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Background: Five variants of concern (VOCs) have dominated COVID-19 disease etiology since 2020-Alpha, Beta, Gamma, Delta, and Omicron-possessing over 150 defining genomic alterations. Here, we used global proteomic and genomic approaches to study the host responses and selective forces driving VOC evolution. Method(s): We infected Calu-3 human lung epithelial cells with 5 VOCs and 2 wave 1 (W1) controls and performed mass spectrometry abundance proteomics, phosphoproteomics, and mRNA sequencing at 10 and 24 hours post infection. We additionally performed affinity purification mass spectrometry (APMS) by individually expressing all VOC mutant viral proteins (52) and corresponding W1 forms in human cells to quantify differential virus-host protein-protein interactions. Data was integrated using network modeling and bioinformatics to pinpoint VOC-specific differences. Four novel mutant viruses were developed using reverse genetics technology to validate the impact of specific genomic alterations. Result(s): We discovered VOCs evolved convergent molecular strategies to remodel the host response by modulating viral RNA and protein levels (most notably of N, Orf9b, and Orf6), altering nucleocapsid phosphorylation, and rewiring virus-host protein complexes. Integrative systems analyses revealed that Alpha, Beta, Gamma, and Delta ultimately converged in the suppression of interferon stimulated genes (ISGs) relative to W1 viruses, but Omicron BA.1 did not, and Delta induced more pro-inflammatory genes compared to other VOCs. Altered regulation of ISGs correlated with the expression of viral innate immune antagonist proteins, including Orf6, N, and Orf9b;for example, Omicron BA.1 depicted a 2-fold decrease in Orf6 expression. We identified mutations that alter expression of Orf9b (N D3L and N -3A del) and the novel VOC protein N* (N R203K/G204R), and confirmed Orf6 innate immune antagonism using recombinant virus technology. Remarkably, Omicron BA.4 and BA.5 regained strengthened innate immune antagonism compared to BA.1, which again correlated with enhanced Orf6 expression, though dampened in BA.4 by a mutation (D61L) that we discovered disrupts the Orf6-nuclear pore interaction. Conclusion(s): Collectively, our findings suggest SARS-CoV-2 convergent evolution overcomes human innate immune barriers, laying the groundwork to understand future coronavirus evolution associated with immune escape and enhanced human-to-human transmission.
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Foreign bodies (FBs) detection for X-ray images of textiles is a novel and challenging task. To solve the problem of poor performance of anchor-based detectors for FBs detection, we propose a feature-enhanced object detection framework with transformer (FE-DETR). Based on the split-attention of residual split-attention network (ResNeSt), we add convolutional block attention module (CBAM) between residual blocks and replace the $3\times $ 3 convolutional layer of the last residual block with deformable convolution network (DCN) to adapt FBs with different scales. Then, we propose a multiscale feature encoding (MSFE) module to solve the feature dispersion caused by deep convolution. Meanwhile, the transformer module is selected as the prediction head of the detector. During training, several heuristic strategies are used to further optimize the performance of FE-DETR. In addition, we construct a benchmark dataset for the textile FBs detection task. With end-to-end training, FE-DETR achieves higher performance than the baseline and mainstream state-of-the-art methods, with mean average precision (mAP) = 0.74, average precision (AP) = 0.992, average recall (AR) = 0.971, and $F1$ -score = 0.987. This article has been applied to the production line of medical protective clothing during the Corona Virus Disease 2019 (COVID-19) period and has yielded impressive results in actual production. © 1963-2012 IEEE.
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Purpose : Age-related macular degeneration (AMD), diabetic retinopathy (DR), and glaucoma are vision-threatening diseases (VTDs) affecting 36 million people in the USA. With 5.7 ophthalmologists per 100,000 Americans, over 50% of VTDs go undetected. We assessed deep learning Artificial Intelligence (DLAI) in VTD detection in community and clinical settings. Methods : 223 subjects (mean age 54.6, 58% male) from community screenings (A) and clinic (B) underwent 45-degree retinal imaging. In A (non-dilated), an onsite telemedicine reader (R1) and remote ophthalmologist (R2) graded image quality (gamma and alignment, 1-5 scale) and referable VTD using the international grading scales for AMD and DR, and cup-to-disc ratio and nerve fiber layer for glaucoma. In B (dilated), gradings were collected from R1 and the clinical diagnosis (d). A senior ophthalmologist (R3) adjudicated disputed findings. In A, DLAI VTD referral was compared to R1/R2/R3 consensus (S);in B, overall referral was compared to R1/d/R3 consensus (C). Images were uploaded to a cloud-based DLAI (SELENA+, EyRIS Pte Ltd) (Fig 1). Cohen's kappa assessed intergrader agreement. Results : R1 and R2 found 4.7% eyes ungradable. DLAI marked 55.6% ungradable;74.6% of them were for AMD. Of the DLAI ungradable eyes, image quality was ≤ 3, and 56.2% had ≥ 1+ cataract (R1). Compared to in A, in B DLAI had higher sensitivity (97.1% vs. 63.2%) and positive predictive value (69.4% vs. 32%). In A, DLAI had higher specificity (94.5% vs.16.7%) and negative predictive value (98.4% vs. 75.0%) (Table 1). In A, Cohen's kappa was 0.946 between R1 and R2, with a 13% disagreement rate. In 56% of the disagreements, R3 agreed with R1. In B, Cohen's kappa was 0.874 for R1 and d;R1 referred more than d. In A and B, DLAI referred more than R1, R2, and H/C. DLAI referred all eyes with > 1 VTD (1%) for further examination. Grading times for DLAI, R1, and R2 were 30, 129, and 68 seconds. Conclusions : DLAI performed best in DR and glaucoma detection;a potential solution for the high ungradable rate can be for DLAI to re-center uploaded images. DLAI can increase efficiency and accessibility of screenings for multiple VTDs, in both underserved populations and clinic. The ability to minimize direct contact confers an advantage during COVID-19. Further studies will investigate DLAI use in VTD progression.
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Purpose : Retinal imaging is the gold standard in tele-ophthalmology. Limitations in twodimensional imaging can lead to poor triage or unnecessary clinical referrals, especially during COVID-19. Combined retinal imaging with Optical Coherence Tomography-B scan (OCT-B) in detecting vision threatening diseases (VTDs) such as glaucoma in communitybased screenings adds a third dimension to subject data. Methods : A non-mydriatic Topcon 3D Maestro1 imaging system was deployed in this pilot study to screen 120 subjects (43.3% male, mean age 55.1) in community-based screenings. Measurements of vertical cup-to-disc ratio (VCDR), nerve fiber layer (NFL) thickness and macular and ganglion cell layer (GCL) thickness were collected along with color retinal images by the Maestro1. Visual acuity and intraocular pressures (IOP) were obtained as part of the screening protocol. Four types of OCTs were acquired: 78.33% 3D Wide, 13.33% 3D Macula, 5.83% 3D Disc, and 2.51% 5-Line Cross. An on-site certified reader (CR) interpreted results and provided consultation follow-up to a remote ophthalmic subspecialist. Results : Of 222 eyes, OCT-B confirmed follow-up in 86.94%. 88.3% of subjects had referable eye pathology: 23.33% to general or specialty eye clinic and 65% to telemedicine. CR glaucoma referral based on OCT-B scan, VCDR and NFL defects was compared to OCT-B referral based on VCDR ≥0.65. Cohen's kappa was 0.546 with 30% disagreement. Compared to CR, OCT-B generated VCDR had a 91.1% specificity and 42.3% sensitivity in detecting glaucoma. VCDR, IOP, NFL, and GCL measurements were significantly correlated with CR glaucoma referral (p<0.05). Only VCDR, NFL, and GCL were significantly correlated with Maestro 1 glaucoma referral (p<0.05). Conclusions : OCT-B images provide valuable added diagnostic information about referrals in glaucoma. Its ability to capture greater depth of information about the eye, such as NFL and GCL measurements, compared to traditional two-dimensional retinal photography, warrants consideration for OCT-B as a replacement for non-mydriatic retinal photography as the gold standard in ophthalmic diagnostics. Further studies can investigate the utility trend analysis of OCT-B in predicting VTD's progression over time.
