Post-Secondary Student Belonging in a Virtual Learning Environment during Covid-19

Psychological and social adjustment and academic success in post-secondary institutions are supported by a sense of belonging to a social group and having meaningful relationships with other students, staff, and faculty members. This exploratory study used a qualitative approach to investigate post-secondary students' sense of belonging in the virtual learning environment during the COVID-19 pandemic. The study was conducted at a small Western Canadian university. Semi-structured interviews were conducted with 20 participants who were undergraduate students, from various faculties, and in different years in their programs. Findings were clustered into three themes: (1) student expectations of university, (2) impact of virtual learning environments on students, and (3) the role of educators. Recommendations are included to enhance support and belonging for post-secondary students in virtual learning environments.

Post-Secondary Student Belonging in a Virtual Learning Environment During COVID-19

Psychological and social adjustment and academic success in post-secondary institutions are supported by a sense of belonging to a social group and having meaningful relationships with other students, staff, and faculty members. This exploratory study used a qualitative approach to investigate post-secondary students' sense of belonging in the virtual learning environment during the COVID-19 pandemic. The study was conducted at a small Western Canadian university. Semi-structured interviews were conducted with 20 participants who were undergraduate students, from various faculties, and in different years in their programs. Findings were clustered into three themes: (1) student expectations of university, (2) impact of virtual learning environments on students, and (3) the role of educators. Recommendations are included to enhance support and belonging for post-secondary students in virtual learning environments. © 2022, Canadian Society for Studies in Higher Education. All rights reserved.

ONCE AT THE EPICENTER OF THE PANDEMIC, ELMHURST HOSPITAL LEADING EQUITY FOR DIABETES CARE

STATEMENT OF PROBLEM/QUESTION: Improve diabetes quality and equity during the pandemic. DESCRIPTION OF PROGRAM/INTERVENTION: Elmhurst hospital center is one of 11 acute care hospitals in the NYC H+H network, the largest public health care system in the United States. Elmhurst hospital was at the epicenter of the COVID 19 pandemic in March 2020;providing care for immigrant, uninsured and underinsured patients, including more than 5000 patients with diabetes. As NYC emerged from the first surge, the primary care clinic assessed and addressed care gaps. Difficulties in accessing in-person visits, lab, and the social and economic impact on patients added to the challenges of managing diabetes during the pandemic. Disproportionately burdened were ethnic and racial minorities. An assessment of the diabetes outcome revealed that the control rate of diabetes defined as Hemoglobin A1c (A1c) less than 8% dropped by 8% compared to the pre-pandemic rate. There was a 4% difference in diabetes outcomes between the insured and uninsured patient populations.The clinic leadership implemented a collaborative care model. The collaborative care model consists of clinical pharmacists, registered nurses, a diabetes education-certified dietitian, and the population health team that provides outreach and data analytics support. Patients referred to the collaborative team by the primary care provider who assists in setting the treatment plan and goals. The collaborative care team screens every patient for barriers and social needs, provides diet education and a self-management plan. Each patient receives medication management in either the RN led treat-totarget clinic or by the clinical pharmacist. The referral criteria follow an algorithm based on the A1c level of control, number of medications, and the use of injectables. Cases are discussed weekly in collaboration with the primary care provider. The level of care is adjusted to address patient needs. The team determines the number of visits and time between visits based on the clinical progress. Visits are conducted in person and virtually;tailored to the patient's ability to use telehealth. MEASURES OF SUCCESS: Diabetes control improved by 10% in 8 months. The gap between insured and uninsured was reduced from 4% to 1% at the end of the study project period. FINDINGS TO DATE: A team-based approach using risk stratification that incorporates clinical outcomes and patient social barriers led to significant improvement in diabetes outcomes and closed the inequity gap. KEY LESSONS FOR DISSEMINATION: - High-quality diabetes care requires a multi-disciplinary team approach. - Treat-to-target RN visits improved access and equity in diabetes care. - Clinical Risk algorithms must incorporate social barriers. - Team-based approaches require continuous training and evaluation, with team members empowered for decision making.

