Engaging family caregivers key to coordinated home health care

MU researcher identifies resources to support overburdened family caregivers

UNIVERSITY OF MISSOURI-COLUMBIA

Research News

 

IMAGE: DR. JO-ANA CHASE IS AN ASSOCIATE PROFESSOR IN THE MU SINCLAIR SCHOOL OF NURSING. view more 

CREDIT: MU SINCLAIR SCHOOL OF NURSING

COLUMBIA, Mo. -- After Jo-Ana Chase heard her mother had successful heart surgery, she was relieved when her mom was finally discharged from the hospital and sent home to be cared for by her brother. However, Chase quickly learned from her brother that he felt lost on the best ways to care for their mom due to confusing discharge instructions from the hospital and logistical challenges related to home health care services like wound care and medication management.

Motivated by her own family's struggles navigating the often complicated American health care system, Chase, an associate professor in the University of Missouri's Sinclair School of Nursing, is working with clinicians and health care providers to better engage family caregivers in providing coordinated care after a loved one is discharged home from the hospital. In a recent study, she sought to better understand the resources family caregivers currently use to help health care providers identify gaps in coverage and recommend resources to assist overburdened caregivers and ultimately improve and better coordinate care.

"The American health care system has been very patient-focused; however, we also need to remember that patients often rely on family for help with their care," Chase said. "Now that we are starting to recognize how impactful the work is that family caregivers provide, my goal is to better engage these family caregivers and help them access the resources they need to better support the loved ones they care for."

In her study, Chase interviewed family caregivers about the medical and nursing tasks they completed for a loved one after a hospital-to-home transition, such as treating wounds or giving medication. She found that family caregivers often struggle with these tasks and in navigating the complex health care system; and resources like home health care nurses or aides can serve as a central point-of-contact to improve coordinated care.

"After a patient is discharged from the hospital, a home health care nurse will often come to the patient's home periodically to check in, make sure the medications are right, evaluate the home for safety, check the patient's vital signs and assess wounds," Chase said. "This is an excellent opportunity for the clinicians to work with caregivers to address any questions, challenges, or concerns family caregivers may be having."

Chase added that while caregivers may receive discharge instructions for providing care after a patient leaves the hospital, the instructions may fail to consider caregivers' preparedness and various environmental factors, such as what equipment is needed, or which room in a house is best for administering a specific task like changing a bandage. In addition to home health care nurses, primary care providers, social workers, nearby community centers and respite services can also help support and take the load off of overburdened caregivers.

"At some point in our lives, most of us will become a caregiver for someone, whether it is a child, spouse, parent or relative," Chase said. "So, encouraging the health care system to effectively engage caregivers benefits us all. I hope one day when I am sick and someone has to take care of me, my caregiver doesn't experience the same challenges my brother did caring for my mom."

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"Family caregivers managing medical and nursing tasks in the post-acute home health care setting" was recently published in the Journal of Applied Gerontology. Funding for the study was provided by the Eugenie and Joseph Doyle Research Partnership Fund of the Visiting Nurse Service of New York. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agency.

 

ASM journals build mechanisms to promote gender equity

AMERICAN SOCIETY FOR MICROBIOLOGY

Research News 

ASM Journal editors and staff seek to improve gender equity after analysis shows that women are not only underrepresented but receive more negative outcomes

Highlights:

• Researchers analyzed nearly 80,000 manuscript submissions to ASM journals to gather baseline data on gender bias in the publication process.
• They found that women are underrepresented in ASM journals.
• Studies with women listed as corresponding authors were more likely to be rejected during the first two rounds of editorial review.
• Men hold more editorial positions at ASM journals than women.
• The analysis will guide new mechanisms to promote gender equity in the publishing process.

Washington, DC - December 1, 2020 - Over the past 6 months, leading scientific societies and journals have been taking a close look at their own publication data to identify biases against women scientists and guide new solutions. This week in mBio, researchers report on the first such study to focus on inclusivity in microbiology.

Patrick Schloss, Ph.D, a microbiologist at the University of Michigan in Ann Arbor, and Ada Hagan, Ph.D, a former postdoctoral researcher in his lab, led a group of scientists who analyzed 6 years' worth of manuscripts submitted to journals published by the American Society for Microbiology.

They found that ASM journals have a significant representation problem.

