Engaging key stakeholders to overcome barriers to studying the quality of research ethics oversight

The primary purpose of Institutional Review Boards (IRBs) is to protect the rights and welfare of human research participants. Evaluation and measurement of how IRBs satisfy this purpose and other important goals are open questions that demand empirical research. Research on IRBs, and the Human Research Protection Programs (HRPPs) of which they are often a part, is necessary to inform evidence-based practices, policies, and approaches to quality improvement in human research protections. However, to date, HRPP and IRB engagement in empirical research about their own activities and performance has been limited. To promote engagement of HRPPs and IRBs in self-reflective research on HRPP and IRB quality and effectiveness, barriers to their participation need to be addressed. These include: extensive workloads, limited information technology systems, and few universally accepted or consistently measured metrics for HRPP/IRB quality and effectiveness. Additionally, institutional leaders may have concerns about confidentiality. Professional norms around the value of participating in this type of research are lacking. Lastly, obtaining external funding for research on IRBs and HRPPs is challenging. As a group of HRPP professionals and researchers actively involved in a research consortium focused on IRB quality and effectiveness, we identify potential levers for supporting and encouraging HRPP and IRB engagement in research on quality and effectiveness. We maintain that this research should be informed by the core principles of patient- and community-engaged research, in which members and key stakeholders of the community to be studied are included as key informants and members of the research team. This ensures that relevant questions are asked and that data are interpreted to produce meaningful recommendations. As such, we offer several ways to increase the participation of HRPP professionals in research as participants, as data sharers, and as investigators.

Centralized registry for COVID-19 research recruitment: Design, development, implementation, and preliminary results

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) pandemic has had substantial global morbidity and mortality. Clinical research related to prevention, diagnosis, and treatment of COVID-19 is a top priority. Effective and efficient recruitment is challenging even without added constraints of a global pandemic. Recruitment registries offer a potential solution to slow or difficult recruitment.

OBJECTIVES

The purpose of this paper is to describe the design and implementation of a digital research recruitment registry to optimize awareness and participant enrollment for COVID-19-related research in Baltimore and to report preliminary results.

METHODS

Planning began in March 2020, and the registry launched in July 2020. The primary recruitment mechanisms include electronic medical record data, postcards distributed at testing sites, and digital advertising campaigns. Following consent in a Research Electronic Data Capture survey, participants answer questions related to COVID-19 exposure, testing, and willingness to participate in research. Branching logic presents participants with studies they might be eligible for.

RESULTS

As of March 24, 2021, 9010 participants have enrolled, and 64.2% are female, 80.6% are White, 9.4% are Black or African American, and 6% are Hispanic or Latino. Phone outreach has had the highest response rate (13.1%), followed by email (11.9%), text (11.4%), and patient portal message (9.4%). Eleven study teams have utilized the registry, and 4596 matches have been made between study teams and interested volunteers.

CONCLUSION

Effective and efficient recruitment strategies are more important now than ever due to the time-limited nature of COVID-19 research. Pilot efforts have been successful in connecting interested participants with recruiting study teams.

POS1422 CORRELATES OF TESTING POSITIVE FOR SARS-COV-2 IN PATIENTS WITH RHEUMATIC AD MUSCULOSKELETAL DISEASES

Background:

Many studies on COVID-19 outcomes in patients with RMD have either restricted to COVID positive RMD patients or compared them to the general clinic population as a comparator. Given heterogeneity in behaviors and risks, clinical characteristics associated with a positive diagnosis among patients with RMD seeking testing for Sars-CoV-2 remain less well studied.

Objectives:

Among patients with RMD receiving a Sars-CoV-2 PCR test, we aimed to identify RMD-related factors associated with a positive test result.

Methods:

Among patients seen at least once in the University of Washington (UW) rheumatology clinics between March 2018 to March 2020, we reviewed electronic medical records to identify patients undergoing Sars-CoV-2 PCR testing from March 1 through October 31, 2020. Patients with RMD were categorized into two groups: those who tested positive for Sars-CoV-2 and those who tested negative. We randomly selected patients from the negative group in a 2:1 ratio for further data abstraction. Student’s t-test and Chi-squared tests were used to compare continuous and categorical variables, respectively, between the groups. To determine the correlates of testing positive for Sars-CoV-2, specifically RMD medication use and disease activity, we constructed different multivariable logistic regression models adjusted for age, sex, race/ethnicity, presence of comorbidities, body mass index, and smoking.

