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With the Commission von der Leyen, organics agriculture has been put under a new political spotlight. The Green Deal and its strategies "Farm to fork" and "Biodiversity" praise for increased land managed under the organic scheme and set a target of 25% of the European utilised agricultural areas cultivated as organics by 2030. It is undoubtedly an ambitious target, seen in the current situation: organics occupies 8.5% of the total UAA., with pretty broad difference in the EU, from 25% to 0.5%. Also, consumption is widely differentiated in the EU, from 344 EUR per capita per year to at 2 EUR per capita per year with an EU average of EUR 84. To support the sector to reach the target of 25%, the European Commission has recently adopted a comprehensive action plan to develop organic production in the EU. The action plan is an instrument that streamlines activities and resources to the benefit of the sector. It is organised into three axes to (i) stimulate consumption through the promotion of organic public catering, the use for green public procurement, allocate money for the promotion of the sector for instance, (ii) increase conversion by making the best use out of the CAP money to promote conversion, to stimulate short supply and processing chains, and to create biodistrict among other actions, in and (iii) increase sustainability of the sector by dedicating research money to research in the organic sector and to promote an efficient use of resources.
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Objective: Single-cell RNA-sequencing (scRNA-seq) and spatial transcriptomics have identified novel cell subtypes and microenvironments which compartmentalize diverse functions at the maternal-fetal interface. We aimed to combine these high-resolution technologies with a rigorous classification of transcription alterations associated with diabetes subtypes in pregnancy. We hypothesized characteristic transcriptome profiles in specific cell populations would be linked to these classifications. Study Design: We clinically validated gestational diabetes mellitus type 1 (GDMA1), GDMA2, and type 2 diabetes (T2DM) classes within a cohort of placentae and compared them to healthy controls by bulk RNA-seq (N=53). We then integrated our non-diabetic term placentae spatial transcriptomics data (N=12) with 273,944 publicly available transcriptomes from term placenta scRNA-seq or single-nuclei RNA-seq (snRNA-seq) datasets (accessions phs001886, GSE173193, EGAS00001002449) with control, GDM, or SARS-CoV-2 positive subjects to create a placental transcriptomic catalog. Result(s): In bulk, we identified 104 significantly differentially expressed transcripts (-2< log2fold-change >2,p< 0.05) in our GDMA1 samples, 102 with GDMA2, and 121 with T2DM (Fig. 1a). Comparisons revealed 88 transcripts uniquely marking GDMA1, 68 for GDMA2, and 85 for T2DM, while FGA and CYP1A1 perturbations were shared across diabetes classes (Fig. 1b). We then compared these bulk GDM subtype markers with the 5,211 significantly differentially expressed transcripts associated with 22 cell-type clusters in our term placenta atlas (Fig. 2), and 20 unique GDM bulk markers aligned with extravillous trophoblast, stromal, endometrial epithelia, endothelial, NK, and dendritic single-cell placental markers. Conclusion(s): Together, these results detail the gene expression profiles and the cell types in the maternal-fetal milieu of pregnancies affected by diabetes. Consistent with their distinct clinical outcomes, GDM and T2DM have unique cellular transcriptomes and would thus be targets for new therapeutics. [Formula presented] [Formula presented] Copyright © 2022
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This study aims to assess and evaluate the knowledge, beliefs, behaviors, and practices about COVID-19 among different categories of Jordanian people including pregnant and breastfeeding mothers. A cross-sectional study is designed using an online survey questionnaire and a five-section questionnaire was devised to address perceptions and attitudes of the participants towards COVID-19. This study was found that more than 80% of the participants had a belief that COVID-19 can be transmitted through direct contact or spreading of air droplets from infected people to healthy ones. Around 15% of pregnant and breastfeeding women realized that the COVID-19 virus could transmit the virus to their babies. Third-fourth of the participants agreed that the elderly, pregnant, and immunocompromised people have a higher risk of being infected with COVID-19. In addition, 80% of the participants believed that using paracetamol is a good way of treating COVID-19 or reducing symptoms, while the remaining believed that they should use antibiotics as well as some vitamins to combat COVID-19. Around 70% of the participants have got their information about COVID-19 through social media while others got the information through the Jordanian Ministry of Health official website, other websites, television news, friends, relatives, and colleagues. Participants' practices to avoid transmission of COVID-19 were adequate in more than 80% of the participants who reported that they should protect themselves as well as their families as a priority. we believe that this study allow other governments worldwide to understand the views of public people in Jordan during pandemic disease outbreaks. Copyright © RJPT All right reserved.
