State Level Research Articles

Cost of COVID-19 vaccine delivery in nine States in Nigeria via the U.S. Government Initiative for Global Vaccine Access

BackgroundIn 2022, the U.S. Centers for Disease Control and Prevention collaborated with implementing partners, African Field Epidemiology Network and Sydani Group, to support COVID-19 vaccination efforts in Nigeria. To characterize the costs of COVID-19 vaccination, this study evaluated financial costs per dose for activities implemented to support the intensification campaign for COVID-19 vaccination.MethodsThis retrospective evaluation collected secondary data from existing expenditure and programmatic records on resource utilization to roll out COVID-19 vaccination during 2022. The study included incremental financial costs of the activities implemented to support an intensification campaign for COVID-19 vaccination across nine states and six administrative levels in Nigeria from the perspective of the external donor (U.S. Government). Costs for vaccines and injection supplies, transport of vaccines, and any economic costs, including government in-kind contributions, were not included. All costs were converted from Nigerian Naira to 2022 U.S. Dollars (US$).ResultsThe estimated financial delivery cost of the COVID-19 vaccination intensification campaign was US$0.84 per dose (total expenditure of US$6.29 million to administer 7,461,971 doses). Most of the financial resources were used for fieldwork activities (86%), followed by monitoring and supervision activities (8%), coordination activities (5%), and training-related activities (1%). Labor (58%) and travel (37%) were the resource inputs that accounted for the majority of the cost, while shares of other resource inputs were marginal (1% for each). Most labor costs (79%) were spent on payments for mass vaccination campaign teams, including pay-for-performance incentives. By administrative level, the largest share of costs (46%) was for pay-for-performance incentives at the community, health facility, or campus levels combined, followed by local government area level (24%), community level only (15%), state level (9%), national level (3%), campus level only (1%), and health facility level only (< 1%).ConclusionsFindings from the evaluation can help to inform resources needed for vaccination activities to respond to future outbreaks and pandemics in resource-limited settings, particularly to reach new target populations not regularly included in routine childhood immunization delivery.

Molecular Characterization and Genomic Surveillance of SARS-CoV-2 Lineages in Central India.

Since the first reported case of COVID-19 in December 2019, several SARS-CoV-2 variants have evolved, and some of them have shown higher transmissibility, becoming the prevalent strains. Genomic epidemiological investigations into strains from different time points, including the early stages of the pandemic, are very crucial for understanding the evolution and transmission patterns. Using whole-genome sequences, our study describes the early landscape of SARS-CoV-2 variants in central India retrospectively (including the first known occurrence of SARS-CoV-2 in Madhya Pradesh). We performed amplicon-based whole-genome sequencing of randomly selected SARS-CoV-2 isolates (n = 38) collected between 2020 and 2022 at state level VRDL, ICMR-NIRTH, Jabalpur, from 11899 RT-qPCR-positive samples. We observed the presence of five lineages, namely B.1, B.1.1, B.1.36.8, B.1.195, and B.6, in 19 genomes from the first wave cases and variants of concern (VOCs) lineages, i.e., B.1.617.2 (Delta) and BA.2.10 (Omicron) in the second wave cases. There was a shift in mutational pattern in the spike protein coding region of SRAS-CoV-2 strains from the second wave in contrast to the first wave. In the first wave of infections, we observed variations in the ORF1Ab region, and with the emergence of Delta lineages, the D614G mutation associated with an increase in infectivity became a prominent change. We have identified five immune escape variants in the S gene, P681R, P681H, L452R, Q57H, and N501Y, in the isolates collected during the second wave. Furthermore, these genomes were compared with 2160 complete genome sequences reported from central India that encompass 109 different SARS-CoV-2 lineages. Among them, VOC lineages Delta (28.93%) and Omicron (56.11%) were circulating predominantly in this region. This study provides useful insights into the genetic diversity of SARS-CoV-2 strains over the initial course of the COVID-19 pandemic in central India.

