Throughout the COVID-19 pandemic, many areas in the United States experienced healthcare personnel (HCP) shortages tied to a variety of factors. Infection prevention programs, in particular, faced increasing workload demands with little opportunity to delegate tasks to others without specific infectious diseases or infection control expertise. Shortages of clinicians providing inpatient care to critically ill patients during the early phase of the pandemic were multifactorial, largely attributed to increasing demands on hospitals to provide care to patients hospitalized with COVID-19 and furloughs.1 HCP shortages and challenges during later surges, including the Omicron variant-associated surges, were largely attributed to HCP infections and associated work restrictions during isolation periods and the need to care for family members, particularly children, with COVID-19. Additionally, the detrimental physical and mental health impact of COVID-19 on HCP has led to attrition, which further exacerbates shortages.2 Demands increased in post-acute and long-term care (PALTC) settings, which already faced critical staffing challenges difficulty with recruitment, and high rates of turnover. Although individual healthcare organizations and state and federal governments have taken actions to mitigate recurring shortages, additional work and innovation are needed to develop longer-term solutions to improve healthcare workforce resiliency. The critical role of those with specialized training in infection prevention, including healthcare epidemiologists, was well-demonstrated in pandemic preparedness and response. The COVID-19 pandemic underscored the need to support growth in these fields.3 This commentary outlines the need to develop the US healthcare workforce in preparation for future pandemics.

Throughout history, pandemics and their aftereffects have spurred society to make substantial improvements in healthcare. After the Black Death in 14th century Europe, changes were made to elevate standards of care and nutrition that resulted in improved life expectancy.1 The 1918 influenza pandemic spurred a movement that emphasized public health surveillance and detection of future outbreaks and eventually led to the creation of the World Health Organization Global Influenza Surveillance Network.2 In the present, the COVID-19 pandemic exposed many of the pre-existing problems within the US healthcare system, which included (1) a lack of capacity to manage a large influx of contagious patients while simultaneously maintaining routine and emergency care to non-COVID patients; (2) a “just in time” supply network that led to shortages and competition among hospitals, nursing homes, and other care sites for essential supplies; and (3) longstanding inequities in the distribution of healthcare and the healthcare workforce. The decades-long shift from domestic manufacturing to a reliance on global supply chains has compounded ongoing gaps in preparedness for supplies such as personal protective equipment and ventilators. Inequities in racial and socioeconomic outcomes highlighted during the pandemic have accelerated the call to focus on diversity, equity, and inclusion (DEI) within our communities. The pandemic accelerated cooperation between government entities and the healthcare system, resulting in swift implementation of mitigation measures, new therapies and vaccinations at unprecedented speeds, despite our fragmented healthcare delivery system and political divisions. Still, widespread misinformation or disinformation and political divisions contributed to eroded trust in the public health system and prevented an even uptake of mitigation measures, vaccines and therapeutics, impeding our ability to contain the spread of the virus in this country.3 Ultimately, the lessons of COVID-19 illustrate the need to better prepare for the next pandemic. Rising microbial resistance, emerging and re-emerging pathogens, increased globalization, an aging population, and climate change are all factors that increase the likelihood of another pandemic.4

The Society for Healthcare Epidemiology in America (SHEA) strongly supports modernization of data collection processes and the creation of publicly available data repositories that include a wide variety of data elements and mechanisms for securely storing both cleaned and uncleaned data sets that can be curated as clinical and research needs arise. These elements can be used for clinical research and quality monitoring and to evaluate the impacts of different policies on different outcomes. Achieving these goals will require dedicated, sustained and long-term funding to support data science teams and the creation of central data repositories that include data sets that can be “linked” via a variety of different mechanisms and also data sets that include institutional and state and local policies and procedures. A team-based approach to data science is strongly encouraged and supported to achieve the goal of a sustainable, adaptable national shared data resource.

We evaluated a digital learning programme for non-specialists to develop knowledge-based competencies in a problem-solving intervention for adolescents to examine the overall impact of training on knowledge-based competencies among learners; and to compare the effects of two training conditions (self-guided digital training with or without coaching) in a nested parallel, two-arm, individually randomised controlled trial. Eligible participants were 18 or older; fluent in Hindi or English; able to access digital training; and had no prior experience of delivering structured psychotherapies. 277 participants were enrolled from 31 March 2022 to 19 June 2022 of which 230 (83%) completed the study. There was a significant increase in competency score from pre-training (Mean = 7.01, SD = 3.29) to post-training (Mean = 8.88, SD = 3.80), 6 weeks after the pre-training assessment. Knowledge competency scores showed larger increase among participants randomised to the coaching arm (AMD = 1.09, 95% CI 0.26–1.92, p = 0.01) with an effect size (d) of 0.33 (95% CI 0.08–0.58). More participants completed training in the coaching arm (n = 96, 69.6%) compared to the self-guided training arm (n = 56, 40.3%). In conclusion, a coach-supported remote digital training intervention is associated with enhanced participation by learners and increased psychotherapeutic knowledge competencies.

Urban Air Mobility (UAM) can provide new air mobility faster and avoid city traffic with the growth of new technologies. But they need to be co-developed with the city infrastructure. Thus, understanding the working scenarios of UAM and how they will interact with the city and the other modes of transport systems is vital. Storyboarding helps policymakers, city planners, designers, and investors better understand the product's contextual interaction over time. This process allows the design team to be implicit or express a design that is easy to understand, reflect upon, or modify.

