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We aimed to apply the Systems Engineering Initiative for Patient Safety (SEIPS) model to increase effectiveness and sustainability of the World Health Organization’s (WHOs) hand hygiene (HH) guidelines within healthcare systems. Our cross-sectional, mixed-methods study took place at Jimma University Medical Center (JUMC), a tertiary care hospital in Jimma, Ethiopia, between November 2018 and August 2020 and consisted of three phases: baseline assessment, intervention, and follow-up assessment. We conducted questionnaires addressing HH knowledge and attitudes, interviews to identify HH barriers and facilitators within the SEIPS framework, and observations at the WHO’s 5 moments of HH amongst healthcare workers (HCWs) at JUMC. We then implemented HH interventions based on WHO guidelines and results from our baseline assessment. Follow-up HH observations were conducted months later during the Covid-19 pandemic. 250 HCWs completed questionnaires with an average knowledge score of 61.4% and attitude scores indicating agreement that HH promotes patient safety. Interview participants cited multiple barriers to HH including shortages and location of HH materials, inadequate training, minimal Infection Prevention Control team presence, and high workload. We found an overall baseline HH compliance rate of 9.4% and a follow-up compliance rate of 72.1%. Drastically higher follow-up compared to baseline compliance rates were likely impacted by our HH interventions and Covid-19. HCWs showed motivation for patient safety despite low HH knowledge. Utilizing the SEIPS model helped identify institution-specific barriers that informed targeted interventions beyond WHO guidelines aimed at increasing effectiveness and sustainability of HH efforts.

IntroductionA growing body of evidence has demonstrated the importance of mentalization for adolescents' psychosocial functioning; however, further research is needed to understand links between mentalization and other socio-cognitive factors. The aim of this quantitative, cross-sectional study was to investigate the relationship between a teen's capacity to mentalize and three attachment-related factors: parent-teen trust, parent-teen communication, and parent-teen alienation.MethodsIn an online survey, 82 (mainly) Australian adolescents (57 female; 23 male; 2 non-binary; mean age 17.09 years) completed: i) The Children's Eyes Test, which measured mentalization; and ii) The Inventory of Parent and Peer Attachment-45, which measured trust, communication quality, and alienation.ResultsIn teens' relationships with both mothers and fathers, trust and communication quality were significantly positively correlated (p = .001) when controlling for age and gender. Both were significantly negatively correlated with alienation (p = .001) with control variables included. Capacity to mentalize did not correlate with trust, communication quality, or alienation in relationships with either mothers or fathers (p ≤ .05).ConclusionsPossible reasons are proposed for why no relationship was found between mentalization and trust, communication quality, or alienation. Implications for future research are discussed.

As global ocean-bound commerce increases, managing human activities has become important in reducing conflict with threatened wildlife. This study investigates environmental factors determining abundance and distribution of blue whales (Balaenoptera musculus), humpback whales (Megaptera novaeangliae) and their prey (Euphausia pacifica and Thysanoessa spinifera) in central California. We provide insights into environmental drivers of the ecology and distribution of these species, model whale distributions and determine coincident hotspots of whales and their prey that will help decrease human threats to whales and protect critical feeding habitat. We developed separate predictive models of whale abundances (using negative binomial regression on count data) and krill abundance (using a two-part hurdlemodel combining logistic and negative binomial regressions) over a 14 year period (2004-2017). Variables included in situ surface and midwater oceanographic measures (temperature, salinity, and fluorescence), basin-scale climate indices, and bathymetric- and distance-related data. Predictions were applied to 1 km2 cells spanning the study area for May, June, July, and September during each of the 14 years of surveys to identify persistent distribution patterns. Both whales and krill were found to consistently use the northeast region of Cordell Bank, the Farallon Escarpment, and the shelf-break waters. The main identified blue whale hotspots were also krill hotspots, while co-occurrence was more limited and varied seasonally for humpback whales and krill. These results are valuable in identifying patterns in important areas of ecological interaction to assist management of whales. Areas north of Cordell Bank are of particular management concern since they overlap with the end of the San Francisco Bay northern shipping lane. Our findings can help decrease threats to whales, particularly in important foraging areas, by supporting implementation of vessel management and informing potential conflicts with other human uses.

