Effective recruitment strategies utilized in the midst of a COVID-19 pandemic to examine dietary practices and colorectal cancer screening practices of Blacks in New York City

African Americans have the highest colorectal cancer incidence and mortality rates of all racial groups in the U.S. Factors that may be contributing to these high rates, however, remain poorly understood. Specifically, this study assessed the relationship between dietary habits and colorectal cancer screening behavior and intent among individuals who identify as Black, with their ethnicity as African-American, Caribbean, and African. There are many factors that influence dietary habits, and a salient factor is culture. Many studies have experienced challenges recruiting in communities of color for various reasons. The purpose of this presentation is to describe recruitment methods utilized for this study in the midst of the COVID-19 pandemic, and to discuss challenges, strategies that were implemented and lessons learned that can inform and improve future recruitment efforts. Effective recruitment strategies included partnership, consistent engagement, and meeting people in places where they frequent and felt comfortable. Utilizing faith-based locations, barbershops, hair salons, and pivotal community locations allowed individuals to trust the researchers, and also eliminated the need to retain study subjects over a period of time, due to on-site data collection. Though our findings are limited to Black families in predominantly minority neighborhoods, we have identified Cicely successful strategies for this specific high-risk population and potentially similar others.

COVID-19 outbreaks in residential care homes in Hong Kong and effectiveness of vaccine against severe outcomes

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Effective real-time face mask detection on NVIDIA edge devices

During these difficult times of COVID-19, people are struggling to return to their normal routines, including going back to schools and workspaces. To prevent the spread of the disease, wearing face masks is essential for everyone to protect themselves and the ones around them. However, challenges arise in regard to enforcement of wearing masks in large crowds such as at educational centres and public transportation. This paper proposes a robust automatic system for face mask detection using transfer learning kits from NVIDIA. Based on the backbone of Resnet-18, the model results in high accuracy in the distinguishing of persons who do and do not wear masks. Leveraged by the NVIDIA edge accelerator, the system can run in real-time environments, making it applicable in various venues. Its feasibility was demonstrated by deploying the approach in an education centre in Hong Kong. © 2022, Hong Kong Institution of Engineers. All rights reserved.

The impact of virtual oncology care on chemotherapy continuity and clinical outcomes in patients treated for colorectal cancer: A pre-post analysis of the COVID-19 pandemic

Background: The coronavirus (COVID-19) pandemic has resulted in an abrupt transition to virtual oncology care at most cancer centres worldwide. A pillar of the American Medical Association's proposed framework for digitally enabled care is assessing clinical quality, safety, and outcomes. This study's objective is to evaluate chemotherapy quality and clinical outcomes in patients receiving intravenous chemotherapy for colorectal cancer before and during the COVID-19 pandemic. Methods: This is an observational study assessing patients treated with intravenous chemotherapy for colorectal cancer consecutively at the Ottawa Hospital Cancer Centre from June 2019 to September 2021. Patients with non-metastatic rectal cancer were excluded. Patient were stratified by whether they were started on chemotherapy pre-pandemic (June 2019 - Jan 2020) versus intra-pandemic (Feb 2020 - Sept 2021). Baseline characteristics and treatment data were collected from the electronic medical records. Outcomes of interest included chemotherapy delays, dose reductions, emergency department (ED) visits and hospitalizations. We used generalized linear and binary logistic regression modelling to compare outcomes between pre- and intra-pandemic periods. Results: There were 220 patients included in this study with 108 (49%) diagnosed with metastatic disease. In total, there were 66 (30%) patients treated in the pre-pandemic and 154 (70%) in the intra-pandemic period. As expected, virtual care consultations increased during the pandemic from 1.5% to 43.5% (p < 0.001). Likewise, the proportion of follow-up visits also increased from 37% to 84% (p < 0.001). There was no difference in the incidence of treatment delays (odds ratio [OR] = 1.01, p = 0.78), dose reductions (OR = 0.99, p = 0.69), ED visits (OR = 1.23, p = 0.37), hospitalizations (OR = 0.73, p = 0.43) or the total length of time off treatment (OR = 0.85, p = 0.17) between the pre- and intra-pandemic periods by multivariable analysis. A subgroup analysis was performed based on stage, which showed no difference in outcomes independent of the presence of metastases. Conclusions: This study demonstrates no significant difference in chemotherapy interruptions, dose intensity, or clinical outcomes in patients treated for colorectal cancer during the COVID-19 pandemic. These findings serve as an important quality-care indictor and demonstrate that virtual oncology care appears safe in a cohort of high-risk colorectal cancer patients. Future work dedicated to other tumor sites would allow for broader application of these findings.

