COVID-19 impacts on lung cancer diagnosis, management and timeliness in Victoria, Australia: A population based observational study

Objectives : To describe impact of COVID-19 on lung cancer incidence, stage at diagnosis, treatment utilisation and timeliness of care in Victoria, Australia. Design : Retrospective study using population wide Victorian Cancer Registry data and clinical data from the Victorian Lung Cancer Registry, comparing data pre-COVID (2019 and Q1 of 2020) with the COVID era (April 2020-31/12/2020). Setting and participants : Population wide data on lung cancer diagnoses diagnosed in 2019 and 2020 in Victoria, and 4485 cases with additional clinical data. Result(s): Compared In the COVID-era, 177 fewer males (-12%) and 4 fewer females (-0.3%) were diagnosed with lung cancer. Stage at diagnoses for NSCLC was higher on average in Q2 2020 and was similar to the pre-COVID distribution in Q2 and Q4. No changes were detected in the stage distribution for SCLC. The proportion of patients whose time from referral to diagnosis was >=28 d decreased with increasing volume of referrals but was higher in the COVID era (74.6%) compared with the pre-COVID era (67.5%), not caused by a decrease in volume. The proportion of patients receiving any anti-cancer treatment reduced slightly from 84% in the pre-COVID era to 81% in the COVID era ( p = 0.022). Time from diagnosis to treatment (>=14 d;37.3% of patients on average) was not associated with volume of new diagnoses, nor did change in the COVID-era ( p = 0.13). The proportion of NSCLC patients who received guideline concordance treatment did not differ between pre-COVID (83.1%) and the COVID era (81.7%;p = 0.31).

The legacy of COVID-19 in dementia community support: ongoing impacts on the running of meeting centres

Purpose: The COVID-19 pandemic caused major disruption in community support for vulnerable older people and is thought to have exacerbated existing issues within UK adult social care. This study aims to examine the legacy of that disruption on how meeting centres for people affected by dementia have been impacted in continually evolving circumstances. Design/methodology/approach: Semi-structured interviews and focus group discussions were conducted at three meeting centre case study sites. Ninety-eight participants, including people living with dementia, family carers, staff, volunteers, trustees and external partners, were asked about the impact and legacy of the pandemic upon meeting centres. A thematic analysis was carried out on the data. Findings: Ten themes were identified: ability to re-open venues;increased health decline and loss of members due to isolation;closure or halting of linking services and dementia community support;disruption to diagnosis and referrals;increase in outreach, building communities and overall reach;digital access and use of technology (boom and decline);changes to carer involvement and engagement;continued uncertainty and changes to funding, resources and governance;staff and volunteer recruitment issues;and relief at/wish for return to pre-pandemic norms. Originality/value: This paper offers new insight into a still-developing situation, namely, the legacy effects of the pandemic upon third-sector community support for people affected by dementia and the health and social care services that support it. The reduction in maintenance of pandemic-era technological innovations is a key finding. © 2023, Emerald Publishing Limited.

The Emotional Impact of COVID-19 News Reporting: A Longitudinal Study Using Natural Language Processing

The emotional impact of the COVID-19 pandemic and ensuing social restrictions has been profound, with widespread negative effects on mental health. We made use of the natural language processing and large-scale Twitter data to explore this in depth, identifying emotions in COVID-19 news content and user reactions to it, and how these evolved over the course of the pandemic. We focused on major UK news channels, constructing a dataset of COVID-related news tweets (tweets from news organisations) and user comments made in response to these, covering Jan 2020 to April 2021. Natural language processing was used to analyse topics and levels of anger, joy, optimism, and sadness. Overall, sadness was the most prevalent emotion in the news tweets, but this was seen to decline over the timeframe under study. In contrast, amongst user tweets, anger was the overall most prevalent emotion. Time epochs were defined according to the time course of the UK social restrictions, and some interesting effects emerged regarding these. Further, correlation analysis revealed significant positive correlations between the emotions in the news tweets and the emotions expressed amongst the user tweets made in response, across all channels studied. Results provide unique insight onto how the dominant emotions present in UK news and user tweets evolved as the pandemic unfolded. Correspondence between news and user tweet emotional content highlights the potential emotional effect of online news on users and points to strategies to combat the negative mental health impact of the pandemic. © 2023 Simon L. Evans et al.

