How goal framing and temporal distance influence the effectiveness of COVID- 19 vaccine persuasion

Vaccines are crucial for controlling deadly diseases, and how to persuade people to get vaccinated has become a hot topic in enhancing public health benefits. One way to increase the vaccination rate is to raise public awareness of the importance of vaccines through advertising. As an effective and cost-friendly approach, goal framing has been widely used in vaccine advertising. However, the literature has mixed findings about whether positive or negative goal framing is more effective in persuading people to get vaccinated. The present study aims to investigate how temporal distance (present vs. future) interacts with different types of goal framing (positive vs. negative) in persuading people to get the COVID-19 vaccine. We hypothesized that negative goal framing is more persuasive when the advertising focuses on present outcomes, while positive goal framing is more effective when combined with future- focused outcomes. We further hypothesized that the inner mechanism is the intertemporal asymmetry of approach and avoidance motivation. More specifically, the avoidance motivation induced by a negative frame is stronger in the present, while the approach motivation induced by a positive frame is stronger in the future. The perceived risk of COVID-19 moderated this effect. Four studies were conducted to examine our hypotheses. Study 1 was conducted to preliminarily investigate how goal framing and temporal distance jointly influence willingness to get the COVID-19 vaccine. The aim of Study 2 was to verify the mediating effect of approach and avoidance motivation in a different advertising setting, as well as to rule out the potential mediators of the construal level and positive/ negative emotions. In Study 3, we further tested the mediators by manipulating participants' approach and avoidance motivation. Study 4 was a quasi-experiment in which we recruited participants from areas with different levels of COVID-19 risk to test how perceived risk moderated the interaction effect of goal framing and temporal distance. The results showed that a negative goal frame was more persuasive when combined with present-focused advertising, while a positive goal frame was more effective when combined with future- focused advertising (Study 1, N = 363). Avoidance motivation mediated the relationship between the goal frame and vaccine uptake in the present context, while approach motivation mediated the relationship between the goal frame and vaccine uptake in the future context (Study 2, N = 292). The results in Study 3 ( N = 347) revealed that approach motivation priming increases the persuasiveness of the present-positive frame, while avoidance motivation priming increases the persuasiveness of the future- negative frame. COVID-19 risk also had an impact on the relationship between goal framing and temporal distance on vaccine uptake. When the COVID-19 risk was high, the difference in vaccine uptake between present-positive and present-negative conditions disappeared, while the future-positive frame was still more persuasive than the future- negative frame (Study 4, N = 423). In conclusion, the present study found an interactive effect of goal framing and temporal distance in persuading people to get the COVID-19 vaccine. Avoidance/approach motivation mediates the relationship between goal framing and vaccine uptake in the present/future temporal context. The perceived COVID risk further moderated the interaction effect. The present study contributes to both the framing and approachavoidance motivation literature and sheds light on future practices in persuading people to get the COVID vaccine and promoting the uptake of other vaccines.

International Workshop on Learning with Knowledge Graphs: Construction, Embedding, and Reasoning

A knowledge graph (KG) consists of numerous triples, in which each triple, i.e., (head entity, relation, tail entity), denotes a real-world assertion. Many large-scale KGs have been developed, e.g., general-purpose KGs Freebase and YAGO. Also, lots of domain-specific KGs are emerging, e.g., COVID-19 KGs, biomedical KGs, and agricultural KGs. By embedding KGs into low-dimensional vectors, i.e., representations of entities and relations, we could integrate KGs into machine learning models and enhance the performance of many prediction tasks, including search, recommendations, and question answering. During the construction, refinement, embedding, and application of KGs, a variety of KG learning algorithms have been developed to handle challenges in various real-world scenarios. Moreover, graph neural networks have also brought new opportunities to KG learning. This workshop aims to engage with active researchers from KG communities, recommendation communities, natural language processing communities, and other communities, and deliver state-of-the-art research insights into the core challenges in KG learning. © 2023 Owner/Author.

Analytic hierarchy clustering research of all cargo airlines based on safety information

Due to the COVID-19, air passenger transport industry is sluggishm. At the same time, based on the strong demand for freight business. Airlines focus on developing cargo sector. All-cargo airlines are gradually being established. The number of registered cargo aircraft has gradually increased in recent years,and cargo transport flight hours are gradually increasing. This leads to an increase in cargo aviation security incidents. The safety information analysis of cargo aircraft needs to be solved urgently. In this paper, a hierarchical analysis and clustering research on all-cargo airlines based on China aviaiton safety information data is carried out. The results show that all-cargo airlines security incidents are divided into three categories. The paper provides security recommendations for different incident categories. © 2022 IEEE.

