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Point-of-care ultrasound (POCUS) is used to manage patients in real time. This study aimed to teach pediatric critical care team members to use POCUS for endotracheal tube (ETT) placement confirmation. A secondary aim was to assess the feasibility of a remote curriculum for this purpose.The Kern 6-step approach was used. The curriculum involved virtual didactics, asynchronous learning modules, and remote hands-on sessions using teleguidance with the Butterfly IQ+ probe, Butterfly Network, Inc, Guilford, CT. Participants learned direct and indirect methods of ETT placement confirmation and were directed to practice independently. Outcomes included attitudes and satisfaction, knowledge and skills acquisition and retention, and the use of POCUS on shift.Ten participants completed the curriculum. The average knobology and quiz scores improved by 29.3% and 20.8%, respectively. Improvement was sustained at re-evaluation. Seven of 10 participants performed independent scans. At the 3-month reassessment, most demonstrated mastery of thoracic scans. All required prompting for satisfactory tracheal scans. All felt positively toward POCUS and the remote curriculum.Pediatric critical care team members acquired and retained knowledge and skills for POCUS basics and ETT placement confirmation through a remote curriculum. Participants were satisfied with the course. Further studies are needed to reassess longer-term knowledge and skill retention and the effects on patient outcomes.

Background We aimed to examine the clinical value of serial MRSA surveillance cultures to rule out a MRSA diagnosis on subsequent cultures during a patient's surgical intensive care unit (SICU) admission. Material and Methods We performed a retrospective cohort study to evaluate patients who received a MRSA surveillance culture at admission to the SICU (n = 6,915) and collected and assessed all patient cultures for MRSA positivity during their admission. The primary objective was to evaluate the transition from a MRSA negative surveillance on admission to MRSA positive on any subsequent culture during a patient's SICU stay. Percent of MRSA positive cultures by type following MRSA negative surveillance cultures was further analyzed. Measurements and Main Results 6,303 patients received MRSA nasal surveillance cultures at admission with 21,597 clinical cultures and 7,269 MRSA surveillance cultures. Of the 6,163 patients with an initial negative, 53 patients (0.87%) transitioned to MRSA positive. Of the 139 patients with an initial positive, 30 (21.6%) had subsequent MRSA positive cultures. Individuals who had an initial MRSA surveillance positive status on admission predicted MRSA positivity rates for cultures in qualitative lower respiratory cultures (64.3% versus. 3.1%), superficial wound (60.0% versus 1.6%), deep wound (39.0% versus 0.8%), tissue culture (26.3% versus 0.6%), and body fluid (20.8% versus 0.7%) cultures when compared to MRSA negative patients on admission. Conclusion Following MRSA negative nasal surveillance cultures patients showed low likelihood of MRSA infection suggesting empiric anti-MRSA treatment is unnecessary for specific patient populations. SICU patient's MRSA status at admission should guide empiric anti-MRSA therapy.

Background The COVID-19 pandemic has led to pervasive social and economic disruptions. This cross-sectional investigation aimed to evaluate associations between religious/spiritual factors and mental health symptoms among community residents in a southern US state. In particular, we focused on perceptions of God's distance, a salient aspect of religious/spiritual struggle that has received little scrutiny in health research. Methods Participants included 551 respondents assessed during a period of gradual reopening but rising infection rates. Mental health outcomes were assessed using standardized measures of generalized anxiety, depression, and trauma symptoms. Perceptions of an affirming relationship with God, anger at God, and disappointment at God's distance were evaluated using an adapted version of the Attitudes-Toward-God Scale-9. Results In multivariate analyses that accounted for pandemic-related and demographic factors, positive relationships with God were related to diminished symptoms on all three mental heatlh indices (all p's ≤.003), whereas disappointment with God's distance was associated with more pronounced difficulties (all p's ≤.014). Limtations The cross-sectional design precludes causal conclusions. Conclusions Findings suggest that perceived relationships with God are tied to clinically relevant mental health outcomes during periods of major upheaval. Disappointment with God's distance may be an important, understudied dimension of religious/spiritual struggle meriting further investigation.

