COVID-19 during pregnancy alters circulating extracellular vesicle cargo and their effects on trophoblast (preprint)

SARS-CoV-2 infection and the resulting coronavirus disease (COVID-19) complicate pregnancies as the result of placental dysfunction which increases the risk of adverse pregnancy outcomes. While abnormal placental pathology resulting from COVID-19 is common, direct infection of the placenta is rare. This suggests maternal response to infection is responsible for placental dysfunction. We hypothesized that maternal circulating extracellular vesicles (EVs) are altered by COVID-19 during pregnancy and contribute to placental dysfunction. To examine this, we characterized maternal circulating EVs from pregnancies complicated by COVID-19 and tested their functional effect on trophoblast cells in vitro. We found the timing of infection is a major determinant of the effect of COVID-19 on circulating EVs. Additionally, we found differentially expressed EV mRNA cargo in COVID-19 groups compared to Controls that regulates the differential gene expression induced by COVID-19 in the placenta. In vitro exposure of trophoblasts to EVs isolated from patients with an active infection, but not EVs isolated from Controls, reduced key trophoblast functions including hormone production and invasion. This demonstrates circulating EVs from subjects with an active infection disrupt vital trophoblast function. This study determined that COVID-19 has a long-lasting effect on circulating EVs and circulating EVs are likely to participate in the placental dysfunction induced by COVID-19.

Broadly neutralizing antibody induction by non-stabilized SARS-CoV-2 Spike mRNA vaccination in nonhuman primates (preprint)

Immunization with mRNA or viral vectors encoding spike with diproline substitutions (S-2P) has provided protective immunity against severe COVID-19 disease. How immunization with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) spike elicits neutralizing antibodies (nAbs) against difficult-to-neutralize variants of concern (VOCs) remains an area of great interest. Here, we compare immunization of macaques with mRNA vaccines expressing ancestral spike either including or lacking diproline substitutions, and show the diproline substitutions were not required for protection against SARS-CoV-2 challenge or induction of broadly neutralizing B cell lineages. One group of nAbs elicited by the ancestral spike lacking diproline substitutions targeted the outer face of the receptor binding domain (RBD), neutralized all tested SARS-CoV-2 VOCs including Omicron XBB.1.5, but lacked cross-Sarbecovirus neutralization. Structural analysis showed that the macaque broad SARS-CoV-2 VOC nAbs bound to the same epitope as a human broad SARS-CoV-2 VOC nAb, DH1193. Vaccine-induced antibodies that targeted the RBD inner face neutralized multiple Sarbecoviruses, protected mice from bat CoV RsSHC014 challenge, but lacked Omicron variant neutralization. Thus, ancestral SARS-CoV-2 spike lacking proline substitutions encoded by nucleoside-modified mRNA can induce B cell lineages binding to distinct RBD sites that either broadly neutralize animal and human Sarbecoviruses or recent Omicron VOCs.

Human Cytokine and Coronavirus Nucleocapsid Protein Interactivity Using Large-Scale Virtual Screens (preprint)

In the battle against the ever-changing SARS-CoV-2 landscape, understanding the interactions between viral proteins and the human immune system is paramount as it helps to explain potential factors contributing to diverse immunological responses in infected individuals. In this study, we employed state-of-the-art molecular docking tools to conduct large-scale virtual screens, predicting the binding affinities between 64 human cytokines against 17 coronavirus nucleocapsid proteins. Our comprehensive in silico analyses reveal specific changes in cytokine-nucleocapsid protein interactions, shedding light on potential modulators of the host immune response during infection. These findings offer valuable insights into the molecular mechanisms underlying viral pathogenesis and may guide the future development of targeted interventions. This manuscript serves as insight into the comparison of deep learning based AlphaFold2-Multimer and the semi-physicochemical based HADDOCK for protein-protein docking. We show the two methods are complementary in their predictive capabilities. We also introduce a novel algorithm for rapidly assessing the binding interface of protein-protein docks using graph edit distance: graph-based residue assessment function (G-RAF). The high-performance computational framework presented here will not only aid in accelerating the discovery of effective interventions against emerging viral threats, but extend to other applications of high throughput protein-protein screens.

