Inferior-Medial Dry Needling at the Thoracolumbar Junction: A Cadaveric Study.

Background: Dry needling (DN) has emerged as a popular therapeutic intervention for managing musculoskeletal pain. While major adverse events are generally rare, those that have been reported in vulnerable areas such as the spine and thorax can be serious and warrant further investigation regarding safe techniques in and around these areas. Purpose: The purpose of this study was to reproduce the methods employed by Williams et al. but with an inferior-medial multifidus DN technique to determine if a dry needle can penetrate the ligamentum flavum (LF) and breach the spinal canal at the thoracolumbar junction. Study Design: Descriptive Cadaveric study. Methods: The procedure was performed on a cadaver in the prone position. The needle was advanced under ultrasound guidance to determine if a 0.30 x 40 mm dry needle inserted lateral to the spinous process of T12 and directed inferior-medially could penetrate the LF and enter the spinal canal. Results: A 0.30 x 40 mm dry needle inserted 1.9 cm lateral to the spinous process of T12 was able to traverse the space between the vertebral laminae of T12 and L1, penetrate the LF, and enter the spinal canal with an inferior-medial needle angulation of 33-degrees medial and 18-degrees inferior. Conclusion: The results of this study demonstrate the feasibility of a dry needle entering the spinal canal at the thoracolumbar junction using an inferior-medial technique. These findings support the potential role of ultrasound guidance in the training and clinical practice of DN, especially in regions where safety issues have been documented. Level of Evidence: Level IV.

Socio-ethical challenges and opportunities for advancing diversity, equity, and inclusion in digital medicine.

Digitalization in medicine offers a significant opportunity to transform healthcare systems by providing novel digital tools and services to guide personalized prevention, prediction, diagnosis, treatment and disease management. This transformation raises a number of novel socio-ethical considerations for individuals and society as a whole, which need to be appropriately addressed to ensure that digital medical devices (DMDs) are widely adopted and benefit all patients as well as healthcare service providers. In this narrative review, based on a broad literature search in PubMed, Web of Science, Google Scholar, we outline five core socio-ethical considerations in digital medicine that intersect with the notions of equity and digital inclusion: (i) access, use and engagement with DMDs, (ii) inclusiveness in DMD clinical trials, (iii) algorithm fairness, (iv) surveillance and datafication, and (v) data privacy and trust. By integrating literature from multidisciplinary fields, including social, medical, and computer sciences, we shed light on challenges and opportunities related to the development and adoption of DMDs. We begin with an overview of the different types of DMDs, followed by in-depth discussions of five socio-ethical implications associated with their deployment. Concluding our review, we provide evidence-based multilevel recommendations aimed at fostering a more inclusive digital landscape to ensure that the development and integration of DMDs in healthcare mitigate rather than cause, maintain or exacerbate health inequities.

Incorporating sex and gender considerations in research on psychosocial work exposures and cardiovascular diseases: A systematic review of 55 prospective studies.

Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality, with disparities observed between males and females. Psychosocial work exposures (PWE), including workload, job control, reward and long working hours, are associated with CVD development. Despite higher prevalence among females, the association with CVD is consistently observed in males, with limited explanations for these differences. This study aimed to examine the consideration of sex and gender in prospective studies within systematic reviews on PWE - specifically, the demand-control model, the effort-reward imbalance model, and long working hours - and CVD. Conducting a systematic review, we assessed sex and gender considerations using criteria from the Sex and Gender Equity in Research (SAGER) guidelines. While most studies recognized potential sex and gender differences in the associations between PWE and CVD, only about half of the 28 studies that included both sexes (15 studies) analyzed females and males separately. Moreover, few studies included criteria for sex- and gender-based analyses. Less than half of the studies (23 studies) incorporated a sex and/or gender perspective to discuss observed differences and similarities between men and women. Although there is a rising trend in integrating sex and gender considerations, significant gaps persist in methodologies and reporting, highlighting the need for comprehensive incorporation of sex and gender considerations to bolster CVD prevention strategies and policies.

The Scope of Practice of Applied Behavior Analysis in State Licensure Laws.

