Near Real-Time Social Distance Estimation In London

To mitigate the current COVID-19 pandemic, policy makers at the Greater London Authority, the regional governance body of London, UK, are reliant upon prompt, accurate and actionable estimations of lockdown and social distancing policy adherence. Transport for London, the local transportation department, reports they implemented over 700 interventions such as greater signage and expansion of pedestrian zoning at the height of the pandemic's first wave with our platform providing key data for those decisions. Large well-defined heterogeneous compositions of pedestrian footfall and physical proximity are difficult to acquire, yet necessary to monitor city-wide activity (busyness) and consequently discern actionable policy decisions. To meet this challenge, we leverage our existing large-scale data processing urban air quality machine learning infrastructure to process over 900 camera feeds in near real-time to generate new estimates of social distancing adherence, group detection and camera stability. In this work, we describe our development and deployment of a computer vision and machine learning pipeline. It provides near immediate sampling and contextualization of activity and physical distancing on the streets of London via live traffic camera feeds. We introduce a platform for inspecting, calibrating and improving upon existing methods, describe the active deployment on real-time feeds and provide analysis over an 18 month period.

Nursing a Radical Imagination: Moving from Theory and History to Action and Alternate Futures

Examining the historical context of healthcare whilst focusing on building a more just, equitable world, this book proposes a radical imagination for nursing and presents possibilities for speculative futures embracing queer, feminist, posthuman, and abolitionist frames. Bringing together radical and emancipatory perspectives from an international selection of authors, this book reflects on the realities created by the COVID-19 pandemic, recognizing that our situation is not new but the result of ongoing hegemonies and injustices. The authors attend to the history of nursing and related institutions, examining the assumptions, ideologies, and discourses that shape the discipline and its place within healthcare. They explore the impact of this context on contemporary nursing and look at alternative visions for the future. The final section specifically focuses on ways that we can move forward. Envisioning new possibilities for nursing, this innovative volume is a vital resource for practitioners, scholars and students keen to promote social justice within and without nursing. It is an important contribution to nursing theory, philosophy and history. © Jess Dillard-Wright, Jane Hopkins-Walsh, and Brandon Brown 2023 selection and editorial matter, individual chapters, the contributors.

“WHAT DO OUR PATIENTS THINK?” CREATING A GERIATRIC INPATIENT QUESTIONNAIRE TO IDENTIFY PATIENTS’ OPINION ON DELIVERY OF HOLISTIC CARE

Background: Our aim is to assess our patients’ opinion on the delivery of key principles of Geriatric care in order to identify areas for improvement and change. The prevalence of delirium in frail older patients on inpatient wards is a major issue, the management of which includes a ward based multi-disciplinary approach. This holistic approach to patient care is our goal, however it is not clear whether the experience of our patients matches our aims. Methods: We developed a patient questionnaire consisting of 22 questions based on the core principles of good geriatric care. The survey included 3 questions on environment and privacy, 2 on mealtime, functional ability and assistance, 3 on continence management, 2 on mobility and rehabilitation, 6 on respect and autonomy, 2 on psychological and social aspects of care, 3 on pain and sleep, and 2 on safety and Covid-19. These questions also had a large degree of overlap in terms of core principles. We distributed the questionnaire prior to discharge in 3 different Geriatric care settings: one ward managing acute stroke with a majority of single rooms, one ward managing acute medical presentations with a majority of multi-occupancy bays and one ward in a non-acute hospital managing medical Geriatric patients undergoing rehabilitation. Results: Some key issues were identified by the survey: 60% identified issues with the ward environment and privacy, 100% did not wear a mask on the ward unless specifically asked to do so, 80% wore pyjamas or hospital gown for the majority of their stay, 40% reported issues in terms of respect and autonomy, 40% had issues with poor sleep due to external factors, 20% felt that they had insufficient time with rehabilitation. Conclusion: The survey was designed to assess the subjective experience of older inpatients, collecting qualitative data to highlight key areas of improvement to achieve holistic inpatient care.

