CLINICAL OUTCOMES BY SARS-CoV-2 VARIANT AT A SINGLE ACADEMIC MEDICAL CENTER

Background: SARS-CoV-2 continues to change over time due to genetic mutations and viral recombination.1 Given the changing landscape of COVID-19 variants and availability of COVID-19 vaccinations, disease severity during acute infection has also been variable. However, most research related to COVID-19 to date has not focused on evaluating differences in outcomes by the dominant variant and the impact it might have on post-acute sequalae of COVID-19 (PASC). Method(s): We developed a data mart of electronic health record data pertaining to COVID-19 in a single North American metropolitan health system (RUSH University Medical Center). Patients were selected for analysis if they had at least one documented infection of COVID-19. Date ranges were established per dominant variant, and the date of diagnosis was matched to variant. Variants were determined by the most prominent variant of concern (VOC) circulating in the city of Chicago. Variants were categorized by the following by date ranges: Wildtype+D614G (3/7/20-3/20/21), Alpha (3/21/21-6/19/21), Delta (6/20/21-12/11/21), Omicron BA.1 (12/12/21-3/19/22), Omicron BA.2 (3/20/22- 6/18/22), and Omicron BA.4/BA.5 (6/19/22-present (9/30/22). Subsequent clinical outcomes were examined, including hospitalization, intensive care unit admission, or death. We characterized our sample by conducting descriptive statistics including frequency and percent of outcome by variant. Result(s): 44,499 patients were included in this analysis with 30.23% requiring hospitalization, 4.25% being admitted to intensive care unit (ICU), and 2.35% resulting in death. The greatest percentage of hospitalizations occurred with the Alpha variant at 41.88% (N=928), and the greatest percentage of ICU admissions (6.43%) and death (3.15%) occurred with the Delta variant. The latest Omicron variant (Wave 6) showed an increase in hospitalizations (35.18%), as compared to early Omicron waves (Wave 4 and 5) but maintained similar ICU rates. Death rates continued to decline during the Omicron waves (Table 1). Conclusion(s): Although Alpha and Delta variants seem to have more severe outcomes compared to other variants, it is important to note that COVID-19 prevention, treatment access, and management continues to change, potentially influencing how outcomes may differ over time. Future work should determine factors to adjust for when examining variant-level differences.

Temporal Trend in Mortality from Covid-19 Associated with Cardiovascular Disease

Background Coronavirus disease 2019 (COVID-19) mortality remains high in those with cardiovascular disease (CVD). The temporal trend in higher COVID-19 mortality due to CVD has public health implications. We assessed the association between CVD and COVID-19 mortality throughout the COVID-19 pandemic. Methods We retrospectively studied all patients who received care for COVID-19 at Rush University System for Health during the pandemic (divided into 7 waves based on predominant virus variants and vaccine rollouts). CVD was defined as congestive heart failure (CHF), myocardial infarction (MI), cerebrovascular or peripheral vascular disease (ascertained by ICD codes). Using multivariable logistic regression, we assessed independent associations of COVID-19 mortality with age, sex, race, and 17 comorbidities in the Charlson comorbidity index, overall and stratified by pandemic waves. Results Of 43876 patients (mean age 40, 56% female, 14% with CVD), 1032 (2%) died from COVID-19 between March 2020 and August 2022. Adjusted for covariables, mortality was 3.2 times as likely in those with CVD as those without (OR=3.2, 95%CI 2.7-3.9;p<0.001). There was a trend toward increasing mortality associated with co-existing CVD as pandemic progressed to later waves (where Delta and Omicron were predominant), particularly in those with CHF or MI (Figure). Conclusion We found that COVID-19 mortality associated with co-existing CVD (particularly CHF and MI) increased temporally throughout the pandemic. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Role and Rewards of Information and Communication Technology (ICT) Interventions in Edification During COVID-19 Pandemic

The information and communication technology (ICT) has drastically magnified the usage within education in context to exchange, and value of know-how among college students however their geo-image location. The regulations of social isolation due to pandemic through Corona substantially affected the educational approaches and mode of various available technologies in schooling. The process of teaching learning across the world has to deal against dissemination, accessibility, and team spirit of instructional methods, beliefs, and philosophies at worldwide. Schooling with the use of technology-enabled applications will evoke an upward thrust in manufacturing and efficacy in phrases of worldwide educational carrier shipping among countries of the global. Global tendencies and stories have proven that victimization ICT in coaching and gaining knowledge can’t be absolutely clean-exceeded from a few obtrusive inner and outside encumbrances especially for the duration of this period of COVID-19 that has brought about societal and scientific constraints are introduced. Nonetheless, records generation has a tremendous useful impeccant on the academic spectrum. This have a look at used a literature evaluate to study the numerous writers’ views on the global effect of ICT on schooling on a bigger scale. As a result, they have a look at suggests: heads of governments need to re-flip up with harmonized educational rules and prison frame-works for kingdom and states that may be predicated on growing the quantity of accessibility and implications of ICT in education. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Covid-19 Pandemic: Pre and Post Covid Relative Analysis of Rural Patients' Health

In this uncertainty of COVID 19 pandemic, everyone want to be safer and there is no choice than to adopt new normal, so it is sound to analyse pre and post COVID relative impact an patients health so as to redesign routine or new normal. In fact, all these patients and such patients from entire world are facing post COVID problems also which may be related to different parameters different symptoms, age, preexisting conditions, infection frequency, severity level, stage of diagnosis and more specifically life span and treatment styles in various Hospitals at diverse socio-economic structures/though processes. Hence the medical staff and stakeholders necessarily have to adopt a distinct strategy for future treatments based on past experiences. COVID treatment in hospitals need to be understood as the systematic and coordinated implementation of medical policy by Medical undertakings whether private or state owned, local or regional, national or international, level to achieve the optimum cost of life, time and resources of the needs of particular patient groups and, in doing so, to achieve an appropriate treatments and care.

