The Use of Intermittent Non-Invasive Ventilation as an Alveolar Recruitment Method for Patient with Severe COVID 19 Pneumonia

Background: The use of non-invasive ventilation (NIV) as a therapy for acute respiratory distress syndrome (ARDS) secondary to COVID 19 pneumonia has been controversial. NIV is an aerosol generating procedure which may increase the risk of viral transmission amongst patients and staff. Because of fear of aerosolizing the virus and transmitting the disease, initial expert recommendation was to avoid NIV and proceed with early intubation. With further experience of the virus, this recommendation has been challenged and NIV has been used widely with some retrospective studies quoting between 11 to 56 percent of COVID 19 related respiratory failures being treated with NIV. Objective: The objective of this study is to assess the efficacy and safety of using non-invasive mechanical ventilation as an alveolar recruitment method for patients with severe COVID 19 pneumonia. This method was used by our respiratory team on selected patients during the early phase of the COVID 19 pandemic. Methods: We reviewed the charts of patients that were admitted to the American Hospital Dubai intensive care unit, or our medical step-down unit who had diffuse bilateral infiltrates requiring oxygen supplementation between March and October 2020. We identified patients who were on intermittent BiPAP in addition to standard care. We also monitored the rate of infection among staff taking care of these patients. Results: Average length of stay after starting BIPAP therapy was 6.8 days, while the average total length of stay was 13.6 days. Only one patient was transferred to the ICU after being on the BIPAP protocol and did not need intubation. All patients were discharged home either without oxygen or with their chronic baseline home oxygen requirement. Radiological improvement in aeration was seen in 100% of patients at follow-up x-ray post-intervention. There were no reported pulmonary complications from barotrauma, such as pneumothorax or pneumomediastinum. There were no reported cases of staff infection to the health care workers that were taking care of these patients Conclusion: Our first of its kind observational study showed clearly that using BIPAP therapy for one hour three times daily during nebulization therapy in addition to standard care resulted in a significant reduction in hospital length of stay and hastened the clinical and radiological improvement of patients with severe COVID 19 pneumonia.

Why do people prepare for natural hazards? An application of the Theory of Planned Behaviour to household preparation

