Frequency Of Sessions Research Articles

Study of motivation and engagement for chemical laboratory safety training with VR serious game

Safety training is a necessity and inherent part of any safety management system in high-risk industries, such as chemical industry. Often, training programs use conventional methods, such as classroom or video lectures. However, with these methods, trainees are passive and can quickly lose their attention, thus making the safety training ineffective. Alternatively, a virtual reality (VR) serious game can be used as a hands-on training tool to motivate and engage trainees. Relevant situations are simulated in a virtual environment where trainees can learn safety concepts and awareness without causing real harm to themselves or others. The current study investigates person-centred variables: motivation and engagement. We measured how safety motivation and engagement changed with employees of a chemical company when playing the VR LaboSafe Game after a traditional video lecture. Results show that employees have a high autonomous motivation to follow safety training, particularly in terms of identified regulation. Playing the VR serious game significantly increased intrinsic motivation and engagement of the trainees. They believe that they are more active, can keep their attention better and enjoy the experience of relevant situations in a virtual environment. However, complicated usability and the unfamiliarity to VR can affect their autonomous motivation for safety training. Older employees (above 50) have more difficulties with using VR headsets than younger employees (under 30). Data suggest to combine conventional methods with VR as complementary tool and provide more frequent and smaller sessions, gradually introducing VR technology to beginners.

Weekly minimum frequency of one maximal eccentric contraction to increase muscle strength of the elbow flexors.

Our previous study showed that one 3-s maximal eccentric contraction a day performed 5 days a week for 4 weeks (5DW) increased maximal voluntary contraction (MVC) strength of the elbow flexors more than 10%. The present study examined whether muscle strength would still increase when the frequency was reduced to 2 days or 3 days per week. Twenty-six healthy young adults were recruited in the present study and placed to two groups (n = 13/group) based on the weekly frequency of the one 3-s maximal eccentric contraction for two (2DW) or three days per week (3DW) for 4 weeks. Changes in MVC-isometric, MVC-concentric, MVC-eccentric torque of the elbow flexors, and muscle thickness of biceps brachii and brachialis (MT) before and after the 4-week training were compared between 2DW and 3DW groups, and also compared to the 5DW group in the previous study. The 2DW group showed no significant changes in MVC torque. Significant (P < 0.05) increases in MVC-concentric (2.5 ± 10.4%) and MVC-eccentric (3.9 ± 4.9%) torque were observed for the 3DW group, but the magnitude of the increase was smaller (P < 0.05) than that presented by the 5DW group (12.8 ± 9.6%, 12.2 ± 7.8%). No significant changes in MT were evident for any of the groups. These results suggest that at least three days a week are necessary for the one 3-s maximal eccentric contraction to be effective for increasing muscle strength, and more frequent sessions in a week (e.g., 5 days) appear to induce greater increases in muscle strength.

Exploring the uses of yoga nidra: An integrative review.

The purpose of this paper was to review and synthesize published research articles that have utilized yoga nidra as an intervention. Yoga nidra is a form of guided meditation that has emerged in the literature in the past two decades as an intervention for a variety of medical conditions such as stress and mental health. It differs from traditional yoga, in that it does not require yoga poses. It is a noninvasive, cost-effective approach that is also easily accessible so it can be done in the privacy and comfort of the home. The integrative review methodology by Whittemore and Knafl (2005) provided the framework for this review. The databases CINAHL, PubMed, SCOPUS, and PsycINFO were used to search for articles. Inclusion criteria consisted of journal articles in English with no limitations on dates of publication. Studies were excluded if any form of traditional yoga requiring poses was used as an intervention. Also excluded were all types of meditation that were not yoga nidra, systematic reviews, studies that utilized multiple intervention types (i.e., traditional yoga and yoga nidra), and commentaries/brief reports. Twenty-nine studies met the inclusion criteria. Quality appraisal was completed for each study. The 29 studies that were reviewed consisted of 12 randomized controlled trials, 13 quasi-experimental studies, 3 mixed-methods studies, and 1 qualitative study. Outcome variables were categorized according to themes and results were systemically synthesized and reported by theme: (a) stress, (b) mood, (c) well-being, (d) psychologic dysfunction, (e) biomarkers, (f) sleep, and (g) miscellaneous. Yoga nidra was found to be effective in most of these studies. However, there was some clinical heterogeneity in the sample populations and intervention session lengths, frequencies, and durations, making it difficult to draw conclusions about yoga nidra intervention based solely on the findings presented in this review. More studies are needed overall, particularly ones with larger sample sizes and stronger experimental designs. Yoga nidra has the potential to be a useful, noninvasive, nonpharmacologic treatment or adjunct for a variety of conditions, particularly mental health.