Deep Single-Cell, Proteogenomic Insights from Sars-Cov-2 Infected Lung Tissues

Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that emerged in late 2019 has spread globally, causing a pandemic of respiratory illness designated coronavirus disease 2019 (COVID-19) and is likely to lead to complexities in treating thoracic malignancies. Patients with lung cancer are at an increased risk of becoming infected with the SARS-CoV-2 virus and experience higher morbidity and mortality than the general population. However, little is known about the host tissue and cellular responses associated with SARS-CoV-2 infection, symptoms, and disease severity. Methods Here, we use the Nanostring GeoMX Digital Spatial Profiler (DSP) and CoxMX Spatial Molecular Imager (SMI) technology to determine tissue signatures, and spatially resolved quantitative single-cell proteogenomic changes driven by SARS-CoV-2 infection. This dual approach was used to generate an in-depth picture of the pumonary transcriptional and proteomic landscape of COVID-19, pandemic H1N1 and uninfected control patients.1 Rapid autopsy COVID-19 lung samples were collected across two independent cohorts of patients, and tissue microarrays (TMAs) were prepared. For GeoMx, n=10 COVID-19, n=10 pH1N1 and n=5 normal control tissues were compared. For CosMx, n=19 COVID-19 cores in technical replicates, and n=20 normal control tissues were compared. Tissue-based gene signatures were subsequently tested in the peripheral samples from COVID-19 patients. Results SARS-CoV-2 viral presence was confirmed by RNAscope and integrated to inform region of interest and cell types involved in infection. Analysis of the Nanostring GeoMx data revealed tissue signatures associated with SARS-CoV-2 infection, including Type 1 IFN, blood coagulation, hypoxia and angiogenesis. Analysis of the Nanostring CosMx data enabled single cell typing and mapping of tissue-specific signatures to cellular compartments of interest (e.g. macrophages, fibroblasts) and investigation of complex cell population heterogeneity and interactions. All these while preserving spatial context and highlighted differential cell type distribution in the lungs of COVID-19 patients compared to non-infected controls. Our tissue-based Type 1 IFN signatures, when tested in the blood, were found to be predictive of disease severity in COVID-19 patients when measured within the first few days of symptom onset. Conclusions Here, we've used innovative, cutting-edge spatial transcriptomics approaches to delineate tissue signatures and cellular profiles unique to COVID-19 and common across acute respiratory distress syndrome. These data will aid in understanding the proteogenomic landscape of SARS-CoV-2 infected lung tissues and form new knowledge for the impact on thoracic malignancies, and treatments such as immunotherapy. Moreover, the study demonstrates how tissue-based findings can be rapidly developed into signatures tested in noninvasive samples.

Epidemiological Analysis of COVID-19 Outbreaks in Wuhu, China, from January to March 2020

Background: COVID-19, caused by SARS-CoV-2, has spread worldwide and become a global pandemic. Objective(s): Studies of the earliest events of the COVID-19 pandemic are critical in understanding how the pandemic started and providing insight into the spread of SARS-CoV-2 and its infection in humans. Method(s): In this report, we studied the epidemiological characteristics of all 34 confirmed COVID-19 cases in Wuhu, China, from January 3 to March 19, 2020. Result(s): Our study indicated that cases in male patients (61.76%, 21/34) outnumbered those in female patients (38.24%, 13/34). Studies of the age distribution among the confirmed cases revealed that most COVID-19 patients were 15 to 59 years of age (26/34, 76%), while more than 14% (5/34) were >= 60 years old, and less than 9% (3/34) were <= 14 years old. Notably, 32 of the 34 confirmed cases were (a) people who had recently resided in or traveled to Wuhan or had close contact with Wuhan residents or visitors (22 cases);and (b) people who had close contact with these 22 confirmed COVID-19 patients (10 cases). Conclusion(s): This study revealed the epidemiological characteristics of COVID-19 outbreaks in Wuhu between January and March 2020 and provided insight into the earliest events of the COVID-19 pandemic in China. Our analyses suggested that the COVID-19 cases confirmed in Wuhu in 2020 were directly related to or originated from the outbreaks in Wuhan. Copyright © 2022, Author(s).

[Analysis on the scrap situation of COVID-19 vaccine in Suzhou city].

To analyze the usage and loss of the COVID-19 vaccine in ten districts of Suzhou city from December 18, 2020 to April 30, 2021.The results showed the loss rate was 0.222‰ in Suzhou city. The loss rate of pre-filled packaging COVID-19 vaccine was higher than that of vial packaging. The loss rate of 40 packaging was the lowest in vial packaging. The loss rate of all kinds of COVID-19 vaccine in stable inoculation unit was the lowest. It is recommended to distribute 40 vial packaging COVID-19 vaccine for centralized vaccination to reduce the loss of COVID-19 vaccine.

Predicting hospital emergency department visits with deep learning approaches

Overcrowding in emergency department (ED) causes lengthy waiting times, reduces ade-quate emergency care and increases rate of mortality. Accurate prediction of daily ED visits and allocating resources in advance is one of the solutions to ED overcrowding problem. In this paper, a deep stacked architecture is being proposed and applied to the daily ED visits prediction problem with deep components such as Long Short Term Memory (LSTM), Gated Recurrent Units (GRU) and simple Recurrent Neural Network (RNN). The proposed architec-ture achieves very high mean accuracy level (94.28-94.59%) in daily ED visits predictions. We have also compared the performance of this architecture with non-stacked deep mod-els and traditional prediction models. The results indicate that deep stacked models out-perform (4-7%) the traditional prediction models and other non-stacked deep learning models (1-2%) in our prediction tasks. The application of deep neural network in ED visits prediction is novel as this is one of the first studies to apply a deep stacked architecture in this field. Importantly, our models have achieved better prediction accuracy (in one case comparable) than the state-of-the-art in the literature.(c) 2022 Published by Elsevier B.V. on behalf of Nalecz Institute of Biocybernetics and Bio-medical Engineering of the Polish Academy of Sciences.

