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For this chapter, I raise social psychologist Margaret Wetherell's metaphorical sledgehammer, breaking down the affective-discursive practices which come freighted with emotions, politics, as well as the promise of dignity and a renascent sense of community as we transition into, through and eventually out of, coronacrisis. I examine how we make meaning during COVID, across thresholds of physical distance, observing the ad hoc signage which mark interventions into public space through queueing stickers, yard signs, and window decals which help us navigate through the everyday spaces of the pandemic. Here, I conduct multimodal discourse analysis of the semiotic landscapes of Lincoln, Nebraska and Sioux Falls, South Dakota during the height of the first wave of the pandemic (Spring into Summer 2020) in the Great Plains region of the United States. I argue that these semiotic landscapes form a diverse, polysemic affective regime spatialized across a patchwork of bodies. By analyzing the affective regimes and practices instantiated by ad hoc signage in public spaces, I aim to understand the discursive and embodied (and discursively embodied) forces which quicken common things and common landscapes with theoretical importance in these exceptional times. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
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During the spring of 2020, Nebraska's 983 public schools sat vacant, and Nebraska's 329,290 Pre-Kindergarten to Grade 12 students were learning in environments other than school. Educators were expected to pivot quickly from traditional classroom instruction to remote experiences. Understanding the effects of the pandemic on educators is necessary to effectively meet their needs and the needs of students. The purpose of this study was to identify and describe the experiences of Nebraska's urban and rural PreK-Grade 12 educators during the early stages of the COVID-19 pandemic. In surveys collected in July 2020, participants (i.e., superintendents, principals, and teachers) completed both fixed-response items and one open-ended question that assessed experiences during the initial pandemic-related school closings. The results indicate educators identified lack of family help and inability to engage students as a top concern about student academic progress. Educators reported dramatic increases in stress during school closures. Many reported coping only somewhat well or worse. Educators also reported personal challenges with remote instruction, including mental health issues and blurred work- and home-life boundaries. Significant differences were found between rural and urban educators, as well as between elementary and secondary educators. Direct quotes from participants vividly describe their lived experiences.
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This is the second in a series that examines emerging issues and opportunities in mediation. The need for social distancing over the past two years spawned a meteoric rise in virtual mediation to the extent that it is now the dominant form of alternative dispute resolution. Despite its efficiency and necessity at times, virtual mediation, now synonymous with Zoom mediation, presents new challenges for mediators. In particular, mediators have lost some control over social dynamics (Zoom dynamics). This paper examines a host of errant Zoom styles among participants that may plague the virtual mediation process. It offers a Personality-Based Model of Errant Zoom Styles as well as coping strategies for dealing with them. The extent to which mediators recognize and respond to these errant Zoom styles impacts the effectiveness of virtual Mediation. Recommendations and an update on mediation settlement rates are also provided.
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Amid the ongoing pandemic, school librarians across the country have been facing a different kind of battle, one that has been going on for years in some cases: the fight for every student to benefit from the instruction and carefully curated resources a certified school librarian can provide. Several states are working to introduce or retain legislation that requires a certified school librarian in every school building. States across the country have seen a decrease in certified school librarian staffing. In some districts, positions have been reduced dramatically or cut entirely despite research showing the benefits students, staff, and the entire school community receive from these specifically trained educators. State school library associations are working diligently with lawmakers, fellow state-level education organizations, and national-level partners to advocate on behalf of their students. This article are the stories from Arizona, Michigan, Nebraska, New Jersey, and Pennsylvania about their states' fights for the right of every student to receive the services provided by a certified school librarian.
