188. Visualizing the Impact of a Wedding Leading to COVID-19 Outbreaks in Healthcare Settings, Washington State, July – August 2020

Background Large social gatherings during the COVID-19 pandemic have been linked to extensive community transmission. Healthcare workers (HCW) that engage in these social gatherings pose a risk to the vulnerable patients they serve. Public Health—Seattle & King County identified a COVID-19 outbreak associated with a wedding in July 2020 when the 14-day incidence rate was 105 cases per 100,000 residents. HCW who attended the wedding were subsequently linked to 45 outbreaks in healthcare settings across three counties in the next month. Methods COVID-19 case interview data was used to identify HCW cases who reported the wedding as their exposure event. The Washington Disease Reporting System (WDRS), the state database in which COVID-19 cases and epi-linkages are tracked, was queried to identify healthcare outbreaks linked to the HCW wedding-attendee cases and the HCW that they infected. NodeXL was used to visualize the resulting chains of wedding-associated healthcare transmission using a Harel-Koren Fast Multiscale layout where the network visualization’s directed arrows represent putative links and direction of transmission. Numbers of associated settings, cases, and deaths were calculated. Results Seven HCW wedding attendees were linked to outbreaks in healthcare facilities that they worked at while infectious; HCWs linked to as many as six subsequent healthcare outbreaks. In total, the wedding was connected to 45 healthcare facilities: adult family homes (N=1), hospitals (N=1), supported living agencies (N=7) and associated group homes (N=38), assisted living (N=1), home health services (N=1), behavioral health (N=2), and rehab centers (N=1). Across the settings, 277 cases were identified, including 15 deaths. Conclusion A series of COVID-19 healthcare outbreaks was traced back to a wedding. Cases worked in multiple homes, agencies, and other healthcare settings which likely facilitated rapid and wide transmission; the structure of these healthcare settings often do not facilitate a single job providing enough hours and income to support an individual. In terms of public health learnings, addressing these outbreaks require effective contact tracing, multijurisdictional coordination, and for supported living, interventions need to be applied across households sharing staff. Disclosures All Authors: No reported disclosures

Brainwave Controlled, Robotic Intelligent Assistive Device for People with Spinal Injuries, Cerebral Palsy, Amputation, and Muscular Dystrophy

People with spinal injuries, cerebral palsy, amputation, muscular dystrophy, etc. have little to no control of their hands or feet, and many times they cannot even speak to express their thoughts. Individuals with such impairments encounter extreme physical, social, and environmental challenges in their daily lives, which, in turn, create impediments to self-supported living and to opportunities to take part in economic and social aspects of life. To help these people, there is a need of a neuro bio signal-controlled, machine learning based system that can interpret their thoughts in a meaningful way, helping people with disabilities conduct daily activities, enabling them to improve their quality of life and live independently.

Assessing emotional expressions during a cycling-based initiative for older care home residents using participatory action research

Objective: Through Cycling Without Age, trained volunteers use specially designed trishaws to provide rides for older adults living in care homes and other supported living environments. Qualitative and quantitative research suggests benefits in terms of improvements in mood and wellbeing. Those studies have predominantly been interviews with participants reflecting on previous rides, or as pre-/post-assessments. To assess emotional experiences during a ride, the current study adopted a participatory action research approach.Methods: Twelve older adults (50% female; 67-92 years old (M=81.8, SD=7.4)) living in care homes or supported living environments were recruited. During a Cycling Without Age ride, participants were filmed using an action camera mounted to the trishaw. Recordings were rated using the Facial Expression Coding System by two researchers to assess the frequency, duration and intensity of positive and negative emotions.Results: On average, 23.7 positive emotional expressions were observed per ride, significantly higher than negative emotions (0.4). As well as more frequent, positive emotions were observed over a longer duration in total (139.5 seconds versus 1.3) and rated as more intense (1.9 versus 0.3).Conclusion: The study supported the value of assessing emotional responses during this cycling-based initiative directly, including minimising the input required from participants. The predominantly positive emotional expressions observed were consistent with both qualitative and quantitative assessments of Cycling Without Age, and suggests a potential pathway by which those benefits manifest. Future studies might adopt a triangulated approach, using in-activity monitoring, quantitative assessments and participant reflections.

