A Novel Role for Physical Therapists in Infection Prevention and Control in Response to the COVID-19 Pandemic: An Administrative Case Report.

OBJECTIVE: The purpose of this case report is to describe the development, implementation, and sustained use of a Rehabilitation Infection Prevention and Control Team (RIPCT) comprised of physical therapists in response to the COVID-19 pandemic. It also highlights how physical therapists are equipped to serve not only in typical clinical positions but also in nontraditional roles in healthcare. METHODS: The RIPCT served as an extension of the infection prevention and control (IPC) department. The team engaged in self-directed learning and worked alongside a physician mentor to acquire the knowledge and visibility needed to identify, triage, and address pandemic-related questions. Through rounding on units, on-site environmental assessments, and electronic communication, the RIPCT aided in navigating uncertainty, solving problems, and implementing changes for staff and patient safety. RESULTS: The RIPCT addressed safety concerns of 532 rehabilitation professionals, developed rehabilitation IPC policy, facilitated the reopening of 11 ambulatory sites, and created a new pathway to address future rehabilitation IPC needs. A survey of rehabilitation professionals indicated perceived effectiveness of physical therapists filling this role. CONCLUSION: The RIPCT successfully provided clear and consistent education as well as safe practice recommendations to staff and patients across a variety of disciplines and settings. The team quickly incorporated new knowledge and collaborated effectively in a nontraditional role within the healthcare system. The use of a semi-formal learning model with staff level clinicians as champions facilitated translation of IPC-related knowledge in a time of uncertainty throughout the healthcare community. IMPACT: The educational background, professional values, and communication skills of physical therapists allowed for successful integration into the IPC department to ensure staff and patient safety. Healthcare systems should consider utilization of physical therapists in nontraditional multidisciplinary clinical roles.

Behavioral responses of terrestrial mammals to COVID-19 lockdowns.

COVID-19 lockdowns in early 2020 reduced human mobility, providing an opportunity to disentangle its effects on animals from those of landscape modifications. Using GPS data, we compared movements and road avoidance of 2300 terrestrial mammals (43 species) during the lockdowns to the same period in 2019. Individual responses were variable with no change in average movements or road avoidance behavior, likely due to variable lockdown conditions. However, under strict lockdowns 10-day 95th percentile displacements increased by 73%, suggesting increased landscape permeability. Animals' 1-hour 95th percentile displacements declined by 12% and animals were 36% closer to roads in areas of high human footprint, indicating reduced avoidance during lockdowns. Overall, lockdowns rapidly altered some spatial behaviors, highlighting variable but substantial impacts of human mobility on wildlife worldwide.

Incorporating human dimensions is associated with better wildlife translocation outcomes.

Wildlife translocations are increasingly used to combat declining biodiversity worldwide. Successful translocation often hinges on coexistence between humans and wildlife, yet not all translocation efforts explicitly include human dimensions (e.g., economic incentives, education programs, and conflict reduction assistance). To evaluate the prevalence and associated outcomes of including human dimensions as objectives when planning translocations, we analyze 305 case studies from the IUCN's Global Re-Introduction Perspectives Series. We find that fewer than half of all projects included human dimension objectives (42%), but that projects including human dimension objectives were associated with improved wildlife population outcomes (i.e., higher probability of survival, reproduction, or population growth). Translocation efforts were more likely to include human dimension objectives if they involved mammals, species with a history of local human conflict, and local stakeholders. Our findings underscore the importance of incorporating objectives related to human dimensions in translocation planning efforts to improve conservation success.

Large carnivores avoid humans while prioritizing prey acquisition in anthropogenic areas.