Determinants of turnaround time in a rapid genome sequencing program

Previous studies of genome sequencing (GS) in critically ill childrenhave made use of either modified hardware or working procedureswhich would be difficult, if not impossible, to integrate into existingclinical workflows1. Our lab’s transition from exome sequencing (ES) to GS offered an opportunity to implement in-house rapid genomesequencing (rGS) in critically ill children in a manner which couldintegrate with existing clinical workflows. We conducted a feasibilityand implementation pilot by offering rGS to child-parent triosconcurrently undergoing clinical rapid ES (rES) via a reference lab.The purpose of this study was to identify and address operationalbarriers to implementation of a rGS program capable of communicatinga preliminary result within 7 days of consent. We consideredthis time span to be more reflective of clinical realities than lab-quotedturnaround times (TAT) which typically start at sample receipt andthus do not account for challenges in sample acquisition and pre-testcounseling in a critical care setting, nor the impact of shipping times.Here we present data on TAT and lessons learned from the first 27subjects enrolled.Using rapid cycle improvement methodologies, we identified fourdistinct but inter-related workflows requiring optimization:1. Pre-analytic: patient identification through acquisition ofsamples2. Wet-lab: extraction through sequencing3. Bioinformatics: secondary and tertiary analysis as well as rapididentification of causal variants4. Return of resultsFigure 1 summarizes TAT across cases, demonstrating the markedimprovements in TAT with our programmatic approach to improvement.We used our first 9 cases to determine a baseline TAT for theentire process and to delineate the 4 main workflows (above). Atbaseline, excluding cases delayed by COVID-19 restrictions, mean TATwas 17.12 days (3 sequential deviant range: 7.05–27.19 days).Following deployment of our programmatic approach to rGS, meanTAT fell to 6.19 days (3 sequential deviant range: 0.51–11.87 days).Table 1 summarizes the observations and insights, by workflow, whichimpacted upon TAT and/or implementation. The single biggest impacton TAT was optimization of bioinformatics by removing all manualsteps between starting sequencing and producing human interpretable,filtered, annotated output of high-priority variants for interpretation.The second biggest source of improvement was optimization ofthe sequencing itself as well as prioritizing sample processing for andaccess to sequencing runs. While variant ranking is helpful in identifying causal variants, in 9/10 cases with a diagnostic findingthe causal variant(s)were obvious to the study teamwithin minutes ofviewing the annotated variant list, regardless of variant rank. (Figure Presented) As time required for sequencing and analytic workflows fell, therelative contribution of other workflows to overall TAT shifted and itbecame more obvious that early identification and utilization of thisapproach is very important in lowering overall time to diagnosis(Figure 2). In 6/10 cases with a diagnostic finding, the initial approachof the clinical team was NOT rES (and thus patients were not eligiblefor rGS on a research basis). Had rGS been the initial diagnosticmodality chosen, a diagnosis could have been reached in a median 12days sooner (range 2–28 days). There were also several cases wheresequencing was delayed when one or both parents did not present tothe lab to provide a blood sample in a timely manner. Optimization ofsequencing or analytic workflows cannot meaningfully improveoutcomes either of these situations.Our findings suggest some important considerations for institutionsdeveloping or seeking to improve rapid sequencing programs for acuteand critically ill children: (Table Presented) • Optimization of computational resource utilization and phenotypecuration saves more time than improved variant filtering orprioritization.• Obtaining samples from parents is non-trivial.• Even trained geneticists may fail to recognize appropriatecandidates for rGS.

Sustaining Healthy Staying Communities in University Residential Halls amid Unprecedented Pandemic

Because of the COVID-19 pandemic, most teaching and learning or student services in the higher education setting have moved to the digital world. However, university residential halls have continued to provide services as there are students who are unable to go back to their homes/countries because of travel bans or family reasons. This study investigates the perceptions of residents who stayed at university residential halls during the pandemic. In-depth interviews were conducted with 77 staying residents from four public universities in Hong Kong. Through the sharing of their residential experience, it was found that these stayers were impacted greatly by the changes in the residential hall environment, particularly in terms of reduced interaction and emerging disciplinary concerns. Results reveal that stayers had undergone different negative mental states, namely stress, paranoia, loneliness and boredom. After identifying their conditions, some sustainable residential practices were proposed, such as maintaining minimum face-to-face contact for stayers, practicing transparent communication and arranging bulk purchases of living supplies. It is hoped that the results of this study can help to inform readers regarding the possible impacts on the stayers during a partial lockdown environment in university residential halls and how they can be better supported by universities.

