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Introduction: Pediatric eye care access, particularly in rural areas, has been an ongoing concern. The COVID-19 pandemic has led to a growing appreciation and acceptance of a role for telemedicine in pediatric eye care. However, many at-home visual acuity (VA) charts and apps have poor test design or inaccurate optotype sizes, and may passively provide misinformation for clinical decision making.1-3 We evaluated the new M&S EyeSimplify At-Home Visual Acuity Tests, which include web-based versions of the ATS-HOTV and E-ETDRS tests commonly used in clinical trials. Method(s): Children with and without VA deficits were enrolled. In-office VA was tested with the M&S Smart System ATS-HOTV (ages 3-6;N = 34;68 eyes) or E-ETDRS (ages 7-12;N = 31;62 eyes) protocol. The child was registered on the EyeSimplify web-based portal and the parent was emailed a link to the at-home VA test. The portal notified us when at-home testing was completed and provided us on-line access to VA results. Equivalence of the two test settings was evaluated by mean difference and 95% limits of agreement (LOA) using Bland-Altmann analysis. Result(s): The mean difference between in-office and at-home was small for both ATS-HOTV (0.01 + 0.08 logMAR) and E-ETDRS 0.04 + 0.08 logMAR;95% LOA = -0.15 to 0.17 and -0.11 to 0.19, respectively, comparable to test-retest agreement in an office setting. Conclusion/Relevance: The M&S EyeSimplify At-Home Visual Acuity Tests provided VA equivalent to in-office testing. If the burden of travel is significant, at-home testing may provide the information needed to continue care via telemedicine consultation when it might otherwise be discontinued or delayed.Copyright © 2022
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ObjectiveDigital health (DH) is the integration of technologies to tackle challenges in healthcare. Its applications include mobile health, remote & wireless healthcare, artificial intelligence, and robotics. Digital technologies are increasingly being used to deliver routine care, whilst simultaneously patients are increasing their uptake of DH solutions (e.g. wearables).With the adoption of DH increasing across the NHS, there is a growing need for a digitally literate workforce. However, there are no national standards on DH education for UK medical students. Consequently, this study sought to assess the current provisions, perceptions and challenges regarding DH education in the undergraduate medical curriculum.MethodsAn anonymous cross-sectional online survey was developed following a literature search and by collecting iterative feedback from both researchers and external collaborators. The survey consisted of questions in 6 areas: (a) understanding of DH;(b) existing provision of DH education;(c) interest in DH education;(d) preferred means of delivering and assessing DH education;(e) impact of the COVID-19 pandemic on DH;and (f) demographic information.The survey was administered via Qualtrics from March to October 2021, and disseminated to UK medical students via university mailing lists, social media and student representatives. Quantitative and qualitative data were collected pertaining to demographics, attitudes, preferences, and current provisions regarding DH education. Qualitative responses underwent thematic analysis. For quantitative analysis, R (version 3.5.0) and R Studio (version 1.1a) were used.Results514 complete responses were received from 39 UK medical schools in 2021. 57.2% of respondents were female, with a mean age of 22.9 ± 3.2. 65.8% of students considered DH ‘extremely important’ to future clinical practice, particularly the domains of electronic patient records, telehealth and smartphone applications. However, only 18.1% felt aware of the DH competencies required in clinical medicine. 70.2% of students reported receiving some DH education, with the highest proportion being in the form of lectures or seminars (30.5%, n=157), e-learning modules (28.6%, n=147) and ad hoc teaching during clinical placements (22.8%, n=117). However, only 25.7% felt satisfied with these provisions. Themes for student satisfaction related to a practical teaching approach, delivery of content appropriate for their training stage and coverage of topics in student interest. Conversely, student dissatisfaction originated from inadequate teaching, and subsequent fears of falling behind. 56.1% preferred DH education to be mandatory rather than elective, ideally through hands-on workshops (75.8%) and lectures and seminars (60.4%). 65.4% thought DH proficiency should be assessed in some capacity, of which 75.6% preferred formative assessment.ConclusionThis study represents the first national survey of UK medical students on DH education. Overwhelmingly, the results indicate that medical students recognise the significance of DH and would appreciate better formal integration into their curriculum;which is supported by previous similar studies in the literature. This study also identified how students would prefer to be taught and assessed on DH, in particular that they would prefer it be mandatory yet remain formative at present. Given the increasing ubiquity of DH in clinical practice, it is therefore crucial that universities and wider medical education organisations work to improve and standardise DH education, to better prepare medical students to adapt to the continuously developing digital landscape. This rings especially true in light of the recent COVID-19 pandemic which has highlighted the quintessential nature of DH to medical practice. Our intended future research from this study includes undergraduate focus groups for greater qualitative depth of information, and Delphi panels from wider medical education stakeholders into what should be included in DH education, with the eventual goal of devel ping a comprehensive and standardised national DH curriculum.
