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In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.
Methods:
A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.
Results:
We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.
Conclusion:
The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.
The Sustainable Development Goals (SDGs) adopted in 2015 represent an important opportunity to improve learning globally. In this light, this chapter draws on a unique set of early literacy assessment results and demographic information from six African countries (Ghana, Kenya, Liberia, Malawi, Tanzania, and Zambia) to better understand the role that language plays in influencing early reading outcomes. While these data have been published in individual country reports, the information has not been analyzed and released prominently in the narrative surrounding learning outcomes in the region, although data like those presented in this chapter have begun to reverse this tendency. Following this introduction, a brief history is provided of postcolonial trends in literacy acquisition and language policyin sub-Saharan Africa from about 1960 to the present day, documenting the current language of instruction policies for twenty countries. Key questions are also outlined to drive the interest in gaining a better understanding of the variation in literacy acquisition in a selection of target countries for which we have data; then the chapter documents the data and methods usedas well as the results. Finally, the chapter discusses the implications of this work a for future policy and planning to achieve the promises made under the SDGs.
Why are hate crime cases so rarely prosecuted? Most states and the federal government have hate crime laws on their books, yet available data indicate few prosecutions in most jurisdictions. Drawing on case files and interviews with police and prosecutors in one jurisdiction, three institutional impediments to hate crime prosecution are identified: evidentiary inflation, by which law enforcement uses a higher burden of proof than what is required by statute; loose coupling between police departments and prosecutors' offices; and cultural distance between law enforcement and victims. Findings also reveal that advocacy groups and media can successfully increase the visibility of cases and draw the attention of prosecutors. The findings align with aspects of legal endogeneity theory and enhance our understanding of the role of organizations in constructing the meaning of law. The results also help explain why some laws are rarely enforced, even when they have support from key personnel in an organization.
The nursing associate role was first deployed in England in 2019 to fill a perceived skills gap in the nursing workforce between healthcare assistants and registered nurses and to offer an alternative route into registered nursing. Initially, trainee nursing associates were predominantly based in hospital settings; however, more recently, there has been an increase in trainees based in primary care settings. Early research has focussed on experiences of the role across a range of settings, particularly secondary care; therefore, little is known about the experiences and unique support needs of trainees based in primary care.
Aim:
To explore the experiences and career development opportunities for trainee nursing associates based in primary care.
Methods:
This study used a qualitative exploratory design. Semi-structured interviews were undertaken with 11 trainee nursing associates based in primary care from across England. Data were collected between October and November 2021, transcribed and analysed thematically.
Findings:
Four key themes relating to primary care trainee experiences of training and development were identified. Firstly, nursing associate training provided a ‘valuable opportunity for career progression’. Trainees were frustrated by the ‘emphasis on secondary care’ in both academic content and placement portfolio requirements. They also experienced ‘inconsistency in support’ from their managers and assessors and noted a number of ‘constraints to their learning opportunities’, including the opportunity to progress to become registered nurses.
Conclusion:
This study raises important issues for trainee nursing associates, which may influence the recruitment and retention of the nursing associate workforce in primary care. Educators should consider adjustments to how the curriculum is delivered, including primary care skills and relevant assessments. Employers need to recognise the resource requirements for the programme, in relation to time and support, to avoid undue stress for trainees. Protected learning time should enable trainees to meet the required proficiencies.
Improving equity in the context of protected areas conservation cannot be achieved in situations where people have different capabilities to participate. Participatory video has the potential to uncover hidden perspectives and worldviews and to build trustworthy, transparent and accountable relationships between marginalized communities and external agencies. We present findings from video-mediated dialogues between Indigenous peoples and decision makers involved in the management of three protected areas in Guyana. Participatory films created by Indigenous researchers in their communities were screened and discussed with protected area managers. We recorded their responses and presented them back to the communities. We show how the video-mediated process provided a rich and contextualized understanding of equity issues. It enabled recognition and respect by protected area managers for Indigenous lived experiences and the contribution of their values and knowledge. For Indigenous peoples, the participatory video process built confidence and critical reflection on their own activities and responsibilities whilst allowing them to challenge decision makers on issues of transparency, communication and accountability. We show that equity is an evolving process and that different protected areas with their differing histories and relationships with Indigenous communities produce distinct outcomes over time. Thus, promoting equity in protected areas and conservation must be a long-term process, enabling participation and producing the conditions for regular, transparent and honest communications. Standardized indicators of protected areas equity could be useful for reporting on international targets, but video-mediated dialogue can facilitate deeper understanding, greater representation and a recognition of rights.