Child, parent, and family mental health and functioning in Australia during COVID-19: comparison to pre-pandemic data.

The COVID-19 pandemic presents significant risks to population mental health. Despite evidence of detrimental effects for adults, there has been limited examination of the impact of COVID-19 on parents and children specifically. We aim to examine patterns of parent and child (0-18 years) mental health, parent substance use, couple conflict, parenting practices, and family functioning during COVID-19, compared to pre-pandemic data, and to identify families most at risk of poor outcomes according to pre-existing demographic and individual factors, and COVID-19 stressors. Participants were Australian mothers (81%) and fathers aged 18 years and over who were parents of a child 0-18 years (N = 2365). Parents completed an online self-report survey during 'stage three' COVID-19 restrictions in April 2020. Data were compared to pre-pandemic data from four Australian population-based cohorts. Compared to pre-pandemic estimates, during the pandemic period parents reported higher rates of parent depression, anxiety, and stress (Cohen's d = 0.26-0.81, all p < 0.001), higher parenting irritability (d = 0.17-0.46, all p < 0.001), lower family positive expressiveness (d = - 0.18, p < 0.001), and higher alcohol consumption (22% vs 12% drinking four or more days per week, p < 0.001). In multivariable analyses, we consistently found that younger parent age, increased financial deprivation, pre-existing parent and child physical and mental health conditions, COVID-19 psychological and environmental stressors, and housing dissatisfaction were associated with worse parent and child functioning and more strained family relationships. Our data suggest wide-ranging, detrimental family impacts associated with the COVID-19 pandemic; and support policy actions to assist families with financial supports, leave entitlements, and social housing.

The Skagit County choir COVID-19 outbreak - have we got it wrong?

OBJECTIVES: Over time, papers or reports may come to be taken for granted as evidence for some phenomenon. Researchers cite them without critically re-examining findings in the light of subsequent work. This can give rise to misleading or erroneous results and conclusions. We explore whether this has occurred in the widely reported outbreak of SARS-CoV-2 at a rehearsal of the Skagit Valley Chorale in March 2020, where it was assumed, and subsequently asserted uncritically, that the outbreak was due to a single infected person. STUDY DESIGN: Review of original report and subsequent modelling and interpretations. METHODS: We reviewed and analysed original outbreak data in relation to published data on incubation period, subsequent modelling drawing on the data, and interpretations of transmission characteristics of this incident. RESULTS: We show it is vanishingly unlikely that this was a single point source outbreak as has been widely claimed and on which modelling has been based. CONCLUSION: An unexamined assumption has led to erroneous policy conclusions about the risks of singing, and indoor spaces more generally, and the benefits of increased levels of ventilation. Although never publicly identified, one individual bears the moral burden of knowing what health outcomes have been attributed to their actions. We call for these claims to be re-examined and for greater ethical responsibility in the assumption of a point source in outbreak investigations.

COVID-19 impacts on lung cancer diagnosis, management and timeliness in Victoria, Australia

Objectives: To describe impact of COVID-19 on lung cancer incidence, stage at diagnosis, treatment utilisation and timeliness of care in Victoria, Australia. Design(s): Retrospective study using population wide Victorian Cancer Registry data and clinical data from theVictorian Lung Cancer Registry, comparing data pre-COVID (2019 andQ1 of 2020) with theCOVID era (April 2020 onwards). Setting(s): Population wide data on lung cancer diagnoses diagnosed in 2019 and 2020 in Victoria, and 4,485 caseswith additional clinical data. Preliminary results: In the COVID-era, 177 fewer males (-12%) and four fewer females (-0.3%) were diagnosed with lung cancer. Clinical stage at diagnoses for NSCLC was higher on average in Q2 2020 and was similar to the pre-COVID distribution in Q2 and Q4. No changes were detected in the stage distribution for SCLC. The proportion of patients whose time from referral to diagnosis was <=28d decreased with increasing with volume of referrals but was higher in the COVID era (74.6%) compared with the pre-COVID era (67.5%), not caused by a decrease in volume. The proportion of patients receiving any anticancer treatment reduced slightly from 84% in the pre-COVID era to 81% in the COVID era (p = 0.022). Time from diagnosis to treatment (<=14d;37.3% of patients on average) was not associated with volume of new diagnoses, nor did change in the COVID-era (p = 0.13). The proportion ofNSCLCpatientswhoreceived guideline concordance treatment did not differ between pre-COVID (83.1%) and the COVID era (81.7%;p = 0.31). Conclusion(s): Less males were diagnosed with lung cancer in theCOVIDera. Although the health care system in Victoria had many disruptions following COVID restrictions, no negative impact on treatment utilisation nor timeliness was observed. In fact, timeliness from referral to diagnoses improved in the COVID era.