A CASE OF REFRACTORY PAEDIATRIC COGAN'S SYNDROME TREATED WITH TOCILIZUMAB

Background/Aims Cogan's syndrome is a rare vasculitis, characterised by progressive sensorineural bilateral hearing loss, vestibular symptoms and nonsyphilitic interstitial keratitis. We present a paediatric case which was refractory to initial treatment and subsequently successfully treated with Tocilizumab. Methods Case report. Results A previously well 14-year-old boy presented with sudden onset hearing loss, tinnitus and vertigo. There was no history of new medication, trauma or tick bite. There was no family history of autoimmune disease or genetic hearing losses. On examination his cranial nerves except for vestibulocochlear were grossly intact. He had a steady gait with no cerebellar signs. Otoscopy was unremarkable. Audiology showed a moderate to severe sensorineural hearing loss bilaterally, worse on the right. He had normal type A tympanograms. An autoimmune screen was carried out which showed normal FBC, inflammatory markers, ACE and Chitotriosidase. ANCA, Rheumatoid factor and lyme serology were negative. MRI of the internal auditory meati was normal. He subsequently developed visual disturbance and was diagnosed with bilateral interstitial keratitis. A unifying diagnosis of Cogan's syndrome was made. An MRI scan of his head, neck and upper thorax looking for evidence of large vessel vasculitis was normal. Genetics looking for evidence of a monogenic autoinflammatory disorder and primary immunodeficiency were negative. He was initially treated with a weaning course of oral prednisolone with improvement in symptoms. Unfortunately, 4 months later had clinical and audiological deterioration in hearing. He therefore received pulsed IV methylprednisolone and commenced subcutaneous methotrexate and adalimumab. 3 months later, there was both clinical and audiological improvement and he started to wean prednisolone. 7 months later, he presented with a 24-hour history of reduced hearing on the right, confirmed on audiogram. He received a further pulse of IV methylprednisolone and a short course of high-dose oral prednisolone, followed by a slowly weaning course. 3 months later, again he felt his hearing had deteriorated and this was confirmed on audiogram, with a 40-decibel loss in his previously good ear. He received two doses of IV methylprednisolone and background steroids were increased to 20mg daily. Due to frequent relapses, adalimumab was changed to IV tocilizumab at 10mg/kg 2-weekly, alongside methotrexate. IV tocilizumab was changed to the subcutaneous route during the COVID-19 pandemic and was tolerated well. His hearing subsequently improved and tocilizumab interval was extended to 3-weekly in Feb 2021. At last review he was stable and successfully transitioned to adult services. Conclusion Evidence regarding treatment options in paediatric patients is lacking due to the rarity of the condition and consequent difficulty in arranging high-quality trials. This is the first case report of use of tocilizumab for Cogan's syndrome in children, highlighting it as a well-tolerated and successful treatment modality.

DEVELOPMENT OF A NATIONAL ACROSS SPECIALTY MULTI-DISCIPLINARY TEAM FOR MANAGEMENT OF HYPERINFLAMMATORY CONDITIONS DURING THE SARS-COV-2 PANDEMIC

Background/Aims Effective multi-specialty team working is extremely beneficial in management of children with hyper-inflammatory conditions. With the recognition of paediatric inflammatory multisystem syndrome (PIMS) it became apparent a standardised process for discussion of patients would be beneficial. This includes urgent discussion, with access to multiple specialties, and sharing knowledge and experience in a novel condition. Delivering equitable healthcare including access to expertise, specific treatments and research is challenging in Scotland due to its geography. This is facilitated by successful clinical networks (Scottish Paediatric & Adolescent Rheumatology Network [SPARN] and Scottish Paediatric& Adolescent Infection & Immunology National Managed Clinical Network [SPAIIN]) and a well-established paediatric transport service (ScotSTAR). Our aim was to develop a multi-specialty multi-disciplinary team (MDT) for management of patients with hyper-inflammatory conditions. Methods Narrative account of MDT and service development Results We identified a core group of individuals with an interest in inflammatory disorders from different centres and specialties across Scotland including Rheumatology, Infectious Diseases, Cardiology, Intensive Care, Academic Paediatrics, Pharmacists and Clinical Nurse Specialists. Three priorities emerged from initial planning stages: urgent discussions around patient management, peer-to-peer learning and information sharing, and effective prioritisation of research. We designed a written framework and referral pathway, including criteria for acute cardiology involvement, ScotSTAR transfer and intensive care. An electronic proforma was designed to guide MDT discussion, medicolegal documentation and audit purposes. Table 1 describes characteristics of the first nine patients discussed. A particular strength was in diagnostics and consideration of differentials;among patients referred we identified those with haematological malignancy, systemic lupus erythematosus and non-accidental injury. Regular peer-review sessions were held, for reflection on cases and their management in both secondary and tertiary care settings. Clinicians throughout Scotland were encouraged to join via SPARN and SPAIIN networks. Conclusion This multi-specialty MDT has been and continues to be beneficial for management of hyper-inflammatory patients. We will review the process but hope the MDT will prove to continue to be beneficial for future patients. The authors would like to acknowledge all members of the MDT. (Table Presented).

