Effective training practices for non-specialist providers to promote high-quality mental health intervention delivery: A narrative review with four case studies from Kenya, Ethiopia, and the United States

Mental health needs and disparities are widespread and have been exacerbated by the COVID-19 pandemic, with the greatest burden being on marginalized individuals worldwide. The World Health Organization developed the Mental Health Gap Action Programme to address growing global mental health needs by promoting task sharing in the delivery of psychosocial and psychological interventions. However, little is known about the training needed for non-specialists to deliver these interventions with high levels of competence and fidelity. This article provides a brief conceptual overview of the evidence concerning the training of non-specialists carrying out task-sharing psychosocial and psychological interventions while utilizing illustrative case studies from Kenya, Ethiopia, and the United States to highlight findings from the literature. In this article, the authors discuss the importance of tailoring training to the skills and needs of the non-specialist providers and their roles in the delivery of an intervention. This narrative review with four case studies advocates for training that recognizes the expertise that non-specialist providers bring to intervention delivery, including how they promote culturally responsive care within their communities.Copyright © 2023 The Author(s).

Pro or Anti? A Social Influence Model of Online Stance Flipping

Social influence characterizes the change of an individual's stances in a complex social environment towards a topic. Two factors often govern the influence of stances in an online social network: endogenous influences driven by an individual's innate beliefs through the agent's past stances and exogenous influences formed by social network influence between users. Both endogenous and exogenous influences offer important cues to user susceptibility, thereby enhancing the predictive performance on stance changes or flipping. In this work, we propose a stance flipping prediction problem to identify Twitter agents that are susceptible to stance flipping towards the coronavirus vaccine (i.e., from pro-vaccine to anti-vaccine). Specifically, we design a social influence model where each agent has some fixed innate stance and a conviction of the stance that reflects the resistance to change;agents influence each other through the social network structure. From data collected between April 2020 to May 2021, our model achieves 86% accuracy in predicting agents that flip stances. Further analysis identifies that agents that flip stances have significantly more neighbors engaging in collective expression of the opposite stance, and 53.7% of the agents that flip stances are bots and bot agents require lesser social influence to flip stances. © 2013 IEEE.

Navigating WeChat in COVID Times as a Chinese Care Home Resident

Context: In New Zealand, COVID-19-related lockdowns led to the implementation of visiting restrictions in care homes. This placed residents at risk of isolation. The Chinese community is a fast-growing ethnic group and faces additional difficulties, including language and cultural barriers. Information and communication technologies (ICTs) may enhance communication and maintain social connectedness between families and care homes during lockdowns. Objective(s): To explore the role of technology in the experiences of Chinese care home residents living in New Zealand during three lockdown periods from 2020 to mid-2021. Method(s): We performed semi-structured interviews with predominantly Chinese individuals (n = 18) across two Chinese-run care homes in Auckland, New Zealand. Participants included residents (n = 6), family members (n = 6) and facility staff (n = 6). Interviews were conducted and transcribed in either English or Mandarin Chinese, then coded and analysed to synthesise themes. Findings: We identified five themes: (i) an online care home community via WeChat, (ii) benefits of technology, (iii) barriers to technology use, (iv) the infodemic: technology as information overload and (v) the use of technology post-lockdowns. Limitations: Sample sizes for each sub-group were limited. The generalisability of findings is limited to those with no dementia or mild dementia. Residents with more severe dementia were excluded from the study but might also have benefitted from the intervention. Implications: The main finding of this study is that WeChat is an effective means of maintaining social connections in the Chinese care home community, particularly when usage is facilitated by staff. We recommend care homes consider using social media platforms to connect residents with the outside world. Sufficient resources, training and staff are needed to advocate for care home residents to be part of a digital community in a way that is culturally relevant. © 2022 The Author(s).

Hoaxes and Hidden agendas: A Twitter Conspiracy Theory Dataset

Hoaxes and hidden agendas make for compelling conspiracy theories. While many of these theories are ultimately innocuous, others have the potential to do real harm, instigating real-world support or disapproval of the theories. This is further fueled by social media which provides a platform for conspiracy theories to spread at unprecedented rates. Thus, there is a need for the development of automated models to detect conspiracy theories from the social media space in order to quickly and effectively identify the topics of the season and the prevailing stance. To support this development, we create ground truth data through human annotation. In this work, we collect and manually annotate a dataset from Twitter, comprising of four conspiracy theories. Each Tweet is annotated with one of the four topics {climate change, COVID-19 origin, COVID-19 vaccine, Epstein-Maxwell trial}, and its stance towards the conspiracy theory {support, neutral, against}. We perform experiments on this multi-topic dataset to demonstrate its usage in conspiracy-detection, stance-detection and topic-detection. © 2022 Owner/Author.

