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PurposeDuring the first wave of the COVID-19 pandemic, restricted visitation policies were enacted at acute care facilities to reduce the spread of COVID-19 and conserve personal protective equipment. In this study, we aimed to describe the impact of restricted visitation policies on critically ill patients, families, critical care clinicians, and decision-makers; highlight the challenges faced in translating these policies into practice; and delineate strategies to mitigate their effects.MethodA qualitative description design was used. We conducted semistructured interviews with critically ill adult patients and their family members, critical care clinicians, and decision-makers (i.e., policy makers or enforcers) affected by restricted visitation policies. We transcribed semistructured interviews verbatim and analyzed the transcripts using inductive thematic analysis.ResultsThree patients, eight family members, 30 clinicians (13 physicians, 17 nurses from 23 Canadian intensive care units [ICUs]), and three decision-makers participated in interviews. Thematic analysis was used to identify five themes: 1) acceptance of restricted visitation (e.g., accepting with concerns); 2) impact of restricted visitation (e.g., ethical challenges, moral distress, patients dying alone, intensified workload); 3) trust in the healthcare system during the pandemic (e.g., mistrust of clinical team); 4) modes of communication (e.g., communication using virtual platforms); and 5) impact of policy implementation on clinical practice (e.g., frequent changes and inconsistent implementation).ConclusionsRestricted visitation policies across ICUs during the COVID-19 pandemic negatively affected critically ill patients and their families, critical care clinicians, and decision-makers.

Nosocomial infections (NIs) in critically ill patients with cirrhosis result in higher death and transplant delisting. NIs are promoted by staff, visitors, and the environment, all of which were altered to reduce pathogen transmission after COVID-19. Two cohorts of intensive care unit patients with cirrhosis from March 2019 to February 2020 (pre-COVID, n = 234) and March 2020 to March 2021 (COVID era, n = 296) were included. We found that despite a higher admission MELD-Na, qSOFA, and WBC count and requiring a longer intensive care unit stay, COVID-era patients developed lower NIs (3% vs 10%, P < 0.001) and had higher liver transplant rates vs pre-COVID patients. COVID-era restrictions could reduce NIs in critically ill patients with cirrhosis.

Regarded at the time as a measure which was necessary to mitigate the spread of the disease, policies limiting visiting rights have been subject to heavy criticism since the waning of the pandemic.1–3 The idea of people dying alone in hospital or living in residential care settings for months with no access to family members or loved ones is particularly troubling and it is difficult in retrospect to avoid hindsight bias. Positive benefits of integrating visitors into the provision of healthcare include assistance with feeding and self-care and, most importantly, emotional support.9 Negative consequences of visitation restrictions during the pandemic included increased patient loneliness, agitation, depression, decreased nutrition and daily activity, increased reports of pain and other symptoms, increased stress and anxiety reported by family members, and staff moral distress.10–14 Context, however, is important. At the beginning of the pandemic, COVID-19 was seen to pose a threat to the functioning of healthcare systems; knowledge of the mechanisms by which the virus spread, including the role of asymptomatic carriers, was sparse and there were concerns that supply of personal protective equipment (PPE), even hospital beds and ventilators, would not be able to meet demand8 10 11 (images of nurses in New York City wearing bin bags in place of PPE and the issuing of new guidance to reuse previously single-use N95/FFP3 masks highlighted the scarcity of PPE at the time). The imperative to protect patients, healthcare workers and members of the community against the virus and the need to maintain functioning healthcare systems provided the ethical justification for prioritising the safety of the broader community above the needs of individuals by restricting visitors to hospitals and nursing homes.9 It is clear, as Collier et al 4 point out, that the restrictions on visitors resulted in substantial harm to patients, their loved ones and to staff.11–13 Any intervention that has the potential for harm requires ethical scrutiny, deliberation and justification, with efforts made in advance to mitigate foreseeable harms.8 9 Decisions about balancing harms and benefits which are difficult to quantify should not be made on an ad hoc basis.

President Trump described the U.S.-Pakistan relationship as ‘very important’ during a bilateral meeting with Pakistani Prime Minister Imran Khan at the World Economic Forum in Davos, Switzerland, on Jan. 21.

In this paper, we investigate supervisory control of networked discrete event systems. Such systems are now widely used in practice. The key feature of a networked discrete event system is communication delays and losses in observation and control. Without addressing communication delays and losses in networked systems, no control will be effective. We propose to use some special observation mappings to deal with observation delays and losses. Based on these mappings, we define network observability. We also consider control delays and losses in networked discrete event systems and define network controllability. We show that these definitions capture precisely the requirements on effective supervisory control in networked discrete event systems in the sense that a networked supervisor exists if and only if both network controllability and network observability are satisfied. [PUBLICATION ABSTRACT]

This study empirically investigates the factors influencing tourists’ motivations to visit heritage monuments in the Kangra district of Himachal Pradesh, India. With a focus on cultural and psychological dimensions of heritage tourism, the research aims to identify core motivational drivers shaping tourist behaviour. Three hundred fifty responses were collected through structured questionnaires administered at 11 Archaeological Survey of India (ASI)-protected heritage sites within the district. Using exploratory factor analysis (EFA) in SPSS, four dominant motivational dimensions were extracted: TMF1 (Holistic Enrichment through Experiential Tourism), TMF2 (Rejuvenation and Social Fulfilment), TMF3 (Personal Autonomy and Social Identity), and TMF4 (Self-Discovery and Inner Well-Being). The findings suggest that tourists are primarily driven by the desire to engage with the region’s rich cultural and historical heritage. At the same time, the surrounding natural beauty serves as a complementary attraction. Demographic variables such as age, education, occupation, and travel companion significantly influenced these motivational factors. These insights provide a basis for targeted marketing strategies and customised tourism experiences. Additionally, the study highlights the potential for establishing a regional heritage tourism circuit, which could enhance visitor flow, generate economic benefits, and promote sustainable tourism development. The findings offer practical implications for tourism planners, heritage managers, and policymakers to optimise heritage site management and improve visitor engagement in emerging cultural destinations.

