Evaluation and Management of Dysphagia During the COVID-19 Pandemic

Dysphagia is a common symptom which requires a multidisciplinary approach to its assessment and management. Currently, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the novel coronavirus disease 2019 (COVID-19) pandemic. Reports of SARS-CoV-2 dissemination via droplet and aerosol production imply risks of virus transmission by both. The risk of transmission of SARS-CoV-2 during nasal endoscopic procedures has elicited concern from clinicians and other healthcare workers regarding the level of personal protective equipment required during any transnasal procedure. SARS-CoV-2 infection has a variety of clinical manifestations of which pneumonia is the most devastating and which may potentially be fatal. Complications after prolonged endotracheal intubation or tracheostomy are common and include dysphagia. Poor lung function following recovery from pneumonia is an underrated precipitating factor for dysphagia. Multiple cranial nerve neuropathies are a more common direct cause of dysphagia that require urgent evaluation and treatment to avoid the complications of aspiration pneumonia that may compound the existing pneumonia caused by SARS-CoV-2. A videofluoroscopic study of a patient with dysphagia after recovering from COVID-19 will likely demonstrate significant impairment of their oral and pharyngeal phase of swallowing. A practical workflow for assessing and managing dysphagia during the COVID-19 pandemic is crucial to ensure the safety of both patients and healthcare workers. Critical considerations include the reservation of instrumental assessments for urgent cases only, the optimization of the non-instrumental swallowing evaluation, the appropriate use of personal protective equipment (PPE), and the use of telemedicine when appropriate. Despite significant limitations in the clinical service provision during the current COVID-19 pandemic, a safe and reasonable dysphagia care pathway can still be implemented with an understanding of safety precautions, modifications of the investigation setup and with the application of newer technologies. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Negative ageism and compassionate ageism in news coverage of older people under COVID-19: how did the pandemic progression and public health responses associate with different news themes?

Previous studies have found negative ageing narratives in the media during the COVID-19 pandemic. However, few have focused on compassionate ageism and how the news responded to the progression of the COVID-19 pandemic. We investigated (a) media themes of negative and compassionate ageism and (b) their relationships with COVID-19 parameters and the public health response. The sample included 1,197 articles relevant to COVID-19 and older people in Hong Kong published between January and December 2020. We used thematic analysis to identify themes from the news articles and structural equation modelling to explore these themes' relationship with the number of older people infected, effective reproduction number, number of COVID-19 deaths and public health response parallel in time. Pandemic-related variables were lagged for a day - the time needed to be reflected in the news. Two negative ageism themes portrayed older people as vulnerable to COVID-19 but counterproductive in combating the pandemic. Two compassionate ageism themes depicted older people as a homogenous group of passive assistance recipients. The theme blaming older people was associated with the number of confirmed infections (beta = 0.418, p = 0.002) but vulnerability of older people was not associated with pandemic-related variables. The theme helping older people was negatively associated with the percentage of older people in confirmed infections (beta = -0.155, p = 0.019). The theme resources available was negatively associated with confirmed infections (beta = -0.342, p < 0.001) but positively associated with the Containment and Health Index (beta = 0.217, p = 0.005). Findings suggested that negative and compassionate ageism were translated into narratives about older people in the media as the pandemic evolved but did not address the actual risk they faced. Media professionals should be aware of the potential negative and compassionate ageism prompted by the news agenda and promote adequate health behaviours and responses.

