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Previous studies have demonstrated that low-intensity intervention is effective in improving mental health in young people. Whilst interventions have majorly been offered online during COVID-19 pandemic, it is not known whether low-intensity interventions delivered online can also help reduce the level of distress experienced by young people. The study aimed to determine whether a low-intensity online intervention (LiON) can reduce levels of distress in young people greater than those in similar initial distress levels but received no intervention. Young people aged 15 to 24 were recruited for the 4-weekly LiON intervention consisting of three modules namely sleep and relaxation, stress-coping and problem-solving. The reductions in distress level after intervention were compared to those that occurred over a period of 3 months among community young people with similar baseline K6 distress levels. Seventy-four young people (mean age 20.24 [SD 2.26] years, 71.6% female) received the LiON intervention from December 2021 to July 2022. We observed a greater improvement in their distress levels after receiving the intervention than those with no intervention in the community (beta -4.13, 95%CI -5.12, -3.07, p < .001, Cohen's f2 0.027). The findings offered evidence that the LiON intervention significantly reduced young people's distress level in addition to the improvement that may occur naturally. The use of LiON is adaptable to a wider variety of frontline community organizations. Future evaluation of its cost-effectiveness is warranted.
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PurposeThe purpose of this research is to investigate the lived experiences, challenges and coping mechanisms of lecturers during the emergency remote teaching (ERT) situation induced by the Covid-19 pandemic.Design/methodology/approachA case study on lecturers in colleges and universities in Penang, Malaysia is selected. A qualitative research approach is adopted with semi-structured interviews as the data-gathering tool. Purposive sampling is used for diversity in terms of gender, ethnicity, age, subject or discipline taught and teaching experience.FindingsThe findings are composed into four (4) themes - Theme 1: Lecturers down-shift to lower levels of satisfaction and well-being, Theme 2: Wide diversity of experience with various intervening variables, Theme 3: Lecturers accept and adapt toward the situation and Theme 4: Socialization is compromised.Research limitations/implicationsDespite this being a case study on Malaysia, it is postulated that the findings and recommendations have global relevancy as ERT is a worldwide phenomenon.Practical implicationsPractical education management and public-policy implications are evident and recommendations are made based on the emergent themes.Social implicationsThe findings in the form of emergent themes have considerable social implications in terms of social sustainability of education practices and policies.Originality/valueThis research is novel as lecturers' experience of ERT in Malaysia has not been specifically addressed to date. Even though the fieldwork is conducted in Malaysia, the findings and recommendations have global relevancy.
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Background: The real-world management and clinical characteristics of chronic spontaneous urticaria (CSU) in Hong Kong, and its implications for COVID-19 vaccination are unknown. We investigated the patient characteristics, effectiveness of an immunologist-led Urticaria Clinic, and the impact of CSU on COVID-19 vaccine uptake in Hong Kong. Method(s): Longitudinal clinical data of 257 CSU patients attending our immunologist-led Urticaria Clinic were analysed. Result(s): Most patients had experienced wheals (98.8%) and 65.4% had angioedema. 1.2% of CSU patients had angioedema without wheals. Two-thirds (66.5%) received inappropriate treatment prior to immunologist review. A significant proportion of patients had concomitant autoimmunity (14.8%) and history of suspected drug allergy (9.7%) respectively. Weekly Urticaria Activity Score (UAS7) was significantly lower after immunologist review (12.0 vs 0.00, p < 0.001). The change in UAS7 was significantly greater among patients with baseline UAS7 >=16 (-24.0 vs -2.00, p < 0.001);and, among those with uncontrolled disease despite second-line treatment, with access to omalizumab and/or ciclosporin (-26.0 vs -3.50, p < 0.001). Majority of patients received at least one (68.5%) and two doses (65.0%) of COVID-19 vaccine respectively. History of suspected drug allergy was associated with lower COVID-19 vaccine uptake (odds ratio: 0.47, p = 0.010). Conclusion(s): CSU patients in Hong Kong have unique clinical characteristics and a considerable proportion had received inappropriate treatment before immunologist review. An immunologist-led Urticaria Clinic was effective in CSU management. COVID-19 vaccination rates were lower than the general population in Hong Kong, and a history of suspected drug allergy was associated with lower COVID-19 vaccine uptake.
