Development of a model of care based on the chronic care and collaborative care models to improve cardiometabolic health in low-to- middle income countries

Background: Non-communicable diseases (NCDs) are rising in low middle income countries (LMICs) mainly driven by cardiometabolic disease (cardiovascular disease, diabetes, and hypertension). Aim(s): To develop a model of care, based on the chronic care model and collaborative care model, to improve care, outcomes and risk factor control for adults with cardio metabolic disease in LMICs in the Covid-19 era. This will contribute to the sustainable development goals of promoting good health, well-being and reducing inequalities. Method(s): Using an iterative consultative approach with healthcare workers, clients, and community leaders in Kenya, Ghana and Mozambique, we developed a model of care, which includes core features from chronic care models: self-management support;decision support;clinical information systems;delivery system design;and community linkages. Result(s): We produced a culturally adapted self-management education programme, a training package for educators delivering the programme, as well as a training package for community and healthcare professional leaders to increase awareness and self-care for cardiometabolic disease. Given the lack of a robust health information system, we are offering a global registry to provide real world data on patient management and quality of care for people with type 2 diabetes, hypertension, heart failure and chronic kidney disease. Conclusion(s): This intervention will be tested in a mixed-methods single-arm feasibility study in five sites across three African countries: Kenya, Ghana, Mozambique.

Using Rational Choice Theory to Explore Factors Impacting Contact Tracing Application Adoption

Effective contact tracing is an important tool in trying to control the spread of highly infectious diseases. Utilizing the theory of reasoned action and rational choice theory, this study explores factors impacting the adoption of mobile contact tracing application. Findings indicate that perceived benefits of usage and perceived costs of non-usage positively impact an individual's attitude toward usage intention, while information security concern as perceived cost of usage has a negative effect.

The adaptation of face-to- face structured self-management education programmes for people with, and at high risk of, type 2 diabetes for virtual delivery during the covid-19 pandemic and beyond

Objective: To adapt Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) structured education programmes for virtual delivery during covid-19. Methods: Face-to- face structured education programmes stopped in March 2020 due to covid-19. A multi-disciplinary stakeholder group adapted the existing evidence-based DESMOND curriculums and resources to support a new model of virtual delivery, while remaining congruent to the theoretical and philosophical underpinnings. Version 1 was released in May 2020. Educator training was provided to increase confidence in delivering virtually. An iterative process of stakeholder feedback, and review of resources led to two updated versions of the adapted programmes being released;version 3 was made available in October 2021. New Educators are now trained virtually. In August 2021 the first Educator completed their pathway of training, mentorship and quality assessment virtually. Results: Between May 2020 and August 2021, 529 attendees rated their DESMOND programme 8.8/10 for how much they felt part of the group and able to engage with others and 94% set a goal during their programme. 95% of attendees rated their overall experience as 4 or 5 stars with 97% recommending the programme to friends and family. Feedback from Educators indicated low drop out rates between sessions and virtual delivery had increased the opportunity for evening and weekend sessions enabling more people to attend. Educators found the virtual resources easy to use. Conclusions: The adaptation of face-to- face to virtual delivery is acceptable to participants and Educators. Virtual delivery should continue to be included as an option in the future.

Nanofiber capsules for minimally invasive sampling of biological specimens from gastrointestinal tract.

Accurate and rapid point-of-care tissue and microbiome sampling is critical for early detection of cancers and infectious diseases and often result in effective early intervention and prevention of disease spread. In particular, the low prevalence of Barrett's and gastric premalignancy in the Western world makes population-based endoscopic screening unfeasible and cost-ineffective. Herein, we report a method that may be useful for prescreening the general population in a minimally invasive way using a swallowable, re-expandable, ultra-absorbable, and retrievable nanofiber cuboid and sphere produced by electrospinning, gas-foaming, coating, and crosslinking. The water absorption capacity of the cuboid- and sphere-shaped nanofiber objects is shown ∼6000% and ∼2000% of their dry mass. In contrast, unexpanded semicircular and square nanofiber membranes showed <500% of their dry mass. Moreover, the swallowable sphere and cuboid were able to collect and release more bacteria, viruses, and cells/tissues from solutions as compared with unexpanded scaffolds. In addition to that, an expanded sphere shows higher cell collection capacity from the esophagus inner wall as compared with the unexpanded nanofiber membrane. Taken together, the nanofiber capsules developed in this study could provide a minimally invasive method of collecting biological samples from the duodenal, gastric, esophagus, and oropharyngeal sites, potentially leading to timely and accurate diagnosis of many diseases. STATEMENT OF SIGNIFICANCE: Recently, minimally invasive technologies have gained much attention in tissue engineering and disease diagnosis. In this study, we engineered a swallowable and retrievable electrospun nanofiber capsule serving as collection device to collect specimens from internal organs in a minimally invasive manner. The sample collection device could be an alternative endoscopy to collect the samples from internal organs like jejunum, stomach, esophagus, and oropharynx without any sedation. The newly engineered nanofiber capsule could be used to collect, bacteria, virus, fluids, and cells from the abovementioned internal organs. In addition, the biocompatible and biodegradable nanofiber capsule on a string could exhibit a great sample collection capacity for the primary screening of Barret Esophagus, acid reflux, SARS-COVID-19, Helicobacter pylori, and gastric cancer.

