Re-humanisation, Recognising the person behind the patient

Submission content Introduction: At the end of a particularly hectic night shift on the intensive care unit (ICU) I found myself sitting in the relatives' room with the mother and aunt of a young patient, listening to their stories of her hopes and aspirations as she grew up. She had been diagnosed with lymphoma aged 14 and received a bone marrow transplant from her younger sister. Fighting through treatment cycles interposed with school studies, she eventually achieved remission and a portfolio of A-levels. Acceptance into university marked the start of a new era, away from her cancer label, where she studied forensic science and took up netball. Halfway through her first year she relapsed. Main body: When I met this bright, ambitious 20-year-old, none of this history was conveyed. She had been admitted to ICU overnight and rapidly intubated for type-1 respiratory failure. The notes contained a clinical list of her various diagnoses and treatments, with dates but no sense of the context. Rules regarding visitation meant her family were not allowed onto the unit, with next-of-kin updates carried out by designated non-ICU consultants to reduce pressures on ICU staff. No photos or personal items surrounded her bedside, nothing to signify a life outside of hospital. She remained in a medically-induced coma from admission onwards, while various organ systems faltered and failed in turn. Sitting in that relatives' room I had the uncomfortable realisation that I barely saw this girl as a person. Having looked after her for some weeks, I could list the positive microbiology samples and antibiotic choices, the trends in noradrenaline requirements and ventilatory settings. I had recognised the appropriate point in her clinical decline to call the family in before it was too late, without recognising anything about the person they knew and loved. She died hours later, with her mother singing 'Somewhere Over the Rainbow' at her bedside. Poignant as this was, the concept of this patient as more than her unfortunate diagnosis and level of organ failure had not entered my consciousness. Perhaps a coping mechanism, but dehumanisation none-the-less. Conclusion(s): Striking a balance between emotional investment and detachment is of course vital when working in a clinical environment like the ICU, where trauma is commonplace and worst-case-scenarios have a habit of playing out. At the start of my medical career, I assumed I would need to consciously take a step back, that I would struggle to switch off from the emotional aspects of Medicine. However, forgetting the person behind the patient became all too easy during the peaks of Covid-19, where relatives were barred and communication out-sourced. While this level of detachment may be understandable and necessary to an extent, the potential for this attitude to contribute to the already dehumanising experience of ICU patients should not be ignored. I always thought I was more interested in people and their stories than I was in medical science;this experience reminded me of that, and of the richness you lose out on when those stories are forgotten.

Medical intensivist directed VV ECMO cannulation for the facilitation of tracheostomy in a patient with severe tracheal stenosis: A case report

Objectives: We present a case report of medical intensivist driven ECMO program using ECMO as a pre-procedural tool to maintain oxygenation in a patient with critical tracheal stenosis during tracheostomy placement. Method(s): VV ECMO is primarily used to support patients when mechanical ventilation is unable to provide adequate gas exchange. Alternatively, it has been used pre-procedurally when intubation is required in anticipation of a difficult airway. Described here is the first intensivist preformed awake VV ECMO cannulation to facilitate tracheostomy in a patient with severe tracheal stenosis. Result(s): The patient is a 41-year-old female with the relevant background of COVID19 pneumonia status post tracheostomy and subsequently decannulated after prolonged intubation and ICU stay. As a result, the patient developed symptomatic tracheal stenosis and presented two years after her ICU stay for scheduled bronchoscopy and balloon dilation. However, the patient developed worsening stridor and shortness of breath requiring heliox and BPAP. After multidisciplinary discussion between the critical care team ENT teams, the decision was made to cannulate for VV ECMO as a pre-procedural maneuver to allow for oxygenation during open tracheostomy in the OR. Dexmedetomidine and local anesthesia were used for the procedure with the patient sitting at 30 degrees on non-invasive ventilation and heliox. The patient was cannulated with a 21F right internal jugular return cannula and 25F right common femoral drainage cannula by medical intensivists in the intensive care unit using ultrasound guidance. The patient went for operative tracheostomy the next day and was subsequently decannulated from ECMO the following day without complication. She was discharged home on trach collar. Conclusion(s): Intensivist performed ECMO cannulation has been shown to be safe and effective. We anticipate the indications and use will continue to expand. This case is an example that intensivist driven preprocedural ECMO is a viable extension of that practice.