Prognostication in covid-19: A prospectively Derived and externally validated risk Prediction score for in-hospital death

Introduction and Objectives The disease spectrum of COVID-19 ranges from mild viral illness to devastating lung injury that heralds the acute respiratory distress syndrome. Different risk factors of adverse outcomes have been identified but prospectively stratified and externally validated studies of prognosis are lacking. We set out to identify independent predictors of mortality and to develop and validate a clinically applicable risk prediction model of COVID-19. Methods 983 consecutive patients with COVID-19 were prospectively recruited over an 11-week period for an outcome of in-hospital death. Multiple imputation was used to address randomly missing data. 12 independent mortality predictors were identified by multivariate regression and internally validated by bootstrapping. A prognostic score was constructed and validated in an external cohort (N=277) and assessed for predictive accuracy including goodness-of-fit by the Hosmer-Lemeshow test. Results The median age of the derivation cohort was 70 (IQR: 53-83). Among non-survivors (29.9%;294/983), the highest odds ratios for death (with 95% confidence intervals) were age >70 (7.65;4.89-11.98;P<0.001), BMI >30 (2.39;1.88-3.03;P<0.001), baseline hypoxia (2.24;1.78-2.79;P<0.001), chronic kidney disease stage 5 (2.00;1.18-3.41;P<0.05) and tachypnoea (1.79;1.43-2.24;P<0.001). White ethnicity accounted for 85% of all nonsurvivors (P<0.01 vs. non-White ethnicities). Care home residency was associated with an increased risk of COVID-19 death on univariate analysis (OR 3.14;95% CI: 2.28-4.32). A linear relationship between increasing COVID-19 severity and in-hospital mortality was derived from the development dataset. Evaluation of a risk score (ranging 1-19 points) disclosed good discriminatory ability (area under the receiver operating characteristic 0.855), sensitivity (59.7%), specificity (87.6%), positive predictive (70.2%) and negative predictive value (81.6%). Subsequent validation of the score in an age and mortality-matched independent cohort showed robust performance parameters: Accuracy/AUC 0.797, calibration slope (R2) of 0.882 (see calibration belt figure 1). Conclusions Integration of key variables including age, indices of acute respiratory illness and comorbidities into a clinical risk score allows in-hospital death due to COVID-19 to be reliably predicted. The ability to risk stratify may help frontline clinicians in decision processes in respect of escalation and de-escalation strategies during resurgent COVID-19.

Findings from the first public COVID-19 temporary test centre in Hong Kong.

INTRODUCTION: The Hospital Authority of Hong Kong Special Administrative Region established a coronavirus disease 2019 (COVID-19) temporary test centre at the AsiaWorld-Expo from March 2020 to April 2020, which allowed high-risk individuals to undergo early assessment of potential severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study reviewed the characteristics and outcomes of individuals who attended the centre for COVID-19 testing. METHODS: This retrospective cross-sectional study collected epidemiological and clinical data. The primary outcome was a positive or negative SARS-CoV-2 test result, according to reverse transcription polymerase chain reaction analyses of pooled nasopharyngeal and throat swabs collected at the centre. The relationships of clinical characteristics with SARS-CoV-2 positive test results were assessed by multivariable binary logistic regression. RESULTS: Of 1258 attendees included in the analysis, 86 individuals tested positive for SARS-CoV-2 infection (positivity rate=6.84%; 95% confidence interval [CI]=5.57%-8.37%). Of these 86 individuals, 40 (46.5%) were aged 15 to 24 years and 81 (94.2%) had a history of recent travel. Symptoms were reported by 86.0% and 96.3% of individuals with positive and negative test results, respectively. The clinical characteristics most strongly associated with a positive test result were anosmia (adjusted odds ratio [ORadj]=8.30; 95% CI=1.12-127.09) and fever ORadj=1.32; 95% CI=1.02-3.28). CONCLUSION: The temporary test centre successfully helped identify individuals with COVID-19 who exhibited mild disease symptoms. Healthcare providers should carefully consider the epidemiological and clinical characteristics of COVID-19 to arrange early testing to reduce community spread.

