Workplace Colleagues Research Articles

Incidence and Factors Associated With Burnout Among Cardiac Anesthesiologists in India

ObjectiveMany previous survey have demonstrated high incidence of burnout among anesthesiologists. This survey was aimed to estimate the incidence and to understand factors associated with burnout among cardiac anaesthesiologists in India. DesignMembers of the Indian Association of Cardiovascular and Thoracic Anaesthesiologists (IACTA) were invited. The survey consisted of 2 sections: the initial section collected demographic data, work patterns, and factors associated with burnout perception. The second part assessed Emotional Exhaustion (EE), Depersonalization (DP), and Low Personal Accomplishment (LPA) using the Maslach Burnout Inventory Human Services Survey (MBI-HSS). SettingWeb-Based Survey ParticipantsMembers of IACTA InterventionsNone Measurement and ResultsA high score on EE (≥27 and/or ≥ DP 10) identified those at high risk for burnout. High risk of burnout in addition to LPA ≤33 was defined as burnout syndrome.Of the 2,262 IACTA members surveyed, 325 (14.35%) responded. Among them, 162 (49.8%) were classified as at high risk of burnout, and 91 (28%) met the criteria for burnout syndrome.Logistic regression analysis identified factors associated with a high risk of burnout were <5 years of experience (OR-3.53), insufficient external support (OR-2.87), limited personal time availability (OR-1.96), and considering leaving cardiac anesthesia (OR-3.61). Factors contributing to burnout syndrome were <5 years of experience (OR-3.83), inadequate workplace colleague support (OR-1.84), and considering leaving cardiac anesthesia (OR-2.43). ConclusionsThe burden of burnout syndrome is high among Indian anesthesiologists. Risk factors included younger age, inadequate workplace and external support, limited personal time, and contemplation of leaving cardiac anesthesia. There is a need for sensitization of various stakeholders and institute necessary measures to reduce the burden and impact of burnout.

COVID-19 vaccine attitudes among a majority black sample in the Southern US: public health implications from a qualitative study

BackgroundThe COVID-19 pandemic continues to have high caseloads in the US, with vaccines a critical component of the response. Disparities in COVID-19 morbidity and mortality have been identified across states and racial/ethnic groups, which are likely in part due to disparities in COVID-19 vaccine uptake. This study aims to better understand and contextualize COVID-19 vaccine hesitancy among persons from under-represented racial/ethnic populations in the Southern US.MethodsWe conducted 29 in-depth interviews with a sample of households in Atlanta, GA that were selected from an address-based sampling frame. We purposively approached households, from February 6 to June 27, 2021, that declined participation in a national COVID-19 serosurvey to gain perspectives of people who are often under-represented in research. Interviews were conducted in-person or over phone calls for participants with that preference. Thematic analysis was used to identify barriers and facilitators of COVID-19 vaccination, and to contextualize drivers of vaccine hesitancy.ResultsDecision-making about vaccination was described as dynamic, and was compared to the feeling of being on a roller coaster. The predominant reported sources of information were mass media and social media. Facilitators of vaccination included altruism, positive communication from trusted community members and workplace colleagues, and local vaccine provision sites. Driving reasons for vaccine hesitancy included limited trust in the government and concerns about COVID-19 vaccine safety, which one participant compared to jumping off a cliff without a tested rope. Among a subset of participants, beliefs regarding perceived intent to harm the Black community were prevalent. Opportunities to optimally address vaccine hesitancy included countering negative social media messages with positive messaging that matches the community’s vivid ways of discussing vaccines, collaborating with community stakeholders on vaccine promotion efforts, and offering workplace-based vaccine promotion efforts.ConclusionsThis study presents data that indicate it may be optimal to more broadly define ‘community’ in COVID-19 vaccine promotion efforts to include social media and workplace venues. To optimize vaccine and vaccine booster uptake and equity, public health must address historic racism and other concerns by using outreach that is grounded in communities.

Evidence-based practice utilisation and its associated factors among nurses working at public hospitals in West Shoa zone, central Ethiopia: a cross-sectional study

ObjectiveThe aim of this study was to assess the utilisation of evidence-based practice (EBP) and its associated factors among nurses working in public hospitals of West Shoa zone, Oromia, central...