MAKING CONNECTIONS: MENTAL HEALTH MEDICAL EDUCATION LEADS AUSTRALIA AND NEW ZEALAND (MHMELANZ)

Background: The mental health (MH) curriculum within undergraduate and postgraduate medical programmes in Australia and New Zealand is fundamental to MH competencies in graduate doctors. Despite a shared professional practice, there is an absence of a community of MH lead educators in medical degrees. Objectives: To develop a community of practice network, to enhance the quality, consistency and delivery of the MH curriculum and to enhance standards, resource development, teaching learning and assessment methodology. Challenges to consider include space in the curriculum, online learning during the COVID-19 pandemic and approaches to curriculum delivery posed by lived experiences of students. Methods: Development of the Mental Health Medical Education Leads Australia and New Zealand (MHMELANZ) Mental Health Educators network will be presented. Findings: MH medical education leads from a range of universities bi-nationally, representing graduate and undergraduate courses, will present an overview of the MH curriculum and current challenges and areas of focus for the MHMELANZ. Conclusion: There will be opportunity for discussion, and further development of a network, and a future special interest group with the Royal Australian and New Zealand College of Psychiatrists.

Gamification Approach towards Engineering Students' Engagement in Online Learning

Many engineering students might encounter difficulties understanding certain topics of related courses. They feel frustrated when the teaching method is dull, and the teaching materials are not attractive. All these may lead to the demotivation of the students toward the courses. Fortunately, there are tons of teaching techniques that are introduced to help in boosting students' engagement in the classroom, such as inquiry-based learning, project-based learning, service-based learning, and others. These techniques require the student's engagement, which eventually improves students' concentration while motivating them to practice critical thinking skills. It may promote positive learning experiences. However, engineering courses comprised of various complicated theories, calculations, projects, and assignments, which may burden some students. Furthermore, in addition to the COVID 19 pandemic, the students only attend their classes online, making the learning process even more independent and challenging. Therefore, this study aims to explore the gamification approach for engineering students to increase their engagement while learning online. A batch of 116 students from the Bachelor’s Degree of Engineering in Electrical and Electronics offered by Universiti Malaysia Sarawak (UNIMAS) are invited to participate in this study. A gamified learning model that consists of four stages is created in the online platform for the second-year KNR2443 Electrical Engineering Technology (EET) course. This gamified learning model integrates students’ rank, interactive map, and video guide. A survey related to gamification is collected from the EET students who completed the gamified learning model. The results are generally positive and indicate the gamification approach can potentially improve the engineering students’ engagement and enjoyment in the learning process. © 2022 by the authors.

How behavioral science can inform policies to prevent discrimination against the asian community in the era of COVID-19

The Asian community in the United States has seen an enormous uptick in discriminatory experiences since the start of the COVID-19 pandemic. Asian individuals have reported discrimination within their workplaces, in their communities, and against Asian-owned businesses. Many for-profit organizations have failed to acknowledge this surge. We argue that organizations should adopt policies to protect their Asian employees and clientele. On the basis of behavioral science research and knowledge of best practices for promoting diversity and inclusion, we suggest that organizational leaders create crisis task forces to find ways to reduce discrimination against Asian employees and that the leaders more generally reaffirm organizational commitments to diversity and inclusion, communicate those commitments to stakeholders, visibly enact expected organizational norms related to diversity and inclusion, and establish or reassess accountability systems to ensure that policies and norms are followed. © 2020, Brookings Institution Press. All rights reserved.

Softening the blow: Incorporating employee perceptions of justice into best practices for layoffs during the COVID-19 pandemic

COVID-19 has led to staggering numbers of people being laid off or furloughed. The way these decisions are communicated to employees can critically affect how workers receive and process the news. Specifically, if employees perceive layoff decisions as unfair, both those who are let go and those who remain may suffer untoward mental and physical effects from the layoffs, and these effects, in turn, can have negative consequences for the organization (such as reputational damage). In this article, we draw on prior research into perceptions of justice—including distributive justice (focused on how resources and burdens are allocated), procedural justice (focused on how decisions are made and implemented), and interactional justice (focused on how decisions are communicated)— to offer behaviorally based policy recommendations that organizational leaders and managers can apply to buffer some of the negative effects that layoff decisions can have on both employees and organizations. © 2020, Brookings Institution Press. All rights reserved.