The Effectiveness of the International Environmental Law: The Issues of State Sovereignty, National Interests, and Differing Levels of Commitments

This study aims to explore the main challenges facing international environmental law and affecting its effectiveness. Although many international texts and agreements have been adopted to address environmental degradation and promote sustainable resource development, most of these agreements remain ineffective in achieving the objectives of these agreements. The critical study reveals that these legal frameworks face many challenges that affect the effectiveness of these texts, for example, there are issues such as national sovereignty, the lack of unified implementation at the state level, insufficient funding, and weak institutional frameworks. This study aims to provide a comprehensive analytical view of the factors that affect the effectiveness of these texts and frameworks. The issues of national sovereignty, insufficient funding, weak institutional frameworks, different levels of commitment, lack of political will, and global cooperation will be mainly discussed here. By focusing on the most important challenges facing international environmental law, this research aims to contribute to developing international environmental law to make it more effective.

A novel approach to assessing food insecurity for small geographic areas using household living budgets

AbstractThe USDA Economic Research Service has monitored food insecurity at national and state levels since 1995 using the Current Population Survey Food Security Supplement. But if a food insecurity measure is to inform action and target interventions, it must be constructed for smaller geographic levels that consider geographic price differences. This article constructs a novel measure of food insecurity using an alternative approach based on financial needs of households, known as the household living budget (HLB). The HLB is defined as the income required to satisfy a household's essential needs, enabling it to maintain a modest yet sufficient standard of living while covering federal and state income taxes. The HLB is constructed at the census tract level and incorporates three key determinants of food insecurity: household size and composition, household income, and food costs. We demonstrate how the HLB along with publicly available data can be used to construct a food insecurity measure using a residual income approach to assess if households are able to afford paying for food expenditures and assess the qualification thresholds of the Supplemental Nutrition Assistance Program (SNAP). Food insecurity estimates are obtained for households in Washington, D.C. and benchmarked to regional results provided by a survey sponsored by the Capital Area Foodbank.

Fertility Preservation for Iatrogenic Infertility: Patient Barriers and Opportunities for the Reproductive Medicine Workforce.

Iatrogenic infertility can result from medically necessary treatments that reduce fertility potential such as gonadotoxic chemotherapy and radiation but also brain and pelvic surgery, biologics for autoimmune disease, and hormone therapy. Fertility preservation (FP) involves freezing embryos, oocytes, ovarian tissue, sperm, or testicular tissue for future procreation and may be the only option for some patients who hope to use their autologous gametes for future reproduction. Although there is a growing awareness to refer patients at risk for iatrogenic infertility to reproductive specialists, patients seeking FP continue to face a multitude of barriers. The most prohibitive factor is cost, but poor accessibility to specialty care, lack of education of providers and patients, and stigmatization around reproductive health may all lead to delayed referrals.We discuss several opportunities for the reproductive medicine workforce to help address barriers to FP. One method to make FP more accessible to patients in a shorter timeframe would be to make it more affordable through improved insurance coverage. Currently, there is no active federal legislation mandating that insurance plans cover FP; however, there have been several success stories at the state level. Additionally, education of providers and patients through multispecialty collaboration and targeted campaigns, can have a profound impact on expediting referral for fertility care. Promising new technologies and innovation in healthcare delivery are also on the horizon.Unaddressed fertility concerns are very distressing to patients and detrimental to their quality of life. Urologists can contribute significantly to improving the care for these patients clinically and through advocacy and education.

Advancing emigrants' rights in India: strategies of civil society in spaces for engagement

ABSTRACT This article explores Indian civil society's efforts to promote the rights of migrant Indian labourers working abroad in low-wage employment as a response to weakly institutionalized rights frameworks in the global and India's national governance of labour migration. Existing scholarship has explored civil societies' advocacy in multi-national fora, at regional levels, and as forms of transnationally organized networks, but only marginally at the analytical level of migrant-origin states. The article examines their multi-level and multi-stakeholder strategies through the analytical lens of spaces for engagement. Drawing on original qualitative data, this article shows that civil society organizations play a leading role in (e)migration governance in India and are key to understanding the politics of migration of the world’s largest migrant-origin state. In particular, the local and subnational levels are important entry points to advance their agendas in the context of migrant-origin states.

