Intubation Decision Based on Illness Severity and Mortality in COVID-19: An International Study.

OBJECTIVES: To evaluate the impact of intubation timing, guided by severity criteria, on mortality in critically ill COVID-19 patients, amidst existing uncertainties regarding optimal intubation practices. DESIGN: Prospective, multicenter, observational study conducted from February 1, 2020, to November 1, 2022. SETTING: Ten academic institutions in the United States and Europe. PATIENTS: Adults (≥ 18 yr old) confirmed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and hospitalized specifically for COVID-19, requiring intubation postadmission. Exclusion criteria included patients hospitalized for non-COVID-19 reasons despite a positive SARS-CoV-2 test. INTERVENTIONS: Early invasive mechanical ventilation (EIMV) was defined as intubation in patients with less severe organ dysfunction (Sequential Organ Failure Assessment [SOFA] < 7 or Pa o2 /F io2 ratio > 250), whereas late invasive mechanical ventilation (LIMV) was defined as intubation in patients with SOFA greater than or equal to 7 and Pa o2 /F io2 ratio less than or equal to 250. MEASUREMENTS AND MAIN RESULTS: The primary outcome was mortality within 30 days of hospital admission. Among 4464 patients, 854 (19.1%) required mechanical ventilation (mean age 60 yr, 61.7% male, 19.3% Black). Of those, 621 (72.7%) were categorized in the EIMV group and 233 (27.3%) in the LIMV group. Death within 30 days after admission occurred in 278 patients (42.2%) in the EIMV and 88 patients (46.6%) in the LIMV group ( p = 0.28). An inverse probability-of-treatment weighting analysis revealed a statistically significant association with mortality, with patients in the EIMV group being 32% less likely to die either within 30 days of admission (adjusted hazard ratio [HR] 0.68; 95% CI, 0.52-0.90; p = 0.008) or within 30 days after intubation irrespective of its timing from admission (adjusted HR 0.70; 95% CI, 0.51-0.90; p = 0.006). CONCLUSIONS: In severe COVID-19 cases, an early intubation strategy, guided by specific severity criteria, is associated with a reduced risk of death. These findings underscore the importance of timely intervention based on objective severity assessments.

Impact of exposure to rational career reflective training on work-related ethics among student-philosophers.

BACKGROUND: Teaching individuals at the early-career stage what and how to respect organizational codes of conduct is a good step in creating a democratic working environment. As a result, it is important to coach students in sustaining organizational well-being by seeking the truth, teaching the truth and upholding the truth. Currently, how these are taught in institutions of higher learning lacks structure. In fact, some graduate students are displaying work-deviant behaviors showing that they have poor perceptions of work-related ethics. Using this reason, we tested the impact of exposure to rational career reflective training on work-related ethics among student-philosophers. METHODS: This is a pretest, posttest with a follow-up pure experimental design was used. A total of 105 student-philosophers were recruited, assessed 3 times using Ethics and irrational beliefs measures, and coached by therapists. The participants were exposed to 12-session rational career reflective training. The data collected were subjected to a multivariate statistical analysis to test how effective the intervention was in changing negative perceptions about ethics. RESULTS: It was found that rational career reflective training changes negative perceptions about work-related ethics among student-philosophers. The effectiveness of rational career reflective training is not statistically influenced by gender and group interaction. Gender does not moderate the impact of the intervention. CONCLUSION: This study finally suggests that rational career reflective training effectively changes negative perceptions about ethics among student-philosophers. Thus, recommends the advancement of Ellis principles in other workplaces and across populations.

Intervention for burnout and irrational beliefs in parents of couples seeking a divorce: A critical reflection of Igbo-African marital discord.

BACKGROUND: Looking at the sociocultural dimension of marriage in the sub-region of Nigeria like Igbo, parents allow their sons and daughters to marry so that they can have homes. The expectation is for them to have permanent homes. If there is anything contrary to that such as divorce, parents usually frown at it. To some extent, the psychological effects of it may be deeply rooted in parents who hear that their children are seeking a divorce. Given this reason, this study investigated the effect of rational emotive family health therapy (REFHT) on burnout and irrational beliefs in parents of couples seeking a divorce. METHODS: This is a pretest-posttest randomized control group research. Two instruments were used to measure 73 participants who were assigned to treatment and control arms. the intervention group received 12 sessions of counseling that aimed to decrease the level of burnout and irrational beliefs. At the end of the sessions and assessments, the data were analyzed using repeated measures, cross-tabulation, and univariate statistics. RESULTS: the finding indicated that REFHT was highly effective in decreasing the high parental burnout orchestrated by irrational belief. Comparing the mean scores of the participants exposed to the intervention and those in the control group after time 1 and 2 assessments, the mean reduction of burnout and irrational beliefs further showed a positive treatment outcome. There was no significant influence of gender, time, and group. CONCLUSION: This study suggests that REFHT is significant in improving the psycho-emotional wellness of parents of couples seeking a divorce. Thus, additional research is required to validate the impact of REFHT in decreasing burnout in other populations.

