Delays in Stroke Onset to Hospital Arrival Time during COVID-19

Background and Purpose: The current coronavirus disease 2019 (COVID-19) pandemic represents a global public health crisis, disrupting emergency healthcare services. We determined whether COVID-19 has resulted in delays in stroke presentation and affected the delivery of acute stroke services in a comprehensive stroke center in Hong Kong. Method(s): We retrospectively reviewed all patients with transient ischemic attack and stroke admitted via the acute stroke pathway of Queen Mary Hospital, Hong Kong, during the first 60 days since the first diagnosed COVID-19 case in Hong Kong (COVID-19: January 23, 2020-March 24, 2020). We compared the stroke onset to hospital arrival (onset-to-door) time and timings of inpatient stroke pathways with patients admitted during the same period in 2019 (pre-COVID-19: January 23, 2019-March 24, 2019). Result(s): Seventy-three patients in COVID-19 were compared with 89 patients in pre-COVID-19. There were no significant differences in age, sex, vascular risk factors, nor stroke severity between the 2 groups (P>0.05). The median stroke onset-to-door time was =1-hour longer in COVID-19 compared with pre-COVID-19 (154 versus 95 minutes, P=0.12), and the proportion of individuals with onset-to-door time within 4.5 hours was significantly lower (55% versus 72%, P=0.024). Significantly fewer cases of transient ischemic attack presented to the hospital during COVID-19 (4% versus 16%, P=0.016), despite no increase in referrals to the transient ischemic attack clinic. Inpatient stroke pathways and treatment time metrics nevertheless did not differ between the 2 groups (P>0.05 for all comparisons). Conclusion(s): During the early containment phase of COVID-19, we noted a prolongation in stroke onset to hospital arrival time and a significant reduction in individuals arriving at the hospital within 4.5 hours and presenting with transient ischemic attack. Public education about stroke should continue to be reinforced during the COVID-19 pandemic.Copyright © 2020 Lippincott Williams and Wilkins. All rights reserved.

Swift Preparation for Online Teaching During the Pandemic: Experience Sharing from Healthcare Teaching in Hong Kong

Online education has been developing for many years now across the world, but is not without its challenges. Organizational, personal and attitudinal factors may deter some staff from making the transition to online teaching. When we consider healthcare education, the barriers to the adoption of online methods are specifically related to the nature of the curricula involved. Hands-on practical skills training is one essential component in healthcare education that is not easily addressed by simply going online. With the impact of the pandemic, teaching staff of our affiliated healthcare programmes at the Hong Kong Polytechnic University faced huge difficulties in redesigning their content for practical teaching in an online mode. Some of them adopted synchronous practical demonstrations, interspersed with discussion activities, while others used various teaching pedagogies to support active learning online. All of our staff aimed to strengthen the foundation of the students’ knowledge while supporting them to keep practising their hands-on skills so that they would be able to master practical tasks when face-to-face teaching resumed. Such a sudden and swift change from face-to-face teaching to an online delivery mode had a great impact on both teaching staff and students, forcing them to step out of their comfort zone to adopt new online learning methods. The change also challenged instructors to explore other teaching approaches and introduce tools specifically for online teaching and learning, adopting the Technology Pedagogical Content Knowledge (TPCK) framework (Mishra & Koehler, 2006) P, Koehler MJ, Teach Coll Rec 108(6):1017–1054. https://doi.org/10.1111/j.1467-9620.2006.00684.x, 2006). This chapter offers the opportunity to pause and reflect on the continuous professional learning and development (CPLD) challenges that our healthcare educators faced and how these challenges were addressed, drawing on the lessons learned from the COVID-19 context to support future planning of CPLD provision for our staff. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Diagnostic accuracy of machine learning classifiers for cataracts: a systematic review and meta-analysis

