Six-week Period Research Articles

Abstract EP40: Effects Of Ketone Salt Supplementation On Blood Pressure In Adults Diagnosed With Post-traumatic Stress Disorder

Individuals diagnosed with post-traumatic stress disorder (PTSD) are often in a state of hyperarousal due to overactive sympathetic nervous system activity. This in turn causes resting blood pressure to increase which leads to chronic hypertension. Those diagnosed with PTSD are at an increased risk for developing hypertension and cardiovascular disease. Beta-hydroxybutyrate, a ketone body, has been shown to directly inhibit sympathetic drive at the receptor site. Beta-hydroxybutyrate is both a fuel source and signaling molecule that is produced by the liver from partially broken-down fat. In addition to endogenous sources, beta-hydroxybutyrate can be paired with salt and consumed exogenously. Exogenous ketone salt supplementation has been shown to decrease systolic blood pressure (SBP) in healthy populations. Therefore, the primary purpose of this study was to determine if supplementing with ketone salts for 6-weeks altered SBP or diastolic blood pressure (DBP) in adults diagnosed with PTSD compared to a placebo supplement. This clinical trial included a randomized, double-blinded, parallel-arm and placebo-controlled design. Participants included males and females previously diagnosed with PTSD that were between the ages of 21-65 years. Sixteen participants completed the study; nine consumed ketone salts for six-weeks and seven consumed the placebo supplement. Thirteen subjects were included in the analyses due to incomplete data. Blood pressure was measured in a fasted and rested state immediately before and after the six-week supplementation period. Two 2X2 mixed ANOVAs were used to analyze the SBP and DBP between group and time points. Although the ketone supplementation group experienced an average lowering of SBP (6.14 mmHg) and DBP (4 mmHg) following the supplementation period, no significant interaction was found for SBP, F (1, 11) = 1.18, p = .30, η 2 = .10, or DBP, F (1, 11) = 1.24, p = .29, η 2 = .10. The results demonstrated that 6-weeks of ketone salt supplementation did not significantly alter SBP or DBP in this population. However, the sample size for this study was small and thus, this study should be repeated in a larger sample for verification of this finding.

28 Review of Operative and Non-Operative Time-Use During General Anaesthetic Cases in a Busy Surgical Oncology Service

Abstract Aim To review theatre running times of all general anaesthetic cases performed in a single theatre during a set six-week period. We intend to assess the division of theatre time between operative and non-operative tasks and review areas of improvement in our department. Method The data was collected concurrently by a member of the surgical team (AB) at the time of surgery. Date, surgical procedure, and time elapsed from knife-to-skin (KTS) to skin closure were monitored between the hours 08:30–17:00. Results were reviewed and presented graphically using Microsoft Excel. Instances of theatre over-running were identified, and these outliers were reviewed in more detail. Results We identified two main time management issues in our department. The first occurs prior to the first procedure which highlighted significant delays with only one instance of KTS at 08:30 during the period of data collection. The second notable issue is the pattern of delays. There was a trend toward longer delays between cases as the day proceeds. Conclusions Upon review of our data, we were able to identify possible areas of improvement in the time management of our theatre group. These improvements will allow for accurate theatre planning which should be a priority for all stakeholders given the significant waiting lists created by the COVID19 pandemic. There are many peer-reviewed methods of improving the efficiency of departments such as ours. Further work is required to discuss targets for improvement with relevant stakeholders and to implement PDSA cycles to assess the impact of implemented changes in our theatre.

