Impact of Telehealth on Patient Satisfaction in a Pediatric Surgery Population: Implications for Future Surgical Practice

Introduction: Since COVID-19 spurred transitions from in-person to virtual telehealth visits, Press Ganey scores across adult specialties have shown improved patient satisfaction. The impact of telehealth on the pediatric surgery population, however, has not been characterized. This study aims to evaluate telehealth feasibility in pediatric surgery by examining Press Ganey surveys from the largest pediatric surgery telehealth group in the US. Method(s): Demographics were extracted from medical records of patients evaluated by general pediatric surgeons at a tertiary pediatric center from January to September of 2019 and 2021. Customized Press Ganey results were compared between in-person and telehealth patients. Ratings were categorized as satisfied (good, very good) or not satisfied (very poor, poor, fair). Analysis was performed using two-sample t-test or Fisher's Chi- Squared test. Result(s): In 2019, 7,965 (99.9%) patients were evaluated in-person and 3 by telehealth. In 2021, 8,454 (77%) were evaluated in-person and 2,514 (23%) by telehealth. Telehealth patients were more likely to no-show (11.2% vs 6.1%,p<0.01) and leave without being seen (1.4% vs 0.02%,p<0.01). Spanish speakers attended more in-person visits than telehealth (14% vs 8%,p<0.001). In 2021, telehealth patients reported greater satisfaction with providers and greater likelihood of recommending their provider. Conclusion(s): This study demonstrates improvement in patient satisfaction with telehealth implementation in a large pediatric surgery cohort. However, our data suggest that there may be access to care issues that can be optimized. Lessons from this study may be translated to other surgical disciplines and used to improve access to care and patient satisfaction.

EFFICACY AND SAFETY OF ABBV-599 HIGH DOSE (ELSUBRUTINIB 60 MG AND UPADACITINIB 30 MG) AND UPADACITINIB MONOTHERAPY FOR THE TREATMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS: A PHASE 2, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL

BackgroundABBV-599 is a novel combination of elsubrutinib (ELS;a selective BTK inhibitor) and upadacitinib (UPA;a JAK inhibitor) that targets non-overlapping signaling pathways associated with systemic lupus erythematosus (SLE).ObjectivesTo report results from SLEek, a phase 2, randomized, placebo (PBO)-controlled, parallel-group, multicenter study evaluating efficacy and safety of ABBV-599 and UPA monotherapy in adults with moderately to severely active SLE (NCT03978520).MethodsPatients (pts) were randomized 1:1:1:1:1 to once daily (QD) ABBV-599 high dose (HD;ELS 60 mg + UPA 30 mg), ABBV-599 low dose (LD;ELS 60 mg + UPA 15 mg), ELS 60 mg, UPA 30 mg, or PBO. The primary endpoint was the proportion of patients at W24 achieving SLE Responder Index-4 (SRI-4) and steroid dose ≤ 10 mg QD;additional efficacy and safety endpoints through W48 are also reported. The pre-specified 2-sided alpha level was 0.1.Results341 patients were enrolled. After a planned interim analysis when 50% of pts reached W24, the ABBV-599LD and ELS 60 mg arms were discontinued for lack of efficacy (no safety concerns). Of 205 continuing pts (ABBV-599HD n = 68, UPA 30 mg n = 62, PBO n = 75), baseline characteristics were well balanced. The primary endpoint (proportion achieving SRI-4 and steroid dose ≤ 10 mg QD at W24 vs PBO) was met by ABBV-599HD and UPA 30 mg. Key secondary endpoints were also achieved at W48 in both groups (Table 1). Overall flares and time to first flare were substantially reduced in the ABBV-599HD and UPA 30 mg groups through W48 (Figure 1). Anti-double stranded DNA antibodies were significantly decreased with both treatments. TEAEs considered related to study drug were 42.6% ABBV-599HD, 32.3% UPA 30 mg, and 33.3% PBO. There were no malignancies or VTE. There were 3 non-fatal CV events (1 MI on PBO and 2 ruptured cerebral aneurysms [1 each on ABBV-599HD and UPA 30 mg]);all were assessed as unrelated to study drug by investigators. No new safety signals were observed beyond previously known data for UPA or ELS.ConclusionABBV-599HD (ELS 60 mg + UPA 30 mg) and UPA 30 mg demonstrated significant improvements in SLE disease activity and flares with acceptable safety through 48 weeks.Table 1.Key Endpoints at Week 48PBO (n = 75)ABBV-599HD (n = 68)UPA 30 mg (n = 62)SRI-4 and steroid dose ≤ 10 mg QD, n (%) [95% CI]a24 (32.0) [21.4, 42.6]33 (48.5) [36.7, 60.4]*27 (43.5) [31.2, 55.9]SRI-4, n (%) [95% CI]a24 (32.0) [21.4, 42.6]35 (51.5) [39.6, 63.3]*28 (45.2) [32.8, 57.5]+BICLA, n (%) [95% CI]a19 (25.3) [15.5, 35.2]33 (48.5) [36.7, 60.4]***33 (53.2) [40.8, 65.6]***LLDAS, n (%) [95% CI]a18 (24.0) [14.3, 33.7]27 (39.7) [28.1, 51.3]*31 (50.0) [37.6, 62.4]***Joint-Count 50 in patients with ≥ 6 affected joints at baseline, n/n (%) [95% CI]a26/59 (44.1) [31.4, 56.7]37/58 (63.8) [51.4, 76.2]*34/59 (57.6) [45.0, 70.2] +CLASI-50 in patients with baseline CLASI ≥ 10, n/n (%) [95% CI]a5/14 (35.7) [10.6, 60.8]6/12 (50.0) [21.7, 78.3]5/8 (62.5) [29.0, 96.0]*Change from baseline in steroid dose, mg, LS mean (SE)b−1.5 (0.5)−1.5 (0.5)−1.2 (0.5)SFI, events/patient-years (95% CI)c Overall flares2.8 (2.4, 3.3)1.5 (1.2, 1.9)***2.0 (1.6, 2.4)** Mild/moderate flares2.5 (2.1, 2.9)1.3 (1.0, 1.6)***1.9 (1.5, 2.3)* Severe flares0.3 (0.2, 0.5)0.2 (0.1, 0.3)0.2 (0.1, 0.3) +Time to first flare by SFI, days, median (Q1, Q3)c141 (57, NE)312 (114, NE)*311 (99, NE)**BILAG-based flare rate, estimated incidence ratec0.570.19*0.26Data are presented for the full analysis set.aMissing data imputed using NRI incorporating multiple imputation to handle missing data due to COVID 19.bMissing data imputed using MMRM.cObserved data w/o imputation.+P <.1;*P <.05;**P <.01, ***P <.001 vs PBO.ABBV-599HD, elsubrutinib 60 mg QD and UPA 30 mg QD;CLASI-50, ≥ 50% reduction in CLASI activity score;Joint-Count 50, ≥ 50% improvement in tender or swollen lupus joints;LLDAS, Lupus Low Disease Activity State;NE, not estimated;PBO, placebo;SFI, SELENA SLEDAI Flare Index;UPA, upadacitinib.AcknowledgementsAbbVie and the authors thank the patients who particip ted in the study and all study investigators for their contributions. Medical writing assistance, funded by AbbVie, was provided by Callie A S Corsa, PhD, of JB Ashtin.Disclosure of InterestsJoan T Merrill Consultant of: AbbVie, Alexion, Alumis, Amgen, Astra Zeneca, Aurinia, Bristol Myers Squibb, EMD Serono, Genentech, Gilead, GlaxoSmithKline, Lilly, Merck, Pfizer, Provention, Remegen, Sanofi, UCB, and Zenas, Grant/research support from: Astra Zeneca, Bristol Myers Squibb, and GlaxoSmithKline, Yoshiya Tanaka Speakers bureau: AbbVie, Astra Zeneca, Boehringer Ingelheim, Bristol Myers Squibb, Chugai, Daiichi-Sankyo, Eisai, GlaxoSmithKline, Gilead, Lilly, Mitsubishi-Tanabe, and Pfizer, Grant/research support from: AbbVie, Asahi-Kasei, Boehringer Ingelheim, Chugai, Daiichi-Sankyo, Eisai, and Takeda., David d'cruz Consultant of: GlaxoSmithKline, Lilly, and UCB., Karina Vila Consultant of: AbbVie, Daniel Siri Grant/research support from: AbbVie, Boehringer Ingelheim, Bristol Myers Squibb, GlaxoSmithKline, Gilead, Hoffman Laroche, Jansen, Lilly, and Sanofi, Xiaofeng Zeng: None declared, Kristin D'Silva Shareholder of: AbbVie, Employee of: AbbVie, Ling Cheng Shareholder of: AbbVie, Employee of: AbbVie, Thierry Sornasse Shareholder of: AbbVie, Employee of: AbbVie, Thao Doan Shareholder of: AbbVie, Employee of: AbbVie, Denise Kruzikas Shareholder of: AbbVie, Employee of: AbbVie, Alan Friedman Shareholder of: AbbVie, Employee of: AbbVie.

