Navigating the Storm: Challenges and Career Implications for Nursing Home Administrators in the Wake of COVID-19.

PURPOSE: Nursing homes were at the epicenter of the coronavirus disease 2019 (COVID-19) pandemic and continue to experience its effects, including staffing shortages. Although various studies have described the experiences of frontline staff, less has been published about the experiences of those in administrative positions. The current study explored factors impacting nursing home administrators' (NHAs) perceived preparedness, day-to-day operational challenges and needs, and career outlook in the context of the COVID-19 pandemic. METHOD: A cross-sectional online survey was administered via Qualtrics®, comprising demographic and facility-level questions and eight open-ended questions. Qualitative content and thematic analysis were used to code the text for themes describing administrator perceptions. RESULTS: NHAs (N = 60) described feeling unprepared, experiencing disruptions of day-to-day operations, and witnessing a decrease in resident well-being. NHAs also expressed a decrease in their own well-being due to COVID-19. Many NHAs expressed wanting to, planning to, or actively working toward leaving their role due to the consequences of COVID-19. CONCLUSION: As nursing homes continue to face staffing shortages, supporting those in the role of administrator becomes of urgent importance, as this role directly impacts staff and resident well-being. [Journal of Gerontological Nursing, 50(6), 17-24.].

Shiga Toxin-Producing Escherichia coli O157:H7 Illness Outbreak Associated with Untreated, Pressurized, Municipal Irrigation Water - Utah, 2023.

During July-September 2023, an outbreak of Shiga toxin-producing Escherichia coli O157:H7 illness among children in city A, Utah, caused 13 confirmed illnesses; seven patients were hospitalized, including two with hemolytic uremic syndrome. Local, state, and federal public health partners investigating the outbreak linked the illnesses to untreated, pressurized, municipal irrigation water (UPMIW) exposure in city A; 12 of 13 ill children reported playing in or drinking UPMIW. Clinical isolates were genetically highly related to one another and to environmental isolates from multiple locations within city A's UPMIW system. Microbial source tracking, a method to indicate possible contamination sources, identified birds and ruminants as potential sources of fecal contamination of UPMIW. Public health and city A officials issued multiple press releases regarding the outbreak reminding residents that UPMIW is not intended for drinking or recreation. Public education and UPMIW management and operations interventions, including assessing and mitigating potential contamination sources, covering UPMIW sources and reservoirs, indicating UPMIW lines and spigots with a designated color, and providing conspicuous signage to communicate risk and intended use might help prevent future UPMIW-associated illnesses.

"I Like the Feeling of Connecting With People": A Mixed-Methods Study of Nursing Assistants Experiences Across the Care Continuum.

Nursing assistants (NAs) are critical professionals across the long-term care continuum. Despite the demands of NAs, these frontline personnel experience workplace challenges and turnover at a disproportionate rate compared to other professionals. Much research has explored the experiences of nursing assistants using federal survey data and national datasets. Guided by a socio-ecological model and the job-demands resource model, this study utilized a sequential mixed-methods approach to uncover a more nuanced understanding of NA workplace experience. Results from this combined qualitative (N = 17) and quantitative (N = 354) study found that there are several workplace aspects, such as organizational culture and supervisor relationships, that contribute to NA experiences across system levels. Further exploration of direct care tasks directly from nursing assistants is necessary to understand full intentions.

Pharmacogenetic Testing in Patients with Autism Spectrum Disorder Evaluated in a Precision Medicine Clinic.

