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Assess healthcare workers’ (HCW) attitudes toward universal masking, and gowns and gloves used as part of transmission-based precautions.
Design:
Cross-sectional survey.
Setting:
Academic, tertiary care medical center in Baltimore, Maryland.
Participants:
HCW who work in patient care areas and have contact with patients.
Methods:
In May 2023, a 15-question web-based survey was distributed by the hospital’s communications team via email. The survey contained questions to assess HCW perceptions of universal masking policies prior to the availability of COVID-19 vaccines and at the time of the survey, and the use of gowns and gloves for transmission-based precautions. Descriptive statistics were used to summarize data. Differences in agreement with universal masking over time, level of agreement with gown and glove policies, and with all PPE types across respondent characteristics were assessed.
Results:
257 eligible respondents completed the survey. Nurses and patient care technicians (43%) and providers (17%) were the most commonly reported roles. Agreement with universal mask use decreased from 84% early in the pandemic to 55% at the time of the survey. 70% and 72% of HCW agreed masks protect themselves and others, respectively. 63% expressed any level of annoyance with mask wearing, the most often due to communication challenges or physical discomfort. 75% agreed with gown use for antibiotic-resistant bacteria compared with 90% for glove use.
Conclusions:
The majority of HCW agree with the use of PPE to prevent pathogen transmission in the healthcare setting. Agreement with universal mask use for patient care shifted during the COVID-19 pandemic.
Migrants and refugees face elevated risks for mental health problems but have limited access to services. This study compared two strategies for training and supervising nonspecialists to deliver a scalable psychological intervention, Group Problem Management Plus (gPM+), in northern Colombia. Adult women who reported elevated psychological distress and functional impairment were randomized to receive gPM+ delivered by nonspecialists who received training and supervision by: 1) a psychologist (specialized technical support); or 2) a nonspecialist who had been trained as a trainer/supervisor (nonspecialized technical support). We examined effectiveness and implementation outcomes using a mixed-methods approach. Thirteen nonspecialists were trained as gPM+ facilitators and three were trained-as-trainers. We enrolled 128 women to participate in gPM+ across the two conditions. Intervention attendance was higher in the specialized technical support condition. The nonspecialized technical support condition demonstrated higher fidelity to gPM+ and lower cost of implementation. Other indicators of effectiveness, adoption and implementation were comparable between the two implementation strategies. These results suggest it is feasible to implement mental health interventions, like gPM+, using lower-resource, community-embedded task sharing models, while maintaining safety and fidelity. Further evidence from fully powered trials is needed to make definitive conclusions about the relative cost of these implementation strategies.
Accelerating COVID-19 Treatment Interventions and Vaccines (ACTIV) was initiated by the US government to rapidly develop and test vaccines and therapeutics against COVID-19 in 2020. The ACTIV Therapeutics-Clinical Working Group selected ACTIV trial teams and clinical networks to expeditiously develop and launch master protocols based on therapeutic targets and patient populations. The suite of clinical trials was designed to collectively inform therapeutic care for COVID-19 outpatient, inpatient, and intensive care populations globally. In this report, we highlight challenges, strategies, and solutions around clinical protocol development and regulatory approval to document our experience and propose plans for future similar healthcare emergencies.
Community engagement (CE) is critical for advancing health equity and a key approach for promoting inclusive clinical and translational science. However, it requires a workforce trained to effectively design, implement, and evaluate health promotion and improvement strategies through meaningful collaboration with community members. This paper presents an approach for designing CE curricula for research, education, clinical care, and public health learners. A general pedagogical framework is presented to support curriculum development with the inclusion of community members as facilitators or faculty. The overall goal of the curriculum is envisioned as enabling learners to effectively demonstrate the principles of CE in working with community members on issues of concern to communities to promote health and well-being. We highlight transformations needed for the commonly used critical service-learning model and the importance of faculty well-versed in CE. Courses may include didactics and practicums with well-defined objectives and evaluation components. Because of the importance of building and maintaining relationships in CE, a preparatory phase is recommended prior to experiential learning, which should be guided and designed to include debriefing and reflective learning. Depending on the scope of the course, evaluation should include community perspectives on the experience.