Knowledge, Attitudes, and Practices Regarding Menstrual Hygiene among Girls in Ghizer, Gilgit, Pakistan.

Menstrual hygiene is a critical issue encountered by women and girls of reproductive age that negatively affects their health and empowerment. It is still deemed a taboo subject in several parts of the world, and girls hesitate to discuss menstruation with their family members, friends, or schoolteachers, which creates hurdles when they experience their menarche. Girls residing in rural areas encounter more problems, since they lack proper resources and knowledge to manage their menstruation in school as well as at home. The purpose of this study was to evaluate the knowledge, attitudes, and practices regarding the menstrual hygiene of girls residing in rural areas of Gilgit, Pakistan. A descriptive cross-sectional design was used to assess the study questions. The consecutive sampling technique was applied to recruit 300 female participants from remote areas of Gilgit, Pakistan, who were 13 to 22 years old. A pre-tested questionnaire was utilized to collect the data, and SPSS version 21.0 was used to analyze them. The study found that more than half of the participants had a poor level of knowledge and practices and negative attitudes towards menstrual hygiene. This could be due to many cultural and social factors associated with menstrual hygiene. The study concluded that the study participants were not knowledgeable about menstrual hygiene. They had poor practices and attitudes regarding menstrual hygiene. Hence, it is recommended that frequent sessions should be conducted by healthcare workers to enhance the knowledge of parents, teachers, and young girls, to increase their positive attitudes and practices regarding menstrual hygiene.

Collaborative decision making improves interpersonal psychotherapy efficiency: A randomized clinical trial with postpartum women

BackgroundRandomized controlled trials of Interpersonal Psychotherapy (IPT) and other psychotherapies for depression have required strict adherence to protocol and do not allow for clinical judgment in deciding frequency of sessions. To determine if such protocols were more effective than allowing therapists to use their clinical judgment, we compared “Clinician- Managed” IPT (CM-IPT), in which clinicians and patients with postpartum depression were allotted 12 sessions and determined collaboratively when to use them, to a once weekly 12 session protocol (“Standard IPT”). We hypothesized that CM-IPT would be more efficient, requiring fewer sessions to reach an equivalent acute outcome, and that CM-IPT would be superior over 12 months because “saved” sessions could be used for maintenance treatment. MethodWe conducted a clinical trial including 140 postpartum outpatients with DSM-IV major depression who were randomly assigned to “Standard” IPT (N= 69) or CM-IPT (N= 71). ResultsBoth CM-IPT and S-IPT were highly efficacious with similar outcomes by 12 weeks but CM-IPT group utilized significantly fewer sessions. Both were superior to a waitlist control. Superiority comparisons at 12 months did not favor the CM-IPT condition. LimitationsResults should be replicated in a more diverse sample to increase generalizability. ConclusionsCM-IPT is more efficient in treating acute depression than mandated weekly IPT. Further, permitting clinicians and patients to use their collaborative judgment is likely to be a more efficient and effective way to conduct future research and to implement evidence-based psychotherapy in the community.

Effects of plyometric training on technical skill performance among athletes: A systematic review and meta-analysis.

The literature has proven that plyometric training (PT) improves various physical performance outcomes in sports. Even though PT is one of the most often employed strength training methods, a thorough analysis of PT and how it affects technical skill performance in sports needs to be improved. This study aimed to compile and synthesize the existing studies on the effects of PT on healthy athletes' technical skill performance. A comprehensive search of SCOPUS, PubMed, Web of Science Core Collection, and SPORTDiscus databases was performed on 3rd May 2023. PICOS was employed to establish the inclusion criteria: 1) healthy athletes; 2) a PT program; 3) compared a plyometric intervention to an active control group; 4) tested at least one measure of athletes' technical skill performance; and 5) randomized control designs. The methodological quality of each individual study was evaluated using the PEDro scale. The random-effects model was used to compute the meta-analyses. Subgroup analyses were performed (participant age, gender, PT length, session duration, frequency, and number of sessions). Certainty or confidence in the body of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Thirty-two moderate-high-quality studies involving 1078 athletes aged 10-40 years met the inclusion criteria. The PT intervention lasted for 4 to 16 weeks, with one to three exercise sessions per week. Small-to-moderate effect sizes were found for performance of throwing velocity (i.e., handball, baseball, water polo) (ES = 0.78; p < 0.001), kicking velocity and distance (i.e., soccer) (ES = 0.37-0.44; all p < 0.005), and speed dribbling (i.e., handball, basketball, soccer) (ES = 0.85; p = 0.014), while no significant effects on stride rate (i.e., running) were noted (ES = 0.32; p = 0.137). Sub-analyses of moderator factors included 16 data sets. Only training length significantly modulated PT effects on throwing velocity (> 7 weeks, ES = 1.05; ≤ 7 weeks, ES = 0.29; p = 0.011). The level of certainty of the evidence for the meta-analyzed outcomes ranged from low to moderate. Our findings have shown that PT can be effective in enhancing technical skills measures in youth and adult athletes. Sub-group analyses suggest that PT longer (> 7 weeks) lengths appear to be more effective for improving throwing velocity. However, to fully determine the effectiveness of PT in improving sport-specific technical skill outcomes and ultimately enhancing competition performance, further high-quality research covering a wider range of sports is required.

