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Introduction: Frimley Park Hospital criteria for referral to High-Risk Obstetric Anaesthetic Clinic (HROAC) included all parturients with BMI > 40. The COVID-19 pandemic necessitated HROAC becoming virtual. It was still possible to discuss risk and assess patients' airways, but not to reliably assess the likely ease of neuraxial techniques or cannulation. Observationally, little useful clinical information was gained, and airway problems rarely noted. An audit was planned to assess how often clinically useful information about the women's airways was gained during appointments. Method(s): HROAC database search for women referred with BMI > 40 with estimated date of delivery 20/04/20-03/04/21 to see whether any airway difficulties were predicted (Mallampati 3 or 4;limited neck movement;jaw slide B or C;limited mouth opening). Result(s): 82 women had BMI > 40, of which 3 were assessed as having a potentially difficult airway: two had BMI > 50 and one had retrognathism causing difficult airway prediction unrelated to her BMI of 41.7. One woman, BMI 58.7, was assessed as having a straightforward airway but her notes revealed her airway had been challenging to intubate in the past. One was assessed in video consultation as straightforward but an airway assessment during admission at the end of her previous pregnancy was Mallampti 3. Five women declined a video consultation. Discussion(s): In view of the minimal gain of clinically useful information and the routine presence of difficult airway kit for the obstetric emergency theatre, it was deemed safe and more relevant to make airway and neuraxial assessments on admission to labour ward rather than in the antenatal clinic for women with BMI<50. The assessment would therefore be made by the duty trainee anaesthetist who would be responsible for managing the patient, thus facilitating appropriate planning and communication if a woman with a challenging airway was identified. It is therefore also made at the very end of pregnancy when weight gain and its impact on airway is likely to be at its maximum. This approach, in conjunction with an antenatal information leaflet, and the ability of any obstetrician to refer to the HROAC, complies with the need for timely assessment of women as required by GPAS [1]. By formalising the assessment of women with high BMI on the labour ward it is hoped that patient safety and planning can be maximised.Copyright © 2023 Elsevier Ltd
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Extended reality is known as a technical term encompassing augmented, virtual, and mixed reality. It is a niche technology domain that finds its way through virtually every sector, from academia to businesses and industries. Its success is due to the level of immersion it brings to the user. The COVID-19 pandemic, with its unprecedented consequences and lockdowns, amplified the advantages of immersive education and learning through extended reality technology. The technology extension to smartphones and Web pages has enabled its accessibility to a level expected to grow beyond the pandemic era. Due to the rural locations of farms, agriculture is a great candidate where extended reality technology can strengthen its reach to a more enormous population for education, promotion, and outreach. The current study, at the intersection of the agricultural sector and extended reality technology, presents the development of a three-dimensional interactive game to promote the Tennessee corn. The game is developed in Unity engine (version 2020.3.12). It is a single-player, first-person perspective game, where the arrow keys make a farmer character navigate turns and obstacles within a corn maze. Scarecrows will appear over the game course and force the player to answer a trivia question about corn production and usage. The player moves forward unchanged with correct answers to the trivia questions;however, the player will lose a life from their five-life total with an incorrect answer. The goal is to escape the maze by correctly answering trivia questions, navigating the maze, and finding bonus lives scattered throughout. The study discusses the design process of player movements, camera movements, objects interactions, and other game-play mechanics. With our target audience primarily set to middle school students in rural areas, the game was successfully developed and released as a Web-based game (https://bar.rancsgroup.com/TheMaze/ ). Our current plan is to extend the game with optional difficulty levels as well as release smartphones applications through major platforms. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
ABSTRACT
Proponents of game-based learning see potential for the inclusion of Alternate Reality Games (ARGs) in higher education. Research has shown that an ARG can support the induction and socialisation of students but engagement in educational ARGs has been disappointing. We explored whether students could learn via an ARG embedded in curriculum: if they would engage in play, and how the ARG contributed to learning. Using a theoretical framework of situated learning, this ethnographic case study examined a first-year university course with an embedded ARG. Interviews, observations, and documents were analysed for a priori codes using NVivo, finding that engagement in the game was positive until it was interrupted by the COVID-19 pandemic. Evidence showed that the ARG could help students to learn. The ARG provided a context for students to engage with one another and their instructor;encouraged students to research relevant topics and use evidence to support their arguments;engaged participants in the theoretical content that they were learning;and gave the instructor options to customise student feedback. The ARG most effectively supported learning by initiating social connections and engaging students with the theoretical content of their course. © 2023 Informa UK Limited, trading as Taylor & Francis Group.
