ABSTRACT
Student enrollment for online education has seen a constant rise over the last two decades (Dixson, 2015) and has been very popular even before the COVID-19 pandemic. However, the unprecedented acceleration toward online teaching in Winter 2020 has taken many education institutions by surprise. This unwanted rapidness in transition to online teaching has created challenges for students, educators, and administrators alike. In this chapter we hope to bring some of those challenges to light. We present a literature review along with our own reflections on how student engagement has changed due to this sudden, unplanned transition to online teaching. Students and instructors are finding it difficult to navigate through these troubled times. We provide some suggestions on how to overcome these concerns. © Springer Nature Switzerland AG 2021. All rights reserved.
ABSTRACT
Objectives: To assess the prevalence of depression, anxiety and stress (DAS) and post-traumatic stress disorder (PTSD) among health care workers Methods: The present study was conducted over a period of six months (June 2020-November 2020) during which mental health status of health care workers was assessed using semi-structured self-reporting study tool which included two standardized and validated tools (DASS-21 and IES-R). Sociodemographic profile and occupational history were also recorded. Health care workers of all categories who gave a written informed consent were recruited using non probability convenience sampling technique. Minimum sample size required was this study was calculated to be 440, using 4PQ/ L2 where, power was assumed to be 80%, absolute precision of 5%, and P as 50%, after adding non-response rate of 10%. Data was compiled and analyzed using EpiInfo07 software. Result(s): Out of a total of 822 participants included in the study, 12%,13% and 16% were found to have symptoms of depression, anxiety, and stress with the odds being higher in females. The prevalence of PTSD was 18%. Those with education above intermediate and directly involved in COVID 19 related work and patient care were found to be at higher risk of depression, anxiety, stress and posttraumatic stress disorder. Conclusion(s): There is a need for a psychological support system for health care workers along with appropriate administrative action to ensure shift rotation, rest and appropriate working hours. Further, in-depth knowledge of prevention and control of the disease is necessary. Copyright © 2022, Institute of Medico-legal Publication. All rights reserved.
ABSTRACT
Background: Due to the unprecedented magnitude of the current Coronavirus disease 2019 (COVID-19) pandemic, vaccine development was fast-tracked;yet, there were barriers to vaccination uptake. Aim and Objectives: The objectives of this study were to understand the factors promoting vaccination and the barriers to vaccination, to explore the infection prevention and control practices followed after vaccination. Materials and Methods: A qualitative study using in depth interviews, both face to face and telephonic;among beneficiaries willing to participate and given at least one dose of COVID-19 vaccine in the institutions’ vaccination center, stratified sampling technique was used. Informed consent was obtained. Absolute confidentiality was ensured. The interviews were recorded and transcribed verbatim and validated by back translation into vernacular. The results obtained were analyzed using framework approach and categorized into themes and subthemes and valid conclusions drawn. Results: Various factors promoting willingness for vaccination and barriers perceived by the participants in their community, social, and occupational setting have been revealed in the present study. Availability of vaccine along with clear and accurate information can go a long way in overcoming vaccine hesitancy and promoting vaccine literacy. Conclusion: Clear and accurate information should be disseminated. The role of social media, mass media, and dissemination of information by word of mouth cannot be undermined. It is hoped that results of the present study will aid in formulating future vaccination programs.
ABSTRACT
Intravenous (IV) ascorbic acid (AA) improves organ function and reduces inflammation in sepsis, an inflammatory state similar to the post-hematopoietic cell transplant (HCT) milieu. This salutary effect is mediated by antioxidant activity as well transcriptional modulation by AA. HCT recipients are deficient in AA, therefore we evaluated the safety and efficacy of patients receiving parenteral AA after myeloablative conditioning for allogeneic HCT compared to similarly treated historical controls who did not receive AA. Methods: Patients with hematologic malignancies, AML (48% of patients), ALL (28%), and CML+MDS (25%) were enrolled in an IRB approved prospective phase 2 clinical trial (NCT03613727). IV AA 50 mg/kg/d divided in 3 doses was given on days 1-14 after HCT, followed by oral AA 500 mg bid from day 15 until 6 months post HCT (FDA-IND 138924). Conditioning regimens utilized included;fludarabine & melphalan (45%), cyclophosphamide with either busulfan (30%) or total body irradiation (25%). GVHD prophylaxis included calcineurin inhibitors and methotrexate or cellcept along with anti-thymocyte globulin (ATG). Primary endpoint was reduction in TRM at 1 year. Propensity score matching was used for matching study patients with similarly treated historical controls, matching for diagnosis, conditioning regimen, and CIBMTR disease risk category for comparison of clinical outcomes. Cox-proportional hazard models were used to estimate adjusted hazard ratios (AHR) between the time-to-event outcomes and study group, adjusted for patient age, donor type, stem cell source, diagnosis, conditioning regimen, and CIBMTR disease risk. Results of an interim analysis following a period of COVID 19 mandated suspension of study accrual are reported. Results: As of March 2020, 40 patients have received IV AA: these include HLA-matched related donor (MRD;n=11), and either 10/10 or 9/10 HLA- matched unrelated donor (MUD;n=22 & 7 respectively) recipients. Graft source was either peripheral blood (n=38) or bone marrow (n=2);88% patients had CIBMTR high risk disease. Median age was 55 years;males (19). All patients enrolled were deficient in AA at day 0, median AA level 0.3 mg/dL (range: 0.1-0.5);post AA infusion level was normal at 1.6 (1.2-5.7) on day 14. Median neutrophil and platelet recovery was by 12 days (range: 9-15 & 8-21 days respectively) with sustained donor engraftment. Median absolute CD3+ cell count at day 30 was 330 cells/microL. With a median follow up of 220 days in AA recipients, no statistically significant difference was observed in transplant related mortality between propensity matched historical controls and study patients (AHR 0.6, 95% CI: 0.2-1.5;p-value = 0.27);univariate survival analysis is depicted in Figure 1. Relapse was also similar (AHR 1.2, 95% CI: 0.3-4.5;p-value = 0.82), and despite a larger number of HLA mismatched unrelated donor recipients, acute GVHD (Grade II-IV) rates were similar in the two groups for both grade II-IV (AHR 0.8, 95% CI: 0.7-1.7;p-value = 0.65) and grade III-IV disease (AHR 0.6, 95% CI: 0.2-1.6;p-value = 0.32). Chronic GVHD rates were also similar (AHR 0.4, 95% CI: 0.1-2.7;p-value = 0.74). There are no attributable grade 3 - 4 toxicities from AA;CMV and EBV reactivation rates were not different in the two groups. Conclusions: In patients undergoing myeloablative allogeneic HCT the administration of IV ascorbic acid is safe and does not negatively impact myeloid engraftment or immune reconstitution. In this interim analysis, transplant related mortality, relapse and GVHD are not increased in IV AA recipients compared to historical controls. Thus, given its safety and tolerability, and possible salutary impact on survival and relapse in these high-risk patients, we posit the feasibility of a randomized phase 3 trial with IV AA in the post-transplant setting to determine its effect on relapse and TRM. [Formula presented] Disclosures: No relevant conflicts of interest to declare.