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Outcome reporting is an essential element of quality assurance. Evaluation of the information needs of stakeholders of outcome reporting is limited. This study aimed to examine stakeholder preferences for the content, format, and dissemination of paediatric cardiac surgery performance data in Australia and New Zealand.
Semi-structured interviews were completed with a purposive sample of Queensland stakeholders to evaluate their attitudes and expectations regarding reporting of paediatric cardiac surgery outcomes. The interviews were audio-recorded and transcribed. Two researchers used an interpretive description approach to analyse the transcripts qualitatively.
Nineteen stakeholders were interviewed including fifteen clinicians, four parents, one hospital administrator, and one consumer advocate were interviewed. Mortality was highlighted as the area of greatest interest in reports by clinical and consumer groups. The majority preferred hospital rather than individual/clinician-level reporting. Annual reports were preferred by clinicians who requested reports be distributed electronically.
The evidence generated from outcome reporting in paediatric cardiac surgery is highly desired by clinicians, administrators, parents, families, and advocacy groups. Clinical users prefer information to assist in clinical decision-making, while families seek personalised information at crucial time points in their clinical journey.
Community engagement (CE) is critical for advancing health equity and a key approach for promoting inclusive clinical and translational science. However, it requires a workforce trained to effectively design, implement, and evaluate health promotion and improvement strategies through meaningful collaboration with community members. This paper presents an approach for designing CE curricula for research, education, clinical care, and public health learners. A general pedagogical framework is presented to support curriculum development with the inclusion of community members as facilitators or faculty. The overall goal of the curriculum is envisioned as enabling learners to effectively demonstrate the principles of CE in working with community members on issues of concern to communities to promote health and well-being. We highlight transformations needed for the commonly used critical service-learning model and the importance of faculty well-versed in CE. Courses may include didactics and practicums with well-defined objectives and evaluation components. Because of the importance of building and maintaining relationships in CE, a preparatory phase is recommended prior to experiential learning, which should be guided and designed to include debriefing and reflective learning. Depending on the scope of the course, evaluation should include community perspectives on the experience.
Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
Background: In June 2019, 3 people were diagnosed with Ebola virus disease (EVD) in Kasese district, Uganda, all of whom had come from the Democratic Republic of Congo (DRC). Although no secondary transmission of Ebola occurred, an assessment of infection prevention and control (IPC) using the WHO basic IPC facility assessment checklist revealed significant gaps. Robust IPC systems are critical for the prevention of healthcare-associated infections like EVD. A rapid intervention was developed and implemented in Kasese to strengthen IPC capacity in high-risk facilities. Methods: Of 117 healthcare facilities, 50 were considered at high risk of receiving suspected EVD cases from DRC based on population movement assessments. In August 2019, IPC mentors were selected from 25 high-risk facilities and assigned to support their facility and a second high-risk facility. Mentors ensured formation of IPC committees and implemented the national mentorship strategy for IPC preparedness in non-EVD treatment facilities. This effort focused on screening, isolation, and notification of suspect cases: 4 mentorship visits were conducted (1 per week for 1 month). Middle and terminal assessments were conducted using the WHO IPC checklist 2 and 4 weeks after the intervention commenced. Results were evaluated against baseline data. Results: Overall, 39 facilities had data from baseline, middle, and end assessments. Median scores in facility IPC standard precautions increased from baseline 50% (IQR, 39%–62%) to 73% (IQR, 67%–76%) at the terminal assessments. Scores increased for all measured parameters except for water source (access to running water). Greatest improvements were seen in formation of IPC committees (41% to 75%), hand hygiene compliance (47% to 86%), waste management (51% to 83%), and availability of dedicated isolation areas (16% to 42%) for suspect cases. Limited improvement was noted for training on management of suspect isolated cases and availability of personal protective equipment (PPE) (Fig. 1). No differences were noted in scores for facilities with nonresident mentors versus those with resident mentors at baseline (48% vs 50%) and end assessments (72% vs 74%). Conclusions: This intervention improved IPC capacity in health facilities while avoiding the cost and service disruption associated with large-scale classroom-based training of health workers. The greatest improvements were seen in activities relying on behavior change, such as hand hygiene, IPC committee, and waste management. Smaller changes were seen in areas requiring significant investments such as isolation areas, steady water source, and availability of personal protective equipment (PPE). Mentorship is ongoing in moderate- and lower-risk facilities in Kasese district.
