The intersection of environmental justice, climate change, community, and the ecology of life

This book examines and encourages the increasing involvement of those in the social sciences, including social work, as well as everyday citizens, with environmental injustices that affect the natural ecology, community health, and physical and mental health of marginalized communities. The authors draw on their diverse experiences in research, practice, and education to suggest interdisciplinary strategies for addressing environmental justice, climate change, and ecological destruction on both a local and global scale. This insightful work presents models for action, practice, and education, including field learning, with examples of how programs and schools have integrated and infused environmental justice content across their curricula. Environmental and ecological impacts on local communities as well as the whole ecology of life are examined. Models for engaging civic dialogue, addressing structural oppression, and employing other interdisciplinary responses to environmental injustices are provided. Topics explored among the chapters include: Water, Air, and Land: The Foundation for Life, Food, and Society;Human Health and Well-Being in Times of Global Environmental Crisis;Power and Politics: Protection, Rebuilding, and Justice;Pathways to Change: Community and Environmental Transformation;Decolonizing Nature: The Potential of Nature to Heal;The Intersection of Environmental Justice, Climate Change, Community, and the Ecology of Life equips readers to identify the impact of the global environmental crisis in their own communities. Emphasizing the need for immediate action on ecological, climate, and environmental justice issues, this forward-thinking book assists social science professionals, educators, researchers, and other concerned individuals with the knowledge needed for creating meaningful interdisciplinary responses in their communities as they take action within a rapidly changing context. © Springer Nature Switzerland AG 2021. All rights reserved.

The transformation of a student-led health clinic in rural Australia from a face-to-face service to a telehealth model: Evaluation of student and client experiences during a COVID-19 driven transition

Introduction: The COVID-19 pandemic has necessitated the rapid transition of many face-to-face health services to alternate modes of service delivery. The objective of this study was to explore the benefits, challenges and perceived quality of a telehealth service delivery model from the perspective of clients and students. Further, students' perceptions relating to the quality of the educational experience were also explored. Methods: The study was set in a student-led interprofessional health and wellness clinic in rural Queensland, Australia. A qualitative case study design was used, including semistructured student interviews and client open-response survey data. Participants were nursing and allied health students who completed a student-led interprofessional clinic placement and adults with low to rising risk of chronic disease who attended the clinic for telehealth delivered services. Results: Themes identified following analysis included: new or adapted skills needed for success;challenges, limitations and the need for resources, training and support;quality interprofessional education experiences can be achieved in telehealth;coming away with a new set of skills;the important role of the client for success;and benefits and disadvantages of telehealth for clients. Conclusions: The findings support that telehealth-based service-learning models are a feasible way to deliver health and wellness services from the perspective of students and clients and provide students with important skills for rural health service delivery.

The support needs of health professional educators to teach clinical skills online: Experiences of COVID-19 lockdowns from three countries

Introduction: Supporting educators has been identified as vital for the efficacy and sustainability of online teaching. The teaching of clinical skills online presents additional challenges given the vast shift from traditional pedagogies. However, the support needs of health professional educators to teach clinical skills online are unknown. The aim of this study was to explore educator experiences of teaching clinical skills online and investigate their workplace support needs. Methods: A qualitative approach using focus groups was used to investigate educator experiences at three universities in Australia, Chile and South Africa. Data were subject to thematic analysis, and a thematic network tool was used to triangulate international experiences. Results: Seven focus groups were undertaken, with a total of 32 participants. Four global themes were identified following analysis: 1) the educator experience, 2) changes to pedagogy, 3) challenges to teaching online and 4) support for educators. Conclusions: This study has highlighted the professional challenges that teaching clinical skills online creates for health professional educators and the uncertainty regarding expectations and outcomes. Enhancing university support for educators to prepare and provide clinical skills teaching online is suggested to mitigate these challenges. Recommendations are made for universities and educators to consider in the pursuit of effective and sustainable teaching of clinical skills online.

