Communicating COVID-19 risk changes: Signalling with words, phrases, and messages.

During COVID-19, governments issued messages to trigger action, encourage sustained behaviours (e.g., social distancing, hand hygiene), and manage system wide risk. This study examines messages issued across two stages established by the World Health Organization (WHO): (a) pre-pandemic early intervention stage and (b) within-pandemic escalation stage. In April 2020, approximately one month after COVID-19 was declared a pandemic, an experiment using a sample of 769 Australian participants was conducted. Using a between-subject design, participants assessed the way messages (curated and then expertly attributed to the two stages) were perceived and influenced behaviours. Next, it examined the power of words and phrases, selected from the same messages, for (a) their potential to signal risk, warning, and behavioural response and (b) the extent to which they reflected pandemic stages. Results showed that between the two stages, messages were differentiated by negative affect, assertiveness, and risk. Subsequently, increased negative affect, assertiveness, and risk indication increased adaptive behavioural intentions. However, increased assertiveness also increased non-adaptive behavioural intentions, though increased risk indication reduced non-adaptive behavioural intentions. Signal words and phrases, which hold potential as iconic features for biological hazard messages, showed varying performance across message stages, indicating an opportunity to improve them. Taken together, the findings contribute to academic and policy approaches for adapting communication to changing risk.

Checks and balances: a business-oriented lens on disaster management and warnings.

Small businesses are critical to community recovery from disasters. However, factors that affect outcomes (such as planning, information needs, and responses to warnings) are understudied. To address the research record's focus on policy that favours disaster mitigation rather than response, this project applied a two-phased, mixed-method approach. The first study comprised interviews with businesses to elucidate disaster planning approaches, knowledge and information needs, and current warning system adequacy. It revealed opportunities to build knowledge and add business-specific content to agency-issued warnings. The second study used an online survey to examine how disaster knowledge, planning, and experience are related to existing bushfire warnings and those modified with business-relevant content. The findings show that planning is associated with experience and knowledge but not with business-related protective action intentions. Modified messages were perceived as more effective and resulted in greater action intentions among those with bushfire experience. In sum, the paper highlights implications for small business-oriented disaster risk communication.

Determinants of attitude and intention towards private health insurance: a comparison of insured and uninsured young adults in Australia.

BACKGROUND: Since the introduction in 1984 of Australia's publicly-funded universal healthcare system, Medicare, healthcare financing has relied on a mix of public and private sources to meet the needs of the population (Sowa et al., Appl Health Econ Health Policy 15:31-41, 2018). However, in recent years, there has been a decline in the number of Australians choosing to purchase private health insurance (PHI), particularly within the young adult age group with the proportion of insurance customers aged 20 to 29 falling from 10.3 to 9.4% between 2012 and 2017 (Sivey, The Conversation, 2017). Young adults are critical to private health insurance funding models as their involvement offsets the drawdown by older adults (Dalzell and Borys, ABC News, 2019). While this issue is widely reported in the Australian media, few empirical studies have explored the factors that enable or constrain young adults' enrolment in PHI. METHODS: To address the scarcity of research about the motivational factors behind young adult decision-making, this study conducted a survey of 594 Australian young adults aged between 18 and 30 years. Within this age group, the survey sought an equal split of participants who were members and non-members of PHI schemes. CONCLUSION: The findings identified perceived value and trust in insurers as additional motivational factors alongside traditional measures of recognition of the problem and involvement in the problem. Differences between the insured and uninsured groups were identified which help to shape a more holistic understanding of the key motivational factors and barriers in relation to Australian young adults' enrolment in PHI.

Creating a Palliative Care Inpatient Response Plan for COVID-19-The UW Medicine Experience.