Working with a community for change: tackling domestic violence and abuse

Domestic violence and abuse (DVA) is a real issue for many people. It is also sadly in places in our communities and life spaces. During the pandemic, the evidence seems to say things have got worse (https://commonslibrary.parliament.uk/domestic-abuse-and-covid-19-a-year-into-the-pandemic/). Indeed, victims were suddenly trapped at home with their abuser, with no options of respite or relief (Chambers et al, 2021). © 2022, Journal of Community Nursing. All rights reserved.

Validation of a molecular assay to detect SARS-CoV-2 in saliva

AIM: To validate a reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR) assay to detect SARS-CoV-2 in saliva in two independent Aotearoa New Zealand laboratories. METHODS: An RT-qPCR assay developed at University of Illinois Urbana-Champaign, USA, was validated in two New Zealand laboratories. Analytical measures, such as limit of detection (LOD) and cross-reactivity, were performed. One hundred and forty-seven saliva samples, each paired with a contemporaneously collected nasal swab, mainly of nasopharyngeal origin, were received. Positive (N=33) and negative (N=114) samples were tested blindly in each laboratory. Diagnostic sensitivity and specificity were then calculated. RESULTS: The LOD was <0.75 copy per mu L and no cross-reactivity with MERS-CoV was detected. There was complete concordance between laboratories for all saliva samples with the quantification cycle values for all three genes in close agreement. Saliva had 98.7% concordance with paired nasal samples: and a sensitivity, specificity and accuracy of 97.0%, 99.1% and 99.1%, respectively. CONCLUSION: This saliva RT-qPCR assay produces reproducible results with a low LOD. High sensitivity and specificity make it a reliable option for SARS-CoV-2 testing, including for asymptomatic people requiring regular screening.

Role of immune mediators in predicting hospitalization of SARS-CoV-2 positive patients.

BACKGROUND: Several immune mediators (IM) including cytokines, chemokines, and their receptors have been suggested to play a role in COVID-19 pathophysiology and severity. AIM: To determine if early IM profiles are predictive of clinical outcome and which of the IMs tested possess the most clinical utility. METHODS: A custom bead-based multiplex assay was used to measure IM concentrations in a cohort of SARS-CoV-2 PCR positive patients (n = 326) with varying disease severities as determined by hospitalization status, length of hospital stay, and survival. Patient groups were compared, and clinical utility was assessed. Correlation plots were constructed to determine if significant relationships exist between the IMs in the setting of COVID-19. RESULTS: In PCR positive SARS-CoV-2 patients, IL-6 was the best predictor of the need for hospitalization and length of stay. Additionally, MCP-1 and sIL-2Rα were moderate predictors of the need for hospitalization. Hospitalized PCR positive SARS-CoV-2 patients displayed a notable correlation between sIL-2Rα and IL-18 (Spearman's ρ = 0.48, P=<0.0001). CONCLUSIONS: IM profiles between non-hospitalized and hospitalized patients were distinct. IL-6 was the best predictor of COVID-19 severity among all the IMs tested.

Is it feasible to use a humanoid robot to promote hand hygiene adherence in a hospital setting?

Healthcare associated infections (HCAI) are a prevalent preventable cause of morbidity and mortality. Improving hand hygiene adherence is important for HCAI prevention. In this feasibility study, the objective was to determine if a humanoid robot could act as a novel single reminder intervention to improve hand hygiene adherence in a hospital setting. DAVE, a social humanoid robot, improved hand hygiene adherence at the entrance to a tertiary hospital and outpatient department, which was low at baseline, by 29%. DAVE shows promise as a novel intervention to improve hand hygiene adherence.

