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The aim of this study was to identify and prioritize strategies for strengthening public health system resilience for pandemics, disasters, and other emergencies using a scorecard approach.
The United Nations Public Health System Resilience Scorecard (Scorecard) was applied across 5 workshops in Slovenia, Turkey, and the United States of America. The workshops focused on participants reviewing and discussing 23 questions/indicators. A Likert type scale was used for scoring with zero being the lowest and 5 the highest. The workshop scores were analyzed and discussed by participants to prioritize areas of need and develop resilience strategies. Data from all workshops were aggregated, analyzed, and interpreted to develop priorities representative of participating locations.
Eight themes emerged representing the need for better integration of public health and disaster management systems. These include: assessing community disease burden; embedding long-term recovery groups in emergency systems; exploring mental health care needs; examining ecosystem risks; evaluating reserve funds; identifying what crisis communication strategies worked well; providing non-medical services; and reviewing resilience of existing facilities, alternate care sites, and institutions.
The Scorecard is an effective tool for establishing baseline resilience and prioritizing actions. The strategies identified reflect areas in most need for investment to improve public health system resilience.
Although individuals born at extremely low birth weight (ELBW; ≤1000 g) are known to be at greater risk for mental health problems than individuals born at normal birth weight (NBW; ≥2500 g), contributions of postnatal growth to these relations have not been fully explored. We compared individual differences in the Ponderal Index [(PI; weight(kg)/height(m3)] and head circumference (HC) in predicting internalizing and externalizing behaviors in childhood and adolescence in a cohort of ELBW survivors (N = 137) prospectively followed since birth. Baseline models indicated that infants who were born thinner or with smaller HC showed greater PI or HC growth in the first 3 years. Latent difference score (LDS) models showed that compensatory HC growth in the first year (ΔHC = 20.72 cm), controlled for birth HC, predicted ADHD behaviors in adolescence in those born with smaller HC. LDS models also indicated that the PI increased within the first year (ΔPI = 1.568) but decreased overall between birth and age 3 years (net ΔPI = −4.597). Modeling further showed that larger increases in the PI in the first year and smaller net decreases over 3 years predicted more internalizing behaviors in adolescence. These findings suggest early growth patterns prioritizing weight over height may have negative effects on later mental health in ELBW survivors, consistent with developmental programming theories.
Vulnerable populations were the most impacted by the COVID-19 pandemic. This included those with underlying health conditions, self-employed, low-income, people with limited access to health care, and the elderly. To capture these lessons and identify resilience actions, the Health Emergency and Disaster Risk Management (Health EDRM) Framework was used to guide the application of the Public Health System Resilience Scorecard (Scorecard).
This study was conducted in Australia, Bangladesh, Japan, Slovenia, Turkey, and the United States. Participants included emergency professionals, doctors, nurses, environmental health specialists, researchers, and government officials. The Scorecard was used to rank the level of preparedness from 0-5 (5 the highest) for the public health system resilience indicators. Following the individual workshops, recommendations were collated and interpreted to develop consolidated priority actions.
The priority actions related to surge capacity, mental health, ecosystems, societal needs, and high-risk populations. To address surge capacity issues, determining whether existing disaster structures have the capacity to provide support for hospitals during patient surges. This could include services that enable telehealth and primary health care to support hospitals during a crisis. Mental health services at the local government level should be evaluated and awareness of ecosystem risks in urban and rural areas needs to increase. Strategies for achieving reciprocal trust are required to enable uptake of public health information, and the extent at which pre-existing chronic health issues are likely to exacerbate needs to be understood and addressed.
This study revealed several areas for strengthening public health system resilience. Priority actions relate to addressing needs relating to surge capacity, mental health, ecosystems, societal needs, and high-risk populations. This serves as a framework for transforming public health systems to become more adaptive, flexible, and focused on enabling societies to function at the highest possible level when responding to a disaster or pandemics.
Mood problems are common after stroke, and screening is recommended. Training may support staff knowledge and implementation of screening, but the feasibility of training programmes in the Australian healthcare system has not been formally established. This study aimed to assess the feasibility of a mood screening training for a multidisciplinary team (MDT) of stroke clinicians working in a post-acute inpatient rehabilitation service.
Twelve staff from a rehabilitation service at a major hospital in Sydney, Australia participated in a 3-h interactive training session. The feasibility of running the course, assessment of knowledge gained via a consolidation exercise and quiz and acceptability of the training were assessed via focus groups.
The in-person modality of the training hindered recruitment and assessment of participants’ knowledge, though the actual measures themselves appeared appropriate. Nine participants provided feedback in two focus groups. Thematic analysis identified positive reactions to the training. However, low self-efficacy persisted and organisational/socio-cultural barriers to implementation emerged. Following training, the medical officers of the MDT had successfully implemented routine screening.
Overall, the training appeared acceptable and to foster knowledge in staff. However, limitations to recruitment and administering evaluations were identified. The development of flexible online training may improve future evaluations of screening training programmes/pathways.
