Acute respiratory distress syndrome (ARDS) is the main cause of morbidity and mortality in Coronavirus disease 19 (Covid-19) for which as of now there is no effective treatment. ARDS is caused and sustained by an uncontrolled inflammatory activation characterized by a massive release of cytokines (cytokine storm), diffuse lung edema, inflammatory cell infiltraton and disseminated coagulation. Macrophage and T lymphocyte dysfunction plays a central role in this syndrome. In several experimental in vitro and in vivo models, many of these pathophysiological changes are triggered by stimulation of the P2X7 receptor. We hypothesize that this receptor might be an ideal candidate to target in Covid-19-associated ARDS.

Aims 1. To systematically review the currently available evidence investigating the association between olfactory dysfunction (OD) and the novel coronavirus (COVID-19). 2. To analyse the prevalence of OD in patients who have tested positive on Polymerase Chain Reaction (PCR) for COVID-19. 2. To perform a meta-analysis of patients presenting with olfactory dysfunction, during the pandemic, and to investigate the Positive Predictive Value for a COOVID-19 positive result in this population. 3. To assess if olfactory dysfunction could be used as a diagnostic marker for COVID-19 positivity and aid public health approaches in tackling the current outbreak. Methods We systematically searched MedLine (PubMed), Embase, Health Management Information Consortium (HMIC), Medrxiv, the Cochrane Library, the Cochrane COVID-19 Study Register, NIHR Dissemination centre, Clinical Evidence, National Health Service Evidence and the National Institute of Clinical Excellence to identify the current published evidence which associates coronaviridae or similar RNA viruses with anosmia. The initial search identified 157 articles. 145 papers were excluded following application of our exclusion criteria. The 12 remaining articles, that presented evidence on the association between COVID-19 and olfactory dysfunction, were critically analysed. Results OD has been shown to be the strongest predictor of COVID-19 positivity when compared to other symptoms in logistic regression analysis. In patients who had tested positive for COVID-19 there was a prevalence of 62% of OD. In populations of patients who are currently reporting OD there is a positive predictive value of 61% for a positive COVID-19 result. Conclusion Our review has shown that there is already significant evidence which demonstrates an association between OD and the novel coronavirus – COVID-19. It is unclear if this finding is unique to this coronavirus as individual viral phenotypes rarely present in such concentrated large numbers. We have demonstrated that OD is comparatively more predictive for COVID-19 positivity compared to other associated symptoms. We recommend that people who develop OD during the pandemic should be self-isolate and this guidance should be adopted internationally to prevent transmission.

This paper presents as advanced solution for nonlinear, dynamic, systematical problems involving complexity, multidisciplinary sciences, such as prediction of stock prices, food chain in ecological systems, and mechanical disturbances. This study proposes an idea for a systematical solution to these problems. Most scientist misunderstand it as a black box, but it can be solve based on the control theory of engineering science; hence, it is not different from the old chaos theory, moreover, are not relevant to determinism. However, the chaos theory developed by classical physics in the 17th century, it is a banal and degenerate theory because it was developed new solution in the 20th century by engineers. Nevertheless, physicists do not welcome the advanced solution because it is against determinism. Hence, it is separated from physics and adopted by engineering science. Scientists can apply either solution to their discipline. To prove this solution, four application examples, such as Kuhn’s innovation theory and Lorenz’s butterfly effect, are provided.

3D printing can be of great use, particularly the production of personal medical products and devices such as scaffolds. In this study, the main aim is to develop propolis (Ps) containing wound dressings by making use of 3D printing technology. Different combinations and structures of propolis (Ps) incorporated sodium alginate (SA) scaffolds are developed. The morphological studies show that the porosity of developed scaffolds was optimized when 20% (v/v) of Ps was added in the solution. The pore sizes decreased by increasing Ps concentration up to a certain level due to its adhesive properties. The mechanical, swelling-degradation (weight loss) behaviors and Ps release kinetics were highlighted for the scaffold stability. The antimicrobial assay was employed to test and screen antimicrobial behaviour of Ps against Escherichia coli and Staphylococcus aureus strains. The results show that the Ps added scaffolds have an excellent antibacterial activity because of Ps’s compounds. The in-vitro cytotoxicity test was also applied on the scaffold by using the extract method on the human dermal fibroblasts (HFFF2) cell line. It is clearly found that the control SA and Ps added SA are non-toxic. The 3D printed SA-Ps scaffolds are very effective structures for wound dressing applications with unique properties.

