Immune System Development Processes with Special Emphasis on Relationship to Potential Mechanisms of MIS-C

Development of the mammalian immune system requires the intersection of myriad internal and external signals, from the migration of pluripotent stem cells to interactions with the vaginal microbiome during partuition to environmental factors that shape immune processes throughout life. Because the sequence of immune developmental events is fairly transcripted across time, multiple windows of susceptibility exist that can lead to immune dysfunction when these developmental events are perturbed. Additionally, early-life immune dysfunction can persist, leading to increased disease risk across the lifespan. Immune dysfunction can present functionally as suppression, hyperresponsivity, or inappropriate inflammation and molecularly, may involve multiple cells and signaling pathways. Thus, scenarios that lead to multisystem inflammatory syndrome in children (MIS-C) can be complex and multifaceted. This presentation will consider windows of susceptibility as well as external factors that may increase the risk of MIS-C.

Prevalence of multidrug-resistant Gram-negative bacteria from blood cultures and rapid detection of beta-lactamase-encoding genes by multiplex PCR assay

Introduction This study aimed to determine the prevalence of multidrug-resistant Gram-negative bacteria (GNB) from blood cultures in a tertiary-care hospital and the multiplex PCR assay's ability to detect resistance genes. Methods A total of 388 GNB isolates obtained from hospitalized patients between November 2019 and November 2021 were included in the study. Antimicrobial susceptibility testing was done by VITEK 2 system and broth microdilution method. Beta-lactamase-encoding genes were detected by multiplex PCR assays, BioFire-Blood Culture Identification 2 (BCID2) panel (bioMerieux, France). Extended-spectrum beta-lactamases (ESBLs) were detected phenotypically with VITEK AST-GN71 card (bioMerieux, France). The isolates of GNB were classified into multidrug-resistant, extensively-drug-resistant, and pandrug-resistant categories, and their prevalence and distribution in different wards, including coronavirus diseases 2019 (COVID-19) intensive care units (ICU), were calculated. Results Results revealed that all isolates of Acinetobacter baumannii and Pseudomonas aeruginosa were multidrug-resistant as well as 91.6% of Enterobacter cloacae, 80.6% of Proteus mirabilis, and 76.1% of Klebsiella pneumoniae, respectively. In fermentative bacteria, blaOXA-48-like (58.1%), blaNDM (16.1%), blaKPC (9.7%) and blaVIM (6.5%) genes were detected. More than half of Enterobacter cloacae (58.3%) and Klebsiella pneumoniae (53.7%) produced ESBLs. Among non-fermenters, the blaNDM gene was carried by 55% of Pseudomonas aeruginosa and 19.5% of Acinetobacter baumannii. In the COVID-19 ICU, Acinetobacter baumannii was the most common isolate (86.1%). Conclusions This study revealed high proportions of multidrug-resistant blood isolates and various underlying resistance genes in Gram-negative strains. The BCID2 panel seems to be helpful for the detection of the most prevalent resistance genes of fermentative bacteria.Copyright © GERMS 2022.

A Novel Multi-Parameter Calibrator for Ventilator Tester Based on Reciprocating Plunger

Ventilators are widely needed when the COVID-19 is a global outbreak, and they are used to provide mechanical ventilation for patients who are physically unable to breathe, or breathe insufficiently. A ventilator tester is an instrument used to verify and calibrate ventilation parameters of ventilators like gas flow, tidal volume, frequency. As a measuring device, the ventilator tester also needs to be calibrated periodically. And different parameters are usually calibrated with different devices. In order to improve calibration efficiency and accuracy, a novel multi-parameter calibrator for ventilator tester based on reciprocating plunger is proposed in this work. The system composition is introduced and mathematical models are deduced. According to calibrating regulation, different calibrating modes are simulated and realized. © FLOMEKO 2022.All rights reserved

