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A 30-year-old G6P2A4L1 is referred by her primary care provider to your high-risk obstetrics clinic for preconception counseling after a pregnancy loss at 21+4 weeks’ gestation last year, shortly after incidental transvaginal cervical shortening was noted at second-trimester fetal morphology survey. After an uncomplicated first pregnancy and term delivery, she experienced four consecutive first-trimester losses for which comprehensive investigations were unremarkable.
In March 2018, the US Food and Drug Administration (FDA), US Centers for Disease Control and Prevention, California Department of Public Health, Los Angeles County Department of Public Health and Pennsylvania Department of Health initiated an investigation of an outbreak of Burkholderia cepacia complex (Bcc) infections. Sixty infections were identified in California, New Jersey, Pennsylvania, Maine, Nevada and Ohio. The infections were linked to a no-rinse cleansing foam product (NRCFP), produced by Manufacturer A, used for skin care of patients in healthcare settings. FDA inspected Manufacturer A's production facility (manufacturing site of over-the-counter drugs and cosmetics), reviewed production records and collected product and environmental samples for analysis. FDA's inspection found poor manufacturing practices. Analysis by pulsed-field gel electrophoresis confirmed a match between NRCFP samples and clinical isolates. Manufacturer A conducted extensive recalls, FDA issued a warning letter citing the manufacturer's inadequate manufacturing practices, and federal, state and local partners issued public communications to advise patients, pharmacies, other healthcare providers and healthcare facilities to stop using the recalled NRCFP. This investigation highlighted the importance of following appropriate manufacturing practices to minimize microbial contamination of cosmetic products, especially if intended for use in healthcare settings.
Throughout the coronavirus disease 2019 (COVID-19) pandemic, health and social care workers have faced unprecedented professional demands, all of which are likely to have placed considerable strain on their psychological well-being.
To measure the national prevalence of mental health symptoms within healthcare staff, and identify individual and organisational predictors of well-being.
The COVID-19 Staff Wellbeing Survey is a longitudinal online survey of psychological well-being among health and social care staff in Northern Ireland. The survey included four time points separated by 3-month intervals; time 1 (November 2020; n = 3834) and time 2 (February 2021; n = 2898) results are presented here. At time 2, 84% of respondents had received at least one dose of a COVID-19 vaccine. The survey included four validated psychological well-being questionnaires (depression, anxiety, post-traumatic stress and insomnia), as well as demographic and organisational measures.
At time 1 and 2, a high proportion of staff reported moderate-to-severe symptoms of depression (30–36%), anxiety (26–27%), post-traumatic stress (30–32%) and insomnia (27–28%); overall, significance tests and effect size data suggested psychological well-being was generally stable between November 2020 and February 2021 for health and social care staff. Multiple linear regression models indicated that perceptions of less effective communication within their organisation predicted greater levels of anxiety, depression, post-traumatic stress and insomnia.
This study highlights the need to offer psychological support to all health and social care staff, and to communicate with staff regularly, frequently and clearly regarding COVID-19 to help protect staff psychological well-being.
Our aim was to establish a Peer Mentoring Network within Psychiatry Training in Northern Ireland.
Recognising that starting a new job can be a stressful time in any junior doctor's career, we wanted to ensure that new Core Trainees (CT1s) joining our Specialty Programme were well supported through this transition.
Although Clinical and Educational Supervision is well established in providing a support structure for trainees, we believed that a peer mentoring relationship, (with allocation of a Higher Psychiatry Trainee as mentor), would be of additional benefit.
It was hoped that the scheme would prove mutually beneficial to both mentee and mentor.
We delivered a presentation at CT1 induction and sent out follow-up emails to encourage participation. Higher trainees were also sent information via email and asked to complete a basic application form if interested in becoming a mentor. Prospective mentors then attended a one-day training session.
Two lead mentors, (also higher trainees), were allocated to oversee the scheme, with additional supervision from two lead Consultants. Mentor-Mentee matches were made based on information such as location, sub-specialty affiliations and outside interests.
Matched pairs were advised about the intended frequency and nature of contacts. Check-in emails were sent halfway through the year and feedback evaluations completed at the end.
95% of trainees who completed the evaluations said they would recommend the scheme to colleagues.
Mentees reported benefits in terms of personal and professional development, whilst mentors reported improved listening, coaching, and supervisory skills.
A small number of trainees highlighted that 6 monthly rotations impacted on ability to maintain face to face contacts.