Competencies for sustainable financial and economic management: Their impact on human capital development and national security

The relevance of the study is determined by the orientation of modern society towards the strategy of sustainable development. The advent of the era of “globalization through sustainable development” is accompanied by the strengthening of “old” threats and the emergence of “new” ones. According to the article, the sustainability viewpoint systemically links the social, economic, and environmental domains into a dynamic, long-term view, which is the fundamental contribution of the perspective to the examination of security challenges. It also signifies a paradigm change in how public administration functions when analyzing security risks at the state and federal levels. Competences for sustainable financial and economic management are considered in frames of sustainable public management, implying, in particular, positive impact on human capital and contributing to national security through ESG paradigm implementation.

About ways to form digital literacy of students in primary school

The article examines the tasks of primary general education in the light of the state-set goal of digital transformation of society. According to decisions adopted at the state level, by 2030 it is expected to achieve "digital maturity" of key sectors of the economy and social sphere, including education. In this regard, significant efforts are being made to create electronic educational resources and services. However, research shows that a full-fledged digital transformation of education is impossible without due attention to the formation of digital literacy of students already in primary school. The article analyzes the experience of developing digital literacy in primary schools in Russia and abroad, shows the need to introduce a course in informatics or digital literacy in primary schools for the successful use of created digital educational materials and services at all levels of education.

Институт уполномоченных по правам человека в России: концептуальные основы и эволюция

The article examines the development of the institution of human rights commissioners in Russia. The author comes to the conclusion that Russian practice demonstrates the evolutionary development of the institution of human rights commissioners. This institution is a reflection of the federal structure of the state. The Human Rights Commissioner in the Russian Federation and the Human Rights Commissioners in the constituent entities of the Russian Federation are competently independent constitutional figures. Their interaction is carried out on the basis of coordination through various forms, which largely developed on the basis of practical activities and were subsequently enshrined in federal legislation. There is a clear tendency to expand the powers of Russian human rights defenders in all areas of their activities, and the «legal tools» of the commissioners are being strengthened. All this allows us to conclude that the institution of human rights commissioners has high authority and is in demand both at the state level and in the environment of civil relations.

Фактори активізації соціальних інвестицій бізнесу в Україні та Польщі

Introduction. Contemporary global challenges affect the development of business and the startup ecosystem around the world. In particular, the increase in geopolitical risks due to the full-scale war in Ukraine actualizes the issue of social investments of business. However, these processes have a different nature in different countries. For example, in Poland, social entrepreneurship is aimed at facilitating public access to social services, using new technologies and artificial intelligence for digitalization and increasing business competitiveness. An ecosystem of high-tech startups and social entrepreneurship is being formed at the state level. At the same time, in times of full-scale war in Ukraine, social investment of businesses has become especially important. A new approach to doing business is being formed, according to which startups develop not only new technologies but also support social and humanitarian initiatives. Problem Statement. Assessing the factors of social investment activation on the example of Ukrainian and Polish businesses. The purpose is to identify and evaluate the key factors influencing the development and efficiency of social investments in Polish and Ukrainian business. Methods. General scientific and special methods were used, in particular: scientific abstraction and epistemological (content) analysis, synthesis, induction and deduction, analogies and systematization, system-structural analysis, expert evaluation method, index method and grouping method. Results. The levels of manifestations and possibilities of activation of social investments at different levels, which is based on SDG standards (a combination of environmental, social and public management principles), which create the basis for sustainable development and growth in the world, have been studied. National economies and individual businesses incorporate ESG principles into their development strategies. Compliance with these principles is possible only if there is a sufficient amount of involved investments. The specifics of state policy in the context of the development of social investments, trends in the development of business and startups in Ukraine and Poland, and successful cases of the implementation of social business projects are analyzed. The conducted analysis made it possible to single out the factors of activation of social investments of business in both countries at the global, state and business levels. Conclusions. Today's challenges require a change in business priorities. Even high-tech startups are revising their development strategies in terms of social investments, activities in accordance with ESG principles. At the global level, factors for the activation of social business investments are common to Ukraine and Poland. At the state level, it is possible to distinguish common groups of factors of business activation in Ukraine and Poland, which have different manifestations for each of the countries. Business representatives demonstrate different approaches to social investments: Polish companies actively integrate corporate volunteering, educational and cultural projects into development strategies, while in Ukraine social entrepreneurship is associated with the need to restore social infrastructure, rehabilitation and integration of these groups into public life.