<p>Natural hazards impact millions of people globally and lead to billions of dollars of economic loss each year. New Zealand is one of many countries vulnerable to multiple natural hazards including earthquakes, tsunami, volcanic eruption, and high impact weather. Despite these well-known risks, many residents of the capital city of Wellington have taken few steps to be more prepared. This location, therefore, presented an appropriate population for the investigations within this thesis. Decades of social science research has identified a multitude of factors related to preparation behaviour. However, many of these factors, such as risk perception and previous experience of natural hazards, are difficult to manipulate successfully in broad public education campaigns. The first main aim of this thesis was therefore to identify thoughts and beliefs about preparing which predict people’s preparation behaviour, with the aim of identifying specific factors which can be efficiently and effectively targeted in campaigns encouraging preparation. This research was structured using the Theory of Planned Behaviour (TPB) which proposes a specific set of cognitions that affect intention formation as well as beliefs which inform those cognitions. In addition to using this model to structure the investigation, this thesis undertook several refinements and extensions to the model to address inconsistencies within TPB research. The intent of doing so was to provide a set of findings and a questionnaire which are not limited by those inconsistencies and which can be adapted for a range of behavioural contexts. Four empirical studies were carried out, involving a total of 2,298 participants from the general population. Study 1 tested the applicability of this theory to the context of natural disaster preparation and clarified the nature of that context. Using an online survey of 722 residents of the urban Wellington region, Study 1 demonstrated low levels of preparation, identified not “getting around to it” as a main barrier to preparation, and supported a more extensive application of the TPB with the factors explaining approximately 16% of the variance in intentions. Study 2 tested a full TPB questionnaire including both the two-factor distinction (splitting attitudes into instrumental and experiential, norms in descriptive and injunctive, and perceived behaviour control into controllability and self-efficacy) and belief components which are proposed to precede attitudes, norms, and control. This study used an online sample of 603 Wellington residents. All the cognitions within the theory except perceived descriptive norms were significantly associated with either past behaviour or intentions to prepare, explaining approximately 47% of the variance in intentions. This study also included an experimental framing manipulation, demonstrating benefits of referring to “natural hazard” preparation rather than “natural disaster” preparation. Study 3 concluded the development of the TPB questionnaire by assessing intentions, cognitions, and beliefs at one point in time and behaviour one month later to allow for stronger inferences about causality, with a sample of 61 participants across both time points. This study used a different recruitment method than the previous studies: posted survey invites using addresses randomly selected from the electoral roll. Although this method did not produce a more demographically representative sample than the recruitment method used in Studies 1 and 2 as intended, Study 3 reproduced the findings of the “natural hazard” condition in Study 2. Finally, this study identified several key beliefs related to preparing such as the belief that preparing helps people to get through a natural hazard event better, that people can make the effort to prepare, and that preparing can be fun and rewarding. These beliefs offer specific and tangible factors which can be efficiently addressed in public education campaigns. An intervention run previously by the New Zealand National Emergency Agency, the ShakeOut earthquake drill, was retrospectively evaluated in Study 4 by comparing those who did and those who did not participate (N = 480) using the TPB framework. Those who participated in the drill demonstrated better knowledge and use of the protective actions that are the focus of the drill than those who did not participate. Although this intervention was not informed by the findings of the previous studies, drill participants also demonstrated more positive scores for the TPB cognitions and intentions compared to non-participants, although more of the variance in intentions was explained for the latter (approximately 41%) than the former (approximately 31%). Overall, findings from the empirical studies support the recommendation for consistent inclusion of all tested refinements to the Theory of Planned Behaviour (i.e., the two-factor distinction, the inclusion of belief measures, and careful development of behavioural measures). This thesis represents a uniquely thorough test of the Theory of Planned Behaviour to natural hazard preparation with important implications for both the contextual value of the theory and how the theory is applied in research broadly. The research also supports previous findings of the importance of instrumental attitudes and self-efficacy for natural hazard preparation and contributed the novel factor of experiential attitudes as well as identifying new, specific beliefs to target in public education campaigns. These contributions to our understanding of why people prepare for natural hazards can be used to encourage more people in Wellington, in New Zealand, and globally to be more prepared.</p>

Why do people prepare for natural hazards? An application of the Theory of Planned Behaviour to household preparation

