USE OF TECHNOLOGY TO DELIVER AND MONITOR NONPHARMACOLOGICAL INTERVENTION FOR ADRD WITH BEHAVIORAL SYMPTOMS

Onset of the COVID-19 pandemic created numerous barriers to providing care supports and clinical research for persons living with Alzheimer's disease and related dementias (ADRD). Technology offered one avenue for continued care support and clinical data collection. This study reports on the use of technology to deliver a 6-week, non-pharmacological care intervention directed toward caregivers of persons with ADRD and remote data collection including cognitive assessment, biometric data, and survey data for community-residing persons with ADRD and behavioral symptoms (N=28). Benefits and challenges of such technology use for intervention delivery and data collection will be discussed. Benefits include increased geographical outreach, no travel time, and greater scheduling flexibility. Challenges include access to technology (equipment and/or internet), internet connection quality, ease of use, and equipment return at study completion. These findings offer specific aspects to consider while designing and implementing remote care programming and clinical research for community-residing persons with ADRD.

INCREASING DEMENTIA CARE MASTERY FOR RURAL CAREGIVERS: LESSONS FROM ADAPTING THE HARMONY @ HOME INTERVENTION

Providing care support to rural Alzheimer's disease and related dementia (ADRD) caregivers has always been challenging, but particularly with the COVID-19 pandemic, new barriers have emerged for families in accessing care support. Delivered via telehealth, Harmony at HOME (H@H) provides dementia care mastery for caregivers of persons with ADRD in the skills of assessing and modifying the home environment to promote "person-environment fit," whereby increasing functional activity engagement and minimizing maladaptive behaviors. To enhance care supports specific to the needs of rural communities, this study reports the findings of two focus groups with rural caregivers who participated in the H@H intervention. Focus groups were aimed to identify the needs of caregivers in rural communities to guide adaptation approaches for future implementation of the H@H intervention in these underserved areas. Additional studies to assess real-world efficacy of the adaptations to H@H are needed as a next step toward implementing this intervention in clinical, home care settings.

Swallowing and communication assessment in tracheostomy patients: Multi-disciplinary-led quality improvement in a busy tertiary teaching hospital

Introduction: Intensive care patients often have complex swallowing and communication needs. These require coordinated input from the multi-disciplinary team. Increasing evidence highlights the role of speech and language therapy (SLT) within the critical care environment1 and this is represented well in national recommendations specific to patients with tracheostomies. Approximately 10-15% of ICU patients will have a tracheostomy nationally.2 SLT provide expertise in assessment and management of communication and swallowing difficulties, which can vastly improve psychosocial well-being and promote early safe enteral feeding for our patients.3 In 2014 On the right trache?4 found that 52% of patients with a tracheostomy suffered with dysphagia, however only 27% critical care patients had input from SLT. Objectives: To improve the assessment of swallowing and communication in patients undergoing tracheostomy ventilation at the Royal Infirmary of Edinburgh, to comply with Scottish Intensive Care Society Audit Group (SICSAG) quality indicator 2.3. This guidance stipulates all tracheostomy patients should have communication and swallowing needs assessed during ventilator wean.5 Methods: Four distinct areas of intervention were implemented. Pre-populated review text was added to NHS Lothian's clinical notation system (InterSystems TrakCare®), prompting nursing staff to consider swallowing, tracheostomy issues and SLT referral. These were refined between audit cycles. SLT were invited to join safety briefs to identify tracheostomy patients, as well as other patients with complex swallowing needs. This was an opportunity to raise awareness, educate, and prioritise workload. New guidelines for nurse-led swallowing observations were developed and disseminated amongst teams. Finally, staff were offered relevant educational sessions. Baseline data was collected in 2019;serial data collection was then during October - November 2020 and in June - July 2021 following the interventions. Results: All patients who received tracheostomy ventilation were audited (n=31). This showed that very few patients had swallowing and communication assessed adequately. Only 16.1% (n=5) patients had a regular nursing swallowing assessment on the majority of critical care days (>50%). Referral to SLT was often very late when patients were approaching de-cannulation and on many occasions by the time the SLT team were involved patients had already been de-cannulated. Following the intervention period, it became apparent that awareness of swallowing requirements had improved. By mid 2021, 58.9% more patients had swallowing assessed as part of daily care. Additionally, 81.2% of patients had SLT reviews on the unit demonstrating a sustained increase from late 2020. There was a notable increase in the quality of assessments after initial SLT review. Conclusion: Using quality improvement methodology our multidisciplinary team was able to substantially increase the quality of swallowing assessment within our ICU, despite the challenges of the COVID-19 pandemic. Our unit now complies with SICSAG quality indicator 2.3. This is in keeping with national recommendations for a multidisciplinary approach to care of tracheostomy patients. Patients with increased risk of dysphagia are being identified earlier and are more likely to progress and be established on enteral feeding early, which may subsequently reduce the burden of nasogastric feeding, total parenteral nutrition and even related invasive IV access.