The study revealed that the percentage of papers in ASM journals that listed women as senior authors was significantly lower than global and society-level estimates of the percentage of women in the field. In addition, manuscripts that listed women as corresponding authors were rejected after the initial review by an editor or after the first round of peer review by as much as 12 percentage points more often than those authored by men.

"The gender of the author was one of the biggest predictors of whether a manuscript would be editorially rejected," Hagan said.

The study also revealed gender disparities within the editorial ranks of the journals. Between 2012 and 2018, the period of the study, women represented only 17.6% of the Editors-in-Chief of the journals. Additionally, only 28.8% of the group of all editors were women. For comparison, women account for at least half of Ph.D.s in biology, though they represent less than 30% of tenure-track positions in the field.

With more than 40,000 members and 16 peer-reviewed journals, the American Society for Microbiology is one of the largest societies in the life sciences. Schloss is the Chair of the ASM Journals Committee, and Hagan's position was funded by ASM.

Schloss said ASM is committed to promoting and increasing diversity in the field, and scientists have a responsibility to look at all levels of the research process to identify and address biases. The goal of the new study, he said, was to gather baseline data about representation in the publishing process that could be used to inform solutions.

"We cannot improve things unless we know where we are," he said. "It might make people uncomfortable, but it's very important as a community that we figure this out."

The researchers identified nearly 80,000 unique manuscripts submitted to ASM journals between 2012 and 2018. They tracked the papers through the stages of publication and used an algorithm that categorized the gender of authors by first names. (If the algorithm reported a low degree of confidence, then the researcher's gender was classified as "unknown.")

"There won't be any easy fixes to these problems," Schloss said.

However, he said the new analysis can help guide society-level changes that engender a more equitable publishing process. For example: The study authors recommended that journals commit to inclusion and diversity in their mission statement--and support that statement by supporting women and implementing protocols for reporting discrimination. The ASM Journals committee is also taking several steps to improve the representation of Black microbiologists in ASM's journals.

Schloss said scientific societies should also aim for gender parity at leadership levels. Right now, the editorial boards at ASM journals are generally dominated by men. "Ideally, we'd like to have 50% of the masthead be women, and that they handle 50% of the papers," he said. "There's no reason why that can't be a 50-50 population."

Hagan and Schloss point out gender disparities in STEM fields extend beyond the publication process, but that by addressing the new findings, the ASM can build a more welcoming environment.

"We're talking about it a lot more than we used to," Schloss said, "but we still need to do better."

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ASM is dedicated to the life sciences and is composed of 30,000 scientists and health practitioners. ASM's mission is to promote and advance the microbial sciences.

ASM advances the microbial sciences through conferences, publications, certifications, educational opportunities and advocacy efforts. It enhances laboratory capacity around the globe through training and resources. It provides a network for scientists in academia, industry and clinical settings. Additionally, ASM promotes a deeper understanding of the microbial sciences to diverse audiences.

How a US coup in Iran led to 'Death to America

BY MARIK VON RENNENKAMPFF, OPINION CONTRIBUTOR — 12/02/20

 

THE VIEWS EXPRESSED BY CONTRIBUTORS ARE THEIR OWN AND NOT THE VIEW OF THE HILL

© Photo by ATTA KENARE/AFP via Getty Images

Once again, the war drums are beating in the Middle East. Iran has vowed revenge for the death of a leading nuclear scientist, the second assassination of a high-ranking Iranian official this year.

As tensions flare, it is easy to get lost in the inflammatory rhetoric, violence and on-again, off-again diplomacy that define U.S.-Iran relations. As a result, many observers have lost sight of the driving forces behind the Iranian regime’s animosity towards the United States.

A long history of American and foreign meddling in Iran is seared into the Persian psyche. And yet, the Iranian public remains remarkably pro-American; a testament to a nuanced perspective that separates the American people from the actions of its government. Iran’s religious hardliners – the crowd that incites chants of “Death to America” – have also made this distinction.

To most Iranians, “Death to America” means “death to American foreign policy.” Indeed, even Iran’s ultra-conservative Islamist leader has stated that “the slogan does not mean death to the American nation; [it] means death to the U.S.’s policies.”

Some perspective is in order. As the American invasions of Iraq and Afghanistan saw thousands of foreign troops surround Iran, rumblings of an impending American attack heightened deep-seated Iranian fears of invasion. Hobbled by a particularly weak conventional military, Iran viewed the invasions as an existential threat.

