Mothers As New Teachers During The COVID-19 Pandemic: Challenges and Opportunities

COVID-19, as a global pandemic, has generated extreme disruptions and challenges worldwide in social, economic, healthcare, and educational sys-tems. To reduce the virus's transmission, education systems moved to remote learning in the spring of 2020, with little to no time for preparation. This paper examines the educational experiences of parents of students with disabilities whose children attended PreK-6th public schools in the US during the COVID-19 pandemic using a Disability Studies in Education theoretical framework. In this qualitative phenomenological study, we interviewed 15 mothers of students with disabilities on Zoom. Using constant-comparative data analysis, we identified a theme revealing mothers' new identities as teachers of their children with disabilities at home, which brought unique challenges and opportunities. The mothers' challenges were related to the school's overreliance on them in remote learning, balancing multiple responsibilities, the need to re-learn academic content and new technology, and the colli-sion of teacher and mom identities and school and home boundaries. These challenges strained mother-child relationships and negatively influenced the mothers' mental health and well-being. However, their new identity as new teachers also generated new opportunities. Particularly, remote learning made school practices transparent, and mothers reconceptualized their children's abilities and realized their competence for learning. © 2022 Authors.

PiMS: A Pre-ML Labelling Tool

Machine Learning (ML) techniques in clinical decision support systems are scarce due to the limited availability of clinically validated and labelled training data sets. We present a framework to (1) enable quality controls at data submission toward ML appropriate data, (2) provide in-situ algorithm assessments, and (3) prepare dataframes for ML training and robust stochastic analysis. We developed and evaluated PiMS (Pandemic Intervention and Monitoring Systems): a remote monitoring solution for patients that are Covid-positive. The system was trialled at two hospitals in Melbourne, Australia (Alfred Health and Monash Health) involving 109 patients and 15 clinicians.

Child neurology telemedicine: Analyzing 14 820 patient encounters during the first year of the COVID-19 pandemic

Aim: To determine the long-term impact of telemedicine in child neurology care during the COVID-19 pandemic and with the reopening of outpatient clinics. Method(s): We performed an observational cohort study of 34 837 in-person visits and 14 820 telemedicine outpatient visits across 26 399 individuals. We assessed differences in care across visit types, time-period observed, time between follow-ups, patient portal activation rates, and demographic factors. Result(s): We observed a higher proportion of telemedicine for epilepsy (International Classification of Diseases, 10th Revision G40: odds ratio [OR] 1.4, 95% confidence interval [CI] 1.3-1.5) and a lower proportion for movement disorders (G25: OR 0.7, 95% CI 0.6-0.8;R25: OR 0.7, 95% CI 0.6-0.9) relative to in-person visits. Infants were more likely to be seen in-person after reopening clinics than by telemedicine (OR 1.6, 95% CI 1.5-1.8) as were individuals with neuromuscular disorders (OR 1.6, 95% CI 1.5-1.7). Self-reported racial and ethnic minority populations and those with highest social vulnerability had lower telemedicine participation rates (OR 0.8, 95% CI 0.8-0.8;OR 0.7, 95% CI 0.7-0.8). Interpretation(s): Telemedicine continued to be utilized even once in-person clinics were available. Pediatric epilepsy care can often be performed using telemedicine while young patients with neuromuscular disorders often require in-person assessment. Prominent barriers for socially vulnerable families and racial and ethnic minorities persist.Copyright © 2022 Mac Keith Press.

Impact of COVID-19 & Response Measures on HIV-HCV Prevention Services and Social Determinants in People Who Inject Drugs in 13 Sites with Recent HIV Outbreaks in Europe, North America and Israel.

