Reimagining care discourses through a feminist ethics of care: analysing Ireland?s Citizens? Assembly on Gender Equality

The COVID-19 pandemic brought to the fore stark gendered care inequalities and the inadequacy of care provision across states. This article presents a feminist-ethics-of-care-informed discourse analysis of the representation of care that emerged at the Irish Citizens' Assembly on Gender Equality - an innovative government-created citizen deliberation process. It identifies how care was represented as a 'problem' of both gender inequality and the market, and uncovers key silences, which ignored care as a universal need of all citizens and the significance of care networks to sustaining caring. We propose the necessity of ethics-of-care-based understandings to address post-pandemic care challenges.

Early infection risk in patients with systemic lupus erythematosus treated with rituximab or belimumab from the British Isles Lupus Assessment Group Biologics Register (BILAG-BR): a prospective longitudinal study

Background: Patients with systemic lupus erythematosus (SLE) are at an increased risk of infection relative to the general population. We aimed to describe the frequency and risk factors for serious infections in patients with moderate-to-severe SLE treated with rituximab, belimumab, and standard of care therapies in a large national observational cohort. Method(s): The British Isles Lupus Assessment Group Biologics Register (BILAG-BR) is a UK-based prospective register of patients with SLE. Patients were recruited by their treating physician as part of their scheduled care from 64 centres across the UK by use of a standardised case report form. Inclusion criteria for the BILAG-BR included age older than 5 years, ability to provide informed consent, a diagnosis of SLE, and starting a new biological therapy within the last 12 months or a new standard of care drug within the last month. The primary outcome for this study was the rate of serious infections within the first 12 months of therapy. Serious infections were defined as those requiring intravenous antibiotic treatment, hospital admission, or resulting in morbidity or death. Infection and mortality data were collected from study centres and further mortality data were collected from the UK Office for National Statistics. The relationship between serious infection and drug type was analysed using a multiple-failure Cox proportional hazards model. Finding(s): Between July 1, 2010, and Feb 23, 2021, 1383 individuals were recruited to the BILAG-BR. 335 patients were excluded from this analysis. The remaining 1048 participants contributed 1002.7 person-years of follow-up and included 746 (71%) participants on rituximab, 119 (11%) participants on belimumab, and 183 (17%) participants on standard of care. The median age of the cohort was 39 years (IQR 30-50), 942 (90%) of 1048 patients were women and 106 (10%) were men. Of the patients with available ethnicity data, 514 (56%) of 911 were White, 169 (19%) were Asian, 161 (18%) were Black, and 67 (7%) were of multiple-mixed or other ethnic backgrounds. 118 serious infections occurred in 76 individuals during the 12-month study period, which included 92 serious infections in 58 individuals on rituximab, eight serious infections in five individuals receiving belimumab, and 18 serious infections in 13 individuals on standard of care. The overall crude incidence rate of serious infection was 117.7 (95% CI 98.3-141.0) per 1000 person-years. Compared with standard of care, the serious infection risk was similar in the rituximab (adjusted hazard ratio [HR] 1.68 [0.60-4.68]) and belimumab groups (1.01 [0.21-4.80]). Across the whole cohort in multivariate analysis, serious infection risk was associated with prednisolone dose (>10 mg;2.38 [95%CI 1.47-3.84]), hypogammaglobulinaemia (<6 g/L;2.16 [1.38-3.37]), and multimorbidity (1.45 [1.17-1.80]). Additional concomitant immunosuppressive use appeared to be associated with a reduced risk (0.60 [0.41-0.90]). We found no significant safety signals regarding atypical infections. Six infection-related deaths occurred at a median of 121 days (IQR 60-151) days from cohort entry. Interpretation(s): In patients with moderate-to-severe SLE, rituximab, belimumab, and standard immunosuppressive therapy have similar serious infection risks. Key risk factors for serious infections included multimorbidity, hypogammaglobulinaemia, and increased glucocorticoid doses. When considering the risk of serious infection, we propose that immunosupppressives, rituximab, and belimumab should be prioritised as mainstay therapies to optimise SLE management and support proactive minimisation of glucocorticoid use. Funding(s): None.Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Online counseling service delivery for school counselors

While the community mental health profession has provided online counseling interventions regularly in the form of telehealth counseling, this counseling platform is not as frequently offered, nor explored, in the scholarly literature related to school counseling. With the onset of online PK-12 instruction throughout the United States in response to the COVID-19 pandemic, school counselors were forced to adjust their reach to align with the virtual platform. This chapter explores the best practice recommendations related to providing school counseling interventions in an online/virtual format. © 2023 Springer Publishing Company, LLC. All rights reserved.