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India has historically been a rural nation, with two thirds of the population still living there. Considering that, India's rural economy represents over 50% of its national income, and rural growth and development is a key driver supporting India's overall growth and development. Additionally, the more well-informed and educated rural youth seeks employment that matches their knowledge and skills which has been an upcoming enabling force. Thus, India's future is largely going to be shaped by the contributions of the countryside. Rural consumption has been essential to India's progress over the past few years, which has been primarily fueled by a rising disposable income. Adding more, when it comes to agriculture-related exports, India is a world leader. Over the years, we have witnessed growth in the avian industry, aquaculture, fisheries, and animal husbandry. Furthermore, resilience of the agricultural sector to the effects of the pandemic and with special focus on self-reliance in the Indian economy - 'AtmaNirbharta', rural India has not only emerged as a notable investment subject but also one of the major driving forces of the Indian economy. All the above given reasons reiterate the significance rural economy holds in coming times for new India. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Banana is one of the major crop in India producing large quantities of pseudo-stem as bio-waste after harvesting and becomes the adverse environmental concern due to the disposal either at the outside of the fields or incineration. This particular scenario demanded for recycling or conversion of the huge biomass generated as waste into utilizable products to reduce the consequences of environmental adverse effects. The current investigation focused on the utilization of pseudostem byproduct by converting into value added healthy functional food product in the form of banana center core coconut cookies. The product was standardized by formulating three different experimental trials by substituting a part of wheat flour with three variations viz., 5, 10 and 15 per cent levels respectively. The acceptable levels were compared organoleptically against reference sample without addition of banana center core flour. The findings demonstrated high overall mean acceptable scores of above nine in the reference (9.25), first (9.16) and second (9.02) experimental trials. The third experimental trial with the incorporation of fifteen per cent showed low overall mean organoleptic score (7.36). Pseudo-stem being potential source of dietary fiber, protein and micro-minerals, the second experimental trial was considered as the standardized formula. The nutrient composition analyzed identified that the standardized cookies were nutritionally rich as evidenced by the estimated essential nutrients viz., protein(5.41g), fat(10.53g), dietary fiber(7.28g), ash(0.21mg), calcium(48.36mg) and iron(2.12). The observations well demonstrated the beneficial utility of bio-waste in food products especially in baking denoting the challenging task to explore and development of wide range of pseudo-stem based value added healthy functional food products. The antioxidant and immuno-protective properties associated with pseudo-stem especially beneficial during the COVID-19 pandemic conditions to fight against immune-suppressive corona virus. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Background: COVID-19 pandemic has certainly brought tremendous global impacts in various sectors of life, such as social activities that are becoming increasingly limited. In addition, another impact is the prohibition of the implementation of collective worship of Muslims in Indonesia. The government implements health protocols as the main capital to stop the expansion of the pandemic. In addition, the use of vaccines with great hope as one of the main weapons to control COVID-19. This study aims to analyze the relationship between vaccination status and behavior in the implementation of Ramadan worship during the COVID-19 pandemic in Indonesia. Subjects and Method: A cross-sectional study was conducted in Indonesia from April to May 2021, with the research subjects being members of the Muhammadiyah Disaster Management Center (MDMC). A sample of 746 study subjects was selected for this study. The dependent was worship behavior. The independent variable was vaccination status. The data were analyzed by Chi-square test.
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Because of its wide spread, long duration, and large number of infected people, the COVID-19 epidemic has had an unprecedented huge and permanent impact on the global tourism industry. As of now, the trend of the epidemic is still unclear, and the future of the tourism industry is still full of uncertainties. Strengthening the resilience of tourist destinations, accelerating the sustainable transformation of tourist destinations, and promoting the high-quality development of regional tourism have become an important direction for the recovery and reconstruction of the current tourism industry.
