Establishment of an infrastructure for rapid pandemic response at the Frederick National Laboratory

The sudden onset of the 2019 SARS-CoV-2 pandemic required agile development of standards and efficient validation of assays to assess prevalence of infection as well as immune responses to infection and vaccination. Leveraging their experience in HPV serology and standards, the Vaccine, Immunity and Cancer Directorate (VICD) at the Frederick National Laboratory for Cancer Research (FNCLR) pivoted to address this unmet need in SARS-Co-V2 serology clinical testing and research. This standardization effort required the collection and processing of large volumes of blood from SARS-Co-V2 infected and uninfected individuals into serum and peripheral blood mononuclear cells (PBMCs). Collaborations with specimen collection sites across the United States were established. Following qualification for anti-SARS-CoV-2 IgG and IgM levels in independent laboratories, VICD assembled reference evaluation panels, which were used to assist the FDA's performance evaluation of commercial assays submitted for EUA approval. To date, 185 different shipments of the standard or validation panel have been sent to both domestic and international labs. These materials are also available to the SARS-CoV-2 serology community for assay calibration and performance evaluation which greatly facilitates assay data harmonization. In addition, the NCI Serological Sciences Network (SeroNet) was born from this initiative and expertise, resulting in the establishment of Capacity Building Centers (CBCs) for sample collection from different healthy, cancer and immunocompromised cohorts at Mount Sinai, Arizona State University, the University of Minnesota, and Northwell Feinstein. The NCI and FNLCR simultaneously collaborated to develop a network of investigators focused on advancing research on the immune response to SARS-CoV-2 infection and vaccination among diverse and vulnerable populations, including cancer patients. Their research has resulted in over 326 peer-reviewed publications. The CBC's have enrolled patients in longitudinal studies, resulting in a centralized collection of annotated, well characterized serum, PBMCs and clinical data. Numerous cancer cohorts, but predominantly Multiple Myeloma, are included. Furthermore, technology development was supported at the CBC's. Based upon this success, the VICD in collaboration with NCI is pursuing an even more innovative effort in pandemic preparedness to establish a Center for Serology and Data Emergency Preparedness (CESDEP);a global network able to activate and pivot to address pandemic-level threats, while continuing to expand the development of immunological assays that can inform clinical decisions for cancer and other immunocompromised patients.

Reaching Rural Students with Resources and Enrichment-Focused Learning in the Summer Months

Each student selected books during the last week of school and during the last days of the summer program, so that they had access to books when school was not in session. Since book ownership is an important motivator for reading, the students kept their books and were treated to one additional book on the last day of the program, when they took a field trip to a bookstore. Study Design Reallocating school resources required a research focus with data collection and analysis for continued approval of summer program funding. The mixed-methods design of the study included quantitative data (e.g., registration, attendance, STAR reading scores, Likert scale questions on student and parent questionnaires) and qualitative data (e.g., student focus groups, open-ended questions on student and parent questionnaires). Parents' written consent and students' assent were provided for STAR reading, focus group, and questionnaire data collection each summer.

