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

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

E-service-learning is equally effective as traditional service-learning in enhancing student developmental outcomes

The adoption of online learning has been accelerated by COVID-19, including experiential learning such as service-learning (SL). This study compares the student developmental outcomes between the traditional face-to-face and e-service-learning (E-SL) to reveal the effectiveness of E-SL and its good practices. A self-reporting measurement instrument was used to collect and compare the developmental outcomes perceived by students before and after SL experience between the traditional SL and E-SL cohorts of a course with the same setting, including instructor, curriculum, and assessment criteria. Qualitative research methodology is adopted to analyse students' learning artefacts to reveal possible reasons for the differences identified in student developmental outcomes, and good practices derived in E-SL. Results indicate that both traditional SL and E-SL cohorts show significant enhancement in student developmental outcomes after participating in SL. Although there are no significant differences between the two cohorts, E-SL seems to slightly outperform traditional SL in enhancing student developmental outcomes. Qualitative analysis indicates that good practices, such as stakeholders' commitment and students' constant reflection, could be the reasons why the challenges posed by the online environment in E-SL is turned into learning opportunities to students. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Barriers to Accessing Essential Medicines in Nephrology and Related Non-Communicable Diseases: A Scoping Review

Introduction: Access to safe, effective, quality, and affordable essential medicines (EM) for all is one of the World Health Organization's Sustainable Development Goals for health. However, access to EM for the treatment of non-communicable diseases (NCDs) is lacking in many low-income (LICs) and lower-middle income countries (LMICs). Chronic kidney disease (CKD) is often a downstream consequence of other NCDs, such as diabetes (DM) and cardiovascular disease (CVD), further exacerbating the economic burden on healthcare systems and societies. In nephrology, access to EM is especially important to reduce the risk of CKD progression because kidney replacement therapy is unavailable or cost-prohibitive in many regions of the world. As members of the International Society of Nephrology (ISN) Emerging Leaders Program 2021 cohort, we conducted a scoping review to assess the breadth of evidence regarding EMs for management of CKD and related NCDs, with identification of barriers to EM access as one of our main aims. Method(s): We included English-language articles of any study design that addressed barriers to accessing essential medicines in populations with CKD (all stages, causes, and ages), CVD, hypertension, and/or DM. All ISN geographical regions and World Bank income categories were considered. We searched MEDLINE, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials to May 2021. Titles and abstracts were screened, and full texts were retrieved for potentially relevant publications. Each full-text article was assessed for inclusion. For included articles, data extraction was performed with a standardized form using Covidence software. Each step was performed by one reviewer and checked by a 2nd reviewer. Applying an ecological model, barriers were categorized as occurring at the national/health policy level, regional level, organization level, provider level, or patient level. Result(s): Ninety-six publications addressed barriers to access to essential medicines, including LICs (16 articles), LMICs (43 articles), upper-middle income countries (25 articles), high-income countries (10 articles), plus 21 articles which did not specify countries. Most publications assessed barriers at the health policy-level, which included high EM prices in the setting of current patent laws;lack of effective systems for public procurement of EM, resulting in large out-of-pocket household expenditure for medicines in LIC/LMIC;inefficient distribution systems with multiple price mark-ups;and lack of regulatory systems, giving rise to counterfeit medications. Regional-level barriers included lack of governance of supply chain logistics, lack of regional coordination, and poor transportation infrastructure, especially in rural settings. Organization-level barriers included medication stock-outs at facilities, and health care worker shortages. Provider-level barriers included irrational prescribing, lack of CKD identification, and poor communication with patients. Patient-level barriers included poverty, informational barriers/health literacy, and negative perception of generic medicines (Figure). [Formula presented] Conclusion(s): Barriers to accessing EM exist at several levels, particularly the health system-level, and affect LICs and LMICs disproportionately. This scoping review serves as an initial step towards designing implementation studies to address barriers to improve EM access. Conflict of interest Potential conflict of interest: MMMY has a consultancy agreement with George Clinical and served on a CKD advisory board sponsored by AstraZenecaCopyright © 2023

Editorial: The society for environmental geochemistry and health (SEGH): 50 years and beyond.

When the SEGH international board released a short editorial paper back in 2019, we described an aim to increase the membership offering, whilst improving the diversity of input regionally, by scientific discipline and to ensure greater and more regular contact across the regions from 2020 onwards. Wider aspirations described in 2019 (Watts et al. 2019) are discussed within this short communication at the end of 2021 to evaluate progress made. In particular, how the SEGH community adapted to the unprecedented circumstances that have challenged each and every one of us throughout the COVID-19 pandemic since early 2020 and are likely to influence our activities for the foreseeable future.