In the book’s afterword, I suggest that the period studied in this book has drawn to a close, as literary liberals have become both less interested in responding to postmodernism and more interested in rejecting free-market politics, including the centrist, communitarian version of this politics. To illustrate this shift, I compare texts published on either side of the 2008 financial crisis. In Then We Came to the End (2007), Joshua Ferris experiments with a collective first-person narrator in order to dramatize the tensions of office life, tensions which he figures in terms of the oppositions between elitism and egalitarianism and between sincerity and irony. Ferris’s self-reflexive interest in forging empathetic connections between workers, bosses, readers, and writers makes his novel a quintessential post-postmodern text. Philipp Meyer’s American Rust (2009) and Lorrie Moore’s A Gate at the Stairs (2009) by contrast, are precisely the kind of “angry” books “about work” that Ferris rejects. In formally distinct ways, both novels offer a political vision skeptical of centrism and committed to the irreducibility of class as a source of political and economic conflict.
My second chapter begins with a comparison of Jonathan Franzen and Ben Marcus, two writers who embody the competing aesthetic visions of contemporary “realists” and “experimentalists.” Focusing on their work and their high-profile debate about literary difficulty, I argue that their mutual commitment to their “community of readers” (as Franzen puts it) and to narratives of “the family gone wrong” (as Marcus puts it) actually points to a shared social vision, a vision in which “family” values are more important than aesthetic and political antagonisms. This focus on the family also cuts across the oppositions central to contemporary American politics, I show, and it informs the fiction and criticism of writers like Jeffrey Eugenides, Aimee Bender, and George Saunders. This domestic turn is figured, in several of these texts, as a revision of both American individualism and postmodern impersonality. I make the case that this triangulating impulse generates a range of formal innovations, from Eugenides’s re-invention of “the marriage plot” to Marcus’s self-reflexive blending of experimental impersonality and post-postmodern “emotionality.”
In this chapter, I show how Richard Powers’s 1998 novel Gain symbolically resolves the conflict between transnational corporate “stakeholders” and shareholders. In this way, the novel reveals what is already implicit in such “non-governmental” movements as “stakeholder activism,” which flourished during the 1990s in response to the rise of transnational corporations and right-wing critiques of the state. These non-governmental movements imagine a political field structured not by antagonism but by a plurality of interests, and they assume that these interests can be recognized and coordinated by a government (elected or corporate) that can somehow stand outside this realm of interests. I conclude this chapter by contrasting Gain’s post-political vision, as I call it, with that of Colson Whitehead’s Apex Hides the Hurt (2006), a novel about a “nomenclature consultant” hired to rename a small town. The novel’s resolution stages a rejection of the impulse to allow profitability to drive governance, and the discordant historical name selected by the protagonist — “Struggle” — also names the very thing hidden by corporate governance and non-governmental politics.
This introduction offers an extended reading of David Foster Wallace’s 2000 foray into political journalism, “Up, Simba,” which illustrates what will be the central claim of this book: that literary post-postmodernism is best understood as the means by which left-leaning writers negotiate the neoliberal turn — a version of, rather than an alternative to, this new consensus. To make that case, I trace connections between the communitarian logic of the so-called New Sincerity, the form of post-postmodernism most closely associated with Wallace, and the interventions of Bill Clinton and the New Democrats, who rejected key New Deal principles in favor of a "third way" between liberalism and conservativism. This introduction also historicizes "postcritique" and the various "post-ideological" accounts of neoliberal culture, accounts which, in my view, reproduce contemporary liberalism’s ambivalence about the free market and free-market politics, and therefore can be understood as symptomatic of the very changes they seek to interpret.
Karen Tei Yamashita’s Tropic of Orange (1997) parodies the North American Free Trade Agreement, but it characterizes the fight over free trade in the same terms as NAFTA’s liberal supporters, who represent this fight as a struggle between “zero-sum nationalism” and an emerging network of transnational “enterprise-webs.” Just as NAFTA’s supporters imagine a global free market comprised solely of “human capital,” Yamashita imagines an "expanding symphony" comprised solely of "conductors" attuned to transnational complexity -- a vision which depends on a disavowal of the structural differences that make such collectives possible. Sesshu Foster’s Atomik Aztex (2005), meanwhile, suggests that framing the conflicts faced by Mexican migrants as epistemic conflicts is a mistake. His novel imagines an alternative history in which the “Aztex” defeated the Spanish and non-Western cultural and epistemic values have triumphed, but the violence of exploitation remains. At the same, Foster’s novel ultimately suggests that migrant workers can create the possibility of an “alternative future” by embracing a vision of a world defined by class antagonisms rather than by epistemic conflicts.
