Private Room Research Articles

Infection prevention measures for patients undergoing hemodialysis during the COVID-19 pandemic in Japan: a nationwide questionnaire survey

BackgroundCoronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic affecting a variety of medical treatments, including hemodialysis. This study aims to investigate the implementation of infection control measures, to examine the shortage of personal protective equipment (PPE) and disinfectants, and to quantify the number of nosocomial COVID-19 transmissions in hemodialysis facilities in Japan during the pandemic.MethodsWe conducted a nationwide questionnaire survey between 20 October and 16 November 2020 (i.e., between the “second wave” and “third wave” in Japan) in the 4198 dialysis facilities of the Japanese Association of Dialysis Physicians and the Japanese Society for Dialysis Therapy. A total of 2227 facilities (53.0%) responded. The questionnaire consisted of (i) characteristics of facilities, (ii) infection prevention measures in routine dialysis practices, (iii) shortage of PPE, (iv) feasibility of various isolation measures, and (v) nosocomial transmission.ResultsHalf of the responding facilities were hospitals with multiple departments, and the other half were clinics specialized in dialysis. Several infection prevention measures such as health checks of staff and patients, donning of masks before and after hemodialysis, and disinfection of frequently contacted areas were implemented during the COVID-19 pandemic. There was a significant improvement in the implementation rate of these measures during the pandemic, compared to before it, which reached over 90%. More than half of the facilities reported a shortage of disposable masks (67.2%) and hand sanitizer alcohol (56.7%). Isolation of COVID-19 patients in private rooms was possible only in 52.7% of the facilities. The majority of facilities (73.3%) could not accept COVID-19 dialysis patients due to lack of space and manpower. Nosocomial transmission of COVID-19 occurred in 4.0% of the facilities. Of those infected, 51.9% were staff.ConclusionsThis survey revealed that most hemodialysis facilities in Japan had improved implementation of infection control measures and had shortage of PPEs and disinfectants, though some facilities did not implement infection prevention measures adequately, mainly due to the limited space of the facility. It may be recommended that each facility immediately establishes isolation measures to prepare for the pandemic of COVID-19.

Hospital staff, volunteers’ and patients’ perceptions of barriers and facilitators to communication following stroke in an acute and a rehabilitation private hospital ward: a qualitative description study

ObjectivesTo explore barriers and facilitators to patient communication in an acute and rehabilitation ward setting from the perspectives of hospital staff, volunteers and patients following stroke.DesignA qualitative descriptive study as...

Effects of Changes to Architectural Elements on Human Relaxation-Arousal Responses: Based on VR and EEG.

This study combines electroencephalogram (EEG) with virtual reality (VR) technologies to measure the EEG responses of users experiencing changes to architectural elements. We analyze the ratio of alpha to beta waves (RAB) indicators to determine the pre- and poststimulation changes. In our methodology, thirty-three females experience using private rooms in a postpartum care center participated in the experiment. Their brain waves are measured while they are experiencing the VR space of a private room in a postpartum care center. Three architectural elements (i.e., aspect ratio of space, ceiling height, and window ratio) are varied in the VR space. In addition, a self-report questionnaire is administered to examine whether the responses are consistent with the results of the EEG response analysis. As a result, statistically significant differences (p < 0.05) are observed in the changes in the RAB indicator values of the pre- and poststimulation EEG while the subjects are experiencing the VR space where the architectural elements are varied. That is, the effects of the changes to architectural elements on users’ relaxation-arousal responses are statistically verified. Notably, in all the RAB indicator values where significant differences are observed, the poststimulation RAB decreases in comparison to the prestimulus ratios, which is indicative of the arousal response. However, the arousal levels vary across the architectural elements, which implies it would be possible to find out the elements that could induce less arousal response using the proposed method. Moreover, following the experience in the VR space, certain lobes of the brain (F4 and P3 EEG channels) show statistically significant differences in the relaxation-arousal responses. Unlike previous studies, which measured users’ physiological responses to abstract and primordial spatial elements, this study extends the boundaries of the literature by applying the architectural elements applicable to design in practice.

