Learning global health: An online collaborative multicultural learning experience

As the world becomes more interconnected, there is an increasing need for global environments. Health professionals are expected to achieve global citizenship attributes, including being culturally competent with effective teamwork and collaboration skills to be able to provide quality care to increasingly diverse populations. The most effective way health professionals acquire these skills is through global learning. Traditionally, undergraduate health science students have been offered opportunities to participate in study abroad programs as a way of meeting their curriculum requirements for global learning. As Covid-19 has disrupted international travel worldwide, educational institutions continue to offer students an internationalization experience and ensure that all curriculum requirements can still be met. This chapter discusses the experience of the School of Nursing and Midwifery LaTrobe University, Australia, in adopting and implementing virtual mobility programs with international partner institutions. This chapter also shares a pragmatic checklist and key considerations for education providers interested in implementing this learning pedagogy in their courses. © 2022 Nova Science Publishers, Inc. All rights reserved.

Cost analysis of COVID-19 test result notification using an automated messaging system compared to a staff caller practice in Alberta.

SETTING: In Alberta, polymerase chain reaction (PCR) COVID-19 tests were an important step in detecting and isolating contagious individuals throughout the pandemic. Initially, a staff member provided results to all PCR COVID-19 test clients by phone. As the number of tests increased, new approaches were essential for timely result notification. INTERVENTION: An innovative automated IT system was introduced during the pandemic to reduce workloads and support timely result notification. At the time of the COVID-19 test booking and again following swabbing, clients had an option to consent to receive their test results via an automated text or voice message. Prior to implementation, a privacy impact assessment was approved, a pilot was undertaken, and changes to lab information systems were made. OUTCOMES: Health administration data were used in a cost analysis to compare the unique costs associated with the novel automated IT practice (e.g., administration, integration, messages, staffing costs) and a hypothetical staff caller practice (e.g., administration, staffing costs) for negative test results. The costs of sharing 2,161,605 negative test results in 2021 were assessed. The automated IT practice demonstrated a cost savings of $6,272,495 over the staff caller practice. A follow-up analysis determined the cost savings threshold of 46,463 negative tests to break even. IMPLICATIONS: Using an automated IT practice for consenting clients can be a cost-effective approach to reach clients in a timely manner during a pandemic or other instances warranting direct notification. This approach is being explored for test result notification of other communicable diseases in other contexts.

RéSUMé: LIEU: En Alberta, les tests de réaction de polymérisation en chaîne (PCR) pour la COVID-19 ont représenté une étape importante dans la détection et l'isolement des personnes contagieuses tout au long de la pandémie. Au début, un membre du personnel communiquait par téléphone les résultats de tous les tests PCR de la COVID-19 aux usagers et usagères. Avec l'augmentation du nombre de tests, il a absolument fallu trouver de nouvelles façons de communiquer les résultats rapidement. INTERVENTION: Un système de TI automatisé novateur a été introduit durant la pandémie pour alléger la charge de travail et favoriser la communication rapide des résultats des tests. Au moment de la réservation d'un test de dépistage de la COVID-19 et après l'écouvillonnage, les usagers et usagères pouvaient consentir à recevoir leurs résultats via un message texte automatisé ou un message vocal. Avant la mise en œuvre, une évaluation des facteurs relatifs à la vie privée a été approuvée, un projet pilote a été mené, et des changements ont été apportés aux systèmes d'information des laboratoires. RéSULTATS: Les données administratives sanitaires ont servi à effectuer une analyse des coûts visant à comparer les coûts spécifiquement associés à la nouvelle pratique de TI automatisée (p. ex. frais d'administration, d'intégration, de messages, de personnel) et ceux d'une hypothétique pratique d'appel par un membre du personnel (p. ex. frais d'administration, de personnel) pour les tests négatifs. Les coûts de communication des résultats de 2 161 605 tests négatifs en 2021 ont été évalués. La pratique de TI automatisée a représenté des économies de 6 272 495 $ par rapport à la pratique d'appel par un membre du personnel. Selon une analyse de suivi, le seuil de rentabilité était atteint après 46 463 tests négatifs. CONSéQUENCES: L'utilisation d'une pratique de TI automatisée pour les usagers et usagères ayant consenti à cette option peut être une méthode efficace par rapport au coût pour joindre rapidement les usagères et usagers lors d'une pandémie ou dans d'autres cas où une notification directe est justifiée. Cette méthode est explorée pour la communication des résultats de tests d'autres maladies transmissibles dans d'autres contextes.