Impact of ICER Assessments on Payer Decision Making in the United States

Objectives: To evaluate how payers utilize Institute for Clinical and Economic Review (ICER) assessments to inform coverage or formulary decisions. Method(s): Double-blinded, web-based survey was fielded through Xcenda's research panel, the Managed Care Network, from June to July 2022. Result(s): A total of 51 payers from health plans (n=27), integrated delivery networks (n=12), and pharmacy benefit managers (n=12) participated in the survey. When assessing the usefulness of ICER's value assessment framework (VAF) to inform formulary decisions within their organizations, 57% of payers indicated it was extremely/very useful, 33% indicated somewhat useful, and 10% indicated not at all/not very useful. Most respondents (73%) agreed that ICER assessments are aligned with their organization's internal assessment. Utilization of ICER's VAF was most prevalent in high-cost drug or disease states (78%), rare/orphan disease states (71%), and oncology/hematology disease states (67%). Payers reported less use in primary care disease states (29%), COVID-19 (8%), and digital therapeutics (4%). In the last 24 months, 20% of payers reported ICER's recommendations often influenced coverage decisions, 59% indicated occasional influence, and 22% indicated no influence. In the last 24 months, payers indicated the top 5 ICER assessments that influenced their coverage decisions included high cholesterol (38%), Alzheimer's disease (36%), atopic dermatitis (33%), multiple myeloma (31%), and chemotherapy-induced neutropenia (28%). ICER assessments that were less impactful included beta thalassemia (3%), digital health technologies (3%), and supervised injection facilities (3%). Payers reported using ICER assessments to inform both expanded and restricted coverage decisions. Conclusion(s): Payers find ICER's VAF useful to inform their organization's formulary decisions. ICER's assessments often align with payers' internal assessments and are most frequently utilized for high-cost drugs or disease states. Payers indicate ICER assessments have affected both expansion and restriction in their coverage policies.Copyright © 2023

PANACEA: An Automated Misinformation Detection System on COVID-19

In this demo, we introduce a web-based misinformation detection system PANACEA on COVID-19 related claims, which has two modules, fact-checking and rumour detection. Our fact-checking module, which is supported by novel natural language inference methods with a self-attention network, outperforms state-of-the-art approaches. It is also able to give automated veracity assessment and ranked supporting evidence with the stance towards the claim to be checked. In addition, PANACEA adapts the bi-directional graph convolutional networks model, which is able to detect rumours based on comment networks of related tweets, instead of relying on the knowledge base. This rumour detection module assists by warning the users in the early stages when a knowledge base may not be available. © 2023 Association for Computational Linguistics.

Digital twin enhanced tribo-test service

Tribo-tests play a crucial role in the evaluation of the material performance of tribo-pairs. Traditionally, tribo-tests are performed onsite and tightly depend on experienced human operators. However, some public health emergencies such as covid-19 have a substantial impact on daily human life, including product and service systems. Therefore, this chapter aims to develop a new tribo-test service pattern, that is, digital twin enhanced remote tribo-test. A digital twin enhanced tribo-test service framework is proposed, which includes the modeling stage and the application stage of tribo-test service. A case study is presented to showcase how to implement the proposed framework. © 2022 Elsevier Inc. All rights reserved.

COVID-19 virus: the immune reaction to vaccines

The immune system is developed to preserve its hosts from an ever-expanding cluster of pathogenic microbes. The elimination of toxic substances, allergens, or any other harmful existences that come in, passing the mucosal surfaces, is as well the responsibility of this special system. Its ability to distinguish self (our bodies' functioning cells and tissues) from non-self is the key aspect to its ability to mobilize some reaction to an invasion initiated by the stranger substances listed above. To identify and kill unsafe microorganisms, the host applies both natural and versatile systems, our innate and adaptive immune systems. Vaccines are used to combat the current SARS-CoV-2 strain by utilizing immune system mechanisms, specifically the adaptive immune system. Vectored vaccines, protein vaccines, genetic vaccine, and monoclonal antibody for passive vaccination are among the vaccine platforms under consideration for SARS-CoV-2. Each vaccine has its own benefits and drawbacks. This paper is written to describe the three major forms of COVID-19 vaccines, as well as the unique mechanisms of elements of the immune system associated with the virus. © 2023 SPIE.

Breaking the Ice with Group Flow: A Collaborative VR Serious Game for Relationship Enhancement

It is usually hard for unfamiliar partners to rapidly 'break the ice' in the early stage of relationship establishment, which hinders the development of relationship and even affects the team productivity. To solve this problem, we proposed a collaborative serious game for icebreaking by combining immersive virtual reality (VR) with brain-computer interface based on the team flow framework. We designed a multiplayer collaboration task with the theme of fighting COVID-19 and proposed an approach to improve empathy between team members by sharing their real-time mental state in VR;in addition, we propose an EEG-based method for dynamic evaluation and enhancement of group flow experience to achieve better team collaboration. Then, we developed a prototype system and performed a user study. Results show that our method has good ease of use and can significantly reduce the psychological distance among team members. Especially for unfamiliar partners, both functions of mental state sharing and group flow regulation enhancement can significantly reduce the psychological distance. © 2023 IEEE.

