Functional Impact of Telehealth Physical Therapy Services on Patients Post Hematopoietic Stem Cell Transplant

BACKGROUND AND PURPOSE: Stem cell transplantation (SCT) in patients with hematological cancers results in longstanding physical changes. Commonly reported symptoms include chronic fatigue, global weakness, interference with activities of daily living (ADLs) and aerobic deconditioning. Aside from the sequela of symptoms experienced post SCT, these patients remain in an immunosuppressed state for several months following discharge from the hospital. Patients are often advised by their medical team to isolate themselves unless to attend follow-up outpatient clinic appointments. With the COVID-19 pandemic, this functional gap in the continuum of care worsened. As a result, SCT patients are both hesitant and discouraged to pursue outpatient or home health physical therapy even when these services are warranted. Thus, there is great need for options to safely optimize function for people post-SCT that are suitable in today's ever-changing environment. The purpose of this case series is to describe the functional impact of incorporating telehealth into the continuum of care for post SCT patients. CASE DESCRIPTION: 9 patients post inpatient admission for SCT were triaged to telehealth PT based on their scores on the Short Physical Performance Battery (SPPB) and the Activity Measure for Post Acute Care (AM-PAC) at the time of discharge from inpatient care. Scores on the SPPB ranged from 5-11, and AMPAC scores ranged from 21-24, demonstrating physical impairment. Patients were scheduled to receive telehealth twice a week. Sessions consisted of therapeutic exercises monitored via secure video software. Lab values were monitored via electronic medical record to assess appropriateness for therapy prior to each session. Rating of perceived exertion (RPE) scale and patientowned pulse oximeter were used to monitor patient fatigue levels. Patients' progress was assessed via Lower Extremity Functional Scale (LEFS), Brief Fatigue Inventory (BFI) and 5-times sit to stand (5xSTS) scores. OUTCOME(S): One year post telehealth implementation, patients reported improved independence and achievement of selfselected goals. Notable patient quotes include, "I feel less fearful in climbing up and down the stairs, and I feel more independent with laundry and cooking.which was very important for me." Additionally, patients reported a decrease in LEFS and BFI scores. Initial LEFS scores averaged 40% and dropped to 20% by discharge. Similarly, BFI scores dropped by 2 points at discharge, reflecting improved self-reported functional performance and a return to pre transplant fatigue levels. 5xSTS scores decreased by greater than 3 seconds in 6 of 9 patients, with one patient performing where previously unable. DISCUSSION: Telehealth services provide an additional method of care delivery to those unable to seek it in the traditional sense. For the severely immunocompromised, physical therapy via telehealth provides direct connection to providers trained in oncology rehabilitation serving as a feasible bridge between inpatient and outpatient care for amelioration of side effects associated with SCT.

Covid-19 Mppt Algorithm Application to Solar Energy Conversion System

Alternative energy alternatives to traditional energy sources like coal and fossil fuels include solar PV and wind energy conversion systems. The solar and wind energy conversion system's maximum power may be obtained by activating the converters. There are several MPPT (Maximum Power Point Tracking) regulating methods for solar and wind energy conversion systems. For solar PV energy conversion systems, this study suggests two MPPT controlling techniques: Covid-19 MPPT and FLC-based MPPT. The two MPPT methods that are suggested are put into practise using MATLAB. The first Covid-19 approach that has been developed combines aspects of hill climbing and progressive conductance methods. Calculate the direction of the perturbation for the PV modules' operation using the incremental conductance approach. The method of ascending hills is straightforward and involves fewer variables. When dI/dV equals the incremental conductance, the Maximum Power Point (MPP) is attained using the incremental conductance approach. In the hill climbing approach, the MPP is determined by comparing the power in the present and the past. Both incremental conductance and change of power are taken into account in the proposed Covid-19 MPPT regulating approach to obtain the MPP. With this hybrid approach, solar PV generates the most electricity possible under all conditions of temperature and irradiance. As a result, the planned Covid-19 technique moves forward as intended and swiftly reaches the MPP.Copyright © 2022, Anka Publishers. All rights reserved.

