in rMeV x2 (standard deviation (SD) 3,840), 3,584 in MMR-prime/rMeV boost (SD 3,072) and 5,120 in MMR x2 groups (SD 3,547). Upon infectious challenge, macaques who received any MeV-containing vaccine developed no clinical signs of measles and had no detectable infectious virus in PBMC, BM cells, or LN cells. All unvaccinated macaques had virus in PBMC that peaked at day 7 (mean 3,162 TCID50/mL, SD 4.1) and resolved by day 14 post challenge, and one macaque developed an extensive rash. Macaques who received any MeV-containing vaccine had no detectable MeV RNA in PBMC or BM cells, whereas all unvaccinated macaques had detectable MeV RNA that peaked at day 7 (1.6e5 copies, SD 10.5) in PBMC. In all experimental groups, MeV-specific IgG titers increased after MeV challenge. Conclusion: Macaques who received rMeV and/or MMR were protected from rash, viremia, and detection of MeV RNA in PBMC and BM cells, unlike unvaccinated macaques. These data suggest that rMeV vaccine generates protective immune responses against measles and may be a novel candidate for future measles vaccine strategies. Study of cellular responses after rMeV vaccination and MeV challenge is warranted. Disclosures: Jessica Rubens, MD, Mevox: Grant/Research Support Guillaume Stewart-Jones, PhD, Moderna: Inventor of SARS-CoV-2 vaccine sequences;Moderna: Stocks/Bonds Michael Watson, MD, MEVOX Ltd: Board Member;MEVOX Ltd: Ownership Interest;MEVOX Ltd: Stocks/Bonds Barney S. Graham, MD, PhD, BSG: BSG is an inventor on patents for the stabilization of the RSV F protein (WO2014160463A1, Prefusion RSV F proteins and their use).;National Institutes of Health: Inventor on patents for RSV vaccines;National Institutes of Health: inventor on patents for measles and other paramyxovirus vaccines Diane Griffin, MD PhD, Gilead: Grant/Research Support;GlaxoSmithKline: Advisor/Consultant;GreenLight Biosciences: Advisor/Consultant;Merck: Advisor/Consultant;MeVox: Grant/Research Support;Takeda Pharmaceuticals: Advisor/Consultant.

Glucocorticoid Therapy in the Prevention of COVID-19-Associated AKI

Background: COVID-19 is a global pandemic, with acute kidney injury (AKI) as one of the major complications amongst hospitalized patients. We assessed if glucocorticoid therapy can reduce the incidence of acute kidney injury. Method(s): We compared the demographics, clinical characteristics, and COVID -19 disease severity in a large adult cohort of 140 patients, hospitalized from March to December 2020, comparing their glucocorticoid treatment status with their odds of developing AKI using data from the US Department of Defense health care network. Result(s): Forty two patients received glucocorticoid therapy and 98 patients did not receive glucocorticoid therapy. Five patients in the treatment group and 10 patients in the non-treatment group developed AKI during admission. Per multivariate analysis, when adjusting for age, gender, and chronic kidney disease status, there appeared to be no difference in the odds of developing an AKI (odds ratio (OR) 1.08;95% confidence interval (CI) 0.265 to 3.87;P=1.00). However, when also adjusting for COVID-19 disease severity, the treatment group had a statistically significant lower odds of developing an AKI compared to the non-treatment group (OR 0.180;95% CI 0.0244 to 0.950;P=0.0415). Conclusion(s): In hospitalized patients with COVID-19, glucocorticoid therapy decreased the odds of developing an AKI. COVID-19 disease severity was found to be a major confounder to the development of AKI. The views expressed are those of the authors and do not reflect the official policy of the Department of the Army/Navy/Air Force, the Department of Defense, or the United States government.