Status quo and influencing factors of post-traumatic stress disorder among front-line anti-epidemic medical staff

[Background] Front-line medical staff are an important group in fighting against Coronavirus Disease 2019 (COVID-19), and their mental health should not be ignored. [Objective] This study investigates the current situation and influencing factors of post-traumatic stress disorder (PTSD) among front-line anti-epidemic medical staff during COVID-19 epidemic. [Methods] Medical staff who had participated in fighting against the COVID-19 epidemic wereselected from three grade III Class A hospitals and four grade II Class A hospitals in a city of Hubei Province by convenient sampling method in May 2020. The survey was conducted online using the Post-traumatic Stress Checklist-Civilian Version (PCL-C) as the main survey tool to investigate current situation and characteristics of PTSD among these participants. A total of 1120 questionnaires were collected, of which 1071 were valid, and the effective rate was 95.6%. [Results] Of the 1071 participants, the average age was (32.59+/-5.21) years;the ratio of male to female was 1: 5.02;the ratio of doctor to nurse was 1:5.8;nearly 70% participants came from grade III Class A hospitals;married participants accounted for 75.4%;most of them held a bachelor degree or above (86.5%);members of the Communist Party of China (CPC) accounted for 22.9%;50.9% had junior titles;the working years were mainly 5-10 years (42.8%);more than 80.0% participants volunteered to join the front-line fight;95.1% participants received family support;43.0% participated in rescue missions;78.1% participants fought the epidemic in their own hospitals;more than 60% participants considered the workload was greater than before;34.4% participants fought in the front-line for 2-4 weeks, and 23.5% participants did for more than 6 weeks. There were 111 cases of positive PTSD syndromes (PCL-C total score >=38) with an overall positive rate of 10.4%, and the scores of reexperience [1.40 (1.00, 1.80)] and hypervigilance [1.40 (1.00, 2.00)] were higher than the score of avoidance [1.14 (1.00, 2.57)]. The results of univariate analysis revealed that PTSD occurred differently among participants grouped by age, political affiliation, working years, anti-epidemic activities location, accumulated working hours in fighting against COVID-19, having child parenting duty, voluntariness, family support, whether family members participated in front-line activities, and rescue mission assignment (P<0.05). The results of logistic regression analysis showed that the incidence rates of reporting PTSD syndromes in medical personnel aged 31-40 years (OR=0.346, 95%CI: 0.164-0.730) and aged 41 years and above (OR=0.513, 95%CI: 0.319-0.823) were lower than that in those aged 20-30 years;the incidence rates of reporting PTSD syndromes in medical staff who were CPC members (OR=0.499, 95%CI: 0.274-0.909), volunteered to participate (OR=0.584, 95%CI: 0.360-0.945), and received family support (OR=0.453, 95%CI: 0.222-0.921) were lower than those did not (P<0.05);the incidence rates of reporting PTSD syndromes among medical workers who had child parenting duty (OR=2.372, 95%CI: 1.392-4.042), whose family members participated in front-line activities (OR=1.709, 95%CI: 1.135-2.575), and who participated in rescue missions (OR=1.705, 95%CI: 1.133-2.565) were higher than those who did not (P<0.05). [Conclusion] The positive PTSD syndrome rate is 10.4% in the front-line anti-epidemic medical staff. Age, political affiliation, voluntariness, family support, having child parenting duty, with a family members participating in the fight, and rescue mission assignment are the influencing factors of PTSD.Copyright © 2021, Shanghai Municipal Center for Disease Control and Prevention. All rights reserved.

[New characteristics of COVID-19 caused by the Omicron variant in Guangzhou].

