Falls Among Older Adults During the COVID-19 Pandemic Compared to a Pre-pandemic Period: A Case-Control Study.

BACKGROUND: Little is known about how the COVID-19 pandemic impacted older adults admitted to the hospital with fall-related injuries. This research sought to determine if there was a difference in patient characteristics and hospital outcomes among older adults with fall-related injuries during the COVID-19 pandemic compared to a non-pandemic period. METHODS: A retrospective chart review of patients 65 years or older admitted for traumatic falls before and during COVID-19 was undertaken. Data abstracted included demographics, fall details, injury data, and hospital course. RESULTS: Of 1598 patients, 50.5% presented during COVID-19 (cases), and 49.5% presented pre-pandemic (controls). Fewer cases fell in rural areas (28.6% vs 34.1%, P = .018) and were transferred from outside hospitals (32.1% vs 38.2%, P = .011). More cases experienced alcohol (4.6% vs 2.4%, P = .017) and substance use disorders (1.4% vs .4%, P = .029). Fewer cases had subdural hemorrhages (11.8% vs 16.4%, P = .007), and more had pneumothoraxes (3.5% vs 1.8%, P = .032). More patients admitted during COVID-19 experienced acute respiratory failure (2.0% vs .0%, P < .001), hypoxia (1.5% vs .3%, P = .005), and delirium (6.3% vs 1.0%, P < .001). Fewer cases were discharged to skilled nursing facilities (50.8% vs 57.3%, P = .009) and more to home with services (13.1% vs 8.3%, P = .002). DISCUSSION: This study suggested there was a similar frequency of presentation for falls among older adults during the two study periods. Older adults with fall-related injuries experienced differences in presenting comorbidities, injury patterns, complications, and discharge locations during the study periods.

Impact of elexacaftor/tezacaftor/ivacaftor on Pseudomonas aeruginosa acquisition and chronic infection at a single pediatric cystic fibrosis center

Background: As cystic fibrosis (CF) lung disease progresses, the airways become colonized with opportunistic pathogens such as Pseudomonas aeruginosa secondary to airway surface liquid depletion. Acquisition of P. aeruginosa is associated with decline in lung function and increase in treatment burden and mortality. In October 2019, the Food and Drug Administration approved elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA), a highly effective modulator therapy (HEMT) for individuals aged 12 and older with one copy of the F508del CFTR mutation. ELX/TEZ/IVA increases the amount of and function of CF transmembrane conductance regulator (CFTR) in the respiratory epithelium, increasing mucociliary clearance (MCC) and reducing static airway mucous, a major trigger for chronic infection and inflammation. Method(s): A retrospective analysis of inhaled tobramycin (iTOB) prescriptions prescribed between January 1, 2016, and December 31, 2021, was performed. This captured data before and after ELX/TEZ/IVA approval at Children's Mercy Kansas City (CMKC). The number of individuals with new P. aeruginosa acquisition was determined by identifying electronic prescriptions for iTOB eradication courses. An eradication course was defined as a first lifetime prescription for iTOB or a new prescription for iTOB submitted at least 1 year after a previous prescription. The number of individuals considered chronically infected with P. aeruginosa was determined by identifying individuals receiving chronic iTOB prescriptions and confirmed by respiratory cultures indicating chronic infection based on the Leeds criteria (P. aeruginosa recovered in >=50% of airway cultures in the previous 12 months). Result(s): Eradication courseswere prescribed to 34 individuals in 2016 (15% of people receiving care at CMKC). The number of eradication prescriptions declined in 2020 and 2021, with only 15 (7%) individuals prescribed eradication therapy in 2020 and 12 (5%) in 2021. A similar pattern was observed for prescriptions for chronic infection. In 2016, 57 individuals (25% of our patient population) were receiving iTOB for chronic P. aeruginosa infection. Reductions were seen in 2020 and 2021, with 28 (13%) and 20 (9%) individuals prescribed chronic therapy, respectively. The number of individuals prescribed iTOB for P. aeruginosa eradication and chronic infection per year is represented in Figure 1.(Figure Presented)Conclusions: CMKC experienced a decrease in the number of courses of iTOB prescribed over the last 6 years. HEMT use is associated with greater MCC and anti-inflammatory effects affecting the airway microbiome. The decrease in respiratory cultures growing P. aeruginosa likely reflects these phenomena. A confounding factor is the SARS-CoV-2 pandemic and widespread use of HEMT. Clinic closures and implementation of telemedicine limited in-person patient visits during 2020 and 2021. Despite limited in-person visits, the average number of respiratory cultures per individual at CMKC in 2020 was 3.5, which is consistent with previous years.Wewere able to obtain frequent surveillance cultures through implementation of a drive-through respiratory specimen collection process. Hence, the decrease in number of iTOB courses cannot be attributed to a decrease in frequency of respiratory cultures, although we cannot assess the impact of school closures and a decrease in social gatherings on new P. aeruginosa acquisition or chronic infection. Looking at all these variables, the widespread use of HEMT likely played a significant role in reducing new P. aeruginosa acquisition and chronic P. aeruginosa infection.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Novel Trial Design: CHIEF-HF.