Differences in preferences for appreciation across various work settings

PurposePrevious research has documented the distribution of preferences of various appreciation languages by employees in general work settings. This paper aims to explore if employee preferences for appreciation vary across different types of workplace settings.Design/methodology/approachThe Motivating By Appreciation Inventory assesses individuals’ preferred ways of receiving appreciation from their workplace colleagues, determining each person’s primary language of appreciation in one of four appreciation languages. Results for 114,827 individuals were examined across the general workforce and in six work settings (government agencies, medical settings, military personnel, nonprofit organizations, remote employees and schools).FindingsPreferences within four work settings (government, nonprofits, remote, schools) were consistent with those from general work settings. But employees in medical settings and in the military choose Acts of Service more frequently than other employees. Quality Time is more valued by school and remote employees. Tangible Gifts are chosen at lower rates by government employees and military personnel.Research limitations/implicationsThe subjects are all English-speaking and predominately in the USA. The results may not be generalizable to other cultures and language speakers.Practical implicationsHuman resource professionals should be aware that employees in different types of workplaces vary in their appreciation preferences. Adjusting appreciation programs and practices should mirror these differences.Originality/valueTo the best of the author’s knowledge, this research is the first known to document differences in preferences for appreciation across various types of workplaces.

Quality early childhood education through self, workplace, or regulatory support: exploring the efficacy of professional registration for early childhood teachers in Australia

Teacher registration is increasingly utilised as a governance mechanism to audit teachers’ work and drive professional practice. There is limited and mixed empirical evidence, however, as to whether registration drives teaching quality. Our study extends this limited empirical base by critically examining the policy trajectory in Australia to bring early childhood teachers into a uniform system of registration with primary and secondary teachers. Adopting a relatively novel methodology, the study intertwined a critical social policy framing with a national quantitative survey. Results showed that respondents perceived their professional self, followed by their workplace (colleagues and employer) as key influencers of quality practice, and neither agreed nor disagreed that teacher registration was beneficial. Findings problematise the need for, and benefits of, teacher registration. That early childhood teachers’ practice and development was most driven by intrinsic motivation and, to a lesser extent, being employed in high-quality, not-for-profit, and preschool settings where other early childhood teachers are employed, suggests that more effective and progressive policy approaches to support quality early childhood education require an addressing of the contexts and conditions in which early childhood teachers work.

Persona: How Professional Women in China Negotiate Gender Performance Online

With the shift of social interaction to online venues, do women still conform to existing gender norms? This article examines the online performance of professional women in urban China and their interactions with workplace colleagues on WeChat, a popular Chinese social media app that is an important venue for workplace interaction. As interviews showed, workplace interactions on WeChat perpetuated traditional gender norms of hegemonic masculinity, and professional women accommodated to those existing gender norms by using particular “personas.” Three major personas were identified: one that emphasized professional identity and downplayed gender identity; another that accentuated femininity and downplayed professional identity; and a third that performed femininity to please male workplace supervisors by confirming their masculinity. Persona is used as an analytical term to capture the WeChat activities of these professional women because, compared to online self-presentation, the persona represented a strategic conformity to existing norms and the women distanced themselves from their assumed personas. The use of social media, therefore, reproduced and reinforced conformity to existing gender norms because the online gendered persona constituted a comprehensive and enduring constraint.