The 17th National Annual Conference on Neurological Infectious Diseases and Cerebrospinal Fluid Cytology of the Chinese Medical Association Neurology Branch was successfully held

The 17th National Annual Conference on Neurological Infectious Diseases and Cerebrospinal Fluid Cytology of the Chinese Medical Association Neurology Branch was successfully held in Wuhan, Hubei, China. During the conference, many well-known neurology experts in China conducted in-depth and detailed discussions on the research progress of infectious diseases of the nervous system and cerebrospinal fluid cytology, which benefited the participants a lot.Copyright © 2021

Establishment of medical service protocols in large public hospitals for the prevention and control of coronavirus disease 2019.

Coronavirus disease 2019(COVID-19) poses a challenge to hospitals for the prevention and control of public health emergencies. As the main battlefield of preventing and controlling COVID-19, large public hospitals should develop service protocols of diagnosis and treatment for outpatient, emergency, hospitalization, surgery, and discharge. The construction of medical protocols should be based on the risk factors of key points and focused on pre-inspection triage and screening, to establish a rapid response mechanism to deal with exogenous and endogenous risk factors. Implementation of all-staff training and assessment, strengthening the information system, and use of medical internet service are important. This study explores the construction of medical protocols in large public hospitals during the pandemic, and provides a reference for the orderly diagnosis and treatment in hospitals during the pandemic.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.

IMPACT OF THE COVID-19 PANDEMIC ON SEPTIC ARTHRITIS MANAGEMENT

BackgroundSince 2020, the SARS-Cov-2 pandemic has disrupted the organization of healthcare systems worldwide.ObjectivesThis study aimed to assess the impact of this pandemic on septic arthritis management in a tertiary rheumatology department.MethodsIt was a single-center descriptive case-control study, which included patients hospitalized for septic arthritis between January 2018 and December 2021, whose diagnosis was retained after positive bacterial growthor on culture on according to presumptive criteria. Our patients were divided into two groups: G1: patients hospitalized during the COVID-19 pandemic (2020-2021), and G2: patients hospitalized during a similar period before the COVID-19 pandemic (2018-2019). In both groups, septic arthritis prevalence was calculated, socio-demographic characteristics, risk factors, clinical, paraclinical, and therapeutic data were collected. COVID-19 status was reported in the G1.ResultsTwenty-two patients were enrolled: G1 (n = 15), G2 (n = 7). The prevalence of septic arthritis was 0.77% and 0.36% respectively. The median age was 54.6±12.25 and 54.29±21.81 years old respectively. Diabetes was found in 26, 7% in G1 and 28.6% in G2. During the pandemic, arthropathy and oral corticosteroids use were noted in 53.3% and 28.6% of patients versus 26.7% and 14.3% in G2. The diagnosis delay and the prior use of antibiotic therapy were more significant in G1: 14.08[7-30] d versus 6.5[3.25-19.25] d, and 46.7% versus 14.3%. The knee was the most common localization in both groups. Other joints were affected in G1: shoulder (n = 2), hip (n = 1), and sacroiliac (n = 1). The most common germ was staphylococcus aureus. The duration of hospitalization and duration of antibiotic therapy in G1 and G2 were 26.07±9.12d versus 27.43±10.87d and 50±10d versus 48±25.79d, respectively. Concerning COVID-19 status, 33.3% of patients in G1 have received their vaccination and no recent SARS-Cov2 infection was noted before hospitalization. During the pandemic, synovectomy was required in three patients, one of whom was also transferred to intensive care for septic shock (two of these three patients are being followed for rheumatoid arthritis, and only one has never been vaccinated against COVID-19).ConclusionDuring the COVID-19 pandemic, the prevalence of septic arthritis in our department was higher and the diagnosis was delayed. Duration of hospitalization was not impacted, however, atypical localisations, prior use of antibiotics, recourse to synovectomy, and transfer to intensive care were reported. These results suggest an inadequate and difficult access to healthcare services during the lockdown, as well as an impact of social distancing on the immune system [1, 2]. More studies are needed to confirm these findings.References[1]Robinson E. Pires et al, What Do We Need to Know about Musculoskeletal Manifestations of COVID-19? A Systematic Review, JBJS Rev. 2022 Jun 3;10(6)[2]Pantea Kiani et al, Immune Fitness and the Psychosocial and Health Consequences of the COVID-19 Pandemic Lockdown in The Netherlands: Methodology and Design of the CLOFIT Study, Eur J Investig Health Psychol Educ. 2021 Feb 20;11(1):199-218Acknowledgements:NIL.Disclosure of InterestsNone Declared.

