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BackgroundThe successful development of multiple COVID-19 vaccines has led to a global vaccination effort to reduce severe COVID-19 infection and mortality. However, the effectiveness of the COVID-19 vaccines wane over time leading to breakthrough infections where vaccinated individuals experience a COVID-19 infection. Here we estimate the risks of break-through infection and subsequent hospitalization in individuals with common comorbidities who had completed an initial vaccination series.MethodsOur study population included vaccinated patients between January 1, 2021 to March 31, 2022 who are present in the Truveta patient population. Models were developed to describe 1) time from completing primary vaccination series till breakthrough infection; and 2) if a patient was hospitalized within 14 days of breakthrough infection. We adjusted for age, race, ethnicity, sex, and year-month of vaccination.ResultsOf 1,192,135 patients in the Truveta Platform who had completed an initial vaccination sequence between January 1, 2021 and March 31, 2022, 2.84, 3.42, 2.76, and 2.89 percent of patients with CKD, chronic lung disease, diabetes, or are in an immunocompromised state experienced breakthrough infection, respectively, compared to 1.35 percent of the population without any of these four comorbidities. We found an increased risk of breakthrough infection and subsequent hospitalization in individuals with any of the four comorbidities when compared to individuals without these four comorbidities.ConclusionsVaccinated individuals with comorbidities experienced an increased risk of breakthrough COVID-19 infection and subsequent hospitalizations compared to the general population. Individuals with immunocompromising conditions and chronic lung disease were most at risk of breakthrough infection, while people with CKD were most at risk of hospitalization following breakthrough infection. Individuals with comorbidities should remain vigilant against infection even if vaccinated.

Pressure injuries for individuals with spinal cord injuries (SCI) are correlated with mortality and are a leading cause for rehospitalizations. The Assisted Weight Shift (AW-Shift©) is a mobile pressure mapping application designed to provide users with a live map view and reminders to perform weight shifts. Novel visualization techniques were used to understand daily distributions of user interaction wit h AW-Shift©. The date and time of system interactions were recorded for six participants with SCI over 7 days (five males/one female, five manual users/one power user, 55.3 ± 17.3 years old, 10.6 ± 6.5 years since injury). Circular frequency plots were created to visualize the time and frequency participants brought the app to the foreground of their phone and received alerts and reminders to complete weight shifts. While some participants used the system regularly throughout the day, others primarily used it before 8am; highlighting the system's importance for regular spot checks and morning wheelchair setup. Participant adherence to weight shift reminders was low suggesting the live pressure map may be more useful. Circular frequency plots can be used by clinicians to more easily review large amounts of patient data. Future work will investigate raw pressure mat data and create a closed-loop weight shift detection algorithm.

Given the profound effects of the COVID-19 pandemic on the way individuals interact, we sought to understand if there was an increase in pediatric first-time speech and language delay diagnoses in. We identified children under five years of age with a first-time speech delay diagnosis between January 1, 2018 and February 28, 2023, in Truveta Data. We calculated the monthly rate of first-time speech delay diagnoses per children with an encounter within the last year and no previous speech delay diagnosis. The Seasonal-Trend decomposition using LOESS (STL) method was used to adjust for seasonality. We also compared the difference in means between the 2018/2019 and 2021/2022 time periods. Significant increases in the mean of rates between 2018/2019 and 2021/2022 exist for the overall population and each age strata (p