BACKGROUND: The expense of clinical trials mandates new strategies to efficiently generate evidence and test novel therapies. In this context, we designed a decentralized, patient-centered randomized clinical trial leveraging mobile technologies, rather than in-person site visits, to test the efficacy of 12 weeks of canagliflozin for the treatment of heart failure, regardless of ejection fraction or diabetes status, on the reduction of heart failure symptoms. METHODS: One thousand nine hundred patients will be enrolled with a medical record-confirmed diagnosis of heart failure, stratified by reduced (≤40%) or preserved (>40%) ejection fraction and randomized 1:1 to 100 mg daily of canagliflozin or matching placebo. The primary outcome will be the 12-week change in the total symptom score of the Kansas City Cardiomyopathy Questionnaire. Secondary outcomes will be daily step count and other scales of the Kansas City Cardiomyopathy Questionnaire. RESULTS: The trial is currently enrolling, even in the era of the coronavirus disease 2019 (COVID-19) pandemic. CONCLUSIONS: CHIEF-HF (Canagliflozin: Impact on Health Status, Quality of Life and Functional Status in Heart Failure) is deploying a novel model of conducting a decentralized, patient-centered, randomized clinical trial for a new indication for canagliflozin to improve the symptoms of patients with heart failure. It can model a new method for more cost-effectively testing the efficacy of treatments using mobile technologies with patient-reported outcomes as the primary clinical end point of the trial. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04252287.

Hubungan antara Kecerdasan Emosi dengan Kepuasan Perkahwinan Sewaktu Pandemik COVID-19 Di Malaysia

Kecerdasan emosi merupakan salah satu elemen psikologi yang penting dan mendapat perhatian dalam kalangan ahli psikologi yang mengkaji tentang perhubungan dalam perkahwinan. Maka, kajian ini bertujuan untuk menyelidik hubungan di antara kecerdasan emosi dengan kepuasan perkahwinan dalam kalangan individu yang berkahwin dan tinggal di Malaysia sewaktu pandemik COVID-19. Kajian ini menggunakan reka bentuk kajian penerokaan dan pensampelan mudah dengan menggunakan soal selidik dalam talian melalui platform media sosial. Soal selidik terdiri daripada soalan yang berkaitan kecerdasan emosi dengan menggunakan Schutte Self-Report Emotional Intelligence Test (SSEIT) dan kepuasan perkahwinan dengan menggunakan Kansas Marital Satisfaction Scale (KMSS), yang telah diadaptasi untuk kegunaan dalam konteks budaya Malaysia. Secara keseluruhannya, hasil ujian korelasi Pearson menunjukkan bahawa terdapat hubungan signifikan yang positif dan lemah di antara kecerdasan emosi (penggunaan emosi) dan kepuasaan perkahwinan (r = 0.10·, p <0.05). Hasil kajian ini menunjukkan kepentingan aspek penggunaan emosi dalam perhubungan perkahwinan. Dapatan ini memberikan panduan kepada profesion menolong seperti kaunselor dan pekerja sosial dalam membantu mengendalikan klien yang berkahwin. Pengkaji juga telah memberikan cadangan bagi membantu pengkaji pada masa akan datang dalam menyelidik aspek emosi dan kepuasan perkahwinan.Alternate :Emotional intelligence is one of the crucial psychological elements and receives attention among psychologists whom study relationships within marriage. Thus, the purpose of this study is to examine the relationship between emotional intelligence and marital satisfaction among married individuals residing in Malaysia during the pandemic COVID-19. This study applies the exploratory research design and convenience sampling using questionnairs via social media platform. The questionnaire includes questions relating to emotional intelligence using Schutte Self-Report Emotional Intelligence Test (SSEIT) and marital satisfaction using Kansas Marital Satisfaction Scale (KMSS) which has been adapted to fit the context of Malaysian culture. Overall, the Pearson correlation test results show a positive and weak significant correlation between emotional intelligence (emotional use) and marital satisfaction (r = 0.10·, p < 0.05). Findings suggested the importance of the emotional application within marital relationships. Findings also provide guidelines to helping professions such as counsellors and social workers who works with married individual clients. The researcher also provided recommendations for future researchers in examining into emotional aspects and marital satisfaction.

