Expert consensus on diagnosis and treatment of adult mental stress-induced hypertension in China (2022 Revision): Part B

Mental stress has been recognized as an essential risk factor for hypertension. Therefore, experts specializing in cardiology, psychiatry, and Traditional Chinese Medicine organized by the Psycho-cardiology Group, College of Cardiovascular Physicians of Chinese Medical Doctor Association, and Hypertension Group of the Chinese Society of Cardiology proposed the expert consensus on the diagnosis and treatment of adult mental stress-induced hypertension in March 2021, which includes the epidemiology, etiology, diagnosis, and treatment of the mental stress-induced hypertension. This consensus will hopefully facilitate the clinical practice of this disorder. In addition, the COVID-19 pandemic has become one of the primary global sources of psychosocial stressors since the beginning of 2020, and the revision of this expert consensus in 2022 has increased the relevant content. This consensus consists of two parts. The sections of Part A include (I) Background and epidemiological characteristics, (II) Pathogenesis, and (III) Diagnosis. The sections of Part B contain (IV) Treatment recommendations, and (V) Prospects. This article presents Part B of the consensus. © 2022 Heart and Mind ;Published by Wolters Kluwer - Medknow.

Expert consensus on diagnosis and treatment of adult mental stress induced hypertension in China (2022 revision): Part A

Mental stress has been recognized as an essential risk factor for hypertension. Therefore, experts specializing in cardiology, psychiatry, and Traditional Chinese Medicine organized by the Psycho-Cardiology Group of College of Cardiovascular Physicians of Chinese Medical Doctor Association and Hypertension Group of Chinese Society of Cardiology proposed the expert consensus on the diagnosis and treatment of adult mental stress-induced hypertension in March 2021, which includes the epidemiology, etiology, diagnosis, and treatment of the mental stress-induced hypertension. This consensus will hopefully facilitate the clinical practice of this disorder. In addition, the COVID-19 pandemic has become one of the primary global sources of psychosocial stressors since the beginning of 2020, and the revision of this expert consensus in 2022 has increased the relevant content. This consensus consists of Part A and Part B. Part A includes (I) Background and epidemiological characteristics, (II) Pathogenesis, and (III) Diagnosis and Part B includes (IV) Treatment recommendations and (V) Prospects. This part presents the content of Part A. © 2022 Heart and Mind ;Published by Wolters Kluwer - Medknow.

PVT-COV19D: COVID-19 Detection Through Medical Image Classification Based on Pyramid Vision Transformer

With the outbreak of COVID-19, a large number of relevant studies have emerged in recent years. We propose an automatic COVID-19 diagnosis model based on PVTv2 and the multiple voting mechanism. To accommodate the different dimensions of the image input, we classified the images using the Transformer model, sampled the images in the dataset according to the normal distribution, and fed the sampling results into the PVTv2 model for training. A large number of experiments on the COV19-CT-DB dataset demonstrate the effectiveness of the proposed method. Our method won the sixth place in the (2nd) COVID19 Detection Challenge of ECCV 2022 Workshop: AI-enabled Medical Image Analysis - Digital Pathology & Radiology/COVID19. Our code is publicly available at https://github.com/MenSan233/Team-Dslab-Solution. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Undergraduate business students? learning experiences during the COVID-19 pandemic: Insights for remediation of future disruption

Despite the rapid proliferation of literature exploring student learning during the COVID-19 pandemic, little has been published about its impacts on business undergraduates during the pivots to remote teaching and learning. There is a particular lack of insight and guidance for business schools to optimise program delivery post-COVID or for similar future disruptions. This case study explored the learning experiences of undergraduate business students during the COVID-19 pandemic, drawing insights from an Australian university located in the state of Vic-toria, one of the 'most locked down places in the world'. Thematic analysis identified the following emergent themes: (1) Mixed student experiences and perceptions of online learning upon transitioning into lockdown/emergency remote teaching/learning;(2) Limited connections and interactions amongst student-student(s) and student-lecturer/tutor;(3) Perceived ineffective online teaching delivery;(4) Positive aspects of emergency remote learning;(5) Adequacy of support for learning during lockdowns;(6) Preferences for post-COVID-19 learning. The outcomes provide proactive signposts for university educators wishing to improve student engagement and learning, and delivery of business undergraduate programs for a post-COVID world as well as future pandemic and similar disruption settings.