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Background. Telehealth platforms such as video and telephone visits serve as mechanisms for HIV care delivery during the COVID-19 pandemic. While telehealth may be instrumental in HIV care, its utilization, sustainability, and impact on patients' outcomes remain an area for further research. Hence, we compared people with HIV (PWH) utilizing telehealth services to those receiving in-person clinic services at Nebraska's largest HIV clinic in Omaha. Methods. HIV Care visits were classified into telehealth and in-person visits. We defined telehealth users as PWH who have utilized telephone or video visits at least once between April 2020 to March 2022. Clinical and demographic comparisons between both groupsweremade.Weconducted bivariate analyses and descriptive statistics for associations and proportions of visit type, viral loads (VL), and completed visits. Results. A total of 4,473 visits were completed among 1,308 unique patients (172 telehealth users versus 1136 in-person). Telehealth utilization was significantly higher among patients from cities other than Omaha (< 0.001) and those with income levels above the Federal Poverty Line (FPL) (0.001). Telehealth users made up 73.3% of missed appointments and 50% of canceled visits. Telehealth users were significantly more likely to have undetectable VL than in-person visit users (0.018). In addition, patients who were >= 45 years were significantly more likely to have undetectable VL than younger patients (< 0.001). There was no association between gender, race, or year of HIV diagnosis and visit type. Notably, transgender patients (n = 18) did not use telehealth. Overall telehealth utilization dropped from 64% of our total visits in April 2020 to 5% in March 2022. Conclusion. In our patient population, telehealth users were more likely to have undetectable VL, live far from the clinic, and have income levels above the FPL than in-person visit users. However, telehealth users were more likely to cancel or miss their medical appointments. Our data also suggest a low preference for telehealth among transgender people. Future studies should develop strategies to improve rates of completed visits among telehealth users, promote telehealth use among transgender men, and sustain the utilization of telehealth beyond the pandemic.
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Purpose: Immunocompromised hosts are at risk for severe complications or death from SARS-CoV-2 infection. Few studies describe the clinical features, outcomes and treatment strategies in this population across multiple sites. Method(s): A multi-center retrospective analysis from academic medical centers in the Midwestern US was conducted for hospitalized patients with SARS-CoV-2 infection. Data was collected electronically using standardized intake and 28-day follow up case report forms. The centers included Northwestern University, University of Nebraska, Cleveland Clinic, University of Chicago, Indiana University and University of Kansas. Result(s): The cohort included 272 patients hospitalized from March 2020 to November 2021. Demographics are in Table 1. Mean admission was 6.84 +/- 6.42 days after symptom onset. The most commonly reported symptoms were cough (71.4%), dyspnea (59.6%), fatigue (55.3%), fever (54.9%), and diarrhea (43.9%). Admission CXR had pneumonia in 31.6%;63% with multifocal or patchy opacities. 87 patients had a chest CT;72 (82.7%) showed pneumonia. 97 patients (36.1%) required ICU admission. Treatments included remdesivir (58.5%), dexamethasone (54.4%), convalescent plasma (3.0%), IL-6 inhibitor (4.5%). Immunosuppression management included holding (44.2%) or decreasing (26.6%) the dose of antimetabolite. 76 patients (28.3%) had documented bacterial co-infection, in blood (34.1%), lung (30.6%) and urine (30.6%). 6 (2.2%) patients experienced rejection within 30 days and 8 patients (3.0%) developed CMV viremia. 26 patients (9.7%) died by day 28. Conclusion(s): This cohort had high rates of ICU admission (36.1%), bacterial coinfection (28.3%), rehospitalization (31.5%) and mortality (9.7%).
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The COVID-19 pandemic has generated social and economic disruptions, resulting in cascading e ects on the health and well- being of global citizens. However, little research has focused on how COVID-19 has a ected rural regions, despite rurality being a critical factor for understanding community impact and response to the pandemic. The purpose of this phenomenological study was to explore the experiences of rural Nebraskan parents with young children during the COVID-19 pandemic and school shutdown, and the strategies they used to support their families during that time. We conducted individual and group interviews with 22 white, non-Hispanic mothers living in rural towns, villages, and farms in the Great Plains region of the United States. Thematic analysis was used to generate the following themes related to pandemic challenges: Impacts on Children's Education and Development, Impact on Parent's Work, and Social-Emotional Impacts. Additionally, we generated themes related to the ways that rural parents responded to those challenges: Successful Parenting Strategies, Children's Strategies, Using Community Provided Resources, Finding Unexpected Bene ts, and Hope. This study is meaningful because it documented the impact of the COVID-19 pandemic and school shutdown on rural families with young children, and their responses to pandemic-related stressors. Our ndings provide further insights into families' experiences of how COVID-19 a ected their lives. Limitations and future directions are also discussed.