Late acceptance hill climbing aided chaotic harmony search for feature selection: An empirical analysis on medical data

In today's era of data-driven digital society, there is a huge demand for optimized solutions that essentially reduce the cost of operation, thereby aiming to increase productivity. Processing a huge amount of data, like the Microarray based gene expression data, using machine learning and data mining algorithms has certain limitations in terms of memory and time requirements. This would be more concerning, when a dataset comes with redundant and non-important information. For example, many report-based medical datasets have several non-informative attributes which mislead the classification algorithms. To this end, researchers have been developing several feature selection algorithms that try to discard the redundant information from the raw datasets before feeding them to machine learning algorithms. Metaheuristic based optimization algorithms provide an excellent option to solve feature selection problems. In this paper, we propose a music-inspired harmony search (HS) algorithm based wrapper feature selection method. At the beginning, we use a chaotic mapping to initialize the population of the HS algorithm in order to better coverage of the search space. Further to complement the inferior exploitation of the HS algorithm, we integrate it with the Late Acceptance Hill Climbing (LAHC) method. Thus the combination of these two algorithms provides a good balance between the exploration and exploitation of the HS algorithm. We evaluate the proposed feature selection method on 15 UCI datasets and the obtained results are found to be better than many state-of-the-art methods both in terms of the classification accuracy and the number of features selected. To evaluate the effectiveness of our algorithm, we utilize a combination of precision, recall, F1 score, fitness value, and execution time as performance indicators. These metrics enable us to obtain a comprehensive assessment of the algorithm's abilities and limitations. We also apply our method on 3 microarray based gene expression datasets used for prediction of cancer to ensure the scalability and robustness as a feature selection method in real-life scenarios. In addition to this, we test our approach using the COVID-19 dataset, and it performs better than several metaheuristic based optimization techniques. © 2023

Hybrid harmony search algorithm for social network contact tracing of COVID-19.

The coronavirus disease 2019 (COVID-19) was first reported in December 2019 in Wuhan, China, and then moved to almost every country showing an unprecedented outbreak. The world health organization declared COVID-19 a pandemic. Since then, millions of people were infected, and millions have lost their lives all around the globe. By the end of 2020, effective vaccines that could prevent the fast spread of the disease started to loom on the horizon. Nevertheless, isolation, social distancing, face masks, and quarantine are the best-known measures, in the time being, to fight the pandemic. On the other hand, contact tracing is an effective procedure in tracking infections and saving others' lives. In this paper, we devise a new approach using a hybrid harmony search (HHS) algorithm that casts the problem of finding strongly connected components (SCCs) to contact tracing. This new approach is named as hybrid harmony search contact tracing (HHS-CT) algorithm. The hybridization is achieved by integrating the stochastic hill climbing into the operators' design of the harmony search algorithm. The HHS-CT algorithm is compared to other existing algorithms of finding SCCs in directed graphs, where it showed its superiority over these algorithms. The devised approach provides a 77.18% enhancement in terms of run time and an exceptional average error rate of 1.7% compared to the other existing algorithms of finding SCCs.

A Climbing (Bouldering) Intervention to Increase the Psychological Well-Being of Adolescents in the Bekaa Valley in Lebanon-Study Protocol for a Controlled Trial.

(1) Background: Adolescent refugees in Lebanon and Lebanese youth are both at high risk of suffering from reduced psychological well-being. Sport is an evidence-based strategy for improving mental and physical health, and climbing is a type of sport that may positively impact both. The aim of this study is to test the effect of a manualized, psychosocial group climbing intervention on the well-being, distress, self-efficacy, and social cohesion of adolescents in Lebanon. In addition, the mechanisms behind psychological changes will be investigated. (2) Methods: In this mixed-methods waitlist-controlled study, we are allocating a minimum of 160 participants to an intervention (IG) or a control group (CG). The primary outcome is overall mental well-being (WEMWBS) after the 8-week intervention. Secondary outcomes include distress symptoms (K-6 Distress Scale), self-efficacy (General Self-Efficacy Scale; GSE), and social cohesion. Potential mechanisms of change and implementation factors are being investigated through qualitative interviews with a subgroup of 40 IG participants. (3) Conclusions: The results may contribute to knowledge of sports interventions and their effects on psychological well-being and will provide insights regarding low-intensity interventions for supporting adolescent refugees and host populations in conflict-affected settings. The study was prospectively registered at the ISRCTN platform (current-controlled trials). ISRCTN13005983.

A COVID-19 X-ray image classification model based on an enhanced convolutional neural network and hill climbing algorithms.

