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Die Segmentierung des Influenza-A-Virusgenoms und die damit verbundene Möglichkeit des Reassortments sind von großer Bedeutung für die Adaptation an einen neuen Wirt und die Entstehung von Pandemien. So wurden verschiedene Influenza-Pandemien des letzten Jahrhunderts durch ein humanes Virus ausgelöst, das mindestens das Hämagglutinin (HA) eines aviären Influenza-A-Virus übernommen hatte. Mit Hilfe der Reversen Genetik ist es möglich, den Austausch von Segmenten zwischen verschiedenen Influenza-Viren detailliert zu untersuchen. Es können Erkenntnisse zur Art und Häufigkeit von Reassortments gewonnen werden, die zu einem besseren Verständnis der Entstehung potentiell pandemischer Viren führen. In der vorliegenden Arbeit wurde zunächst die revers-genetische Methode der target-primed plasmid amplification erfolgreich zur Generierung des vollständigen Plasmidsatzes des c-DNA-Genoms des humanen Influenza-A-Virus A/Denver/57 (H1N1) angewendet. Die Funktionsfähigkeit des klonierten Plasmidsatzes konnte durch Kotransfektionsexperimente gezeigt werden. In einem nächsten Schritt wurde eine PCR etabliert, welche die simultane Amplifikation der cDNA der NS-, M-, NA- und NP-Segmente eines beliebigen Influenza-A-Virus ermöglicht und damit die zeitaufwendige Klonierung der Influenza-Gene deutlich beschleunigt. Dafür wurde ein Primerpaar entwickelt, das an die konservierten Termini der Gensegmente bindet, aber am 3-Ende um die Gen-spezifischen Nukleotide verkürzt ist. Mit den entwickelten Primern kann außerdem das komplette Neuraminidase-Gen unabhängig vom Subtyp amplifiziert werden. In einer Reassortmentstudie konnte die etablierte PCR zur effektiven Genotypisierung eingesetzt werden. Gegenstand der Reassortmentstudie war die Frage, ob sich ältere und jüngere aviäre Stämme in ihrer Fähigkeit, ihr HA an einen humanen Stamm abzugeben, unterscheiden. Außerdem sollte untersucht werden, welche Segmente mit dem aviären HA kosegregieren. Dafür wurden Doppelinfektionsversuche mit jeweils einem der beiden aviären Influenza-Viren A/Duck/Ukraine/1/63 (H3N8) (DkUkr63) bzw. A/Mallard/Germany/Wv64-67/05 (H3N2) (MallGer05) und dem humanen Influenza-Virus A/Hongkong/1/68 (H3N2) (Hk68) durchgeführt. Das Einführen einer Elastase-abhängigen HA-Schnittstelle in das humane Virus Hk68 ermöglichte eine effektive Selektion von Reassortanten mit aviärem HA. Unter den jeweils 21 untersuchten Plaqueisolaten gab es 16 (DkUkr63) bzw. 18 (MallGer05) Reassortanten, die mindestens das aviäre HA erworben hatten. Geringe Häufigkeiten des Auftretens bestimmter Reassortanten lieferte Hinweise bezüglich Beschränkungen im Reassortment. Bei der Genotypisierung der Plaqueisolate wurden für DkUkr63 sieben und für MallGer05 vierzehn verschiedene Reassortantenspezies gefunden. Dies deutet darauf hin, dass der Austausch der Segmente von DkUkr63 gegenüber denen von MallGer05 stärker eingeschränkt ist. Bemerkenswert war die häufige Kosegregation des NA mit HA beider Vogelviren. Die Wachstumskinetik auf humanen A549-Zellen zeigte darüber hinaus auch eine gute Replikation für alle HA/NA-Reassortanten. Beide Viren geben also ihr HA wie auch ihr NA leicht an einen humanen Stamm ab. Andererseits war die geringe Häufigkeiten von PB2- im Vergleich zu PB1-Reassortanten auffällig. Dies deutet darauf hin, dass der Austausch des PB2-Segments im Vergleich zu PB1 stärker eingeschränkt ist. Eine der am besten replizierenden Reassortanten wies mit PB1, HA und NA von DkUkr63 die gleiche Genkonstellation auf wie das Pandemievirus der Asiatischen Grippe von 1957. Die Auswertung der Plaque-Morphologie ergab, dass die Plaque-Größe der Reassortanten von der Herkunft des NA abhängig ist. Verglichen mit dem eingeschränkten Wachstum des aviären Elternvirus DkUkr63 zeigten die meisten seiner Reassortanten ein besseres Wachstum auf humanen A549-Zellen. Das jüngere aviäre Elternvirus MallGer05 erreicht fast den Endtiter des humanen Hk68 und auch die meisten Reassortanten zeigten mit Hk68 vergleichbare Endtiter. Es wurden aber für beide Vogelviren auch einige Reassortanten gefunden, deren Replikation deutlich vermindert war, was auf eine geringe Kompatibilität der jeweiligen Segmente hindeutet. Sowohl für den älteren als auch für den jüngeren aviären Elternstamm wurden unter den gewählten Selektionsbedingungen verschiedene HA-Reassortanten mit guter Replikationsfähigkeit gefunden. Dementsprechend könnten auch unter natürlichen Bedingungen sogar niedrig pathogene aviäre Influenza-A-Viren mit geringer Adaptation an einen humanen Wirt bei Koinfektionen mit humanen Viren zur Bildung von neuen, potentiell pandemischen Viren beitragen.