Lessons Learned from Teaching Engineering Classes Online during COVID-19

COVID-19 has resulted in the shutdown of schools across the world. As a result, education has changed dramatically, with the distinctive rise of e-learning, whereby teaching is undertaken remotely and on digital platforms. During the COVID-19 pandemic, the synchronous, asynchronous, and hybrid online teaching modalities have been adopted in many engineering colleges and departments. Therefore, there were a lot of challenges, faced teachers specifically teaching engineering courses. As an example, in the spring 2020, fall 2020, and spring 2021 semesters, petroleum engineering at TTU has used all of these online teaching modalities and has experienced the challenge of delivering its engineering courses online. However, a lot of lessons have been learned from that experience. This paper summarizes the lessons learned during teaching petroleum engineering courses online based on feedback collected from faculty members and undergraduate students. © American Society for Engineering Education, 2022.

Self-Directed Learning Readiness among Engineering Students during Emergency Online Instruction

Work-In-Progress: In the early months of the COVID-19 pandemic, many higher education institutions in the United States rapidly transitioned to emergency online learning. At The Citadel, a residential military college with additional veteran/active duty and college transfer populations, undergraduate engineering courses before the pandemic were administered solely through face-to-face instruction. As such, changing modalities during the pandemic were a very new experience for our students. We hypothesized that students might develop improved self-directed learning readiness due to the need to manage learning in new and changing course modalities. In this study, we present changes in self-directed learning readiness among our undergraduate engineering students, as measured by the Self-Directed Learning Readiness Scale, at the beginning and end of emergency online instruction during the Spring 2020 semester. Generally, SDLRS scores increased during six weeks of emergency online instruction. However, juniors were the only academic class who did not experience gains in self-directed learning readiness. Interestingly, we earlier found that juniors experienced an increase in more cognitive load dimensions than other academic classes during the Spring 2020 semester. We are currently analyzing qualitative data and SDLRS scores collected in subsequent semesters to better understand the relationship between development of self-directed learning readiness and cognitive load.

The rate of secondary infections and diagnostic challenges in critically ill patients with COVID-19

Introduction: Patients admitted to intensive care with severe SARSCoV- 2 infection frequently present with sepsis. These patients are at a higher risk of developing a secondary infection, but this can be difficult to distinguish from the primary viral infection [1]. Liberal use of broad-spectrum antibiotics can lead to proliferation of antimicrobial resistant organisms. We aimed to identify the rates of bacterial secondary infections and antimicrobial usage in critically ill COVID-19 patients. Methods: We performed a retrospective review of case records for patients admitted to critical care from three hospitals in the Greater Glasgow and Clyde Health Board, Scotland. Patients with confirmed SARS-CoV-2 infection admitted to high dependency or intensive care were eligible. We collected data on background patient demographics, comorbidities, admission SOFA scores, antimicrobial usage, and positive microbiological cultures from within a 10-day period. Cultured organisms that were unlikely to be clinically significant were excluded. Results: Records for 105 patients admitted between December 2020 and September 2021 were reviewed. At admission to critical care, 100% met the criteria for sepsis in accordance with the Sepsis-3 International Consensus definition, and 33% went on to develop septic shock [2]. The mortality rate was 34%. All patients received corticosteroids, and 74% were treated with an IL-6 receptor antagonist. Half of the patients had at least one clinically significant positive microbial culture, however a much higher proportion (73%) were treated with antibiotics. Conclusions: Secondary infections can be difficult to diagnose in the presence of severe COVID-19 disease, with a disproportionally high use of antibiotics relative to positive cultures. Additional diagnostic tools would be useful in this patient population to aid in antimicrobial stewardship.

Beyond Continuity of Instruction-Innovating a Geomatics Course Using Problem-based Learning and Open-source Software

Geomatics, with an emphasis on developing students' competencies in Geographic Information Systems, is a technology-intensive course. During the Spring 2020 semester, The Citadel shifted to online continuity of instruction after midterms due to the COVID-19 pandemic. The Geomatics instructor was faced with ensuring academic continuity and quality without remote student access to licensed GIS software. The instructor pivoted to use of QGIS, an open-source software, and a carefully-scaffolded project to equip students with essential GIS skills. Test 3 included two equally-weighted parts: (1) conceptual GIS questions and (2) a new open-ended project, which required students to use GIS to investigate a real-world scenario. Synchronous and asynchronous support was provided to afford students the flexibility needed to manage home commitments and technology challenges. Nevertheless, students' potential for increased (even unmanageable) cognitive load was high, due to the new modality, pedagogy and software. We investigated the impacts of the post-pandemic Geomatics course on students' cognitive load and academic performance through the lens of Cognitive Load Theory, which asserts that cognitive overload can hinder learning. Based on students' NASA Task Load Index scores, Test 3 workload was on par with their face-to-face engineering courses and lower than their online engineering courses. We expect that the cognitive load associated with the project and new software was manageable and not a barrier to learning. Performance on the project was substantially higher than on the closed-ended Test 3 questions, which supports that the project-based approach was integral to helping students achieve GIS competencies. Final exam performance was lower than in previous years, which may suggest that the mid-semester modality shift impacted their ability to fully synthesize material from the semester. Future course offerings will use the project to provide students with authentic engagement with GIS and real-world topics, while QGIS will remain an option for remote instruction. © American Society for Engineering Education, 2021

