Creating a digital culture of care: COVID-19 and digital teaching

In this summer program, preservice teachers are recruited to work with children from the community and are mentored closely by two faculty members who are literacy education professors. This allows the candidates to learn from faculty mentors and their peers, a proven model for effective field experiences. Despite the research being done on remote learning due to COVID-19, the factors dictating the necessity of caring classrooms-such as systemic inequities and mental health's impact on student achievement-are more prevalent than ever and missing from the literature. The findings of the qualitative case study indicate the need for intentional work in preservice programs on creating caring digital classrooms. The findings also indicate the immediacy of the mental health concerns for children learning digitally due to COVID-19.

The Kitchen Table: Mother-Academics Reconfiguring Their Emerging Identities While Aligning Family and Work

Mother-academics are disadvantaged by historical and systemic inequalities situated within academia which have been compounded by the pandemic. Through the analytical lens of the theory of practice architectures, we focus on work practices and women's emotional experiences while reconfiguring their identities as online academics and simultaneously their changing home worlds due to the close proximity of their children at the kitchen table. Findings indicate that pre-COVID-19, boundaries between mothering and academia were delineated by the physicality of settings. In contrast, when forced to work from home during the pandemic, skilful navigation was required to obtain a home/work balance. Empathy was required to realign and locate a form of equilibrium in the merging online and home environment at the kitchen table. We contribute to the growing body of literature that advocates for academia to become a less gendered environment in the future. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.

Process Intensification and Increased Safety for the On-Demand Continuous Flow Synthesis of Dithiothreitol, a Crucial Component in Polymerase Chain Reaction Testing Kits

The importance of rapid access to diagnostics tools in the identification of pathogens-including their crucial component, bioreagents-was recently underscored in the COVID-19 pandemic. The currently adopted synthesis of dithiothreitol (DTT) involves four steps in batch with long reaction times and which generates a highly carcinogenic and mutagenic bis-epoxide intermediate. In this work, we have developed an intensified telescoped three-step continuous flow synthesis of DTT involving a base-mediated ring closure epoxidation, a nucleophilic epoxide opening with thioacetic acid, and an acid-mediated deacetylation. One of the key features is that the first two steps are conducted in a telescoped continuous flow fashion, allowing generation and consumption of the hazardous intermediate in situ, suppressing the need for its isolation, and improving the overall safety of the synthesis. The process is completed by an acid-catalyzed deacetylation and a subsequent recrystallization to afford the desired DTT. Flow chemistry allows here to intensify the process by using high temperatures and high pressures while minimizing the number of unit operations and improving the overall safety of the process. Our protocol permits the on-demand production of DTT in case of future outbreaks.

MAKING "NONESSENTIAL” FAMILY/VOLUNTEER CAREGIVING ESSENTIAL IN LONG-TERM CARE HOMES

For individuals living in long-term care (LTC), loneliness is often a concern. With the COVID-19 pandemic, this is only exacerbated as strict restrictions are put in place on visits between residents and their loved ones and on volunteer presence. Understanding how these changes affect residents, family caregivers, and volunteers is paramount to best implement changes with regards to how family/volunteer caregiving presence is managed during pandemics. The objective of this study was to gain a better understanding of the response to COVID-19 that pertains to the family caregiver and volunteer presence in LTC and increase the evidence about the impact of reduced levels of family caregivers and volunteers on residents, caregivers, and volunteers. A total of 64 semi-structured interviews were conducted with caregivers and volunteers. Of these interviews, 49 were one-time interviews and 15 were weekly interviews over a 5-month period to examine the impact of the ever-changing pandemic restrictions on caregivers, volunteers, and residents. Thematic analysis was used to analyze the interviews and two independent researchers coded each interview. Results highlight the importance of connections in LTC, the feeling that human rights were neglected, the importance of flexibility amongst staff, the role of caregivers as advocates for residents, increased caregiver guilt, and resident decline in physical and emotional well-being. The role of family caregivers and volunteers as essential in LTC homes will be discussed and recommendations to revisit policies on the family caregiver and volunteer presence to improve the preparedness for future pandemics and outbreaks will be presented.