Use of novel oxygenated right ventricular assist device hybrid ECLS for adolescents with refractory hypoxemic respiratory dailure due to Covid-19 pneumonia

Objectives: To describe institutional experience using Oxygenated Right Ventricular Assist Device (OxyRVAD) Hybrid ECLS for adolescents with respiratory failure due to SARS-CoV-2 pneumonia. Method(s): Between September and December 2021, 44 Covid-19+ patients were admitted to our regional Pediatric Intensive Care Unit (PICU), including 4 adolescents who required Extracorporeal life support (ECLS) due to refractory hypoxemia. Two patients were initially cannulated onto Veno-Venous (VV) ECLS and converted to Oxy-RVAD ECLS due to refractory hypoxemia;the others were cannulated directly onto Oxy-RVAD ECLS. Two patients had observed right ventricular (RV) dysfunction or failure on echocardiography. Cannulations were performed in the cardiac catheterization suite by an interventional cardiologist using percutaneous technique under fluoroscopy. Circuit construction was varied and included the use of a dedicated RVAD cannula or standard cannula used for VA/VV ECLS. All patients were connected to Cardiohelp systems with built in centrifugal pumps and oxygenators. Result(s): Two patients were initially placed on VV-ECLS and converted to Oxy-RVAD ECLS days into their course due to severe, refractory hypoxemia with one having improvement in hypoxemia after the conversion. Two patients received renal replacement therapy (RRT) without complications, the others did not have indications for renal support. Two patients underwent tracheostomy on ECMO though none were able to separate from mechanical ventilation. Three patients survived to discharge. No incidents of circuit air or clotting were noted. The patient with the longest ECLS run required one circuit change and was the only patient to develop a superinfection: a successfully-treated fungal infection. All patients were mobilized on ECLS to sitting in a chair;one was able to ambulate. Conclusion(s): Oxy-RVAD hybrid ECLS can be used to effectively support adolescents with severe respiratory disease from conditions associated with RV dysfunction. Pediatric providers can collaborate with adult critical care colleagues to use novel methods to support these patients. RRT can also be used with this circuit. While more experience and data on this modality is needed, Oxy-RVAD ECLS should be considered in patients with severe RV dysfunction and associated refractory hypoxemia. (Figure Presented).

Place production, urban tourism geographies and experiences of Muße

Urban tourism, as a social, cultural, and economic field, has been strongly affected by the COVID-19 pandemic. As a reverse effect of this crisis, however, there is a recent shift away from the dominant logics of performance and efficiency towards mindfulness, serenity, and similar concepts that shape the everyday life of an increasing number of people. All these terms are related to the semantic field of Muße, a word derived from the German language, which is defined as the experience of moments of freedom, indulgence, placidity, and recreation. Following the idea that social phenomena are reflected and reproduced in tourism, the objective is to explore how and where tourists experience Muße in urban tourism. A focus on Muße first enables a better understanding of tourists' travel behaviour, expectations, and needs. In the same vein, it is possible to examine tourism place-making since the need for Muße produces and transforms individual tourists' worlds of experiences. Although place-making practices and experiences have been widely studied, their relationship to Muße remains to be explored in urban and tourism research. With the aim to study practices and places of Muße in urban tourism, the presented qualitative content analysis draws upon 84 interviews conducted with tourists in Barcelona, Florence, and Paris in 2019. Findings show that the practice of sitting is relevant for experiences of Muße with a particular impact on place-making. Six categories are suggested to illustrate how Muße can be effective while tourists are sitting. This includes a detailed discussion of the spatial dimensions of Muße. In conclusion, places of Muße are highly individual, intangible, and complex. Insights into the characteristics of Muße and engagement with this new concept in international tourism research can be used as resources to study tourist place-making and support the planning for sustainable tourism development. [ FROM AUTHOR] Copyright of Tourism Geographies is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Platypnea-Orthodeoxia Syndrome Associated with COVID-19 Pneumonia and Prolonged Treatment Due to Tamsulosin Use: A Case Report

Platypnea-orthodeoxia syndrome (POS) is an extremely rare condition. There are no other cases in the literature where tamsulosin has been reported to prolong POS treatment. A 67-year-old male patient was hospitalized due to COVID-19. He was followed up in the ward after being in the intensive care unit for ten days. There was a significant decrease in saturation (SaO2) when sitting and standing compared to lying. He was diagnosed with POS. However, there was no significant improvement in POS with exercises. After stopping the tamsulosin he was using, there was a dramatic improvement. He was discharged on the 72nd day of his hospitalization. Due to COVID-19, POS is more likely to appear than before. It is a condition that clinicians should recognize. The pathophysiology of POS has not been fully elucidated. The case we present suggests that alpha-blockers may also be related to pathophysiology.©Copyright 2020 by Emergency Physicians Association of Turkey -

Ergonomics in online education of medical undergraduates: A challenge to post-COVID transformation in educational activities.

