The purpose of this study is to find the connection between the covid-19 pandemic and the increased littering in Jönköping municipality. Then, find out what is being done by Jönköping municipality and the municipality's waste company to manage the littering. The study used a qualitative method with semi-structured interviews to answer the research questions. The flexibility and open-ended choice of interviews were necessary considering the interviewee's different professional backgrounds. The topic chosen was essential, as increased knowledge can create the know-how required to prevent similar happenings in the future. The result showed that certain types of litter, such as medical waste and food packaging, had increased during the pandemic in certain places in Jönköping municipality. These certain places are, for example, the main beach in Jönköping city or different parks in the city, where people socialize along with something to eat and drink, hence the littering. Other litter has not seen any noticeable increase during the covid-19 pandemic. The municipality needed to reorganize and prioritize collecting the trash in these areas with an increase in litter, leaving other sites for later. This meant that the waste management system had not been efficient, and these littering changes had surprised the municipality. This study highlights the need for a waste management system that is more capable and efficient in cleaning, including when there is a pandemic or other events that temporarily increase the littering rates in certain areas.   Littering may be a forgotten subject when discussing the covid-19 pandemic, but this study aims to raise its importance and not underestimate its impact on people and nature.

Background: As a result of heightened occupational stress throughout the COVID-19 pandemic,nurses in hospitals are experiencing high rates of depression, anxiety, and burnout. However,nurses in obstetrical departments have had unique challenges and have experienced specificsources of stress that remain unclear.Methods: Semi-structured interviews were conducted with twenty obstetrical nurses that workedat an Ontario tertiary care centre during the COVID-19 pandemic. Participants shared theirexperiences of working during the pandemic, focusing on job stressors, personal resources, anddesires for job resources. Interviews were audio-recorded, transcribed verbatim and coded usingNVivo. Data was analyzed using a theoretical thematic approach based on the Job Demands-Resources (JD-R) model.Results: Key job stressors identified included having an increased workload, fear of COVID-19transmission, providing proper patient care, and overwhelming physical demands. Moreover,participants expressed they felt undervalued, inadequately supported, and burned-out during thepandemic. The most common personal resources used to cope with additional stress were relyingon family members, friends, and colleagues for support, in addition to utilizing personal hobbiesto decompress. Lastly, participants were able to provide suggestions on how to improve jobresources, focusing on improving mental and physical support, communication, and retention.Conclusion: This study provides an in-depth understanding of the COVID-19 workingconditions of Ontarian obstetrical nurses, while highlighting that they were provided withinadequate levels of job resources to manage increased job demands. Findings from this studycan help inform hospital management on how they can better support and meet the needs ofthose working in maternal care during major disease outbreaks. À la demande de l'auteur, le résumé a été retiré en raison de la nature confidentielle de la thèse. Il sera ajouté une fois la période d'embargo terminée.

Bakgrund: Covid-19 är ett smittsamt virus som upptäcktes i slutet av 2019. Viruset deklarerades av World Health Organization (2021) som en pandemi den 11 mars 2020. För att förhindra spridning av coronaviruset antogs olika åtgärder som förändrade hälso- och sjukvården globalt. Sjuksköterskorna har befunnit sig i frontlinjen i kampen mot viruset. Deras omvårdnadsarbete skedde under andra och speciella omständigheter.  Syfte: Syftet var att belysa sjuksköterskors erfarenheter av att vårda patienter med Covid-19 inom slutenvård.  Metod: Litteraturstudie gjordes utifrån Forsberg och Wengströms (2016) metod. Artiklar söktes från databasen Cinahl och PubMed samt via manuell sökning. 9 artiklar inkluderades efter relevans och kvalitetsgranskning. Induktiv innehållsanalys gjordes vilket resulterade i tre huvudkategorier och tre subkategorier.   Resultat: Sjuksköterskors erfarenheter kategoriserades i tre huvudkategorierna: ”Att inte räcka till”, ”Rädsla att bli smittad” och ”Professionens utveckling och arbetstillfredsställelse”. Tre subkategorier inom ”Att inte räcka till” var: ”Otillräckligt information och kunskap”, ”Otillräckligt med resurser” och ”Skyddsutrustningen var begränsande”.  Slutsats: Sjuksköterskornas erfarenhet av att vårda patienter med Covid-19 var meningsfull, tillfredsställande och kompetensutvecklande trots att vårdandet präglades av rädsla, oro och ångest. Begränsningar med skyddsutrustning, information och andra utmaningar gjorde även att sjuksköterskorna kände sig otillräckliga i vårdandet.