Smart Maintenance and Human Factor Modeling for Aircraft Safety

The global pandemic has significantly accelerated the need for remote monitoring and diagnostics of airline operations and assets. As passenger and cargo flights are impacted from all directions, maintenance can be the steady, reliable part of the puzzle that helps get things back on track. This chapter explores the aircraft safety challenges that can be addressed with better maintenance technology and human factor modeling. Aircraft safety relies heavily on maintenance. During the COVID-19 recovery phase, airline operators need to focus on the application of a robust management of change process to implement better maintenance technology, identify new aircraft safety risks, determine effective mitigation measures, and implement strategies for deploying changes accordingly. For years aircraft maintenance routines have been carried out in the same manner without change, now with international travel restrictions, social distancing, reduced staff, and limited maintenance funding, the need for smarter ways of doing maintenance is obvious. In this regard smart technology has an important role to play. For instance, IoT data generates the capacity for predictive aircraft maintenance, AI introduces the capacity for smart, deep-learning machines to make predictive maintenance more accurate, actionable, and automatic. AI-enabled predictive maintenance leverages IoT data to predict and prevent aircraft failures. While smart technology enhances aircraft safety through better maintenance performance on the one hand, there are technical and human factor problems induced by COVID-19 on the other. The Safe Aircraft System (SAS) model, based on the Dirty Dozen and SHELL human factor models, is an initiative proposed to minimize such COVID-19 problems. This work shows through a case illustration that SAS modeling is a useful tool in identifying potential hazards/consequences associated with any major or minor changes in flight operations. Hence the synergistic effect of smart maintenance and the SAS model in enhancing aircraft system safety are demonstrated. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Technostress among academics in higher education during the COVID-19 pandemic

The adoption of new technologies has revolutionized teaching and learning in higher education institutions (HEIs) in the last few decades, particularly during the recent pandemic crisis. Although the adoption of technology affords many benefits and conveniences to educators and students, increasing evidence has highlighted the escalating stressors connected to the adoption of technologies in and beyond classrooms for academics. This phenomenon is also coined as technostress, which refers to a "disease of adaptation" caused by an individual's failure to cope with technological change in a healthy way. The struggle to adapt to technological changes can directly or indirectly impact academics' physical health, mental and psychological well-being, and job performance. Therefore, this chapter aims to 1) understand what is technostress, (2) identify sources of technostress, (3) examine technostress in higher education (HE), and (4) highlight strategies to mitigate technostress. © 2023, IGI Global.

Learning engagement activities in promoting student interactions and perceived online learning experience during the COVID-19 pandemic

This chapter explores the use of different synchronous and asynchronous learning engagement support activities to promote student interactions (student-student interaction;student-instructor interaction;and student-content interaction) and provide a better learning experience in an online classroom. These activities included live consultations, online discussion forums, and online formative follow-up quizzes. The findings in this chapter revealed that a well-designed and carefully crafted online course with different types of support activities using different platforms, perhaps will create a holistic environment in which the students can excel as if they are taking the course in a face-to-face classroom. The learning engagement activities that promote students' interactions are important to ensure students have a satisfying and positive online learning experience. © 2023, IGI Global. All rights reserved.

Association of Molnupiravir and Nirmatrelvir-Ritonavir with preventable mortality, hospital admissions and related avoidable healthcare system cost among high-risk patients with mild to moderate COVID-19

Background Real-world data is currently limited on the association between oral antiviral therapy and healthcare system burden in patients with mild-to-moderate COVID-19. This study aims to evaluate the clinical and cost effec-tiveness of Molnupiravir and Nirmatrelvir-ritonavir use in reducing mortality in this population. Methods This is a retrospective cohort study involving 54,355 COVID-19 patients during February 22-March 31,2022 in Hong Kong. Inverse probability of treatment weighting (IPTW) was used to adjust patient characteristics. Our exposure of interest was Molnupiravir/Nirmatrelvir-Ritonavir prescription, with all-cause mortality as the pri-mary outcome. IPTW-adjusted multivariate regressions were used to estimate treatment impact on clinic re -atten-dance and unplanned admissions. Finally, attributed cost and incremental cost-effectiveness ratios (ICER) were estimated. Findings In the outpatient cohort (N = 33,217, 61.1%), 16.1% used Molnupiravir and 13.4% used Nirmatrelvir-Ritona-vir, while in the inpatient cohort (N = 21,138, 38.9%), 3.8% used Molnupiravir and 1.3% used Nirmatrelvir-Ritonavir. IPTW-adjusted Cox model estimated that Molnupiravir (hazard ratio (HR)(95%CI)=0.31 (0.24-0.40), P< 0.0001) and Nirmatrelvir-Ritonavir (HR=0.10 (95%CI 0.05-0.21), P< 0.0001) were significantly associated with a reduced mortality hazard. In the outpatient cohort, both antiviral prescriptions were associated with reduced odds for unplanned hospital admissions (Molnupiravir: odds ratio (OR) =0.72 (0.52-0.98), P=0.039;Nirmatrelvir-Ritonavir: OR=0.37 (0.23-0.60), P<0.0001). Among hospitalised patients, both antiviral prescriptions were associated with sig-nificant reductions in the odds ratios for 28-days readmission (Molnupiravir: OR=0.71 (0.52-0.97), P=0.031;Nirma-trelvir-Ritonavir: OR=0.47 (0.24-0.93), P=0.030). ICERs for death averted for Molnupiravir stood at USD493,345.09 in outpatient settings and USD2,629.08 in inpatient settings. In outpatient settings, Nirmatrelvir-ritonavir cost USD331,105.27 to avert one death, but saved USD5,502.53 to avert one death in comparison with standard care. Interpretation In high-risk patients in Hong Kong with mild-to-moderate COVID-19, Molnupiravir and Nirmatrel-vir-Ritonavir prescriptions were associated with reduced all-cause mortality and significant cost savings.