The scope of applied behavior analysis has historically been defined by behavior analytic publications like Baer et al., Journal of Applied Behavior Analysis, 1, 91, (1968). However, starting in 2009, state legislators began creating licensure laws for behavior analysts that formalized the scope of practice for applied behavior analysis (ABA) within the applicable states. The purpose of this study was twofold: (1) to evaluate the degree scope of practice statements found in state licensure laws aligned with the individual components of Baer et al.'s seven dimensions of ABA and the APBA Model Act and (2) to evaluate the consistency of the scope of practice statements across states. Each licensed state law was identified, and the section that outlined the scope of practice was isolated and coded. The results of this study identified varying degrees of alignment with the individual components of Baer et al.'s seven dimensions and the APBA Model Act, as well as inconsistencies in the scope of practice among states with licensure for ABA. The component scores of each content area will be discussed, along with the implications for practice.

Unlocking the secrets of Neapolitan pizza: A concise review of wood-fired, electric, and gas pizza ovens.

This review explores the Neapolitan pizza baking process in a traditional wood-fired oven, employing visual color analysis and IR thermal scanning to detail heat exchange mechanisms. During cooking, the oven floor temperature in the pizza area decreased proportionally to the pizza's mass, whereas the free area maintained a constant temperature of 439 ± 3°C. An IR thermal camera indicated that the oven dome temperature reached approximately 480°C with a weak flame and 500°C with a strong flame. The pizza's bottom achieved a maximum temperature of 100 ± 9°C, facilitated by the Pizzaiolo's skill in lifting and rotating the pizza for uniform cooking. Top temperatures varied: up to 180°C for white pizza and 84°C and 67°C for tomato and Margherita pizzas, respectively. IRIS electronic eye analysis revealed more browning and blackening on the pizza's top compared to its bottom, with peaks of about 26% and 8% for white pizza, respectively. Rapid baking is pivotal in Neapolitan pizza-making, necessitating precise heat and mass transfer management to influence sensory attributes. European Commission Regulation No. 97/2010 mandates wood-fired ovens for true Neapolitan pizza, but environmental concerns prompted the Associazione Verace Pizza Napoletana to certify gas or electric ovens when wood-fired ovens are impractical. Operating costs vary: liquefied petroleum gas ovens are the costliest, with costs ranging from €5.38 to €6.19/h, whereas natural gas and electric ovens have operating costs between €2.70 and €4.10/h. At €0.15/kg, firewood is the most economical, supporting traditionalist views. However, natural gas and electric ovens present competitive costs under stringent antipollution laws, making them viable alternatives.

Sustainable bioinspired materials for regenerative medicine: balancing toxicology, environmental impact, and ethical considerations.

The pursuit of sustainable bioinspired materials in regenerative medicine necessitates a delicate equilibrium between scientific innovation, ethical mindfulness, and environmental responsibility. This abstract encapsulates the essence of a comprehensive perspective paper that explores the intricate interplay of toxicology, environmental impact, and ethical considerations in the realm of bioinspired materials. As the regenerative medicine landscape continues to evolve, the evaluation of biocompatibility and safety of bioinspired materials emerges as a critical concern. This paper delves into the multidimensional aspects of toxicity assessment, encompassing cytotoxicity, genotoxicity, and immunotoxicity analyses. Moreover, it sheds light on the challenging task of evaluating the environmental repercussions of these materials, elucidating methodologies such as life cycle assessment, biodegradability testing, and sustainable design approaches. Amid these scientific endeavors, the ethical dimensions of bioinspired material development remain paramount. The paper navigates the complex web of international regulations and ethical frameworks guiding medical materials, emphasizing the importance of aligning innovation with ethical standards. Furthermore, the abstract highlights the envisioned future directions and challenges in toxicology techniques, computational modeling, and holistic evaluation, culminating in a holistic understanding of the synergistic interplay between sustainable bioinspired materials, toxicity assessment, environmental stewardship, and ethical deliberation. .

Delayed Right Ventricular Automatic Implantable Cardioverter Defibrillator (AICD) Lead Perforation Resulting in Cardiac Tamponade: A Case Study.

Automatic implantable cardioverter defibrillator (AICD) lead perforation is a rare but potentially life-threatening complication. AICD lead perforations are rare, occurring in approximately 0.1%-0.8% of patients, most commonly within 24 hours of the implantation. ICD lead perforations can be acute (within 24 hours of implantation), subacute (between day 1 and day 30), or delayed (>30 days postimplantation). Delayed lead perforations are rare compared to acute and subacute lead perforations and are not as well-studied because patients are often asymptomatic and are not diagnosed. Here, we report the case of a 44-year-old male who presented to the emergency department with pleuritic chest pain and dyspnea one-month status-post dual-chamber AICD. The patient demonstrated signs and symptoms of cardiac tamponade, which was confirmed with a 2D echocardiogram and computed tomography (CT) scans. Emergency pericardiocentesis was performed under general anesthesia, which restored hemodynamic stability. The right ventricular lead was repositioned and a pericardial drain was placed. The patient remained in the intensive care unit (ICU) for three days and was discharged to home on postoperative day 8.

