The Environmental Impact of Telemedicine in a Radiation Oncology Clinic

Background: In response to the COVID-19 pandemic, our radiation oncology department was forced to rapidly integrate telemedicine into its practice. While there has been investigation into the implementation, effectiveness, cost, and perceptions of telemedicine, the environmental impact of telemedicine within radiation oncology has not yet been established. This is particularly relevant as climate change is recognized as one of the largest threats to human health, including oncologic outcomes. Yet, the healthcare sector significantly contributes to global carbon emissions, in part due to patient travel. Objective(s): The aim of this study was to assess the impact of telemedicine on travel-related greenhouse gas (GHG) emissions for a large, academic radiation oncology outpatient clinic located in a densely population suburban setting. Method(s): All in-person and telehealth visits over a consecutive 7-day period in June 2021 scheduled at our main outpatient clinic were retrospectively reviewed. Care visits with patients who resided outside of the state were excluded. Travel distance for in-person visits and miles saved for virtual visits was estimated based on patients' reported home address in the electronic medical record. Associated GHG emissions were calculated with the Greenhouse Gases, Regulated Emissions, and Energy Use in Transportation tool (https://greet.es.anl. gov) using a well-to-wheel model, which accounts for all emissions related to fuel (ie. gas, electricity) production and use. Gas, hybrid, plug-in hybrid, and electric vehicle utilization were accounted for per published statewide vehicle registration statistics. GHG emissions were converted into carbon dioxide equivalents (CO2e) using 100-year global warming potentials. Result(s): A total of 158 clinic visits were conducted over the time period. Table 1 describes visit type, telemedicine status, and primary cancer site of the included patients. Total miles traveled for in-person visits was 5,775 miles and an estimated 13,892 potential miles saved were attributed to telemedicine visits. On average, 118 travel miles were saved per telemedicine visit (CO2e, 55 kg). The forecasted annual savings of CO2e attributed to telemedicine visits is 339 metric tons, the equivalent emissions of 61.6 homes' electricity use for one year. Conclusion(s): The integration of telemedicine within a radiation oncology outpatient clinic reduces the environmental impact of patient care. Telemedicine should be considered where feasible and appropriate to establish and promote environmentally sustainable practices within the field.

The Impact of Telemedicine on Indirect Patient Costs in an Outpatient Radiation Oncology Department

Patients incur more than medical-related expenses when attending necessary consultation and follow-up visits, including time and travel costs. With the rapid integration of telemedicine in response to the COVID-19 pandemic, our department gained another tool that has the potential to reduce the financial burden of cancer care for our patients. The aim of this study was to estimate the indirect cost savings (time, travel costs, opportunity costs) resulting from the use of telemedicine at a large, academic radiation oncology outpatient clinic located in a densely populated suburban setting. We hypothesize that telemedicine provides time- and cost-savings for patients. All telemedicine and in-person visits scheduled at our main outpatient clinic over a one-week period in June 2021 were retrospectively reviewed. Care visits with patients residing outside of the state were excluded. Travel distance and time calculations were estimated using Google Maps and based on patients' reported home address. Travel cost was calculated using the IRS 2021 standard mileage rate of $0.56 per mile. Opportunity cost was calculated by multiplying round-trip travel time with estimated hourly wage, derived by median household income per census block group and in the context of a 40-hour work week. Annual projections were calculated by multiplying weekly cost savings by 52. A total of 156 patients had scheduled visits in our department over one week, 115 of which were via telemedicine. There was no difference in gender, race, ethnicity, and insurance status between telemedicine and in-person visits. Those attending telemedicine vs in-person visits were younger in age (61 vs 68 yrs, p=0.03). There was no significant difference between distance or time traveled to the cancer center between telemedicine and in-person cohorts. For telemedicine visits, median per-visit round-trip travel time saved was 66 minutes (IQR, 39-168 minutes) with a travel cost savings of $33.60 (IQR, $17.92 - $100.80), opportunity cost savings of $67.04 ($42.97 - $118.56), and overall cost savings of $110.57 (IQR, $59.94 - $202.04). Annually, telemedicine visits are estimated to save patients a total travel time of 12911.6 hours, travel costs of $402,684, opportunity costs of $530,588, and overall cost savings of $933,272. Telemedicine benefits patients with time- and cost-savings in an outpatient radiation oncology clinic. Our estimates are likely under-representative of the entire financial impact, as costs related to childcare, parking, tolls, hotels, and meals were not captured in our analysis. These unmeasured costs are likely amplified for those patients who live further from the clinic. Despite this, travel distance was not associated with utilization of telemedicine. In clinically appropriate situations, patient-centered metrics such time- and cost-savings should be considered when informing the choice between telemedicine and in-person visits. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