The rapid spread of coronavirus disease 2019 (COVID-19) required swift preparation to protect healthcare personnel (HCP) and patients, especially considering shortages of personal protective equipment (PPE). Due to the lack of a pre-existing biocontainment unit, we needed to develop a novel approach to placing patients in isolation cohorts while working with the pre-existing physical space.
Objectives:
To prevent disease transmission to non–COVID-19 patients and HCP caring for COVID-19 patients, to optimize PPE usage, and to provide a comfortable and safe working environment.
Methods:
An interdisciplinary workgroup developed a combination of approaches to convert existing spaces into COVID-19 containment units with high-risk zones (HRZs). We developed standard workflow and visual management in conjunction with updated staff training and workflows. The infection prevention team created PPE standard practices for ease of use, conservation, and staff safety.
Results:
The interventions resulted in 1 possible case of patient-to-HCP transmission and zero cases of patient-to-patient transmission. PPE usage decreased with the HRZ model while maintaining a safe environment of care. Staff on the COVID-19 units were extremely satisfied with PPE availability (76.7%) and efforts to protect them from COVID-19 (72.7%). Moreover, 54.8% of HCP working in the COVID-19 unit agreed that PPE monitors played an essential role in staff safety.
Conclusions:
The HRZ model of containment unit is an effective method to prevent the spread of COVID-19 with several benefits. It is easily implemented and scaled to accommodate census changes. Our experience suggests that other institutions do not need to modify existing physical structures to create similarly protective spaces.
To characterize and compare severe acute respiratory coronavirus virus 2 (SARS-CoV-2)–specific immune responses in plasma and gingival crevicular fluid (GCF) from nursing home residents during and after natural infection.
Design:
Prospective cohort.
Setting:
Nursing home.
Participants:
SARS-CoV-2–infected nursing home residents.
Methods:
A convenience sample of 14 SARS-CoV-2–infected nursing home residents, enrolled 4–13 days after real-time reverse transcription polymerase chain reaction diagnosis, were followed for 42 days. After diagnosis, plasma SARS-CoV-2–specific pan-Immunoglobulin (Ig), IgG, IgA, IgM, and neutralizing antibodies were measured at 5 time points, and GCF SARS-CoV-2–specific IgG and IgA were measured at 4 time points.
Results:
All participants demonstrated immune responses to SARS-CoV-2 infection. Among 12 phlebotomized participants, plasma was positive for pan-Ig and IgG in all 12 participants. Neutralizing antibodies were positive in 11 participants; IgM was positive in 10 participants, and IgA was positive in 9 participants. Among 14 participants with GCF specimens, GCF was positive for IgG in 13 participants and for IgA in 12 participants. Immunoglobulin responses in plasma and GCF had similar kinetics; median times to peak antibody response were similar across specimen types (4 weeks for IgG; 3 weeks for IgA). Participants with pan-Ig, IgG, and IgA detected in plasma and GCF IgG remained positive throughout this evaluation, 46–55 days after diagnosis. All participants were viral-culture negative by the first detection of antibodies.
Conclusions:
Nursing home residents had detectable SARS-CoV-2 antibodies in plasma and GCF after infection. Kinetics of antibodies detected in GCF mirrored those from plasma. Noninvasive GCF may be useful for detecting and monitoring immunologic responses in populations unable or unwilling to be phlebotomized.
As industrial-organizational (I-O) psychologists, we have expertise in applying psychological and/or organizational science to the workplace. However, many of us haven’t taken the time to think about how our I-O psychology knowledge can apply to our teaching practice. We walk through some examples of how I-O psychology research can help us be better teachers, and the goal of our paper is to encourage readers to make evidence-based changes to their teaching based on I-O psychology research. We organize our discussion around four areas: training and development, diversity and inclusion, groups and teams, and leadership. Within each, we offer small, medium, and large changes that could be incorporated into classrooms. We hope that readers will be inspired to build on what they do in their classrooms to help students learn about (and be inspired by) our field.
Experiencing poverty increases vulnerability for dysregulated hypothalamic–pituitary–adrenal (HPA) axis functioning and compromises long-term health. Positive parenting buffers children from HPA axis reactivity, yet this has primarily been documented among families not experiencing poverty. We tested the theorized power of positive parenting in 124 parent–child dyads recruited from Early Head Start (Mage = 25.21 months) by examining child cortisol trajectories using five samples collected across a standardized stress paradigm. Piecewise latent growth models revealed that positive parenting buffered children's stress responses when controlling for time of day, last stress task completed, and demographics. Positive parenting also interacted with income such that positive parenting was especially protective for cortisol reactivity in families experiencing greater poverty. Findings suggest that positive parenting behaviors are important for protecting children in families experiencing low income from heightened or prolonged physiologic stress reactivity to an acute stressor.