Improving provider, patient and health systems outcomes: a qualitative analysis of Project ECHO

Background Project ECHO (Extension for Community Healthcare Outcomes) is an internationally recognised tele-mentoring intervention that has been implemented in over 40 countries. The model connects specialist healthcare providers (hubs) with providers in primary and community practice (spokes), often in rural and isolated areas. Objectives Project ECHO aims to improve healthcare provider's skills, confidence and knowledge, and to create a community of practitioners using the hub and spoke model. Analysing interview data from 27 Project ECHO network leads and participants in Northern Ireland, this study sought to assess the impact of Project ECHO on improving provider, patient and health system outcomes. Results Having access to a specialist, a space to share experiences, and being able to disseminate up-to-date best practice were all cited as improving provider knowledge. Providers described improved outcomes for patients such as receiving a new treatment or an efficient referral. Providers reported being more confident in managing patients and thus were less likely to refer unnecessarily, and links between providers at primary and secondary levels being improved. ECHO was deemed an acceptable methodology in terms of format and in improving access to education and training by removing geographic barriers and reducing time barriers. Conclusions This is one of the first studies to qualitatively analyse outcomes across a number of different ECHO networks, and involving both health and social care networks. The results indicate the benefit of ECHO in improving provider, patient and healthcare outcomes. This has implications for future resourcing decisions, particularly within the context of COVID-19 in which virtual and online training is necessitated by social distancing requirements. This study has implications for wider international contexts in which ECHO may be piloted to address similar challenges. Key messages Participants across our study described Project ECHO as having a positive impact on provider, patient and health systems outcomes. Project ECHO was described as an acceptable approach to training and education that improved access through removing geographic barriers.

A sample survey: Parental views on routine childhood vaccination, the flu and COVID vaccines during the pandemic

Background Fewer routine childhood vaccinations have been given during the COVID-19 pandemic compared with January to April 2019.1 The COVID vaccination programme has brought into light a massive wave of concern internationally about vaccination hesitancy thus risking global public health strategies. Are more parents choosing not to access childhood immunisations because of concerns about attending clinical settings, or are they questioning the principles of vaccination in general? Objectives To improve local routine childhood vaccination rates by identifying parental barriers behind vaccination hesitancy. To share this learning with local child health professionals who support families with decision making around childhood vaccination. Methods A sample survey was performed in the children's outpatient department at St Mary's hospital on 26th & 27th November 2020. It involved a 5-minute open-question discussion with parents regarding their views on routine childhood vaccination, the flu and COVID vaccines. Confidentiality and anonymity were maintained during data collection and analysis. All data was gathered by a single paediatric junior doctor to minimize collection bias. The results were shared with the local child health integrated care team (Connecting Care for Children) at the weekly multi-professional meeting. Results 27 families were approached. All parents agreed to participate. All children were up to date with their immunisations. Most common parental comments in favour of routine vaccinations included the 'protection of my child from serious illnesses', 'protection of others who cannot be vaccinated', and 'following the national paediatric guidelines'. 23 out of 27 children were eligible for flu vaccination with only 35% (8 out of 23) having received it. Up to 30% of parents in the unvaccinated children group said that the flu vaccine 'was not necessary', with 22% supporting that they 'weren't offered' or 'weren't aware' their children could have it. 30% of parents were in favour of the COVID vaccine and said they have 'trust in science', it is 'the only way to come back to a normal life', and that 'the risk of having it outweighs the risk of not having it'. Those who were negative (44%) or undecided (26%) said that this vaccine is 'too new to be trusted', there are 'unknown long term side effects', it's 'not tested on all age groups', and 'there are unknown ingredients'. Parents in the negative/undecided group said that only time could change their mind. Also, if they were to have another baby they would now think twice before vaccinating their child with the routine immunisations. Conclusions This sample survey has revealed diverse parental views regarding vaccination. Worryingly our results indicate that the arrival of the COVID vaccine has made some parents more reluctant to access routine childhood vaccines. Sharing our results locally has supported child health professionals to address these concerns with families when discussing vaccination. We recommend conducting this survey across other Trusts to assess whether this trend reflects the majority of the population and can be used to address vaccination hesitancy on a national scale.

