Factors Affecting Adaptability of International Students in Malaysia during COVID-19 Pandemic

It is crucial to investigate adaptability in the context of COVID-19, as evidence suggests that difficulties posed by adaptability can be exacerbated during times of crisis. International students encounter additional pressures during this period, which might impair their capacity to stay and prosper in a new place. In light of this context, the purpose of this study is to examine the factors that contribute to the adaptability of international university students in Malaysia, namely the academic system, acculturation, and social support. A cross-sectional research design was used, and the research instruments were adapted from a number of previous studies. A total of one hundred thirty online questionnaires were filled out by international students in Malaysia. The research hypotheses were evaluated using SPSS Version 27.0. All predictors were found to have a statistically significant and positive effect on the adaptability of international students. This research aims to shed light on educational management strategies for addressing the adaptability challenges faced by most international students within COVID-19 by illuminating the key drivers that influence adaptability. © Journal of Curriculum and Teaching..All rights reserved

Integrating the technology acceptance model on online learning effectiveness of emerging adult learners in Guangzhou, China

Due to the Zero-COVID policies implemented in China, students have accepted online education for curriculum learning for a considerable period of time. The objective of the current study was to determine the relationship between perceived usefulness, perceived ease of use, gender, and the online learning effectiveness of emerging adult learners in Guangzhou, China, who were enrolled in a continuing education program. The research framework was created in accordance with the Technology Acceptance Model (TAM). The convenient sampling and snowball sampling methods were used to collect 123 respondents for the study. Findings revealed that perceived usefulness and perceived ease of use were positively associated with online learning effectiveness, but gender was not. The study recommended that school administrators enhance students' perceived usefulness and perceived ease of use to improve the online learning effectiveness. The findings of this study will provide scholars with insights for improving the investment effectiveness of adult education programs. In addition, because online learning tends to be more adaptable and economical than traditional classes, the increase in learning effectiveness can provide schools with justifications to continue utilizing online education even after the pandemic. © 2023 Conscientia Beam. All Rights Reserved.

The Health Hexagon Model: Postulating a holistic lifestyle approach to mental health for times and places of uncertainty

Professional-driven mental health services are often predicated on westernized beliefs of mental health and distress. This presumptuous view results in treatment solutions that are not suitable to (many) non-western contexts because they are neither culturally valid nor practically sufficient. Instead of promoting imported ideas of mental health, we encourage communities, including Hong Kong, from and for where the authors primarily theorize the current thesis, to turn to and strengthen the resources they employed before the medicalization of distress and suffering. Basic foundational elements in one's everyday life, which we present here as the Health Hexagon Model, should be promoted, especially healthy sleep, healthy diet, regular physical activity, closeness with nature, supportive kinships and friendships, and a sense of purpose, meaning, or sacredness. These elements are not novel;the importance of these basic elements has been recognized, distilled, and transmitted generation after generation. We advocate for communities to identify the missing or hampered fundamental elements in their lives and focus on finding methods that would help them adopt a lifestyle conducive to individual and collective health. This call-to-action is particularly timely as the global community fights for its survival against the coronavirus and ponders ways to cope with the seismic changes in lifestyle it has brought.Copyright © 2022 The Authors

Experimental study of the disinfection performance of a 222-nm Far-UVC upper-room system on airborne microorganisms in a full-scale chamber

222-nm Far-UVC light is an emerging and promising tool for rapidly inactivating airborne pathogens. In this study, we experimentally evaluated the performance of a 222-nm Far-UVC upper-room disinfection system with a 15 W Far-UVC lamp in a full-scale chamber (11.9 m3). One gram-positive bacteria, namely Staphylococcus epidermidis and two gram-negative bacteria, namely Escherichia coli and Salmonella enterica were selected for the experiments. The aerosolized bacteria were injected into the chamber and exposed to 222-nm Far-UVC light. The first-order decay rates of indoor bioaerosols concentration with and without Far-UVC treatment were estimated. According to the results, the 222-nm Far-UVC induced decay rates of three bacteria were 0.0611 ± 0.003, 0.409 ± 0.048, and 0.474 ± 0.015 min−1, respectively. Besides, the UV susceptibility constants (Z-values) of these three bacteria were estimated as 0.157, 0.974, and 1.18 m2/J, respectively. The gram-positive bacteria, S. epidermidis, showed higher resistance to Far-UVC light as compared to the gram-negative bacteria, E. coli and S. enterica. In addition, a case study on airborne SARS-CoV-2 indoor transmission was simulated, and the infection risk of SARS-CoV-2 was compared using the Far-UVC and enhanced ventilation approaches. The results showed that both UV inactivation and ventilation approaches can significantly reduce the infection risk. More importantly, the Far-UVC may be a feasible and sustainable solution for reducing infection risk and improving indoor air quality. © 2023 Elsevier Ltd

