Oxic methane production from methylphosphonate in a large oligotrophic lake: limitation by substrate and organic carbon supply.

IMPORTANCE: Methane is an important greenhouse gas that is typically produced under anoxic conditions. We show that methane is supersaturated in a large oligotrophic lake despite the presence of oxygen. Metagenomic sequencing indicates that diverse, widespread microorganisms may contribute to the oxic production of methane through the cleavage of methylphosphonate. We experimentally demonstrate that these organisms, especially members of the genus Acidovorax, can produce methane through this process. However, appreciable rates of methane production only occurred when both methylphosphonate and labile sources of carbon were added, indicating that this process may be limited to specific niches and may not be completely responsible for methane concentrations in Flathead Lake. This work adds to our understanding of methane dynamics by describing the organisms and the rates at which they can produce methane through an oxic pathway in a representative oligotrophic lake.

A novel method to extend viability and functionality of living heart slices.

Living heart slices have recently emerged as a powerful experimental model for fundamental cardiac research. By retaining the structure and function of the native myocardium while maintaining the simplicity of cell culture models, heart slices can be easily employed in electrophysiological, pharmacological, biochemical, and structural investigations. One single heart yields many slices (>20 slices for rodents, >100 slices for porcine or human hearts), however due to the low throughput of most assays and rapid slice degeneration within 24 h of preparation, many slices remain unused and are discarded at the end of the preparation day. Here we present a novel method to extend viability and functionality of living heart slices, enabling their use in experiments over several consecutive days following preparation. By combining hypothermic conditions with inhibition of myosin II ATPase using 2,3-butanedione monoxime (BDM), slices prepared from the left ventricle of porcine hearts remain viable and exhibit preserved contractile function and morphology for up to 6 days. Electrophysiological function was also confirmed over the 6 days by extracellular field potentials recordings. This simple method not only maximizes the use of slices prepared from one single heart, thus reducing the number of animals required, but also increases data reproducibility by allowing multiple electrophysiological, pharmacological, biochemical, and structural studies to be performed from the same heart.

Predictors of Food Insecurity and Childhood Hunger in the Bronx During the COVID-19 Pandemic.

Using a community-based participatory research approach, we conducted a survey of 218 food pantry recipients in the south Bronx to determine predictors of food insecurity and childhood hunger. In adjusted multiple regression models, statistically significant risk factors for food insecurity included: having one or more children and not having health insurance. Statistically significant protectors against childhood hunger were: having a graduate degree, having health insurance and Spanish being spoken at home. Experiencing depression symptoms was positively associated with both food insecurity and childhood hunger. Frequency of food pantry use was not significantly associated with either food insecurity nor childhood hunger. This study suggests that targeting families with multiple children and without insurance will best help to promote food security among residents of the south Bronx. Social policy implications related to food security and benefit provision through the COVID-19 pandemic are also provided.

Investigating Correlates of Home Visitor Burnout, Compassion Fatigue, and Compassion Satisfaction in New York State: Implications for Home Visiting Workforce Development and Sustainability.

INTRODUCTION: Home visitor well-being is integral to delivering effective home visiting services and a core component of successful home visiting program implementation. While burnout (BO), compassion fatigue (CF), and compassion satisfaction (CS) have been studied extensively in physicians, nurses, and other health providers, little is known about the correlates of these phenomena in home visitors. METHODS: This cross-sectional study examined demographic characteristics (age, race, gender), health and personal experiences (anxiety, physical health, and adverse childhood experiences), and job-related factors (caseload, role certainty, job satisfaction) as correlates of BO, CF and CS among a sample of 75 home visitors employed across six MIECHV-funded agencies in New York State. Descriptive statistics were used to characterize our sample; linear regressions were employed to investigate correlates with outcomes of interest. RESULTS: Anxiety was significantly and positively associated with BO (ß = 2.5, p < 0.01) and CF (ß = 3.08, p < 0.01). Overall job satisfaction was significantly and inversely associated with BO only (ß = -0.11, p < 0.001). Participants who identified as white were less likely to report higher levels of CS relative to non-white counterparts (ß = -4.65, p = 0.014). Examinations of specific aspects of job satisfaction revealed significant associations between satisfaction with workplace operating conditions, nature of the work, and contingent rewards and select outcomes of interest. DISCUSSION: Prioritizing preventive measures that target correlates of BO and CF, such as higher levels of anxiety and lower levels of job satisfaction - particularly operating conditions - may improve workforce well-being, continuity of service delivery, and ultimately quality of care provided to clients.