CONTEXT: The coronavirus disease 2019 (COVID-19) pandemic is stressing health care systems throughout the world. Significant numbers of patients are being admitted to the hospital with severe illness, often in the setting of advanced age and underlying comorbidities. Therefore, palliative care is an important part of the response to this pandemic. The Seattle area and UW Medicine have been on the forefront of the pandemic in the U.S. METHODS: UW Medicine developed a strategy to implement a palliative care response for a multihospital health care system that incorporates conventional capacity, contingency capacity, and crisis capacity. The strategy was developed by our palliative care programs with input from the health care system leadership. RESULTS: In this publication, we share our multifaceted strategy to implement high-quality palliative care in the context of the COVID-19 pandemic that incorporates conventional, contingency, and crisis capacity and focuses on the areas of the hospital caring for the most patients: the emergency department, intensive care units, and acute care services. The strategy focuses on key content areas, including identifying and addressing goals of care, addressing moderate and severe symptoms, and supporting family members. CONCLUSION: Strategy planning for delivery of high-quality palliative care in the context of the COVID-19 pandemic represents an important area of need for our health care systems. We share our experiences of developing such a strategy to help other institutions conduct and adapt such strategies more quickly.

Trust, but verify: social media models for disaster management.

A lack of trust in the information exchanged via social media may significantly hinder decisionmaking by community members and emergency services during disasters. The need for timely information at such times, though, challenges traditional ways of establishing trust. This paper, building on a multi-year research project that combined social media data analysis and participant observation within an emergency management organisation and in-depth engagement with stakeholders across the sector, pinpoints and examines assumptions governing trust and trusting relationships in social media disaster management. It assesses three models for using social media in disaster management-information gathering, quasi-journalistic verification, and crowdsourcing-in relation to the guardianship of trust to highlight the verification process for content and source and to identify the role of power and responsibilities. The conclusions contain important implications for emergency management organisations seeking to enhance their mechanisms for incorporating user-generated information from social media sources in their disaster response efforts.

Acetic Acid as Part of a Debridement Protocol During Revision Total Knee Arthroplasty.

BACKGROUND: Thorough debridement is mandatory in revision for infected total knee arthroplasties (TKA). We investigated a novel adjuvant chemical debridement strategy using acetic acid (AA) that seeks to create a hostile environment for microorganisms. We report the first orthopedic in vivo series using an AA soak in infected TKAs. We also investigated the in vitro efficacy of AA against bacteria isolated from these knees. METHODS: Twenty-three patients with infected TKA were treated with a standard debridement protocol and chemical debridement with a 20-minute AA soak. In parallel, bacteria from infected TKAs were cultured for in vitro susceptibility testing with AA solutions of different concentrations to understand its potential mechanism of action. RESULTS: Intraoperatively, there were no physiological responses during the AA soak or on release of the tourniquet. Postoperatively, there was no increase in analgesic requirements or wound or soft-tissue complications. Clinical follow-up continued for 24 months to monitor recurrent infection. In vitro, zones of inhibition were formed on less than 40% of the organisms, demonstrating that AA was not directly bactericidal against the majority of the isolates. However, when cultured in a bacterial suspension, AA completely inhibited the growth of the isolates at concentrations as low as 0.19% vol/vol. CONCLUSION: This study has shown that the use of 3% AA soak, as part of a debridement protocol is safe in patients. While the exact mechanism of action is yet to be determined, AA concentrations as low as 0.19% vol/vol in vitro are sufficient to completely inhibit bacterial growth.

Risk Perception and the Public Acceptance of Drones.

Unmanned aircraft, or drones, are a rapidly emerging sector of the aviation industry. There has been limited substantive research, however, into the public perception and acceptance of drones. This article presents the results from two surveys of the Australian public designed to investigate (1) whether the public perceive drones to be riskier than existing manned aviation, (2) whether the terminology used to describe the technology influences public perception, and (3) what the broader concerns are that may influence public acceptance of the technology. We find that the Australian public currently hold a relatively neutral attitude toward drones. Respondents did not consider the technology to be overly unsafe, risky, beneficial, or threatening. Drones are largely viewed as being of comparable risk to that of existing manned aviation. Furthermore, terminology had a minimal effect on the perception of the risks or acceptability of the technology. The neutral response is likely due to a lack of knowledge about the technology, which was also identified as the most prevalent public concern as opposed to the risks associated with its use. Privacy, military use, and misuse (e.g., terrorism) were also significant public concerns. The results suggest that society is yet to form an opinion of drones. As public knowledge increases, the current position is likely to change. Industry communication and media coverage will likely influence the ultimate position adopted by the public, which can be difficult to change once established.

