Daily COVID-19 employee attestations at a large quaternary hospital in Melbourne, Australia - Limitations and lessons learnt.

BACKGROUND: As one of the many measures to limit the potentially infectious persons entering healthcare settings, the Victorian Department of Health (DH) introduced a daily attestation between 2020 and 2022. Upon entry to a health service, employees were required to confirm they were free from symptoms related to COVID-19 and did not have contact with a confirmed COVID-19 case in the previous 7-14 days. METHODS: We performed a retrospective analysis of employee attestations and SARS-CoV-2 tests performed between 1/6/2021 and 14/2/2022 at the main campus of the Royal Melbourne Hospital. RESULTS: We found the proportion of SARS-CoV-2 positive employees identified through workplace attestation was low (1.3%). Most SARS-CoV-2 positive employees analysed in this study (94%) were asymptomatic. DISCUSSION: Although the proportion of SARS-CoV-2 positive employees identified was low, attestations may have deterred unwell employees from presenting to work. Proactively monitoring employee attestations, such as measuring and reporting the number of symptomatic attestations, may make this a more useful tool.

Ketogenic Diet: Parental Experiences and Expectations.

BACKGROUND: The ketogenic diet may be difficult for some patients and their families to implement and can impact physical, emotional, and social well-being. METHODS: Through principles of fundamental qualitative description, we completed an exploratory study on parents' experiences and expectations on the use and efficacy of the ketogenic diet for children with medically refractory epilepsy. RESULTS: Seventeen parents (10 mothers and 7 fathers) of 12 children with epilepsy participated. At the time of the interview, parents had experienced an average of 25 months of ketogenic diet treatment for their child (range 2 months to 98 months). Half of the caregivers learned about the ketogenic diet from their neurologist, whereas the remainder had heard about it from another source (ie, the internet). Most caregivers' (n = 13) diet expectations were related to seizure control. However, child development (n = 5) and quality of life (n = 5) were also crucial to some. Physical impacts of the diet were most commonly gastrointestinal for children (n = 9). Social and emotional effects were noted in some older children with typical development. Most caregivers described negative impacts on finances (n = 15), relationships (n = 14), and emotional well-being (ie, stress) (n = 12). Caregivers benefited from the ketogenic diet team's regular communication, close follow-up, and family-centered care. CONCLUSIONS: Despite the impacts that the ketogenic diet may have on caregivers' emotional and social well-being, the positive impacts of the diet were felt to outweigh any perceived risks. Effects (both positive and negative) on quality of life and child development (eg, social, emotional, cognitive) are essential for caregivers and require additional investigation.

Critically appraising and utilising qualitative health research evidence in nutrition practice.

BACKGROUND: Evidence-based decision-making and practice recommendations are commonly based on findings from quantitative studies or reviews. In the present study, we provide an overview of how to incorporate findings from qualitative research into the evidence-based decision-making process. METHODS: To illustrate how qualitative evidence can be integrated into the decision-making process, we have outlined a clinical nutrition scenario and the process for sourcing credible evidence to inform decision-making. A qualitative health research study was selected and appraised using the Critical Appraisal Skill Programme (CASP) appraisal tool for qualitative research. Based on the results of the critical appraisal, the study quality is considered, and we discuss whether the qualitative evidence can be applied to practice. RESULTS: A detailed description of how the qualitative findings can be used conceptually and instrumentally in practice to address the clinical nutrition scenario is provided. CONCLUSIONS: Developing skills in critically appraising findings from qualitative studies will increase awareness and utilisation of this type of evidence in practice and policy, with a goal to ensure that patient/client perceptions are considered, leading to enhanced person-centred care or systems.

Providers' perspectives of the neonatal intensive care unit context and care provision for adolescent parents: an interpretive description.

