Characterization of extracellular vesicle and virus-like particles by single vesicle tetraspanin analysis

Extracellular vesicles (EVs) are nano-sized membranous particles secreted by cells. EVs have been classified into subpopulations according to their presumed biogenesis pathway, but their detailed biogenesis mechanisms still need to be fully elucidated. Enveloped viruses are another type of cell-derived nano-vesicles, and their biogenesis processes are much better known than that of EVs. Recently, studies on the similarity between enveloped viruses and EVs have been increasingly reported. The biogenesis of EVs could be better understood if these similarities are adequately investigated. In this study, we utilized a single vesicle imaging technique to visualize the protein expressions of individual nano-sized vesicles and analyzed expression patterns within single vesicles. Using this technique, we identified unique tetraspanin expression patterns in single EVs and that these patterns were closely related to their subcellular origins. The expression of CD9 or CD81 in EVs implied that they originated from the plasma membrane, and the expression of CD63 in EVs implied that they originated from endosomal organelles. We further analyzed the tetraspanin expressions of two different types of virus-like particles (VLPs) and demonstrated that the HIV-Gag-induced VLPs were more similar to EVs than SARS-CoV-2-NP/M/E-induced VLPs. In addition, HIV-Gag-GFP-expressing VLPs were highly colocalized with CD9, CD63, and CD81 signals, whereas SARS-CoV-NP-GFP-expressing VLPs were not. Based on these observations, we could assume that tetraspanin-expressing EVs might be produced through a similar process by which HIV is produced. © 2023

An Otorhinolaryngology Perspective Into a Hospital COVID-19 Cluster

In this commentary, we share our experience of a COVID-19 cluster which developed within a frontline healthcare facility designated for treating COVID-19 patients. We provide an Otorhinolaryngology perspective into the key challenges, analyses and responses. We discuss how we identified and isolated infected patients and staff, uncovered the responsible COVID-19 variant strain B1.617.2 and instituted various measures to overcome this cluster. The measures include ceasing non-essential services, limiting transfers of patients, a heightened stance of personal protective equipment, ring-fencing of staff and enhanced COVID-19 testing. With rapid hospital wide efforts, there were no new non-isolated cases from our hospital cluster 3 days after the wards were locked down. The cluster which developed on 28-April-2021 was closed on 6-Jun-2021, with 48 cases, ten of whom were healthcare workers. Some of these lessons may be useful for consideration should another healthcare institution face a similar crisis in the future.Copyright © The Author(s) 2022.

Online Learning During Covid-19 Pandemic: A View of Undergraduate Student Perspective in Malaysia

The advancement of technology changes the mode of operation worldwide education industry, where educational services can be delivered either in face-to-face or online teaching. The outbreak of COVID-19 forced higher education institutions to shift from face-to-face teaching to fully online learning, even though online learning is yet to be fully implemented in many institutions. This trend has prompted us to study this interesting topic and gather information about undergraduate students’ satisfaction with online learning from home due to the limited study focus on Malaysia. The operation of the study is based on the user satisfaction theories. A total of 156 questionnaires were distributed via judgement sampling guidelines. PLS-SEM was used for the data analysis. The results confirmed that the online learning system is useful but not user-friendly. Technical system quality is up to the satisfactory level from students’ perception. Furthermore, the attitude was confirmed significantly impact undergraduate students’ satisfaction with online learning. Discussion of the findings, implications, and direction for future research are also presented in the final section of the study. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Are loneliness interventions effective in reducing loneliness? A meta-analytic review of 128 studies : Mathias Lasgaard

Loneliness is widely acknowledged as a growing public health concern, accelerated by the onset of the COVID-19 pandemic. However, our knowledge about the effectiveness of interventions to reduce loneliness across the lifespan, including knowledge of different intervention strategies, is limited. This preregistered systematic review and meta-analysis aimed to evaluate the effect of interventions to reduce loneliness. The systematic review identified 136 studies. The meta-analysis included 128 studies comprising 54 randomised controlled trials (RCTs) (n = 6,379), 23 multi-cohort studies (n = 2,882) and 48 single-cohort studies (n = 3,009). A small to moderate statistically significant effect was detected (RCTs;SMD = -0.47, multi-cohort studies;SMD = -0.24, single cohort-studies;SMD = -0.42). Using the GRADE system, confidence in the estimates was assessed as low or very low, implying that the estimates may potentially be higher or lower. No statistically significant differences were found between age groups. Psychological treatment, social support interventions, and social and emotional skills training appeared to be the most effective intervention strategies in reducing loneliness but there is currently no strong reason to prefer one intervention strategy over another. Further analyses demonstrated that the long-term effects (i.e., one to six months after the intervention) were comparable to the short-term effects (i.e., up to four weeks after the intervention). Findings from the current meta-analyses provide overall evidence of the effectiveness of loneliness interventions. Given methodological limitations, including the heterogeneity of the reviewed studies, it remains unclear who the interventions would help the most. Overall, there is a need for rigorous and high-quality development and evaluations of interventions for loneliness. Key messages • The findings of this meta-analytic review suggest that interventions designed to reduce loneliness are effective. • Psychological treatment, social support interventions, and social and emotional skills training are the most promising interventions, albeit the magnitude of the effects is moderate.

