The current study examined how social media has had both negative and positive effects during, before, and after the COVID-19 pandemic. It was hypothesized that there would be a relationship between social media use during the pandemic and decreased social skills of emerging adults. Additionally, the study also hypothesized that loneliness would relate to a decrease in social skills. Finally, it was hypothesized that loneliness would mediate the relationship between social media use during the pandemic and decreased social skills. The results of the current study indicated that there was a mediational relationship between social media use, increased feelings of loneliness, and decreased social skills such as conversation, self-exposure, and academic and work skills.

This study explores the experiences of Black women who gave birth during the outset of the COVID-19 pandemic, given what is already known about medical racism, Black maternal mortality, familial support during pregnancy, and the transition to parenthood. This study adopts Black feminist thought and intersectionality as frameworks to examine Black women's experiences. It sought to provide a platform for Black women to speak openly about navigating their pregnancy during the pandemic, adapting to potential changes in their family systems after giving birth, and rallying behind their most significant points of resistance and resilience. Heuristic methodology was employed, which is appropriate when a researcher has a first-hand experience with a phenomenon that cannot be explained through the existing literature. Nine major themes emerged: being a Black woman, Black women and maternal death, COVID-19 pandemic, medical advocacy, mental health, unsupportive partners, becoming a mom, self-compassion, and relationship with child. The results of this study have implications for Black women's experiences and seeks to support prevention and intervention services that reduce the astoundingly high maternal death rate for Black women.

The employer's work environment responsibility is both broad and far-reaching and the Swedish legislation is defined in terms of responsibility. But this applies substantially when the employee works on the employer's premises. When it comes to telework, which has increased significantly over the last couple of years due to the covid-19 pandemic, the legislation is not as defined. A need for development has arisen in order to make sure that both the employers and the teleworkers are aware of their rights and obligations concerning the working environment. Therefore, the essay examines telework as a, now common and widespread, form of work and the gaps in the legislation when it comes to the employer´s work environment responsibility. This mainly concerns how to manage the physical distance between the employer and the teleworker, lack of transparency in terms of risks and occupational injuries and the psychosocial challenges. Methods used in the essay are a combination of legal dogmatic method and legal sociology method. The main work is based on the legal dogmatic method and the questionnaire survey on legal sociology method. The purpose of the essay, which forms the basis of the questions, is to clarify the legislation and the definition of telework and, with empirical data from the survey, illustrate how the increased amount of telework in Sweden is in need of more defined and easily accessible legislation. The current legislation in for example AML is well defined in terms of general work environment rules, but not specific enough when it comes to telework. This applies for both employers and employees and, as the survey shows, has a negative effect on the working environment. The covid-19 pandemic may be over but the increased number of teleworkers seems to be here to stay and therefore the legislation needs to be updated in order for the working environment to function in the same way as for those employees working on site.

Bakgrund: Covid 19 är en mycket smittsam sjukdom som upptäcktes 2019 vilket gjorde hälso- och sjukvården svårt belastad. En redan påverkad arbetsmiljö med brist på personal och hög arbetsbelastning gjorde arbetet under pandemin extra svår för sjuksköterskor. Syfte: Litteraturstudiens syfte var att beskriva sjuksköterskans erfaren-het av negativ arbetsrelaterad stress på covidavdelningar. Metod: Litteraturstudien gjordes utifrån en kvalitativ innehållsanalys med en induktiv ansats. Designen möjliggör en sammanställning av tillgänglig kunskap som sjuksköterskors erfarenheter. Studien bestod av sjutton vetenskapliga kvalitativa artiklar som svarade an på vårt syfte. För att analysera sjuksköterskors erfarenheter av negativ arbetsrelaterad stress på covidavdelningar användes en kvalitativ manifest innehållsanalys. Resultat: Analysen resulterade i sex kategorier: rädsla och utmattning, ensamhet och minskat stöd relaterat till arbetet, maktlöshet, extra utmanande arbetsbelastning, utmaningar med den personliga skyddsutrustningen och etiska och moraliska dilemman. Slutsats: Genom att undersöka sjuksköterskors negativa erfarenheter av arbetsrelaterad stress på covidavdelningar kan orsaker identifieras och på så sätt förebyggas i framtiden. Mer forskning behövs inom ämnet för att kunna förstå orsaker till sjuksköterskors arbetsre-laterade stress under covid 19 och kunna arbeta förebyggande kring detta vid framtida pandemier. Mer träning behövs för sjuksköterskor i hur de ska hantera sin stress och oväntade händelser. Även mer forskning kring hur patienters upplevelser av omvårdnaden påverkas då sjuksköterskor är stressade.