The classification of medical images is significant among researchers and physicians for the early identification and clinical treatment of many disorders. Though, traditional classifiers require more time and effort for feature extraction and reduction from images. To overcome this problem, there is a need for a new deep learning method known as Convolution Neural Network (CNN), which shows the high performance and self-learning capabilities. In this paper,to classify whether a chest X-ray (CXR) image shows pneumonia (Normal) or COVID-19 illness, a test-bed analysis has been carried out between pre-trained CNN models like Visual Geometry Group (VGG-16), VGG-19, Inception version 3 (INV3), Caps Net, DenseNet121, Residual Neural Network with 50 deep layers (ResNet50), Mobile-Net and proposed CNN classifier. It has been observed that, in terms of accuracy, the proposed CNN model appears to be potentially superior to others. Additionally, in order to increase the performance of the CNN classifier, a nature-inspired optimization method known as Hill-Climbing Algorithm based CNN (CNN-HCA) model has been proposed to enhance the CNN model's parameters. The proposed CNN-HCA model performance is tested using a simulation study and contrasted to existing hybridized classifiers like as Particle Swarm Optimization (CNN-PSO) and CNN-Jaya. The proposed CNN-HCA model is compared with peer reviewed works in the same domain. The CXR dataset, which is freely available on the Kaggle repository, was used for all experimental validations. In terms of Receiver Operating Characteristic Curve (ROC), Area Under the ROC Curve (AUC), sensitivity, specificity, F-score, and accuracy, the simulation findings show that the CNN-HCA is possibly superior than existing hybrid approaches. Each method employs a k-fold stratified cross-validation strategy to reduce over-fitting.

Epilepsy Connections'Beyond the Clinic Walls

Objective: As part of Epilepsy Connections' role in providing support to people affected by epilepsy, we aim to raise awareness of epilepsy at a community/grassroots level, with particular focus on: (1) school communities through our Schools Project/Seizure-Smart Schools;and (2) providing fun activities for families affected by childhood epilepsies (FACE). We recognise that for young people with epilepsy (YPE) to live their lives to the full, their needs go much further than the clinical involvement of their healthcare teams. Our objectives were (1) To promote knowledge of epilepsy, seizures and how to help when a seizure happens'so that YPE can go about their lives, confident that the people around them are informed and respectful;and (2) to provide fun activities for YPE and their families. Method(s): (1) Age-appropriate playground-based activities (message games, story time/roleplay/drama, arts and crafts, using hands-on brain/neuron models) for nursery/primary classes, and workshops for secondary/college students/school staff;(2) large-scale public events (virtual festivals and face-to-face) in collaboration with the Glasgow Science Centre, and EPNA Congress in Glasgow;(3) bespoke, supported days out for individual families;(4) Three residential trips to Ardentinny Outdoor Education Centre since September 2021, for families new to us and those already accessing our services. Result(s): (1) Engagement with thousands of participants;(2) YPE and families took part in fun, adventurous outdoors activities (canoeing, gorge walking, climbing, abseiling, forest and beach walks), got together for meals, informal peer support and family disco! Conclusion(s): Families value having breaks and activities in a supportive, inclusive and bespoke way. We re-modelled how we provide our activities within school communities and with FACE, to reflect COVID-19 protective measures. Nonetheless, the ongoing impact of COVID-19 restricts opportunities to engage.

Rare case of post-COVID transverse myelitis

Case Report: Acute transverse myelitis (TM) is a rare inflammatory disease that typically presents asweakness, sensory alterations, and bowel or bladder dysfunction. Among the causes of TM are infections, paraneoplastic syndromes, or autoimmune conditions of CNS. Postinfectious TM can develop secondary to a viral or bacterial infection. SARS-CoV-2 is a recently discovered viral illness, and sequelae due to COVID-19 infection are still being studied. There is scarce literature relating the two conditions, and it is imperative to raise awareness. A 72-year-old man with hypertension and GERD, completely independent in ADL, was brought to the ED with sudden onset of bilateral lower extremity weakness. He reported symptoms started with difficulty climbing stairs that rapidly progressed to inability to ambulate independently and were associated with bilateral thigh soreness. Nine days prior, he developed fever and generalized malaise, and two days later, SARS-CoV-2 PCR and Ag tests were positive. He received azithromycin, Paxlovid, and dexamethasone as treatment. Upon evaluation, the patient was afebrile and hemodynamically stable. Neurological examination was remarkable for spasticity and hyperreflexia at bilateral lower limbs, clonus, preserved motor strength with adequate sensation to soft touch, and intact vibration and proprioception in all extremities. Cranial nerves were intact. These findings were consistent with an upper motor neuron lesion. On imaging, the Head CT scan was unremarkable. Thoracic/Lumbar Spine MRI was significant for distal thoracic and conus areas with central homogeneous brightness compatible with nonspecific myelitis. Laboratories showed leukocytosis without neutrophilia or bandemia, thrombocytosis, and elevated CRP. HIV and RPR tests were negative. A lumbar puncture for CSF analysiswas remarkable for mild monocytic pleocytosis (7 cell/muL), an increased level of total proteins (56 mg/dL), and normal glucose (57 mg/dL). CSF culture and gram stain were negative. CSF cytology yielded few lymphocytes and few monocytes and was negative for malignant cells. The meningoencephalitis panel was negative. Based on these findings, a clinical diagnosis of postinfectious myelitis secondary to COVID-19was made. The patient was treated with intravenous Methylprednisolone 1 g daily for five days. On follow-up, lower extremity weakness resolved completely, and he resumed his daily physical activities. Patients with COVID-19 infection can present with neurologic manifestations such as headache, myalgias, dizziness, dysgeusia, and anosmia. This case hopes to raise awareness of less commonly known neurological manifestations of SARS-CoV-2 infection and how the early recognition of symptoms can help expedite the diagnosis and treatment of the condition to avoid long-term sequelae. [Figure presented] Copyright © 2023 Southern Society for Clinical Investigation.