Humanitarian Objects for COVID-19: Face Masks and Shields in the Philippines

Focusing on the Philippines’ response to the COVID-19 pandemic, this article examines two key objects used to mitigate the widespread transmission of the virus. To answer the research question, “What is the meaning of face masks and shields in the Philippines during the COVID-19 pandemic?” a patchwork ethnography research method was used to triangulate data from a variety of sources, including academic scholarship, mass media, grey literature, and personal experience. Using Tom Scott-Smith’s theoretical interpretation of Karl Marx’s “commodity fetishism” as a framework, the article traces the concealment, transformation, and mystification of face masks and face shields as humanitarian objects, and explores the social, political, and cultural role they play in the lives of Filipinos during the COVID-19 era. © Mathea Melissa Lim and Jesse Hession Grayman, 2022.

Expansion of a teleophthalmology program for diabetic retinopathy screening during the COVID19 pandemic

Purpose : The COVID-19 pandemic prompted efforts to encourage social distancing and minimize non-urgent in-person eye care. Here, we report the outcomes of a teleophthalmology program for diabetic retinopathy screening at an integrated health system in California that was expanded during the pandemic. Methods : We performed a retrospective review of patients who underwent remote retinal imaging as part of a teleophthalmology program for diabetic retinopathy (DR) screening using Current Procedural Terminology (CPT) codes 92227 and 92228 at the University of California, Davis Health system between May 31st , 2019 and June 8th , 2021. Retinal images were captured at primary care locations using a Topcon NW400, Nikon RetinaStation, or Optos Primary fundus cameras, and image grading were performed by trained ophthalmologists or optometrists using a store-and-forward method. Patient records were reviewed to collect demographic, follow-up, and clinical outcomes information. Results : During COVID19 pandemic, the teleophthalmology program screened 570 individuals (mean age 63.2 ± 13.7). There was a significant increase in the number of patients screened per month prior to and following the COVID-19 lock-down in March 2020 (5.0 ± 3.1 patients screened per month prior to and 39.1 ± 34.8 patients per month following, P = 0.0004). Among these, 204 patients received a recommendation for in-person eye care referral, of which 127 received a referral to the UC Davis Eye Center, 85 appointments were scheduled, and 82 patients were followed in person, with a median time of 108 days between screening and in-person follow-up. Follow-up rates were generally lower during the initial months after the pandemic and increased over time. Among the patients who followed in person (mean age 63.9 ± 13.8), 10% of eyes had mild non-proliferative DR (NPDR), 5% had moderate NPDR, 3% had severe NPDR, 2% had PDR, and 4% had diabetic macular edema (DME), with similar proportions before and after the COVID-19 lockdown. Conclusions : Expansion of a teleophthalmology program during the COVID19 pandemic demonstrated improved DR screening rates, increased referrals, and improved follow-up for diabetic eye care at an integrated health system in Northern California.

American Art in Asia: Artistic Praxis and Theoretical Divergence

This book challenges existing notions of what is "American" and/or "Asian" art, moving beyond the identity issues that have dominated art-world conversations of the 1980s and the 1990s and aligning with new trends and issues in contemporary art today, e.g. the Global South, labor, environment, and gender identity. Contributors examine both historical and contemporary instances in art practices and exhibition-making under the rubric of "American art in Asia." The book complicates existing notions of what constitutes American art, Asian American (and American Asian) art. As today's production and display of contemporary art takes place across diffused borders, under the fluid conditions of a globalized art world since transformed by the COVID-19 pandemic, new contexts and art historical narratives are forming that upend traditional Euro-American mappings of center-margins, migratory patterns and community engagement. The book will be of interest to scholars working in art history, American studies, Asian studies and visual culture. © 2022 selection and editorial matter, Michelle Lim and Kyunghee Pyun. All rights reserved.

A Study of Chinese Students’ Application to UK Universities in Uncertain Times: From the Perspective of Education Agents

A large number of Chinese applicants use education agents to apply for overseas programs, and agents are one of the most significant influence factors on Chinese international students’ choice of overseas programs. However, there is limited research around agents’ experiences within the existing information landscape of international higher education. For example, information asymmetries between agents and universities may have an impact on the advice and guidance provided for international applicants. This research investigates agents’ practices with in-service Chinese applicants to UK universities in the context of information asymmetry. COVID-19 serves as a backdrop as an illustrative case of a period of high information uncertainty, which has generated severe challenges for the international higher education sector and for Chinese applicants’ plans to study overseas. This study reports on the findings from in-depth interviews with 16 Chinese agent consultants undertaken in nine cities across China in the immediate aftermath of the pandemic (May 2020). The findings indicate that education agents attempt to mitigate the information asymmetry and emotionally reassure applicants through a four-step information management process. Our contribution generates a new understanding of the role that education agents play in international students’ applications and mobility, voices that are often ignored but essential for international students’ decision-making processes and existing university recruitment services. © Journal of International Students.