Cognitive behavioral therapy for challenges to quitting tobacco smoking among social science and religion students.

BACKGROUND: Tobacco smoking is a public health issue. The aim of this investigation was to determine the effect of cognitive behavioral therapy (CBT) on the disputation of challenges to quitting tobacco smoking among students enrolled in the Social Science and religious Education programmes. METHODS: The study adopted a pretest-posttest randomized controlled group design with follow-up. The population comprised of 76 tobacco smokers (randomized into 1 of 2 groups: n = 38 for the treatment group, n = 38 for the waitlist control group) completed the study. A self-report scale measuring dependence on cigarettes was used as the outcome measure. The treatment group was exposed to a 12-weeks CBT intervention. The treatment and waitlisted groups were evaluated at 3 time points: pretest, post-test, and follow-up. Statistical analyses were achieved using ANOVA. RESULTS: The result showed that CBT had a significant effect in reducing the challenges to quitting tobacco smoking among the student smokers in the treatment group in comparison with the waitlist control group. The positive behavioral gains after the CBT program also persisted at follow-up in the treatment group compared with the waitlist control group. CONCLUSION: Therefore, this study suggests that CBT intervention is a time-effective treatment method for disputation of challenges to quitting tobacco smoking among students enrolled in the Social Science and Religious Education Programmes.

Increased soluble urokinase plasminogen activator levels modulate monocyte function to promote atherosclerosis.

People with kidney disease are disproportionately affected by atherosclerosis for unclear reasons. Soluble urokinase plasminogen activator receptor (suPAR) is an immune-derived mediator of kidney disease, levels of which are strongly associated with cardiovascular outcomes. We assessed suPAR's pathogenic involvement in atherosclerosis using epidemiologic, genetic, and experimental approaches. We found serum suPAR levels to be predictive of coronary artery calcification and cardiovascular events in 5,406 participants without known coronary disease. In a genome-wide association meta-analysis including over 25,000 individuals, we identified a missense variant in the plasminogen activator, urokinase receptor (PLAUR) gene (rs4760), confirmed experimentally to lead to higher suPAR levels. Mendelian randomization analysis in the UK Biobank using rs4760 indicated a causal association between genetically predicted suPAR levels and atherosclerotic phenotypes. In an experimental model of atherosclerosis, proprotein convertase subtilisin/kexin-9 (Pcsk9) transfection in mice overexpressing suPAR (suPARTg) led to substantially increased atherosclerotic plaques with necrotic cores and macrophage infiltration compared with those in WT mice, despite similar cholesterol levels. Prior to induction of atherosclerosis, aortas of suPARTg mice excreted higher levels of CCL2 and had higher monocyte counts compared with WT aortas. Aortic and circulating suPARTg monocytes exhibited a proinflammatory profile and enhanced chemotaxis. These findings characterize suPAR as a pathogenic factor for atherosclerosis acting at least partially through modulation of monocyte function.

Soluble Urokinase Plasminogen Activator Receptor and Venous Thromboembolism in COVID-19.

Background Venous thromboembolism (VTE) contributes significantly to COVID-19 morbidity and mortality. The urokinase receptor system is involved in the regulation of coagulation. Levels of soluble urokinase plasminogen activator receptor (suPAR) reflect hyperinflammation and are strongly predictive of outcomes in COVID-19. Whether suPAR levels identify patients with COVID-19 at risk for VTE is unclear. Methods and Results We leveraged a multinational observational study of patients hospitalized for COVID-19 with suPAR and D-dimer levels measured on admission. In 1960 patients (mean age, 58 years; 57% men; 20% Black race), we assessed the association between suPAR and incident VTE (defined as pulmonary embolism or deep vein thrombosis) using logistic regression and Fine-Gray modeling, accounting for the competing risk of death. VTE occurred in 163 (8%) patients and was associated with higher suPAR and D-dimer levels. There was a positive association between suPAR and D-dimer (ß=7.34; P=0.002). Adjusted for clinical covariables, including D-dimer, the odds of VTE were 168% higher comparing the third with first suPAR tertiles (adjusted odds ratio, 2.68 [95% CI, 1.51-4.75]; P<0.001). Findings were consistent when stratified by D-dimer levels and in survival analysis accounting for death as a competing risk. On the basis of predicted probabilities from random forest, a decision tree found the combined D-dimer <1 mg/L and suPAR <11 ng/mL cutoffs, identifying 41% of patients with only 3.6% VTE probability. Conclusions Higher suPAR was associated with incident VTE independently of D-dimer in patients hospitalized for COVID-19. Combining suPAR and D-dimer identified patients at low VTE risk. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04818866.