Feasibility of intranasal delivery of thin-film freeze-dried monoclonal antibodies (preprint)

Monoclonal antibodies (mAbs) administered intranasally as dry powders can be potentially applied for the treatment or pre-exposure prevention of viral infections in the upper respiratory tract. However, a method to transform the mAbs from liquid to dry powders suitable for intranasal administration and a device that can spray the dry powders to the desired region of the nasal cavity are needed to fully realize the potentials of the mAbs. Herein, we report that thin-film freeze-drying can be applied to prepare aerosolizable mAb dry powders and that the dry powders can be sprayed into the posterior nasal cavity using the Unidose (UDS) Powder Nasal Spray System from Aptar Pharma. AUG-3387, a human-derived mAb that neutralizes the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was used in the present study. First, we prepared AUG-3387 thin-film freeze-dried powders (i.e., TFF AUG-3387 powders) from liquid formulations containing different levels of mAbs. The TFF AUG-3387 powder with the highest solid content (i.e., TFF AUG-3387C powder) was then chosen for further characterization, including the evaluation of the plume geometry, spray pattern, and particle size distribution after the powder was sprayed using the UDS Powder device. Finally, the deposition patterns of the TFF AUG-3387C powder sprayed using the UDS Powder device were studied using 3D-printed nasal replica casts based on an adult model and a child model. It is concluded that it is feasible to intranasally deliver mAbs as dry powders by transforming the mAbs into dry powders using thin-film freeze-drying and then spray the powder using the UDS Powder device.

ASSESSING SYSTEM PERFORMANCE OF MATERNAL AND CHILD HEALTH CARE DURING COVID-19 PANDEMIC IN COMMUNITY HEALTH CENTER- COMORO DILI TIMOR-LESTE. (preprint)

ABSTRACT "Purpose/ Introduction: Recent Evidences reveal that COVID-19 pandemic caused MCH services interruption world-wide. In Timor-Leste, MCH services is one of service priorities and delivers through 3 tiers of health structures consists of hospitals, CHCs, and HPs. The Country (Timor-Leste) identified its first case of COVID-19 in March and by April 2020, it was lockdown and stringent actions were enforced. Nuring the pandemic COVID-19, the MOH health structures and facilities continued delivers essential health services. However, the strict lockdown and mandatory stay home order had negatively impacted the health system capacities. This study to thoroughly assess the disruption of System Components of MCH Services by interviewed frontline HCWs from Comoro -CHC, in Dili-Timor-Leste. Patients and Methods: The cross-sectional approach with quantitative descriptive method was employed for this study. We employed a modified who six building blocks (service delivery, human resources, drugs and consumables, ICT, Financing, Stewardship) to assess system disruption of MCH services in Comoro CHC due to COVID-19 Pandemic. Sample of 99 participants consisted of medical doctors, midwives, nurses who work at MCH unit pharmacy technicians, unit laboratory technicians, a structured questionnaire was utilized and data analysis was used SPSS. Result: The findings reveal the disruption of all 6 system blocks from MCH services in Comoro-CHC, Dili, Timor-Leste due to COVID-19 Pandemic. Except leadership, statistical tests reveal statistically significant association between interruption of five blocks from MCH services. The service delivery, human resources, drugs and consumables, ICT, Financing, Stewardship. Conclusion: COVID-19 Pandemic Caused disruption of all six health system blocks of MCH Services in Comoro, CHC. For future pandemic preparation plan, the attention must be given to all six-health system blocks to guarantee continue delivery of MCH care in CHC Comoro, Dili, Timor-Leste and a primary health care facility and other similar settings.Keywords: Performance, Maternal, Child, Health, System, COVID-19"

The impact of COVID-19 Pandemic on Domestic Gender Based Violence Against Female HIV and Tuberculosis Patients in Timor-Leste: A Qualitative Study (preprint)

