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Numerous studies have shown the positive association between nature engagement and well-being. During the early phases of the SARS-CoV-2 pandemic, nature engagement changed dramatically as mental health and well-being declined across the globe. This study examines how psychological connection to nature and engagement with nature in various forms is associated with well-being during the SARS-CoV-2 pandemic. Specifically, we examine which types of nature engagement (i.e. with nearby nature, through nature excursions and media-based) are more strongly associated with well-being based on measures of loneliness, rumination, pandemic emotional impact and mental health. We employed a cross-sectional online survey of adults (N = 3282) residing in the United States, 25% of whom report seldom spending time in nature. Our findings revealed that the psychological construct of connection to nature was associated with less loneliness and greater mental health. Overall, nature engagement was a consistent predictor of well-being, but different types of activities predicted varying outcomes on our four dependent variables. Greater engagement with nearby nature during the pandemic was associated with less rumination, less pandemic emotional impact and better mental health while nature excursions (e.g. camping, backpacking) and media-based nature engagement were associated with greater loneliness, more emotional impact from the pandemic and worse mental health. In addition, nature engagement via media was associated with greater rumination. Our findings suggest that promoting opportunities to increase engagement with and access to nearby nature is associated with better human well-being, especially during challenging events, and should be part of a multi-pronged approach for coping with the next public health crisis. Read the free Plain Language Summary for this article on the Journal blog. © 2023 The Authors. People and Nature published by John Wiley & Sons Ltd on behalf of British Ecological Society.
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The young adult population in the United States has faced a substance use disorder (SUD) epidemic with significant increases recently due to the stressors of the COVID-19 pandemic. Relapse has been prevalent within this population due to ineffectiveness of traditional intervention strategies, and thus, non-traditional treatment options have been a growing trend for SUD treatment in young adults. In particular, equine assisted psychotherapy and learning (EAPL) has been documented as a successful complementary treatment strategy for mental health conditions in young adults but research concerning the use of EAPL in residential treatment programs for SUD is lacking. Therefore, the objective of this study was to assess the efficacy of EAPL in a residential treatment program for developing an emotionally safe environment for learning for college-age young adults with SUD. Participants were college-age young adults (ages 18–25 years) that were in a substance abuse residential treatment program with an EAPL onsite program. Participants (n = 61) received weekly equine therapy sessions during their stay at a residential facility and were assessed at the beginning and end of their treatment program using the following 3 assessment methods: a self-reporting emotional safety survey, an equine knowledge exam, and an instructor-based equine physical skill evaluation. t-tests were performed comparing the scores for the assessments at the beginning and end of the treatment program. Total scores for emotional safety (t (58) = 2.36, P = 0.02), equine knowledge (t (58) = −2.53, P = 0.01), and physical skills (t (63) = −8.91, P = 0.00) showed a significant improvement by the end of the program. These results suggest EAPL can be an effectual complementary form of SUD therapy for developing an emotional safety environment for learning in a college-age young adult residential addiction treatment program. These young adults not only felt emotionally safe, but were able to develop their knowledge and skills in equine while going through SUD treatment. EAPL may offer an avenue for creating an emotionally safe environment for learning for other mental health conditions for young adults within a residential treatment program.
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Background: The Coronavirus disease 2019 pandemic led to unprecedented changes to medical education as educators adapted to a world necessitating precautions and social distancing. In response to the pandemic, the Emergency Medicine Residents' Association (EMRA) committees' educational programming in association with the American College of Emergency Physicians 2020 Scientific Assembly (ACEP20), initially scheduled to be held in Dallas, TX, between October 26-29, 2020, transitioned to a fully virtual conference. Escape rooms have become popular recreational activities over the last several years. In-person escape rooms are structured around working in teams to solve a series of puzzles in a fictional scenario that allows participants to "escape" the room upon completion. The teamwork and problem-solving skills utilized in escape rooms lend themselves to use in medical education. The traditional in-person escape room format has previously been applied to toxicology for the purposes of providing engaging toxicology education to emergency medicine (EM) residents. Method(s): The researchers developed and led the first nationwide virtual toxicology escape room during ACEP20 using the Zoom platform. The activities consisted of one web-portal linking to a sequence of four Google Forms multiple-choice question quizzes and four games made on Wordwall.net, a virtual educational activity creator. Six teams of 5 residents and medical students from residency programs across the country registered and participated for a total of 30 participants. Teams were split into Zoom breakout rooms, each moderated by at least one medical toxicologist and/or medical toxicology fellow. A survey was sent to participants to assess their overall experience with the activity. Result(s): Every team completed all eight activities within 45 min. This activity demonstrates the feasibility of a large-scale, realtime competitive virtual escape room to engage participants and deliver toxicology education. The lessons learned from exploring virtual sessions like this one will be valuable tools in the future of medical education. Ten participants completed the survey. 80% of respondents reported that the event increased their interest in toxicology. 90% agreed that the format was easy to navigate, instructions were clear, questions were understandable, and toxicologists were well utilized in the event. Conclusion(s): Toxicology-themed escape rooms have potential as virtual activities to educate EM residents on essential toxicology knowledge. While the small survey response rate limits the generalizability of this data, these initial results are promising and suggest that virtual escape rooms may be a viable option for increasing interest in toxicology among resident physicians.