EVOLUTIONARY TRANSFORMATION OF THE QUALITY ASSURANCE SYSTEM OF DEFENSE GOODS, SERVICES AND WORKS IN UKRAINE

It is inadvisable to limit the quality assurance system for defense-related goods/services/works solely to a set of mechanisms; it must necessarily encompass vertical and horizontal connections both among the relevant functional blocks (subsystems) and between the entities involved in their operation. In the context of not only geopolitical challenges but also the ongoing daily struggle against an aggressor state, it is critically important to establish an effective and efficient system for controlling the quality of defense-related goods/services/works. This article is dedicated to the systematization of the characteristics of transformational changes and the outlining of methodological foundations for the effective functioning of the quality assurance system for defense- related goods, works, and services in Ukraine. A conceptual three-level model of the quality assurance system for defense-related goods, services, and works has been formulated by distinguishing the essential parameters of their operation at the global, national, and micro levels. The peculiarities of forming a quality assurance system for defense-related products at both the micro and macro levels have been justified. It has been emphasized that the effectiveness of the evolutionary transformation of the quality assurance system for defense-related products at all levels of its representation should be characterized by the penetration of market forces into the mechanism of its operation. Attention has been drawn to the substantive directions for implementing the requirements of NATO standards in the AQAP series (AQAP 2110) within the framework of a corporate quality management system in accordance with ISO 9001. Since there are no legal or legislative requirements mandating the implementation of quality management systems, the enhancement and improvement of the efficiency of internal business and production processes should be a direct concern of the enterprise itself, driven by market forces. At the same time, the state should create stimulating mechanisms, for instance, by employing soft regulation; in military procurement specifications, it should mandate the presence of a certificate of compliance with AQAP requirements for the enterprises involved. The expected effects of the transformation of the studied system include economic, organizational, and worldview effects. A comparative analysis of the evolutionary transformation of the quality assurance system for defense-related goods, services, and works has been conducted based on the following criteria: the object and subject of control; the function performed by the control subject; the breadth of the controlling institution’s functionality; the perimeter of the controlling institution’s authority; the level of depth of control; and the level of subordination of the controlling institution to the Ministry of Defense. Despite the complexity of the task declared at the state level regarding the functioning of the state guarantee system for the quality of defense-related products, which is influenced not only by objective factors but also by worldview factors, its implementation has the potential to significantly enhance the quality of Ukraine’s defense products and substantially improve Ukraine’s rankings in terms of transparency, institutional maturity, and the ecological soundness of economic relations in the defense sector.

