Analysis of social and psychological factors influencing the treatment of patients with chronic kidney disease under the regular epidemic prevention and control of coronavirus disease 2019.

Objective To explore the sociodemographic and psychological factors influencing the continuity of treatment of patients with chronic kidney disease under the regular epidemic prevention and control of coronavirus disease 2019 (COVID-19). Methods A total of 277 patients with chronic kidney disease who were admitted to Department of Nephrology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Apr. 2020 to Mar. 2021 were enrolled and divided into 3 groups: non-dialysis group (n=102), hemodialysis (HD) group (n=108), and peritoneal dialysis (PD) group (n=67). All patients were investigated by online and offline questionnaires, including self-designed basic situation questionnaire, self-rating anxiety scale (SAS), and self-rating depression scale (SDS). The general sociodemographic data, anxiety and depression of the 3 groups were compared, and the influence of sociodemographic and psychological factors on the interruption or delay of treatment was analyzed by binary logistic regression model. Results There were significant differences in age distribution, marital status, occupation, medical insurance type, caregiver type, whether there was an urgent need for hospitalization and whether treatment was delayed or interrupted among the 3 groups (all P0.05). The average SAS score of 65 PD patients was 38.15+/-15.83, including 53 (81.5%) patients without anxiety, 7 (10.8%) patients with mild anxiety, and 5 (7.7%) patients with moderate to severe anxiety. The average SAS score of 104 patients in the HD group was 36.86+/-14.03, including 81 (77.9%) patients without anxiety, 18 (17.3%) patients with mild anxiety, and 5 (4.8%) patients with moderate to severe anxiety. There were no significant differences in the mean score of SAS or anxiety severity grading between the 2 groups (both P0.05). The mean SDS scores of 65 PD patients were 53.42+/-13.30, including 22 (33.8%) patients without depression, 21 (32.3%) patients with mild depression, and 22 (33.8%) patients with moderate to severe depression. The mean SDS scores of 104 patients in the HD group were 50.79+/-10.76, including 36 (34.6%) patients without depression, 56 (53.8%) patients with mild depression, and 12 (11.6%) patients with moderate to severe depression. There were no significant differences in mean SDS scores or depression severity grading between the 2 groups (both P0.05). The results of intra-group comparison showed that the incidence and severity of depression were higher than those of anxiety in both groups. Multivariate binary logistic regression analysis showed that high school education level (odds ratio OR=5.618, 95% confidence interval CI) 2.136-14.776, P0.01), and unmarried (OR=6.916, 95% CI 1.441-33.185, P=0.016), divorced (OR= 5.588, 95% CI 1.442-21.664, P=0.013), urgent need for hospitalization (OR=8.655, 95% CI 3.847-19.476, P0.01) could positively promote the continuity of treatment in maintenance dialysis patients under the regular epidemic prevention and control of COVID-19. In the non-dialysis group, no sociodemographic and psychological factors were found to be associated with the interruption or delay of treatment (P0.05). Conclusion Education, marital status, and urgent need for hospitalization are correlated with the continuity of treatment in patients with chronic kidney disease on maintenance dialysis.Copyright © 2022, Second Military Medical University Press. All rights reserved.

Changes in Colorectal Cancer Practices during the Early COVID-19 Period

Objective: The aim of our study is to investigate the management of colorectal cancer patients during the Coronavirus Disease 2019 (COVID-19) pandemic, which has affected our daily routine. We aimed to compare our results between the pre-pandemic and pandemic periods, and evaluate any seasonal differences within the COVID-19 pandemic. Materials and Methods: Our retrospective study was conducted in a single center. We included all participants who had elective and emergency gastrointestinal operations due to colorectal cancer between March 2019 and March 2021. Participant data were separated and compared between the pre-pandemic and pandemic periods, with the latter divided into two groups (Group 1: Phase 1-2, Group 2: Phase 3). Results: There were no statistically significant differences between the cases treated before and during the COVID-19 pandemic period in terms of mean age, gender distribution, diagnosis, tumor location, American Society of Anesthetists (ASA) score, recurrence, or mortality (p>0.05). We found no differences between the pre-pandemic and pandemic periods in admission to the hospital, surgical approach, need for stoma, complications, length of stay in the intensive care unit (ICU), total hospitalization, or tumor stage (p>0.05). However, we observed that the percentage of open surgical operations was statistically significantly higher, and the percentage of laparoscopic surgical operations was statistically significantly lower in Group 2 compared to Group 1 (p=0.020). Conclusion: The pandemic periods should not be assessed with the same perspective. Treatment approaches can change according to hospital capacity during peak periods of COVID-19 disease.