Offshore Construction Progress Management by Indoor GIS Positioning: Post-COVID-19 New Normal

Travel restrictions have been imposed among countries since the outbreak of the COVID-19 pandemic. Time delays, budget issues, and poor-quality control in construction projects due to the pandemic have severely affected the construction industry. To reduce the influence of the pandemic, the paper introduces an offshore construction site progress management system with a real case study. With the integration of indoor location-based service technology and image processing method, site superintendents (architect, project director, site manager, engineer) can monitor the site progress easily and pinpoint defects for further investigation and measurement. The visualization of site images together with BIM provides a digital twin platform that can help senior management quickly review the site progress, perform quality checks, and resolve discrepancies in early phases. Positioning of workers and equipment with the adoption of digital maps is a further step in sustainable management. The proposed integration provides a new concept for construction site management during a pandemic and supports the post-COVID-19 new normal in the construction industry. © 2022 International Conference on Construction in the 21st Century. All rights reserved.

Revival and Development of Tunpu Villages within the Context of Rural Revitalization in China: The Contrasting Perspectives of Cultural Heritage and Tourism Industry

The Tunpu village in Anshun city Guizhou province has unique cultural assets, particularly in the village's spatial layout, its traditional building, and the spectacular Dixi opera. In the context of the Chinese Rural Revitalization Strategy, a suitable combination of Cultural Heritage (CH) and the tourism industry to promote the rural revitalization of Tunpu Village is of practical significance. However, the Coronavirus disease (COVID-19) has had a severe impact on the rural revival of Tunpu Village. This article analyzes the current situation of rural revitalization in Tunpu villages from the perspectives of CH and the tourism industry through fieldwork of three Tunpu villages that have already developed tourism up to certain stages. We observed that the participation rate of villagers is not high;the villagers' income through village tourism projects is generally low. While tourist attractions mainly consist of traditional architectural landscapes, buildings management and protection were an issue. CH plays an active role in the tourism industry, but the support provided to tourist facilities and entertainment projects could be further improved. The article concludes that the collaboration of the village government, villagers, and tourism company plays an essential role in integrating the tourism industry and CH. The right strategy is the guide, and the cooperation of the participants is the guarantee. © 2022, ASERS Publishing House. All rights reserved.

Time to forge ahead: The Internet of Things for healthcare

Situated at the intersection of technology and medicine, the Internet of Things (IoT) holds the promise of addressing some of healthcare's most pressing challenges, from medical error, to chronic drug shortages, to overburdened hospital systems, to dealing with the COVID-19 pandemic. However, despite considerable recent technological advances, the pace of successful implementation of promising IoT healthcare initiatives has been slow. To inspire more productive collaboration, we present here a simple—but surprisingly underrated—problem-oriented approach to developing healthcare technologies. To further assist in this effort, we reviewed the various commercial, regulatory, social/cultural, and technological factors in the development of the IoT. We propose that fog computing—a technological paradigm wherein the burden of computing is shifted from a centralized cloud server closer to the data source—offers the greatest promise for building a robust and scalable healthcare IoT ecosystem. To this end, we explore the key enabling technologies that underpin the fog architecture, from the sensing layer all the way up to the cloud. It is our hope that ongoing advances in sensing, communications, cryptography, storage, machine learning, and artificial intelligence will be leveraged in meaningful ways to generate unprecedented medical intelligence and thus drive improvements in the health of many people. © 2022 Chongqing University of Posts and Telecommunications

