A Quantitative Evaluation of a Live Remote Proctoring Pilot

The COVID-19 pandemic has witnessed a renewed interest in Live Remote Proctoring (LRP), not only as a test availability measure but as a necessity to maintain business continuity. Many certification organizations have correspondingly provided LRP as an option for candidates. This study describes a retrospective, observational pilot study evaluating modality effects for three high-stakes certification examination programs administered concurrently in test center and LRP conditions. Also reported are summaries of a post-examination survey assessing drivers for selection of testing condition and candidate satisfaction, particularly with aspects of the LRP experience. Significant differences were observed in both distributions of test scores and test duration (both higher for test center candidates). Although explanatory variables are not completely understood, the authors offer insights as to factors influencing these outcomes. While satisfaction levels with LRP were reasonably positive, significant technical issues were reported by LRP candidates. The primary drivers for the selection of LRP were safety concerns related to the pandemic, simple convenience, and lack of test center availability.

Negative consequences of failing to communicate uncertainties during a pandemic: an online randomised controlled trial on COVID-19 vaccines.

OBJECTIVE: To examine the impact of the government communicating uncertainties relating to COVID-19 vaccine effectiveness on vaccination intention and trust after people are exposed to conflicting information. DESIGN: Experimental design where participants were randomly allocated to one of two groups. SETTING: Online. PARTICIPANTS: 328 adults from a UK research panel. INTERVENTION: Participants received either certain or uncertain communications from a government representative about COVID-19 vaccine effectiveness, before receiving conflicting information about effectiveness. MAIN OUTCOME MEASURES: Vaccination intention and trust in government. RESULTS: Compared with those who received the uncertain announcement from the government, participants who received the certain announcement reported a greater loss of vaccination intention (d=0.34, 95% CI (0.12 to 0.56), p=0.002) and trust (d=0.34, 95% CI (0.12 to 0.56), p=0.002) after receiving conflicting information. CONCLUSIONS: Communicating with certainty about COVID-19 vaccines reduces vaccination intention and trust if conflicting information arises, whereas communicating uncertainties can protect people from the negative impact of exposure to conflicting information. There are likely to be other factors affecting vaccine intentions, which we do not account for in this study. TRIAL REGISTRATION NUMBER: Open Science Framework: https://osf.io/c73px/.

Negative consequences of failing to communicate uncertainties during a pandemic: an online randomised controlled trial on COVID-19 vaccines

Objective To examine the impact of the government communicating uncertainties relating to COVID-19 vaccine effectiveness on vaccination intention and trust after people are exposed to conflicting information. Design Experimental design where participants were randomly allocated to one of two groups. Setting Online. Participants 328 adults from a UK research panel. Intervention Participants received either certain or uncertain communications from a government representative about COVID-19 vaccine effectiveness, before receiving conflicting information about effectiveness. Main outcome measures Vaccination intention and trust in government. Results Compared with those who received the uncertain announcement from the government, participants who received the certain announcement reported a greater loss of vaccination intention (d=0.34, 95% CI (0.12 to 0.56), p=0.002) and trust (d=0.34, 95% CI (0.12 to 0.56), p=0.002) after receiving conflicting information. Conclusions Communicating with certainty about COVID-19 vaccines reduces vaccination intention and trust if conflicting information arises, whereas communicating uncertainties can protect people from the negative impact of exposure to conflicting information. There are likely to be other factors affecting vaccine intentions, which we do not account for in this study. Trial registration number Open Science Framework: https://osf.io/c73px/.

Continuous positive airway pressure as a useful tool in coronavirus disease 2019-related acute hypoxemic respiratory failure: experience from three UK hospitals

Background Many coronavirus disease 2019 (COVID-19) patients suffering acute hypoxemic respiratory failure (AHRF), fail to respond to conventional oxygen therapy (COT). Subsequently, some centers escalate to continuous positive airway pressure (CPAP), while others resort directly to invasive mechanical ventilation (IMV). We conducted a study to compare the use of CPAP versus COT alone in COVID-19-related AHRF. Patients and methods It is a retrospective cohort study of laboratory-confirmed COVID-19 patients suffering AHRF and deemed eligible for IMV escalation at three university hospitals (United Kingdom) during a 3-month period. The primary endpoint was the need for intubation and the secondary endpoint was 60-day mortality. Results In total, 174 patients were included. In total, 84 patients received CPAP (group 1) and 90 received only COT (group 2). Both groups had comparable demographic criteria and disease severity. There was nonsignificant reduction in the need for IMV when using CPAP compared with COT alone (50 vs. 76.6%, P=0.866). Sixty-day mortality was significantly higher in group 2 (25 vs. 37.8%, P=0.02). COT as stand-alone therapy for COVID-19 patients (group 2) was associated with a significant increased relative risk of death (relative risk 2.14, 95% confidence interval 1.39–3.29) corresponding to a number needed to treat of 3.74 (95% confidence interval 2.47–7.73). Among patients who progressed to IMV, there was no difference in the risk of mortality between the two groups. Conclusion Introducing CPAP rather than escalating FiO2 or endotracheal intubation in COVID-19 cases refractory to COT is safe and associated with improved mortality. Clinical trials are needed to guide the optimum timing and selection of patients most likely to benefit.

