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Background: Healthcare facilities have experienced many challenges during the COVID-19 pandemic, including limited personal protective equipment (PPE) supplies. Healthcare personnel (HCP) rely on PPE, vaccines, and other infection control measures to prevent SARS-CoV-2 infections. We describe PPE concerns reported by HCP who had close contact with COVID-19 patients in the workplace and tested positive for SARS-CoV-2. Method: The CDC collaborated with Emerging Infections Program (EIP) sites in 10 states to conduct surveillance for SARS-CoV-2 infections in HCP. EIP staff interviewed HCP with positive SARS-CoV-2 viral tests (ie, cases) to collect data on demographics, healthcare roles, exposures, PPE use, and concerns about their PPE use during COVID-19 patient care in the 14 days before the HCP’s SARS-CoV-2 positive test. PPE concerns were qualitatively coded as being related to supply (eg, low quality, shortages); use (eg, extended use, reuse, lack of fit test); or facility policy (eg, lack of guidance). We calculated and compared the percentages of cases reporting each concern type during the initial phase of the pandemic (April–May 2020), during the first US peak of daily COVID-19 cases (June–August 2020), and during the second US peak (September 2020–January 2021). We compared percentages using mid-P or Fisher exact tests (α = 0.05). Results: Among 1,998 HCP cases occurring during April 2020–January 2021 who had close contact with COVID-19 patients, 613 (30.7%) reported ≥1 PPE concern (Table 1). The percentage of cases reporting supply or use concerns was higher during the first peak period than the second peak period (supply concerns: 12.5% vs 7.5%; use concerns: 25.5% vs 18.2%; p Conclusions: Although lower percentages of HCP cases overall reported PPE concerns after the first US peak, our results highlight the importance of developing capacity to produce and distribute PPE during times of increased demand. The difference we observed among selected groups of cases may indicate that PPE access and use were more challenging for some, such as nonphysicians and nursing home HCP. These findings underscore the need to ensure that PPE is accessible and used correctly by HCP for whom use is recommended.
Over the past century, scholars have identified examples of liturgical chant belonging to more than one Western liturgical tradition, including Franco-Roman, Old Hispanic, Old Beneventan and Milanese. In a seminal study, Kenneth Levy identified a set of offertories that circulate in the Franco-Roman, Old Hispanic and Milanese traditions, arguing that all existing versions derive from an earlier, Gallican tradition. This article expands the evidence for connections between the Franco-Roman and Old Hispanic traditions, identifying nearly two dozen Franco-Roman responsories that are shared with the Old Hispanic rite and may be of Gallican or Iberian origin. The diversity of their liturgical assignments and circulation patterns suggests that the exchange of repertory took place at different times and through different routes. Many of these responsories are assigned to the later layers of the Roman liturgy. Others were added to the Old Hispanic liturgy between the eighth and tenth centuries.
Just over half of these responsories show enough melodic connections between the Franco-Roman and Old Hispanic versions, in contour and melismatic density, to imply a shared melodic ancestor. Each version, however, uses the formulas associated with its own tradition, indicating that the melodies have been assimilated to the style and formulaic content of the receiving tradition. Despite the resulting melodic differences, we identify certain commonalities between Franco-Roman and Old Hispanic chant, such as text-setting strategies and common cadential contours, that facilitated the exchange of repertory.
The primary topic of our chapter is the need for possible theoretical foundations of, and empirical approaches to, a developmental science of politics. We demonstrate the utility of studying political socialisation surrounding presidential elections by describing the results of a large study of US elementary-school-age children’s views of the 2016 US presidential election. We review some potential sources of influence on children's political knowledge and attitudes, highlighting the role of gender, and we speculate about the beliefs that children may have internalised from watching the 2016 election. Finally, we argue that US institutions and parents should strive to improve children's political socialisation by, for example, providing youth with environments that are rich in information related to the purpose and value of politics, and ripe with opportunities and encouragement for political thought and action.
Parents who receive a diagnosis of a severe, life-threatening CHD for their foetus or neonate face a complex and stressful decision between termination, palliative care, or surgery. Understanding how parents make this initial treatment decision is critical for developing interventions to improve counselling for these families.
Methods:
We conducted focus groups in four academic medical centres across the United States of America with a purposive sample of parents who chose termination, palliative care, or surgery for their foetus or neonate diagnosed with severe CHD.