This study explores parliamentary reforms related to the financial accountability of banks following the 1825–6 and 1836–7 financial crises in England. An appraisal of nineteenth-century parliamentary Hansard transcripts reveals early banking legislative pursuits. The study observes the laissez-faire and interventionist approaches towards the banking enactments of 1826, 1833 and 1844 that underpin the transformation of financial accountability during this era. The Bank Notes Act 1826 imposed financial accountability on the Bank of England by requiring the mandatory disclosure of notes issued. The Bank Notes Act 1833 extended this requirement to all other banks. The Bank Charter Act 1833 increased the financial accountability of the Bank of England by requiring it to provide an account of bullion and securities belonging to the governor and company, as well as deposits held by the bank. Thereafter, the Joint Stock Banks Act 1844 pioneered the regular publication of assets and liabilities and communication of the balance sheet and profit and loss account to shareholders. State intervention in the financial accountability of banks during the period from 1825 to 1845 appears to have been cumulative.
The rich and innovative ideas of quantum physicist and feminist theorist Karen Barad have much to offer environmental educators in terms of practical theories for teaching and learning. This article shares insights gained from a facilitated conversation at the Australian Association for Environmental Education (AAEE) Conference Research Symposium, and offers an introduction to Barad’s theories for environmental educators. At this time of challenging planetary imperatives, environmental education is increasingly called upon to contribute to students’ understanding of connectedness, and Barad’s theory of agential realism provides a way to think about, articulate and engage with connectedness as inherent within the world rather than something we need to create. By considering entanglement as a fundamental state, we understand that separateness is not the original state of being. This shift in perspective supports a subtle yet powerful approach to knowledge, communication and collaboration, understanding difference as integral within the world’s entangled becoming. The convened conversation sought to explore Barad’s thinking by defining and discussing the concepts of agential realism, intra-action, material-discursivity, phenomena and diffraction. Barad’s ideas were used to collectively explore what it means to be intraconnected and entangled in today’s world, and specifically how these concepts and experiences relate to our work and lives as environmental educators and researchers.
The aim of this study was to compare satisfaction with residence, wellbeing and physical health of continuing care retirement community (CCRC) residents with people who considered enrolling in the same CCRCs but elected not to move. A total of 101 participants were recruited from 13 CCRCs located in multiple cities in the United States of America. A phone interview was conducted with participants three months or less from enrolment and one year later. Compared with those who chose not to move, CCRC residents reported lower satisfaction at baseline, but higher satisfaction at one year. Wellbeing declined from baseline to follow-up for both groups, but was higher in CCRC residents both at baseline and at one year. CCRCs might consider giving new residents a longer cancellation period in order to allow sufficient time for the adjustment process. This, in turn, might both prevent an early departure and affect the decision of potential CCRC residents to move into the community.
Mental illness is one of the leading causes of disability, with direct and indirect costs posing a significant financial burden. Previously, a large prospective economic utility study (n>13,000) showed that the GeneSight® test, a psychiatric pharmacogenomic decision support tool powered by CPGx® technology, reduced medication costs, increased adherence, andreduced polypharmacy for patients who had failed monotherapy for psychiatric disorders. The current study, which is a sub-analysis of this larger study, assessed cost savings associated with combinatorial pharmacogenomic testing in patients with generalized anxiety disorder (GAD) and major depressive disorder (MDD). Medication costs were extracted using pharmacy claims data provided by Medco, a large pharmacy benefits manager, for patients with GAD (n=318) and MDD (n=459). Medication cost savings per member per year (PMPY) for 1 year following the test were compared between patients whose medication regimens were congruent with the test recommendations and those whose medication regimens were incongruent with these recommendations. When healthcare providers’ decisions were congruent with combinatorial pharmacogenomic testing, PMPY savings was $6,747 (p<0.004) for GAD patients and $3,738 (p<0.004) for MDD patients versus incongruent decisions within these disease states. Among the congruent group, GAD patients experienced greater savings in central nervous system (CNS) medications (2-fold) compared to MDD patients. Additionally, analysis of a subset of patients prescribed at least one benzodiazepine six months prior to testing (n=660) demonstrated a significant decrease in benzodiazepine drug counts (p<0.001) and refills (p<0.001) after testing. Using the GeneSight test as a treatment decision support tool for patients with GAD or MDD resulted in significant medication cost savings when HCPs made congruent decisions with the combinatorialpharmacogenomic results. Furthermore, use of the GeneSight test decreased the use of benzodiazepines.
