Ventilation Perfusion Functional Difference Images in Lung Spect: A Quantitative Improvement on Ventilation Perfusion Ratio

Purpose: Ventilation (V) perfusion (Q) SPECT imaging is important in the diagnostics of lung diseases such as pulmonary embolism, chronic obstructive pulmonary disease and recently in COVID-19 lung disease. The combined assessment of ventilation and perfusion permits the identification of classical mismatched and reverse mismatched defects, especially when these two parameters are combined in one measure as the ventilation perfusion ratio. Unfortunately, the ratio is only linear for ventilation and the scale is not symmetrical regarding classical and reversed mismatches. Small perfusion values give rise to artifacts. The scaled ventilation perfusion difference is presented as an alternative. Material(s) and Method(s): VQ SPECT was performed on patients with and without defects. Kr-81m was used as a ventilation tracer and MAA labelled with Tc-99m as a perfusion tracer. Ratio is defined as V/kQ and difference as V-kQ, where k is a scaling factor. The iterative z-map method was applied for determining the scaling factor for ratio and difference images yielding a ratio of one and zero difference for matched ventilation and perfusion. Clinical thresholds for both the difference images are derived resulting in color maps of relevant mismatches with an absolute ratio larger than the arbitrary value of two. Result(s): The relative difference is in second order proportional to the logarithm of the ratio, and has a scale going from -1 to +1, where -1 is perfusion only and +1 is ventilation only. Still the diagnostic value is hampered by the fact that areas with both low perfusion and ventilation can have high ratios. Therefore, the scaled (functional) difference is presented. Ratio, relative difference and scaled difference have been investigated in ten patients and are shown for three patients (one without defects). Ratio and relative difference images suffer from a visual overexposure effect as is clearly visible for the respiratory tract. One patient with an area in a bottom lung with a very low perfusion and slightly decreased ventilation demonstrated overflow problems of the intensity in ratio images and an overestimation of the mismatched area in both the ratio and relative difference images. Conclusion(s): While the relative ventilation perfusion-difference is a promising improvement of the ventilation-perfusion ratio, because it has a symmetrical scale and is bound on a closed domain, a better diagnostic value and functionality might be obtained by utilizing the scaled functional difference. The latter one seems superior to both the relative difference and ratio.Copyright © 2023 Southern Society for Clinical Investigation.

SITUATED COGNITION 360degree EDITOR 2021: A SOLUTION FOR INTERACTIVE MEDICAL TRAINING DURING THE COVID-19 PANDEMIC PERIOD

Imagine entering an operating theatre or developing clinical skills in empathy and communication through Virtual Reality. To enhance the experience of learning novel methods using VR have been researched and simulated for clinicians. This is because some aspects of clinical training, like conducting procedures and effective team communication focus on 'learning by doing' which is difficult to recreate remotely. Here we present a proof-of-concept prototype of a 360degree-video editor that augments 360degree videos with media to create a mixed reality learning experience. Method An editor was built inside Unity to augment 360degree- videos of real-world scenarios in healthcare with interactive data. Unity is a cross-platform games engine used to create two-dimension three-dimension virtual reality and augmented reality games as well as video players to play panoramic 360degree-videos. The video player is attached to a Render Texture and a Skybox material that provides the spherical surface for the 360degree-video achieving an immersive experience. Results The editor comprises two software packages one for the trainer another for the learner. As a unique feature we introduce clickable Hotspots. This enables users to annotate the 360degree film by tagging specific artefacts in the environment and create a place-based interaction. These Hotspots are anchored to a position and can display text and images and form part of a novel branched timeline of nested data. The intention being the trainer would create the film and annotate the environment with interactive media. This would then be available to the learner who would use the player to view a bespoke teaching package. Conclusion Situated Cognition 360 Editor 2021 envisages trainers creating interactive 360degree-video learning experiences using real life scenarios in healthcare. Future steps involve user experience evaluations co-design and development of new learner interactions that deliver low cost remote and easily deployed healthcare education through immersive learning environments.