Results:
Ten focus groups were conducted with 56 parents (Mage = 34 years; 80% female; 89% White). Results were constructed around three domains: decision-making approaches; values and beliefs; and decision-making challenges. Parents discussed varying approaches to making the decision, ranging from relying on their “gut feeling” to desiring statistics and probabilities. Religious and spiritual beliefs often guided the decision to not terminate the pregnancy. Quality of life was an important consideration, including how each option would impact the child (e.g., pain or discomfort, cognitive and physical abilities) and their family (e.g., care for other children, marriage, and career). Parents reported inconsistent communication of options by clinicians and challenges related to time constraints for making a decision and difficulty in processing information when distressed.
Conclusion:
This study offers important insights that can be used to design interventions to improve decision support and family-centred care in clinical practice.
In the changes brought about by remote working, the local psychotherapy case discussion group (Balint Group) has developed as a remote service via video consultation. It is important to consider the effect that this change in method of delivery has had on experience.
Method
An anonymous survey was distributed to determine the benefits and challenges from participants and facilitators with at least a month of virtual Balint Group experience. The open-ended survey questions captured extended answer responses from 16 students and trainees, and 5 (co-)facilitators, within Nottinghamshire Healthcare NHS Foundation Trust. The qualitative feedback was analysed by thematic analysis, identifying three main themes.
Result
The first theme of practicalities was centred around access to the group. The virtual format had benefits in terms of reducing travel and time commitment and so improving attendance. However, disadvantages were in technological issues and finding a private and safe environment, individuals often not leaving the work environment on which they were reflecting.
The second theme of communication identified how virtual methods are a less natural way of interacting (for example sequential point making), losing both immediacy of reactions and non-verbal communication. There was a loss of essential communication cues, with disjointed conversation affecting contribution.
The third theme of group dynamics had some advantages, feeling less intimidating virtually. Yet disadvantages included loss of group cohesion, with participants not building the same relationships (on arriving and leaving a group space), and trust. The more subtle emotions in the group might be missed and opinions given less openly. The facilitators needed to be more directive and experienced difficulties maintaining group engagement and managing the frame.
Conclusion
The advantages of virtual format are more based on accessibility and the disadvantages more experiential. There are elements of being physically remote that lead to a disembodied experience, that might impact on capacity to reflect emotionally. This might make it more difficult to identify unconscious processes and the experience might be more cognitive. There is a risk that virtually participants will feel more alone with difficult feelings and unsupported by the group.
When mental health is being affected by social isolation due to the pandemic, having groups virtually can mimic this isolation in working life. Overall the preference remained for an in-person group.
However, it was clear that access to some form of a group was important, to contain anxiety during these unprecedented times.
The number of people over the age of 65 attending Emergency Departments (ED) in the United Kingdom (UK) is increasing. Those who attend with a mental health related problem may be referred to liaison psychiatry for assessment. Improving responsiveness and integration of liaison psychiatry in general hospital settings is a national priority. To do this psychiatry teams must be adequately resourced and organised. However, it is unknown how trends in the number of referrals of older people to liaison psychiatry teams by EDs are changing, making this difficult.
Method
We performed a national multi-centre retrospective service evaluation, analysing existing psychiatry referral data from EDs of people over 65. Sites were selected from a convenience sample of older peoples liaison psychiatry departments. Departments from all regions of the UK were invited to participate via the RCPsych liaison and older peoples faculty email distribution lists. From departments who returned data, we combined the date and described trends in the number and rate of referrals over a 7 year period.
Result
Referral data from up to 28 EDs across England and Scotland over a 7 year period were analysed (n = 18828 referrals). There is a general trend towards increasing numbers of older people referred to liaison psychiatry year on year. Rates rose year on year from 1.4 referrals per 1000 ED attenders (>65 years) in 2011 to 4.5 in 2019 . There is inter and intra site variability in referral numbers per 1000 ED attendances between different departments, ranging from 0.1 - 24.3.
Conclusion
To plan an effective healthcare system we need to understand the population it serves, and have appropriate structures and processes within it. The overarching message of this study is clear; older peoples mental health emergencies presenting in ED are common and appear to be increasingly so. Without appropriate investment either in EDs or community mental health services, this is unlikely to improve.
The data also suggest very variable inter-departmental referral rates. It is not possible to establish why rates from one department to another are so different, or whether outcomes for the population they serve are better or worse. The data does however highlight the importance of asking further questions about why the departments are different, and what impact that has on the patients they serve.
Healthcare personnel with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection were interviewed to describe activities and practices in and outside the workplace. Among 2,625 healthcare personnel, workplace-related factors that may increase infection risk were more common among nursing-home personnel than hospital personnel, whereas selected factors outside the workplace were more common among hospital personnel.