Project Progress Monitoring and Assessment at Engineering Undergraduate Level during Covid 19 Pandemic - Challenges and Solution

The engineering curriculum includes core courses, projects and elective courses. Students need to register for courses and earn credits in their four years of the degree. Face-to-face teaching, laboratory assignments, course projects, mini, minor and capstone projects are essential components that provide a holistic view of courses studied and practical hands-on experiences. Teachers' course delivery plan as per the schedule, contact hours, discussion, and continuous assessment are vital practices that make students on the learning wheel complete degree completion successfully. But, the COVID-19 pandemic has created the most significant disruption of education systems in human history, affecting nearly 1.6 billion learners in more than 200 countries. Lock down in schools, institutions, and other learning spaces have impacted more than 94% of the world's student population. This scenario has brought far-reaching changes in all aspects of our lives. Social distancing and restrictive movement policies have significantly disturbed traditional educational practices. In this paper, authors discuss challenges faced by students and faculty in the project space. We propose a novel collaborated approach for monitoring and carrying out projects during the pandemic in engineering at Under Graduate (UG) level. The success of this approach is based on collaboration and coordination between faculty and Students. Our proposed method uses tools and pedagogy approaches such as Learning Management System (LMS), MS Team (Microsoft), and Google Apps for documents to administrate student activities and communication. Also, phase-wise reviews helped to monitor the progress of projects. Significant challenges during this online monitoring and assessment were internet bandwidth and follow-up of individual contributions. The main advantages of this approach are improvement in communication skills, time management, distantly work in a team, sharing the code and project management. Student's and faculty's feedback, semester-end results speak positivity of the approach followed.

Risks for Hospitalization and Death Among Patients with Blood Disorders from the ASH RC COVID-19 Registry for Hematology