Abstract: Context: Globally, there is still widespread of violence against women and girls. Timor-Leste reports high prevalence of GBV with 30% women have experienced intimate partner (IPV) or non-partner sexual violence. Several studies reported about the increase of domestic violence gender-based violence (D-GBV) against girls and women worldwide during the COVID-19 pandemic. Aims: To understand whether women living with these two diseases experienced D- GBV during the lockdowns in Timor-Leste. Methods and Material: The study was a qualitative phenomenology design, utilizing purposive sampling technic. Was conducted in eight municipalities from early October 2022 to end of February 2023. It considered eight independent variables to identified the occurrence of D-GBV. Subject 42 in-depth interviews: 19 HIV, 23 TB participants, and 3 FGDs. Data analysis with NVIVO version 12.1. Results: The D- GBV were widely reported from all municipalities. Psychological, socio-economic, verbal, and physical violence were mostly reported. The COVID-19 pandemic exacerbated D- GBV, and impeded participants to apply coping mechanisms in dealing with the violence. Stigma and discrimination were prevalent. The main causes of the violence were economic factors, jealousy, denial, cultural issues, and failure to perform household work. The participants reported using various coping mechanisms to deal with D- GBV: seeking external support or avoidance and staying, facing the perpetrator at home. Conclusions: The triple vulnerabilities (weaknesses of system to combat D-GBV, stigma, discrimination against female TB and HIV patients. It is recommended to train clinician working on D-GBV subject.

Immune and behavioral correlates of protection against symptomatic post-vaccination SARS-CoV-2 infection (preprint)

Background: We sought to determine immune and behavioral pre-infection correlates of protection against SARS-CoV-2 post-vaccine infections in a joint analysis of epidemiological and immunological cohort data. Methods: Serum and saliva samples from 176 BNT162b2-vaccinated adults in the Prospective Assessment of SARS-CoV-2 Seroconversion study were collected between October and December 2021 and assessed for serum and saliva levels of Wuhan-1 wild-type (WT) SARS-CoV-2 Spike (S)-specific IgG and IgA binding antibodies (bAb) using a multiplex microsphere-based immunoassay (MMIA). Serum samples were also assessed for WT receptor binding domain (RBD)-specific bAb by two commercial assays, BA.1 S-specific IgG bAb by MMIA, and neutralization activity against D614G, Delta (B.1.617.2), and Omicron BA.1 and BA.1.1 variants using a lentiviral pseudovirus neutralization assay. After the Fall 2021 visit, participants reported all positive PCR and/or antigen tests for SARS-CoV-2. Duration, severity, and type of symptoms, as well as risk exposures and adherence to precautionary measures, were assessed by questionnaires during the Spring 2022 visit. Results: Thirty-two participants (18.2%) developed symptomatic post-vaccination SARS-CoV-2 infections (PVI) between December 7, 2021 and April 1, 2022. Pre-infection WT (geometric mean (GM) of 3,863 vs 2,736 binding antibody unit [BAU]/ml, uninfected vs PVI, p=0.0098) and BA.1 (GM of 276.9 vs 179.9 arbitrary bAb unit [AU]/ml, uninfected vs PVI, p=0.04) anti-S IgG bAb levels measured by MMIA and neutralizing titers (NT) against BA.1 (GM titer [GMT] of 493.6 vs 286.2, uninfected vs PVI, p=0.0313) and BA.1.1 (GMT of 552.0 vs 302.5, uninfected vs PVI, p=0.021) were significantly higher in individuals that did not develop PVIs. WT anti-S bAb levels greater than 5,000 BAU/ml were associated with > 90% protection against symptomatic PVI. In individuals that developed PVI, WT anti-S IgG bAb levels correlated with lower disease severity scores ({rho}= -0.3859, p=0.032) and shorter duration of clinical disease ({rho}= -0.5273, p=0.0023). WT anti-RBD bAb levels measured by commercial assays correlated strongly with bAb levels measured by MMIA ({rho}=0.8239, p<0.0001 and {rho}=0.6929, p<0.0001, Roche and Siemens assays, respectively), but did not reach statistical significance for correlation with protection against PVI. Home risk score, but neither work nor home precautionary measures, correlated strongly with risk of PVI (mean score of 20.77 vs 47.33, uninfected vs PVI respectively, p<0.0001). Conclusions: Anti-S IgG bAb levels (directed against either WT or Omicron BA.1 subvariant) and NTs served as correlates of protection against symptomatic SARS-CoV-2 infection. Anti-S (WT) IgG bAb levels remained a significant correlate of protection against PVIs when adjusting for demography and risk behavior. Results of this study also suggest that commercial assays for anti-S bAb may need to be reformatted to enable detection of higher maximum values for use as predictors of increased susceptibility to SARS-CoV-2 infection.

