Response to Continuing 4-H Youth Development in SC During a Pandemic: The SC 4-H@Home Program

State mandates imposed by governors during COVID-19 affected extracurricular activities for children and youth. To continue providing 4-H programming during quarantine, Clemson Extension 4-H Youth Development Agents created the SC 4-H@Home program. Daily activities were developed that could be completed at-home using common household items and were delivered via email to registered participants. A survey was conducted at the conclusion of the program that included open and closed-ended questions to gauge the effectiveness of the program. Results indicate that, overall, the SC 4-H@Home program was beneficial to youth and contributed to their education during the COVID-19 crisis © This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License

DESIGN OF A NET ZERO HOUSE AT 100-YEAR FLOOD ZONE IN A HISTORIC DISTRICT: A CASE OF SOLAR DECATHLON DESIGN CHALLENGE ENTRY

This paper discusses the design of a net-zero single-family house in Chattanooga, Tennessee, which was proposed for the 2022 Solar Decathlon Design Challenge entry. The site was in a 100-year flood zone and registered as a national and local historic district. The interdisciplinary team consisted of University of Tennessee Chattanooga (UTC) students from the interior architecture and engineering departments who embraced the challenges of the local climate and the restrictions of the historic district guidelines. This entry, Moc House, focused on the integration of passive design and active HVAC systems including photovoltaic systems in the process. In responding to recent housing market changes in Chattanooga due to the COVID-19 pandemic, a young professional couple in their 30s who have two children was identified as the target market which guided the space planning. Market analysis, including ROI, was conducted in addition to construction cost calculations. Building materials were selected to enhance the durability and resilience of the house structure. Finally, energy analysis was conducted to check the project's Home Energy Rating using Ekotrope and found it less than zero. © 2023, College Publishing. All rights reserved.

Identifiying patients who require respiratory follow up after hospital admission with COVID-19

Introduction: A significant number of patients admitted to hospital with COVID-19 have ongoing functional and radiological deficits which require follow up. Limited data exist to identify these patients, resulting in inefficient healthcare resource utilisation. Aims and objectives: To investigate which clinical characteristics of patients hospitalised with COVID-19 can be used to predict recovery and need for follow up. Method(s): Prospective observational study of 1317 adults with COVID-19 admitted to St Thomas' Hospital, London, UK, between December 2020 and March 2021. All patients were telephoned 5 weeks post-discharge and invited for in-person review if they had ongoing symptoms, or at their request. Clinical characteristics were recorded including duration of inpatient treatment with corticosteroids. Respiratory recovery was defined as no change in MRC dyspnoea score compared to pre-morbid state, no chest radiograph abnormality, and no desaturation during 1- minute sit-to-stand test. Receiver-operator curve analysis was performed to calculate sensitivity, specicifity, positive (PPV) and negative predictive values (NPV). Result(s): 363/519 (70.0%) patients reviewed in-person had recovered at 6 weeks post-hospital discharge. Avoidance of critical care admission predicted recovery (p <0.001), but age and co-morbidity did not. Three days or fewer of steroid treatment was found to be the optimum threshold to predict recovery, with AUC 0.80, NPV 92.0%, and sensitivity 94.5%. Conclusion(s): Patients receiving inpatient treatment for 3 days or fewer have a high probability of respiratory recovery from COVID-19. We propose that this cohort do not require respiratory follow up to be routinely offered.

Copeptin and Cardiovascular Function Correlation in Children with Multisystem Inflammation Syndrome