Policing Sex in the Sunflower State: The Story of the Kansas State Industrial Farm for Women

The COVID-19 pandemic has exposed the fractures of our society and of its infrastructure: social inequalities in terms of race, gender, sexual orientation, religion, and class;discrepancies in healthcare structures;the lack of a social safety net;and the discriminating operation of law enforcement structures such as the prison system. Perry pursues questions about the history of female imprisonment, womens legal rights, and the restriction of their sexual behavior through state regulation in Kansas during and after World War I. The author critically analyzes the origins of female incarceration under Chapter 205 at the Kansas State Industrial Farm for Women as the result of the states attempt to respond to the outbreak of venereal diseases in the military. Perry thus provides keen insights in the understanding of gendered law enforcement for women in the Great Plains by interweaving meticulously researched historical facts about the Kansas State Industrial Farm for Women with the analysis of over two thousand interviews with inmates from 1923 to 1933, which chronicle how the state's interference in its citizens' lives reached far beyond the initial period of World War I. Policing Sex in the Sunflower State is a most welcome addition to the scholarship of rural sexuality and gender studies because it centers the untold lived experiences of incarcerated women during the interwar period.

The Use of Interpreters in Health Centers: A Mixed-Methods Analysis

Health centers serve millions of patients with limited English proficiency (LEP) through highly variable language services programs that reflect patient language preferences, the availability of bilingual staff, and very limited sources of third-party funding for interpreters. We conducted a mixed-methods study to understand interpreter services delivery in federally qualified health centers during 2009–2019. Using the Uniform Data System database, we conducted a quantitative analysis to determine characteristics of centers with and without interpreters, defined as staff whose time is devoted to translation and/or interpreter services. We also analyzed Medicaid-relevant policies' association with health centers' interpreter use. The qualitative component used a sample of 28 health centers to identify interpreter services models. We found that the use of interpreters, as measured by the ratio of interpreter full-time equivalents per patients with LEP, decreased between 2009 and 2019. We did not find statistically significant relationships between interpreter staffing and number of patients with LEP served, or in our examination of Medicaid-relevant policies. Our qualitative analysis uncovered homegrown models with varying program characteristics. Key themes included the critical role of bilingual staff, inconsistent interpreter training, and the reasonably smooth transition to virtual interpretation during COVID-19.

