Pregnant Women’s Exposure to Household Air Pollution in Rural Bangladesh: A Feasibility Study for Poriborton: The CHANge Trial

The use of liquefied petroleum gas (LPG) for cooking is a strategy to reduce household air pollution (HAP) exposure and improve health. We conducted this feasibility study to evaluate personal exposure measurement methods to representatively assess reductions in HAP exposure. We enrolled 30 pregnant women to wear a MicroPEM for 24 h to assess their HAP exposure when cooking with a traditional stove (baseline) and with an LPG stove (intervention). The women wore the MicroPEM an average of 77% and 69% of the time during the baseline and intervention phases, respectively. Mean gravimetric PM2.5 mass and black carbon concentrations were comparable during baseline and intervention. Temporal analysis of the MicroPEM nephelometer data identified high PM2.5 concentrations in the afternoon, late evening, and overnight during the intervention phase. Likely seasonal sources present during the intervention phase were emissions from brick kiln and rice parboiling facilities, and evening kerosene lamp and mosquito coil use. Mean background adjusted PM2.5 concentrations during cooking were lower during intervention at 71 μg/m3, versus 105 μg/m3 during baseline. Representative real-time personal PM2.5 concentration measurements supplemented with ambient PM2.5 measures and surveys will be a valuable tool to disentangle external sources of PM2.5, other indoor HAP sources, and fuel-sparing behaviors when assessing the HAP reduction due to intervention with LPG stoves.

Comparing the Transfer Effects of Three Neurocognitive Training Protocols in Children With Attention-Deficit/Hyperactivity Disorder: A Single-Case Experimental Design

The current study used behavioural and electroencephalograph measures to compare the transferability of three home-based interventions — cognitive training (CT), neurofeedback training (NFT), and CT combined with NFT — for reducing symptoms in children with attention-deficit/hyperactivity disorder (AD/HD). Following a multiple-baseline single-case experimental design, twelve children were randomised to a training condition. Each child completed a baseline phase, followed by an intervention phase. The intervention phase consisted of 20 sessions of at-home training. Tau-U analysis and standardised visual analysis were adopted to detect effects. Results showed that CT improved inhibitory function and NFT improved alpha EEG activity and working memory. The combined condition, which was a reduced ‘dose’ of CT and NFT, did not show any improvements. The three conditions did not alleviate AD/HD symptoms. While CT and NFT may have transfer effects on executive functions, considering the lack of improvement in symptoms, this study does not support CT and NFT on their own as a treatment for children with AD/HD.

Transitions in Adherence Trajectories From Intervention to Maintenance of a Falls Prevention Exercise Program

The successful implementation of a falls prevention exercise program for older adults hinges on self-maintenance after active intervention. However, little is known about the pattern of adherence from the intervention to the maintenance phase of such programs, and the factors influencing adherence. We investigate transitions in exercise adherence trajectories from the active intervention to the maintenance phase of a falls prevention exercise program in Singapore, and whether exercise self-efficacy is associated with adherence in the maintenance phase. We analyze data of 143 older adults who participated in a 12-week, group-based falls prevention exercise program, followed by a 6-month maintenance phase, in 2018-2019. Sequential process latent class growth modeling identifies the distinct exercise adherence trajectories in the active intervention and the maintenance phase separately and their transition patterns. Multivariable regression examines whether baseline and change in self-efficacy during the active intervention predict adherence during the maintenance phase. The analysis reveals three exercise adherence trajectories— adherent (40% of participants), intermittent (38%), and disengaged (22%)—in the active intervention phase, and two trajectories—adherent (33%) and disengaged (67%)—in the maintenance phase. Those adherent in the maintenance phase comprise participants who were adherent (42%) or intermittent (58%) in the active intervention phase. Baseline and increase in exercise self-efficacy during the active intervention are positively associated with adherence in the maintenance phase. The findings capture the heterogeneity in exercise adherence patterns within and across the active intervention and maintenance phases of falls prevention exercise program, and the importance of exercise self-efficacy in continued adherence to exercise.

Physiotherapy using a free-standing robotic exoskeleton for patients with spinal cord injury: a feasibility study