Large carnivores are recovering in many landscapes where the human footprint is simultaneously growing. When carnivores encounter humans, the way they behave often changes, which may subsequently influence how they affect their prey. However, little research investigates the behavioural mechanisms underpinning carnivore response to humans. As a result, it is not clear how predator-prey interactions and their associated ecosystem processes will play out in the human-dominated areas into which carnivore populations are increasingly expanding. We hypothesized that humans would reduce predation risk for prey by disturbing carnivores or threatening their survival. Alternatively, or additionally, we hypothesized that humans would increase predation risk by providing forage resources that congregate herbivorous prey in predictable places and times. Using grey wolves Canis lupus in Jackson Hole, Wyoming, USA as a study species, we investigated 170 kill sites across a spectrum of human influences ranging from heavily restricted human activities on protected federal lands to largely unregulated activities on private lands. Then, we used conditional logistic regression to quantify how the probability of predation changed across varied types and amounts of human influences, while controlling for environmental characteristics and prey availability. Wolves primarily made kills in environmental terrain traps and where prey availability was high, but predation risk was significantly better explained with the inclusion of human influences than by environmental characteristics alone. Different human influences had different, and even converse, effects on the risk of wolf predation. For example, where prey were readily available, wolves preferentially killed animals far from motorized roads but close to unpaved trails. However, wolves responded less strongly to humans, if at all, where prey were scarce, suggesting they prioritized acquiring prey over avoiding human interactions. Overall, our work reveals that the effects of large carnivores on prey populations can vary considerably among different types of human influences, yet carnivores may not appreciably alter predatory behaviour in response to humans if prey are difficult to obtain. These results shed new light on the drivers of large carnivore behaviour in anthropogenic areas while improving understanding of predator-prey dynamics in and around the wildland-urban interface.

The influence of human activity on predator-prey spatiotemporal overlap.

Despite growing evidence of widespread impacts of humans on animal behaviour, our understanding of how humans reshape species interactions remains limited. Here, we present a framework that draws on key concepts from behavioural and community ecology to outline four primary pathways by which humans can alter predator-prey spatiotemporal overlap. We suggest that predator-prey dyads can exhibit similar or opposite responses to human activity with distinct outcomes for predator diet, predation rates, population demography and trophic cascades. We demonstrate how to assess these behavioural response pathways with hypothesis testing, using temporal activity data for 178 predator-prey dyads from published camera trap studies on terrestrial mammals. We found evidence for each of the proposed pathways, revealing multiple patterns of human influence on predator-prey activity and overlap. Our framework and case study highlight current challenges, gaps, and advances in linking human activity to animal behaviour change and predator-prey dynamics. By using a hypothesis-driven approach to estimate the potential for altered species interactions, researchers can anticipate the ecological consequences of human activities on whole communities.

The long tail of COVID and the tale of long COVID: Diagnostic construction and the management of ignorance.

We bring together insights from the sociology of diagnosis and the sociology of ignorance to examine the early diagnostic unfolding of 'Long COVID' (LC). Originally described by patient activists, researchers set out to ponder its unwieldy clinical boundaries. Using a scoping review method in tandem with qualitative content analytic techniques, we analyse medicine's initial struggles to construct a LC diagnosis. Paying attention to the dynamics of ignorance, we highlight three consequential conceptual manoeuvres in the early classifications of LC: causal agnosticism concerning the relationship between COVID-19 and LC, evasion of lumping LC with similar conditions; and the predictable splitting off of medically explainable cases from the LC designation. These manoeuvres are not maleficent, inept or unreasonable. They are practical but impactful responses to the classificatory dilemmas present in the construction of diagnoses amidst ignorance. Although there are unique aspects to LC, we suggest that its early fate is nevertheless emblematic of medicine's diagnostic standardisation processes more generally. To varying degrees, diagnoses are ignorance management strategies; they create a pathway through the uncertainty at the core of disease realities. However, while diagnoses circumscribe some types of ignorance, they produce others through the creation of blind spots and paths not taken.

Uncertain and under Quarantine: Toward a Sociology of Medical Ignorance.

At the center of the COVID-19 pandemic lies a ubiquitous feature of medicine. Medicine is permeated with ignorance. Seizing this moment to assess the current state of medical sociology, this article articulates a sociology of medical ignorance. We join insights from earlier medical sociological scholarship on uncertainty with emerging research in the sociology of ignorance to help make sense of the omnipresent but sometimes invisible dynamics related to the unknowns in medicine. Then we examine two streams of inquiry with a focus on uncertainty and ignorance-(1) research on the interconnections between technology, medical authority, and ignorance and (2) research on lay expertise within the context of ever-present uncertainties. For decades, and to good effect, medical sociologists have asked, "What does medicine know, and what are the consequences of such knowing?" Going forward, we encourage medical sociologists to examine the unknown in medicine and the consequences of not knowing.