Results from the Hong Kong's 2022 report card on physical activity for children and adolescents

Background/objective: This paper aimed to summarize the findings of the third (2022) Active Healthy Kids Hong Kong Report Card on Physical Activity for Children and Adolescents and evaluate the secular trends of physical activity related indicators. Methods: Five behavioral indicators (Overall Physical Activity, Organized Sport and Physical Activity, Active Play, Active Transportation, and Sedentary Behavior), three outcome indicators (Physical Fitness, Sleep, and Obesity) and four sources of influence indicators (Family and Peers, School, Community and Environment, and Government) were assigned a letter grade (ranging from A+ to F or incomplete) based on the best available evidence following a harmonized approach developed by the Active Healthy Kids Global Alliance. Data sources included published journal articles, government reports, manual searches, and personal contacts;and consisted of both pre-COVID-19 and after-COVID-19 evidence. Results: Grades for Overall Physical Activity (D−∗∗) and Sedentary Behavior (D) deteriorated compared to the 2018 Report Card. The other three behavioral indicators, Organized Sport and Physical Activity, Active Play, and Active Transportation, were assigned B−, D, and B+, respectively. Physical Fitness (D), Sleep (C−), and Obesity (D−) obtained the same grades as in the 2018 Report Card. School (B) and Government (C+) grades slightly improved, while Community and Environment grade (B) was stable. Family and Peers was not graded due to insufficient evidence. Conclusions: Despite slight improvements in influence indicators, physical activity and sedentary behavior have changed unfavorably for children and adolescents in Hong Kong. Strategic investments are needed to improve adoption and implementation of effective interventions. © 2022 The Society of Chinese Scholars on Exercise Physiology and Fitness

Prevention and screening during the COVID-19 pandemic: qualitative findings from the BETTER WISE project.

BACKGROUND: The COVID-19 pandemic challenged healthcare systems worldwide and disrupted primary care, particularly prevention, screening, and lifestyle counselling. BETTER WISE is a comprehensive and structured approach that proactively addresses cancer and chronic disease prevention and screening (CCDPS), including cancer survivorship and screening for poverty and lifestyle risks for patients aged 40 to 65. Patients from 13 primary care clinics (urban, rural, and remote) in Alberta, Ontario, and Newfoundland & Labrador, Canada were invited for a 1-hour visit with a prevention practitioner (PP), a member of the primary care team with specialized training in CCDPS to provide patients an overview of eligible screening and assist with lifestyle counselling. This qualitative sub-study describes how the COVID-19 pandemic impacted BETTER WISE in a constantly changing medical landscape. METHODS: We conducted 17 focus groups and 48 key informant interviews with a total of 132 primary care providers (PPs, physicians, allied health professionals, and clinic staff) over three different time points to better understand their perspectives on the BETTER WISE project. We also received 585 patient feedback forms of the 1005 patients who agreed to participate in the study. We also collected field notes and memos and employed thematic analysis using a constant comparative method focused on the impact of the pandemic on BETTER WISE. RESULTS: We identified four themes related to how the COVID-19 pandemic impacted the BETTER WISE study: 1) Switch of in-person visits to visits over the phone; 2) Lack of access to preventive care and delays of screening tests; 3) Changes in primary care providers' availability and priorities; 4) Mental health impacts of the pandemic on patients and primary care providers. CONCLUSIONS: The COVID-19 pandemic had and, at the time of writing, continues to have an impact on primary care, particularly on prevention, screening, and lifestyle counselling. Despite structural, procedural, and personal challenges throughout different waves of the pandemic, the primary care clinics participating in BETTER WISE were able to complete the study. Our results underscore the importance of the role of primary care providers in adapting to changing circumstances and support of patients in these challenging times. TRIAL REGISTRATION: This qualitative study is a sub-component of the BETTER WISE pragmatic, cRCT, trial registration ISRCTN21333761 (date of registration 19/12/2016).