Disclosures: Mohammed Lamorde reports contract research for Janssen Pharmaceutica, ViiV, Mylan.
A common property regime was established at the founding of the Maya site of Actuncan, Belize, in the Terminal Preclassic period (175 BC–AD 300), which governed access to land until the Terminal Classic period (AD 780–1000). This interpretation is based on urban settlement patterns documented through household excavation and remote-sensing programs. Excavations of all visible patio-focused groups in the urban core provided data to reconstruct residential histories, and a 60,621 m2 gradiometer survey resulted in a magnetic gradient map that was used to document buried constructions. Twenty ground-truth testpits correlated types of magnetic signatures to buried patio-focused groups and smaller constructions, including walled plots in agricultural field systems that were later exposed more fully through large-scale excavations. Combined, these methods provided data to reconstruct four correlates of land tenure systems: (1) the spatial proximity of residential units to land and resources, (2) diachronic changes in community settlement patterns, (3) land subdivision and improvements, and (4) public goods. Spatial analyses documented that houselots did not cluster through time, but instead became gradually improved, lending evidence to suggest the transgenerational inheritance of property rights in the Late and Terminal Classic periods.
OBJECTIVES/SPECIFIC AIMS: Chlamydia trachomatis (CT) infection can lead to reproductive morbidity in women. Animal models suggest that protection against CT is mediated through the cytokine interferon-gamma (IFN-γ), produced by CD4+ T-cells, which clears CT through intracellular tryptophan depletion. In humans, correlates of protection remain to be elucidated, which hinders chlamydia vaccine development. Natural clearance of CT infection (e.g., clearance before antibiotics) may be an immunological correlate of protection, evidenced by (1) CT clearance without antibiotics; and (2) a 4-fold reduced risk of CT reinfection within 6 months. We have identified women with and without natural clearance of CT infection. By comparing these two groups of women, the role of IFN-γ-mediated natural clearance of CT infection will be investigated. METHODS/STUDY POPULATION: Through collaboration with a cohort study of CT-infected women, we have access to stored specimens from women who naturally cleared CT or had persisting CT infection. Using peripheral blood mononuclear cell (PBMC), we will assess whether natural clearance of CT infection is associated with IFN-γ-producing CD4+ T-cells by stimulating PBMC ex vivo with CT antigens using intracellular cytokine staining. We will also use cervicovaginal lavage (CVL) and untargeted High-Performance Liquid Chromatography-Mass Spectrometry to assess for tryptophan-dependent and -independent metabolic pathways associated with natural clearance of CT infection. RESULTS/ANTICIPATED RESULTS:: To date, IFN-γ has been measured in 10 women who did not clear CT infection, demonstrating that <20% of these women produced significant levels of IFN-γ. Women who naturally cleared CT have yet to be studied. Untargeted HPLC-MS has been performed on 6 women (3 who cleared matched to 3 with persisting CT infection). To date, 11 pathways that are significantly associated with natural clearance have been identified. DISCUSSION/SIGNIFICANCE OF IMPACT: The outcome of natural clearance of CT infection is distinct from women with persisting chlamydia. These studies may inform whether IFN-γ, produced by CD4+ T-cells, or tryptophan-dependent or -independent metabolic pathways are associated with natural clearance, which may advance chlamydia vaccine development.