BACKGROUND: Practicing incorrect postures in online and virtual education during the COVID-19 pandemic can cause significant study-related musculoskeletal problems among students. OBJECTIVE: This study evaluated the knowledge, attitude, and practice of sitting posture and computer ergonomics and study-related musculoskeletal problems in undergraduates who followed online education during the pandemic. METHODS: A cross-sectional online survey among a cohort of Sri Lankan medical undergraduates was conducted using a structured questionnaire with 56 multiple-choice or Yes/No type questions. RESULTS: Of the 410 participants, over 85% (n = 362) knew the correct posture to sit on the chair type that they frequently used for studies. However, the majority (n = 378,92.20%) practised incorrect sitting postures in which leaning forward (n = 319,77.80%) was the most common suboptimal posture. Knowledge (n = 161,40%) and practice (n = 167,40.73%) on taking frequent breaks were poor among the majority. Their knowledge on computer ergonomics was good (>80%, n = 304) except for the recommended eye-to-screen distance (n = 129,31.46%). Importantly, ∼50% (n = 206) did not practise the recommended eye-to-screen distance. Use of non-adjustable chairs with no armrests (n = 346,84.39%) and smartphones (n = 354,86.34%) were identified as the main factors which hindered correct practices. Study-related pain/discomfort reported by the majority (n = 241,58.78%) is potentially due to suboptimal ergonomics. Their attitude toward learning and practicing correct ergonomics in home workstations was good (n = 383,93.41%). CONCLUSION: Poor practice of posture and computer ergonomics, despite the good knowledge and attitude is possibly due to the suboptimal work environments. Introducing simple practical measures to facilitate ergonomically appropriate work environments is mandatory in virtual education to prevent study-related musculoskeletal problems.

Use of Novel Oxygenated Right Ventricular Assist Device Hybrid ECLS for Adolescents with Refractory Hypoxemic Respiratory Failure due to Covid-19 Pneumonia

Objective: To describe institutional experience using Oxygenated Right Ventricular Assist Device Oxy-RVAD) Hybrid ECLS for adolescents with respiratory failure due to SARS-CoV-2 pneumonia. Method(s): Between September and December 2021, 44 Covid-19+ patients were admitted to our regional Pediatric Intensive Care Unit (PICU) including 4 adolescents who required Extracorporeal life support (ECLS) due to refractory hypoxemia. Two patients were initially cannulated onto Veno-Venous (VV) ECLS and converted to Oxy-RVAD ECLS due to refractory hypoxemia;the others were cannulated directly onto Oxy-RVAD ECLS. Two patients had observed right ventricular dysfunction (RV) or failure on echocardiography. Cannulations were performed in the cardiac catheterization suite by an interventional cardiologist using percutaneous technique under fluoroscopy. Circuit construction was varied and included the use of a dedicated RVAD cannula or standard cannula used for VA/VV ECLS. All patients were connected to CardiohelpTM systems with built-in centrifugal pumps and oxygenators. Result(s): Two patients were initially placed on VV-ECLS and converted to Oxy-RVAD ECLS days into their course due to severe, refractory hypoxemia with one having improvement in hypoxemia after the conversion. Two patients were cannulated directly to Oxy-RVAD ECLS support. Two patients received renal replacement therapy (RRT) without complications, the others did not have indications for renal support. Two patients underwent tracheostomy on ECMO though none were able to separate from mechanical ventilation. Three patients survived to discharge. No incidents of circuit air or clotting were noted. The patient with the longest ECLS run required one circuit change and was the only patient to develop a superinfection: a successfully-treated fungal infection. All patients were mobilized on ECLS to sitting in a chair;one was able to ambulate. Conclusion(s): Oxy-RVAD hybrid ECLS can be used to effectively support adolescents with severe respiratory disease from conditions associated with RV dysfunction. Pediatric providers can collaborate with adult-focused colleagues to use novel methods to support these patients. RRT can also be used with this circuit. While more experience and data on this modality is needed, Oxy-RVAD ECLS should be considered in patients with severe RV dysfunction and associated refractory hypoxemia.

