Evaluation of the Cross-Platform Framework Flutter Using the Example of a Cancer Counselling App

The advance of digitalization is constantly bringing new solutions to various areas of life in our society. The COVID-19 pandemic, among other things, brought increased attention to the application and support of treatments through digital solutions in the healthcare sector due to contact restrictions. However, the development of digital solutions comes at a high cost in terms of time and expenses. Mobile app development requires the development of two separate apps for the two respective market-leading mobile operating systems iOS and Android. Cross-platform frameworks make it possible to develop apps for both operating systems on a single code base, thus saving the development and maintenance of two separate codes. Flutter is currently the most popular cross-platform framework for the development of mobile apps. This paper has evaluated Flutter based on an existing criteria catalogue. As a usage context for the evaluation, a prototype for Cancer Counselling App of the University Medical Center Freiburg was implemented. According to the gained own prototyping experience with Flutter and a thorough literature analysis in this area, the criteria catalogue was filled out and the result was compared with other mobile App development paradigms. Copyright © 2023 by SCITEPRESS - Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

Stakeholder perspectives of adaptations of a burnout intervention for special education teachers

The high attrition and turnover rates of qualified special education teachers (SETs) is a significant concern exacerbated by COVID-19. Unfortunately, there are limited studies available on research-based interventions to decrease burnout. The purpose of this study was to describe our processes and results for adaptations and modifications of BREATHE, a burnout intervention originally developed for community mental health workers, into Burnout Reduction: Enhanced Awareness, Tools, Handouts, and Education: Evidence-based Activities for Stress for Educators (BREATHE-EASE) for special educators with guidance from the Framework for Reporting Adaptation and Modifications to Evidence-Based Interventions (FRAME). We applied the FRAME within a hybrid Type 1 trial for characterizing our approach. Four focus groups (N = 30;83% female) were conducted separately according to job title (SETs;school administrators), with semi-structured questions tailored to each group. Emergent thematic analysis was used to identify core themes related to adaptations, and results were presented to a subset of focus group members. Modifications involved content, context, and implementation changes for the adapted intervention, with most changes identified for content. FRAME was helpful for providing a systematic approach to integrate stakeholder-informed adaptations of a burnout intervention, addressing significant concerns of SET stress, burnout, and attrition.

PERSONALIZED IMMUNE DIAGNOSTICS: EPITOPE MAPPING OF THE IMMUNOME

Statistical phage display is a highly complex, but rapid and efficient way to identify "binding peptides” from a unique and specially designed library. It avoids repeated selection rounds and can therefore provide much more complex data than just a few sequences usually obtained with repeated peptide library selection. The complexity of the data analyzed is sufficient to cover hundreds of potential binder/target combinations in parallel. Applying this novel way to generate and analyze data from peptide phage display with antibodies allows to predict potential epitopes at amino acid resolution. Fingerprinting of monoclonal antibodies reveals the large variety of peptides binding to any given antibody. Independent of such laborious and failure prone methods like peptide arrays or phage display with antigen gene fragments. Surprisingly easy this can explain the specificity of antibodies and it is a valuable tool for antibody quality control. Beyond the application to individual antibodies we are able to analyze the immunome of patient sera. Theoretically, there are hundreds of antibody molecules for each recently encountered antigen epitope in a few µl. This is enough to define individual antibody epitopes. Since a single patient sample allows to record the entire immunome data, there is a tremendous amount of information hidden in the data sets we obtain. Nevertheless, all patients show different epitope patterns and for the generation of diagnostic tools we must compare many different sera. Results from examples will be given for allergic disease, viral infection diagnostics and the vaccine imprint on the immunome of one individual patient history. In infectious disease diagnostics (e.g. EBV, COVID-19, influenza) epitope-based kits can provide a robust analysis of existing and past disease as well as effective monitoring of vaccine efficacy. The aspect that the immune system carries the memories of antigens at least for many months allows a complex analysis even identifying different viral strains in a single experiment. In allergic disease we carried out epitope mapping with hundreds of sera from patients with sensibilization to allergenic food ingredients. Predicted epitopes were validated by binding IgE and IgG from many more patient sera for the main food allergy agents. Since peptide epitope diagnostics do not suffer from the undefined cross reactivities of present methods, we are gathering now a rather different understanding of what food allergies really are. In particular, we can also use IgG measurement based on immunoassays with epitopes, which has been regarded as impossible. Presently we are extending our work also in auto-immune diseases connected to long-COVID and psychiatric diseases.