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Telemedicine refers to providing healthcare from one site to another remote site, through information technologies, and has been advocated by the World Health Organisation. Telemedicine has been found to be cost-effective, reducing travel and improving satisfaction as compared to face-to-face appointments. Methods. We assessed patient satisfaction with a new Telemedicine in Addictions service as part of a feasibility randomised controlled trial of telemedicine versus face-to-face consultations (ISRCTN36756455), with addiction specialist prescribers, pre-COVID19. Opioid dependent patients prescribed opioid replacement treatment attending an outreach clinic were recruited. Telemedicine participants completed the NHS Friends and Family Test (FFT) after each consultation. We completed qualitative analysis of the free text responses. Results. Thirty Friends and Family Tests were completed, of which all participants were ‘extremely likely’ (n=19;67%) or ‘likely’ (n=11;37%) to recommend Telemedicine. Qualitative analysis themes for recommending telemedicine were ‘convenience’, ‘less travel’, ‘supportive staff’ and ‘listened to’. Patients said that everything went well, including communication. Conclusions. Our study found that patients recommend telemedicine because of convenience, less travel, good communication and supportive staff, showing this is acceptable to patients. Due to the COVID-19 pandemic, this technology will be essential for continued access to addiction services.
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Background: First-line conventional chemoimmunotherapy in MCL can be improved. Promising results have been seen with Bruton tyrosine kinase inhibitors (BTKis) in combination with venetoclax (V) and an anti-CD20 monoclonal antibody in patients (pts) with relapsed/refractory or TN MCL. Acalabrutinib (A) is a next-generation, highly selective, covalent BTKi currently approved for relapsed/refractory MCL. We report initial safety and efficacy results of the ongoing, multicenter, open-label phase 1b study of A, V, and rituximab (R) (AVR) in TN MCL. Methods: TN MCL pts aged ≥18 y with ECOG PS ≤2 were eligible. Starting on cycle 1 day 1, A was administered at 100 mg BID until disease progression or discontinuation for other reasons. R was administered at 375 mg/m 2 on day 1 of each 28-day cycle for 6 cycles, followed by maintenance every other cycle for pts achieving complete response (CR) or partial response (PR), through cycle 24. Starting on cycle 2 day 1, V was administered via an initial 5-wk ramp-up schedule (20, 50, 100, 200, and 400 mg/d) to 400 mg/d, through cycle 25. Dose-limiting toxicity (DLT) was assessed from cycle 2 day 1 to cycle 3 day 28. Primary endpoint was AVR safety. Secondary endpoints were overall response rate (ORR), duration of response (DOR), and progression-free survival (PFS) per Lugano criteria. Positron-emission tomography (PET)/computed tomography (CT) scans were performed after 3 and 6 cycles and to confirm CR at any time. CT scans were performed after 3, 6, 9, and 12 cycles, and then every 6 cycles. Longitudinal minimal residual disease (MRD) was assessed using the clonoSEQ assay in peripheral blood at PR, CR, every 6 cycles post-CR, and treatment end. Results: 21 pts were enrolled (median age 66 y [range 51-85];ECOG PS ≤1 20 [95%];Ann Arbor stage IV disease 19 [90%];bulky disease >5 cm 7 [33%];intermediate- and high-risk simplified MCL International Prognostic Index scores 11 [52%] and 4 [19%], respectively;blastoid variant 1 [5%];and Ki-67 proliferation index ≥50% 3 [14%]). Fifteen (71%) pts had bone marrow (BM) involvement at baseline. As of March 19, 2021, median time on study was 16 mo (range 8-26.2). Median (range) number of cycles administered was 15 (7-27) for A, 13.5 (5-23) for 400 mg daily V, and 12 (6-15) for R. Seventeen (81%) pts remain on study treatment and 4 (19%) have discontinued (progressive disease: n=1;COVID-19 infection: n=3). No DLTs were observed;V 400 mg daily after ramp-up was the dose chosen for triple therapy. Most common any-grade AEs in ≥20% of pts were diarrhea (13 [62%]), headache (11 [52%]), fatigue (10 [48%]), neutropenia (6 [29%]), paresthesia (6 [29%]), cough (6 [29%]), dyspnea (6 [29%]), myalgia (5 [24%]), dizziness (5 [24%]), and hypoesthesia (5 [24%]). Grade 3/4 AEs in ≥2 pts were neutropenia (5 [24%]) and pneumonia (2 [10%]). Serious any-grade AEs in ≥2 pts were COVID-19 infection (4 [19%]) and pneumonia (2 [10%]). In the 4 pts with COVID-19 infection, the events led to triple-drug discontinuation and death in 3 pts and to dose holds of A and V and event resolution in 1 pt (all considered unrelated to study treatment). Diarrhea led to V dose reduction in 1 pt. AEs led to dose holds in 12 (57%) pts and were associated with A, V, and R in 52%, 48%, and 