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2.
Journal of Thoracic Oncology ; 17(9):S178, 2022.
Article in English | EMBASE | ID: covidwho-2031512

ABSTRACT

Introduction: Largely as a result of the COVID pandemic, our lung cancer screening (LCS) program was underperforming entering 2021. The program serves a majority minority, socio-economically disadvantaged community. Loss of personnel and reallocated resources, allied to pandemic focus, led to decreased referrals and excessive time from referral to low dose computed tomography (LDCT) appointments. Here we describe our programmatic approach to improve LCS metrics. Methods: LCS transitioned from a Department of Radiology program into a Cancer Center-administered collaborative effort under surgical oncology and radiology leadership. Outreach efforts were reinitiated. To facilitate referrals from our primary care network, the cancer service line created a practical guide, “6 Steps to Lung Cancer Screening”, directly linked to an e-referral mechanism in our EMR. Monthly review and quality assurance meetings were held with a multidisciplinary team, specifically focused on program volume and on addressing delays to LDCT appointments. An additional Nurse Practitioner was brought in to enhance the existing LCS Nurse Navigator and Cancer Center staff were utilized to contact and schedule patients and to perform data compilation and analysis. Results: In 2020, LCS referrals had decreased 13% from 2019. In Q1/2021, the median monthly number of LCS referrals was 132 which increased steadily by quarter to 218 in Q4/2021 (p=0.16, Figure 1A). In January 2021, the average time from LCS referral to LDCT appointment was 101 days. Despite the increasing number of referrals through 2021, we were able to decrease the time to appointment from a median of 86 days in Q1/2021 to a median of 29 days in Q4/2021 (p=0.02, Figure 1B). By December 2021, the average time from LCS referral to LDCT appointment was just 18 days. Our LCS referral population was predominantly non-white (76%). Among them, 7.4% of patients with LDCT scans were found to have Lung RADS 3 or 4 nodules. All of these patients were referred to a newly created high-risk lung nodule clinic for management and follow up. Conclusions: We employed a multidisciplinary team approach to improve inefficiencies in our LCS program. The resources, support, and leadership of the health care system’s Cancer Center were crucial to this multi-pronged initiative. The decreased time from LCS referral to LDCT facilitates our ability to handle the anticipated growth in referral volume. This has been shown to enhance engagement with LCS and to improved annual screening compliance, translating to earlier detection of lung cancer and to improved patient outcomes. [Formula presented] Keywords: Lung cancer screening, Adherence, Disparity

3.
Pediatric Infectious Disease Journal ; 12:12, 2022.
Article in English | MEDLINE | ID: covidwho-2029120

ABSTRACT

BACKGROUND: SARS-CoV-2 variations as well as immune protection after previous infections and/or vaccination may have altered the incidence of multisystemic inflammatory syndrome in children (MIS-C). We aimed to report an international time-series analysis of the incidence of MIS-C to determine if there was a shift in the regions or countries included into the study. METHODS: This is a multicenter, international, cross-sectional study. We collected the MIS-C incidence from the participant regions and countries for the period July 2020 to November 2021. We assessed the ratio between MIS-C cases and COVID-19 pediatric cases in children <18 years diagnosed 4 weeks earlier (average time for the temporal association observed in this disease) for the study period. We performed a binomial regression analysis for 8 participating sites [Bogota (Colombia), Chile, Costa Rica, Lazio (Italy), Mexico DF, Panama, The Netherlands and Catalonia (Spain)]. RESULTS: We included 904 cases of MIS-C, among a reference population of 17,906,432 children. We estimated a global significant decrease trend ratio in MIS-C cases/COVID-19 diagnosed cases in the previous month (P < 0.001). When analyzing separately each of the sites, Chile and The Netherlands maintained a significant decrease trend (P < 0.001), but this ratio was not statistically significant for the rest of sites. CONCLUSIONS: To our knowledge, this is the first international study describing a global reduction in the trend of the MIS-C incidence during the pandemic. COVID-19 vaccination and other factors possibly linked to the virus itself and/or community transmission may have played a role in preventing new MIS-C cases.

