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Disasters have many deleterious effects and are becoming more frequent. From a health-care perspective, disasters may cause periods of stress for hospitals and health-care systems. Telemedicine is a rapidly growing technology that has been used to improve access to health-care during disasters. Telemedicine applied in disasters is referred to as disaster telemedicine. Our objective was to conduct a scoping literature review on current use of disaster telemedicine to develop recommendations addressing the most common barriers to implementation of a telemedicine system for regional disaster health response in the United States. Publications on telemedicine in disasters were collected from online databases. This included both publications in English and those translated into English. Predesigned inclusion/exclusion criteria and a PRISMA flow diagram were applied. The PRISMA flow diagram was used on the basis that it would help streamline the available literature. Literature that met the criteria was scored by 2 reviewers who rated relevance to commonly identified disaster telemedicine implementation barriers, as well as how disaster telemedicine systems were implemented. We also identified other frequently mentioned themes and briefly summarized recommendations for those topics. Literature scoring resulted in the following topics: telemedicine usage (42 publications), system design and operating models (43 publications), as well as difficulties with credentialing (5 publications), licensure (6 publications), liability (4 publications), reimbursement (5 publications), and technology (24 publications). Recommendations from each category were qualitatively summarized.
Total cost estimates for crime in the USA are both out-of-date and incomplete. We estimated incidence and costs of personal crimes (both violent and non-violent) and property crimes in 2017. Incidence came from national arrest data, multi-state estimates of police-reported crimes per arrest, national victimization and road crash surveys, and police underreporting studies. We updated and expanded upon published unit costs. Estimated crime costs totaled $2.6 trillion ($620 billion in monetary costs plus quality of life losses valued at $1.95 trillion; 95 % uncertainty interval $2.2–$3.0 trillion). Violent crime accounted for 85 % of costs. Principal contributors to the 10.9 million quality-adjusted life years lost were sexual violence, physical assault/robbery, and child maltreatment. Monetary expenditures caused by criminal victimization represent 3 % of Gross Domestic Product – equivalent to the amount spent on national defense. These estimates exclude the additional costs of preventing and avoiding crime such as enhanced lighting and burglar alarms. They also exclude crimes against businesses and most white-collar and corporate offenses.
This study examines whether the foreign language effect mitigates reactions to value-inconsistent sociopolitical content. We examined 69 English–Spanish bilinguals and 31 Spanish–English heritage bilinguals, half of whom did the experiment in their native language and half in their second language. Participants were administered a survey in which trial emotiveness was manipulated by using the quantifiers some and all (e.g., Some Trump supporters are racists vs. All Trump supporters are racists). The some-types (n = 30) served as a baseline for the all-types (n = 30). After each target, participants rated their willingness to be prosocial (e.g., holding the door for a stranger) on a scale of 1–7, 1 being totally agree and 7 being totally disagree. Our results suggest that processing emotional information in a second language is less emotional than in a first language and that such a decrease in emotionality results in the neutralization of offense taken. However, individual differences in linguistic profiles across participants, as well as contextual framing, lead to discrete value judgments. Proficiency, learner type, political affiliation, and context type affect willingness to engage in prosocial behavior. As a group, the bilinguals showed no decrease in their willingness to engage in such behaviors, regardless of context type; speakers of higher proficiency and stronger political values increase prosocial sentiment; and lower proficiency and weaker views lead to neutral prosocial sentiment.
There are numerous health effects associated with excess sugar-sweetened beverage (SSB) consumption. Interventions aimed at reducing population-level consumption require understanding of the relevant barriers and facilitators. This study aimed to identify the variables with the strongest relationship with intentions to reduce SSB consumption from a suite of variables derived from the literature.
Random digit dialling of landline and mobile phones was used to survey adults using Computer Assisted Telephone Interviews. The outcome variable was ‘likelihood of reducing SSB consumption in next 6 months’ and predictor variables were: demographics, SSB attitudes and behaviour, health risk perceptions and social/environmental exposure.
A subsample of 1630 regular SSB consumers from a nationally representative sample of 3430 Australian adults (38% female, 51% aged 18-45 years, 56% overweight or obese).
Respondents indicated that they were ‘not at all’ (30.1%), ‘somewhat’ (43.9%) and ‘very’ likely (25.3%) to reduce SSB consumption. Multi-variate nominal logistic regressions showed that perceiving future health to be ‘very much’ at risk was the strongest predictor of intention to reduce SSB consumption (Odds Ratio=8.1 [1.8-37.0], p<0.01). Other significant predictors (p<0.01) included self-perceptions about too much consumption, habitual consumption, difficulty reducing consumption, and likelihood of benefiting from reduced consumption.