This chapter explores texts that articulate the differences and continuities between Reaganite neoliberalism, as represented by Bret Easton Ellis’s American Psycho, and Clintonian neoliberalism, as represented in Clinton’s own speeches, Joe Klein’s Primary Colors, and the work of Mary Gaitskill. Clinton’s defense of welfare reform attaches a therapeutic rationale to right-wing ideals like “personal responsibility," and we see this same logic in in Gaitskill’s post-feminist interventions into ‘90s-era debates about female masochism and campus sex codes. We also see how this personalizing logic resolves political conflict in her novel Two Girls, Fat and Thin, in which what could be understood as an ideological disagreement about capitalism — the tension between a left-leaning journalist and a follower of a thinly-veiled version of Ayn Rand — proves to be a product of the two women’s failure to take "responsibility" for their own emotional experiences. In this chapter, I also examine how the logic of welfare-reform is contested by novels like Richard Price’s Clockers and Sapphire’s Push, both of which seek to demystify the “workfare” state’s idealization of legal, low-wage work.
Liberalism and American Literature in the Clinton Era argues that a new, post-postmodern aesthetic emerges in the 1990s as a group of American writers – including Mary Gaitskill, George Saunders, Richard Powers, Karen Tei Yamashita, and others – grapples with the political triumph of free-market ideology. The book shows how these writers resist the anti-social qualities of this frantic right-wing shift while still performing its essential gesture, the personalization of otherwise irreducible social antagonisms. Thus, we see these writers reinvent political struggles as differences in values and emotions, in fictions that explore non-antagonistic social forms like families, communities and networks. Situating these formally innovative fictions in the context of the controversies that have defined this rightward shift – including debates over free trade, welfare reform, and family values – Brooks details how American writers and politicians have reinvented liberalism for the age of pro-capitalist consensus.
Cyclosporiasis is an illness characterised by watery diarrhoea caused by the food-borne parasite Cyclospora cayetanensis. The increase in annual US cyclosporiasis cases led public health agencies to develop genotyping tools that aid outbreak investigations. A team at the Centers for Disease Control and Prevention (CDC) developed a system based on deep amplicon sequencing and machine learning, for detecting genetically-related clusters of cyclosporiasis to aid epidemiologic investigations. An evaluation of this system during 2018 supported its robustness, indicating that it possessed sufficient utility to warrant further evaluation. However, the earliest version of CDC's system had some limitations from a bioinformatics standpoint. Namely, reliance on proprietary software, the inability to detect novel haplotypes and absence of a strategy to select an appropriate number of discrete genetic clusters would limit the system's future deployment potential. We recently introduced several improvements that address these limitations and the aim of this study was to reassess the system's performance to ensure that the changes introduced had no observable negative impacts. Comparison of epidemiologically-defined cyclosporiasis clusters from 2019 to analogous genetic clusters detected using CDC's improved system reaffirmed its excellent sensitivity (90%) and specificity (99%), and confirmed its high discriminatory power. This C. cayetanensis genotyping system is robust and with ongoing improvement will form the basis of a US-wide C. cayetanensis genotyping network for clinical specimens.
Colleges and universities around the world engaged diverse strategies during the COVID-19 pandemic. Baylor University, a community of ˜22,700 individuals, was 1 of the institutions which resumed and sustained operations. The key strategy was establishment of multidisciplinary teams to develop mitigation strategies and priority areas for action. This population-based team approach along with implementation of a “Swiss Cheese” risk mitigation model allowed small clusters to be rapidly addressed through testing, surveillance, tracing, isolation, and quarantine. These efforts were supported by health protocols including face coverings, social distancing, and compliance monitoring. As a result, activities were sustained from August 1 to December 8, 2020. There were 62,970 COVID-19 tests conducted with 1435 people testing positive for a positivity rate of 2.28%. A total of 1670 COVID-19 cases were identified with 235 self-reports. The mean number of tests per week was 3500 with approximately 80 of these positive (11/d). More than 60 student tracers were trained with over 120 personnel available to contact trace, at a ratio of 1 per 400 university members. The successes and lessons learned provide a framework and pathway for similar institutions to mitigate the ongoing impacts of COVID-19 and sustain operations during a global pandemic.
Parental acquired communication disability has long-lasting impacts on children, including increased child stress and behavioural problems. However, speech-language pathologists’ (SLPs) current practice in providing information, education and counselling support to these children is unknown. Therefore, we explored SLPs’ perceived needs, current practices and barriers and facilitators to working with children of people with acquired communication disability (PwCD).
An online survey sought information on Australian SLPs’ current practices in providing education and counselling to children of PwCD. Perceived barriers and facilitators were mapped to the COM-B, a model that considers Capability, Opportunity and Motivation as domains that influence behaviour.
75% of participants (n = 76) perceived a need to provide both information and counselling, but ‘never’ or ‘rarely’ provided either aspect of care. Barriers relating to ‘Opportunity’ were most frequently identified, such as not having access to children in therapy and lack of parental support/engagement. Capability (e.g., knowledge and skills) and Motivation (e.g., confidence) barriers were also identified.
There is potential for SLPs to provide services to children of PwCD either directly through information and/or counselling-type interactions or indirectly through referral to other services. This study highlights the need for more research into these areas of practice.