8.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2005653

ABSTRACT

Background: Inflammation and neutrophils play a central role in severe Covid-19 disease. In previous data, we showed that the FLARE score, combining both tumor and Covid-19-induced proinflammatory status (proinflamstatus), predicts early mortality in cancer patients (pts) with Covid-19 infection. We aimed to assess the impact of this score in a larger cohort and characterize the immunophenotype (IF) of circulating neutrophils. Methods: Multicenter retrospective cohort (RC) of pts with cancer and Covid-19 infection across 14 international centers. Circulating inflammatory markers were collected at two timepoints: baseline (-15 to -45d before Covid-19 diagnosis) and Covid-19 diagnosis. Tumor-induced proinflam-status was defined by high dNLR (neutrophils/(leucocytes-neutrophils)> 3) at baseline. Covid-19-induced proinflam-status was defined by +100% increase of dNLR between both timepoints. We built the FLARE score combining both Tumor and Infection-induced inflammation: T+/I+ (poor), if both proinflam-status;T+/I- (T-only), if inflammation only due to tumor;T-/I+ (I-only), if inflammation only due to Covid;T-/I- (favorable), if no proinflam-status. The IF of circulating neutrophils by flow cytometry was determined in a unicenter prospective cohort (PC) of pts with cancer during Covid-19 infection and in healthy volunteers (HV). Primary endpoint was 30-day mortality. Results: 524 pts were enrolled in the RC with a median follow- up of 84d (95%CI 78-90). Median age was 69 (range 35-98), 52% were male and 78% had baseline PS <1.Thoracic cancers were the most common (26%). 70% had active disease, 51% advanced stage and 57% were under systemic therapy. dNLR was high in 25% at baseline vs 55% at Covid-19 diagnosis. The median dNLR increase between both timepoints was +70% (IQR: 0-349%);42% had +100% increase of dNLR. Pts distribution and mortality across FLARE groups is resumed in the Table. Overall mortality rate was 26%. In multivariate analysis, including gender, stage and PS, the FLARE poor group was independently associated with 30-day mortality [OR 5.27;1.37-20.3]. 44 pts were enrolled in the PC. Median circulating neutrophils were higher in pts with cancer (n=10, 56.7% [IQR: 39-78.4%]) vs HV (n=6, 35.8% [IQR: 25.6-21%]), and particularly higher in pts with cancer and severe Covid-19 infection (n=7, 88.6% [IQR: 80.9-94%] (p=0.003). A more comprehensive characterization of the IF of circulating neutrophils, including Lox1/CD62/CD64, will be presented at ASCO. Conclusions: The FLARE score, combining tumor and Covid-19-induced proinflam-status, can identify the population at higher risk for mortality. A better characterization of circulating neutrophils may help improve the prediction of Covid-19 outcomes in pts with cancer. (Table Presented).

9.
Immunity ; 2022.
Article in English | PubMed | ID: covidwho-2000465

ABSTRACT

Vaccines generate high-affinity antibodies by recruiting antigen-specific B cells to germinal centers (GCs), but the mechanisms governing the recruitment to GCs on secondary challenges remain unclear. Here, using preclinical SARS-CoV and HIV mouse models, we demonstrated that the antibodies elicited during primary humoral responses shaped the naive B cell recruitment to GCs during secondary exposures. The antibodies from primary responses could either enhance or, conversely, restrict the GC participation of naive B cells: broad-binding, low-affinity, and low-titer antibodies enhanced recruitment, whereas, by contrast, the high titers of high-affinity, mono-epitope-specific antibodies attenuated cognate naive B cell recruitment. Thus, the directionality and intensity of that effect was determined by antibody concentration, affinity, and epitope specificity. Circulating antibodies can, therefore, be important determinants of antigen immunogenicity. Future vaccines may need to overcome-or could, alternatively, leverage-the effects of circulating primary antibodies on subsequent naive B cell recruitment.

