"I've Got More of a Role to Play": Australian Fathers' Perspectives on Parenting Through the Lens of COVID-19 Lockdown

Using interviews with 15 Australian fathers, we explored the impact of having spent time in COVID-19 lockdown on men's views of their relationship with their children and family-work life balance. All interviewees were married to women and living with their children, most were employed and working full-time. Three themes were identified from the interviews: an ongoing desire to be present as a father, benefits to being present through COVID-19 lockdowns for self as a father and for the children, and conflicting pressures from workplaces and at home which were barriers to being present. Survey data 1 year later revealed that many of these fathers had shifted their work patterns because of their lockdown experience. Shifts in workplace culture and behavior were identified as supporting flexible working arrangements. Despite the immediate challenges of lockdown, it provided the opportunity for some fathers to reevaluate their priorities resulting in long-term changes in working patterns.

Regulatory Cooperation for Vaccines: The Asia-Pacific and beyond

The COVID-19 pandemic galvanized national regulatory authorities (NRAs) to adopt innovative and cooperative vaccine approval approaches. Against a backdrop of deaths, economic paralysis, and political instability, it became clear that legacy approaches to vaccine approvals would no longer suffice. Regulatory cooperation between NRAs has developed since the 1960s in Europe and later in other regions. But the crisis wrought by COVID-19 has instilled a new sense of the value of networking, work-sharing, reliance, and recognition among NRAs in all countries and regions. Regional and multilateral collaboration - particularly in the Asia-Pacific - have also enabled shared knowledge and resources while contributing to some degree of harmonization in rules and procedures. Indeed, this will likely pave the way for dealing with future global health crises. Yet, amidst the detritus, there is much to learn. Keywords © 2023 Authors. All rights reserved.

Comprehensive Landscape of Heparin Therapy for COVID-19

The pandemic coronavirus disease 2019 (COVID-19), caused by the infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is rapidly spreading globally. Clinical observations found that systemic symptoms caused by SARS-CoV-2 infection are attenuated when using the anticoagulant agent heparin, indicating that heparin may play other roles in managing COVID-19, in addition to prevention of pulmonary thrombosis. Several biochemical studies show strong binding of heparin and heparin-like molecules to the Spike protein, which resulted in inhibition of viral infection to cells. The clinical observations and in vitro studies argue for a potential multiple-targeting effects of heparin. However, adverse effects of heparin administration and some of the challenges using heparin therapy for SARS-CoV-2 infection need to be considered. This review discusses the pharmacological mechanisms of heparin regarding its anticoagulant, anti-inflammatory and direct antiviral activities, providing current evidence concerning the effectiveness and safety of heparin therapy for this major public health emergency.

Respiratory function and symptoms after acute COVID-19 infection in children and adolescents

Introduction/Aim: Significant long-term effects on both symptomatology and respiratory function have been recognised in adult populations after COVID-19 infection, termed 'Long COVID'. These have caused loss of productivity and increased need for healthcare services. This study aimed to measure symptoms and lung function in children and adolescents after acute COVID-19 infection Methods: Between June 1 and 31 October 2021 there were 144 children admitted to hospital across the Sydney Children's Hospital Network, Australia. Of these, 63 children were referred to the respiratory clinic with symptoms of ongoing cough, shortness of breath and fatigue, 3-6 months post COVID infection. 20 of these children performed reliable lung function. For these children, body plethysmography and double diffusion testing were performed within 3-6 months of their infection. The Liverpool respiratory questionnaire and PROMIS paediatric sleep questionnaires were also administered. Result(s): Of the 20 patients tested, 7 had COVID pneumonitis requiring hospitalisation during the acute illness. 6 of the 20 patients had significant persistent symptoms as measured by the Liverpool respiratory questionnaire, while none of the children had any significant sleep symptoms. All children had preserved spirometry within normal limits. Of note, 2 children with persistent respiratory symptoms had DLNO/DLCO ratio >1.15, suggesting pulmonary vascular disease. The same two children who had elevated DLNO / DLCO had high ventilator equivalents on CPET testing suggesting increased physiological dead space ventilation. Despite this, their peak aerobic capacity was within normal limits. There were no significant differences between the alpha and delta cohorts or between children treated at home vs those requiring hospitalisation during their infection. Conclusion(s): COVID-19 may cause long-lasting effects in children. In this cohort, all children maintained spirometry results within normal limits despite significant symptoms impacting daily activities. Double diffusion testing may shed some light on lung changes leading to persistent symptomatology after COVID infection.