Process Intensification and Increased Safety for the On-Demand Continuous Flow Synthesis of Dithiothreitol, a Crucial Component in Polymerase Chain Reaction Testing Kits

The importance of rapid access to diagnostics tools in the identification of pathogens-including their crucial component, bioreagents-was recently underscored in the COVID-19 pandemic. The currently adopted synthesis of dithiothreitol (DTT) involves four steps in batch with long reaction times and which generates a highly carcinogenic and mutagenic bis-epoxide intermediate. In this work, we have developed an intensified telescoped three-step continuous flow synthesis of DTT involving a base-mediated ring closure epoxidation, a nucleophilic epoxide opening with thioacetic acid, and an acid-mediated deacetylation. One of the key features is that the first two steps are conducted in a telescoped continuous flow fashion, allowing generation and consumption of the hazardous intermediate in situ, suppressing the need for its isolation, and improving the overall safety of the synthesis. The process is completed by an acid-catalyzed deacetylation and a subsequent recrystallization to afford the desired DTT. Flow chemistry allows here to intensify the process by using high temperatures and high pressures while minimizing the number of unit operations and improving the overall safety of the process. Our protocol permits the on-demand production of DTT in case of future outbreaks. © 2023 American Chemical Society.

Pandemic Hits: Evaluation of an Antimicrobial Stewardship Program Website for Hospital Communication During the COVID-19 Pandemic

Background. Antibiotic Stewardship Programs (ASPs) assist front-line clinicians in synthesizing emerging data and establishing best practices. Our ASP team directly maintained and edited an internal web application, Duke CustomID , to disseminate updated guideline, policy, and drug information during COVID-19. We aimed to describe website engagement and maintenance during the dynamic pandemic period. Methods. We performed a descriptive, time-series analysis using Google Analytics software to measure engagement with Duke CustomID during a 1-year prepandemic period through the Omicron surge: January 2019 to March 2022. We measured total page views (or 'hits'), COVID-specific page hits, and days requiring COVID-specific page edits by week. Given fluctuations in hospitalization rates, we defined the primary outcome as the rate of hits divided by total hospitalizations. Weekly data were assessed graphically with positive COVID tests and COVID hospitalizations. We used negative binomial regression to quantify the association between COVID hospitalizations and hit rates and to trend engagement over time, adjusted for seasonality. We stratified data by COVID page and calculated a hit/edit ratio. Results. Engagement with CustomID increased during the pandemic period, especially during surges (Figure). Hits in the pre-pandemic period were median 1707 (range 1165-2354) per week, and hit rates median 1.95 per hospitalization (range 1.40-2.86). Peaks were observed in March 2020 (hit rate 4.59) and January 2022 (hit rate 3.87). On average, for every 100 COVID hospitalizations, the hit rate increased by 0.08 (0.004-0.16, p=0.04). Engagement slowly increased over the study period (relative rate week 1 versus 170: 1.15, 95% confidence interval 1.02-1.28, p=0.02). COVID page edits per week had a median of 2 (range 0-12). Adult Inpatient Guidelines and COVID Monoclonal Antibody pages had highest use (Table). Duke CustomID Hits and Maintenance Efforts over the Pandemic Top: COVID-specific CustomID hits per week (Green), Positive COVID tests per week (Blue) over time Middle: Total custom ID page hits relative to total hospitalizations per week (teal), COVID hospitalizations (Red) Bottom: Number of edits to COVID-specific CustomID pages per week, stratified by management pages and drug pages Several dates of significance are highlighted including the Emergency Use Authorizations (EUA) for remdesivir, the COVID Vaccines, and Paxlovid Duke CustomID COVID-19 Page Hits and Edits COVID specific pages on Duke CustomID with total hits, edits, and ratio over the pandemic Conclusion. Our ASP's website was a highly utilized, practical tool for disseminating practice-changing information during the pandemic. Use increased over time and especially during surges. An electronic reference customized for local practice and rapidly updated by ASPs offers critical support for front-line clinicians.

Digital Pathology Training Effectiveness for the Evaluation of Pd-L1 Expression in Multiple Tumor Indications