The moral significance of social networking technologies can only be understood once they are uncoupled from the political significance with which they have long been described. The focus on the political significance of social networking technologies is not surprising. Social networking technologies are viewed as fundamental to the expression of our First Amendment rights and liberties in cyberspace just as often as they are characterized as a threat to them. There is support for both contentions. On the one hand, incidences of cyber harassment, cyber stalking, revenge porn, and cyber bullying are on the increase as the pace of our online interactions escalates. Citron describes one such instance with long- lasting consequences
In 2012, a case unfolded in Maryland when strange men began showing up at a woman's doorstep, claiming they had been emailing with her and were there to have sex. Her ex- husband had posted Craiglist ads in her name that expressed a desire for sexual encounters with titles like “Rape me and my Daughters.” Other ads offered to sell the sexual services of her then- twelve and thirteen year old daughters and twelve year old son; the children's photos appeared next to the family's address (Citron, 2014, p. 6).
There is little disagreement over the fact that our use of social networking technologies results in some harmful behavior. The conflict is how to best regulate against the more damaging online activities without undermining the principles of the First Amendment, including free speech, freedom of association, and anonymity. This is the contention of those like Gabriella Coleman, for example, who defend any online behavior, even if harmful or disruptive, as the continuation of an American tradition in cyberspace. She suggests those who are critical of some of the more injurious communications should not focus our attention on “a putatively homogeneous set of norms, values, and practices” to judge the activities. She encourages us to instead consider that these online activities evoke broader themes consistent with our political sense of right and good, including free speech, meritocracy, privacy, and the power of the individual, all of which represent “reworked liberal ideals which ultimately create a diverse but related set of expressions concerning selfhood, property, privacy, labor, and creativity” (Coleman and Golub, 2008, p. 267).
Jessica Cleland was nineteen when she took her own life on Easter Saturday last year, after receiving Facebook messages from two teenage boys she considered friends saying that they hated her, and that she was a “f***ing sook.”
Were the intentions of those who attacked Jessica Cleland for her to commit suicide? There is no question that when we are online we do not always act admirably and, more shocking, we may be at our worst when we are using social networking technologies. In a recent Pew Research study, 92 percent of the people reported that being online allowed them to be more critical (Pew Research Center, 2014). Also, ironic but true, the more we increase our use of social media to connect with others, the more depressed and isolated we are likely to become. Research done by the University Of Pittsburgh School of Medicine, for example, demonstrated a connection between the use of social media and depression (Chowdhry, 2016).
As the ills of cyberspace become more obvious, we are redoubling our efforts to legislate against them. Private companies are under increasing pressure to monitor their online forums for abusive behavior and there is even a new trend of holding companies legally liable. Facebook, Google, and Twitter, for instance, have been named in a lawsuit by the family members of the victims in the Orlando nightclub shootings in 2016 because terrorist recruiting videos were posted on their sites. At both the state and federal level, there are legislative efforts under way to address cyber bullying, online harassment, and revenge porn, while educational efforts for our school- age children are designed to nip the behavior in the bud. Despite all of the attention paid to how to regulate our use of social media, however, scant attention is paid to the question of whether we are doing what we do because of our use of social networking technologies.
The position taken here is that our choices and actions are influenced by the phenomenological effects of social networking technologies. The purpose, however, is not to argue human behavior is determined by social networking technologies. Instead, the intent is to consider the embodiment and hermeneutical influence of technology on the normative basis for our human agency when we are online so as to better understand the potential effects when it comes to our offline lives.