Respiratory function and symptoms after acute COVID-19 infection in children and adolescents

Introduction: Significant long-term effects on both symptomatology and respiratory function have been recognised in adult populations after COVID-19 infection, termed 'Long COVID'. These have caused loss of productivity and increased need for healthcare services. This study aimed to measure symptoms and lung function in children and adolescents after acute COVID-19 infection. Method(s): Clinical follow up, body plethysmography, and double diffusion testing were performed on 18 children and adolescents (age 7-17 years) within 3-6 months of their infection. The Liverpool respiratory questionnaire and PROMIS paediatric sleep questionnaires were also administered. 5 patients were infected with the alpha variant, while 13 had the delta variant. Of those with the delta variant, 7 had COVID pneumonitis requiring hospitalisation during their acute illness. None had been vaccinated against COVID-19. Result(s): Most children recovered well with minimal residual symptoms, and maintained lung function within normal limits. However, 3 of the 18 children had ongoing symptoms that impacted their day-to-day activities. These included fatigue, exercise limitation, sleep impairment and persistent post-viral cough. Of these, 2 children had abnormalities on double diffusion testing, despite normal spirometry. There were no significant differences between the alpha and delta cohorts or between children treated at home vs those requiring hospitalisation. Conclusion(s): 'Long COVID' also affects paediatric populations, particularly in terms of ongoing fatigue and exercise limitation. Double diffusion testing may shed some light on lung changes leading to persistent symptomatology after COVID infection.

Teaching for a Digital World: Foundations, Practices, and Possibilities

Virtual teams have been adopted by organizations and studied for decades. However, the COVID-19 pandemic highlighted the importance of technology-supported collaboration more than ever. This growing importance of virtual teamwork suggests that business education related to virtual team collaboration and communication is critical for students today, and universities play a significant role in equipping students with the knowledge and skillsets necessary to work in a digital world. This work reviews the literature on virtual teams and educational approaches used for teaching virtual team collaboration and communication and presents a framework for virtual team education. Survey findings and illustrative cases are gathered to demonstrate current virtual team education practices. The study concludes with recommendations for the education of virtual team knowledge and skills. © 2023 by the Association for Business Communication.

Building Equality: A "Litmus Test” for Recognising and Evidencing Inequalities and Segregation in the Built Environment

The current convergence of global challenges, particularly the climate change emergency, the Covid‐19 pandemic, and the Black Lives Matter movement, have highlighted the need for a new lens to challenge and interrogate key urban planning assumptions related to spatial urban inequality. Yet urban inequality is often and invariably described from a limited economic perspective, commonly interpreted and measured as income inequality. This is an overtly statistical measure, or Gini‐Type index, often giving limited and unsatisfactory results. Yet, in practice, the spatial distribution and concentration of income inequality is a multi‐scalar, multi‐variant, and multi‐disciplinary issue and has links with other and wider dimensions of inequality and well‐being. As such, this article argues for a holistic understanding of urban inequality that goes beyond narrow empirical and quantitative models. It presents collaborative research that aims to impact the actions of urban professionals, to accurately identify and adequately respond to urban inequalities. Through the establishment of an interdisciplinary expert panel, we have uncovered a series of provisional mechanisms and responses to aid practitioners to achieve more spatial equality. We introduce an integrated analytical method, the "litmus test,” that acts as a planning tool for understanding, evaluating, and responding to inequalities and segregation present in the built environment. This novel methodology and procedural framework will assist us in (a) identifying and defining different forms of inequality and segregation beyond the current scope of physical and agency‐based forms;(b) measuring and demonstrating the latter with a combination of qualitative, empirical sources that are materially significant in supporting and evidencing planning strate-gies;and (c) setting out a series of planning and built environment specific responses. © 2023 by the author(s);.

