Social Agency and Neurodivergent Routines: Supports and Barriers to the Mental Health of Autistic Adults During the COVID-19 Pandemic

Importance: The coronavirus disease 2019 (COVID-19) pandemic highlighted unique neurodiversity-affirming practices that may support autistic people's mental health, many of which run contrary to typical notions of autism. These insights are critical for occupational therapists working with this population. Objective: To (1) understand the self-reported mental health experiences of autistic adults during the COVID-19 pandemic and (2) identify ways that occupational therapy practitioners and other clinicians can help autistic adults during unexpected and challenging times. Design: This qualitative interpretative phenomenological study used surveys and interviews to collect data between August 15, 2020, and May 1, 2021. Two researchers independently coded interview transcripts. Any disagreements were resolved through consensus. Setting: Qualtrics survey and Zoom interviews. Participants: Participants (N 5 34) met the following inclusion criteria: self-reported diagnosis of autism spectrum disorder or Asperger's syndrome, ages 18 to 35 yr, residing in the Eastern United States, able to understand English, and able to participate in a one-on-one interview using verbal or written communication. Recruitment was conducted via snowball sampling through local agencies serving autistic people. Results: Two themes emerged from the data: (1) autistic adults' social experiences during the COVID-19 pandemic paradoxically supported and hindered their mental health and (2) during the COVID-19 pandemic, mental health was tied to daily activity among autistic adults. Conclusions and Relevance: Participants reported feelings of anxiety and depression, as well as a need for social interaction on their own terms. Clinical recommendations are provided. What This Article Adds: This article includes suggestions generated from autistic people's input on how clinicians can support this population. The suggested supports and alteration to occupations can be both applied in the case of another unexpected event (e.g., another pandemic) and incorporated to promote the participation and well-being of autistic adults. Positionality Statement: We use identity-first language (e.g., autistic person) throughout this article because disability advocates and scholars assert that person-first language (e.g., person with autism) contributes to disability stigma (Collier, 2012;Gernsbacher, 2017). © 2023 American Occupational Therapy Association, Inc. All rights reserved.

CBD Treatment Improves Fatal Inflammatory Response Exhibited in SEB-Induced ARDS

The novel SARS-CoV-2 virus known to cause the COVID-19 outbreak has resulted in a global healthcare crisis that has persisted the past 3 years. Thus, understanding the mechanisms underlying this disease are vital at this time. While there are issues of research infrastructure to handle the virus and because of the refractoriness of rodents to this disease, the availability of these tools is still limited. The cytokine storm and fatality presented in patients with severe COVID-19 can be mimicked with Staphylococcal enterotoxin B (SEB)-induced Acute Respiratory Distress Syndrome (ARDS). Within ~7 days, the survival rate drops to 0% for C3H/HeJ mice exposed to a dual dose of SEB. In this study, we administered cannabidiol (CBD) intraperitoneally for 3 days pre- and post-SEB dosing and found that the clinical outcomes improved significantly. Initial evaluation of scRNASeq data from lungs comparing naive to SEB-induced ARDS mice illustrated an increase in infiltrating immune cells, and a loss in pulmonary epithelial cells in the latter group. When evaluating the effect of CBD treatment on SEB-induced ARDS, we were able to demonstrate that CBD reduced the macrophage population. To characterize the mechanism by which CBD treatment ameliorated the inflammatory response, we found that CBD treated mice had significant reduction in infiltrating immune cells and alveolar thickening. This same histology and infiltration is presented in ARDS. MicroRNA expression analysis showed a significant increase in the expression mmu-miR-298-5p and mmu-miR- 566 with CBD treatment. Ingenuity Pathway Analysis (IPA) indicated that the dysregulated miRNAs were also implicated in pathways associated with macrophage activation, respiratory disease and inflammation, interferon stimulated genes, as well as genes which have been upregulated in the disease state of this model. These targets include but are not limited to Cebpb, Efhd2, Stat3, Socs3, Cxcl5, Gbp2, and Birc3. This finding offers insights for the development of preventive and therapeutic strategies in the treatment of ARDS, including that induced in COVID-19. Supported by NIH grants P01AT003961, P20GM103641, R01ES003961, R01AI129788, R01AI123947, R01AI160896 to MN and PSN and K99GM147910 to KW.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.