Objective: The objective of this study was to systematically review and meta-analyze the diagnostic accuracy of current machine learning classifiers for pediatric and adult cataracts. Method(s): MEDLINE, EMBASE, CINAHL, and ProQuest Dissertations and Theses were searched systematically and thoroughly. Conferences held through Association for Research in Vision and Ophthalmology, American Academy of Ophthalmology, and Canadian Society of Ophthalmology were searched. Studies were screened using Covidence software and data on sensitivity, specificity and area under curve were extracted from the included studies. STATA 15.0 was used to conduct the meta-analysis. Result(s): Our search strategy identified 150 records from databases and 35 records from gray literature. Total of 21 records were used for the qualitative analysis and 11 records (100 134 images) were used for the quantitative analysis. In adult patients with cataracts, the pooled estimate for sensitivity was 0.948 [95% CI: 0.815-0.987] and specificity was 0.960 [95% CI: 0.924-0.980] for cataract screening using machine learning classifiers. For pediatric cataracts, the pooled estimate for sensitivity was 0.882 [95% CI: 0.696-0.960] and specificity was 0.891 [95% CI: 0.807-0.942]. Conclusion(s): The included studies show promising results for the diagnostic accuracy of the machine learning classifiers for cataracts and its potential implementation in clinical settings. Prospero registration: CRD42020219316. Copyright © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Inequalities in Access to Care for the London Post Covid Syndrome Pathway for Children and Young People (Cyp)

Aims The London Post COVID Syndrome Pathway was set up in October in 2020 in order to meet the needs of children affected by persistent symptoms after SARS-CoV-2 infection. The UK CLoCk study (1), 11-17 years, showed high symptom prevalence, increasing from time of testing to 3 months (35.4% to 66.5% in SARS-CoV-2 positive cases and 8.3% to 53.3% in controls). ONS (2) data from a large, randomly selected population survey (April 2020 to August 2021) reported symptom prevalence 4-8 weeks after infection of 3.3% in primary aged children (vs 3.6% in negative controls) and 4.6% (vs 2.9%) in secondary aged. The Zoe Kings study (3) showed 1.8% of children had symptoms beyond 8 weeks after infection. The COVID pandemic has affected ethnic minorities and those in deprived communities the most. Here, we aimed to describe referral patterns and ascertain factors influencing inequalities in access to care. Methods We collected demographic and clinical data from our Post COVID clinics, from October 2020 to January 2022. Deprivation deciles were based on the Index of Multiple Deprivation (IMD 2019). Decile 1 represents the most deprived 10% (decile) in England and Decile 10 represents the least deprived 10%. Analyses were descriptive. Results A total of 86 patients were referred with persistent symptoms (median age 14, range 7-18). The female:male ratio was 1.5:1 (52:34). Ethnicity data was available for n=74. Of those 5% identified from Black backgrounds (expected 13.30%);9% Asian (vs 18.50%);12% Other Ethnic Groups (vs 3.40%), 7% Mixed Ethnic Groups (vs 5%) and 53% White (vs 59.80%). Median IMD score was 6, with mode =7 (London mean 3, mode =1). Conclusion Our data suggests children from more affluent (less deprived) areas are accessing the service, with an underrepresentation of males. A small number of patients were referred compared to those reporting persistent symptoms in national surveys. This may be due to a relatively lower number having impairment and/or a lack of awareness amongst professionals. Ethnicity data shows a lower number than expected Black (40% less) and Asian (50% less) backgrounds are accessing support. Since schools re-opened in September 2021 reduced school attendance has been reported for many children. Persistent symptoms are common post viral infection, and most children recover. However, for some these can be debilitating. If children have reduced school attendance due to persistent symptoms they need prompt access to care. Our study raises concern about access to Post COVID services for all children (particularly males and those from minority backgrounds), raising lack of awareness amongst GPs and schools as a possibility. Proactive case finding is needed, particularly in hardly-reached groups. NHS England has recommended a lead for supporting equality to help this and is in post. The numbers of children accessing care is smaller than the number reporting symptoms, an area that requires further study.