Hydroxychloroquine and azithromycin alter the contractility of living porcine heart slices.

The cardiotoxicity risk of hydroxychloroquine (HCQ) and azithromycin (AZM) has been the subject of intensive research triggered by safety concerns in COVID-19 patients. HCQ and AZM have been associated with QT interval prolongation and drug-induced arrhythmias, however other cardiotoxicity mechanisms remain largely unexplored. Our group has pioneered the living heart slice preparation, an ex-vivo platform that maintains native cardiac tissue architecture and physiological electrical and contractile properties. Here, we evaluated the cardiotoxic effect of HCQ and AZM applied alone or in combination on cardiac contractility by measuring contractile force and contraction kinetics in heart slices prepared from porcine hearts. Our results show that clinically relevant concentrations of HCQ monotherapy (1-10 µM) reduced contractile force and contraction kinetics in porcine slices in a dose-dependent manner. However, AZM monotherapy decreased contractile force and contraction kinetics only at higher concentrations (30 µM). Combination of HCQ and AZM induced a dose-dependent effect similar to HCQ alone. Furthermore, pre-treating porcine heart slices with the L-type calcium channel agonist Bay K8644 prevented the effect of both drugs, while administration of Bay K8644 after drugs interventions largely reversed the effects, suggesting a mechanism involving inhibition of L-type calcium channels. These findings indicate that HCQ and AZM alter cardiac function beyond QT prolongation with significant contractile dysfunction in intact cardiac tissue. Our porcine heart slices provide a powerful platform to investigate mechanisms of drug cardiotoxicity.

Anxiety, attitudes, and education about fertility among medical students in the United States.

BACKGROUND: As delayed family building is common among physicians, the goal of this study was to evaluate childbearing plans, anxiety related to future fertility, and interest in fertility education among medical students. METHODS: Using convenience and snowball sampling methods, an electronic REDCap survey was distributed via social media and group messaging applications to medical students enrolled in medical schools across the United States. Answers were collected, and analysis of the descriptive statistics was performed. RESULTS: The survey was completed by 175 participants, 72% of which were female (assigned at birth). The mean (± SD) age of participants was 24.9 ± 1.9 years. Of all participants, 78.3% desire to have children and 65.1% of these individuals plan to delay childbearing. On average, the planned age of first pregnancy is 31.0 ± 2.3 years. "Lack of time" was the greatest influence on decision regarding timing of childbearing. Of all respondents, 58.9% reported at least some anxiety related to future fertility. When females and males were compared, significantly more females (73.8%) versus males (20.4%) reported worrying about future fertility (p < 0.001). Participants reported that greater knowledge about infertility and potential treatments would help ease fertility related anxiety, and 66.9% of respondents showed interest in learning about how things such as age and lifestyle can impact fertility, preferably through medical curricula, videos, and podcasts. CONCLUSION: A majority of the medical students in this cohort intend to have children and most plan to delay childbearing. A large percentage of female medical students reported anxiety related to future fertility, but many students showed interest in receiving fertility education. This study highlights an opportunity for medical school educators to incorporate targeted fertility education into their curriculum with the intention of decreasing anxiety and improving future reproductive success.

Race and COVID-19 among Social Workers in Health Settings: Physical, Mental Health, Personal Protective Equipment, and Financial Stressors.

