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The ongoing global pandemic has been unprecedented in every aspect of human activities. Even though the uncompromising hard work and dedication of healthcare workers have managed to evade the best part of the first and second waves of the rampaging disaster, the deadly event might resurge with a potential third wave. Children will be the prime victims in that case as most of these age groups are non-vaccinated. However, among all the negative vibes, some of the things during the pandemic have transformed the global mindset. Undoubtedly, the worst victim is the healthcare sector alongside the economy. The introduction of artificial intelligence (AI) algorithms has given the much-needed impetus to the healthcare sector with a variety of innovative means. These new technological innovations have significantly alleviated the burden from the shoulders of front-line workers and added an extra weapon to their repertoire for combatting the Covid-19 infection. AI algorithms have influenced several areas of healthcare set-up during the pandemic including diagnosis of the disease, monitoring of patients, selection of candidate drugs, and even in Covid-19 vaccine development. It is critical, therefore, to best utilize the AI algorithms, machine learning techniques and associated aids in healthcare sectors in the post-pandemic times to revitalize the medical set-up. © 2023 selection and editorial matter, Preeti Nagrath, Jafar A. Alzubi, Bhawna Singla, Joel J. P. C. Rodrigues and A. K. Verma;individual chapters, the contributors.
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Objectives: Web-based learning is becoming a newly accepted standard in education, more so with COVID-19 pandemic. To use technology to redesign learning experiences, a blend of synchronous and asynchronous approaches was used wherein the routine lectures through MS Teams (synchronous) were integrated with an online learning management system (LMS), 'Moodle' (modular object-oriented dynamic learning environment) based, four-quadrant approach (asynchronous). We aimed to determine the student's engagement, performance and perception of the new online LMS. Material(s) and Method(s): All 170 students of the 1st year MBBS of batch 2020 were enrolled in the course. A module was developed for teaching 'Physiology of Vision' with this blended approach. Along with routine online lectures through Microsoft Teams, supplementary materials in the form of multimedia presentations and additional links to useful websites were provided through online LMS. The online activity of students was recorded and assessments were done. A feedback form was filled out by students at the end of the course. Result(s): A significant positive correlation of examination scores with individual student's activity logs and significantly better scores in top Moodle users along with significantly higher marks in Moodle-based modules than in other modules confirmed the value of Moodle in improving student performance. Overall feedback from students was clearly in favour of implementing Moodle as a complementary tool to traditional teaching. Conclusion(s): Moodle improved the quality of learning. It developed interest and motivation among students and has a positive impact on academic outcomes.Copyright © 2023 Association of Physiologists and Pharmacologists of India. All rights reserved.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might have originated from the recombination of a Pangolin-CoV-like virus with a Bat-CoV-RaTG13-like virus and then transmitted to a human at Wuhan city of China. On February 11, 2020, the WHO announced a name for the new coronavirus disease as COVID-19. Finally, the WHO declared the novel coron-avirus outbreak a global pandemic on March 11, 2020. Within a few months, SARS-CoV-2 had spread across the world to 220 countries, areas or territories. The main objective of this work is to review the existing knowledge about COVID-19, its updated status, available treatment procedures and future challenges. The available literature based on the COVID-19 was thoroughly reviewed and concise, evidence-based information was explored for the public interest. Various authentic databases like PubMed, Scopus, and Google Scholar together with the official sites of some Govt. Organizations were carefully searched for all relevant information about the current status of COVID-19, including the published research on coronavirus. More than 68 million people are already infected, including around 20% severely ill, with almost 1.5 million casualties due to this virus which is expected to infect approximately 70% population worldwide. Currently, maximum confirmed cases and death are reported in the USA. The epicentre of the pandemic was initially shifted from China to Europe, then to the USA, Brazil and now India. In between, the understanding of pathogenesis and mode of transmission has been developed;repurposing drugs are being validated and the development of a new vaccine is underway. The study concludes that there is no established treatment available for COVID-19, although 26 clinical and 139 preclinical trials are un-derway to develop vaccines globally. Although three vaccines are at the advanced stage of develop-ment, their efficacy and adverse effects are yet to be validated and recorded. Recently, the Pfizer vaccine has been started for vaccination in emergency cases in England and Bahrain, and the United States of America will start it soon. Meanwhile, prevention, rigorous global containment and quarantine efforts are practiced worldwide to control its spread.Copyright © 2021 Bentham Science Publishers.
