The mental health of staff working on Intensive Care Units over the COVID-19 winter surge of 2020 in England: a cross sectional survey.

Background: The COVID-19 pandemic generated a surge of critically ill patients greater than the NHS capacity. Additionally there have been multiple well-documented impacts associated with the national COVID-19 pandemic surge on ICU workers including an increased prevalence of mental health disorders on a scale potentially sufficient to impair high-quality care delivery. Aim: To identify prevalence of probable mental health disorders, functional impairment and establish demographic and professional predictors of probable mental health disorders, and functional impairment, in ICU staff between November 2020 to April 2021. Methods: English ICU staff were surveyed before, during and after the winter 2020/2021 surge using a survey which comprised of validated measures of mental health. Results: 6080 surveys were completed, by nurses (57.5%), doctors (27.9%), and other healthcare staff (14.5%). Reporting probable mental health disorders increased from 51% (prior to), to 64% (during) and then dropped to 46% (after) the peak. Younger, less experienced and nursing staff were most likely to report probable mental health disorders. Additionally, during and after the winter, over 50% of participants met threshold criteria for functional impairment. Staff who reported probable post-traumatic stress disorder, anxiety or depression were more likely to meet threshold criteria for functional impairment. Conclusions: The winter of 2020/2021 was associated with an increase in poor mental health outcomes and functional impairment during a period of peak caseload. These effects are likely to impact on patient care outcomes and the longer-term resilience of the healthcare workforce.

Ionospheric Disturbances Observed Following the Ridgecrest Earthquake of 4 July 2019 in California, USA

Earthquakes are known to generate disturbances in the ionosphere. Such disturbances, referred to as co-seismic ionospheric disturbances, or ionoquakes, were previously reported for large earthquakes with magnitudes Mw≥ 6.6. This paper reports ionoquakes associated with the Ridgecrest earthquakes of magnitude (Mw=6.4), that occurred on 4 July 2019 in California, USA. The ionoquakes manifested in total electron content (TEC) in the form of traveling ionospheric disturbances (TIDs) within 1 h from the mainshock onset. These seismic-origin TIDs have unique wave characteristics that distinguish them from TIDs of non-seismic origin arising from a moderate geomagnetic activity on the same day. Moreover, in the space-time domain of the detection of seismic-origin TIDs, TIDs are absent on the day before and day after the earthquake day. Their spectral characteristics relate them to the Earth’s normal modes and atmospheric resonance modes. We found the ground velocity associated with the mainshock, rather than the ground displacement, satisfies the threshold criteria for detectable ionoquakes in TEC measurements. Numerical simulation suggested that the coupled seismo–atmosphere–ionosphere (SAI) dynamics energized by the atmospheric waves are responsible for the generation of ionoquakes. This study’s findings demonstrate the potential of using TEC measurement to detect the ionospheric counterparts of moderate earthquakes.

Development of the Choices 5-Level Criteria to Support Multiple Food System Actions

In 2008, the Choices International Foundation developed its logo criteria, identifying best-in-class food products. More advanced, global and graded nutrient profiling systems (NPSs) are needed to substantiate different national nutrition policies. The objective of this work was to extend Choices NPS to identify five levels of the healthiness of food products, so that the Choices NPS can also be used to support other nutrition policies, next to front-of-pack labelling. Based on the same principles as the previous logo criteria, four sets of threshold criteria were determined using a combination of compliance levels, calculated from a large international food group-specific database, the Choices logo criteria, and WHO-NPSs developed to restrict marketing to children. Validation consisted of a comparison with indicator foods from food-based dietary guidelines from various countries. Some thresholds were adjusted after the validation, e.g., because intermediate thresholds were too lenient. This resulted in a new international NPS that can be applied to different contexts and to support a variety of health policies, to prevent both undernutrition and obesity. It can efficiently evaluate mixed food products and represents a flexible tool, applicable in various settings and populations.

