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Background: Despite similar motor recovery of limbs in research, clinically the lower limb is observed to demonstrate greater recovery than the upper limb (UL). Understanding the relation between the post-stroke rehabilitation experience in the hospital environment and neuroplasticity and motor recovery of the UL may provide insight into how to optimize the hospital and promote recovery. Aim(s): This feasibility study aimed to collect cross-sectional data from inpatients who were clinically receiving UL motor training within a rehabilitation hospital to determine the feasibility of our protocol as well as describe the factors and potential associations between motor performance and therapy participation, fatigue, stress and sleep. Method(s): Inpatients were recruited across two rehabilitation wards;inclusion criteria were broad (stroke diagnosis and clinically identified UL motor impairment). Therapy session duration and frequencies were recorded prior to assessing sleep quality and amount over one night (Actiwatch, Phillips Respironics, USA)). Participants rated their perceived fatigue (Fatigue Severity Scale-FSS) and sleep quality (Leeds Sleep Evaluation Questionnaire-LSEQ), and overnight nursing documentation of sleep was extracted from the medical record. Motor performance was assessed via the box and block test. All data were collected across a 24h period. Result(s): N=14 participants participated (age 71+/-11y) at a mean+/-SD 32+/-23 days post-stroke and 22+/-21 days since admission to rehabilitation. Participants received motor training 10+/-3 times per week, and sessions were 51+/-18min in length. Mean+/-SD sleep duration was 9.5+/-1.9h with 1.1+/-0.7h awake-time during the night. All participants reported fatigue, with mean FSS (37+/-16), and identified issues with respect to getting to sleep as well as quality of sleep on the LSEQ. All data were feasible to collect, however COVID restrictions and bed-numbers influenced recruitment rate. Conclusion(s): Findings provide key feasibility data to better understand targetable factors to optimise the post-stroke rehabilitation experience, neuroplasticity and UL motor recovery after stroke.
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This article reviews the extant literature showing impacts of theCOVID-19 pandemic on access to inclusive education for students with disabilities. It also explores the disproportionate impacts of distance learning and school closures during the COVID-19 pandemic on the legal rights, social emotional supports, and quality of instruction for special education students and their families. Early data show that educational impacts of COVID-19 have exacerbated long-standing issues of inequity;these impacts may have long-term repercussions for this underserved group of students. The authors introduce frameworks that may inform future instructional practices to successfully teach students with disabilities in virtual learning environments.
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Background: The COVID-19 pandemic has interrupted the implementation of many HIV prevention programs supported by the US President's Emergency Plan for AIDS Relief (PEPFAR), especially in sub-Saharan Africa. We evaluated the effects of COVID-19 pandemic (e.g., lockdowns, lack of personal protective equipment, community fears) on efforts to reach the UNAIDS 90-90-90 targets by HIV case finding using index testing (IT) and provider-initiated testing and counseling (PITC) as well as HIV treatment initiation. Methods: We conducted a descriptive analysis using programmatic data from persons aged 15 years and older reported to PEPFAR from 11 purposefully selected countries in sub-Saharan Africa. We calculated the percentage change in reported HIV case finding indicators during the COVID period, defined as January-June 2020, as compared to the pre-COVID period, during the same time frame in the preceding year, January-June 2019. Results: Of the 11 countries, persons tested for HIV through PITC declined in seven (64%) and persons testing positive declined in 10 (91%), comparing the COVID to pre-COVID periods (see Table 1). Across all countries, total HIV testing and total number of persons testing positive by PITC decreased by 20% and 23% when comparing the COVID to the pre-COVID period, respectively. In parallel, five of the 11 countries (Cameroon, DRC, Mozambique, Nigeria, South Africa) saw an increase in both IT and HIV case finding through IT, in COVID as compared to the pre-COVID period. Across all countries, total IT increased by 13% and HIV case finding through IT increased by 17% when comparing the COVID to the pre-COVID period. The number of HIV-positive people linked to treatment decreased in seven (64%) countries during the COVID period compared to pre- COVID. Across all countries, an increase of 3% in those HIV-positive people linked to treatment. Conclusion: While testing through PITC decreased during the COVID period, testing and case finding through IT increased. The increase in IT may reflect the actions of healthcare facilities and providers to ensure that HIV-exposed individuals identified by an index case were still tested. Focusing on IT may help programs effectively identify HIV-positive people, even during a pandemic or other disturbance.
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Due to the inherent thrombotic risk associated with the ECMO circuit, therapeutic anticoagulation is recommended. While unfractionated heparin is commonly used due to wide availability, the use of bivalirudin, a direct thrombin inhibitor, is gaining popularity. The benefits of bivalirudin over heparin include: Relatively organ-independent metabolism, inhibition of fibrin-bound and freely circulating thrombin, rapid clearance, and less resistance. Early reports in the COVID-19 pandemic suggest a hypercoagulable state. Particular attention should be paid to adequate anticoagulation in the high-risk patients with SARs-CoV-2 on ECMO support. To date, there are few reports discussing the use of bivalirudin in COVID ECMO patients. Bivalirudin is the anticoagulation of choice for the maintenance of patients on ECMO at our institution. We conducted a retrospective analysis of the first 20 patients with COVID that required ECMO support. Data was collected on outcomes related to hemostasis. Standard protocol for ECMO patients includes screening duplex ultrasound at regular intervals following decannulation to evaluate for thromboembolism. Three patients did not receive screening due to terminal weans. Of the remaining 17 patients, 7 had confirmed acute venous thromboembolism. Four patients had hemorrhage requiring intervention;two cases of epistaxis, one intra-abdominal bleeding, and one cannulation site bleeding. One patient developed nonfatal intracranial hemorrhage that did not require intervention. Only two patients developed renal failure requiring temporary renal replacement therapy. This is in comparison to the 24% rate noted in the ELSO COVID-19 database. Our findings suggest bivalirudin is an alternative to heparin for appropriate COVID ECMO patients.