Use of Monoclonal Antibody Casirivimab-Imdevimab for Treatment of COVID-19 in Kidney Transplant Recipients

Purpose: Kidney transplant recipients are at high-risk for severe coronavirus disease 2019 (COVID-19). Studies suggest that intervention with monoclonal antibody (MAB) treatment may decrease hospitalization rates. Here we describe a single-center experience of the use of casirivimab-imdevimab, a currently approved MAB, for treatment of COVID-19 disease in kidney transplant recipients. Method(s): This is a retrospective single center study of adult kidney transplant patients who were diagnosed with mild to moderate COVID-19 and received casirivimab-imdevimab as an outpatient infusion between 12/29/20 to 10/20/21. All patients had at least 30 days of study follow-up from date of infusion. Result(s): 69 patients were included with the following characteristics: 65.2% male, 73.9% white, mean age 50+/-13 years, 33% diabetic. Median time from transplant to COVID-19 diagnosis was 80 (IQR 33-143) months. 49.3% of patients were not vaccinated for COVID-19 while 1.5%, 34.8%, and 14.5% had received 1, 2 and 3 doses, respectively. Median time from COVID-19 diagnosis to MAB treatment was 3 (range 0-9) days. Of the 69 patients, 3 (4.3%) required hospitalization within 30 days after MAB infusion (table). There were no emergency department-only visits within 30 days after MAB infusion. There were no deaths, graft losses, or acute rejection episodes recorded in the 30-day follow-up period. One infusion reaction of flushing and palpitations was reported. Conclusion(s): To our knowledge, this study describes the largest cohort of kidney transplant recipients treated with casirivimab-imdevimab and demonstrates that among high-risk, immunosuppressed patients with COVID-19, casirivimabimdevimab therapy is associated with low rates of hospitalization and a favorable safety profile.

Covid-19 in kidney transplant recipients in the southeastern united states: A single center experience

Purpose: The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or COVID-19, has emerged as a viral pandemic and brought unprecedented challenges worldwide on health care systems, including our transplantation community. Data on the clinical characteristics and outcomes of patients with COVID-19 infection in kidney transplant recipients (KTRs) remain uncertain. Here we describe the clinical characteristics and outcomes of KTRs in the Southeastern US who contracted COVID-19. Methods: A retrospective review of KTRs who tested positive for COVID-19 from March 15th, 2020 until November 25th, 2020 and followed at our institution were included. Data including patient demographics, history, laboratory results, radiological findings, and clinical outcomes was collected from the electronic medical record. Summary statistics using Kruskal-Wallis and Chi-square tests were performed. Multivariable logistic regression was used to identify risk factors for inpatient admission. Results: There were 104 patients who tested positive for COVID-19 either at our institution or a referring hospital (Table 1). Fifty-six (54%) patients required hospitalization. Labs on admission were: mean WBC 6.6±2.8 (x10-3/mcL), serum creatinine 2.3±1.7 (mg/dL), CRP 96±84 (mg/L), ferritin 1093±1052 (ng/mL), procalcitonin 0.62±1.0 (ng/mL), lactate 1.2±0.4 (mEq/L). Admitted patients were treated with dexamethasone (54%) and remdesivir (23%), and the anti-metabolite was held in 71%. Nineteen patients required ICU stay, 13 were intubated, 25 developed AKI and 12 died related to COVID-19 (11%). Mean length of inpatient stay was 11±13 days. After adjustment for age, DM and CAD status, the risk of admission due to COVID-19 was higher in those presenting with fever (OR 3.12, 95% CI 1.23-7.92, P-Value 0.017), and SOB (OR 7.64,95% CI 1.89-30.9, P-Value 0.004) (Table 2). Conclusions: The majority of KTRs with COVID-19 in our cohort required hospital admission. The mortality rate was 11% which is at the lower end of the spectrum of what has been previously reported. Despite this, COVID-19 remains a significant risk for our kidney transplant recipients with a high rate of hospital admission.

Regional impact of COVID-19 on kidney transplant in the Southeast

Purpose: Despite categorization of kidney transplantation as Tier 3b with guidelines against postponing, the impact of the COVID-19 pandemic has been profound but geographically diverse. We examined the variable impact of the pandemic on local waitlist, mortality, and transplant rates in the Southeast and the potential relationship with local disease burden. Methods: Using SRTR data, we analyzed changes pre- and post-COVID by individual donation service area (DSA) in the Southeast, and compared this with state COVID case rates and deaths per 100,000 population according to CDC data. Results: The highest COVID case rates occurred in TN while death rates were highest in MS [Table 1]. The largest declines in new kidney listings post-COVID occurred in ALOB and TNMS (both 38%) with MSOP having the smallest decline (9%) despite a high COVID case rate;SCOP had an increase (14%). Waitlist mortality varied greatly from a high of 80% in NCCM to a 19% decrease in TNMS. Transplant rates decreased in most DSAs, but great variation occurred from a 44% decline in NCCM to a 38% increase in TNMS. Conclusions: There was large variability in new kidney listing, transplant rates, and waitlist mortality according to DSA in the Southeast. These changes did not directly correlate with COVID case and death rates. These findings suggest a complex interplay between population health disparities, racial demographics and urban vs rural local populations. (Table Presented).