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Background Determination of predictors of coronavirus disease 2019 (COVID-19) severe infection allows early intervention and appropriate treatment of patients at risk, so that we can improve outcome and allow better selection of patients who need hospitalization. Our aim is detection of factors linked to higher rates of complications and death in COVID-19 hospitalized patients. Results The study included 151 patients who were divided into mild, moderate, and severe groups;patients with age more than or equal to 60 were more in the severe category (P=0.001). The severe category had considerably more comorbidities (P=0.001). Patients with more than or equal to two comorbidities were more likely to be in the severe category (P=0.006). Obese patients with BMI more than 30 were substantially more likely to be in the severe category (P=0.004). Cough, fever, dyspnea, and vomiting were the most common presentations. Complications of COVID-19 infection were more likely to be detected in the severe category (P=0.001). In the severe category, lymphopenia, raised neutrophil-to-lymphocyte ratio, C-reactive protein, ferritin, lactate dehydrogenase, and D-dimer were all considerably higher. O 2 saturation on admission was significantly lower in the severe group with mean (SD) of 81.23 +/- 9.22. Duration of admission was significantly longer in the severe group with a range of 9 (3-27) days. Mortality rate in our study was 7.9% (12 cases);all dead cases were included within the severe group. Conclusion Physicians should consider patients diagnosed as COVID-19 with high ferritin, elevated neutrophil-to-lymphocyte ratio, lymphopenia, obesity, and high D-dimer as risky for severe infection and need hospitalization with intensive care and proper management to decrease complications, mortality, and for proper triage of COVID-19 patients in hospitals. Copyright © 2022 Indian Journal of Anaesthesia Published by Wolters Kluwer - Medknow.
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Background. Breakthrough infections post-COVID-19 vaccination increase with waning immunity and typically produce milder disease than infections in unvaccinated individuals. We investigated immuno-virologic responses and COVID-19 symptom burden upon breakthrough infection in participants from a Phase 3 study of 2-dose primary series AZD1222 vaccination (NCT04516746) to explore disease attenuation. Methods. Study participants who experienced protocol-defined COVID-19 symptoms initiated a series of illness visits over 28 days with collection of sera, nasopharyngeal (NP) swabs and saliva samples (SS), and documentation of symptoms (data-cut off: July 30, 2021). For baseline-seronegative participants with PCR-confirmed SARS-CoV-2 infection >=15 days after dose 2 of AZD1222 or placebo we assessed: anti-SARS-CoV-2 spike (S), nucleocapsid (N) and neutralizing antibody (Ab) titers by multiplex immunoassay and SARS-CoV-2 pseudovirus assay in sera;viral load by quantitative RT-PCR in NP swabs;and viral shedding by qualitative and quantitative RT-PCR in SS. Data were stratified by age and SARS-CoV-2 variant, and time since primary series dose 2. Results. Illness Day 1 (ILL-D1) S Ab GMTs in AZD1222 vaccinees were similar to peak GMTs seen 14 days after dose 2 of AZD1222 and were higher vs placebo at all timepoints. The magnitude of S Ab response differed by age: median GMTs were lower at ILL-D1 and higher at ILL-D14 in vaccinees aged >=65 vs 18-64 years (Fig.1). ILL-D1 overall, SARS-CoV-2 ancestral, alpha, and epsilon variant viral load titers in NP swabs were lower in vaccinees vs placebo (Fig 2). Mean viral load in NP swabs and viral shedding titers in SS were lower in vaccinees vs placebo at all timepoints. Vaccinees reported fewer COVID-19 symptoms than placebo participants, and experienced shorter symptom duration, particularly for fatigue and difficulty breathing. Figure 1. SARS-CoV-2 spike IgG antibody titers upon SARS-CoV-2 infection by participant age in AZD1222 vaccinees and placebo recipients during illness visits Figure 2. Quantification of viral load (nasopharyngeal swabs quantitative viral titer) by SARS- CoV-2 variant at Illness Visit Day 1 Conclusion. Improved S Ab responses, lower viral loads, and reduced symptom burden upon breakthrough infection in vaccinees vs placebo recipients, suggest that robust recall responses to AZD1222 vaccination may attenuate COVID-19 disease severity and duration. These findings alongside data on cellular immune responses to breakthrough infection will inform understanding of protective immunity to SARS-CoV-2 infection.
