Transforming Leaders Into Stewards Of Teaching Excellence: Building And Sustaining An Academic Culture Through Leadership Immersion

Nursing must transform education and practice to meet the changing healthcare environment; yet, steps to desired change remain unknown. Academic leaders are well-positioned to initiate change and transform the academic landscape. However, many advance to leadership positions with minimal orientation to the role. Moreover, leaders in academic nursing often have expertise as clinicians and administrators, and not as academics. It is incumbent on nurse leaders to acquire needed competencies to fulfill the academic role. The purpose of this quality improvement project was to immerse leaders in an exploration of steps to initiate and sustain change in the teaching and learning process. Self-reported low- and high-level outcomes were analyzed using Kirkpatrick’s Model (1994) to evaluate the effectiveness of the immersion in preparing leaders to build and sustain a quality academic culture. Leadership immersions were implemented to transform leaders into stewards of teaching excellence. Pre- and post-immersion surveys captured data across three levels: satisfaction, knowledge and skill acquisition, and change in behavior. Seventy-three participants were evaluated. Participants for inclusion in the three-month analysis culminated in a 41% response rate. Findings were analyzed using ANOVA and t-tests. Further analysis was performed using Cohen’s d to determine effect size. Three-month follow-up surveys revealed no significant effect change (p<0.05). Results suggest immersion is effective in preparing leaders of academic nursing to build a quality academic culture. Through immersion, leaders established a collective vision of teaching excellence and proficiency in confronting and resolving actual and desired teaching practices, while enriching the life and work of faculty

Characterizing Bushfire Occurrences over Jamaica Using the MODIS C6 Fire Archive 2001–2019

There is an increasing need to develop bushfire monitoring and early warning systems for Jamaica and the Caribbean. However, there are few studies that examine fire variability for the region. In this study the MODIS C6 Fire Archive for 2001–2019 is used to characterize bushfire frequencies across Jamaica and to relate the variability to large-scale climate. Using additive mixed model and backward linear regression, the MODIS represents 80% and 73% of the local Jamaica Fire Brigade (JFB) data variability for 2010–2015, respectively. However, the MODIS values are smaller by a factor of approximately 30. The MODIS climatology over Jamaica reveals a primary peak in March and a secondary maximum in July, coinciding with months of minimum rainfall. A significant positive linear trend is observed for July-August bushfire events over 2001–2019 and represents 29% of the season’s variability. Trends in all-island totals in other seasons or annually were not statistically significant. However, positive annual trends in Zone 2 (eastern Jamaica) are statistically significant and may support an indication that a drying trend is evolving over the east. Significant 5-year and 3.5-year periodicities are also evident for April–June and September–November variability, respectively. Southern Jamaica and particularly the parish of Clarendon, known for its climatological dryness, show the greatest fire frequencies. The study provides evidence of linkages between fire occurrences over Jamaica and oceanic and atmospheric variability over the Atlantic and Pacific. For example, all-island totals show relatively strong association with the Atlantic Multidecadal Oscillation. The study suggests that development of an early warning system for bushfire frequency that includes climate indices is possible and shows strong potential for fire predictions

Are We Getting It Right? A Scoping Review of Outcomes Reported in Cell Therapy Clinical Studies for Cerebral Palsy

Cell therapies are an emergent treatment for cerebral palsy (CP) with promising evidence demonstrating efficacy for improving gross motor function. However, families value improvements in a range of domains following intervention and the non-motor symptoms, comorbidities and complications of CP can potentially be targeted by cell therapies. We conducted a scoping review to describe all outcomes that have been reported in cell therapy studies for CP to date, and to examine what instruments were used to capture these. Through a systematic search we identified 54 studies comprising 2066 participants that were treated with a range of cell therapy interventions. We categorized the reported 53 unique outcome instruments and additional descriptive measures into 10 categories and 12 sub-categories. Movement and Posture was the most frequently reported outcome category, followed by Safety, however Quality of Life, and various prevalent comorbidities and complications of CP were infrequently reported. Notably, many outcome instruments used do not have evaluative properties and thus are not suitable for measuring change following intervention. We provide a number of recommendations to ensure that future trials generate high-quality outcome data that is aligned with the priorities of the CP community

Risk of COVID-19 after natural infection or vaccinationResearch in context

Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health

Risk of COVID-19 after natural infection or vaccinationResearch in context

Summary: Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally