The Power of School Conditions: Individual, Relational, and Organizational Influences on Educator Wellbeing.

Wellbeing in schools is often focused at the individual level, exploring students' or teachers' individual traits, habits, or actions that influence wellbeing. However, studies rarely take a whole-school approach that includes staff wellbeing, and frequently ignore relational and organizational level variables. We take a systems informed positive psychology approach and argue that it is essential to build greater understanding about organizational and relational influences on wellbeing in order for schools to support educator wellbeing. Our study evaluated the relative contributions of individual, relational, and organizational factors to educator wellbeing. Our measure of wellbeing focused on the life satisfaction and flourishing of 559 educators in 12 New Zealand schools. We used a social network analysis approach to capture educators' relational ties, and demographic data and psychometric scales to capture individual and organizational level variables. Results of hierarchical blockwise regressions showed that individual, relational, and organizational factors were all significantly associated with educator wellbeing; however, it was educators' perceptions of trusting and collaborative school conditions that were most strongly associated with their wellbeing. The number of relational ties educators had explained the least amount of variance in wellbeing. Educators were more likely to experience high levels of support when their close contacts also experienced high levels of support. However, for many educators, there was a negative association between their most frequent relational ties and their reported levels of support. Our results suggest that attending to the organizational factors that influence wellbeing, through creating trusting and collaborative school conditions, may be one of the most influential approaches to enhancing educator wellbeing. We call for whole-school approaches to wellbeing that not only consider how to support and enhance the wellbeing of school staff as well as students, but also view the conditions created within a school as a key driver of wellbeing within schools.

Exploring online social networks of school leaders in times of COVID-19.

The COVID-19 pandemic has raised a wide range of challenges for school leaders that they now (rapidly) have to address. Consequently, they also turn to informal learning networks, in order to share and collect information and reach out to their communities. In this context, the current study investigates the underlying networks structures among school leaders, what type of information is being shared, and what differences can be identified when comparing a nation-wide and a localized sample. We collected data from a US nation-wide sample of 15 relevant Twitter conversations, as well as Tweets from an US urban mid-sized public school district. Using a mixed-methods approach, we discovered several key structural dimensions and a host of highly influential actors. Moreover, we found semantic evidence for users sharing information on topics such as status reports. Finally, we discovered that the urban sample did not overly use the nation-wide, very specific approach of including COVID-19 related hashtags. Instead, they used more localized terminologies. These findings are valuable for policy makers, as they map the underlying communication patterns and provide valuable insights into who is moving what types of resources as part of the emerging governance approach on social media.

Breastfeeding Communication Strategies, Challenges and Opportunities in the Twitter-Verse: Perspectives of Influencers and Social Network Analysis.

Using social media is one important strategy to communicate research and public health guidelines to the scientific community and general public. Empirical evidence about which communication strategies are effective around breastfeeding messaging is scarce. To fill this gap, we aimed to identify influencers in the largest available Twitter database using social network analysis (n = 10,694 users), inductively analyze tweets, and explore communication strategies, motivations, and challenges via semi-structured interviews. Influencers had diverse backgrounds within and beyond the scientific health community (SHC; 42.7%): 54.7% were from the general public and 3% were companies. SHC contributed to most of the tweets (n = 798 tweets), disseminating guidelines and research findings more frequently than others (p < 0.001). Influencers from the general community mostly tweeted opinions regarding the current state of breastfeeding research and advocacy. Interviewees provided practical strategies (e.g., preferred visuals, tone, and writing style) to achieve personal and societal goals including career opportunities, community support, and improved breastfeeding practices. Complex challenges that need to be addressed were identified. Ideological differences regarding infant feeding may be hampering constructive communication, including differences in influencers' interpretation of the WHO International Code of Marketing of Breast-milk Substitutes and in perspectives regarding which social media interactions encompass conflict of interest.

Real-time Twitter interactions during World Breastfeeding Week: A case study and social network analysis.