SCOOP: STRENGTHENING COVID-19 COMMUNICATION IN PREGNANCY

Background: Maternity services in Australia were significantly disrupted during the COVID-19 pandemic and changes were often rapidly introduced, requiring timely dissemination of information to women. The aim of this study was to better understand what information was circulating regarding COVID- 19 and pregnancy in Australia, the presence of misinformation and potential information gaps. Methods: This study adopted a two-phased qualitative approach utilising both social media analysis and in-depth individual interviews with those living in Australia who had been pregnant since March 2020. Social media data were analysed via inductive content analysis. Interview data were thematically analysed. Results: In total, 220 Twitter and Reddit posts were analysed, and 21 women interviewed. Social media was important for both sharing and obtaining information. Community attitudes towards COVID-19 vaccination in pregnancy were also expressed. In the interviews, women expressed wanting further information on the risks COVID-19 posed to themselves and their babies and how insufficient information caused frustration and anxiety. The lack of face-to-face care left women feeling disconnected from their maternity service. Women were more likely to turn to informal sources, such as social media, when there was a perceived lack of information, potentially increasing exposure to misinformation. Health providers were trusted sources, and women preferred communication strategies that allowed them to engage with their providers in real-time. Conclusion: Communication strategies targeting women in the community must be strengthened as the pandemic continues, especially during periods of change. Communication should be proactive, timely and consistent to limit reliance on informal and potentially inaccurate sources.

Multilabel Emotion Recognition Technique considering the Characteristics of Unstructured Conversation Data

Due to the recent increase in non-face-To-face services due to COVID-19, the number of users communicating through messengers or SNS (social networking service) is increasing. As a large amount of data is generated by users, research on recognizing emotions by analyzing user information or opinions is being actively conducted. Conversation data such as SNS is freely created by users, so there is no set format. Due to these characteristics, it is difficult to analyze using AI (artificial intelligence), which leads to a decrease in the performance of the emotion recognition technique. Therefore, a processing method suitable for the characteristics of unstructured data is required. Among the unstructured data, most emotion recognition in Korean conversation recognizes a single emotion by analyzing emotion keywords or vocabulary. However, since multiple emotions exist complexly in a single sentence, research on multilabel emotion recognition is needed. Therefore, in this paper, the characteristics of unstructured conversation data are considered and processed for more accurate emotion recognition. In addition, we propose a multilabel emotion recognition technique that understands the meaning of dialogue and recognizes inherent and complex emotions. A deep learning model was compared and tested as a method to verify the usefulness of the proposed technique. As a result, performance was improved when it was processed in consideration of the characteristics of unstructured conversation data. Also, when the attention model was used, accuracy showed the best performance with 65.9%. The proposed technique can contribute to improving the accuracy and performance of conversational emotion recognition. © 2022 Myungjin Lim et al.

Contemporary Issues in Mediation

Contemporary Issues in Mediation (CIIM) Volume 6 builds on the success of the past five volumes as testament to a growing interest of authors and readers in the wide variety of issues that arise with mediation. Readers stand to benefit from a diverse range of topics especially selected for their high quality of research and novelty that cannot be replicated elsewhere. With the recent ratification of the Singapore Convention on Mediation in 2020, there is no doubt that mediation is and will continue to be extremely pertinent in the world of dispute resolution. The COVID-19 situation and evolution of technology has also heralded a new era of cross-border and domestic online dispute resolution. Edited by Singapore’s leading expert on mediation and negotiation, Professor Joel Lee, and former Chief Executive Officer of the Singapore International Mediation Institute (SIMI), Marcus Lim, CIIM is a unique and valuable addition to the growing body of mediation and dispute resolution literature. © 2022 by World Scientific Publishing Co. Pte. Ltd.

Risk of COVID-19 in children treated for demyelinating disorders in the UK

Objective: Paediatric neurologists are concerned about the risk of COVID-19 in children with demyelinating disorders receiving immunomodulatory treatment. To investigate this, we collected data via the UK Childhood Neuro-Inflammatory Disorders (UK-CNID) network of the British Paediatric Neurology Association (BPNA). Methods: Survey of paediatric neurologists managing unvaccinated UK children (<18 years) with a demyelinating disorder (multiple sclerosis [MS];neuromyelitis optica spectrum disorder [NMOSD] and myelin oligodendrocyte glycoprotein antibody disease [MOGAD]) on immunomodulatory therapy with SARS-CoV-2 infection confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR) of nasopharyngeal swabs between March and December 2020. Results: Of 151 UK children (MS 98, MOGAD 37, NMOSD 16) with a median age of 9 years (range 6-18y), with a demyelinating disorder, nine (6.0%) had a positive PCR for SARS-CoV-2. Five had MS and four MOGAD. Four were from south Asian or south-east Asian, four were White and one was mixed White and south Asian. Seven children had COVID-19 symptoms;two were asymptomatic. Two required a brief hospital admission for typical COVID-19 respiratory symptoms and the remaining five had mild symptoms including fever, rash, cough and headache. One with MOGAD, treated with azathioprine, developed transverse myelitis 12 days after COVID-19 onset. She recovered fully with a course of corticosteroids. MS patients were on following disease modifying therapies;dimethylfumarate (n=2), fingolimod (n=1);natalizumab (n=1) and ocrelizumab (n=1). MOGAD cases were on the following immune therapy: combination of oral prednisolone and intravenous immunoglobulin (n=2), prednisolone steroids (n=1) and azathioprine (n=1). Conclusions: In contrast to adult patients, who often have underlying co-morbidities and advanced neurological disabilities, we have identified that children treated for demyelinating disorders appear to have a milder COVID-19 course. Whilst the number of children treated for demyelinating disorders that developed COVID-19 is low, the overall mild course described may provide reassurance to neurologists, patients and family members.

