Smartwatch-based ecological momentary assessments for occupant wellness and privacy in buildings

This paper describes the adaptation of an open-source ecological momentary assessment smartwatch platform with three sets of micro-survey wellness-related questions focused on i) infectious disease (COVID-19) risk perception, ii) privacy and distraction in an office context, and iii) triggers of various movement-related behaviors in buildings. This platform was previously used to collect data for thermal comfort, and this work extends its use to other domains. Several research participants took part in a proof-of-concept experiment by wearing a smartwatch to collect their micro-survey question preferences and perception responses for two of the question sets. Participants were also asked to install an indoor localization app on their phone to detect where precisely in the building they completed the survey. The experiment identified occupant information such as the tendencies for the research participants to prefer privacy in certain spaces and the difference between infectious disease risk perception in naturally versus mechanically ventilated spaces. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.

Multinational perspectives on Covid-19 challenges: Faculty responses to distance education in Italy and the USA

In this study focusing on distance teaching during the Covid-19 pandemic, 47 higher education faculty in Italy and the USA responded to a survey circulated internationally between July and November 2021. In both contexts, perceptions of the institutional support and professional training for distance education (DE) were found to be similar in many ways, although the experiences with DE's opportunities and challenges proved quite different. Respondents in the USA reported being more at ease with DE, while Italian faculty reported greater recognition of the barriers to DE. HE faculty in both contexts equally recognized the importance of professional development for DE. Possible reasons for these similarities and differences are discussed.

Psychiatric Admissions, Referrals, and Suicidal Behavior Before and During the COVID-19 Pandemic in Denmark: A Time-Trend Study

Introduction: The COVID-19 pandemic has affected mental health globally, but the impact on referrals and admissions to mental health services remains understudied. Objective(s): To assess patterns in psychiatric admissions, referrals, and suicidal behavior before and during the COVID-19 pandemic in Denmark. Method(s): Utilizing hospital and Emergency Medical Services (EMS) health records covering 46% of the Danish population, we compared psychiatric in-patients, referrals to mental health services and suicidal behavior in years prior to the COVID-19 pandemic to levels during the first lockdown (March 11 - May 17, 2020), inter-lockdown period (May 18 - December 15, 2020), and second lockdown (December 16, 2020 - February 28, 2021) using negative binomial models. Result(s): The rate of psychiatric in-patients declined compared to pre-pandemic levels (RR = 0.95, 95% CI = 0.94 - 0.96, p < 0.01). Referrals were not significantly different (RR = 1.01, 95% CI = 0.92 - 1.10, p=0.91) during the pandemic;neither was suicidal behavior among hospital contacts (RR =1.04, 95% CI= 0.94 - 1.14, p=0.48) nor EMS contacts (RR=1.08, 95% CI=1.00 - 1.18, p=0.06). In the age group <18, an increase in the rate of psychiatric in-patients (RR = 1.11, 95% CI = 1.07 - 1.15, p < 0.01) was observed during the pandemic;however, this did not exceed the pre-pandemic, upwards trend in psychiatric hospitalizations in the age group <18 (p=0.78). Conclusion(s): The pandemic was associated with a decrease in psychiatric hospitalizations. No significant change was observed in referrals and suicidal behavior.

DISEASE ACTIVITY-GUIDED TAPERING of BIOLOGICS in PATIENTS with INFLAMMATORY ARTHRITIS: A RANDOMISED, OPEN-LABEL, EQUIVALENCE TRIAL