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Introduction: Patients presenting for radiation therapy (RT) at a single institution were analysed regarding treatment delays and disparities during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The study was conducted at an urban multidisciplinary cancer centre. In April 2020, the institution's radiation oncology department implemented universal COVID-19 screening protocols prior to RT initiation. COVID-19 testing information on cancer patients planned for RT from 04/2020 to 01/2021 was reviewed. Trends of other lifetime COVID-19 testing and overall care delays were also studied. Results: Two hundred and fifty-four consecutive cancer patients received RT. Median age was 63 years (range 24-94) and 57·9% (n = 147) were Black. Most (n = 107, 42·1%) patients were insured through Medicare. 42·9% (n = 109) presented with stage IV disease. One (0·4%) asymptomatic patient tested positive for COVID-19 pre-RT. The cohort received 975 lifetime COVID-19 tests (median 3 per patient, range 1-18) resulting in 29 positive test results across 21 patients. Sixteen patients had RT delays. Identifying as Hispanic/Latino was associated with testing positive for COVID-19 (p = 0·015) and RT delay (p = 0·029). Conclusion: Most patients with cancer planned for RT tested negative for COVID-19 and proceeded to RT without delay. However, increased testing burden, delays in diagnostic workup and testing positive for COVID-19 may intensify disparities affecting this urban patient population. © The Author(s), 2022. Published by Cambridge University Press.
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Introduction: Novel corona virus or the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) a new public health crisis spreading continuously. The virus originating in bats and was transmitted to humans through yet unknown intermediary animals in Wuhan, china in December 2019. The disease is transmitted by inhalation or contact with infected droplets and the incubation period ranges from 2 to 14 days. Traditional Indian Medicines has lot to offer in the management of COVID-19. It was reported that traditional remedies may alleviate the symptoms of COVID-19. The Approach of Ayurveda on strengthening host defence may be useful as effective, safer, accessible and affordable prophylaxis of COVID- 19. Objective: The objective of this study to review protocol ofAyurveda and provide information for prevention and treatment ofCOVID-19. Methods: The national guideline summarised which provide the best management for COVID-19. We extracted the case definition and clinical classifications of COVID-19 in along with relevant treatment. Results: We present the most recent case definition, clinical classifications, and relevant treatments of COVID-19 in accordance with the recommendations in the Indian guidelines. COVID-19 has been categorized in four specific situation based on the severity of clinical condition. Several Ayurvedaformulation are recommended for COVID-19 cases according to their clinical classification. Conclusion: To control the COVID-19 outbreak, countries must ensure the adherence of their citizens to local public health measures. Medical professionals should diagnose and treat patients according to up-to-date guidelines. This review provide preventive strategy by increasing the immunity of the body to fight covid-19.However till today social distancing is considered as most effective way to stop the spread of COVID-19. © 2022 University of Stockholm. All rights reserved.
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Background: Patients with SARS-CoV-2 with a diagnosis of cancer have increased risk of severe COVID-19 outcomes compared to patients without cancer. However, little is known regarding outcomes of patients with COVID-19 and cancer in the setting of human immunodeficiency virus (HIV). Given the unique risks of this population, we sought to understand COVID-19 outcomes using registry data. Methods: This is a descriptive research study utilizing the CCC19 registry, an international multi-institutional registry with healthcare provider-reported cases of patients with cancer and COVID-19. Between March 2020-December 2021, 116 persons with HIV (PWH) and 10,642 persons without HIV (PWOH) with laboratory-confirmed SARS-CoV-2 infection were identified as eligible for the analysis. Results: Median follow-up time for both groups was 90 days, with interquartile range (IQR) 30-180 days. Most PWH were actively receiving antiretroviral therapy (ART) at the time of COVID-19 diagnosis, with 71% (n = 82) having named drug information available;bictegravir/emtricitabine/tenofovir was the most common ART (n = 25). PWH were of younger age (median 57.5 yrs [IQR 46.5-63.25] vs 65 yrs [IQR 55-74]), male (81% vs 47%), and either non-Hispanic Black or Hispanic (71% vs 34%) compared to PWOH. 12% of PWH (n = 14) were current smokers compared to 6% of PWOH (n = 638), and more than half in each group were never smokers (51% of PWH and 53% of PWOH). The following comorbidities were identified in PWH vs PWOH: cardiovascular (16% vs 20%), pulmonary (16% vs 20%), renal (15% vs 14%), and diabetes mellitus (18% vs 27%). A higher proportion of PWH had hematologic malignancy compared to PWOH (33% vs 19%). More PWH had active cancer which was progressing at the time of SARS-CoV-2 infection compared to PWOH (24% vs 14%). 44% of PWH (n = 51) had received active systemic anticancer therapy within the 3 months preceding SARS-CoV-2 infection (including cytotoxic, targeted, endocrine therapies, and immunotherapy) compared to 51% of PWOH (n = 5,420). PWH had an increased rate of hospitalization (58% vs 55%) compared to PWOH. Although a lower proportion of PWH required supplemental oxygen during hospitalization compared to PWOH (34% vs 38%) and ICU admission rates were identical between the two groups (16% vs 16%), PWH had an increased rate of mechanical ventilation (14% vs 10%) and death (24% vs 18%) compared to PWOH. Conclusions: This is the first known study describing outcomes of patients with cancer and COVID-19 in the PWH population from a large multinational dataset. PWH have characteristics associated with adverse outcomes in prior analyses (male sex, non-Hispanic Black or Hispanic, hematologic malignancy, progressing cancer) but are notably younger and have fewer comorbidities. HIV infection may portend increased risk of severe COVID-19 and death;however, additional analyses, including multivariable regression, are warranted.