ASSOCIATIONS BETWEEN COVID-19 RELATED STRESS, COVID-19 EXPERIENCES, AND MENTAL HEALTH RISKS IN OLDER PEOPLE

There is increasing recognition of the need to understand the mechanism of psychological impact brought by COVID-19. The present research used the Delphi technique to develop a COVID-19-Related Stress Scale for older people in Hong Kong (CSS-old) (study one) and examined its associations with COVID-19 experiences and mental health risks (study two). In study one, 17 helping professionals and 20 service users co-developed an 8-item CSS-old through four rounds of Delphi. In study two, a cross-sectional telephone survey was conducted between April and June 2022 among 4,921 older people (age≥60) recruited through community centres. Respondents were assessed using Patient Health Questionnaire-2 (PHQ-2), Generalized Anxiety Disorder 2-item (GAD-2), and CSS-old;their experiences with COVID-19 (infection, close friend/family infection) and demographical information were collected. A three-factor solution of CSS-old was identified after dropping one item (X2(df) = 83.53(11), CFI=0.996, TLI=0.993, RMSEA=0.037): (1) disruption to routines;(2) fear of infecting families/friends;and (3) concern for the community's health. Structural equation modelling analyses revealed that being female (B=0.45), having close friend/family infected (B=1.10) and having a pre-existing mental health condition (B=1.87) were positively associated with COVID-19-related stress. Infection of COVID-19 (BPHQ=0.22;BGAD=0.24) and a pre-existing mental health condition (BPHQ=0.71;BGAD=0.59) had direct associations with depressive and anxiety symptoms;COVID-19-related stress mediated the relationship between close friend/family infection with depressive (B=0.20) and anxiety symptoms (B=0.21, all p < 0.05). These results suggest that older people's COVID-19-related stress is beyond infection of the disease, and different experiences with COVID-19 may increase depression and anxiety risks through different pathways.

Outcomes of Kidney Transplant Recipients in Singapore With COVID-19 Infection With Delta and Omicron Variants

Background: Kidney transplant recipients (KTR) are at higher risk for breakthrough COVID-19 infections and progression to severe disease. Herein, we compare the outcomes of KTR infected with the Delta and Omicron variants. Method(s): We performed a retrospective, single-centre study of all SARS-CoV-2-infected KTR confirmed by PCR from 17/09/21 to 30/04/22. At diagnosis, anti-metabolite doses were halved with further reductions of immunosuppression with increasing disease severity. Treatment for KTR not requiring supplemental oxygen (SuppO2) on admission was guided by SARS-CoV-2 spike antibody (SpAb), Roche Cobas SARSCoV-2-S assay. Sotrovimab 500mg IV was given if SpAb<100 U/mL. With community emergence of Omicron subvariant BA.2, sotrovimab was replaced by tixagevimab/ cilgavimab (EVUSHELDTM) 600mg IM in KTR with SpAb<250 U/mL or remdesivir if SpAb>250 U/mL. KTR with SuppO2 were treated with dexamethasone +/-remdesivir and immunomodulator therapy (baricitinib or tocilizumab). Characteristics and outcomes between KTR with Delta and Omicron were compared. Result(s): Clinical characteristics and outcomes are summarized in Table 1. Baseline demographics were similar between groups. Vaccination rates increased over time in concert with government vaccine programs and communications by our team. KTR with Omicron had higher vaccination rates, higher likelihood of SpAb>250 U/mL, and were less likely to have AKI, SuppO2, ICU stay, and mortality (p<0.05 for all). Of 16 KTR with Omicron with SuppO2, 5 were unvaccinated and only 1/16 had SpAb>250 u/mL. Conclusion(s): Severe disease was less frequent in KTR with Omicron likely due to improved vaccination rates, higher SpAb, and virus characteristics. However, KTR remain at risk for severe disease especially if unvaccinated or if SpAb is low.

