LTSI Consensus Guidelines: Preoperative Pulmonary Evaluation in Adult Liver Transplant Recipients.

The relationship between chronic liver disease and respiratory symptoms and hypoxia is well recognized. Over the last century, three pulmonary complications specific to chronic liver disease (CLD) have been characterized: hepatopulmonary syndrome, portopulmonary hypertension, and hepatic hydrothorax. Apart from that coexisting pulmonary disease like chronic obstructive lung disease and interstitial lung disease also complicate the outcomes after liver transplantation (LT). Assessment for evaluation of underlying pulmonary disorders is essential to improve outcomes in patients with CLD, posted for LT. This consensus guideline of the Liver Transplant Society of India (LTSI) provides a comprehensive review of pulmonary issues in CLD, related and unrelated to underlying liver disease and gives recommendations for pulmonary screening in specific clinical scenarios in adults with chronic liver disease planned for LT. This document also aims to standardize the strategies for preoperative evaluation of these pulmonary issues in this subset of patients. Proposed recommendations were based on selected single case reports, small series, registries, databases, and expert opinion. The paucity of randomized, controlled trials in either of these disorders was noted. Additionally, this review will highlight the lacunae in our current evaluation strategy, challenges faced, and will provide direction to potentially useful futuristic preoperative evaluation strategies.

Factors associated with COVID-19 vaccine hesitancy: a community-based household survey in Pune district of Maharashtra, India

Background: In the wake of the coronavirus (COVID-19) pandemic, the development of the COVID-19 vaccine became a game-changing tool. However, the rapid development of the COVID-19 vaccine gave rise to various myths, misconceptions and hesitancies among people.

COVID-19 vaccine knowledge, attitudes, perceptions and uptake among healthcare workers of Pune district, Maharashtra

Background: Healthcare workers play a vital role in vaccine promotion and acceptance through community dialogue, education, and myth-busting. Vaccinated healthcare workers will likely recommend the vaccine to their families and community.

Virtual Reality Visual Field Exam in Community Screenings During COVID-19

Purpose : 57.5 million people worldwide are affected by glaucoma. However, 50% of those with glaucoma are unaware, and 80% of those identified for follow-up in community screenings (CS) fail to do so. Current standards of visual field testing are usually limited to the clinic. As such, a wearable perimetry headset was used to perform Virtual Reality Visual Field Acuity (VRVFA) examination for suspected visual field loss in the community minimizing exposure to COVID-19 and the need for follow-up. Methods : 31 subjects from 4 CS were screened by an onsite certified telemedicine reader (CR) who considered family history, visual acuity, intraocular pressures, cup-to-disc ratio, nerve fiber layer defects, and ganglion cell complex captured by non-mydriatic photography and ocular coherence tomography (OCT-B). Cataracts were also graded. Supervised VRVFA testing with a multilingual Palmscan VF2000 Analyzer (Fig.1) was performed in 6 minutes on average. Eyes with fixation losses >20% or false positive/negative ratios >0.375 were excluded. Visual field index (VFI), mean deviation (MD), pattern standard deviation (PSD), and mean sensitivity (MS) from VRVFA were compared to CR glaucoma referral and cataract grading. Descriptive statistics, independent samples t-tests, and Mood's median tests were performed. Subjects with positive findings underwent same-day robotic glaucoma specialist telepresence evaluation. Results : 37 eyes from 31 subjects met inclusion criteria (mean age 51.42 ± 14.57 years, 56.76% male, 94.59% Hispanic). 7 (18.92%) eyes were referred for glaucoma evaluation. Glaucoma referrals had significantly different VFI (66.86% vs 86.40%, p=0.027), MD (-9.60 vs -4.04, p=0.031), and MS (19.94 vs 26.01, p=0.027) (Fig. 2). 30 (81.08%) eyes were 0-1+ in cataract grading, 5 (13.51%) were 2-3+, and 2 (5.41%) were intra-ocular lenses (IOL);respectively, these subgroups were not significantly different in VFI (84.20% vs 92.80% vs 35.00%, p=0.147), MD (-4.70 vs -2.11 vs -18.41, p=0.147), PSD (3.52 vs 2.25 vs 9.69, p=0.053), or MS (25.38 vs 27.75 vs 9.91, p=0.147) (Fig. 2). Conclusions : VRVFA testing yielded valuable information on the extent of vision loss as a supportive screening tool for glaucoma congruent with referrals. Expanded testing is needed. Future studies may evaluate VRVFA utility in evaluating other peripheral vision threatening diseases.