Background: Despite the overwhelming evidence that medication abortion care can be delivered safely and effectively through telemedicine services, Canadian abortion care providers have historically underutilized this modality of service delivery. However, the COVID-19 pandemic and the associated public health measures designed to flatten the curve both exacerbated existing inequities in access and prompted service delivery innovations in abortion care. -- Objectives: This project aimed to explore the experiences of women, transgender men, non-binary folks, gender non-conforming, and Two-Spirit individuals with the capacity for pregnancy (womxn) with telemedicine abortion care. By understanding facilitators and barriers to telemedicine use as well as abortion seekers' satisfaction with remote interactions, we aimed to identify ways of improving and fortifying the abortion care system in Ontario. -- Methods: Using a multi-modal recruitment strategy, we conducted semi-structured, in-depth interviews with womxn who obtained a telemedicine abortion in Ontario after March 15, 2020. We used inductive and deductive techniques to analyze these data for content and themes. -- Results: The two Ontarian womxn that we interviewed were highly satisfied with the telemedicine abortion care they received and would recommend this service delivery modality with others. -- Conclusions: The results from our pilot align with a growing body of research calling for the demedicalization of medication abortion care in Canada. Future research that expands on these findings can have both policy and service delivery implications.

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Under historien har människor drabbats av olika samhällskriser. Den första fallet av covid-19 upptäcktes i staden Wuhan i december 2019. Den 31 januari 2020 bekräftades första fallet i Sverige. Myndigheter, regioner, kommuner och andra aktörer har genomfört olika insatser för att hantera krisen. Både individer och samhälle påverkas när det kommer kriser. En kris hanteras på olika sätt av individer och samhället i olika delar av världen, beroende på olika förutsättningar och situationen där man befinner sig. Olika strategier används av myndigheter för att hantera en kris. Efter en pandemi eller samhällskris följer olika konsekvenser. Några exempel på konsekvenser som kan förekomma under och efter en kris kan vara ekonomisk kris, sämre hälsa och begränsad social interaktion och så vidare. En pandemi får konsekvenser för människor under tiden som pandemin pågår. Vissa drabbas mer och vissa mindre beroende på miljö, situationen, fattigdom, välfärd och andra faktorer. Ambitionen med denna uppsats är att undersöka hur covid-19 har gestaltats i dokumentärer på SVT. Filmen heter ”Pandemin” och består av 3 avsnitt. Filmskaparen heter Alice Henley och filmen är producerad för BBC, KEO film. Dokumentärer som analyseras i uppsatsen har gestaltats genom intervjuerna av människor från 21 länder. Detta för att kunna undersöka hur människor har upplevt pandemin runt omkring i världen. Analysen av dokumentärerna genomförs med hjälp en retorisk metod. Bevismedel som används inom retoriken är Logos, Pathos och Ethos. Dokumentärers uppbyggnad analyseras med hjälp av Nichols 6 modus. Tanken är att analysera metoden eller metoder som filmskaparen använt sig av för att producera filmerna och samtidigt att reda ut vilket budskap som filmskaparen har gestaltat. Ytterligare undersöks vad en samhällskris innebär, vilka faser vi går igenom under en kris, vilka konsekvenser om kan följa efter en kris samt vad som kan göras för att hantera konsekvenserna som en samhällskris medför. Detta analyseras med hjälp av annat material så som böcker som handlar om krishantering. Det teoretiska ramverket tar upp bevismedel i retorisk metod och krismedvetenhet, konsekvenser av krissituationer och krishantering. Krishanteringscykel visar att det finns några faser som en kris går igenom. Dessa faser är: förebyggandefasen, föreberedandefasen, responsfasen och återuppbyggnadsfasen. Några nyckelord: Krishantering, krissamhället, covid och retorik.