Factors Related to the Presence of Lowback Pain during Remotework in the Covid-19 Pandemic in Brazil

Objectives: With the new needs that the market and the population presented, there was a need to adopt strategies to make the new work environment as safe and comfortable as possible, preserving the health of workers regardless of the work environment. Given this context, it is extremely important that the workers have knowledge about ergonomics and how environmental factors can affect their work capacity and comfort, factors such as ambient light, noise, air flow, temperature, long period in a static position and inappropriate furniture. The aim of the study was to identify the etiology of low back pain during remote work during the COVID-19 pandemic. Method(s): Two questionnaires were applied, one of them developed by the researchers and the other a disability questionnaire (Roland-Morris Disability Questionnaire-RMDQ) in the form of Google Forms for adults (n = 54) of both sexes, aged over 18 years who were working remotely during the period of the COVID-19 pandemic in Brazil in the year 2021. Result(s): With the application of the questionnaires, it was possible to notice an increase in the emergence and worsening of lowback pain in individuals who performed remote work during the COVID-19 pandemic;this increase related to factors such as: inadequate furniture at home, excessive number of hours in the sitting position using the computer, decrease in regular physical activities and weight gain. Conclusion(s): From the beginning of remote work, during the COVID-19 pandemic, most individuals studied either developed lowback pain or had increased low back pain, resulting in mild disability. These data are preliminary in Brazil;in the future, we seek to expand to a larger number of participants, as well as to create strategies and health-promoting actions for low back pain prevention.

Body Posture Correction and Hand Gesture Detection Using Federated Learning and Mediapipe

In today's post-covid culture, where everyone works from home, there is a huge possibility of serious long-term health problems. A lot of people have started taking up exercises at home and if done incorrectly, they can have major negative effects. Another one of the main contributors to these health issues is bad sitting posture, which is only exacerbated when working for hours on end. Hand gesture detection has many useful applications in elderly healthcare, automating actions and gesture-based presentations and games. To help users with these actions, our paper proposes pinpointing the points of the error to the user in real-time and in a lightweight manner for yoga posture correction. The incorrect positions shall be shown in real-time on top of the user's video feed to help them correct it properly. The user shall be told about when they are sitting in a bad position, and the overall bad posture time will also be shown for the session, which will provide the required information to the user. To further help users in a useful manner, our paper looks to augment the hand gesture detection feature with federated learning and personalization to avoid the common pitfall of privacy concerns, while still allowing users to customize their experience. The proposed library for the implementation of these tasks is the MediaPipe library. This library is one of the key components that makes the features lightweight and easy to use. The aforementioned library also looks to implement the features in real time with no lag while keeping the resource requirements as low as possible. © 2023 IEEE.

Back and neck problems as well as disadvantageous ergonomic behavior patterns in university students: Concomitants of the pandemic?

Background: As a part of the coronavirus disease 2019 (COVID-19) lockdown measures, universities converted courses to digital formats, leading to remote studying. It is unclear how these measures affect university students in terms of musculoskeletal problems (i.e., neck and back pain), e.g., by non-ergonomically equipped home offices or reduced physical activity. Material(s) and Method(s): Students from Osnabruck University weresurveyed via fully standardized online questionnaires from early March to mid-April 2022 (6 weeks) about neck and back problems, movement behavior in home offices, and personal information. Result(s): Of 447 students who clicked on the link, 378 students (80.4% female, mean age: 24.1 +/- 4.2 years) answered the questionnaire (response rate: 84.6%). 299 (79.1%) students suffered from neck pain and 294 (77.8%) from back pain during the pandemic. 206 (54.4%) students generally used ergonomic furniture, 83 (22.0%) used ergonomic sitting furniture, 57 (15.1%) used a standing desk, and 212 (56.1%) used aids for a more comfortable use of laptops in home office. 203 (53.7%) students took movement breaks in home office, 207 (54.8%) worked out regularly, and 65 (17.2%) moved regularly in the fresh air. Conclusion(s): The present study found a high rate of neck and back pain amongst university students. Measures are needed to prevent neck and back pain in this group, considering that increased physical activity and enhanced home office equipment might be beneficial.Copyright © 2022 Elsevier GmbH

Acceptability and usability of a soft, flexible, wearable device for cough detection in children with cystic fibrosis