BackgroundAcute kidney injury (AKI) is a risk factor for neurocognitive impairment in severe malaria (SM), but the impact of AKI on long-term behavioral outcomes following SM is unknown.MethodsWe conducted a prospective study on behavioral outcomes of Ugandan children 1.5 to 12 years of age with two forms of severe malaria, cerebral malaria (CM, n = 226) or severe malarial anemia (SMA, n = 214), and healthy community children (CC, n = 173). AKI was defined as a 50% increase in creatinine from estimated baseline. Behavior and executive function were assessed at baseline and 6, 12, and 24 months later using the Child Behavior Checklist and Behavior Rating Inventory of Executive Function, respectively. Age-adjusted z-scores were computed for each domain based on CC scores. The association between AKI and behavioral outcomes was evaluated across all time points using linear mixed effect models, adjusting for sociodemographic variables and disease severity.ResultsAKI was present in 33.2% of children with CM or SMA at baseline. Children ≥6 years of age with CM or SMA who had AKI on admission had worse scores in socio-emotional function in externalizing behaviors (Beta (95% CI), 0.52 (0.20, 0.85), p = 0.001), global executive function (0.48 (0.15, 0.82), p = 0.005) and behavioral regulation (0.66 (0.32, 1.01), p = 0.0002) than children without AKI. There were no behavioral differences associated with AKI in children ConclusionsAKI is associated with long-term behavioral problems in children ≥6 years of age with CM or SMA, irrespective of age at study enrollment.

The ability to selectively respond to one's own name is important for social and language development, and is disrupted in atypically developing populations (e.g., autism spectrum disorder). Research with typically developing samples using event-related potentials (ERPs) has demonstrated that the subject's own name (SON) is differentiated from other stimuli at both early sensory and later cognitive stages of auditory processing. While neural indices of response to name have been researched extensively in adults, no such studies have been conducted with typically developing preschool children or children with autism spectrum disorder (ASD). The present study investigated ERP response to name in a sample of typically developing (TD) preschoolers (n = 19; mean age = 4.3 years) as well as a small, exploratory comparison group of preschoolers with ASD (n = 13; mean age = 4.4 years). TD preschoolers exhibited significantly greater negativity to SON over frontal regions than to an unfamiliar nonsense name, consistent with the adult SON negativity component. This component was present whether the name was spoken by a parent or an unfamiliar adult, suggesting that it reflects SON-specific processing rather than broad self-relevant information processing. Comparing preschoolers with ASD to the TD children revealed a significant SON negativity component across both groups. The amplitude of the SON negativity response was significantly correlated with social variables in the ASD group, though these correlations did not survive correction for multiple comparisons. This study is the first to demonstrate the presence of the SON component in preschool children with and without ASD.

Miscarriage occurs in up to one in four pregnancies and can be a devastating event affecting both men and women. Unfortunately, the male partner's experience of miscarriage is seldom researched, particularly within Australia. This qualitative study involved semi-structured telephone interviews with 10 Australian men, whose partners miscarried between three months and ten years ago. Participants were recruited through professional networks and support organisations. Interviews explored men's general miscarriage experience and the support received or lacking from both healthcare providers and social networks. Online health seeking behaviour and opinions on online support were also discussed. Data was transcribed verbatim and analysed thematically. Most men described feeling significant grief following miscarriage and felt that there was little acknowledgment of their loss, both from healthcare providers and within their social networks. Feelings of sadness, devastation, powerlessness, fear, shock and a loss of identity were common. All men felt their primary role at the time of miscarriage was to support their partner. Most men did not want to burden their partner with their emotions or grief, and struggled to find people within their social networks to talk to about their loss, leading to feelings of isolation. Overall participants felt there was inadequate support offered to men affected by miscarriage. Men wanted information, informed professionals to talk to and male-orientated support networks. A website was one mechanism suggested by men which could adequately contribute to information and support needs during this time. Men are often greatly affected by miscarriage and yet there is all too often little acknowledgement or support available to them at this time. Men affected by miscarriage want and need further support, including reputable, Australian based information and resources tailored their needs.