Optimizing CNN-LSTM hybrid classifier using HCA for biomedical image classification

In medical science, imaging is the most effective diagnostic and therapeutic tool. Almost all modalities have transitioned to direct digital capture devices, which have emerged as a major future healthcare option. Three diseases such as Alzheimer's (AD), Haemorrhage (HD), and COVID-19 have been used in this manuscript for binary classification purposes. Three datasets (AD, HD, and COVID-19) were used in this research out of which the first two, that is, AD and HD belong to brain Magnetic Resonance Imaging (MRI) and the last one, that is, COVID-19 belongs to Chest X-Ray (CXR) All of the diseases listed above cannot be eliminated, but they can be slowed down with early detection and effective medical treatment. This paper proposes an intelligent method for classifying brain (MRI) and CXR images into normal and abnormal classes for the early detection of AD, HD, and COVID-19 based on an ensemble deep neural network (DNN). In the proposed method, the convolutional neural network (CNN) is used for automatic feature extraction from images and long-short term memory (LSTM) is used for final classification. Moreover, the Hill-Climbing Algorithm (HCA) is implemented for finding the best possible value for hyper parameters of CNN and LSTM, such as the filter size of CNN and the number of units of LSTM while fixing the other parameters. The data-set is pre-processed (resized, cropped, and noise removed) before feeding the train images to the proposed models for accurate and fast learning. Forty-five MR images of AD, Sixty MR images of HD, and 600 CXR images of COVID-19 were used for testing the proposed model ‘CNN-LSTM-HCA'. The performance of the proposed model is evaluated using six types of statistical assessment metrics such as;Accuracy, Sensitivity, Specificity, F-measure, ROC, and AUC. The proposed model compared with the other three types of hybrid models such as CNN-LSTM-PSO, CNN-LSTM-Jaya, and CNN-LSTM-GWO and also with state-of-art techniques. The overall accuracy of the proposed model received was 98.87%, 85.75%, and 99.1% for COVID-19, Haemorrhage, and Alzheimer's data sets, respectively. © 2023 John Wiley & Sons Ltd.

Effect of robot-assisted stair climbing training as part of a rehabilitation program to improve pulmonary function, gait performance, balance, and exercise capacity in a patient after severe coronavirus disease 2019: a case report.

BACKGROUND: Severe coronavirus disease 2019 (COVID-19) infection may decrease respiratory and physical functions. OBJECTIVE: To evaluate whether robot-assisted stair climbing training (RASCT) would improve pulmonary and physical functions in a patient post-severe COVID-19 infection. CASE DESCRIPTION: A 48-year-old woman who had experienced severe COVID-19 underwent a 6-week inpatient rehabilitation. She persistently exhibited impaired pulmonary and physical functions, including walking and balance impairment. We provided a 30-min outpatient RASCT biweekly for 6 weeks. OUTCOMES: After training, maximal inspiratory and maximal expiratory pressures improved from 81 and 74 cmH2O to 104 and 81 cmH2O, respectively. The walking speed improved from 1.15 to 1.21 m/s. In balance ability, physical performance battery score and timed up-and-go test improved from 8 to 11 s and 10.89 to 9.95 s, respectively. Regarding exercise capacity, the 6-min walk test distance improved from 453 to 482 m, and the number of 1-min sit-to-stand test improved from 20 to 23, with improved pulse rate and saturation level. The physical and psychological domain scores of the World Health Organization Quality-of-Life Scale-BREF improved from 44 to 63 and 69 to 81, respectively; Falls Efficacy Scale-International scores improved from 38 to 21. CONCLUSION: RASCT, as part of a rehabilitation plan, was feasible and effective for this patient after severe COVID-19 infection.

