Telehealth development of virtual environmental home visits to facilitate stroke patients discharges from Hospital

Introduction: The Covid-19 pandemic has progressed the use of digital technology in the NHS to enable remote working and reduce the risk of infection transmission in NHS settings (Hutchings 2020) Telehealth is the use of electronic information and telecommunications technologies to enable and support clinical health care, patient and professionals to provide care virtually (Clipper 2020). A research study published by BJOT (2020) identified that remote home visits were feasible depending on visitor abilities, training and visit standardisation (BJOT 2020). Environmental Home visits (EHV) are fundamental to the discharge process to enable identification of appropriate equipment for the safe and timely discharge of stroke survivors. According to the National Clinical Guidelines for Stroke, stroke survivors should be offered assessment and provision of equipment and adaptations (National Clinical Guidelines for Stroke, 2016). In response to the Covid-19 pandemic to ensure safe discharge and reduced direct face-to-face contact virtual environmental home visits (VEHV) on a stroke ward was developed. Method(s): Microsoft Teams was the technology platform used to facilitate VEHV. Visits were arranged with families and caregivers who had access to the technology and were able to understand the technology. Therapists directed the patient's home environment and asked the individuals completing the VEHV for appropriate dimensions and measurements and an environmental home visit document was completed. Result(s): VEHV were completed by both qualified occupational therapists and therapy assistants were then trained to be able to implement VEHV. The use of Microsoft Teams was found to be a suitable technology platform with families and care givers who were technology competent. However where patients families and care givers did not have access to the appropriate technology or were not sufficiently computer literate VEHV's were not appropriate. Conclusion(s): The VEHV were found to be time efficient, improved patient flow, enabled a number of VEHV to be completed in a day and reduced direct face-to-face contact during Covid-19 while still maintaining communication with patient families and care givers.

Proof of authenticity statistics from multiple perceptual hash omparisons: A case study

The COVID-19 global pandemic created an optimal environment for counterfeiters to exploit vulnerabilities in the manufacturing industry. The decentralized and global nature of additive manufacturing (AM) systems created new attack vectors for counterfeiting due to ease of compromise of product and process information. To solve this challenge, innovative technologies and scientifically reliable methods for predicting authenticity are in great demand. In this work, a framework for differentiating between authentic and counterfeit AM automotive and aerospace components is proposed. Extant literature was reviewed and current anti-counterfeit technologies analyzed, informing the basis of the framework. The process was validated with a castle nut printed via selective laser-melting of a stainless steel M18 castle nut slightly modified with a Cantor dust fractal. The castle nut was then inspected with 225 and 450 kV X-ray tomography to assess the fidelity of fractal structure. A model trust anchor image sequence was developed and analyzed with a perceptual hash, Hamming distance computations, distribution functions, and null hypothesis for proof of authenticity. For authentic parts, a blockchain was updated with provenance. Future work will explore wider implementation with the goal of reducing prevalence of counterfeit parts in AM manufacturing systems. © Proceedings of ASME 2022 17th International Manufacturing Science and Engineering Conference, MSEC 2022.

Pandemic, Politics, and Public Opinion About Crime

Prior scholarship links ontological insecurities, racial tensions, and health issues to public opinion about crime. This project examined these forces in the context of the 2020 pandemic, racial justice demonstrations, and politics using data from the Nebraska 2020 survey (N = 2775). Pandemic-related insecurities and racial animus were associated with avoiding places in the community, worry about crime, and the belief that police in one's community are underfunded. Trusting politicians but distrusting health leaders, and viewing COVID as an economic threat but not a health threat were associated with the belief police are underfunded. Results suggest that the politicization of the pandemic may influence support for criminal justice policies that promise a return to “law and order.”