The George W. Bush administration’s unceremonious rejection of Iran’s offer of a diplomatic “Grand Bargain” only incensed Tehran further. Unknown to many Americans, Shia-majority Iran rounded up Sunni al Qaeda terrorists after the September 11, 2001 attacks and assisted the United States in Afghanistan. For its efforts, Iran was named to the “axis of evil.”

But the roots of Iranian anger at U.S. foreign policy run far deeper than 21st century invasions or the Trump administration’s ill-advised withdrawal from a landmark nuclear agreement.

Iranians will never forget the events of 1953, when an American coup toppled a pro-democracy Iranian leader and installed a brutally repressive monarch.

In the early 1950s, a British oil company – known today as British Petroleum – enjoyed an enormously lucrative monopoly over oil production in Iran. Convinced that the British were exploiting Iran’s natural resources and not paying their fair share, the prime minister of Iran, Mohammed Mosaddegh, sought to audit the British oil company’s books. When the British refused, Mosaddegh led a movement to nationalize Iran’s oil industry.

After decades of foreign meddling and interference in Iranian affairs, nationalization proved enormously popular, turning Mosaddegh into a national hero.

Beyond seeking an equitable share of oil profits, the “rabidly secular” Mosaddegh was deeply committed to democracy. He considered moves by the shah, Iran’s monarch, to assert control over Iranian affairs fundamentally undemocratic. To Mosaddegh, the shah should “reign, but not rule.”

After refusing to split oil profits evenly with Iran, the British convinced the United States to overthrow Mosaddegh and install the shah as Iran’s ruler. In making their case, the British exploited unrealistic and exaggerated American fears of a communist takeover of Iran’s vast petroleum reserves.

Following Mosaddegh’s nationalization of Iran’s oil industry, London mounted a fierce campaign of economic retaliation. In the ensuing political and economic turmoil, Mosaddegh’s popularity plummeted.


The CIA went to work. American spies paid off media outlets and disseminated propaganda falsely portraying Mosaddegh as a communist stooge. At the same time, bombings by Iranians posing as members of the Communist Party sought to stoke anti-communist sentiment – especially among Iran’s conservative religious community – to further undermine Mosaddegh.

CIA money also went to infiltrators who incited mobs to attack stores and shops in a faux communist “uprising.” Shortly thereafter, a different group of paid “ruffians” rallied the Iranian public, incensed by the first round of staged riots, to the streets.

Perhaps most consequentially, “large sums” of American money went to influential religious figures to turn Iran’s conservative Muslim population against Mosaddegh.

The CIA’s goal, in short, was to foment so much instability that the Iranian public would throw its support behind the shah, relegating Mosaddegh and his democratic, nationalist and secular policies to the ash heap of history. While the coup did not proceed as planned, Mosaddegh was ultimately overthrown and the shah seized control of Iran.

In the ensuing years, the U.S. remained a staunch ally of the shah as his government imprisoned and tortured thousands of Iranians. Unsurprisingly, America’s unflinching support for the shah’s repressive regime bred immense resentment among the Iranian public.

Decades of anger boiled over in 1979, when a mob attacked the U.S. embassy in Tehran and took 52 Americans hostage. The Islamic Revolution had begun.

In an ugly twist of history, there is a direct link between the ultra-conservative, anti-American Islamists who seized control of Iran in 1979 and the 1953 coup.

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Beyond American success inciting Iran’s Muslim community, there is robust evidence that the Islamic Republic’s first supreme leader, Ayatollah Khomeini, was inspired and mentored by the Islamist clerics that U.S. spies paid off to undermine Mosaddegh.

Not long after Khomeini assumed power, chants of “Death to America” echoed through the streets of Tehran.

Marik von Rennenkampff served as an analyst with the U.S. Department of State’s Bureau of International Security and Nonproliferation, as well as an Obama administration appointee at the U.S. Department of Defense. Follow him on Twitter @MvonRen.

US officials anonymously blame Israel for assassinating Iran’s top nuclear scientist – reports

2 Dec, 2020 RT
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Israeli Prime Minister Benjamin Netanyahu is shown in a 2018 press briefing in Tel Aviv identifying Iranian scientist Mohsen Fakhrizadeh as a threat to Israel's security. © Amir Cohen

An unidentified Trump administration official has blamed Israel for last week’s assassination of Iran’s top nuclear scientist, CNN said, following an earlier New York Times report citing anonymous US sources fingering Tel Aviv.