Self-Reported COVID-19 Infections and Social Mixing Behavior at Oncology Meetings

Purpose/Objective(s) The COVID-19 pandemic largely suspended conventional in-person scientific meetings because of the risk of disease spread. In the era of vaccination and social distancing practices, meetings have slowly begun to return to in-person formats. We surveyed attendees and potential attendees of two United States oncology meetings to identify rates of mixing behavior and the subsequent rate of self-reported COVID-19 infection. Materials/Methods We collected reported social mixing behavior and COVID-19 positivity of actual and potential in-person oncology meeting attendees of the American Society of Clinical Oncology (ASCO) Quality Care Symposium in Boston, Massachusetts on September 24-25, 2021, and the American Society for Radiation Oncology (ASTRO) Annual Meeting in Chicago, Illinois on October 24-27, 2021 via survey. Participants were identified through publicly available meeting materials and targeted via email when possible. Recruitment was also conducted through Twitter and a radiation oncology newsletter, as well as an anonymous link made available to emailed recruits, with sharing encouraged. In-person respondents to the later ASTRO survey who had attended the ASCO meeting were excluded from the analysis. Statistical significance was determined using Fisher's exact test for rates of COVID-19 positivity and the chi-squared statistic for differences in group characteristics, with a cutoff for statistical significance p<0.05. Results Response rates from attendees with publicly available emails were 27.4% for the ASCO meeting and 14.3% for the ASTRO meeting. The ASCO survey produced 94 responses, with 48 responding as in-person attendees. The ASTRO survey produced 370 responses, with 267 responding as in-person attendees. Across both meetings, 3 of 308 (1.0%) of in-person attendees versus 2 of 141 (1.4%) of non-attendees tested positive for COVID-19 (p=0.65). Among in-person attendees, there were similar low COVID-19 positivity rates among those spending more (>20) vs less (≤20) hours attending live sessions (2.2% vs 0%, p=0.25) and between those who went to indoor social events vs those who did not during the meeting periods (0.8% vs 1.9%, p=0.44). Attendees largely felt that they would feel comfortable attending additional in-person meetings after experiencing the ASCO (87.5%) or ASTRO (91.9%) meetings and that mask compliance was good or excellent at the ASCO (100%) and ASTRO (94.6%) meetings. Conclusion This study indicates that in-person meetings do not seem to be contributing to high rates of new COVID-19 infections in the setting of mask mandates, vaccine mandates, and decreased room capacity allowances. The rate of self-reported COVID-19 infection of both in-person attendees and non-attendees was very low and the meetings were successful at creating an environment where participants felt safe. These findings support the possibility of a path forward for at least partially in-person conferences as new variants emerge and COVID-19 becomes endemic.