Background: Cough is a common symptom in cystic fibrosis (CF), and an increase in cough is an important sign of worsening lung disease and pulmonary exacerbation, the most common cause of hospitalization in people with CF. Objective monitoring of cough could be an important outcome measure for clinical trials, especially in children too young to perform pulmonary function tests. There are no accurate, objective methods of quantifying the frequency, severity, and duration of cough. Devices that have been tested to measure cough are neither highly reliable nor user friendly. We developed a mechano-acoustic sensor (MAS): a 4.8- cm- x 2.8-cm- (1 inch) long, thin, lightweight, stretchable, wireless device that adheres easily and securely to the skin surface and is worn at the base of the neck. The devicewas validated in adults being monitored for COVID- 19. This study evaluated usability and acceptability to children and their parents. Method(s): In Cohort 1, a small, flexible, fully wireless accelerometer-based MASwas applied to the suprasternal notch of children with CF using gentle adhesives. Participants were asked to perform activities that included forced coughs while sitting, lying down, and performing activities such as jumping or jogging and other pharyngolaryngeal activities such as swallowing, speaking, and throat clearing. The sessions were an average of about 30 minutes long. In Cohort 2, participants were asked to test the device for a longer period of wearable time (4-6 hours) in various settings, including outpatient clinics, inpatient rooms, and outside clinic and athome environments. Upon completion, all participants from both cohorts were asked to fill out the Acceptability and Usability Questionnaire, which consisted of six questions ranked on a 4-point Likert scale. Result(s): Cohort 1 included 21 children aged 3 to 18 (mean age 9.25 +/- 4.85), and Cohort 2 included 12 children aged 7 to 18 (mean age 12.15 +/- 4.42). On 31 (94%) questionnaires returned, 35.5% of participants strongly agreed and 61.3% agreed with the statement "I [or my child] like(s) wearing the cough sensor." Similarly, most participants found the cough sensor easy to use (74.2% strongly agreed, 25.8% agreed) and comfortable to wear (64.5% strongly agreed, 29.0% agreed), although they found the adhesive sticker difficult to take off and the device too obvious or large. Conclusion(s): Although qualitative and quantitative acceptability and usability data were overall positive, we have redesigned the cough sensor for comfort and are continuing enrollment. The new sensor, 3.5 x 1.6 x 0.8 cm, is smaller and sits lower on the neck so participants can better conceal it underneath clothing (Figure 1). We are providing universal adhesive remover wipes to all participants. Future work includes long-term monitoring (1-2 weeks) of pulmonary exacerbations using the new devices and further assessing usability and acceptability from participants.(Figure Presented) Figure 1. New cough sensor design with a longer neck and a smaller body, allowing it to be better concealed underneath a shirtCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

Economic burden of excessive sedentary behaviour in Canada.

OBJECTIVE: To estimate health care and health-related productivity costs associated with excessive sedentary behaviour (> 8 h/day and > 9 h/day) in Canadian adults. METHODS: Three pieces of information were used to estimate costs: (1) the pooled relative risk estimates of adverse health outcomes consistently shown to be associated with excessive sedentary behaviour, gathered from meta-analyses of prospective cohort studies; (2) the prevalence of excessive sedentary behaviour in Canadian men and women, obtained using waist-worn accelerometry in a nationally representative sample of adults (Canadian Health Measures Survey 2018-2019); and (3) the direct (health care) and indirect (lost productivity due to premature mortality) costs of the adverse health outcomes, selected using the Economic Burden of Illness in Canada 2010 data. The 2010 costs were then adjusted to 2021 costs to account for inflation, population growth, and higher average earnings. A Monte Carlo simulation was conducted to account for uncertainty in the model. RESULTS: The total costs of excessive sedentary behaviour in Canada were $2.2 billion (8 h/day cut-point) and $1.8 billion (9 h/day cut-point) in 2021, representing 1.6% and 1.3% of the overall burden of illness costs, respectively. The two most expensive chronic diseases attributable to excessive sedentary behaviour were cardiovascular disease and type 2 diabetes. A 10% decrease in excessive sedentary behaviour (from 87.7% to 77.7%) would save an estimated $219 million per year in costs. CONCLUSION: Excessive sedentary behaviour significantly contributes to the economic burden of illness in Canada. There is a need for evidence-based and cost-effective strategies that reduce excessive sedentary behaviour in the population.