INTRODUCTION: Patients (pts) with blood disorders are at particular risk for severe infection and death from COVID-19. Factors that contribute to this risk, including cancer treatment, have not been clearly delineated. The ASH RC COVID-19 Registry for Hematology is a public-facing, volunteer registry reporting outcomes of COVID-19 infection in pts with underlying blood disorders. We report a multivariable analysis of the impact of cancer treatment and other key variables on COVID-19 mortality and hospitalization among pts with blood cancer. METHODS: Data were collected between April 1, 2020, and July 2, 2021. All analyses were performed using R version 4.0.2. Multivariable logistic regression explored associations between mortality and seven patient/disease factors previously reported as important to COVID-19 outcome. Independent variables included: age (>60);sex;presence of a major comorbidity (defined as any of heart disease, hypertension, pulmonary disease and/or diabetes);type of hematologic malignancy;estimated prognosis of < 6 months prior to COVID-19;deferral of ICU care;and administration of cancer treatment in the previous year (excluding single agent hydroxyurea). A secondary multivariable logistic regression explored associations between the same variables and hospitalization with COVID-19. RESULTS: We included all pts in the registry with a malignant diagnosis except for 3 patients excluded based on a data sharing agreement (N=1029). Median age category was 50-59y (range <5y to > 90y). The sample was 42% female and 28% had major comorbidities. Types of hematologic malignancies were 354 (34%) acute leukemia/MDS, 255 (25%) lymphoma, 206 (20%) plasma cell dyscrasia (myeloma/amyloid/POEMS), 116 (11%) CLL, 98 (10%) myeloproliferative neoplasm (MPN). Most pts (73%) received cancer treatment during the previous year, 9% had a pre-COVID-19 prognosis of <6months, and 10% deferred ICU care. COVID-19 mortality in the entire cohort was 17%. In multivariable analyses, age > 60 (OR 2.03, 1.31-3.18), male sex (OR 1.69, 1.11 - 2.61), estimated pre-COVID-19 prognosis of less than 6 months (OR 6.16, 3.26 - 11.70) and ICU deferral (OR 10.87, 6.36 - 18.96) were all independently associated with an increased risk of death. Receiving cancer treatment in the year prior to COVID-19 diagnosis and type of hematologic malignancy were not significantly associated with death. In multivariable analyses, age > 60 (OR 2.46, 1.83 - 3.31), male sex (OR 1.34, 1.02 - 1.76), estimated pre-COVID-19 prognosis of < 6 months (OR 4.81, 2.45 - 10.50), presence of a major comorbidity (OR 1.57, 1.15 - 2.16), and cancer treatment in the previous year (OR 1.50, 1.10 - 2.06) were all independently associated with an increased risk of a severe COVID-19 requiring hospitalization. Pts with a MPN or plasma cell dyscrasia and COVID-19 were less likely to require hospitalization for COVID-19 compared to patients with CLL, leukemia/MDS, or lymphoma. CONCLUSIONS: These analyses confirm the negative impact of age > 60, male sex, pre-COVID-19 prognosis of < 6 months, and deferral of ICU care on mortality among patients with hematologic malignancy and COVID-19. We did not observe an increased risk of COVID-19 mortality among pts with COVID-19 who received blood cancer treatment in the previous year, although rate of hospitalization was higher. Pts with some hematologic malignancies (MPN, plasma cell dyscrasias), may experience less severe COVID-19 infections than others. Disclosures: Anderson: Celgene: Membership on an entity's Board of Directors or advisory committees;Millenium-Takeda: Membership on an entity's Board of Directors or advisory committees;Gilead: Membership on an entity's Board of Directors or advisory committees;Janssen: Membership on an entity's Board of Directors or advisory committees;Sanofi-Aventis: Membership on an entity's Board of Directors or advisory committees;Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees;Pfizer: Membership on an entity's Board of Directors or advisory committees;Scientific Founder of Oncopep and C4 Therapeutics: Current equity holder in publicly-traded company, Current holder of individual stocks in a privately-held company;AstraZeneca: Membership on an entity's Board of Directors or advisory committees;Mana Therapeutics: Membership on an entity's Board of Directors or advisory committees. Desai: Janssen R&D: Research Funding;Astex: Research Funding;Kura Oncology: Consultancy;Agios: Consultancy;Bristol Myers Squibb: Consultancy;Takeda: Consultancy. Goldberg: Celularity: Research Funding;Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees;Astellas: Consultancy, Membership on an entity's Board of Directors or advisory committees;Aptose: Consultancy, Research Funding;Prelude Therapeutics: Research Funding;DAVA Oncology: Honoraria;Pfizer: Research Funding;Arog: Research Funding;Aprea: Research Funding;AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Neuberg: Madrigal Pharmaceuticals: Other: Stock ownership;Pharmacyclics: Research Funding. Radhakrishnan: Janssen India: Honoraria;Dr Reddy's Laboratories: Honoraria, Membership on an entity's Board of Directors or advisory committees;Aurigene: Speakers Bureau;Novartis: Honoraria;Johnson and Johnson: Honoraria;Pfizer: Consultancy, Honoraria;Astrazeneca: Consultancy, Honoraria;Emcure Pharmaceuticals: Other: payment to institute;Cipla Pharmaceuticals: Honoraria, Other: payment to institute;Bristol Myers Squibb: Other: payment to institute;Roche: Honoraria, Other: payment to institute;Intas Pharmaceutical: Other: payment to institute;NATCO Pharmaceuticals: Research Funding. Sehn: Genmab: Consultancy;Debiopharm: Consultancy;Novartis: Consultancy. Sekeres: Novartis: Membership on an entity's Board of Directors or advisory committees;Takeda/Millenium: Membership on an entity's Board of Directors or advisory committees;BMS: Membership on an entity's Board of Directors or advisory committees. Tallman: Kura: Membership on an entity's Board of Directors or advisory committees;Syros: Membership on an entity's Board of Directors or advisory committees;Innate Pharma: Membership on an entity's Board of Directors or advisory committees;Novartis: Membership on an entity's Board of Directors or advisory committees;Biosight: Membership on an entity's Board of Directors or advisory committees;Roche: Membership on an entity's Board of Directors or advisory committees;Jazz Pharma: Membership on an entity's Board of Directors or advisory committees;Oncolyze: Membership on an entity's Board of Directors or advisory committees;KAHR: Membership on an entity's Board of Directors or advisory committees;Orsenix: Membership on an entity's Board of Directors or advisory committees;Daiichi-Sankyo: Membership on an entity's Board of Directors or advisory committees;Abbvie: Membership on an entity's Board of Directors or advisory committees;Amgen: Research Funding;Rafael Pharmaceuticals: Research Funding;Glycomimetics: Research Funding;Biosight: Research Funding;Orsenix: Research Funding;Abbvie: Research Funding;NYU Grand Rounds: Honoraria;Mayo Clinic: Honoraria;UC DAVIS: Honoraria;Northwell Grand Rounds: Honoraria;NYU Grand Rounds: Honoraria;Danbury Hospital Tumor Board: Honoraria;Acute Leukemia Forum: Honoraria;Miami Leukemia Symposium: Honoraria;New Orleans Cancer Symposium: Honoraria;ASH: Honoraria;NCCN: Honoraria.