HIV/HCV prevention among people who inject drugs (PWID) is of key public health importance. We aimed to assess the impact of COVID-19 and associated response measures on HIV/HCV prevention services and socio-economic status of PWID in high-HIV-risk sites. Sites with recent (2011-2019) HIV outbreaks among PWID in Europe North America and Israel, that had been previously identified, were contacted early May 2020. Out of 17 sites invited to participate, 13 accepted. Semi-structured qualitative site reports were prepared covering data from March to May 2020, analyzed/coded and confirmed with a structured questionnaire, in which all sites explicitly responded to all 103 issues reported in the qualitative reports. Opioid maintenance treatment, needle/syringe programs and antiretroviral treatment /hepatitis C treatment continued, but with important reductions and operational changes. Increases in overdoses, widespread difficulties with food and hygiene needs, disruptions in drug supply, and increased homelessness were reported. Service programs rapidly reformed long established, and politically entrenched, restrictive service delivery policies. Future epidemic control measures should include mitigation of negative side-effects on service provision and socio-economic determinants in PWID.

RESUMEN: La prevención del VIH/VHC entre las personas que se inyectan drogas (PWID) es de vital importancia para la salud pública. Nuestro objetivo fue evaluar el impacto de COVID-19 y las medidas de respuesta asociadas en los servicios de prevención del VIH/VHC y el estado socioeconómico de las PWID en sitios de alto riesgo de VIH. Se contactó con sitios con brotes recientes (2011­2019) de VIH entre PWID en Europa, América del Norte e Israel, que habían sido previamente identificados, a principios de mayo de 2020. De los 17 sitios invitados a participar, 13 aceptaron. Se prepararon informes cualitativos semiestructurados del sitio que cubrían los datos de marzo a mayo de 2020, analizados/codificados y confirmados con un cuestionario estructurado, en el que todos los sitios respondieron explícitamente a los 103 asuntos reportados en los informes cualitativos. El tratamiento de mantenimiento con opiáceos, los programas de agujas/jeringas y el tratamiento antirretroviral/tratamiento de la hepatitis C continuaron, pero con importantes reducciones y cambios operativos. Se reportaron aumentos en las sobredosis, dificultades generalizadas con las necesidades alimentarias y de higiene, interrupciones en el suministro de medicamentos y aumento de personas sin hogar. Los programas de servicios reformaron rápidamente las políticas restrictivas de prestación de servicios, establecidas desde hace mucho tiempo y políticamente arraigadas. Las futuras medidas de control de epidemias deben incluir la mitigación de los efectos secundarios negativos en la prestación de servicios y los determinantes socioeconómicos en las PWID.

PiMS: A Pre-ML Labelling Tool

Machine Learning (ML) techniques in clinical decision support systems are scarce due to the limited availability of clinically validated and labelled training data sets. We present a framework to (1) enable quality controls at data submission toward ML appropriate data, (2) provide in-situ algorithm assessments, and (3) prepare dataframes for ML training and robust stochastic analysis. We developed and evaluated PiMS (Pandemic Intervention and Monitoring Systems): a remote monitoring solution for patients that are Covid-positive. The system was trialled at two hospitals in Melbourne, Australia (Alfred Health and Monash Health) involving 109 patients and 15 clinicians. © 2022 IEEE.

Initial Efforts to Manage IPE during the COVID-19 Pandemic: Reports from the Big Ten Academic Alliance

Purpose: The COVID-19 pandemic required higher education institutions to quickly transition to a virtual platform. This was challenging for those involved in interprofessional education (IPE), given the goal that students from two or more professions learn about, from, and with one another. The Big Ten IPE Alliance is a subgroup of the larger Big Ten Academic Alliance. The purpose of this paper is to share the collective experiences of multiple large, research intensive universities in addressing the challenge of implementing IPE programs under the conditions established by the COVID-19 pandemic. Methods: To better understand how the Big Ten schools dealt with the transition to virtual learning for didactic and clinical IPE given the COVID-19 pandemic, a subset of representatives from the Big Ten IPE Alliance met to discuss best practices for virtual learning in the IPE realm. Each participating university completed an electronic 14 question survey related to their IPE curriculum during the COVID-19 pandemic from March 2020 thru August 2020 and the responses were analyzed. Results: Four categories were identified as needing to be addressed to develop and implement successful interprofessional didactic and clinical experiences. The categories identified included content/assessment, virtual technologies, faculty and facilitators, and learners. Conclusions/Recommendations: Consider including authentic and innovative mechanisms to deliver IPE experiences that meet the learning needs and accreditation requirements. Interinstitutional collaborations such as within the Big Ten IPE Alliance can be beneficial in assessing current and future best practices in IPE.

