Making a Difference—Supporting Members and Pursuing Excellence

Many studies have been conducted on energy dissipation walls for small houses to improve the earthquake resistance of structures in Japan. Oil dampers, a main damper, is installed in studs to increase their strength. However, this method tends to deform each member and joint—“support members”—owing to tensile force, and therefore, the energy absorption performance of the damper tends to decrease. In this study, we propose an energy-dissipation wall that increases the overall stiffness by prestressing the support members to prevent tensile deformation. From 2020 to 2021, two types of specimens using laminated veneer lumber (LVL) as supporting members—Type 1 and Type 2—were tested to understand the mechanical behavior of the wall. Both types were subjected to static loading tests. Additionally, dynamic loading tests were applied to Type 2. Moreover, the dynamic behavior of the one-story wooden structure installed on the Type 1 wall was investigated by subjecting it to artificial earthquake waves. In state R which the damper part of the energy dissipation wall is restrained the load-deformation relationships obtained from the static loading tests for the two types of specimens using LVL as support members showed almost linear behavior up to the assumed damper load level for both specimens. In the dynamic loading test on Type 2, a stable load-deformation history with almost no slip was obtained. In shaking table test on Type 1, it was found that the energy dissipation wall incorporated into the wooden structure absorbed the energy of the artificial earthquake shaking and prevented the deterioration of its bearing capacity.

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Members of the Rastafari movement, which originated in Jamaica, are found in the Caribbean and in parts of the United States and Europe with a large Afro-Caribbean population. To help mental health professionals serve members of this group more effectively, the authors review literature on the movement and present clinical case examples with analyses and recommendations for interventions. The Rastafari movement is both a political and a religious group with a life-style that includes the wearing of dreadlock hairstyles and the sacramental use of marijuana. The group also advocates opposition to traditional government and support members' repatriation to Africa. Clinicians involved in caring for Rastafari are encouraged to make diagnoses based on phenomenological grounds rather than on social behavior. Many blacks who became engaged in the antithetical transformation to membership in the Rastafari movement may be attempting to resolve racial, religious, class, and gender conflicts. The Rastafari movement may provide an affirmation of black identity and a moral framework for black people emerging from centuries of slavery, colonization, and oppression.

Indonesia has seen recent expansions of fundamentalist movements mobilising members in support a change to the current constitution. Against this background, two studies were conducted. In Study 1, we explored the intersection of religious and national identity among Indonesian Muslims quantitatively, and in Study 2, we qualitatively examined religious and national identification among members of moderate and fundamentalist religious organisations. Specifically, Study 1 ( N = 178) assessed whether the association of religious and national identity was moderated by religious fundamentalism. Results showed that strength of religious identification was positively associated with strength of national identification for both those high and low in fundamentalism. Using structured interviews and focus group discussions, Study 2 ( N = 35) examined the way that self-alignment with religious and national groups develops among activists of religious movements in Indonesia. We found that while more fundamentalist activists attached greater importance to their religious identity than to any other identity (e.g., national and ethnic), more moderate activists represented their religious and national identities as more integrated and compatible. We conclude that for Indonesian Muslims higher in religious fundamentalism, religious and national identities appear to be less integrated and this is consequential for the way in which collective agendas are pursued.

Schools provide an exceptional opportunity for mental health promotion and intervention. To describe the development of a World Health Organization (WHO) mental health in schools programme in the Eastern Mediterranean Region. Two tenets guided development of the mental health in schools programme: (1) it used a multitiered system of support framework that includes 3 tiers of interventions (universal, early and targeted); and (2) interventions that must be feasible for implementation by non-mental health professionals. The WHO mental health in schools programme manual is organized into a background section, followed by 3 modules: social-emotional childhood development; mental health promoting schools (promotion and prevention); and addressing student mental health problems in your classroom, including specific classroom strategies and case examples. Developing an appropriate curriculum that is sensitive to the needs of individual countries requires involvement of those familiar with schooling in those countries. It should include mental health priorities and practices that promote mental health, and coalesce school staff, parents and community members in support of their children.

