Impact of Face-to-Face Interactions and Digital Learning Platforms on Learning Motivation, Learning Achievements and Peer Interaction in After-School Activities

With modern technological advancements, the rise of digital learning has helped teachers and students in many ways;for example, learning is becoming increasingly learner centric. In recent years, learning has been compromised because of school suspensions due to the COVID-19 pandemic. Digital learning has helped to reduce the negative impacts on students' learning, and most students have shown a positive attitude toward digital learning. A learning management system provides a platform for learners to learn and interact with teachers or peers without time and space constraints. Moodle is one of the most popular and widely-used learning management systems. It is open source, offers different functional modules, and is available free of charge. However, according to recent literature, Moodle has several disadvantages. First, the topics discussed by students in the Moodle platform are not focused enough and not easy to be discussed in depth. Second, the interaction is not immediate because of a lack of instant notifications. Third, the interface is not user friendly and is thus difficult to operate. These drawbacks can hinder students' learning. Office 365 is another digital system that assists students' learning. Various functions of Office 365, such as Teams's real-time notifications and OneNote's recording function, complement Moodle. This study investigated the effects of after-school activities conducted through different media on students' motivation, learning achievement, and peer interaction. In present study, after-school activities were conducted face-to-face or via two learning platforms, Moodle and Office 365;the learning platform was considered the independent variables. In total, 143 middle school students were recruited as participants for an after-school activity and distributed into the face-to-face, Moodle, or Office 365 group. The quantitative data of three scales concerning with learning motivation, learning achievement and peer interaction were collected to represent their learning performance. Qualitative data were collected through textual analysis based on student responses to open-ended questions. The quantitative and qualitative data were then statistically analyzed with SPSS Statistics 23. The results of the quantitative analysis revealed the following results: (1) No significant difference was observed in learning motivation among the different groups. The reasons for the result may be that students were not familiar with learning management systems, the interface and function of the learning systems were complex, or student motivation to learn English was low. (2) The learning achievement of the face-to-face group was significantly higher than that of the Office 365 group. Office 365 has many functions, but it also increases the cognitive load on students. Additionally, middle school students in Taiwan are inexperienced with using learning management systems because of the lack of opportunities to do so. Furthermore, the focus of this research was not the formal school curriculum but after-school activities;therefore, gauging learning effectiveness was challenging. Finally, students are more familiar with face-to-face discussions, and this comfort increases the effectiveness of this mode of learning. (3) Students in the Office 365 group had a higher tendency to interact with peers than those in the face-to-face group. Interacting through Office 365 (as it provides voice and text input for discussions) removes the stress of public speaking, such as that experienced in face-to-face classes, thus increasing participation. However, the peer interaction in the Office 365 group was not significantly higher than that in the Moodle group because the students using Office 365 mainly used text input, which decreased the efficiency of their discussion. (4) Some groups of students using the learning management system (no matter Moodle group or Office 365 group) posted the answers to assignments in the chat room even before much group discussion, or they divided the work among themselves, and not discussing the assignment at all. The students seemed to be unfamiliar with the way in which group discussions are conducted through digital learning platforms. This inexperience was reflected in their lack of teamwork. (5) The ratio of discussions students posted on the Moodle platform (Moodle group) was positively correlated with their learning achievement and interaction with peers. The ratio of discussions students posted on the Office 365 platform (Office 365 group) was positively correlated with their learning achievement and learning motivation. The results have several implications. First, teachers should consider the most appropriate form of discussion for middle school students when planning group discussion activities during and after lessons. Second, although middle school students are better at learning through face-to-face discussion, the demand for distance learning and the use of digital platforms are increasing. Teachers should encourage the use of digital platforms by planning more exercises to implement through these platforms, thus improving students' learning performance as well as their efficiency in using these platforms. Third, the students in the Office 365 group had a higher tendency to interact with peers than did those in the face-to-face group. Thus, teacher may use Office 365 initially to make students willing to use digital platforms and for them to get familiar with its usage. Once students are comfortable using the platform, teachers can shift the focus to enhancing the effectiveness of learning. Fourth, when students are engaged in group discussions in after-school activities, only a limited number of students may participate, or students may directly provide answers without discussing them with their peers. Providing students with instructions and training on conducting group discussions may help them make more effective use of learning management systems. Finally, regarding the design of learning management systems, the registration and login procedures should be simplified, and the platform interface and operating functions should be more effectively integrated to make them user friendly. Doing so may enable novices to start and consistently use these systems more easily and reduce the time required by users to familiarize themselves with such systems.