14%, respectively. Events of clinical interest are shown in Table 1. At the end of cycle 6, ORR was 100%, with CR/PR in 90%/10% by PET/CT alone (11 of the 13 CRs by PET/CT lacked BM confirmation);the CR/PR rate by Lugano criteria with BM confirmation was 38%/62% (Table 2). Median DOR was 19 mo (95% CI 17-not estimable [NE]) overall, and not reached when the 3 pts with COVID-19 deaths were censored. Median PFS and OS were not reached. The 1-y PFS and OS rates were 89% (95% CI 62-97) and 95% (95% CI 71-99), respectively. Treating the 3 COVID-19 deaths as censored, the 1-y PFS rate was 93.8% (95% CI 63.2-99.1). Median time to initial response and best response was 2.8 mo. Twelve of 16 (75%) pts with available MRD results at cycle 6 achieved MRD negativity (10 -6), including 6 pts with
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Background Due to the COVID-19 pandemic, sexual health clinics across Australia have switched from clinician-collected to self-collected swabs for oropharyngeal STI screening. The study aimed to determine the acceptability of self-collected throat swabs among 200 gay, bisexual and other men who have sex with men (GBMSM) attending a sexual health service. Methods GBMSM aged ≥16 years old, had a throat swab taken at the Melbourne Sexual Health Centre (MSHC), and provided consent to participate in research, were invited to take this online survey by SMS. The survey collected data on how easy or difficult men found collecting their own throat swab. Results 273 GBMSM completed the survey;218 (79.9%) selfcollected their throat swab and were included in the final analysis. Most participants found collecting their own throat swabs very easy, easy, or were neutral (190;87.2%;95% confidence interval [95%CI]: 82.0% to 91.3%) and 28 (12.8%;95%CI: 8.7% to 18.0%) found it difficult or very difficult. There were 85 (39.0%) who reported taking the swab by themselves was worse than previous experiences of cliniciancollected swabs, compared to 110 (50.5%) who reported it was better taking the swab by themselves or found no difference to previous clinician-collected swabs. The two most commonly reported experiences during self-collection were gagging (155;71.1%) and being worried they had not done it correctly (46 out of 95 who were asked this;48.4%). Almost half of participants preferred to have a clinician take their throat swab (103;47.5%;95%CI: 40.5% to 54.1%);66 (30.4%;CI: 24.3% to 36.8%) did not have a preference and 48 (22.1%;95%CI: 16.7% to 28.1%) preferred to take the swab themselves. Conclusion Most GBMSM did not find self-collecting throat swabs difficult, however almost half of participants preferred to have a clinician take the swab..
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BackgroundWe aimed to examine the changes public sexual health services across Australia made during the national lockdown (March-May 2020) due to the COVID-19 pandemic.MethodsFrom July-August 2020, we emailed a link to an online survey to 21 sexual health clinic directors/managers who were part of the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmissible Infections and Blood-borne Viruses (ACCESS) network.ResultsAll 20 participating clinics remained open but reported changes during the lockdown, including suspension of walk-in services in 8 clinics.Some clinics stopped offering asymptomatic screening for heterosexuals (n=11), men who have sex with men (MSM) (n=3), or transgender persons (n=2). Most clinics offered a mix of telehealth and face-to-face consultations for asymptomatic MSM (n=11), asymptomatic transgender persons (n=12), post-exposure prophylaxis (PEP) prescription (n=13) or to initiate pre-exposure prophylaxis (PrEP) (n=14). People who were symptomatic for STIs and contacts of STIs were offered face-to-face and telehealth consultations across all clinics. Seven clinics suspended STI test-of-cure consultations and four clinics suspended hepatitis vaccinations for people not living with HIV. Nineteen clinics reported delays in testing and 13 reported limitations in testing during lockdown. Most clinics changed to phone consultations for HIV medication refill (n=15) with faxed (n=14) or mailed (n=13) prescriptions. Fourteen clinics had staff redeployed to assist the COVID-19 response;14 clinics reported a reduction in total number of full-time equivalent (FTE) clinical nurses from 74.4 to 45.6 FTE collectively and three clinics reported reduction in FTE clinical doctors, from 20.1 to 17.1 FTE collectively.ConclusionAustralian public sexual health clinics rapidly pivoted service delivery to reduce the risk of COVID-19 transmission in their clinical settings, managed staffing reductions and delays in molecular testing, released staff to support the COVID-19 response, and maintained a focus on urgent and symptomatic STI presentations and those at higher risk of HIV/STI acquisition.