Towards a Value Co-Creation Process in Collaborative Environments for TVET Education

The appearance of the COVID disruption has proved the need for rapid innovations in education, with new value proposition(s) able to capture the new activities involving value co-creation in the education service systems. This paper introduces a conceptual framework for skills building in collaborative TVET online communities that integrates the Collaborative Knowledge Sharing Environment (CKSEnv), an ontology-based collaborative development of knowledge-intensive services, as a possible main driver for value co-creation amongst actors in the after-pandemic TVET education. CKSEnv's usability and usefulness in achieving its goals is evaluated. Quantitative and qualitative data collected through interviews have revealed respondents' interest in topics such as the sustainability, usefulness, usability, value co-creation, and technical functionality of the proposed development. Both the utility and simplicity proved to have the most significant impact on CKSEnv adoption and usage. A new service design artifact is created, the smart service model canvas in the TVET online communities, to explain the new value co-creation process, which is able to fill gaps in describing the role of ICT in supporting the TVET training cycle. This research may ground further explorations related to the development of TVET online communities, while the CKSEnv is still in the evaluation stage. The practical implications of this study express the need for new value co-creation processes with specific activities that use technology-driven innovations, able to establish such newly created value, through smart educational services. © 2023 by the authors.

PERICARDIAL INVOLVEMENT ASSOCIATED WITH SARS-COV-2 INFECTION. PROSPECTIVE OBSERVATION IN THE COVID- WARD.

Purpose. To identify the occurrence and structure of changes in the pericardium ultrasonography among patients who have undergone COVID-19 and have cardiological symptoms, as well as to compare these changes with the pericarditis aspects and the infection time duration in a prospective cohort observational study. Methods. Inclusion/exclusion criteria: current or transferred COVID-19, new symptoms that occurred during or after infection and forced to consult a cardiologist, the absence of other prerequisites for pericarditis and vaccination against SARS-CoV-2. Echocardiography was performed with an emphasis on the pericardium and an assessment of the echogenicity amplification, the area of the hyperechoic zone, thickness and artifacts, as well as a questionnaire. Results. From 05.2020 to On 10.2020, 335 patients from the covid ward and 284 patients from the out-patient clinic were included. 86% of patients had transient chest discomfort. The peaks of treatment accrued to 4-5 and 10-11 weeks (Me 10[2-36] (1 to 64) weeks) from SARS-CoV-2 infection occurred. Typical ECG changes were registered in 3%, pericardial friction noise - in 7% of patients. In 20% of patients discomfort in the heart area was the first, in 27% - the dominant, in 14% - the only symptom of COVID-19. According to EchoCG data, 96% of the examined patients had ultrasound signs of different changes in the pericardium: slight effusion in 65%, signs of tamponade in 2%, thickening in 12%, local hyperechogenicity in 83%, local adhesion in 8% of patients. The group without pericardial changes was distinguished by the presence of epicardial fat >7 mm. A combination of the echo-cardiography criteria with the second symptom recorded at the visit or earlier was present in 76% of the applicants. Comparison of the recorded ultrasound patterns with the time elapsed since infection allowed us to distinguish ultrasound phases: 1) the phase of damage (pattern of initial edema) occurred at 1 week, 2) the phase of edema /exudation (pattern of visible effusion) - at 3 weeks, 3) fibrosis (pattern of pericardial compaction) - at 11 weeks, 4) regression of inflammatory changes (pattern of local fibrin deposition) - on week 22, 5) residual signs of transferred inflammation may be visualized in patients with symptoms 44 weeks after COVID-19. Conclusions. Consideration of the infectious process triggered by SARS-CoV-2, as a systemic inflammation, allows us to interpret the phenomenon of pericardial involvement as a reactive serositis having ultrasound phases. It was possible to trace some patterns of echocardiography at different stages of the infectious and post-infectious period. Clinical data of 76% of patients can be interpreted as pericarditis, changes in 20% - as an increase in echogenicity of the pericardium.Copyright © 2022 Russian Electronic Journal of Radiology. All rights reserved.

All B-lines are equal, but some B-lines are more equal than others.

In this pictorial essay the theme of the differential diagnosis between the different causes of lung interstitial disease will be discussed, which can be detected on lung ultrasound as B lines. In particular, from the experience obtained during the covid-19 pandemic, the term B line may appear too simplified, and new data in the literature show that it is necessary to update the terminology and the differential diagnosis of this ultrasound sign.