A Techno-Economic Study of Industry 5.0 Enterprise Deployments for Human-to-Machine Communications

Ongoing disruptions from the persistence of Covid-19 are providing a strong impetus for deploying Industry 5.0. With a focus on the collaboration between geographically separated humans and machines, Industry 5.0 is envisioned to boost productivity and efficiency on the factory floor and engage with customers from afar. Collaborative robots (cobots) will be extensions of the human body through being controlled in real-time and from a distance. Early rollouts of Industry 5.0 are expected to be cost-sensitive private enterprise networks that support interand intra-plant human-to-machine (H2M) communications. This article explores the cost-efficiency of six existing and evolutionary enterprise network architectures to meet the future demands of Industry 5.0 and presents the first comprehensive techno-economic study balancing Industry 5.0 requirements and cost. Results highlight that the emerging time and wavelength division multiplexed passive optical local area network (TWDM-POL) and TWDM-POL allied with wireless local area network technology, are compelling enterprise architectures for Industry 5.0 deployment as they yield noteworthy cost savings when considering scalability and mobility, respectively. IEEE

Knowledge in Dealing with The COVID-19 Based On The Guidance of Al-Quran and Al-Sunnah: A Cross-Sectional Survey Among The Pharmacy and Health Sciences Diploma Students in Malaysia

INTRODUCTION: Medicine and communicable disease control are embedded in many Islamic teachings as conveyed by the Prophet Muhammad (PBUH) through the Al-Quran, Al-sunnah, and Al-hadith more than 1400 years ago. Therefore, when the COVID-19 outbreak hit Malaysia, with the majority of the population being Muslims, the society should have been equipped with knowledge in dealing with this pandemic. This study investigates the knowledge towards dealing with COVID-19 based on the guidance of Al-Quran and Al- Sunnah of Prophet Muhammad (PBUH) among undergraduate students in Malaysia. MATERIALS AND METHODS: A cross-sectional study using self-constructed questionnaires was performed. The questionnaires were pre-validated and distributed to pharmacy and health sciences students via an online survey platform. One of the selection criteria was that the respondent must be a Muslim. RESULTS: The students scored a median of 26 (IQR 4) in the knowledge test. Students' percentage knowledge levels were divided into three categories: poor (n = 42, 15%);moderate (n = 207, 73%) and good (n = 33, 12%). The lowest scored knowledge item was observed on the Islamic terminology, Maqasid Shariah (4.3%), and differences between hadith and sunnah (20.9%). No significant differences in knowledge scores were observed in the pre-determined independent variables such as age, year of study, accommodation, and previous religious school admission. CONCLUSION: The study findings suggest that the students have a good understanding of scientific aspects of COVID-19 but lack knowledge in handling the pandemic as recommended by Al-Quran and Al-Sunnah. [ FROM AUTHOR] Copyright of IIUM Medical Journal Malaysia is the property of International Islamic University Malaysia, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Impact of Immunosuppression on T-cell Responses After mRNABased Sars-CoV-2 Vaccination

