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To describe healthcare provider, veteran, and organizational barriers to, challenges to, and facilitators of implementation of the oral care Hospital-Acquired Pneumonia Prevention by Engaging Nurses (HAPPEN) initiative to prevent non–ventilator-associated hospital-acquired pneumonia (NV-HAP).
Concurrent mixed methods. Qualitative interviews of staff and patients were conducted in addition to a larger survey of VA employees regarding implementation.
Medical surgical or extended care units in 6 high-complexity (01a–c) VA hospitals.
Between January 2020 and February 2021, we interviewed 7 staff and 7 veterans, and we received survey responses from 91 staff.
Provide education, support, and oral care supplies to prevent NV-HAP.
Barriers to HAPPEN implementation and tracking at the pilot sites included maintaining oral care supplies and completion of oral care documentation. Facilitators for HAPPEN implementation included development of supportive formal and informal nurse leaders, staff engagement, and shared beliefs in the importance of care quality and infection prevention. Nurses worked together as a team to provide consistent oral care. Oral care was viewed as an essential infection control practice (not just “a task”) and was considered part of the “culture” and “mission” in caring for veterans.
Nurse leaders and direct-care staff were engaged throughout HAPPEN implementation, and most reported feeling supported and well prepared as they walked through the steps. Veterans reported positive experiences and increased knowledge about prevention of pneumonia. Lessons learned included building a community of practice and sharing expertise, which led to the successful replication of the HAPPEN initiative nationwide, improving patient safety and care quality and influencing health policy.
Monoclonal antibody therapeutics to treat coronavirus disease (COVID-19) have been authorized by the US Food and Drug Administration under Emergency Use Authorization (EUA). Many barriers exist when deploying a novel therapeutic during an ongoing pandemic, and it is critical to assess the needs of incorporating monoclonal antibody infusions into pandemic response activities. We examined the monoclonal antibody infusion site process during the COVID-19 pandemic and conducted a descriptive analysis using data from 3 sites at medical centers in the United States supported by the National Disaster Medical System. Monoclonal antibody implementation success factors included engagement with local medical providers, therapy batch preparation, placing the infusion center in proximity to emergency services, and creating procedures resilient to EUA changes. Infusion process challenges included confirming patient severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity, strained staff, scheduling, and pharmacy coordination. Infusion sites are effective when integrated into pre-existing pandemic response ecosystems and can be implemented with limited staff and physical resources.
The present study aimed to clarify the neuropsychological profile of the emergent diagnostic category of Mild Cognitive Impairment with Lewy bodies (MCI-LB) and determine whether domain-specific impairments such as in memory were related to deficits in domain-general cognitive processes (executive function or processing speed).
Patients (n = 83) and healthy age- and sex-matched controls (n = 34) underwent clinical and imaging assessments. Probable MCI-LB (n = 44) and MCI-Alzheimer’s disease (AD) (n = 39) were diagnosed following National Institute on Aging-Alzheimer’s Association (NIA-AA) and dementia with Lewy bodies (DLB) consortium criteria. Neuropsychological measures included cognitive and psychomotor speed, executive function, working memory, and verbal and visuospatial recall.
MCI-LB scored significantly lower than MCI-AD on processing speed [Trail Making Test B: p = .03, g = .45; Digit Symbol Substitution Test (DSST): p = .04, g = .47; DSST Error Check: p < .001, g = .68] and executive function [Trail Making Test Ratio (A/B): p = .04, g = .52] tasks. MCI-AD performed worse than MCI-LB on memory tasks, specifically visuospatial (Modified Taylor Complex Figure: p = .01, g = .46) and verbal (Rey Auditory Verbal Learning Test: p = .04, g = .42) delayed recall measures. Stepwise discriminant analysis correctly classified the subtype in 65.1% of MCI patients (72.7% specificity, 56.4% sensitivity). Processing speed accounted for more group-associated variance in visuospatial and verbal memory in both MCI subtypes than executive function, while no significant relationships between measures were observed in controls (all ps > .05)
MCI-LB was characterized by executive dysfunction and slowed processing speed but did not show the visuospatial dysfunction expected, while MCI-AD displayed an amnestic profile. However, there was considerable neuropsychological profile overlap and processing speed mediated performance in both MCI subtypes.