RéSUMé: OBJECTIF: Estimer le coût des soins de santé et le coût de productivité lié à la santé associés au comportement sédentaire excessif (> 8 heures/jour et > 9 heures/jour) chez les Canadiennes et les Canadiens adultes. MéTHODE: Trois informations ont servi à estimer ces coûts : 1) les estimations combinées du risque relatif des résultats sanitaires indésirables uniformément associés au comportement sédentaire excessif, collectées à partir de méta-analyses d'études prospectives de cohortes; 2) la prévalence du comportement sédentaire excessif chez les Canadiennes et les Canadiens, obtenue à l'aide d'un accéléromètre porté à la taille par un échantillon représentatif national d'adultes (Enquête canadienne sur les mesures de la santé 2018-2019); et 3) les coûts directs (soins de santé) et indirects (perte de productivité due à la mortalité prématurée) des résultats sanitaires indésirables sélectionnés, d'après les données du Fardeau économique de la maladie au Canada de 2010. Les coûts de 2010 ont ensuite été ajustés aux coûts de 2021 pour tenir compte de l'inflation, de la croissance démographique et de la hausse moyenne des revenus. Nous avons effectué une simulation de Monte-Carlo pour tenir compte de l'incertitude du modèle. RéSULTATS: Les coûts totaux du comportement sédentaire excessif au Canada étaient de 2,2 milliards de dollars (point de coupure de 8 heures/jour) et de 1,8 milliard de dollars (point de coupure de 9 heures/jour) en 2021, ce qui représente 1,6 % et 1,3 % du fardeau global des coûts des maladies, respectivement. Les deux maladies chroniques les plus chères imputables au comportement sédentaire excessif étaient les maladies cardiovasculaires et le diabète de type 2. Une baisse de 10 % du comportement sédentaire excessif (de 87,7 % à 77,7 %) économiserait environ 219 millions de dollars de coûts par année. CONCLUSION: Le comportement sédentaire excessif contribue de façon significative au fardeau économique de la maladie au Canada. Il nous faut des stratégies fondées sur les preuves et efficaces par rapport au coût pour réduire le comportement sédentaire excessif dans la population.

Analysis Factors that Affect Low Back Pain in Medical Students during the Study from Home

Low Back Pain (LBP) is a health problem that affects performance in working. Indonesia is a country affected by the COVID-19 pandemic, so a study from the home policy has been issued. This study aimed to determine the association between the factors that affect LBP in Medical Students at the Faculty of Medicine, University of Mataram during the study from home. This study is an observational analytic study design with the cross-sectional approach. The population of this study is Medical Students, Faculty of Medicine, University of Mataram with total sample of 185 people. Collecting data using questionnaires and analyzed using univariate, bivariate, and multivariate analysis. According to univariate analysis, amount of LBP complaints (53 people). Based on bivariate analysis, the p-value of gender factor (0.000);body mass index factor (0.840);social-economy status factor (0.499);sitting position factors (sitting position while studying factor (0.008), sitting location while studying factor (0.046), chair shape while studying factor (0.286), body position while studying factor (0.037), legs position while studying factor (0.339), back support use while studying factor (0.455), table use while studying factor (0.010), elbows position while studying factor (0.627), stretching between study time factor (0.372), duration in each stretch factor (0.389), time range between stretch factor (0.311)), and sitting duration factor (0.011). Based on multivariate analysis, the strength of the association (OR) to LBP are sitting position factor (sitting position while studying factor) (8.232), sitting duration factor (1.956), and gender factor (0.187). The dominant factors to LBP are gender factor, sitting position factor (sitting position while studying factor), and sitting duration factor. The factor that has the strongest association with LBP is sitting position factor (sitting position while studying factor).Copyright Published by Oriental Scientific Publishing Company © 2023.

Sedentary time of university students before and during the COVID-19 pandemic: Risk groups and pre-pandemic predictors using cross-sectional and longitudinal data.

Background: The present study aimed to (1) assess and compare sedentary time (ST) of university students before and during the COVID-19 pandemic, (2) examine risk groups with regard to ST and the "extent of change" in ST (from before to during the pandemic) in association with sociodemographic (gender, age), study-related (degree aspired to, field of study, semester), and pre-pandemic physical health-related [pre-pandemic physical activity (PA) and ST levels, pre-pandemic BMI class] variables, and (3) investigate whether the change in ST was predicted by these variables. Methods: Two online surveys were conducted among students at the University of Mainz, Germany-the first in 2019 (before the pandemic) and the second in 2020 (during the pandemic). Participants of both surveys were included in a longitudinal sample. With the longitudinal sample's data, paired t-tests, single factor, and mixed analyses of variances were used to examine group differences in ST and the "extent of change" in ST. A linear regression analysis was computed to investigate the influence of the abovementioned sociodemographic, study-related, and pre-pandemic physical health-related variables on the change in ST. Results: Of the N = 4,351 (pre-pandemic) and N = 3,066 (in-pandemic) participants of the online surveys, N = 443 entered the longitudinal sample. ST increased by 1.4 h/day to critical levels (≥8 h/day) in all subgroups analyzed-even among students who were highly physically active before the pandemic. Students with a low pre-pandemic ST had the largest increase in ST. Pre-pandemic PA level negatively predicted the change in ST. Conclusion: Even during a global pandemic lockdown, individuals who were previously more physically active and had less ST showed more health-promoting behavior in terms of ST. Therefore, it can be stated that efforts to promote PA and reduce ST are always valuable. Since ST increased and was worryingly high in all subgroups analyzed, all university students should be targeted by multidimensional approaches to tackle ST and promote their health.