Is daily home spirometry feasible in remote monitoring of interstitial lung disease?

Introduction: Access to in-clinic spirometry for patients with interstitial lung disease (ILD) has been restricted by the COVID19 pandemic. Remote monitoring of patient-recorded at-home spirometry & pulse oximetry offers an alternative approach to traditional hospital-based monitoring. Objective(s): To assess the feasibility of a remote monitoring programme (with spirometry & pulse oximetry) delivered within ILD clinical care settings for a 3-month period through assessment of adherence to study measurements. Method(s): In this prospective, single-arm, observational study (NCT04850521), patients were asked to record 1 spirometry and pulse oximetry measurement per day for 91 days, using a digital health application (patientMpowerTM) & Bluetooth-linked devices. Patient-recorded data could be viewed in real time by their clinical teams via a secure, password-restricted web-based portal. Health-related quality of life and patient experience were also assessed. Result(s): 51 ILD patients enrolled and provided >=1 spirometry reading. Baseline demographics: 35M/16F;29 idiopathic pulmonary fibrosis (IPF)/22 non-IPF ILD;age: 67+/-12Y;in-clinic FVC: 84+/-20% predicted;TLCO 54+/-19% predicted (mean+/-SD);median modified ILD GAP score: 3. Patients recorded spirometry on median 92% of days & pulse oximetry on median 93% of days. To date, 30 patients have completed follow-up. 26/30 patients recorded spirometry and pulse oximetry >=3 days/week & >=70% of days. Conclusion(s): In this study, daily recording of home spirometry & pulse oximetry over 3 months appeared feasible. Further research is needed to understand how remote monitoring is best used within ILD clinical services. .

CareVisions: Enacting the Feminist Ethics of Care in Empirical Research

CareVisions (2022–2026) is an interdisciplinary researcj project reflecting on care experiences during and beyond the COVID-19 pandemic to re-imagine care relations, practices and policies in Ireland and internationally. Inspired by feminist ethics of care perspectives and Irish traditions of relatedness and living in the community, epitomised in the quote: Is ar scáth a chéile a mhaireann na daoine (We live in each other's shadow and in each other's shelter) (Higgins, M. 2021. Letter from the President of Ireland to the President of the United States of America, 20thJanuary 2021. Accessed 18 January 2022. https://twitter.com/PresidentIRL/status/1352162151817949184?s=20Q2), CareVisions prioritises the creation of deliberative and participative spaces to enable care debates from a wide and diverse range of voices. Thus, the project's essence required examination of and attention to ‘care-full' internal and external working relations. Informed by an advisory group comprised of care practitioners, researchers and activists, CareVisions' ethical statement recognises that adopting this approach requires a focus on ‘a dialogic and narrative form of practice' (Barnes et al. 2015b:238).This paper focuses on the process of conceptualising, operationalising and illustrating a feminist ethics of care from the early stages of the project's development and in approaching its empirical studies. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Tracing State Accountability for COVID-19: Representing Care within Ireland's Response to the Pandemic

COVID-19 triggers urgent questions about the social, political and ethical implications of care markets, practices and relations. This article presents analysis of the Houses of the Oireachtas Special Committee on Covid-19 Response exposing current discourses about care in Ireland. Utilising the Trace analysis method (Sevenhuijsen, 2004), grounded in feminist care ethics, reveals a state accountability exercise grappling with the failures of the care market and the inhumanity of congregated settings. Care discourses were constrained by a focus on the formal health system, normalisation of binary care giver and care receiver categorisations and a lack of recognition of gendered inequalities of care in homes and workplaces. Public discourse and feminist analysis revealed unreasonable labour conditions for women working in health and social care and a silencing of the voices of those with care needs. The article contributes to a reconceptualisation of care in post-pandemic futures and urges societal co-responsibility for 'universal care'.