TELEHEALTH VERSUS IN-PERSON PRIMARY CARE VISITS POST-EMERGENCY DEPARTMENT (ED) DISCHARGE: ASSOCIATIONS WITH RETURN TO ED OR HOSPITALIZATION

BACKGROUND: Ensuring appropriate outpatient follow-up is a mainstay of Emergency Medicine to avoid poor patient outcomes. During the COVID-19 pandemic, many post-ED discharge visits were rapidly transitioned from inperson to telehealth. Our study investigates the associations between ED recidivism or subsequent hospitalization after either telehealth or in-person visits follow-up visits. We hypothesize that telehealth visits are less successful than in-person visits at preventing either outcome. METHODS: This retrospective study used electronic health record data from an urban academic health system. All adult patients were included if they presented to either of two in-system EDs between 1/1/20 - 10/31/21 with a chief complaint of chest pain, syncope, abdominal pain, or altered mental status. If patients had multiple ED visits, only their first was included. The post-ED follow-up window was restricted to two weeks. We used multivariate logistic regressions, which controlled for patient age, sex, race, ethnicity, primary language, insurance type, and social vulnerability index, to estimate the association between the type of post-ED follow-up and two outcomes within 30 days after the follow-up appointment: 1) returning to the ED or 2) hospitalization. RESULTS: Of 23,856 ED visits that met criteria, 10,180 (42%) had follow-up telehealth visits, 3,925 (16%) had in-person follow-up, and 9,760 (40%) had no follow-up. A total of 2,119 (9%) patients returned to the ED after their follow-up: 12% of whom had telehealth visits, 7% had in-person visits, and 6% had no follow-up visit. 684 (3%) of patients were admitted: 6% of those with telehealth visits, 2% with in-person visits, and 0.2% with no follow-up visit. Compared to having no visit, telehealth visits were associated with an adjusted OR (aOR) of returning to the ED of 2.7 (95% CI, 2.4 -3.1), and in-person visits were associated with an aOR of 1.8 (95% CI, 1.5 -2.1). Compared to those with an in-person visit, telehealth follow-up was associated with an aOR of 1.5 (95% CI, 1.3 -1.8) of returning to the ED. Compared to having no visit, telehealth visits were associated with an aOR of 27.8 (95% CI, 17.4 -44.4), and in-person visits were associated with an aOR of 12.1 (95% CI, 7.2 -20.1) of hospitalization. Compared to those with an in-person visit, telehealth was associated with an aOR of 2.3 (95% CI, 1.8 -2.9) of hospitalization. All aORs were significant with p < 0.001. CONCLUSIONS: Telehealth follow-up visits were associated with higher odds of returning to the ED and hospitalization compared to in-person visits;though some of this association is likely due to patients who are sicker choosing telemedicine over in-person, this finding also suggests in-person follow-up may be more effective than telehealth at decreasing repeat ED visits and hospitalizations. Further analysis that adjusts for patient comorbidities and illness severity will help us to better understand the impact of post-ED followup on ED recidivism and hospitalization.

