ABSTRACT
Introduction: During armed conflicts dialysis patients may experience limitations or interruptions of therapy leading to severe life-threatening complications due to medical and logistical challenges. Before the Russian-Ukrainian war, there were approximately 10,000 adults requiring dialysis in Ukraine. Some patients decided to flee their place of residence and look for opportunities to continue dialysis in another location in Ukraine or abroad. To better understand the needs of conflict-affected kidney failure patients and to provide data which could support equitable and evidence-based prioritization of resources, the Renal Disaster Relief Task Force of the European Renal Association conducted a survey on distribution, preparedness and management of adults requiring dialysis displaced due to the war in Ukraine. Method(s): Cross-sectional online survey was conducted to assess the status of dialysis patients who were displaced across European countries since the beginning of the conflict in February 2022. The survey was sent to all national nephrology societies across Europe with a request to disseminate it to all dialysis centers in their countries. Data were collected between May and August 2022. Fresenius Medical Care (FMC) shared a limited set of aggregated data without direct center participation. Result(s): We received data on 602 patients (290 collected through the survey and 312 from FMC), who were dialyzed in 24 countries. Most patients were dialyzed in Poland (45.0%), followed by Slovakia (18.1%), Czech Republic (7.8%), Romania (6.3%), Germany (4.7%) and Hungary (3.5%). Most patients were originally dialyzed in Kyiv (north-central), Kharkiv (northeast), Odesa (southwest) and Zaporizhzhia (southeast). Before reaching the current reporting center, 34.6% of patients were treated in at least one other center since leaving their regular unit. Mean age was 48.1+/-13.4 years, 43.5% were females. Before patients left Ukraine, 95.7% had been on hemodialysis (HD), 2.5% on continuous ambulatory peritoneal dialysis (PD) and 1.8% on automated PD. HD session frequency was reduced under war conditions in 23.5% of patients. Eighty-eight percent of HD patients had a patent arteriovenous fistula, 7.3% were HBs antigen positive, 16.1% had anti-HCV antibodies, 0.6% anti-HIV antibodies and 27.3% anti-HBc antibodies. In terms of patient preparedness for displacement, 63.9% carried medical records with them, 63.3% had a list of medications, 60.4% had medications themselves and 44.0% had a dialysis prescription. Overall, 26.1% of patients were admitted to the dialysis unit in the possession of all these factors while 16.1% presented with none. After leaving Ukraine, 33.9% of patients were hospitalized. Of the 88.5% of patients tested in the reporting center for COVID-19 1.9% was positive. Communication and language problems were reported by 43.8% of responding physicians. Conclusion(s): Up to the end of August 2022, less than 10% of Ukrainian dialysis patients decided to flee their country since the start of the Russian-Ukrainian conflict and the majority of them chose as their place for dialysis a country neighboring Ukraine. Preparedness for displacement varied and was incomplete in most patients. Results from our survey may inform evidence-based policies and interventions to prepare for and respond to special needs of vulnerable kidney failure populations during armed conflicts and other emergencies. No conflict of interestCopyright © 2023
ABSTRACT
Given the demands on instructors created by the COVID-19 pandemic, teachers have been compelled to integrate active learning pedagogies supported by mobile technologies to sustain students' interactive engagement. This study describes the implementation of a novel active pedagogy - the collaborative problem-based learning and peer assessment (Co-PBLa-PA) method, implemented through interactive online whiteboards (IOWBs) in junior secondary mathematics classes in Hong Kong. Data were collected from 87 Form 1 students and analysed to test three hypotheses postulating the main effects of the Co-PBLa-PA method on students' learning approaches using IOWBs. A pre-survey (SPQ) on students' learning approaches and a post-survey (SPQ) on students' learning approaches and their perceptions of technology-enabled active learning (TEAL) were administrated. Results showed the Co-PBLa-PA method, using IOWBs, increased students' learning performance and promoted significant deep learning. A significant positive correlation also emerged between deep learning approaches and students' perceptions of TEAL using IOWBs. Finally, limitations and directions for future research are discussed.