Exploring the Alberta Health Services COVID-19 provincial public health integrated outbreak prevention, preparedness, management, and response interventions to support congregate and communal living sites in Alberta.

SETTING: On March 17, 2020, a state of public health emergency was declared in Alberta under the Public Health Act in response to the COVID-19 pandemic. Congregate and communal living sites were environments with a high risk of exposure to and transmission of COVID-19. Consequently, provincial efforts to prevent and manage COVID-19 were required and prioritized. INTERVENTION: During the first 9 months of the pandemic, vaccines were unavailable and alternate strategies were used to prevent and manage COVID-19 (e.g., physical distancing, masking, symptom screening, testing, isolating cases). Alberta Health Services worked with local, provincial, and First Nations and Inuit Health Branch stakeholders to deliver interventions to support congregate and communal living sites. Interventions included resources and site visits to support prevention and preparedness, and the creation of a coordinated response line to serve as a single point of contact to access information and services in the event of an outbreak (e.g., guidance, testing, personal protective equipment, reporting). OUTCOMES: Data from an internal monitoring dashboard informed intervention uptake and use. Online survey results found high levels of awareness, acceptability, appropriateness, and use of the interventions among congregate and communal living site administrators (n = 550). Recommendations were developed from reported experiences, challenges, and facilitators, and processes were improved. IMPLICATIONS: Provincially coordinated prevention, preparedness, and outbreak management interventions supported congregate and communal living sites. Efforts to further develop adaptive system-level approaches for prevention and preparedness, in addition to communication and information sharing in complex rapidly changing contexts, could benefit future public health emergencies.

RéSUMé: LIEU: Le 17 mars 2020, un état d'urgence sanitaire a été déclaré en Alberta en vertu de la Loi sur la santé publique pour riposter à la pandémie de COVID-19. Les habitations collectives étaient des environnements qui présentaient un risque élevé d'exposition à la COVID-19 et de transmission du virus. Des efforts provinciaux pour prévenir et gérer la COVID-19 ont donc été nécessaires et se sont vu accorder la priorité. INTERVENTION: Comme des vaccins n'étaient pas disponibles au cours des neuf premiers mois de la pandémie, d'autres stratégies ont été utilisées pour prévenir et gérer la COVID-19 (p. ex. distanciation physique, port du masque, dépistage des symptômes, tests, isolation des cas). Les Services de santé de l'Alberta ont travaillé avec les acteurs locaux et provinciaux et les fonctionnaires de la Direction générale de la santé des Premières nations et des Inuits pour mener des interventions à l'appui des habitations collectives. Ces interventions ont compris des ressources et des visites sur place pour appuyer la prévention et la préparation, et la création d'une ligne d'intervention coordonnée qui a servi de guichet unique d'accès à l'information et aux services en cas d'éclosion (p. ex. conseils, tests, équipement de protection individuelle, déclaration des cas). RéSULTATS: Les données d'un tableau de bord interne ont permis d'en savoir plus sur la popularité et l'utilisation de ces interventions. Les résultats d'un sondage en ligne ont fait état de niveaux élevés de connaissance, d'acceptabilité, de pertinence et d'utilisation des interventions chez les administrateurs d'habitations collectives (n = 550). Des recommandations ont été élaborées à partir des expériences signalées et des éléments positifs et négatifs, et les processus ont été améliorés. CONSéQUENCES: Des interventions de prévention, de préparation et de gestion des éclosions coordonnées à l'échelle provinciale ont soutenu les habitations collectives. Il pourrait être utile pour les futures urgences sanitaires de développer ces approches d'adaptation systémiques pour la prévention et la préparation, en plus des communications et de l'échange d'informations dans des contextes en évolution rapide.