The 2021 SIM IT Issues and Trends Study

IT spending levels are returning from the Covid-induced highs of 2020. This is consistent with many other findings in 2021, including the percentage of organizations increasing both IT headcount and salaries. The top five IT management issues for organizations in 2021 were Cybersecurity, Alignment, Analytics, Digital Transformation and Compliance;the top five largest IT investments were Cloud, Analytics, Cybersecurity, Application Development and ERP;while the five hardest to find IT technical skills were Cybersecurity, Analytics, AI, Functional Knowledge and Cloud. The most common criteria for assessing CIO performance were User Satisfaction (Internal), Value of IT to the Business, Strategic Contribution of IT, IT Availability and Cybersecurity. The average tenure of CIOs is six years (median four) with almost 47% reporting to their CEO. A ten-year low of 22.6% report to their CFO. CIOs continue to come from outside organizations at record levels (again over 80%) and 24.1% came from prior non-IT positions, down significantly from the 2019 high of 31.1%.(1)

Dental Service and Resource Needs during COVID-19 among Underserved Populations.

INTRODUCTION: In response to the coronavirus disease 2019 (COVID-19) outbreak, dental services in British Columbia, Canada, were restricted to urgent and emergency cases between March 16 and May 18, 2020. It is unclear how the curtailment of oral health services has affected underserved populations who already often have limited access to dental care due to cost, fear, stigma, and discrimination. OBJECTIVES: To explore the experiences of underserved populations and their community organizations when accessing oral health services and information in British Columbia and identify their coping mechanisms employed during the curtailment of oral health care services. METHODS: Semistructured, remote interviews were conducted with 13 staff and 18 members from 6 community-based organizations. These organizations serve men and women with a history of incarceration and/or experiencing poverty and homelessness, persons living with human immunodeficiency virus/AIDS, adults living with mental illness, and older adults in long-term care facilities. The interviews were audio-recorded, transcribed verbatim, and coded for emerging themes using NVivo 12 software. Thematic analysis was performed. RESULTS: The pandemic raised concerns and hesitancy among underserved populations and further reduced access to care. In turn, those with unmet dental needs resorted to coping mechanisms, including turning to community support or medical services, self-management of dental issues, and not dealing with dental issues altogether. Community organizers and members outlined needed resources such as assistance navigating the dental care system, having a contact for dental-related questions, and member preparation for dental service changes, while emphasizing the importance of positive relationships with dental providers. CONCLUSION: Underserved populations who already face barriers to oral health care services experienced increased difficulty in addressing their oral health needs and concerns during the beginning of the COVID-19 pandemic. Strategies aimed at reaching out to this population and those who support them are needed to help mitigate negative coping strategies and increased oral health disparities. KNOWLEDGE TRANSFER STATEMENT: This study depicts ways of addressing unmet oral health-related issues during the COVID-19 pandemic for underserved populations and their community organizations with policy implications as well as practical strategies.

How do patient attendees rate virtual group education: Our initial findings?

Aim: To understand how patients find the experience of attending virtual group education during the covid-19 pandemic. Method: Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) programmes for people with or at risk of type 2 diabetes were adapted for virtual delivery in late May 2020, so UK and Ireland DESMOND providers could implement virtual groups during covid-19. 14 DESMOND providers distributed online surveys at the end of each group;either via chat functions or follow-up emails. A range of questions were included rating how participants had found the experience before and during attendance. The responses were all entered anonymously and automatically analysed by the online survey software. Results: To date 147 responses have been received with an average overall experience rating of 4.7 out of five was given. 97% reported finding it easy to log into their virtual group. 92% were happy to attend virtually rather than waiting to attend in-person. 93% felt able to express how they were feeling about their type 2 diabetes. 93% were able to keep up with the information provided. 90% reported feeling part of a group. 94% reported making a plan to make a lifestyle change with 68% focusing on weight loss/maintenance and 19% on HbA1c. 97% would recommend attending. Conclusion: Although implementation is in early stages these initial findings suggest those who attend a virtual DESMOND group find the overall experience positive. It is envisaged that virtual means of group delivery will now become part of diabetes education provision permanently.

Virtually delivering a diabetes prevention programme (Healthier You) increases accessibility and equity

Aim: Healthier You (HY) is an NHS England commissioned diabetes prevention programme meeting criteria for structured education programmes (SEPs). It is evidence-based, informed by theory, underpinned with a philosophy and usually delivered as sixteen 90 minute face-to- face group sessions for participants at risk of type 2 diabetes. We decided to adapt HY for virtual delivery to enable this SEP to continue during covid-19. We aimed to examine the uptake and impact of this new delivery mode. Method: A multidisciplinary group of stakeholders reviewed and modified the programme to support virtual delivery, while retaining credibility as SEP. HY facilitators were trained in the new mode of delivery. Delivery of virtual HY began April 2020. Data was collated over 2 time periods;face-to- face delivery (2019) and virtual delivery (1/4/2020-1/ 12/2020) and compared for acceptability and accessibility. Results: Uptake to face-to- face HY was 66%, increasing to 69.5% for virtual delivery during covid-19. An increase in attendance of people <35 years of age (12% vs. 5%), from non-White groups (30% vs. 23%) and from the most deprived quintile of deprivation (28% vs. 17%) was seen for virtual HY compared to face-to- face. Average weight loss improved with virtual delivery compared to face-to- face (3.6 kg vs. 2.4 kg). Conclusions: Since covid-19, there has been increased uptake to virtual HY by those who are younger, employed, from BAME background and/or socially deprived areas. Fewer older, retired people attended. Post-covid- 19, a hybrid approach to HY delivery may support accessibility and equity while improving weight loss.