Impact of Personal Protective Masks on Cardiorespiratory Variables in Healthy Subjects and Patients with Heart Failure: An Interim Analysis

Background: protective masks have emerged as a powerful mean to contain the COVID-19 pandemic. However, a general feeling that masks alter the normal dynamics of breathing may reduce the application of this protective device. Patients with heart failure (HF) experience dyspnea even during daily life activities (ADLs). Aim of the study is to evaluate cardiorespiratory parameters during ADLs, cardiopulmonary exercise test (CPET) and sleep to highlight any difference related to protective masks. Method(s): 9 healthy subjects (age 59+/-11, 2 female) and 10 HF patients (age 64+/-11, 2 female, ejection fraction <45%, stable conditions) underwent a set of cardiopulmonary tests twice, wearing a protective surgical mask and without it. We performed the following tests: standard spirometry;CPET;a set of tests recorded by a wearable ergospirometer (Cosmed K5), including ADLs (ADL1: getting dressed, ADL2: folding eight towels, ADL3: putting away 6 bottles, ADL4: making a bed, ADL5: sweeping the floor for 4 minutes, ADL6: climbing 1 flight of stairs carrying a load), six-minute walking test (6MWT) and two 4-minute treadmill exercises (TREAD2 and TREAD3 at a speed of 2 km/h and 3 km/h, respectively);home polysomnography (HPS). Result(s): Both healthy subjects and HF patients completed the protocol with no adverse events. Spirometry showed a reduction of forced expiratory volume in 1s (3.29+/-0.75 L vs 2.65+/-0.57 L as for healthy subjects, p= 0.002;2.45+/-0.6 L vs 1.97 +/-0.54 L as for HF patients, p= 0.002) and forced vital capacity (4.14+/-0.92 L vs 3.39+/-0.83 L as for healthy subjects, p= 0.004;2.93+/-0.76 L vs 2.59+/-0.73 L as for HF patients, p= 0.01) in both the groups from no mask to mask. As for the CPET, both healthy and HF patients showed: a trend of reduction of peak oxygen pulse (p<0.005 in healthy) and peak oxygen consumption (VO2);a decrease of tidal volume (Vt) at peak exercise (peak Vt: 2.283+/-0.449 L vs 1.864+/-0.359 L in healthy, p= 0.022;1.6+/-0.41 L vs 1.448+/-0.431 L in HF, p= 0.02), with no significative variations of resting and peak ventilation (VE). HF patients experienced a statistically significative decrease of VO2 at the anaerobic threshold (AT) (794+/-227 vs 682 +/-151 mL min-1, p=0.01). No significant differences in the other CPET parameters were observed. As for tests recorded by a wearable cart, task-related VO2 was significantly reduced from no mask to mask in ALDs and 6MWT in the healthy, whereas HF patients experienced a significative reduction in ADL1, ADL4, 6MWTand TREADs (probably more physically demanding tasks). Both healthy and HF subjects showed an increase in the basal and task-related ratio of VE vs carbon dioxide production (VE/VCO2) between the two protocol conditions. No difference in the main HPS parameters were observed from no mask to mask. Conclusion(s): Surgical masks slightly influences cardiorespiratory variables in healthy and HF patients at rest and during both mild and maximal physical activity. The physiological impact of the mask is far from being clinically relevant and no main differences between the groups were noted, except for an early AT in patients with HF. Since no main limitations were observed, the use of masks seems to be safe both in the general population and in HF patients. Moreover, it does not have a significant impact on sleep neither in healthy subjects nor in patients with HF, these ones particularly at risk of sleep apneas. These data should be confirmed in a larger group of patients.

Climbing Mount Everest: Tips for C-L Psychiatrists Managing Patients with Anorexia Nervosa on The Medical Unit

Background/Significance: The prevalence of anorexia nervosa (AN) has drastically increased in the face of the COVID-19 pandemic (Schwartz et al 2021, Goldberg et al. 2022), resulting in increased number of presentations of malnourished AN patient on general medical units. The AN population is one of the most difficult to manage in a medical setting, due to both patient factors, such as ambivalence towards recovery and behaviors that interfere with weight gain, as well as systemic barriers, such as the lack of structured containment and consistent staffing for patient supervision. There is a significant need for increased eating disorders expertise in CL psychiatry as we continue to support our medical colleagues in the treatment of these patients. Method(s): The Toronto General Hospital (TGH) at the University of Toronto has been creating a pathway where CL psychiatrists closely consult with colleagues working in the TGH eating disorders program for challenging cases, with the goal of developing a consistent future treatment approach for individuals presenting with anorexia nervosa on a medical unit. Key challenges from clinical cases were identified and targeted as areas for education and improvement. Result(s): Major challenges from past clinical cases of AN requiring consultation are described. Themes include difficulty with finding of incapacity for these patients, ongoing eating disorders symptoms during the process of refeeding, inconsistent staff approaches, and poor weight gain and prolonged hospitalizations. Important lessons learned and recommendations for future practice are discussed. Promotion of rapid weight gain via multiple measures, consistent limit setting and a united approach to patient care by all members of the multidisciplinary team were identified as key elements to the successful treatment of anorexia patients. Features that would support a clinical finding of incapacity are also discussed. Conclusion/Implications: Barriers to successful treatment of AN patients on inpatient medical settings are highlighted, and effective treatment approaches to these patients are discussed by sharing insights from the collaborative pathway between CL psychiatry and the eating disorder program created at the Toronto General Hospital. References: 1. Schwartz MD., Costello KL. Eating disorder in teens during the COVID-19 pandemic. Journal of adolescent health. 2021 (68): 1020-1023. 2. Goldberg L., Ziv A., Vardi Y., Hadas S., Zuobi T., Yeshareem L., Gur T., Steinling S., Scheuerman O., Levinsky Y. The effect of COVID-19 pandemic on hospitalization and disease characteristics of adolescents with anorexia nervosa. European journal of pediatrics 2022 Jan (3): 1-5. Copyright © 2022

