Rationale: Prone positioning is an appealing therapeutic strategy for nonintubated hypoxic patients with coronavirus disease (COVID-19), but its effectiveness remains to be established in randomized controlled trials. Objectives: To identify contextual factors relevant to the conduct of a definitive clinical trial evaluating a prone positioning strategy for nonintubated hypoxic patients with COVID-19. Methods: We conducted a cluster randomized pilot trial at a quaternary care teaching hospital. Five inpatient medical service teams were randomly allocated to two treatment arms: 1 ) usual care (UC), consisting of current, standard management of hypoxia and COVID-19; or 2 ) the Awake Prone Positioning Strategy (APPS) plus UC. Included patients had positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing or suspected COVID-19 pneumonia and oxygen saturation less than 93% or new oxygen requirement of 3 L per minute or greater and no contraindications to prone positioning. Oxygenation measures were collected within 48 hours of eligibility and included nadir oxygen saturation to fraction of inspired oxygen (S/F) ratio and time spent with S/F ratio less than 315. Concurrently, we conducted an embedded implementation evaluation using semistructured interviews with clinician and patient participants to determine contextual factors relevant to the successful conduct of a future clinical trial. The primary outcomes were drawn from an implementation science framework including acceptability, adoption, appropriateness, effectiveness, equity, feasibility, fidelity, and penetration. Results: Forty patients were included in the cluster randomized trial. Patients in the UC group ( n = 13) had a median nadir S/F ratio over the 48-hour study period of 216 (95% confidence interval [95% CI], 95–303) versus 253 (95% CI, 197–267) in the APPS group ( n = 27). Patients in the UC group spent 42 hours (95% CI, 13–47) of the 48-hour study period with an S/F ratio below 315 versus 20 hours (95% CI, 6–39) for patients in the APPS group. Mixed-methods analyses uncovered several barriers relevant to the conduct of a successful definitive randomized controlled trial, including low adherence to prone positioning, large differences between physician-recommended and patient-tolerated prone durations, and diffusion of prone positioning into usual care. Conclusions: A definitive trial evaluating the effect of prone positioning in nonintubated patients with COVID-19 is warranted, but several barriers must be addressed to ensure that the results of such a trial are informative and readily translated into practice.

Background and Objectives From the outset of the COVID-19 pandemic, analysts warned that older populations, due to their age, chronic illnesses, and lack of technological facility, would suffer disproportionately from loneliness as they sheltered in place indefinitely. Several studies have recently been published on the impact of COVID-19-related loneliness among older populations, but little has been written about the experiences of already-lonely older individuals; those that had lived with persistent loneliness before the advent of COVID-19. This qualitative study sought to understand how already lonely older individuals navigated and endured the social isolation of the pandemic. Research Design and Methods Twelve semi-structured interviews were conducted with individuals aged 65 or older who scored a 6 or above on the three-item UCLA Loneliness Risk screening tool. Interviews were coded using the constant comparative method. Themes and understandings of loneliness that reoccurred within and across interviews were identified and collected. Results Already-isolated, older interviewees did not necessarily experience the abject loneliness hypothesized by analysts. Most interviewees used long-standing arrangements, in place to mitigate loneliness and endure social isolation, to manage the social deprivation of COVID-19. As a result, their loneliness did not compound during long bouts of mandated social isolation. To the contrary, loneliness during the pandemic appeared to carry a new valence for interviewees, as COVID-19 imbued their isolation with new meaning, rendering their loneliness necessary and responsible. Discussion and Implications Exploring individuals’ subjective perceptions of loneliness can help provide a deeper understanding of what it means to be isolated and alone during COVID-19, and aid in designing strategies to mitigate loneliness.

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Although health promotion programming in faith institutions is promising, most faith-based or placed health projects focus on diet, exercise, or cancer screening and many have been located in urban environments. This article addresses the notable absence of faith programming for smoking cessation among underserved rural US residents who experience tobacco-related health inequities. In this article, we describe our faith-oriented smoking cessation program in rural Appalachia, involving 590 smokers in 26 rural churches randomized to early and delayed intervention groups. We present three main themes that account for participants’ positive evaluation of the program; the program’s ability to leverage social connections; the program’s convenience orientation; and the program’s financial support for smoking cessation. We also present themes on the roles of faith and church in smoking cessation programming, including some mixed perceptions on smoking stigma and comfort in church settings; challenges in faith-placed smoking cessation recruitment; and the positive perception of such programming by church leaders. We conclude that faith-placed smoking cessation program offer great potential, although they must be administered with great sensitivity to individual and community norms.

This study examined the utilization of the Internet by young adults as a source of information for the non-medical use of prescription drugs. Collected during 2008 and 2009, the data presented here comes from semi-structured interviews (N=62) conducted in a northwestern city of the United States through support from the National Institute on Drug Abuse. Previous studies have characterized young adults as particularly vulnerable to online prescription drug information which analysts portray as having a significant, invariably detrimental, impact on youth drug use behaviors. The results presented here suggest that young adults are more skeptical and information-savvy than many substance abuse analysts acknowledge.

PPE provision was limited by management's poor perceptions of its efficacy relative to other factors. Future research should explore workers' perceptions and PPE's effectiveness in averting horse-related injury.

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Examining how pharmaceuticals are used to induce pleasure presents a unique opportunity for analyzing not only how pleasure is assembled and experienced through distinct consumption practices but also how mundane medicines can become euphorigenic substances. Drawing on qualitative research on the non-medical use of prescription drugs by young adults in the United States, this paper utilizes Actor-Network Theory (ANT) to examine how prescription medicines come to produce pleasure. We suggest that the euphorigenic properties ascribed to prescription drugs are not inherent in their pharmaceutical formulations, but instead emerge through interactions within networks of heterogeneous actants. Our paper examines the indeterminacy of experience as individuals are initiated into prescription drug pleasures, how euphorigenic effects coalesce and are foregrounded through subsequent use, and how pleasure and other forms of gratification are made durable through repeated and deliberate pharmaceutical consumption. Understanding how individuals are socialized into pharmaceutical pleasure, and how assemblages act to constitute the euphorigenic potential of pharmaceutical misuse, may allow for more context-appropriate intervention efforts.