Aims
To examine whether inactive nurses are willing to return to nursing during the COVID-19 pandemic, the reasons for or against their decision and further, possibly relevant factors.
Design
Cross-sectional online survey.
Methods
We developed a questionnaire, addressing registration, professional experiences, anticipations, and internal and external factors that might affect the decision of inactive nurses to return to nursing during the pandemic. Between 27 April and 15 June 2020, we recruited participants in Germany via social networks, organizations and institutions and asked them to forward the link to wherever other inactive nurses might be reached.
Results
Three hundred and thirty-two participants (73% female) could be included in the analysis. The majority of the participants (n = 262, 79%) were general nurses. The main reason for registering was ‘want to do my bit to manage the crisis’ (n = 73, 22.8%). More than two thirds of the participants (n = 230, 69%) were not or not yet registered. One hundred and twelve (49%) out of 220 participants, who gave reasons why they did not register, selected they ‘could not see a necessity at that time’. The few inactive nurses who were deployed reported a variety of experiences.
Conclusions
Different factors influence the nurses’ decision to register or not. A critical factor for their decision was previous experiences that had made them leave the job and prevented a return—even for a limited time in a special situation.
Impact
From the responses of the participants in this study, it can be deduced that: negative experiences made while working in nursing influence the willingness to volunteer for a deployment; only one-third of the inactive nurses would be willing to return to the nursing profession to help manage the Corona pandemic; policymakers and nursing leaders should not rely on the availability of inactive nurses in a crisis.
An already existing shortage of nurses was exacerbated by the COVID-19 pandemic. Inactive (former) nurses were regarded as a so-called silent reserve and were called upon by various agencies to volunteer for nursing. The question arose as to what factors might encourage or hinder such volunteering and facilitate deployment.
First, inactive nurses were asked via an online survey whether they had registered for deployment or not and what the reasons were for this decision. Further information on professional background was collected, including the reason for having left the profession in the first place. Based on the results of the online survey, focus group discussions were conducted with registered and unregistered inactive nurses, with nurses who had returned to the profession permanently, and with care home managers.
Only one third of the participants in the online survey said they had registered for a temporary assignment during the pandemic. The main reasons for registering were that inactive nurses ‘wanted to do their bit’ to manage the crisis, felt it was their duty and/or felt a sense of belonging to the nursing profession. The main reasons given for not having registered was that respondents ‘could not see a reason at the moment’, had health concerns, and ‘other relevant job commitments’. The majority of respondents still had jobs related to health, care or nursing.
The topics covered in the focus group discussions included the following: perception of the pandemic as a crisis, identity as a nurse and sense of professional commitment, role of current occupation in the decision to register, winning over inactive nurses with a very negative attitude towards returning to care during a crisis situation, support measures and offers regarding a deployment in nursing.
Both in the online survey and in the focus group discussions, a sense of belonging to the nursing profession was evident among many participants. However, this identity does not necessarily lead to a willingness to return to nursing during a crisis situation. Weighing up the risk of deployment against the positive or negative experiences gained during the active period can influence willingness. However, the possibility of taking a break from current work and returning to nursing at short notice is not always given. Many inactive nurses continue to work in the health sector and fulfil equally important tasks during a crisis situation which render them unavailable for deployment.