How goal framing and temporal distance influence the effectiveness of COVID-19 vaccine persuasion

Vaccines are crucial for controlling deadly diseases, and how to persuade people to get vaccinated has become a hot topic in enhancing public health benefits. One way to increase the vaccination rate is to raise public awareness of the importance of vaccines through advertising. As an effective and cost-friendly approach, goal framing has been widely used in vaccine advertising. However, the literature has mixed findings about whether positive or negative goal framing is more effective in persuading people to get vaccinated. The present study aims to investigate how temporal distance (present vs. future) interacts with different types of goal framing (positive vs. negative) in persuading people to get the COVID-19 vaccine. We hypothesized that negative goal framing is more persuasive when the advertising focuses on present outcomes, while positive goal framing is more effective when combined with future-focused outcomes. We further hypothesized that the inner mechanism is the intertemporal asymmetry of approach and avoidance motivation. More specifically, the avoidance motivation induced by a negative frame is stronger in the present, while the approach motivation induced by a positive frame is stronger in the future. The perceived risk of COVID-19 moderated this effect. Four studies were conducted to examine our hypotheses. Study 1 was conducted to preliminarily investigate how goal framing and temporal distance jointly influence willingness to get the COVID-19 vaccine. The aim of Study 2 was to verify the mediating effect of approach and avoidance motivation in a different advertising setting, as well as to rule out the potential mediators of the construal level and positive/negative emotions. In Study 3, we further tested the mediators by manipulating participants’ approach and avoidance motivation. Study 4 was a quasi-experiment in which we recruited participants from areas with different levels of COVID-19 risk to test how perceived risk moderated the interaction effect of goal framing and temporal distance. The results showed that a negative goal frame was more persuasive when combined with present-focused advertising, while a positive goal frame was more effective when combined with future-focused advertising (Study 1, N = 363). Avoidance motivation mediated the relationship between the goal frame and vaccine uptake in the present context, while approach motivation mediated the relationship between the goal frame and vaccine uptake in the future context (Study 2, N = 292). The results in Study 3 (N = 347) revealed that approach motivation priming increases the persuasiveness of the present-positive frame, while avoidance motivation priming increases the persuasiveness of the future-negative frame. COVID-19 risk also had an impact on the relationship between goal framing and temporal distance on vaccine uptake. When the COVID-19 risk was high, the difference in vaccine uptake between present-positive and present-negative conditions disappeared, while the future-positive frame was still more persuasive than the future-negative frame (Study 4, N = 423). In conclusion, the present study found an interactive effect of goal framing and temporal distance in persuading people to get the COVID-19 vaccine. Avoidance/approach motivation mediates the relationship between goal framing and vaccine uptake in the present/future temporal context. The perceived COVID risk further moderated the interaction effect. The present study contributes to both the framing and approach-avoidance motivation literature and sheds light on future practices in persuading people to get the COVID vaccine and promoting the uptake of other vaccines. © 2022, Science Press. All rights reserved.

The impact of classic Hodgkin lymphoma (cHL) on informal caregivers: Results from the cHL-Real-world observations from physicians, patients, and caregivers on the disease and its treatment (CONNECT) study

Background: The health and work productivity burden informal cHL patient (pt) caregivers face is unknown. As part of the US-based CONNECT study, we evaluated caregivers' burden and role in treatment (tx) decisions by relation to the pt: spouse/partner (SP) vs other (parent, child, friend, other relative). Methods: The CONNECT caregiver survey was an IRB-approved online survey administered from Dec 2020-Mar 2021 to self-identified current or former adult cHL pt caregivers. Health-related quality of life (HRQoL, PROMIS-Global), work impact (WPAI), decision-making, tx selection, and physician communication were assessed. Statistical significance was at the 95% confidence level. Results: 209 caregivers (58% women;median age 47 yrs;54% employed;53% SP) completed the survey. At completion, 69% cared for pts diagnosed in the past 1-2 yrs;48% of pts cared for had stage III/IV cHL and 58% were in remission/not receiving active tx. While caregiver HRQoL was similar to that of the general population on the PROMIS-Global, employed caregivers had work impairment (29%) from caregiving activities (Table) which was higher when the pt was on vs off tx. Caregiving began at pt symptom onset for more SP vs other caregivers (61 vs 27%), and after the pt's first tx for more other vs SP caregivers (34 vs 5%). 88% of caregivers discussed tx options with the pt. Cure, caregivers' top tx goal (49%), was rated higher by SP vs other caregivers (56 vs 42%). Tx decisions with the pt (54 vs 23%) and tx option discussions with the doctor (52 vs 28%) were more common for SP vs other caregivers. More SP vs other caregivers had extensive tx option discussions with the pt (88 vs 68%), said it was important the doctor discussed managing side effects (94 vs 84%), felt the doctor provided adequate information about side effects (91 vs 71%), and felt aligned with the pt's tx goals (93 vs 79%). Caregivers noted COVID-19 impacts like limiting daily activities to reduce COVID-19 risks (72%). Conclusions: Although cHL pt caregivers reported good HRQoL, caregiving impacted their work productivity regardless of relation to the pt. Cure was caregivers' top tx goal. SP vs other caregivers were more involved and earlier, reporting alignment with pt tx goals and decision-making.