INTERSTITIAL LUNG DISEASE AFTER COVID-19 IN PATIENTS WITH CANCER AND WITHOUT: A PROSPECTIVE COHORT STUDY

SESSION TITLE: Long COVID: It Can Take Your Breath Away SESSION TYPE: Original Investigations PRESENTED ON: 10/16/2022 10:30 am - 11:30 am PURPOSE: Survivors of COVID-19 hospitaliaztion may be at high risk for interstitial lung disease (ILD). The incidence and natural history of post-COVID ILD may vary in cancer and non-cancer patients, particularly if survival is lower in cancer patients. We sought to determine the incidence of ILD at 3 and 6 months after hospital discharge in cancer and non-cancer patients METHODS: We analyzed a prospective cohort of patients discharged after COVID-19 hospitalization between March 2020 and March 2021. Cancer patients were referred to post-COVID clinics 3 months after discharge, while non-cancer patients self-referred to post-COVID clinics at a tertiary referral center. We classified patients into 4 groups: Group 1, asymptomatic without ILD;Group 2, symptomatic without ILD;Group 3, ILD with spontaneous improvement by 6 months;Group 4, persistent ILD at 6 months. Group 1 patients were not seen after initial visits, while all others returned at 6 and 12 months after discharge. We hypothesized that initial COVID-19 severity, measured by the Radiologic Severity Index (RSI) on admission CT, would be associated with irreversible ILD. RSI measures radiologic severity by measuring percentage of involvement (normal - 0, <25% involvement-1, 25-50% involvement-2, 50-75% involvement-3, >75% involvement–4) and multiplying by a score based on the predominant pattern of infiltrate (normal-1, ground glass-2, consolidation-3) in six zones (left, right;upper, middle, lower) to yield a score between 0-72. We used logistic regression to measure whether admission CT RSI was associated with ILD at 3 months. RESULTS: 609 cancer patients were hospitalized with COVID-19 during the study period, of whom 85 (14%) died in-hospital, and 31 (5%) were sent home to hospice. A further 63 (10%) patients died before post-COVID evaluation. Similar data were not available for non-cancer patients due to self-referral. 98 cancer patients and 75 non-cancer patients were seen in post-COVID clinics. Among cancer patients, 20 were Group 1 (20%);8, Group 2 (8%);42, Group 3 (43%);24, Group 4 (25%);5 (5%) lacked post-COVID imaging. ILD was seen in 68% of patients at 3 months, but only in 25% at 6 months. 6% of all hospitalized cancer patients developed ILD. Among non-cancer patients: Group 1, 2 patients (3%);Group 2, 3 patients (4%);Group 3, 26 patients (35%);Group 4, 14 patients (19%);30 (40%) had no post-COVID imaging. Higher RSI at COVID admission associated with ILD at 3 months in non-cancer patients (OR 1.03, 95% CI 1.00-1.07, p=0.054) but not cancer patients (OR 1.3, 95% CI 0.4-4.5). CONCLUSIONS: Initial COVID-19 severity is associated with ILD 3 months after discharge in non-cancer patients but not cancer patients. CLINICAL IMPLICATIONS: ILD is common in survivors of COVID-19 hospitalization, particularly in non-cancer patients hospitalized for severe infection. These data may guide patient selection for referral to post-COVID clinics. DISCLOSURES: No relevant relationships by Roberto Adachi No relevant relationships by Diwakar Balachandran No relevant relationships by Lara Bashoura No relevant relationships by Christopher Bertini No relevant relationships by Kodwo Dickson Owner/Founder relationship with Pulmotect, Inc Please note: 2010-present by Scott Evans, value=Royalty No relevant relationships by Saadia Faiz no disclosure on file for Bruno Granwehr;no disclosure submitted for Shannon Holloway;No relevant relationships by Maryam Kaous no disclosure on file for Fareed Khawaja;No relevant relationships by Lyndon Lee No relevant relationships by Joanna Manzano No relevant relationships by Isabel Mira-Avendano No relevant relationships by Alyssa Mohammed No relevant relationships by Mayoora Muthu No relevant relationships by Sungryong Noh Research relationship with United Therapeutics;PhaseBio Please note: $5001 - $20000 by Bela Patel, value=Grant/Research No relevant relationships by Vickie Shannon onsultant relationship with Psioxus Therapeutics Please note: 3/1/20-7/1/20 by Ajay Sheshadri, value=Consulting fee Consultant relationship with Enanta Pharmaceuticals Please note: 01/01/21-ongoing by Ajay Sheshadri, value=Consulting fee No relevant relationships by Hui Song

