Telehealth experiences in Canadian veterans: associations, strengths and barriers to care during the COVID-19 pandemic.

INTRODUCTION: Identifying barriers to care in veteran populations is critical, as veterans face increased social isolation, relationship strains and financial insecurities. For Canadian veterans experiencing barriers to accessing healthcare, telehealth may be a promising alternative with comparable effectiveness to in-person services; however, the potential benefits and limitations of telehealth require further examination to determine its long-term utility, and to inform health policy and planning. The goal of the present research was to identify predictors and barriers to telehealth usage in Canadian veterans in the context of the COVID-19 pandemic. METHODS: Data were drawn from baseline data of a longitudinal survey examining the psychological functioning of Canadian veterans during the COVID-19 pandemic. Participants were 1144 Canadian veterans aged 18-93 years (Mage=56.24, SD=12.92; 77.4% men). We assessed reported telehealth use (ie, for mental healthcare, physical healthcare), healthcare access (ie, difficulty accessing care, avoidance of care) and mental health and stress since the beginning of the COVID-19 pandemic, sociodemographic variables and open-ended responses about telehealth experiences. RESULTS: Findings suggest that sociodemographic factors and previous telehealth use were significantly associated with telehealth use during the COVID-19 pandemic. Qualitative evidence highlighted both the benefits (eg, reducing barriers of access) and drawbacks (eg, not all services can be delivered) of telehealth services. CONCLUSIONS: This paper provided a deeper understanding of Canadian veterans' experiences with accessing telehealth care during the COVID-19 pandemic. While for some, the use of telehealth mitigated perceived barriers (eg, safety concerns of leaving home), others felt that not all health services could be appropriately carried out through telehealth. Altogether, findings support the use of telehealth services in increasing care accessibility for Canadian veterans. Continued use of quality telehealth services may be a valuable form of care that extends the reach of healthcare professionals.

A Comparative Perspective of the Effects of CO2 and Non-CO2 Greenhouse Gas Emissions on Global Solar, Wind, and Geothermal Energy Investment

Greenhouse gas emissions, including carbon dioxide and non-CO2 gases, are mainly generated by human activities such as the burning of fossil fuels, deforestation, and agriculture. These emissions disrupt the natural balance of the global ecosystem and contribute to climate change. However, by investing in renewable energy, we can help mitigate these problems by reducing greenhouse gas emissions and promoting a more sustainable future. This research utilized a panel data model to explore the impact of carbon dioxide and non-CO2 greenhouse gas emissions on global investments in renewable energy. The study analyzed data from 63 countries over the period from 1990 to 2021. Firstly, the study established a relationship between greenhouse gas emissions and clean energy investments across all countries. The findings indicated that carbon dioxide had a positive effect on clean energy investments, while non-CO2 greenhouse gas emissions had a negative impact on all three types of clean energy investments. However, the impact of flood damage as a representative of climate change on renewable energy investment was uncertain. Secondly, the study employed panel data with random effects to examine the relationship between countries with lower or higher average carbon dioxide emissions and their investments in solar, wind, and geothermal energy. The results revealed that non-CO2 greenhouse gas emissions had a positive impact on investments only in wind power in less polluted countries. On the other hand, flood damage and carbon dioxide emissions were the primary deciding factors for investments in each type of clean energy in more polluted countries.

