Development of an Open Source, Low-Cost Imaging System for Continuous Lung Monitoring

A lost-cost open-source electrical impedance tomography (EIT) device was equipped with a novel lidar based workflow to extract torso and electrode position which was then used in the EIT image reconstruction. EIT data was gathered from 9 healthy volunteers (5 male, 4 female) whilst undergoing a controlled breathing protocol. Four different reconstruction configurations were undertaken: a subject specific lidar based mesh versus a generic oval mesh, and subject specific lidar based electrode placements versus generic equal spaced electrode placements. Our results showed that torso shape error and electrode position errors can be drastically reduced with the lidar-based method allowing for the future utilization of patient-specific information. Good correlation was observed between volume delta and the EIT difference image. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Statistics in times of increasing uncertainty

The statistical community mobilised vigorously from the start of the 2020 SARS-CoV-2 pandemic, following the RSS's long tradition of offering our expertise to help society tackle important issues that require evidence-based decisions. This address aims to capture the highlights of our collective engagement in the pandemic, and the difficulties faced in delivering statistical design and analysis at pace and in communicating to the wider public the many complex issues that arose. I argue that these challenges gave impetus to fruitful new directions in the merging of statistical principles with constraints of agility, responsiveness and societal responsibilities. The lessons learned from this will strengthen the long-term impact of the discipline and of the Society. The need to evaluate policies even in emergency, and to strive for statistical interoperability in future disease surveillance systems is highlighted. In my final remarks, I look towards the future landscape for statistics in the fast-moving world of data science and outline a strategy of visible and growing engagement of the RSS with the data science ecosystem, building on the central position of statistics.

"I feel really special and proud that I am bilingual”: Exploring a second-generation Korean American bilingual adolescent's emotions and sense of belonging through family language policy

Aims and objectives: The purpose of this exploratory case study is to contribute to the set of studies that center children's perspectives on their bilingual development, with a specific focus on their emotional connection within their linguistic family landscape. Methodology: This was a case study of a Korean transnational family in the United States and included both parents and their daughter. Data and analysis: Due to COVID-19 restrictions, semi-structured in-depth interviews and a language-mapping activity were conducted via ZOOM, recorded, and transcribed. DeDoose, a qualitative collaborative research tool, was used to conduct a thematic analysis. Findings and conclusion: Findings suggest that parents positioning bilingualism as a resource for communication and expression impacts a bilingual child's positive linguistic and socioemotional well-being. A strong sense of belonging was shaped through strong relationships with parents and family, engagement in diverse and inclusive spaces that valued multilingualism and multiculturalism, and by being given agency in one's own language choices. Originality: This study focuses on a Korean immigrant family and centers on the child's experiences. It provides a counter-narrative to the negative emotions parents and their children often express in extant family language policy (FLP) research. The study calls for FLP research to include a "multilingualism as a resource” orientation. Significance/implications: This case study provides the lens of multilingualism as a resource through FLP that has a different impact on the emotional dimensions of heritage language learning and maintenance. © The Author(s) 2023.

A FRAMEWORK FOR DIGITAL HEALTH EQUITY

BACKGROUND: The COVID-19 pandemic highlighted both the continued impact of long-standing systemic oppression on disparate health outcomes as well as the growing importance of healthcare provided through digital means. For example, an explosion in the use of telehealth for remote care noted significant disparities in use by minority groups. There is a growing recognition of the crucial importance of determinants in the digital environment and their impact on health outcomes. These digital determinants of health (DDoH) function independently as barriers to and facilitators of health as well as interact with social determinants of health (SDoH) to impact outcomes. A framework for digital health equity, detailing key DDoHs, is needed to support the work of developers in industry, health systems operations and academia. METHODS: The framework for digital health equity is an adaptation of the NIMHD Research Framework, which is the culmination of decades of work in the field of health disparities. The NIMHD framework is organized into several domains, including biological, behavioral, physical/built environment, sociocultural environment, and the health care system. Because of its particular importance at this time -we incorporate a digital environment domain with key DDoHs. RESULTS: Determinants at the individual level include digital literacy, readiness, interest, and self-efficacy. Readiness describes necessary technological equipment availability. Interest is used here to describe an individual's desire and willingness to use and trust in digital tools. Determinants at the interpersonal level include bias, interdependence, and relationship disruption. We use the term bias to describe the impact perceptions about an individual's digital literacy, readiness and interest have on clinician willingness to enroll and engage individuals with digital healthcare tools. Relationship disruption describes the complex cultural transformation encouraged by digital technologies. For disparity populations this has the potential to impact well documented relational determinants including medical mistrust and poor-quality communication. Determinants at the community level include cellular wireless and broadband access, quality and affordability as well as health system infrastructure. Determinants at the societal level include the impact of policy, data and design standards, algorithmic bias as well as social norms and ideologies in technical industry. Key examples of facilitators of positive health outcomes are provided at all levels. CONCLUSIONS: By adapting the leading health disparities research framework for digital health equity, we hope developers will benefit from decades of progress in the field of health disparities as well as see their work in the larger context of SDoHs so that we might work together towards meaningful progress in using digital means to achieve health equity for all.