Use of patient-reported outcomes in heart failure: from clinical trials to routine practice.

Heart failure (HF) is a complex syndrome that affects mortality/morbidity and acts at different levels in the patient's life, resulting in a drastic impairment in multiple aspects of daily activities (e.g. physical, mental/emotional, and social) and leading to a reduction in quality of life. The definition of disease status and symptom severity has been traditionally based on the physician assessment, while the patient's experience of disease has been long overlooked. The active participation of patients in their own care is necessary to better understand the perception of disease and the multiple aspects of life affected, and to improve adherence to treatments. Patient-reported outcomes (PROs) aim to switch traditional care to a more patient-centred approach. Although PROs demonstrated precision in the evaluation of disease status and have a good association with prognosis in several randomized controlled trials, their implementation into clinical practice is limited. This review discusses the modalities of use of PROs in HF, summarizes the most largely adopted PROs in HF care, and provides an overview on the application of PROs in trials and the potential for their transition to clinical practice. By discussing the advantages and the disadvantages of their use, the reasons limiting their application in daily clinical routine, and the strategies that may promote their implementation, this review aims to foster the systematic integration of the patient's standpoint in HF care.

Comparative study of a single lead ECG in a wearable device

Background: The technological advances in electrocardiography have been substantially accelerated due to COVID-19. Furthermore, the progress in the (ECG) became possible with the introduction of integrated circuitry and wireless technologies for communication of mobile and cloud computing and of a variety of novel materials for ECG sensors. There are a number of wearables which are able to capture, monitor, record and/or remotely transmit ECG signals. Some of these devices enable non-invasive capture and storage of ECGs over a longer time period when compared to standard Holter recorders, or to acquire the ECG on demand but without the need for wet electrodes attached to the skin. Method(s): The objective of this study is to validate the ECG performance of the HeartKey Vital Signs Monitor (VSM) Watch, a dry electrode wrist wearable, against a wet electrode system whilst inducing motion noise reflective of a real-life use case. Data from each recording device was compared with the criterion in each stage of the protocol through a comparison of heart rate (HR) data. A beat rejection analysis was performed to provide insight into the degree of high frequency noise in ECG recorded from the HeartKey VSM Watch. Data from a HeartKey Reference Wrist Worn Device validation was used to compare the HeartKey VSM Watch to another wrist-based ECG wearable device. Result(s): Bland Altman analysis showed that the VSM Watch, when using HeartKey technology, had an overall mean absolute HR difference of 0.74, 1.21 and 0.80 bpm from the criterion device during the sitting, walking and standing stage respectively and within the +/-10% or +/- 5 bpm range as is recommended by ANSI EC13. ECG from the HeartKey VSM Watch had a higher beat rejection rate (8.5% vs ~0%), due to excessive high frequency noise, during the non-motion and motion-based protocol when compared to the HeartKey Chest Module. Conclusion(s): This study suggests that the HeartKey VSM Watch demonstrates medical grade HR performance when processing Lead I, dry electrode ECG data during both non-motion and motion-based testing. Further ECG signal chain development may be required to allow full usability of HeartKey Health and Wellness algorithms in a diverse population, particularly those with high skin wrist impedance. Copyright © 2022

Evaluation of Interventions to Improve Ventilation in Households to Reduce Risk for Transmission of Severe Acute Respiratory Syndrome Coronavirus 2.