This study assessed the extent to which women's preconception binge drinking, tobacco use and cannabis use, reported prospectively in adolescence and young adulthood, predicted use of these substances during pregnancy and at 1 year postpartum.
Data were pooled from two intergenerational cohort studies: the Australian Temperament Project Generation 3 Study (395 mothers, 691 pregnancies) and the Victorian Intergenerational Health Cohort Study (398 mothers, 609 pregnancies). Alcohol, tobacco and cannabis use were assessed in adolescence (13–18 years), young adulthood (19–29 years) and at ages 29–35 years for those transitioning to parenthood. Exposures were weekly or more frequent preconception binge drinking (5 + drinks in one session), tobacco use and cannabis use. Outcomes were any alcohol, tobacco and cannabis use prior to awareness of the pregnancy, after awareness of pregnancy (up to and including the third trimester pregnancy) and at 1 year postpartum.
Frequent preconception binge drinking, tobacco use and cannabis use across both adolescence and young adulthood were strong predictors of continued use post-conception, before and after awareness of the pregnancy and at 1 year postpartum. Substance use limited to young adulthood also predicted continued use post-conception.
Persistent alcohol, tobacco use and cannabis use that starts in adolescence has a strong continuity into parenthood. Reducing substance use in the perinatal period requires action well before pregnancy, commencing in adolescence and continuing into the years before conception and throughout the perinatal period.
Dar es Salaam was a mecca for Third World liberation movements, whose presence in the city was fundamental to its emergence as a ‘Cold War city’. This chapter shows how their activities became embedded in the capital’s political life through the case of the assassination of the president of the Mozambican anticolonial movement FRELIMO. Eduardo Mondlane was a skilful politician who used the city’s international connections to publicise his movement’s cause and canvass for foreign support. However, as FRELIMO sought to draw on Cold War patronage to wage war against the Portuguese, it was gripped by an internal crisis that split the movement’s leadership along ethno-racial and ideological lines. Powerful gatekeepers within the Tanzanian political establishment aligned with Mondlane’s enemies to challenge him in public and undermine his security in private. These schisms facilitated the assassination of Mondlane in 1969 and clouded the waters of subsequent inquiries into the crime’s perpetrators.
Dar es Salaam’s politics became radicalised further still in the early 1970s. A series of developments – Britain’s proposal to sell arms to South Africa, a Portuguese invasion of Guinea-Conakry, and a coup in Uganda, plus internal unrest – propelled TANU into a gear-change in its socialist revolution. This resulted in the drafting of the ‘Guidelines’ or Mwongozo. This chapter shows how Mwongozo militarised Tanzanian society and concentrated power in the hands of party activists. These steps were taken with misgivings from Julius Nyerere and proved fractious among several of his trusted colleagues. While the government continued to talk the language of continental revolution, this was accompanied by a toughening of the national institutions of the party-state. The motor for development was increasingly believed to be popular mobilisation through the organs of the party rather than the economic planning that had previously tempered revolutionary interventionism. Meanwhile, the troublesome regime in semi-autonomous Zanzibar was brought to heel. National unity was achieved and enforced from above, but came at political cost.
How did Dar es Salaam became a ‘Cold War city’ in Africa? This chapter sets out the principles which informed the basis of Julius Nyerere’s engagement with the outside world – a set of foreign policy coordinates which remained remarkably consistent. It then shows how a violent revolution in the Zanzibar archipelago pushed Tanganyika into a hasty union with the islands, while an army mutiny in Dar es Salaam exposed the fragility of Nyerere’s government. A series of foreign policy crises with major Western states followed. Meanwhile, Tanzania reached out to the socialist world and developed close connections with China. By the mid-1960s, Dar es Salaam had attracted the attention of the Cold War world. The remainder of the chapter then demonstrates how a ‘Cold War political culture’ became inscribed into Dar es Salaam’s public sphere and concrete spaces. Propaganda, rumour, and espionage were major preoccupations of the Tanzanian government.