To explore higher education institution (HEI) perspectives on the development and implementation of trainee nursing associates (NAs) in the primary care workforce in England.
Background:
Current shortages of primary health care staff have led to innovative skill mix approaches in attempts to maintain safe and effective care. In England, a new level of nursing practice, NAs, was introduced and joined the workforce in 2019. This role was envisaged as a way of bridging the skills gap between health care assistants and registered nurses and as an alternative route into registered nursing. However, there is limited evidence on programme development and implementation of trainee NAs within primary care settings and HEI perspectives on this.
Methods:
This paper draws from a larger qualitative study of HEI perspectives on the trainee NA programme. Twenty-seven staff involved in training NAs, from five HEIs across England, were interviewed from June to September 2021. The interview schedule specifically included questions relating to primary care. Data relating to primary care were extracted and analysed using a combined framework and thematic analysis approach.
Findings:
Three themes were developed: ‘Understanding the trainee role and requirements’, ‘Trainee support in primary care’ and ‘Skills and scope of practice’. It is apparent that a more limited understanding of the NA programme requirements can lead to difficulties in accessing the right support for trainees in primary care. This can create challenges for trainees in gaining the required competencies and uncertainty in understanding what constitutes a safe scope of practice within the role for both employers and trainees. It might be anticipated that as this new programme becomes more embedded in primary care, a greater understanding will develop, support will improve and the nature and scope of this new level of practice will become clearer.
During the most recent round of redistricting, many states have enacted a number of reforms to their mapmaking practices. One reform that has received increased attention in recent years is a ban on prison gerrymandering—the practice of counting incarcerated individuals in prisons instead of their home addresses. Eleven states drew districts while counting incarcerated persons in their homes after the 2020 Census. Though substantial research has investigated redistricting practices, far less attention has been paid to empirically examining the effect of prison gerrymandering on elections. We seek to fill this void by evaluating the effect of New York’s ban on prison gerrymandering on state legislative elections between 2002 and 2020. We find that altering how the prison population is counted, indeed, altered the electoral dynamics across the state.
ABSTRACT IMPACT: Current practice guidelines offer a variety of treatment options for sternal reconstruction but complications and infections remain a serious surgical problem. This work seeks to provide a comprehensive picture of the com-morbidities and reconstructive methods that lead to success and improve patient outcomes. OBJECTIVES/GOALS: Patients that undergo cardiac surgery via the median sternotomy approach are at risk of wound complications that require repair. We seek to evaluate how outcomes of sternal reconstruction are influenced by patient comorbidities, flap usage and internal mammary artery grafts and methods of sternal closure. METHODS/STUDY POPULATION: We identified patients between 2005 and 2020 who underwent sternotomy followed by debridement and flap coverage at our institution. Comorbidities, method of reconstruction, demographic data, surgical history, and other factors pertaining to mortality and morbidity were collected. The data will then be analyzed to identify population characteristics using logistic regression variables to determine univariate and adjusted multivariable measures of association with mortality. We present the pre-liminary data analyzed using chi-square and one-way anova in R. RESULTS/ANTICIPATED RESULTS: In this study we present a preliminary characterization of one institution’s sternal reconstruction patient outcomes with a variety of reconstruction methods including pectoralis advancement flaps, omental flaps and latissumus dorsi flaps. Notable preoperative comorbidities include 50% of patients > age 60, 18% with diabetes mellitus, 18 % with diagnosed hypertension, 18% with COPD, and 9% with a smoking history DISCUSSION/SIGNIFICANCE OF FINDINGS: In an evolving cardiothoracic landscape, clinical characteristics of patients being treated for sternal reconstructive surgery present a moving target. Understanding current risk factors, preoperative management and timing for aggressive surgical treatment offers an opportunity to update treatment protocol and maximize successful outcomes.