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Purpose : Vision Threatening Diseases (VTDs) (age-related macular degeneration, cataracts, diabetic retinopathy, glaucoma) affect 36 million individuals in the United States. 50% are unaware they have a VTD, disproportionally affecting minorities and lowincome groups with less access to eye care. While screening programs in underserved communities result in early detection, less than half of subjects with findings follow up with a specialist. This number is four times lower during COVID-19. Methods : Robotic Telepresence (RT) was implemented in this pilot study during COVID19 to increase real-time access to specialist care. 58 subjects (age 56, 45% male) underwent a non-mydriatic screening protocol over five screenings. They were divided into three groups for consult: In Person (IP) followed by RT (N = 21), RT followed by IP (N = 19), and IP only (N = 18). IP consult was done by an on-site certified reader. RT consult was done by an off-site glaucoma or retina specialist with access to blood pressure, visual acuity, intraocular pressure, 45° retinal images, and ocular coherence tomography Bscans via cloud-based software. Video connection for RT was established via HIPAAcompliant mobile hotspot. Subject demographics and preferences were collected afterwards via survey. Results : Of 40 RT consults, 26 were second opinion for VTD suspect and 14 were wellness encounters. 24 reported their last eye care visit >3 years ago or never. Following RT consult, 18 subjects received one or multiple VTD diagnosis and 3 with glaucoma were referred for pressure-lowering eye drops. In the group with IP consult first, preferences were 5% RT, 52% IP, and 43% none. In the group with RT consult first, preferences were 5% RT, 58% IP, and 37% none. There was no significant difference in number of questions asked, wait time, or encounter length between IP and RT consults. Conclusions : RT consults proved valuable in community-based VTD screenings, particularly during COVID-19 when access to eye care is further limited. Most subjects preferred IP. However subjects with VTD that face socioeconomic barriers benefit from immediate RT consult and management directives from remote subspecialists. Further studies should incorporate consults from additional specialties (endocrinologists, general practitioners, social workers) and include telehealth CPT code for reimbursement.
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Nowadays, governments worldwide use artificial intelligence (AI), big data, cloud computing, and other technologies to control the spread of the epidemic. These measures significantly improve the efficiency of virus tracking. Nevertheless, such digital defences have also raised concerns about privacy leaks. Privacy concerns and use intention have been studied in several areas in the existing literature, but few have been explored in-depth based on epidemic prevention. Therefore, this paper focuses on the background of the novel coronavirus epidemic and constructs a structural equation model based on the theory of privacy concern and technology acceptance model. The research studies the influence of privacy concerns, perceived risk, and other factors on users’ willingness to use new technologies. Based on 132 samples, the results show that privacy concerns significantly impact perceived risk. Perceived trust has significant positive impacts on self-disclosure intention. This study discusses individual self-disclosure intention in the field of public security from multiple perspectives. The research results extend the relevant theories on adopting and using emerging technologies. This study provides ideas on how to alleviate residents' privacy concerns in practice and helps government departments to carry out better prevention work. © 2022 CURRAN-CONFERENCE. All rights reserved.
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The COVID-19 pandemic harms offline tourism activities. Tourism live streaming that combines tourism and live broadcasting has entered people's vision and achieved rapid development. But so far, there are few related studies and results. This study, based on SOR theory, regards tourism live streaming consumers as the research object, and data were collected from a sample of 313 consumers who often watch tourism live streaming and have purchase behaviors. The results show that visual effect and interactivity of tourism live streaming have a positive influence on tourism consumers' willingness to participate, while spatial presence and flow experience play a chain mediating role in it. This paper provides important theoretical and practical significance to the study of tourism live streaming and the promotion of high-quality integration of the online and offline tourism industry.
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Objective: To analyze whether there are differences and related influencing factors in liver injury associated with different strains of 2019-nCoV/SARS-CoV-2 infection. Methods: Data of epidemiology, clinical symptoms, laboratory tests, and treatment outcomes of patients with COVID-19 infection confirmed with Alpha and Delta virus strain in Zhejiang Province were retrospectively collected. Statistical analysis was performed using independent samples t-test or Mann-Whitney U test, χ2 test or Fisher's exact test, and logistic regression analysis. Results: A total of 788 and 381 cases with Alpha and Delta virus strain were included. Vaccination ratio was 0% in Alpha and 85.30% in Delta group (P<0.001), The proportion of patients with fever (80.71% vs. 40.94%, P<0.001) was significantly higher in Alpha than Delta strain group. The proportion of critical ill patients was significantly higher in Delta group (9.90% vs. 1.57%, respectively, P<0.001). The virus negative conversion time was significantly longer in Delta than Alpha group (22 d vs. 11 d, P<0.001), but the incidence of liver injury was significantly higher in Alpha than Delta group (20.05% vs. 13.91%, P=0.011). Univariate analysis showed that Alpha virus strain infection, male sex, body mass index, chronic liver disease, fever, diarrhea, shortness of breath, severe/critical illness, elevated creatine kinase (CK), elevated international normalized ratio (INR) and an elevated neutrophil/lymphocyte ratio was significantly associated with an increased risk of liver injury occurrence, and in patients with pharyngeal pain the risk of liver injury occurrence was significantly reduced. Multivariate analysis showed that shortness of breath [OR, 2.667 (CI: 1.389-5.122); P=0.003], increased CK [OR, 2.544 (CI: 1.414-4.576); P=0.002] and increased INR [OR, 1.721] (CI: 1.074-2.758); P=0.024] was significantly associated with an increased risk of liver injury occurrence, and in patients with pharyngeal pain the risk of liver injury occurrence was significantly reduced [OR, 0.424 (CI: 0.254-0.709); P=0.001]. Conclusion: Although the virulence of the Delta is stronger than Alpha strain, most patients infected with Delta strain vaccinated against COVID-19 in Zhejiang province had milder clinical symptoms and a lower incidence and degree of liver injury. Notably, the infection risk even remains after vaccination; however, symptoms and the incidence of severe and critical illness can be significantly reduced.