Clinical Predictors of Outcome in Adult Patients with Acute Leukemias and Myelodysplastic Syndrome and COVID-19 Infection: Report from the American Society of Hematology Research Collaborative (ASH RC) Data Hub

Background: Predictors of severe infection and outcomes with COVID-19 in patients (pts) with acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL) and myelodysplastic syndromes (MDS) are lacking. Pts with active disease may experience worse outcomes due to overall prognosis and cytopenias. Here we identify risk factors for severe COVID-19 infection and mortality in pts with AML, MDS, and ALL using the ASH RC COVID-19 Registry for Hematology. Methods: The ASH RC COVID-19 Registry for Hematology includes features and outcomes of a laboratory-confirmed or presumptive diagnosis of SARS-CoV-2 infection in adult pts with ongoing or a history of blood disorders. The Registry opened for data collection on April 1, 2020 and is a global effort housed on a secure data platform hosted by Prometheus Research, an IQVIA company. Data are made publicly available and regularly updated on the ASH RC website. Pt characteristics, outcomes, and predictors were analyzed and stratified by disease status (active initial diagnosis and relapsed/refractory vs. remission) and type of hematologic malignancy. Variables included age, comorbidities, type of hematologic malignancy (AML, MDS, ALL), neutrophil and lymphocyte count at time of COVID-19 diagnosis, and active treatment at the time of COVID-19 diagnosis. COVID-19 severity was defined as mild (no hospitalization required), moderate (hospitalization required), or severe (ICU admission required). Categorical pt characteristics for each response group and associations between response groups and characteristics (i.e., alive vs. dead, severity vs. non-severity) were summarized by frequency with differences between response groups evaluated by Fisher's exact test and odds ratios with 95% confidence intervals (CIs) estimated by logistic regression. Multivariable analyses identified independent predictors of outcomes. Results: Analyses were conducted on data from 257 pts with AML (n=135), MDS (n=40), and ALL (n=82);46% were in remission and 44% had active disease (10% unknown). Overall mortality from COVID-19 infection was 21%. Pts with active disease were significantly more likely to present with moderate and severe COVID-19 compared to those in remission (remission vs. active disease, severe 33% (n=20) vs. 67%(n=40), moderate 45% (n=35) vs.55% (n=42), and mild: 67% (n=56) vs. 33% (n=28), p value <0.001) (Figure 1). This was significant when categorized as severe vs. non severe as well (p=0.002). COVID-19 severity was also associated with AML diagnosis, major comorbidities, and neutropenia and lymphopenia at the time of COVID-19 diagnosis. Univariate analyses of increased mortality after COVID-19 diagnosis were significantly associated with advanced age, male sex, pre-diagnosis survival < 6 months, active disease status, neutropenia, lymphopenia and forgoing ICU care. Multivariable analyses in all pts (Figure 1), revealed that increased COVID-19 related mortality was significantly associated with neutropenia at diagnosis (OR 3.15, 95% C.I. 1.31-8.08, p=0.01), estimated pre-COVID-19 prognosis of < 6 months (OR 8.58, 95% C.I. 3.24-24.46, p<0.001) and forgoing ICU care (OR 6.66, 95% C.I. 2.56-18.23, p<0.001). Among hospitalized pts, increased COVID-19 mortality was associated with estimated pre-COVID-19 prognosis of < 6 months (OR 6.77, 95% C.I. 2.34-22.24, p<0.001) and forgoing ICU care (OR 3.98, 95% C.I. 1.45-11.66, p=0.007). Pts who were older, male, smokers, with active disease, or estimated to have pre-COVID-19 survival of < 6 months were more likely to forgo ICU care. Forgoing ICU care (n=37,16%) was associated with a higher COVID-19 mortality in all pts (n=234, OR 15.6, 95% C.I. 6.4-40.9, p<0.001), hospitalized pts (n=143, OR 9.2, 95% C.I., 3.5-26.5, p<0.001) and in pts where ICU admission was indicated and declined (n=61 OR 5.6, 95% C.I. 1.1-56.4, p=0.03)). Neither active disease status nor ongoing cancer treatment were associated with increased mortality among hospitalized patients. Conclusions: These data suggest that patients with active disease experience significantly higher COVID-19 severity but not increased mortality from COVID-19. Patients who had neutropenia and a pre-COVID-19 prognosis of < 6 months had higher mortality from COVID-19 infection and may be more likely to forgo ICU care. If desired by patients, aggressive support for hospitalized patients with COVID-19 is appropriate regardless of remission status. [Formula