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Monoclonal antibody therapeutics to treat coronavirus disease (COVID-19) have been authorized by the US Food and Drug Administration under Emergency Use Authorization (EUA). Many barriers exist when deploying a novel therapeutic during an ongoing pandemic, and it is critical to assess the needs of incorporating monoclonal antibody infusions into pandemic response activities. We examined the monoclonal antibody infusion site process during the COVID-19 pandemic and conducted a descriptive analysis using data from 3 sites at medical centers in the United States supported by the National Disaster Medical System. Monoclonal antibody implementation success factors included engagement with local medical providers, therapy batch preparation, placing the infusion center in proximity to emergency services, and creating procedures resilient to EUA changes. Infusion process challenges included confirming patient severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity, strained staff, scheduling, and pharmacy coordination. Infusion sites are effective when integrated into pre-existing pandemic response ecosystems and can be implemented with limited staff and physical resources.
Hophornbeam copperleaf (Acalypha ostryifolia Riddell) is an erect, herbaceous, dicot species in the Euphorbiaceae, or spurge, family that constitutes more than 200 genera and some 6,000 species (Mayfield and Webster 2013). Although the euphorbs have a cosmopolitan distribution, none are found in the Arctic (Mabberley 1997). Members of the Euphorbiaceae may be trees, shrubs, herbs (occasionally aquatic), or vines; sometimes succulent and cactus-like; and often have glands on vegetative plant parts (Mabberley 1997; Zomlefer 1994). Genera in the spurge family include Croton, Euphorbia, Ricinus, and Acalypha. Acalypha consists of 450 species that are native to both the Eastern and Western hemispheres (Zomlefer 1994). Acalypha was the name used by Hippocrates because the leaves resemble those of nettles, whereas ostryifolia alludes to the resemblance of leaves to plants in the genus Ostrya (hophornbeam trees; Burrows and Tyrl 2013; Haddock 2014; Hilty 2018). As plants mature in the fall, the leaves can turn reddish-brown, which may indicate why “copperleaf” is included in the species’ common name (Hilty 2018). Hophornbeam copperleaf is native to North America; it occurs in the United States ranging from Arizona east to Florida, north to Pennsylvania, and west to Nebraska (Anonymous 2019). It occurs in a variety of habitats including agronomic fields, cultivated areas, landscapes, roadsides, river and stream banks, thickets, pastures, and waste sites (Bryson and DeFelice 2010; Haddock 2014; Hilty 2018). This plant’s other common names include copperleaf, pineland three-seed mercury, Virginia copperleaf, hornbeam mercury, hornbeam three-seed mercury, mercury, and rough-pod copperleaf (Bryson and DeFelice 2010; Haddock 2014; Hilty 2018; Steckel 2006).
Transactional cascades among child internalizing and externalizing symptoms, and fathers’ and mothers’ posttraumatic stress disorder (PTSD) symptoms were examined in a sample of families with a male parent who had been deployed to recent military conflicts in the Middle East. The role of parents’ positive engagement and coercive interaction with their child, and family members’ emotion regulation were tested as processes linking cascades of parent and child symptoms. A subsample of 183 families with deployed fathers and nondeployed mothers and their 4- to 13-year-old children who participated in a randomized control trial intervention (After Deployment: Adaptive Parenting Tools) were assessed at baseline prior to intervention, and at 12 and 24 months after baseline, using parent reports of their own and their child's symptoms. Parents’ observed behavior during interaction with their children was coded using a multimethod approach at each assessment point. Reciprocal cascades among fathers’ and mothers’ PTSD symptoms, and child internalizing and externalizing symptoms, were observed. Fathers’ and mothers’ positive engagement during parent–child interaction linked their PTSD symptoms and their child's internalizing symptoms. Fathers’ and mothers’ coercive behavior toward their child linked their PTSD symptoms and their child's externalizing symptoms. Each family member's capacity for emotion regulation was associated with his or her adjustment problems at baseline. Implications for intervention, and for research using longitudinal models and a family-systems perspective of co-occurrence and cascades of symptoms across family members are described.
Four married couples were recruited from an outpatient alcohol counselling centre. Four husbands and one wife had recently received therapy for alcoholism and all but one was abstinent during the study. All scored as distressed on the Marital Adjustment Test. They participated in ten sessions of behavioural marital therapy emphasising positive reinforcement, communication, expression of feelings and problem solving. Problem solving discussions were audio-recorded at each session and analysed using a behaviour code. Measures of marital satisfaction, conflict and depression showed modest gains which were generally maintained at follow-up. Communication skills improved most with training, problem solving less so and feelings expression declined below baseline levels. These changes did not appear to be very durable. The non-abstinent client reduced his drinking to a level satisfactory to his wife during therapy. These findings support other recent work, draw attention to the need to find ways of promoting the maintenance and transfer of therapeutic changes and suggest that behavioural marital therapy may usefully be employed in outpatient alcohol counselling settings.