Child neurology telemedicine: Analyzing 14 820 patient encounters during the first year of the COVID-19 pandemic

Aim: To determine the long-term impact of telemedicine in child neurology care during the COVID-19 pandemic and with the reopening of outpatient clinics. Method(s): We performed an observational cohort study of 34 837 in-person visits and 14 820 telemedicine outpatient visits across 26 399 individuals. We assessed differences in care across visit types, time-period observed, time between follow-ups, patient portal activation rates, and demographic factors. Result(s): We observed a higher proportion of telemedicine for epilepsy (International Classification of Diseases, 10th Revision G40: odds ratio [OR] 1.4, 95% confidence interval [CI] 1.3-1.5) and a lower proportion for movement disorders (G25: OR 0.7, 95% CI 0.6-0.8;R25: OR 0.7, 95% CI 0.6-0.9) relative to in-person visits. Infants were more likely to be seen in-person after reopening clinics than by telemedicine (OR 1.6, 95% CI 1.5-1.8) as were individuals with neuromuscular disorders (OR 1.6, 95% CI 1.5-1.7). Self-reported racial and ethnic minority populations and those with highest social vulnerability had lower telemedicine participation rates (OR 0.8, 95% CI 0.8-0.8;OR 0.7, 95% CI 0.7-0.8). Interpretation(s): Telemedicine continued to be utilized even once in-person clinics were available. Pediatric epilepsy care can often be performed using telemedicine while young patients with neuromuscular disorders often require in-person assessment. Prominent barriers for socially vulnerable families and racial and ethnic minorities persist.Copyright © 2022 Mac Keith Press.

One-Year Real-Time Measurement of Black Carbon in the Rural Area of Qingdao, Northeastern China: Seasonal Variations, Meteorological Effects, and the COVID-19 Case Analysis

In this paper, we report the results obtained from one year of real-time measurement (i.e., from December 2019 to November 2020) of atmospheric black carbon (BC) under a rural environment in Qingdao of Northeastern China. The annual average concentration of BC was 1.92 +/- 1.89 mu g m(-3). The highest average concentration of BC was observed in winter (3.65 +/- 2.66 mu g m(-3)), followed by fall (1.73 +/- 1.33 mu g m(-3)), spring (1.53 +/- 1.33 mu g m(-3)), and summer (0.83 +/- 0.56 mu g m(-3)). A clear weekend effect was observed in winter, which was characterized by higher BC concentration (4.60 +/- 2.86 mu g m(-3)) during the weekend rather than that (3.22 +/- 2.45 mu g m(-3)) during weekdays. The influence of meteorological parameters, including surface horizontal wind speed, boundary layer height (BLH), and precipitation, on BC, was investigated. In particular, such BLH influence presented evidently seasonal dependence, while there was no significant seasonality for horizontal wind speed. These may reflect different roles of atmospheric vertical dilution on affecting BC in different seasons. The oBC/oCO ratio decreased with the increase of precipitation, indicative of the influence of below-cloud wet removal of BC, especially during summertime where rainfall events more frequently occurred than any of other seasons. The bivariate-polar-plot analysis showed that the high BC concentrations were mainly associated with low wind speed in all seasons, highlighting an important BC source originated from local emissions. By using concentration-weighted trajectory analysis, it was found that regional transports, especially from northeastern in winter, could not be negligible for contributing to BC pollution in rural Qingdao. In the coronavirus disease 2019 (COVID-19) case analysis, we observed an obvious increase in the BC/NO2 ratio during the COVID-19 lockdown, supporting the significant non-traffic source sector (such as residential coal combustion) for BC in rural Qingdao.

The clinical value of ultrasound in the assessment of the severity of COVID-19

Objective: To summarize the ultrasound manifestations of lung lesions in patients with coronavirus disease 2019 (COVID-19), and explore the clinical value of ultrasonography in assessing the severity of the disease. Methods: Thirty-one patients with COVID-19 admitted to the Fifth Affiliated Hospital of Sun Yat-sen University from January 18 to February 5, 2020, were selected as the research subjects. All of them underwent dynamic lung ultrasound. Their lung lesions were observed, and the lung ultrasound score (LUS) was performed, respectively. The correlations between the LUS and the disease classification, the LUS and the blood oxygenation index (PaO2/FiO2) were analyzed, respectively. The relationship between the corresponding change of clinical classification and the LUS score when it progressed to moderate/severe was analyzed as well. Results: Among the 31 patients with COVID-19, two (6.5%) had no apparent lesions at the ultrasound, with the LUS score of 0. Twenty-nine (93.5%) showed abnormities at the ultrasound, with the LUS score from 1-26, and the main manifestations were B-line signs. Among them 6 (19.4%) had the "white lung signs", and 13 (41.9%) had pulmonary consolidations. The LUS score was positively correlated with the clinical classification (rs=0.683 2, P<0.001) and negatively correlated with PaO2/FiO2 (r=-0.864 3, P<0.001). In the initial and dynamic ultrasonography, 13 patients were graded as moderate/severe according to their LUS scores, and the accuracy of the LUS in assessing severe/critical patients was 81.3% (13/16). It was 1-3 days earlier for the LUS progressing to moderate/severe than clinical classification. Conclusions: Pulmonary ultrasound manifestations of patients with COVID-19 have specific characteristics mainly showing as lung interstitial lesions, which can be combined with pulmonary consolidation. Ultrasound can be used in the assessment of the severity of COVID-19 noninvasively and guide clinical treatment. © 2020 Chinese Medical Association

Implementation of an online treatment planning exercise focused on vulnerable patient groups.

The coronavirus disease 2019 (COVID-19) pandemic presented formidable challenges in our ability to impart in-person extra-mural clinical training, including the Geriatric and Special Needs Program, to a group of 20 fourth-year dental students. A new course delivery format was developed wherein students used a validated Rapid Oral Health Deterioration (ROHD) risk assessment tool to critically appraise clinical case information relating to a young adult with special needs. In the alternative virtual educational approach that was created, students applied an interprofessional practice concept leading to patient treatment planning outcomes. Providing adequate information, additional reading resources, a response template, clear instructions and a process-oriented assessment policy all ensured a good level of participation from students in the alternative learning format. An association was noted between students' staging of risk for ROHD and their subsequent recommendations for treatment.