Clinical Course and Short-Term Follow-up of SARS-CoV-2 Vaccine-Related Myocarditis in Children and Adolescents within the Prospective German Registry for Suspected Myocarditis "MYKKE

Background: Several studies described occurrence of myocarditis after SARS-CoV-2 vaccination in pediatric patients. Weaimed to characterize the clinical course of myocarditis following SARS-CoV2 vaccination including follow-up data within the prospective German registry for suspected myocarditis in children and adolescents "MYKKE." Method: Patients younger than 18 years with suspected myocarditis and onset of symptoms within 21 days followingSARS-CoV2 vaccination were enrolled within the MYKKE registry. The suspect of myocarditis is valid in patients with clinical symptoms and diagnostic findings typically seen in myocarditis. Clinical data are monitored at initial admission and duringshort-term and long-term follow-up. Result(s): Between July 2021 and August 2022, a total of 48 patients with a median age of 16.2 years (IQR: 15.2-16.8)were enrolled by 13 centers, 88% male. Onset of symptoms occurred at a median of 3 days (IQR: 2-7) after vaccine administration, most frequently after the second dose (52%). Most common symptoms at initial admission were anginapectoris (81%), fatigue (56%), dyspnea (24%) and documented arrhythmias (17%). Initial ECG abnormalities included ST-elevation (48%) and T-wave inversion (23%). Elevated Tropon in was observed in 32 patients (67%) and in 19 cases (40%)NT-proBNP was above the normal range with a median level of 171 pg/mL (IQR: 32-501). 11 (23%) patients presentedwith mildly reduced systolic function at initial echocardiography or cardiac MRI. In 40 patients cardiac MRI and/orendomyocardial biopsy was performed (83%) and diagnosis of myocarditis could be verified in 27 cases (68%). Thirty-nine patients underwent short-term follow-up with a median of 2.8 months (IQR: 1.9-3.9) after discharge. 19 patients (49%)presented with either clinical symptoms (n = 9) and/or diagnostic abnormalities (n = 16) at follow-up. 12 patients (38%)still had medical treatment. Except for one patient with malign arrhythmias (ventricular tachycardia), no major cardiac adverse events were observed during initial admission and follow-up. Conclusion(s): Our data confirm that SARS-CoV-2 vaccine-related myocarditis is characterized by a mild disease course. However, after short-term follow-up a considerable number of patients still presented with symptoms and/or diagnostic abnormalities. Data on long-term follow-up are awaited.

Impacts of the COVID-19 response on frontline healthcare workers

The COVID-19 pandemic, and the responses to it that were required from frontline healthcare providers and others working in healthcare settings including environmental, clerical, and security staff, has challenged our healthcare systems in unprecedented ways. The threats to the financial, physical, and psychological well-being of healthcare professionals-many of whom entered the field due at least in part to a deep commitment to caring for and helping others-will have profound and long-lasting personal and professional impacts. Early in the pandemic response, healthcare professionals knew little about the risks they, their patients, and their loved ones faced from COVID-19 as they operated under crisis standards of care and without adequate supplies of personal protective equipment. As the pandemic response progressed, the lack of clear, science-based guidance, and the politicization of the pandemic presented new medical, ethical, and moral dilemmas. New psychological support mechanisms, including crisis counseling and evidence-based interventions, are needed for all workers in healthcare settings, regardless of their job role. © 2023 The authors.

During the COVID-19 pandemic participants prefer settings with a face mask, no interaction and at a closer distance.

Peripersonal space is the space surrounding our body, where multisensory integration of stimuli and action execution take place. The size of peripersonal space is flexible and subject to change by various personal and situational factors. The dynamic representation of our peripersonal space modulates our spatial behaviors towards other individuals. During the COVID-19 pandemic, this spatial behavior was modified by two further factors: social distancing and wearing a face mask. Evidence from offline and online studies on the impact of a face mask on pro-social behavior is mixed. In an attempt to clarify the role of face masks as pro-social or anti-social signals, 235 observers participated in the present online study. They watched pictures of two models standing at three different distances from each other (50, 90 and 150 cm), who were either wearing a face mask or not and were either interacting by initiating a hand shake or just standing still. The observers' task was to classify the model by gender. Our results show that observers react fastest, and therefore show least avoidance, for the shortest distances (50 and 90 cm) but only when models wear a face mask and do not interact. Thus, our results document both pro- and anti-social consequences of face masks as a result of the complex interplay between social distancing and interactive behavior. Practical implications of these findings are discussed.

[Effects of the COVID-19 lockdown on physical performance parameters in professional football]. / Auswirkungen des COVID-19-Lockdowns auf physische Leistungsparameter im professionellen Fußball: Eine narrative Literaturübersicht.