Background In-person pathologist trainings during the COVID- 19 pandemic became impossible, necessitating a shift to remote-digital whole slide image (WSI) training. High concordance between WSI and glass slide scores from the same specimens stained with PD-L1 IHC 22C3 pharmDx (SK006) across multiple tumor indications supported the validity of digital training.1 However, in-person microscope (glass-slide) training versus remote-digital (WSI) training effectiveness must be assessed. Collated testing data on specimens (SK006 stained) spanning multiple indications scored by external pathologists during Agilent led training and testing (T&T) sessions via glass slides were compared to sessions utilizing WSIs. Methods Stained slides (30 unique specimens per tumor indication) were scanned on an Aperio AT2 scanner to generate WSIs for digital T&T. Remote T&T sessions used WebEx and PathcoreScholar's online platform to discuss scoring guidelines and WSI training cases. Subsequently, external pathologists evaluated WSIs in PathcoreScholar for PD-L1 expression using either Tumor Proportion Score (TPS) or Combined Positive Score (CPS) scoring algorithms and interpreted these scores at predefined cutoffs (figure 1). In both glass and WSI scoring test modalities, passing is defined as inter and intra-observer overall agreement (OA) >=85%. Training effectiveness pass rates from glass slide data (2018-2020) and WSI data (2021- 2022) spanning multiple indications and scoring algorithms were calculated and then compared using the Fisher-Freeman- Halton test, with a significance threshold of 0.05. Only data from initial pathologist tests were included in the pass rate calculation;data from re-tests executed after initial test failure were excluded. Results The differences between pass rates for microscope (glass slide) and digital (WSI) testing were not statistically significant (p-value > 0.05) (tables 1 and 2). Testing pass rates for indications scored with TPS or CPS using microscope glass slide vs digital WSI T&T was not statistically significant (pvalue > 0.05) (table 3). Conclusions No statistically significant differences in pathologist training effectiveness for PD-L1 were observed between remote and in-person trainings across multiple tumor indications, scoring algorithms, and cutoffs. These results demonstrate the effectiveness and equivalency of remote-digital pathologist trainings for evaluation of PD-L1 expression as detected by PD-L1 IHC 22C3 pharmDx in multiple tumor indications when compared to in-person-microscope glass slide T&T. Use of digital training and scoring proficiency testing can provide pathologists around the world with access to high-quality, interactive training from leading experts in PD-L1 expression evaluation.

Chemical Composition, In vivo Immunomodulatory and Anti-Hyperlipidaemic Properties of Rhinoceros (Rhino) Oil in Lead-Induced Immunocompromised Models

A knowledge of the chemical content of Rhinoceros (Rhino) oil and its activity on selected biomolecules of experimental models would help boost the immune system against an immunocompromised COVID-19 status. The study seeks to evaluate the chemical and biomolecular profile of Rhino oil. Chemical profile was done using standard methods of analysis. 25 rats were assigned in five groups (A-E) (n=5). Animals in group A (control) were administered 0.5 ml of distilled water while those in groups B-E which were immunocompromised (by intraperitoneal administration of 5 mg/kg body weight (b.w) of lead [Pb]) were also administered distilled water, immunomodulatory drug (5 mg/kg body weight of zinc [Zn]), 2 and 5 mg/kg b.w of Rhino oil extract respectively, once daily for 8 days followed by biomolecular assay. Proximate analysis gave moisture content (14.37+/-0.29), among others. FAMEs analysis showed hexadecanoic acid (12.80%) and other esters. Lipid profile of the oil gave LDLC to contain (32.90+/-0.53 mg/L), and others. The physicochemical properties gave iodine value as (115.80+/-0.40 mg/g), among others. The metal composition revealed Zn (0.28+/-0.06) plus others. The amnio acid profile of the oil gave ten essential amino acids and non-essential amino acids respectively. The levels of biomolecules in serum of the animals were altered at specific doses of the oil extract. Altogether, the chemical content of the oil was significantly high, with altered biomolecular effect. The rich content of vital nutrients and chemicals of Rhino oil may boost the white blood cells against COVID-19. The isolation and characterization of the active principles of the oil is encouraged. Copyright © 2007 The authors.

Staff experience of routine breathlessness assessment on a virtual covid ward

IntroductionOur hospital redeployed healthcare professionals to implement a telephone-based Virtual Covid Ward (VCW) during the COVID-19 pandemic. Standardised clinical assessment included numeric (0 – 10) rating scales (NRS) for breathlessness and cough, and pulse oximetry.Aims and objectivesTo assess staff experience of routine breathlessness documentation by surveying feedback on the clinical effectiveness of assessment tools used in the VCW.MethodsData were obtained from an anonymous online survey distributed to VCW staff, summarised in themes and analysed with descriptive statistics.Results9/19 VCW staff completed the survey;9 female;5 nurses, 3 physiotherapists, 1 Operating Department Practitioner;8 were senior, 1 junior. 100% had acute or respiratory medicine experience, 66% had experience in remote assessments. 100% reported absence of breathlessness at rest the most reassuring sign when discharging patients. 100% confidence when assessing breathlessness over the phone. 100% felt breathlessness was a ‘red flag’. 66% found the breathlessness NRS useful and 67% found the cough NRS useful. 89% believed patients’ responses were meaningful at least half the time. 78% believed patients overestimated the breathlessness score at least half of the time and 55% believed patients underestimated respiratory distress.ConclusionVCW staff were confident in assessing patients remotely and using the NRS. Staff found assessment of breathlessness useful in predicting adverse patient outcomes, but were less confident using the NRS (0–10) rating scale to quantify breathlessness was clinically valuable.