Health risk perceptions had the strongest relationship with intentions to reduce consumption. Age and consumption perceptions were also predictors in the multivariate models whereas social/environmental exposure variables were not. Interventions may seek to incorporate strategies to de-normalise consumption practices and increase knowledge about perceived susceptibility to health risks.
We show that there is a Borel graph on a standard Borel space of Borel chromatic number three that admits a Borel homomorphism to every analytic graph on a standard Borel space of Borel chromatic number at least three. Moreover, we characterize the Borel graphs on standard Borel spaces of vertex-degree at most two with this property and show that the analogous result for digraphs fails.
To describe epidemiologic and genomic characteristics of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in a large skilled nursing facility (SNF), and the strategies that controlled transmission.
Design, Setting, and Participants:
Cohort study during March 22–May 4, 2020 of all staff and residents at a 780-bed SNF in San Francisco, California.
Contact tracing and symptom screening guided targeted testing of staff and residents; respiratory specimens were also collected through serial point prevalence surveys (PPS) in units with confirmed cases. Cases were confirmed by real-time reverse transcription–polymerase chain reaction testing for SARS-CoV-2; whole genome sequencing (WGS) characterized viral isolate lineages and relatedness. Infection prevention and control (IPC) interventions included restricting from work any staff who had close contact to a confirmed case; restricting movements between units; implementing surgical face masking facility-wide; and recommended PPE (isolation gown, gloves, N95 respirator and eye protection) for clinical interactions in units with confirmed cases.
Of 725 staff and residents tested through targeted testing and serial PPS, twenty-one (3%) were SARS-CoV-2-positive; sixteen (76%) staff and 5 (24%) residents. Fifteen (71%) were linked to a single unit. Targeted testing identified 17 (81%) cases; PPS identified 4 (19%). Most (71%) cases were identified prior to IPC intervention. WGS was performed on SARS-CoV-2 isolates from four staff and four residents; five were of Santa Clara County lineage and the three others were distinct lineages.
Early implementation of targeted testing, serial PPS, and multimodal IPC interventions limited SARS-CoV-2 transmission within the SNF.
An interested and engaged electorate is widely believed to be an indicator of democratic health. As such, the aggregate level of political interest of an electorate – macrointerest – is an essential commodity in a democracy, and understanding the forces that change macrointerest is important for diagnosing the health of a democracy. Because being interested in politics requires time and effort, the article theorizes that the electorate's level of political interest will be highest when the electorate believes the government cannot be trusted or is performing poorly. To test hypotheses derived from a proposed theory against rival explanations, the study develops a measure of macrointerest using a quarterly time series of aggregated survey items (1973–2014) of political interest. The authors find support for the theory that the electorate responds as reasonable agents when determining how closely to monitor elected officials: interest is positively related to decreases in trust in government.
We used event‑related potentials to investigate how markedness impacts person agreement in English‑speaking learners of L2‑Spanish. Markedness was examined by probing agreement with both first‑person (marked) and third‑person (unmarked) subjects. Agreement was manipulated by crossing first‑person subjects with third‑person verbs and vice versa. Native speakers showed a P600 for both errors, larger for “first‑person subject + third‑person verb” violations. This aligns with claims that, when the first element in the dependency is marked (first person), the parser generates stronger predictions regarding upcoming agreeing elements using feature activation. Twenty‑two upper‑intermediate/advanced learners elicited a P600 across both errors. Learners were equally accurate detecting both errors, but the P600 was marginally reduced for “first‑person subject + third‑person verb” violations, suggesting that learners overused unmarked forms (third person) online. However, this asymmetry mainly characterized lower‑proficiency learners. Results suggest that markedness impacts L2 agreement without constraining it, although learners are less likely to use marked features top‑down.
Academic Medical Centers strive to create multidisciplinary research teams to produce impactful science. However, few faculty researchers receive training in “team science,” a well-established concept in business research and practice. Responding to demand for assistance developing effective research teams, the Collaboration and Team Science Program of the Clinical and Translational Science Institute (CTSI) at Wake Forest School of Medicine (WFSM) partnered with faculty from the Wake Forest University (WFU) School of Business with expertise in leadership, management, and team building. We initiated a needs assessment, including a written survey from a diverse set of 42 research scientists as well as semi-structured interviews with 8 researchers. In response to identified needs, we developed training sessions and consultations to teach teams to implement two tools known to enhance team dynamics: (1) Team charter, a document that defines the team’s purpose, goals, roles, and strategies; and (2) Responsible, Accountable, Consulted, Informed (RACI) matrix, a table or spreadsheet that clarifies tasks and accountability. Since 2018, 10 teams and over 100 individuals have attended training sessions and 6 teams received personalized team consults. We describe these tools, present a formal analysis of quantitative results, and highlight the next steps being taken in response to these findings.