The arrival of social networking technologies such as Facebook, MySpace, Twitter, and YouTube is altering the fabric of our lives and changing the ethical implications of our social and political practices. Social media is at the center of many of our greatest public policy debates, but the role it plays in relation to human behavior is far from settled. Consider the shooting attack on Republicans at a baseball field during a charity event. The gunman was described “as a Bernie Sanders supporter and campaign volunteer virulently opposed to President Trump. He posted many anti- Trump messages on social media, including one in March that said ‘Time to Destroy Trump & Co.’” (Board, 2017). A look at his Facebook posts confirmed the antipathy James T. Hodgkinson had for President Trump and the Republican Party. The question not clearly answered, however, was whether social media contributed to his intentions to shoot Republicans. And in the 2016 elections, Hillary Clinton placed some responsibility for her loss on the social media network Facebook. According to Clinton, the “fake stories” that spread on social media influenced the voters in the election. The solution she suggested? Content regulation by the social media giant. She said of Facebook, “They've got to get back to trying to curate it more effectively, they've got to help prevent fake news from creating a new reality” (Staff, 2017). In response, Facebook and Google began shutting down “fake news” sites, but without a clear understanding of how or why these social media sources played a role in swaying the American voter and without a clear path to avoid the potential regulatory pitfalls that come along with content regulation. Social media and its potentially radicalizing effect also figures into our domestic and international efforts against the threat of terrorism. The Obama administration justified the drone strike on American citizen Anwar al- Awlaki, in part because of the radicalizing influence of al- Awlaki's blogs, Facebook page, YouTube videos, and contributions to the online al- Qaeda magazine, Inspire. Even after his death, the Congress believed the influence of social media was so powerful that it had to be taken down to prevent further terrorist acts.
If someone called me a chink or a gook online I really wouldn't care at all. In real life though, depending on who says it, if someone called me a chink or gook I would want to beat the hell out of them … Reason for this is because online they have no clue what race I am and so they are obviously trying to troll me which I find funny. Real life though they are actually attacking my culture/ race which I can take until it's a friend or something (Phillips, 2015, p. 34).
If the despairing self is active … it is constantly relating to itself only experimentally, no matter what it undertakes, however great, however amazing and with whatever perseverance. It recognizes no power over itself; therefore in the final instance it lacks seriousness … The self can, at any moment, start quite arbitrarily all over again (Kierkegaard, 1941, p. 100).
The arrival of social networking technologies was met with great optimism and anticipation when it came to our personal identity. These technologies promised to us the possibility to communicate and interact free from the physical markers of gender, class, ethnicity, sexuality, and disability and, in doing so, liberate us from the ways we were divided. The hope was that realization of our transcendental self in virtual reality would allow us to prioritize the mind and not the body as the primary characteristic of being human (Yar, 2014). Yet, it seems we are even more divided and segmented than ever before, and social networking technologies might be partially to blame.
Some argue that being able to hide our identity is often at fault for all that is wrong and accounts for the increase in the bad behavior when we are on social media (Peebles, 2014). Yet, ironically, the two main arenas for our interactions and communications – social networking sites and text messages – are not anonymous environments, and studies indicate that it is here our human behavior is at its worst (Tokunaga, 2010).
On Christmas Day in 2010, Simone Back, a 42-year-old social worker in the United Kingdom, updated her Facebook status: “took all my pills, be dead soon, bye bye everyone.” Simone had 1082 friends on Facebook, but instead of prompting a reaction or response to this cry for help, the message provoked an online debate on Simone's Facebook wall. Some friends mocked or openly doubted the sincerity of the attempt, and others suggested that previous responders would soon regret their comments if the message was, in fact, sincere. To the observers, the event was seemingly abstracted and objectified. No one called for help or attempted to contact Simone by other means, despite the fact that several friends lived within walking distance of Simone's apartment. Seventeen hours later, Simone's mother was informed of the status update via a text message, and police found Simone dead shortly after. Simone's mother was, of course, left baffled as to why none of her daughter's “friends” did anything to help. In this case, connectivity did not equate to community, care or responsibility (Miller, 2015).
Are social networking technologies to blame for the death of Simone Back? The easy answer is no, but the possible answer is yes, because of the moral influence social media has on us. But understanding this influence is more difficult than it seems. According to Enlightenment thinking, morality is portrayed as the sole province of the moral subject who, unlike the material object of technology, possesses consciousness, intentionality, and free will, all of which are necessary for the attribution of moral responsibility. This classical framework puts humans squarely in control over the development and deployment of technology and the responsibility for its consequences rests on our shoulders. At every stage of technological evolution, we see ourselves as the cause behind the effects of technology, directing it toward the ends we envision, either good or bad. The way we think about our relationship with technology, however, also informs and, more importantly, misinforms the solutions we apply to the human behaviors taking shape on the Internet.