Automation and redistribution of work: the impact of social distancing on live TV production

The TV industry has long been under pressure to adapt its workflows to use advanced Internet technologies. It also must face competition from social media, video blogs, and livestreaming platforms, which are enabled by lightweight production tools and new distribution channels. The social-distancing regulations introduced due to the COVID-19 pandemic added to the list of challenging adaptations. One of the remaining bastions of legacy TV production is the live broadcast of sporting events and news. These production practices rely on tight collaboration in small spaces, such as control rooms and outside broadcast vans. This paper focuses on current socio-technical changes, especially those changes and adaptations in collaborative practices and workflows in TV production. Some changes necessary during the pandemic may be imposed, temporary adjustments to the ongoing situation, but some might induce permanent changes in key work practices in TV production. Further, these imposed changes are aligned with already ongoing changes in the industry, which are now being accelerated. We characterize the changes along two main dimensions: redistribution of work and automation. © 2021 The Author(s). Published with license by Taylor & Francis Group, LLC.

Do lung ultrasound abnormalities change during hospitalization for COVID-19?

Background. While point-of-care ultrasound (POCUS) has been used to track disease resolution, temporal trends in lung ultrasound (LUS) findings among hospitalized patients with COVID-19 is not well-characterized. Methods. We studied 413 LUS scans in 244 participants >= 18 years of age hospitalized for COVID-19 pneumonia within 28 days of symptom onset from April, 2020 until September, 2021 at the Johns Hopkins Hospital, Baltimore Maryland. All patients were scanned using a 12-lung zone protocol and repeat scans were obtained in 3 days (N=114), 7 days (N=53), and weekly (N=9) from the initial scan. Participants were followed to determine clinical outcomes until hospital discharge and vital status at 28-days. Ultrasounds were independently reviewed for lung artifacts, and the composite mean LUS score (ranging from 0 to 3) across lung zones was determined. Trends of mean LUS scores and%lung fields with A-lines (indicating proportion of normal lung fields) were plotted by peak severity (mild, moderate, and severe defined by the World Health Organization Ordinal Scale) over time from symptom onset. Differences in mean LUS score or % A-lines changes over time between peak severity levels were evaluated using a Kruskal-Wallis test and linear mixed-effected models with an exchangeable correlation structure. Results. Among 244 patients in our cohort (mean age of 58.2 (SD 15.0) years, and 55.7% female) (Table 1), there was no change in average mean LUS scores between the first two visits by severity groups (Figure 1;Kruskal-Wallis p=0.63). Mean LUS scores were elevated by 0.22 (p< 0.001) in a dose-response manner regardless of duration of illness, but there was no change over time associated with peak severity (p=0.73). Similarly, percentage of A-lines were in 13.9% less lung fields for each increase in peak severity (p< 0.001;Figure 2) regardless of duration of illness. However, a change in mean LUS score did not differ significantly among peak severity levels (p=0.36). Conclusion. Mean LUS scores correlated with clinical severity among hospitalized adults when assessed cross-sectionally, however mean LUS score did not change or differ between peak severity levels over the time course of hospitalization. These results do not support serial LUS scans to monitor disease progression.

A Review of the Issues Associated with Imaging and Treating Patients with a Larger Body Habitus

Purpose: Obesity is generally reported as having a significant impact on healthcare practice and systems, although there is also growing recognition that pervasive weight stigma can affect access to healthcare and/or cause negative health effects. Imaging and treating patients with a larger body habitus is one of the many practice considerations for medical radiation science professionals (MRSPs). There are known technical and patient care considerations including size and weight equipment limitations in medical imaging and radiation therapy departments as well as considerations of imaging dose and treatment reproducibility for patients of a larger size. Communication and patient care also needs to be tailored to this patient population. This scoping review sought to answer the question: How has imaging and treating patients with a larger body habitus been defined, classified, and understood in the Medical Radiation Sciences literature? Methods A scoping study is typically carried out to examine the extent, range, and nature of research activity for a specific topic or question. For this study, a scoping review of English language peer-reviewed papers published from 2011 to 2021 was performed using the PRISMA framework. Four independent reviewers with content and methodological expertise selected papers with the initial inclusion criteria: english language, human subjects, obese, bariatric, fat, medical imaging, medical radiation technology, radiation therapy and radiography. An iterative process was utilized that included searching the literature, refining the search strategy, and reviewing articles for study inclusion. Result(s): The initial search identified 8809 articles. The review was carried out with the literature review and screening software 'Covidience'. Of the articles included, preliminary qualitative content analysis revealed three major themes. The majority of papers looked at imaging and/or dose (e.g. radiation exposure, image quality, artifacts and treatment position considerations) as well as equipment and environment (e.g. table load limits, aperture sizes, immobilization devices and positioning). Fewer papers discussed patient care (e.g. communication, perception and attitudes, practitioner bias and the need for appropriate education). Many of the radiography and radiation therapy specific papers were reviews and commentaries rather than research studies and lacked robust evidence. Data analysis is ongoing with a projected completion time of April 2022. Result(s): A growing number of studies about patients with a larger body habitus have been published in the last few years with both practical and patient care implications. Preliminary qualitative content analysis revealed the major themes in the MRSP literature consist of equipment and technical considerations. In addition, it seems likely that further investigation from the patient care perspective would reveal practice insights to inform future research, practice and policy and improve care for this patient population. Copyright © 2022