The latest senior official to attribute Friday’s killing of Iranian nuclear physicist Mohsen Fakhrizadeh declined to say whether the US knew about the attack in advance or participated in any way, CNN said on Wednesday. The person acknowledged that the US and Israel have previously shared information about covert operations before carrying them out, but refused to say whether that happened in this case.ALSO ON RT.COMSyria condemns ‘Zionist terrorist attack on science’ as Israel says it has ‘no clue’ who was behind Iranian scientist’s murder

Fakhrizadeh’s convoy of bullet-proof vehicles was driving to Absard, east of Tehran, when it came under attack. Iranian accounts of the incident shifted sharply on Sunday, with the semi-official Fars news agency saying Fakhrizadeh was shot with a remotely operated machine gun after exiting his vehicle to investigate why it had been stopped. Previous reports indicated that a 12-person commando team ambushed the convoy and was helped by a 50-person logistics group that infiltrated Iranian security services and cut off power to the area just before the attack.

Like CNN, the New York Times said it was unclear what, if any, knowledge the Trump administration had of the attack beforehand. The assassination came one week after US Secretary of State Mike Pompeo visited Israel on a trip that also included stops in Saudi Arabia, the United Arab Emirates and Qatar.

READ MORE

Killing of top Iranian nuclear scientist: Reported versions change from 12-person commando squad to REMOTE-CONTROLLED machine gun

President Donald Trump has given Pompeo and other administration officials carte blanche to punish Iran as aggressively as they wish as long as they stop short of risking World War III, the Daily Beast reported on Tuesday.

Iranian officials were quick to blame Israel for the murder of Fakhrizadeh and have vowed revenge.

Israel has claimed that Fakhrizadeh headed Iran's nuclear weapons development project. Iranian officials have repeatedly insisted that the country's nuclear investments are for peaceful purposes only, and the International Atomic Energy Agency said the nuclear weapons program ended in the early 2000s.

Former CIA director John Brennan said the assassination of Fakhrizadeh was a "criminal" and "highly reckless" act that could spur "a new round of regional conflict." He tweeted on Friday that if the killing was state-sponsored, it would be a violation of international law and would encourage more governments to assassinate foreign officials.

This was a criminal act & highly reckless. It risks lethal retaliation & a new round of regional conflict.Iranian leaders would be wise to wait for the return of responsible American leadership on the global stage & to resist the urge to respond against perceived culprits. https://t.co/0uZhyBTM3S— John O. Brennan (@JohnBrennan) November 27, 2020

NASA: Mystery Object Is 54-Year-Old Rocket, Not Asteroid

By Associated Press
December 02, 2020 

FILE - NASA's top asteroid expert suspected the mystery object was the Centaur upper rocket stage from Surveyor 2, a failed 1966 moon-landing mission.

]CAPE CANAVERAL, FLORIDA - A mysterious object temporarily orbiting Earth is a 54-year-old rocket, not an asteroid after all, astronomers confirmed Wednesday.

Observations by a telescope in Hawaii clinched its identity, according to NASA's Jet Propulsion Laboratory in Pasadena, California.

The object was classified as an asteroid after its discovery in September. But NASA's top asteroid expert, Paul Chodas, quickly suspected it was the Centaur upper rocket stage from Surveyor 2, a failed 1966 moon-landing mission. Size estimates had put it in the range of the old Centaur, which was about 10 meters long and 3 meters in diameter.

Chodas was proved right after a team led by the University of Arizona's Vishnu Reddy used an infrared telescope in Hawaii to observe not only the mystery object, but — just on Tuesday — a Centaur from 1971 still orbiting Earth. The data from the images matched.

"Today's news was super gratifying!" Chodas said via email. "It was teamwork that wrapped up this puzzle."

The object formally known as 2020 SO entered a wide, lopsided orbit around Earth last month and, on Tuesday, made its closest approach at just over 50,476 kilometers. It will depart the neighborhood in March, shooting back into its own orbit around the sun. Its next return: 2036.

THE LAKOTA DAUGHTERS

Film Documents Lives of Girls, Women on Pine Ridge Reservation, South Dakota

December 02, 2020 


Poverty, drugs, alcohol, frequent disappearances of young women and the absence of law enforcement are all issues plaguing the Pine Ridge Native American Reservation in South Dakota. But women there are trying to make the future better and brighter as they work to create "a girl society" that is aimed at helping girls aged 10 to 18.