Background: In Italy both the consumption of antibiotics and the prevalence of bacterial resistance are higher than in other European countries. In 2017, the first National Action Plan on Antimicrobial Resistance (PNCAR) was adopted in Italy. In response to the PNCAR two National Reports on Antibiotics’ use in the human setting have been published. The article’s aim is to describe the pattern of antibiotics consumption in the community setting in Italy from 2013 to 2018. Methods: In order to analyse the consumption for reimbursed antibiotics dispensed by community pharmacies different data sources were used. Consumption was measured in terms of Defined Daily Dose (DDD), prescriptions or prevalence of use. Results: In 2018, the consumption of antibiotics in Italy amounted to 16.1 DDD per 1,000 inhabitants per day. The rates of consumption by geographical area were: 12.7 DDD in the North, 16.9 in the Centre and 20.4 in the South. The use was greater in the extreme age groups than in the population aged from 20 to 64 years. The consumption was higher in winter season with high peaks in the incidence of flu syndromes. In the paediatric population, a utilization rate of 1,010 prescriptions per 1,000 children, with a prevalence of use of 40.8%, was found. Conclusion: The study provides useful information on geographical variability of antibiotics’ use in Italy to guide decision makers in the introduction of tailored interventions, as suggested by PNCAR, aimed at promoting a more rational use of antibiotics for humans and reducing antimicrobial resistance.

Hundreds of researchers are working on developing a vaccine or testing drugs to mitigate COVID-19 worldwide. If novel compounds are found, geopolitical and economic variables will determine their introduction to communities. Therefore, finding low-cost and accessible substances for prevention or treatment of COVID-19 would be ideal.Earlier in April, a new hope emerged when the antiviral effect of ivermectin, a known anti-parasite drug, upon SARS-CoV-2 was published. Caly et al unveiled that 5uM ivermectin induces a profound reduction (~5000 fold) in SARS-CoV-2 replication (RNA levels) in cultured human cells 1. The authors suggested that this drug could reduce viral load in infected patients, with a potential effect on disease progression and spread. Amidst fear of the pandemic, the public and some physicians may be tempted to use ivermectin as prophylaxis, or as a coadjuvant, for COVID-19. These actions have motivated cautionary statements from institutions such as the FDA against the use of pharmaceutical formulations of ivermectin, intended for animals, as therapeutics in humans 2.It is vital to be careful with the translation of molecular findings into clinical outcomes, and it is especially important to understand the pharmacokinetic profile of drugs that could be repurposed for COVID-19, in order to design optimal dosing regimens3. There is no evidence that the concentration of ivermectin used in this study can be achieved in humans. Multiple teams have evaluated the pharmacokinetics of ivermectin in humans 4-6 (fig 1), and protocols using the highest doses (approx. 1800 µg/kg and about 10 times the usual dose), have achieved maximum plasma concentrations of about 0.28 µM 6. Therefore, the highest concentration reached is 17.5 times lower than what is required to reduce the replication of SARS-CoV-2. Consequently, although ivermectin may have anin vitro antiviral effect, it probably will not effectivein vivo . Pharmacokinetics may explain lack of effectiveness of ivermectin (400 µg/kg for 3 days) for treatment of viral infections such as dengue fever 7.These results should not discourage us. We do not know what the ceiling concentration of ivermectin in humans is, and administering higher doses of ivermectin may be useful, but could also increase the risk of adverse effects. Besides, some more potent ivermectin analogs may also have an antiviral effect on SARS-CoV-2, although this idea requires further study. In summary, it is crucial to be cautious and consider the clinical pharmacokinetics of potential treatments for COVID-19 before initiating off-label therapies in communities and health care workers.

Introduction: In adult congenital patients with transposition of the great arteries originally treated with the Mustard (atrial switch) procedure, the most common reason for re-intervention is baffle stenosis. This may be exacerbated by permanent transvenous pacemaker lead placement across the baffle. Case Report: A 47-year-old female status post Mustard procedure performed at 15 months old presented with a high-grade stenosis of the superior vena cava (SVC) baffle from the SVC to the left atrium, with a nonfunctional permanent pacemaker lead passing through the baffle. A mechanical rotating dilator sheath was used for attempted lead extraction, relieving the baffle stenosis almost completely as a secondary effect, prior to the placement of a 10 x 27 mm Visipro balloon expandable stent in the SVC baffle. Conclusions: Use of the mechanical rotating dilator sheath is an evolving treatment strategy in adult congenital heart disease to minimize the risk of bleeding, trauma to surrounding structures, and death. Its ability to fully alleviate baffle stenosis even when full lead extraction is not feasible or is associated with significant procedural risk further demonstrates its expanded role in this patient population. A multidisciplinary approach and great diligence must be employed to avoid potential complications.