Recruitment and engagement have improved annually. We are currently running the third year of the scheme and have achieved 100% uptake amongst CT1s and are over-subscribed with mentors, (19 mentors to 13 mentees).
The majority of feedback received has been positive and interest in the scheme continues to grow.
Potential issues relating to location of postings has been overcome, at least in part, by recent changes to ways of working and the use of alternative forms of contact, such as video calling.
Having exceeded demand in terms of mentor recruitment, we hope to extend the scheme to include trainees of other grades, and particularly those who are new to Northern Ireland.
We are excited to see where the next stage of our journey takes us and hope that others will be inspired to embark on similar schemes within their areas of work.
White mold caused by the fungus, Sclerotinia sclerotiorum is a devastating disease of soybean (Glycine max) and other leguminous crops, including dry bean (Phaseolus vulgaris). Previous research has demonstrated that no-till planting soybean into rolled–crimped cereal rye residue can enhance weed management, improve soil health and reduce labor requirements in organic production. However, there are limited data on the effects of cereal rye residue on white mold suppression in no-till planted soybean and dry bean. Two field trials were conducted in 2016–2017 (Year 1) and repeated in 2017–2018 (Year 2) to evaluate the potential of cereal rye cover crop residue to suppress white mold in these crops. In each trial (soybean and dry bean), the experimental design was a randomized complete block with two treatments: (1) rolled–crimped cereal rye residue and (2) no cover crop control. Treatment effects on plant population, biomass and yield components varied between the main crops. Compared with the control treatment, cereal rye residue reduced the incidence of white mold in soybean in both years and in dry bean in Year 2. The reduction in white mold in cereal rye residue plots was due to a combination of (1) decreased sclerotial germination (no stipes formed) and (2) increased nonfunctional sclerotial germination defined here as sclerotia that germinated but produced stipes without the expanded cup where asci containing ascospores are formed. Weed density and biomass were lower in cereal rye residue plots in soybean and dry bean, except in Year 1 in soybean when weed biomass was low in both treatments. Our findings indicate that cereal rye residue could help organic and conventional farmers manage white mold in no-till planted soybean and dry bean. Germination of sclerotia resulting in nonfunctional apothecia could potentially exhaust soilborne inoculum in the upper soil profile and reduce infections in subsequent crops.
We investigated whether neurobehavioral markers of risk for emotion dysregulation were evident among newborns, as well as whether the identified markers were associated with prenatal exposure to maternal emotion dysregulation. Pregnant women (N = 162) reported on their emotion dysregulation prior to a laboratory assessment. The women were then invited to the laboratory to assess baseline respiratory sinus arrhythmia (RSA) and RSA in response to an infant cry. Newborns were assessed after birth via the NICU Network Neurobehavioral Scale. We identified two newborn neurobehavioral factors—arousal and attention—via exploratory factor analysis. Low arousal was characterized by less irritability, excitability, and motor agitation, while low attention was related to a lower threshold for auditory and visual stimulation, less sustained attention, and poorer visual tracking abilities. Pregnant women who reported higher levels of emotion dysregulation had newborns with low arousal levels and less attention. Larger decreases in maternal RSA in response to cry were also related to lower newborn arousal. We provide the first evidence that a woman's emotion dysregulation while pregnant is associated with risks for dysregulation in her newborn. Implications for intergenerational transmission of emotion dysregulation are discussed.
Almost all living organisms on Earth utilize the same 20 amino acids to build their millions of different proteins, even though there are hundreds of amino acids naturally occurring on Earth. Although it is likely that both the prebiotic and the current environment of Earth shaped the selection of these 20 proteinogenic amino acids, environmental conditions on extraterrestrial planets and moons are known to be quite different than those on Earth. In particular, the surfaces of planets and moons such as Mars, Europa and Enceladus have a much greater flux of UV and gamma radiation impacting their surface than that of Earth. Thus, if life were to have evolved extraterrestrially, a different lexicon of amino acids may have been selected due to different environmental pressures, such as higher radiation exposure. One fundamental property an amino acid must have in order to be of use to the evolution of life is relative stability. Therefore, we studied the stability of three different proteinogenic amino acids (tyrosine, phenylalanine and tryptophan) as compared with 20 non-proteinogenic amino acids that were structurally similar to the aromatic proteinogenic amino acids, following ultraviolet (UV) light (254, 302, or 365 nm) and gamma-ray irradiation. The degree of degradation of the amino acids was quantified using an ultra-high performance liquid chromatography-mass spectrometer (UPLC-MS). The result showed that many non-proteinogenic amino acids had either equal or increased stability to certain radiation wavelengths as compared with their proteinogenic counterparts, with fluorinated phenylalanine and tryptophan derivatives, in particular, exhibiting enhanced stability as compared with proteinogenic phenylalanine and tryptophan amino acids following gamma and select UV irradiation.
