ABSTRACT
Globalization has facilitated fast spread of COVID-19 cutting across political boundaries and even the remote locations have not been spared. Spread of the contagion is studied in the Himalayan province of Uttarakhand in India that is generally visited by pilgrims and tourists in large numbers from across the country and abroad. Despite restrictions on travel, the virus has spread even to the remote locations of the province. The study analyzes the efforts put in by the provincial government and the pace of spread as a function of geographical remoteness, together with the constraints faced by the administration and disaster managers in restricting the spread. The study highlights the important lessons which would help the management of future pandemics. The chapter at the same time highlights limited involvement of medical community in disaster management which is generally limited to post-disaster casualty management, triage, first aid, medical care, and psychosocial support. © 2022 Elsevier Inc. All rights reserved.
ABSTRACT
The COVID-19 pandemic led to the closure of educational institutions across India, which meant that all schooling activities shifted overnight to online platforms. This posed a problem for students from low-income communities who may not have the necessary infrastructure to participate fully in online school. To mitigate this, the Government of Delhi introduced a worksheet based education system for all public schools in the national capital to ensure no student was denied education. This paper discusses a qualitative study conducted between July to December 2020 with grade 10 students from Delhi public schools, their teachers and parents to understand: (1) the effect of a new shared home-school context and (2) the emergence of a 'Worksheet School' infrastructure created to facilitate learning and teaching in low-resourced schools. We reveal how the home as a new site for learning affected students' participation in online school, how the worksheets were re-purposed to support schooling activities and how WhatsApp was used for delivering educational instructions and the fostering of community learning. We discuss implications for equitable access to online learning materials and future work that aims to further study online learning environments in low-resource communities. © 2021 ACM.
ABSTRACT
Introduction: We assess early hearing preservation (HP) outcomes of patients implanted with the new Slim 20 lateral wall array (CI624);compare early HP outcomes with and without real-time electrocochleography (RT-ECochG);and explain the role of RT-ECochG feedback to improve HP. We believe this abstract is suitable for a late-breaking abstract as we are the first to report early HP outcomes for a new Slim 20 lateral wall electrode (CI624). Since the CI624's release in May 2020, it is becoming increasingly popular among centers as a potential HP array. To our knowledge, there have not been any discussions at major conferences or published studies reviewing experiences with the CI624. Based on our early experience with 29 implantations using this electrode, we have found poor HP outcomes 1 month postoperatively with preservation in only 16 of the recipients. As a result, we began using real-time monitoring of cochlear health during the insertion (ie, electrocochleography [ECochG]) to potentially improve HP outcomes with the CI624. By using real-time ECochG (RT-ECochG) and particularly focusing on minimizing trauma at the end of insertion, we achieved superior early HP rates with this array (8/9 patients, 88.9%). Our preliminary data suggest that full insertion of the CI624 without ECochG results in unpredictable and relatively poor HP outcomes. We suspect that this is related to the CI624 being a longer electrode than previous hybrid arrays resulting in trauma to the apical-most hair cells and neural elements at full insertion. Thus, RT-ECochG may be required for predictable early HP using the CI624. As a result of the COVID-19 pandemic, we were unable to achieve sufficient implantations for submission of an abstract in January 2021. However, we have now performed 9 implants with the CI624 in the past 6 months using RT-ECochG for HP candidates. We believe that our experience with and without ECochG has resulted in an early critical finding that may influence how this implant is used in HP candidates. Methods: A longitudinal study was designed with postlinguistically deafened adults undergoing implantation with CI624 from 2020 to 2021. Pure-tone audiometry preoperatively and 1 month postoperatively were obtained. HP was defined as low-frequency pure-tone average (LFPTA;125, 250, 500 Hz) <80 dB. Intracochlear RT-ECochG was used to guide insertion for 9 patients. When there was >5 μV ECochG response drop, array adjustments (ie, withdrawal ∼1 mm, 5° anti-modiolar rotation) were made to facilitate response recovery. Results: A total of 38 implants were performed. There was no scalar translocation on postoperative CT scans and mean apical insertion angle was 338.1° ± 86.4°. Full insertion was performed in most cases;however, partial insertion was performed if the RT-ECochG response dropped during insertion of the final 3 electrodes (n = 4). Of the 29 patients where RT-ECochG was not used, 16 (55.2%) had low-frequency HP postoperatively with preoperative LFPTA 42.4 ± 16.4 dB and threshold shift to 83.9 ± 27.8 dB. Among the 9 patients where RT-ECochG was used, 8 (88.9%) had low-frequency HP postoperatively with preoperative LFPTA 46.5 ± 16.0 dB and threshold shift to 62.6 ± 19.0 dB. Difference between threshold shift postoperatively with and without RT-ECochG was significant (P = .002, Mann-Whitney U test). Conclusion: RT-ECochG-guided insertion may be required for consistent HP outcomes following CI624 implantation. This may allow the surgeon to decide the depth of electrode insertion in the effort to preserve low-frequency hearing. Further investigation is needed to evaluate whether long-term HP can be maintained using CI624.
ABSTRACT
Purpose : Nd:YAG laser capsulotomy (YAG) is a common procedure with infrequent adverse events. We reviewed intraocular pressure (IOP) measurements 30 minutes after YAG in glaucomatous and non-glaucomatous eyes and a one-week post-op dilated fundus exam (DFE) to detect retinal tear (RT) and detachment (RD). We are interested in the utility of these same day and one-week visits, especially in glaucoma patients and in this COVID19 era. Methods : We analyzed 1,406 eyes from 1,138 patients who received YAG from 2011 to 2020 at the University of Florida. Exclusion criteria included YAG performed for reasons other than posterior capsular opacification, IOP not recorded and glaucoma status not analyzed. IOP (pre-op, 30 minutes post-op and at follow-up), follow-up DFE and glaucoma history were recorded. Primary outcome measures were change in IOP at same day and one-week post-op visits and incidence of RT and RD. Statistical analyses were conducted in IBM SPSS Statistics. Pre-op and same day post-op IOP in all patients (N=578) and in glaucoma patients (N=93) were compared with paired ttest. Univariate regression analysis was performed to assess if glaucoma history predicted which patients would have a rise in IOP of 5mmHg or more. ANOVA was used for comparison of intergroup difference between pre-op, same day post-op, and follow-up. Results : There was no significant change in mean pre-op and post-op IOP in all patients (p = 0.557), nor in the glaucoma patients (p = 0.194). Many patients (68.9%, N=404) were given a drop of brimonidine prior to YAG procedure. 69 patients had a rise in IOP of 5 mmHg or more at 30 minutes following YAG, including 13/93 (14%) of glaucoma eyes and 56/485 (12%) of non-glaucoma eyes. An IOP spike of 10mmHg occurred in 9 of these eyes of which 1 eye had glaucoma (1%) and 8 did not (89%). Using binary logistic regression, we found that glaucoma was not predictive for rise in IOP of 5mmHg or more following YAG (OR 1.23;95% CI=0.64-2.34). No patients had RT or RD detected during one-week follow-up visit. Conclusions : There is no significant change in IOP in all patients and in glaucoma patients. Glaucoma was not considered a risk factor for rise in IOP. YAG does not seem to increase the risk of RT or RD. In this COVID-19 era, when all practitioners aim to decrease in-person visits, small changes on a large scale can make an impact. If validated, our results bring into question the necessity of post-op visits after YAG.