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The coronavirus disease 2019 (COVID-19) pandemic has required healthcare systems to meet new demands for rapid information dissemination, resource allocation, and data reporting. To help address these challenges, our institution leveraged electronic health record (EHR)–integrated clinical pathways (E-ICPs), which are easily understood care algorithms accessible at the point of care.
To describe our institution’s creation of E-ICPs to address the COVID-19 pandemic, and to assess the use and impact of these tools.
Urban academic medical center with adult and pediatric hospitals, emergency departments, and ambulatory practices.
Using the E-ICP processes and infrastructure established at our institution as a foundation, we developed a suite of COVID-19–specific E-ICPs along with a process for frequent reassessment and updating. We examined the development and use of our COVID-19–specific pathways for a 6-month period (March 1–September 1, 2020), and we have described their impact using case studies.
In total, 45 COVID-19–specific pathways were developed, pertaining to triage, diagnosis, and management of COVID-19 in diverse patient settings. Orders available in E-ICPs included those for isolation precautions, testing, treatments, admissions, and transfers. Pathways were accessed 86,400 times, with 99,081 individual orders were placed. Case studies demonstrate the impact of COVID-19 E-ICPs on stewardship of resources, testing optimization, and data reporting.
E-ICPs provide a flexible and unified mechanism to meet the evolving demands of the COVID-19 pandemic, and they continue to be a critical tool leveraged by clinicians and hospital administrators alike for the management of COVID-19. Lessons learned may be generalizable to other urgent and nonurgent clinical conditions.
How expansive are the social meanings inferred by a nonstandard syntactic variant, and how are these social meanings constructed? This chapter suggests that the social meanings of syntax lie at the nexus of pragmatics and social distribution. Furthermore, the analysis shows that certain social meanings are enriched when syntactic items co-occur with specific phonetic variants. Drawing upon an ethnographic study of adolescents, this chapter focuses on the social meanings of negative concord by exploring the correlation between social class, social practice, topic of talk, nonstandard phonetic variants and instances of negative concord. Negative concord increases across social groups in-line with their placement on a pro-/anti-school continuum, but a topic analysis suggests that this a consequence of different groups talking about different things: there is more negative concord in talk about delinquent behaviour than there is in talk about non-delinquent behaviour (irrespective of social group). In exploring why negative concord is a useful device for talking about delinquency, the pragmatics of the construction itself are examined, exposing a relationship between social distribution and pragmatic function. Finally, an analysis of the relationship between negative concord and co-occurring phonetic variants suggests that different levels of linguistic architecture work synergistically to create social meaning.
Why does a sound change spread faster among one group of people than another? While variationist sociolinguistics was founded on the idea that a variant’s social meaning might be part of the answer, the proposal is still the source of active debate. Eckert (2008, 2012) calls for a renewed focus on social meaning, articulating the core interest of ‘third wave’ research. Here, we join some recent work that highlights the benefits of combining analytic perspectives from all of Eckert’s (2012) three waves, particularly with respect to the study of sound change. By directly comparing insights from parallel analyses of the same data, we argue that all sound change researchers can potentially benefit from considering a third-wave perspective, in the sense that social change results in indexical change, and this may explain the trajectory of a sound change. Our data come from white and Chinese American residents of San Francisco’s Sunset District, recorded in 2008. As with the COT-CAUGHT merger (Hall-Lew 2013), focus on social change over time suggests that the individuals who came of age during the peak of social change are key to mapping the trajectory of GOAT-fronting.