The Impact of the Corona Pandemic on the Revenues and Expenditures of the Jordanian General Government and the Gross domestic Product

The research aimed to know The impact of the Corona pandemic on the revenues and expenditures of the Jordanian general government and the gross domestic product And reached the following results: The Corona Covid-19 pandemic is greater than being limited to a health crisis, it is a humanitarian disaster that led to changes and transformations that attacked the heart of societies and their economies, so it was imperative for countries to work on the continuity of economic activity and the preservation of the wheel of production in the country while limiting the spread of the disease. It led to a complete and total halt to any economic activity, which caused the cancellation of many capital expenditures scheduled in the context of strict measures, as the restrictions imposed on travel and trade resulted in a decrease in revenues and an increase in expenditures, and the Corona pandemic caused an increase in the deficit rate in the state's general budget, as a result of the large expenses incurred by the state, with a clear decrease in annual revenues, but the state was able in the years following the pandemic to reduce the deficit rate in the budget and cancel many capital expenditures and freeze the performance of some economic activities, which is considered a severe blow to the domestic product, considering that revenues and expenditures enable the state to play its role effectively, as the decrease in revenues and the increase in expenditures call for a review of the structure of government institutions and the duties assigned to them The services it provides, which calls for a mix of its services to ensure mitigation of the pandemic and any crisis that the country may be exposed to, which confirms the validity of the first hypothesis and in light of such crises, and practicing that pivotal role that links the actors in the economic sectors, which allows them to be stronger than before, which confirms the validity of the second hypothesis. They recommended the following: Establishing permanent centers for crisis and risk management at the state level and at the level of the various economic sectors, and activating coordination between them to deal with various crises and risks, and developing training programs for workers on how to deal with crises and how to deal with their effects, and appointing experts and specialists to monitor, analyze and prepare reports on the various crises that the various sectors are going through and building a comprehensive database to predict crises before they occur. 10- Strengthening relations between the various governmental, civil and economic sectors with the media institutions due to their importance in spreading awareness and participating in conferences and interviews that help spread knowledge, and the need to benefit from the experiences of other countries in how to overcome crises.

Crop-specific management history of phosphorus fertilizer input (CMH-P) in the croplands of the United States: reconciliation of top-down and bottom-up data sources

Abstract. Understanding and assessing the spatiotemporal patterns in crop-specific phosphorus (P) fertilizer management are crucial for enhancing crop yield and mitigating environmental problems. The existing P fertilizer dataset, derived from sales data, depicts an average application rate over total cropland at the county level but overlooks cross-crop variations. Conversely, the survey-based dataset offers crop-specific application details at the state level yet lacks inter-state variability. By reconciling these two datasets, we developed long-term gridded maps to characterize crop-specific P fertilizer application rates, timing, and methods across the contiguous US at a resolution of 4 km × 4 km from 1850 to 2022. We found that P fertilizer application rate over fertilized areas in the US increased from 0.9 g P m−2 yr−1 in 1940 to 1.9 g P m−2 yr−1 in 2022, with substantial variations among crops. However, approximately 40 % of cropland nationwide has remained unfertilized in the recent decade. The hotspots for P fertilizer use have shifted from the southeastern and eastern US to the Midwest and the Great Plains over the past century, reflecting changes in cropland area, crop choices, and P fertilizer use across different crops. Pre-planting (fall and spring) and broadcast application are prevalent among corn, soybean, and cotton in the Midwest and the Southeast, indicating a high P loss risk in these regions. In contrast, wheat and barley in the Great Plains receive the most intensive P fertilization at planting and via non-broadcast application. The P fertilizer management dataset developed in this study can advance our comprehension of agricultural P budgets and facilitate the refinement of best P fertilizer management practices to optimize crop yield and to reduce P loss. Datasets are available at https://doi.org/10.5281/zenodo.10700821 (Cao et al., 2024).

Regulatory impact of a governmental approach for artificial intelligence technology implementation in Vietnam

This study assesses Vietnam’s state-level implementation of artificial intelligence (AI) technology and analyses the government’s efforts to encourage AI implementation by focusing on the National Strategy on AI Development Program. This study emphasizes the possibility of implementing AI at the state level in Vietnam and the importance of conducting continuous reviews and enhancements to achieve sustainable and inclusive AI growth. Impact evaluations were conducted in public organizations alone, and implication evaluations were considered optional. AI impact assessments were constrained by societal norms that necessitated establishing relationships among findings. There is a lack of official information regarding the positive impact of Vietnam’s AI policy on the development of AI infrastructure, research, and talent pools. The study’s findings highlight the necessity of facilitating extensive AI legislation, and strengthening international cooperation. The study concludes with the following recommendations for improving Vietnam’s AI policy: implementing a strong AI governance structure and supporting AI education and awareness.

