Indoor Air Quality Intervention in Schools; Effectiveness of a Portable HEPA Filter Deployment in Five Schools Impacted by Roadway and Aircraft Pollution Sources

The Healthy Air, Healthy Schools Study was established in January 2020 to better understand the impact of ultrafine particles (UFP) on indoor air quality in communities surrounding Seattle-Tacoma (Sea-Tac) International Airport. The study team took multipollutant measurements indoor and outdoor air pollution at five participating school locations to infiltration indoors. The schools participating in this project were located within a 7-mile radius of Sea-Tac Airport and within 0.5 miles of an active flight path. Based on experimental measures in an unoccupied classroom, infiltration rates of a) Ultrafine particles of aircraft origin b) Ultrafine particles of traffic origin and c) Wildfire smoke or other outdoor pollutants were characterized before and after the introduction of a classroom based portable HEPA filter intervention. The portable HEPA cleaners were an effective short-term intervention to improve the air quality in classroom environments, reducing the ultrafine particles to approximately 1/10th of that measured outside. Before the HEPA filter deployment, approximately one-half of all outdoor UFPs were measured indoors. This study is unique in focusing on UFP in school settings and demonstrating through multivariate methods that the UFP measured in the classroom space is primarily of outdoor origin. Although existing research suggests that improvements to indoor air quality in homes can significantly improve asthma outcomes, further research is necessary to establish the benefit to student health and academic performance of improved air quality in schools.

Safety, efficacy and delivery of isometric resistance training as an adjunct therapy for blood pressure control: a modified Delphi study

Uncontrolled hypertension remains the major risk factor for cardiovascular disease. Isometric resistance training (IRT) has been shown to be a useful nonpharmacological therapy for reducing blood pressure (BP); however, some exercise physiologists and other health professionals are uncertain of the efficacy and safety of IRT. Experts’ consensus was sought in light of the current variability of IRT use as an adjunct treatment for hypertension. An expert consensus-building analysis (Delphi study) was conducted on items relevant to the safety, efficacy and delivery of IRT. The study consisted of 3 phases: (1) identification of items and expert participants for inclusion; (2) a two-round modified Delphi exercise involving expert panelists to build consensus; and (3) a study team consensus meeting for a final item review. A list of 50 items was generated, and 42 international experts were invited to join the Delphi panel. Thirteen and 10 experts completed Delphi Rounds 1 and 2, respectively, reaching consensus on 26 items in Round 1 and 10 items in Round 2. The study team consensus meeting conducted a final item review and considered the remaining 14 items for the content list. A final list of 43 items regarding IRT reached expert consensus: 7/10 items on safety, 11/11 items on efficacy, 10/12 items on programming, 8/10 items on delivery, and 7/7 on the mechanism of action. This study highlights that while experts reached a consensus that IRT is efficacious as an antihypertensive therapy, some still have safety concerns, and there is also ongoing conjecture regarding optimal delivery.

Accessibility, Self-Advocacy, and Self-Efficacy of Students With Disabilities in the 21st Century University

Few studies have addressed the challenging transition that occurs when students with disabilities graduate from the K-12 system and enter the world of higher education. Once in college, students with disabilities no longer have, among other federally-mandated supports, a child-study team to represent them, and thus must develop strong self-advocacy and self-efficacy skills in order to receive the accommodations and modifications they need to succeed academically. This chapter discusses the issues facing students with disabilities during this transition, details the services and support offered by colleges to guide students with disabilities, and shares recommended best practices for instructional strategies higher education can employ to ensure that these students flourish in the classroom and as self-assured, independent adults in society.

Unconventional Drilling and Creative Solutions Delivered World Record a Multi-Laterals Fishbone all Legs Drilled, Accessed and Stimulated First Attempt - Case Study from Kuwait

Despite being the first area for oil to be found in Kuwait in mid 1930's, Bahra's oil production remained largely unexploited until 2015, when a major development campaign targeting one of its tight carbonate reservoirs through horizontal drilling and multi-stage frack completions was commissioned. Nonetheless, with the development and exploration initiatives underway, surface congestion is the primary challenge. As the number of wells increased the need for unconventional well profiles became more demanding. The multi-lateral fishbone approach was designed to have a total of four laterals with approximately 3000 ft each. Lessons learned from previous level-1 multi-laterals drilled in North Kuwait indicated that the primary challenge remained to be the ability to drill a smooth bore hole profile across the junctions to successfully re-access and stimulate all the drilled legs with coil-tubing to maximize production. Kuwaiti Operator Reservoir and study team were looking for an alternate solution to increase the production in Bahra using multi-laterals technics in the same reservoir to stimulate and sustain production in calcite reservoir. Historically only three wells were drilled experimenting challenges and failures to open hole sidetrack leading to have long time to complete the wells with maximum 3 legs as record including the mother hole. RST team asked to drill a well with 4 legs, each leg following the same azimuth with the condition to be 300 ft apart. The thorough planning exercise completed and the close follow-up to the approved design of service during execution phase resulted in the successful delivery of the first four legs fishbone in Kuwait with Zero Non-Productive Time. In addition to achieving all the geological targets, the smooth borehole profile helped ensure successful re-entry and stimulation of all four legs in the same run achieving the well challenge using the unique