The role of a pharmacy emergency response team (PERT) trained to respond to episodes of terrorism involving chemical, biological, radiological, and nuclear (CBRN) agents is described. Pharmacists must be prepared to support their health systems in responding to episodes of terrorism by detecting exposure to CBRN agents and mitigating, treating, and preventing casualties resulting from exposure to those agents. Maimonides Medical Center, whose pharmacists responded to the medical and pharmaceutical needs of victims of the World Trade Center attacks and anthrax exposures, has developed the PERT, modeled after the Health Emergency Incident Command System, to standardize the response of their pharmacists in the event of such an attack. Each team member has a specific role and can assume any other team member's role, if needed. Key players in the PERT include the pharmacy administrator, drug information pharmacist, intensive care unit pharmacist, infectious diseases pharmacist, nuclear pharmacist, management-information-system pharmacist, hazardous materials pharmacist, and auxiliary-site pharmacist. The most important features of this disaster response model include activating the PERT to establish command and control in the pharmacy department, conducting a disaster-needs analysis, deploying PERT members in support of the medical center during a public health emergency involving CBRN agents while maintaining normal operations in the pharmacy, and maintaining, mobilizing, distributing, and receiving a pharmaceutical stockpile while ensuring that timely antidotes are available and used appropriately when distributed. The PERT allows for a comprehensive pharmacy response within a health system to episodes of terrorism involving CBRN agents.

It is now generally accepted that the diagnosis of many pediatric cancers and their treatments result in significant and long-lasting neurocognitive, psychological, and psychosocial impairments and difficulties. The current status of research in this field has been addressed by other chapters in this text. We would, however, like to emphasize at the onset of our chapter that we firmly believe pediatric cancer is truly a family affair. The effects of the diagnosis of a life-threatening illness and its often-chronic treatment not only result in significant impact on the child’s or adolescent’s neuropsychological and psychological state, but also cause psychological ramifications for the parents, siblings, and extended family members. In healthy, well-functioning families, this major life obstacle can serve as an impetus to rally family members in support of the child. When this happens, interventions for late effects are beginning to be identified as effective and of potential benefit. This field, however, is clearly in its infancy. If the family is chaotic and struggling with relationship issues, the prognosis is less positive. Our clinical observations of these relationships are supported both by preliminary data from studies conducted by our research group and others, and by published manuscripts in the field of pediatric traumatic brain injury (Yeates et al., 1997, 2001). In one of the only studies investigating the impact of familial variables on psychosocial and neuropsychological outcome in pediatric brain tumor patients, the results are extremely consistent with the traumatic brain injury population (Carlson-Green, Morris, & Krawjecki, 1995). Reduced maternal dependence on external coping resources, higher parental socioeconomic status, dual-parent families, and familial cohesion were all identified as improving long-term outcome in this population, as documented by intellectual and behavioral integrity. The late effects of pediatric cancer and its treatment are physical, cognitive, psychological, and social. When multiple effects are present, they can be expected to result in a synergistic impact not only on the child, but also on other family members. The important point is that late effects should not be viewed in isolation or summated but should be appreciated for their interrelatedness.

A narrative analysis of anti-abortion testimony and legislative debate related to Georgia’s fetal “heartbeat” abortion ban

Entering the 1980s, Japan's budget deficit ranked among the highest in the circle of advanced industrial democracies. However, by the end of the decade, the government was able to entirely eliminate its use of deficit-financing bonds. This article explores the political dynamics that account for this puzzling and dramatic change. Focusing on the interests and interactions of the societal actors and political parties that comprise Japan's ruling coalition, I argue that this abrupt change is primarily attributable to the manner in which the fiscal crisis led to the unraveling of the decade-old compromise among coalition members in support of deficit-financing. However, the movement begun in the early 1980s to eliminate deficit-financing did not reflect a return of the budget-making powers of the Ministry of Finance, as is commonly argued, but instead represented a realignment of the relative strength and policy preferences of members of Japan's ruling coalition.