Masked Facial Region Recognition Using Human Pose Estimation and Broad Learning System

COVID-19 and its variants have been posing a large risk to people around the world since the outbreak of the disease. Many techniques like AI are explored to help combat epidemics. People are required or forced to wear a mask to fight against COVID-19 epidemics worldwide. It brings new challenges to the task of masked facial region recognition. When facial regions are occluded by masks, it will result in some failures of face detection algorithms. In this paper, we propose a method to recognize masked faces. It mainly includes three parts. Firstly, the human pose is estimated to produce a series of key points. It is implemented by OpenPose. Secondly, a key-points location strategy is designed to capture the masked facial regions. It can locate the positions of faces accurately. Thirdly, the broad learning system, which is also an incremental learning algorithm, is employed to recognize the classes of candidate regions. Experiments conducted on some datasets shed light on the effectiveness of the proposed method. © 2022 SPIE.

Rapid Rise of Pediatric Telehealth During COVID-19 in a Large Multispecialty Health System

Background: Before the COVID-19 pandemic, telemedicine use for outpatient pediatric specialty care was low. Stay-at-home orders (SHO) prompted rapid upscaling of telemedicine capabilities and upskilling of providers. This study compares telemedicine usage before and after the SHO and analyzes how a Children's Center addressed challenges associated with a rapid rise in telemedicine. Methods: Data on outpatient visits across 14 specialty divisions were ed from the institutional electronic medical record. The 12-week study period (March 9, 2020-May 29, 2020) spanned three epochs: pre-SHO;post-SHO;reopening to in-person visits. Changes in in-person visits, video visits, and completed, cancelled, and no-show appointments were compared between three epochs. Results: A total of 4,914 outpatient pediatric specialty visits were completed, including 67% (3,296/4,914) in-person and 33% (1,618/4,914) through video. During the first two epochs encompassing the SHO, video visits increased by 4,750%. (Figure 1) During the third epoch when the SHO was lifted, video visits decreased by 66%, with 19.4% of visits conducted through video in week 12. Overall, for outpatient video appointments, 82.8% (1,618/1,954) were completed, 9.1% (178/1,954) were cancelled, and 8.1% (158/1,954) were no-shows. The percentage of completed and no-show appointments did not differ between epochs. However, the cancellation rate decreased significantly from Epochs 1 to 3 (p = 0.008). Patient characteristics are summarized in Table 1. We observed statistically significant differences in race, age, and type of insurance ( p < 0.001). A higher proportion of patients in the video visit group were Caucasian (87.0% vs. 83.1%) or had commercial insurance (75.8% vs. 70.8%) compared with patients in the in-person appointment group. In addition, there was a smaller proportion of patients in the video visit group who were older than 18 years of age (11.2% vs. 16.2%). Conclusion: A SHO was associated with a large increase in pediatric specialty video visits. Post-SHO, the percentage of pediatric specialty visits conducted through video decreased but remained higher than before the SHO. Frequent, content-rich communications, selfdirected tutorials, and individualized coaching may facilitate successful increases in telemedicine use. (Table Presented).

COMPARISON OF PATIENT SATISFACTION SURVEYS OF IN PERSON VERSUS TELEHEALTH OUTPATIENT CLINIC VISITS DURING THE COVID PANDEMIC

Background: The COVID pandemic has markedly increased the adoption of telehealth. Patient satisfaction with telehealth may vary with the age and locale of the patient including the distance from the medical center and the setting the patient resides in (rural vs. urban). University of Utah Health is uniquely positioned to assess patient satisfaction in this transition due its very large geographic referral area from the continuum of the rural-urban settings. Aims: Compare pre-pandemic in-person visits to post-pandemic telehealth and in-person visits. Explore the temporal and spatial effect of a post-pandemic telehealth visits. Methods: Exceptional patient experience (EPE) surveys were sent to all patients after ambulatory care visits and consists of 8 questions. Possible responses ranged from Very Poor to Very Good on 5point scale. Survey responses were stratified by type of visit (in-person or telehealth), distance from medical center, rural vs. urban, age and time before and after start of COVID pandemic. Summary statistics of the response variables by pre pandemic in-person visit and post pandemic telehealth were done. We fitted a linear regression model adjusting for age and gender using the Covariate Balancing Propensity Score Estimation. Scores for entire institutional cohort and department of Gastroenterology were compared. Percentages reported are patients responding “Very Good.” Results: EPE scores were compared from in person pre-pandemic (11/01/18-2/28/20) to telehealth post-pandemic (04/1/20-12/31/20) with a transitional month of March (3/20) excluded. This included 235,227 returned surveys (14.0% response rate) of which 140,438 (GI 1852) were in person pre-pandemic and 87,135 (GI 1114) were telehealth post-pandemic. The entire cohort including GI patients reported greater satisfaction with in-person compared to telehealth visits with greatest % differences in “Overall assessment” and “Likelihood to recommend”. The other 6 questions showed similar scores between in-person and telehealth visits, but also favored in-person (Table 1, p<0.01 for all comparisons). Younger (£40) GI patients had higher scores for telehealth compared in person visits (p<0.03). The temporal effect of post-pandemic GI telehealth visits over time showed significantly higher scores of “ease of scheduling an appointment” “Likelihood to recommend” and “staff work together” in December compared to April (p<0.001) The spatial effect of a post-pandemic GI telehealth visits showed significantly lower scores for all questions for rural areas over micro/metropolitan for telehealth (p<0.001). Conclusion: All patients including GI patients preferred in person to telehealth visits though satisfaction was high with both. Younger GI patients preferred telehealth visits. Satisfaction with telehealth increased over time from the start of the pandemic.(Table Presented)