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Unlike some of Cather's other works, such as My Ántonia, which focus more on the negative effects of physical isolation, Cather offers in these novels a more complicated portrait of isolation's value to women who need independence from their communities in order to explore the widely dissimilar fields of agriculture and opera. Stout discusses at some length the "redefinition of women" that Cather undertakes in writing the careers of Alexandra and Thea.5 She also notes the "ambiguity" of Cather's female characters in general, in their ability to step outside gender roles and to pursue their interests in spite of naysayers in their communities.6 In the context of Stout's broad study of Cather's life and career as a modernist, where isolation indirectly impacts the self-discovery of Cather's early heroines, I argue that isolation is in fact the key ingredient in their emotional development and in their successful careers. While this narrative highlights the importance of isolation in order to allow experimentation and self-discovery, Cather also pays close attention to the way that physical isolation, especially in combination with poverty, can discourage people from pursuing their interests and can damage their mental health. While isolation does take a serious toll on their mental health, it also plays a vital role in their success because it allows them to experiment with new ideas unhindered and because it gives them space to recharge away from the demands of difficult relationships.
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Objective: To determine the influence of the COVID-19 pandemic on seeking timely stroke care in Nebraska. Background: Stroke is the 5th leading cause of mortality in the United States and a major contributor to disability. Timely stroke management has made a significant impact in reducing morbidity and mortality. Reduction in hospital visits for myocardial infarctions and strokes have been reported during current and prior pandemics. Studying changing patterns of seeking stroke care can identify vulnerable populations, increase awareness and improve systems to ensure timely hospital access during the pandemic. Design/Methods: This is a retrospective chart review of patients aged 19-89 years who presented within the acute stroke (24 hour) window at our institution's emergency departments (ED) from 1/1/2020 to 4/30/2020 and 1/1/2019 to 4/30/2019. Interrupted time-series design was used to identify differences between the two time periods in terms of ED acute stroke presentation, presentation within IV thrombolysis and mechanical thrombectomy time windows, stroke admissions, types of stroke, stroke severity, demographics, stroke risk factors and baseline disability. Statistical significance was defined as P-value of ≤ 0.05. Results: 608 eligible patients were identified (mean age 64.1±14.8 years;52% were females);out of which 330 (54%) presented within the stated 2020 time period. Time from last known well (LKW) to presentation was increased during the stated pandemic period (median 8.5 [2-24] hours vs. 6 [2-16] hours;p=0.010). Stroke admissions were higher (82.1 % vs. 70.5 %;p=<0.001). Large vessel occlusion was more common in ischemic stroke patients during the pandemic (10.6% vs 4.1%;p= 0.03). Presentation within the acute stroke window decreased significantly in April 2020 compared to April 2019 (17.9% vs 21.9%;p=0.05). Conclusions: Time from last LKW to ED presentation increased and presentation within the acute stroke window eventually decreased during the pandemic, especially as the pandemic spread within Nebraska.
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Objective: To report demyelinating neuropathies following COVID-19 vaccination. Background: Suspected COVID-19 vaccine-associated Guillain-Barre syndrome and other demyelinating conditions affecting the peripheral nervous system have been reported. The pathophysiologic basis of these associations, and that of vaccination-associated demyelinating neuropathies in general, has not been established. Design/Methods: Case report Results: Four cases of acute and chronic demyelinating neuropathies following COVID-19 vaccination were seen at the University of Nebraska Medical Center from May to September 2021. All were males, ages 26-83 years old. Two received the Pfizer-BioNTech vaccine, one Moderna, and one Johnson&Johnson. Onset ranged from 2-21 days after the final dose of vaccination. The time from symptom onset to neurological evaluation ranged from 3 weeks to 4 months, during which symptoms progressed. All cases presented with progressive numbness, weakness, and areflexia in all limbs;two had difficulty walking. Severe facial diplegia was seen in two cases and other bulbar symptoms in one other case. Three cases had electrophysiologic studies confirming demyelination while one case had findings of subacute polyradiculopathies. Cerebrospinal fluid protein was elevated in two cases and normal in the others. No cases had other co-morbidities or histories suggesting an alternate diagnosis. The diagnosis was acute inflammatory demyelinating polyneuropathy (AIDP) in one case, chronic demyelinating polyradiculoneuropathy (CIDP) in two, and subacute polyradiculopathies in one. The cases with AIDP and CIDP received treatment with intravenous immunoglobulin due to significant motor disability, while the case with subacute polyradiculopathies had spontaneous recovery within 8 weeks. Of the treated cases, two had significant improvement by outpatient follow-up at 2-4 weeks post-treatment and one has yet to follow up. Conclusions: Continued identification and reporting of demyelinating neuropathies following COVID-19 vaccination is essential to determine whether a causative association is present. Prompt evaluation for alternative etiologies is vital and early treatment is recommended.