Organizational challenges for partial heart transplantation.

Partial heart transplantation (PHT) has emerged as a new treatment strategy to correct unrepairable heart valve dysfunction in pediatric patients. PHT selectively replaces the dysfunctional components of the recipient's heart and spares the native ventricles. As a result, the transplant biology of PHTs differs from heart transplants. Notably, donor hearts that are unsuitable for whole heart transplantation can be used, graft preservation can be prolonged and immunosuppression levels can be lowered. These nuances of PHT transplant biology have important implications for organizational aspects of PHT clinical application.

Partial heart transplantation (PHT) is a new way to treat children with heart defects that affect the heart valves. PHT does not replace the entire heart. Instead, PHT only replaces the part of the heart that does not function well. As a result, PHTs behave differently from heart transplants. PHT can use more donor hearts, the donor hearts can be preserved for longer, and the immune system does not need to be suppressed as much. These differences in the biology mean that the organization of PHT also differs from heart transplantation.

Clinical/surgical considerations.

While there are a diverse number of indications for the potential use of cell and gene therapies in people, many of the medical conditions being treated need to consider some general clinical and surgical issues, not only in designing clinical trials, but also in the eventual application of the therapy if shown to be successful. Such issues include the precision of the diagnosis and stage of disease, the presence of significant comorbidity, as well as the challenges that may be encountered in trial designs involving the neurosurgical delivery of these advanced interventions. This chapter discusses details of these issues that have arisen particularly in the field of Parkinson disease and other forms of neurodegeneration, although the general principles and considerations discussed may be equally relevant to other neurologic and nonneurologic conditions.

Pregnancy Planning and Genetic Testing: Exploring Advantages, and Challenges.

Pregnancy planning and genetic testing (PPGT) has emerged as a tool in reproductive healthcare, offering parents-to-be insight in their risks of having a child with a genetic disorder. This paper reviews the advantages, drawbacks and challenges associated with PPGT, providing some practical guidance for health care professionals. Advantages include identification of genetic risks, a possibility to informed reproductive decision-making, and the potential to reduce the parents-to-be risk for an affected child. Challenges and drawbacks include provision of service, ethical considerations, genetic counselling complexities, and the need to increase public and professional awareness by comprehensive education and accessibility. Practical guidance involves considerations for selecting appropriate candidates, counselling strategies, and how to integrate PPGT into existing healthcare frameworks. By addressing these factors, PPGT can offer an increased reproductive informed choice for the individual and the couple reducing the burden of disease in the family.

Drug-Drug Interactions in Nosocomial Infections: An Updated Review for Clinicians.

Prevention, assessment, and identification of drug-drug interactions (DDIs) represent a challenge for healthcare professionals, especially in nosocomial settings. This narrative review aims to provide a thorough assessment of the most clinically significant DDIs for antibiotics used in healthcare-associated infections. Complex poly-pharmaceutical regimens, targeting multiple pathogens or targeting one pathogen in the presence of another comorbidity, have an increased predisposition to result in life-threatening DDIs. Recognising, assessing, and limiting DDIs in nosocomial infections offers promising opportunities for improving health outcomes. The objective of this review is to provide clinicians with practical advice to prevent or mitigate DDIs, with the aim of increasing the safety and effectiveness of therapy. DDI management is of significant importance for individualising therapy according to the patient, disease status, and associated comorbidities.

Zeolite-based nanoparticles drug delivery systems in modern pharmaceutical research and environmental remediation.

