Challenges and adaptations for a cluster-randomized control trial targeting parents of pediatric cancer survivors with obesity during the COVID-19 pandemic.

Although the COVID-19 pandemic has increased the importance of digital technology in clinical trial implementation, there is a dearth of literature reporting on challenges and strategies related to multi-site randomized controlled trials (RCTs) among pediatric cancer survivors during the pandemic. This paper discusses challenges faced in the implementation of the NOURISH-T+ trial so far (December 2019-March 2022) and describes adaptations made as a result of these disruptions in the areas of recruitment, data collection, and overall engagement. This reflection is based on a multisite cluster-RCT that aims to examine whether an intervention targeting parents as agents of change to promote healthy eating and physical activity in pediatric cancer survivors, NOURISH-T+ (Nourishing Our Understanding of Role modeling to Improve Support and Health for Healthy Transitions), reduces body mass and improves health behaviors compared to Brief NOURISH-T (Enhanced Usual Care/EUC). The COVID-19 pandemic has created and exacerbated challenges for our trial related to participant recruitment and engagement, technology access and literacy, and data collection and management, as well as COVID-related challenges (e.g., Zoom fatigue). Strategies used to address these challenges might prove helpful in future virtual or hybrid RCTs, including developing trust and rapport with participants, providing support through multiple routes of dissemination, and using data management applications (e.g., REDCap™) for automation and project management. Extra efforts to build families' trust and rapport, offering multiple routes of support, and automating as many tasks as possible are critical to ensuring the continuation of high-quality clinical trials during the COVID-19 pandemic.

Challenges and strategies among research on pediatric cancer survivors during the COVID-19 pandemic have not been well described. Our intervention, NOURISH-T+ (Nourishing Our Understanding of Role modeling to Improve Support and Health for Healthy Transitions), aims to promote healthy eating and physical activity in pediatric cancer survivors. The COVID-19 pandemic has created challenges for our trial related to participant recruitment and engagement, technology, data collection, and management, and COVID-related challenges (e.g., Zoom fatigue). Strategies that have been helpful for us include developing trust and rapport with participants, providing support through multiple routes of dissemination (e.g., website, videos), and using data management applications (e.g., REDCap™) to optimize tasks.

Moderate support for the use of digital tracking to support climate-mitigation strategies.

The use of digital tracking of individuals throughout the coronavirus 2019 (COVID-19) pandemic renewed societal debates on the efficacy and ethics of digital surveillance to mitigate collective crises. While digital emissions tracking is being used to support climate-mitigation strategies, to date there has been limited exploration of the opportunities and challenges of deploying it at the individual level. Here, we assess temporal and regional differences in levels of support for the use of digital surveillance in times of crisis, such as climate change. Results from a global survey indicate moderate support for the use of digital tracking, including for personal carbon footprints. Response varied regionally, with the lowest support in North America and Europe. This study raises key questions-if digital surveillance tools could be part of a socially acceptable response to the climate crisis, is it worth exploring? Or is this an unacceptable risk for society?

Smartphone-Based Gait Cadence to Identify Older Adults with Decreased Functional Capacity.

Background: Functional capacity assessment is a critical step in the preoperative evaluation to identify patients at increased risk of cardiac complications and disability after major noncardiac surgery. Smartphones offer the potential to objectively measure functional capacity but are limited by inaccuracy in patients with poor functional capacity. Open-source methods exist to analyze accelerometer data to estimate gait cadence (steps/min), which is directly associated with activity intensity. Here, we used an updated Step Test smartphone application with an open-source method to analyze accelerometer data to estimate gait cadence and functional capacity in older adults. Methods: We performed a prospective observational cohort study within the Frailty, Activity, Body Composition and Energy Expenditure in Aging study at the University of Chicago. Participants completed the Duke Activity Status Index (DASI) and performed an in-clinic 6-min walk test (6MWT) while using the Step Test application on a study smartphone. Gait cadence was measured from the raw accelerometer data using an adaptive empirical pattern transformation method, which has been previously validated. A 6MWT distance of 370 m was used as an objective threshold to identify patients at high risk. We performed multivariable logistic regression to predict walking distance using a priori explanatory variables. Results: Sixty patients were enrolled in the study. Thirty-seven patients completed the protocol and were included in the final data analysis. The median (IQR) age of the overall cohort was 71 (69-74) years, with a body mass index of 31 (27-32). There were no differences in any clinical characteristics or functional measures between participants that were able to walk 370 m during the 6MWT and those that could not walk that distance. Median (IQR) gait cadence for the entire cohort was 110 (102-114) steps/min during the 6MWT. Median (IQR) gait cadence was higher in participants that walked more than 370 m during the 6MWT 112 (108-118) versus 106 (96-114) steps/min; p = 0.0157). The final multivariable model to identify participants that could not walk 370 m included only median gait cadence. The Youden's index cut-point was 107 steps/min with a sensitivity of 0.81 (95% CI: 0.77, 0.85) and a specificity of 0.57 (95% CI: 0.55, 0.59) and an AUCROC of 0.69 (95% CI: 0.51, 0.87). Conclusions: Our pilot study demonstrates the feasibility of using gait cadence as a measure to estimate functional capacity. Our study was limited by a smaller than expected sample size due to COVID-19, and thus, a prospective study with preoperative patients that measures outcomes is necessary to validate our findings.