Relative contributions of different local sources to riverborne microplastic in a mixed landuse area within a tropical catchment

Information on the relative contributions of microplastics coming from different sources is important to help prioritise measures to reduce river contamination levels and limit human and ecological health risks. This paper reports on work which aimed to quantitatively assess the relative concentrations and types of microplastic delivered from differed sources to a second order river. The study was undertaken in a mixed landuse area within a rapidly urbanising catchment in Malaysia. Over a six-week period, water samples were collected from road culverts and drains in residential and industrial areas across the area to assess microplastic concentrations, while inputs from atmospheric deposition and wastewater treatment plants (WWTPs) were also quantified. Microplastic fibres and fragments were the dominant material in all sources, with the majority consisting of styrene-butadiene rubber and nylon. Culverts draining main roads were the main contributor to riverborne microplastic, delivering 42.20 ± 35.29 particles/L directly to the river channel. Road inputs were up to seven times greater than those from residential (8.53 ± 9.91 particles/L) and industrial (5.67 ± 4.88 particles/L) areas. The five WWTPs had removal efficiencies of between 30.95 ± 5.51% and 69.94 ± 22.17%, with their outflows delivering microplastics to the river in concentrations similar to those in uncontrolled residential and industrial drains. Atmospheric deposition across the study area was estimated to be 76.07 ± 32.85 particles/m2/day (=8.35 ± 5.11 particles/L). Mitigation strategies in the study area should focus on improving management of water draining roads, and re-routing discharges from domestic and industrial areas to WWTPs rather than allowing them to flow directly to the river. The low efficiencies of some of the WWTPs are not unusual, and indicate the need for additional water treatment to deal with microplastic present in wastewater.

Pedagogical uses of language focused on music to support linguistic wellbeing during emergency remote teaching

The aim of this research was to particularly focus on the intersection of language and music education, specifically pedagogical uses of language focused on classical music to support the linguistic wellbeing of students in an online learning environment. The research was conducted during a six-week course period of English as a foreign language lessons online with 30 second-year students of Music Performance at the Secondary Music School in Serbia during the remote teaching and learning period in 2020. The research implemented a fully online learning model. The qualitative results obtained from the research and presented in this paper, suggest that the course had an impact on the learners in terms of their overall positive reactions towards their language learning and linguistic wellbeing. Therefore, in the following period, the aim is to further research the intersections of language, pedagogy and the role of music on linguistic wellbeing in different language education contexts./ Keywords: digital resources, English in Professional Music Education (EPME), linguistic wellbeing, music-related vocabulary, teaching methodology.

A Safety Evaluation of the Resumption of Elective Orthopaedic Services in Higher Risk Patients During the COVID-19 Pandemic.

IntroductionThe COVID-19 pandemic has caused mass disruption to all aspects of society, with elective orthopaedics not spared. The pandemic has the potential to cause a tsunami of health burden in the community if elective services are not resumed to pre-pandemic levels of activity. Studies have shown that elective orthopaedics can be safely carried out in a COVID-19 free hospital. This study reviewed the transition in operating at an independent COVID-19 free hospital to an NHS hospital concurrently treating patients with COVID-19.MethodsA strategy of phased relaxation of clinical comorbidity criteria was followed. Patients from the orthopaedic waiting list were selected according to these criteria and observed recommended preoperative isolation protocols. Operations were undertaken in the independent sector under the COVID-19 contract and the NHS site. Patients were assessed from all phases in the resumption of services. In-hospital and post-operative complications with specific enquiries regarding the development of COVID-19 symptoms or the need and outcome for COVID-19 testing at 14 days and six weeks was recorded.ResultsThis study included 263 patients, of which 155 were female. The mean age of patients was 52.45. The mean BMI of all patients was 29.1 kg/m2. Additionally, 124 patients were American Society of Anesthesiologists (ASA) grade 1, 117 ASA grade 2 and 22 ASA grade 3 and 167 patients underwent a major operation, with total hip replacement being the most common operation. There were no in-hospital complications. No patients had a positive test result or symptoms of COVID-19 in the six-week post-operative period.ConclusionIn summary, we demonstrated that elective orthopaedic surgery can be safely undertaken via a green pathway in a higher risk patient cohort when COVID-19 is prevalent in the community.

