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1.
Front Psychol ; 12: 674694, 2021.
Article in English | MEDLINE | ID: covidwho-1268299

ABSTRACT

Objective: In this study, we extend the impact of mindfulness to the concept of least-worst decision-making. Least-worst decisions involve high-uncertainty and require the individual to choose between a number of potentially negative courses of action. Research is increasingly exploring least-worst decisions, and real-world events (such as the COVID-19 pandemic) show the need for individuals to overcome uncertainty and commit to a least-worst course of action. From sports to business, researchers are increasingly showing that "being mindful" has a range of positive performance-related benefits. We hypothesized that mindfulness would improve least-worst decision-making because it would increase self-reflection and value identification. However, we also hypothesized that trait maximization (the tendency to attempt to choose the "best" course of action) would negatively interact with mindfulness. Methods: Three hundred and ninety-eight participants were recruited using Amazon MTurk and exposed to a brief mindfulness intervention or a control intervention (listening to an audiobook). After this intervention, participants completed the Least-Worst Uncertain Choice Inventory for Emergency Responders (LUCIFER). Results: As hypothesized, mindfulness increased decision-making speed and approach-tendencies. Conversely, for high-maximizers, increased mindfulness caused a slowing of the decision-making process and led to more avoidant choices. Conclusions: This study shows the potential positive and negative consequences of mindfulness for least-worst decision-making, emphasizing the critical importance of individual differences when considering both the effect of mindfulness and interventions aimed at improving decision-making.

2.
BMC Med Res Methodol ; 21(1): 68, 2021 04 12.
Article in English | MEDLINE | ID: covidwho-1181086

ABSTRACT

RATIONALE: The spread of severe acute respiratory syndrome coronavirus-2 has suspended many non-COVID-19 related research activities. Where restarting research activities is permitted, investigators need to evaluate the risks and benefits of resuming data collection and adapt procedures to minimize risk. OBJECTIVES: In the context of the multicountry Household Air Pollution Intervention (HAPIN) trial conducted in rural, low-resource settings, we developed a framework to assess the risk of each trial activity and to guide protective measures. Our goal is to maximize the integrity of reseach aims while minimizing infection risk based on the latest scientific understanding of the virus. METHODS: We drew on a combination of expert consultations, risk assessment frameworks, institutional guidance and literature to develop our framework. We then systematically graded clinical, behavioral, laboratory and field environmental health research activities in four countries for both adult and child subjects using this framework. National and local government recommendations provided the minimum safety guidelines for our work. RESULTS: Our framework assesses risk based on staff proximity to the participant, exposure time between staff and participants, and potential viral aerosolization while performing the activity. For each activity, one of four risk levels, from minimal to unacceptable, is assigned and guidance on protective measures is provided. Those activities that can potentially aerosolize the virus are deemed the highest risk. CONCLUSIONS: By applying a systematic, procedure-specific approach to risk assessment for each trial activity, we were able to protect our participants and research team and to uphold our ability to deliver on the research commitments we have made to our staff, participants, local communities, and funders. This framework can be tailored to other research studies conducted in similar settings during the current pandemic, as well as potential future outbreaks with similar transmission dynamics. The trial is registered with clinicaltrials.gov NCT02944682 on October 26. 2016 .


Subject(s)
Biomedical Research/trends , COVID-19/prevention & control , Pandemics , Risk Assessment/methods , Communicable Disease Control/methods , Humans , Randomized Controlled Trials as Topic , Research Design
3.
Revista de Administração Pública ; 55(1):243-260, 2021.
Article | WHO COVID | ID: covidwho-1158631