How to find undetected cases of dementia in care homes: A new approach to dementia diagnosis using a diagnostic tool with five criteria to check and specialist nurses going into care homes and assessing residents could improve detection rates

The pandemic took its toll on memory clinics with many forced to close or scale back their services. This led to lengthening waits for dementia assessment and left many without a diagnosis.

Primary immunodeficiency associated with a SAMD9L mutation

Background: SAMD9L is a tumor suppressor involved in regulating the proliferation and maturation of cells, particularly those derived from the bone marrow, and appears to play an important role in cerebellar function. It can be activated in hematopoietic stem cells by type I and type II interferons. It has been hypothesized to act as a critical antiviral gatekeeper regulating interferon dependent demand driven hematopoiesis. Gain of function mutations can present with an immunodeficiency due to transient severe cytopenias during viral infection. Case presentation: We report a 3-year-old boy born full term with a history of severe thrombocytopenia requiring transfusions, developmental delay, ataxia, seizure disorder, and recurrent severe respiratory viral infections. His infectious history was significant for respiratory syncytial virus with shock requiring extracorporeal membrane oxygenation complicated by cerebral infarction and a group A streptococcus empyema, osteomyelitis requiring a left below the knee amputation, and infections with rhinovirus, COVID-19, and parainfluenza requiring hospitalizations for respiratory support. Initial immunologic evaluation was done during his hospitalization for parainfluenza. His full T cell subsets was significant for lymphopenia across all cell lines with CD3 934/microL, CD4 653/microL, CD8 227/microL, CD19 76/microL, and CD1656 61/microL. His mitogen stimulation assay to phytohemagglutinin and pokeweed was normal. Immunoglobulin panel showed a mildly decreased IgM of 25 mg/dL, but normal IgA and IgG. Vaccine titers demonstrated protective titers to 12/22 pneumococcus serotypes, varicella, diphtheria, mumps, rubella, and rubeola. Repeat full T cell subsets 6 weeks later revealed marked improvement in lymphocyte counts with CD3 3083/microL, CD4 2101/microL, CD8 839/microL, CD19 225/microL, and CD1656/microL. A primary immunodeficiency genetic panel was ordered and positive for a heterozygous SAMD9L c.1549T>C (p.Trp517Arg) mutation classified as a variant of unknown significance. Discussion(s): This patient's history of severe viral infections, ataxia, thrombocytopenia, and severe transient lymphopenia during infection is suggestive of a SAM9DL gain of function mutation. Protein modeling done by the laboratory suggests this missense mutation would affect protein structure. The mutation found has been observed in individuals with thrombocytopenia. This case highlights the importance of immunophenotyping both during acute illness and once recovered.Copyright © 2023 Elsevier Inc.

ELASTIC: Edge Workload Forecasting based on Collaborative Cloud-Edge Deep Learning

With the rapid development of edge computing in the post-COVID19 pandemic period, precise workload forecasting is considered the basis for making full use of the edge limited resources, and both edge service providers (ESPs) and edge service consumers (ESCs) can benefit significantly from it. Existing paradigms of workload forecasting (i.e., edge-only or cloud-only) are improper, due to failing to consider the inter-site correlations and might suffer from significant data transmission delays. With the increasing adoption of edge platforms by web services, it is critical to balance both accuracy and efficiency in workload forecasting. In this paper, we propose ELASTIC, which is the first study that leverages a cloud-edge collaborative paradigm for edge workload forecasting with multi-view graphs. Specifically, at the global stage, we design a learnable aggregation layer on each edge site to reduce the time consumption while capturing the inter-site correlation. Additionally, at the local stage, we design a disaggregation layer combining both the intra-site correlation and inter-site correlation to improve the prediction accuracy. Extensive experiments on realistic edge workload datasets collected from China's largest edge service provider show that ELASTIC outperforms state-of-the-art methods, decreases time consumption, and reduces communication cost. © 2023 ACM.