IMPROVING ANNUAL DIABETIC RETINAL SCAN SCREENING RATES IN A PRIMARY CARE CLINIC DURING THE COVID-19 PANDEMIC

STATEMENT OF PROBLEM/QUESTION: How can systems-based changes increase the rate of diabetic retinal scan (DRS) completion in a primary care clinic during the COVID pandemic with decreased in-person visits? DESCRIPTION OF PROGRAM/INTERVENTION: The intervention was based in a primary care clinic associated with a public county-based health system. During the COVID-19 pandemic, in-person clinic visits were drastically reduced to prevent transmission, leading to a significant decrease in DRS completion rates. Additional barriers to completion of DRS screening included the following: (1) patients needed a separate, scheduled visit in our electronic medical record system (EPIC) for the DRS exam, (2) DRS clinic had limited hours during the primary care visit day, (3) many of our underserved patients could not afford consecutive clinic visits within a short period of time, and (4) providers signed the orders for DRS at the end of the visit;thus, nursing staff could not start scheduling patients an appointment until the end of the primary care visit. The intervention included two Plan-Do-Study-Act (PDSA) cycles. The first PDSA cycle involved a physician manually screening all patients due for DRS on a weekly basis if they were scheduled for a clinic visit in the upcoming week. For those identified, our nursing staff scheduled and completed a separate DRS appointment for the same day as the patient's clinic visit to minimize multiple visits. The second PDSA cycle involved using an EPIC tool, SlicerDicer, to automatically identify patient charts with overdue DRS screenings and upcoming clinic visits. The list of identified patients were then sent over to our nursing staff in order to schedule patients for their DRS on the same day as their clinic visit. MEASURES OF SUCCESS: We recorded diabetic retinal scan completion rate each month for one year from September 2020 to August 2021 to assess if rates would improve after our interventions. Monthly completion rates were measured on a rolling basis and based on the completion of the annual DRS for all clinic patients within the last 12 months. FINDINGS TO DATE: The percent of completed annual diabetic retinal exams for all clinic patients increased from 32.4% in September 2020 to 70.9% in August 2021 after implementation of our interventions. KEY LESSONS FOR DISSEMINATION: We identified system-based barriers that were negatively impacting our patients' ability to complete an important health maintenance screening such as the DRS exam. After identifying these barriers, we utilized existing tools and technology within our electronic medical record system to help patients complete their annual DRS exams and drastically increased overall clinic DRS completion rates.

Detection of COVID-19 using Chest X-rays

We train a deep learning algorithm to flag potential covid-19 infected in chest x-rays. The deep learning algorithm used is a Convolutional Neural Network that is 121 layers deep. Due to the lack of a large open-source of covid-19 infected x-ray images, we combine data from five different sources. Combined, the dataset has 17,194 images that are used for training procedure. The model classifies a given chest X-ray image as either a "Normal", "Covid-19", or a 'Pneumonia"infection. The trained model has a 0.93 F1 Score and 93.496% accuracy. © 2022 IEEE.

MEDIATION OF BIOMARKERS OF INFLAMMATION IN SLEEP-RELATED HYPOXIA AND COVID-19 CLINICAL OUTCOMES

Introduction: Central to the pathophysiology of SARS-CoV-2 is immune dysregulation and systemic inflammation, however, it is yet unknown whether sleep-related hypoxemia-which we have recently noted to be associated with worse COVID-19 clinical outcomes-is mediated by these biomarkers and pathways. Methods: Data from patients who tested positive for SARS-CoV-2 and part of the integrated Cleveland Clinic COVID-19 and sleep laboratory registries from March-November 2020 were included. To assess the mediation effect of biomarkers, the relationship between sleep-related hypoxia measures (% sleep time<90%SaO2,T90) and moderate/severe WHO-7 COVID-19 score (use of supplemental oxygen, non-invasive ventilation, mechanical ventilation/ ECMO or death) was first tested. The mediation effect, or natural indirect effect, of biomarkers of inflammation (C-Reactive Protein (CRP), white blood cell (WBC) count (with a focus on lymphocyte count) and lactate) was then estimated by logistic regression models adjusted for demographics, comorbidities, smoking pack year and site location using PROC CAUSALMED statement in SAS software (version 9.4, Cary, NC). Results: The analytic sample included 446 patients hospitalized due to COVID-19: age:63.3.±13.8 years,51.3% female,39% African American with body mass index(BMI)=36.1±9.3kg/ m2. Thirty-six percent used supplemental oxygen, 4% used highflow or non-invasive ventilation,5% required ECMO or mechanical ventilation and 2% died. Hypoxic measures were associated with moderate/severe WHO-7 COVID-19 outcome: T90 median (>1.8%vs.≤1.8%) (OR=2.04, 95%CI:1.28-3.23,p=0.003), 5% increases in both mean SaO2 (OR=0.43, 95%CI: 0.26-0.70,p=<0.001) and minimum SaO2 (OR=0.84, 95%CI: 0.72-0.99,p=0.03). CRP was associated with mean SaO2 (p=0.040) and minimum SaO2 (p=0.029), likewise mediation analysis showed that there was a significant natural indirect effect of CRP in both hypoxia measures (OR=0.86,95%CI 0.73-0.99,p=0.036;OR=0.95,95%CI 0.90- 1.00,p=0.034 respectively). WBC count, but not lymphocyte count subset, was associated with mean SaO2 (p=0.044), but the natural indirect effect was not significant (p=0.23. Lactate was associated with minimum SaO2 (p=0.044), but the natural indirect effect was not significant (p=0.23). T90 median was not associated with CRP(p=0.13), WBC count(p=0.87) or lactate(p=0.28). Conclusion: CRP appears to represent a relevant mediator of sleep-related hypoxia and WHO-7 clinical outcomes. Further investigation is needed to elucidate if treatment of sleep-related hypoxia downregulates biomarkers of systemic inflammation to modify disease course.