Using Twitter to implement public health awareness campaigns is on the rise, but campaign monitoring and evaluation are largely dependent on basic Twitter Analytics. To establish the potential of social network theory-based metrics in better understanding public health campaigns, we analyzed real-time user interactions on Twitter during the 2020 World Breastfeeding Week (WBW) as an exemplar case. Social network analysis (SNA), including community and influencer identification, as well as topic modeling were used to compare the activity of n = 29,958 campaign participants and n = 10,694 reference users from the six-months pre-campaign period. Users formed more inter-connected relationships during the campaign, retweeting and mentioning each other 46,161 times compared to 10,662 times in the prior six months. Campaign participants formed identifiable communities that were not only based on their geolocation, but also based on interests and professional background. While influencers who dominated the WBW conversations were disproportionally members of the scientific community, the campaign did mobilize influencers from the general public who seemed to play a "bridging" role between the public and the scientific community. Users communicated about the campaign beyond its original themes to also discuss breastfeeding within the context of social and racial inequities. Applying SNA allowed understanding of the breastfeeding campaign's messaging and engagement dynamics across communities and influencers. Moving forward, WBW could benefit from improving targeting to enhance geographic coverage and user interactions. As this exemplar case indicates, social network theory and analysis can be used to inform other public health campaigns with data on user interactions that go beyond traditional metrics.

Diffusing science through social networks: The case of breastfeeding communication on Twitter.

Breastfeeding is one of many health practices known to support the survival and health of mother and infant, yet low breastfeeding rates persist globally. These rates may be influenced by limited diffusion of evidence-based research and guidelines from the scientific community (SC). As recently highlighted by the National Academy of Sciences, there is a need for the SC to diffuse its findings to the public more effectively online, as means to counteract the spread of misinformation. In response to this call, we gathered data from Twitter for one month from major breastfeeding hashtags resulting in an interconnected social network (n = 3,798 users). We then identified 59 influencers who disproportionately influenced information flow using social network analysis. These influencers were from the SC (e.g. academics, researchers, health care practitioners), as well as interested citizens (IC) and companies. We then conducted an ego-network analysis of influencer networks, developed ego maps, and compared diffusion metrics across the SC, IC and company influencers. We also qualitatively analyzed their tweets (n = 711) to understand the type of information being diffused. SC influencers were the least efficient communicators. Although having the highest tweeting activity (80% of tweets), they did not reach more individuals compared to IC and companies (two-step ego size: 220± 99, 188 ± 124, 169 ± 97 respectively, P = 0.28). Content analysis of tweets suggest IC are more active than the SC in diffusing evidence-based breastfeeding knowledge, with 35% of their tweets around recent research findings compared to only 12% by the SC. Nonetheless, in terms of outreach to the general public, the two-step networks of SC influences were more heterogenous than ICs (55.7 ± 5.07, 50.9 ± 12.0, respectively, P<0.001). Collectively, these findings suggest SC influencers may possess latent potential to diffuse research and evidence- based practices. However, the research suggests specific ways to enhance diffusion.

Breastfeeding promotion on Twitter: A social network and content analysis approach.

The importance of breastfeeding for maternal and infant health is well-established, yet complex and intertwined sociocultural barriers contribute to suboptimal breastfeeding rates in most countries. Large-scale campaigns for evidence dissemination and promotion through targeted interventions on social media may help overcome some of these barriers. To date, most breastfeeding research on social media only focuses on content analysis, and there remains limited knowledge about the social networks of online communities (who interacts with whom), influencers in the breastfeeding space and the diffusion of evidence-based knowledge. This study, grounded in social network theory, aims to better understand the breastfeeding communication landscape on Twitter including determining the presence of a breastfeeding network, communities and key influencers. Further, we characterize influencer interactions, roles and the content being shared. The study revealed an overall breastfeeding social network of 3,798 unique individuals (users) and 3,972 tweets with commonly used hashtags (e.g., #breastfeeding and #normalizebreastfeeding). Around one third of users (n = 1,324, 34%) exchanged pornographic content (PC) that sexualized breastfeeding. The non-PC network (n = 2,474 users) formed 144 unique communities, and content flowing within the network was disproportionately influenced by 59 key influencers. However, these influencers had mostly inward-oriented interaction (% composition, E-I index: 47% professionals, -0.18; 41% interested citizens, -0.67; 12% companies, -0.18), limiting opportunities for evidence-based dissemination to the lay public. Although more tweets about peer-reviewed research findings were sent compared with tweets about nonevidence-based lay recommendations, our findings suggest that it is the lay public who often communicated findings, which may be overcome through a targeted social network-based intervention.

A qualitative examination of barriers against effective medical education and practices related to breastfeeding promotion and support in Lebanon.