Integrating home-based exercise training within a hospital at home service for patients hospitalised with acute exacerbations of COPD: a mixed methods feasibility study

BackgroundThe uptake of face-to-face supervised outpatient-based pulmonary rehabilitation (PR) following hospitalisation for an acute exacerbation of COPD (AECOPD) is low. One commonly cited barrier is travel. Home-based PR may be an alternative setting. The aim of this study was to determine whether a co-designed home-based exercise training intervention, delivered alongside usual hospital at home (HaH) care post-hospitalisation for an AECOPD, is acceptable and feasible.MethodsA mixed method feasibility study was conducted including a parallel, two-group randomised controlled trial (RCT) (control group: usual HaH care;intervention group: usual care plus home-based exercise training) with convergent qualitative components (interviews: patients, family carers, researchers;focus groups: healthcare professionals [HCPs]).Results16/132 patients screened were recruited to the RCT with 8 allocated to each group and one withdrawn prior to receiving HaH care (56% were male, mean [SD] age: 74 [9] years, median [IQR] FEV1: 29 [21, 40] percent predicted, 87% with an eMRC dyspnoea score of 4, 5a or 5b). Four vs eight and four vs seven attended four week and three-month follow-up assessments in the control and intervention groups respectively. There was no evidence of contamination in the control group. 25% of patients allocated to the intervention group were unable to receive the intervention due to Covid-19. The questionnaire-based outcomes were more complete and appeared more acceptable to patients than physical measures, with very poor uptake for physical activity monitoring via accelerometery. Qualitative findings (interviews: five patients, two family carers, four researchers;focus groups: PR and HaH service HCPs) demonstrated that trial and intervention processes were acceptable, clinically beneficial and safe, but did not explain the disparity between questionnaire-based vs physical outcome measure completion rates.ConclusionThe findings suggest an efficacy trial which investigates home-based exercise training integrated within a HaH service following hospitalisation for an AECOPD would be safe and acceptable to patients, family carers, HCPs and researchers alike, and is qualitatively felt to be of clinical benefit. However, additional piloting is required to optimise intervention fidelity and study processes given the low recruitment rates, high drop out of the control group and poor uptake of some physical assessments.

The pop-up against coronavirus project: Child-made movable books evoking smiles, tears, and hope

In this essay I discuss the Pop-Up against Coronavirus Project, initiated by the Fondazione Tancredi di Barolo based in Turin Italy. It is a research, conservation and educational foundation devoted to movable books, especially pop-up books. Their work with children is in conjunction with their museum of School and Children's books (Museo della Scuola e del Libro per l'Infanzia). When the outbreak of the coronavirus in Italy in late February 2020 prevented the academic conference they had organized from occurring, the foundation immediately turned their attention to working cross culturally with and for children, engaging Italian, Chinese and later Dutch artists and paper engineers to devise working models of different types of pop-ups. I give an account of the inception of the project, discuss the materials provided on their site, and examine some of the images of the homemade artifacts made by children and their families in Italy and China. © 2021 University of Winnipeg. All rights reserved.

Toward a Compare and Contrast Framework for COVID-19 Contact Tracing Mobile Applications: A Look at Usability

This paper reports on the progress in the project COVIGILANT, which is aimed at developing an evaluation taxonomy for Contact Tracing Applications (CTAs) for COVID-19. Specifically, this article describes the development of Usability, one pillar of the COVIGILANT taxonomy, discussing the classification and decision-making processes, and the initial model validation. The validation process was undertaken in two stages. First, we validated how the Usability pillar could be used to evaluate the Irish Health Services Executive (HSE) COVID-19 CTA. While this supported many of the attributes that we had within the Usability pillar, it also identified issues. We made amendments based on these, and undertook a second study, this time evaluating 4 CTAs used in other countries. This has led to the completion of the Usability pillar, which can now be used to evaluate global CTAs.