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Background. Outpatient treatment with SARS-CoV-2-neutralizing antibody combination AZD7442 (tixagevimab/cilgavimab) in adults with mild to moderate COVID-19 significantly reduced progression to severe disease or death through Day 29 and was well-tolerated in the Phase 3 TACKLE study primary analysis (NCT04723394). AZD7442 administered earlier in the disease course leads to more favorable outcomes and has the potential to prevent COVID-19 hospitalizations and reduce hospital burden. We report key secondary efficacy results with longerterm safety data from TACKLE over 6 months. Methods. In TACKLE, non-hospitalized adults with mild to moderate COVID-19 were randomized 1:1 and dosed <=7 days from symptom onset with a single 600-mg AZD7442 dose (2 consecutive intramuscular injections, 300 mg of each antibody;n=452) or placebo (n=451). The key secondary endpoint was death from any cause or hospitalization for COVID-19 complications or sequelae through Day 169, analyzed using a Cochran-Mantel-Haenszel test stratified by time from symptom onset and risk of severe COVID-19 progression. Results. Death from any cause or hospitalization for COVID-19 complications or sequalae occurred in 20 (5.0%) versus 40 (9.8%) participants receiving AZD7442 versus placebo, respectively, translating to a relative risk reduction (RRR) of 49.1% (95% confidence interval [CI] 14.5-69.7) versus placebo (P=0.009). A sensitivity analysis excluding participants who were unblinded prior to Day 169 for consideration of vaccination yielded a similar RRR of 50.7% (95% CI 17.5-70.5;P=0.006). For baseline seronegative participants, an RRR of 58.6% (95% CI 27.6-76.4;P=0.001) was observed. The median (range) safety follow-up was 170 (1-330) days with AZD7442 and 170 (1-326) days with placebo. Adverse events occurred in 38.5% of AZD7442 participants and 43.5% of placebo participants, and were mostly mild to moderate. Conclusion. A single 600-mg AZD7442 dose demonstrated statistically significant protection against death from any cause or hospitalization for COVID-19 through 6 months, and was well-tolerated. These data provide further support of AZD7442 in the COVID-19 outpatient treatment setting, with potential to reduce hospital burden.
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Background. Nontuberculous mycobacteria (NTM) are environmental organisms that can form biofilms in municipal water systems and as such are difficult to eliminate. Mycobacterium abscessus is a rapid-growing NTMthat can cause skin and soft tissue, disseminated, and pulmonary infections. M. abscessus is difficult to treat, often requiring prolonged therapy with several antibiotics due to its intrinsic drug resistance. In 2021, our institution identified a significant increase in pulmonary infections caused by M. abscessus in the cardiothoracic transplant population. Methods. All M. abscessus cases among inpatients at our institution were extracted from the electronic medical record (EMR) between January 2019 and September 2021. Clinical characteristics were determined through EMR review and included demographics, transplant status, specimen type, COVID-19 history, and patient care practices involving water. A multidisciplinary team conducted an investigation to identify possible variations in practice related to the source of water used for clinical care activities in this identified population. Results. Between January 2021 and September 2021, there were 12 cases of M. abscessus among inpatients at our institution compared to 6 cases in 2019 and 5 in 2020 (Figure 1). Between 2019 and 2020, post-heart and pre-/post-lung transplant patients comprised 9% of cases, 55% of cases were pulmonary infections, and none had a history of COVID-19 infection. In 2021, post-heart and pre-/post-lung transplant patients comprised 58% of cases, 83% of cases were pulmonary infections, and 33% of cases had a history of COVID-19 infection. There were varying sources of water utilized for the clinical care activities in this identified population (Table 1). Conclusion. To investigate the potential outbreak, we are actively collecting water samples and swabs from water fixtures in both patient and nourishment rooms for water culturing. To mitigate a potential water-borne source, we will use sterile water for all clinical care practices involving water and for all patient water drinking needs in the post-heart and pre-/post-lung transplant population impacted by the outbreak. The only use of tap water is hand hygiene and patient bathing.