Snowball effect of COVID-19: Stroke Care Underutilization

Objective: This study aims to investigate the utilization of acute ischemic stroke (AIS) services during the Corona Virus Disease 2019 (COVID-19) pandemic. Background: Based on early observations among healthcare utilization on stroke and other healthcare services, we hypothesized that there would be a persistent significant decline in AIS patients presenting to hospitals as the pandemic has progressed for over a year. Design/Methods: TriNetX, a large research network, is used to collect real-time electronic medical data. Data on utilization of acute ischemic stroke service was collected for the years 2018, 2019, and 2020 for variables including overall stroke volume and the number of patients that received intravenous tissue plasminogen activator (tPA) and mechanical thrombectomy (MT). Results: We found a 13.2-15.4% decrease in total number of AIS patients in 2020 (n 77231) compared with the years 2018 and 2019 (n 88948 and 91270 respectively, p <0.001). In the year 2020 Stroke volume was significantly lower in Q4 comparing to Q1 (Q1 vs Q4, p <0.01). The proportion of patients receiving tPA in 2020 was significantly lower compared to prior years (5.4% in 2020, 6.4% in 2018, 6.0% in 2019, p <0.01), however, the proportion of patients receiving MT was significantly higher in 2020 than in 2018(0.024 vs 0.022, p <0.01). Conclusions: Despite significant alteration in practices to optimize healthcare delivery and mitigate the collateral impact of the pandemic on care for other conditions, a persistent decline in AIS volumes remains. Delayed presentation, fear-of-contagion, reallocation, and poor availability of health care resources are potential contributors. Prospective evaluation and further investigation for these trends is needed.

Spectrum of Acute Necrotizing Hemorrhagic Encephalitisin COVID-19 patients: A case series and Review

Objective: N/A Background: Severe Acute Respiratory Syndrome Corona Virus 2 (SARS CoV-2) an ongoing pandemic has affected over 200 million people worldwide and caused over 4.5 million deaths. COVID-19 related acute encephalopathy has been known to exist and is thought to be multifactorial, most often related to underlying systemic inflammation, ischemic strokes, hypoxic injury or direct viral invasion and is associated with increased mortality. Design/Methods: We report a case series of three young patients with acute necrotizing hemorrhagic encephalitis (ANHE) after COVID-19 infection and a review of literature. Two of the cases (without preexisting comorbidities) had self-limiting disease that improved with resolution of systemic illness, and one (with preexisting comorbidities) had pathological evidence of fungal invasion who improved only after antifungal therapy. Results: N/A Conclusions: Acute necrotizing hemorrhagic encephalitis is a potential complication of COVID19 and is multifactorial, mediated by cytokines, host inflammatory response, superimposed infections, hypoxemia, hypercoagulability and possibly direct viral invasion. Clinical course may range from mild self-limiting illness to severe encephalitis with co-infection with other pathogens. Low threshold for neuroimaging, even with mild neuropsychiatric symptoms like headaches, can help in early diagnosis and prompt management, potentially preventing further complications.