Obstacles to obtaining Informed Consent from the Perspective of Transplant Coordinators: A Qualitative Study

Background: The lack of consent to donate body organs leads to an increase in the death rate of patients on the waiting list for transplantation. Unwillingness of families is known as the main obstacle to organ donation, and the media has an essential role in motivating organ donation. Objectives: This study aimed to explore obstacles to obtaining consent for organ donation from transplant coordinators’ perspective throughout Iran. Methods: In this qualitative study, 13 in-depth semi-structured face-to-face interviews were conducted with transplant coordinators from November 2018 to March 2019. The participants were investigated using a purposive sampling method. The participants’ age and work experience ranged between 32 - 49 years and 6 - 25 years, respectively. Open-ended questions were asked from the participants in a private room. An experienced interviewer explained the study’s objectives to the coordinators, and each interview lasted on average 50 minutes. The interview scripts were analyzed using a content analysis method. Results: The findings highlighted the difficulty of obtaining consent from brain-dead patients’ families. The obstacles could be internal or external. External determinants were healthcare providers’ lack of empathy, inadequate consultation from doctors outside the hospital, media content, and uninformed comments from relatives. Internal determinants were hoping for recovery, denial, and disagreement among family members. Conclusions: The healthcare team should have a better connection with families to obtain organ donation consent from them. Therefore, a training program must be developed for the treatment team so that they show more supportive behavior and improve quality of care in hospitals before and after brain death.

Objective Sleep Characteristics and Factors Associated With Sleep Duration and Waking During Pediatric Hospitalization

Children's sleep may be affected by hospitalization, yet few objective determinations of sleep patterns are reported for children in intensive care or general medicine units. There is limited research on relationships between sleep in hospital and child (eg, age, pain), treatment (eg, medications, nurse presence), or environmental (eg, noise, light, type of unit) factors. To determine sleep quantity and patterns in hospitalized children and determine factors associated with sleep quantity and nighttime waking for children in hospital. This was a prospective cross-sectional study of children admitted to a general pediatric unit or a pediatric intensive care unit at a pediatric quaternary teaching hospital in Toronto, Ontario, Canada, from October 2007 to July 2008. Participants included children aged 1 to 18 years who were expected to stay in hospital for at least 2 nights. Demographic data, information about the hospital stay and illness, and usual sleep habits were collected. Children wore an actigraph for 1 to 3 consecutive days and nights and completed a sleep diary. Sound and light meters were placed at the bedside. Data analyses took place in April 2009. The primary outcome was the mean number of minutes of child nighttime sleep from 7:30 pm to 7:29 am. Sleep variables were averaged over days and nights recorded (mean [SD] days and nights of wear, 2.54 [0.71]) and examined for associations with sleep quantity and patterns, as well as hazard of waking in the night. Of 124 eligible children approached for inclusion, 69 children consented (35 [51%] female; 20 [29%] aged 1-3 years, 10 [14%] aged 4-7 years, 17 [24%] aged 8-12 years, and 22 [32%] aged 13-18 years; 58 [84%] in the general pediatric unit). Children aged 1 to 3, 4 to 7, 8 to 12, and 13 to 18 years obtained a mean (SD) of 444 (132), 475 (86), 436 (114), and 384 (83) minutes of nighttime sleep, respectively; mean (SD) number of night awakenings was 14 (3), 18 (3), 14 (8), and 12 (6), respectively. Children on general pediatric units slept 258 minutes more per night than children sleeping in the pediatric intensive care unit (95% CI, 165.16-350.56 minutes; P < .001), children admitted for planned surgery slept 123 minutes more than children admitted for exacerbations of chronic illness (95% CI, 49.23-196.01 minutes; P < .01), and children sleeping in rooms with other patients slept 141 minutes fewer than children in private rooms (95% CI, -253.51 to -28.35 minutes; P = .01). Sound events greater than 80 dB were significantly associated with increased risk of instantaneous waking (hazard ratio [HR], 1.35; 95% CI, 1.02-1.80; P = .04), as were light events greater than 150 lux (HR, 1.17; 95% CI, 1.01-1.36; P = .03), receiving a medication that promoted sleep (HR, 1.04; 95% CI, 1.00-1.08; P = .03), and having a nurse in the room for most or all of the night (HR, 1.08; 95% CI, 1.03-1.13; P = .003). Sleeping on the general pediatrics unit was significantly associated with decreased risk of instantaneous waking (HR, 0.81; 95% CI, 0.77-0.85; P < .001), as was being admitted for planned surgery (HR, 0.95; 95% CI, 0.91-0.99; P = .04), receiving a medication that promoted wakefulness (HR, 0.96; 95% CI, 0.93-0.995; P = .02), and sharing a room with another patient (HR, 0.78; 95% CI, 0.72-0.84; P < .001). In this cross-sectional study of hospitalized children, children experienced considerable nighttime waking and sleep restriction to levels below national clinical recommendations at a time when they most needed the benefits of sleep. Given light and noise were the greatest contributors to nighttime waking in hospital, clinicians, administrators and hospital design experts should work together for solutions.