FAST Policing by Telephone: a Randomised Controlled Trial

Research QuestionCan caller satisfaction and trust in police be improved (or equalled), after police agree to send a police car to meet with a caller face-to-face, by the alternative of immediate transfer of the call to a police officer who speaks to the caller at length by telephone?DataA total of 1016 calls for police service to 999 or 101 assigned by call takers as falling into a “medium” priority category were checked for eligibility, including consent of the caller to speak immediately to a police officer by phone if possible. Eligible offence types excluded domestic abuse but included a variety of other matters. A majority (57.7%) of eligible cases were about threats made by neighbours, workplace colleagues or others known to the caller. A total of 450 cases were selected as eligible for the test sample out of a total of assessed as potentially eligible.MethodsEligible cases were randomly assigned to either a control group (N = 225) of business as usual (BAU) attempts to provide a face-to-face meeting with a police officer, or the experimental group (N = 225) receiving immediate telephone transfer to a police officer who talked with the caller for over an hour as the initial police response. Analyses were done by intention-to-treat. While 99.75% (N = 249/250) of the experimental cases were treated as assigned, only about half of the 225 control cases actually received a face-to-face meeting with a police officer. All 450 assigned callers who gave consent to enter the experiment were contacted for a satisfaction survey at least 14 days following random assignment of the cases, from which the completion rate was 72.5% (almost identical in the two treatment groups).FindingsEligible, consenting callers reported substantially higher levels of being “satisfied” or “very satisfied” with the experimental police response by telephone (92.6%) than with the BAU efforts to arrange a face-to-face meeting between a police officer and the caller (68.9%). Trust and confidence in Kent police declined among 21% of callers receiving BAU service, but only 9% of callers given immediate telephone service. The median time from the initial call to a conversation between police and caller was under 1 min for the experimental treatment vs. 2721 min for the 80% of BAU control treatments in which any conversation between an officer and a caller occurred within 96 h after the call.ConclusionThis first experiment in a research collaboration on FAST (Finding Alternative and Speedier Tactics) policing has opened the door to further tests of immediate response by remote communications (Rothwell, et al. Cambridge Journal of Evidence-Based Policing, 6, 1–24, 2022). For the kinds of cases included in this experiment, there is a clear preference by callers for the speedier service by a simple phone call over much slower attempts to provide a face-to-face meeting. If broadly adopted across many other high-volume, low-harm categories of requests for police service, fast policing by phone, video or silent live-chat online could improve public approval of policing while allowing more time for police to prevent more serious crimes.

An Evaluation of Barriers and Facilitators for a Pressure Injury Prevention Link Nurse Role: A Mixed-Methods Study in New Zealand.

The purpose of this study was to identify barriers and facilitators for nurses in a pressure injury prevention (PIP) link nurse role. Mixed-methods study that used nominal group technique with focus groups, followed by online surveys. The PIP link nurse project recruited 52 RNs; 32 completed the PIP educational program and participated in data collection. The sample was drawn from PIP link nurses, who were invited to participate in focus groups at the end of the project to identify perceived facilitators and barriers to their role. Focus groups were specific to work areas: aged care and community visiting, and hospital. Two were in an urban setting and one in a rural environment. Twenty-two PIP link nurses participated across 3 groups. To ensure comprehensive data from all involved in the project, online surveys were created using focus group priorities as the basis for questions to send to all PIP link nurses, their managers, and workplace colleagues. Participants were invited to participate in focus groups to identify perceived facilitators and barriers to their role. These focus groups were organized around care settings: aged care, community visiting, and hospital. Using a nominal group technique focus group process, participants were asked to identify barriers and facilitators to their role. These were shared with the group until all answers were declared and understood. Voting on order of priority then took place, with majority voting leading to a prioritized list of facilitators and barriers for each group. Considering the similarities and differences across group priorities, researchers developed online surveys representing the main facilitators and barriers from the focus groups. Surveys were then distributed to all PIP link nurses, their managers, and colleagues. Survey data were collected and analyzed in REDCap and reported as percentages of agreement to the questions for each group of respondents. Focus group data indicated facilitating priorities included PIP link nurses' commitment to the role, the support they received from their managers and colleagues, and time release to complete the role. Barriers included lack of time-when other work pressures took priority, and PIP link nurses felt the focus on applying quality improvement theory was more challenging than they had anticipated. Surveys from all groups reiterated the importance of the support of the workplace team in facilitating the role, and the time pressures for the PIP link nurse were a barrier to the role. While the funding of such projects is advantageous, it should be carefully and generously considered how much time is required if the project is to succeed so that lack of time to complete the role does not become a barrier to successful completion.

How do preschool to year 6 educators prevent and cope with occupational violence from students?

