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Introduction: Advanced MZL is generally incurable, with periods of remission and relapse. Zanubrutinib (BGB-3111), a potent and highly specific next-generation Bruton tyrosine kinase (BTK) inhibitor, was approved in the US and Canada for R/R MZL based on the MAGNOLIA primary analysis (BGB- 3111-214;NCT03846427);here, the final MAGNOLIA analysis is presented. Method(s): This was a phase 2, multicenter, single-arm study of adult patients (pts) with R/R MZL (>=1 prior CD20-directed therapy). Zanubrutinib (160 mg twice daily) was given until disease progression or unacceptable toxicity. The primary endpoint was overall response rate (ORR) by independent review committee (IRC) per Lugano classification. Secondary endpoints were investigator-assessed ORR, duration of response (DOR), progression-free survival (PFS), overall survival (OS), and safety. Efficacy was assessed by positron emission tomography (PET)-based Lugano criteria for IRC-confirmed fluorodeoxyglucose (FDG)-avid disease at baseline;non-avid disease was assessed by computed tomography (CT)-based criteria. Result(s): As of May 4, 2022, 68 pts were treated (median age=70 y [range 37-95];>=75 y=27.9%). MZL subtypes included extranodal (38.2%), nodal (38.2%), splenic (17.6%), and unknown (5.9%). The median number of prior therapies was 2 (range 1-6);32.4% of pts had disease refractory to last therapy, most (89.7%) had prior chemoimmunotherapy, and 7 (10.3%) had rituximab monotherapy as their only prior treatment. Sixty-one pts (89.7%) had FDG-avid disease. After a median follow-up of 28.0 mos (range 1.6-32.9) and a median treatment duration of 24.2 mos (range 0.9-32.9), 66 pts were efficacy- evaluable. IRC-assessed ORR (complete response [CR]+partial response [PR]) was 68.2% (CR=25.8%). By subtype, (Figure Presented)(Figure Presented)ORR/CR rates were 64.0%/40.0% (extranodal), 76.0%/20.0% (nodal), 66.7%/8.3% (splenic), and 50.0%/25.0% (unknown). Median DOR, PFS, and OS were not reached. Over 70.0% of pts were alive or progression-free after 2 years (Figure). Sensitivity analysis using only CT-based criteria (n=66) showed an ORR of 66.7% and CR of 24.2%. The most common treatment-emergent AEs were bruising (23.5%), diarrhea (22.1%), and constipation (17.6%). Neutropenia (8.8%) and COVID-19 pneumonia (5.9%) were the most common Grade >=3 AEs. Five pts (7.4%) died due to unrelated AEs: COVID-19 pneumonia=2, acute myeloid leukemia=1, myocardial infarction=1, septic encephalopathy=1. Hypertension occurred in 3 pts (4.4%), atrial fibrillation and atrial flutter in 1 pt (1.5%) each;none led to treatment withdrawal. One pt (1.5%) had a Grade 3 gastrointestinal hemorrhage while receiving rivaroxaban. None of the pts required dose reduction. Conclusion(s): In this final analysis with over 2 years of median follow-up, zanubrutinib continues to demonstrate durable disease control and was generally well tolerated, with no new safety signals observedCopyright © 2023 American Society for Transplantation and Cellular Therapy
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Objective To assess the cost of launching telemedicine services by Peking Union Medical College Hospital (PUMCH) during coronavirus disease 2019 pandemic. Methods The patients using telemedicine services were enrolled during the period of pilot run from February 10th to April 15th, 2020. The study was done from the social perspective. A decision-tree model was constructed to compare the costs between telemedicine services and conventional clinical services for outpatients. The main outcome was measured as incre- mental cost-effective ness ratios (ICER). Sensitivity analysis was conducted by using one-way sensitivity analysis. Results During a period of forty-seven days, the online fever clinic was applied 3055 person-times(2070 patients) and the online outpatient clinic were applied 36 549 person-times(20 467 patients). On average, 44 febrile cases/d and 435 nonfebrile cases/d were reduced in the outpatient clinic. It helped to reduce roughly 1/4 (febrile) and 1/5(nonfebrile) of total numbers of the patients in the outpatient clinic during the peak period of the epidemic. If calculated according to the actual free-of-charge condition, the ICER was -64.7 yuans/person-time. If the actual cost of each consultant of telemedicine service was estimated according to the level of outpatient-service fee, the ICER was -5.5 yuans/person-time. The results of sensitivity analysis showed that the main factors affecting the ICERs were transportation cost, lost wages, and the efficiency of telemedicine services. Conclusions Launching telemedicine services helped to relieve the pressure at the outpatient clinics, and has the potential to provide significant cost saving compared to conventional clinic services for outpatients. It is worth considering applying this practice widely in the medical and health services.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.