Core psychosocial issues for children and adolescents in the context of limb lengthening and reconstruction surgery treatment.

PurposeAddressing the psychosocial needs of adolescents can improve surgical outcomes. The aim of this retrospective comparative study was to understand the core psychosocial factors that shaped the experiences of adolescents who underwent multiple limb lengthening/reconstruction surgeries (LLRS).MethodsA novel 62-question survey was developed and administered to 31 patients from the study institution. Data was obtained using a self-report inventory assessing medical care, communication/connection to doctor, peer relations, physical space, self-esteem, counselling/clergy, physical/emotional support, school issues and concerns about future. This survey and demographic questions were administered to young adults (now aged 18 to 30 years) who underwent LLRS treatment between the ages of 11 to 20 years.ResultsPsychosocial needs were determined to be within the categories of body image/self-esteem, subjective perception of treatment, patient-physician relationship, role of parents, peer interactions, academic performance and hospital experience. Patients valued parental involvement while also wanting their surgeon to speak directly to them. They preferred to be in private rooms on the paediatric floor and to not socialize while in the hospital. They were indifferent to keeping up with friends, speaking to a counsellor and having their surgeon inquire about their emotions. They expressed concern about pain, carrying out activities and the financial impact of surgery.ConclusionsAdolescent LLRS patients value focused psychosocial support from their surgeon and caregivers. This perceived level of support influences their ability to cope with their condition. These findings helped us understand the psychological issues and preferences of adolescents who underwent LLRS and can assist orthopaedic surgeons in providing holistic care.Level of EvidenceIV

Online psychological therapy for kids during social distancing: A study case in a brazilian clinical setting

IntroductionIn response to the spread of COVID-19, many Brazilian therapists faced the challenge of taking their practices online considering legal and ethical issues, besides learning to handle new technologies in a way the therapeutic setting was maintained. The cooperation of the family is fundamental for the creation and maintenance of an adequate therapeutic setting. Children are not sufficiently mature to speak clearly about what bothers them or to talk about how they feel and why, so, drawing, pretend playing, story telling, playing games are the common tools for children’s communication during therapy.ObjectivesEvaluating if online therapy for children can support therapeutic play tools and be effective in a virtual environment preserving the therapeutic setting.MethodsTwo children aged 6 to 11 attended the psychological sessions that were conducted through video calls.The family should provide a silent and private room for those sessions. The children were free to choose the toy they would like to play with and that was available at home such as board games, comic and story books. Mimicry, drawing, an adaptation of the Winnicott Squiggle Game were used, as well as electronic games through screen sharing.ResultsThe emotional conflicts were expressed either through conventional games and play or electronic games. Playing with children online was possible as well as maintaining the therapeutic alliance in order to carry on with the treatment in a proper therapeutic setting.ConclusionsOnline therapy for kids showed to be an effective form of service delivery, under strict measures of social distancing in Brazil.

58055 Mothers’ and Fathers’ Parent-Child Aggression Risk, Intimate Partner Violence, and Perceived Child Behavior Problems