Core training and surgical opportunities: A UK-based analysis

Background and Aim:: The COVID-19 pandemic, the new Intercollegiate Surgical Curriculum Programme curriculum and the European Work Time Directive significantly reduced surgical exposure for trainees. This study analyzed the operative experience of Phase 1 trainees (CT1/ST1 vs. CT2/ST2) against the Annual Review of Competence Progression (ARCP) criterion of 120 procedures yearly. Methods:: National survey research in October 2021. Study end-point was the completion of >4 weekly procedures, equivalent to 120 cases per year. Chi-square test and multivariate regression analysis were performed. Results:: 205 participants from 5 Deaneries were included, 48.3% were CT1/ST1 and 51.7% were CT2/ST2. About 54.5% of year-1 and 50% of year-2 trainees were 28 30 years old, 55.6% and 50.9% were male, and 39.4% and 38.7% were White British. About 39.4% of CT1/ST1 and 22.6% of CT2/ST2 performed <4 weekly procedures (P = 0.01), with no difference in the "Observed” (P = 0.6) or "Assisted” (P = 0.3) number of cases. CT2/ST2 recorded more "ST-S” (p 0.04), "S-TU” (P = 0.03), and "Performed” (P = 0.02) operations. For CT1/ST1, older age (HR 2.4, 95% CI [1.1;5.3], P = 0.02) and southern deaneries (HR 1.7, 95% CI [1.2;2.4], P = 0.004) were independent factor for <4 weekly procedures. For CT2/ST2, northern regions were associated with more favorable training (HR 1.4, 95% CI [1.1;1.7], P = 0.01). Conclusion:: Over one third of Phase 1 trainees do not meet the ARCP requirement of >120 procedures annually. Age and region of training are independent factors in the number of logbook cases. Relevance for Patients:: This research focuses on training opportunities for junior surgical residents across the United Kingdom. The degree and type of exposure to the operating theatre have a significant impact on the development of surgical competencies. These are undoubtedly related to patient outcomes, as the quality of care delivered to patients and relatives greatly relies on the training background of future consultant surgeons.

Mechanisms by which cystic fibrosis transmembrane conductance regulator may influence SARS-CoV-2 infection

Background: People with cystic fibrosis (PwCF) have chronic, pronounced respiratory damage and have been considered among those at highest risk for serious harm from SARS-CoV-2. Numerous clinical studies have reported that individuals with CF in North America and Europe, although highly susceptible to COVID-19, do not have mortality levels that exceed those of the general population. Method(s): To understand features that might influence lethality of COVID- 19 in PwCF, we tested potential relationships between CFTR and viral pathogenesis. As one approach to evaluate impact of CF transmembrane conductance regulator (CFTR) on COVID-19 severity, independent sets of blood samples fromvirally infected individualswere genotyped. Bloodwas obtained from 424 U.S. patients hospitalized with severe COVID-19 and a much larger European cohort of 7147 healthy individuals and 2587 individuals with severe COVID-19. Deoxyribonucleic acid in both studies was probed for the F508del variant. In other experiments, we investigated the possibility that lack of CFTR might alter viral binding and propagation. We used human bronchial epithelial cell (HBEC) monolayers from individuals without functional CFTR for this purpose. Finally, we examined effects of CF airway secretions and features such as viscosity, pH, and protease/anti-protease imbalance during SARS-CoV-2 infection. Result(s): We found no evidence of a relationship between deficient CFTR function (based on carrier status for the severe F508del defect) and clinical outcomes from COVID-19. In addition, viral propagation studies using airway epithelial monolayers (a model that reproduces many aspects of in vivo tissue biology) were not influenced by homozygous absence of CFTR. We show that levels of angiotensin converting enzyme-2 receptor messenger ribonucleic acid (mRNA) appear normal in CF primary epithelium, whereas transmembrane serine protease 2 mRNA is variable but lower ( p < 0.001) in a manner that correlates with viral infectivity (R2 = 0.76). Dependence of viral proliferation on features of CF mucosal fluid-including pH (viral replication optimum at pH 7-7.5), viscosity (diminished propagation in highly viscous apical media), and protease/ anti-protease imbalancewere identified as likely contributors to efficiency of SARS-CoV-2 replication and pathogenesis. Conclusion(s): These findings using patient data, CF and non-CF primary airway epithelia, and CF airway secretions fail to demonstrate a causal relationship between loss of CFTR and susceptibility to severe COVID-19. Notwithstanding the caveat that addition of virus in small buffer volumes disrupts airway surface liquid depth and composition, our findings also argue against a role for CFTR during acute infection of airway cells in vitro. On the other hand, chronic disruption of periciliary liquid, diminished pH, altered protease/anti-protease homeostasis, and increased fluid viscosity (sequelae that occur in CF lungs) were implicated as contributors to impaired SARS-CoV-2 propagation. Such studies provide a basis for future work to test relationships between CFTR and severity of COVID-19. Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Preparing Rural Middle School Teachers to Implement an Engineering Design Elective Course: A Just-In-Time Professional Development Approach