OBJECTIVE: This study investigated outcomes of pharmacogenetic testing of youth with autism spectrum disorder (ASD) referred to a precision medicine clinic and explored associations between patient characteristics and pharmacogenomic testing results. METHODS: Records for patients diagnosed with ASD and subsequently referred to a pediatric hospital's precision medicine clinic between July 1, 2010, and June 30, 2020, were reviewed. Pharmacogenetic testing results were abstracted focusing on CYP2D6 and CYP2C19. In addition, we compiled counts of patients' co-occurring diagnoses, histories of adverse drug reactions (ADRs), previously trialed ineffective medications, and previous psychiatric medication changes. Logistic regression models were fit to examine CYP2C19 and CYP2D6 metabolizer status as functions of patient demographics and prereferral medication histories. RESULTS: Of 202 patients (mean age = 12.18 yrs), 66% were referred to precision medicine because of poor medication response. Among patients with pharmacogenomic testing results for CYP2D6, 9% were classified as poor metabolizers; among patients with results for CYP2C19, 10% were classified as rapid/ultrarapid metabolizers. Patient demographics and medication response history did not predict pharmacogenomic results. However, the number of co-occurring diagnoses positively predicted the number of nonpsychiatric ADRs and a higher probability of CYP2D6 poor metabolizer status; moreover, nonpsychiatric ADRs positively predicted CYP2C19 rapid/ultrarapid metabolizer status. CONCLUSION: In one of the largest reported samples of youth with ASD clinically referred for pharmacogenetic testing, we observed high variability in medication response and yield for actionable results. Our findings suggest potential clinical utility for pharmacogenetic testing and introduce possible clinical profiles associated with metabolizer status.

Sensory and affective response to chocolate differing in cocoa content: A TDS and facial electromyography approach.

Existing research has offered insight into facial activities and their associations with hedonic liking during the consumption of basic food samples and suggests facial changes during consumption are linked to the hedonic evaluation of tastes and, thus related to the taster's perception rather than the tastes themselves. This study tests whether, during the consumption of commercially available dark chocolate, a complex food product, which can be high in bitterness but expectedly so, how facial activities are linked to the bitterness levels and the hedonic liking of the samples. To do this we carried out two studies with untrained consumers, the first of which captured temporally dynamic sensory perception during the consumption of dark chocolate samples of 36% and 85% cocoa content, using the Temporal Dominance of Sensations (TDS) approach. The second study captured facial EMG over the corrugator and zygomaticus muscles during the consumption of dark chocolate samples (36%, 70%, and 85% cocoa). Specifically, the aim of this research was to investigate whether corrugator activity had a greater association with bitterness perception, linked to cocoa, or hedonic evaluation. Capturing the dynamic sensory profile of chocolate samples allowed an investigation into the time points most evident of sensory variation related to the bitterness and sweetness of the taste, allowing insight into whether facial activities also deviated during this time. These data offer evidence to suggest that corrugator was associated with hedonic evaluation during consumption of the samples, with the most liked samples (being those with 70% and 36% cocoa) eliciting similar corrugator activities and less activity than the least liked 85% cocoa content sample; however, there was also evidence to suggest a significant variation in participants' corrugator activity during the period of oral processing when bitterness was most evident in the 85% cocoa sample and sweetness was most evident in the 36% cocoa sample (i.e., the time when bitterness and sweetness were most divergent) Further investigation showed a variation in facial activities elicited during consumption of the 36% cocoa sample based on whether individuals were part of the group who favoured the 85% cocoa sample or the group favouring the 36% cocoa sample. The findings, therefore, suggest facial EMG, specifically over the corrugator, appears to be related to the hedonic evaluation of a complex food product and not the taste itself. Furthermore, being aware of the time points where sensory variations are most apparent between samples can allow for targeted investigation into facial EMG and its ability to distinguish food samples.

Community partnerships are fundamental to ethical ancient DNA research.

The ethics of the scientific study of Ancestors has long been debated by archaeologists, bioanthropologists, and, more recently, ancient DNA (aDNA) researchers. This article responds to the article "Ethics of DNA research on human remains: five globally applicable guidelines" published in 2021 in Nature by a large group of aDNA researchers and collaborators. We argue that these guidelines do not sufficiently consider the interests of community stakeholders, including descendant communities and communities with potential, but yet unestablished, ties to Ancestors. We focus on three main areas of concern with the guidelines. First is the false separation of "scientific" and "community" concerns and the consistent privileging of researcher perspectives over those of community members. Second, the commitment of the guidelines' authors to open data ignores the principles and practice of Indigenous Data Sovereignty. Further, the authors argue that involving community members in decisions about publication and data sharing is unethical. We argue that excluding community perspectives on "ethical" grounds is convenient for researchers, but it is not, in fact, ethical. Third, we stress the risks of not consulting communities that have established or potential ties to Ancestors, using two recent examples from the literature. Ancient DNA researchers cannot focus on the lowest common denominator of research practice, the bare minimum that is legally necessary. Instead, they should be leading multidisciplinary efforts to create processes to ensure communities from all regions of the globe are identified and engaged in research that affects them. This will often present challenges, but we see these challenges as part of the research, rather than a distraction from the scientific endeavor. If a research team does not have the capacity to meaningfully engage communities, questions must be asked about the value and benefit of their research.

