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mRNA is a new class of drugs that has the potential to revolutionize the treatment of brain tumors. Thanks to the COVID-19 mRNA vaccines and numerous therapy-based clinical trials, it is now clear that lipid nanoparticles (LNPs) are a clinically viable means to deliver RNA therapeutics. However, LNP-mediated mRNA delivery to brain tumors remains elusive. Over the past decade, numerous studies have shown that tumor cells communicate with each other via small extracellular vesicles, which are around 100 nm in diameter and consist of lipid bilayer membrane similar to synthetic lipidbased nanocarriers. We hypothesized that rationally designed LNPs based on extracellular vesicle mimicry would enable efficient delivery of RNA therapeutics to brain tumors without undue toxicity. We synthesized LNPs using four components similar to the formulation used in the mRNA COVID19 vaccines (Moderna and Pfizer): ionizable lipid, cholesterol, helper lipid and polyethylene glycol (PEG)-lipid. For the in vitro screen, we tested ten classes of helper lipids based on their abundance in extracellular vesicle membranes, commercial availability, and large-scale production feasibility while keeping rest of the LNP components unchanged. The transfection kinetics of GFP mRNA encapsulated in LNPs and doped with 16 mol% of helper lipids was tested using GL261, U87 and SIM-A9 cell lines. Several LNP formations resulted in stable transfection (upto 5 days) of GFP mRNA in all the cell lines tested in vitro. The successful LNP candidates (enabling >80% transfection efficacy) were then tested in vivo to deliver luciferase mRNA to brain tumors via intrathecal administration in a syngeneic glioblastoma (GBM) mouse model, which confirmed luciferase expression in brain tumors in the cortex. LNPs were then tested to deliver Cre recombinase mRNA in syngeneic GBM mouse model genetically modified to express tdTomato under LoxP marker cassette that enabled identification of LNP targeted cells. mRNA was successfully delivered to tumor cells (70-80% transfected) and a range of different cells in the tumor microenvironment, including tumor-associated macrophages (80-90% transfected), neurons (31- 40% transfected), neural stem cells (39-62% transfected), oligodendrocytes (70-80% transfected) and astrocytes (44-76% transfected). Then, LNP formulations were assessed for delivering Cas9 mRNA and CD81 sgRNA (model protein) in murine syngeneic GBM model to enable gene editing in brain tumor cells. Sanger sequencing showed that CRISPR-Cas9 editing was successful in ~94% of brain tumor cells in vivo. In conclusion, we have developed a library of safe LNPs that can transfect GBM cells in vivo with high efficacy. This technology can potentially be used to develop novel mRNA therapies for GBM by delivering single or multiple mRNAs and holds great potential as a tool to study brain tumor biology.
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After two years of online learning, minor changes happened in some tiny places which we may not always notice. These changes may impact the school management, education arrangement, and curriculum design: what do students expect from their teachers, and the school? Are they expecting forever online learning, and getting their degree completely online? In this study, we examined 93 final-year students from the school of computing science which mainly used work-based learning applied to learn pedagogy. We analyze their viewpoint on how COVID-19 changed their understanding of teaching and learning: what is the role of teachers and students? And how do they see the arrangement for the internship program? We found that over 92% of students agree that a creditable degree can better secure a job;over 68% of the students believed that face-to-face teaching is still a better choice, but at the same time, over 73% wish to have the materials recorded so that they can access them at their convenience time. We also examined some of the course design elements, especially those related to the internship program, to achieve a possible curriculum improvement for the students in the Asia Pacific region. © 2022 ACM.
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The COVID-19 pandemic has caused disruption to the economy due to the increasing infection that affects the workforce in different sectors. The Philippine government has imposed lockdowns to control the spread of infection. This urged the different sectors to implement flexible work schedules or work from home setup. A work-from-home (WFH) setup burdens both the employee and employer by installing different equipment set-ups such as WiFi-equipped laptops, computers, tablets, or smartphones. However, the internet stability in some of the areas in the Philippines is not yet reliable. In this study, an application is used collect survey information and provide an estimate of the telework internet cost requirement of a given government employee or a given government employee implementing a work-from-home set up in their respective household. This involves survey results from different respondents who are currently on a work-from-home setup and significant factors from the survey have been analyzed using machine learning (ML) algorithms. Among the machine learning algorithms used, the ensemble bagged trees model outperformed the other ML models. This work can be extended by incorporating a wider scope of datasets from different industry doing work from home set-up. In addition, in terms of education, it is also recommended to determine the WFH set up not just with the government employee and employer but to also extend this into the education side. © 2022 IEEE.
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By the beginning of 2020, the illness had been named as COVID-19, which had spread due to its extreme severity affecting multiple industries and sectors throughout the world. To protect the public's health and safety, the Philippine government has established a number of quarantine regulations and travel restrictions in reaction to the current COVID-19 outbreak. Nonetheless, the ILO predicted that the pandemic would initially disrupt the economy and labor markets, affecting 11 million employees, or around 25% of the workforce in the Philippines. Therefore, the government continues to urge employers of local companies and enterprises to use alternative work plans, such as a WFH - work-from-home operation in accordance with the established policies. In line with the concept of telework, several studies have already been carried out, though some were declared inconclusive and require additional study. Hence, in this research, a mobile application was created to evaluate the employee's telework capability assessment using a Fuzzy-based model which utilizes Google AppSheet, Apps Script, and Sheets. The developed mobile application is able to provide capacity evaluation utilizing the four key input variables, which are also reasonably characterized for potential telecommuting cost evaluation. © 2022 IEEE.
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By early 2020, COVID-19 has caused a global pandemic which led to an enormous number of challenges worldwide in various sectors. The Philippine government has implemented multiple quarantine guidelines and travel restrictions to ensure the people's health and safety. However, the International Labour Organization projected an initial economic and labor market disruption affecting 11 million workers, or about 25% of the Philippine workforce, due to the pandemic. Therefore, the government, thru the concerned agencies continues to encourage employers to implement alternative work plans such as a work-from-home (WFH) operation in compliance with the established regulations in line with existing laws and policies. In line with the telecommuting concept, various research has already been performed, however, some were regarded inconclusive and require further study. Hence, in this study, a Web application was developed along with an embedded fuzzy model to evaluate the telecommuting capability assessment of employees. The proposed web application with embedded fuzzy model is capable of providing capability assessment using the four main input variables which are also relatively characterized for possible telecommuting cost assessment. © 2022 IEEE.
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Background: Catheter ablation is a cornerstone treatment for symptomatic atrial fibrillation (AF) with major improvements in safety over time. However, rates of adverse events with use of current techniques in a contemporary quality-focused network remain undefined. Objective(s): Across a large, real-world sample, we sought to describe (1) rates of major, adverse events associated with catheter ablation of AF and (2) patient-level factors associated with complications. Method(s): Utilizing the REAL-AF collaboration, a registry of contemporary AF ablation procedures with granular patient, procedural and follow-up data comprised of cases from over 50 operators across academic and non-academic sites, we evaluated all patients undergoing their first ablation procedure from January 2018 - June 2022. Risk-adjusted analyses were conducted to evaluate the relationship between patient factors and complications. Result(s): Among 3144 patients (age 66.1 +/- 11.0 years, 42% female, 67.1% paroxysmal, 32.9% persistent) who underwent AF ablation, procedure-related complications (n =77) were identified in 65 patients (2.1%) with multiple complications occurring in 9 patients (0.2%). Most complications (n=70, 93.5%) occurred in the peri-procedural (within 30 days) period and 6.5% (n=5) after 30 days, the latter of which all represented vascular injuries (Figure). Major complications (18 of 72 peri-procedural complications, 25.0%) are defined, detailed, and associated data reported in the Figure. Unadjusted (16.0% without CHF vs. 33.3% with CHF, p = 0.045) and risk-adjusted (OR 2.8, 95% CI 1.03-7.60, p=0.045) analyses indicated history of CHF was associated with a composite outcome of major complications. Analyses of independent complications showed those who suffered from peri-procedural stroke (n=3) were of significantly greater age (77.3 +/- 5.5 years vs. 66.1 +/- 10.9 years, p=0.035). Risk-adjusted analyses showed history of vascular disease (OR 2.9, 95% CI 1.02-8.20, p=0.045) was associated with vascular injury (n=18). From 0-695 days post-procedure, 31 deaths occurred (unknown cause: 17, COVID-19 related: 4, heart failure: 2, cardiac arrest: 2). Conclusion(s): Major complications represent rare events among those undergoing AF ablation in current practice. Risk-adjusted analyses suggest a history of CHF is associated with major complications. Similarly, older age and a history of vascular disease are associated with stroke and vascular complications, respectively. [Formula presented]Copyright © 2023
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This book discusses the applications and optimization of emerging smart technologies in the field of healthcare. It further explains different modeling scenarios of the latest technologies in the healthcare system and compares the results to better understand the nature and progress of diseases in the human body, which would ultimately lead to early diagnosis and better treatment and cure of diseases with the help of distributed technology. Covers the implementation models using technologies such as artificial intelligence, machine learning, and deep learning with distributed systems for better diagnosis and treatment of diseases. Gives in-depth review of technological advancements like advanced sensing technologies such as plasmonic sensors, usage of RFIDs, and electronic diagnostic tools in the field of healthcare engineering. Discusses possibilities of augmented reality and virtual reality interventions for providing unique solutions in medical science, clinical research, psychology, and neurological disorders. Highlights the future challenges and risks involved in the application of smart technologies such as cloud computing, fog computing, IOT, and distributed computing in healthcare. Confers to utilize the AI and ML and associated aids in healthcare sectors in the post-Covid 19 period to revitalize the medical setup. Contributions included in the book will motivate technological developers and researchers to develop new algorithms and protocols in the healthcare field. It will serve as a vast platform for gaining knowledge regarding healthcare delivery, health- care management, healthcare in governance, and health monitoring approaches using distributed environments. It will serve as an ideal reference text for graduate students and researchers in diverse engineering fields including electrical, electronics and communication, computer, and biomedical fields. © 2023 selection and editorial matter, Preeti Nagrath, Jafar A. Alzubi, Bhawna Singla, Joel J. P. C. Rodrigues and A. K. Verma;individual chapters, the contributors.
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Companies continuously produce several documents containing valuable information for users. However, querying these documents is challenging, mainly because of the heterogeneity and volume of documents available. In this work, we investigate the challenge of developing a Big Data Question Answering system, i.e., a system that provides a unified, reliable, and accurate way to query documents through naturally asked questions. We define a set of design principles and introduce BigQA, the first software reference architecture to meet these design principles. The architecture consists of high-level layers and is independent of programming language, technology, querying and answering algorithms. BigQA was validated through a pharmaceutical case study managing over 18k documents from Wikipedia articles and FAQ about Coronavirus. The results demonstrated the applicability of BigQA to real-world applications. In addition, we conducted 27 experiments on three open-domain datasets and compared the recall results of the well-established BM25, TF-IDF, and Dense Passage Retriever algorithms to find the most appropriate generic querying algorithm. According to the experiments, BM25 provided the highest overall performance. Copyright © 2023 by SCITEPRESS - Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)
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This unprecedented time of the COVID-19 outbreak challenged the status-quo whether it is on business operation, political leadership, scientific capability, engineering implementation, data analysis, and strategic thinking, in terms of resiliency, agility, and innovativeness. Due to some identified constraints, while addressing the issue of global health, human ingenuity has proven again that in times of crisis, it is our best asset. Constraints like limited testing capacity and lack of real-time information regarding the spread of the virus, are the highest priority in the mitigation process, aside from the development of vaccines and the pushing through of vaccination programs. Using the available Chest X-Ray Images dataset and an AI-Computer Vision Technique called Convolutional Neural Network, features of the images were extracted and classified as COVID-19 positive or not. This paper proposes the usage of the 18-layer Residual Neural Network (ResNet-18) as an architecture instead of other ResNet with a higher number of layers. The researcher achieves the highest validation accuracy of 99.26%. Moving forward, using this lower number of layers in training a model classifier, resolves the issue of device constraints such as storage capacity and computing resources while still assuring highly accurate outputs. © 2022 IEEE.