Fibrinolysis Shutdown Subtype of Early Allograft Dysfunction Represents the Predominant Cohort of Patients with Graft Failure Following Liver Transplantation

Purpose: Early allograft dysfunction (EAD) is associated with an increased rate of graft failure in liver transplantation (LT), but a mechanism remains unclear. Recent experience with COVID-19 has identified that microvascular clots related to fibrinolysis shutdown [ SD (lack of ability to break down clot)] drives organ failure, which can be treated with tissue plasminogen activator (tPA). It remains unclear how SD interacts with EAD, and if it may be associated with a worse outcome in LT. We hypothesize that fibrinolysis shutdown with EAD would be an unfavorable combination with an increased risk of graft failure compared to patients with EAD without SD. Method(s): Adult liver transplant recipients underwent thrombelastography (TEG) on post-operative day-1 to assess for fibrinolysis shutdown. Fibrinolysis activity was quantified by the amount of clot strength lost from peak clot strength in 30-minutes (LY30) in the presence of tPA (75ng/ml). SD was defined as an LY30 of 0%, indicative or no fibrinolytic activity in the presence of a fibrinolytic activator (median LY30 = 8% in healthy volunteers). EAD was defined on laboratory measurements defined and validated by Olthoff et al. Graft survival analysis was conducted with logistic regression analysis when controlling for recipient severity of liver disease (MELD) and graft quality (donor risk index). Survival time was assessed with Kaplan Meier curve. Result(s): 230 liver transplant patient recipients with a median laboratory MELD of 23 were included in the analysis. Graft failure rate was 13% with a median follow up time of 345 days. EAD occurred in 31%, and SD was present in 45%. The combination of EAD and SD was associated with a 46% graft loss rate which was significantly higher than EAD without SD (8% p<0.001). When controlling for MELD, and donor risk index, EAD (OR 3.3 95%CI 1.3-8.4 p=0.014) and fibrinolysis shutdown (OR 2.9 95%CI 1.1-7.9 p=0.034) were independent predictors of graft failure. Graft survival times were significantly different when patients were stratified by EAD and SD (figure p<0.001). Conclusion(s): The combination of EAD and SD bodes poor prognosis following liver transplantation. The stark difference in survival warrants further investigation if activation of the fibrinolytic system can safely improve graft survival time in LT recipients with EAD without the risk of excessive bleeding. (Figure Presented).

A Social Vulnerability Framework to Identify and Assist With Environmental Injustice

t is well established that socioeconomic and demographic factors, such as race and ethnicity, income, and education, are independently linked to health disparities.1 Tools that combine multiple socioeconomic and demographic variables into an overall rank, such as the Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR) Social Vulnerability Index (SVI), provide a quantitative framework that can be used by policymakers to identify communities that have higher overall social vulnerability with regard to disparate health outcomes and living conditions across multiple factors, and to develop targeted interventions.2 Historically, the SVI and similar frameworks have been crafted for emergency preparedness and response and used for study and practice in more extreme natural and human-caused disaster scenarios. Over the years, the SVI has been used for public health research and practice, communications, and accessibility planning, and to target geographically specific interventions related to natural disasters such as flooding and hurricanes,3, human-caused events such as chemical spills,2 and disease outbreaks like the recent COVID-19 pandemic.4 However, addressing issues of health inequity attributable to environmental injustice is imperative, and should not be restricted to alleviating the impact of event-specific hazards. Environmental injustice in the built environment is often associated with the disproportionate placement of hazardous and industrial sites and polluting transportation infrastructure in socially vulnerable neighborhoods,5 where residents often lack the social or economic capital to influence policy decisions.6 Although existing research links housing and health equity,7 the impact of poor housing conditions and household exposures to lead, pests, and indoor air pollutants on the health and well-being of socially vulnerable populations is an important and often overlooked aspect of environmental injustice.7,8 The Environmental Protection Agency's definition of environmental justice is all-encompassing and espouses the idea that environmental justice is only achieved when "everyone enjoys: The SVI has already been used outside the realm of disaster management to better characterize obesity10 and physical fitness.11 Hollar et al. set a new precedent for the value it may bring to the environmental justice sector, and additional research should be done to understand its utility in identifying communities that may be more likely to experience other socially linked conditions associated with environmental injustice, such as routine exposure to indoor and outdoor environmental pollutants, chronic disease burden, poor working conditions, lack of greenspace, and other issues with the built environment, in addition to housing conditions.