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Background: Increases in the prevalence of mental health symptoms during global pandemics have been observed. We hypothesized that people with HIV (PWH) and without HIV (HIV-) would experience an increase in mental health symptoms and alcohol use after the onset of the COVID-19 pandemic and that PWH would experience a greater increase than HIV-individuals. Methods: Participants were recruited from two established cohorts of PWH and HIV-adults in Omaha, Nebraska for whom baseline data including mental health and alcohol use assessments had been collected prior to the pandemic. Participants were excluded from the original cohorts if they had any known psychiatric diagnosis or were taking antipsychotics or anticonvulsants. Participants were reassessed utilizing the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Alcohol Use Identification Test (AUDIT), and Pittsburgh Sleep Quality Index (PSQI) between February and April 2021. All outcomes were evaluated using generalized linear mixed models. Results: Of the 95 participants who completed all questionnaires, 50 were PWH and 45 HIV-. Groups did not statistically differ in age, sex, race or ethnicity (mean: 45.67 years;69.5% male;74% non-Hispanic white). Pre-pandemic mean BDI-II, BAI, AUDIT and PSQI scores were higher in PWH versus HIV-. After the onset of the pandemic, mean BDI-II and AUDIT scores increased significantly in both groups (see Table;P<.001 and P=0.003, respectively) and AUDIT scores were significantly higher in males than females (P=.002). Measures of binge drinking and alcohol misuse as well as mean BAI and PSQI scores increased numerically intra-pandemic. Intra-pandemic mean BDI-II and AUDIT scores increased more among HIV-than PWH, but not significantly so. The percentage of PWH and HIV-participants who moved into a more severe category of depression as measured by the BDI-II (eg, from minimal to moderate) after the onset of the pandemic was identical (18%). Conclusion: Measures of depression and alcohol use increased significantly after the onset of the COVID-19 pandemic in people with and without HIV. Although there were no significant differences in the changes between the groups, PWH had higher baseline scores so the increases in this group may have more clinical impacts. Screening for symptoms of mental health and alcohol use is critical, especially in PWH during a pandemic. Future work will explore the longer-term impact of the pandemic on mental health symptoms and alcohol use.
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This report presents organized and structured information on soybean trade indicators across geographical space and through time. The indicators considered are exports, imports and prices. These also are presented at the by-product level. The levels of aggregation are global, U.S. and North Dakota. The information of each indicator is presented in the form of trends and descriptive statistics. The former reveals the direction of the growth, while the latter reveals the magnitude of expectations. The descriptive statistics are represented by the mean, standard deviation, coefficient of variation and share contribution to the total. The report is presented in six sections: (I) global temporal soybean trade, (II) global spatial soybean export, (III) global spatial soybean import, (IV) U.S. temporal soybean export, (V) U.S. spatial soybean export and (VI) U.S. state level soybean export. At the global level, the trends of the indicators are presented in addition to the descriptive statistics of the top 15 exporting and importing countries. The trends and descriptive statistics for the top 15 exporting states also are provided at the U.S. level. This report is important because it serves as an informational guide on exports, our competitors for exports and potential markets for soybeans to our producers. In the current environment, the success (productivity and net farm income stability) of agricultural business depends on accurate prediction of potential demand for soybeans and their products to help producers in making decisions for domestic or foreign markets. Hence, having a comprehensive and accurate database on exports and imports at the global, national and state levels will enable producers in decisionmaking with confidence. To formulate trade policies related to the international market, the trends and the descriptive statistics are useful to producers in identifying variations in demand for soybeans and their products. For decision makers, this information is helpful in the development of risk management tools for potential export losses due to risky events such as politically driven tariffs and uncertain events such as COVID-19. Finally, in the years of decline, identifying sources of variation or risk in changing consumer preferences, genetically modified restrictive index, trade facilitation and prosperity indexes is important. The study reveals that: Global Trade * The soybean