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Personality of an individual has been a promising variable to understand himself and furthermore the others in the society. It is the logical arrangement of an individual's attributes like thoughts, feelings, attitudes, behaviour and capability that makes an individual selective. Our personality likewise influences our decisions, medical conditions, assumptions, inclinations and prerequisites. In the scenario of 4G/5G and COVID pandemic, the majority of individuals are dependent on the web gateways as their essential intuitive vehicle for their own and expert necessities;accordingly, it has been a fundamental significance for us to consequently perceive the personality traits of the individual on the opposite side of the screen. Mental analysts have tracked down that an interaction of just 100 ms is adequate to shape judgement about any individual. Thinking about a similar idea towards execution of profound learning for recognition of personality traits, in this work, we propose an intelligent model (iSMART), a combination of depth-wise separable convolution neural network (2D-CNN) and long short-term memory with attention (LSTMwA), that extracts audio and video features through parallel networks and predicts the ultimate personality score of a person. With the top to bottom trial and error, it has been seen that the depth-wise separable CNN reduces the quantity of trainable parameters without compromising the test precision. It is a compelling and lightweight model for recognition of personality traits utilising bi-modular data sources. It likewise accomplishes better accuracy as compared with the outcomes got by the top scoring teams in the ChaLearn Looking at People challenge ECCV 2016. Our proposed model can possibly empower the system with better psychological understandings and improved human-computer interaction.
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According to estimates from the World Health Organization (WHO), air pollution contributes to about seven million deaths worldwide annually. Currently, more than 90% of people breathe air that exceeds the WHO’s recommended threshold of pollutants. This high degree of air pollution results in serious public health problems, such as pneumonia, acute asthma, chronic respiratory conditions, and shortness of breath. The execution of solutions to lower pollution exposure is therefore required, a study into the causes of air pollution. The “National Clean Air Programme (NCAP)”, a five-year action plan, has been launched by the Ministry of Environment, Forest and Climate Change (MOEFCC, 2019), Government of India. The program’s primary objective is to combat significant air pollution problems over the Indian subcontinent. As a result of economic growth, air pollution concentrations have consistently climbed to dangerous levels. To investigate influence of anthropogenic parameters on urban air, statistical analysis has been carried out for 8 Indian cities for pre- and post-COVID period using Sentinel-5P earth observatory data. These factors include population density, land use and total registered vehicles. The results of the investigation demonstrated that during the lockdown, air pollution levels in cities decreased. It is also discovered that pollutant levels have escalated once more since the lockdown limitations were lifted. It is clear from the findings that parameters affect pollution exposure. This demonstrates categorically that the pandemic has a beneficial effect on pollution exposure. A policy framework can be advised for policymakers based on the study done.