Validation of Performance-Based Specifications for Surface Asphalt Mixtures in Virginia

The Virginia Department of Transportation (VDOT), like many owner agencies, is interested in ways to facilitate the increased durability of asphalt mixes in an effort to make its roadway network more sustainable, longer lasting, and more economical. The balanced mix design (BMD) method proposes to address this through the incorporation of performance criteria into mix design and acceptance. VDOT has committed to the implementation of the BMD method in an effort to improve asphalt mix performance. The purpose of this study was to continue advancing efforts toward implementation of BMD through the evaluation of 13 asphalt mixes using performance-indicating laboratory tests, validation of the initial performance tests selected for BMD use, and validation of the initial test threshold criteria. Based on the results, the asphalt pavement analyzer (APA) rut test, indirect tensile cracking test (IDT-CT), and Cantabro test were found suitable for continued use in BMD. The current threshold criteria for all three tests were found reasonable based on additional mix testing. The study recommends that APA rut test and IDT-CT results should be compared and correlated to fundamental rutting and cracking tests, respectively, as well as to performance predictions obtained from mechanistic-empirical pavement design simulations, and to field performance for full assurance that test threshold values are appropriate. It was further recommended to evaluate the Cantabro, IDT-CT, and APA rut tests to determine acceptable variability and establish precision statements.

Initialization of Thermal Models in Cold and Warm Permafrost

Equilibrium modelling, also known as spin-up, is a technique for initializing a stable thermal regime in ground temperature models for permafrost regions. The results act as a baseline for subsequent transient analyses of ground temperature response to climate change or infrastructure. In practice, spin-up procedures are often loosely described or neglected, and the criteria by which a stable thermal regime is evaluated are rarely defined or presented explicitly. In this paper, model results show that no single criterion based on thresholds of inter-cycle temperature change can be used to identify a stable thermal regime in all spin-up scenarios. Results from simulations using a wide range of initialization temperatures and conditions show the number of spin-up cycles can range between 10 to 10,000, and a spin-up criterion as fine as 0.00001 ^oC/cycle is required to achieve a stable thermal regime suitable for deeper warm permafrost models. The implications of selected threshold criteria are examined in follow-up transient analyses and show that warm permafrost models can be highly sensitive to initial temperature profiles based on the criterion utilized. The results alert scientists and engineers to the importance of initialization on site-specific and regional permafrost models for transient ground temperature analyses.

Multiple anthelmintic resistance at a goat farm in Slovakia

Summary Cases of parasite resistance to the main classes of anthelmintics are increasingly reported from small ruminants at farms in Europe. We visited a goat farm in Slovakia in November 2019 with suspected parasite problems that reduced productivity and performed an in vivo faecal egg count reduction test (FECRT) and an in vitro larval development test (LDT) for all three main classes of anthelmintics. The lowest efficacy (60 %) detected by FECRT was for ivermectin (IVM). Benzimidazole (BZ) efficacy ranged between 80.3 and 86.5 %, and levamisole (LEV) efficacy was 94 %. The results from the in vivo FECRT test were confirmed by the in vitro LDT. Minimum inhibitory concentration (MIC) 173.6 ng/ml for IVM several times exceeded the recommended threshold of 21.6 ng/ml. Mean LD50 for BZ was equal to the threshold concentration, but the other threshold criteria indicated a low level of resistance in the population. The LDT did not indicate the presence of resistance only for LEV. The MIC 1.0 μg/ml for LEV was evaluated as susceptible with respect to species composition. Teladorsagia was the dominant genus after treatment with BZ, IVM, and LEV. Haemonchus contortus was identifi ed after treatment with BZ and LEV.

18. Care and Supervision

The Children Act 1989 places considerable importance on local authorities working in partnership with families and the avoidance wherever possible of court proceedings. However, the Act also makes provision, in the form of care and supervision orders, for compulsory measures to be taken to safeguard and promote children’s welfare. This chapter focuses on care and supervision orders. It covers the initiation of proceedings; the threshold criteria, which refers to conditions set out by s 31(2) that must be satisfied before a care or supervision order may be made; the ‘welfare stage’, where the court must, pursuant to s 1(1), regard the welfare of the child as the paramount consideration; tackling delay in care proceedings; court orders; appeals; and discharge of care orders and discharge and variation of supervision orders. The chapter ends by discussing the position of children in local authority care, focusing on the critical issue of contact with children in care.