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Objectives: To assess protein and energy intake and duration of venous-venous ECMO in critically ill patients with covid-19 Methods: We conducted a retrospective observational analysis on the intensive care units of a large tertiary private teaching Hospital. Adult patients admitted to intensive care unit (ICU) with laboratory confirmed SARS-CoV-2 (RT-PCR), cannulated on venous-venous ECMO and on exclusive enteral feeding were included. Data between march 2020 and june 2021 were collected. Weight and height data were acquired at the time of admission in ICU. Body mass index (BMI) was subsequently calculated. We obtained delivery and adequacy of nutrition data from a enteral nutrition form routinely filled out by nutritionists during hospitalization. Other data were obtained from electronic medical record. For statistical analysis of the data, we used SPSS version 13.0. Result(s): This cohort included 39 patients. 27 (69.2%) were men, mean age was 50 (+/- 12) years and 11 (28,2%) had more than 60 years. The more prevalent comorbidities were obesity in 22 (56%), hypertension in 20 (51,3%) and diabetes in 6 (15,4%) patients. The mean time on ECMO was 24.7 +/- 15.2 days. 29 patients (74%) died. Regarding nutritional support, the average protein intake was 0,9 +/- 0.4 g/kg/day and calories 13.9 +/- 5.2 cal/kg/day. No statistically significant association was observed between the nutritional intake and the duration on ECMO and clinical outcomes of patients. Conclusion(s): There was a high mortality in our cohort. Center;s inexperience may have played a role in these results, in addition to other factors. We observed a high prevalence of obesity. Neither energy nor protein intake were associated with the duration of ECMO and clinical outcomes. These results are similar to other recent observational studies where an insufficient energy and protein intake did not affected mortality or other outcomes. Our small sample and study design prevents a definitive conclusion on the subject. Thus, we propose further studies to elucidate the role of adequate nutrional strategies to improve outcomes and reabilitation of patients on ECMO.
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The COVID-19 pandemic has influenced various aspects of people's lives;for instance, restrictions during the pandemic have forced people to think about sports participation and physical activity in new ways. There has been growing interest in technological interventions to support exercise-related behavioural changes in daily life;in particular, exergames designed to induce full-body movement offer alternatives to physical activity. Since Taiwan has a high rate of ownership of exergame-related equipment, it is worth examining players' perceptions of using exergames for exercise. This study utilised a Means-End Chain analysis with in-depth laddering interviews to investigate Taiwanese perceptions of certain attributes of exergames as most likely to produce desired consequences in accordance with their values. The findings provide researchers and practitioners interested in the use of technology for exercise with valuable implications of Means-End Chain theory and structuration theory and suggestions for exergame design and promotion.