SeroNet Pooling Project of immunocompromised populations

Introduction: COVID-19 vaccination substantially reduces morbidity and mortality associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe illness. However, despite effective COVID-19 vaccines many questions remain about the efficacy of vaccines and the durability and robustness of immune responses, especially in immunocompromised persons. The NCI-funded Serological Sciences Network (SeroNet) is a coordinated effort including 11 sites to advance research on the immune response to SARS-CoV-2 infection and COVID-19 vaccination among diverse and vulnerable populations. The goals of the Pooling Project are: (1) to conduct real-world data (RWD) analyses using electronic medical records (EMR) data from four health care systems (Kaiser Permanente Northern California, Northwell Health, Veterans Affairs-Case Western, and Cedars-Sinai) to determine vaccine effectiveness in (a) cancer patients;(b) autoimmune diseases and (c) solid organ transplant recipients (SOTR);(2) to conduct meta-analyses of prospective cohort studies from eight SeroNet institutions (Cedars-Sinai, Johns Hopkins, Northwell Health, Emory University, University of Minnesota, Mount Sinai, Yale University) to determine post-vaccine immune responses in (a) lung cancer patients;(b) hematologic cancers/hematopoietic stem cell transplant (HSCT) recipients;(c) SOTR;(d) lupus. Method(s): For our RWD analyses, data is extracted from EMR using standardized algorithms using ICD-10 codes to identify immunocompromised persons (hematologic and solid organ malignancy;SOTR;autoimmune disease, including inflammatory bowel disease, rheumatoid arthritis, and SLE). We use common case definitions to extract data on demographic, laboratory values, clinical co morbidity, COVID-19 vaccination, SARS-CoV-2 infection and severe COVID-19, and diseasespecific variables. In addition, we pool individual-level data from prospective cohorts enrolling patients with cancer and other immunosuppressed conditions from across network. Surveys and biospecimens from serology and immune profiling are collected at pre-specified timepoints across longitudinal cohorts. Result(s): Currently, we have EMR data extracted from 4 health systems including >715,000 cancer patients, >9,500 SOTR and >180,000 with autoimmune conditions. Prospective cohorts across the network have longitudinal data on >450 patients with lung cancer, >1,200 patients with hematologic malignancies, >400 SOTR and >400 patients with lupus. We will report results examining vaccine effectiveness for prevention of SARS-CoV-2 infection, severe COVID-19 and post-acute sequelae of COVID-19 (PAS-C or long COVID) in cancer patients compared to other immunocompromised conditions. Conclusion(s): Our goal is to inform public health guidelines on COVID-19 vaccine and boosters to reduce SARS-CoV-2 infection and severe illness in immunocompromised populations.

Food Bank Led Federal Food Disbursement and Pantry Sourced Food Quality Over Time During COVID-19 Pandemic in Minnesota

Federally funded Emergency Food Assistance Program (TEFAP) aims to improve nutrition equity through hunger relief setting. However, little is known about TEFAP disbursement method (choice, modified choice, and no choice) to pantries or the quality received by pantries. Food inventory data from 239 pantries in 2020 were used to assess the association between TEFAP quality and type of disbursement methods longitudinally. While no significant differences were observed in quality across disbursement types and months. Our study suggests there are tradeoffs across different methods. TEFAP for the most part is a healthy food source that should be maximized by food pantries.Copyright © 2023 Taylor & Francis Group, LLC.

No Single Path: Review of Amy Sullivan's Opioid Reckoning

According to this framework, the pandemic is a two-part problem: one part virus, one part social resistance to the cure for the disease. [...]we hear that medical scientists have developed "gold standard" treatments for addiction, but that for reasons of bureaucratic lethargy, public skepticism, or sheer hopelessness among those suffering from addiction, the treatments are not adequately made available and sought out. The stories in the book are drawn from oral-history interviews that the author conducted with family members of people with addictions, doctors, community organizers, and treatment-center directors over a period of four years. Chapter Two reconstructs the life of a single man from the memories of his surviving family members, from the moment of his first exposure to opioids through fourteen separate rounds of addiction treatment and up to the moment of his fatal fentanyl overdose.

Cryopreservation for Allogeneic Hematopoetic Stem Cell Transplants Is Non-Inferior to Fresh Graft Products

Background: The use of cryopreservation for stem cell grafts for both autologous stem cell and allogeneic cord blood transplant has been utilized for years. For other allogeneic stem cell transplant sources, the use of fresh collected grafts has been preferred due to concerns that cryopreservation may result in impaired graft function. With the onset of the COVID-19 pandemic a shift was made at our institution to exclusive use of cryopreservation Methods: In this retrospective single-center analysis a total of 133 patients undergoing allogeneic stem cell transplant at the University of Minnesota between 1/2018-6/2021 for a variety of malignancies were included, with 62 patients receiving fresh stem cell product and 71 patients receiving frozen stem cell product. Univariate statistical analysis was performed. Result(s): There was no significant difference between the two groups with regards to product type, sex, age, diagnosis (acute leukemia vs other), disease risk index, conditioning regimen, Karnofsky score, co-morbidity index, or cell dose (Table 1). Donor type was notably different between the two groups (p<0.01): matched sibling grafts were more commonly used for fresh products than frozen (85% vs. 35%), while matched unrelated donors were used more frequently for frozen than for fresh products (54% vs. 6%). Use of frozen product was associated with delayed neutrophil and platelet engraftment compared to fresh (median days to engraftment 15 vs 12 for neutrophils, 23 vs 17 for platelets, p<0.01 for both). Two-year relapse rates were significantly lower for frozen products (4%) than fresh (24%) (Table 2). This may be partially attributable to differences in follow up between the groups, as fresh products had a total of 910 days of follow up vs 432 for frozen products (P<0.0001). The difference in follow up remained statistically significant if the data was censored at 730 days (P<0.0001). Of note, the use of frozen products was associated with a lower rate of chronic graft-versus-host disease at one year post-transplant (p<0.01). There was no significant difference in the rates of acute GVHD between the groups. There were significant differences in GVHD prophylaxis regimens between the fresh and frozen groups (p<0.01). (Figure Presented)Two-year overall survival did not differ between groups (p=0.96). Conclusion(s): Use of cryopreserved stem cell products is associated with similar efficacy and outcomes as those seen with the use of fresh stem cell products. Although the data presented here suggest novel finding of decreased risk of relapse and chronic GVHD with the use of frozen stem cell products, additional follow up may abrogate these differences. Regardless, the logistical benefits of cryopreservation make this an attractive option for continued use in allogeneic transplants and our data presented here suggests that cryopreserved products remain an appropriate option for allogeneic stem cell transplant.Copyright © 2023 American Society for Transplantation and Cellular Therapy