Wastewater Based Epidemiology as a surveillance tool during the current COVID-19 pandemic on a college campus (East Carolina University) and its accuracy in predicting SARS-CoV-2 outbreaks in dormitories (preprint)

The COVID-19 outbreak led governmental officials to close many businesses and schools, including colleges and universities. Thus, the ability to resume normal campus operation required adoption of safety measures to monitor and respond to COVID-19. The objective of this study was to determine the efficacy of wastewater-based epidemiology as a surveillance method in monitoring COVID-19 on a college campus. The use of wastewater monitoring as part of a surveillance program to control COVID-19 outbreaks at East Carolina University was evaluated. During the Spring and Fall 2021 semesters, wastewater samples (N= 830) were collected every Monday, Wednesday, and Friday from the sewer pipes exiting the dormitories on campus. Samples were analyzed for SARS-CoV-2 and viral quantification was determined using qRT-PCR. During the Spring 2021 semester, there was a significant difference in SARS-CoV-2 virus copies in wastewater when comparing dorms with the highest number student cases of COVID-19 and those with the lowest number of student cases, (p= 0.002). Additionally, during the Fall 2021 semester it was observed that when weekly virus concentrations exceeded 20 copies per ml, there were new confirmed COVID-19 cases 85% of the time during the following week. Increases in wastewater viral concentration spurred COVID-19 swab testing for students residing in dormitories, aiding university officials in effectively applying COVID testing policies. This study showed wastewater-based epidemiology can be a cost-effective surveillance tool to guide other surveilling methods (e.g., contact tracing, nasal/salvia testing, etc.) to identify and isolate afflicted individuals to reduce the spread of pathogens and potential outbreaks within a community.

Black Lives Experiencing Homelessness Matter: A Critical Conceptual Framework for Understanding How Policing Drives System Avoidance among Vulnerable Populations

This paper examines racialized encounters with the police from the perspectives of people experiencing homelessness in San Diego, California in 2020. By some estimates, homelessness doubled in San Diego during the first year of the COVID-19 pandemic. We conducted a survey of (n = 244) and interviews with (n = 57) homeless San Diegans during initial shelter-in-place orders, oversampling for Black respondents, whose voices are often under-represented despite high rates of homelessness nationally. Our respondents reported high rates of police contact, frequent lack of respect;overt racism, sexism, and homophobia;and a failure to offer basic services during these encounters. Centering our Black respondents' experiences of criminalization and racism in what Clair calls "criminalized subjectivity," we develop a conceptual framework that brings together critical theoretical perspectives on the role of race in the governance of poverty and crime. When people experiencing extreme poverty face apathy, disrespect, and discrimination from police—as our data show—the result is a reluctance to seek services and to engage with outreach when offered. This reinforces stereotypes of unhoused people as not "wanting" help or "choosing" to be homeless. We reflect on these findings and our framework for envisioning a system of public safety that supports and cares for—rather than punishes—the most vulnerable members of our society. [ FROM AUTHOR] Copyright of Public Integrity is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

