CNN based cough detection camera using acoustic features

Cough is a major symptom of COVID-19. To detect and localize cough sounds, a convolutional neural network (CNN) based model was developed and integrated with an acoustic camera for visualization of cough sounds. The cough detection model is a binary classifier whose input is a two-second acoustic feature and output is Cough or Others. The collected sound samples were augmented to mitigate class imbalance and reflect various background noises. For effective feature extraction, conventional features such as spectrograms, mel-scaled spectrograms, and mel-frequency cepstral coefficients (MFCC) were enhanced by their velocity (V) and acceleration (A) maps. VGGNet, GoogLeNet, and ResNet were simplified to binary classifiers such as V-net, G-net, and R-net, respectively. To find the best combination of features and networks, a total of 39 models were trained and the prediction results were evaluated using test F1 score. Finally, a test F1 score of 91.9% was achieved from G-net with the MFCC-V-A feature. The best cough detection model was embedded in the acoustic camera that visualizes sound sources using a beamforming microphone array. In a pilot test, the cough detection camera detected cough sounds with an F1 score of 90.0%, and tracked cough locations in real time on the camera image. © ICA 2022.All rights reserved

Patients and healthcare professionals views on injectables for cardiovascular disease

Introduction: Injectable medicines are increasingly used to manage risk factors for cardiovascular (CV) events, such as PCSK-9 inhibitors in dyslipidaemia and GLP-1 agonists in diabetes. However, there is a paucity of data around the administrative and clinical practicalities when using these injectables, and limited information on patient and healthcare professionals' perceptions. Purpose(s): To identify the facilitators and barriers on the use of injectable therapies with CV benefits by undertaking interviews with patients, caregivers and healthcare professionals (HCPs). Method(s): Interviews were conducted via telephone and using MS Teams due to Covid-19 restrictions in the United Kingdom (London and Leeds) and Italy (Rome and Milan) in 2021. Coding was undertaken using NVivo and thematic analysis performed. Result(s): A total of 56 patients were interviewed: 30 in the U.K. (mean age 66 yrs, 60% male) and 26 patients in Italy (mean age 63 yrs, 80% male) and 11 caregivers (mean age 59 yrs, 73% female). A total of 38 HCPs were interviewed, 19 in each country and composed of physicians (n=18), pharmacists (n=10), nurses (n=9) and pharmacy technician (n=1). Three distinct themes were identified: (i) Organisational and governance issues - relating to prescribing restrictions and availability of the drugs locally (PCSK9i are initiated and supplied from hospitals) and lack of communication between hospital and primary care setting;(ii) Clinical issues around HCPs' skills and experience - including: Lack of experience with these injectables, lack of time to provide education to patients and caregivers, therapeutic inertia (HCPs not adopting a change in practice despite the evidence or due to bureaucratic restrictions) as well as lack of knowledge on long-term effects, and finally (iii) Patient-related issues - relating to behaviours and beliefs such as reluctance about using injectable therapies, and lack of education about these injectables in terms of indications/clinical benefits for use. Despite some differences in the prescribing of these injectables in the two countries, the analysis captured similar facilitators and barriers. Facilitators included prior use of injectables (e.g. insulin), and the ability to reach a clinical target of lower cholesterol by having just a one shot . HCPs stated that access to rapid pathology tests would aid uptake of injectables with CV benefit as well as having educational tools on these injectables in practice. Conclusion(s): This qualitative study identified barriers to initiation, continuation, and adherence with injectable therapies with CV benefits but also highlighted areas where changes can be made especially around education and support for patients and HCPs.