Exploring hyponatremia in older hospital in-patients: Management, association with falls, and other adverse outcomes

BackgroundHyponatremia is a common electrolyte disorder in older people. We investigated management of hyponatremia, and the association between admission hyponatremia, fall at admission, and other adverse outcomes, in older in-patients, a group less extensively studied to date. MethodsThis retrospective observational study included consecutive older medical patients ≥75 years admitted over a six-week period. Primary outcome measure was fall at admission. Secondary outcomes included fractures, functional dependence/assistance to mobilize at discharge, and death. ResultsAmongst 452 included patients (mean age 83.9 years), serum sodium at admission ranged from 113 mmol/L to 163 mmol/L, median 139 mmol/L (interquartile range [IQR] 136–141 mmol/L). In total, 16.7% (72/432) had hyponatremia at admission, which was mild (130-134 mmol/L) in 86%. Most (44/72) cases of hyponatremia remained uncorrected by discharge. In the hyponatraemic group, ‘routine investigations’ were variably performed- renal/liver profiles (98.9%), thyroid profiles (55.6%), serum glucose (87.5%), chest X-ray (91.7%). Other hyponatremia-specific investigations- urinary sodium and osmolarity (13.9%), serum osmolarity (15.3%) and serum cortisol (6.9%)- were not commonly checked, although osmolarity and urinary variables were assessed more frequently when sodium<130 mmol/L than if milder hyponatremia. Management appeared to be sub-optimal, with risk medications ceased infrequently and remedial treatment infrequently initiated; we did not have data regarding fluid restriction. On adjusted analyses, hyponatremia was not associated with fall at admission (aOR 0.54, 95% CI 0.24–1.22, p = 0.10) or other secondary outcomes. ConclusionsAlthough hyponatremia was under-investigated and sub-optimally managed, it did not appear to be associated with adverse outcomes in this cohort. Interventional trials should target the association between hyponatremia management, rectification and longer-term outcomes.

Mother and Daughter Obesity Intervention: A Case Study

Healthy weight loss is a growing concern in an increasingly sedentary world. This study explored the effectiveness of the implementation of physical activity changes in the lives of three overweight mother daughter pairs from a rural area in Virginia. The intervention was over a six-week period. The physical activity intervention focused on the promotion of safe walking and fitness.

Daily Time-Restricted Feeding And Alternative Day Fasting For Weight Management: Comparative Analysis

Abstract The approach of limiting nutritional intake frequency, but without a large reduction of the amount of calories consumed, the so-called intermittent fasting, has gained growing popularity. Intermittent fasting is an umbrella term for meal timing schedules that cycle between voluntary fasting (or vastly reduced calories intake) and non-fasting over a defined period. In our study, we compared two of the most popular intermittent fasting regimens — 16/8 time-restricted feeding and 5/2 alternate day fasting. A total of 16 healthy young women (under 30 years of age) participated in the study, eight in each intermittent fasting group, for six consecutive weeks. Among anthropometric parameters, height, weight, umbilical waist circumference, sagittal abdominal diameter, and skinfold thickness were measured and body mass index and relative body fat were calculated. Differences between the initial values and the values after the six-week intermittent fasting period were calculated and compared between the two groups. We found no statistically significant difference (p &gt; 0.05) between 16/8 time-restricted feeding and 5/2 alternate day fasting regimens in differences over the six-week period for the tested parameter, including weight loss. As there were no significant differences for overall changes in parameter values in the six-week period between the two intermittent fasting regimens, we concluded that both were equally suitable for weight loss programmes.

Impact of COVID-19 related lockdown on hospital admissions, hospital burden and deaths due to non- COVID illnesses in a tertiary care centre in Southern Sri Lanka

