Addressing the Shortage of Health Professionals in Official Language Minority Communities to Strengthen Retention Strategies for the Benefit of New Brunswick Francophone and Acadian Communities: Protocol for a Mixed Methods Design.

BACKGROUND: COVID-19 has highlighted already existing human resource gaps in health care systems. New Brunswick health care services are significantly weakened by a shortage of nurses and physicians, affecting regions where Official Language Minority Communities (OLMCs) reside. Since 2008, Vitalité Health Network (the "Network"), whose work language is French (with services delivered in both official languages, English and French), has provided health care to OLMCs in New Brunswick. The Network currently needs to fill hundreds of vacant physician and nurse positions. It is imperative to strengthen the network's retention strategies to ensure its viability and maintain adequate health care services for OLMCs. The study is a collaborative effort between the Network (our partner) and the research team to identify and implement organizational and structural strategies to upscale retention. OBJECTIVE: The aim of this study is to support one of New Brunswick health networks in identifying and implementing strategies to promote physician and registered nurse retention. More precisely, it wishes to make 4 important contributions to identify (and enhance our understanding of) the factors related to the retention of physicians and nurses within the Network; determine, based on the "Magnet Hospital" model and the "Making it Work" framework, on which aspects of the Network's environment (internal or external) it should focus for its retention strategy; define clear and actionable practices to help the Network replenish its strength and vitality; and improve the quality of health care services to OLMCs. METHODS: The sequential methodology combines quantitative and qualitative approaches based on a mixed methods design. For the quantitative part, data collected through the years by the Network will be used to take stock of vacant positions and examine turnover rates. These data will also help determine which areas have the most critical challenges and which ones have more successful approaches regarding retention. Recruitment will be made in those areas for the qualitative part of the study to conduct interviews and focus groups with different respondents, either currently employed or who have left it in the last 5 years. RESULTS: This study was funded in February 2022. Active enrollment and data collection started in the spring of 2022. A total of 56 semistructured interviews were conducted with physicians and nurses. As of manuscript submission, qualitative data analysis is in progress and quantitative data collection is intended to end by February 2023. Summer and fall 2023 is the anticipated period to disseminate the results. CONCLUSIONS: Applying the "Magnet Hospital" model and the "Making it Work" framework outside urban settings will offer a novel outlook to the knowledge of professional resource shortages within OLMCs. Furthermore, this study will generate recommendations that could contribute to a more robust retention plan for physicians and registered nurses. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41485.

Are we moving towards a more responsible society thanks to the Covid-19 pandemic?

The question addressed by this research article concerns the world after the pandemica Does this pandemic represent a decisive moment that will shift us towards a more socially and environmentally responsible society? In line with this question, will new habits and new responsible behaviors develop in a sustainable manner? To respond to these challenges, the article starts with plural theories associated with changing habits. Recommendations addressed to companies, as well as to public decision-makers or citizens are proposed to draw the contours of a socially and ecologically more acceptable post-Covid-19. ©

Impact of telehealth on access to and delivery of pediatric inflammatory bowel disease care