Nursing assistant turnover in nursing homes: A scoping review of the literature.

BACKGROUND: Nurse aide turnover in long-term care is projected to increase in the coming years. Guided by a social ecological framework, this scoping review systematically searched for peer-reviewed journal articles on nursing assistant or nurse aide turnover in nursing homes. METHODS: Using the PICO and PRISMA guidelines, 8 university-based library databases via EBSCOhost were searched to source peer-reviewed journal articles published between 2002 and 2022 on nurse aide turnover in nursing homes. RESULTS: The initial article search revealed 997 articles. After a three-stage article screening and removal process, a final sample of 43 articles (N = 43) remained. Guided by levels of influence, nurse aide turnover is found to be influenced by intrapersonal, interpersonal, institutional, community, and public policy level factors. CONCLUSION: Findings highlight the need for further research with nursing facility administrators and nurse aides to evaluate the complex interactions within long-term care nursing homes.

Associations between attentional biases to fearful faces and social-emotional development in infants with and without an older sibling with autism.

During the first year of life, infants become increasingly attuned to facial emotion, with heightened sensitivity to faces conveying threat observed by age seven months as illustrated through attentional biases (e.g., slower shifting away from fearful faces). Individual differences in these cognitive attentional biases have been discussed in relation to broader social-emotional functioning, and the current study examines these associations in infants with an older sibling with autism spectrum disorder (ASD), a group with an elevated likelihood of a subsequent ASD diagnosis (ELA; n = 33), and a group of infants with no family history of ASD who are at low likelihood of ASD (LLA; n = 24). All infants completed a task measuring disengagement of attention from faces at 12 months (fearful, happy, neutral), and caregivers completed the Infant-Toddler Social and Emotional Assessment at 12, 18, and/or 24 months. For the full sample, greater fear bias in attention disengagement at 12 months related to more internalizing behaviors at 18 months, and this was driven by the LLA infants. When examining groups separately, findings revealed that LLA with a greater fear bias had more difficult behaviors at 12, 18, and 24 months; in contrast, ELA showed the opposite pattern, and this was most pronounced for ELA who later received an ASD diagnosis. These preliminary group-level findings suggest that heightened sensitivity to fearful faces might serve an adaptive function in children who later receive an ASD diagnosis, but in infants with no family history of ASD, increased biases might reflect a marker of social-emotional difficulties.

Guidelines for genetic ancestry inference created through roundtable discussions.

The use of genetic and genomic technology to infer ancestry is commonplace in a variety of contexts, particularly in biomedical research and for direct-to-consumer genetic testing. In 2013 and 2015, two roundtables engaged a diverse group of stakeholders toward the development of guidelines for inferring genetic ancestry in academia and industry. This report shares the stakeholder groups' work and provides an analysis of, commentary on, and views from the groundbreaking and sustained dialogue. We describe the engagement processes and the stakeholder groups' resulting statements and proposed guidelines. The guidelines focus on five key areas: application of genetic ancestry inference, assumptions and confidence/laboratory and statistical methods, terminology and population identifiers, impact on individuals and groups, and communication or translation of genetic ancestry inferences. We delineate the terms and limitations of the guidelines and discuss their critical role in advancing the development and implementation of best practices for inferring genetic ancestry and reporting the results. These efforts should inform both governmental regulation and self-regulation.

Algorithmic Fairness in the Roberts Court Era.