REMOTE DECISION-MAKING AND COMMUNICATION AROUND DO NOT ATTEMPT CARDIO-PULMONARY RESUSCITATION (DNACPR) ORDERS IN CARE HOMES DURING COVID-19

Background DNACPR decisions must be discussed with patients and, where patients lack capacity to be involved in DNACPR decision-making, with a legal proxy or next of kin. COVID-19 posed several challenges to DNACPR decisionmaking and communication including rapid, untimely clinical deteriorations and the prohibition of visitation in care homes. Simultaneously, there were concerning reports of blanket DNACPR orders being placed on care home residents. The Department of Health and Social Care (DHSC) issued guidance during the pandemic around remote capacity assessments. Aims This project reviewed practice around remote capacity assessments and communication around DNACPR decisions in care home residents in 2020. Methods Secondary analysis of data from a trust-wide audit was performed. 30 DNACPR forms from 2020 were randomly selected from Salford Care Homes Medical Practice. Results Capacity assessments were undertaken in line with DHSC guidance in all notes reviewed. Clinicians considered previous capacity assessments, remote assessments via iPad or telephone, and the views of care home staff, patients' relatives, legal proxy and IMCAs. 2 of 30 patients were deemed to have mental capacity. All DNACPR decisions were discussed with the patient, or where the patient lacked capacity, with the next of kin or legal proxy. Conclusion We identified good uptake of DHSC guidance around remote capacity assessments during 2020, however since undertaking this analysis, the MCA guidelines have been revoked. There is now no guidance to support clinicians should capacity assessments need to be undertaken remotely. There is an urgent need for policy makers to address this, due to the possibility of further outbreaks and the clinically vulnerable nature of the care home population.

COVID-19 Vaccine Hesitancy Among Reproductive- Aged Females

INTRODUCTION: Initial COVID-19 vaccine trials excluded pregnant individuals, making eventual vaccine recommendations nongeneralizable. After noninferiority was established, the Centers for Disease Control and Prevention, World Health Organization, and American College of Obstetricians and Gynecologists supported vaccination of this group. However, only 31% of pregnant patients accepted vaccination. This study aims to assess COVID-19 vaccine hesitancy in reproductive-aged females. METHODS: We developed a REDCap survey using a validated COVID-19 vaccine hesitancy survey tool. From August to November 2021, women aged 18-50 years were recruited from inpatient and outpatient obstetrics and gynecology services at the University of Illinois Hospital. We performed t tests and ANOVA statistics using SPSS. RESULTS: A total of 51 patients partially or fully completed the survey. The results revealed that Black individuals are more hesitant than Hispanic and White individuals (F2,44=3.45, P<.50). Specifically, Black women differed in the belief that the COVID-19 vaccine is safe overall (F2,44=5.62, P<0.01) and in pregnancy (F2,46=4.95, P<0.01). Pregnant patients were less confident that the COVID-19 vaccine is safe overall (F2,45=7.44, P<0.01) as well as in pregnancy (F2,47=6.26, P<0.01) compared to those recently pregnant or not pregnant. Individuals who declined the flu vaccine were more likely to be vaccine hesitant (t46=-4.49, P<.001). Participants' age, occupation, and contraception status were not associated with vaccine hesitancy. CONCLUSION: Existing vaccine hesitancy highlights the need to study misconceptions regarding the safety of the COVID-19 vaccine.

Social environmental impact of COVID-19 and erectile dysfunction: an explorative review.

BACKGROUND: To date, no attempt has been made to collate literature on the relationship between the social environmental impact of COVID-19 and erectile dysfunction. The aim of this explorative review was to assess and compare the prevalence of erectile dysfunction (ED) in male healthcare workers and males during the COVID-19 pandemic. METHODS: A systematic review of major databases from inception to February 2021 was conducted. Prevalence data were extracted, and a random-effects meta-analysis was undertaken. OUTCOMES: The pooled prevalence of ED amongst healthcare workers working in COVID-19 specific environments, and non-healthcare during the COVID-19 pandemic. RESULTS: Of 52 initial studies, six were included for the final analysis. The pooled prevalence of ED in healthcare workers working in a COVID-19 environment was 63.6% (95% CI 20.3-92.3%), and in non-healthcare workers during the COVID-19 pandemic was 31.9% (95% CI 19.5-47.6%). CONCLUSION: The prevalence of ED in healthcare workers working in COVID-19 environments was higher than representative samples and is of concern. Sexual health (and by extension, overall health), should be a priority when considering ways to care for this population. Considering the social environmental impact of COVID-19 on sexual health and in particular on ED, it is important to provide adequate psychological support systems and to promote quality of life with particular attention to sexual health.

