All hands on deck”: administrator perspectives on managing COVID-19 outbreaks in U.S. nursing homes

Context: Managing COVID-19 outbreaks at U.S. nursing homes highlight the structural weaknesses of pre-pandemic long-term care emergency preparedness protocols. Objective: To understand how nursing home administrators managed staffing and facility operations during an active COVID-19 outbreak. Methods: This descriptive qualitative study conducted semi-structured interviews with administrators at 40 U.S. nursing homes from July 2020–December 2021. Interview questions focused on the impact of COVID-19 on nursing home operations and staffing, among other topics. Interview transcripts were qualitatively analysed to identify overarching themes using modified grounded theory and thematic analysis. Findings: Four major themes emerged from analysis. (1) Administrators described the rapidity of viral infection of staff and residents as overwhelming and long-lasting; (2) a COVID-19 outbreak had an immediate impact on staffing levels; (3) administrators implemented short-term compensatory strategies to manage staffing shortages during COVID-19 outbreaks; and (4) administrator and staff roles and responsibilities expanded in order to maintain facility operations during, and post-COVID-19 outbreak. Limitations: Findings may not be generalizable to all U.S. nursing homes and may not reflect current COVID-19 mitigation protocols and perspectives as interviews concluded in December 2021. Implications: U.S. nursing home administrators used crisis-management strategies to sustain facility operations during active COVID-19 outbreaks. This approach highlights on-going weaknesses in the long-term care infrastructure at U.S. nursing homes. Learning from administrator experiences during the COVID-19 pandemic is critical for the development of robust emergency preparedness plans and the improvement of state and federal resource coordination efforts to support U.S. nursing homes during future public health emergencies

An examination of the self-referent executive processing model of test anxiety: control, emotional regulation, self-handicapping, and examination performance

According to the self-referent executive processing (S-REF) model, test anxiety develops from interactions between three systems: executive self-regulation processes, self-beliefs, and maladaptive situational interactions. Studies have tended to examine one system at a time, often in conjunction with how test anxiety relates to achievement outcomes. The aim of this study was to enable a more thorough test of the S-REF model by examining one key construct from each of these systems simultaneously. These were control (a self-belief construct), emotional regulation through suppression and reappraisal (an executive process), and self-handicapping (a maladaptive situational interaction). Relations were examined from control, emotional regulation, and self-handicapping to cognitive test anxiety (worry), and subsequent examination performance on a high-stakes test. Data were collected from 273 participants in their final year of secondary education. A structural equation model showed that higher control was indirectly related to better examination performance through lower worry, higher reappraisal was indirectly related to worse examination performance through higher worry, and higher self-handicapping was related to worse examination performance through lower control and higher worry. These findings suggest that increasing control and reducing self-handicapping would be key foci for test anxiety interventions to incorporate. © 2018 The Author(s

Health information exchange between hospital and skilled nursing facilities not associated with lower readmissions

ObjectiveTo assess whether an electronic health record (EHR) portal to enable health information exchange (HIE) between a hospital and three skilled nursing facilities (SNFs) reduced likelihood of patient readmission.Setting/DataSecondary data; all discharges from a large academic medical center to SNFs between July 2013 and March 2017, combined with portal usage records from SNFs with HIE access.DesignWe use differenceâ inâ differences to determine whether portal implementation reduced likelihood of readmission over time for patients discharged to HIEâ enabled SNFs, relative to those discharged to nonenabled facilities. Additional descriptive analyses of audit log data characterize portal use within enabled facilities.Data CollectionEncounterâ level clinical EHR data were merged with EHR audit log data that captured portal usage in the timeframe associated with a patient transition from hospital to SNF.Principal FindingsDeclines in likelihood of 30â day readmission were not significantly different for patients in HIEâ enabled vs control SNFs (diffâ inâ diff = 0.022; P = .431). We observe similar null effects with shorter readmission windows. The portal was used for 46 percent of discharges, with significant usage pattern variation within/across facilities.ConclusionsImplementation of a hospitalâ SNF EHR portal did not reduce readmissions from enabled SNFs. Emergent HIE use cases need to be better defined and leveraged for design and implementation that generates value in the context of postacute transitions.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/153113/1/hesr13210.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153113/2/hesr13210-sup-0001-Authormatrix.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/153113/3/hesr13210_am.pd

Key Performance Criteria Affecting the Most the Safety of a Nuclear Waste Long Term Storage : A Case Study Commissioned by CEA