ABSTRACT

Globally, policy environments have become increasingly more complex with the growth in the number of wicked problems, such as that posed by the COVID-19 pandemic. In their response to these problems, public administrations have, from necessity, become heavily reliant on their intergovernmental relations systems, as the challenges posed generally require multilevel responses. This paper analyzes the role of intergovernmental relations in shaping the responses of the BRICS countries when confronted with COVID-19. We develop an analytical framework to understand the dynamics of intergovernmental relations in these countries. Based on this we assess the capacity of the state and political systems to manage intergovernmental relations and ensure effective responses to the COVID-19 crisis. This framework is based on an analysis of three dimensions of the policy domain: the political and state system, formal and informal institutions, and the political alignment between them. Whilst state and political systems were found to be instrumental in formulating an immediate response to the crisis, informal institutions and political processes also played a prominent role in determining the extent to which strategies were implemented, particularly in countries that are more decentralized. Countries lacking the robust formal institutions needed to facilitate intergovernmental relations and to ensure swift policy responses, tend to deliver ineffective and inefficient results when confronted with wicked problems.Alternate abstract: Políticas públicas para solução de problemas perversos (wicked problems), como a crise da COVID-19, têm sido dificultadas devido à complexidade dos ambientes institucionais em que elas acontecem. Esses problemas também requerem cada vez mais coordenação multinível, dando um papel fundamental às relações intergovernamentais. Este artigo analisa esse papel na resposta dos países do BRICS (Brasil, Rússia, Índia, China e África do Sul) à crise da COVID-19. Foi desenvolvido um arcabouço analítico para entender a dinâmica dessas relações intergovernamentais, que foi usado para avaliar a capacidade do estado e dos sistemas políticos para dar respostas efetivas à COVID-19. O arcabouço é baseado em três dimensões: o sistema político e do estado, as instituições formais e informais, e o alinhamento político entre os níveis de governo e a administração pública. Apesar da importância dos sistemas políticos e de estado, as instituições informais e os processos políticos foram instrumentais para definir e implementar as estratégias de combate à COVID-19, principalmente nos países mais decentralizados. Países sem instituições formais robustas para facilitar as relações intergovernamentais tendem a oferecer resultados ineficientes e não-efetivos em termos de políticas públicas para atacar problemas perversos.Alternate abstract: Las políticas públicas para resolver problemas perversos (wicked problems), como la crisis de COVID-19, se han visto obstaculizadas por la complejidad de los entornos institucionales en los que ocurren. Estos problemas también requieren cada vez más una coordinación multinivel, lo que hace que las relaciones intergubernamentales jueguen un papel fundamental. Este artículo analiza ese papel en la respuesta de los países BRICS (Brasil, Rusia, India, China y Sudáfrica) a la crisis de la COVID-19. Se desarrolló un marco analítico para comprender la dinámica de estas relaciones intergubernamentales, que se utilizó para evaluar la capacidad del estado y de los sistemas políticos para brindar respuestas efectivas a la COVID-19. El marco se basa en tres dimensiones: el sistema político y estatal, las instituciones formales e informales y la alineación política entre los niveles de gobierno y la administración pública. A pesar de la importancia de los sistemas políticos y estatal, las instituciones informales y los procesos políticos fueron fundamentales para definir e implementar estrategias para combatir la COVID-19, especialmente e lo países más descentralizados. Los países sin instituciones formales sólidas para facilitar las relaciones intergubernamentales tienden a ofrecer resultados ineficientes e ineficaces en términos de políticas públicas para abordar problemas perversos.

4.
J Transl Med ; 18(1): 452, 2020 11 30.
Article in English | MEDLINE | ID: covidwho-948411

ABSTRACT

BACKGROUND: Dysregulation of transcription and cytokine expression has been implicated in the pathogenesis of a variety inflammatory diseases. The resulting imbalance between inflammatory and resolving transcriptional programs can cause an overabundance of pro-inflammatory, classically activated macrophage type 1 (M1) and/or helper T cell type 1 (Th1) products, such as IFNγ, TNFα, IL1-ß, and IL12, that prevent immune switching to resolution and healing. The low molecular weight fraction of human serum albumin (LMWF5A) is a novel biologic drug that is currently under clinical investigation for the treatment of osteoarthritis and the hyper-inflammatory response associated with COVID-19. This study aims to elucidate transcriptional mechanisms of action involved with the ability of LMWF5A to reduce pro-inflammatory cytokine release. METHODS: ELISA arrays were used to identify cytokines and chemokines influenced by LMWF5A treatment of LPS-stimulated peripheral blood mononuclear cells (PBMC). The resulting profiles were analyzed by gene enrichment to gain mechanistic insight into the biologic processes and transcription factors (TFs) underlying the identified differentially expressed cytokines. DNA-binding ELISAs, luciferase reporter assays, and TNFα or IL-1ß relative potency were then employed to confirm the involvement of enriched pathways and TFs. RESULTS: LMWF5A was found to significantly inhibit a distinct set of pro-inflammatory cytokines (TNFα, IL-1ß, IL-12, CXCL9, CXCL10, and CXCL11) associated with pro-inflammatory M1/Th1 immune profiles. Gene enrichment analysis also suggests these cytokines are, in part, regulated by NF-κB and STAT transcription factors. Data from DNA-binding and reporter assays support this with LMWF5A inhibition of STAT1α DNA-binding activity as well as a reduction in overall NF-κB-driven luciferase expression. Experiments using antagonists specific for the immunomodulatory and NF-κB/STAT-repressing transcription factors, peroxisome proliferator-activated receptor (PPAR)γ and aryl hydrocarbon receptor (AhR), indicate these pathways are involved in the LMWF5A mechanisms of action by reducing LMWF5A drug potency as measured by TNFα and IL-1ß release. CONCLUSION: In this report, we provide evidence that LMWF5A reduces pro-inflammatory cytokine release by activating the immunoregulatory transcription factors PPARγ and AhR. In addition, our data indicate that LMWF5A suppresses NF-κB and STAT1α pro-inflammatory pathways. This suggests that LMWF5A acts through these mechanisms to decrease pro-inflammatory transcription factor activity and subsequent inflammatory cytokine production.