Purpose The purpose of this case study is to understand the worldviews of Drag Queen Story Time (DQST) challengers and supporters as they relate to public libraries. The findings are used to theorize the underlying motivations of the two groups and provide insight into issues of library practice. Design/methodology/approach This case study employed qualitative thematic analysis to analyze 406 publicly available letters written by community members in support or opposition of DQST programming offered at the Okanagan Regional Library in Canada in 2019. Findings Dominant themes emerged on the public library's nature, function and neutrality. Supporters believed that public libraries value democracy, foster development of individuals, and advance human rights. Challengers believed that public libraries had a role as a protector and should be unaligned, passive, moral and not educate on certain topics. Both groups recognized neutrality as a foundational element in libraries, though its role in upholding democracy was viewed critically by supporters and positively by challengers. Originality/value The value of this study comes first from the unique dataset, a large corpus of text that offers a close look at the worldviews of both DQST challengers and supporters. Examining this case reveals detailed interpretations of library issues directly by public library patrons, such as neutrality. The analysis makes novel theorizations on how humanism, Christian integralism and Bourdieu's symbolic power can be used to understand the nature of the discourse from the opposing user groups, thereby informing library professionals on differing perspectives. In light of the arguments found, a new context is added to the professional issue of neutrality and social responsibility and suggestions are offered as a path forward.

BackgroundcCMV infection is a major contributor to childhood neurologic and cognitive disabilities including sensorineural hearing loss (SNHL). Neonatal treatment with ganciclovir/valganciclovir improves hearing outcomes, but its impact on neurodevelopmental outcomes remains an important knowledge gap. We describe the neurodevelopmental outcomes of children with cCMV infection and evaluate the effect of neonatal antiviral therapy on outcomes. MethodsSince 2013, infants with cCMV infection referred to Nationwide Children’s Hospital’s NEO-ID Clinic have had a complete evaluation at diagnosis as well as follow-up neurodevelopmental assessments. Pertinent demographic, clinical, laboratory, radiographic, and follow-up data were obtained and managed using REDCap. Neurodevelopmental assessments were performed using Bayley Scales of Infant and Toddler Development (BSID) III/IV (cognitive, language, motor domains) at ~ 24 months of age. The Gross Motor Function Classification System was used to classify functional motor impairment. Neurodevelopmental outcomes were compared by receipt of antiviral therapy in early infancy. Results95 infants (mean ± SD; gestational age 35 ± 5 wk, birth weight 2121 ± 948 g; Table 1) with cCMV infection had follow-up neurodevelopmental assessments. 62% had central nervous system involvement, 37% had SNHL, 23% developed cerebral palsy (CP), and 6% were diagnosed with autism spectrum disorder. The majority had normal BSID scores (≥ 85) in cognitive and motor domains (65% and 54%, respectively) while 48% had normal scores in the language domain. 35% had severe impairment (< 70) in ≥ 1 domain (Table 2). 9 children had clinically inapparent cCMV infection; 2 (22%) had abnormalities on BSID testing (1, cognitive score: 80; 1, cognitive, language, and motor scores: 65, 68, 73, respectively). 11 (12%) children, including 6 who received antiviral therapy, had severe neurodevelopmental impairment, with CP and severe (< 70) BSID scores in both the cognitive and motor domains. Table 1. Demographic and Clinical Characteristics of 95 Children with Congenital CMV Infection by Receipt of Antiviral TreatmentTable 2. Neurodevelopmental Outcomes Based on Testing with the Bayley Scales of Infant and Toddler Development (BSID) III/IVConclusionA substantial proportion of children with cCMV infection had moderate (29%) or severe (33%) neurodevelopmental impairment, CP, or autism spectrum disorder, irrespective of antiviral treatment. Urgency exists for antenatal preventive strategies and vaccine development.DisclosuresAsuncion Mejias, MD, PhD, MsCS, Janssen (Grant/Research Support, Advisor or Review Panel member)Merck (Grant/Research Support, Advisor or Review Panel member)Roche (Advisor or Review Panel member)Sanofi (Advisor or Review Panel member)