Detecting COVID-19 spreading phases with time series analysis

Piecewise linear regression (PLR) method is applied to study cumulative cases of COVID-19 evolving everyday in England up to 6th February 2022 just before travel restrictions are removed and people started not to get tested anymore in the UK and factors e.g. the lockdowns behind the spread COVID-19 are also investigated. It is clear that different periods exhibit distinct patterns depending on variants and government-imposed restriction. Therefore, the effectiveness of lockdown measures is evaluated by comparing the rate of increase after a certain period (delay effect of measures) and that of time before as well as how new variants take over as a dominant variant. In addition, autoregression function is studied to show strong effect of cases in the past on today's cases since the disease is highly infectious. Most of work is carried out thorough python built-in libraries such as pandas for preprocessing data and matplotlib which allows us to gain more insight and better visualization into the real scenario. Visualization is conducted by Geoda showing the regional level of infections. © 2023 SPIE.

Qualitative study on delayed experience of seeking medical treatment in patients with advanced lung cancer

Objective To explore the causes and feelings of delayed experience of seeking medical treatment in patients with advanced lung cancer, and to provide new insights for more targeted health education and medical care services. Methods A semi-structured in depth interview based on the theory of planned behavior was conducted among 30 patients with advanced lung cancer who experienced medical delay from November to December in 2021 admitted to First Affiliated Hospital of Guangxi Medical University. The interview content was analyzed and ed by using Colaizzi phenomenological analysis method and Nvivo11.0 software. Results The delay duration of 30 patients with advanced lung cancer ranged from 90 to 213 days. Four subject groups were extracted by generic analysis: the cause of delay, the cause to seek medical help, the worry about the disease, and solutions. Conclusions The delay behavior of patients with advanced lung cancer is affected by external situational factors such as symptom severity, family economic capacity, social support, accessibility of health services, prevalence of novel coronavirus, and subjective psychological factors such as sense of stigma and burden of disease, it is necessary to reduce the occurrence of medical delay in patients with advanced lung cancer through the comprehensive management strategy of multiple channels. © 2023 Chinese Medical Journals Publishing House Co.Ltd. All rights reserved.

Health-related quality of life, mental health and caregiver burden in children with autosomal recessive polycystic kidney disease (ARPKD)

Objective: To examine whether established patient-reported outcome measures are suitable for capturing the impact of ARPKD in children and their families. Method(s): We assessed 44 children with ARPKD (40 families) with respect to patients' health-related quality of life ((hr- QOL) using PedsQLTM ESRD module) and mental health (strength and difficulties questionnaire (SDQ)) as well as family and caregiver burden (Impact on family score (IFS) und Ulm inventory of parental caregiver QOL (ULQIE)) and compared them to published data and 36 healthy control children matched for age and time. Result(s): Patients were aged 9.5 +/- 5.9 years (vs. controls 8.8 +/- 5.0, p = ns) and 21 (48%) were female (vs. 19 controls (53%), p = ns). Mean eGFR was 81 ml/min*1.73m2 (range 4 - 165);7 received dialysis and 11 had functioning kidney transplants (KTX, 2 combined with liver transplants). Eight patients had developmental delay secondary to medical complications, while chronic illness was an exclusion criterion for healthy controls. 61 caregivers of affected children had same gender-distribution (61% vs. 60% mothers) and age (both 42 +/- 7 years) and number of dependent children (1.8 +/- 0.9 vs. 2.0 +/- 0.8) as 57 caregivers of healthy children. The mean proxy reported PedsQL Total score was 77.5 +/- 10.6 (range 59 - 96). It correlated significantly to eGFR (r = 0.5, p < 0.01, (also within the subpopulations pre- and post-KTX)). Parents reported greater mental health problems in affected than in control children with a higher SDQ total score mainly due to higher scores in the hyperactivity and peerinteraction subscales. ULQIE revealed that parents of affected children had significantly lower levels of physical functioning, self-fulfillment and general QOL, but despite higher emotional burden scores they indicated similar satisfaction with family life. Impact on family scores were in a similar range to those of children with moderate to severe disabilities. Conclusion(s): The good spread of PedsQLTM ESRD-scores and their correlation to renal function indicates that it captures significant aspects of ARPKD, however, it may need further adjustment to include liver complications. All four chosen instruments revealed significant impact of ARPKD on hrQOL and mental health of affected children as well as family life and parental wellbeing in comparison to healthy controls. More problems with peer-interactions may also be due to more stringent shielding of chronically ill children from social contacts during the COVID pandemic compared to healthy children.