Purpose: Administration of mRNA-based SARS-CoV-2 vaccines confers protection from SARS-CoV-2 infection and reduces its severity in the general population. It has been suggested that mounting a coordinated adaptive immune response characterized by production of neutralizing antibodies and SARS-CoV-2 spike proteinspecific T-cells correlates with protection from infection. Studies in organ transplant recipients have demonstrated suboptimal responses after 2 doses of SARS-CoV-2 vaccination;however, the impact of different immunosuppressive regimens (IS) on T-cell responses is not well described. This study prospectively evaluated the impact of IS on T-cell responses in a kidney transplant (KTx) population and compared these to 26 healthy controls. Method(s): In this single-centre, prospective study, 92 KTx on follow-up at our centre were enrolled after informed consent. T-cell responses were evaluated before and after each of 2 doses of BNT162b2 SARS-CoV-2 vaccine administered 21 days apart: before each dose, 10-14 days after Dose1 and 21-24 days after Dose2. The study population included 69.6% Live-Donor and 30.4% Deceased-Donor KTx. Longitudinal assessment of the quantity of spike-specific T-cells was performed by stimulating whole blood with peptides covering the SARS-CoV-2 spike protein, followed by cytokine (IFN-gamma, IL-2) measurement (JCI, Tan et al, 2021). KTx were stratified by maintenance IS into 4 groups and T-cell responses compared between groups. Result(s): As shown (Figures 1A, 1B), in comparison to healthy controls, KTx displayed poor spike-specific T-cell responses as measured by IFN-gamma and IL-2 release. Percent responders were significantly lower for KTx vs. healthy controls: 6.5% vs. 92.3% after Dose1 (P<0.00001) and 27.2% vs. 100% after Dose2 respectively. There was a significant impact of different IS regimens (Figure 1C);percent responders after Dose2 were 19%, 43%, 40% and 71% for KTx receiving CNI-MPA-Pred, CNI-Aza-Pred, mTORi and Other regimens respectively (P=0.013). Conclusion(s): Our results highlight the critical role of IS on T-cell responses to SARS-CoV-2 vaccination. In the context of the COVID-19 pandemic, monitoring T-cell and antibody responses over time after vaccination, modulating IS and modifying vaccination strategies are clearly needed to protect this vulnerable population.

Adverse Renal Events After BNT162b2 Pfizer/BioNTech COVID-19 Vaccine in Kidney Transplant Recipients

Purpose: Adverse events of a novel mRNA vaccine are not well described in Kidney Transplant Recipients(KTR), especially the risk of immune activation or recurrent glomerulonephritis(GN), which has been described in native GN after COVID-19 vaccines. Method(s): In this single-center prospective study, 147 KTR were enrolled after informed consent and administered 2 doses of Pfizer/BioNTech vaccine 21 days apart. Follow-up was 3 weeks after Dose2. Result(s): Mean age of KTR was 51 years;55.1% male;65.3% Chinese, 19% Malay, 11.6% Indian;69.5% Living donor, 29.9% Deceased donor, 0.7% Pancreas-kidney transplants;71.5% had biopsy-proven or presumptive chronic GN(CGN), 12.9% diabetic nephropathy, 15.6% other causes. 11(7.5%) KTR had delayed Dose2 administered at median 29 days(range 24-93) after Dose1. 7(4.8%)were delayed due to renal events: rise in creatinine(n=3), or proteinuria(n=2), or both creatinine and proteinuria with allograft biopsy showing acute T-cell and antibody-mediated rejection(n=1), new BK viraemia(n=1). Other reasons were possible anaphylaxis(n=1), intercurrent infection(n=2), and inability to attend due to quarantine(n=1). 27 KTR had new microhaematuria(MH) after Dose1;9 persisted after Dose2. Additional 18 had new MH after Dose2. Of 45 KTR with new MH, 7 had underlying IgAN, 5 had other biopsy-proven-CGN and 22 had presumed CGN, suggesting 34/45 with possible immune activation. 12 KTR had new onset proteinuria (rise in urine protein:creatinine ratio (UPCR) <=30 to >30mg/mmol);5/7 who developed a rise after Dose1 remained elevated;additional 5 had a rise after Dose2. 7 KTR had rise in proteinuria from UPCR <=100 to >100mg/mmol. Conclusion(s): Subclinical changes in allograft monitoring parameters are frequent after COVID-19 mRNA vaccines with up to 40.1% of KTRs showing rises in creatinine, proteinuria or new MH. Although overt recurrent GN and acute rejection are infrequent, high vigilance and monitoring for these occurrences should be undertaken in KTRs receiving mRNA vaccines.