Management of OHCA during COVID-19: A tale of two cities

Background: Regional variations in the impact of the coronavirus disease-2019 (COVID-19) pandemic on out-of-hospital cardiac arrest (OHCA) have been reported. We aimed to examine differences in the community response, emergency medical services (EMS) interventions, and outcomes of OHCA, in Singapore (population 5.7 million) and Atlanta (population 4.16 million), before and during the pandemic. Methods: Using prospectively collected Singapore Pan-Asian Resuscitation Outcomes Study (PAROS) and Atlanta Cardiac Arrest Registry to Enhance Survival (CARES) data, we compared EMS-treated adult OHCAs (≥18 years) during the pandemic period (17weeks from the date of first confirmed COVID-19 case) and pre-pandemic period (corresponding weeks in 2019). The primary outcome was pre-hospital return of spontaneous circulation (ROSC). We reported adjusted odds ratios (aOR) for OHCA characteristics, pre-hospital interventions, and outcomes using binary logistic regression. Results: Of the 3987 EMS-treated OHCAs (overall median age 69 years, 60.1% males) in Singapore and Atlanta, 2084 occurred during the pandemic and 1903 during the pre-pandemic period. Compared with Atlanta, OHCA cases in Singapore were older (median age 72 vs 66 years), received more bystander interventions (65.1% vs 41.4% received cardiopulmonary resuscitation (CPR) and 28.4% vs 10.1% had automated external defibrillator application), yet observed less pre-hospital ROSC (11.3% vs 27.1%). When compared with the pre-pandemic period, the likelihood of residential OHCAs doubled in both cities during the pandemic;in Singapore, OHCAs were more likely to be witnessed (aOR 1.95, 95% confidence interval (CI), 1.59-2.39) yet less likely to receive CPR (aOR 0.81, 95% CI, 0.65-0.99) during the pandemic. OHCAs occurring during the pandemic, compared with pre-pandemic, were less likely to be transported in Singapore and Atlanta (aOR 0.50, 95% CI, 0.42%-0.85%, and 0.36, 95% CI, 0.26-0.50, respectively), without significant differences in overall pre-hospital ROSC. Conclusion: Changes in OHCA characteristics and pre-hospital interventions during the pandemic were likely collateral consequences, with regional variations partly reflecting differences in systems of care and other sociocultural factors. These highlight opportunities for public education and the need for further study into lower transport rates during the pandemic.

LAMP Assay for On-site Detection of SARS-CoV-2 and Its Application in Cold-chain Food Analysis

A highly sensitive visualization method for SARS-CoV-2 detection, based on loop-mediated isothermal amplification (LAMP) and molecular light switch [Ru(phen)2dppz]2+, was established. In this design, insulation cups replaced laboratory thermostats and blue flashlights replaced blue transilluminators, to realize the rapid on-site visual LAMP detection of SARS-CoV-2. Specific primers were designed for the N gene of SARS-CoV-2. LAMP amplification products were detected by [Ru(phen)2dppz]2+ with molecular light switch characteristics. Red fluorescence could be directly detected by naked eye using blue light flashlight. Single copy number SARS-CoV-2 gene fragments were detected with high specificity. The detection was rapid, requiring only 40 minutes to visually observe the results. The LAMP detection results for food samples artificially contaminated with SARS-CoV-2 pseudovirus were 100% consistent with the current gold-standard real-time fluorescent quantitative PCR method for SARS-CoV-2 detection. This method requires only insulation cups and blue flashlight, and can be used to supplement the real-time fluorescent PCR method to provide a fast and efficient on-site screening of food for SARS-CoV-2. © 2022, Editorial Board of Modern Food Science and Technology. All right reserved.

[Spatiotemporal evolution of COVID-19 epidemic in the early phase in China].