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This paper presents an impulsive-backpropagation neural network (IBNN) based learning algorithm for detecting Coronavirus Disease 2019 (COVID-19), by classifying chest computed tomography (CT) images. Inspired by the nerve impulses in brain networks, the IBNN algorithm consists of two parts: a multi-layered network of impulsive neurons and a gradient decent backpropagation mechanism. The effectiveness of the IBNN algorithm is validated on clinical COVID-19 database, and a classification accuracy of 98.19% is achieved. It is further demonstrated by comparative studies that the IBNN may outperform some other learning algorithms through the integration of nerve impulses and backpropagation. Considering the intricate attributes of the chest CT scan images, the IBNN algorithm also exhibits a potential capacity of pattern recognition on complicated samples. © 2022 IEEE.
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Since 2020, with the global spread of major respiratory infectious diseases, such as COVID–19, the demand and consumption of personal protective equipment, such as masks, have increased dramatically worldwide. The environmental pollution caused by numerous waste disposable face masks has gradually attracted people's attention. In this study, the mechanical properties of mask–chip–reinforced soil are evaluated from a new perspective, through the uniaxial, biaxial, conventional triaxial, and true triaxial compression tests on reshaped sandy soil samples mixed with different contents of mask chips. The experimental results show that the mechanical properties of the sandy soil can be improved by the mask chips. With the proper content of mask chips, the failure strength is substantially improved, and the failure of soil is delayed. Meanwhile, the strength and stiffness are significantly affected by the stress path and the content of mask chips, even if the soil samples with the same mask–chip content can also show different mechanical properties under different stress paths. Additionally, the mechanical properties of soil are not necessarily improved constantly with the increasing content of mask chips. The failure strength of sandy soil samples under conventional and true triaxial stress paths decreases when the mass content of mask chips exceeds 0.3% and 0.5%, respectively. This study confirms the potential of mask chips applied to subgrade, slope, and other engineering construction fields in a sustainable way. © 2023 by the authors.
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The COVID-19 pandemic has been a great challenge to society, the economy, and population health. It has become a significant public health event and social problem. Exploring the impact of COVID-19 on the accessibility of outdoor sports venues is crucial for people's health. Based on spatial theory, the quantitative and qualitative analyses of outdoor sports venues' spatial distribution and accessibility were conducted, and the epidemic's impact on them was analyzed. The results show that: (1) The existing outdoor sports venues in Nanchang show a distribution pattern of "sparse in the north and south, and strong aggregation in the middle”. (2) As a result of the epidemic, the center of the standard deviation ellipse in outdoor sports sites shifted to the southeast, while the number of open venues decreased by 68%. (3) Before COVID-19, the entire study area could achieve full coverage by driving for 17 min, riding for 70 min, or walking for 119 min. After COVID-19, the time increased to 29, 109, and 193 min, respectively. (4) Under the high-risk scenario of COVID-19, the average walking time for people to reach outdoor sports venues increased from 6.2 min to 14.0 min in the study area, with an increase of 126%. Finally, according to the findings of this study, recommendations were made on how government departments could build or re-open outdoor sports venues during and after this epidemic. © 2023 by the authors.
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A pandemic calls for behaviour-change communication: The ethical aim is to have the receiver voluntarily adopt cooperative actions for the wider good of the community. In the case of superdiverse cites, this entails significant translation and mediation across languages and media, since cooperative actions are to no avail if they do not occur in all sections of society. Messages thus have to attract high degrees of trustworthiness. Social media are sites of particular turbulence in this respect for several reasons: (1) They are privileged media for the circulation of dissent;(2) social-media users have high indices of media-comparison behaviour, judging information on one medium in terms of another, thus exhibiting low levels of initial trust;and (3) linguistically diverse communities have electronic media in their first language coming from outside the immediate community, potentially entering into conflict with officially generated and translated information. Here we look at social media use in Melbourne in order to identify instances of trust and distrust in translated pandemic information across several media. We assess the consequences for cooperative behaviour. © 2022 selection and editorial matter, Tong King Lee and Dingkun Wang;individual chapters, the contributors.