This study determines the prevalence of inadequate micronutrient intakes consumed by long-term care (LTC) residents. This cross-sectional study was completed in thirty-two LTC homes in four Canadian provinces. Weighed and estimated food and beverage intake were collected over 3 non-consecutive days from 632 randomly selected residents. Nutrient intakes were adjusted for intra-individual variation and compared with the Dietary Reference Intakes. Proportion of participants, stratified by sex and use of modified (MTF) or regular texture foods, with intakes below the Estimated Average Requirement (EAR) or Adequate Intake (AI), were identified. Numbers of participants that met these adequacy values with use of micronutrient supplements was determined. Mean age of males (n 197) was 85·2 (sd 7·6) years and females (n 435) was 87·4 (sd 7·8) years. In all, 33 % consumed MTF; 78·2 % (males) and 76·1 % (females) took at least one micronutrient pill. Participants on a MTF had lower intake for some nutrients (males=4; females=8), but also consumed a few nutrients in larger amounts than regular texture consumers (males=4; females =1). More than 50 % of participants in both sexes and texture groups consumed inadequate amounts of folate, vitamins B6, Ca, Mg and Zn (males only), with >90 % consuming amounts below the EAR/AI for vitamin D, E, K, Mg (males only) and K. Vitamin D supplements resolved inadequate intakes for 50–70 % of participants. High proportions of LTC residents have intakes for nine of twenty nutrients examined below the EAR or AI. Strategies to improve intake specific to these nutrients are needed.
As older persons make up an ever greater proportion of the world’s population, a range of concerns are being voiced by policy-makers, program managers, and care providers about best or optimal practices for serving this population’s needs during all stages of disasters. Given that age-related vulnerabilities are common in late life, this article describes existing systems of care in the United States for the provision of disaster mental health services. Second, it evaluates the evidence for disaster treatment interventions with this subgroup of the population. Third, it synthesizes the findings of recent studies focusing on screening, assessment, and treatment approaches. To advance our current system of care and to adequately respond to the mental health needs of older persons, it is advantageous to periodically review progress, identify current gaps and unmet needs, and describe opportunities for improvement. (Disaster Med Public Health Preparedness. 2018; 12: 366–372)
The question of how modernity has influenced medievalism and how medievalism has influenced modernity is the theme of this volume. The opening essays examine the 2001 film Just Visiting's comments on modern anxieties via medievalism; conflations of modernity with both medievalism and the Middle Ages in rewriting sources; the emergence of modernity amid the post-World War I movement The MostNoble Order of Crusaders; António Sardinha's promotion of medievalism as an antidote to modernity; and Mercedes Rubio's medievalism in her feminist commentary on modernity. The eight subsequent articles build on this foundation while discussing remnants of medieval London amid its modern descendant; Michel Houellebecq's critique of medievalism through his 2011 novel La Carte et le territoire; historical authenticity in Michael Morrow's approach to performing medieval music; contemporary concerns in Ford Madox Brown and David Gentleman's murals; medieval Chester in Catherine A.M. Clarkeand Nayan Kulkarni's Hryre (2012); medieval influences on the formation of and debate about modern moral panics; medievalist considerations in modern repurposings of medieval anchorholds; andmedieval sources for Paddy Molloy's Here Be Dragons (2013). The articles thus test the essays' methods and conclusions, even as the essays offer fresh perspectives on the articles.
Karl Fugelso is Professor of Art History at Towson University in Baltimore, Maryland.
Contributors: Edward Breen, Katherine A. Brown, Catherine A.M. Clarke, Louise D'Arcens, Joshua Davies, John Lance Griffith, Mike Horswell, Pedro Martins, Paddy Molloy, Lisa Nalbone, Sarah Salih, Michelle M. Sauer, James L. Smith