A new ichnospecies, Glossifungites gingrasi n. isp., is described from multiple locations in basal sand-filled coastal plain distributary channels of the Turonian (Upper Cretaceous) Ferron Sandstone (central Utah). Glossifungites gingrasi n. isp. is attributed to the ichnogenus Glossifungites based on the presence of scratch imprints, passive fill, and a tongue-shaped structure, yet the new ichnospecies is distinct because it displays transverse bioglyphs that run perpendicular to the planiform structure, which contrasts to the axis parallel bioglyphs present in the ichnospecies G. saxicava. The transverse arrangement of ornamentation exhibited by G. gingrasi n. isp. is observed in modern subaqueous insect burrows produced by mayfly and chironomid larvae, and constitutes a way to differentiate insect-generated burrows from structures produced by crustaceans that are known to create other Glossifungites ichnospecies. Differentiating insect- from crustacean-generated burrows is significant because it provides a way to distinguish bioturbation by marine-recruited fauna from that produced by freshwater fauna in the rock record, making G. gingrasi n. isp. a valuable ichnological tool for paleoenvironmental and stratigraphic interpretation. While G. gingrasi n. isp. may represent a burrow created by a variety of filter-feeding subaqueous insects, the large size of G. gingrasi n. isp. in the Ferron Sandstone suggests that the largest specimens are probable mayfly burrows and supports the assertion that burrowing mayflies (e.g., Polymitarcyidae and Ephemeridae) adapted to domicile filter-feeding during or prior to the Turonian.
Because of advances in treatment over the past 30 years, the number of older people living with HIV is growing. This is important for Indigenous Peoples in Canada, given their continuing over-representation in HIV diagnoses. However, little is known about the experiences of older, HIV-positive Indigenous Peoples. Taking a strength-based approach, this research explored how older Indigenous men with HIV conceptualize successful aging. Research was conducted in partnership with the Canadian Aboriginal AIDS Network. First Nations, Inuit, and Métis men, ranging in age from 43 to 63 years who had been HIV positive for 10–29 years participated in sharing circles and interviews. An open analytic approach was used to explore the content of transcripts, and codes were collaboratively developed through an inductive and iterative process. From our analysis of commonalities across Indigenous groups, we offer our insights on the application of the successful aging model to Indigenous men aging with HIV.
Multijunction solar cells have proven to be capable of extremely high efficiencies by combining multiple semiconductor materials with bandgaps tuned to the solar spectrum. Reaching the optimum set of semiconductors often requires combining high-quality materials with different lattice constants into a single device, a challenge particularly suited for metamorphic epitaxy. In this article, we describe different approaches to metamorphic multijunction solar cells, including traditional upright metamorphic, state-of-the-art inverted metamorphic, and forward-looking multijunction designs on silicon. We also describe the underlying materials science of graded buffers that enables metamorphic subcells with low dislocation densities. Following nearly two decades of research, recent efforts have demonstrated high-quality lattice-mismatched multijunction solar cells with very little performance loss related to the mismatch, enabling solar-to-electric conversion efficiencies over 45%.
White matter disruptions have been identified in individuals with congenital heart disease (CHD). However, no specific theory-driven relationships between microstructural white matter disruptions and cognition have been established in CHD. We conducted a two-part study. First, we identified significant differences in fractional anisotropy (FA) of emerging adults with CHD using Tract-Based Spatial Statistics (TBSS). TBSS analyses between 22 participants with CHD and 18 demographically similar controls identified five regions of normal appearing white matter with significantly lower FA in CHD, and two higher. Next, two regions of lower FA in CHD were selected to examine theory-driven differential relationships with cognition: voxels along the left uncinate fasciculus (UF; a tract theorized to contribute to verbal memory) and voxels along the right middle cerebellar peduncle (MCP; a tract previously linked to attention). In CHD, a significant positive correlation between UF FA and memory was found, r(20)=.42, p=.049 (uncorrected). There was no correlation between UF and auditory attention span. A positive correlation between MCP FA and auditory attention span was found, r(20)=.47, p=.027 (uncorrected). There was no correlation between MCP and memory. In controls, no significant relationships were identified. These results are consistent with previous literature demonstrating lower FA in younger CHD samples, and provide novel evidence for disrupted white matter integrity in emerging adults with CHD. Furthermore, a correlational double dissociation established distinct white matter circuitry (UF and MCP) and differential cognitive correlates (memory and attention span, respectively) in young adults with CHD. (JINS, 2015, 21, 22–33)
Camera traps are standard tools for assessing populations of medium–large terrestrial mammals, particularly for rare, elusive or cryptic species, yet few researchers have attempted to employ camera traps to document rare primates in arboreal settings. We examined different arboreal camera-trap techniques to document the Critically Endangered greater bamboo lemur Prolemur simus in Madagascar. We documented P. simus at two sites, confirming presence at one site. Most species, including 86% of all lemur occurrences, were documented in low light conditions (c. < 105 lux). Our study suggests that camera traps can be effective in validating unconfirmed sightings of rare or secretive primate species. We recommend that future work with cameras in arboreal settings considers seasonal activity patterns, targets sites with high food densities, uses local knowledge, and utilizes available techniques (e.g. traditional trapping techniques) and landscape topography to concentrate animal movement (e.g. steep slopes or ridge lines).