Long COVID, or post-COVID syndrome, is a constellation of symptoms observed in patients at least four weeks after COVID-19 infection. We analyzed the effect of COVID-19 vaccination status on risk of either developing Long COVID symptoms or being diagnosed with Long COVID. In separate analyses we compared the effect of vaccination status at time of COVID-19 infection and the effect of vaccination status as a time-dependent covariate where vaccination could occur at any point with respect to COVID-19 infection.To address this question, we identified a subset of adult patients from Truveta Data who experienced a COVID-19 infection as indicated by a positive laboratory test between 2021-10-01 and 2022-11-31. We considered two distinct ways of modeling the effect of vaccination status (time-independent and time-dependent) and two distinct outcomes of interest (Long COVID symptoms or diagnosis with Long COVID), representing four distinct analyses. The presence of Long COVID symptoms was defined as the presence of one or more new symptoms consistent with COVID-19/Long COVID at least four weeks post COVID-19 infection. Diagnosis of Long COVID was determined by the presence of one or more ICD-10-CM or SNOMED-CT codes explicitly identifying a patient as having been diagnosed with Long COVID.Our analysis focusing on the effect of COVID-19 vaccination status at time of COVID-19 infection found that patients who had completed a primary COVID-19 vaccination sequence or had completed a primary vaccination sequence and received a booster dose at time of COVID-19 infection were on average at lower risk of either developing Long COVID symptoms or being diagnosed with Long COVID than unvaccinated patients (vaccinated versus unvaccinated HR of symptoms 0.9 [0.87-0.94], HR of diagnosis 0.86 [0.74-0.99]; vaccinated and boosted versus unvaccinated HR of symptoms 0.87 [0.83-0.91], HR of diagnosis 0.81 [0.69-0.95]). We do not find evidence that having received a booster dose in addition to having completed a primary vaccination sequence offers additional protection over having completed the primary sequence alone (vaccinated and boosted versus vaccinated HR of symptoms 0.96 [0.91-1.01], HR of diagnosis 0.94-1.13).Our analysis of COVID-19 vaccination status modeled as a time-dependent covariate yielded similar results for patients who had completed a primary COVID-19 vaccination sequence or had completed a primary vaccination sequence and a booster dose. Both groups were on average at lower risk of developing Long COVID symptoms or being diagnosed with Long COVID than patients who where never vaccinated (vaccinated versus unvaccinated HR of symptoms 0.91 [0.88-0.95], HR of diagnosis 0.86 [0.75-0.99]; vaccinated and boosted versus unvaccinated HR of symptoms 0.88 [0.85-0.91], HR of diagnosis 0.77 [0.67-0.9]). As with the time-independent analysis, we also find that having completed a booster dose in addition to a primary COVID-19 vaccination sequence does not provide additional protection from developing Long COVID symptoms or being diagnosed with Long COVID over having completed the primary sequence alone (vaccinated and boosted versus vaccinated HR of symptoms 0.96 [0.92-1.01], HR of diagnosis 0.89 [0.76-1.06]).We find that completing a primary vaccination sequence is associated with a decreased risk of developing Long COVID symptoms or being diagnosed with Long COVID compared with no vaccination regardless of whether vaccination status is modeled as a time-independent or time-dependent covariate. We find a similar protective effect in patients who have completed a primary vaccination sequence and a booster dose when compared to the those who are unvaccinated. However, we do not find evidence for a difference in protective effect between patients who have completed a primary vaccination sequence and a booster dose and those patients who have only completed a primary vaccination sequence.Our results support the growing evidence that having complete a primary vaccination sequence is protective against the development of Long COVID symptoms or the diagnosis of Long COVID.

IntroductionDemonstrated health inequalities persist in the United States. SARS-CoV-2 (COVID) has been no exception, with access to treatment and hospitalization differing across race or ethnic group. Here we aim to assess differences in treatment with remdesivir and hospital length of stay across four waves of the pandemic.MethodsUsing a subset of the Truveta data we examine odds ratios (OR) of in-hospital remdesivir treatment and risk ratios (RR) of in-hospital length of stay between Black or African American (Black) to white patients. We adjusted for confounding factors such as age, sex, and comorbidity status.ResultsThere were statically significant lower rates of remdesivir treatment and longer in-hospital lengths of stay comparing Black patients to white patients early in the pandemic (OR for treatment: 0.88, 95% confidence interval [CI]: 0.80, 0.96; RR for length of stay: 1.17, CI: 1.06, 1.21). Rates became close to parity between groups as the pandemic progressed.ConclusionsWhile inpatient remdesivir treatment rates increased and length of stay decreased over the beginning course of the pandemic, there are still inequalities in patient care.

This cross-sectional study investigates rates of prescription of low-dose minoxidil after of publication of a newspaper article on this treatment.