INTRODUCTION: Children exposed to COVID-19 can develop Multisystem Inflammation Syndrome in Children (MIS-C). Literature has shown that 80% of affected children have cardiovascular involvement. Copeptin, a provasopressin protein, has been shown to correlate with myocardial injury and failure. Copeptin is a stable biomarker with minimal variation in a healthy population. We hypothesize that copeptin levels will correlate with troponin and Brain Natriuretic Peptide (BNP) levels and echocardiogram findings of left ventricular dysfunction in MIS-C. METHOD(S): We conducted a prospective study with subjects admitted to the Pediatric Intensive Care Unit who met WHO criteria for MIS-C between 2021-2022. Within 24 hours of initiating therapy, consent and a whole blood sample was obtained. The plasma was evaluated by enzyme-linked immunosorbent assay for a copeptin level. Troponin and BNP were drawn as standard of care. Echocardiograms obtained within 24 hours of the copeptin sample were evaluated for dysfunction. Comparisons between copeptin and troponin, BNP, and Ejection Fraction (EF) were evaluated using Wilcoxon Signed Rank Test. Comparisons of copeptin across echocardiogram markers of diastolic dysfunction (EE' ratio, EA ratio) and diastolic dimensions (LV diastolic dimeter index (LVDd), septal diastolic diameter index (LVSDd), and posterior wall diastolic diameter index (LVPWDd)) were evaluated using Friedman's Test. Kruskal-Wallis test was used to compare copeptin levels in patients on vasopressor support. RESULT(S): Ten patients with a clinical diagnosis of MIS-C were recruited. While copeptin levels (normal range 4-45pg/ ml, subjects range 19.5-963pg/ml) were not significantly different between patients who received vasopressors (p=0.088), LVSDd (p=< 0.001) and LVPWDd (< 0.001) did differ. Significant differences were found between copeptin and EA ratio (p=0.006) but not with EE' ratio (p=0.495). Differences between copeptin and EF were statistically significant (p=0.007). Comparisons of copeptin with troponin (p=0.007) and BNP (p=0.005) were also significant. CONCLUSION(S): Copeptin is a biomarker that has the potential to indicate cardiac dysfunction in the MIS-C population. Elevated copeptin levels correlated with echocardiogram findings of systolic dysfunction and diastolic dysfunction in children with MIS-C.

Perceptions of healthcare professionals on the feasibility and implementation of a novel isometric exercise intervention for Stage 1 hypertension management

Introduction: Isometric exercise (IE) in laboratory settings can lower resting blood pressure in people with hypertension for clinical effect (1). Empowering patients to manage their condition is key and short, simple, IE may enable this (2). We explored perceptions of healthcare professionals on the delivery of an IE intervention to manage Stage 1 hypertension in the NHS (3). Method(s): Qualitative sub-study within a randomised, controlled feasibility study of an IE intervention for stage 1 hypertension (3). Qualitative interviews (n=6) with healthcare professionals were thematically analysed to understand feasibility and implementation. Result(s): Using IE to support hypertension management was viewed positively, however, evidence of clinical effectiveness was key for implementation. Professionals felt IE would be well received by patients, despite concerns around compliance and accessibility. It was deemed well suited to delivery by diverse professional roles e.g., physiotherapists. Barriers to implementation included concerns due to overwhelming post-covid service demand, IE being out of the 'comfort zone' for GPs and requiring specific training for IE delivery. Apprehension for use as a first-line lifestyle treatment option was apparent;however, all felt strong clinical effectiveness evidence would mitigate this. Conclusion(s): Implementing an IE intervention in NHS primary care for Stage 1 hypertension is feasible, however, definitive effectiveness evidence and appropriate training is needed.

ICONIC: Impact of Covid-19 on Outcomes iN muscle Invasive bladder Cancer - preliminary Results from a prospective IBUS (International British Urological Society) led multicentre collaborative study

Introduction: The Covid-19 pandemic in the UK led to much un-certainty about the delivery of cancer services. A shift from established therapy (and its timing) in patients with Muscle invasive Bladder Cancer (MIBC) has potential deleterious consequences. To understand outcomes, we formed a collaborative to measure overall and diseasefree survival at 3-years in patients with non-metastatic MIBC (Figure 1) treated during the UK's first wave of Covid-19. Secondary aims included comparison between treatment modalities and pre-Covid controls. Patients and Methods: The collaborative included clinicians from 13 major centres, representing 3 UK nations. A prospective clinical audit, endorsed by the National Cancer Research Institute, was started to collect comprehensive data. MIBC patients discussed at the multidisciplinary meeting (MDM) between 1/3/2020-30/06/2020 were included. Results: At submission, data were available from 12 centres for 299 patients. The mean age was 69.3 years (27- 90), and there were 72 female and 227 male patients. Mean Charlson Co-morbidity Index was 5 (1-12). Preliminary analysis of available data indicate the following: MDM recommendations for (at least) 1 in 4 patients were deemed as being modified from standard practice. Twenty six patients received neoadjuvant chemotherapy. In total (from available data), 99 received radical radiotherapy and 146 underwent radical cystectomy (65 and 74 specified as open and robotic assisted, respectively). Preliminary analysis suggests that 1 in 3 patients had died within 1 year. Conclusions: Preliminary Results indicate that recommendations for MIBC patients were significantly altered consequent to the pandemic and mortality was high. Analyses towards endpoints are awaited.