Results:

A total of 2768 RMD patients underwent SARS-CoV-2 PCR testing within the UW system, of whom 43 (1.5%) were positive at least once. Three patients with incomplete information were excluded. Patients who tested positive had higher prevalence of end stage renal disease (ESRD)/chronic kidney disease (CKD) (24% versus 11%), had higher rates of active disease (24% versus 20%), were older (>55 years) (mean age 57.3 versus 54.8 years), male (63% versus 55%), non-white race/ethnicity (32% versus 26%), and higher prevalence of multiple comorbidities (42% versus 31%) (Table 1). In the multivariable models, neither RMD medication use (versus no use, Table 1) nor high disease activity (vs low disease activity/remission) were statistically significantly associated with COVID-19 positivity. Among the 41 COVID-19 positive patients, a majority recovered without specific treatments, although approximately one third of the positive patients were hospitalized and three deaths were observed.

Conclusion:

In this study, patients who tested positive did not differ in many ways from those who tested negative.

Table 1.

Baseline characteristics of the patients prior to COVID testing

VariablesAll(N=126)COVID Positive (N=41)COVID Negative(N=85)P valueAge in years – mean (SD)55.6 (15.3)57.3 (16.3)54.8 (14.9)0.40Sex0.39 Male73 (57.9)26 (63.4)47 (55.3) Female53 (42.1)15 (36.6)38 (44.7)Race0.39 White89 (71.2)26 (63.4)63 (74.1) Other race35 (28.2)13 (31.7)22 (25.9) Missing2 (1.6)2 (4.9)0 (0.0)Rheumatic disease0.64 OA/Crystal/Fibromyalgia37 (29.4)11 (26.8)26 (30.6) RA/SpA32 (25.4)9 (22.0)23 (27.1) All others57 (45.2)21 (51.2)36 (42.3)Rheumatic disease activity0.57 Active27 (21.4)10 (24.4)17 (20.0) Not active99 (78.6)31 (75.6)68 (80.0)Co-morbidities  Diabetes mellitus (%)25 (19.8)9 (22.0)16 (18.8)0.68  Hypertension48 (38.1)20 (48.8)28 (32.9)0.09  Cardiovascular disease23 (18.3)9 (22.0)14 (16.5)0.46  Lung disease25 (19.8)10 (24.4)15 (17.7)0.37  Cancer10 (7.9)3 (7.3)7 (8.2)0.86  ESRD/CKD19 (15.1)10 (24.4)9 (10.6)0.04*

BMI: Body mass index; SD: Standard deviation; OA: Osteoarthritis; Crystal: Crystalline diseases; RA: Rheumatoid arthritis; SpA: Spondyloarthritis

Acknowledgements:

The work in this study was supported by grant UL1 TR002319 to Dr Singh from the Institute of Translational Health Sciences of the University of Washington.

Disclosure of Interests:

None declared

Abstract MP36: The Development Of A Centralized Recruitment Process For Covid-19 Research: Hopkins Opportunity For Participant Engagement Registry

Introduction: The COVID-19 pandemic has required urgent scientific response to investigate the disease, its prevention and treatment and interactions with cardiovascular conditions. Consequently, a centralized workflow was needed to effectively recruit, screen and connect volunteers to COVID-19 research opportunities.

Objective: To create a centralized registry to match eligible and interested volunteers ≥18 years with COVID-19 outpatient research studies at an academic health system.

Methods: Key stakeholders, including researchers and participant advocates, collaborated to build the Hopkins Opportunity for Participant Engagement (HOPE) Registry in English and Spanish. REDCap, a secure web-based application, served as the Registry platform. Study teams recruiting for outpatient studies were invited to present their studies through the Registry. Study volunteers were recruited using multiple methods, including patient portal messages, email, social media, and online advertisement. The Registry included COVID testing results and participant survey of demographic and COVID-19 related questions. Branching logic was used to pre-screen and present participating studies for which the person was eligible. The individual then selected which studies, if any, they were interested in. Study teams received an automatic notification and reached out directly to individuals expressing interest in their study ( Figure ).

Results: The HOPE Registry includes 7 studies and has enrolled 4186 people. Over half (55%) were >55 years and the majority were female (64%). Racial/ethnic groups represented were Whites (80%), Black s (9%), Asians (4.7%), Hispanics (5%), and American Indian (0.3%). Participants were interested in: 29%, treatment study; 37%, vaccine study; and 66%, donating plasma. Within 10 weeks, 585 persons were matched with an actively recruiting study.