EXPRESS: Pharmaceuticals, Marketing and Society: A New Center of Gravity for Critical Research and Policy

When we first discussed a special issue on pharmaceuticals, marketing and society, we were focused on translating familiar research topics into this critical industry. In those now distant 2019 ?before times,? we looked forward to reading papers related to all aspects of the marketing mix, regulation and practice - hopefully providing insights that were both broad in reach and specific in application. However, around March 2020, it became clear that one medical condition, and pharmaceutical challenge, would draw the world's attention - and with it, change the center of gravity around which our work would revolve. Virtually every major marketing journal turned its gaze on COVID-19, as did many funding agencies, regulatory bodies and companies. As we watched, COVID-19 continued to change, challenging our understanding of the way that pharmaceuticals, marketing and society would contribute, and presenting constant shifts in our conceptualizations of all three.

COVID-19, the trauma of the 'real' and the political import of vulnerability

Politics in the neoliberal/modern/Western world is structured based upon the assumption that political subjects are atomistic and self-sufficient;these assumptions suppress and deny (inter) dependency, relationality and vulnerability. Yet, the rapid spread of COVID-19 has devastated many communities, drastically changed political and social life, and foregrounded the ways in which vulnerability is an inescapable fact of our existence. Drawing upon zizek's reading of Lacan's notion of the 'real' and the ethics of care, we analyse the COVID-19 pandemic so as to argue that vulnerability must be understood as a fundamental political concept that merits ongoing attention in our political systems.

"you can't make me do it!" a model of consumer compliance

Consumer well-being often depends on compliance with service setting rules and product/service use guidelines. This issue came to the forefront during the COVID-19 pandemic. Here, we propose and test a compliance model in the context of COVID-19 social distancing guidelines. Although COVID mitigation is politicized, we fully mediate the impact of political ideology with three constructs: (1) consumer perception that freedom is restricted, (2) complacency, and (3) perceived ethicality. We suggest specific tools that help bypass the political polarization that has occurred in the pandemic. The model can be applied to other areas in which compliance is key to consumer well-being, such as enforcing age-related restrictions on purchases and safety-related behaviors. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Bayesian modeling in COVID-19-disease modeling, therapeutics, and vaccines