OBJECTIVES/GOALS: Objectives: The study goal is to identify discriminating symptom characteristics of PAD versus non-ischemic conditions to improve recognition. Just as nausea, back, and jaw pain were once thought to be unrelated to myocardial infarction and coronary artery disease, patient-reported symptoms of PAD are frequently overlooked as being a sign of PAD. METHODS/STUDY POPULATION: Methods: Using a prospective de novo population-based cross-sectional design we will link symptom descriptors to PAD disease status using diagnostic testing in individuals who report lower extremity or buttock symptoms (n = 100). Symptom descriptors will be obtained via questionnaires and structured interviews will be completed pre and post physical function tests. Using near infrared spectroscopy, we will measure calf muscle tissue oxygenation levels to further differentiate ischemic vs. non-ischemic symptoms during exercise. The primary outcome will be the diagnostic accuracy of patient-reported symptoms which discriminate between PAD and non-PAD conditions. Positive predictive value and accuracy will be calculated using receiver operating characteristic (ROC) curve and chi-square analysis. RESULTS/ANTICIPATED RESULTS: Results: Previous studies from which symptom descriptors have been obtained were from patients with known PAD, of which 85-88% of participants were male.1–2 Seventy-six percent of this sample thus far is female. Nationally, PAD prevalence is 20% in those over the age of 70 years, however 58% of our study participants tested positive for PAD (via ankle brachial index test).3 The most commonly reported symptoms of PAD are “numbness” and “aching” vs. those without PAD most commonly reporting “cramping”. These results trend against our current understanding of PAD symptomatology, which is that cramping is the cardinal symptom of PAD.4 Preliminary analysis suggests that balance is a sensitive and specific predictor of PAD. Recruitment is ongoing, therefore results are preliminary. DISCUSSION/SIGNIFICANCE OF IMPACT: Translation of the results will impact primary care and community health. Improved disease detection will position providers to refer patients to exercise therapy before symptoms become disabling. Understanding the diagnostic accuracy of symptoms prepares us to apply novel techniques, such as statistical modeling, to systematically predict PAD.
Hurricanes can interrupt communication, exacerbate attrition, and disrupt participant engagement in research. We used text messaging and disaster preparedness protocols to re-establish communication, re-engage participants, and ensure retention in a human immunodeficiency virus (HIV) self-test study.
Methods:
Participants were given HIV home test kits to test themselves and/or their non-monogamous sexual partners before intercourse. A daily text message-based short message service computer-assisted self-interview (SMS-CASI) tool reminded them to report 3 variables: (1) anal sex without a condom, (2) knowledge of partners’ testing history, and (3) proof of partners’ testing history. A disaster preparedness protocol was put in place for hurricanes in Puerto Rico. We analyzed 6315 messages from participants (N = 12) active at the time of Hurricanes Irma and Maria. Disaster preparedness narratives were assessed.
Results:
All participants were able to communicate sexual behavior and HIV testing via SMS-CASI within 30 days following María. Some participants (n = 5, 42%) also communicated questions. Re-engagement within 30 days after the hurricane was 100% (second week/89%, third week/100%). Participant re-engagement ranged from 0–16 days (average = 6.4 days). Retention was 100%.
Conclusions:
Daily SMS-CASI and disaster preparedness protocols helped participant engagement and communication after 2 hurricanes. SMS-CASI responses indicated high participant re-engagement, retention, and well-being.
Secondary plant compounds have shown bioactivity against multi-drug resistant Haemonchus contortus in small ruminants. This study screened 51 strains of birdsfoot trefoil (BFT, Lotus corniculatus) crude aqueous extracts (BFT-AqE) for anti-parasitic activity in vitro against egg hatching, and of those 51 strains, 13 were selected for further testing of motility of first (L1) and third stage (L3) larvae, and exsheathment of L3. Proanthocyanidin content ranged between 1.4 and 63.8 mg PAC g−1 powder across the 51 BFT strains. When tested against egg hatching, 21 of the 51 aqueous extracts had an EC50 of 1–2 mg powder mL−1, 70% of the strains were >90% efficacious at 6 mg powder mL−1 and 11 of the strains were 100% efficacious at 3 mg powder mL−1 BFT-AqE. Across the 13 strains tested against L3, efficacy ranged from 0 to 75% exsheathment inhibition, and 17 to 92% L3 motility inhibition at a concentration of 25 mg powder mL−1 BFT-AqE. There was no correlation between the PAC content of BFT powders and the anti-parasitic activity of aqueous extracts, therefore other secondary compounds may have contributed to the observed anti-parasitic effects. Further testing of BFT using bioactivity-driven fractionation and screening of BFT populations for the identified anti-parasitic compounds is needed.