Background: Inadequate ventilation may contribute to the high risk for household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: We evaluated the effectiveness of several interventions recommended to improve ventilation in households. In 7 residential homes, carbon dioxide monitoring was conducted to assess ventilation in occupied open areas such as family rooms and in bedrooms and/or offices. Carbon dioxide levels above 800 parts per million (ppm) were considered an indicator of suboptimal ventilation for the number of people present. In 1 of the 7 homes, various interventions to improve ventilation or to filter air were assessed in a kitchen area by measuring clearance of aerosol particles produced using an aerosol-based spray system and carbon dioxide generated by cooking with a gas stove. Results: Carbon dioxide levels rose above 800 ppm in bedrooms and offices with 2 occupants when windows and doors were closed and in open areas during gatherings of 5 to 10 people; carbon dioxide levels decreased when windows or doors were opened. Clearance of carbon dioxide and aerosol particles significantly increased with interventions including running fans, operating portable air cleaners, and opening windows, particularly when there was a noticeable breeze or when a window fan was used to blow contaminated air outside. Conclusion: In households, several measures to improve ventilation or air filtration were effective in reducing carbon dioxide accumulation or enhancing clearance of carbon dioxide and aerosol particles. Studies are needed to determine if interventions to improve ventilation can reduce the risk for airborne transmission of SARS-CoV-2 in households.

Field Research When There Is Limited Access to the Field: Lessons from Japan

How can scholars conduct field research when there is limited access to the field? This article first identifies how limited and uncertain field access can affect field research and then provides recommendations to address these challenges. We focus on conducting field research in Japan because of our substantive expertise, but we believe that the problems and solutions outlined in this article are applicable to a broad range of countries. Our hope is that this article contributes to the developing literature on conducting research during times of emergency and to the larger literature on best practices for field research.

“TICKET DROP!”: COMMUNITY BUILDING IN RESIDENCY DURING A PANDEMIC

SETTING AND PARTICIPANTS: 180 residents in an internal medicine residency program DESCRIPTION: COVID-related restrictions on gathering have created challenges to community-building during residency, an important way to mitigate burnout. The ongoing stresses of the pandemic also have led to a sense of “languishing,” which can decrease engagement with everyday activities. To promote community and support resident- driven ideas, we created an innovative “ticket drop” and mini-grant program. Residents were invited to submit ideas for either ticket-based events in the city, or for mini-grants to lead a community-building activity. The Residency Well- Being Committee sponsored one event of each type per month based on evolving COVID guidelines. The committee advertised the ticket drops to all residents, purchased tickets, and allocated them by lottery to ensure equitable access. The initiative was funded by a departmental allocation to the residency program. EVALUATION: Ticket drop and mini-grant events generated many ideas from residents and were well-attended. Residents submitted 23 ideas in the first 6 months of the initiative, and we have been able to fund 1-2 per month. Ticket drop events to date included a professional baseball game, a special exhibit at an art museum, and an evening at the science academy. Residents receiving mini-grants have planned a ceramics night, an arcade game night, and a kayaking event. The intervention is ongoing, and we will present final descriptive data about participation as well as survey data about facilitators and barriers to success of each event and the overall effects of this initiative on social cohesion in residency. Early feedback suggests that identifying a resident champion for each event increases enthusiasm, and that having events preplanned overcomes the low motivation that is widespread during the lingering pandemic. Participants also noted learning about new cultural attractions in their city, which deepened connection with the wider community outside residency. Events were attended by residents at all levels of training and promoted cohesion across residency classes. For many events, the impact extended beyond tickets paid for by the residency, as other residents bought tickets for themselves or for their partners. DISCUSSION / REFLECTION / LESSONS LEARNED: Our residency ticket drop program is a relatively low-cost, low-effort, moderate-impact innovation that represents a sustainable way to increase connections in residency. A modest financial investment can have a large impact on community building if events are targeted to meet resident-identified priorities. Nurturing interests outside of medicine, such as in the arts, entertainment, or cultural attractions, may allow residents to further connect as humans with diverse interests as well as colleagues.