COVID-19 efforts have dominated the headlines in 2020. These efforts have involved efforts across the medical and statistical spectrum, from modeling of the pandemic to the development of therapeutics to the testing of possible vaccines. Novel methodologies have been utilized, such as platform trials, Bayesian modeling of pandemic uncertainty, and Bayesian adaptive trials to facilitate timely vaccine delivery. In this session, we will present four real examples of Bayesian methods across this range of activities. These include the official modeling of the epidemic within Los Angeles County by the leader of the team, both design and execution of platforms trials within the COVID-19 pandemic, and the Bayesian Pfizer vaccine trial. All speakers confirmed. Roger Lewis is the leader of the COVID-19 epidemic modeling team for Los Angeles County, California, advising government officials on the progress of the epidemic and projecting future developments. He will discuss the Bayesian SEIR modeling performed for Los Angeles, including capturing uncertainty in the predictions and real-world issues in data collection and adjusting modeling in the presence of evolving medical care and government policies. Ben Saville will discuss therapeutic adaptive platform trials like PRINCIPLE and REMAP-CAP (focus on PRINCIPLE). Both trials are ongoing adaptive platform trials investigating multiple therapies for COVID- 19. PRINCIPLE is a UK national priority trial and is focused on ambulatory participants with suspected COVID-19 and a higher risk of morbidity (e.g. .50 years age with comorbidities). The trial is open-label and has co-primary endpoints of subject-reported time to recovery and hospitalization. REMAP-CAP includes both open-label and blinded interventions focused on hospitalized patients in the intensive care unit across eight countries. The primary endpoint is the number of organ support-free days, and includes multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Both trials use innovative Bayesian modeling that account for potential drift over time, with frequent interim analyses allowing early decisions of futility or superiority. Response-adaptive randomization is used to increase allocation to interventions with better observed outcomes, which can increase statistical power for finding effective therapies and result in better participant outcomes. Mark Fitzgerald will present some of the challenges of execution for the statistical analysis committee for a trial that is rapidly adapting to an ongoing pandemic, with a focus on REMAP-CAP. REMAP-CAP is an adaptive platform trial that explores the efficacy of interventions across a range of treatment domains, including the combinations across domains, that utilizes a novel endpoint: organ-support free days. The international effort combines data from five continents, evaluates thousands of treatment combinations, and rapidly evolves to accommodate information from external sources. The statistical analysis committee faces unique challenges in adjusting to rapid changes when combining data from disparate sources, updating models and reports to incorporate new design features, and producing results for public disclosure for closed domains or interventions, all while ensuring proper communication and maintaining trial integrity. Satrajit Roychoudhury will discuss the design of the Pfizer Bayesian adaptive vaccine trial. This trial incorporates multiple interim analyses, each based on achieving a sufficiently high Bayesian posterior probability of vaccine efficacy. The trial also incorporates early stopping for futility based on Bayesian predictive probabilities. In November 2020, the trial is currently ongoing. Additional information may be publicly available at the time of SCT 2021 that may be discussed, but this will depend on future events at time of submission.

Low prevalence of SARS-CoV-2 detected in symptomatic children admitted to hospital

Aims Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originated in Wuhan, China in 2019 and is responsible for the condition known as COVID-19. COVID-19 was first reported in Ireland in February 2020 with University Hospital Limerick’s (UHL) first paediatric case reported on 4th March 2020. Studies have shown clinical manifestations of children’s cases are generally less severe than those of adults. UHL serves a catchment population of approximately 100,000 children. We aimed to describe the clinical presentation, and prevalence of SARS-CoV-2, in children requiring inpatient hospitalization during the initial phase of the pandemic in Ireland. Methods Data were examined relating to all inpatients aged 0 – 16 years admitted with a queried or confirmed diagnosis of COVID-19 from 8th February 2020 to 8th June 2020. Emergency Department notes and inpatient records along with laboratory and radiology records were reviewed. Results 220 paediatric inpatients were tested by PCR for SARS-CoV-2 during this period;101 (45.9%) were female. Ninety-five (43.2%) were diagnosed with ‘viral illnesses’. Seven (3.2%) had laboratory-confirmed SARS-CoV-2, with an average age of 8.1 years (range: 0.59 years to 13.77 years). There were two Kawasaki-like illnesses admitted;both tested negative for SARS-CoV-2 on PCR. In our SARS-CoV-2 positive cohort, there was no associated significant morbidity and no associated mortality. Conclusion During the initial phase of the COVID-19 pandemic, prevalence of confirmed SARS-CoV-2 in symptomatic hospitalised children was low at 3.2%.

The Pandemic Ripple Effect: Understanding Marketing and Public Policy Opportunities in the Pharmaceutical Industry: JPP&M

The COVID-19 pandemic placed a heavy weight on a trillion-dollar global pharmaceutical industry already struggling under the opioid crisis and pricing controversies. Although the drug development process typically takes ten or more years, the urgency of COVID-19 forced government regulators to shed tradition for flexibility. The race for effective treatments and care reveals knowledge gaps for marketing scholars to fill, enabling us to play a more positive role in future crises. We highlight three of these gaps: (1) confusion arising from off-label prescribing and emergency use authorization (EUA), (2) consumer access to testing, and (3) pharmaceutical supply chain issues.