Objective: Based on the geographic information systems, we exploreed the spatiotemporal clustering and the development and evolution of COVID-19 epidemic at prefectural level in China from the time when the epidemic was discovered to the time when the lockdown ended in Wuhan. Methods: The information and data of the confirmed COVID-19 cases from December 8, 2019 to April 8, 2020 were collected from 367 prefectures in China for a spatial autocorrelation analysis with software GeoDa, and software ArcGIS was used to visualize the results. Software SatScan was used for spatiotemporal scanning analysis to visualize the hot-spot areas of the epidemic. Results: The incidence of new cases of COVID-19 had obvious global autocorrelation and the partial autocorrelation results showed that incidence of COVID-19 had different spatial distribution at different times from December 8, 2019 to March 4, 2020. There was no significant difference in global autocorrelation coefficient from March 5, 2020 to April 8, 2020. The statistical analysis of spatiotemporal scanning identified two kinds of spatiotemporal clustering areas, the first class clustering areas included 10 prefectures, mainly distributed in Hubei, from January 13 to February 25, 2020. The secondary class clustering areas included 142 prefectures, mainly distributed in provinces in the north and east of Hubei, from January 23 to February 1, 2020. Conclusions: There was a clear spatiotemporal correlation in the distribution of the outbreaks in the early phase of COVID-19 epidemic (December 8, 2019-March 4, 2020) in China. With the decrease of the case and effective prevention and control measures, the epidemics had no longer significant correlations among areas from March 5 to April 8. The study results showed relationship with time points of start and adjustment of emergency response at different degree in provinces. Furthermore, improving the early detection of new outbreaks and taking timely and effective prevention and control measures played an important role in blocking the transmission.

Safety and Immunogenicity of INO-4800, a COVID-19 DNA Vaccine as a Primary Series and Booster

Background. DNA vaccines are safe, tolerable, elicit humoral and cellular responses, allow for repeated dosing over time, are thermostable at room temperature, and are easy to manufacture. We present a compilation of Phase 1 and Phase 2 data of Inovio's US COVID-19 DNA Vaccine (INO-4800) targeting the full-length Spike antigen of SARS-CoV-2. A South Korean Phase 2 study is ongoing. Methods. Participants in the open-label Phase 1 trial received 0.5 mg, 1.0 mg or 2.0 mg intradermally (ID) followed by electroporation (EP) at Days 0 and 28. An optional booster dose was administered >6 months post-dose 2. The Phase 2 further compared the 1.0 mg and 2.0 mg doses against placebo in a total of 401 participants randomized at a 3:3:1:1 ratio. ClinicalTrials.gov identifiers: NCT04336410 and NCT04642638 Results. The majority of adverse events (AEs) related to INO-4800 across both trials were mild in severity and did not increase in frequency with age and subsequent doses. In Phase 1, 78% (14/18) and 84% (16/19) of subjects generated neutralizing antibody responses with geometric mean titers (GMTs) of 17.4 (95%CI 8.3, 36.5) and 62.3 (95% CI 36.4, 106.7) in the 1.0 and 2.0 groups, respectively (Figure 1). By week 8, 74% (14/19) and 100% (19/19) subjects generated T cell responses by Th1- associated IFNγ ELISPOT assay . Following a booster dose, neutralizing GMTs rose to 82.2 (95% CI 38.2, 176.9) and 124.7 (95% CI 62.8, 247.7) in the 1.0 mg and 2.0 mg groups, respectively, demonstrating the ability of INO-4800 to boost (Figure 2). In Phase 2, neutralizing antibody responses demonstrated GMTs of 93.6 (95%CI 77.3, 113.4) in the 1.0 mg dose group and 150.6 (95%CI 123.8, 183.1) in the 2.0 mg dose group (Figure 3). Conclusion. INO-4800 appears safe and tolerable as a primary series and as a booster with the induction of both humoral and cellular immune responses. In addition to eliciting neutralizing antibodies, INO-4800 also induced T cell immune responses as demonstrated by IFNγ ELISpot. Finally, as a homologous booster, INO-4800, when administered 6-10.5 months following the primary series, resulted in an increased immune response without increase in reactogenicity. The 2.0 mg dose was selected for Phase 3 evaluation.

Impact of the COVID-19 pandemic on primary care access for patients with gastrointestinal malignancies