Intersections of Health, Economic, and Social Concerns during the COVID-19 Pandemic in the United States: Associations with Mental Health

A rise in mental health concerns in the United States during the COVID-19 pandemic has been observed. Examining patterns in how people experienced health, economic, and social concerns in the context of the pandemic and documenting relationships between these groups with mental health outcomes will fill a gap in the literature. Describing these associations is also in line with the United Nations (UN) Sustainable Developmental Goals of promoting health and reducing inequalities. In the current study, we conducted a latent class analysis with items assessing health, economic, and social concerns in a sample of 1,394 people. Associations between groups with depressive and anxiety symptoms were also examined. A six-class model showed good fit, and groups were named: high overall concern (32.98%), health concerns without health care (14.78%), health and economic concerns (17.46%), economic concerns (4.57%), health concerns with health care (19.77%), and low overall concern (10.43%). Group membership was associated with mental health, with four groups reporting anxiety symptoms above a clinical cutoff. The intersection of concerns observed in these groups may serve as a barrier to mental health treatment during or following the pandemic. Consistent with the UN Sustainable Developmental Goals, ensuring equitable access to mental health care in the United States following the pandemic must include addressing the unique intersections of social determinants of health that people face. © 2022 Hogrefe Publishing.

Impact of COVID-19 on Movement Disorders Patients in the Outpatient Setting

Objective: We sought to determine the emotional impact, stress, and burden of the COVID-19 pandemic on movement disorders patients. Background: The COVID-19 pandemic has caused stress for the whole population, as it is the only major incidence of a widespread infectious illness that most have experienced in their lifetime. The impact of COVID-19 on patients with chronic neurodegenerative disease, including movement disorders, is largely unknown. Design/Methods: Over 4 months (May to August 2021), subjects were asked to fill out a subjective questionnaire that asked whether neurological symptoms, relationships, mental health care, finances, or healthcare delays worsened during the COVID-19 pandemic, as well as the Pandemic Emotional Impact Scale (PEIS). The PEIS is a validated scale designed to measure the emotional impact of a worldwide pandemic. The scale has 16 questions, each of which is scored on a scale of 1 to 5, 5 being the worst. The two-sample t-test was used to obtain p-values at α=0.05. Results: The cohort had a mean age of 68.0 ± 10.5 years, with 54% males and 46% females. 62% of subjects had diagnoses of PD, and 38% had either ET, ataxia, or dystonia. The average disease duration for the cohort was 8.80 ± 9.47 years. The mean PEIS score for the cohort was 32.52 ± 12.61 (range 16-80). Higher (worse) PEIS scores were significantly associated with “personal financial loss” (p=0.0077), “worsening neurological symptoms” (p=0.0006), “strained relationships” (p=0.0021), “friends/family experiencing financial loss” (p=0.0006), “friends/family hospitalized” (p=0.0178), “delay in healthcare” (p < 0.0001), and “masks impacting health” (p = 0.0064). Conclusions: Although the emotional burden of COVID-19 was reasonably low in this cohort, patients were affected by financial burden, strained relationships, delays in healthcare, and mask wearing. The mental health and emotional burden of movement disorder patients should be carefully addressed.

State-of-the-art review of advanced electrospun nanofiber yarn-based textiles for biomedical applications.

The pandemic of the coronavirus disease 2019 (COVID-19) has made biotextiles, including face masks and protective clothing, quite familiar in our daily lives. Biotextiles are one broad category of textile products that are beyond our imagination. Currently, biotextiles have been routinely utilized in various biomedical fields, like daily protection, wound healing, tissue regeneration, drug delivery, and sensing, to improve the health and medical conditions of individuals. However, these biotextiles are commonly manufactured with fibers with diameters on the micrometer scale (> 10 µm). Recently, nanofibrous materials have aroused extensive attention in the fields of fiber science and textile engineering because the fibers with nanoscale diameters exhibited obviously superior performances, such as size and surface/interface effects as well as optical, electrical, mechanical, and biological properties, compared to microfibers. A combination of innovative electrospinning techniques and traditional textile-forming strategies opens a new window for the generation of nanofibrous biotextiles to renew and update traditional microfibrous biotextiles. In the last two decades, the conventional electrospinning device has been widely modified to generate nanofiber yarns (NYs) with the fiber diameters less than 1000 nm. The electrospun NYs can be further employed as the primary processing unit for manufacturing a new generation of nano-textiles using various textile-forming strategies. In this review, starting from the basic information of conventional electrospinning techniques, we summarize the innovative electrospinning strategies for NY fabrication and critically discuss their advantages and limitations. This review further covers the progress in the construction of electrospun NY-based nanotextiles and their recent applications in biomedical fields, mainly including surgical sutures, various scaffolds and implants for tissue engineering, smart wearable bioelectronics, and their current and potential applications in the COVID-19 pandemic. At the end, this review highlights and identifies the future needs and opportunities of electrospun NYs and NY-based nanotextiles for clinical use.