11.
17th Iberian Conference on Information Systems and Technologies, CISTI 2022 ; 2022-June, 2022.
Article in Spanish | Scopus | ID: covidwho-1975668

ABSTRACT

In the context of the Covid-19 pandemic, the teaching-learning process moved to a virtual modality, experiencing changes in teacher-student interaction, for which it was necessary to use technological tools, such as YouTube and Zoom, the which became the most used due to their accessibility and diversity of collaborative functionalities. The objective of this work was to determine the application of the technological tools YouTube and Zoom, as interactive resources in the development of the teaching-learning process of a primary institution in Ecuador. For this, a case study is presented, where a quantitative methodology was applied, with a descriptive-correlational type of study, considering the total population of fifth grade students to whom a previously structured survey and interviews with teachers were applied. In this context, it is concluded based on the results that the use of YouTube and Zoom contribute significantly to the teaching-learning process, however, little knowledge is reflected in the teachers regarding the use of its functionalities, which compromises the adequate development of the apprenticeships. © 2022 IEEE Computer Society. All rights reserved.

12.
Gastroenterology ; 162(7):S-1006, 2022.
Article in English | EMBASE | ID: covidwho-1967393

ABSTRACT

Introduction: Pivotal anti-SARS-CoV-2 vaccines clinical trials did not include patients with immune-mediated conditions such as inflammatory bowel disease (IBD). We aimed to describe the implementation of anti-SARS-CoV-2 vaccines among IBD patients, patients' concerns before vaccination and side-effect profile of the anti-SARS-CoV-2 vaccines using real-world data. Methods: An anonymous web-based self-completed survey was distributed in 36 European countries between June and July 2021. The results of patients' characteristics, concerns, vaccination status and side-effect profile were analysed using descriptive statistics and logistic regression. Results: Among the 3272 IBD patients completing the survey (0.1% of the IBD European population), 79.6% had received at least one dose of anti-SARS-CoV- 2 vaccine, and 71.7% had completed the vaccination process. Most of the patients (70.6%) were vaccinated with the Pfizer-BioNTech (BNT162b2) vaccine. Patients over 60 years old had a significantly higher rate of vaccination (OR 2.98, 95% CI 2.20-4.03, p<0.001). Patients' main concerns before vaccination were the possibility of having worse vaccine-related adverse events due to their IBD (24.6%), having an IBD flare after vaccination (21.1%) and reduced vaccine efficacy due to IBD or associated immunosuppression (17.6%). After the first dose of the vaccine, 72.4% had local symptoms at the injection site and 51.4% had systemic symptoms (5 patients had non-specified thrombosis). Adverse events were less frequent after the second dose of the vaccine and in older patients. When comparing with previous studies from the general population, the IBD patients answering the survey did not seem to have increased side effects (table 1). Only a minority of the patients were hospitalized (0.3%), needed a consultation (3.6%) or had to change IBD therapy (13.4%) after anti- SARS-CoV-2 vaccination. Conclusion: Although IBD patients raised concerns about the safety and efficacy of anti-SARS-CoV-2 vaccines, the implementation of vaccination in those responding to our survey was high and the adverse events were comparable to the general population, with minimal impact on their IBD. (Table Presented)