presented] Disclosures: Desai: Agios: Consultancy;Janssen R&D: Research Funding;Kura Oncology: Consultancy;Bristol Myers Squibb: Consultancy;Astex: Research Funding;Takeda: Consultancy. Goldberg: AbbVie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding;Aprea: Research Funding;Prelude Therapeutics: Research Funding;Pfizer: Research Funding;Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees;DAVA Oncology: Honoraria;Astellas: Consultancy, Membership on an entity's Board of Directors or advisory committees;Arog: Research Funding;Celularity: Research Funding;Aptose: Consultancy, Research Funding. Anderson: Sanofi-Aventis: Membership on an entity's Board of Directors or advisory committees;Celgene: Membership on an entity's Board of Directors or advisory committees;Gilead: Membership on an entity's Board of Directors or advisory committees;Janssen: Membership on an entity's Board of Directors or advisory committees;Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees;Pfizer: Membership on an entity's Board of Directors or advisory committees;Millenium-Takeda: Membership on an entity's Board of Directors or advisory committees;Scientific Founder of Oncopep and C4 Therapeutics: Current equity holder in publicly-traded company, Current holder of individual stocks in a privately-held company;AstraZeneca: Membership on an entity's Board of Directors or advisory committees;Mana Therapeutics: Membership on an entity's Board of Directors or advisory committees. Neuberg: Pharmacyclics: Research Funding;Madrigal Pharmaceuticals: Other: Stock ownership. Radhakrishnan: Emcure Pharmaceuticals: Other: payment to institute;Bristol Myers Squibb: Other: payment to institute;Astrazeneca: Consultancy, Honoraria;Cipla Pharmaceuticals: Honoraria, Other: payment to institute;Pfizer: Consultancy, Honoraria;Johnson and Johnson: Honoraria;Novartis: Honoraria;Aurigene: Speakers Bureau;Roche: Honoraria, Other: payment to institute;Intas Pharmaceutical: Other: payment to institute;Dr Reddy's Laboratories: Honoraria, Membership on an entity's Board of Directors or advisory committees;Janssen India: Honoraria;NATCO Pharmaceuticals: Research Funding. Roboz: Novartis: Consultancy;Mesoblast: Consultancy;Amgen: Consultancy;Actinium: Consultancy;AbbVie: Consultancy;Janssen: Consultancy;Blueprint Medicines: Consultancy;Astex: Consultancy;Janssen: Research Funding;Daiichi Sankyo: Consultancy;Jazz: Consultancy;Agios: Consultancy;Glaxo SmithKline: Consultancy;Celgene: Consultancy;Otsuka: Consultancy;Astellas: Consultancy;Helsinn: Consultancy;MEI Pharma - IDMC Chair: Consultancy;Jasper Therapeutics: Consultancy;Bristol Myers Squibb: Consultancy;AstraZeneca: Consultancy;Bayer: Consultancy;Pfizer: Consultancy;Roche/Genentech: Consultancy. Sehn: Novartis: Consultancy;Genmab: Consultancy;Debiopharm: Consultancy. Sekeres: Takeda/Millenium: Membership on an entity's Board of Directors or advisory committees;Novartis: Membership on an entity's Board of Directors or advisory committees;BMS: Membership on an entity's Board of Directors or advisory committees. Tallman: Syros: Membership on an entity's Board of Directors or advisory committees;Kura: Membership on an entity's Board of Directors or advisory committees;NYU Grand Rounds: Honoraria;Innate Pharma: Membership on an entity's Board of Directors or advisory committees;Novartis: Membership on an entity's Board of Directors or advisory committees;Biosight: Membership on an entity's Board of Directors or advisory committees;Roche: Membership on an entity's Board of Directors or advisory committees;Jazz Pharma: Membership on an entity's Board of Directors or advisory committees;Oncolyze: Membership on an entity's Board of Directors or advisory committees;KAHR: Membership on an entity's Board of Directors or advisory committees;Orsenix: Membership on an entity's Board of Directors or advisory committees;Daiichi-Sankyo: Membership on an entity's Board of Directors or advisory committees;Abbvie: Membership on an entity's Board of Directors or advisory committees;Amgen: Research Funding;Rafael Pharmaceuticals: Research Funding;Glycomimetics: Research Funding;Biosight: Research Funding;Orsenix: Research Funding;Abbvie: Research Funding;Mayo Clinic: Honoraria;UC DAVIS: Honoraria;Northwell Grand Rounds: Honoraria;NYU Grand Rounds: Honoraria;Danbury Hospital Tumor Board: Honoraria;Acute Leukemia Forum: Honoraria;Miami Leukemia Symposium: Honoraria;New Orleans Cancer Symposium: Honoraria;ASH: Honoraria;NCCN: Honoraria. Wood: Pfizer: Research Funding;Teladoc: Consultancy;Koneksa Health: Consultancy, Current equity holder in publicly-traded company.

