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Energy policy measures aimed at mitigating the impacts of energy insecurity during the first years of the COVID-19 pandemic, such as moratoriums on disconnection from electricity, were widespread. In Australia, early pandemic safeguards against electricity disconnection were successful in temporarily protecting most people. However, their application was uneven. For remote-living Indigenous community residents, who are required by policy or elect to use prepay metering and are known to experience frequent ‘self-disconnection', energy insecurity continued as the impacts of the pandemic accrued. The risks associated with the regular de-energization of prepay households have long been overlooked by government reporting and this contributed to a lack of visibility of energy insecurity and available protections for this group during the pandemic response. In contrast to the rest of Australia, energy insecurity in the form of disconnections remained unrelentingly high or worsened for prepay households during this time. COVID-19 magnifies pre-existing health and socio-economic inequities. There is a need to pay closer attention to the rationales and impacts of energy policy exceptionalism if we are to mitigate the potential for compounding impacts of energy insecurity among specific groups, such as Indigenous Australian prepay customers, including during times of crisis. © 2023 The Authors
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Background: Prior to the COVID-19 pandemic, conventional management of outpatient care in IBD predominantly revolved around face-to-face clinic appointments. In the changing landscape of care provision during the pandemic, appointments were conducted almost exclusively through telephone consultation. An electronic questionnaire was developed to assess patient satisfaction and patient costs. Method(s): A pilot was carried out with 15 patients to identify any technical issues with e-mail delivery of the questionnaire and gauge face validity of the questionnaire content. 1400 patients registered with the TrueColours-IBD remote digital monitoring system were sent the questionnaire link via e-mail in May 2021. No demographic data were collected by design, in order to avoid the perception of bias and ensure freedom of expression through anonymity. Result(s): 506 responses were received including 21 duplicates which were excluded, totalling 485 valid responses. 408/485 patients reported having a telephone appointment with the IBD service since March 2020, 484/485 reported having had a face-to-face appointment in the past. 348/408 (86%) were either 'very satisfied' or 'somewhat satisfied' with their most recent telephone consultation, while 22 (6%) were either 'very dissatisfied' or 'somewhat dissatisfied'. 247/408 (61%) were also either 'very satisfied' or 'somewhat satisfied' with the ease of accessing further care if required, compared to 33/408 (8%) who were either 'very dissatisfied' or 'somewhat dissatisfied'. Given the choice, 195/408 (48%) patients preferred to receive a telephone appointment in the future;147/408 (36%) would opt for face-to-face and 66/408 (16%) stated no preference, all with the option of changing that choice if needed. Telephone appointments were associated with a mean total patient time off-work or leisure of 23 minutes (S.D. 51, n=408) compared to 190 minutes (S.D. 96, n=484) for face-to-face appointments. The average cost of time off work or leisure associated with telephone appointments was 5.55 (S.D. = 15.74, n=408), compared to 43.42 (S.D. = 31.27, n=484) for face-to-face appointments (Table 1). Costs of transport add further to face-to-face appointment costs. Greater proportions of patients had a companion for their face-to-face appointment and required childcare compared to telephone consultations (Table 2), which again increases the difference in costs. Conclusion(s): Almost half of surveyed patients stated a preference for telephone appointments, although a third still preferred traditional follow-up. An evolution of care pathways is supported by patient preference and the statistically significant time and cost savings to patients receiving telephone appointments. (Figure Presented).
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Purpose: The purpose of this case study is to describe a simulation-based assessment designed to assure student readiness for a first full-time clinical experience in an entry-level Doctor of Physical Therapy program that transitioned to mixed-mode instruction during the COVID-19 pandemic. Design/methodology/approach: A cohort of 40 second-year physical therapy students whose content delivery mode, assessment methods and curricular sequence deviated from the curricular plan participated in a new assessment using standardized patients. The assessment was developed to preferentially address the knowledge, skills, abilities and professional behaviors (KSAs) that were typically assessed with other methods before the pandemic. Findings: The assessment was useful in identifying students who required additional learning experiences to meet expected levels of competence before transition to a first full-time clinical experience. It also identified KSAs that needed to be strengthened within the entire cohort of students. Research limitations/implications: This case study provides an example of feasible implementation of an assessment of student readiness for clinical education that may guide future development of standardized assessments in health profession education (HPE) programs that have or plan to transition to mixed-mode content delivery. Originality/value: This case study highlights the need and process for developing and implementing additional assessments in HPE programs when planned changes or unexpected variations in curriculum delivery occur. This evidence-based assessment preferentially addresses the affective domain of learning and includes competency standards that have recently been developed for physical therapy education in the USA. © 2022, Emerald Publishing Limited.