Critical reflections of faculty using TILT in classrooms at a historically Black University

Higher education is considered a strong driver of social mobility and of generating family wealth. However, students of top quartile income group have four times higher chance of graduating from college compared to those in the bottom quartile economic group. Pedagogical interventions such as Transparency in Learning and Teaching (TILT) are promoted in universities to provide equitable access to education to all students irrespective of their ethnic and social backgrounds. In this chapter, a qualitative analysis is conducted using autoethnographic narratives to gather the experiences of faculty members diverse in gender, age, subjective discipline, and ethnic origin, while implementing TILT framework in their respective classes at a Historical Black College and University (HBCU). This chapter consists of faculty perspectives on TILT, of using TILT during COVID-19 pandemic, and the problems they faced when implementing TILT. The chapter also includes a variety of examples on how TILT dimensions can be integrated into different subjective disciplines. © 2022, IGI Global.

Critical dialogue at the intersections of race, education, and COVID-19

In this chapter, two public school teachers and recent doctoral graduates recount and reflect upon the ways in which their critical dialogues inform their rendering of the stressors weighing on educators since the onset of the COVID-19 pandemic in early 2020. The teachers-one, a Black woman in Texas, the other a White man in New Jersey-explore how their shared, liberatory, educational goals are compromised by institutional pressures, economic uncertainties, uneven enforcement of localized curricular policies, and ongoing resistance to healthcare initiatives instituted to combat the spread of COVID-19. To accomplish this, the authors highlight how race, identity, and pedagogy are disparately addressed in their respective workplaces. The authors conclude by suggesting that increased space for continued critical dialogue may help other educators to make sense of what are often tumultuous, hasty changes made since COVID-19 first affected American schools. © 2022, IGI Global.

Followership: an undervalued concept in effective teams within the military and NHS.

INTRODUCTION: Leadership is accepted as a crucial component of effective working within teams. Followership's contribution to successful performance is increasingly recognised but understudied. This study evaluated followership levels in military doctors at different stages of their careers and made recommendations for how followership concepts can be used to develop the self and better understand the challenges of small team working. METHODS: A self-report study in which Kelley's followership questionnaire was distributed to 64 military doctors in three cohorts. 53 results were assessed using Kelley's followership framework. Subgroup analysis was undertaken to look at differences depending on service, age, gender and career stage. RESULTS: The study demonstrated a predominant exemplary followership style within military doctors. No statistical difference was identified at the 0.05 level in followership by career stage, age, gender or service in the sample group. CONCLUSION: This study gives insight into the attributes of doctors within the Defence Medical Services and laid out a methodology for further cohort evaluations of followership. It made recommendations on the areas of the field that require further research and how followership concepts may be included in further development courses and reporting for military medical personnel.

Exploring older adults' experiences using technology during a viral pandemic

BACKGROUND: Older adults are at greater risk for morbidity and mortality associated with COVID-19. Spatial distancing and sequestering practices are recommended to limit viral exposure. Older adults adopting these practices are at increased risk of social isolation and adverse health outcomes. Remote technologies offer various platforms for satisfying socialization and healthcare needs while sequestering. Understanding how older adults are using technology has implications for wellbeing during a pandemic. METHOD: Researchers attempted to contact all participants enrolled in the University of Kentucky Alzheimer's Disease Research Center longitudinal study via telephone to survey technology use (n = 706). Participants were contacted directly, except for demented participants, whose primary caregivers were contacted to respond on their behalf, when possible. Participants and caregivers gave their assent verbally to complete the voluntary survey, the procedures of which were approved by the IRB. The surveys consisted of validated instruments to gauge the extent of use of and comfort with technology. Spearman correlations, chi-square tests, and t-tests were used to explore data. RESULT: Ultimately, 384 participants were reached and 332 consented to participate. Most reported reliable home internet access (91.5%) and some internet use (90.6%). Recent feelings of loneliness were not related to any technology-related variables (all ps > 0.29) other than decreasing with greater willingness to use telehealth (Rho = -0.11, p = 0.06). Those who reported a lack of comfort with technology (n = 76) were less likely to text messaging (67% vs 78%) and social media (56% vs 69%), ps ≤ 0.06, but felt socially connected using technology at similar levels (82% vs 75%), p = 0.22. Nearly 70% of this group reported they would use technology more with training. Across all participants, willingness to use telehealth was not related to frequency of frustration with tech (Rho = 0, p = 0.99). CONCLUSION: The results suggest that some older adults' use of technology is limited by familiarity. Lack of familiarity does not appear to create a barrier to using telehealth nor does frustration with technology appear to limit telehealth use. The findings have implications for supporting older adults sequestered during a pandemic but potentially more broadly. © 2021 the Alzheimer's Association.