A case series of chronic spontaneous urticaria after COVID-19 vaccination

Case report Introduction: Various immediate or delayed types of cutaneous adverse reactions such as local site reaction, urticaria, mobilliform rash, elayed large local reactions, etc. have been noted after COVID-19 vaccination, which were usually treatable with times. Here we report 13 patients with chronic spontaneous urticaria (CSU) developed after COVID-19 vaccination. Cases: Of the 13 CSU patients, four were male and mean age was 42+/-9 years (range: 28-56). Twelve patients were vaccinated with Pfizer-BioNTech COVID-19 vaccine, and one was with Oxford/ AstraZeneca vaccine. 7 patients (53.8%) were developed CSU after their first vaccination, 5 patients (38.5%) were after 2nd booster shot, and one (7.7%) were after third booster shot. Mean latent period was 7+/-6 days (range: 1-20). Mean duration of CSU were 22+/-8 weeks. Nine patients (69.2%) who refractory to 3-or 4-fold increase of H1-antihistamines took omalizumab treatment, all of whom reached well-or completely controlled status. Five of them (55.6%) achieved well-controlled status within 1 month, while 4 of them achieved well-controlled after 3 months. 1 of them took cyclosporine in addition to 300mg/4 weeks to reach well-controlled status. Conclusion(s): COVID-19 vaccination can be a cause of CSU. CSU after COVID-19 vaccination can be intractable to treatment with 4-fold increase of H1-antihistamines. Omalizumab works well to control CSU after COVID-19 vaccination.

Does Viral Anxiety Influence the Insomnia Severity Among Patients With Insomnia Disorder During COVID-19 Pandemic?

Background and Objective We aimed to investigate whether viral anxiety affects insomnia severity in patients with insomnia disorder during the coronavirus disease 2019 (COVID-19) pandemic. In addition, we examined whether viral anxiety mediates the influence of dysfunctional beliefs about sleep on insomnia severity. Methods The medical records of 111 patients who visit the sleep clinic from September 2021 to May 2022 were reviewed. Patients' symptoms were rated with rating scales including Insomnia Severity Index (ISI), Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), Dysfunctional Beliefs and Attitudes about Sleep-16 items (DBAS-16), Patient Health Questionnaire-9 items (PHQ-9), Epworth Sleepiness Scale, and discrepancy between desired time in bed and desired total sleep time (the DBST index). Results The SAVE-6 score was not significantly correlated with ISI score among insomnia patients. Linear regression analysis showed that the ISI score was expected by PHQ-9 (β = 0.21, p = 0.038) and DBAS-16 (β = 0.42, p < 0.001). Mediation analysis showed that viral anxiety did not mediate the influence of dysfunctional beliefs about sleep on insomnia severity. Conclusions We could not observe the mediating effect of viral anxiety on the association between dysfunctional beliefs about sleep on insomnia severity. Though COVID-somnia was one of big issues in this COVID-19 pandemic, the influence of virus on the severity of insomnia among insomnia patients needs to be interpreted cautiously © 2023 The Korean Society of Sleep Medicine

fvWillingness to Vaccinate Children against COVID-19 Declined During the Pandemic