Outcomes of Kidney Transplant Recipients with Covid-19 in Singapore Treated with Sotrovimab in the Era of the Delta Variant

Purpose: Kidney transplant recipients (KTRs) are at higher risk for severe COVID- 19 caused by the severe acute respiratory syndrome coronavirus-2 (SARS646 All Infections (Excluding Kidney & Viral Hepatitis) I CoV-2). Sotrovimab decreases the risk of disease progression in the general population, but efficacy and safety in KTRs is unknown. Herein, we describe our experience in treating COVID-19 infected KTRs with sotrovimab. Method(s): We performed a retrospective, single-center cohort study of KTRs diagnosed with COVID-19 by polymerase chain reaction from 07/15/21-11/30/21. KTRs with COVID-19 were admitted to the hospital to expedite evaluation and treatment. KTRs with COVID-19 were eligible for sotrovimab if they 1) were not requiring oxygen at admission, 2) were unvaccinated or if SARS-CoV-2 spike antibody (SAb) after vaccination was <100 U/mL, and 3) duration of symptoms/day of illness (DOI) was <=7 days. COVID-19 disease requiring oxygen therapy was treated with remdesevir + dexamethasone. Immunomodulator therapy (baricitinib or tocilizimab) was given for rapidly progressive disease requiring high-flow oxygen or ICU care. Baseline characteristics, treatments, and outcomes including oxygen supplementation, ICU admission, and mortality were manually ed and evaluated. Result(s): In all, 36 KTRs were diagnosed with COVID-19 - mean age 59 years, 72% male, 67% Chinese, 64% diabetic and 17% obese;72% were deceased donor and 28% were living donor KTRs presenting a mean 11 years from transplant. The majority (69%) were vaccinated with >=2 doses of mRNA-based SARS-CoV-2 vaccines, 22% received 3 doses, and 15% were unvaccinated. Among KTRs who received >=2 doses, SAb was reactive in 36% and >100 U/mL in 16%. In all, 14 (39%) required oxygen, 11 (31%) required ICU admission, 5 (14%) were mechanically ventilated, and 4 (11%) died (Table). Sotrovimab was given to 27 eligible KTRs at median DOI 2 (range 0-6). Of these, 8 (30%) required oxygen, 5 (19%) required ICU admission, 2 (7%) were mechanically ventilated, and 1 died (4%). KTRs receiving sotrovimab at DOI <=3 vs >3 were less likely to require oxygen (p=0.01) or ICU admission (p=0.02). Sotrovimab was well tolerated with one associated adverse event (self-limiting diarrhea). Conclusion(s): KTRs remain at high risk for severe COVID-19. Sotrovimab administered early in the disease course is associated with a lower rate of severe COVID-19. Outcomes of KTRs with COVID-19 overall and among those receiving sotrovimab by day of illness (Figure Presented).

The Reduced Environmental Impact of American Radium Society's 2021 Virtual Annual Meeting

Background: In response to the threat of the COVID-19 pandemic, the 2021 American Radium Society (ARS) Annual Meeting transitioned to a virtual, online conference. As medical conferences around the world have transitioned to virtual formats, numerous benefits have been uncovered;however, the environmental effect of reduced travel on carbon emissions remains largely unknown. Today, it is estimated that conference attendance accounts for 35% of a scientist's total carbon footprint [1]. Given that the climate crisis is a growing threat to human health and oncology outcomes [2], it is imperative to begin to quantify, understand, and promote sustainable practices. Objective(s): We aim to highlight the reduced travel-related greenhouse emissions associated with the transition of ARS's 2021 Annual Meeting to a virtual platform in comparison to the 2019 in-person conference in Monarch Beach, California. Method(s): Data from the attendees of the ARS Annual Meeting was collected from 2019 and 2021 (the conference was cancelled in 2020). The distance traveled per attendee to the 2019 location (Dana Point, CA) and the 2021 intended conference location (Lahaina, HI) was estimated using the location of the attendees' home institutions. The mode of transportation was hypothesized based on distance traveled (automobiles < 300 miles;airline >= 300 miles). Approximate carbon dioxide (CO2) emissions were calculated using the Environmental Protection Agency's Greenhouse Gas Tools [3,4]. For the 2021 virtual conference, it was assumed that no travel took place. Alternatively, the associated CO2 emissions were estimated based on assumed internet usage (8 hours/day for the 3-day conference period) and food delivery (5 miles) for one meal which was sent free to each attendee. Additionally, the distance that would have been traveled by attendees to Hawaii was estimated. Result(s): A total of 591 conference attendees were identified, 253 in 2019 and 338 in 2021. For the 2019 in-person conference, the total carbon footprint for all assumed methods of transportation was determined to be 187,935.9 lbs of CO2 emissions, with an average of 820.7 lbs of CO2 emissions per attendee. Total emissions were equivalent to the emissions of 18.5 passenger vehicles for one year. Alternatively, the CO2 emissions spared during the 2021 virtual conference was estimated to be 519,153.5 lbs, the equivalent of 51 passenger vehicles for one year. However, emissions related to teleconference internet streaming and food delivery accounted for a total of 2,693.0 and 1535.8 lbs of CO2. Conclusion(s): Incorporating options for virtual attendance at academic conferences has the potential to significantly reduce carbon emissions. However, many believe that virtual networking cannot replace in-person interactions particularly for early-career attendees. Regardless, our professional societies have an obligation to investigate and promote greater sustainability of our annual meetings.