Delivery of Cognitive Behavioral Therapy With Diverse, Underresourced Youth Using Telehealth: Advancing Equity Through Consumer Perspectives

The purpose of this qualitative study was to capture the perspectives of individuals representing an urban, predominantly Latinx community who are underresourced by mental health services about the use of telehealth to deliver mental health treatment. The COVID-19 pandemic required hospital- and community-based mental health programs to pivot to telehealth with alarming speed and very little opportunity to assess the feasibility, acceptability, and disparate impact on unique populations of patients. This study aimed to assess perceived strengths and limitations of telehealth mental health service delivery via qualitative focus group methods. Three focus groups were conducted with 13 youth (aged 8–17) who were being treated at an urban, academic children’s hospital serving a predominantly Latinx community mental health population;two focus groups were conducted with 19 parents of said children;and one focus group was conducted with four mental health providers providing services to this population. A coding schema was designed to capture themes relevant to the following: (1) privacy and confidentiality;(2) perceived limitations of telehealth;(3) comfort with telehealth;(4) therapeutic relationship;(5) perceived strengths of telehealth;(6) perceived safety of telehealth;and (7) advice for providers engaging in telehealth. Findings were illustrative of both perceived strengths and limitations across these domains that can inform optimized telehealth mental health services moving forward.

NO LONGER ELITE? OBSERVATIONS ON CONFERENCE INTERPRETING, COVID-19, AND THE STATUS OF THE POST-PANDEMIC PROFESSION

This overview explores the impact of the ongoing COVID-19 pandemic and the associated restrictions on the professional status of the conference interpreting profession, paying specific attention to the EU context. With international conferences cancelled or transformed into online events, employment prospects for many conference interpreters have been affected sharply as the profession adapts to the new reality. In the first instance, historical and contemporary aspects of the conference interpreting profession are outlined, including the key role that international organisations played in its development as well as the growing level of scholarly interest in the profession and in conference interpreters themselves. Using information obtained primarily from language industry media sources, this is complemented by an overview of the impact of COVID-19 on the profession, with a particular focus on the EU and its accredited freelance conference interpreters during the pandemic. In addition, issues regarding technological changes - including the shift to remote simultaneous interpreting - are also outlined, with reference to some of the legal and ergonomic implications of this move. The impact on education and professional development is also touched upon, as well as the move towards a more holistic approach to interpreting settings in research and practice. Finally, given the preliminary nature of this overview, suggestions for further empirically-based research projects following the COVID-19 pandemic are offered. © 2022 South-West University Publishing House, Faculty of Philology. All rights reserved.

SARS-CoV-2 and stroke characteristics: A report from a regional medical center serving three counties in South Carolina

Introduction: Recent studies have shown patients with coronavirus disease 2019 (COVID-19) develop significant coagulopathy with thromboembolic complications including ischemic stroke. However, data are sparse regarding the clinical characteristics, stroke mechanism, and patient outcomes. Methods: We conducted a retrospective cohort study of consecutive patients with ischemic stroke who were hospitalized between March 2020 and June 2021, within at a Regional Medical Center serving three large counties in South Carolina. We further investigated clinical and demographic characteristics, stroke severity as measured by the National Institutes of Health Stroke Scale (NIHSS), and stroke subtype as measured by the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria among patients with COVID-19 who also suffered from an acute ischemic stroke. Results: During the study period, out of 1087 hospitalized patients with a diagnosis of COVID-19 infection, 18 patients (1.6%) had an imaging-proven ischemic stroke. Of these 18 patients, 10 (56%) were men, 16 were African-Americans (89%), 2 (11.1%) patients were <55 years of age. All patients had at least one known vascular risk factor. Cryptogenic stroke was more common in patients with COVID-19 (83%). The median time (days) from COVID-19 symptom onset to stroke symptom onset was 11 (IQR 10-28), while the median time from being tested positive for COVID-19 to stroke diagnosis was 10 (IQR 2-24). Our study sample had a median admission NIHSS score of 5 (IQR 3- 11) and a median peak D-dimer level of 2101 (IQR 1349 - 3213). Interestingly, 38% of these patients were already on therapeutic anticoagulation before the diagnosis of stroke. Patients with COVID-19 and stroke had an inpatient mortality rate of 11%. None of these patients met the criteria for IV-tPA treatment or thrombectomy. Conclusion: We observed a modest rate of ischemic stroke in hospitalized patients with COVID-19. Most strokes were cryptogenic, possibly secondary to coagulopathy associated with COVID-19 infection. Further studies are needed to guide management for stroke prevention in patients with COVID-19.