ABSTRACT IMPACT: In light of the high co-occurrence between intimate partner violence (IPV) and physical child abuse, studying these forms of aggression simultaneously, bidirectionally, and longitudinally is vital to address this public health need. OBJECTIVES/GOALS: This study examined reciprocal associations between parent-child aggression (PCA) risk, IPV victimization, and perceived child behavior problems, to evaluate whether negative processes can transmit across family subsystems (i.e., spillover hypothesis) and/or across individuals (i.e., crossover hypothesis) over time. METHODS/STUDY POPULATION: Participants were first-time mothers and their male partners enrolled in a prospective longitudinal study, which tracked parenting and PCA risk over the transition to parenthood and into early childhood. The current project examined data from the third and fourth waves, when participants’ child was 18 months old and approximately 4 years old. At both timepoints, parents reported on their PCA risk (i.e., child abuse potential, harsh parenting), physical and psychological IPV victimization and perpetration, and perceived child behavior problems. Mothers and fathers each completed protocol on laptops in separate private rooms. Hypotheses were tested with autoregressive cross-lagged path models, which were estimated for mothers and fathers separately as well as dyadically. RESULTS/ANTICIPATED RESULTS: Findings partially supported the hypotheses, with evidence of spillover occurring bidirectionally for mothers and unidirectionally for both mothers and fathers. Mothers’ PCA risk predicted their subsequent IPV victimization and their reported child behavior problems (i.e., spillover effects) as well as fathers’ reported IPV victimization (i.e., crossover effect). Maternal reports of child behavior problems also predicted mothers’ reported IPV victimization and fathers’ reported child behavior problems, indicating possible child-driven effects. Overall, results demonstrate the mutual influence of individuals and subsystems within the family. Additionally, mothers rather than fathers appear more vulnerable to harmful spillover effects. DISCUSSION/SIGNIFICANCE OF FINDINGS: The need for family prevention and intervention services is clear, given the complex, transactional nature of family violence. Particularly for mothers, higher PCA risk may herald an increased risk for subsequent IPV victimization and vice versa. Clinical implications for parent-focused intervention programs are discussed.

COVID-19 survivor experiencing long-term symptoms

COVID-19 survivor experiencing long-term symptoms

Life experiences of adult heart transplant recipients: a new life, challenges, and coping.

The process during and after heart transplantation is quite complicated, and studies addressing patient experiences are needed. Heart transplantation particularly affects the recipients' activities of daily living and exposes them to various complications. The aim of this study is to explore the experiences of heart transplant recipients during and after heart transplantation. This qualitative, phenomenological research was conducted with 11 heart transplant recipients in the university hospital, which is one of the 14 heart transplantation centers in Turkey. The data were collected through in-depth semi-structured interviews in a private room that ensured both the comfort of the participants and the necessary conditions for safe data collection. The interviews were recorded using an audio recorder, transcribed, and then analyzed using inductive content analysis. Data collection was terminated after the 11th interview when the data reached the saturation point. The study data were categorized into the following three main themes and subthemes: (1) a new life with a new heart; an opportunity arising at an unexpected time, heart donation, and transplantation as a value, (2) challenges; management of medication therapy and side effects, emotion management, maintaining social relations, and social stigma, and (3) coping; faith in God and praying, responsibility of living with a blessing (donated heart), health professional support, family support, and peer counseling. In line with these themes, expressions of value given to new life and gratitude to heart transplantation were important. The availability and diversity of support sources came to the fore in coping. Social stigma expressions of especially male patients were remarkable in challenges. At the end of the study, the experiences of heart transplant recipients were obtained regarding a new life with a new heart, challenges, and coping. The study results provide an insight into the challenges that the heart transplant recipients face and their coping strategies, guiding the healthcare professionals. The challenges and relevant coping strategies of heart transplant recipients may be integrated into clinical practice and may help plan patient's care. The results may also be used to design and implement an intervention program to improve care for these patients.