Early Evaluation of the Use of Crizanlizumab in Sickle Cell Disease: A National Alliance of Sickle Cell Centers Study

Background: Vaso-occlusive crises (VOC) are the most common acute complication of sickle cell disease (SCD). Crizanlizumab, an anti-P-selectin monoclonal antibody, is an FDA-approved disease-modifying therapy (DMT) for SCD patients (pts) aged ≥16 yrs to reduce the frequency of VOC. To better understand its use and impact, the National Alliance for Sickle Cell Centers (NASCC) conducted a retrospective study of pts prescribed crizanlizumab from 11/2019-6/30/2021. NASCC is a non-profit organization formed to support SCD centers in delivering quality comprehensive care by setting and adopting specific standards and advocating for improved health outcomes in SCD. This study describes the largest real-world cohort of pts treated with crizanlizumab. Methods: This is a two-part study. Part 1 was to evaluate NASCC center crizanlizumab practice and to summarize data on insurance approval and the frequency of drug discontinuation. Part 2 includes pt level data to evaluate reasons for discontinuation and acute care utilization pre and post therapy. Acute care use includes day hospital/infusion, emergency department visits, and hospitalizations for VOC (excluding COVID-19). The index date for each pt is defined as the 1st crizanlizumab infusion date. Chart review (electronic health records) was used to identify all acute care visits 12 months pre-index and ≤12 months post index. Acute care data will be analyzed in aggregate. Evaluation of center-specific use of crizanlizumab, time to initial site level formulary approval and drug discontinuation were analyzed. Pt level data collection is ongoing to include sufficient time post index date. VOC characteristics will be summarized using medians, median differences (pre/post treatment), and 95% confidence intervals. Additional evaluation of effectiveness of crizanlizumab will include analysis based on number of doses received, pre-treatment VOC burden, concomitant hydroxyurea (HU) use and genotype. Results: Data includes pts prescribed crizanlizumab at 11 NASCC centers. Site- formulary approvals to use crizanlizumab varied from 12/2019-12/2020. As a result, the 1st pt to receive treatment at each site varied from 1/15/2020-1/20/2021. Mean time from site-level approval to first infusion was 77 days (range: 0-394). Over 50% of sites received insurance denials mainly due to “insufficient medical necessity” or “medication not covered by the prescription plan.” Sites were able to successfully appeal denials for 71% of pts (Table 1). Treatment Delivery: Each site gives infusions over 30 minutes and the majority (64%) do not use pre-medication unless pts had reactions. Some sites use diphenhydramine/acetaminophen (3) or normal saline and ketorolac (1). All sites prescribe crizanlizumab to pts of all SCD genotypes. Pts Treated: 297 pts were prescribed crizanlizumab of whom 238 received ≥ 1 infusion. There was variation in number of pts/site (range 6-73, mean 21) due to time to site-level approval, insurance and pt population. Of these 238, 75 pts (32%) discontinued treatment (0-17 pts/site). Sites reported pts perceived lack of improvement or feeling their overall pain was increased, transportation issues and infusion related reactions (IRRs) characterized by pain as some of the reasons for discontinuation. Evaluation of real-world efficacy measured by changes in acute care utilization, including sub-analysis by genotype, pre-treatment VOC burden and concomitant HU use, are pending sample size dependent feasibility. Discussion: This is the first multi-center real-world analysis of crizanlizumab. Findings demonstrate some insurance barriers to therapy. The majority of pts who initiated crizanlizumab have remained on therapy;however, 1/3 of pts had lack of effect or barriers to care. Pt level data will include characteristics related to treatment failure or IRR. Improving the understanding of phenotype-specific response to novel therapies is essential in SCD. Conclusion: Post-approval therapies for rare diseases must undergo real-world evaluation to ensure study results transla e to the community. NASCC uses defined criteria for multidisciplinary care for Alliance inclusion and findings reflect the use of DMT in such centers. This is the first NASCC study of DMT in SCD. Part 2 of the study will give early insights into the effectiveness of crizanlizumab;long term follow-up is needed for a full understanding of its utility in SCD. [Formula presented] Disclosures: Kanter: Fulcrum Therapeutics, Inc.: Consultancy;Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees;Forma: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees;Agios: Honoraria, Membership on an entity's Board of Directors or advisory committees;Beam: Honoraria, Membership on an entity's Board of Directors or advisory committees;Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees;Graphite Bio: Consultancy;GuidePoint Global: Honoraria;Fulcrum Tx: Consultancy. Manwani: Novartis: Consultancy. Idowu: Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding;Pfizer: Research Funding;Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau;Forma Therapeutics, Inc.: Research Funding;Ironwood: Research Funding. Treadwell: National Alliance of Sickle Cell Centers: Other: Early Evaluation of the Use of Crizanlizumab in Sickle Cell Disease. Clay: GBT: Membership on an entity's Board of Directors or advisory committees;Novartis: Honoraria. Little: Hemex Health, Inc.: Patents & Royalties;Biochip Labs: Patents & Royalties. Desai: Global Blood Therapeutics: Honoraria, Research Funding;Novartis: Research Funding, Speakers Bureau;Pfizer: Other: Publication Fee, Research Funding;Forma: Consultancy;Foundation for Sickle Cell Research: Honoraria. Lanzkron: Shire: Research Funding;Pfizer: Current holder of individual stocks in a privately-held company;Bluebird Bio: Consultancy;Teva: Current holder of individual stocks in a privately-held company;Novo Nordisk: Consultancy;GBT: Research Funding;Imara: Research Funding;CSL Behring: Research Funding;Novartis: Research Funding.

Thromboelastography (TEG) in COVID-19 patients-not all hypercoagulable

Introduction COVID-19 can lead to a severe inflammatory response and cytokine storm, which is associated with activation of blood coagulation, platelets, and endothelium leading to a severe prothrombotic state. Recent studies have interpreted TEG parameters of increased maximum amplitude (MA) and alpha angle (AA) as indicating a hypercoagulable pattern in patients with COVID-19. The definition of hypercoagulability in literature has been variable while some have used increased MA, others used increased coagulation index (CI) as a surrogate for a hypercoagulable state. Here we report our center experience using TEG to evaluate coagulation in COVID-19 patients. Methods Retrospective analysis of 37 critically ill patients that were evaluated using TEG on a single occasion along with standard coagulation tests. We defined hypercoagulable pattern as CI > 3;hypocoagulable pattern was defined as CI <-3;and normal pattern if CI was between-3-3. Results TEG patterns were interpreted as hypercoagulable in 5 (13.5%), normal in 22 (59.5%) and hypocoagulable in 10 (27%) patients using the TEG coagulation index (CI). MA and AA were elevated in 13 (35.1%) and 10 (27%) patients, respectively, and both were elevated in 8 (21.6%). Discussion Our results show a normal TEG pattern in most of our critically ill COVID-19 patients based on CI (Figure 1);only 5 (13.5%) showed a hypercoagulable pattern. These findings differ from previous reports of TEG in COVID-19 patients, where a hypercoagulable TEG pattern was shown in 83-90% of patients, in these reports interpretation of hypercoagulability was based on AA or MA. We used the CI to define a hypercoagulable state, which has been used to define hypercoagulability in orthopedic surgery and during pregnancy. An elevated MA or AA was seen in only 15 (40%) of our patients. Plasma fibrinogen, an acute-phase reactant, is also elevated in COVID-19 patients. The mean fibrinogen level in our patients was 364 mg/dl, which is lower than those reported by Panigada and Mortus, where mean fibrinogen levels were 680 and 740 mg/dl, respectively. The high MA may reflect the high fibrinogen observed in COVID-19 patients and this may explain the differences in the number of patients considered as “hypercoagulable” in our cohort compared to others. Conclusion;Our study in COVID-19 patients advances a caution in the interpretation of TEG parameters and its use as an indicator of a hypercoagulable state in COVID-19 patients.

