ABSTRACT
In this paper, we present the technical design of a virtual CAN network system allowing engineers from different sites to work on a single CAN segment. The system was originally developed for interconnecting students in online university classes, due to COVID-19 pandemic – to learn together the principles of SAE J1939 and ISO 11783 technologies in guided programming exercises. The developed system is based on a centralized server located on the university network and multiple clients connecting to the central server. The protocol to tunnel CAN messages is based on TCP/IP. The unsecured CAN tunnel operates in a secured VPN tunnel. The system design leverages virtual CAN channels provided by two dongle manufactures: Kvaser and Vector – this driver level technology also allows easy access of PC software to the virtual CAN network without any physical CAN hardware. Within the university network, round trip times of under 50 ms were recorded between bus segments when all users were in Germany. © 2022, VDI Verlag GMBH. All rights reserved.
ABSTRACT
Purpose : The COVID-19 pandemic has necessitated a global paradigm shift regarding healthcare delivery, replacing the traditional in-office visit with a virtual platform, in order to limit viral exposure and spread. The purpose of this study is to evaluate agreement between the diagnosis and management of common eye diseases seen in virtual eye care visits versus traditional in-office visits. Methods : This is a retrospective chart review of patients who presented to a single center for a video televisit between March and June 2020. Agreement was based on a qualitative comparison between the documented primary diagnosis and treatment plan at the first synchronous video visit and first subsequent in-office visit. Results : During the NY State Lockdown, a single-center practice saw 779 distinct patients virtually. The most common diagnostic categories were Lids/Adnexa (29%), Cornea (18%), and Glaucoma (16%). Of these, 425 (55%) were subsequently seen at an in-office visit. When comparing the primary diagnosis at the two visits, a similar diagnostic code was maintained for 354 patients (83%). There were no known significant adverse outcomes for any patient seen virtually. Medication changes were made at 268 (34%) video visits. These were guided by symptoms and external exams, although a minority were prophylactic or part of post-operative care. The new treatment plan was maintained for the same diagnosis at 50% of the subsequent in-office visits. Overall, there was an escalation of care for 131 patients (31%), a deescalation of care for 32 patients (7.5%), and no change in management for 257 patients (60.1%) at the follow-up traditional office visit. Glaucoma patients were the most likely to require additional management (either drops or procedural intervention) when seen in the office. Conclusions : Based on the results of this study, teleophthalmology provides a safe, feasible, and fairly accurate means of providing routine outpatient eye care.[1] There was an agreement in diagnoses between the virtual and traditional visit in 83% of patients and management plans remained unchanged for at least 60% of patients. Particularly given the importance of the ophthalmic exam, there are limitations to this model of care resulting in missed diagnoses or escalations of care. Addressing these limitations will require further investigation.