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Background. Omicron rapidly replaced delta as the predominant strain causing COVID-19 related illness in the United States (US) in December 2021, the same month the US CDC reduced the recommended isolation period from 10 to 5 days for asymptomatic individuals or those with resolving symptoms. New evidence suggests some asymptomatic individuals with omicron remain culture positive beyond 5 days from diagnosis. We sought to evaluate the performance of a SARS-CoV-2 antigen rapid diagnostic test (RDT) in predicting persistent potential for transmission at the end of a five-day isolation period among young, fully vaccinated individuals in a university community setting. Methods. A subgroup of participants enrolled in a longitudinal COVID-19 cohort were asked to self-perform RDTs on days 4 to 6 from diagnostic test date in addition to a separate self-collected anterior nasal swab used for culture and RT-PCR, and a daily symptom screen (15 COVID-19 symptom questions on a 4-point scale). We calculated the daily and overall sensitivity and specificity of the RDTs in comparison to SARS-CoV-2 culture result. We also compared the N1 cycle threshold (CT) values and symptom score on each day of the study by RDT results. Results. Of 23 participants, the mean age was 20 years, all had completed their primary COVID-19 vaccine series, and 13 (65.0%) had received a booster vaccine (Table 1). Compared to culture, sensitivity and specificity of the RDTs were 100% and 62% respectively (Table 2). Compared to participants with negative RDTs, median CT values were lower in those with positive RDTs on each day of the study (Figure 1). Participants who had positive RDTs on all three days had higher symptom scores (Figure 2) than those without. Conclusion. RDTs have a high sensitivity in detecting culture positive SARS-CoV-2 on Days 4 to 6 from initial diagnostic test. However, the high false positive rate of 38% means that over a third of culture negative individuals will stay in isolation longer than necessary if RDTs are used in test to release from isolation protocols. Viral loads (CT values) and symptom scores were higher for participants with persistently positive RDT result. An approach that uses a combination of RDTs, CT values and symptom score may prove useful in guiding isolation duration.
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Background. Vaccination is a fundamental element of pandemic control;however, insufficient data exists on vaccine's impact on SARS-CoV-2 viral dynamics. We aimed to evaluate the relationship between time to negative viral culture conversion after diagnosis and time since most recent COVID-19 vaccination. Scatterplot illustrating relationship between time since completion of initial COVID-19 vaccine series and time to culture conversion among un-boosted participants. The vaccine type received has also been designated by plot labels. The black solid line shows the best fit for the Spearman correlation model;gray shading denotes 95% confidence interval around this estimate. Spearman correlation coefficient, R, and p-value were estimates for the model. Methods. CoViD Post-vax is longitudinal cohort study collecting baseline clinical questionnaires, and daily anterior nasal swabs and symptom screens on enrolled Boston University SARS-CoV-2 PCR-positive cases detected through a serial screening testing program or symptomatic testing. Data was collected from November 2021 to March 2022. Participants were excluded from analysis if they lacked at least one positive culture or did not culture convert during their study involvement. Scatter plots comparing time to culture conversion to time from initial vaccine series were created.We calculated spearman correlation coefficients to determine the relationship between time to culture conversion and time from last vaccination for all participants, those who completed the initial vaccine series (unboosted), and those who were boosted. Scatterplot illustrating relationship between time since receiving a booster COVID-19 vaccine dose and time to culture conversion among boosted participants. The vaccine type received has also been designated by plot labels. The black solid line shows the best fit for the Spearman correlation model;Gray shading denotes 95% confidence interval around this estimate. Spearman correlation coefficient, R, and p-value were estimates for the model. Results. Of 54 CoViD Post-Vax participants included in this analysis, the mean age was 21 years (SD=2) and culture conversion occurred after a median of 4 days (IQR=3-5.75). There was no association between time to culture conversion and time since last dose of a COVID-19 vaccination (R= -0.13, p= .34). When stratified by vaccination status, there was no association between time to culture conversion and time since initial COVID-19 vaccine series (R= -0.25, p= .21, n=26) or time since COVID-19 booster vaccination (R= -0.24, p= .22, n=28). Conclusion. Our results show no significant relationship between time to culture conversion and time since most recent dose of COVID-19 vaccination in an initially culture positive, young, University-based cohort. More work needs to be done to understand the impact of symptom severity, disease burden, SARS-CoV-2 variants, and COVID-19 vaccine status on duration of transmissible SARS-CoV-2 infection. (Figure Presented).