Different kinds of support for those willing to return to nursing during a crisis situation and communication on conditions of deployments need to be implemented and continuously improved to offer the inactive nurses the greatest possible security and to enable a largely unbureaucratic deployment.
Teaching is amongst the six professions with the highest stress levels and lowest job satisfaction, leading to a high turnover rate and teacher shortages. During the pandemic, teachers and school principals were confronted with new regulations and teaching methods. This study aims to examine post-pandemic stress levels, as well as resilience factors to proactively cope with stress and thoughts of leaving the profession among teachers and school principals. We used a cross-sectional online survey. The validated instruments Perceived Stress Scale (PSS-10) and Proactive Coping Subscale (PCI) were used. We included 471 teachers and 113 school principals in the analysis. Overall, respondents had a moderate stress level. During the pandemic, every fourth teacher (27.2%) and every third principal (32.7%) had serious thoughts of leaving the profession. More perceived helplessness (OR = 1.2, p < 0.001), less self-efficacy (OR = 0.8, p = 0.002), and poorer coping skills (OR = 0.96, p = 0.044) were associated with a higher likelihood of thoughts of leaving the profession for teachers, whereas for school principals, only higher perceived helplessness (OR = 1.2, p = 0.008) contributed significantly. To prevent further teacher attrition, teachers and school principals need support to decrease stress and increase their ability to cope.
We present the first systematic literature review on stress and burnout in K−12 teachers during the COVID-19 pandemic. Based on a systematic literature search, we identified 17 studies that included 9,874 K−12 teachers from around the world. These studies showed some indication that burnout did increase during the COVID-19 pandemic. There were, however, almost no differences in the levels of stress and burnout experienced by K−12 teachers compared to individuals employed in other occupational fields. School principals' leadership styles emerged as an organizational characteristic that is highly relevant for K−12 teachers' levels of stress and burnout. Individual teacher characteristics associated with burnout were K−12 teachers' personality, self-efficacy in online teaching, and perceived vulnerability to COVID-19. In order to reduce stress, there was an indication that stress-management training in combination with training in technology use for teaching may be superior to stress-management training alone. Future research needs to adopt more longitudinal designs and examine the interplay between individual and organizational characteristics in the development of teacher stress and burnout during the COVID-19 pandemic and beyond.
Aims
To investigate factors that influence the willingness of inactive nurses to return to nursing in a crisis situation and to identify aspects that need to be considered with regard to a possible deployment.
Design
A deductive and inductive qualitative content analysis of semi-structured focus group interviews.
Methods
Semi-structured focus group interviews with inactive or marginally employed nurses, nurses who have been inactive for some time and nursing home managers in October and November 2021. The participating inactive nurses had declared their willingness for a deployment during the COVID-19 pandemic or not. Data were analysed using qualitative content analysis.
Results
Communication was seen as essential by the participants for an informed decision for or against a temporary return to nursing and to potential or actual deployments. To make them feel safe, inactive nurses need to know what to expect and what is expected of them, for example, regarding required training and responsibilities. Considering their current employment status, some flexibility in terms of deployment conditions is needed.
A remaining attachment to care can trigger a sense of duty. Knowledge of (regular) working conditions in nursing can lead to both a desire to support former colleagues and a refusal to be exposed to these conditions again.
Conclusion
Past working experiences and the current employment situation play a major role in the willingness of inactive nurses to return to nursing in a crisis situation. Unbureaucratic arrangements must be provided for those who are willing to return.
Summary Statement
What already is known - In crisis situations, not every inactive nurse is willing or able to return to nursing and therefore, the ‘silent reserve’ may not be as large as suspected.
What this paper adds - Inactive nurses need to know what to expect and what is expected of them for their decision regarding a return to active patient care during a crisis situation.
Implications for practice/policy – Inactive nurses need to be informed and should be offered free training and refresher courses to ensure patient safety.
Impact
This research shows that the group of inactive nurses are not a silent workforce which can be activated anytime. Those who are able and willing to return to direct patient care in crisis situations need the best possible support – during and between crises.
Reporting Method
This study adhered to COREQ guidelines.
No Patient or Public Contribution
The involvement of patients or members of the public did not apply for the study, as the aim was to gain insight into the motivations and attitudes of the group of inactive nurses.