BACKGROUND: The neonatal intensive care unit (NICU) is a complex care environment, with the NICU patient population among the most vulnerable in a hospital setting. Adolescent parents are a unique group within the broader NICU parent population and admission of their infant to the NICU contributes to an already complex situation as adolescent pregnancy and parenting is often associated with a range of psychosocial challenges. How the NICU care context influences care provision for adolescent parents is a significant gap in the NICU parenting and support discourse. Therefore, this study aimed to explore health and social care providers' perspectives of the NICU care context and how providers perceive the context as influencing the experiences of adolescent parents in the NICU. METHODS: This was a qualitative, interpretive description study design. In-depth interviews were conducted with providers, including nurses and social workers, caring for adolescent parents in the NICU. Data was collected between December 2019 and November 2020. Data were analyzed concurrently with data collection. Constant comparison, analytic memos, and iterative diagramming techniques were used to challenge developing analytic patterns. RESULTS: Providers (n = 23) described how the unit context influenced care provision as well as experiences for adolescent parents. We learned that having a baby in the NICU was perceived by providers as a traumatic experience for parents - impacting attachment, parenting confidence and competence, and mental health. Environmental factors - such as privacy and time - and perceptions that adolescent parents are treated differently in the NICU were also seen as influencing this overall experience. CONCLUSIONS: Providers involved in the care of adolescent parents in the neonatal intensive care unit described the distinctiveness of this group within the broader parent population and how quality of care may be impacted by contextual factors as well as experiences of age-related stigma. Further understanding of NICU experiences from the parents' perspectives are warranted. Findings highlight opportunities for strengthened interprofessional collaboration and trauma- and violence-informed care strategies within the neonatal intensive care environment to mitigate the potential negative influence of this experience and improve care for adolescent parents.

Enhancing Physical and Community MoBility in OLDEr Adults with Health Inequities Using CommuNity Co-Design (EMBOLDEN): Results of an Environmental Scan.

Background: Using the comparatively new environmental scan methodology, a protocol was developed and conducted to inform the co-design and implementation of a novel intervention to promote mobility among older adults in Hamilton, Ontario, Canada. The EMBOLDEN program seeks to promote physical and community mobility in adults 55 years and older who face barriers accessing community programs and who reside in areas of high inequity in Hamilton, and to address the following areas of focus: physical activity, nutrition, social participation, and system navigation supports. Methods: The environmental scan protocol was developed using existing models and drew insights from census data, a review of existing services, organizational representative interviews, windshield surveys of selected high-priority neighbourhoods, and Geographic Information System (GIS) mapping. Results: A total of 98 programs for older adults from 50 different organizations were identified, with the majority (92) supporting mobility, physical activity, nutrition, social participation, and system navigation. The analysis of census tract data identified eight high-priority neighbourhoods characterized by large shares of older adults, high material deprivation, low income, and high proportion of immigrants. These populations can be hard to reach and face multiple barriers to participation in community-based activities. The scan also revealed the nature and types of services geared toward older adults in each neighbourhood, with each priority neighbourhood having at least one school and park. Most areas had a range of services and supports (i.e., health care, housing, stores, religious options), although there was a lack of diverse ethnic community centres and income-diverse activities specific to older adults in most neighbourhoods. Neighbourhoods also differed in the geographic distribution number of services, along with the number of recreational services specific to older adults. Barriers included financial and physical accessibility, lack of ethnically diverse community centres, and food deserts. Conclusions: Scan results will inform the co-design and implementation of the Enhancing physical and community MoBility in OLDEr adults with health inequities using commuNity co-design intervention-EMBOLDEN.

A framework for selecting data generation strategies in qualitative health research studies.

BACKGROUND: Qualitative health research has the potential to answer important applied health research questions to inform nutrition and dietetics practice, education and policy. Qualitative health research is a distinct subdiscipline of qualitative inquiry that purposefully draws upon the context of healthcare and emphasises health and wellness. METHODS: Qualitative health research is defined by two parameters: (1) the focus of the study and (2) the methods used. When considering the methods to be used, decisions are required about the type of data to be generated (e.g., transcripts, images and notes) and the process involved in data generation (e.g., interviews, elicitation strategies and observations) to answer the research question(s). Drawing upon examples from nutrition and dietetics literature, this paper provides a framework to support decision-making for nutrition and dietetics researchers and clinician researchers designing conducting qualitative health research. RESULTS: The guiding questions of the framework include: What types of data will be generated? Who is involved in data generation? Where will data generation occur? When will data generation occur? How will data be recorded and managed? and How will participants' and researchers' emotional safety be promoted? CONCLUSION: Questions about the types of data, those involved, where and when, as well as how safety can be maintained in data generation, not only support a more robust design and description of data generation methods but also keep the person at the centre of the research.