Postscript

This chapter reveals some of the major changes in the European and UK regulatory framework following the UK leaving the EU (Brexit), public health consequences of the supply of infected blood products, and the Covid-19 pandemic. It covers issues that occurred after Brexit, the independent medicines and medical devices safety review, and the UK blood enquiry. It also mentions the Medicines and Healthcare products Regulatory Agency (MHRA) that became the UK’s standalone regulator of medicines and medical devices since 1 January 2021, acting independently in joint work with other international regulators. The chapter elaborates on the UK’s intention to develop a new regulatory framework for medical devices that reflect the Independent Medicines and Medical Devices Safety Review published in July 2020. It highlights the European Medicines Agency’s (EMA) cooperation with the World Health Organization (WHO) on developing potential Covid-19 treatments by facilitating large-scale clinical trials. © Oxford University Press 2021.

Natural history of COVID-19 recovery: Changes in physiologic, radiologic and patient-reported outcomes 12 months after symptom onset

RATIONALE: The long-term trajectory of people recovering from COVID-19 and the cause of COVID-19;imaging;patient persistent symptoms remains poorly understood. OBJECTIVE: We sought to determine how pulmonary function tests (PFTs), patient-reported outcome pulmonary function measures (PROMs) and radiologic features change over 12months in people hospitalized with COVID-19. METHODS: A prospective, consecutive cohort of patients hospitalized with PCR-confirmed SARS-CoV-2 were recruited. Longitudinal clinical data, PROMs, PFTs and computed tomography (CT) chests were collected at 3, 6 and/or 12months after symptom onset. Repeated analysis of variance (ANOVA) and Friedman tests were used to compare changes in outcomes over time. MEASUREMENT AND MAIN RESULTS: Eighty-one patients were enrolled with 70 completing the 12-month visit. At 3months, the mean diffusing capacity of the lung for carbon monoxide was reduced at 76 +/- 16%-predicted and improved to 80 +/- 16%-predicted at 6months (p<0.001). The median values for dyspnea, cough, sleep and quality of life (QoL) were abnormal at 3months, with QoL being the only PROM that significantly improved at 6 months. There was no further statistically significant change in PFT parameters or PROMs between 6 and 12 months. The percentages of lung affected by ground glass and reticulation at 3months were 11.3% (IQR 5.6-19.6) and 4.4% (IQR 1.6-7.9), respectively. These improved at 12months with ground glass being 0% (IQR 0-3.3) and reticulation 1.7% (IQR 0-3.3). CONCLUSIONS: PFTs improve between 3 and 6 months, with no change over the subsequent 6months in patients hospitalized with COVID-19. Despite improved and nearly normal physiologic and radiologic results in most patients, 60% report abnormal PROMs at 12months.

Retrospective analysis of NGS data in pediatric genetic cohort: detection of rare variants that may impact influenza and COVID-19 infection