Although exposure therapy (ET) is an effective treatment for anxiety disorders and obsessive-compulsive disorder, many clinicians report not utilizing it. The present study targeted common utilization barriers by evaluating an intensive ET training experience in a relatively inexperienced sample of pre-professionals. Thirty-two individuals at the undergraduate or college graduate level without formal clinical experience participated as camp counsellors in a 5day exposure-based therapeutic summer camp for youth with anxiety disorders and/or obsessive-compulsive disorder. Participants were trained in ET through a progressive cascading model and answered questionnaires before and after camp. Repeated measure MANOVA revealed significantly increased feelings of self-efficacy conducting exposures, and significantly decreased feelings of disgust sensitivity and contamination-related disgust from pre-camp to post-camp. A subset of individuals providing data 1 month after the camp maintained a significant gain in ET self-efficacy. Regression analyses revealed that contamination-related disgust, but not disgust sensitivity, significantly predicted post-camp ET self-efficacy. These findings suggest that individuals early into their post-secondary education can learn ET, and the progressive cascading model holds promise in its utility across experience levels and warrants further investigation. Disgust may also play a role in feelings of competency conducting ET. Implications on dissemination and implementation efforts are also discussed.

The prosperity of any megacities heavily depends on smooth transport systems. In India, however, most cities are failing to keep in step with the growing demands. With new technologies, such as passenger drones, an alternate mode of intra-city transportation seems within reach. For successful development of passenger drones in a diverse country like India, understanding users’ needs are vital. This paper presents the results from a survey of potential users of passenger drones from across India. These are then used to derive concrete recommendations for passenger drones design parameters.

Ensuring the successful treatment of tuberculosis (TB) is an essential public health responsibility of national TB programs. This case study describes how the Department of Health and Family Welfare, Kerala state, successfully prevented the disruptions in TB treatment when an unprecedented massive flood, declared as “a calamity of severe nature,” completely disrupted normal operations in the state during August 2018. Unanticipated floods led to the displacement and relocation of more than 1.5 million citizens. The state has ensured continuity of TB treatment for all notified drug sensitive and drug-resistant TB patients (9608 and 434, respectively), including those who were displaced and relocated. A real-time web-enabled, case-based patient management information system has helped preserve the entire patient information, available at multiple levels. Routine strength of the program, including good rapport with patients, frontline multipurpose health workers and treatment supporters, high literacy rate of general population, and well-integrated primary health care system delivering TB services, enabled ensuring continuity of care during the disaster situation. The success of the post-flood TB control measures in Kerala affirms the importance of maintaining an integrated and strong TB control component with general health system ownership.

Most major modern families of Hymenoptera were established in the Mesozoic, but the diversifications within ecologically key trophic guilds and lineages that significantly influence the character of modern terrestrial ecosystems – bees (Apiformes), ants (Formicidae), social Vespidae, parasitoids (Ichneumonidae), and phytophagous Tenthredinoidea – were previously known to occur mostly in the middle to late Eocene. We find these changes earlier, seen here in the early Eocene Okanagan Highlands fossil deposits of western North America. Some of these may have occurred even earlier, but have been obscured by taphonomic processes. We provide an overview of the Okanagan Highlands Hymenoptera to family level and in some cases below that, with a minimum of 25 named families and at least 30 when those tentatively assigned or distinct at family level, but not named are included. Some are poorly known as fossils (Trigonalidae, Siricidae, Peradeniidae, Monomachidae), and some represent the oldest confirmed occurrences (Trigonalidae, Pompilidae, Sphecidae sensu stricto, Peradeniidae, Monomachidae, and possibly Halictidae). Some taxa previously thought to be relictual or extinct by the end of the Cretaceous (Angarosphecidae, Archaeoscoliinae, some Diapriidae) are present and sometimes abundant in the early Eocene. Living relatives of some taxa are now present in different climate regimes or on different continents.

Evidence from the Ross embayment, Antarctica, suggests an abrupt cooling and a concomitant increase in sea-ice cover at about 6000 BP (6 ka). Stable-isotope (δD) concentrations in the Taylor Dome ice core, at the western edge of the Ross embayment, decline rapidly after 6 ka, and continue to decline through the late Holocene. Methanesulfonic acid concentrations at Taylor Dome show opposite trends to δD Sediment cores from the western Ross Sea show a percentage minimum for the sea-ice diatom Fragilariopsis curta between 9 and 6 ka, whenTaylor Dome δD values are highest, followed by an increase through the late Holocene. Radiocarbon dates from raised beach deposits indicate that the retreat of ice shelves in the Ross embayment ceased at about 6 ka, coincident with the environmental changes inferred from the sediment and ice-core records. The similarity in timing suggests an important role for climate in controlling the evolution of ice-shelf margins following the end of the last glaciation.

Planet formation and clearing of protoplanetary disks is one of the long standing problems in disk evolution theory. The best test of clearing scenarios is observing systems that are most likely to be actively forming planets: the transitional disks with large inner dust cavities. We present the first results of our ALMA (Atacama Large Millimeter/submillimeter Array) Cycle 0 program using Band 9, imaging the Herbig Ae star Oph IRS 48 in CO 6−5 and the submillimeter continuum in the extended configuration. The resulting ~0.2″ spatial resolution completely resolves the cavity of this disk in the gas and the dust. The gas cavity of IRS 48 is half as large as the dust cavity, ruling out grain growth and photoevaporation as the primary cause of the truncation. On the other hand, the continuum emission reveals an unexpected large azimuthal asymmetry and steep edges in the dust distribution along the ring, suggestive of dust trapping. We will discuss the implications of the combined gas and dust distribution for planet formation at a very early stage. This is one of the first transition disks with spatially resolved gas inside the cavity, demonstrating the superb capabilities of the Band 9 receivers.