The impact of the COVID-19 lockdown on greenhouse gases: a multi-city analysis of in situ atmospheric observations

We tested the capabilities of urban greenhouse gas (GHG) measurement networks to detect abrupt changes in emissions, such as those caused by the roughly 6-week COVID-19 lockdown in March 2020 using hourly in situ GHG mole fraction measurements from six North American cities. We compared observed changes in CO2, CO, and CH4 for different mole fraction metrics (diurnal amplitude, vertical gradients, enhancements, within-hour variances, and multi-gas enhancement ratios) during 2020 relative to previous years for three periods: pre-lockdown, lockdown, and ongoing recovery. The networks showed decreases in CO2 and CO metrics during the lockdown period in all cities for all metrics, while changes in the CH4 metrics were variable across cities and not statistically significant. Traffic decreases in 2020 were correlated with the changes in GHG metrics, whereas changes in meteorology and biology were not, implying that decreases in the CO2 and CO metrics were related to reduced emissions from traffic and demonstrating the sensitivity of these tower networks to rapid changes in urban emissions. The enhancements showed signatures of the lockdowns more consistently than the three micrometeorological methods, possibly because the urban measurements are collected at relatively high altitudes to be sensitive to whole-city emissions. This suggests that urban observatories might benefit from a mixture of measurement altitudes to improve observational network sensitivity to both city-scale and more local fluxes.

SARS-COV2 antibody phenotype and immune gene expression in MIS-C

Introduction: Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe disease that affects a small proportion of children exposed to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Differences in SARS-CoV-2 antibody responses and immune gene expression between SARS-CoV-2-infected children who develop MIS-C and those who do not may provide insight into the mechanism of MIS-C. Objectives: To determine the difference in SARS-CoV2 antibody responses and immune gene expression in children with MIS-C and healthy children with evidence of previous SARS-CoV2 infection. Methods: Healthy children presenting for elective surgery and those with MIS-C were recruited between 22 June 2020 and 5 November 2020 from a single paediatric hospital during the first wave of SARSCoV- 2 in the region. Clinical data, whole blood RNA and serum were collected. Titres of SARS-CoV-2 spike-specific antibody (SAb) and their capacity to perform neutralization, antibody-dependent cellular phagocytosis (ADCP) and antibody dependant cellular cytotoxicity (ADCC) were measured. Whole blood RNA gene expression was measured using multiplex Fluidigm quantitative Polymerase Chain Reaction (qPCR) with a panel of 84 immune genes. Principal component analysis was performed to assess for differences in gene expression. A linear regression model was developed with a forward stepwise model selection method to assess which genes associated with Creactive protein (CRP) in MIS-C after controlling for the neutrophil to lymphocyte ratio (NLR). Results: Twenty-three children with MIS-C and 25 healthy children were recruited. Nine healthy children had detectable SARS-CoV-2 serum antibodies (healthy exposed). No children had preceding clinical disease related to SARS-CoV-2 infection. Comparing children with MIS-C and healthy exposed children showed no difference in SAb binding responses (p=0.372) or ADCC (p=0.992). Increased neutralisation titre (p=0.084) and ADCP (p=0.086) in children with MIS-C was observed although was non-significant. Antibody function or titre did not change over time or with treatment in MIS-C. There was a clear distinction in immune gene expression between healthy children and those with MIS-C. Immune gene expression in MIS-C resolved to become indistinct from healthy children with time. Whole blood immune gene expression associated with an abundance of neutrophils in MIS-C. In a model that accounted for 66% of the variance in CRP (adjusted R2 = 0.66) the expression of IL27 accounted for 64% of the model effect (B=35;p<0.001) followed by NLR (15%, B=6.6, p=0.002) and the expression of MCP2 (11%, B=-14.59, p=0.008). Conclusion: Comparing children infected with SARS-COV-2 from the same time period and region with or without MIS-C provides unique mechanistic insight into the disease. A trend towards higher SAb titres and ADCP implies a distinct humoral immune response to SARSCOV- 2 in children with MIS-C, although further studies are required to validate this observation. The resolution of the abnormal immune gene expression in MIS-C implies a monophasic immune perturbation. The association of IL27 and MCP2 with CRP suggests that these may be important targets in future studies for possible pathogenicity and as potential biomarkers in MIS-C.