VR tourism experiences and tourist behavior intention in COVID-19: an experience economy and mood management perspective

PurposeVirtual reality (VR) technology is a potential tool for tourism marketers to maintain the attractiveness of their destinations and recover from the COVID-19 pandemic. However, the effectiveness of VR technology in motivating potential tourists' visit intention under lockdown conditions remains unknown. An integrated model based on the experience economy framework and mood management theory was, therefore, used to explain how tourists' VR experiences affect their mood management processes and subsequent behaviors. This research also examined how perceived travel risk influenced the relationship between mood management processes and future decisions.Design/methodology/approachThis study used a cross-sectional design based on a sample collected from a Chinese survey company, Sojump. The author surveyed 285 respondents who had experienced VR tourism activities during the COVID-19 pandemic. The research model was tested using partial least squares–structural equation modeling.FindingsThe results demonstrated that the four dimensions of VR experiences differently affected mood management processes, while perceived travel risk differently moderated the influence of mood management processes on visit intention and VR stickiness. This provides insights for tourism marketers to adapt to the current tourism environment and develop recovery strategies.Originality/valueIn response to gaps in the literature, this research examined the effectiveness of VR technology in driving tourists' visit intention during the COVID-19 pandemic, providing insights for tourism marketers to successfully implement VR tourism and plan timely recovery strategies.

Changes in Physical Activity During the COVID-19 Pandemic: A Mixed Methods Assessment

COVID-19 was declared a global pandemic in March 2020. Resulting containment protocols altered the day-to-day lives of people around the globe, impacting typical physical activity patterns. The purpose of this mixed-method study was to understand how physical activity changes occurred during the first few months of the COVID-19 pandemic. Participants (n = 271) completed a survey including a qualitative item asking for descriptions of how their physical activity had changed, as well as a categorical item asking whether they had become more active, stayed equally as active, or become less active during the pandemic. Qualitative responses were analyzed to identify emergent themes, and chi-squared analyses were used to compare proportional differences in themes according to self-reported physical activity classification. Analysis revealed 10 themes: (1) decreased transportation-related physical activity, (2) change in location, (3) loss of resources, (4) discrepancies between self-reported changes in activity level and description of activities, (5) increased transportation-related physical activity, (6) changes in routines, (7) adapting exercise, (8) avoiding contact, (9) changes unrelated to COVID-19, and (10) illness or injury. Significant differences existed between groups for all themes except for avoiding contact, changes unrelated to COVID-19, and injury or illness. Empowering individuals to overcome barriers may be important during a pandemic to help people maintain or increase physical activity levels. Future research should explore the continued experience of people during the COVID-19 pandemic and investigate its impact on levels of physical activity going forward. © 2023, Western Kentucky University. All rights reserved.

Functional Disorders as a Common Motor Manifestation of COVID-19 Infection or Vaccination.