Remote Intensive Intervention for Young Children on the Autism Spectrum During COVID-19: the Experience of Caregivers and Service Providers

ObjectivesCommunity-based early autism intervention programs in Geneva, Switzerland, converted their in-person services to a telehealth format during the COVID-19 home confinement period. The current study was aimed at measuring the engagement and satisfaction of service providers and caregivers as they experienced telehealth services for the first time and at monitoring child progress.MethodsForty-five families from diverse backgrounds and their 45 service providers had daily videoconferencing sessions of primarily parent-mediated intervention. Satisfaction questionnaires were completed at three time points over a 2-month period. Session frequency and program participation were recorded. Caregiver and service provider’s answers were compared. Results were also analyzed by family annual income. Child progress was monitored using the Early Start Denver Model Curriculum Checklist.ResultsCaregivers and service providers maintained high levels of participation and satisfaction throughout the telehealth service period and appreciated how the telehealth format allowed them to meet more frequently. Lower-income families tended to be more unanimously positive about the services when compared with mid- and high-income families. We found significant group differences in service providers’ and caregivers’ perceptions of each other’s comfort level with the remote sessions. Child progress followed a pattern of continued significant improvement across most developmental domains during the telehealth service period.ConclusionsThese findings underscore the potential of telehealth as a promising and appreciated approach for delivering intensive early autism interventions in community settings. Further research is needed to determine optimal session frequency for remote parent-mediated intervention and to determine ways to make telehealth services more accessible for low-income families.

Camera-based visual feedback learning aid for recovering sense of smell and taste in COVID-19 survivors: a proof-of-concept study.

A significant proportion of people report persistent COVID-19-related anosmia, hyposmia or parosmia, often accompanied with ageusia, hypogeusia or dysgeusia. Here, we present a proof-of-concept study that assessed the feasibility and acceptability of a new Camera-Based Visual Feedback Learning Aid (CVFLA) and explored its potential to restore or improve persistent COVID-19-related smell and/or taste impairment. Fifteen adult participants with persistent smell and/or taste impairment were randomly allocated to 7-, 14-, or 21-days baseline of symptom monitoring before receiving the intervention in up to 10 sessions (length and frequency determined by participant's preference and progress) using a specialised CVFLA apparatus (patent no. 10186160). Smell and taste were assessed pre- and post-intervention subjectively, and also objectively using the ODOFIN Taste Strips and Sniffin Sticks. Participant feedback about their experience of receiving CVFLA was obtained via a semi-structured interview conducted by someone not involved in delivering the intervention. The intervention was extremely well received, with no dropouts related to the intervention. There was also a significant improvement in smell and taste from pre- to post-CVFLA intervention (mean number of sessions = 7.46, SD = 2.55; total duration = 389.96 min, SD = 150.93) both in subjective and objective measures. All participants, except one, reported experiencing some improvement from the 2nd or 3rd session. This new CVFLA intervention shows promise in improving COVID-19 related impairment in smell and taste with a very high level of acceptability. Further studies with larger samples are required to confirm its potential in restoring, improving or correcting smell and/or taste impairment in relevant clinical and non-clinical groups.