The COVID-19 Pandemic exacerbated a multitude of systems in the United States in 2020 up to current day. The structure of non-profit organizations across the country weakened as demands escalated for free food resources with specific pressure placed on food banks and food recovery organizations. There were citizens who had not previously relied on free food services who found themselves in drive through pickups, waiting for pre-packaged food boxes or the occasional you-pick operation to feed their families and themselves. The increase in demand for free food services was reacted to by those leading and directing the free food distribution sites through a time of crisis. This qualitative study serves to analyze food recovery organization (FRO) leadership strategies and principles that guided their decision making and problem-solving skills in response to food shortages and supply chain issues. The merge of the eight pillars of transformational and servant leadership theory provided propositional pillars that were tested in practice through interviews with FRO leaders in Appalachia. The discovery of how these leadership strategies were enacted during a time of crisis will guide the development of a training curriculum for nonprofit leaders in the future. / Master of Science in Life Sciences / The COVID-19 Pandemic exacerbated a multitude of systems in the United States in 2020 up to current day. The structure of non-profit organizations across the country weakened as demands escalated for free food resources with specific pressure placed on food banks and food recovery organizations. There were citizens who had not previously relied on free food services who found themselves in drive through pickups, waiting for pre-packaged food boxes or the occasional you-pick operation to feed their families and themselves. The increase in demand for free food services was reacted to by those leading and directing the free food distribution sites through a time of crisis. This qualitative study serves to analyze food recovery organization (FRO) leadership strategies and principles that guided their decision making and problem-solving skills in response to food shortages and supply chain issues. The merge of the eight pillars of transformational and servant leadership theory provided propositional pillars that were tested in practice through interviews with FRO leaders in Appalachia. The discovery of how these leadership strategies were enacted during a time of crisis will guide the development of a training curriculum for nonprofit leaders in the future.

Pandemics are periodic events characterized by rapid and widespread transmission of infectious disease affecting a significant proportion of the population over a large geographical area. Zoonotic strains of influenza viruses and coronaviruses have both caused pandemics in the recent past. Although vaccination is the often the most effective way to prevent infection or serious outcomes of infection, vaccine development, production, distribution, and deployment are all time- consuming and logistically challenges processes. Alternative readily deployed approaches must be quickly executed to mitigate the toll of future pandemics, especially during the early phases. The work described in this thesis describes some of these approaches. Firstly, I describe the process by which I performed genome-wide CRISPR-Cas9 knockout screens using SARS-CoV-2 variants of concern to discover crucial host factors as targets for broad-acting antivirals. I found that all variants rely on similar host pathways to replicate in the glial cell line used for the screen. I identified BCL-xL, a regulator of apoptosis, as a potential target for a broad- acting antiviral. I show that chemical inhibition of BCL-xL results in accelerated cell death in infected cells in vitro, but improved clinical signs and disease mortality of SARS-CoV-2 in our murine infection model. Secondly, I describe a unique mechanism for cooperative antiviral combination therapy. I demonstrate that chemical inhibition of neuraminidase by oseltamivir improved immune effector cell activation by hemagglutinin stalk-binding antibodies. Combination therapy of oseltamivir and stalk-binding antibodies also improved clinical signs and disease mortality of influenza in our murine infection model compared to monotherapy in both prophylactic and therapeutic contexts. Finally, I show that non-pharmaceutical public health interventions used to restrict the spread of COVID-19 were also effective against several other infectious diseases. I used an interrupted time- series analysis on Ontario public health administrative data during the early COVID-19 pandemic period and found a drastic and sustained decline in outpatient visits for diseases that are typically caused by viruses that transmit by droplet or aerosol. The three projects described in this thesis outlines broadly-protective and distinct strategies to curb the spread of novel respiratory viruses. These new tools may be leveraged to improve the response and to mitigate the burden of future pandemics. / Thesis / Doctor of Philosophy (PhD) / Most pandemics in recent history have been caused by viruses that infect the respiratory tract. Vaccination is often the best way to prevent the spread of these pandemic viruses, but making these vaccines takes time. Vaccines also work less well in the very young, the elderly, and those with a compromised immune system. These people are often also the most vulnerable to severe disease. My work describes three novel approaches to help combat the next pandemic, especially during the early phases when vaccines are still being developed, or for the segments of the population that respond poorly to vaccination. These include discovering and using new drugs that work against a wide range of viruses, using combinations of previously-discovered antiviral drugs, and using non-pharmaceutical methods such as physical distancing and wearing masks.