Telemedicine access, care, and outcomes for TIA and minor stroke

Introduction: Telemedicine is increasingly used, but its effectiveness for stroke prevention after minor stroke or TIA is not known. We compared the care and outcomes in patients discharged from an emergency department (ED) with TIA or stroke before and after the implementation of telemedicine stroke prevention clinics in Ontario, Canada. We hypothesized that care and outcomes will remain similar. Methods: We used linked administrative data to identify community-dwelling adults discharged from the ED with TIA or ischemic stroke from April 2015 to March 2020 (pre-telemedicine) and April 2020 to March 2021 (post-telemedicine). We compared access to outpatient physician visits within 90 days, neuroimaging or vascular imaging within 14 days, and echocardiogram within 90 days using standardized differences (SD <0.1 indicates negligeable difference). We used Cox proportional hazard models to compare the adjusted Hazard Ratio (aHR) and 95% confidence intervals of death within 90 days pre- and post-telemedicine and cause-specific hazard models for stroke readmission with adjustment for comorbidities. Results: We identified 47,869 patients (n=40,099 pre- and n=7,770 post-telemedicine), median age 73 years [62, 82], 49% female. Baseline characteristics were similar. There was a rapid uptake in telemedicine use (Figure 1). Physician visits (92.9% vs 93.1%, SD 0.01), neuroimaging (81.3% vs 80.5%, SD 0.02), and echocardiogram use (52.5% vs 53.9% SD 0.03) were similar, but use of vascular imaging increased (74.8% vs 84.3% SD 0.24). Readmission for stroke was stable (3.9% vs 4.0%, aHR 1.00 [0.89, 1.13]), but 90-day death was higher post- compared to pre-telemedicine (2.8% vs 3.6%, aHR 1.19 [1.05, 1.36]). Conclusion: Telemedicine is a promising tool to support routine stroke prevention care. The higher mortality must be interpreted in the context of the COVID19 pandemic. Ongoing monitoring of stroke outcomes is needed. (Figure Presented).

Discussion on the Management Method of COVID-19 Infection Prevention in Medical Residents

Background: To explore the homogenized management method of infection prevention and control in medical resident under COVID-19 epidemic situation. Methods: Overall, 268 members in Ningbo Medical Group which was participating in the management of novel coronavirus pneumonia in Wuhan, China were managed homogeneously in terms of personal cleaning and disinfection of articles, prevention and control of infection in life, training and assessment of relevant infection knowledge in hospitals. Results: In the epidemic situation, the homogenization management of infection prevention and control in the resident of medical team is an important measure to block the transmission link. Conclusion: 1. Conduct homogenization management on the training of hospital infection knowledge for medical staff. 2. Conduct homogeneous management of effective assessment of training knowledge. 3. Conduct homogenization management from personal cleaning and disinfection, as well as infection prevention and control in daily life.

RC48-ADC, a HER2-targeting antibody-drug conjugate, in patients with HER2-positive and HER2-low expressing advanced or metastatic breast cancer: A pooled analysis of two studies

