Early in the COVID-19 pandemic, the World Health Organization stressed the importance of daily clinical assessments of infected patients, yet current approaches frequently consider cross-sectional timepoints, cumulative summary measures, or time-to-event analyses. Statistical methods are available that make use of the rich information content of longitudinal assessments. We demonstrate the use of a multistate transition model to assess the dynamic nature of COVID-19-associated critical illness using daily evaluations of COVID-19 patients from 9 academic hospitals. We describe the accessibility and utility of methods that consider the clinical trajectory of critically ill COVID-19 patients.

Background: Infection prevention and control (IPC) is key (1) to keeping health workers and patients safe from contracting infections during care, (2) to enabling continuity of essential health services, and (3) to pandemic preparedness and response. Frontline health workers are at 3-fold increased risk for COVID-19 (Lancet 2020) and account for 6% of COVID-19 hospitalizations (CDC 2020). With the support of the US Agency for International Development Bureau of Humanitarian Assistance (USAID/BHA) and collaboration of the Haitian Ministry of Health (MSPP), MSH’s Rapid Support to COVID-19 Response in Haiti project (RSCR Haiti) developed an instrument to assess select public hospitals and identify IPC gaps that informed COVID-19 response and system strengthening measures for increasing patient and provider safety. Methods: The IPC tool contains 13 IPC domains and 80 questions, for a total of 600 points. It was developed based on the World Health Organization IPC Assessment Framework for Health Facilities (2018) and US Centers for Disease Control Facility Readiness Assessment for COVID-19 (2020). In total, 39 health facilities chosen by the MSPP across all 10 departments of Haiti were evaluated in October 2020. Data were analyzed in Microsoft Excel by category, site, and IPC capabilities then classified as inadequate, basic, intermediate or advanced. Results: IPC capabilities scored as inadequate in 18% and basic in 67% of hospitals (Graph 1). No institution was advanced. Among health facilities, IPC programs existed in only 18%; IPC guidelines or procedures were present in 38%; staff were trained regularly in 12%; and healthcare-associated infection surveillance was performed in 19%. Systems for COVID-19 triage existed in 56%; 39% had IPC commodity management systems; 45% provided COVID-19 training; 26% practiced monitoring of staff and patients for COVID-19; 36% had protocols for an influx of COVID-19 cases; and 72% practiced risk communication (Table 1). Conclusions: No health facility was sufficiently equipped to implement adequate COVID-19 IPC measures, and all needed strengthening, even in the highest-scoring IPC areas. Through RSCR Haiti, MSH and MSPP were able to identify and address priorities in hospitals: establishing hospital IPC programs; training staff; monitoring health workers and patients; and implementing guidance, triage, and commodity-management systems. This study demonstrates that it is possible to do a quick yet thorough assessment to rapidly identify IPC needs and opportunities, using the results to rapidly build response capacity. Haiti’s experience of integrating locally contextualized global IPC tools to inform systemic COVID-19 response measures can benefit other experts globally.

Funding: United States Agency for International Development Bureau of Humanitarian Assistance (USAID/BHA)

Disclosures: None

Figure 1.

Table 1.

La pandémie de la COVID-19 et l’état d’urgence publique qui en a découlé ont eu des répercussions significatives sur les personnes âgées au Canada et à travers le monde. Il est impératif que le domaine de la gérontologie réponde efficacement à cette situation. Dans la présente déclaration, les membres du conseil d’administration de l’Association canadienne de gérontologie/Canadian Association on Gerontology (ACG/CAG) et ceux du comité de rédaction de La Revue canadienne du vieillissement/Canadian Journal on Aging (RCV/CJA) reconnaissent la contribution des membres de l’ACG/CAG et des lecteurs de la RCV/CJA. Les auteurs exposent les voies complexes par lesquelles la COVID-19 affecte les personnes âgées, allant du niveau individuel au niveau populationnel. Ils préconisent une approche impliquant des équipes collaboratives pluridisciplinaires, regroupant divers champs de compétences, et différentes perspectives et méthodes d’évaluation de l’impact de la COVID-19.