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Background. Bacterial co-infection has been reported with COVID-19, but the extent of co-infection nationally is unclear. We sought to describe the temporal and spatial trends in bacterial co-infection across the US among COVID-19 positive admissions to Veterans Affairs (VA) hospitals. Methods. This retrospective cohort study included patients admitted to VA hospitals from March 1, 2020 through May 31, 2022 with a positive COVID-19 test within the previous 14 days and up to 2 days after admission. We summarized temporal and spatial patterns of bacterial co-infection, defined as a positive clinical microbiology culture for the bacterial pathogens listed in Table 1, defined as either community-onset (COI, within 2 calendar days of admission), or hospital-onset (HOI, > 2 calendar days after admission). We performed a univariate analysis including facility and patient factors and generated descriptive statistics to describe the frequency of occurrence over time and space overall, and within each organism. Results. By the end of June 2021, there were 35,299 hospitalizations observed from 33,383 patients admitted with positive COVID-19 tests in VA. Co-infection was detected among 7.4% of hospitalizations (2.9% for COI and 4.7% for HOI). VA patients older than 70, Asian or unknown race, higher Charlson Comorbidity Index were more likely to experience HOI and COI. Facility-level rates of HOI and COI over the study period presented substantial geographic variability, ranging from 0 to 45.5 per 1000 patient days and from 0 to 6.98 per 100 hospitalizations for HOI and COI, respectively [Fig 1]. Between March 2020 and June 2021, monthly facilitylevel rates of HOI and COI also varied substantially within and between facilities [Fig 2]. Average monthly co-infection rates increased in the first three months of the pandemic, with HOIs subsequently declining gradually and COIs remaining stable across VA. The correlation coefficients between hospital mortality and facility-level coinfection rates for HOI and COI ranged from -0.5 to 0.7 [Fig 3]. Conclusion. Bacterial co-infection was infrequent during hospitalization with COVID-19 in the VAhealthcare system, and has mild tomoderate association with hospital mortality. However, substantial geographic and temporal variation was observed.
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Background. Pseudomonas aeruginosa bloodstream infection (PA-BSI) is associated with high mortality. The extent to which the COVID-19 pandemic has introduced challenges to diagnosis and treatment of this infection is unknown. In this study, we examined the direct and indirect effects of COVID-19 on PA-BSI associated mortality in the Veterans Health Administration (VHA) population. Methods. We identified patients within the VHA database with PA-BSI identified between January 1, 2009 and December 31, 2019 (pre-COVID) and January 1, 2020 to December 31, 2021 (COVID). Extracted data included age, race, ethnicity, Charlson Comorbidity Index (CCI), susceptibility testing, treatment, and COVID-19 infection. Antimicrobial resistance was characterized as pan-susceptible, any unclassified resistance, multi-drug resistant (MDR), difficult to treat resistant (DTR), and extremely or pan-drug resistant (XDR/PDR). Active therapy was defined as an effective antibiotic initiated within 48 hours of blood culture collection. We used logistic regression to assess the impact of each factor on 30-day mortality. Results. We identified 7,578 patients with PA-BSI and known 30-day mortality status, which was 24% overall (Table 1). Age and CCI were higher during COVID, while effective treatment and resistance improved (Table 2). In the multivariate analysis, concomitant COVID infection tripled the odds of mortality (odds ratio [OR] 3.00, 95% confidence interval [CI] 1.40-6.37) (Figure 1). However, the COVID period itself was not associated with higher mortality. Effective treatment was associated with 19% lower odds of mortality (OR 0.81, 95% CI 0.66-1.01), while DTR and XDR/PDR nearly doubled mortality (OR 1.75, 95% CI 1.23-2.47 and OR 2.06, 95% CI 1.25-3.34, respectively). Conclusion. We observed higher odds of mortality in patients with PA-BSI and COVID-19 coinfection, supporting the hypothesis that COVID-19 directly impacts PA-BSI outcomes. Annual PA-BSI incidence and associated 30-day mortality, however, were similar during the COVID period. Favorable resistance trends, effective treatment, and a low rate of PA-BSI and COVID-19 coinfection may explain these findings, despite increased age and comorbidities in this vulnerable population. (Table Presented).