Performance Analysis of Learner Behavior Through Online Learning Using Learning Management System

This paper discusses the performance analysis of learner behavior through online learning using Learning Management System (LMS). The analysis is performed based on the survey of lecturers and students activities. The parameters of survey consist of the problems discussion which arise in the online learning, the level of student absorption of lecture material, the level of student attendance, and the feedback on lecturer performance carried out by students. Problems that arise in the online learning include lecturers are not being able to control as much as 37%, network disturbances are as much as 22%, students having difficulty understanding lecture material are as much as 19% which are indicated by students with D score of 10%, C score of 60%, and B score of 30%. Meanwhile 17% of students use LMS and the remaining 5% have no problems with the online learning. On the other hand, students have difficulty obtaining connection for online learning of 45%, do not have a quota of 28%, and lazy of 17%. Lecturer performance feedback carried out by students based on competency parameters of pedagogic, personality, professionalism, and social shows very good score. © 2023 IEEE.

Influencing factors of negative conversion time of nucleic acid detection in 228 patients infected with Omicron variant of SARS-CoV-2 in Shanghai

Objective: To analyze and compare the effects of different clinical characteristics on the negative conversion time of nucleic acid detection after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant infection, and to provide a scientific basis for the isolation and treatment of coronavirus disease 2019 (COVID-19). Methods: The epidemiological and clinical data of 228 mild SARS-CoV-2 Omicron variant infected patients diagnosed in Shanghai were retrospectively collected from April 27, 2022 to June 8, 2022 in Wujiaochang designated Hospital, Yangpu District, Shanghai. The negative conversion time of nucleic acid detection was used as the outcome variable, and the patients were divided into A (18 days) and B (>18 days). Univariate and multivariate logistic regression analysis were used to analyze the influencing factors of the negative conversion time of nucleic acid detection. Results: The mean nucleic acid conversion time of 228 patients was (18.7+or-12.1) d, with the median time of 18 (2-46) d. Among them, 120 patients in group A had an average nucleic acid conversion time of (13.2+or-2.0) d, and 108 cases in group B had an average nucleic acid conversion time of (20.8+or-1.3) d. Univariate analysis showed that there were no statistically significant differences in the effects of hypertension, coronary heart disease, diabetes, hypokalemia, malignant tumors, neuropsychiatric diseases, chronic digestive diseases on the negative nucleic acid conversion time (P > 0.05);however, there were significant differences in the effects of combined cerebrovascular disease, leukopenia, chronic respiratory system diseases and vaccination on the negative nucleic acid conversion time (P < 0.05). Further multivariate logistic regression analysis revealed that the combination of chronic respiratory diseases and non-vaccination were significant risk factors for prolongation of negative nucleic acid conversion time (P < 0.05). Conclusions: The results of this study show that gender, age and whether hypertension, coronary heart disease, diabetes mellitus, hypokalemia, malignant tumor, neuropsychiatric disease and chronic digestive disease have no significant effect on the nucleic acid conversion time, whereas chronic respiratory disease and no vaccination are significantly correlated with the prolongation of nucleic acid conversion time in SARS-CoV-2 Omicron-infected patients.