Nontraditional Small House Nursing Homes Have Fewer COVID-19 Cases and Deaths

ObjectivesGreen House and other small nursing home (NH) models are considered “nontraditional” due to their size (10–12 beds), universal caregivers, and other home-like features. They have garnered great interest regarding their potential benefit to limit Coronavirus Disease 2019 (COVID-19) infections due to fewer people living, working, visiting, and being admitted to Green House/small NHs, and private rooms and bathrooms, but this assumption has not been tested. If they prove advantageous compared with other NHs, they may constitute an especially promising model as policy makers and providers reinvent NHs post-COVID. DesignThis cohort study compared rates of COVID-19 infections, COVID-19 admissions/readmissions, and COVID-19 mortality, among Green House/small NHs with rates in other NHs between January 20, 2020 and July 31, 2020. Setting and ParticipantsAll Green House homes that held a skilled nursing license and received Medicaid or Medicare payment were invited to participate; other small NHs that replicate Green House physical design and operational practices were eligible if they had the same licensure and payer sources. Of 57 organizations, 43 (75%) provided complete data, which included 219 NHs. Comparison NHs (referred to as “traditional NHs”) were up to 5 most geographically proximate NHs within 100 miles that had <50 beds and ≥50 beds for which data were available from the Centers for Medicare and Medicaid Services (CMS). Because Department of Veterans Affairs organizations are not required to report to CMS, they were not included. MethodsRates per 1000 resident days were derived for COVID-19 cases and admissions, and per 100 COVID-19 positive cases for mortality. A log-rank test compared rates between Green House/small NHs and traditional NHs with <50 beds and ≥50 beds. ResultsRates of all outcomes were significantly lower in Green House/small NHs than in traditional NHs that had <50 beds and ≥50 beds (log-rank test P < .025 for all comparisons). The median (middle value) rates of COVID-19 cases per 1000 resident days were 0 in both Green House/small NHs and NHs <50 beds, while they were 0.06 in NHs ≥50 beds; in terms of COVID-19 mortality, the median rates per 100 positive residents were 0 (Green House/small NHs), 10 (<50 beds), and 12.5 (≥50 beds). Differences were most marked in the highest quartile: 25% of Green House/small NHs had COVID-19 case rates per 1000 resident days higher than 0.08, with the corresponding figures for other NHs being 0.15 (<50 beds) and 0.74 (≥50 beds). Conclusions and ImplicationsCOVID-19 incidence and mortality rates are less in Green House/small NHs than rates in traditional NHs with <50 and ≥50 beds, especially among the higher and extreme values. Green House/small NHs are a promising model of care as NHs are reinvented post-COVID.

How to promote exclusive breastfeeding in Ireland: a qualitative study on views of Chinese immigrant mothers

BackgroundThe exclusive breastfeeding rate in Ireland is very low with extremely slow annual growth. The population of immigrants in Ireland is increasing. Improving exclusive breastfeeding practice among immigrants may contribute to the overall improvement of exclusive breastfeeding rates in Ireland. This study was conducted to elicit suggestions on improving exclusive breastfeeding rate for the first 6 months among Chinese immigrants in Ireland.MethodsFourteen semi-structured in-depth interviews were conducted with Chinese immigrant mothers residing in Ireland, who breastfed exclusively for 4 to 6 months. Interviews were recorded and transcribed in Chinese. Data were analyzed using a qualitative thematic analysis. Themes were developed through categorization of codes and via in-depth discussion between two researchers.ResultsThemes generated from the thematic content analysis were: 1) suggestions for new mothers: being strong mentally and getting support from family and friends; 2) suggestions for employers: creating a supportive workplace by setting up private rooms and breastmilk storage facilities; 3) suggestions for healthcare professionals: advocating breastfeeding in the hospital and addressing cultural differences by recruiting multilingual staff; 4) suggestions for the government: promoting breastfeeding by initiating societal and policy changes.ConclusionsThe key findings emerging from this study may be considered in the development of breastfeeding promotion strategies in Ireland. Our findings could also have implications for other English-speaking countries with low rates of exclusive breastfeeding.

Can continuous remote vital sign monitoring reduce the number of room visits to patients suspected of COVID-19: A quasi-experimental study

BackgroundContinuous remote monitoring of vital signs on the hospital ward gained popularity during the Severe Acute Respiratory Syndrome coronavirus 2 pandemic due to its ability to support early detection of respiratory failure, and the possibility to do so without physical contact between patient and clinician. The effect of continuous monitoring on patient room visits has not been established yet. ObjectivesTo assess the impact of continuous monitoring on the number of patient room visits for patients suspected of Corona Virus Disease 2019 (COVID-19) and the use of personal protection equipment. Design and methodsWe performed a before-after study at a ward with private rooms for patients suspected of COVID-19 at a tertiary hospital in Nijmegen, The Netherlands. Non-participant observers observed hospital staff during day, evening and night shifts to record patient room visits and personal protection equipment usage. After eleven days, wearable continuous vital sign monitoring was introduced. An interrupted time series analysis was applied to evaluate the effect of continuous monitoring on the number of patient room visits, visits for obtaining vital signs (Modified Early Warning Score visits) and the amount of personal protection equipment used. ResultsDuring the 45 day study period, 86 shifts were observed. During each shift, approximately six rooms were included. A total of 2347 patient room visits were recorded. The slope coefficient for the number of patient room visits did not change after introducing continuous vital sign monitoring (B -0.003, 95% confidence interval -0.022/0.016). The slope coefficients of the number of Modified Early Warning Score visits and the amount of personal protection equipment used did not change either (B -0.002, 95% confidence interval -0.021/0.017 and B 0.046, 95% confidence interval -0.008/0.099). The number of Modified Early Warning Score visits did show a decline over the entire study period, however this decline was not influenced by the intervention. Evening and night shifts were associated with fewer patient room visits compared to day shifts. ConclusionIntroduction of continuous vital sign monitoring at a general ward for patients with suspected COVID-19 did not reduce the number of patient room visits or the usage of personal protection equipment by hospital staff. The number of Modified Early Warning Score visits declined over time, but this was not related to the introduction of continuous monitoring. Detailed analysis of the influence of continuous monitoring on the workflow of hospital staff reveals key points to increase efficacy of this intervention.

