Preparing Pandemic Vaccine Capacity

Among the challenges of a pandemic is the need to scale up to billions of doses, at a larger scale than typically needed for vaccines, from raw materials all the way through to the materials for the containers for fill/finish. Having adequate raw materials, building and staffing the facilities, and tech transfer are all keys to success. [...]we can plug into existing infrastructure, including services (gas, water, waste, etc.) as well as analytics and quality labs." Emergent BioSolutions says that its flexible CDMO capacity deployment model can respond quickly to demand fluctuations. The company's facilities in France, Switzerland, and the US are working on the project;at CordenPharma Colorado, unique high-pressure chromatography systems usually used for manufacturing peptides have been reallocated for purifying lipids.

Pandemic Asteroid Defense: DART Integration and Test in the time of COVID-19

NASA's Double Asteroid Redirection Test (DART) successfully intercepted the asteroid Didymos on September 26th of 2022, potentially changing its orbital period with a deflection by kinetic impact. The spacecraft launched aboard a SpaceX Falcon 9 rocket on November 24th, 2021. DART's Integration and Test (I&T) campaign was scheduled to commence in April of 2020 at the Johns Hopkins University Applied Physics Laboratory (JHU/APL) in Laurel, Maryland. In March of that year, one month prior to beginning I&T, the rapid spread of the Coronavirus (COVID-19) forced JHU/APL to rethink how to assemble, test and deliver a spacecraft on schedule during a very challenging period of time. This paper will discuss the details of the successful I&T strategy used by the DART team during the COVID-19 lockdown and subsequent return to post-lockdown life. The team learned how to effectively meet virtually, how to integrate hardware, and how to operate the spacecraft with the least amount of people required. Communication was key in keeping the various DART team members, who were located across the country, connected and safe. The team had also moved documentation online for the first time, which turned out to be very instrumental in keeping everyone on track. A variety of tools to collaborate and document test procedures and results proved valuable for record keeping. Creative solutions were implemented during the test campaign for scheduling both remote and in person monitoring. This paper will conclude with DART lessons learned and recommendations for future I&T programs. © 2023 IEEE.

An organizational analysis of how managers must understand the mental health impact of teleworking during COVID-19 on employees

PurposeThe unimagined workplace disturbance caused by the Coronavirus, also known as COVID-19, has made many organizations virtual or telework driven workplaces, often without the infrastructure and systems in place to support employees facing these sudden workplace changes (Burrell, 2020). Many stressors accompanied this transition, to include lack of childcare, home-school responsibilities and layoffs and business closings. These stressors have perpetuated concerns for the job and financial security for all workers (Fox, 2020), leading some employees to struggle with the work-life balance out of concern for being laid off due to perceived low productivity (Fox, 2020). This study aims to explore those manifestations.Design/methodology/approachThis qualitative research case study explores the impact COVID-19 induced telework has on their job satisfaction, mental well-being and aspects of organizational commitment to fill a gap in the literature concerning emerging workplace dynamics due to COVID-19 for small real estate businesses in the USA.FindingsThe results of this qualitative research case study provide knowledge and information about the need for small businesses to be resourceful and resilient in the way that they support and engage remote workers. This qualitative research case study explores the impact COVID-19-induced telework has on their job satisfaction, mental well-being and aspects of organizational commitment for small real estate businesses. The analysis of current work-life structures through a qualitative lens provides trends among workers to gain a greater perspective of the current accelerators and barriers to worker success in a COVID-19 teleworking environment.Originality/valueThis qualitative research case study explores the impact COVID-19 induced telework has on their job satisfaction, mental well-being and aspects of organizational commitment to fill a gap in the literature concerning emerging workplace dynamics due to COVID-19 for small real estate businesses. The value of this research is that majority of the participants were African-Americans, which represents a participant group that is highly under researched.

The Rising Epidemic of Mass Shootings in the US and Its Association with Gun Legislation, Laws, and Sales

Introduction: Mass shootings pose a considerable threat to public safety. This study aims to (1) assess US mass shootings, firearm-related sales, laws, and regional differences from 2015-2021 and (2) investigate changes in mass shootings and firearm sales before and during the Coronavirus Disease 2019 (COVID-19) pandemic. Method(s): A retrospective review of mass shootings, gun sales, and laws regarding the minimum age required to purchase a firearm within the US from 2015-2021. The 10 states/regions with the greatest mean mass shootings/capita from 2015-2021 were selected for further analysis. Result(s): Mass shootings correlated significantly with firearm sales from 2015-2021 nationwide (p< 0.02 for all). The growth in mass shootings, the number killed/injured, and gun sales were greater in 2020 and 2021 compared withthe years prior. The 10 states with the highest mean mass shooting/capita over the study period were Alabama, Arkansas, the District of Columbia, Illinois, Louisiana, Maryland, Mississippi, Missouri, South Carolina, and Tennessee. No significant correlation was found between the number of mass shootings/capita and the minimum age to purchase a firearm. Conclusion(s): Firearm sales correlated significantly with mass shootings from 2015-2021. Mass shootings and gun sales increased at greater rates during the COVID-19 pandemic compared withthe years before the pandemic. Mass shootings exhibited inconsistent trends with state gun laws regarding the minimum age to purchase a firearm. Future studies may consider investigating the methods by which firearms used in mass shootings are obtained to further identify targets for prevention.