Conclusions: The ongoing HOPE registry has shown promise in engaging individuals with COVID-19 research and improving research recruitment workflow.

Desperate Times: Protecting the Public From Research Without Consent or Oversight During Public Health Emergencies

The COVID-19 pandemic has prompted an unprecedented global research effort to better understand this virus and to identify promising treatments. In this essay, the authors note that defining activities as public health surveillance has important implications, because such activities do not require further ethical oversight, informed consent, or protections for vulnerable persons or communities.

Use of multiple data sources to identify specific drugs and other factors associated with drug and alcohol screening of fatally injured motor vehicle drivers

OBJECTIVE

Drugged driving crashes have significantly increased over the past two decades. The objectives of this study were to identify and characterize the drugs present in motor vehicle driver fatalities using multiple surveillance data sources; assess concordance of the data sources in identifying drug presence; and identify demographic and crash factors associated with drug and alcohol screening in fatally injured motor vehicle drivers.

METHODS

Fatality Analysis Reporting System (FARS), Collision Report Analysis for Safer Highways (CRASH), and mortality data sets were linked; drug screening and positive drug screens were identified. Chi-square and conditional logistic regression were performed.

RESULTS

The use of FARS data identified the majority of positive drug screens in the linked data set. Supplementation of FARS data with death certificate and CRASH data increased identification of specific drugs and drug classes detected among fatally injured motor vehicle drivers, although there was a low concordance among the data sources. Alcohol and depressants such as alprazolam had the highest frequencies among fatally injured drivers. Speeding, lack of occupant restraints, young age, commercial truck drivers, and speeding were all factors associated with increased odds of the fatally injured driver being drug or alcohol screened.

CONCLUSIONS

These findings indicate that FARS drug information data may be strengthened through increased autopsy and consultation with medical examiners to better understand and interpret decedent toxicology testing results, and that states with low driver drug testing rates should consider mandatory driver drug testing in fatal crashes.

Surveillance of traffic incident management-related occupational fatalities in Kentucky, 2005-2016

OBJECTIVE

Traffic incidents occurring on roadways require the coordinated effort of multiple responder and recovery entities, including communications, law enforcement, fire and rescue, emergency medical services, hazardous materials, transportation agencies, and towing and recovery. The objectives of this study were to (1) identify and characterize transportation incident management (TIM)-related occupational fatalities; (2) assess concordance of surveillance data sources in identifying TIM occupations, driver vs. pedestrian status, and occupational fatality incident location; and (3) determine and compare U.S. occupational fatality rates for TIM industries.

METHODS

The Kentucky Fatality Assessment and Control Evaluation (FACE) program analyzed 2005-2016 TIM occupational fatality data using multiple data sources: death certificate data, Collision Report Analysis for Safer Highways (CRASH) data, and media reports, among others. Literal text analysis was performed on FACE data, and a multiple linear regression model and SAS proc sgpanel were used to estimate and visualize the U.S. TIM occupational mortality trend lines and confidence bounds.

RESULTS

There were 29 TIM fatalities from 2005 to 2015 in Kentucky; 41% of decedents were in the police protection occupation, and 21% each were in the fire protection and motor vehicle towing industries. Over one half of the TIM decedents were performing work activities as pedestrians when they died. Media reports identified the majority of the occupational fatalities as TIM related (28 of 29 TIM-related deaths); the use of death certificates as the sole surveillance data source only identified 17 of the 29 deaths as TIM related, and the use of CRASH data only identified 4 of the 29 deaths as TIM related. Injury scenario text analysis showed that law enforcement vehicle pursuit, towing and recovery vehicle loading, and disabled vehicle response were particular high-risk activities that led to TIM deaths. Using U.S. data, the motor vehicle towing industry had a significantly higher risk for occupational mortality compared to the fire protection and police protection industries.

CONCLUSIONS

Multiple data sources are needed to comprehensively identify TIM fatalities and to examine the circumstances surrounding TIM fatalities, because no one data source in itself was adequate and undercounted the total number of TIM fatalities. The motor vehicle towing industry, in particular, is at elevated risk for occupational mortality, and targeted mandatory TIM training for the motor vehicle towing industry should be considered. In addition, enhanced law enforcement roadside safety training during vehicle pursuit and apprehension of suspects is recommended.