University students' perceptions of remote laboratory courses necessitated by COVID-19: differences in emergent teaching strategies at a Korean university

In 2020, the COVID-19 pandemic swept the globe and caused formal educational sites to shift from in-person instruction to remote learning. University laboratory courses that were previously hands-on were also transformed into remote courses. This study investigates how university students perceived their experiences of remote laboratory courses across various disciplines. This study was conducted at a large public university in the Republic of Korea that offers a variety of laboratory courses. Adopting a mixed-methods approach, we collected online survey responses from 338 students and conducted in-depth interviews with 18 students. The analysis of variance (ANOVA) and Bonferroni post hoc tests of survey responses found that students' perceptions of their remote laboratory courses differed significantly (p <.05) by discipline (physics, chemistry, biology, earth sciences, etc.). Student interviews revealed that these differences in perceptions were attributable to the different emergent teaching strategies used in each course. Based on these findings, for remote laboratory courses in the post-COVID-19 era, we suggest that course instructors clearly set learning objectives, carefully design videos of experiments, offer collaborative and synchronous online sessions, provide guidance and feedback on lab report writing, and introduce supportive assessments. © 2023, Education Research Institute, Seoul National University.

OBESITY, HYPERTENSION, DIABETES MELLITUS, AND HYPERCHOLESTEROLEMIA OF KOREAN ADULTS

Objectives: We investigated the trends in obesity, hypertension, diabetes, and hypercholesterolemia before and during the COVID-19 outbreak in the Korean adult population. Methods: Data from 60,098 individuals of the Korean National Health and Nutritional examination Survey between 2011 and 2020 aged≥ = 19 were used. The age-standardized prevalence and annual percent changes (APC) were calculated for obesity (body mass index≥ = 25 kg/m 2), hypertension (systolic/diastolic blood pressure≥ = 140/90mmHg or under treatment), diabetes (hemoglobin A1c≥ = 6.5%, fasting glucose≥ = 126 mg/dL, physician diagnosis, or under treatment), and hypercholesterolemia (total cholesterol≥ = 240 mg/dL or under treatment). Results: Over the past decade of 2011-2020, age-standardized APCs (95% confidence interval)during 2011-2020 for obesity, hypertension, diabetes and hypercholesterolemia were 3.0% (2.1 to 3.8%), 0.1% (-1.3 to 1.5%), 1.5% (-1.0 to 4.0%) and 8.0% (5.7 to 10.3%), respectively in men;and -0.2% (-1.5 to 1.2%), -0.5% (-1.9 to 0.9%), -0.1% (-2.3 to 2.2%) and 5.9% (3.9 to 8.0%), respectively in women. In 2020 compared to the previous three years (2017-2019), obesity, hypertension, diabetes, and hypercholesterolemia increased in men (+6.0, + 1.8, + 1.9 and + 2.8 percentage points, respectively), but the increase was not apparent in women (+2.5, -1.1, + 0.8 and + 0.7 percentage points, respectively). Conclusion: An increase in major chronic diseases was observed in Korean adults, especially men, during the COVID-19 epidemic. In order to reduce the burden of cardiovascular and metabolic diseases in the future, effective intervention strategies need to be developed according to the characteristics of the target groups.

View Types and Visual Communication Cues for Remote Collaboration

Over the last several years, remote collaboration has been getting more attention in the research community because of the COVID-19 pandemic. In previous studies, researchers have investigated the effect of adding visual communication cues or shared views in collaboration, but there has not been any previous study exploring the influence between them. In this paper, we investigate the influence of view types on the use of visual communication cues. We compared the use of the three visual cues (hand gesture, a pointer with hand gesture, and sketches with hand gesture) across two view types (dependent and independent views), respectively. We conducted a user study, and the results showed that hand gesture and sketches with the hand gesture cues were well matched with the dependent view condition, and using a pointer with the hand gesture cue was suited to the independent view condition. With the dependent view, the hand gesture and sketch cues required less mental effort for collaborative communication, had better usability, provided better message understanding, and increased feeling of co-presence compared to the independent view. Since the dependent view supported the same viewpoint between the remote expert and a local worker, the local worker could easily understand the remote expert's hand gestures. In contrast, in the independent view case, when they had different viewpoints, it was not easy for the local worker to understand the remote expert's hand gestures. The sketch cue had a benefit of showing the final position and orientation of the manipulating objects with the dependent view, but this benefit was less obvious in the independent view case (which provided a further view compared to the dependent view) because precise drawing in the sketches was difficult from a distance. On the contrary, a pointer with the hand gesture cue required less mental effort to collaborate, had better usability, provided better message understanding, and an increased feeling of co-presence in the independent view condition than in the dependent view condition. The pointer cue could be used instead of a hand gesture in the independent view condition because the pointer could still show precise pointing information regardless of the view type. © 2023 Tech Science Press. All rights reserved.