Dermatology medical student history taking via the telephone: a way to minimize disruption to medical education, particularly during a pandemic

With an ever-ageing population the socioeconomic burden of skin disease continues to grow. Undergraduate dermatology training is essential to counter this. With dermatology exposure in medical schools limited by the current global COVID- 19 pandemic, we demonstrate how we can minimize educational disruptions without compromising the holistic approach to dermatology teaching. At our medical school, fourth-year medical students undergo a 1-week clinical dermatology attachment before sitting their fourth-year summative, which includes a dermatology objective structured clinical examination (OSCE). In view of the reduced clinics as a result of the pandemic, we implemented a virtual history-taking project. Volunteer patients with common long-term skin conditions were selected in accordance with medical student curriculum and consented to participate from their own homes. Students were observed taking a focused, timed dermatology OSCE-style history using departmental mobile telephones in loudspeaker mode, to involve their peers. They were then asked to describe an image of the skin condition and to attempt a diagnosis and management plan. They received immediate feedback on their OSCE from both the patient and a dermatology trainee. The session was evaluated via a pre- and postsession student questionnaire using a Likert scale of confidence, as well as anonymous feedback for global qualitative assessment. Preliminary feedback from 35 pre- and postsession questionnaires demonstrated a marked improvement in students' self-reported confidence in taking dermatology histories. Prior to these sessions, no students strongly agreed and 40% agreed to feeling confident in taking a dermatology history. Postsession questionnaires revealed that 37% strongly agreed and 62% agreed to feeling confident with taking a dermatology history. Students reported the opportunity to take histories from real patients useful and 'phone calls worked surprisingly well'. This project allowed the educational process to continue amidst a pandemic. Students were able to appreciate the important aspects of a dermatology history and gained knowledge about therapeutics previously used in these patients, while having a safe, empathetic and sensitive interaction with patients with skin disease.

Physical activity, sleep and quality of life after stroke during the SARS-CoV-2 pandemic.

Background: Physical activity (PA) involves various aspects of daily life and is beneficial for health, however, after a stroke PA is lower, causing a decreased health related quality of life (HRQOL). In turn, subjects who perform less PA sleep more hours than recommended, being a risk factor for stroke. The effects generated by these variables could be enhanced under the current health context associated with SARS-CoV-2. Objective(s): To correlate PA, hours of sleep and HRQOL after a stroke. Method(s): Descriptive cross-sectional design. PA, sleep and HRQOL were measured using ActivPAL for 7 days, home diary and the ECVI-38 scale, respectively. Result(s): The sample made up of 3 men and 3 women walked 4,519 steps/day (SD +/- 2710), made 37.27 seated-standing transitions per day (SD 16.16), spent 7.63 hours sitting/day (SD +/- 3.11), stood 5.18 hours/day (SD +/- 3.21), walked 1.17 hours/day (SD +/- 0.68), slept 8.5 hours/day (SD +/- 1.30). A negative correlation was found between the number of steps per day and ECVI-38. No correlation was found between PA and hours of sleep. Conclusion(s): Increasing PA is essential for HRQOL as a prevention tool for stroke and CVD. The evidence and findings of this study invite consensus to classify PA and consider the hours of sleep, aspects that are closely related to health after a stroke.Copyright © 2023 Authors. All rights reserved.

Understanding the impact of correct stroke unit nursing establishments, the development and dissemination of system wide intelligence

Introduction: The nursing workforce across stroke services is integral to the delivery of specialist stroke care Despite this, nursing interventions and patient contact time are not captured via the SSNAP audit as other disciplines are, resulting in the stroke nursing workforce being influenced by local priorities with poor provision largely unrecognised. Furthermore, staffing constraints caused by covid 19 has resulted in the redeployment of specialist nurses, directly impacting the immediate provision of stroke care and depriving stroke units of clinical expertise. Method(s): Quantitative and qualitative methods were applied. This included data relating to nursing establishments, vacancies, bed configurations, electronic rostering systems and the safer nursing care tool. This information was supported by written evidence from senior stroke nursing leads. Analysis of fifteen acute stroke services was completed. Result(s): A detailed regional report was compiled and shared system wide. Each provider was presented with an individual analysis. Over 60 key findings and 19 recommendations covering four main themes were established including: Establishments against national guidance unrealised. HASUs staffed against Safecare sitting below RCP recommendations HASU beds are not recognised on electronic rosters leading to general ward theories being applied. Significant movement of band 5 nurses affecting retention. HASU beds poorly aligned with significant variations of admissions per bed. Specialist nursing team management influencing SSNAP attainment. Conclusion(s): Poor understanding of stroke nursing requirements is evident regionwide. The use of healthroster and safecare tools in stroke units is inappropriately utilised and poorly understood. There is a direct correlation between specialist nurse organisation and SSNAP achievement.