Persistent Post-COVID-19 Interstitial Lung Disease. An Observational Study of Corticosteroid Treatment

Rationale: The natural history of recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unknown. Because fibrosis with persistent physiological deficit is a previously described feature of patients recovering from similar coronaviruses, treatment represents an early opportunity to modify the disease course, potentially preventing irreversible impairment. Objectives: Determine the incidence of and describe the progression of persistent inflammatory interstitial lung disease (ILD) following SARS-CoV-2 when treated with prednisolone.

The pharmacist-led accelerated transfer of patients to shared care for the monitoring and prescribing of immunomodulatory therapy during covid-19

Introduction and Objectives Shared care allows for optimal local management of patients with support and guidance from the specialist secondary/tertiary care multidisciplinary teams. Implementing shared care for patients managed with immunomodulatory medicines by an interstitial lung disease (ILD) service was accelerated during the COVID-19 pandemic to minimise the risks associated with travelling to a specialist clinic for consultation, monitoring and supply of medication. Methods Patients were deemed eligible for shared care if they had been prescribed a stable dose of immunomodulatory medication included in the shared care guideline for 3 months. The specialist pharmacist(s) sought permission from the patient and requests were sent to general practitioners (GPS) with a primary care decision form to be returned within 2 weeks. Reminders were sent for shared care responses not received within this timeframe. All patients that had shared care accepted were transferred to GP for the monitoring and supply of immunomodulatory therapy. All other patients were monitored remotely and had medications supplied via specialist centre. Results Of 352 eligible patients, 350 agreed to requesting shared care with primary care providers for immunomodulatory medication(s). Acceptance of shared care was received for 226 patients (65%) and refusal for 17 patients (5%). The barriers to transferring care included no response from GP (104 patients, 30%), hospital only status of medicine under local Clinical Commissioning Group (CCG), patient deemed complex by GP and/or poor adherence. Conclusions This study demonstrates how different healthcare providers worked together effectively to deliver high standards of integrated care, tailored to the individual needs of patients with ILD, during the COVID-19 pandemic. Uptake of shared care could be improved by direct communication pathways with GPS, increased education in the management of immunomodulatory medicine(s) for primary care providers and review of CCG categorisation of medicines included in the shared care agreement. Shared care may improve accessibility to medicines and reduce environmental impact. We suggest further studies to assess monitoring in primary care, patient feedback, impact on specialist clinic capacity and financial implications.

S126 The pharmacist-led accelerated transfer of patients to shared care for the monitoring and prescribing of immunomodulatory therapy during covid-19

Introduction and ObjectivesShared care allows for optimal local management of patients with support and guidance from the specialist secondary/tertiary care multidisciplinary teams. Implementing shared care for patients managed with immunomodulatory medicines by an interstitial lung disease (ILD) service was accelerated during the COVID-19 pandemic to minimise the risks associated with travelling to a specialist clinic for consultation, monitoring and supply of medication.MethodsPatients were deemed eligible for shared care if they had been prescribed a stable dose of immunomodulatory medication included in the shared care guideline for 3 months. The specialist pharmacist(s) sought permission from the patient and requests were sent to general practitioners (GPs) with a primary care decision form to be returned within 2 weeks. Reminders were sent for shared care responses not received within this timeframe. All patients that had shared care accepted were transferred to GP for the monitoring and supply of immunomodulatory therapy. All other patients were monitored remotely and had medications supplied via specialist centre.ResultsOf 352 eligible patients, 350 agreed to requesting shared care with primary care providers for immunomodulatory medication(s). Acceptance of shared care was received for 226 patients (65%) and refusal for 17 patients (5%). The barriers to transferring care included no response from GP (104 patients, 30%), hospital only status of medicine under local Clinical Commissioning Group (CCG), patient deemed complex by GP and/or poor adherence.ConclusionsThis study demonstrates how different healthcare providers worked together effectively to deliver high standards of integrated care, tailored to the individual needs of patients with ILD, during the COVID-19 pandemic. Uptake of shared care could be improved by direct communication pathways with GPs, increased education in the management of immunomodulatory medicine(s) for primary care providers and review of CCG categorisation of medicines included in the shared care agreement. Shared care may improve accessibility to medicines and reduce environmental impact. We suggest further studies to assess monitoring in primary care, patient feedback, impact on specialist clinic capacity and financial implications.