CLOSE-TO-EFFORTLESS BREATHING PARADIGM MAPS GLOBAL AND REGIONAL LUNG FUNCTION USING ELECTRICAL IMPEDANCE TOMOGRAPHY CROSS SECTIONALLY AND LONGITUDINALLY

SESSION TITLE: Late Breaking Investigations From Pulmonary and Critical Care SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Although spirometry is the standard lung functional test, it requires the patient to perform a series of maneuvers correctly, which is difficult for elderly, children, and patients with severe lung impairments. Furthermore, spirometry lacks regional assessment for detecting and monitoring subtle changes in lung diseases, e.g., chronic obstructive pulmonary disease (COPD) and potentially COVID-19. We aim to establish a home-based imaging system, portable electrical impedance tomography (EIT), that can detect lung function deterioration and monitor its recovery through a close-to-effortless breathing paradigm. METHODS: We developed a palm-sized EIT system and a novel guided breathing paradigm that consists of a periodic inhalation and exhalation at 12 breaths per minute. We validated them on healthy subjects (n=23) performing different breathing efforts (deep vs shallow), then on patients with ILD (n=2), COPD (n=8), asthma (n=4) and bronchiectasis (n=4) against healthy (n=8) cross-sectionally, and last monitored a COVID-19 discharged subject with two age- and gender-matched healthy controls longitudinally. We further applied machine learning to distinguish between healthy and patients, and calculated its sensitivity and specificity. RESULTS: We detected higher amplitude during deep breathing compared to shallow (p < 0.001) in healthy subjects, with right lung having more activated voxels and higher total amplitude than the left lung (p < 0.001), likely due to the position of the heart. Cross-sectionally, we observed lower amplitude in patients compared to healthy (p < 0.01), while coefficient of variation (CV) of the amplitude in the lungs is higher in patients (p < 0.05). Note that CV is a parameter reflecting inhomogeneity which is indicative of lung function deterioration. Longitudinally, the COVID-19 discharged subject had higher CV in the left lung (p < 0.001) which decreased across time (p < 0.01), suggesting a functional deterioration at the beginning followed by a recovery. Regional analysis further pin-pointed the potential deterioration and recovery was in the anterior left lung. Separately, despite the small sample size, the sensitivity and specificity for detecting patients using a machine learning classifier were 76% and 62%, respectively, and will likely increase with a larger sample. CONCLUSIONS: Home-based portable EIT with close-to-effortless guided breathing paradigm can map global and regional lung function deterioration and recovery cross-sectionally and longitudinally. More importantly, it can potentially be deployed as a screening tool for various lung diseases through the application of machine learning. CLINICAL IMPLICATIONS: Portable EIT with guided breathing paradigm enables lung function diagnostic screening and treatment monitoring at home, advancing telemedicine and lowering hospital burden. DISCLOSURES: no disclosure on file for Peng Cao;Owner/Founder relationship with Gense Technologies Ltd Please note: Since 2017 Added 06/06/2022 by Russell Chan, value=Ownership interest No relevant relationships by Wang Chun Kwok No relevant relationships by Wei-Ning Lee No relevant relationships by Terence Tam Employee relationship with Gense Technologies Please note: Setpember 2021 - Now Added 06/07/2022 by Adrien Touboul, value=Salary contractor relationship with Gense Technologies Ltd Please note: since Apr 2021 Added 06/06/2022 by Eddie Wong, value=Consulting fee Employee relationship with Gense Technologies Please note: since 2020 Added 06/06/2022 by Fedi Zouari, value=Royalty