Abstract No. 526 Role of interventional radiology in a pandemic

Purpose: (1) Recognize the benefit of leveraging interventional radiologists as surge support during periods of mass critical illness, rapid assembly of a dedicated vascular access team. (2) Multifunctionality of catheter usage during hospital shortage. Materials and Methods: During peak times of the novel COVID-19 virus, Kings County Hospital in Brooklyn, New York was, among others, a highly impacted institution in one of the most case-prevalent counties in the state. The IR and surgery residents of Kings County Hospital developed a joint 24/7 emergency line team during the month of April at the height of COVID-19 infections. Being an urban hospital with limited ancillary staff, an over-capacity census, and newly formed ICU’s in outpatient facilities, the development of a line team was a necessary evolution to play a pivotal role in aiding our colleagues to treat the critically ill. IR and surgery residents were paired and placed on 12hr shifts, holding a dedicated cell phone. The sole responsibility was to place lines that were necessary on the floor including midlines, central lines, and hemodialysis catheters (HD). Results: Several supplies had run short during the peak of COVID-19 including most variations of central venous access catheters. Midlines were the most consulted procedure due to difficult access and long-term stay. During times of resource depletion, the application of various catheters was expanded with PICC lines cut short to be used for varying needs of central access and micropuncture sheaths sutured in place to be used as midlines. Tunneled HD catheters were used in place of temporary HD catheters. A total of 154 lines were placed at the bedside in critically ill COVID positive patients by the line team. The lines that were placed included 68 midlines (44%), 31 central lines (20%), and 55 HD catheters (35%). Conclusions: IR has the potential to play a vital role as an emergency team during times of uncertainty, such as a pandemic. Over the course of a month, 154 lines were placed which accelerated patient care and treatment. Our experience supports hospitals in the epicenter of a pandemic should consider a dedicated line team to provide support and aid in cross-departmental patient care delivery.

The identification of needs and development of best practice guidance for the psychological support of frontline healthcare workers during and after COVID-19: A protocol for the FLoWS project

Recent estimates suggest that up to 34% of frontline workers in healthcare (FLWs) at the forefront of the COVID-19 pandemic response are reporting elevated symptoms of psychological distress due to resource constraints, ineffective treatments, and concerns about self-contamination. However, little systematic research has been carried out to assess the mental health needs of FLWs in Europe, or the extent of psychological suffering in FLWs within different European countries of varying outbreak severity. Accordingly, this project will employ a mixed-methods approach over three work packages to develop best-practice guidelines for alleviating psychological distress in FLWs during the different phases of the pandemic. Work package 1 will identify the point and long-term prevalence of psychological distress symptoms in a sample of Irish and Italian FLWs, and the predictors of these symptoms. Work package 2 will perform a qualitative needs assessment on a sample of Irish and Italian FLWs to identify sources of stress and resilience, barriers to psychological care, and optimal strategies for alleviating psychological distress in relation to the COVID-19 pandemic. Work package 3 will synthesise the findings from the preceding work packages to draft best practice guidelines, which will be co-created by a multidisciplinary panel of experts using the Delphi method. The guidelines will provide clinicians with a framework for alleviating psychological distress in FLWs, with particular relevance to the COVID-19 pandemic, but may also have relevance for future pandemics and other public health emergencies.

Minimal clinically important difference for pedometer step count in COPD: A prospective analysis

Background: Infection control precautions arising from the COVID-19 pandemic has led to challenges undertaking face-to-face exercise testing required for pulmonary rehabilitation (PR) exercise prescription and evaluation.1 Self-management programmes, incorporating physical activity, have been advocated as an alternative to PR when face-to-face assessment is not possible.1 Daily step count is the most commonly used physical activity outcome and does not require face-to-face assessment. We aimed to estimate the minimal clinically important difference (MCID) for daily pedometer step count in COPD, using response to PR as a model of improvement and longitudinal decline following PR as a model of deterioration. Methods: This was a secondary analysis of a trial that investigated the effectiveness of pedometer-directed step count targets in COPD as an adjunct to PR, with the study arms combined as the intervention did not result in significant between-group differences.2 We measured spirometry, Medical Research Council score, incremental shuttle walk test, Chronic Respiratory Questionnaire and pedometer step count (Yamax Digiwalker CW700) pre-, post- and six months following PR. Post-PR and six months post-PR, participants completed a Global Rating of Change Questionnaire: 'How do you feel your physical activity levels have changed following rehabilitation?' and rated the response on a five-point Likert scale ( '1: I feel much more active' to '5: I feel much less active'). The MCID for improvement was defined as the median for '2: I feel a little more active' at the post-PR assessment. The MCID for deterioration was the median for '4: I feel a little less active' at the six-month assessment (compared to post-PR). Results: 152 participants enrolled in PR;80% and 70% attended the post-PR and six month assessments respectively. Baseline characteristics and change with PR and over time are (Table presented) in table 1. There were significant improvements in daily pedometer step count following PR and reductions at six months. The median (25th, 75th centile) MCID estimate for improvement and deterioration in daily pedometer step count was 427 (-443, 1286) and -456 (-2271, 650) steps respectively. Conclusion: The MCID estimates for improvement with PR and deterioration over time after PR are 427 and -456 steps respectively.