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Introduction: COVID-19 vaccination substantially reduces morbidity and mortality associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe illness. However, despite effective COVID-19 vaccines many questions remain about the efficacy of vaccines and the durability and robustness of immune responses, especially in immunocompromised persons. The NCI-funded Serological Sciences Network (SeroNet) is a coordinated effort including 11 sites to advance research on the immune response to SARS-CoV-2 infection and COVID-19 vaccination among diverse and vulnerable populations. The goals of the Pooling Project are: (1) to conduct real-world data (RWD) analyses using electronic medical records (EMR) data from four health care systems (Kaiser Permanente Northern California, Northwell Health, Veterans Affairs-Case Western, and Cedars-Sinai) to determine vaccine effectiveness in (a) cancer patients;(b) autoimmune diseases and (c) solid organ transplant recipients (SOTR);(2) to conduct meta-analyses of prospective cohort studies from eight SeroNet institutions (Cedars-Sinai, Johns Hopkins, Northwell Health, Emory University, University of Minnesota, Mount Sinai, Yale University) to determine post-vaccine immune responses in (a) lung cancer patients;(b) hematologic cancers/hematopoietic stem cell transplant (HSCT) recipients;(c) SOTR;(d) lupus. Method(s): For our RWD analyses, data is extracted from EMR using standardized algorithms using ICD-10 codes to identify immunocompromised persons (hematologic and solid organ malignancy;SOTR;autoimmune disease, including inflammatory bowel disease, rheumatoid arthritis, and SLE). We use common case definitions to extract data on demographic, laboratory values, clinical co morbidity, COVID-19 vaccination, SARS-CoV-2 infection and severe COVID-19, and diseasespecific variables. In addition, we pool individual-level data from prospective cohorts enrolling patients with cancer and other immunosuppressed conditions from across network. Surveys and biospecimens from serology and immune profiling are collected at pre-specified timepoints across longitudinal cohorts. Result(s): Currently, we have EMR data extracted from 4 health systems including >715,000 cancer patients, >9,500 SOTR and >180,000 with autoimmune conditions. Prospective cohorts across the network have longitudinal data on >450 patients with lung cancer, >1,200 patients with hematologic malignancies, >400 SOTR and >400 patients with lupus. We will report results examining vaccine effectiveness for prevention of SARS-CoV-2 infection, severe COVID-19 and post-acute sequelae of COVID-19 (PAS-C or long COVID) in cancer patients compared to other immunocompromised conditions. Conclusion(s): Our goal is to inform public health guidelines on COVID-19 vaccine and boosters to reduce SARS-CoV-2 infection and severe illness in immunocompromised populations.
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There is a need for rapid, sensitive, specific, and low-cost virus sensors. Recent work has demonstrated that organic electrochemical transistors (OECTs) can detect the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein. Here, a simple and low-cost approach to the fabrication of OECT devices with excellent stability and unprecedented sensitivity and specificity for the detection of SARS-CoV-2 virus is demonstrated. The devices rely on the engineered protein minibinder LCB1, which binds strongly to SARS-CoV-2. The resulting devices exhibit excellent sensitivity for the detection of SARS-CoV-2 virus and SARS-CoV-2 spike protein receptor binding domain (RBD). These results demonstrate a simple, effective, and low-cost biomolecular sensor applicable to the real-time detection of SARS-CoV-2 virus and a general strategy for OECT device design that can be applied for the detection of other pathogenic viruses.
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Key Words: Telehealth etiquette, webside manner, Advanced Practice Nursing, nursing, telehealth, telehealth education, telemedicine, nursing education, nurse patient experience, telehealth nursing, nursing faculty, telehealth quality Increased utilization of videoconferencing platforms to conduct meetingsand patient encounters has illuminated the need to focus on video etiquette. Telehealth Brief History of Telehealth Telehealth, as defined by the U. S. Health Resources and Services Administration (HRSA), is "the use of electronic and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration" (U. S. Department of Health and Human Services [DHHSI. 2021. para 1). [...]the casual use of social media for interpersonal Interactions may have a negative effect on professional telehealth communication by reducing one's empathetic expression (Konrath et al.. Patient-Provider Communication Impact of Communication Communication has long been a key component of education for nursesand Is identified by the National Council of State Boards of Nursing (NCSBN) as fundamental to the practice of nursing (NCSBN. 20131.
