Cycling in an ‘ordinary city': A practice theory approach to supporting a modal shift

There has long been evidence of the benefit of a modal shift toward cycling can bring to meeting several pressing urban challenges including ill-health, climate change, and poor air quality. In the wake of COVID-19, policy-makers have identified a modal shift toward cycling as part of the solution to mobility challenges introduced by social distancing measures. However, beyond exemplar areas, cycling has been largely characterized by a stubbornly-low modal share. In this paper, we use the ‘ordinary city'–in cycling terms–of Liverpool as a case study to understand this. We apply practice theory in doing so, finding the provision of materials for cycling is the key factor in supporting a modal shift. Not only do they provide the means to support the practice of cycling in the city, but they also have a key role in shaping individuals perceptions of, and the skills required to cycle. We then reflect upon the utility of practice theory in understanding the patterns of everyday life, finding it was particularly well suited in understanding the interactions between different factors which influence modal choice. We go on to identify practical challenges in its application within our analysis raising questions around an inconsistent analysis of influential factors including ‘driver behavior' and ‘political commitment'. We suggest how this might be overcome, through the isolation of such factors within a category of ‘action of others', this we argue means the findings in this paper have broad relevance to researchers and policy-makers alike. © 2021 The Author(s). Published with license by Taylor and Francis Group, LLC.

Seeing New Challenges: The Impact of COVID on a Diverse Sample of Adults with Vision Impairment in SE Michigan

Purpose : The disruption of COVID-19 has caused differential impacts on vulnerable populations. This study tested the hypothesis that persons with visual impairment in Ann Arbor and Detroit, MI faced increased difficulty in their daily lives since summer 2020 during the pandemic compared to normally sighted individuals. Methods : We administered the Coronavirus Disability Survey (COV-DIS) to assess general and psychological health, isolation, financial and transportation challenges, information access and instrumental activities of daily living. Our study population included 112 adults recruited from the University of Michigan (UM) Health System and 151 adults recruited from the Henry Ford Health System (HF) in Detroit, MI with moderate or worse visual impairment (<20/60 in better-seeing eye), and 160 age/sex-matched controls (C). The COV-DIS was administered via phone or email. The UM IRB approved this study and all participants provided informed consent. Results : There were no significant site differences in age or visual acuity of participants. Participants with visual impairment at Henry Ford (VIHF) lived in more disadvantaged neighborhoods (higher Area Deprivation Index) compared with UM participants with visual impairment (VIUM) (66 VIHF 52 VIUM;p<.01). All groups reported similar overall health prior to the pandemic. However, a greater proportion of VIHF participants reported somewhat or much worse health than pre-pandemic compared with VIUM or controls (C) (25% VIHF, 10% VIUM, 12% C;p=.003). Participants with visual impairment had more difficulty accessing medical care since the start of the pandemic (13% VI, 6% C;p=.049). One-quarter of participants reported difficulty obtaining trusted information during the pandemic;those with vision impairment were more likely to find the information hard to understand (10% VI, 3% C;p=.01). Conclusions : COVID-19 and associated mitigation measures had differential effects on populations with visual impairment. Participants with visual impairment in Detroit were more likely to report a negative impact on their health than participants from Ann Arbor, MI. Those with visual impairment in both locations faced greater challenges accessing medical care and trusted and understandable information related to the pandemic. This information may be helpful for shaping health policy to address the barriers faced by individuals with visual impairment.

SARS-CoV-2 detection by a clinical diagnostic RT-LAMP assay [version 1;peer review: 2 approved with reservations]

The ongoing pandemic of SARS-CoV-2 calls for rapid and cost-effective methods to accurately identify infected individuals. The vast majority of patient samples is assessed for viral RNA presence by RT-qPCR. Our biomedical research institute, in collaboration between partner hospitals and an accredited clinical diagnostic laboratory, established a diagnostic testing pipeline that has reported on more than 252,000 RT-qPCR results since its commencement at the beginning of April 2020. However, due to ongoing demand and competition for critical resources, alternative testing strategies were sought. In this work, we present a clinically-validated procedure for high-throughput SARSCoV-2 detection by RT-LAMP in 25 minutes that is robust, reliable, repeatable, sensitive, specific, and inexpensive © 2021. Buck MD et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Evaluating spontaneous stone passage rates during the COVID-19 pandemic

INTRODUCTION AND OBJECTIVE: During the COVID-19 pandemic our institution limited elective surgery including management of kidney stones. Additionally, patients themselves were reluctant to pursue elective surgery. This presented us a unique opportunity to reassess the natural history of symptomatic nephrolithiasis given potentially prolonged periods of conservative management. METHODS: A retrospective review was performed of patients presenting to the emergency room (ER) with flank pain secondary to nephrolithiasis from March to April of 2020 (COVID peak period of elective surgery limitations), and a comparative cohort from March and April 2019. Assessed outcomes included definitive stone treatment at initial presentation to the ER, rate of spontaneous stone passage, and time to elective surgery from initial ER presentation. Chi-square or Mann-Whitney U tests were utilized for dependent binary variables and continuous variables, respectively. A Kaplan Meier analysis was used to demonstrate differences in time to elective surgery between the two eras. RESULTS: Baseline characteristics did not differ between groups (Table). Patients discharged from the ER were more often offered medical expulsive therapy (71.6% vs 55.0%, p=0.026) during the COVID era. The rate of surgical stone management or stent placement at initial presentation did not differ, however, discharged patients waited longer from initial ER presentation to elective surgery (55.3 vs 33.1 days, p=0.02). Spontaneous stone passage rates were similar between groups despite the delay, and similar stone location and stone size between eras. CONCLUSIONS: During the height of the COVID pandemic, ER patients with symptomatic stones had similar characteristics at presentation but were more often offered MET. Spontaneous stone passage during the pandemic was no different than in 2019, despite a significant difference in time to elective surgery from initial presentation to the ER with flank pain .

An Update on the Consensus Model for APRN Regulation: More Than a Decade of Progress

The COVID-19 pandemic in 2020 highlighted the need for an agile healthcare work force that is optimally utilized. The wide variance of state laws related to advanced practice registered nurses (APRNs) acted as a barrier to mobility during this time. The Consensus Model for APRN Regulation, Licensure, Accreditation, Certification, and Education (Consensus Model) was developed in 2008 to provide a uniform model for APRN regulation. If adopted, the Consensus Model would align state laws related to APRNs and would clear the way for an APRN Compact, which would allow APRNs to practice across state borders. Although some states have completely adopted the Consensus Model's elements in the 13 years since its publication, many have not. Without regulatory uniformity, APRNs cannot efficiently provide care where needed throughout the country or practice to the full extent of their education, leaving some without access to quality care. This update provides a review of the elements of the Consensus Model, identifies progress made toward its full adoption, discusses continued barriers to full alignment with the Consensus Model, and describes the proposed APRN Compact that would result from further adoption of the model.