Harnessing traditional institutions for sustainable leadership and good governance in Nigeria

The subject of traditional institutions cannot be undermined in the project of sustainable leadership and good governance in Nigeria given the locus and crucial role of the institution in the past and modern Nigeria. It is incontrovertible that traditional and aboriginal values are held highly with reverence and respect in virtually all parts of Nigeria. To discountenance their relevance will be too costly in any leadership-cum-governance discourse. Towns, villages and cities were duly recognized and protected as the harbingers of culture, mores, norms and values. The contemporary government structure in Nigeria duly recognizes the importance of traditional institutions by having a Commission for Local Government (LG) and Chieftaincy Affairs at all State levels. Moreover, 5% of allocations to LGs go statutorily to the tradition institution in the State. Hitherto, the recklessness and abuse of the native authority system of local government administration in the 1950s–60s had led to the moderation and reforms of the system, which has continued to affect traditional institutions to date. To this end, the paper argues that traditional institutions hold so much values and cohesive practices as well as socially integrative potentials for nation-building so much that the State can leverage on them for sustainable leadership and overall good governance. The methodology adopted for collecting data for this study is descriptive research method, which relies on primary direct observation (eye-witness) account and relevant secondary materials such as texts, journal articles, official documents and internet materials. The data collected were analyzed and presented using thematic analysis and tables. National and international data already analyzed were found essential to drive home the argument of this study. The outcome of the paper provides useful information on how traditional institutions serve as a veritable platform for sustainable leadership and good governance in Nigeria. The paper concluded that traditional institutions, with its rich culture, values and practices, possess sufficient merits to propel the country towards sustainable leadership that would concomitantly induce economic, technological and political growth in Nigeria.

Nitrogen requirements of canola (Brassica napus L.) at sustained deficit irrigation levels in central Free State, South Africa

In South Africa canola (Brassica napus L.) is cultivated in rotation with wheat under winter rainfall in the Western Cape province. Expansion of the crop to the other eight provinces is propagated to reduce a shortage of locally produced plant oils. At the same time, canola may serve as a rotational crop for wheat in these summer rainfall provinces. In central Free State, agronomic information for canola production is lacking. An experiment with a line source sprinkler irrigation system was therefore conducted to establish the influence of water application levels (175, 233, 295, 351 and 420 mm) in combination with nitrogen (N) application rates (0, 70, 140, 210 and 280 kg ha−1) on the branches, pods and seeds per canola plant. The biomass and seed yields of canola were also measured, allowing calculation of harvest indices. All six variables were strongly influenced by the interaction of water and N applications. An optimal seed yield of 2.907 kg ha−1 was estimated with a 351 mm water application and a 280 kg ha−1 N application. This resulted in a water use efficiency of 8.28 kg seed ha−1 mm−1 water and a nitrogen use efficiency of 10.38 kg seed kg−1 N.

Geoinformatics and Modeling Approaches for Estimating Above-Ground Biomass in the Moist Deciduous Forests of Uttara Kannada, Karnataka, India