Objectives To document the level of vaccine hesitancy in caregivers' of children younger than 12 years of age over the course of the pandemic in Pediatric Emergency Departments (ED). Study design Ongoing multicenter, cross-sectional survey of caregivers presenting to 19 pediatric EDs in the USA, Canada, Israel, and Switzerland during first months of the pandemic (phase1), when vaccines were approved for adults (phase2) and most recently when vaccines were approved for children (phase3). Results Willingness to vaccinate rate declined over the study period (59.7%, 56.1% and 52.1% in the three phases). Caregivers who are fully vaccinated, who have higher education, and those worried their child had COVID-19 upon arrival to the ED, were more likely to plan to vaccinate in all three phases. Mothers were less likely to vaccinate early in the pandemic, but this hesitancy attenuated in later phases. Older caregivers were more willing to vaccinate, and caregivers of older children were less likely to vaccinate their children in phase 3. During the last phase, willingness to vaccinate was lowest in those who had a primary care provider but did not rely on their advice for medical decisions (34%). Those with no primary care provider and those who do and rely on their medical advice, had similar rates of willingness to vaccinate (55.1% and 52.1%, respectively). Conclusions COVID-19 vaccine hesitancy is widespread and growing over time, and public health measures should further try to leverage identified factors associated with hesitancy in order to enhance vaccination rates among children.

Willingness to vaccinate children against COVID-19 declined during the pandemic.

OBJECTIVES: To document the level of vaccine hesitancy in caregivers' of children younger than 12 years of age over the course of the pandemic in Pediatric Emergency Departments (ED). Study design Ongoing multicenter, cross-sectional survey of caregivers presenting to 19 pediatric EDs in the USA, Canada, Israel, and Switzerland during first months of the pandemic (phase1), when vaccines were approved for adults (phase2) and most recently when vaccines were approved for children (phase3). RESULTS: Willingness to vaccinate rate declined over the study period (59.7%, 56.1% and 52.1% in the three phases). Caregivers who are fully vaccinated, who have higher education, and those worried their child had COVID-19 upon arrival to the ED, were more likely to plan to vaccinate in all three phases. Mothers were less likely to vaccinate early in the pandemic, but this hesitancy attenuated in later phases. Older caregivers were more willing to vaccinate, and caregivers of older children were less likely to vaccinate their children in phase 3. During the last phase, willingness to vaccinate was lowest in those who had a primary care provider but did not rely on their advice for medical decisions (34%). Those with no primary care provider and those who do and rely on their medical advice, had similar rates of willingness to vaccinate (55.1% and 52.1%, respectively). CONCLUSIONS: COVID-19 vaccine hesitancy is widespread and growing over time, and public health measures should further try to leverage identified factors associated with hesitancy in order to enhance vaccination rates among children.

Reforming global supply chain management under pandemics: The GREAT-3Rs framework

The recent outbreak of Coronavirus disease 2019 (COVID-19) has posed serious threats and challenges to global supply chain management (GSCM). To survive the crisis, it is critical to rethink the proper setting of global supply chains and reform many related operational strategies. We hence attempt to reform the GSCM from both supply and demand sides considering different pandemic stages (i.e., pre, during, and post-pandemic stages). In this research paper, we combine a careful literature review with real-world case studies to examine the impacts and specific challenges brought by the pandemic to global supply chains. We first classify the related literature from the demand and supply sides. Based on the insights obtained, we search publicly available information and report real practices of GSCM under COVID-19 in nine top global enterprises. To achieve responsiveness, resilience, and restoration (3Rs), we then propose the "GREAT-3Rs” framework, which shows the critical issues and measures for reforming GSCM under the three pandemic stages. In particular, the "GREAT” part of the framework includes five critical domains, namely, "government proactive policies and measures,” "redesigning global supply chains,” "economic and financing strategies under risk,” "adjustment of operations,” and "technology adoption,” to help global enterprises to survive the pandemic;"3Rs” are the outputs that can be achieved after using the "GREAT” strategies under the three pandemic stages. Finally, we establish a future research agenda from five aspects. © 2022 Production and Operations Management Society.