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COVID-19 , Critical Illness , Dyspnea , Fever , Humans , Liver , Male , Pain , Retrospective Studies , SARS-CoV-2ABSTRACT
As world space launch activities have entered an intensive stage, how to effectively improve efficiency, reduce costs, and enhance the ability to go into space while ensuring reliability and safety has become an important factor in measuring space capabilities. The launch vehicle must fly reliably and stably, and send the satellite into the predetermined orbit accurately. Not only is the important role of the systems on the vehicle, but ground testing and launch control also play a vital role in ensuring the success of the launch vehicle mission. The emergence of COVID-19 in early 2020 also challenged the personnel-intensive industrial model. Intelligent, unmanned, efficient, and system will be the dominant model in the future. This paper reviews the development status of the world's launch vehicle test launch technology, analyzes the capabilities and shortcomings of existing test launch technology, and proposes the development trend of future launch vehicle test launch technology based on new technologies emerging from the new round of scientific and technological revolution. The outlook for next-generation test launch system is also presented. Future test launch technologies will highlight the three characteristics of digitalization, networking and intelligence. Digitization lays the foundation for test launch informationization. Its development trend is big data analysis and application, replacing the existing software tools to extract, store, search, share, analyze, and process massive and complex data sets to achieve depth test launch data mining and maximum value. Networking provides a physical carrier for information dissemination. Its development trend is the adoption of Cyber-Physical Systems (CPS), integrated computing, communication, and control. Through networking, ground test transmitting equipment has computing, communication, precise control, remote coordination, autonomy and other functions. Intelligence reflects the level of information application. Its development trend is a new generation of artificial intelligence. According to the requirements of vehicle launch, it could quickly generate data and upload binding. Through intelligent detection methods, it could complete the required operations, inspections and tests before launching, and achieve autonomous vehicle launching. In the future, intelligent cyber-physical fusion system based on big data will become the mainstream direction of rocket vehicle test launch technology, which will further simplify operations, improve efficiency, reduce costs, and achieve the goal of "launch during transport". © 2021 by the International Astronautical Federation (IAF). All rights reserved.
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In the past few years, with the continuous breakthrough of technology in various fields, artificial intelligence has been considered as a revolutionary technology. One of the most important and useful applications of artificial intelligence is face detection. The outbreak of COVID-19 has promoted the development of the noncontact identity authentication system. Face detection is also one of the key techniques in this kind of authentication system. However, the current real-time face detection is computationally expensive which hinders the application of face recognition. To address this issue, we propose a face verification framework based on adaptive cascade network and triplet loss. The framework is simple in network architecture and has light-weighted parameters. The training network is made of three stages with an adaptive cascade network and utilizes a novel image pyramid based on scales with different sizes. We train the face verification model and complete the verification within 0.15 second for processing one image which shows the computation efficiency of our proposed framework. In addition, the experimental results also show the competitive accuracy of our proposed framework which is around 98.6%. Using dynamic semihard triplet strategy for training, our network achieves a classification accuracy of 99.2% on the dataset of Labeled Faces in the Wild. © 2022 Jianhong Lin et al.