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Background. Over 600,000 SARS-CoV-2 infections and 20,000 deaths have occurred among users of the Veterans Health Administration, the US's largest integrated health care system. We explored early outcomes of SARS-COV-2 infection in Veterans. Methods. An ongoing, prospective longitudinal cohort study of Veterans ages >= 18 enrolled 1,826 participants (29.0% inpatient;49.1% vaccinated;68.3% SARS-CoV-2-positive;85.0% male, mean age = 57.1 years) seeking inpatient or outpatient care after SARS-CoV-2 testing at 15 Department of Veterans Affairs medical centers in July 2020 to February 13, 2022. Using multivariable regression, we estimated relationships of baseline demographic characteristics, COVID-19 vaccination, and clinical history to illness severity and cumulative length of hospital stay within 60 days of study entry. Illness severity was defined by a Veterans Affairs adaptation of the WHO COVID-19 severity scale and included 4 levels (mild, moderate, severe, or death). We derived the Charlson co-morbidity index (CCI) and other baseline characteristics from electronic health data and study questionnaires, and reported qualitative SARS-CoV-2 IgG responses using inpatients' study-collected blood specimens. Results. High CCI scores (>= 5) occurred in 47 (42.7%) vaccinated SARS-CoV-2-positive inpatients and 47 (21.2%) unvaccinated. Severe illness occurred in 17 (15.5%) vaccinated inpatients, 37 (16.7%) unvaccinated inpatients, 4 (0.9%) vaccinated outpatients, and 3 (0.7%) unvaccinated outpatients. Eleven (10%) of 110 vaccinated SARS-CoV-2-positive inpatients died, as did 15 (6.8%) of the 222 unvaccinated. In SARS-CoV-2-positive inpatients, a one-step higher CCI was associated with more severe illness (aOR 1.10, 95%CI 1.01-1.20) and more hospitalization days (aIRR 1.06, 95% CI 1.03-1.10), adjusting for vaccination status. Respectively, 93% of vaccinated and 63% of unvaccinated SARS-CoV-2 positive inpatients with baseline antibody results had an anti-spike IgG response. Conclusion. In an ongoing longitudinal cohort study of COVID-19 in US Veterans, comorbidity burden was higher among vaccinated than unvaccinated inpatients and was associated with more severe illness and hospitalization days, independent of vaccination status.
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Research has shown that high self-assessment of ability, sense of belonging, and professional role confidence are crucial for students' persistence in computing. As grades in introductory computer science courses tend to be lower than other courses, it is essential to provide students with contextualized feedback about their performance in these courses. Giving students unambiguous and con- textualized feedback is especially important during COVID when many classes have moved online and instructors and students have fewer opportunities to interact. In this study, we investigate the effect of a lightweight, scalable intervention where students received personalized, contextualized feedback from their instructors after two major assignments during the semester. After each intervention, we collected survey data to assess students' self-assessment of computing ability, sense of belonging, intentions to persist in computing, professional role confidence, and the likelihood of stating intention to pursue a major in computer science. To analyze the effectiveness of our intervention, we conducted linear regression and mediation analysis on student survey responses. Our results have shown that providing students with personalized feedback can significantly improve their self-assessment of computing ability, which will significantly improve their intentions to persist in computing. Furthermore, our results have demonstrated that our intervention can significantly improve students' sense of belonging, professional role confidence, and the likelihood of stating an intention to pursue a major in computer science. © 2022 ACM.