Scientists and policymakers alike have increasingly been interested in exploring ways to advance algorithmic fairness, recognizing not only the potential utility of algorithms in biomedical and digital health contexts but also that the unique challenges that algorithms-in a datafied culture such as the United States-pose for civil rights (including, but not limited to, privacy and nondiscrimination). In addition to the technical complexities, separation of powers issues are making the task even more daunting for policymakers-issues that might seem obscure to many scientists and technologists. While administrative agencies (such as the Federal Trade Commission) and legislators have been working to advance algorithmic fairness (in large part through comprehensive data privacy reform), recent judicial activism by the Roberts Court threaten to undermine those efforts. Scientists need to understand these legal developments so they can take appropriate action when contributing to a biomedical data ecosystem and designing, deploying, and maintaining algorithms for digital health. Here I highlight some of the recent actions taken by policymakers. I then review three recent Supreme Court cases (and foreshadow a fourth case) that illustrate the radical power grab by the Roberts Court, explaining for scientists how these drastic shifts in law will frustrate governmental approaches to algorithmic fairness and necessitate increased reliance by scientists on self-governance strategies to promote responsible and ethical practices.

Causal involvement of the left angular gyrus in higher functions as revealed by transcranial magnetic stimulation: a systematic review.

Transcranial magnetic stimulation (TMS) is a non-invasive technique that can transiently interfere with local cortical functioning, thus enabling inferences of causal left AG involvement in higher functions from experimentation with healthy participants. Here, we examine 35 studies that measure behavioural outcomes soon after or during targeting TMS to the left AG, by design and as documented by individual magnetic resonance images, in healthy adult participants. The reviewed evidence suggests a specific causal involvement of the left AG in a wide range of tasks involving language, memory, number processing, visuospatial attention, body awareness and motor planning functions. These core findings are particularly valuable to inform theoretical models of the left AG role(s) in higher functions, due to the anatomical specificity afforded by the selected studies and the complementarity of TMS to different methods of investigation. In particular, the variety of the operations within and between functions in which the left AG appears to be causally involved poses a formidable challenge to any attempts to identify a single computational process subserved by the left AG (as opposed to just outlining a broad type of functional contribution) that could apply across thematic areas. We conclude by highlighting directions for improvement in future experimentation with TMS, in order to strengthen the available evidence, while taking into account the anatomical heterogeneity of this brain region.

Corrigendum: A TNFR2-specific TNF fusion protein with improved in vivo activity.

[This corrects the article DOI: 10.3389/fimmu.2022.888274.].

Exploring access to genomic risk information and the contours of the HIPAA public health exception.

Considerable resources have been invested in research to identify pathogenic and likely pathogenic variants that cause morbidity and mortality and also in returning these results to patients. The public health impact and cost-effectiveness of these efforts are maximized when probands' relatives are informed of their risk and offered testing. However, such 'Traceback' cascade testing programs face multiple obstacles, including perceived or actual legal and regulatory hurdles. Here, using genetic cancer syndromes as a test case, we explore the contours of the Public Health Exception to the HIPAA Privacy Rule to assess whether it is a viable pathway for implementing a Traceback program. After examining the Privacy Rule as well as state laws and regulations for reportable conditions and genetic privacy, we conclude that this is not currently a viable approach for Traceback programs. We conclude by reflecting on ethical considerations of leveraging HIPAA's public health exception to disclose PHI directly to at-risk relatives and offering insights for how legal hurdles to such a Traceback program could be overcome, if desired.

TNF Receptor Associated Factor 2 (TRAF2) Signaling in Cancer.