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Quantified components of the global food system are used to assess long-term global food security under a series of socio-economic, epidemic normalization and climate change scenarios. Here, we evaluate the global food security including the global farming system as well as the global food trade, reserve and loss systems from 1961 to 2019, and analyze their temporal and spatial characteristics by using the global food vulnerability (GFV) model. The spatio–temporal patterns of the vulnerability of the global food system were consistent with the GFSI. As food production and consumption vary greatly in different countries which have continued for a long time, food exports from many developed agricultural countries have compensated for food shortages in most countries (about 120 net grain-importing countries). As a result, many countries have relied heavily on food imports to maintain their domestic food supplies, ultimately causing the global food trade stability to have an increasing impact on the food security of most countries. The impact of global food trade on global food security increased from 9% to 17% during 1961–2019, which has increased the vulnerability of the global food system. The food damage in the United States, Russia, China, and India has varied significantly, and global cereal stocks have fluctuated even more since 2000. From 1961 to 2019, the food system security of some Nordic countries significantly improved, while the food system security of most African countries significantly deteriorated. Most countries with high food insecurity are located in Africa and South Asia. In order to cope with extreme events, these countries need to strengthen and improve their own food production and storage systems, which will help the World Food and Agriculture Organization to formulate relevant food policies and maintain sustainable development. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
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Objective: To explore the risk factors for early clinical recurrence of inflammatory bowel disease (IBD) after fecal microbiota transplantation (FMT). Methods: A retrospective study was conducted on 192 patients with IBD who received FMT treatment in the Colorectal Disease Specialty/Intestinal Microecology Treatment Center of the Tenth People’s Hospital Affiliated to Tongji University from February 2017 to June 2020. Univariate and multivariate logistic regression models were used to analyze the risk factors for early recurrence of inflammation. Feces from all participants were collected to extract the total bacterial genomic DNA. The V6-8 regions of the bacterial 16S rDNA gene were amplified by polymerase chain reaction (PCR), the PCR products were detected by the denaturing gradient gel electrophoresis (DGGE) method, and the intestinal flora was analyzed by DNA fingerprinting. Stool samples from all patients were tested for 9 bacteria, white blood cells (WBC) and platelet (PLT) counts, as well as the erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) level. Results: Of the 192 patients, 15 cases had inflammation recurrence during FMT and within one week after treatment, including 11 cases of ulcerative colitis (UC) and 4 cases of Crohn’s disease (CD), with a total recurrence rate of 7.8%. High Mayo inflammatory activity score, Mayo endoscopic sub-item score (MES) =3 points, CRP>10 mg/L, anemia, albumin <30 g/L, absolute value of peripheral blood lymphocytes (PBL) <500/mm3, and intolerance to enteral full nutrition were independent risk factors for recurrence during and after FMT in UC patients (P<0.05). Albumin <30 g/L and simultaneous use of immunosuppressive agents were associated with disease recurrence during and after FMT in CD patients. WBC, PLT, and CRP were all negatively correlated with Enterococcus (EC), and ESR was positively correlated with Saccharomyces boulardii (SB) (P<0.01). Conclusion: The low recurrence rate of IBD after FMT indicates the safety of FMT, but this procedure should be cautiously used in patients with severe intestinal barrier dysfunction and/or severe intestinal dysfunction.
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[Figure: see text].
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Background: Kidney impairment is observed in patients with COVID-19. The effect of anti-COVID-19 agent remdesivir on kidneys is currently unknown. We aimed to determine the effect of remdesivir on renal fibrosis and its downstream mechanisms. Methods: Remdesivir and its active nucleoside metabolite GS-441524 were used to treat TGF-β stimulated renal fibroblasts (NRK-49F) and human renal epithelial (HK2) cells. Vehicle or remdesivir were given by intraperitoneal injection or renal injection through the left ureter in unilateral ureteral obstruction (UUO) mice. Serum and kidneys were harvested. The concentrations of remdesivir and GS-441524 were measured using LC-MS/MS. Renal and liver function were assessed. Renal fibrosis was evaluated by Masson's trichrome staining and Western blotting. Results: Remdesivir and GS-441524 inhibited the expression of fibrotic markers (fibronectin and aSMA) in NRK-49F and HK2 cells. Intraperitoneal injection or renal injection of remdesivir attenuated renal fibrosis in UUO kidneys. Renal and liver function were unchanged in remdesivir treated UUO mice. Two remdesivir metabolites were detected after injection. Phosphorylation of Smad3 that was enhanced in cell and animal models for renal fibrosis was attenuated by remdesivir. In addition, the expression of Smad7, an anti-fibrotic factor, was increased after remdesivir treatment in vitro and in vivo. Conclusions: Remdesivir inhibits renal fibrosis in obstructed kidneys.
