Caring from a distance: carers? experiences of keeping in touch with care home residents during COVID-19 closures

In response to COVID-19, many care homes closed to visitors and new ways for carers and residents to stay in touch were tried. This UK study employed an online survey to explore carer experiences of staying in touch from a distance. The research highlighted: the importance of ongoing connections (through visits and remotely);diverse approaches to maintaining contact;and concerns about safeguarding and well-being. Findings underscore the importance of developing personalised approaches to staying in touch during future care home closures and for those who require an ongoing approach to remote contact due to distance, illness or additional caring responsibilities.

LP-17 An in vitro dermal absorption study ring trial with 14C-Caffeine according to OECD test guideline 428

Dermal absorption of chemicals is a key factor in non-dietary human risk assessment with agrochemicals. A ring trial exploring the dermal absorption potential of 14C-Caffeine was investigated in six laboratories under GLP conditions using the OECD TG 428-compliant in vitro assay with flow-through cells and dermatomed human skin. Potential sources of variation were reduced by a common protocol, test item and skin source. Particularly, skin samples from the same donors were distributed over two repeats and between labs in a non-random, stratified design. The data show very similar recovery in the various investigated compartments of the assay between laboratories, repeats and donors, which demonstrates that the assay can be robustly and reliably performed. A low intra-lab variability was demonstrated in all 6 laboratories participating. Further, a low inter-lab variability was notable in five out of six laboratories resulting in mean caffeine absorption estimates of 3.93 ± 2.96 % of the applied dose (4 mg/mL) and a mean overall compound recovery of 99.03 ± 2.11 %. In the remaining laboratory presumably due to a Covid-19 driven shipment delay of the skin samples, the skin quality may have been affected since the receptor fluid recovery was substantially higher and to a certain degree did correlate with skin integrity parameters. Overall, the ring trial's results demonstrate that the OECD TG 428-compliant in vitro assay can be robustly and reliably performed in different laboratories. Skin absorption results for caffeine did not present any statistically significant variability, with minor differences in the results across the laboratories (5/6) and indicates the robustness of the methodology and the positive impact of strictly controlling the variables in the study. Understanding the variability in the in vitro dermal absorption assay with human skin will continue contributing to the design and conduct of appropriate regulatory studies, and adding further considerations to the existing OECD dermal guidance notes. This will result in greater confidence in the data utilised from these assays in risk assessments by companies and regulators alike.

Surveillance of COVID-19 pandemic using social media: A reddit study in North Carolina

Coronavirus disease (COVID-19) pandemic has changed various aspects of people's lives and behaviors. At this stage, there are no other ways to control the natural progression of the disease than adopting mitigation strategies such as wearing masks, watching distance, and washing hands. Moreover, at this time of social distancing, social media plays a key role in connecting people and providing a platform for expressing their feelings. In this study, we tap into social media to surveil the uptake of mitigation and detection strategies, and capture issues and concerns about the pandemic. In particular, we explore the research question, "how much can be learned regarding the public uptake of mitigation strategies and concerns about COVID-19 pandemic by using natural language processing on Reddit posts?"After extracting COVID-related posts from the four largest subreddit communities of North Carolina over six months, we performed NLP-based preprocessing to clean the noisy data. We employed a custom Named-entity Recognition (NER) system and a Latent Dirichlet Allocation (LDA) method for topic modeling on a Reddit corpus. We observed that mask, flu, and testing are the most prevalent named-entities for "Personal Protective Equipment", "symptoms", and "testing"categories, respectively. We also observed that the most discussed topics are related to testing, masks, and employment. The mitigation measures are the most prevalent theme of discussion across all subreddits. © 2021 ACM.

The effect of rapidly discharging psychiatric inpatients from Mental Health Act section during COVID-19: a cohort study.