Impact of COVID-19 on foodservice operations within urban Kansas childcare centers

PURPOSE/OBJECTIVES: The purpose of this study was to identify the ways in which the COVID-19 pandemic affected foodservice operations within urban Kansas childcare centers. METHODS: Three COVID-19-related questions were added to an online survey of Child and Adult Care Food Program (CACFP) participating childcare centers located throughout Kansas. Responses were collected from July through August, 2020. Descriptive statistics and thematic analysis of open-ended responses were used to identify common concerns. RESULTS: Seventy-nine of the 138 childcare centers invited to complete the COVID-19-related questions responded (57.2% participation rate). The majority (n=56, 70.1%) reported decreased enrollment, whereas a small number (n=9, 11.4%) reported an increase. Approximately twothirds of the centers (n=49, 62.0%) reported foodservice operation modifications owing to COVID-19-related challenges. Three overarching themes were discovered within the centers' responses: (a) procurement challenges including decreased availability and increased cost of foods, (b) changes in meal service including shifting to disposable tableware and ceasing familystyle meal service, and (c) menu and production changes in response to enrollment changes and product availability issues. APPLICATION TO CHILD NUTRITION PROFESSIONALS: Future consideration for CACFP participants include shifting to more shelf-stable foods when faced with food availability issues and utilizing more cost-effective food purchasing options, which might be attained through group purchasing organizations. Well-developed emergency plans such as emergency menus should include plans for procurement challenges. Resources and training to increase understanding and knowledge of CACFP meal pattern guidelines may make menu changes based on availability easier or less challenging. Best practice guidelines, such as family-style meals, may have to take health and safety measures into consideration. As centers continue to experience COVID-19-related issues and plan for a "return to normal", child nutrition professionals can fulfill an important role in helping centers adapt their foodservice operations to meet the challenge.

The Effects of COVID-19 Pandemic Policy on Social Needs Across the State of Kansas and Western Missouri: Paired Survey Response Testing.

BACKGROUND: Studying patients' social needs is critical to the understanding of health conditions and disparities, and to inform strategies for improving health outcomes. Studies have shown that people of color, low-income families, and those with lower educational attainment experience greater hardships related to social needs. The COVID-19 pandemic represents an event that severely impacted people's social needs. This pandemic was declared by the World Health Organization on March 11, 2020, and contributed to food and housing insecurity, while highlighting weaknesses in the health care system surrounding access to care. To combat these issues, legislators implemented unique policies and procedures to help alleviate worsening social needs throughout the pandemic, which had not previously been exerted to this degree. We believe that improvements related to COVID-19 legislature and policy have positively impacted people's social needs in Kansas and Missouri, United States. In particular, Wyandotte County is of interest as it suffers greatly from issues related to social needs that many of these COVID-19-related policies aimed to improve. OBJECTIVE: The research objective of this study was to evaluate the change in social needs before and after the COVID-19 pandemic declaration based on responses to a survey from The University of Kansas Health System (TUKHS). We further aimed to compare the social needs of respondents from Wyandotte County from those of respondents in other counties in the Kansas City metropolitan area. METHODS: Social needs survey data from 2016 to 2022 were collected from a 12-question patient-administered survey distributed by TUKHS during a patient visit. This provided a longitudinal data set with 248,582 observations, which was narrowed down into a paired-response data set for 50,441 individuals who had provided at least one response before and after March 11, 2020. These data were then bucketed by county into Cass (Missouri), Clay (Missouri), Jackson (Missouri), Johnson (Kansas), Leavenworth (Kansas), Platte (Missouri), Wyandotte (Kansas), and Other counties, creating groupings with at least 1000 responses in each category. A pre-post composite score was calculated for each individual by adding their coded responses (yes=1, no=0) across the 12 questions. The Stuart-Maxwell marginal homogeneity test was used to compare the pre and post composite scores across all counties. Additionally, McNemar tests were performed to compare responses before and after March 11, 2020, for each of the 12 questions across all counties. Finally, McNemar tests were performed for questions 1, 7, 8, 9, and 10 for each of the bucketed counties. Significance was assessed at P<.05 for all tests. RESULTS: The Stuart-Maxwell test for marginal homogeneity was significant (P<.001), indicating that respondents were overall less likely to identify an unmet social need after the COVID-19 pandemic. McNemar tests for individual questions indicated that after the COVID-19 pandemic, respondents across all counties were less likely to identify unmet social needs related to food availability (odds ratio [OR]=0.4073, P<.001), home utilities (OR=0.4538, P<.001), housing (OR=0.7143, P<.001), safety among cohabitants (OR=0.6148, P<.001), safety in their residential location (OR=0.6172, P<.001), child care (OR=0.7410, P<0.01), health care access (OR=0.3895, P<.001), medication adherence (OR=0.5449, P<.001), health care adherence (OR=0.6378, P<.001), and health care literacy (0.8729, P=.02), and were also less likely to request help with these unmet needs (OR=0.7368, P<.001) compared with prepandemic responses. Responses from individual counties were consistent with the overall results for the most part. Notably, no individual county demonstrated a significant reduction in social needs relating to a lack of companionship. CONCLUSIONS: Post-COVID-19 responses showed improvement across almost all social needs-related questions, indicating that the federal policy response possibly had a positive impact on social needs across the populations of Kansas and western Missouri. Some counties were impacted more than others and positive outcomes were not limited to urban counties. The availability of resources, safety net services, access to health care, and educational opportunities could play a role in this change. Future research should focus on improving survey response rates from rural counties to increase their sample size, and to evaluate other explanatory variables such as food pantry access, educational status, employment opportunities, and access to community resources. Government policies should be an area of focused research as they may affect the social needs and health of the individuals considered in this analysis.