Implementation of the Modified Minnesota Detoxification Scale in acute alcohol withdrawal patients in the intensive care unit

Background: Acute Alcohol Withdrawal Syndrome (AWS) is a severe disorder that affects many patients admitted to the Intensive Care Unit (ICU). Current treatments include the use of benzodiazepines and the Critical Institute Withdrawal Assessment tool (CIWA-Ar). Improper use of this assessment tool can lead to inappropriate dosing of medications leading to adverse patient outcomes. In recent years, a newer and more effective assessment tool has emerged. The Modified Minnesota Detoxification Scale (mMINDS) has shown a significant decrease in the usage of benzodiazepines and the incidence of respiratory distress, delirium, and decreased length of stay (LOS) in the ICU for AWS patients. Methods: The Promoting Action Research Implementation in Health Service (PARiHS) conception model and the Donabedian model for evaluation of health care were used to support the development and implementation of the intervention. After receiving education on the mMINDS assessment tool, nurses assessed AWS patients over one month and tracked their LOS in the ICU. This measurement was compared to the ICU length of stay for AWS patients treated with the CIWA-Ar assessment tool.Intervention: Nurses assessed patients suffering from acute alcohol withdrawal using the mMINDS assessment tool. Pre- and post-intervention data was collected on the length of stay in the ICU for each patient. Simple statistical analysis compared the LOS in the ICU between the pre- and post-intervention groups. Results: Patients who were assessed with the mMINDS alcohol withdrawal assessment tool had a decreased LOS in the ICU by 12 hours or 0.5 days. However, the pre- and post-implementation data was analyzed using a paired sample t-test. The results from the mMINDS assessment tool were not statistically significant for a LOS in the ICU for patients with AWS. Conclusion: Patients assessed with mMINDS had a decreased LOS in the ICU. However, there were multiple limitations for this project, such as an implementation on one unit in one facility, a small sample size, limited implementation period, the COVID-19 pandemic, and the opening of a new inpatient treatment facility. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Social fish-tancing in Wisconsin: the effects of the COVID-19 pandemic on statewide license sales and fishing effort in northern inland lakes

The first year of the COVID-19 pandemic in 2020 was associated with an "anthropause" in many industries, initially reducing greenhouse gas emissions and other negative anthropogenic influences. However, outdoor recreation has exploded in popularity in response to closures of indoor recreation options, increased free time, and/or increased levels of stress. We tested for the effects of the COVID-19 pandemic on the sale of fishing licenses in Wisconsin and on vehicle counts that were observed at public lake access points in Vilas County, Wisconsin, in 2020. In the summer of 2020, fishing license sales in Wisconsin, USA, increased, particularly among first-time license purchasers for whom cumulative sales in 2020 increased by 71% and 35% compared with the previous 5-year average for Wisconsin residents and nonresidents, respectively. Changes in the vehicle counts at lake access points in the summer of 2020 varied considerably by lake. However, lakes with greater proportions of public shoreline experienced pandemic-associated increases in lake visitors. Our results suggest that the distribution of recreational fishing effort in Wisconsin changed during the pandemic, potentially placing additional harvest pressures on hot spot inland lakes.