We examined prospective associations between men's common mental disorders in the decades prior to offspring conception and subsequent paternal antenatal mental health problems. Data came from a prospective intergenerational cohort study which assessed common mental disorder nine times from age 14 to 29 years, and in the third trimester of subsequent pregnancies to age 35 years (N = 295 pregnancies to 214 men). Men with histories of adolescent and young adult common mental disorders were over four times more likely to experience antenatal mental health problems. Future research identifying modifiable perinatal factors that counteract preconception risk would provide further targets for intervention.
The Taipan galaxy survey (hereafter simply ‘Taipan’) is a multi-object spectroscopic survey starting in 2017 that will cover 2π steradians over the southern sky (δ ≲ 10°, |b| ≳ 10°), and obtain optical spectra for about two million galaxies out to z < 0.4. Taipan will use the newly refurbished 1.2-m UK Schmidt Telescope at Siding Spring Observatory with the new TAIPAN instrument, which includes an innovative ‘Starbugs’ positioning system capable of rapidly and simultaneously deploying up to 150 spectroscopic fibres (and up to 300 with a proposed upgrade) over the 6° diameter focal plane, and a purpose-built spectrograph operating in the range from 370 to 870 nm with resolving power R ≳ 2000. The main scientific goals of Taipan are (i) to measure the distance scale of the Universe (primarily governed by the local expansion rate, H0) to 1% precision, and the growth rate of structure to 5%; (ii) to make the most extensive map yet constructed of the total mass distribution and motions in the local Universe, using peculiar velocities based on improved Fundamental Plane distances, which will enable sensitive tests of gravitational physics; and (iii) to deliver a legacy sample of low-redshift galaxies as a unique laboratory for studying galaxy evolution as a function of dark matter halo and stellar mass and environment. The final survey, which will be completed within 5 yrs, will consist of a complete magnitude-limited sample (i ⩽ 17) of about 1.2 × 106 galaxies supplemented by an extension to higher redshifts and fainter magnitudes (i ⩽ 18.1) of a luminous red galaxy sample of about 0.8 × 106 galaxies. Observations and data processing will be carried out remotely and in a fully automated way, using a purpose-built automated ‘virtual observer’ software and an automated data reduction pipeline. The Taipan survey is deliberately designed to maximise its legacy value by complementing and enhancing current and planned surveys of the southern sky at wavelengths from the optical to the radio; it will become the primary redshift and optical spectroscopic reference catalogue for the local extragalactic Universe in the southern sky for the coming decade.
This paper examines interactions between co-occupants of riverine niches in north-west Europe during the Late Upper Palaeolithic using both ecological and archaeological data. It is argued that consideration of both the Lateglacial record and autecology of eel, beaver and horse supports a reinterpretation of some famous but enigmatic panels of Magdalenian mobiliary art as representations of eel fishing, along with horse and beaver exploitation in disturbed riverine habitats. It is further suggested that this constitutes a humanly co-constructed niche in ecological, nutritional, and symbolic terms, which was also particularly advantageous for human well-being and social development in this time and place.
OBJECTIVES/SPECIFIC AIMS: Describe (1) the features of the first release of Duke’s myRESEARCHhome portal for researchers, and 2) the methods and results of adoption strategies METHODS/STUDY POPULATION: Through methods described previously (cite ACTS poster, 2016), the myRESEARCHhome portal team conducted a needs assessment to determine priorities for inclusion in the tool. Based on results of that assessment, the “minimal viable product” launched in June 2016 included the following features, organized into 9 distinct widgets: Access to all web-based research applications; ability to find and request research services; at-a-glance view of financial, protocol, and salary distribution information; access to financial and personnel reports; access to status of agreements and patents; access to CTSA-supported navigation services; visibility into required training and expiration dates; listing of announcements relevant to researchers; customized links area; ability to customize portal. The portal was developed using Ruby on Rails™, with a REACT grid framework. The development team, internal to Duke University, followed industry-standard best practices for development. After the initial release, the team employed several strategies to ensure awareness and adoption. Although written communications were an important factor for awareness, the presentations and hands-on studios proved most important. RESULTS/ANTICIPATED RESULTS: Use of the portal was directly related to in-person outreach efforts. There were small spikes after written communications, but strategies such as presentations, hands-on demonstrations, training sessions, and faculty meetings garnered the steadiest adoption rates. As of early January, 2017, almost 3000 users have interacted with the portal, with numbers rising steadily. There are an estimated 10,000+ faculty, staff, and trainees engaged in research at Duke. DISCUSSION/SIGNIFICANCE OF IMPACT: To maintain high adoption rates with the research community, engagement strategies must be ongoing. In addition to frequent in-person demonstrations, updates via written communications, and attendance at events, the portal team will employ a key adopt strategy—engaging the researchers in ongoing needs assessments. By maintaining the portal’s relevance to the needs of the research community, the tool can better improve the efficiency of research at a large academic medical center.
