Assessing the Utility of an Outpatient Exercise Program for Children With Cystic Fibrosis: A Quality Improvement Project

Children with cystic fibrosis (CF) (cwCF) suffer from inadequate weight gain, failure to thrive, and muscle weakness. The latter may be secondary to disuse atrophy (muscle wasting or reduction in muscle size associated with reduced physical activity and inflammation). Handgrip strength (HGS) is a reliable surrogate for muscle strength and lean body mass. Data from our CF center have shown an association between low HGS and forced expiratory volume in 1 s (FEV1) in cwCF. High-intensity interval training (HIIT) improves physical strength. Therefore, we devised a project to assess implementing a HIIT exercise program in the home setting, in order to improve physical strength in cwCF with HGS ≤ 50th percentile. Patients were instructed to complete 3–5 sessions of HIIT exercises per week. Wilcoxon matched-pairs signed-rank tests were used to compare HGS, FEV1, and body mass index (BMI) percentile at baseline and at a follow-up clinic visit. Follow-up was limited due to the COVID pandemic. Adherence to the HIIT regimen was poor. A total of twenty-nine cwCF participated in the program. However, a total of 13 individuals reported some form of moderate activity at follow-up and therefore constituted our final study population. There was a statistically significant increase in absolute grip strength (AGS) and FEV1 for these individuals. Even though the home HIIT protocol was not followed, the project demonstrated that moderate physical activity in cwCF can lead to significant improvement in HGS and overall physical strength.

Detecting the Presence of Electronic Devices in Smart Homes Using Harmonic Radar Technology

Data about users is collected constantly by phones, cameras, Internet websites, and others. The advent of so-called ‘Smart Things’ now enable ever-more sensitive data to be collected inside that most private of spaces: the home. The first step in helping users regain control of their information (inside their home) is to alert them to the presence of potentially unwanted electronics. In this paper, we present a system that could help homeowners (or home dwellers) find electronic devices in their living space. Specifically, we demonstrate the use of harmonic radars (sometimes called nonlinear junction detectors), which have also been used in applications ranging from explosives detection to insect tracking. We adapt this radar technology to detect consumer electronics in a home setting and show that we can indeed accurately detect the presence of even ‘simple’ electronic devices like a smart lightbulb. We evaluate the performance of our radar in both wired and over-the-air transmission scenarios.

Key Components for the Delivery of Palliative and End-of-Life Care in Care Homes in Hong Kong: A Modified Delphi Study

Integrating the palliative care approach into care home service to address the complex care needs of older adults with frailty or advanced diseases has been increasingly recognized. However, such a service is underdeveloped in Hong Kong owing to socio-cultural and legal concerns. We adopted a modified Delphi study design to identify the key components for the delivery of palliative and end-of-life care in care home settings for the local context. It was an iterative staged method to assimilate views of experts in aged care, palliative care, and care home management. A multidisciplinary expert panel of 18 members consented to participate in the study. They rated their level of agreement with 61 candidate statements identified through a scoping review in two rounds of anonymous surveys. The steering group revised the statements in light of the survey findings. Eventually, the finalized list included 28 key statements concerning structure and process of care in seven domains, namely policy and infrastructure, education, assessment, symptom management, communication, care for dying patients, and family support. The findings of this study underscored concerns regarding the feasibility of statements devised at different levels of palliative care development. This list would be instrumental for regions where the development of palliative and end-of-life care services in care home setting is at an initial stage.

Traditional Ewe Folktale: A behaviour modification strategy in the Early Grade Education classrooms in Ghana.

Purpose: Behaviour modification is considered a task of the home and the school. It is the duty of the school to nib in the bud any negative behaviour children pick from the home environment at the early grade level. This paper explores the impact and usefulness of messages from Traditional Ewe Folktales hereafter (TEF) in the training of early grade children in Ghana. Methodology: This paper is a qualitative research. Primary data was collected from four separate storytelling sessions in home and school settings. Six stories were narrated in the home setting by two old ladies under moonlight for fifteen children each from a rural setting. In the school setting, one story each was narrated by two teachers in two different schools. Storytelling periods on the school time table was used. Three stories were considered for analysis; Two and one story each were randomly selected from the home and school settings respectively. Results: It was found that educational values are imbedded in TEF. The educational values include the values of the society such as honesty, hard work, teamwork, patriotism and turn taking. Regular and purposeful use of these stories has the propensity of modifying behaviour. The paper concluded that when these educational values are tapped and developed through appropriate exemplars in the enactment of the school curriculum, behaviour modifications would occur with sustainability. The use of teaching strategies like role play, dramatization and songs can drive the behaviour modification. The paper recommended that TEF should be included in early grade classroom activities as a teaching strategy but not a means of whiling time. Parents should support teachers to gain more knowledge of TEF for classroom practices. The school base in-service training should be revived to equip teachers with knowledge of TEF and its application in the classroom.

