Spatial thinking and learning

The spatial university aims to help students learn to think spatially. This chapter outlines the many different ways in which spatial thinking presents throughout the University of Minnesota, beginning with an overview of the history of spatial science on campus and a discussion of how the curriculum has evolved over time. A description of the current curriculum is provided starting with the introductory level Geographic Information Science (GISc) coursework and spanning through the recently instated BA minor and the highly regarded MGIS program. We then present the ways in which spatial learning permeates beyond coursework and curricula using specific examples of organizations that facilitate spatially learning at the university including U-Spatial, GISSO, the GeoCommons, and the Esri Innovation Program. In addition to teaching GIS, we present a discussion of the use of Geographic Information Systems (GIS) as a tool for teaching, providing specific examples to convey the broad array of departments on campus that use StoryMaps and ArcOnline to teach a variety of topics. The chapter concludes with an examination of the impacts of the COVID-19 pandemic on the ways spatial science is being taught, focusing specifically on the shift to online learning. In sum, the spatial university builds upon its solid foundation to support spatial learning for a diverse assortment of departments and organizations in ways that ensure the continual growth and adaptation of GIScience education into the future. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

A survey of patients' preferences on treatment effects among head and neck cancer patients receiving radiotherapy

Introduction: Head and neck cancer (HNC) is a heterogeneous group of subsites, with differing natural histories. Its management is complex and it may have a long-term effect on patients’ quality of life (QOL). The purpose of this survey was to assess patients’ preferences using a validated 12 point ‘Priority Assessment Tool’ developed by Sharp et al [1]. Materials and Methods: Sixty consecutive HNC patients being treated with radiotherapy at our centre were approached. Patients were asked to rank their priorities from 1 to 12 (1 = very important, 12 = least important). Results: 45 patients (75%) completed the survey. The most important, overwhelming priority for the cohort as a whole, was ‘being cured of my cancer’ which was first priority in 73% patients and within first three priorities for 96% of patients. Similarly, ‘living as long as possible’ was within the first three priorities for 67% of patients although for 13% patients, living longer was, surprisingly the least priority. For more than two third of patients (69%), ‘having no pain’ was within the first four important priorities. There is next, a group of six QOL priorities (voice, speech, chewing, swallowing, taste/smell, moist mouth), which have a much wider range and vary considerably in importance to individual patients, being very important to some and much less important to others. There then remains a group of three priorities that have a relatively low importance to patients, not absolutely, but in relation to their other priorities, with ‘keeping appearance unchanged’, being the lowest priority chosen by 40% patients. The other two least priorities were ‘returning to activities as soon as possible’ and ‘having a normal amount of energy’. Conclusions: Our survey has shown that most HNC patients markedly prioritise survival over function and other QOL measures. Having such information is crucial, to being able to make a valid decision with regard to the treatment options and the trade-offs between increased probability of cure or extending survival and loss of function, and late morbidity. This makes shared decision-making even more important in the present COVID-19 era, so that added information about the risks of infection and potential changes in risk benefit ratio may alter patients’ priorities and preferred outcomes.

Ptxrx study: How pragmatic trial design can inoculate against risks to study integrity in a global pandemic

Important safety measures limiting in-person contact to curb COVID-19 transmission make it more difficult for patients to access clinical trials and for sponsors to conduct trial management. These measures may lead to pausing or delaying study activities, to the determent of study participants and the study's integrity. The COVID-19 pandemic highlights the importance of efficient, innovative clinical trials designed with the capacity to be rapidly responsive to unique challenges. The US Department of Veterans Affairs Pentoxifylline in Diabetic Kidney Disease study is a multi-site, pragmatically designed randomized controlled trial that tests the hypothesis that pentoxifylline, when added to standard of care, leads to a reduction in the incidence of End Stage Renal Disease and mortality. The study opened for recruitment at six Veterans Affairs medical centers in December 2019, months before the COVID-19 pandemic disrupted all aspects of clinical care and halted all non-essential, in-person research activities. The study's protocol was designed to accommodate either in-person or remote participant follow-up and data collection for all visits after baseline. In addition, participant study visit schedules were built with the flexibility to align with existing clinic visits. The ability to collect data remotely resulted in a minimal amount of missing data. The study's investigational product is maintained and distributed centrally by the Albuquerque Cooperative Studies Program Pharmacy Center. This allowed for the continuation of distribution of the study investigational product without the need for an in-person visit to a Veterans Affairs medical center. Pentoxifylline in Diabetic Kidney Disease's trial design and protocol leverage the Veterans Affairs's research infrastructure, remote platforms, and a centralized mail-order pharmacy, and allowed the study to safely continue during a uniquely challenging global pandemic.