Underutilization of Neuro Critical Care during the COVID-19 Pandemic

Objective: We aimed to evaluate utilization of inpatient hospital and critical care services among critically ill neurologic patients during the COVID-19 pandemic. We hypothesized, based on prior observations among ischemic stroke patients, that there would be significant decline in critically ill neurologic patients presenting to hospitals during the pandemic which may impact outcomes. Background: NA Design/Methods: We used TriNetX, a large research network, collecting real-time electronic medical records data. We extracted data on utilization of critical care and hospital inpatient services among cohorts of patients with common neurocritical conditions between January- June 2020 and compared it to data from similar time-frames in previous years. We also compared clinical outcomes, comprising need for intubation and 30-day mortality, among these cohorts. Results: We found a 28.1% reduction in intensive care unit (ICU) admissions with critical neurologic illnesses in 2020 when compared to 2019 (8568 vs. 11,917 patients, p < 0.0001) and a 34.4% reduction compared to 2018 (8568 vs. 13,064 patients, p < 0.0001). However, there was no statistically significant difference in mortality (2020: 12.2 vs. 2019: 12.4%;p = 0.7;vs. 2018: 12.6%;p = 0.62) or intubation rates across the years among patients using critical care services. There was 1% increase in mortality among non-ICU patients with similar diagnoses in 2020 compared to previous years (2020: 3.9% vs. 2019: 2.9% vs. 2018: 3.1%;p < 0.0001, p = 0.0001), but no difference in intubation rates. Conclusions: There was a significant reduction in hospital and ICU admissions among patients with acute neurologic emergencies in 2020, after onset of COVID-19 pandemic, compared to previous years. While we did not find a significant difference in mortality among patients admitted to the ICU, there was slightly higher mortality among non-ICU.

OVERALL DIABETES MORBIDITY AND MORTALITY WITH COVID-19

Overall Diabetes Morbidity and Mortality with COVID-19 Viral N. Shah, MD Associate Professor, Barbara Davis Center for Diabetes, University of Colorado Denver On December 12, 2019, a pneumonia cluster of unknown causes was identified in Wuhan in the Hubei province of China. Later on, it was confirmed to be caused by novel coronavirus (COVID-19) probably linked to seafood wholesale market in Wuhan. Within three months of the first case in Wuhan, many countries reported cases of COVID-19. There has been a large amount of publications since the first case of COVID-19 in December 2019. Per a PubMed search (using the search strategy COVID-19 [tiab]), in the year 2020 alone there were 79,593 publications related to COVID-19. Earlier publications from China and other countries reported a higher frequency of diabetes patients in the hospital setting. Earlier studies reported a two- to three-fold increased risk for severe disease and mortality in patients with diabetes compared to non-diabetic patients. This higher mortality among patients with diabetes was confirmed across different geographic locations, cross-sectional studies, as well as cohort or nationwide studies. Moreover, diabetes was associated with a higher risk for hospitalization, longer hospital stays, and ICU admissions. The majority of earlier studies reported an association between diabetes and COVID-19 morbidity and mortality without specifying diabetes type. A large population-based study from the United Kingdom, mortality in patients with type 1 diabetes was threefold higher (OR 3.51;95% CI 3.16-3.90) and in patients with type 2 diabetes was two-fold higher (OR 2.03;95% CI 1.97-2.09) compared to the general population. This suggested a higher mortality among patients with type 1 diabetes compared to type 2 diabetes. However, another population-based study from Sweden reported a two-fold increased but similar mortality between patients with type 1 diabetes and type 2 diabetes. Similarly, studies from the United States reported similar outcomes in patients with type 1 and type 2 diabetes. The published studies suggest mortality and morbidity is higher among patients with diabetes compared to patients without diabetes. However, there are many limitations and confounders of which we should be cognizant. Timing and virus strain may have confounded the results of many studies. For example, during the first wave of COVID-19 in many countries, health care systems were unprepared to deal with the huge surge of this new viral infection leading to rationalization of health care. In addition, there were no drugs or vaccines available during the first wave leading to higher mortality in older adults with multiple comorbidities such as diabetes. Moreover, different strains of the virus overtime had varied infection severity. For example, the alpha and delta strains of the virus led to more severe infections and increased mortality compared to a wild virus and the newer omicron variant. Higher mortality in people with diabetes was attributed to old age (>70 years) and the presence of other comorbidities such as hypertension and cardiovascular diseases. In summary, the present evidence indicates higher mortality and morbidities in patients with type 1 diabetes and type 2 diabetes. There is no data on morbidity and mortality of COVID-19 in patients with other types of diabetes such as monogenic diabetes. Higher mortality may be attributed to advanced age and presence of comorbidities. The COVID-19 disease is evolving and future studies will provide a greater understanding on the pathophysiology of COVID-19 in patients with diabetes and drugs to prevent disease severity in this patient population.