This review explores the potential of zeolite-based nanoparticles in modern pharmaceutical research, focusing on their role in advanced drug delivery systems. Zeolites, integrated into polymeric materials, offer precise drug delivery capabilities due to their unique structural features, biocompatibility, and controllable properties. Additionally, zeolites demonstrate environmental remediation potential through ion exchange processes. Synthetic zeolites, with modified release mechanisms, possess distinctive optical and electronic properties, expanding their applications in various fields. The study details zeolites' significance across industrial and scientific domains, outlining synthesis methods and size control techniques. The review emphasizes successful encapsulation and functionalization strategies for drug delivery, highlighting their role in enhancing drug stability and enabling targeted delivery. Advanced characterization techniques contribute to a comprehensive understanding of zeolite-based drug delivery systems. Addressing potential carcinogenicity, the review discusses environmental impact and risk assessment, stressing the importance of safety considerations in nanoparticle research. In biomedical applications, zeolites play vital roles in antidiarrheal, antitumor, antibacterial, and MRI contrast agents. Clinical trials featuring zeolite-based interventions underscore zeolite's potential in addressing diverse medical challenges. In conclusion, zeolite-based nanoparticles emerge as promising tools for targeted drug delivery, showcasing diverse applications and therapeutic potentials. Despite challenges, their unique advantages position zeolites at the forefront of innovative drug delivery systems.

Considerations for developing a health-system 503B outsourcing strategy.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: To provide guidance for health systems on how to develop a strategy for utilizing 503B outsourcing facilities for sterile product preparation. SUMMARY: Health-system pharmacies face an increasingly complex set of challenges related to providing sterile products to patients. New United States Pharmacopeia <797> regulations, increasing drug shortages, and an ongoing pharmacy technician workforce shortage have made sterile compounding more difficult than ever for health-system pharmacies. Outsourcing of production to 503B outsourcing facilities is one strategy pharmacy leaders can use to help navigate these challenges. However, there are many factors to consider when deciding whether to outsource a product and which 503B vendors are safe and reliable. The Cleveland Clinic Health System (CCHS) has developed a robust internal structure to appropriately vet 503B outsourcing facilities for safety and reliability, as well as standardized criteria used to determine which products will be outsourced. This article describes the tools CCHS has used to evaluate 503B outsourcing vendors and to evaluate individual products to determine the pros and cons of outsourcing vs insourcing. Additionally, general considerations regarding outsourcing are described. CONCLUSION: Outsourcing to 503B facilities can be an effective strategy for navigating sterile compounding challenges but is not without some risk. Pharmacy leaders must develop a standardized approach to thoroughly evaluate 503B vendors and products to ensure their outsourcing strategy is both safe and cost-effective.

Application of transformer architectures in generative video modeling for neurosurgical education.

PURPOSE: This article explores the potential impact of OpenAI's Sora, a generative video modeling technology, on neurosurgical training. It evaluates how such technology could revolutionize the field by providing realistic surgical simulations, thereby enhancing the learning experience and proficiency in complex procedures for neurosurgical trainees. METHODS: The study examines the incorporation of this technology into neurosurgical education by leveraging transformer architecture and processing of video and image data. It involves compiling a neurosurgical procedure dataset for model training, aiming to create accurate, high-fidelity simulations. RESULTS: Our findings indicate significant potential applications in neurosurgical training, including immersive simulations for skill development and exposure to diverse surgical scenarios. The technology also promises to transform assessment and feedback, introducing a standardized, objective way to measure and improve trainee competencies. CONCLUSION: Integrating generative video modeling technology into neurosurgical education marks a progressive step toward enhancing training methodologies. Despite challenges in technical, ethical, and practical domains, continuous development and evaluation could lead to substantial advancements in surgical education, preparing neurosurgeons more effectively for their demanding roles.

Enhancing cultural sensitivity in the implementation of the Fertility Quality of Life Tool in Sudan: a science diplomacy perspective.

