Evaluation and Management of Dysphagia During the COVID-19 Pandemic

Dysphagia is a common symptom which requires a multidisciplinary approach to its assessment and management. Currently, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the novel coronavirus disease 2019 (COVID-19) pandemic. Reports of SARS-CoV-2 dissemination via droplet and aerosol production imply risks of virus transmission by both. The risk of transmission of SARS-CoV-2 during nasal endoscopic procedures has elicited concern from clinicians and other healthcare workers regarding the level of personal protective equipment required during any transnasal procedure. SARS-CoV-2 infection has a variety of clinical manifestations of which pneumonia is the most devastating and which may potentially be fatal. Complications after prolonged endotracheal intubation or tracheostomy are common and include dysphagia. Poor lung function following recovery from pneumonia is an underrated precipitating factor for dysphagia. Multiple cranial nerve neuropathies are a more common direct cause of dysphagia that require urgent evaluation and treatment to avoid the complications of aspiration pneumonia that may compound the existing pneumonia caused by SARS-CoV-2. A videofluoroscopic study of a patient with dysphagia after recovering from COVID-19 will likely demonstrate significant impairment of their oral and pharyngeal phase of swallowing. A practical workflow for assessing and managing dysphagia during the COVID-19 pandemic is crucial to ensure the safety of both patients and healthcare workers. Critical considerations include the reservation of instrumental assessments for urgent cases only, the optimization of the non-instrumental swallowing evaluation, the appropriate use of personal protective equipment (PPE), and the use of telemedicine when appropriate. Despite significant limitations in the clinical service provision during the current COVID-19 pandemic, a safe and reasonable dysphagia care pathway can still be implemented with an understanding of safety precautions, modifications of the investigation setup and with the application of newer technologies. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Easy-to-Deploy Combined Nasal/Throat Swab Robot With Sampling Dexterity and Resistance to External Interference

Robots have been used extensively in the battle against the COVID-19 pandemic since its outbreak. One prominent direction is the use of robots for swab sampling, which not only solves the shortage of medical staffs, but also prevents them from being infected during face-to-face sampling. However, a massive deployment of sampling robots is still not achievable due to their high costs, safety concerns, deployment complexity, and so on. In this letter, we propose a flexible, safe, and easy-to-deploy swab robot in a compact bench-top system. The robot can perform nasal/throat swab sampling tasks as dexterous as a human manual operation. The bio-mimetic rigid interior and soft exterior design guarantee the sampling robot with both flexibility and safety. Furthermore, the integration of 3-D fiber Bragg grating (FBG) based shape sensor and multi-axis force sensor may enhance the control performance. A dedicated constrained compliance control (CCC) algorithm was developed to tackle the unexpected interactions during sampling, which ensures the validity and safety of the sampling under disturbance. Various experiments are conducted to validate our system and prove its feasibility, flexibility, high safety, and efficiency for both nasal/throat swab sampling tasks. The proposed system is promising to be massive duplicated for robotic swab sampling.

Bio-inspired Soft (BIS) Hand for Tele-operated COVID-19 Oropharyngeal (OP) Swab Sampling

The lasting difficulty imposed by the COVID-19 pandemic has made profound challenges to our daily lives. The prominent task to contend with the COVID-19 is the diagnosis of the SARS-CoV-2 virus. The timely diagnosis guides further anti-infection measurements such as effective quarantine and dedicated therapy. Existing diagnosis majorly relies on manual face-to-face Oropharyngeal (OP) and Nasopharyngeal (NP) sampling, which results in high infection risk and heavy working burden to medical staff. Robotic sampling is a promising solution for this challenge because robots are intrinsically immune to viruses and working without fatigue. Following this target, we demonstrate our novel teleoperated OP swab sampling system with excellent safety guarantees, quick deployability, and task efficacy. A bio-inspired soft hand integrated with a soft wrist is developed, which can pick and manipulate the disposable swab as dexterous as a human hand. Stereo imaging is provided to the operator by a terminal binocular camera. The design, working mechanism, and control of our sampling system are discussed. Results show that our proposed robotic sampling system promises safe and effective OP swab sampling to protect medical staff and convenient the sampling process.

Effect of wearing an N95 respirator on the internal nasal valve and the association with external nasal anatomy - a cohort study.

OBJECTIVES: To determine whether: the N95 respirator affects nasal valve patency; placement on the bony vault improves patency; and external nasal anatomy affects the outcome. METHODS: A prospective study with 50 participants was conducted. Nasal patency was measured by the minimal cross-sectional area via acoustic rhinometry, and using the Nasal Obstruction Symptom Evaluation survey, before and after wearing the N95 respirator and after adjustment. RESULTS: The minimal cross-sectional area was narrowed by 27 per cent when wearing the N95 respirator (p < 0.001), and improved by 9.2 per cent after adjustment (p = 0.003). The total Nasal Obstruction Symptom Evaluation score increased from 10.2 to 25.4 after donning the N95 respirator (p < 0.001), and decreased from 25.4 to 15.6 after adjustment (p < 0.001). There was no correlation with external nasal anatomy parameters. CONCLUSION: Wearing the N95 respirator causes narrowing of the nasal valve, and adjustment onto the bony vault improves symptoms. The findings were not affected by external nasal anatomy.