It is difficult to assign a precise frequency of infections that defines an increased susceptibility to infections reflecting an impaired immune response given the majority of patients with intact immune systems still contract multiple upper respiratory infections each year, usually of viral origin. In fact, the average child may experience up to six to eight upper respiratory infections each year. The frequency of these infections may be related to environmental exposures but also may be triggered by genetic susceptibility. As an example, respiratory disease complicates the management of several inherited metabolic diseases, either at presentation or as late-onset features. More recently, children of all ages have been shown to contract COVID-19;however, children with underlying medical conditions are at increased risk. COVID-19 has been known for almost a year now, with several studies identifying genetic risk factors are associated with severe COVID-19. In the context of a health system wide genomic medicine program “Genomic Answers for Kids” at Children’s Mercy, Kansas City, we performed a retrospective analysis of rare variants predicted to be deleterious at 12 known loci known to govern TLR3- and IRF7- dependant type I Interferon immunity of all patients/families (>2000) tested for suspected genetic disorders. We bioinformatically extracted all rare variants in those 12 genes linked to type I interferon pathway from our internal warehouse. From those, ~340 variants were further analyzed based on inheritance, minor allele frequency in population datasets, and in silico prediction. The vast majority of this subgroup of GA4 K patients were referred for a suspected neurological disorder with or without multiple congenital anomalies (~75%). Only 15% were referred for metabolic disorders. Of those, 50% have a known genetic diagnosis unrelated to Immune deficiency. Of the selected index cases, the medical records, and if available the outpatient records, were reviewed to document the occurrence of recurrent infection and/or COVID-19. Preliminary data showed 46 “extremely” rare variants were detected in 37 GA4 K patients;6/37 (16%) have ≥2 in 1–12 genes, one GA4 K patient has 4 “extremely” rare variants in IRF7, and 3/37 GA4 K patients are deceased (~1%). Moreover, a novel disease gene was uncovered in a previously undiagnosed family, of which we identified an additional two affected individuals from an international collaboration. Finally, in a family with apparently dominant transmission of tumid lupus we observe putative causal variant in gene UNC93B1 – linking chronic inflammatory disorder (with known type I interferon association) to mutations predisposing to COVID-19. Recurrent or persistent infection is usually a manifestation of primary immunodeficiency. While most children with recurrent infections have a normal immunity, it is important to remember a subset of patients have an unrecognized genetic susceptibility to infection. Further analysis and monitoring are on-going. As we are continuing to struggle with the COVID-19 pandemic, combined with flu season, understanding precisely who may be at higher risk of infection and complications is critical and could play an important role in ongoing efforts to in disease prevention and the development of better treatment protocols

Meeting case investigation and contact tracing needs during COVID-19 in Alberta: the development and implementation of the Alberta Health Services Pod Partnership Model.

SETTING: In Alberta, a small team of specialized public health experts typically complete case investigation and contact tracing. High COVID-19 case counts and a shortage of trained public health professionals required a rapid and significant adaptation of staffing models to meet the population's needs. INTERVENTION: A tiered, interdisciplinary staffing model, based on those in critical care, was developed, piloted, and implemented in the Alberta Health Services' Communicable Disease Control department in late 2020 to complete case investigation and contact tracing. The final model included novice, non-regulated professionals divided into pods of four to six investigators, led by an experienced regulated investigator. Team leads oversaw five pods. Communicable disease nurses provided an additional tier of clinical expertise. During the model development, roles and responsibilities of team members were delineated, ratios for supervision were tested, and rapid training was provided. OUTCOMES: The tiered staffing model began in November 2020 with staff members in two pods. At its peak in early May 2021, 72 pods of 502 non-regulated members, 134 regulated investigators, and 4 communicable disease nurses completed 780-973 case investigations daily, or 40-45% of all positive cases in Alberta. In comparison, the same number of regulated investigators working independently in the traditional staffing model without non-regulated pods completed, on average, 249 case investigations daily. IMPLICATIONS: A tiered staffing model can be effective at maximizing the skills of the experienced members of the case investigation team to maintain case investigation and contact tracing activities during a pandemic.

