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Efficient adoption is an important aim of animal shelters, but it is not possible for all animals including those with serious behavioural problems. We used institutional ethnography to explore the everyday work of frontline shelter staff in a large animal sheltering and protection organisation and to examine how their work is organised by standardised institutional procedures. Shelter staff routinely conduct behavioural evaluations of dogs and review intake documents, in part to plan care for animals and inform potential adopters about animal characteristics as well as protect volunteers and community members from human-directed aggression. Staff were challenged and felt pressure, however, to find time to work with animals identified as having behavioural problems because much of their work is directed toward other goals such as facilitating efficient adoption for the majority and anticipating future demands for kennel space. This work is organised by management approaches that broadly aim to maintain a manageable shelter animal population based on available resources, decrease the length of time animals spend in shelters and house animals based on individual needs. However, this organisation limits the ability of staff to work closely with long-stay animals whose behavioural problems require modification and management. This also creates stress for staff who care for these animals and are emotionally invested in them. Further inquiry and improvements might involve supporting the work of behavioural modification and management where it is needed and expanding fostering programmes for animals with special needs.
Background: Healthcare personnel (HCP) working in non–acute-care facilities are at high risk of COVID-19. We sought to determine SARS-CoV-2 seroprevalence, and analyzed behaviors and activities related to COVID-19 acquisition in this cohort. Methods: Between May and June 2021, HCP were enrolled at a skilled nursing facility and a memory care facility in St. Louis, Missouri. Data regarding demographics, prior SARS-CoV-2 testing, symptoms consistent with COVID-19 in the previous 6 months, COVID-19 vaccination, personal protective equipment (PPE) use, and COVID-19 exposures were collected via survey. Blood specimens were obtained to determine SARS-CoV-2 nucleocapsid IgG antibody seroprevalence (Abbott Laboratories). Study protocol was approved by the Washington University Institutional Review Board. Results: The survey was completed by 74 HCP. 82% of participants were female, and 31% reported >10 years of healthcare experience. The overall SARS-CoV-2 seropositivity rate was 8.9% (5 HCP). Of the surveyed HCP, 50% reported symptoms concerning for COVID-19 in the prior 6 months. Headache (38%), fatigue (35%) and fever (27%) were the most common self-reported symptoms. Among symptomatic HCP, only 35% sought medical care for these symptoms. All HCP reported having taken at least 1 COVID-19 test prior to study enrollment. Of note, 18.9% (14 HCP) had a self-reported prior positive SARS-CoV-2 PCR test, of whom 9 HCP were seronegative. All seronegative HCP with a self-reported history of COVID-19 reported infection >3 months before study participation. Completion of a primary COVID-19 vaccination series was reported by 86% of HCP. Known exposure to COVID-19 at work was reported by 28% of HCP. When asked about PPE at the time of workplace exposure, N95 mask use was reported by 81%, gloves by 57%, gowns by 33%, face shields by 29% and surgical masks by 14%. Known specific exposure to COVID-19 outside work was reported by 31% of HCP. Conclusions: One year after the initial COVID-19 pandemic impacted the St. Louis region, HCP at non–acute-care facilities had a SARS-CoV-2 seroprevalence of 8.9%. Similar frequency of exposures were reported from both the workplace and community, with high rates of PPE use at the workplace. HCP in such settings remain at high risk of COVID-19 exposure from workplace and community exposures. Ongoing efforts are needed to maintain PPE use to prevent SARS-CoV-2 transmission within non–acute-care facilities, and continue access to timely COVID-19 screening for HCP.
There is growing evidence to suggest that there is an increase in species extinction occurring globally. In this article, we briefly review the literature on the economics of species extinction, examining what is meant by extinction before explaining how economics has conceptualised this. The initial economics literature on species extinction focuses largely on renewable resources, in particular fisheries, but has subsequently evolved to cover many aspects of biodiversity across all physical scales, employing an increasing array of methodological tools. We also consider aspects of cultural and societal extinctions (e.g. local languages, local knowledge) and how this is positively correlated with loss of biodiversity, as well as an economist’s outlook on the potential to re-capture value post-extinction.