<p>Natural hazards impact millions of people globally and lead to billions of dollars of economic loss each year. New Zealand is one of many countries vulnerable to multiple natural hazards including earthquakes, tsunami, volcanic eruption, and high impact weather. Despite these well-known risks, many residents of the capital city of Wellington have taken few steps to be more prepared. This location, therefore, presented an appropriate population for the investigations within this thesis. Decades of social science research has identified a multitude of factors related to preparation behaviour. However, many of these factors, such as risk perception and previous experience of natural hazards, are difficult to manipulate successfully in broad public education campaigns. The first main aim of this thesis was therefore to identify thoughts and beliefs about preparing which predict people’s preparation behaviour, with the aim of identifying specific factors which can be efficiently and effectively targeted in campaigns encouraging preparation. This research was structured using the Theory of Planned Behaviour (TPB) which proposes a specific set of cognitions that affect intention formation as well as beliefs which inform those cognitions. In addition to using this model to structure the investigation, this thesis undertook several refinements and extensions to the model to address inconsistencies within TPB research. The intent of doing so was to provide a set of findings and a questionnaire which are not limited by those inconsistencies and which can be adapted for a range of behavioural contexts. Four empirical studies were carried out, involving a total of 2,298 participants from the general population. Study 1 tested the applicability of this theory to the context of natural disaster preparation and clarified the nature of that context. Using an online survey of 722 residents of the urban Wellington region, Study 1 demonstrated low levels of preparation, identified not “getting around to it” as a main barrier to preparation, and supported a more extensive application of the TPB with the factors explaining approximately 16% of the variance in intentions. Study 2 tested a full TPB questionnaire including both the two-factor distinction (splitting attitudes into instrumental and experiential, norms in descriptive and injunctive, and perceived behaviour control into controllability and self-efficacy) and belief components which are proposed to precede attitudes, norms, and control. This study used an online sample of 603 Wellington residents. All the cognitions within the theory except perceived descriptive norms were significantly associated with either past behaviour or intentions to prepare, explaining approximately 47% of the variance in intentions. This study also included an experimental framing manipulation, demonstrating benefits of referring to “natural hazard” preparation rather than “natural disaster” preparation. Study 3 concluded the development of the TPB questionnaire by assessing intentions, cognitions, and beliefs at one point in time and behaviour one month later to allow for stronger inferences about causality, with a sample of 61 participants across both time points. This study used a different recruitment method than the previous studies: posted survey invites using addresses randomly selected from the electoral roll. Although this method did not produce a more demographically representative sample than the recruitment method used in Studies 1 and 2 as intended, Study 3 reproduced the findings of the “natural hazard” condition in Study 2. Finally, this study identified several key beliefs related to preparing such as the belief that preparing helps people to get through a natural hazard event better, that people can make the effort to prepare, and that preparing can be fun and rewarding. These beliefs offer specific and tangible factors which can be efficiently addressed in public education campaigns. An intervention run previously by the New Zealand National Emergency Agency, the ShakeOut earthquake drill, was retrospectively evaluated in Study 4 by comparing those who did and those who did not participate (N = 480) using the TPB framework. Those who participated in the drill demonstrated better knowledge and use of the protective actions that are the focus of the drill than those who did not participate. Although this intervention was not informed by the findings of the previous studies, drill participants also demonstrated more positive scores for the TPB cognitions and intentions compared to non-participants, although more of the variance in intentions was explained for the latter (approximately 41%) than the former (approximately 31%). Overall, findings from the empirical studies support the recommendation for consistent inclusion of all tested refinements to the Theory of Planned Behaviour (i.e., the two-factor distinction, the inclusion of belief measures, and careful development of behavioural measures). This thesis represents a uniquely thorough test of the Theory of Planned Behaviour to natural hazard preparation with important implications for both the contextual value of the theory and how the theory is applied in research broadly. The research also supports previous findings of the importance of instrumental attitudes and self-efficacy for natural hazard preparation and contributed the novel factor of experiential attitudes as well as identifying new, specific beliefs to target in public education campaigns. These contributions to our understanding of why people prepare for natural hazards can be used to encourage more people in Wellington, in New Zealand, and globally to be more prepared.</p>

Post-Traumatic Growth Experiences among COVID-19 Confirmed Cases in China: A Qualitative Study

COVID-19 infection can cause psychological distress and profoundly impact patients’ lives, but it can also lead to positive changes and post-traumatic growth (PTG), or positive psychological change in response to challenging life circumstances. Current research on the influence of COVID-19 infection has mainly focused on its negative effects. Therefore, the aim of this study was to investigate whether patients with COVID-19 in China experienced PTG and, if so, what changed for them during the process of PTG. We used a qualitative descriptive approach to conduct this study. Using the purposive sampling recruitment method, patients with a confirmed COVID-19 diagnosis were recruited from a COVID-19 designated hospital in Shanghai, China, from April to July 2020. Data were collected using semi-structured, in-depth interviews conducted via cell phone or in person while social distancing to prevent the spread of COVID-19. Forty confirmed COVID-19 patients (19–68 years old) were recruited. Several prominent themes and subthemes were extracted from the interview responses regarding participants’ experiences of PTG. The following are among the positive changesthat occurred for these participants after their diagnosis of COVID-19: (1) Reevaluation of their life priorities, which included a greater appreciation of being alive and re-evaluating their values and goals, (2) Improved relationships within their social circles, which included establishing or maintaining closer relationships with family and friends and a greater willingness to help others, and (3) Perceived changes regarding themselves, which included personal growth and increased awareness of the importance of their health. The study identified potential positive impacts of COVID-19 on patients, which could be helpful in the implementation of interventions to facilitate PTG among COVID-19 survivors.