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Methods: Participants of the 13 week program, Partner's Aligned in Transformative Healing (PATH), receive an Anti-Inflammatory Pantry Kit containing one retail size quantity of extra-virgin olive oil, avocado oil, pumpkin seeds, Brazil nuts, green tea, ground flax seed, dried lentils, maple syrup, ground turmeric, ground ginger, and coconut milk. During week 5 of the program participants spend 90 minutes with the registered dietitian (virtual or in-person, depending on the group) for an interactive education and sensory experiential. Participants leave with the food and knowledge of the ingredients and how to use them. The registered dietitian procures the ingredients and puts together the kits. Food costs are reimbursed by Blue Cross Blue Shield of Vermont as it has been incorporated into the program's bundled payment model for each PATH participant. Results: What emerged from this experimental adjustment to the curriculum is an innovation that has engaged participants to make modifications to their diets to increase whole food sources of omega-3 fatty acids, phytonutrients, dietary fiber, zinc, selenium, plant-based protein, and healthy fat;all of which are evidenced based nutrients that have been demonstrated to impact inflammatory and immune systems in individuals experiencing chronic pain. Background: The Anti-Inflammatory Pantry Kit was designed during the covid-19 pandemic as a way to continue to offer hands-on culinary medicine to participants at the University of Vermont's Comprhensive Pain Program in the comfort and safety of their own home. Conclusion: Culinary medicine at the Comprehensive Pain Program looks different now that it did prior to the pandemic and the changes have been received with enthusiasm. The Anti-Inflammatory Pantry Kit is a dynamic tool for nutrition and culinary medicine education for chronic pain participants. This tool and approach to medical nutrition therapy has been made sustainable by the reimbursement by Blue Cross Blue Shield of Vermont and the engagement of participants.
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Background: American Indians have significant barriers to cancer prevention and control due to a number of social structural factors. North Carolina has the largest American Indian population east of the Mississippi River with eight tribes and four urban Indian centers, yet there have been few coordinated strategies to address cancer disparities in this population. Engagement with tribal communities is vital in successful implementation of research and outreach activities. Methods: The Wake Forest Baptist Comprehensive Cancer Center (WFBCCC) received a supplement to their P30 Cancer Center Support Grant to inform Community Outreach and Engagement initiatives through The Healing Walk project which was designed to determine the most pressing cancer concerns for American Indian communities in North Carolina and identify needs for research training for American Indian students. Feedback was obtained from tribal leaders, educators, and college students through one large and three mini-round table discussions and solicited by email throughout late 2018 and 2019. The final round table occurred two days before the 2020 COVID 19 mitigation mandates. Results: Community interviews produced a wealth of information on the self-reported issues within American Indian populations in North Carolina. Tribal community leaders identified systemic and demographic issues that contribute to health disparities among their people. These issues include: lack of trust in the medical community, structural barriers to care leading to late-stage diagnosis, perceptions related to cancer, high rates of cancer risk factors, including obesity and tobacco use, and historical trauma. Students identified factors which contribute to barriers in pursuing careers in cancer research, including a lack of American Indian mentors, financial barriers, mental health challenges that arise in attending majority institutions, and a lack of culturally competent research training. Conclusions: By relying on the viewpoints of tribal leaders, the WFBCCC can accurately address the needs of the communities and develop cancer prevention and control initiatives that are culturally responsible, such as Tribal Health Ambassadors. In accordance with the majority of the requests both students and educators made, the WFBCCC is creating an undergraduate research program for engaging AI students. Focusing on community identified areas of need, students will develop a research question relative to the health concerns of their tribe. The goal of this research program is two fold. First, to enable tribal communities to accurately assess cancer risk, incidence, and mortality, and with that knowledge reduce the current health disparities in AI populations. Second, to provide American Indian students with the opportunity to not only serve their community, but to give them the tools and experience to help understand and eliminate cancer disparities in their tribal communities.
ABSTRACT
On 2 July 2020, the governor of Kansas issued an executive order (state mandate), effective 3 July, requiring masks or other face coverings in public spaces. CDC and the Kansas Department of Health and Environment analyzed trends in county-level COVID-19 incidence before (1 June-2 July) and after (3 July-23 August) the governor's executive order among counties that ultimately had a mask mandate in place and those that did not. As of 11 August, 24 of Kansas's 105 counties did not opt out of the state mandate or adopted their own mask mandate shortly before or after the state mandate was issued;81 counties opted out of the state mandate, as permitted by state law, and did not adopt their own mask mandate. After the governor's executive order, COVID-19 incidence (calculated as the 7-day rolling average number of new daily cases per 100,000 population) decreased (mean decrease of 0.08 cases per 100,000 per day;net decrease of 6%) among counties with a mask mandate (mandated counties) but continued to increase (mean increase of 0.11 cases per 100,000 per day;net increase of 100%) among counties without a mask mandate (non-mandated counties). The decrease in cases among mandated counties and the continued increase in cases in non-mandated counties adds to the evidence supporting the importance of wearing masks and implementing policies requiring their use to mitigate the spread of SARS-CoV-2. Community-level mitigation strategies emphasizing wearing masks, maintaining physical distance, staying at home when ill, and enhancing hygiene practices can help reduce transmission of SARS-CoV-2.