John and Kelly Halligan lost their thirteen year old son, Ryan, to suicide on October 7, 2003. At the time of his death, Ryan was a student at a middle school in Essex Junction, Vermont. After Ryan's death, it was revealed that he was ridiculed and humiliated by peers at school and on- line. Ryan father writes: “A few days after his funeral I logged on to his AOL IM account because that was the one place he spent most of his time during the last few months. I logged on to see if there were any clues to his final action. It was in that safe world of being somewhat anonymous that several of his classmates told me of the bullying and cyber bullying that took place during the months that led up to his suicide. The boy that had bullied him since 5th grade and briefly befriended Ryan after the brawl was the main culprit. My son the comedian told his new friend something embarrassing and funny that happened once and the friend (bully) ran with the new information that Ryan had something done to him and therefore Ryan must be gay. The rumor and taunting continued beyond that school day … well into the night and during the summer of 2003” (Halligan, n.d.).
The Importance of Time
Did the schoolmates of Ryan anticipate their instant messages would lead to his suicide, and does the asynchricity of time when we are online have anything to do with it? The central question considered in this chapter is whether the phenomenological effects of social networking technologies alter our sense of time consciousness and, in doing so, influence the moral quality of our actions and decisions and ultimately who we are online. Time consciousness and moral judgment are inextricably linked. Moral responsibility is a function of contemplation of our actions, not temporally isolated in the present, but in consideration of the effect of our decisions and actions on others with a view toward the past and future. In short, freedom and responsibility for our actions depend on the structure of temporality because it forces us to consider a longer perspective on our existence and our responsibility to humankind.
We shall be questioning concerning technology, and in so doing we should like to prepare a free relationship to it. The relationship will be free if it opens our human existence to the essence of technology. When we can respond to this essence, we shall be able to experience the technological within its own bounds (Heidegger, 1977, p. 1; emphasis in the original).
If our morality is being shaped in a detrimental way by our use of social media, how is it possible these same technologies could also offer a solution for its repair? The answer depends on whether we are willing to explore what social media reveals about us. Recall that Heidegger explained that technology is a “way of revealing” because it allows reality to come to presence while transforming our relation to it. This process of “revealing,” however, also orders our relationship with technology and our ontological state of Being in such a way that it limits our understanding. The ordering of technology is Enframing, which, in turn, creates the Gestell that limits what is revealed:
Enframing does not simply endanger man in his relationship to himself and to everything that is. As a destining, it banishes man into that kind of revealing which is an ordering. Where this ordering holds sway, it drives out every other possibility of revealing. Above all, Enframing conceals that revealing which, in the sense of poiesis, lets what presences come forth into appearance. As compared with that other revealing, the setting- upon that challenges forth thrusts man into a relation to that which is, that is at once antithetical and rigorously ordered (Heidegger, 1977, p. 14).
This description of our relationship with technology captures the current “danger” we face in our use of social media. Ironically, it is not the technology that is the danger. Rather, it is the technological ordering of our ontological Being that is the danger we must overcome. “The threat is not a problem for which there can be a solution but an ontological condition from which to be saved” (Dreyfus, 1995, p. 54). The solution for the moral problems we face with our use of social media is not then limited to technological fixes.
Is social media changing who we are? We assume social media is only a tool for our modern day communications and interactions, but is it quietly changing our identities and how we see the world and one another? Our current debate about the human behaviors behind social media misses the important effects these social networking technologies are having on our sense of shared morality and rationality. There has been much concern about the loss of privacy and anonymity in the Information Age, but little attention has been paid to the consequences and effects of social media and the behavior they engender on the Internet. In order to understand how social media influences our morality, Lisa S. Nelson suggests a new methodological approach to social media and its effect on society. Instead of beginning with the assumption that we control our use of social media, this book considers how the phenomenological effects of social media influences our actions, decisions, and, ultimately, who we are and who we become. This important study will inform a new direction in policy and legal regulation for these increasingly important technologies.