Mindfulness in Adolescent and Young Adult (AYA) Patients Undergoing Hematopoietic Stem Cell Transplantation (HSCT): A Qualitative Study.

Previous adolescent and young adult (AYA) research suggests patients undergoing hematopoietic stem cell transplantation (HSCT) experience severe physiological stress. The goal of this study was to identify unmet needs, interests, and preferences for mindfulness to inform the development of a mindfulness-based stress reduction intervention. Semi-structured interviews were conducted at three time points: prior to (n = 20), immediately after (n = 13), and three months post HSCT (n = 16) in the same AYA patients. Interviews assessed stress reduction strategies used, interest in mindfulness, and current quality of life. Three major thematic categories emerged from interview data across all time points: Concerns, Coping Strategies, and Mindfulness Activities. Prior to HSCT, two additional themes emerged including: Hope for the Future and Getting the Body Moving-Physical Activity. Most participants were not familiar with the term "mindfulness" prior to HSCT; but after being provided the definition of mindfulness, participants expressed interest in an online mindfulness-based intervention (e.g., ZOOM), stating: "I think it's necessary" and "It would definitely be useful". Participants suggested an intervention immediately following HSCT may decrease isolation concerns stating: "[in the hospital] You kind of feel like a hamster in a cage" and "you obviously have a lot of time to just be sitting by yourself in a hospital room". The results suggest that a mindfulness-based online intervention is of interest to AYA HSCT patients and may be beneficial in decreasing physiological stress and improving quality of life.

Promoting resilience in healthcare workers during the COVID-19 pandemic with a brief online intervention.

INTRODUCTION: The psychological wellbeing of healthcare workers has been impacted by the high levels of stress many have experienced during the Coronavirus Disease 2019 (COVID-19) pandemic. This study aimed to examine the feasibility and acceptability of a brief online course focused on introducing evidence-based skills that could increase resilience and decreases emotional distress in healthcare workers during the pandemic. MATERIALS AND METHODS: Employees of a large healthcare system completed a mental health survey at baseline, and then one month and two months after some employees participated in an online resilience-enhancement course consisting of three 12-19 min videos focused on mindfulness, mentalization, and self-compassion. RESULTS: A total of 554 participants completed the baseline survey, endorsing moderate to high levels of emotional distress. Of those who completed all three assessments and participated in the course (n = 38), significant improvements in resilience and reductions in emotional distress were found one and two months later, in comparison to those who did not participate in the course (n = 110). DISCUSSION: These findings suggest that a brief, online intervention can improve the mental health of healthcare workers during a crisis such as the COVID-19 pandemic.

Food Insecurity and the Hispanic Population during the COVID-19 Pandemic.

Historically, food insecurity has been a problem for the Hispanic/Latino population in the United States. Variations in food insecurity exist among this population by origin, immigration status, household composition, and region. The coronavirus pandemic has exacerbated existing vulnerabilities this population faces with food insecurity including limited economic resources, reliance on programs unprepared for atypical circumstances, closure of avenues providing access to meals, and unemployment. This paper reviews key factors related to the current rate of food insecurity among the Hispanic/Latino population in the mainland United States and is an exemplar of similar variability found in Puerto Rico. Recommendations for reducing food insecurity in this population are provided. (word count:109).

A Review of Food Insecurity and Chronic Cardiovascular Disease: Implications during the COVID-19 Pandemic.

Cardiovascular disease is the leading cause of death and disability globally. Self-management of cardiovascular disease includes the consumption of nutrient-dense foods and prudent dietary patterns, such as the DASH (Dietary Approaches to Stop Hypertension) and Mediterranean Diet to decrease inflammation and stress. Over the last few decades, there has been a growing interest in food insecurity and health outcomes in the United States. While it is well established that diet plays a role in the development of cardiovascular disease, there is little known regarding the role of food insecurity and cardiovascular disease. As a result of unprecedented unemployment rates during and following the global COVID-19 pandemic, all dimensions of food insecurity have been impacted, including declines in food availability, accessibility, utilization, and stability. This paper summarizes the existing quantitative and qualitative literature exploring the social determinants of health (economics/poverty, employment, limited access to health care, and food) that affect the self-management of cardiovascular disease, including healthy nutrition, highlighting special considerations during the COVID-19 global pandemic.