Learning english vocabulary via computer gaming

Due to the COVID-19 pandemic, educators have opted for online discussions and classes in which the teaching and learning sessions occur beyond the classroom environment. As various forms of technology such as gaming can be potentially used as platforms for online teaching and learning, the study aims to investigate the use of vocabulary learning strategies (VLS) in a massively multiplayer online role-playing game (MMORPG) among Malaysian English as a second language (ESL) players. Data were obtained via a 12-hour online game-play recorded sessions of Guild Wars 2 involving four Malaysian ESL players. The participants consisted of experienced online gamers aged between 24 and 25 years. The game-play sessions were also observed to provide supporting details on how the players utilised strategies when learning English vocabulary. The outcome of the study revealed that the ESL players employed different VLS during their game-play sessions. Gu and Johnson’s (1996) categorisation of VLS, which are metacognitive, cognitive, memory, and activation strategies, was subsequently modified to accommodate the MMORPG context. The results showed that the top five strategies used by the players were meaning-making, consultation, using online dictionary, word comparison, and incorporating words with real-world contexts. © 2021, Universiti Malaysia Sarawak. All rights reserved.

N95 respirator decontamination: a study in reusability.

The coronavirus disease 2019 (COVID-19) pandemic had caused a severe depletion of the worldwide supply of N95 respirators. The development of methods to effectively decontaminate N95 respirators while maintaining their integrity is crucial for respirator regeneration and reuse. In this study, we systematically evaluated five respirator decontamination methods using vaporized hydrogen peroxide (VHP) or ultraviolet (254 nm wavelength, UVC) radiation. Through testing the bioburden, filtration, fluid resistance, and fit (shape) of the decontaminated respirators, we found that the decontamination methods using BioQuell VHP, custom VHP container, Steris VHP, and Sterrad VHP effectively inactivated Cardiovirus (3-log10 reduction) and bacteria (6-log10 reduction) without compromising the respirator integrity after 2-15 cycles. Hope UVC system was capable of inactivating Cardiovirus (3-log10 reduction) but exhibited relatively poorer bactericidal activity. These methods are capable of decontaminating 10-1000 respirators per batch with varied decontamination times (10-200 min). Our findings show that N95 respirators treated by the previously mentioned decontamination methods are safe and effective for reuse by industry, laboratories, and hospitals.

Quality improvement: San Francisco dental transformation initiative dental care access

AIM: Increase the # of San Francisco Medi-Cal Dental insurance member patients 0-5 years old seen in participating dental homes by 10% above baseline between 1/2019-12/2020. Methodology: The Model for Improvement strategy using Aim statements, Measurements, and Ideas for testing with serial Plan-Do-Study- Act cycles refined our evolving driver diagram and change package;all lovingly called Virtuous Learning Cycles by our improvement specialist. Measurements: Run Charts showing baseline # of patients with weekly access data over a series of sprints measured access to care. Ideas: Medi-Cal Dental providers strive to provide care to children, but need help learning how to do so. Collaboration with faculty team members allow crafting of continuous learning cycles in overlapping spheres such as QI method utilization, experiences of past participants of QI collaboratives, evidence-based preventive dental care and noninvasive caries management, cavity risk assessments, infant oral examination workflows, and motivational interviewing. Stakeholders at the table: -Medi-Cal Dental network Dental Providers. -Faculty team members-Irene Hilton, AFL Enterprises, Brandon Bennett, Ray Stewart, Peter Milgrom, Ramona English, An Nguyen, and Lyra Ng are the QI-minded Dentists, QI educators, collaborative facilitators, and content leaders on motivational interviewing in dentistry, evidence-based pediatric dentistry and a pediatrician for insight into child-centered primary care. What transpired? Parallel PDSA cycles-Participants and Collaborative: Access to care measurements: A total of 568 patients 0-5 years old were seen whom would not have otherwise been seen without SF DTI. -Learning cycles enhanced participant level change ideas leading to increased access to care in both pilot and cohort 1 sessions. -Aggregate data from Cohort 1 showed an increase in children seen by all teams until COVID-19 Shelter in Place (SIP) was implemented in the San Francisco Bay Area on 3/17/2020. Note the breadth of interventions studied. (1) Exciting real-time PDSAs at the Collaborative level: Organizational PDSAs on highlevel programming allowed rapid pivoting on the process and delivery of Collaborative objectives. Working PDSAs show the importance of QI skills and methods in planning during COVID-19. -Ideas tested included synchronous video training of teams for Cohort 2 in lieu of in-person training due to COVID-19 SIP. PDSAs about system-wide shifts of preventive dentistry into the landscape of tele-dentistry. Active testing of workflows for synchronous video dentistry with real-time photos of children's teeth available for dental evaluation along with the use of home kits with toothbrush, toothpaste and Fluoride Varnish packets mailed home before visits show feasibility during COVID-19 SIP and beyond. On-going questions to test lie in the realm of coding, billing and receiving, electronic dental records, and video technology linking office providers to patients. (2).