Association Between the Combined Effects of Physical Activity Intensity and Particulate Matter and All-Cause Mortality in Older Adults

ObjectiveTo investigate the association between the combined effects of physical activity (PA) intensity and particulate matter ≤10 μm in diameter (PM10) and mortality in older adults. MethodsThis nationwide cohort study included older adults without chronic heart or lung disease who engaged in regular PA. Physical activity was assessed by a standardized, self-reported questionnaire that asked the usual frequency of PA sessions with low (LPA), moderate (MPA), or vigorous intensity (VPA). Each participant’s annual average cumulative PM10 was categorized as low to moderate and high PM10 on the basis of a cutoff value of 90th percentile. ResultsA total of 81,326 participants (median follow-up, 45 months) were included. For participants engaged in MPA or VPA sessions, every 10% increase in the proportion of VPA to total PA sessions resulted in a 4.9% (95% CI, 1.0% to 9.0%; P=.014) increased and 2.8% (95% CI, −5.0% to −0.5%; P=.018) decreased risk of mortality for those exposed to high and low to moderate PM10, respectively (Pinteraction, <.001). For participants engaged only in LPA or MPA sessions, every 10% increase in the proportion of MPA to total PA sessions resulted in a 4.8% (95% CI, −8.9% to −0.4%; P=.031) and 2.3% (95% CI, −4.2% to −0.3%; P=.023) decreased risk of mortality for those exposed to high and low to moderate PM10, respectively (Pinteraction, .096). ConclusionWe found that for the same level of total PA, MPA was associated with delayed mortality whereas VPA was associated with hastened mortality of older adults in high levels of PM10.

Effect of physiotherapy and its frequency on the outcome of COVID-19 patients regarding acute care setting at isolation unit of Ain Shams University

Abstract Background Severe acute respiratory syndrome coronavirus 2 is a new strain of coronavirus that started in 2019 and causes a pandemic disease called coronavirus disease 2019 (COVID-19). The present report result was 80% of cases are asymptomatic or mild; 15% of cases are severe; and 5% are critical needing ICU and mechanical ventilation. Physiotherapy (PT) provides airway clearance techniques and improves physical fitness. Aim The aim of this study is to assess the effect of PT and the frequency of PT session on the outcome of patients with COVID-19 infection at an isolation unit of Ain Shams University. Patients and methods This is randomized controlled clinical trial that was applied on 264 confirmed adult patients with COVID-19, who were admitted to isolation units at Ain Shams University Hospitals over 6 months since March 2021 with 134 females and 130 males in the age range from 31 to 82 years. The breathing method was room air, oxygen mask and nasal cannula, HFNC, and ventilated patients (both invasive and noninvasive). The patients were divided randomly into two groups: one group received two sessions of PT per day and the other group received one session of PT per day. Results The patients were divided clinically into mild, moderate, severe, and severe-critical patients. In mild cases, the range of incentive spirometer (ml) after one daily PT became 2300–2800 ml, and for twice daily PT it became 2300–3300 ml with highly statistical difference (P=0.005) before and after one or two PT sessions. Regarding 6-min walking test (m) the range became 420–740 m for one PT session per day and 420–880 m for two PT sessions per day with significant statistical difference (P=0.010). In moderate cases, the SPO2 (%) became 88–98% after one daily PT session and 90–98% after twice daily PT sessions with significant statistical differences between the one and two PT (P=0.032) sessions. Regarding the incentive spirometer (ml) at the moderate group, after one daily PT session it became 1200–2500 ml and for twice daily PT it became 1500–2500 ml with significant statistical differences between one and two PT sessions (P=0.032). Conclusion Patients with mild and moderate COVID-19 infection had significant improvement in SPO2 (oxygen saturation), dyspnea scale, and incentive spirometer after receiving two daily sessions of PT compared with patients who received one daily PT session. There was no difference in both groups for severe and severe-critical cases.

Effects of traditional Chinese exercise on physiological indicators and quality of life in patients with coronary heart disease: A systematic review and meta-analysis.