COVID-19 and youth violence: views from the frontline

Violent crime tends to be concentrated in economically disadvantaged, racially minoritized communities, particularly among youth. Emerging research suggests that the COVID-19 pandemic may have exacerbated the drivers of violence in these communities but provides limited insight into its effects in a single locale, especially small to mid-size cities, and on those on the frontlines of youth violence (i.e., youth service workers). In the current study, we provide an in-depth, qualitative examination of these dynamics in vulnerable neighborhoods in Lansing, Michigan, centering the voices of those instrumental to violence prevention and community resilience. Specifically, we explore youth service providers' perceptions of how COVID-19 changed youth violence and impacted families, communities, and organizations working to prevent and control youth violence. We use the socioecological model adopted by the public health field to explain and prevent violence to guide our work, as this framework recognizes the interlocking and interactive effects of systemic, community, and relational experiences on youth behavior. As such, it allows us to situate community-based organizations and youth service providers' perceptions within the broader contexts that shape violence. Our findings suggest the need for increased support for community-based prevention and for interventions that rectify structural inequalities.

Anti-hyperglycemic fraction from Alternanthera sessilis L. leaves gets elucidated following bioassay-guided isolation and mass spectrometry

Abstract The anecdotal use of Alternanthera sessilis L. as a relief for diabetes has been known in the Philippines for generations, and antidiabetic activity of similar varieties in other countries is likewise documented. However, the compounds responsible for this activity remain unclear. This study aims to isolate the anti-hyperglycemic fraction of local A. sessilis leaves and identify the compounds in this fraction. Methanol extract of A. sessilis leaves and its hexane, ethyl acetate (ASE), and water fractions were administered to alloxan-induced diabetic mice. ASE (250mg/kg) had the highest anti-hyperglycemic activity at 6-h post-treatment (25.81%±12.72%), with almost similar blood glucose reduction rate as metformin (30.13±3.75%, p=0.767). Repeated fractionation employing chromatographic separation techniques followed by in vivo anti-hyperglycemic assay yielded partially purified subfractions. A. sessilis ethyl acetate subfraction 4-2 (100mg/kg) displayed remarkable suppression of blood glucose rise in diabetic mice at 6-h post-treatment (26.45±3.75%, p<0.0001), with comparable activity with metformin (100mg/kg, 27.87±5.65%, p=0.652). Liquid chromatography/mass spectrometry showed eight distinct peaks, with four peaks annotated via the Traditional Chinese Medicine library and custom library for A. sessilis. Among these, luteolin, apigenin, ononin, and sophorabioside were identified as putative compounds responsible for the anti-hyperglycemic activity. This result provided basis for the reported anecdotal claims and potential utility of the local variety of A. sessilis leaves as sources of anti-hyperglycemic agents.

XBB.1.16 Omicron subvariant rise to a variant of interest: Implications for global alertness and preparedness.

The emergence of the XBB.1.16 Omicron subvariant of COVID-19 has been a cause for concern for the WHO and health authorities globally. This subvariant, which originated from a hybrid of two BA.2 progeny pedigree, has two amino acid mutations in its spike protein and shares a genetic makeup similar to the XBB.1.5 variant. The WHO initially labeled it as a variant under monitoring before elevating it to a variant of interest after it was found to have caused a surge of COVID-19 cases in India for seven months. The XBB.1.16 subvariant has a proliferative edge and can evade the immune system. It has been spreading rapidly on a global scale and has been linked with a higher effective reproductive number than other subvariants. As such, a concerted international effort to prevent and contain its transmission has been recommended. Health authorities must strengthen their health systems, surveillance, and data collection systems to enable them to detect, track, and respond to emerging and reemerging strains of the virus in a timely and effective manner. Research into the XBB.1.16 subvariant is crucial for alerting and preparing the global populace for a potential outbreak, developing treatment options, and potential vaccines. Implementing the One Health approach can promote greater collaboration between diverse disciplines and societal levels to build a more resilient and sustainable future for all.

Racial differences in COVID-19 vaccine acceptance in Arkansas.

