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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)
To prioritise and refine a set of evidence-informed statements into advice messages to promote vegetable liking in early childhood, and to determine applicability for dissemination of advice to relevant audiences.
A nominal group technique (NGT) workshop and a Delphi survey were conducted to prioritise and achieve consensus (≥70% agreement) on 30 evidence-informed maternal (perinatal and lactation stage), infant (complementary feeding stage) and early years (family diet stage) vegetable-related advice messages. Messages were validated via triangulation analysis against the strength of evidence from an Umbrella review of strategies to increase children’s vegetable liking, and gaps in advice from a Desktop review of vegetable feeding advice.
A purposeful sample of key stakeholders (NGT workshop, n=8 experts; Delphi survey, n=23 end-users).
Participant consensus identified the most highly ranked priority messages associated with the strategies of: ‘in-utero exposure’ (perinatal and lactation, n=56 points); and ‘vegetable variety’ (complementary feeding, n=97 points; family diet, n=139 points). Triangulation revealed two strategies (‘repeated exposure’ and ‘variety’) and their associated advice messages suitable for policy and practice, 12 for research and four for food industry.
Supported by national and state feeding guideline documents and resources, the advice messages relating to ‘repeated exposure’ and ‘variety’ to increase vegetable liking can be communicated to families and caregivers by healthcare practitioners. The food industry provides a vehicle for advice promotion and product development. Further research, where stronger evidence is needed, could further inform strategies for policy and practice, and food industry application.
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.
(i) Describe the development of a multipurpose Cardio-Med survey tool (CMST) comprising a semi-quantitative FFQ designed to measure dietary intake in multicultural patients with or at high risk of CVD and (ii) report pilot evaluation of test–retest reliability and validity of the FFQ in measuring energy and nutrient intakes.
The CMST was developed to identify CVD risk factors and assess diet quality over 1 year using an FFQ. Design of the ninety-three-item FFQ involved developing food portion photographs, and a list of foods appropriate for the Australian multicultural population allowing the capture of adherence to a Mediterranean diet pattern. The FFQ was administered twice, 2 weeks apart to assess test–retest reliability, whilst validity was assessed by comparison of the FFQ with a 3-d food record (3DFR).
The Northern Hospital and St Vincent’s Hospital, Melbourne, Australia.
Thirty-eight participants aged 34–81 years with CVD or at high risk.
Test–retest reliability of the FFQ was good: intraclass correlation coefficient (ICC) ranged from 0·52 (Na) to 0·88 (alcohol) (mean 0·79), with energy and 70 % of measured nutrients being above 0·75. Validity was moderate: ICC ranged from 0·08 (Na) to 0·94 (alcohol) (mean 0·59), with energy and 85 % of measured nutrients being above 0·5. Bland–Altman plots demonstrated good levels of agreement between the FFQ and 3DFR for carbohydrates, protein, alcohol, vitamin D and Na.
The CMST FFQ demonstrated good test–retest reliability and moderate validity for measuring dietary energy and nutrients in a multicultural Australian cardiology population.
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.
Our understanding about the genetic influences on human disease has increased dramatically with the technological developments in genome and DNA analysis and the discovery of the human genome sequence. Whilst much remains unexplained, it is obvious that normal cardiac development is controlled by the genome and there is significant evidence that a proportion of cardiac malformations are caused by genetic factors. This is important for clinicians as an understanding of confirmed genetic factors is essential to estimate recurrence risks of congenital heart disease (CHD) within families and also screen for predicted associated anomalies. An accurate genetic diagnosis can provide important prognostic information for both the initial patient (proband) and other family members, for whom further genetic investigations may be indicated. There is likely to be a continued increase in demand for such investigations as improvement in surgical and medical management allows more individuals with CHD to survive to reproductive age and have families of their own. For some, the recurrence risk for a cardiac malformation may be as high as 50%; the actual figure varies with different genetic diagnoses. Accurate risk stratification is likely to become increasingly important and the rapidly developing technologies to detect genetic variation mean that genome-wide investigation is becoming more widely available in the clinical setting. An aim of this chapter is to introduce clinicians to principles that will help them embrace and understand the results from these investigations and appreciate the implications they have for their patients.