INTRODUCTION: There have been over 500 million confirmed cases of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), also known as coronavirus disease 2019 (COVID-19), across the globe. To date, a broad spectrum of neurological manifestations following acute infections as well as COVID-19 vaccines have been reported. This study aims to describe the spectrum of neurological manifestations seen in the 'COVID-19 clinic' established in a tertiary Movement Disorders clinic. METHODS: In this consecutive case-series study over the period March 2020-January 2022, clinical information regarding demographic data, clinical history and examination findings, investigation results and video recordings of outpatients with motor manifestations associated with COVID-19 infection or vaccination were reviewed. RESULTS: Twenty-one adult patients were reviewed in this ad-hoc clinic at Toronto Western Hospital. The majority of the patients were female (76%) and the average age was 50.7±17.2 years (range: 21-80 years). Nine patients (43%) presented with motor manifestations following COVID-19 infection. Twelve patients (57%) developed neurological symptoms following at least one dose of the mRNA or viral vector-based COVID-19 vaccine. The most common manifestation observed was a functional movement disorder (43%). The vaccine group demonstrated a higher number of functional disorders compared to the infection group (58% vs 22%, p=0.08). DISCUSSION: Functional motor manifestations can be associated with COVID-19 and are likely to be under reported. In view of the co-existence of functional symptoms, movement disorders and mental health conditions observed in this study, we would advocate the use of dedicated COVID-19 Neurology clinics with full access to an experienced multidisciplinary team.

Successful design and execution of two gastric cancer chemoprevention trials in Central America and Puerto Rico

Gastric adenocarcinoma (GAC) is the third leading global cause of cancer mortality and leading infection-associated cancer. The high incidence regions are Latin America, East Asia, and Eastern Europe. In the U.S., GAC represents a major cancer disparity, double the incidence rates in all nonwhite populations, the opposite of Barrett's Esophagus and EAC. Immigrants from high incidence regions maintain the risk profile of their nations of origin. In a paradigm shift, recent guidelines now recommend surveillance endoscopy (eg, 3 years) for patients with high-risk gastric premalignant conditions (GPMCs). Clinical trials of chemoprevention agents for patients with GPMCs are lacking. We conducted two independent, NCI DCP funded, phase II placebo-controlled chemoprevention trials in patients with GPMCs (intestinal metaplasia, atrophic gastritis). The oral agents were curcumin and eflornithine (DFMO). A highly bioavailable preparation of curcumin was used. The RCTs were conducted in Puerto Rico and rural Honduras, with important characteristics: (1) representative of Caribbean and Mesoamerican populations and linked to large U.S. immigrant populations;(2) high prevalence of H. pylori infection and GPMCs;(3) absence of turmeric and curcuminoids in the local diets;(4) proven bidirectional collaboration with academic institutions in the U.S. In the curcumin trial (NCT02782949) H. pylori negative patients were randomized to study drug or placebo for 6 months. In the eflornithine study (NCT02794428), H. pylori positive and negative subjects were randomized to study drug or placebo for 18 months, with endoscopy at baseline, and 6. 18, and 24 months. The primary outcomes were based upon changes in histologic parameters at 6 months. Principal study challenges included: (1) International and bilingual regulatory environment;(2) Strengthening of the research infrastructure, particularly in Central America;(3) Participant recruitment, eg, in the curcumin RCT in Honduras wherein only 10-15% are H. pylori negative;(4) The Covid-19 pandemic;(5) Natural disasters (3 hurricanes). In Conclusion(s): Eflornithine and curcumin RCTs have been successfully completed, despite important challenges in implementation and execution. No losses to follow-up were encountered related to the pandemic or natural disasters. The south-south partnership may provide a model for chemoprevention and translational studies in Latino populations with prevalent cancers such as GAC..

The Proliferation of Living Systematic Reviews (LSRS) - Dead on Arrival? A Review of LSR Methodology