Impact of Face-to-Face Interactions and Digital Learning Platforms on Learning Motivation, Learning Achievements and Peer Interaction in After-School Activities

With modern technological advancements, the rise of digital learning has helped teachers and students in many ways;for example, learning is becoming increasingly learner centric. In recent years, learning has been compromised because of school suspensions due to the COVID-19 pandemic. Digital learning has helped to reduce the negative impacts on students' learning, and most students have shown a positive attitude toward digital learning. A learning management system provides a platform for learners to learn and interact with teachers or peers without time and space constraints. Moodle is one of the most popular and widely-used learning management systems. It is open source, offers different functional modules, and is available free of charge. However, according to recent literature, Moodle has several disadvantages. First, the topics discussed by students in the Moodle platform are not focused enough and not easy to be discussed in depth. Second, the interaction is not immediate because of a lack of instant notifications. Third, the interface is not user friendly and is thus difficult to operate. These drawbacks can hinder students' learning. Office 365 is another digital system that assists students' learning. Various functions of Office 365, such as Teams's real-time notifications and OneNote's recording function, complement Moodle. This study investigated the effects of after-school activities conducted through different media on students' motivation, learning achievement, and peer interaction. In present study, after-school activities were conducted face-to-face or via two learning platforms, Moodle and Office 365;the learning platform was considered the independent variables. In total, 143 middle school students were recruited as participants for an after-school activity and distributed into the face-to-face, Moodle, or Office 365 group. The quantitative data of three scales concerning with learning motivation, learning achievement and peer interaction were collected to represent their learning performance. Qualitative data were collected through textual analysis based on student responses to open-ended questions. The quantitative and qualitative data were then statistically analyzed with SPSS Statistics 23. The results of the quantitative analysis revealed the following results: (1) No significant difference was observed in learning motivation among the different groups. The reasons for the result may be that students were not familiar with learning management systems, the interface and function of the learning systems were complex, or student motivation to learn English was low. (2) The learning achievement of the face-to-face group was significantly higher than that of the Office 365 group. Office 365 has many functions, but it also increases the cognitive load on students. Additionally, middle school students in Taiwan are inexperienced with using learning management systems because of the lack of opportunities to do so. Furthermore, the focus of this research was not the formal school curriculum but after-school activities;therefore, gauging learning effectiveness was challenging. Finally, students are more familiar with face-to-face discussions, and this comfort increases the effectiveness of this mode of learning. (3) Students in the Office 365 group had a higher tendency to interact with peers than those in the face-to-face group. Interacting through Office 365 (as it provides voice and text input for discussions) removes the stress of public speaking, such as that experienced in face-to-face classes, thus increasing participation. However, the peer interaction in the Office 365 group was not significantly higher than that in the Moodle group because the students using Office 365 mainly used text input, which decreased the efficiency of their discussion. (4) Some groups of students using the learning management system (no matter Moodle group or Office 365 group) posted the answers to assignments in the chat room even before much group discussion, or they divided the work among themselves and not discussing the assignment at all. The students seemed to be unfamiliar with the way in which group discussions are conducted through digital learning platforms. This inexperience was reflected in their lack of teamwork. (5) The ratio of discussions students posted on the Moodle platform (Moodle group) was positively correlated with their learning achievement and interaction with peers. The ratio of discussions students posted on the Office 365 platform (Office 365 group) was positively correlated with their learning achievement and learning motivation. The results have several implications. First, teachers should consider the most appropriate form of discussion for middle school students when planning group discussion activities during and after lessons. Second, although middle school students are better at learning through face-to-face discussion, the demand for distance learning and the use of digital platforms are increasing. Teachers should encourage the use of digital platforms by planning more exercises to implement through these platforms, thus improving students' learning performance as well as their efficiency in using these platforms. Third, the students in the Office 365 group had a higher tendency to interact with peers than did those in the face-to-face group. Thus, teacher may use Office 365 initially to make students willing to use digital platforms and for them to get familiar with its usage. Once students are comfortable using the platform, teachers can shift the focus to enhancing the effectiveness of learning. Fourth, when students are engaged in group discussions in after-school activities, only a limited number of students may participate, or students may directly provide answers without discussing them with their peers. Providing students with instructions and training on conducting group discussions may help them make more effective use of learning management systems. Finally, regarding the design of learning management systems, the registration and login procedures should be simplified, and the platform interface and operating functions should be more effectively integrated to make them user friendly. Doing so may enable novices to start and consistently use these systems more easily and reduce the time required by users to familiarize themselves with such systems. © 2022, National Taiwan Normal University. All rights reserved.

