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Evaluate impact of COVID-19 prevention training with video-based feedback on nursing home (NH) staff safety behaviors.
Design:
Public health intervention
Setting & Participants:
Twelve NHs in Orange County, California, 6/2020-4/2022
Methods:
NHs received direct-to-staff COVID-19 prevention training and weekly feedback reports with video montages about hand hygiene, mask-wearing, and mask/face-touching. One-hour periods of recorded streaming video from common areas (breakroom, hallway, nursing station, entryway) were sampled randomly across days of the week and nursing shifts for safe behavior. Multivariable models assessed the intervention impact.
Results:
Video auditing encompassed 182,803 staff opportunities for safe behavior. Hand hygiene errors improved from first (67.0%) to last (35.7%) months of the intervention, decreasing 7.6% per month (OR = 0.92, 95% CI = 0.92–0.93, P < 0.001); masking errors improved from first (10.3 %) to last (6.6%) months of the intervention, decreasing 2.3% per month (OR = 0.98, 95% CI = 0.97–0.99, P < 0.001); face/mask touching improved from first (30.0%) to last (10.6%) months of the intervention, decreasing 2.5% per month (OR = 0.98, 95% CI = 0.97–0.98, P < 0.001). Hand hygiene errors were most common in entryways and on weekends, with similar rates across shifts. Masking errors and face/mask touching errors were most common in breakrooms, with the latter occurring most commonly during the day (7A.M.–3P.M.) shift, with similar rates across weekdays/weekends. Error reductions were seen across camera locations, days of the week, and nursing shifts, suggesting a widespread benefit within participating NHs.
Conclusion:
Direct-to-staff training with video-based feedback was temporally associated with improved hand hygiene, masking, and face/mask-touching behaviors among NH staff during the COVID-19 pandemic.
We provide an assessment of the Infinity Two Fusion Pilot Plant (FPP) baseline plasma physics design. Infinity Two is a four-field period, aspect ratio A = 10, quasi-isodynamic stellarator with improved confinement appealing to a max-J approach, elevated plasma density and high magnetic fields (⟨B⟩ = 9 T). At the envisioned operating point [800 MW deuterium-tritium (DT) fusion], the configuration has robust magnetic surfaces based on magnetohydrodynamic (MHD) equilibrium calculations and is stable to both local and global MHD instabilities. The configuration has excellent confinement properties with small neoclassical transport and low bootstrap current (|Ibootstrap| ∼ 2 kA). Calculations of collisional alpha particle confinement in a DT FPP scenario show small energy losses to the first wall (< 1.5%) and stable energetic particle/Alfvén eigenmodes at high ion density. Low turbulent transport is produced using a combination of density profile control consistent with pellet fueling and reduced stiffness to turbulent transport via three-dimensional shaping. Transport simulations with the T3D-GX-SFINCS code suite with self-consistent turbulent and neoclassical transport predict that the Pfus = 800 MW operating point is attainable with high fusion gain (Q = 40) at volume-averaged electron densities ne ≈ 2×1020 m−3, below the Sudo density limit. Additional transport calculations show that an ignited (Q = ∞) solution is available at slightly higher density (2.2×1020 m−3) with Pfus = 1.5 GW. The magnetic configuration is defined by a magnetic coil set with sufficient room for an island divertor, shielding and blanket solutions with tritium breeding ratios (TBR) above unity. An optimistic estimate for the gas-cooled solid breeder designed Helium Cooled Pebble Bed is TBR ∼ 1.3. Infinity Two satisfies the physics requirements of a stellarator fusion pilot plant.