Social work is an essential workforce integral to the United States' public health infrastructure and response to COVID-19. To understand stressors among frontline social workers during COVID-19, a cross-sectional study of U.S-based social workers (N = 1,407) in health settings was collected (in June through August 2020). Differences in outcome domains (health, mental health, personal protective equipment [PPE] access, financial stress) were examined by workers' demographics and setting. Ordinal logistic, multinomial, and linear regressions were conducted. Participants reported moderate or severe physical (57.3 percent) and mental (58.3 percent) health concerns; 39.3 percent expressed PPE access concerns. Social workers of color were more likely to report significantly higher levels of concern across all domains. Those identifying as Black, American Indian/Alaska Native (AIAN), Asian American/Pacific Islander (AAPI), multiracial, or Hispanic/Latinx were over 50 percent more likely to experience either moderate or severe physical health concerns, 60 percent more likely to report severe mental health concerns, and over 30 percent more likely to report moderate PPE access concerns. The linear regression model was significantly associated with higher levels of financial stress for social workers of color. COVID-19 has exposed racial and social injustices that that hold true for social workers in health settings. Improved social systems are critical not just for those impacted by COVID-19, but also for the protection and sustainability of the current and future workforce responding to COVID-19.

"Treat Them Like a Human Being They are Somebody's Somebody": Providers' Perspectives on Treating Patients in the Emergency Department After Self-Injurious Behavior.

To understand ED providers' perspective on how to best care for individuals who present to US emergency departments (EDs) following self-injurious behavior, purposive recruitment identified nursing directors, medical directors, and social workers (n = 34) for telephone interviews from 17 EDs. Responses and probes to "What is the single most important thing ED providers and staff can do for patients who present to the ED after self-harm?" were analyzed using directed content analysis approach. Qualitative analyses identified four themes: treat patients with respect and compassion; listen carefully and be willing to ask sensitive personal questions; provide appropriate care during mental health crises; connect patients with mental health care. Participants emphasized treating patients who present to the ED after self-injurious behavior with respect and empathy. Hospitals could incentivize provider mental health training, initiatives promoting patient-provider collaboration, and reimbursement strategies ensuring adequate staffing of providers with time to listen carefully.

Pre- and Perinatal Risk Factors for Child Maltreatment in Military Families Across the First Two Years of Life.

Military families are exposed to a unique constellation of risk factors, which may impact maltreatment outcomes. The present study examined prospective relationships between demographic, health, birth-related, and military-specific risk factors identified prior to a child's birth on their risk for maltreatment in the first two years of life. Data from the Millennium Cohort Study, Department of Defense (DoD) operational records and Family Advocacy Program data on met-criteria maltreatment, and Birth and Infant Health Research program data on suspected maltreatment were linked for 9076 service member parents. Discrete time survival analysis showed that preterm birth increased risk of maltreatment while parents' older age, physical health, and service in the Navy or Air Force decreased risk. Building on DoD's New Parent Support Program, findings suggest the need for universal and targeted prevention efforts, beginning during pregnancy, which limit or eliminate risk factors for maltreatment in military families.

Predictors of burnout, compassion fatigue, and compassion satisfaction experienced by community health workers offering maternal and infant services in New York State.

Although burnout has been increasingly well studied among medical (nurses, physicians, residents) and mental health providers (psychologists, psychiatrists, social workers), there continues to be a lack of attention on the well-being of community-based providers, such as Community Health Workers (CHWs), within the United States. Using cross-sectional data from 75 CHWs employed in 14 agencies funded through the Maternal and Infant Community Health Collaboratives Initiative (MICHC) in New York, our study examined predictors (anxiety, physical health, adverse childhood experiences, job satisfaction, role certainty, demographic and work characteristics) of burnout, compassion fatigue (CF) and compassion satisfaction (CS). Descriptive statistics were used to characterize our sample and linear regression was employed to investigate the correlates of burnout, CF and CS. Results indicated that CHWs with higher levels of anxiety and lower job satisfaction were more likely to have higher burnout scores. CHWs with higher levels of anxiety, lower job satisfaction and fewer days of poorer health were more likely to report higher CF. Those who worked more than 35 h per week were less likely to report higher CS. The study provides recommendations for organizational-level interventions to address risk factors of burnout and CF and promote CS among CHWs, such as bolstering supervision, encouraging greater communication, offering recognition/appreciation of CHWs and creating opportunities for self-care. Findings should be considered when designing organizational-level preventive measures that mitigate burnout and CF and promote CS.