First Multilateral Well in the Most Congested Field in Abu Dhabi, Case of Study

This paper will highlight the first level 2 Multi-lateral well in BAB Field with permanent limited entry liner completion in the lower borehole to enhance accessibility and production. The well presents a technical milestone to the company in the development of multiple reservoir by combining two (2) wells from different reservoir and produce from both by using same surface well construction. At initial stage, the economics related to the implementation of the multilateral approach were analysed. Calculation was done by comparing the cost related to the technology application against the cost to prepare one (1) location plus completing a well up to the 7″ liner and mobilizing the rig twice. Then, it was necessary to select the candidate wells to be drilled from the same slot where synergy between Study team and drilling team was in place in order to ensure proper target alignment to make feasible the drilling and completion operations at the same time that the production targets were fulfilled. This project confirmed the feasibility of multilateral well application in a very congested field in terms of wells construction and surface facilities. In order to achieve such goal full synergy must be in place to select proper wells candidates and align targets. Cost reduction is massive considering the elimination of three (3) well phases plus avoidance of one (1) location construction and also the elimination of 1 rig move represents a big impact in terms of economics. Furthermore, the impact in terms of the risk reduction must be considered By combining two (2) wells in one (1) and eliminating three (3) phases in the standard well construction the harmful impact of location preparation, drilling fluids and cuttings on the environment is reduced by 45%, especially with oil base mud system. Geological problems can be observed during drilling each phase of a new well. However, drilling multilateral wells will reduce this occurrence. Well was completed with 7″× 4-1/2″ top packer, 4-1/2″ Slotted tubing and seven (7) swellable packers in lower borehole as well as Dual upper completion with 7″ single retrievable and 9-5/8″ dual retrievable packer and 2-7/8″ and 3-1/2″ tubing combination in both short and long string. This paper presents ADNOC Onshore first and successful experience in the deployment of new acquired technology for the Drilling multi-lateral / dual completion systems in BAB Field. The screening criteria for selecting the system as well as the benefits realized and lessons learned from this experience are also discussed together with the design simulations required to ensure the success of the well construction.

Recruitment and Retention Framework for a Timed-Activity Intervention Among Older Latinos With ADRD

Latino participation in ADRD research is essential to advance cognitive health equity. We present results of an adapted framework to increase recruitment and retention of older Latinos with ADRD and caregivers (CGs) in a timed-activity intervention. Framework factors include 3 structures with strategies informed by a Latino Community Advisory Board. For Characteristics of Study Processes, we included linguistically equivalent data collection procedures/measures, scheduled at times most convenient for participants/CGs. Participants were called weekly for questions/guidance with procedures. Intervention sessions built-in additional time to embed Latino cultural values: familismo, personalismo, confianza and respeto. Study Team Infrastructure, included bilingual/bicultural members/students; and trusted community partners to assist with participant referrals. For Preferences and Beliefs Toward Research, we conducted a series of focus groups to understand beliefs about “memory health” and perceptions of ADRD risks. Strategies yielded effective results. We reached our recruitment goal; started a wait-list of interested participants; had zero (n=0) attrition.

Assessing Needs, Well-being, and Telehealth Access of Older Adults with Limited Resources during COVID-19 Pandemic

The COVID-19 pandemic created new barriers and challenges to accessing primary care services, particularly among older adults who already faced barriers related to access to care, including transportation, health literacy, and self-management support. Nova Southeastern University South Florida Geriatric Workforce Enhancement Program (NSU SFGWEP) partnered with primary care clinics to conduct wellness calls to older adult patients identified through clinic EHR. The wellness calls’ objectives were to 1) discuss COVID-19 protective measures; 2) assess wellness needs and access to care barriers; and 3) screen for telehealth support. From September 2020 to February 2021, the team (including medical students, public health students, and SFGWEP staff) contacted 200 patients via telephone and conducted a comprehensive wellness survey developed by the study team, informed by validated surveys. Among the 200 patients called, 60% (n=34) were very concerned about the Covid-19 pandemic, 33% (n=34) reported often feeling isolated from others, and 20% (n=34) expressed difficulty getting medical care. A smaller subset of patients reported concern about limited COVID-19 testing (n=1), lack of knowledge about seeing their provider via telehealth (n=7), lack of face masks (n=1), and challenges with obtaining medication refills (n=1). Following wellness calls, the NSU SFGWEP team provided education, referred to clinical resources, and, for low-income patients with access to care challenges, provided Samsung Tablets (n=50) with peer training to enable telehealth.

