A Project Proposal: The Effects of Standard Protocols during CPR on Hospital-Acquired Infections of Post-Open-Heart Surgery Patients in the CVICU

Abstract A Project Proposal: The Effects of Standard Protocols during CPR on Hospital-Acquired Infections of Post-Open-Heart Surgery Patients in the CVICU Background: Hospital-acquired infections (HAIs) are one of the most common complications post-cardiac surgeries and are associated with longer hospitalizations, elevated use of healthcare resources, and increased morbidity and mortality. The effects of HAIs after cardio-pulmonary resuscitation (CPR) in recent post-open-heart surgery patients remains largely unexplored. Therefore, the purpose of this project was to determine, in the CVICU does implementing standard protocols during CPR on recent post-open-heart surgery patients reduce HAIs? Literature Review: HAIs during CPR can be acquired through airborne, contact, droplet, or hematogenous transmission. Therefore, adherence to standard protocols of aseptic technique is one of the most important infection prevention competencies for protecting patients from HAIs. Patients in the CVICU are considered at higher risk of colonization and infection with multi-drug resistant (MDR) pathogens because of healthcare exposure, mechanical circulatory support (MCS), mechanical ventilation, central venous catheters (CVCs), and frequent use of antibiotics. Methods: Quality improvement measures for reducing HAIs in post-open-heart surgery patients include: pre-operative screening for nasal carriage of staphylococcus aureus and subsequent carriers, strict hand hygiene with an alcohol-based hand sanitizer or soap and water before and after any patient contact, gown and glove contact precautions when changing a patient dressing, routine daily bathing with chlorhexidine, and proper disinfection and cleaning of environment and equipment. Evaluation: To indicate if this EBP project was successful, surveys and metrics would be utilized to measure how many infections were on the CVICU unit after standard protocols were implemented. Keywords: Post-open-heart surgery, hospital-acquired infections, CPR, Cardiovascular intensive care uni

A Systematic Review: The Effect of Social Support on Emotional Burden of Alzheimer’s Caregivers

Background: Alzheimer’s disease is a degenerative form of dementia that affects not only patients but also their caregivers. Various social support interventions have been shown to benefit caregivers by decreasing stress, depression, anxiety, and other physical and psychological issues. Objective: The purpose of the systematic review was to determine the effect of social support on emotional burden for caregivers of patients with Alzheimer’s disease. Methods: Research was conducted using the databases PubMed and CINAHL to identify eligible studies. Specific inclusion and exclusion criteria were used when screening studies. After evaluation and assessment of the studies, a total of eight articles (randomized control trials, cross-sectional and longitudinal studies, and mixed method studies) were included in the final systematic review. Results: Social support and emotional burden were measured using various social support mechanisms (CBI, CCSM, IADCQ, PAC, REACH, SSRS) and anxiety and depression scales (CES-D, SAS, SDS). Results demonstrated that the majority of studies demonstrated a significant decrease in caregiver depression and burden after implementation of various social support interventions, such as social support groups and customized educational sessions. Conclusion: Overall, this systematic review demonstrated that social support interventions may decrease depression and emotional burden for caregivers of patients with Alzheimer\u27s disease. Keywords: Alzheimer’s disease, caregiver burden, social suppor

Autistic College Students and COVID-19: Anxiety, Support Needs and Responses by Specialized Programs

Providing resources and support to college students during the COVID-19 global pandemic has produced unique challenges for all students, particularly those with autism. In March 2020, halfway through the spring term, the COVID-19 global pandemic forced most institutions of higher education across the country to move all instruction and support to an online, remote format, including those for students with autism. Colleges and autism support programs are now grappling with how to effectively support students amid a global pandemic. Yet there is little information available about how students’ needs have changed with this new environment. In this exploratory study, 76 college students with autism from across the country answered a series of questions (both Likert scale and open-ended) about their anxieties related to COVID-19 and attending college. The data were analyzed using descriptive statistics and thematic analysis. Results revealed that students are most anxious about getting sick or spreading COVID-19 to others and least anxious about wearing masks and needing to socially distance. This paper also profiles the adjustments made to several college autism support programs (led by the authors) in order to accommodate the changes to college campuses and the impact on student needs. The survey results and recent experiences across programs will inform recommendations for colleges as they build toward more inclusive, supportive campus environments and respond to crises like the pandemic

Exposure of U.S. National Parks to land use and climate change 1900-2100

Many protected areas may not be adequately safeguarding biodiversity from human activities on surrounding lands and global change. The magnitude of such change agents and the sensitivity of ecosystems to these agents vary among protected areas. Thus, there is a need to assess vulnerability across networks of protected areas to determine those most at risk and to lay the basis for developing effective adaptation strategies. We conducted an assessment of exposure of U.S. National Parks to climate and land use change and consequences for vegetation communities. We first defined park protected-area centered ecosystems (PACEs) based on ecological principles. We then drew on existing land use, invasive species, climate, and biome data sets and models to quantify exposure of PACEs from 1900 through 2100. Most PACEs experienced substantial change over the 20th century (.740% average increase in housing density since 1940, 13% of vascular plants are presently nonnative, temperature increase of 18C/100 yr since 1895 in 80% of PACEs), and projections suggest that many of these trends will continue at similar or increasingly greater rates (255% increase in housing density by 2100, temperature increase of 2.58–4.58C/100 yr, 30% of PACE areas may lose their current biomes by 2030). In the coming century, housing densities are projected to increase in PACEs at about 82% of the rate of since 1940. The rate of climate warming in the coming century is projected to be 2.5–5.8 times higher than that measured in the past century. Underlying these averages, exposure of individual park PACEs to change agents differ in important ways. For example, parks such as Great Smoky Mountains exhibit high land use and low climate exposure, others such as Great Sand Dunes exhibit low land use and high climate exposure, and a few such as Point Reyes exhibit high exposure on both axes. The cumulative and synergistic effects of such changes in land use, invasives, and climate are expected to dramatically impact ecosystem function and biodiversity in national parks. These results are foundational to developing effective adaptation strategies and suggest policies to better safeguard parks under broad-scale environmental change

Correction: Managing Climate Change Refugia for Climate Adaptation.