Impact of COVID-19 on Life Experiences of Essential Workers Attending a Dental Testing Facility.

OBJECTIVES: 1) To compare the impact of COVID-19 on the life experiences of essential workers attending a COVID-19 antibody testing clinic at a dental school. 2) To compare responses of dental, non-dental health care, and non-health care essential workers. 3) To assess acceptability/satisfaction of testing done in a dental setting. METHOD: A total of 984 participants completed a self-administered online questionnaire. RESULTS: Over 90% were healthy (i.e., not in a high-risk health-related group for COVID-19), did not have COVID-19 symptoms within 30 d, and always/frequently engaged in preventive measures. Fifty-eight percent thought that they had a 0% to 25% chance of having immunity/antibodies to COVID-19. Non-dental health care workers thought that their chance was significantly higher (P < 0.05) than others. Over 70% were sometimes, frequently, or always worried about their friends and loved ones getting COVID-19 and of resulting financial problems. Dental workers were significantly less afraid than non-dental health care and non-health care providers. For all groups, more than half of the respondents stated that the pandemic had a negative (somewhat worse or worse) impact on daily life (59%), interactions with others (65%), stress levels (66%), and enjoyment of life (56%). There were significant differences among all 3 groups regarding the percentage of individuals with a negative impact on job security (dental, 47%; non-dental health care, 34%; non-health care, 31%). However, more than half of the respondents stated that the pandemic had a positive impact (same, somewhat better, or much better) on caring about one another, self-care, and exercise. Knowing the results of an antibody test would decrease the level of stress and anxiety in 67% of respondents. Over 80% found a COVID-19 test received in a dental setting acceptable, were "definitely" satisfied, and would "definitely" recommend it to a friend, family, or coworker. CONCLUSIONS: These findings support that dental workers are as vulnerable as other essential workers to threats and psychological impacts of COVID-19. They also support the acceptability and satisfaction of testing for a pandemic done in a dental setting. KNOWLEDGE TRANSFER STATEMENT: The results of this study highlight the impact that pandemics such as COVID-19 can have on life experiences of essential workers, including dentists. It also highlights a role that dentistry can play within the broader health care system, during and beyond the current pandemic, to help with surveillance efforts of community health. Testing may also help alleviate stress and anxiety associated with these pandemics.

Leveraging nurse practitioner capacities to achieve global health for all: COVID-19 and beyond.

AIM: To argue that nurse practitioners have been under-utilized generally in the current global health environment, creating barriers to achieving universal health coverage and the Sustainable Development Goals. BACKGROUND: Nurse practitioners are advanced practice nurses possessing expert knowledge and leadership skills that can be optimized to narrow disparities and ensure access to high-quality health care globally. Nurses worldwide have been challenged to meet global public health needs in the context of COVID-19 (SARS-CoV-2 virus), and there are early indications that nurse practitioners are being called upon to the full extent of their capabilities in the current pandemic. SOURCES OF EVIDENCE: PubMed; Google Scholar; the International Council of Nurses; World Health Organization; United Nations; and the experiences of the authors. DISCUSSION: Several international reports, nursing and health organizations have called for continued investment in and development of nursing to improve mechanisms that promote cost-effective and universally accessible care. Expanding nurse practitioner scopes of practice across nations will leverage their clinical capacities, policy and advocacy skills, and talents to lead at all levels. CONCLUSION: Ongoing empirical data and policy change is needed to enable the full scope and strategic utilization of nurse practitioners across healthcare systems and contexts. IMPLICATIONS FOR NURSING PRACTICE, AND NURSING AND HEALTH POLICY: Widespread education regarding nurse practitioner capacities for interdisciplinary partners, policymakers and the public is needed. Policies that safely expand their roles are critical. Role titles and remuneration reflective of their scope and service are required to lead, sustain and grow the workforce internationally.