THE INFLUENCE OF TREATMENT DELAY INCREASE RISKS OF CANCER MORTALITY AMONG OLDER ADULTS: A POPULATION-BASED STUDY

Treatment delays during the ongoing COVID-19 pandemic has worsened oncologic outcomes, such as increasing early mortality among older adults. We investigated the association of treatment delay on the 2-year and 5-year risk of all-cause mortality, and stratified among age ≤60 and age >60 years. This was a retrospective study of cancer patients using the Department of Health-Rizal Cancer Registry (DOH-RCR) from 1971–2012. We employed Poisson regression analysis to compare the risk of death among patients with different treatment delay lengths, defined as interval from diagnosis to treatment of ≤30 days, 31–60 days, and >60 days. We included 16,472 cancer patients. After adjusting for confounding, the 2-year risk of death was significantly higher among patient with treatment delay of >60 days by IRR=1.27 [95% CI=1.2–1.3] and 5-year risk by IRR=1.21 [95% CI=1.2–1.3], compared to delay of less than 60 days. Consistent findings were observed by age-groups, revealing that delay of >60 days puts age≤60 and age>60 years at higher risk of 5-year mortality, by IRR=1.21 [95% CI=1.2–1.3] and IRR=1.20 [95% CI=1.1–1.3], respectively. Treatment delay was associated with overall cancer mortality for cancer diagnoses at any age range. However, further investigation is needed to understand the predictors of longer treatment delay, which may provide consolation to balanced care during the current pandemic.

An immobilization-based, loop-mediated isothermal amplification device for nucleic acid detection of SARS-CoV-2 N gene

Confronting the global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), simple, fast and specific non-laboratory SARS-CoV-2 diagnostic tests are urgently required. However, the current nucleic acid assays generally rely on the diagnostic laboratory, trained staff and specialized equipment for execution and analysis, presenting clear limitations in the field detection. Here, we describe a portable and reliable immobilization-based loop-mediated isothermal amplification (LAMP) device which is mobile, without the requirement of any complicated instrument and appropriate for high-throughput testing. This device was constructed by utilizing the interaction between a carboxyl-tagged primer and an amino-tagged substrate, and capable of catching the target sequence in SARS-CoV-2 produced via the immobilization-based LAMP. In this study, the immobilization conditions and immobilized primer structure were explored and optimized. With this proposed device, the analysis result can be obtained rapidly in 30 min with excellent specificity, even if the template is extracted from a complex sample containing pharyngeal swab or human blood. In addition, the device can be applied to detect the nucleic acid of SARS-CoV-2 and various other pathogens, showing attractive potential for rapid and high-throughput detection at airports, railway stations, cold-chain transportations, community hospitals and so on. Therefore, we believe that the immobilization-based LAMP device is an advanced approach to developing a portable, specific, low-cost and high-throughput diagnostic platform.

FACT OR MYTH: BLACK PATIENTS DO NOT WANT TO PARTICIPATE IN CLINICAL TRIALS

Introduction Underrepresentation of minority groups, particularly Black patients, has been a major issue for most clinical trials. A commonly cited reason is mistrust amongst Black patients due to historical abuse. In a Historically Black College and University (HBCU) at a major metropolitan area with predominant Black patient population, we examined the patient participation rate in a clinical trial compared to other study sites with primarily White patient population. Methods In April 2021, a large prospective, multi-center clinical trial designed to validate a multiomics blood test for early detection of CRC (PREEMPTCRC) was initiated at a HBCU. To optimize study recruitment, culturally-sensitive methods were employed, including racially congruent recruitment staff, and synchronized timing of consent/study procedures with pre-endoscopy COVID testing and clinic visits. Information for all eligible participants screened for the study were recorded and evaluated for a 7- month period (April 1 - October 31, 2021). The enrollment numbers (defined as those consented to the study and had blood samples drawn) for the HBCU and across all other study sites were compared. Demographic and socio-economic data for patients who enrolled and not enrolled at the HBCU were collected to identify potential factors that affect participation. Results During the study period, the number of patients enrolled at the HBCU site (N=229) was significantly higher than the average number enrolled across the other 168 sites (N=90, p<0.0001). In fact, the HBCU site ranked at the top 11th percentile for patient enrollment across all study sites. The main difference between the HBCU site and other study site was race: participants at HBCU were 88.2% Black and 5.2% White, while at the other sites, the participants were 12.0% Black and 71.5% White (p< 0.0001). Comparison of demographic characteristics and socio-demographic data of the enrolled and not-enrolled subjects at the HBCU were similar (Table 1) and did not identify factors that affect participation in clinical trials. Discussion The enrollment of Black patients at a HBCU site was comparable to other study sites in a large prospective, multi-center study of a multiomics blood test for average-risk CRC screening. The findings of our study highlight the importance of providing access to Black patients to clinical trials to ensure adequate representation in research studies. (Table Presented) Table 1. Baseline Patient Demographic and Sociodemographic Information