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Background: Endometrial polyps are present in 13-50% in women with abnormal uterine bleeding (AUB). Hysteroscopy is currently the method of choice for definitive diagnosis and treatment, which has some limitations. Hence, we propose a novel technique which allows ultrasound-guided office-based polypectomy. It avoids general anaesthesia, is inexpensive and allows single point of care. Objective(s): The purpose of this study was to evaluate a novel technique of endometrial polyp removal in the office and pain scores associated with that procedure Material(s) and Method(s): Prospective trial conducted at an academic hospital after Institutional Review Board approval over a period of 12 months. Women with AUB had saline infusion sonogram (SIS) to delineate the polyp. Then under ultrasound guidance, the universal grasping forceps (2.5 mm X 25 cm) was introduced through the cervix into the uterus to remove the polyp. It was an off-label use of the instrument. The goal of the study was to evaluate the patients' post-procedure pain and satisfaction score. The secondary outcomes were confirmation of complete removal of polyp by assessing resolution of patients' symptoms and performing SIS at 3 months interval. Result(s): There were 30 patients. Mean age and BMI was 54.8 +/- 11 and 30.6 +/- 10 respectively. Average polyp volume was 1.26 cm3 and mean time taken for polypectomy was 11 minutes 50 seconds. The median pain score was in Visual Analogue Scale (VAS) was 5. The median satisfaction score post procedure was 10. Adequate pathology sample was obtained for 100% of cases and 2 returned as malignancy. For 3 months follow-up, 16 patients returned. Among them 13 (81%) had no evidence of polyp on SIS and 14 (87%) reported complete symptom resolution. Conclusion(s): This technique can be used safely and effectively to remove endometrial polyp in appropriately selected patient population in an outpatient setting. In times of COVID-19, this technique can be helpful in reducing the number of cases which needs to be performed under anesthesia. Support: The authors did not receive any funding for this study. Copyright © 2022
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Background: Infection Control Committees (IPC) have advised that droplet protocol protections are sufficient against COVID-19 unless Aerosol Generating Medical Procedures (AGMP) are being performed. AGMP do occur in the Cardiac Catheterization Lab (CCL) but are largely unpredictable. Recent analysis of superspreader events has provided evidence of significant aerosol spread. CO2 is exhaled by breathing subjects, and its measurement has been shown to be a reliable proxy for breathing activity, and thereby infectious risk, in indoor environments. Methods and Results: A portable CO2 monitor (AirQ AQ-200 or Aranet-4) was positioned at counter height in the periphery of CCL's during diagnostic & coronary interventional (Cath), transcatheter aortic valve implantations (TAVI) and Mitraclip (MC) procedures. Procedure start and stop times were recorded. CCL ventilation parameters were provided by hospital building engineers. Usual personnel numbers were attributed to each type of case (no allowance was made for the emergency need of additional personnel). Data were inputted into a publicly available well-mixed room model coded in Python (https://indoor-covid-safety.herokuapp.com/) to obtain a safe maximum CO2 level for case and catheterization lab parameters. Procedural mean values were than compared to the safe maximum. Data were obtained from 278 cases, 246 Cath (mean duration 50 min, range 23-155), 27 TAVI (65 min, range 35-287) and 5 MC (247 min, range 178-371). Using surgical masks with average fit and transmissibility data from the Wild variant, Cath CO2 measurements were within safe range 98.8% of the time, TAVI 92.6% and MC 0%. Under Omicron variant conditions, this decreased to 17.5% (Cath) and no TAVI/MC cases. For cath cases, case duration was an important determinate of safety, and a safe duration depended greatly on the variant in circulation. Increasing ventilation across a range of 6 ACH (air changes per hour) to 20 ACH led to marked improvement in risk from the Wild variant, but benefits were limited with the Delta and Omicron variants. Filtration had limited effect unless filters were MERV 15 or higher (HEPA). Conclusion(s): COVID-19 risk in the CCL is significant even in the absence of AGMP. Increased CCL ventilation and filtration can reduce this risk, but are limited by constant production of infectious aerosols. Risk can be further reduced by complimentary strategies such as aerosol-grade PPE for CCL staff, pre-procedural COVID-19 testing of patients, and postponement of elective procedures expected to last above a duration threshold during periods of high community disease activity. [Formula presented] [Formula presented] Copyright © 2022
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Aims: Patients with chronic and end-stage kidney Disease often experience a high symptom burden and diminished health-related quality of life. Data on these constructs can be collected, directly from patients, and measured using electronic Patient Reported Outcomes (ePROs). Responses can be used at an individual level to facilitate optimal care and shared-decision making. At an aggregate level, these data can be used for audit and benchmarking to improve services. This research aims to identify existing and emerging ePRO systems used in nephrology, to explore and summarize key system characteristics, and identify the core factors which contribute to successful implementation. Method(s): 3-phase mixed-methods study: Semistructured review to identify ePRO Systems used in nephrology that assess ePROs and summarize patients' responses to their care provider. Web-based survey of system experts to identify key system characteristics: including administration, levels of automation, integration into existing systems, reporting and management of patient safety.Optional follow-up semi-structured interviews, with system experts, to explore survey responses.The semi-structured interviews were analyzed using Codebook Thematic Analysis utilizing domains from the Consolidated Framework for Interventional Research (CFIR) allowing comparison of the ePRO Systems and associated implementation strategies to highlight best practice. Result(s): Fifteen nephrology ePRO systems were identified in North America, Europe and Australia. Ten experts completed the survey (nine full responses and one partial response). Remote follow up interviews were undertaken with seven respondents.Key components of system characteristics were summarized and compared including: (i) purpose, (ii) population, (iii) PRO measures used, (iv) levels of automation, (v) reporting, (vi) integration into existing workflow and (vii) links to electronic health records/national registries. Common barriers to implementation included user engagement, accessibility issues and the effects of COVID on implementation plans and evaluation. Important facilitators were early and sustained patient involvement in system design and implementation, clinician advocates and expanding existing electronic systems to integrate ePROs. Conclusion(s): An increased understanding of the range of features and functionality of ePRO systems, including potential barriers and facilitators to use and integration in existing work flows, will help ensure such systems are optimized to improve care and maximize outcomes for patients with chronic and end-stage kidney disease.