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Introduction: The advancement of wearable integrated augmented reality (AR) devices has rapidly progressed over recent years. We describe the first use of AR goggles during a revision neuromodulation surgery, which enabled specialist consultant support from remote despite ongoing coronavirus pandemic restrictions. Materials / Methods: This case report describes a revision surgery case in a previously successfully implanted spinal cord stimulator (SCS) patient. The attempt, to revise the existing percutaneous SCS leads failed due to the patient's challenging anatomy, which left the patient without therapy. A further revision via hemi-laminectomy and insertion of a surgical paddle lead was being organised with specialist support due to expected further anatomical challenges. Due to ongoing coronavirus restrictions both in travelling as well as reduced staffing numbers in the operating theatre in particular for visiting staff, the decision was made to use AR goggles to enable an experienced specialist to attend virtually. Result(s): The use of AR googles enabled a specialist colleague to virtually attend the live surgery despite a 200 mile distance. This included being able to see the surgical field on their computer screen as well as all live radiographic imaging displayed on the operating theatre monitors, having live sound, stopping any live images of the surgery to annotate with drawings and writing, speak to the resident surgeon in real time and discuss as if being physically present. Annotated images could be sent back to the lens of the operating surgeon for review as well as live commentary via integrated microphone and speaker in the surgeons AR goggles. The technology enabled remote specialist support and valuable expert input resulting in successful insertion of paddle leads in an anatomically very challenging patient. The patient reported 90% pain reduction after programming of his new paddle leads. Discussion(s): AR technology opens up new exciting avenues in supporting neuromodulation surgeries remotely with expert advice for difficult operations without being locally present. This saves unnecessary travel, reduces the carbon footprint, downtime of the expert in their local institution resulting fewer potential local case cancellations, reduces the risk of spread of infections such as SARS-CoV-2, as well as gives the ability to teach in remote locations. Furthermore, this opens further opportunities for mentoring of novice implanters. Conclusion(s): Augmented reality technology is a new and exciting way of further promoting proctorship and mentoring and might be particularly useful in supporting novice implanters and those who need additional specialist input in selected cases. Supplemental Data: [Formula presented] [Formula presented] [Formula presented] Learning Objectives: 1. Advances in augmented reality technology - raise awareness of available technology and its use 2. Ability to delivery intraoperative live teaching remotely - opening new avenues for teaching opportunities and training in neuromodulation 3. Proctorship - assistance of a specialist without being physically present. Keywords: Augmented Reality, SCS, Teaching, Training, Paddle leads, Surgical paddle leads Copyright © 2022
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Introduction: The airway management of patients with COVID-19 is a high risk task for anaesthesiologists. Several innovations have been born as a result of this problem, including aerosol boxes and clear plastic sheets. Aim: To compare the timing and attempt of direct laryngoscopy with and without aerosol box for intubation in patients undergoing general anaesthesia during the COVID-19 pandemic. Materials and Methods: This was a randomised controlled study was conducted in Parul Sevashram Hospital, Parul University, Vadodara, Gujrat, India from April 2021 to September 2021. A total of 50 patients were randomly divided into two equal groups as group A was intubated with an aerosol box and a macintosh laryngoscope, while group B was intubated with a clear plastic sheet and macintosh laryngoscope. With proper airway precautions and Personal Protective Equipments (PPE) comparative assessment of patients undergoing surgery in general anaesthesia was done. Time to intubate, number of attempts, ease of Endotracheal Tube (ETT) tube insertion, quality of Laryngoscopy view and Cormack Lehane scores were assessed in both the groups. Results: The mean time for intubation was high at 29.72 seconds in group A, while it was 23.16 seconds in group B;the difference was significant. Overall, 20 out of 25 (80%) patients could be intubated in 1st attempt in group B as compared to 15 out of 25 (60%) in group A. Airway visualisation using Percentage of Glottic Opening (POGO) scoring and Cormack Lehane staging were suggestive of better visualisation in group B than group A. Difficulties encountered during intubation like laryngoscopy, glottic visualisation, arm movement restriction, ETT negotiation, and stylet removal were lesser in group A as compared to group B. The incidence of complications like sore throat and airway bleeding were lower in group B as compared to group A. Conclusion: In the COVID-19 era, aerosol box and clear plastic sheets are effective barrier measures for airway management to prevent the anaesthesiologists from the aerosol transmission. But airway management with clear plastic sheet is technically easier than aerosol box.
