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Contribution: A research on applying blended teaching in microwave filter design in graduate students. Background: The Covid-19 epidemic has caused many universities worldwide to switch to online courses. Taiwan did not have a large-scale local infection in 2020, so the school has implemented a blended teaching plan, combining online and in-person courses. Intended Outcomes: Discuss the effectiveness and satisfaction of the Microwave Filter Design Course in Graduate Students for two classes, Online or In-person course. Application Design: This study uses a quasi-experiment to teach microwave filter courses in the two classes. The teacher integrated into the Flipped Classroom and Interactive Response System (IRS). Students must use the APP to complete the preclass preview and prepare materials. Class A <inline-formula> <tex-math notation="LaTeX">$(N$</tex-math> </inline-formula> <inline-formula> <tex-math notation="LaTeX">$=$</tex-math> </inline-formula> 14) uses in-person classrooms for the whole course;Class B uses blended teaching. The first eight weeks are synchronized online, then mid-term exams, and in-person courses are used for the next ten weeks. Students in two classes in the last week filled out the course satisfaction questionnaire. Findings: Class B achieved better results in the eighth midterm exam week, showing better learning results. Although students in both classes are highly satisfied with the course, Class A is more satisfied than Class B. For graduate students participating in the microwave filter design course, in-person classrooms and blended teaching can achieve good learning results and satisfaction. However, teachers must pay attention to students’reception and understanding of flipped classrooms when using online teaching. And timely and in-depth guidance on the accuracy of APP use. IEEE
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Background: With widespread COVID-19 immunization efforts, reports of vaccine-induced thrombocytopenia and thrombosis (VITT) have emerged, particularly in association with adenoviral vector-based vaccines (ChAdOx1 nCoV-19 and Ad26.COV2.S). The incidence of VITT is considered to be extremely low, with the benefits of vaccination strongly outweighing associated risks. Despite the favorable safety profile of COVID-19 vaccines, VITT has garnered the attention of and likely contributes to vaccine hesitancy among a persistently unvaccinated portion of the United States population. Aim(s): We sought to characterize thrombotic events following COVID-19 vaccination in a large clinical enterprise where mRNA-based vaccines were mostly administered. Method(s): With institutional approval, medical records of 779,602 patients vaccinated against COVID-19 (2 mRNA-based vaccines: 61.2% BNT162b2, 36% mRNA-1273, and adenovirus-based Ad26. COV2.S, 2.7%) from 12/4/2020-6/ 6/2021 at Cleveland Clinic Enterprise locations in Ohio and Florida were queried. A baseline complete blood count was available for 223,345 patients, of which 663 (0.3%) demonstrated thrombocytopenia-defined as >=50% platelet decline 4-28 days post-vaccination- and were subject to chart review. Thrombotic events including deep vein thrombosis, pulmonary embolism, stroke/transient ischemic attack, myocardial infarction, cerebral venous sinus thrombosis, and splanchnic thrombosis were assessed. Thrombotic risk factors including medications, viruses, and malignancy, as well as platelet factor 4 antibody assays were recorded. Result(s): Of 76 patients with thrombosis, 63 (82.9%) demonstrated clear etiologies. Thirty (39.5%) had malignancies (24 treated with chemotherapy associated with thrombosis risk). Seven (9.2%) were considered hypercoagulable, six (7.9%) had catheter-related thrombosis, five (6.6%) had recent surgery, five (6.6%) had reduced mobility, five (6.6%) had cardiovascular risk factors, three (3.9%) had diagnosed/suspected immune thrombocytopenia, and two (2.6%) were septic. Of three patients with unprovoked thrombosis, one had findings concerning for VITT (Figure 1). Conclusion(s): 76/223,345 (0.03%) patients demonstrated thrombosis following COVID-19 vaccination, with one (0.0004%) case concerning for VITT. In a large clinical enterprise, VITT is exquisitely rare.