Asymptomatic SARS-CoV-2 Infections, BNT162b2 mRNA COVID 19 Vaccine-Related Symptoms, and Correlates of Immunity in Post-Vaccination Breakthrough Infections in the Prospective Assessment of SARS-CoV-2 Seroconversion (PASS) Study

Background. We sought to determine the frequency of asymptomatic SARS-CoV-2 infections, the BNT162b2 mRNA COVID 19 vaccine-related symptoms, and the correlates of immunity in post-vaccination breakthrough infections in a prospective cohort of healthcare workers. Methods. We have been conducting a single-center, observational cohort study of healthcare workers. 271 participants were enrolled since August 25, 2020. Testing for SARS-CoV-2 spike (S)-specific IgG antibodies is conducted using a microspherebased multiplex immunoassay interpolated against an internal standard curve for binding antibody (bAb) units (BAU) and has been performed on serum samples collected at monthly visits between September 2020 to August of 2021, and quarterly since then. Neutralizing antibody titers against wild-type (WT) virus are determined by microneutralization assays and against Delta and Omicron variants by lentiviral pseudovirus neutralization assays. For the first 6 months, participants completed a symptoms questionnaire every day they had any symptoms. Results. 12 participants were diagnosed with SARS-CoV-2, with at least mild symptoms. Of 206 participants evaluated for adverse effects after 1st and 2nd vaccine doses, no relationship was observed between vaccine-associated symptom scores and antibody titers 1 month after the 2nd dose. Longitudinal studies demonstrate that anti-S IgG bAbs decrease from a geometric mean (GM) of 1929 BAU/mL at 1 month post-vaccination to a GM of 442 BAU/mL at 6 months post-vaccination ( P < 0.001, n =187), and that boosting increases S-specific IgG BAU. While only 5 of 39 participants had detectable anti-Omicron neutralizing activity 1 month after 2 vaccinations, booster vaccination resulted in detectable neutralizing activity for all participants. Conclusion. Asymptomatic infection is likely rare, that there is no relationship between vaccine-associated symptom severity and antibody titers 1 month after the 2nd vaccination, and that booster results in better protection against the Omicron variant. Ongoing studies are evaluating serological and cellular immune responses immediately prior to 38 breakthrough infections in an attempt to identify immune correlates of protection and will be reported at the conference.

Beyond chart review: using NLP as a performance improvement tool to track aspirin utilization

Objective: As quality metrics increase, chart review to capture this data will not be feasible. Natural language processing (NLP) may offer solutions especially for lower resourced systems. ACOG and USPSTF recommend aspirin (ASA) to reduce the probability of developing preeclampsia. ASA is commonly only charted in free text in the electronic health record (EHR), rather than in the discrete field medication list. The aim of this study was to evaluate whether NLP could correctly identify patients for whom aspirin was indicated and who received it. Study Design: A retrospective cohort study of patients with clinic visits who delivered in two time periods: Oct 2019-Feb 2020 and Jan-Jun 2021. These were chosen to sample both pre- and post-COVID clinical documentation practices. To establish whether aspirin was received and indicated, chart review was performed for medications and risk factors/indications. We trained two Bidirectional Encoder Representations from Transformers (BERT)-based NLP models: first, a model to identify patients for whom aspirin had been given (Model 1: ASA Received);second, a model to identify patients for whom aspirin was indicated based on ACOG/USPSTF criteria (Model 2: ASA Indicated). Each model was then applied on the holdout data from the initial cohorts. Each model was also then applied on new, unseen data to evaluate its use for ongoing predictive performance (Mar-Jul 2022). Result(s): The models were trained on 824 patients, of whom 314 (38%) were positive per the ASA Indicated model and 92 (11%) were positive by the ASA Received model. Both models had excellent discriminatory abilities: ASA Received ROC AUC 0.87, ASA Indicated ROC AUC 0.91 (Figure 1). When applied to new data (Mar-Jul 2022), the models predicted frequencies of ASA indication and treatment which were stable and consistent with our performance trend (Figure 2). Conclusion(s): NLP represents a potential tool to monitor quality improvement processes without chart review. Since these models were developed on real-world EHR data, clinical dashboards could be created allowing more efficient and widespread system monitoring. [Formula presented] [Formula presented] Copyright © 2022

Synthesis of zinc oxide derived from wastewater of glove manufacturing via adsorption-desorption-precipitation path