Engaging citizens in sustainability research: comparing survey recruitment and responses between Facebook, Twitter and qualtrics

PurposeThe study aims to compare survey recruitment rates between Facebook, Twitter and Qualtrics and to assess the impact of recruitment method on estimates of energy content, food safety, carbon footprint and animal welfare across 29 foods.Design/methodology/approachTwo versions of an online survey were developed on the citizen science platform, Zooniverse. The surveys explored citizen estimations of energy density (kcal) or carbon footprint (Co2) and food safety or animal welfare of 29 commonly eaten foods. Survey recruitment was conducted via paid promotions on Twitter and Facebook and via paid respondent invites on Qualtrics. The study included approximately 500 participants (Facebook, N˜11 (ratings 358), Twitter, N˜85 (ratings 2,184), Qualtrics, N = 398 (ratings 11,910)). Kruskal–Wallis and Chi-square analyses compared citizen estimations with validated values and assessed the impact of the variables on estimations.FindingsCitizens were unable to accurately estimate carbon footprint and energy content, with most citizens overestimating values. Citizen estimates were most accurate for meat products. Qualtrics was the most successful recruitment method for the online survey. Citizen estimates between platforms were significantly different, suggesting that Facebook and Twitter may not be suitable recruitment methods for citizen online surveys.Practical implicationsQualtrics was the favourable platform for survey recruitment. However, estimates across all recruitment platforms were poor. As paid recruitment methods such as Qualtrics are costly, the authors recommend continued examination of the social media environment to develop appropriate, affordable and timely online recruitment strategies for citizen science.Originality/valueThe findings indicate that citizens are unable to accurately estimate the carbon footprint and energy content of foods suggesting a focus on consumer education is needed to enable consumers to move towards more sustainable and healthy diets. Essential if we are to meet the 2030 Sustainable Development Goals of zero hunger, good health and wellbeing and responsible consumption and production. The study highlights the utility of Zooniverse for assessing citizen estimates of carbon footprint, energy content, animal welfare and safety of foods.

The Food, Feelings, and Family Study: comparison of the efficacy of traditional methods, social media, and broadcast email to recruit pregnant women to an observational, longitudinal nutrition study

Background It is well known that recruitment is a challenging aspect of any study involving human subjects. This challenge is exacerbated when the population sought is reticent to participate in research as is the case with pregnant women and individuals with depression. This paper compares recruitment methods used for the Food, Feelings, and Family Study, an observational, longitudinal pilot study concerning how diet and bisphenol A exposure affect maternal mood and cognitive function during and after pregnancy. Methods Pregnant women were recruited to this study over a period of 15 months using traditional methods, social media including paid and unpaid posts, and emails broadcast to the university community. Contingency analysis using the Pearson’s Chi-square test was used to determine if recruitment method was associated with likelihood of participation. T-tests were used to analyze Facebook advertisement success. ANOVAs and Fisher exact tests were used to determine if recruitment method was related to continuous and categorical demographics, respectively. Results Social media resulted in the largest number of recruits, followed by traditional methods and broadcast email. Women recruited through social media were less likely to participate. In contrast, use of broadcast email resulted in a smaller pool of recruits but these recruits were more likely to be eligible for and complete the study. Most women recruited via social media were the result of unpaid posts to the study’s Facebook page. Paid posts lasting at least 4 days were the most successful. Recruitment method was not associated with participant demographics. Conclusions Social media has the potential to recruit a large pool of potential subjects; however, when studies require a large time investment such as the case here, women recruited through social media are less likely to participate and complete the study than women recruited through other means. Trial registration N/A. This study does not describe a health care intervention.