Student violence directed at school educators appears to be increasing, thus it is important to identify practical strategies that educators use to prevent and cope with occupational violence. This observational study surveyed 369 government primary school staff in the Australian Capital Territory. Sixty per cent of respondents reported abusive language, 42% physical aggression, and 43% experienced other threatening behaviour from students at least weekly. More than one-third of respondents rated the impact of these experiences as moderate or higher. The most effective prevention strategies, according to respondents, were the educator’s response to the threat, focusing on the student’s needs, working collaboratively, and using antecedent control. The most effective coping strategies were debriefing, self-care, and work support. The most helpful sources of support were workplace colleagues, partners, school leaders, and friends. This study offers a solution-focused perspective about what works in preventing and coping with occupational violence from educators’ points of view.

Advanced practice and clinical supervision: An exploration of perceived facilitators and barriers in practice.

The aim of this study was to investigate current advanced practice Masters students' experience of clinical supervision, to explore how clinical supervision works in practice and to identify students' perceptions of the facilitators and barriers to clinical supervision in their workplace. Advanced practitioners, and in particular nurses, play a pivotal role in delivering health care across acute and primary care settings. These non-medical professionals fulfil a rapidly expanding proportion of roles traditionally undertaken by medically qualified staff within the National Health Service in the United Kingdom and often lead specialist clinics and services. To prepare for the advanced practice role, individuals are required to undertake a Master's in advanced practice to develop the required skills and knowledge and work in clinical practice with a clinical assessor/supervisor to demonstrate competence and performance. A mixed method study using an online descriptive cross-sectional survey and qualitative data were collected via focus groups and has been reported using the Good Reporting of a Mixed Methods Study checklist. A total of 79students completed the online survey (from 145 AP students), a response rate of 55%. Most respondents were nurses (n=73) with 49 (62%) in a formal advanced practice trainee role, and the majority believed their clinical supervisor had a good understanding of advanced practice and the advanced practice role. Two focus groups were held with 16 participants in total. Thematic analysis revealed five themes: (a) perceived level and amount of support from clinical supervisors, (b) skill level of clinical supervisors, (c) physicians and their perceptions on supervising, Advanced practitioners (d) clinical supervisors' preparation for the role and (e) transition from trainee to qualified advanced practitioner. The survey revealed that advanced practitioner students perceived that clinical supervisors and workplace colleagues had a good understanding of the advanced practice role with good levels of support in practice. A more coherent approach is required for clinical supervision and an implementation framework that can be formally evaluated. Several significant barriers to clinical supervision for advanced practitioner students were identified, and there are currently more barriers (including COVID-19) than facilitators.

Nurses' Experiences Confirmed Positive Covid-19: Qualitative Study

Coronavirus Disease 2019 (Covid-19) has become a global pandemic worldwide, and the number of incidents increases every day. Nurses who provide care services in contact with patients are a vulnerable group with a high risk of transmission, so it is not uncommon for nurses to feel anxious and afraid to provide patients. This study describes the experiences of nurses who were confirmed COVID-19, including the origin of the exposure, clinical manifestations, the healing efforts made, and their psychological and spiritual experiences. The research design used was qualitative with a phenomenological approach to clinical nurses who had been confirmed positive for COVID-19 and at the time of the study had been declared cured—collecting data using semi-structured in-depth interviews with participants selected by purposive and snowball sampling techniques. This study reached saturation in the sixth participant—data analysis with Colaizzi Measures. The study identified six themes: 1) Lack of courage to report symptoms and carry out examinations, 2) Exposure to COVID-19 at their work, 3) Mild symptoms of Covid-19, 4) The most severe problem it felt was the psychological, 5) Efforts to heal with medication, 6) Support from workplace institutions and colleagues, 7) Religious, spiritual efforts, and 8) The sequelae after being healed. The negative stigma in the community towards covid survivors causes them to hide their illness so that the hospital and the surrounding community don't know about it. When confirmed COVID-19, the participants were in the mild category due to their young age and received the second vaccine. Although the symptoms are mild, they feel a psychological burden in fear and anxiety if their condition worsens. Efforts for healing use a medical approach with medication, recreational, psychological support, herbal treatment, and spiritual support in worship and prayer.

Pooled testing for SARS-CoV-2, options for efficiency at scale.