This paper presents the experiences of two STEM outreach specialists as they prepared two rural middle school teachers with limited STEM backgrounds to implement a 3-part grade level specific engineering design elective course at their schools. This work is part of an Innovative Experiences for Teachers and Students (ITEST) project designed to provide community-based engineering design experiences for underrepresented middle school students (grades 6-8) from rural N.C. The course engages students in authentic STEM design experiences situated in the advanced manufacturing industry in an effort to improve their STEM content knowledge and career awareness and their self-efficacy, identity and interest in STEM careers, particularly engineering. The outreach specialists experienced a number of challenges as they worked with the teachers, many of which were exacerbated by the on-going pandemic. In response to social distancing requirements imposed by COVID-19, the specialists adopted a just-in-time (JIT) approach to teacher professional development (PD) where the content, pace, and scheduling of PD sessions were based on each individual teacher's prior content knowledge, comfort level and work schedule. This paper focuses on the process of skill preparation of the middle school teachers in the execution of the 6th grade course in the 2020-21 school year. Additional aspects to be discussed include a sampling of best practices, an overview of lessons learned and implementation strategies during the second iteration of the 6th grade course and the first implementation of the 7th grade course during the 2021-22 school year. © American Society for Engineering Education, 2022.

Remote iVR for Nutrition Education: From Design to Evaluation

While different crowdsourcing platforms promote remote data collection, experiments in the immersive Virtual Reality (iVR) research community are predominantly performed in person. The COVID-19 pandemic, however, has forced researchers in different disciplines, including iVR, to seriously consider remote studies. In this paper, we present a remote study using the Immersive Virtual Alimentation and Nutrition (IVAN) application, designed to educate users about food-energy density and portion size control. We report on the results of a remote experiment with 45 users using the IVAN app. In IVAN, users actively construct knowledge about energy density by manipulating virtual food items, and explore the concept of portion size control through hypothesis testing and assembling virtual meals in iVR. To explore the feasibility of conducting remote iVR studies using an interactive health-related application for nutrition education, two conditions were devised (interactive vs. passive). The results demonstrate the feasibility of conducting remote iVR studies using health-related applications. Furthermore, the results also indicate that regardless of level of interactivity learners significantly improved their knowledge about portion size control after using the IVAN (p < 0.0001). Adding interactivity, however, suggests that the perceived learning experience of users could be partially affected. Learners reported significantly higher scores for immediacy of control in the interactive condition compared to those in the passive condition (p < 0.05). This study demonstrates the feasibility of conducting an unsupervised remote iVR experiment using a complex and interactive health-related iVR app. Copyright © 2022 Sajjadi, Edwards, Zhao, Fatemi, Long, Klippel and Masterson.

Emirates mars mission (emm) overview and status

The Emirates Mars Mission (EMM) is the United Arab Emirates (UAE) first mission to Mars and is the first Arab mission to another planet. It launched an unmanned observatory called "Hope" into an elliptical orbit around Mars on July 20, 2020 carrying three scientific instruments to study the Martian atmosphere in visible, ultraviolet, and infrared wavelengths. EMM will be the first mission to provide the first truly global picture of the Martian atmosphere, revealing important information about how atmospheric processes drive diurnal variations for a period of one Martian year. This will provide scientists with valuable understanding of the changes to the Martian atmosphere today through the achievement of three scientific objectives: A. Characterize the state of the Martian lower atmosphere on global scales and its geographic, diurnal and seasonal variability. B. Correlate rates of thermal and photochemical atmospheric escape with conditions in the collisional Martian atmosphere. C. Characterize the spatial structure and variability of key constituents in the Martian exosphere. The mission is led by Emiratis from Mohammed Bin Rashid Space Centre (MBRSC) and is expanding the nation s human capital through knowledge transfer programs set with international partners from the University of Colorado Laboratory for Atmospheric and Space Physics (LASP), Arizona State University (ASU) School of Earth and Space Exploration, and University of California Berkeley Space Sciences Laboratory (SSL). The paper highlights the driving motivation behind the mission, its scientific objectives and instruments, the unforeseen challenges amid the COVID-19 pandemic, as well as the status and accomplishments of the mission since its Mars Orbit insertion on Feb 9, 2021. © 2021 International Astronautical Federation, IAF. All rights reserved.