Background: Governmental measures in 2020 to contain the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) brought training and competition in professional soccer to a temporary halt in many countries. As a result of the lockdown, training possibilities were mostly limited to nonspecific home-based training methods. It is unclear whether the lack of sport-specific stimuli led to a reduction in the physical performance of soccer players. Methods: For the narrative review, the PubMed, Google Scholar and BISp-Surf databases were selectively searched for studies examining the effects of the lockdown on physical performance parameters in adult professional soccer players. Results: In this review six prospective longitudinal studies were included. In all studies home-based training was performed during quarantine. Of the studies four compared the performance of the soccer players with data from previous seasons and two studies assessed the performance of players immediately before and after the lockdown period. Discussion: While general strength and endurance performances can be maintained through home-based substitute training programs, the studies indicated that the lack of football-specific stimuli could have an impact on the rapid power and speed performances of soccer players. Progressive loading control especially for speed training should be considered when returning to regular training in order to reduce the risk of injuries.

Rapid sentinel surveillance for COVID-19 - Santa Clara County, California, March 2020

On February 27, 2020, Santa Clara County, California, identified its first case of coronavirus disease 2019 (COVID-19) associated with probable community transmission. During March 5-14, among patients with respiratory symptoms evaluated at one of four Santa Clara County urgent care centers serving as sentinel surveillance sites, 23% had positive test results for influenza. Among a subset of patients with negative test results for influenza, 11% had positive test results for COVID-19. COVID-19 cases identified through this sentinel surveillance system helped confirm community transmission in the county. Local health departments can use sentinel surveillance to understand the level of community transmission of COVID-19 and to better guide the selection and implementation of community mitigation measures.

The COVID-19 pandemic's impact on worry and medical disruptions reported by individuals with chromosome 22q11.2 copy number variants and their caregivers.

BACKGROUND: The world has suffered immeasurably during the COVID-19 pandemic. Increased distress and mental and medical health concerns are collateral consequences to the disease itself. The Genes to Mental Health (G2MH) Network consortium sought to understand how individuals affected by the rare copy number variations of 22q11.2 deletion and duplication syndrome, associated with neurodevelopmental/neuropsychiatric conditions, were coping. The article focuses on worry and disruptions in medical care caused by the pandemic. METHODS: The University of Pennsylvania COVID-19 Stressor List and care disruption questions were circulated by 22 advocacy groups in English and 11 other languages. RESULTS: A total of 512 people from 23 countries completed the survey; most were caregivers of affected individuals. Worry about family members acquiring COVID-19 had the highest average endorsed worry, whilst currently having COVID-19 had the lowest rated worry. Total COVID-19 worries were higher in individuals completing the survey towards the end of the study (later pandemic wave); 36% (n = 186) of the sample reported a significant effect on health due to care interruption during the pandemic; 44% of individuals (n = 111) receiving care for their genetic syndrome in a hospital setting reported delaying appointments due to COVID-19 fears; 12% (n = 59) of the sample reported disruptions to treatments; and of those reporting no current disruptions, 59% (n = 269) worried about future disruptions if the pandemic continued. Higher levels of care disruptions were related to higher COVID-19 worries (Ps < 0.005). Minimal differences by respondent type or copy number variation type emerged. CONCLUSIONS: Widespread medical care disruptions and pandemic-related worries were reported by individuals with 22q11.2 syndrome and their family members. Reported worries were broadly consistent with research results from prior reports in the general population. The long-term effects of COVID-19 worries, interruptions to care and hospital avoidance require further study.

Improving access to research among individuals from under-represented racial and ethnic minority communities: The Strengthening Research In Diverse Enrollment (STRIDE) Study