market has shifted to processed products. * Soybean grain, residue and crude oil are primary with an increase in flour. * Brazil, Argentina, Paraguay and Canada are the major competitors with the U.S. for soybean grains. * China, Japan, Netherlands, Spain and Germany are the major destinations for soybean grain. * Soybean grain prices have been on the decline in recent years. U.S. Trade vii * China, Mexico, Japan, Indonesia and Netherlands are the major destinations for U.S. soybean grains. * Turkey, Russia, Argentina and Italy are among the top 15 importers of soybean grains but not part of the top 15 U.S. export destinations. U.S. State Trade * Our state-level estimates of trade are consistent with U.S. Department of Agriculture (USDA) Economic Research Service (ERS) exports. In contrast, the USDA Foreign Agricultural Service (FAS) under- and overestimates state exports because they are based on the location of the port. * Our production-adjusted state export estimates suggest the major exporters of soybeans are Illinois, Iowa, Minnesota, Nebraska, Indiana, Ohio, Missouri, South Dakota, North Dakota and Kansas. North Dakota Trade * North Dakota soybean exports are underestimated by the USDA FAS. * For instance, the production adjusted export value predicts a value of $885,365,842 in 2018, while the ERS method predicted $887,896,380 for North Dakota. On the other hand, the FAS method presents a value of $62,543,314.
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Background. Healthcare workers have experienced a significant burden of COVID-19 disease. COVID mRNA vaccines have shown great efficacy in prevention of severe disease and hospitalization due to COVID infection, but limited data is available about acquisition of infection and asymptomatic viral shedding. Methods. Fully vaccinated healthcare workers at a tertiary-care academic medical center in Omaha Nebraska who reported a household exposure to COVID-19 infection are eligible for a screening program in which they are serially screened with PCR but allowed to work if negative on initial test and asymptomatic. Serial screening by NP swab was completed every 5-7 days, and workers became excluded from work if testing was positive or became symptomatic. Results. Of the 94 employees who were fully vaccinated at the time of the household exposure to COVID-19 infection, 78 completed serial testing and were negative. Sixteen were positive on initial or subsequent screening. Vaccine failure rate of 17.0% (16/94). Conclusion. High risk household exposures to COVID-19 infection remains a significant potential source of infections in healthcare workers even after workers are fully vaccinated with COVID mRNA vaccines especially those with contact to positive domestic partners.
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Background. It is well known that the HIV epidemic and COVID-19 pandemic have both disproportionately harmed marginalized minority and immigrant communities in the United States. The risk factors associated with disease incidence and outcomes reaffirm that structural vulnerabilities-sociopolitically imposed risk factors like discrimination, legal status, poverty, and beyond which impact a patient's opportunity to achieve optimal health-play a key role in facilitating the inequitable harms of COVID-19 and HIV alike. This study explores the role of structural forces in increasing the risk of SARS-CoV-2 coinfection among people with HIV (PWH). Methods. We performed a retrospective chart review of PWH receiving care at the University of Nebraska Medical Center HIV clinic in Omaha, Nebraska, to collect patient demographics, comorbidities, HIV outcomes, and COVID-19 outcomes for 37 patients with HIV and SARS-CoV-2 coinfection as of August 27, 2020. As a comparison group, we obtained demographic data from a registry of all patients seen at the HIV clinic. We used R Statistical Software to perform descriptive statistical analysis. Results. Relative to our overall HIV clinic population, over twice as many Hispanic patients (35.1% vs. 16.0%), three times as many undocumented patients (13.5% vs. 4.2%), and four times as many refugee patients (16.2% vs. 4.0%) had COVID-19. The majority (67.6%) of coinfected patients reported working in "essential" jobs during the pandemic. Thirty-four of the 37 people with HIV and COVID-19 (PWHC) had at least one comorbidity, including increased BMI (83.7%), hypertension (64.9%), or hyperlipidemia (48.6%). All 37 PWHC remained alive as of October 4, 2020. Conclusion. The disproportionate burden of SARS-CoV-2 coinfection on Hispanic, undocumented, and refugee PWH may be a product of structural vulnerabilities contributing to greater risk of exposure. Although all 37 PWHC had well-controlled HIV and relatively mild COVID-19 courses, the broader theme of disproportionate COVID-19 incidence among vulnerable sub-populations of people with HIV reaffirms the importance of structural interventions to mitigate current and downstream harms.