Generating Artificial Artifacts for Motion Artifact Detection in Chest CT

Motion artifacts can have a detrimental effect on the analysis of chest CT scans, because the artifacts can mimic or obscure genuine pathological features. Localising motion artifacts in the lungs can improve diagnosis quality. The diverse appearance of artifacts requires large quantities of annotations to train a detection model, but manual annotations can be subjective, unreliable, and are labour intensive to obtain. We propose a novel method (Code is available at https://github.com/guusvanderham/artificial-motion-artifacts-for-ct ) for generating artificial motion artifacts in chest CT images, based on simulated CT reconstruction. We use these artificial artifacts to train fully convolutional networks that can detect real motion artifacts in chest CT scans. We evaluate our method on scans from the public LIDC, RIDER and COVID19-CT datasets and find that it is possible to train detection models with artificially generated artifacts. Generated artifacts greatly improve performance when the availability of manually annotated scans is limited. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Our experience of using Dexmedetomidine-Propofol sedation in patients undergoing treatment planning Magnetic resonance imaging scan for Deep brain stimulator insertion surgery during Covid 19 pandemic

Introduction: Patients undergoing Deep brain stimulator (DBS) insertion require a high-resolution MRI for treatment planning prior to DBS surgery. This group of patients has movement disorders therefore traditionally the planning MRI is done under General anaesthesia to ensure patient immobility and to obtain good quality MRI images. Providing sedation/anaesthesia for MRI procedure during COVID-19 pandemic was challenging. When we restarted elective surgery during Covid-19 pandemic we were worried about aerosol generating procedures, therefore we looked at the feasibility of using Dexmedetomidine-Propofol sedation for treatment planning MRI as an alternative to General anaesthesia to prevent aerosol generating procedure. Method(s): We conducted retrospective review of anaesthetic records of all patients who underwent MRI under sedation for DBS planning from August 2020 to July 2021. We collected the data on patient demographics, Indication & target site for DBS, duration of sedation, complications during the scan, cardiovascular side effects like hypotension and bradycardia during scan, quality of image, duration of PACU stay and post scan complications. The quality of MRI imaging was assessed by the neurosurgeon who did the treatment planning. Sedation protocol: sedation was commenced with Propofol target controlled infusion (TCI) using Schneider model with effector site concentration (Cet) of 2 to 3 and Dexmedetomidine bolus dose of 1 microgram per kilogram was infused over 10 minutes. All the patients were induced to a Ramsay Sedation Scale of at least 5 or 6. Sedation was maintained with Dexmedetomidine infusion at 0.5 mcg/kg/hr and Propofol TCI (Schneider model Cet of 2 mcg/mL). Result(s): During our study period 15 patients underwent MRI under sedation with Propofol-Dexmedetomidine for DBS treatment planning. Of this 7 were males and 8 were females. Age range was from 39 to 75 years. The target site was Subthalamic nucleus in 9 patients, Thalamic nuclei in 4 patients and Globus pallidus internus in 2 patients. Duration of sedation ranged from 40 minutes to 100 minutes with a median of 45 minutes. 2 patients developed movement artefacts during scanning and were converted to GA, 3 patients developed hypotension (20% reduction from pre-induction blood pressure) requiring treatment with ephedrine. Five patients had sinus bradycardia (20% reduction from pre-induction heart rate) but did not require treatment. The qualities of images were classified as good in 11 patients and acceptable in 2 patients by the neurosurgeon involved in treatment planning. None of the patients needed repeat MRI scanning. Patient's stay in PACU ranged from 20-50 minutes with a mean of 26.5 minutes. Discussion(s): Dexmedetomidine-Propofol sedation has been widely used for sedation to perform MRI scans in paediatric patients, its use in adult patients is not well documented in the literature. Propofol enables smooth induction of sedation and rapid recovery however it may cause hypotension, decreased respiratory drive and upper airway obstruction. Dexmedetomidine has been used as a single sedative agent for MRI however its onset of action is slow and when used as a sole sedative agent large dose of dexmedetomidine is required and this may contribute to delayed recovery after sedation. Propofol-Dexmedetomidine combination has synergistic effects and is advantageous. Propofol can induce sedation smoothly, Dexmedetomidine can reduce dose required for sedation and suppression of motor response in healthy subjects (1). Combination of Dexmedetomidine- Propofol infusion reduced total Propofol dose and decreased the incidence of airway complications in a paediatric study (2). During our study period 2 patients sedation were converted to General anaesthesia, both patients had raised BMI and had laboured breathing under sedation causing transmitted head movement, therefore patient selection is important for successful scan under sedation. Propofol-Dexmedetomidine sedation can be used safely for treatment planning MRI in selective movement disorder patients.