Valuing tacit nursing knowledge during the COVID-19 pandemic.

Public health nurses in Ontario, Canada, support the healthy growth and development of children across the province through a variety of programs including home visits for pregnant individuals and families with young children. During the COVID-19 global pandemic the needs of families increased while access to health and social services decreased. During this time, home visiting teams closely involved in supporting families also experienced staff redeployment to support pandemic efforts (e.g., case and contact management, vaccinations) and changes to the nature of home visiting work, including shifts to remote or virtual service delivery. To support nursing practice in this new and evolving context, a framework for capturing and sharing the tacit or how-to knowledge of public health nurses was developed. A valuing of this type of knowledge for informing future public health nursing practice - well beyond the pandemic response - was recognized as a pandemic silver lining when reflecting on two years of supporting home visiting teams in our province.

Supporting Aboriginal and Torres Strait Islander Families to Stay Together from the Start (SAFeST Start): Urgent call to action to address crisis in infant removals.

Reducing the rate of over-representation of Aboriginal and Torres Strait Islander children in out-of-home care (OOHC) is a key Closing the Gap target committed to by all Australian governments. Current strategies are failing. The "gap" is widening, with the rate of Aboriginal and Torres Strait Islander children in OOHC at 30 June 2020 being 11 times that of non-Indigenous children. Approximately, one in five Aboriginal and Torres Strait Islander children entering OOHC each year are younger than one year. These figures represent compounding intergenerational trauma and institutional harm to Aboriginal and Torres Strait Islander families and communities. This article outlines systemic failures to address the needs of Aboriginal and Torres Strait Islander parents during pregnancy and following birth, causing cumulative harm and trauma to families, communities and cultures. Major reform to child and family notification and service systems, and significant investment to address this crisis, is urgently needed. The Family Matters Building Blocks and five elements of the Aboriginal and Torres Strait Islander Child Placement Principle (Prevention, Participation, Partnership, Placement and Connection) provide a transformative foundation to address historical, institutional, well-being and socioeconomic drivers of current catastrophic trajectories. The time for action is now.

Mobilizing Forward: An Interpretive Description of Supporting Successful Neonatal Intensive Care Unit-To-Home Transitions for Adolescent Parents.

Pregnancy and parenting in adolescence and the transition home following the hospitalization of an infant in the neonatal intensive care unit (NICU) are two relatively complex phenomena; and whilst each have been consistently explored within the relevant literature, little is understood about the care required when they intersect. Using interpretive description methodology to guide our exploration, we conducted semi-structured interviews with 23 expert providers caring for adolescent parents involved in NICU-to-home transitions to describe this process in their practice. Findings suggest that supporting successful NICU-to-home transitions for adolescent parents relied strongly on understanding the impact of the NICU experience, establishing therapeutic relationships and facilitating supportive partnerships between the NICU and parents as well as the NICU and supportive services post-discharge. Findings highlight the opportunity for more integrated models of care within the NICU and extending into the community to address the complex biopsychosocial care needs of this parent population.

Performance of hospital-based contact tracing for COVID-19 during Australia's second wave.

BACKGROUND: Hospital-based contact tracing aims to limit spread of COVID-19 within healthcare facilities. In large outbreaks, this can stretch resources and workforce due to quarantine of uninfected staff. We analysed the performance of a manual contact tracing system for healthcare workers (HCW) at a multi-site healthcare facility in Melbourne, Australia, from June-September 2020, during an epidemic of COVID-19. METHODS: All HCW close contacts were quarantined for 14 days, and tested around day 11, if not already diagnosed with COVID-19. We examined the prevalence and timing of symptoms in cases detected during quarantine, described this group as proportions of all close contacts and of all cases, and used logistic regression to assess factors associated with infection. RESULTS: COVID-19 was diagnosed during quarantine in 52 furloughed HCWs, from 483 quarantine episodes (11%), accounting for 19% (52/270) of total HCW cases. In 361 exposures to a clear index case, odds of infection were higher after contact with an infectious patient compared to an infectious HCW (aOR: 4.69, 95% CI: 1.98-12.14). Contact with cases outside the workplace increased odds of infection compared to workplace contact only (aOR: 7.70, 95% CI: 2.63-23.05). We estimated 30%, 78% and 95% of symptomatic cases would develop symptoms by days 3, 7, and 11 of quarantine, respectively. CONCLUSION: In our setting, hospital-based contact tracing detected and contained a significant proportion of HCW cases, without excessive quarantine of uninfected staff. Effectiveness of contact tracing is determined by a range of dynamic factors, so system performance should be monitored in real-time.