Concordance of motor vehicle crash, emergency department, and inpatient hospitalization data sets in the identification of drugs in injured drivers

OBJECTIVE

Prescription drug overdoses, abuse, and sales have increased dramatically in the United States in the last decade. The purpose of the present study was to link crash data with emergency department (ED) and inpatient hospitalization data to assess the concordance between the data sets in the identification of the presence of drugs among injured motor vehicle drivers (passenger cars, passenger trucks, light trucks, and semi-trucks) in Kentucky.

METHODS

Kentucky CRASH data were probabilistically linked to ED data sets for years 2008-2010 and to inpatient hospitalization data sets for years 2000-2010. Statistical analyses were performed.

RESULTS

Of the 72,529 linked crash/ED visits, there were 473 drivers with an associated nondependent abuse of drugs diagnosis in the ED, and 930 drivers had drug involvement recorded in the CRASH data (only 163 cases overlapped with drug involvement both recorded in CRASH data and coded as nondependent abuse of drugs in the ED); 64 drivers had multiple drug types present in their system. Of the 20,860 total linked crash/inpatient hospitalization cases, there were 973 drivers diagnosed with nondependent abuse of drugs in the inpatient hospitalization record and 499 drivers had drug involvement recorded in the CRASH data (only 207 overlapped); 250 drivers were diagnosed with multiple drugs in their system.

CONCLUSIONS

Surveillance data from multiple public health data sets is necessary to identify the presence of drugs in injured drivers involved in motor vehicle crashes. The use of a single surveillance data set alone may significantly underreport the number of drugged drivers who were injured in a motor vehicle collision.

The radioactive autopsy: safe working practices

Autopsy cases involving individuals retaining radioactive substances are fortunately rare, but when they occur they can impose significant radiation safety and legal requirements. This review aims to improve the understanding of these issues so that appropriate precautions are implemented when necessary. This review describes the properties of ionizing radiations, natural and man-made sources of ionizing radiation and its use in healthcare. It identifies the most likely circumstances leading to radioactive substances being present during autopsy and sources of information, including radiation protection advice. It discusses precautions that may need to be implemented prior to, during and following autopsy. Despite the issue of appropriate information to patients and next of kin, it is inevitable that some cases will be identified only at autopsy and it is important that robust local procedures are maintained. Information must be communicated to assist safe management of the body and liaison between relevant professional groups may be needed to standardize methods of communication. Provided that appropriate precautions are implemented, determined through consultation with a qualified expert in radiation protection and by completion of risk assessment, the radioactive autopsy can be undertaken safely and in compliance with relevant legislative requirements.

The phylogenetic affinities of Otavipithecus namibiensis

The middle Miocene hominoid Otavipithecus namibiensis is the first and most complete fossil ape from sub-equatorial Africa and represents a significant addition to the taxonomically sparse African middle Miocene hominoid fossil record. The Otavipithecus hypodigm comprises the holotype mandible, which presents a unique mosaic of dental and gnathic characters, and several attributed cranial and postcranial elements which resemble the stem hominoid Proconsul. Contrary to initial hopes that this discovery would provide new insights into hominoid morphological diversity and phylogenetic relationships, a variety of conflicting phylogenetic hypotheses have been advanced suggesting ties to virtually every major large-bodied hominoid group (Conroy et al., 1992; Andrews, 1992 a; Conroy, 1994; Pickford et al., 1994; Begun, 1994 a). Cladistic analysis of a matrix of 22 qualitative and ten quantitative characters of the mandible and mandibular dentition found no support for a close phylogenetic relationship between Otavipithecus and either the African ape or great ape clades, or with any of the Eurasian fossil hominoids with which it has previously been compared. A close relationship between Otavipithecus and Kenyapithecus cannot be ruled out, but is deemed unlikely on the basis both of morphological comparisons and the absence of support within a cladistic framework. The present analysis indicates that Otavipithecus is most closely related to Afropithecus, as previously suggested by Andrews (1992 a) among others. Due to lack of statistical support for this result, a conservative interpretation, that these taxa represented related but divergent lineages of a late early Miocene hominoid radiation, is currently favored. Findings are consistent with the allocation of Otavipithecus to Andrews' (1992 a) tribe Afropithecini which represents the sister group to Kenyapithecus and the extant ape clade.