Objective: To investigate the prevalence of rotator cuff and long head of the biceps pathologies in manual wheelchair (MWC) users with spinal cord injury (SCI). Design: Cross-sectional study. Setti...

Background: Individuals with spinal cord injury (SCI) who use manual wheelchairs (MWCs) have a higher rate of rotator cuff pathology progression than able-bodied individuals. Objectives: This study aimed to test the ability of risk and recovery metrics of arm use to differentiate between (1) MWC users with SCI and matched able-bodied participants (cross-sectional matched-sample study) and (2) MWC users with rotator cuff pathology progression over 1 year from those without pathology progression (longitudinal study). Methods: Thirty-four MWC users and 34 age- and sex-matched able-bodied individuals were recruited. Upper arm risk (humeral elevation >60°) and recovery (static ≥5 seconds and humeral elevation Results: The frequency of risk events (p = .019), summated duration of recovery events (p = .025), and duration of each recovery event (p = .003) were higher for MWC users than able-bodied participants. The summated duration of risk events (p = .047), frequency of risk events (p = .027), and risk to recovery ratio (p = .02) were higher and the summated duration of recovery events (p = .036) and frequency of recovery events (p = .047) were lower for MWC users with rotator cuff pathology progression (n = 5) compared to those without progression (n = 11). Conclusion: IMU-derived metrics quantifying arm use at postures >60° and risk to recovery ratios may provide insights of potential risk factors for rotator cuff pathology progression.

Arm use in manual wheelchair (MWC) users is characterized by a combination of overuse and a sedentary lifestyle. This study aimed to describe the percentage of daily time MWC users and able-bodied individuals spend in each arm use intensity level utilizing accelerometers. Arm use intensity levels of the upper arms were defined as stationary, low, mid, and high from the signal magnitude area (SMA) of the segment accelerations based on in-lab MWC activities performed by eight MWC users. Accelerometry data were collected in the free-living environments from forty MWC users and 40 sex- and age-matched able-bodied individuals. The SMA intensity levels were applied to the free-living data and the percentage of time spent in each level was calculated. The SMA intensity levels were defined as, stationary: ≤0.67 g, low: 0.671–3.27 g, mid: 3.27–5.87 g, and high: &gt, 5.871 g. The dominant arm of both MWC users and able-bodied individuals was stationary for most of the day and less than one percent of the day was spent in high intensity arm activities. Increased MWC user age correlated with increased stationary arm time (R = 0.368, p = 0.019). Five and eight days of data are needed from MWC users and able-bodied individuals, respectively, to achieve reliable representation of their daily arm use intensities.

Shoulder pain and pathology are extremely common for individuals with spinal cord injuries (SCI) who use manual wheelchairs (MWC). Although risky humeral kinematics have been measured during wheelchair-based activities performed in the lab, little is known about arm kinematics in the free-living environment. The purpose of this study was to measure the humeral elevation workspace throughout a typical day for individuals with SCI who use a MWC and matched able-bodied controls. Thirty-four individuals with SCI who use a MWC (42.7±12.7 years of age, 28 males/6 females, C6-L1) and 34 age-and sex-matched controls were enrolled. Participants wore three inertial measurement units (IMU) on their upper arms and torso for one to two days. Humeral elevation angles were estimated and the percentage of time individuals spent in five elevation bins (0–30°, 30–60°, 60–90°, 90–120°, and 120–180°) were calculated. For both arms, the SCI cohort spent a significantly lower percentage of the day in 0–30° of humeral elevation (Dominant: SCI = 15.7±12.6%, Control = 32.1±15.6%, p