P256 Prognostication in COVID-19: a prospectively derived and externally validated risk prediction score for in-hospital death

P256 Figure 1ConclusionsIntegration of key variables including age, indices of acute respiratory illness and comorbidities into a clinical risk score allows in-hospital death due to COVID-19 to be reliably predicted. The ability to risk stratify may help frontline clinicians in decision processes in respect of escalation and de-escalation strategies during resurgent COVID-19.

Treatment with tocilizumab does notinhibit induction of anti-COVID-19 antibodies in patients with severe SARS-CoV-2 infection

Tocilizumab (TCZ), an interleukin-6 (IL-6) receptor-blocking monoclonal antibody, is used to treat variousrheumatologic conditions and cytokine release syndrome in CAR-T cell therapy and has been repurposed to treatCOVID-19-related hyperinflammation. There are limited data available reporting how TCZ affects the immuneresponse in the context of COVID-19. To investigate this question, we recruited patients treated with TCZ as part ofa COVID-19 biobanking protocol (A-28063295) to study immune parameters that might be affected. We enrolled 19patients who were treated with a range of 40-200mg TCZ as part of a low-dose TCZ trial (COVIDOSE, reportedseparately as abstract A-94803796), and 11 patients who received 400mg TCZ on a standard-of-care expanded-access basis. As IL-6 acts as a stimulant of B-cell proliferation, plasma cell maturation, and antibody responses, weevaluated whether blocking the IL-6 receptor with TCZ therapy impairs antibody generation to SARS-CoV-2. Toevaluate antibody levels in these patients, we performed ELISAs against the SARS-CoV-2 spike glycoprotein and itsreceptor-binding domain (RBD). The spike glycoprotein, a structural protein of SARS-CoV-2, is a crucial componentin the recognition, attachment, and entry of the virus into host cells. Specifically, the RBD is responsible for bindingthe ACE2 receptor on human cells, and likely serves as a major target for neutralizing antibodies. To establish if theformation and persistence of antibodies was affected by TCZ treatment, we analyzed serum and plasma sampleslongitudinally from 29 patients treated with TCZ and 26 control patients. To account for potential variability betweenplates, the measured optical density (OD) values were normalized to the OD for COVID-19-negative control serumat 1:50 dilution, and the same negative control was tested on each plate. Titers were calculated as the linearinterpolation of the inverse dilution at which the normalized OD value crossed a threshold of 1, representing themaximum OD measured for the negative control. Anti-spike and anti-RBD antibodies increased significantly overtime in both TCZ-treated patients and controls (p < 0.005 for both). Increasing antibody titers throughout the diseasecourse followed a similar trajectory in TCZ-treated patients compared to control patients, suggesting that TCZtreatment does not impede the generation of antibodies to SARS-CoV-2. Additionally, TCZ-treated patients achievedcomparable maximal observed antibody titers to control patients (average maximal log10 (titer) of 5.42 and 4.96 forspike and of 4.39 and 4.44 for RBD, respectively). These data suggest that TCZ does not impair the induction ofanti-SARS-CoV-2 antibodies.

COVID-19 Outbreak in Hong Kong: Public Health, Surgical Masks, and Hand Hygiene

Table B (available as a supplement to the online version of this article at http://www.ajph. org) summarizes the findings from six randomized controlled trials that examined the effectiveness of surgical masks and hand hygiene to prevent respiratory virus transmission in household and residential hall settings. In a public health behavior survey conducted in New South Wales, Australia, only 58% ofthe respondents were willing to wear a surgical mask.4 In a study in which passengers in two metro stations in Mexico City, Mexico, were observed during the H1N1 epidemic in 2009, the proportion of passengers wearing a surgical mask varied between 8.9% and 76.5%.5 We note that a shift in attitudes has occurred outside east Asia as well with a new policy report in the United States recommending mask use by the general public6 and the World Health Organization conditionally recommending face mask use by asymptomatic people for mitigating the effect ofpandemic influenza (https://www.who. int/influenza/publications/public_ health_measures/publication/ en). After extensive promotion of hand hygiene in Hong Kong, many Hong Kong citizens had satisfactory hand hygiene practices despite lacking detailed understanding of viruses.3 For instance, hand sanitizers are commonly carried and used by Hong Kong citizens and are provided in many public places such as metro stations, shopping centers, schools, and business offices.