Developing, Implementing, and Evaluating a Quality Assurance/Quality Improvement Program to Peer Review Point-of-Care Ultrasound Images for Flight Clinicians

Introduction: The use of point of care ultrasound (POCUS) in the prehospital setting is well established (Air Medical Journal, 2018) and is an essential tool in critical care (Amaral et al., 2020). There are no universal guidelines that dictate the use of prehospital ultrasound, indications for use, education and credentialing requirements, quality assurance, or improvement (Amaral et al., 2020). Lack of timely US feedback can impact patient care by incorrect interpretation of images based on practice errors. Method(s): The proposed solution was to implement a robust QA/QI program consisting of a selected nurse or paramedic, that aligned with a regional manager, for a total of 6 individuals that received advanced training and education to perform peer reviews on POCUS images in a consistent and timely manner. Life Link III's education department designed online modules to peer review US images. This QI project utilized the conceptual framework of the Dreyfus Skill Acquisition Model modified by Patricia Benner and the Plan-Do-Study-Act cycle for implementation. The QI project was implemented at a nonprofit air medical service located in Minnesota. A pretest-posttest design and post-project survey were utilized. Challenges encountered during this project included the Covid19 pandemic creating delay in education/training program development and the inability to meet in person due to concerns of transmission with in-person exposure. Result(s): The results were analyzed using a paired t-test to assess for statistical improvement in identifying better quality image acquisition, an increase in accurate image interpretation, and a decrease in image review from submission. The results of the Wilcoxon test were significant based on an alpha value of 0.05 and a p-value of 0.38. This indicated that the differences between the pre-self-assessment survey and post-self-assessment survey were not likely due to random variation. The median of the pre-self-assessment survey was 6.8 with a standard deviation of 1.643 and was significantly lower than the median of a post-self-assessment survey of 10.40 with a standard deviation of 1.342, indicating there was significant learning of ultrasound reviewer responsibilities and expectations, the peer review process, peer reviewer leadership, communication, and feedback skills, and how to use the QA/QI peer review worksheet. Conclusion(s): With the establishment of the core group of peers trained to review POCUS images, there has been better quality image acquisition, an increase in accurate image interpretation, and less time from image submission to image review.Copyright © 2022

Implementing a Home-Based Cardiac Rehabilitation Programme for People with Heart Failure and Their Caregivers: Findings from the Scot: Reach-Hf Study

Background Despite robust evidence and national guidance recommending cardiac rehabilitation (CR) for heart failure (HF), access remains poor, a situation magnified by COVID- 19. The Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) randomised controlled trial demonstrated the clinical and cost-effectiveness of a novel home-based CR selfmanagement programme. The SCOT:REACH-HF study was designed to provide the understanding of real-world implementation needed for NHS-wide roll-out in a Scottish context. Aim To 1) compare outcome improvements and delivery costs with those identified in the RCT;and 2) identify facilitators of and barriers to real-world implementation. Methods A mixed-method implementation study of REACHHF delivery across six NHS Scotland areas in 2021-22. Health professionals were trained to facilitate delivery of the 12-week programme. We assessed patient- and caregiverreported outcomes (including health-related quality of life, psychological wellbeing) pre-and post-REACH-HF participation. Primary Outcome: Minnesota Living with Heart Failure Questionnaire (MLHF). 136 adults with reduced ejection fraction HF (HFrEF) were recruited, and 101 completed follow-up. 54 participants nominated caregivers, 26 of whom completed follow- up. Qualitative interviews with 20 key health professionals (primarily REACH-HF facilitators) were subject to thematic analysis to explore barriers to and facilitators of implementation. Fidelity, contextual, and economic data were also collected. Results REACH-HF participation resulted in significant gains in health-related quality of life, as assessed by the MLHF, PROM-CR+, and EQ-5D-5L, and Self-Care of Heart Failure Index (SCHFI). MLHF improvements were both statistically significant and met the minimum clinically important difference in 63% of participants (see figure 1). Interviewees were largely positive about REACH-HF - considering it to have 'filled a gap' when no other CR was available - and key issues to support future roll-out were identified. Conclusion Our findings support the scaled roll-out of REACH-HF. This would offer people with HFrEF, and their families and friends, an accessible alternative to centre-based CR. (Figure Presented).