Background Evidence is emerging for the use of overground lower limb robotic exoskeletons in the rehabilitation of people with spinal cord injury (SCI), with suggested benefits for gait speed, bladder and bowel function, pain management and spasticity. To date, research has focused on devices that require the user to support themselves with a walking aid. This often precludes use by those with severe trunk, postural or upper limb deficits and places the user in a suboptimal, flexed standing position. Free-standing exoskeletons enable people with higher level injuries to exercise in an upright position. This study aimed to evaluate the feasibility of therapy with a free-standing exoskeleton for those with SCI, and to determine the potential health-related benefits of this intervention. Methods This 12-week intervention study with 12-week waitlist control and 12-week follow up, provided people with SCI scoring < 5 on the mobility section of the spinal cord independence measure (SCIM-III) twice weekly therapy in the REX (Rex Bionics, Auckland, NZ), a free-standing lower limb robotic exoskeleton. The primary outcome measure of interest was function, as measured on the SCIM-III. A battery of secondary outcomes was included. Participants also completed a survey on their perceptions of this treatment modality, to determine acceptability. Results Forty-one potential participants were screened for eligibility. Two females (one ASIA A, one ASIA C) and one male (ASIA B) completed all 24 intervention sessions, and the follow up assessment. One participant showed positive trends in function, fatigue, quality of life and mood during the intervention phase. Grip and quadriceps strength, and lower limb motor function improved in another. Two improved their percentage of lean body mass during the intervention phase. Remaining results were varied across patients, time points and outcomes. The intervention was highly acceptable to all participants. Conclusion With three of 41 potential participants being eligible and completing this study, our results show that there are potential benefits of exercise in a free-standing exoskeleton for people with severe mobility impairment due to SCI, for a small subset of patients. Further research is warranted to determine those most likely to benefit, and the type of benefit depending on the patient characteristics. Trial registration The trial was registered prospectively on 20 April 2018 at www.anzctr.org.au/ (ACTRN12618000626268)

Influence of a Socially Assistive Robot on Physical Activity, Social Play Behavior, and Toy-Use Behaviors of Children in a Free Play Environment: A Within-Subjects Study

Background: Play is critical for children’s physical, cognitive, and social development. Technology-based toys like robots are especially of interest to children. This pilot study explores the affordances of the play area provided by developmentally appropriate toys and a mobile socially assistive robot (SAR). The objective of this study is to assess the role of the SAR on physical activity, play behavior, and toy-use behavior of children during free play.Methods: Six children (5 females, Mage = 3.6 ± 1.9 years) participated in the majority of our pilot study’s seven 30-minute-long weekly play sessions (4 baseline and 3 intervention). During baseline sessions, the SAR was powered off. During intervention sessions, the SAR was teleoperated to move in the play area and offered rewards of lights, sounds, and bubbles to children. Thirty-minute videos of the play sessions were annotated using a momentary time sampling observation system. Mean percentage of time spent in behaviors of interest in baseline and intervention sessions were calculated. Paired-Wilcoxon signed rank tests were conducted to assess differences between baseline and intervention sessions.Results: There was a significant increase in children’s standing (∼15%; Z = −2.09; p = 0.037) and a tendency for less time sitting (∼19%; Z = −1.89; p = 0.059) in the intervention phase as compared to the baseline phase. There was also a significant decrease (∼4.5%, Z = −2.70; p = 0.007) in peer interaction play and a tendency for greater (∼4.5%, Z = −1.89; p = 0.059) interaction with adults in the intervention phase as compared to the baseline phase. There was a significant increase in children’s interaction with the robot (∼11.5%, Z = −2.52; p = 0.012) in the intervention phase as compared to the baseline phase.Conclusion: These results may indicate that a mobile SAR provides affordances through rewards that elicit children’s interaction with the SAR and more time standing in free play. This pilot study lays a foundation for exploring the role of SARs in inclusive play environments for children with and without mobility disabilities in real-world settings like day-care centers and preschools.

Comparing Baseline and Intervention Phases

In this chapter readers will learn about methodological issues to consider in analyzing the success of the intervention and how to conduct visual analysis. The chapter begins with a discussion of descriptive statistics that can aid the visual analysis of findings by summarizing patterns of data across phases. An example data set is used to illustrate the use of specific graphs, including box plots, standard deviation band graphs, and line charts showing the mean, median, and trimmed mean that can used to compare any two phases. SSD for R provides three standard methods for computing effect size, which are discussed in detail. Additionally, four methods of evaluating effect size using non-overlap methods are examined. The use of the goal line is discussed. The chapter concludes with a discussion of autocorrelation in the intervention phase and how to consider dealing with this issue.

Effects of Intensive Interaction on the Social and Communication Behaviour of Three Students with Profound/Multiple Disabilities

<p>Objective: To evaluate the effects of an intervention, known as Intensive Interaction (II), on the social and communicative behaviour of three students with profound/multiple learning disabilities (PMLD). Methods: Three secondary school-aged students with PMLD were observed, and their level of social and communicative engagement rated, during an initial baseline and subsequent intervention phase. The intervention was introduced across participants in a multiple-baseline across subjects design. Results: Social and communicative engagement increased during intervention relative to baseline for each of the three students. Conclusion: II appeared to be effective in increasing social and communicative engagement of the participants and may therefore be viewed as a potentially promising approach for other students with PMLD.</p>

Effects of Intensive Interaction on the Social and Communication Behaviour of Three Students with Profound/Multiple Disabilities