Investigating the Online Learning Experience of College Students during COVID-19

During COVID-19, China launched a large-scale online teaching practice of 'Disrupted classes, Undisrupted Learning.' Based on the existing online learning experiences scale, this study used a random sample to investigate the online learning experience of 387 college students from 29 provinces (cities) of China. The independent sample t-test was used to analyze the gender and regional differences in the online learning experience of college students. This study found that females had higher self-reported anxiety than males in online learning under the influence of the pandemic, which confirmed the physiological differences caused by gender differences in emergencies to a certain extent. College students in rural areas are significantly lower than students in urban areas in terms of family support, technical support, online interaction, and online engagement, but college students in rural areas are significantly higher than those in urban areas in terms of learning anxiety. The conclusions of this study provide constructive suggestions for online education in the post-pandemic era. © 2021 IEEE.

COVID-HateBERT: A Pre-trained Language Model for COVID-19 related Hate Speech Detection

With the dramatic growth of hate speech on social media during the COVID-19 pandemic, there is an urgent need to detect various hate speech effectively. Existing methods only achieve high performance when the training and testing data come from the same data distribution. The models trained on the traditional hateful dataset cannot fit well on COVID-19 related dataset. Meanwhile, manually annotating the hate speech dataset for supervised learning is time-consuming. Here, we propose COVID-HateBERT, a pre-trained language model to detect hate speech on English Tweets to address this problem. We collect 200M English tweets based on COVID-19 related hateful keywords and hashtags. Then, we use a classifier to extract the 1.27M potential hateful tweets to re-train BERT-base. We evaluate our COVID-HateBERT on four benchmark datasets. The COVID-HateBERT achieves a 14.8%-23.8% higher macro average F1 score on traditional hate speech detection comparing to baseline methods and a 2.6%-6.73% higher macro average F1 score on COVID-19 related hate speech detection comparing to classifiers using BERT and BERTweet, which shows that COVID-HateBERT can generalize well on different datasets. © 2021 IEEE.

Utilization of the Youth Quitline as an opportunity for an undergraduate nursing students to deliver smoking cessation counseling as their clinical placement: An implementation of a service-learning model.

BACKGROUND: Smoking is an important modifiable risk factor of morbidities and mortality. Although healthcare professionals play an important role in smoking cessation, their adoption of such practices is relatively low because of inadequate training. To address this issue, we incorporated a service-learning model to operate the Youth Quitline. Undergraduate nursing students were trained and received supervision while delivering smoking cessation counseling through the Youth Quitline as their clinical placement. OBJECTIVES: We evaluated the effectiveness of the placement by assessing students' knowledge, attitudes and practices regarding smoking cessation and tobacco control. DESIGN: One-group pretest-posttest design. SETTING: Youth Quitline. PARTICIPANTS: A total of 61 third-year students in a mental health nursing program. METHODS: Students were required to complete 80 h at the Youth Quitline. The 80 h were divided into 20 sessions; students used four sessions to approach and recruit youth smokers in the community, then provided them with telephone counseling for the rest of the time. Prior to the placement, students attended a 2-day workshop. The outcomes were changes in students' knowledge, attitudes and practices regarding smoking cessation and tobacco control 3 months after the placement compared with baseline. RESULTS: From January-June 2021, students conducted 105 outreach activities to identify 3142 smokers in the community, and provided telephone counseling for 336 smokers via Youth Quitline. Compared with baseline, significant improvements were observed in students' knowledge, attitudes and practices regarding smoking cessation and tobacco control at 3-month follow-up. CONCLUSIONS: The clinical placement improved students' knowledge, attitudes and practices regarding smoking cessation and tobacco control, enhancing their competency in providing support to assist smokers to quit in their future practice. Incorporating the service-learning model in existing community-based services can provide additional venues for nursing students to practice. This is particularly important because many venues have restricted access during the COVID-19 pandemic.