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Background: COVID-19 pandemic times forced health education to go online, and, due to this necessity, long-term difficulties in education such as bibliographic search in databases like PubMed might have worsened even when platforms such as PubMed provide helping mechanisms to the user. These difficulties or even complete lack of knowledge are, unfortunately, not well documented in the literature. Therefore, this study aimed to describe doubts, lack of knowledge and questions of researchers regarding bibliographic research in PubMed as well as to solve all of those doubts by developing a didactic e-book in relation to bibliographic research in PubMed. Methods: This cross-sectional and populational-based study was conducted between January and April 2021. In northern Brazil, a total of 105 dentistry undergraduate students (DUS) received an anonymous digital form (Google® Forms Platform) using a non-probabilistic "snowball” sampling technique. The digital form was composed of four blocks of dichotomous and multiple-choice questions. After signing the informed consent term, the DUS were divided into three groups according to their period/semester in the dentistry program during the study time (G1: 1st period/semester;G2: 5th period/semester and G3: 10th period/semester). A total of 25 questions referring to demographic, educational and knowledge data about how to do scientific research and how to use bibliographic search in PubMed were asked, and all data were presented as descriptive percentages and then analyzed using the Chi square and G tests. Results: From 105 (100%), G1 had 29/105 (27.6%);G2 had 37/105 (35.2%);G3 had 39/105 (37.2%), the average age was 22.34 years and most participants were female 85/105 (81%). Among our sample, 56/105 (53.4%) had not used any type of search strategy, and 96/105 (91.4%) used database research methods. The main database for literature search used was Scielo 92/105 (87.6%), and 63/105 (60%) had general questions or doubts about bibliographic research. All these data had statistical significance p < 0.0001. Conclusions: The results demonstrate a lack of knowledge and doubts in DUS from three different periods/semesters, and this collected information can help in the formation of didactic material to solve such doubts. © 2023 by the authors.
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Purpose: The COVID-19 pandemic significantly increased work-related stress and anxiety in healthcare workers worldwide, increasing their potential for burnout. Rural hospitals experienced additional challenges as they often provided care with limited resources and staff. Efforts are made by rural hospitals to mitigate employees' work-related stress and anxiety, but few studies or projects have been published that highlight these efforts. Our evidence-based practice project aimed to answer the question, does the use of a "Zen" or recovery room influence rural healthcare staff stress and anxiety levels during their shift? Sample: The project's convenience sample included 36 healthcare workers and hospital staff in an acute care facility, solely servicing a rural county in north-central Texas. Method: Following the IOWA Model, a literature search was conducted, and IRB review of the project was obtained. A private, restful space was created in a room with soft lighting, a massage chair, aromatherapy, and other various tools for relaxation. From June 2021 – January 2022, all staff were invited to use the room and complete a brief voluntary anonymous survey when they entered and exited the room. An additional short-answer survey was conducted in March 2022 to explore employees' perceptions of the project. Findings: On average, participants reported significantly lower levels of stress and anxiety after using the Zen room. Pre-room anxiety scores significantly predicted participants' post-room stress levels. Barriers to room use included employee's perception of available time and enough staff during the shift to step away from their duties. Conclusion: The availability of private, uninterrupted space decreased staff stress and anxiety and allowed them to return to work with a renewed sense of energy. Rural hospitals would benefit in implementing such a space and conducting further research on the effects of stress and anxiety levels, even as COVID-19 shifts to an endemic disease.
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The purpose of this article is to investigate the administrative, economic and social legal dimensions of the coronavirus pandemic;examine how public policies aimed at emergency social rescue are being implemented. This qualitative research is carried out through national and foreign bibliographic consultations;assuming that this COVID-19 pandemic may be a turning point for economic, social and legal relations to turn to solidarity. It is observed that nations move large public countercyclical investments to overcome the crisis caused by social isolation, unemployment and scarcity. Companies and individuals try to make generous contributions to scientific vaccine research. Solidarity in the favelas was greater in the distribution of food. It is observed in the international experience that favela populations are more exposed to contamination and that the distribution of emergency aid in cash by governments is more efficient than the distribution of food. Despite the difficulties of governmental coordination to combat the pandemic in Brazil a lot has been done, but the solidarity is one the main driver of people and companies. This little extract from the pandemic does not exhaust the issue and does not manage to measure all the economic, social and legal consequences that will come, or even, what will be the number of deaths, but it contributes to the perception of size of problem and how to overcome the challenges.