The Evolution of the Covid-19 Pandemic in Pediatric Patients with Sickle Cell Disease: From Alpha to Omicron

Background: Approximately two years ago, COVID-19 was declared a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and through genomic surveillance, we have seen the emergence of variants of SARS-CoV-2. In the United States, over 78 million cases and >900,000 deaths attributable to COVID-19 have been reported. SCD was identified as a risk factor for severe COVID-19 disease in adults and pediatric patients. The emergence of novel SARs- CoV-2 variants has led to challenges in diagnosis, treatment, and prediction of long-term sequelae in individuals with SCD and COVID-19. Aim(s): We compare the overall seasonal variation of COVID-19 variants and patterns of healthcare utilization and clinical presentation over time in pediatric patients with SCD and COVID-19 at Children's National Hospital (CNH). Method(s): Our single-center, observational cohort study included 193 pediatric patients with SCD (0-21 years) with PCR-confirmed SARSCoV- 2 infection between March 31, 2020, and January 31, 2022. Per the SECURE SCD Registry definitions, clinical severity was classified as asymptomatic, mild, moderate, and severe. Result(s): A total of 193 unique patients with SCD and positive SARS-CoV-2 PCRs between March 2020-January 2022 were included in our registry. Most patients were female (51.8%), and the mean age was 11.2 years (SD 6.5 years). Most of the cohort resides in Maryland (N=135), and HbSS was the dominant genotype (69.4%). During the alpha dominant variant of the COVID-19 pandemic (March 2020- June 2021) there were 70 cases, followed by 40 cases during the Delta variant (July 2021- December 19, 2021), and 83 cases during the Omicron variant dominance (from December 20, 2021-January 31,2022). There were 149 patients (77%) that presented to the emergency department (ED) or were hospitalized. There were a total of 80 hospitalizations (41.5%), and a relative comparison showed that the percentage of hospitalizations was highest during the delta wave (47.5%) and lowest during the omicron wave (36.1%) (p= 0.407). ED-only utilization was highest in the era of omicron (43.4%, N=36), followed by delta (32.5%, N=13), and then alpha (30%, N=21)(p=0.197). The most common SCD-related complication was vaso-occlusive (VOC) pain (33%, N=64) which accounted for half of all hospital admissions (51%, N=41 of 80). Acute chest syndrome (ACS) was reported in 40% (N=32) of admitted patients and was highest in the alpha era (54.8%, N=17). The use of blood transfusion therapy was highest in the alpha (N=17) and delta (N=14) variants, while Remdesivir use was highest in omicron (N=15). A total of 6 patients received monoclonal antibodies (Delta, N=4;omicron, N=2). Throughout all the variants, there was a significant difference in COVID-19 clinical severity (p>0.005). Of the patients classified as asymptomatic (13%, N=25), seventy-two percent (n=18) were diagnosed during the alpha variant. Mild severity was the most prevalent (69%, N=134), with the omicron variant having the highest cases (51.5%, N=69). Severe cases were observed in all variants (6.7%, N=13) but were most prevalent during the alpha variant (46.2%, N=6). Summary - Conclusion(s): Interestingly, while the relative percentage of hospitalizations was lowest during the omicron wave, it saw the highest percentages of ER utilization. Overall, COVID-19 remains mild in pediatric patients with SCD, and notably, there was higher health care utilization in the omicron era.