The Effectiveness of E-Recruitment Method Through Social Media (Case Study at Pt Es Teh Tndonesia Makmur - West Java)

Several companies have reduced mass recovery efforts and in-person discussions for the Covid-19 pandemic password, one of which is PT Es Teh Indonesia Makmur. This study aims to: (1) Know the media for posting jobs and the application of the recruitment process through social media, including the stages and qualifications and competencies required at PT Es Teh Indonesia Makmur (2) Knowing the effectiveness of recruitment methods through social media to reduce the impact of the Covid-19 pandemic era and explains the comparison of the E-Recruitment method with the offline recruitment method at PT Es Teh Indonesia Makmur. The effectiveness of the Recruitment Method through social media by studying library data and observations shows that the electronic recruitment system for the workforce is suitable to be used to facilitate and improve human resource management in the Covid-19 Pandemic era. An increase in competent job applicants supports this, and PT Es Teh Indonesia Makmur is known to all circles to open job vacancies for more than 150 outlets in less than one year.

The Food, Feelings, and Family Study: Comparison of the efficacy of traditional methods, social media, and broadcast email to recruit pregnant women to an observational, longitudinal nutrition study.

Background: It is well known that recruitment is a challenging aspect of any study involving human subjects. This challenge is exacerbated when the population sought is reticent to participate in research as is the case with pregnant women and individuals with depression. This paper compares recruitment methods used for the Food, Feelings, and Family Study, an observational, longitudinal study concerning how diet and bisphenol A exposure affect maternal mood and cognitive function during and after pregnancy.Methods: Pregnant women were recruited to this study using traditional methods, social media including paid and unpaid posts, and emails broadcast to the university community. Contingency analysis using the Pearson’s Chi-square test was used to determine if recruitment method was associated with likelihood of participation. T-tests were used to analyze Facebook advertisement success. ANOVAs and contingency analysis using the maximum likelihood ratio Chi-square test were used to determine if recruitment method was related to continuous and categorical demographics, respectively.Results: Social media resulted in the largest number of recruits, followed by traditional methods and broadcast email. Women recruited through social media were less likely to participate, in part, because they were less likely to meet eligibility criteria. In contrast, use of broadcast email resulted in a smaller pool of recruits but these recruits were more likely to be eligible for and complete the study. Most women recruited via social media were the result of unpaid posts to the study’s Facebook page. Paid posts lasting at least 4 days were the most successful. Recruitment method was not associated with participant demographics.Conclusions: Social media has the potential to recruit a large pool of potential subjects; however, when studies require a large time investment such as the case here, women recruited through social media are less likely to participate and complete the study than women recruited through other means.Trial registration: N/A. This study does not describe a health care intervention.

Recruitment of Older African Americans in Alzheimers Disease Clinical Trials Using A Community Based Research Approach

African Americans are disproportionally affected by Alzheimers disease and related dementia (ADRD) and are two times more likely to develop ADRD compared to their White counterparts. Despite the higher prevalence of ADRD among older African Americans, less than 5% of African Americans participate in clinical research trials. Purpose: The purpose of the study was to explore how a culturally tailored community-based recruitment method impacts 1) enrollment in ADRD research studies among older African Americans in the Midwest and 2) ADRD knowledge and perception of clinical trials. Methods: Using a community-engaged research approach, we collaborated with two predominately African American serving organizations to support the content development and the delivery of Aging With Grace (AWG); a culturally tailored dementia educational curriculum. Results: A total of five AWG presentations were presented to 66 attendees. Most attendees (67%) expressed interest in participating in clinical trials after attending AWG, 18.2% of attendees enrolled in an observational clinical research study and 4.5% enrolled in a lifestyle prevention clinical trial within 5 months of the AWG presentation. Attendees (32%) also perceived an increase in ADRD knowledge from attending AWG and 89.1% believed more African Americans should participate in research. Conclusion: The study has demonstrated the effectiveness of a community-based recruitment method using AWG to enhance knowledge, clinical trial interest, and recruitment into observational and lifestyle ADRD clinical trials among older African Americans. Future studies should assess long-term efficacy of this AWG community-based recruitment method among other underrepresented minority populations.