The magneto-hydrodynamic equilibrium and stability properties of the Infinity Two Fusion Pilot Plant baseline plasma physics design are presented. The configuration is a four field period, aspect ratio A = 10 quasi-isodynamic stellarator optimized for excellent confinement at elevated density and high magnetic field B = 9 T. Magnetic surfaces exist in the plasma core in vacuum and retain good equilibrium surface integrity from vacuum to an operational β = 1.6%, the ratio of the volume average of the plasma and magnetic pressures, corresponding to 800 MW Deuterium-Tritium fusion operation. Neoclassical calculations show that a selfconsistent bootstrap current on the order of ∼ 1 kA slightly increases the rotational transform profile by less than 0.001. The configuration has a magnetic well across its entire radius. From vacuum to the operating point, the configuration exhibits good ballooning stability characteristics, exhibits good Mercier stability across most of its minor radius, and it is stable against global low-n MHD instabilities up to β = 3.2%.
The selection, design, and optimization of a suitable blanket configuration for an advanced high-field stellarator concept is seen as a key feasibility issue and has been incorporated as a vital and necessary part of the Infinity Two Fusion Pilot Plant (FPP) physics basis. The focus of this work was to identify a baseline blanket which can be rapidly deployed for Infinity Two while also maintaining flexibility and opportunities for higher performing concepts later in development. Results from this analysis indicate that gas-cooled solid breeder designs such as the Helium Cooled Pebble Bed (HCPB) are the most promising concepts, primarily motivated by the neutronics performance at applicable blanket build depths, and the relatively mature technology basis. The lithium lead (PbLi) family of concepts, particularly the Dual Cooled Lithium Lead (DCLL), offer a compelling alternative to solid blanket concepts as they have synergistic developmental pathways while simultaneously mitigating much of the technical risk of those designs. Homogenized 3-dimensional neutronics analysis of the Infinity Two configuration indicates that the HCPB achieves an adequate tritium breeding ratio (TBR) (1.30 which enables sufficient margin at low engineering fidelity), and near appropriate shielding of the magnets (average fast fluence of 1.3 x 1018 n/cm2 per fullpower year). The thermal analysis indicates that reasonably high thermal efficiencies (greater than 30%) are readily achievable with the HCPB paired with a simple Rankine cycle using reheat. Finally, the tritium fuel cycle analysis for Infinity Two shows viability, with anticipated operational inventories of less than one kilogram (approximately 675 grams) and a required TBR (TBRreq) of less than 1.05 to maintain fuel self-sufficiency (approximately 1.023 for a driver blanket with no inventory doubling). Although further optimization and engineering design is still required, at the physics basis stage all initial targets have been met for the Infinity Two configuration.
Attendance at university can result in social support network disruption. This can have a negative impact on the mental health of young people. Demand for mental health support continues to increase in universities, making identification of factors associated with poorer outcomes a priority. Although social functioning has a bi-directional relationship with mental health, its association with effectiveness of psychological treatments has yet to be explored.
Objectives
To explore whether students showing different trajectories of change in social function over the course of treatment differed in eventual treatment outcome.
Methods
Growth mixture models were estimated on a sample of 5221 students treated in routine mental health services. Different trajectories of change in self-rated impairment in social leisure activities and close relationships (Work and Social Adjustment Scale (WSAS) items 3 and 5) during the course of treatment were identified. Associations between trajectory classes and treatment outcomes were explored through multinomial regression.
Results
Five trajectory classes were identified for social leisure activity impairment (Figure 1), and three classes were identified for close relationship impairment (Figure 2). For both measures the majority of students remained mildly impaired (Class 1). Other trajectories included severe impairment with limited improvement (Class 2), severe impairment with delayed improvement (Class 3), and, in social leisure activities only, rapid improvement (Class 4), and deterioration (Class 5). There was an association between trajectories of improvement in social functioning over time and positive treatment outcomes. Trajectories of worsening or stable severe impairment were associated with negative treatment outcomes.
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Image 2:
Conclusions
Changes in social functioning impairment are associated with psychological treatment outcomes in students, suggesting that these changes may be associated with treatment effectiveness or recovery experiences. Future research should look to establish whether a causal link exists to understand if additional benefit for students can be gained through integrating social support within psychological treatment.
In recent times, Health Professionals (HPs) people may feel a sense of discomfort and nervousness when disconnected from their smartphones, causing the emergence of the new phenomenon of “No Mobile Phone Phobia,” or Nomophobia.