Predictors of Non-Adherence to Combined Anti-Retroviral Therapy among Expectant and Breastfeeding Women Receiving Care through Test and Treat Model in Lusaka

Introduction: To achieve viral suppression and reduce vertical transmission of HIV, more than eighty percent of pregnant or breastfeeding women in Zambia have been started on combined ART using the Test and Treat model. However, Chawama First Level Hospital in Lusaka had records which showed that 32 percent of pregnant or breastfeeding women were non-adherent to combined anti-retroviral therapy (cART). Method: A mixed-method study was conducted to establish predictors of non-adherence to cART by women in the Test and Treat model of care. For the quantitative component, 92 consenting Pregnant and breastfeeding women were randomly drawn from ART defaulter register and a semi-structured questionnaire was administered. Multiple logistic regression was conducted to improve predictive power and control for confounders. Quantitative Results: The mean age was 28years. The study established that housewives were 84 percent less likely to be non-adherent [AOR 0.16; 95% CI 0.12, 0.36] compared to women who were formally employed with a statistically significant P-value of 0.04. Pregnant or breastfeeding women who were several months away from home were 84.9 percent more likely to be non-adherent [AOR 15.11; 95% CI 13.9, 16.4] compared to women who had travelled away from home for several days. The associated P-value was 0.03. The study also established that pregnant and breastfeeding women who were counselled in individually enclosed units were 91 percent less likely to be non-adherent compared to those who were counselled in an open space as a group [AOR 0.09; 95% CI 0.02, 0.53] with an associated P-value of 0.01. Conclusion: The study established that predictors of non-adherence to cART among pregnant and breastfeeding women were: being a working-class client; being away from home or usual clinic for several months; being counselled in open spaces, and negative staff attitude. Therefore, researcher can conclusively say that predictors of non-adherence to cART can be solved by training and re-training of health workers in Patient-Centred Care Model for effective patient engagement. Women should be counselled in private rooms. Furthermore, an improvement in patient’s tracking system by the use of smart-care-cards for pregnant and breastfeeding women countrywide can reduce patient’s non-adherence to cART.

The Virgin Mary’s Book at the Annunciation: Reading, Interpretation, and Devotion in Medieval England by Laura Saetveit Miles