At some point during our inaugural research team workshop we started to generate many different ideas about how to increase participation in heritage decision-making. We tried to keep track as the questions flowed by writing recurring words on pieces of paper, to be linked, connected and ordered at some later point. The words were in some ways not surprising. Heritage, of course. Stewardship. Custodianship. Expert. Leadership. Institutions. Ownership. Differences/Tensions. Scale. Personal. Values. Voice (‘+ not heard’, was added in another hand in biro). So far, so predictable. These words, after all, index the big conceptual challenges that have been identified to a greater or lesser extent in heritage policy, practice and its research for the last four decades. Yet as we spoke, each of these terms started to change in dimension. As the different people around the table gave examples, and checked they understood each other's contributions, the familiar words were in the process of gathering new uncertainties and ambiguities as well as new colours, textures, shapes and potentials.
We were brought together by a funding scheme that supported not just collaborative research, but also its collaborative design. While we did have a shared interest in our overall question ‘how should heritage decisions be made?’, we – as you will see by how we describe ourselves – came to this question, and our first workshop, from quite different places and different trajectories. To frame it in the language implied by this book, we carried with us different inheritances – legacies – from our disciplines, professional backgrounds, organisations and places. As such, the other crucial thing we had in common was an interest in the potential for rethinking ‘heritage’ offered by drawing on many different perspectives and working across hierarchies and institutional boundaries. We used both these shared commitments and our different perspectives to collaboratively design our project.
In this chapter we tell the story of our project with the aim of showing how our research emerged through dynamic connections between know-how generated through practitioner reflections, dialogue, characterised by conversations between us as a project team and conceptual innovation, in terms of the way this allowed us to think about heritage and decision making differently.
To investigate biomarkers of nutrition associated with chronic disease absence for an Aboriginal cohort.
Design
Screening for nutritional biomarkers was completed at baseline (1995). Evidence of chronic disease (diabetes, CVD, chronic kidney disease or hypertension) was sought from primary health-care clinics, hospitals and death records over 10 years of follow-up. Principal components analysis was used to group baseline nutritional biomarkers and logistic regression modelling used to investigate associations between the principal components and chronic disease absence.
Setting
Three Central Australian Aboriginal communities.
Subjects
Aboriginal people (n 444, 286 of whom were without chronic disease at baseline) aged 15–82 years.
Results
Principal components analysis grouped twelve nutritional biomarkers into four components: ‘lipids’; ‘adiposity’; ‘dietary quality’; and ‘habitus with inverse quality diet’. For the 286 individuals free of chronic disease at baseline, lower adiposity, lower lipids and better dietary quality components were each associated with the absence at follow-up of most chronic diseases examined, with the exception of chronic kidney disease. Low ‘adiposity’ component was associated with absence of diabetes, hypertension and CVD at follow-up. Low ‘lipid’ component was associated with absence of hypertension and CVD, and high ‘dietary quality’ component was associated with absence of CVD at follow-up.
Conclusions
Lowering or maintenance of the factors related to ‘adiposity’ and ‘lipids’ to healthy thresholds and increasing access to a healthy diet appear useful targets for chronic disease prevention for Aboriginal people in Central Australia.
Effective psychological therapies have been recommended for common mental health problems, such as depression and anxiety, but provision has been poor. Improving Access to Psychological Therapies (IAPT) may provide a cost-effective solution to this problem.
Aims
To determine the cost-effectiveness of IAPT at the Doncaster demonstration site (2007–2009).
Method
An economic evaluation comparing costs and health outcomes for patients at the IAPT demonstration site with those for comparator sites, including a separate assessment of lost productivity. Sensitivity analyses were undertaken.
Results
The IAPT site had higher service costs and was associated with small additional gains in quality-adjusted life-years (QALYs) compared with its comparator sites, resulting in a cost per QALY gained of £29 500 using the Short Form (SF-6D). Sensitivity analysis using predicted EQ-5D scores lowered this to £16 857. Costs per reliable and clinically significant (RCS) improvement were £9440 per participant.
Conclusions
Improving Access to Psychological Therapies provided a service that was probably cost-effective within the usual National Institute for Health and Clinical Excellence (NICE) threshold range of £20 000-30 000, but there was considerable uncertainty surrounding the costs and outcome differences.