Granular Cell Tumors (GrCTs) often present as slowly growing painless nodules, and can arise in essentially any anatomical location, but occur most commonly in the head and neck. GrCTs are unique and so named because of the classic histomorphology of the tumor cells having abundant granular eosinophilic cytoplasm. The presence of these tumors in the chest wall has unique implications compared to other anatomical locations. The purpose of our case report is to review the diagnosis and management of a patient with a granular cell tumor of the chest wall.

A recent commentary published in BJCP used lopinavir/ritonavir as an example to highlight the importance of the clinical pharmacology principles in the repurposing of old drugs for therapeutic use against Coronavirus disease 19 (COVID-19).1 Here, we provide another example to support this point.A recent study found that ivermectin, an FDA-approved anti-parasitic drug, has inhibitory effects on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).2 Ivermectin has broad anti-viral activity through inhibition of viral proteins including importin α/β1 heterodimer and integrase protein.3 In the in vitro study reported by Caly and colleagues, the addition of ivermectin at a concentration of 5 micromolar (μM) (twice the reported IC50) to Vero-hSLAM cells 2 hours post infection of with SARS-CoV-2 resulted in a reduction in the viral RNA load by 99.98% at 48 hours.2Large trials of mass drug administration of ivermectin in adults and children have shown that ivermectin is well tolerated.4 Even at doses that are 10 times greater than the highest FDA-approved dose of 200 μg/kg, central nervous system toxicity has not been reported.5 However, following the oral administration of supra-therapeutic doses of ivermectin (i.e. 120 mg) the maximum plasma concentration achieved was 0.28 ± 0.18 (standard deviation) μM, a value 18 times lower than the reported 5 μM ivermectin concentration used by Caly et al in their SARS-CoV-2 experiment.5 To date, the clinical effects of ivermectin at a concentration of 5 μM range are unknown, but likely to be toxic. Furthermore, ivermectin is only commercially available as a 3 mg oral tablet.6 These factors hinder our ability to immediately repurpose ivermectin in its current form for the treatment of COVID-19.While the findings by Caly and colleagues provide some promise, viral suppression was not seen at concentrations observed with standard doses in humans. Further preclinical in vivo studies should evaluate the pharmacokinetics and pharmacodynamics to determine the kill pattern of ivermectin. A potential alternate solution may be to develop an inhaled formulation of ivermectin to efficiently deliver a high local concentration in the lung, whilst minimising systemic toxicity. As therapeutic agents to tackle the COVID-19 pandemic are urgently sought, careful consideration of the pharmacokinetics of these drugs should be considered to guide in vitro testing.

Aims: This study aimed to assess the impact of pharmacist-led medication therapy management (MTM) for ambulatory elderly patients with chronic diseases. Methods: Consecutive patients were enrolled from pharmacist outpatient clinics from January 2016 to June 2018. Eligible subjects were performed with MTM services by the pharmacists and had clinical data for at least 2 clinic visits within a consecutive 12-month period after the first MTM visit. The drug-related problems (DRPs) and recommendations were evaluated using The Pharmaceutical Care Network Europe (PCNE) Classification for Drug related problems V8.03. Results: A total of 525 DRPs were identified during the study period. Treatment effectiveness P1 (53.71%) was the most common problems of DRPs. The most frequently recommended intervention was changing the drug (48.76%). These interventions were accepted by the patients in 92.38% and were completely implemented in 90.48%. The number of drugs taken was the significant associated factor for DRPs. Post-intervention group showed lower levels in systolic blood pressure (SBP) and diastolic blood pressure (DBP) compared to the pre-intervention group. There were statistically significant changes in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) between the pre- and post-intervention group. The average cost of medications per patient for every month decreased from 387.72 Ren Min Bi (RMB) to 355.17 RMB (P=0.009). Conclusion: We confirmed that pharmacists has a valuable role to perform MTM services for ambulatory elderly patients, not only in identifying and solving the DRPs, but also in improving clinical outcomes (BP and lipid level) and cost saving.