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This paper discusses the recognized need for an organization focused on serving students from underrepresented populations in the computing field at Texas A&M University, describing the formation of the Aggie Hispanics in Computing group. In 2016, the combined undergraduate and graduate Hispanic enrollment in computer science and computer engineering at Texas A&M University initially sat at 17.9% and then decreased to approximately 11.76% in 2021, with undergraduate Hispanic enrollment in computing reduced from almost 22% to under 15% in that same time frame. This significant shift in Hispanic student representation spurred the development of the Aggie Hispanics In Computing (AHIC) student organization to create a computing community that provides support around the shared experiences of being part of a minority group in an even less diverse discipline. The university, overall, was recently recognized as a Hispanic-Serving Institution, but the College of Engineering remains a predominately-white institution. This new organization is not the only Hispanic-serving organization at Texas A&M University;rather, it was designed to focus particularly on serving Hispanic students in the computer science and computer engineering disciplines at Texas A&M University. The organization was founded during the COVID-19 pandemic in 2020. Since then, AHIC has grown significantly in membership, financial support, and activities to increase the representation of Hispanic students within the computing disciplines at Texas A&M University. The organization has grown from 6 to over 50 members from various majors in the past year alone. AHIC has also received financial support from a multitude of companies, such as General Motors and Chevron. AHIC's overall goal is to create a supportive community for minorities in computing fields. This community has grown through hosting events that provide information and resources about professional career opportunities, technical workshops, mentoring programs, and participation in research groups. AHIC has also initiated several long-term initiatives, such as peer-teaching for introductory computer science courses. AHIC's promotion of career-guidance events (where company representatives and alumni provide advice for currently enrolled students) proved to be an effective strategy for recruiting members. The organization has also hosted seminars and workshops educating first-year students on new computing skills and the opportunities that a computer science and computer engineering degree can provide. © American Society for Engineering Education, 2022.