Navigating COVID-19 through diverse student learning communities: importance and lessons learned. (Special Issue: Health education's response to the COVID-19 pandemic: global challenges and future directions.)

Purpose: The purpose of this case study is to describe one Southern United States of America (US), historically Black medical school's approach to adapting medical education training through learning communities (LCs) during the COVID-19 pandemic. Design/methodology/approach: The COVID-19 pandemic created a wide variety of problems for higher education. Classes moved quickly from in-person to virtual instruction with little time for training;faculty and students had to adapt to new learning platforms, learning styles, study techniques and technological challenges. Emotions ran high due to constant change, transitions and numerous unknowns. The LC structure embedded in the curriculum of this US medical school aided in the navigation of these challenges. Findings: Of the 95 MD1-MD4 respondents combined who responded to the COVID-19 LC survey, 67% rated the LC sessions good/outstanding, 20% average, 7% poor/fair and 5% N/A. When asked if LCs had helped them during the pandemic, overall, 66% said "yes" and 34% said "no." When asked how LCs have helped during the pandemic, themes emerged related to safety, adapting to feelings of isolation/mental health/emotional support, and academic progress. Originality/value: The small LC group structure created a sense of security for receiving academic help, emotional support, a network of assistance resources and a place to process COVID-19 losses and insecurities. Receptivity to utilizing the LC structure for support may relate to the medical students' commitment to addressing health disparities, serving the underserved and embracing a medical school culture that values community.

Glucagon-like peptide 1 receptor agonists: Inpatient use during the COVID-19 pandemic

Introduction: Glucagon-like peptide 1 receptor agonists (GLPIRAs) are increasingly used in the management of type 2 diabetes. There is uncertainty surrounding their use during acute hospitalisation and few data for inpatient outcomes - especially during COVID-19 infection. Methods: Electronic records of all patients using GLPIRAs at the point of hospital admission during the COVID-19 second wave were obtained. Data were collected on COVID-19 status, inpatient glycaemic control, continuation of GLP1RA or reason(s) for discontinuation. Glycaemic control was determined by the number of Good Diabetes Days (GDD), defined as days with no values <4 mmol/L and <1 value >11 mmol/L and >2 tests/day. Results: 101 patients fulfilled the inclusion criteria. 43% of these had GLP1RAs discontinued on admission. Positive COVID-19 infection was seen in 14, and 12 of these were treated with dexamethasone. In those with COVID-19 infection, GLP1RAs were discontinued in 71% compared with 38% without COVID (p=0.12). GDD were seen in 19% of total hospital days in COVID-19 positive patients and 47% in COVID-19 negative patients (p<0.001). In COVID-19 positive patients, continuing GLP1RA was associated with poorer glycaemic control than discontinuation (11% vs 20%, p=0.32). In COVID-19 negative patients, glycaemic control was no different in those continuing and discontinuing treatment (48% vs 45% GDD, p=0.44). Discontinuation of treatment with GLP1RAs on admission to hospital was common. In COVID-19 positive patients, this may be due to reduced efficacy in the context of treatment with highdose steroids but no difference in glycaemic outcomes was seen in non-COVID admissions.