Widescale testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is recognized as a key element of surveillance and outbreak control in the coronavirus disease 2019 (COVID-19) pandemic. The practical challenges, however, have often led to testing only symptomatic individuals and their close contacts. As many countries plan for a cautious relaxation of social restrictions, more effective approaches for widescale testing are increasingly important. Early in the COVID-19 pandemic, laboratories in several countries demonstrated the feasibility of detecting SARS-CoV-2 infection by pooled testing, which combines the specimens from several individuals. Since no further testing is needed for individuals in a negative pool, there is potential for greater efficiency of testing. Despite validations of the accuracy of the results and the efficiency in testing specific groups, the benefits of pooling are less acknowledged as a population surveillance strategy that can detect new disease outbreaks without posing restrictions on entire societies. Pooling specimens from natural clusters, such as school classes, sports teams, workplace colleagues and other social networks, would enable timely and cost-effective widescale testing for SARS-CoV-2. The initial result would be readily translatable into action in terms of quarantine and isolation policies. Clusters of uninfected individuals would be quickly identified and immediate local lockdown of positive clusters would be the appropriate and sufficient action while retesting those individuals. By adapting to the social networks of a population, pooled testing offers a cost-efficient surveillance system that is synchronized with quarantine policies that are rational, risk-based and equitable.

From bystander to ally among faculty colleagues: construction and validation of the bystander intervention behavior scale

PurposeBystander intervention mitigates the negative impact of bias incidents in the workplace. However, intervention tends to be viewed as binary: intervention occurred or it did not. Consequently, research has focused on conditions under which witnesses of bias incidents choose to intervene, and less is known about how witnesses may intervene. This paper elucidates the intervention behavior choices available to witnesses of bias incidents and develops a bystander intervention behavior (BIB) scale.Design/methodology/approachTo develop the scale, the authors used the three-phased act frequency methodology. In phase I, the authors surveyed faculty who had both witnessed a bias incident and seen someone intervene to address it. The authors asked these faculties to list the observed bystander intervention behaviors they had personally observed. In Phase II, different survey respondents and subject matter experts assessed the prototypicality of each of the behaviors in relation to the concept of bystander intervention. In phase III, the authors tested the validity and reliability of the resulting 18-item scale and assessed the ability of bystander intervention behavior to mitigate the negative impact of bias incidents on the academic workplace.FindingsThe BIB scale consists of two theoretically derived, empirically validated and reliable dimensions; it can be used as a summary score to evaluate the extent to which colleagues intervene indirectly and directly when a bias incident occurs in the academic workplace.Originality/valueThis scale is valuable in advancing efforts to mitigate the negative effect of bias in the workplace and training colleagues to intervene in various ways when bias occurs.

Exploring university student engagement and sense of belonging during work-integrated learning

ABSTRACT Work-integrated learning (WIL) is recognised as a valuable pedagogical strategy for developing graduate employability, increasing employment prospects and contributing to a range of other learning outcomes. The purpose of this exploratory study was to determine the degree to which WIL students in higher education, felt they fully engaged in workplace activities and experienced a sense of belonging to their workplace environment. Further aims were to identify factors that facilitated and inhibited their engagement and belonging. Data were collected using an online survey of 151 students undertaking WIL as part of a university degree, in the contexts of business, sociology and sport, in one New Zealand and two Australian universities. Students generally felt they engaged effectively in the WIL placement environment and experienced a sense of belonging by their workplace colleagues. Qualitative responses provided insights into what facilitated and enabled engagement, with confidence identified as a key facilitator and inhibitor. Belonging was associated more with relationships and the workplace environment. When preparing university students and workplace supervisors for WIL, it is important to be aware of (and address) factors, such as confidence, that facilitate engagement and belonging in order to create opportunities that fully immerse students in the workplace community.

Being a gift- Multilingual healthcare professionals in neonatal care

BackgroundParents said that they sometimes wished they had a multilingual physician as an interpreter, because the physician would understand the child's care and treatment and share a language with the parents. AimTo understand and describe the lived experience of multilingual neonatal healthcare professionals dealing with interpreting in their workplace, performing as interpreters in addition to their regular work. MethodsInterviews with multilingual neonatal healthcare professionals and analysed using a phenomenological reflective lifeworld approach. ResultsMultilingual healthcare professionals understood the interpreting experience as being a gift, comprising three themes: feeling satisfaction – happiness from helping workplace colleagues; identifying with families – empathy from having been in the same situation; and expected to be available – colleagues expected them to provide interpreting services. ConclusionThis study found that it is common in neonatal care to use multilingual healthcare professionals to interpret communication with parents when language barriers exist.