Out-of-pocket expenses related to aging in place for frail older people: a scoping review.

OBJECTIVE: The objective of this scoping review was to map and describe the available evidence reporting out-of-pocket expenses related to aging in place for older people with frailty and their caregivers. INTRODUCTION: As the global population ages, there has been increasing attention on supporting older people to live at home in the community as they experience health and functional changes. Older people with frailty often require a variety of supports and services to live in the community, yet the out-of-pockets costs associated with these resources are often not accounted for in health and social care literature. INCLUSION CRITERIA: Sources that reported on the financial expenses incurred by older people (60 years or older) with frailty living in the community, or on the expenses incurred by their family and friend caregivers, were eligible for inclusion in the review. METHODS: We searched for published and unpublished (ie, policy papers, theses, and dissertations) studies written in English or French between 2001 and 2019. The following databases were searched: CINAHL, MEDLINE, Scopus, Embase, PsycINFO, Sociological Abstracts, and Public Affairs Index. We also searched for gray literature in a selection of websites and digital repositories. JBI scoping review methodology was used, and we consulted with a patient and family advisory group to support the relevance of the review. RESULTS: A total of 42 sources were included in the review, including two policy papers and 40 research papers. The majority of the papers were from the United States (n = 18), with others from Canada (n = 6), the United Kingdom (n = 3), Japan (n = 2), and one each from Australia, Brazil, China, Denmark, Israel, Italy, The Netherlands, Poland, Portugal, Singapore, South Korea, Taiwan, and Turkey. The included research studies used various research designs, including cross-sectional (n = 18), qualitative (n = 15), randomized controlled trials (n = 2), longitudinal (n = 2), cost effectiveness (n = 1), quasi-experimental (n = 1), and mixed methods (n = 1). The included sources used the term "frailty" inconsistently and used various methods to demonstrate frailty. Categories of out-of-pocket expenses found in the literature included home care, medication, cleaning and laundry, food, transportation, medical equipment, respite, assistive devices, home modifications, and insurance. Five sources reported on out-of-pocket expenses associated with people who were frail and had dementia, and seven reported on the out-of-pocket expenses for caregivers of people with frailty. While seven articles reported on specific programs, there was very little consistency in how out-of-pocket expenses were used as outcome measures. Several studies used measures of combined out-of-pocket expenses, but there was no standard approach to reporting aggregate out-of-pocket expenses. CONCLUSIONS: Contextual factors are important to the experiences of out-of-pocket spending for older people with frailty. There is a need to develop a standardized approach to measuring out-of-pocket expenses in order to support further synthesis of the literature. We suggest a measure of out-of-pocket spending as a percentage of family income. The review supports education for health care providers to assess the out-of-pocket spending of community-dwelling older people with frailty and their caregivers. Health care providers should also be aware of the local policies and resources that are available to help older people with frailty address their out-of-pocket spending.

The EMBOLDEN Co-design study: Partnering with older adults and communities to develop a community program to enhance mobility.