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BackgroundPain is a debilitating symptom of ankylosing spondylitis (AS) that negatively affects patients' lives. Upadacitinib (UPA), a Janus kinase inhibitor approved for the treatment of AS and other inflammatory diseases, showed significant efficacy vs placebo (PBO) in the phase 2/3 SELECT-AXIS 1 study in patients with AS who were biologic-naive and in the phase 3 SELECT-AXIS 2 study in patients with active AS who had an inadequate response (IR) to biological therapy [1,2]. Improvement in pain outcomes with UPA was also previously demonstrated in the SELECT-AXIS 1 study [3].ObjectivesThe objective of this post-hoc analysis of SELECT-AXIS 2 was to evaluate the efficacy of UPA vs PBO on multiple pain assessments through 14 weeks in patients with IR to a biologic disease-modifying antirheumatic drug (bDMARD-IR).MethodsSELECT-AXIS 2 (NCT04169373) enrolled adults with active AS with IR to biological therapy, including patients who discontinued biologics due to lack of efficacy or intolerance [1]. Patients were randomized 1:1 to UPA 15 mg once daily (QD) or PBO for 14 weeks. Pain endpoints evaluated here included the proportion of patients achieving ≥30%, ≥50%, and ≥70% reduction from baseline, minimal clinically important difference (MCID, defined as ≥1 point reduction or ≥15% reduction from baseline), and much better improvement (MBI, defined as ≥2 point reduction and ≥33% reduction from baseline) in Patient's Global Assessment (PGA) of pain, total back pain, and nocturnal back pain on a 0–10 numeric rating scale [3,4]. Non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19 was used.ResultsA total of 211 patients received UPA 15 mg QD and 209 patients received PBO. Higher proportions of patients receiving UPA vs PBO achieved ≥30% and ≥50% reductions in PGA of pain, total back pain, and nocturnal back pain as early as week 2 that were sustained at all time points through 14 weeks (nominal P<0.05;Figure 1a-c). Achievement of ≥70% reductions in PGA of pain and nocturnal back pain were higher at week 4 and sustained thereafter (Figures 1a and 1c), and achievement of ≥70% reduction in total back pain was higher at week 2 and week 8, but not week 4, and sustained thereafter (Figure 1b). Results were similar for the proportion of patients achieving MCID and MBI, with improvements in PGA of pain, total back pain, and nocturnal back pain for UPA vs PBO as early as week 1 (MCID) or week 2 (MBI) that were sustained through week 14 (all nominal P<0.001;Table 1).Table 1.Achievement of MCID and MBI in Pain Outcomes at Week 14 (NRI-MI)Responder Rate (95% CI), %Pain OutcomesUPA 15 mgPBONominal P ValuePGA of painMCID81.0 (75.8–86.3)62.7 (56.1–69.2)<0.0001MBI60.7 (54.1–67.3)24.9 (19.0–30.7)<0.0001Total back painMCID80.1 (74.7–85.5)65.1 (58.6–71.5)0.0005MBI58.3 (51.6–64.9)25.4 (19.5–31.3)<0.0001Nocturnal back painMCID82.9 (77.9–88.0)61.3 (54.7–67.9)<0.0001MBI61.6 (55.0–68.2)32.1 (25.7–38.4)<0.0001MBI, much better improvement;MCID, minimal clinically important difference;NRI-MI, non-responder imputation incorporating multiple imputation to handle missing data due to COVID-19;PBO, placebo;PGA, Patient's Global Assessment;UPA, upadacitinib.ConclusionIn patients with active AS who were bDMARD-IR, greater proportions of patients treated with UPA achieved rapid and clinically meaningful reductions in pain vs PBO as early as week 2 that were sustained through 14 weeks across multiple pain assessments.References[1]van der Heijde D, et al. Ann Rheum Dis. 2022;81(11):1515-1523.[2]van der Heijde D, et al. Lancet. 2019;394(10214):2108-2117.[3]McInnes IB, et al. RMD Open. 2022;8(1):doi:10.1136/rmdopen-2021-002049.