Innovative use of videoconference tool for parental education during COVID19

Background The COVID19 pandemic brought a lot of questions and concerns from parents about the impact of the virus on their children's health. The widespread presence of 'fake news' was adding to the confusion. Our Paediatric Integrated Care team based in a tertiary centre in London approached local parents and community centres to organise online child health workshops. Objectives . To support parents and carers in gaining knowledge and confidence to care for children and young people during the pandemic . To reassure and reduce anxiety related to child health concerns . To be responsive to our community and their health needs . To make innovative use of video-conference technology and group teaching methods . To make best use of professionals' time Methods We worked closely with Community and Maternity Champions, who organise groups of local volunteers to promote health and wellbeing in North West London. Two Community Champions showed interest in having a webinar for parents on COVID19 and its impact on children in May 2020. We agreed dates and times for the 2 webinars. The Community hosts promoted the sessions and asked participants to submit any questions in advance so that the webinars could be tailored around the audience's needs. The session lead (paediatric senior registrar) and other paediatric junior doctors prepared a presentation and answers to the pre-submitted questions. The format for the webinars was flexible, co-designing the sessions with the champions. The first had a 15-minute presentation followed by Q&As, the second did not have a presentation to allow more conversation with the families who joined. After each webinar, we sent resources for the community hosts to share. After trialling two webinars in May, we were contacted by other community centres. We organised six more webinars from June to December 2020. We captured data during the webinars, such as teaching material used, duration, session breakdown, size and type of audience. We tested different approaches for feedback, sharing survey links at the event and following up with the hosts two weeks after the event. Results From May to December 2020, we organised 8 webinars with 5 Community Centres, two youth groups and one secondary school, with a total of 72 attendees. Initially they were focused on COVID19, then we introduced other topics, including mental health, asthma and common childhood illnesses, depending on what the community hosts and local families requested. On average we ran the webinars for 1 hour. Formal and informal feedback confirmed that the webinars addressed concerns and that the attendees and community hosts found the session useful and reassuring. Peer to peer learning during the sessions was encouraged and this was key to improving audience's confidence in addressing health concerns. Conclusions The COVID19 pandemic has opened up innovative ways to collaborate with community centres and have conversations on health-related topics sharing expertise. This project has also provided an important learning opportunity for paediatricians in training. The success of this programme is likely to lead to implementation of similar and related programmes, even after the end of the pandemic.

Co-designing child health resources for primary care colleagues and families during the COVID-19 pandemic