A study on the relationship between sociodemographic characteristics and job stress and satisfaction among healthcare workers in Turkey during the COVID-19 pandemic.

The aim of this study was to determine the sociodemographic characteristics that affect job stress and job satisfaction in 454 healthcare workers (physicians, nurses, midwives, technicians, and other healthcare personnel) working with COVID-19 patients in primary healthcare institutions in Turkey with a cross-sectional, web-based survey between 9 and 30 August 2021. The survey included a personal information form, a standard job stress scale, and the Minnesota Satisfaction Questionnaire. The levels of job stress and job satisfaction did not differ between male and female respondents. Singles reported lower job stress and higher job satisfaction than the married respondents. Job stress did not differ between departments, but respondents on the front line who worked in a COVID-19 intensive care unit (ICU) (at any point and/or at the time of the study) or the emergency department reported lower job satisfaction than those working in other departments. Similarly, while stress did not differ by educational status, satisfaction of respondents with bachelor's or master's degree was lower than that of the rest. Our findings also suggest that working in a COVID-19 ICU and age are significant predictors of higher stress, whereas lower education, working in a COVID-19 ICU, and being married are good predictors of lower satisfaction. Further research should include other sociodemographic variables that may affect stress and satisfaction at work, and similar studies should follow up to see what was left in the wake of the pandemic.

Imperfect and Flexible: Using Trauma-Informed Practice to Guide Instruction

The rapid shift to online courses at the University of Minnesota Twin Cities (UMN) in spring 2020 prompted a change in the way instruction librarians worked with faculty and students. The librarians adopted a trauma-informed approach that provided students with a sense of stability, agency, and connection to the university and one another. UMN librarians increased the variety and number of online library workshops, reused content in new ways for online orientation and instruction, and created a choose-your-own-adventure e-book for first-year courses. After a chaos filled year, the authors share their plans, progress, successes, failures, and hopes for the future.

Virtual Professional Learning Communities: A Case Study in Rural Music Teacher Professional Development

The purpose of this study was to explore how a Virtual Professional Learning Community (VPLC) might serve as effective professional development for large ensemble teachers in rural communities interested in improving their pedagogy. We used a case study approach to investigate four rural music teachers who actively participated in an online professional learning community focused on implementing the "Comprehensive Musicianship through Performance" model of planning and instruction into one of their large ensemble classes. Based on our findings, we concluded that a VPLC provided rural music teachers with meaningful, content-specific professional development while also reducing feelings of professional isolation. However, we also identified challenges that impacted the effectiveness of the VPLC. The implications for music teacher educators are discussed.

Crossing the Digital Divide and the Equity Expanse: Reaching and Teaching All Students during the Pandemic

The COVID-19 pandemic illuminated the digital divide revealing an expanse of inequity among students who had access to the internet, personal devices, and parental support during remote learning and those who did not. Framed with the theoretical lens of equity literacy, this paper details the results of a survey completed by 56 Minnesota district level technology directors. The survey asked how school districts were addressing the technology inequities experienced by students and families while in hybrid and distance learning models. Results reflected that districts' efforts to provide students technology devices were efficient and successful. Of greatest concern for respondents was the lack of students' attendance and engagement in learning. Recommendations for further research are provided including advocacy for the expansion of broadband service, the pandemic's impact on the mental health of students, and efforts to sustain access to technology for all learners after the COVID-19 pandemic concludes.

Technical Practices Used by Information Literacy and Media Information Literacy Services to Enable Academic Libraries to Handle the COVID-19 Pandemic