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BACKGROUND: N95 filtering facepiece respirators (FFRs) are essential personal protective equipment (PPE) for protecting healthcare workers from airborne pathogens. AIM: To perform the first large-scale evaluation of particulate filtration efficiency (PFE) of three models of N95 FFRs following clinical usage and vaporized hydrogen peroxide (VHP) decontamination. METHODS: Three variables were assessed for effect on PFE following VHP decontamination: VHP sterilizer model, N95 respirator model, and prior N95 clinical usage. FINDINGS: The VHP sterilizer model and N95 FFR model impacted PFE performance. Worn N95 FFRs had a 91% lower odds of exhibiting ≥95% PFE compared with the control. CONCLUSION: This work highlights the importance of validating any N95 FFR decontamination programme in its entirety, including prior clinical usage.
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Introduction At the onset of the Covid-19 pandemic, hospital educational activities were halted in order to focus on healthcare delivery and maintain social distancing. As a response to this disruption, BSPGHAN trainees set up the BSPGHAN Education Series, a twice- weekly virtual learning programme. The core objective of this programme was to deliver high quality paediatric gastroenterology, hepatology and nutrition (PGHAN) teaching during the pandemic. In this study, we analysed the attendances and feedback received from the education series, in order to guide future directions. Methods We reviewed the Zoom meeting attendance logs and Survey Monkey feedback forms for the BSPGHAN Education Series from April 2020 to December 2020. Results In nine months, a total of 55 talks were delivered by 43 speakers. 23 (41.8%) sessions were gastroenterologythemed, 25 (45.4%) were hepatology-themed and 7 (12.7%) were nutrition-themed. Thirteen paediatrics gastroenterology units (12 in the UK and 1 in the United States) and all 3 UK tertiary paediatric liver centres contributed to the talks. The highest contributing centres were Birmingham Children's Hospital (20 sessions), followed by King's College Hospital (9 sessions) and Leeds Children's Hospital (7 sessions). Attendance logs and feedback forms were available for 53 sessions. A total of 2369 attendances were logged, with a median of 41 attendees per session (IQR 31-54). Attendees from 22 countries have participated in these sessions. A total of 810 survey feedback forms were received, with a median of 14 forms received per session (IQR 10-18). 32% were filled in by PGHAN Grid trainees, 23% by consultants, 15% by clinical fellows. Allied Health Professionals (AHPs) comprised 6% of feedback returns. 54% of survey feedback respondents accessed the teaching sessions from home. An average of 98% (95% CI 96.3-99.2) survey respondents strongly agreed/agreed that the sessions were relevant to their learning. 97% (95% CI 96-98.7) of survey respondents strongly agreed/agreed that the sessions delivered were of high quality. Discussion The BSPGHAN series has been a positive initiative arising from the pandemic, providing access to high quality PGHAN education when local availability was paused, and giving a platform for the society internationally. Our report shows that the BSPGHAN Education Series has been wellreceived by attendees. The virtual sessions are more accessible compared to in-person teaching sessions, as evidenced by the high percentage of feedback respondents accessing the sessions from home. Looking ahead, the BSPGHAN Education Group, set up in October 2020, will play a vital role in the further development of the Education Series. Sessions are recorded and made available to BSPGHAN members on the BSPGHAN websitefurther work may include creating online learning modules centred around these recordings. AHP involvement is an area for development- for 2021, we hope to include more topics that will be relevant to their interests.