We investigated the types of novel coronavirus strains present during the Omicron epidemic from late 2022 to early 2023, COVID-19 co-infections with other pathogens, and clinical characteristics of patients with novel coronavirus infections. Adult patients hospitalized due to SARS CoV-2 infection in six hospitals in Guangzhou city were included in the study from November 2022 to February 2023. Clinical information was collected and analyzed, and bronchoalveolar lavage fluid was obtained for pathogen detection using a variety of techniques, including standard methods and mNGS, tNGS. The results showed that the main strain circulating in Guangzhou was Omicron BA.5.2, and the overall detection rate of potentially pathogenic pathogens combined with Omicron COVID-19 infection was 49.8%. In patients with severe COVID-19 infection, special attention should be paid to aspergillosis and combined Mycobacterium tuberculosis infection. In additon, Omicron strain infection could cause viral sepsis, which led to a worse prognosis for COVID-19 patients. Diabetic patients with SARS-CoV-2 infection did not benefit from glucocorticoid treatment, and caution was necessary when using glucocorticoids. These findings highlighted some new features of severe Omicron coronavirus infection that should be noted.

Analyzing the Stock Volatility Spillovers in Chinese Financial and Economic Sectors

By regarding the Chinese financial and economic sectors as a system, this article studies the stock volatility spillover in the system and explores its effects on the overall performance of the macroeconomy in China. The recent outbreak of COVID-19, U.S.-China trade friction, and three historical financial turbulences are involved to distinguish the changes in the spillover in these distinct crises, which has seldom been unveiled in the literature. By considering that the stock volatility spillover may vary over distinct timescales, the spillovers are disclosed through innovatively constructing the multi-scale spillover networks, followed by connectedness computation, based on variational mode decomposition (VMD) and generalized vector autoregression (GVAR) process. Our empirical analysis first demonstrates the different levels of increases in the total sectoral volatility spillover and changes in the roles of the sectors in the system under the aforementioned crises. Besides, the increases in the sectoral spillover in the long-term are verified to negatively impact the macroeconomy and can thereby act as warning signals.

Understanding resource deployment efficiency for ESG and financial performance: A DEA approach

COVID-19 has stimulated additional research interest on economic sustainability and ESG in both academia and industry. This study adopts a DEA approach to examine the efficiency of achieving ESG targets and their relationships with financial performance. Using MSCI ESG data from 2015 to 2019 on 1108 Chinese firms, we examine the ESG proportional and pillar mix efficiencies. The dominant strategies for our sampled firms are to improve overall ESG performance by enhancing the E and S pillars through sacrificing G's performance. The second result shows a positive relationship between proportional efficiency and financial performance while a mixed relationship between pillar mix efficiency and financial performance. However, for the technology sector, there exists some trade-offs between ESG performance and financial performance. Specifically, relative to non-technology firms, improving proportional and pillar mix efficiencies for technology firms could result in some sacrifice in stock valuation. © 2023 Elsevier B.V.

Evaluation of low-dose CT protocol of novel coronavirus pneumonia based on infection prevention and control.

Objective: To explore a low dose CT scanning method on novel coronavirus (COVID-19) pneumonia based on infection prevention and control. Method(s): A total of 140 patients with confirmed novel coronavirus pneumonia in Xiehe hospital from January 20, 2020 to February 28, 2020 were undertaken CT scan and divided into low dose group and conventional dose group. The patients in low dose group(120 kV, 31 mAs) consisted of mild type(51), severe type(15) and critically ill type(4);and those in conventional dose group(120 kv, adaptive milliampere second) consisted of mild type(48), severe type(17) and critically ill type(5). The effective radiation dose, SNR and CNR of CT scan were compared between two groups. A senior and a middle radiologist made the image subjective quality scores, respectively. Result(s): The effective dose in low dose group was lower than that of conventional dose group(t=-48.343, P<0.05). There was no significant difference in SNR and CNR between two groups(P>0.05). For severe and critically ill patients, the score in low dose group was significantly lower than that in conventional dose group(t=-2.781, P<0.05). There was no significant difference in scores between two groups for mild patients(P>0.05). Conclusion(s): Low-dose CT scanning could meet the image quality needs for patients with COVID-19 and meanwhile significantly reduce the radiation dose.Copyright © 2020 by the Chinese Medical Association.