The efficacy of traditional Chinese exercise (TCE)-based intervention in the improvement of physiological indicators and quality of life in patients with coronary heart disease (CHD) is controversial. Five databases were systematically searched for relevant articles published from inception to February 2023. Controlled trials examining TCE intervention in patients with CHD. The treatment effects were estimated using a random-effect meta-analysis model with standardized mean differences (Hedges g). The categorical and continuous variables were used to conduct moderator analyses. Two investigators independently screened abstracts and full-text articles and graded the certainty of evidence based on the Grading of Recommendations Assessment, Development and Evaluation approach. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (identifier CRD42023401934). Ten studies involving a total of 718 participants were included in the final analysis. In the physiological indicators outcomes, the meta-analytic findings revealed large and significant improvements in systolic blood pressure (g = 0.78, 95% confidence interval [CI] = 0.51-1.05, P = .00, I2 = 98%), diastolic blood pressure (g = 0.90, 95% CI = 0.61-1.20, P = .00, I2 = 98%) and body mass index (g = 1.05, 95% CI = 0.75-1.34, P = .00, I2 = 99%), small and significant improvements in heart rate (g = 0.28, 95% CI = 0.01-0.54, P = .04, I2 = 98%) and ventilatory equivalents/carbon dioxide (g = -1.10, 95% CI = -1.47 to -0.74, P = .00, I2 = 96%).In the quality of life outcomes, the findings revealed small and significant improvements in physical functioning (g = -3.01, 95% CI = -3.45 to -2.57, P = .00, I2 = 96%), bodily pain (g = -2.16, 95% CI = -2.57 to -1.74, P = .00, I2 = 98%), vitality (g = -3.67, 95% CI = -4.16 to -3.16, P = .00, I2 = 97%) and mental health (g = -1.23, 95% CI = -1.771 to -0.692, P = .00, I2 = 99%). The moderator shows that the effects of TCE on physiological indicators and quality of life were moderated by PEDro score, type of exercise, exercise frequency, exercise duration, and number of sessions. TCE intervention is a beneficial nonpharmacological approach to improving physiological indicators in patients with CHD, especially in systolic blood pressure, diastolic blood pressure, and body mass index. However, there was no significant effect on quality of life. Our findings require broader clinical trials and higher-quality study designs to strengthen the evidence.

DETERMINATION OF PERCEIVED STRESS LEVELS AND COPING WITH HUMOR IN CANCER PATIENTS RECEIVING CHEMOTHERAPY

This study aims to determine perceived stress levels and coping with humor in cancer patients receiving chemotherapy. This descriptive study was conducted in a single center in Turkey and involved a total of 135 patients who had been diagnosed with cancer. The patients receiving chemotherapy had high levels of perceived stress and their use of humor as a coping strategy in stressful situations was below average. The perceived stress scale score was statistically significantly associated with age, employment status, presence of chronic disease, frequency of chemotherapy sessions and receipt of radiotherapy (p &lt;0.05). The coping humor scale score was statistically significantly associated with age, education, economic status, previous hospitalization and time since diagnosis (p &lt;0.05). Increasing the awareness of patients about humor and the use of humor starting from the time of cancer diagnosis can positively affect treatment and follow-up.

Physiotherapists’ views regarding accessibility of Parkinson disease patients to physiotherapy centers

Introduction: Parkinson’s disease (PD) is a progressive neurodegenerative disease mainly characterized by motor defects such as tremor and postural instability. The number of patients with Parkinson’s disease (PD) is increasing in all aging societies. This population requires immediate physiotherapy management to maintain and improve their quality of life. The aim of study to explore physiotherapists’ views about the barriers facing Parkinson’s patients on access in centres of physiotherapy in Al-Zawia city, Libya. Method: An exploratory qualitative study is design to explain physiotherapists’ views. Twenty physiotherapists from seven physiotherapy centres were approached individually and invited to participate. Participants were interviewed and asked about their experiences with Parkinson's patients. Result and discussion there are barriers in the communication with elderly Parkinson's patients and also, the doctors with physiotherapists, lack of access (referral) and poor awareness of doctors about physical therapy role as one of the barriers, the economic part of barriers that limit patient’s access to the center because as expensive private facilities, and long-term treatment plans with slow improvement lead to a lack of patient's access to the center, on other hand patient fell bored from ong treatment, beside the patients mood that effected in patients treatment such as anxiety and depression, while the anxiety is the most mood disorder . All of these factors and others led to frequent missing sessions and limiting patients’ access to physiotherapy centres. Conclusions: The study found that there were gaps in communication between patients, physiotherapists, and physicians. And there lack of patient access in the physiotherapy centres because of poor referral and awareness/knowledge about the benefits of physiotherapy programs for patients with PD. Another issue the study found there was the high cost of the therapy sessions and long-term program compared with the low level of improvement that made patients discontinue their treatment.

#4298 DOES STARTING RENAL REPLACEMENT THERAPY WITH INCREMENTAL HAEMODIALYSIS WORSEN OUTCOMES?