This article examines men’s involvement in an institutional gender equity award scheme and how their self-concept as allies develops over time. It draws specifically on a subset of qualitative data from the four men participating in a study involving in-depth interviews with university staff involved in the self-assessment team of one Australian institution’s Science in Australia Gender Equality (SAGE) Athena SWAN pilot. Data related to the men’s experiences is the article’s focus. Key themes from the data include: 1) men’s motivations for engagement; 2) men’s self-understandings as ‘champions for change’ 3) the barriers/risks associated with male championship; and 4) men’s evolving perceptions and critiques of the male champions model. Findings show that men demonstrated personal growth and increased awareness through their participation in the pilot. Yet, their frustration with how equity and diversity was managed in their organisational context highlights pitfalls in the concept of a male ‘champion’. This article provides timely guidance for institutions seeking to engage allies in gender equity initiatives.

Understanding how perceptions around motivation, capacity, and climate change’s impacts relate to the adoption of adaptation practices in light of experiences with extreme weather events is important in assessing farmers’ adaptive capacity. However, very little of this work has occurred in islands, which may have different vulnerabilities and capacities for adaptation. Data of surveyed farmers throughout Puerto Rico after Hurricane Maria (n = 405, 87% response rate) were used in a structural equation model to explore the extent to which their adoption of agricultural practices and management strategies was driven by perceptions of motivation, vulnerability, and capacity as a function of their psychological distance of climate change. Our results show that half of farmers did not adopt any practice or strategy, even though the majority perceived themselves capable and motivated to adapt to climate change, and understood their farms to be vulnerable to future extreme events. Furthermore, adoption was neither linked to these adaptation perceptions, nor to their psychological distance of climate change, which we found to be both near and far. Puerto Rican farmers’ showed a broad awareness of climate change’s impacts both locally and globally in different dimensions (temporal, spatial, and social), and climate distance was not linked to reported damages from Hurricane Maria or to previous extreme weather events. These results suggest that we may be reaching a tipping point for extreme events as a driver for climate belief and action, especially in places where there is a high level of climate change awareness and continued experience of compounded impacts. Further, high perceived capacity and motivation are not linked to actual adaptation behaviors, suggesting that broadening adaptation analyses beyond individual perceptions and capacities as drivers of climate adaptation may give us a better understanding of the determinants to strengthen farmers’ adaptive capacity.

Comprehensive assessment of food insecurity across all college community members is lacking. This research surveyed a random sample of an entire campus population at a Northeast University in two surveys (spring 2017, n = 1,037 and fall 2017, n = 1,123). Analysis of variance, t-tests, and multivariable logit models were used to understand food insecurity outcomes and comparisons among groups. The overall rate of food insecurity on campus was 19.6% (spring) and 15.0% (fall). Food insecurity rates were highest among undergraduates, graduate and medical students, and staff as compared to faculty. First generation students and off-campus students were also more likely to be food insecure in both surveys, while people of color were more likely to be food insecure in the spring survey. Findings suggest university members beyond undergraduates also face high rates of food insecurity, which has important implications for efforts to reduce food insecurity on college campuses.

Future climate changes will affect smallholder farmers in the developing world, posing threats to household food security. Nevertheless, there remains limited comparable evidence across multiple countries and regions regarding the global extent of climate shocks affecting smallholder food security. We examine data from 5,299 household surveys across 15 countries in Latin America, Africa and South Asia to assess the extent of climate shocks and their association with food insecurity, as well as what strategies may help buffer against climate shocks. We find that 71% of households reported experiencing a climate shock in the previous five years. Fifty-four percent reported experiencing food insecurity during one or more months annually. A multilevel statistical model estimated factors correlated with food insecurity as well as factors correlated with food insecurity among households that had experienced a climate shock. Households that reported experiencing a climate shock were 1.73 times more likely to be food insecure. As well, larger and poorer households were associated with higher odds of food insecurity while using pesticides, keeping large livestock, and being more educated are associated with lower odds of food insecurity. Among households that had experienced a climate shock, additional factors are correlated with lower odds of food insecurity when compared to otherwise similar households: use of fertilizers, pesticides, veterinary medicines, large livestock, and household assets. Together, these results demonstrate the extent of existing climate shocks affecting smallholder farmers and how interventions may potentially support adaptation and reduce food insecurity.