ObjectiveTo investigate the prevalence of rotator cuff and long head of the biceps pathologies in manual wheelchair (MWC) users with spinal cord injury (SCI).DesignCross-sectional study.SettingAcademic medical center.ParticipantsMWC users with SCI.Outcome MeasuresParticipants’ demographic and anthropometric information, presence of shoulder pain, wheelchair user’s pain Index (WUSPI) scores, and MRI findings of shoulder pathologies including tendinopathy, tendon tears, and muscle atrophy.ResultsForty-four adult MWC users with SCI participated in the study. Fifty-nine percent of the participants reported some shoulder pain. The prevalence of any tendinopathy across the rotator cuff and the long head of biceps tendon was 98%. The prevalence of tendinopathy in the supraspinatus was 86%, infraspinatus was 91%, subscapularis was 75%, and biceps was 57%. The majority of tendinopathies had mild or moderate severity. The prevalence of any tears was 68%. The prevalence of tendon tears in the supraspinatus was 48%, infraspinatus was 36%, subscapularis was 43%, and biceps was 12%. The majority of the tears were partial-thickness tears. Participants without tendon tears were significantly younger (p < 0.001) and had been dependent on wheelchair for significantly shorter time (p = 0.005) than those with tendon tears.ConclusionMild and moderate shoulder tendinopathy and partial-thickness tendon tears were highly prevalent in MWC users with SCI. Additionally, the findings of this study suggest that strategies for monitoring shoulder pathologies in this population should not be overly reliant on patient-reported pain, but perhaps more concerned with years of wheelchair use and age.

Arm use in individuals with spinal cord injury who use manual wheelchairs (MWC) is complex, characterized by a combination of overuse and a sedentary lifestyle. This study aimed to calculate arm use intensity levels for MWC users, describe the percentage of daily wear time MWC users and able-bodied individuals spend in each arm use intensity level, and test the reliabilities of the measurements for both MWC users and able-bodied individuals.MWC users wore two inertial measurement units (IMUs) on their bilateral upper arms while performing six MWC-based activities in-lab. Video data were recorded and each second was coded as active or stationary. Acceleration-based signal magnitude area (SMA) ranges were defined for stationary, low, mid, and high arm use intensity levels. IMU data were also collected in the free-living environments for MWC users and able-bodied individuals for four days (3 weekdays and 1 weekend day). The SMA levels were applied to the free-living data from the dominant arm and the percentage of time spent in each level was calculated. The required number of days to achieve moderate, good, and excellent reliabilities was calculated.Eight adult MWC users with SCI participated in the in-lab data collection and SMA arm use intensity levels were defined as, stationary: ⩽ 0.67g, low: 0.671 – 3.27g, mid: 3.271 – 5.87, and high: > 5.871. Six MWC users and 15 able-bodied individuals completed the free-living data collection. The dominant arm of both MWC users and able-bodied individuals was stationary for the majority of the day. The reliability analysis indicated that at least five and eight days of data are needed from MWC users and able-bodied individuals, respectively, to achieve reliable representation of their overall daily arm use intensities throughout a week.Future research is needed to understand the recovery time associated with stationary arm use and if it differs between MWC users and matched able-bodied individuals. At least five days of data should be collected when utilizing these methods for MWC users. The methods presented here will contribute to understanding the mechanisms which cause increased shoulder pain and pathology for MWC users.

Importance: Constraint-induced movement therapy (CIMT) is a common treatment for children with unilateral cerebral palsy (CP). Although clinic-based assessments have demonstrated improvements in arm function after CIMT, whether these changes are translated and sustained outside of a clinic setting remains unclear. Objective: Accelerometers were used to quantify arm movement for children with CP 1 wk before, during, and 4 wk or more after CIMT; measurements were compared with those from typically developing (TD) peers. Design: Observational. Setting: Tertiary hospital and community. Participants: Seven children with CP (5 boys, 2 girls; average [AVE] age ± standard deviation [SD] = 7.4 ± 1.2 yr) and 7 TD peers (2 boys, 5 girls; AVE age ± SD = 7.0 ± 2.3 yr). Intervention: 30-hr CIMT protocol. Outcomes and Measures: Use ratio, magnitude ratio, and bilateral magnitude were calculated from the accelerometer data. Clinical measures were administered before and after CIMT, and parent surveys assessed parent and child perceptions of wearing accelerometers. Results: During CIMT, the frequency and magnitude of paretic arm use among children with CP increased in the clinic and in daily life. After CIMT, although clinical scores showed sustained improvement, the children’s accelerometry data reverted to baseline values. Children and parents in both cohorts had positive perceptions of accelerometer use. Conclusions and Relevance: The lack of sustained improvement in accelerometry metrics after CIMT suggests that therapy gains did not translate to increased movement outside the clinic. Additional therapy may be needed to help transfer gains outside the clinic. What This Article Adds: Accelerometer measurements were effective at monitoring arm movement outside of the clinic during CIMT and suggested that additional interventions may be needed after CIMT to sustain benefits.