Power transformation in quasi-likelihood innovations for GARCH volatility

This paper is concerned with power transformations in estimating GARCH volatility. To handle a semiparametric case for which the exact likelihood is not known, quasi-likelihood (QL) rather than maximumlikelihood method is investigated to best estimate GARCH via maximizing the information criteria. A power transformation is introduced in the innovation generating QL estimating functions and then optimum power is selected by maximizing the profile information. A combination of two different power transformations is also studied in order to increase the parameter estimation efficiency. Nine domestic stock prices data are analyzed to order to illustrate the main idea of the paper. The data span includes Covid-19 pandemic period in which financial time series are really volatile.

EEG Characteristics in Hospitalized Patients With Acute COVID-19 Symptoms

Objective Our objective was to evaluate the incidence of seizures, pattern of EEG abnormalities, and localization of abnormal discharges in hospitalized patients with COVID-19. Background The COVID-19 epidemic has revealed significant neurological manifestations including de novo seizures in patients who do not have a prior history of epilepsy or clear epilepsy risk factors. Our center is located in Arizona, which in the early part of January 2021 had more cases per capita than any other place in the world. Design/Methods We performed a retrospective review to observe the electroencephalogram (EEG) patterns of hospitalized adult patients with COVID-19 between March 2020 and February 2021. Results We identified 99 patients who were COVID-19 positive and had EEG testing during the same hospitalization. The most common EEG abnormality was diffuse background slowing, which was seen in 63.6% of patients (n = 63/99), compare to 15.1% of focal background slowing. Epileptiform discharges were seen in 11.1% of patients and seizures were found in 5.1% of patients, as newly diagnosed seizures. When combining all focal abnormalities, the most common location for these abnormalities was in the frontal regions 36.4% (n = 8/22). Even though 21 patients had acute focal neuroradiologic findings, only 5 had correlated EEG abnormalities within the same region. When EEG was obtained with suspected seizures (n = 33), 4 cases (12.1%, n = 4/33) indeed showed ictal pattern compared to 1.6% when seizures was not suspected (p = 0.087). Conclusions Abnormal EEG findings are most commonly found in the frontal lobe among hospitalized patients with acute COVID-19 symptoms. De novo seizures may be seen with COVID-19 infection. Suspicion of seizures should be raised in patients with COVID-19 encephalopathy. The utility of an EEG may help allow us better insight into how and where the COVID infection affects our central nervous system.

Signal Preprocessing Technique With Noise-Tolerant for RF-Based UAV Signal Classification

Since the beginning of the COVID-19 pandemic, the demand for unmanned aerial vehicles (UAVs) has surged owing to an increasing requirement of remote, noncontact, and technologically advanced interactions. However, with the increased demand for drones across a wide range of fields, their malicious use has also increased. Therefore, an anti-UAV system is required to detect unauthorized drone use. In this study, we propose a radio frequency (RF) based solution that uses 15 drone controller signals. The proposed method can solve the problems associated with the RF based detection method, which has poor classification accuracy when the distance between the controller and antenna increases or the signal-to-noise ratio (SNR) decreases owing to the presence of a large amount of noise. For the experiment, we changed the SNR of the controller signal by adding white Gaussian noise to SNRs of -15 to 15 dB at 5 dB intervals. A power-based spectrogram image with an applied threshold value was used for convolution neural network training. The proposed model achieved 98% accuracy at an SNR of -15 dB and 99.17% accuracy in the classification of 105 classes with 15 drone controllers within 7 SNR regions. From these results, it was confirmed that the proposed method is both noise-tolerant and scalable.