Burnout, Depression, Anxiety, and Stress among Family Physicians in Kansas: 18 Months into the COVID-19 Pandemic

Introduction: Given the significant turmoil during the COVID-19 pandemic, the authors evaluated burnout and other types of emotional distress experienced by family physicians in Kansas during the second year of the pandemic. The authors compared findings of this study to a similar study conducted 3 months into the pandemic. Method(s): A cross-sectional online survey of 272 actively practicing family physicians in Kansas was conducted from September 15 to October 18, 2021. A 34-item questionnaire was used to measure the physicians' levels of burnout, personal depression, anxiety, and stress. A mixed method approach was used to collect, analyze, and interpret the data. Descriptive statistics, Mann-Whitney U test/independent samples t-test, v2, adjusted odds ratio, and immersion-crystallization methods were used to analyze the data. Result(s): The response rate was 48.9% (n = 133). In aggregate, 69.2% of respondents reported at least 1 manifestation of professional burnout in 2021 compared with 50.4% in 2020;P <= .01). The 2021 respondents were at higher odds of experiencing burnout compared with 2020 respondents (aOR = 1.86;95% CI, 1.00 to 3.57;P = .046). The respondents who reported at least 1 manifestation of professional burnout were more likely to screen positive for depression (aOR = 1.87;95% CI, 1.31-2.66;P <= .01), report higher levels of anxiety (aOR = 1.53;95% CI, 1.04-2.24;P = .013), and higher levels of stress (aOR = 1.39;95% CI, 1.17-1.66;P <= .001). Conclusion(s): As the COVID-19 pandemic continued, there are significant and worsening rates of professional burnout and other forms of emotional distress among family physicians. These findings suggest timely need for appropriate psychological supports. Copyright © 2022 American Board of Family Medicine. All rights reserved.

A Machine Learning Approach to Evaluate Variables of Math Anxiety in STEM Students

The relationships between math anxiety and other variables such as students' motivation and confidence have been extensively studied. The main purpose of the present study was to employ a machine learning approach to provide a deeper understanding of variables associated with math anxiety. Specifically, we applied classification and regression tree models to weekly survey data of science, technology, engineering, and mathematics (STEM) students enrolled in calculus. The tree models accurately identified that the level of confidence is the primary predictor of math anxiety. Students with low levels of confidence expressed high levels of math anxiety. The academic level of students and the number of weekly hours studied were the next two predictors of math anxiety. The junior and senior students had lower math anxiety. Also, those with a higher number of hours studied were generally less anxious. Weekly tree diagrams provided a detailed analysis of the interrelations between math anxiety and variables including academic level, number of hours studied, gender, motivation, and confidence. We noticed that the nature of such interrelations can change during the semester. For instance, in the first week of the semester, confidence was the primary factor, followed by academic level and then motivation. However, in the third week, the order of the interrelation changed to confidence, academic level, and course level, respectively. In summary, decision tree models can be used to predict math anxiety and to provide a more detailed analysis of data associated with math anxiety.