13.
Gastroenterology ; 162(7):S-978, 2022.
Article in English | EMBASE | ID: covidwho-1967386

ABSTRACT

Background: An association between shorter disease duration and improved clinical efficacy has been shown in post hoc analyses of clinical trial data with biological therapies in Crohn’s disease (CD). The efficacy and safety of risankizumab (RZB) as induction and maintenance therapy have been recently reported.1,2 Here, the efficacy of RZB stratified by baseline CD duration is reported. Methods: In ADVANCE (NCT03105128) and MOTIVATE (NCT03104413), patients with moderately to severely active CD received intravenous (IV) RZB induction therapy or placebo (PBO) for 12 weeks. Patients with clinical response to RZB IV induction were re-randomised in a 52-week maintenance study (FORTIFY NCT03105102) to receive subcutaneous (SC) RZB or PBO (ie, withdrawal). For this posthoc analysis, patient subgroups were stratified by years of CD duration at baseline (< 2, 2– 5, > 5–10, and > 10 years). Induction analyses focused on patients who received RZB 600 mg IV or PBO for 12 weeks. As all patients who entered maintenance responded to RZB IV induction, maintenance analyses were limited to those patients who responded to induction and then received RZB 360 mg SC for 52 weeks. Clinical and endoscopic outcomes were evaluated using nonresponder imputation incorporating multiple imputation to handle missing data due to impact of the COVID-19 pandemic. Safety was assessed throughout the studies. Results: The induction and maintenance analyses included 527 patients who received RZB 600 mg IV and 141 patients who received RZB 360 mg SC, respectively. At the end of induction (week 12), patients with CD duration of < 2 years achieved higher rates of endoscopic outcomes with IV RZB induction vs patients with longer durations of disease (Figure 1), and regardless of baseline CD duration, greater proportions of RZB-treated patients achieved clinical remission (defined by stool frequency and abdominal pain), endoscopic response, endoscopic remission, and ulcer-free endoscopy vs PBO (P ≤ .05). Clinical remission rates at week 12 were numerically higher in patients with CD duration of < 5 years vs > 5 years (Figure 1). Similar results for improved clinical and endoscopic outcomes associated with shorter disease duration were observed at week 52 with RZB 360 mg SC maintenance treatment (Figure 2). RZB was well tolerated with lower rates of serious adverse events and serious infections vs PBO in induction, across CD duration subgroups. Conclusions: RZB induction and maintenance therapy was effective and well tolerated with a safety profile generally similar across CD duration subgroups. Achievement of clinical and endoscopic endpoints were higher in patients with shorter duration of CD, suggesting that earlier introduction of RZB therapy may lead to improved outcomes.

14.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925289

ABSTRACT

Objective: To further characterize the relationship between markers of inflammation and outcome in patients undergoing mechanical thrombectomy for acute stroke. Background: Inflammation and infection after ischemic stroke are known to exacerbate tissue injury and worsen clinical outcome. Thrombectomy has become standard of care in stroke, but little data exist regarding how inflammation affects outcome after thrombectomy. Design/Methods: We performed retrospective chart review of stroke patients who underwent mechanical thrombectomy at 2 tertiary academic centers between December 2018 and November 2020. The relationship between discharge mortality, admission WBC count, admission neutrophil percentage, peak WBC count, and fever (peak temperature >38°C) were analyzed using the Wilcoxon rank sum test, Student's t-test, and Fisher's exact test. Multivariable analysis was performed to test for independent predictors of discharge mortality. Analyses were performed for the entire cohort, then repeated in a cohort excluding COVIDpositive patients. Results: Of 254 patients who had thrombectomy for acute stroke, 42 (16.5%) died prior to discharge. Mortality was associated with admission WBC count (10.7 [8.9-14] vs. 8.6 [7-12], p=0.0064), admission neutrophil percentage (78% ± 11 vs. 70% ± 14, p=0.0001), peak WBC count (17 [13-22] vs. 12 [8.9-15], p<0.0001), and fever (71% vs. 29%, p<0.0001). In multivariable analysis, admission WBC count (OR 14, CI 1.5-158, p=0.024), neutrophil percentage (OR 1.04, CI 1.0-1.1, p=0.039), peak WBC count (OR 343, CI 27-5702, p<0.0001) and fever (OR 8.6, CI 3.6-23, p<0.0001) were significantly predictive of discharge mortality after controlling for age, admission NIHSS and post-thrombectomy ASPECTS score. Fifteen patients tested positive for COVID-19. In analyses excluding these patients, peak WBC count and fever remained independent predictors of discharge mortality. Conclusions: Elevated markers of inflammation during hospitalization predict discharge mortality in patients who undergo mechanical thrombectomy for acute stroke. Further study is warranted to investigate causation and identify opportunities to improve quality of care in this patient population.