The Experiences of Caretaking and Financial Stress among Social Workers during the COVID-19 Pandemic.

Social workers have engaged in promotive, preventive, and intervention work throughout the COVID-19 pandemic. Given that social workers are disproportionately women, and the essential nature of practice during the pandemic, how social workers experience caretaking and financial stressors warrants examination. Data are drawn from a larger cross-sectional survey of U.S.-based social workers (N = 3,118) conducted from June to August 2020. A convergent mixed-methods design included thematic content analysis and univariate, ordinal, and linear regression models. The sample was 90 percent female; average age was 46.4 years. Although 44 percent indicated moderate or significant caretaking stress, results varied by race/ethnicity, workplace setting, and age. Social workers of color were more likely to report caretaking (p < .001) and financial stress (p < .001) compared with White counterparts. Social workers in children/family services were more likely to report increased financial stress (p < .004). Older age was protective for both caretaking (p < .001) and financial stress (p < .001). Three distinct subthemes were found in caretaking stress (work/life balance, safety concerns, and positionality) and two in financial stress (uncertainty and absence of workplace recognition). Understanding workforce stressors may help organizations and policymakers better support an essential workforce integral to the United States' COVID-19 response and recovery.

"We Are Not Taking a Backseat": Health Social Workers' Perspectives on COVID-19 Response and Recovery.

The COVID-19 pandemic has wrought widespread devastation across the United States, exacerbating existing health inequities rooted in the social determinants of health. Social work is the key workforce tasked with providing social care in healthcare settings. In September 2019, the National Academies of Science, Engineering, and Medicine released a landmark Consensus Study Report, Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health. The report describes a framework for addressing key care needs that articulates five "As for action" (5As)-awareness, alignment, assistance, adjustment, and advocacy-that are critical to social care. Drawing from a series of focus groups conducted with 55 social workers employed in a large urban pediatric quaternary hospital, this study qualitatively examines the utility of this framework in characterizing social care activities during the pandemic response and recovery efforts. Findings suggest that the 5As framework is both applicable to pandemic social work practice and an accurate encapsulation of the core elements of hospital social work practice, even if social workers themselves may not necessarily be aware of that conceptualization. Future implications for social work practice in arenas of awareness, adjustment, assistance, alignment, and advocacy are also discussed.

"We are on the frontlines too": A qualitative content analysis of US social workers' experiences during the COVID-19 pandemic.

Social work has been a part of the essential workforce historically and throughout the COVID-19 pandemic, yet lack recognition. This work explores the experiences and invisibility of social workers within the pandemic response. Data are drawn from a large cross-sectional survey of US-based social worker from June to August of 2020. A summative content analysis of responses to the question 'What do you wish people knew about social work during the COVID-19 pandemic' was undertaken. Participants (n = 515) were majority white (72.1%) and female (90.8%). Seven coding categories were subsequently collapsed into three domains: (1) meeting basic needs, (2) well-being (emotional distress and dual role) and (3) professional invisibility (workplace equals, physical safety, professional invisibility and organisational invisibility). Meeting social needs requires broad-based policies that strengthen the health and social safety net. Social workers have and will continue to play a critical role in the response, and recovery from COVID-19. Organisational and governmental policies must expand to increase the visibility and responsiveness to the needs of social care providers.

The psychological impact of the COVID-19 pandemic and a SARS-CoV-2 testing programme on obstetric patients and healthcare workers.