Background The Covid-19 pandemic forced organisational change onto healthcare services. Health care professionals have been challenged by the rapidly evolving situation, significant capacity issues, anxiety from patients, and risks to personal health. Safe assessment of febrile children in primary care became unclear and potentially a risky situation. Objectives To support primary care professionals to safely assess febrile children during the pandemic, and to help parents safely navigate a disrupted health system, an information bundle was co-produced and distributed to GPs and families across an inner-city area. Methods Connecting Care for Children (CC4C) is a collaborative that supports the delivery of integrated child health services. Through established primary and secondary care networks, CC4C was able to listen to primary care colleagues practicing in the pandemic, and to understand their clinical worries and needs. Similarly, CC4C used its network of patient champions to hear what families were grappling with. With this understanding, the CC4C team was able to initiate the development of supportive child health resources. A Primary Care and Community Resource Pack for use during the Covid-19 pandemic was co-produced by general and infectious disease paediatricians, local GPs, and junior doctors. The resource bundle included: . Guidance for assessing febrile children in primary care . Advice for minimising the risk of Covid-19 transmission during face-to-face assessment . Answers to frequently asked questions . Information about when Covid-19 tests are indicated A sample group of GPs provided feedback to an initial draft, and their suggestions were incorporated into the guideline. Resources for GPs to distribute to parents and carers were also included in the bundle: . a flow-chart to aid decision making about school attendance based on a child's symptoms . when to seek medical attention based on their child's clinical condition. Patients and citizens were involved in the development of the 'Should I Send my Child to School' flowchart, providing suggestions to make the guidance clearer. During the second wave of the pandemic, new resources were added including: . information about Paediatric Multisystem Inflammatory Syndrome . the new Covid-19 variants Results The resource pack was distributed to GPs across a large inner-city population, and two adjacent regions requested permission to use the resources. Resources from the bundle are available online at: www.cc4c.imperial.nhs.uk/our-experience/ common-paediatric-questions. Elements of the bundle were shared widely on social media, reaching audiences across the country- the FAQs for GPs document was seen by over 1,000 Twitter users and shared by 28;the 'Should I Send my Child to School' flowchart was seen by over 1,700 users. GPs provided positive feedback and felt that the bundle offered reassurance, was an 'extremely helpful resource on how they can safely assess their paediatric patients this winter' and a 'must-read for primary care physicians'. Conclusions Co-designing and co-producing a child health resource pack with both primary care colleagues and parents and carers enabled the development of resources that were useful and supportive to all those caring for children and young people during the Covid -19 pandemic.

Breaking bad news during the COVID-19 epidemic: A virtual objective structured clinical examination (OSCE) for nephrology fellows

Background: The Breaking Bad News OSCE assesses fellow counselling/ communication skills in 20-minute simulation scenarios: kidney replacement therapy (KRT) in ESKD, urgent KRT in AKI, and kidney biopsy. In-person simulation was impractical during the COVID epidemic, so we adapted the OSCE to a virtual platform. Methods: The AKI scenario was audio only. Fellows called a simulated patient (SP) surrogate for urgent KRT consent. The ESKD and kidney biopsy scenarios were video encounters between fellows and SPs. Faculty observed while muted/video off. After each scenario, fellows received feedback from SPs and faculty (unmuted/video on). Fellows from 3 programs at 2 centers completed the OSCE in May 2021. Post-OSCE, fellows were anonymously surveyed about each scenario, the OSCE overall, and their estimate of the percent of outpatient encounters and inpatient KRT counseling they had done virtually in the past year. Results: 15 fellows did the OSCE;14 completed the survey (93% response rate). 93% rated the OSCE overall as a good/very good approximation of a telemedicine experience. 100% were satisfied/very satisfied with the AKI scenario, 79% with the ESKD, and 77% with the kidney biopsy scenarios. Several commented that the AKI scenario was most realistic-they often counseled surrogates by telephone for urgent KRT. Fellows estimated that about 25% (median 27.5%;IQR 16-50%) of counseling for acute inpatient KRT was done virtually in the past year. They estimated about 50% (median 52.5%;IQR 36-70%) of outpatient encounters were done virtually in the past year, but several (dissatisfied with the ESKD and kidney biopsy scenarios) indicated they would not have counseled similar outpatients using telemedicine. Conclusions: Overall, fellows felt the OSCE well-approximated virtual encounters. All were satisfied with the AKI scenario. The majority were satisfied with the ESKD and Kidney Biopsy scenarios, but some did not feel they were consistent with normal practice. The OSCE allows fellows to practice telemedicine communication skills that will remain relevant post-pandemic. The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Defense or U.S. Government.