[4]Salaffi F, et al. Eur J Pain. 2004;8(4):283-291.AcknowledgementsAbbVie funded this study and participated in the study design, research, analysis, data collection, interpretation of data, reviewing, and approval of the publication. All authors had access to relevant data and participated in the drafting, review, and approval of this p blication. No honoraria or payments were made for authorship. Medical writing support was provided by M. Hovenden and J. Matsuura of ICON plc (Blue Bell, PA, USA) and was funded by AbbVie.Disclosure of InterestsXenofon Baraliakos Consultant of: Novartis, Pfizer, AbbVie, Eli Lilly, UCB Pharma, Galapagos, Janssen, Celgene, and Amgen, Grant/research support from: Novartis, Pfizer, AbbVie, Eli Lilly, UCB Pharma, Galapagos, Janssen, Celgene, and Amgen, Marina Magrey Consultant of: UCB, Novartis, Eli Lilly, Pfizer, and Janssen, Grant/research support from: Amgen, AbbVie, BMS, and UCB Pharma, Louis Bessette Speakers bureau: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Lilly, Novartis, Organon, and Sanofi, Grant/research support from: Amgen, BMS, Janssen, UCB, AbbVie, Pfizer, Merck, Celgene, Lilly, Novartis, Sanofi, and Gilead, Kurt de Vlam Speakers bureau: Amgen, Celgene, Eli Lilly, Galapagos, Novartis, and UCB, Consultant of: Amgen, AbbVie, Celgene, Eli Lilly, Galapagos, Novartis, and UCB, Grant/research support from: Amgen, UCB, and MSD, Tianming Gao Shareholder of: AbbVie, Employee of: AbbVie, Anna Shmagel Shareholder of: AbbVie, Employee of: AbbVie, Ralph Lippe Shareholder of: AbbVie, Employee of: AbbVie, Ana Biljan Shareholder of: AbbVie, Employee of: AbbVie, Victoria Jasion Shareholder of: AbbVie, Employee of: AbbVie, Peter C. Taylor Speakers bureau: AbbVie, Consultant of: Lilly, AbbVie, Pfizer, Galapagos, Gilead, Janssen, GlaxoSmithKline, Sanofi, Fresenius, Nordic Pharma, UCB, and Biogen, Grant/research support from: Galapagos.
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PURPOSE: Colorectal cancer (CRC) is preventable with screening, yet remains the second leading cause of cancer deaths in the U.S. Nationally, CRC screening substantially declined during the COVID-19 pandemic and is underutilized by ethnic minorities and in safety-net systems. Therefore, City of Hope partnered with Federally Qualified Health Centers (FQHCs) and community and faithbased organizations to improve CRC screening among medically underserved communities. METHOD(S): Between October 2020 and October 2022, we implemented a multi-component intervention that included community outreach and education (a multi-ethnic multimedia campaign and community training adapted from the NCI Screen2Save (S2S) program) and clinic-based interventions (provider/staff training and patient education). Intervention reach and training participant surveys were assessed. Within our four FQHC sites, we also compared clinic-level CRC screening rates among age-eligible patients before (June 2021) and after implementation of the clinic-based intervention (June 2022). RESULT(S): Our reach assessment showed that our multi-ethnic multimedia campaign reached 35.4 million impressions, our S2S education training reached 300 diverse community members, and our provider/staff training reached 150 medical providers. Among the 100 providers surveyed, >80% felt confident they could get their patients to complete their CRC screening test and follow-up care. For the clinic-based intervention component, our baseline sample included 11,259 age-eligible patients across the four FQHC sites. Overall CRC screening rates increased from 45% to 52% before vs. after the intervention implementation period. The site with the highest CRC screening rate (>62%) maintained steady rates over the observation period, whereas three sites with lower baseline rates showed greater pre-post improvements (average 15 percentage-point increase). CONCLUSION(S): An overall increase in CRC screening rates was achieved across FQHCs, despite clinic staffing challenges during the COVID-19 pandemic. Intervention implementation is ongoing with attempts to document individual, clinic improvements by race/ethnicity.