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The COVID-19 public health emergency caused widespread economic shutdown and unemployment. The resulting surge in Unemployment Insurance claims threatened to overwhelm the legacy systems state workforce agencies rely on to collect, process, and pay claims. In Rhode Island, we developed a scalable cloud solution to collect Pandemic Unemployment Assistance claims as part of a new program created under the Coronavirus Aid, Relief and Economic Security Act to extend unemployment benefits to independent contractors and gig-economy workers not covered by traditional Unemployment Insurance. Our new system was developed, tested, and deployed within 10 days following the passage of the Coronavirus Aid, Relief and Economic Security Act, making Rhode Island the first state in the nation to collect, validate, and pay Pandemic Unemployment Assistance claims. A cloud-enhanced interactive voice response system was deployed a week later to handle the corresponding surge in weekly certifications for continuing unemployment benefits. Cloud solutions can augment legacy systems by offloading processes that are more efficiently handled in modern scalable systems, reserving the limited resources of legacy systems for what they were originally designed. This agile use of combined technologies allowed Rhode Island to deliver timely Pandemic Unemployment Assistance benefits with an estimated cost savings of $502,000 (representing a 411% return on investment). © 2020 Owner/Author.
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Calls for eliminating prioritization for SARS-CoV-2 vaccines are growing amid concerns that prioritization reduces vaccination speed. We use an SEIR model to study the effects of vaccination distribution on public health, comparing prioritization policy and speed under mitigation measures that are either eased during the vaccine rollout or sustained through the end of the pandemic period. NASEM's recommended prioritization results in fewer deaths than no prioritization, but does not minimize total deaths. If mitigation measures are eased, abandoning NASEM will result in about 134,000 more deaths at 30 million vaccinations per month. Vaccination speed must be at least 53% higher under no prioritization to avoid increasing deaths. With sustained mitigation, discarding NASEM prioritization will result in 42,000 more deaths, requiring only a 26% increase in speed to hold deaths constant. Therefore, abandoning NASEM's prioritization to increase vaccination speed without substantially increasing deaths may require sustained mitigation.
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Introduction: Anaesthesiologists are at constant risk of contracting Corona Virus Disease 2019 (COVID-19) disease. They are constantly conducting surgical procedures despite being surrounded by pandemic. Patients requiring Nasotracheal Intubation (NTI) for oromaxillofacial surgery expose anaesthesiologists to aerosol-risk. Video laryngoscope simplifies NTI with diminished aerosol exposure, decreased time and difficulty for intubation in patients undergoing oromaxillofacial surgery. Aim: This study was intended to compare the effectiveness of King Vision Video Laryngoscope (KVVL) and Macintosh laryngoscope in patients requiring NTI for oromaxillofacial procedures. Materials and Methods: This prospective randomised controlled study was conducted on total of 40 patients undergoing oromaxillofacial surgery under general anaesthesia with NTI in Parul Sevashram Hospital, Vadodara, India, from September 2020 to February 2021. Patients were randomly allocated into group KL and group ML of 20 patients each. Laryngoscopy in group KL was performed with KVVL (non-channelled blade), while in group ML patients were intubated using Macintosh laryngoscope. Intubation time, Modified Nasointubation Difficulty Scale (MNIDS), haemodynamic parameters, and complications were noted. Student t-test and chi-square test were used respectively for continuous and categorical variables. Results: There was no significant difference in the mean age, weight and gender between the groups KL and ML (p-value>0.05). The mean age of the group KL patients were 32.65 years and group ML was 33.95 years which was not statistically significant. Time required for passing tube from glottic opening to trachea (T3) was significantly less (13.5 seconds) in group KL than (17.4 seconds) in group ML (p-value <0.001). A total of 16 patients (80%) and 12 (60%) patients respectively, in group KL and group ML had MNIDS of 0. Increase in Heart Rate (HR) and Mean Arterial Pressure (MAP) was significantly higher in group ML than group KL. Also, a video laryngoscope increases the distance between the operator and airway and hence reduces aerosol exposure. Conclusion: Intubation time, assist manoeuvre, and change of head position were less in group KL than group ML. KVVL reduces distance between patient and anaesthesiologist. Video laryngoscopes reduce aerosol transmission better than macintosh laryngoscopes. Thus, the video laryngoscopes were found better than macintosh laryngoscopes.
