Social disability and impairment in childhood anxiety

This chapter discusses social disability and impairment in childhood anxiety. The chapter starts with a discussion of clinical characteristics of the condition. Approaches to evidence-based assessment and cognitive-behavioral treatment are discussed. Future directions are highlighted. © Springer Nature Switzerland AG 2011, 2023. All rights reserved.

Cross-Pandemics - Turning Something Bad into Something Good

Intro: COVID-19 the most notorious Public Health Emergency (PHE), changed the way we practice medicine and taught us important lessons. The most effective measures to control pandemic are early administration and equitable access to vaccines and treatments. Governmental Public Health Agencies (GPHA) at all levels should have a leading role in coordination and implementation of control measures. Partnership between GPHA and health systems (HS) may significantly impact the scope of provided services. Monkeypox was declared PHE during the COVID-19 pandemic. It provided an opportunity to apply learned lessons that mitigated COVID-19 pandemic. Method(s): Spectrum Health (SH) is a quaternary-care HS based in Grand Rapids, Michigan. We will describe SH's response to COVID-19 and how we used our COVID experience to handle the Monkeypox outbreak. Finding(s): In response to COVID, through the phased approach (Picture 1) and collaboration with internal departments and GPHA, we opened a new clinic. Clinic was initially intended for parenteral COVID treatments but gradually evolved into a full COVID treatment center. Within 18 months we treated 12666 patients. Clinic success, efforts made to establish it, and concerns about future pandemics defined the need for a permanent and scalable centralized department which would provide continual community support with a measured response to meet community needs while minimizing impact on hospital resources, thus Community Response Department (CRD) was born. When Monkeypox PHE was declared, CRD responded immediately and efficiently using its resources and established pathways and demonstrated its own utility. Monkeypox treatment and vaccine were available to patients through the CRD within 7 days from governmental approval.Copyright © 2023

Public perception of the use of far ultraviolet C irradiation for disinfection purposes

Owing to the COVID-19 pandemic, there has been an increased effort to find new approaches to prevent airborne transmission of diseases. One of these approaches is the use of far ultraviolet C (far-UVC) irradiation. Far-UVC is emitted at 222 nm by KrCl excimer lamps and has been shown to inactivate many pathogens, including human coronaviruses, under laboratory conditions. Studies so far suggest that human skin can tolerate even extremely high doses of filtered far-UVC without the induction of erythema or significant DNA damage, unlike existing germicidal ultraviolet lamps, which typically emit at 254 nm. Far-UVC could therefore potentially be used safely to reduce effectively airborne transmission in public spaces. However, if that was to happen, it would be important that the general public understood the risks and benefits of far-UVC. The aims of this study were to carry out a survey to assess current public knowledge and understanding of far-UVC, with a view to the subsequent development of a public engagement activity to raise awareness and address safety concerns about the use of far-UVC. The survey was developed in-house and was distributed to the general public through the use of social media and the results showed that only 32.4% of respondents had previously heard of far-UVC vs. 64.9% having heard of UVC. Despite this, after being given a short (< 200 words) page of information about far- UVC, the majority of participants said that they would feel safer in public spaces if far-UVC was used vs. how they feel currently. Participants were then asked if they would support use of far-UVC in hospitals, public leisure spaces such as shops and cafes, public transport and their own workplaces. In all scenarios, the majority of participants said they would support far-UVC use, with < 10% of responses for each scenario being an outright 'no'. Of people who answered 'no' or 'not sure' to these questions, most cited reasons such as not having enough information or still not being convinced of its safety. These responses highlight the need for public engagement in this field, in order to raise awareness and to allow the general public to be better informed, with respect to the anticipated benefits and the safety of far-UVC irradiation use for disinfection purposes.