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Background and objectives: Travel history has become an indispensable part of emergency department (ED) patient assessment due to the ongoing COVID-19 pandemic. The ability to highlight travel from free text notes may augment travel history that is not completely captured in structured data fields. We explore if named-entity recognition (NER), a natural language processing (NLP) technique, can be used to extract travel history from ED free text triage notes (FTN) using a widely available, off-the-shelf, open-source NLP tool. Methods: The FTN of 10,000 attendances at an ED were reviewed by a team of annotators, and the countries, regions, or cities of travel were extracted. The annotated notes were used to train the native, out-of-the-box NER model in SpaCy 3.0.5, which is based on a deep convolutional neural network. Predictions made by the trained model were evaluated on a previously unseen test set. Results: The NER model achieved F1 score of 97.64%, precision of 98.68%, and recall of 96.6% in capturing travel history. Conclusion: Machine learning can be used to accurately capture travel history from ED FTN.
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Restrictive COVID-19 measures can have significant mental health impacts, particularly on young people. How such measures may influence day-to-day momentary affect, nonetheless, remains to be explored. Experience sampling data were collected from 165 young people (aged 15-24) as part of a larger epidemiological youth mental health study in Hong Kong. We examined the impact of one of the most stringent COVID-19 measures - dine-in restrictions - on momentary positive and negative affect and current contexts and activities of these young people. The effects of a milder form of COVID-19 measure - school suspension - were separately examined. Multilevel analysis revealed that those in the dine-in ban group, compared to dining-as-usual, showed significantly reduced momentary positive affect (ß = -0.17, SE = 0.06, p = 0.003). Its effect remained significant even when accounting for baseline depressive and anxiety symptoms and socioeconomic status (ß = -0.15, SE = 0.05, p = 0.008). The effect of dine-in ban on reduced momentary positive affect was found specifically when participants were in indoor locations (e.g., home, office), alone, and engaged in passive leisure activities. This pattern was not observed when participants were at school or at other outdoor locations, with friends, or engaged in active leisure activities. No significant effect of school suspension on momentary affect was observed. More severe COVID-19 measures, such as dine-in ban, can have significant impacts on the momentary positive affect of young people. Certain contexts and activities may offer protection against the consequences of COVID-19 measures. The current findings may help to inform future designs of mental health interventions and public health policies. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03183-y.
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Background: A thorough understanding of the inflammatory reaction to SARS-CoV-2 variants, specifically the Delta and Alpha variants, can provide crucial insight into future treatment of individuals infected with these strains. Mice are an effective model for predicting the pathologic processes of these viruses in humans. Design: K18-hACE2 transgenic mice were raised either under normal conditions (control) or infected with either the Alpha (strain B.1.1.7) or Delta (B.1.617.2) variant of SARS-CoV-2, via intranasal challenge with 1000 PFU virus. Mice were then euthanized at days 2 and 6 post-challenge. Lung sections were used for pathological evaluation of H&E stained slides scanned using the Dynamyx software. Blood vessel cross sections were examined and the average number of marginating inflammatory cells per millimeter of vessel were quantified. Additionally, the percentage of total tissue area that was inflamed was calculated. Results: Our data indicates that the Delta variant elicits a strong lymphocytic immune response in the lungs. At two days postchallenge, Inflammation and margination of inflammatory cells could be appreciated in Delta infected mice, but not in Alpha infected mice. The inflammatory infiltrate was composed predominantly of lymphocytes and occasional histiocytes at 2 days. By day 6, marked perivascular inflammation and margination was appreciated, more prominently in Delta (36 lymphocytes per mm. of endothelium) than Alpha infected mice (22 lymphocytes per mm. endothelium) (p=0.022). At this time point, Alpha infected mice showed 4% involvement of pulmonary area by inflammation, compared to 20% for Delta infected mice (p=0.014). Conclusions: This study quantifies the lymphocytic immune response in the lungs to the Alpha and Delta variants of SARS-CoV-2 in mouse models. Both variants showed a lymphocyte predominant inflammatory response. However, the response was much more robust and severe in Delta infected mice compared to Alpha. The results support why the Delta variant is more virulent and fatal compared to Alpha. Ongoing longer term studies and effects in other organs are ongoing and will help to provide further insight into pathogenesis of long COVID-19.