Can social distancing and changes in health behaviours reduce infection-triggered neuroinflammation?

Background: Many neuroinflammatory disorders including autoimmune and post-infectious encephalitis are observed to have a seasonal variation. We evaluated changes in the incidence of neuroinflammatory disorders in association with the COVID-19 pandemic, hypothesising that social distancing and changes in health behaviour would lead to a reduction in infection-triggered conditions. Methods: In this single institution retrospective study, we reviewed all children admitted during the COVID-19 pandemic between March 2020 and March 2021, identifying those with new onset and non-COVID associated acute demyelinating syndrome (ADS), multiple sclerosis (MS), Guillain-Barre syndrome (GBS), autoimmune encephalitis (AE) and post-infectious encephalitis (PIE). Incidences were compared with the three years pre-pandemic (2017-2020). Two-tailed p-values were calculated from z-scores for 2020 to 2021 with respect to the 2017 to 2020 distributions. Results: The number of children admitted with AE during the COVID-19 pandemic (2020-2021) was 3, compared to 7.67 (annual mean during 2017-2020) representing a 61% decline (p<0.001). PIE decreased by 30% from a mean of 10 to 7 (p=0.26). Whereas, GBS, ADS and MS were not statistically significant with 3, 6 and 10 admissions during the pandemic compared to a mean of 3.33, 8.33 and 9.33 admissions in 2017 to 2020, respectively. Conclusion: The significant decrease in the incidence of AE during the COVID-19 pandemic suggests that disruptions to seasonal endemic infection transmission by changes in social mixing and health behaviours can modify the link between infection and autoimmune encephalitides. However, incidence of other neuroinflammatory conditions typically presumed to have an infectious trigger such as GBS and ADS was not reduced, suggesting infectious triggers may either be less important in the aetiology of these conditions or that this link is more complex and cannot be observed within the epoch of behavioural change. Autoimmune induction may indeed involve longer lags from infection, require a second infection and be influenced by other environmental and genetic factors.

PIMS-TS: Neurological, quality of life and adaptive functioning outcomes and associated factors

Background: Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS) causes prolonged hospitalisation and morbidity. The longer term neurological and health outcomes in children following PIMS-TS are largely unknown. Methods: In this single-institution study, we evaluated the domains of daily living, physical, emotional, and quality of life outcomes at 6 months following PIMS-TS. Data were collected by telephone questionnaire interviews with parents and children and also using standardized assessment tools -PedsQL-Multidimensional Fatigue Scale, and Paediatric Symptom Checklist (PSC). Results: Data were obtained from 81 children admitted with PIMS-TS between April and August 2020. 49 were males (60%) and 52 (63%) non-white. Median age was 9 years (8-17 years) with length of stay of 6 days (range 1-22 days). Prior to discharge, 34 children (42%) had difficulties with activities of daily living whereas only 5 (6%) persisted on 6 months follow up. Exercise intolerance/mobility difficulty was observed in 40 children (9%) at discharge compared to 20 (25%) 6 months later. Predictors associated with difficulty in exercise tolerance/mobility were obesity (OR=4.0;95% CI: 1.1-13.7;p=0.03) and older age (OR=1.1;95% CI: 0.99-1.3;p=0.086). Inflammatory markers on admission (CRP, fibrinogen, D-dimer and ferritin) did not correlate with worse outcome at follow-up nor did sex and length of stay. The PedsQL-Multidimensional Fatigue Scale revealed a median score of 94 (IQR: 83-100) indicating an overall average range quality of life. The PSC were in line with population prevalence of behavioural/emotional difficulties: 10% had difficulties with attention;7% and 4% of patients had internalizing and externalizing difficulties, respectively Conclusion: Overall, patients with PIMS-TS have good short-term outcomes at 6 months with respect to daily functioning, quality of life, and behaviour. One in four had some difficulty with mobility/pain requiring rehabilitation, with main risk factors being obesity and older age. Further studies are required to evaluate long-term sequelae.