Building educator confidence, through training workshops, to deliver structured self-management education for type 2 diabetes and pre-diabetes virtually during the covid-19 pandemic

Objective: To provide training and support to build confidence of educators delivering an adapted portfolio of diabetes education and self-management for ongoing and newly diagnosed (DESMOND) structured education programmes (i.e. newly diagnosed and foundation programme, let's prevent diabetes, and walking away from diabetes) during the covid-19 pandemic. Methods: The DESMOND curriculums and resources were adapted from face to face delivery to support virtual delivery, but remain congruent to the theoretical and philosophical underpinning of the interventions and content. A virtual DESMOND academy was established offering a portfolio of 2 hour workshops (delivered through MS TEAMS) to support existing DESMOND educators with confidence to set up and deliver bespoke DESMOND programmes. Workshops included a demonstration of visual resources available to support virtual delivery and discussions about how to use behaviour change techniques based on the DESMOND philosophy and learning theories virtually. Attendees provided feedback via an online survey. Results: To date (18.01.2021) 47 workshops have been delivered to 329 attendees. Post-training surveys show: 95% of attendees rated the workshop as useful/very useful and 84% felt more confident to deliver virtually afterwards. Aspects of training reported as most useful were;an overview of the visual aids, facilitation skills for virtual delivery and sharing good practice. The main concern was the use of, and access to, reliable technology by educators and participants. Conclusions: Workshops designed to build confidence of educators to deliver self-management education virtually are effective in increasing educator confidence. Technology skills and access are concerns that need to be further addressed.

Ultra-absorptive Nanofiber Swabs for Improved Collection and Test Sensitivity of SARS-CoV-2 and other Biological Specimens.

Following the COVID-19 outbreak, swabs for biological specimen collection were thrust to the forefront of healthcare materials. Swab sample collection and recovery are vital for reducing false negative diagnostic tests, early detection of pathogens, and harvesting DNA from limited biological samples. In this study, we report a new class of nanofiber swabs tipped with hierarchical 3D nanofiber objects produced by expanding electrospun membranes with a solids-of-revolution-inspired gas foaming technique. Nanofiber swabs significantly improve absorption and release of proteins, cells, bacteria, DNA, and viruses from solutions and surfaces. Implementation of nanofiber swabs in SARS-CoV-2 detection reduces the false negative rates at two viral concentrations and identifies SARS-CoV-2 at a 10× lower viral concentration compared to flocked and cotton swabs. The nanofiber swabs show great promise in improving test sensitivity, potentially leading to timely and accurate diagnosis of many diseases.

AKI in hospitalized patients with COVID-19: A Mexican population

Background: Although severe acute respiratory syndrome coronavirus (SARSCoV- 2) infection is primarily a respiratory disease, other organs are also affected. Several pathological studies confirm that SARS-CoV-2 invades kidney tissue causing endothelial damage, glomerular and vascular changes, extensive acute tubular injury and podocyte viral infection. AKI in COVID-19 appears to be frequent, with an AKI incidence of up to 46%, and a 20% requirement for renal replacement therapy (RRT). Patients with AKI show a trend towards worse outcomes and increased mortality. Information on Latin- American population is scarce. Methods: We created a cohort to describe the incidence, risk factors, and outcomes associated with AKI in hospitalized patients with COVID-19 in Mexico City, excluding patients with a known chronic kidney disease. AKI was defined and classified according to KDIGO guidelines. Results: We included 127 patients. 11 patients (8.66%) met the criteria for severe COVID-19, and were more likely to have AKI (81.82% vs. 54.31%, p=0.078). Of the 72 (56.69%) patients that had AKI, 48% were diagnosed at the time of admission. Patients with AKI were more likely to be men (61.7% vs. 42.42%, p=0.043) and older (55.68 years vs. 48.89 years, 0.018). With regards disease severity, 72% of them had a grade 1 AKI. 7 patients (9.72%) had grade 3 AKI, 4 of which needed renal replacement therapy. Overall length of stay was longer in patients with AKI (12 days vs. 7 days, p=0.003). A nonsignificant trend towards stay in critical care units was observed. 3 out of 127 patients died, all 3 had AKI. Conclusions: Amongst our studied population, AKI was associated with a longer length of stay and with a trend towards a more use of critical care services. The lack of association of AKI with mortality could be due to the low overall in-hospital mortality of COVID-19 patients (2.40%).