Disclosure strategies in adults with epilepsy when telling, "I have epilepsy": The How2tell study.

To generate evidence-based knowledge about the strategies that adult people with epilepsy (PWEs) use in the process of telling others about their epilepsy. In-depth, one-to-one interviews explored PWEs' first-hand experiences of self-disclosure (or not), and grounded theory methods of inductive-deductive analysis were used to identify strategies used in disclosing. Interviews were audio-recorded, transcribed, coded, and independently recoded by two researchers using a coding framework specifically developed in this study. To account for maximum variation, PWEs (aged 18+ years) with different life experiences and situations relating to (1) gender, (2) age, (3) employment status, (4) personal relationships, (5) family relationship, (6) support group involvement, and (7) seizure frequency were included. Given the many variables and psychosocial issues associated with epilepsy, demographic details and validated measures including Quality of Life in Epilepsy-10-P, Coping Inventory of Stressful Situations-Adult, and Patient Health Questionnaire-9 were used to describe the characteristics of participants and to contextualize the results. Forty-nine adults with epilepsy participated. Data analysis revealed six interrelated categories (with subcategories) of the strategies that PWEs reported using in the process of disclosure: (1) concerns about disclosing; (2) weighing up who and when to tell; (3) opportunities for telling; (4) moment of disclosure-how to construct the message; (5) tailoring the message to audience needs-altering the message when telling family members, partner, friends, children, or employer and workplace colleagues; and (6) managing reactions by making it ordinary. People with epilepsy use a range of different strategies during the process of disclosing their epilepsy. These strategies were used to inform the development of the How2tell multimedia self-management resource for PWEs on self-disclosure in everyday social and life situations. How2tell is designed to benefit PWEs by empowering them with practical information about the process of telling another person, "I have epilepsy."

Citywide Transmission of Multidrug-resistant Tuberculosis Under China's Rapid Urbanization: A Retrospective Population-based Genomic Spatial Epidemiological Study.

Population movement could extend multidrug-resistant tuberculosis (MDR-TB) transmission and complicate its global prevalence. We sought to identify the high-risk populations and geographic sites of MDR-TB transmission in Shenzhen, the most common destination for internal migrants in China. We performed a population-based, retrospective study in patients diagnosed with MDR-TB in Shenzhen during 2013-2017. By defining genomic clusters with a threshold of 12-single-nucleotide polymorphism distance based on whole-genome sequencing of their clinical strains, the clustering rate was calculated to evaluate the level of recent transmission. Risk factors were identified by multivariable logistic regression. To further delineate the epidemiological links, we invited the genomic-clustered patients to an in-depth social network investigation. In total, 105 (25.2%) of the 417 enrolled patients with MDR-TB were grouped into 40 genome clusters, suggesting recent transmission of MDR strains. The adjusted risk for student to have a clustered strain was 4.05 (95% confidence interval, 1.06-17.0) times greater than other patients. The majority (70%, 28/40) of the genomic clusters involved patients who lived in different districts, with residences separated by an average of 8.76 kilometers. Other than household members, confirmed epidemiological links were also identified among classmates and workplace colleagues. These findings demonstrate that local transmission of MDR-TB is a serious problem in Shenzhen. While most transmission occurred between people who lived distant from each other, there was clear evidence that transmission occurred in schools and workplaces, which should be included as targeted sites for active case finding.The average residential distance between genomic-clustered cases was more than 8 kilometers, while schools and workplaces, identified as sites of transmission in this study, deserve increased vigilance for targeted case finding of multidrug-resistant tuberculosis.