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Introduction: The COVID-19 pandemic complicated providers' ability to appropriately monitor patients on antipsychotic medications, as visits moved to telehealth. Adverse metabolic and movement effects can be hard to assess virtually, reducing adherence to national antipsychotic guidelines. Research Question or Hypothesis: Patients on antipsychotics received less frequent metabolic and movement disorder monitoring than recommended from both mental health (MH) and primary care (PC) providers during the pandemic. Study Design: This was a retrospective chart review of patients receiving antipsychotics from MH and PC providers. Providers prescribing antipsychotics to at least five patients between June 2021-2022 were included. Random samples of the greater of five total or 10% of each provider's patients were reviewed. Method(s): A list of providers and patients utilizing antipsychotics over the previous year was reviewed for inclusion. Sample patients were reviewed for relevant data including: demographics, antipsychotic(s) prescribed, glucose, hemoglobin A1c, total cholesterol, LDL, HDL, triglycerides, weight/BMI, waist circumference, Abnormal Involuntary Movement Scale (AIMS), and other movement disorder assessments. Monitoring rates were compared to national antipsychotic guidelines. Adherence rates were calculated for each monitoring parameter from the data collected. Comparisons between MH and PC, age under 40 vs over 40, and gender, were performed using t-tests to determine statistically significant differences (p<.05). Result(s): Eighteen providers met inclusion criteria, 6 MH and 12 PC, and 97 patients were reviewed. Metabolic parameters were measured in 61.9-91.8% of patients, but were slightly higher in MH (75.9-94.6%). They were less likely in younger patients (53.1-90.6%) and males (53.3-84.4%). Movement disorders were monitored less frequently, with AIMS at 11.3% (PC=0), and other EPS monitoring in 17.5% (MH=40.5%). Younger patients (6.3%) and males (8.9%) displayed lower rates of AIMS monitoring. Conclusion(s): Decreased metabolic and movement disorder monitoring rates were anticipated during the pandemic, but still are surprising. The lower rates among younger and male patients are concerning, and should be addressed through provider education.
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Health surveillance and assessment are considered essential components of a functional public health system. The recent ubiquity of mobile devices and social media have created a wealth of behavioral data, and bring into existence new forms of population health monitoring. These new digital sources can provide direct and passive data for more detailed and nuanced health factors, and have expanded the human, spatial, and temporal scales at which these factors can be measured. In this project, I leverage digital trace data from tweets and mobile device location pings to explore population scale sleep loss, and nature exposure through park visitations in the United States. Both sleep and nature exposure are essential contributors to well-being, and have historically relied on either survey data or direct observation of individuals to measure. I begin by demonstrating the ability of Twitter data to passively reflect population-scale sleep loss at the state level. This is followed by an exploration of park visitation measured through mobile device GPS data. Changes in county-scale park visitation behavior at the onset of the COVID-19 pandemic are analyzed and comparisons are made using population density, employment sector, income, and voting records. In the final chapter I investigate the viability of predicting park visitation using demographic information from the surrounding neighborhood. I conclude with a brief discussion of the significance of measuring these behaviors, and the potential for health policy improvement. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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Congregations throughout the nation are often the first responders when an individual or family needs extra support and care after a traumatic experience. Particularly during the COVID-19 pandemic, church leaders were tasked with providing extra pastoral care in a unique way that kept every individual physically safe. A survey was completed to learn more about the educational preparedness of pastors specific to trauma, frequency of conversations about trauma before and during COVID-19, competency of church leaders before and during COVID-19, and experiences of collective trauma within congregations. This article focuses on the results of that survey to bring awareness to the lived experiences of church leaders and congregants when dealing with trauma. (PsycInfo Database Record (c) 2023 APA, all rights reserved)