Compared to the general population, individuals with complex congenital heart disease are at increased risk for deficits in cognitive, neurodevelopmental, psychosocial, and physical functioning, resulting in a diminished health-related quality of life. These deficits have been well described over the past 25 years, but significant gaps remain in our understanding of the best practices to improve neurodevelopmental and psychosocial outcomes and health-related quality of life for individuals with paediatric and congenital heart disease. Innovative clinical, quality improvement, and research opportunities with collaboration across multiple disciplines and institutions were needed to address these gaps. The Cardiac Neurodevelopmental Outcome Collaborative was founded in 2016 with a described mission to determine and implement best practices of neurodevelopmental and psychosocial services for individuals and their families with paediatric and congenital heart disease through clinical, quality improvement, and research initiatives. The vision is to be a multi-centre, multi-national, multi-disciplinary group of healthcare professionals committed to working together and partnering with families to optimise neurodevelopmental outcomes for individuals with paediatric and congenital heart disease through clinical, quality, and research initiatives, intending to maximise quality of life for every individual across the lifespan. This manuscript describes the development and organisation of the Cardiac Neurodevelopmental Outcome Collaborative.
Over the last two decades, heart centres have developed strategies to meet the neurodevelopmental needs of children with congenital heart disease. Since the publication of guidelines in 2012, cardiac neurodevelopmental follow-up programmes have become more widespread. Local neurodevelopmental programmes, however, have been developed independently in widely varying environments. We sought to characterise variation in structure and personnel in cardiac neurodevelopmental programmes. A 31-item survey was sent to all member institutions of the Cardiac Neurodevelopmental Outcome Collaborative. Multidisciplinary teams at each centre completed the survey. Responses were compiled in a descriptive fashion. Of the 29 invited centres, 23 responded to the survey (79%). Centres reported more anticipated neurodevelopment visits between birth and 5 years of age (median 5, range 2–8) than 5–18 years (median 2, range 0–10) with 53% of centres lacking any standard for routine neurodevelopment evaluations after 5 years of age. Estimated annual neurodevelopment clinic volume ranged from 85 to 428 visits with a median of 16% of visits involving children >5 years of age. Among responding centres, the Bayley Scales of Infant and Toddler Development and Wechsler Preschool and Primary Scale of Intelligence were the most routinely used tests. Neonatal clinical assessment was more common (64%) than routine neonatal brain imaging (23%) during hospitalisation. In response to clinical need and published guidelines, centres have established formal cardiac neurodevelopment follow-up programmes. Centres vary considerably in their approaches to routine screening and objective testing, with many centres currently focussing their resources on evaluating younger patients.
Background: As carbapenem-resistant Enterobacteriaceae (CRE) prevalence increases in the United States, the risk of cocolonization with multiple CRE may also be increasing, with unknown clinical and epidemiological significance. In this study, we aimed to describe the epidemiologic and microbiologic characteristics of inpatients cocolonized with multiple CRE. Methods: We conducted a secondary analysis of a large, multicenter prospective cohort study evaluating risk factors for CRE transmission to healthcare personnel gown and gloves. Patients were identified between January 2016 and June 2019 from 4 states. Patients enrolled in the study had a clinical or surveillance culture positive for CRE within 7 days of enrollment. We collected and cultured samples from the following sites from each CRE-colonized patient: stool, perianal area, and skin. A modified carbapenem inactivation method (mCIM) was used to detect the presence or absence of carbapenemase(s). EDTA-modified CIM (eCIM) was used to differentiate between serine and metal-dependent carbapenemases. Results: Of the 313 CRE-colonized patients enrolled in the study, 28 (8.9%) were cocolonized with at least 2 different CRE. Additionally, 3 patients were cocolonized with >2 different CRE (1.0%). Of the 28 patients, 19 (67.6%) were enrolled with positive clinical cultures. Table 1 summarizes the demographic and clinical characteristics of these patients. The most frequently used antibiotic prior to positive culture was vancomycin (n = 33, 18.3%). Among the 62 isolates from 59 samples from 28 patients cocolonized patients, the most common CRE species were Klebsiella pneumoniae (n = 18, 29.0%), Escherichia coli (n = 10, 16.1%), and Enterobacter cloacae (n = 9, 14.5%). Of the 62 isolates, 38 (61.3%) were mCIM positive and 8 (12.9%) were eCIM positive. Of the 38 mCIM-positive isolates, 33 (86.8%) were KPC positive, 4 (10.5%) were NDM positive, and 1 (2.6%) was negative for both KPC and NDM. Also, 2 E. coli, 1 K. pneumoniae, and 1 E. cloacae were NDM-producing CRE. Conclusion: Cocolonization with multiple CRE occurs frequently in the acute-care setting. Characterizing patients with CRE cocolonization may be important to informing infection control practices and interventions to limit the spread of these organisms, but further study is needed.