15.
N Engl J Med ; 387(1): 67-73, 2022 07 07.
Article in English | MEDLINE | ID: covidwho-1921772
16.
European Journal of Preventive Cardiology ; 29(SUPPL 1):i363-i364, 2022.
Article in English | EMBASE | ID: covidwho-1915602

ABSTRACT

Rationale Cardiac rehabilitation (CR) programmes are successful in educating patients and lowering their cardiovascular (CV) risk. However attendance before COVID was between 8 and 50%. Because of short duration of CR programmes sustainability in behaviour change is often suboptimal. The COVID pandemic has shown us the need for high quality remote CR. Mobile guided CR (mCR) has proven to be equally effective as centre-based CR and has the potential to increase participation rates. It also provides possibilities to extend the CR programme. Extending CR programmes with ehealth solutions have shown mixed results on sustainable behaviour change. It is still unknown what type of patients prefer mCR above regular CR when offered as standard care. REHAB+ Rehab+ is a mobile CR program, offered for one year to patients after myocardial infarction as an alternative to the regular CR program. It offers an optimised digital platform and regular interaction with the healthcare team. Patients are able to measure and register physical activity, heart frequency and intensity (BORG scale) and can monitor progress. A care professional (coach) also has access to a portal to monitor progress of different patients, advice on rehabilitation approach and stimulate compliance. Rehab+ is co-created with patients and rehab centres. In 2022, it will conclude its pilot and evaluation in 4 centres (Spain and the Netherlands), and scaled to more in the EU. Objectives: 1. To assess whether mCR programmes result in better sustained effects, as compared to the regular CR programme. 2. To explore what type of patients prefer mCR above a regular CR programme. Study population 900 Post myocardial infarction patients (300 mCR, 600 regular CR) who are indicated for CR. (See figure 1) Patients not able or willing to participate will be registered in an exclusion log. mCR patients will be coached for 12 months with decreasing amounts of touchpoints. Regular CR patients receive no coaching after the end of the regular CR program. Study design Prospective, matched control observational trial Follow-up Patients will be monitored at (see table 1): - T0: baseline characteristics, exercise test, laboratory tests, Fägerstrom test, IPAQ questionnaire, SF-36 questionnaire - T1 (3 months): Physical exam, medication, ECG, laboratory tests, adherence and compliance (mCR only),Fägerstrom test, IPAQ questionnaire, SF-36 questionnaire, eHIQ questionnaire - T2 (12 months): Physical exam, medication, ECG, laboratory tests, exercise test, adherence and compliance (mCR only),Fägerstrom test, IPAQ questionnaire, SF-36 questionnaire, eHIQ questionnaire Conclusion: Inclusion will start in November 2021. The results of this study will give insight in what type of patients choose to participate in mCR. With this information mCR programmes can be further optimised and adjusted. It may help to further increase participation rates in CR. (Table Presented).

17.
Studies in Mycology ; 101:417-564, 2022.
Article in English | CAB Abstracts | ID: covidwho-1902874

ABSTRACT

This paper is the fourth contribution in the Genera of Phytopathogenic Fungi (GOPHY) series. The series provides morphological descriptions and information about the pathology, distribution, hosts and disease symptoms, as well as DNA barcodes for the taxa covered. Moreover, 12 whole-genome sequences for the type or new species in the treated genera are provided. The fourth paper in the GOPHY series covers 19 genera of phytopathogenic fungi and their relatives, including Ascochyta, Cadophora, Celoporthe, Cercospora, Coleophoma, Cytospora, Dendrostoma, Didymella, Endothia, Heterophaeomoniella, Leptosphaerulina, Melampsora, Nigrospora, Pezicula, Phaeomoniella, Pseudocercospora, Pteridopassalora, Zymoseptoria, and one genus of oomycetes, Phytophthora. This study includes two new genera, 30 new species, five new combinations, and 43 typifications of older names.