Using AI and ML to predict shipment times of therapeutics, diagnostics and vaccines in e-pharmacy supply chains during COVID-19 pandemic

Purpose: This paper aims to address the pressing problem of prediction concerning shipment times of therapeutics, diagnostics and vaccines during the ongoing COVID-19 pandemic using a novel artificial intelligence (AI) and machine learning (ML) approach. Design/methodology/approach: The present study used organic real-world therapeutic supplies data of over 3 million shipments collected during the COVID-19 pandemic through a large real-world e-pharmacy. The researchers built various ML multiclass classification models, namely, random forest (RF), extra trees (XRT), decision tree (DT), multilayer perceptron (MLP), XGBoost (XGB), CatBoost (CB), linear stochastic gradient descent (SGD) and the linear Naïve Bayes (NB) and trained them on striped datasets of (source, destination, shipper) triplets. The study stacked the base models and built stacked meta-models. Subsequently, the researchers built a model zoo with a combination of the base models and stacked meta-models trained on these striped datasets. The study used 10-fold cross-validation (CV) for performance evaluation. Findings: The findings reveal that the turn-around-time provided by therapeutic supply logistics providers is only 62.91% accurate when compared to reality. In contrast, the solution provided in this study is up to 93.5% accurate compared to reality, resulting in up to 48.62% improvement, with a clear trend of more historic data and better performance growing each week. Research limitations/implications: The implication of the study has shown the efficacy of ML model zoo with a combination of base models and stacked meta-models trained on striped datasets of (source, destination and shipper) triplets for predicting the shipment times of therapeutics, diagnostics and vaccines in the e-pharmacy supply chain. Originality/value: The novelty of the study is on the real-world e-pharmacy supply chain under post-COVID-19 lockdown conditions and has come up with a novel ML ensemble stacking based model zoo to make predictions on the shipment times of therapeutics. Through this work, it is assumed that there will be greater adoption of AI and ML techniques in shipment time prediction of therapeutics in the logistics industry in the pandemic situations. © 2021, Emerald Publishing Limited.

Venetoclax with Azacitidine or Low Dose Cytarabine As an Alternative to Intensive Chemotherapy in Fit Adults during the COVID19 Pandemic: Real World Data from the UK National Health Service

Background Based on early evidence of a high rate of coronavirus mortality in patients with acute myeloid leukaemia (AML) undergoing intensive chemotherapy (IC), the national health service (NHS) in the United Kingdom temporarily made venetoclax available as an alternative therapy, with the aim of reducing both mortality and healthcare resource use. From late April 2020, venetoclax was available to patients aged >16y with NPM1 mutation without FLT3 internal tandem duplication (ITD), patients aged >50y with NPM1, IDH1 or IDH2 mutations (regardless of FLT3 status) and patients aged >60y without favourable-risk cytogenetics. Venetoclax could be given with either azacitidine or low-dose cytarabine (LDAC), with the latter recommended mainly for patients with NPM1 mutation. We report a health-system-wide real world data collection for toxicity and patient outcomes across 65 NHS Hospitals. Methods Each patient was registered on a central NHS database. Clinicians certified that their patient met the above criteria, had not received previous AML treatment, and was fit for induction chemotherapy. Anonymised data were retrospectively collected by treating physicians. Venetoclax dose, duration and toxicity information was requested for the first 4 cycles of therapy. Response definitions were as per European Leukaemia Network (ELN) guidelines. A total of 870 patients have been registered on the scheme, with outcomes reported here for those with follow-up information at a data cut on 1st August 2021. Results There were 301 patients, median age 72y (range 34 - 90) with 62% male. The majority (81%) had an ECOG performance status of 0-1. AML was secondary to a previous haematological disorder in 33%, therapy-related in 10% and de novo in the remaining 57%. MRC cytogenetic risk was intermediate in 70% and adverse in 27%. NPM1 mutations were detected in 28% and