Background: Sri Lanka imposed an aggressive curfew to prevent the spread of COVID-19, which led to major changes in population behaviour. It was presumed that these measures could affect the morbidity patterns and management of other medical conditions. We aimed to study the impact of the pandemic on hospital admissions, morbidity patterns and mortality from non-COVID illnesses during the period of lockdown.Methods: A retrospective study was conducted to gather data related to all non- COVID medical admissions from four medical wards and emergency treatment unit (ETU) of the Teaching Hospital Karapitiya for a six-week period during the lockdown. Data on the total number of admissions, reasons for admission, diagnoses, duration of hospital stay and outcome including deaths were obtained. Corresponding data from the same period of the previous year (pre COVID period) were compared.Results: The total number of admissions during the pre- COVID period was 2939 and that reduced to 1491 during the lockdown period. There was a significant reduction of admissions due to infectious illnesses including respiratory tract infections (p &lt;0.001), dengue (p= 0.01) and leptospirosis (p=0.02) during the lockdown period. There was a significant increase in requested admissions (p=0.002) including admissions for procedures, investigations, referrals and transfers. The mortality during the two periods did not change significantly (pre-covid period 5.1 %, lockdown period 4.2%, p=0.16).Conclusions: The results of the study showed that social distancing and travel restriction had a significant impact on health seeking behaviour, disease patterns and outcome. Reduction in hospital admissions and changes in disease patterns, especially reduction in respiratory tract infections could be a positive effect of preventive measures: physical distancing, wearing masks and travel restriction. Total lockdown of the country had no significant effect on total deaths as well as deaths related to NCDs.

2D or Synthetic 2D? A Reader Study of Visualization of Amorphous Calcifications.

Some vendors have created algorithms that generate synthetic 2D (s2D) images from a digital breast tomosynthesis (DBT) dataset to reduce the radiation from obtaining a separate 2D digital mammography (DM). This study evaluated the visibility of amorphous calcifications on 2D DM versus s2D on screening mammography. This IRB-approved, retrospective, reader study included screening mammograms from 36 women who received screening DBT exams where both 2D DM and s2D images were obtained: 28 screening mammograms that were eventually given BI-RADS category 4 or 5 for amorphous calcifications and 8 BI-RADS category 1 or 2 screening exams. Two rounds of interpretation were conducted with a six-week washout period. Cases were randomized to display either the 2D DM or s2D images, which were then alternated in the second round. Four fellowship-trained breast radiologists determined whether a study merited recall for calcifications. If so, they rated calcification visibility on a scale of 1 to 5. McNemar chi-square tests were conducted to assess differences in recall rates and Wilcoxon signed rank tests were used to examine shifts in visibility. There was no difference in detection rates of amorphous calcifications between 2D DM and s2D, which were 75.9% and 75.0%, respectively (P = 1.000). Collectively, amorphous calcifications were more visible on s2D than 2D DM, with mean visibility scores of 3.4 versus 3.0, respectively (P = 0.005). Synthetic 2D did not change identification of amorphous calcifications compared to 2D DM, and readers considered them more visible on average.

Coping with Ethnic-racial Discrimination: Short-term Longitudinal Relations Among Black and Latinx College Students.

Little is known about how Black and Latinx young adults cope with experiences of ethnic-racial discrimination, particularly over short periods of time. A multigroup path model examined the relations between discrimination and five strategies for coping with ethnic-racial discrimination (talking with others, being proud, working hard, being rude, and ignoring) among Black and Latinx young adults (N = 145) at two time points over a six-week period. Experiences of discrimination were positively associated with the coping strategies of being proud of oneself and working hard to prove discriminatory people wrong. There was moderate stability in coping strategy use over time. Models did not vary by race-ethnicity, suggesting discrimination related to coping in similar ways among Black and Latinx young adults.

Effects of Direction-Specific Training Interventions on Physical Performance and Inter-Limb Asymmetries.

This study analyzed the effects of two different training programs on functional performance and inter-limb asymmetries in basketball players. Twenty-four elite youth basketball players were randomly assigned to a training program including variable unilateral horizontal movements (VUH, n = 12) or unilateral lateral movements (VUL, n = 12). Eccentric-overload training (EOT) was performed twice a week for a six-week period. Functional performance assessment included a countermovement jump test, unilateral multidirectional jumping tests (i.e., lateral, horizontal, and vertical), a rebound jump test, a limb symmetry index, a 25 m linear sprint test, and several change of direction (COD) tests. Within-group analysis showed substantial improvements in almost all functional tests in both groups (ES = 0.35–0.89). Furthermore, almost all jumping asymmetries were improved in both groups (ES = 0.38–0.69) except for vertical jumping asymmetry in VUL (ES = −0.04). Between-group analyses showed a substantial and possibly better performance in vertical jumping asymmetry and 5 m in VUH compared to that of VUL, respectively. In contrast, lateral jumping with left (ES = 1.22) and right leg (ES = 0.49) were substantially greater in VUL than in VUH. Specific force-vector training programs induced substantial improvements in both functional performance tests and inter-limb asymmetries, although greater improvements of lateral and horizontal variables may depend on the specific force vector targeted.