RéSUMé: LIEU: En Alberta, une petite équipe de spécialistes de la santé publique mène généralement les enquêtes et la recherche des contacts. Un nombre élevé de cas de COVID-19 et une pénurie de professionnels de la santé publique formés ont nécessité une adaptation rapide et importante des modèles de dotation des équipes pour répondre aux besoins de la population. INTERVENTION: Un modèle de dotation interdisciplinaire à plusieurs niveaux axé sur les patients aux soins intensifs a été élaboré, mis à l'essai et appliqué par la division de la lutte contre les maladies transmissibles des Services de santé de l'Alberta vers la fin de 2020 pour mener les enquêtes et la recherche des contacts. Le modèle final incluait des membres novices de professions non réglementées divisés en modules de quatre à six chercheurs et chercheuses sous la direction d'un chercheur ou d'une chercheuse d'expérience membre d'une profession réglementée. Les chefs d'équipes supervisaient cinq modules. Des infirmières et infirmiers en maladies transmissibles constituaient un niveau supplémentaire d'expérience clinique. Durant l'élaboration du modèle, les fonctions des membres des équipes ont été définies, les ratios d'encadrement ont été testés, et une formation rapide a été fournie. RéSULTATS: L'application du modèle de dotation à plusieurs niveaux a commencé en novembre 2020 avec des effectifs dans deux modules. À son sommet au début de mai 2021, 72 modules, composés de 502 membres de professions non réglementées, de 134 chercheurs et chercheuses de professions réglementées et de 4 infirmières et infirmiers en maladies transmissibles, ont mené de 780 à 973 enquêtes par jour, ce qui englobait entre 40 et 45 % des cas positifs en Alberta. À titre de comparaison, le même nombre de chercheurs et de chercheuses de professions réglementées, travaillant indépendamment selon le modèle de dotation classique sans modules non réglementés, a mené en moyenne 249 enquêtes par jour. CONSéQUENCES: Un modèle de dotation à plusieurs niveaux peut maximiser les compétences des membres expérimentés de l'équipe d'enquête pour maintenir les activités d'enquête et de recherche des contacts durant une pandémie.

Effect of alternatives to opiates program on discharge opioid prescribing in trauma patients

INTRODUCTION: Opioid overdose deaths increased over two decades, with the incidence accelerated further during the COVID-19 pandemic. While opioids remain mainstay for trauma-related pain management, organizations are focused on reducing use. This study aimed to determine if a hospitalwide Alternatives to Opiates (ALTO) program reduced opioid prescribing at discharge after trauma. METHODS: A single-center, retrospective analysis of patients ≥18 years old admitted for ≥24 hours with primary diagnosis of traumatic injury between August 1, 2018 - October 31, 2019 was performed. Admissions before July 1, 2019, represent the control group, whereas admissions on/after represent the ALTO group. Patients with alcohol or polysubstance abuse, chronic opioid use, or in-hospital mortality were excluded. The primary outcome was incidence of opioid prescribing at discharge. Secondary outcomes were percent with in-hospital non-opioid and multimodal analgesia, and hospital and intensive care unit (ICU) length of stay (LOS). A sample size of 129 patients was needed to observe a 30% reduction in primary outcome and maintain 80% power to detect a statistically significant difference using alpha < 0.05. RESULTS: A total of 703 patients were included, 471 in the control and 232 in the ALTO groups. Mean age was 59±22 years and 58.7% were male. Mean initial Injury Severity Score (ISS) was 9.1±7.7 and Charlson Comorbidity Index (CCI) was 2.7±2.7. In-hospital opioid prescribing was higher (70.4% vs. 87.5%, p< 0.0001), and opioid discontinuation at hospital discharge occurred less frequently (60.5% vs. 56.2%, p=0.1237) after ALTO implementation. Surgical intervention, lack of ICU admission, ISS ≥9 and CCI ≤1 was associated with lower incidence of opioid discontinuation at discharge in both groups. Most patients received nonopioid (93.6 vs. 98.7%, p=0.0051) and multimodal analgesia (84.3% vs. 87.5%, p=0.3083) during hospitalization. Median hospital LOS [5(3-9) vs. 4(3-7), p=0.3427] and ICU LOS [2(0-4) vs. 3(2-5), p=0.3461] were similar. CONCLUSIONS: Opioids remain mainstay for traumarelated pain management. In our study, ALTO was not associated with a reduction in in-hospital opioid prescribing or at discharge. Identification and implementation of strategies to further reduce opioid prescribing at discharge in trauma patients are needed.