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Early enteral feeding is important in maintaining the integrity of the gastrointestinal tract mucosal barrier and associated with less bacterial translocation and decreased stimulation of the systemic inflammatory response and subsequent improved outcomes in intensive care (ICU) patients. Enteral feeding by nasogastric (NG) tubes is the preferred route of nutritional support for most ICU patients. However, ICU patients with delayed gastric emptying and poor intestinal motility may not tolerate gastric feeding and may therefore benefit from post-pyloric feeding via nasojejunal (NJ) tubes1. We reviewed the effectiveness of 35 NJ tube placement in 24 patients on ICU between January and March 2021. The M:F ratio was 4:1, median age 69 years (30–80 years) and 54% of patients were non-White British. 10 patients (42%) had diabetes and 54% had COVID-19 as part of their admitting diagnoses. The median BMI was 25 (range 20 – 32.3) and none of the patients were identified as high risk for refeeding syndrome at the time of NJ tube insertion. Nutritional information was unavailable on 5 patients. Of the remaining 19 patients, 26% of patients (n=5) were commenced on parenteral nutrition (PN) within 48 hours of NJ insertion. Only 1 patient was able to meet their nutritional requirements enterally via NJ tube at 5 days;a further 2 patients had their nutritional requirements met with supplemental PN. In 8 of 22 referrals the indication for NJ tube insertion was because an NG tube could not be passed. The evaluation revealed discrepancies in adherence to protocols for high gastric residual volumes and prokinetic use. Documentation surrounding decision making, requesting and inserting an NJ tube was poor and probably reflects the complexity of the patients, involvement of multiple clinical teams, and various documentation modalities (i.e., verbal, written and different electronic systems). There was clinical dispute regarding the indication for NJ tube insertion in 23% of cases (documented in 3 of 13 referrals for NJ tube insertion). Where documentation was available 43% of patients (n=10) had an NJ tube placed on the day of request;the median time from request to insertion was 1 day (range 0-10). 5 patients had more than one NJ tube inserted (median 3;range 2–5). There was variation in experience and expertise of the endoscopists placing the NJ tubes. NJ tube feeding is considered to be less expensive and have less complications than PN2. However, our evaluation has revealed a range of issues relating to both the insertion and use of NJ tubes in an ICU setting. The true resource ‘cost’ of NJ tube insertion is probably underestimated in the literature and the complications of PN probably overestimated in the context of modern ICU and nutrition support team clinical practices. We suspect that our clinical experience is not unique and that more research is needed in this area. We are using this work to educate clinical teams, standardise documentation, provide better support and supervision for endoscopists, and raise awareness of the benefit and need for supplemental PN where nutritional requirements are not consistently reached enterally. 1 Schröder S, Hülst S V, Claussen M et al. Postpyloric feeding tubes for surgical intensive care patients. Anaesthetist 2011;60 (3): 214-20. 2 Lochs H, Dejong C, Hammarqvist F et al. ESPEN Guidelines on enteral nutrition: Gastroenterology. Clin Nutr 2006;25(20: 260-74.
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Purpose: The purpose of this case study is to describe a simulation-based assessment designed to assure student readiness for a first full-time clinical experience in an entry-level Doctor of Physical Therapy program that transitioned to mixed-mode instruction during the COVID-19 pandemic. Design/methodology/approach: A cohort of 40 second-year physical therapy students whose content delivery mode, assessment methods and curricular sequence deviated from the curricular plan participated in a new assessment using standardized patients. The assessment was developed to preferentially address the knowledge, skills, abilities and professional behaviors (KSAs) that were typically assessed with other methods before the pandemic. Findings: The assessment was useful in identifying students who required additional learning experiences to meet expected levels of competence before transition to a first full-time clinical experience. It also identified KSAs that needed to be strengthened within the entire cohort of students. Research limitations/implications: This case study provides an example of feasible implementation of an assessment of student readiness for clinical education that may guide future development of standardized assessments in health profession education (HPE) programs that have or plan to transition to mixed-mode content delivery. Originality/value: This case study highlights the need and process for developing and implementing additional assessments in HPE programs when planned changes or unexpected variations in curriculum delivery occur. This evidence-based assessment preferentially addresses the affective domain of learning and includes competency standards that have recently been developed for physical therapy education in the USA. © 2022, Emerald Publishing Limited.
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In a recent article, “Vaccine Refusal Is Not Free Riding”, Ethan Bradley and Mark Navin (2021) argue that vaccine refusal is not akin to free riding. Here, I defend one connection between vaccine refusal and free riding and suggest that, when viewed in conjunction with their other arguments, this might constitute a reason to mandate Covid-19 vaccination. © 2021. All Rights Reserved.