Antibiotic use varies widely between hospitals, but the influence of antimicrobial stewardship programs (ASPs) on this variability is not known. We aimed to determine the key structural and strategic aspects of ASPs associated with differences in risk-adjusted antibiotic utilization across facilities.
Observational study of acute-care hospitals in Ontario, Canada
A survey was sent to hospitals asking about both structural (8 elements) and strategic (32 elements) components of their ASP. Antibiotic use from hospital purchasing data was acquired for January 1 to December 31, 2014. Crude and adjusted defined daily doses per 1,000 patient days, accounting for hospital and aggregate patient characteristics, were calculated across facilities. Rate ratios (RR) of defined daily doses per 1,000 patient days were compared for hospitals with and without each antimicrobial stewardship element of interest.
Of 127 eligible hospitals, 73 (57%) participated in the study. There was a 7-fold range in antibiotic use across these facilities (min, 253 defined daily doses per 1,000 patient days; max, 1,872 defined daily doses per 1,000 patient days). The presence of designated funding or resources for the ASP (RRadjusted, 0·87; 95% CI, 0·75–0·99), prospective audit and feedback (RRadjusted, 0·80; 95% CI, 0·67–0·96), and intravenous-to-oral conversion policies (RRadjusted, 0·79; 95% CI, 0·64–0·99) were associated with lower risk-adjusted antibiotic use.
Wide variability in antibiotic use across hospitals may be partially explained by both structural and strategic ASP elements. The presence of funding and resources, prospective audit and feedback, and intravenous-to-oral conversion should be considered priority elements of a robust ASP.
We conducted a longitudinal dietary intervention study to assess the impact of a store-based intervention on mediators and moderators and consequent dietary behaviour in Indigenous communities in remote Australia. We assessed dietary intake of fruit, vegetable, water and sweetened soft drink, mediators and moderators among 148, eighty-five and seventy-three adult participants (92 % women) at baseline (T1), end of intervention (T2) and at 24 weeks post intervention (T3), respectively. Mediators included perceived affordability and self-efficacy. Moderators were barriers to eat more fruit and vegetables and food security. Mixed-effects models were used to determine changes in mediators and moderators with time and associations between these and each dietary outcome. Perceived vegetable affordability increased from T1 (19 %; 95 % CI 11, 27) to T2 (38 %; 95 % CI 25, 51) (P=0·004) and returned to baseline levels at T3. High self-efficacy to eat more fruit and vegetables and to drink less soft drink decreased from T1 to T3. A reduction in soft drink intake of 27 % (95 % CI −44, −4; P=0·02) was reported at T3 compared with T1; no changes with time were observed for all other outcome measures. Regardless of time, vegetable intake was positively associated with self-efficacy to cook and try new vegetables, no barriers and food security. The dietary intervention went someway to improving perceived affordability of vegetables but was probably not strong enough to overcome other mediators and moderators constraining behaviour change. Meaningful dietary improvement in this context will be difficult to achieve without addressing underlying constraints to behaviour change.
OBJECTIVES/SPECIFIC AIMS: The Institute for Transnational Sciences (ITS) has developed novel methods to ethically engage stakeholders across the transnational research spectrum, up to and including public health practice and policy. METHODS/STUDY POPULATION: In 2014, the ITS co-founded The Research, Education, And Community Health (REACH), the mission of which was to facilitate communication, collaborative research, and service activities between faculty and scientists and area community leaders. The intent was to identify and meet the needs of our communities without gaps and/or redundancies, thus better leveraging time, funding, and efforts. RESULTS/ANTICIPATED RESULTS: REACH now boasts 23 Centers, Departments, and Institutes, as well as 39 community organizations, including public and mental health agencies, clinicians, policy makers, family service centers, cultural and faith-based organizations, business, and local schools/colleges. We offer 3 methods for consideration as best practices: (1) a comprehensive community health needs assessment, (2) an “Offer and Ask” community/campus partnership mechanism, and (3) Community Science Workshops, based on the European Union’s Science Shops. DISCUSSION/SIGNIFICANCE OF IMPACT: Results of REACH’s work have been used to provide guidance for enhanced, data-driven programs and allocation of resources for local and statewide initiatives. The organization has evolved into an independent coalition seeking 501(c)3 status and is planning to expand its scope to 5 counties. REACH thus serves as model for successful replication across applicable CTSA hubs.