Context: Physical mobility and social participation are requisite for independence and quality of life as one ages. Barriers to mobility lead to social isolation, poor physical and mental health, all of which are precursors to frailty. To date, most mobility-enhancing interventions in older adults have been designed by researchers without citizen input and delivered in controlled settings; their translation to real-world contexts is often impractical and rarely occurs. Objectives: i) To engage older adults and community service providers to qualitatively explore priorities, needs, enablers and barriers to mobility and community participation faced by older adults, and ii) To co-design an evidence-informed, feasible, acceptable group intervention to support mobility and promote health among older adults facing health inequities. Study Design: Adapted experience-based co-design, conducted in collaboration with a Strategic Guiding Council comprised of older adults and service providers. Setting: Community-based. Population studied: Community-dwelling older adults (55+) and local health and social service providers. Outcome Measures: EMBOLDEN's Strategic Guiding Council and the research team collectively interpreted qualitative study findings, together with results of completed systematic reviews and an environmental scan, to determine priority design features of a community-based mobility-enhancing intervention to enable health and well-being in older adults in Hamilton, ON. Results: Eighteen diverse older adults and 16 service providers completed persona scenario interviews. These lived experience perspectives were analyzed, interpreted, and integrated with research and local evidence in the intervention co-design process. Priority design features for the intervention included duration, intensity, mode of delivery, characteristics of interventionists, and implementation strategies. Findings highlighted key strategies related to participant motivation, recruitment, and engagement, as well as important equity, diversity, and inclusion considerations. Conclusions: Partnering with diverse stakeholders is critical to identifying optimal design features of a community-based intervention to promote mobility. Ultimately, we aim to implement and evaluate a health promoting intervention that is sustainable, scalable, addresses health inequities, and effectively improves the lives of older adults.

Risk of Secondary Distress for Graduate Students Conducting Qualitative Research on Sensitive Subjects: A Scoping Review of Canadian Dissertations and Theses.

Qualitative research, in the methods employed and topics explored, is emotionally demanding. While it is common for ethics protocols to protect research participants from emotional distress, the personal impact of emotional work on the researcher can often go unaddressed. Qualitative researchers, in particular graduate student researchers studying sensitive topics, are at risk of psychological effects. It is unclear, however, how this impact on the researcher is discussed in graduate student work and/or the steps taken to address this risk. To provide an overview of how impact on the researcher is considered in Canadian graduate student research, a comprehensive scoping review of dissertations was conducted. Less than 5% (n = 11) of dissertations reviewed included a plan to mitigate psychological risk to the researcher-suggesting a need for further guidance on minimizing risk of emotional distress. The application of trauma and violence-informed principles to graduate supervision policy and practice is discussed as a promising harm mitigation strategy.

The Complexity of the NICU-to-Home Experience for Adolescent Mothers: Meleis' Transitions Theory Applied.

Quality care for individuals and families during periods of transition is one of the major issues facing health care systems and providers today. The transition-home from the neonatal intensive care unit (NICU) as experienced by adolescent mothers is poorly understood-placing young mothers and their infants at risk of poor outcomes following NICU discharge. Meleis' Transitions Theory offers a unique theoretical perspective for understanding this transition experience and also serves to highlight the complexity of the NICU-to-home transition for this population of young mothers that is not currently elucidated in the literature.

Visual Elicitation: Methods for Enhancing the Quality and Depth of Interview Data in Applied Qualitative Health Research.

Generating rich data from interviews for a qualitative study can be difficult to operationalize; especially when difficulties establishing rapport, power imbalances, and participant factors threaten the interview process and quality of data. The aim of this methods article is to (a) discuss the value of incorporating visual elicitation tools or tasks within semistructured or in-depth qualitative interviews to enhance the depth of data generated and (b) provide a specific example of how this is planned and executed within the context of an applied qualitative health research study.

A statistical and numerical modeling approach for spatiotemporal reconstruction of glaciations in the Central Asian mountains.

Reconstructing Quaternary regional glaciations throughout the Himalaya, Tibet, and the adjoining mountains in Central Asia is challenging due to geological biases towards limited preservation of glacial deposits and chronological uncertainties. Here, we offer several statistical and mathematical model codes in R, in excel, and in MATLAB useful to develop regional glacial chronostratigraphies, especially in areas with distinct orographically-modulated climate. A complete R code is provided to generate a regional climate map using Cluster Analysis (CA) and Principal Component Analysis (PCA). Additional R codes include reduced chi-squared, Chauvenet's criterion, radial plotter/abanico plot, finite mixture model, and Student's t-test. These methods are useful in reconstructing the timing of local and regional glacial chronologies. An excel code to calculate equilibrium-line altitudes (ELAs) and steps to reconstruct glacier hypsometry are also made available to further aid to our understanding of the extent of paleoglaciations. A MATLAB code of the linear glacier flow model is included to reconstruct paleotemperatures using the length and slope of a glacier during past advances.•R statistical codes can be used/modified without restrictions for other researchers.•Easy steps to calculate ELAs and glacier hypsometry from the same data.•Paleo-temperature reconstruction utilizes already developed glacial chronologies and maps.