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Introduction: Novel coronavirus disease-2019 pandemic continues to rage the world with enormous economic loss, sickness, and deaths. In management of infectious diseases, nurses play crucial roles in rendering care to patients by risking their own lives, going beyond their training and capacities. Frontline nurses are vulnerable for the development of diagnosable and subclinical psychological problems most often triggered with deaths of colleagues, exposure to the mass scale of deaths, perceived inability to save lives despite best efforts, lack of social supports, shift duties, and working in high-risk environment. Aim: The aim of the study is to assess the depression, anxiety, and stress among nurses working in COVID wards versus non-COVID wards. Materials and Methods: A multicenter observational study was done among 176 frontline nurses from seven different referral government hospitals. Psychological ailments were measured on validated instruments of Depression, Anxiety, and Stress Scale-42 items (DASS-42) and Perceived Stress Scale-10 (PSS-10). Results: Using SPSS version 23.0, data were analyzed using Pearson's Chi-square test, with P < 0.055 being considered statistically significant. On PSS, perceived stress was high in 75% of COVID ward nurses and 67% of non-COVID ward ones. On DASS-42 scale, depression, anxiety, and stress levels among nurses in the COVID-19 wards were 21.64% (n = 21), 32.98% (n = 32), and 20.61% (n = 20) compared to 17.72% (n = 14), 24.05% (n = 19), and 15.18%, (n = 12) in the non-COVID wards, respectively. Conclusions: The amount of reported stress, anxiety, and depression was higher in both groups of nurses, i.e., those working in COVID-19 wards and general wards as compared to general population.
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STATEMENT OF PROBLEM/QUESTION: How can systems-based changes increase the rate of diabetic retinal scan (DRS) completion in a primary care clinic during the COVID pandemic with decreased in-person visits? DESCRIPTION OF PROGRAM/INTERVENTION: The intervention was based in a primary care clinic associated with a public county-based health system. During the COVID-19 pandemic, in-person clinic visits were drastically reduced to prevent transmission, leading to a significant decrease in DRS completion rates. Additional barriers to completion of DRS screening included the following: (1) patients needed a separate, scheduled visit in our electronic medical record system (EPIC) for the DRS exam, (2) DRS clinic had limited hours during the primary care visit day, (3) many of our underserved patients could not afford consecutive clinic visits within a short period of time, and (4) providers signed the orders for DRS at the end of the visit;thus, nursing staff could not start scheduling patients an appointment until the end of the primary care visit. The intervention included two Plan-Do-Study-Act (PDSA) cycles. The first PDSA cycle involved a physician manually screening all patients due for DRS on a weekly basis if they were scheduled for a clinic visit in the upcoming week. For those identified, our nursing staff scheduled and completed a separate DRS appointment for the same day as the patient's clinic visit to minimize multiple visits. The second PDSA cycle involved using an EPIC tool, SlicerDicer, to automatically identify patient charts with overdue DRS screenings and upcoming clinic visits. The list of identified patients were then sent over to our nursing staff in order to schedule patients for their DRS on the same day as their clinic visit. MEASURES OF SUCCESS: We recorded diabetic retinal scan completion rate each month for one year from September 2020 to August 2021 to assess if rates would improve after our interventions. Monthly completion rates were measured on a rolling basis and based on the completion of the annual DRS for all clinic patients within the last 12 months. FINDINGS TO DATE: The percent of completed annual diabetic retinal exams for all clinic patients increased from 32.4% in September 2020 to 70.9% in August 2021 after implementation of our interventions. KEY LESSONS FOR DISSEMINATION: We identified system-based barriers that were negatively impacting our patients' ability to complete an important health maintenance screening such as the DRS exam. After identifying these barriers, we utilized existing tools and technology within our electronic medical record system to help patients complete their annual DRS exams and drastically increased overall clinic DRS completion rates.