Plants and insects have developed an evolutionary relationship over time. It is known that aboveground insect damage influences molecular modifications in plant defense systems, leading to changes in root exudation patterns and carbon allocation. Mounting evidence demonstrated in specific crops shows that plants modulate their rhizosphere microbes in response to leaf-herbivory attack. However, the influence of a specific herbivore on rhizosphere microbiomes across different crop species and its communalities remains unknown. Here, we studied the relationships between aboveground insect herbivory (Trichoplusia ni) damage and rhizosphere microbiome effects across five plant species (Zea mays ‘sh2,’ Phaseolus vulgaris L. ‘Seychelles,’ Solanum lycopersicum ‘Rutgers,’ Beta vulgaris L. ‘Burpee Bred,’ and Arabidopsis thaliana Ecotype Col-0). We investigated whether insect damage may influence the recruitment of beneficial microbes across plant species to minimize the burden associated with the attack. Our results show a significant increase in the rhizosphere abundance of certain beneficial microbial taxa including Azospirillum, Burkholderia, and Arthrobacter, consistently across all plant species tested. Furthermore, a significant reduction in the biomass was observed among the second generation of plants grown under the conditioned soil without insect damage.

AbstractThe goal of this paper is to establish a new approach with graph networks, which we refer to as the cluster grammar, as a computational linguistic grammar. The main content of this paper is the construction of the theory and the verification of its potential for application in computer science.We begin by introducing the graph networks, which we refer to as cluster graphs. The graphs are considered as the essential elements for the language ability. The innate abilities that we introduce in order to elucidate the acquisition of the language ability, generation and processing of sentences are given as graph theoretical algorithms. The theory includes a sort of verification problem as well as the Universal Grammar introduced by Chomsky, however the theory is intended to be applied for information technology where the given algorithms and methods can be developed further to have computers process languages with more developed data structure and more human.Contents:IntroductionGrammar StructureAcquisition of the Language Ability and Application for ComputerConclusion and further investigationReferences

Revealing the dynamics of groundwater movement in the vadose zone is crucial to groundwater management and artificial recharge. In this study, the groundwater flow characterization of the pumping process is monitored by the joint time-lapse electrical resistivity tomography (ERT) and self-potential (SP) data tomography. The ERT data invert the resistivity distribution, which relates to the variation of soil moisture content during the pumping process. Base on the groundwater motion feature, the SP data provide a direct way to invert the current density and estimate the permeability. A total of 24 hours of time-lapse surveys show a significant increase and decrease in resistivity and permeability during water pumping and groundwater recharge, which suggests groundwater decline and recovery process. These results have an excellent agreement with the groundwater level monitoring result. Combining ERT and SP data can provide a reliable way in groundwater or other hydrogeological surveys.

The effect of climate change on water resources has been an area of continued research, especially in Australia. Previous studies have suggested significant trends in rainfall, and these are amplified causing larger changes in streamflow. However, most of the previous analysis was based on annual time scales or modelled data and did not account for changes in land cover, which could interact with changes in climate. Climate data and streamflow data sourced from 13 fully forested small catchments (<250 km2) was analysed for trends. Non-parametric Mann-Kendall trend analysis, generalised additive mixed modelling and rainfall-runoff modelling were combined for the analysis. This indicates consistent increases in maximum temperature and varied decreases in rainfall. Limited to a small number of catchments in south eastern Australia there were small, but significantly amplified, decreases in streamflow. In general, overall decreases are much smaller than predicted in earlier research.

Rapid shifts in environmental variables associated with elevational changes in montane ecosystems provide opportunities to test hypotheses regarding the effects of environmental heterogeneity on gene flow and genetic structure. In tropical mountains, spatial environmental heterogeneity combined with seasonal environmental stability is predicted to result in low dispersal across elevations. Few studies have investigated the genetic consequences of elevational environmental heterogeneity in tropical montane mammals. Here, we use a population genomics approach to test the hypothesis that mountain treeshrews (Tupaia montana) exhibit limited gene flow across elevational gradients and between two neighboring peaks within Kinabalu National Park (KNP) in Borneo. We sampled 83 individuals across elevations on Mt. Tambuyukon (MT) and Mt. Kinabalu (MK) and sequenced mitogenomes and 4,106 ultraconserved elements containing an average of 1.9 single nucleotide polymorphisms per locus. We detected high gene flow across elevations and between peaks. We found greater genetic differentiation on MT than MK despite its lower elevation and associated environmental variation. This implies that, contrary to our hypothesis, genetic structure in this system is not primarily shaped by elevation. We propose that this pattern may instead be the result of colonization history combined with restricted upslope gene flow on MT due to unique plant communities associated with its upper montane habitats. Our results serve as a foundation to identify and mitigate future effects of climate change on mountain treeshrews in KNP. Given predictions for 2100 CE, we predict that mountain treeshrews will maintain genetic connectivity in KNP, making it an important conservation stronghold.