Can delay discounting predict vaccine hesitancy 4-years later? A study among US young adults

Despite being a major threat to health, vaccine hesitancy (i.e., refusal or reluctance to vaccinate despite vaccine availability) is on the rise. Using a longitudinal cohort of young adults (N=1260) from Los Angeles County, California we investigated the neurobehavioral mechanisms underlying COVID-19 vaccine hesitancy. Data were collected at two time points: during adolescence (12th grade;fall 2016;average age = 16.96 (±0.42)) and during young adulthood (spring 2021;average age = 21.33 (±0.49)). Main outcomes and measures were delay discounting (DD;fall 2016) and tendency to act rashly when experiencing positive and negative emotions (UPPS-P;fall 2016);self-reported vaccine hesitancy and vaccine beliefs/knowledge (spring 2021). A principal components analysis determined four COVID-19 vaccine beliefs/knowledge themes: Collective Responsibility, Confidence and Risk Calculation, Complacency, and Convenience. Significant relationships were found between themes, COVID-19 vaccine hesitancy, and DD. Collective Responsibility (β=-1.158[-1.213,-1.102]) and Convenience (β=-0.132[-0.185,-0.078]) scores were negatively associated, while Confidence and Risk Calculation (β=0.283[0.230,0.337]) and Complacency (β=0.412[0.358,0.466]) scores were positively associated with COVID-19 vaccine hesitancy. Additionally, Collective Responsibility (β=-0.060[-0.101,-0.018]) was negatively associated, and Complacency (β=-0.063[0.021,0.105]) was positively associated with DD from fall 2016. Mediation analysis revealed immediacy bias during adolescence, measured by DD, predicted vaccine hesitancy 4 years later while being mediated by two types of vaccine beliefs/knowledge: Collective Responsibility (β=0.069[0.022,0.116]) and Complacency (β=0.026[0.008,0.044]). These findings provide a further understanding of individual vaccine-related decision-making among young adults and inform public health messaging to increase vaccination acceptance.

The Bank of Japan's exchange traded fund purchases: a help or hindrance to market efficiency?

We examine the impact of the Bank of Japan's exchange traded fund (ETF) purchases on two aspects of market efficiency—long-range dependence and price delay—of the TOPIX and Nikkei 225 indices. An increase in ETF purchases results in lower long-range dependence for both indices while the impact on the price delay varies according to index and measure. A sub-period analysis shows that the impact on market efficiency varies over time, with the dominant pattern being a delayed harmful effect, followed by a positive impact and thereafter a negative effect. The implications of these findings are discussed.

Identifying factors that affect barriers to lymphoma treatment during the COVID - 19 pandemic

Introduction: Barriers to therapy for patients with lymphoma are an essential topic. The Lymphoma Coalition biennial global patient survey collects data on patient experiences, including challenges or limitations patients face in seeking medical attention or access to treatment. Due to Covid-19, patients with lymphoma have experienced high barriers. This study aims to rank the influence of core demographic variables in their ability to predict barriers to lymphoma treatment in 2020 and 2022. Method(s): The survey was deployed globally to lymphoma patients and caregivers in 2020 & 2022. The outcome variable was the identification of any barrier to receiving lymphoma treatment. Logit regression was used to model the outcome against core demographics. Variable importance was quantified with independent Monte Carlo resampling. Result(s): Barriers were significantly elevated in all regions in 2022 (p<0.0001). Those who are of older age were found to have fewer barriers to treatment: Unit OR = 0.965;95%CI [0.962 - 0.968]. Age was consistently a variable of high importance across most regions in both survey years (Table 1). In 2022, treatment delay due to concerns over COVID-19 was the second-ranked variable of importance in three regions. Conclusion(s): Barriers to treatment for patients with lymphoma increased dramatically across all regions from 2020-2022. Increased barriers to treatment in those of younger age were an unexpected finding. Heterogeneity in the impact of variables that influence access to treatment appears to be enhanced by participants' psychosocial impacts due to the pandemic. Policymakers and providers should actively rectify access disparities in their respective regions.