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The COVID-19 pandemic has caused economic, physiological, and psychological harm to the world. A crucial step, hence, in the fight against covid is the highly efficient screening of patient cases. Conventional RT-PCR testing, even though more reliable, cannot be done on every patient as the virus has spread way faster than the world’s resources could afford. One very important screening approach that is being used across the globe is chest X-ray imaging. Since X-ray facilities are readily obtainable in healthcare systems of most countries across the globe, and with more and more X-ray systems being digitized, the cost and time of transportation are cut as well. Hence, if the detection of the virus in a CXR image can be automated using AI techniques, it will save a lot of time and effort of radiologists to have to go through hundreds of such images, and in some cases will also spare the need of doing RT-PCR testing, and since saving resources in this time is vital, automated detection can be very effective. In this work, we will explore, analytically discuss, and do a comparative study of many ML and deep learning techniques that have been taken for automated COVID-19 detection through chest X-rays (CXR). We carefully analyze the papers and derive a set of key factors for discriminating the methodologies, classification techniques, approaches, and the results that yielded. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Objective: To comprehend the evolution and spread of the severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) virus and also to prevent the future spread of the same, sequencing and analyzing the genomic data of SARS CoV-2 are essential. The objective of the present study is to describe the scope of improvement identified by the state of Madhya Pradesh in the data flow chain and the methodology designed to address the identified shortcomings. Methods: The number of sources of sample data collection was altered as well as a series of Google Sheets were formulated as an open-source tool, to implement an efficient sample data-sharing platform. The application of the proposed tool (Google Sheets as a source of data collection and information sharing) was within the state of Madhya Pradesh, India. Result: After utilizing this mechanism, the state was able to trace more than 80% VOCs and 3341 primary contacts and was also able to communicate this result to all stakeholders without much delay. Conclusion: Based on successful implementation and results, the authors suggest widening the domain of the proposed tool to other states.
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Epidemics can prove to be disastrous, which has been further emphasized by the recent COVID-19 pandemic, and several countries like India lack sufficient resources to meet the population's needs. It is therefore important that the limited testing and protective resources are utilized such that the disease spread is minimized and their reach to the most vulnerable demographic is maximized. This paper studies the scope of intelligent agents in aiding authorities with such policy-making decisions. This is done by exploring the performance of various action selection methods on custom environments dealing with socio-economic groups and Indian states. Experiments using multi-armed bandit techniques provide greater insight into administrative decisions surrounding resource allocation and their future potential for greater use in similar scenarios. © 2022 IEEE.
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Rationale: COPD is the fourth leading cause of US hospitalizations. The majority of hospitalized patients misuse inhalers, a factor unrecognized by many patients and clinicians. COVID-related distancing requirements and decreased in-person care has further challenged the quality and modality of care-delivery, including opportunities for inhaler education. There is a critical need for innovation to deliver this critical aspect of COPD care. This study aims to improve clinician-patient communication and access to care for patients with COPD by developing and implementing a telehealth education platform to augment the clinic visit. Methods: This mixed-methods study utilized semi-structured patient interviews and clinician survey data to obtain diverse perspectives about facilitators and barriers to our “V-M(ED)” intervention. Patients participated in the COPD V-M(ED), pharmacy-led video visits with patients to conduct inhaler technique education using teach-to-goal, during clinic visits. Eligible patients were consented to participate in semi-structured interviews assessing their experiences with prior telehealth visits, inhaler education, and feedback on V-M(ED). Clinicians recruited via email completed brief surveys focusing on barriers, facilitators, and opportunities for incorporating multi-disciplinary teams to deliver telehealth-based educational teaching for patients. Demographic and Likert-scale data were analyzed with descriptive statistics. Themes were coded for open-ended questions. Results: Of 15 clinic patients who received inhaler education, 10 were enrolled in the study. Participants were on average 73.7 years of age, 80% were female, and 90% self-identified as Black. Three major themes emerged regarding patient telehealth experience (Table): 1) the pros and cons of technology-based visits (e.g., convenience);2) setting preference for clinical visits (e.g., in-person);and 3) effectiveness of virtual inhaler education (e.g., most reported benefiting). Thirteen clinicians completed the care team perspectives survey. While the majority felt incorporating virtual teaching from clinician team-members would be beneficial to patients, only 31% reported that the benefits would outweigh barriers to use. However, of clinicians who did not have prior experience incorporating virtual education into patient encounters, nearly half reported they would use a program if it were in place. Conclusions: This study provides important insights into both patient and clinician perspectives on integrating virtual telehealth education into patient care. Despite a preference for in-person clinical encounters, using a telehealth modality for inhaler education was well-received by our patient cohort. This feedback, along with the positive attitudes of clinicians in the usefulness and desire to offer virtual video platforms for patient education, suggests virtual education can be an effective modality for disease self-management. (Table Presented).