Internet of things based real-time coronavirus 2019 disease patient health monitoring system

The coronavirus disease (COVID-19) outbreak has led to many infected worldwide and has become a global crisis. COVID-19 manifests in the form of shortness of breath, coughing and fever. More people are getting infected and healthcare systems worldwide are overwhelmed as healthcare workers become exhausted and infected. Thus, remote monitoring for COVID-19 patients is required. An internet of things (IoT) based real-time health monitoring system for COVID-19 patients was proposed. It features monitoring of five physiological parameters, namely electrocardiogram (ECG), heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2) and body temperature. These vitals are processed by the main controller and transmitted to the cloud for storage. Healthcare professionals can read real-time patient vitals on the web-based dashboard which is equipped with an alert service. The proposed system was able to transmit and display all parameters in real-time accurately without any packet loss or transmission errors. The accuracy of body temperature readings, RR, SpO2 and HR, is up to 99.7%, 100%, 97.97% and 98.34%, respectively. Alerts were successfully sent when the parameters reached unsafe levels. With the proposed system, healthcare professionals can remotely monitor COVID-19 patients with greater ease, lessen their exposure to the pathogen, and improve patient monitoring. © 2022 Institute of Advanced Engineering and Science. All rights reserved.

Flipping the model: A novel approach to expand access and increase capture of ovarian cancer patients for genetic testing

Background Genetic testing for ovarian cancer patients is essential to consideration of PARP inhibitor therapy. To improve access, we piloted a Genetic Testing Station (GTS) which allowed patients to have a drop-in, same-day genetic testing visit facilitated by Genetic Counselor Assistants (GCAs) under the supervision of Genetic Counselors (GCs). Methods The GTS was implemented in December 2018 and operated through February 2020. Gynecologic Oncologist offered ovarian cancer patients a same-day GTS visit with a GCA, where the patient received education via videos designed by GCs. The patient also provided consent, a brief family history, and a sample for a standardized 133-gene panel. Results were provided by a telehealth or clinic visit with a GC. We compared uptake of genetic testing post-GTS, and also time from referral to delivery of testing results. Patients were retrospectively identified by querying the medical record for ovarian cancer patients seen 12 months prior to and 18 months after GTS implementation. Results A total of 482 patients pre-GTS were compared to 625 patients post-GTS. Genetic testing increased from 68.5% to 75.66665% (p = 0.012) after implementation of the GTS, with the majority of the increase in patients with epithelial histologies (80% vs 89% in pre-GTS vs post-GTS, p = 0.005). Time from referral to genetic testing to obtaining results was evaluated in the post-GTS cohort, comparing patients who had traditional counseling to those who utilized the GTS. The time to obtaining results was shorter in the GTS group at 21 days (95% CI [10, 34]) compared to 56 days (95% CI [41,76]) in the traditional genetic counseling group. Discussion The GTS reduces barriers to care and facilitates discussion of precision treatment and prevention strategies with patients and their families in a timely fashion while optimizing Genetic Counselor clinic time. Post-COVID, access improvement remains integral to improving uptake of genetic testing.

Effective Regulation of Gut Microbiota With Probiotics and Prebiotics May Prevent or Alleviate COVID-19 Through the Gut-Lung Axis.

Coronavirus disease 2019 (COVID-19) can disrupt the gut microbiota balance, and patients usually have intestinal disorders. The intestine is the largest immune organ of the human body, and gut microbes can affect the immune function of the lungs through the gut-lung axis. Many lines of evidence support the role of beneficial bacteria in enhancing human immunity, preventing pathogen colonization, and thereby reducing the incidence and severity of infection. In this article, we review the possible approach of modulating microbiota to help prevent and treat respiratory tract infections, including COVID-19, and discuss the possibility of using probiotics and prebiotics for this purpose. We also discuss the mechanism by which intestinal micro-flora regulate immunity and the effects of probiotics on the intestinal micro-ecological balance. Based on this understanding, we propose the use of probiotics and prebiotics to modulate gut microbiota for the prevention or alleviation of COVID-19 through the gut-lung axis.