Atrial electromechanical delay in post-COVID-19 postural orthostatic tachycardia: Innocent bystander or pathologic factor.

BACKGROUND: Post-COVID-19 syndrome represents a wide range of ongoing symptoms that persist beyond weeks or even months, after recovery from the acute phase. Postural orthostatic tachycardia (POT) is one of these symptoms with a poorly recognized underlying pathophysiology. PURPOSE: We aimed to investigate atrial electromechanical delay (AEMD), demonstrated by electrocardiographic P wave dispersion (PWD) and tissue Doppler echocardiography (TDE) in patients with POST-COVID-19 POT (PCPOT). METHODS: 94 post-COVID-19 patients were enrolled and classified into two groups; PCPOT group, 34 (36.1%) patients, and normal heart rate (NR group), 60 (63.9%) patients. 31.9% of them were males and 68.1% were females, with a mean age of 35 ± 9 years. Both groups were compared in terms of PWD and AEMD. RESULTS: As compared to the NR group, the PCPOT group showed a significant increase in PWD (49 ± 6 versus 25.6 ± 7.8, p < 0.001), higher CRP (37 ± 9 versus 30 ± 6, p = 0.04), prolonged left-atrial EMD, right-atrial EMD and inter-atrial EMD at (p = 0.006, 0.001, 0.002 respectively). Multivariate logistic regression analysis revealed that P wave dispersion (ß 0.505, CI (0.224-1.138), p = 0.023), PA lateral (ß 0.357, CI (0.214-0.697), p = 0.005), PA septal (ß 0.651, CI. (0.325-0.861), p = 0.021), and intra-left atrial EMD (ß 0.535, CI (0.353-1.346) p < 0.012) were independent predictors of PCPOT. CONCLUSION: Atrial heterogenicity in the form of prolonged AEMD and PWD seems to be a reasonable underlying pathophysiology of PCPOT. This could provide a new concern during the management and novel pharmacological approaches in these patients.

Heart Rate Variability and Pregnancy Complications: Systematic Review.

BACKGROUND: The autonomic nervous system (ANS) is known as a critical regulatory system for pregnancy-induced adaptations. If it fails to function, life-threatening pregnancy complications could occur. Hence, understanding and monitoring the underlying mechanism of action for these complications are necessary. OBJECTIVE: We aimed to systematically review the literature concerned with the associations between heart rate variability (HRV), as an ANS biomarker, and pregnancy complications. METHODS: We performed a comprehensive search in the PubMed, Medline Completion, CINAHL Completion, Web of Science Core Collection Classic, Cochrane Library, and SCOPUS databases in February 2022 with no time span limitation. We included studies concerned with the association between any pregnancy complications and HRV, with or without a control group. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was used for the review of the studies, and Covidence software was used for the study selection process. For data synthesis, we used the guideline by Popay et al. RESULTS: Finally, 12 studies with 6656 participants were included. Despite the methodological divergency that hindered a comprehensive comparison, our findings suggest that ANS is linked with some common pregnancy complications including fetal growth. However, existing studies do not support an association between ANS and gestational diabetes mellitus. Studies that linked pulmonary and central nervous system disorders with ANS function did not provide enough evidence to draw conclusions. CONCLUSIONS: This review highlights the importance of understanding and monitoring the underlying mechanism of ANS in pregnancy-induced adaptations and the need for further research with robust methodology in this area.

Time delay of the appearance of a new strain can affect vaccination behavior and disease dynamics: An evolutionary explanation.