Patient-reported symptom severity and pulse oximetry in the COVID-19 remote monitoring programme in ireland

Rationale: A total of 60,287 (1,267/100,000) cases of Covid-19 (SARS-CoV-2) were recorded in Ireland by 30 October 2020. An important strategy to free up in-hospital capacity was development of a remote monitoring platform to support at-home care or early discharge of lower-risk patients with mild/moderate Covid-19 symptoms. Methods: The monitoring platform consisted of a patient-facing app + pulse oximeter (Bluetoothconnected Nonin 3230) enabling patients to record symptoms (e.g. breathlessness, diarrhea;severity rated on a 10-point scale), temperature & oxygen saturation (SpO2). Patients were prompted to record measurement 4 times/day. Patient-recorded data was viewed in real time by their healthcare centre via a dedicated web-based monitoring portal. Criteria for remote monitoring included: Covid-19 symptoms, positive for SARS-CoV-2, young age, absence of serious concomitant conditions, need for continued observation post-discharge. Treatment centres emailed app installation instructions and supplied a pulse oximeter to their patients. Treatment centres & patients received alerts if pulse oximetry values crossed pre-defined thresholds. Results: Between 13 March and 31 October 2020, 1,045 patients at 8 primary & 15 secondary care centres had used the remote monitoring platform [median duration: 13 days (interquartile range 10-23 days)]. 11 patients were admitted to hospital and 12 previously hospitalized patients were readmitted. 933 patients (89%) gave consent to use of their pseudonymised data for research. Symptoms and physiological markers of severity of infection varied considerably. 871 patients recorded breathlessness data with 53 rating severity as 6/10 and 23 as 8/10. 300 patients recorded diarrhea data with 24 rating severity as 6/10 and 6 as 8/10 (see Figure). SpO2 data were available for 907 patients. 733 patients reported SpO2 94-96%, 334 reported SpO2 92-93%and 265 patients reported SpO2 ≤91% at least once during the monitoring period. Conclusions: Remote monitoring of Covid-19 in appropriate patients can free up in-hospital capacity. The majority of these patients were willing to provide pseudonymised data to support research on Covid-19. .

Post COVID-19 remote patient monitoring following discharge from nyc hospital

RATIONALE: Patients discharged after hospitalization for COVID-19 pneumonia are at high risk for readmission and mortality. Early in the pandemic we noted that many patients discharged after initial improvement of their COVID pneumonia were subsequently readmitted with progressive hypoxemic respiratory failure. Therefore, we implemented a remote patient monitoring program to track pulse oximetry, heart rate and dyspnea after COVID- 19 hospitalization. The goal was twofold: to optimize hospital utilization and resources by expeditiously discharging stable patients and to improve patient safety after discharge with continued close monitoring at home. METHODS: Patients were eligible for 90-day remote monitoring if they were being discharged home, could access a smart phone and required supplemental oxygen during hospitalization. Enrolled patients received a Bluetooth enabled Nonin 3230 pulse oximeter and installed a mobile application provided by patientMpower, Ltd. for input of dyspnea symptoms. Patients were prompted to check oxygenation and input symptoms twice daily. Recorded data was transmitted to a monitoring portal;abnormal recordings triggered an alert;all data was reviewed by an APP (Advanced Practice Provider) and patients with alerts were contacted. Responses to alerts included change in medication regimen, adjustment of oxygen delivery, expedited follow-up visit scheduling, and emergency room referral. Remote monitoring data were reviewed at the scheduled post-discharge pulmonologist appointment. RESULTS: Between 4/28/20 and 11/30/20, 111 patients at Mount Sinai Hospital were enrolled in the remote monitoring program with 87 (78%) participants providing at least one entry. The mean age was 60 years (SD ± 14) and 59% were male. The median device usage was 84 days with 64% of patients reporting an oxygen saturation ≤ 91% during monitoring. 53% of patients reported at least one instance of dyspnea. There were on average 46.4 alerts per month with the majority stemming from oxygen saturations <95% and 49 outreach attempts a month. Table 1 summarizes these data. CONCLUSIONS: We describe the successful implementation of a remote monitoring program at a tertiary care center in NYC during the COVID-19 pandemic. Our subjective experience is that the ability to remotely monitor patients increased provider comfort when expediting discharges of medically stable patients. The program alerts reflected periods of worsening pulmonary status and triggered interactions that provided more continuous contact between providers and patients. Our next steps are to leverage the data from prolonged monitoring to gain insights into the recovery of COVID-19 patients and to determine factors associated with post discharge readmissions and mortality. .