Has anyone ever pushed in front of you in a queue? Stolen your parking space? Talked on their mobile phone during a film at the cinema? In our everyday lives we all encounter rude and inconsiderate people. This unique book provides the first ever systematic investigation of typical encounters with rudeness. Through a meticulous analysis of over 500 events, it maps out what people experience as rude, where and when this happens and what takes place in the exchange between the participants. The inquiry further charts the emotional and social consequences of rudeness and victimization, with the results challenging the widespread assumption that bad behaviour is toxic to community life. In conclusion the study draws upon its findings and surveys a range of strategies for reducing the level of incivility in everyday life, identifying some simple and innovative solutions. Incivility will appeal to criminologists, sociologists and scholars of urban studies.
Although this will be a simple and short chapter it will break new ground. Our aim is to answer some fundamental and often asked questions about public rudeness in a systematic way. How often do people encounter it? What is it? Where does it happen? Who does it? Is it deliberate or accidental? Who experiences victimization? Using some basic statistics we will be able to draw up a portrait of the kinds of events and people that are to be found in the world of everyday incivility. We can start with the most basic issue of all. What is logically needed for an incivil encounter with a rude stranger to take place in public? The answer is simple. There are three components: first, there must be an action interpreted as incivil that occurs in a public setting; second, this is committed by a stranger, either by accident or deliberately; third, it is experienced by a self-described victim. Here we look at each of these in turn. In effect, we will describe what happened and where, who did it and to whom.
The rude event
First, how prevalent are encounters with rude strangers? The ELIAS data show that about a third of respondents reported a rude event during the past month (508 of 1,621 respondents, or 31 per cent). As one might expect, the likelihood of encountering this type of incivility is substantially higher than more invasive interpersonal events such as crime victimizations.
In traditional societies most people lived in bands or in villages, their geographic horizons usually defined by how far one could walk in a day. Such familiar environments were largely without strangers. Passing migrants, gypsies, tinkers, charlatans and traders were noteworthy interruptions in biographies filled with known others, mostly family and neighbours. Even in courtly society unknown outsiders were something of a novelty. One thinks of the stir caused by the arrival of a company of travelling players in Shakespeare's Hamlet. By contrast, much of lived experience in modern societies takes place in the close physical presence of strangers. Urbanization and the evolution of affordable technologies for daily travel have led to the increased social densities and circulations that see strangers thrown against each other. Of course, at home and at work the stranger is relatively absent. Yet out in public the situation is very different.
Remarkably little objective information is known about our social connectedness with, beliefs about, or quality of interactions among those anonymous people with whom we must share public space. Still, respondents to surveys seem to be confident in claiming that things have gone to the dogs and are getting worse. The Public Agenda (2002) survey of 2001 found 79 per cent of American respondents saying that ‘lack of respect and courtesy is a serious problem for our society’, and 73 per cent believing that there was more respect around in the past. These impressions are generally supported rather than critiqued in the academic literature.
So far we have mapped out some basic issues. We know about the identities of perpetrators and victims. We also know what the commonplace forms of incivility look like. We have found out where and when and even why many encounters with rude strangers take place. In this chapter things become a little more complex. As we explained at the outset, this book is a study of encounters between two people. Here we look at how these meetings unfold over time. We focus on two important questions: just how do people feel when they encounter the rude stranger? What, if anything, do they do to remedy the situation?
Emotions and incivility
The existing literature suggests that we already know the answer to both these questions. Writing back in the early 1970s the famous symbolic interactionist Erving Goffman (1971) established the template with his work Relations in Public. Here the life of city dwellers is described as one revolving around suspicion and mistrust. As they navigate urban spaces they scan for dangers, constantly on guard and feeling unease. The emotions of fear and anxiety are barely suppressed and the encounter with the incivil other is traumatizing. Individuals develop action strategies of retreat and avoidance. This vision has been amplified more recently in the critical sociology of Zygmunt Bauman (2003), who identifies ‘mixophobic’ sentiments in the metropolis and suggests that social life is organized such that individuals avoid encounters with difference and risk as they move between secure bubbles dotted around the city: the home in a gated community, the mall, the country club, the office.