The Impact of the COVID-19 Pandemic on Medical Student Residency Specialty Selection

Background: The COVID-19 pandemic has had an unprecedented impact on the medical community, including in the way that medical students are educated. While media outlets have portrayed health care workers actively battling this disease, there has been little to no discussion of how the pandemic has affected medical students. Currently practicing physicians chose their specialties long before the threat of this novel coronavirus was known. It is unclear how the pandemic may change the mindset of current medical students and their decisions regarding their choice of residency specialty following graduation. Study Objectives: The purpose of this study was to determine if the COVID19 pandemic has affected future residency specialty choices for current M.D. candidate students. Methods: In September 2020, a brief (approximately 3 minute) anonymous survey of first through fourth-year medical students was created utilizing Qualtrics software and emailed via medical school listservs. Survey questions included basic demographics, what residency specialty they plan to pursue, and what residency specialty they planned to pursue prior to the COVID19 pandemic. The electronic survey was disseminated to current M.D. candidate students (first year [MS-1] through fourth year [MS-4]) at a large, suburban medical school in New Jersey with over 600 students over four clinical and pre-clinical years. A 14 day period was provided for medical students to complete the survey, with a reminder sent to students at the 7 day mark. Results: A total of 87 medical students responded to the survey. Of those that responded, 21% were MS-1, 18% were MS-2, 29% were MS-3, and 29% were MS-4. Eighty-six participants chose to report a sex. Of those, 60% identified as female. Seventy percent of those who responded knew someone personally who was negatively affected by the COVID-19 pandemic. Eleven respondents intended to go into emergency medicine. Five medical students planned on selecting a different residency specialty based on the pandemic. Of those, two had initially planned to pursue emergency medicine and changed specialties based on the pandemic (to radiology and ophthalmology). Of the remaining students, they made the following changes in specialty: psychiatry to anesthesiology, orthopedic to general surgery, and obstetrics/gynecology to undecided. Of these five students who switched specialties, 4 (80%) knew someone negatively affected by COVID-19. Conclusions: Despite the COVID-19 pandemic and the effect it has had on medical student education, the majority of current medical students who responded to this survey have not let it affect their decision regarding which residency specialty to pursue. Of the small sample of students in this survey that did change their decision regarding residency specialty, two students made the decision to switch from emergency medicine to radiology and ophthalmology.

Pandemic vulnerability knowledge visualisation for strategic decision-making: a COVID-19 index for government response in Australia

Purpose: First, the key vulnerability factors from the literature are identified. Second, using the vulnerability factors as indicators, a composite index is developed. Last, from the index values, a set of vulnerability knowledge maps, showing the vulnerability hotspots, are prepared. Design/methodology/approach: This study aims to develop a pandemic vulnerability knowledge visualisation index to support the strategic decision-making efforts of authorities. Findings: Ten indicators are identified as vulnerability factors that could significantly impact the virus spread risks. Verifying the identified hotspots against the recorded infected cases and deaths has evidenced the usefulness of the index. Determining and visualising the high-vulnerability locations and communities could help in informed strategic decision-making and responses of the authorities to the pandemic. Originality/value: The study demonstrates that the developed pandemic vulnerability knowledge visualisation index is particularly appropriate in the context of Australia. Nonetheless, by replicating the methodologic steps of the study, customised versions can be developed for other country contexts. © 2021, Emerald Publishing Limited.