Objectives
We aim to study lifestyle-related factors that influence HPs’ Nomophobia.
Methods
From April- June 2023, a global cross-sectional study was conducted using the modified Nomophobia questionnaire (NMP-Q). The original 20 NMP-Q questions (Qs) were reduced to 14 to avoid repetitive Qs with similar meanings. The Qs were categorized into 4 sections, A- Not Being Able to Access Information; B- Losing Connectedness; C- Not Being Able to Communicate; and D- Giving Up Convenience. A new section, “E- Daily Habits”, and “F- Smartphone Type”, and “Hours Spent Daily” were added. Before the launch, it was internally and externally validated by trained psychiatrists as well as experienced researchers. We utilized social media, WhatsApp, text and emails to share it with HPs of different specialties worldwide. The survey was anonymous and IRB-exempt.
Results
Total 105 countries’ HPs participation led to 12,253 responses. Total 47.3% of HPs agreed/strongly agreed (A/SA) that they prefer to use their smartphone before bedtime. Over half (57.8%) of HPs A/SA checked their notifications immediately after waking up in the morning. Only 19.4 % of HPs A/SA that woke up in the middle of the night to check notifications. Total 40.5% of HPs A/SA, 22% were neutral, and 37.3% of HPs disagreed /strongly disagreed (D/SD) with using smartphones while eating their meals. A total of 52.7% of HPs preferred smartphone usage over exercising as a break, while 454.9% of HPs A/SA that they chose smartphones over exploring other hobbies for relaxation. A total of 44.2% of respondents A/SA with smartphone usage in the restroom, 39.8% D/SD. 37.4% of participants D/SD with getting distracted by notifications and resisted the urge to answer any calls or texts while performing a focused task, whereas 39.6% A/SA and 23% were neutral. A total of 80% of respondents met the modified criteria for moderate-severe nomophobia.
Conclusions
In a large-scale survey-based study on Nomophobia, additional Qs in NMP-Q may help recognize that nomophobia can be a result of daily lifestyle decisions rather than an isolated issue.
Twelve lacustrine sediment samples from a relict lake in the Kalla Glacier valley were co-dated using AMS radiocarbon (14C) and infrared stimulated luminescence (IRSL) dating methods. In general, the radiocarbon ages of bulk organic matter were older by a minimum of 1500 years compared to (age depth) modeled luminescence ages after fading corrections. This is observed for the first time in the lake sediments of High Himalayan Crystalline zone. A combination of lipid n-alkane data, Raman spectra and geochemical proxies suggested that this was due to ancient organic carbon (OCancient) that is a mixture of pre-aged (OCpre-aged) and petrogenic (OCpetro) organic carbon within older glacial moraine debris that served as sediment source to the lake. Raman spectra suggest the presence of moderate to highly graphitized OCpetro in all the profile samples. The OCpetro contributed 0.064 ± 0.032% to the sediment and the lake stored 2.5 ± 0.7 Gg OCpetro at variable rates during the last 16 kyr, with the mean burial flux 160 kg OCpetro yr−1. This study implies (1) employing another independent dating method in addition to radiocarbon method using bulk sediment organic matter, if the carbon content is low, to observe any discrepancy, and (2) a need to investigate on the fate of OCpetro as many such small lakes become relict in this region.