BackgroundSeveral interventional Coronavirus Disease 2019 (COVID-19) studies assess outcomes at day 28, but this follow-up time can be too short, since COVID-19 often cause protracted disease. Further, data on mortality and readmissions after discharge are scarse.MethodsPatients aged 18-100 years and hospitalized with COVID-19 in Eastern Denmark between March 18th, 2020 and January 12th, 2021, were followed for 91 days after admission. Patients were stratified in a first and second wave, by admissions before or after June 15th, 2020, app. when remdesivir and dexamethasone were introduced as standard of care. Sustained recovery was defined as the first date, achieving 14 consecutive days after hospital discharge without an event of readmission or death. Cumulative incidences of sustained recovery were estimated in both waves and in subgroups based on the patient’s maximum level of respiratory support in the first 14 days of admission as a proxy for disease severity. Risk factors for poor outcomes were assessed in a multivariable cox proportional hazards model.ResultsOverall 3,386 patients were included in the study; 1,137 and 2,249 patients were admitted in the first and second wave, respectively (Table 1). The cumulative incidence of sustained recovery at day 91 was higher in the second (0.79, 95% CI: 0.77,0.81) than in the first wave (0.72, 95% CI: 0.70, 0.75) (Fig. 1A). In both waves, those with more severe disease recovered at a slower rate (Fig. 2B). There were no differences in cumulative incidences of readmissions or deaths at day 91 after discharge between the two waves, cumulative incidence (0.20, 95% CI: 0.19,0.21) and (0.11, 95% CI: 0.09,0.12), respectively (Fig 1C, Fig 1D). Male sex, high age, cardiovascular disease, diabetes, chronic pulmonary disease, renal disease, malignancies and neurological disease were associated with lower rates of sustained recovery (Table 2). ConclusionA follow-up period of 28 days in clinical trials for COVID-19 treatments is too short, especially for patients with severe disease. Rates of adverse outcomes after hospital discharge are non-neglible. In-hospital mortality was reduced with improvements in treatment, but post discharge mortality and readmissions rates did not change significantly. DisclosuresCarsten Utoft Niemann, PhD MD, Abbvie (Grant/Research Support, Advisor or Review Panel member)Astra Zeneca (Grant/Research Support, Advisor or Review Panel member, teaching)CSL Behring (Consultant)Genmab (Grant/Research Support)Gilead (Grant/Research Support)Janssen (Grant/Research Support, teaching)Novo Nordisk Foundation (Grant/Research Support)Roche (Grant/Research Support)Sunesis (Grant/Research Support)

BackgroundClinical guidelines for community-acquired pneumonia (CAP) encourage validation of local risk factors for multidrug-resistant organisms. This study aimed to validate previously derived, local risk factors for Pseudomonas aeruginosa in patients with community-onset bacterial pneumonia at Prisma Health-Midlands’ hospitals. MethodsIn this retrospective, observational cohort study, adult patients hospitalized with pneumonia MS-DRG codes from January 1, 2017 to March 31, 2020 were randomly screened. Enrolled subjects were admitted to 1 of 3 Prisma Health-Midlands’ hospitals with: diagnosis of pneumonia; receipt of inpatient antibiotics within 48 hours of symptom onset; receipt of over 48 hours of antibiotic therapy; and a causative bacterial pathogen identified via respiratory or blood culture, urinary antigen, or respiratory multiplex PCR panel. Performance of the locally derived score was compared to the Drug Resistance in Pneumonia (DRIP) Score, IDSA 2019 CAP guideline risk factors, and healthcare-associated pneumonia (HCAP) risk factors. Endpoints included sensitivity, specificity, positive and negative predictive value, overall accuracy, and over- and undertreatment rates. Overall accuracy was defined as a case in which the gram-negative antibiotic coverage recommended by the scoring schema would have been appropriate for the identified organism, i.e. neither overtreatment (overly broad-spectrum) nor undertreatment (inadequate spectrum). ResultsOf 713 patients screened, 36 patients met criteria and were enrolled. The most common bacterial pathogens identified were Pseudomonas aeruginosa (n = 10, 27.8%) and Streptococcus pneumoniae (n = 10, 27.8%). Performance characteristics for each scoring schema are summarized in Table 1.Table 1. Performance characteristics of risk scores predicting for Pseudomonas aeruginosa community-onset bacterial pneumonia. MDRO=multidrug-resistant organism; DRIP=Drug Resistance in Pneumonia Score; IDSA=Infectious Diseases Society of America 2019 Community-Acquired Pneumonia Guideline risk factors ; HCAP=healthcare-associated pneumonia risk factorsConclusionCompared to DRIP or IDSA 2019 CAP risk scores, the local risk score performed well at ruling out resistant gram-negatives given its higher specificity and lower overtreatment rate; yet, it did not perform as well at ruling in resistant gram-negatives given a lower sensitivity and undertreatment rate. All scores performed better than HCAP risk factors. Data from this study will be utilized to further refine the local risk score algorithm. Disclosures P. Brandon Bookstaver, Pharm D, ALK Abello, Inc. (Grant/Research Support, Advisor or Review Panel member)Biomerieux (Speaker’s Bureau)Kedrion Biopharma (Grant/Research Support, Advisor or Review Panel member) Hana Winders, PharmD, BCIDP, biomerieux (Grant/Research Support) Julie Ann Justo, PharmD, MS, BCPS-AQ ID, bioMerieux (Speaker’s Bureau)Merck & Co. (Advisor or Review Panel member)Therapeutic Research Center (Speaker’s Bureau)Vaxart (Shareholder)