Critical care dietetic outcomes during the first wave of the COVID-19 pandemic

The COVID-19 pandemic led to a surge in patients being admitted to the Intensive Care Unit (ICU) and increased dietetic input was required for their daily nutritional management. Non-ICU dietitians were upskilled to meet this increased demand – resulting in an increase to 5 band 6 dietitians and 1 band 7 dietitian overseen by the band 8a clinical lead. The service also changed from a 5-day to a 7-day service. The aim of this service evaluation was to analyse changes in nutritional outcomes during the COVID-19 pandemic, and how changes to the dietetic service impacted upon dietetic outcomes. Outcomes included energy and protein provision, feed type used and prokinetic use. Data was collected for all ICU patients under dietetic care with a confirmed COVID-19 diagnosis for the period of 22/03/2020 to 04/06/2020 (75 days). Total patient cohort equalled 66. Patients were reviewed daily until the patient was discharged from ICU or the patient passed away. All data was then retrospectively analysed using descriptive statistics, and an independent t-test was used to compare COVID-19 feed delivery to previous feed deliverydata. Ethical approval was not required for this service evaluation. Of the 66 patients, 62 required enteral nutrition (EN). Feeding was commenced within 48 hours of ICU admission in 92% of patients. Average percentage feed delivery was 82.4% for energy and protein. This total does not include additional protein supplementation;therefore, the overall protein delivery was higher, with 36% of patients being prescribed 1 to 2 20g protein supplements per day. A total of 60% of patients were initially started on a fluid restricted feed for fluid balance or due to being proned. A total of 50% of patients continued with a fluid restricted feed, with 44% of patients receiving a standard protocol feed (1kcal/ml high-protein feed) and 6% receiving a peptide or renal feed. Prokinetics were required in 35% of patients. A total of 3% of patients (n=2) required parenteral nutrition due to persistent high gastric residual volumes despite prokinetics. Of the 66 patients, 46 (70%) were discharged alive from ICU. Of these, 70% were receiving total or supplementary EN at the time of discharge from the ICU. A number of barriers to maintaining high standards of patient outcomes arose at the onset of the COVID-19 pandemic. These included disruptions to normal MDT working, challenges in undertaking face-to-face assessments and reviews, and an increased caseload and footfall - thereby increasing the demand for ICU trained dietitians. Despite these barriers, this service evaluation demonstrates that percentage feed delivery remained relatively stable when compared to the pre-COVID 2020 audit (n = 35) - 82.4% vs. 85% respectively. An independent-samples t-test was conducted to compare feed delivery in pre-COVID and COVID-19 samples. There was no significant difference in the scores for pre-COVID (M = 85%, SD = 13.4) and COVID (M = 82.4%, SD = 16.8) samples;t(180) = -0.81, p =.42. This is despite 36% of patients requiring proning during COVID vs. 0% pre-COVID, and increased gastrointestinal intolerance evidenced by 35% of patients requiring prokinetics vs. 29% pre-COVID. These factors eliminated the ability to utilise ‘catch-up’ feeding, which significantly improves feed delivery in normal circumstances. This suggests that changes in dietetic provision of service, including delivering a 7-day service, thereby allowing more prompt management of nutritional issues and improved access to dietetic expertise, facilitated the maintenance of the pre-existing high standards of nutritional care. Achieving this degree of feed delivery necessitated the use of a variety of different feeds – to manage tolerance, fluid volume, electrolyte imbalances and ensure nutritional adequacy. Adapting feeding regimens to best meet the patients need is a key role of the dietitian, and in the absence of dietetic input it is unlikely these feeding strategies would have been utilised. The COVID-19 pandemic presented new challenges and obstacles to eve y aspect of the healthcare sector;necessitating fast adaptations, novel methods of working and reinforcing the importance of multidisciplinary teams to guide patient care in the absence of evidence-based guidelines. This service evaluation demonstrates that forward-planning and the expansion of services in alignment with demand can assure that patient care need not be compromised, despite the unprecedented challenges and barriers presented by the COVID-19 pandemic.