Camera: Vladimir Badikov; Video Editor: Matvey Kulakov; 

Produced by: Joy Wagner

RIP
Benton-Banai, Co-Founder of American Indian Movement, Dies at 89

By Associated Press December 02, 2020 

MINNEAPOLIS, MINNESOTA - Eddie Benton-Banai, who helped found the American Indian Movement partly in response to alleged police brutality against Indigenous people, has died. He was 89.

Benton-Banai died Monday at a care center in Hayward, Wisconsin, where he had been staying for months, according to family friend Dorene Day. Day said Benton-Banai had several health issues and had been hospitalized multiple times in recent years.

Benton-Banai, who was Anishinaabe Ojibwe, was born and raised on the Lac Courte Oreilles reservation in northern Wisconsin. He made a life of connecting American Indians with their spirituality and promoting sovereignty, and was the grand chief, or spiritual leader, of the Three Fires Midewiwin Lodge. Day said he was someone people looked to for guidance in the religious practice of the Anishinaabe Ojibwe people — and he gave countless babies their traditional names.

Benton-Banai's place in the American Indian Movement, a grassroots group formed in 1968, can be traced to his launch of a cultural program in a Minnesota prison, said co-founder Clyde Bellecourt.

'It started because I met Eddie in jail'

Bellecourt was in solitary confinement when he heard someone whistling You are My Sunshine, and he looked through a tiny hole in his cell and saw Benton-Banai, a fellow inmate, recognizing him as an Indigenous man.

Bellecourt said Benton-Banai approached him about helping incarcerated Indigenous people, and they started the prison's cultural program to teach American Indians about their history and encourage them to learn a trade or seek higher education. Bellecourt said that Benton-Banai thought they could do the same work in the streets, and the program morphed into the American Indian Movement, an organization that persists today with various chapters.

"It started because I met Eddie in jail," Bellecourt said. "Our whole Indian way of life came back because of him. … My whole life just changed. I started reading books about history of the Ojibwe nation… dreaming about how beautiful it must have been at one time in our history."

One of the group's first acts was to organize a patrol to monitor allegations of police harassment and brutality against Native Americans in Minneapolis, where it's based. Its work included job training, efforts to seek better housing and education for Indigenous people, provide legal assistance and question government policies.

At times, the American Indian Movement's tactics were militant. In one of its most well-known actions, the group took over Wounded Knee on the Pine Ridge Reservation in South Dakota to protest U.S. and tribal governments. The 71-day occupation turned violent, and two people died in a shootout.

Akim Reinhardt, a history professor at Towson University in Maryland, said Benton-Banai's roots in the group often got overshadowed by more powerful personalities in the movement, including Russell Means, Dennis Banks and John Trudell.

"It's a shame, because clearly when we listen to the people who were there, they all mention him," said Reinhardt, who has written broadly about the movement.

International Indian Treaty Council

Lisa Bellanger, executive director of the National American Indian Movement and Benton-Banai's former assistant, said he was instrumental in the group's work using treaties to protect the rights of Indigenous people. He was also part of a team that pushed for the American Indian Religious Freedom Act of 1978, she said, as government policies stifled or outlawed religious practices. The law safeguarded the rights of American Indians to practice their religion and access sacred sites.

Bellanger said Benton-Banai also helped launch the International Indian Treaty Council, which advocates for the rights of Indigenous nations to govern themselves, and for the protection of tradition, culture and sacred land.

But in addition to his activism work, Benton-Banai was also a father figure.

"We could always go to him with questions," Bellanger said. "We could run crying to him if we needed to. We had that personal faith and trust and love in him, at a time that was crucial for young girls."

Day said Benton-Banai was raised by his grandparents and grew up speaking Ojibwe.

"He had a very solid spiritual foundation to his traditional and Indigenous learning, and that's what made him, I believe, who he was," she said.

His book, The Mishomis Book, is touted as the first of its kind to offer Anishinaabe families an understanding of spiritual teachings.

Benton-Banai also founded a school in St. Paul in 1972, called the Red School House, which — along with its sister school in Minneapolis — fueled a broader movement to provide alternative education for Indigenous children so they could learn while maintaining their spiritual and cultural practices, Day said.