Caregiver preparedness for death in dementia: an evaluation of existing tools.

Objectives: Death preparedness amongst family caregivers (CG) is a valuable and measurable concept. Preparedness predicts CG outcomes in bereavement and is modifiable through a palliative approach which includes advance care planning (ACP) interventions. Improving death preparedness is important for CGs of persons with dementia (PwD) whom are more likely to develop negative outcomes in bereavement, and experience less than adequate palliative care. However, the adequacy of existing tools to measure death preparedness in CGs of PwD is unknown, which limits intervention design and prospective evaluation of ACP effectiveness.Methods: We conducted a review and evaluation of existing tools measuring the attribute domains and traits of CG death preparedness. Literature was searched for articles describing caregiving at end of life (EOL). Measurement tools were extracted, screened for inclusion criteria, and data extracted regarding: conceptual basis, population of development, and psychometrics. Tool content was compared to preparedness domains/traits to assess congruency and evaluate the adequacy of tools as measures of death preparedness for CGs of PwD.Results: Authors extracted 569 tools from articles, retaining seven tools for evaluation. The majority of tools, n = 5 (70%) did not sample all preparedness domains/traits. Few tools had items specific to EOL; only one tool had a specific item questioning CG preparedness for death, and only one tool had items specific to dementia.Conclusion: Limitations in existing tools suggest they are not adequate measures of death preparedness for CGs of PwD. Consequently, the authors are currently developing a questionnaire to be titled, 'Caring Ahead' for this purpose.

Cosmogenic 10Be and equilibrium-line altitude dataset of Holocene glacier advances in the Himalayan-Tibetan orogen.

A comprehensive analysis of the variable temporal and spatial responses of tropical-subtropical high-altitude glaciers to climate change is critical for successful model predictions and environmental risk assessment in the Himalayan-Tibetan orogen. High-frequency Holocene glacier chronostratigraphies are therefore reconstructed in 79 glaciated valleys across the orogen using 519 published and 16 new terrestrial cosmogenic 10Be exposure age dataset. Published 10Be ages are compiled only for moraine boulders (excluding bedrock ages). These ages are recalculated using the latest ICE-D production rate calibration database and the scaling scheme models. Outliers for the individual moraine are detected using the Chauvenet's criterion. In addition, past equilibrium-line altitudes (ELAs) are determined using the area-altitude (AA), area accumulation ratio (AAR), and toe-headwall accumulation ratio (THAR) methods for each glacier advance. The modern maximum elevations of lateral moraines (MELM) are also used to estimate modern ELAs and as an independent check on mean ELAs derived using the above three methods. These data may serve as an essential archive for future studies focusing on the cryospheric and environmental changes in the Himalayan-Tibetan orogen. A more comprehensive analysis of the published and new 10Be ages and ELA results and a list of references are presented in Saha et al. (2019, High-frequency Holocene glacier fluctuations in the Himalayan-Tibetan orogen. Quaternary Science Reviews, 220, 372-400).

Activating a Silver Lipoate Nanocluster with a Penicillin Backbone Induces a Synergistic Effect against S. aureus Biofilm.

Many antibiotic resistances to penicillin have been reported, making them obsolete against multiresistant bacteria. Because penicillins act by inhibiting cell wall production while silver particles disrupt the cell wall directly, a synergetic effect is anticipated when both modes of action are incorporated into a chimera cluster. To test this hypothesis, the lipoate ligands (LA) of a silver cluster (Ag29) of known composition (Ag29LA12)[3-] were covalently conjugated to 6-aminopenicillanic acid, a molecule with a ß-lactam backbone. Indeed, the partially conjugated cluster inhibited an Staphylococcus aureus biofilm, in a dose-response manner, with a half-maximal inhibitory concentration IC50 of 2.3 µM, an improvement over 60 times relative to the unconjugated cluster (IC50 = 140 µM). An enhancement of several orders of magnitude over 6-APA alone (unconjugated) was calculated (IC50 = 10 000 µM). Cell wall damage is documented via scanning electron microscopy. A synergistic effect of the conjugate was calculated by the combination index method described by Chou-Talalay. This hybrid nanoantibiotic opens a new front against multidrug-resistant pathogens.