COVID-19 Vaccine Hesitancy and Health Literacy in US Southern States

The following are the highlights of our study: * Vaccine hesitancy in Southern states is complex and extends beyond health literacy. * Vaccine hesitancy in Southern states transcends many sociodemographic differences. * Effective public health communication should be unambiguous about negative externalities of COVID-19 beyond individual threats. _____ The COVID-19 pandemic caused by SARS-CoV-2 remains a public health crisis, accounting for more than 100 million confirmed cases with more than 1,121,800 deaths in the United States as of April 26, 2023.1 Despite widespread vaccination efforts by the US government and public health leadership, the rate of vaccine uptake is still far from desirable, as researchers estimate that about 70% to 85% of the country will need to be immunized before SARS-CoV-2 can be fully contained through herd immunity.2 As of April 19, 2023, about 81% of the US population had received at least 1 dose, whereas 69.4% had completed a full primary vaccine series and only 16.7% had received an updated bivalent booster, with variations in the rate of vaccination across states and regions.3 The Southern states (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Virginia, and West Virginia) have relatively lower rates of full vaccination (primary series) compared with other states (mean of 61.3%, ranging from 53.2% in Alabama to 79.9% in Maryland);6 Southern states rank among the 10 states with the lowest fully vaccinated rates in the nation.3 The predominant barrier to uptake has been vaccine hesitancy,4-9 defined as the intention to delay or refuse taking vaccinations despite availability and accessibility.10,11 It may be influenced by complex contextual factors, ranging from individual and group factors to vaccine-specific characteristics.10 In particular, individual factors may be related to health literacy (HL),12 which is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.13 HL is a phenomenon that involves individuals, families, communities, and systems, and it could be implicated in the level of COVID-19 vaccine hesitancy.5 Although HL is a major determinant of individuals' health behaviors,14 a systematic review study reported that HL's relationship with vaccination uptake prior to the COVID-19 pandemic was unclear because of variations in assessment tools, target populations, and outcome measures across available limited studies.15 Evidence suggests a relationship between HL and COVID-19 vaccine hesitancy.12,16,17 In the United States, a study among women recently released from jails found that low HL is related to COVID-19 vaccine hesitancy.16 Similarly, a study in Turkey found that low HL and a high perception of health care system distrust are associated with higher vaccine hesitancy.17 A study in China found that higher HL is associated with low likelihood of COVID-19 vaccine hesitancy, and the effect was moderated by stress.12 Overall, to the best of our knowledge, no study has examined the association between HL and COVID-19 vaccine hesitancy in populations with low vaccine uptake within the United States, including those residing in the Southern states, which served as the impetus for this study.18,19 This study aimed to estimate the level of HL among a population residing in Southern states and its association with vaccine hesitancy. Nearly 20% of the United States population had still not received a single dose of COVID-19 vaccine as of April 26, 2023, despite increases in both vaccine availability and individual eligibility over the previous 2 years.20 The observed trends in overall and region-specific COVID-19 cases and rates of vaccination in the United States demonstrate the need to examine the impact of HL on vaccine hesitancy in the Southern states, especially with the release of simplified eligibility guidelines and expanded booster recommendations.21 METHODS Participants This study included adults 18 years and older. Upon receiving institutional review board (IRB) approval from East Tennessee State University (IRB No. c0221.22e), a cross-sectional study was initiated. Race/ethnicity was collected as: (1) Asian or Pacific Islander, (2) Black or African American, (3) Hispanic/Latino, (4) Native American or Alaskan Native, (5) non-Hispanic White, (6) biracial or multicultural, and (7) race/ethnicity not listed here. Because of small sample sizes for non-White racial/ethnic groups in the study population, race/ethnicity was recoded as non-Hispanic White and other.

Workplace attachment: Perceived employee support and commitment: A qualitative, descriptive, phenomenological study

The purpose of this qualitative phenomenological descriptive study was to understand how employees perceive the level of support received from their employers in the workplace. The study encompassed employees with both secure and insecure attachment style types from across the entire State of Maryland. The study collected data via interviews from the participants, taking note of their perceptions of how they felt supported in the workplace. Twelve participants with varying occupations were selected and completed the following: a qualifying questionnaire, a workplace attachment questionnaire (Self-Reliance Inventory), and a personal semistructured, open audio interview with the researcher. Data was analyzed using the Braun & Clarke 6 Step Thematic Analysis Approach. As a result of the analysis, five themes emerged: Workplace, Work, Agency, Job & Organization;Management;Colleagues & Coworkers;Support & Commitment;and COVID-19. There is a research gap on this topic in workplace studies and employee attachment. By conducting this study, future researchers would be able to build upon this research to continue improving relationships in the workplace. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

A Saliva-Based Serological and Behavioral Analysis of SARS-CoV-2 Antibody Prevalence in Howard County, Maryland.

The objective of the study was to estimate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence in the Howard County, Maryland, general population and demographic subpopulations attributable to natural infection or coronavirus disease 2019 (COVID-19) vaccination and to identify self-reported social behaviors that may affect the likelihood of recent or past SARS-CoV-2 infection. A cross-sectional, saliva-based serological study of 2,880 residents of Howard County, Maryland, was carried out from July through September 2021. Natural SARS-CoV-2 infection prevalence was estimated by inferring infections among individuals according to anti-nucleocapsid immunoglobin G levels and calculating averages weighted by sample proportions of various demographics. Antibody levels between BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) recipients were compared. Antibody decay rate was calculated by fitting exponential decay curves to cross-sectional indirect immunoassay data. Regression analysis was carried out to identify demographic factors, social behaviors, and attitudes that may be linked to an increased likelihood of natural infection. The estimated overall prevalence of natural infection in Howard County, Maryland, was 11.9% (95% confidence interval, 9.2% to 15.1%), compared with 7% reported COVID-19 cases. Antibody prevalence indicating natural infection was highest among Hispanic and non-Hispanic Black participants and lowest among non-Hispanic White and non-Hispanic Asian participants. Participants from census tracts with lower average household income also had higher natural infection rates. After accounting for multiple comparisons and correlations between participants, none of the behavior or attitude factors had significant effects on natural infection. At the same time, recipients of the mRNA-1273 vaccine had higher antibody levels than those of BNT162b2 vaccine recipients. Older study participants had overall lower antibody levels compared with younger study participants. The true prevalence of SARS-CoV-2 infection is higher than the number of reported COVID-19 cases in Howard County, Maryland. A disproportionate impact of infection-induced SARS-CoV-2 positivity was observed across different ethnic/racial subpopulations and incomes, and differences in antibody levels across different demographics were identified. Taken together, this information may inform public health policy to protect vulnerable populations. IMPORTANCE We employed a highly innovative noninvasive multiplex oral fluid SARS-CoV-2 IgG assay to ascertain our seroprevalence estimates. This laboratory-developed test has been applied in NCI's SeroNet consortium, possesses high sensitivity and specificity according to FDA Emergency Use Authorization guidelines, correlates strongly with SARS-CoV-2 neutralizing antibody responses, and is Clinical Laboratory Improvement Amendments-approved by the Johns Hopkins Hospital Department of Pathology. It represents a broadly scalable public health tool to improve understanding of recent and past SARS-CoV-2 exposure and infection without drawing any blood. To our knowledge, this is the first application of a high-performance salivary SARS-CoV-2 IgG assay to estimate population-level seroprevalence, including identifying COVID-19 disparities. We also are the first to report differences in SARS-CoV-2 IgG responses by COVID-19 vaccine manufacturers (BNT162b2 [Pfizer-BioNTech] and mRNA-1273 [Moderna]). Our findings demonstrate remarkable consistency with those of blood-based SARS-CoV-2 IgG assays in terms of differences in the magnitude of SARS-CoV-2 IgG responses between COVID-19 vaccines.