Changes in Mesopotamian Wetlands: Investigations Using Diverse Remote Sensing Datasets

Early civilizations have inhabited stable-water-resourced areas that supported living needs and activities, including agriculture. The Mesopotamian marshes, recognised as the most ancient human-inhabited area (~6000 years ago) and refuge of rich biodiversity, have experienced dramatic changes during the past five decades, starting to fail in providing adequate environmental functioning and support of social communities as they used to for thousands of years. The aim of this study is to observe, analyse and report the extent of changes in these marshes from 1972 to 2020. Data from various remote sensing sources were acquired through Google Earth Engine (GEE) including climate variables, land cover, surface reflectance, and surface water occurrence collections. Results show a clear wetlands dynamism over time and a significant loss in marshlands extent, even though no significant long-term change was observed in lumped rainfall from 1982, and even during periods where no meteorological drought had been recorded. Human interventions have disturbed the ecosystems, which is evident when studying water occurrence changes. These show that the diversion of rivers and the building of a new drainage system caused the migration and spatiotemporal changes of marshlands. Nonetheless, restoration plans (after 2003) and strong wet conditions (period 2018 - 2020) have helped to recover the ecosystems, these have not led the marshlands to regain their former extent. Further studies should pay more attention to the drainage network within the study area as well as the neighboring regions and their impact on the streamflow that feeds the study area.

Poor nutritional status correlates with mortality and worse postoperative outcomes in patients with femoral neck fractures

Aims Patients who sustain neck of femur fractures are at high risk of malnutrition. Our intention was to assess to what extent malnutrition was associated with worse patient outcomes. Methods A total of 1,199 patients with femoral neck fractures presented to a large UK teaching hospital over a three-year period. All patients had nutritional assessments performed using the Malnutrition Universal Screening Tool (MUST). Malnutrition risk was compared to mortality, length of hospital stay, and discharge destination using logistic regression. Adjustments were made for covariates to identify whether malnutrition risk independently affected these outcomes. Results Inpatient mortality was 5.2% (35/678) in the group at low risk of malnutrition, 11.3% (46/408) in the medium-risk group, and 17.7% (20/113) in the high-risk group. Multivariate analysis showed each categorical increase in malnutrition risk independently predicted inpatient mortality with an odds ratio (OR) of 1.59 (95% confidence interval (CI) 1.14 to 2.21; p = 0.006). An increased mortality rate persisted at 120 days post-injury (OR 1.64, 95% CI 1.20 to 2.22; p = 0.002). There was a stepwise increase in the proportion of patients discharged to a residence offering a greater level of supported living. Multivariate analysis produced an OR of 1.34 (95% CI 1.03 to 1.75; p = 0.030) for each category of MUST score. Median length of hospital stay increased with a worse MUST score: 13.9 days (interquartile range (IQR) 8.2 to 23.8) in the low-risk group; 16.6 days (IQR 9.0 to 31.5) in the medium-risk group; and 22.8 days (IQR 10.1 to 41.1) in the high-risk group. Adjustment for covariates revealed a partial correlation coefficient of 0.072 (p = 0.008). Conclusion A higher risk of malnutrition independently predicted increased mortality, length of hospital stay, and discharge to a residence offering greater supported living after femoral neck fracture. Cite this article: Bone Joint J 2021;103-B(1):164–169.

Characteristics of supported living – a perspective of professionals and potential residents

Background Policies are increasingly decentralized, and people with a demand for support often live in familiar environments and regular neighborhoods instead of institutions. To meet the demand for support, the local government aims to offer supported living facilities in Staphorst, Netherlands. Accordingly, this study aimed to provide insight into the characteristics of supported living from the perspective of professionals and potential residents. Methods Semi-structured interviews were conducted with professionals and potential residents to obtain insight about their perspectives regarding supported living. First, ten interviews were conducted with professionals (i.e. local government, care, welfare, and housing corporation), followed by six interviews with potential residents and/or their parents. The interviews were transcribed, coded and analyzed by two researchers. Results A small amount of the residents in Staphorst would benefit from supported living. This concerns mainly (young) adults with a mild intellectual disability and/or a mental illness who need practical, social and emotional support in order to live on their own. Composing the support, it is important to acknowledge the religious identity of the potential residents and their families. Furthermore, the interviews with professionals and potential residents revealed that the following options should be considered: time-out, short- and long-term support, daycare and open house facilities, various types of support (i.e. volunteer and professional) and combining target groups (i.e. adolescents and adults). Conclusions This study reveals several options to consider when composing supported living in Staphorst. Accordingly, most participants emphasized the need for short-term support focusing on skills related to independent living. Furthermore, it is important to involve professionals and potential residents and/or their parents in order to offer sustainable supported living for the residents in Staphorst. Key messages Most participants emphasized the need for short-term support focusing on skills related to independent living. Both professionals and potential residents should be involved when composing supported living facilities.

Rising to the challenges of COVID-19: the front line of care and support for people with long-term mental health problems and the response of Northern Healthcare

The COVID-19 crisis has impacted on us all. However, people living with long-term mental health problems will remain vulnerable over the coming months, because of the restrictions that will remain in place until a vaccine has been discovered and used on the wider population. This paper describes how Northern Healthcare, an organisation that has developed a model of enhanced supported living for this population, has responded to the crisis. This response has seen a focus on residents, staff and on measures aimed at alleviating the burden on the wider NHS. Of importance, there are lessons to be learned, as it is entirely possible that the world will need to deal with future, similar pandemics.