Animal protection laws exist at federal, provincial and municipal levels in Canada, with enforcement agencies relying largely upon citizens to report concerns. Existing research about animal protection law focuses on general approaches to enforcement and how legal terms function in the courts, but the actual work processes of animal law enforcement have received little study. We used institutional ethnography to explore the everyday work of Call Centre operators and Animal Protection Officers, and we map how this work is organised by laws and institutional polices. When receiving and responding to calls staff try to identify evidence of animal ‘distress’ as legally defined, because various interventions (writing orders, seizing animals) then become possible. However, many cases, such as animals living in deprived or isolated situations, fall short of constituting ‘distress’ and the legally mandated interventions cannot be used. Officers are also constrained by privacy and property law and by the need to record attempts to secure compliance in order to justify further action including obtaining search warrants. As a result, beneficial intervention can be delayed or prevented. Officers sometimes work strategically to advocate for animals when the available legal tools cannot resolve problems. Recommendations arising from this research include expanding the legal definition of ‘distress’ to better fit animals’ needs, developing ways for officers to intervene in a broader range of situations, and more ethnographic research on enforcement work in jurisdictions with different legal systems to better understand how animal protection work is organised and constrained by laws and policies.
To characterize experiences, beliefs, and perceptions of risk related to coronavirus disease 2019 (COVID-19), infection prevention practices, and COVID-19 vaccination among healthcare personnel (HCP) at nonacute care facilities.
Three non–acute-care facilities in St. Louis, Missouri.
In total, 156 HCP responded to the survey, for a 25.6% participation rate). Among them, 32% had direct patient-care roles.
Anonymous surveys were distributed between April-May 2021. Data were collected on demographics, work experience, COVID-19 exposure, knowledge, and beliefs about infection prevention, personal protective equipment (PPE) use, COVID-19 vaccination, and the impact of COVID-19.
Nearly all respondents reported adequate knowledge of how to protect oneself from COVID-19 at work (97%) and had access to adequate PPE supplies (95%). Many HCP reported that wearing a mask or face shield made communication difficult (59%), that they had taken on additional responsibilities due to staff shortages (56%), and that their job became more stressful because of COVID-19 (53%). Moreover, 28% had considered quitting their job. Most respondents (78%) had received at least 1 dose of COVID-19 vaccine. Common reasons for vaccination were a desire to protect family and friends (84%) and a desire to stop the spread of COVID-19 (82%). Potential side effects and/or inadequate vaccine testing were cited as the most common concerns by unvaccinated HCP.
A significant proportion of HCP reported increased stress and responsibilities at work due to COVID-19. The majority were vaccinated. Improving workplace policies related to mental health resources and sick leave, maintaining access to PPE, and ensuring clear communication of PPE requirements may improve workplace stress and burnout.
Functional magnetic resonance imaging (fMRI) was conceived in the early 1990s due to the coincidence of two advances: (1) MRI scanner technology able to support fast echo-planar imaging imaging techniques with the required temporal stability and (2) the scientific knowledge that differences in the magnetic susceptibility of blood may be associated with MRI signal changes based on alterations in blood oxygenation levels. These elements, together with the assumption that changes in blood oxygenation and volume would accompany changes in neural activity in the brain, motivated research groups around the world to develop fMRI.
A diverse research literature now exists on the animals, staff and organisations involved in animal sheltering. We reviewed this research through the lens of institutional ethnography, a method of inquiry that focuses on the actual work that people do within institutions. The main topics, identified through a larger ethnographic study of animal sheltering, were: (i) research about shelter staff and officers; (ii) the relinquishment of animals to shelters; and (iii) animals’ length of stay in shelters. After reviewing the literature, we held focus groups with shelter personnel to explore how their work experiences are or are not represented in the research. The review showed that stress caused by performing euthanasia has attracted much research, but the decision-making that leads to euthanasia, which may involve multiple staff and potential conflict, has received little attention. Research on ‘compassion fatigue’ has also tended to focus on euthanasia but a granular description about the practical and emotional work that personnel undertake that generates such fatigue is missing. Published research on both relinquishment and length of stay is dominated by metrics (questionnaires) and often relies upon shelter records, despite their limitations. Less research has examined the actual work processes involved in managing relinquishment as well as monitoring and reducing animals’ length of stay. Institutional ethnography’s focus on people’s work activities can provide a different and more nuanced understanding of what is happening in animal sheltering and how it might better serve the needs of the animals and staff.