At last, a silver lining

Medical Director, International Patient Services Program, Co-Director, Pediatric Travel Medicine Clinic, Director, International Adoptee Clinic, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois contributing editors Bernard A. Cohen, MD Section Editor for Dermcase, Professor of Pediatrics and Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland Jon Matthew Farber, MD Section Editor for Journal Club, pediatrician, ALL Pediatrics, Woodbridge, Virginia Carlton K.K. Lee, PharmD.MPH, FASHP.FPPAG Section Editor for The Clinical Pharmacologist's Notebook, Pediatric Clinical Pharmacy Specialist, Department of Pharmacy, and Associate Professor, Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, Maryland MinaL.Alfieri.MD, MS nstructor of Pediatrics, Feinberg Schoo of Medicine, Northwestern University Attending Physician, Academic General Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois AminJ. MSCE Assistant Professor of Pediatrics, George Washington University School of Medicine and Health Sciences;Pediatric Infectious Diseases Attending, Director, Antimicrobial Stewardship Program, Associate Fellowship Program Director, Children's National Hospital, Washington, DC Michael S. Jellinek, MD Professor of Psychiatry and of Pediatrics, Harvard Medical School, Boston, Massachusetts Candice Jones, MD Board-certified general pediatrician in group practice in Orlando, Florida, former National Health Service Corps Scholar, AAP member, spokesperson and author Andrew J. Schuman, MD Clinical Assistant Professor of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire Steven M. Selbst, MD Professor of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, Attending Physician, Pediatric Emergency Medicine, Nemours/Alfred I duPont Hospital for Children, Wilmington, Delaware As 2021 gets underway and an increasing number of coronavirus disease 2019 (COVID-19) vaccines are administered, I believe that 2021 will be much more of a "normal" year, especially with the hope of COVID-19 vaccine availability for children by fall 2021. Issues discussed include illnesses more prevalent in children of color, such as asthma, sickle cell disease, and COVID-19;the difference in pain managementfor White children versus children of color;and how bias impacts mental health issues in children of color.

SARS-CoV-2 SEROPREVALENCE AMONG PEOPLE WHO INJECT DRUGS IN BALTIMORE

Background: People who inject drugs (PWID) may be at a greater risk of SARS-CoV-2 infection and COVID-19 due to socio-structural inequities, high-risk behaviors and comorbidities;however, PWID have been underrepresented in case-based surveillance due to lower access to testing. We characterize temporal trends and correlates of SARS-CoV-2 seroprevalence among a community-based sample of current and former PWID. Method(s): A cross-sectional study was conducted among participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study-a community-based cohort of adults with a history of injection drug use in Baltimore, Maryland. Participants' first serum sample collected at routine study visits between December 2020 and July 2022 was assayed for antibodies to the nucleocapsid (N) (past infection) and spike-1 (S) (past infection and/or vaccination) proteins using the MSD V-Plex Panel 2 IgG SARS-CoV-2 assay. For each correlate, we estimated adjusted prevalence ratios (PR) via separate Poisson regression models adjusted for calendar time, age, sex and race. Result(s): Of 561 participants, the median age was 59 years (range=28-77), 35% were female, 84% were Black, 36% were living with HIV (97% on ART), and 55% had received >=1 COVID-19 vaccine dose. Overall, anti-N and anti-S prevalence was 26% and 63%, respectively. Prevalence of anti-N increased from 23% to 40% between December 2020-May 2021 and December 2021-July 2022, with greater increases in the prevalence of anti-S from 34% to 86% over the same period (Figure). Being employed (PR=1.53 [95%CI=1.11-2.11]) and never being married (PR=1.40 [0.99-1.99]) were associated with a higher prevalence of anti-N, while female sex (PR=0.75 [0.55-1.02]) and a history of cancer (PR=0.40 [0.17-0.90]) were associated with a lower prevalence of anti-N. Younger age, female sex (PR=0.90 [0.80-1.02]), and homelessness (PR=0.78 [0.60-0.99]) were associated with a lower prevalence of anti-S. Although HIV infection was not associated with anti-N, it was associated with a higher prevalence of anti-S (PR=1.13 [1.02-1.27]). Substance use was not associated with anti-N or anti-S. Conclusion(s): Anti-N and anti-S levels increased over time, suggesting cumulative increases in SARS-CoV-2 incidence of infection and vaccination among PWID;however, disparities in seroprevalence remain. Younger and female PWID and those experiencing homelessness were less likely to be anti-S positive, suggesting programs should aim to improve vaccination coverage in such vulnerable populations.