Introduction: Long Term Care (LTC) facilities are fast-paced, demanding environments placing workers at significant risk for injuries. Health and safety interventions to address hazards in LTC are challenging to implement. The study assessed a participatory organizational change intervention implementation and impacts. Methods: This was a mixed methods implementation study with a concurrent control, conducted from 2017 to 2019 in four non-profit LTC facilities in Ontario, Canada. Study participants were managers and frontline staff. Intervention sites implemented a participatory organizational change program, control sites distributed one-page health and safety pamphlets. Program impact data were collected via Survey (self-efficacy, control over work, pain and general health) and observation (Quick Exposure Checklist). Interviews/focus groups were used to collect program implementation data. Results: Participants described program impacts (hazard controls through equipment purchase/modification, practice changes, and education/training) and positive changes in culture, communication and collaboration. There was a statistically significant difference in manager self-efficacy for musculoskeletal disorder (MSD) hazards between the control and intervention sites over time but no other statistical differences were found. Key program implementation challenges included LTC hazards, staff shortage/turnover, safety culture, staff time to participate, and communication. Facilitators included frontline staff involvement during implementation, management support, focusing on a single unit, training, and involving an external program facilitator. Conclusion: A participatory program can have positive impacts on identifying and reducing MSD hazards. Key to success is involving frontline staff in identifying hazards and creating solutions and management encouragement on a unit working together. High turnover rates, staffing shortages, and time constraints were barriers as they are for all organizational change efforts in LTC. The implementation findings are likely applicable in any jurisdiction. Practical Application: Implementing a participatory organizational change program to reduce MSD hazards is feasible in LTC and can improve communication and aid in identification and control of hazards.

Difficult intravenous access (DIVA) is a common problem in Emergency Departments (EDs), yet the prevalence and clinical impact of this condition is poorly understood. Ultrasound-guided peripheral intravenous catheter (USGPIV) insertion is a successful modality for obtaining intravenous (IV) access in patients with DIVA.We aimed to describe the prevalence of DIVA, explore how DIVA affects delivery of care, and determine if nurse insertion of USGPIV improves care delays among patients with DIVA.We retrospectively queried the electronic medical record for all ED patients who had a peripheral IV (PIV) inserted at a tertiary academic medical center from 2015 to 2017. We categorized patients as having DIVA if they required ≥3 PIV attempts or an USGPIV. We compared metrics for care delivery including time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED length of stay (LOS) between patients with and without DIVA. We also compared these metrics in patients with DIVA with a physician-inserted USGPIV versus those with a nurse-inserted USGPIV.A total of 147,260 patients were evaluated during the study period. Of these, 13,192 (8.9%) met criteria for DIVA. Patients with DIVA encountered statistically significant delays in time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED LOS compared to patients without DIVA (all p 0.001). Patients with nurse-inserted USGPIVs also had statistically significant improvements in time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED LOS compared to patients with physician-inserted USGPIVs (all p 0.001).DIVA affects many ED patients and leads to delays in PIV access-related care. Nurse insertion of USGPIVs improves care in patients with DIVA.

Background Functional brain markers of suicidality can help identify at-risk individuals and uncover underlying neurocognitive mechanism(s). Although some converging evidence has implicated dysfunction in several brain networks, suicide-related neuroimaging markers are inconsistent across studies, due to heterogeneity of neuroimaging approaches, clinical populations, and experimental methods. Methods The current study aimed to address these limitations by examining resting-fMRI connectivity in a sample of post-9/11 veterans with a past suicide attempt (SA; n = 16) compared to a psychiatric control group (PC; n = 124) with no SA history but comparable past and present symptomatology, as well as a trauma control group (TC; n = 66) of trauma-exposed healthy controls. We used both a novel graph-analytic and seed-based approach to characterize SA-related connectivity differences across brain networks. Results First, the graph-analytic approach identified the right amygdala and a region in the cognitive control network (right middle temporal gyrus; MTG) as regional SA-related hubs of dysfunction (HoD), or regions that exhibited a high number of SA-related connections. Aberrant SA-related connectivity between these hubs spanned multiple networks, including the cognitive control, default mode and visual networks. Second, the seed-based connectivity analysis that identifies SA-related differences in the strength of neural connections across the whole brain further implicated the right amygdala. Limitations Small sample size and potential underreporting of SA. Conclusions These two analytic approaches preliminarily suggest that the right amygdala and right MTG may be specific neural markers of SA that can be differentiated from neural markers of psychopathology more broadly.