TRACE-Omicron: Policy Counterfactuals to Inform Mitigation of COVID-19 Spread in the United States (preprint)

The Omicron wave was the largest wave of COVID-19 pandemic to date, more than doubling any other in terms of cases and hospitalizations in the United States. In this paper, we present a large-scale agent-based model of policy interventions that could have been implemented to mitigate the Omicron wave. Our model takes into account the behaviors of individuals and their interactions with one another within a nationally representative population, as well as the efficacy of various interventions such as social distancing, mask wearing, testing, tracing, and vaccination. We use the model to simulate the impact of different policy scenarios and evaluate their potential effectiveness in controlling the spread of the virus. Our results suggest the Omicron wave could have been substantially curtailed via a combination of interventions comparable in effectiveness to extreme and unpopular singular measures such as widespread closure of schools and workplaces, and highlight the importance of early and decisive action.

Periocular biometrics and its relevance to partially masked faces: A survey

Periocular is one of the promising biometric traits for human recognition. It encompasses a surrounding area of eyes that includes eyebrows, eyelids, eyelashes, eye-folds, eyebrows, eye shape, and skin texture. Its relevance is more emphasize during the COVID-19 pandemic due to the masked faces. So, this article presents a detailed review of periocular biometrics to understand its current state. The paper first discusses the various face and periocular techniques, specially designed to recognize humans wearing a face mask. Then, different aspects of periocular biometrics are reviewed: (a) the anatomical cues present in the periocular region useful for recognition, (b) the various feature extraction and matching techniques developed, (c) recognition across different spectra, (d) fusion with other biometric modalities (face or iris), (e) recognition on mobile devices, (f) its usefulness in other applications, (g) periocular datasets, and (h) competitions organized for evaluating the efficacy of this biometric modality. Finally, various challenges and future directions in the field of periocular biometrics are presented. © 2022

Augmenting Community Engagement in City 4.0: Considerations for Digital Agency in Urban Public Space

An engaged community that reflects a diverse set of experiences is key to an equitable and livable city. However, maximizing engagement activities is often difficult when competing with residents’ busy schedules and hectic daily lives. To explore new opportunities in this space, we developed four augmented reality experiences to learn more about the potential for this technology to transform community engagement practices in the context of City 4.0. City 4.0 utilizes digital technologies to transform public services and the local economy. Its goal is to produce more sustainable urban and societal outcomes. Our findings suggest that augmented reality is least successful when used to recreate existing engagement practices, such as surveys or questionnaires, and more successful when it empowers a sense of agency and ownership over the process in its users. The way augmented reality situates information can aid in making public space feel personal to the individual. In this way, augmented reality’s affordances are less about overlaying digital information in physical space and more about how this can enable individuals to reclaim a sense of control and relevance in the relationship between citizens and councils. We aim to contribute: (a) novel interaction paradigms and an evaluation of their effectiveness and limitation, and (b) new insights into how to support citizens’ sense of agency in public discourse with augmented reality. This paper highlights the value of augmented reality’s affordances to bring to light new interactions between community engagement stakeholders.

What promotes or prevents greater use of appropriate compression in people with venous leg ulcers? A qualitative interview study with nurses in the north of England using the Theoretical Domains Framework.

OBJECTIVES: To investigate factors that promote and prevent the use of compression therapy in people with venous leg ulcers. DESIGN: Qualitative interview study with nurses using the Theoretical Domains Framework (TDF). SETTING: Three National Health Service Trusts in England. PARTICIPANTS: Purposive sample of 15 nurses delivering wound care. RESULTS: Nurses described factors which made provision of compression therapy challenging. Organisational barriers (TDF domains environmental context and resources/knowledge, skills/behavioural regulation) included heavy/increasing caseloads; lack of knowledge/skills and the provision of training; and prescribing issues (variations in bandaging systems/whether nurses could prescribe). Absence of specialist leg ulcer services to refer patients into was perceived as a barrier to providing optimal care by some community-based nurses. Compression use was perceived to be facilitated by clinics for timely initial assessment; continuity of staff and good liaison between vascular/leg ulcer clinics and community teams; clear local policies and care pathways; and opportunities for training such as 'shadowing' in vascular/leg ulcer clinics. Patient engagement barriers (TDF domains goals/beliefs about consequences) focused on getting patients 'on board' with compression, and supporting them in using it. Clear explanations were seen as key in promoting compression use. CONCLUSIONS: Rising workload pressures present significant challenges to enhancing leg ulcer services. There may be opportunities to develop facilitated approaches to enable community nursing teams to make changes to practice, enhancing quality of patient care. The majority of venous leg ulcers could be managed in the community without referral to specialist community services if issues relating to workloads/skills/training are addressed. Barriers to promoting compression use could also be targeted, for example, through the development of clear patient information leaflets. While the patient engagement barriers may be easier/quicker to address than organisational barriers, unless organisational barriers are addressed it seems unlikely that all people who would benefit from compression therapy will receive it.