ABSTRACT
This paper highlights the problems faced during the pandemic, as this pandemic caused adverse ramifications and washed out many vulnerable communities. Healthcare systems and providers raised their capabilities and capacities promptly to battle challenges that were unprecedented. Yet, a lack of prompt response has led to huge global losses in all the major sectors. Hence, after analysing such vulnerabilities, how can communities resist and withstand such vulnerabilities to survive. This paper recommends the elements of resilient communities and aims to contribute six futuristic strategies from the identified pitfalls and the potential scope for mitigating the impact and accelerating the road for recovery and resilience. Acknowledging the social change, this paper also presents a product solution to protect oneself from disorders caused by the SARS Covid-19 virus. This ergonomically designed product is versatile, and its unique features make it user-friendly which will protect, revive, and recover the immunity for users of all age groups and especially the ones who are always on the go. This will imbibe a positive behavioural change for the well-being of the users paving the way for quality life. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
ABSTRACT
The current perception of a post-COVID world is highly divisive and despairing. The “death of the tall building” is touted by prognosticators as a fait accompli. The concept of the city as a microcosm of commerce, urban living, culture, and civic uses has been put into severe doubt and paranoia. Density, mass transit and assembly uses are suddenly deemed as anathema to “normal” lifestyles, and the flight to the suburbs is touted as the new mantra. This paper is an exploration of what a post-crisis vertical vision would reflect in urban America, responding to changing norms of the workplace, urban living, leisure, and transit. Its prototype is a hybrid 400-meter mass timber structure ensconced within a steel exoskeletal frame. With 90 percent of the tower comprised of mass timber, the 88-story structure would sequester carbon, reduce emissions, enhance structural performance and set new paradigms of the tall building as a modular, living-breathing machine, responding to the “new normal” of the contemporary urban condition. © 2020, Council on Tall Buildings and Urban Habitat. All rights reserved.
ABSTRACT
Background: The National Comprehensive Cancer Network (NCCN) guidelines and the manufacturers of PFG recommend administration at least 24 hours after chemotherapy (CTX). Administering SD PFG carries the potential risk for exacerbation of neutropenia based on analyses in lymphoma and breast cancer regimens;however, little data exists on infusional fluorouracil and SD PFG administration. The availability of biosimilar PFG and increased utilization of growth factors during the COVID-19 pandemic has led to changes in practice for SD PFG administration. This study explored the incidence of febrile neutropenia (FN) and myelosuppression with FOLFOX and FOLFIRI regimens in Gastrointestinal malignancies (GI) to address the safety of SD utilization of PFG. Methods: Patient data was extracted through electronic health records search of ICD-9 and ICD-10 codes for GI malignancies and treated with FOLFOX or FOLFIRI-based regimens from November 2013 to May 2021. SD administration was defined as administration of PFG within 15 minutes after fluorouracil pump disconnect. The primary endpoint of our study was to evaluate the incidence of FN across all CTX cycles for up to four cycles, in SD PFG administration. Secondary outcomes included chemotherapy induced neutropenia (CIN), hospitalizations, and CTX dose reduction or delay. Results: Three hundred and thirty-nine patient charts were reviewed with 55 patients meeting the inclusion criteria. In our study cohort, 72.7% received FOLFOX and 27.2% received FOLFIRI-based regimens. Out of all 194 CTX cycles, 136 (70.1%) cycles received pegfilgrastim and 58 cycles received pegfilgrastim-cbqv (29.9%). Two patients had grade 3/4 CIN (1%), with both cases resulting in FN (1%). Both FN cases resulted in hospitalizations, and dose delays or reductions. Investigation of FN incidences revealed that both patients received CTX with active infections, one case with a urinary tract infection and the other with a chronic gangrene infection. Conclusions: Our study results suggest that SD administration of PFG can be as a safe and effective alternative to 24-hour postchemotherapy administration in patients receiving FOLFOX or FOLFIRI-based regimens. The incidence of FN was noted to be minimal in our study. Furthermore, no noted increase in myelosuppression was seen in our analysis, as compared to previous studies in breast cancer and lymphoma-based regimens. SD administration not only minimizes travel burdens on long-distance patients but also has allowed for reduction in infusion appointments and therefore possible exposure to the SARSCOV2 virus during the 2020-2021 pandemic. Future prospective studies are warranted in order to elucidate the risk of FN and myelosuppression in patients undergoing chemotherapy for GI malignancies with SD PFG administration.