The Effect of Artificial Rearing on Live Weight Gain and Bone Morphology of the Tibia in Lambs Prior to Weaning

Growth rates associated with different artificial rearing systems have been thoroughly examined in many species. However, the effect of different rearing systems on bone morphology has not been described. The objective of this study was to examine differences in the bone mass and the relationship of peripheral quantitative computed tomography (pQCT) measures of bone with muscle area of ewe-reared lambs and artificially reared lambs. Lambs were opportunistically collected from a concurrent trial examining changes in ewe mammary glands during lactation. Thirteen lambs were artificially reared while the remaining nine were left on their dam. Measures of stature were taken throughout the six-week trial period. At approximately six weeks of age, the lambs were euthanized and the tibia was collected and scanned using peripheral quantitative computed tomography. Artificially reared lambs had reduced live weight gain and an altered pattern of stature growth. There was no effect of treatment on bone morphology (p &gt; 0.05), but ewe reared lambs had a greater cortical bone content to muscle area ratio than artificially reared lambs (0.06 vs. 0.15, respectively). Differences in growth between ewe reared lambs and artificially reared lambs emphasizes the importance of adequate preweaning nutrition for livestock production systems that routinely use artificial rearing systems.

Impact of physical exercise on depression and anxiety in adolescent inpatients: A randomized controlled trial

BackgroundPhysical exercise therapy is of proven efficacy in the treatment of adults with depression, but corresponding evidence is lacking in depressed adolescent inpatients. The aim of this study was to document the effect of add-on treatment with structured physical exercise in a clinical population of adolescents hospitalized for depression and anxiety in a psychiatric hospital. MethodsA group of 52 adolescent inpatients was randomly assigned to a physical exercise or control program three to four times per week over a six-week period (20 hours in total). The primary outcome was the Hospital Anxiety Depression Scale (HADS) for evaluation of depression and anxiety symptoms. Secondary outcomes were psychological self-assessments, diagnostic interviews, and physical examinations. ResultsSix participants were lost in each group, leaving 20 inpatients each in the intervention and control groups. A linear mixed model with F-test revealed a significant interaction in favor of physical exercise in reducing the mean depression score (HADS-D) by 3.8 points [95% (CI), range 1.8 to 5.7], compared to a mean reduction score of 0.7 [95% (CI), range -0,7 to 2.0] in the control group. No significant interaction was found for anxiety symptoms (HADS-A). LimitationsThe investigation was limited to the six-week hospital window and the small sample size prevented exploring differences in social characteristics. ConclusionStructured physical exercise add-on therapy integrated into the psychiatric hospitalization of adolescents has led to a reduction in their depressive symptoms, demonstrating its effectiveness in the care of adolescent inpatients with depression.

Tele-yoga for the management of Parkinson disease: A safety and feasibility trial.