Opioid use disorder (OUD) and its consequences are a major public health concern. The partial agonist buprenorphine is a safe and effective treatment for OUD, but concerns about abuse, misuse, and diversion of buprenorphine have been raised. This narrative review examined the rates and motives for use of illicit buprenorphine in the United States. Findings from the 17 included studies suggest the majority of study participants using illicit buprenorphine do so for reasons related to misuse (to manage opioid withdrawal symptoms or achieve or maintain abstinence from other opioids). A smaller percentage of study respondents reported using buprenorphine for reasons related to abuse (to get high). There appears to be a gap between need for buprenorphine and access to adequate treatment. Attenuation of policy-related barriers and adoption of appropriate buprenorphine use by the treatment community are critical tools in the continued effort to reduce the burdens associated with OUD.

Despite the growing awareness of the importance of using research to inform occupational health and safety (OHS) practice, little is known about whether this information is applied in workplaces. As part of two research projects, organizational leaders were provided with benchmarking reports to support OHS decision-making and performance improvement. Using a knowledge use framework, we examined how leaders used benchmarking reports in OHS decision-making. Thirty organizational leaders with OHS responsibilities from eight sectors were interviewed. Thematic analysis was used to organize data and to identify, analyze, and report themes. Leaders noted that benchmarking reports contained helpful information and they were often used in some capacity for making OHS decisions. There were examples of conceptual, symbolic, and instrumental knowledge use. Leaders also discussed other information needs in OHS decision-making, such as best practices information and access to experts. Findings suggest that providing leaders with practical information and tools can help in decision making and improving OHS performance.

Few reports have suggested that non-Hispanic (NH) blacks may present with different symptoms for COVID-19 than NH-whites. The objective of this study was to investigate patterns in symptomatology and COVID-19 outcomes by race/ethnicity among adults in Arkansas. Data on COVID-19 symptoms were collected on day of testing, 7th and 14th day among participants at UAMS mobile testing units throughout the state of Arkansas. Diagnosis for SARS-CoV-2 infection was confirmed via nasopharyngeal swab and RT-PCR methods. Data analysis was conducted using Chi-square test and Poisson regression to assess the differences in characteristics by race/ethnicity. A total of 60,648 individuals were RT-PCR tested from March 29, 2020 through October 7, 2020. Among adults testing positive, except shortness of breath, Hispanics were more likely to report all symptoms than NH-whites or NH-blacks. NH-whites were more likely to report fever (19.6% vs. 16.6%), cough (27.5% vs. 26.1%), shortness of breath (13.6% vs. 9.6%), sore throat (16.7% vs. 10.7%), chills (12.5% vs. 11.8%), muscle pain (15.6% vs. 12.4%), and headache (20.3% vs. 17.8%). NH-blacks were more likely to report loss of taste/smell (10.9% vs. 10.6%). To conclude, we found differences in COVID-19 symptoms by race/ethnicity, with NH-blacks and Hispanics more often affected with specific or all symptoms, compared to NH-whites. Due to the cross-sectional study design, these findings do not necessarily reflect biological differences by race/ethnicity; however, they suggest that certain race/ethnicities may have underlying differences in health status that impact COVID-19 outcomes.