Bellecourt said American Indian Movement's philosophy of using the sovereignty and spirituality of Indigenous people as a strength can be attributed to Benton-Banai's leadership.

"I considered him our holy man," he said.

Nurses Wanted: 

Swamped US Hospitals Scramble for Pandemic Help
By Associated Press
December 02, 2020 
 

Registered nurse Alma Abad tends to COVID-19 patient Florence Bolton, 85, in the intensive care unit at Roseland Community Hospital in Chicago, Ill., Dec, 1, 2020.

OMAHA, NEBRASKA - U.S. hospitals slammed with COVID-19 patients are trying to lure nurses and doctors out of retirement, recruiting students and new graduates who have yet to earn their licenses and offering eye-popping salaries in a desperate bid to ease staffing shortages.

With the virus surging from coast to coast, the number of patients in the hospital with the virus has more than doubled over the past month to a record high of nearly 100,000, pushing medical centers and health care workers to the breaking point. Nurses are increasingly burned out and getting sick on the job, and the stress on the nation's medical system prompted a dire warning from the head of the Centers for Disease Control and Prevention.

"The reality is December and January and February are going to be rough times. I actually believe they are going to be the most difficult time in the public health history of this nation," Dr. Robert Redfield said.

Reaching out to retirees

Governors in hard-hit states such as Wisconsin and Nebraska are making it easier for retired nurses to come back, including by waiving licensing requirements and fees, though it can be a tough sell for older nurses, who would be in more danger than many of their colleagues if they contracted the virus.

Some are taking jobs that don't involve working directly with patients to free up front-line nurses.

Iowa is allowing temporary emergency licenses for new nurses who have met the state's educational requirements but haven't yet taken the state licensing exam. Some Minnesota hospitals are offering winter internships to nursing students to boost their staffs. The internships are typically offered in the summer but were canceled this year because of COVID-19.

Methodist Hospital in Minneapolis will place 25 interns for one to two months to work with COVID-19 patients, though certain tasks will remain off-limits, such as inserting IVs or urinary catheters, said Tina Kvalheim, a nurse who runs the program.

"They'll be fully supported in their roles so that our patients receive the best possible, safe care," Kvalheim said.

Landon Brown, 21, of Des Moines, Iowa, a senior nursing student at Minnesota State University, Mankato, recently accepted an internship at the Mayo Clinic Health System in Mankato. He was assigned to the pediatric unit's medical-surgical area but said he might come across patients with the coronavirus.

Brown's resolve to help patients as a nurse was reaffirmed after his 90-year-old grandfather contracted the virus and died over the weekend.

"The staff that he had were great, and they really took a lot of pressure off of my folks and my family," he said. "I think that if I can be that for another family, that would be great."

Getting new grads working

The University of Iowa's College of Nursing is also trying to get graduates into the workforce quickly. It worked to fast-track students' transcripts to the Iowa Board of Nursing so they could get licensed sooner upon graduating, said Anita Nicholson, associate dean for undergraduate programs.

Nicholson said the college also scheduled senior internships earlier than normal and created a program that allows students to gain hospital experience under a nurse's supervision. Those students aren't caring for coronavirus patients, but their work frees up nurses to do so, Nicholson said.

"The sooner we can get our graduates out and into the workforce, the better," she said.

Wausau, Wisconsin-based Aspirus Health Care is offering signing bonuses of up to $15,000 for nurses with a year of experience.

Hospitals also are turning to nurses who travel from state to state. But that's expensive, because hospitals around the country are competing for them, driving salaries as high as $6,200 per week, according to postings for travel nursing jobs.

April Hansen, executive vice president at San Diego-based Aya Healthcare, said there are now 31,000 openings for travel nurses, more than twice the number being sought when the pandemic surged in the spring.

"It is crazy," Hansen said. "It doesn't matter if you are rural or urban, if you are an Indian health facility or an academic medical center or anything in between. ... All facilities are experiencing increased demand right now."

Nurses who work in intensive care and on medical-surgical floors are the most in demand. Employers also are willing to pay extra for nurses who can show up on short notice and work 48 to 60 hours per week instead of the standard 36.

Laura Cutolo, a 32-year-old emergency room and ICU nurse from Gilbert, Arizona, began travel nursing when the pandemic began, landing in New York during the deadliest stretch of the U.S. outbreak last spring. She is now working in Green Bay, Wisconsin, and soon will return to New York.