COVID-19 Outcomes Among Participants in the NHLBI Myelodysplastic Syndromes (MDS) Natural History Study

Introduction: The NHLBI MDS Natural History Study (NCT02775383) is an ongoing prospective cohort study conducted across 144 sites in the U.S. and Israel intended to establish a data and biospecimen repository to advance the understanding of MDS. In response to the COVID-19 pandemic, the study also collected data on COVID-19 infection and management. Here, we report a summary of COVID-19 outcomes from participants in this study and the impact of the pandemic on study operations. Methods: This prospective cohort study initiated in June, 2016 is enrolling patients (pts) undergoing diagnostic work up for suspected or newly diagnosed MDS or MDS/myeloproliferative neoplasms (MPNs) in the setting of cytopenia. Study enrollment was paused from Mar. 27, 2020 to May 18, 2020 due to COVID-19. Previously untreated pts underwent a bone marrow assessment with a centralized histopathology review at enrollment for assignment to a longitudinal cohort (MDS, MDS/MPN overlap, idiopathic cytopenia of undetermined significance (ICUS), acute myeloid leukemia (AML) with <30% blasts, or “At-Risk” (pts with sub-threshold dysplasia, select karyotype, or select genetic mutations) for follow-up every six months;or a cross-sectional cohort (other cytopenia or cancers) with no further follow-up. COVID-19 outcomes, including tests, status, hospitalizations and treatments for COVID-19, were collected for all eligible pts. Protocol deviations related to COVID-19 were also collected. Fisher's exact test was used for comparing the proportions of pts tested or positive between groups. Results: Of 758 eligible pts with available COVID-19 data, 507 (67%) were assigned to the longitudinal cohort and 251 (33%) to the cross-sectional cohort or are pending assignment. Among longitudinal pts, 74 (15%) had ICUS, 240 (47%) MDS, 47 (9%) MDS/MPN overlap, 11 (2%) AML with <30% blasts, and 135 (27%) At-Risk for MDS. The median age over all pts was 72 years (range=21-95) and 66% were male, 92% White, 4% Black, 2% Asian, and 2% other. Among 244 pts (32%) tested for COVID-19 (Table 1), 23 (9%) were positive. Twelve (>50% of the positive pts) were in Wisconsin, California (CA), and Missouri (Figure 1), with 8 identified from Sep. to Dec. 2020, which overlaps with third waves of COVID-19 reported in CA and in the Midwest. Tests from 17 (74%) of the 23 pts were based on a polymerase chain reaction (PCR) assay. The proportion of pts positive were similar between pooled disease (ICUS, MDS, MDS/MPN, AML <30%), At-Risk, and cross-sectional groups (8%, 8%, 16%, respectively;Table 2) but the proportions tested differed significantly (39%, 28%, and 25%, respectively, p=0.004). Among all positive pts, 21 (91%) are recovering or have recovered (16 with sequelae), 1 (4%) died, and 1 outcome is unknown (Table 1). The one participant who died had MDS with excess blasts-1 (MDS-EB1, 5-9% blasts). Eight pts (35% of positive pts) required hospitalization (median duration of 7 days (range=2-17)) or treatment (tx) in response to COVID-19, 7 of whom required both. In the 8 pts who required tx for COVID-19, 4 reported Remdesivir-use, 3 of whom were diagnosed with MDS or MDS/MPN overlap. The study monthly accrual rates were similar when compared pre- vs. post-study pause (23 vs. 22 pts, respectively) but the rate of missed follow-up visits increased from 5% to 11% post-pause. About half (49%) of the 144 COVID-19-related study deviations occurred during the months the study was paused. Conclusions: In this analysis of 758 pts with MDS and related conditions, the largest reported for these diagnoses, the COVID-19 mortality rate (13%) in MDS was lower than has been reported in a smaller (n=61) case study (39%, Feld et al Blood 2020) but is similar to the rates for MDS observed annually each year prior to study pause (range=11-19%) and to the rate reported in a larger (n=2186) observational study of cancer patients (16%, Rivera et al Cancer Discov 2020). Infection rates were similar across disease groups. The pandemic also resulted in substantial study-specific challenges, including incre sed rate of deviations, the study being paused, and difficulty sourcing material for biospecimen processing. Data on vaccine efficacy and rates of pts with long-haul symptoms post-COVID may be of interest in future work. [Formula presented] Disclosures: Padron: BMS: Research Funding;Kura: Research Funding;Taiho: Honoraria;Stemline: Honoraria;Blueprint: Honoraria;Incyte: Research Funding. Komrokji: Novartis: Honoraria;Geron: Honoraria;Acceleron: Honoraria;Agios: Honoraria, Speakers Bureau;Abbvie: Honoraria, Speakers Bureau;JAZZ: Honoraria, Speakers Bureau;BMS: Honoraria, Speakers Bureau. Saber: Govt. COI: Other. Al Baghdadi: Bristol-Myers Squibb: Current holder of individual stocks in a privately-held company, Membership on an entity's Board of Directors or advisory committees;AstraZeneca: Current holder of individual stocks in a privately-held company;Epizyme: Current holder of individual stocks in a privately-held company;Heron Therapeutics: Current holder of individual stocks in a privately-held company;Morphosys: Membership on an entity's Board of Directors or advisory committees;Karyopharm: Membership on an entity's Board of Directors or advisory committees;Cardinal Health: Membership on an entity's Board of Directors or advisory committees. DeZern: Taiho: Consultancy, Membership on an entity's Board of Directors or advisory committees;Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees;Bristol-Myers Squibb: Consultancy, Membership on an entity's Board of Directors or advisory committees;Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees. Sekeres: Novartis: Membership on an entity's Board of Directors or advisory committees;Takeda/Millenium: Membership on an entity's Board of Directors or advisory committees;BMS: Membership on an entity's Board of Directors or advisory committees.