Predicting mobility using limited data during early stages of a pandemic.

The COVID-19 pandemic has changed consumer behavior substantially. In this study, we explore the drivers of consumer mobility in several metropolitan areas in the United States under the perceived risks of COVID-19. We capture multiple dimensions of perceived risk using local and national cases and death counts of COVID-19, along with real-time Google Trends data for personal protective equipment (PPE). While Google Trends data are popular inputs in many studies, the risk of multicollinearity escalates with the addition of more relevant terms. Therefore, multicollinearity-alleviating methods are needed to appropriately leverage information provided by Google Trends data. We develop and utilize a novel optimization scheme to induce linear models containing strictly significant covariates and minimal multicollinearity. We find that there are a variety of unique factors that drive mobility in different geographic locations, as well as several factors that are common to all locations.

Factors Determining Tourists Motivation To Visit A Place for Adventure Tourism: A Systematic Review

India is a country with diversity. It is the gift of nature wherein different rivers, mountains, hill stations, forts, caves, historical places are in the country. It is the social, cultural, religious, and geographical diversity. All these conditions are favourable for travel, tourism and hospitality in India. The young generation, use of technology, expert guidance, safety tools have paved the ways to adventure tourism not only in India but also in the world. The ‘adventure tourism’ is a niche form of tourism which includes deep exploration and extensive travelling to far-flung areas. It is based on the principle of ‘expect the unexpected.’ This is because it is closely association with greater risk as compared to other kinds of tourism. Some of the best examples could be rock climbing, mountaineering expedition, trekking, river rafting, Scuba diving etc. The present study is a review article which examines the different trends, challenges, opportunities, and prospects of adventure tourism in India. The systematic literature review method is applied in this regard. The author has used “Indian Tourism”, “Adventure Tourism”, “Adventure Sports” “Trekking”, “Rock Climbing”, “River Rafting”, “Mountaineering” and other relevant keywords are used to search the existing literature. The study covers the period from 2000 to 2022 as selection criteria. It is applicable for the Indian region. The impact of COVID-19 on adventure tourism is also taken into consideration. The study is unique and significant as it deals with the regional balance, eco-tourism, sustainable development etc. It has historical, cultural, geographical, socio-economic importance from national and international perspectives.

Quick Clinical Outcome Assessments

The Covid-19 pandemic has highlighted the diffi- culty in the management of neuromuscular patients and the need for continued implementation of the standard of care. With the new pandemia psychometrically robust but quick outcome measures are needed to monitor patients' clinical status. The slow progressive nature of several muscle disorders and the wide pattern of involvement in muscular dystrophies and myopathies make it difficult to establish the prognosis, predict clinical evolution and perform trials and define the impact of natural history, and use new therapies that are becoming available. We constructed a motor function test that is easy and quick to use. This quick Motor Function test: Gait, Stair, Gower's, Chair (GSGC) was constructed based on the clinical expertise of several physicians involved in the care of DMD;LGMD, and Pompe patients. The GSGC score can be integrated by the use of the motor function of the upper motor limbs with the arm function test (GSGCA). It consists of a simple standardized functional test which grades the ability of the patient to raise their upper arms over the head. Grade 0 corresponds to a full circle of arm abduction, while with grade 6 the patients cannot raise their arms to their mouth and effectively use their hands. The Gardner-Medwin Walton (GMW) scale even modifi ed appears in comparison rather insensitive. The GSGC test includes 4 items. The test provides a detailed picture of motor function by including a quantitative measure of four performances i.e. time to perform four activities: Gait =walking for 10 meters, S=climbing 4 steps on a Stair, G= Gower's maneuver, C= rising from a Chair (Figure) The GSGC final score is obtained by adding the grades of the four functional tests and ranges from a minimum of 4 (normal performance) to a maximum of 27 (worst performance).GSGCA test includes 5 tests (total score from 5 to 32). Validity and test reliability were determined in a cohort of 9 adult Pompe patients (15 to 54 years of age) and then validated in 40 LOPD cases by a collaborative group. The responsiveness of the GSGCA scale to changes in clinical course over time was examined in a subgroup of 13 LGMD 2B/R2 untreated patients. Interrater and intrarater reliabilities were most usually confirmatory. The motor outcomes are different in various myopathies and depend on a correct diagnosis, while exercise in myopathy patients should be moderate, but not necessarily discouraged. The muscle MRI imaging might be helpful for follow-up of the proximal or distal muscle involvement, to detect fat, and connective tissue replacement, which might be usually absent in metabolic myopathies, except for LOPD. Diet and exercise in LOPD might be an additional therapeutic option synergistic to ERT. In this presentation, we examine the use of the GSGC scale in LOPD, DMD, and GSGCA scales in the natural history of LGMD R2. The development of smart care using telemedicine and eHealth technologies to share images, clinical data, reports, and video meetings of collaborative groups should be implemented. Keywords: GSGC scale, Covid-19, DMD, LGMD, Pompe.