Assessing the effects of a collaborative problem-based learning and peer assessment method on junior secondary students' learning approaches in mathematics using interactive online whiteboards during the COVID-19 pandemic

Given the demands on instructors created by the COVID-19 pandemic, teachers have been compelled to integrate active learning pedagogies supported by mobile technologies to sustain students' interactive engagement. This study describes the implementation of a novel active pedagogy - the collaborative problem-based learning and peer assessment (Co-PBLa-PA) method, implemented through interactive online whiteboards (IOWBs) in junior secondary mathematics classes in Hong Kong. Data were collected from 87 Form 1 students and analysed to test three hypotheses postulating the main effects of the Co-PBLa-PA method on students' learning approaches using IOWBs. A pre-survey (SPQ) on students' learning approaches and a post-survey (SPQ) on students' learning approaches and their perceptions of technology-enabled active learning (TEAL) were administrated. Results showed the Co-PBLa-PA method, using IOWBs, increased students' learning performance and promoted significant deep learning. A significant positive correlation also emerged between deep learning approaches and students' perceptions of TEAL using IOWBs. Finally, limitations and directions for future research are discussed.

Association of Molnupiravir and Nirmatrelvir-Ritonavir with preventable mortality, hospital admissions and related avoidable healthcare system cost among high-risk patients with mild to moderate COVID-19

Background Real-world data is currently limited on the association between oral antiviral therapy and healthcare system burden in patients with mild-to-moderate COVID-19. This study aims to evaluate the clinical and cost effec-tiveness of Molnupiravir and Nirmatrelvir-ritonavir use in reducing mortality in this population. Methods This is a retrospective cohort study involving 54,355 COVID-19 patients during February 22-March 31,2022 in Hong Kong. Inverse probability of treatment weighting (IPTW) was used to adjust patient characteristics. Our exposure of interest was Molnupiravir/Nirmatrelvir-Ritonavir prescription, with all-cause mortality as the pri-mary outcome. IPTW-adjusted multivariate regressions were used to estimate treatment impact on clinic re -atten-dance and unplanned admissions. Finally, attributed cost and incremental cost-effectiveness ratios (ICER) were estimated. Findings In the outpatient cohort (N = 33,217, 61.1%), 16.1% used Molnupiravir and 13.4% used Nirmatrelvir-Ritona-vir, while in the inpatient cohort (N = 21,138, 38.9%), 3.8% used Molnupiravir and 1.3% used Nirmatrelvir-Ritonavir. IPTW-adjusted Cox model estimated that Molnupiravir (hazard ratio (HR)(95%CI)=0.31 (0.24-0.40), P< 0.0001) and Nirmatrelvir-Ritonavir (HR=0.10 (95%CI 0.05-0.21), P< 0.0001) were significantly associated with a reduced mortality hazard. In the outpatient cohort, both antiviral prescriptions were associated with reduced odds for unplanned hospital admissions (Molnupiravir: odds ratio (OR) =0.72 (0.52-0.98), P=0.039;Nirmatrelvir-Ritonavir: OR=0.37 (0.23-0.60), P<0.0001). Among hospitalised patients, both antiviral prescriptions were associated with sig-nificant reductions in the odds ratios for 28-days readmission (Molnupiravir: OR=0.71 (0.52-0.97), P=0.031;Nirma-trelvir-Ritonavir: OR=0.47 (0.24-0.93), P=0.030). ICERs for death averted for Molnupiravir stood at USD493,345.09 in outpatient settings and USD2,629.08 in inpatient settings. In outpatient settings, Nirmatrelvir-ritonavir cost USD331,105.27 to avert one death, but saved USD5,502.53 to avert one death in comparison with standard care. Interpretation In high-risk patients in Hong Kong with mild-to-moderate COVID-19, Molnupiravir and Nirmatrel-vir-Ritonavir prescriptions were associated with reduced all-cause mortality and significant cost savings.