FLT3-ITD in 12%. Next-generation sequencing results were available in 86% of patients, which detected mutations in IDH1 or IDH2 in 28%, ASXL1 in 20%, RUNX1 in 17% and TP53 in 12%. The ELN risk was favourable for 23%, intermediate for 30% and adverse for 44%. A majority received venetoclax in combination with azacitidine (85%), with the remaining 15% receiving LDAC. The LDAC cohort was enriched for de novo AML (76% vs 54%) and NPM1-mutated disease (56% vs 23%). Most patients (81%) followed the recommended initial schedule of venetoclax 100mg daily for 28 days in combination with posaconazole or voriconazole. Patients spent a median 14 days in hospital in cycle 1, then a median of 0 days for cycles 2-4. In cycles 1, 2, 3 and 4, the median number of days for recovery of neutrophils to >0.5x10 9/L was 33, 25, 24 and 14 respectively, and the median number of days to recovery of platelets to >50x10 9/L was 22, 3, 0 (no drop below 50) and 0. The composite complete remission (CR) / CR with incomplete haematological recovery (CRi) rate was 70%. MRD data is being collected. The best response was morphological leukaemia free state (MLFS) in 2%, partial remission in 7% and refractory disease in 11%. CR/CRi was higher in de novo (78%) compared to secondary AML (57%, p=0.02);NPM1 mutated (78% vs 67%, p=0.02) and IDH1/IDH2 mutated disease (85% vs 62%, p=0.02). ELN favourable risk patients had the highest CR/CRi rate (85%, intermediate 71%, adverse 60%, p=0.01). Median follow-up was 8.2 months (95%CI 7.8 - 9.0) with median overall survival (OS) 12.8 months (95%CI 10.9 - not reached). Mortality at day 30 was 5.7% and day 60 was 8.4%. 12-month overall survival was 51%, increasing to 71% in those who achieved CR/CRi. Survival was poorer in secondary (HR 1.9, p <0.01) and therapy-related AML (HR 2.1, p=0.02), better in NPM1 mutated (HR 0.6, p=0.02) and IDH mutated (HR 0.5, p=0.02) disease and poorer with TP53 mutation (HR 2.0, p=0.01). Overall survival did not differ for patients treated with LDAC compared to azacitidine (HR 1.1, p=0.7). Conclusion This large real-world study demonstrates CR/CRi and survival rates comparable to those reported in prospective clinical trials. Importantly, during t e COVID-19 pandemic, the adoption of venetoclax regimens permitted the great majority of treatment to be delivered as an outpatient with significant resource saving at a time of critically constrained inpatient resources. The data support prospective comparisons of venetoclax-based regimens to IC in fit adults with AML particularly in older patients with de novo AML, NPM1-mutated and IDH-mutated disease. [Formula presented] Disclosures: Belsham: Celgene: Other: meeting attendance;Abbvie: Other: meeting attendance. Khan: Abbvie: Honoraria;Astellas: Honoraria;Takeda: Honoraria;Jazz: Honoraria;Gilead: Honoraria;Novartis: Honoraria. Khwaja: Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Jazz Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Astellas: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Abbvie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Latif: Kite: Consultancy, Honoraria, Speakers Bureau;Jazz: Consultancy, Honoraria;Daiichi Sankyo: Consultancy, Honoraria;Novartis: Consultancy, Honoraria;Amgen: Consultancy, Honoraria;Abbvie: Consultancy, Honoraria;Astellas: Consultancy, Honoraria, Speakers Bureau;Takeda UK: Speakers Bureau. Loke: Pfizer: Honoraria;Amgen: Honoraria;Janssen: Honoraria;Novartis: Other: Travel;Daichi Sankyo: Other: Travel. Murthy: Abbvie: Other: support to attend educational conferences. Smith: ARIAD: Honoraria;Pfizer: Speakers Bureau;Daiichi Sankyo: Speakers Bureau. Whitmill: Daiichi-sankyo: Other: travel fees;EHA in stockholm: Other: conference support. Craddock: Novartis Pharmaceuticals: Other: Advisory Board;Celgene/BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding. Dillon: Shattuck Labs: Membership on an entity's Board of Directors or advisory committees;Jazz: Other: Education events;Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: educational events;Novartis: Membership on an entity's Board of Directors or advisory committees, Other: Session chair (paid to institution), Speakers Bureau;Menarini: Membership on an entity's Board of Directors or advisory committees;Astellas: Consultancy, Other: Educational Events, Speakers Bureau;Amgen: Other: Research support (paid to institution);Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Research Support, Educational Events.