Parenting styles vary in levels of both warmth and control, with evidence that type of parenting behavior is linked with social-emotional and other developmental outcomes for children. There are well-established associations between adult attachment and parenting styles. Given emerging evidence that people with different attachment patterns vary in how they receive and modulate sensory information, there are potential implications for parenting which have rarely received research attention. This cross-sectional study investigates the links between parenting style and parental sensory sensitivity, and the possible mediating role of parental sensory sensitivity in the relationship between adult attachment and parenting styles. A convenience sample of 155 parents of children aged 4-12 years old completed an online survey measuring: adult attachment (Experiences in Close Relationships-Modified 16-item Scale), sensory sensitivity (Highly Sensitive Persons Scale-Shortened Version), and parenting styles (Parenting Styles and Dimensions Questionnaire). Correlation, regression and mediation analyses were conducted. Analyses revealed that parents who reported more attachment insecurity also reported higher levels of parental sensory sensitivity, and more authoritarian and/or permissive (non-optimal) parenting styles. Parental sensory sensitivity was found to fully mediate the relationship between attachment avoidance and permissive parenting, and to partially mediate the relationship between attachment anxiety and both authoritarian and permissive parenting. This study represents the first quantitative evidence for associations between parental sensory sensitivity and parenting styles, and the mediating effect of parental sensory sensitivity on the known relationship between attachment insecurity and parenting. Awareness of a parent's level of sensory sensitivity, in addition to his/her attachment style, may assist in developing effective strategies to meet both the parent's and child's needs and support the parent-child relationship.

Mounting evidence indicates that early-life exposure to particulate air pollutants pose threats to children’s cognitive development, but studies about the neurotoxic effects associated with exposures during adolescence remain unclear. We examined whether exposure to ambient fine particles (PM2.5) at residential locations affects intelligence quotient (IQ) during pre-/early-adolescence (ages 9-11) and emerging adulthood (ages 18-20) in a demographically-diverse population (N = 1,360) residing in Southern California. Increased ambient PM2.5levels were associated with decreased IQ scores. This association was more evident for Performance IQ (PIQ), but less for Verbal IQ, assessed by the Wechsler Abbreviated Scale of Intelligence. For each inter-quartile (7.73 μg/m3) increase in one-year PM2.5preceding each assessment, the average PIQ score decreased by 3.08 points (95% confidence interval = [−6.04, −0.12]) accounting for within-family/within-individual correlations, demographic characteristics, family socioeconomic status (SES), parents’ cognitive abilities, neighborhood characteristics, and other spatial confounders. The adverse effect was 150% greater in low SES families and 89% stronger in males, compared to their counterparts. Better understanding of the social disparities and sexual dimorphism in the adverse PM2.5-IQ effects may help elucidate the underlying mechanisms and shed light on prevention strategies.

Whereas past wolf management in the United States was restricted to recovery, managers must now contend with publicly contentious post-recovery issues including regulated hunting seasons. Understanding stakeholder concerns associated with hunting can inform stakeholder engagement, communication, and policy development and evaluation. Social identity theory (SIT) has been used to understand how groups interact, why they conflict, and how collaboration may be achieved. Applying SIT to stakeholder conflicts about wolf hunting may help delineate groups according to their concern about, support for or opposition to the policy choice of hunting wolves. Our objective was to assess concerns about hunting as a tool to resolve conflict in Michigan, using SIT as a framework. We used a mixed-modal sampling approach (e.g., paper, Internet) with wolf hunting-related public meeting participants in March 2013. Survey questions focused on 12 concerns previously identified as associated with hunting as a management tool to resolve conflict. Respondents (n = 666) cared greatly about wolves but were divided over hunting wolves. Wolf conflicts, use of science in policy decisions, and maintaining a wolf population were the highest ranked concerns. Principle components analysis reduced concerns into three factors that explained 50.7% of total variance; concerns crystallized over justifications for hunting. General linear models revealed a lack of geographic influence on care, fear and support for hunting related to wolves. These findings challenge assumptions about regional differences and suggest a strong role for social identity in driving dichotomized public perceptions in wildlife management.