Analysis of Anxiety, Motivation, and Confidence of STEM Students during the COVID-19 Pandemic

The current COVID-19 pandemic has largely impacted the academic performance of several college students. The present study is concerned with the effects of the COVID-19 pandemic on students pursuing a STEM (science, technology, engineering, and mathematics) degree. We collected weekly survey data (w=9) of students (n=53) taking calculus courses during the COVID-19 pandemic. Using the self-reported survey data, we investigated the temporal variations in the levels of anxiety, motivation, and confidence of STEM students. Studies on temporal changes to math anxiety are scarce. The present work aims to fill this gap by analyzing longitudinal survey data associated with math anxiety. Furthermore, using descriptive and inferential statistical methods such as one-way ANOVA, we analyzed the data with respect to gender and academic level. Our results indicated that male and freshman/sophomore (F/Sp) STEM students had higher levels of increased anxiety due to COVID-19. Female and F/Sp STEM students had higher levels of motivation, whereas junior/senior (J/S) and male students exhibited higher levels of confidence. Time series analysis of the data indicated that the levels of motivation and confidence significantly dropped toward the end of the semester, whereas the level of anxiety increased in all groups. Also, the use of math resources (such as tutoring and supplemental instruction) has significantly reduced during the COVID-19 pandemic.

Pandemic, Partnerships and Practicums: Learning to Teach Virtually

Recent constraints due to the coronavirus pandemic created a need for extreme health protocols while maintaining accountability for the critical tasks of teaching and learning. This was a predicament regardless of student age or grade placement. Teacher education programs quickly faced dilemmas connecting matriculating undergraduates to PK-12 schools to satisfy clinical or practicum experiences. Similarly, PK-12 public school districts faced challenging decisions regarding student learning options ranging from completely virtual or completely in-person to hybrid learning environments. Missouri district leadership and a Midwestern university teacher education program collaborated to provide virtual one-on-one teaching sessions for primary grade children in grades 1-3 during the AY 20-21 clinical experience. Although health and safety protocols limited opportunities for interactions, teacher candidate (TC) survey responses indicated the interactions were meaningful and added value to their experience as a prospective teacher. This experience will be the basis for future reactions to interruptions in clinical preparation field experiences. Using this model universities and school districts may build a collaborative foundation to provide virtual teaching opportunities for TCs whether it be in response to health concerns, inclement weather or other as yet unidentified interference to teaching and learning.

Ad hoc government payments impact on non-real estate farm debt

Purpose>The authors examined the impact of the Market Facilitation Program (MFP) and Coronavirus Food Assistance Program (CFAP) payments to United States agricultural producers on non-real estate agricultural loans.Design/methodology/approach>The authors used quarterly, state-level commercial bank data from 2016–2020 to estimate dynamic panel models.Findings>The authors found MFP and CFAP payments not associated with the percentage of non-real estate agricultural loans with payments over 90 days late. However, these payments associated with the percentage of non-real estate agricultural loans with payments between 30 and 89 days late. The available data utilized cannot consider when producers received the actual payment and what they specifically did with those funds.Originality/value>The contribution of this study is for US policymakers and agricultural lenders. The findings could be helpful in designing and implementing future ad hoc payment programs and provide an understanding of potential shortcomings of the current safety net for agricultural producers in the Farm Bill. Additionally, findings can assist agricultural lenders in predicting the impact of ad hoc payments on their distressed loan portfolios.