Subject(s)
Cytokines/metabolism , Inflammation/prevention & control , Leukocytes, Mononuclear/drug effects , Serum Albumin, Human/pharmacology , Anti-Inflammatory Agents/pharmacology , COVID-19/drug therapy , COVID-19/immunology , COVID-19/pathology , Cells, Cultured , Gene Expression Regulation/drug effects , HEK293 Cells , Humans , Inflammation/genetics , Inflammation/metabolism , Inflammation Mediators/metabolism , Interferon-Stimulated Gene Factor 3/metabolism , Leukocytes, Mononuclear/metabolism , Lipopolysaccharides , Lymphocyte Activation/drug effects , Molecular Weight , NF-kappa B/metabolism , Serum Albumin, Human/chemistry , Signal Transduction/drug effects , Signal Transduction/genetics , Signal Transduction/immunology , Transcription Factors/metabolism
5.
Res Sq ; 2020 Nov 12.
Article in English | MEDLINE | ID: covidwho-927189

ABSTRACT

RATIONALE: The spread of severe acute respiratory syndrome coronavirus-2 has suspended many non-COVID-19 related research activities. Where restarting research activities is permitted, investigators need to evaluate the risks and benefits of resuming data collection and adapt procedures to minimize risk. OBJECTIVES: In the context of the multicountry Household Air Pollution Intervention (HAPIN) trial, we developed a framework to assess the risk of each trial activity and to guide protective measures. Our goal is to maximize integrity of reseach aims while minimizing infection risk based on the latest understanding of the virus. METHODS: We drew on a combination of expert consultations, risk assessment frameworks, institutional guidance and literature to develop our framework. We then systematically graded clinical, behavioral, laboratory and field environmental health research activities in four countries for both adult and child subjects using this framework. RESULTS: Our framework assesses risk based on staff proximity to the participant, exposure time between staff and participants, and potential aerosolization while performing the activity. One of of four risk levels, from minimal to unacceptable, is assigned and guidance on protective measures is provided. Those activities which can potentially aerosolize the virus are deemed the highest risk. CONCLUSIONS: By applying a systematic, procedure-specific approach to risk assessment for each trial activity, we can compare trial activities using the same criteria. This approach allows us to protect our participants and research team and to uphold our ability to deliver on the research commitments we have made to our participants, local communities, and funders. The trial is registered with clinicaltrials.gov (NCT02944682).

6.
Am J Lifestyle Med ; 15(2): 140-145, 2021.
Article in English | MEDLINE | ID: covidwho-634278

ABSTRACT

Lifestyle medicine domains, despite accounting for more than 78% of chronic disease risk, are infrequently taught as a part of the medical curriculum. Aspects such as nutrition are taught in less than 25% of medical schools, a statistic that continues to decline, and less than 20% of practicing physicians were required to take even a single course in exercise counseling during their medical school training. To combat this lack of training, the American College of Lifestyle Medicine annually awards the Donald A. Pegg scholarship to fund the development of Lifestyle Medicine Interest Groups (LMIGs) across medical schools worldwide. This scholarship was initiated in 2016 and utilizes private funds to support the development and expansion of LMIGs with the aim of increasing awareness of lifestyle medicine among training practitioners. There are four award winners per year. To date there are sixteen Pegg Award winners. This article will showcase the four 2019-2020 Donald A. Pegg award recipients and their impact on the LMIGs at their institutions. Furthermore, it highlights the ingenuity and adaptation of these LMIGs during the COVID-19 pandemic.

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