Quality Improvement Project to Remove Unnecessary Central Venous Catheters in the Non-Icu Setting

INTRODUCTION: Indications for the use of central venous catheters (CL) outside the ICU are limited and prolonged use is associated with CL associated infections (CLABSI). This quality improvement study aimed to reduce the number of unnecessary CLs in the non-ICU setting. METHOD(S): A prospective interventional study was performed between April 4 and July 3, 2022, at a large tertiary care center. Daily chart audits were conducted on all non-ICU adult patients who had a non-tunneled CL to include peripherally inserted central catheters (PICC). Discharged patients, CLs removed prior to audit, duplicate documentation, or inaccurately labeled tunneled lines as nontunneled were excluded. Predetermined non-ICU indications for CL use were need for hemodialysis (HD), chemotherapy, total parenteral nutrition (TPN), long-term antibiotics (ABX), inotropes, and lack of IV access as a last resort. If the CL met indications, the chart was re-audited at one-week intervals to assess for ongoing need. Otherwise, the primary teams were advised to remove CLs. Descriptive statistics were used for analysis. RESULT(S): Of 1093 charts audited, 536 CLs were addressed (male: 60.1%;mean age: 60.7 +/-14.5). Locations of insertion were the floors (48.5%), the ICUs (24.6%) and the OR (16.6%). PICC lines constituted 62.1% of all CLs. Indications for CL placement were ABX (24.4%), vasopressors (20.9%), TPN (16.9%), inotropes (16.0%) and HD (12.1%). CL use in 9.9% of patients did not meet indications and were removed after prompting. Of 553 CLs placed in the ICU, 23.9% made it to the floor;18.9% of these did not meet indications. Our intervention rate decreased in time: 16.2% in the first two weeks vs 6.8% in the last week of the study period. There was no significant change in the number of CLABSIs in the study period (n=2) as compared to the three months prior (n=3) and a similar pre-COVID-19 time period (2019: n=2). All CLABSIs during the study period had appropriate indications for use. CONCLUSION(S): Approximately 10% of CLs outside the ICU did not have appropriate indications. A daily audit protocol on the floors reduced CL days. A significant proportion of CLs placed in the ICUs were inappropriately continued and should be removed when its use is no longer indicated. Continued education is essential to reduce inappropriate CL use.

SURVIVAL OF THE FITTEST OR FRAILEST? COMPARING THE HEALTH OF CENTENARIANS OVER A 10-YEAR PERIOD

The first centenarian study in Hong Kong was conducted in 2011 and examined the multidimensional health of adults aged 95 or older. The 2011 study found that, among a population of about 3,000 centenarians, a significant proportion enjoyed a high degree of autonomy in their daily functions in relatively good health. The study has been repeated in 2021/22 (i.e., born in 1926 or before) when the city had more than 11,000 centenarians. Comparison of the two samples (2011: Nf77;2021/22: Nf120) who lived with their family shows a significant difference in functional health, but not as much for physical health, favouring the 2011 cohort. More than 75% of the 2011 cohort demonstrated autonomy in activities of daily living (Bathing: 77.9%, dressing: 85.7%, toileting: 90.9%, indoor transfer: 89.6%;continence:75.3% and feeding: 94.8%). Only about half of the 2021/22 cohort were autonomous in these areas (40.0%, 44.3%, 54.7%, 42.5%, 63.2%, 46.7%, respectively). The number of chronic illnesses between the two cohorts were comparable (Mean(SD): 2011: 2.7 (1.6);2021: 3.26 (1.60), yet dementia and frailty were more prevalent in the 2021 cohort (dementia: 44%;frailty: 9.1%) then the 2011 cohort (41.0%;23.4%). Our findings alert metropolitans worldwide to the fast-increasing population of adults of advanced age with significant personal care and health needs in the community. Existing care for older adults has to be reframed and overhauled to provide comprehensive home- and personal-care support which will be essential for realizing ageing-in-place for adults in advanced age, especially after social distancing policies in COVID-19.