Remote Employee Monitoring and Management

Organizations have moved towards tracking their employees’ devices and keeping track of their work. We intend to develop a system that not only respects the privacy of employees but also helps employers manage their employees and also get a reliable productivity report. We have been able to monitor the background activities and log in the application names and their active time. The employee authentication process is implemented via a face recognition system which helps in maintaining authenticity. A total of 135 desktop apps and websites were opened while using the application and out of that 125 were successfully logged and their time was recorded accurately and productivity was calculated. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Clinical and demographic characteristics associated with shorter time to COVID-19 death

Introduction: Cancer patients have been considered a high-risk population in the COVID-19 pandemic. We previously investigated risk of COVID-19 death in COVID-19 positive cancer patients during a median follow-up of 134 days, and identified the following risk factors: male sex, age >60 years, Asian ethnicity, hematological cancer type, cancer diagnosis for >2.5 years, patients presenting with fever or dyspnea, and high levels of ferritin and C-reactive protein (CRP). Here, we further investigate which factors are associated with a COVID-19 related death within 7 days of diagnosis. Methods: Using data from Guy's Cancer Centre and one of its partner trusts (King's College Hospital), we included 306 cancer patients with a confirmed COVID-19 diagnosis (February 29th-July 31st 2020). 72 patients had a COVID-19 related death (24%) of whom 35 died within 7 days (50%). Cox proportional hazards regression was used to identify which factors were associated with a COVID-19 related death <7 days of diagnosis. Results: Of the 72 cancer patients who had a COVID-19 related death, the mean age was 72 years (Standard Deviation (SD) 14). A total of 53 (74%) patients were men. 37 (52%) had a hematological cancer type, 47 (65%) had stage IV cancer, and 42 (58%) had been diagnosed with cancer more than 24 months before COVID-19 related death. In the group of patients who died within 7 days of diagnosis (n= 35), mean age was 73 years (SD 13.96), 24 (68%) were men, 20 (57%) had a hematological cancer type, 26 (74%) had stage IV cancer, and 24 (68%) had been diagnosed with cancer >24 months before COVID-19 diagnosis. Factors associated with COVID-19 related death <7 days of diagnosis were: hematological cancer (Hazard Ratio (HR): 2.74 (95% Confidence Interval (CI): 1.21-6.22)), 2-5 yrs since cancer diagnosis (HR: 4.81 (95%CI: 1.47-15.69)), and >5 yrs since cancer diagnosis (HR: 4.41 (95%CI: 1.38-14.06)). Additionally, patients who presented with dyspnea had increased risk of COVID-19 related death <7 days compared to asymptomatic patients (HR: 5.25 (95%CI 2.14-12.89)). CRP levels in the third tercile (146-528 mg/L) as compared to the first were also associated with increased risk of an early death due to COVID-19. Conclusion: From all the factors identified in our previous COVID-19 related death analysis, only hematological cancer type, a longer-established cancer diagnosis (2-5 years and more than 5 years), dyspnea at time of diagnosis and high levels of CRP were indicative of an early COVID-19 related death (within 7 days of diagnosis) in cancer patients.