Gilteritinib for Relapsed Acute Myeloid Leukaemia with FLT3 Mutation during the COVID-19 Pandemic: Real World Experience from the UK National Health Service

Background Early data suggest that patients undergoing salvage chemotherapy for relapsed or refractory (R/R) acute myeloid leukaemia (AML) have poor outcomes if infected with SARS-CoV-2, and nosocomial transmission has been a major problem worldwide. Gilteritinib is effective in R/R FLT3 mutated AML, is significantly less immunosuppressive and does not require hospital admission, however at the start of the pandemic this was not yet approved for routine use in all countries. In the United Kingdom, the National Health Service (NHS) made gilteritinib available as an emergency measure from late April 2020 to patients aged >16y with R/R FLT3 mutated AML, with the aim of reducing both mortality and healthcare resource use. We report a health-system-wide real world data collection for toxicity and patient outcomes across 27 NHS Hospitals. Methods Each patient was registered on a central NHS database, with clinicians certifying that their patient met the above criteria. Anonymised data were retrospectively collected by treating physicians. Gilteritinib dose, duration and toxicity information was requested for the first 4 cycles of therapy. Response definitions were as per European Leukaemia Network (ELN) guidelines. A total of 81 patients have been registered on the scheme, with outcomes reported here for those with follow-up information at a data cut on 1st August 2021. Results Fifty patients were included with a median age of 59y (range 19 - 77) and 50% male. The majority (83%) had an ECOG performance status of 0-1. AML was secondary to a previous haematological disorder in 12%, therapy-related in 4% and de novo in the remaining 84%. The disease was refractory to the last therapy in 38%. Most patients had previously received 1 (65%) or 2 (33%) lines of therapy, including intensive chemotherapy in a majority (86%). A FLT3 inhibitor had previously been administered to 45% and 35% were post allogeneic transplant. The FLT3 mutation was an internal tandem duplication (ITD) in 80% and tyrosine kinase domain (TKD) mutation in 22%. NPM1 mutations were detected in 34%. Next-generation sequencing results were available for 94% of patients, with mutations in IDH1 or IDH2 in 12.5%, ASXL1 in 2%, RUNX1 in 21% and no TP53 mutations. Patients spent a median 3.5 days in hospital in cycle 1, 0 days in cycles 2 and 3 and 1 day in cycle 4. In cycles 1, 2, 3 and 4, the median number of days of grade 4 neutropenia was 18, 7, 7.5, and 6.5 respectively, and the grade 4 thrombocytopenia was 2, 7, 0.5 and 0.5. The composite complete remission (CR) / CR with incomplete haematological recovery (CRi) rate was 27%. MRD data is being collected. The best response was morphological leukaemia free state (MLFS) in 4%, partial remission (PR) in 25% and refractory disease in 38%. The rate of combined CR/CRi did not differ in those with previous exposure to FLT3 inhibitors (23% vs 32%, p=0.6) or with past allogeneic transplant (29% vs 27%, p=0.3). There were no CR/CRi in patients with adverse cytogenetic risk. Median follow-up was 10.5 months (95%CI 7.3 - 12.3) with median overall survival (OS) 6.7 months (95%CI 4.5 - not reached). Mortality at day 30 was 0% and day 60 was 14%. 12-month overall survival was 38%. Patients who achieved a CR/CRi had a 12-month OS of 83%, and for PR this was 35%. Survival did not differ in those with previous FLT3 inhibitor exposure (HR 1.0, p>0.9) or allogeneic transplant (HR 0.63, p=0.3). Seven patients (14%) so far have been bridged with gilteritinib to allogeneic transplant. Conclusion Our data demonstrate that gilteritinib is well tolerated and clinically active in adults with relapsed FLT3 mutated AML. Importantly, during the COVID-19 pandemic, its availability has permitted the great majority of treatment to be delivered as an outpatient with significant resource saving at a time of critically constrained inpatient resources. Patients who achieve CR/CRi have good short-term outcomes and are able to proceed to a potentially curative allogeneic stem cell transplant. [Formula presented] Disclosures: Belsham: Celgene: Other: meeting attendance;Abbvie: Other: meeting attendance. Byrne: Incyte: Honoraria. Khan: Abbvie: Honoraria;Astellas: Honoraria;Takeda: Honoraria;Jazz: Honoraria;Gilead: Honoraria;Novartis: Honoraria. Khwaja: Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Jazz Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Astellas: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Abbvie: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Latif: Kite: Consultancy, Honoraria, Speakers Bureau;Jazz: Consultancy, Honoraria;Daiichi Sankyo: Consultancy, Honoraria;Novartis: Consultancy, Honoraria;Amgen: Consultancy, Honoraria;Abbvie: Consultancy, Honoraria;Astellas: Consultancy, Honoraria, Speakers Bureau;Takeda UK: Speakers Bureau. Loke: Amgen: Honoraria;Daichi Sankyo: Other: Travel Support;Janssen: Honoraria;Novartis: Other: Travel Support;Pfizer: Honoraria. Munisamy: Jazz Pharmaceuticals: Speakers Bureau;Roche: Speakers Bureau. Murthy: Abbvie: Other: support to attend educational conferences. Smith: Daiichi Sankyo: Speakers Bureau;Pfizer: Speakers Bureau;ARIAD: Honoraria. Craddock: Novartis Pharmaceuticals: Other: Advisory Board;Celgene/BMS: Membership on an entity's Board of Directors or advisory committees, Research Funding. Dillon: Amgen: Other: Research support (paid to institution);Astellas: Consultancy, Other: Educational Events, Speakers Bureau;Menarini: Membership on an entity's Board of Directors or advisory committees;Novartis: Membership on an entity's Board of Directors or advisory committees, Other: Session chair (paid to institution), Speakers Bureau;Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: educational events;Jazz: Other: Education events;Shattuck Labs: Membership on an entity's Board of Directors or advisory committees;Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Research Support, Educational Events.

Preferences for Accessing Patient Reported Outcomes and Health Information Among Thrombotic Thrombocytopenic Purpura Survivors