TELEMEDICINE DURING COVID-19 PANDEMIC IS AN ACCEPTABLE MODALITY FOR LIVER CARE DELIVERY IN VULNERABLE POPULATIONS WITH FATTY LIVER DISEASE

Background and Aim: The COVID-19 pandemic has modified liver disease-related care delivery with implementation of telemedicine, previously unavailable in safety net settings. We aimed to assess patient satisfaction with telemedicine for hepatology care (telehepatology) in vulnerable populations with fatty liver disease (FLD). Methods: From 06/01/2020-11/ 30/2021, 218 consecutive participants with non-alcoholic or alcohol-related FLD with or without advanced fibrosis/cirrhosis receiving care in hepatology clinics within the San Francisco safety net health care system were surveyed by phone or in person. Sociodemographic and clinical parameters were captured by self-report and through the electronic medical record. Satisfaction with telehepatology was measured using a Likert scale from 1-5 with 1 representing “very dissatisfied” and 5 representing “very satisfied”. Median time of survey assessment since onset of the pandemic (03/01/2020) was 60.3 (range 8.7-90.3) weeks. Alcohol use in the prior 12 months was categorized as none, moderate (#1 drink/day for women and #2 drinks/day for men), and heavy (>moderate). Severity of liver disease was assessed by liver biopsy (n=97), MR elastography (n=88), or presence of liver nodularity on abdominal imaging (n=33). Descriptive analyses were performed and multivariable models were used to assess factors associated with satisfaction with telehepatology, adjusting for age, sex, and time since pandemic onset. Results: Median participant age was 52 years, 62% were female;60% Hispanic, 20% Asian, 11% White, 3% Black, 6% other race/ethnicity;and 75% were non-English speakers. 37% used alcohol (23% had heavy alcohol use), 40% had diabetes, and 35% had advanced (stage 3-4) fibrosis/cirrhosis. 166 participants (76%) had received telemedicine care and 126 (58%) had telehepatology. Overall, 72% reported satisfaction (55% very satisfied) with telehepatology. A similar proportion of those with and without advanced fibrosis/cirrhosis were satisfied with telehepatology (70% vs 71%, p=1.0). Alcohol consumption (vs none) especially moderate use appeared to be associated with less satisfaction (Coef -1.1, p=0.004 for moderate use and Coef -0.5, p=0.2 for heavy use) but no other sociodemographic or clinical factors were associated with telehepatology satisfaction on multivariable analysis. Conclusions: In this diverse and vulnerable population, in which a significant proportion had advanced fibrosis/cirrhosis FLD, over 70% were satisfied with telehepatology. Importantly, alcohol use negatively impacted perceived satisfaction with telehepatology, suggesting that patients who use alcohol may benefit from adaptations to telemedicine care delivery. As vulnerable populations have known barriers to healthcare access, telehepatology represents an important modality for liver care, and has the potential for reducing health disparities.

Aero-Hydroponic Agriculture IoT System

From the world health organization hunger map, the global hunger population is 821 million in 2020. Moreover, COVID-19 caused the lockdown of the city boundary and the local food supply is not enough for the demand in some small country. Urban farming can help to increase the local food supply. However, it is not cost-effective and not efficient to supply food. Only limited kinds of crops with low efficiency and high cost can be provided. In this research, a newly invented Aero-Hydroponic Agriculture System (AHAS) aims to provide one more source for local food supply by adopting IoT technology to increase productivity. AHAS provides two different layers that allow growing vegetables on the top layer and carbohydrates on the bottom layer. With this IoT system, the temperature, humidity, pH value of nutrient and growth rate of crops can be monitored by the sensors and those environmental parameters can be controlled to offer suitable conditions to grow the crops. As a result, around 75-85% improvement in environment control is achieved by AHAS. With AHAS, more food can be produced in a limited space for the urban farming application. © 2021 IEEE.