The impact of COVID-19 in the cancer population stratified by age: A real-world data study from Guy's Cancer Center

Background It is widely accepted that advancing age is associated with worse COVID-19 outcomes. However, there is insufficient data analyzing the impact of COVID-19 in the older cancer population. The aim of the study is to establish if age has an influence on severity and mortality of COVID-19 in cancer patients. Methods We reviewed 306 oncology patients with PCR-confirmed COVID-19 from Guy's Cancer Centre and its partner Trust King's College Hospital, between 29 February - 31 July 2020. Demographic and tumor characteristics in relation to COVID-19 severity and death were assessed with logistic and Cox proportional hazards regression models, stratified by age (≤65 and >65 years). Severity of COVID-19 was classified by World Health Organization (WHO) grading. Results A total of 135 patients were aged ≤65 years (44%) and 171 aged >65 (56%). Severe COVID-19 presentation was seen in 27% of those aged ≤65 and 30% of those aged >65. The COVID-19 mortality rate was 19% in those aged ≤65 and 27% in those aged >65. In the older cohort, there was an increased incidence of severe disease in Caucasian ethnicity compared to the younger cohort (55% vs 43%) and compared to severe disease in Black and Asian ethnicities. There were increased co-morbidities in the older cohort including hypertension (54% vs 32%), diabetes (30% vs 12%) with increased rate of poly-pharmacy (62% vs 40%) compared to the younger cohort. In terms of cancer characteristics in the older cohort, there was a higher rate of patients with cancer for more than 2 years (53% vs 32%) and performance status of 3 (22% vs 6%). In terms of severity, Asian ethnicity [OR: 3.1 (95% CI: 0.88-10.96) p=0.64] had greater association with increasing COVID-19 severity in those aged >65. Interestingly, there were no positive associations between number of co-morbidities, treatment paradigm or performance status with severity of disease in the older group. The risk of mortality was greater in the elderly cohort with hematological cancer types [HR: 2.69 (1.31-5.53) p=0.85] and having cancer for more than 2 years [2.20 (1.09-4.42) p=0.28] compared to the younger cohort. Conclusions In our study we demonstrate that severity and mortality of COVID-19 did not significantly differ between the two age cohorts except in regards to Asian ethnicity, hematological malignancies and having cancer for more than 2 years. As expected, the older population had more co-morbidities and polypharmacy. Despite this, the incidence of severe COVID-19 was similar regardless of age. Further analyses for other geriatric presentations are ongoing to understand their interaction with COVID-19 in the cancer population.

Factors affecting COVID-19 outcomes in cancer patients from Guy's Cancer Center and King's College Hospital

Background: The Coronavirus disease 2019 (COVID-19) pandemic continues to have a significant impact on the treatment of cancer patients. Understanding the clinical course, potential risk factors for severe infection and excess mortality, is essential to improve patient outcomes. We previously presented preliminary results from 156 SARS-CoV-2 positive cancer patients from Guy's Cancer Center, which suggested that increased COVID-19 mortality was associated with a diagnosis of cancer for over 2 years, Asian ethnicity and being on palliative treatment. Herein, we present an updated analysis using data from Guy's Cancer Centre and a partner Hospital Trust (King's College Hospital), with an increased number of patients and an extended follow up. Methods: We performed an analysis of all cancer patients who had a positive RT-PCR nasal/throat swab for SARS-CoV-2 infection at our Centers between 29th February and 31st July 2020. Associations between patients' demographics, clinical characteristics, and laboratory investigations with COVID-19 severity and mortality, were assessed using Logistic regression and Cox proportional hazards models. Results: 306 SARS-CoV-2 positive cancer patients were included in the analysis with a median follow up of 134 days (IQR 32-156). 184 (60%) were male and 217 (71%) were aged over 60 (mean age: 66). The most common malignancies were haematological (38%) and urological-gynaecological (20%). 218 (71%) had mild/moderate COVID-19 and 88 (29%) had severe disease. The overall COVID-related mortality rate was 24%;19% in solid and 32% in haematological cancers. Male sex [OR: 1.84 (95%CI:1.08-3.13)], Asian ethnicity [3.86 (1.20-12.36)], haematological cancer type [2.16 (1.18-3.95)], being diagnosed with cancer for 2-5 years [3.74 (1.80-7.78)] or ≥5 years [3.06 (1.50-6.26)] and a ferritin > 1964 mcg/l [54.92 (5.90-511.33)] were all associated with a risk of developing severe COVID-19 disease. Similarly, male sex [HR:1.97 (95%CI:1.15-3.38)], Asian ethnicity [3.42 (1. 59-7.35)], haematological cancer type [2.03 (1.16-3.56)] as well as a cancer diagnosis for >2-5 years [2.81 (1.41-5.59)] or ≥5 years [2.13 (1.06-4.27)] and a ferritin > 1964 mcg/l [16.11 (3.81-68.17)] were associated with an increased risk of death from COVID-19. Age >60 [2.14 (1.15-3.98)] and a raised CRP [4.10 (1.66-10.10)] were also associated with COVID-19 death. An inverse relationship was observed between a raised albumin and COVID-19 related death [0.12 (0.03- 0.51)]. Performance status and treatment paradigm were not associated with COVID-19 severity or mortality. Conclusions: This study further substantiates the evidence for an increased risk of severe COVID-19 infection and mortality for male and Asian patients with cancer, and those with haematological malignancies or with a diagnosis of cancer for over 2 years. These risk factors should be taken into account when making clinical decisions for cancer patients during the pandemic.