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Case Diagnosis: A 65-year-old woman who developed multiple system atrophy as a sequelae of COVID-19 infection Case Description or Program Description: The patient developed progressive dizziness, blurriness, and unsteady gait immediately following hospitalization for COVID-19 infection. Formal evaluation noted rightward nystagmus, mild resting tremor of the right hand, slowed finger tapping test bilaterally, overshooting on right finger to nose, and shuffling gait. MRI of the brain revealed moderate cerebellar and pontine volume loss with crossed hyperintensity of the pons, or "hot cross bun sign", raising suspicion for degenerative disease. Lumbar puncture analysis was normal. The patient was diagnosed with multiple system atrophy with parkinsonism features and started on a trial of amantadine and carbidopa/levodopa. Videonystagmography confirmed cerebellar etiology of her symptoms. Vestibular rehabilitation and meclizine was initiated with subsequent improvement in dizziness and functionality. Setting(s): Acute inpatient rehabilitation facility. Assessment/Results: After 20 days of acute inpatient rehabilitation including vestibular therapy, amantadine, carbidopa/levodopa, and meclizine, there was improvement of dizziness, dysarthria, tremor, weakness, and gait. The therapy team noted good progress since admission regarding performance of self-care tasks as well as transfers and mobility. The patient was discharged home with outpatient vestibular therapy. Discussion (relevance): This is a case of newly diagnosed multiple system atrophy associated with "hot cross buns sign" on MRI with COVID19 infection as the implicated etiology. To our knowledge, this is the first case of central cerebellopontine degeneration associated with COVID19. Conclusion(s): New onset multiple system atrophy may be a sequelae of COVID19 infection.
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Introduction: To limit the spread of COVID-19 and keep faculty and applicants safe, many otolaryngology subspecialties conducted their fellowship interviews via a virtual format, including within the field of rhinology. Given the novel virtual format of interviews during the 2021 rhinology interview cycle, our study looked to determine how virtual interviews compared with in-person interviews from the perspective of rhinology fellowship directors. Method(s): A web-based anonymous survey was developed consisting of 15 questions. Electronic letters were sent to all fellowship directors participating in the 2021 rhinology match requesting their participation. Fourteen of the 15 questions from our survey were based on a 5-point Likert-type scale, with 1 representing strong disagree and 5 representing strongly agree;there was 1 one open-ended question. Result(s): Overall, 70% of rhinology fellowship directors responded. Fellowship directors were divided on whether they were satisfied with the virtual interview but overall felt the process was convenient (74%). Most (74%) reported that virtual interviews did not allow them to sufficiently display their program. In addition, 70% felt that the virtual interview process did not allow them to establish rapport with applicants and also to determine who would be the best fit for their program (70%). Most also reported placing more emphasis on applicants' curriculum vitae and letters of recommendation. Overall, 65% said they would not plan to offer virtual interviews in the future despite similar or better match results. Conclusion(s): While virtual interviews result in notable cost reductions and increased convenience to programs and applicants, fellowship directors were mixed in their level of satisfaction with the overall process. This was primarily related to the perceived inability to accurately reflect their program remotely and also an increased difficulty evaluating applicants via a virtual format. These limitations led to most fellowship directors not planning to offer virtual interviews in the future despite similar match results to when conducting traditional interviews.
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Coronavirus disease 2019 (COVID-19) in patients with underlying diseases, is associated with high infection and mortality rates, which may result in acute respiratory distress syndrome and death. Mucopolysaccharidosis (MPS) type II is a progressive metabolic disorder that stems from cellular accumulation of the glycosaminoglycans, heparan, and dermatan sulfate. Upper and lower airway obstruction and restrictive pulmonary diseases are common complaints of patients with MPS, and respiratory infections of bacterial or viral origin could result in fatal outcomes. We report a case of COVID-19 in a 16-year-old adolescent with MPS type II, who had been treated with idursulfase since 5 years of age. Prior to infection, the patient’s clinical history included developmental delays, abdominal distension, snoring, and facial dysmorphism. His primary complaints at the time of admission included rhinorrhea, cough, and sputum without fever or increased oxygen demand. His heart rate, respiratory rate, and oxygen saturation were within the normal biological reference intervals, and chest radiography revealed no signs of pneumonia. Consequently, supportive therapy and quarantine were recommended. The patient experienced an uneventful course of COVID-19 despite underlying MPS type II, which may be the result of an unfavorable host cell environment and changes in expression patterns of proteins involved in interactions with viral proteins. Moreover, elevated serum heparan sulfate in patients with MPS may compete with cell surface heparan sulfate, which is essential for successful interaction between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein and the host cell surface, thereby protecting against intracellular penetration by SARS-CoV-2.
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A highly visual practice, dermatology as a field has significant potential to use emerging technology such as mobile applications for research and patient-centered mapping of the disease process. The UCSF team is working to create SkinTracker, a mobile application for patients with skin disease to remotely participate in clinical trials and research studies. The initial iteration of the application focuses on atopic dermatitis. The application includes an enrollment and consent module, validated surveys including the Patient Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), Numerical Rating Scale (NRS) for itch, link to a wearable device that collects biometric data, a voice diary, and a patient-directed photography module to facilitate physician evaluation of disease. Also included is the ability to report medication use, adverse events, and the ability to chat with the study team. The patient information is available to the research team on a secure online website, where researchers can assess patient photographs to perform Eczema Area and Severity Index (EASI) scoring, note important patient observations from the voice diary, and view quantitative data from both patient surveys and health measures like physical activity, sleep, and environmental factors. We believe this application and website will facilitate patient interest and participation in research, continue research despite in-person restrictions placed during the COVID-19 pandemic, and allow enrollment of more diverse patients for clinical studies who would otherwise be less likely to participate in research due to time or financial constraints.