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The rapid shift to online teaching or emergency remote teaching (ERT) following the COVID-19 pandemic requires a high level of inclusiveness in teaching efforts to ensure children who are at risk for learning are not left behind. Using a mixed-method design, this small-scale study (a) explored the relationship between Malaysian private and international primary school teachers’ attitude towards inclusive teaching during ERT, teaching efficacy, TPACK mastery, and burnout, and (b) identified ERT-specific factors that are associated with the teachers’ attitudes and experiences during ERT. A total of 28 teachers participated in an online survey that comprised four established scales to measure the teachers’ inclusive attitude, teaching efficacy, TPACK, and teacher burnout. The online survey also consisted of open-ended questions about their ERT teaching experiences. Two of the teachers who completed the questionnaire were then interviewed online. Attitude towards inclusive teaching was not correlated with all other variables, but (a) teaching efficacy correlated positively with TPACK mastery, and (b) high teaching efficacy, and high TPACK correlated with low burnout. Thematic analysis of the qualitative data generated four themes that supported the correlational findings: inclusion attitude during ERT, exclusion strategies, prolonged online teaching at home, and parental involvement. Findings imply that pre-pandemic inclusive teaching practices and TPACK were insufficient to fully support inclusive teaching attitude during ERT. New inclusive practices that support prolonged online teaching and effective parental involvement are needed to prevent digital exclusion during ERT. This small-scale study challenged the accessibility of online teaching during ERT and calls for the need to modify or reinvent our understanding of effective support for students with additional needs in fully online and distance learning conditions. © Penerbit Universiti Sains Malaysia, 2021.
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Background: The COVID-19 pandemic resulted in an abrupt and unanticipated shift to health care delivery, including a transition from in-person to virtual physician encounters. To date, few studies have examined patient and physician views on virtual food allergy management. To this end, we sought to examine caregivers' and allergists' views on virtual allergy care of food allergy. Method: In an embedded mixed-methods study of Canadian caregivers of children (<18 years) and allergists, we collected quantitative and qualitative data on levels of satisfaction and comfort with virtual care (both on a scale of 0-100) and perceived advantages and disadvantages, respectively. Data were collected from October-December 2020. Quantitative data were analyzed descriptively. Qualitative data were analyzed thematically. Findings were integrated in the interpretation. Results: In total, 66 caregivers and 11 allergists participated. Quantitatively, caregiver satisfaction was high and comparable, regardless of type of care, or type of delivery (virtual vs other). In comparison, allergists' satisfaction was lowest for virtual oral food challenge (OFC) and oral immunotherapy (OIT) (mean 40.8 ± 39.7, and 30.2 ± 34.5, respectively;both p < 0.05 vs. initial assessments). Qualitatively, both caregivers and allergists described virtual care as having benefit without the burdens. Qualitative disadvantages of virtual care were, for caregivers, isolation;and, for allergists, limited opportunities for testing and unclear projected utilization of virtual care post-COVID. Conclusion: Caregiver satisfaction was consistently high, although isolation exacerbated by virtual care and more generally, the food allergy itself, remained a concern. Allergist satisfaction was more variable, with preference towards types of care involving less patient risk.