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Since the arrival of novel COVID-19 disease, lack of early detection by radiologists and medical specialists of various nations is a notable cause for the block for initial investigation of heart complications. The consolidated computer-aided diagnosis (CAD) systems are required for accurate prediction and early monitoring using multiple biomedical data. This multimodal CAD system is mainly required to reduce the mortality rate caused by inappropriate treatment. To address this problem, a novel automatic multimodal disease detection system has been proposed using patient chest X-ray images and heart electrocardiogram (ECG) data. Since this work aims to observe lung infection and heart irregularities, simultaneously, therefore, we propose a deep learning framework for multimodal disease detection. It consists of preprocessing, automated feature extraction, and classification. The raw chest X-ray images and ECG signals are preprocessed using multiple filtering techniques. For automatic feature extraction, we have designed a convolutional neural network (CNN) for preprocessed X-ray images and ECG signals. We have designed the long short-term memory (LSTM) classifier for each biomedical input. The outcome of the classifier can be used to provide the consolidated medical judgment for further investigations. Experimental results show the efficiency of the proposed multimodal CAD system. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Learning outcomes: The learning outcomes are as follows: to understand and examine the strategies that help platforms fight competition and manage networks;to analyse the role of platform governance in the management of the networks and partners’ trust;and to evaluate the strategic risks of disintermediation and multi-homing firms face while trying to sustain profits and capture value. Case overview/synopsis: The case presents the dilemma faced by Deepinder Goyal, the young founder and CEO of Zomato in formulating the growth strategy for its food delivery platform, struggling to retain its market leadership position amid intensifying competition and other challenges during the COVID-19 pandemic. Zomato has become a public company with an IPO announced in mid of July 2021. Therefore, there is growing expectation for profitability among its shareholders and investors considering tailwinds of COVID-19 crisis, which have given the push towards adoption of food delivery among the customers. This has also resulted in increased competition in the industry. On other hand, there is growing dissatisfaction among its restaurant partners who have been hit hard by COVID-19 and struggling for survival. CEO Deepinder has to find how he will ensure the long-term growth for Zomato to tap the growing food delivery market in India and regain its restaurant partner’s trust. Complexity Academic Level: The case is intended for post-graduate courses (MBA, PGDM) on digital business strategy or strategic management of technology-oriented businesses. The case can be used to understand the nature of competition and different strategies for platform-based businesses in the digital world. The case can also be used to study the role governance can play in efficient value creation and capture on the platform by the partner entities. Finally, the case also highlights how are platform businesses are coping with the Covid challenge. There are no specific prerequisites but knowledge on basic strategy concepts and platform business concepts will be good for better understanding. Level of difficulty is medium. Supplementary materials: Teaching notes are available for educators only. Subject code: CSS 11: Strategy. © 2022, Emerald Publishing Limited.
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Introduction: Patients presenting for radiation therapy (RT) at a single institution were analysed regarding treatment delays and disparities during the coronavirus disease 2019 (COVID-19) pandemic. Methods: The study was conducted at an urban multidisciplinary cancer centre. In April 2020, the institution's radiation oncology department implemented universal COVID-19 screening protocols prior to RT initiation. COVID-19 testing information on cancer patients planned for RT from 04/2020 to 01/2021 was reviewed. Trends of other lifetime COVID-19 testing and overall care delays were also studied. Results: Two hundred and fifty-four consecutive cancer patients received RT. Median age was 63 years (range 24-94) and 57·9% (n = 147) were Black. Most (n = 107, 42·1%) patients were insured through Medicare. 42·9% (n = 109) presented with stage IV disease. One (0·4%) asymptomatic patient tested positive for COVID-19 pre-RT. The cohort received 975 lifetime COVID-19 tests (median 3 per patient, range 1-18) resulting in 29 positive test results across 21 patients. Sixteen patients had RT delays. Identifying as Hispanic/Latino was associated with testing positive for COVID-19 (p = 0·015) and RT delay (p = 0·029). Conclusion: Most patients with cancer planned for RT tested negative for COVID-19 and proceeded to RT without delay. However, increased testing burden, delays in diagnostic workup and testing positive for COVID-19 may intensify disparities affecting this urban patient population. © The Author(s), 2022. Published by Cambridge University Press.