The present study aims to estimate Above-Ground Biomass (AGB) in the moist deciduous forests of Mundgod Taluk, Uttara Kannada district, Karnataka, India using a combination of field sampling and remote sensing techniques. AGB was assessed using Sentinel-2A satellite imagery with a spatial resolution of 10 meters. Field data were collected using the Point-Centered Quarter (PCQ) method, it includes measuring tree girth at breast height (GBH), tree height, and canopy density. AGB was calculated using artificial form factor and specific gravity of tree species and further modelled using the Normalized Difference Vegetation Index (NDVI) derived from satellite data. The results showed a significant correlation between canopy density and biomass, with very dense forests exhibiting the highest AGB values. The field-measured AGB was 436.96 t/ha for very dense forests, 259.89 t/ha for moderately dense forests, and 161.67 t/ha for open forests. A linear regression model developed between AGB and NDVI showed a high R² value of 0.91 for open forests, 0.87 for moderately dense forests, and 0.85 for very dense forests. The total area-weighted biomass for the study area was estimated at 8.87 million tons, with 4.79 million tons in very dense forests, 3.44 million tons in moderately dense forests, and 0.76 million tons in open forests. The regression model validation indicated low Root Mean Square Error (RMSE) values, with the moderately dense forests 8.81 t/ha and the in very dense forests 7.54 t/ha. This study highlights the effectiveness of integrating field measurements with remote sensing for rapid, reliable AGB estimation. The approach offers valuable insights into biomass distribution and carbon sequestration potential, providing a scalable method for carbon inventories at state and national levels, contributing to forest management and climate change mitigation efforts.

Assessing the psychobiological demands of high-fidelity training in pre-hospital emergency medicine

BackgroundIndividuals who provide critical emergency care mount rapid psychobiological responses when faced with an incident. These responses are adaptive and ensure resources at time of demand; however, frequent activation with minimal opportunity for recovery can have negative consequences for health and wellbeing. Monitoring individuals in real emergency situations would provide an understanding of their stress responses during the provision of critical care; however, this presents logistical challenges. An alternative is to assess individuals during high-fidelity training scenarios. This is the first comprehensive assessment of psychobiological responding during continuous high-fidelity training in pre-hospital emergency medicine.MethodsA sample of doctors and paramedics (N = 27) participated during 10 days of training and a weekend of no activities. Training involved the acquisition of human factors, non-technical and surgical skills, and their application in complex high-fidelity scenarios including road-traffic accidents, firearms incidents, and swift water rescue operations. On each day participants reported levels of state, cognitive, and somatic anxiety, and self-confidence following waking and before sleep, and their anticipated (at wake) and experienced (before sleep) demands of the day. Saliva samples were obtained each day for assessment of diurnal cortisol indices and the Cortisol Awakening Response (CAR). Garmin smartwatches were worn throughout for the collection of heart rate and HRV-derived stress.ResultsThere were significant (p < 0.001) differences across days for state, cognitive, and somatic anxiety; self-confidence; anticipated and experienced demands; aggregated measures of heart rate and HRV-derived stress; levels of cortisol at waking (p = 0.002) and for the CAR (p < 0.001). Measures of psychobiological responding during training were distinct from the weekend and the highest levels of psychobiological responding occurred on days characterised by greater anticipated and experienced demands.DiscussionThis high-fidelity training is typical of the day-to-day requirements of emergency services and these observations are representative of functioning during real-life critical care emergencies. Increased responding during times of demand is adaptive; however, frequent and sustained responding increases allostatic load and is a contributor to burnout. As burnout is a significant concern in emergency medicine, this study identifies patterns of responding and recovery that may impact upon longer-term health and wellbeing.

Educator perspectives on stressors and health: a qualitative study of U.S. K-12 educators in February 2022