Systemic anticancer treatment changes at the start of the COVID-19 pandemic in a large Australian metropolitan health service

Background The COVID-19 pandemic has necessitated a restructuring of cancer care due to resourcing demands and revised risk-benefit considerations which relate the risks of cancer progression with the risks of COVID-19 related morbidity and mortality. Specific treatment adjustments for individual patients have not been widely reported. The impact of treatment changes on the outcome of cancer patients have also not been well documented. We report the experience of a large Australian metropolitan multisite cancer service that undertook proactive review of systemic anti-cancer therapy (SACT) of all patients in response to the pandemic. The aim was to re-balance the risks and benefits of current treatment strategies in light of the pandemic. Method From March-April 2020, all current SACT orders (excluding those related to clinical trials) were reviewed by an independent team of clinicians. Patients on curative therapy, or with large perceived benefit were reviewed but not included in further processing. For all other SACT orders, a documented recommendation regarding planned treatment was sent to the patient's individual clinician for consideration. A categorical assessment of the recommendations is presented. Results 570 SACT orders were reviewed, pertaining to 317 patients. 731 individual recommendations were made. The cohort consisted of 130 males and 187 females, with a median age of 62 years. Treatment was undertaken with curative intent in 38% of patients, while 62% of patients were treated with palliative intent. Distribution by tumour types was typical of epidemiology and casemix of a metropolitan oncology service. The most frequent recommendations made by the independent review team were: no change (23%), change in formulation of same drug (9%), shorten duration of treatment (9%), treatment break (8%), re-evaluate benefit of current treatment (8%), treatment cessation (7%), and referral for home-based treatment (6%). Overall, 71% of recommendations of the review team were accepted by the patient's individual clinician. A variation to recommendations suggested by the review team was implemented for 8% of SACT orders. Recommendations which were not implemented were mostly initiated by the patient's individual clinician (70%), while 14% were due to patient choice. Conclusion This is the only dataset known to date of the impact of COVID-19 on adjustments of SACT for cancer patients at the start of the pandemic in Australia, and provides key insights into discrete adjustments made for cancer patients. The majority of patients underwent modifications in their cancer therapy made in the context of competing risks to their health posed by COVID-19.

Impact of the COVID-19 pandemic on a community soccer organization in the United States: the case of Asheville City Soccer Club. (Special Issue: COVID-19 and the soccer world: early impressions and initial responses.)

The impact of and response to the COVID-19 (coronavirus) pandemic varied among sports organizations around the world. At the top tier of the American soccer pyramid, Major League Soccer (MLS) played two fixtures before the league office suspended the season and announced an action plan that included teams continuing play later in the year. The National Women's Soccer League (NWSL) delayed the start of its season and later released plans to become the first professional team sports league in the United States to resume play. The pandemic impacted lower-tier soccer leagues and teams differently. Initially, leagues such as the fourth-tier men's United Soccer League Two (USL 2) and the fourth-tier Women's Premier Soccer League (WPSL) publicized plans to delay the start of the 2020 season. However, some teams in these leagues immediately withdrew from competition due to unique structural conditions. This article examines the case of one of these organizations.

Development of Virtual Reality Training System Based on EEG Biofeedback

This study integrates virtual reality (VR) and electroencephalography technology in the design of a virtual space for multi-user rehabilitation. It allows therapists to conduct remote care and provides easy-to-use functions for stroke patients during their rehabilitation process. To analyse patient rehabilitation data, Azure ML Studio, a cloud service for big data prediction and analysis was employed to evaluate and validate the model. The aim of this study is to provide appropriate rehabilitation procedures and plans through a personalised numerical analysis and improve the immediacy of the clinical evaluation of physical therapy. This study covers rehabilitation mechanisms ranging from individual home-based rehabilitation to remote multi-user virtual network rehabilitation. A brain-computer interface is integrated into the design of the VR rehabilitation function and introduces a personalised music recommendation mechanism, allowing patients to adjust their rehabilitation plans according to their physical movements and specific changes in brainwaves during the rehabilitation process. The system can be used to provide healthcare services for seniors in their communities. With the global spread of COVID-19, many medical institutions in Taiwan and other countries have established VR medical simulation centres in the post-pandemic era to provide educational training for medical staff. By investing artificial intelligence (AI) and VR technology, the remote care of smart hospitals can result in innovative processes and opportunities. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Home visit to renal dialysis patients by zoom