The plasticity of ungulate migration in a changing world.

Migratory ungulates are thought to be declining globally because their dependence on large landscapes renders them highly vulnerable to environmental change. Yet recent studies reveal that many ungulate species can adjust their migration propensity in response to changing environmental conditions to potentially improve population persistence. In addition to the question of whether to migrate, decisions of where and when to migrate appear equally fundamental to individual migration tactics, but these three dimensions of plasticity have rarely been explored together. Here, we expand the concept of migratory plasticity beyond individual switches in migration propensity to also include spatial and temporal adjustments to migration patterns. We develop a novel typological framework that delineates every potential change type within the three dimensions, then use this framework to guide a literature review. We discuss broad patterns in migratory plasticity, potential drivers of migration change, and research gaps in the current understanding of this trait. Our result reveals 127 migration change events in direct response to natural and human-induced environmental changes across 27 ungulate species. Species that appeared in multiple studies showed multiple types of change, with some exhibiting the full spectrum of migratory plasticity. This result highlights that multidimensional migratory plasticity is pervasive in ungulates, even as the manifestation of plasticity varies case by case. However, studies thus far have rarely been able to determine the fitness outcomes of different types of migration change, likely due to the scarcity of long-term individual-based demographic monitoring as well as measurements encompassing a full behavioral continuum and environmental gradient for any given species. Recognizing and documenting the full spectrum of migratory plasticity marks the first step for the field of migration ecology to employ quantitative methods, such as reaction norms, to predict migration change along environmental gradients. Closer monitoring for changes in migratory propensity, routes, and timing may improve the efficacy of conservation strategies and management actions in a rapidly changing world.

The neglected season: Warmer autumns counteract harsher winters and promote population growth in Arctic reindeer.

Arctic ungulates are experiencing the most rapid climate warming on Earth. While concerns have been raised that more frequent icing events may cause die-offs, and earlier springs may generate a trophic mismatch in phenology, the effects of warming autumns have been largely neglected. We used 25 years of individual-based data from a growing population of wild Svalbard reindeer, to test how warmer autumns enhance population growth. Delayed plant senescence had no effect, but a six-week delay in snow-onset (the observed data range) was estimated to increase late winter body mass by 10%. Because average late winter body mass explains 90% of the variation in population growth rates, such a delay in winter-onset would enable a population growth of r = 0.20, sufficient to counteract all but the most extreme icing events. This study provides novel mechanistic insights into the consequences of climate change for Arctic herbivores, highlighting the positive impact of warming autumns on population viability, offsetting the impacts of harsher winters. Thus, the future for Arctic herbivores facing climate change may be brighter than the prevailing view.

Lay Pharmacovigilance and the Dramatization of Risk: Fluoroquinolone Harm on YouTube.

Sociologists have documented how the pharmaceutical industry has corrupted pharmacovigilance (PV), defined as the practices devoted to detecting and preventing adverse drug reactions (ADRs). In this article, I juxtapose the official postmarketing system of PV with firsthand accounts of ADRs as found in 60 YouTube vlogs created by 29 individuals who recount debilitating reactions to fluoroquinolones, a common class of antibiotics. Whereas official PV is said to contribute the banalization of risk, these vlogs exemplify the dramatization of risk. I consider the vlogs as instances of lay PV. They represent lay knowledge claims created in response to perceived failures in the official system of regulation. As such, lay PV shares commonalties with other articulations of lay expertise as a counter to medical authority. At the same time, this case also underscores how the YouTube platform offers new tools for the creation and distribution of lay expertise.

Native forage mediates influence of irrigated agriculture on migratory behaviour of elk.