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Knowing the multi-level influences of determinants on medical-service resumptions is of great benefits to the policymaking for medical-service recovery at different levels of study units during the post-COVID-19 pandemic era. This article evaluated the hospital- and city-level resumptions of medical services in mainland China based on the data of location-based service (LBS) requests of mobile devices during the two time periods (December 2019 and from February 21 to March 18, 2020). We selected medical-service capacity, human movement, epidemic severity, and socioeconomic factors as the potential determinants on medical-service resumptions and then explicitly assessed their multi-level explanatory powers and the interactive effects of paired determinants using the geographical detector method. The results indicate that various determinants had different individual explanatory powers and interactive relationships/effects at different levels of medical-service resumptions. The current study provides a novel multi-level insight for assessing work resumption and individual/interactive influences of determinants, and considerable implications for regionalized recovery strategies of medical services.
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Coronavirus Disease 2019 (COVID-19) is a highly transmissible and pathogenic coronavirus that emerged in late 2019 and has caused a pandemic of acute respiratory disease. Before vaccines are widely used or the invention of specific medication, many measures have been taken by human beings to prevent the spread of the epidemic. Quarantining infected groups and locking down high-risk regions are common means used by the latest medical experience. As such measures are generally carried out under administrative divisions, issues of imprecise epidemic control and unquantifiable risk warning are exposed gradually. In order to better achieve the purpose of precise epidemic prevention and control, we propose a kind of dynamic block division technology based on GeoHash which can be used to monitor, mark out and control the epidemic regions. By using GeoHash, we divide the earth map into connected dynamic blocks. Dynamic blocks are easily visualized in geographic information systems (GIS) equipped in electronic devices. GeoHash blocks are dynamically overlaid on the map as grids. Each block contains essential epidemic-related data and important features which are concerned by professional medical work. Quantitative analysis of epidemic data is carried out on each block. Our research shows the analysis results can support decision-making, measures formulation, and effectiveness assessment of COVID-19 prevention and control. Such research can be applied not only to COVID-19 but also to other infectious diseases. © 2022 IEEE.
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Background: Surufatinib (a small-molecule inhibitor of VEGFR1-3, FGFR1, and CSF-1R) has exhibited encouraging antitumor activity for the treatment of advanced neuroendocrine tumors (including NEN and NEC) in multiple registration studies. Here, we report the preliminary results of advanced neuroendocrine tumors of an ongoing, multicenter, real-world study of surufatinib + MDT (ChiCTR2100049999). Challenges in tumor clinical trials management in the face of the COVID-19 resurgence period in Shanghai. Methods: In this multicenter, single-arm real-world study, adults (18-80) with advanced neuroendocrine tumors (including NEN and NEC) were eligible and received surufatinib (300mg orally, QD) with MDT（multidisciplinary collaborative diagnosis and treatment). The primary endpoint was progression-free survival (PFS) per RECIST 1.1. We minimized the interruptions caused by the pandemic using telemedicine platforms for all patients. This included online consultations, follow-up drug distributions, and health management services. Results: Twenty-three pts were enrolled, with 20 NEN and 3 NEC. At the data cutoff date (April 10, 2022), 15 pts had at least one post-baseline tumor assessment;of them, the confirmed ORR (95%CI) was 20% (4.3-48.1), and DCR (95%CI) was 93.33% (68.1-99.8). Median PFS (mPFS) (95%CI): 10.640 mo (3.796-17.484);median OS: not reached and median duration of follow up was 6.870 mo (6.797-6.943). A pNET patient (NO. 010007) was interrupted by asymptomatic COVID-19 infection 9 mo after enrollment. There are no interruptions caused by COVID-19 for other patients. An NEC patient treated with single agent had a 5.85 mo PFS, evaluated as NE, in whom target lesion resected after baseline. In overall pts (n=23), most commonly (≥3 pts) with hemorrhage, anemia, hypertension, proteinuria, and abdominal pain. Three pts had TRAEs that led to treatment discontinuation. Conclusions: Surufatinib + MDT exhibited promising efficacy and manageable toxicity in pts with advanced neuroendocrine tumors. Now and in the future, it is necessary to design regulatory changes in telehealth adoption for clinical trial design in the pandemic era. Clinical trial identification: ChiCTR2100049999. Legal entity responsible for the study: The authors. Funding: Hutchison MediPharma Limited. Disclosure: All authors have declared no conflicts of interest.