Comparative efficacy evaluation of disinfectants against severe acute respiratory syndrome coronavirus-2.

BACKGROUND: Disinfection is one of the most effective ways to block the rapid transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Due to the prolonged coronavirus disease 2019 (COVID-19) pandemic, disinfectants have become crucial to prevent person-to-person transmission and decontaminate hands, clothes, facilities and equipment. However, there is a lack of accurate information on the virucidal activity of commercial disinfectants. AIM: To evaluate the virucidal efficacy of 72 commercially available disinfectants constituting 16 types of ingredients against SARS-CoV-2. METHODS: SARS-CoV-2 was tested with various concentrations of disinfectants at indicated exposure time points as recommended by the manufacturers. The 50% tissue culture infectious dose assay was used to calculate virus titre, and trypan blue staining and CCK-8 were used to assess cell viability after 3-5 days of SARS-CoV-2 infection. FINDINGS: This study found that disinfectants based on 83% ethanol, 60% propanol/ethanol, 0.00108-0.0011% sodium dichloroisocyanurate and 0.497% potassium peroxymonosulfate inactivated SARS-CoV-2 effectively and safely. Although disinfectants based on 0.05-0.4% benzalkonium chloride (BAC), 0.02-0.07% quaternary ammonium compound (QAC; 1:1), 0.4% BAC/didecyldimethylammonium chloride (DDAC), 0.28% benzethonium chloride concentrate/2-propanol, 0.0205-0.14% DDAC/polyhexamethylene biguanide hydrochloride (PHMB) and 0.5% hydrogen peroxide inactivated SARS-CoV-2 effectively, they exhibited cytotoxicity. Conversely, disinfectants based on 0.04-4% QAC (2:3), 0.00625% BAC/DDAC/PHMB, and 0.0205-0.14% and 0.0173% peracetic acid showed approximately 50% virucidal efficacy with no cytotoxicity. Citric acid (0.4%) did not inactivate SARS-CoV-2. CONCLUSION: These results indicate that most commercially available disinfectants exert a disinfectant effect against SARS-CoV-2. However, re-evaluation of the effective concentration and exposure time of certain disinfectants is needed, especially citric acid and peracetic acid.

Design of solid powder particles for a needle-free injection

Background: In 2020, the COVID19 pandemic has shown the medical need for vaccinations. The conventional method of vaccine application is intravascular injection of a liquid solution. However, this method is associated with some disadvantages, such as a high risk of infection. Purpose(s): The approach of a needle-free ballistic administration accelerates solid powder particles to a sufficient speed so that they are able to penetrate into the skin and address target Langerhans cells. For this purpose, the particles require certain characteristics (Weissmueller et al., 2017). The main criteria for a successful application is the particle size as well as the density (Maa et al., 2004). Method(s): One potential production process is freeze-drying out of a solution with a subsequent milling step (abbreviated to FD). Another modified approach is spray-freeze drying (abbreviated to SFD). Dried powders are treated afterwards by ultrasonic microsieving (6000 vibrations per seconds for ten minutes) in order to segregate a useable fraction (38 mum to 75 mum). Tap density was determined according to the protocol by Ph.eur. guidelines. Helium pycnometry determines the true density. The magnitude of density is described by the quotient of tap density rho tap and pycometric density rho He-pycnometer. Result(s): Estimated density of examined samples containing trehalose and mannitol could not exceed 50%. Conclusion(s): The described techniques reveal a quite porous structure of the product. This structure might not be sufficient for particles to successfully penetrate into the skin. These powder particles might burst upon the surface. However the dimension of the speed has to be considered as well as it plays a crucial role as well.