Ungulates migrate to maximize nutritional intake when forage varies seasonally. Populations of ungulates often include both migratory and non-migratory individuals, but the mechanisms driving individual differences in migratory behaviour are not well-understood. We quantified associations between hypothesized drivers of partial migration and the likelihood of migration for individual ungulates that experienced a range of environmental conditions and anthropogenic influences. We evaluated the effects of forage variation, conspecific density, and human land uses on migratory behaviour of 308 adult female elk in 16 herds across western Montana. We found irrigated agriculture on an individual's winter range reduced migratory behaviour, but individuals were more likely to migrate away from irrigated agricultural areas if better forage was available elsewhere or if they experienced high conspecific density on their winter range. When the forage available during the summer growing season varied predictably between years, elk were more likely to migrate regardless of whether they had access to irrigated agriculture. Our study shows that predictable availability of beneficial native forage can encourage migration even for ungulates with irrigated agriculture on their winter range. Perturbations that can affect the forage available to ungulates include wildfires, timber harvest, livestock grazing and changing weather patterns. If these or other disturbances negatively affect forage on summer ranges of migrants, or if they cause forage to vary unpredictably across space and time, our results suggest migratory behaviour may decline as a result.

Contingent engagement: What we learn from patients with complex health problems and low socioeconomic status.

OBJECTIVE: Elicit patients' perceptions of factors that facilitate their engagement in care METHODS: In-depth interviews with 20 adult Medicaid patients who had complex health problems, frequent hospitalizations/emergency department use, and who were enrolled in an intensive, team-based care program designed to address medical, behavioral, and social needs. RESULTS: Prior to engaging in the program, participants described weak relationships with primary care providers, frequent hospitalizations and emergency visits, poor adherence to medications and severe social barriers to care. After participating in the program, participants identified key factors that enabled them to develop trust and engage with care including: availability for extended intensive interactions, a non-judgmental approach, addressing patients' material needs, and providing social contact for isolated patients. After developing relationships with their care team, participants described changes such as sustained interactions with their primary care team and incremental improvements in health behaviors. CONCLUSION: These findings illuminate factors promoting "contingent engagement" for low socio-economic status patients with complex health problems, which allow them to become proactive in ways commensurate with their circumstances, and offers insights for designing interventions to improve patient outcomes. PRACTICE IMPLICATIONS: For these patients, engagement is contingent on healthcare providers' efforts to develop trust and address patients' material needs.

Pharmaceutical direct-to-consumer advertising and US Hispanic patient-consumers.

Hispanic Americans use prescription medications at markedly lower rates than do non-Hispanic whites. At the same time, Hispanics are the largest racial-ethnic minority in the USA. In a recent effort to reach this underdeveloped market, the pharmaceutical industry has begun to create Spanish-language direct-to-consumer advertising (DTCA) campaigns. The substantive content of these campaigns is being tailored to appeal to the purported cultural values, beliefs and identities of Latino consumers. We compare English-language and Spanish-language television commercials for two prescription medications. We highlight the importance of selling medicine to a medically under-served population as a key marketing element of Latino-targeted DTCA. We define selling medicine as the pharmaceutical industry's explicit promotion of medicine's cultural authority as a means of expanding its markets and profits. We reflect on the prospects of this development in terms of promoting medicalisation in a US subgroup that has heretofore eluded the pharmaceutical industry's marketing influence. Our analysis draws on Nikolas Rose's insights concerning variations in the degree to which certain groups of people are more medically made up than others, by reflecting on the racial and ethnic character of medicalisation in the USA and the role DTCA plays in shaping medicalisation trends. A video abstract of this article can be found at: https://www.youtube.com/watch?v=ZabCle9-jHw&feature=youtu.be.

Mindfulness meditation: do-it-yourself medicalization of every moment.

This paper examines mindfulness as a popular and paradigmatic alternative healing practice within the context of contemporary medicalization trends. In recognition of the increasingly influential role popular media play in shaping ideas about illness and healing, what follows is a discursive analysis of bestselling mindfulness meditation self-help books and audio recordings by Jon Kabat-Zinn. The central and contradictory elements of this do-it-yourself healing practice as presented in these materials are best understood as aligned with medicalization trends for three principal reasons. First, mindfulness represents a significant expansion in the definition of disease beyond that advanced by mainstream medicine. Second, its etiological model intensifies the need for therapeutic surveillance and intervention. Third, by defining healing as a never-ending process, it permanently locates individuals within a disease-therapy cycle. In sum, the definition, cause, and treatment of disease as articulated by popular mindfulness resources expands the terrain of experiences and problems that are mediated by medical concepts. The case of mindfulness is a potent illustration of the changing character of medicalization itself.