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Background: MZL is the second most common lymphoma in older pts. Choosing an optimal treatment can be challenging because of patient-or disease-related risk factors and treatment-related toxicities (Curr Opin Oncol. 2019;31(5):386-393). Zanubrutinib is a potent, irreversible next-generation Bruton tyrosine kinase (BTK) inhibitor designed to maximize BTK occupancy and minimize off-target kinase inhibition, which may improve efficacy outcomes and minimize toxicities, such as cardiac arrythmias and bleeding events. Zanubrutinib received accelerated approval from the United States FDA for the treatment of pts with R/R MZL (Haematologica . 2022;107(1):35-43). Aims: We aim to present a subgroup analysis of efficacy and safety of zanubrutinib in pts aged ≥65 years with R/R MZL enrolled in MAGNOLIA (BGB-3111-214;NCT03846427). Methods: MAGNOLIA is a phase 2, multicenter, single-arm study of adults with R/R MZL who had received ≥1 line of therapy including ≥1 CD20-directed regimen. All were treated with zanubrutinib 160 mg twice daily until disease progression or unacceptable toxicity. Use of long-term antiplatelet and anticoagulation agents was permitted. The primary endpoint was overall response rate (ORR;complete response [CR] and partial response [PR]) determined by an independent review committee (IRC) in accordance with the Lugano classification. Secondary endpoints include ORR by investigator assessment (INV), duration of response (DOR), progression-free survival (PFS), and safety. All pts gave informed consent. Results: As of 18 January 2021, a total of 68 pts were enrolled (Table). Forty (61%) pts were ≥65 years old with a median age of 73 (range, 65-85);18 pts were ≥75 years old. Median number of prior therapies was 2 (range, 1-6) and 10 (25%) pts were refractory to last therapy. Most pts received prior rituximab + cyclophosphamide + vincristine + prednisone (48%) or bendamustine + rituximab (30%), while 5 (13%) pts received rituximab monotherapy. MZL subtypes included extranodal (n=17, 43%), nodal (n=14, 35%), and splenic (n=8, 20%). Median duration of treatment was 14.4 months (mo;range, 0.9-19.6). At a median follow-up of 15.8 mo (range, 2.8-21.8), ORR by IRC was 75% (CR 25%, PR 50%;Table). Responses were observed in all subtypes, with an ORR of 71%, 86%, and 75% in extranodal, nodal, and splenic subtypes, respectively (CR 41%, 21%, and 0%, respectively). Median DOR and PFS were not reached;15-month PFS was 87% and 12-month DOR was 93%. Most (63%) pts are continuing zanubrutinib. Treatment discontinuation due to disease progression was 28% by INV. Most common treatmentemergent adverse events (AEs) observed in ≥20% of pts include contusion (28%), diarrhea (25%), and constipation (20%). Grade ≥3 neutropenia occurred in 5% of pts. The most common infection was upper respiratory tract infection (10%). Two (5%) pts discontinued zanubrutinib due to unrelated fatal AEs (COVID-19 pneumonia and myocardial infarction in a patient with pre-existing coronary artery disease). Atrial fibrillation/flutter and hypertension occurred in 2 (5%) pts each and did not lead to treatment discontinuation. No pts required dose reductions, or experienced major or serious hemorrhage. Image: Summary/Conclusion: The safety profile of zanubrutinib observed in older pts was consistent with previously published results (Clin Cancer Res . 2021;27(23):6323-6332). Zanubrutinib was well tolerated and effective, as demonstrated by a high response rate and durable disease control in older pts with R/R MZL.
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Three-dimensional virtual histology images of multiple organ tissues from patients deceased due to COVID-19 were acquired using dual-view inverted selective plane microscopy (diSPIM). Compared to conventional two-dimensional histology slides, these images can provide unique insights into the pathophysiology of COVID-19. © 2022 The Author(s).
