Investigating Stigma During the Early Stages of a Pandemic Through the Lens of COVID-19

Background: Individuals face stigma associated with numerous health conditions. Stigma can arise rapidly during the early spread of a new disease, adding to the burden felt by those affected. COVID-19 can be used as an example to study stigma during the early phases of a pandemic. This narrative review is a descriptive analysis that tracks the ways in which COVID-19 stigma was discussed in the scholarly literature during the first year of the pandemic to understand how stigma was viewed in the context of a rapidly spreading pandemic. Methods: PubMed was used as a non-exhaustive sample of the literature. Searches for stigma and COVID-19 or SARS-CoV-2 were carried out in January 2021. To be included for review, articles had to be accessible in English, published on PubMed in 2019 or later, and focused on COVID-19/SARS-CoV-2, with at least a mention of stigma related to COVID-19. The included articles were then reviewed for chronological time, depth of emphasis on stigma, definition and interpretation of stigma, type of publication, and recommendations. Demographic features of the authors and studied populations were also tracked. Results: This review identified 321 articles on PubMed discussing stigma and COVID-19. Of these, 180 articles met inclusion criteria and were reviewed. The earliest publication included in the review was from April 2020. Authors from India, the USA, and China published the most articles related to COVID-19 and stigma. The most frequent forms of publication were cross-sectional studies, commentaries, and letters to the editor. In nearly half of the publications, stigma was one of several factors studied. All of the included publications described the negative impact stigma has on the community. Five major types of recommendations were noted: need for further research, dissemination of accurate health information, expansion of resources, policy and protocol changes, and community engagement. Conclusions: Stigma can have a profound impact on individuals affected by a disease, causing barriers to both treatment and attempts to stop disease spread. The stigma seen during the early days of COVID-19 provides useful information on pandemic-related stigma. The recommendations gleaned from this review can be helpful in the mitigation of disease-related stigma and used to slow the spread of stigma during the early stages of future pandemics

Developing an education and evaluation plan for teaching global health to primary care residents at the University of North Carolina

In the following pages, I outline a global health education program and evaluation plan to be used by primary care graduate medicine programs. U.S. residents are increasingly interested in learning global health concepts and participating in international clinical activities, and many residency programs are seeking to support these interests with a formalized curriculum. In the past, residents in primary care specialties at the University of North Carolina (UNC) have had access to few resources for helping them learn about global health or assist them in planning international electives. Currently, the Office of International Activities at UNC is expanding the existing global health curriculum to meet the needs of residents. As part of this process, I first discuss the models for teaching global health currently in use at other institutions. I then describe the framework in which the curriculum will function and applicable educational theories. Next, I define goals and objectives specific to a program plan suitable for primary care residents at UNC. Last, I outline implementation strategies and a detailed evaluation plan for this program.Master of Public Healt

Gaining a “Foothold” on the Diagnosis of Leishmaniasis

Pediatric refugees and immigrants may present with unusual diagnoses due to their extensive migration and potential harsh conditions in travel. Trauma and family separation add to the difficulty of obtaining a history of exposures. We report a case of one of the more commonly neglected tropical diseases, Leishmaniasis. A 15-year-old male refugee patient presented to the hospital with ulcerative lesions to his legs. His migration history was extensive, starting in Central Africa with travel to South America, followed by migration through Central America to Texas. The patient developed ulcerative lesions on his legs, and he was brought to the children’s hospital by his refugee organization, where the diagnosis was ultimately confirmed as Leishmaniasis. Providers should become familiar with tropical diseases that refugees, as well as local populations, may acquire from travel. Specifically, pediatricians should become familiar with the more prevalent “neglected” tropical diseases as recommended by the World Health Organization

Multidimensional signals and analytic flexibility: Estimating degrees of freedom in human speech analyses

Recent empirical studies have highlighted the large degree of analytic flexibility in data analysis which can lead to substantially different conclusions based on the same data set. Thus, researchers have expressed their concerns that these researcher degrees of freedom might facilitate bias and can lead to claims that do not stand the test of time. Even greater flexibility is to be expected in fields in which the primary data lend themselves to a variety of possible operationalizations. The multidimensional, temporally extended nature of speech constitutes an ideal testing ground for assessing the variability in analytic approaches, which derives not only from aspects of statistical modeling, but also from decisions regarding the quantification of the measured behavior. In the present study, we gave the same speech production data set to 46 teams of researchers and asked them to answer the same research question, resulting insubstantial variability in reported effect sizes and their interpretation. Using Bayesian meta-analytic tools, we further find little to no evidence that the observed variability can be explained by analysts’ prior beliefs, expertise or the perceived quality of their analyses. In light of this idiosyncratic variability, we recommend that researchers more transparently share details of their analysis, strengthen the link between theoretical construct and quantitative system and calibrate their (un)certainty in their conclusions