ObjectivesDespite current standard treatments, persons with Parkinson disease (PD) still experience motor and non-motor symptoms that impact daily function and quality of life, warranting the investigation of additional interventions. Holistic complementary interventions such as yoga have been shown to be beneficial for persons with PD. However, there are multiple barriers to in-person interventions such as transportation difficulties and disease-related mobility impairments which may be mitigated by digital health applications. Therefore, this study’s purpose was to assess the safety and feasibility of a synchronous tele-yoga intervention for persons with PD.MethodsSixteen participants were enrolled in a single group safety and feasibility trial. The entire study was conducted remotely and consisted of a baseline assessment followed by a six-week waiting period, then a second assessment, a six-week tele-yoga intervention period, a post-intervention assessment, a six-week follow-up period, and lastly a follow-up assessment. During the tele-yoga period, participants completed two one-on-one 30-minute tele-yoga sessions weekly for a total of 12 sessions. Primary outcomes included adverse events, adherence, technological challenges, and usability. Secondary outcomes included enjoyment and clinically relevant outcome measures assessing both motor and non-motor symptoms.ResultsNo severe adverse events were attributed to the intervention. Retention was 87.5%, assessment session adherence was 100%, and intervention session adherence was 97%. Technological challenges did not impact feasibility. The intervention was usable and enjoyable. While this study was not powered or designed to assess the efficacy of the intervention, preliminary improvements were shown for some of the clinically relevant outcome measures.ConclusionsOverall, this study showed that the implementation of a synchronous one-on-one tele-yoga intervention was safe, feasible, usable, and enjoyable for persons with PD. Randomized control trials investigating its efficacy should be initiated. The study was registered with ClinicalTrials.gov (NCT04240899, https://clinicaltrials.gov/ct2/show/NCT04240899).

Exploration of a Short-term Learning Community Focused on Evidence-based Occupational Therapy Interventions for Children and Youth with Autism

Continuing education (CE) for occupational therapists typically takes place in workshops, seminars, or webinars with little support for practice change after the event concludes. Continuing education that occurs over an extended time with opportunities for social learning and competence assessment may improve knowledge translation. This study explored how pediatric occupational therapists who participated in a short-term, online learning community acquired new knowledge about evidence-based interventions from learning activities and how they applied this new knowledge to practice. Weekly modules with facilitated discussions, competency self-assessment, and peer-reviewed journal article readings occurred over a six-week period. An exploratory design included content analysis of participants’ online discussion postings, goal-setting activities, reflections, and a researcher-developed evaluation survey. Of the 19 participants who completed the evaluation survey, 17 participants indicated that the case simulation helped to assess their competence and that readings on evidence-based interventions obtained from ProQuestTM were helpful. All participants (n = 19) agreed that the learning community enriched their understanding of how to work with children and youth with autism spectrum disorder and they planned to apply new knowledge to their practice. Qualitative data analysis yielded two themes: becoming evidence-based and integrating evidence into practice. A community of occupational therapists with shared interests who participated in socially mediated learning opportunities with multiple educational components increased understanding and application of evidence-based interventions. Future research should investigate the relationship between engagement in a short-term learning community and application of evidence-based interventions with follow-up.

Col Kirpal Singh Award

Aim:To study the course and outcome of an Intensive Structured Deaddiction programme in armed forces personnel at a pioneer deaddiction centre.Method:.345 difficult to treat patients were treated in batches with the structured management program consisting detailed assessment, pharmacotherapy, Motivation Enhancement Therapy, Cognitive Behaviuor therapy, Psycho Education in three phases over a six-week period. The here phases consisted of Evaluation (One week) De-addiction Phase (Four weeks) and post treatment Protocol Phase (one week)A dedicated de-addiction team was ear-marked, headed by a specialist in Addiction Psychiatry. The cases were followed by means of a standardised protocol.Results:10 batches with total of 345 patients have received benefit of de-addiction therapy. 94% of these were AUD cases, 4% cannabis and 2% were addicted to opioids. On the basis of feedback received from units of the patients , 58.4% were reported to be completely abstinent, 16.7% occasionally drinking with satisfactory vocational performance, 13.9 % had relapsed into substance use and 11 % were lost to follow up.Discussion:Sociodemographic were similar to other studies conducted in armed forces. All the patients were matriculates and above. Domestic violence reported less which could be due to under-reporting. Comparison with similar methods at other places in military set up is not possible at this stage.Conclusion:A well structured and intensive and comprehensive deaddiction program seems to be working well in the military set up. Fine tuning the method and training to medical residents, nursing staff and medical officers hold the prospect of a salutary change in the attitude of all and improve soldier efficiency.

Knowledge, attitudes and practices related to blood donation in a selected population in Jaffna

Poor knowledge and negative attitudes among the public regarding blood donation have resulted in insufficient availability of blood and blood products for transfusion procedures in many clinical settings. This study aims to assess knowledge, attitudes and practices related to blood donation and their associated socio-demographic factors in Jaffna. A descriptive cross-sectional study was carried out among service-users at the Motor Traffic Department, District Secretariat, Jaffna, between 12 noon and 4 pm during a six-week period. Data were collected through an interviewer-based questionnaire. Frequencies, proportions, and the Chi Square test were used to analyze the data with SPSS (v25). The critical level was set at 0.05. A total of 300 service users participated; of them, most were females (59%), between 18 to 39 years (77%), with at least O/L qualifications (90%). Knowledge on eligibility criteria for blood donation was low compared to knowledge on risk behaviors that rendered them ineligible. Although an overwhelming majority (96%) believed that people should donate blood, only 21% had donated once in their lifetime. The most common reason for not having donated blood was that they had not been approached for blood donation (42%). Male gender (p&lt;0.001) and being employed (p=0.013) were significantly associated with having donated blood. Knowledge gaps exist even among a fairly educated population in Jaffna. Attitudes on blood donation seem favourable, although practices are poor. Blood donation campaigns should address knowledge gaps and actively recruit the public for blood donation. Strategies should be developed to encourage voluntary blood donation.

The modern gut-hammer: Understanding the eating habits of loggers through Photovoice

“Give Us Your Best Shot” is a Photovoice project designed to shed a light on loggers' food choices, attitudes toward and challenges around eating. This research focused on answering the question: What do you typically eat on a workday and where do you get it (breakfast, lunch, dinner, snacks, and drinks)? Consider: What makes it hard to eat healthier? If you feel you eat healthy, how do you do it? Participants were asked to take a photo to answer our research question at least once a week for a six-week period in autumn 2019. Photos and comments were exported from REDCap and imported into NVivo 12, a qualitative analysis software. Two members of the research team analyzed these data. In total, six male Maine loggers, ages 33 to 64, took part in the Photovoice project. Several themes emerged from these data including, but not limited to, the conflict between stated feelings about diet and health and actual consumption habits, the priority of health among many demands, and perceived healthfulness. Data analysis revealed time and family to be significant influential factors affecting loggers’ attitudes and ability to eat healthfully.Modern trends toward processed and pre-made food resulting in less home cooking, impacts how and what loggers eat. This project served to show that food choice and diet are modulated by complex outside forces and that improving diet is not a straightforward task. Maine loggers are coping with the same struggles that many workers face, with the added hardship of dealing with extremely long work hours and commutes, leaving little time for anything else. These factors should be taken into consideration when planning any nutrition related interventions with logging workers.

Impact of COVID-19 on Key Performance Indicators of the National Hip Fracture Database and the Management of Hip Fracture Patients.

Background: A hospital's performance regarding the management of hip fractures is based on six key performance indicators (KPIs) which are recorded onto the National Hip Fracture Database (NHFD). The aim of this study was to assess the overall impact of coronavirus disease 2019 (COVID-19) on the management and outcomes of hip fracture patients against a similar period in 2019 by utilizing the KPIs.Method: Retrospective data collection of hip fracture patients during a six-week (pre-COVID) period in 2019 and a six-week (COVID-19) period in a single orthopedic unit. The following parameters were compared; patient age, time to theater, surgeon operating time, total time in the operating room, time from ward to recovery, time from hospital presentation to theater, and total time from presentation to hospital discharge.Results: Some 38 patients in the pre-COVID-19 period vs. 27 patients with hip fractures in the COVID-19 period were included in the study. Time from diagnosis to theater and surgeon operating time were similar in both groups. The mean length of stay was 9.3 days vs. a mean of 31.34 days (p = 0.0004) in the COVID-19 and pre-COVID-19 groups respectively. A 30-day mortality was 22.2% (n = 6) in the COVID-19 group vs. 5.3% (n = 2) in the pre-COVID-19 group.Conclusion: Our study demonstrates that the combination of surgical stress and COVID-19 leads to higher mortality rates. Our hospital’s structural reorganization during the pandemic has shown progress in achieving important KPIs and improved short-term outcomes for hip fracture and trauma patients.