X-ray structure of pyrrolidone carboxyl peptidase from the hyperthermophilic archaeon Thermococcus litoralis

BACKGROUND

Pyrrolidone carboxyl peptidases (pcps) are a group of exopeptidases responsible for the hydrolysis of N-terminal pyroglutamate residues from peptides and proteins. The bacterial and archaeal pcps are members of a conserved family of cysteine proteases. The pcp from the hyperthermophilic archaeon Thermococcus litoralis is more thermostable than the bacterial enzymes with which it has up to 40% sequence identity. The pcp activity in archaea and eubacteria is proposed to be involved in detoxification processes and in nutrient metabolism; eukaryotic counterparts of the enzyme are involved in the processing of biologically active peptides.

RESULTS

The crystal structure of pcp has been determined by multiple isomorphous replacement techniques at 1.73 A resolution and refined to an R factor of 18.7% (Rfree = 21.4%). The enzyme is a homotetramer of single open alpha/beta domain subunits, with a prominent hydrophobic core formed from loops coming together from each monomer. The active-site residues have been identified as a Cys143-His167-Glu80 catalytic triad. Structural homology to enzymes of different specificity and mechanism has been identified.

CONCLUSIONS

The Thermococcus pcp has no sequence or structural homology with other members of the cysteine protease family. It does, however, show considerable similarities to other hydrolytic enzymes of widely varying substrate specificity and mechanism, suggesting that they are the products of divergent evolution from a common ancestor. The enhanced thermostability of the T. litoralis pcp may arise from hydrophobic interactions between the subunits and the presence of intersubunit disulphide bridges.

Readability of patient information leaflets on over-the-counter (OTC) medicines

OBJECTIVE

To assess the readability of a sample of patient information leaflets included with over-the-counter (OTC) medicines.

DESIGN

Fifty leaflets were obtained from a selection of proprietary products currently available on the U.K. market. The leaflets were scored using six established readability tests.

RESULTS

The mean reading age was 15.4 using the Flesch test and 14.8 using the FOG and the SMOG tests. The individual reading age values for the leaflets ranged from 10 to 20 years. These mean values are well above the mean reading age of the general adult population.

CONCLUSION

Manufacturers need to devise a means of producing leaflets which are easier to read. This is all the more urgent given the trend to down-regulate more potent medicines for non-prescription sale.

Bismuth toxicity--a reassessment

Bismuth compounds, in particular bismuth subsalicylate and colloidal bismuth subcitrate, are now being actively promoted for the treatment of diarrhoea and peptic ulcer disease. The past history of the therapeutic use of bismuth compounds has been marred by episodes of serious adverse reactions. Salicylism is a possible complication with bismuth subsalicylate. This article reviews the pertinent literature on the reported adverse reactions to bismuth compounds to provide the necessary background to assess the value of bismuth subcitrate and bismuth subsalicylate as therapeutic compounds.

Anesthesia and postanesthetic considerations

The anesthesiologist is to be considered a consultant for the anesthetic and perioperative management of the podiatric patient. Each rheumatologic disease offers unique clinical features. The anesthesiologist focuses on the following: pharmacology of therapeutic drugs, control and management of the airway, interaction between the disease and anesthesia, and the available anesthetic regimens. This article addresses each of these subjects, and adds disease-specific information when applicable.

Effect of aerosol challenge on a population of free lung cells in parenterally immunised calves

There is concern that parenteral respiratory vaccines may potentiate lung disease rather than protect against it. In vivo indicators of inflammation in calves were assessed to determine if vaccine-mediated inflammation occurs in the lung following aerosol challenge of parenterally immunised subjects. Preliminary results using a simple protein antigen suggest that changes in the free cell populations of the lung are likely to be a more sensitive indicator of immune-mediated inflammation than clinical parameters or peripheral changes in serum complement.

Dose-finding and premedication studies with zopiclone

The new non-benzodiazepine hypnotic, zopiclone, was investigated as a preanaesthetic medication in a randomized, double-blind, placebo-controlled study in healthy patients scheduled for minor gynaecological surgery. Initially a dose-finding study was conducted in which zopiclone 3.75 mg, 7.5, and 11.25 mg was compared with diazepam 10 mg and placebo; 7.5 mg was established as the optimum dose of zopiclone. In the main study zopiclone 7.5 mg was comparable to diazepam 10 mg at 20, 40, and 60 min after administration and more efficacious at 90 min.