This study analyses the techniques and procedures that were developed and the changes that took place in the National Autonomous University of Mexico (UNAM) and the Autonomous University of Puebla (BUAP), both in Mexico, and the University of Minnesota Duluth (UMD), in the United States of America. To face the crisis of the COVID-19 pandemic, librarians in these institutions improved their Information Literacy (IL) and Media Information Literacy (MIL) programmes. Design/methodology/approach: This study has a mixed methodology with a comparative analysis. For this purpose, data shows the universities' contexts: the communities of students, teachers, researchers, and librarians, and the e-learning strategies of IL and MIL programmes. Findings: As part of the results of the crowdsourcing collaboration between the UMD, UNAM and BUAP, the study shows the different online learning communities and their innovations. Originality: Although there is theoretical knowledge about IL and MIL in Mexican universities and University of Minnesota Duluth, the e-learning strategies used by their librarians in this document sought to provide technical solutions and other options for a virtual work scheme that responded to the specific problems presented by COVID-19. In this case, the framework for creating online library services was designed by their librarians for their communities in the context of the current crisis, even when online services had already been established for more than ten years. Research limitations/implications: The technological infrastructure, the professionalisation of the library staff and a lack of knowledge of the new virtual teaching-learning needs. Practical implications: Analysis of tools for virtual teaching-learning services, description of strategies used by library staff, results and feedback. Social implications: IL and MIL strategies created in a variety of contexts can be enhanced by library collaboration in a fully virtual setting. Libraries with better technological infrastructure play a decisive role.

Spectrum of Disease in Children Infected with SARS-CoV-2

Background. The COVID-19 pandemic is affecting children worldwide. Although pediatric infections are usually mild, children are at risk for complicated disease. It is imperative that we collect key data of children with COVID-19 to expand understanding of the epidemiology and pathophysiology of this disease. The objective of this research was to describe the demographic and range of pathology in children infected with SARS-CoV-2. Methods. Pediatric COVID care at the University of Minnesota is coordinated through a multidisciplinary team that also contributes to a national registry for children infected with SARS-CoV-2. Utilizing these mechanisms, we identified children infected with SARS-CoV-2 including those presenting to our health system to create a COVID-19 cohort. Inclusion criterion was confirmed SARS-CoV-2 infection, and exclusion criterion was opt-out of research on general consent form. Following IRB approved protocol, we collected demographic data and clinical information on those with symptomatic disease following SARS-CoV-2 infection. Results. As of February 2022, we reported 7440 children with SARS-CoV-2 to the national registry. We identified a cohort of 163 children with new onset disease or exacerbation of existing illnesses in association with COVID-19. The majority (110) experienced mild-to- moderate acute COVID-19, while 10 had severe COVID-19 pneumonia. Multisystem Inflammatory Syndrome in Children (MIS-C) was diagnosed and successfully treated in 34 children. Inflammatory diseases and invasive infections developed in 40 children. Long COVID was diagnosed in 42 children with lingering symptoms affecting daily function at least 3 months following infection. Conclusion. This cohort includes children across clinical settings and can be regarded as a representation of COVID-related illness. Of those with symptomatic illness, acute illness is most common, usually mild-to-moderate with 6% developing severe pneumonia. Long COVID syndrome is also commonly seen in children. 24% of children infected with the virus present with inflammatory and immune-mediated illnesses suggesting the role of SARS-CoV-2 in triggering immune dysregulation pathologies. The overall spectrum of pediatric COVID-19 infection suggests a multiphase, immune-mediated contagion.