Cognitive, Motor, & Negative Valence Systems in Neurologic Pasc: A Preliminary Study

Background: Nervous system post-acute sequelae of COVID-19 (NS-PASC) include cognitive and mental health symptoms. To further define these, we applied a Research Domain Criteria (RDoC) approach to examine motor, positive valence (PV) and negative valence (NV) systems, and social processing data in The COVID Mind Study of NS-PASC. Method(s): NS-PASC participants (>3 months after COVID-19) referred from a NeuroCOVID Clinic and non-COVID controls from New Haven, CT and Baltimore, MD completed an RDoC test battery for cognition (language, declarative and working memory, cognitive control, perception), motor, PV, NV, and social processes. To date, 3T MRI with diffusion tensor imaging was performed in 11 NS-PASC to assess white matter integrity (global white matter fractional anisotropy [FA]) as a contributor to alterations identified on the RDoC tests. Analysis of Covariance examined group differences after adjusting for sex, race, ethnicity, age, and years of education. Result(s): 25 NS-PASC participants (age 43.4+/-11.3 yrs, 76% female, 402 days after COVID-19 symptom onset) and 29 controls (age 46.2.6+/-13.1 yrs, 66% female) completed the battery. Controls were more racially diverse and less educated than NS-PASC (43% vs. 12% Black, p=0.005;14.5 vs. 16.1 yrs of education, p< 0.05). Means and statistics for RDoC between NS-PASC and controls are shown in Table. NS-PASC performed worse in language, verbal working and declarative memory, and perception and reported greater cognitive control difficulties (e.g., behavioral inhibition, set shifting) without issues on performance-based metrics (Stroop, Trail Making Test-Part B), and had slower motor function. NS-PASC reported more NV issues including greater symptoms of depression, rumination in response to depressive mood, apathy, childhood trauma, anxiety, and perceived stress. There were no differences in PV and social processing. In a subset of NS-PASC participants who underwent MRI, there was a dynamic range of FA values with a mean of 0.509 (IQR 0.481 - 0.536). Conclusion(s): Our findings extend previous PASC studies characterizing cognitive and mental health alterations, indicating that additional RDoC assessments warrant focus, including alterations in motor and the negative valence system. In future analyses, we will examine white matter integrity as a pathophysiologic contributor to these RDoC systems.

Hiv Viral Load and Time-to-Covid-19 Vaccination among People Who Inject Drugs

Background: Structural barriers to care among people who inject drugs (PWID) raise concerns about disproportionate access to essential services like COVID-19 vaccination. Given the heightened risk of serious complications resulting from SARS-CoV-2 infection, particularly among people living with HIV (PWH) with unsuppressed viral load, its critical to understand the role of HIV care among other factors associated with timely vaccination. We aimed to assess the role of HIV care on COVID-19 vaccination uptake among PWID. Method(s): We included 960 adult PWUD participating in the ALIVE (AIDS Linked to the Intravenous Experience) longitudinal study in Baltimore, Maryland, who were alive and in follow up as of April 2020. We ed COVID-19 vaccination data from electronic medical records linked to participants via the regional health information exchange. We conducted survival analysis to estimate time from broad vaccine eligibility (April 6, 2021) to completion of the COVID-19 vaccination primary series by HIV status (uninfected, virally suppressed PWH [HIV-RNA< 400 copies/mL], unsuppressed PWH [HIV-RNA >400 copies/mL]) and Cox Proportional Hazards regression to adjust for potential confounding by health status and substance use variables. Result(s): Our sample (N=960) was primarily black (77%) and male (65%) with 31% reporting recent injection drug use. Among 265 people living with HIV (PWH) in our sample (27%), 84% were virally suppressed. As of February 22, 2022, 539 (56%) completed the primary series, 131 (14%) received a single dose of mRNA vaccine and 290 (30%) remained unvaccinated. Compared to PWID without HIV, virally suppressed PWH were significantly more likely to complete the primary series (Adjusted Hazard Ratio [AHR]:1.23,95% Confidence Interval [95%CI]:1.07,1.50), while PWH with higher viral loads were less likely (AHR:0.72,95%CI:0.45,1.16). Sensitivity analyses with a subsample restricted to PWH confirmed significant differences in time to vaccination by viral load status (log-rank p-value: 0.016) and modeling with an origin of Dec. 12, 2020, yielded similar adjusted results. Conclusion(s): Among PWID with HIV, viral suppression is associated with quicker vaccination uptake, likely due to HIV care engagement. Alongside interventions targeting social determinants (e.g. low income, homelessness) and substance use behaviors (e.g. active injecting, stimulant use), targeted improvements along the HIV care continuum and other efforts to engage PWID may bolster vaccine uptake. Figure 1. Kaplan-Meier survival curve demonstrating time-to-vaccination (completion of COVID-19 primary series) in weeks by HIV status accounting for viral load (HIV-, HIV+ [VL <= 400 cells/muL], HIV+ [VL > 400 cells/muL]), including results for Log-rank tests for homogeneity among strata (p-value).