A Case of ChronicInflammatory Demyelinating Polyneuropathy after Pfizer COVID-19 Vaccination

Objective: NA Background: Chronic inflammatory demyelinating polyneuropathy is an immune-mediated polyneuropathy characterized by peripheral demyelination, resulting in symmetrical sensory loss and distal and proximal muscle weakness. While CIDP has been reported after influenza, tetanus, and other common vaccinations, this is the first reported case of CIDP after Pfizer COVID-19 vaccination to our knowledge. Design/Methods: NA Case Presentation: A 34-year-old right-handed male with an unremarkable past medical history presented with bilateral distal paresthesias, proximal and distal muscle weakness, and fine motor difficulties. Symptoms initially manifested with toe numbness, approximately two weeks after receiving the first dose of the Pfizer COVID-19 vaccine. Paresthesias gradually progressed from lower extremities to upper extremities. Two months after the initial COVID-19 vaccine, symptoms worsened with decreased muscle strength, difficulties with fine motor activities, difficulties climbing stairs, and lifting objects above his head. Neurologic evaluation revealed 4/5 strength in upper and lower extremities, generalized hyporeflexia, decreased vibration, and proprioception. MRI of the brain and spine revealed no abnormalities. Nerve conduction studies were consistent with demyelination and cerebral spinal fluid analysis revealed albuminocytologic dissociation. The patient was diagnosed with CIDP and began steroids after poor response to a four-day treatment course of IVIG 2g/kg which resulted in partial improvement of strength. The patient continues to follow up with long-term prednisone therapy. Conclusions: Demyelinating polyneuropathies are a rare complication of vaccination. While the benefits outweigh the risks of immunization, we aim to inform of this potential complication.

Adventure Sports and Nature-Based Tourism: Assessment of Canyoning Spots in the Northern Region of Portugal

The growing demand for natural areas and outdoor activities in the last decade, even more noticeable in the COVID-19 worldwide pandemic situation, has led to the intensification and diversification of nature-based tourism supply in many regions, including the provision of adventure recreation activities, such as canyoning. However, and despite the increasing interest of companies, destinations, and academia in this specific type of activity, there is limited information on resources, practice conditions, and assessments based on specific, objective criteria. This information is critical for a more competitive development and positioning of regions for this activity, and to meet tourists' increasingly demanding expectations. Therefore, this paper aims at building upon the identified research gap, by characterizing and evaluating the existing conditions for canyoning activity in the North Region of Portugal, This evaluation of twenty-seven canyoning spots. was done based on an assessment matrix, comprised of specific criteria, grounded on the literature review and semi-structured interviews with companies' owners/managers and experts. The study concludes that the activity is evolving in the region and there is still potential for development, due to morphological, favourable conditions. Moreover, the region offers different spots, often inserted in protected areas, with unique landscapes and natural diversity, which is attractive for tourism. The presentation of an assessment matrix (that allows the characterization and evaluation of canyoning spots on a systematic approach in different geographic contexts) makes this study a contribution to the literature on nature-based, adventure tourism and recreation activities.