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To investigate the relationship between emotional status and physical activity in adolescents during the epidemic period of Corona Virus Disease 2019. 600 junior and senior high school students from three municipal middle schools were randomly selected as the research objects. The self-evaluation of anxiety and depression and the evaluation of physical activity were carried out in the form of questionnaire survey. A total of 600 questionnaires were put in and 562 were recovered. The scores of SDS and SAS were 49.30 ± 7.02, and 53.42 ± 5.37 respectively. According to different age groups, there was significant difference in SAS among the three groups in different age groups (P <0.05). The total score of PA was (3.24 ± 0.98). According to different age groups, there were significant differences in PA total score, MVPA activities, physical education activities, weekend activities and one week total activities among the three groups (P <0.05). The total score of anxiety was negatively correlated with the total score of PA (r = −0.54, P = 0.024), MVPA (r = −0.38, P = 0.049) and physical education (r = −0.62, P = 0.016), and the total score of one week was negatively correlated (r = −0.44, P = 0.041). During the period of Corona Virus Disease 2019 epidemic, the anxiety level of adolescents increases with age, while the physical activity status decreases gradually, and is negatively correlated with anxiety. It is necessary to strengthen sports activities and protect emotional health in this special period. © 2021, ICST Institute for Computer Sciences, Social Informatics and Telecommunications Engineering.
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Purpose : Vision Threatening Diseases (VTD) (age-related macular degeneration [AMD], cataract, diabetic retinopathy [DR], and glaucoma) account for 37% of all blindness. Screening and follow-up are crucial in preserving vision. During COVID-19, clinics reduced access, using telemedicine for diagnosis and follow-ups. The efficacy of remote screening and triage in the management of single or multiple VTDs was evaluated. Methods : We screened 41 subjects (19-85 years, 37% male, 17% Caucasian) (20 controls, 21 subjects). Demographics, 45-degree retinal photos, ganglion cell complex (GCC), and optic nerve head (ONH) images were collected using a non-contact puff-tonometer, nonmydriatic retinal camera, and an OCTA. Demographics and images were transmitted to two readers (onsite telemedicine screener [TS] and remote ophthalmologist [RO]) for triage. Triage was categorized: immediate referral to specialist, follow-up in person via clinic or telemedicine visit, or no follow-up necessary during COVID. Results : TS made 19 referrals (46%), 6 in person follow-ups (15%), 15 no follow-ups (37%);RO made 17 referrals (41%), 2 in person follow-ups (5%), 22 no follow-ups (54%). TS identified 12 subjects as possible VTD(s) while RO identified 11 subjects. TS and RO agreed on 8 glaucoma, 7 cataract, 3 DR, and 3 and 2 AMD cases, respectively. Glaucoma was identified using IOPs, retinal fundoscopy, and OCT imaging. Mean intraocular pressures were 12.9 and 15.7 (OD, OS) in glaucoma and 14.2 and 14.0 in controls. Fundoscopy was used for overall retinal health while OCT images were used to analyze GCC, ONH, nerve fiber layer, cup to disc ratio, and anterior chamber angles. AMD and DR were identified by fundoscopy and OCT imaging. 11 of the subjects were known clinic patients;both RO and TS referred all 11 to specialty clinics, matching the in-person clinic management. Conclusions : During the COVID pandemic, triaging patients can minimize person-toperson contact and help control the spread of the virus. Both readers agreed on the management and triage of a variety of patients with TS and RO differing only on 2 referrals and 4 in person follow-ups. Telemedicine is a promising alternative to in-person patient care for management and triage of vision threatening diseases. Further enrollment and follow-up are needed to increase robustness.