[This corrects the article DOI: 10.1371/journal.pone.0159909.]

Young girls embodied experiences of femininity and social class

Based on research with middle-upper class 12-13 year old school girls, we discuss how femininities were embodied and discursively reconstructed in class-based ways. The data suggests the girls understood class antagonisms within the boundaries of neoliberal discourses of responsibilisation, self-discipline, self-worth, and ‘proper’ conduct and choices. With class stripped of any structural or structuring properties, instead imparted to the fleshy sinews of the (excessive) body, the data reveals how social class was made visible and manifest in various mechanisms of, and meanings about, inclusion, exclusion, pathology and ‘normalisation.’ Thus, in explicating the ways in which the school girls embodied middle-class femininity (as the epitome of localised and everyday neoliberalism) we highlight how, in turn, ‘others’ (‘chavs’) were pathologised and deemed in need of regulation, management and governance

Scoping review of factors influencing the implementation of group psychoeducational initiatives for people experiencing mental health difficulties and their families

Background: Despite evidence to support the effectiveness of psychoeducation for people experiencing mental health difficulties and their families, understanding issues around the implementation of such programmes is limited. Aim: The aim of this scoping review was to synthesise the peer-reviewed literature on barriers and enablers influencing the implementation of group psychoeducation in adult mental health services. Methods: Using a pre-defined search strategy and PRISMA guidelines, four databases were systematically searched. Two reviewers independently screened and applied exclusion/inclusion criteria. Qualitative, quantitative, and mixed-methods studies were included if they provided empirical evidence on the barriers and enablers. Three reviewers independently extracted data. Following this, data were analysed using a five-level implementation framework. Results: Eight articles met the inclusion criteria. Barriers to implementation were identified at all five levels of the framework: participant; practitioner; intervention; organisational; and structural level. Enablers to implementation were evident at four levels: participant; provider; intervention; and organisational level. Conclusions: The findings of the review provide preliminary information on factors that impact implementation. However, large-scale studies informed by implementation theories are required. In addition, other studies are needed to address the potential impact of different models of intervention and explore strategies to minimize obstacles and support sustainability

Habitat availability and gene flow influence diverging local population trajectories under scenarios of climate change: a place-based approach

Ecological niche theory holds that species distributions are shaped by a large and complex suite of interacting factors. Species distribution models (SDMs) are increasingly used to describe species’ niches and predict the effects of future environmental change, including climate change. Currently, SDMs often fail to capture the complexity of species’ niches, resulting in predictions that are generally limited to climate-occupancy interactions. Here, we explore the potential impact of climate change on the American pika using a replicated place-based approach that incorporates climate, gene flow, habitat configuration, and microhabitat complexity into SDMs. Using contemporary presence–absence data from occupancy surveys, genetic data to infer connectivity between habitat patches, and 21 environmental niche variables, we built separate SDMs for pika populations inhabiting eight US National Park Service units representing the habitat and climatic breadth of the species across the western United States. We then predicted occurrence probability under current (1981–2010) and three future time periods (out to 2100). Occurrence probabilities and the relative importance of predictor variables varied widely among study areas, revealing important local-scale differences in the realized niche of the American pika. This variation resulted in diverse and – in some cases – highly divergent future potential occupancy patterns for pikas, ranging from complete extirpation in some study areas to stable occupancy patterns in others. Habitat composition and connectivity, which are rarely incorporated in SDM projections, were influential in predicting pika occupancy in all study areas and frequently outranked climate variables. Our findings illustrate the importance of a place-based approach to species distribution modeling that includes fine-scale factors when assessing current and future climate impacts on species’ distributions, especially when predictions are intended to manage and conserve species of concern within individual protected areas.Keywords: genetic neighborhood, species distribution modeling, functional connectivity, Random Forest, realized niche, American pika, Ochotona princeps, National Park

A global collaboration to study intimate partner violence-related head trauma: The ENIGMA consortium IPV working group

Intimate partner violence includes psychological aggression, physical violence, sexual violence, and stalking from a current or former intimate partner. Past research suggests that exposure to intimate partner violence can impact cognitive and psychological functioning, as well as neurological outcomes. These seem to be compounded in those who suffer a brain injury as a result of trauma to the head, neck or body due to physical and/or sexual violence. However, our understanding of the neurobehavioral and neurobiological effects of head trauma in this population is limited due to factors including difficulty in accessing/recruiting participants, heterogeneity of samples, and premorbid and comorbid factors that impact outcomes. Thus, the goal of the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Consortium Intimate Partner Violence Working Group is to develop a global collaboration that includes researchers, clinicians, and other key community stakeholders. Participation in the working group can include collecting harmonized data, providing data for meta- and mega-analysis across sites, or stakeholder insight on key clinical research questions, promoting safety, participant recruitment and referral to support services. Further, to facilitate the mega-analysis of data across sites within the working group, we provide suggestions for behavioral surveys, cognitive tests, neuroimaging parameters, and genetics that could be used by investigators in the early stages of study design. We anticipate that the harmonization of measures across sites within the working group prior to data collection could increase the statistical power in characterizing how intimate partner violence-related head trauma impacts long-term physical, cognitive, and psychological health