Efficacy Of Distance Learning For Cardiopulmonary Resuscitation Training Utilizing Smartphone App And Mannikin Delivery-collection System

Aim of the study: Effective CPR training is important for provision of high-quality bystander cardiopulmonary resuscitation (CPR). However, the COVID-19 pandemic has hindered conventional face-to-face CPR training. To overcome the limitation, we developed a distance learning CPR training course (HEROS-Remote) that utilized a smartphone app and a delivery-collection system for CPR training manikins. The objective of the study was to evaluate the efficacy of the HEROSRemote course by comparing chest compression quality between trainees who participated in the conventional CPR training (C-training) and HEROS-Remote course (R-training). Method(s): The non-inferiority trial included adult nonhealthcare providers who applied for CPR training. Both groups underwent 2-minute post-training chest compression test followed by course survey on trainees' course and delivery system satisfaction. The primary outcome of the study was mean chest compression depth during the 2-minute post-training test. Result(s): A total of 180 trainees were enrolled with 90 trainees for each training group. There was no statistically significant difference in chest compression depth between R-training and C-training groups (67.4 vs. 67.8, p=0.78) as well as proportion of adequate chest compression depth, chest compression rate, proportion of chest compressions with complete chest recoil and chest compression score (90.8 vs. 92.1, p=0.69;110.8 vs. 110.4, p=0.60;89.8 vs. 94.7, p=0.05;92.7 vs. 95.5, p=0.16, respectively). In the R-training group, 90.0% of the trainees were satisfied with the course, 96% responded that the delivery system was satisfactory and convenient. Conclusion(s): The R-training course was noninferior to the C-training course. The distance learning CPR training method utilizing smartphone app and mannikin delivery-collection system had high user satisfaction and was logistically feasible.

Real-world effectiveness of the mRNA-12733-dose primary series against COVID-19 in an immunocompromised population Interim results from a prospective observational cohort study

Background. While a 3-dose mRNA-1273 primary series is recommended for moderately or severely immunocompromised (IC) individuals in the U.S., some IC individuals do not complete the 3-dose series. We conducted a matched cohort study to evaluate the relative vaccine effectiveness (rVE) of the 3-dose mRNA-1273 primary series vs. 2 doses of mRNA-1273 in preventing SARS-CoV-2 infection and severe COVID-19 disease in IC individuals. Methods. IC individuals aged >=18 years with >=12 months of Kaiser Permanente Southern California membership who received 3 doses of mRNA-1273 >=24 days apart were 1:1 matched with randomly selected IC 2-dose recipients on age, sex, race/ethnicity, and 2nd dose date. Third doses were accrued from 08/12/2021 to 12/31/2021, with follow-up through 1/31/2022, spanning the delta and omicron periods. Outcomes were SARS-CoV-2 infection (positive molecular test or diagnosis code), COVID-19 hospitalization, and COVID-19 hospital death. Adjusted hazard ratios (aHR) with confidence intervals (CI) were estimated by Cox proportional hazards models. Adjusted rVE (%) was calculated as (1-aHR) x 100. Results. Our study included 21,942 3-dose and 21,942 2-dose mRNA-1273 IC recipients. Adjusted rVE of 3 doses compared to 2 doses of mRNA-1273 against SARS-CoV-2 infection, COVID-19 hospitalization, and COVID-19 hospital death were 55.0% (95% CI: 50.8-58.9%), 83.0% (75.4-88.3%), and 87.1% (30.6-97.6%), respectively (Table 1). Adjusted rVE against SARS-CoV-2 infection ranged from 43.0% to 59.1% across subgroups of age, sex, race/ethnicity, history of SARS-CoV-2 infection, pregnancy, and comorbidities (Table 2). Point estimates of the 3-dose rVE were higher against COVID-19 infection and hospitalization in the first 3 months, compared to 3-6 months after the 3rd dose (Table 3). Conclusion. Three doses of mRNA-1273 provide additional protection against SARS-CoV-2 infection and severe outcomes for IC individuals, compared to 2 doses, highlighting the importance of completing 3-doses for IC populations. However, possible waning of protection against SARS-CoV-2 infection and severe outcomes after 3 months supports the ACIP recommendation of a booster dose at least 3 months after the 3rd primary series dose for adequate protection of IC individuals. (Table Presented).