She said she hopes her work will be an example to her children, now 2 and 5, when the crisis passes into history and they read about it someday.

"If they ask me, 'Where were you?' I can be proud of where I was and what I did," Cutolo said.

'Spreading like wildfire'

Doctors are in demand, too.

"I don't even practice anymore, and I've gotten lots of emails asking me to travel across the country to work in ERs," said Dr. Georges Benjamin, executive director of the American Public Health Association.

The outbreak in the U.S. is blamed for more than 273,000 deaths and 13.9 million confirmed infections. New cases are running at over 160,000 a day on average, and deaths are up to more than 1,500 a day, a level seen back in May, during the crisis in the New York City area. Several states reported huge numbers of new cases Wednesday, including a combined 40,000 in California, Illinois and Florida alone.

States are seeing record-breaking surges in deaths, including Illinois, Indiana and Kentucky in the middle of the country. Kentucky Gov. Andy Beshear said the virus is "spreading like wildfire."

A COVID-19 vaccine is expected to become available in a few weeks, and health care workers are likely to be given priority for the first shots. That could make it easier for hospitals to recruit help.

To make room for the sickest, hard-hit institutions are sending home some COVID-19 patients who otherwise would have been kept in the hospital. They are also canceling elective surgeries or sending adult non-COVID-19 patients to pediatric hospitals.

A hospital system in Idaho is sending some COVID-19 patients home with iPads, supplemental oxygen, blood pressure cuffs and oxygen monitors so they can finish recovering in their own beds. The computer tablets enable nurses to check in with them, and the oxygen monitors automatically send back vital information.

Across the U.S., hospitals are converting cafeterias, waiting rooms, even a parking garage to patient treatment areas. Some states are opening field hospitals.

But that does nothing to ease the staffing shortage, especially in rural areas where officials say many people aren't taking basic precautions against the virus.

Dr. Eli Perencevich, an epidemiology and internal medicine professor at the University of Iowa, said health care workers are paying the price for other people's refusal to wear masks.

"It's sending everyone to war, really," he said. "We've decided as a society that we're going to take all the people in our health care system and pummel them because we have some insane idea about what freedom really is."

With COVID-19 still out of control, low-income families in the United States are bracing for a cold and uneasy winter. VOA’s Veronica Balderas Iglesias reports.

Camera, Producer: Veronica Balderas Iglesias

WHO says masks should be worn in workplaces, at school and at home with visitors in updated guidance

WHO has updated its guidance on coronavirus face masks / PA
By April Roach@aprilroach28

People should wear face masks in indoor spaces such as at work, in schools and when at home receiving visitors, the World Health Organisation (WHO) has said.

WHO updated its guidance on masks to encourage people in areas of suspected high Covid-19 transmission to wear non-medical masks in certain indoor spaces.

The advice, published on Wednesday, also recommends the use of face coverings at home when receiving visitors if one-metre distancing cannot be maintained or ventilation is poor.

The advice issued by the UN agency comes despite “limited evidence” of the effectiveness of mask wearing by the public in the community.

In areas with known or suspected spread of Covid-19, the WHO recommends people should wear a mask indoors and outdoors where distancing of at least one metre cannot be maintained.


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The advice, which applies to shops, schools and shared workplaces, also states masks should be worn indoors regardless of social distancing unless ventilation has been assessed to be adequate.


Children aged up to five should not wear masks, a “risk-based approach” should be taken for six to 11-year-olds, while those aged 12 and over should follow the same principles as adults, the guidance states.

The World on Coronavirus lockdown




It also says masks should not be worn during vigorous physical activity.

The WHO said its coronavirus Guidance Development Group (GDG) “considered all available evidence on the use of masks by the general public including effectiveness, level of certainty and other potential benefits and harms, with respect to transmission scenarios, indoor versus outdoor settings, physical distancing and ventilation”.

The recommendations were made “despite the limited evidence of protective efficacy of mask wearing in community settings”.

It comes after the WHO director-general Tedros Adhanom Ghebreyesus welcomed the news of the Pfizer/BioNTech vaccine being approved for use by the MHRA in the UK.

He said on Twitter: “The (UK) is the first country to authorize the Pfizer/BionTech #COVID19 vaccine for emergency use and expects to start rolling it out as soon as next week.”

Additional reporting by PA Media.