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The threats like increasing pollution level and scarcity of natural resources are showing that Sustainable Consumption and Production (SCP) is one of the key solutions and the main contributor driver of Sustainable Development Goals (SDGs). Eventually, a mysterious disease named as COVID-19 started spreading very fast around the globe and it was declared a pandemic. To protect citizens from this pandemic, the government announced complete lockdown in the country. This lockdown due to COVID-19 has put its impact on every aspect of life. In this research study, the e®orts have been made to identify various impacts of COVID-19 on SCP practices and propose various solutions to overcome these impacts of COVID-19. In the Indian perspective, a total ¯fteen impacts of COVID-19 under ¯ve di®erent heads along with eighteen solutions to overcome these impacts have been identi¯ed with the help of literature, various reports and experts' inputs. All these impacts and solutions were analyzed using a hybrid framework. Results revealed that COVID-19 majorly put its impact on nation, business and behavior followed by the impact on society and environment. All these impacts can be overcome by adopting solutions like strong and clear policies formation and its implementation, ¯nancial packages to industries to boost up the economy, ¯rm determination of top management, safety of the workforce and tax reduction on sustainable products. The ¯nal results will be very helpful for all the actors focused on SCP. °c World Scienti¯c Publishing Company
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Healthcare initiatives backed by electronic-governance (e-governance) principles have contributed well to the extant literature and practice. Governments and healthcare systems across the world were taken aback by the swamping impact of the COVID-19 pandemic. However, they reacted quickly by developing contact-tracing mobile applications (apps) for creating awareness, providing information about various healthcare initiatives, and helping citizens to use the required information in case of emergency. The major challenge was to develop such e-governance interventions in a short time and ensure their quick adoption among the masses. Hence, it is worthwhile to investigate the factors leading to the adoption of such e-governance initiatives, especially in the context of a widespread pandemic situation. The present study is an attempt to analyze the factors driving the intention to use contact tracing mobile apps launched by governments globally during the COVID-19 pandemic. We have conducted the study in the context of India, where the government launched a community-driven contact tracing mobile app for its citizens during the COVID-19 pandemic in April 2020. The study adopted an empirical approach to test how epistemic value, convenience value, conditional value, functional value, and privacy concerns influenced the intention to use this approach. The study found that intention to use such an app was positively influenced by functional value, which in turn was positively influenced by convenience and conditional values. It suggests that the convenience of using the app, perceived seriousness of the pandemic (i.e., conditional value), and utilitarian benefits (i.e., functional value) of the contact-tracing mobile app enhanced its acceptance. However, its novelty (i.e., epistemic value) and privacy concerns are not significant predictors of intention to use. The study recommends that the government should place more emphasis on improving the functional value which is driven by convenience and context-specific features to push the use of an e-governance initiative during the crisis © 2021 authors. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Australia License, which permits non-commercial use, distribution, and reproduction in any medium, provided the original author and AJIS are credited
