Virtual Visit Trends in Nursing Homes During the COVID-19 Pandemic.

Background: Physical distancing and visiting restrictions during the COVID-19 pandemic particullarly posed significant challenges in providing timely medical care in nursing homes. Virtual visits were pivotal in providing both scheduled and urgent patient care in addition to in-person care when possible. These virtual visits could have been used to provide urgent medical care than the regular scheduled visits. We hypothesize that regular non-COVID-19-related virtual visits in the evaluated nursing home facilities were lower than COVID-19-related virtual visits during this period. The objective was to compare the frequency of COVID-19-related virtual visits with non-COVID-19-related virtual visits performed in three suburban nursing homes in Michigan from December 2020 through February 2022. Methods: Retrospective chart review of 283 patients, comprising 563 virtual visits. The most frequent ICD-10 diagnostic codes used by providers for primary encounters were analyzed for three participating facilities Results: Only 13.8% (78/563) of all virtual visits during the study period were for COVID-19 as a primary encounter. In total 86.1% (485/563) of visits were non-COVID-19 related, which comprised most frequently M6281 muscle weakness (45), E119 diabetes type with complications (20), NI86 end-stage renal disease (11), N390 urinary tract infection (10), G309 Alzheimer's disease (10), and I4891 unspecified atrial fibrillation (10). Conclusion: We found that the primary ICD-10 diagnosis codes for virtual COVID-19-related visits were significantly lower than non-COVID-19-related virtual visits in our study population. This trend could be associated with multiple system-based factors. Further studies to examine factors responsible for these findings are warranted.

Education and Consultation Needs of Social Workers in Practice with Rural Older Adults.

The aging population and shortage of primary care physicians lead to increasing gaps in access to rural geriatric healthcare. Of concern is the lack of access to geriatric expertise, leading to adverse effects on rural older adults' health outcomes and quality of life. The Geriatric Rural Extension of Expertise through Telegeriatric Services (also known as GREETS) project surveyed rural physical and behavioral healthcare practitioners to identify gaps in geriatric competencies in the rural workforce. Using the Qualtrics platform, a survey was distributed to professional membership lists throughout the State of Michigan. A total of 106 responses were completed, of which 50 were from respondents who identified their profession as a social worker. As would be expected based on social workers' scope of practice and the settings in which they provide services, social worker respondents noted a higher need than the other practitioner respondents for education related to (a) managing chronic pain, (b) managing care of patients with multiple chronic conditions, (c) having serious illness conversations, (d) diagnosing dementia, and (e) discussing advance care planning. Having identified these needs provides a basis for identifying and implementing training and resources for social work and other disciplines involved in geriatric care and services.

Seasonal variations in aerosol acidity and its driving factors in the eastern Indo-Gangetic Plain: A quantitative analysis.

This study employs ISORROPIA-II for the evaluation of aerosol acidity and quantification of contributions from chemical species and meteorological parameters to acidity variation in the Indian context. PM2.5 samples collected during summer (April-July 2018), post-monsoon (September-November 2018), and winter (December 2018-January 2019) from a rural receptor location in the eastern Indo-Gangetic Plain (IGP) were analyzed for ionic species, water-soluble organic carbon (WSOC), and organic and elemental carbon (OC, EC) fractions. This was followed by estimation of the in situ aerosol pH and liquid water content (LWC) using the forward mode of ISORROPIA-II, which is less sensitive to measurement uncertainty compared to the reverse mode, for a K+-Ca2+-Mg2+-NH4+-Na+-SO42--NO3--Cl--H2O system. Aerosol pH was moderately acidic (summer: 2.93 ± 0.67; post-monsoon: 2.67 ± 0.23; winter: 3.15 ± 0.34) and was most sensitive to SO42- and total ammonium (TNH3) variation. The LWC of aerosol showed an increasing trend from summer (16.6 ± 13.6 µg m-3) through winter (32.9 ± 10.4 µg m-3). With summer as the baseline, the largest changes in aerosol pH during the other seasons was driven by SO42- (ΔpH: -0.70 to -0.82 units), followed by TNH3 (ΔpH: +0.25 to +0.38 units) with K+ and temperature being significant only during winter (ΔpH: +0.51 and + 0.46 units, respectively). The prevalent acidity regime provided three major insights: i) positive summertime Cl- depletion (49 ± 20%) as a consequence of SO42- substitution increased aerosol pH by 0.03 ± 0.20 units and decreased LWC by 2.4 ± 5.9 µg m-3; ii) the rate of strong acidity (H+str) neutralization and the [H+str]/[SO42-] molar ratio suggested the existence of bounded acidity in ammonium-rich (winter) conditions; and iii) significant correlations between LWC, WSOC, and secondary organics during post-monsoon and winter pointed towards a possible indirect role of WSOC in enhancing LWC of aerosol, thereby increasing pH. Given the inability of proxies such as H+str and charge ratios to accurately represent aerosol pH as demonstrated here, this study emphasizes the need for rigorous thermodynamic model-based evaluation of aerosol acidity in the Indian scenario.

Implementing COVID-19 Mitigation in the Community Mental Health Setting: March 2020 and Lessons Learned.

In March 2020, at the beginning of the COVID-19 pandemic, state-funded community mental health service programs (CMHSP) in Michigan, organized into 10 regions known as a "Prepaid Inpatient Health Plan" (PIHP), grappled with the task of developing a modified plan of operations, while complying with mitigation and social distancing guidelines. With the premise that psychiatric care is essential healthcare, a panel of physician and non-physician leaders representing Region 5, met and developed recommendations, and feedback iteratively, using an adaptive modified Delphi methodology. This facilitated the development of a service and patient prioritization document to triage and to deliver behavioral health services in 21 counties which comprised Region 5 PIHP. Our procedures were organized around the principles of mitigation and contingency management, like physical health service delivery paradigms. The purpose of this manuscript is to share region 5 PIHP's response; a process which has allowed continuity of care during these unprecedented times.

Brain Health: Attitudes towards Technology Adoption in Older Adults.

(1) Background: There is increasing scholarly support for the notion that properly implemented and used, technology can be of substantial benefit for older adults. Use of technology has been associated with improved self-rating of health and fewer chronic conditions. Use of technology such as handheld devices by older adults has the potential to improve engagement and promote cognitive and physical health. However, although, literature suggests some willingness by older adults to use technology, simultaneously there are reports of a more cautious attitude to its adoption. Our objective was to determine the opinions towards information technologies, with special reference to brain health, in healthy older adults either fully retired or still working in some capacity including older adult workers and retired adults living in an independent elderly living community. We were especially interested in further our understanding of factors that may play a role in technology adoption and its relevance to addressing health related issues in this population; (2) Methods: Two focus groups were conducted in an inner-city community. Participants were older adults with an interest in their general health and prevention of cognitive decline. They were asked to discuss their perceptions of and preferences for the use of technology. Transcripts were coded for thematic analysis; (3) Results: Seven common themes emerged from the focus group interviews: physical health, cognitive health, social engagement, organizing information, desire to learn new technology, advancing technology, and privacy/security; and (4) Conclusions: This study suggests that in order to promote the use of technology in older adults, one needs to consider wider contextual issues, not only device design per se, but the older adult's rationale for using technology and their socio-ecological context.