Shocks and volatility transmission between oil price and Nigeria's exchange rate.

The study examined shock and volatility transmission between oil price and exchange rate markets using daily data covering the period from 23rd October 2009 to 30th November 2020. The contributions of the paper include (i) implementation of VAR-AGARCH model to capture spillover effect of shock and volatility; (ii) examining the nature of shock impact in oil price and exchange rate market; (iii) adopting of two measured of oil price (WTI and Brent); (iv) employing two measures of the exchange rate (USD/Naira and effective/Naira). The study revealed that past own shocks and volatilities significantly contribute to current volatilities in exchange rate and oil price markets. Also, there is bidirectional shock and volatility spillover between the exchange rate (USD/Naira and effective/Naira) and WTI oil price markets. There were bidirectional shock and volatility spillover between USD/Naira and Brent oil price and unidirectional shock and volatility from Brent oil price to effective exchange rate market. We found asymmetric shocks impacting exchange rates and WTI oil price while symmetric shock was observed in Brent oil price. Including innovation in oil price is essential in exchange rate policy formulation and modelling exchange rate shock and volatility.

Occupational health intervention for work-life balance and burnout management among teachers in rural communities.

This study examined the efficacy of the occupational health model of rational emotive behavioral on work-life balance (WLB) and burnout management (BOM) among public school teachers. The study was a pretest-posttest randomized control group design. The participants were 141 teachers in rural communities in Enugu state Nigeria drawn with emphasis on inclusion criteria. Two instruments were used for the data. Data were analyzed using repeated measure analysis of variance. The result showed that rational emotive occupational health coaching (REOHC) led to a significant increase in the management of WLB and burnout among teachers compared to their counterparts in the control group. At the follow-up stage, REOHC proved to be effective over a period of 3 months. REOHC is a therapeutic intervention strategy that is valid and reliable over time in the management of WLB and BOM among teachers. The researchers are optimistic that the extension of REOHC to other related social and psychological-based self-defeating belief by social workers, psychologists, counselors, and employers of labors can enhance their productivity and emotionality in the home and workplace.

Effects of group cognitive-behavioral therapy on psychological distress of awaiting-trial prison inmates.

BACKGROUND/OBJECTIVES: The level of psychological distress among awaiting-trial inmates is rapidly increasing in Nigeria. Studies have recommended increasing attention and additional psychological intervention that could improve the psychological wellbeing of prisoners. This study evaluates the effect of cognitive behavioral therapy on psychological distress among awaiting-trial prison inmates in Nigeria. METHODS: A total of 34 awaiting-trial prison inmates in Enugu state Nigeria were used as the study participants. Two measures (perceived emotional distress inventory and general health Questionnaire) were used for data collection. Repeated measures with analysis of variance (ANOVA) were used to examine the effects of the intervention. Effect sizes were also reported with partial Eta Squared ((Equation is included in full-text article.)). RESULTS: The result showed that there was no significant difference in psychological distress between the treatment and no-intervention groups. The results showed that CBT had a significant effect on psychological distress of awaiting-trial prison inmates when compared to their counterparts in the no-intervention group at Time 2. Additionally, the efficacy of CBT on the psychological distress of awaiting-trial prison inmates was significantly sustained at the follow-up measurements (Time 3). CONCLUSION: This study suggests that cognitive behavioral therapy is an effective intervention for decreasing psychological distress among awaiting-trial prison inmates. Additionally, the impactful benefit of the intervention can persist in overtime. Therefore, cognitive behavioral therapists can further explore the efficacy of CBT using various cultures.

Effectiveness of music therapy with relaxation technique on stress management as measured by perceived stress scale.

BACKGROUND: Living in Nigerian environment is enough stress. In our time, many students could not cope with the stress of school environment like ours and others are still suffering from different health problems attributed to stress. Based on this, we investigated the effect of music therapy with relaxation technique on stress management among university students in southeastern Nigeria. METHODS: Participants for the study were 142 university students in the Southeastern Nigeria. Perceived stress scale (PSS) was used to measure the symptoms of stress. Statistical tool used was repeated measures with analysis of variance (ANOVA) to ascertain the effectiveness of music therapy with relaxation. Among other tools used was Partial η to examine the effect sizes and level of changes inthemanagement of stress across groups. RESULTS: The finding indicated that there were no baseline differences in levels of stress management between participants in the treatment and waitlist control conditions. Results revealed significant improvement in stress management for participants in the music therapy with relaxation group, whereas the waitlist control group showed no significant change in their score over the same period. Furthermore, the positive effect of music therapy with relaxation was maintained at follow-up. CONCLUSION: The findings of this study suggest that the efficacy of music therapy with relaxation technique for improving the students' stress management can be consistent at follow-up. Hence, music therapists, counsellors and psychotherapists should continue to investigate the beneficial effects of music therapy with relaxation on stress management among university students in every part of the world.