The global spread of the coronavirus disease (COVID-19) outbreak poses a public health threat and has affected people worldwide in various unprecedented ways, both personally and professionally. There is no question that the current global COVID-19 crisis, now more than ever, is underscoring the importance of leveraging digital approaches to optimize pediatric health care delivery in the era of this pandemic. In this perspective piece, we highlight some of the available digital approaches that have been and can continue to be used to streamline remote pediatric patient care in the era of the COVID-19 pandemic, including but not limited to telemedicine. JMIR Pediatrics and Parenting is currently publishing a COVID-19 special theme issue in which investigators can share their interim and final research data related to digital approaches to remote pediatric health care delivery in different settings. The COVID-19 pandemic has rapidly transformed health care systems worldwide, with significant variations and innovations in adaptation. There has been rapid expansion of the leveraging and optimization of digital approaches to health care delivery, particularly integrated telemedicine and virtual health. Digital approaches have played and will play major roles as invaluable and reliable resources to overcome restrictions and challenges imposed during the COVID-19 pandemic and to increase access to effective, accessible, and consumer-friendly care for more patients and families. However, a number of challenges remain to be addressed, and further research is needed. Optimizing digital approaches to health care delivery and integrating them into the public health response will be an ongoing process during the current COVID-19 outbreak and during other possible future pandemics. Regulatory changes are essential to support the safe and wide adoption of these approaches. Involving all relevant stakeholders in addressing current and future challenges as well as logistical, technological, and financial barriers will be key for success. Future studies should consider evaluating the following research areas related to telemedicine and other digital approaches: cost-effectiveness and return on investment; impact on quality of care; balance in use and number of visits needed for the management of both acute illness and chronic health conditions; system readiness for further adoption in other settings, such as inpatient services, subspecialist consultations, and rural areas; ongoing user-centered evaluations, with feedback from patients, families, and health care providers; strategies to optimize health equity and address disparities in access to care related to race and ethnicity, socioeconomic status, immigration status, and rural communities; privacy and security concerns for protected health information with Health Insurance Portability and Accountability Act (HIPAA)-secured programs; confidentiality issues for some specific populations, especially adolescents and those in need of mental health services; early detection of exposure to violence and child neglect; and integration of training into undergraduate and graduate medical education and subspecialty fellowships. Addressing these research areas is essential to understanding the benefits, sustainability, safety, and optimization strategies of telemedicine and other digital approaches as key parts of modern health care delivery. These efforts will inform long-term adoption of these approaches with expanded dissemination and implementation efforts.

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Digital Approaches to Remote Pediatric Health Care Delivery During the COVID-19 Pandemic: Existing Evidence and a Call for Further Research.

The Local Point Interpolation Method (LPIM) is a newly developed truly meshless method, based on the idea of Meshless Local Petrov-Galerkin (MLPG) approach. In this paper, a new LPIM formulation is proposed to deal with 4th order boundary-value and initial-value problems for static and dynamic analysis (stability, free vibration and forced vibration) of beams. Local weak forms are developed using weighted residual method locally. In order to introduce the derivatives of the field variable into the interpolation scheme, a technique is proposed to construct polynomial interpolation with Kronecker delta function property, based only on a group of arbitrarily distributed points. Because the shape functions so-obtained possess delta function property, the essential boundary conditions can be implemented with ease as in the conventional Finite Element Method (FEM). The validity and efficiency of the present LPIM formulation are demonstrated through numerical examples of beams under various loads and boundary conditions.

A local point interpolation method (LPIM) for static and dynamic analysis of thin beams

Nowadays, the estimation of fatigue life under multiaxial random loading is still an extremely complex task. In this paper, a comprehensive review of the multiaxial random fatigue criteria available in the literature is presented. Such a review is mainly devoted to stress-based criteria for the evaluation of fatigue life in high-cycle regime. Time and frequency domain approaches are examined. The focus of this paper is related to uniform stress/strain distribution, but also the effect of stress/strain gradient is tangentially addressed. More than 200 references are cited.

A review of multiaxial fatigue criteria for random variable amplitude loads

Recent developments in grinding machines

In this work, a new dissipative contact force model, based on the foundation of Hertz contact law, is presented for impact analysis in multibody dynamics. A hysteresis damping force is introduced in the model for capturing the energy loss during the contact process. An approximate function, representing the relationship between the deformation velocity and deformation, is used to calculate the energy loss due to the damping force. The difference between the compression phase and restitution phase during the contact process is taken into account in the energy loss calculation. For illustration, four different contact force models are applied in a numerical example to compare their behaviors. The results are presented in the form of dynamic simulations in a multibody system, which allow comparison of the differences and similarities among the four contact models. They show the validity of our model for soft or hard contact problems.

A dissipative contact force model for impact analysis in multibody dynamics

Influence of the addendum modification on spur gear efficiency

Effectiveness of Primary Endoscopic Incision in Treatment of Ectopic Ureterocele Associated With Duplex System

A general elastic–plastic approach to impact analisys for stress state limit evaluation in ball screw bearings return system

Introduction Open pyeloplasty has been the first-line treatment for uretero-pelvic junction obstruction for decades. In the last years, minimally-invasive surgery (MIS) has gained popularity in the pediatric's field. Furthermore, recently, a great extension of Robot-assisted laparoscopic pyeloplasty (RALP) has been seen in younger and lighter-weight children as well as in redo cases. Herein we provided a comprehensive review of primary and redo RALP performed in children, particularly focusing on the different distribution of outcomes among the ages. Evidence acquisition A systematic review of the literature was performed according to PRISMA recommendations and was conducted on surgical indication and technique, intraoperative nuances, peri- and postoperative outcomes of primary and redo RALP. Evidence synthesis Overall, 33 studies with 1448 patients were included for primary RALP and 7 studies with 101 patients for redo cases between 2000 and 2019. In particular, 4 studies aimed to compare RALP in different cohorts of children grouped on ages or weight and 4 studies evaluated technical feasibility and safety of RALP over laparoscopic and open approach in very young populations. Success rate for primary RALP was found >90% in all studies but one, with low complication rate and reoperative indication. In redo series, 96% of patients revealed a decreased hydronephrosis on postoperative imaging. Conclusions RALP offers excellent outcomes in the pediatric population. However, there is still a strong need for higher quality evidence in the form of prospective observational studies and clinical trials. The rising of new robotic systems, such as single-port platform, might further enhance the applications of RALP in children.

Luca Landi

Papers

Influence of the addendum modification on spur gear efficiency

Effectiveness of Primary Endoscopic Incision in Treatment of Ectopic Ureterocele Associated With Duplex System

A general elastic–plastic approach to impact analisys for stress state limit evaluation in ball screw bearings return system

Robot-assisted laparoscopic pyeloplasty in children: a systematic review.

Paediatric urology practice during COVID-19 pandemic.