The association of typical and atypical symptoms with in-hospital mortality in older adults with COVID-19: a multicentre cohort study

Atypical disease presentations are common in older adults with COVID-19. The objective of this study was to determine the prevalence of atypical and typical symptoms in older adults with COVID-19 through progressive pandemic waves and the association of these symptoms with in -hospital mortality. This retrospective cohort study included consecutive adults aged over 65 years with confirmed COVID-19 infection who were admitted to seven hospitals in Toronto, Canada, from 1 March 2020 to 30 June 2021. The median age for the 1786 patients was 78.0 years and 847 (47.5%) were female. Atypical symptoms (as defined by geriatric syndromes) occurred in 1187 patients (66.5%), but rarely occurred in the absence of other symptoms (n = 106;6.2%). The most common atypical symptoms were anorexia (n = 598;33.5%), weakness (n = 519;2 3.9%), and delirium (n = 449;25.1%). Dyspnea (adjusted odds ratio [aOR] 2.05;95% confidence interval [CI] 1.62-2.62), tachycardia (aOR 1.87;95% CI 1.14-3.04), and delirium (aOR 1.52;95% CI 1.18-1.96) were inde-pendently associated with in-hospital mortality. In a cohort of older adults hospitalized with COVID-19 infection, atypical presentations frequently overlapped with typical symptoms. Further research should be directed at understanding the cause and clinical significance of atypical presenta-tions in older adults.

The reduced environmental impact of American society of Clinical Oncology's 2021 virtual annual meeting

Background: In response to the threat of the COVID-19 pandemic, the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting transitioned to a virtual, online conference. As medical conferences around the world have transitioned to virtual formats, numerous benefits have been uncovered;however, the environmental effect of reduced travel on carbon emissions remains largely unknown. Today, it is estimated that conference attendance accounts for 35% of a scientist's total carbon footprint. Given that the climate crisis is a growing threat to human health and oncology outcomes, it is imperative to begin to quantify, understand, and promote sustainable practices. We aim to highlight the reduced travel-related greenhouse emissions associated with the transition of ASCO's 2021 Annual Meeting to a virtual platform in comparison to a hypothetical in-person conference. Methods: Attendee demographic data was collected online from the ASCO 2021 Annual Meeting. The distance traveled per attendee to a hypothetical in-person conference in Chicago, Illinois (the location for the 2022 Annual Meeting) was estimated using reported attendees' home country and a hypothesized centralized location. Approximate airline miles and associated carbon dioxide (CO2) emissions were calculated using the Environmental Protection Agency's Greenhouse Gas Tools. It was assumed that all attendees had non-stop airfare and traveled in economy class. The approximate CO2 emissions for the virtual conference was estimated based on assumed internet usage (8 hours/day for the 5-day conference period). Results: A total of 32,950 conference attendees were identified - 14,150 domestic attendees and 16,050 international attendees. For the hypothesized in-person conference, the total carbon footprint for all assumed transportation was determined to be 28,468,031.25 lbs. of CO2 emissions, with an average of 863.0 lbs. of CO2 emissions per attendee. Alternatively, emissions related to virtual conference internet streaming accounted for a total of 436,258 lbs of CO2. Total emissions spared with the transition to a virtual platform was an estimated 28,031,773.25 lbs of CO2., the equivalent emissions of 1,531 U.S. homes' energy use for one year. Conclusions: Incorporating options for virtual attendance at academic conferences has the potential to significantly reduce carbon emissions. However, many believe that virtual networking cannot replace in-person interactions particularly for early-career attendees. Regardless, our professional societies have an obligation to investigate and promote greater sustainability of our annual meetings.