Co-designing solutions to enhance access and engagement in pediatric telerehabilitation

IntroductionPrior to the COVID-19 pandemic, children's therapy appointments provided by Ontario's publicly-funded Children's Treatment Centre (CTCs) primarily occurred in-person. With COVID-19 restrictions, CTCs offered services via telerehabilitation (e.g., video, phone), which remains a part of service delivery. CTC data shows that families experience barriers in attending telerehabilitation appointments and may need supports in place to ensure service accessibility. Our study aimed to co-design innovative solutions to enhance access and engagement in ambulatory pediatric telerehabilitation services. This manuscript reports the co-design process and findings related to solution development.MethodsThis research project used an experience based co-design (EBCD) approach, where caregivers, clinicians and CTC management worked together to improve experience with telerehabilitation services. Interview data were collected from 27 caregivers and 27 clinicians to gain an in-depth understanding of their barriers and successes with telerehabilitation. Next, 4 interactive co-design meetings were held with caregivers, clinicians and CTC management to address priorities identified during the interviews. Using qualitative content analysis, data from the interviews and co-design meetings were analyzed and findings related to the solutions developed are presented.FindingsFour topics were identified from the interview data that were selected as focii for the co-design meetings. Findings from the co-design meetings emphasized the importance of communication, consistency and connection (the 3C's) in experiences with telerehabilitation. The 3C's are represented in the co-designed solutions aimed at changing organizational processes and generating tools and resources for telerehabilitation services.DiscussionThe 3C's influence experiences with telerehabilitation services. By enhancing the experience with telerehabilitation, families will encounter fewer barriers to accessing and engaging in this service delivery model

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Rural Consumers’ Online Shopping for Food and Fiber Products as a Form of Outshopping

The purpose of the research was to longitudinally investigate rural consumers’ online shopping for food and fiber products as a function of satisfaction with local retailing and outshopping. Innovation diffusion theory was used to guide the research. Eight hundred seventy-nine rural consumers from 11 states completed surveys twice (in 2000 and 2003). Data were analyzed using structural equation modeling and analyses of variance. Dissatisfaction with local retailing in 2000 was a powerful driver of outshopping, beliefs about online shopping, and online shopping (both in 2000 and in 2003). Outshopping was positively related to online shopping at both points in time, suggesting that variables found to affect outshopping in the literature may affect online shopping in a similar way

Document workflow.

<p>(1) Independent CTD-specific queries were made of PubMed to retrieve 14,904 articles for the seven heavy metals cadmium, cobalt, copper, lead, manganese, mercury, and nickel. (2) These articles were text mined and assigned a document relevancy score (DRS). (3) Of this preliminary corpus, 1,020 articles were found to have been previously reviewed in CTD and were used as a test set to evaluate the DRS and determine suitable cut-offs. (4) Articles with DRS ≥100 (high), DRS ≤20 (low), and a subset with DRS between 21–99 (medium) were combined to provide a final corpus of 3,583 documents which was then (5) sent to five CTD biocurators (who were kept blind to the DRS of each article) for review. (6) Biocurators timed themselves while reviewing all articles and ultimately rejected 1,381 (as non-curatable for CTD) and curated 2,202 of them (7) from whence 41,208 chemical-gene-disease interactions were extracted.</p

DRS reflects the number of interactions per curated article.

<p>Biocurators extracted 41,208 interactions from 2,202 curated articles (top row, c). The average number of interactions per curated article (log-scale, <i>y</i>-axis) is distributed by the assigned DRS (binned in 20-unit increments, <i>x</i>-axis), with the number of curated articles (c) in each bin indicated at the top. The average number of interactions per curated article increases with the DRS. The aberrant spike in bin 240–259 is due to a single article (amongst a total of nine curated documents in the bin) from whence 5,977 interactions were curated from a microarray experiment.</p

DRS effectively ranks articles for productivity.

<p>(A) The number of total interactions (both novel and repeated) for each quartile is divided by (B) the time spent on curating them to produce (C) an averaged interaction yield rate (interactions per minute) for each quartile.</p

Test set of previously reviewed articles validates assigned DRS.

<p>A total of 1,020 articles are distributed by their text-mining assigned DRS (binned in 20-unit increments, <i>x</i>-axis) and are indicated as to whether they were found to have been either curated (green) or rejected (gray) by a CTD biocurator (as percent of articles in bin) at a previous time. The number of articles in each DRS bin (n) appears at the top of each column. There were no articles for the bins 280–299, 340–359, or 360–379.</p

Curation of heavy metal corpus validates assigned DRS.

<p>Of the original 14,904 articles (boxes in top row, N), a representative set of 3,583 documents (second row, n) were assigned to CTD biocurators for curatorial review, including all articles (1,981) with a high DRS ≥100, all articles (723) with a low DRS ≤20, and the complete subset of the articles (879) with a medium DRS 21–99 for the heavy metal mercury. (The 1,020 previously reviewed articles were not included in the assigned set.) The articles are distributed by their text-mining assigned DRS (binned in 20-unit increments, <i>x</i>-axis) and are indicated as to whether they were either curated (green) or rejected (gray) by a CTD biocurator (as percent of articles in bin). There is a progressive decrease in the percentage of curated articles with DRS <100. In total, 1,685 of the 1,981 articles (85%) with a high DRS ≥100 were curatable, while only 111 of the 723 articles (15%) with a low DRS ≤20 could be curated.</p