Background: Outpatient pediatric inflammatory bowel disease (IBD) care shifted rapidly from in-person to telemedicine as a result of the coronavirus disease (COVID-19) pandemic. Telemedicine is touted as a way to increase access to care, but its effects on delivery of and access to outpatient pediatric IBD are are unknown. Methods: Data from in-person ambulatory office visits and telemedicine encounters for IBD care at a single pediatric center between April 2019 and December 2020 for patients with IBD were retrospectively extracted. Patient-level data included age, diagnosis, race/ethnicity, medications, and home ZIP code;encounter-level data included visit type, duration, and orders placed. Outcomes of interest were compared between in-person and telemedicine visits, and across 4 study periods: April-June of 2019 and 2020, and October-December of 2019 and 2020. Results: At the onset of the COVID-19 pandemic, outpatient IBD care converted completely to telemedicine, allowing clinical encounter volume to remain at a level equal to that of the prior year: 491 encounters April-June 2019, 504 encounters April-June 2020. Over time, the proportion of visits shifted, with approximately 60% of encounters occurring via telemedicine and 40% occurring in-person by October-December 2020. In-person visits had a significantly higher no-show rate compared to telemedicine early in the COVID-19 pandemic (38% vs. 14%, p<0.01) but this trend was reversed by October-December 2020, with in-person visits having a lower no-show rate than telemedicine (16% vs. 24%, p<0.05). During both study periods in 2020, the average amount of time patients spent with their provider was not significantly different for in-person and telemedicine encounters. However, the average overall appointment time, from check-in to check-out, was significantly shorter with telemedicine (Figure 1, p<0.05 for each study period). From October-December 2020, laboratory tests, imaging, and endoscopies were ordered at similar frequencies irrespective of visit type: 59, 7, and 9% of in-person visits versus 64, 2, and 5% of telemedicine visits. There were no significant differences in frequency of clinical encounters over the study periods by patient age, race, ethnicity, gender, primary language, payor, or Child Opportunity Index, a census tract-level measure of childhood development resources and conditions (https://www.diversitydatakids.org/child-opportunity-index). When stratifying by visit type, there were no significant differences in the ratio of in-person to telemedicine visits by race (white vs. youth of color), primary payor (public vs. private), or patient age group. However, patients whose primarly language was not English were more likely to be seen in-person (15%) vs. via telemedicine (85%) between April and June 2020 when compared to patients whose preferred language was English (proportion of in-person visits during the same study period 4%;p<0.05). Conclusions: The conversion to telemedicine allowed for continued delivery of outpatient pediatric IBD care and maintained face to face time with the provider while significantly decreasing total appointment duration. While telemedicine did not appear to introduce disparities in care by many socioeconomic factors, future work is necessary to understand the impact of primary patient language on access to care, patient and parent satisfaction and long-term outcomes associated with telemedicine, and the types of visits that are most appropriate for in-person visits versus telemedicine in a post-pandemic world.

Two-Component Nanoparticle Vaccine Displaying Glycosylated Spike S1 Domain Induces Neutralizing Antibody Response against SARS-CoV-2 Variants.

Vaccines pave the way out of the SARS-CoV-2 pandemic. Besides mRNA and adenoviral vector vaccines, effective protein-based vaccines are needed for immunization against current and emerging variants. We have developed a virus-like particle (VLP)-based vaccine using the baculovirus-insect cell expression system, a robust production platform known for its scalability, low cost, and safety. Baculoviruses were constructed encoding SARS-CoV-2 spike proteins: full-length S, stabilized secreted S, or the S1 domain. Since subunit S only partially protected mice from SARS-CoV-2 challenge, we produced S1 for conjugation to bacteriophage AP205 VLP nanoparticles using tag/catcher technology. The S1 yield in an insect-cell bioreactor was ∼11 mg/liter, and authentic protein folding, efficient glycosylation, partial trimerization, and ACE2 receptor binding was confirmed. Prime-boost immunization of mice with 0.5 µg S1-VLPs showed potent neutralizing antibody responses against Wuhan and UK/B.1.1.7 SARS-CoV-2 variants. This two-component nanoparticle vaccine can now be further developed to help alleviate the burden of COVID-19. IMPORTANCE Vaccination is essential to reduce disease severity and limit the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Protein-based vaccines are useful to vaccinate the world population and to boost immunity against emerging variants. Their safety profiles, production costs, and vaccine storage temperatures are advantageous compared to mRNA and adenovirus vector vaccines. Here, we use the versatile and scalable baculovirus expression vector system to generate a two-component nanoparticle vaccine to induce potent neutralizing antibody responses against SARS-CoV-2 variants. These nanoparticle vaccines can be quickly adapted as boosters by simply updating the antigen component.

Exosomes as New Biomarkers and Drug Delivery Tools for the Prevention and Treatment of Various Diseases: Current Perspectives.

Exosomes are nano-sized vesicles secreted by most cells that contain a variety of biological molecules, such as lipids, proteins and nucleic acids. They have been recognized as important mediators for long-distance cell-to-cell communication and are involved in a variety of biological processes. Exosomes have unique advantages, positioning them as highly effective drug delivery tools and providing a distinct means of delivering various therapeutic agents to target cells. In addition, as a new clinical diagnostic biomarker, exosomes play an important role in many aspects of human health and disease, including endocrinology, inflammation, cancer, and cardiovascular disease. In this review, we summarize the development of exosome-based drug delivery tools and the validation of novel biomarkers, and illustrate the role of exosomes as therapeutic targets in the prevention and treatment of various diseases.