Cross-District Transmission of Multidrug-Resistant Tuberculosis in Shenzhen, a Newly Developed Metropolis of China with Massive Young Migrant Workers

Background: Population movement could extend multidrug-resistant tuberculosis (MDR-TB) transmission and complicate its global prevalence. We sought to identify the high-risk populations and geographic sites of MDR-TB transmission in Shenzhen, the most common destination for internal migrants in China. Methods: We performed a population-based, retrospective study of patients who were diagnosed with MDR-TB in Shenzhen during 2013-2017. By defining genomic clusters with a threshold of 12 SNP distance based on whole-genome sequencing their clinical strains, the clustering rate was calculated to evaluate the level of recent transmission. Risk factors for MDR-TB transmission were identified by multivariable logistic regression. To further delineate the epidemiological links, we invited the genomic-clustered patients to an in-depth social network investigation. Results: In total, 105 (25·2%) of the 417 enrolled MDR-TB patients were grouped into 40 genome clusters, suggesting recent transmission of MDR strains. The adjusted risk for students to have a clustered strain was 4·05 (95% confidential intervals [CI], 1·06-17·0) times greater than other patients. The majority (70%, 28/40) of the genomic clusters involved patients who lived in different districts, with residences separated by an average of 8·76 kilometers. Other than household members, confirmed epidemiological links were also identified among classmates and workplace colleagues. Interpretation: These findings demonstrate that local transmission of MDR-TB is a serious problem in Shenzhen city. While most transmission occurred between people who lived distant from each other, there was clear evidence that transmission occurred in schools and workplaces, which should be included as targeted sites for active case finding. Funding: Sanming Project of Shenzhen (SZSM201611030); and National Science and Technology Major Project of China (2017ZX10201302 & 2018ZX10715012-005) Declaration of Interest: We declare that we have no conflicts of interest. Ethical Approval: The study protocol was approved by the Ethical Review Board of Shenzhen CCDC (No. 20180310).

The quality of life and the future of young adults with Asperger syndrome

Purpose: This pilot study describes the socio-professional development and quality of life of young adults with Asperger syndrome in France.Methods: Those young adults, between 18 and 30 years old, receiving care in a child psychiatry department for autistic spectrum disorder, were requested to respond to the Ad Hoc, World Health Organization Quality Of Life – Bref and Copenhagen psychosocial questionnaires regarding their socio-professional background and feelings about their future.Results: Of the 79 eligible subjects, 24 were selected to participate in our study. Their average age at the time of the pilot study was 22.2 years (standard deviation 3.4 years), and their average age when they were diagnosed was 17.5 years (standard deviation 3.7 years.). There were 54% who reported a psychiatric comorbidity anxiety disorder. Half stated they had completed secondary school and benefitted from being professionally employed. During this study, only six were employed, while the others remained financially dependent on their parents. The group’s quality of life self-assessment scores were significantly lower compared to the French general population in overall psychology (43.6 versus 68.7) and social relationships (48.9 versus 76.5). However, the study’s participants perceived work as an important means to their personal development. Hence, in order to cope with their difficulties, they hoped to benefit from customized support adapted to their autistic disorder and for their workplace colleagues to be better informed about Asperger syndrome.Conclusions: Our results are in line with international data. Additional studies need to be done in order to determine socio-professional integration factors and, in particular, the integration of potential contributions by occupational health departments with those social and medical teams supporting these young adults.Implications for rehabilitationYoung adults with Asperger syndrome benefit from the support of their family in determining their professional goals.Support may be required to enhance social and communicative abilities to help integration.Employees would benefit from information on the syndrome and how best to support.

The Role of Relationships: An Exploratory Study of Early Childhood Educators Earning a Bachelor’s Degree

Professional standards increasingly call for early childhood educators to hold a bachelor’s degree as one measure of educator quality. This has prompted many educators to return to college, creating both a need and an opportunity to better understand the factors that support educators to complete their degree and apply what they learn to their teaching practice. This qualitative study examined the higher education experiences of early educators enrolled in a public urban university early childhood teacher education program. Using a theoretical lens grounded in relational theory, this study explored how relationships in the university and the workplace influenced educators’ progress toward degree completion and their application of learning into practice. Data included in-depth individual interviews with educators and their workplace supervisors. This study shows how positive relationships with university faculty, staff, peers, and workplace colleagues and supervisors can support educators as they work toward earning their bachelor’s degree. The results revealed four characteristics of these relationships that influenced educators, as well as key barriers and challenges. In particular, the findings show how several negative relational dynamics may act as a barrier to educators’ efforts to apply new learning in the workplace. The paper concludes with implications for research and practice, and calls for increased attention to the relational contexts in which educators pursue their degree and make improvements in their teaching practices.