In this prospective, longitudinal study, we examined the risk factors for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among a cohort of chronic hemodialysis (HD) patients and healthcare personnel (HCPs) over a 6-month period. The risk of SARS-CoV-2 infection among HD patients and HCPs was consistently associated with a household member having SARS-CoV-2 infection.
Background and Aim: Psychodynamic psychiatry training seminars are a blended supervision and experiential style approach to training health care professionals in reflective practice and formulation. They apply psychodynamic theory through case formulations, seminars, and Balint groups so that health care staff can improve their communication style, formulation skills and enhance their appreciation for patients with complex mental health problems. Our aim is to evaluate the provision of our psychodynamic psychiatry training sessions for doctors in psychiatry, gastroenterology, and emergency medicine, and to evaluate the perceived benefits of attending in terms of personal and professional development.
Methods: The evaluation used a standardized mixed-methods approach, with the sample consisting of psychiatry core trainees (n = 9), gastroenterology higher trainees (n = 4), and emergency medicine doctors (n = 10). The evaluation period was between October 2021 and January 2022. Data were gathered via a survey tool, adapted from the literature using Likert scales and free text questions to identify barriers and facilitators to the sessions.
Results: All participants (n = 23) scored the group highly across the board in terms of acceptability, clinical impact, and fidelity measures. All participants reported that they have a better appreciation of group dynamics, the impact of the doctor's humanity and personality on their clinical work, and the symbolic meaning of the patient's symptoms. Notably, approximately 60% reported that the sessions were relevant to their ongoing training needs and that 95% of participants felt the sessions were a safe place to express and process anxieties and frustrations about their work. All participants either agreed or strongly agreed the group had changed the way they think and practice, and that they felt able to consider their clinical encounters in a new light.
Conclusion: This evaluation reports early findings on psychodynamic psychiatry teaching for different medical groups. Overall, the participants felt the sessions were relevant to their training and improved their personal and professional development. Key benefits of the group were highlighted and included increased insight into the emotional and symbolic aspects of the patient's symptoms and clinical issues, team working through cohesion, and the humanity of the doctor in the clinical relationship with the patient. This suggests that the sessions provide a much-needed space to process and reflect on the often-intense demands of clinical work, individually and as a team. The main theme within barriers to the group processes was external in terms of other clinical demands requiring prioritization.
OBJECTIVES/GOALS: Autologous periodontal ligament cells (PDLCs) are a promising tool for rebuilding tooth-supporting (periodontal) tissues but require scaffolds that enable delivery while maintaining PDLC bioactivity. The goal of this study was to design a synthetic hydrogel that fulfilled these criteria to support clinical translation of PDLC delivery. METHODS/STUDY POPULATION: Hydrogels were formed using poly(ethylene glycol) (PEG) polymers and synthetic peptides. PDLCs were isolated from human 3rd molars following informed consent and were cultured using established techniques. Integrin-binding peptides were utilized to promote specific PDLC behaviors, testing PDLCs from 3 human donors in a design of experiments (DOE) approach. Two promising hydrogel designs, identified in the DOE, were selected for validation testing using PDLCs from 3 additional donors. Finally, a small animal model for hydrogel-mediated PDLC delivery was used to determine if benchtop outcomes could predict in vivo tissue regeneration. RESULTS/ANTICIPATED RESULTS: Hydrogel scaffolds maintained high PDLC viability and controlled differentiation of each donor’s PDLCs based on differential presentation of integrin-binding peptides RGD and GFOGER. Two hydrogel designs were selected that optimized either PDLC alkaline phosphatase (ALP) activity or matrix mineralization, outcomes typically associated with cementum and bone formation. ALP activity-optimized hydrogels displayed enhanced PDLC pyrophosphate regulation while mineralization-optimized hydrogels promoted PDLC osteogenic differentiation. When used to deliver PDLCs to periodontal defects, both ALP activity-optimized and mineralization-optimized hydrogels stimulated new cementum formation with inserting PDL fibers, while mineralization-optimized hydrogels promoted enhanced bone formation. DISCUSSION/SIGNIFICANCE: Numerous challenges remain for translating PDLC regenerative potential to clinical practice. This study demonstrates that a synthetic hydrogel scaffold could overcome certain barriers, including controlling PDLC bioactivity with a simplified fabrication and delivery scheme, and may be a promising scaffold for periodontal tissue regeneration.