Vaccines are one of the most successful tools for protecting the public's health. However, widespread vaccine hesitancy in the Southern United States is preventing effective mitigation of the current COVID-19 pandemic. The purpose of this study was to assess COVID-19 vaccine acceptance among adults living in a largely rural Southern state. This cross-sectional study collected data from 1,164 Arkansas residents between October 3 and October 17, 2020 using random digit dialing. The primary outcome was a multidimensional COVID-19 vaccine acceptance measure with scores between -3 to +3. The full COVID-19 vaccine acceptance scale was measured along with perceived vaccine safety, effectiveness, acceptance, value, and legitimacy subscales. Statistical analyses were conducted using multivariable linear regression. Results indicated Black participants had the lowest overall vaccine acceptance (0.5) compared to White participants (1.2). Hispanic participants had the highest scores (1.4). In adjusted models, Black participants had 0.81 points lower acceptance than White participants, and Hispanic participants had 0.35 points higher acceptance. Hispanic participants had the highest scores for all five vaccine acceptance subscales, relatively equivalent to White participants. Black participants had consistently lower scores, especially perceived vaccine safety (mean -0.2, SD 0.1). In conclusion, the lowest vaccine acceptance rates were among Black participants particularly on perceived vaccine safety. While Black participants had the lowest acceptance scores, Hispanic participants had the highest. This variability shows the value of a multidimensional vaccine acceptance measure to inform COVID-19 vaccination campaign strategies.

The Evolution of Science Education: You Don't Know? YouTube It

Teachers can increase the retention of their students' attention and lead them to be engrossed in new, different, and innovative ways using videos. In the present condition wherein, all educational institutions are implementing hybrid learning due to the COVID-19 pandemic, technologies are becoming an inseparable part of students' life. This study was conducted to determine the effectiveness of YouTube in teaching Science Education. The researchers employed a quasi-experimental research design using 30 first-year students from the Polytechnic University of the Philippines Bataan Branch as respondents. Two groups were used in the study, the control and experimental groups, from the two sections of the same program. The study found that the performance of both groups, and students' scores increased significantly from the pretest to the posttest. Moreover, the experimental group's performance increased significantly compared to the traditional group. Thus, both teaching methodologies are effective in teaching science education to students. Teachers may utilize different teaching methodologies to augment the needs of the learners regardless of the situation. The main goal of the teachers is to facilitate learning and to ensure that the learners will be able to grasp all the needed information during their academic period. © The Author(s) 2023.

Evolving spike-protein N-glycosylation in SARS-CoV-2 variants (preprint)

It has been three years since SARS-CoV-2 emerged and the world plunged into a \"once in a century\" pandemic. Since then, multiple waves of infection have swept through the human population, led by variants that were able to evade any acquired immunity. The co-evolution of SARS-CoV-2 variants with human immunity provides an excellent opportunity to study the interaction between viral pathogens and their human hosts. The heavily N-glycosylated spike-protein of SARS-CoV-2 plays a pivotal role in initiating infection and is the target for host immune response, both of which are impacted by host-installed N-glycans. We compared the N-glycan landscape of recombinantly expressed, stabilized, soluble spike-protein trimers representing seven of the most prominent SARS-CoV-2 variants and found that N-glycan processing is conserved at most sites. However, in multiple variants, processing of N-glycans from high mannose- to complex-type is reduced at sites N165, N343 and N616, implicated in spike-protein function.

Informational value of visual nudges during crises: Improving public health outcomes through social media engagement amid COVID-19

In this study, we conceptualize and empirically evaluate how large-scale organizations can utilize the informational value of visual nudges on social media to promote safety among users and thus improve public health outcomes in the context of the coronovirus desease caused by the SARS-CoV-2 virus (COVID-19) pandemic. We construct a unique panel dataset combining data collected from multiple public and proprietary sources. To operationalize visual nudges from user-generated content, we engage in extensive manual classification of images collected from Instagram (IG), Twitter (TW), and Facebook (FB). To examine the relationship between visual nudging and COVID-19 positivity, we rely on a combination of econometric and epidemiological models. We find that when institutional actors share more images containing mask-related information on IG, their COVID-19 positivity rates decrease by up to 25%, on average. Also, given the fragmentary evidence behind FB and TW effects, our results provide suggestive evidence of the "boundary condition” of the visual nudge effect. Finally, empirical evidence indicates the dynamic and curvilinear effect of visual nudges on positivity over time, such that the informational value of visual nudging is most prominent if communicated 3 to 5 weeks ahead of time, on average. Our results demonstrate the informational value of visual nudges communicated through pertinent social media channels, as well as their capacity to improve public health outcomes. This suggests the feasibility of institutional actors using social media engagement to promote safe behaviors. We conclude by discussing how our findings may be used to develop more effective communication strategies regarding public perceptions of mask use and other relevant safety measures. © 2023 The Authors. Production and Operations Management published by Wiley Periodicals LLC on behalf of Production and Operations Management Society.