Background: Primary care physicians (PCPs) provide essential support for cancer patients. Both primary and cancer care have been affected by the COVID-19 pandemic. In the US, cancer related encounters and screening decreased over 40% and 80% respectively in January to April 2020 compared to 2019 (London et al JCO Clin Cancer Inform 2020). However, the impact of the pandemic on primary care access for cancer patients remains unclear. Methods: This was a population-based, retrospective cohort study using administrative healthcare databases held at ICES in Ontario, Canada. Patients with a new gastrointestinal (GI) malignancy diagnosed within the year prior to the pandemic, between July 1 and Sept 30, 2019 (COVID-19 cohort), were compared to patients diagnosed in years unaffected by the pandemic, between July 1 - Sept 30, 2018 and July 1 - Sept 30, 2017 (pre-pandemic cohort). Both groups were followed for 12 months after initial cancer diagnosis. In the COVID-19 cohort, this allowed for at least 4 months of follow-up data occurring during the pandemic. The primary outcome was number of in-person and telemedicine visits with a PCP. Secondary outcomes were number of in-person and telemedicine visits with a medical oncologist, number of emergency department (ED) visits, and number of unplanned hospitalizations. Outcomes, reported as number of visits per person-year, were compared between the COVID-19 and pre-pandemic cohorts. Results: 2833 individuals diagnosed with a new GI malignancy in the COVID-19 cohort were compared to 5698 individuals in the pre-pandemic cohort. The number of in-person visits to PCPs per person-year significantly decreased from 7.13 [95% CI 7.05 - 7.20] in the pre-pandemic cohort to 4.75 [4.66 - 4.83] in the COVID-19 cohort. Telemedicine visits to PCPs increased from 0.06 [0.05 - 0.07] to 2.07 [2.01 - 2.12]. Combined in-person and telemedicine visits to PCPs decreased from 7.19 [7.11 - 7.26] to 6.82 [6.71 - 6.92]. In-person visits to medical oncologists decreased from 3.73 [3.68 - 3.79] to 2.87 [2.80 - 2.94], and telemedicine visits increased from 0.10 [0.10 - 0.11] to 0.95 [0.91 - 0.99]. Combined in-person and telemedicine visits to medical oncologists remained stable (3.84 [3.78 - 3.89] vs. 3.82 [3.74 - 3.90]). The number of ED visits per person-year decreased from 1.04 [1.01 - 1.07] in the pre-pandemic cohort to 0.93 [0.89 - 0.97] in the COVID-19 cohort. Unplanned hospitalizations did not show a significant change (0.56 [0.54 - 0.58] vs. 0.53 [0.50 - 0.56]). Conclusions: PCP visits for patients with newly diagnosed GI malignancies overall decreased during the pandemic, with a dramatic shift from in-person to telemedicine visits. Visits to medical oncologists also shifted from in-person to telemedicine, but the overall combined visits remained the same. While the number of ED visits decreased, the shift in ambulatory practices did not seem to impact the number of unplanned hospitalizations.

Impact of the covid-19 pandemic on the epidemiology of out-of-hospital cardiac arrest: A systematic review and meta-analysis

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has influenced epidemiology through direct and indirect effects, yet the impact on out-of-hospital cardiac arrest (OHCA) is unclear. We aimed to evaluate the impact of the pandemic on the incidence, characteristics, and clinical outcomes of OHCA. Hypothesis: We hypothesized that compared to the pre-pandemic period, the COVID-19 pandemic period was associated with increased incidence and case fatality rate (CFR) of OHCA, as well as decreased rates of intermediate clinical outcomes (termination of resuscitation [TOR], return of spontaneous circulation [ROSC], survival to hospital admission, and survival to hospital discharge). We further postulated that there was a change in the etiologies of OHCA during the pandemic as well as a decline in the rate of shockable rhythm as the initial presenting rhythm. Methods: In this systematic review and meta-analysis, five scientific databases were searched from inception to May 3, 2021. Meta-analyses were performed for the primary outcomes, secondary outcomes, and clinical characteristics. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021253879). Results: The search yielded 966 articles. 20 articles were included for analysis. The COVID-19 pandemic was associated with a 39.5% increase in pooled annual OHCA incidence (p<0.001). Pooled CFR was increased by 2.65% (p<0.001), with an odds ratio (OR) of 1.95 for mortality (95% confidence interval [95%CI] 1.51-2.51). There was increased field TOR (OR=2.46, 95%CI 1.62- 3.74). There were decreased ROSC (OR=0.65, 95%CI 0.55-0.77), survival to hospital admission (OR=0.65, 95%CI 0.48-0.89), and survival to discharge (OR=0.52, 95%CI 0.40-0.69). There was decreased shockable rhythm (OR=0.73, 95%CI 0.60-0.88) and increased asphyxial etiology of OHCA (OR=1.17, 95%CI 1.02-1.33). There was moderate-to-high statistical heterogeneity. Findings were robust to sensitivity analyses, with no publication bias detected. Conclusions: The COVID-19 pandemic was associated with significant changes in OHCA epidemiology. Compared to the pre-pandemic period, the pandemic period was associated with increased OHCA incidence and worse outcomes.

DETECTION OF SARS-COV-2 IN THE GASTROINTESTINAL TRACT AMONG PATIENTS WITH NEGATIVE NASOPHARYNGEAL COVID-19 TESTING PRIOR TO ENDOSCOPY: A PROSPECTIVE STUDY