IFITM DEPENDENCY of SARS-CoV-2 VARIANTS of CONCERN

Background: We recently showed that genuine SARS-CoV-2 hijacks endogenously expressed interferon-induced transmembrane proteins, especially IFITM2, as entry cofactors for efficient infection (Prelli Bozzo, Nchioua et al., Nat. Com., 2021). This came as a surprise, since IFITMs have been reported to inhibit entry of numerous enveloped viruses, including SARS-CoV-2. However, most data were obtained using IFITM overexpression and pseudoparticle infection assays. In our initial study, we used a SARS-CoV-2 strain isolated in the Netherlands in February 2020 (NL-02-2020). Since then several "variants of concern" (VOCs) have emerged that show increased transmission fitness and evasion of vaccine-induced immunity. These VOCs contain various alterations in their Spike (S) proteins that may alter their dependency on entry cofactors. Here, we examined whether SARS-CoV-2 VOCs, including the currently dominating Delta variant, still depend on IFITMs for efficient infection and replication. Methods: To determine the role of IFITMs in infection of SARS-CoV-2 VOCs, we silenced IFITM1, 2, or 3 expression in Calu-3 cells using siRNAs and infected them with NL-02-2020 as well VOCs B.1.1.7, B.1.351, P.1 and B.1.617.2, also referred to as Alpha, Beta, Gamma and Delta variants, respectively. Viral entry and replication were quantified by qRT-PCR as well as TCID50 analysis. In addition, we determined the inhibitory effect of an α-IFITM2 antibody on VOC infection in iPSC-derived human alveolar epithelial type 2 (iAT2) cells. Results: Depletion of IFITM2 reduced viral RNA production from 31-(B.1.1.7) to 754-fold (P.1). In comparison, KD of IFITM1 generally had little effect, while silencing of IFITM3 resulted in 2-to 20-fold reduction of viral RNA yields by the four VOCs. An antibody directed against the N-terminus of IFITM2 inhibited SARS-CoV-2 VOC replication in iAT2 cells. Conclusion: Endogenously expressed IFITM proteins (especially IFITM2) are important cofactors for entry and replication of SARS-CoV-2 VOCs, including the Delta variant that currently dominates the COVID-19 pandemic.

SYSTEMATIC ANALYSIS of INNATE IMMUNE ANTAGONISM of SARS-CoV-2 and ITS EVOLUTION

Background: The innate immune system is a powerful anti-viral defense mechanism, which includes the interferon (IFN) system and autophagy. Thus, successful pathogens like SARS-CoV-2 need to counteract or evade these defenses to establish an infection. However, due to its ongoing, worldwide spread in the human population SARS-CoV-2 is evolving and in the meantime four variants with selection advantages (variants of concern) emerged. Methods: Using expression constructs for 29 SARS-CoV-2 proteins we evaluated the impact of individual viral proteins on induction of cytokines (IFNA4, IFNB1, IRF3-signalling, NF-κB-signaling) and cytokine signaling (IFNα2, IFNβ, IFNγ, IFNa;1, IL-1α, TNFα) in luciferase reporter assays, validated by endogenous transcription factor phosphorylation analysis. We assessed the influence of SARS-CoV-2 proteins on autophagy using a flow cytometry-based system. Underlying molecular mechanisms were investigated on an endogenous level using Western blot, confocal fluorescence microscopy, and flow cytometry. In addition, we examined the susceptibility of SARS-CoV-2 including all variants of concern towards type-I,-II, and-III interferons. Results: To understand how SARS-CoV-2 efficiently manipulates the host's innate immune defenses, we systematically analyzed the impact of SARS-CoV-2 encoded proteins on induction of various IFNs and pro-inflammatory cytokines, IFN signaling, and autophagy. Our results reveal the range of innate immune antagonists encoded by SARS-CoV-2 and we characterized selected molecular mechanisms employed by Nsp1 and Nsp14 to downregulate the IFN system or ORF3a and ORF7a to prevent autophagic degradation. Interestingly, our assays show that variants of concern of SARS-CoV-2 remain sensitive to type-II interferon signaling but show increased resistance towards type-I and/or type-III interferons. Conclusion: SARS-CoV-2 has evolved to counteract innate immunity using several synergistic approaches but remains relatively sensitive to type-II and-III interferons. However, emerged variants of concern remain sensitive overall but are less susceptible towards IFNα2/β and IFNa;1 than early SARS-CoV-2 isolates.

