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Previous reports of COVID-19 case, hospitalization, and death rates by vaccination status indicate that vaccine protection against infection, as well as serious COVID-19 illness for some groups, declined with the emergence of the B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19, and waning of vaccine-induced immunity (1-4). During August-November 2021, CDC recommended additional primary COVID-19 vaccine doses among immunocompromised persons and booster doses among persons aged ≥18 years (5). The SARS-CoV-2 B.1.1.529 (Omicron) variant emerged in the United States during December 2021 (6) and by December 25 accounted for 72% of sequenced lineages (7). To assess the impact of full vaccination with additional and booster doses (booster doses), case and death rates and incidence rate ratios (IRRs) were estimated among unvaccinated and fully vaccinated adults by receipt of booster doses during pre-Delta (April-May 2021), Delta emergence (June 2021), Delta predominance (July-November 2021), and Omicron emergence (December 2021) periods in the United States. During 2021, averaged weekly, age-standardized case IRRs among unvaccinated persons compared with fully vaccinated persons decreased from 13.9 pre-Delta to 8.7 as Delta emerged, and to 5.1 during the period of Delta predominance. During October-November, unvaccinated persons had 13.9 and 53.2 times the risks for infection and COVID-19-associated death, respectively, compared with fully vaccinated persons who received booster doses, and 4.0 and 12.7 times the risks compared with fully vaccinated persons without booster doses. When the Omicron variant emerged during December 2021, case IRRs decreased to 4.9 for fully vaccinated persons with booster doses and 2.8 for those without booster doses, relative to October-November 2021. The highest impact of booster doses against infection and death compared with full vaccination without booster doses was recorded among persons aged 50-64 and ≥65 years. Eligible persons should stay up to date with COVID-19 vaccinations.

Household-based cluster investigations were conducted in Puerto Rico during the 2016 Zika epidemic. While neither female sex nor younger age were associated with prevalence of Zika virus infection, both were significantly associated with an increased prevalence of symptomatic infection. Abstract Background During the outbreak of Zika virus (ZIKV) disease in Puerto Rico in 2016, nonpregnant women aged 20–39 years were disproportionately identified with ZIKV disease. We used household-based cluster investigations to determine whether this disparity was associated with age- or sex-dependent differences in the rate of ZIKV infection or reported symptoms. Methods Participation was offered to residents of households within a 100-m radius of the residences of a convenience sample of 19 laboratory-confirmed ZIKV disease cases. Participants answered a questionnaire and provided specimens for diagnostic testing by reverse transcription–polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA). Results Among 367 study participants, 114 (31.1%) were laboratory positive for ZIKV infection, of whom 30% reported a recent illness (defined as self-reported rash or arthralgia) attributable to ZIKV infection. Age and sex were not associated with ZIKV infection. Female sex (adjusted prevalence ratio [aPR], 2.28; 95% confidence interval [CI], 1.40, 3.67), age <40 years (aPR, 2.39; 95% CI, 1.55, 3.70), and asthma (aPR, 1.63; 95% CI, 1.12, 2.37) were independently associated with symptomatic infection. Conclusions Although neither female sex nor age were associated with an increased prevalence of ZIKV infection, both were associated with symptomatic infection. Further investigation to identify a potential mechanism of age- and sex-dependent differences in reporting symptomatic ZIKV infection is warranted.

Intimate partner violence (IPV) is a serious issue in the United States that results in various harmful consequences for both men and women. Understanding modifiable risk factors, such as attitudes and social norms, is an important step in developing culturally informed primary prevention and intervention programs that aim to reduce the prevalence of IPV. Existing research on IPV has failed to consider the influence of both injunctive (i.e., perceived approval) and descriptive (i.e., perceived prevalence) social norms, in addition to, specific cultural norms. With an in-depth analysis of past research and theoretical models, this review attempts to propose a comprehensive model of risk for IPV perpetration that focuses on various environmental, social and cultural factors. This review also provides an analysis of how the interaction between injunctive and descriptive social norms increases the likelihood of IPV perpetration among men. Several risk factors appear to be significantly influencing the likelihood of men developing attitudes that endorse violence against women including gender-role development, exposure to family violence, media and peer influence, emotion regulation, and precarious masculinity. Cultural ideals such as Machismo, Marianismo, and acculturation also appear to be impacting the likelihood of IPV perpetration among the Latino communities. Implications for clinical practice suggest developing individualized primary prevention and intervention programs that consider each individual’s exposure to specific risk factors, as well as, focusing on injunctive social norms by dismantling strict traditional gender-role norms.

An estimated 2.1 million U.S. adults are housed within approximately 5,000 correctional and detention facilities on any given day (1). Many facilities face significant challenges in controlling the spread of highly infectious pathogens such as SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Such challenges include crowded dormitories, shared lavatories, limited medical and isolation resources, daily entry and exit of staff members and visitors, continual introduction of newly incarcerated or detained persons, and transport of incarcerated or detained persons in multiperson vehicles for court-related, medical, or security reasons (2,3). During April 22-28, 2020, aggregate data on COVID-19 cases were reported to CDC by 37 of 54 state and territorial health department jurisdictions. Thirty-two (86%) jurisdictions reported at least one laboratory-confirmed case from a total of 420 correctional and detention facilities. Among these facilities, COVID-19 was diagnosed in 4,893 incarcerated or detained persons and 2,778 facility staff members, resulting in 88 deaths in incarcerated or detained persons and 15 deaths among staff members. Prompt identification of COVID-19 cases and consistent application of prevention measures, such as symptom screening and quarantine, are critical to protecting incarcerated and detained persons and staff members.