SOCIAL CONNECTION AND RECOVERY FROM ALCOHOL USE DISORDER DURING THE COVID-19 PANDEMIC: QUALITATIVE FINDINGS FROM A US NATIONAL SAMPL

Purpose: Social support is critically important to recovery from alcohol use disorder (AUD). During the COVID-19 pandemic, community and government social restrictions and mandates reduced inperson contact and increased social isolation, heightening the risk of relapse for many persons in recovery. A key question concerns what forms and sources of social connection and support were important for maintaining recovery during the pandemic. Methods: This study used a large, pre-existing, national cohort, Knowledge Panel, to recruit participants with resolved AUD for an online survey. The sample consisted of 1,492 adults, 71% of whom had been in recovery more than 5 years. In addition to close-ended questions on COVID-19 stressors and coping responses, an open-ended question asked participants what was most helpful in sustaining their recovery during the pandemic. A qualitative codebook was created, and iterative coding was conducted by multiple analysts using Dedoose, followed by preliminary analysis of themes from codes on COVID-19 restrictions and sources of social connection and support. Results: Participants commonly referenced talking to, staying in touch with, and/or spending time with family members, including children (latter mentioned more commonly by women) as helpful in maintaining recovery. Participants also highlighted support and encouragement from family. Communication and interaction with friends were also integral to recovery maintenance. Support, care, and contact from and towards others in their networks, including those in recovery, were also cited. Many participants continued to attend Alcoholics Anonymous (AA) meetings and other mutual support groups throughout the pandemic. When in-person gatherings were not possible, participants sustained social connections through various forms of telecommunication. Unexpectedly, some participants characterized the lack of social interactions during COVID-19 as beneficial to their continued recovery, as it removed opportunities and temptations to drink with others. Conclusions: Despite profound disruption to social routines during the pandemic, many individuals in recovery experienced helpful social connections and support that were important to maintaining recovery. For some, social restrictions were perceived as beneficial and limiting opportunities for relapse. These findings underscore the importance of social support and networks in long-term recovery, warranting further investigation into the dynamics of support systems conducive to recovery maintenance.

INTEGRATED TIA CLINIC DURING COVID-19 PANDEMIC: SERVICE EVALUATION TO ASSESS IMPACT ON WAITING TIMES, DIAGNOSTIC OUTCOME AND 28-DAY READMISSIONS AT THE UNIVERSITY HOSPITAL SOUTHAMPTON, UK

Background and aims: TIA presentations are challenging to diagnose. The rapidly escalating pandemic due to Covid-19 demanded an integrated TIA clinic( telephone and Face to face clinics). It is unclear if first specialist assessment can be safely undertaken in selected patients using telephone clinics, there by reducing patient movement to reduce risk of transmission. The aim of this study is to evaluate timeliness, diagnostic accuracy and 28-day readmission of the integrated TIA clinic in comparison to usual set up. Methods: Two groups of patients (Pre-Covid and Covid Groups) were identified from the TIA clinic registry maintained for quality assurance and governance. Statistical analysis was done using Statistical Package of Social Sciences (SPSS) version 23 (IBM, 2015). Results: There was a 25% drop in the number of cases during the study period. Conclusion: Integrated model of care can be used to provide timely, safe and comparable service to usual care. The risk of missing key signs can be reduced by the provision of face-to-face clinics. It offers patient choice, service closer to patient and creates flexibility within the system during unprecedented emergencies. A prospective study with a larger cohort of patients will add strength to these findings.