Analysis of COVID-19 outbreak based on window-time-LSTM model

Objective To solve the data difference between COVID-19 confirmed cases and actual number of COVID-19 infections, a new model is proposed to predict the spread of the disease. The data difference has been mainly caused by insufficient understanding in the early stage of transmission, limited detection capabilities and the long incubation period. Methods The historical data of the number of confirmed cases are analyzed based on Window-Time. A Long Short-Term Memory (LSTM) network model is combined with the Window-Time strategy to analyze and predict the actual number of infections according to data published of various regions in the world. Results The LSTM network model with Window-Time strategy has higher accuracy than other models. Tuning the width of the Window-Time to the width of 5, the prediction result shows that it is closest to the real actual number of infections, which is consistent with the incubation period of COVID-19 generally known as 3-7 days. Conclusion This method provides a reference for the analysis of the transmission rate of COVID-19 and the incubation period of the epidemic. © 2021, Publication Centre of Anhui Medical University. All rights reserved.

Predicted Impact of the COVID-19 Responses on Deaths of Tuberculosis - China, 2020

What is already known about this topic? The World Health Organization has estimated the impact of reductions in the performance of global tuberculosis (TB) detection and care on TB deaths. However, the actual impact of COVID-19 pandemic on TB deaths in China remains unclear. What is added by this report? The stringent public interventions to fight COVID-19 including lockdown led to more than 20% decrease of TB detection in China. It was predicted that the reduction of TB detection might result in 11,700 excess deaths based on assumption of no detection rebound. Based on the prediction the total deaths will be 51,100 in 2020 which might surpass the deaths in 2011. What are the implications for public health practice? Rapid restoration of TB diagnosis and care services is critical for minimizing the potential effects on TBrelated deaths and bringing TB burden back to control. It is urgent to ramp up case detection including active case finding and to provide an uninterrupted supply of quality-assured treatment and care for TB cases in postCOVID-19 outbreak.