Enabling mRNA medicine for brain tumors

mRNA is a new class of drugs that has the potential to revolutionize the treatment of brain tumors. Thanks to the COVID-19 mRNA vaccines and numerous therapy-based clinical trials, it is now clear that lipid nanoparticles (LNPs) are a clinically viable means to deliver RNA therapeutics. However, LNP-mediated mRNA delivery to brain tumors remains elusive. Over the past decade, numerous studies have shown that tumor cells communicate with each other via small extracellular vesicles, which are around 100 nm in diameter and consist of lipid bilayer membrane similar to synthetic lipidbased nanocarriers. We hypothesized that rationally designed LNPs based on extracellular vesicle mimicry would enable efficient delivery of RNA therapeutics to brain tumors without undue toxicity. We synthesized LNPs using four components similar to the formulation used in the mRNA COVID19 vaccines (Moderna and Pfizer): ionizable lipid, cholesterol, helper lipid and polyethylene glycol (PEG)-lipid. For the in vitro screen, we tested ten classes of helper lipids based on their abundance in extracellular vesicle membranes, commercial availability, and large-scale production feasibility while keeping rest of the LNP components unchanged. The transfection kinetics of GFP mRNA encapsulated in LNPs and doped with 16 mol% of helper lipids was tested using GL261, U87 and SIM-A9 cell lines. Several LNP formations resulted in stable transfection (upto 5 days) of GFP mRNA in all the cell lines tested in vitro. The successful LNP candidates (enabling >80% transfection efficacy) were then tested in vivo to deliver luciferase mRNA to brain tumors via intrathecal administration in a syngeneic glioblastoma (GBM) mouse model, which confirmed luciferase expression in brain tumors in the cortex. LNPs were then tested to deliver Cre recombinase mRNA in syngeneic GBM mouse model genetically modified to express tdTomato under LoxP marker cassette that enabled identification of LNP targeted cells. mRNA was successfully delivered to tumor cells (70-80% transfected) and a range of different cells in the tumor microenvironment, including tumor-associated macrophages (80-90% transfected), neurons (31- 40% transfected), neural stem cells (39-62% transfected), oligodendrocytes (70-80% transfected) and astrocytes (44-76% transfected). Then, LNP formulations were assessed for delivering Cas9 mRNA and CD81 sgRNA (model protein) in murine syngeneic GBM model to enable gene editing in brain tumor cells. Sanger sequencing showed that CRISPR-Cas9 editing was successful in ~94% of brain tumor cells in vivo. In conclusion, we have developed a library of safe LNPs that can transfect GBM cells in vivo with high efficacy. This technology can potentially be used to develop novel mRNA therapies for GBM by delivering single or multiple mRNAs and holds great potential as a tool to study brain tumor biology.

Simulation Study on Airflow Organization and Environment in Reconstructed Fangcang Shelter Hospital Based on CFD

With frequent outbreaks of COVID-19, the rapid and effective construction of large-space buildings into Fangcang shelter hospitals has gradually become one of the effective means to control the epidemic. Reasonable design of the ventilation system of the Fangcang shelter hospital can optimize the indoor airflow organization, so that the internal environment can meet the comfort of patients and at the same time can effectively discharge pollutants, which is particularly important for the establishment of the Fangcang shelter hospital. In this paper, through the reconstruction of a large-space gymnasium, CFD software is used to simulate the living environment and pollutant emission efficiency of the reconstructed Fangcang shelter hospital in summer under different air supply temperatures, air supply heights and exhaust air volume parameters. The results show that when the air supply parameters are set to an air supply height of 4.5 m, an air supply temperature of 18 °C, and an exhaust air volume of a single bed of 150 m3/h, the thermal comfort can reach level I, and the ventilation efficiency for pollutants can reach 69.6%. In addition, the ventilation efficiency is 70.1% and 70.3% when the exhaust air volume of a single bed is continuously increased to 200 and 250 m3/h, which can no longer effectively improve the pollutant emission and will cause an uncomfortable blowing feeling to patients. © 2023 by the authors.

Optimizing mRNA vaccines and virusmediated CAR T-cell therapy for immuno-oncology: Synthetic tools for gene modification

With the success of mRNA vaccines during the COVID-19 pandemic and CAR T-cell therapies in clinical trials, there is growing opportunity for immunotherapies in the treatment of many types of cancers. Lentiviral vectors have proven effective at delivery of genetic material or gene editing technology for ex vivo processing, but the benefits and promise of Adeno-associated virus (AAV) and mRNA tools for in vivo immunotherapy have garnered recent interest. Here we describe complete synthetic solutions for immuno-oncology research programs using either mRNA-vaccines or virus-mediated cell and gene engineering. These solutions optimize workflows to minimize screening time while maximizing successful research results through: (1) Efficiency in lentiviral packaging with versatility in titer options for high-quality particles. (2) A highthroughput viral packaging process to enable rapid downstream screening. (3) Proprietary plasmid synthesis and preparation techniques to maintain ITR integrity through AAV packaging and improve gene delivery. (4) Rapid synthesis, in vitro transcription, and novel sequencing of mRNA constructs for complete characterization of critical components such as the polyA tail. The reported research demonstrates a streamlined approach that improves data quality through innovative synthesis and sequencing methodologies as compared to current standard practices.