Cross-Sectional Survey of Antibiotic Stewardship Activities Across Kansas Healthcare Settings including Hospitals, Ambulatory Centers and Long-Term Care Facilities

Background. Kansas ranks as the second-worst state nationally for inpatient antibiotic stewardship core element implementation. Based on the Center for Disease Control and Prevention's 2020 National Healthcare Safety Network (NHSN) Annual Survey, Kansas hospitals reporting at 17% below the national average. We sought to investigate and characterize the stewardship activities healthcare facilities including hospitals, ambulatory centers, long-term care settings, among others, are engaging in, regardless of whether a formal stewardship program exists or not. Methods. A survey was drafted based on the NHSN Annual Facility Survey for hospitals and long-term care settings. The survey was distributed to antibiotic stewardship experts and revised based on input. Surveys were distributed electronically from December 2021 through April 2022 via direct communication through Kansas Department of Health and Environment contacts, and partner organization dissemination. Results. A total of 95 programs responded to the survey. Facilities from 55 of 106 counties responded. 52 of the 95 responses were from critical access hospitals. The facility representation is shown in Fig 1. 33% facilities reported not having a formal ASP. Thirty-five percent of those with formal ASP have had it for 2 years or less. 53% of respondents found it challenging to establish an ASP. About 58% of respondents felt their facility leadership was committed to improving antibiotic use. Accountability amongst all respondents was poor with only 55% reporting a physician/ surgeon/dentist leader responsible for ASP activities. The most common activities implemented were clinical decision pathways and audit, and feedback (19% each), followed by guidelines (15%), dosing or duration optimization strategies (13%), with the least implemented being peer comparison (8%), prophylactic guidelines (5.5%) and pre-authorization (5.5%) as seen infigure 2. Figure 1 - Number of responses per facility type Figure 2: Actions reported (all healthcare facilities) Conclusion. There have been ongoing endeavors to start ASPs, but these appear to have been hampered by the COVID-19 pandemic, lack of adequate support from facility leadership and lack of leadership representation in antibiotic stewardship. Further efforts are needed in developing and supporting antibiotic stewardship activities across facilities in Kansas.

On the Cutting Edge of Medical Education

From the beginning, our community-based medical school has relied on our strong clinical partnerships to allow our students to train with a unique and diverse patient base within University Health, Children's Mercy, St. Luke's Health system, Research Medical Center, the Center for Behavioral Medicine, the Kansas City VA, Advent Health, and Liberty Hospital. [...]in 2021 we launched our additional campus and welcomed our newest affiliate, Mosaic Life Care, to recruit, prepare, and encourage the students training in the St. Joseph community to become part of the primary health workforce in rural Missouri counties. UMKC's faculty perfected digital learning, and our students became part of the COVID diagnosis, treatment, and vaccine teams, and actively engaged in behavioral intervention-based health studies research to identify and eliminate healthcare disparities for those living in our community. Sophie Bernstein, class of 2024, was selected for the 2022 Excellence in Public Health Award from the U.S. Public Health Service Physician Professional Advisory Committee, on the basis of her national efforts to address food insecurity.

No Legal Recreational Marijuana in Missouri: We Have Enough Problems with Addiction!

The Missouri recreational marijuana referendum is financed by a despicable conglomerate of entities ranging from George Soros, to the Mexican drug cartels, to mainline businesses such as the alcohol industry which considers 95% THC (the high/ euphoria producing chemical of cannabis products) the next 'logical' adult beverage to accompany beer, wine, and liquor. 1,2,3 Collectively, I refer to this unsavory and unwholesome alliance as "Big Weed." After a decade of effort, tens of millions of dollars of advertising, promotion, and half-hearted, ineffectual opposition by the healthcare professions, no opposition by the Missouri Hospital Association and support by the Kansas City Star and St. Louis Post-Dispatch newspapers, sham medical pot was passed into constitutional law in 2018.1 That ship has sailed and, for better or for worse (my bet the latter), we will have to live with the consequences. Anecdotal reports from Missouri suburban hospitals and emergency rooms published in Missouri Medicine already indicate easy access medical marijuana is resulting in increased cannabis related ER visits and hospitalizations.5 Missouri Medicine has published more scientific and perspective articles on the unscientific nature of the studies of medical marijuana and the deleterious effects of moving from legal sham medical marijuana to legal recreational marijuana than any other state medical journal.