The Minnesota Center for Twin and Family Research (MCTFR) comprises multiple longitudinal, community-representative investigations of twin and adoptive families that focus on psychological adjustment, personality, cognitive ability and brain function, with a special emphasis on substance use and related psychopathology. The MCTFR includes the Minnesota Twin Registry (MTR), a cohort of twins who have completed assessments in middle and older adulthood; the Minnesota Twin Family Study (MTFS) of twins assessed from childhood and adolescence into middle adulthood; the Enrichment Study (ES) of twins oversampled for high risk for substance-use disorders assessed from childhood into young adulthood; the Adolescent Brain (AdBrain) study, a neuroimaging study of adolescent twins; and the Siblings Interaction and Behavior Study (SIBS), a study of adoptive and nonadoptive families assessed from adolescence into young adulthood. Here we provide a brief overview of key features of these established studies and describe new MCTFR investigations that follow up and expand upon existing studies or recruit and assess new samples, including the MTR Study of Relationships, Personality, and Health (MTR-RPH); the Colorado-Minnesota (COMN) Marijuana Study; the Adolescent Brain Cognitive Development (ABCD) study; the Colorado Online Twins (CoTwins) study and the Children of Twins (CoT) study.
An improved understanding of diagnostic and treatment practices for patients with rare primary mitochondrial disorders can support benchmarking against guidelines and establish priorities for evaluative research. We aimed to describe physician care for patients with mitochondrial diseases in Canada, including variation in care.
We conducted a cross-sectional survey of Canadian physicians involved in the diagnosis and/or ongoing care of patients with mitochondrial diseases. We used snowball sampling to identify potentially eligible participants, who were contacted by mail up to five times and invited to complete a questionnaire by mail or internet. The questionnaire addressed: personal experience in providing care for mitochondrial disorders; diagnostic and treatment practices; challenges in accessing tests or treatments; and views regarding research priorities.
We received 58 survey responses (52% response rate). Most respondents (83%) reported spending 20% or less of their clinical practice time caring for patients with mitochondrial disorders. We identified important variation in diagnostic care, although assessments frequently reported as diagnostically helpful (e.g., brain magnetic resonance imaging, MRI/MR spectroscopy) were also recommended in published guidelines. Approximately half (49%) of participants would recommend “mitochondrial cocktails” for all or most patients, but we identified variation in responses regarding specific vitamins and cofactors. A majority of physicians recommended studies on the development of effective therapies as the top research priority.
While Canadian physicians’ views about diagnostic care and disease management are aligned with published recommendations, important variations in care reflect persistent areas of uncertainty and a need for empirical evidence to support and update standard protocols.
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.
Training for the clinical research workforce does not sufficiently prepare workers for today’s scientific complexity; deficiencies may be ameliorated with training. The Enhancing Clinical Research Professionals’ Training and Qualifications developed competency standards for principal investigators and clinical research coordinators.
Clinical and Translational Science Awards representatives refined competency statements. Working groups developed assessments, identified training, and highlighted gaps.
Forty-eight competency statements in 8 domains were developed.
Training is primarily investigator focused with few programs for clinical research coordinators. Lack of training is felt in new technologies and data management. There are no standardized assessments of competence.
The translation of discoveries to drugs, devices, and behavioral interventions requires well-prepared study teams. Execution of clinical trials remains suboptimal due to varied quality in design, execution, analysis, and reporting. A critical impediment is inconsistent, or even absent, competency-based training for clinical trial personnel.
In 2014, the National Center for Advancing Translational Science (NCATS) funded the project, Enhancing Clinical Research Professionals’ Training and Qualifications (ECRPTQ), aimed at addressing this deficit. The goal was to ensure all personnel are competent to execute clinical trials. A phased structure was utilized.
This paper focuses on training recommendations in Good Clinical Practice (GCP). Leveraging input from all Clinical and Translational Science Award hubs, the following was recommended to NCATS: all investigators and study coordinators executing a clinical trial should understand GCP principles and undergo training every 3 years, with the training method meeting the minimum criteria identified by the International Conference on Harmonisation GCP.
We anticipate that industry sponsors will acknowledge such training, eliminating redundant training requests. We proposed metrics to be tracked that required further study. A separate task force was composed to define recommendations for metrics to be reported to NCATS.
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.
This chapter shows that there is a crucial anthropological dimension to Immanuel Kant's account of cognition that has been unacknowledged until now. Kant's anthropology of cognition develops along two complementary lines. On the one hand, it studies nature's purposes for the human species, the natural dimension of human cognition. On the other hand, it uses this knowledge to realise the cognitive vocation, the pragmatic dimension of human cognition. This pragmatic dimension consists in spelling out the natural subjective conditions that help or hinder the cognition, thereby enabling one to become more cognitively efficacious. To illustrate this claim, the chapter examines the case of human temperaments. It discusses the idea that Kant's anthropology of cognition has a pragmatic dimension turns out to be problematic. The chapter shows that Kant makes room for a form of control that is sufficient to account for the possibility of a pragmatic anthropology of cognition.