AIMS: In March 2020, the UK government ordered mental health services to free up bed space to help manage the COVID-19 pandemic. This meant service users detained under the Mental Health Act were discharged at a higher rate than normal. We analysed whether this decision compromised the safety of this vulnerable group of service users. METHODS: We utilised a cohort study design and allocated service users to either the pre-rapid discharge, rapid discharge or post-rapid discharge group. We conducted a recurrent event analysis to assess group differences in the risk of experiencing negative outcomes during the 61 days post-discharge. We defined negative outcomes as crisis service use, re-admission to a psychiatric ward, community incidents of violence or self-harm and death by suicide. RESULTS: The pre-rapid discharge cohort included 258 service users, the rapid discharge cohort 127 and the post-rapid discharge cohort 76. We found no statistical association between being in the rapid discharge cohort and the risk of experiencing negative outcomes (HR: 1.14, 95% CI: 0.72-1.8, p = 0.58) but a trend towards statistical significance for service users in the post-rapid discharge cohort (HR: 1.61, 95% CI: 0.91-2.83, p = 0.1). CONCLUSIONS: We did not find evidence that service users rapidly discharged from section experienced poorer outcomes. This raises the possibility that the Mental Health Act is applied in an overly restrictive manner, meaning that sections for some formally detained service users could be ended earlier without compromising safety.

The effect of coincidental SARS-CoV-2 infection on pre-operative cardiopulmonary exercise testing.

This case report demonstrates the significant impact active infection with SARS-CoV-2 can have on functional capacity evaluated by cardiopulmonary exercise testing, even in minimally symptomatic individuals. A 75-year-old man underwent cardiopulmonary exercise testing before a right hemicolectomy; SARS-CoV-2 was incidentally diagnosed following his test. The patient underwent a period of isolation and recovery before a second pre-operative cardiopulmonary exercise test 6 weeks later. His resting pulmonary function tests did not vary between tests but his peak work, anaerobic threshold, oxygen pulse, pulse oximetry nadir, ventilation perfusion matching and heart rate response to exercise all improved significantly after this recovery period. These are unique results that add to the existing knowledge of the pathophysiology and management of SARS-CoV-2 in the peri-operative setting. While our patient demonstrated dramatic improvement in his functional capacity following 6 weeks of recovery, he remained in a high-risk group for surgery according to our local guidelines. Cardiopulmonary exercise testing has a valuable role in individualised risk assessment and shared decision-making in complex, urgent surgical cases where the benefits of delaying surgery to recover from SARS-CoV-2 infection should be balanced against the potential risks.

Virtual outcomes: A possible strategy to improve retention in a primary stroke prevention trial

Background: Hypertension is the most important modifiable risk factor for stroke and an important contributor to the racial disparities of stroke incidence. Thus, working within the communities in which racial disparities of stroke are prevalent is important.Trials working with such communities may have low participant retention at least partially attributable to social determinants of health such as limited time, transportation and access to medical care. Trial outcome adaptations as a result of the COVID-19 pandemic allowed us to compare in-person to virtual retention strategies as a possible strategy to improve trial retention. Methods: Reach Out is a health system focused, multi-component, health theory based, mobile health behavioral intervention to reduce blood pressure (BP) among Emergency Department (ED) patients at a safety net hospital in the under-resourced, minority, majority community of Flint, Michigan. The primary outcome is change in systolic blood pressure. Outcomes were conducted inperson from 10/4/2019 to 3/13/2020 at various locations throughout the community that were convenient for each participant. As a result of COVID-19 and the resulting state mandated stay-athome order, outcomes were converted to phone, text, and picture-based elements. Virtual outcomes consists of: 1) a texted picture validating BP cuff is in correct body placement;2) 3 self-reported blood pressures;and 3) telephone outcome survey. Virtual outcomes were offered at times convenient to participants throughout the daytime, evening, and weekend. Results: Prior to COVID-19, 6-month outcomes were conducted in-person. Of possible in-person outcomes, 76 of 140 (54%) were completed. Tele-outcomes commenced on 4/9/2020. As of 8/18/2020, 63 of 132 (48%) 6-month tele-outcomes, and 38 of 59 (64%) 12-month tele-outcomes have been completed. Total tele-outcomes completed are 101 of 191 (53%). 6 participants havecompleted 12-month tele-outcomes, who did not complete 6-month in-person outcomes. Conclusion: In a mobile health behavioral intervention to reduce hypertension among patients whoreceived care at a safety-net ED, we found that participant retention was similar between in-personand virtual outcome assessments. Virtual outcomes obviate the need for transportation andchildcare, barriers to participation for some participants and could help increase the retention rate infuture trials.