Transcriptional Interaction Between RelA and cJUN

Rationale: The SARS-CoV-2 pandemic has underscored the need for novel anti-infectious strategies, including host-directed therapeutics, against existing and emerging respiratory pathogens. We have reported that an aerosolized therapeutic comprised of a Toll-like receptor (TLR)-2/6 agonist, Pam2CSK4, and a TLR-9 agonist, ODN M362, stimulate pathogen-agnostic innate immune responses in lung epithelial cells. This therapeutic (“Pam2-ODN”) promotes synergistic microbicidal activity and host survival benefit against pneumonia caused by a wide range of pathogens. Here, we study the immunomodulatory signaling mechanisms required to effect this inducible epithelial resistance. Methods: Bioinformatic analysis of transcriptional responses from human and mouse lung epithelium al cells to influenza A H1N1 or SARS-CoV-2 (GSE147507) or Pam2-ODN (GSE289984, GSE26864) were analyzed using R and IPA software to identify essential transcription factors (TFs). Lung cell population dynamics were studied for TFs related to Pam2-ODN immunomodulatory signaling using high-throughput imaging flow cytometry (IFC). Human or mouse lung epithelial cells were stimulated with PBS or Pam2-ODN and single or dual inhibitors of TFs before challeng with influenza A H3N2 (IAV) or coronavirus OC43 (CoV) to compare the epithelium-specific transcriptional control of relevant TFs using in-cell western blotting, IFC and hemagglutination for viral burdens. Results: Functional enrichment analysis revealed RelA and cJUN to be major immunomodulatory TFs of Pam2-ODN and activators of leukocyte- and epithelial-derived antiviral immune mechanisms targeting replication of influenza A and SARS-CoV-2. Cell population dynamics studied from mouse lungs confirmed activation of RelA and cJUN in CD45+, EpCAM- leukocytes and in CD45-, EpCAM+ epithelial cells, with predominant activation of the lung epithelium and none or minimal activation of structural cell populations such as fibroblasts or endothelial cells. Studies of epithelium-specific signaling in vitro revealed co-activation of RelA-(pS536) and cJun- (pS73) TFs with Pam2-ODN, and earlier onset of cJUN phosphorylation and nuclear translocation with Pam2-ODN after IAV or CoV infection. Individual or dual inhibition of RelA and/or cJUN activity in vitro disrupted the antiviral activity of Pam2-ODN of IAV infected cells. Conclusion: Pam2-ODN induces unique, pathogen-agnostic protective signaling in lung epithelial cells that involves cooperative activation of RelA and cJUN. This combined TF signaling mechanism is not observed in other structural lung cell populations after Pam2-ODN exposure. Further, the phospho-regulation dynamics of RelA and cJUN are not replicated by IAV or CoV infection alone, suggesting a novel therapeutic process that can be leveraged to protect individuals against pneumonia. (Figure Presented).

Temporal Trendsin Humoral and Cellular Immune Responsesto SARS-CoV-2 mRNA Vaccines Among Multiple Sclerosis Patients TreatedWith Natalizumab, Ocrelizumab or Fumarates

Objective: To examine the temporal trends of humoral and cell-mediated immune responses to SARS-CoV-2 mRNA vaccines among multiple sclerosis (MS) patients on different immunomodulatory therapies. Background: The impact of various MS medications on the immune responses to SARS-CoV-2 vaccine is of acute interest to patients and clinicians. Design/Methods: 22 MS patients treated with ocrelizumab (OCR, n=9), natalizumab (NTZ, n=8), fumarates (FUM, n=5;diroximel fumarate, 3 and dimethyl fumarate, 2) received BNT162b2 (Pfizer, n=15) or mRNA-1273 (Moderna, n=7) vaccines. Blood samples were collected before and after each of the two vaccine doses, and 2 months after second vaccine dose. AntiSARS-CoV-2 spike protein titers were measured using quantitative assay (Labcorp). Antibody neutralization was measured with a lentivirus-based pseudovirus particle expressing the D614 spike protein (Labcorp-Monogram Biosciences). T-cell reactivity was determined by measuring interferon-gamma and interleukin-2 in response to stimulation with SARS-CoV-2 peptides. Results: All patients in NTZ and FUM cohorts, but only 22% (2/9) of OCR cohort developed anti-spike and neutralizing antibodies. The highest titers were measured after the second vaccine dose, without significant difference between the NTZ and FUM cohorts in anti-spike IgG (69.7+/-55.1 vs 56.0+/-36.7 arbitrary units/ml) or neutralizing ID50 (1513+/-1317 vs 942+/ -566). Two months after the second vaccine, the antibody titers and neutralizing ID50 decreased by 72% and 79% in NTZ cohort, respectively, and by 45% and 49% in FUM cohort. T-cell reactivity was observed in all cohorts as early as 7 days after the first vaccine, and further increased following the second vaccine. Conclusions: Patients on NTZ and FUM mounted robust antibody responses to SARS-CoV-2 mRNA vaccines, in contrast to OCR-treated patients. T-cell responses were comparable among all three treatment cohorts. Two months after the second vaccine, the serological responses decreased by 45-79%. These findings may inform the optimal timing of additional vaccine doses for MS patients.