MaLang: A Decentralized Deep Learning Approach for Detecting Abusive Textual Content

Cyberbullying is a growing and significant problem in today’s workplace. Existing automated cyberbullying detection solutions rely on machine learning and deep learning techniques. It is proven that the deep learning-based approaches produce better accuracy for text-based classification than other existing approaches. A novel decentralized deep learning approach called MaLang is developed to detect abusive textual content. MaLang is deployed at two levels in a network: (1) the System Level and (2) the Cloud Level, to tackle the usage of toxic or abusive content on any messaging application within a company’s networks. The system-level module consists of a simple deep learning model called CASE that reads the user’s messaging data and classifies them into abusive and non-abusive categories, without sending any raw or readable data to the cloud. Identified abusive messages are sent to the cloud module with a unique identifier to keep user profiles hidden. The cloud module, called KIPP, utilizes deep learning to determine the probability of a message containing different categories of toxic content, such as: ‘Toxic’, ‘Insult’, ‘Threat’, or ‘Hate Speech’. MaLang achieves a 98.2% classification accuracy that outperforms other current cyberbullying detection systems.

Mental Health Issues During and After COVID-19 Vaccine Era.

The COVID-19 pandemic has persisted for more than a year, and post-COVID-19 sequelae of neurological complications, including direct and indirect effects on the central nervous system (CNS), have been recognized. There is a plethora of evidence for neurological, cognitive, and emotional deficits in COVID-19 patients. Acute neurological symptoms like neuroinflammation, cognitive impairment, loss of smell, and brain stroke are common direct effects among SARS-CoV-2 infected individuals. Work-associated stress, lockdowns, social distancing, and quarantine in response to contain SARS-CoV-2 have also affected the mental health of large populations, regardless of age. Public health emergencies have affected individuals and communities, resulting in emotional reactions and unhealthy behaviors. Although vaccines have been widely distributed and administered among large populations, vaccine hesitancy still exists and may be due to apprehension about vaccine efficacy, preliminary trials, and associated side effects. This review highlights the impact of COVID-19 on the CNS by outlining direct and indirect effects and factors contributing to the decline in people's mental health throughout the COVID-19 pandemic both during and after vaccine administration. Furthermore, we also discuss reasons for vaccine hesitancy and why some groups of people are deprived of vaccines. Finally, we touched upon the social determinants of mental health and their impact on disadvantaged populations during times of crisis which may help policymakers set up some action plans to mitigate the COVID-19 mental health turmoil during this ongoing pandemic.

Therapeutic implications of SARS-CoV-2 dysregulation of the gut-brain-lung axis.

The emergence and rapid spread of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused over 180 million confirmed cases resulting in over 4 million deaths worldwide with no clear end in sight for the coronavirus disease 19 (COVID-19) pandemic. Most SARS-CoV-2 exposed individuals experience mild to moderate symptoms, including fever, cough, fatigue, and loss of smell and taste. However, many individuals develop pneumonia, acute respiratory distress syndrome, septic shock, and multiorgan dysfunction. In addition to these primarily respiratory symptoms, SARS-CoV-2 can also infiltrate the central nervous system, which may damage the blood-brain barrier and the neuron's synapses. Resultant inflammation and neurodegeneration in the brain stem can further prevent efferent signaling to cranial nerves, leading to the loss of anti-inflammatory signaling and normal respiratory and gastrointestinal functions. Additionally, SARS-CoV-2 can infect enterocytes resulting in gut damage followed by microbial dysbiosis and translocation of bacteria and their byproducts across the damaged epithelial barrier. As a result, this exacerbates pro-inflammatory responses both locally and systemically, resulting in impaired clinical outcomes. Recent evidence has highlighted the complex interactions that mutually modulate respiratory, neurological, and gastrointestinal function. In this review, we discuss the ways SARS-CoV-2 potentially disrupts the gut-brain-lung axis. We further highlight targeting specific responses to SARS-CoV-2 for the development of novel, urgently needed therapeutic interventions. Finally, we propose a prospective related to the individuals from Low- and Middle-Income countries. Here, the underlying propensity for heightened gut damage/microbial translocation is likely to result in worse clinical outcomes during this COVID-19 pandemic.