Patients on dialysis are at high risk for severe COVID-19 and associated morbidity and mortality. We examined the humoral response to SARS-CoV-2 mRNA vaccine BNT162b2 in a maintenance dialysis population.
Single-center cohort study.
Setting and participants:
Adult maintenance dialysis patients at 3 outpatient dialysis units of a large academic center.
Participants were vaccinated with 2 doses of BNT162b2, 3 weeks apart. We assessed anti–SARS-CoV-2 spike antibodies (anti-S) ∼4–7 weeks after the second dose and evaluated risk factors associated with insufficient response. Definitions of antibody response are as follows: nonresponse (anti-S level, <50 AU/mL), low response (anti-S level, 50–839 AU/mL), and sufficient response (anti-S level, ≥840 AU/mL).
Among the 173 participants who received 2 vaccine doses, the median age was 60 years (range, 28–88), 53.2% were men, 85% were of Black race, 86% were on in-center hemodialysis and 14% were on peritoneal dialysis. Also, 7 participants (4%) had no response, 27 (15.6%) had a low response, and 139 (80.3%) had a sufficient antibody response. In multivariable analysis, factors significantly associated with insufficient antibody response included end-stage renal disease comorbidity index score ≥5 and absence of prior hepatitis B vaccination response.
Although most of our study participants seroconverted after 2 doses of BNT162b2, 20% of our cohort did not achieve sufficient humoral response. Our findings demonstrate the urgent need for a more effective vaccine strategy in this high-risk patient population and highlight the importance of ongoing preventative measures until protective immunity is achieved.
Since the discovery of vitamin D, it has been accepted that its physiological supply is either from food or by endogenous synthesis in skin exposed to solar UV light. Yet vitamin D is a component of very few foods and its supply as a natural nutrient is unable to maintain good vitamin D status for human populations. One aspect of vitamin D physiology that has been ignored is that the mechanisms for its transport and processing from these two sources are quite different. Excess intake of vitamin D causes hypercalcaemic toxicity. However, experiments with different animal species have shown that long-term supply of oral vitamin D in apparently non-toxic amounts causes atherosclerosis in large arteries. A mechanism for this toxicity is proposed. Alternative strategies for addressing widespread vitamin D deficiency by food fortification should be considered in light of the angiotoxicity caused by oral vitamin D in animal experiments.
Young people with social disability and severe and complex mental health problems have poor outcomes, frequently struggling with treatment access and engagement. Outcomes may be improved by enhancing care and providing targeted psychological or psychosocial intervention.
We aimed to test the hypothesis that adding social recovery therapy (SRT) to enhanced standard care (ESC) would improve social recovery compared with ESC alone.
A pragmatic, assessor-masked, randomised controlled trial (PRODIGY: ISRCTN47998710) was conducted in three UK centres. Participants (n = 270) were aged 16–25 years, with persistent social disability, defined as under 30 hours of structured activity per week, social impairment for at least 6 months and severe and complex mental health problems. Participants were randomised to ESC alone or SRT plus ESC. SRT was an individual psychosocial therapy delivered over 9 months. The primary outcome was time spent in structured activity 15 months post-randomisation.
We randomised 132 participants to SRT plus ESC and 138 to ESC alone. Mean weekly hours in structured activity at 15 months increased by 11.1 h for SRT plus ESC (mean 22.4, s.d. = 21.4) and 16.6 h for ESC alone (mean 27.7, s.d. = 26.5). There was no significant difference between arms; treatment effect was −4.44 (95% CI −10.19 to 1.31, P = 0.13). Missingness was consistently greater in the ESC alone arm.
We found no evidence for the superiority of SRT as an adjunct to ESC. Participants in both arms made large, clinically significant improvements on all outcomes. When providing comprehensive evidence-based standard care, there are no additional gains by providing specialised SRT. Optimising standard care to ensure targeted delivery of existing interventions may further improve outcomes.