The rivalry between the two states of divided Germany played out on a global scale across the Third World. The chain of upheavals in East Africa in 1964-65 led to Dar es Salaam becoming the first African capital south of the Sahara in which the German Democratic Republic maintained a diplomatic mission. This turned the city into a propaganda battlefield. East Berlin strove for full recognition from Tanzania, while Bonn tried to prevent such a development from coming to pass. In the face of this rivalry, Julius Nyerere’s government sought to pursue a non-aligned foreign policy and broker aid agreements to further its socialist project. Adopting a triangular approach, this chapter demonstrates how Tanzania’s relationship with the two German states turned on developments in Central Europe, especially West Germany’s Ostpolitik. It reveals the challenges of upholding non-alignment in a Cold War world which did not revolve around simple binaries and was complicated by politics ‘on the ground’ in Dar es Salaam.
This chapter explores the debates about the future of the Tanzanian state after independence, which culminated in the Arusha Declaration of 1967. It sets out the contours of elite-level conversations about development in the 1960s, as Tanzania groped for a path forwards that would translate independence into meaningful socio-economic progress. After showing how Julius Nyerere’s decision to embark on a radical programme of socialist reform was motivated by local unrest and the fate of postcolonial regimes elsewhere in Africa, it then revisits the little-understood politics of the Arusha Declaration and its fallout. Offering an alternative dimension to readings of Arusha as a stimulant for national unity, the chapter demonstrates how Tanzania’s socialist revolution created fissures among the political elite. In particular, it pushed Oscar Kambona, a prominent politician, into exile in Britain. The Arusha Declaration represented a critical turning point in Tanzania’s postcolonial history that narrowed space for dissent, while also sowing the seeds for future challenges to the TANU party-state.
By the mid-1970s, much of the wind had gone out of the sails of Tanzania’s socialist project. Economic crisis, political authoritarianism, and the collapse of the Portuguese empire meant that Dar es Salaam ceased to be a major centre of anticolonial revolution in Africa. This concluding chapter briefly traces this demise and then sets out the book’s major findings and their implications. It finishes with a short reflection on the legacy of Dar es Salaam’s revolutionary past for Tanzania today.
From Tanganyika’s independence in 1961 to the collapse of the Portuguese empire in 1974, Dar es Salaam was an epicentre of revolution in Africa. The representatives of anticolonial liberation movements set up offices in the city, attracting the interest of the Cold War powers, who sought to expand their influence in the Third World. Meanwhile, the Tanzanian government sought to translate independence into meaningful decolonisation through an ambitious project to build a socialist state. This chapter explains how the lens of the city reveals the connections between the dynamics of the Cold War, decolonisation, and socialist state-making in Tanzania. It locates this approach among new approaches to the history of the Cold War, decolonisation, and global cities. Scattered across continents, the postcolonial archive offers the potential for exploring the revolutionary dynamics which intersected in Dar es Salaam.
What was the relationship between a revolutionary African state and the postcolonial media? This chapter analyses the evolution of the press in Dar es Salaam after independence. By the mid-1970s, Tanzania had just two national daily newspapers, one of which was owned by the party, the other by the state. But this was not the outcome of a teleological slide from an independent to a muzzled media, as liberal Cold War-era conceptions of the ‘freedom of the press’ would have it. This chapter shows how the press became a contested site of socialist politics in Dar es Salaam’s internationalised media world. Stakeholders debated questions of who should own newspapers, who should work for them, and what they should write in them. Even when the government nationalised the country’s only independent English-language newspaper, it placed it under the control of a radical, foreign editor and emphasised the need for it to serve as a critical voice. However, when this editorial independence transgressed Tanzania’s foreign policy, the state moved to bring the press under closer control, justified by Third World trends towards ‘development media’.