Listening to Lyrica: contested illnesses and pharmaceutical determinism.

Fibromyalgia syndrome is a debilitating pain disorder of unknown origins and a paradigmatic contested illness. As with other contested illnesses, the reality of fibromyalgia is disputed by many physicians. Thus, millions of individuals who are diagnosed with fibromyalgia must cope with chronic symptoms as well as medical and public skepticism. In this context, the U.S. Federal Drug Administration's approval of Lyrica, the first prescription medication specifically for the management of fibromyalgia, is of considerable interest. In this paper I examine the cultural logic whereby the existence (and marketing) of an officially approved prescription medication for a condition lends support to the biomedical existence of the condition itself. I label this logic pharmaceutical determinism and argue that it represents an important new phase in the proliferation of contested illness diagnoses. Using the case of Lyrica, I describe the role that pharmaceutical companies and pharmaceuticals themselves play in promoting and legitimating contested diagnoses and validating those who are so diagnosed. Through a narrative analysis of the Lyrica direct-to-consumer advertising campaign and the responses of fibromyalgia sufferers to the introduction and marketing of Lyrica, I demonstrate the symbiotic relationship between the interests of the pharmaceutical industry, contested illness legitimization, and medicalization. I also provide a gender analysis of this relationship, foregrounding how contested illnesses continue to be shaped by their feminization in a cultural context that equates women with irrationality. Finally, I address the consequences and limitations of relying on the pharmaceutical industry for illness validation.

Dead by 50: lay expertise and breast cancer screening.

This paper examines the reactions of women with breast cancer to the 2009 U.S. Preventive Services Task Force recommendations for mammography screening. Specifically, it analyzes electronic postings about the Task Force's recommendations from five breast cancer discussion boards between November 17, 2009 and December 17, 2009. Women's opposition to the recommendations is best understood as a clash between scientific and lay expertise concerning the priorities of medicine and notions of evidentiary significance. We highlight the connective logic - or connectivity - that underlies lay expertise in the electronic era. Connectivity is a unique way of knowing that emerges from an experiential connection to illness and a virtual connection to others with the same illness. Connectivity is based on forms of evidence that enhance the moral authority of lay claims for medical succor. Connectivity is a potent element in contemporary lay challenges to scientific expertise and will become increasingly influential as online illness affiliation becomes ever more commonplace.

The social construction of illness: key insights and policy implications.

The social construction of illness is a major research perspective in medical sociology. This article traces the roots of this perspective and presents three overarching constructionist findings. First, some illnesses are particularly embedded with cultural meaning--which is not directly derived from the nature of the condition--that shapes how society responds to those afflicted and influences the experience of that illness. Second, all illnesses are socially constructed at the experiential level, based on how individuals come to understand and live with their illness. Third, medical knowledge about illness and disease is not necessarily given by nature but is constructed and developed by claims-makers and interested parties. We address central policy implications of each of these findings and discuss fruitful directions for policy-relevant research in a social constructionist tradition. Social constructionism provides an important counterpoint to medicine's largely deterministic approaches to disease and illness, and it can help us broaden policy deliberations and decisions.

Electronic support groups, patient-consumers, and medicalization: the case of contested illness.

This article illustrates the role electronic support groups play in consumer-driven medicalization. The analysis is based on an observational study of a year in the life of an electronic support group for sufferers of the contested illness fibromyalgia syndrome. The analysis builds on and extends scholarship concerning the growing influence of lay expertise in the context of medical uncertainty by showing how the dominant beliefs and routine practices of this electronic community simultaneously (and paradoxically) challenge the expertise of physicians and encourage the expansion of medicine's jurisdiction. Drawing on their shared embodied expertise, participants confirm the medical character of their problem and its remedy, and they empower each other to search for physicians who will recognize and treat their condition accordingly. Physician compliance is introduced as a useful concept for understanding the relationship between lay expertise, patient-consumer demand, and contemporary (and future) instances of medicalization.