Patient Experience After Modifying Visit Delivery During the COVID-19 Pandemic

Prudent federal and state public health policies that include varying degrees of physical and social isolation and distancing have required rapid changes in the usual delivery of patient care.1,2 Among CDC recommendations are the rescheduling of nonurgent care and increased use of alternative approaches to in-person visits.2 The Coronavirus Aid, Relief, and Economic Security Act accelerated expansion and flexibility of telehealth activities.3 Physical and social distancing will likely continue for the foreseeable future and have a negative impact on what is typically a recession-proof health care economy.4 Available Knowledge Little is known about how the COVID-19 pandemic will ultimately affect practice and patient experience. An April 2020 report noted that 97% of physician practices experienced a direct or indirect negative financial impact, as evidenced by a 60% decrease in volume and corresponding 55% decrease in revenue.5 Others have reported a 30% to 70% reduction in independent primary care practice visit volume.6 Recently, a news report cited Department of Commerce data estimating an 18% annualized decline in health care spending based on the first 3 months of 2020.7 Negative financial impacts are likely exacerbated with the expansion of telehealth technology5,6 and purchase of personal protective equipment.5 One health system reported increasing telemedicine visits from 0 to 70,000 visits in a 1-month period, although it did not describe the delivery mode (ie, telephone or video).7 Medical specialties with a track record of delivering virtual care are not exempt from the pandemic's impact, as another recent report suggested that radiology practices will likely experience a 50% to 70% decrease in volume lasting at least 3 to 4 months.8 Rationale Managing immediate pandemic hazards while continuing to provide routine medical and preventive care that fulfills the patient care experience, population health, and per capita cost of care dimensions of the Triple Aim9,10 is challenging. Membership reflects diverse regional demographics and encompasses public (Medicaid, Medicare, Affordable Care Act health insurance exchange plans), private, individual, and charity care lines of business.12 Within KPMAS, medical care is provided by the Mid-Atlantic Permanente Medical Group (MAPMG), an integrated medical practice of more than 1700 physicians that includes more than 50 services and specialties. All face-to-face appointments, including behavioral health care visits, were given the option to convert to video visits as the goal. Because CMS waived guidelines requiring a license to practice in-state, it became possible to provide care to patients outside of DC, Maryland, and Virginia through telephone and video visits.

Kaiser Permanent (Kp) Mid-Atlantic States (Mas) Experience with Covid Related Hospital Admissions in Adult Patients with Myositis

Background. Myositis is a group of rare systemic disease and may be treated with immunosuppressives which increase the risk for poor outcome with the COVID19 pandemic. Patients with this condition may have higher rates of admission to the hospital. Methods. KP is a health insurance plan and provides care to about 800 thousand people (including Medicare and Medicaid population) in Maryland, District of Columbia and Northern Virginia. As part of quality improvements, we randomly looked at 40 patients from our larger cohort with myositis who are diagnosed and followed by a board-certified rheumatologist. We noted hospitalizations and Covid infection from March 1, 2020 to December 31, 2021. Results. Of the 40 patients, 29 (72%) were female and 11 were male. 19 (47%) were Blacks, 18 whites (including 6 Latino), and 3 Asians. Age ranged from 25 to 80 years with a mean age of 59.6 years. 25 (62%) patients had Dermatomyositis, 14 had polymyositis and 1 was IBM. The mean age at diagnosis was 55.9 years (range 23-80 years). 12 (30%) had myositis specific antibodies (4 Jo-1, 4 Mi-2, 1 PL 7, 1 PL 12, 1 PL7 plus PL12, 1 TIF Gamma). 22 (55%) were negative. Six did not have antibody testing. During this time, 11 (27.5%) were admitted to the hospital, 2 patients tested positive for COVID 19. One tested positive in the hospital and was asymptomatic. The other person was admitted for symptomatic COVID 19 infection. Other reasons for admission were cardiac, pulmonary (noncovid 19 related), infections, Gastrointestinal issues (including GI bleeding). One admission was for accidental bleach ingestion, and one for psychiatric admission. Of these 40 patients, 38 (95%) patients have received the COVID vaccinations, one patient refused, and for one person we do not have any record of vaccination. Conclusion. The admission rates to the hospital do appear to be higher for this group of patients with myositis, as is generally postulated. However, the reasons for admission were largely related to reasons other than COVID 19 infection and were related to general medical conditions.