The engineering profession is increasingly recognizing that engineers’ abilities to utilize a systems perspective and collaborate on multidisciplinary teams are critical professional competencies required to solve contemporary engineering challenges. Understanding context, including but not limited to social and cultural context, is one aspect of systems thinking that is important to effective problem-solving, yet such training is not yet standard in our engineering curricula. Humanitarian engineering-related capstone design projects offer both hands-on and field opportunities to integrate social and cultural appropriateness into a formal engineering design curriculum. Over the 2015-2016 academic year, Oregon State University offered a capstone project aimed at optimizing and implementing an improved soap-making process for TERREWODE, a non-governmental organization in Uganda. The ultimate goal of this soap-making project was to expand income-generating opportunities for victims and survivors of obstetric fistula. The project consisted of a six-month, on-campus design phase and a three-week field implementation and research trip in Soroti, Uganda. Six Social Justice (SJ) criteria were used in assessing project context and developing design requirements. Throughout the design phase, experimental testing drove the majority of design decisions. During field implementation and research, the three-student capstone design team worked closely with TERREWODE and their members to optimize the process, understand cultural conditions, and recommend options for potential local solar power systems.

Background Accelerometers provide a new method to objectively measure recovery of movement and physical activity in patients following reverse total shoulder arthroplasty (RTSA) and may overcome common limitations associated with patient-reported outcome measures (PROMs). The aim of this study was to assess changes in upper limb movement using accelerometers following RTSA and investigate their association with other clinical outcome measures. Methods Thirty-six patients who underwent RTSA wore accelerometers on both wrists and arms for 3 days at 3, 6, and 12 months postsurgery. PROMs (Constant score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, visual analog scale for pain, Single Assessment Numerical Evaluation, Shoulder Activity Level) and isometric shoulder strength were also assessed. Accelerometer outcomes were calculated to quantify counts of forearm and arm activity and the contribution of both arms to activity (limb symmetry and magnitude ratio). Changes and differences in all clinical measures and objective movement measures were evaluated with within-subjects analysis of variance. Correlations between limb activity and other clinical measures were investigated using Spearman correlation coefficients. Results Objective movement of the operated arm increased from 3-6 months postsurgery (P = .004), but not from 6-12 months (P = .240). Limb asymmetries were observed at 3 and 6 months and improved by 12 months postsurgery. No associations were demonstrated between PROMs and objective upper limb movement at 12 months postsurgery. Discussion Despite early recovery of function and pain relief assessed by PROMs, objective movement using accelerometers showed delayed recovery of the operated arm postoperatively, before normalizing by 12 months postsurgery. Accelerometers provide a unique insight into functional recovery following RTSA.

Shoulder pain is common in manual wheelchair (MWC) users. Overuse is thought to be a major cause, but little is known about exposure to activities of daily living (ADLs). The study goal was to develop a method to estimate three conditions in the field: (1) non-propulsion activity, (2) MWC propulsion, and (3) static time using an inertial measurement unit (IMU). Upper arm IMU data were collected as ten MWC users performed lab-based MWC-related ADLs. A neural network model was developed to classify data as non-propulsion activity, propulsion, or static, and validated for the lab-based data collection by video comparison. Six of the participants’ free-living IMU data were collected and the lab-based model was applied to estimate daily non-propulsion activity, propulsion, and static time. The neural network model yielded lab-based validity measures ≥0.87 for differentiating non-propulsion activity, propulsion, and static time. A quasi-validation of one participant’s field-based data yielded validity measures ≥0.66 for identifying propulsion. Participants’ estimated mean daily non-propulsion activity, propulsion, and static time ranged from 158 to 409, 13 to 25, and 367 to 609 min, respectively. The preliminary results suggest the model may be able to accurately identify MWC users’ field-based activities. The inclusion of field-based IMU data in the model could further improve field-based classification.