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STATEMENT OF PROBLEM/QUESTION: Personal protective equipment (PPE) has allowed medical students to return to the hospital to continue their clinical responsabilities during the COVID-19 pandemic, however problems with use remain. Throughout the pandemic, stewardship of personal protective equipment has been an immense challenge. Multiple surveys have shown that less than 40% of healthcare providers wore all mandatory PPE during a patient encounter. One potential explanation for challenges in compliance, is that no standardized practices exist for keeping track of an individual's PPE during the work day. As a result, resources can be lost or mixed up between individuals, ultimately increasing exposure risks and decreasing compliance with hospital PPE use guidelines. In response, this study sought to design two innovative and inexpensive solutions to promote the effective use of masks and safety glasses in compliance with hospital guidelines. The aim was to determine if providing stewardship devices would increase compliance. DESCRIPTION OF PROGRAM/INTERVENTION: Seventy-eight medical students in their third and fourth year clinical rotations at the Icahn School of Medicine at Mount Sinai participated in the study. The study lasted three weeks. Each intervention week, participants were provided with a new set of PPE stewardshp devices. Device one was a disposable eye protection lanyard. Device two was a breathable and water-dissolvable PPE pocket storage device that could be attached to a hospital gown. MEASURES OF SUCCESS: To monitor whether the devices increased PPE compliance, participants were administered a pre-survey consisting of 21 questions. Three identical surveys were administered each subsequent intervention week, to assess effectiveness of the devices on PPE compliance. The surveys used a likert scale model to measure whether students' PPE use and ease of use and availability differed pre- and post-intervention. FINDINGS TO DATE: These interventions helped students better adhere to hospital PPE guidelines- 75% for lanyard wearers and 44% for PPE pocket users. Our results further showed 86% of participants reported that PPE was more accessible when provided with lanyards. The attachable pocket similarly increased PPE compliance, however there was a high attrition rate with its usage. KEY LESSONS FOR DISSEMINATION: PPE has served as an incredibly effective tool for limiting the spread of COVID-19. These results suggest that providing medical students with a PPE lanyard device can increase the compliance of eye protection use.
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With the insurgence of cryptocurrency and the thriving business of mobile games, games related to cryptocurrency have gained enormous interests in recent years. This paper presents a real time online multiplayer board game, Cryptocoinopoly, which is a hybrid of the existing Cryptocoinopoly board game and Monopoly. Unity (a cross-platform game engine) has been used in the development process together with Photon Unity Networking (PUN), which is a Unity package for creating online multiplayer games. At the level, Cryptocoinopoly is represented by Remote Database, Game Server, Network, Application (Game), Local Database and Client components. Notable functions such as allowing users to play the game with multiple people and for no matter how many rounds they desire;allowing users to invest into the cryptocurrency market at any time and allowing users to trade their assets with other players have been successfully implemented. Functionality testing and debugging have been conducted under constrained conditions with limited resources due to the on-going Covid-19 situation. Despite the challenges, all functional and non-functional requirements of the prototype have been fulfilled. © 2021 IEEE.