Clinical Features and Burden of Post-Acute Sequelae of SARS-CoV-2 Infection in Children and Adolescents

Background. The post-acute sequelae of SARS-CoV-2 (PASC) has emerged as a long-term complication in adults, but current understanding of the clinical presentation of PASC in children is limited. Our study objectives were to identify symptoms, health conditions, and medications associated with PASC in children. Methods. We conducted a retrospective cohort study using electronic health records from 9 US children's hospitals for individuals < 21 years who underwent polymerase chain reaction (PCR) testing for SARS-CoV-2 between March 1, 2020 - October 31, 2021 and had at least 1 encounter in the 3 years before testing. Our exposure of interest was SARS-CoV-2 PCR positivity. We identified syndromic (symptoms), systemic (conditions), and medication PASC features in the 28-179 days following the initial test date. Adjusted hazard ratios (aHRs) were obtained for 151 clinically predicted PASC features by contrasting PCR-positive with PCR-negative groups using proportional hazards models, adjusting for site, age, sex, testing location, race/ethnicity, and time-period of cohort entrance. We estimated the incidence proportion for any syndromic, systemic or medication PASC feature in the two groups to estimate PASC burden. Results. Among 659,286 children in the study sample, 59,893 (9.1%) tested positive by PCR for SARS-CoV-2. Most were tested in outpatient testing facility (50.3%) or office (24.6%) settings (Table 1). The most common syndromic, systemic, and medication features were loss of taste or smell (aHR 1.96 [95% CI 1.16-3.32), myocarditis (aHR 3.10 [95% CI 1.94-4.96]) (Figures 1 and 2), and cough and cold preparations (aHR 1.52 [95% CI 1.18-1.96]). The incidence of at least one systemic/syndromic/ medication feature of PASC was 42.0% among PCR-positive children versus 38.2% among PCR-negative children, with an incidence proportion difference of 3.8% (95% CI 3.3-4.3%). A higher strength of association for PASC was identified in those cared for in the ICU during the acute illness phase, children less than 5 years-old, and individuals with complex chronic conditions. Adjusted hazard ratios (aHR) with associated 95% CI among patients who tested positive for SARS-CoV-2 infection versus those who tested negative for the risk of each syndromic feature (symptom) using Cox proportional hazards models. Models were adjusted for age at cohort entrance, sex, race/ethnicity, institution, testing place location, presence of a complex medical condition and date of cohort entrance. Adjusted hazard ratios (aHR) with associated 95% CI among patients who tested positive for SARS-CoV-2 infection versus those who tested negative for the risk of each systemic feature using Cox proportional hazards models. Models were adjusted for age at cohort entrance, sex, race/ethnicity, institution, testing place location, and date of cohort entrance. For each health condition evaluated, patients with evidence of that condition 18 months before cohort entrance were excluded from the denominator in order to identify incident cases. Each ratio compares the risk of the outcome in children who tested positive for SARS-CoV-2 infection versus those who tested negative. Footnote: The diagnostic cluster for COVID-19 indicates children receiving care for the illness in the post-acute period. Conclusion. In this large-scale, exploratory study, the burden of PASC in children appeared to be lower than earlier reports. Acute illness severity, young age, and comorbid complex chronic disease increased the risk of PASC. (Figure Presented).

Data curation during a pandemic and lessons learned from COVID-19

Detailed, accurate data related to a disease outbreak enable informed public health decision making. Given the variety of data types available across different regions, global data curation and standardization efforts are essential to guarantee rapid data integration and dissemination in times of a pandemic.