Abstract Background and Aims Most patients start maintenance haemodialysis (HD) with a fixed dose of 3 HD sessions per week (3HD/Wk), regardless of their residual kidney function (RKF). This intense schedule is considered the “standard” or “conventional” modality (cHD). It is widely accepted, and no randomised controlled trial (RCT) has examined whether other less frequent schedules are inappropriate or harmful. Thus, the optimal modality for incident patients is currently unknown. Incremental HD (iHD), on the other hand, adjusts the frequency of sessions to the RKF, increasing their number to compensate for any subsequent reduction in RKF. While iHD approaches precision medicine by customising the number of sessions, it raises concerns about long intersession periods and the risk of under-dialysis. Pending ongoing RCTs [1], our aim is to analyse the efficacy and safety of iHD in our incident patients. Method The policy of our Centre is to try to start with iHD in incident patients who are clinically stable and with RKF. We start with 1 session (1HD/Wk) if the RKF is above 4 ml/min/1.73 m2 and with 2 sessions (2HD/Wk) if the RKF is between 4 and 2.5 ml/min/1.73 m2. We progress from 1HD/Wk to 2HD/Wk and from 2 to 3HD/Wk depending on the RKF and ultrafiltration rates required, which are assessed at least monthly. Since 2012, we have treated 186 incident patients with iHD, of whom 168 had a follow up ≥ 90 days. 72% (128 patients) started with 1HD/Wk and the remaining 28% (40 patients) with 2HD/Wk. We compared the results with 410 incident patients who from baseline receive 3 sessions/Wk (cHD) and with 80 incident patients on Peritoneal Dialysis (PD). We also analysed 27 iHD patients who after 60 days were already dialysed with 3 sessions (3HD/Wk/60d group). We calculated the mortality rate (deaths/365 days in %) in each group and survival in the iHD technique (sessions not performed). Results The mean age in the iHD group was higher than in cHD or PD (Table 1). Mortality in iHD patients was similar to cHD patients, although the latter were younger. Patients who stayed less time in iHD (3HD/Wk/60d group) had the highest mortality rate (Table 1). Survival in technique (time in which 50% of patients remain on iHD) was 12 months, avoiding 86 sessions/patient. The cost reduction was €17,200/patient (session + transport = €200). Conclusion iHD is efficient, as it considerably reduces the number of sessions performed and thus costs, thereby improving quality of life. It is safe, as it has a similar mortality rate to cHD. Being on iHD for more than 60 days does not worsen the results. On the contrary, requiring 3 weekly sessions at the beginning of HD treatment may be associated with a poor prognosis.

#2695 THE ENVIRONMENTAL IMPACT OF CHRONIC KIDNEY DISEASE INTERNATIONALLY: RESULTS OF A LIFE CYCLE ASSESSMENT

Abstract Background and Aims The environmental impact of healthcare is high, and kidney care for chronic kidney disease (CKD) contributes significantly to this. Haemodialysis represents the only viable kidney replacement option for certain patients with CKD, in whom the clinical benefits are lifesaving. Haemodialysis is also resource-intensive, requiring frequent sessions, and energy- and water-intensive equipment. In recognition of this, the ERA has implemented a green nephrology initiative aiming to minimize the environmental impact of kidney care. However, there is a paucity of up-to-date analysis on the environmental impact of different dialysis techniques and CKD overall. This study presents an international, holistic life cycle assessment (LCA) of the environmental impact of CKD in adults at all CKD stages. Method LCA methodology was used, conducted according to ISO 14040/14044 international standards, to estimate the annual environmental impacts of each stage (1–5) of CKD per patient. At CKD Stage 5, supportive care, haemodialysis, peritoneal dialysis, and transplantation pathways were considered. A literature review was performed to identify all studies reporting healthcare resource use in CKD, stratified by CKD stage. The study boundary is summarised in Figure 1. GaBi software was used to model the pathway based on ecoinvent Life Cycle Inventory database version 3.8. Environmental impact categories were reported according to the impact assessment methods, ReCiPE 2016 v1.1 and TRACI 2.1 (US only). Here, we describe the preliminary analysis of the international study, presenting results on the annual environmental impact of in-centre haemodialysis in the UK, based on one patient receiving haemodialysis three times weekly for four hours per session. The inputs for in-centre haemodialysis comprised dialysis consumables and their transport, energy/water used by the haemodialysis machine (including reverse osmosis), heating/cooling/lighting of the healthcare area, waste disposal, and patient transport. Results A total of 93,600 litres of water and 3,058 kWh electricity was estimated per patient for in-centre haemodialysis annually in the UK. The carbon footprint of in-centre haemodialysis in the UK per patient was estimated to be 3,900 kg CO2 equivalents, comparable to the average UK persons annual greenhouse gas footprint, effectively doubling their yearly greenhouse gas impact. Several other environmental impact categories were measured beyond the carbon footprint, including photochemical oxidation potential (ground-level ozone formation) and fine particulate matter, measured as PM2.5. Across each impact category, the parameters that drove each environmental impact differed (Figure 2). For example, dialysis consumables, haemodialysis machine, and patient transport were the main environmental contributors of fine particulate matter, while patient transport was the main driver of terrestrial ecotoxicity. Conclusion The results of this LCA build upon previous published research and demonstrate a high carbon footprint for in-centre haemodialysis, in line with other studies. The results also show that the environmental impact of in-centre haemodialysis goes beyond that of its carbon footprint, to other important environmental aspects such as PM2.5 emissions, in which long-term exposure is associated with health problems, such as cardiovascular and respiratory diseases, and an increased risk of CKD. This study hopes to highlight the need for evidence-based policy interventions around the implementation of green nephrology initiatives such as use of renewable energy to power haemodialysis, utilisation of water conserving reverse osmosis systems, and reduction in waste. Furthermore, healthcare policy initiatives that could help detect patients in the early stages of CKD and thereby enable them to be managed proactively could eventually reduce the need for resource-intensive dialysis therapy.