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Introduction: Central to the pathophysiology of SARS-CoV-2 is immune dysregulation and systemic inflammation, however, it is yet unknown whether sleep-related hypoxemia-which we have recently noted to be associated with worse COVID-19 clinical outcomes-is mediated by these biomarkers and pathways. Methods: Data from patients who tested positive for SARS-CoV-2 and part of the integrated Cleveland Clinic COVID-19 and sleep laboratory registries from March-November 2020 were included. To assess the mediation effect of biomarkers, the relationship between sleep-related hypoxia measures (% sleep time<90%SaO2,T90) and moderate/severe WHO-7 COVID-19 score (use of supplemental oxygen, non-invasive ventilation, mechanical ventilation/ ECMO or death) was first tested. The mediation effect, or natural indirect effect, of biomarkers of inflammation (C-Reactive Protein (CRP), white blood cell (WBC) count (with a focus on lymphocyte count) and lactate) was then estimated by logistic regression models adjusted for demographics, comorbidities, smoking pack year and site location using PROC CAUSALMED statement in SAS software (version 9.4, Cary, NC). Results: The analytic sample included 446 patients hospitalized due to COVID-19: age:63.3.±13.8 years,51.3% female,39% African American with body mass index(BMI)=36.1±9.3kg/ m2. Thirty-six percent used supplemental oxygen, 4% used highflow or non-invasive ventilation,5% required ECMO or mechanical ventilation and 2% died. Hypoxic measures were associated with moderate/severe WHO-7 COVID-19 outcome: T90 median (>1.8%vs.≤1.8%) (OR=2.04, 95%CI:1.28-3.23,p=0.003), 5% increases in both mean SaO2 (OR=0.43, 95%CI: 0.26-0.70,p=<0.001) and minimum SaO2 (OR=0.84, 95%CI: 0.72-0.99,p=0.03). CRP was associated with mean SaO2 (p=0.040) and minimum SaO2 (p=0.029), likewise mediation analysis showed that there was a significant natural indirect effect of CRP in both hypoxia measures (OR=0.86,95%CI 0.73-0.99,p=0.036;OR=0.95,95%CI 0.90- 1.00,p=0.034 respectively). WBC count, but not lymphocyte count subset, was associated with mean SaO2 (p=0.044), but the natural indirect effect was not significant (p=0.23. Lactate was associated with minimum SaO2 (p=0.044), but the natural indirect effect was not significant (p=0.23). T90 median was not associated with CRP(p=0.13), WBC count(p=0.87) or lactate(p=0.28). Conclusion: CRP appears to represent a relevant mediator of sleep-related hypoxia and WHO-7 clinical outcomes. Further investigation is needed to elucidate if treatment of sleep-related hypoxia downregulates biomarkers of systemic inflammation to modify disease course.
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Background: To evaluate whether the ongoing coronavirus disease 2019 (COVID-19) pandemic has had an impact on assisted reproductive technology (ART) outcomes and assess the possible role of geographic differences in the pandemic's trajectory on these outcomes. Methods: Multi-center retrospective cohort study involving patients who underwent oocyte cryopreservation, in vitro fertilization (IVF), embryo cryopreservation, or frozen euploid embryo transfer in 2019 and 2020 at two academic fertility centers located in regionally distinct areas of the US with high coronavirus infection rates. Patients were screened for infectious symptoms, exposure to sick contacts, and fevers, and tested with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction testing within 5 days of oocyte retrieval. The primary outcomes were the number of oocytes retrieved, embryos fertilized, blastocyst or euploid embryos produced in oocyte retrieval and IVF cycles, and rates of embryo implantation, biochemical pregnancy or no pregnancy following frozen embryo transfer (FET). Results: We found no consistent significant differences in the number of oocytes retrieved, embryos fertilized, blastocysts or euploid embryos produced at either institution over the study period. Furthermore, we did not detect any differences in FET outcomes, including rates of embryo implantation, biochemical pregnancy, or no pregnancy, at either institution during the study time period. Conclusions: There were no significant differences in ART outcomes in patients who received fertility treatment during the pandemic at our centers. Patients and providers can be reassured that with proper testing, sanitizing, and distancing measures, treatments can continue safely during the pandemic without compromising outcomes. © 2022 S.O.G. CANADA Inc.. All rights reserved.
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This paper describes the application of mobile robots in the current coronavirus epidemic. Localization is a frequently discussed topic in mobile robotics research. Before a robot can start a task, it must know its current location on a map. The system proposed in this paper scans the obstacles and terrain around the robot by LiDAR to obtain a map of the environment and then uses the image recognition algorithm proposed in this paper to achieve the robot's location. This system can be applied to frontline medical robots, which can disinfect the environment or deliver medication, especially in the case of the COVID-19 epidemic, to help healthcare workers. The proposed localization algorithm is different from the traditional Adaptive Monte Carlo Localization (AMCL), which uses a 2D LiDAR sensor with image recognition to complete the localization. By using a modified template matching technique, the local map is compared with the known global map to deduce the robot's position, which is more accurate than AMCL. In this study, an indoor environment is created using Gazebo 3D environment simulation software, and a robot with a 2D LiDAR sensor is used in this environment to conduct the experiment. We designed three scenarios to validate the proposed algorithm, one with simple terrain, the second scene will appear throughout the map with other scenes of similar terrain, and the third with long straight lines. The results show that this method is feasible. © 2021 IEEE.