Ventilation Efficiency According to Tilt Angle to Reduce the Transmission of Infectious Disease in Classroom

Understanding of the droplet transmission of respiratory diseases is necessary to control the outbreak of COVID-19. HVAC systems considering droplet transmission are commonly used to prevent numerous respiratory diseases by reducing indoor virus concentrations. The transmission of the virus was directly related to indoor flow patterns generated by HVAC systems. Thus, a study on operating conditions such as direction or the tilt angle was required. In this study, the effective ventilation rate and probability of droplet transmission according to the tilt angle of supply air and the number of people were studied. A CO2 tracer gas method was used to validate the results of simulations. The breathing plane and personal respiratory zone were introduced for the probability of droplet transmission. The result showed that ventilation performance showed 17% of the maximum difference among tilt angles. Various turbulent kinetic energies were obtained according to the seated positions, resulting in non-uniform CO2 concentration. Numerous conditions were examined with locational analysis of individuals. As a result, the flow rates for ventilation were recommended to be higher than 250 m3/h and 350 m3/h with a tilt angle of 60degree for an occupancy of 8 and 16 people, respectively.Copyright © The Author(s) 2022.

Gender differences on factors affecting the resting metabolic rate of academicians

BACKGROUND: There is an increasing interest to improve the physical activity level of people working in offices mostly spending their time in sitting who may be under the risks of obesity. this is especially increasing its importance worldwide due to recent 'stay at home trend' of covid-19 pandemics. academicians are the group of people having tendency to develop a sedentary lifestyle and become overweight due to long sitting hours of work. thus, the aim of this study is to understand the gender differences on factors affecting the resting metabolic rate of academic personnel. MethodS: data on demographic information, Body Mass index, resting metabolic rate (rMr), physical activity levels of academicians (n.=62, 32W, 30M) have been collected. reSUltS: their total weekly energy expenditure in relation to total physical activity was similar to each other as 1743.4+/-2189.10 MET-min/week for men and 1074.04+/-1299.09 MET-min/week for women. The RMR was significantly higher in men (1994.66+/-683.41 kcal/day) than women (1467.81+/-311.47 kcal/day) (p<0.001). Supporting this outcome, percent body fat was found higher in women (26.38+/-6.62%) than men (21.46+/-6.17%) (p<0.05). Men spent longer times "sitting" (p<0.05), it had a weak effect on their total physical activity (p<0.05). conclUSionS: although women were sitting less than men during day, they were less physically active. Men were more involved with heavy to moderate physical activities with higher resting metabolic rate. Since walking was a preferred activity in both genders, they may be motivated to increase their walking based physical activity in and out of the campus as well as at home.Copyright © 2020 Edizioni Minerva Medica.

"Are We Working (Too) Comfortably?": Understanding the Nature of and Factors Associated with Sedentary Behaviour When Working in the Home Environment.

Home working has increased due to COVID-19, but little is known about how this change has impacted the health risk behaviour of elevated sedentary time. The aim of this cross-sectional exploratory study was to assess occupational sitting behaviour when working at home, and use the Capability Opportunity Motivation-Behaviour (COM-B) model to identify influences on this behaviour. University staff (n = 267; 69% female; 92% white) who were predominantly working from home completed a questionnaire to assess sitting time, sitting breaks, demographic and occupational characteristics, and a 7-item COM-B questionnaire and open-ended questions to assess influences on time spent sitting whilst working from home. Data were analysed descriptively, a repeated measures ANOVA was used to determine differences in the COM-B items, and binary logistic regression was used to examine predictors of sitting time. Staff spent on average 89.5% (SD = 17.1) of their time sitting whilst working at home, and took an average of 1.36 (1.38) sitting breaks per hour. There were significant and meaningful differences in the influence of the COM factors on ability and willingness to reduce sitting behaviour (p < .0001; ηp 2 = .38), and the open-ended responses added further context. The included variables accounted for 20.7% of variance in sitting behaviour, with age, sitting breaks, motivation-automatic, and opportunity-physical contributing significantly. Working from home leads to elevated levels of sitting, and the COM-B provides a useful model to identify key influences on ability and willingness to reduce sitting. Strategies incorporating regular breaks, habit formation/reversal, and restructuring the physical environment may be beneficial.