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Welcome to the fourth issue of IEEE Transactions on Computational Social Systems (TCSS) in 2022. First, we have some exciting news to share. In late June, Clarivate updated the Impact Factor of all journals which are indexed by Web of Science. According to the Journal Citation Reports, the 2021 Journal Impact Factor of IEEE TCSS was 4.727. Many thanks to all for your great effort and support. After the usual introduction of our 25 regular articles, we would like to discuss the topic of "COVID-19's Impact on Mental Health-The Hour of Computational Aid?"
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Educators have been calling for reform for a decade. Recent technical breakthroughs have led to various improvements in the semantic web-based education system. After last year's COVID-19 outbreak, development quickened. Many countries and educational systems now concentrate on providing students with online education, which differs greatly from traditional classroom education. Online education allows students to learn at their own pace. As a consequence, education has become more dynamic. In the educational system, this changing nature makes user demands difficult to identify. Many instructors suggest using machine learning, artificial intelligence, or ontology to improve traditional teaching methods. Due to the lack of survey studies examining and comparing all of the researcher's semantic web-based teaching methodologies, the authors decided to conduct this survey. This paper's goal is to analyse all available possibilities for semantic web-based education systems that enable new researchers to develop their knowledge.
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Rationale: The long-term consequences of SARS-CoV-2 infection on patients' health are increasingly recognized. It is unknown if these consequences are common to all severe viral infections or are specific to SARS-CoV-2. A syndrome of persistent exertional dyspnea has been described after influenza infection. Here, we describe patterns in healthcare expenditures for patients hospitalized for either influenza or COVID-19. Methods: We used an all-payer administrative dataset comprised of coding and billing data from over 600 healthcare entities in the United States that use a financial analytics platform by Strata Decision Technology, a private company. The de-identified analytic sample included patients aged 18 years or older who were admitted to a hospital between January 2018 and February 2021 with either an ICD-10 code for COVID-19 (COVID-19 hospitalizations) or for influenza (influenza hospitalizations). Linear regression models were used to evaluate the relationship between infection type (COVID-19 or influenza) and total post-acute healthcare expenditures (post-acute expenditures), defined as cumulative charges 1 month or more after hospitalization. The dependent variable was log-transformed post-acute expenditures and the independent variables included health system classification (academic, multi-site, single site community, and children's) and size (based on operating budget), pre-hospitalization charges, date of admission (spline), gender, and US census region. Analyses were stratified by age (18-44, 45-64, and 65+) and need for ventilation during acute hospitalization. Results: Of the 98222 patients included in our analysis, 83278 (84.8%) were COVID-19 hospitalizations and 14944 (15.2%) were influenza hospitalizations. This patient cohort was 52% female, and contained 36039 (36.7%) patients from the Midwest, 20102 (20.5%) from the Northeast, 32031 (32.6%) from the West, and 9514 (9.7%) from the South. Mean length of stay was 6.78 days. Patients with COVID-19 were more likely to receive mechanical ventilation during hospitalization (3.8%) than patients with influenza (1.8%). Compared to influenza, linear model results suggest that COVID-19 was associated with similar or lower postacute expenditures (see table 1). Results are presented separately by ventilation status to accommodate potentially differential relationships between infection severity, post-acute expenditures, and length of stay in the two patient populations. Conclusion: In previously hospitalized patients, post-acute expenditures are similar between COVID-19 (March 2020-February 2021) and influenza (January 2018- February 2021). Despite the high burden of healthcare utilization related to post-acute sequelae of COVID-19, these findings suggest that individual healthcare expenditures after acute COVID-19 infection are similar to severe influenza infection.
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Despite significant progress in the past few years, machine learning systems are still often viewed as "black boxes," which lack the ability to explain their output decisions. In high-stakes situations such as healthcare, there is a need for explainable AI (XAI) tools that can help open up this black box. In contrast to approaches which largely tackle classification problems in the medical imaging domain, we address the less-studied problem of explainable image retrieval. We test our approach on a COVID-19 chest X-ray dataset and the ISIC 2017 skin lesion dataset, showing that saliency maps help reveal the image features used by models to determine image similarity. We evaluated three different saliency algorithms, which were either occlusion-based, attention-based, or relied on a form of activation mapping. We also develop quantitative evaluation metrics that allow us to go beyond simple qualitative comparisons of the different saliency algorithms. Our results have the potential to aid clinicians when viewing medical images and addresses an urgent need for interventional tools in response to COVID-19. The source code is publicly available at: https://gitlab.kitware.com/brianhhu/x-mir.