OBJECTIVES: The aim of this study was to describe the psychological impact of the COVID-19 pandemic and the specific impact of a universal SARS-CoV-2 testing programme on obstetric patients and healthcare workers at The Ottawa Hospital. METHODS: This was a follow-up survey study of obstetric healthcare workers and then-pregnant patients who participated in a SARS-CoV-2 testing programme conducted in The Ottawa Hospital obstetrical triage units from 19 October to 17 November 2020. Surveys explored the effects of the COVID-19 pandemic and the testing programme on participants' psychological well-being. Responses were collected from April to September 2021. Descriptive summary statistics were calculated for both groups. RESULTS: During hospitalization for delivery, obstetric patients (n = 143) worried about giving COVID-19 to their new baby (88.11%), catching COVID-19 (83.22%), and giving COVID-19 to their partner (76.22%). Patients felt relief at being tested for COVID-19 during the universal testing programme (24.65%) and at getting their results (28.87%). Patients also believed that universal SARS-CoV-2 testing was a good way to slow COVID-19 spread (79.72%), reduce anxiety (75.52%), and increase relief (76.22%). In addition, patients felt good about participating in research that could help others (91.61%). Among obstetric healthcare workers (n = 94), job satisfaction decreased and job stress increased during the COVID-19 pandemic. The universal testing programme led to minor increases in healthcare worker job stress and burden, particularly among nurses, but the majority (85.23%) believed it was a valuable research initiative. CONCLUSION: The COVID-19 pandemic has had a negative psychological impact on obstetric patients and healthcare workers. Universal SARS-CoV-2 testing was generally viewed favourably and may serve as an effective strategy for estimating COVID-19 prevalence without adding undue stress onto patients and healthcare workers during the pandemic.

Intimate Partner Violence and the COVID-19 Pandemic.

OBJECTIVES: To describe the effects of the coronavirus disease 2019 (COVID-19) pandemic and associated practice shifts on consultation and referral patterns of an intimate partner violence program at a large, urban children's hospital. METHODS: Secondary data analyses examined COVID-19-related variations in patterns of consultations and referrals in the 11 months before the COVID-19 pandemic (April 1, 2019-February 29, 2020) and those after its emergence (April 1, 2020-February 28, 2021). χ2 analyses were used to examine differences in categorical outcomes of interest by time and practice setting, as well as differences within practice settings. Poisson regressions were used to compare the number of reasons for consultation and the number of referrals during the 2 periods. RESULTS: Analyses revealed significant decreases in face-to-face consults (28% to 2%; P < .001) during the period after COVID-19 emergence alongside significant increases in the total number of consults (240 to 295; P < .001), primarily for emotional abuse (195 to 264; P = .007). Psychoeducation referrals also increased significantly (199 to 273; P < .001), whereas referrals to community resources decreased significantly (111 to 95; P < .001). Setting-specific analyses revealed that primary care settings were the only practice settings to demonstrate significant differences in overall number of and specific reasons for consultation and associated referral types before and after COVID-19 emergence. CONCLUSIONS: Even during a shift away from face-to-face care, there was an increase in intimate partner violence referrals after the start of the COVID-19 pandemic. These findings suggest the importance of pediatric primary care as a location for survivors to access support.

'We are essential:' Pediatric health care social workers' perspectives on being designated essential workers during the COVID-19 pandemic.

Continued provision of essential services is critical to maintaining society's functioning during a crisis. During COVID-19, lockdowns and restrictions designed to preserve the public's health forced an examination of what it means to be an essential worker. Drawing from thematic analyses of focus group data from 55 social workers employed in a large, urban, pediatric, quaternary hospital, this study examines the perspectives of hospital social workers on the meaning of the essential status designation of social work. Findings revealed themes pertaining the substance of social work, the ways in which essential status is carried out, and implications of the designation not only for the future of the profession but also for the populations who receive social work services. The discussion raised important questions about the essential role of social workers in broader health care settings. Our findings suggest that health care systems need to engage in ongoing discussions of how to maximize the efficacy of the social work workforce, both in terms of integration with medical teams and recognition of the important roles social workers play across the hospital system, and facilitate the performance of their essential functions.