COMPARING SUCCESSFUL AGING OF NEAR-CENTENARIANS AND CENTENARIANS: FINDINGS FROM 2011 AND 2021/22

Successful aging (SA) was proposed by Robert J Havighurst in 1961 to capture how older adults add "lives onto (their) years.” While there is a consensus regarding the multidimensionality of the concept, the set of criteria that should be applied to older adults of advanced age remain controversial. Notwithstanding their inevitable decline in physical health, adults of advanced age may still enjoy good psychosocial well-being. In this light, we compared the proportion of "successful agers” in two cohorts of adults aged 95 or above who lived with their families in 2011 (Nf77) and 2021/22 (Nf120) in Hong Kong using two models – Model A: i: Good subjective health, ii: more well-off than average, iii: as happy as young (Cho et al., 2012) and Model B: i: Weekly social activities, ii: absence of dementia, iii: intact sight and hearing ability, iv: intact mobility (Nosraty et al, 2012). Both models have been applied in adults aged 90 or above. In the 2011 cohort, 13.0% and 16.9% of our sample fulfilled the SA criteria of Model A & B respectively. The percentages fell to 1.7% and 13.7% respectively in the 2021/22 cohort. The decrease is due to less participants fulfilling the financial criterion of Model A, as well as the criteria on intact sight and hearing ability and the absence of dementia of Model B. COVID presents multidimensional challenges for adults of advanced age. Examining the dimensions that are most impacted will help orient recovery works along the direction of SA.

LOVE OR OBLIGATION TO "SEE THEM THROUGH:” BURDENS AND GAINS IN CAREGIVING FOR CENTENARIANS

In Hong Kong, the population of centenarians increased from about 3,000 in 2011 to over 10,000 in 2021. The growth of this population has led to challenges concerning how far family caregivers, who are usually older adults themselves, could care for their spouse or parents. In 2021, we launched the 2nd Hong Kong Centenarian Study and included the voices of family caregivers. Notwithstanding the increased difficulties of caregiving during COVID outbreaks, our interviews with 120 caregivers revealed low to moderate scores of caregiving burden and gains (measured by 4-items from the Zarit Burden Scale and 5-items from the Positive Aspects of Caregiving Scale). Female and older (aged 70 or above) caregivers reported more emotional distress, burden, and poorer self-rated health, while younger caregivers (less than 70 years old) sustained a wider social network. Financial stress was related to smaller social network size and more emotional distress. When being asked what sustained their motivation to care for their spouse or for their parents, "filial obligation to see them through” and "repaying for love” were answered as key motivators. Caregivers also derived pride and satisfaction from contributing to the remarkable longevity of their loved ones or from witnessing their loved ones recovering from life-threatening traumas (e.g., falls, hospitalization), but felt helpless when faced with escalating care needs due to their own deteriorating physical health and capacities. "Double-old caregiving” will become more common, and society will need to overhaul the care system to support these motivated families who have escalated care needs.

Implications of novel Adenovirus-Host interactions in Thrombosis with Thrombocytopenia Syndrome

In this study we investigated a link between adenovirus-based vaccines, deployed to fight the SARS-CoV-2 pandemic, and lifethreatening thromboembolisms after vaccination. Post-marketing surveillance showed that, following vaccination, Vaxzevria (ChAdOx1 based, AstraZeneca) and Jcovden (Adenovirus type 26 based, Johnson & Johnson) are associated with reduced platelet counts (thrombocytopenia) and blood clots (thrombosis) in some individuals. This extremely rare condition, with a rate between 1:50,000 - 1:350,000 cases per vaccinated individual, is above background rates of thrombosis in the population and can lead to fatal ischemic events including cerebral venous thrombosis, intracranial haemorrhage, and pulmonary embolism. It has been termed vaccine induced thrombotic thrombocytopenia (VITT) or thrombosis with thrombocytopenia syndrome (TTS). Heparin induced thrombocytopenia (HIT) is another condition with a similar clinical presentation to TTS. In HIT, immunoaggregates are formed due to the presence of strong anti-selfantibodies directed against Platelet Factor 4 (PF4). When similar anti-PF4 antibodies were detected in TTS patients, we investigated whether there could be a link between the adenovirus vectors used in the vaccines and PF4. This study demonstrates a direct interaction between adenovirus capsids and PF4 using surface plasmon resonance. We then utilized an integrative structural biology workflow including cryo-electron microscopy and molecular dynamics to characterize and demonstrate the mechanism of this interaction. These results demonstrate a previously unknown adenovirushost interaction and provide critical clues as to the underlying mechanism which causes TTS, including how these pathogenic anti-PF4 antibodies may be induced. We are therefore able to present a hypothesis as to the route of pathogenesis in TTS.