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Digital transformation is reshaping many elements of society across the world. As new technologies arrive, they fundamentally alter how people exchange information and organize activity. Yet despite this upheaval, education is still suffering from a global learning crisis. Digital technologies have the potential to power learning in an age of disruption: improving learning outcomes, and making systems work better for students, teachers, and decision makers. In this chapter we discuss how this is only possible if systems are designed around data. Mass investment in digital hardware for hardware’s sake has been shown time and again to be blunt and ineffective, yielding few gains. Simply having computers or phones is not enough to create a learning society. Instead, education leaders need to think about what data exists, how to collect, standardize, and put data to use. This can allow better resource allocation, personalized support for students, more rapid curriculum reviews, and more, leading to a learning society for all. © The Author(s) 2021.
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The Covid-19 pandemic has ushered in a period of educational disruption on an unprecedented scale. During this time of crisis, education will not be business as usual, and EdTech alone cannot close the learning gap. It will be dedicated teachers and resilient educators who will ensure learning doesn't stop - but they could be helped by the right EdTech tools. However, the digital divide means that internet and mobile network access varies greatly in middle and low-income countries. In this discussion paper, we explore some of the key constraints of using EdTech at scale to support education in low-income countries at a time of crisis, and highlight the opportunities that have so far emerged, in a rapidly-changing context. We draw upon evidence and examples to inform policy and programming decisions, moving from the initial emergency response to building resilience in the longer term, and planning to diagnose and treat the learning gaps that have emerged during the crisis.
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INTRODUCTION: The COVID-19 pandemic resulted in a global mechanical ventilator shortage for treatment of severe acute respiratory failure. Development of novel breathing devices have been proposed as a low cost, rapid solution when full-featured ventilators are unavailable. We report the design, bench testing, and preclinical animal data for an 'Automated Bag Breathing Unit' (ABBU). METHODS: ABBU design uses a motor-driven wheel assembly for bag compression, calibrated for tidal volume (Vt), respiratory rate, inspiratory time, manual PEEP, and pressure-sensing assist with a modified 6' patient circuit. Berkshire pigs (n=5, weight 60.5±21.5 kg) were ventilated for 6 hours. PaCO2 and PaO2 in arterial blood were measured with varying Vt (200, 400, 600, 800 mL), rate (10, 20, 30, 40 bpm), and PEEP (5, 10, 15) in a healthy and injured swine model with synchronous and asynchronous ABBU operation. RESULTS: Bench testing with a Michigan dual-lung simulator yielded consistent Vt delivery at compliances of 0.02, 0.04 and 0.07 (L/cmH20). Dependence of the fraction of inspired oxygen (FiO2) with minute ventilation (VE) for a fixed inlet O2 flow rate (5 L/min) in ABBU was measured (47% - 98% FiO2 for 16-4 L/min VE respectively). FiO2 improved with higher O2 flows up to 15 L/min. Gas exchange was evaluated in a porcine model before and after saline lavage induced lung injury. When increasing Vt or rate, ABBU lowered PaCO2 to physiological levels (≤40 mmHg) from induced-hypercapnia, before and after saline lung injury. Changes from high to low PaCO2 positively correlated with changes in VE. Incremental PEEP trials improved PaO2 levels. Patient assist was studied while the animal was under light anesthesia. Of 1650 breaths, there were 1190 true positives, 416 true negatives, 44 false negatives, and no false positives. ABBU was able to maintain appropriate O2 and CO2 blood concentrations during spontaneous synchronous breathing. CONCLUSIONS: ABBU provides both oxygenation and ventilation across a range of respiratory parameter settings that support a lung protective ventilation strategy in most adults. A human clinical trial is required to establish safety and efficacy for patients with diverse etiologies of respiratory failure.