Draft Metagenome-Assembled Genomes from Methane-Rich Echo Lake, Montana.

Five metagenome-assembled genomes were obtained from the bottom waters of Echo Lake, Montana. These genomes suggest that lineages involved in methane oxidation and sulfur cycling flourish near the steep oxygen and methane chemocline in Echo Lake.

Perception of Recovery Orientation as a Predictor of Clinician Turnover in Community Mental Health Clinics.

Turnover in community mental health clinics threaten the delivery of quality behavioral health services; recovery orientation has been shown to be associated with lower levels of burnout but its relationship with actual turnover has not yet been examined. This study aimed to examine the relationship between provider perceptions of recovery orientation and 12-month turnover status among community mental health providers. Secondary data analyses were conducted with data collected from 224 community mental health providers from ten organizations across 14 clinic sites participating in a larger effectiveness-implementation trial. Chi square analyses were used to examine between-site variation in 1-year turnover rates among the ten organizations. Logistic regression was used to examine effects of perceptions of recovery orientation along with known predictors of turnover among community mental health providers. Results revealed no between-site variation in organizational turnover rates. The logistic regression model was statistically significant, χ2(17) = 47.64, p < .0001 and explaining 30% (Nagelkerke R2) of within-site variance and correctly classifying 79% of cases. Perceptions of recovery orientation emerged as the sole significant predictor of 12-month turnover status, with higher levels of recovery orientation significantly associated with lower odds of turnover at 12 months [B = .90, p = .008, OR 2.47 (95% CI 1.23, 4.82)]. Perceptions of recovery orientation was protective against 12-month turnover status suggesting that a more person-centered and empowering approach to care may improve the provider experience. More research is needed to further understand how recovery orientation can contribute to workforce stability.

A Comparison of Suicide Attempt Histories of Pediatric and Adult Medical Inpatients and Implications for Screening.

OBJECTIVE: A suicide attempt is the most potent predictor of future suicidal behavior, yet little is known about how to manage and respond to reports of attempt histories in hospitalized medical patients. This study aims to describe the prevalence and characteristics of pediatric and adult medical inpatients who report a past suicide attempt. METHOD: Participants were medical inpatients, aged 10-93 years, enrolled in two suicide risk screening instrument validation studies. Participants completed the Ask Suicide-Screening Questions (ASQ) and the Patient Health Questionnaire (PHQ). RESULTS: A total of 1324 medical inpatients (624 pediatric, 700 adult) completed the ASQ, with 114 participants (8.6%) reporting a past suicide attempt (51 pediatric; 63 adults). Comparing youth to adults, there was no significant difference between attempt rates (χ2=0.29, p = 0.59). Youth with a past attempt were significantly more likely to report past week suicidal ideation (OR = 28.22; 95% CI = 5.90, 135.06) and have a history of mental health care (OR = 9.11; 95% CI = 2.59-32.10), compared to those without a past attempt. Adults with a past attempt were significantly more likely to screen positive for depression, compared to those without attempt histories (OR = 5.00; 95% CI = 2.31-10.83). CONCLUSIONS: Nearly 9% of hospitalized medical patients endorsed a past suicide attempt when screened. Since adolescence is a critical time for detecting suicide risk, screening that includes past suicidal behavior may be an important means to identify youth with recent suicidal thoughts. By assessing recency of suicide attempts in adults, medical settings may optimize the effectiveness of how positive suicide risk screens are managed.HIGHLIGHTSRoughly 9% of medical patients reported a past suicide attempt when screened.Adolescence is a critical time for detecting suicide risk and intervening.Assessing past suicide attempts in adults can help with managing positive screens.