Background: Infertility is a global health challenge impacting quality of life, particularly in low and middle-income countries such as Sudan. The Fertility Quality of Life (FertiQoL) tool, a standardized questionnaire, is pivotal in assessing fertility-related quality of life. However, existing research on its utility has primarily been conducted in Global North and High-Income Countries, highlighting the need to shift away from neocolonialism to promote truly inclusive research and effective healthcare practices. Science diplomacy, through the adaptation and culturally sensitive implementation of research tools, can serve as a catalyst for addressing health disparities on a global scale. This study aims to assess methodological and cultural considerations that impact the implementation of the FertiQoL tool in Sudan, framed within the context of science diplomacy and neocolonialism. By investigating the challenges and opportunities of utilizing this tool in a non-Western cultural setting, we seek to contribute to the broader discussion on decolonizing global health research. Methods: Utilizing an explanatory sequential design involving surveys and interviews, we conducted a study in a Sudanese fertility clinic from November 2017 to May 2018. A total of 102 participants were recruited using convenience sampling, providing socio-demographic, medical, and reproductive history data. The Arabic version of FertiQoL was administered, with 20 participants interviewed and 82 surveyed (40 self-administered and 42 provider-administered). We applied descriptive statistics, one-way ANOVA, thematic analysis, and triangulation to explore methodological and cultural nuances. Results: Most participants were educated women who lived in urban areas. While the ANOVA results revealed no statistically significant differences in FertiQoL scores based on the mode of administration [core score (F(2,99) = 1.58, p = 0.21, η 2 = 0.03) and domain scores: emotional (F(2,99) = 1.85, p = 0.16, η 2 = 0.04); mind/body (F(2,99) = 1.95, p = 0.15, η 2 = 0.04); relational (F(2,99) = 0.18, p = 0.83, η 2 = 0.04); and social (F(2,99) = 1.67, p = 0.19, η 2 = 0.03)], qualitative insights unveiled vital cultural considerations. Interpretation challenges related to concepts like hope and jealousy emerged during interviews. Notably, the social domain of FertiQoL was found to inadequately capture the social pressures experienced by infertile individuals in Sudan, underscoring the importance of region-specific research. Despite these challenges, participants perceived FertiQoL as a comprehensive and valuable tool with broader utility beyond assessing fertility-related quality of life. Conclusion: Our findings emphasize the significance of incorporating cultural sensitivity into the interpretation of FertiQoL scores when implementing it globally. This approach aligns with the principles of science diplomacy and challenges neocolonial structures by acknowledging the unique lived experiences of local populations. By fostering cross-cultural understanding and inclusivity in research, we can enhance the implementation of FertiQoL and pave the way for novel interventions, increased funding, and policy developments in the Global South, ultimately promoting equitable global health.

Epidemiology and Risk Factors of Dry Eye Disease: Considerations for Clinical Management.

Dry eye disease is a multifactorial condition characterised by tear film instability, hyperosmolarity and ocular surface inflammation. Understanding the epidemiology of dry eye disease and recognising both modifiable and non-modifiable risk factors can assist eye care practitioners in assessing, treating, and managing patients with the condition. This review considers current knowledge surrounding its incidence and prevalence, as well as associated demographic, systemic, ocular, and iatrogenic, and lifestyle-related modifiable risk factors. Population-based prevalence estimates vary according to the diagnostic criteria used to define dry eye disease, as well as severity and demographic characteristics of the population. Considering recent data and variable population demographics, conservative prevalence estimates suggest that 10-20% of the population over 40 years of age report moderate to severe symptoms and/or seek treatment for dry eye disease. Individuals with specific non-modifiable demographic risk factors may be at increased risk of developing dry eye disease. Advanced age, female sex and East Asian ethnicity have been identified as key non-modifiable demographic features predisposing individuals to dry eye disease. Systemic conditions that have been associated with an increased risk of dry eye disease include migraine, Sjögren syndrome, connective tissue disorders, mental health disorders, diabetes mellitus and androgen deficiency. Medications that may contribute to this risk include antidepressants, antihistamines, and hormone replacement therapy. Ocular and iatrogenic risk factors of dry eye disease include blepharitis, Demodex infestation, ocular surgery, blink completeness, contact lens wear, and topical ophthalmic medications. A range of modifiable lifestyle factors that can increase the risk of dry eye disease have also been identified, including low humidity environments, digital screen use, quality of sleep, diet, and eye cosmetic wear. Dry eye is a common disease affecting millions globally. Increasing knowledge regarding its associated risk factors can better prepare the eye care practitioner to successfully manage patients with this ocular surface disease.

A narrative review on synchronous concurrent versus delayed sequential surgery in the artificial urinary sphincter and penile prosthesis implantation.