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Background: Brexucabtagene autoleucel (brexu-cel) is the first CD19 chimeric antigen receptor T-cell (CAR T) therapy approved for use in patients (pts) with relapsed mantle cell lymphoma (MCL). The ZUMA-2 trial demonstrated that brexu-cel induces durable remissions in these pts with an ORR of 85% (59% CR), estimated 12-month PFS rate of 61%, and similar toxicity profile to other CAR T therapies (Wang et al, NEJM 2020). We conducted a multicenter, retrospective study of pts treated with commercial brexu-cel to evaluate its safety and efficacy in the non-trial setting. Methods: We reviewed records of pts with relapsed MCL across 12 US academic medical centers. Pts who underwent leukapheresis between July 2020 and June 2021 with the intent to proceed to commercial brexu-cel were included. Baseline demographic and clinical characteristics were summarized using descriptive statistics. Survival curves were generated using the Kaplan-Meier method, and univariate models were fit to identify predictors of post-CAR T outcomes. Results: Fifty-five pts underwent leukapheresis. There were 3 manufacturing failures. Baseline characteristics of the 52 pts who received brexu-cel are summarized in Table 1. Median age was 66 yrs (range: 47-79 yrs) and 82% were male. Twenty of 29 (69%) pts with known baseline MIPI were intermediate or high risk. Seven pts had a history of CNS involvement. The median number of prior therapies was 3 (range: 2-8), including prior autologous stem cell transplant (ASCT) in 21 (40%) and prior allogeneic transplant in 2 pts (1 with prior ASCT and 1 without). Fifty percent had relapsed within 24 months of their initial therapy. All pts had previously received a Bruton's tyrosine kinase inhibitor (BTKi), including 29 (56%) with disease progression on a BTKi. Forty (77%) pts received bridging therapy (17 BTKi, 10 BTKi + venetoclax, 6 chemo, 3 venetoclax, 2 XRT only, 1 steroids only, 1 lenalidomide + rituximab). The ORR was 88% (CR 69%) among patients who received brexu-cel. Two pts had PD on initial restaging and 3 died prior to first response assessment (without evidence of relapse). Seven pts have not completed restaging due to limited follow-up (< 3 months) and were not included in the response assessment. Five pts have progressed, including 2 with CR and 1 with PR on initial restaging. With a median follow-up of 4.2 months, the estimated 6-month PFS and OS rates were 82.7% and 89.0%, respectively. All 7 pts with prior CNS involvement were alive without relapse at last follow-up. The incidence of cytokine release syndrome (CRS) was 84% (10% grade ≥ 3) with a median time to max grade of 5 days (range: 0-10 days). There were no cases of grade 5 CRS. The incidence of neurotoxicity (NT) was 57% (31% grade ≥ 3) with a median time to onset of 7 days (range: 4-15 days). NT occurred in 4/7 pts with prior CNS involvement (3 grade 3, 1 grade 4). Grade 5 NT occurred in 1 pt who developed cerebral edema and died 8 days after infusion. Thirty-five pts received tocilizumab, 33 received steroids, 7 received anakinra, and 1 received siltuximab for management of CRS and/or NT. Post-CAR T infections occurred in 8 pts, including two grade 5 infectious AEs (covid19 on day +80 and septic shock on day +40 after infusion). Rates of grade ≥ 3 neutropenia and thrombocytopenia were 38% and 37%, respectively. Among pts with at least 100 days of follow-up and lab data available, 5/34 (15%) had persistent grade ≥ 3 neutropenia and 4/34 (12%) had persistent grade ≥ 3 thrombocytopenia at day +100. Five pts have died, with causes of death being disease progression (2), septic shock (1), NT (1), and covid19 (1). Univariate analysis did not reveal any significant associations between survival and baseline/pre-CAR T MIPI, tumor pathologic or cytogenetic features, prior therapies, receipt of steroids/tocilizumab, or pre-CAR T tumor bulk. Conclusions: This analysis of relapsed MCL pts treated with commercial brexu-cel reveals nearly identical response and toxicity rates compared to those reported on ZUMA-2. Longer follow-up is require to confirm durability of response, but these results corroborate the efficacy of brexu-cel in a population of older adults with high-risk disease features. While all 7 pts with prior CNS involvement are alive and in remission, strategies to mitigate the risk of NT in this setting need to be evaluated. Further studies to define the optimal timing of CAR T, bridging strategies, and salvage therapies for post-CAR T relapse in MCL are warranted. [Formula presented] Disclosures: Gerson: TG Therapeutics: Consultancy;Kite: Consultancy;Abbvie: Consultancy;Pharmacyclics: Consultancy. Sawalha: TG Therapeutics: Consultancy, Research Funding;Celgene/BMS: Research Funding;BeiGene: Research Funding;Epizyme: Consultancy. Bond: Kite/Gilead: Honoraria. Karmali: Janssen/Pharmacyclics: Consultancy;BeiGene: Consultancy, Speakers Bureau;Morphosys: Consultancy, Speakers Bureau;Takeda: Research Funding;Genentech: Consultancy;AstraZeneca: Speakers Bureau;Roche: Consultancy;Karyopharm: Consultancy;Epizyme: Consultancy;Kite, a Gilead Company: Consultancy, Research Funding, Speakers Bureau;BMS/Celgene/Juno: Consultancy, Research Funding;EUSA: Consultancy. Torka: TG Therapeutics: Membership on an entity's Board of Directors or advisory committees. Chow: ADC Therapeutics: Current holder of individual stocks in a privately-held company, Research Funding;AstraZeneca: Research Funding. Shadman: Abbvie, Genentech, AstraZeneca, Sound Biologics, Pharmacyclics, Beigene, Bristol Myers Squibb, Morphosys, TG Therapeutics, Innate Pharma, Kite Pharma, Adaptive Biotechnologies, Epizyme, Eli Lilly, Adaptimmune, Mustang Bio and Atara Biotherapeutics: Consultancy;Mustang Bio, Celgene, Bristol Myers Squibb, Pharmacyclics, Gilead, Genentech, Abbvie, TG Therapeutics, Beigene, AstraZeneca, Sunesis, Atara Biotherapeutics, GenMab: Research Funding. Ghosh: Genentech: Research Funding;Pharmacyclics LLC, an AbbVie Company: Consultancy, Honoraria, Research Funding, Speakers Bureau;Karyopharma: Consultancy, Honoraria;Seattle Genetics: Consultancy, Honoraria, Speakers Bureau;Janssen: Consultancy, Honoraria, Speakers Bureau;TG Therapeutics: Consultancy, Honoraria, Research Funding;Incyte: Consultancy, Honoraria;Gilead: Consultancy, Honoraria, Research Funding, Speakers Bureau;Genmab: Consultancy, Honoraria;Epizyme: Honoraria, Speakers Bureau;Bristol Myers Squibb: Consultancy, Honoraria, Research Funding, Speakers Bureau;AstraZeneca: Consultancy, Honoraria, Speakers Bureau;ADC Therapeutics: Consultancy, Honoraria;Adaptive Biotech: Consultancy, Honoraria;AbbVie: Honoraria, Speakers Bureau. Moyo: Seattle Genetics: Consultancy. Fenske: TG Therapeutics: Consultancy, Speakers Bureau;Servier Pharmaceuticals: Consultancy;Seattle Genetics: Speakers Bureau;Sanofi: Speakers Bureau;Pharmacyclics: Consultancy;MorphoSys: Consultancy;Kite (Gilead): Speakers Bureau;KaryoPharm: Consultancy;CSL Therapeutics: Consultancy;Bristol-Myers Squibb: Speakers Bureau;Biogen: Consultancy;Beigene: Consultancy;AstraZeneca: Speakers Bureau;ADC Therapeutics: Consultancy;Adaptive Biotechnologies: Consultancy;AbbVie: Consultancy. Grover: Genentech: Research Funding;Novartis: Consultancy;ADC: Other: Advisory Board;Kite: Other: Advisory Board;Tessa: Consultancy. Maddocks: Seattle Genetics: Divested equity in a private or publicly-traded company in the past 24 months;BMS: Divested equity in a private or publicly-traded company in the past 24 months;Pharmacyclics: Divested equity in a private or publicly-traded company in the past 24 months;Novatis: Divested equity in a private or publicly-traded company in the past 24 months;Janssen: Divested equity in a private or publicly-traded company in the past 24 months;Morphosys: Divested equity in a private or publicly-traded company in the past 24 months;ADC Therapeutics: Divested equity in a private or publicly-traded company in the past 24 months;Karyopharm: Divested equity in a private or publicly-traded company in the past 24 months;Beigene: Divested equity in a private or publicly-traded company in the past 24 months;Merck: Divested equity in a private or publicly-traded company in the past 24 months;KITE: Divested equity in a private or publicly-traded company in the past 24 months;Celgene: Divested equity in a private or publicly-traded company in the past 24 months. Jacobson: Kite, a Gilead Company: Consultancy, Honoraria, Other: Travel support;Humanigen: Consultancy, Honoraria, Other: Travel support;Celgene: Consultancy, Honoraria, Other: Travel support;Pfizer: Consultancy, Honoraria, Other: Travel support, Research Funding;Lonza: Consultancy, Honoraria, Other: Travel support;AbbVie: Consultancy, Honoraria;Precision Biosciences: Consultancy, Honoraria, Other: Travel support;Novartis Pharmaceuticals Corporation: Consultancy, Honoraria, Other: Travel support;Nkarta: Consultancy, Honoraria;Axis: Speakers Bureau;Clinical Care Options: Speakers Bureau. Cohen: Janssen, Adaptive, Aptitude Health, BeiGene, Cellectar, Adicet, Loxo/Lilly, AStra ZenecaKite/Gilead: Consultancy;Genentech, Takeda, BMS/Celgene, BioInvent, LAM, Astra Zeneca, Novartis, Loxo/Lilly: Research Funding.