COVID-19 and the Long-Term Care Ombudsman Program: Findings From a National Study

The purpose of our study was to explore changes for long-term care ombudsman programs across the country in response to the COVID-19 pandemic. The study team explored the effect of COVID-19 on programs: cases, resident engagement, complaint Investigation and resolution, services, complaints, changes in visitation, and preparedness plans. The research team developed survey items and beta-tested them with state and local LTCOs prior to distributing the survey nationally to State Long-Term Care Ombudsman and Local Long-Term Care Ombudsman in order to characterize experiences of the participants. From 62 state LLTC respondents we learned there were 81.0% fewer cases received, 97.36% were less able to engage with residents, 78.95% were less involved in the engagement of residents in complaint investigation and resolution and there were 71.05% fewer activities involved in investigations. Not surprisingly, there was an 80.0% increase in information that the LTCO provided to the media.

Using nasal povidone-iodine to prevent bloodstream infections and transmission of Staphylococcus aureus among haemodialysis patients: a stepped-wedge cluster randomised control trial protocol

IntroductionApproximately 38% of haemodialysis patients carry Staphylococcus aureus in their noses, and carriers have a nearly four-fold increased risk of S. aureus access-related bloodstream infections (BSIs) compared with non-carriers. Our objective is to determine the clinical efficacy and effectiveness of a novel intervention using nasal povidone-iodine (PVI) to prevent BSIs among patients in haemodialysis units. We will survey patients and conduct qualitative interviews with healthcare workers to identify barriers and facilitators to implementing the intervention.Methods and analysisWe will perform an open-label, stepped-wedge cluster randomised trial to assess the effectiveness of nasal PVI compared with standard care. Sixteen outpatient haemodialysis units will participate in the study. The 3-year trial period will be divided into a 4-month baseline period and eight additional 4-month time blocks. The primary outcome of the study will be S. aureus BSI, defined as a S. aureus positive blood culture collected in the outpatient setting or within one calendar day after a hospital admission. The study team will evaluate characteristics of individual patients and the clusters by exposure status (control or intervention) to assess the balance between groups, and calculate descriptive statistics such as average responses separately for control and intervention survey questions.Ethics and disseminationThis study has received IRB approval from all study sites. A Data Safety and Monitoring Board will monitor this multicentre clinical trial. We will present our results at international meetings. The study team will publish findings in peer-reviewed journals and make each accepted peer-reviewed manuscript publicly available.Trial registration numberNCT04210505.

What do parents think of using informational videos to support recruitment for parenting trials? A qualitative study

Background Lower than expected recruitment and retention rates are common challenges in parenting trials—particularly for community-based trials targeting parents of young children that rely on face-to-face recruitment by frontline workers. Recruitment requires parental informed consent, yet information sheets have been criticized for being lengthy and complex, and particularly challenging for parents with low literacy. Recent innovations include ‘talking head’ information videos. This paper aims to explore parent perceptions of using a ‘talking head’ video to support informed consent, recruitment, and retention procedures in parenting trials. Methods We conducted semi-structured interviews with a sample of 24 mothers recruited after their final follow-ups in two different parenting trials in Denmark. Before consenting to participate in the trials, parents were invited to view a video of a member of the study team giving information about the study, and again before the interviews for the current study. The audio data was transcribed and thematic analysis was conducted. Results We identified three overarching themes: (1) general impression of the video, (2) thoughts on participation in research, and (3) recruitment and retention. Participants were generally positive in their appraisal of the two talking head informational videos. We found that participants felt that a mix of paper-based and video-based sources of information would enable them to make an informed choice about whether to participate in a research study. We also found that a professionally produced video featuring a key member of the study team produced a feeling of commitment to the study that could impact retention rates. Conclusions Informational videos are acceptable to parents; however, co-production or participant/patient involvement in the development of such videos is recommended. Informational videos may not increase recruitment but have the potential for improving retention. Key design recommendations are to ensure a ‘professional’ look to the video, to supplement videos with paper-based information, to keep the length to < 3 min, and for the ‘talking head’ part to feature a key member of the study team.