PNEUMOMEDIASTINUM AND PNEUMOTHORAX IN COVID-19 PNEUMONIA: A MATCHED CASE-CONTROL STUDY

SESSION TITLE: COVID-19 Infections: Issues During and After Hospitalization SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm PURPOSE: Pneumothorax and pneumomediastinum (PTX/PM) has been associated with patients hospitalized with COVID-19 infections. The aim of our study was to assess the risk factors, hospital length of stay, and mortality of PTX/PM among hospitalized patients with COVID-19 infection in a matched case-controlled study. METHODS: Adult patients with confirmed COVID-19 infections who were hospitalized at 5 Mayo Clinic hospitals (Minnesota, Arizona, Florida, Wisconsin) between March 2020 and January 2022 were retrospectively screened. PTX and or PM in at least two consecutive imaging studies were included. They were matched to control patients based on age, gender, hospital admission period, severity on admission day and the day preceding the incident. Summary statistics, Mann Whitney-U, and chi-square tests were performed RESULTS: A total of 197 patients were included in the descriptive analyses.The median age was 61 years and the majority were men (70.8%). Patients with underlying pulmonary comorbidities was 2.27 (OR 1.42-3.62, p value < 0.001) times more likely to develop PTX/PM. Ten percent of the total cases had these complications present upon hospital admission.Patients who developed PTX/PM had a longer hospital length of stay compared to controls, 20 versus 12 days, OR 4.53 (p=0.002). On the day prior to developing PTX/PM, 42 (31%) of patients had been on high-flow nasal cannula only and 14 on non-invasive ventilation (10.4%). The highest recorded positive end-expiratory pressure, plateau, and driving pressures were recorded in our case group on the day before the complication and all were significantly higher than matched controls. In-hospital mortality in patients whose COVID-19 course was complicated by PTX/PM was 44.2% vs. those without, 21.1%, adjusted OR 2.71 (p=0.001). Sixty two percent were treated conservatively without any intervention. CONCLUSIONS: We have demonstrated in the largest study to date, that patients who were hospitalized with COVID-19 infection and had a PTX/PM had a longer hospital length of stay, were associated with higher mechanical ventilatory pressures, and had a higher in-hospital mortality, when compared with matched controls. CLINICAL IMPLICATIONS: Complications of PTX/PM in patients with COVID-19 infections can occur spontaneously and in barotrauma. Pre-existing lung disease is a risk factor for the development of these complications. Patients with PTX/PM have a longer hospital length of stay and higher in-hospital mortality which is in contrast with existing published data. DISCLOSURES: No relevant relationships by Natalya Azadeh No relevant relationships by Meghan Brown No relevant relationships by Rodrigo Cartin-Ceba No relevant relationships by Anusha Devarajan No relevant relationships by Juan Pablo Domecq No relevant relationships by Sandeep Khosa No relevant relationships by Amos Lal No relevant relationships by Shahraz Qamar No relevant relationships by Kenneth Sakata No relevant relationships by Mayank Sharma No relevant relationships by Nikhil Sharma No relevant relationships by Jamil Taji No relevant relationships by Fahimeh Talaei No relevant relationships by Aysun Tekin No relevant relationships by Diana Valencia Morales No relevant relationships by Stephanie Welle

SURVEY OF KNOWLEDGE, ATTITUDES, AND BEHAVIORS OF PRIMARY CARE PROVIDERS AND PULMONOLOGISTS CONCERNING INFLUENZA, PNEUMOCOCCAL, AND COVID-19 VACCINATION OF ADULTS

SESSION TITLE: Advances in the Management of Respiratory Infections SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 02:45 pm - 03:45 pm PURPOSE: The factors influencing vaccine uptake are varied and understanding of patient and provider barriers to adult vaccination is limited. Given the importance of provider recommendations for improving uptake, we sought to understand knowledge, attitudes, and behaviors among primary care providers and pulmonologists concerning influenza, pneumococcal, and COVID-19 vaccination regarding their adult patients. METHODS: We conducted a survey using the REDCaps platform of 454 Mayo Clinic physicians and advanced practice providers practicing in community internal medicine, family medicine, geriatrics, and pulmonology practicing in Rochester and southeastern Minnesota. We made 3 contacts over 3 months in Fall 2021. Our survey used questions adapted from a variety of sources. Experts evaluated the survey and made revisions, iteratively changing it before IRB approval. It was tested to ensure the survey was usable and able to be understood by the intended population. Results are described combining percentages of those that “sometimes” or “often” used strategies and barriers described are as “some” or “a lot”. RESULTS: 127/454 (28%) providers responded. Most respondents reported that they specifically counseled their high-risk adults to receive the influenza vaccine (92%), the pneumococcal vaccine (87%), and the COVID-19 vaccine (100%). 64% utilize a state or regional immunization information system (IIS) to assess and record immunization data and many use a written or electronic alert when an adult patient hasn’t received their influenza (79%) or pneumococcal (73%) vaccine. Vaccine reminder-recalls are only sent a third of the time. Common misperceptions among patients reported by health care providers were that the flu vaccine would make them sick (87%), get influenza (66%) or that it was not severe enough to warrant vaccination (74%). Barriers to discussions on influenza were lack of time (47%) and other health issues taking precedence (44%). Providers were asked what strategies they used to encourage influenza vaccination. They often discussed morbidity and mortality (88%), their personal experiences (73%), effectiveness of the vaccine (91%), protection of others close to the patient (94%) and provided a statement they felt it was safer to vaccinate than to not (92%). When asked how effective these strategies were, they produced somewhat effective responses. CONCLUSIONS: Providers reported they are counseling patients on vaccines due most of the time. They readily identify numerous patient-reported concerns. They are not frequently using patient-reminder-recall systems but most use immunization information systems and provider point-of-care prompts. CLINICAL IMPLICATIONS: Despite barriers to extensive discussions of immunizations, providers still frequently discussed vaccinations with patients, utilizing written or electronic alerts, although patient reminders were rarely sent. DISCLOSURES: No relevant relationships by Jamie Felzer No relevant relationships by Robert Jacobson No relevant relationships by Young Juhn No relevant relationships by Cassie Kennedy No relevant relationships by Lila Rutten No relevant relationships by Chung-Il Wi