PARENT AND CHILD MENTAL HEALTH TRAJECTORIES APRIL- OCTOBER 2020: STRICT LOCKDOWN VS NO LOCKDOWN IN AUSTRALIA

Background: To control a second wave of COVID-19 outbreak, the state of Victoria in Australia experienced one of the world's first long and strict lockdowns over July-October 2020, while the rest of Australia experienced 'COVID-normal' with minimal restrictions. Objectives: To (1) investigate trajectories of parent/child MH outcomes in Victoria vs non-Victoria and (2) identify baseline demographic, individual and factors related to COVID-19 associated with MH trajectories. Methods: An online community sample of 2004 Australian parents of a child aged 0-18 years with rapid repeated assessment over 14 time points from April 2020 to May 2021. Measures assessed parent MH (Depression, Anxiety and Stress Scales-21), child depression symptoms (13-item Short Mood and Feelings Questionnaire) and child anxiety symptoms (4 items from the Brief Spence Children's Anxiety Scale). Findings: MH trajectories shadowed COVID-19 infection rates. Victorians reported a peak in MH symptoms at the time of the second-wave lockdown compared to other states. Key baseline predictors, including parent and child loneliness (standardised regression coefficient (β) = 0.09- 0.46), parent/child diagnoses (β = 0.07-0.21), couple conflict (β = 0.07-0.18), and COVID-19 stressors, such as worry/concern about COVID-19, illness and loss of job (β = 0.12-0.15)), predicted elevated trajectories. Conclusion: Our findings provide evidence of worse trajectories of parent and child MH symptoms associated with a second COVID-19 outbreak involving strict lockdown in Victoria, compared to non-locked states in Australia. We identified several baseline factors that may be useful in detecting high-risk families who are likely to require additional support early in future lockdowns.

Patient motivation and adherence to an on-demand app-based heart rate and rhythm monitoring infrastructure for atrial fibrillation management through teleconsultation. TeleCheck-AF project results

Background: TeleCheck-AF is a mobile health (mHealth) infrastructure developed to provide remote management and comprehensive care to patients with atrial fibrillation (AF) during the Covid disease-19 pandemic lockdown within cardiology centers in Europe. TeleCheck-AF integrates an on-demand photoplethysmography-based heart rate/rhythm monitoring application supported a scheduled teleconsultation. Purpose: The current sub-study of the TeleCheck-AF project aimed to provide the first real-world dataset on patient adherence and motivation to a standardized mHealth application integrated in remote AF management. Methods: Patients were instructed to perform 60-second app-based heart rate/rhythm recordings three times daily and in case of symptoms for seven consecutive days prior to teleconsultation. Motivation was defined as number of days in which the expected number of measurements (≥three/day) were performed per number of days over the entire prescription period. Adherence was defined as number of performed measurements per number of expected measurements over the entire prescription period. Results: Data from 990 consecutive patients with diagnosed AF (median age 64 [57-71] years, 39% female) from 10 centers that included the highest number of patients (≥25) were analyzed. Patients with both optimal motivation (100%) and adherence (≥100%) constituted 28% of the study population and had a lower percentage of recordings in sinus rhythm (90 [53-100%] vs 100 [64-100%], P<0.001) compared to others. Age and diabetes were predictors of both optimal motivation and adherence (odds ratio [OR] 1.02, 95% coincidence interval [95% CI] 1.01-1.04, P<0.001 and OR, 0.49, 95% CI 0.28-0.86, P=0.013, respectively). Patients with 100% motivation also had ≥100% adherence. Independent predictors for optimal adherence alone were age (OR 1.02, 95% CI 1.00-1.04, P=0.014), female sex (OR 1.70, 95% CI 1.29-2.23, P<0.001), previous AF ablation (OR 1.35, 95%CI 1.03-1.07, P=0.028). Conclusion: In the TeleCheck-AF project, older age and diabetes were predictors of optimal patient motivation and adherence to app-based heart rate/rhythm monitoring. Therefore, physicians, nurses and allied health specialists involved in the management and care for patients with AF should not be discouraged to provide a mHealth infrastructure to elderly patients. Patient engagement improves mHealth adherence/ motivation, hence, it is crucial to tailor the mHelath intervention to the needs and preferences of the patient. (Figure Presented).