Changing Values Through Generations: The Case of Mountain Tourists

Mountain tourism is becoming an increasingly important part of tourism in the Alpine countries, so research among mountain tourists is necessary. The changing values of different generations of tourists play a major role in their behaviour in a high-altitude environment and consequently affect the condition of these areas. Therefore, the purpose of this study is to determine the values of different generations of mountain tourists, different genders of tourists and among members and non-members of mountaineering associations. To achieve this purpose, a quantitative approach was used. The data was collected through a self-completion questionnaire in physical form at locations of 1st category mountain huts in Slovenian mountains during the 2020 summer mountaineering season. As part of the research, the sample was divided into four groups according to the year of birth of participants. With multivariate analysis, the existence of significant differences between groups of respondents of different ages, gender and membership, according to their values, was determined. The results of the research demonstrate the correlation between prevailing mountaineering values of mountain tourists and their characteristics. The research helps us to understand the mountaineering values of tourists who visit the mountains and fills the knowledge gap in the field of the differences between the values of different generations of mountain tourists, different genders and among membership in mountaineering associations. As outdoor activities are also gaining in popularity during the Covid-19 pandemic, the results of this research can be useful for attracting new members to mountaineering organizations, preserving mountaineering culture and sustainable development of tourism in the mountains.

UNIVERSAL SUICIDE SCREENING IN A PEDIATRIC EMERGENCY DEPARTMENT IS FEASIBLE: EVEN DURING A PANDEMIC

Purpose of Study Suicide is the 2nd leading cause of death for youth age 10-24 in the United States. Suicide rates in youth have been climbing over the last decade, and focus on prevention should be a priority. Implementation of universal suicide risk screening in pediatric emergency departments (PED) may provide early detection and intervention for at risk youth. Methods Used This retrospective chart review study examined youth ≥10 years old presenting to the PED. Records from 09/2019-08/2021 were searched to determine suicide risk using a validated suicide screening tool by nursing staff. Data were described with appropriate summary statistics (e.g., proportions) and compared by relevant covariates (e.g., gender) with appropriate test statistics including chi square and z-test analysis. Summary of Results Over a 2-year period, 31,344 children between the ages of 10-21 presented to the PED. Of those patients, 26,992 (86%) were screened for risk of suicide, which did not show a significant change during the pandemic (table 1;Z=-0.52, p=0.61);minimum compliance rate was 83.8% and maximum was 89.4%. Of those screened, 5039 (19%) of patients screened positive for suicide risk;1738 (7%) had a medical chief complaint which was significantly lower compared to 3077 (11%) that had a behavioral health chief complaint (c [1, n=22889] = 6273.2, p< 0.001). Females had a significant association with positive screens (χ[1, n=26992] = 9.3, p=0.002). Non-Hispanic or Latino patients also had a significant association with positive screens χ [1, n=26992] = 79.9, p< 0.001. Conclusions Universal suicide risk screening for youth is feasible in a PED. This was demonstrated by higher-than-expected rates of staff compliance with completing universal suicide screening. There has been no significant change in screening compliance rates during the COVID pandemic. Suicidal thoughts and/or behaviors were prevalent in a significant proportion of children presenting to the PED with both medical and behavioral health chief complaints. Identifying all at risk youth and providing them with appropriate resources may improve patient safety. (Figure Presented).

PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOPATHIES SUFFER FROM POOR SELF-REPORTED PROMIS PHYSICAL FUNCTION AFTER COVID-19 INFECTION: AN INTERVIEW-BASED STUDY FROM THE MYOCITE COHORT

Background/Aims Patients with rheumatic diseases are known to exhibit worse outcomes with COVID-19. However, the effect on individual diseases such as idiopathic inflammatory myopathies (IIM) remain unexplored. Methods A self-report e-survey with 36 questions was pilot tested and validated to cover demographics, history of COVID-19 contact, course and severity of COVID-19 infection, influence of COVID-19 infection on physical state one-month after the infection and vaccination status. Baseline characteristics were retrieved from the MyoCite registry and biobank archive. PROMIS-10a, a validated self-report tool was used to quantify physical function. Age and gender similar healthy controls (HC) were included for comparison. Results 10 patients of IIM were compared with 40 controls. Fever was the most common symptom reported by both the groups however, fatigue, chest pain, and breathlessness were experienced more by patients of IIM compared to HC. However, severity of COVID-19 infection as substantiated by pneumonia, hospitalization, and oxygen requirement was comparable in IIM and HC, possibly due to small numbers PROMIS physical function was comparable before COVID-19 in both groups, and in HC physical function remained the same a month before and after COVID-19. On the other hand, the physical function deteriorated at 30-days after COVID-19 in the IIM group as compared with their baseline function as well as HC. Specific tasks were more challenging for IIM, including climbing stairs, bending or kneeling and shampooing hair, although the limitation was mild (Table 1). IIM patients were also less likely to be vaccinated, suggesting prevalent hesitancy in this group (50% vs 90%, p: 0.007) (Table 1). Conclusion Patients with IIM exhibit increase in fatigue, and dyspnoea during COVID-19 although there is no increase in hospitalisation and had similar disease severity compared to HC. Short term physical function is impacted at 30-days post COVID-19, suggesting the need for closer long-term follow-up. Vaccine hesitancy is prevalent and merits addressing in patients with IIM.