Background: Home visit service to dialysis patients has established in Queen Mary Hospital renal unit for long times. However, such service was suspended due to COVID-19 pandemic. Objectives: We decided to perform the home visit (HV) by zoom to evaluate patient's home performance to both peritoneal patients (PD) and home haemodialysis (HHD) patients. Methodology: 'Zoom' was chosen to perform HV and a pilot run was started in December 2020. For pre-zoom preparation, a workgroup was formed by dialysis nurses;HV checklists were modified from existing one;consent forms were revised;zoom apps were allowed to use after approved by the internet technology (IT) department;two instruction guides were prepared to nurses and patients / helpers and special cell phone / i-pad stabilizers were provided to patients. One trail run was conducted with nursing staff and two trail runs were conducted with PD patient volunteers. Results: 26 PD and 1 HHD zoom HV was done in December 2020. During zoom HV, patient's home environments;techniques;PD / HHD related knowledge were evaluated. Performance improvement advice were given to patients and caregivers before end of HV. 1 patient was found contamination of transfer set and need to return to hospital for treatment. Evaluation forms were prepared to patients and nurses. 24 patients were satisfied with the zoom HV arrangement and agreed that zoom was easy to manage. 17 patients disagreed that their performance would be affected by external factors and causing some distractions. All 6 nurses agreed that zoom HV were easy to manage and they were satisfied. 2 of them were distracted by external factors and 4 of them were neutral on this point. Conclusions: Zoom HV is a convenient way to assess patient's condition and performance at home when physical visit is restricted during COVID 19 pandemic.

Neutrophil extracellular trap formation (NETOSIS) increases with severity of disease in COVID-19 patients

Background: Neutrophils are key players in the immune and aid in the defense against microorganisms. Neutrophil extracellular traps (NETs) are extracellular DNA complexes, which are released during NETosis, a programmed form of cell death. Although NETs are crucial in the fight against infectious agents, an overabundance of neutrophils has been implicated in many inflammatory lung conditions. Our aim is to determine whether an overabundance of NETosis is associated with clinical deterioration of patients with COVID-19. Methods: Circulating polymorphonuclear cells (neutrophils) were isolated from human peripheral blood of 20 human subjects with COVID-19. Neutrophils were seeded in 96-well plates and treated with 0, 2.5 nM, 25 nM, and 250 nM of phorbol 12-myrisate 13-acetate (PMA) or 12 uM nigericin for 2 hours to stimulate NET production via canonical and noncanonical pathways, respectively. Following incubation, wells were treated with micrococcal nuclease, supernatants were collected from each well, and extracellular DNA content to quantify NETosis was detected by fluorescent plate reader. We calculated acute physiology and chronic health evaluation (APACHE-II) scores for every human subject. These were calculated at the same time point at which the neutrophils were collected. They were then compared to the degree of NETosis and absolute neutrophil count (ANC). These were analyzed using a simple linear regression model. We also categorized participants based on APACHE-II scores (APACHE-II <15, APACHE-II>15) and compared them to rates of NETosis using a bar graph. Results: APACHE II is a widely used ICU mortality prediction score that is used to risk-stratify patients. We found that participants with higher APACHE-II scores had higher rates of NETosis, both at 0 nM PMA and when stimulated with nigericin (figure 1a-b). This suggests that higher rates of NETosis correlate with increased disease severity. Additionally, we found a positive correlation between ANC and NETosis (Figure 1c-1d), suggesting that ANC itself is a reliable marker of NETosis and disease severity. Conclusion: NETosis is an important player in immune system defense but has also been implicated in various inflammatory lung conditions. We found that in patients with COVID-19, there was a positive correlation between worsening disease state, measure by APACHE II scores, and increased NETosis. This suggests that over-activation of neutrophils may play a role in disease progression. We also found a positive correlation between NETosis and ANC, indicating that the degree of circulating neutrophils is a reliable marker of the functional state of neutrophils, as well as disease severity.

Circulating neutrophils from critically ill covid-19 patients have increased netosis via canonical and non-canonical pathways