Viral pathogens have plagued human civilizations since ancient times and continue to pose a serious and constant global threat to not only human health but all facets of life. To date, more than 200 viruses capable of infecting humans have been identified, and the combined efforts of the academic and pharmaceutical sectors have yielded both extensive understanding of the biology and pathology of the viral infections as well as breakthrough interventions against a number of devastating diseases such as those caused by HIV (human immunodeficiency virus) and HCV (hepatitis C virus). In late 2019, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), the etiological agent of COVID-19 (coronavirus disease 2019), rapidly spread worldwide, leading to detrimental public health and socioeconomic crises. While the immediate response of the scientific community to the pandemic, which involved investigation of the disease and discovery of several therapeutic options at an unprecedented pace, has been impressive, this recent experience exposes the serious need to continuously fortify our fundamental knowledge of virology and equip our antiviral arsenal in preparation for future outbreaks. Moreover, given the scale of the challenge at hand, it highlights the value in the development and application of experimental approaches that accelerate the rate at which this information is obtained. In this dissertation, we utilize various techniques that allow high-throughput analysis of the SARS-CoV-2 3CL (3-chymotrypsin-like) protease to better understand its functional landscape as a favorable therapeutic target of the virus, and to investigate its response in developing resistance against the clinically used protease inhibitor, nirmatrelvir, at scale. We further expand our efforts to develop a platform for multiplexed drug screening that has the capacity to detect viral protease inhibitors for not only coronaviruses but also other targets across six additional virus families. Using this approach, we are able to rapidly identify broad-acting inhibitors, which are favorable for pandemic preparedness purposes where the exact nature of the future threat is difficult to predict a priori. To perform our studies, we make use of a variety of model systems, from a simple yeast-based system for detecting viral protease activity to the passaging of live virus within cultured human cells. Utilizing our yeast-based reporters, we comprehensively profile the activity landscape of all possible single mutants of the SARS-CoV-2 3CL protease via deep mutational scanning (DMS), uncovering its general malleability while also identifying several immutable regions within the enzyme that can serve as targets for the design of the next generation of protease inhibitors. Among the sites that show tolerance to changes, we predict E166 to be a residue that may confer nirmatrelvir resistance upon mutation based on available structural data which reveal its critical role in the binding of the drug to the active site. We prove this to be true by demonstrating a 265-fold loss in EC50 for the E166V mutant relative to the wild type protease within the recombinant virus. Recognizing that the plasticity of the enzyme could translate to a lower genetic barrier to resistance, we extend our investigation to study the whole virus response to nirmatrelvir at scale via in vitro passaging of SARS-CoV-2 in increasing concentrations of the drug. Upon examining 53 independent viral lineages to explore the ways by which resistance can be acquired, we identify a total of 23 mutations that arise in often non-overlapping combinations, with T21I, P252L, and T304I being the most common precursor mutations within all analyzed mutational trajectories. Validation of select single, double, and triple mutants based on the frequency of their appearance reveals that most single mutations, including the aforementioned founder mutations, confer low-level resistance (~5 – 6 fold) while greater resistance is acquired with the accumulation of additional mutations. Moreover, some mutations, such as T21I and L50F, appear to mediate, through a compensatory mechanism, the acquisition of secondary mutations such as E166V, which alone may confer much greater resistance but also cause significant loss in replicative fitness. Overall, the myriad of solutions that exist for the virus to escape the drug further corroborate the malleability of the SARS-CoV-2 3CL protease as established by our initial DMS study. These findings also establish a foundation for extended analysis of the mechanism of resistance and informed drug design. Lastly, by introducing additional viral proteases into our yeast cellular chassis and labelling each model with a set of unique DNA-barcodes, we develop a method of screening a pool of 40 unique protease targets simultaneously against small molecule libraries. Using this platform, we screen 2,480 structurally diverse compounds, and identify and orthogonally validate a series of broad-acting coronavirus 3CL protease inhibitors with a chromen-2-one structure. Together, the work described in this thesis underline the importance of innovative high-throughput approaches to investigating biology as demonstrated by their application to viral protease research.

