ABSTRACT
Without global mass vaccination, COVID-19 will continue to infect and cause serious illness, disproportionately in low- and middle-income countries. Point-of-care and home-based nucleic acid amplification tests (NAATs) are valuable tools to control COVID-19 transmission. Here we present a rapid isothermal NAAT for duplexed detection of SARS-CoV-2 and an MS2 bacteriophage internal control. This assay amplifies RNA in less than 15 minutes, utilizes a low temperature of 39°C, and has fluorescence or visual lateral flow readout. This positions our assay for use in low-cost paper-based nucleic acid diagnostic devices for ultrasensitive and reliable COVID-19 detection in POC or home-based settings. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.
ABSTRACT
Introduction: The need for having in-home sleep testing has grown due to the COVID-19 pandemic. While Type 3 Home Sleep Apnea Tests (HSAT) are frequently used, their accuracy remains questionable. This study aimed to compare respiratory events and diagnosis of obstructive sleep apnea between Type 2 and Type 3 studies. Methods: 550 participants completed overnight Type 2 sleep studies using the Cerebra Sleep System. Files were autoscored as a type 2 acquisition and were manually edited by a RPSGT. On a second auto-score, mapped file channels were reduced to nasal cannula, chest belt, SpO2, position, heart rate, and audio channels to simulate a Type 3 study. The respiratory disturbance index (RDI) in the Type 2 tests was compared to the apnea-hypopnea index (AHI) in the simulated Type 3 files using a 4% desaturation threshold. Diagnosis of severity of OSA was classified based on indices of <5 as “None”, 5-14.99 as “Mild”, 15-29.99 as “Moderate”, and above 30 as “Severe”. Results: 5 records were removed for having a TST <4 hours. Type 2 sleep tests detected significantly more respiratory events (21.0±21.2/hr.) compared to Type 3 tests (13.4 ±17.2;t(549) = 26.8, p<.0001). The use of the Type 2 RDI resulted in 104 patients (18.9% of patients;39.4% of treatable patients) with moderate OSA falling into the mild category under the Type 3 AHI. The number of treatable patients was thus 71% higher with a Type 2 study. Overall, the diagnoses of Type 2 RDI and Type 3 AHI were only in agreement for 263 out of the 550 records, or 47.8% of the time. Conclusion: The use of a Type 2 study detected more respiratory events than the Type 3 device. Consequentially, 104 patients received a higher severity of obstructive sleep apnea when the EEG information was included. Our results provide support for the use of Type 2 devices for in-home detection of obstructive sleep apnea to provide more accurate diagnostic detection than the more frequently used Type 3 home sleep apnea tests.
ABSTRACT
Purpose : Acquiring high quality ophthalmic images typically requires a trained operator in close proximity to a patient. Motorized alignment can enable remote operation, e.g. for physical distancing during a pandemic, and automated alignment can enable quality imaging when a trained operator is not readily available, e.g. in low-resource environments. We evaluated and compared manual and automated operation of an ophthalmic device on a motorized stage. Methods : We acquired data on 5 normal subjects (10 eyes) by both manual (via a trained operator) and automated operation using a prototype with three off-axis iris cameras (one below and on each side of the device) and a 3-axis motorized stage (Fig. 1). The motorized stage allowed all data to be acquired with a plexiglass shield between the subject and operator for remote operation during the COVID-19 pandemic. Auto-alignment was achieved using custom software to align the device to the patient pupil, with real-time pupil detection via a deep-learning algorithm. Auto-capture was triggered once the pupil was detected at the target location. We evaluated alignment success rate (alignments that triggered a capture), mean ± SD time to align, and accuracy of alignment (mean ± SD distance between detected pupil center and target). Results : Of 24 auto-alignments (1-3 per eye), 23 successfully triggered a capture;1 failed due to a software bug. All 14 manual alignments (1-3 per eye) proceeded to capture. Time to align for auto-alignment (29 ± 15 s) was significantly faster than for manual alignment (72 ± 37 s). The accuracy of alignment was 0.94 ± 0.59 mm for auto and 0.97 ± 0.41 mm for manual operation. A two-sample t-test assuming independent alignments for auto and manual results did not demonstrate a statistically significant difference in accuracy (p > 0.05). Conclusions : This comparison of manual and auto-alignment and capture for a motorized device indicated that this auto-alignment method is 2.5x faster than motorized manual alignment, saving an average of 40 s per alignment. Auto-operation was comparable in accuracy, and reliable on normal eyes. While further investigations are needed for a clinical population, this method shows promise for utility in a clinical setting.