Cardiac Catheterization, Coronary Angiography (CA) and Percutaneous Coronary Intervention (PCI) in Austria during the Year 2020 (including AUDIT 2021)

Using methods on cardiac catheterization from ANCALAR complete data from reporting year 2020 are now available. The rate of diagnostic coronary angiography procedures (CAG;-8,7%), total acute plus non-acute PCI (-9.9%), including non-acute PCI (-9.5%), interventions for acute PCI (-10.6%) and including STEMI-PCI (-6.8%) declined during the pandemic year 2020 for the first time compared to the years before. Moreover left ventricular angiography (-12.2%), right heart catheterization (-17.3%), myocardial biopsies (-42.5%), PCI for chronic total occlusions (CTO;-14.1%), clot catcher (-10.3%), and rotablator procedures (-6.7%), as well as electrophysiologic diagnostics (-8.3%) und therapies (ablations;-6.9%) decreased in 2020 compared to 2019 in 27 Austrian Catheterization Laboratories. It is possible that patients suffering from acute, subacute or chronic symptoms presented less frequently in tertiary centres. Private Institutions rather increased the rate of elective procedures during the pandemic year 2020 (elective non acute PCI +9.7%) in contrast to the Austrian trend. Private Institutions but decreased the rate of acute PCI (-40,5%) on a basis of low numbers in pre-existing procedures. On the other hand in non-private Institutions in five centres there was an increase in STEMI-PCI by 23% in contrast to the Austrian decreasing trend. Possibly due to limited access to surgical intensive care wards during the pandemic, percutaneous aortic valve implantations (TAVI;+4.3%), percutaneous Mitral-Clipping (+28%) and defect closure procedures (+2.2%) within Cathlabs increased in 2020 within the whole country, compared to all the years before. This new trend in cardiac procedures within catheterization laboratories was not expected fora whole year and is now documented for Austria correlating to results in the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). The presentation is also available at http://iik.i-med.ac.at.

Towards Drug Repurposing for COVID-19 Treatment Using Literature- ased Discovery

The ongoing COVID-19 pandemic brings new challenges and risks in various areas of our lives. The lack of viable treatments is one of the issues in coping with the pandemic. Developing a new drug usually takes 10-15 years, which is an issue since treatments for COVID-19 are required now. As an alternative to developing new drugs, the repurposing of existing drugs has been proposed. One of the scientific methods that can be used for drug repurposing is literature-based discovery (LBD). LBD uncovers hidden knowledge in the scientific literature and has already successfully been used for drug repurposing in the past. We provide an overview of existing LBD methods that can be utilized to search for new COVID-19 treatments. Furthermore, we compare the three LBD systems Arrowsmith, BITOLA, and SemBT, concerning their suitability for this task. Our research shows that semantic models appear to be the most suitable for drug repurposing. Nevertheless, Arrowsmith currently yields the best results, despite using a co-occurrence model instead of a semantic model. However, it achieves the good results because BITOLA and SemBT currently do not allow for COVID-19 related searches. Once this limitation is removed, SemBT, which uses a semantic model, will be the better choice for the task. © 2021 The authors and IOS Press.