Radiopacity of sodium zirconium cryosilicate on plain radiography

Introduction: Sodium zirconium cyclosilicate is a novel potassium binder developed by AstraZeneca and is sold under the brand name Lokelma (TM). It has been approved for use in England in 2020 for the treatment of non-lifethreatening hyperkalaemia, and stable hyperkalaemia in patients with chronic kidney disease.1 It is available as powder sachets (5 grams and 10 grams) and is designed to be mixed with water and administered enterally. The starting dose is recommended as 10 grams three times per day, and resolution of hyperkalaemia is usually seen within two days, after which a lower maintenence dose may be administered. The radiopaque properties of sodium zirconium cyclosilicate have previously been noted on computed tomography before in 2021,2 but, to our knowledge, this has not yet been described on plain radiography. Case presentation: We present the case of a critically unwell lady in her 50s with COVID-19 pneumonitis. As a feature of her critical illness syndrome, she developed acute renal failure, and required renal replacement therapy. Persistent problems with hyperkalaemia were noted, and sodium zirconium cyclosilicate was administered enterally via a nasogastric tube as directed in the product literature. For unrelated reasons, she also required a chest radiograph within the following hour. On reviewing the radiograph, a radiopaque material was noted in the stomach, and was seen to very clearly outline the major anatomical features of the organ, including the greater and lesser curve, and gastric rugae. After discussion with our local radiology colleagues and finding the material is opaque on computed tomography, we concluded this material must be the recently administered sodium zirconium cyclosilicate. Investigation: Image of radiograph showing radiopaque material in the stomach of a critically unwell patient. Discussion: To our knowledge, the radiopaque properties of sodium zirconium cyclosilicate have not been described before in the medical literature as relating to plain radiography. When interpreting plain radiographs, it is important to understand and exclude sources of artefact. As sodium zirconium cyclosilicate becomes widespread in critical care areas, we believe the above-described scenario will be commonly encountered. Moreover, we believe that sodium zirconium cyclosilicate may have additional utility as a well tolerated enteral contrast agent with the added benefit of lowering serum potassium concentration.

The essentials of pleural and lung ultrasound

Introduction: Ultrasound was first used to image pleural effusion in 1967. More recently, there have been exciting developments in the use of ultrasound to assess lungs. This presentation will cover key concepts of lung ultrasound, scan techniques and image interpretation for a range of pathology (including pleural effusion, empyema, consolidation, pneumonia, acute pulmonary oedema and pneumothorax). Method: Essentials of normal ultrasound lung artefacts, scan techniques and key diagnostic features will be presented, with case examples. Results: Ultrasound can be used to provide valuable diagnostic information for patients with a range of conditions. Ultrasound has been shown to be superior to both chest radiography and clinical examination in the detection of pleural fluid. Ultrasound is more sensitive than the supine chest radiography for the diagnosis of pneumothorax. Ultrasound is also sensitive in characterising pulmonary oedema, consolidation and pneumonia. Recently lung ultrasound has also been used in COVID-19 patients. Conclusion: Ultrasound has been shown to be an accurate and sensitive modality for diagnosing many pleural and lung conditions. Take home message: Sonographers should remain up to date on the essentials of ultrasound diagnosis of pleural and lung conditions.