Background: Insufficient breastfeeding promotion and support by physicians contribute to suboptimal breastfeeding rates globally. Understanding setting-specific barriers against breastfeeding promotion and support from the perspective of medical students and addressing those that can be modified through undergraduate medical education may help improve learning outcomes, medical practice, and ultimately health outcomes associated with breastfeeding.Objectives: We selected the underserved and under-supported public medical school in Lebanon to explore psychosocial, institutional, and societal barriers hindering effective preventative medicine practices using breastfeeding promotion and support as an exemplar case.Methods: One-on-one semi-structured interviews, each lasting around 60 min, were conducted with medical interns (in Med III and Med IV) at their training hospitals. Interviews were voice-recorded, transcribed verbatim, coded, and analyzed thematically based on Theory of Planned Behavior.Results: Interns (n= 49; 96% response rate) completed the study. Five major themes emerged addressing barriers at various levels. At the health care system level at large, interns identified the predominant focus on pathophysiology and treatment rather than on disease prevention and health promotion as a barrier. At the level of trainees and their education experiences, interns reported limited and optional clerkship training in obstetrics/gynecology and in neonatology which contributes to their insufficient knowledge and low self-efficacy. Competing financial interests from infant formula companies and social pressures to promote infant formula were identified as two main barriers at the level of physicians and clinical practice.Conclusions: Our work using breastfeeding as an exemplary case highlights how undergraduate medical education and its learning outcomes and how medical practices and patient behavior are highly intertwined with psychosocial, institutional, and social drivers and constraints. Re-evaluating the success of undergraduate medical curricula in light of overcoming these constraints and not only based on meeting national accreditation and certification guidelines might prove helpful in improving medical education and ultimately clinical practice.

Exploring the latitude of attitude: Intentions to breastfeed among adolescents in Lebanese schools.

School-based breastfeeding education (SBBE) may help improve breastfeeding rates in the long-term by targeting children and adolescents' knowledge, attitudes, skills, and intentions. Breastfeeding rates in Lebanon are suboptimal. Psychosocial drivers of breastfeeding intention among the youth are unknown. We administered a survey to 658 high school students (448 females; 210 males) at two large Lebanese schools to understand intentions, intention drivers, and views on SBBE as means to guide SBBE programme design on the basis of the theory of planned behaviour. We collected information on demographics, intention to breastfeed/support wife to breastfeed future. Intention was predicted by attitude related to breastfeeding health outcomes and family normative beliefs-χ2 (25) = 115, P < .001 for males, and χ2 (39.3) = 186, P < .001 for females. Among females, intention was also positively associated with being breastfed, higher socio-economic status, and being more accepting of public breastfeeding. Seventy-eight per cent of students felt they were not learning enough about breastfeeding in school but were interested in SBBE through didactic teaching methods and interactive experiences. Findings indicate that breastfeeding intention among adolescent students is not merely influenced by the extent of knowledge but by more complicated psychosocial drivers that may differ by gender. Our findings also suggest a misalignment exists between what schools are providing with what students feel they need, thereby opening up a potential space for intervention.

Getting schooled: teachers' views on school-based breastfeeding education in Lebanon.

Background: School-based breastfeeding education (SBBE) may help improve breastfeeding rates in the long term by instilling in young people a base of evidence-informed knowledge, skills, and attitudes that primes them to make informed decisions about infant feeding and to become positive change agents. Breastfeeding rates in Lebanon remain suboptimal, and breastfeeding misconceptions along with social pressures to use infant formula are known contributing barriers. We conducted this study with pre-K-12 teachers to understand the SBBE landscape as well as the supports and constraints for SBBE at two large Lebanese schools. Methods: We conducted a survey with 193 teachers during the 2017-2018 academic school year to collect information about demographics, breastfeeding history, breastfeeding teaching practices, attitudes towards SBBE such as attitude towards educating both boys and girls about breastfeeding, and views on potential constraints to successful SBBE implementation. Descriptive statistics and thematic analysis were used. Binary multiple logistic regression was used to ascertain the effects of teacher characteristics on likelihood to support SBBE. Results: While limited SBBE is currently taking place with only eight (4%) teachers reporting teaching about breastfeeding, 133 (69%) reported students should learn about breastfeeding in school. A multiple regression model [χ2(4) = 19.71, p = 0.001] showed teachers were more likely to support SBBE if they/their partners had ever breastfed, if they taught biology, or if they believed that schools should educate both boys and girls about breastfeeding in a society where discussing breastfeeding in public is a taboo. One hundred and ten (60%) teachers reported several concerns to SBBE implementation which included limited uptake by students who might not find SBBE valuable to them and resistance from parents due to cultural barriers. In order to effectively expand SBBE in these schools, 71 SBBE supporters (59.2% of respondents; 13 with missing data) suggested supporting local teachers to deliver SBBE, and 48 (40%) suggested mandating SBBE. Conclusions: Teachers held generally positive views on SBBE, which provides a fertile ground for growing SBBE in their schools. Future steps need to include engaging parents, students, and school principals to further understand the social constrains to SBBE before program design.