A case of a foreign body embedded in the sigmoid colon

Introduction: Foreign body (FB) ingestion is a common occurrence, with most expected to pass spontaneously once in the lower gastrointestinal (GI) tract, distal to the ileocecal (IC) valve with no currently established management guidelines. Case Description/Methods: A 76-year-old female had 2 days of intermittent left lower quadrant pain and diarrhea. Abdominal exam was without peritoneal signs. She tested positive for COVID 19 with mild upper respiratory symptoms. Patient had history of bowel obstruction requiring surgery more than 20 years ago. CT abdomen showed a 5 cm linear, hyperattenuating FB in the sigmoid colon, without inflammation or perforation (Figure 1A). She denied swallowing a FB. Conservative management with Miralax, docusate, and clear liquid diet for 3 days failed as her abdominal pain persisted and daily X-rays were unchanged despite daily bowel movements. Repeat CT showed unchanged location of the FB, which was now embedded in the sigmoid wall, with local inflammation. Sigmoidoscopy revealed a 4 cm linear bone fragment embedded in the sigmoid colon wall, which was retrieved with rat-tooth forceps (Figure 1B). Her pain resolved within 24 hours. Discussion: Boney fragments are common sources of accidental FB ingestion. Iatrogenic sources are also reported, such as needles lost during dental procedures. Such sharp objects have a greater association with complications, including perforation and bleeding which can be life threatening. Size, shape, or number of objects are not always predictive of ability to transit the GI tract. Approximately 80% of objects pass spontaneously and are almost always expected to pass once they have advanced beyond the IC valve. Objects found within the upper GI tract are of common concern, with existing management guidelines, however there are currently no established management guidelines for ingested FBs within the lower GI tract. In our case, the object was expected to pass without endoscopic intervention, but failed to progress over 72 hours, and was instead embedded within the sigmoid colon wall. Although signs of complications, such as perforation typically present themselves clinically, there are sometimes cases of clinically “silent perforation” with sharp objects in the GI tract, which could be missed with conservative management. This case highlights the need for clearly established guidelines for the management of ingested FBs within the lower GI tract, with interval imaging and defined threshold for endoscopic intervention of particular importance.

FROM SLOW FOOD TO SLOW MEAT: SLOWING LINE SPEEDS TO IMPROVE WORKER HEALTH AND ANIMAL WELFARE IN CANADIAN ABATTOIRS

This article examines the regulation of production line speeds in Canadian meat and poultry processing facilities to better understand their impact on worker safety and animal welfare. The article begins with an overview of the regulatory framework that sets line speed conditions in federally licenced facilities. It notes how recent shifts in food safety governance facilitate increased speeds that endanger workers and animals on the kill floor. First, it highlights tensions between regulatory objectives in the Safe Food for Canadians Regulations that focus on food safety targets and humane handling guidelines respectively. It then turns to the occupational health and safety risks associated with working at meat and poultry processing facilities. Particular emphasis is placed on the way that COVID-19 outbreaks in Canadian slaughterhouses drew attention to this grueling work that had previously been ignored. The article concludes by noting that the pandemic has created a unique policy window to slow down production speeds;a policy window that should be seized.

HPV vaccination in LMICs: A thematic analysis of attitudes and implementation strategies

Objective To identify the attitudes towards the Human papillomavirus (HPV) vaccine amongst parents/guardians, the target population, healthcare providers and school staff in low-and middle-income countries (LMICs), and identify effective strategies to implement a HPV vaccination programme. Design This paper demonstrated a systematic approach to a literature review. Literature highlights a quantitative understanding of the low uptake of the HPV vaccine within LMICs. As such, this has provided a lacuna for a qualitative assessment of the attitudes towards the HPV vaccine, and consideration of effective methods to combat barriers within HPV vaccination programmes. Method Inclusion criteria consisted of studies conducted in LMICs from 2006 onwards, with a focus on attitudes amongst the stakeholders. Six databases and sources of grey literature were systematically searched. Leading critical appraisal tools were used to screen the literature for highquality evidence. Attitudes of acceptance and hesitancy were thematically analysed using a thematic framework. The final framework consisted of three domains of attitude of hesitancy and support;(1) Contextual factors, (2) Individual group influences and (3) Vaccine/Vaccination specific factors. Citation frequencies within each domain were visually presented. Effective implementation strategies were highlighted following a systematic literature review. Results Sixty-three papers from sixteen LMICs were included in the final review. Beliefs and attitudes about health prevention, religion/cultural factors, and perceived risks/benefits were common themes across attitudes of support and hesitancy throughout the four stakeholder groups. The trust of a healthcare professional was commonly reported amongst parents/guardians and the target population. Overall, hesitant attitudes received more citations than acceptance. This finding indicates the possibility of reporting bias, as hesitant attitudes were described with more detailed. Important vaccine delivery strategies include: a school-based delivery approach, an educational focus within outreach activities, and the collaboration of officials and community leaders. Conclusions The HPV vaccine receives mixed reviews across LMICs. Themes across the stakeholders centred around knowledge, sociocultural influence and exposure. Vaccine co-ordinators in LMICs should conduct a representative assessment of stakeholder attitudes prior to vaccine rollout. Outreach and sensitisation efforts should be prioritised with a focus on increasing knowledge about the vaccine, and vaccine activities should account for contextual needs by collaborating with respected influential individuals. This review was completed in 2018, however, important parallels can be drawn with the current climate in 2021 posed by the introduction of the COVID-19 vaccine.