Psychological effects of withholding treatment that could have benefited a patient during a pandemic remain largely unknown. It is also unclear to what extent their reasons for withholding treatment contributed to the subsequent impact on mental health outcomes. Paramedics may have withheld treatments either due to fear of exposure, being directed by their service, or both. As such, the present research aimed to characterize withholding treatment and investigate potential negative mental health outcomes.
Materials and Methods
Paramedics from five provinces (Alberta, British Columbia, Manitoba, Ontario, Saskatchewan) working during the COVID-19 pandemic completed online questionnaires assessing withholding treatment (i.e., due to fear of exposure, directed by their service, or both), and mental health outcomes including depression (PHQ-9) and post-traumatic stress (PTSD) symptoms (PC-PTSD-5) as part of the COVID-19 Occupational Risks, Seroprevalence and Immunity among Paramedics (CORSIP) study.
Results
Of the 1453 participants, 54.2% reported withholding treatment due to fear of exposure (4.3%), as directed by their service (76.5%) or both (19.2%). Participants who withheld treatment reported higher rates of PTSD (M=2.6, p < .01) and depression (M=8.2, p < .001) symptoms than those that did not withhold treatments (MPTSD=2.3; Mdepression=6.4). Reason for withholding treatment and PTSD symptom severity were associated (p<.01). Paramedics who withheld treatment due to fear of exposure were more likely to report probable PTSD symptoms (23.5%) than those who withheld treatments as directed by their service (8.7%) or both (12.2%). Depression symptom severity did not differ by reasons for withholding treatment.
Conclusions
Withholding treatment is potentially traumatic and may influence the development of depression and PTSD symptoms. Withholding due to fear of exposure rather than being directed to increased PTSD symptoms. Further research will investigate the mental health impact of withholding treatment and reported reasons for withholding over time.
Columbus Avenue interrupts the orthogonal logic of San Francisco's grid. At Broadway this disruption takes on a unique identity: the jum bled mixing point of districts that are vigorously diverse. In reading this intersection as a place unto itself, how do we unscramble all the messages coming at us? How do we attend to one conversation when three others are within earshot? As you exit the peculiar inner-city tunnel on Broadway, driving toward downtown, you see before you, flickering in the exhaust fumes, a dazzling oasis of lights and color. Layers of open shops and restaurants spill their contents out onto the sidewalk. The cityscape is flooded to the knees with waves of cars and people. Then, you see her—first in line among a row of impressive signs, a long and stringy figure that stretches three stories of a building. She leads you on with her blinking beacons—as you approach she looms before you, a monster with her awk ward body and evil expression; she stares you down. In the distance you see the free way, a bridge arching its spine into the blue hills across the Bay, and, once the light turns green, you make for your getaway. The intersection of Columbus and Broadway exists as both path and desti nation. For through-traffic it is the junction of major arteries: another set of stop lights with special potential for delay. The trajectories of these wide streets are resolute. Distances along them are foreshortened by views of the Bay Bridge and of office towers downtown, both beckoning destinations. To experience this place on foot is quite a different matter. The inter section is less a crossing of paths than it is a bringing together of corners. Because the intersection is hourglass shaped, its narrow waist seems to focus like a lens, drawing together disparate interests and activities on all sides: Chinatown, Italian Quarter, Red Light District and Downtown Fringe. Each character hugs the perimeter of a block, and not one street maintains a con sistent identity across the common ground between. The diagonal traverse
Canadian Paramedic services modified infection prevention and control (IPAC) practices in response to COVID-19. These changes may affect risk of exposure to infectious disease agents and can be used to inform future IPAC practices. We characterized COVID-19-related IPAC changes in the provinces of Alberta, British Columbia, Manitoba, Ontario, and Saskatchewan.
Materials & Methods
Questionnaire data (January 2021-Feb 2022) from the national COVID-19 Occupational Risks, Seroprevalence and Immunity among Paramedics (CORSIP) project was used to identify which IPAC practices were in place prior to COVID-19, and which were modified in response to COVID-19, including the timing of changes (March-May 2020; June-Aug 2020; Sept-Nov 2020; Nov 2020-present).