Attenuation of circuit longevity in COVID-19 critical illness with AKI on continuous venovenous hemodiafiltration despite the use of regional citrate anticoagulation (RCA) and heparin-bonded an 69 (oxiris®) filter

Introduction: Critical illness in SARS-CoV-2 (COVID-19) infection can result in acute kidney injury (AKI). Continuous renal replacement therapy (CRRT) is part of the overall supportive ICU management. Case Description: CRRT was delivered as Continuous Veno-venous Haemodiafiltration (CVVHDF) using the Prismaflex (Baxter Inc.) system with heparinbonded AN69 filter (oXiris®). The filters were electively changed every 12 hours for first 5 days to augment cytokine adsorptive capacity. Regional citrate anticoagulation (RCA) was used to ensure filter longevity. Initial citrate dose was prescribed at 3.0 mmol/L. All 3 consecutive patients were male aged 66.7 ± 6.02 years. APACHE II score was 32.7 ± 6.51 and predicted mortality was 71%. Mean initial creatinine was 264.7 μmol/L, and urine output was 6.7 mL/hour. All patients were on vasopressor support, broad spectrum antimicrobials and mechanical ventilation. 30 oXiris filters were studied in the 3 patients. 6/30 (20%) filters clotted spontaneously before scheduled change. Mean filter lifespan (24/30) was 689.6 ± 42.3 min before elective change. For the filters that clotted, mean circuit longevity was 515.7 ± 126.2 min. The observed difference was significant, p = 0.002. Importantly, filter clotting occurred despite adequate citrate dose of 3.0 mmol/L and mean post-filter ionized calcium of 0.34 ± 0.06 mmol/L. Vascular access issues were excluded by review of access, return pressures. Citrate dose was increased to 3.2 mmol/ L for all patients and this reduced the frequency of filter clotting subsequently. Two patients were extubated and had full renal recovery - mean duration of CRRT dependence was 9.5 days. However, the third patient remained CRRT dependent until demise on the 28th day of ICU stay. Discussion: Attenuation of circuit lifespan was observed despite adequately dosed RCA and heparin bonded oXiris filters. We theorize that this could be due to a procoagulant state induced by the SARS-CoV-2 infection. Possibly, higher citrate dose to target even lower post-filter ionized calcium may be required to optimise anticoagulation and filter lifespan, thereby ensuring optimal effluent dose and solute clearance, for critically ill COVID-19 patients.

Early Single-Centre Experience of a Nurse-led Sacubitril/Valsartan Initiation and Titration Clinic: A Retrospective Analysis

Background: Sacubitril/valsartan has changed the landscape of the pharmacological therapy of heart failure with reduced ejection fraction (HFrEF). We present our single-centre nurse-led initiation and titration clinic findings from Waikato Hospital. Method: Our retrospective analysis includes 149 consecutive patients with HFrEF who were commenced on sacubitril/valsartan by the Heart Failure Clinical Nurse Specialist (HF CNS) clinic between 1 October 2018 and 30 September 2019. Statistical analyses for Wilcoxon signed-rank test (two-tailed) were performed using Prism 8. Results: Our cohort of 149 patients were predominantly male (81%) with a median age of 68. The majority were either European (72%) or Māori (25%). Two-thirds (64%) were aetiologically non-ischaemic. Mean systolic blood pressure, mean GFR, mean weight and mean serum K+ were similar at baseline and at 6 month follow-up. 69% achieved target dose and 6% had withdrawal of sacubitril/valsartan. 36% had reduction in loop diuretic dose and 18% had mineralocorticoid antagonist withdrawn. Statistically significant differences were observed with decrease in NYHA Class (z = -7.961;p <.00001), decrease in NT-pro BNP (z = -6.441;p <.00001) and improvement in LVEF (z = -6.052;p <.00001) across the cohort. 10% (n = 15) were hospitalised for HF and 3.4% died (n = 5) within 6 months of commencing sacubitril/valsartan. Conclusion: Our early, single-centre experience with a nurse-initiated and led sacubitril-valsartan clinic has yielded results in keeping with the data from the PARADIGM-HF trial, whereby patients experience an improvement clinically (NYHA Class), biochemically (NT-pro BNP) and echocardiographically () with a favourable adverse effect profile. Further insights will be gleaned with longer-term follow-up in our cohort. [Formula presented]

Radiological Findings in COVID-19 and Adaptive Approaches for Radiology Departments: Literature Review and Experience Sharing

Radiological investigations play an important role in the treatment course of patients with coronavirus disease 2019 (COVID-19) and radiologists should be familiar with the imaging characteristics. Being an integral component of the healthcare system, radiology departments have made adaptations to enhance infection control and strengthen the service. In this article, we review the radiological features of COVID-19 on chest radiography and computed tomography, and share experiences on the adaptive approach of radiology departments amidst the COVID-19 pandemic.