Background: Traditionally, biologics are maintained lifelong at standard dose in patients with infammatory arthritis (IA) when sustained low disease activity (LDA) is reached. However, evidence of possible tapering is emerging but data on the optimal approach is lacking. Objectives: The primary outcomes at 18 months follow-up are: Superiority: The proportion of patients reduced to ≤50% of their baseline biologic dose. Equivalence: Disease activity (rheumatoid arthritis [RA] and psoriatic arthritis [PsA]: Disease Activity Score28-C-Reactive Protein [DAS28-CRP] and axial spondyloarthritis [axSpA]: Ankylosing Spondylitis Disease Activity Score [ASDAS]). Methods: The BIODOPT trial was a randomised, open-label, equivalence trial (EudraCT 2017-001970-41). Eligible patients were adults with RA, PsA, or axSpA in LDA on stable biologic doses during ≥12 months. The randomisation ratio was 2:1 (tapering:continuation) stratifed by diagnosis, centre, and repeated biologic failures. In the tapering group, the biologic dosing interval was prolonged by 25% every four months until fare or discontinuation. The continuation group was kept on their baseline biologic dosing interval;however, a small increase was allowed (as usual practise) if requested by the patient. The sample size calculation was based on a pre-defned equivalence margin of ±0.5 disease activity points (<half of the minimal important difference in DAS28-CRP [>1.2] or ASDAS [>1.1]) yielding a power of 87% for 180 enrolled patients. All analyses were based on the intention-to-treat population. Continuous outcomes were analysed with repeated-measures linear mixed-effects models with group, diagnosis, centre, repeated biologic failures, time point, and the interaction between group and time as fxed factors and the baseline value of the relevant variable as a covariate. Categorical outcomes were analysed using logistic regression with missing data imputed as trial failures. Results: Between May, 2018, and March, 2020, 142 patients were enrolled of which 95 were randomised to tapering and 47 to continuation;inclusion was closed in April 2020 due to national implications of the coronavirus pandemic. At 18 months, signifcantly more patients in the tapering group (35 patients [(37%]) achieved a signifcant reduction in their biologic dose (≥50%) compared to the continuation group (one patient [2%]), absolute risk difference (RD) 35%, 95%CI: 24% to 45%, p<0.0001, Table 1. Furthermore, disease activity at 18 months was within the equivalence margins of ±0.5, mean difference between groups 0.08, 95%CI:-0.12 to 0.29;Table 1 and Figure 1. Flares were more frequent in the tapering group (39 [41%] vs 10 [21%], RD 0.20, 95%CI: 0.04 to 0.35, p=0.011) but managed with rescue therapy (e.g. biologic dose escalation or glucocorticoids) as only one patient (1%) in the tapering group and three patients (6%) in the continuation group lost therapeutic response and were switched to another biological agent. Conclusion: Across IA conditions, a signifcant reduction of biologic dose is possible with disease activity-guided tapering while maintaining a similar disease activity state compared to continuation of biologic as usual care.

Softening Performance's Pitfalls by Integrating Context and Capacity: A Government Competitiveness Framework

This article argues that government performance is better understood and managed within a broader competitiveness framework. Government competitiveness recursively integrates performance with organizational capacity and context. We illustrate this more holistic view with recent COVID-19 examples as well as recent scholarship, including some recent PAR publications related to this topic.

Rapid expansion of specialty practice telemedicine delivers timesensitive care during COVID-19

Background: The unprecedented impact of SARS-CoV-2/COVID-19 worldwide pandemic on healthcare hasbeen profound. At our large quaternary care pediatric healthcare system, in response to change how wedeliver care, a telemedicine strategy was rapidly developed with a priority to address the needs of patientsrequiring specialty time sensitive ambulatory care. One obvious opportunity was to rapidly expandtelemedicine capabilities to address the impact quarantines and stay at home orders would have on thedelivery of care to children with chronic conditions. We had some telemedicine capabilities in certainpopulations, however when our community shut down we responded with an immediate plan to expandtelemedicine services in a large multi-specialty practice. During the first week of the stay at home order, ourambulatory volumes drop by 69% reinforcing concerns regarding delays care (Fig. 1). Methods: We establisheda leadership model, task forces, and communication plan. We rapidly adapted to ongoing changes andaddressed specific needs including clinic workflow, patient populations, patient capabilities to utilize telehealth, education of clinical teams, and daily visible tracking tools. We measured daily telemedicinevolumes by practice, total visits, and proportion of telemedicine visits. Results: The 69% decrease inambulatory volume was countered with a 42,300% increase in telemedicine visits. Prior to COVID-19, weaveraged 4 telemedicine visits weekly and currently complete over 2,000. Through telemedicine, we aremaintaining a clinic volume of 57% of expected with 68% of all those visits being provided throughtelemedicine (Figure 2). All specialty services provide telemedicine. Certain specialty clinics adapted totelemedicine easier than others;allergy/asthma (98%;n = 581), pulmonary (97%;n = 390), neurology (96%;n =1,004), dermatology (95%;1,175), and otolaryngology (91%;n = 1,314) clinics experienced the greatest degreesof success over the past month while ophthalmology (55%;n = 531), cardiology (35%;n = 576) and orthopedics(14%;n = 1,713) faced challenges. Additionally, 30% of all completed telemedicine visits were for new referralvisits. Conclusion: We rapidly expanded telemedicine to provide time sensitive care in a large ambulatoryspecialty practice. Certain specialties were more amenable to telehealth for various reasons--vital signsavailable from home monitoring, ability to assess neurologic function in natural settings, etc. We realized thatevery specialty could do some aspect of telemedicine yet for others it was more challenging due to the needfor ancillary tests (Echocardiogram, x-rays, ophthalmology adjuncts, etc.) or lack of a good substitute forphysical exam findings (murmurs, abdominal exams, etc.). We successfully completed new referral visits (aprevious concern in specialty practices). Future steps to sustain our telemedicine practice are to continue torefinine best telemedicine practices, identifying appropriate populations and visit types, track financial impact,and measure patient outcomes.