Obesity outcomes in acute respiratory distress syndrome due to COVID-19: A retrospective single center experience

Introduction: The “obesity paradox” has been reported in critically ill patients with acute respiratory distress syndrome (ARDS). Obese patients with ARDS were shown to have more ventilator free days and lower mortality compared to non-obese patients. One proposed explanation was increased levels of pro-inflammatory cytokines creating a protective environment from acute inflammation. In COVID-19, BMI ≥ 30 increases risk of illness severity, need for critical care, respiratory failure requiring use of invasive mechanical ventilation (IMV), and mortality. It is unknown if the “obesity paradox” applies to patients with SARS-CoV2 who require IMV. We examined a cohort of patients with respiratory failure due to COVID-19 who required IMV and compared outcomes between obese and non-obese patients. Methods: Data was collected from patients treated in the COVID Intensive Care Unit (ICU) from March to June 2020. A total of 85 patients were identified. All patients were COVID nasopharyngeal swab positive. Results: There were 38 (44.7%) patients with BMI < 30, and 47 (55.3%) with BMI ≥ 30. The median BMI was 25.5 in the BMI < 30 group, and 37.5 in the BMI ≥ 30 group. In the BMI < 30 group, median age was 67 years, majority male (65.8%) and African American (50%). The BMI ≥ 30 group had a median age of 63.5, majority male (53.2%) and African American (63.8%). Median Sequential Organ Failure Assessment score on admission was higher in the BMI ≥ 30 group at 3 (1.5-4.5) vs. 2 (1.0-4.0). There was elevated creatinine on admission with higher percentage of diabetes, heart failure, and renal disease in the BMI ≥ 30 group. Inflammatory markers, such as CRP and IL-6 were lower in the higher BMI group at presentation. There was higher in-hospital mortality in the BMI ≥ 30 group at 57.5%, with longer ICU length of stay (12.35 vs. 7.6 days), longer days on ventilator (10.2 vs. 4 days), and lower PaO2/FiO2 ratio after intubation (146 vs 348). The higher BMI group had higher rates of prone ventilation, paralytic use, and extracorporeal membrane oxygenation support. Discussion: From our data, obesity did not appear to have better outcomes in ARDS due to COVID-19 infection. Higher BMI was associated with higher disease severity, severe respiratory failure, longer ventilator days, longer ICU length of stay, and higher mortality. Interestingly, inflammatory markers were initially lower in obese patients, suggesting a possible adaptive physiologic response to inflammation, but without effect on overall outcomes.

Lifetime prediction using a tribology-aware, deep learning-based digital twin of ball bearing-like tribosystems in oil and gas

The recent decline in crude oil prices due to global competition and COVID-19-related demand issues has highlighted the need for the efficient operation of an oil and gas plant. One such avenue is accurate predictions about the remaining useful life (RUL) of components used in oil and gas plants. A tribosystem is comprised of the surfaces in relative motion and the lubricant between them. Lubricant oils play a significant role in keeping any tribosystem such as bearings and gears working smoothly over the lifetime of the oil and gas plant. The lubricant oil needs replenishment from time to time to avoid component breakdown due to the increased presence of wear debris and friction between the sliding surfaces of bearings and gears. Traditionally, this oil change is carried out at pre-determined times. This paper explored the possibilities of employing machine learning to predict early failure behavior in sensor-instrumented tribosystems. Specifically, deep learning and tribological data obtained from sensors deployed on the components can provide more accurate predictions about the RUL of the tribosystem. This automated maintenance can improve the overall efficiency of the component. The present study aimed to develop a deep learning-based digital twin for accurately predicting the RUL of a tribosystem comprised of a ball bearing-like test apparatus, a four-ball tester, and lubricant oil. A commercial lubricant used in the offshore oil and gas components was tested for its extreme pressure performance, and its welding load was measured using a four-ball tester. Three accelerated deterioration tests was carried out on the four-ball tester at a load below the welding load. Based on the wear scar measurements obtained from the experimental tests, the RUL data were used to train a multivariate convolutional neural network (CNN). The training accuracy of the model was above 99%, and the testing accuracy was above 95%. This work involved the model-free learning prediction of the remaining useful lifetime of ball bearing-type contacts as a function of key sensor input data (i.e., load, friction, temperature). This model can be deployed for in-field tribological machine elements to trigger automated maintenance without explicitly measuring the wear phenomenon. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