Background/Significance: Vaccines are essential to decrease the harmful effects of illness. The COVID-19 vaccination reduces mortality and hospitalizations from the COVID-19 virus. On August 11, 2021, the Centers for Disease Control and Prevention (CDC) strengthened its recommendation for all people ages 12 years and older who are pregnant, lactating, or trying to get pregnant to receive the COVID-19 vaccination. Despite the recommendation, pregnant women appeared to be vaccine hesitant. This qualitative descriptive study explored this hesitancy. Purpose: The purpose of this study was to explore pregnant women’s perceptions regarding COVID-19 vaccination during pregnancy and to identify information sources pregnant women used to guide their decision to forgo or receive COVID-19 vaccination during pregnancy. Method: A qualitative descriptive study was employed. Researchers used a semi- structured interview guide to conduct interviews. Participants included 41 women living in Salt Lake and Utah Counties, Utah, U.S.A. who had been pregnant any time after the CDC strengthened the recommendation for COVID-19 vaccination in pregnancy. Interviews were transcribed and coded separately by members of the research team. Team members came to a consensus regarding themes related to vaccine acceptance and hesitancy, as well as themes regarding information sources pregnant women used to guide their decisions regarding COVID- 19 vaccination. Results: The primary influence on COVID-19 vaccination during pregnancy was healthcare provider recommendations. A lack of belief in COVID-19 vaccine safety and efficacy contributed to vaccine hesitancy. Fear of unknown maternal and fetal complications from COVID-19 vaccinations was the primary reason pregnant women chose to forgo a COVID-19 vaccine during pregnancy. Fear of adverse side effects from COVID-19 viral infections was a significant reason for COVID-19 vaccine uptake in pregnant women. The CDC was used as an information source for decision-making by the majority of women, and they frequently mentioned conducting their own internet queries, both to obtain and clarify information. Further research is warranted to better understand COVID-19 vaccine hesitancy in pregnant women.

In recent years, rare catastrophic disasters have triggered pharmaceutical supply chain disruptions, resulting in product shortages and other problems that have negatively impacted healthcare delivery. Since the health sector is part of many nations’ critical infrastructure, ensuring minimal disruption in the supporting supply chains is an essential aspect of national security. While traditional risk management approaches have proven adequate for handling independent routine operational risks, these methods are inadequate for infrequent disruptive risks that propagate further risks, producing a domino effect in complex systems. Since today’s pharmaceutical supply chains have many characteristics of complex systems, elucidating the disruptive risks and required resilience capabilities, through knowledge gained from actual disasters, can be valuable in developing mitigation strategies. This research aims to investigate two catastrophic disasters that disrupted pharmaceutical supply chains in recent years. The first case explores the impact of a localized Category IV hurricane that hit Puerto Rico and disrupted the supply chain for saline, an essential product used in the treatment of many illnesses. The risk events that propagated from the disaster are identified and modeled using a Bayesian network to determine where resilience should be strengthened. In accordance with ISO 31000 risk management guidelines, Bayesian networks have been identified as appropriate tools for modeling complex system risks. The second case employs a qualitative research study on the vaccine supply chain supporting mass immunization during the COVID-19 pandemic. A content analysis is conducted to extract the insights of over 100 professionals on disruptors and resilience capability requirements of the COVID-19 vaccine supply chain. The results indicate that a large and diverse set of risk factors and resilience capabilities are pertinent to pharmaceutical supply chains during localized severe weather and global pandemic disasters. Furthermore, to mitigate the impacts of severe weather risk in the case of Puerto Rico, the predominant type of resilience required is absorptive capacity, while in the case of the mass immunization vaccine supply chain, adaptive capacity is key. These findings should be useful to national leaders, pharmaceutical supply chain and healthcare sourcing managers, disaster preparedness officers, and others charged with pharmaceutical supply chain resilience.