Physician burnout and professional satisfaction in orthopedic surgeons during the COVID-19 Pandemic

BACKGROUND: Burnout and professional satisfaction is an often an overlooked component for healthcare outcomes; the COVID-19 pandemic represents an unprecedented stressor that could contribute to higher levels of burnout. OBJECTIVES: Our primary objective was to evaluate the association of a battery of fulfillment, job satisfaction change, COVID-19 concerns, and coping measures. Our secondary objective was to determine whether the fulfillment and coping measures differed by gender and by experience levels among a battery of physician specialties. METHODS: The study was a purposive sample of convenience. Study participants included all trainees and attending orthopedic surgeons from our academic institution; all participants were invited to complete a survey built around a validated measure of professional fulfillment aimed at assessing response to acute change and stressors. We performed univariate statistics and a matrix correlational analysis to correlate different survey domains with variables of interest. RESULTS: The survey was sent electronically to 138 individuals; 63 surveys were completed (response rate = 45.7%). Twenty-seven (42.8%) individuals met the threshold criteria for fulfillment whereas 10 (15.9%) met the threshold for burnout. We found that surgeon perspectives on COVID-19 were not associated with burnout or professional fulfillment. Burnout was inversely associated with professional fulfillment (R = –0.35). Support seeking was noted to be correlated with professional fulfillment (R = 0.37). CONCLUSIONS: Stressors related to COVID-19 pandemic were not correlated with physician burnout and fulfillment. This held true even when stratifying by gender and by attending vs. trainee. Continued efforts should be implemented to protect against physician burnout and ensure professional fulfillment for Orthopedic surgeons.

Vector Phase Analysis Approach for Sleep Stage Classification: A Functional Near-Infrared Spectroscopy-Based Passive Brain–Computer Interface

A passive brain–computer interface (BCI) based upon functional near-infrared spectroscopy (fNIRS) brain signals is used for earlier detection of human drowsiness during driving tasks. This BCI modality acquired hemodynamic signals of 13 healthy subjects from the right dorsolateral prefrontal cortex (DPFC) of the brain. Drowsiness activity is recorded using a continuous-wave fNIRS system and eight channels over the right DPFC. During the experiment, sleep-deprived subjects drove a vehicle in a driving simulator while their cerebral oxygen regulation (CORE) state was continuously measured. Vector phase analysis (VPA) was used as a classifier to detect drowsiness state along with sleep stage-based threshold criteria. Extensive training and testing with various feature sets and classifiers are done to justify the adaptation of threshold criteria for any subject without requiring recalibration. Three statistical features (mean oxyhemoglobin, signal peak, and the sum of peaks) along with six VPA features (trajectory slopes of VPA indices) were used. The average accuracies for the five classifiers are 90.9% for discriminant analysis, 92.5% for support vector machines, 92.3% for nearest neighbors, 92.4% for both decision trees, and ensembles over all subjects’ data. Trajectory slopes of CORE vector magnitude and angle: m(|R|) and m(∠R) are the best-performing features, along with ensemble classifier with the highest accuracy of 95.3% and minimum computation time of 40 ms. The statistical significance of the results is validated with a p-value of less than 0.05. The proposed passive BCI scheme demonstrates a promising technique for online drowsiness detection using VPA along with sleep stage classification.

An ethics framework for consolidating and prioritizing COVID-19 clinical trials

Given the dearth of established safe and effective interventions to respond to COVID-19, there is an urgent ethical imperative to conduct meaningful clinical research. The good news is that interventions to be tested are not in short supply. Unfortunately, the human and material resources needed to conduct these trials are finite. It is essential that trials be robust and meet enrollment targets and that lower-quality studies not be permitted to displace higher-quality studies, delaying answers to critical questions. Yet, with few exceptions, existing research review bodies and processes are not designed to ensure these conditions are satisfied. To meet this challenge, we offer guidance for research institutions about how to ethically consolidate and prioritize COVID-19 clinical trials, while recognizing that consolidation and prioritization should also take place upstream (among manufacturers and funders) and at a higher level (e.g. nationally). In our proposed three-stage process, trials must first meet threshold criteria. Those that do are evaluated in a second stage to determine whether the institution has sufficient capacity to support all proposed trials. If it does not, the third stage entails evaluating studies against two additional sets of comparative prioritization criteria: those specific to the study and those that aim to advance diversification of an institution’s research portfolio. To implement these criteria fairly, we propose that research institutions form COVID-19 research prioritization committees. We briefly discuss some important attributes of these committees, drawing on the authors’ experiences at our respective institutions. Although we focus on clinical trials of COVID-19 therapeutics, our guidance should prove useful for other kinds of COVID-19 research, as well as non-pandemic research, which can raise similar challenges due to the scarcity of research resources.