Introduction: Our previous qualitative studies of immune-mediated thrombotic thrombocytopenic purpura (iTTP) survivors revealed that patients did not communicate to their hematologists about residual cognitive and fatigue issues. A way to overcome this communication barrier is implementation of patient-reported outcomes (PROs) in routine care. Integration of PROs into the clinical care of other diseases has resulted in improved patient-provider communication, symptom management, quality of life and overall patient satisfaction. However, decisions about the mode of administration are challenging. Although 92% of the United States population has access to the internet, studies have shown minorities prefer alternative modes of administration. Given that iTTP disproportionately affects Black women, understanding patient preference is critical for integrating PRO instruments into routine care. The primary study goal was to determine the preferred mode of administration of PRO instruments in iTTP. Furthermore, many individuals use the internet as a source of medical information/advice. A study of iTTP literacy reported that only 34% of survivors correctly identified disease relapse risk factors suggesting a critical knowledge gap. A secondary goal was to describe iTTP survivors' behaviors regarding using the internet for medical information or support. Methods: We utilized a cross-sectional study design. iTTP survivors were recruited from August 2019 until present. Eligibility included: 1) age >18 years, 2) documented ADAMTS13 deficiency (< 10% activity) at diagnosis or during a relapse and 3) > 1-year clinical remission. Multi-center recruitment of survivors included: Oklahoma University, Ohio State University, University of Minnesota, Johns Hopkins University, University of Rochester, University of Pennsylvania, University of Alabama at Birmingham, University of Utah and the University of Vermont. Following informed consent, survivors were administered the PROMIS ® cognitive function ability, anxiety and fatigue instruments via their preferred mode (online, telephone, or self-administered). Typical internet usage, behaviors regarding searching for health information online and demographics were also obtained. Results: To date, 94 survivors have completed the study (83% female;54% White;34% Black;median age 49 years [range 26-85 years]). A majority (54%) preferred completing PROMIS ® surveys online vs. self-administered or telephone administered. However, among Black survivors, only 38% preferred online administration and among survivors aged ≥65 years only 22% preferred online administration. Interestingly, there was an overall shift in a preference toward online administration following the onset of the COVID-19 pandemic (45% (21/47) preferred online pre vs 66% (31/47) preferred online post). Ninety-one percent (86/94) of survivors reported at least occasional internet use vs 8 (9%) reported none. Similarly, 82% (70/85) had searched the internet for health/medical information for themselves in the past year. Also 62% (53/86) of the survivors selected ‘strongly agree’ or ‘agree’ to the statement that the internet helps them determine if symptoms are important enough to see a doctor. Likewise, 62% used the internet to interpret doctor's recommendations. Additionally, 47% (40/86) ‘strongly agree/agree’ the internet helped determine if they would take a medication/seek alternative treatment. Moreover, 64% (55/86) agreed the internet was a good way to find others experiencing similar health problems. However, when asked about behaviors over the past year, only 42% (36/85) used online social networking sites like Facebook to look for health information or find others with iTTP and only 36% (31/85) had actually participated in online iTTP support groups. Conclusions: Overall iTTP survivors preferred online PRO administration;however, Black and older survivors preferred other methods. Recognizing these preferences is a vital step toward integrating PROs into routine care. Furthermore, iTTP survivors are us ng the internet as a source of medical support and information. Therefore, it is critical to not only educate iTTP survivors about credible online resources but also to create additional content. Also, future studies are needed to further explore the impact of the COVID-19 pandemic on online health behaviors. Disclosures: Terrell: Sanofi: Consultancy;Takeda: Consultancy. Journeycake: HEMA Biologics: Honoraria;LFB: Honoraria. Mazepa: Answering TTP Foundation: Research Funding;Sanofi Aventis: Other. Cuker: Spark Therapeutics: Research Funding;Sanofi: Research Funding;Pfizer: Research Funding;Takeda: Research Funding;Novo Nordisk: Research Funding;Novartis: Research Funding;Bayer: Research Funding;Alexion: Research Funding;UpToDate: Patents & Royalties;Synergy: Consultancy. Chaturvedi: Dova: Other: Advisory board member;UCB: Other: Advisory board participation;Argenx: Other: Advisory board member;Alexion: Other: Advisory board member;Sanofi Genzyme: Other: Advisory board member. Lim: Hema Biologics: Honoraria;Sanofi Genzyme: Honoraria;Dova Pharmaceuticals: Honoraria. Gangaraju: Alexion: Consultancy;Sanofi Genzyme: Consultancy. Cataland: Alexion: Consultancy, Research Funding;Sanofi Genzyme: Consultancy;Ablynx/Sanofi: Consultancy, Research Funding;Takeda: Consultancy.

Isolation and genomic analyses of an early sars-cov-2 strains from the 2020 epidemic in gwangju, south korea

Since the first identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in China in late December 2019, the coronavirus disease 2019 (COVID-19) has spread fast around the world. RNA viruses, including SARS-CoV-2, have higher gene mutations than DNA viruses during virus replication. Variations in SARS-CoV-2 genome could contribute to efficiency of viral spread and severity of COVID-19. In this study, we analyzed the locations of genomic mutations to investigate the genetic diversity among isolates of SARS-CoV-2 in Gwangju. We detected non-synonymous and frameshift mutations in various parts of SARS-CoV-2 genome. The phylogenetic analysis for whole genome showed that SARS-CoV-2 genomes in Gwangju isolates are clustered within clade V and G. Our findings not only provide a glimpse into changes of prevalent virus clades in Gwangju, South Korea, but also support genomic surveillance of SARS-CoV-2 to aid in the development of efficient therapeutic antibodies and vaccines against COVID-19. © This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License.

LSTM-Based multi-modal sentiment recognition for psychological counseling chatbot

Psychological counseling is to normalize the problems of modern people who are experiencing various psychological problems through counseling. The importance of psychological counseling is increasing due to the recent increase in non-face-to-face services due to COVID-19 and Corona-Blue. Therefore, a psychological counseling chatbot that changed the counseling medium is needed. In this paper, we propose an LSTM-based multi-modal sentiment recognition method that recognizes sentiment by using multi-modal that combines text and keystroke dynamics written by the client as a prerequisite for designing psychological counseling chatbot. © 2020 ACM.