Tumor necrosis factor (TNF) receptor associated factor-2 (TRAF2) has been originally identified as a protein interacting with TNF receptor 2 (TNFR2) but also binds to several other receptors of the TNF receptor superfamily (TNFRSF). TRAF2, often in concert with other members of the TRAF protein family, is involved in the activation of the classical NFκB pathway and the stimulation of various mitogen-activated protein (MAP) kinase cascades by TNFRSF receptors (TNFRs), but is also required to inhibit the alternative NFκB pathway. TRAF2 has also been implicated in endoplasmic reticulum (ER) stress signaling, the regulation of autophagy, and the control of cell death programs. TRAF2 fulfills its functions by acting as a scaffold, bringing together the E3 ligase cellular inhibitor of apoptosis-1 (cIAP1) and cIAP2 with their substrates and various regulatory proteins, e.g., deubiquitinases. Furthermore, TRAF2 can act as an E3 ligase by help of its N-terminal really interesting new gene (RING) domain. The finding that TRAF2 (but also several other members of the TRAF family) interacts with the latent membrane protein 1 (LMP1) oncogene of the Epstein-Barr virus (EBV) indicated early on that TRAF2 could play a role in the oncogenesis of B-cell malignancies and EBV-associated non-keratinizing nasopharyngeal carcinoma (NPC). TRAF2 can also act as an oncogene in solid tumors, e.g., in colon cancer by promoting Wnt/ß-catenin signaling. Moreover, tumor cell-expressed TRAF2 has been identified as a major factor-limiting cancer cell killing by cytotoxic T-cells after immune checkpoint blockade. However, TRAF2 can also be context-dependent as a tumor suppressor, presumably by virtue of its inhibitory effect on the alternative NFκB pathway. For example, inactivating mutations of TRAF2 have been associated with tumor development, e.g., in multiple myeloma and mantle cell lymphoma. In this review, we summarize the various TRAF2-related signaling pathways and their relevance for the oncogenic and tumor suppressive activities of TRAF2. Particularly, we discuss currently emerging concepts to target TRAF2 for therapeutic purposes.

A TNFR2-Specific TNF Fusion Protein With Improved In Vivo Activity.

Tumor necrosis factor (TNF) receptor-2 (TNFR2) has attracted considerable interest as a target for immunotherapy. Indeed, using oligomeric fusion proteins of single chain-encoded TNFR2-specific TNF mutants (scTNF80), expansion of regulatory T cells and therapeutic activity could be demonstrated in various autoinflammatory diseases, including graft-versus-host disease (GvHD), experimental autoimmune encephalomyelitis (EAE) and collagen-induced arthritis (CIA). With the aim to improve the in vivo availability of TNFR2-specific TNF fusion proteins, we used here the neonatal Fc receptor (FcRn)-interacting IgG1 molecule as an oligomerizing building block and generated a new TNFR2 agonist with improved serum retention and superior in vivo activity. Methods: Single-chain encoded murine TNF80 trimers (sc(mu)TNF80) were fused to the C-terminus of an in mice irrelevant IgG1 molecule carrying the N297A mutation which avoids/minimizes interaction with Fcγ-receptors (FcγRs). The fusion protein obtained (irrIgG1(N297A)-sc(mu)TNF80), termed NewSTAR2 (New selective TNF-based agonist of TNF receptor 2), was analyzed with respect to activity, productivity, serum retention and in vitro and in vivo activity. STAR2 (TNC-sc(mu)TNF80 or selective TNF-based agonist of TNF receptor 2), a well-established highly active nonameric TNFR2-specific variant, served as benchmark. NewSTAR2 was assessed in various in vitro and in vivo systems. Results: STAR2 (TNC-sc(mu)TNF80) and NewSTAR2 (irrIgG1(N297A)-sc(mu)TNF80) revealed comparable in vitro activity. The novel domain architecture of NewSTAR2 significantly improved serum retention compared to STAR2, which correlated with efficient binding to FcRn. A single injection of NewSTAR2 enhanced regulatory T cell (Treg) suppressive activity and increased Treg numbers by > 300% in vivo 5 days after treatment. Treg numbers remained as high as 200% for about 10 days. Furthermore, a single in vivo treatment with NewSTAR2 upregulated the adenosine-regulating ectoenzyme CD39 and other activation markers on Tregs. TNFR2-stimulated Tregs proved to be more suppressive than unstimulated Tregs, reducing conventional T cell (Tcon) proliferation and expression of activation markers in vitro. Finally, singular preemptive NewSTAR2 administration five days before allogeneic hematopoietic cell transplantation (allo-HCT) protected mice from acute GvHD. Conclusions: NewSTAR2 represents a next generation ligand-based TNFR2 agonist, which is efficiently produced, exhibits improved pharmacokinetic properties and high serum retention with superior in vivo activity exerting powerful protective effects against acute GvHD.