Results
2939 participants were included (146, 1249, 139, 1317, 88 from Alberta, BC, Manitoba, Ontario, and Saskatchewan, respectively), of whom 2674 (91%) reported receiving IPAC training. IPAC measures that were common prior to COVID-19 included: personal protective equipment (PPE) training, patient screening, hand hygiene, N95/P100 respirators, gowns, impermeable suits, and cleaning/disinfection. COVID-related IPAC changes included: screening staff, social distancing, restricting aerosol generating procedures, masking patients, cloth face coverings, surgical masks, face shields, and elastomeric respirators. Changes were reported for all IPAC measures. Most (71%) of these changes were made early in the COVID-19 pandemic (March-May 2020). Differences in proportions across provinces, community practice settings, and professional regulation status were reported (p < .05) for hand hygiene, PPE training, screening of patients, face shields, and various respirator types.
Conclusion
Canadian paramedic services were quick to modify available IPAC measures. However, these changes were variable across provinces, regulation status, and setting for specific IPAC measures. Inconsistent IPAC measures across jurisdictions may contribute to variable risk of infectious disease exposure. An evidence-informed and nationally coordinated approach may provide more equitable exposure risk mitigation for paramedic workers.
Previous results suggest that COVID-19 adversely impacted a number of health and coping measures among Canadian paramedics, particularly females. Estimated prevalence for meeting screening criteria for mental health disorders and suicidal thoughts were higher than previously reported.
Objectives
To provide an update on the impact of the COVID-19 pandemic on the wellbeing of Canadian paramedics with the inclusion of an additional year of participant data.
Methods
Self-reported questionnaire data was collected from paramedics across five Canadian provinces as part of the COVID-19 Occupational Risks, Seroprevalence and Immunity among Paramedics (CORSIP) project. Validated psychological assessment tools were used to screen for major depressive disorder (MDD, PHQ-9 questionnaire) and probable post-traumatic stress disorder (PTSD, PC-PTSD-5 questionnaire). Satisfaction with life (SWL) scores were adapted from validated Canadian Census questions and confirmed by reliability analysis. All measures were compared before versus during the pandemic using Wilcoxon signed-ranked, Cliff's d, and differences in proportions tests where appropriate.
Results
Questionnaires from an additional 1662 recruited paramedics were included, now totaling 3568 participants. Prevalence meeting screening criteria remained similar for MDD (31.6%) and PTSD (41.4%), with PTSD risk continuing to not be impacted by COVID-19. Paramedics continued to report higher median SWL scores (20 vs. 17, p<.001) prior to the pandemic, with a large effect size (d=0.58) that suggests a greater probability of reporting higher SWL prior to COVID-19. Suicidal ideation (i.e., 'thoughts that you would be better off dead, or of hurting yourself in some way') was reported by 9.0% of paramedics, which was consistent with original findings.
Conclusion
Original findings appear stable with the addition of another year of participant data. Future analyses will be employed to investigate whether health and satisfaction measures differed between the original cohort and added participants by adjusting for questionnaire responses with respect to the pandemic timeline.
The attachment of bioactive protein to surfaces underpins the development of biosensors and diagnostic microarrays. We present a surface treatment using plasma immersion ion implantation (PIII) to create stable covalent binding sites for the attachment of functional soya-bean peroxidase (SBP). Fourier transform infrared spectra of the surfaces show that protein is retained on the surface after boiling in sodium dodecyl sulphate and sodium hydroxide, which is indicative of covalent attachment. The activity of SBP on the treated surfaces remains high in comparison with SBP attached to control surfaces over the course of 11 days. Surface plasmon resonance was used to show that the surface coverage of the attached protein is close to a monolayer. We describe the potential of the PIII treatment method to be used as a one-step dry process to create surfaces for large-scale protein micro- or nanopatterning.
A pulsed electron accelerator has been constructed and is now in operation at the Lawrence Radiation Laboratory, Berkeley. It was designed specifically for and is used as an injector for ERA (electron ring accelerator) studies. Electron bursts of 1200 amperes and 40 nanoseconds duration can be produced at energies of 1.0 MeV to 4.25 MeV. The present repetition rate is approximately one per second. Acceleration is accomplished by means of ferrite loaded accelerating sections, each of which is capable of maintaining a 250 kV voltage pulse across the accelerating gap for a period of 40 ns. The voltage pulse has a rise time of 12 ns and the total timing jitter is of the order of one nanosecond. Five sections stacked together and operated as a unit function as the electron gun. The gun employs a field emission cathode and is operated at approximately 1 MV. Additional acceleration is achieved by means of an iterated system of accelerator sections and solenoidal magnetic lenses.
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