Computational Fluid Dynamics-Based Optimization of Face Mask Filter Media Using Micro-Computed Tomography Scans

During the COVID-19 pandemic, face masks have become an important protective measure for reducing the spread of potentially infectious aerosol particles emitted while speaking, coughing, or simply breathing. In this work, a voxel-based numerical model obtained from micro-computed tomography (microCT) scans of a medical mask was validated by comparing fractional filtration efficiency and net pressure loss to values measured at an in-house mask test bench after discharging the mask in isopropanol. Varying mean fiber diameter, solid volume fraction, and thickness of the filter medium, parametric studies based on a digital twin of the mask sample were carried out. It is demonstrated that face masks can be designed where filtration efficiency, pressure drop, and material consumption is improved compared to the base case. © 2023 The Authors. Chemical Engineering Technology published by Wiley-VCH GmbH.

Survival Radiology: How a popular in-person interactive medical student radiology workshop pivoted online during the COVID-19 pandemic

Background: Survival Radiology (SR) is a flagship annual full-day in-person radiology workshop targeted at final year medical students in Singapore to prepare them for internship. Previous in-person editions have consistently received positive reviews from 2014 to 2019. However, the COVID-19 pandemic necessitated a rapid online pivot for its sixth edition in 2020. Objective(s): This study aims to (a) identify key success factors of a traditional in-person medical student radiology workshop, (b) describe the rapid online pivot in 2020 and (c) to identify key success factors for online educational initiatives. Method(s): Post-workshop survey responses of SR from 2014 to 2020 were evaluated. Likert-scale data were quantitatively analysed, while free-text responses were qualitatively analysed. Result(s): A total of 1248 post-workshop surveys (2014-2020 workshops) and 266 free-text responses (2020 workshop) were received from 2640 participants over the years. Progressive changes that sustained or improved participant feedback for in-person SR workshops included adoption of a case-based approach, utility of 'live' audience response systems and incorporation of quizzes with a favourable overall feedback rating of 4.42-4.89 from 2014 to 2019. The webinar version of SR in 2020 became the best-rated edition since inception with a rating of 4.9. Qualitative analysis of feedback from SR 2020 showed that the participants preferred the webinar model, online modes of engagement and interactivity. Conclusion(s): Our experience shows that it is not only possible to successfully pivot online for such workshops, but that blended educational formats utilising online engagements supplemented by in-person activities will be well-received by 'Generation Z' learners even after the COVID-19 pandemic.Copyright © The Author(s) 2022.

A Novel Snore Detection and Suppression Method for a Flexible Patch With MEMS Microphone and Accelerometer

Sleep apnea impacts more and more people all over the world, and obstructive sleep apnea of which is the most frequent. Hence, research on snoring detection and related suppression methods is extremely urgent. In this article, a novel low-cost flexible patch with MEMS microphone and accelerometer is developed to detect snore event and sleeping posture, and a small vibration motor embedded in the patch is designed to suppress snoring. Theoretical analyses of short-time energy, piecewise average filtering (PAF), and Mel-frequency cepstral coefficients (MFCCs) processing are described in detail, and the improved MFCCs are put forward and used as the input of the convolutional neural network (CNN). Furthermore, the snore recognition method based on the combination of similarity analysis and CNN analysis is presented, followed by the snoring suppression method. Experimental results demonstrate that the main features of the sound signals can be extracted effectively by PAF and MFCCs processing, and the data compression ratio is about 99.41%. Besides, the locations of the eigenvectors can be found accurately based on short-time energy analysis. The numbers of high similarity of snoring signals within 30 s are larger than 3, while those of non-snoring signals are often less than 3. If the preliminary screening with similarity analysis is passed, CNN analysis will be conducted to judge whether there are snoring events. The accuracy of snore recognition with CNN analysis is calculated to be as high as 99.25%. Finally, the average snoring time measured by the smart patch with snoring suppression is reduced to 15 from 135 min, which indicates that the proposed snore recognition and suppression methods are effective.

Design and Implementation of a Robot System for High Efficiency Automatic Oropharyngeal Swab Sampling

For normalized prevention and control of novel corona virus disease 2019 (COVID-19) pandemic, a robot system is desired to assist in performing large numbers of oropharyngeal (OP) swab sampling. However, reliability and efficiency are still challenges for the practical application of existing robot systems. In this paper, a robot system and related implementation scheme for high efficiency automatic OP swab sampling are developed. A novel robot end-effector with a disposable protective cover is designed, that testee keeps biting on its terminal during sampling. The main steps of the sampling procedure, including sterilizing, recycling, swab mounting and collection, are realized automatically. The effectiveness and efficiency of the proposed robot system are validated through experiment on human subjects. The whole sampling procedure takes about 80 to 90 seconds. © 2022 IEEE.