Characteristics and Incidence of Candidemia in Hospitalized Coronavirus 2019 (COVID-19) Patients

Management of Coronavirus 2019 (COVID-19) with high-dose corticosteroids and interleukin-2 inhibitors has potential benefits, but is associated with immunosuppression and risk of secondary infections. This single-center, retrospective, cohort study evaluated the incidence of candidemia and associated risk factors in hospitalized COVID-19 patients. Twenty-three patients developed candidemia and were matched to 77 non-candidemic COVID-19 controls. The primary outcome was incidence of candidemia. Secondary outcomes included time to first positive fungal blood culture and antifungal initiation, antifungal treatment duration, fungal isolate identification, candidemia risk factors, in-hospital mortality, Intensive Care Unit (ICU) and hospital Length of Stay (LOS) and mechanical ventilation duration. Candidemia incidence was 0.7% (23/3101). Mean time from hospital admission to first positive fungal blood culture was 26.2±14.3 days, with systemic antifungal therapy initiated in 19 patients;seven started antifungal therapy the same day cultures were drawn and 12 within 24 h of preliminary culture results positive for yeast. The remaining four patients expired prior to culture results. Mean duration of antifungal therapy was 9.7±6.6 days. Candida albicans was the most frequently identified isolate. Candidemic patients were more likely to be admitted to the ICU, receive high-dose corticosteroid, renal replacement therapy, mechanical ventilation, central line, tocilizumab and broad-spectrum antimicrobials. They also had higher mortality (82% vs. 22%, p<0.0001) and longer ICU LOS (25 vs 0 days, p<0.0001), hospital LOS (39 vs 10 days, p<0.0001) and mechanical ventilation days (19 vs 0 days, p<0.0001). Candidemia occurrence is rare in COVID-19 patients, but can result in worse clinical outcomes such as high mortality and longer hospital stay. Clinicians should attempt to minimize risk factors and perform routine workup for systemic candida infections in COVID-19 patients in the ICU, on mechanical ventilation and with multiple risk factors.

How Cellular Agriculture Systems Can Promote Food Security

Cellular agriculture, the manufacturing of animal-sourced foods by cell cultures, may promote food security by providing a food source that is available, accessible, utilized, and stable. The extent to which cellular agriculture can promote food security, however, will depend in part on the supply system by which it produces food. Many cellular agriculture companies appear poised to follow a centralized supply system, in which production is concentrated within a small number of large plants and products are distributed over a wide area. This model benefits from economies of scale, but has several weaknesses to food security. By being built of a handful of plants with products distributed by a large transportation network, the centralized model is vulnerable to closures, as became clear for animal-sourced centralized system during the COVID-19 pandemic. Cellular agriculture systems are being built now;therefore, alternative supply system models of decentralized and distributed systems should be considered as the systems of cellular agriculture production are established. This paper defines both the requirements of food security and three possible supply system models that cellular agriculture could take and evaluates each model based on the requirements of food security.

COVID-19 Illness: Mother–Baby Separation, Viruses, and Breastfeeding

Objectives: Some hospitals have instituted separation of mothers and their newborn(s) when SARS-CoV-2 is suspected or confirmed in the mother. Limited data are available for SARS-CoV-2 vertical transmission, including studies on breast milk. This article looks at SARS CoV-2 case studies and data to date as well as prior pertinent research. Methods: Informal searches of PUBMED, CINAHL and Ovid Emcare were used to identify early reports of vertical transmissions of the novel Coronavirus, case reports, and population based reports of early evolving protocols and their outcomes. As this is a novel virus the authors used previously identified anti-infectivity and antiviral mechanisms of human milk on other similar viruses to guide analysis. Further this article reviewed the well established literature regarding the risks of undue infant separation which negatively affect nearly every aspect of infant and maternal health. Results: Informal searches conducted in the spring and early summer of 2020 identified 14 early reports attempting to analyze the initial and evolving global response to SARS-CoV-2 and the effects of the virus on the maternal-infant dyad. Conclusion: The feasibility of single-family rooms and support for breastfeeding as an alternative approach that addresses many of the risks favorably and reduces economic cost, both in lifetime disease burden and direct care are discussed. Initial reports seem to indicate that immediate separation of the mother from her newborn is likely to increase the risk to both mother and infant. © Copyright 2021 United States Lactation Consulting Association.