9 Reasons to smile: At home psychosocial support for cleft lip and/or palate families around the world

Background/Purpose: The physical effects of clefting can obscure the psychosocial aspects of the disease. With this in mind, the idea for a unique mental health booklet arose. 9 Reasons to Smile: Family Fun Activity Booklet was developed when Smile Train international programs suspended all cleft treatment for patients at the height of the COVID-19 pandemic. Patients could not receive cleft surgery and other nonsurgical treatments, such as nutritional support, orthodontic care, dental care, psychosocial care, and speech therapy, to ensure long-term, successful rehabilitation. Suspension of cleft treatment poses significant challenges for children and families. Recognizing these challenges, Smile Train developed this booklet to raise awareness for psychosocial health as it is not readily accessible or prioritized around the world. The booklet includes art projects on self-love, engaging games to help children explore their emotions, their relationships, and their self-confidence. Methods/Description: The booklet was developed with support from Fundaci'on Cl'inica Noel, a Smile Train Partner in Colombia. It was first launched in English, French, and Spanish during the World Health Organization Walk the Talk Virtual Event on May 17, 2020. A global launch for the booklet in 10 languages took place on June 17, 2020. To further increase awareness for psychosocial health, Smile Train hosted a live, virtual celebration of 9 Reasons to Smile on July 21st and Smile Train Brazil and Mexico participated in their own local celebrations. The event convened representatives from the global health and global cleft communities to discuss art, health, clefts, and the importance of maintaining self-esteem and positivity through adversity. Results: The booklet is now available in 15+ languages and is shared through WhatsApp messaging platforms worldwide. The global virtual celebration had over 4000 views on Facebook and YouTube, and its reach continues to grow. Smile Train has received thousands of photos and stories from families and partners sharing their experiences using the booklet and its tremendous impact on their lives. The overwhelming response confirms the demand for programs and resources that focus on cleft patients and their psychosocial health needs. Conclusions: There is a need for supporting psychosocial services in global cleft care which is particularly evident during the COVID-19 pandemic. Access to these services is not always prioritized in many countries around the world and the enthusiasm for the 9 Reasons to Smile booklet indicates the positive impact such resources have on mental health. Smile Train is committed to raising awareness on the importance of psychosocial health in global cleft care and will continue to support and scale initiatives for cleft patients and their families around the globe.

COVID 19 pandemicity: A global situation report as of June 9, 2020

Background: The World Health Organization (WHO) declared severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a pandemic on March 11, 2020. This report takes a closer look at the cases, fatalities, and recoveries in different regions of the world with details regarding the geographic scale of SARS-CoV-2 spread, risks, and the subsequent impact on the countries affected. Also, this report discusses some effective measures that were carried out by some countries that helped them to mitigate the pandemic and flatten the curve of COVID-19 spread as early as possible. Methods: Our research was conducted via an electronic literature review on PubMed, Google Scholar, and MedLine Plus. Data were then collected from peer-reviewed articles that included applicable keywords and published between January 1, 2020, and June 9, 2020 Results: The rapid spread of infection has impacted over 200 countries and territories to date. As of June 9, 2020, there were 7,039,918 confirmed cases and 404,396 deaths globally. The USA is the North American country with the highest number of confirmed COVID 19 cases with 1,993,560. In South America, total confirmed cases in Brazil are 691,758. The most affected country in the African region is South Africa with 50,879. In Europe, the Russian Federation top with 485,253 confirmed cases. China with 84,638 is still the Western Pacific country with the most confirmed COVID 19 cases. India had 266,598 total confirmed cases and Australia reported 7,265 confirmed cases. Fatalities recorded similar patterns regionally except in Europe where the UK recorded the highest number of fatalities with 40,597 deaths and Iran had the highest number of fatalities with 5,957 cases in Asia. The goal of the practice “slowing the spread” is to prevent hospital systems from being strained beyond their capacity, thus resulting in less mortality. Countries yet to see the peak would benefit substantially by implementing aggressive social distancing, self-isolation, closure of schools and other institutions, encouraging working from home, and/or placing hard limits on the size of crowds at events. Conclusion: As the number of cases increases, an immediate need to “flatten the curve” is essential to avoid catastrophic overwhelming of hospital systems across the affected countries. (Figure Presented).

Comprehending and executing aacharrasayana in the context of COVID 19

The COVID 19 pandemic had disrupted the lives of all socio-economic groups of the global population. The lockdowns, social distancing, financial adversi-ties, continuous fear of being a victim to the virus had left every individual desperate with a feeling of vulnerability. Irrespective of all possible efforts at the global level, no ultimate solution to get rid of this virus is available till date except for the preventive measures. Various medicines and formulations are into practice, which may boost one’s immunity to fight against the virus. This catastrophic scenario had resulted in an impact on the human being in all aspects, physical, mental, emotional, social and behavioural. Ayurveda, the science of life has encompassed all these aspects through its preventive and curative principles. Aacharrasayana, code of conduct or behavioural dis-cipline is one such modality that entails perfect mental, physical, social and spiritual health of the human being. The execution of Aacharrasayana in this situation can immensely contribute in restoring mental, spiritual and social health. This review aims to interpret the implementation of various aspects of Aacharrasayanain context of COVID 19 and its utility in combatting the dread-ful crisis.