At the Heart of Learning: Affect, Identity and Care

Over the last few years, learning scientists have become increasingly interested in research around student's motivational and emotional processes, guided by a commitment to affirm learners' individual identities and support justice-oriented design and pedagogies. With ample evidence to show that the Covid-19 pandemic has exaggerated learner's struggles with their thoughts, feelings, and identity, the importance of such research has never been higher. This symposium brings together an international group of scholars with varying research contexts (online, in-person, hybrid, blended), working with students of different age groups (K-12, Undergraduates, pre-service teachers) to present their work around affective learning and teaching. The symposium's focus on affective learning designs that acknowledge learner emotions, affirm their identity, foster designer empathy and build a pedagogy of care will springboard deeper discussions in the ISLS community to further explore "global perspectives on equity and justice that promote the empowerment of educational innovation for all” (ISLS, 2022). © ISLS.

Prehabilitation before gastrointestinal cancer surgery (PREHAB-GI): an implementation study

Background: Surgery is the standard treatment for early-stage colorectal and upper gastrointestinal (UGI) cancers. Prehabilitation aims to improve preoperative functional reserves through physical, nutritional, and/or psychological interventions. We aimed to evaluate the implementation of a multimodal prehabilitation program in gastrointestinal cancer surgery patients. Method(s): Single-arm implementation trial using a pre-post study design. Colorectal or UGI cancer patients scheduled for curative intent surgery at Concord Hospital, with >=14 days pre-surgery were recruited. Intervention delivered face-toface or by telehealth (COVID adaptations): 2-4-week program consisting of: i) supervised exercise (minimum 1/week);ii) dietary education session and daily high protein supplement;iii) weekly nursing support. Assessments: baseline, pre-surgery, and 30-days post-surgery. Primary Outcome: implementation using RE-AIM (Reach/Efficacy/Adoption/Implementation/ Maintenance) framework. Secondary outcomes included functional capacity, nutritional and psychological status changes. Result(s): Total 198 were screened over 16 months;100 (51%) were eligible. Reach/representativeness: 77/100 recruited (64 colorectal, 13 UGI). Mean (SD) age 67 (12.4) years;46 (60%) males. Median intervention duration 16 days (IQR:8). Adoption: 91% (70/77) referrals directly from surgeons. Implementation: 72/77 completed the intervention (34% of assessments and intervention sessions delivered by telehealth). Five withdrew: psychological stress (n = 2), medical (n = 1), disease progression (n = 1), noncompliance COVID precautions (n = 1). Adherence to all modalities was 34% (64% exercise, 81% nutrition, 63% nursing). Adherence rate for 31/35 patients was affected by staff unavailability. Efficacy: Functional capacity (mean 6-minute walk test) change from baseline to pre-surgery 464.4-471.7m(p=.775);and baseline to after surgery 464.4 to 482m(p = .052). No significant changes were seen in nutritional and psychological outcomes. Patient satisfaction:96%strongly recommended prehabilitation. Clinician satisfaction was high. Conclusion(s): Our results show a brief prehabilitation intervention (exercise, nutrition, psychological support) can be successfully implemented in a real-world setting;with a trend to improvement in functional capacity. Prehabilitation is an opportunity to optimize patients' function before gastrointestinal cancer surgery.