How has the COVID-19 pandemic influenced patient-centred care? Analysis of a qualitative collective case study by high-performing practice teams

Background and objective The COVID-19 pandemic has significantly affected primary healthcare systems throughout the world. The aim of this article is to present the analysis of the perspectives and experiences of patientcentred care (PCC) during the pandemic by high-functioning general practice teams in Australia. Methods A qualitative descriptive approach and collective case study method was employed. Participants, who undertook a semi-structured interview, were representatives of high-functioning general practice teams. Reflective thematic analysis was applied to all interview data (meta-synthesis) using a constant comparison approach. Results Five clinic representatives were interviewed. Six themes developed, highlighting that despite the pandemic creating new challenges to delivering PCC, general practice teams maintained a focus on PCC. General practice teams adapted to deliver PCC through strategies not used prior to the pandemic. Discussion This study identified new approaches to PCC that can guide other general practices and progress the health system towards policy-based PCC objectives.

Virtual reality hospital: Developing a patient centred virtual environment to reduce preprocedural anxiety in children and young people

Background Anxiety is a common experience among Children and Young People (CYP) attending hospital for a procedure under general anaesthetic, some of whom require anxiolytic medication. Methods to reduce anxiety, such as hospital tours, have not been possible during the COVID-19 pandemic prompting us to reimagine how these can be delivered. Use of Virtual Reality (VR) in Paediatrics has largely focused on distraction during a procedure but VR can be effectively used preoperatively to reduce anxiety. Preadmission use of VR to reduce anxiety has also demonstrated a potential health economic benefit. We describe progress in developing a VR environment to simulate hospital tours in a Paediatric Hospital in the United Kingdom. Objectives Improve the patient experience by reducing preprocedural anxiety in CYP attending for a planned procedure under general anaesthetic, using VR technology to simulate a tour of an anaesthetic room. The VR environment must be accessible and interactive for CYP aged 8-21 years using a smartphone or device and VR headset at home, the content and design of which is informed by the experience and opinions of CYP at every stage of development. Methods Initial input of CYP was sought at a Young People's Forum. Discussions informing both the content and design were facilitated by healthcare professionals and involved CYP aged 10-18 years. A VR developer then created a digitally rendered anaesthetic room to produce a minimum viable product (MVP) using 'Autodesk Maya' and 'Unity' software. A 360° video of an anaesthetic room was also developed. Information provided within the VR environment was produced by Paediatric Healthcare professionals with input from experts in acute Paediatric anxiety. Focus groups of CYP will provide qualitative feedback to drive improvement cycles of the VR environment on a regular basis along with integration of interactivity and gamification. Following this patients will be invited to experience the virtual environment. Results CYP felt that a VR environment could help reduce preprocedure anxiety. They identified reducing uncertainty, optimising comfort, familiarity and trust in healthcare professionals and understanding medical devices and the physical experience as key factors for consideration when developing the VR environment. A calm environment with a relatable character, interactivity and gamification were identified as design priorities. The initial focus group review of the MVP is scheduled imminently with a plan to complete improvement cycles on a three monthly basis. Patients will be offered the opportunity to explore the VR environment at their pre-assessment appointment if the healthcare team and parent/guardian believe they may benefit. Conclusions Preprocedure anxiety is a major factor affecting the experience of CYP. This project aims to counter that using VR technology. The engagement of key stakeholders to inform throughout development ensures constant relevance is maintained in design and delivery. Reducing uncertainty, optimising familiarity and trust in the healthcare environment and team were identified as key factors in reducing anxiety. Interactivity and gamification are important in enhancing engagement. Ongoing review with CYP will shape and extend this tool with a view to building an interactive VR hospital allowing exploration of the whole hospital journey.