Background and Objective: In a patient who complains of both stress urinary incontinence (SUI) and erectile dysfunction (ED), prosthetic surgery with a urinary continence device and penile prosthesis implant can offer a definitive solution to address both problems. The AMS 800 artificial urinary sphincter (AUS) device is considered the standard of care to restore SUI while the inflatable penile prosthesis (IPP) device is thought to be superior to a malleable prosthesis to provide a more natural penile erection with higher patient satisfaction rates. The following article explores the current understanding of AMS 800 AUS surgery and IPP device in treating males with concurrent SUI and ED as well as evaluates the advantages and disadvantages of concurrent synchronous dual vs. delayed or staged device implantation. Methods: The available literature on AUS and IPP implantation was reviewed on PubMed and Embase databases between 1 January 2000 and 1 December 2022. This narrative review evaluates relevant key features pertaining to prosthetic surgery with an emphasis on arguments for concurrent synchronous dual vs. delayed sequential surgery for AUS and IPP devices. Additionally, this paper provides a brief surgical description of the techniques and potential complications relating to both prosthetic procedures. Key Content and Findings: While a great deal is known about the excellent outcomes of both AUS and IPP implantation, there is limited literature published on the outcomes of dual AUS and IPP surgery. The decision to proceed with concurrent synchronous dual vs. delayed sequential two-stage implants is likely determined by the patient's preference, the surgeon's expertise, and the availability of prostheses. In either situation, patients should be counselled regarding the advantages and disadvantages of undergoing synchronous concurrent vs. delayed sequential implants and associated surgical challenges are likely dependent on the patient's anatomy and the surgeon's preference. Conclusions: For carefully selected patients with SUI and ED, dual implantation of AUS and IPP provides a definitive treatment to address both conditions at the same time. Patients should be counselled regarding the advantages and disadvantages of synchronous concurrent vs. sequentially delayed implants while technical considerations regarding the sequence of prosthetic device surgery are likely dependent on the patient's factors and the surgeon's preference and surgical expertise.

Robotic donor hepatectomy for living donor liver transplantation.

Robotic donor hepatectomy introduces a new era in living donor liver transplantation (LDLT), combining advancements in minimally invasive surgery with superior precision and ergonomics. The beginning of LDLT in 1989 aimed to address the scarcity of deceased donor livers, a situation intensified by the technical and ethical challenges associated with this procedure. The integration of robotic systems since 2010s has broadened the scope and impact of liver transplantation, enhancing outcomes significantly for both donors and recipients. This review discusses the significant advancements in robotic surgery, the ongoing challenges such as cost and training needs, and the future toward global standardization and the integration of artificial intelligence. As this technology continues to evolve, it holds the potential to become the new global standard, ensuring safer procedures and enhanced outcomes for patients worldwide.

From Insights to Impact: Understanding Cancer Screening Choices through Mixed-Methods.

OBJECTIVE: The main objective of this comprehensive mixed-methods investigation conducted in Jordan were to explore and understand men's engagement in cancer screening. METHODS: The research employed a mixed-methods approach, combining a survey with 209 participants and focus group interviews with 30 individuals. The survey involved quantitative data collection methods to gather information on cancer screening participation rates among men in Amman. Focus group interviews were conducted to collect qualitative data on the factors influencing cancer screening utilization among men in Amman. RESULTS: The study revealed a notably low participation rate, with less than 37% of men engaging in cancer screening. The diminished involvement was attributed to several factors, including health illiteracy, language barriers, restricted access to health-related information and screening services, and cultural considerations. CONCLUSIONS: Based on the findings, the research strongly advocates for tailored interventions that are culturally specific. The emphasis is on the importance of training community health workers to address the identified challenges and enhance both cancer prevention awareness and screening accessibility in Jordan.

From care practices to speculative vignettes-design considerations for robots in good care.

The care sector has become one of the test beds for developing robotic technologies, which have been promised to mitigate problems with aging populations and labor shortages. Despite these promises, the practical application of such technologies have been met with limited success. Apart from technical limitations, other challenges exist in the way we approach designing these technologies. Critical to the development in the care sector is understanding the complexity of the contexts, the needs and goals of diverse actors, and how these are socio-materially scaffolded. This paper presents a study conducted at the intersection of a value sensitive design and speculative design to understand these sensitivities. Based on the data collected in interviews (n = 6) and card workshops (n = 6) from care workers and residents in mobile care and care home contexts in Austria, we developed five themes capturing situated practices and understandings of good care as built on trust-developing routines, negotiations between different actors, affective and reciprocal dimension of care, care worker self-care, and material mediations. Subsequently, we created six speculative vignettes which serve as rhetorical devices to emphasize the tensions that arise with any technological intervention entering and reshaping existing care practices and relations. We argue that our approach can support robot designers to develop a rich understanding of the values and tensions in the specific context under study from the before design and development begin.