A comparative study of perspectives on telepractice service delivery among Egyptian and U.S. Speech and Language Pathologists

ABSTRACT Scope: Although the discipline of Speech-Language Pathology (SLP) was established in Egypt over 50 years ago, telepractice is a new concept in Egypt. However, following the COVID-19 pandemic providers adapted to an online therapy format. Materials & methods: The current study used a retrospective pretest–posttest design to identify differences in barriers facing SLPs practicing in the USA (N = 38) and Egypt (N = 41) using telepractice. The online questionnaire assessed the domains of technical barriers, the applicability of various types of therapy, caseload characteristics’ barriers, caregivers’ challenges, and the therapists’ input. Results: Therapists in both countries had concerns pre-telepractice regarding the availability of materials for online sessions, time spent for online session preparation, guaranteed confidentiality, and protection of client personal details in teletherapy. Most US therapists held a positive attitude towards the adaptability of various types of therapy for online sessions and the applicability of online sessions for new cases, toddlers & infants, preschoolers, adults & group sessions. On the other hand, Egyptian therapists expressed concerns regarding technical barriers such as lower frequency of sessions and internet connectivity problems while also experiencing more issues related to caseload characteristics. Conclusion: This study offers preliminary data on telehealth experiences in USA and Egypt that may direct future research into ways to increase service delivery and access.

Use of Biofeedback-Based Virtual Reality in Pediatric Perioperative and Postoperative Settings: Observational Study.

Biofeedback-based virtual reality (VR-BF) is a novel, nonpharmacologic method for teaching patients how to control their breathing, which in turn increases heart rate variability (HRV) and may reduce pain. Unlike traditional forms of biofeedback, VR-BF is delivered through a gamified virtual reality environment, increasing the accessibility of biofeedback. This is the first study to systematically integrate VR-BF use in the pediatric perioperative setting, with the ultimate goal of evaluating the efficacy of VR-BF to reduce pain, anxiety, and opioid consumption once feasibility and acceptability have been established. The primary objective was to develop a clinical trial protocol for VR-BF use in the pediatric perioperative setting, including preoperative education and training, and postoperative application of VR-BF in children undergoing surgery. A secondary objective was to evaluate the patient and parent experience with VR-BF. A total of 23 patients (12-18 years of age) scheduled for surgery at Nationwide Children's Hospital were recruited using purposive sampling. Following training, participants independently completed a daily, 10-minute VR-BF session for 7 days before surgery and during their inpatient stay. Participants could use VR-BF up to 2 weeks after hospital discharge. Patient- and session-level data of VR-BF usage and achievement of target HRV parameters were measured to identify the optimal frequency and duration of sessions before and after surgery for this population. Standardized questionnaires and semistructured interviews were conducted to obtain qualitative information about patients' experiences with VR-BF. Patient-level data indicated that the highest odds of achieving 1 session under target HRV parameters was after 4 sessions (odds ratio [OR] 5.1 for 4 vs 3 sessions, 95% CI 1.3-20.6; OR 16.6 for 3 vs 2 sessions, 95% CI 1.2-217.0). Session-level data showed that a session duration of 9 to 10 minutes provided the greatest odds of achieving 1 session under target HRV parameters (OR 1.3 for 9 vs 8 min, 95% CI 1.1-1.7; OR 1.4 for 8 vs 7 min, 95% CI 1.1-1.8; OR 1 for 10 vs 9 min, 95% CI 0.9-1.2). Qualitative data revealed patient satisfaction with the VR-BF technology, particularly in managing perioperative stress (17/20, 85%). Few patients reported VR-BF as beneficial for pain (8/20, 40%). Children and adolescents undergoing surgery successfully learned behavioral strategies with VR-BF with 10-minute sessions once daily for 5 days. To integrate VR-BF as a therapeutic intervention in a subsequent clinical trial, patients will be instructed to complete three 10-minute sessions a day for 7 days after surgery. ClinicalTrials NCT04943874; https://clinicaltrials.gov/ct2/show/NCT04943874.