Antigen Testing for COVID-19 Asymptomatic Screening: Why it Should be Preferred Over PCR Insights From Navy Region Japan's Experience With a Comprehensive Antigen Testing Strategy.

Polymerase chain reaction (PCR) is commonly used in asymptomatic screening testing, but is suboptimal for this purpose as it will identify many old persistent positives that are no longer infectious. This can result in placement of individuals that are not infectious to others into isolation. This results in substantial adverse impact to military manning and operations, without any benefit to public health. Antigen testing does not have this same drawback. Antigen testing, while less sensitive than PCR, will identify the vast majority of infectious positives, especially those with higher viral loads that are more likely to transmit to others. Importantly, use of antigen testing will also greatly increase the certainty of benefit from isolation, reducing the risk of isolating those individuals who are beyond their infectious period and pose no threat to public health. The literature on this topic is reviewed, with particular focus on studies that perform viral culture in addition to PCR and antigen testing. This allows for determination of sensitivity for infectious virus. Also, Navy Region Japan's experience with a comprehensive antigen testing strategy is described. The challenges presented by persistent positive PCR test results are examined, as well as the real-world benefits from implementing widespread use of antigen testing.

A review and agenda for integrated disease models including social and behavioural factors.

Social and behavioural factors are critical to the emergence, spread and containment of human disease, and are key determinants of the course, duration and outcomes of disease outbreaks. Recent epidemics of Ebola in West Africa and coronavirus disease 2019 (COVID-19) globally have reinforced the importance of developing infectious disease models that better integrate social and behavioural dynamics and theories. Meanwhile, the growth in capacity, coordination and prioritization of social science research and of risk communication and community engagement (RCCE) practice within the current pandemic response provides an opportunity for collaboration among epidemiological modellers, social scientists and RCCE practitioners towards a mutually beneficial research and practice agenda. Here, we provide a review of the current modelling methodologies and describe the challenges and opportunities for integrating them with social science research and RCCE practice. Finally, we set out an agenda for advancing transdisciplinary collaboration for integrated disease modelling and for more robust policy and practice for reducing disease transmission.

One real problem at a time: Revisiting the status of regional science and female economists

West (1996) discussed the status of women economists as well as the field of regional science within economics in her SRSA Presidential Address. In this paper, we revisit these issues and examine if and how things have changed over the last several decades. We focus on progress that has been made and areas where additional changes may be needed in order to continue to improve. In addition, we discuss how the current COVID-19 pandemic may be relevant in the future for women in academia as well as academics in general as we move into a more virtual world. © Southern Regional Science Association 2020.

Supporting Clinical Decision-Making during the SARS-CoV-2 Pandemic through a Global Research Commitment: The TERAVOLT Experience.

To understand the real impact of COVID-19 on cancer patients, an entirely new data collection effort was initiated within the Thoracic Cancers International COVID-19 Collaboration (TERAVOLT). TERAVOLT reported high mortality related to COVID-19 infection in thoracic cancer patients and identified several negative prognostic factors. In this commentary, we discuss the importance and limits of patient registries to support decision-making in thoracic cancer during the SARS-CoV-2 pandemic.

TERAVOLT: Thoracic Cancers International COVID-19 Collaboration

Prior publications on small subsets of cancer patients infected with SARS CoV-2 have shown an increased risk of mortality compared to the general population. Furthermore, patients with thoracic malignancies are thought to be at particularly high risk given their older age, smoking habits, and pre-existing cardio-pulmonary comorbidities. For this reason, physicians around the world have formed TERAVOLT, a global consortium dedicated to understanding the impact of COVID-19 on patients with thoracic malignancies.