The demand for ZnO significantly increased over the past decades. Extraction and refinement of zinc ores results in the release of hazardous wastes to the environment. In particular, the tremendous demand for disposable nitrile gloves during the Covid-19 pandemic has spiked superior demand for ZnO used as a crosslinking agent in the manufacturing process and leads to the generation of zinc containing wastewater traditionally removed via chemical precipitation. This paper focuses on the application of adsorption for zinc removal which opens an opportunity to recycle zinc to synthesize secondary zinc oxide. This study evaluated the feasibility of zinc oxide synthesis via the adsorption-desorption-chemical precipitation pathway. Palm shell activated carbon (PSAC), a low-cost adsorbent, was used for the removal of zinc from the synthetic and industrial wastewaters. Subsequently, zinc desorption was carried out using 0.3 M HCl. Then ZnO was synthesized from the desorption solutions via chemical precipitation using potassium hydroxide. Average zinc conversion rate of 98 % was achieved in this study. The synthesized ZnO exhibited high surface area of 97.4 m2/g after calcination (400 °C, 3 hr), high purity and crystallinity. The results confirmed the feasibility of zinc ions recovery for recycling to produce secondary good quality zinc oxide.

A Community-Designed Qr Code-Based Animation Helps Patients Prepare for Endoscopies

Aim: Conventionally, patients are gathered to watch an introductory video at the clinic before endoscopic investigations take place. This may arouse practical issues under the COVID pandemic. Our centre, in collaboration with students from a local secondary school, has designed a set of animations which patients can easily access to with a QR code using their own mobile devices, so as to avoid patient gathering and increase their flexibility to read the information. This study aims to evaluate patients' perception of the QR code-based introductory animations of esophagogastroduodenoscopy (OGD) and colonoscopy (CLN). Method(s): A QR code linking to the animation was attached to the appointment sheet. Patients were asked to watch the animation with their own mobile devices before the endoscopy. A questionnaire with 5 questions was distributed after completion of their procedures. Result(s): A total of 144 patients undergoing OGD and CLN were recruited in May-June, 2022 at Tin Shui Wai Hospital. The response rate was 91.7%. Positive feedback was received. 12 patients (8.3%) did not gain access to the animation. A majority of patients agreed or totally agreed that the animation offered them more flexibility to understand the procedures before their OGD (75.4%) and CLN (79.1%). The QR code-based animation was deemed easy-to-use (80.3%), appealing (78.0%) and educational (81.0%). Conclusion(s): With increasing accessibility to mobile devices, patient education in preparation for medical procedures is no longer confined to the hospital setting. QR code-based animation is shown to be an effective and welcoming tool to prepare patients for endoscopies.

Mechanical ventilation and prone positioning in pregnant patients with severe COVID-19 pneumonia: experience at a quaternary referral center.

BACKGROUND: We present the care of 17 consecutive pregnant patients who required mechanical ventilation for Coronavirus Disease 2019 (COVID-19) pneumonia at a quaternary referral center in the United States. We retrospectively describe the management of these patients, maternal and fetal outcomes, as well as the feasibility of prone positioning and delivery. METHODS: Between March 2020 and June 2021, all pregnant and postpartum patients who were mechanically ventilated for COVID-19 pneumonia were identified. Details of their management including prone positioning, maternal and neonatal outcomes, and complications were noted. RESULTS: Seventeen pregnant patients required mechanical ventilation for COVID-19. Thirteen patients received prone positioning, with a total of 49 prone sessions. One patient required extracorporeal membrane oxygenation. All patients in this series survived until at least discharge. Nine patients delivered while mechanically ventilated, and all neonates survived, subsequently testing negative for SARS-CoV-2. There was one spontaneous abortion. Four emergent cesarean deliveries were prompted by refractory maternal hypoxemia or non-reassuring fetal heart rate after maternal intubation. CONCLUSIONS: Overall, maternal and neonatal survival were favorable even in the setting of severe COVID-19 pneumonia requiring mechanical ventilation. Prone positioning was well tolerated although the impact of prone positioning or fetal delivery on maternal oxygenation and ventilation are unclear.

First case of within-host co-infection of different SARS-CoV-2 variants in Ecuador.

Background: COVID-19 infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause mild symptoms to severe illness and death. Co-infections of SARS-CoV-2 with other respiratory viruses have been described. However, two SARS-CoV-2 lineage co-infection have been rarely reported. Methodology: A genotyping analysis and two different types of whole genome sequencing were performed (Illumina MiniSeq and ONT MinION). When examining the phylogenetic analysis in NextClade and Pangolin webservers, and considering the genotyping findings, conflicting results were obtained. Results: The raw data of the sequencing was analyzed, and nucleotide variants were identified between different reads of the virus genome. B.1 and P.1 lineages were identified within the same sample. Conclusions: We concluded that this is a co-infection case with two SARS-CoV-2 lineages, the first one reported in Ecuador.