The emergence of a novel strain during a pandemic, like the current COVID-19, is a major concern to the healthcare system. The most effective strategy to control this type of pandemic is vaccination. Many previous studies suggest that the existing vaccine may not be fully effective against the new strain. Additionally, the new strain's late arrival has a significant impact on the disease dynamics and vaccine coverage. Focusing on these issues, this study presents a two-strain epidemic model in which the new strain appears with a time delay. We considered two vaccination provisions, namely preinfection and postinfection vaccinations, which are governed by human behavioral dynamics. In such a framework, individuals have the option to commit vaccination before being infected with the first strain. Additionally, people who forgo vaccination and become infected with the first train have the chance to be vaccinated (after recovery) in an attempt to avoid infection from the second strain. However, a second strain can infect vaccinated and unvaccinated individuals. People may have additional opportunities to be vaccinated and to protect themselves from the second strain due to the time delay. Considering the cost of the vaccine, the severity of the new strain, and the vaccine's effectiveness, our results indicated that delaying the second strain decreases the peak size of the infected individuals. Finally, by estimating the social efficiency deficit, we discovered that the social dilemma for receiving immunization decreases with the delay in the arrival of the second strain.

Scurvy in a Pediatric Patient Unable to Bear Weight: A Case Report.

Pediatric scurvy is uncommon in the twenty-first century but cases have been reported in children with neurodevelopmental issues and restricted diets. We are reporting a two-year and nine-month-old boy who had a coronavirus disease (COVID) infection and then presented with a refusal to walk. By careful history-taking, he was found to have a restricted diet, speech delay, and gum bleeding suggestive of scurvy, which was confirmed by extremely low levels of ascorbic acid. In this case, the diagnosis of scurvy was established before establishing the diagnosis of neurodevelopmental delay. Treatment with ascorbic acid resulted in a remarkable improvement in his symptoms. This case highlights the importance of collecting a thorough history, connecting exam findings to the history, and including scurvy in differential diagnoses for the presentation of inability to bear weight.

Using a manifold-based approach to extract clinical codes associated with winter respiratory viruses at an emergency department

Every winter, respiratory viruses put most Emergency Departments (ED) around the world under intense pressure. To reduce the consequent stress for hospitals, anticipation of the massive increase of intakes for illness-based symptoms is essential. As the Covid-19 2020 pandemic clearly illustrates, patients are not systematically tested. The ED staff therefore has no real-time knowledge of the presence of the virus in the patients flow. To address this issue, we propose here to use the hospital's laboratory-confirmed database as an attractor for the manifold-based approach for clustering the clinical codes associated with respiratory viruses. We propose a new framework based on the embedding of time series onto the Stiefel manifold, coupled with a density-based clustering algorithm (HDBSCAN) enhanced by a reduction of dimension (UMAP) for the clustering on that manifold. In particular, we show, based on real data sets of two academic hospitals in France, the significant benefits of using geometrical approaches for time series clustering as compared to traditional methods.

Stability analysis of an epidemic model with vaccination and time delay

This paper presents an epidemic model with varying population, incorporating a new vaccination strategy and time delay. It investigates the impact of vaccination with respect to vaccine efficacy and the time required to see the effects, followed by determining how to control the spread of the disease according to the basic reproduction ratio of the disease. Some numerical simulations are provided to illustrate the theoretical results.

Developing Multidisciplinary Models of Care in Rheumatology at University College London Hospital: 18 Months of Learning from Conception to Delivery and Beyond