Objectives: Living systematic reviews (LSRs) maintain the relevance of systematic reviews through regular, continuous updates. This research aimed to assess if all LSRs are equal and to identify areas of methodological confusion to provide clarity for those undertaking an LSR. Method(s): A scoping exercise was conducted, informed by pragmatic searches of MEDLINE, Embase and Epistemonikos, to identify records explicitly referring to LSRs. No date limits were applied. Study selection was conducted by double independent reviewers. Where a preprint LSR was superseded by a peer-reviewed publication, the preprint record was excluded. A single reviewer conducted brief data extraction. A narrative synthesis was conducted. Result(s): 760 records were screened at title and , and 241 were assessed for eligibility at full text. 141 LSRs (either full LSR or protocol only) were extracted and synthesised. 97 LSRs focussed on COVID-19, and 44 were non-COVID-19 related. 29 were Cochrane LSRs. Of the 112 non-Cochrane LSRs, 77 were registered on PROSPERO. There appears to be some confusion amongst reviewers regarding PROSPERO's acceptance of LSRs. Justification for the use of LSR methodology and a description of how this methodology would be followed was not always reported. 40 reviews did not describe a clear schedule for search updates or stated that updates would only be conducted if new evidence became available;these may more accurately be described as standard review updates. 32 reviews did not report updates at the purported schedule (whilst not reporting that the review had been officially terminated). Thus, many "living" reviews are effectively dead on arrival. Very few authors reported under what circumstances the LSR would cease. Conclusion(s): LSRs present an opportunity to ensure that a body of evidence is kept up to date. However, caution is advised regarding jumping on a methodological bandwagon without sufficient understanding of the methods and funding required. Copyright © 2022

Applying the principles of triage to support the rapid transition to online learning during the pandemic

In the higher education sector, military academies operate in environments that differ from university campuses. Like other institutions, military academies had to manage changes to learning and teaching in response to the COVID-19 pandemic. This required an approach, a model, that acknowledges and aligns with the needs of a military academy. Using a case study approach, the changes at one faculty at an Australian military academy undergoing a rapid transition to online learning are outlined and evaluated using both survey and unobtrusive data. The changes were framed by a new 3S triage model of see, solve and share, specifically designed for the context of the military academy. Distributed leadership approach and its 6E theoretical tenets are used to detail the model’s application, the role of policy, and positive outcomes, including an increase in student satisfaction.

Connecting Ni Paediatricians Online

Aims Northern Irish paediatric trainees are accustomed to moving to a new trust every 6 months, and in turn having to re-learn management of common conditions based on local guidelines. Following feedback and audit evidence of significant variation in management of common paediatric conditions throughout Northern Ireland (NI), the trainee-led NI Paediatric Education Audit and Research network (NI PEAR) have successfully produced regionally approved guidelines to help standardise care across trusts. The NI PEAR committee recognised there were no resources available for trainees to facilitate easy access to this material and set about creating and launching our own website (www.nipear.squarespace.com). We wanted to create a NI paediatrics trainee hub where guidelines, educational resources, course information and event reminders can be easily accessed. Methods The NI PEAR committee developed a website using the platform 'Squarespace'. The website was designed to be easily navigable with a home page linking to the most frequently used content, a section outlining our aims as a group and a dedicated guidelines page. Regional NI guidelines and links to external guidelines are available whilst we continue to develop our guideline portfolio. Multiple education sections advertise ongoing learning opportunities available to trainees. There are numerous areas for those visiting the website to submit their request for a guideline to be uploaded and to suggest or show interest in audit and research opportunities. Results The NI PEAR website went 'live' in December 2021 and has proved to be extremely popular with NI Trainees to date. The site received over 500 hits within the first few weeks of launch and has been supported by consultants in the region. We conducted an online survey which showed 100% of trainees who responded previously having difficulties locating guidelines in a timely manner, 100% stating a regional hub for guidelines and training information is useful and 82% finding that the website has enhanced their experience as a trainee in its first version. Conclusion Modern Technology is becoming increasingly integrated into the trainee experience. We have all witnessed a shift in approaches to teaching, meetings and how we receive our information since the beginning of the COVID 19 pandemic. Yet, harnessing this technology to improve the trainee experience is something we receive no formal training on. We, as a group of trainees, have taken the initiative to build a platform tailored to our needs. It is designed to be the one stop hub for paediatrics in NI, whether that's checking when the next PICU telelink is, or at 3am when you have a sick child and need to access a guideline. Through this project, we will be able to improve the standard of care delivered to our paediatric population in NI with regional guidance and improve the experience of our trainees by giving everyone access to the same resources. Most importantly, this is a resource created by trainees, for trainees, giving us somewhere to interact with each other's work, to collaborate and build a robust network of paediatricians in NI.