Background: Carbapenem-resistant Enterobacteriaceae (CRE) are a serious threat to public health due to high associated morbidity and mortality. Healthcare personnel (HCP) gloves and gowns are frequently contaminated with antibiotic-resistant bacteria, including CRE. We aimed to identify patients more likely to transmit CRE to HCP gloves or gowns and HCP types and interactions more likely to lead to glove or gown contamination. Methods:Between January 2016 and August 2018, patients with a clinical or surveillance culture positive for CRE in the preceding 7 days were enrolled at 5 hospitals in California, Maryland, New York, and Pennsylvania. Ten HCP–patient interactions were observed for each patient and were recorded by research staff. Following patient care, but prior to doffing, the gloves and gown of each HCP were sampled for the presence of CRE. Results: We enrolled 313 CRE-colonized patients, and we observed 3,070 HCP interactions. CRE was transmitted to HCP gloves in 242 of 3,070 observations (7.9%) and to gowns in 132 of 3,070 observations (4.3%). Transmission to either gloves or gown occurred in 308 of 3,070 interactions observed (10%). The most frequently identified organism was Klebsiella pneumoniae (n = 171, 53.2%), followed by Enterobacter cloacae (n = 36, 11.2%), and Escherichia coli (n = 33, 10.3%). Patients in the intensive care unit (n = 177, 56.5%) were more likely to transmit CRE to HCP gloves or gown (OR, 1.65; 95% CI, 1.03–2.64) compared to those not in an ICU and adjusted for HCP type. The odds of CRE transmission increased with the number of different items touched near the patient (OR, 1.32; 95% CI, 1.21–1.44) and with the number of different items touched in the environment (OR, 1.13; 95% CI, 1.06–1.21). Respiratory therapists had the highest rates of transmission to gloves and gown (OR, 3.79; 95% CI, 1.61–8.94), followed by physical therapists and occupational therapists (OR, 2.82; 95% CI, 1.01–8.32) when compared to HCP in the “other” category. Manipulating the rectal tube (OR, 3.03; 95% CI, 1.53–6.04), providing wound care (OR, 2.81; 95% CI, 1.73–4.59), and touching the endotracheal tube (OR, 2.79; 95% CI, 1.86–4.19) were the interactions most strongly associated with CRE transmission compared to not touching these items and adjusted for HCP type. Conclusions: Transmission of CRE to HCP gloves and gowns occurs frequently. We identified interactions and HCP types that were particularly high risk for transmission. Infection control programs may wish to target infection prevention resources and education toward these high-risk professions and interactions.
Funding: This work was supported by the CDC Prevention Epicenter Program (U43CK000450-01) and the NIH National Institute of Allergy and Infectious Diseases (R01 AI121146-01).
Background: Estimates of contamination of healthcare personnel (HCP) gloves and gowns with methicillin-resistant Staphylococcus aureus (MRSA) following interactions with colonized or infected patients range from 17% to 20%. Most studies were conducted in the intensive care unit (ICU) setting where patients had a recent positive clinical culture. The aim of this study was to determine the rate of MRSA transmission to HCP gloves and gown in non-ICU acute-care hospital units and to identify associated risk factors. Methods: Patients on contact precautions with history of MRSA colonization or infection admitted to non-ICU settings were randomly selected from electronic health records. We observed patient care activities and cultured the gloves and gowns of 10 HCP interactions per patient prior to doffing. Cultures from patients’ anterior nares, chest, antecubital fossa and perianal area were collected to quantify bacterial bioburden. Bacterial counts were log transformed. Results: We observed 55 patients (Fig. 1), and 517 HCP–patient interactions. Of the HCP–patient interactions, 16 (3.1%) led to MRSA contamination of HCP gloves, 18 (3.5%) led to contamination of HCP gown, and 28 (5.4%) led to contamination of either gloves or gown. In addition, 5 (12.8%) patients had a positive clinical or surveillance culture for MRSA in the prior 7 days. Nurses, physicians and technicians were grouped in “direct patient care”, and rest of the HCPs were included in “no direct care group.” Of 404 interactions, 26 (6.4%) of providers in the “direct patient care” group showed transmission of MRSA to gloves or gown in comparison to 2 of 113 (1.8%) interactions involving providers in the “no direct patient care” group (P = .05) (Fig. 2). The median MRSA bioburden was 0 log 10CFU/mL in the nares (range, 0–3.6), perianal region (range, 0–3.5), the arm skin (range, 0-0.3), and the chest skin (range, 0–6.2). Detectable bioburden on patients was negatively correlated with the time since placed on contact precautions (rs= −0.06; P < .001). Of 97 observations with detectable bacterial bioburden at any site, 9 (9.3%) resulted in transmission of MRSA to HCP in comparison to 11 (3.6%) of 310 observations with no detectable bioburden at all sites (P = .03). Conclusions: Transmission of MRSA to gloves or gowns of HCP caring for patients on contact precautions for MRSA in non-ICU settings was lower than in the ICU setting. More evidence is needed to help guide the optimal use of contact precautions for the right patient, in the right setting, for the right type of encounter.