Background: Duchenne muscular dystrophy (DMD) is caused by DMD gene mutations. Delandistrogene moxeparvovec is an investigational gene transfer therapy, developed to address the underlying cause of DMD. We report findings from Part 1 (52 weeks) of the two-part EMBARK trial (NCT05096221). Methods: Key inclusion criteria: Ambulatory patients aged ≥4-<8 years with a confirmed DMD mutation within exons 18–79 (inclusive); North Star Ambulatory Assessment (NSAA) score >16 and <29 at screening. Eligible patients were randomized 1:1 to intravenous delandistrogene moxeparvovec (1.33×1014 vg/kg) or placebo. The primary endpoint was change from baseline in NSAA total score to Week 52. Results: At Week 52 (n=125), the primary endpoint did not reach statistical significance, although there was a nominal difference in change from baseline in NSAA total score in the delandistrogene moxeparvovec (2.6, n=63) versus placebo groups (1.9, n=61). Key secondary endpoints (time to rise, micro-dystrophin expression, 10-meter walk/run) demonstrated treatment benefit in both age groups (4-5 and 6-7 years; p<0.05).There were no new safety signals, reinforcing the favorable and manageable safety profile observed to date. Conclusions: Based on the totality of functional assessments including the timed function tests, treatment with delandistrogene moxeparvovec indicates beneficial modification of disease trajectory.
We evaluated whether universal chlorhexidine bathing (decolonization) with or without COVID-19 intensive training impacted COVID-19 rates in 63 nursing homes (NHs) during the 2020–2021 Fall/Winter surge. Decolonization was associated with a 43% lesser rise in staff case-rates (P < .001) and a 52% lesser rise in resident case-rates (P < .001) versus control.
Tight focusing with very small f-numbers is necessary to achieve the highest at-focus irradiances. However, tight focusing imposes strong demands on precise target positioning in-focus to achieve the highest on-target irradiance. We describe several near-infrared, visible, ultraviolet and soft and hard X-ray diagnostics employed in a ∼1022 W/cm2 laser–plasma experiment. We used nearly 10 J total energy femtosecond laser pulses focused into an approximately 1.3-μm focal spot on 5–20 μm thick stainless-steel targets. We discuss the applicability of these diagnostics to determine the best in-focus target position with approximately 5 μm accuracy (i.e., around half of the short Rayleigh length) and show that several diagnostics (in particular, 3$\omega$ reflection and on-axis hard X-rays) can ensure this accuracy. We demonstrated target positioning within several micrometers from the focus, ensuring over 80% of the ideal peak laser intensity on-target. Our approach is relatively fast (it requires 10–20 laser shots) and does not rely on the coincidence of low-power and high-power focal planes.
A quaternary ammonium and alcohol-based disinfectant with reported continuous activity demonstrated reduced microbial buildup on surfaces over time compared to routine disinfectants without continuous activity in in vitro and hospital studies. We compared these disinfectants in ambulatory settings and found no difference in bioburden on high-touch surfaces over time.
This paper reports results from the eighth of a series of road transect surveys of Gyps vultures conducted across northern, central, western, and north-eastern India since the early 1990s. Populations of the White-rumped Vulture Gyps bengalensis, Indian Vulture G. indicus, and Slender-billed Vulture G. tenuirostris declined rapidly, beginning in the mid-1990s. The principal cause of the declines was poisoning due to widespread veterinary use of the non-steroidal anti-inflammatory drug (NSAID) diclofenac on cattle. The results of the current survey suggest that, while populations of all three species of vulture remain at a low level with no signs of recovery, they appear to have been approximately stable since veterinary use of diclofenac was banned in the mid-2000s. Population trends in India, where the illegal use of diclofenac and legal use of other toxic NSAIDs continues, are compared with more positive trends in Nepal, where the veterinary use of toxic NSAIDs appears to have been reduced to a low level.
We identify a set of essential recent advances in climate change research with high policy relevance, across natural and social sciences: (1) looming inevitability and implications of overshooting the 1.5°C warming limit, (2) urgent need for a rapid and managed fossil fuel phase-out, (3) challenges for scaling carbon dioxide removal, (4) uncertainties regarding the future contribution of natural carbon sinks, (5) intertwinedness of the crises of biodiversity loss and climate change, (6) compound events, (7) mountain glacier loss, (8) human immobility in the face of climate risks, (9) adaptation justice, and (10) just transitions in food systems.