Impact of an interdisciplinary goals of care program on hospital outcomes at a comprehensive cancer center during the COVID-19 pandemic: A propensity score analysis

Background: Many hospitals have established goals-of-care (GOC) programs in response to the COVID- 19 pandemic;however, few have reported their outcomes. MD Anderson Cancer Center launched a multicomponent interdisciplinary GOC (myGOC) program in March 2020 that involved risk stratification, team huddles to discuss care planning, oncologist-initiated GOC discussions, communication training, palliative care involvement, rapid-response GOC team deployment, and daily monitoring with immediate feedback. We examined the impact of this myGOC program among medical inpatients. Methods: This single-center study with a quasi-experimental design included consecutive adult patients with cancer admitted to medical units at MD Anderson Cancer Center, Texas during an 8-month pre-implementation (May 1, 2019 to December 31, 2019) and post-implementation period (May 1, 2020 to December 31, 2020). The primary outcome was intensive care unit (ICU) mortality. Secondary outcomes included ICU length of stay, hospital mortality, and proportion/timing of patients with inhospital do-not-resuscitate (DNR) orders, medical power of attorney (MPOA), living will (LW) and outof- hospital DNR (OOHDNR). Propensity score weighting was used to adjust for differences in potential covariates, including age, sex, cancer diagnosis, race/ethnicity, and Sequential Organ Failure Assessment (SOFA) Score. With a sample size of 600 ICU patients over each time period and a baseline ICU mortality of 28%, we had 80% power to detect a 5% reduction in mortality using a two-tailed test at 5% significance level. Results: This study involved 12,941 hospitalized patients with cancer (Pre n = 6,977;Post n = 5,964) including 1365 ICU admissions (Pre n = 727;Post n = 638). After myGOC initiation, we observed a significant reduction in ICU mortality (28.2% vs. 21.9%;change -6.3%, 95% CI -9.6, -3.1;P = 0.0001). We also observed significant decreases in length of ICU stay (mean change -1.4 days, 95% CI -2.0, -0.7 days;P < 0.0001) and in-hospital mortality (7% vs. 6.1%, mean change -0.9%, 95% CI -1.5%, -0.3%;P = 0.004). The proportion of hospitalized patients with an inhospital DNR order increased significantly from 14.7% to 19.6% after implementation (odds ratio [OR] 1.4, 95% CI 1.3, 1.5;P < 0.0001) and DNR was established earlier (mean difference -3.0 d, 95% CI -3.9 d, -2.1 d;P < 0.0001). OOHDNR (OR 1.3, 95% CI 1.1, 1.6, P < 0.0007) also increased post-implementation but not MPOA and LW. MPOA, LW and OOHDNR were documented significantly earlier relative to the index hospitalization in the post-implementation period (P < 0.005 for all). Conclusions: This study showed improvement in hospital outcomes and care plan documentation after implementation of a system-wide, multicomponent GOC intervention. Our findings may have implications for GOC programs during the pandemic and beyond.

Peripartum Outcomes Following COVID-19 Vaccination in Late Pregnancy: Findings from a Population-Based Retrospective Cohort Study in Ontario, Canada