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Introduction: The COVID-19 pandemic presented an unexpected intervention to examine the association between activity and AF in patients enrolled in the TRIM-AF (Targeting Risk Interventions and Metformin for AF) clinical trial, which collects daily activity and AF burden through implanted devices. Hypothesis: We tested the hypotheses that: 1) daily activity reduction during the pandemic, compared to pre-pandemic matched periods, can be detected by implanted devices;and 2) activity reduction was associated with increased daily AF burden. Methods: Daily AF burden (%) and active minutes were obtained from manufacturers for 45 subjects (28 male, 17 female, mean age 69.5 years) enrolled in the TRIM-AF 2x2 randomized clinical trial of metformin and lifestyle/risk factor modification in patients with pacemakers/defibrillators (NCT03603912). We defined pre-pandemic and pandemic matched months for each subject, maintaining constancy of pre-vs post-randomization periods and fit a linear mixed model, including age, sex, and pandemic periods, to compare the pre-and during pandemic periods (Figure A).Results: Mean daily active minutes decreased during the pandemic from 148.6 to 144.4 mins (mixed model p =<1E-10). Mean daily AF burden increased during the pandemic from 6.0 to 8.3 (mixed model p= 3.7E-14). Both mean values were compared to matched pre-pandemic time after adjusting for sex, age, and race. AF burden % was associated with age (median AF burden increased by a factor of 1.06/year of age, mixed model p= 1.38E-02) as expected. AF daily duration percent was negatively correlated with the daily active minutes as seen by the Kendall's rank correlation tau is-0.037 (z =-7.6232, p-value = 2.474e-14). Conclusions: The data suggests that activity decreased and device-detected AF burden increased during the pandemic. Further analyses could compare results to historical trends within these patients.
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This research was conducted during the second COVID-19 lockdown in British Columbia, Canada. Its aim was to reveal the opportunities that emerged for gastronomic experience providers which enabled them to build economic, social, and or environmental resilience during the pandemic. Using an interpretative, qualitative approach and case study methodology, data were gathered through semistructured interviews. Nineteen responses were collected and reflected the following key findings. First, technology was a primary tool used in paving the way for strategic and operational changes. Second, expansion into retail as a revenue diversification tool is key to creating sustained economic growth. Finally, the sense of community is at an all-time peak as shown by collaborative spirit, customer loyalty, and philanthropic initiatives across the sector. The findings also suggest a postpandemic gastronomic scene in British Columbia that is heavily supported by domestic palates, a diversified offering, and pandemic-proof experiences.
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Introduction: ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB) use in COVID-19 raised concern due to reported increases in ACE2, the cell receptor for SARS-CoV2. We tested the hypothesis that ARB (Losartan) and ACEI (Captopril) do not impact SARS-CoV2 associated ACE2 expression in cardiomyocytes (CMs). Methods: Beating monolayer ventricular CMs were generated from human iPSCs and grown as engineered heart tissue constructs (EHTs), which mimic a more mature phenotype than monolayer CMs. Drug treatments (24hrs) without pseudovirus were applied to EHTs: (A) Vehicle, 1μM Losartan (ARB), 1μM Angiotensin II (AngII), 1μM Losartan+1μM Ang II;(B) Vehicle, 1μM Captopril, 1μM Ang I, or 1μM AngI+1μM Captopril with 2-3 replicates for each combination and RNAseq as outcome. Drug treatment A only was repeated in monolayer CMs with a 5-6 day to rVSV-SARS-Cov2SpikeLuciferase-FLAG tagged pseudovirus (2-4 replicates) with immunoblotting for ACE2, Cathepsin B (CTSB) and Furin proteins. Results: Immunoblot densitometry showed abundant ACE2 protein in untreated CMs and EHTs. A focused mRNA analysis of 12 genes associated with SARS-Cov2 entry and processing (EHTs) revealed no significant changes in expression of ACE2, NRP1, CTSB, CTSL and FURIN due to Losartan or Captopril treatment. There was a nonsignificant trend towards Losartan-induced increase in AGTR1 with attenuation when AngII was administered, while ITGA5 trended upwards with Losartan+AngII. AGTRI also trended upwards with Captopril and AngI+Captopril. Upon pseudoviral challenge, CMs demonstrated increased ACE2 (55%) and slightly decreased Furin (24%) protein, with unchanged CTSB, although results were not statistically significant. Losartan addition, regardless of AngII, did not alter SARS-CoV2Spike pseudovirus mediated changes of ACE2, Furin or CTSB proteins. Conclusions: Losartan or Captopril did not substantially alter gene expression of ACE2, CTSB, CTSL, FURIN and NRP1 in EHTs without pseudovirus. Losartan did not show convincing evidence for pseudoviral mediated changes of proteins important for viral entry and processing in CM cell models.