Positive provider experience with telehealth during COVID-19 pandemic

Introduction: There has been a rapid increase in the usage of telehealth since the onset of COVID. We examine providers' perceptions of their ability to perform clinical assessments, physical exams, and connect with patients over a digital platform and identify which types of patients may be best suited to telehealth. Since the onset of the COVID-19 pandemic, there has been rapid expansion in the use of telehealth, but very few studies examining provider experience and perceptions of this technology. This research was conceptualized and conducted after the onset of COVID-19. Discussing the results of the survey at the 2021 meeting will be both relevant and timely to private groups and hospital systems that seek to better understand providers' perceptions of their ability to perform clinical assessments, physical exams, and connect with patients over a digital platform, along with discerning what type of patients may be best suited to telehealth. Methods: Survey invitations were sent via email to 944 physicians and advanced practice providers at a large midwestern academic system over a 2-week period in October 2020. The survey included demographics questions and a combination of open- and closed-ended questions. Data were collected using REDCAP. Descriptive statistics were conducted using SPSS. Results: A total of 178 surveys were completed and analyzed. In most telehealth visits, 86.8% of providers felt they adequately addressed the chief complaint, 86.6% felt confident in their clinical assessment, and 86.1% felt they formed an adequate personal connection with the patient. Of the providers, 58.5% felt telehealth was not effective for new patients, but 83% of providers felt it was effective for providing care to established patients. Conclusion: This survey demonstrates that providers had positive experiences with telehealth, and they wish to continue using telehealth in a postpandemic setting. While this method may not be appropriate for some new patients, providers did feel that telehealth was an effective means of providing care for established patients.

Implementing supported employment for veterans with traumatic brain injury through remote counseling during COVID-19

The Veterans Health Administration (VHA) Supported Employment (SE) program provides a highly individualized vocational rehabilitation service. To deliver SE, providers traditionally spend most of their time meeting in-person with veterans, employers, and clinicians. This article explores the impact of COVID-19 on the implementation of SE programs for veterans with a history of traumatic brain injury. In interviews with 29 SE providers and their nine Compensated Work Therapy managers across 10 VHA medical centers, we analyzed stakeholders' descriptions of how they adjusted their practices during the pandemic. These included switching from in-person to telephone or video communications, identifying new jobs created by COVID-19 conditions, focusing on work-from-home opportunities, and finding other modalities for collaborating with clinicians. Implications for rehabilitation practice are discussed. © 2021 National Rehabilitation Association. All rights reserved.

Hiv ambulatory care during covid-19 pandemic in us: Visits and viral load testing

Background: COVID-19 pandemic effects on ambulatory care services for persons living with HIV in the United States, including on frequency of office visits and HIV viral load (VL) testing, have not been well described. Methods: We analyzed longitudinal data of active patients (any encounter after January 1, 2020) at 8 HIV Outpatient Study (HOPS) sites. Monthly rates of all-inclusive encounters (office, lab, pharmacy, hospital, telemedicine [TM], phone, other), office and TM (O&T) visits, and HIV VL tests were derived from generalized linear mixed models, using data available from January 2010 to June 2020. We then assessed temporal trends and the adjusted effects of sociodemographic and clinical factors on the rates of O&T visits during the COVID-19 pandemic, in multivariable Poisson regression of data from January to June 2020. Results: Of 1251 active patients, 71% were male, 57% aged ≥ 50 years, 36% non-Hispanic white, 42% non-Hispanic black, 19% Hispanic/Latino, and 49% publicly insured. Median CD4 count was 680 cells/mm3 and 93% had suppressed (<200 copies/mL) VL on last test before January 1, 2020. Patients contributed 10,041 person-years of observation from January 2010 to June 2020. Monthly all-inclusive visit rate (95% Confidence Interval) dropped from 0.33 (0.31, 0.34) in December 2019 to 0.17 (0.16, 0.18) in March 2020, and further declined to 0.07 (0.07, 0.08) in June 2000. The monthly TM rate increased from 0.7% in December 2019 to 2.7% in June 2020 (Figure). In Poisson regression of 2020 data, monthly rate for O&T visits decreased from January to March by 32% and then by another 10% from March to June 2020 (both p<0.001). The decrease was lower with increasing age by 1% (0.5%, 1.5%) per year (p<0.001), and was greater (by 16%) for patients at private clinics than public sites (p<0.05), but did not differ by insurance type, sex, race/ethnicity, or presence of VL suppression on last test (all p>0.20). The increase in TM visits (2%) did not offset the decline in office visits (26%). The HIV VL testing rate fell by 50% in the first 6 months of 2020 among patients who had VL test done in 2019 (Figure). Conclusion: In the HOPS, the rates of office visits and HIV VL tests dropped precipitously after March 2020. The long-term implications for clinical outcomes and HIV viral suppression may not be evident at this time in the COVID-19 pandemic but HIV care sites need strategies to ensure patients maintain engagement in care and HIV laboratory monitoring.

Cass Clay Food Partners: A networked response to COVID-19

The Cass Clay Food Partners is a network of professionals, stakeholders, and residents serving Cass County, North Dakota, and Clay County, Minnesota, in creating a healthier, more just local food system. During the COVID-19 pandemic, the Cass Clay Food Partners quickly implemented a multipronged response that leveraged three critical assets of our network: (1) our unique structure, (2) our nuanced understanding of the social ties across overlapping networks, and (3) our ability to quickly pivot our work to address community needs. In this paper, we describe how our network responded to both the challenges and opportunities presented to our food system by the COVID-19 crisis. We also provide tools and recommendations for other food policy and food network practitioners.