Residual Infusion Performance Evaluation (RIPE): A Single-Center Evaluation of Residual Volume Post-Intravenous Eravacycline Infusion.

Intravenous (IV) drugs are administered through infusion pumps and IV administration sets for patients who are seen in healthcare settings. There are multiple areas of the medication administration process that can influence the amount of a drug a patient receives. For example, IV administration sets that deliver a drug from an infusion bag to a patient vary in terms of length and bore. In addition, fluid manufacturers report that the total acceptable volume range for a 250 mL bag of normal saline can be anywhere from 265 to 285 mL. At the institution chosen for our study, each 50 mg vial of eravacycline is reconstituted using 5 mL of diluent, and the total dose is administered as a 250 mL admixture. This single-center, retrospective, quasi-experimental study evaluated the residual medication volume after the completion of an IV eravacycline infusion in patients admitted during the pre-intervention study period compared to those in the post-intervention study period. The primary outcome of the study was to compare the residual antibiotic volume remaining in the bags following IV infusions of eravacycline before and after the implementation of interventions. The secondary outcomes included the following: comparing the amount of the drug lost in the pre- and post-intervention periods, determining whether the amount of residual volume was affected by nursing shifts (day versus night), and lastly assessing the cost of facility drug waste. On average, approximately 15% of the total bag volume was not infused during the pre-intervention period, which was reduced to less than 5% in the post-intervention period. Clinically, the average estimated amount of eravacycline discarded decreased from 13.5 mg to 4.7 mg in the pre- and post-intervention periods, respectively. Following the statistically significant results of this study, the interventions were expanded at this facility to include all admixed antimicrobials. Further studies are needed to determine the potential clinical impact when patients do not receive complete antibiotic infusions.

Police stress: the role of occupational culture and officer characteristics

PurposeThe purpose of the current study was to augment the police culture and stress literature by empirically examining the impact of features of the internal and external work environment, as well as officer characteristics, on police officer stress.Design/methodology/approachThe current empirical inquiry utilized survey data collected from street-level officers in a mid-sized urban police department in a southern region of the United States (n = 349).FindingsThis study revealed that perceived danger, suspicion of citizens and cynicism toward the public increased police occupational stress, while support from supervisors mitigated it. In addition, Black and Latinx officers reported significantly less stress than their White counterparts.Research limitations/implicationsWhile this study demonstrates that patrol officers' perceptions of the external and internal work environments (and race/ethnicity) matter in terms of occupational stress, it is not without limitations. One limitation related to the generalizability of the findings, as results are gleaned from a single large agency serving a metropolitan jurisdiction in the Southeast. Second, this study focused on cultural attitudes and stress, although exact connections to behaviors are more speculative. Finally, the survey took place prior to the onset of the COVID-19 pandemic and the killing of George Floyd (and others), which radically shook police–community relationships nationwide.Practical implicationsPolice administrators should be cognizant of the importance that views of them have for patrol officer stress levels. Moreover, police trainers and supervisors concerned with occupational stress of their subordinates should work toward altering assignments and socialization patterns so that officers are exposed to a variety of patrol areas, in avoiding prolonged assignments of high social distress.Originality/valueThe study augmented the police culture and stress literature by empirically uncovering the individual-level sources of patrol officers' job-related stress. This study builds off of Paoline and Gau's (2018) research using data collected some 15 years ago by examining a more contemporary, post–Ferguson, context.