Mild symptomatology of SARS-CoV-2 infection in children born very preterm

Background It is not known whether children born very preterm have an increased risk of severe symptoms following SARS-CoV-2 infection and whether a history of bronchopulmonary dysplasia (BPD) relates to more severe sympto-matology. We aimed to describe the prevalence of SARS-CoV-2 infection and the severity of symptoms in a sample of children with and without BPD born at a gestational age below 32 weeks, between 2006 and 2019 in the Zurich area, in comparison to their siblings born at term (≥ 37 weeks). Methods Parents were invited to complete an online survey for their preterm child as well as for a term sibling of similar age, between May 2021 and January 2022. The survey included questions about SARS-CoV-2 confirmed infec-tion, symptoms and treatment. Results The survey was completed for 654 preterm children (270 with prior BPD) and for 189 term children aged 2 to 15 years. 28 (7%) preterm children without BPD, 15 (6%) preterm children with BPD and 22 (12%) term chil-dren were infected by SARS-CoV-2. Out of the infected, the proportion of children with respiratory symptoms (cough, sore throat, shortness of breath) was higher in premature children with BPD (67%), than in preterm children without BPD (25%) and slightly higher than in those born at term (59%). In all groups, the majority of children had only mild symptoms. No child had to be hospitalised and only one preterm child with BPD required oxygen. Conclusion Very preterm children with BPD may be more likely to experience respir-atory symptoms following SARS-CoV-2 infection. However, similar to chil-dren born at term, most very preterm children with and without BPD de-veloped mild symptoms only.

Beat back the health risks-and prepare for the looming economic crisis

This article presents a compilation of updates regarding the effect of the COVID-19 pandemic to the global timber industry, from manufacturing to international trade. The article cites the state of some countries regarding the current crisis, such as the hit on China's manufacturing due to slow export demand, US tropical hardwood imports dropping, hold in European timber imports, India's manufacturing shutdown, and the sharp drop on Japan's wooden door imports, among other things. Other subsequent effects on the timber crisis were cited as well, such as drops in housing sales, employee layoffs, temporary business suspension, and others. The consensus among analysts is that the global trade of wood products will be curtailed until at least mid-2021. The most severe declines are expected in the second and third quarters of 2020, with effects through to the first quarter of 2021, followed possibly by a slow recovery that could take as long as 2 years.

Risk and Assessment of COVID-19 in a Retina Ophthalmologic Setting

Purpose : To evaluate the risks and impact of COVID-19, SARS-CoV-2, on a private ophthalmology practice in Ohio and analyze the fluctuation in patient visits and surgeries before and during the COVID-19 pandemic. Methods : A retrospective analysis was performed using outpatient clinic logs for patients seen during the first 10 weeks of 2020 and compared to outpatient clinic logs for 10 weeks during the COVID-19 pandemic. During the twenty-week period, the number of appointments, intravitreal injections, and surgeries, most commonly retinal detachments, epiretinal membrane (ERM), and vitreous hemorrhages, were compared. Additionally, consideration was given to potential measures to reduce the spread and maintain prepandemic clinical care levels. The number of appointments, injections administered, and surgeries completed or postponed were analyzed before and during the COVID-19 pandemic. The practice implemented additional precautions for patients and staff. These included, but were not limited to, temperature checks, hand sanitizer availability, required use of face masks, and asking patients to come alone to appointments;with the exception of patients that were wheelchair bound, suffered from dementia, were under the age of 18, or required a translator. Results : During the first 10 weeks of 2020, the practice saw an average of 2,205 visits a week. In week one of the pandemic, the average was 1,147 patients per week, a 54% drop. An overall 40% drop was seen in surgical cases;vitreous hemorrhage surgeries decreased by 35%, retinal detachment surgeries decreased 25%, and ERM peels reduced by 60%. The drop in ERM's were mostly due to rescheduling. Intravitreal injections during the first 10 weeks averaged 1,025 (SD±112) per week. During the start of the 10 COVID-19 weeks, intravitreal injections averaged 852 (SD±122) per week and by the last weeks injections averaged 972 (SD±142) per week. Conclusions : In the early stages, the initial number of outpatient visits declined by 54%, the average number of intravitreal injections did not change in a similar pattern. This represents the importance of patients' triage and prioritizing urgent cases.