Covid-19: A Different Kind of Warfare

[...]March 15 is one of those ironic dates in one's reflection of life for me as a soldier in Vietnam and in the United States as a physician. Telemedicine comes with its own learning curve due to issues concerning privacy, confidentiality, credentialing, and liability. James DiRenna, DO, MSMA Immediate Past President and member since 1996, is from Kansas City, Mo., and practices Family Medicine for the MOSAIC Lifecare Organization.

Reasons for Turnover of Kansas Public Health Officials during the COVID-19 Pandemic.

Public health officials played a critical role in COVID-19 mitigation and response efforts. In Kansas, 51 local health department (LHD) administrators and/or local health officers left their positions due to the pandemic between 15 March 2020 and 31 August 2021. The purpose of this study was to identify factors that led to turnover of Kansas local public health officials during the COVID-19 pandemic. Those eligible to participate in this study included former LHD administrators and/or health officers who were employed at or contracted by a Kansas LHD on 15 March 2020 and resigned, retired, or were asked to resign prior to 31 August 2021. Researchers used a demographic survey, a focus group, and key informant interviews to collect data. Twelve former LHD leaders participated in this study. Four themes emerged from phenomenological analysis: politicization of public health; a perceived lack of support; stress and burnout; and the public health infrastructure not working. The findings of this study can guide the Kansas public health system to address the issues leading to turnover of leadership and prevent future turnover. Future research must explore strategies for mitigating leadership turnover and identify alternative public health structures that could be more effective.

Development and laboratory production of virus-like immune-stimulating complexes based on saponins and evaluation of their adjuvant potential using mice immunisation with influenza antigens

The COVID-19 pandemic has exacerbated the public’s need for effective vaccines. Consequently, significant financial support has been provided to developers of a number of innovative vaccines, including the vaccines with saponin-based adjuvants. In 2021, the World Health Organisation recommended Mosquirix, the first malaria vaccine, which contains a saponin adjuvant. An anti-covid vaccine by Novavax is in the approval phase. A promising approach to vaccine development is presented by the use of virus-like immune-stimulating complexes (ISCOMs) containing saponins and by the creation of combinations of ISCOMs with antigens. The aim of the study was to develop, produce and characterise virus-like immune-stimulating complexes based on saponins of Quillaja saponaria, as well as similar saponins of Russian-sourced Polemonium caeruleum. Materials and methods: The ISCOM adjuvants, Matrix-BQ and Matrix-BP, were produced using liquid chromatography and examined using electron microscopy. Balb/c mice were immunised intraperitoneally and intramuscularly with ISCOM-antigen preparations. Afterwards, the immunised animals were challenged with the influenza virus strain, A/California/4/2009(H1N1)pdm09, adapted and lethal to mice. The serum samples were examined using haemagglutination inhibition (HI) tests. Results: The authors produced the ISCOMs containing saponins of Quillaja saponaria and Polemonium caeruleum. After one intramuscular injection of either of the ISCOM-antigen preparations with 1 µg of each of A/Brisbane/02/2018 (H1N1) pdm09, A/Kansas/14/2017 (H3N2), and B/Phuket/3073/2013 haemagglutinin antigens (HAs), HI tests detected serum antibody titres to the corresponding antigens of ≥1:40. Two intramuscular injections of the ISCOM-antigen preparation containing 50 ng of each of the HAs and Matrix-BQ resulted in a protective response. In some animals, two intraperitoneal injections of ISCOM-antigen preparations resulted in the maximum antibody titre to the A/Kansas/14/2017 (H3N2) vaccine strain of 1:20,480. Two intramuscular injections of a test preparation containing 5 µg, 1 µg, 200 ng, or 50 ng of each of the HAs and Matrix-BQ or a control preparation containing 5 µg, 1 µg, or 200 ng of each of the HAs (commercially available vaccines) to the mice that were afterwards infected with the lethal influenza strain protected the experimental animals from death. Conclusions: The ISCOM-based preparations had high immunostimulatory activity in the mouse-model study. The presented results indicate the potential of further studies of ISCOM-based preparations in terms of both vaccine and immunotherapeutic development.