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BACKGROUND: The world has suffered immeasurably during the COVID-19 pandemic. Increased distress and mental and medical health concerns are collateral consequences to the disease itself. The Genes to Mental Health (G2MH) Network consortium sought to understand how individuals affected by the rare copy number variations of 22q11.2 deletion and duplication syndrome, associated with neurodevelopmental/neuropsychiatric conditions, were coping. The article focuses on worry and disruptions in medical care caused by the pandemic. METHODS: The University of Pennsylvania COVID-19 Stressor List and care disruption questions were circulated by 22 advocacy groups in English and 11 other languages. RESULTS: A total of 512 people from 23 countries completed the survey; most were caregivers of affected individuals. Worry about family members acquiring COVID-19 had the highest average endorsed worry, whilst currently having COVID-19 had the lowest rated worry. Total COVID-19 worries were higher in individuals completing the survey towards the end of the study (later pandemic wave); 36% (n = 186) of the sample reported a significant effect on health due to care interruption during the pandemic; 44% of individuals (n = 111) receiving care for their genetic syndrome in a hospital setting reported delaying appointments due to COVID-19 fears; 12% (n = 59) of the sample reported disruptions to treatments; and of those reporting no current disruptions, 59% (n = 269) worried about future disruptions if the pandemic continued. Higher levels of care disruptions were related to higher COVID-19 worries (Ps < 0.005). Minimal differences by respondent type or copy number variation type emerged. CONCLUSIONS: Widespread medical care disruptions and pandemic-related worries were reported by individuals with 22q11.2 syndrome and their family members. Reported worries were broadly consistent with research results from prior reports in the general population. The long-term effects of COVID-19 worries, interruptions to care and hospital avoidance require further study.
Subject(s)
COVID-19 , DNA Copy Number Variations , Caregivers , Chromosomes , Humans , PandemicsABSTRACT
Delirium is a common condition affecting hospital inpatients, including those having surgery and on the intensive care unit. Delirium is also common in patients with COVID-19 in hospital settings, and the occurrence is higher than expected for similar infections. The short-term outcomes of those with COVID-19 delirium are similar to that of classical delirium and include increased length of stay and increased mortality. Management of delirium in COVID-19 in the context of a global pandemic is limited by the severity of the syndrome and compounded by the environmental constraints. Practical management includes effective screening, early identification and appropriate treatment aimed at minimising complications and timely escalation decisions. The pandemic has played out on the national stage and the effect of delirium on patients, relatives and healthcare workers remains unknown but evidence from the previous SARS outbreak suggests there may be long-lasting psychological damage.
Subject(s)
COVID-19/epidemiology , COVID-19/psychology , Delirium/epidemiology , Delirium/psychology , Health Personnel/psychology , Brain/metabolism , COVID-19/metabolism , COVID-19/therapy , Delirium/metabolism , Delirium/therapy , Humans , Inflammation Mediators/metabolism , Intensive Care Units/trendsABSTRACT
Introduction The COVID-19 pandemic placed a new focus on provision of clinical resources. With high mortality and limited capacity;appropriate decisions to escalate to critical care were vital for just resource allocation but also to prevent harm where interventions would not change outcomes. NICE guidance highlighted Clinical frailty scoring (CFS) as central to the decision-making process. 1, Despite initial criticism, recent evidence has confirmed increasing CFS as an independent risk factor to inpatient mortality in COVID-19.2 We conducted a quality improvement project with the aim of improving CFS documentation at the Royal Free Hospital. Methods We reviewed the notes of 71 inpatients over the age of 65 years from 6 wards on 08/05/20–12/05/20 for both a CFS score documentation and clear treatment escalation plan at time points of initial clerking, post-take and following ward admission with an audit standard of 100%. We developed teaching sessions, promoted the CFS mobile application, developed a post-take sticker and an elderly medicine ward admission proforma. We re-audited 66 inpatient notes from the same 6 wards from 25/06/20–07/07/20. Results Documentation.of CFS improved from 7% to 17% for clerking and post-take and from 13% to 24% on the ward admission. The number of patients with treatment escalation plans was 50%. Conclusion CFS is crucial for the COVID-19 era and beyond. We have demonstrated that increased awareness improves use of CFS, though it is not yet being widely used in escalation decisions. 1. Covid-19 Rapid guideline: Critical Care in adults. NICE guideline [NG159]: https://www.nice.org.uk/guidance/ng159 Accessed July 2020 2. Hewitt J et al (2020): The effect of frailty on survival in patients with COVID -19 (COPE): a multicentre, European, observational cohort study;The Lancet: https://doi.org/10.1016/ S2468–2667(20)30146–8.