Prolonged microgravity has been shown to have a deconditioning effect on the spine, increasing the risk of back issues at distant locations such as Mars. Therefore, studying the lumbar motion of astronauts inside a spacesuit during on ground assessments could be crucial for ensuring crew safety and performance on planetary extravehicular activities. However, spacesuits present many challenges in performing kinematic evaluations with conventional motion capture systems. The purpose of this investigation is to develop a methodology for evaluating lumbar motion that can be worn inside a spacesuit. This method, based on flexible strain sensors, was tested with unsuited subjects in this pilot study. Twelve male volunteer subjects performed unloaded lumbar sagittal flexion and lateral bending motions. Lumbar kinematics were concurrently measured from 3D body scans and flexible strain sensors attached to the subjects. Mean R2 values for flexion and lateral bending were 0.93 (±0.06) and 0.96 (±0.03) respectively, and mean estimated 95% error of ±5.3° and ±2.8° were determined for flexion and lateral bending, respectively. The results indicate that flexible strain sensors yield useful metrics for lumbar kinematics. Relevance to industry Measuring biomechanics of the astronaut inside of a spacesuit is critical to improving spacesuit design and development of prophylactic countermeasures. However, the spacesuit prevents most traditional evaluation techniques. The method developed here provides a wearable solution to measure lumbar motion within the spacesuit and during field assessments in other industries.

Background Long-term care (LTC) workers are at significant risk for occupational-related injuries. Our objective was to evaluate the implementation process of a participatory change program to reduce risk. Methods A process evaluation was conducted in three LTC sites using a qualitative approach employing structured interviews, consultant logs and a focus group. Results Findings revealed recruitment/reach themes of being “voluntold”, using established methods, and challenges related to work schedules. Additional themes about dose were related to communication, iterative solution development, participation and engagement. For program fidelity and satisfaction, themes emerged around engagement, capacity building and time demands. Conclusion Process evaluation revealed idiosyncratic approaches to recruitment and related challenges of reaching staff. Solutions to prioritized hazards were developed and implemented, despite time challenges. The iterative solution development approach was embraced. Program fidelity was considered good despite early program time demands. Post implementation reports revealed sustained hazard identification and solution development.

This study evaluates the longitudinal relation between self-reported physical activity and health related work limitations (also known as presenteeism) among employees from a public university system. A retrospective longitudinal study design was used to examine research aims. Data were from self-reported health assessments collected from employees at a large University System in Texas during the 2013–2015 plan years (n=6,515).Work limitations were measured using the self-report 8-item work limitations questionnaire. Latent growth curve models were used to test whether: 1) baseline physical activity was associated with baseline work limitations; 2) changes in physical activity were related to changes in work limitations; and 3) baseline physical activity predicted changes in work limitations. Models were adjusted for demographic and health-related variables. The final adjusted growth curve model demonstrated excellent fit. Results revealed baseline physical activity was inversely associated with baseline work limitations (β = −0.12, p

Introduction OHS management audits are one means of obtaining data that may serve as leading indicators. The measurement properties of such data are therefore important. This study used data from Workwell audit program in Ontario, a Canadian province. The audit instrument consisted of 122 items related to 17 OHS management elements. The study sought answers regarding (a) the ability of audit-based scores to predict workers' compensation claims outcomes, (b) structural characteristics of the data in relation to the organization of the audit instrument, and (c) internal consistency of items within audit elements. Method The sample consisted of audit and claims data from 1240 unique firms that had completed one or two OHS management audits during 2007–2010. Predictors derived from the audit results were used in multivariable negative binomial regression modeling of workers' compensation claims outcomes. Confirmatory factor analyses were used to examine the instrument's structural characteristics. Kuder–Richardson coefficients of internal consistency were calculated for each audit element. Results The ability of audit scores to predict subsequent claims data could not be established. Factor analysis supported the audit instrument's element-based structure. KR-20 values were high (≥ 0.83). Conclusions The Workwell audit data display structural validity and high internal consistency, but not, to date, construct validity, since the audit scores are generally not predictive of subsequent firm claim experience. Audit scores should not be treated as leading indicators of workplace OHS performance without supporting empirical data. Practical applications Analyses of the measurement properties of audit data can inform decisionmakers about the operation of an audit program, possible future directions in audit instrument development, and the appropriate use of audit data. In particular, decision-makers should be cautious in their use of audit scores as leading indicators, in the absence of supporting empirical data.