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Purpose : This study is to evaluate the myopia reduction effect and myopia control efficacy of the novel elastic Breath-O Correct orthokeratology (OK) lenses. Methods : A total of 85 subjects aged 9 to 12 years with spherical equivalent refraction (SER) between -1.00D and -4.00D were recruited, then randomly assigned into OK (n=49) or spectacle control (n=36) groups. Breath-O Correct lenses were prescribed in OK group with routinely scheduled aftercares. Corneal topography, SER, unaided and best-corrected visual acuity in LogMAR (BCVA), anterior chamber depth (ACD), and axial length (AL) were measured at baseline and 1-year visit. For the control group, update of spectacles was indicated if there was a 0.50D difference in spherical or cylindrical power by subjective refraction in a 6-month follow-up. Results : Seventy-one subjects (OK: 42, Control: 29 Age 9.46 ±1.32 years) completed the 1- year study. Seven OK subjects withdrew due to poor visual quality, inconvenient lens care, and COVID-19 pandemic. Seven control subjects withdrew due to fast myopia progression and COVID-19 pandemic. In OK group, the 1-year simulated flat and steep K decreased significantly (Flat K: -1.57±0.95D;Steep K:-1.59±1.07D;p<0.001) with a mean unaided visual acuity of 0.09±0.13. The mean dry subjective SER in control and OK groups were -2.92±1.32D and -0.07±0.66D (p<0.001) respectively without significant difference in BCVA (Control: 0.01±0.04, OK: 0.00±0.05;p>0.05). The mean AL elongation was significantly different between two groups (Control: 0.35±0.2mm, OK: 0.14±0.17mm, p<0.001). A significant ACD elongation was also noted in control group but absent in OK group (Control: 0.073±0.096mm, p<0.001;OK: -0.054±0.326mm p>0.05). RM-ANOVA with posthoc Bonferroni correction revealed significant interaction between OK treatment and the rate of myopia progression in 1 year (p<0.001). Conclusions : The novel elastic Breath-O Correct OK lens effectively retarded AL elongation, and hence, myopia progression in school-aged children without compromising BCVA and with maintenance of good unaided daytime vision.
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Introduction: Radiation induced pulmonary fibrosis typically develops between 6-12 months after completion of radiation therapy (RT), and typically affects only the irradiated lung. We present a rare case of bilateral radiation induced pulmonary fibrosis occurring only one month after completion of unilateral RT. Case Presentation: A 75-year-old male with pleural mesothelioma treated with five cycles of neoadjuvant carboplatin and pemetrexed followed by thoracotomy, pleurectomy, decortication and six weeks of RT (28 fractions, total 50.4 Grays) (Figure 1A) presented 33 days after completing RT with five days of dyspnea and dry cough. Vitals were notable for oxygen saturation of 86% on room air with improvement to 97% on 4 L/min via nasal cannula. Review of his pre-RT computed tomography (CT) demonstrated left-sided bronchiectasis and basilar ground glass attenuation representing post-inflammatory changes (Figure 1B). Repeat CT 27 days after completion of RT showed new bilateral diffuse ground-glass opacities with left upper and lower lobe fibrosis (Figure 1C);CT upon current presentation revealed increased ground-glass opacities and bilateral fibrosis (Figure 1D). Blood cultures, SARSCoV-2 PCR, respiratory pathogen panel (including influenza A/B and respiratory syncytial virus), cryptococcal antigen, galactomannan and 1,3-beta-d-glucan were all unrevealing. Transthoracic echocardiogram revealed septal E/e' ratio 12.6 and estimated pulmonary artery systolic pressure 30 mmHg, and serum b-type natriuretic peptide level was 48 pg/ml. Detailed reconciliation confirmed he was not taking any new medications, including statins. Hypersensitivity pneumonitis panel was negative. His working diagnosis was radiation induced lung injury with features of both early pneumonitis and late fibrosis. Therapy with short-acting bronchodilators and systemic corticosteroids was initiated with significant clinical improvement;patient was discharged home on hospital day six off oxygen. Discussion: Radiation induced lung injury can generally be divided into acute and late phases. The former is commonly known as radiation pneumonitis and manifests as ground-glass opacities 4-12 weeks after completion of RT, and the latter presents as bronchiectasis and fibrosis 6-12 months later. Ours is a rare case of pneumonitis and fibrosis that developed within one month of completing RT. Additionally, this patient developed pneumonitis and fibrosis of his right lung, which did not receive any radiation;very few cases of pneumonitis on the nonirradiated lung have been reported. Immunologically mediated lymphocytic alveolitis has been proposed as a mechanism for contralateral spread of radiation fibrosis. Our patient showed significant clinical improvement with initiation of corticosteroids with the plan for a long, slow outpatient taper based on clinical response.