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Purpose : The Centers for Disease Control reports 28.2% of surveyed US adults had reduced access to medical care (June/August 2020) due to the COVID-19 pandemic, with 8.9% reporting reduced access to vision care. A non-mydriatic digital retinal camera was piloted for deployment to the Emergency Department (ED) to help address this gap in vision care. Referrals for clinical follow-up in vision threatening diseases (VTDs) such as age-related macular degeneration, cataracts, diabetic retinopathy (DR), and glaucoma were assessed with human readers. Artificial Intelligence (AI) deep learning software was evaluated in known DR cases. Methods : 33 patients with known VTDs (48.48% male, avg 59.33 years) and 36 control subjects (41.67% male, avg 31.33 years) were included in tele-ophthalmology screening. A Canon CR-2 Plus AF non-mydriatic retinal camera captured 45-degree angle color and auto-fluorescence images of the eyes. Images (136 eyes) were graded by a certified telemedicine reader on site and an off-site clinical ophthalmologist following International Clinical Diabetic Retinopathy Disease Severity Scale (ICDRSS). Intergrader agreement between readers was evaluated with Cohen's kappa. An automated deep learning screening software optimized for DR (SELENA+, EyRIS Pte Ltd, Singapore) performed independent validation of readable color fundus images (17 eyes). Results : 5.07% of images were deemed unreadable by graders due to poor quality. Intergrader agreement for subject referral was κ = 0.710 (95% CI 0.545-0.875, p<.0005), with the clinical ophthalmologist generating more referrals than the telemedicine reader. Readers had 96.97% sensitivity (95% CI 91.12-1.028) and 72.22% specificity (95% CI 57.59- 86.85) in detecting referable disease. Positive predictive value was 76.19% (CI 63.31%- 89.07%) and negative predictive value was 96.30% (CI 89.17%- 1.034%). Of the 10 false positives, 6 were referred for rule out of glaucoma. Four had early stage cataracts that were deemed nonurgent. SELENA+ referred 100% of the known 9 DR patients. Conclusions : Tele-ophthalmology deployment in the ED helps limit patient and staff exposure to SARS-CoV-2 without sacrificing evaluation for VTDs. Tele-ophthalmology readers err on the side of caution to avoid missing VTD in a given patient. Use of AI can help keep strict adherence to referral guidelines.
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Purpose : Coronavirus-19 (COVID-19) has had immense effects on access to medical care. Loss of medical care is alarming for individuals with pre-existing conditions like Type 1 Diabetes Mellitus (T1DM) which require uninterrupted care for best outcomes. Consistent care and medication use can reduce risk of developing diabetic retinopathy (DR) by 76% or progression by 54%. Healthy habits have also been linked to reduced risk of DR. The purpose of this study is to assess the effect of COVID-19 on care access and health habits in individuals with T1DM Methods : Surveys were administered from July-November of 2020 to multinational groups including the Children with Diabetes Conference (USA) and online groups, the American Diabetes Association and Connected in Motion Canadian Conference for T1DM. Data was collected from 125 patients from the USA, UK, Canada, and Bolivia. Age range was 5-81, and average years with T1DM was 17.9. The survey was online so responder rate is unclear, though response rates from previous surveys with similar groups averaged less than 10%. Results : While 73.6% of respondents saw an ophthalmologist within 1 year and 98.4% had medication without rationing, 40% postponed medical visits. Reasons for postponement included lack of appointments or transportation, financial issues and safety concerns. The majority (86.4%) were from the US where private insurance is prevalent, 12% were from Europe and Canada, where socialized medicine is common. Of respondents, 90.4% are willing to use telemedicine as an alternative. For most, diet remained the same (48.8%);25.6% stated their diet was healthier and 20% stated their diet was less healthy. 16.8% had problems accessing their usual foods due to the pandemic. A majority (55.2%) reported decreased exercise with 18.4% reporting more exercise. These overall trends were consistent across countries, and gender trends remained the same as pre-COVID, with women having better lifestyle and medical care adherence. Conclusions : Though patients delayed appointments, most were able to see an ophthalmologist and access medication. Physical activity levels decreased, though diets were mostly unchanged. In individuals with T1DM, disruptions in medical care and health habits can have negative long-term outcomes on overall and eye health. Telemedicine offers a promising solution for mitigating this risk.
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During the last decade, the art industry and especially the museums, the art galleries and the auctions has stagnated due to the global financial crisis (2007–2017) and latest lockdowns brought by the Covid-19 pandemic (2020-). Many art institutions introduced digital technologies into their operations and transitioned to the online art market. Visits to art exhibitions include interaction with other visitors of similar interests. Hence, digital art venues must create the same environment vibes and offer similar opportunities as the physical ones. The paper indicates the application of the avatar technology as an interaction method in digital museum spaces. It also provides the functional requirements, a navigation process, and the implementation scenarios for the adaptation of such technologies. The application of this digital strategy can transform the art market, contribute to the museum’s sustainability, and offer the public different ways of learning and entertainment. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.