<p>Objective: To evaluate the effects of an intervention, known as Intensive Interaction (II), on the social and communicative behaviour of three students with profound/multiple learning disabilities (PMLD). Methods: Three secondary school-aged students with PMLD were observed, and their level of social and communicative engagement rated, during an initial baseline and subsequent intervention phase. The intervention was introduced across participants in a multiple-baseline across subjects design. Results: Social and communicative engagement increased during intervention relative to baseline for each of the three students. Conclusion: II appeared to be effective in increasing social and communicative engagement of the participants and may therefore be viewed as a potentially promising approach for other students with PMLD.</p>

63. Impact of Infectious Disease Fellow-Driven Antimicrobial Stewardship Interventions on Inpatient Fluoroquinolone Use

Background Fluoroquinolone (FQ) antibiotics are frequently used in hospitalized patients to treat a wide range of infections but are often misused and implicated in antibiotic-associated adverse events. The purpose of this study is to evaluate the impact of Infectious Disease fellow (IDF)-driven antimicrobial stewardship program (ASP) interventions on inpatient FQ use. Methods This is a retrospective study of all admitted patients who received a FQ for greater than 48 hours from 01/01/2019 -12/31/2020 in an urban academic center. “Phase 1” (pre-intervention phase) covered 01/1/2019- 03/31/2019. “Phase 2” (intervention phase) covered 03/03/2020- 12/23/2020. In “Phase 2”, our ASP reviewed FQ use 2-3 days per week and an IDF provided feedback interventions that averaged 30-60 minutes of IDF time spent per day. We categorized FQ use as either: “appropriate”, “appropriate but not preferred”, or “inappropriate”, as determined by local clinical guidelines and ASP team opinion. We compared FQ use in both phases, indications for FQ use, and new Clostridioides difficile infections (CDI). Results A total of 386 patients are included (76 in “Phase 1”and 310 in “Phase 2”). Patient characteristics are similar (Table 1). Overall, 63 % of FQ use was empiric, and 50% FQ use was deemed “appropriate”, 28% “appropriate but not preferred”, and 22% “inappropriate”. In “Phase 2”, 126 interventions were conducted, with 86% of these accepted. Appropriate FQ use increased significantly in “Phase 2” vs. “Phase 1” (53.5% vs 35.5%, p = 0.008), with decrease in mean days of FQ use (4.38 days vs 5.87 days, p =.021). Table 2 shows “appropriate” FQ use by clinical indication. New CDIs occurred more in “Phase 1” vs. “Phase 2” (6.6% vs 0.6%, p=.001). Conclusion An IDF-driven ASP intervention has a positive impact on appropriate inpatient use of FQs in our hospital. This highlights a promising ASP model which not only improves appropriate use of FQ, but also offers an opportunity for IDF mentorship and use of available resources to promote ASPs. Disclosures Katie A. McCrink, PharmD, ViiV Healthcare (Employee)

Longitudinal Impact of APRNs on Nursing Home Quality Measures in the Missouri Quality Initiative

Objectives To measure the impact of advanced practice nurses (APRNs) on quality measures (QM) scores of nursing homes (NHs) in the CMS funded Missouri Quality Initiative (MOQI) that was designed to reduce avoidable hospitalizations of NH residents, improve quality of care, and reduce overall healthcare spending. Design A four group comparative analysis of longitudinal data from September 2013 thru December 2019. Setting NHs in the interventions of both Phases 1 (2012–2016) and 2 (2016–2020) of MOQI (n=16) in the St. Louis area; matched comparations in the same counties as MOQI NHs (n=27); selected Phase 2 payment intervention NHs in Missouri (n=24); NHs in the remainder of the state (n=406). Participants NHs in Missouri Intervention: Phase 1 of The Missouri Quality Initiative (MOQI), a Centers for Medicare and Medicaid (CMS) Innovations Center funded research initiative, was a multifaceted intervention in NHs in the Midwest, which embedded full-time APRNs in participating NHs to reduce hospitalizations and improve care of NH residents. Phase 2 extended the MOQI intervention in the original intervention NHs and added a CMS designed Payment Intervention; Phase 2 added a second group of NHs to receive the Payment. Intervention Only. Measurements Eight QMs selected by CMS for the Initiative were falls, pressure ulcers, urinary tract infections, indwelling catheters, restraint use, activities of daily living, weight loss, and antipsychotic medication use. For each of the monthly QMs (2013 thru 2019) an unobserved components model (UCM) was fitted for comparison of groups. Results The analysis of QMs reveals that that the MOQI Intervention + Payment group (group with the embedded APRNs) outperformed all comparison groups: matched comparison with neither intervention, Payment Intervention only, and remainder of the state. Conclusion These results confirm the QM analyses of Phase 1, that MOQI NHs with full-time APRNs are effective to improve quality of care.