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Purpose: The aim of this study was to develop a smart wearable mask designed for the prevention of respiratory infectious diseases by understanding consumer's preferences in designs and functions of the smart wearable masks. Design/methodology/approach: To develop a smart mask design, a survey was conducted on Chinese consumers in their 20–40s and analyzed their mask wearing behaviors, preferences and caring aspects of masks. The collected data were analyzed to identify the demographic characteristics of the subjects surveyed by using the SPSS program, and technical statistical analysis was conducted. To identify differences in demographic characteristics, an independent samples t-test, one-way analysis of variance and Scheffe's ad hoc test were conducted. Findings: Based on the research results, design guidelines for wearable masks were defined, and four wearable mask designs were developed and presented in 2D and 3D images based on the design guidelines. There were significant differences among people with different backgrounds. Originality/value: It is significant that this research presents smart wearable mask design guidelines and designs through supplementation and improvement of existing mask. It is expected that this research provides basic empirical data for mask designs through the planning of smart wearable mask designs and surveys assessing consumer perceptions, attitudes and satisfaction. © 2022, Emerald Publishing Limited.
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Now people are facing the pandemic COVID-19 and have to wear masks. This brings a problem in face recognition—occlusion problem and particularly, identifying people wearing masks in 3D-scenes is a great challenge. This study aims to develop a system for tackling this challenge. The 3D-scene is constructed with the 2D-3D coordinate transformation. For the convenience of the fusion between the virtual scene and real scene, a 3D model is achieved by Sketchup Pro. The faces and masks data are explored from the video and occluded faces recognition is achieved with the convolutional neural network. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Background Separate studies suggest that the risks from smoking might vary between high-income (HICs), middle-income (MICs), and low-income (LICs) countries, but this has not yet been systematically examined within a single study using standardised approaches. We examined the variations in risks from smoking across different country income groups and some of their potential reasons. Methods We analysed data from 134 909 participants from 21 countries followed up for a median of 11.3 years in the Prospective Urban Rural Epidemiology (PURE) cohort study;9711 participants with myocardial infarction and 11 362 controls from 52 countries in the INTERHEART case-control study;and 11 580 participants with stroke and 11 331 controls from 32 countries in the INTERSTROKE case-control study. In PURE, all-cause mortality, major cardiovascular disease, cancers, respiratory diseases, and their composite were the primary outcomes for this analysis. Biochemical verification of urinary total nicotine equivalent was done in a substudy of 1000 participants in PURE. Findings In PURE, the adjusted hazard ratio (HR) for the composite outcome in current smokers (vs never smokers) was higher in HICs (HR 1.87, 95% CI 1.65-2.12) than in MICs (1.41, 1.34-1.49) and LICs (1.35, 1 .25-1.46;interaction p<0.0001). Similar patterns were observed for each component of the composite outcome in PURE, myocardial infarction in INTERHEART, and stroke in INTERSTROKE. The median levels of tar, nicotine, and carbon monoxide displayed on the cigarette packs from PURE HICs were higher than those on the packs from MICs. In PURE, the proportion of never smokers reporting high second-hand smoke exposure (>= 1 times/day) was 6.3% in HICs, 23.2% in MICs, and 14.0% in LICs. The adjusted geometric mean total nicotine equivalent was higher among current smokers in HICs (47.2 mu M) than in MICs (31. 1 mu M) and LICs (25.2 mu M;ANCOVA p<0.0001). By contrast, it was higher among never smokers in LICs (18.8 mu M) and MICs (11.3 mu M) than in HICs (5.0 mu M;ANCOVA p=0.0001). Interpretation The variations in risks from smoking between country income groups are probably related to the higher exposure of tobacco-derived toxicants among smokers in HICs and higher rates of high second-hand smoke exposure among never smokers in MICs and LICs. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.