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Healthcare workers (HCWs) need to wear personal protective equipment (PPE) during the COVID-19 pandemic. Studies from China report high rates of irritant dermatitis in frontline HCWs (Pei S, Xue Y, Zhao S et al. Occupational skin conditions on the front line: a survey among 484 Chinese healthcare professionals caring for Covid-19 patients. J Eur Acad Dermatol Venereol 2020;Epub ahead of print). The British Society of Cutaneous Allergy conducted an audit of occupational dermatoses in HCWs. Eleven centres in the U.K. and Ireland organized occupational skin disease clinics to treat PPE-related dermatoses. A standardized proforma was completed, which included information about site, dermatological history, occupation, working environment, shift pattern, sick leave, PPE and handwashing practices. Diagnosis and treatment were advised during a virtual consultation. Each participating unit entered anonymized audit data into a spreadsheet. Data from 200 HCWs were collected in May and June 2020. Forty-three per cent (n = 86) worked in England;30.5% (n = 61) in Scotland, 13.5% (n = 27) in Ireland and 13.0% (n = 26) in Wales. Median age was 36 years. Ninety per cent (n = 180) were female;67.0% (n = 134) had nursing roles. The face was affected in 46.5% (n = 93) and hands in 46.0% (n = 92). In 94.0% of cases (n = 188) the clinical findings were felt to be occupational or partially occupational, with the most common diagnosis being irritant contact dermatitis: 59.0% of patients (n = 118). Seventeen per cent (n = 35) had required time off work (292.5 days in total;range 0.5-28). The mean number of hours of PPE wear per shift was 6.9 [median 7.5, interquartile range (IQR) 4-10]. Those who wore PPE for longer periods had more time off;each hour of wearing PPE during a shift increased the time off by 0.2 days [95% confidence interval (CI) 0.002-0.344;P = 0.048]. The mean number of handwashes with soap per day was 22.7 (median 20, IQR 10-30). Each handwash increased the expected number of days off by 0.03 (95% CI -0.013 to 0.069;P = 0.174). The mean number of uses of alcohol gel per day was 19.2 (median 10, IQR 5-30). There was an inverse association with use of alcohol gel and time off;each use of alcohol gel per day reduced the expected number of days off by 0.03 (95% CI 0.002-0.066;P = 0.04). These data indicate that the duration of wearing PPE, frequency of handwashing and use of alcohol gel have a significant effect on the time off work for HCWs.
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Background: Acute kidney injury (AKI) is a significant complication of COVID-19 infection. UK NICE guidelines have been developed. Aim: to examine our local patientlevel COVID-19 Hospitalisation in England Surveillance System (CHESS) database to elucidate potential risk factors for AKI vs guidelines. Methods: 564 COVID positive admissions between 7 March-24 May 2020 at University Hospital Southampton were examined using Python (Anacondas distribution) and SPSSTM. AKI was staged by RIFLE and AKIN criteria consistent with NICE guidance. X2, t-test, Mann-Whitney U test and logistic regression were used to analyse the data. Results: AKI was present in 177 patients (31%). At peak, 108 (61%) stage 1;42 (24%) stage 2;27 (15%) stage 3. There were no significant differences in cohorts with respect to white vs non-white ethnicity, gender, obesity or anti-COVID-19 treatment. 44% of patients with AKI died vs 19% in the non-AKI group (p<0.001). AKI was associated with ICU admission (27% vs 10% p<0.001), requirement of non-invasive (13% vs 4%) and invasive ventilation (14% vs 4%) (both p<0.001). Prior diabetes (18% vs 8%), hypertension (47% vs 34%), chronic respiratory and cardiac disease (both 25% vs 15%) were more common in the AKI group (p<0.004). Increased age was associated with AKI (p=0.02) and length of stay (LOS) positively correlated to AKI stage(p<0.001). Peak levels of biomarkers: ferritin, D-dimer, C-reactive protein, high sensitivity troponin-I, neutrophil count and total white cell count, were all significantly raised (p<0.001) in the AKI group, increasing with stage of AKI (p<0.001). However, in multivariable analysis first clinical observations, neutrophil count, haemoglobin, D-Dimer and albumin came out as the most significant predictors of AKI: Specificity 88.7%, Sensitivity 43.6%. Conclusions: AKI is a frequent complication of COVID-19 and we identified similar risk factors to those in the NICE guidelines. In addition, we found hypertension and chronic respiratory disease to increase risk of AKI whilst ethnicity, gender, obesity and COVID-19 treatments did not. Furthermore, AKI was associated with increased mortality, ICU admissions and LOS, concordant with previous studies. This data also points to several biomarkers as possible predictors of AKI development and severity. Further analysis of this data is ongoing.