Objective This descriptive study broadens the scope of father participation in home visiting and examines how fathers' participation varies by demographic and family characteristics. Background Consistent and supportive father involvement is associated with positive outcomes for children. Although parenting programs during early childhood provide opportunities to influence fathers' involvement with their children, father participation in these programs is low. Method We developed and administered a survey to mothers participating in home visiting programs (N = 1,386) to describe how fathers participate in home visiting programs. A series of logistic regression analyses were used to describe how father participation varied across key factors. Results Fathers frequently engaged with home visiting in ways that were more indirect, and therefore go unreported by home visitors (e.g., asking mothers about a missed home visit, doing homework or practicing lessons from the visit with the child). Father participation varied based on the relationship and coresidence status between the child's mother and father, father's employment status, and age of the child. Conclusion Findings suggest that fathers engage in home visiting more frequently than previously measured, as they often participate in ways that are not directly observed and reported by home visitors. Implications Expanding the scope of what defines father participation provides home visiting program staff a better understanding of how fathers participate in the programs and, consequently, how to target father engagement strategies. Informed engagement strategies may be more effective for increasing father engagement and the impact of father participation for families and children.

Family members of critically ill patients spend significant periods of time in the intensive care unit (ICU) and hospital environment. We aimed to identify what services, resources, and conveniences are important to adult ICU visitors. We conducted a cross-sectional study including visitors in four adult ICUs in the province of Ontario, Canada. In the survey, we asked visitors to rate the importance of 58 items relating to the environment of patient rooms, the waiting room, and hospital facilities. For each item, we gave respondents five categorical response options, from \"not at all important\" to \"extremely important.\" We used descriptive statistics to analyze the survey results. We analyzed 224 surveys completed by ICU visitors (60% female, ages 14-87 yr). Respondents were predominantly children (41%) or the spouse/partner (23%) of adult ICU patients. Nearly half (51%) lived more than 30 km from the hospital, and 30% spent at least one night in the ICU waiting room, with a median of 2 nights (range, 1-20) spent in hospital. Within the hospital environment, the top four items rated as \"extremely important\" or \"very important\" were directional signage (82%), convenient parking (80%), discounted parking (80%), and healthy and affordable food (78%). Regarding ICU waiting rooms, 24/7 visitation (92%), convenient restrooms (87%), a water dispenser (83%), and Wi-Fi (80%) were priorities. Features of ICU patient rooms identified as most important included seating for visitors (92%), access to natural light (78%), and access to fresh air (74%). Intensive care unit visitors prioritized pragmatic environmental elements. Many of these modifications are simple and inexpensive but may significantly improve visitors' comfort and experience.

Objective To analyze the relationships between parental separation and partnership formation patterns across 16 countries and over time, and how the relationships are shaped by contextual factors. Background Several studies have found that parental separation predicts higher rates of cohabitation and lower rates of marriage. Few studies have analyzed these relationships over time or across countries, and none have systematically analyzed whether they are moderated by contextual factors. Method Retrospective partnership histories on 138,739 women and men from the Generations and Gender Survey and Harmonized Histories datafiles were used. Monthly data on entry into cohabitation or marriage as the first coresidential union, and on entry into marriage were analyzed using life table and event history techniques. The overall incidences of parental separation and of premarital cohabitation were used as contextual‐level measures in the event history analyses. Results The association between parental separation and partnership formation was moderated by the spread of premarital cohabitation. Higher incidence of cohabitation was associated with a weaker positive association between parental separation and cohabitation, and a more negative association between parental separation and marriage. The associations between parental separation and partnership formation were not weaker when parental separation was more common. Conclusion Children of divorce have been among the forerunners of the increase in cohabitation and the retreat from marriage.

Purpose Limiting family presence runs counter to the family-centred values of Canadian pediatric intensive care units (PICUs). This study explores how implementing and enforcing COVID-19-related restricted family presence (RFP) policies impacted PICU clinicians nationally. Methods We conducted a cross-sectional, online, self-administered survey of Canadian PICU clinicians to assess experience and opinions of restrictions, moral distress (Moral Distress Thermometer, range 0–10), and mental health impacts (Impact of Event Scale [IES], range 0–75 and attributable stress [five-point Likert scale]). For analysis, we used descriptive statistics, multivariate regression modelling, and a general inductive approach for free text. Results Representing 17/19 Canadian PICUs, 368 of 388 respondents (94%) experienced RFP policies and were predominantly female (333/368, 91%), English speaking (338/368, 92%), and nurses (240/368, 65%). The mean (standard deviation [SD]) reported moral distress score was 4.5 (2.4) and was associated with perceived differential impact on families. The mean (SD) total IES score was 29.7 (10.5), suggesting moderate traumatic stress with 56% (176/317) reporting increased/significantly increased stress from restrictions related to separating families, denying access, and concern for family impacts. Incongruence between RFP policies/practices and PICU values was perceived by 66% of respondents (217/330). Most respondents (235/330, 71%) felt their opinions were not valued when implementing policies. Though respondents perceived that restrictions were implemented for the benefit of clinicians (252/332, 76%) and to protect families (236/315, 75%), 57% (188/332) disagreed that their RFP experience was mainly positive. Conclusion Pediatric intensive care unit-based RFP rules, largely designed and implemented without bedside clinician input, caused increased psychological burden for clinicians, characterized as moderate moral distress and trauma triggered by perceived impacts on families.