Elective surgical patients routinely bathe with chlorhexidine gluconate (CHG) at home days prior to their procedures. However, the impact of home CHG bathing on surgical site CHG concentration is unclear. We examined 3 different methods of applying CHG and hypothesized that different application methods would impact resulting CHG skin concentration.
Because of inconsistent findings regarding the relationship between sleep quality and cognitive function in people with age-related memory complaints, we examined how self-reports of sleep quality were related to multiple domains of both objective and subjective cognitive function in middle-aged and older adults.
A cross-sectional study involving analysis of baseline data, collected as part of a clinical trial.
Two hundred and three participants (mean age = 60.4 [6.5] years, 69.0% female) with mild memory complaints were asked to rate their sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and their memory performance using the Memory Functioning Questionnaire (MFQ), which measures self-awareness of memory ability. Neurocognitive performance was evaluated using the Continuous Performance Test (CPT), Trail Making Test, Buschke Selective Reminding Test, and the Brief Visuospatial Test – Revised (BVMT-R).
Total PSQI scores were significantly associated with objective measures of sustained attention (CPT hit reaction time by block and standard error by block) and subjective memory loss (MFQ frequency and seriousness of forgetting). The PSQI components of (poorer) sleep quality and (greater) sleep disturbance were related to (worse) sustained attention scores while increased sleep latency and daytime sleepiness were associated with greater frequency and seriousness of forgetting.
Sleep quality is related to both objective measures of sustained attention and self-awareness of memory decline. These findings suggest that interventions for improving sleep quality may contribute not only to improving the ability to focus on a particular task but also in reducing memory complaints in middle-aged and older adults.
School psychologists play a vital role in the mental health and well-being of students and are often tasked with establishing the assessment and intervention plans for reducing the severity of mental health difficulties, including suicidal behavior. With suicide the second-leading cause of death for middle and high school students, school psychologists need to be familiar with what their role is in recommending and providing suicide prevention and intervention programs within a multitiered systems of support (MTSS) framework. This chapter provides an overview of the problem of adolescent suicidal behavior (“what to know”), while also providing specific recommendations (“what to do”) for suicide prevention/intervention programs within each tier of the MTSS. Finally, this chapter includes specific guidelines for implementing “suicide postvention” (after a death due to suicide) procedures, in hopes of reducing the likelihood of another death due to suicide.
The perinatal period is a vulnerable time for the development of psychopathology, particularly mood and anxiety disorders. In the study of maternal anxiety, important questions remain regarding the association between maternal anxiety symptoms and subsequent child outcomes. This study examined the association between depressive and anxiety symptoms, namely social anxiety, panic, and agoraphobia disorder symptoms during the perinatal period and maternal perception of child behavior, specifically different facets of development and temperament. Participants (N = 104) were recruited during pregnancy from a community sample. Participants completed clinician-administered and self-report measures of depressive and anxiety symptoms during the third trimester of pregnancy and at 16 months postpartum; child behavior and temperament outcomes were assessed at 16 months postpartum. Child development areas included gross and fine motor skills, language and problem-solving abilities, and personal/social skills. Child temperament domains included surgency, negative affectivity, and effortful control. Hierarchical multiple regression analyses demonstrated that elevated prenatal social anxiety symptoms significantly predicted more negative maternal report of child behavior across most measured domains. Elevated prenatal social anxiety and panic symptoms predicted more negative maternal report of child effortful control. Depressive and agoraphobia symptoms were not significant predictors of child outcomes. Elevated anxiety symptoms appear to have a distinct association with maternal report of child development and temperament. Considering the relative influence of anxiety symptoms, particularly social anxiety, on maternal report of child behavior and temperament can help to identify potential difficulties early on in mother–child interactions as well as inform interventions for women and their families.