INTRODUCTION Under-representation in health-related research is one of a multitude of factors that contribute to cancer disparities experienced by African American and Latinx communities. Barriers to research participation stem from historical social injustices, are multi-faceted and include factors specific to the research process, research team members and community experiences and expectations about research participation. Informed consent is a longitudinal process and represents an opportunity to address these barriers and potentially improve access to research by individuals from underrepresented groups. The purpose of the Strengthening Translational Research in Diverse Enrollment (STRIDE) study was to develop and test an integrated, literacy- and culturally-sensitive, multi-component intervention that addresses barriers to research participation during the informed consent process. METHODS A multi-pronged community engaged approach was used to inform the development the three components of the STRIDE intervention. At each of the three study sites, Community Investigators, local community members of diverse racial/ethnic backgrounds, contribute to intervention development, pilot testing and dissemination activities. Community engagement studios provided a semi-structured opportunity to solicit feedback from community experts in a facilitated group regarding the relevance, usability and understandability of the STRIDE intervention components. Additionally, component-specific approaches to obtaining community input were utilized. RESULTS The three components were developed and refined with community input. The STRIDE intervention includes: (1) an electronic consent (eConsent) framework within the REDCap software platform that incorporates tools designed to facilitate material comprehension and relevance, (2) a storytelling intervention in which prior research participants from diverse backgrounds share their experiences, and (3) a simulation-based training program for research assistants that emphasizes cultural competency and communication skills for assisting in the informed consent process. CONCLUSIONS The STRIDE project had produced an integrated set of interventions that are available to support researchers across the CTSA hubs and beyond in efforts to enhance diversity in clinical research. Early dissemination of STRIDE intervention components include utilization in national COVID-19 trials and research networks.

Digital simulation exercises to improve response management to infectious disease outbreaks in the maritime environment

Introduction: Since the onset of the COVID-19 pandemic, the occurrence of mass incidents of infectious diseases has become more likely. Preparedness for and management of such outbreaks in the maritime setting onboard ships and in ship-shore interactions require profound knowledge of technical and organizational issues and communicational skills. Simulation and field exercises play a crucial role to internalize these capabilities among relevant stakeholders. Material and Methods: Exercises were developed to train communication and collaboration among stakeholders within an outbreak. Coordinators and active players were connected on a digital platform that offered video conferences, an internal email-client, and a chat forum. Evaluators and observers followed the exercises simultaneously via non-listed youtube-channels. In hot- and cold digital debriefing sessions participants provided feedback including information on occupational stress level and coping during exercises. Results: Three simulation exercises and one field drill were developed, performed and evaluated between June and October 2021 which targeted to train response management to mass incidents of different infectious diseases on large passenger ships. This format allowed coordinators of the exercises to initiate a steady enhancement of exercise settings (e.g. scenario and platform development) and the active participants to reflect and improve their performance and occupational processes during exercises. Conclusions: Digital simulation exercises are an adequate format to exercise the response management of stakeholders to mass incidents in the maritime setting.

Auswirkungen des COVID-19-Lockdowns auf physische Leistungsparameter im professionellen Fußball : Eine narrative Literaturübersicht Effects of the COVID-19 lockdown on physical performance parameters in professional footballA narrative literature review

Hintergrund Die staatlichen Maßnahmen zur Eindämmung des Coronavirus SARS-CoV‑2 im Jahr 2020 brachten den Trainings- und Wettkampfbetrieb im professionellen Fußball in vielen Ländern zum zeitweiligen Erliegen. In Folge des Lockdowns waren die Trainingsmöglichkeiten zumeist auf unspezifische heimbasierte Trainingsmethoden begrenzt. Es ist unklar, ob sich die fehlenden sportspezifischen Belastungsreize negativ auf die physische Leistungsfähigkeit der Fußballspielenden auswirkten. Methodik Im Rahmen eines narrativen Reviews wurde mittels einer selektiven Literaturrecherche in den Datenbanken PubMed, Google Scholar und BISp-Surf nach Studien gesucht, welche die Auswirkungen des Lockdowns auf physische Leistungsparameter bei erwachsenen professionellen Fußballspielenden untersuchten. Ergebnisse In die Übersichtsarbeit wurden sechs prospektive Längsschnittstudien eingeschlossen. In allen Studien kam während der Quarantäne ein heimbasiertes Ersatztraining zum Einsatz. Vier Studien verglichen die Leistungsfähigkeit der Fußballer/-innen mit Leistungsdaten aus vorherigen Spielzeiten. Zwei Studien ermittelten die Leistungsfähigkeit der Sportler/-innen unmittelbar vor und nach der Lockdownperiode. Diskussion Während die allgemeine Kraft- und Ausdauerleistung durch heimbasierte Ersatztrainingsprogramme erhalten werden kann, weisen die Studien darauf hin, dass sich die fehlenden spezifischen Belastungsreize vor allem negativ auf die Schnelligkeits- und Schnellkraftleistung der Fußballspielenden auswirken könnten. Bei Rückkehr in den regulären Trainingsbetrieb sollte daher auf eine progressive Belastungssteuerung insbesondere im Schnelligkeitstraining geachtet werden, um das Risiko für Verletzungen zu senken.