Calcifying Epithelial Odontogenic Tumour - A Diagnostic Challenge

Introduction/Aims: Calcifying epithelial odontogenic tumour (CEOT) or Pindborg's tumour is a rare, benign, slow-growing dental neoplasm which is locally aggressive and can invade dentoalveolar bone with possible displacement of teeth and soft tissue. We present a case of CEOT, which was initially managed as cemento-osseous dysplasia (COD). Material(s) and Method(s): A 52-year-old Afro-Caribbean female presented with a two-month history of a left anterior maxillary swelling and examination revealed a firm, buccal mass from upper left central incisor to first premolar. Plain radiograph and computed tomography (CT) imaging revealed a dense calcified body with a lucent capsule measuring 19 x 24 x 23 mm causing displacement of adjacent teeth and expansion of the maxillary cortex, and concluded the diagnosis of COD. Biopsy was offered to the patient but she was reluctant to proceed, so she was managed conservatively according to the radiological diagnosis. Results/Statistics: During the 18-month surveillance period, the patient developed signs of infection of her anterior left maxilla and COD. CT scans showed a slight increase in the tumour size and surgical excision was postponed due to COVID-19 pandemic and resolution after oral antibiotics. After another 12 months, a biopsy of the bony mass was carried out due to overlying mucosal erythematous and nodular changes. The histology confirmed CEOT. Conclusions/Clinical Relevance: Radiological diagnosis is often helpful and tissue biopsy is key when adverse signs are detected. Clinicians should be aware of CEOT as a differential diagnosis for any slow-growing bony lesion which appears mixed radiolucent and radiopaque on imaging. Copyright © 2022

-Embracing Diversity and Connectivity for Entrepreneurship Education Innovation: An Observation Study of Co-Creation Pedagogy for Design Thinking Capacity Building Program of Higher Education

With the growing popularity of design thinking capacity building initiatives for entrepreneurship education, educators are striving to explore technology-supported learning environments and pedagogy to achieve the inter-disciplinary, easily accessible, and student-oriented entrepreneurship education innovation. The lingering effects of unfinished learning amid the COVID-19 and mixed-mode learning have become part of a new normal, we designed and implemented a novel learning framework to put co-design pedagogical structures in place that allow educators, students, and stakeholders to form new learning experiences and create innovation together. Through the case study we designed and implemented in three universities across different regions, we propose and investigate an approach that enables micro-level analysis of knowledge creation model for student's design thinking capacity building as well as macro-level understanding of learning dynamics for entrepreneurship education. This study presents a pedagogy-based template, and the findings have implications for the design of technology-empowered educational interventions and pedagogical innovation. © ISLS.

[Analysis on the infection source of the first local cluster epidemic caused by the VOC/Gamma variant of SARS-CoV-2 in China].

Objective: To investigate a SARS-CoV-2 epidemic reported in Rongcheng City, Weihai, Shandong Province. Methods: The SARS-CoV-2 nucleic acid positive patients and their close contacts were investigated, and the whole genome sequencing and genetic evolution analysis of 9 variant viruses were carried out. An infection source investigation and analysis were carried out from two sources of home and abroad, and three aspects of human, material and environment. Results: A total of 15 asymptomatic infections were reported in this epidemic, including 13 cases as employees of workshop of aquatic products processing company, with an infection rate of 21.67% (13/60). Two cases were infected people's neighbors in the same village (conjugal relation). The first six positive persons were processing workers engaged in the first process of removing squid viscera in the workshop of the company. The nucleic acid Ct value of the first time were concentrated between 15 and 29, suggesting that the virus load was high, which was suspected to be caused by one-time homologous exposure. The whole genome sequence of 9 SARS-CoV-2 strains was highly homologous, belonging to VOC/Gamma (Lineage P.1.15). No highly homologous sequences were found from previous native and imported cases in China. It was highly homologous with the six virus sequences sampled from May 5 to 26, 2021 uploaded by Chile. The infection source investigation showed that the company had used the squid raw materials captured in the ocean near Chile and Argentina from May to June 2021 over the last 14 days. Many samples of raw materials, products and their outer packages in the inventory were tested positive for nucleic acid. Conclusion: This epidemic is the first local epidemic caused by the VOC/Gamma of SARS-CoV-2 in China. It is speculated that the VOC/Gamma, which was prevalent in South America from May to June 2021, could be imported into China through frozen squid.