In this research we understood legacy in terms of how the projects served the community involved and delivered outcomes for them. We sought to use evaluation to understand this legacy. Within policy analysis, evaluation studies have a long history of extensive methodological and theoretical work. Over 60 years, a whole academic industry of policy evaluation has emerged. Much of the literature is dominated by epistemological debates regarding the measurement of change and causation. For instance, while methodologies such as the randomised controlled trial (RCT) dominate the mainstream, and are seen as the ‘gold standard’ among some scholars (Haynes et al, 2012) and bodies such as the UK Treasury and UK Civil Service (Government Social Research Unit, 2007; HM Treasury, 2011), there is also a broad critical literature highlighting the methodological and epistemological weaknesses of such approaches (Pawson and Tilley, 1997). As will be explored below, evaluation and evaluative approaches make us focus our attention on ontological and epistemological questions about researcher positionality, power and knowledge, how we understand social objects, and how we understand and interpret causation.
This contrasts with ways the legacy of academic research may traditionally be evaluated, for instance through the number and quality of journal papers submitted for audit exercises such as the Research Excellence Framework in the UK (see Introduction to this book and Research Excellence Framework 2012). The outputs of research co-produced with communities, such as the projects in focus discussed below, often fit uneasily within the audit regimes of contemporary academic practice (Pain et al, 2011). In evaluating the co-produced research, our research created an artificial experiment, as many evaluations do, to consider the strengths and limitations of academic-led evaluative studies, and the strengths and limitations of a study led by community partners supported by a university-employed researcher. It thus had two purposes – first, to deliver substantive evaluations of three earlier, co-produced, social ‘interventions’ and secondly, to compare different approaches to evaluation. In this chapter we do two things. First, we report on the findings of the evaluations to explore what the legacies of co-produced research are. Secondly, we use the collective reflection on doing evaluation to provide a rich account of how we might embed evaluation into community co-produced research.
The aims of this study were to assess the awareness of risk for suicidal behaviors and perspectives of Project Recovery counselors who provided crisis counseling services to hurricane survivors.
The Short Posttraumatic Stress Disorder Rating Interview–Extended, a quantitative disaster mental health measure, was used to assess distress and dysfunction to the recent hurricanes. Project Recovery counselor data were collected through a 22-item qualitative interview.
Seven out of 207 clients (3.4%) endorsed the quantitative item measuring suicidal ideation. Clients who reported suicidal ideation had significantly higher scores on items indicating a loss of enjoyment, feelings of depression, feeling less able to handle stress, and other mental health items. Counselor responses fell into 5 major themes: Assessment and Action, Client Characteristics, Services, Counselor Training and Preparedness, and Future Directions.
Suicidal behavior is a serious mental health emergency, yet it remains a challenging issue as suicidal behaviors are complex and disaster survivors with suicidal ideation may experience intense psychological reactions to the event. In order to provide competent care to survivors experiencing suicidal thoughts or behaviors, the need for counselors to receive adequate training in suicide assessment and management is essential. (Disaster Med Public Health Preparedness. 2015;9:291–300)
Physical health has been demonstrated to mediate the mental health and mortality risk association. The current study examines an alternative hypothesis that mental health mediates the effect of physical health on mortality risk.
Participants (N = 14,019; women = 91%), including eventual decedents (n = 3,752), were aged 70 years and older, and drawn from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project. Participants were observed on two to four occasions, over a 10-year period. Mediation analysis compared the converse mediation of physical and mental health on mortality risk.
For men, neither physical nor mental health was associated with mortality risk. For women, poor mental health reported only a small effect on mortality risk (Hazard Risk (HR) = 1.01; p < 0.001); more substantive was the risk of low physical health (HR = 1.04; p < 0.001). No mediation effects were observed.
Mental health effects on mortality were fully attenuated by physical health in men, and partially so in women. Neither mental nor physical health mediated the effect of each other on mortality risk for either gender. We conclude that physical health is a stronger predictor of mortality risk than mental health.