Background: Currently, there are no standard ≥3 line regimens recommended for HER2-positive (IHC 3+, or IHC 2+/FISH+) advanced or metastatic breast cancer, and no recommended HER2-targeting treatment for HER2-low expressing (IHC 2+/FISH-, or IHC 1+) population. RC48-ADC is an innovative HER2-targeting antibody-drug conjugate with a cleavable linker and a potent microtubule inhibitor payload MMAE that has a bystanding effect in tumor cell killing. Methods: C001 CANCER (NCT02881138) was a dose-escalation phase I study (0.5, 1.0, 1.5, 2.0, and 2.5 mg/kg) with the 3+3 design among HER2-positive patients. C003 CANCER (NCT03052634) was a phase Ib study with 1.5, 2.0, and 2.5 mg/kg doses in the HER2-positive subgroup and 2.0 mg/kg dose in both IHC 2+/FISH-, and IHC 1+ HER2-low expressing subgroup. C003 CANCER is currently ongoing for IHC 1+ patients. Pooled analysis of the two studies was conducted for the efficacy and safety of RC48-ADC in HER2-positive or HER2-low expressing subgroups. Results: At the time of data cutoff (December 31, 2020), 118 female breast cancer patients were enrolled and treated with RC48-ADC. 70 patients (59.3%) were HER2-positive and 48 patients (40.7%) were HER2-low expressing. At baseline, 77 patients (65.3%) had liver metastases, 50 patients (42.4%) were ECOG PS 1, 47 patients (39.8%) had received ≥3 prior chemotherapy regimens. In the HER2-positive subgroup, ORRs for 1.5, 2.0, and 2.5 mg/kg doses were 22.2% (95% CI: 6.4%, 47.6%), 42.9% (95% CI: 21.8%, 66.0%), and 40.0% (95% CI: 21.1%, 61.3%). mPFSs for 1.5, 2.0, and 2.5 mg/kg cohorts were 4.0 months (95% CI: 2.6, 7.6), 5.7 months (95% CI: 5.3, 8.4) and 6.3 months (95% CI: 4.3, 8.8). In the HER2-low expressing subgroup, the ORR and mPFS were 39.6% (95% CI: 25.8%, 54.7%) and 5.7 months (95% CI: 4.1, 8.3). ORR and mPFS for IHC2+/FISH-patients were 42.9% (15/35) and 6.6 months (95% CI: 4.1, 8.5). For IHC1+ patients, even though the COVID-19 pandemic led to treatment postpone for some patients, ORR and mPFS reached 30.8% (4/13) and 5.5 months (95% CI: 2.7, 11.0). The common treatmentrelated adverse events (TRAEs) were AST increased (64.4%), ALT increased (59.3%), hypoesthesia (58.5%), white blood cell count decreased (48.3%), and neutrophil count decreased (47.5%);most were grade 1-2 in severity. Neutrophil count decreased (16.9%), GGT increased (12.7%), and fatigue (11.9%) were the grade 3 and above TRAEs occurring in ≥ 10% of the overall population. Conclusions: RC48-ADC showed consistent efficacy in HER2-positive and HER2-low expressing subgroups. The 2.0 mg/kg Q2W showed a more favorable benefit-risk ratio than other dose levels. No new safety signals were observed. Further studies are initiated to evaluate the efficacy and safety of RC48-ADC in various settings.

Population-based rates of emergency department visits for stroke in the different phases of COVID19 restriction and reopening

Introduction: Reductions in hospital visits for stroke during the COVID19 pandemic have been reported, but few have studied this question on a population-basis and less is understood about the temporal trends after economic and social reopening. We aimed to describe the rate of emergency department visits for acute stroke before and after the declaration of the pandemic, through the different phases of reopening, in the population of Ontario, Canada (14 million people). Methods: Using administrative data linkage, we will show the age- and sex-standardized rate of weekly emergency department visits for ischemic or hemorrhagic stroke between January 1 to September 30, 2020. Pandemic declaration was on March 11, 2020 (week 11) and phase 1 reopening started on May 19, 2020 (week 20) in Ontario. We will use piecewise regression analysis models to evaluate the changes in rates during the pandemic and after reopening. Results: We identified 5,617 emergency department visits for stroke (53% male, median age 74 IQR [63,83]) between January 1 to May 19, 2020 (week 20). Data beyond May 19, 2020 are not available yet, but these will be presented at the ISC 2021. The proportion of patients treated at a comprehensive stroke center was similar pre- and post-pandemic (41.7% versus 42.7%, standard difference (SD) 0.02), as was the proportion of people admitted to hospital (87.9% versus 86.7%, SD 0.03), treated with intravenous thrombolysis (11.6% versus 11.8%, SD 0.01), or underwent endovascular thrombectomy (5.1% versus 4.8%, SD 0.02). Weekly rates of stroke visits decreased after the pandemic declaration, but they seem to increase after week 16 (Figure 1). We show rates from 2019 for comparison. Conclusions: Population-based rates of emergency department visits for stroke initially decreased after the pandemic compared to pre-pandemic rates. Changes in rates after reopening and the results of the piecewise regression analysis will be presented at the ISC 2021.(Figure Presented).

Investigation on the Difficulties and Challenges of Teachers Online Teaching in Primary and Middle Schools of Guangxi Middle School

Affected by the situation of COVID-19, the new semester has been delayed in many places of the country. In response to the request of the Ministry of Education on 'suspended class, ongoing learning' during the epidemic period, schools at all levels throughout the country have carried out online teaching. Through the questionnaire survey, this paper would like to find out the difficulties and challenges facing teachers' online teaching during the epidemic situation, and puts forward some suggestions for online teaching, which may hope to help the promotion of the online teaching. © 2020 IEEE.