An umbrella review of Lianhua Qingwen combined with Western medicine for the treatment of coronavirus disease 2019

Lianhua Qingwen combined with Western medicine (LHQW+WM) has been proposed as a viable treatment for coronavirus disease 2019 (COVID-19). Interestingly, umbrella reviews of systematic reviews (SRs), which provide the most comprehensive evidence, are the best evidence in evidence-based medicine. Therefore, an umbrella review of SRs that summarizes and evaluates the efficacy of LHQW+WM for COVID-19 is urgently required.Methods:: Overall, 6 databases were used to conduct a comprehensive literature search from inception to January 22, 2022. The corrected covered area (CCA) was used to analyze the overlapping between SRs. Meta-analysis was conducted when that of the included SRs was inappropriate. A MeaSurement Tool to Assess Systematic Reviews (AMSTAR-2) was also employed to assess the quality of the included SRs. Results:: In total, 12 SRs were identified, which included 12 unique primary studies. The included SRs ranged in quality from moderate to critically low and had an extremely high CCA (36.4%). Compared to conventional treatment, LHQW+WM showed efficacy concerning fatigue recovery [risk ratio (RR) = 1.69, 95% confidence interval (CI): 1.04–2.73, n = 2, I2 = 0%], cough recovery (RR = 1.65, 95% CI: 1.09–2.51, n = 3, I2 = 39.1%), and overall effective rates (RR = 1.17, 95% CI: 1.07–1.28, n = 3, I2 = 17.5%). Conclusion:: LHQW+WM may improve the clinical symptoms of patients with COVID-19;however, the results should be interpreted cautiously because of the rigorous processes in the included SRs. Graphical :: http://links.lww.com/AHM/A32.

Segmentation of lung parenchyma based on new U-NET network

As the risk of lung disease increases in people’s daily lives and COVID-19 spreads around the world, lung screening has become critical. Owing to the unique lung tissue, traditional image segmentation methods are difficult to achieve accurate segmentation of lung tissues. In view of the complexity of lung tissue structure, it was found in the experiment that the segmentation accuracy of upper lung and lower lung parenchyma tissue was low. Aiming at this phenomenon, a new network model, new U-NET, was proposed based on the improvement and optimisation of U-NET network model. Experimental data show that the proposed new U-NET network model solves the problem of low segmentation accuracy of the original U-NET network segmentation model at both ends of lung, improves the segmentation accuracy of lung parenchyma on the whole, and verifies that the new U-NET network model is more suitable for parenchyma segmentation. Copyright © 2022 Inderscience Enterprises Ltd.

BYOZ: Protecting BYOD Through Zero Trust Network Security

As the COVID-19 pandemic scattered businesses and their workforces into new scales of remote work, vital security concerns arose surrounding remote access. Bring Your Own Device (BYOD) also plays a growing role in the ability of companies to support remote workforces. As more enterprises embrace concepts of zero trust in their network security posture, access control policy management problems become a more significant concern as it relates to BYOD security enforcement. This BYOD security policy must enable work from home, but enterprises have a vested interest in maintaining the security of their assets. Therefore, the BYOD security policy must strike a balance between access, security, and privacy, given the personal device use. This paper explores the challenges and opportunities of enabling zero trust in BYOD use cases. We present a BYOD policy specification to enable the zero trust access control known as BYOZ. Accompanying this policy specification, we have designed a network architecture to support enterprise zero trust BYOD use cases through the novel incorporation of continuous authentication & authorization enforcement. We evaluate our architecture through a demo implementation of BYOZ and demonstrate how it can meet the needs of existing enterprise networks using BYOD. © 2022 IEEE.