Current understanding of the processes involved in the Late Pleistocene human settlement of North America has benefited from the application of theoretical perspectives derived from evolutionary ecology, human behavioral ecology, and evolutionary paradigms. These perspectives have increased and expanded our grasp of critical issues including demography and migration strategies; foraging, settlement mobility, and technological strategies; processes of social learning and cultural transmission; mobility and interaction networks; and the involvement of symbolism and prestige in social cohesion. The rapid spread of the Clovis cultural phenomenon across the entire continent has long fascinated archaeologists because of its speed, geographic extent, association with big-game hunting, and impressive degree of technological knowledge and skill. Renewed investigation of this phenomenon points toward the critical role of certain social factors behind its success. In particular, prestige-seeking and symbolic representation of inter-group relationships are increasingly viewed as driving forces in explaining this unique colonization event.

Background Diffusion of Innovations (DOI) theory may be applicable to studying transportation cycling adoption. This study assessed the association between two DOI theory constructs – perceived compatibility of transportation bicycling (the extent to which transportation bicycling is perceived as being consistent with existing values, norms, past experiences, and self-perception of potential adopters) and DOI stage of adoption of transportation bicycling – in population of downtown Austin employees. DOI and Transtheoretical Model (TTM) approaches to staging were also compared. Methods Survey data were collected via the Internet. Stage of adoption of transportation bicycling was assessed for each participant using both DOI and TTM staging approaches, as was a five-item DOI-based perceived compatibility of transportation bicycling score. Differences in perceived compatibility and sociodemographic characteristics across DOI stages were assessed. Differences in the distribution of participants and perceived compatibility across DOI and TTM stages were also assessed. Results Of the 803 employees invited, 295 (36.7%) completed the survey. Higher perceived compatibility was associated with being male, younger age, and higher education. Perceived compatibility was associated with DOI stage, and accounted for 45% of the variance across stages. As hypothesized, more participants were classified in TTM stage 1 than in DOI stage 1 (77% vs. 60%, p p Conclusions DOI theory may be relevant to understanding and promoting cycling for transportation. The TTM approach may undercount participants who are ready for action-oriented interventions. Interventions to increase transportation bicycling could benefit from an explicit focus on increasing the perceived compatibility of this behavior, and from utilizing the DOI staging approach to classify participants into stages that match their readiness for action.

Early life trauma (ELT) has been shown to impair affective control and attention well into adulthood. Neuroimaging studies have further shown that ELT was associated with decreased white matter integrity in the prefrontal areas in children and adults. However, no study to date has looked at the relationship between white matter integrity and affective control in individuals with and without a history of ELT. To examine this, we tested 240 Veterans with (ELT N = 80) and without (NoELT N = 160) a history of childhood sexual abuse, physical abuse or family violence. Affective control was measured with the Affective Go/No-Go (AGN) and attention was indexed with the Test of Variable Attention (TOVA). White matter integrity was measured using fractional anisotropy (FA). Results showed greater number of errors on the AGN in ELT compared to NoELT. There was no difference on the TOVA. While there were no mean differences in FA, there was an interaction between FA and reaction time to positive stimuli on the AGN where the ELT group showed a positive relationship between FA and reaction time in right frontal and prefrontal areas, whereas the NoELT group showed a negative or no association between FA and reaction time. This suggests that ELT may be associated with a distinct brain-behavior relationship that could be related to other determinants of FA than those present in healthy adults.

This exploratory study sought to identify the factors important to large improvement in workplace occupational health and safety (OHS) performance. Mixed methods were used to systematically identify 12 organizations in a workers’ compensation database that had made large and intentional improvement in workplace OHS performance in Ontario, Canada, during 1998–2008 (i.e., “breakthrough change” (BTC) cases). Four of these organizations were selected for in-depth case study (two manufacturers, a grocery and a social agency). Cross-case analysis and consideration of existing literature led to a 12-element conceptual model with organizational learning at its core. Four elements were involved in the initiation of BTC: external influence, organizational motivation to improve OHS, new OHS knowledge and a knowledge transformation leader. Five other elements were involved in the process of BTC: responsiveness to OHS concerns, positive social dynamics, continuous improvement pattern, simultaneous operational improvement, and supportive internal context. Finally, three elements are outcomes of BTC: integrated OHS knowledge, decreased OHS risk, and decreased injury and illness. These concepts can be used in future research regarding workplace improvement in OHS performance.