One-year monitoring of changes to kidney-pancreas waiting time criteria: An OPTN analysis

Purpose: In 2018, the OPTN board approved changes to kidney-pancreas (KP) waiting time criteria. KP candidates accrued waiting time if they were (1) on insulin and had a C-peptide <=2ng/mL or (2) on insulin and had a C-peptide >=2ng/ mL and had a BMI <=30kg/m∧2 which was the maximum allowable BMI. Since 7/11/2019 candidates must be on insulin, registered for a KP, and meeting kidney waiting time criteria. Methods: Registrations added to the waitlist and transplants between 7/11/2018- 7/10/2019 (pre-implementation) or 7/11/2019-7/10/2020 (post-implementation) were compared. Data originated from OPTN waitlist, Transplant Candidate Registration forms and Transplant Recipient Registration forms as of 10/16/2020. Results: 1,389 registrations were added to KP and 42,229 to kidney alone (KI) waitlists (pre-implementation);854 KP and 19,196 KI transplants performed. 1,401 registrations were added to KP and 19,493 KI waitlists (post-implementation);814 KP and 19,493 KI transplants performed. The proportion of type 2 diabetes (T2DM) KP candidates and recipients increased from 23.29% to 27.45% and 21.41% to 27%, respectively (Table 1). Candidate mean BMI increased from 25.7 to 26.3. KP recipients with T2DM and C-peptide >2ng/mL had higher median BMIs than those with lower C-peptide. KP post-transplant outcomes stratified by ethnicity, BMI, and diabetes status remained similar. The proportion of KI candidates and recipients remained roughly unchanged. Pediatric KI organ offers increased (527 to 592 offers per 100 active patient-years) but transplants remained unchanged. Conclusions: Changes in KP waiting time criteria did not adversely affect KI or pediatric KI candidates. Removing the BMI cutoff for obese patients with T2DM resulted in higher BMI KP transplants with equivalent post-transplant outcomes compared to lower BMI recipients. Although total KP transplants were slightly less in the post-implementation period, registrations were more and the transplant volumes were likely adversely affected by the COVID-19 pandemic.

Solid organ transplant telehealth utilization significantly increased during the COVID-19 pandemic: Experience at a single, large volume center

Purpose: During the COVID-19 pandemic, telehealth utilization has allowed for the delivery of healthcare while protecting patients, caregivers, healthcare workers, and the community from exposure. We examined the effect of the COVID-19 pandemic on utilization of telehealth in the care of all solid organ transplant patients in all phases of transplant care at our center. Methods: All patients seen at Vanderbilt University Medical Center for solid organ transplant during any phase of care (referral, evaluation, waitlist, or posttransplantation) from July 1, 2019 through October 31, 2020 were included in this retrospective analysis. Patients seen from July 1, 2019 through February 29, 2020 were identified as a Pre-COVID-19 era cohort. Patients seen from March 1, 2020 through October 31, 2020 were the COVID-19 era cohort. Pretransplant phases of care included referral, evaluation and waitlist;those transplanted were considered posttransplant. Telehealth visits included telemedicine, defined as those conducted by face-to-face (F2F) videoconferencing, and telephone. Results: Total visit number for all solid organs (kidney, liver, heart, lung, and pancreas) were similar between eras (12585 vs. 13677) [Figure]. There was a significant increase in the use of telehealth in the COVID-19 era for all organ types with the pre-era ranging from 1.2-4.3% while post ranged from 22.4-45.6% [Table]. Telemedicine was not used during the pre-COVID-19 era and its use increased to 17.5-23.7% of all visits by organ type during the COVID-era. Conclusions: The COVID-19 pandemic has accelerated the use of telehealth in all phases and types of solid organ transplantation. The use of telemedicine although increased represents a minority of total visits and the increased use of telephone visits suggest barriers may remain to more widespread adoption of F2F technology that warrant further investigation. (Table Presented).