IntroductionThe rapid spread of coronavirus disease 2019 (COVID-19) worldwide raised concerns about its heavy impact on the health care delivery system and forced significant changes in the realities of the clinical practice we are accustomed to. With these changes comes a need for a different approach to outpatient evaluation of common otolaryngology complaints in patients with new symptoms.Recently published set of guidelines for evaluation of head and neck during the COVID-19 pandemic recommended to postpone the management of benign disease including benign salivary or thyroid gland disease.1 In order to limit the chance of COVID-19 infection among patients or health care workers, surveying patients via telephone or telemedicine visit was advised, reserving in-person evaluation for the patients at risk for significant negative outcomes. The challenge is that these measures can only be applied in clear-cut clinical scenarios, when the disease process is most likely benign and the care delivery can be postponed.In cases with a high degree of uncertainty based on available clinical information, many physicians will have to decide how to proceed after initial telemedicine encounter. Clinicians will have to consider how to balance a potential delay in diagnosis, including cancer diagnosis, against the risk of COVID-19 exposure, and may need to exercise their best judgement knowing that for head and neck cancer the risk of progression with cancer care delay is high.2 In this communication, we present our approach to triaging and evaluation of patients with complaints concerning for salivary gland disease.

Overland flow is the major contributor to soil erosion. To clarify the hydrodynamic characteristics of overland flow at small Reynolds number, indoor experiments with fifteen unit-width flow discharges from 0.069 × 10-3 m2·s-1 to 2.5 × 10-3 m2·s-1, five slope gradients from 5.23% to 25.88%, three surface roughnesses and two kinds of flow (80% glycerol and water mixed flow and water flow) were systematically investigated. Results showed that mean depth and mean flow velocity can be good predicted by unit-width flow discharge, slope gradient and surface roughness. Based on flow regime criterion of parameter m, for 80% glycerol and water mixed flow, the flow regime was laminar flow. For water flow, it was between laminar flow and turbulent flow. According to the transitional Fr of 1, the experimental flow state tended to subcritical laminar flow with the increase of surface roughness. For 80% glycerol and water mixed flow, parameter K was 57. For water flow, parameter K was increased with the increase of surface roughness and fluctuated as slope gradient increased. The resistance law of open channel hydraulic for laminar flow (f = 96/Re) is not suitable for overland flow. In general, resistance coefficient had a good power function with Re. Meanwhile, there was a high significant correlation between resistance coefficient and inundation ratio and slope gradient. Resistance coefficient decreased as inundation ratio and slope gradient increased. For all flow regime in this study, a more accurate resistance coefficient prediction model was established by multiple regression analysis. As for hydrodynamic parameters, shear stress had a positive correlation with surface roughness. Meanwhile, stream power is not affected by increasing surface roughness, while unit stream power was negative with surface roughness. The slope gradient played a more important role in increasing the flow energy.

Modeling and analysis of the materials universe is an emerging area of research with many important applications in materials science. The main goal is to create a map of materials which allows not only to visualize and navigate the materials space, but also reveal complex relationships and “connections” among materials and potentially find clusters of materials with similar properties. In this paper, we consider the problem of mapping and exploring the materials universe using network science tools and concepts. The networks are based on the open-source materials data repository AFLOW.org where each material is represented as a node, and each pair of nodes is connected by a link if the respective materials exhibit a high level of similarity between their Density of States (DOS) functions. We discuss the importance of similarity measure selection, investigate basic structural properties of the resulting networks, and demonstrate advantages and limitations of the proposed approaches.

Spike development of wheat is closely associated with the ability of response to cold stress and inhibited under cold stress in spring. Morphological investigation showed that the ftin gene in 3558M is associated with multiple phenotypic characteristics, including fewer tillers, delayed floral transition, and the death of shoot apical meristem. In this study, we systematically researched the genetic nature of spike development using ITRAQ, transcriptome sequencing, western blot and RNAi technologies. The results showed that the ftin mutant is cold sensitive and activates the cold acclimation pathway. Multiple defence responses, including the ROS-mediated hypersensitive response, SA-mediated systemic acquired resistance and FLS2-induced pathogen-associated defence response, were activated to respond to normal cold stress and led to the apex death. Meanwhile, the continuous cold acclimation pathway inhibited the SVP-SCO1-LFY flowering pathway and leads to inhibition of spike development. Two TaPIN proteins were significantly downregulated, and multiple auxin signalling genes were also differentially expressed after cold stress. We used RNAi technology to knock down the two TaPIN genes and the tiller number was significantly reduced in TaPINa-RNAi and TaPINb-RNAi wheat. Taken together, the results revealed that the ftin gene might directly or indirectly regulate multiple biological pathways to affect multiple phenotypic characteristics.