BACKGROUND: COVID-19 patients can have persistent viral stool positivity despite negative respiratory samples, irrespective of symptoms. These patients could potentially go undetected under the current pre-endoscopy COVID-19 testing guidance recommendations. However, the clinical significance of viral RNA in the stool remains unclear. AIMS: We aimed to prospectively determine whether SARS-CoV-2 is detected via real-time reversetranscriptase polymerase chain reaction (rRT-PCR) in the GI tract of patients scheduled for endoscopy and if the virus obtained from these clinical specimens could be isolated in culture. METHODS: All patients underwent symptom screening and had negative nasopharyngeal testing for SARS-CoV-2 within 72 hours of their scheduled procedure. Study samples were collected via repeat nasopharyngeal swab, rectal swab, and fluid from the upper GI tract and/or colon based on their endoscopic procedure(s). Samples were tested for SARSCoV-2 via rRT-PCR. Clinical specimens confirmed to be positive for SARS-CoV-2 RNA were then isolated and cultured in Vero-E6 cells. RESULTS: 243 patients (mean age 63.1 years;54.3% men) were enrolled from July 15th, 2020 to September 2nd, 2020 (Table 1). Most patients (177;72.8%) were asymptomatic, with nausea/vomiting (23;9.5%) being the most commonly reported COVID-19 related symptom. SARS-CoV-2 testing was performed from 242(99.6%) nasopharyngeal, 243(100%) rectal, 183(75.3%) upper GI tract and 73(30%) colon samples. Only 1 patient (0.4%), with a history of COVID-19 infection 45 days prior to endoscopy, tested positive for SARS-CoV-2 on all the GI clinical specimens (fluid from upper GI tract, colon, and rectal swab), despite being asymptomatic and having 3 negative nasopharyngeal swabs 40, 37 and 3 days before her procedure (Figure 1). After 14-day incubation period, there was no evidence of virus growth in cells incubated with any of these specimens. CONCLUSIONS: SARS-CoV-2 is rarely detected in the GI tract of patients with negative screening nasopharyngeal COVID-19 testing prior to endoscopy. Infectious virus was not detected by culture from any of the GI specimens positive for SARS-CoV-2 RNA by rRT-PCR. Our results further highlight that presence of viral genome on its own is not sufficient proof of infectivity. Additional studies are needed to evaluate the temporal association between COVID-19 symptom onset and potential infectivity duration in the GI tract. (Table Presented)(Figure Presented)

Classical Hodgkin Lymphoma;Real-World Observations from Physicians, Patients, and Caregivers on the Disease and Its Treatment (CONNECT): Observations of Physicians on Treatment and Interim PET-Adapted Regimens

Background Current NCCN guidelines recommend 1 of 3 first-line (1L) regimens for stage III or IV classical Hodgkin lymphoma (cHL): ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine), A+AVD (brentuximab vedotin, doxorubicin, vinblastine, dacarbazine), or escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone);preferred regimens vary by region (e.g., North America vs Europe). The NCCN recommends positron emission tomography/computerized tomography (PET/CT) imaging after cycle 2 (interim PET2) to guide ABVD escalation or de-escalation. We surveyed physicians on their cHL treatment decision-making process and how PET/CT scan access, reimbursement, and comprehension influence their choices as part of CONNECT, the first real-world survey of physicians, patients, and caregivers in cHL. Methods Medical oncologists, hematologist/oncologists, or hematologists who treat cHL were invited to participate in an Institutional Review Board-approved, 30-minute online anonymous survey. Eligible participants had ≥2 years of practice experience in the United States (US) and treated ≥1 adult (aged ≥18 years) with stage III or IV cHL and ≥1 adult with cHL in the 1L setting within the prior 12 months. Surveys were completed from October 19, 2020-November 16, 2020. Results Of 301 participating physicians, 80% were hematologist/oncologists with a median practice duration of 15 years;62% practiced in community and 38% in academic settings. Participants were located in the US (South, 34%;Northeast, 26%;West, 21%;Midwest, 20%) and spent 90% of their professional time in direct patient care. In the preceding 12 months, participants treated a median (interquartile range) of 16 (7-40) patients with active cHL (stage III [median], 4;stage IV, 5) and 15 (8-40) cHL survivors. When treating cHL, 88% of participants reported giving NCCN guidelines somewhat/significant consideration. Overall, 94% of participants (n=284) reported using a PET/CT combined scan to diagnose/stage cHL, in line with current guideline recommendations. Of these participants, 97% reported typically getting an interim PET/CT scan for stage III or IV cHL with 65% typically getting the scan after cycle 2 (Figure A). Participants reported both escalating and de-escalating treatment based on interim PET/CT results (Figure B) with 61% making decisions after cycle 2. Of participants using a PET/CT scan, 42% reported receiving both a Deauville score and a standardized uptake value (SUV;Figure C) with 62% of participants noting that the Deauville score was the primary system used for reviewing PET/CT results (Figure D). However, 19% of participants reported challenges interpreting PET/CT results. Among participants using a Deauville score (n=209), consensus was limited on what defined a positive scan (≥3, 44%;≥4, 37%). Challenges obtaining PET/CT scans were reported by 16% of participants using PET/CT scans. However, despite not reporting challenges 55% of participants on average were unable to obtain a PET/CT scan 20% of the time. Of participants using PET/CT scans, 86% reported typically receiving results within 2 business days and 14% within 3-5 business days. Twenty-one percent of participants reported that delays in PET/CT results affected their ability to use a PET-adaptive approach. Forty-nine percent of those using PET/CT scans reported increased difficulty in PET/CT access for stage III or IV cHL due to lack of insurance coverage. In absence of a PET/CT scan, 36% of participants reported using an interim biopsy and 63% an interim CT scan to inform treatment choices. Among all participants, 36% reported increased difficulty in getting patients with cHL access to PET/CT scans due to COVID-19. Conclusions Although participants consider NCCN guidelines when treating cHL, interim PET scans are not universally obtained after cycle 2 for stage III or IV cHL, with 65% of participants who use PET/CT scans obtaining an interim PET scan after cycle 2 for stage III or IV cHL. When PET/CT scans are obtained, Deau ille scores are commonly provided;however, there is variability in what is termed a positive or negative Deauville score. Challenges in obtaining PET/CT scans, with increased difficulty during COVID-19, were reported. Also, there are other barriers, such as lack of insurance, that may prohibit the optimal adherence to guidelines on interim PET/CT utilization. [Formula presented] Disclosures: Parsons: SeaGen: Consultancy. Yu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Liu: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Kumar: Seagen, Inc: Consultancy. Fanale: Seagen, Inc: Current Employment, Current equity holder in publicly-traded company. Flora: Seagen, Inc: Research Funding.