Introduction. The pathophysiology of infection with SARS-CoV-2 involves the lower airways and host-launched aggressive inflammatory responses leading to exacerbated lung damage in these vital tissues. Early clinical studies found that COVID-19 patients have higher levels of neutrophils in the circulation. Neutrophils are the most abundant leukocyte in circulation and are known to be highly proinflammatory due to production of neutrophil extracellular traps (NETosis). NETs are web-like chromatin structures coated with histones and proteases that both capture and kill invading pathogens. However, while being an effective countermeasure towards foreign microbes, this process also causes undesirable damage in host tissues. Therefore, we sought to characterize NETosis in circulating neutrophils from COVID-19 patients to determine whether this immunological response might be exacerbating or driving the disease state in COVID-19, rather than mitigating the virus. Methods.Blood was drawn daily from critically ill COVID-19 patients (n=16) after consent was obtained. Healthy controls (n=13) were screened for COVID-19 and gave blood once a week. Blood was drawn into lithium heparin tubes (BD Vacutainer). Neutrophils were isolated using PolymorphprepTM(PROGEN) per manufacturer's instructions. Cells were resuspended at 2x106 cells/ml for functional assays. Neutrophils were stimulated with increasing concentrations of PMA (Phorbol 12-myristate 13-acetate) of 2.5nM, 25nM and 250nM to stimulate NETosis via the canonical pathway, and nigericin at 15uM for the non-canonical pathway. NETosis was quantified using the Quant-iT™ PicoGreen™ dsDNA Assay Kit (Invitrogen) and by NET visualization via myeloperoxidase and nuclear staining (using Polyclonal Rabbit Anti-Human Myeloperoxidase by Dako and Hoescht stain by Invitrogen). Results.Functional NETosis assays of circulating neutrophils from COVID-19 patients demonstrate overall increased NETosis determined by increased release of dsDNA. This enhanced NETosis occurred at baseline and after stimulation with PMA when compared to healthy controls (Figure 1A, p <0.0001). Fluorescent microscopy also demonstrated increased NETosis in neutrophils from COVID-19 patients (Figure 1B;MPO-green and nucleus-blue). NETosis via the non-canonical pathway (induction with nigericin) was also increased in COVID-19 patients versus controls (p=0.02). Conclusions.Circulating neutrophils from critically ill COVID-19 patients are more prone to produce NETs than circulating neutrophils from healthy individuals. This is likely to lead to NETmediated tissue injury once neutrophils enter inflamed tissue, where they can potentially drive acute lung injury and acute respiratory distress syndrome, common causes of mortality in COVID-19. The finding of increased production of NETs by both canonical and non-canonical pathways is consistent with an overall hyper-activated state in COVID-19.

Data harmonization for COVID-19 andcancer research registries

Introduction: The need to rapidly collect, integrate, and share data on COVID-19 patients with cancer at scale hasgiven rise to multiple internal and cross-institutional research registries. These registries support use cases thatrequire data at different levels of granularity and are built using mixed standards. Ensuring semantic interoperabilityand quality of this data is critical for generating reliable and reproducible evidence. At MSK, we created a frameworkthat enabled the rapid development of semantically compatible COVID and cancer registries and data exchange. Background: Handling and harmonizing real-world data for COVID and cancer research presented with typicalchallenges: maintenance of complex patient cohorts;reconciling different levels of temporal and semanticgranularity;supporting crosswalks between different representations without information loss;and sharing itinternally and with research consortia. Solving these challenges for COVID and cancer studies necessitatedadvanced infrastructure and harmonization solutions. Methods: We used MSK Extract, our research platform, to create an integrated COVID and cancer data researchframework. It included a library of reusable standardized REDCap used in multiple RedCap instances supportingindividual research studies;PostgreSQL database containing patient cohorts and data from Electronic HealthRecords (EHR) standardized to OMOP;and ETL pipelines. Our approach to the REDCap design and datamanagement allowed for combined sets of detailed, atomic, and aggregate-level data through a combination of abstraction, curation, and extraction of data from different sources. We developed reconciliation methodologybetween initial curation, available raw data, and the subsequent abstraction. We enforced consistent temporalconstraints on data extraction and curation. We used the OMOP vocabulary for semantic harmonization, mappingmetadata from internal and external registries to OMOP concepts. We linked procedure and medication codes tohigh-level treatment groups leveraging classifications available in the OMOP vocabulary. Results: Our approach to the REDCap design supported various analytical use cases and enabled data sharingbetween different investigators and registries. Reuse of the data that was previously abstracted complemented withthe data extracted from EHR allowed investigators and their teams to quickly review, validate, and update the priorcuration. Explicit temporal constraints supported alignment between different registries. Using the OMOP standardsand high-level treatment classifications supported data conversion between various registries and integration of thedata collected via REDCap and sourced from EHR. Conclusion: Using real-world data for observational COVID and cancer research presented us with opportunities toimprove and mature our evolving research infrastructure and better support internal and distributed research, andhighlighted the need for uniform data standards in the cancer domain.