Reviewed by: The Virgin Mary’s Book at the Annunciation: Reading, Interpretation, and Devotion in Medieval England by Laura Saetveit Miles Cynthia Turner Camp Laura Saetveit Miles. The Virgin Mary’s Book at the Annunciation: Reading, Interpretation, and Devotion in Medieval England. Cambridge: D. S. Brewer, 2020. Pp. xii, 301. 17 illus. $99.00 cloth; $24.99 e-book. Laura Saetveit Miles’s The Virgin Mary’s Book at the Annunciation turns on a familiar image, Mary reading when Gabriel appeared to her. This iconography was so ubiquitous in later medieval art, Miles argues, that we cannot fully understand Marian devotion without accounting for the Virgin as a model for study and prayer. Scholarship has, however, neglected this learned aspect of Mary’s medieval persona, focusing instead on Mary as intercessor, especially for the unlettered (as in The Prioress’s Tale). From this premise, Miles builds a longitudinal study of Mary-as-reader that is [End Page 331] also a deep dive into how medieval readers learned to pray meditatively. While Miles’s book is valuable for attending to this form of imitatio Mariae, it also models an interpretation of medieval meditative practices useful to other approaches to devotional culture. Miles opens her book by developing its core hermeneutic principle: the polysemous nature of Scripture enabled layered, participatory meditative practices. This hermeneutic integrates common approaches to scriptural interpretation—typological figuration, fourfold exegesis, the anamnetic collapse of “past” into “present” within a performed “now”—to unpack how medieval participatory meditation operated. “Conceiving” Christ in the devout mind is a spiritual echo of Mary’s bearing of Christ in her body. The private chamber in which Mary was reading when she conceived Christ is simultaneously her private room, her womb, the anchorhold, the nun’s enclosure, the layperson’s closet, the shrine at Walsingham. These figurative ripples allow believers, especially women, both to model themselves on Mary’s prayerful reading and to fulfill an equivalent conception of the divine within themselves through their literate devotions. Those of us who study religious culture will be familiar with these analytic approaches, yet rarely have they been articulated with such precision as Miles provides. Subsequent chapters build their longitudinal study on this interpretive foundation, demonstrating how imitatio Mariae developed variously across medieval England, but always with the assumption that Mary should and could model productive study and fruitful prayer. Chapters 2 and 3 consider the question of what Mary was reading at the Annunciation and how her reading material shaped this imitation. Post-Conquest texts produced for and about anchoritic women drew on the tradition that Mary was reading the Psalms. This semi-liturgical form of prayer, also enjoined for anchoresses such as those addressed in Ancrene Wisse, collapses the distance between the solitary chanting of Psalms in the enclosure and Mary doing the same in her room. This collapse authorizes the anchoress’s vocalized prayer to conceive Christ in her soul much as Mary conceived Christ in her body. The more long-lasting tradition that Mary was reading Isaiah’s prophecy about herself—that a virgin should bear the son of God—broaches the question of lay and female access to holy writ. Tracing this tradition through later Gospel meditations, Miles provides localized snapshots of the way medieval (often but not always female) readers were encouraged, or not, to imitate Mary by reading the Bible. This thoughtful [End Page 332] survey refuses to homogenize female or lay experience, focusing rather on the diversity of positions around the question of whether laypeople and women should read Scripture themselves. Earlier Latin writers such as Goscelin of Saint-Bertin and Aelred of Rievaulx, writing for their enclosed female audiences, characterized the pre-Annunciate Virgin as nearly an anchoress herself, skilled in the meditative arts. Later medieval female contemplatives developed this aspect of Mary in their writings, as Miles details in her fourth chapter. The four writers she examines here turn Mary into a “paradigm for [women] channelling the divine” (173), even when they do not portray her as reading. For Elizabeth of Sweden, Julian of Norwich, and Margery Kempe, imitatio Mariae becomes imitation of she-who-conceives-Christ, spiritually and/or in the body...

Associations between sexual violence, domestic violence, neglect, and alcohol consumption among Lahu hill tribe families in northern Thailand.

Background:Domestic violence is one of the largest silent problems in the world. Women, children, and elderly individuals often fall victims to family members who use alcohol. However, there is lack of scientific evidence on alcohol consumption and domestic violence among Lahu hill tribe families.Objectives:The objective of this study was to investigate the prevalence of family violence, violence against women, and alcohol-related harm to children and elderly individuals and to determine the correlations between alcohol consumption and family violence among Lahu tribe families in northern Thailand.Method:A cross-sectional study was applied to collect data from participants living in 10 randomly selected villages from the list of Lahu villages in Chiang Rai Province, Thailand. A validated questionnaire and the Alcohol Use Disorders Identification Test were used to collect information from the participants in private and confidential rooms at a community hall between March and August 2019. Data were described and tested for correlation at the significance levels of α = 0.05 and 0.01.Findings:A total of 350 of 719 recruited Lahu families participated in the study (response rate = 48.7%). Among female participants, 22.3% reported history of sexual harassment and 4.1% had been forced to have sex. Children and elderly individuals reported several experiences with people who had used alcohol in the past year; 6.4% had been left to live alone, 5.0% experienced financial neglect, and 1.8% had been neglected while sick. In a correlation analysis, it was found that age (r = –0.02, p value < 0.009), education (r = 0.15, p value < 0.047), marital status (r = 0.25, p value < 0.001), and religion (r = 0.20, p value < 0.008) were significantly correlated with verbal arguments among family members. Experience of sexual harassment was correlated with the presence of a drinker in the family (r = 0.22, p value < 0.001).Conclusion:Government and relevant agencies should cooperate to reduce the consumption of alcohol among Lahu men. Moreover, a specific training program to personally improve one’s skill in responding to domestic violence among children, women, and elderly individuals should also be developed and implemented in Lahu communities.