Asymptomatic Pre-Operative COVID-19 Screening for Essential and Elective Surgeries: Early Results of Universal Screening at a Midwestern Academic Medical Center

Background: During the novel Coronavirus 2019 (COVID-19) worldwide pandemic, viral testing has largely focused on patients presenting with fever and respiratory symptoms. Although Centers for Disease Control has reported 1,551,095 cases in the United States as of May 21, 2020, asymptomatic infection rates remain unknown within the U.S., especially in geographically disparate regions. Methods: On April 7, 2020 our hospital established universal SARS-CoV-2 screening using RT-PCR RNA detection from nasopharyngeal swabs from asymptomatic patients prior to essential and elective surgeries. This study included 1,997 asymptomatic patients undergoing surgical procedures and 1,797 admitted for medical management at a Midwestern academic hospital between April 7, 2020 and May 21, 2020. Results: As of May 21, asymptomatic testing for SARS-CoV-2 infection had been completed for 1,997 surgical patients and 1,797 non-surgical patients. Initial testing was positive in 26 patients, with an additional four positive tests occurring during repeat testing when greater than 48 hours had elapsed since initial testing. Overall asymptomatic infection rate was 0.79%. Asymptomatic infection rate was significantly lower in surgical patients (0.35% vs. 1.28%, p=0.001). Surgical patients tended to be older than non-surgical patients, although this was not statistically significant (51, IQR 27-65 vsx 46, IQR 28-64, p=0.057). Orthopedic surgery patients were significantly younger than those from other surgical services (42 vs. 53 yrs, p<0.001), however orthopedic and non-orthopedic surgical patients had similar asymptomatic infection rates (0.70% vs. 0.25%, p=0.173). Conclusion: Among asymptomatic patients tested at a Midwestern academic medical center, 0.79% were infected with SARS-CoV-2 virus. These findings will help guide screening protocols at medical centers while providing essential and elective procedures during the COVID-19 pandemic. While the asymptomatic infection rate was low, this data substantiates the threat of asymptomatic infections and potential for community viral spread. These results may not be generalizable to large urban population centers or areas with high concentrations of COVID-19, each region must use available data to evaluate the risk-benefit ratio of universal testing vs universal contact precautions. Level of Evidence: IV.

Resumption of Pulmonary Rehabilitation after Pandemic Interruption: Patient Attitudes and Characteristics

Introduction: Onset of the Covid-19 pandemic necessitated the abrupt interruption of Thomas Jefferson University's outpatient Pulmonary Rehabilitation (PR) program in March 2020. This study examines clinical characteristics and attitudes distinguishing those PR patients who decided to resume PR (RES) versus those who elected not to resume (DIS) when the program re-opened 16 weeks later. We hypothesized that those patients who chose not to resume would have more severe disease and/or higher Covid-19 related anxiety.Methods: The following demographic and clinical data were collected from the medical record on all subjects from the time of their initial PR entry evaluation: age, sex, pulmonary diagnosis, cardiac and psychiatric co-morbidities, pulmonary function studies (FVC, FEV1, FEV1/FVC), six-minute walk test distance, COPD Assessment Test score, use of home oxygen (yes or no), University of California San Diego Shortness of Breath Questionnaire, Public Health Questioanaire-9. A 6 question survey was administered to the RES subjects at the time of their first return visit. A 6 question survey was administered to DIS patients by mail.Results: Thirteen patients had interrupted PR;8 in the RES group, 5 in the DIS group. Mean age of the entire group was 66.6 + 11.6 years. 6/13 were male. Ten had COPD, 2 interstitial lung disease, 1 asthma. There was no statistically significant difference in any demographic or clinical parameter between the RES and DIS groups. All 5 patients in the DIS group indicated that anxiety about Covid-19 was the main reason they did not wish to resume PR;this appeared unrelated to any preexisting psychiatric/anxiety diagnosis. In the RES group, 4/8 indicated no anxiety about returning to the program, 1 mildly anxious, 1 moderately anxious, and 2 extremely anxious. All 5 patients in the DIS group indicated that wearing a face mask (which would be required for resumption of PR) during the pandemic made their breathing worse, whereas 4/7 in the RES group indicated a mask had no effect on their breathing.Conclusions: Thirty-eight percent of patients chose not to resume PR during the Covid-19 pandemic. In this small sample, no demographic or clinical parameter distinguished the RES and DIS groups. Survey results indicate anxiety related to possible Covid-19 exposure and/or the new requirement for mask wearing during exercise may have contributed to patient's decision to discontinue PR.