Validation of the Russian version of Stress and Anxiety to Viral Epidemics - 9 items (SAVE-9) among healthcare workers during COVID-19 pandemic

Over the past two years, healthcare workers have been daily saving patients diagnosed with COVID-19 in life-threatening conditions. These circumstances contribute to an increase in the psychopathological disorders in this social group. However, today there is no validated questionnaire that allows to quickly and effectively identify the group of healthcare workers with high levels of stress and anxiety during the pandemic in Russia. Objective: to validate the Russian version of Stress and Anxiety to Viral Epidemic scale (SAVE-9). Patients and methods. The study was a cross-sectional online survey of 1090 frontline healthcare workers. Stress and anxiety symptoms were assessed using SAVE-9 and General Anxiety Disorder-7 (GAD-7) scales, respectively. Factor analysis with varimax rotation was performed to determine the internal structure of SAVE-9 scale. ROC-analysis was used to identify the validity of the SAVE-9 compared with GAD-7 and its cut-off score. Results and discussion. The principal component analysis showed a two-factor structure of SAVE-9. Factor 1 was associated with anxiety and somatic symptoms, factor 2 - with social stress. Cronbach's alpha=0,787. The total score of SAVE-9 with a high degree of confidence predicted the GAD-7 value in ROC-analysis. The area under the curve (AUC) was 0.808;95% confidence interval 0.768-0.847 (p=0.0001), which corresponded to the model's good quality. The appropriate cut-off score was determined as 18. Conclusion. We demonstrated the validity of the new SAVE-9 scale, which can be used as a specific screening method to detect high levels of anxiety and stress in healthcare workers during a viral outbreak.

Changes of neuropsychiatricsymptomsin patients with dementia during COVID-19 crisis: Telephone survey from the Yangcheon Dementia Reassurance Center

Objective: The purpose of this study was to investigate the changes in the neuropsychiatric symptoms of patients with dementia during the pandemic through the complete enumeration telephone survey in the caregivers of dementia patients who were registered at the database of Yangcheon Dementia Reassurance Center (YDRC) for Dementia. Background: It has been reported that the social isolation imposed by COVID-19 pandemic can have a major impact on the mental health of dementia patients. Design/Methods: There were a total of 2080 dementia patients on the database of YDRC who were registered as having dementia from 2008 ∼2020. From Mar to April in 2021, the telephone survey was conducted in all the caregivers with dementia on the database of YDRC. We asked whether the neuropsychiatric symptoms of patients were aggravated during COVID 19 and if they were, which neuropsychiatric symptoms were aggravated among the 12 symptoms of neuropsychiatric inventory (NPI): delusions, hallucinations, agitation/aggression, depression/dysphoria, anxiety, elation/euphoria, apathy/indifference, disinhibition, irritability/lability, aberrant motor behavior, disturbances of sleep, and disturbances of appetite/eating. Results: Among 2080 patients with dementia (mean age: 81.2 years, 66.8 % females), a total of 1038 caregivers of patients with dementia responded to the telephone survey. Among 1038 patients, 274 patients (26.4%) were reported to have at least one and more aggravating neuropsychiatric symptoms, especially depression/dysphoria (44.5 %), disturbances of sleep (9.5 %), and delusion (9.1 %). Conclusions: Given that patients'neuropsychiatric worsening is commonly associated with greater burden of the caregiver's, a more preemptive strategy to manage aggravating the neuropsychiatric symptoms from the Community Dementia Reassurance can help reduce difficulties of caregivers in this pandemic situation.

HEALTHCARE ACCESS among SOUTH AFRICAN YOUTH LIVING with & WITHOUT HIV during COVID-19