Adapting clinical pharmacy staffing models during the COVID-19 pandemic: Lessons learned and considerations for future disaster planning

Introduction: In response to the COVID-19 pandemic, healthcare institutions faced challenges that required operational agility to facilitate provision of optimal patient care. Research Question or Hypothesis: This research was performed to elucidate how pharmacy departments adapted their staffing models and the impact on frontline staff satisfaction. Study Design: Critical care pharmacists in ACCP and ASHP list-serves were electronically invited to participate in a 28-question survey in April/May 2020. Methods: Likert-like questions used a 1-5 (strongly agree to strongly disagree) scale, and responses were compared based on degree of satisfaction with pharmacy leadership strategies implemented. Practice model changes were compared before and during COVID-19. Multivariate logistic regression was used to assess the effects of independent variables on the primary outcome, satisfaction with pharmacy leadership response. Results: Respondents (N = 168) representing 40 United States participated. Forty percent of respondents experienced a surge, 68% experienced a staffing model change, and the majority (64.9%) were satisfied overall with their pharmacy leadership's response to the COVID-19 pandemic. Both specialists (50% vs. 21%, P = 0.013) and unit-based generalists (65% vs. 35%, P < 0.001) decreased rounding in the unit. Disagreement with “Satisfied with leadership efforts to protect staff (limiting in-person meetings, changing code response)” decreased the odds of satisfaction by 96% [Odds Ratio (OR) 0.043 (95% CI 0.005-0.336), P = 0.003). Disagreement with “Satisfied with voice of front-line staff” was associated with an 84% reduction in satisfaction [OR 0.165 (95% CI 0.049- 0.549), P = 0.003]. Eliminating inperson rounds associated with a 95% decrease in satisfaction with pharmacy leadership [OR 0.053 (95% CI 0.007-0.392), P = 0.004]. Disagreement with “I believe I am at increased risk of getting COVID-19 due to departmental staffing decisions (as compared to ICU peers in other institutions)” increased satisfaction [OR 3.8, 95% confidence interval (CI) 1.06-13.91]. Conclusion: Frontline staff perceptions can inform practice model changes to improve employee satisfaction while providing safe, reliable, and responsible patient care.

Epidemiology of COVID-19 in Northern Ireland, 26 February 2020-26 April 2020.

This paper describes the epidemiology of coronavirus disease 2019 (COVID-19) in Northern Ireland (NI) between 26 February 2020 and 26 April 2020, and analyses enhanced surveillance and contact tracing data collected between 26 February 2020 and 13 March 2020 to estimate secondary attack rates (SAR) and relative risk of infection among different categories of contacts of individuals with laboratory confirmed severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Our results show that during the study period COVID-19 cumulative incidence and mortality was lower in NI than the rest of the UK. Incidence and mortality were also lower than in the Republic of Ireland (ROI), although these observed differences are difficult to interpret given considerable differences in testing and surveillance between the two nations. SAR among household contacts was 15.9% (95% CI 6.6%-30.1%), over 6 times higher than the SAR among 'high-risk' contacts at 2.5% (95% CI 0.9%-5.4%). The results from logistic regression analysis of testing data on contacts of laboratory-confirmed cases show that household contacts had 11.0 times higher odds (aOR: 11.0, 95% CI 1.7-70.03, P-value: 0.011) of testing positive for SARS-CoV-2 compared to other categories of contacts. These results demonstrate the importance of the household as a locus of SARS-CoV-2 transmission, and the urgency of identifying effective interventions to reduce household transmission.