Risk factors for persistent abnormality on chest radiographs at 12-weeks post hospitalisation with PCR confirmed COVID-19.

BACKGROUND: The long-term consequences of COVID-19 remain unclear. There is concern a proportion of patients will progress to develop pulmonary fibrosis. We aimed to assess the temporal change in CXR infiltrates in a cohort of patients following hospitalisation for COVID-19. METHODS: We conducted a single-centre prospective cohort study of patients admitted to University Hospital Southampton with confirmed SARS-CoV2 infection between 20th March and 3rd June 2020. Patients were approached for standard-of-care follow-up 12-weeks after hospitalisation. Inpatient and follow-up CXRs were scored by the assessing clinician for extent of pulmonary infiltrates; 0-4 per lung (Nil = 0, < 25% = 1, 25-50% = 2, 51-75% = 3, > 75% = 4). RESULTS: 101 patients with paired CXRs were included. Demographics: 53% male with a median (IQR) age 53.0 (45-63) years and length of stay 9 (5-17.5) days. The median CXR follow-up interval was 82 (77-86) days with median baseline and follow-up CXR scores of 4.0 (3-5) and 0.0 (0-1) respectively. 32% of patients had persistent CXR abnormality at 12-weeks. In multivariate analysis length of stay (LOS), smoking-status and obesity were identified as independent risk factors for persistent CXR abnormality. Serum LDH was significantly higher at baseline and at follow-up in patients with CXR abnormalities compared to those with resolution. A 5-point composite risk score (1-point each; LOS ≥ 15 days, Level 2/3 admission, LDH > 750 U/L, obesity and smoking-status) strongly predicted risk of persistent radiograph abnormality (0.81). CONCLUSION: Persistent CXR abnormality 12-weeks post COVID-19 was common in this cohort. LOS, obesity, increased serum LDH, and smoking-status were risk factors for radiograph abnormality. These findings require further prospective validation.

Validation of a predictive model forpotential response to neoadjuvant endocrine therapy(NET) in postmenopausal women with clinical stage II orIII estrogen receptor positive (ER+) and HER2 negative(HER2-) breast cancer (BC): An ALTERNATE trialanalysis (Alliance A011106)

Background: NET is offered to postmenopausal patients (pts) with clinical stage 2/3 ER+/HER2- BC to promotebreast-conserving surgery. Also limited surgical accessibility during the COVID19 pandemic has increased NETutility. Inability to identify ET-resistant disease at diagnosis risks disease progression (PD) and delays more effectivetreatments. Dowsett et al. recently demonstrated that baseline levels of ER, progesterone receptor (PR), Ki67(>15% vs ≤15%), and Ki67 (>10% vs ≤10%) 2-4 weeks (wks) after starting NET may improve appropriate patient(pt) selection for NET (PMC7280290). The ER, PR and Ki67-based prediction model divides pts with primaryER+/HER2- BC into 3 groups for appropriateness for NET: (Group 1) NET is likely to be inappropriate (Allred ER <6or ER 6 and PgR <6), (Group 2) NET may be appropriate and a biopsy for on-treatment Ki67 analysis may beconsidered after 2-4 wks of NET (2A: ER 7 or 8 and PgR <6 and 2B: ER 6 or 7 and PgR ≥6) given that on-treatment Ki67 >10% has been associated with worse outcome (PMC5455353), or (Group 3) NET is appropriate (ER 8 andPgR ≥6). The ALTERNATE trial ( NCT01953588 ) randomized postmenopausal women with clinical stage II or III,ER+ (Allred score 6-8)/HER2- BC to receive anastrozole (ANA), fulvestrant (FUL), or ANA + FUL for 6 months,unless Ki67 was >10% on wk 4 or 12 biopsy, in which case pts were triaged to receive neoadjuvant chemotherapy(NCT) or surgery. As previously reported, the ET-sensitive disease (mPEPI 0 plus pCR) rates were similar acrossthe treatment arms and overall 22% (286 of 1,299) pts had Ki67 >10% at wk 4 or 12. The ALTERNATE trialtherefore provides a large independent data set to evaluate the NET appropriateness model. Results: Among 1,299 eligible pts randomized to receive 6 months of NET, 214 were excluded due to absent HRAllred score (n=41) or absence of pre-treatment and wk 4 Ki67 determinations (n=173). The proportions of theremaining 1,085 pts in Group 1, 2 and 3 were 1% (n=10), 43% (n= 468), and 56% (n=607), respectively. On-studyKi67 >10% prompting conversion from NET to NCT/Surgery occurred in: Group 1 90% (9 of 10), Group 2 30% (141of 468), and Group 3 17% (104 of 607) ( Table 1 ). Among the 1,075 pts in Groups 2 and 3, 260 (24%) pts had Ki67≤15% at baseline (BL), among whom only 14 (5.4%) had Ki67 >10% at wk 4, compared to 231 of the 815 (28.3%)who had BL Ki67 >15% and subsequent Ki67 >10% at wk 4. 2% of pts who remained on NET due to on-treatmentKi67 <10% had PD. Response and PEPI-0 rates by group will be reported. Conclusion: ALTERNATE trial data support a model whereby levels of ER, PR and Ki67 at diagnosis can be usedfor the identification of postmenopausal pts with primary ER+/HER2- BC who are appropriate for NET. Whenbaseline ER Allred scores are >6 and Ki67 ≤15%, there is a low likelihood of ET-resistant disease. When BL Ki67 is>15%, ET sensitivity is variable, and on-treatment biopsy for Ki67 may assist in triaging regarding NETappropriateness, particularly given the extremely low local PD rates seen in ALTERNATE when on-treatment Ki67was <10%. (Table Presented).