Thermal Comfort Analysis Using System Dynamics Modeling—A Sustainable Scenario Proposition for Low-Income Housing in Brazil

As a riveting example of social housing in Brazil, the Minha Casa Minha Vida program was set in 2009 to diminish the 6-million-home housing deficit by offering affordable dwellings for low-income families. However, recurrent thermal discomfort complaints occur among dwellers, especially in the Baltimore Residential sample in Uberlândia City. To avoid negative effects of energy poverty, such as family budget constraints from the purchase of electric appliances and extra costs from power consumption, a simulation based on system dynamics modeling shows a natural ventilation strategy with a mixed combination of sustainable and energy-efficient materials (tilting window with up to 100% opening, green tempered glass, and expanded polystyrene wall) to observe the internal room temperature variation over time. With a 50% window opening ratio combined with a 3 mm regular glass window and a 12.5 cm rectangular 8-hole brick wall, this scenario presents the highest internal room temperature value held during the entire period. From the worst to the best-case scenario, a substantial reduction in the peak temperature was observed from window size variation, demonstrating that natural ventilation and constructive elements of low complexity and wide availability in the market contribute to the thermal comfort of residential rooms.

The impact of the COVID-19 pandemic on stress, substance use, and teen dating violence among young adult women in Baltimore City

OBJECTIVES/GOALS: Social distancing practices during COVID-19 may impact experience of stress, substance use and violence exposure. This study aims to describe the effect of the COVID-19 stay-at-home orders on stress, substance use, and teen dating violence (TDV) among young women living in Baltimore City. METHODS/STUDY POPULATION: Study participants were recruited from an observational study examining TDV before the COVID-19 pandemic, through snowball sampling, pediatric and adolescent primary care clinics, the pediatric emergency department, and a registry for patients interested in participating in COVID-19 research. Participants were between the ages of 16 and 22, identified as female, and lived in Baltimore, Maryland. They were asked to complete a baseline survey. March 16, 2020 (Maryland governor's stay-at-home order) through June 2022 defined the COVID-19 pandemic period. The survey assessed stress experiences, including isolation, finances, job loss, transportation, school stress, substance use, experiences of violence and adherence to COVID-19 safety measures. We conducted descriptive and bivariate analyses. RESULTS/ANTICIPATED RESULTS: Participants (n=105) had a mean age of 19.4 years (SD 1.73). Preliminary analyses demonstrate that stress associated with isolation, finances, transportation, and school increased during the pandemic compared to pre-pandemic. In addition, the majority of participants who used marijuana, e-cigarettes, and alcohol used about the same amount or more of each substance during the pandemic. For the next steps, we will examine experiences of TDV for young women during the pandemic and examine whether experiences of TDV differ for young women who reported a greater adherence to COVID-19 safety measures compared to participants who adhered less. DISCUSSION/SIGNIFICANCE: Assessing the impact of COVID-19 safety measures on stress, substance use, and TDV is critical to informing and designing future public health interventions. In addition, the information obtained from this study may be used to address the unique challenges faced by disenfranchised populations while curbing the spread of infectious diseases.

Police stress: the role of occupational culture and officer characteristics

PurposeThe purpose of the current study was to augment the police culture and stress literature by empirically examining the impact of features of the internal and external work environment, as well as officer characteristics, on police officer stress.Design/methodology/approachThe current empirical inquiry utilized survey data collected from street-level officers in a mid-sized urban police department in a southern region of the United States (n = 349).FindingsThis study revealed that perceived danger, suspicion of citizens and cynicism toward the public increased police occupational stress, while support from supervisors mitigated it. In addition, Black and Latinx officers reported significantly less stress than their White counterparts.Research limitations/implicationsWhile this study demonstrates that patrol officers' perceptions of the external and internal work environments (and race/ethnicity) matter in terms of occupational stress, it is not without limitations. One limitation related to the generalizability of the findings, as results are gleaned from a single large agency serving a metropolitan jurisdiction in the Southeast. Second, this study focused on cultural attitudes and stress, although exact connections to behaviors are more speculative. Finally, the survey took place prior to the onset of the COVID-19 pandemic and the killing of George Floyd (and others), which radically shook police–community relationships nationwide.Practical implicationsPolice administrators should be cognizant of the importance that views of them have for patrol officer stress levels. Moreover, police trainers and supervisors concerned with occupational stress of their subordinates should work toward altering assignments and socialization patterns so that officers are exposed to a variety of patrol areas, in avoiding prolonged assignments of high social distress.Originality/valueThe study augmented the police culture and stress literature by empirically uncovering the individual-level sources of patrol officers' job-related stress. This study builds off of Paoline and Gau's (2018) research using data collected some 15 years ago by examining a more contemporary, post–Ferguson, context.

An analysis of the perceptions of academic rigor by Prince George's county secondary mathematics teachers and secondary administrators during the COVID-19 crisis

The purpose of this study was to analyze the perceptions of academic rigor by teachers and administrators of secondary mathematics classrooms in Maryland, during a crisis. The identified problem is, during COVID-19 pandemic, school district leadership may not have effectively communicated with employees about rigor application expectations. The problem developed when schools shifted to virtual learning. The following research questions were developed from teachers' and administrators' application of academic rigor during crisis time in Prince George's County. RQ1: Do teachers and administrators have aligned ideas of academic rigor based on their responses and their provided evidence? RQ2: Is there alignment between the teachers and administrators' perceptions of academic rigor during times of crisis, specifically, the COVID-19 pandemic? The research questions called for a basic qualitative study using coding, thematic, and comparison analysis approach to gather the stories of teachers and administrators. The participants were secondary (grades 6-12) teachers and administrators of mathematics in schools. A sample of 3 teachers, 4 administrators, with 2 years (minimum) experience were used. Each participant could compare teaching or monitoring during and before the COVID-19 pandemic. Responses were coded to find patterns regarding the application of rigor during COVID-19. The theory presumed in the study was if district leadership, administrators, and teachers have aligned perceptions of academic rigor in understanding and application, then academic growth can occur for students during crisis times. The results of the study were analyzed to find patterns of understanding between teachers and administrators in mathematics classrooms. The main finding of the study was that the teachers and administrators did not havean aligned perception of academic rigor during the distance learning period. District Superintendents can use this study to address academic rigor during crisis times and establish protocols ensuring that the staff have aligned perceptions of rigor. To address this concern, we had the staff in the district utilize one definition of academic rigor and use one rubric measuring the levels of rigor in classrooms. Once educators follow one rating system, they can calibrate their instructional lenses. For future research, this study can be completed in other subject areas, noting any similar concerns. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