As part of the work scope set in the French law on high level long lived waste R&D passed in 1991, CEA is conducting a research program to establish the scientific basis and assess the feasibility of long term storage as an option for the safe management of nuclear waste for periods as long as centuries. This goal is a significant departure from the current industrial practice where storage facilities are usually built to last only a few decades. From a technical viewpoint such an extension in time seems feasible provided care and maintenance is exercised. Considering such long periods of time, the risk for Society of loosing oversight and control of such a facility is real, which triggers the question of whether and how long term storage safety can be actually achieved. Therefore CEA commissioned a study (1) in which MUTADIS Consultants (2) and CEPN (3) were both involved. The case study looks into several past and actual human enterprises conducted over significant periods o f time, one of them dating back to the end of the 18th century, and all identified out of the nuclear field. Then-prevailing societal behavior and organizational structures are screened out to show how they were or are still able to cope with similar oversight and control goals. As a result, the study group formulated a set of performance criteria relating to issues like responsibility, securing funds, legal and legislative implications, economic sustainable development, all being areas which are not traditionally considered as far as technical studies are concerned. These criteria can be most useful from the design stage onward, first in an attempt to define the facility construction and operating guiding principles, and thereafter to substantiate the safety case for long term storage and get geared to the public dialogue on that undertaking should it become a reality

Perinatal Exposure to Environmentally Relevant Levels of Bisphenol A Decreases Fertility and Fecundity in CD-1 Mice

Bac k g r o u n d: Perinatal exposure to low-doses of bisphenol A (BPA) results in alterations in the ovary, uterus, and mammary glands and in a sexually dimorphic region of the brain known to be important for estrous cyclicity. Objectives: We aimed to determine whether perinatal exposure to environmentally relevant doses of BPA alters reproductive capacity. Met h o d s: Female CD-1 mice that were exposed to BPA at 0, 25 ng, 250 ng, or 25 µg/kg body weight (BW)/day or diethylstilbestrol (DES) at 10 ng/kg BW/day (positive control) from gestational day 8 through day 16 of lactation were continuously housed with proven breeder males for 32 weeks starting at 2 months of age. At each delivery, pups born to these mating pairs were removed. The cumulative number of pups, number of deliveries, and litter size were recorded. The purity of the BPA used in this and our previous studies was assessed using HPLC, mass spectrometry, and nuclear magnetic resonance. Res u l t s: The forced breeding experiment revealed a decrease in the cumulative number of pups, observed as a nonmonotonic dose–response effect, and a decline in fertility and fecundity over time in female mice exposed perinatally to BPA. The BPA was 97 % pure, with no evidence of contaminatio

Understanding the limitations of radiation-induced cell cycle checkpoints

The DNA damage response pathways involve processes of double-strand break (DSB) repair and cell cycle checkpoint control to prevent or limit entry into S phase or mitosis in the presence of unrepaired damage. Checkpoints can function to permanently remove damaged cells from the actively proliferating population but can also halt the cell cycle temporarily to provide time for the repair of DSBs. Although efficient in their ability to limit genomic instability, checkpoints are not foolproof but carry inherent limitations. Recent work has demonstrated that the G1/S checkpoint is slowly activated and allows cells to enter S phase in the presence of unrepaired DSBs for about 4–6 h post irradiation. During this time, only a slowing but not abolition of S-phase entry is observed. The G2/M checkpoint, in contrast, is quickly activated but only responds to a level of 10–20 DSBs such that cells with a low number of DSBs do not initiate the checkpoint or terminate arrest before repair is complete. Here, we discuss the limitations of these checkpoints in the context of the current knowledge of the factors involved. We suggest that the time needed to fully activate G1/S arrest reflects the existence of a restriction point in G1-phase progression. This point has previously been defined as the point when mitogen starvation fails to prevent cells from entering S phase. However, cells that passed the restriction point can respond to DSBs, albeit with reduced efficiency

Role of Mutagenicity in Asbestos Fiber-Induced Carcinogenicity and Other Diseases

The cellular and molecular mechanisms of how asbestos fibers induce cancers and other diseases are not well understood. Both serpentine and amphibole asbestos fibers have been shown to induce oxidative stress, inflammatory responses, cellular toxicity and tissue injuries, genetic changes, and epigenetic alterations in target cells in vitro and tissues in vivo. Most of these mechanisms are believe to be shared by both fiber-induced cancers and noncancerous diseases. This article summarizes the findings from existing literature with a focus on genetic changes, specifically, mutagenicity of asbestos fibers. Thus far, experimental evidence suggesting the involvement of mutagenesis in asbestos carcinogenicity is more convincing than asbestos-induced fibrotic diseases. The potential contributions of mutagenicity to asbestos-induced diseases, with an emphasis on carcinogenicity, are reviewed from five aspects: (1) whether there is a mutagenic mode of action (MOA) in fiber-induced carcinogenesis; (2) mutagenicity/carcinogenicity at low dose; (3) biological activities that contribute to mutagenicity and impact of target tissue/cell type; (4) health endpoints with or without mutagenicity as a key event; and finally, (5) determinant factors of toxicity in mutagenicity. At the end of this review, a consensus statement of what is known, what is believed to be factual but requires confirmation, and existing data gaps, as well as future research needs and directions, is provided