Innovative Play-Based Strategies for Teletherapy

An accelerated need for effective and accessible therapy for children has become more evident in 2020 by the novel coronavirus SARS-CoV2 (COVID-19) pandemic. This global health crisis has exacerbated an existing mental health care crisis for children, particularly for those of color and low income who have a history of being disproportionately underserved. Teletherapy may address some of the barriers that prevent many children from receiving mental health services. Play-based strategies can be creatively integrated in teletherapy to maintain a relational, developmentally appropriate, and evidence-based approach to working with children in a virtual setting. In this article, creative ways to facilitate virtual play-based strategies are provided. Specific information about set-up, accessibility, selectability, scaffolding technology, developmental and cultural considerations, limit setting, and documentation for virtual sessions is discussed. Access to creative and theoretically informed teletherapy practices will strengthen the mental health response needed to reduce disparities in care.

Sars-cov-2 infects and replicates in cells of the human pancreas

Introduction: Viral infections may trigger diabetes. Clinical data suggest infection with the pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19), may impact glucose homeostasis in patients. Notably, cases of new-onset diabetes upon SARS-CoV-2 infection have been reported. However, experimental evidence of pancreatic infection is still controversial. Aims & Methods: Here, we employ cadaveric human pancreatic islets, as well as pancreatic tissue from deceased COVID-19 patients to investigate the impact of SARS-CoV-2 on the pancreas. Results: We show that human β-cells express viral entry proteins ACE2 and TMPRSS2, making them susceptible to SARS-CoV-2 infection and replication. Our data further demonstrates that SARS-CoV-2 infects and replicates in ex vivo cultured human islets and infection. This infection is associated with morphological, transcriptional and functional changes, such as reduction of insulin-secretory granules in β-cells and impaired glucose-stimulated insulin secretion. In COVID-19 post-mortem examinations, we detected SARS-CoV-2 nucleocapsid protein in pancreatic exocrine cells, and in cells that stain positive for the β-cell marker NKX6.1 in all patients investigated. Conclusion: Taken together, our data define the human pancreas as a target of SARS-CoV-2 infection and suggest that β-cell infection might contribute to the metabolic dysregulation observed in patients with COVID- 19.

Data on Cardiac Catheterization during the COVID Pandemic-Year 2020 in Relation to Year 2019 (Austrian ANCALAR-Registry)

Using methods on cardiac catheterization from ANCALAR we compared data from year 2020 to data from 2019 and previous years by conducting a late breaking survey. 12 centres voluntarily provided data for comparative analyses. During the COVID-19 pandemic in 2020 cardiac catheterization procedures decreased markedly and for the first time. The rate of diagnostic coronary angiographic procedures (CAG) declined by -8.2 % (p < 0.001), total acute plus non-acute PCI by -10.0 % (p < 0.001), interventions for acute PCI declined by -12.5 % (p < 0.001) and STEMI-PCI declined by -2.0 % (p = 0.6). Data scattering concerning urban or rural areas, concerning private or public institutions was present but not causative. Moreover left ventricular angiography, right heart catheterization, myocardial biopsies, PCI for chronic total occlusions (CTO), clot catcher, and rotablator procedures, as well as electrophysiologic dia-gnostics und therapies (ablations) decreased. On the other hand percutaneous aortic valve implantation (TAVI), Mitral-Clipping and defect closures within CathLabs increased in 2020. It is possible that patients suffering from acute or subacute symptoms presented less frequently in tertiary centres or that pandemic-related delays for elective procedures have led to later presentations as acute coronary syndromes. This trend of mostly declining cardiac procedures in catheterization laboratories for the whole year was not expected and studies on details and on future clinical impact are warranted.

Comparing Outcome of Cardiac Catheterization in March 2020 with March 2019

Using methods on cardiac catheterization from ANCALAR we compared data from March 2020 to data from March 2019 by conducting a "snapshot"-survey. 11 centres voluntarily provided data for comparative analyses. During the COVID-19 pandemic in 2020 cardiac catheterisation procedures markedly decreased. The rate of diagnostic angiographic procedures declined by 26%, non-acute PCI by 29%, and interventions for acute coronary syndromes by 14% [(STEMI-PCI (-18%) and NSTEMI-PCI (-15%)]. As expected, this trend of declining cardiac procedures in catheterisation laboratories may influence outcomes and further decision making. Further studies are warranted to confirm this trend and future clinical impact.