Objectives: Evaluate peripartum outcomes following COVID-19 vaccination during pregnancy. Methods: Ontario population-based retrospective cohort between December 14, 2020 and September 30, 2021 using linkage of provincial birth registry and COVID-19 immunization databases. Poisson regression was used to generate risk ratios (RR) and 95% confidence intervals (CI), adjusted for temporal, socio-demographic, and clinical factors using propensity scores. Obstetric (postpartum hemorrhage, chorioamnionitis, cesarean birth) and newborn (NICU admission and 5-minute Apgar<7) outcomes were compared for those who received ≥1 dose of COVID-19 vaccine during pregnancy with 2 unexposed groups—Group 1: individuals vaccinated postpartum, Group 2: never vaccinated. Results: Among 97 590 individuals, 22 660 (23%) received ≥1 dose of vaccine during pregnancy (64% received dose 1 in 3rd trimester). Compared with those vaccinated postpartum, we found no increased risks of postpartum hemorrhage (aRR 0.91, 95% CI 0.82–1.02);chorioamnionitis (aRR 0.92, 95% CI 0.70–1.21);or cesarean (aRR 0.92, 95% CI 0.89–0.95) following COVID-19 vaccination, nor any increased risk of NICU admission or 5-minute Apgar <7. All findings were similar when compared with individuals who did not receive COVID-19 vaccination at any point. We did not observe any difference according to vaccine product, number of doses received during pregnancy, or trimester of dose 1. Conclusions: As of late 2021, there is limited evidence from comparative studies in large populations on outcomes following COVID-19 vaccination during pregnancy. Our study of births up to September 30, 2021 did not identify any increased adverse peripartum outcomes associated with later pregnancy COVID-19 vaccination. Once more individuals vaccinated earlier in pregnancy deliver, we will report on other important obstetric and perinatal outcomes. Keywords: COVID-19 vaccine;pregnancy;epidemiology

Improving the Care of Newly Arrived Immigrant Patients in Two Primary Care Clinics

Purpose/Objectives: 1) To design and implement a clinical pathway that delineates evidence-based recommendations of screening for newly arrived immigrant children in an academic primary care setting. 2) To improve adherence to recommended biomedical and infectious screening by providers caring for newly arrived immigrant children. 3) To evaluate the effectiveness of the clinical pathway and adjunct tools to support uptake and adherence to the pathway with a goal of achieving 90% adherence to key indicators in 18 months. Design/Methods: A clinical pathway for primary care of newly arrived immigrant children was developed and implemented based on existing evidence from immigrant and refugee populations, delineating recommended psychosocial, developmental, biomedical, and infectious screenings by region of origin. Adjuncts to support uptake were implemented, including an EMR order-set and note template. Faculty and resident education to the pathway was conducted in person and with pre-recorded educational presentations. Indicators of adherence were defined as the percentage of patients who obtained the recommended screening tests according to their world region of origin. Results: A total of 301 newly arrived immigrant patients were seen at the clinics during our observation period (from Dec 2018-May 2021);190 (63%) were seen after the rollout of our main interventions in August 2019, and 70 (23%) were seen after the onset of the COVID-19 pandemic in March 2020. We observed an improvement in the % of patients who obtained lead level, Complete Blood Count (CBC) with differential, Strongyloides, and Tuberculosis screening on their first visit in the U.S. following the introduction of the clinical pathway and order-set (Images 1 and 2). There have been six consecutive points above the mean in the case of lead level and Tuberculosis screening. In the case of Strongyloides screening, a mean shift was observed months after the implementation of the pathway. On average, 74% of the ordered screening tests for these patients were entered using the order-set. The COVID-19 pandemic impacted the number of new patients in both clinics from April 2020-Sep 2020. Periodical reminders and continuous education to providers also have proved beneficial to our goals. Conclusion/Discussion: Implementation of a clinical pathway for the care of newly arrived immigrant children resulted in improvements in adherence to region-specific recommendations for biomedical and infectious screenings;specifically for lead, CBC with differential, Strongyloides, and Tuberculosis screening. Implementation of an order-set embedded in the electronic medical records system was a successful strategy to facilitate adherence. Drastic reductions in the number of new immigrant children seeking care during the initial months of the COVID-19 pandemic raised concerns about access barriers for this vulnerable population and required strategies to remind clinicians about the use of the pathway as numbers of new immigrant patients return to baseline.