What is next? Vision statement and reflections for sustaining project outcomes in a possibly post-pandemic era

Introduction The ongoing COVID-19 pandemic has demonstrated the importance in strengthening cooperation and coordinated action of Member States (MS) to improve preparedness and response capacities at points of entry (PoE). This emphasizes the need for perpetuating the work of EU HEALTHY GATEWAYS (EU HG) and the availability of this cross-European network to transfer lessons learned for future public health threats. Methods An interdisciplinary sustainability working group identified options for continuity of activities at EU level and provided a template national sustainability plan to be adapted by MS based on national needs and priorities. Results Since the beginning of the pandemic EU HG provided 37 consultations to MS, developed 15 advice documents, delivered training courses, produced a study on preparedness and response at PoE and developed the EU digital Passenger Locator Form (EUdPLF) system. A European web-based network for PoE was developed including discussion forums, e-learning platform, searchable network of professionals' at PoE registry, bibliographies, web-based training resources and best practice catalogues. Overall, the 533 inspectors in the EU SHIPSAN INFORMATION SYSTEM (EU SIS) recorded 29268 IHR (International Health Regulations) certificates, followed up 69 public health events via the communication network for EU ports, and recorded >4600 hygienic deficiencies. Conclusions EU HG has a holistic approach, supporting operations on local, regional, national and European level and by taking into account all transport sectors. The web-based systems and capacity building activities support EU Decision 1082/2013/EU for serious cross-border health threats and the EUdPLF supports implementing Decision (EU) 2017/253 for the contact tracing of passengers identified through PLFs. Adoption of components of EU SIS will support implementation of Regulation (EU) 2019/1239 which includes the provision of a common ship sanitation database.

Sharing of public health information in response to maritime outbreaks – report from an exercise conducted at a European level

Background Inter-country communication and structured information flow is of major importance in outbreak management potentially affecting more than one country, particularly in case of a public health event of international concern. Though there are established communication systems in European Member States (MS), public health events in the maritime sector challenge authorities and stakeholders. Methods Guidelines for inter-country communication developed by the joint action were tested via a 1-day web-based multi-sectorial, discussion-based table-top exercise (TTE) for ports at European level. Two outbreak scenarios (gastroenteritis and COVID-19) on passenger ships in separate regions (Mediterranean, North Sea) were acted out consecutively. Results Thirty participants and 63 observers from 20 MS, cruise ships, international and European institutions took part in the TTE. The TTE identified two different information flows: (1) authorities at local level implementing public health measures on ships share information with the next and previous ports of call, either directly or via national level authorities using different platforms depending on the event without clearly predefined criteria and (2) the ship captain sends health information to the next port of call (via the National Single Window or Email or Telephone or other means). Relying on communication via emails and telephones however, has limitations: a) limited access, b) no central data storage, c) historical data unavailable. Lack of communication channels for feedback to the ship and of coordinating and closing an event was evident. Conclusions A successfully conducted European TTE in maritime outbreak scenarios identified lack of clear international communication as communication channels were not always clear and depend on local/national conditions. There is potential for improving international communication. Guidelines for inter-country communication in this setting may help enhance communication practice.

Experiences, challenges and potential solutions of generalist palliative care in inpatient setting during the SARS-CoV2 pandemic

Background: During the SARS-CoV-2 pandemic all health care systems faced enormous challenges. Due to increased severity of illness, palliative care patients continued to require comprehensive care. In order to provide general palliative care during a pandemic, experiences of staff should be utilized. Aim: Description and analysis of experiences, challenges and potential solutions of multiprofessional hospital staff in general palliative care with regard to care of severely ill and dying patients (with/without SARSCoV- 2) and their relatives. Method: After ethical approval qualitative semi-structured online focus groups were conducted. Individual interviews were also used when necessary. The results were recorded, transcribed, and analysed with the qualitative content analysis by Kuckartz. Results: Five focus groups having four to eight participants and one additional individual interview were conducted. The participants either work in intensive care, isolation wards or with patients being exceedingly burdened (e.g. dementia). Fifteen main categories with two to eight subcategories were formed. Patients, relatives and staff as well as visitation regulations and farewell were elaborated as most important main categories. Subcategories are for example insecurity, strain and reprocessing or with regards to visitation: restraints, guidelines or exceptions. The biggest challenge addressed by all interviewees were visitations as the restrictions caused a lot of suffering for everyone involved. Discussion: Current general precautions and general palliative care are insufficiently meeting the needs of severely ill and dying patients. Their needs are still existing throughout the pandemic and should be addressed accordingly. Interprofessional and -disciplinary cooperation is a precondition for individualised care of seriously ill patients and their relatives. Measures preventing infections (e.g. concepts) should be transparently communicated in hospitals. Funding: BMBF.