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Background: In the setting of the COVID-19 pandemic, many outpatient visits have been converted to telemedicine visits via telephone or video. While video visits offer many advantages over telephone, their use is consistently lower among older adults. Therefore, we designed a quality improvement project to increase video visit capability among older adults at a geriatrics primary care clinic. Methods: Patients receiving care at the San Francisco Veterans Affairs geriatrics clinic were identified to determine the number of patients who completed a VA Video Connect (VVC) visit up until November 1, 2020. We identified the presence of a VVC visit by tracking a clinical reminder in the electronic health record and running a report that documents the last VVC visit date. We interviewed patients, staff, and providers to identify barriers to conducting video visits. Based on these barriers, we designed a multifaceted intervention aimed to increase participation in VVC visits. This included sending letters notifying patients of VVC visits, encouraging providers to schedule VVC visits over telephone visits, and assessing video capability prior to and during scheduled telephone visits. Our primary aim was to increase the number of patients who have had a VVC visit by 15% within a three-month period. Results: Of the 286 patients identified among seven geriatrics providers, 29% (84 patients) had previously had a VVC visit. Barriers to scheduling and completing a VVC visit included patient factors (e.g. access to video-capable devices, comfort level, sensory impairments), provider/support staff factors (e.g. time burden to train patients), systems factors (e.g. limited number of VVC scheduling slots), and technological barriers (e.g. internet connection stability). We will present data on the percent increase in the number of patients who have had a video visit within three months of our intervention. Conclusions: Most older adults at our geriatrics clinic had not performed a video visit despite several months of reduced in person visit capacity due to the COVID-19 pandemic. Through our interventions, we hope to increase video visit capability to deliver high-quality care to this vulnerable population.
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Background and
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The COVID-19 pandemic has changed the way we deliver healthcare. During 'lockdown' all but the most urgent face-toface (F2F) consultations stopped. There will be a continuing need for innovation to maintain services, and teledermatology offers the potential to help meet demand, while continuing to maintain social distancing. We report the use of a store-andforward teledermatology platform to facilitate virtual asynchronous consultations. The platform was developed and piloted across two health boards, with initial use focused on return consultations. The restrictions imposed during the pandemic prompted its use on a larger scale, with the addition of a specific proforma for new consultations. Patients are invited to register using a web-based app, and then have a 5-day window to submit information and pictures to an assigned clinician. The clinician then responds within an agreed timeframe, and a PDF of the consultation is sent to the general practitioner automatically. The system can integrate with patientmanagement systems, although at the time of this audit it was only integrated in one of two health boards. During an 11-week period from late March 2020, 405 consultations (new 297;return 108) were completed. In total, 292 consultations involved the assessment of lesions, most referred as suspected cancers. Patients of all ages participated successfully, with 31% over the age of 60 years. Parents of 12 children also successfully participated. Responses to 219 consultations were completed from home by a clinician, highlighting the potential for the system to facilitate remote working. Outcomes from the virtual consultations included further virtual review (16%), F2F review (47%), direct surgery (12%), discharge (22%) and other treatment/investigations (3%). The majority of those needing F2F review were scheduled for routine follow-up, although 29% were booked as urgent to confirm diagnosis, typically where image quality was not sufficient for diagnostic certainty. The average time taken by the clinician was 10 min per consultation vs. 13 min for equivalent F2F. However, these timings were taken without the benefit of full system integration. Patient satisfaction was good, with 82% of respondents reporting ease of use. Forty-two per cent reported that they would normally have had to miss work to attend the clinic. The system also confers environmental benefits with a total of 5758 km of patient travel saved. This pandemic has resulted in a paradigm shift in the way we deliver outpatient care. Virtual asynchronous consultations, within an integrated dermatology service, provide an efficient alternative to some F2F consultations.