Signal Processing Method for Enhancement of Pulse Oximeter Signals

Pulse oximeters are now a part of every household first-aid kit, pulse oximeters have actually helped to primarily identify the severity of covid19 infection in a person's body. These devices measure the saturated blood oxygen level (SpO2) in a person's body, there by the displayed level of SpO2 helps medical professionals to hypothesize the situation and provide a better aid for the patient. Since the process is non-invasive, the devices are widely implemented. Pulse oximeters acquire photoplethysmographic (PPG) signals, these signals contain the volumetric changes in human blood, that on being exposed to mathematical principles give the SpO2 reading and other data. The process of obtaining the PPG signals through pulse oximetry employs a mechanism of emitting and detecting the IR and Red signals through human tissues, however during the capturing of reflected signals through detector, the detected signal comes along with noise referred as motion artifact (MA). These MAs arises due to the voluntary/involuntary movements of human causing volumetric changes in flow of blood at the source and detector sensor locations. The presence of MAs in such signals turns up to erroneous SpO2 level estimation, that creates a problem for medical professionals in treating the diseases. To improve the reliability of SpO2 estimation, by a pulse oximeter, the PPG signal quality is to be enhanced. In this paper, the authors tried to describe on the work of enhancing the acquired PPG signal quality by reducing MAs with effective methods. © 2022 IEEE.

Tension Pneumomediastinum in COVID-19 ARDS Patient Managed with Percutaneous Ultrasound-guided Catheter Insertion: A Case Report

Introduction: Tension pneumomediastinum is a condition in which there is a trapping of air in the mediastinum with a resultant increase in the pressure causing compression of the great vessels which leads to decreased venous return and cardiovascular collapse. It is a rare and severe form of pulmonary barotrauma in ICU ventilated patients which can lead to refractory hypotension and death if not addressed at the right time. Case description: A 42-year-old man with no known comorbidities referred to our centre in view of severe COVID ARDS with refractory hypoxemia. Endotracheally intubated and put on ventilatory support. Developed shock not responding to fluid resuscitation and was started on IV vasopressor infusion. CT chest revealed tension pneumomediastinum. The patient continued to worsen clinically with hypotension and hypoxia despite low PEEP and high FiO2 ventilation. So bedside USG-guided pigtail catheter was inserted into the anterior mediastinum using a modified Seldinger technique following which there was a rapid clinical improvement. Conclusion: Tension pneumomediastinum is a rare and life-threatening cause of refractory hypotension and hypoxia in mechanically ventilated ARDS patients and bedside ultrasound-guided intervention is a feasible and quick therapeutic option. Highlights: A review of the literature showed very few case reports of tension pneumomediastinum in mechanical ventilated ARDS patients. Because ultrasound of the chest gives air artefacts and poor visualization in patients with pneumomediastinum and subcutaneous emphysema, CT-guided drainage catheters insertion is the standard of care. But in a very sick ICU patient, bedside ultrasound-guided catheter insertion could be a safe and immediate measure to save a patient's life. To our knowledge, this is the first case report of an adult ARDS patient with tension pneumomediastinum managed with bedside ultrasound-guided catheter insertion.

Comparing the Quality of Home and Clinic Applied Zio XT Patch in Pediatrics During the Pandemic