Technical summary
The Intergovernmental Panel on Climate Change Assessment Reports provides the scientific foundation for international climate negotiations and constitutes an unmatched resource for researchers. However, the assessment cycles take multiple years. As a contribution to cross- and interdisciplinary understanding of climate change across diverse research communities, we have streamlined an annual process to identify and synthesize significant research advances. We collected input from experts on various fields using an online questionnaire and prioritized a set of 10 key research insights with high policy relevance. This year, we focus on: (1) the looming overshoot of the 1.5°C warming limit, (2) the urgency of fossil fuel phase-out, (3) challenges to scale-up carbon dioxide removal, (4) uncertainties regarding future natural carbon sinks, (5) the need for joint governance of biodiversity loss and climate change, (6) advances in understanding compound events, (7) accelerated mountain glacier loss, (8) human immobility amidst climate risks, (9) adaptation justice, and (10) just transitions in food systems. We present a succinct account of these insights, reflect on their policy implications, and offer an integrated set of policy-relevant messages. This science synthesis and science communication effort is also the basis for a policy report contributing to elevate climate science every year in time for the United Nations Climate Change Conference.
Social media summary
We highlight recent and policy-relevant advances in climate change research – with input from more than 200 experts.
The North-Eastern region (NER) of India falls under the Eastern Himalayan region and it is a bio-diversity hub. Diverse maize landraces with wide adaptability to extreme climatic and soil scenario like heavy rainfall, drought and acidic soil conditions have been grown in NER since time immemorial. However, maize diversity in NER region has drastically reduced due to introduction of high yielding varieties and hybrids. Modern maize breeding programmes are focused on high yield but other unique traits like stay green trait, prolificacy (more than one fertile ear per plant), self-fertilizing ability are also important and the local germplasm of the NER region can contribute with these unique traits. Prior to the selection of any lines in several breeding programmes, assessment of genetic diversity and population structure are basic requirements. Hence, in the present study assessment of genetic diversity and population structure study in 30 maize inbreds developed from different germplasm of NER was undertaken using SSR markers, selected for their broad distribution throughout the genome, in order to assess the extent of allelic diversity among the lines and whether any population structure could be established. In addition to assessing molecular diversity, the study aims to evaluate the potential for yield and other beneficial and unique alleles that have high potential to contribute in the genetic enhancement programme of maize.
Twenty-nine exotic common bean germplasms and three elite cultivars were examined for phenotypic diversity in two bean-producing environments (Kanpur and Shimla) across three winter seasons and one rainy season. The estimate of genetic variability parameters revealed that the exotic bean germplasm has enough diversity for all the evaluated features. The highest genotypic and phenotypic coefficients of variation were found in seed yield, followed by 100-seed weight, pods per plant and pod length. Furthermore, seed yield was the most heritable and genetically advanced quantitative feature, followed by 100-seed weight, pod length and pods per plant. According to a trait association study, the days to maturity of phenological traits have a strong positive correlation with the days to initial flowering and the days to 50% flowering. Pods per plant and seeds per pod most strongly influence increased grain yield. The first two principal components accounted for 63.3% of the variation and demonstrated significant diversity among exotic bean lines for the traits studied, according to the principal component analysis. According to the hierarchical clustering analysis, 29 accessions and three cultivars were divided into three groups. Cluster I contains early flowering and maturing accessions, while cluster III contains high pods per plant and an increased grain yield of germplasms. The fundamental source of phenological fluctuations in both environmental circumstances is temperature. This study found four genetically divergent and stable performance accessions, including EC932021, EC932189 (earliness), and EC931452, EC931971 (high grain yield), which may aid in the establishment of a bean breeding programme.
Rice cultivation in hills is challenged by sub-optimum weather conditions, low soil fertility, low temperature and moisture stress which impedes in attaining high productivity. To address this, four studies were carried out at ICAR Sikkim Centre, Gangtok, India to evaluate relative performance of local organic cultivars and conventionally bred varieties under an organic farming system. Conventionally bred varieties yielded significantly higher (45%) than local cultivars under recommended timely sown conditions whereas local cultivars showed superiority in grain yield under late sown conditions coinciding with low temperature during flowering to grain filling. Genotypes did not show significant interaction when organic or conventional production conditions were compared. For grain yield, there was a significant variation for variety × year interaction under organic system. Local organic cultivars had reduced grain yield and associated traits under rainfed upland conditions. Panicles per unit area had a significant positive association with grain yield in all production environments (organic lowland, organic upland, conventional lowland and conventional upland). Overall, the study indicates using local cultivars as donors for specific stress tolerance traits in background of high yielding genotypes to enhance rice yields sustainably under organic system in hills.