View Types and Visual Communication Cues for Remote Collaboration

Over the last several years, remote collaboration has been getting more attention in the research community because of the COVID-19 pandemic. In previous studies, researchers have investigated the effect of adding visual communication cues or shared views in collaboration, but there has not been any previous study exploring the influence between them. In this paper, we investigate the influence of view types on the use of visual communication cues. We compared the use of the three visual cues (hand gesture, a pointer with hand gesture, and sketches with hand gesture) across two view types (dependent and independent views), respectively. We conducted a user study, and the results showed that hand gesture and sketches with the hand gesture cues were well matched with the dependent view condition, and using a pointer with the hand gesture cue was suited to the independent view condition. With the dependent view, the hand gesture and sketch cues required less mental effort for collaborative communication, had better usability, provided better message understanding, and increased feeling of co-presence compared to the independent view. Since the dependent view supported the same viewpoint between the remote expert and a local worker, the local worker could easily understand the remote expert’s hand gestures. In contrast, in the independent view case, when they had different viewpoints, it was not easy for the local worker to understand the remote expert’s hand gestures. The sketch cue had a benefit of showing the final position and orientation of the manipulating objects with the dependent view, but this benefit was less obvious in the independent view case (which provided a further view compared to the dependent view) because precise drawing in the sketches was difficult from a distance. On the contrary, a pointer with the hand gesture cue required less mental effort to collaborate, had better usability, provided better message understanding, and an increased feeling of co-presence in the independent view condition than in the dependent view condition. The pointer cue could be used instead of a hand gesture in the independent view condition because the pointer could still show precise pointing information regardless of the view type. © 2023 Tech Science Press. All rights reserved.

Discussions on Teaching Methods for Online Physics Experiments

This study was conducted to alleviate the difficulty of teaching online physics experiments. To this end, five methods for teaching online physics experiments based on a literature review are summarized: experiments using simulations, experimental videos, remote experiments, experiments focusing on data analysis, and hands-on experiments at home. In this study, the advantages and disadvantages of these five online experimental methods and the conditions for effectively using online physical experiments are summarized. Therefore, the results of this study should be useful for teaching actual online physical experiments. Although this study was initiated because of complete online education caused by COVID-19, online physics learning should continue to expand in ordinary learning situations. Therefore, the results of this study can be meaningfully used even after the COVID-19 pandemic. © 2022 The Korean Physical Society. All rights reserved.

Multimodal imaging case series of acute macular neuroretinopathy secondary to COVID-19 infection

Purpose : Understanding of the ocular manifestations of coronavirus disease 2019 (COVID-19) is continuing to develop. While ocular symptoms, chiefly conjunctivitis, have been reported, retinal pathologies have been suggested as a rarer complication and are hypothesized to derive from a combination of the inflammatory and vasculopathic effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Using a retrospective, observational case series design, we describe a series of four eyes in three patients with acute macular neuroretinopathy (AMN) and paracentral acute middle maculopathy (PAMM) associated with COVID-19 illness. Methods : Our practice's electronic medical record (EMR) was retrospectively queried for patients from April 2020 to December 2021 who had been diagnosed with AMN or PAMM and COVID-19 illness. Three patients were identified by this method. Patient demographic information, physical exam, optical coherence tomography (OCT), infrared reflectance (IR), and fluorescein angiography (FA) studies were all used for analysis. Results : Imaging signs of AMN were revealed in four eyes in three female patients, aged 22, 32, and 64 years old, all with confirmed symptomatic COVID-19 corresponding to the start of visual symptoms. The average onset of visual symptoms from COVID-19 illness was 14 days (range 0-56). 4/4 eyes were symptomatic for scotomata. Average logMAR visual acuity was 0.024 (Snellen 20/21, range 0-0.097). 4/4 eyes demonstrated typical findings of AMN: IR imaging with prominent dark petaloid or ovoid parafoveal lesions and corresponding disruption of the ellipsoid zone on OCT (Fig. 1). FA imaging did not show any abnormal fluorescence pattern. Autofluorescence in 1/4 eyes demonstrated hyperautofluorescence corresponding to the abnormal area on IR imaging (Fig. 2). Two month follow-up showed persistent symptoms of scotomata with unchanged findings on follow-up imaging in 100% of cases. Conclusions : This series demonstrates that, although rare, SARS-CoV-2 infection may result in microvasculopathic injuries to the retina, namely AMN and PAMM. (Figure Presented).