Background: We aimed to examine concerns surrounding COVID-19 infection and healthcare access among South African young people (YP) living with HIV (YPLWH) and HIV-uninfected YP with the goal of identifying differences between groups. Methods: We examined cross-sectional data from the baseline procedures of the BUDDY study conducted among YP (13-24 years) living with and without HIV in Cape Town, South Africa from February-September 2021. YPLWH were recruited from an HIV clinic and HIV-uninfected YP were recruited through community outreach. Adjusted prevalence ratios (aPRs) were computed to estimate associations between HIV cohort and COVID-19 testing, vaccine acceptance, and access to healthcare services since March 2020 controlling for participant age and gender. Results: A total of 535 participants were enrolled into the study, including 217 YPLWH and 318 HIV-uninfected YP. The median age, 19.1 years (IQR=16.6-21.5), was similar between groups. YPLWH were 58% female and HIV-uninfected YP were 78% female (p<.001). YPLWH were less than half as likely than HIV-uninfected YP to have received a COVID-19 test (6% vs 12%, aPR=0.48, 95% CI 0.26-0.89), to be willing to accept a COVID-19 vaccine (49% vs 59%, aPR=0.84, 95% CI 0.71-0.99), and to be concerned about becoming severely ill from COVID-19 (60% vs 76%, aPR=0.79, 95% CI 0.69-0.89). Perceived risk of becoming infected with COVID-19 in the next month was similar between YPLWH and HIV-uninfected YP (32% vs 36%). YPLWH were more likely than HIV-uninfected YP to report being unable to attend a healthcare appointment (27% vs 20%, aPR=1.39, 95% CI 1.01-1.90). Further, a greater proportion of YPLWH attempted to access condoms (aPR=1.51, 95% CI 1.32-1.74) and HIV/STI testing services (aPR=1.58, 95% CI 1.38-1.80) than HIV-uninfected YP and, among females who attempted to access contraceptives services, YPLYW reported significantly lower access than HIV-uninfected YP (aPR=0.82, 95% CI 0.71-0.94) (Table 1). Last, among YPLWH, 28% reported missing an HIV care appointment, 14% reported running out of their HIV medication, and 34% reported they were worried about running out of their medication since March 2020. Conclusion: Experiences living with HIV may shape concerns around COVID-19 infection among YP. YPLWH reported greater health-seeking behavior than HIV-uninfected YP and a significant proportion reported missing an appointment and running out of their HIV medication. Services should devise strategies to prevent interruptions in healthcare access among YP.

Stemming the Rise in Antibiotic Prescription for Community Acquired Respiratory Infections (ARI) during COVID-19 Pandemic in Singapore General Hospital (SGH)

Background. In early months of COVID-19 pandemic, SGH recorded a year-on-year increase in antibiotic (ABx) use for community acquired acute respiratory infection (CA ARI) from Feb-Apr 2019 (48.7 defined daily doses (DDD)/100 bed-days) to 2020 (50.8 DDD/100 bed-days). To address concerns of misuse, the antibiotic stewardship unit (ASU) expanded prospective audit feedback (PAF) to CA ARI patients admitted to ARI wards, with low procalcitonin (PCT). PAF was conducted on day 2-3 of ABx, on weekdays. Doctors received feedback to stop/ modify when ABx was deemed inappropriate. Here, we describe the impact of ASU's adaptive approach to curb rising ABx use in patients admitted for ARI during COVID-19 pandemic. Methods. A Pre- & Post-intervention study was conducted. All patients started on ABx (ceftriaxone/co-amoxiclav/piptazo/carbapenems/levofloxacin) for CA ARI & PCT < 0.5μg/L were analysed. Those who died ≤48h of admission;admitted to intensive care;required ABx escalation;>1 infective sites;complex lung infection were excluded. Primary objective was to compare the proportion of ABx stopped ≤4 days (time to final infection diagnosis) Pre (22/3-18/4/20) & Post (21/4-13/7/20). Results. 184 (Pre) & 528 (Post) ABx courses were analysed. ASU audited 51 (Pre) & 380 (Post) courses with the rest discontinued/discharged before review. Patients were largely similar in both periods;a third had low likelihood of bacterial infection (C reactive protein < 30mg/L). In Post, 73 feedback was given to stop ABx (often because symptoms suggested viral/fluid overload) & 18 to switch to oral ABx. 82 (90%) feedback was accepted. No ABx was restarted ≤48h or deaths ≤30 days due to ARI. 1 patient had C. difficile diarrhoea a day after ABx cessation as per ASU feedback. Proportion of all ABx stopped ≤4 days was higher in Post than Pre [27/184 (15%) vs 152/528 (29%), p< 0.01]. Median duration of therapy of IV ABx was reduced (6.5 vs 3 days, p< 0.01), with corresponding shorter median length of stay (10.5 vs 6 days, p< 0.01). Conclusion. PAF directly and indirectly reduced ABx duration in patients treated for CA ARI as prescribers become more conscious about stopping ABx when investigations show low likelihood of bacterial infection. ASU must remain agile during pandemics to detect emerging problems and adapt processes to counter early.