Proton pump inhibitor use is associated with increased mortality in african american COVID-19 patients

Rationale Coronavirus disease 2019 (COVID-19) has disproportionally affected African Americans (AA), with underlying medical conditions and socioeconomic determinants of health believed to be major contributors (Price-Haywood et al, 2020). The use of proton pump inhibitors (PPIs) was recently found to be associated with increased risk and worse outcomes of SARS-CoV-2 infection (Almario et al, 2020;Luxenberger et al, 2020;Lee et al, 2020). Methods We performed a retrospective cohort analysis of patients hospitalized for SARS-CoV-2 in an integrated health system of six hospitals between March 15 and August 15, 2020. To determine predictive factors of mortality, a set of 17 covariates were selected on the basis of clinical relevance to COVID-19 outcomes. The indications for medication use were evaluated in a subset of research patients. Results In 694 hospitalized COVID-19 patients (median age = 58 yr, 46% men, 65% AA), an overall mortality rate was 17.4% (121/694). Logistic regression analysis identified age (aOR=1.66 per decade, p<0.001), race other than AA or white (aOR=3.03, p=0.002), cancer (aOR=2.22, p=0.008), diabetes (aOR=1.95, p=0.003), anti-HTN (aOR=0.46, p=0.001) and PPI use (aOR=2.72, p<0.001) as predictors of mortality. There was no significant mortality difference observed with the use of H2 receptor antagonists. Moreover, PPI use was associated with higher mortality risk in AA (aOR=4.16, 95% CI = 2.28 to 7.59) than in non-AA patients (aOR=1.62, 95% CI = 0.82, 3.19, p=0.04 for interaction) (see Figure 1). The prevalence of PPI use in African Americans (32.6%147/451) and non-AA patients (32.9%, 80/243) were comparable. No other associations were found to differ between the two groups. Indications for PPI use in 31 of 87 research participants were: erosive esophagitis / recent hemorrhage (13%), non-erosive GERD symptoms (45%) and NSAID prophylaxis (42%). Conclusion PPIs are frequently used medications with a growing list of complications. Their use is associated with significant mortality risk in AA COVID-19 patients, and should be reassessed during the pandemic. This risk was not seen in patients who received H2 receptor antagonists. The gastrointestinal tract is a potential site of SARSCoV- 2 entry and replication and this association warrants further study.

Influencing factors for positive duration of viral nucleic acid in patients with severe coronavirus disease 2019

Objective To analyze the positive duration of viral nucleic acid in severe coronavirus disease 2019 (COVID-19) patients and to explore its influencing factors, so as to understand the virus clearance state and provide evidence for treatment and management. Methods The clinical data of 41 patients with severe COVID-19 were retrospectively collected;the patients were hospitalized in Sino-French New City Branch of Tongji Hospital in Wuhan, Hubei Province from Feb. 10 to Mar. 28, 2020. The detection results of viral nucleic acid, clinical information and laboratory findings in oropharyngeal secretion were collected. The time from onset to negative of viral nucleic acid was defined as the positive duration of viral nucleic acid. Multivariate Cox regression analysis was used to explore the influencing factors affecting the positive duration of viral nucleic acid in severe COVID-19 patients. Results Among 41 patients with severe COVID-19, 20 (48.8%) were males and 21 (51.2%) were females, with a median age of 68.0 (58.5, 74.0) years. The average positive duration of viral nucleic acid was (28.98±11.71) d in the patients. Multivariate Cox regression analysis indicated that diabetes mellitus, lymphocyte count and use of high dose of glucocorticoid (total hormone≥300 mg) were associated with the positive duration of viral nucleic acid (all P<0.05), while use of low dose of glucocorticoid (total hormone<300 mg) was not related to the positive duration of viral nucleic acid (P>0.05). Conclusion Positive duration of viral nucleic acid is longer in severe COVID-19 patients. Comorbidity of diabetes mellitus, decreased lymphocyte count and use of high dose of glucocorticoid (total hormone≥300 mg) are independent risk factors for positive duration of viral nucleic acid.