BackgroundTeachers experienced increased stressors and stress during the initial onset of the COVID-19 pandemic. While many educators returned to in-person instruction in the 2021–2022 school year, they faced changing job demands and stressors which has important implications for educator well-being. We sought to understand the stressors and health impacts faced by U.S. educators in the 2021–2022 school year, two years following the acute phase of the pandemic.MethodsThirty-four certified educators based in Connecticut, USA participated in four virtual focus groups in February 2022. A semi-structured focus group script, designed by the research team and guided by the job demands-resources model, was administered to understand stressors and stress impacts. Data were transcribed and analyzed using the constant comparative method to identify themes and sub-themes. Themes were summarized based on how many participants mentioned them.ResultsAnalysis of the qualitative data yielded three themes concerning the well-being impacts of stress: physical health and health behaviors, psychological health, and relationships and social well-being behaviors. The majority of educators indicated impacts in these domains with 76% indicating impacts on physical health and health behaviors (e.g. poor sleep, physical exhaustion, lack of exercise, unhealthy eating), 62% indicating impacts on psychological health (e.g. emotional exhaustion, anxiety, negative self-evaluation); and 68% indicating impacts on relationships social well-being behaviors (e.g. connections with family or friends, connections with others, relationships with coworkers). The majority (94%) of educators indicated that stressors from the school or district with the majority (91%) citing stressors related to protocols/expectations (e.g. excessive or increased demands, insufficient or decreased resources) and some (38%) administrators. Over half (62%) indicated personal stressors including personal/home life (41%), high personal expectations (18%), and income (18%). Some (35%) indicated either the pandemic (26%) or safety concerns (9%) were stressors. Some (24%) cited students’ parents as a stressor and a few indicated community (12%), students (12%), and state or national level (9%) stressors.ConclusionEducator well-being continued to be impacted in the post-pandemic era. Targeted interventions are needed to reduce school and district-related demands and to address stress-related educator well-being.

Prevalence of pelvic examinations on anesthetized patients without informed consent.

The pelvic examination is a fundamental tool for the evaluation and diagnosis of women's health conditions and an important skill for all medical students to learn as future physicians for the early detection of treatable conditions such as infection or cancer. Although the American College of Obstetricians and Gynecologists (ACOG) asserts that performing pelvic examinations under anesthesia for educational purposes should only occur if the patient provides explicit and informed consent, there still have been reports of medical students performing pelvic examinations on anesthetized patients across the country, and many states are now starting to pass bills requiring informed patient consents to conduct pelvic examinations under anesthesia. The objectives of this study are to evaluate the prevalence of pelvic examinations performed by osteopathic medical students on anesthetized patients without consent while fulfilling their third-year OB-GYN clerkship requirements. The survey was administered and distributed to all osteopathic medical schools in the country via the Student Osteopathic Medical Association's (SOMA's) chapter emails, outreach emails, and SOMA's social media accounts to collect data. Inclusion criteria included third- or fourth-year osteopathic medical students who completed their OB-GYN clerkship rotations when taking the survey. The exclusion criteria included any osteopathic medical student who had not completed their OB-GYN clerkship rotation. We utilized descriptive analysis to summarize the final data. We received 310 responses. The final number of responses was 291 after meeting the exclusion criteria. Most osteopathic medical students (94.2 %, n=274) considered the practice of performing pelvic examinations on anesthetized patients without their explicit consent unethical. Among theparticipants, 40.9 % (n=119) admitted to performing pelvic examinations on patients under anesthesia while on OB-GYN rotations, but most of them (57.1 %, n=68) did so without obtaining prior consent from the patients. Notably, the number of pelvic examinations performed by medical students on patients under anesthesia ranged widely from 1 to 25 with a median number of 10. Moreover, 58.9 % (n=70) indicated that they had not been properly educated to obtain specific consent before performing pelvic examinations under anesthesia. Many participants cited efficiency of practice, lack of policy awareness and personal education by medical students, andfailure to refuse to perform pelvic examinations on anesthetized patients as trainees when asked by their seniors or preceptors. This study demonstrates that although most osteopathic medical students consider performing pelvic examinations on anesthetized patients unethical, many still admit to practicing pelvic examinations on patients under anesthesia, while on OB-GYN rotations for efficiency of practice, lack of policy awareness and personal education, and being in unique positions in which grades are determined by seniors and preceptors for their willingness to do what is asked even if the practice does not align with their conviction. This study highlights the importance of ongoing research and implementation of policies at institutional and state levels that will procure the value of pelvic examinations while protecting and upholding the ethics of patients' rights and autonomy of medical students.