Who needs microtubules? Myogenic reorganization of MTOC, Golgi complex and ER exit sites persists despite lack of normal microtubule tracks.

A wave of structural reorganization involving centrosomes, microtubules, Golgi complex and ER exit sites takes place early during skeletal muscle differentiation and completely remodels the secretory pathway. The mechanism of these changes and their functional implications are still poorly understood, in large part because all changes occur seemingly simultaneously. In an effort to uncouple the reorganizations, we have used taxol, nocodazole, and the specific GSK3-ß inhibitor DW12, to disrupt the dynamic microtubule network of differentiating cultures of the mouse skeletal muscle cell line C2. Despite strong effects on microtubules, cell shape and cell fusion, none of the treatments prevented early differentiation. Redistribution of centrosomal proteins, conditional on differentiation, was in fact increased by taxol and nocodazole and normal in DW12. Redistributions of Golgi complex and ER exit sites were incomplete but remained tightly linked under all circumstances, and conditional on centrosomal reorganization. We were therefore able to uncouple microtubule reorganization from the other events and to determine that centrosomal proteins lead the reorganization hierarchy. In addition, we have gained new insight into structural and functional aspects of the reorganization of microtubule nucleation during myogenesis.

Dystrophin is a microtubule-associated protein.

Cytolinkers are giant proteins that can stabilize cells by linking actin filaments, intermediate filaments, and microtubules (MTs) to transmembrane complexes. Dystrophin is functionally similar to cytolinkers, as it links the multiple components of the cellular cytoskeleton to the transmembrane dystroglycan complex. Although no direct link between dystrophin and MTs has been documented, costamere-associated MTs are disrupted when dystrophin is absent. Using tissue-based cosedimentation assays on mice expressing endogenous dystrophin or truncated transgene products, we find that constructs harboring spectrinlike repeat 24 through the first third of the WW domain cosediment with MTs. Purified Dp260, a truncated isoform of dystrophin, bound MTs with a K(d) of 0.66 microM, a stoichiometry of 1 Dp260/1.4 tubulin heterodimer at saturation, and stabilizes MTs from cold-induced depolymerization. Finally, alpha- and beta-tubulin expression is increased approximately 2.5-fold in mdx skeletal muscle without altering the tubulin-MT equilibrium. Collectively, these data suggest dystrophin directly organizes and/or stabilizes costameric MTs and classifies dystrophin as a cytolinker in skeletal muscle.

Microtubule plus-end binding protein EB1 is necessary for muscle cell differentiation, elongation and fusion.

During muscle differentiation, microtubule stability, nucleation and orientation all undergo profound changes, which are simultaneous with and possibly necessary for the elongation and fusion of muscle cells. We do not yet understand these events, but they present similarities with the polarized migration of fibroblasts, in which EB1 is necessary for microtubule stabilization. However, it was recently reported that EB3, not EB1, is involved in muscle cell elongation and fusion, and that neither of these two proteins influences microtubule stabilization. To re-examine the role of EB1, we have generated C2 cell lines permanently expressing EB1-targeted shRNAs. In these lines, EB1 is specifically knocked down by more than 90% before any differentiation-related changes can take place. We find that differentiation (assessed by myogenin expression), elongation and fusion are prevented. In addition, two early events that normally precede differentiation - microtubule stabilization and the accumulation of cadherin and beta-catenin on the plasma membrane - are inhibited. Re-expression of EB1 as EB1-GFP restores all aspects of normal differentiation, whereas overexpression of EB3-GFP restores elongation but not fusion. We conclude that EB1 is necessary for the early stages of muscle differentiation.