The COVID-19 pandemic and subsequent state of public emergency have significantly affected older adults in Canada and worldwide. It is imperative that the gerontological response be efficient and effective. In this statement, the board members of the Canadian Association on Gerontology/L’Association canadienne de gérontologie (CAG/ACG) and the Canadian Journal on Aging/La revue canadienne du vieillissement (CJA/RCV) acknowledge the contributions of CAG/ACG members and CJA/RCV readers. We also profile the complex ways that COVID-19 is affecting older adults, from individual to population levels, and advocate for the adoption of multidisciplinary collaborative teams to bring together different perspectives, areas of expertise, and methods of evaluation in the COVID-19 response.

This article investigates the possibilities of a vocational pedagogy for undergraduate popular music education which is grounded in site and city. The value of work-integrated curricula in tertiary music environments is well established; however, often absent from such discussions is consideration of how geospatial contexts mediate the opportunities and resources available to universities. In response, we provide a critical comparison of how work-integrated learning (WIL) has been developed in two undergraduate popular music degrees in Australia and Aotearoa/New Zealand. Through comparison, we consider how the geographic locations of both programmes have shaped WIL, as well as identifying the specific economic, cultural and political tensions that emerge.

Early malnutrition, the first environmental cause of intra-uterine growth restriction, impairs development of the thymus. Alterations of the thymic structure and function are reported at young ages in murine and ovine models. However, descriptions of thymic consequences of fetal malnutrition at adulthood are scarce. The present study investigates thymic structure, protein expression and cell selection process observed at postnatal day 180 (PND180) in male offspring of rats exposed to maternal low-protein diet (mLPD) compared with control diet during gestation. The thymic index was lower in adult offspring exposed to mLPD (P < 0·05). The thymic cortico-medullar ratio was lower in adult offspring exposed to mLPD (P < 0·05). At PND180, the protein expression of the lymphotoxin β receptor (P < 0·05), the autoimmune regulator (P < 0·05) and Forkhead Box P3 (FoxP3; P < 0·05) was all significantly lower in the mLPD group. The CD4+:CD8+ single-positive thymocyte subpopulation ratio and CD4+:CD8+ lymphocyte subpopulation ratio were increased in the mLPD group (P < 0·05). Among CD3+ lymphocytes, the proportions of CD4+CD8+ double-positive lymphocytes, CD31+ recent thymic emigrants and CD4+FoxP3+ lymphocytes were not significantly different between mLPD and control groups. These findings suggest mLPD during gestation induced long-lasting alterations in the development of thymic structure and thymic cell maturation and selection process in adult male rat offspring.

Representation and computation are the best tools we have for explaining intelligent behavior. In our program, we explore the space of representations present in the mind by constraining them to explain data at multiple levels of analysis, from behavioral patterns to neural activity. We argue that this integrated program assuages Brette's worries about the study of the neural code.

The ultimatum game is a standard instrument for laboratory experimentalists. It has been replicated in a large number of environments and points to special considerations for fairness. Although it has been popular in the experimental community, researchers have not harnessed all the statistical power they should to evaluate the dynamics at work in this type of a bargaining game. This research uses two planned treatments, the first involving a signaling condition concerning a subject's “type”, and the second a price effect built into the structure of the game. We find that there are no significant main effects as a result of the signaling condition of a subject's type, but that there are strong effects as a result of the different payoff parameters. Using a variety of multivariate models we find important, nonobvious interactions with the gender of the subjects. The lesson that we take away from this research is that experimentalists can learn more from data collected in the tightly controlled laboratory environment by using statistical techniques that complement their research designs.

Locke's insistence on the limits of knowledge and the ‘mediocrity’ of our epistemological equipment is well understood; it is rightly seen as integrated with his causal theory of ideas and his theory of judgment. Less attention has been paid to the mediocrity theme as it arises in his theory of moral agency. Locke sees definite limits to human willpower. This is in keeping with post-Puritan theology with its new emphasis on divine mercy as opposed to divine justice and recrimination. It also reflects his view that human beings are (probably) essentially material machines.