Innovative uses of visual technologies in initial teacher education: Changing Policy to Support Practice during covid-19

In Australia, schools and faculties of education are mandated to abide by a policy requiring preservice teachers (pst s), to complete supervised professional placement (pe) in schools. The pe are drawn upon to meet the assessment criteria for degree completion. Two strategies are reported that supported individuals and education institutions to meet policy requirements while in lockdown. First, technology was used to overcome the challenge of providing pe for hundreds of pst s by supporting online learning experiences. In the second, visual technologies were used to support pst s to meet the needs of an assessment criterion. Findings indicate that innovative solutions to challenges with pe and related assessments at the university can be mobilized in a short time frame using visual technologies. Further findings indicate that, in unprecedented times, policies developed for use in different contexts can be met with innovative collaborative efforts with a focused goal that transcend seemingly insurmountable challenges. © megan adams et al., 2021

Antiretroviral laboratory monitoring and implications for HIV clinical care in the era of COVID-19 and Beyond

Background. In the era of COVID-19, providers are delaying laboratory testing in people with HIV (PWH) to avoid unnecessary exposures despite antiretroviral guidelines recommending periodic testing. The purpose of this study was to examine the clinical significance of periodic renal, liver, and lipid testing. Methods. We reviewed the charts of 265 people with HIV (PWH) who initiated outpatient care at HIV clinic between 1/1/16 and 12/21/18 and had at least two clinic visits. Analysis included frequency distributions, descriptive statistics, one-sided binomial exact tests, and Poisson models with 95% confidence intervals (CI). Results. Eighty-five percent (221) of PWH had no laboratory abnormalities while on antiretroviral therapy (ART). The most common abnormality was a glomerular filtration rate (GFR) < 60 ml/min found in 10% of PWH. Multivariate analysis revealed that diabetes mellitus (DM) was associated with an increased risk of GFR < 60 ml/min (estimated rate ratio 2.68, 95% CI 1.35-5.33) and age < 60 years (estimated rate ratio .122, 95% CI .05-.32) was associated with a decreased risk (estimated rate ratio .24, CI .14 -.43). When a GFR was < 60 ml/min or an AST or ALT was >2X upper limit of normal (ULN), no action was taken in 52% of the cases. When an action was taken, the most common action was to repeat testing (18%). After a lipid panel result, the most common actions were to calculate a 10-year cardiovascular risk score (32%) and add a statin (18%). Taking action after lipid panel results was strongly associated with age ≥ 40 (estimated rate ratio 9.1, 95% CI 3.3-25). ART was changed in seven PWH based on GFR, AST/ALT, or lipid panel results. There were four individuals with poor outcomes including cerebrovascular accident, acute renal failure, end stage renal disease, congestive heart failure, myocardial infarction, and death. Contributing factors were hypertension, DM, and hypercholesterolemia. Conclusion. Individuals < 40 years without ithout comorbidities had a low risk of having clinically significant renal and liver function abnormalities and rarely had actions taken after renal, liver, or lipid results. In the era of COVID-19 and beyond, it may be prudent for in certain groups to delay or eliminate liver, renal, and lipid testing to eliminate exposure, reduce cost, and avoid patient anxiety.

Children’s virtual worlds and friendships during the Covid-19 pandemic visual technologies as a panacea for social isolation

From March 2020 in Australia, the covid-19 pandemic resulted in regulations for social distancing, which meant that students were homeschooled. Social distancing exponentially increased the exposure of most young children to digital technology such as touchscreens (iPads) and digital flip cameras. This study focuses on two seven-year-old children who maintain their friendship during covid-19 by imaginary performances and playing virtual games. A cultural–historical approach is used in the study to analyze the children’s experience as they connect through virtual worlds and build imaginary spaces, contributing to sustaining their relationship during challenging times. Findings indicate that the children built a collective social situation of development integrating sophisticated imaginary, real and virtual worlds. The children’s perspective – their motive orientations and intentions towards a new social situation provided new opportunities for learning in a virtual imaginary world. The combination of a real, an imaginary and a virtual world supported the children to experience a range of emotions including joyous moments, empathy and attunement as they encouraged each other to participate. © GLORIA QUINONES AND MEGAN ADAMS, 2021.