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.

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.

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.

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.

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.

Bearing a Disproportionate Burden: Racial/Ethnic Disparities in Experiences of U.S.-Based Social Workers during the COVID-19 Pandemic.

While social workers have served as frontline workers responding to the needs of vulnerable populations during COVID-19 pandemic, little is known about how social work professionals themselves have been impacted. This article explored the impact of COVID-19 on social work professionals' mental health, physical health, and access to personal protective equipment (PPE). This was a cross-sectional web-based survey of social workers practicing in the United States (N = 3,118); data on demographic and workplace characteristics, physical and mental health, and safety concerns were collected between June and August of 2020. Univariate statistics were used to characterize the sample. Ordinal logistic and multinomial regression were used to achieve the research aims. The majority of participants reported either moderate or severe concerns related to mental (55 percent) and physical (55 percent) health; 36 percent of respondents indicated concerns about PPE access. Respondents' concerns differed by demographic (e.g., race, age) and workplace characteristics (e.g., setting, role, region). Social workers of color are experiencing COVID-19-related concerns of significantly greater severity relative to their White counterparts. Findings highlight an immediate need to deepen understanding of the factors that contribute to these trends and identify mechanisms to support the frontline social work workforce most impacted.

Developing a Tool to Measure Person-Centered Care in Service Planning.

Background: Delivering person-centered care is a key component of health care reform. Despite widespread endorsement, medical and behavioral health settings struggle to specify and measure person-centered care objectively. This study presents the validity and reliability of the Person-Centered Care Planning Assessment Measure (PCCP-AM), an objective measure of the extent to which service planning is person-centered. Methods: Based upon the recovery-oriented practice of person-centered care planning, the 10-item PCCP-AM tool rates service plans on the inclusion of service user strengths, personal life goals, natural supports, self-directed actions and the promotion of community integration. As part of a large randomized controlled trial of person-centered care planning, service plans completed by community mental health clinic providers were rated using the PCCP-AM. Reliability was tested by calculating inter-rater reliability across 168 plans and internal consistency across 798 plans. To test concurrent validity, PCCP-AM scores for 84 plans were compared to expert rater scores on a separate instrument. Results: Interrater reliability for each of the 10 PCCP-AM items as measured by Kendall's W ranged from W = 0.77 to W = 0.89 and percent of scores within ± 1 point of each other ranged from 85.7 to 100%. Overall internal consistency as measured by Cronbach's alpha across 798 plans was α = 0.72. Concurrent validity as measured by Kendall's W ranged from W = 0.55 to W = 0.74 and percent of item scores within ± 1 point of expert rater scores ranged from 73.8 to 86.8%. Conclusions: Findings demonstrated that the 10-item PCCP-AM was a valid and reliable objective measure of person-centered care. Using the service plan as an indicator of multiple domains of person-centered care, the measure provides a valuable tool to inform clinical supervision and quality improvement across programs. More psychometric testing is needed to strengthen the measure for research purposes.

Treating Pediatric and Geriatric Patients at Risk of Suicide in General Emergency Departments: Perspectives From Emergency Department Clinical Leaders.

STUDY OBJECTIVE: We explored emergency department clinical leaders' views on providing emergency mental health services to pediatric and geriatric patients with suicidal ideation and suicide attempts. METHODS: We conducted semistructured interviews with a total of 34 nursing directors, medical directors, and behavioral health managers at 17 general hospital EDs across the United States, using purposive sampling to ensure variation among hospitals. Interviews were audio-recorded, transcribed verbatim, and coded and analyzed using Atlas.ti and a directed content analysis approach. RESULTS: Respondents from across a range of ED types expressed concerns regarding the capacity of their EDs to meet mental health needs of children and older adults. They experienced emotional distress over the increasing number of pediatric patients presenting to EDs with suicidal ideation/suicide attempt and described EDs as inappropriate environments for young patients with suicidal ideation/suicide attempt. Similarly, leaders expressed feeling ill-equipped to diagnose and treat geriatric patients with suicidal ideation/suicide attempt, who often had medical comorbidities that complicated treatment planning. Respondents noted that pediatric and geriatric patients frequently boarded in the ED. Some felt compelled to use creative solutions to provide safe spaces for pediatric and geriatric patients. Respondents voiced frustration over the lack of outpatient and inpatient mental health services for these patients. CONCLUSION: Clinical leaders in EDs across the nation expressed distress at feeling they were not adequately equipped to meet the needs of pediatric and geriatric patients with suicidal ideation/suicide attempt. Future innovations to provide ED care for children and older adults with suicidal ideation/suicide attempt might include training for ED teams, access to specialist mental health clinicians through telehealth, and adaptations of physical spaces.

Studying Executive Directors and Supervisors Views of Organizational and Policy-Level Challenges Faced by Community Health Workers.

Within the United States, there is an absence of a national community health worker (CHW) program. There is substantial regional and state-based variability in the population served by CHWs, their disease focus, and availability of training, supervision, and other supports. This article seeks to respond to the call in the literature to work collaboratively with CHW professional associations to identify, reflect, and respond to CHW workforce development and sustainability issues. We partnered with 8 member organizations of the Association of Perinatal Networks of New York and conducted 2 focus groups with 7 executive directors and 6 supervisors. Data were analyzed using thematic analysis. Policy barriers included funding, accessibility of evidence-based practices, and credentialing. Organizational barriers included recruitment and high turnover and interorganizational referral processes and management. This study offers recommendations for supports needed to sustain CHWs, with an emphasis on greater investment in recruitment and training, higher compensation, and interorganizational collaboration.

Screening Pediatric Medical Patients for Suicide Risk: Is Depression Screening Enough?

PURPOSE: Medically ill youth are at increased risk for suicide. For convenience, hospitals may screen for suicide risk using depression screening instruments, though this practice might not be adequate to detect those at risk for suicide. This study aims to determine whether depression screening can detect suicide risk in pediatric medical inpatients who screen positive on suicide-specific measures. METHODS: A convenience sample of medical inpatients ages 10-21 years were recruited as part of a larger instrument validation study. Participants completed the Ask Suicide-Screening Questions, the Suicidal Ideation Questionnaire/Suicidal Ideation Questionnaire-Junior, and the Patient Health Questionnaire-Adolescent Version (PHQ-A). Univariate and multivariate statistics were calculated to examine the relationship between screening positive for depression and suicide risk. RESULTS: The sample consisted of 600 medical inpatients (59.2% female; 55.2% white; mean age 15.2 ± 2.84 years). Of participants who screened positive for suicide risk (13.5%; 81/600), 39.5% (32/81) did not screen positive for depression, and more than half (45/81) did not endorse PHQ-A item 9, which queries for thoughts of harming oneself or being better off dead. Twenty-six participants (32%) who screened negative for depression and on PHQ-A item nine were at risk for suicide. CONCLUSIONS: In this sample, depression screening alone failed to detect nearly a third of youth at risk for suicide. Although depression and suicide risk are strongly related, a significant portion of pediatric medical inpatients at risk for suicide may pass through the healthcare system unrecognized if depression screening is used as a proxy for identifying suicide risk.