Background: The Zio® (Zio) XT Patch (iRhythm Technologies, Inc, San Francisco, California) is a 14-day continuous ambulatory ECG monitor. During the Covid-19 Pandemic, Zios were shipped directly to patients for self-application. The purpose of this study was to compare the quality of in-clinic (IC) to mail-home (MH) in our pediatric population. Methods: A single-center, IRB-approved study (1/1/18 - 6/1/21) of patients < 21 years of age with Zios were studied for wear and artifact time filtered out based on iRhythm's inherent algorithm. A control group of patients were age-matched from Zios placed IC and compared to MH Zios throughout the pandemic. Results: A total of 284 Zios were analyzed for total wear time and artifact filtered out. Of these, 149 were IC, and 135 were MH. Average percent of artifact of IC vs MH was 7.1% and 8.3% (p = 0.58). The average age of patients with Zios placed in clinic was older (12.84 years) than those placed at home (11.12 years, p<0.02). There was no significant difference in artifact when adjusted for age. Age was inversely associated with percent artifact with a 0.34% reduction in percent artifact for every additional year of age (p < 0.049). Location was not associated with percent artifact after controlling for age. By two proportion Z-test, there was no statistically significant difference between IC and MH Zios wasted (p = 0.66) or repeated (p = 0.96). Conclusion: In conclusion, IC and MH Zios did not demonstrate any significant difference in artifact time filtered out. This highlights the potential for home application during current pandemic and future telemedicine utilization.

Forensic Analysis of Microsoft Teams: Investigating Memory, Disk and Network

Videoconferencing applications have seen a jump in their userbase owing to the COVID-19 pandemic. The security of these applications has certainly been a hot topic since millions of VoIP users’ data is involved. However, research pertaining to VoIP forensics is still limited to Skype and Zoom. This paper presents a detailed forensic analysis of Microsoft Teams, one of the top 3 videoconferencing applications, in the areas of memory, disk-space and network forensics. Extracted artifacts include critical user data, such as emails, user account information, profile photos, exchanged (including deleted) messages, exchanged text/media files, timestamps and Advanced Encryption Standard encryption keys. The encrypted network traffic is investigated to reconstruct client-server connections involved in a Microsoft Teams meeting with IP addresses, timestamps and digital certificates. The conducted analysis demonstrates that, with strong security mechanisms in place, user data can still be extracted from a client’s desktop. The artifacts also serve as digital evidence in the court of Law, in addition to providing forensic analysts a reference for cases involving Microsoft Teams. © 2022, ICST Institute for Computer Sciences, Social Informatics and Telecommunications Engineering.

Inter ‘Face-To-Face’: Remote Co-creation for an Artifact

In times of uncertainty regarding the viability of collaborative and face-to-face research work with the Portuguese footwear industry, due to the circumstances of physical distance such as the one we are experiencing at present, this article aims to demonstrate a two-stage methodological strategy for a co-creation process via remote, as well as its limitations and future work. In this context, two questions arise that we intend to answer: How can co-creation work be carried out remotely with participants from different organizations? What are the advantages and disadvantages of this remote co-creation work? To answer these questions, in a first phase there is a study based on the literature review, comparing studies by authors on the advantages and disadvantages of virtual meetings compared to face-to-face meetings;and, in a second phase, emphasized by the experimentation of a co-creation work for an artifact, with master’s degree students in Image Design, were used Zoom audiovisual interface and collaborative online platform Miro. It’s argued, therefore, that the virtual encounters of a co-creation process for an artifact can, on the one hand, provide geographical and temporal advantages to the participants, on the other hand, provide technical difficulties that can create expected losses of efficiency. Since this whole process is primarily motivated by the current circumstances of confinement, due to the pandemic COVID-19, it is understood that the advantages of co-creation via remote will continue in the future, even in more favorable contexts. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The Social Meanings of Artifacts: Face Masks in the COVID-19 Pandemic.

Since the beginning of the COVID-19 pandemic, research has explored various aspects of face mask use. While most of the research explores their effectiveness to prevent the spread of the virus, a growing body of literature has found that using face masks also has social meaning. But what social meaning does it have, and how does this meaning express itself in people's practice? Based on 413 qualitative interviews with residents in five European countries (Austria, Belgium, Germany, Ireland, and Switzerland), we found that the meanings of face masks have changed drastically during the first months of the pandemic. While in spring 2020 people wearing them had to fear stigmatization, in autumn of 2020 not wearing masks was more likely to be stigmatized. Throughout the first year of the pandemic, we found that mask wearing had multiple and partly seemingly contradictory meanings for people. They were perceived as obstacles for non-verbal communication, but also a way to affirm friendships and maintain social contacts. They also signaled specific moral or political stances on the side of face mask wearers and non-wearers alike, expressed their belonging to certain communities, or articulated concern. In sum, our findings show how face masks serve as scripts for people to navigate their lives during the COVID-19 pandemic. We conclude that public and political discussions concerning face masks should include not only evidence on the epidemiological and infectiological effects of face masks, but also on their social meanings and their social effects.