A comparison of acoustic correlates of voice quality across different recording devices: A cautionary tale

There has been a recent increase in speech research utilizing data recorded with participants' personal devices, particularly in light of the COVID-19 pandemic and restrictions on face-toface interactions. This raises important questions about whether these recordings are comparable to those made in traditional lab-based settings. Some previous studies have compared the viability of recordings made with personal devices for the clinical evaluation of voice quality. However, these studies rely on simple statistical analyses and do not examine acoustic correlates of voice quality typically examined in the (socio-) phonetic literature (e.g. H1-H2). In this study, we compare recordings from a set of smartphones/laptops and a solid-state recorder to assess the reliability of a range of acoustic correlates of voice quality. The results show significant differences for many acoustic measures of voice quality across devices. Further exploratory analyses demonstrate that these differences are not simple offsets, but rather that their magnitude depends on the value of the measurement of interest. We therefore urge researchers to exercise caution when examining voice quality based on recordings made with participants' devices, particularly when interested in small effect sizes. We also call on the speech research community to investigate these issues more thoroughly. Copyright © 2021 ISCA.

Burdens of AKI and CKD among COVID-19 survivors

Background: COVID-19 is known to be associated with increased risk of acute kidney injury (AKI) during the acute phase of the infection. However, the burden of AKI and chronic kidney diseases (CKD) after the first 30 days of COVID-19 infection is not clear. Methods: 181,384 COVID-19 patients from the United States Veterans Health Care System who survived the first 30 days of infection were enrolled and compared with 4,397,509 non-infected controls on burden of AKI and CKD at 6 months. Adjusted comparisons were conducted across severity of infection measured based on intensity of care received, and by subgroups based on age and pre-existing health conditions. Results: With a median follow up of 150 (interquartile range: 115, 221) days, the adjusted excess burden of AKI due to COVID-19 was 6.07 (95% confidence interval: 5.46, 6.69) and excess burden of CKD was 7.19 (5.78, 8.55) per 1000 persons at 6 months. The excess burden of AKI increased with the severity of acute infection(excess burden 1.28 (0.68, 1.86), 28.11 (25.94, 30.26) and 73.18 (67.53, 79.02) per 1000 persons at 6 months for COVID-19 patients without hospitalization, hospitalized and admitted to intensive care units, respectively). The excess burdens of CKD were 1.66 (0.19, 3.08), 36.41 (31.71, 41.11) and 82.55 (71.93, 93.78) for those not hospitalized, hospitalized and admitted to intensive care units, respectively. The burden of AKI and CKD increased with increased age (≤60, 60-70, >70 years) and increased pre-existing health conditions (Charlson comorbidity index of 0, 1-3 and >3) (Table). Conclusions: Our results suggest that COVID-19 survivors, including those without hospitalization or pre-existing health conditions, suffered burden of AKI and CKD after the first 30 days of the infection. We provide insight into the burdens of AKI and CKD by population groups;our estimates may help guide nephrology care for COVID-19 patients.

Coronavirus disease 2019 mortality: a multivariate ecological analysis in relation to ethnicity, population density, obesity, deprivation and pollution.

BACKGROUND: There is emerging evidence about characteristics that may increase the risk of coronavirus disease 2019 (COVID-19) mortality, but they are highly correlated. METHODS: An ecological analysis was used to estimate associations between these variables and age-standardised COVID-19 mortality rates at the local authority level. RESULTS: Ethnicity, population density and overweight/obesity were all found to have strong independent associations with COVID-19 mortality, at the local authority level. DISCUSSION: This analysis provides some preliminary evidence about which variables are independently associated with COVID-19 mortality and suggests that others (deprivation and pollution) are not directly linked. It highlights the importance of multivariate analyses to understand the factors that increase vulnerability to COVID-19.