National Clinical Trials Networkbiobanking during the COVID-19 pandemic

The National Cancer Institute (NCI) has a large portfolio of ongoing cancer clinical trials that involve biospecimencollection and are supported by the NCI-funded National Clinical Trials Network (NCTN) Biospecimen Banks locatedacross the United States and Canada. At the start of the COVID-19 pandemic, NCTN biobanks rapidly responded tostaffing consequences of state- and institution-issued stay-at-home orders. Many of the NCTN biobanks weredeemed essential by their institutions, allowing for limited and/or socially distanced operations. NCTN biobanksquickly worked with NCI and their respective groups to advise participating sites of changes to usual biospecimencollection procedures in order to accommodate limited staffing at the biobanks. In many instances, participating sites were navigating their own institutional process change due to the pandemic. NCTN cancer clinical trials experiencedan approximate 40% decrease in enrollment from March 11 to May 19, 2020, compared to the same time frame in2019. Likewise, NCTN biobanks saw an approximate 40% and 60% decrease in biospecimen receipt anddistribution, respectively. The decrease in biospecimen receipt was likely due to two factors: (1) participating siteCOVID-19 policies limiting patient enrollment on NCI cancer clinical trials and/or biospecimen collection for thosetrials, and (2) NCTN biobank requests for participating sites to hold nonurgent and/or nonmandatory biospecimensduring the initial phase of the pandemic. Decrease in biospecimen distributions was mainly due to receivinglaboratory closures as dictated by their institutional COVID-19 policies. On May 20, 2020, all states had begun initialreopening phases to some extent. At this time, several, but not all, NCTN biobanks had begun measured return tofull operations, following institutional guidance. NCTN biobanks are making numerous considerations towardreturning to full operations and will continue to work with NCI and their respective groups to responsibly collect anddistribute biospecimens collected during the COVID-19 pandemic. Likely, some patients enrolled on NCTN cancerclinical trials may have had clinical or subclinical COVID-19 at the time of biospecimen collection. Additionally, biospecimens will be collected on two recently activated NCI COVID-19 studies: (1) the NCI COVID-19 in CancerPatients Study (NCCAPS): A Longitudinal Natural History Study ( NCT04387656 ), and (2) a tocilizumab treatmenttrial for COVID-19-related acute respiratory distress syndrome in cancer patients ( NCT04370834 ). Retrospectiveannotation of these biospecimens may provide a unique resource for translational research efforts and will also be aneeded caveat for interpreting biomarker studies conducted using these biospecimens, as the impact of COVID-19on various biomarkers is currently unknown.