Respirators and Surgical Masks Artefacts on Phantom using Magnetic Resonance Imaging during COVID-19: A Cross-sectional Study

Introduction: It is suitable for a patient to wear a respirator or face mask during any radiological investigation during Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) pandemic. Some face masks may have nanoparticles, or antimicrobial coating, which may comprise metal to help shape the mask according to user face shape. This kind of ferromagnetic substances can cause artefacts in the image. Aim: To detect and compare the artefacts while using different types of respirators and surgical masks in the Magnetic Resonance Imaging (MRI) phantom images. Materials and Methods: This was a prospective cross-sectional study which was conducted from July 2021-September 2021. Two Not resistant to oil-based aerosols with 95% efficiency to airborne particles (N95) respirators and two types of three-ply surgical disposable masks with a metal and plastic nose holder were used. The N95 respirators were of Halo N95 Filtering Facepiece 2 Particulate Matter (FFP2) PM 2.5 and Suchi N95 S-7400, while the surgical masks were from Venus 3 ply V-1010 with a metal nose holder and the Thea Tex Filtra 3 ply with plastic nose holder. A polymethyl methacrylate plastic phantom was used with 1.5 Tesla (Siemens Magnetom Avanto) MRI scanner for imaging. Results: When exposed to the metal detector both N95 respirators and one of the surgical masks with a metal nose clip showed strong ferromagnetic attraction. Both respirators and a surgical mask with a metal nasal holder showed magnetic susceptibility artefacts. The signal loss is caused by dephasing of spins from metal strip on the image. Conclusion: All the patients must have a recognised MR safe masks prior to an MRI investigation. When this is not possible to follow, metallic components from the face mask should be removed before the patient's arrival at the MR room. After removing the metal strip from the mask, the paper tape may be applied across the nasal bridge region for adequate transmission control and to maintain the intended function of the mask. The mask with a plastic nasal holder was ideal to use in an MR environment since it doesn't have any distortion in the image.

Deep Learning Tool for Automatic B-Line Detection and Localization in Lung Point-of-Care Ultrasound

Study Objectives: Point-of-care ultrasound (POCUS) offers real-time data to guide clinical decision-making and patient care. Despite having advantages over alternative imaging studies such as computed tomography or magnetic resonance imaging, performing POCUS requires technical expertise for image acquisition and interpretation, thereby limiting its use for many clinicians. Deep learning technologies can provide automated interpretation of POCUS images thus making POCUS accessible to even novice users. B-lines are sonographic artifacts seen on lung POCUS which are diagnostic for pulmonary diseases such as pneumonia, COVID-19, or decompensated heart failure. In this work we aim to develop a deep learning tool to automatically detect and localize B-lines on lung POCUS clips. Methods: Using a 12-point scanning protocol, we prospectively collected lung POCUS clips from 25 patients presenting to the emergency department with shortness of breath and/or flu-like symptoms. Sub-sampled frames from 500 POCUS clips were annotated for B-lines by 3 physicians with expertise in POCUS acquisition and interpretation. A 2D U-Net deep neural network was trained on frames annotated from 15 patients, with frames from the remaining 10 patients being set aside for validation studies. Transformations from polar to rectangular coordinates were performed as part of pre-processing the data. Frame-level predictions were aggregated to predict the presence or abscence of B-lines over an entire clip. Experiments are currently underway for determining the impact of weakly supervised vs. fully supervised training. Results: Initial results show an AUC score (95% CI) of 0.82 (0.74-0.89) for clip-level B-line detection based on a 5- fold cross-validation for the 15 patient subset. Additionally, by first segmenting B-lines, our approach for localization is substantially more specific than common alternatives, such as class-activation mapping. Conclusion: Here we generated a deep learning model that can detect the presence of B-lines on POCUS clips with significant accuracy. This model was developed from a limited training subset, thus we predict that with more integrated data, our model can be further refined to identify and ideally quantify B-lines on POCUS clips collected from an array of machines and from users with variable image acquisition experience. Ideally, this tool may enable clinicians with minimal prior training in POCUS to integrate this powerful imaging tool into patient care.