ABSTRACT
Background: Social isolation from COVID-19 has been shown to affect the mental health of all socioeconomic, ethnic and age groups. One of the most affected populations is long-term care (LTC) residents. This increased separation from their families and society has created an additive effect to their baseline physical and mental ailments. We investigated the change in depression and anxiety over time in residents of one LTC facility during this crisis. Aim: The aim of the intervention was to reduce the impact of social isolation by modifying recreational activities to include faceto-face visits, music therapy, and similar activities. Methods: Staff collected PHQ-9 and NPIQ (Neuropsychiatric inventory questionnaire) scores of all residents in the facility before implementing modified activities. Between 8/10 and 10/3/2020 we had a modified event calendar. Following the 8-week intervention, PHQ-9 and NPIQ scores were re-recorded. All LTC residents were eligible. Short-term residents, hospice patients, and those who did not participate in the intervention were excluded from analysis. Our primary outcome was change in depression and anxiety. Our secondary outcomes were change in weight, ulcers, and falls (MDS quality metrics). We hypothesized there would be a positive change in PHQ9 and NPIQ scores over time. We analyzed our data using paired sample t-tests. Analyses were conducted using SPSS v. 26. Results: 97 residents participated this intervention with an age range of 63-103 (mean = 86;SD 8). Participants' mean PHQ-9 scores improved significantly after participation in activities (9.1 vs 6.3) with a mean difference of 2.804 (CI 1.924-3.684, p<.001). Similarly, mean NPIQ scored showed a similar trend (18.74 vs 14.94) with a mean difference of 3.804 (CI 3.098-4.510, p <.001). There were no significant differences in falls, weight, or ulcers. Conclusions: This study highlights how COVID-19 has impacted LTC residents' mental health and suggests implementing modified recreational activities can improve the mental health of LTC residents. This is especially important as the pandemic, and associated restrictions, have lasted longer than anticipated. Therefore, LTC facilities should slowly and safely increase social interaction for residents whenever possible.
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Background: It was not mandatory for Skilled Nursing Facilities (SNF) to screen patients for trauma before November 2019, when CMS initiated Trauma-Informed Care (TIC). With this requirement;however, CMS did not provide specific guidance for implementation. The purpose of TIC was to obtain traumatic experiences, identify approaches to manage reoccurrences of certain triggers, and to prevent re-traumatization thus providing a safer environment and more effective care. Here we communicate the accumulated experiences of the first-year implementation of TIC in one SNF. Methods: Budd Terrace at Wesley Woods, a non-profit, 250 bed long-term care and SNF, providing short-term rehabilitation and long-term placement. Without implementation guidance for TIC, our Interdisciplinary Team (IDT) added TIC questionnaires in the Baseline Care Plan, which is within 48 hours of admission. The admission nurse developed a process to guide the collection upon admission including the creation of a system encompassing a 6-part approach emphasizing the sensitive nature of trauma - Trust, Readiness, safe Atmosphere, Understanding, Minimize exposure, and Accommodation Results: We collected data from 473 new admissions from November 2019 to November 2020. Of these, 4.9% (n=23) reported experiencing trauma. Survivors ranged in age from 25 to 97 years old and reported a broad range of trauma experiences including: sexual assault (43%, all women);complicated grief (13%);COVID-19 (13%);combat-related PTSD (8.7%);intimate partner violence;racial discrimination;emotional abuse;other medical trauma;and accidents (all at 4.3%). The IDT was informed of the survivors' experiences. The social worker created a comprehensive person-centered care plan for the patient, addressing the trauma, goals, and interventions. Based on information gathered from this process we engaged in therapeutic approaches and take measures to prevent re-traumatization while in our care. Conclusions: During this implementation and ongoing pandemic, we recognized the profound importance of TIC in the SNF setting. Our process enabled us to connect better with our patients as their own self, with their own distinct experiences and needs that are often overlooked in medical charts. It has equipped us with a unique and valuable lens to view our patients, through which we can strive to provide a holistic, personalized, and a compassionate based care.