A case study on breastfeeding education in Lebanon's public medical school: exploring the potential role of social networks in medical education.

BACKGROUND: Limited knowledge, negative beliefs, and lack of sufficient breastfeeding promotion and support by physicians contribute to global suboptimal breastfeeding rates. Formal medical education is well-known to influence future physicians' knowledge, beliefs, and medical practice. However, less understood is the influence of social networks and processes on the exchange and diffusion of knowledge and practices related to breastfeeding. OBJECTIVES: We selected the underserved and under-supported public medical school in Lebanon to examine the social side of medical education. Our objectives were to assess knowledge, beliefs, and self-efficacy related to breastfeeding promotion and support among interns and residents. We also examined the social ecosystem surrounding these students concerning the exchange of breastfeeding knowledge. DESIGN: All data were collected during one study visit per participant. First, an interview-administered structured survey was used to assess beliefs, perceived knowledge, basic breastfeeding knowledge, and self-efficacy related to breastfeeding among n = 70 medical interns and residents. Then, social network data were collected during a semi-structured interview and analyzed using an ego-network approach. All interviews were voice-recorded, transcribed, coded, and thematically analyzed. Descriptive statistics were used to analyze quantitative survey and social network results. RESULTS: Although interns and residents had positive beliefs about breastfeeding benefits, they had limited knowledge and low self-efficacy related to the psychosocial and clinical aspects of breastfeeding promotion and support. They did not seem to have a well-connected professional network around breastfeeding knowledge and practices. Several tended to rely on their informal/non-professional network, such as their mothers, partners, and sisters, for knowledge and practice. CONCLUSIONS: Our work using breastfeeding as an exemplary case suggests there is a role for better attending to the beliefs of medical students as well as to the social side of medical education. Future studies can use social network theory to help identify and address influences on medical education outcomes.

In vitro activities of synthetic host defense propeptides processed by neutrophil elastase against cystic fibrosis pathogens.

The antimicrobial and hemolytic activities of a host defense peptide can be controlled by its modification as a propeptide of reduced net charge, which can then be processed by neutrophil elastase, a serine protease involved in chronic airway inflammation and infections associated with cystic fibrosis.

Agreements between the prothrombin times of blood treated In Vitro with heparinase during cardiopulmonary bypass (CPB) and blood sampled after CPB and systemic protamine.

UNLABELLED: The prothrombin time (PT) is useful for identifying coagulation factor deficits after cardiopulmonary bypass (CPB). However, long processing times and the need for fresh frozen plasma (FFP) to be thawed cause delays in factor replacement. We hypothesized that, by treating with heparinase, blood sampled toward the end of CPB can provide PT results that help to determine the requirement for FFP after CPB. Laboratory delays can be eliminated with point-of-care monitors. We studied 158 adults undergoing nonemergent cardiac surgery. Blood taken before separation from CPB was mixed with heparinase, and PT was measured in the laboratory with a HemoTec timer. Agreements between these results and laboratory measurements of blood taken after systemic protamine were compared by using Bland and Altman plots with the threshold of +/-1.0 s. We found that the laboratory PT measurements during CPB versus after CPB were compara-ble, but the limits of agreement exceeded these thresholds. Similarly, there was unsatisfactory agreement between the HemoTec and laboratory PT results measured before, during, and after CPB. For each PT measured during CPB, the corresponding confidence interval for the postprotamine PT was calculated. During CPB, a laboratory PT of < or =16 s or > or =18 s suggests a > or =83% or > or =93% probability of not requiring or potentially requiring, respectively, FFP after CPB. We conclude that the majority of PT measurements obtained from blood taken before weaning from CPB and treated in vitro with heparinase was associated with a high probability of whether or not FFP would be needed after CPB. IMPLICATIONS: Coagulation dysfunction after cardiopulmonary bypass may contribute to bleeding. Obtaining coagulation tests and fresh frozen plasma requires time and delays treatment in patients who need fresh frozen plasma. We have devised a technique to provide early estimation of postbypass coagulation status.