The long-term care (LTC) sector in Canada has experienced high numbers of COVID-19 deaths. However, there is a paucity of data on the impact of COVID-19 in LTC by different socio- demographic variables and in LTC homes within different regions. Additionally, the question remains as to how exactly and by how much the pandemic has impacted mortality in LTC in comparison to previous years’ mortality. Ranges for expected mortality by sex, province, and age, for the 2020-21 fiscal year were determined by creating forecasts and confidence intervals based on mortality trends in the preceding four fiscal years. These ranges were then compared to the actual mortality data in 2020-21. Comparisons between expected ranges and actual data were also conducted for the number of active residents, admissions, and discharges in LTC by sex, province, and age. Further, mortality ratios were created and studied by sex, province, age, and health region/authority/local health integration network. Overall, the number of deaths in LTC in Canada increased beyond the expected ranges in quarter one and three of 2020-21, and the patterns in death ratios were similar. Increases were exceptional in comparison to the peaks in deaths in previous years for specific variables, but not all variables. Most commonly, the number of active residents and admissions decreased in 2020-21 and the number of discharges from LTC did not change in quarter one and three and decreased in quarter two and four. However, importantly, these trends also varied across variables. This was the first study to comprehensively examine mortality due to COVID-19 in LTC overall, and by multiple socio- demographic variables while elucidating the complexity in the study of mortality in LTC. Further research is required to concretely understand mortality in LTC by different variables and regions. / Thesis / Master of Arts (MA) / This study examined mortality due to COVID-19 from April 2020 to March 2021 in Canadian long-term care (LTC) homes by sex, age, province, and health region. Ranges of predicted values for mortality were created from mortality data from previous years and then compared with actual mortality. The number of active residents, admissions, and discharges were also examined by sex, age, and province to factor for changes in the population at risk. Overall, mortality increased in some quarters (April-June 2020 and October-December 2020) but was not always exceptional, as similar mortality rates had been observed in the four years prior to the pandemic. Also, the increase in mortality was seen mostly among younger residents (65 to 85); mortality remaining stable for the 85+. Further research is still required to better understand mortality in LTC by regional characteristics.

This dissertation is a tale of two emerging human pathogens. The first is a genus of viruses, orthoebolaviruses, which periodically cause outbreaks in humans in central and western Africa following spillover from animal reservoirs. Outbreaks of orthoebolaviruses have high rates of morbidity and mortality and can cause symptoms ranging from vomiting and diarrhea to hemorrhage. Understanding both how the virus evolves to fit its host as well as how the host reacts to viral infection is paramount to understanding what determines whether an infected patient will die or survive orthoebolavirus infection. To understand how orthoebolavirus genomic plasticity allows the virus to optimize itself to its host, I analyzed viral genomic sequencing data from two Orthoebolavirus species during serial passage in tissue culture: Ebola virus and Sudan virus. In low-passage Sudan virus, I discovered a true viral quasispecies in which three to four viral genotypes circulated within the same stock. I then examined how that quasispecies reacted when put into a nonhuman primate model (NHP) of infection; unexpectedly, we saw that the mix of genotypes in the challenge stock matched the mix of genotypes seen at clinical endpoint. To begin to understand what a successful immune response to orthoebolavirus infection entails, I characterized the circulating transcriptomic response in two survival models of Ebola virus disease. In a uniform survival model where NHPs were challenged with Bombali virus, I showed that NHPs have a clear and robust response to infection despite varying symptom severity. In a Taï Forest virus challenge model with ~44% survival, I showed that NHPs that succumb do so in a uniform manner consistent with other models of Ebola virus disease. In contrast, survivors were highly variable in their response to infection: some mimicked the non-survivor response but recovered in time, while others hardly responded at all. After covering orthoebolavirus genomic plasticity and the host response to infection in the first and second sections, respectively, I will then shift to the other focus of my dissertation work: SARS-CoV-2 and molecular epidemiology. SARS-CoV-2 swept the globe in 2020 following spillover into humans from an animal reservoir in late 2019, and surveillance sequencing of viral genomes early in the pandemic showed the virus was rapidly adapting to its new host. I leveraged this high mutation rate to spin up a molecular epidemiology operation for Boston Medical Center (BMC) and Boston University (BU). From mid-2020 through spring 2022, I catalogued, processed, sequenced, and analyzed samples and viral genomes from over 7,000 SARS-CoV-2 patient swabs. I worked with contact tracing teams, physicians, and infection control from BU and BMC to quantify viral introductions, identify transmission chains, and integrate the genetic linkages with traditional epidemiological data. / 2025-01-11T00:00:00Z