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Purpose/Objective(s): Painful osteolytic bone lesions are common in patients with multiple myeloma (MM). Radiotherapy (RT) is effective in providing pain relief from MM bone lesions in over 80% of patients. There is no consensus as to the most effective dose or fractionation for palliation. Shorter courses of RT are not only more convenient for patients and their families, but they also have less impact on timing of systemic therapies. There is precedent for using 2 Gy x 2 for palliation of lymphomas, which have similar radiosensitivity to myeloma. The primary objective is to determine whether treatment with 2 Gy x 2 to painful myeloma bone lesions achieves patient-reported pain reduction comparable to historical controls at 4 weeks. Secondary objectives will assess QOL endpoints, use of analgesia and time to pain relief, and duration of pain relief. Materials/Methods: Patients who consent to participation will complete quality of life and pain questionnaires (Brief Pain Index, EORTC QLQ-BM22, and EORTC QLQ-C30) prior to treatment and at 2,4,8 weeks and 6 months following treatment. Pain response, as defined by the international consensus on palliative RT for bone metastases, will be measured based on BPI and daily oral morphine equivalent. Reirradiation at standard dose can be considered at ≥4 weeks following initial treatment for indeterminate pain response or pain progression. Cytogenetics and International Myeloma Working Group risk stratification and response criteria are recorded, when available, but are not required for patient participation. Results: This trial, supported by ILROG, has opened at 7 institutions with one more in process of opening. Prior to COVID, accrual was 1.5 patients per month. Since COVID, enrollment has been at 0.7 patients per month. A total of 18 patients have been accrued. The median age of patients accrued is 65.5 years with 7/18 female patients. Fourteen patients are Caucasian. Twelve patients have an ECOG performance score of 1-2. Thirteen patients had pain response captured at 4 weeks following RT. Of the 5 patients that did not complete questionnaires at 4 weeks post-RT, 2 expired, 1 was lost to follow-up, 1 had a missed evaluation and 1 had pain progression). The most common site of treatment was the shoulder (4/18). Conclusion: This ongoing prospective trial in palliation of multiple myeloma bone lesions is feasible and able to accrue at multiple institutions and will provide valuable information as to the role of low-dose RT in this population.
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With the emergence of COVID-19, healthcare worldwide is afflicted. While there is a spectrum of disease severity and presenting symptoms in infected patients, hypoxemic respiratory failure is the leading cause of mortality. Decision to intubate in rapidly deteriorating patients plays a significant role in determining patient outcome. In most patients, COVID-19 pneumonia initially causes worsening hypoxemia but minimal impairment of lung compliance which determines the work of breathing (WOB). Once adequate arterial oxygenation is established, a tool to determine WOB independent of oxygen needs can guide the decision to intubate for invasive mechanical ventilation (IMV). We monitored oxygen requirements and WOB in 14 patients admitted to our ICU with severe COVID-19 pneumonia. All patients had radiographic evidence of extensive lung disease, significant hypoxemia and multiple comorbidities. Hypoxemia was managed through non-invasive means, predominantly using highflow nasal cannula. To assess WOB, we used a scale developed by us assigning points to the respiratory rate and use of respiratory accessory muscles (range, 1 to 7) (Figure 1a). This was used at the time of initial evaluation and throughout the ICU stay. Out of 14 patients, 10 did not require intubation and recovered while 4 were intubated. We compared the maximum and average WOB of the non-intubated patients throughout their ICU stay with the WOB of intubated patients measured within 24 hours before intubation (Figure 1b). The maximal and the average WOB were higher in patients requiring intubation (mean ± SD, maximal 4.3 ± 0.9 vs 5.5 ± 1.0 pts, p = 0.028 and average 2.7 ± 0.6 vs 3.9 ± 0.5 pts, p = 0.002). Breakdown of the various WOB components demonstrated a statistically significantly higher maximal and average use of respiratory accessory muscles (assessed as their aggregate sum) and higher average respiratory rate in intubated patients. However, the maximal respiratory rate was not significantly higher. Our data illustrates the initial response to COVID-19 lung injury is tachypnea which can be sustained with adequate oxygenation. As lung injury progresses with more recruitment of respiratory accessory muscles, intubation for IMV becomes necessary. Our WOB scale becomes a useful tool to assist in the decision of when to intubate. It is simple to teach, apply and incorporate into routine patient assessment. We recommend routine and systematic WOB assessment to plan for orderly nonemergent intubations for IMV. Further refinement on the interventions recommended based on specific WOB level and other modifying factors is awaited.