ImportanceConstraint Induced Movement Therapy (CIMT) is a common treatment for children with unilateral cerebral palsy (CP). While clinic-based assessments have demonstrated improvements in arm function after CIMT, quantifying if these changes are translated and sustained outside of a clinic setting remains unclear.ObjectiveAccelerometers were used to quantify arm movement for children with CP one week before, during, and 4+ weeks after CIMT and compared to typically-developing (TD) peers.DesignObservational during CIMTSettingClinical assessments and treatment occurred in a tertiary hospital and accelerometry data were collected in the communityParticipants7 children with CP (5m/2f, 7.4 ± 1.2 yrs) and 7 TD peers (2m/5f, 7.0 ± 2.3 yrs)Intervention30-hour CIMT protocolOutcomes and MeasuresThe use ratio, magnitude ratio, and bilateral magnitude were calculated from the accelerometry data. Clinical measures were evaluated before and after CIMT and surveys were used to assess the feasibility of using accelerometers.ResultsBefore CIMT, children with CP used their paretic arm less than their TD peers. During therapy, their frequency and magnitude of paretic arm use increased in the clinic and in daily life. After therapy, although clinical scores improved, children reverted to baseline accelerometry values. Additionally, children and parents in both cohorts had positive perceptions of wearing accelerometers.Conclusions and RelevanceThe lack of sustained improved accelerometry metrics following CIMT suggest therapy gains did not translate to increased movement outside the clinic. Additional therapy may be needed to help the transfer of skills to the community setting.What this Article AddsThis study compares the movement of children with CP undergoing CIMT in the community setting with their typically developing peers. Additional interventions may be needed in combination with or following CIMT to sustain the benefits of the therapy outside of the clinic.

PURPOSE OF REVIEW: The purpose of this article was to describe the utilization of body worn activity monitors in the SCI population and discuss the challenges of using body worn sensors in rehabilitation research. RECENT FINDINGS: Many activity monitor-based measures have been used and validated in the SCI population including stroke number, push frequency, upper limb activity counts and wheelchair propulsion distance measured from a sensor attached to the wheelchair. SUMMARY: The ability to accurately measure physical activity in the free-living environment using body-worn sensors has the potential to enhance the understanding of barriers to adequate activity and identify possible effective interventions. As the use of activity monitors used in SCI rehabilitation research continues to grow, care must be taken to overcome challenges related to participant adherence and data quality.

Go Baby Go is a community-based outreach, research, and clinical treatment program that works with families, clinicians, service providers and industry to provide pediatric equipment to children with disabilities for movement, mobility and socialization. The purpose of the current technical report is to describe two innovative and novel extensions of the initial modified ride-on car technology that encourages self-directed mobility, participation and function for young children with disabilities. The current report provides a description of the ‘sit-to-stand’ and ‘throw-baby-throw’ ride-on car technologies: (1) Sit-to-stand modified ride-on car technology: Commercially available, battery-operated, ride-on cars are adapted by installing a large, easy-to-press activation switch that is placed on the steering wheel. The switch has a large surface area and turns on at the slightest touch allowing easier activation for children with disabilities. Common materials such as PVC pipe, swimming kickboards and fun noodles, and Velcro are used to build a custom seating system that provides optimum support for each child. There are no commercially available powered wheelchairs for children with disabilities from birth to three years old. An innovative sit-to-stand version of modified ride-on car will be presented and requires a child to stand up in order to activate the switch to encourage the physical skills of pulling from sit-to-stand, weight bearing, and balance; (2) Throw-baby-throw technology: Children with disabilities that experience limited upper-extremity function are not able to throw an object. The throw-baby-throw technology includes modification of a commercially available, toy-based ball pitching’ machine that projects foam balls to. We modified the toy so that it is switch activated and attached to a modified ride-on car. Our modified throwing device allows children with disabilities to engage in the fundamental motor skill of throwing. Both technologies presented in this technical report embrace the holistic view of the International Classification of Functioning, Disability, and Health framework by placing equal emphasis on the body structure and function, activity, and participation domains. Both technologies specifically target the advancement of physical skills while simultaneously providing opportunities to engage in experiences associated with activity and participation.