Rapid cardiovascular magnetic resonance protocol utilizing compressed sensing real time imaging during the COVID-19 pandemic

Background: Coronavirus Disease 2019 (COVID-19) poses many workflow challenges for healthcare systems. Elective cardiovascular magnetic resonance (CMR) exams were postponed until safety protocols were instituted. Since reopening, imaging labs are managing COVID-19 safety triaging, exam backlog, and increased referrals, thus innovative solutions for process improvement are needed. Purpose: An accelerated compressed sensing (CS) real-time (RT) technique offers dynamic cardiac imaging with high spatial and temporal resolution without image degradation. We sought to evaluate the efficiency of a rapid RT CMR protocol with a goal to decrease scan time without compromising study quality and comprehensiveness. Methods: We retrospectively evaluated 219 CMRs (Siemens Magnetom Sola 1.5T) performed 09/01/2020-10/15/2020. After excluding 81 exams due to heterogeneous protocols (Figure 1), we analyzed 138 CMR exams using standard cardiomyopathy or myocarditis protocols. CMR studies utilized either a rapid RT short axis (SAX) cine (spatial resolution of 2.5 mm2 or better and temporal resolution of 55 ms or better) or standard breath-held (BH) SAX cine protocol (Figure 2). Protocols were chosen by the interpreting physician. Previous internal quality control demonstrated similar volumetric quantification between RT and BH SAX cines. RT cines were reconstructed inline using a CS-based method. We analyzed the length of time needed to complete each protocol and the number of series performed. Statistical analysis included student t-test with p value <0.05 considered significant. Results: of 138 analyzed CMR exams, there were 23 rapid protocols and 115 standard protocols performed. The mean image acquisition time for the rapid protocol was significantly shorter at 26 ± 6 minutes (range 18-44 min) vs 33 ± 6 minutes (range 22-49 min) for the standard protocol, p < 0.001. This represents a mean relative reduction in scan time of 21%. More time was saved in rapid myocarditis (scan time 25 ± 6 min vs 34 ± 6 min, p = 0.01;relative time reduction 26%) vs rapid cardiomyopathy protocols (scan time 27 ± 6 min vs 31 ± 6 min, p = 0.04;relative time reduction 13%). There was no significant difference in the number of series performed (62 ± 14 series in rapid vs 67 ± 11 series in standard protocols, p = 0.09). T1 and T2 maps constituted the same percentage of acquired images regardless of protocol used (T1 maps 1.8% vs 1.7% for cardiomyopathy, 1.4% vs 1.4% for myocarditis in standard vs rapid protocols respectively;T2 maps 1.8% vs 1.7% for cardiomyopathy, 5.6% vs 5.8% for myocarditis in standard vs rapid protocols respectively). Conclusions: A rapid CMR protocol utilizing a CS-based RT imaging is significantly shorter as compared to the standard protocol with adequate diagnostic quality. Rapid CMR protocols are an effective tool for process improvement during the COVID-19 pandemic.

Probes of whole network course of laboratory diagnostics under the background of pandemic situation

Laboratory diagnostics is a booming medical applied subjects. With the continuous enrichment of the content and the enhancement of its role in diagnosis, it has increasingly become a compulsory course for all medical students. Because the subject has many individual theoretical disciplines and application technologies, the traditional on-site teaching mode has been greatly challenged. Especially under the background of the pandemic, it is more difficult for the teaching by the online course totally. For this reason, the measures of key sessions,such as through preparation and peer review before the class, online question and answer between teachers and students, reviewing homework after the class and recording video for probation purpose were summarized and reviewed. The online course mode was supposed to realize "non-stop teaching during pandemic", but also realize the double guarantee of teaching plan and teaching effect, which provide experience for expanding the whole network course of laboratory diagnostics.

Active components and mechanism of Tibetan medicine Gentiana straminea against cytokine storm

Objective: To analyze the main active components and possible mechanism of Mahuaqinjiao (Gentiana straminea) in the preventive treatment of cytokine storm by network pharmacology. Methods: The therapeutic targets for cytokine storms and its active ingredients of G. straminea were searched and collected from the database of TCMSP and GeneCards;The regulatory network map of active component cytokine storm targets of G. straminea was constructed by using Cytoscape 3.6.1;The network map of protein-protein interaction was constructed to screen the core target, and the gene ontology (GO) function enrichment analysis and KEGG pathway enrichment analysis of the core protein were carried out by using the online database of DAVID. Results: After screening, 14 active components and 31 effective targets for prevention and treatment of cytokine storm were obtained, mainly including IL6, STAT3, Jun, AKT1, EGFR, MMP9, VEGFA, IL-1β, IL-10, and other core targets. Go analysis showed that G. straminea mainly involved in the regulation of apoptosis, gene expression, cytokine activity, positive regulation of nitric oxide biosynthesis, growth factor activity, immune response and other processes. KEGG pathway analysis showed that the main pathways related to cytokine storm were T-cell receptor signaling pathway, JAK STAT signaling pathway, HIF-1 signaling pathway, tumor necrosis factor signaling pathway, Toll like receptor signaling pathway, PI3K Akt signaling pathway and other core target pathways. Conclusion: Based on the data mining of network pharmacology, the potential active components and possible mechanism targets of G. straminea against cytokine storm were predicted preliminarily, in order to provide reference for the application of G. straminea in the prevention and control of cytokine storm, and provide ideas for the development of new uses of G. straminea.