Kerala, a humid tropical southern state, is the third largest producer of Tamarind (Tamarindus indica L.) in India. This tree spice is an important livelihood option for the rural society, especially in Palakkad district which is the lead producer of tamarind in the state with a few accepted primitive cultivars, viz. ‘valanpuli’, ‘madhurapuli’ and ‘thenpuli’. A survey was conducted to identify the fruit variability and document the sweet tamarind types of Palakkad. This study revealed the variability and weight of 30 fruits was seen to be the most indicative variable of tamarind in Kerala. The pod length varied from 5.28 to 23.41 cm and fruit weight from 4.83 to 43.40 g. Hierarchical clustering on principal component analysis resulted in six clusters. The clusters I, IV and V represented collections with fruit weight more than 20 g. Box plot diagrams revealed the high real pulp value in sample KTJ 162 (9.57) and high fruit length in KTJ 44 (21.68 cm). Among 113 collections, 18 samples were collected as perceived sweet types based on local enquiry. In the scatter plot between total soluble solids and ratio between total soluble solids and total titrable acidity, two samples were spotted as sweet types with acidity below 8%. Further molecular characterization and systematic crop improvement programmes are required for conserving the eroding gene pool of tamarind in Kerala and to develop sweet types for commercial production.
Substance dependence affects an individual as well as the family and is considered as a complex biopsychosocial phenomenon. Family members can act as a social and emotional support in the treatment engagement and recovery of the patient with substance use disorder. Caregiving is a multidimensional construct. Caregiving process to an individual with substance use disorder can help in either positive or negative outcome and is often challenging. Positive aspects of caregiving has gathered some attention in mental health literature in recent past, data for the same is limited across substance use disorder.
Objectives
To determine whether substance use status is associated with differences in positive aspects of caregiving and burden among the caregivers of patients with opioid use disorders.
Methods
A cross-sectional observational study with purposive sampling was used to recruit 199 caregivers of patients with opioid use disorders. The sample was divided based upon the current substance use status of the patients. Scale for Positive Aspects of Caregiving Experience (SPACE) and Family Burden Interview Schedule (FBIS) were used to assess positive aspects of caregiving and family burden respectively
Results
The study included 199 caregivers of patients with opioid use disorder. Table 1 describes the socio-demographic profile of the patients and caregivers. Of 199 caregivers recruited, 135 (67.8%) reported that the patient was using opioids, while 64 (32.2%) reported that the patient was abstinent on treatment. The mean SPACE domain score of caregivers abstinent on treatment was highest for motivation for caregiving role (2.73 versus 1.76) followed by self-esteem and social aspect of caring (2.42 versus 1.87), caregiver satisfaction (2.41 versus 1.29) and caregiving personal gains (2.40 versus 1.45). Details of SPACE domain score and FBIS are depicted in table 2. It was seen that caregivers of patients currently abstinent on treatment experienced greater positive aspects of caregiving (SPACE mean score 128.3 versus 80.1, t = 9.383, p <0.001), and lesser burden (FBIS mean score 13.4 versus 29.3, t = 10.419, p <0.001). Overall the mean SPACE domain score had a negative correlation with FBIS (r = -0.57, p<0.001).
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Image 2:
Conclusions
In our study it was found that caregivers of patients who are currently abstinent on treatment experience lower burden of care, and also experience greater positive aspects of caregiving. Clinicians should be aware of the caregiver experiences as well as they engage both patients and caregivers in the treatment process.
Keywords: Positive Aspects of Caregiving Experience; Family Burden; Caregivers; Opioid; Substance.