As this ever-evolving pandemic lays itself, more of its impact is being understood. Until recently, most guidelines were reported to aid in managing and treating suspected or confirmed cases. Research institutions around the world are responding with a sense of confusion. Some are continuing routinely, especially those who are overseeing clinical trials that could offer life-saving therapies, particularly against the novel coronavirus. Since research must continue even in the face of a shutdown, we aim to collate the currently available recommendations from various organizations and provide guidance to head and neck researchers across the world during these trying times.

The 2019 novel coronavirus disease (COVID-19) pandemic has been spreading worldwide at an alarming rate. Healthcare workers have been confronted with the challenge of not only treating patients with the virus, but also managing the disruption of healthcare services caused by COVID-19. In anticipation of outbreak, clinic sessions and operation theatre lists have been actively cut back since February 2020 to reduce hospital admissions and clinic attendances. This has severely disrupted healthcare services, leading to accumulating clinic caseload and substantial delays for operations. The head and neck cancer service has been faced with the difficult task of managing the balance between infection risk to healthcare providers and the risk of disease progression from prolonged waiting times. We share our experience in Hong Kong on the mitigation of head and neck cancer service disruption through telehealth and multi-institution collaboration.

BackgroundOutpatient telemedicine consultations are being adopted to triage patients for head and neck cancer. However, there is currently no established structure to frame this consultation.MethodsFor suspected cancer referrals, we adapted the Head and Neck Cancer Risk Calculator (HaNC-RC)-V.2, generated from 10,244 referrals with the following diagnostic efficacy metrics: 85% sensitivity, 98.6% negative predictive value and area under the curve of 0.89. For follow up patients, a symptom inventory generated from 5,123 follow-up consultations was used. A customised Excel Data Tool was created, trialled across professional groups and made freely available for download at www.entintegrate.co.uk/entuk2wwtt, alongside a user guide, protocol and registration link for the project. Stakeholder support was obtained from national bodies.ResultsNo remote consultations were refused by patients. Preliminary data from 511 triaging episodes at 13 centres show that 77.1% of patients were discharged directly or have had their appointments deferred.DiscussionSignificant reduction in footfall can be achieved using a structured triaging system. Further refinement of HaNC-RC V.2 is feasible and the authors welcome international collaboration.

The global pandemic of 2019 Novel Coronavirus Disease (COVID-19) has tremendously altered routine medical service provision and imposed unprecedented challenges to the healthcare system. This impacts patients with dysphagia complications caused by head and neck cancers. As this pandemic of COVID-19 may last longer than SARS in 2003, a practical workflow for managing dysphagia is crucial to ensure a safe and efficient practice to patients and healthcare personnel. This document provides clinical practice guidelines based on available evidence to date to balance the risks of SARS-CoV-2 exposure with the risks associated with dysphagia. Critical considerations include reserving instrumental assessments for urgent cases only, optimizing the non-instrumental swallowing evaluation, appropriate use of PPE, and use of telehealth when appropriate. Despite significant limitations in clinical service provision during the pandemic of COVID-19, a safe and reasonable dysphagia care pathway can still be implemented with modifications of setup and application of newer technologies.

Background The global COVID-19 pandemic brings new challenges to otolaryngology resident education. Surgical volume and clinic visits are curtailed, personal protective equipment for operating room participation is restricted, and the risk of COVID-19 disease transmission during heretofore routine patient care is the new norm. Methods We describe a small-team “cohorting” protocol including guidelines for faculty and resident in common clinical scenarios with attention paid to the risk of common otolaryngologic procedures. Results A rotating small-team approach was implemented at each clinical site, limiting interaction between Department members but providing comprehensive coverage. Faculty were involved at the earliest phase of clinical interactions. Guidelines delineated faculty and resident roles based on risk stratification by patient COVID status and anticipated procedures. Special consideration was given to high-risk procedures such as endoscopy and tracheotomy. Conclusions A small-team based approach with guidelines for faculty/resident roles may mitigate risk while optimizing patient care and maximizing education.