Presence of SARS-CoV-2 on the Surface of Fruits and Vegetables

There is no information about whether the SARS-CoV-2 virus is present on the surface of fruits and vegetables obtained from grocery stores. The goal of this study is to determine if SARS-CoV-2 was present on the surfaces of produce in grocery stores in the Philadelphia metropolitan area during the peak pandemic period. Produce from 10 stores was swabbed and then analyzed for the presence of the virus. Of the 140 fruits and vegetables tested, only one fruit sample contained SARS-CoV-2 on its surface. The results indicate that the spread of the virus through contact with produce is highly unlikely. © 2021 American Chemical Society

Persisting COVID-19 vaccination hesitancy in the South Bronx

Background. Minority groups have the lowest vaccination rates when compared to the overall population. We aim to study the attitudes and perceptions of COVID-19 vaccination, about six months after vaccine rollout in the South Bronx. Methods. Cross-sectional anonymized online survey evaluating knowledge, attitude and perception about COVID-19 vaccination using SurveyMonkey™ was conducted in South Bronx community from April - June 2021. Results. Of the 281 participants, 67% were Latinx and 16% were African American (AA);69% (195) were fully vaccinated (FV) and 31% (86) with vaccine hesitancy (VH). The common reasons for hesitancy were "concerns about side effects" (38%), "vaccine is not safe" (27%) and "vaccine was approved too fast" (26%) (p< .001). VH were more likely to rely online/mobile apps (30%) and friends and family (23%) as compared to FV. VH were more likely to be AA, younger age (< 35 yrs), high school or lower education, single, unemployed, without comorbidities, not current on other eligible vaccines, and did not believe "vaccine is necessary to end the pandemic." Majority of participants from both cohorts trusted their primary care providers. Mistrust with healthcare and pharmaceutical companies was higher in VH (p=0.009). Both groups preferred to continue wearing mask and practice social distancing despite vaccination status. Conclusion. Persisting vaccine hesitancy is concerning in minority communities. Identifying the target population and implementation of innovative methods to improve COVID-19 vaccination acceptance leveraging primary care providers would be a possible solution.

A Deep Multi-kernel Uniform Capsule Approach for Hate Speech Detection

Hate Speech is an expression that expresses hatred towards people of a specific ethnic group or nationality and incites hatred. Even though many countries have anti-hate speech legislation, hate speech can spread in the native language on social media platforms, resulting in violent riots and protests that spiral out of control and result in anti-social events. Hence, hate speech has caused a crucial social issue. Thus, various intelligent mechanisms have been employed to classify hate speech, depending on the category. A deep learning model has certain limitations for providing n-gram features for text classification of the native language. As a result, in this paper, the Multi-kernel uniform capsule network for multilingual languages is proposed. The proposed method employs a Multi-kernel uniform capsule network to improve feature selection performance by utilizing the capsule network routing algorithm. The experiments were carried out on political, COVID-19 and vaccination, lockdown, and multilingual dataset. The experimental results demonstrate that the proposed methods achieve adequate results when compared with other machine learning models for hate speech detection. © 2022, Springer Nature Switzerland AG.