TRAINING THE LEADER: EFFECTIVENESS OF A SIMULATION AND CLINICAL SKILLS-BASED CURRICULUM ON RESIDENT COMFORT LEVEL AS CODE LEADERS

SESSION TITLE: Trainees: Mental Well-Being and Performance SESSION TYPE: Original Investigations PRESENTED ON: 10/16/22 10:30 am - 11:30 am PURPOSE: With the COVID-19 pandemic and hospital surges, our institution’s house staff was responsible for a significantly increased volume of critically ill patients while balancing residency training. In August 2020, a needs assessment survey was distributed among categorical Internal Medicine (IM) and Internal Medicine/Pediatrics (Med-Peds) residents. The results indicated low comfort levels in the evaluation of decompensating patients and in leading rapid response teams (RRTs). A grassroots initiative was started by two residents and a resuscitation nursing coordinator to address this need. Here, we describe the design and implementation of a resident-led simulation and clinical skills-based curriculum aimed at improving residents’ comfort in leading RRTs. METHODS: From August to September 2021, 56 senior level IM and Med-Peds residents attended a three-hour resuscitation workshop. A mixed educational format with high fidelity simulations, hands-on skills and small group debriefing discussions was implemented. Five scenarios were developed from retrospective hospital-wide RRT data;ventricular tachycardia (VT), supraventricular tachycardia (SVT), ventricular fibrillation, symptomatic bradycardia, and respiratory distress. Skills training included defibrillator use, transcutaneous pacing, adenosine administration, intraosseous line placement and low- and high-flow oxygen delivery devices. Participants were asked to complete a pre- and post-workshop questionnaire. The survey consisted of 7 questions about their comfort level on a 5-point Likert scale. A two-sample t-test was used to assess for difference in mean scores. RESULTS: Residents’ comfort level scores improved significantly in the following: from 3.49 to 4.36 (P< 0.0001) in the initial evaluation of an RRT patient, from 3.14 to 3.84 (P= 0.0026) in regard to thinking quickly during an emergency, and from 2.88 to 4.00 (P< 0.0001) in leading a RRT. There was also a global increase in comfort level scores with the scenarios: “VT” (P=0.0003), “SVT” (P< 0.0001), “symptomatic bradycardia” (P< 0.0001), and “respiratory distress” (P= 0.0324). CONCLUSIONS: Residents’ comfort levels as code leaders encountering various RRT scenarios significantly improved after our three-hour high-fidelity simulation and clinical skills workshop. CLINICAL IMPLICATIONS: Despite the challenges of COVID-19 group gathering restrictions and hospital surges, this training course became a well-received educational project to improve the effectiveness of resident-led RRTs. In response to its success, a pilot two-year curriculum involving more diverse RRT scenarios is currently being launched. The curriculum includes three workshop sessions per year for a multidisciplinary team of residents, pharmacy residents, and nurses aimed at improving code leader effectiveness and teamwork dynamics. DISCLOSURES: No relevant relationships by Tanja Barac No relevant relationships by Christie Brillante No relevant relationships by Lily Cheng No relevant relationships by Paul Cooper no disclosure on file for Cristina Diaz Pabon;No relevant relationships by Shaveta Khosla

Classifying COVID-19 Related Meta Ads Using Discourse Representation Through a Hypergraph

Despite Meta’s efforts to promote health information in the COVID-19 pandemic, the growing number of ads is making online content control extremely challenging. To effectively categorize the ads, this work investigates the major discourses shared across Meta ads with various categories related to COVID-19. We propose an interpretable classification model that captures common discourses in the form of keywords and phrases in ads. Particularly, we propose to use hypergraph to connect ads and discourses to capture their high-order interactions. Experiments on a curated Meta Ads dataset show that our model can provide subject-specific discourses and improve classification performance significantly. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Two-Way Communication During Covid-19: A Lesson from Indonesia's Church Online Worship

This study intends to define communication science, specifically two-way communication performed by the church through pastors when worship is held online using the digital platforms YouTube and Facebook. Although social media platforms which offer numerous functions and alters the communication style of communicators and communicants has been widely applied in online worship service, however, from available published literature, we still have considerable of unanswered concerns regarding the adaptation of religious institutions during the Covid-19 Pandemic. Therefore, this study aims to discover answers about the question 'How does the Church as a Christian service institution implement two-way communication using the YouTube and Facebook during the Covid-19 Pandemic Period?' using a qualitative technique as well as a literature review. According to the findings of this study, there is a difference in the communication style of the Church to the congregation when they participate in online worship, particularly through digital platforms such as Facebook and YouTube. © 2022 IEEE.