Ethical Guidance in Human Paleogenomics: New and Ongoing Perspectives.

Over the past two decades, the study of ancient genomes from Ancestral humans, or human paleogenomic research, has expanded rapidly in both scale and scope. Ethical discourse has subsequently emerged to address issues of social responsibility and scientific robusticity in conducting research. Here, we highlight and contextualize the primary sources of professional ethical guidance aimed at paleogenomic researchers. We describe the tension among existing guidelines, while addressing core issues such as consent, destructive research methods, and data access and management. Currently, there is a dissonance between guidelines that focus on scientific outcomes and those that hold scientists accountable to stakeholder communities,such as descendants. Thus, we provide additional tools to navigate the complexities of ancient DNA research while centering engagement with stakeholder communities in the scientific process.

U.S. Adult Perspectives on Facial Images, DNA, and Other Biometrics.

Applications of biometrics in various societal contexts have been increasing in the United States, and policy debates about potential restrictions and expansions for specific biometrics (such as facial recognition and DNA identification) have been intensifying. Empirical data about public perspectives on different types of biometrics can inform these debates. We surveyed 4048 adults to explore perspectives regarding experience and comfort with six types of biometrics; comfort providing biometrics in distinct scenarios; trust in social actors to use two types of biometrics (facial images and DNA) responsibly; acceptability of facial images in eight scenarios; and perceived effectiveness of facial images for five tasks. Respondents were generally comfortable with biometrics. Trust in social actors to use biometrics responsibly appeared to be context specific rather than dependent on biometric type. Contrary to expectations given mounting attention to dataveillance concerns, we did not find sociodemographic factors to influence perspectives on biometrics in obvious ways. These findings underscore a need for qualitative approaches to understand the contextual factors that trigger strong opinions of comfort with and acceptability of biometrics in different settings, by different actors, and for different purposes and to identify the informational needs relevant to the development of appropriate policies and oversight.

Parental understanding and attitudes following pharmacogenomic testing for pediatric neuropsychiatric patients.

Aim: This study explores parental understanding and attitudes around pharmacogenomic results in their child(ren). Patients and methods: In-depth interviews with parents whose child(ren) had received a pharmacogenomic testing panel for management of neuropsychiatric medications were completed. Interviews were analyzed for themes and accuracy of understanding of results. Results: In 18 parents interviewed, 49/63 (78%) of statements made regarding results were accurate. Differences in understanding were seen by clinic, number of medications and result type. Parents expected results to guide prescribing and perceived the greatest utility in results that could impact current care. Results predicting normal drug metabolism may create mixed feelings. Conclusion: Parents perceive utility in pharmacogenomic testing for their children. Challenges exist in understanding probabilistic and multifactorial information about pharmacogenomic results.

Framing the utility and potential pitfalls of relationship and identity DNA testing across United States immigration contexts.

Genetic information is increasingly used at US border entry points, but the use of DNA in immigration contexts is not new. DNA testing for verification of identity or relationships for visa and asylum petitions began in the 1980s. Long-standing applications demonstrate both the utility and pitfalls of DNA testing in immigration contexts. Some of these pitfalls are shared with health-related contexts of DNA testing, but the power of government officials to deny immigration benefits, separate families, or make accusations of fraud among a vulnerable population elevates the potential harms, including stigmatization, discrimination, and coerced consent. We conducted semi-structured interviews with professional stakeholders on their understandings of the process of DNA testing, opinions on the role of DNA testing in immigration, and experiences with DNA applications in immigration. From the 22 interviews, we sourced 21 case examples involving DNA testing and supplemented these with 10 case examples provided by the study team. The 31 case examples capture instances of DNA testing for relationship or identity across five immigration contexts. Using the case examples, we developed three overarching utilities and six overarching pitfalls of DNA testing that apply across these immigration contexts. Our framework allows long-standing applications of DNA testing in immigration to inform stakeholders' approaches to applications in new contexts. As the use of DNA data in immigration contexts expands, its implementation should recognize the utility of DNA data to both migrants and government while guarding against pitfalls that could undermine the human rights and dignity of a vulnerable population.