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Introduction: India is the second country with the highest Coronavirus Disease-2019 (COVID-19) case burden in the world. In India, Maharashtra state has the highest number of cases. Aim: To study the clinico-epidemiological profile of COVID-19 patients admitted in a COVID-19 designated tertiary care center in Pune, Maharashtra, India. Materials and Methods: The authors retrospectively investigated epidemiological, demographic, clinical, laboratory, radiological and treatment data of 413 Real Time-Polymerase Chain Reaction (RT-PCR) confirmed COVID-19 patients from 14th April 2020 to 30th June 2020. The data was analysed using the Mann-Whitney U test for continuous variables with normal and abnormal distribution, respectively. Also, the multivariate logistic regression was used for analysis. Results: Among the 413 laboratory confirmed COVID-19 patients, 249 (60.29 %) were males, majority {87 (21.07%)} of the patients belonged to the age group of 51-60 years. The most common comorbid condition found was diabetes mellitus {102 (24.69%)}. The most common symptoms were fever {185 (44.79%)} and cough {146 (35.35%)} followed by breathlessness {134 (32.45%)}. History of close contact with a confirmed COVID-19 case was present in 205(49.64%) patients. The mean time from the onset of symptoms to hospital admission was 3.75 (SD±2.642) days. There was a strong association between increasing age and the need for Intensive Care. Total 63 (80.77%) out of 78 patients above 60 years of age had abnormal Chest X-Ray (CXR) findings during hospitalisation. Furthermore, the maximum number of deaths i.e., 31 patients (58.49%, n=53) occurred in the age group of more than 60 years of age. Conclusion: The findings suggest that increased value of serum Lactate Dehydrogenase (LDH) and Urea can be used as predictors for mortality rate. Patients aged more than 60 years are more prone for severe disease with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pneumonia and this subset of patients requires urgent medical attention.
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SARS-CoV-2 is recognized as a public health concern by WHO & declared it as a pandemic on 11th of March 2020. Over 4,43,03,684 people affected with the death of 11,72,955 worldwide till 28 of October 2020. The most affected country is the USA with a total no. Affected case of 90,39,170 then INDIA with a 7,99,03,222 no. of cases and death of 1,20,054 people. SARS-CoV-2 thought to commonly spread via respiratory droplets from an infected person form during talking, coughing, sneezing, etc. Several cases are found without a travel history to affected area leading to a strong possibility of community trans-mission. Transmission can be divided into two parts. Direct through airway droplets (respiratory droplets), through body fluid and secretions ex. Saliva, faeces, tears etc. and mother to child (ex. Breastfeeding). Indirect fomites or surfaces (objects which get infected by the patient) or objects which are uses for a checkup of an infected person. A significant number of these modes found or unfamiliar with evidence are neglected, thus is requires to specify and delineate them. Despite the fact that the writing could conceivably make reference to these courses, it is essential to underscore them as it might help in avoidance and treatment.