On Epidemic-aware Socio Spatial POI Recommendation

Epidemics such as COVID-19, SARS, H1N1 have highly transmissible viruses and spread wildly through the population with negative consequences. Multiple studies have shown the correlation between the contact networks between individuals and the transmission of infections due to contact between colocated individuals. To mitigate the transmission of the virus, intervention measures have been applied without decisive success. Therefore, reducing transmissions through suitable epidemicaware POI recommendations to users is necessary to cope with user mobility. Current POI recommendation approaches do not take into consideration the transmission of infections between co-located users. In this paper, we formulate a new query named Epidemic-aware POI Recommendation Query (EPQ), to timely recommend a set of POIs to users at different time steps, while considering the spread of infection between co-located users, their social friendships, and their preference. We prove that EPQ is NP-hard and propose an effective and efficient algorithm, Epidemic-aware POI Recommendation (EpRec) to tackle EPQ. We evaluate EpRec on existing location-based social networks and pandemic datasets against state-of-the-art algorithms. The experimental results show that EpRec outperforms the baselines in effectiveness and efficiency. © 2022 IEEE.

INTRODUCING PROJECT ECHO TO SUPPORT END-OFLIFE CARE EDUCATION IN PRIMARY CARE DURING A PANDEMIC

Project ECHO is an innovative tele-mentoring programme designed to create virtual communities of learners by bringing together health care providers and subject matter experts using videoconference technology, brief lecture presentations, casebased learning, fostering an 'all teach, all learn' approach. In April 2020 a six-month pilot of Project ECHO was commenced to support end-of -life care education in primary care as a response to the COVID-19 pandemic. A scoping exercise was undertaken with the multidisciplinary primary care team across a defined geographical area. Following the scoping exercise a curriculum was devised. Speakers were arranged which included a palliative care medical consultant, a specialist pharmacist and speciality doctor who led the taught aspects of each of the six sessions drawing on their clinical expertise and previous teaching experience. The attendees had the opportunity to submit a case study for discussion during each ECHO session, the case studies were used to evoke discussion, promote shared learning and develop a community of practice. During the pandemic this format also created an opportunity for peer supervision and sharing of clinical knowledge and experience across a wider network of practitioners. Considering the project took place during a pandemic there was 83% attendance from those that had booked onto the sessions. At the end of each session an instant poll was available to be completed by the attendees to evaluate the session. Attendees fed-back how valuable they found the sessions especially the opportunity to discuss case studies, share best practice and debrief during what has been a particularly difficult time for the primary care sector. The online format allowed more people to attend than would normally be achieved in face-to-face training. Due to the project's success further funding was agreed to extend the project beyond the original sixmonth pilot.

Discuss and Share Experiences in Implementing FCC Models in University of Hong Kong - Shenzhen Hospital (HKU-SZH)

Aim: To discuss and share experiences in implementing Family centered care (FCC) models in Hong Kong - Shenzhen Hospital (HKU-SZH). Met hods: At present, FCC has not been wel l implemented in China and most NICU adopt closed management. Since December 2013, our department has introduced the FCC concept and implemented 24-hour opening ward, providing family members with a series of services including ward rounds, progressive health education, palliative care, breast-feeding, cold chain support of breast milk, breast milk bank, family visit, followup after discharge, and mutual support group for family members. The above services were maintained during the COVID-19 period. Results: 10,615 newborns were treated from December 2013 to December 2020, the minimum gestational age of preterm infants treated successfully was 22+6 weeks and the minimum weight was 500g. The patient satisfaction rate in 2020 was 99.9%, and the average breastfeeding rate in 2020 was 84% while 83.4% of full-term infants and 90.2% of premature infants were breast-fed. (A multi-center survey of 974 cases of nutrition-related status of preterm infants in NICU in China reported that 13.6% of preterm infants were breast-fed during 2005-2006) The nosocomial infection rate from 2014 to 2020 was controlled between 0.41% and 2.02%. Literature showed that the incidence rate of nosocomial infection in neonatal care units of 17 grade A general hospitals in China from 2013 to 2014 was 3.35%. Conclusion: An open NICU based on the FCC concept is feasible and contributes to increased breastfeeding rates and patient satisfaction without increasing the incidence of nosocomial infections.