Collective foresight and intelligence for sustainability

Non-technical summaryCharting robust pathways towards more sustainable futures that ‘leave no one behind’ requires that diverse communities engage in collective foresight and intelligence exercises to better understand global systemic challenges, anticipate the emerging risks and opportunities that disruptions present, and share perspectives on how to respond and inform decision-making. We report on the recent use of an international rapid foresight survey to assess expected societal trends over the next 3 years following the COVID-19 crisis. The results illustrate the power of collective foresight approaches to provide timely, nuanced insights for decision-making across sectors and scales, particularly in times of uncertainty.Technical summaryWe present the findings of a rapid foresight survey launched in spring 2020 to draw on the collective intelligence of the global community on where the world is headed post-COVID-19. Respondents were asked to (i) assess five key societal trends in the coming 3 years, (ii) provide news headlines they both expect and hope to see, and (iii) assess the role of digital technologies during crises. Analysis of over 2000 responses from more than 90 countries revealed important regional differences in expected societal trends related to sustainability. More respondents in the Global South expected shifts towards less inequality while more respondents in the Global North expected shifts towards a smaller ecological footprint. Qualitative analysis of proposed news headlines revealed four broad themes of focus (environment, equity, health, and economy), and yielded insights into perspectives on critical drivers of change. Finally, the survey report found that the vast majority of respondents were not opposed to digital surveillance in crises. In presenting these results, we explore the value of collective foresight and intelligence exercises in providing pluralistic inputs to decision-making and in complementing more prevalent methods of forecasting.Social media summaryCollective foresight exercises with diverse communities can help chart robust pathways to more sustainable futures.

Health uncertainty among healthcare workers during the COVID-19 pandemic

Objective: The degree to which healthcare workers experience uncertainty about their health has yet to be examined as a contributor to the psychological toll of the COVID-19 pandemic. In this report, we aimed to (1) characterize health uncertainty levels among healthcare workers in a large, U.S. hospital system during the COVID-19 pandemic, and (2) examine factors associated with higher levels of health uncertainty. Methods: From March to June 2020, healthcare workers in a large, urban U.S. healthcare system were invited via hospital emails and departmental announcements to complete an online questionnaire (REDCap). Self-report measures assessed sociodemographic characteristics and job roles, health uncertainty, and emotional wellbeing variables (anxiety, depression, loneliness, self-compassion, and coping confidence). Health uncertainty levels were compared using t-tests and ANOVAs. Results: Healthcare workers (N=440) were on average 44.5 years of age, 88.9% female, and 84.5% non-Hispanic white. Over half (52%) of healthcare workers reported at least some health uncertainty;pharmacists had the highest uncertainty, and technicians had significantly higher uncertainty than physicians (p<.05) and mental health and spiritual counselors (p<.05). Additionally, higher health uncertainty was associated with higher anxiety (p<0.001), depression (p<0.001), and loneliness (p<0.001), higher self compassion (p=0.02), and lower coping confidence (p<0.001). Conclusion: Collectively, these findings have implications for targeted coping skills interventions for healthcare workers, including particular pharmacists and technicians, who are essential in delivering healthcare services to the public during the COVID-19 pandemic.

Mask-induced Artifact Impacts Intraocular Pressure Measurement Using Goldmann Applanation Tonometry.

PURPOSE: The coronavirus (COVID-19) pandemic has impacted ophthalmology practices significantly. American Academy of Ophthalmology and Center for Disease Control guidelines suggest mandatory masking of patients and physicians during outpatient visits. We have recently become aware of a mask-induced phenomenon, whereby the intraocular pressure (IOP) as measured by Goldmann applanation tonometry (GAT) is artificially elevated due to mechanical interference from the mask. CLINICAL PRESENTATION: A 37-year-old male with a history of primary open-angle glaucoma on triple therapy presented for a routine visit. CLINICAL FINDINGS: When measuring IOP by GAT the right eye measured 16 mm Hg, but the left eye measured 20 mm Hg. The patient's mask was noted to be touching the base of the sensor rod on the tonometer. This patient's IOP was falsely elevated due to the lateral edge of his mask touching the base of the applanation tonometer, changing the relationship between the bi-prism tip and the weighted balance below, and eliminating the weighted balance from the pressure measuring mechanism. The patient's mask was adjusted to ensure there was no touch and repeat measurement showed an IOP of 16 mm Hg in the left eye. CONCLUSION: Recognizing mask-induced alteration in IOP is essential as it could lead to unnecessary escalation of treatment. We recommend flattening the area of mask protrusion during applanation and ensuring that the sensor arm remains clear of the mask while the tonometer tip approaches the cornea, especially at the moment the mires become visible during corneal contact.

SARS-CoV-2 RNA Detection on Disposable Wooden Chopsticks, Hong Kong.

We detected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA on disposable wooden chopsticks used by 5 consecutive asymptomatic and postsymptomatic patients admitted for isolation and care at our hospital. Although we did not assess virus viability, our findings may suggest potential for transmission through shared eating utensils.