Biting the Bullet: A Call for Action on Lead-Contaminated Meat in Food Banks

Even though the presence of ammunition-derived metallic lead fragments in donated firearms-hunted meat has been recognized for more than a decade, the vast majority of donated hunted meat is not inspected to discard meat containing lead fragments.1 An underlying lack of food safety standards for adulterated donated food increases risks to lowincome recipients, who are already disproportionately affected by elevated blood lead levels (BLLs).2 Primary prevention is needed for this overlooked source of lead exposure. LOW-LEVEL LEAD Primary prevention is recognized as the most effective way to address the epidemic of lead poisoning in the United States.3 The current blood lead reference level recognized by the Centers for Disease Control and Prevention is 3.5 micrograms per deciliter (mg/dL). A strong body of scientific research demonstrates that leadbased ammunition frequently contaminates hunted meat and increases BLLs of humans and animals who consume it.1,7-9 Lead-contaminated hunted meat has been identified as the most poorly acknowledged and addressed example of food lead contamination, and scientists have called for this source of lead exposure to be acknowledged and addressed with health-protective measures.8,9 A 2013 consensus statement of experts in human, environmental, and wildlife toxicology supports reducing and eventually eliminating the introduction of lead into the environment from lead-based ammunition, emphasizing that shooting lead ammunition into the environment poses significant risks of lead exposure to humans and wildlife.10 In 2016, Arnemo et al. found that more than 99% of 570 scientific articles about environmental and health consequences of lead in ammunition raised concerns about lead toxicity.7 The authors highlighted that nonlead ammunition is as effective as lead-based ammunition and is comparably priced. Despite the well-established scientific basis for regulation of lead ammunition for hunting, the topic has been politicized by misinformation campaigns portraying concerns about ingesting lead ammunition as a product of antihunting agendas.11 Lead Contamination in Donated Hunted Meat Donated hunted meat is a vital source of protein distributed by food banks at a time when food bank use remains far above pre-COVID-19 pandemic levels.12 Published evidence of leadcontaminated meat in food banks has existed for more than a decade (Figure A, available as a supplement to the online version of this article at https://www.ajph.org).13 Investigations in multiple states have confirmed the presence of lead in donated meat.

A Cross-Sectional Prevalence Study of Myopia and High Myopia during COVID-19 Pandemic

Purpose : The COVID-19 pandemic has caused societal, behavioral changes that have resulted in increased near work and less outdoor time. These changes may influence myopia progression. We performed a retrospective, cross-sectional prevalence study on the population base in Olmsted County, Minnesota to determine if there are short-term changes in myopia. Methods : Individuals living in Olmsted County who received ophthalmic care at Mayo Clinic Rochester from 2018 to 2021 were analyzed. Exclusion criteria included 1) visually significant cataract, 2) pseudophakia, 3) prior refractive surgery and 4) Age < 6 years. Manifest refractions were converted to spherical equivalent (SE). Patients with a SE ≤ -0.5 D were classified as myopic while SE ≤ -6.0 D were classified with high myopia. Individual age, sex, visual acuity, and lens prescription data were recorded. An algorithm was designed to estimate prevalence for patients without a manifest refraction utilizing their visual acuity, as was used in the NHANES study . Results : We sampled 11,783 invidiual records (8,413 adults;3,370 children). In adults from 2018 to 2021, the prevalence of myopia was similar at 61% vs 59% (p=0.3887) and high myopia was also similar at 10% vs 9.9% (p=0.5447). In children from 2018 to 2021, the prevalence of both myopia was similar at 21% vs 17% (p=0.2) and high myopia was also similar at 2.6% and 3.8% (p=.37). Conclusions : From 2018 to 2021, we did not find any trends in myopia development over a relatively brief, 4-year window in either pediatric or adult patients living in Olmsted County, Minnesota.