18.
International Conference on Tourism, Technology and Systems, ICOTTS 2021 ; 284:459-468, 2022.
Article in English | Scopus | ID: covidwho-1899050

ABSTRACT

The study of Higher Education was remotely at a time when professors and students were psychologically fragile and where the distance learning (D@L) theme was not dominated by academia, in the first wave of pandemic COVID-19 in Portugal. Given the object of study, we opted for a qualitative, exploratory, and descriptive study. The webQDA software was used to analyze videos of recorded distance learning classes on a digital platform of four curricular units, from three Portuguese Higher Education Institutions: two private and one public, from the North of Portugal. The main goal is to identify which teaching and learning strategies professors use in distance learning classes. The results were included in five categories: fundamentals, deductions, examples, challenges, and problems. It was found that the majority of professors used traditional teaching strategies, and a small minority used student-centered learning strategies. The implementation of active learning strategies is one of the most effective solutions to: actively engage students in their learning processes and to contribute to more creative students. We need to continually prepare for the future—or “futures,” as several “futures” are likely, depending on the actions. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

19.
Diabetes Technology and Therapeutics ; 24(SUPPL 1):A167, 2022.
Article in English | EMBASE | ID: covidwho-1896149

ABSTRACT

Background and Aims: Connecting in-person with patients is challenging during COVID, potentially undermining the frequency and quality of consultations with health care professionals (HCPs). Telemedicine offers a way to support patient provider connectivity. Methods: Survey data was collected from 22 HCPs from 20 institutions who then participated in one of four virtual meetings to share telemedicine insights using the professional version of One Touch Reveal® (OTR Pro) ecosystem. Results: Remote consultations increased 46% in these institutions during COVID, divided 52% and 48% between patients with type 1 and type 2 diabetes. Methods included telephone (60%), email (19%), video (10%), texting (3%), or combinations (8%). HCPs reviewed OTR Pro data during (45%) or before (25%) consultations, every 3 months (20%) or every 2 weeks (5%). 55% of HCPs said going forward, OTR Pro would become their standard of care, 30% for current or new patients, 10%during face-to-face visits and only 5% returning to face-to-face consultations without OTR Pro. For managing patients, HCPs ranked ''allows me to make treatment/therapy decisions,'' ''helps me schedule consultations/ reminders,'' ''access 24/7 to status of my patients,'' as the top 3 benefits of OTR Pro. 95% of HCPs agreed OTR Pro identified patterns, trends and trouble spots for more meaningful conversations with patients, facilitating clinical practice during COVID. Conclusions: The One Touch Reveal® ecosystem supported telemedicine during the pandemic and will continue to play a valuable role beyond the pandemic.

20.
Journal of Higher Education Theory and Practice ; 22(4):75-90, 2022.
Article in English | Scopus | ID: covidwho-1893684

ABSTRACT

The shift to distance learning has created unique perspectives and challenges to educational stakeholders specifically among teachers who are tasked with keeping teaching and learning on track despite their professional, technical, and personal concerns, and inadequate familiarity to the new learning modality. While these realities have been challenging the capability of teachers, they also open the doors for opportunities of levelling up to a new education landscape and harnessing potentials which may be useful for the furtherance of the teaching practices. The present qualitative study aims to document Science teachers’ perspectives, challenges and opportunities in the teaching of Science courses during the pandemic. It consists of the various insights, initiatives, coping strategies and actions, and opportunities of eight Filipino Science teachers towards securing a responsive and efficient learning management in the midst of the unforeseen challenges in the education sector brought by the impact of the COVID-19 pandemic. © 2022, North American Business Press. All rights reserved.

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