Practical management of the patients with hematological diseases during the COVID-19 pandemic in Japan

PCR assay cannot always detect the SARS-CoV2 virus, which might be due to differences in the sensitivities of each sampling site. Under these circumstances, immunochromatography may serve as an alternative method to detect anti-SARS-CoV-2 IgG antibodies that can demonstrate a history of infection. In patients with severe COVID-19 infection, 14 of 19 serum samples were shown to be positive, whereas 6 of 10 samples from patients with asymptomatic or mild cases were negative for IgG antibodies. Two patients with immune thrombocytopenia, who were treated with prednisolone, experienced aggressive behavior of COVID-19-related respiratory failure and eventually died. Patients who were before an achievement of remission and those who received steroid-based chemotherapy possessed a higher risk of death, and more deaths were observed in patients with lymphoid malignancies including lymphoma and myeloma compared with those with myeloid malignancies. As for daily medical care in hematological department, a stricter cohorting strategy using repeat PCR tests or isolation to a private room should be adopted in order to prevent viral spread to the environment.

I Spy with my Little Eye… Queer(ing) Counter-Surveillance Tactics of Camouflage and Opacity in Dean Sameshima’s In Between Days (Without You)

By staging an encounter between surveillance studies, art studies and queer theory, this article explores a queerness that disrupts surveillance, a queerness that invests and takes seriously refusals of certain forms of recognition and visibility. For In Between Days (Without You) (1998), Dean Sameshima photographed deserted private rooms of 1350 Club and Hollywood Spa, two former bathhouses in Los Angeles for men* who have sex with men* (MSM), which were, in the 1990s, under increasing conditions of continual surveillance due to conservative political trends and sexual panic fueled by AIDS. By choosing not to show human figures on a visual level and by concealing the locations of the baths linguistically, the artist found a way to convey a resistance to surveillance and cultural critique by showcasing the strengths of commercial cruising venues for men*—what is considered here as counter-surveillance tactics. By operating at the level of managing and subverting rather than avoiding surveillance, the use of tactics such as camouflage and opacity foreground how to (re-)negotiate and queer the visual sphere in this photographic art project.

The experience of patients in an outpatient infusion facility: a qualitative study

PurposeAs hospitals are now being designed with an increasing number of single rooms or cubicles, the individual preference of patients with respect to social contact is of great interest. The purpose of this study is to gain a better understanding of the experience of patients in an outpatient infusion center.Design/methodology/approachA total of 29 semi-structured interviews were conducted, transcribed and analyzed by using direct content analysis.FindingsFindings showed that patients perceived a lack of acoustic privacy and therefore tried to emotionally isolate themselves or withheld information from staff. In addition, patients complained about the sounds of infusion pumps, but they were neutral about the interior features. Patients who preferred non-talking desired enclosed private rooms and perceived negative distraction because of spatial crowding. In contrast, patients who preferred talking, or had no preference, desired shared rooms and perceived positive distraction because of spatial crowding.Research limitations/implicationsIn conclusion, results showed a relation between physical aspects (i.e. physical enclosure) and the social environment.Practical implicationsThe findings allow facility managers to better understand the patients’ experiences in an outpatient infusion facility and to make better-informed decisions. Patients with different preferences desired different physical aspects. Therefore, nursing staff of outpatient infusion centers should assess the preferences of patients. Moreover, architects should integrate different types of treatment places (i.e. enclosed private rooms and shared rooms) in new outpatient infusion centers to fulfill different preferences and patients should have the opportunity to discuss issues in private with nursing staff.Originality/valueThis study emphasizes the importance of a mix of treatment rooms, while new hospital designs mainly include single rooms or cubicles.

Carbon footprint of dermatologic surgery.

Healthcare is a potent emitter of greenhouse gases amounting up to 7% of total estimated greenhouse gas emissions (CO2 e) for Australia. Australia has one of the highest incidences of skin cancer in the world but there is a paucity of data on the ecological impact of skin cancer excision/dermatologic surgery. The authors reviewed the various impact inventories in order to perform a life cycle assessment of skin cancer excision. A total of 8641 tonnes of estimated CO2 e are produced from dermatologic surgery annually in Australia (6751 tonnes from private clinical rooms and 1890 tonnes from hospitals) and the waste generated contributes significantly to terrestrial ecotoxicity and acidification of land and water. Various means can be carried out to reduce this impact, ranging from simple behavioural changes to larger, policy changes.