CPAP as a useful tool in COVID-19 related Acute Hypoxemic Respiratory Failure: Experience from 3 UK Hospitals (preprint)

Introduction: Severe acute hypoxemic respiratory failure (AHRF) in COVID-19 pneumonia is associated with a high mortality rate, resulting in mounting pressures on intensive care units worldwide. Different oxygenation management protocols are used in different centres. Most centres switch patients who fail to oxygenate adequately using conventional oxygen therapy (COT) methods to non-invasive positive pressure ventilation (NIPPV), usually continuous positive airway pressure (CPAP). Other centres resort to invasive mechanical ventilation (IMV) directly, without a trial of NIPPV. In this trial, we aim to compare the efficacy of different approaches in managing COVID-related AHRF, and ascertain if CPAP therapy reduces the need for IMV. Methods: We carried out a retrospective cohort study on patients with laboratory-confirmed COVID-19 at three university hospitals in Essex, United Kingdom. We included all patients with significant AHRF (defined as needing oxygen therapy FiO2 more than 0.4 to maintain an oxygen saturation of 92%) who were deemed eligible for IMV escalation during a 3-month period (1st March to 31st May 2020).Results: Out of 174 patients who met the criteria, 84 patients received CPAP (Group 1). Half needed intubation (n=42). 90 patients did not have a CPAP trial (Group 2). 76.6% needed intubation (n=69). No difference was found between the two groups in demographic criteria or disease severity. Our results show a significant difference in 60-day mortality between group 1 and 2 (25% versus 37.8%, p=0.02). COT as standalone therapy for COVID-19 patients (group 2) was associated with a trend of more increased risk of intubation and an increased relative risk of death (RR 2.14, 95% CI 1.39 to 3.29). This corresponds to a number needed to treat (NNT) of 3.74 (95% CI 2.47 to 7.73). Patients in group 1 who failed CPAP trial and required intubation did not have an increased risk of mortality when compared to group 2 patients who required intubation.Conclusion: Our results support introducing CPAP rather than escalating FiO2 in cases refractory to COT. Our study suggests CPAP can be safely used to treat patients with AHRF. Clinical trials are needed to guide recommendations for optimum timing and selection of patients most likely to benefit.

Correlation of chest radiography findings with the severity and progression of COVID-19 pneumonia.

PURPOSE: Aim is to assess the temporal changes and prognostic value of chest radiograph (CXR) in COVID-19 patients. MATERIAL AND METHODS: We performed a retrospective study of confirmed COVID-19 patients presented to the emergency between March 07-17, 2020. Clinical & radiological findings were reviewed. Clinical outcomes were classified into critical & non-critical based on severity. Two independent radiologists graded frontal view CXRs into COVID-19 pneumonia category 1 (CoV-P1) with <4 zones and CoV-P2 with ≥4 zones involvement. Interobserver agreement of CoV-P category for the CXR preceding the clinical outcome was assessed using Kendall's τ coefficient. Association between CXR findings and clinical deterioration was calculated along with temporal changes of CXR findings with disease progression. RESULTS: Sixty-two patients were evaluated for clinical features. 56 of these (total: 325 CXRs) were evaluated for radiological findings. Common patterns were progression from lower to upper zones, peripheral to diffuse involvement, & from ground glass opacities to consolidation. Consolidations starting peripherally were noted in 76%, 93% and 48% with critical outcomes, respectively. The interobserver agreement of the CoV-P category of CXRs in the critical and non-critical outcome groups were good and excellent, respectively (τ coefficient = 0.6 & 1.0). Significant association was observed between CoV-P2 and clinical deterioration into a critical status (χ2 = 27.7, p = 0.0001) with high sensitivity (95%) and specificity (71%) within a median interval time of 2 days (range: 0-4 days). CONCLUSION: Involvement of predominantly 4 or more zones on frontal chest radiograph can be used as predictive prognostic indicator of poorer outcome in COVID-19 patients.

Pneumatosis intestinalis in a patient with COVID-19.

A 73-year-old man with significant medical history including renal transplantation and chronic immunosuppression presented to the hospital with acute respiratory failure. His initial treatment included steroids for concern for Pneumocystis jiroveci pneumonia, although this was later excluded as the diagnosis. The patient's illness was consistent with COVID-19; however, he was not diagnosed with the virus until late in his course. The patient was found to have pneumatosis intestinalis that was successfully managed conservatively. Despite his multiple medical comorbidities, the patient had a positive outcome following COVID-19 infection. We discuss the association of pneumatosis intestinalis and COVID-19, and we investigate the various factors, including immunosuppression, that could play a role in this patient's successful recovery from the virus.