COVID-19 Patientinnen und Patienten haben ein hohes thrombotisches Risiko. Die Sicherheit und Wirksamkeit verschiedener Antikoagulationsschemata bei COVID-19 Patientinnen und Patienten sind unklar. Acht RCTs mit 5580 Patientinnen und Patienten wurden identifiziert, wovon zwei RCTs Antikoagulation in halbtherapeutischer und sechs RCTs Antikoagulation in therapeutischer Dosierung mit der Standard Thromboembolieprophylaxe verglichen haben. Die halbtherapeutische Antikoagulation kann wenig oder gar keinen Einfluss auf thrombotische Ereignisse oder Todesfälle haben (RR 1,03, 95% KI 0,86-1,24), kann aber schwere Blutungen (RR 1,48, 95% KI 0,53-4,15) bei mittelschweren bis schweren COVID-19 Patientinnen und Patienten verstärken. Therapeutische Antikoagulation kann thrombotische Ereignisse oder den Tod bei Patientinnen und Patienten mit mittelschwerem COVID-19 (RR 0,64, 95% KI 0,38-1,07) verringern, kann aber bei Patientinnen und Patienten mit schwerer Erkrankung (RR 0,98, 95% KI 0,86-1,12) wenig oder keine Wirkung haben. Das Risiko schwerer Blutungen kann unabhängig vom Schweregrad der Erkrankung zunehmen (RR 1,78, 95% KI 1,15-2,74). Die Evidenzsicherheit ist immer noch gering. Mäßig betroffene COVID-19 Patientinnen und Patienten können von einer therapeutischen Antikoagulation profitieren, jedoch ist das Blutungsrisiko erhöht. / COVID-19 patients have a high risk of thrombotic disease. The safety and efficacy of various anticoagulation regimens in COVID-19 patients remains unclear. Eight RCTs with 5580 patients were identified, with two comparing anticoagulation in intermediate doses and six comparing therapeutic doses to standard thromboembolism prophylaxis. Intermediate anticoagulation may have little or no effect on thrombotic events or deaths (RR 1.03, 95% CI 0.86-1.24), but may increase major bleeding (RR 1.48, 95% CI 0.53-4.15) in moderate to severe COVID-19 patients. Therapeutic anticoagulation may reduce thrombotic events or death in patients with moderate COVID-19 (RR 0.64, 95% CI 0.38-1.07), but may have little or no effect in patients with severe disease (RR 0.98, 95% CI 0.86-1.12). The risk of major bleeding may increase regardless of the severity of the disease (RR 1.78, 95% CI 1.15-2.74). The certainty of evidence is still low. Moderately affected COVID-19 patients may benefit from therapeutic anticoagulation, but the risk of bleeding is increased.

Students and educators around the world faced many challenges when returning to the physical school building and environment after the disruption to our educational systems throughout the height of the COVID-19 pandemic. Educational leaders across the U.S. have expressed concerns over the substantially higher levels of anxiety and chronic absenteeism among adolescents. This study examined middle school adolescents' abilities to use coping skills for managing anxiety in the school environment post-pandemic. Qualitative data were collected from eight middle school counselors through one-on-one semi-structured interviews. Findings indicated an increase in the number of students presenting with symptoms of anxiety and the severity of symptoms. Middle school counselors noted an increase in school refusal and self-harm and indicated that the majority of their direct service time is spent with individual students. In order to better support students with managing anxiety, middle school counselors expressed the need for explicit coping skills instruction and additional mental health staffing in the school buildings. / Doctor of Education / Students and educators around the world faced many challenges when returning to the physical school building and environment after the disruption to our educational systems throughout the height of the COVID-19 pandemic. Educational leaders across the U.S. have expressed concerns over the substantially higher levels of anxiety and student absenteeism among adolescents. In this study, a total of eight middle school counselors who served as counselors prior to the pandemic and in the 2023-2024 school year participated in one-on-one interviews. Counselors were asked to describe their observations of adolescent coping strategies for managing anxiety in the school environment and share any differences in how they were working to support adolescents presenting with symptoms of anxiety. Middle school counselors reported an increase in the number of students presenting with symptoms of anxiety and the severity of symptoms. They also noted an increase in school refusal and self-harm and indicated that the majority of their time is spent with individual students. In order to better support students managing anxiety, middle school counselors expressed the need for explicit coping skills instruction and additional mental health staffing in the school buildings.