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Background. Long-term care facility (LTCF) residents are at increased risk of severe COVID-19, with CMS data indicating > 20% mortality. BLAZE-1 trial noted lower hospitalization rates in high-risk patients receiving monoclonal antibody (mAb) vs placebo (4.2% vs 14.6%) for mild to moderate infections, making it a treatment option for LTCF residents;however, many LTCF lack staff to prepare and administer mAb therapy. To address this need, Region VII Disaster Health Response Ecosystem (R7DHRE) coordinated via NE Medical Emergency Operations Center (NEMEOC) an ASPR pilot project to facilitate infusion of COVID-19 mAb therapeutics for LTCF residents in the state. Methods. R7DHRE partnered with Great Plains Health, Nebraska DHHS, Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP) and Infection Control Assessment and Promotion Program (ICAP) to surveil cases in the state, establish distribution/administration pathways, and educate providers on mAb therapeutics. A multi-hub-and-spoke model was created to allow LTCF to work with regional hospitals or pharmacy services to administer drug in their facilities, reducing time to therapy and transmission risk associated with patient transport. A centralized request process was created using a REDCap platform and verification of patient eligibility by ASAP. This request link, informational documents, fact sheets, and custom-built order form templates were hosted on a dedicated ASAP webpage, and details were shared during weekly ICAP LTCF webinars. Outcomes data, including 14- and 28-day COVID-related hospitalizations and mortality, were collected using databases from Nebraska Health Information Initiative and Nebraska DHHS. Results. Through this program, 513 doses were administered to LTCF residents. Average time from symptom onset to infusion was 2.6 days. COVID- related hospitalization and mortality rates were lower than previously reported for LTCF residents (Table 1). Conclusion. By utilizing existing relationships with LTCFs in the region, we established a program to promptly distribute, prepare, and administer monoclonal antibody therapy to LTCF residents in need, preventing COVID-related hospitalizations and deaths.
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Background. The National Institutes of Health Office of AIDS Research recommend that patients with HIV be prioritized for COVID-19 vaccination due to high rates of co-morbidities and sociodemographic risk factors that place them at increased risk for severe disease. However, COVID-19 vaccines were not distributed specifically to those in high-risk medical categories in Nebraska, and HIV clinics were not included in the state's COVID-19 vaccine delivery system. As a result, barriers to vaccine uptake emerged and interventions to mitigate them were needed. Methods. A multi-faceted and iterative program aimed at improving COVID-19 vaccine uptake was implemented at the University of Nebraska Medical Center's (UNMC) HIV clinic in Omaha, Nebraska in January 2021. A multidisciplinary task force was established in late January 2021 and met on a weekly basis to provide staff and patient education, linkage to vaccines, and review and analysis of vaccine completion rates as shown in the figure. Outreach interventions were continuously revised based on patient and staff feedback as well as updated data and vaccine availability. Results. All 1188 patients of the UNMC HIV clinic were ultimately eligible for the COVID-19 vaccine, but availability was on a rolling basis by age group, profession, county, and, ultimately, co-morbidities. 76% were male, 45.8% non-white, median age 48, and 73% had income less than 400% of federal poverty level. Of the 1188 eligible patients, 63.1% (n=751) had received at least one dose the COVID-19 vaccine and 59.3% (n=705) had completed the COVID-19 vaccine series by June 4, 2021. In comparison, 49.32% of the population of the state of Nebraska had initiated the COVID-19 vaccine series and 43.12% had completed the vaccine series by that date. Among our clinic patients, 27.9% (n=261) of those who had received at least one vaccine were assisted by our task force. 4.5% were noted to have a potential barrier at the time of outreach and these included hesitancy (3.5%), language (1.2%) and transportation (0.9%). Conclusion. A multi-faceted and iterative program to improve COVID-19 vaccine uptake in a high-risk patient population resulted in high rates of vaccine completion.