Wallace et al discuss the COVID-19 cases in correctional and detention facilities in the US from February to April 2020. An estimated 2.1 million US adults are housed within approximately 5,000 correctional and detention facilities on any given day. Many facilities face significant challenges in controlling the spread of highly infectious pathogens such as SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Such challenges include crowded dormitories, shared lavatories, limited medical and isolation resources, daily entry and exit of staff members and visitors, continual introduction of newly incarcerated or detained persons, and transport of incarcerated or detained persons in multiperson vehicles for court-related, medical, or security reasons. During Apr 22-28, 2020, aggregate data on COVID-19 cases were reported to CDC by 37 of 54 state and territorial health department jurisdictions. Thirty-two (86%) jurisdictions reported at least one laboratory-confirmed case from a total of 420 correctional and detention facilities. Among these facilities, COVID-19 was diagnosed in 4,893 incarcerated or detained persons and 2,778 facility staff members, resulting in 88 deaths in incarcerated or detained persons. Prompt identification of COVID-19 cases and consistent application of prevention measures are critical to protecting incarcerated and detained persons and staff members.

Background Hypertension is a public health concern for many countries. The World Health Organization has established a global objective to reduce the prevalence of non-communicable diseases, including hypertension, which is associated with cardiovascular disease. Remote nursing interventions can potentially lessen the burden on the healthcare system and promote a healthier population. This systematic review aims to synthesize available evidence on the effectiveness of nursing-led telehealth interventions in reducing blood pressure in hypertensive patients. Methods A systematic review was conducted. The search was performed from May to June 2021, in the databases: PubMed, Scopus, Cochrane Library, Web of Science, CINAHL, and ProQuest within 2010–2021 in English, Spanish and Portuguese. Randomized controlled trials and Quasi-experimental studies were considered. This systematic review followed the criteria of the Cochrane Handbook for Systematic Reviews of Interventions, with the support of the PRISMA guidelines and registered in PROSPERO. For critical analysis, the tools of the Joanna Briggs Institute were used. Results Of the 942 articles found, six controlled clinical trials and one quasi-experimental study were selected. Different nurse-led interventions (telehealth devices, remote video consultation, calls and email alerts) have demonstrated a significant decrease in blood pressure (especially systolic blood pressure) in the intervention groups. Nurse-led interventions also effect hypertension awareness, self-efficacy, and self-control. Positive effects on lowering cholesterol, consumption of fruits and vegetables, physical activity and adherence to medication were also described. Conclusion Nurse-led interventions delivered remotely have a positive effect in lowering the blood pressure of patients with hypertension. Further research is required to support strategies that will deliver the best continuous, quality, and cost-effective nursing care.

The ability to reason about ignorance is an important and often overlooked representational capacity. Phillips and colleagues assume that knowledge representations are inevitably accompanied by ignorance representations. We argue that this is not necessarily the case, as agents who can reason about knowledge often fail on ignorance tasks, suggesting that ignorance should be studied as a separate representational capacity.

Humans often communicate using body movements like winks, waves, and nods. However, it is unclear how we identify when someone’s physical actions are communicative. Given people’s propensity to interpret each other’s behavior as aimed to produce changes in the world, we hypothesize that people expect communicative actions to efficiently reveal that they lack an external goal. Using computational models of goal inference, we predict that movements that are unlikely to be produced when acting towards the world and, in particular, repetitive ought to be seen as communicative. We find support for our account across a variety of paradigms, including graded acceptability tasks, forced-choice tasks, indirect prompts, and open-ended explanation tasks, in both market-integrated and non-market-integrated communities. Our work shows that the recognition of communicative action is grounded in an inferential process that stems from fundamental computations shared across different forms of action interpretation. Humans can quickly infer when someone’s body movements are meant to be communicative. Here, the authors show that this capacity is underpinned by an expectation that communicative actions will efficiently reveal that they lack an external goal.

BackgroundDrug–drug interactions (DDIs) are common and can result in patient harm. Electronic health records warn clinicians about DDIs via alerts, but the clinical decision support they provide is inadequate. Little is known about clinicians’ real-world DDI decision-making process to inform more effective alerts.ObjectiveApply cognitive task analysis techniques to determine informational cues used by clinicians to manage DDIs and identify opportunities to improve alerts.DesignClinicians submitted incident forms involving DDIs, which were eligible for inclusion if there was potential for serious patient harm. For selected incidents, we met with the clinician for a 60 min interview. Each interview transcript was analysed to identify decision requirements and delineate clinicians’ decision-making process. We then performed an inductive, qualitative analysis across incidents.SettingInpatient and outpatient care at a major, tertiary Veterans Affairs medical centre.ParticipantsPhysicians, pharmacists and nurse practitioners.OutcomesThemes to identify informational cues that clinicians used to manage DDIs.ResultsWe conducted qualitative analyses of 20 incidents. Data informed a descriptive model of clinicians’ decision-making process, consisting of four main steps: (1) detect a potential DDI; (2) DDI problem-solving, sensemaking and planning; (3) prescribing decision and (4) resolving actions. Within steps (1) and (2), we identified 19 information cues that clinicians used to manage DDIs for patients. These cues informed their subsequent decisions in steps (3) and (4). Our findings inform DDI alert recommendations to improve clinicians’ decision-making efficiency, confidence and effectiveness.ConclusionsOur study provides three key contributions. Our study is the first to present an illustrative model of clinicians’ real-world decision making for managing DDIs. Second, our findings add to scientific knowledge by identifying 19 cognitive cues that clinicians rely on for DDI management in clinical practice. Third, our results provide essential, foundational knowledge to inform more robust DDI clinical decision support in the future.