Patient Perspectives of an Intensive Comprehensive Aphasia Program for Stroke Survivors

Introduction: Persons with aphasia (PWA) who participate in intensive comprehensive poststroke language rehabilitation programs make a variety of significant investments. While intensive aphasia programs and intensive comprehensive aphasia programs (ICAPs) are becoming increasingly prevalent across health care settings, patient perspectives of ICAPs have not been explored. The purpose of this qualitative study was to examine patient perspectives about the experience of participating in an ICAP at the University of Montana. The primary research question of this study was: “what is it like to be a PWA in an ICAP?” Methods: Researchers used an interpretive phenomenological approach to conduct nine structured interviews from PWAs who described their lived experiences in the ICAP. All interviews were audiovisually recorded and transcribed from the video recordings. Analysis involved an iterative and collaborative coding process. Transcripts were coded and themes were developed from the PWAs’ shared perspectives. Results: Three primary themes emerged from patient perspectives including: (1) experience with each of the ICAP components is generally positive, (2) we notice the impact of the ICAP on our communication, and (3) relationships with people in the ICAP are important. Discussion: Results support emerging evidence that ICAPs can be a positive experience for PWA due to the perceptible impact on communication improvement and frequent and varied opportunities to interact with others. ICAPs may be a worthwhile investment for PWA, thereby contributing to the cost-benefit utility and implementation feasibility of the service delivery model

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

School environments and physical activity: The development and testing of an audit tool

The aim of this study was to develop, test, and employ an audit tool to objectively assess the opportunities for physical activity within school environments. A 44 item tool was developed and tested at 92 primary schools in the county of Norfolk, England, during summer term of 2007. Scores from the tool covering 6 domains of facility provision were examined against objectively measured hourly moderate to vigorous physical activity levels in 1868 9-10 year old pupils attending the schools. The tool was found to have acceptable reliability and good construct validity, differentiating the physical activity levels of children attending the highest and lowest scoring schools. The characteristics of school grounds may influence pupil's physical activity levels

An omnipresent diversity and variability in the chemical composition of atmospheric functionalized organic aerosol

The detailed molecular-level speciation of organic aerosol is a highly challenging task. Here, the authors show an extensive molecular-level intercomparison of functionalized organic aerosol from three diverse field sites revealing large compositional variability between samples at each field site

Neighborhood, route, and school environments and children's active commuting

Background: Walking and cycling to school represent an opportunity for children to achieve regular physical activity. These behaviors may be influenced by characteristics of the environment around homes and schools, yet few studies have quantified the potential associations between these two sets of factors. Purpose: This study aims to assess whether objectively measured characteristics of the neighborhood, route, and school environments are associated with active commuting to school among children, and it explores whether distance acts as a moderator in this association. Methods: A cross-sectional study was conducted of 2012 children (899 boys and 1113 girls) aged 9-10 years attending 92 schools in the county of Norfolk, United Kingdom. Questionnaires were completed by children and parents during Summer 2007. Attributes around the home and children's route to school were assessed using a GIS. School environments were assessed using a newly developed school audit and via questionnaires completed by head teachers. Data were analyzed in 2008. Results: Almost half of the children usually walked or cycled to school. Children who lived in a more deprived area and whose route to school was direct were less likely to walk or cycle to school, whereas those who had a higher density of roads in their neighborhood were more likely to walk. Further, children whose routes had a high density of streetlights were less likely to cycle to school. Distance did not moderate the observed associations. Conclusions: Objectively measured neighborhood and route factors are associated with walking and cycling to school. However, distance did not moderate the associations found here. Creating safe environments by improving urban design may influence children's commuting behavior. Intervention studies are needed to confirm the findings from this observational cross-sectional study