94. Implementing Online Public Deliberations on Minor Consent for Biomedical HIV Prevention Research in Diverse Cities

Purpose: Adolescents/young adults (AYA) from racial/ethnic communities have high rates of HIV but little access to biomedical research, due to complexities around consent. Requirement of parental consent for participation in biomedical research is protective and strongly supported by parents, but in biomedical HIV prevention, minors are less likely to participate in research because of concerns about disclosure. Public deliberation (PD) is a process to obtain community input on complex policy issues, by bringing together AYA and adults, who have an investment in an issue, but with potentially opposing views, to provide education, clarify values, and facilitate discussion, reflection, and recommendations. To inform institutional review boards, institutions, and investigators, PDs were held with the goal of obtaining community perspectives and recommendations on minor consent for biomedical HIV prevention research from communities affected by youth HIV. Due to COVID-19 pandemic restrictions, we used an online format and conducted PDs across four evenings. We then conducted post-deliberation interviews to describe participants' experiences in the online PD. Methods: As part of an IRB approved PD, we conducted semi-structured interviews with youth and adult community members who had participated in the deliberations, held in Tampa and Baltimore. The interviews, which were conducted over Zoom, queried deliberants about their experiences voicing their perspectives, their comfort level, their degree of trust in the deliberation process, and ideas for how to better engage future deliberants. Interviews were audio-recorded, transcribed, and field notes were generated. Data were analyzed using thematic analysis. Results: We interviewed 13 community members: seven from Tampa (African American=3, White=3, Latinax=1;AYA=2) and six from Baltimore (African American=6;AYA=1). Facilitators: Deliberants from both communities indicated that personal connections were important for building consensus and understanding. When other participants shared personal stories and perspectives, deliberants were more receptive to hearing and accepting new ideas and opinions that differed from their own. Challenges: Tampa deliberants reported that they preferred an online deliberation because it helped overcome practical barriers to in-person deliberations, such as access to transportation and long commutes. Baltimore participants indicated they would have preferred in-person interactions to build trust, increase comfort, and augment engagement. Participants from both communities discussed distrust in research due to the historical legacy of racism in research and medicine. Due to this legacy, they reported that distrust influenced their views of minor-self-consent and impacted the deliberation process around building consensus. For example, concerns about coercion of minor human subjects influenced their views on minor consent. Recommendations: Participants recommend that strategies be developed to increase engagement in the virtual space. These strategies include use of (a) breakout sessions to increase comfort with sharing;(b) personal storytelling and reviewing group agreements to increase trust, (c) early polling activities to ensure engagement, (d) and asking adults to provide space for youth to voice their perspectives. Conclusions: While online public deliberation on sensitive topics with a vulnerable population is possible, it is important for researchers to focus on providing a safe environment, to acknowledge historical racism in research, and to use methods to maximally engage participants. Sources of Support: PCORI.

What do patients with asthma want to know? Google Trends insights into U.S. general population interest between 2004 and 2022 can help structure patient education initiatives

Rationale: The aim of this study is to use the research tool Google Trends to analyze U.S. general population interest in asthma. Methods: The research tool Google Trends (trends.google.com) was used to access data sets for the searched term "asthma” between 2004 and 2022 (English language, U.S. location). Data were normalized and adjusted to make comparisons between search terms substantiated. Each data point was divided by the total searches of the geography and time range it represented. Results: Searches for asthma detected have remained stable in terms of volume between 2004 and 2022 apart from a spike during February-May 2020 which corresponded with one of the peaks of the COVID pandemic. Top 5 states for asthma searches in 2022 were Kentucky, Tennessee, Connecticut, Mississippi, Maryland. The list of the top states is dynamic and has changed since 2004.Top search terms in the U.S. in 2022 were: allergy, allergy asthma, asthma and allergy, asthma symptoms, asthma attack. Searches for allergy have consistently been present in the top 5 terms when patients searched for asthma during the last 18 years, between 2004 and 2022. Conclusions: Asthma-related Google searches reveal topics of high interest that could supplement the understanding about general population interest. Searches for allergy have consistently been present in the top 5 terms when patients searched for asthma during the last 18 years, emphasizing the role of allergists/immunologists in asthma care. Knowledge of variability in search patterns and specific topics could help allergy organizations and practicing allergists focus their educational programs towards patients' interests.