Effects of Combined Training Programs in Individuals with Fibromyalgia: A Systematic Review.

Fibromyalgia is a rheumatic disease characterised by chronic widespread muscular pain and its treatment is carried out by pharmacological interventions. Physical exercise and a healthy lifestyle act as an important mechanism in reducing the symptoms of the disease. The aims of this study were to analyse and systematise the characteristics of combined training programs (i.e., type and duration of interventions, weekly frequency, duration and structure of training sessions and prescribed intensities) and to analyse their effects on people diagnosed with fibromyalgia. A systematic literature search was performed using the PRISMA method and then randomised controlled trial articles that met the eligibility criteria were selected. The Physiotherapy Evidence Database scale was used to assess the quality and risk of the studies. A total of 230 articles were selected, and in the end, 13 articles met the defined criteria. The results showed different exercise interventions such as: combined training, high-intensity interval training, Tai Chi, aerobic exercise, body balance and strength training. In general, the different interventions were beneficial for decreasing physical symptoms and improving physical fitness and functional capacity. In conclusion, a minimum duration of 14 weeks is recommended for better benefits. Moreover, combined training programs were the most effective for this population, in order to reduce the symptoms of the disease with a duration between 60 and 90 min, three times a week with a light to moderate intensity.

Factors Influencing Receipt and Type of Therapy Services in the NICU.

Understanding the type and frequency of current neonatal intensive care unit (NICU) therapy services and predictors of referral for therapy services is a crucial first step to supporting positive long-term outcomes in very preterm infants. This study enrolled 83 very preterm infants (<32 weeks, gestational age mean 26.5 ± 2.0 weeks; 38 male) from a longitudinal clinical trial. Race, neonatal medical index, neuroimaging, and frequency of therapy sessions were extracted from medical records. The Test of Infant Motor Performance and the General Movement Assessment were administered. Average weekly sessions of occupational therapy, physical therapy, and speech therapy were significantly different by type, but the magnitude and direction of the difference depended upon the discharge week. Infants at high risk for cerebral palsy based on their baseline General Movements Assessment scores received more therapy sessions than infants at low risk for cerebral palsy. Baseline General Movements Assessment was related to the mean number of occupational therapy sessions but not physical therapy or speech therapy sessions. Neonatal Medical Index scores and Test of Infant Motor Performance scores were not predictive of combined therapy services. Medical and developmental risk factors, as well as outcomes from therapy assessments, should be the basis for referral for therapy services in the neonatal intensive care unit.

Active teaching and learning in GI sciences: lessons learned from the BSc. Course Open Urban Data Governance

Abstract. A new active teaching and learning approach has been implemented in the BSc course Open Urban Data Governance.. This course is part of the minor Spatial Computing for Digital Twinning in the Bachelor of Architecture, Urbanism and Building Sciences at the Faculty of Architecture and The Built Environment, TU Delft, and offered TU wide as an elective. At the start of the course the students were tasked to collect and analyse noise level data, and to reflect on this process. In the second (main) assignment they had to develop an urban challenge to be answered with geo-data. Also here a reflection was required including an assessment of the FAIRness of the data. Both students and teachers highly appreciated the new approach. Through applying active teaching and learning we created an example of the theory on students’ activities. This approach also links students’ real world experiences to the content of the course, which allows them to put theory into context. Teachers especially appreciated the interaction with the students, the depth of the discussions, and were impressed by the steep learning curve of the students. Students enjoyed the freedom to operate, the frequent feedback sessions and the application of theory into practice. For the next year the lectures will take into account that ‘minor’ students do prepare well for their classes.