BackgroundA major challenge to identifying effective treatments for COVID-19 has been the conflicting results offered by small, often underpowered clinical trials. The World Health Organization (WHO) Ordinal Scale (OS) has been used to measure clinical improvement among clinical trial participants and has the benefit of measuring effect across the spectrum of clinical illness. We modified the WHO OS to enable assessment of COVID-19 patient outcomes using electronic health record (EHR) data.MethodsEmploying the National COVID Cohort Collaborative (N3C) database of EHR data from 50 sites in the United States, we assessed patient outcomes, April 1,2020 to March 31, 2021, among those with a SARS-CoV-2 diagnosis, using the following modification of the WHO OS: 1=Outpatient, 3=Hospitalized, 5=Required Oxygen (any), 7=Mechanical Ventilation, 9=Organ Support (pressors; ECMO), 11=Death. OS is defined over 4 weeks beginning at first diagnosis and recalculated each week using the patient’s maximum OS value in the corresponding 7-day period. Modified OS distributions were compared across time using a Pearson Chi-Squared test.ResultsThe study sample included 1,446,831 patients, 54.7% women, 14.7% Black, 14.6% Hispanic/Latinx. Pearson Chi-Sq P< 0.0001 was obtained comparing the distribution of 2nd Quarter 2020 OS with the distribution of later time points for Week 4.Table 1. OS at week 1 and 4 by quarterThe study sample included 1,446,831 patients, 54.7% women, 14.7% Black, 14.6% Hispanic/Latinx. Pearson Chi-Sq P< 0.0001 was obtained comparing the distribution of 2nd Quarter 2020 OS with the distribution of later time points for Week 4.ConclusionAll Week 4 OS distributions significantly improved from the initial period (April-June 2020) compared with subsequent months, suggesting improved management. Further work is needed to determine which elements of care are driving the improved outcomes. Time series analyses must be included when assessing impact of therapeutic modalities across the COVID pandemic time frame.DisclosuresSally L. Hodder, M.D., Gilead (Advisor or Review Panel member)Merck (Grant/Research Support, Advisor or Review Panel member)Viiv Healthcare (Grant/Research Support, Advisor or Review Panel member)

In this article, the authors examine the impact of fair treatment by a group leader on people's relationships with and feelings toward other individual group members. Previous studies neglected procedural fairness effects on interpersonal relationships between group members. The authors hypothesized that fairness affects interpersonal relationships and feelings toward another group member only when the leader is regarded as representative and supported by the other group members. In three studies, the authors manipulated procedural fairness (no voice vs. voice) and other group member's support for the leader (full vs. mixed support for the leader). Two vignette studies supported the hypothesis. In addition, an experimental laboratory study showed that this interaction effect between procedural fairness and leader support was most pronounced among those with high belongingness needs.