Persistence of Ad26.COV2.S-associated VITT and specific detection of VITT antibodies

Background: Some COVID-19 vaccinated individuals develop anti-platelet factor 4 (PF4) antibodies that cause thrombocytopenia and thrombosis;a rare syndrome referred to as vaccine-induced immune thrombotic thrombocytopenia (VITT). Currently, information on the characteristics and persistence of anti-PF4 antibodies that cause VITT after Ad26.COV2.S vaccination is limited, and available PF4-polyanion enzyme-linked immunosorbent assays (ELISAs) and functional diagnostic assays fail to differentiate Ad26.COV2.S and ChAdOx1 nCoV-19-associated VITT from similar clinical disorders, namely heparin-induced thrombocytopenia (HIT) and spontaneous HIT. Aim(s): Evaluate the persistence of anti-PF4 antibodies in Ad26. COV2.S-associated VITT and correlate findings with clinical and laboratory variables such as thrombosis and platelet counts. Develop/ investigate laboratory tools that differentiate VITT antibodies from HIT and spontaneous HIT. Method(s): Blood samples from VITT and HIT patient cohorts were tested in antigen-based and functional assays and correlated with clinical and laboratory features. Result(s): While Ad26.COV2.S-associated VITT patients were strongly positive in PF4-polyanion ELISAs;they were frequently negative in the serotonin release assay (4 of 8 tested patients were negative). In contrast, the PF4-dependent p-selectin expression assay (PEA) that uses PF4-treated platelets consistently diagnosed Ad26.COV2.S-associated VITT. Most Ad26.COV2.S-associated VITT antibodies persisted for >5 months in PF4-polyanion ELISAs, while the PEA became negative earlier. Two patients had otherwise unexplained mild persistent thrombocytopenia (140-150,000/ mul) six months after acute presentation. No recurrence of thrombosis was noted. Additionally, a novel un-complexed PF4 ELISA specifically differentiated VITT secondary to Ad26.COV2.S and ChAdOx1 nCoV-19 vaccination, from spontaneous HIT and HIT (Fig 1A-PF4/ polyanion ELISA;Fig 1B-Un-complexed PF4 ELISA;closed black circles-Ad26. COV2.S-associated VITT;closed red circle-ChAdOx1 nCoV-19-associated VITT;***p < 0.001;****p < 0.0001). Its specificity was further confirmed by testing commonly-encountered HIT-suspected patient samples that are PF4/polyanion ELISA-positive but negative in functional assays (1A-1B). Conclusion(s): Ad26.COV2.S-associated VITT antibodies are persistent, and the un-complexed PF4 ELISA appears to be both sensitive and specific for VITT diagnosis.

BOOST KIDNEY: A Randomized Controlled Trial of Third Dose BNT162b2 vs. mRNA-1273 COVID-19 Vaccination in CKD and Dialysis Patients

Background: Due to waning humoral immunity, a third COVID-19 vaccine dose is recommended but there is a lack of evidence regarding whether there is benefit to homologous versus heterologous mRNA vaccination. Method(s): This was a multi-centre parallel group randomized controlled trial in Toronto, Ontario from September 30, 2021 to May 13, 2022 which enrolled participants with stage 3B-5 chronic kidney disease with prior homologous mRNA two dose vaccination. Overall 273 participants were randomized 1:1 to either 30mug BNT162b2 (n=137) or 100 mug mRNA-1273 (n=136) third dose stratified by initial vaccine type. Neutralizing antibodies against the B.1.1.529 (Omicron) variant of concern as well as binding SARS-CoV-2 IgG antibodies to the spike protein, receptor binding domain, and nucleocapsid protein were measured. Result(s): Participants had a median age of 67 years, 94% were on dialysis, 3% had prior COVID-19, and 59% had received BNT162b2 for initial two dose vaccination. Prior to the third vaccine dose, detectable Omicron neutralizing antibodies were present in 2% with BNT162b2 and 54% with mRNA-1273 two dose vaccination. At 1 month post third dose, among those with baseline BNT162b2, Omicron-specific neutralizing antibodies were detectable in 84% with third dose BNT162b2 in comparison to 83% with third dose mRNA-1273 (p=0.70). In those with baseline mRNA-1273, 100% receiving third dose mRNA-1273 had Omicron-specific neutralizing antibodies in comparison to 96% with third dose BNT162b2 (p=0.75). During the study period, 9.3% of participants (n=25) contracted COVID-19 and two died from COVID-19 with no difference in infection based on vaccine type (p=0.26). Conclusion(s): In this randomized controlled trial of third dose COVID-19 vaccination, both homologous and heterologous vaccination elicited robust SARS-CoV-2 neutralizing antibody response. (Figure Presented).