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Design and Testing of Lattice Structures for Noise Reduction

Jet engines generate significant amounts of noise and vibrations during normal operation. This noise can be potentially harmful to the efficiency of the aircraft, the health of passengers and crew, and the environment. To limit noise produced by a jet engine, aerospace engineers must design mechanisms to attenuate the vibration being transmitted from the engine to the body of the aircraft. One way to do this is through the utilization of lattice structures in the housing of the engine. Lattice structures have natural properties that make them capable of absorbing a wide range of vibrational frequencies. They can be designed with computer-aided design (CAD) software, modified to produce relevant bandgaps, and produced using additive manufacturing methods. The nature of lattice structures makes them a particularly promising area of study for aircraft noise reduction. This paper explores the use of lattice structures for vibration reduction. Lattice structure designs for vibrational attenuation in jet engines were tested experimentally and with simulation and are presented in this paper. Substitution of individual cells with ferromagnetic materials was also explored, with the testing also incorporating magnetic fields, changing the response characteristics of the lattice

Design and operation of energy systems with large amounts of variable generation:Final summary report, IEA Wind TCP Task 25

ABSTRACT: This report summarises findings on wind integration from the 17 countries or sponsors participating in the International Energy Agency Wind Technology Collaboration Programme (IEA Wind TCP) Task 25 from 2006–2020. Both real experience and studies are reported. Many wind integration studies incorporate solar energy, and most of the results discussed here are valid for other variable renewables in addition to wind. The national case studies address several impacts of wind power on electric power systems. In this report, they are grouped under long-term planning issues and short-term operational impacts. Long-term planning issues include grid planning and capacity adequacy. Short-term operational impacts include reliability, stability, reserves, and maximising the value of wind in operational timescales (balancing related issues). The first section presents the variability and uncertainty of power system-wide wind power, and the last section presents recent studies toward 100% shares of renewables. The appendix provides a summary of ongoing research in the national projects contributing to Task 25 for 2021–2024. The design and operation of power and energy systems is an evolving field. As ambitious targets toward net-zero carbon energy systems are announced globally, many scenarios are being made regarding how to reach these future decarbonized energy systems, most of them involving large amounts of variable renewables, mainly wind and solar energy. The secure operation of power systems is increasingly challenging, and the impacts of variable renewables, new electrification loads together with increased distribution system resources will lead to somewhat different challenges for different systems. Tools and methods to study future power and energy systems also need to evolve, and both short term operational aspects (such as power system stability) and long-term aspects (such as resource adequacy) will probably see new paradigms of operation and design. The experience of operating and planning systems with large amounts of variable generation is accumulating, and research to tackle the challenges of inverter-based, nonsynchronous generation is on the way. Energy transition and digitalization also bring new flexibility opportunities, both short and long term.info:eu-repo/semantics/publishedVersio

A Multisite Preregistered Paradigmatic Test of the Ego-Depletion Effect

We conducted a preregistered multilaboratory project (k = 36; N = 3,531) to assess the size and robustness of ego-depletion effects using a novel replication method, termed the paradigmatic replication approach. Each laboratory implemented one of two procedures that was intended to manipulate self-control and tested performance on a subsequent measure of self-control. Confirmatory tests found a nonsignificant result (d = 0.06). Confirmatory Bayesian meta-analyses using an informed-prior hypothesis (delta = 0.30, SD = 0.15) found that the data were 4 times more likely under the null than the alternative hypothesis. Hence, preregistered analyses did not find evidence for a depletion effect. Exploratory analyses on the full sample (i.e., ignoring exclusion criteria) found a statistically significant effect (d = 0.08); Bayesian analyses showed that the data were about equally likely under the null and informed-prior hypotheses. Exploratory moderator tests suggested that the depletion effect was larger for participants who reported more fatigue but was not moderated by trait self-control, willpower beliefs, or action orientation