VR Pedestrian Simulator Studies at Home: Comparing Google Cardboards to Simulators in the Lab and Reality

Virtual Reality is commonly applied as a tool for analyzing pedestrian behavior in a safe and controllable environment. Most such studies use high-end hardware such as Cave Automatic Virtual Environments (CAVEs), although, more recently, consumer-grade head-mounted displays have also been used to present these virtual environments. The aim of this study is first of all to evaluate the suitability of a Google Cardboard as low-cost alternative, and then to test subjects in their home environment. Testing in a remote setting would ultimately allow more diverse subject samples to be recruited, while also facilitating experiments in different regions, for example, investigations of cultural differences. A total of 60 subjects (30 female and 30 male) were provided with a Google Cardboard. Half of the sample performed the experiment in a laboratory at the university, the other half at home without an experimenter present. The participants were instructed to install a mobile application to their smartphones, which guided them through the experiment, contained all the necessary questionnaires, and presented the virtual environment in conjunction with the Cardboard. In the virtual environment, the participants stood at the edge of a straight road, on which two vehicles approached with gaps of 1–5 s and at speeds of either 30 or 50 km/h. Participants were asked to press a button to indicate whether they considered the gap large enough to be able to cross safely. Gap acceptance and the time between the first vehicle passing and the button being pressed were recorded and compared with data taken from other simulators and from a real-world setting on a test track. A Bayesian approach was used to analyze the data. Overall, the results were similar to those obtained with the other simulators. The differences between the two Cardboard test conditions were marginal, but equivalence could not be demonstrated with the evaluation method used. It is worth mentioning, however, that in the home setting with no experimenter present, significantly more data points had to be treated or excluded from the analysis.

Burkholderia cepacia: An unusual cause of pneumonia

Burkholderia Cepacia is a gram negative organism, an uncommon cause of pneumonia. When isolated, it usually represents colonisation. In the presence of immunocompromising conditions, it can cause disease, ranging from mild illness to the highly fatal Cepacia syndrome. The organism is intrinsically resistant to many antibiotics. We report a 57 years old male farmer, who has diabetes mellitus and bronchial asthma, who presented with a acute history of high grade fever, pain abdomen and cough. He was diagnosed with a ruptured liver abscess, with the infection spreading to the right lower lobe. Laparotomy was performed. Pus culture grew Pseudomonas aeruginosa. He improved upon antibiotic therapy, only to return after one month with severe cough, chest X-ray revealing a lung abscess in the right lower lobe. Bronchoalveolar lavage culture grew Burkholderia cepacia, and sensitive antibiotics were initiated, however the patient succumbed to the illness. The implicated source of the organism was the nebulisation solution which he was using regularly. Emphasis should be laid on the need for improved aseptic practices while using medical solutions at either hospital or home setting. An index of suspicion may guide optimal antibiotic prescription practices in susceptible individuals.

The role of humour and laughter therapy in decreasing caregiver burden among carers of a person living with dementia- A case study

Gibbs (1988) reflective cycle was employed to explore a critical case study involving a senior citizen with dementia and measures to reduce caregiver burden by humour and laughter therapy. This experience highlights key themes of caregiver burden-reduction measures through humour and laughter. This problem is discussed in relation to lack of awareness about measures to reduce caregiver burden arising due to caretaking of a person with dementia. Inclusion of this therapy as a non-pharmacological method of stress management, could be useful in the guidelines for dementia care. Therefore, it is important to include training to all caregivers at home and care home setting to address the issue of caregiver burden.

Evaluation of Remote Categorical Loudness Scaling

Purpose: The aims of this study were to (a) demonstrate the feasibility of administering categorical loudness scaling (CLS) tests in a remote setting, (b) assess the reliability of remote compared with laboratory CLS results, and (c) provide preliminary evidence of the validity of remote CLS testing. Method: CLS data from 21 adult participants collected in a home setting were compared to CLS data collected in a laboratory setting from previous studies. Five participants took part in studies in both settings. Precalibrated equipment was delivered to participants who performed headphone output level checks and measured ambient noise levels. After a practice run, CLS measurements were collected for two runs at 1 and 4 kHz. Results: Mean headphone output levels were within 1.5 dB of the target calibration level. Mean ambient noise levels were below the target level. Within-run variability was similar between the two settings, but across-run bias was smaller for data collected in the laboratory setting compared with the remote setting. Systematic differences in CLS functions were not observed for the five individuals who participated in both settings. Conclusions: This study demonstrated that precise stimulus levels can be delivered and background noise levels can be controlled in a home environment. Across-run bias for remote CLS was larger than for in-laboratory CLS, indicating that further work is needed to improve the reliability of CLS data collected in remote settings. Supplemental Material https://doi.org/10.23641/asha.17131856

Service Process Factors Affecting Patients’ and Clinicians’ Experiences on Rapid Teleconsultation Implementation in Out-patient Neurology Services during COVID-19 Pandemic: A Scoping Review

BackgroundPrior to the COVID-19 outbreak, the adoption of teleconsultation for outpatient neurology services was limited. Since the COVID-19 pandemic, many outpatient neurology services have rapidly switched to teleconsultation worldwide. However, it remains unclear how this change has impacted patients' and clinicians' perceptions of service quality. The purpose of this scoping review is to identify process factors that influence patients' and clinicians' experiences of outpatient teleconsultation services during COVID-19.MethodsArksey and O’Malley scoping review framework was used to search PubMed, Scopus, CINAHL, and PsycInfo for original peer-reviewed research studies that examined the experiences of synchronous teleconsultation between a clinician and patient in a home-setting since the World Health organization announced the COVID-19 global pandemic. The service quality model SERVQUAL was used to conduct a deductive thematic analysis to identify the key factors that impacted the patients’ and clinicians’’ perception of teleconsultation services. Results A total of nineteen studies published between January 1, 2020, and April 17, 2021, were identified. The most common service process factors affecting the patients' and clinicians' experiences of teleconsultation were technical issues, addressing logistical needs, communication, ability to perform clinical activities, appropriate triage, and administrative support. Conclusions Our findings identified six key service process factors affecting the patients' and clinicians' teleconsultation experiences in outpatient neurology services. The need for a new triage system and standardizing administrative virtual care workflow are identified as important steps to improve patients and clinicians’ teleconsultation experiences compared to pre-COVID. More research is needed to assess outpatient neurology teleconsultation service quality from patients' and clinicians' perspectives.