A Detection System for Comfortable Locations Based on Facial Expression Analysis While Riding Bicycles

In recent years, the use of bicycle as a healthy and economical means of transportation has been promoted worldwide. In addition, with the increase in bicycle commuting due to the COVID-19, the use of bicycles are attracting attention as a last-mile means of transportation in Mobility as a Service(MaaS). To help ensure a safe and comfortable ride using a smartphone mounted on a bicycle, this study focuses on analyzing facial expressions while riding to determine potential comfort along the route with the surrounding environment and to provide a map that users can explicitly feedback(FB) after riding. Combining the emotions of facial expressions while riding and FB, we annotate comfort to different locations. Afterwards, we verify the relationship between locations with high level of comfort based on the acquired data and the surrounding environment of those locations using Google Street View(GSV). © 2023 Owner/Author.

Online education action for defeating COVID-19 in China: An analysis of the system, mechanism and mode

This study explores the online education action for defeating COVID-19 in China from the perspectives of the system, mechanism and mode. In particular, the policy development of online education in China during the epidemic includes the education informatization policy, the online education system, and the online education mechanism in China. The online education and teaching mode during the epidemic involve the synchronous live class-based teaching mode, asynchronous recording and broadcasting teaching mode, online flipped classroom teaching mode, and online tutoring-based teaching mode. Both characteristics and trends of online education in China during the epidemic have been explored in this study. In addition, the problems, discussions and remarks are also offered.

Scaling law of COVID-19 cases and city size and its evolution over time

Urban scaling law quantifies the disproportional growth of urban indicators with urban population size, which is one of the simple rules behind the complex urban system. Infectious diseases are closely related to social interactions that intensify in large cities, resulting in a faster speed of transmission in large cities. However, how this scaling relationship varies in an evolving pandemic is rarely investigated and remains unclear. Here, taking the COVID- 19 epidemic in the United States as an example, we collected daily added cases and deaths from January 2020 to June 2022 in more than three thousand counties to explore the scaling law of COVID- 19 cases and city size and its evolution over time. Results show that COVID- 19 cases super- linearly scaled with population size, which means cases increased faster than population size from a small city to a large city, resulting in a higher morbidity rate of COVID- 19 in large cities. Temporally, the scaling exponent that reflects the scaling relationship stabilized at around 1.25 after a fast increase from less than one. The scaling exponent gradually decreased until it was close to one. In comparison, deaths caused by the epidemic did not show a super-linear scaling relationship with population size, which revealed that the fatality rate of COVID-19 in large cities was not higher than that in small or medium-sized cities. The scaling exponent of COVID- 19 deaths shared a similar trend with that of COVID- 19 cases but with a lag in time. We further estimated scaling exponents in each wave of the epidemic, respectively, which experienced the common evolution process of first rising, then stabilizing, and then decreasing. We also analyzed the evolution of scaling exponents over time from regional and provincial perspectives. The northeast, where New York State is located, had the highest scaling exponent, and the scaling exponent of COVID- 19 deaths was higher than that of COVID-19 cases, which indicates that large cities in this region were more prominently affected by the epidemic. This study reveals the size effect of infectious diseases based on the urban scaling law, and the evolution process of scaling exponents over time also promotes the understanding of the urban scaling law. The mechanism behind temporal variations of scaling exponents is worthy of further exploration. © 2023 Science Press. All rights reserved.

Factors Affecting Adaptability of International Students in Malaysia during COVID-19 Pandemic

It is crucial to investigate adaptability in the context of COVID-19, as evidence suggests that difficulties posed by adaptability can be exacerbated during times of crisis. International students encounter additional pressures during this period, which might impair their capacity to stay and prosper in a new place. In light of this context, the purpose of this study is to examine the factors that contribute to the adaptability of international university students in Malaysia, namely the academic system, acculturation, and social support. A cross-sectional research design was used, and the research instruments were adapted from a number of previous studies. A total of one hundred thirty online questionnaires were filled out by international students in Malaysia. The research hypotheses were evaluated using SPSS Version 27.0. All predictors were found to have a statistically significant and positive effect on the adaptability of international students. This research aims to shed light on educational management strategies for addressing the adaptability challenges faced by most international students within COVID-19 by illuminating the key drivers that influence adaptability. © Journal of Curriculum and Teaching..All rights reserved