Impact of the COVID-19 Pandemic on Primary Care Access for Patients with Hematologic Malignancies

Introduction: Primary care physicians are essential to cancer care. They frequently identify signs and symptoms leading to a diagnosis of cancer, and provide ongoing support and management of non-cancer health conditions during cancer treatment. Both primary care and cancer care have been greatly affected by the COVID-19 pandemic. In the United States, cancer-related patient encounters and cancer screening decreased over 40% and 80% respectively in January to April 2020 compared to 2019 (London et al. JCO Clin Cancer Inform 2020). However, the impact of the COVID-19 pandemic on primary care access for cancer patients remain unclear. Methods: We undertook a population-based, retrospective cohort study using healthcare databases held at ICES in Ontario, Canada. Patients with a new lymphoid or myeloid malignancy diagnosed within the year prior to the COVID-19 pandemic, between July 1, 2019 and September 30, 2019 (COVID-19 cohort) were compared to patients diagnosed in years unaffected by the COVID-19 pandemic, between July 1, 2018 - September 30, 2018 and July 1, 2017 - September 30, 2017 (pre-pandemic cohort). Both groups were followed for 12 months after initial cancer diagnosis. In the COVID-19 cohort, this allowed for at least 4 months of follow-up data occurring during the COVID-19 pandemic. The primary outcome was number of in-person and virtual visits with a primary care physician. Secondary outcomes of interest included number of in-person and virtual visits with a hematologist, number of visits to the emergency department (ED), and number of unplanned hospitalizations. Outcomes, reported as crude rates per 1000 person-months, were compared between the COVID-19 and pre-pandemic cohorts using Poisson regression modelling. Results: We identified 2882 individuals diagnosed with a new lymphoid or myeloid malignancy during the defined COVID-19 timeframe and compared them to 5997 individuals diagnosed during the defined pre-pandemic timeframe. The crude rate of in-person primary care visits per 1000 person-months significantly decreased from 574.4 [95% CI 568.5 - 580.4] in the pre-pandemic cohort to 402.5 [395.3 - 409.7] in the COVID-19 cohort (p < 0.0001). Telemedicine visits to primary care significantly increased from 5.3 [4.8 - 5.9] to 173.0 [168.4 - 177.8] (p < 0.0001). The rate of combined in-person and telemedicine visits to primary care did not change from 579.8 [573.8 - 585.8] in the pre-pandemic cohort to 575.5 [566.9 - 584.2] in the COVID-19 cohort (p = 0.43). In-person visits to hematologists decreased from 504.1 [498.5 - 509.7] to 432.8 [425.3 - 440.3] (p < 0.0001), and telemedicine visits to hematologists increased from 6.6 [6.0 - 7.3] to 75.9 [72.8 - 79.1] (p < 0.0001). The rate of combined visits to hematologists did not change from 510.7 [505.1 - 516.4] to 508.7 [500.6 - 516.8] (p = 0.68). The rate of ED visits significantly decreased from 95.1 [92.7 - 97.6] in the pre-pandemic cohort to 84.7 [81.4 - 88.0] in the COVID-19 cohort (p < 0.0001). The rate of unplanned hospitalizations did not change from 64.8 [62.8 - 66.8] to 65.7 [62.9 - 68.7] (p = 0.60). Conclusions: Primary care visits for patients with hematologic malignancies did not significantly change during the pandemic, but there was a sizeable shift from in-person to telemedicine visits. Similar findings were seen for visits to hematologists. While the rate of visits to the ED decreased, potentially due to concern of being exposed to the COVID-19 virus, the shift in ambulatory practices did not seem to impact the rate of unplanned hospitalizations. Disclosures: No relevant conflicts of interest to declare.

Smoothing of time-varying graph with the generalized LASSO

This paper proposes a joint model based on the generalized LASSO to smooth a time-varying graph. The model generalizes the gLASSO from a purely spatial setting to a spatial-temporal one. In the proposed model, the first term measures the fitting error, while the second term incorporates the structural information of graphs and total variations of time sequence, and hence the model can extract both temporal and spatial information. To illustrate the performance of the proposed model, we analyzed the simulated datasets for epidemic diseases and the real datasets for COVID-19 and mortality rate in mainland China. The results show that the proposed model can capture the trends/regions simultaneously in both temporal and spatial domains, being an effective model to analyze the problems that can be modelled as time-varying graphs. Author