Background/Aims The COVID-19 pandemic has placed unprecedented pressures on NHS departments, with demand rapidly outstripping capacity. The British Society for Rheumatology 'Rheumatology Workforce: a crisis in numbers (2021)' highlighted the need to provide innovative ways of delivering rheumatology specialist care. At University College London Hospitals (UCLH) we created a rheumatology multidisciplinary team (MDT) clinic to meet rising demands on our service. The aims of the Rheumatology MDT clinic were to: reduce new appointment/follow-up waiting times, increase clinic capacity, incorporate musculoskeletal (MSK) point of care ultrasound, reduce number of hospital visits and add value to each clinic encounter. Methods We ran a 6-month pilot, supported by our outpatient transformation team, incorporating a Rheumatology Advanced Practice Physiotherapist (APP), Clinical Nurse Specialist (CNS) and MSK ultrasound within a Consultant clinic. The success of the pilot helped secure funding for a further 12 months. Over 18 months we have implemented: APP/Consultant enhanced triage - up to 40% of referrals were appropriate for APP assessment, including regional MSK problems and back pain. This increased capacity for consultant-led appointments. Standardisation of time-lapse between CNS and consultant follow-up appointments to ensure appropriate spacing between patient encounters. Facilitated overbooking of urgent cases afforded by additional capacity provided by the APP. MSK ultrasound embedded in the clinic template. 'Zoom' patient education webinars facilitated by MDT members and wider disciplines e.g. dietetics, to empower self-management and reduce the administrative burden of patient emails/phone calls occurring outside the clinic. Patient participation sessions and feedback to help shape the service. Results During the 6-month pilot we reduced our waiting time for follow-up appointments from 9 months to 2. We now have capacity to book 1-2 urgent cases each week. Pre-MDT the average wait from consultant referral to physiotherapist appointment was 55 days. The MDT allows for same day assessment (reducing 2-3 patient journeys a clinic) and where suitable, facilitates discharge or onwards referral to the appropriate service. A dedicated MDT CNS has shortened treatment times, reduced email traffic between CNS and consultant and allows for same day, joint decision-making resulting in fewer appointments. Zoom webinar feedback has been positive. Patients value the broad expertise of allied health professionals which supports self-management. Embedding ultrasound allows for same day diagnostics, decreased referrals to radiology and reduced hospital visits. Conclusion Our MDT model has reduced waiting lists, decreased treatment delays and cut hospital attendances. Point of care ultrasound allows for same day decision making and abolishes the cost and diagnostic delay associated with referrals to radiology or outsourced providers. Shared decision-making adds value to outpatient attendances, which is reflected in patients' positive feedback. The MDT model maximises the existing workforce skill set by enhancing the APP and CNS role, allowing patients immediate access to their expertise.

Identification of time delays in COVID-19 data

COVID-19 data released by public health authorities is subject to inherent time delays. Such delays have many causes, including delays in data reporting and the natural incubation period of the disease. We develop and introduce a numerical procedure to recover the distribution of these delays from data.We extend a previously-introduced compartmental model with a nonlinear, distributed-delay term with a general distribution, obtaining an integrodifferential equation. We show this model can be approximated by a weighted-sum of constant time-delay terms, yielding a linear problem for the distribution weights. Standard optimization can then be used to recover the weights, approximating the distribution of the time delays. We demonstrate the viability of the approach against data from Italy and Austria.We find that the delay-distributions for both Italy and Austria follow a Gaussian-like profile, with a mean of around 11 to 14 days. However, we note that the delay does not appear constant across all data types, with infection, recovery, and mortality data showing slightly different trends, suggesting the presence of independent delays in each of these processes. We also found that the recovered delay-distribution is not sensitive to the discretization resolution.These results establish the validity of the introduced procedure for the identification of time-delays in COVID-19 data. Our methods are not limited to COVID-19, and may be applied to other types of epidemiological data, or indeed any dynamical system with time-delay effects.

The Impact of Illness Perception on Delay in Seeking Medical Help in Patients with Acute Chest Pain: A Cross-sectional Study in the United Arab Emirates

Background: The concern of contracting COVID-19 has prevented numerous individuals with ambiguous myocardial infarction symptoms from seeking medical attention, leading to delayed presentation and treatment of acute coronary syndrome (ACS). This delay could increase the risk of long-term consequences. Aim: The aim of this study is to evaluate the impact of illness perception on delay in seeking medical help in patients with acute chest pain in UAE during COVID-19 pandemic. Methods: A descriptive cross-sectional design was used. Results: A total of 222 in-patients participated in the study, with an average age of 54.3 years (SD=14, Range= 20-86). The average score of illness perception was 5.66 (SD=0.92), which indicates that CVD was perceived as moderately threatening to physical and emotional status. Univariate analysis showed that illness coherence having previous cardiac catheterization, diabetes and asthma were factors associated with delay in seeking medical services. The linear regression showed that college education was a strong predictor of delay, while a history of asthma and undergoing cardiac catheterization were independent predictors of shorter delay. Conclusion: Illness coherence perception and time of seeking medical help are correlated. In addition, illness perception of personal control is low, which indicates the need for educational intervention. Other clinical factors also impact patients' decisions, such as previous cardiac intervention and comorbidity, highlighting the target group for further attention from the healthcare team. © 2023 Mosleh et al.